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Objective:To investigate the clinical characteristics of choledocholithiasis com-bined with periampullary diverticulum and influencing factor for difficult cannulation of endoscopic retrograde cholangiopancreatography (ERCP).Methods:The retrospective case-control study was conducted. The clinical data of 1 920 patients who underwent ERCP for choledocholithiasis in 15 medical centers, including the First Hospital of Lanzhou University, et al, from July 2015 to December 2017 were collected. There were 915 males and 1 005 females, aged (63±16)years. Of 1 920 patients, there were 228 cases with periampullary diverticulum and 1 692 cases without periampullary diverticulum. Observation indicators: (1) clinical characteristics of patients with choledocholithiasis; (2) intraoperative and postoperative situations of patients undergoing ERCP for choledocholithiasis; (3) influencing factor analysis for difficult cannulation in patients undergoing ERCP for choledocholithiasis. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M(range) or M( Q1, Q3), and com-parison between groups was conducted using the Wilcoxon rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. The Logistic regression model was used for univariate and multivariate analyses. Results:(1) Clinical characteristics of patients with choledocholithiasis. Age, body mass index, cases with complications as chronic obstructive pulmonary disease, diameter of common bile duct, cases with diameter of common bile duct as <8 mm, 8?12 mm, >12 mm, diameter of stone, cases with number of stones as single and multiple were (69±12)years, (23.3±3.0)kg/m 2, 16, (14±4)mm, 11, 95, 122, (12±4)mm, 89, 139 in patients with choledocholithiasis combined with periampullary diverticulum, versus (62±16)years, (23.8±2.8)kg/m 2, 67, (12±4)mm, 159, 892, 641, (10±4)mm, 817, 875 in patients with choledocholithiasis not combined with periampullary diver-ticulum, showing significant differences in the above indicators between the two groups ( t=?7.55, 2.45, χ2=4.54, t=?4.92, Z=4.66, t=?7.31, χ2=6.90, P<0.05). (2) Intraoperative and postoperative situations of patients undergoing ERCP for choledocholithiasis. The balloon expansion diameter, cases with intraoperative bleeding, cases with hemorrhage management of submucosal injection, hemostatic clip, spray hemostasis, electrocoagulation hemostasis and other treatment, cases with endoscopic plastic stent placement, cases with endoscopic nasal bile duct drainage, cases with mechanical lithotripsy, cases with stone complete clearing, cases with difficult cannulation, cases with delayed intubation, cases undergoing >5 times of cannulation attempts, cannulation time, X-ray exposure time, operation time were 10.0(range, 8.5?12.0)mm, 56, 6, 5, 43, 1, 1, 52, 177, 67, 201, 74, 38, 74, (7.4±3.1)minutes, (6±3)minutes, (46±19)minutes in patients with choledocholithiasis combined with periampullary diverticulum, versus 9.0(range, 8.0?11.0)mm, 243, 35, 14, 109, 73, 12, 230, 1 457, 167, 1 565, 395, 171, 395, (6.6±2.9)minutes, (6±5)minutes, (41±17)minutes in patients with choledocholithiasis not combined with periampullary diverticulum, showing significant differences in the above indicators between the two groups ( Z=6.31, χ2=15.90, 26.02, 13.61, 11.40, 71.51, 5.12, 9.04, 8.92, 9.04, t=?3.89, 2.67, ?3.61, P<0.05). (3) Influencing factor analysis for difficult cannulation in patients undergoing ERCP for choledocholithiasis. Results of multivariate analysis showed total bilirubin >30 umol/L, number of stones >1, combined with periampullary diverticulum were indepen-dent risk factors for difficult cannulation in patients with periampullary diverticulum who underwent ERCP for choledocholithiasis ( odds ratio=1.31, 1.48, 1.44, 95% confidence interval as 1.06?1.61, 1.20?1.84, 1.06?1.95, P<0.05). Results of further analysis showed that, of 1 920 patients undergoing ERCP for choledocholithiasis, the incidence of postoperative pancreatitis was 17.271%(81/469) and 8.132%(118/1 451) in the 469 cases with difficult cannulation and 1 451 cases without difficult cannula-tion, respectively, showing a significant difference between them ( χ2=31.86, P<0.05). In the 1 692 patients