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Objective:To investigate the application value of pulse-indicated continuous cardiac output (PICCO) monitoring combined with critical care ultrasound-oriented convulsive therapy in the management of fluid intake in shock patients.Methods:Eighty-two patients with shock who received treatment in Shaoxing People's Hospital, China between May 2017 and May 2020 were included in this study. They were randomly assigned to undergo either PICCO monitoring (control group, n = 41) or PICCO monitoring combined with critical care ultrasound-oriented convulsive therapy (study group, n = 41). Fluid intake management-related indexes [24-hour total fluid intake, central venous pressure, mean arterial pressure, oxygenation index and lactic acid] and treatment outcome-related indexes (mechanical ventilation time, intensive care unit length of stay, 24-hour remission rate, 28-day mortality rate, sequential organ failure assessment score) were compared between control and study groups. Results:24-hour total fluid intake and lactic acid level in the study group were (2 516.98 ± 254.78) mL and (0.60 ± 0.05) mmol/L, respectively, which were significantly lower than those in the control group [(2 920.02 ± 295.33) mL, (1.34 ± 0.15) mmol/L, t = 16.573, 3.837, P < 0.01, P = 0.041). Central venous pressure, mean arterial pressure and oxygenation index in the study group were (13.381 ± 1.41) mmHg, (82.34 ± 8.22) mmHg and (224.06 ± 23.21) mmHg, respectively, which were significantly higher than those in the control group [(8.53 ± 0.85) mmHg, (70.92 ± 7.18) mmHg, (192.30 ± 19.70) mmHg, t = 5.152, 6.754, -2.498, all P < 0.05]. Mechanical ventilation time and intensive care unit length of stay in the study group were (7.54 ± 0.72) days and (11.46 ± 1.11) days, respectively, which were significantly shorter than those in the control group [(11.72 ± 1.13) days, (18.29 ± 1.73) days, t = 4.727, 5.224, both P < 0.05). 24-hour remission rate in the study group was significantly higher than that in the control group [85.37% (35/41) vs. 63.41% (26/41), χ2 = 5.185, P < 0.05]. 28-day mortality rate in the study group was significantly lower than that in the control group [7.32% (3/41) vs. 29.27% (12/41), χ2 = 6.608, P < 0.05]. Sequential organ failure assessment score in the study group was significantly lower than that in the control group [(6.86 ± 0.63) points vs. (11.05 ± 0.91) points, t = 4.814, P < 0.05]. Conclusion:PICCO monitoring combined with critical care ultrasound-oriented convulsive therapy exhibits an obvious effect in the management of fluid intake in shock patients, which can greatly reduce total fluid intake and remarkably improve treatment outcome-related indexes.
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Objective:To investigate the value of jugulo-omohyoid lymph nodes(JOHLN) for the prediction of lateral cervical lymph nodes metastasis behind internal jugular vein in patients with papillary thyroid carcinoma(PTC) and its clinical significance.Methods:The clinical data of 220 patients who underwent lateral neck dissection in our center were retrospectively analyzed, and the early warning effect and clinical significance of JOHLN on lymph node metastasis of the posterior internal jugular vein were analyzed.Results:In this study, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of JOHLN for predicting lymph node metastasis in the posterior group of internal jugular vein were 83.5%, 46.4%, 82.0%, 49.1%, and 74.1%, respectively. The accuracy rate for JOHLN prediction of upper tumor was 84.3%; In this study, side neck skip metastasis was found in 11 cases, all of which were JOHLN metastasis, upper tumors were found in 9 cases and 2 were located in the middle. Among the skip metastases, 6 cases had lymph node metastasis in the posterior group of internal jugular vein, and they were all upper tumors.Conclusions:JOHLN can effectively predict the risk of lateral neck metastasis. Especially for the upper PTC, preoperative evaluation of JOHLN can help decision-making of lateral neck lymph node dissection.
