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Information technology has become an important driver to facilitate higher education developments in the context of new medical sciences. A new “virtual-real combination” experimental teaching model was designed and created through integrating information technology with experimental teaching by Experimental Teaching Center of Basic Medical Sciences and Department of Pathogen Biology, Nanjing Medical University and was applied in Human Parasitology teaching, which achieved satisfactory teaching effectiveness. This new model showed effective to deepen the understanding of the basic human parasitology knowledge, improve the operative skills, and cultivate the moral literacy and comprehensive capability among medical students. This report presents the teaching protocols and implementation, teaching effectiveness and evaluation, and experiences of comprehensive schistosome experiments.
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Objective:To explore the effects of tigacycline-based combination therapy on procalcitonin (PCT), high sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) in patients with multiple drug-resistant acinetobacterbaumannii post-operative abdominal infection in intensive care unit (ICU).Methods:Seventy-five patients with multiple drug-resistant acinetobacter baumannii post-operative abdominal infection in ICU admitted to West Central Hospital of Hainan Prorvincefrom October 2015 to October 2018 were selected and divided into the control group (37cases) and the observation group (38 cases) according to random number table method. The control group was treated with cefoperazone-sulbactam on the basis of routine treatment, while the observation group was treated with tegacycline on the basis of the control group. Both groups were treated for 1 week. The clearance of acinetobacterbaumannii and clinical efficacy of the two groups were counted; the levels of serum PCT, hs-CRP and IL-6 and ummune function were compared.Results:The clearance rate of acinetobacterbaumannii in the observation group was significantly higher than that in the control group: 76.32%(29/38) vs. 54.05%(20/37), χ2 = 4.10, P = 0.043. Compared with before treatment, the levels of serum PCT, hs-CRP and IL-6 in the two groups were decreased after 1 week of treatment, and the levels of serum PCT, hs-CRP and IL-6 in the observation group were lower than those in the control group ( P<0.05). Compared with before treatment, the levels of peripheral blood CD 3+, CD 4+, CD 4+/CD 8+ were increased and peripheral blood CD 8+ was decreased in both groups, and the levels of peripheral blood CD 3+, CD 4+, CD 4+/CD 8+ in the observation group were higher than those in the control group ( P<0.05), while the level of peripheral blood CD 8+ in the observation group was lower than that in the control group ( P<0.05). The total effective rate in the observation group was significantly higher than that in the control group: 89.47% (34/38) vs. 67.57% (25/37), χ2 = 4.13, P<0.05. Conclusions:Tigacycline combined with cefoperazone-sulbactam in the treatment of intra-abdominal infection after surgery of acinetobacterbaumannii in ICU could reduce the levels of serum PCT, hs-CRP, IL-6, reduce the body′s inflammatory response and improve the immune function, and improve the treatment efficiency of intra-abdominal infection.
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Objective:To explore the effect of postoperative delirium risk management in elderly patients with hip fragility fracture based on failure mode and effect analysis (FMEA) theory, and to provide a basis for reducing the incidence of postoperative delirium.Methods:A total of 50 patients admitted to the First Affiliated Hospital of Sun Yat-sen University due to hip fragility fractures from January to December 2019 were selected as the control group, and 50 patients admitted to the First Affiliated Hospital of Sun Yat-sen University for hip fragility fractures from January to December 2020 were selected as the observation group. The control group received routine care, and the observation group implemented risk control intervention measures based on FMEA theory on the basis of the control group. The risk priority number (RPN) value, incidence of delirium, duration of delirium, pain score, satisfaction, and average length of hospital stay were compared between the two groups of patients in each link of failure risk.Results:The RPN values of each link failure risk of the observation group were 100.80 ± 13.39, 103.96 ± 9.96, 103.76 ± 8.04, delirium duration was (36.33 ± 9.07) min, pain scores were 1.86 ± 0.76, 4.16 ± 1.17, average length of stay was (8.98 ± 4.64) days, and incidence of delirium was 6.0% (3/50), the RPN values of each link failure risk of the control group were 274.10 ± 8.48, 291.00 ± 10.10, 287.78 ± 11.64, delirium duration (78.70 ± 20.10) min, pain scores 2.26 ± 1.02, 4.74 ± 1.19, average length of stay was (11.50 ± 7.66) days, and incidence of delirium was 22.0% (11/50). The differences between two groups showed significant differences ( t values were 1.99-93.24, χ2=4.07, P<0.05). The patient satisfaction score of the observation group was 99.36 ± 1.01, which was higher than that of the control group 89.63 ± 2.62, and the difference was statistically significant ( t=24.50, P<0.05). Conclusions:The perioperative implementation of postoperative delirium risk management model based on FMEA theory in elderly patients with hip fractures can reduce the incidence of postoperative delirium, relieve pain, shorten hospital stay, and improve satisfaction degree. It is worthy of clinical promotion.
