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Objective To analyze the postoperative therapeutic effect of prokinetic agents in patients after tricuspid valve replacement （TVR） under cardiopulmonary bypass. Methods Patients received TVR under cardiopulmonary bypass （during June 2010 to December 2021） in the department of Cardiovascular Surgery of the First Affiliated Hospital of Naval Medical University were selected as the subjects of our study. The data of basic characteristics, first postoperative defecation time and postoperative recovery condition were collected and retrospectively analyzed in the patients taking prokinetic agents within three days after surgery （prevention group） and patients not taking prokinetic agents within three days after surgery （control group）. Results A total of 184 patients were selected, including 101 in the prevention group and 83 in the control group. The first defecation time of patients in the prevention group was significantly earlier than that in the control group （P<0.05）. The incidences of abdominal distension and pulmonary infection in the prevention group were significantly lower than that in the control group. The length of time in ICU, postoperative mechanical ventilation and nasogastric tube decompression in the prevention group were significantly shorter than that in the control group （P<0.05）. Conclusion Taking prokinetic agents within three days after TVR under cardiopulmonary bypass could effectively improve the prognosis of patients.
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Objective To investigate the curative effect of bone plate screw external fixation minimally invasive treatment assisted with 3-dimensional printing extraposition mold in distal radius fractures.Methods The clinical and follow up data in 15 cases of distal radius fractures treated by bone plate screw ex-ternal fixation minimally invasive treatment assisted with 3-dimensional printing extraposition mold were ret-rospectively analyzed.The volar inclination angle,ulnar deviation angle,radius length at the time of before surgery,immediately after surgery,and 2 years after surgery were measured,by using standard anteroposterior and lateral X-ray films,as well as the wrist jiont flexion extension motion and dorsal extension motion at the time of 2 years after surgery were measured by using protractor.The grip strength of the hand 2 years after surgery was measured by using grip strength meter.Visual Analog Scale(VAS)score was used to evaluate the pain level or wrist joint before and 2 years after surgery;Gartland Werley score was used to evaluate the wrist joint function 2 years after surgery.Results The follow-up lasted for 24.0-33.0 months with an aver-age of 26.5 months.The Gartland-Werley scores were excellent in 12 cases,good in 2 cases and fair in 1 case 2 years after surgery.The wrist joint flexion motion was(52.0±11.7)°,the wrist joint dorsal extension motion was(65.0±4.8)°,the grip strength of the affected side was(84.0±4.2)％of the healthy side.Compared with before operation,the volar inclination angle,ulnar deviation angle and radius shortening value and VAS score up were significantly improved 2 years after surgery(P＜0.05),and there was no statistically significant difference in immediately after surgery imaging parameters(volar inclination angle,ulnar deviation angle and radius shortening)immediately after surgery compared to 2 years after surgery(P＞0.05).Conclusion The bone plate screw external fixation minimally invasive treatment assisted with 3-dimensional printing extrapo-sition mold in distal radius fractures has the advantages of individualized bone plate screw,precision guidance position angle,minimal invasion,low demand for skin and soft tissue condition and easy taking out.The fixa-tion is reliable and the joint function recovered well and the short follow up effect is satisfactory.
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Objective To investigate the clinical effect of transcranial Doppler(TCD)in severe craniocerebral injury.Methods A total of 45 patients with severe craniocerebral injury who underwent decompression surgery for the bone flap were selected from February 2018 to March 2023 in Suqian First Hospital.CT and TCD examinations were performed in all patients,and the correlation between Helsinki CT score and TCD parameters was analyzed.Among them,37 patients who underwent intracranial pressure(ICP)monitoring were divided into normal ICP group(n=3),mildly elevated ICP group(n=14),moderately elevated ICP group(n=11)and severely elevated ICP group(n=9)according to different ICP levels.TCD parameters of the four groups were compared.Results Helsinki CT score was positively correlated with pulsatility index(PI)and resistance index(RI)(r=0.91,0.89,P<0.01),and was negatively correlated with the end of diastolic velocity(Vd)(r=-0.92,P<0.01).Helsinki CT score was not correlated with systolic peak velocity(Vs)(r=-0.39,P=0.08).There were significant differences in PI,Vd and RI among patients with different ICP(P<0.05).There was no significant difference in Vs among patients with different ICP(P>0.05).Conclusion TCD can better reflect the patient's condition,can play an early warning role in the deterioration of the disease,and has high clinical application value.
