Two cases of familial benign pemphigus treated with botulinum toxin type A / 中华皮肤科杂志

Botulinum toxin type A was firstly used to treat two patients with familial benign pemphigus, who showed poor response to conventional therapies. Case 1, a 64-year-old male patient, presented with erythema and erosions on bilateral axillary and inguinal regions for 2 years, and was injected with botulinum toxin type A at a dose of 50 U in the right axillary fossa and right groin separately. Case 2, a 33-year-old female patient, presented with erythema and blisters on bilateral axillary and inguinal regions and the right waist for 9 years, and was injected with botulinum toxin type A at a dose of 25 U in the left axillary fossa, right waist and bilateral groins separately. After the injection of botulinum toxin type A, sweating was inhibited in the 2 patients within 1 week, and skin lesions were gradually attenuated within 2 weeks. One month after the injection, erythema and erosions on bilateral axillary and inguinal regions mostly regressed in the case 1, and no recurrence was observed during 18-month follow-up. Six weeks after the injection, most of the skin lesions regressed in the case 2, only patchy hyperpigmentation was observed, and no obvious new lesions occurred. A few lesions recurred in the case 2 during 10-month follow-up, but were attenuated after the treatment with topical glucocorticoids.

Clinical efficacy of transanal minimally invasive surgery with glove method and transanal endoscopic microsurgery in the treatment of rectal neoplasms / 中华消化外科杂志

Objective:To investigate the clinical efficacy of transanal minimally invasive surgery (TAMIS) with glove method and transanal endoscopic microsurgery (TEM) in the treatment of rectal neoplasms.Methods:The retrospective cohort study was conducted. The clinicopathological data of 60 patients with rectal neoplasms who were admitted to the First Affiliated Hospital of Fujian Medical University from March 2015 to May 2017 were collected. There were 34 males and 26 females, aged from 49 to 74 years, with an average age of 62 years. Of the 60 patients, 30 undergoing TAMIS with glove method and 30 undergoing TEM were allocated into TAMIS group and TEM group, respectively. Observation indicators: (1) surgical situations and postoperative recovery; (2) postoperative short-term complications; (3) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect tumor recurrence and metastasis up to August 2018. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Count data were represented as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact propability. Comparison of ordinal data between groups was analyzed by the Mann-Whitney U test. Results:(1) Surgical situations and postoperative recovery: patients in the two groups underwent surgery successfully. The operation time, volume of intraoperative blood loss, time to postoperative first flatus, time to postoperative semi-fluid diet intake, postoperative anal pain score, duration of postoperative hospital stay and cases with Kirwan classification Ⅰ, Ⅱ, Ⅲ, Ⅳ, Ⅴ of anus function at 3 months after surgery were respectively (35±7)minutes, (9±5)mL, (2.7±0.9)days, (2.9±0.6)days, 2.1±0.9, (3.6±1.9)days, 29, 1, 0, 0, 0 in the TAMIS groups and (38±7)minutes, (9±6)mL, (2.5±0.8)days, (2.7±0.7)days, 1.8±0.9, (4.0±2.3)days, 28, 1, 1, 0, 0 in the TEM group, showing no significant difference in the above indicators between the two groups ( t=-1.377, -0.099, 0.931, 0.770, 1.418, -0.789, Z=-0.607, P>0.05). Total operation time and treatment expenses were (38±7)minutes and (8 507±1 471)yuan in the TAMIS group, versus (46±7)minutes and (9 551±1 747)yuan in the TEM group, showing significant differences between the two groups ( t=-4.628, -2.506, P<0.05). Results of postoperative pathological examination showed negative margin in the two groups. (2) Postoperative short-term complications: of 2 patients with postoperative short-term complications in the TAMIS group, 1 had postoperative urine retention due to preoperative prostatic hyperplasia and was improved after 3 days of bladder training, 1 was diagnosed as sepsis due to postoperative cold and fever at 2 days after operation with escherichia coli detected in blood culture, and the patient was cured after anti-infection treatment. Of 3 patients with postoperative short-term complications in the TEM group, 1 had anal incontinence at 2 days after operation and was improved after 4 days of anus function exercise, 1 had hematochezia and was improved after hemostatic therapy under colonoscopy, 1 had perineal infection and was improved after anti-inflammation. There was no significant difference in the short-term complications between the two groups ( P>0.05). (3) Follow-up: patients in the TAMIS group and TEM group were respectively followed up for (17±4)months and (16±3)months, with no significant difference between the two groups ( t=0.200, P>0.05). During the follow-up, 1 case of rectal tubular adenoma in the TAMIS group had local tumor recurrence at 1 year after surgery, with a diameter of about 0.5 cm and a distance of about 12 cm from the anal margin. The patient had no recurrence after endoscopic retreatment and was confirmed tubular adenoma by postoperative pathological examination. One patient with poorly differentiated adenocarcinoma in the TEM group was detected mesorectal lymph node metastasis at 6 months after surgery by magnetic resonance imaging examination and underwent laparoscopic radical resection of rectal cancer. The postoperative pathological examination showed no residual cancer cells in the rectum specimen and there was 1 positive in 15 lymph nodes for pathological examination. No tumor recurrence or metastasis occurred by the end of follow-up. There was no significant difference in postoperative tumor recurrence and metastasis between the two groups ( P>0.05). Conclusions:The clinical efficacy of TAMIS with glove method in the treatment of upper-middle rectal neoplasms is comparable to TEM, which is safe and feasible. In addition, the TAMIS with glove method has shorter time and lower treatment expenses.