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Objective@#To evaluate the impact of long-term treatment with Entecavir(ETV)on renal function in elderly patients with chronic hepatitis B(CHB).@*Methods@#Elderly patients with CHB receiving ETV(0.5 mg/d)antiviral therapy who were followed up for 234 weeks in Beijing Friendship Hospital were retrospective analyzed.The estimated glomerular filtration rate(eGFR)(CKD-EPI creatinine formula)was used to evaluate renal function changes at baseline and 52, 104, 156, 208 and 234 weeks after treatment.@*Results@#A total of 40 included patients with CHB aged 60-81 years were enrolled, with baseline eGFR value(n=40) of (64.25±11.32)ml·min-1·1.73 m-2.The eGFR values at all time points after treatment were as following: (63.85±11.53)ml·min-1·1.73 m-2, (63.71±11.58)ml·min-1·1.73 m-2, (59.95±9.59)ml·min-1·1.73 m-2, (62.28±15.32)ml·min-1·1.73 m-2, (65.78±15.99)ml·min-1·1.73 m-2 at 52 weeks(40 cases), 104 weeks(40 cases), 156 weeks(38 cases), 208 weeks(36 cases)and 234 weeks(28 cases)after ETV treatment respectively.And the difference of eGFR values among all time points was not statistically significant(F=0.291, P=0.072). The results of the pairwise comparison showed that as compared with the baseline eGFR value, the eGFR values had no statistically significant difference at all time points after treatment(P>0.05). The baseline creatinine value in all 40 patients was(57.23±9.67)μmol/L.Creatinine values at 52 weeks(15 cases), 104 weeks(5 cases), 156 weeks(6 cases), 208 weeks(8 cases)and 234 weeks(6 cases)after ETV treatment, were(63.78±8.63)μmol/L, (67.86±11.21)μmol/L, (71.46±13.75)μmol/L, (68.22±8.99)μmol/L and(79.53±9.58)μmol/L respectively, with no significant difference(F=0.266, P=0.067). The results of the pairwise comparison showed that as compared with the baseline creatinine value, the creatinine values had no significant difference at all time points after ETV treatment(P>0.05).@*Conclusions@#ETV treatment has no effect on renal function in elderly patients with chronic hepatitis B.
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Objective To evaluate the impact of long-term treatment with Entecavir(ETV)on renal function in elderly patients with chronic hepatitis B(CHB).Methods Elderly patients with CHB receiving ETV(0.5 mg/d)antiviral therapy who were followed up for 234 weeks in Beijing Friendship Hospital were retrospective analyzed.The estimated glomerular filtration rate (eGFR) (CKD-EPI creatinine formula)was used to evaluate renal function changes at baseline and 52,104,156,208 and 234 weeks after treatment.Results A total of 40 included patients with CHB aged 60-81 years were enrolled,with baseline eGFR value(n=40) of (64.25±11.32)ml · min-1 · 1.73 m-2.The eGFR values at all time points after treatment were as following..(63.85 ±11.53) ml · min-1 · 1.73 m-2,(63.71± 11.58)ml· min-1 · 1.73 m-2,(59.95±9.59)ml· min-1 · 1.73 m-2,(62.28± 15.32)ml· min-1 · 1.73 m-2,(65.78± 15.99)ml · min-1 · 1.73 m-2 at 52 weeks(40 cases),104 weeks(40 cases),156 weeks(38 cases),208 weeks(36 cases)and 234 weeks(28 cases)after ETV treatment respectively.And the difference of eGFR values among all time points was not statistically significant(F =0.291,P =0.072).The results of the pairwise comparison showed that as compared with the baseline eGFR value,the eGFR values had no statistically significant difference at all time points after treatment(P ＞ 0.05).The baseline creatinine value in all 40 patients was (57.23 ± 9.67) μmol/L.Creatinine values at 52 weeks(15 cases),104 weeks(5 cases),156 weeks(6 cases),208 weeks (8 cases)and 234 weeks(6 cases) after ETV treatment,were(63.78 ± 8.63)μmol/L,(67.86 ± 11.21) μmol/L,(71.46 ± 13.75) μmol/L,(68.22 ± 8.99) μmol/L and (79.53 ± 9.58)μmol/L respectively,with no significant difference(F =0.266,P =0.067).The results of the pairwise comparison showed that as compared with the baseline creatinine value,the creatinine values had no significant difference at all time points after ETV treatment(P＞0.05).Conclusions ETV treatment has no effect on renal function in elderly patients with chronic hepatitis B.