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Objective To observe the efficacy of ivabradine combined with levosimendan in patients with acute myocardial infarction complicated with heart failure.Methods A total of 78 patients with acute myocardial infarction complicated with heart failure admitted to the hospital from May 1,2020 to December 31,2022 were selected and divided into control group(n = 39)and study group(n = 39)by random number table method.In addition to basic treatment,the control group received levosimendan,and the study group ivabradine and levosi-mendan.The treatment period of both groups was 4 weeks.Compare two groups of patients'vital signs,clinical curative effect and heart function index,serological indexes,inflammatory factors and security.Results Compared with before treatment,the systolic blood pressure,diastolic blood pressure and heart rate of the two groups were decreased after treatment(P<0.05),and the systolic blood pressure,heart rate,diastolic blood pressure and heart rate of the study group were significantly decreased compared with the control group(P<0.05).Compared with the control group,the total effective rate of the study group was significantly higher(P<0.05).Compared with before treatment,the levels of CO and LVEF were increased(P<0.05),while the levels of LVEDV and LVESV were decreased(P<0.05).Compared with the control group,the levels of CO and LVEF in the study group were higher(P<0.05),and the levels of LVEDV and LVESV in the study group were lower(P<0.05).Compared with before treatment,the levels of cTnI,sST2 and NT-proBNP in both groups were decreased after treatment(P<0.05),and the serum levels of cTnI,sST2 and NT-proBNP in the study group were significantly decreased compared with the control group(P<0.05).Tumor necrosis factor α(TNF-α),myeloperoxidase(MPO)and highly sensitive C-reactive protein(hs-CRP)were all decreased after treatment in the two groups(P<0.05),and those in the study group were much lower(P<0.05)No difference between the incidence of adverse reactions to the total contrast the two groups(P>0.05).Conclusion Levosimendan combined with ivabadinehave a definite effect on patients with acute myocardial infarction complicated with heart failure for the improved cardiac function,reduced inflammation,regulated serum sST2,cTnI,and NT-proBNP level.It is also safe and reliable
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Objective To observe the clinical effect of Yangming meridian acupuncture combined with acupuncture push based on the theory of"treating flaccence and taking Yangming"in the treatment of Guillain-Barre syndrome.Methods 52 cases of patients with conventional rehabilitation combined with Yangming meridian acupuncture combined with acupuncture based on the theory of"treating potence and taking Yangming alone"were taken as the study group and 52 cases of patients with conventional rehabilitation alone as the control group.Limb muscle strength score,clinical efficacy,limb sensory function,limb motor function,upper limb median nerve electrophysiology and daily living ability were compared between the two groups.Results After treatment,muscle strength scores of proximal lower extremity,distal lower extremity,proximal upper extremity,distal upper extremity,median sensory nerve action potential(SNAP),motor conduction velocity(MCV),sensory conduction velocity(SCV)and modified Barthel index(MBI)were increased in 2 groups(P＜0.05).The study group was more obvious(P＜0.05).The total effective rate of the study group(86.54%)was higher than control group(69.23%)(P＜0.05).After treatment,the sensory function and motor function of limbs in 2 groups were better than before treatment(P＜0.05),especially in the study group(P＜0.05).After treatment,the distal motor latency(DML)of upper limb median nerve was decreased in 2 groups(P＜0.05),and more significantly in the study group(P＜0.05).Conclusion Yangming meridian acupuncture combined with acupuncture pushing based on the theory of"treating impotence and taking Yangming"is effective in the treatment of Guillain-Barre syndrome,which can improve the muscle strength,sensation and motor function of limbs,and regulate nerve electrophysiology.
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BACKGROUND:Previous studies on the effects of valgus and varus angles of tibial component on short-term postoperative outcomes after mobile bearing unicompartmental knee arthroplasty have been reported in and outside China.However,there are few reports on the effect of the valgus and varus angles of tibial component on short-term postoperative outcomes after fixed bearing unicompartmental knee arthroplasty. OBJECTIVE:To investigate the effect of valgus and varus angles of tibial component on short-term clinical outcomes in patients with medial knee osteoarthritis undergoing fixed bearing unicompartmental knee arthroplasty. METHODS:120 patients(122 knees)who underwent fixed bearing unicompartmental knee arthroplasty for medial knee osteoarthritis in Department of Orthopedic Surgery,Affiliated Hospital of Xuzhou Medical University from August 2020 to January 2023 were selected as the study subjects.Two physicians measured the varus angle of femoral prosthesis,valgus and varus angles of tibial prosthesis,flexion and extension angles of femoral prosthesis,and posterior inclination angle of tibial prosthesis after unicompartmental knee arthroplasty based on postoperative X-ray.After excluding the influence of the other three angles,the measurement results of the tibial component varus angle were divided into three groups:<-2°,-2° to 2°,>2°,which were denoted as groups 1,2,and 3,respectively.The range of knee motion,the hospital for special surgery knee score,the American knee society score,and forgotten joint score were recorded and compared before and after the operation. RESULTS AND CONCLUSION:(1)A total of 120 patients(122 knees)were enrolled in this study.They were divided into three groups according to the size of the valgus and varus angles of the tibial prosthesis after operation:37 patients in the first group,60 patients in the second group,and 23 patients in the third group.There was no significant difference between the three groups in terms of baseline information such as age,gender,and side of surgery(P>0.05).(2)Patients were followed up for 3-30 months after arthroplasty.(3)The hospital for special surgery knee score of the second group was higher than that of the first group(P=0.015)and the third group(P=0.012).The American knee society score of the second group was significantly higher than that of the first group(P=0.014)and the third group(P<0.001).The forgotten joint score of the second group was higher than that of the first group(P=0.033)and the third group(P=0.016).(4)After fixed bearing unicompartmental knee arthroplasty,when the valgus angle of tibial prosthesis was-2° to 2°,which can achieve better short-term clinical results,the degree of prosthesis self-realization is higher.