Application value of different digestive tract reconstruction methods in laparoscopic distal gastrectomy / 中华消化外科杂志

Objective To investigate the application value of different digestive tract reconstruction methods in laparoscopic distal gastrectomy (LDG).Methods The retrospective cohort study was conducted.The clinicopathological data of 164 with early gastric cancer (GC) who were admitted to the First Affiliated Hospital of Fujian Medical University between June 2010 and April 2015 were collected.Of 164 patients undergoing LDG,45 receiving Billroth Ⅰ (B Ⅰ) anastomosis,39 receiving Billroth Ⅱ (B Ⅱ) anastomosis,44 receiving Roux-en-Y anastomosis and 36 receiving uncut Roux-en-Y anastomosis were allocated into the B Ⅰ group,B Ⅱ group,RY group and uncut RY group,respectively.Observation indicators:(1) surgical and postoperative recovery situations;(2) postoperative short-term complications situations;(3) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative nutriology and long-term complications up to May 2017.Measurement data with normal distribution were represented as x±s.Comparison among groups was analyzed using the ANOVA,and pairwise comparisons were done by the Tukey hsd test.Count data were described as the frequency and percentage,and comparisons among groups were analyzed the chi-square test or Fisher exact probability.Ordinal data were analyzed by the Kruskal Wallis test.Results (1) Surgical and postoperative recovery situations:patients in 4 groups underwent successfully LDG.Cases undergoing total LDG and assisted LDG and digestive tract reconstruction time in the B Ⅰ,B Ⅱ,RY and uncut RRY groups were respectively 0,29,13,15 and 45,10,31,21 and (42±7)minutes,(55±8)minutes,(64±8)minutes,(51±6) minutes,with statistically significant differences among 4 groups (x2 =21.628,F=74.441,P＜0.05).(2)Postoperative short-term complications situations:2,2,3 and 1 patients in the B Ⅰ,B Ⅱ,Roux-en-Y and uncut Roux-en-Y groups had respectively postoperative short-term complications,showing no statistically significant difference among 4 groups (x2 =0.840,P＞0.05).(3) Follow-up situations:all patients were followed up,and follow-up time in the B Ⅰ,B Ⅱ,RY and uncut RY groups were respectively (10.8 ± 3.5) months,(10.9 ±3.4)months,(11.3±3.2) months and (11.2±2.2) months,with no statistically significant difference among 4 groups (F=0.200,P＞0.05).① Comparisons of postoperative 1-year nutritional indexes:rates of changes in body mass index (BMI),hemoglobin (Hb),total protein (TP) and albumin were respectively 93％±7％,91％±7％,90％±7％,90％±9％ and 94％±9％,97％±11％,95％±9％,97％±9％ and 101％±9％,99％±7％,98％±7％,99％±7％ and 101％±10％,103％±7％,100％±10％,103％±9％ in the B Ⅰ,B Ⅱ1,RY and uncut RY groups,showing no statistically significant difference among 4 groups (F=1.182,0.724,1.050,0.971,P＞0.05).②)Of 164 patients within 1 year postoperatively,47 were complicated with gastric retention (27,12,6 and 2 with severity in grade 1,2,3 and 4),87 with residual gastritis (53,24,10 and 0 with severity in grade 1,2,3 and 4),and 38 with bile reflux (severity in grade 1).Of 38 patients with bile reflux,33 were combined with residual gastritis,showing a correlation between residual gastritis and bile reflux (r=0.396,P＜0.05).Cases with gastric retention,residual gastritis and bile reflux within 1 year postoperatively were respectively 16,9,21,1and 35,30,13,9 and 16,18,3,1 in the B Ⅰ,B Ⅱ],RY and uncut RY groups,showing statistically significant differences among 4 groups (x2 =21.261,41.103,30.469,P＜ 0.05).There were statistically significant differences in gastric retention occurrence between uncut RY group and B Ⅰ group or B Ⅱ group or RY group (x2 =12.958,6.675,20.065,P＜0.05),and in residual gastritis occurrence between RY group and B Ⅰ group or B Ⅱ group (x2 =20.831,18.587,P＜0.05) and between uncut RY group and B Ⅰ group or B Ⅱ group (x2 =22.452,20.220,P＜0.05).There were statistically significant differences in bile reflux occurrence between RY group and B Ⅰ group or B Ⅱ group (x2 =10.942,16.926,P＜0.05),and between uncut RY group and B Ⅰ group or B Ⅱ group (x2 =12.958,18.620,P＜0.05).Conclusion Roux-en-Y and uncut Roux-en-Y anastomoses are superior to B Ⅰ and B Ⅱ anastomoses in improving residual gastritis and bile reflux in the postoperative digestive tract reconstruction of LDG,and uncut Roux-en-Y anastomosis can effectively reduce occurrence of postoperative gastric retention.

