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Closed-loop hospital management can effectivly cope with the COVID-19 pandemic. In order to ensure the continuity of treatments for hemodialysis patients under closed-loop management and minimize possible medical and infection risks, Huashan Hospital affiliated to Fudan University and 9 hospitals in Shanghai established a hemodialysis alliance in January 2021.The alliance optimized hemodialysis resources within the region through overall planning by preparing sites, materials and personnel shifts in advance, and establishing management systems and work processes to ensure that patients could be quickly and orderly diverted to other blood dialysis centers for uninterrupted high-quality hemodialysis services, in case that some hemodialysis centers in the alliance under closed-loop management.From November 2021 to April 2022, 317 of 1 459 hemodialysis patients in the alliance were diverted to other centers for treatment, accumulating 1 215 times/cases of treatments without obvious adverse reactions. The practice could provide a reference for medical institutions to quickly establish mutual support mode under major public health events.
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Objective To observe the effect of high flux hemodialysis (HFHD) combined with artificial kidney on fibroblast growth factor-23 (FGF-23) in patients with maintenance hemodialysis (MHD). Methods Eighty cases who regularly carried out long-term HFHD in nephrology blood purification center of NO.85 Hospital of PLA were enrolled. All the patients firstly received HFHD alone for 1 month, and then according to random principle, they could receive HFHD followed by hemoperfusion (HP) for treatment (HFHD+HP group) or HP followed by HFHD for treatment (HP+HFHD group). These two types of treatment were respectively carried out for 3 months, and then exchanged to proceed the procedure, the interval of exchange being 1 month (in this month, the two groups of patients all underwent simple HFHD treatment). The therapeutic course was 8 months including 2 cycles. The serum samples were taken from patients undergoing simple HFHD before and after the first month of blood purification, and patients in HFHD+HP group and HP+HFHD group before and after the last month for determination of serum creatinine (SCr), calcium, phosphorus, parathyroid hormone (iPTH), FGF-23 levels. Results The SCr level in HFHD + HP group before hemodialysis was significantly lower than that in simple HFHD group (μmol/L:773.45±212.23 vs. 803.27±192.47, P0.05). After hemodialysis, the serum iPTH, FGF-23 were dropped significantly in HFHD + HP and HP + HFHD groups compared with those in simple HFHD group (P 0.05). But the levels of serum phosphorus, iPTH, and FGF-23 in HFHD+HP group were significantly lower than those of HP+HFHD group [serum phosphorus (mmol/L):1.47±0.22 vs. 1.60±0.23, iPTH (μg/L):490.12±145.23 vs. 516.34±165.75, FGF-23 (μg/L): 802.11±92.58 vs. 822.39±107.23, P < 0.05 or P < 0.01]. Conclusions In the aspect of elimination of large and medium sized molecules, the effect of combined artificial kidney is much better than that of simple HFHD. The rates of toxin elimination in different types of combined artificial kidney treatment are different, and the HFHD+HP type has greater effect than HP+HFHD type on elimination of toxins with large or medium sized molecules such as iPTH, FGF-23, etc.
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<p><b>OBJECTIVE</b>To evaluate the therapeutic effect of pedicled muscular flaps combined with partial thoracotomy for treatment of pythorax-resulted wounds and defects.</p><p><b>METHODS</b>35 cases with pythorax-resulted refractory infected wound and dead space, were retrospectively analyzed. The wound and dead space were eliminated with pedicled muscular flaps, including latissimus dorsi muscular flaps and serratus anterior muscle flaps in 21 patients, pectoralis major muscle flaps with rectus muscle flaps in 8 patients, latissimus dorsi muscul flaps and vertical rectus muscle flaps in other 6 patients.</p><p><b>RESULTS</b>34 flaps survived completely except for 1 verticle rectus muscular flap with partial necrosis at distal end. Primary healing was achieved in 29 cases. The other 6 cases were discharged with drainage. Among the 6 cases, 3 cases healed spontaneously, 2 cases underwent reoperation, 1 case need long-term drainage in the fistula.</p><p><b>CONCLUSION</b>Pedicled muscular flap, combined with partial thoracotomy can effectively treat refractory wound and dead space resulted by pythorax.</p>
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Humanos , Terapia Combinada , Métodos , Empiema Pleural , Cirurgia Geral , Retalho Miocutâneo , Transplante , Músculos Peitorais , Transplante , Reoperação , Estudos Retrospectivos , Músculos Superficiais do Dorso , Transplante , Toracotomia , Métodos , CicatrizaçãoRESUMO
