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Allogeneic hematopoietic stem cell transplantation (allo-HSCT) could effectively treat multiple hematological diseases. At present, with persistent improvement of transplantation techniques and rapid development of economy, more and more patients with hematological diseases are able to survive for a long time due to allo-HSCT treatment. Chronic ocular graft-versus-host disease (coGVHD) is the most common ocular complication after allo-HSCT, which is primarily manifested with refractory dry eye. In severe cases, it may cause imbalance of ocular surface homeostasis and limbal stem cell insufficiency, further leading to a series of complications that threaten the visual function and eye health, such as corneal perforation and symblepharon, etc. It is highly difficult to cure these symptoms. At present, relevant studies of clinical manifestations, diagnostic criteria, treatment specification and pathogenesis of coGVHD have been gradually deepened within the international community. However, related research and the establishment of clinical specification are still in the primary stage in China. In this article, research progress on clinical characteristics and related mechanisms of coGVHD was reviewed, aiming to deepen the understanding of this disease by ophthalmologists, especially specialists in corneal and ocular surface diseases, and provide novel ideas for subsequent in-depth research.
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Objective To explore the significance of parathyroid hormone (PTH) measurement in drainage liquid after thyroid surgery,and to evaluate its relationship with parathyroid glands in situ.Methods Form Dec.2013 to Aug.2014,166 patients who underwent unilateral thyroidectomy were chosen as the research object.According to the number of parathyroid reserved in situ,patients were divided into group A0,group A1 and group A2.The levels of blood PTH and serum calcium were measured before and after operation,and postoperative PTH in drainage liquid was measured.Results The levels of postoperative blood PTH and serum calcium were lower than those before operation(P＜0.05).The difference of PTH level in drainage liquid in each group had statistical significance(P＜0.05).The level of drainage liquid PTH was highest in group A2,following group A1,and finally group A0.We found a positive correlation between the number of parathyroid glands protected in situ and the level of drainage liquid PTH.Conclusion Drainage liquid PTH measurement can be used to determine whether parathyroid gland is reserved in situ and its secretion function.
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Objective To study the risk factors of lymph node metastasis in the central neck compartment of thyroid carcinoma,and to explore the reasonable range of lymph node dissection in central neck dissection for clinically node-negative papillary thyroid microcarcinoma patients.Methods From Dec.2015 to Dec.2016,a total of 200 patients with CN0 papillary thyroid carcinoma were randomly divided into two groups according to the registration number:unilateral central neck dissection group and bilateral central neck dissection group in Department of Thyroid Surgery,Fujian Medical University Union Hospital.The risk factors of lymph node metastasis and value of bilateral central neck dissection were analyzed.Results The risk factors of lymph node metastasis in the central papillary thyroid carcinoma were ≥0.7 cm in diameter and older than 45 years in age and gender in male.Further analysis found that contralateral central lymph node metastasis occurred in patients with tumor diameter ≥0.5 cm.The positive rate was 22％.The number of lymph nodes detected in the unilateral and bilateral central areas was 9.53±6.04 and 12.19±7.18,P=0.035,respectively.The positive numbers of lymph nodes were 1.17±1.47 and 2.11±2.75,P=0,022 respectively.Conclusion In patients with tumor diameter ≥0.5 cm,bilateral central neck dissection is conducive to improving the thoroughness of tumor dissection and does not increase the risk of complications.