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BACKGROUND:Some patients with cervical spondylosis have not been fully corrected sagittal position balance after cervical surgery,and this continuous sagittal position imbalance may be an important reason for the poor long-term clinical outcome of patients. OBJECTIVE:To analyze the correlation between the cervical sagittal position balance parameters and their changes and the clinical efficacy of patients in the unbalanced state after anterior cervical decompression and fusion and to explore the necessity of surgical correction of sagittal balance in order to improve the clinical effect in the later stage. METHODS:A retrospective analysis was performed on 125 patients with cervical spondylosis who underwent anterior cervical decompression and fusion in the Department of Spinal Surgery of Affiliated Hospital of Southwest Medical University from July 2019 to July 2022.Follow-up patients had good postoperative recovery(neck disability index score less than 10%one week after surgery)and had complete follow-up data.According to the axial vertical distance(C2-7 SVA)in sagittal position one week after surgery,patients were divided into type I imbalance group(C2-7 SVA loss≤5 mm,n=27),type Ⅱ imbalance group(C2-7 SVA loss>5 mm,and≤10 mm,n=19),and type Ⅲ imbalance group(C2-7 SVA loss>10 mm,n=12),and non-unbalanced group(C2-7 SVA in the normal range,n=67).The changes of visual analog scale score and neck disability index were compared among groups postoperatively and the last follow-up,as well as the changes of imaging sagittal balance parameters C2-7 cobb angle,C2-7 SVA value,neck inclination angle,T1 inclination angle,and thoracic entrance angle.The correlation between the late clinical effect and postoperative cervical sagittal disequilibrium was explored. RESULTS AND CONCLUSION:(1)There was no statistical difference in general data among the four groups(P>0.05).All patients underwent successful surgery without serious complications and postoperative wound infection.The follow-up time was more than 1 year.(2)There was no significant difference in preoperative symptom score and clinical efficacy one week after surgery(P>0.05).At the last follow-up,pain visual analog scale score,neck disability index and C2-7 SVA were lower than those before surgery but higher than those one week after surgery(P<0.05).C2-7 cobb angle was increased compared with those before operation(P<0.05).T1 inclination angle was decreased compared with those before operation(P<0.05).(3)Pearson correlation test showed that the change of neck disability index was positively correlated with the change of C2-7 SVA(P<0.05).(4)It is indicated that anterior cervical decompression and fusion is effective in the treatment of cervical spondylosis,and can effectively relieve the symptoms of patients.Patients with more severe cervical sagittal disequilibrium after surgery had worse curative effect in the later period.Continuous sagittal disequilibrium in patients with cervical spondylosis after surgery is an important cause of poor curative effect in the later stage.Clinicians should pay more attention to the correction of cervical sagittal balance before and during surgery,formulate surgical strategies and plans according to sagittal balance parameters before surgery,and correct C2-7 SVA intraoperatively to the normal range.