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Objective@#To explore the treatment of penile incarceration with a metal ring.@*METHODS@#Based on our experience in the successful management of a case of penile incarceration with a metal ring by coiling and bloodletting from the corpus cavernosum, we reviewed the relevant literature and analyzed the indications, advantages and disadvantages of different methods for the treatment of penile incarceration with a circular foreign body.@*RESULTS@#The clamping and cutting methods were non-invasive, fast, effective, and with few complications, which could be applied to the treatment of penile strangulation at all levels. However, clamping was not desirable enough for a hard metal ring and the cutting method took a longer time and might increase the risk of unnecessary damage to the penile skin, urethra and cavernous body. Prepuce edema decompression and the thin tube-coiling method, with the advantages of minimal invasiveness, simple operation and no need of special tools, were suitable for penile strangulation injury under level 3, but might cause penile skin injury and potential postoperative erectile dysfunction. Surgical resection, as an invasive procedure, could be applied to severe penile strangulation at level 4 or 5.@*CONCLUSIONS@#The principle for the treatment of penile incarceration with a circular foreign body is to remove the foreign object as soon as possible and not to add secondary damage.
Subject(s)
Humans , Male , Bloodletting , Methods , Constriction, Pathologic , Therapeutics , Erectile Dysfunction , Foreign Bodies , Therapeutics , Jewelry , Penis , Wounds and Injuries , Pathology , Postoperative Complications , UrethraABSTRACT
Objective@#To explore the clinical value of bendopnea in chronic heart failure patients with reduced ejection fraction (HFrEF).@*Methods@#According to the existence of bendopnea or not, a total of 192 consecutive chronic heart failure patients with HFrEF admitted to our department from January 2014 to January 2016 were divided into the bendopnea group and non-bendopnea group. Subgroup analysis was performed in the subgroups with various bendopnea symptoms appearance time (0-10 s, 11-20 s and 21-30 s). The relationship between bendopnea and left ventricular ejection fraction (LVEF), 6-minute walking distance (6-MWD), NT-proBNP and NYHA classification were analyzed.@*Results@#Bendopnea was confirmed in 74 out of 192 (38.54%) cases with HFrEF, and the average time of symptoms appearance was (8.62±2.29) s. LVEF and 6-MWD values were significantly lower in the bendopnea group than those in the non-bendopnea group (both P<0.05). The NT-proBNP level and the prevalence of patients with NYHA grade Ⅳ were significantly higher in the bendopnea group than those in the non-bendopnea group (both P<0.05). There were significant difference on LVEF, 6-MWD, NT-proBNP and patients with NYHA grade Ⅳ in bendopnea patients with various bendopnea symptoms appearance time (all P<0.05) and shorter bendopnea symptoms appearance time was related to severe symptoms and signs of chronic heart failure.@*Conclusion@#The incidence rate of bendopnea is high in patients with HFrEF, and which is related closely to the cardiac function and shorter bendopnea symptoms appearance time is related to severe symptoms and signs of chronic heart failure in HFrEF patients.
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Objective@#To investigate the effects of transrectal ultrasound conductance (TRUSC)-guided administration of traditional Chinese medicine on histological prostatitis in men with small-size BPH and low urinary tract symptoms (LUTS) after transurethral resection of the prostate (TURP).@*METHODS@#This study included 167 BPH patients without surgical contraindications. We randomized the patients into an experimental group (n = 84) and a control group (n = 83), with no statistically significant differences between the two groups in age, prostate volume, International Prostate Symptom Score (IPSS), and quality of life (QoL) (P >0.05). The patients of the experimental group received TRUSC-guided administration of traditional Chinese medicine, qd, for 7 days before TURP, while those of the control group underwent TURP only. After treatment, we compared the results of postoperative pathological examination of the prostate tissue, the histological grade of inflammation, IPSS, and QoL scores between the two groups of patients.@*RESULTS@#In the experimental group, there were 12 cases of non-inflammation (14.3%), 43 cases of mild inflammation (51.2%), 28 cases of moderate inflammation (33.3%), and 1 case of severe inflammation (1.2%), as compared with 8 cases of non-inflammation (9.6%), 28 cases of mild inflammation (33.7%), 45 cases of moderate inflammation (51.8%), and 2 cases of severe inflammation (2.4%) in the control group (P <0.05). Compared with the baseline, both the experimental and control groups showed significant improvement at 4 weeks after surgery in IPSS (22.20±4.14 vs 4.26±2.64 and 23.05±4.11 vs 7.02±4.15, P <0.05) and QoL scores (4.33±0.83 vs 1.25±1.64 and 4.25±0.91 vs 2.05±1.95, P <0.05).@*CONCLUSIONS@#TRUSC-guided administration of traditional Chinese medicine can significantly alleviate histological inflammation and improve QoL in men with small-size BPH and LUTS after TURP.