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Objective To identify the influence factors and construct a predicted model for liver, lung, bone, or brain metastasis among patients with left or right colorectal cancer. Methods Patients with colorectal cancer with information on liver, lung, bone, and brain metastasis were retrospectively filtered and analyzed from 2010 to 2018 from the SEER database. These patients were divided into three groups based on their primary tumor location. Multivariate logistic regression analysis was conducted to identify the influence factors on metastasis. A nomogram that could predict metastasis was established and further validated by the AUC of ROC curves. Results A total of 49335 eligible patients were chosen from the SEER database. N stage and CEA were identified as risk factors for all metastases, which were unrelated to primary tumor location. By contrast, race had varying effects on liver metastasis between different groups (P < 0.05). The nomogram model predicting liver metastasis was successfully established, and the AUCs based on the three groups were 0.821 (95%CI: 0.813-0.830), 0.841 (95%CI: 0.833-0.848), and 0.796 (95%CI: 0.782-0.811), respectively. Conclusion The influence factors and predictive models on liver metastasis were different in patients with colorectal cancer and different primary tumor locations.
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Objective:To investigate the results of the superficial circumflex iliac artery(SCIA)-based conjoined flap for covering extremely large lower limb defects.Methods:From February 2017 to June 2019, 15 patients were admitted, who suffered from severe degloved injury for the lower limb, including 9 males and 6 females with a median year of 45 (ranged, 36-67 ) years old. All were taken thorough and radical debridement and covered by the VSD device during the emergency operation. The dimension of defects was ranged from 25.0 cm ×8.0 cm to 50.0 cm ×15.0 cm. Using the lower abdominal wall or side chest wall as the donor site, the conjoined flap was dissected when the wound surface became granulating. The perforator match fashions included bilateral SCIA, and ipsilateral SCIA and thoracodorsal artery(TA). The donor sites were primary closure. The follow-up was accomplished by the same surgeon.Results:Fourteen flaps survived completely without significant complications, and distal necrosis was observed in one longitudinal flap, which was healed with the skin graft in the second stage. All flaps were available for a mean follow-up of 18 (ranged 16-24) months. The aesthetic outcomes were achieved on the recipient site without hairy appearance and hyper-pigmentation. A concealed line scare was left on the donor site, without the hernia and limited function. At the last follow-up, 7 cases were excellent and 1 case was good, evaluated with the LEFS criteria. And 6 cases were excellent and 1 case was good, assessed by the AOFAS criteria.Conclusion:The simultaneous reconstruction of extreme lower limb defects and better salvage treatment could be achieved by the SCIA-based conjoined flap. And as a versatile flap, it was blessed with concealed donor site, various design fashions, and larger dissection size in selected cases.
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Objective:To understand the iodine nutritional status and the prevalence of goiter and thyroid nodules among children in Suqian City, and to provide a basis for prevention and treatment of iodine deficiency disorders.Methods:From May 2019 to July 2020, the counties (districts) in Suqian City were divided into 5 areas according to east, west, south, north, and middle, each area selected 1 township (street) every year, and 40 non-boarding students aged 8 - 10 years were selected (balanced age and gender) from 1 primary school from each township (street). Children's urine samples and household salt samples were collected to detect urinary iodine and salt iodine contents, and some children were subjected to thyroid examination and height and weight measurements.Results:A total of 1 999 urine samples were collected from children aged 8 to 10 years, and the median urinary iodine was 221.0 μg/L. There was a statistically significant difference among different counties (districts, H = 147.89, P < 0.05). A total of 1 999 edible salt samples were collected from children's homes, and the salt iodine content was (24.01 ± 4.55) mg/kg. Among them, iodized salts was 1 979, the coverage rate of iodized salt was 99.00%; the qualified iodized salts was 1 910, and the iodized salt qualified rate was 96.51%, and the consumption rate of qualified iodized salt was 95.55%. A total of 1 000 cases of children's thyroid were examined, and 22 cases of goiter, 51 cases of solid thyroid nodules, and 54 cases of thyroid cyst were detected, and the detection rates were 2.20%, 5.10%, and 5.40%, respectively. There were significant differences in the detection rates of solid nodules and cysts beteen different counties (districts, χ 2 = 16.41, 37.66 , P < 0.05), but there was no significant difference in the detection rates of goiter (χ 2 = 8.65 , P > 0.05). According to Spearman correlation analysis, children's thyroid volume was positively correlated with height and weight ( r = 0.403, 0.315, P < 0.05). Conclusions:The iodine nutrition of children in Suqian City is at an excessively suitable level of iodine, and the salt iodine monitoring indicators meet the national iodine deficiency disorders elimination standards (the coverage rate of iodized salt ≥ 95%, and the consumption rate of qualified iodized salt > 90%). The children's thyroid volume is affected by factors such as height and weight.
