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Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in the world, and the new cases of HCC in China account for more than half of the global cases every year. High incidence mortality and limited treatment methods are the main challen-ges for HCC prevention and treatment in China. Immunotherapy has brought new treatment options and hope of prolonging the survival to patients with advanced HCC. Data from the IMbrave 150 study published in the New England Journal of Medicine in May 2020 showed that the median overall survival of all patients was 19.2 months, and the median overall survival of the Chinese subgroup was 24.0 months, which suggested significant efficacy in prolongating patient survival and controlling tumor. Interven-tional therapy has been playing an important role in the treatment of HCC, and more and more clinical studies have adopted systematic therapy combined with interventional therapy. Interven-tional therapy and systematic therapy have synergistic efficacy which lead to significant clinical efficacy. The authors introduce the diagnosis and treatment of an advanced HCC patient undergoing interventional therapy combined with bevacizumab plus attilizumab treatment, which lead to signifi-cant clinical efficacy of tumor controlling.
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Objective To observe the protective effect of gradual ischemic postconditioning (IP) capable of improving reperfusion on reperfusion injury in patients with ST-segment elevation acute myocardial infarction (STEAMl) undergoing primary percutaneous coronary intervention (PPCI).Methods 102 in-patients with STEAMI undergoing PPCI in the Department of Cardiology in the First People's Hospital of Kunshan City Affiliated to Jiangsu University from February 2011 to August 2014 were enrolled in this study. They were divided into three groups by a random number table: IP group (32 cases), gradual IP group (30 cases) and routine reperfusion group (40 cases). In IP group, after the opening of the infarction related blood vessel, ischemic postconditioning within the first minute of arterial reperfusion was made through three episodes of 1 minute inflation and 1 minute pressure withdrawn of an angioplasty balloon, and then persistent reperfusion was carried out. In the gradual IP group, the patients received three times of gradual angioplasty balloon inflation and denation, 1 minute/1minute, 30 seconds/30 seconds and 15 seconds/15 seconds respectively, presenting the gradual change of IP time. In the routine reperfusion group, after the opening of blocked blood vessel, the patients underwent routine PCI to persistently recover the coronary artery blood supply. The changes of related lead ST segment regression (Sum-STR), incidence of reperfusion arrhythmia, corrected thrombolysis in myocardial infarction (TIMI) franle count (CTFC), peaks of MB isoenzyme of creatine kinase (CK-MB), left ventricular ejection fraction (LVEF) and frequency of adverse events in follow-up period were compared among the three groups.Results The baseline characteristics were comparable in three groups. The incidence of ventricular premature beats was significantly lower in gradual IP group than that in routine reperfusion group [30.0% (9/30) vs. 55.0% (22/40),P 0.05). The incidence of ventricular tachycardia was significantly lower in IP and gradual IP groups than that in routine reperfusion group [15.6% (5/32), 13.3% (4/30) vs. 40.0% (16/40), bothP 0.05). In IP group and gradual IP group, the Sum-STR incidence, CTFC, CK-MB peaks were lower than those of routine reperfusion group [Sum-STR: (56.7±18.3)%, (57.3±21.5)% vs. (44.6±21.6)%; CTFC: 25.47±5.37, 24.46±6.41 vs. 31.62±7.56; CK-MB peaks (U/L): 126.3±78.5, 121.6±82.5 vs. 147.4±72.5; allP 0.05). In routine reperfusion group, one patient died because the ventricular fibrillation could not be corrected and another one died of no-reflow during operation. Each group had 1 patient died during the 4 weeks of follow-up after operation, in the routine reperfusion group, one died of refractory heart failure, and the cause of death of other two patients, one in IP group and another in gradual IP group, was considered due to subacute thrombosis in stent. Major bleeding events were not found in each group.Conclusion Gradual IP can ameliorate myocardial reperfusion injury more significantly in patients with STEAMI undergoing PPCI.