"Evaluation on therapentic effect of ""ladder dosage"" propranolol on mixed and deeper infantile hemangioma" / 吉林大学学报(医学版)

Objective:To treat the mixed and deeper infantile hemangioma with ladder dosage propranolol, and to explore its efficacy and safety.Methods:A total of 98 infants with hemangioma were treated by ladder treatment of propranolol.Before treatment,comprehensive assessments of electrocardiogram(ECG),heart color ultrasound, blood glucose,liver function,kidney function,myocardial enzymes and blood routine were conducted.After excluding contraindications,the dose of propranolol incrementally doubled from 0.5 mg·kg-1·d-1 to 4.0 mg·kg-1·d-1.Propranolol was taken 3 times a day.Before and after medication for 1 and 2 h,ECG was monitored.The changes of tumor size,texture,color and other changes or an onset of adverse reactions were dynamicly observed.The infants were visited every month.The efficacy was evaluated using Achauer system.Results: After medication,98 cases had different degrees of color changes or tumor consistency softening.After the dosage of propranolol was increased to 4.0 mg·kg-1·d-1,the change of tumor was the fastest.According to the 4-grade method, there were 84 cases(85.71%) as gradeⅣ (excellent),2 cases (2.04%) as grade Ⅲ (good),4 cases (4.08%) as gradeⅡ (medium)and 8 cases (8.16%) as gradeⅠ (poor).The curative effect of mixed hemangioma was better than that of deeper hemangioma(P<0.05).The recovery time of 74 cases of hemangiomas was 6 months.The major adverse reactions were heart rate decline(5/98,5.10%),drowsiness(3/98,3.06%),diarrhea(7/98,7.14%),loss of appetite (1/98,1.02%), and convulsions (2/98,2.04%).After treatment,all adverse reactions disappeared.Two months after drug withdrawal there were 4 cases of recurrence,and they were continously treated with propranolol.Conclusion: The efficacy of oral ladder dosage propranolol in treatment of mixed and deeper infantile hemangioma is increased significantly and there are no significant adverse reactions.

