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ABSTRACT A previous study has reported the therapeutic effects of interlaminar/transforaminal approaches under full-endoscopic visualization to treat L5-S1 lumber disc herniation (LDH). However, the comparison of interlaminar/transforaminal approaches to treat other segments of LDH remains unclear. Objective: To evaluate the clinical efficacy of full-endoscopic interlaminar and transforaminal lumbar discectomy to treat LDH. Methods: A total of 93 patients with LDH who underwent fully-endoscopic lumbar interlaminar/transforaminal discectomy were retrospectively collected. Patients were divided into a Transforaminal group (n=41) and an Interlaminar group (n=52). Clinical efficacy was evaluated by visual analogue scale (VAS), the Oswestry disability index (ODI), and the modified MacNab scoring system. Results: Of the 93 patients, involving segments in LDH referred to L3-4, L4-5, and L5-S1. The fluoroscopy times in the Interlaminar group were smaller than that of the Transforaminal group. We found no obvious significances between the Transforaminal and Interlaminar groups regarding operation time, incision length, postoperative landing time, hospitalization, and incision healing time. Postoperative VAS and ODI scores notably improved at follow-up. Besides, almost 90% LDH patients achieved excellent/good outcomes. Conclusion: The full-endoscopic visualization technique via interlaminar and transforaminal approaches safely and effectively treat LDH. Level of Evidence III, Retrospective Study.
RESUMO Um estudo anterior relatou os efeitos terapêuticos das abordagens interlaminar/transforaminal sob visualização totalmente endoscópica para tratar a hérnia de disco lombar (HDL) L5-S1. No entanto, a comparação das abordagens interlaminar/transforaminal para o tratamento de outros segmentos de HDL permanece pouco clara. Objetivo: Avaliar a eficácia clínica da discectomia lombar interlaminar e transforaminal totalmente endoscópica no tratamento da HDL. Métodos: Foram recolhidos retrospetivamente 93 pacientes com HDL submetidos a discectomia lombar interlaminar/transforaminal totalmente endoscópica. Os pacientes foram divididos em um grupo transforaminal (n=41) e um grupo interlaminar (n=52). A eficácia clínica foi avaliada através da escala visual analógica (EVA), do índice Oswestry de incapacidade (ODI) e do sistema de pontuação de MacNab modificado. Resultados: Dos 93 pacientes, os segmentos envolvidos na HDL referiam-se a L3-4, L4-5 e L5-S1. Os tempos de fluoroscopia no grupo Interlaminar foram menores do que no grupo Transforaminal. Não encontramos significâncias óbvias entre os grupos Transforaminal e Interlaminar em relação ao tempo de operação, comprimento da incisão, tempo de pós-operatório, hospitalização e tempo de cicatrização da incisão. As pontuações EVA e ODI pós-operatórias melhoraram notavelmente no acompanhamento. Além disso, quase 90% dos pacientes com HDL obtiveram resultados excelentes/bons. Conclusão: A técnica de visualização totalmente endoscópica através de abordagens interlaminar e transforaminal trata a HDL de forma segura e eficaz. Nível de Evidência III, Estudo Retrospectivo.
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Objective@#To compare and correlate the findings of intravoxel incoherent motion (IVIM) magnetic resonance (MR) imaging and arterial spin labeling (ASL) imaging in characterizing parotid gland tumors. @*Materials and Methods@#We retrospectively reviewed 56 patients with parotid gland tumors evaluated by MR imaging. The true diffusion coefficient (D), pseudo-diffusion coefficient (D*), and fraction of perfusion (f) values of IVIM imaging and tumor-to-parotid gland signal intensity ratio (SIR) on ASL imaging were calculated. Spearman rank correlation coefficient, chi-squared, Mann-Whitney U, and Kruskal-Wallis tests with the post-hoc Dunn-Bonferroni method and receiver operating characteristic curve assessments were used for statistical analysis. @*Results@#Malignant parotid gland tumors showed significantly lower D than benign tumors (p = 0.019). Within subgroup analyses, pleomorphic adenomas (PAs) showed significantly higher D than malignant tumors (MTs) and Warthin’s tumors (WTs) (p < 0.001). The D* of WTs was significantly higher than that of PAs (p = 0.031). The f and SIR on ASL imaging of WTs were significantly higher than those of MTs and PAs (p < 0.05). Significantly positive correlation was found between SIR on ASL imaging and f (r = 0.446, p = 0.001). In comparison with f, SIR on ASL imaging showed a higher area under curve (0.853 vs. 0.891) in discriminating MTs from WTs, although the difference was not significant (p = 0.720). @*Conclusion@#IVIM and ASL imaging could help differentiate parotid gland tumors. SIR on ASL imaging showed a significantly positive correlation with f. ASL imaging might hold potential to improve the ability to discriminate MTs from WTs.
