Efficacy of one-incision remoual of axillary apocrine glands in children and adult patients with axillary osmidrosis: a comparative analysis / 中华医学美学美容杂志

Objective:To evaluate the safety and efficacy of single incision apocrine gland excision in the treatment of children and adult patients with axillary osmidrosis.Methods:Medical records and follow-up results were reviewed for 164 patients who underwent surgical treatment in our department by the same surgeon from January 2013 to December 2016. There were 54 males and 110 females, aged 8-61 years. with a median age of 22 years. The patients were divided into the children group ( n=31) and the adults group ( n=133), and differences between the two groups were compared. Results:The end point of follow-up was December 2019, the cure and overall satisfaction rates in the third year after surgery were 77.6% (125/161) and 88.2% (142/161) for the total population, including 87.5% (27/31) and 93.5% (29/31) for the children, respectively. There were no significantly differences in the cure rate, scar, pigmentation and the patients' satisfaction between two groups during the follow-up. The cure rate, significantly improved rate and satisfaction rate in patients who became adult during the follow-up were 80.0% (20/25), 92.0% (23/25) and 96.0% (24/25), respectively.Conclusions:Single incision apocrine gland excision could be performed for children patients. Our procedure is safe, reliable and consistant, and worthy of clinical application.

Clinical effect of Huangqi Chifeng Decoction combined with modified Duhuo Jisheng Decoction in the treatment of ischemic stroke during recovery / 国际中医中药杂志

Objective:To evaluate the clinical curative effect of Huangqi Chifeng Decoction combined with modified Duhuo Jisheng Decoction on patients with ischemic stroke (IS) during recovery.Methods:Prospective cohort study. A total of 220 patients with IS during recovery who met inclusion criteria in the First People's Hospital of Dongcheng District in Beijing, were enrolled and divided into control group ( n=110) and observation group ( n=110) by random number table method between January 2015 and July 2020. The control group was given basic treatment, while observation group was given Huangqi Chifeng Decoction combined with modified Duhuo Jisheng Decoction. All were treated for 1 month. Before and after treatment, Traditional Chinese Medicine (TCM) syndromes were scored. The activities of daily living were evaluated by Barthel index. The quality of life was evaluated by stroke specific quality of life scale (SS-QOL). The severity of neurological impairment was evaluated by National Institute of Health Stroke Scale (NIHSS). The functional recovery of stroke was evaluated by modified Rankin scale (mRS). The adverse reactions during treatment were observed and recorded. Results:After treatment, scores of TCM syndromes, mRS and NIHSS in observation group were significantly lower than those in the control group ( t=21.87, 4.66, 12.06, P<0.01), while scores of Barthel index and SS-QOL were significantly higher than those in the control group ( t=14.13, 5.80, P<0.01). During treatment, there were no obvious adverse reactions in either group. Conclusion:Huangqi Chifeng Decoction combined with modified Duhuo Jisheng Decoction can improve clinical symptoms and nerve function in patients with IS during recovery, which is beneficial to improve outcomes and quality of life.

First-line biologic therapy with tumor necrosis factor inhibitors for psoriatic arthritis: a prospective observational study

ABSTRACT BACKGROUND: Psoriatic arthritis (PsA) is a chronic inflammatory disease that affects multiple joints. It is associated with psoriasis and treated with synthetic and biologic drugs. OBJECTIVE: The objective of this study was to assess the outcomes of patients who received biologic therapy with tumor necrosis factor (TNF) inhibitors in terms of effectiveness, safety, functionality, and quality of life. DESIGN AND SETTING: A prospective observational study was performed at a single center in Belo Horizonte, Brazil. METHODS: Patients with PsA who received their first TNF inhibitor treatment were followed up for 12 months. Disease activity was measured using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Clinical Disease Activity Index (CDAI). Functionality was measured using the Health Questionnaire Assessment (HAQ), and quality of life was evaluated using the European Quality of Life Five Dimensions (EQ-5D). Multiple linear regression was used to identify predictors of the clinical response at 12 months. RESULTS: A total of 143 patients treated with adalimumab or etanercept were evaluated. Most of the clinical measures were significantly improved at 12 months. However, 31%-51% of the patients did not achieve good clinical control. No differences were observed between adalimumab and etanercept, except for poor functionality at 12 months among patients treated with etanercept. The main predictors of a worse clinical response were female sex, etanercept use, poor functionality, or lower quality of life at baseline. The main adverse reactions were alopecia, headache, injection site reaction, sinusitis, flu, dyslipidemia, and infections. CONCLUSION: TNF inhibitor therapy was effective and safe. However, despite improvements in clinical measures, most patients did not achieve satisfactory control of the disease.

