A comparative study of human immunoglobulin versus recombinant human tumor necrosis factor-α receptor Ⅱ:IgG Fc fusion protein in the treatment of toxic epidermal necrolysis / 中华皮肤科杂志

Objective:To evaluate and compare efficacy of intravenous immunoglobulin (IVIG) versus recombinant human tumor necrosis factor-α receptor Ⅱ:IgG Fc fusion protein (rhTNFR:Fc) in the treatment of toxic epidermal necrolysis (TEN) .Methods:Clinical data were collected from patients with TEN treated with IVIG or rhTNFR:Fc in Wuhan No.1 Hospital from 2013 to 2019. There were 11 patients in the IVIG group, including 3 males and 8 females, aged 25-72 years, and the median TEN-specific severity-of-illness score (SCORTEN) was 3 points; there were 10 patients in the rhTNFR:Fc group, including 5 males and 5 females, aged 32-84 years, and the median SCORTEN was 2 points. These patients all showed no response to the 5-day treatment with prednisolone acetate at a dose of 0.6-1.0 mg·kg -1·d -1, and then received IVIG at a dose of 400 mg·kg -1·d -1 for 5 consecutive days, or subcutaneous injection of rhTNFR:Fc at a dose of 25 mg every other day for 4-6 sessions. Changes in skin lesions and adverse events were recorded in the 2 groups. Statistical analysis was carried out by using Mann-Whitney U test. Results:Compared with the rhTNFR:Fc group, the IVIG group showed a significant decrease in the time to onset of reduction of skin lesion exudate (1.73 ± 1.19 days vs. 3.00 ± 1.56 days, P < 0.05) , time to onset of pain relief in the lesion area (1.64 ± 1.28 days vs. 3.70 ± 1.63 days, P < 0.05) , time to lightening of color of the lesion base (2.45 ± 1.12 days vs. 3.90 ± 1.59 days, P < 0.05) , time to onset of new epidermis growth (3.09 ± 1.13 days vs. 5.20 ± 1.22 days, P < 0.05) , and in the time to onset of lesion drying at the intertriginous sites (4.82 ± 2.22 days vs. 7.90 ± 3.14 days, P < 0.05) . However, there was no significant difference in the length of hospital stay between the IVIG group (17.70 ± 8.33 days) and rhTNFR:Fc group (16.70 ± 4.71 days, P > 0.05) . No adverse reactions were observed during the treatment, and no recurrence or complications were found in the 21 patients during the follow-up of 6 months. Conclusion:IVIG and rhTNFR:Fc are both effective in the treatment of TEN, but IVIG is superior to rhTNFR:Fc in terms of the time to onset of pain relief, skin lesion exudate reduction and epidermal growth.

Changes of pharmacokinetics and application of physiologically based pharmacokinetic modeling in pharmacotherapy during pregnancy / 药学学报

The rational medication in pregnant women is a clinical issue that clinicians and pharmacists must take seriously. Most tissues and organs undergo anatomical and physiological changes during pregnancy that affect the absorption, distribution, metabolism, and excretion of drugs in vivo, which ultimately lead to changes in bioavailability. In order to achieve an effective therapeutic concentration, dose adjustment might be required during this period. In the past ten years, the application of modeling and simulation methods in the field of drug development and clinical therapy has continued to expand, for instance, using population pharmacokinetic (PPK) and physiologically based pharmacokinetic (PBPK) modeling to adjust dosage regimen in special populations. Rigorously designed and validated models will effectively make up for the deficiencies of clinical trials, provide valuable references for the design of clinical research, and even replace part of them. This article will introduce the physiological changes that affect the pharmacokinetic properties of the drug during pregnancy and review the progress in the application of PBPK modeling in pharmacokinetic studies in pregnant women.