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There are many medications available to treat spasticity, but the tolerability of medications is the main issue for choosing the best treatment. The objectives of this study were to compare the efficacy and adverse effects of tolperisone compared to baclofen among patients with spasticity associated with spinal cord injury. Patients received baclofen plus physical therapy (BAF+PT, n=135) or tolperisone plus physical therapy (TOL+PT, n=116), or physical therapy alone (PT, n=180). The modified Ashworth scale score, the modified Medical Research Council score, the Barthel Index score, and the Disability Assessment scale score were improved (P<0.05 for all) in all the patients at the end of 6 weeks compared to before interventions. After 6 weeks, the overall coefficient of efficacy of the intervention(s) in the BAF+PT, TOL+PT, and PT groups were 1.15, 0.45, and 0.05, respectively. The patients of the BAF+PT group reported asthenia, drowsiness, and sleepiness and those of the TOL+PT group reported dyspepsia and epigastric pain as adverse effects. When comparing drug interventions to physical therapy alone, both baclofen plus physical therapy and tolperisone plus physical therapy played a significant role in the improvement of daily activities of patients. Nonetheless, baclofen plus physical therapy was tentatively effective. Tolperisone plus physical therapy was slightly effective. In addition, baclofen caused adverse effects related to the sedative manifestation (Level of Evidence: III; Technical Efficacy Stage: 4).
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Humans , Spinal Cord Injuries/complications , Tolperisone , Muscle Relaxants, Central/adverse effects , Baclofen/adverse effects , China , Retrospective StudiesABSTRACT
Objective@#To investigate the antibiotic resistance spectrum and genetic characteristics of multidrug-resistant Staphylococcus aureus(MDRSA) nasal isolate among primary school students, and to provide a scientific basis for the prevention and control of masal MDRSA resistance and the selection of clincal drugs in children.@*Methods@#Antibiotic susceptibility experiments were performed on all SA isolates of 1 705 primary school students from 8 primary schools in Guangzhou selected by using multistage cluster stratified sampling method. MDRSA antibiotic susceptibility spectrum was analyzed, and the resistant, virulence and immune evasion cluster(IEC) genes detected by polymerase chain reaction(PCR).@*Results@#The prevalence of MDRSA nasal carriage was 20.76%(354/1 705), and the proportion of multidrug resistance among SA isolates was 96.20%(354/368). The predominant resistant antibiotics of MDRSA isolates were penicillin(99.72%), erythromycin(96.33%), clindamycin(90.96%) and teicoplanin(90.11%). Notably, 240(67.80%, 240/354) MDRSA isolates were resistant to more than six antimicrobial categories. And the predominant detection rates of resistant genes were BlaZ(92.66%), Tet(M)(49.72%), virulence genes Tst(25.42%) and IEC genes Sak(92.09%), Hlb(61.58%).@*Conclusion@#We found high prevalence of nasal colonization MDRSA from healthy children. Moreover, MDRSA isolates has a high resistant rate to multiple antibiotics, and the proportion of resistant to ≥6 antimicrobial categories is high.