Efficacy of microneedle radiofrequency for treatment of moderate acne vulgaris / 中华医学美学美容杂志

Objective:To evaluate the clinical efficacy of microneedle radiofrequency in the treatment of moderate acne vulgaris.Methods:From August 2018 to August 2020, 393 patients (192 males and 201 females, aged 15-38 years) with moderate acne were enrolled in the Department of Dermatology, the First Affiliated Hospital of Shantou University Medical College and Shantou Chaonan Minsheng Hospital, including 201 patients in experimental group and 192 patients in control group. In the experimental group, microneedle radiofrequency therapy was used once every 2 weeks for 3 times in total. The control group adopted the fire needle, once every 2 weeks, a total of 3 times. The efficacy of both groups was evaluated at week 8.Results:A total of 378 patients were actually completed: 196 patients in the experimental group, and 182 patients in the control group. At the eighth week of follow-up, the total effective rate was 81.12% in the experimental group and 70.43% in the control group. The efficacy of the two groups was statistically different (χ 2=4.42, P<0.05). Conclusions:The efficacy of microneedle radiofrequency therapy in the treatment of moderate acne vulgaris is better than that of fire needle, with good tolerance, short recovery period, few adverse reactions and high compliance, which has clinical promotion value.

Clinical effects of botulinum toxin A intradermal injection in treatment of erythematotelangiectatic rosacea / 中华医学美学美容杂志

Objective:To evaluate the efficacy and safety of intradermal injection of botulinum toxin A (BTX-A) in the treatment of erythematotelangiectatic rosacea.Methods:From January 2019 to December 2020, 30 patients with erythematotelangiectatic rosacea were treated in the Department of Dermatology at Xijing Hospital, Fourth Military Medical University. There were 26 females and 4 males, the age range from 23 to 42 years, with the average (30.9±5.7) years. Patients were randomly divided into two groups and given intradermal injection of botulinum toxin A. In detail, 0.25 U and 0.5 U was injected at each point in the low and high concentration group of BTX-A. The clinician erythema assessment (CEA) scores were recorded before treatment and at 2, 4, 8 and 12 weeks after treatment. The standard grading system scores for rosacea were recorded before treatment and at 12 weeks after treatment.Results:Both treatments could significantly reduce CEA scores, but the declined degree was more significant ( P<0.05), the onset time was shorter and the duration of efficacy was longer in the high concentration group. The scores of flushing, persistent erythema, burning sensation, stinging sensation and the total score of the standard grading system for rosacea after treatment in both two groups were significantly lower than those before treatment (high concentration group: t=5.00, 5.93, 4.10, 2.74, 12.37; low concentration group: t=6.17, 4.12, 2.87, 2.81, 7.88; P<0.05), and the improvement in high concentration group was significantly more than that in low concentration group ( t=2.02, 2.31, 2.15, 2.56, P<0.05). There was no significant difference in the overall effective rate between the two treatments ( P>0.05). Conclusions:Intradermal injection of BTX-A is safe and effective in the treatment of rosacea. Compared with the low concentration group, the efficacy is better, the onset time is shorter and the duration of efficacy is longer in the high concentration group.