Dose optimization of continuous renal replacement therapy in sepsis-induced acute kidney injury / 中华危重病急救医学

Sepsis is a life-threatening organ dysfunction caused by dys-regulated host response to infection. Acute kidney injury (AKI) caused by sepsis is one of the most common and severe clinical disease, which incidence and mortality remains high level, and has poor clinical outcomes. Continuous renal replacement therapy (CRRT) is an indispensable tool for the treatment of critically ill patients with severe AKI, but there is no consensus on the appropriate treatment dose of CRRT. By reviewing the process of high volume hemofiltration (HVHF) and standard volume hemofiltration (SVHF), comparing their benefits and risks, and making suggestions for therapeutic schedule improvement, reference for clinical work was provided.

Clinical efficacy of submucosal tunnel endoscopic resection for upper gastrointestinal muscularis propria submucosal tumors / 中华消化外科杂志

Objective To evaluate the clinical efficacy of submucosal tunnel endoscopic resection (STER) for upper gastrointestinal muscularis propria submucosal tumors (SMTs) with diameter ≥3.5 cm.Methods The clinical data of 14 patients with SMTs≥3.5 cm who were admitted to the Second Xiangya Hospital of Central South University between October 2011 and July 2014 were retrospectively analyzed, including 13 patients with tumor at esophagus and 1 patient with tumor at cardia.All patients underwent STER and the observed indexes included operation tine, tumor location and diameter, results of pathological examination and occurrence of postoperative complications.All patients were followed up regularly at the out-patient department including reexamination of gastroscopy, endoscopic ultrasonography (EUS) and computed tomography (CT) till August 2014.Measurement data with normal distribution were presented as average (range).Results All the 14 patients underwent STER successfully with mean operation time of 83 minutes (range, 60-160 minutes).Fourteen tumors were exited, with 13 located at esophagus and 1 at gastric cardia.En bloc resection was achieved in 13 patients and the tumors were extracted through the tunnel.The tumor in the remaining 1 patient was large with a diameter of 5.3 cm and close to trachea, it was extracted by 2 pieces.The average diameter of 14 tumors extracted was 4.1 cm and postoperative pathological examination confirmed the tumors as leiomyomas.Three patients had postoperative complications, subcutaneous emphysema occurred in 1 patient and retrosternal pain in 1 patient.One patient suffered mucosal laceration and recovered after a metal stent was inserted for 2 weeks.The average duration of postoperative hospital stay was 6.4 days (range, 4.0-8.0 days).All patients were followed up for a median time of 11.5 months (range, 1.0-24.0 months) with no recurrence.Conclusion STER is a safe and effective method for SMTs with diameter≥3.5 cm.

Comparison of peroral endoscopic full-thickness myotomy and circular myotomy for severe achalasia / 中华消化外科杂志