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Objective:To learn about the iodine nutritional status of pregnant women in Suqian City, Jiangsu Province, and to provide evidence for scientific supplementation of iodine of pregnant women.Methods:From May 2016 to July 2020, five sampling districts were divided in each county (district) of Suqian City according to the oriation of east, west, south, north and center each year. One township (street) was selected from each district, and 20 pregnant women who lived in the local area for more than half a year were selected from each township (street). The 30 g of household salt samples of pregnant women and 5 ml of urine samples at random once were collected to test the salt iodine and urinary iodine content.Results:A total of 2 483 household salt samples of pregnant women were tested, and the median salt iodine was 23.9 mg/kg; among them, 2 454 were iodized salt, and the coverage rate of iodized salt was 98.8%; the qualified iodized salt was 2 383, the qualified rate of iodized salt was 97.1%, and the consumption rate of qualified iodized salt was 96.0%. There were statistically significant differences in coverage rate of iodized salt, qualified rate of iodized salt and consumption rate of qualified iodized salt between different years (χ 2 = 10.55, 13.23, 11.37, P < 0.05). A total of 2 483 urine samples of pregnant women were tested, and the median urinary iodine was 167.6 μg/L, which was at the appropriate iodine level. However, the median urinary iodine of pregnant women in 2020 was 146.7 μg/L, lower than the WHO/UNICEF/ICCIDD recommendation standard (150 μg/L). The differences of median urinary iodine of pregnant women in different years, pregnancy periods and regions were statistically significant ( H = 26.08, 8.17, 19.87, P < 0.05). Conclusions:The coverage rate of iodized salt, qualified rate of iodized salt and consumption rate of qualified iodized salt in Suqian City , meet the national standard for eliminating iodine deficiency disorders. Iodine nutrition of pregnant women in Suqian City is at an appropriate iodine level, but some pregnant women may have iodine deficiency.
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Objective:To investigate the effect of using the free medial planar artery flap(MPAF) pedicled by the superficial branch of the medial plantar artery in repair of pulp defect of thumb and finger.Methods:Ten patients with pulp defect of thumb and finger were repaired with MPAF of foot in the Department of Hand Surgery of the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University from November 2020 to January 2022. There were 3 cases of cutting injury, 2 cases of chainsaw injury, 2 cases of extrusion injury and 3 cases of avulsion injury. Digits injuried: 4 index fingers, 3 thumbs, 2 middle fingers, and 1 ring finger. After admission, Doppler ultrasound was performed to understand the running course of medial plantar artery. Emergency surgeries were performed to repair the pulp defects of thumb and finger with free MPAF, and donor sites were repaired by skin grafting. The area of soft tissue defects was 2.0 cm×2.5 cm-3.0 cm×4.5 cm, and the size of flap was 2.5 cm×3.0 cm-3.5 cm×5.0 cm after debridement. Postoperative effect was assessed over the follow-up at outpatient clinics by same group of surgeons. Functional recovery was evaluated according to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association.Results:All 10 free MPAFs pedicled by the superficial branch of medial plantar artery survived. After the transfer, the colour, texture and thickness of the flaps were matched with the digit with pulps realistic appearance. Secondary flap thinning surgery was not required. Two cases had blisters at the distal end of the flap, and healed after fluid extraction and dressing change. All patients had 3 to 18 months of follow-up. The TPD of the flap was 4-7 mm. The skin grafts in the donor sites survived well. At the last follow-up, the upper limb function was evaluated according to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, with the results of 8 cases in excellent and 2 in good.Conclusion:Free MPAF pedicled by the superficial branch of medial plantar artery can repair the pulp defect of thumb and finger with reliable blood supply, excellent texture and good appearance. And there is no damage to the main vessels in the donor site.
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Objective@#This study aimed to investigate the impact of polycystic ovary syndrome (PCOS) on fertility-sparing treatment in young patients with atypical endometrial hyperplasia (AEH) or endometrioid endometrial cancer (EEC). @*Methods@#A total of 285 patients with EEC (n=76, FIGO stage IA, without myometrium invasion) or AEH (n=209) who received progestin-based fertility-sparing treatment were evaluated retrospectively. Among the 285 patients, 103 (36.1%), including 70 AEH cases and 33 EEC cases, were diagnosed with PCOS. General characteristics, cumulative 16- and 32-week complete response (CR) rate, pregnancy outcome and recurrence were compared between patients with or without PCOS. @*Results@#The cumulative 16-week CR rate was lower in the PCOS group than in the non-PCOS group (18.4% vs. 33.8%, p=0.006). Patients with PCOS took longer treatment duration to achieve CR (7.0 months vs. 5.4 months, p=0.006) and shorter time to relapse after CR (9.6 months vs. 17.6 months, p=0.040) compared with non-PCOS group. After adjusting for patient age, body mass index, PCOS, homeostasis model assessment-insulin resistance index, and serum testosterone levels, we found that body mass index ≥25 kg/m2 (HR=0.583; 95% CI=0.365–0.932; p=0.024) and PCOS (HR=0.545; 95% CI=0.324–0.917; p=0.022) were significantly correlated with lower 16-week CR rate. @*Conclusion@#PCOS was associated with lower 16-week CR rate, longer treatment duration and shorter recurrence interval in patients with AEH or EEC receiving fertility-preserving treatment.
