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1.
Article in Chinese | WPRIM | ID: wpr-888055

ABSTRACT

In recent years, only a small number of new Chinese medicines have been approved for marketing, which has embodied the bottleneck in the development of the Chinese medicine industry. To tackle this problem, the National Medical Products Administration has issued a series of regulations and technical requirements. In the context of new regulations, this study deeply explored the research and development strategies of new Chinese medicines under the guidance of the new classification of drug registration, and discussed the key technical issues in the research and development.


Subject(s)
China , Drugs, Chinese Herbal , Medicine, Chinese Traditional , Pharmaceutical Preparations , Research
2.
Article in Chinese | WPRIM | ID: wpr-910462

ABSTRACT

Extramural vascular invasion (EMVI) is a prognostic factor in rectal cancer. The previous evaluation of EMVI relies on the analysis of postoperative pathological results. With the development of MRI, MRI can accurately assess the status of EMVI (mrEMVI). MrEMVI has become the important prognostic indicator for rectal cancer. The risk of local recurrence and distant metastasis in mrEMVI-positive patients will be significantly increased. The aim of this article is to review the diagnostic features, clinical significance, and impact on treatment patterns of EMVI, and project its future development trend of EMVI.

3.
Article in Chinese | WPRIM | ID: wpr-908494

ABSTRACT

Objective:To investigate the clinical relationship between carbapenem-resis-tant Klebsiella pneumoniae (CRKP) infection and the severity of acute pancreatitis. Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 109 patients with acute pancreatitis who were admitted to Sir Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine from January 2017 to January 2018 were collected. There were 66 males and 43 females, aged (48±17)years. Blood, body fluid or anal swab samples of patients were collected aseptically. Patients were treated with gallbladder puncture and drainage, nasobiliary drainage, surgical debridement, computed tomography (CT) guided interventional drainage or conservative treatment, respectively, after being comprehensively diagnosed. Observation indicators: (1) severity of acute pancreatitis and results of CRKP infection test; (2) diagnostic value of CRKP infection for severity of acute pancreatitis; (3) treatment of acute pancreatitis; (4) prognosis of patients. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Spearman correlation analysis were performed for correlation analyses. The receiver operating characteristic (ROC) curve was conducted to evaluate the diagnostic value. Results:(1) Severity of acute pancreatitis and results of CRKP infection test: of 109 patients, there were 37 cases with mild acute pancreatitis, 8 cases with moderate-severe acute pancreatitis, 64 cases with severe acute pancreatitis. There were 45 cases with mild disease and 64 cases with severe disease, 48 cases with CRKP infection and 61 cases without CRKP infection. There were 3 cases and 45 cases with CRKP infection in the 45 mild disease cases and 64 severe disease cases, respectively, showing a significant difference ( χ2=43.430, P<0.05). Result of Pearson correlation analysis showed that CRKP infection was positively correlated with the severity of acute pancreatitis ( r=0.631, P<0.05). The duration of hospital stay were (66±6)days and (24±3)days for the cases with CRKP infection and cases without CRKP infection, respectively, showing a significant difference ( t=47.661, P<0.05). (2) Diagnostic value of CRKP infection for severity of acute pancrea-titis: the area under the ROC curve, sensitivity, and specificity of CRKP infection for the diagnosis of SAP were 0.799 (95% confidence interval as 0.714?0.885, P<0.05), 0.688, and 0.911, respectively. (3) Treatment of acute pancreatitis: of 109 patients, 17 cases underwent nasobiliary drainage, 19 cases underwent gallbladder puncture and drainage, 42 cases underwent surgical debridement, 48 cases underwent CT guided interventional drainage and 43 cases underwent conservative treatment. One patient may undergo multiple treatments. Of 109 patients, 66 patients underwent one and more invasive treatments with 47 cases undergoing CRKP infection and 43 patients did not undergo invasive treatment with 1 case undergoing CRKP infection, respectively, showing a significant difference ( χ2=50.134, P<0.05). (4) Prognosis of patients: all 109 patients were followed up for 3?9 months, with a median follow-up time of 6 months. During the follow-up, there were 15 cases and 6 cases dead in the 48 cases with CRKP infection and the 61 cases without CRKP infection, respec-tively, showing a significant difference ( χ2=7.919, P<0.05). Conclusion:CRKP infec-tion is positively correlated with the severity of acute pancreatitis, and CRKP infection is associated with the duration of hospital stay and types of invasive treatments.