with choledocholithiasis not combined with periampullary diverticulum, the incidence of postopera-tive pancreatitis was 17.722%(70/395) and 8.250%(107/1 297) in 395 cases with difficult cannula-tion and 1 297 cases without difficult cannulation, respectively, showing a significant difference between them ( χ2=29.00, P<0.05). In the 228 patients with choledocholithiasis combined with peri-ampullary diverticulum, the incidence of postoperative pancreatitis was 14.865%(11/74) and 7.143%(11/154) in 74 cases with difficult cannulation and 154 cases without difficult cannulation, respectively, showing no significant difference between them ( χ2=3.42, P>0.05). Conclusions:Compared with patients with choledocholithiasis not combined with periampullary divertioulum, periampullary divertioulum often occurs in choledocholithiasis patients of elderly and low body mass index. The proportion of chronic obstructive pulmonary disease is high in choledocholithiasis patients with periampullary diverticulum, and the diameter of stone is large, the number of stone is more in these patients. Combined with periampullary diverticulum will increase the difficult of cannulation and the ratio of patient with mechanical lithotripsy, and reduce the ratio of patient with stone complete clearing without increasing postoperative complications of choledocholithiasis patients undergoing ERCP. Total bilirubin >30 μmol/L, number of stones >1, combined with periampullary diverticulum are independent risk factors for difficult cannulation in patients of periampullary diverticulum who underwent ERCP for choledocholithiasis.
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Objective To improve the quality for authorized distribution of traditional Chinese medicine pieces, reduce patient complaints and increase patient satisfaction. Methods Patient’s complaints against different drug dispensing modes were analyzed. PDCA cycle was used for quality improvements. Results The new quality control mode includes pre monitoring measures, such as pharmacist resident in pharmaceutical factories and unannounced factory inspections, the fast-track handing measures for the problems occurred in patients, pharmacies, pharmaceutical factories and express delivery companies, and retrospective measures, such as evaluation of pharmaceutical factories and quarterly pharmaceutical factory communication meetings. Conclusion Three years after the new quality control mode, patient’s complaints were significantly reduced. The authorized distribution quality for traditional Chinese medicine pieces was greatly improved.
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Objective@#To analyze dermoscopic features of blue nevi.@*Methods@#Clinical and dermoscopic data were collected from patients with confirmed blue nevi in the Department of Dermatology and Venereology, Wuxi People′s Hospital from January 2008 to May 2018, and analyzed retrospectively. Chi-square test was used to analyze differences between groups.@*Results@#Totally, 65 patients with 66 skin lesions were enrolled into this study. A total of 23 skin lesions were subjected to dermoscopy, which showed homogeneous pattern in 20 (87.0%) lesions, pseudo-pigment network pattern in 2 (8.7%) lesions, and cerebriform pattern in 1 (4.3%) lesion, and the homogeneous pattern was more common than the other patterns (χ2 = 8.79, P < 0.05) . Under the dermoscope, 10 lesions were monochromatic (43.5%) , 11 were dichromatic (47.8%) , and 2 were multichromatic (8.7%) . Scar-like hypopigmentation was observed in 4 lesions (17.4%) , and vascular structures were observed in 5 (21.7%) , including punctate vessels in 4 (17.4%) and linear irregular vessels in 1 (4.3%) . Papillary hyperplasia was observed in 2 lesions (8.7%) . Additionally, pigmentation around lesions, white streaks, dots/globules, blotches, comedo-like openings were observed in 1 lesion (4.3%) each.@*Conclusions@#Blue homogeneous pattern is the most common dermoscopic feature of blue nevi. Pseudo-pigment network pattern, cerebriform pattern, scar-like hypopigmentation, multiple vascular patterns, papillary hyperplasia, white streaks, dots/globules, blotches, comedo-like openings can also be observed in blue nevus lesions.