Subject(s)
Humans , Male , Drugs, Chinese Herbal , Lower Urinary Tract Symptoms , Drug Therapy , Medicine, Chinese Traditional , Methods , Prostatic Hyperplasia , Drug Therapy , Pathology , Prostatitis , Drug Therapy , Pathology , Quality of Life , Transurethral Resection of Prostate , Treatment Outcome , Ultrasonography, Interventional , MethodsABSTRACT
Objective To observe the neurotoxicity of epidural different dose of dexmedetomi-dine in combination with 0.75% bupivacaine.Methods Twenty-five rabbits weight 2-3 kg without gender tendency and equipped with an epidural lumbar catheter were allocated randomly to five groups with 5 cases each.The control group (group C)received injections of 1.5 ml normal saline,0.75%bupivacaine 1.5 ml plus normal saline 0.5 ml in group B,and the other treatment groups received in-jections of 0.75% bupivacaine 1 ml plus dexmedetomidine 0.1 μg/kg (group D1 ), 0.75%bupivacaine 1 ml plus dexmedetomidine 0.2 μg/kg (group D2 )or 0.75% bupivacaine 1 ml plus dexmedetomidine 0.4 μg/kg (group D3),in the same volume of 1.5 ml.After successive 3-day epi-dural administration of the drugs and a 3-day observation,the rabbits were killed and the spinal cord was examined under optical and electron microscope.Results Serious damages of neuron were found in 1 animal from group D2 and 2 from group D3 under optical microscope.There was unclear bounda-ries between gray and white matter.Some nerve cells appeared necrosis in the grey matter of spinal cord and the number of nerve cells was decreased.Some reversible changes were found in all groups under electron microscope.Conclusion Epidural administration of dexmedetomidine can induce spinal cord and spinal nerves injury dose-dependently,and the motor function can recuperated completely.
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Objective To explore the curative effect of breathing machine in the treatment of acute heart failure complicated with respiratory failure.Methods 1 1 0 patients with acute heart failure and respiratory failure in emergency ICU of our hospital were selected,they were randomly divided into control group and observation group.The control group received routine therapy,the observation group was given breathing machine on the basis of routine therapy.The treatment efficacy of the two groups was compared.Results Before treatment,PaO2 ,PaCO2 ,PH and SaO2 between the two groups had no obvious differences (P >0.05 ).After treatment,PaO2 ,PH and SaO2 in the observation group were (1 1 .41 ±2.25)kPa,(7.42 ±0.1 9),(97.1 1 ±2.1 7)%,which were significantly higher than those in the control group,PaCO2 was (5.21 ±0.22)kPa,which was significantly lower than the that of the control group,the differences were statistically significant (t =2.501 ,P =0.01 4;t =2.598,P =0.01 1 ;t =2.855,P =0.005;t =-2.691 ,P =0.008).The level of sernm brain natriuretie peptide of the observation group[(472.32 ± 298.06)pg/L]was significantly lower than that of the control group,the difference was statistically significant(t =-2.263,P <0.05).Conclusion The clinical effect of breathing machine EICU in treatment of acute heart failure complicated with respiratory failure is remarkable,and can effectively improve the clinical symptoms,and is worth further clinical application.