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Objective@#This study investigated the characteristics of progestin-insensitive endometrioid endometrial cancer (EEC) and atypical endometrial hyperplasia (AEH) patients receiving fertility-sparing treatments and assessed the therapeutic effects of second-line fertility-preserving treatments. @*Methods@#Three hundred and thirty-eight patients with EEC (n=75) or AEH (n=263) receiving fertility-preserving treatment were retrospectively analyzed. ‘Progestin-insensitive’ was defined as meeting one of the following criteria: 1) presented with progressed disease at any time during conservative treatment, 2) remained with stable disease after 7 months of treatment, and/or 3) did not achieve complete response (CR) after 10 months of treatment. Clinical characteristics and treatment results of progestin-insensitive patients receiving second-line treatment and those of progestin-sensitive patients were compared. @*Results@#Eight-two patients (59 AEH and 23 EEC) were defined as progestin-insensitive and 256 as progestin-sensitive. In multivariate analysis, body mass index ≥28.0 kg/m2 (odds ratio [OR]=1.898) and lesion size >2 cm (OR=2.077) were independent predictors of progestin-insensitive status. Compared to AEH patients, progestin-insensitive EEC patients had poorer second-line treatment responses (28-week cumulative CR rate after changing second-line treatment, 56.3% vs. 85.4%, p=0.011). No statistical difference was found in CR rate among different second-line treatments. @*Conclusion@#Obesity and larger lesion size were independent risk factors associated with progestin-insensitive status. In progestin-insensitive patients receiving second-line treatment, EEC patients had lower CR rate comparing with AEH patients. Further study with larger sample size is needed to evaluate efficacy of different second-line treatments for progestin insensitive patients.
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The presence of tension blister often predicts severe soft tissue damage，which not only increases the risk of wound complications but also prolongs the surgical treatment time. However，the developed tension blister has been proposed as a potential decompressive approach for it may relieve the pressure of osteofascial compartment and improve the likelihood of relieving clinical symptoms，as well as avoid unnecessary surgery in cases of suspected osteofascial compartment syndrome. Recently，the osteofascial system has been increasingly recognized that associations were found between the tension blister and osteofascial self-release processing. Thus，the timing of blister occurrence and regression substantially influences physicians′ clinical decisions，making blister management as part of the treatment of fractures. In this review，the authors give an overview of the characteristics，mechanism，stress reduction effect，prevention，current treatment status and complications of the fracture-related tension blister，hoping to help orthopedic physicians understand and treat the tensile blister.
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Objective:To investigate the effects of periodontal tissue regeneration combined with orthodontics on periodontitis.Methods:Eighty-six patients with periodontitis who received treatment in the Yongkang First People's Hospital, China between January 2017 and December 2018 were included in this study. They were randomly assigned to receive either periodontal tissue regeneration (control group, n = 43) or periodontal tissue regeneration combined with orthodontics (observation group, n = 43). Periodontal function, clinical efficacy, complications and patient satisfaction were compared between the control and study groups. Results:Before treatment, there were no significant differences in plaque index, gingival bleeding index, probing depth, bleeding on probing and attachment loss between the control and study groups (all P > 0.05). After treatment, plaque index, gingival bleeding index, probing depth, bleeding on probing and attachment loss in the observation group were (0.85 ± 0.27) points, (0.64 ± 0.25) points, (2.25 ± 0.24) mm, (34.30 ± 0.48)% and (3.70 ± 0.55) mm, respectively, and they were (1.36 ± 0.30) points, (1.24 ± 0.53) points, (3.49 ± 0.38) mm, (57.88 ± 0.75) %, and (4.61 ± 0.92) mm, respectively. There were significant differences in these indexes between the observation and control groups ( t = 8.286, 6.714, 18.092, 173.648, 5.567, all P < 0.05). Total effective rate in the observation group was significantly higher than that in the control group [95.35% (41/43) vs. 79.07% (34/41), χ2 = 5.108, P < 0.05). Total effective rate in the observation group was significantly lower than that in the control group [2.33% (1/43) vs. 16.28% (7/43), χ2 = 4.962, P < 0.05]. Patient satisfaction in the observation group was significantly higher than that in the control group [(91.17 ± 3.52) points vs. (84.43 ± 2.50) points, t = 10.237, P < 0.05]. Conclusion:Periodontal tissue regeneration combined with orthodontics on periodontitis for treatment of periodontitis is highly safe and effective. It can promote the recovery of oral function and increase patient satisfaction.