Analysis of bile bacterial diversity in patients with recurrent common bile duct stones / 中华消化内镜杂志

Objective:To compare the bile bacterial diversity in patients with different types of common bile duct stones (CBDS).Methods:A total of 45 patients with CBDS diagnosed by abdominal ultrasound, abdominal CT and (or) magnetic resonance cholangiopancreatography (MRCP) and treated by endoscopic retrograde cholangiopancreatography (ERCP) in the First Affiliated Hospital of Air Force Medical University from August 2017 to January 2018 were divided into the non-stone (NS) group, the primary cholesterol stone (PCS) group, the primary pigment stone (PPS) group, and the recurrent stone (RS) group. 16S rRNA sequencing was used to analyze the microbile community structure and diversity in bile which was collected before contrast medium injection.Results:Thirty-three patients were in the non-RS group (8 in the NS group, 8 in the PCS group, and 17 in the PPS group) and 12 were in the RS group. The proportion of patients with intra-diverticular papilla [41.67% (5/12) VS 3.03% (1/33), χ2=8.27, P=0.004], loose stones [91.67% (11/12) VS 36.36% (12/33), χ2=10.77, P=0.001] and pigmental stones [100.00% (12/12) VS 51.52% (17/33), χ2=7.04, P=0.008] were significantly higher in the RS group than those in the non-RS group. There was no significant difference in other baseline data ( P>0.05). At the phylum and genus level, the bacterial abundance was similar in the RS and PPS group. Alpha and Beta diversity analysis showed that the microbial diversity was similar between the RS and PPS group, both of which were lower than those in the NS and PCS group ( P<0.05). MetaStat analysis revealed that Helicobacter pylori was the dominant bacteria in the RS group, and Proteobacteria and Escherichia coli were the dominant bacteria in both RS and PPS groups. Conclusion:Bacterial abundance of bile in the RS group is similar to that of the PPS group, but the diversity of biliary bacteria flora in the RS group and PPS group are significantly lower than those in the PCS group and NS group. Helicobacter pylori is the dominant biliary bacteria in the RS group.

The clinical application of mobile internet remote guidance platform for vestibular rehabilitation / 中华耳鼻咽喉头颈外科杂志

Objective: To guide the patients with vertigo who are suitable for vestibular rehabilitation therapy (VRT), and to evaluate the curative effect through a remote guidance platform based on mobile internet. Methods: Adult outpatients, who were diagnosed as vestibular disorders and required VRT, were selected and conducted baseline evaluation and formulated vestibular rehabilitation plan according to their symptoms, diagnosis and vestibular function examination results. These patients downloaded and installed the mobile internet remote guidance platform app for VRT, and then registered and uploaded medical records. According to the VRT plan formulated by clinicians for patients, the platform launched corresponding exercise guidance videos to guide them to complete 4-week VRT exercise at home. Before and after VRT, the patients were scored with Visual Analogue Scale (VAS), Activities-specific Balance Confidence (ABC), Dizziness Handicap Inventory (DHI) and Self-rating Anxiety Scale (SAS). The rehabilitation effects were statistically analyzed by SigmaStat 4.0 software. Results: From October 2019 to October 2021, 233 patients with vertigo completed the registration of vestibular rehabilitation guidance platform, of whom 187 patients insisted on 4-week rehabilitation training and completed the scale evaluation. Among 187 patients, 65 were male and 122 were female; Age was (49.8±16.0) years; The medical history ranged from one to 192 months, with a median of eight months. Compared with that before rehabilitation exercise, the subjective feeling of vertigo in 170 patients was improved, and the overall effective rate was 90.9% (170/187). The subjective symptoms of vertigo were basically improved after rehabilitation training in patients with unilateral vestibular dysfunction, vestibular neuritis, sudden deafness with vertigo, Hunt syndrome and acoustic neuroma. There were significant differences in ABC, DHI and SAS scores before and after VRT (P<0.05). Of those patients with Meniere's disease in the intermittent period and the patients with Meniere's disease who underwent surgical treatment, more than 90% of their subjective symptoms of vertigo or dizziness improved after VRT, and there were significant differences in the scores of ABC, DHI and SAS before and after VRT exercise (P<0.05). In patients with vestibular migraine, 36.7% (11/30) had no improvement or even aggravation of subjective symptoms of vertigo after VRT, however, the DHI score after rehabilitation exercise was lower than that before exercise, and the difference was statistically significant (P<0.05). In patients with bilateral vestibular dysfunction, although most (6/8) subjective symptom scores were improved compared with those before exercise, there was no significant difference in ABC, DHI and SAS scores before and after rehabilitation (P>0.05). Conclusion: VRT with the help of vestibular rehabilitation mobile internet remote guidance platform can effectively improve the subjective symptoms of vertigo, balance ability and anxiety in patients with unilateral vestibular lesions.