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Objective@#To assess the value of non-invasive prenatal testing (NIPT) for the identification of fetal chromosomal aneuploidies.@*Methods@#For 9470 pregnant women with a moderate-to-high risk by conventional serological screening or advanced maternal age, peripheral venous blood samples were collected and, following extraction of free fetal DNA, subjected to large-scale parallel sequencing on a Illumina Hiseq2000 platform. Those with a high risk by NIPT were validated by invasive prenatal diagnosis.@*Results@#Out of the 9470 samples, 194 cases (2.0%) were positive by NIPT testing. These included 50 trisomy 21, 11 trisomy 18, 17 trisomy 13, 44 other autosomal aneuploidies, 55 sex chromosomal aneuploidies, and 17 chromosomal copy number variations. As validated by amniotic fluid or umbilical blood chromosomal karyotyping analysis, NIPT has a false positive rate of 2.0%, 18.2%, 41.2%, 97.7%, 81.8%, 94.1%, respectively. The test has a sensitivity of 100% and a specificity of 98.79%.@*Conclusion@#For common chromosomal aneuploidies such as trisomy 21 and trisomy 18, NIPT has a good sensitivity and specificity, therefore has good value for clinical application.
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Microfocused ultrasound (MFU),as a new approach for facial skin tightening and lifting,has been widely applied in recent years.Its action mechanism is that heat can be transmitted to the deep dermis and superficial musculoaponeurotic system through precise and depth-consistent microcoagulation zones,leading to the contraction and remodeling of skin collagen without damage to the epidermis.MFU has high safety with few serious adverse reactions.However,there are still doubts whether it can lead to subcutaneous scar formation,the risk of lipolysis,or nerve,vessel and eye injuries,etc.Appropriate use and selection of patients can minimize the occurrence of these rare adverse reactions as much as possible.
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OBJECTIVE@#To assess the value of non-invasive prenatal testing (NIPT) for the identification of fetal chromosomal aneuploidies.@*METHODS@#For 9470 pregnant women with a moderate-to-high risk by conventional serological screening or advanced maternal age, peripheral venous blood samples were collected and, following extraction of free fetal DNA, subjected to large-scale parallel sequencing on a Illumina Hiseq2000 platform. Those with a high risk by NIPT were validated by invasive prenatal diagnosis.@*RESULTS@#Out of the 9470 samples, 194 cases (2.0%) were positive by NIPT testing. These included 50 trisomy 21, 11 trisomy 18, 17 trisomy 13, 44 other autosomal aneuploidies, 55 sex chromosomal aneuploidies, and 17 chromosomal copy number variations. As validated by amniotic fluid or umbilical blood chromosomal karyotyping analysis, NIPT has a false positive rate of 2.0%, 18.2%, 41.2%, 97.7%, 81.8%, 94.1%, respectively. The test has a sensitivity of 100% and a specificity of 98.79%.@*CONCLUSION@#For common chromosomal aneuploidies such as trisomy 21 and trisomy 18, NIPT has a good sensitivity and specificity, therefore has good value for clinical application.
Subject(s)
Female , Humans , Pregnancy , Aneuploidy , Chromosome Disorders , Diagnosis , DNA Copy Number Variations , Prenatal Diagnosis , Sensitivity and Specificity , Trisomy , Trisomy 18 SyndromeABSTRACT
Microfocused ultrasound (MFU) , as a new approach for facial skin tightening and lifting, has been widely applied in recent years. Its action mechanism is that heat can be transmitted to the deep dermis and superficial musculoaponeurotic system through precise and depth-consistent microcoagulation zones, leading to the contraction and remodeling of skin collagen without damage to the epidermis. MFU has high safety with few serious adverse reactions. However, there are still doubts whether it can lead to subcutaneous scar formation, the risk of lipolysis, or nerve, vessel and eye injuries, etc. Appropriate use and selection of patients can minimize the occurrence of these rare adverse reactions as much as possible.