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Objective:To explore the effects of nursing intervention with pregnant body mass management combined with role -based health education on stage of labor, pelvic floor function recovery, psychological status changes, maternal and neonatal outcomes in primiparas. Methods:From March 2019 on, pregnant body mass management combined with role -based health education nursing was implemented in the hospital. On basis of the theory, nursing regimens of pregnant body mass management combined with role-based health education we formulated. During the period from August 2018 to February 2019, 120 primiparas who underwent delivery in the hospital were randomly enrolled as control group. During the period from August 2019 to February 2020, 120 primiparas were randomly enrolled as observation group. The duration of labor stages, postpartum pelvic muscle strength, scores of Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA), and delivery outcomes were compared between the two groups. Results:After nursing, the cesarean section rate was 20.83% (25/120) in observation group and 32.50% (39/120) in control group, there was significant difference between the two groups ( χ 2 value was 4.176, P<0.05). The spending time of ending the first, second and third stage of labor was (517.27±8.95), (48.33±5.62), (10.26±1.63) min in observation group and (537.31±7.92), (57.29±5.58), (18.28±1.61) min in control group, there was significant difference between the two groups ( t values were 18.369, 12.393, 38.347, P<0.001). After nursing, normal rate of pelvic floor muscle strength was 68.33% (82/120) in observation group and 54.17% (65/120) in control group, there was significant difference between the two groups ( χ 2 value was 5.074, P<0.05). After nursing, scores of HAMD and HAMA were (4.43±1.02), (5.56±0.87) points in observation group and (6.09±1.15), (6.88±0.93) points in control group, there was significant difference between the two groups ( t values were 11.830, 11.354, P<0.05). After nursing, adverse outcome rates of primiparas and neonates were 3.33% (4/120) and 5.83% (7/120) in observation group, and 10.00% (12/120), 15.83% (19/120) in control group, there was significant difference between the two groups ( χ 2 values were 4.286, 6.211, P<0.05). Conclusions:Pregnant body mass management combined with role-based health education nursing is conducive to shortening labor stages of primiparas, improving postpartum pelvic floor muscle strength and adverse emotions, and thus reducing the occurrence of maternal and neonatal adverse outcomes.
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Objective:To explore the value of synthetic MRI in quantitative monitoring of knee joint structural and cartilage changes of amateur marathon runners before and after the whole marathon.Methods:Totally 26 amateur marathon enthusiasts from Zhuhai City, Guangdong Province were recruited from October 2019 to January 2020. The right knee joints were scanned 1 week before the race and within 48 h after the race. The scanning sequence included the three-dimensional proton density weighted image with isotropic (3D-CUBE-PD) sequence and synthetic MRI sequence. The conventional contrast weighted images T 1WI, T 2WI, proton density (PD) weighted imaging, short-T 1 inversion recovery (STIR) and T 1, T 2, PD mapping were obtained by the latter scans. The 3D-CUBE-PD sequence was used as a reference to evaluate the detection of knee joint lesions. The knee articular cartilage was divided into 8 subregions: central medial femoral condyle (CMFC), posterior medial femoral condyle (PMFC), central lateral femoral condyle (CLFC), posterior lateral femoral condyle (PLFC), medial tibia plateau (MTP), lateral tibia plateau (LTP), patella and trochlear. Based on the synthetic MRI quantitative mapping, the T 1, T 2 and PD values of each cartilage subregion were measured independently by 2 radiologists. The ICC was used to evaluate the consistency of the measurement between observers. The T 1, T 2 and PD values of knee cartilage before and after marathon exercise were compared by Wilcoxon signed rank test. Results:The 2 radiologists had good consistency in the measurement of T 1, T 2 and PD values of knee articular cartilage with the ICC values of 0.912, 0.933 and 0.954, respectively. The synthetic MRI quantitative mapping sequence can detect all cartilage damage ( n=3) and joint effusion ( n=15), and 7 of 9 meniscus injuries were detected. The T 1, T 2 and PD values of the knee cartilage as a whole before the race were higher than those after race, and the differences were statistically significant (all P<0.05). The T 1 values were statistically significant except patellar cartilage and trochlear cartilage, and T 2 values were significantly different in the CMFC, LTP, MTP ( P<0.05). Conclusion:Synthetic MRI has a good display of knee joint structural lesions, and its quantitative parameters T 1, T 2 and PD can detect the changes of knee cartilage before and after marathon.