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<p><b>BACKGROUND</b>This study evaluated the efficacy of percutaneous nucleoplasty using coblation technique for the treatment of chronic nonspecific low back pain (LBP), after 5 years of follow-up.</p><p><b>METHODS</b>From September 2004 to November 2006, 172 patients underwent percutaneous nucleoplasty for chronic LBP in our department. Forty-one of these patients were followed up for a mean period of 67 months. Nucleoplasty was performed at L3/4 in 1 patient; L4/5 in 25 patients; L5/S1 in 2 patients; L3/4 and L4/5 in 2 patients; L4/5 and L5/S1 in 7 patients; and L3/4, L4/5, and L5/S1 in 4 patients. Patients were assessed preoperatively and at 1 week, 1 year, 3 years, and 5 years postoperatively. Pain was graded using a 10-cm Visual Analogue Scale (VAS) and the percentage reduction in pain score was calculated at each postoperative time point. The Oswestry Disability Index (ODI) was used to assess disability-related to lumbar spine degeneration, and patient satisfaction was assessed using the modified MacNab criteria.</p><p><b>RESULTS</b>There were significant differences among the preoperative, 1-week postoperative, and 3-year postoperative VAS and ODI scores, but not between the 3- and 5-year postoperative scores. There were no significant differences in age, sex, or preoperative symptoms between patients with effective and ineffective treatment, but there were significant differences in the number of levels treated, Pfirrmann grade of intervertebral disc degeneration, and provocative discography findings between these two groups. Excellent or good patient satisfaction was achieved in 87.9% of patients after 1 week, 72.4% after 1 year, 67.7% after 3 years, and 63.4% at the last follow-up.</p><p><b>CONCLUSIONS</b>Although previously published short- and medium-term outcomes after percutaneous nucleoplasty appeared to be satisfactory, our long-term follow-up results show a significant decline in patient satisfaction over time. Percutaneous nucleoplasty is a safe and simple technique, with therapeutic effectiveness for the treatment of chronic LBP in selected patients. The technique is minimally invasive and can be used as part of a stepwise treatment plan for chronic LBP.</p>
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Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Diskectomy, Percutaneous , Methods , Low Back Pain , General Surgery , Retrospective Studies , Treatment OutcomeABSTRACT
<p><b>BACKGROUND</b>Posterior cervical decompression is an accepted treatment for multilevel cervical spondylotic myelopathy (CSM). Each posterior technique has its own advantages and disadvantages. In the present study, we compared the functional and radiological outcomes of expansive hemilaminectomy and laminoplasty with mini titanium plate in the treatment of multilevel CSM.</p><p><b>METHODS</b>Forty-four patients with multilevel CSM treated with posterior cervical surgery in Department of Orthopedic Surgery, Beijing Army General Hospital from March 2011 to June 2012 were enrolled in this retrospective study. Patients were divided into two groups by surgical procedure: Laminoplasty (Group L) and hemilaminectomy (Group H). Perioperative parameters including age, sex, duration of symptoms, operative duration, and intraoperative blood loss were recorded and compared. Spinal canal area, calculated using AutoCAD ® software(Autodesk Inc., San Rafael, CA, USA), and neurological improvement, evaluated with Japanese Orthopedic Association score, were also compared.</p><p><b>RESULTS</b>Neurological improvement did not differ significantly between groups. Group H had a significantly shorter operative duration and significantly less blood loss. Mean expansion ratio was significantly greater in Group L (77.83 ± 6.41%) than in Group H (62.72 ± 3.86%) (P < 0.01).</p><p><b>CONCLUSIONS</b>Both surgical approaches are safe and effective in treating multilevel CSM. Laminoplasty provides a greater degree of enlargement of the spinal canal, whereas expansive hemilaminectomy has the advantages of shorter operative duration and less intraoperative blood loss.</p>
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Cervical Vertebrae , Pathology , General Surgery , Decompression, Surgical , Methods , Retrospective Studies , Spinal Cord Diseases , Pathology , General SurgeryABSTRACT