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<p><b>OBJECTIVE</b>To assess the value of combined chromosomal karyotyping and BACs-on-Beads(BoBs) assay for the prenatal diagnosis of high risk gravida from Ningbo.</p><p><b>METHODS</b>For 2779 women, results of conventional karyotyping analysis and BoBs assay were compared.</p><p><b>RESULTS</b>For common aneuploidies involving chromosomes 13, 18, 21, X and Y, the two methods have yielded a concordance rate of 98.78%. Eight cases detected with microduplication by BoBs were missed by karyotyping analysis. On the other hand, 17 structural chromosomal abnormalities, 10 chimeras and 1 triploidy detected by karyotyping analysis were missed by BoBs.</p><p><b>CONCLUSION</b>The BoBs technology has featured high throughput and rapidity, and can detect 9 microdeletion syndromes, which can improve the quality of prenatal diagnosis and provide an ideal complementary for conventional chromosomal karyotyping.</p>
Subject(s)
Adult , Female , Humans , Pregnancy , Chromosome Aberrations , Chromosome Deletion , Chromosomes, Artificial, Bacterial , Genetics , Karyotyping , Methods , Prenatal Diagnosis , MethodsABSTRACT
BACKGROUND:Three dimensional finite element analysis is widely used in orthopedics, but research in the knee flexion movement is not much. OBJECTIVE:To analyze biomechanical properties of knee flexion using finite element analysis.METHODS:Three dimensional finite element models and models of knee flexion at 30 degrees, 60 degrees and 120 degrees were established. Femoral forward movement, femur inward movement, tibia internal rotation and tibia vara were analyzed at different flexion angles. RESULTS AND CONCLUSION:(1) When knee flexion was at 30 degrees, 60 degrees and 120 degrees, the femur had backward movement. The backward movement value was larger at 60 degrees than at 30 and 120 degrees (P0.05). (2) The femur had outward movement at 30 degrees, and inward movement at 120 degrees. The inward movement value was significantly larger at 120 degrees than at 30 and 60 degrees (P0.05). (3) Tibia internal rotation was not significantly different at 30, 60 and 120 degrees of flexion (P>0.05). (4) Tibia vara was found at 30, 60 and 120 degrees of flexion, but the tibia vara was not obvious at 120 degrees. The tibia vara was maximum at 60 degrees, and significantly higher than that at 120 degrees (P0.05). (5) These findings verify that backward movement was most obvious at 60 degrees. Femur inward movement was most large at 120 degrees. Tibia internal rotation was noticeable at 30 and 120 degrees. Tibia vara was remarkable at 60 degrees.
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Objective:To investigate ulinastatin (UTI) combined with Xingnaojing injection in the treatment of acute cerebral hemorrhage (ACH) and its effect on the serum high sensitivity C reactive protein (hs-CRP),D-dimer (D-D) and neuron specific enolase(NSE) levels.Methods:110 cases of ACH patients admitted in our hospital from January 2015 to December 2016 were selected and divided into two groups according to the random number table method.The control group was given UTI treatment,while the observation group was given UTI combined with Xingnaojing treatment.Then the brain edema absorption effect,NIHSS score,serum hs-CRP,D-D and NSE levels before and after the treatment of the two groups were recorded and compared;the safety ofmedicidstion of the two groups was evaluated.Results:At the 14th day after treatment,the total effective rate of cerebral hematoma absorption in the observation group was 89.1％,which was significantly higher than 67.3％ of the control group (P＜0.01).At the 14th day after treatment,the NIHSS scores of both groups were significantly lower than those before the treatment (P＜0.01);compared with that of the control group of the same time period,at the 14th day after treatment,the improvement effect of NIHSS score in the observation group was more significant (P＜0.01).Compared with those before the treatment,the serum hs-CRP,D-D and NSE levels of both groups at the 14th day after treatment were significantly decreased (P＜0.01);at the 14th day after treatment,the serum indicators of the observation group improved more significantly than those of the control group (P＜0.01).The incidence rate of adverse reaction in the observation group was 3.6％ compared with 5.5％ of the control group (P＞0.05).Conclusion:Ulinastatin combined with Xingnaojing Injection could rapidly relieve or eliminate hematoma in the treatment of acute cerebral hemorrhage,control the inflammatory response,improve the blood coagulation system and fibrinolytic system,protect the nerve cells and reduce the neurological damagee.