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<p><b>OBJECTIVE</b>To study application of needlescopic assisted hemithyroidectomy and central neck dissection using bilateral breast approach.</p><p><b>METHODS</b>Totally 145 cases of papillary thyroid cancer patients received endoscopic hemithyroidectomy in Fujian Medical University Union Hospital were randomized to needle assisted endoscopic group (NE group, n=81) and conventional endoscopic group (CE group, n=64). The average age of the patients was 35.9 years and 11 patients were male.All patients underwent hemithyroidectomy and central neck dissection through bilateral breast approach, the NE group additional used the MiniLap-assisted intraoperation.The operative time, postoperative complications and cosmetic results were analyzed by t-test and χ(2) test.</p><p><b>RESULTS</b>The operation time of thyroid gland in NE and CE Group was (42±7) min and (31±7) min(t=9.082, P=0.000), respectively. The operation time of central neck dissection was (33±6) min and (26±3) min (t=9.050, P=0.000), respectively.There were 4 cases occurs transient recurrent laryngeal nerve paralysis in CE group and no case occur in NE group(χ(2)=5.206, P=0.036). There was no significant different in other postoperative complications and cosmetic results.</p><p><b>CONCLUSIONS</b>Hemithyroidectomy and central neck dissection using bilateral breast approach and needlescopic assisted technique isa safe and reliable approach, with high cosmetic effect. Application needle assistive devices can shorten the operation time while no significant increase trauma in patients, it will makes endoscopic thyroid surgery easier to promote.</p>
Subject(s)
Adult , Female , Humans , Male , Breast , Carcinoma , General Surgery , Carcinoma, Papillary , Endoscopy , Neck Dissection , Needles , Operative Time , Postoperative Complications , Thyroid Neoplasms , General Surgery , Thyroidectomy , MethodsABSTRACT
Objective To assess clinical significance of the right side lymph node dissection behind recurrent laryngeal nerve (RLN) in papillary thyroid carcinoma (PTC).Methods Clinical data of 111 cases of PTC adimitted in our hospital (Department of Vascular and Thyroid Surgery,the Union Hospital of Fujian Medical University) from Feb.2013 to Mar.2014 were retrospectively analyzed.Central lymph node metastasis was analyzed.Univariate and multivariate analysis were made to analyze relations between the right side lymph node (Ⅵ b2) metastasis behind RLN and gender,age,tumor size,capsule infiltration and so on.Results Among 111 cases of PTC,71 had central lymph node metastasis (63.96％).Total metastasis number of the right side lymph node behind recurrent laryngeal nerve (Ⅵ b2) was 2.720±2.037,and the transfer rate was 27.03％ (30/111) (P＜0.05),all lower than those of Ⅵ bl.The one-way ANOVA results showed that metastasis of the right side lymph node behind RLN (Ⅵ b2) was related with age,lateral neck dissection,and Ⅵ b1 lymph node metastasis (P＜0.05) while Ⅵ bl lymph node metastasis was the only independent risk factor for metastasis of the right side lymph node behind RLN(Ⅵ b2) in PTC.Conclusion For patients with right PTC,the metastasis rate of Ⅵ b2 is high,thus dissection of this area is favorable and can accurately reflect lymph node metastasis and further to guide tumor staging and postoperative treatment.
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Objective To assess the clinical significance of reverse trendelenburg position in preventing postoperative nausea and vomiting(PONV)in thyroid surgery.Methods 110 patients with papillary thyroid carcinoma(PTC) admitted from Feb.2013 to Mar.2014 were prospectively divided into experimental group and the control group according to whether reserve trendelenburg position was adopted.Univariate and multivariate method were used to analyze relations between PONV and surgical position,gender,age,body mass index,hypertension,surgical time,ASA classification,anesthesia,and motion sickness.Results Of the 110 cases of PTC,the incidence of PONV was 16.28％ (7/43) in the experimental group while it was 37.31％ (25/67) in the control group.The difference had statistical significance(P ＜ 0.05).Statistical analysis showed that PONV was related to patients'gender,surgical position,surgical time,and motion sickness,while only surgical position and motion sickness was the independent risk factors.Conclusion Reverse trendelenburg position surgery can help to prevent PONV and promote recovery.