4.
Article in Chinese | WPRIM | ID: wpr-907298

ABSTRACT

As a multiplex PCR pathogen detection system, Filmarray has the characteristics of high flux and high positive rate.This paper evaluates the pathogen detection performance, clinical value and economic value of Filmarray in children with community acquired pneumonia.Bronchoalveolar lavage fluid is a good respiratory sample type for Filmarray in pathogen detection.Filmarray respiratory panel(FARP)can be used as one of the supplementary detection methods for pathogens in CAP when the conventional ways is negative.Not only it can provide more pathogenic information of children with severe CAP, but also provide early pathogen warning signals for severe CAP.Furthermore, it may be more suitable for severe CAP or children with severe CAP transformation tendency.Filmarray pneumonia panel(FAPP)provides rapid respiratory pathogen results and drug-resistant gene results to assist in the targeted use of antibiotics in the early stage of severe CAP or when the condition worsens, which is expected to play a certain antibiotic management potential.The results of FARP and FAPP need to be interpreted by doctor based on the clinical characteristics of the children.Confounding factors need to be strictly controlled in the evaluation of different clinical indicators and economic value of the two detection systems.

5.
Article in Chinese | WPRIM | ID: wpr-879119

ABSTRACT

Classical Chinese patent medicines(CPMs) are a kind of modern preparation developed from the experience of compatibility and application about ancient prescriptions. Its rich history of human use and reliable clinical efficacy imply the unique theoretical essence and precious value of traditional Chinese medicine(TCM). With the development of evidence-based medicine and the improvement of medical policy, it is particularly urgent to evaluate the clinical values of post-marketing classical CPMs. In this paper, some problems on the clinical value evaluation of CPMs would be described, and it is considered that the simplified evaluation procedures can lead to the lack of evidence for evaluating clinical value of CPMs, causing the difficulty in evaluating the quality of CPM, lack of R&D motivation of enterprises, low content of science and technology, and poor international development. Based on this background, it points out that the clinical value evaluation is the core of the post-marketing evaluation of the classical CPMs, and the eva-luation should be based on the direction of literature research and the latest practice. We should adhere to the research mode of combination disease with syndrome, and select the appropriate type of trials, with clinical efficacy, health economic benefits and safety eva-luation as the main content of the studies, in order to refine the indications and standardize the clinical positioning. Clinical value eva-luation is the basis and main content of post-marketing comprehensive researches on classic and famous CPMs to clarify their clinical value, obtain the conditions for continued marketingand standardize their clinical application, so as to optimize the evidence and quality service of classic and famous CPMs and inherit the core value concept of Chinese medicine.


Subject(s)
China , Drugs, Chinese Herbal , Humans , Marketing , Medicine, Chinese Traditional , Nonprescription Drugs
6.
Article in Chinese | WPRIM | ID: wpr-880762

ABSTRACT

OBJECTIVE@#To assess the clinical value of individualized pharmaceutical services for patients receiving vancomycin for severe infections and establish clinical monitoring procedures during vancomycin treatment.@*METHODS@#Data were collected from patients with severe infections who received vancomycin treatment with individualized pharmacy services (test group, 144 cases) or without such services (control group, 884 cases) between January, 2017 and December, 2018. Using propensity score matching, the patients in the two groups with comparable baseline data were selected for inclusion in the study (62 in each group), and the efficacy, safety and economic indicators were compared between the two groups.@*RESULTS@#The curative effects of the treatment did not differ significantly between the two groups, with the overall response rates of 95.16% in the test group and 91.94% in the control group (@*CONCLUSIONS@#The participation of clinical pharmacists during the treatment can improve the clinical benefits of vancomycin in patients with severe infections.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Humans , Infections/drug therapy , Pharmaceutical Services , Retrospective Studies , Vancomycin/therapeutic use
7.
Article in English | WPRIM | ID: wpr-719413