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Objective To evaluate the efficacy and safety of transurethral thulium-Yag laser(Tm-Yag Laser) resection of bladder tumor in the treatment of non-muscle invasive bladder cancer(NMIBC).Methods The clinical data of 186 patients who underwent transurethral resection with pathologically identified of NMIBC were retrospectively analyzed.76 cases and 110 cases were in the transurethral resection of bladder cancer Tm-Yag Laser group and TURBT group,respectively.The operative time,intraoperative blood loss,incidence of obturator nerve reflex,days for urethral catheterization,duration of hospitalization after surgery,detection rate of muscle layer in postoperative pathologic examination and recurrence between the two groups were compared.All patients were followed up for 24 months.Regularly gemcitabine intravesical instillation chemotherapy and cystoscopy were performed postoperation.Results The operative time [(27.08±5.56) min vs.(25.55±5.37) min,P>0.05]and intraoperative blood loss [(14.23±4.05) mL vs.(15.10±3.24) mL,P>0.05]showed no differences between the two groups.The incidence of obturator nerve reflex in Tm-Yag laser group was lower than that in TURBT group (0.0% vs.5.5 %,x2=4.28,P=0.038).The days for urethral catheterization [(3.48±1.05) d vs.(4.02±1.14) d,t=3.328,P=0.001]and the duration of hospitalization after surgery [(4.47±1.08) d vs.(5.02±1.13) d,t=3.350,P=0.001]in Tm-Yag laser group were significantly shorter than those in TURBT group.In Tm-Yag laser group,the detection rate of muscle layer in postoperative pathologic examination was higher than that in TURBT group(x2=14.96,P=0.001).The total rate of tumor recurrence in Tm-Yag laser group was significantly lower than that in TURBT group(13.2 % vs.25.5%,x2=4.18,P=0.041).Conclusion Transurethral Tm-Yag laser is safe and effective in the treatment of NMIBC.It can avoid the incidence of complications and reduce tumor recurrence rate,which is worthy of promotion.
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BACKGROUND:A variety of factors contribute to biliary injury that is difficult to be repaired. Stent implantation is extensively used for bile duct injury, but either scaffolds made by metal or plastics can lead to certain adverse reactions. OBJECTIVE:To explore the biological characteristics of a novel biodegradable scaffold and its repair effects on bile duct injury. METHODS:The biological characteristics of the novel biodegradable scaffold were detected by fresh bile, and its degradation was observed at different time points. Thirty Bama mini pigs were included and were randomly divided into observation group (n=15) and control group (n=15). After bile duct injury models were prepared, the control group was subjected to the bile duct interrupted suture, while the observation group was subjected to the novel biodegradable scaffold combined with omentum majus. The biological properties of the scaffolds were observed. Hepatic enzymes and serum total bilirubin levels were detected, as wel as hematoxylin-eosin staining, Masson staining and immunohistochemistry detection ofα-smooth muscle actin were performed. RESULTS AND CONCLUSION:Before and 1, 3 and 6 months after surgery, hepatic enzymes and total bilirubin of two groups were detected, and neither intra-group nor intergroup comparisons had significant differences (P>0.05). Hematoxylin-eosin staining and Masson staining revealed that inflammatory reactions and fiber hyperplasia at the anastomotic site in the observation group were lighter than those in the control group at different time points after surgery. Theα-smooth muscle actin-positive scores in both two groups were in a rise at 1 and 3 months after surgery, and peaked at the 3rd month, and then began to decline. Moreover, theα-smooth muscle actin-positive scores in the observation group were significantly lower than those in the control group at 3 and 6 months after surgery (P<0.05). These results show that the novel biodegradable scaffold has good biological characteristics and can obtain ideal repair effects in the bile duct injury.