A multi-center retrospective study of perioperative chemotherapy for gastric cancer based on real-world data / 中华胃肠外科杂志

Objective: To explore the effect of perioperative chemotherapy on the prognosis of gastric cancer patients under real-world condition. Methods: A retrospective cohort study was carried out. Real world data of gastric cancer patients receiving perioperative chemotherapy and surgery + adjuvant chemotherapy in 33 domestic hospitals from January 1, 2014 to January 31, 2016 were collected. Inclusion criteria: (1) gastric adenocarcinoma was confirmed by histopathology, and clinical stage was cT2-4aN0-3M0 (AJCC 8th edition); (2) D2 radical gastric cancer surgery was performed; (3) at least one cycle of neoadjuvant chemotherapy (NAC) was completed; (4) at least 4 cycles of adjuvant chemotherapy (AC) [SOX (S-1+oxaliplatin) or CapeOX (capecitabine + oxaliplatin)] were completed. Exclusion criteria: (1) complicated with other malignant tumors; (2) radiotherapy received; (3) patients with incomplete data. The enrolled patients who received neoadjuvant chemotherapy and adjuvant chemotherapy were included in the perioperative chemotherapy group, and those who received only postoperative adjuvant chemotherapy were included in the surgery + adjuvant chemotherapy group. Propensity score matching (PSM) method was used to control selection bias. The primary outcome were overall survival (OS) and progression-free survival (PFS) after PSM. OS was defined as the time from the first neoadjuvant chemotherapy (operation + adjuvant chemotherapy group: from the date of operation) to the last effective follow-up or death. PFS was defined as the time from the first neoadjuvant chemotherapy (operation + adjuvant chemotherapy group: from the date of operation) to the first imaging diagnosis of tumor progression or death. The Kaplan-Meier method was used to estimate the survival rate, and the Cox proportional hazards model was used to evaluate the independent effect of perioperative chemo therapy on OS and PFS. Results: 2 045 cases were included, including 1 293 cases in the surgery+adjuvant chemotherapy group and 752 cases in the perioperative chemotherapy group. After PSM, 492 pairs were included in the analysis. There were no statistically significant differences in gender, age, body mass index, tumor stage before treatment, and tumor location between the two groups (all P>0.05). Compared with the surgery + adjuvant chemotherapy group, patients in the perioperative chemotherapy group had higher proportion of total gastrectomy (χ(2)=40.526, P<0.001), smaller maximum tumor diameter (t=3.969, P<0.001), less number of metastatic lymph nodes (t=1.343, P<0.001), lower ratio of vessel invasion (χ(2)=11.897, P=0.001) and nerve invasion (χ(2)=12.338, P<0.001). In the perioperative chemotherapy group and surgery + adjuvant chemotherapy group, 24 cases (4.9%) and 17 cases (3.4%) developed postoperative complications, respectively, and no significant difference was found between two groups (χ(2)=0.815, P=0.367). The median OS of the perioperative chemotherapy group was longer than that of the surgery + adjuvant chemotherapy group (65 months vs. 45 months, HR: 0.74, 95% CI: 0.62-0.89, P=0.001); the median PFS of the perioperative chemotherapy group was also longer than that of the surgery+adjuvant chemotherapy group (56 months vs. 36 months, HR=0.72, 95% CI:0.61-0.85, P<0.001). The forest plot results of subgroup analysis showed that both men and women could benefit from perioperative chemotherapy (all P<0.05); patients over 45 years of age (P<0.05) and with normal body mass (P<0.01) could benefit significantly; patients with cTNM stage II and III presented a trend of benefit or could benefit significantly (P<0.05); patients with signet ring cell carcinoma benefited little (P>0.05); tumors in the gastric body and gastric antrum benefited more significantly (P<0.05). Conclusion: Perioperative chemotherapy can improve the prognosis of gastric cancer patients.