ABSTRACT

Resveratrol was first isolated in 1939 by Takaoka from Veratrum grandiflorum O. Loes. Following this discovery, sporadic descriptive reports appeared in the literature. However, spurred by our seminal paper published nearly 60 years later, resveratrol became a household word and the subject of extensive investigation. Now, in addition to appearing in over 20,000 research papers, resveratrol has inspired monographs, conferences, symposia, patents, chemical derivatives, etc. In addition, dietary supplements are marketed under various tradenames. Once resveratrol was brought to the limelight, early research tended to focus on pharmacological activities related to the cardiovascular system, inflammation, and cancer but, over the years, the horizon greatly expanded. Around 130 human clinical trials have been (or are being) conducted with varying results. This may be due to factors such as disparate doses (ca. 5 to 5,000 mg/day) and variable experimental settings. Further, molecular targets are numerous and a dominant mechanism is elusive or nonexistent. In this context, the compound is overtly promiscuous. Nonetheless, since the safety profile is pristine, and use as a dietary supplement is prevalent, these features are not viewed as detrimental. Given the ongoing history of resveratrol, it is reasonable to advocate for additional development and further clinical investigation. Topical preparations seem especially promising, as do conditions that can respond to anti-inflammatory action and/or direct exposure, such as colon cancer prevention. Although the ultimate fate of resveratrol remains an open question, thus far, the compound has inspired innovative scientific concepts and enhanced public awareness of preventative health care.


Subject(s)
Cardiovascular System , Colonic Neoplasms , Congresses as Topic , Delivery of Health Care , Dietary Supplements , Family Characteristics , Humans , Inflammation , Veratrum
8.
Chinese Journal of Immunology ; (12): 223-226,229, 2019.
Article in Chinese | WPRIM | ID: wpr-744638

ABSTRACT

Objective: To investigate the clinical value of peripheral blood neutrophil to lymphocyte ratio ( NLR) in patients with acute respiratory distress syndrome, and to compare the role of NLR and procalcitonin ( PCT) in the prognosis of patients with acute respiratory distress syndrome. Methods: From October 2015 to December 2017, 79 cases of ARDS patients were selected as case group, and 79 health examination persons were also selected as control group. According to the situation of death in 28 days of the ARDS patients were divided into survival group ( 38 cases) and death group ( 41 cases). The peripheral blood white blood cell count ( WBC), neutrophils count ( NC), lymphocyte count ( LC) and serum PCT level were detected, and calculate NLR. The clinical value of NLR and PCT in patients with acute respiratory distress syndrome ( NLR) were evaluated by receiver operating characteristic curve ( ROC) and the area under the curve ( AUC). The Kaplan-Merier method was used to analyze survival rate of patients with ARDS. Results: The levels of WBC, NC, NLR and PCT in ARDS patients were significantly higher than those of the control group ( P< 0. 05), while the level of LC was significantly lower than that of the control group ( P<0. 05). The level of NLR and PCT in the survival group were significantly lower than those in the death group ( P<0. 05). The AUC of NLR and PCT for evaluating the prognosis of ARDS patients were 0. 786 and0. 689 respectively. With Kaplan-Meier analysis of survival curves, ARDS patients whose NLR ≥13. 80 and PCT ≥ 4. 01 μg/L had lower 28 day survival rate as compared with those with NLR<13. 80 and PCT<4. 01 μg/L ( P<0. 001). Conclusion: The NLR and PCT could be used as biomarkers for evaluating the prognosis of ARDS patients, but the effect of NLR is better than that of PCT.