<p><b>OBJECTIVE</b>To explore the influence of rosa roxburghii tratt preparation on immune function of arseniasis patients caused by burning coal.</p><p><b>METHODS</b>According to the diagnosis standard for endemic arseniasis(WS/T 211-2001), 62 cases of arseniasis patients who resided in endemic arseniasis area in Guizhou province were selected and divided stratified randomly into two groups: rosa roxburghii tratt juice treatment group and superoxide dismutase(SOD)-enriched rosa roxburghii tratt juice treatment group, with 31 patients in each group.Each patient took 120 ml/d rosa roxburghii tratt preparation or SOD-enriched rosa roxburghii tratt orally for one month. Another 30 healthy residents from a neighbour township 12 km away where arsenic was not prevalent were selected as controls. A 2 ml blood and 50 ml urine samples were collected from individuals and the urine arsenic contents, peripheral blood T-lymphocyte subsets (CD3(+), CD4(+), CD8(+) T cell), serum immunoglobulin (IgG, IgM, IgA) and complement (C3, C4) were detected. The differences between more than two groups on above indicators were compared. The correlations between urinary arsenic and immune parameters were analyzed.</p><p><b>RESULTS</b>Among the rosa roxburghii tratt juice group, SOD-enriched rosa roxburghii tratt juice before intervention group and the control group, the levels of urine arsenic were (76.55 ± 23.02) , (72.60 ± 25.91) and (26.33 ± 11.30) µg/g Cr respectively and IgG were (11.31 ± 1.68), (11.35 ± 1.94) and (9.23 ± 1.75) g/L respectively. The differences were statistically significant(F values were 82.01, 13.82, both P values < 0.05). After intervention with rosa roxburghii tratt preparation, the levels of urine arsenic were (53.21 ± 16.51) and (51.72 ± 17.70)µg/g Cr, both decreased than before intervention (t values were 5.80 and 3.78, both P values < 0.05). The levels of CD3(+) were (44.47 ± 7.14)%, (43.44 ± 6.61)% and (70.78 ± 5.26)%, CD4(+) were (29.87 ± 5.67)%, (29.42 ± 5.87)% and (46.08 ± 5.87)%, CD4(+)/CD8(+) were(1.25 ± 0.42), (1.22 ± 0.39) and (1.79 ± 0.26) and C4 were (0.13 ± 0.08), (0.13 ± 0.09) and (0.20 ± 0.11) g/L respectively among the two treatment group before intervention and the control group. The differences were significant (F values were 178.04, 76.71, 23.13 and 5.26, all P values < 0.05). After intervention, the levels of CD3(+) were (59.73 ± 7.38)% and (66.31 ± 7.57)%, CD4(+) were (34.00 ± 7.97)% and (39.11 ± 5.81)%, CD4(+)/CD8(+) were (1.41 ± 0.37) and(1.58 ± 0.26), all increased than before intervention(t values were 12.47, 25.18, 5.41, 10.47, 3.22 and 5.05, all P values < 0.05). The levels of urine arsenic and CD3(+), CD4(+), CD4(+)/CD8(+), C4 were inversely correlated correlation, while positive correlation existed between the level of urine arsenic and IgG(r values were -0.68, -0.56, -0.51, -0.43 and 0.36, all P values < 0.01).</p><p><b>CONCLUSIONS</b>The level of urinary arsenic level is closely related to immune function suppression in arseniasis patients caused by burning coal, rosa roxburghii tratt preparation can effectively improve immune function of arseniasis patients.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Arsenic , Urine , Arsenic Poisoning , Allergy and Immunology , China , Coal , Complement System Proteins , Allergy and Immunology , Immunoglobulins , Allergy and Immunology , Plant Extracts , Pharmacology , Rosa , Chemistry , Superoxide Dismutase , Pharmacology , T-Lymphocyte Subsets , Allergy and ImmunologyABSTRACT
Objective To discuss the metastasis principle of cervical lymph nodes in CN0 papillary thyroid carcinoma(PTC) and to define the proper surgery scope.Methods Clinical data of the 450 cases of CN0 PTC patients undergoing surgery from Feb.2008 to Feb.2011 in the First Hospital,Jilin University were retrospectively analyzed.Results There were 219 (48.67％) pN + cases and 231 (51.33 ％) pN0 cases.In CN0 PTC cases,lymph node metastasis was most commonly detected in area Ⅵ,about 46.22％ (208/450) (unilateral cancer 41.08％,bilateral cancer 58.09％).The lymph node metastasis rate was 4.44％ (20/450),6.00％ (27/450),and 8.89％ (40/450)respectively in area IIa,area Ⅲ,and area Ⅳ.The metastasis of lymph node was rare in Vb area,only about 2.22 ％ (10/450).No metastasis was found in the 2 cases undergoing area I lymph node dissection.When the tumor diameter was no less than 1.0 cm,capsule invaded or multifocal,male,＜ 45 years old,lymph node metastasis rate was significantly increased (P ＜ 0.05).In addition,when the tumor was located at the upper pole of the thyroid,the lymph node metastasis rate was 33.57％ (48/143) in Ⅱa,Ⅲ,Ⅳ areas in the affected side.When the tumor was at the lower pole of the thyroid,the lymph node metastasis rate was 10.48％ (13/124)in the contralateral area Ⅵ.Conclusion Lymph node metastasis occurs most commonly in area Ⅵ in PTC,followed by area Ⅱ a,area Ⅲ,area Ⅳ.Routine lymph node dissection in area Ⅵ is recommended for the initial surgery.When the tumor diameter is ≥ 1.0 cm,thyroid capsule invasion is involved or more than 3 metastasized lymph nodes were found in area Ⅵ,the range of lymph node dissection should properly be expanded to area Ⅱa-Ⅳ.When the tumor is located at the lower pole of the thyroid,area Ⅵ in the contralateral side should be cleaned.If the tumor is located at the upper pole of the thyroid,area Ⅱa,Ⅲ,Ⅳ in the affected side should be cleaned.