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ObjectiveTo observe the clinical efficacy and safety of Tinglu Yixin prescription in the treatment of patients with heart failure with preserved ejection fraction （HFpEF） combined with diabetes （syndromes of Qi and Yin deficiency and water retention and blood stasis） from taste-based compatibility and descending adverse Qi with bitter and pungent medicinals. MethodA total of 108 HFpEF patients with diabetes （syndromes of Qi and Yin deficiency and water retention and blood stasis） treated in the Nanjing Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Nanjing University of Chinese Medicine from May 2022 to March 2023 were enrolled in this study and randomized into an observation group （54 patients） and a control group （54 patients）. Both groups received conventional Western medicine treatment according to the guide recommendations for chronic heart failure and diabetes， and the observation group additionally received Tinglu Yixin prescription. The treatment course for both groups was 12 weeks. The New York Heart Association （NYHA） grading of cardiac function， left ventricular end diastolic diameter （LVEDD）， left atrium diameter （LAD）， the ratio of early diastolic maximum mitral flow velocity （E） to early diastolic mitral annular motion velocity （e'） （E/e'）， N-terminal pro-B-type natriuretic peptide （NT-proBNP）， hemoglobin A1c （HbA1c）， 6-minute walking test （6MWT）， Minnesota Living with Heart Failure Questionnaire， traditional Chinese medicine （TCM） syndrome scores， and safety indicators were determined before and after treatment. ResultFinally， 104 patients were included for analysis， including 52 patients in the observation group and 52 patients in the control group. After treatment， 35 and 47 patients in the control and observation groups showed improved cardiac function， which indicated the total response rates of 67.3% and 90.4%， respectively. The total response rate regarding the cardiac function in the observation group was higher than that in the control group （χ2=2.754， P<0.05）. The observation group outperformed the control group in reducing LVEDD and LAD （P<0.05）， decreasing the E/e' ratio （P<0.05）， lowering the NT-proBNP and HbA1c levels （P<0.05）， and recovering the 6MWT and Minnesota quality of life score TCM syndrome scores （P<0.05）. None of the safety indicators in the two groups showed abnormal values before and after treatment， and no serious adverse reaction was observed. ConclusionTinglu Yixin prescription can improve the heart function， exercise tolerance， and quality of life， lower the HbA1c level， and alleviate the TCM syndrome in the patients with HFpEF combined with diabetes （syndrome of qi and yin deficiency and water stagnation and blood stasis）.
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OBJECTIVE To compare the clinical effects of different doses of meropenem in the treatment of septic shock. METHODS One hundred and six patients with septic shock were randomly divided into standard-dose group and high-dose group， with 53 cases in each group. Patients in the standard-dose group were given standard dose of meropenem （initial intravenous injection of 1 g meropenem more than 30 minutes， followed by 1 g meropenem intravenously every 8 hours， each time for more than 3 hours）； patients in the high-dose group were given high dose of meropenem （initial intravenous injection of 2 g meropenem more than 30 minutes， followed by 2 g meropenem intravenously every 8 hours， each time for more than 3 hours）； other treatment measures were determined based on the specific conditions of the patients. The main observation indicators were the increments of sequential organ failure assessment （SOFA） scores and simplified acute physiology score Ⅱ （SAPS Ⅱ） after 3， 5 and 7 days of treatment in both groups. Secondary observation indicators included in-hospital mortality， 90-day all-cause mortality， 7-day microbial cure rate， 7-day clinical cure rate， serum procalcitonin （PCT） and C-reactive protein （CRP） levels after 3， 5 and 7 days of treatment， hospitalization days in the intensive care unit， ventilator treatment days， the highest dose of norepinephrine. The occurrence of adverse drug reaction in the two groups was observed. RESULTS The increments of SOFA scores and SAPS Ⅱ after 7 days of treatment， the levels of PCT and CRP after 5 and 7 days of treatment as well as the 90-day all-cause mortality in the high- dose group were significantly lower than the standard-dose group （P＜0.05）. There were no statistically significant differences in other indicators between the two groups （P＞0.05）. CONCLUSIONS High-dose meropenem treatment for septic shock has better clinical effects and is safer than standard-dose meropenem.
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Gastric cancer （GC） is a common malignant tumor of the digestive tract. T helper cells 17 （Th17） and T regulatory cells （Treg） are differentiated subsets of CD4+T cells. Th17/Treg imbalance has been shown to be closely related to the progression of GC. Traditional Chinese medicine （TCM） can not only improve the survival prognosis of GC patients， but also play a role in enhancing the efficacy and reducing the toxicity of postoperative chemotherapy for GC. This paper systematically sorted out the action rules of TCM in the intervention of GC by regulating Th17/Treg balance. The results showed that the TCM compound could regulate the balance of GC Th17/Treg by invigorating the spleen and invigorating Qi， warming Yang， removing blood stasis and detoxifying. The mechanism of regulating Th17/Treg balance in the intervention of GC is mainly to inhibit the excessive differentiation of Th17 and Treg and the overexpression of transcription factors and cytokines， reverse the excessive drift of GC Th17/Treg balance to Th17 or Treg， and thus restore the immune balance of GC Th17/Treg.