Studies on efficacy of a bioabsorbable steroid-eluting sinus stent in the frontal sinus opening of chronic rhinosinusitis with nasal polyps / 中华耳鼻咽喉头颈外科杂志

Objective: To assess the efficacy of a bioabsorbable steroid-eluting sinus stent in improving surgical outcomes when placed in the frontal sinus ostium (FSO) following full endoscopic sinus surgery (ESS) in patients with whole group chronic rhinosinusitis with nasal polyps (CRSwNP). Methods: Patients with whole group CRSwNP who had similar lesions on bilateral sinus between September 2019 and March 2020 in Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Changhai Hospital were chosen. Patients with CRSwNP who underwent extended ESS were randomly assigned to receive a steroid-eluting sinus stent in one FSO whereas the contralateral side received surgery alone. Endoscopic evaluations recorded at 30, 90 days postoperative were graded by an independent assessment panel to assess the need for interventions in the FSO. Semi-quantitative data with CT and endoscopic score were performed by rank sum test. The need for postoperative intervention and the patency rate of FSO were analyzed using the McNemar test. Results: Thirty-one patients with whole group CRSwNP met all eligible criteria, including 17 males and 14 females, with the age of (44.5±11.8) years(x¯±s). Stents were successfully placed in one FSO of all patients. At 30 days post-ESS, the assessment panel reported that steroid-eluting stents reduced the need for postoperative interventions by 41.0% (χ2=5.314,P=0.021), the need for oral steroid interventions by 40.0% (χ2=4.133,P=0.042) and the need for surgical interventions by 74.8% (χ2=4.292,P=0.038) compared to control sinuses with no stents. Clinical surgeons also reported greater diameter of FSO compared to control sinuses at 30 days post-ESS (74.2% vs 48.4%, χ2=4.351, P=0.037). These results at 90 days post-ESS were consistent with those at 30 days post-ESS. Conclusion: Bioabsorbable steroid-eluting sinus stents in the FSO can reduce polyp formation, adhesion, and the need for postoperative interventions in FSO of CRSwNP patients and improve the early postoperative outcomes.

Innovative practice of " two hearts and four wings" in the construction of safe hospital / 中华医院管理杂志

The construction of safe hospital is the foundation of high-quality development of the hospital, and innovation provides power for the construction of safe hospital from the perspective of high-quality development. Taking Zhejiang Provincial People′s Hospital as an example, the authors introduced the innovation construction path of safe hospital in detail, and put forward the construction strategy of safe hospital with " two hearts" (patient-centered, employee-centered)and " four wings" (multimedia doctor-patient communication, Wulin aunt medical studio, integrated operation safety inspection, third-party medical liability insurance). Through the combination of basic safety management and innovative practice, the hospital vigorously promoted the culture of " two hearts" , and established an efficient collaborative information management system, so as to form replicable and promotable practical experience and promote the development of safe hospital.

Practice of applying multimedia technology in doctor-patient communication before diagnosis and treatment / 中华医院管理杂志

The existing doctor-patient communication pattern often falls prey to insufficient informed consent and even medical disputes. In the patient centered perspective, Zhejiang Provincial People′s Hospital explored a new communication mode centering on patients. Based on diagnosis-related groups catalogues and high-frequency surgeries catalogues of the departments, multimedia technology was called into play to produce dubbed PPTs and videos that were easy to understand, standardized and homogeneous, which were embedded into medical records system. Following observation of the PPT or video, patients could directly sign an informed consent on the computer. This practice not only deepens patient′s understanding and achieves homogeneous level of the communication, but also elevates doctor′s work efficiency, contributing to building a harmonious doctor-patient relationship.