Short-term efficacy of sublingual immunotherapy in patients with allergic rhinitis of all ages / 中国基层医药

Objective:To investigate the short-term efficacy of sublingual immunotherapy in patients with allergic rhinitis of all ages.Methods:The data of 230 patients with allergic rhinitis of all ages who received sublingual immunotherapy in The Third People's Hospital of Bengbu from November 2020 to September 2021 were included in this study. Patient distribution characteristics were analyzed. Ninety-three patients were randomly selected and divided into child, adolescent, and adult groups according to different ages. Total nasal symptom scores measured before and 4 months after sublingual immunotherapy were compared among patients of different ages to evaluate the short-term efficacy of sublingual immunotherapy. The skin prick test was used to determine the allergic state of patients. Change in total nasal symptom score after treatment relative to that before treatment was used to evaluate the efficacy of sublingual immunotherapy.Results:The age range of patients receiving sublingual immunotherapy was large (3-71 years), but the average age was only 17.70 years. Ninety-three patients were followed up, including 50 children and 43 adolescents or adults. After 4 months of sublingual immunotherapy, total nasal symptom score in children and adolescents or adults were significantly decreased compared with those before treatment [(3.66 ± 1.69) points vs. (6.60 ± 1.96) points, (3.49 ± 1.72) points vs. (6.28 ± 2.28) points, both P < 0.001]. Before and after treatment, there was no significant difference in total nasal symptom score between children and adolescents or adults (both P > 0.05). Conclusion:Patients with allergic rhinitis who receive sublingual immunotherapy tend to be young. Short-term sublingual immunotherapy is effective for allergic rhinitis. There is no remarkable difference in the efficacy of sublingual immunotherapy between patients with allergic rhinitis of all ages.

Clinical efficacy of Bacille Calmette-Guerin polysaccharide nucleic acid combined with montelukast in the treatment of bronchial asthma and its effect on lung function and serum inflammatory factor level / 中国基层医药

Objective:To investigate the clinical efficacy of Bacille Calmette-Guerin polysaccharide nucleic acid combined with montelukast in the treatment of bronchial asthma and its effect on lung function and serum inflammatory factor level.Methods:Eighty patients with bronchial asthma who met inclusion criteria and received treatment in The First People's Hospital of Huzhou from January 2019 to December 2020 were included in this study. They were randomly assigned to undergo either routine systematic treatment and oral montelukast (control group, n = 40) or routine systematic treatment, oral montelukast, and intramuscular injection of Bacille Calmette-Guerin polysaccharide nucleic acid in combination (combined group, n = 40). The changes in serum inflammatory factors and pulmonary function after treatment relative to before treatment, clinical efficacy and adverse reactions were compared between the two groups. Results:Total response rate in the control and combined groups was 80.00% (32/40) and 95.00% (38/40) respectively. Total response rate in the combined group was significantly higher than that in the control group ( χ2 = 4.11, P = 0.043). There were no significant differences in peak expiratory flow rate, forced expiratory volume in 1 second, maximum voluntary ventilation, forced vital capacity, airway resistance and forced expiratory volume in 1 second/forced vital capacity between the two groups before treatment (all P > 0.05). In the combined group, peak expiratory flow rate, forced expiratory volume in 1 second,forced expiratory volume in 1 second/forced vital capacity, maximum voluntary ventilation and forced vital capacity were significantly increased, and airway resistance was significantly decreased after treatment compared with before treatment ( t = -4.81, -5.09, -7.39, -4.12, -7.14, 5.17, all P < 0.001). After treatment, clinical efficacy in the combined group was superior to that in the control group. Before treatment, there were no significant differences in the St George's Respiratory Questionnaire score and Asthma Control Test score between the two groups (both P > 0.05). After treatment, St George's Respiratory Questionnaire score in the combined group was significantly decreased, while Asthma Control Test score was significantly increased compared with before treatment ( t = 9.19, -3.44, both P < 0.001). Before treatment, there were no significant differences in serum interleukin-4, interleukin-5, and interferon-γ levels between the two groups (all P > 0.05). After treatment, serum levels of interleukin-4, interleukin-5, and interferon-γ in the combined group were significantly lower than those in the control group ( t = 6.95, 4.72, -11.24, all P < 0.001). No drugs-related adverse reactions were found in each group during the treatment period. Conclusion:Bacille Calmette-Guerin polysaccharide nucleic acid combined with montelukast is highly effective on bronchial asthma. The combined therapy can improve quality of life and lung function, decrease serum inflammatory factor levels, and is safe.