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Objective The aim of this study is to investigate the efficacy of using transcatheter aortic valve replacement(TAVR)with self-expanding valve(SEV)to treat patients with pure aortic regurgitation(PAR)and to understand the preliminary experience of such procedure.Methods A total of 20 PAR patients who underwent TAVR using the TaurusElite system at Wuhan Asia Heart Hospital and Wuhan Asia Heart Disease Hospital from April 2022 to May 2023 were included in the study.Patient baseline data,echocardiographic data,follow-up data during hospitalization and 30 days after the procedures were collected and analyzed.Results The mean age of the patients was(73.5±5.5)years,and the mean STS score was(8.7±3.6)％.16(16/20)cases had severe PAR before the procedure.After TAVR treatment,the success rate of the procedure was 20/20,with only 1 case of valve-in-valve(ⅥⅤ).The 30-day follow-up results showed that none of the 20 patients experienced death,disabling stroke,myocardial infarction,and conversion to surgery.The degree of residual PAR after the procedure was none or mild in all patients.The interventional outcome was ideal.Conclusions The preliminary experience shows that,with strict patient selection and standardized procedural steps,using TAVR with SEV to treat patients with PAR could have high feasibility and ideal early clinical outcomes and can potentially be popularized.Such experience will be further validated in future clinical trials.
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Objective:To evaluate the technical approach and application value of DynaCT biliary reconstruction with CT images fusion (DynaCT-CT fusion) for the treatment of complex hepatolithiasis.Methods:The data of 18 patients with complex hepatolithiasis admitted to the First Affiliated Hospital of Guangzhou Medical University from May 2022 to October 2022 were retrospectively analyzed, including 7 males and 11 females, aged (50.6±15.0) years. Preoperative DynaCT biliary reconstruction with CT images fusion was performed to guide the percutaneous transhepatic one-step biliary fistulation (PTOBF). The technical data, including the bile duct with stones identified by preoperative imaging, the actual bile duct with stones confirmed intraoperatively, the satisfied stone removal time for each targeted bile duct, the actual stone removal time for each targeted bile duct, the intraoperative identification of CT-negative stones, the postoperative complications and reoperation were analyzed.Results:In 18 patients, a total of 95 target bile ducts with stones were identified by preoperative DynaCT-CT fusion technology, involving the first, secondary and tertiary bile ducts. Preoperative CT identified 29 lesions of stones involving the first and secondary bile ducts. CT negative stones were confirmed in 5 patients by DynaCT-CT fusion. Bile duct stricture occurred in 12 patients. All procedures were completed without postoperative bile leakage or hemorrhage. A total of 82 lesions of stones were successfully removed with a removal time of (25.9±12.8) min. The satisfied stone removal time for each targeted bile duct was (10.1±7.6) min, and the actual stone removal time was (10.5±7.4) min. Immediate stone clearance was achieved in 13 patients. Biliary tract infection occurred in 2 patients, and 5 patients underwent reoperation for residual or recurrent stones.Conclusion:The DynaCT-CT fusion technology guided PTOBF is feasible and safe in patients with complex hepatolithiasis. It could effectively detect more stones, shorten the stone clearance time. DynaCT-CT fusion technology provides a new strategy for the treatment of hepatolithiasis.
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Objective:To explore the clinical efficacy of hip arthroscopy (HA) and periacetabular osteotomy (PAO) in the treatment of borderline developmental dysplasia of the hip (BDDH).Methods:The clinical data of 57 patients with BDDH treated with HA or PAO from July 2016 to June 2020 were retrospectively studied. According to surgical methods, they were divided into HA group and PAO group. There were 32 patients (6 males and 26 females) in HA group, with an average age of 34.5±6.4 years, ranging from 19 to 47 years. There were 25 patients (5 males and 20 females) in the PAO group, with an average age of 37.2±6.9 years, ranging from 21 to 50 years. Patients were followed up till May 2023. Imaging data of patients before the surgery and during follow-up were collected including lateral center edge angle (LCEA), anterior center edge angle (ACEA), extrusion index, T?nnis angle, femoral neck anteversion angle, and T?nnis grade. The modified Harris hip score (mHSS), non-arthritic hip score (NAHS) and hip outcome score activity of daily living scale (HOS-ADL) were evaluated at 6 months, 12 months and the final follow-up.Results:All patients were followed up for an average of 54.2±8.2 months in HA group and 55.5±9.4 months in PAO group separately. Before surgery, there were no significant differences in LCEA, ACEA, T?nnis angle, extrusion index, femoral neck anteversion angle and T?nnis grade between the two groups ( P>0.05). α angle of HA was 60.8°±5.8°, which was significant different from α angle of PAO 53.0°±5.9° ( t=5.07, P<0.001). At the final follow-up, in HA group, LCEA, ACEA, T?nnis angle, extrusion index were 20.0°±2.1°, 20.0°±2.6°, 30.6%±2.3%, 10.8°±1.6°, 39.8°±5.4, which were all significantly different from pre-operation data ( P<0.05). While there was no significant difference between pre- and post-operation in T?nnis grade (χ 2=5.72, P=0.057). In PAO group, LCEA, ACEA, T?nnis angle, extrusion index were 33.0°±3.0°, 33.3°±4.0°, 15.0%±4.0%, 2.8°±1.7° which were all significantly different from pre-operation data ( P<0.05). While there were no significant differences between pre- and post-operation in α angle and Tonnis grade ( P>0.05). Between HA group and PAO group, there were significant differences in LCEA, ACEA, T?nnis angle, extrusion index and α angle ( P<0.05), while no significant difference was found in T?nnis grade (χ 2=3.024, P=0.996). There were no significant differences between the two groups in preoperative mHHS, NAHS and HOS-ADL ( P>0.05). At 6 months,12 months and the final follow-up after operation, the mHHS, NAHS and HOS-ADL were significantly improved compared to pre-operation data ( P<0.05). At 6 months and 12 months after operation, the three hip function scores in HA group were significantly better than those in PAO group ( P<0.05). At the final follow-up, there was no significant difference in three hip scores between the HA group and the PAO group ( P>0.05). Conclusion:Both HA and PAO can achieve good short- and mid-term clinical efficacy in the treatment of BDDH. Specifically, HA is superior to PAO in the early clinical efficacy, and the mid-term clinical efficacy is similar. PAO is able to improve the acetabular radiographic parameters of BDDH (except α angle) while HA can only improve α angle. However, they all can effectively delay the imaging progression of hip osteoarthritis.