9.
Article in Chinese | WPRIM | ID: wpr-744388

ABSTRACT

Objective To investigate the effect of combined use of Chinese and western medicine on follicular development and ovulation in infertility patients.Methods The clinical data of 86 infertile patients treated in special clinic of the No.155 Central Hospital of PLA from January 2014 to June 2017 were retrospectively analyzed.According to the treatment method,the patients were divided into control group (n =40) and observation group (n =46).The control group was given corresponding westem medicine treatment,the observation group was treated with Chinese medicine on the basis of the control group,and all patients received ultrasound examination before and after treatment.At the end of treatment,the dominant follicle,ovulation rate,pregnancy rate,luteinized unrupture follicle syndrome and ovarian hyperstimulation syndrome were recorded and compared between the two groups by ultrasonography.The adverse reactions of the two groups were recorded during the treatment.Results (1) Ultrasound monitoring showed that the dominant follicle rate(95.65%),ovulation rate(78.26%) and pregnancy rate(56.52%) in the observation group were significantly higher than those in the control group (55.00%,50.00% and 30.00%) (x2 =19.811,P < 0.001;x2 =7.523,P < 0.001;x2 =6.102,P < 0.001);(2) The incidence rate of adverse reactions in the observation group was 6.52%,which was significantly lower than 45.00% in the control group,the difference was statistically significant(x2 =17.164,P < 0.001).Conclusion The combined treatment of Chinese and western medicine on infertility patients has more significant clinical efficacy.Under the guidance of ultrasound monitoring,the drug dosage and time can be more accurate,which can further improve the pregnancy rate with a certain security,it is worth widely used in clinical.

10.
Article in Chinese | WPRIM | ID: wpr-742910

ABSTRACT

Objective In this study, we constructed a plasmid, specifically expressed SUMO protein, and to study the expression level of anti-SUMO antibody in the serum of patients with primary biliary cholangitis, systemic lupus erythematosus, rheumatoid arthritis, Connective tissue disease, sjogren′s syndrome which were typical of autoimmune diseases.And to investigate whether anti-SUMO antibodies can be used as specific serum markers of PBC.Methods Plasmids containing SUMO1, SUMO2 and SUMO3 fragments were prepared by PCR and ET cloning and introduced into E.coli for protein induction and purification, respectively.Dot blot was used to preliminarily screen anti-SUMO antibody-positive specimens from serum samples of PBC patients and were verified by western blot to obtain positive reference serum.Through the establishment of the optimal anti-SUMO antibody ELISA diagnostic system, the positive rates of three subtypes of anti-SUMO antibody in PBC, SLE, SS, RA and CTD were detected, and their differences were analyzed by chi-square test.ResultsThe anti-SUMO antibody label has a specificity of up to 99%in PBC and a sensitivity of around 86%.After chi-square test analysis, the positive detection rate of anti-SUMO antibody in PBC was higher than that of nonPBC autoimmune disease and healthy controls (P<0.01).There was no significant difference in the expression of anti-SUMO antibody in other autoimmune disease populations (non-PBC autoimmune diseases) (P>0.05).Conclusion The highly specific anti-SUMO antibody is expected to become a novel antibody for diagnosis of PBC, which is of great significance for improving the clinical diagnosis efficiency of PBC.

11.
Article in Chinese | WPRIM | ID: wpr-803267

ABSTRACT

Objective@#To investigate the clinical value of abdominal ultrasound in the diagnosis of acute appendicitis.@*Methods@#From March 2015 to April 2017, 60 patients with acute appendicitis admitted to Hangzhou Hospital of Zhejiang Medical Hospital Health Care Group were selected in this study.All patients were diagnosed by abdominal ultrasound and performed surgical treatment.The clinical value of abdominal ultrasound in the diagnosis of acute appendicitis was analyzed.@*Results@#The diagnostic rate of acute simple appendicitis was 94%(33/35). The diagnostic rate of acute gangrene perforated appendicitis was 87%(7/8). The diagnostic rate of abscess classification around the appendix was 100%(5/5). The diagnosis of abdominal gray-scale ultrasound examination was consistent with the results of surgical pathological diagnosis, with an accuracy rate of 93%(56/60).@*Conclusion@#In the diagnosis of acute appendicitis, abdominal gray-scale ultrasound examination is a direct, simple, safe and accurate method, which is worthy of extensive promotion and application.