Efficacy of bifidobacteria combined with Kangfuxin liquid in the treatment of gastrointestinal ulcer in older adult patients and its effects on intestinal flora / 中国基层医药

Objective:To investigate the efficacy of bifidobacteria combined with Kangfuxin liquid in the treatment of gastrointestinal ulcer in older adult patients and its effects on intestinal flora. Methods:A total of 84 older adult patients with gastrointestinal ulcer who received treatment in The First People's Hospital of Yongkang from January 2020 to December 2021 were included in this study. They were randomly assigned to receive either Kangfuxin liquid treatment (control group, n = 42) or Kangfuxin liquid combined with bifidobacteria treatment (combined group, n = 42) based on conventional symptomatic treatment. Efficacy and intestinal flora were compared between the two groups. Results:Total response rate and Helicobacter pylori eradication rate in the combined group were 97.62% and 88.10%, respectively, which were significantly higher than those in the control group ( χ2 = 8.63, 7.25, both P < 0.05). After treatment, the numbers of Bifidobacteria, Lactobacilli, Digestive cocci and Eubacteria in the combined group were greater than those in the control group, and the numbers of Enterococci, Enterobacter and Clostridium were lower than those in the control group ( t = 11.84, 6.50, 6.33, 7.16, 3.21, 3.24, 6.98, all P < 0.05). After treatment, the levels of interleukin-6 (IL-6) and interleukin-17 (IL-17) in the combined group were (5.09 ± 0.85) ng/L and (6.13 ± 1.27) ng/L, respectively, which were significantly lower than those in the control group, and interferon-γ and prostaglandin E2 (PGE2) levels in the combined group were (25.95 ± 3.67) ng/L and (20.06 ± 0.92) ng/L, respectively, which were significantly lower than those in the control group ( t = 8.28, 7.28, 8.19, 9.10, all P < 0.001). Conclusion:Bifidobacteria combined with Kangfuxin liquid is highly effective on gastrointestinal ulcer in older adult patients. The combined method can adjust intestinal flora and improve inflammatory indicators, and therefore is worthy of clinical promotion.

Efficacy of percutaneous kyphoplasty versus percutaneous vertebroplasty in the treatment of single-segment osteoporotic vertebral compression fractures / 中国基层医药

Objective:To investigate the clinical efficacy of percutaneous kyphoplasty (PKP) versus percutaneous vertebroplasty (PVP) in the treatment of single-segment osteoporotic vertebral compression fractures (OVCF) in the older adult patients. Methods:A total of 117 older adult patients with single-segment OVCF who received treatment in Binzhou Central Hospital from January 2016 to March 2018 were included in this study. They were randomly assigned to undergo either PVP (observation group, n = 60) or PKP (control group, n = 57). Therapeutic effects, treatment cost and the incidence of complications were compared between the two groups. Results:In the observation group, the amount of bone cement, operative time, treatment cost and the amplitude of increase in vertebral height post-operation relative to preoperative vertebral height were (4.69 ± 1.94) mL, (27.59 ± 5.81) minutes, (6 537.24 ± 898.36) yuan, (2.54 ±1.37) mm, respectively, and they were (5.78 ± 2.04) mL, (38.63 ± 8.17) minutes, (24 371.85 ± 2 365.54) yuan, (8.65 ± 1.48) mm, respectively in the control group. There were significant differences in these indices between the two groups ( t = 6.18, 9.25, 10.26, 7.23, all P < 0.05). Before treatment, there were no significant differences in Cobb angle and vertebral compression rate between the two groups (both P > 0.05). After treatment, Cobb angle of injured vertebrae in the control group was significantly lower than that in the observation group [(9.25 ± 2.36)° vs. (20.38 ± 3.87)%, t = 10.25, P < 0.05]. Vertebral compression rate in the control group was significantly lower than that in the observation group [(20.06 ± 3.53)% vs. (24.76 ± 5.35)%, t = 6.23, P < 0.05]. There was no significant difference in the incidence of complications between the two groups [26.67% (16/60) vs. 17.54% (10/57), χ2 = 8.92, P < 0.05). Conclusion:PVP is more simple and less expensive in the clinical treatment of OVCF than PKP, but PKP is more effective and has lower incidence of complications than PVP. PKP can be preferred if there is no concern about economic and medical conditions.