Prevalence of heart failure in Chinese cognitive impairment patients： a meta-analysis / 上海预防医学

Objective:Heart failure （HF） and cognitive impairment have become serious medical problems in China. This study used meta-analysis to comprehensively evaluate the prevalence of cognitive impairment in patients with HF in China， and provided suggestions for intervention and prevention of cognitive impairment in this population. Methods:A systematic retrieval was conducted by searching relevant literatures regarding cognitive impairment in Chinese HF patients. These reports were published on CNKI， Wanfang， SinoMed， VIP and PubMed， from January 1， 1980 to July 10， 2020. The Agency for Healthcare Research and Quality （AHRQ） criteria and Newcastle-Ottawa Scale were used to evaluate the literature quality of cross-sectional studies and case-control studies， respectively. Stata16.0 was used for combined prevalence and effect value. Results:A total of 20 articles with medium quality were included. Six of them were case-control studies， with a total sample size of 933 people， and healthy people as controls. The Odds Ratios （OR） value of the prevalence of cognitive impairment in patients with HF was 2.77 （95% CI： 2.05-3.74）. 14 articles were cross-sectional studies with a total sample size of 3000. In China， the prevalence of cognitive impairment in patients with HF was 54.3% （95% CI： 0.43-0.65）. Subgroup analysis showed that the prevalence of cognitive impairment was increased with age， and women had a higher prevalence （58.4%） than that in men （48.4%）. The prevalence in studies using the Montreal Cognitive Assessment （MoCA）to evaluate cognitive impairment （63.6%） was higher than those using Mini-mental State Examination （MMSE）（41.7%）. The limitations of this study include the following： only used the relevant literature on cognitive impairment in patients with HF in China； failed to explain the source of heterogeneity， unable to determine the impact of the study area on heterogeneity， and unable to determine the causality of HF and cognitive impairment. Conclusion:The prevalence of cognitive impairment in patients with HF in China is high and significantly affected by age， gender and other factors. Appropriate measures should be taken for prevention and timely intervention.

Professor 's experience in treatment of alopecia areata with the combination of acupuncture and Chinese herbs based on theory / 中国针灸

Professor -'s clinical experience of treating alopecia areata with combination of acupuncture and Chinese herbs based on theory was summarized. Professor divides alopecia areata into disease and disease. Alopecia areata belonging to disease locates on the skin and is related to the lung and kidney, and belonging to disease locates in the meridians and is related to the heart, spleen and stomach. Acupuncture is chosen when the disease locates in the skin and meridians. If both viscera and meridians suffered, acupuncture and Chinese herbs should be combined. As for the acupuncture, professor used the method of harmonizing needling to treat alopecia areata, which includes regulating the origin of , regulating the deficiency and excess of and regulating the operation of local . As for the Chinese herbs, disease can be washed out by Chinese herbs of relieving exterior wind and activating meridians and collaterals. The disease can be washed out by Chinese herbs in mild condition, and long course of disease can be given Guizhi decoction as the base, add or subtract according to syndrome.

Influence of closed irrigation drainage of HACC on ischemia/reperfusion injury of graft flap in rats / 中华医学美学美容杂志