12.
Article in Chinese | WPRIM | ID: wpr-800185

ABSTRACT

Objective@#To evaluate the clinical value of high-risk factors in combination with stratification method in predicting the clinical prognosis of patients diagnosed with N2-3M0 nasopharyngeal carcinoma (NPC).@*Methods@#A total of 226 N2-3M0 NPC patients who underwent IMRT from November 2013 to May 2015 were enrolled in this study. The relationship between tumor volume, cervical metastatic lymph node characteristics (necrosis and fusion) and T and N staging was analyzed. The high-risk factors that affected the survival were identified. The value of high-risk factors combined with stratification method in predicting the clinical prognosis was assessed.@*Results@#N3 staging, Vn≥47.15cm3 and lymph node fusion (LNF) were the high-risk factors for distant metastasis in patients with stage N2-3M0 NPC. All patients were classified into the low-risk, medium-risk, high-risk and extremely high-risk groups according to high-risk factors. For patients in the low-risk, medium-risk, high-risk and extremely high-risk groups, the 3-year overall survival rates were 84.2%, 76.7%, 58.7% and 36.4%(all P<0.001), 87.3%, 85.2%, 54.5% and 12.1% for the distant metastasis-free survival (DMFS) rates (all P<0.001), 76.8%, 74.3%, 49.2% and 12.1%for the progression-free survival (PFS) rates (all P<0.001), and 89.2%, 88.5%, 91.5% and 88.3% for the loco-regional recurrence-free survival (LRRFS) rates (P=0.914), respectively. The risk stratification method showed the best curve separation for DMFS compared to the Vn, N staging and LNF classification groups (all P<0.05).@*Conclusion@#High-risk factors in combination with stratification method has the highest clinical value in predicting the clinical prognosis of N2-3M0 NPC patients.

13.
Chinese Journal of Hepatology ; (12): 741-747, 2019.
Article in Chinese | WPRIM | ID: wpr-796907

ABSTRACT

Currently, one-third of the world's chronic hepatitis B virus (HBV) carriers are in China. Therefore, it is important to develop treatment strategies that can accomplish virological suppression and improve clinical outcomes for China's huge HBV-infected population. Studies have shown that alanine aminotransferase (ALT) levels are significantly associated with the progression of liver disease, incidence of liver complications as well as an important indicator for deciding whether to initiate anti-HBV treatment. Clinically, antiviral therapy is usually only considered when the ALT level is greater than 2 times the upper limit of normal. However, a normal or low and elevated level of ALT does not mean that there is no change in liver tissues status. Several studies have suggested that normal or low and elevated levels of ALT are significantly associated with the progression of liver disease. In this context, if the level of ALT is considered as one of the mandatory requirements for the indication of anti-HBV therapy, many patients may be neglected and delayed in treatment, suggesting that the anti-HBV treatment threshold should be considered. Now, from the above discussion, this article mainly summarizes the guiding significance of ALT level in anti-HBV treatment and the value of ALT normalization in the state of illness and clinical prognosis, and also compares the difference of ALT normalization rates among different anti-HBV drugs for chronic hepatitis B patients. Besides this, it also states the limitations of current indications for anti-HBV therapy, so as to provide reference for improving the indications.

14.
Article in Chinese | WPRIM | ID: wpr-850867

ABSTRACT

Chinese materia medica (CMM) compound is the quintessence of traditional Chinese medicine culture, the main form in clinic of traditional Chinese medicine, the main categories and direction of research and registration of new CMM products, and an important carrier for traditional Chinese medicine inheritance and innovation. Due to the characteristics of complicated chemical constituents, weak research foundation, unclear effective components and multi-target effects, coupled with the limitations of research methods and evaluation of CMM compound preparation, how to scientifically carry out the design of CMM compound preparation has become a difficult question to answer. In this paper, from the basic attributes and requirements of drugs, combined with the discussion of research and development path, rule, strategy of new CMM compound preparation, it is proposed that the design of CMM compound preparation should be based on clinical value and inheritance and innovation, in the principle of the safety and effectivity of preparations, respecting traditional medicine experience, quality by design, whole quality evaluation, and quality uniformity and stability, etc. The pretreatment, dosage, process, dosage form, formulation design, equipment selection and industrial production in the CMM compound preparation design are also discussed.