Effects of deafness capsule combined with vinpocetine injection on hearing function, hemorheology and T lymphocyte subsets in patients with sudden deafness / 中国基层医药

Objective:To investigate the effects of deafness capsule combined with vinpocetine injection on hearing function, hemorheology and T lymphocyte subsets in patients with sudden deafness.Methods:Eighty patients with sudden deafness who received treatment in Wenzhou Central Hospital from April 2017 to October 2019 were included in this study. They were randomly assigned to undergo treatment either with vinpocetine injection (control group, n = 40) or with deafness capsule combined with vinpocetine injection (observation group, n = 40) for 1 month. Efficacy, hearing function, hemorheology, T lymphocyte subsets and adverse reactions were compared between the control and observation groups. Results:Total response rate in the observation group was significantly higher than that in the control group [90.00% (36/40) vs. 67.50% (27/40), χ2 = 6.050, P = 0.014). There was no significant difference in the incidence of adverse reactions between the two groups ( P > 0.05). After 1 month of treatment, plasma viscosity, high-shear whole blood viscosity, low-shear whole blood viscosity in the observation group were (1.21 ± 0.29) mPa·s, (2.41 ± 0.31) mPa·s, (5.25 ± 1.29) mPa·s respectively, which were significantly lower than those in the control group [(1.65 ± 0.22) mPa·s, (4.94 ± 0.36) mPa·s, (8.64 ± 1.32) mPa·s, t = 7.64, 33.68, 11.61, all P < 0.001). The percentages of CD 8+, CD 4+, and CD 4+/CD 8+ T lymphocyte subsets in the observation group were (24.28 ± 2.16)%, (46.05 ± 6.52)% and (1.90 ± 0.28) respectively, and they were (27.41 ± 2.09)%, (40.54 ± 5.48)%, (1.48 ± 0.24) respectively in the control group ( t = 6.58, 4.09, 7.20, all P < 0.001). Pure tone threshold in the observation group was significantly lower than that in the control group [(38.07 ± 4.82) dB vs. (51.97 ± 5.96) dB, t = 11.46, P < 0.001). Conclusion:Deafness capsule combined with vinpocetine injection is highly effective on sudden deafness. The combined therapy can improve the hearing function, hemorheology, and the immunological function of T lymphocyte subsets in patients with sudden deafness.

Effects of modified radical prostatectomy via an extraperitoneal approach on urinary control and sexual function in patients with prostate cancer / 中国基层医药

Objective:To investigate the effects of modified radical prostatectomy via an extraperitoneal approach on urinary control and sexual function in patients with prostate cancer.Methods:Fifty-six patients with stable prostate cancer who received treatment in Deqing People's Hospital between March 2015 and March 2018 were included in this study. They were randomly divided into observation and control groups ( n = 28/group). The observation group was subjected to modified radical prostatectomy via an extraperitoneal approach. The control group underwent standard laparoscopic surgery. Clinical efficacy and the effects of modified radical prostatectomy via an extraperitoneal approach on urinary control and sexual function were compared between the two groups. Results:Amount of blood loss and postoperative drainage were (125.39 ± 11.12) mL and (65.39 ± 10.12) mL in the observation group, and (224.79 ± 14.01) mL and (104.79 ± 15.01) mL in the control group. There were no significant differences in amount of blood loss and postoperative drainage between the two groups ( t = 18.83, 15.67, both P < 0.05). At 1, 3 and 6 months after surgery, the percentage of patients who had urinary control recovery in the observation group was 53.57% (15/28), 78.57% (22/28), 98.21% (27/28), respectively, which were significantly higher than those in the control group [21.43% (6/28), 35.71% (10/28), 67.86% (19/28), χ2 = 4.12, 7.21, 5.01, all P < 0.05]. At 1, 3 and 6 months after surgery, the score of erectile function recovery in the observation group was (15.98 ± 0.28) points, (15.99 ± 0.72) points, and (18.91 ± 0.48) points, which were significantly higher than those in the control group [(17.11 ± 0.34) points, (13.11 ± 0.48) points, (13.41 ± 0.39) points, t = 3.01, 12.89, 15.78, all P < 0.05]. Conclusion:Modified radical prostatectomy via an extraperitoneal approach can improve postoperative urinary control and sexual dysfunction.