Objective:To investigate the effects of quaternary ammonium salt of chitosan combined with closed irrigation on ischemia-reperfusion injury (I/R) in rat skin flap.Methods:Fourty-five adult male SD rats were randomly divided into 3 groups: sham-operated group, I/R group and chitosan group. Before operation, collection of arterial blood for testing PCT and hs-CRP were used as basic values. Right low abdominal island flap fed by the superficial epigastric artery was created in rats of all three groups. After operation, we flushed and dressed the wound with 10% saline of sham-operated group and I/R group. Quaternary ammonium salt of chitosan combined with closed irrigation were used in chitosan group. Flaps were assessed histologically at 3 d, 5 d and 7 d of reperfusion. The tissue was collected to make the SOD, MDA and PCT, hs-CRP testing, pathological section observation and to calculate the flap survival rate.Results:Marked neutrophil infiltration and edema were observed in I/R group, while less neutrophil infiltration was observed in chitosan group. Compared with the sham-operated group, the PCT and hs-CRP levels of the I/R group after modeling for 3 and 5 days were significantly increased. There were statistically significant differences ( P<0.05); Compared with the sham-operated group, the PCT and hs-CRP levels of the Chitosan group after modeling for 3 days, 5 days were significantly increased. There were statistically significant differences ( P<0.05); Compared with the I/R group, the PCT and hs-CRP levels of the Chitosan group after modeling for 3 and 5 days were significantly induced. There were statistically significant differences ( P<0.05); after modeling for 7 days, the values between all groups were no statistically significant differences ( P>0.01). Compared with the sham-operated group, the SOD level of the I/R group after modeling for 3, 5 and 7 days was significantly induced. MDA level was significantly increaesd; compared with the sham-operated group, the SOD level of the Chitosan group after modeling for 3, 5 and 7 days were significantly induced. MDA level was significantly increaesd; Compared with the I/R group, the SOD level of the chitosan group after modeling for 3, 5 and 7 days were significantly increased. MDA level was significantly induced. They all had statistically significant differences ( P<0.05). In the chitosan group, the survival of flaps was (85.34±10.02)%, which was significantly greater than the I/R group, in which only (41.11±14.17)% of the flap survived ( P<0.05). Conclusions:Quaternary ammonium salt of chitosan combined with closed irrigation can significantly improve flap survival, reduce I/R in transplanted rats＇ skin flaps.

Advance in Repeatitive Transcranial Magnetic Stimulation for Dysphagia after Stroke (review) / 中国康复理论与实践

Repeatitive transcranial magnetic stimulation can adjust cortical excitability and improve swallowing function in patients with dysphagia after stroke. High frequency stimulations with 90% to 130% resting motor threshold (rMT) in the early stage, as well as low frequency stimulations with 100% to 130% rMT for 1200 pulse in the recovery period, may be beneficial to the recovery of swallowing function, and bilateral stimulation may be more effective.

Simultaneous Determination of Four Alkaloid Components in Xiangbin Decoction by UPLC-QqQ-MS/MS / 中国实验方剂学杂志

Objective: To establish a quantitative method for the simultaneous determination of arecaine,arecoline,norisoboldine and boldine in Xiangbin decoction by ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-QqQ-MS/MS), and compare the variation of their contents between single and mixed decoctions. Method: The separation was carried on a Waters ACQUITY UPLC BEH Shield RP18(2.1 mm×150 mm,1.7 μm)column, with 0.1%formic acid solution-acetonitrile as mobile phase for gradient elution. The flow rate was 0.2 mL·min-1, and the column temperature was 30℃. The quantitative MRM transitions of the four components were m/z 142.10/44.11 for arecaine,m/z 156.20/44.07 for arecoline,m/z 314.29/265.12 for norisoboldine and m/z 328.13/265.10 for boldine. The determination was performed in multiple reaction monitoring (MRM) mode by mass spectrometry with electrospray ionization (ESI) source under positive mode. Result: The linear ranges of arecaine,arecoline,norisoboldine and boldine were 0.479 0-57.48,0.976 0-78.08,0.812 0-64.96, 0.091 2-18.24 μg·L-1,respectively. The average recoveries of the above compounds ranged from 93.73%to 104.34%, with RSD (n=6) of less than 5%. The contents of arecoline,arecoline,norbibeldine and boltinine in Xiangbin decoction were (90.07±1.26),(445.27±12.39),(742.35±38.39),(38.50±3.33) μg·g-1,which were significantly lower than the contents in Linderae Radix and Arecae Semen. Conclusion: The method is rapid,sensitive,accurate and reproducible,and suitable for the simultaneous determination of multiple components in Xiangbin decoction,so as to provide a basis for the quality control of Xiangbin decoction. The compatibility of Xiangbin decoction has a significant effect on the dissolution contents of arecaine,arecoline,norisoboldine and boldine.