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Objective To explore the effects of lifestyle intervention on index of early artery diseases in nondiabetic patients with metabolic syndrome (MS). Methods Eighty-seven nondiabetic patients with MS were randomly assigned to the intervention group ( n =47) and the control group ( n =40).The patients in the intervention group received health education,diet control,regular physical exercises,and unhealthy habit correction; however,the control group did not receive any intervention.All the patients were followed up for 9 months.Body mass index (BMI),waist circumference (WC),systolic blood pressure (SBP),diastolic blood pressure (DBP),triglyceride (TG),total cholesterol (TC),high-density lipoprotein cholesterol ( HDL-C ),low-density lipoprotein cholesterol ( LDL-C ),fasting blood glucose (FBG),HbAlc,fasting insulin (FINS),HOMA-IR,high sensitivity C-reactive protein (hs-CRP),carotid intima-media thickness (IMT),brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index(ABI) were measured at baseline and at 9 months.ResultsAfter 6 or 9 months' intervention,BMI,WC,SBP,TG,HDL-C,FPG,HbAlc,FINS,HOMA-IR and hs-CRP of the intervention group were improved (all P ＜ 0.05). HDL-C,FPG,HbAlc,FINS,HOMA-IR and hs-CRP of the intervention group were further improved at 9 months when compared to 6 months ( all P ＜ 0.05 ). In comparison with the control group,BMI,WC,HDL-C,FPG,HbA1 c,FINS,HOMA-IR and hs-CRP were significantly improved in the intervention group at 9 months ( all P ＜ 0.05 ).After 6 or 9 months' intervention,baPWV and ABI were significantly changed ( both P ＜ 0.05 ) in the intervention group although IMT of the carotid did not changed (P ＞0.05). BaPWV and ABI were significantly changed in the intervention group when compared with those in the control group at 9 months ( both P ＜ 0.05).The abnormal rate of baPWV in the intervention group at 9 months was 44.68％. BaPWV and ABI were associated with hs-CRP and HOMA-IR.ConclusionsIn nondiabetic MS patients, health management could significantly improve insulin resistance,modify metabolic disorders,and prevent the development of atherosclerosis.
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la alta prevalencia e incidencia de los traumatismos dentales en la población, la necesidad de atención inmediata, así como la inestable evolución a corto, mediano y largo plazo, motivó la realización de esta investigación. Objetivo: evaluar a corto plazo el comportamiento de los dientes traumatizados, después de la aplicación de tratamientos. Método: se realizó un estudio de intervención, en la Clínica Estomatológica Docente del municipio Céspedes, desde junio de 2008 hasta mayo de 2009. El universo de estudio estuvo constituido por diecinueve pacientes que asistieron a las consultas de urgencias estomatológicas afectados por traumatismos dentarios. Se obtuvo una muestra no probabilística de diecinueve pacientes, los que presentaron treinta y nueve dientes lesionados. El universo y la muestra coincidieron según los criterios de inclusión. Se realizaron tratamientos de urgencia de acuerdo con los requerimientos de cada caso y consultas de seguimiento. Resultados: la localización más frecuente de los traumatismos fue en los incisivos centrales superiores; veintitrés afectados, trece dientes presentaron fractura no complicada de corona, y cuatro, fractura complicada. Otras lesiones observadas fueron: infractura del esmalte, fractura no complicada de corona y raíz, y fractura no complicada de corona más subluxación. El resultado de los tratamientos fue satisfactorio en veintiséis dientes y parcialmente satisfactorio en seis, de los treinta y tres que recibieron tratamientos antes de las veinticuatro horas. Conclusiones: se encontró diferencia significativa en los resultados a corto plazo entre el tiempo transcurrido para la atención de urgencia y la cooperación de los pacientes.
Background: the high prevalence and incidence of dental traumatisms in population, the necessity of immediate attention, as well as the short, medium and long-term unstable evolution, motivated the realization of this investigation. Objective: to evaluate the short-term behavior of traumatized teeth, after the application of treatments. Method: an intervention study was carried out at the Teaching Odontology Clinic from Céspedes municipality, from June 2008 to May 2009. The study universe was constituted by nineteen patients that were attended in the emergency-room affected by dental traumatisms. A non-probabilistic sample of nineteen patients, who presented thirty-nine injured teeth, was obtained. The universe and the sample coincided with the inclusion criteria. Urgency treatments according to requirements of each case and follow-up consultations were carried out. Results: the most frequent localization of traumatisms was in the upper central incisors; twenty-three affected, thirteen teeth presented non complicated crown fracture, and four, complicated fractures. Other lesions were observed: enamel infracture, non complicated crown-root fractures, and non complicated crown fractures besides subluxation. The result of treatments was satisfactory in twenty-six teeth and partially satisfactory in six of the thirty-three that received treatments before twenty-four hours. Conclusions: significant difference in short-term results among the time lapsed for the emergency attention and the cooperation of patients.