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Objective@#To evaluate the long-term ef efficacy and safety of topical 1% atropine for retarding pregressive myopia.@*Methods@#A randomized controlled study evaluating atropine and placebo in 570 Chinese children aged 8~14 years recruited from pediatric ophthalmology in Yunnan Provincial the Second People s Hospital during Jan. 2015 to Dec. 2019. In experimental group, patients received drops every two weeks for 24 months, then every three weeks for 12 months, followed by no drops for 12 months. In control group, all children wear single focus frame glasses. Spherical equivalent, axial length, intraocular pressure and atropinerelated side effects were examined at 6, 12, 24, 36 and 48 months for all children.@*Results@#At the end of stage Ⅰ, the myopia progression in the atropine treatment group (-0.27±0.81)D was significantly lower than that in the control group (-1.29±0.13)D, and the increase of axial length in the atropine group (0.11±0.13)mm was also significantly lower than that in the control group (0.41±0.19)mm (P<0.05). At the end of stage Ⅱ, the average myopia progression in the atropine treatment group (-0.31±0.28)D was significantly lower than that in the control group (-0.80±0.66)D (P<0.01). Similarly, the axial growth of the experimental group (0.14±0.09)mm was significantly lower than that of the control group (0.39±0.14)mm (P<0.01). After the withdrawal of atropine eye drops (stage Ⅲ), there was no significant refractive regression in the experimental group. During the whole follow-up period, no serious adverse events related to atropine were found.@*Conclusion@#Local intermittent use of 1% atropine eye drops and the gradual reduction of atropine eye drops can ensure the effectiveness in the treatment of myopia, reducing the side effects of atropine, avoiding refractive regression after drug withdrawal, and improving children s compliance at the same time.
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Objective:To explore the clinical effects of general anesthesia of sevoflurane inhalation in abdominal surgery for patients with mild-to-moderate chronic obstructive pulmonary disease (COPD).Methods:The clinical data of 68 patients with COPD abdominal surgery who admitted to the Department of Anesthesiology of Yiwu Central Hospital from June 2016 to June 2018 were retrospectively analyzed.According to the ratio of forced expiratory volume in 1 second in predicted value (FEV 1%pre), the patients were divided into mild group (FEV 1%pre≥80%, n=39) and moderate group (80%>FEV 1%pre≥50%, n=29). The blood gas indicators[arterial partial pressure of oxygen (PaO 2), arterial partial pressure of blood carbon dioxide (PaCO 2), blood oxygen saturation (SaO 2)], vital signs[heart rate (HR), mean arterial pressure (MAP)] and systemic vascular resistance (SVR) were compared between the two groups after entering (T0), after completion of induction (T1), at abdominal exploration (T2), before the end of surgery (T3) and after extubation (T4). The recovery quality indicators were analyzed in the two groups. Results:In the mild group at T1, T2 and T3, the PaO 2 values were (301.6±76.2)mmHg, (292.6±73.4)mmHg, (112.8±34.1)mmHg, respectively, and the SaO 2 values were (99.1±0.8)%, (98.8±1.0)%, (94.5±2.2)%, respectively, all of which were significantly improved compared with those at T0 ( t=23.51, 22.73, 12.34, 2.75, 2.93, 2.22, all P<0.05), while the PaCO 2 values were (40.5±9.3)mmHg, (40.2±9.1)mmHg, (43.7±7.9)mmHg, respectively, which were significantly decreased compared with those at T0 ( t=0.98, 1.12, 0.84, all P<0.05). The moderate group showed the same trend as the mild group, but there were no statistically significant differences between the two groups (all P>0.05). At T4, the PaO 2, PaCO 2 and SaO 2 levels in the two groups showed no significant changes compared with those at T0, and there was no statistically significant difference between the two groups at the same time (all P>0.05). At T1 and T2, the MAP levels in the mild group were (75.5±11.0)mmHg, (80.7±11.9)mmHg, respectively, the HR values were (71.4±12.5)times/min, (74.2±13.6)times/min, respectively, the SVR values were (9.1±1.6)×10 2 dynesos -1ocm -5, (9.9±2.0) ×10 2 dynesos -1ocm -5, which were significantly lower than those at T0 ( t=1.35, 0.95, 1.83, 0.64, 1.42, 0.27, all P<0.05). The moderate group showed the same trend as the mild group, but there were no statistically significant differences between the two groups (all P>0.05). At T3 and T4, there were no significant changes in levels of MAP, HR and SVR between the two groups compared with those at T0, and there were no significant significant differences between the two groups (all P>0.05). The spontaneous breathing time, duration of eye opening, time of fist, time of removing tracheal catheter and time of returning to the ward in the mild group were slightly shorter than those in the moderate group (all P>0.05). Conclusion:When general anesthesia of sevoflurane inhalation is used in abdominal surgery of COPD patients, the trend of blood gas indicators is not affected by COPD, which can provide reference for clinical establishment of anesthesia regimens.