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Objective:To compare the efficacy of endoscopic submucosal dissection (ESD) and surgery for circumferential superficial esophageal squamous cell neoplasm.Methods:A retrospective analysis was performed on 153 patients with superficial esophageal squamous cell neoplasm who underwent ESD or surgery at Cancer Hospital, Chinese Academy of Medical Sciences from November 2013 to October 2021. There were 116 cases in ESD group and 37 cases in the surgical group. The en block resection rate, complete resection rate, operation time, perioperative complication incidence, postoperative quality of life, postoperative disease-free survival and overall survival were compared.Results:In the ESD group, the en block resection rate was 100.0% (116/116) and the complete resection rate was 96.6% (112/116). The longitudinal diameter of lesion had no significant correlation with complications or complete resection rate ( P>0.05). The operation time of the ESD group was significantly shorter than that of the surgical group (175.1±52.2 min VS 266.7±88.2 min, t=-5.991, P<0.001). There was no significant difference in the incidence of perioperative complications between the ESD group and surgical group [5.2% (6/116) VS 8.1% (3/37), P=0.452]. According to EORTC-QLQ-C30 and EORTC-QLQ-OES18, emotional function ( P=0.008),cognitive function ( P=0.013) and the total health level ( P<0.001) of the ESD group were significantly higher than those in the surgical group. Fatigue ( P=0.002), pain ( P<0.001), dyspnea ( P<0.001), insomnia ( P<0.001), anorexia ( P<0.001), diarrhea ( P<0.001) and reflux ( P<0.001) in the surgical group were significantly higher than those in ESD group. There was no significant difference in disease-free survival or overall survival between the two groups ( P>0.05). Polyglycolic acid combined with autologous esophageal mucosal transplantation combined with temporary esophageal stent implantation could reduce the rate of esophageal scar stenosis after ESD [53.3% (24/45) VS 100.0% (55/55), P<0.001] and significantly reduce the number of postoperative dilation [1.00 (0.00, 5.00) VS 9.00 (5.00, 14.00), P<0.001] compared with balloon dilation alone. Conclusion:ESD is superior to traditional surgery for the treatment of circumferential superficial esophageal squamous cell neoplasm because of high operational safety, shorter operation time, less trauma, better postoperative life quality. Postoperative esophageal stenosis can still be well cured after endoscopic treatment. Therefore, ESD can be used as the first choice for the treatment of circumferential superficial esophageal squamous cell neoplasm.
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Objective To observe the clinical effect of Yi'naokang Capsules combined with Donepezil Hydrochloride Tablets in treating post-stroke cognitive impairment(PSCI).Methods 110 patients who met the diagnostic criteria of PSCI in the outpatient department were included.According to the random number table method,the patients were divided into trial group and control group,with 55 cases in each group.Patients in control group were treated with routine western medicine,including the treatment of Donepezil Hydrochloride Tablets and secondary prevention of stroke such as lowering blood pressure,lowering blood lipid,lowering blood glucose and anti-platelet aggregation.The trial group was treated with Yi'naokang Capsules on the basis of the treatment in control group,and both groups were treated for 6 months.Before and after 6 months of treatment,the cognitive function of patients was evaluated by the Montreal Cognitive Assessment(MoCA)scale.The activity of daily living(ADL)scale was used to evaluate the ability of daily living,and the severity of cerebral white matter lesions was evaluated by Fazekas scale,and the adverse reactions were also observed.Results After 6 months of treatment,the total score of the MoCA,the scores of visual space and executive function,attention,delayed recall and the ADL of the two groups were all improved(P＜0.05),and the improvement degree of the trial group was better than that of the control group(P＜0.05).The Fazekas score of the trial group after treatment was no significant difference when compared with that before treatment(P＞0.05),but it increased in the control group after treatment(P＜0.05),and the effect of delaying white matter lesion in the trial group was better than that in the control group(P＜0.05).Conclusion Yi'naokang Capsules combined with Donepezil Hydrochloride Tablets are superior to Donepezil alone in the treatment of PSCI,which can safely and effectively improve the cognitive function and daily living ability of patients,as well as prolong the progress of white matter lesions.