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Objective@#To investigate the distribution and drug resistance situation of staphylococcus aureus (SA) and methicillin-resistant staphylococcus aureus (MRSA) from the classroom environments in primary schools of Guangzhou.@*Methods@#The air and the surfaces of door handles, desks, chairs, light switches and floor were sampled in the classrooms of 8 primary schools selected through stratified clustering method in Guangzhou from May to June, 2016. SA and MRSA were isolated and identified, and drug sensitivity tests were conducted.@*Results@#A total of 760 samples were collected, the detection rate of SA and MRSA were 8.8% and 4.2%, respectively. There were statistically significant differences in the detection rate of staphylococcus aureus among different sampling sites(P<0.01).Detection of SA and MRSA on the floor,light’s witches and surface of deskes was both above 6.0%. The multiple drug resistance rate of MRSA was up to 100.0%, and the main resistance mode was Penicillin-Erythromycin-Rifampin-Tetracycline-Teicolanin.@*Conclusion@#MRSA can be detected in air, door handles, desk surface, chair surface, light switch and floor of primary schools. Relevant administration departments should pay attention to the environments health of Guangzhou primary schools.
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Objective@#To investigate the contamination, antimicrobial resistance and virulence genes of S. aureus from toilets of primary schools in Guangzhou.@*Methods@#The surface samples of toilets were collected from eight primary schools in Guangzhou from May to July 2016. The standard microbiological assays, disk diffusion methods and PCR technique were used for the isolation and identification, antimicrobial resistance and virulence genes of S. aureus .@*Results@#The contamination rate of S. aureus and MRSA was 6.25% and 3.13%, respectively. There was significant difference in the contamination rate of S. aureus among different sampling sites ( χ 2=15.15, P <0.01) and the highest contamination rate was on the ground (15.00%).The most predominant antibiotic for S. aureus was penicillin (100.00%) and the proportions of resistant to teicoplanin, erythromycin,rifampicin, clindamycin and linezolid were more than 75.00%.The multidrug resistant rate of S. aureus was 85.00%.The detection rate of virulence genes of S. aureus was sea (50.00%), tst (30.00%), etb (15.00%), eta (10.00%), seb (10.00%) and pvl (5.00%), respectively.@*Conclusion@#The contamination rate of S. aureus from toilets of primary schools in Guangzhou is in a lower level among similar researches. However, the contamination of MRSA is serious, which accounts for half of S. aureus . In addition, S. aureus isolates show high multi-drug resistant rate and high detection rate of virulence genes.
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Objective:To explore the clinicopathologic characteristics of gastric mixed adenoneuroendocrine carcinoma (MANEC). Methods:From January 2011 to December 2016, the clinical and pathological data of 35 patients with gastric MANEC who were diagnosed and surgically treated in Tianjin Medical University Cancer Institute and Hospital were analyzed retrospectively. Results:The average age of the 32 men and 3 women in this study was 61.6±7.5 years. Tumor locations were as follows:17 related to gastric cardia, 9 related to gastric body, 8 related to gastric antrum, and 1 related to gastric stump. Clinical symptoms were non-specific and the diagnosis relies on post-operative pathological examination. Using the histological microscope, the affected structures were detected in neuroendocrine systems and tissue linings. Immunohistochemical staining showed that carcinoembryonic antigen (CEA) and cytokeratins 8 and 18 (CK8/18) were expressed in 32 and 33 adenocarcinoma-related cases, respectively, whereas synaptophysin (Syn) and chromogranin A (CgA) were revealed in 33 and 27 neuroendocrine-related cases, respectively. Al patients received surgical resection. A total of 17 incidents of death were reported at three years after the operation, and most of the patients were at clinical stageⅢorⅣ. Conclusion:Gastric MANEC is a rare neoplasm and is often diagnosed at its advanced stage and mainly occurs in the aged population. Neuroendocrine structures and glandular tissues are the most frequent location of such condition. Diagnosis relies on both immunohistochemical and histological examinations. Surgical resection is the most effective treatment, but the prognosis of this condition remains poor.
