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1.
Article in Chinese | WPRIM | ID: wpr-882915

ABSTRACT

Objective:To study the value of ultrasound-guided endoscopic retrograde appendicitis therapy in children with uncomplicated appendicitis.Methods:This study was a single center, retrospective study, including all electronic cases of appendicitis diagnosed clinically in Department of Pediatrics, the Second Affiliated Hospital of Air Force Military Medical University from October 2018 to October 2020 and received ultrasound-guided endoscopic retrograde appendicitis therapy.The clinical features, treatment and prognosis of the children were retrospectively analyzed.Results:A total of 152 electronic cases were included, there were 77 males and 75 females, aged(6.84±3.09) years.All the 152 children were treated with ultrasound-guided endoscopic retrograde appendicitis therapy.Intubation success rate and clinical success rate was 98.03%(149/152 cases)and 97.99%(146/149 cases), respectively.The median time of endoscopic therapy was 42.50 (31.00, 56.00) minutes.Mean postoperative hospital stay was (2.81 ±1.41) days, and the mean total hospital stay was (4.19 ±1.71) days.A total of 139 patients were followed up with a median follow-up time of 5 (1, 26) months.During the follow-up, the recurrence rate was 7.19%(10/139 cases), and the median time of recurrence was 2 (1, 3) months.Conclusions:Ultrasound-guided endoscopic retrograde appendicitis therapy had high effective rate and low recurrence rate in children with uncomplicated appendicitis, preserved the physiological function of appendix and avoided radiation damage.It can be used as a safe and effective treatment for acute and chronic uncomplicated appendicitis in children.

2.
Article in Chinese | WPRIM | ID: wpr-906589

ABSTRACT

@#Objective    To investigate the feasibility, effectiveness and durability of aortic sinoplasty in repairing aortic roots of patients with acute type A aortic dissection. Methods    From January 2014 to July 2017, 43 consecutive patients with acute type A aortic dissection underwent aortic sinoplasty to repair aortic root in our institution, including 34 males and 9 females, aged 32-65 (50.1±8.1) years. The perioperative and follow-up data were retrospectively analyzed, and statistical analysis on the preoperative, postoperative and follow-up ultrasound indicators was performed. Results    Thirty-day mortality was 4.7%. Preoperative aortic regurgitation was corrected and false lumen was eliminated immediately after operation in all patients. There was no late death, or aortic root or valve re-intervention and two patients were lost during a follow-up of 18-45 (27.9±6.7) months. There was no residual dissection found. No patients had significant dilation of aortic root. No statistically significant difference was found when comparing the maximum of root diameter and aortic regurgitation grade between at discharge and follow-up. Conclusion    Aortic sinoplasty for aortic root repair in acute type A aortic dissection is a simple and reliable technique and demonstrates excellent early outcomes.

3.
Article in Chinese | WPRIM | ID: wpr-912845

ABSTRACT

Objective:To evaluate and analyze the patient experience of residents contracted with primary medical institutions, for providing a basis for improving quality of contracted family doctor services.Methods:Using the Chinese version of the primary care assessment tools(PCAT), a household survey was conducted on 1 400 contracted residents in 9 community health service centers and 9 township health centers in a city from May to June 2020, and their medical experience in primary medical institutions was statistically analyzed. At the same time, interviews were conducted with institutional managers and family doctors. Descriptive statistics and one-way ANOVA were used for data analysis.Results:1 333 valid questionnaires were collected, and the effective recovery rate was 95.2%.The total PCAT scoring was 25.17. Seven dimensions of first contact, continuous, coordination, comprehensiveness, patient and family centered, community-oriented and cultural competence scored in average 3.57, 3.68, 3.54, 3.40, 3.72, 3.67 and 3.59 respectively.372 people(47.1%) had not been referred by the contracted institution before going to the superior hospital or specialized hospital. There were significant differences in the scores of four core dimensions in different types of institutions, age, education level, occupation and income( P<0.001). Conclusions:Given the initial progress of contracted family doctor services in the city, there is still room for improvement. It is suggested to further improve the comprehensiveness, coordinationand accessibility of services, and promote the high-quality development of contracted family doctor services.