The clinical effects of acupuncture combined with Mingmu-Dihuang pill on dry eyes / 国际中医中药杂志

Objective To evaluate the effect and safety of acupuncture combined with Mingmu-Dihuang pill in patients with dry eyes.Methods A total of 100 patients with dry eye were enrolled in line with the inclusion criteria and divided into experimental group and control group by random figure table.The experimental group was treated with acupuncture combined with Mingmu-Dihuang pill,and the control group was treated with artificial tears.After 2 months of treatment,the Schirmer test (schirmerI,SIT),tear film break up time (BUT),fluorescent staining (FL) and clinical symptom score were observed and compared,and the clinical efficacy and safety were evaluated.Results The total effective rate of the experimental group was 89.0％ (89/100) and the control group was 67.0％ (67/100),and the difference was significant (x2=14.121,P＜0.001).After treatment,the levels of BUT (7.89 ± 1.65 s vs.5.01 ± 1.72 s,t=8.543),SIT (7.45 ± 1.68 mm vs.5.01 ± 1.72 mm,t=5.991) in the experimental group were significantly higher than those of the control group,and the difference is significant (P＜0.01).The FL score and dry eye score in the experimental group were significantly lower than those of the control group (t were 11.551,12.342,P＜0.01).Conclusions Acupuncture combined with Mingmu-Dihuang pill has better clinical effect and good safety for the treatment of dry eye patients.

Clinical study of cervical necrotizing fasciitis accompanied with descending necrotizing mediastinitis treated with cervical double parallel incision combined with mediastinoscope or thoracoscope / 中华口腔医学杂志

Objective@#To summarize the experience of applying cervical double parallel incision combined with mediastinoscope or thoracoscope in the treatment of cervical necrotizing fasciitis (CNF) accompanied with descending necrotizing mediastinitis (DNM), so as to provide a reference for clinical practice.@*Methods@#The clinical data of six patients with CNF accompanied with DNM who were admitted to the Department of Stomatology and the Department of Otolaryngology Head and Neck Surgery, The First People′s Hospital of Changzhou from September 2014 to September 2018 were retrospectively analyzed. All of the six patients were confirmed by CT of neck and chest, among whom there were two males and four females aged from 48 to 73. Three patients were treated with cervical double parallel incision combined with mediastinoscope to be combined with cervical and thoracic drainage under general anesthesia while the other three with cervical double parallel incision combined with thoracoscope to be combined cervical and thoracic drainage under general anesthesia. The CT of neck and chest as well as infectious indicators including hematology, C-reactive protein (CRP) and procalcitonin (PCT) were reexamined during the postoperative period.@*Results@#The cervical and thoracic combined drainage was unobstructed in all of the six patients, no secondary surgery was performed, and the infectious indicators gradually decreased. All patients had off-bed activities on the first day after the operation, were all cured and discharged after an average of 21 days (16 to 36 days) in hospital and followed up for an average of 18 months (4 to 30 months) after the operation. None of them experienced infection relapse, and they were all satisfied with the appearance of the cervical incision.@*Conclusions@#Cervical double parallel incision combined with mediastinoscope or thoracoscope for the treatment of CNF accompanied with DNM has the advantages of complete drainage, small trauma, excellent efficacy and aesthetic operative area, thus being deserved to be clinically popularized.