Objective To analyze safety,efficacy and resection methods of video-assisted thoracic surgery(VATS) for the treatment of intralobar pulmonary sequestration(IPS).Methods Data of 17 patients who were diagnosed as IPS and received VATS from December 2006 to September 2011 were retrospectively analyzed.The patients were 7 males and 10 females with the mean age of 40.3 (14-61) years.Diagnosis was confirmed in 9 patients by enhanced CT and unconfirmed in 8 patients.Three ports were used for surgery.After the aberrant artery was confirmed,liner stapler was used in 16 patients to cut it and Hem-o-lok was used in 1 patient because the aberrant artery was about 3 mm in diameter and long enough.If the diameter of the aberrant artery was longer than 10 mm,a stapling device without knife was used to occlude it centrally and a second stapling device was used to cut it peripherally.Wedge resection or lobectomy was performed due to the different conditions.When the lesion was small with linited range in CT image and the lesion was easily distinguished from normal lung tissue during operation,wedge resection was preferred.Results Seventeen patients underwent VATS successfully without any conversion to thoracotomy or any serious complications.Five patients were planned to receive wedge resection and one was converted to lobectomy.Another 12 patients were planned to receive lobectomy and all succeeded.The mean operating time was 128 (80-170)min.The mean blood loss was 80 (5-200) ml.The mean days of chest tube maintained were 4.0 (2-6) days.The mean postoperative hospitalization days were 7.6 (4-11) days.All patients were diagnosed as IPS according to operating in-sight and postoperative pathology.There was no patient suffering from chronic cough,bloody sputum or recurrent pneumonia during the follow-up.Conclusion VATS for the treatment of IPS is safe and feasible.If conditions permit,wedge resection or segmentectomy may be preferred.
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Objective To investigate the correlations of the expressions of CXCR4 and vascular endothelial growth factor (VEGF) in esophageal cancer and their associations with patients' clinicopathological features.Methods The paraffin-embedded samples of 127 patients with esophageal cancer treated by thoracic surgery in Zhongshan Hospital in 2005 were collected. The CXCR4 and VEGF expressions in esophageal cancer tissues were detected with immunohistochemical technique. The immunostaining was evaluated according to the staining area and intensity. Results The overall expression rate was 88.2% and 79.5%, respectively. CXCR4 expression was significantly associated with tumor grade, size, tumor depth, regional lymph node metastasis and TNM stage (P<0.05);VEGF expression was significantly associated with tumor depth, TNM stage and tumor grade.In addition, there were significant correlations between CXCR4 and VEGF (P<0.01). Conclusions There was significant association between CXCR4, VEGF expressions and clinicopathological features of esophageal cancer. There might be some potential correlation between CXCR4 and VEGF expression in esophageal cancer.
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Objective To investigate appropriate diagnosis and treatment of solitary fibrous tumor of the pleura (SFTP).Methods Clinical and pathological data of ten patients treated in our hospital from 2002 to 2007 were reviewed. Results Our series consisted of three men and seven women. In two patients correct diagnosis was made before operation through ultrasonography-gnided core needle biopsy. All the patients were treated surgically including three resected by video-assisted thoracic surgery (VATS). Histopathologically, five tumors were malignant and the other five were benign. Immunohistochemical staining showed malignant SFTP (3/5) were less frequently positive for CD34 than benign group (5/5). Nestin was only detected in malignancies (2/5), which were negative for CD34. Except for one, all patients were followed-up for 6 to 35 months (mean 17.3 months). One patient experienced a recurrence and one died of brain metastasis. Conclusion Ultrasonography-guided core needle biopsy combined with immunohistochemical analysis is a safe and rapid method to provide a confirmatory diagnosis before surgery. For smaller, pedunculated tumors, VATS may be a bettor approach. Besides, we speculated CD34-negative and nestin-posifive might be a malignant marker for SFTP.
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Purpose:To investigate the mechanisms,susceptibility,prevention and treatment of the tumor patients'renal function,which was injured by the Body Gama Kinfe treatment.Methods:There were 7 patients,who had been observed for the effect of hydration,vaso-dilation,diuresis,basifying urine,anti-coagulation,detocifiation,even hemodialysis.Results:All patients' renal function gradually recovered.Conclusions:The tumour patients' renal function can be acutely injured by Body Gama Kinfe treatment.The patients who were elderly or inherent in renal failure would be prone to injary.In general we could improve the situation by better prevention,early-diagnosis,efficient treatment,so that we can not only alleviate the injuries,but also speed recovery,thus achieving better prognosis.