4.
Article in Chinese | WPRIM | ID: wpr-912698

ABSTRACT

Objective:To analyze the grid management strategy of medical alliances in Rizhao city, Shandong province, and to provide references for improvement of this policy.Methods:In August 2020, semi-structured interviews were conducted with 31 managers of three medical alliances in Rizhao city, regarding the objectives, specific measures, problems and influencing factors of the grid layout of the medical alliances. The grounded theory was used to sort out the interview data, along with the Mazmanian-Sabatier model for further analysis.Results:The analysis resulted in 8 main categories and 19 sub-categories, including theoretical and technical support, target group characteristics, policy causality theory, current status of policy directives, inter-agency relations, socioeconomic conditions and technology, public attitudes, and media campaigns. On this basis, a theoretical framework for the implementation of the grid layout of medical alliance was formed based on the Mazmanian-Sabatier model.Conclusions:The socio-economic conditions and technologies for implementing the grid-based management of medical alliances in Rizhao city were relatively mature, enjoying strong public support and good social response. But on the other hand, there were still such problems as unclear policies, imperfect mechanisms for synergy of interests among different subjects, and incomplete supporting policies. In the future, it is expected to form a policy implementation synergy, introduce supporting policies and strengthen primary teams building, in order to ensure the orderly promotion and long-term implementation of the policy.

5.
Article in Chinese | WPRIM | ID: wpr-912323

ABSTRACT

Objective:To evaluate the short-term outcomes of cuff wrapping technique using remnant aortic wall in modified Bentall procedure.Methods:Between January 2018 and December 2018, 23 patients underwent modified Bentall procedure with the remnant aortic wall as a cuff to cover the sewing area of composite valved graft and the aortic annulus for proximal hemostasis. After the sewing ring of the composite valved graft was sutured to the aortic annulus by continuous suture, the remnant aortic wall was sutured to the graft just distal to the sewing ring by continuous suture. There were 21 males and 2 females, aged from 22 to 72 with a mean of(50.96±13.23)years. Short-term outcomes were assessed by cardiopulmonary bypass time, clamp aorta time, mechanical ventilation time, ICU time, postoperative stay time, effusion drainage till the first postoperative day, Left ventricular end diastolic diameter(LVEDD), left ventricular ejection fraction(LVEF), and follow-up results.Results:There were no postoperative and follow-up death. Cardiopulmonary bypass time was(157.74±39.85)min, ranged from 114 to 275 min; clamp aorta time(122.61±30.25)min, ranged from 84 to 212 min; mechanical ventilation time(11.65±3.08)h, ranged from 7.87 to 20.33 h; ICU time(81.43±45.88) h, ranged from 15.18 to 184.77 h; postoperative stay time(8.73±2.80)days, ranged from 6 to 15 days. Effusion drainage was(336.82±117.65)ml, ranged from 200 to 670 ml till the first postoperative day. Follow-up was performed from 19 to 30 months, with a mean of(23.17±3.17)months. There were significant differences between preoperative LVEDD and postoperative LVEDD before discharge[(49.78±6.21)mm vs.(58.78±10.54)mm, P<0.05]; There were a little decrease of follow-up LVEDD compared with postoperative LVEDD, but no significant difference between them[(48.87±4.63)mm vs.(49.78±6.21)mm, P>0.05] . There were a little decrease of postoperative LVEF compared with preoperative LVEF, but no significant difference between them(0.57±0.07 vs. 0.59±0.05, P>0.05). There were significant differences between follow-up LVEF and preoperative LVEF(0.62±0.04 vs. 0.57±0.07, P<0.05), postoperative LVEF before discharge( P<0.05). Conclusion:Cuff wrapping technique using remnant aortic wall in modified Bentall procedure has got good short-term results. This modification may be a simple, effective way in controlling proximal bleeding.