Efficacy of Watchman occlusion of the left atrial appendage in patients ≥85 years with atrial fibrillation / 中华老年医学杂志

Objective:To analyze the safety and efficacy of left atrial appendage closure(LAAC)with Watchman in patients ≥85 years with atrial fibrillation(AF).Methods:515 elderly patients with atrial fibrillation, including 73 patients aged 85 years or older(85~91), who had undergone Watchman LAAC at Zhoupu Hospital affiliated to Shanghai Health Medical College from August 2016 to December 2020, were retrospectively analyzed.Of those ≥85 years, 44(60.3%)with transesophageal echocardiography records were assigned to the elderly group.Fifty-three patients aged 60 to 65 were selected as the control group.Differences in baseline data, intraoperative conditions, antithrombotic treatment plans and 1-year follow-up prognosis were compared between the two groups.Results:Compared with the control group, there was no difference in AF types, history of ischemic stroke/transient ischaemic attack(all P>0.05), but there were higher incidences of coronary heart disease and renal insufficiency, more severe heart failure, higher CHA 2DS 2-VASC(6.0±1.5 vs.3.6±1.5), HAS-BLED(3.2±1.2 vs.2.3±1.3)scores( t values were 7.682 and 3.871, respectively, P<0.05), and a lower one-stop surgery rate(6 cases or 13.6% vs. 27 cases or 50.9%, χ2=10.517, P<0.05)in the advanced age group.There was no difference in the diameter of the Watchman device, rate of device replacement, compression percentage and residual flow between the two groups during the perioperative period.The incidences of device-related thrombosis were 4.5%(2/44)and 3.8%(2/53)for the advanced age group and the control group, respectively, but the difference was not statistically significant( P>0.05). During the 12-month follow-up, there were no cases of ischemic stroke or intracerebral hemorrhage.Three died of heart failure and 1 died of cancer. Conclusions:LAAC with Watchman is safe and effective for patients over 85 years with AF, but the decision on the procedure should be based on careful assessment of patients' cardiac and renal function and general health.

Comparison of the long-term outcomes of focused ultrasound ablation surgery for uterine fibroids and myomectomy / 中华妇产科杂志

Objective:To compare the long-term outcomes after focused ultrasound ablation surgery (FUAS) versus myomectomy for uterine fibroids.Methods:A retrospective study was conducted on women who were treated by FUAS or myomectomy for uterine fibroids at First Medical Center of Chinese PLA General Hospital from January 2007 to January 2015. Regular follow-up was conducted to evaluate the symptoms relief, symptoms recurrence, the need for re-interventions and complications of the two groups.Results:The effective rates were 95.7% (730/763) and 95.5% (1 151/1 205) in women who were treated by FUAS and myomectomy, no statistical difference was seen between the two groups ( χ2 =0.027, P=0.869). The cumulative rates of symptoms recurrence at 1 year, 3 years, 5 years, 8 years and 10 years of follow-up in FUAS group were 1.8%, 6.8%, 11.9%, 15.2% and 15.9%, respectively; and the cumulative re-intervention rates were 0.7%, 4.1%, 6.8%, 9.9% and 11.0%, respectively. The cumulative rates of symptoms recurrence at 1 year, 3 years, 5 years, 8 years and 10 years of follow-up in myomectomy group were 1.8%, 5.9%, 10.6%, 14.2% and 14.9%, respectively; and the cumulative re-intervention rates were 0.9%, 4.5%, 7.8%, 10.3% and 11.4%, respectively. No statistical differences were seen between the two groups (all P>0.05). There were no significant differences in the effective rate, symptoms recurrence rate and re-intervention rate between the two groups in patients with intermural fibroids; but the effective rate of FUAS (95.9%, 235/245) was higher than that of myomectomy (89.1%, 115/129), the symptoms recurrence rate (11.9%, 28/235) was lower than that of myomectomy (27.8%, 32/115), and the re-intervention rate (7.7%, 18/235) was lower than that of myomectomy (17.4%, 20/115) in patients with submucosal fibroids, there were significant different (all P<0.05). The effective rate of FUAS (91.0%, 132/145) was lower than that of myomectomy (97.0%, 322/332), the symptoms recurrence rate (32.6%, 43/132) was higher than that of myomectomy (9.9%, 32/322), and the re-intervention rate (22.0%, 29/132) was higher than that of myomectomy group (6.2%, 20/132) in patients with subserosal fibroids, there were significant different (all P<0.01). The incidences of total [1.8% (14/763) vs 21.9% (264/1 205)], minor and moderate adverse events were lower in FUAS group than myomectomy group (all P<0.001). Conclusion:Satisfaction with long-term outcomes after FUAS treatment or myomectomy for uterine fibroids is comparable.