15.
Article in Chinese | WPRIM | ID: wpr-821731

ABSTRACT

Objective@#To detect the altered levels of miR-422a in serum of traumatic brain injury (TBI) patients and explore its clinical value as diagnostic and prognostic indicator for TBI. @*Methods@#Serum miR-422a levels were determined by TaqMan quantitative real-time polymerase chain reaction (qRT-PCR) in 75 mild traumatic brain injury (mTBI) patients, 75 severe traumatic brain injury (sTBI) patients and 75 healthy controls. The differences of serum miR-422a levels were compared between the TBI patients with and without lesions on head CT. Receiver operating characteristic (ROC) curve analyses were used to evaluate the diagnostic efficacy of miR-422a for mTBI and sTBI patients. Spearman correlation analysis was used to assess the relationship between the levels of miR-422a and the severity and prognosis of TBI patients. @*Results@#Compared with healthy controls [(31.1×10 -5 (18×10 -5 , 51.5×10 -5 )], the serum miR-422a level was significantly increased in both the patients of mTBI 81.6×10 -5 (51.2×10 -5 , 131.1×10 -5 ) (Z=-6.647, P<0.001)]and sTBI [132.5×10 -5 (51.5×10 -5 , 240.5×10 -5 ) (Z=-7.345, P<0.001)]. The serum miR-422a level of sTBI patients was significantly higher than that of mTBI patients (Z=-2.573, P=0.01). The area under ROC curve (AUC ROC ) of miR-422a for distinguishing healthy controls from TBI patients was 0.831 (95%CI: 0.776 to 0.886, P<0.001). The AUC ROC of miR-422a for distinguishing healthy controls from mTBI patients was 0.814 (95%CI: 0.744 to 0.885, P<0.001). The AUC ROC of miR-422a for distinguishing healthy controls from sTBI patients was 0.847 (95%CI: 0.785 to 0.910, P<0.001). miR-422a level of the TBI patients with lesions on head CT were significantly increased compared with that without lesions on head CT (P=0.025). In addition, the level of miR-422a in TBI patients with unfavorable outcome was significantly higher than that in TBI patients with favorable outcome (P=0.031). Spearman correlations analysis showed that the level of the miR-422a was significantly negatively correlated with GCS score (Glasgow coma scale) (r=-0.231, P=0.004) and GOS score (Glasgow outcome scale) (r=-0.208, P=0.011). @*Conclusion@#The level of serum miR-422a in TBI patients was significantly increased and related to the condition and prognosis of TBI patients. Serum miR-422a may be a potential biomarker for the assessment of diagnosis and prognosis of TBI patients.

16.
Article in Chinese | WPRIM | ID: wpr-772541

ABSTRACT

OBJECTIVE@#To establish a set of evaluation system of digital radiography clinical value and provide foundation for the maturity assessment of digital radiography.@*METHODS@#The evaluation system of clinical value of digital radiography was established by literature survey,expert consultation,and percentage weight method.@*RESULTS@#The expert authority coefficients were 0.81 and 0.88,respectively.After two rounds of consultation,variation coefficients of each item ranged from 0 to 0.207,and the coefficient coordination were 0.599.The index system consisted of 5 first-level indexes and 12 second-level indexes.The weights of first-level indexes such as image quality,safety,usability,economic and social indicators share of the weight are 0.298,0.294,0.199,0.121 and 0.088 respectively.@*CONCLUSIONS@#A completed and scientific evaluation system was established,which provides a scientific assessment tool for clinical value of digital radiography.