Objective To compare the efficacy and safety of full-thickness peroral endoscopic myotomy (POEM) and circular myotomy for patients with severe achalasia.Methods The clinical data of 123 patients with severe achalasia who were admitted to the Second Xiangya Hospital of Central South University from August 2011 to May 2013 were retrospectively analyzed.Seventy patients who received full-thickness POEM were in the full-thickness myotomy group,and the other 53 patieuts who received circular myotomy were in the circular myotomy group.The clinical efficacies and incidences of complications of the 2 groups were compared.Patients in the 2 groups were followed up at the out-patient department till May 2014.The consecutive measurement data were presented by (x) ± s and analyzed using thc t test; the non-consecutive data were presented by M (range) and analyzed using the Wilcoxon rank test.Data before and after operation were compared using the repeated measure of analysis of variance.The count data were analyzed using the chi-square test.Results All the patients successfully received POEM.The operation time of the full-thickness myotomy group and the circular myotomy group were (57 ± 8)minutes and (63 ± 12)minutes,with significant difference between the 2 groups (t =3.421,P ＜0.05).The incidences of complications of the full-thickness myotomy group and the circular myotomy group were 14.3％ (10/70) and 11.3％ (6/53),with no significant difference between the 2 groups (x2=0.234,P ＞0.05).Atotal of 119 patients were followed up,with the median time of 18 months (range,12-24 months).The Eckardt scores at postoperative month 6 and 12 were 0 (range,0-3) and 0 (range,0-3) in the full-thickness myotomy group,and 0 (range,0-2) and 0 (range,0-3) in the circular myotomy group,with no significant difference between the 2 groups (Z =0.525,1.476,P ＞ 0.05).The sussess rates of the full-thickness myotomy group and the circular myotomy group were 98.6％ (69/70) and 98.1％ (52/53),with no significant difference between the 2 groups (x2=0.040,P ＞ 0.05).The diameters of the esophagus at postoperative month 6 of the full-thickness myotomy group and the circular myotomy group were (3.2 ± 0.3) cm and (3.4 ± 0.4) cm,with no significant difference between the 2 groups (t =1.927,P ＞ 0.05).The diameters of the esophagus at postoperative month 6 and 12 were significantly lesser than (5.9 ± 1.0) cm and (5.9 ± 1.0) cm before operation (F =780.923,493.018,P ＜ 0.05).No recurrence was detected in the 2 groups during the follow-up.Conclusion The short-term efficacy and incidence of complications of full-thickness myotomy and circular myotomy are comparable,while the operation time of patients who received full-thickness myotomy is shorter.

Influence of baicalin combined with NB-UVB on melanin synthesis and tyrosinase activity in melanocytes / 吉林大学学报(医学版)

Objective To observe the synthesis of melanin and tyrosinase activity of the cultured normal human melanocytes after treated with baicalin and NB-UVB, and to provide theoretical evidence for study on the new therapy method of vitiligo.Methods The normal human menlanocytes cultured in vitro were divided into control group,different concentrations of baicalin groups,different doses of NB-UVB group and baicalin combined NB-UVB group.The proliferation rate of melanocytes was measured by MTT assay,the level of melanin was tested by NaOH pyrolysis,and the tyrosinase activity was measured by dopa oxidization.Results Compared with control group,the proliferation rates in 10-4 mol·L-1 baicalin group and 30 mJ·cm-2 NB-UVB group had no significant difference(P>0.05 ). Compared with control group, the levels of melanin and tyrosinase activities in baicalin group,NB-UVB group and combined group were increased (P<0.05 or P<0.01);compared with baicalin group and NB-UVB group,the level of melanin and tyrosinase activity in combined group were increased(P<0.01). Conclusion Baicalin combined with NB-UVB has better promotion effect on melanin synthesis than used alone.

Evaluation on efficacy of different doses of propranolol in treatment of infantile hemangioma / 吉林大学学报(医学版)

Objective To investigate the clinical effects of different doses of propranolol in treatment of infantile mixed and deep hemangioma,and to provid theoretical and experimental evidence for the treatment of hemangioma. Methods The selected 62 patients with mixed and deep hemangioma were divided randomly into low dose (1.5mg·kg-1 ·d-1 )and high dose (3.0 mg·kg-1 ·d-1 )of propranolol groups,3 times a day,6 months as a course,the changes in hemangioma size and the incidence of adverse reactions were recorded.Results The efficacy was evaluated using Achauer system.The total effective rate was 80.65% in low dose of propranolol group and 93.55% in high dose of propranolol group,including 6 cases of class Ⅰ (poor),9 cases of class Ⅱ (moderate), 11 cases of classⅢ (good),and 5 cases of class Ⅳ (excellent)in low dose propranolol group;while 2 cases of class Ⅰ (poor),4 cases of class Ⅱ (moderate),10 cases of class Ⅲ (good)and 15 cases of Ⅳ (excellent)in high dose of propranolol group.The efficacy in high dose of proprandol group was significantly better than that in low dose of proprandol group (P0.05)and there was no significant difference in the incidence of adverse reaction between two groups (P>0.05).Conclusion The efficacy of oral 3.0 mg·kg-1 ·d-1 propranolol in treatment of infantile mixed and deep hemangioma is increased significantly, and there is no significant adverse reactions after increasing doses.Therefore,high dose of propranolol should be recommended in order to improve the therapeutic effect.