6.
Article in Chinese | WPRIM | ID: wpr-912299

ABSTRACT

Objective:To compare the mid-term result of two different valve-sparing root replacement techniques in acute type A aortic dissection: including reimplantation and remodeling.Methods:From March 2009 to December 2019, 41 patients with acute type A dissection and root involvement, who underwent a valve-sparing root replacement using reimplantation(36 cases) or remodeling(5 cases) were retrospectively analyzed in current study. The average age was(44.63±11.34) years old, 36 males. The differences of perioperative variables, postoperative aortic insufficiency and postoperative survival were compared between the two groups.Results:Thirty-day mortality for two groups was 2.8% and 20%( P=0.23). Remodeling group was significantly inferior to reimplantation group in terms of blood consumption(red blood cells, plasma and platelets), postoperative mechanical ventilation time, reoperation for bleeding and hemofiltration for acute renal failure. The median follow-up time of 39 discharged survivors was 34.56(3-121) months, and the follow-up rate was 100%. There was no follow-up death, no bleeding or embolism events, and no cardiovascular reoperation. Grade 2 or sever aortic regurgitation in remodeling group was significantly higher than that in reimplantation group( P=0.02). A Cox regression analysis identified that the remodeling technique was the independent risk factors of postoperative aortic regurgitation. Conclusion:Compared with remodeling technique, reimplantation technique has better perioperative and mid-term results in patients with acute type A aortic dissection. The rate of reoperation for bleeding, the blood consumption and the postoperative aortic regurgitation are significantly reduced. The long-term results need further follow-up.

7.
Article in Chinese | WPRIM | ID: wpr-798670

ABSTRACT

Objective@#To explore the formation mechanism of the weakening of village clinic′s medical service capacity in the context of new medical reform.@*Methods@#Purposive sampling method was used to enroll 38 rural doctors and managers of rural health centers and health offices in the interview from October 2015 to November 2015. And grounded theory was adopted to analyze reasons and their mechanism of the weakening of village clinic′ s medical service capacity.@*Results@#29 first-grade categories and 7 second-grade categories were worked out in text encoding. With the implementation of the ongoing healthcare reform, support from financial, policy and technology increased significantly, but due to the synthetic action of unexpected negative effects of the reform, superposition and accumulation of disturbance and ineffective support, village clinic′ s medical service capacity began to weaken.@*Conclusions@#The weakened village clinic′ s medical service capacity is a result of the synthetic action of 3 reasons. The persistence of this status will intensify the vulnerability of rural health service system and be bad for the implementation of hierarchical medical policy and the strategy of rural vitalization. Measures should be taken to optimization the essential medicine system, establish a comprehensive assessment mechanism for basic medical service and basic public health service of village clinic, strength the strategic purchasing of medical insurance, improve the financial compensation mechanism, and complete training system of village doctors, aims to promoting sustainable development of village clinic.

8.
Article in Chinese | WPRIM | ID: wpr-798669

ABSTRACT

Objective@#To explore the current status of village doctors′ vulnerability in Shandong province in the context of ongoing healthcare reform.@*Methods@#A cross-section study was conducted from October 2015 to November 2015 based on a self-designed questionnaire for village doctors. The questionnaire included 6 parts: fundamental state, disturbance from surroundings, disturbance from job, emotional support, instrumental support and self-ability of village doctors. Mean and standard deviation were adopted to describe the level of disturbance and support. Quadrant analysis was adopted to analyze village doctors′ vulnerability. The set pair analysis was adopted to calculate the vulnerability index and sample cluster analysis was adopted to classify village doctors based on the vulnerability index.@*Results@#The total disturbance score was 3.39±0.46, and contribution from professional risk was the biggest(19.95%). The self-ability score was 3.33±0.40, and contribution from financial support was the smallest(4.09%). According to the set pair analysis, village doctors′ vulnerability total score was 0.49±0.06, ranging in a medium category. According to the sample cluster analysis, 27.2%(277/1 018)of the village doctors stayed at the upper category, as 30.3%(309/1 018) was defined as a medium category. According to the quadrant analysis, 35.5%(361/1 018)of the village doctors were found as in crisis vulnerability.@*Conclusions@#In general, village doctors′ vulnerability stays in the medium category. They have to fight against high disturbance from surroundings, with more emotional support and less financial support expected.

9.
Article in Chinese | WPRIM | ID: wpr-798668

ABSTRACT

Objective@#To define the connotation of village doctors′ vulnerability.@*Methods@#On the basis of document analysis, Delphic method was used to consult and argument the connotation of village doctors′ vulnerability from October 2015 to November 2015.@*Results@#Twenty and 16 specialists were consulted in two rounds of the consulting. According to these consultations, the acceptance rate of the specialists for the seven consulting units increased from 74.29% to 93.16%.@*Conclusions@#The vulnerability of village doctors was identified, as a status in which their self-ability and support against their exterior environment could not to cope with the disturbances they faced, while the vulnerability was co-determined by disturbance and response ability of village doctors.