Professor 's experience in triple-stage regimen for herpes zoster with herbal thread moxibustion of medicine / 中国针灸

The clinical experience of professor is introduced in treatment of herpes zoster and post-neuralgia with herbal thread moxibustion of medicine combined with acupuncture. Professor divides the pathological process of herpes zoster into pre-herpes stage, herpes stage and post-herpes stage. At pre-herpes stage, in pathogenesis of medicine, the deficiency of antipathogenic , invasion of pathogens, retarded and blood circulation in dragon and fire pathways are involved. Clearing heat, detoxification, promoting circulation in the pathways and dispersing and blood are considered in treatment. The herbal thread moxibustion is provided at " point" and " point" and seize "the head and tail of snake", and 3 needles are used at each of ends of skin leison. At herpes stage, toxin stagnation in dragon and fire pathways, stagnation on skin and muscle, and blood disturbance and dysfunction of three kinds of are considered in pathogenesis. The treatment focuses on removing pathogens and toxin, assisted with regulating and blood circulation, removing herpeses and promoting wound healing. The herbal thread moxibustion is used at " point", " point" and the two ends of skin lesion. The local row-like puncture is provided at skin lesion according to the intercostals nerve distribution. At post-herpes stage, the retention of pathogens and stagnation of blood in dragon and fire pathways are considered in pathogenesis. The treatment focuses on activating blood circulation, removing stasis and eliminating the pathogen residuals. " point", " point" and the two ends of skin lesion are selected in herbal thread moxibustion, or sweeping and dragging techniques of acupuncture are adopted. The timely application of herbal thread moxibustion controls the development of herpes zoster and prevents from post-neuralgia.

Design and Implementation of A Portable Mobile Controlled Transcranial Direct Current Stimulator / 中国康复理论与实践

Objective:To design and implement a low-power and portable transcranial direct current stimulator controlled by mobile phones. Methods:The constant current stimulation circuit was realized by a field effect transistor, which could output stable and adjustable low-intensity direct current, and the impedance detection circuit and the over-current protection circuit increased the effectiveness and safety of the stimulator. The control and real-time detection of the stimulation circuit was realized through a microcontroller, and the parameters' settings of the stimulator and the display and preservation of the actual stimulus information were realized through the Android software on the smartphone. Results:The output current strength and accuracy, maximum load, as well as the timing, device connection, stimulus information collection and display all achieved the expected goals. Conclusion:The design realized the mobile control of the stimulator, with portability, low cost and low power consumption, providing a new solution for wider applications.

COMTH score for the survival of patients with malignant biliary stricture: a retrospective study / 中华消化内镜杂志

Objective@#To investigate the history, risk factors for prognosis of malignant biliary stricture (MBS) patients receiving conservative therapy after endoscopic retrograde cholangiopancreatography(ERCP) and to set up a predictive model for overall survival (OS).@*Methods@#MBS patients who underwent ERCP and conservative therapy in Xijing Hospital and PLA No.451 Hospital from January 2009 to December 2013 were enrolled to the present study. Predictive factors associated with OS were identified in the training cohort by stepwise multivariate Cox regression analysis. A predictive model was then developed and externally validated in the validation cohort.@*Results@#Between January 2009 and December 2013, 152 and 149 patients were eligible to the training and validation cohort respectively. In the training cohort, tumors were mainly originated from bile duct (33.6%), pancreas (23.5%) or ampulla (20.4%). 76.3% (116/152) patients died during the observation period. The median OS for the training population was 5.0 months (3.9-6.2 months). CA19-9≥1 000 U/mL, non-ampulla tumor, metastasis, pre-ERCP total bilirubin≥7 mg/dL and hilar stricture were identified as independent predictive factors of poor OS (all P<0.05). Based on these factors, the COMTH predictive model was developed. The median OS of patients with COMTH>8 in the training and validation cohorts were both 3.0 months, which were significantly shorter than those with COMTH≤8 (10.0 and 6.9 months in the training and validation cohorts respectively, both P<0.001).@*Conclusion@#The prognosis of MBS patients undergoing ERCP is poor. The survival chance of patients with COMTH>8 is even more dismal.