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Background@#In China, secondary cytoreductive surgery (SCR) has been widely used in ovarian cancer (OC) over the past two decades. Although Gynecologic Oncology Group-0213 trial did not show its overall survival benefit in first relapsed patients, the questions on patient selection and effect of subsequent targeting therapy are still open. The preliminary data from our pre-SOC1 phase II study showed that selected patients with second relapse who never received SCR at recurrence may still benefit from surgery. Moreover, poly(ADP-ribose) polymerase inhibitors (PARPi) maintenance now has been a standard care for platinum sensitive relapsed OC. To our knowledge, no published or ongoing trial is trying to answer the question if patient can benefit from a potentially complete resection combined with PARPi maintenance in OC patients with secondary recurrence. @*Methods@#SOC-3 is a multi-center, open, randomized, controlled, phase II trial of SCR followed by chemotherapy and niraparib maintenance vs chemotherapy and niraparib maintenance in patients with platinum-sensitive second relapsed OC who never received SCR at recurrence. To guarantee surgical quality, if the sites had no experience of participating in any OC-related surgical trials, the number of recurrent lesions evaluated by central-reviewed positron emission tomography–computed tomography image shouldn't be more than 3. Eligible patients are randomly assigned in a 1:1 ratio to receive either SCR followed by 6 cyclesof platinum-based chemotherapy and niraparib maintenance or 6 cycles of platinum-based chemotherapy and niraparib maintenance alone. Patients who undergo at least 4 cycles of chemotherapy and must be, in the opinion of the investigator, without disease progression, will be assigned niraparib maintenance. Major inclusion criteria are secondary relapsed OC with a platinum-free interval of no less than 6 months and a possibly complete resection. Major exclusion criteria are borderline tumors and non-epithelial ovarian malignancies, received debulking surgery at recurrence and impossible to complete resection. The sample size is 96 patients. Primary endpoint is 12-month non-progression rate.
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Objective@#To explore the clinical effects of general anesthesia of sevoflurane inhalation in abdominal surgery for patients with mild-to-moderate chronic obstructive pulmonary disease (COPD).@*Methods@#The clinical data of 68 patients with COPD abdominal surgery who admitted to the Department of Anesthesiology of Yiwu Central Hospital from June 2016 to June 2018 were retrospectively analyzed.According to the ratio of forced expiratory volume in 1 second in predicted value (FEV1%pre), the patients were divided into mild group (FEV1%pre≥80%, n=39) and moderate group (80%>FEV1%pre≥50%, n=29). The blood gas indicators[arterial partial pressure of oxygen (PaO2), arterial partial pressure of blood carbon dioxide (PaCO2), blood oxygen saturation (SaO2)], vital signs[heart rate (HR), mean arterial pressure (MAP)] and systemic vascular resistance (SVR) were compared between the two groups after entering (T0), after completion of induction (T1), at abdominal exploration (T2), before the end of surgery (T3) and after extubation (T4). The recovery quality indicators were analyzed in the two groups.@*Results@#In the mild group at T1, T2 and T3, the PaO2 values were (301.6±76.2)mmHg, (292.6±73.4)mmHg, (112.8±34.1)mmHg, respectively, and the SaO2 values were (99.1±0.8)%, (98.8±1.0)%, (94.5±2.2)%, respectively, all of which were significantly improved compared with those at T0 (t=23.51, 22.73, 12.34, 2.75, 2.93, 2.22, all P<0.05), while the PaCO2 values were (40.5±9.3)mmHg, (40.2±9.1)mmHg, (43.7±7.9)mmHg, respectively, which were significantly decreased compared with those at T0 (t=0.98, 1.12, 0.84, all P<0.05). The moderate group showed the same trend as the mild group, but there were no statistically significant differences between the two groups (all P>0.05). At T4, the PaO2, PaCO2 and SaO2 levels in the two groups showed no significant changes compared with those at T0, and there was no statistically significant difference between the two groups at the same time (all P>0.05). At T1 and T2, the MAP levels in the mild group were (75.5±11.0)mmHg, (80.7±11.9)mmHg, respectively, the HR values were (71.4±12.5)times/min, (74.2±13.6)times/min, respectively, the SVR values were (9.1±1.6)×102 dynesos-1ocm-5, (9.9±2.0) ×102 dynesos-1ocm-5, which were significantly lower than those at T0 (t=1.35, 0.95, 1.83, 0.64, 1.42, 0.27, all P<0.05). The moderate group showed the same trend as the mild group, but there were no statistically significant differences between the two groups (all P>0.05). At T3 and T4, there were no significant changes in levels of MAP, HR and SVR between the two groups compared with those at T0, and there were no significant significant differences between the two groups (all P>0.05). The spontaneous breathing time, duration of eye opening, time of fist, time of removing tracheal catheter and time of returning to the ward in the mild group were slightly shorter than those in the moderate group (all P>0.05).@*Conclusion@#When general anesthesia of sevoflurane inhalation is used in abdominal surgery of COPD patients, the trend of blood gas indicators is not affected by COPD, which can provide reference for clinical establishment of anesthesia regimens.