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BACKGROUND:There are studies on three-dimensional finite element analysis of total knee replacement, but few research concerns contact pressure and contact area inside and outside polyethylene liner of fixed prosthesis and rotating platform prosthesis in total knee replacement. OBJECTIVE:To explore the contact pressure and contact area inside and outside polyethylene liner of fixed platform prosthesis and rotating platform prosthesis in total knee replacement. METHODS:We established three-dimensional finite element models of fixed platform prosthesis and rotating platform prosthesis in total knee replacement and compared contact pressure and contact area inside and outside polyethylene liner of fixed platform prosthesis and rotating platform prosthesis in total knee replacement. RESULTS AND CONCLUSION:The peak contact pressure inside and outside polyethylene liner of fixed platform prosthesis and rotating platform prosthesis in total knee replacement was minimum at 0° of genuflex. The peak contact pressure inside polyethylene liner was higher than that outside polyethylene liner of fixed platform prosthesis and rotating platform prosthesis in total knee replacement at 0°-90° of genuflex (P<0.05). The peak contact pressure inside and outside polyethylene liner of fixed platform prosthesis was higher than that of rotating platform prosthesis in total knee replacement at 60°-120° of genuflex (P<0.05). The contact area inside and outside polyethylene liner of fixed platform prosthesis and rotating platform prosthesis in total knee replacement was maximum at 0° of genuflex. The contact area inside polyethylene liner of fixed platform prosthesis in total knee replacement was lower than that of outside at 0°-30° of genuflex (P<0.05). The contact area inside polyethylene liner of fixed platform prosthesis in total knee replacement was lower than that of outside at 0°-90° of genuflex (P<0.05). The contact area inside and outside polyethylene liner of fixed platform prosthesis was lower than that of rotating platform prosthesis in total knee replacement at 30°-120° of genuflex (P<0.05). These results suggested that peak contact pressure inside polyethylene liner of fixed and rotating platform prostheses was higher than that outside in total knee replacement, and the inside contact area was lower than that of outside. Inside and outside contact pressure of the rotating platform prosthesis was lower than that of fixed platform prosthesis. Inside and outside contact area of the rotating platform prosthesis was higher than that of fixed platform prosthesis.
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BACKGROUND: Renin-angiotensin-aldosterone system existed in bone tissue. Recent studies on antihypertensive drugs found that angiotensin converting enzyme inhibitor type antihypertensive drug was possibly effective for osteoporosis. Perindopril is one of the commonly used antihypertensive drugs. Whether perindopril affected bone metabolism or could be used in anti-osteoporosis has not been reported. OBJECTIVE: To observe effects of perindopril on bone metabolism in a rat model of osteoporosis induced by retinoic acid. METHODS: Fifty Sprague-Dawley rats were randomly divided into five groups, with ten in each group. In the model group and each perindopril groups, rats were intragastricaly administered retinoic acid solution 80 mg/kg per day. After successful model establishment, rats in different perindopril groups were intragastrical y administered perindopril 2, 4 and 8 mg/kg per day, once a day, for 42 consecutive days. In the normal control and model groups, rats were given an equal volume of distil ed water. Serum calcium, phosphorus, alkaline phosphatase, bone mass and bone mineral density were detected in each group. Expression of bone specific alkaline phosphatase and tartrate-resistant acid phosphatase mRNA in bone tissue was determined. RESULTS AND CONCLUSION: Compared with the model group, after treatment with perindopril, serum calcium and phosphorus levels were increased, alkaline phosphatase activities were significantly decreased, bone mass and bone mineral density were obviously increased in rats with retinoic acid-induced osteoporosis. Expression of bone specific alkaline phosphatase mRNA was higher in the perindopril 8 mg/kg group than in the perindopril 2 and 4 mg/kg groups and model group. Tartrate-resistant acid phosphatase mRNA expression was higher in the perindopril 8 mg/kg group than in the model group. These results indicated that perindopril could improve partial bone metabolic biochemical markers in osteoporosis rats, promoted bone formation by up-regulating bone specific alkaline phosphatase mRNA expression, and had a certain preventive effect on retinoic acid-induced osteoporosis.