10.
Article in Chinese | WPRIM | ID: wpr-872244

ABSTRACT

Objective:By investigating the demand of " Internet-based health education" for urban and rural residents, to identify the main functions of " Internet-based health education" platform and the priority order that platform design should follow, in an effort to help promote the accurate dissemination of health education.Methods:Since April 2019, a stratified random sampling method was used to collect urban and rural residents in 3 counties and cities of a city. The survey mainly investigated the importance of the preliminary function and the specific demand of residents for " Internet-based health education" . With data collected and based on Kano model, the Better-Worse coefficient was used for quantitative analysis.Results:There are 14 main functions of the function item identification and discovery platform; among them, privacy, and without product placement are regarded requisites of the platform, while simple and stable operation among others rank the expected functions. in addition, artistic interface, fun experience, etc. were seen as the undifferentiated functions.Conclusions:The platform design for " Internet-based health education" should follow the priority order of privacy, without product placement, simple and stable operation, information authority, low attrition, comprehensive functions, perfect supervision, free service and high popularity.

11.
Article in Chinese | WPRIM | ID: wpr-872216

ABSTRACT

Objective:To investigate the cognition and willingness of nursing staff to Internet plus nursing service, and analyze the related factors that affect their participation in Internet plus nursing service.Methods:From April to May 2019, 150 nurses from three hospitals in Weifang were investigated by questionnaire and key person interview. Descriptive analysis and binary logistic regression analysis were used to analyze the intention of nursing staff to participate in Internet plus nursing service. The interview mode was used to analyze the appropriate mode of Internet plus nursing service from the perspective of nursing staff.Results:142 valid questionnaires were obtained, of which 137(96.5%)indicated willingness to provide Internet plus nursing services, and 135(95.1%) realized the necessity of the service. Education, marriage, nurses′judgment on the necessity of the service and their own subjective judgment of their competence were the factors affecting nurses′ participation in the Internet plus nursing service.Conclusions:Multiple factors affect the choice of nursing staff′s behavior in Internet plus nursing service.From the perspective of nursing staff, the Internet plus nursing service mode needs joint efforts from many aspects.

12.
Article in Chinese | WPRIM | ID: wpr-872210

ABSTRACT

Objective:To define the connotation of village doctors′ vulnerability.Methods:On the basis of document analysis, Delphic method was used to consult and argument the connotation of village doctors′ vulnerability from October 2015 to November 2015.Results:Twenty and 16 specialists were consulted in two rounds of the consulting. According to these consultations, the acceptance rate of the specialists for the seven consulting units increased from 74.29% to 93.16%.Conclusions:The vulnerability of village doctors was identified, as a status in which their self-ability and support against their exterior environment could not to cope with the disturbances they faced, while the vulnerability was co-determined by disturbance and response ability of village doctors.

13.
Article in Chinese | WPRIM | ID: wpr-872209

ABSTRACT

Objective:To explore the formation mechanism of the weakening of village clinic′s medical service capacity in the context of new medical reform.Methods:Purposive sampling method was used to enroll 38 rural doctors and managers of rural health centers and health offices in the interview from October 2015 to November 2015. And grounded theory was adopted to analyze reasons and their mechanism of the weakening of village clinic′ s medical service capacity.Results:29 first-grade categories and 7 second-grade categories were worked out in text encoding. With the implementation of the ongoing healthcare reform, support from financial, policy and technology increased significantly, but due to the synthetic action of unexpected negative effects of the reform, superposition and accumulation of disturbance and ineffective support, village clinic′ s medical service capacity began to weaken.Conclusions:The weakened village clinic′ s medical service capacity is a result of the synthetic action of 3 reasons. The persistence of this status will intensify the vulnerability of rural health service system and be bad for the implementation of hierarchical medical policy and the strategy of rural vitalization. Measures should be taken to optimization the essential medicine system, establish a comprehensive assessment mechanism for basic medical service and basic public health service of village clinic, strength the strategic purchasing of medical insurance, improve the financial compensation mechanism, and complete training system of village doctors, aims to promoting sustainable development of village clinic.