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<p><b>OBJECTIVE</b>To investigate the clinical diagnosis, treatment, and prevention of fallopian tube prolapse (FTP) after hysterectomy.</p><p><b>METHODS</b>A total of 7949 patients received hysterectomy from January 1983 to August 2005 in Peking Union Medical College Hospital, and 9 cases (including 1 case from other hospital) of FTP after hysterectomy were involved during this period. All of them were diagnosed according to pathological results and were followed up. The symptoms, diagnosis, and treatment of the FTP patients were analyzed retrospectively.</p><p><b>RESULTS</b>The incidence of FTP after hysterectomy was 0.1% (8/7949), with the incidence of FTP after transabdominal hysterectomy being 0.06% (4/6229), after trans-vaginal hysterectomy being 0.5% (4/780), after laparoscopic assistant vaginal hysterectomy being 0 (0/940). There was no symptom in 3 cases. The pelvic examination revealed the typical prolapsed fimbrial end of a fallopian tube in 3 cases and the other 6 cases revealed red granulation tissue. All of them were excised vaginally and cauterized. The results were proved by pathological examination. No recurrence was reported during follow-up.</p><p><b>CONCLUSIONS</b>FTP is a rare complication after hysterectomy. The prognosis is well after proper diagnosis and treatment Fixation of accessories onto the pelvic wall and complete peritonealization at the time of hysterectomy are the most important methods to prevent FTP after hysterectomy.</p>
Subject(s)
Adult , Female , Humans , Middle Aged , Fallopian Tube Diseases , General Surgery , Follow-Up Studies , Hysterectomy , Postoperative Complications , ProlapseABSTRACT
<p><b>OBJECTIVE</b>To observe the Chinese herbal medicine Selaginella-induced radiosensitization of terminal nasopharyngeal carcinoma (NPC).</p><p><b>METHODS</b>Totally 180 patients with NPC were divided equally into 3 groups with the same radiotherapeutic protocols. The patients in group A received radiotherapy alone, those in group B were given daily Selaginella (30 g) prepared into 50 ml decoction during the entire course of radiotherapy, and those in group C had Selaginella 30 g daily in the late course of radiotherapy.</p><p><b>RESULTS</b>The complete remission rate of nasopharyngeal primary lesions in groups B and C was significantly higher than that in group A, with also significantly higher complete remission rates of the cervical lymph nodes. The acute toxicity of the skin and mucous membrane was milder in the latter two groups, but the differences were not significant.</p><p><b>CONCLUSION</b>Selaginella may induce radiosensitization for terminal NPC and does not increase the acute toxicity of radiotherapy.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Carcinoma, Squamous Cell , Drug Therapy , Radiotherapy , Combined Modality Therapy , Drugs, Chinese Herbal , Therapeutic Uses , Nasopharyngeal Neoplasms , Drug Therapy , Radiotherapy , Phytotherapy , Radiation-Sensitizing Agents , Therapeutic Uses , Selaginellaceae , Chemistry , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To evaluate the quality of clinical literatures related with treatment of lung cancer with combined use of chemotherapy and Chinese herbs in respect of the scientific research design adapted.</p><p><b>METHODS</b>According to the "Scale for Quality and Information Evaluation of TCM Clinical Research Literature" formulated by the group of methodology of this article, the literatures related with lung cancer published between 1979 to 2000 were evaluated in respect of the randomization and controlling of the trial.</p><p><b>RESULTS</b>The method of randomization was not described in 93.7% of the literatures; problems or mistakes of randomized allocation existed in 2.5%, with no record about the state of dropped out or absconded cases in follow-up study in 29.1%, also no record about case screening was found in all the literatures. Besides, the blind trial method was seldom used, also some problems of key links concerning samples homogeneity and conclusion reasoning presented. All these bugs could influence quality of the randomized control trial.</p><p><b>CONCLUSION</b>Randomized control trial has been applied progressively in TCM clinical researches of lung cancer, however, there are still problems such as insufficiency of samples, and improving of the reliability and quality of the trial is needed.</p>