Subject(s)
Delphi Technique , Radiographic Image Enhancement , Reference Standards
17.
Chinese Journal of Urology ; (12): 690-693, 2018.
Article in Chinese | WPRIM | ID: wpr-709583

ABSTRACT

Objective To evaluate the clinical value of three-dimensiomal (3D) image reconstruction in the urologic robot-assisted laparoscopic surgery.Methods From Sept.2017 to Jun.2018,7 patients (3 male cases,4 female cases) diagnosed with genitourinary tumors in Beijing United Family Hospital were involved in this study.The median age was 55 years(IQR 36-64 years).There were 1 case of renal tumor,1 case of adrenal gland tumor,1 case of retroperitoneal tumor,1 case of metastatic tumor post-nephrectomy,1 case of bladder neuroendocrine tumor and 1 case of urachal tumor.All the patients underwent four-phase enhanced CT scan and the CT images were imported into 3D visualization system for 3D image reconstruction,aiming to assist surgery planning and tumor locating.The main parameters of 3D image reconstruction included tumor size,location and the relationships among tumor,organs and blood vessels.All the 7 patients underwent robot-assisted laparoscopic surgeries,including 2 cases of partial nephrectomy (1 case with no blockage of renal artery),1 case of excision of right adrenal gland tumor,1 case of transperitoneal excision of left renal hilus chromaffinoma,1 case of transperitoneal excision of right adrenal gland and postcaval metastatic tumors,1 case of transperitoneal radical cystectomy + orthotopic bladder substitution + extended pelvic lymph node dissection,1 case of transperitoneal excision of urachal tumor + partial cystectomy + pelvic lymph node dissection.Results 3D image reconstruction svstem allows accurate evaluation of tumors,related vessels,surrounding tissue and organs before operation.All the 7 cases surgeries were uneventful,no case was converted to open or conventional laparoscopic surgery,the median operation time was 225 min (IQR 135-280 min),the median blood loss was 50 ml (IQR 20-600 ml).One patient had fever post-operation and there was no over Clavien Dindo Ⅱ perioperative complication.Conclusions 3D image reconstruction shows the great clinical value in approach selection,reduction of tissue and organ damage,reduction of surgery related complication and improving the success rate in robot-assisted laparoscopic surgery.

18.
Clinical Medicine of China ; (12): 368-371, 2018.
Article in Chinese | WPRIM | ID: wpr-706688

ABSTRACT

Objective To investigate the clinical value of immediate fluid resuscitation and delayed resuscitation in patients with traumatic shock. Methods The patients with traumatic shock treated in the Critical Care Medicine Department of People's Hospital of Wenjiang District from March 2014 to March 2017 were selected. According to the number of admission cases,one hundred and twenty patients with traumatic shock were randomly divided into two groups,60 cases in each group. The control group was given early immediate fluid resuscitation,the observation group was given delayed resuscitation,and the blood coagulation and blood routine indexes of the two groups were compared before and after the fluid resuscitation in the two groups,and the amount of fluid rehydration and the fatality rate in the two groups of patients with 1 h shock were observed,and the incidence rate of acute respiratory distress syndrome ( ARDS) and multiple organ dysfunction syndrome (MODS) were compared. Results After treatment,the blood clotting and blood routine indexes of the two groups were improved (P<0. 05),of which the thromboplastin time (PT) ((11. 04±1. 17) s),activated partial thromboplastin time (APTT) ((28. 12±5. 93) s) in the observation group in the observation group were lower than those of the control group( (15. 12±1. 26) s,(36. 17±9. 05) s) (t = -15. 37,-9. 81,P<0. 05),platelet countPLT) ((146. 92±16. 85)×109 / L) was higher than that of the control group ((114. 18±10. 69)×109 / L ) (t= -9. 77,P<0. 05),and the blood routine hemoglobin (Hb) ((112. 21±9. 46) g/ L),and the base surplus (BE)((-5. 30 ± 2. 45) mmol/ L ) were all higher than those of the control group ((92. 95 ± 11. 20) g/ L, (-8. 27±3. 53) mmol/ L ) (t= -11. 46,-8. 99,P<0. 05),blood lactic acid (BL) ((2. 79±1. 12) mmol/ L ) was lower than that of the control group ((3. 54±1. 37) mmol/ L) (t = -8. 99,P<0. 05). The volume of 1 h infusion of shock in the observation group ((569. 96±187. 34) ml ) was lower than that of the control group((1957. 35±204. 14) ml) (t = 8. 725,P<0. 05). The incidence of ARDS (3. 33% (2/ 60)),MOD(3. 33%(2/ 60)) and fatality(1. 67%(1/ 60)) were lower than those of the control group(8. 33%(5/ 60),6. 67%(4/60),6. 67%(4/ 60) ( χ2 = 2. 725,3. 214,2. 985,P< 0. 05) . Conclusion The early stage of traumatic shock delayed fluid resuscitation is conducive to the protection of the blood coagulation function of patients,to improve blood indicators,to reduce the amount of 1 h infusion and to reduce the incidence of ARDS and MODS.