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@#Objective To systematically review the clinical effect of music therapy in patients with insomnia. Methods PubMed,Web of Science,Embase,CBM,CNKI,Wanfang Data,and VIP were searched for related articles published up to December 3 2021,and literature screening and data extraction were performed strictly according to the inclusion and exclusion criteria. RevMan 5.3 and Stata 16.0 were used for data analysis and evaluation. Results A total of 20 randomized controlled trial articles were included,with 1378 patients in total, among whom there were 704 patients in the experimental group and 703 patients in the control group. The meta-analysis showed that music therapy effectively improved the symptoms of patients with insomnia,with significant differences in clinical response rate (risk ratio=1.66,95% confidence interval [CI]:1.35-2.05,P<0.001),PSQI score (weighted mean difference [WMD]=-1.10,95%CI -1.57 to-0.63,P<0.001),and ISI score (WMD=-0.30,95%CI -0.76 to -0.15,P=0.19). Conclusion Music therapy has obvious advantages and therapeutic significance in the clinical observation of patients with insomnia. Clinical response rate and PSQI score are mainly selected as outcome measures in most articles,and therefore,more sleep indicators can be used for outcome observation.
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Objective:To explore the clinical effect of laparoscopic anatomical hepatic segment Ⅷ (S8) resection.Methods:Of 16 patients with liver cancer who underwent laparoscopic anatomical hepatic S8 resection at the National Cancer Center from October 2020 to October 2022 were were enrolled, including 13 males and 3 females, aged (59.1±10.9) years. The operation time, intraoperative blood loss, occurrence of intraoperative blood transfusion, and postoperative complications were retrospectively analyzed. Recurrence and survival were followed up by outpatient and telephone reviews.Results:Laparoscopic anatomical hepatic S8 resection was successfully performed in 16 patients without conversion to laparotomy. Among them, 10 patients underwent the intraoperative ultrasound guided hepatic parenchymal approach, and 6 underwent laparoscopic Glissonean pedicle puncture for the positive staining of S8 using indocyanine green. The operation time was (274.8±82.8) min, and the intraoperative blood loss was [ M( Q1, Q3)] 100.0 (50.0, 200.0) ml. There were no intraoperative blood transfusion or postoperative complication. The drainage tube was successfully removed and the patients were discharged 5 to 7 days after surgery. The patients were followed up for 5 to 24 months and all survived. Two patients had tumor recurrence. Conclusion:Laparoscopic anatomical S8 resection is safe and feasible.
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Objective:To analyze the clinical effect of small incision approach conjoint fascial sheath (CFS) suspension in the treatment of congenital severe blepharoptosis, and to discuss its advantages and disadvantages compared with conventional CSF suspension.Methods:From February 2020 to August 2022, 42 cases of severe blepharoptosis in the Department of Burn, Plastic and Cosmetic Surgery, Shaanxi Provincial People's Hospital were divided into the observation group (23 cases, 39 eyes) and the control group (19 cases, 37 eyes). The observation group was treated with small incision CFS suspension surgery, while the control group was treated with conventional CFS suspension surgery. The correction effect, complications, recovery time and other conditions between the two groups at different times after surgery were compared.Results:During postoperative follow-up at 1 week, 1 month, 3 months, and 6 months, there was no significant difference in the corrective effect between the two surgical methods at each time point (all P>0.05). The incidence of complications in the observation group at each time point that was 26.3%, 15.7%, 10.5%, and 5.2%, respectively, while the incidence of complications in the control group was 60.0%, 20.0%, 14.2%, and 8.6%, with statistical differences in the first week after surgery (χ 2=8.74, P=0.011). The average postoperative swelling time in the observation group was 4.2 days, which was less than 5.8 days in the control group. During a 6-month follow-up, it was found that there was a decrease in scar hyperplasia in the observation group of 9.1% (2/22) compared to the control group of 16.7% (3/18) (χ 2=0.023, P=0.878). The difference was of no statistical significance. Conclusions:CFS suspension with small incision in the treatment of moderate and severe blepharoptosis has the advantages of ideal correction effect, small damage range, and few postoperative complications, but the operation area is small, the operation is difficult, and the surgeon has higher requirements.