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Objective To evaluate the efficacy and safety of focal fractional laser treatment(FFLT)for atrophic acne scars. Methods A randomized, self-controlled study was performed. A total of 20 patients with atrophic facial acne scars were enrolled into this study. Treatments were randomly administered in a split-face manner. Half of each subject′s face received FFLT(FFLT side), and the other half underwent full-face fractional CO2 laser resurfacing(control side), for one session. All the patients were followed up for 3 months after the treatment. Evaluation was based on the ECCA grading scale (échelle d′évaluation clinique des cicatrices d′acné)and patient satisfaction score. A VISIA skin detector was used to take photographs and evaluate skin texture. Moreover, physical parameters of the skin, including erythema index, melanin index and transepidermal water loss (TEWL), were measured. Adverse effects were recorded and evaluated. Statistical analysis was carried out by paired t test, Wilcoxon paired rank test, Fisher′s exact test and repeated-measure analysis of variance. Results The ECCA score decreased from 51.24 ± 17.61 at the baseline to 34.46 ± 14.99 at 3 months after the treatment at the FFLT side(t = 7.886, P 0.05). Compared with those before the treatment, skin texture scores decreased in both sides (both P 0.05)from 2 weeks to 3 months after the treatment(all P > 0.05). Conclusion FFLT can improve therapeutic outcomes in atrophic acne scars with reduced adverse reactions.
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measured to compare the correlation between the changes of T lymphocyte subsets before and after operation and the change of platelet. Results Thirty-one patients were underwent laparoscopic splenectomy. The T lymphocyte subsets and CD3 + ,CD4 + and CD3 + / CD4 + in all patients showed an increase trend as the time prolonged after operation,and the differences were significant( F = 6. 91,3. 93,4. 18;P = 0. 023,0. 004,0. 011). While the ratio of CD3 + / CD8 + and CD3 + CD4 + / CD3 + CD8 + were decreased as time increased,and differences were statistically significant( F = 2. 59,3. 67;P = 0. 001,0. 002). They were related with platelet change after operation and correlation statistics analysis showed R values were 0. 332,0. 271,0. 345,- 0. 119,- 0. 164,and the P value were 0. 039,0. 021,0. 002,0. 017,0. 023. Conclusion ITP patients have the imbalance of T lymphocyte subsets,and splenectomy can improve the imbalance of T lymphocyte subsets in patients with ITP. T lymphocyte subsets may serve as a reference index to indicate the prognosis of the patients.
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In China, medical system reforms have made an obvious achievement in recent years .However, lots of urgent problems still exist.Doctors are not satisfied with their working environment.The high-pressure job with low remuneration reduces doctors'enthusiasm for work.Meanwhile, both the threat to personal safety and disrespect from patients bring negative effects to doctor's physical and mental health .The main factors causing this situation include the leaky health care system , the incomplete health -care legislation, the misleading reports and the poor medical knowledge of patients .Therefore, some countermeasures should be taken to solve problems mentioned above and the construction of medical ethics should be strengthened at the same time .