14.
Article in Chinese | WPRIM | ID: wpr-872201

ABSTRACT

Objective:To explore the current status of village doctors′ vulnerability in Shandong province in the context of ongoing healthcare reform.Methods:A cross-section study was conducted from October 2015 to November 2015 based on a self-designed questionnaire for village doctors. The questionnaire included 6 parts: fundamental state, disturbance from surroundings, disturbance from job, emotional support, instrumental support and self-ability of village doctors. Mean and standard deviation were adopted to describe the level of disturbance and support. Quadrant analysis was adopted to analyze village doctors′ vulnerability. The set pair analysis was adopted to calculate the vulnerability index and sample cluster analysis was adopted to classify village doctors based on the vulnerability index.Results:The total disturbance score was 3.39±0.46, and contribution from professional risk was the biggest(19.95%). The self-ability score was 3.33±0.40, and contribution from financial support was the smallest(4.09%). According to the set pair analysis, village doctors′ vulnerability total score was 0.49±0.06, ranging in a medium category. According to the sample cluster analysis, 27.2%(277/1 018)of the village doctors stayed at the upper category, as 30.3%(309/1 018) was defined as a medium category. According to the quadrant analysis, 35.5%(361/1 018)of the village doctors were found as in crisis vulnerability.Conclusions:In general, village doctors′ vulnerability stays in the medium category. They have to fight against high disturbance from surroundings, with more emotional support and less financial support expected.

15.
Article in Chinese | WPRIM | ID: wpr-871674

ABSTRACT

Objective:To evaluate the safety and efficacy of balloon occlusion technique combined with total arch replacement and frozen elephant trunk in the treatment of complex aortic arch diseases.Methods:The clinical data of 100 patients undergoing balloon occlusion technique combined with total arch replacement and frozen elephant trunk surgery in Fuwai Hospital from August 2017 to September 2018 were retrospectively reviewed, and the early clinical results were analyzed.Results:The average circulatory arrest time was(5.2±3.1) min. The lowest nasopharyngeal and bladder temperature was(27.9±1.0) ℃ and(29.2±1.2) ℃, respectively. One patient died in hospital due to multiple organ failure caused by acute liver failure, and a total of 4 patients died within 30 days. Other postoperative complications included cerebral infarction in 3 cases, paraplegia in 2 cases, low cardiac output syndrome requiring IABP assistance in 1 case, renal failure requiring continuous dialysis in 5 cases, redo for bleeding in 4 cases, reintubation in 3 cases, recurrent laryngeal nerve injury in 1 case, and osteofascial compartment syndrome in 1 case.Conclusion:Balloon occlusion technique combined with total arch replacement and frozen elephant trunk is safe and feasible in the treatment of complex aortic arch diseases. Its organ protection effect still needs to be confirmed by large sample comparison study.

16.
Chinese Journal of Radiology ; (12): 998-1002, 2020.
Article in Chinese | WPRIM | ID: wpr-868359

ABSTRACT

Objective:To explore the CT features of benign and malignant thymus diseases in order to improve the diagnostic accuracy of thymus diseases in children.Methods:The clinical data and imaging data of children with thymic diseases who underwent CT examination in children′s Hospital Affiliated to Capital Institute of Pediatrics from August 2014 to may 2019 were retrospectively analyzed. There were 32 males and 18 females with an average age of (6±4) years (range 5 days to 14.2 years). According to the clinical diagnosis and/or pathological results, all children were divided into benign group (22 cases) and malignant group (28 cases). The clinical manifestations and CT signs (thymus volume, shape, border, density, internal characteristics, relationship with surrounding structures, enhancement pattern and extent) of benign group and malignant group were summarized and compared.Results:The clinical manifestations of benign group and malignant group were varied, and fever was the most common sign. In the benign group, 8 cases showed thymus deficiency, all of them were diagnosed as primary immunodeficiency disease, and the clinical manifestations were repeated and persistent respiratory tract infection history. In 28 cases of malignant group, 20 cases had peripheral invasion and distant metastasis, including 7 cases of lymph node, 6 cases of pleura, 6 cases of lung, 2 cases of pericardium, 2 cases of liver, 2 cases of spleen, 2 cases of kidney and 1 case of bone. All 6 cases of pleural involvement occurred in children with non Hodgkin′s lymphoma. There were significant differences in CT findings between the two groups ( P<0.05); there were no significant differences in terms of shape, density, internal calcification or cystic change, enhancement pattern and enhancement extent of thymus lesions between the two groups ( P>0.05). Conclusions:Benign lesions of thymus usually manifests as absence or normal size of thymus, well-defined, non-necrotic, no displacement of vessels, no peripheral or distant invasion on CT; whereas malignant lesions are mostly enlarged, well or ill-defined, with internal necrosis and vessel displacement, surrounding or distant invasion. CT manifestations of benign and malignant thymus diseases have featured characteristics, and the combination of clinical manifestations is helpful for the differential diagnosis.