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Background@#Two randomized phase III trials (EORTC55971 and CHORUS) showed similar progression-free and overall survival in primary or interval debulking surgery in ovarian cancer, however both studies had limitations with lower rate of complete resection and lack of surgical qualifications for participating centers. There is no consensus on whether neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) could be a preferred approach in the management of advanced epithelial ovarian cancer (EOC) in the clinical practice. @*Methods@#The Asian SUNNY study is an open-label, multicenter, randomized controlled, phase III trial to compare the effect of primary debulking surgery (PDS) to NACT-IDS in stages IIIC and IV EOC, fallopian tube cancer (FTC) or primary peritoneal carcinoma (PPC).The hypothesis is that PDS enhances the survivorship when compared with NACT-IDS in advanced ovarian cancer. The primary objective is to clarify the role of PDS and NACT-IDS in the treatment of advanced ovarian cancer. Surgical quality assures include at least 50% of no gross residual (NGR) in PDS group in all centers and participating centers should be national cancer centers or designed ovarian cancer section or those with the experience participating surgical trials of ovarian cancer. Any participating center should be monitored evaluating the proportions of NGR by a training set. The aim of the surgery in both arms is maximal cytoreduction. Tumor burden of the disease is evaluated by diagnostic laparoscopy or positron emission tomography/computed tomography scan. Patients assigned to PDS group will undergo upfront maximal cytoreductive surgery within 3 weeks after biopsy, followed by 6 cycles of standard adjuvant chemotherapy. Patients assigned to NACT group will undergo 3 cycles of NACT-IDS, and subsequently 3 cycles of adjuvant chemotherapy. The maximal time interval between IDS and the initiation of adjuvant chemotherapy is 8 weeks. Major inclusion criteria are pathologic confirmed stage IIIC and IV EOC, FTC or PPC; ECOG performance status of 0 to 2; ASA score of 1 to 2. Major exclusion criteria are non-epithelial tumors as well as borderline tumors; low-grade carcinoma; mucinous ovarian cancer. The sample size is 456 subjects. Primary endpoint is overall survival.
ABSTRACT
Background@#Two randomized phase III trials (EORTC55971 and CHORUS) showed similar progression-free and overall survival in primary or interval debulking surgery in ovarian cancer, however both studies had limitations with lower rate of complete resection and lack of surgical qualifications for participating centers. There is no consensus on whether neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) could be a preferred approach in the management of advanced epithelial ovarian cancer (EOC) in the clinical practice. @*Methods@#The Asian SUNNY study is an open-label, multicenter, randomized controlled, phase III trial to compare the effect of primary debulking surgery (PDS) to NACT-IDS in stages IIIC and IV EOC, fallopian tube cancer (FTC) or primary peritoneal carcinoma (PPC).The hypothesis is that PDS enhances the survivorship when compared with NACT-IDS in advanced ovarian cancer. The primary objective is to clarify the role of PDS and NACT-IDS in the treatment of advanced ovarian cancer. Surgical quality assures include at least 50% of no gross residual (NGR) in PDS group in all centers and participating centers should be national cancer centers or designed ovarian cancer section or those with the experience participating surgical trials of ovarian cancer. Any participating center should be monitored evaluating the proportions of NGR by a training set. The aim of the surgery in both arms is maximal cytoreduction. Tumor burden of the disease is evaluated by diagnostic laparoscopy or positron emission tomography/computed tomography scan. Patients assigned to PDS group will undergo upfront maximal cytoreductive surgery within 3 weeks after biopsy, followed by 6 cycles of standard adjuvant chemotherapy. Patients assigned to NACT group will undergo 3 cycles of NACT-IDS, and subsequently 3 cycles of adjuvant chemotherapy. The maximal time interval between IDS and the initiation of adjuvant chemotherapy is 8 weeks. Major inclusion criteria are pathologic confirmed stage IIIC and IV EOC, FTC or PPC; ECOG performance status of 0 to 2; ASA score of 1 to 2. Major exclusion criteria are non-epithelial tumors as well as borderline tumors; low-grade carcinoma; mucinous ovarian cancer. The sample size is 456 subjects. Primary endpoint is overall survival.