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BACKGROUND:To reduce the amount of bleeding and the amount of hemoglobin after total knee replacement has been a key project in the clinical research in the division of bone and joint. Currently, ice therapy has been widely used in the clinic for tissue sweling and pain due to various physical and chemical factors. OBJECTIVE:To investigate the risk factors of postoperative hemoglobin after total knee replacement and discuss the effects of ice intervention. METHODS: 240 patients with osteoarthritis based on the random draw principles were equaly divided into the treatment group and the control group. The general information, disease status, diagnosis and treatment and prognosis of the two groups were investigated. Al patients were actively subjected to artificial total knee replacement. On the basis of the treatment in the control group, the treatment group received ice intervention at 2 hours after replacement for 7 consecutive days. RESULTS AND CONCLUSION:The postoperative hemoglobin decrease occurred in 34 patients, with the incidence of 14.2% among 240 patients at 7 days after replacement. Multivariate logistic regression analysis results showed that age, no ice treatment, body mass index were the main risk factors for hemoglobin decrease after total knee replacement (P 0.05). Results verify that clinical application of total knee replacement facilitated the knee recovery in patients with osteoarthritis, but hemoglobin decrease and bleeding existed. Active ice intervention can reduce the risk and relieve postoperative pain.
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Objective To observe the clinical effect of headless compression Screw (HCS)under arthroscope in the treat-ment of patella fracture.Methods Nineteen patients of patella transverse fractures were selected,all of them were treated with HCS fixation under arthroscope,reviewed and followed-up after surgery.Results X-ray examination after surgery of 3 -5 weeks found that the fracture lines blurred or disappeared,and the patella articular surface was smooth without displacement.The healing time of fracture was 8 weeks on average after operation;There was no statistical difference in the range of the knee joint in the af-fected side in (135.42±5.82)°and the contralateral side in (139.38±6.55)°(P >0.05);The knee Lysholm score of the last follow-up was 86-100 points[(93.7±4.14)points],which was significantly higher than the preoperative score of 65.7 (P <0.05);There was no fracture displacement in the period of followed-up,drop of internal fixator,fracture and other complications.Conclusion HCS fixation under arthroscope in treatment of patella fracture is effective.The joint function recovered quickly with less complica-tion.It could be one of the effective methods for the treatment of patella transverse fracture.
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Objective To evaluate the efficacy of systemic glucocorticoids and intravenous immunoglobulin (IVIG)for the treatment of toxic epidermal necrolysis (TEN). Methods Clinical data on TEN inpatients treated with systemic glucocorticoids alone or in combination with IVIG were collected from the Department of Dermatology, First Affiliated Hospital of Nanjing Medical University from January 2006 to December 2012. Therapeutic outcomes were evaluated in these patients. Statistical analysis was carried out by using a multiple linear regression analysis, binary logistic regression analysis and Cox regression analysis with the SPSS 16.0 software. Results A total of 48 inpatients with TEN were included in this study. Multiple linear regression analysis showed that the maximum daily dose of glucocorticoids for disease control was decreased gradually over years (β=-0.461, P=0.004). However, binary logistic regression analysis revealed no obvious changes in the frequency of administration of IVIG over years. Cox regression analysis showed that both hospitalization duration (RR=0.351, 95.0%CI:0.150-0.825)and the time required for the control of skin lesions (RR=0.492, 95.0%CI:0.245-0.986)decreased with the increase in the frequency of IVIG administration. In addition, with the increase in the maximum daily dose of glucocorticoids for disease control, the time required for the control of skin lesions was also shortened (RR=0.997, 95.0%CI:0.994 -1.000), while no obvious changes were observed in hospitalization duration. Conclusions IVIG shows superiority in controlling lesions, reducing complications and improving the prognosis of TEN. Compared with systemic glucocorticoids, IVIG shows better therapeutic efficacy and less adverse effects, and may be preferentially selected.