19.
China Journal of Endoscopy ; (12): 5-10, 2018.
Article in Chinese | WPRIM | ID: wpr-702854

ABSTRACT

Objective To assess the safety, efficacy and the clinical value of endoscopic treatment for duodenal lesions. Methods 59 patients with duodenal lesions were treated by endoscope from December 2012 to December 2016. The clinical data were retrospectively analyzed. Results There were 31 male and 28 female patients, aged 17 ~ 81 (58.2 ± 13.3) years. The lesion location included the duodenal bulb (n = 24, 40.68%) and the descending part (n = 21, 25.42%). The diameter of the lesions ranged from 0.2 to 5.0 (1.4 ± 0.9). Thirty-nine (66.10%) lesions originated from the mucosa, including inflammatory/hyperplastic polyps (n = 18, 30.51%), villous/tubular adenoma (n = 6, 10.17%). Twenty (33.90%) lesions originated from the submucosa, including Brunner's glands adenoma (n = 4, 6.78%), ectopic pancreas (n = 5, 8.47%), lipoma (n = 4, 6.78%). There were 4 delayed bleeding, 5 intraoperative perforation. Two patients received extended surgical resection later, and all the 59 patients showed no recurrence during the followed up (range, 3 ~ 30 months) using endoscopy. Conclusion Endoscopic treatment is a safe, effective, valuable method for the management of duodenal lesions.

20.
Article in Chinese | WPRIM | ID: wpr-702273

ABSTRACT

Objective To investigate the clinical value of preoperative neutrophil to lymphocyte ratio in predicting lymph node metasta-sis after radical resection of esophageal carcinoma. Methods The clinical data of 110 patients with esophageal carcinoma who underwent radical resection of esophageal carcinoma from February 2015 to March 2017 in our hospital were retrospectively analyzed. NLR≥4 was the critical point,all patients were divided into high NLR group(NLR≥4) in 45 cases,the low NLR group(NLR<4) 65 cases,compared two groups of patients with clinical characteristics,lymph node metastasis,and regression analysis of factors influencing lymph node metastasis af-ter radical resection of esophageal carcinoma by logistic. Results There were 87 patients with lymph node metastasis in 110 cases,among which 43 cases(95. 56%) had lymph node metastasis in 45 cases of high NLR group,and 44 cases(67. 69%) had lymph node metastasis in 65 cases in low NLR group. The number of lymph node metastasis,depth of tumor invasion and distant metastasis in the high NLR group were higher than those in the low NLR group(P<0. 05),which indicated that the preoperative NLR level was related to lymph node metastasis af-ter radical resection of esophageal carcinoma. The number of lymph node metastasis and lymph node metastasis in the high NLR group were higher than those in the low NLR group(P<0. 05). The tumor T stage(OR=1. 898,95%CI:1. 151~3. 130),NLR≥4(OR=1. 919,95%CI:1. 076~3. 422) is the independent risk factors of lymph node metastasis in patients with esophageal cancer(P<0. 05). Conclusion The preoperative NLR was higher in patients with esophageal cancer and its lymph node metastasis,the greater the risk of distant metastasis tumor the deeper the infiltrating,it is more likely,to suggest it should expand the range of lymph node dissection in the operation,the lymph node metastasis,radical dissection has certain value.

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