17.
Article in Chinese | WPRIM | ID: wpr-864252

ABSTRACT

Objective:To observe the variation of glutamate(AMPA) receptor interacting protein(GRIPs)and apoptosis of oligodendrocyte precursor cells (OPCs)under oxygen glucose deprivation (OGD) condition, so as to explore the role of GRIPs in AMPA receptor-induced excitotoxic injury.Methods:OPCs were divided into control group, 60 min OGD group and 120 min OGD group.Real-time polymerase chain reaction (PCR) and Western blot were used to detect the mRNA and protein expressions of GRIP1 and GRIP2 under OGD conditions.OPCs were divided into blank control group, OPCs+ OGD group, OPCs+ cyclic adenosine monophosphate(cAMP)+ OGD group, OPCs+ cAMP+ OGD+ GRIP1 small interfering RNA(siRNA) group, OPCs+ cAMP+ OGD+ GRIP1 siRNA negative control group, OPCs+ cAMP+ OGD+ GRIP2 siRNA group, OPCs+ cAMP+ OGD+ GRIP2 siRNA negative control group again, and terminal-deoxynucleoitidyl transferase mediated nick end labeling(TUNEL) kit was used to detect the apoptosis of each group.Fluo-4 fluorescent probe was used to measure the changes of intracellular free calcium.Results:OGD caused damage to OPCs, and the light microscope showed that the cell contour was not clear and the cell body retracts.The expressions of GRIP1 (1.233±0.060 vs.1.003±0.079, P<0.05) and GRIP2 (1.396±0.069 vs.1.001±0.037, P<0.05) were significantly higher than those in control group after 60 min of OGD was, and the longer the period of OGD, the higher the expression levels of GRIP1 (1.416±0.064 vs.1.233±0.060, P<0.01) and GRIP2 (1.680±0.018 vs.1.396±0.069, P<0.01) were.When GRIP1 and GRIP2 were down-regulated, the level of intracellular free calcium ion decreased(0.054±0.003 vs.0.074±0.003, P<0.01; 0.060±0.003 vs. 0.074±0.003, P<0.01), and the apoptosis rate decreased as well [(20.703±3.882)% vs.(11.470±1.679)%, P<0.05; (19.070±1.106)% vs.(14.448±0.849)%, P<0.01]. Conclusions:GRIP1 and GRIP2 are involved in the damage of OPCs that are caused by OGD, which may trigger AMPA receptor-mediated excitotoxicity by regulating Ca 2+ permeability.

18.
Article in Chinese | WPRIM | ID: wpr-864210

ABSTRACT

Functional constipation(FC) in children is a kind of common gastrointestinal disease caused by a variety of factors.At present, basic therapy and drug therapy are main treatments of FC in children.The drug therapy has a good curative effect, but it is prone to cause symptom recurrence after drug withdrawal.Moreover, the long-term medication costs much.In recent years, research has indicated that intestinal flora disturbance may be a vital mechanism of FC, In this article means that regulating the gut microbiota can provide a theoretical support for microbial treatment in FC.In this article, the research progress of the correlation between intestinal flora and FC in children and its mechanism were reviewed.