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Humans , Antineoplastic Combined Chemotherapy Protocols , Therapeutic Uses , Double-Blind Method , Drug Therapy, Combination , Drugs, Chinese Herbal , Therapeutic Uses , Evaluation Studies as Topic , Lung Neoplasms , Drug Therapy , Phytotherapy , Randomized Controlled Trials as Topic , Reference Standards , Research DesignABSTRACT
<p><b>OBJECTIVE</b>To study the clinical efficacy and adverse reaction of comprehensive therapy mainly with Chinese anti-cancer medicinal perfusion/embolization and assisted with Chinese drug-therapy based on TCM Syndrome Differentiation in treating primary liver cancer.</p><p><b>METHODS</b>Forty-one patients with liver cancer were divided into the treated group and the control group. To the treated group turmeric oil microballoon, cinobufotalin, Aidi injection and iodized oil were given via hepatic artery perfusion/embolization, and to the control group chemotherapeutic agents and iodized oil were given for instead. Besides, both groups were given Chinese herbs according to TCM Syndrome Differentiation additionally.</p><p><b>RESULTS</b>The tumor inhibitory rate in the treated group and the control group was 77.78% and 69.57% respectively, with insignificant difference between them. The improvement of fatigue and anorexia in the treated group was better than that in the control group (P < 0. 05). The 6-month, 12-month and 24-month survival rate in the treated group and control group was 61.11% vs 56.62%, 27.78% vs 30.43% and 22.22% vs 26.09%, respectively, the difference between the two groups was insignificant. The occurrence of adverse reactions such as decreasing of white blood cells, platelet and hemoglobin, nausea and vomiting were obviously lower in the treated group than those in the control group (P < 0.05).</p><p><b>CONCLUSION</b>Chinese anti-cancer medicinal perfusion/embolization has affirmative short-term clinical effect in treating primary liver cancer with few adverse reactions, which was tolerable to patients, but its long-term clinical efficacy needs further observation.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Antineoplastic Agents, Phytogenic , Carcinoma, Hepatocellular , Drug Therapy , Therapeutics , Chemoembolization, Therapeutic , Methods , Drug Therapy, Combination , Drugs, Chinese Herbal , Liver Neoplasms , Therapeutics , Medicine, Chinese Traditional , PhytotherapyABSTRACT
<p><b>OBJECTIVE</b>To observe the effect of combination of Syndrome Differentiation (SD) depending treatment and chemotherapy on prognostic factors in patients with non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>One hundred and twenty patients with NSCLC were randomly divided into the TCM group, the western medicine (WM) group and the combined TCM and WM (TCM-WM) group. Besides the conventional supporting and symptomatic treatment given to all the 3 groups, to the TCM group, Chinese drug medication according to patients' SD (intravenons injection, decoction or Xiaoji Decoction) was given, to the WM group chemorherapy was given, and to the TCM-WM group, all the treatment used in both TCM and WM group were given. The long-term efficacy was analyzed by Kaplan-Meier method, the 24 prognostic factors that influencing survival rate were analyzed by COX regression model multiple factors analysis to screen the risk factor and protective factor.</p><p><b>RESULTS</b>The median survival period in the TCM group was 285.00 +/- 17.92 days, in the WM group was 265.00 +/- 1.80 days, insignificant difference was found between them (P > 0.05), that in the TCM-WM group was 359.00 +/- 7.00 days, which was longer than that in the above two groups with significance (P < 0.05). The half-year and 1-year survival rates in the TCM group were 84.4% and 18.1%, in the WM group 82.5% and 20.6%, and in the TCM-WM group 92.5% and 42.7%. The 1-year survival rate in the TCM-WM group was higher than that in the TCM and WM group with significant difference (P < 0.05). Analysis on 24 prognostic factors indicated that there was significant difference (P < 0.05) in influence of such factors on survival rate as clinical stage, lymph node invasion, complications, TCM Syndrome typing, lactate dehydrogenase, carcinoembryonic antigen (CEA), CA199, Karnofsky scoring before treatment, therapeutic method, total scores of quality of life, stability of treatment, CD3+, etc. The former seven were the risk factors for prognosis of midlate NSCLC patients, and the latter 5 the protective factors.</p><p><b>CONCLUSION</b>TCM-WM treatment could prolong patients' survival period, elevate the long-term survival rate, it could be taken as one of the best comprehensive therapies for mid-late NSCLC patients who have missed the opportunity of surgical resection.</p>