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Objective To evaluate the plasma level of miR-21 in hepatocellular carcinoma (HCC) patients and its clinical diagnostic significance .Methods Case-control study was used .The plasma level of miR-21 was measured by real-time quantitative PCR.The relative expressions of miR-21 were calculated. This study included 60 cases of patients with HCC , 71 patients with liver cirrhosis ( LC ) , 52 healthy volunteers ( HV) from January to June in 2014 in Henan Province People′s Hospital.The receiver operating characteristic ( ROC) curves were analyzed to determine the sensitivity and specificity of miR-21 expression levels in HCC diagnosis. Differences between groups were assessed by the t-test.Results Plasma microRNA-21 level in the 60 patients with hepatocellular carcinoma ( 2.6 ±1.1 ) was significantly higher than in patients with chronic hepatitis (1.6 ±0.9) and healthy volunteers (1.0 ±0.6) (t=5.322,P=0.004;t =8.349, P =0.000 3, respectively ) .Plasma microRNA-21 level in the HCC patients were positively correlated with tumor size and differentiation (tdif=3.366,P=0.019;tsize =3.490,P=0.012). ROC analysis of plasma microRNA-21 yielded an AUC of 0.796 with 70.0% sensitivity and 65.3%specificity when differentiating hepatocellular carcinoma from chronic hepatitis , and an AUC of 0.934 with 89.5% sensitivity and 81.8% specificity when differentiating hepatocellular carcinoma from healthy volunteers.Conclusion The plasma level of miR-21 in HCC patients has high specificity , and maybe help to diagnose of HCC.
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Objective To investigate the expression of cyclooxygenase-2(COX-2)in breast cancer tissues,as well as the relationship between COX-2 and the clinicopathological features.Method The expression of COX-2 was detected in 60 cases of breast cancer tissues and 20 cases of breast normal tissues by using immunohistochemistry,and combined with clinicopathological information for analysis.Results The COX-2 expression rate was 65.0%(39/60)in breast cancer tissues and 10.0%(2/20)in breast normal tissues respectively.There was statistic difference between the two(P<0.01).The over expression of COX-2 was significantly correlated with TNM stages,lymphatic metastasis and the expression of epidermal growuth factor receptor-2(C-erbB-2)(P<0.05 or<0.01).Conclusion The expression of COX-2 in breast cancer tissues is significantly higher,which might play a fairly important role in tumorigenesis and progression of breast cancer.
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Purpose To observe the histopathologic changes of acquired immure deficiency syndrome (AIDS) in a Chinese Rhesus monkeys model and the pathogenesis that initiated the changes.Methods Chinese Rhesus monkeys were sacrificed after being inoculated SIVmac239 by Ⅳ(n=2)for four months.Autopsy was carried out by pathologic routine method.The lymph nodes, heart, liver, spleen, lung, kidney, digestive tract and other tissues were selected, the tissues fixed with 10% neutral formalin, and the pathologic sections were prepared by HE staining and immunohistochemical staining and special staining after paraffin imbedding.Results The main histopathological changes appeared in the immune system in different organs. The lymph nodes began to display the complex changes in a short period of time infected by the virus, including proliferation of lymphoid follicles, atrophy, or both; some lymphoid follicles of lymph nodes had few lymphocytes, with fibrous hyperplasia and immune complex (IC) deposition, displaying a burning down phenomenon.Splenomegaly and blood vessel and its endothelial cell proliferation in splenic corpuscles were noted with the immune complex deposition. Other parts of the mucosa-associated lymphoid tissue had different degrees of hyperplasia, or atrophy.Conclusion Histopathologic changes in Chinese Rhesus monkeys infected by SIVmac239 strain are very similar to human AIDS, which suggests that the model is a useful tool for the prevention and treatment study of AIDS.