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AIM: To investigate the changes in retinal nerve fiber layer(RNFL)and macular retinal thickness(MRT)in children with refractive abnormalities and amblyopia, and their predictive value of outcome.METHODS: A total of 168 children with myopic refractive abnormalities and monocular amblyopia admitted to our hospital from January 2020 to October 2022 were selected as the observation group, with 118 cases of mild to moderate amblyopia and 50 cases of severe amblyopia, and 168 children with normal vision were included as the control group in a 1:1 ratio during the same period. The changes of RNFL and MRT in two groups of children were statistically counted, and the correlation between the severity of refractive abnormalities and RNFL and MRT in children with amblyopia was analyzed. Additionally, the observation group was divided into effective subgroup and ineffective subgroup based on the therapeutic effect. The general information, as well as RNFL and MRT of the effective subgroup and the ineffective subgroups before and after treatment were compared. Logistic was used to analyze the factors influencing efficacy, and ROC curves was plotted to analyze the predictive value of RNFL and MRT alone or in combination for efficacy.RESULTS: RNFL and MRT of cases of severe amblyopia were higher than those of the mild to moderate amblyopia and the control groups(all P&#x003C;0.05); the severity of amblyopia in children with refractive abnormalities is positively correlated with RNFL and MRT(rs=0.745 and0.724, both P&#x003C;0.001); among patients of mild to moderate and severe, there were statistically significant differences between the effective and ineffective subgroups in terms of initial treatment age, fixation form, treatment compliance, as well as RNFL, MRT, and their differences before and 1mo postoperatively(all P&#x003C;0.05). Logistic analysis showed that initial treatment age, fixation nature, treatment compliance, RNFL and MRT before and 1mo postoperatively were all factors influencing the therapeutic effect of amblyopia with refractive abnormalities in children(all P&#x003C;0.05); after 1mo of treatment, the combined prediction of RNFL and MRT was significantly better than that of single prediction in children with mild to severe amblyopia.CONCLUSION:There are differences in RNFL and MRT in children with abnormal refractive amblyopia, and they are closely related to the different degrees and curative effects of children. The combination of RNFL and MRT after 1mo of treatment has certain value in predicting children with different degrees of abnormal refractive amblyopia.
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ObjectiveTo explore the clinical efficacy and safety of Qifu Yixin prescription in treating chronic heart failure in the patients with the syndrome of heart Qi deficiency， so as to provide clinical evidence for the treatment of chronic heart failure with this prescription and promote the clinical application and transformation of this prescription. MethodA total of 106 chronic heart failure patients with the syndrome of heart Qi deficiency who met the criteria in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine （TCM） from September 2022 to May 2023 were selected and randomized into an observation group （53 cases） and a control group （53 cases）. Both groups received routine Western medicine treatment. In addition， the observation group received Qifu Yixin prescription， while the control group received placebo. The treatment course for both groups was 12 weeks. The New York heart association （NYHA） cardiac function grading， N-terminal pro-B-type natriuretic peptide （NT-proBNP）， soluble growth-stimulating expression gene 2 （sST2）， left ventricular ejection fraction （LVEF）， the ratio of early diastolic maximum mitral flow velocity （E） to early diastolic mitral annular motion velocity （e'） （E/e'）， left ventricular end diastolic diameter （LVEDD）， TCM syndrome scores， 6-minute walking test （6MWT）， Minnesota Living with Heart Failure Questionnaire （MLHFQ）， and Kansas City Cardiomyopathy Questionnaire （KCCQ） were determined before and after treatment. ResultFinally， 102 patients were included for analysis， including 51 patients in the observation group and 51 patients in the control group. After treatment， 42 patients in the observation group showed improved cardiac function grading， with a total response rate of 82.35%， and 32 patients in the control group showed improved cardiac function grading， with a total response rate of 62.75%. The total response rate regarding the cardiac function in the observation group was higher than that in the control group （χ2=4.923， P<0.05）. The observation group outperformed the control group in lowering the NT-proBNP level， elevating LVEF， decreasing the E/e' ratio （P<0.05）， reducing LVEDD and sST2 levels， and recovering TCM syndrome score， 6MWT score， MLHFQ score， and KCCQ score （P<0.05）. None of the safety indexes in the two groups showed abnormal values before and after treatment， and no serious adverse reaction was observed. ConclusionQifu Yixin prescription can improve the heart function， exercise tolerance， and quality of life and alleviate the TCM syndrome of the chronic heart failure patients with the syndrome of heart Qi deficiency by inhibiting myocardial fibrosis.