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Objective To evaluate the change of extended spectrum β-lactamase (ESBLs) Producing Klebsiella Pneumoniae (ESBLs-KPN) and Escherichia coli (ESBLs-ECO) causing nosocomial infection after antimicrobial intervention. Methods We regularly monitored the data on the yearly consumption [defined as daily dose (DDD) per 1 000 patient-days] of frequently used antibiotics from Dec. 2004 to Dec. 2007. From Jan. 2005 to Dec. 2007, we monitored the resistance of frequently used antibiotics and the timely integrative antimicrobial intervention was based on the outcome of antimicrobial resistance. We also monitored the isolation rate of ESBLs-KPN and ESBLs-ECO causing nosocomial infection. The departments studied were the experimental group and other comparable medical departments were the control group(ICU was excluded).Results The isolation rate of ESBLs-KPN ((43.90%)) and ESBLs-ECO (45.83%) in the experimental group was higher than that in the control group (28.04% and 24.90%, respectively) before the intervetion (P＜0.05). The isolation rate of ESBLs-KPN decreased (from 26.47% to 17.65%) in the experimental group and that in the control group increased ( ESBLs-KPN: from 34.18% to (52.94%;) ESBLs-ECO: from 47.13% to 63.78%) from 2005 to 2007 (P＜0.05). The isolation rate of ESBLs-KPN and ESBLs-ECO in the experimental group was lower than that in the control group after the antimicrobial intervention (P＜0.05). Usage of ceftazidime and cefoperazone/sulbactam and imipenem was reduced and the consumption of cefepime was increased in the experimental group ((P＜0.05)). Consumption of ceftazidime and cefoperazone/sulbactam and cefepime was increased. Conclusion The prevalence of ESBLs-KPN and ESBLs-ECO may be decreased after the integrative antimicrobial intervention.
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Objective To evaluate the immediate and late outcomes after percutaneous coronary intervetion (PCI) for unprotected left main coronary artery (LMCA) stenoses. Methods Between December 1992 and December 2002, directional coronary atherectomy (DCA) and/or stenting were performed for unprotected LMCA stenoses in 174 patients (121 DCA, 53 stenting procedures), including 85 patients clarified as coronary artery bypass grafting (CABG) ineligible or at high surgical risk. Clinical follow-up examinations were conducted on an outpatient basis at least once a month in the first 6-month after the procedure, and by regular visits or phone contact later. Follow-up coronary angiography was requested 3, 6 and 12 months after initial PCI. Results Procedural success was achieved in 158 patients (90.8%). In the 6-month follow-up, all-cause mortality was 9.8% (17/174); Cardiac mortality was 4.6% (8/174) and all cardiac deaths occurred in patients at high surgical risks; Target lesion revascularization (TLR) was performed in 34 of the 152 (22.4%) patients after angiography; The estimated cardiac death-free, death-free, cardiac event-free survival were 95.4%, 89.7%, 63.8% one year after PCI; 94.3%, 85.6%, 59.8% two year after PCI; and 94.3%, 84.5%, 57.5% three year after PCI, respectively. Conclusion PCI is feasible for unprotected LMCA disease, especially for ostial and mid-shaft lesions. Despite acceptable immediate results, major adverse cardiac events after PCI remain to be an unresolved issue.
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Objective To investigate immune changes in patients with chronic obstructive pulmonary disease during exacerbations(ECOPD).Methods A randomized,prospective clinical trial was done in 65 patients with ECOPD from Feb.2004 to Oct.2004.They were divided into two groups:one group with general treatment and another with general treatment plus Pidotimod which was given 800mg orally twice daily for 15 days and then 800mg orally once daily for 15 days.Twenty healthy individuals sevred as the control.Levels of CD_ 14 、CD_ 158b 、CD~+_3、CD~+_4、CD~+_8、CD~+_4/CD~+_8 in peripheral blood were measured by flow cytometry at baseline(D1)and then again at(D15)and at the end of treatments(D30),in the meanwhile clinical picture was observed to evaluate patients' conditions.Results Totally 60 patients completed the trial correctly(30 in pidotimod group and 30 in control group).The two groups were satistically homogeneous.The positive rate of sputum bacteriological examination was 42.67%.On D1,the percentage of CD_ 14 、CD_ 158b in two groups was not different from healthy volunteers.On D15,the above immunologic parameters of the control group was decreased compared with pidotimod group,and CD_ 14 was satistically low(P