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<p><b>OBJECTIVE</b>To evaluate the association of gr/gr deletion in the AZFc region of Y chromosome with idiopathic male infertility using Meta-analysis.</p><p><b>METHODS</b>All relevant case-control studies addressing the relationship between gr/gr deletion and idiopathic male infertility were identified from PubMed, VIP and CNKI (from January 2003 to August 2010). Statistical analyses were performed with the RevMan4. 2 software.</p><p><b>RESULTS</b>Twenty eligible articles were selected in this study, including 5 246 cases of idiopathic infertility and 4 380 controls. The integrated data from the 20 studies revealed a significantly higher frequency of gr/gr deletion in the patients than in the controls, with an odds ratio (OR) of 1.63 (95% CI: 1.23 -2.44) (P = 0.002). However, when the Meta-analysis was limited to 16 studies with stricter case and control selection criteria, the overall OR increased to 1.84 (95% CI: 1.47 - 2.29) (P < 0.000 01). Thirteen studies showed that oligozoospermia patients had a significantly higher frequency of gr/gr deletion than controls (OR = 2.12, 95% CI: 1.61 - 2.80) (P < 0.000 01). Eight studies showed a significant association between the gr/gr deletion subtype without DAZ1/DAZ2 gene copies and spermatogenic impairment (OR = 1.83, 95% CI: 1.31 - 2.55) (P = 0.000 4), but no statistically significant differences were found in the frequency distribution of the gr/gr deletion subtype missing DAZ3/DAZ4 gene copies between the patients and controls (OR = 1.43, 95% CI: 0.97 -2.11) (P = 0.07).</p><p><b>CONCLUSION</b>The present data suggest that gr/gr deletion may be one of the risk factors of male infertility.</p>
Subject(s)
Humans , Male , Chromosome Deletion , Chromosomes, Human, Y , Infertility, Male , GeneticsABSTRACT
Objective To explore the reason of misdiagnosis and discuss the reoperation in thyroid carcinoma.Methods The data of 77 patients that had reoperation because of misdiagnosis were analyzed.Results The daignosis of all 77 cases were only based on pre-operative physical and uhrasound examination.The post-reoperative follow up (3～41 monthes):no case was found local recurrence.Conclusions The preoperative frozen section may avoid misdaignosis and the effect of reoperation for misdaignosed cases are satisfactory.
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<p><b>OBJECTIVES</b>To suggest the clinical classification of the far-lateral lumbar disc herniation and offer the considerations for clinical choice of different surgical procedures.</p><p><b>METHODS</b>According to the locations of the herniated disc and relevant clinical symptoms, the far-lateral lumbar disc herniation was divided into three types: Type I: posterolateral and foraminal herniation(double herniations); Type II: foraminal disc herniation and Type III: extraforaminal herniation. From January 2002 to January 2007, 38 patients with far lateral lumbar disc herniation underwent surgery in the institute. The surgical options were decided by means of the classification. The surgical procedures included (1) discectomy by inter-TP (transverse process) approach, (2) discectomy with partial facetectomy and (3) discectomy with facetectomy and PLIF (posterior lumbar interbody fusion). Among the 38 patients, there were 25 males and 13 females. The mean age was 58.4 years old. The herniated discs located at L(3-4) in 17, L(4-5) in 13, and 8 cases at L(5)S(1). Twenty-three patients were simple disc herniation, 15 cases with concomitant lumbar spinal stenosis. The symptoms and signs of exiting root compression at herniated disc level were presented in all patients and passing root compression presented in 7 Type I cases as well; while intermittent claudication being presented in 15 and low back pain in 21 patients. The VAS (visual analog pain scale) of radicular leg pain was taken before and after the operation. The postoperative outcomes were evaluated through the MacNab's method in all the patients.