19.
Article in Chinese | WPRIM | ID: wpr-863483

ABSTRACT

Objective:To investigate the efficacy of β-elemene combined with gefitinib in the treatment of advanced lung adenocarcinoma patients with slow progression after first-line gefitinib treatment and its effects on quality of life and immune function.Methods:A prospective cohort study design was used to enroll patients with advanced lung adenocarcinoma who met the inclusion criteria from June 2017 to December 2018 in our hospital. They were divided into experimental group and control group by random number table method. The experimental group was given elemene combined with gefitinib, and the control group was only given gefitinib. The clinical efficacy, quality of life and immune function of the two groups were compared after 2 cycles of treatment. The PFS2 (time from slow progression of disease to rapid progression of disease) was followed up.Results:A total of 61 patients were included. There were 30 cases in the experimental group and 31 cases in the control group. The disease control rates of the experimental group and the control group were 83.3% (25/30) and 58.1% (18/31) respectively, and the difference was statistically significant ( χ2=4.680, P=0.031). The short-term efficacy of the experimental group was better than that of the control group, and the difference was statistically significant ( Z=-2.623, P=0.009). The median PFS2 of the experimental group was 4.20 months (95% CI: 3.94-4.46), and the median PFS2 of the control group was 4.00 months (95% CI: 2.94-5.07), with a statistically significant difference ( χ2=4.948, P=0.026). Quality of life was compared between the two groups: in terms of physical function, emotional function and overall quality of life, score differences before and after treatment of the experimental group were higher than those of the control group, with statistically significant differences [6.67(-6.66, 20.00) vs. 0(-6.66, 6.66), Z=-2.429, P=0.015; 29.17(2.08, 56.26) vs. 12.49(-14.59, 39.57), Z=-2.263, P=0.024; 16.67(-33.33, 56.67) vs. 8.34(-18.74, 35.42), Z=-2.249, P=0.025]. In terms of immune function, CD4 + T cells level in the experimental group increased after treatment compared with that before treatment (44.27%±6.78% vs. 41.17%±3.73%, t=-2.426, P=0.022), and CD8 + T cells level decreased compared with that before treatment (21.47%±3.18% vs. 23.50%±2.37%, t=2.532, P=0.017). After treatment, the level of CD4 + T cells in the experimental group was significantly higher than that in the control group (44.27%±6.78% vs. 39.63%±5.80%, t=2.725, P=0.011). Conclusion:β-elemene combined with gefitinib has a certain effect in the treatment of advanced lung adenocarcinoma patients with slow progression after first-line gefitinib treatment, and the quality of life and immune function are improved. It is worthy of further clinical research.

20.
Article in Chinese | WPRIM | ID: wpr-829201

ABSTRACT

@#Objective    To explore the early clinical outcomes of patients with acute type A aortic dissection and intramural hematoma. Methods    The clinical data of 61 patients with acute type A aortic dissection or intramural hematoma in our hospital from January 23, 2020 to March 10, 2020 were retrospectively analyzed, including 43 males and 18 females, aged 22-81 (52.1±13.0) years. The patient's time of visit, clinical characteristics and early survival were analyzed. Kaplan-Mier survival curve and log-rank test were used for the survival analysis. Results    There were 48 (78.7%) patients diagnosed with acute type A aortic dissection and 13 (21.3%) patients with intramural hematoma; 34 patients received operation and 11 were emergent. The 30-day mortality was 2.9% among the patients receiving operation. There were 48 patients alive and 13 patients dead during the study period. The cumulative survival rates for all the patients on postoperative 1 day, 3 days and 7 days were 93.4%, 86.4% and 77.5%, respectively. The cumulative survival rates for the patients with dissection on postoperative 1 day, 3 days and 7 days were 95.7%, 88.7% and 79.4%, respectively. The cumulative survival rates for the patients with hematoma on postoperative 1 day, 3 days and 7 days were 92.3%, 84.6% and 84.6%, respectively. The difference of survival rates between the two groups was not statistically significant (P>0.05). The cumulative survival rate of all the patients on postoperative 14 days was 74.5%. No statistically significant difference in survival rate on postoperative 14 days was found between patients with intramural hematoma and patients with aortic dissection (P>0.05). The proportions of the patients with unstable hemodynamics were found statistically significant between the survival patients and the dead patients (P<0.05). Conclusion    Patients with acute aortic dissection and intramural hematoma who survive to the hospital still have the risk of death under active drug therapy, and rupture of the dissection is the leading cause of death in these patients, especially for those with hemodynamic unstability.

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