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ObjectiveTo explore the relationship between chronic kidney disease (CKD) and cerebral small vessel disease (SVD) in elderly patients. MethodsOne hundred and fifty-two elderly male CKD patients for experimental group and 158 elderly male for control group were recruited. Demographic data and vascular risk factors were recorded. White matter lesion (WML) was semi-quantitatively assessed by cerebral magnetic resonance imaging (MRI), and lacunar infarction (LI) was also calculated. Results(1) The prevalenees of hypertentsion and diabetes mellitus were higher in elderly CKD patients than those in control group (30. 9% vs. 19.0%, 23.7%vs. 14.6%;both P～0. 05). (2) The percentages of grade 2 and grade 3 WMLs were higher in elderly CKD patients than those in control group (34.9% vs. 24.1%, 25.7% vs. 16.5%;both P<0.05). Prevalence of LI was higher in elderly CKD patients than that in control group (45.4% vs.25.3% ,X2= 13. 70, P<0. 05). The similar Resultswere also obtained except for control subjects with hypertension and diabetes mellitus. (3) The logistic regression analysis showed that age, hypertension and low glomerular filtration rate (GFR) were closely associated with SVD in elderly CKD patients. ConclusionsHypertention and diabetes mellitus are risk factors for CKD in elderly patients. SVD is associated with CKD, and age, hypertension and low GFR may be risk factors for SVD in elderly CKD patients.
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Cycloxygenase-2 plays an important role in many human tumorigenesis, and is overexpressod in breast cancer. Therefore, it is necessary to investigate the relationship between COX-2 and breast cancer, and to develop the desirable COX-2 inhibitor. These can privide a new antitumor method.
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Objective To investigate the clinical feature of POEMS syndrome,and raise the level of diagnosis and treat- ment.Methods The clinical data of 2 cases of POEMS syndrome were analyzed and relevant literature were reviewed. Results The clinical manifestation of 2 cases included splenohepatomegalia,splanchnocoel hydrops,endocrine func- tional disorder,nigrescence on face,protein of CSF and IgA and immunoglobulin light chain of serum increasing.The symptoms of 2 patients improved after treatment with hormone and L-Sarcolysinum.Conclusion POEMS syndrome is a rare and complicated disease that can be misdiagnosed.Follow up associated with immunology,endocrine and bone marrow aspiration examination should be carried in time on the patients suspected with POEMS syndrome,which is valu- able to the diagnosis and reducing misdiagnosis and mistreatment.
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Cerebrovascular Intervention is to study the subject of diagnosing and treating cerebrovascular disease with interventional endovascular techniques monitored and guided by neuroimaging. With the continuous development of computer, imaging and angiography techniques, their study method and category are being innovated and expanded continuously in recent years. This article reviews the novel techniques of imaging diagnosis, intra-arterial thrombolysis, angioplasty and endovascular embolization in cerebrovascular diseases, and also evaluates their clinical applications.
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Lipid abnormality is a major risk factor of atherosclerosis and coronary heart disease.Pharmacological agents used to manage lipid abnormalities have been rapidly developed in recent years.Many new drugs have shown significant effects in the regulation of lipid abnormalities.Eight groups of drugs used to regulate lipid abnormalities were outlined in this paper,and the current recommendation for regulation of lipid abnormalities with some new drugs were discussed in details.
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ObjectiveTo investigate clinical features,diagnosis and treatment of hyperlipidemic severe acute pancreatitis(HSAP) in late pregnancy. MethodsA retrospective analysis was made on 12 HSAP cases. ResultsHSAP accounting for 20%(12/60) of severe acute pancreatitis (SAP) cases, develops during the period of 28~36 weeks of pregnancy. There were 5 cases in SAP type Ⅰand 7 cases in SAP type Ⅱ. Multiple organ dysfunction syndrome (MODS) was complicated in 4 cases. HSAP is featured with severe hypertriglyceridemia (29?14)mmol/L, significant systemic inflammatory response syndrome (SIRS), large amount of lipidemic bloody ascites. All cases underwent successful. Cesarean section followed by pancreatic operation and were cured. ConclusionHSAP in late pregnancy is a specific type of SAP with fulminant clinical course leading to fetal distress. Effective management of pregnant hypertriglyceridemia helps to prevent HSAP.