</p><p><b>RESULTS</b>By using the new classification system, the 38 patient were divided into Type I 10 cases, Type II 19 cases and Type III 9 cases. The adopted surgeries included discectomy by intertransverse approach in 5, discectomy with partial facetectomy in 7, and discectomy with facetectomy and PLIF in the rest 26 cases. The mean follow-up period was ranging from 6 months to 4 years and 10 months, average 2 years and 11 months. The mean VAS scores of radicular pain was 7.4 preoperatively, 2.7 at 2 weeks after the operation and 3.1 at final follow-up. The final clinical outcomes by MacNab's method were as follow: excellent results in 20 cases, good in 12, fair in 5 and poor in 1 case. The overall improvement ratio was 84.2%. The postoperative complications included superficial wound infection in 1 case, insufficient decompression in 1 case and leakage of cerebrospinal fluid in 1 case respectively. No breakage and loosening of internal fixation were detected.</p><p><b>CONCLUSIONS</b>A new clinical classification of far lateral lumbar disc herniation was suggested, which is significant to understanding the relevant pathology and choosing the surgical procedures.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Diskectomy , Methods , Follow-Up Studies , Intervertebral Disc Displacement , Classification , General Surgery , Lumbar Vertebrae , Spinal Fusion , Treatment OutcomeABSTRACT
Objective To observe the protective effects of a mixture for protecting liver and supplementing stomach (保肝益胃合剂) on rat acute liver damage induced by carbon tetrachloride (CCl_4). Methods The model of rat acute liver damage was established by injection of CCl_4 2 ml/kg into the abdominal cavity.The rat models were treated respectively by the mixture for protecting liver and supplementing stomach 30 g?kg~(-1)?d~(-1),the polyene phosphatide acid radical choline capsule [Yi Shanfu (易善复), 180 mg?kg~(-1)?d~(-1)],the glycyrrhizic acid diaminogen capsule [Gan Lixin (甘利欣),30 mg?kg~(-1)?d~(-1)] infused into the stomach.The activities of serum alanine transaminase (ALT) and aspartate transaminase (AST) were detected.In the mean time,the liver pathological changes were observed,the degree of liver cell necrosis was evaluated,and the rat mortality was noted in various groups of treatment.Results The values of ALT,AST and the score of liver cell necrosis in the group treated with the mixture for protecting liver and supplementing stomach [(1.168?1.066) kU/L,(1.845?2.212) kU/L,(0.56?0.53) score] were significantly lower than those in the model group [(4.982?3.502) kU/L,(7.030?3.616) kU/L, (1.38?0.92) scores],and all the differences being statistically significant (all P
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@#ObjectiveTo compare the effect and prognosis of two kinds of internal fixation (improved Giebel blade plate and traditional straddle nail) after high tibial osteotomy (HTO) on osteoarthritis of knee with genu varus deformity. Methods37 knees of 32 cases were treated with straddle nail (25 knees) or Giebel blade plate (12 knees). All the cases were followed up for 6～28 months. ResultsThe clinical bone healing time of osteotomy was 8～12 weeks. There was no significant differences between 2 groups in the increased score in HSS Standard and in the clinical bone healing time. ConclusionBoth internal fixation with improved Giebel blade plate and traditional straddle nail get similarly satisfactory prognosis, while the former shows more advantages to allow early functional exercises.
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Objective To evaluate pericardial devascularization with splenectomy (PCDV) for the treatment of cirrhotic portal hypertension. Methods From January 1994 to December 2004, 177 patients were treated by PCDS, among them posthepatitic cirrhosis was identified in 170 cases, and alcoholic cirrhosis in 7. One hundred and thirty two patients were operated on electively, 25 prophylactically, and 20 emergently. Results The bleeding control rate was 95% , the overall operative mortality rate was 4. 5%. The main causes of death were upper gastrointestinal bleeding, hepatic failure and intra-abdomimal hemorrhage. The mean follow-up time was 3. 6 years. The 5-year survival rate was 90%. The 5-year recurrent bleeding rate was 5. 1% , The rate of postoperative hepatic encephalopathy was 5. 1%. Conclusions This procedure has the advantage of high successful rate of bleeding control, low complication rate, and long term survival.