Comparative study on the efficacy of transumbilical single port and three port laparoscopic cholecystectomy in the treatment of calculous cholecystitis / 国际外科学杂志

Objective:To explore the efficacy of transumbilical single-port and three-port laparoscopic cholecystectomy (LC) in the treatment of calculous cholecystitis and its influence on immunological indicators and recovery of gastrointestinal function.Methods:One hundred and twenty patients with calculous cholecystitis who were treated in Suzhou Municipal Hospital of Anhui Province from June 2018 to June 2020 were prospectively selected as the research subjects, and the patients were randomly divided into single-hole group and three-hole group by random number table method. Group of 60 cases. The single port group used the transumbilical single port method LC, and the three port group used the transumbilical three port method LC. Compare the 24-hour pain VAS scores and the use of analgesics of the two groups of patients; compare the surgical indicators of the two groups of patients; compare the immunological indicators of the two groups before and after treatment; compare the two groups of patients The recovery of gastrointestinal function after operation; the occurrence of postoperative complications between the two groups was compared.Results:There was no statistically significant difference in intraoperative blood loss, hospitalization expenses, preoperative IgG, IgA, IgM levels, and postoperative complications between the two groups of patients ( P>0.05). The two groups of patients had significantly lower levels of IgG, IgA, and IgM after treatment ( P<0.05). In the single hole group, the pain VAS score, the use rate of analgesics, the time of hospitalization, the time of anal exhaust, the time of bowel sound returning to normal and the time of defecation were (4.65±0.61) points, 11.67%(7/60), (2.52±0.47) d, (13.65±3.72) h, (11.64±3.25) h and (20.31±4.12) h, respectively. The three-hole group were (6.87±0.58) points, 23.33% (14/60), (4.58±0.37) d, (17.36±4.12) h, (15.47±4.12) h and (26.48±4.25) h, respectively. It was significantly lower in the single-hole group than in the three-hole group ( P<0.05). In the single hole group, the operation time, abdominal wall cosmetology score and the levels of IgG, IgA, IgM after treatment were (76.36±4.58) min, (4.72±0.13) points, (1 108.48±42.65) mg/dL, (208.12±10.86) mg/dL, (154.65±8.72) mg/dL, respectively. The three-hole group were (51.37±5.25) min, (3.25±0.35) mg/dL, (1 072.39±28.42) mg/dL, (193.08±10.35) mg/dL and (145.28±8.42) mg/dL, respectively, and those in the single-hole group were significantly higher than those in the three-hole group ( P<0.05). Conclusion:Under the premise of proficiency in surgical operation techniques, the single-port method reduces pain, reduces the use of analgesics, has less impact on immunological indicators, recovers gastrointestinal function faster, and has better postoperative abdominal wall cosmetic effects.

Retrospective analysis of early surgical treatment of acute calculous cholecystitis with elevated liver enzymes / 国际外科学杂志

Objective:To investigate the safety and feasibility of early operation for acute calculous cholecystitis with elevated liver enzymes.Methods:The clinical data concerned about 39 patients with acute calculous cholecystitis complicated with elevated liver enzymes in The First Department of General Surgery, The First Affiliated Hospital of Anhui University of Science and Technology between January 2018 to December 2018 were analyzed retrospectively.There were 14 males and 25 females, the age was(57.59±15.30) years(range 29 to 84 years). All patients were given hepatoprotective therapy and antibiotic therapy, A total of 18 patients received early surgical treatment within 7 days (surgical group), 21 patients who received only hepatoprotective therapy and antibiotic therapy(control group). Observation indicators: (1)Total bilirubin, white blood cells and pancreatin in both groups at admission; (2)Data of liver enzyme indexes (ALT, AST, GGT) of the two groups at admission and 3 days after admission; (3)The length of hospital stay in the two groups, and gallstone-related events after discharge(the incidence of gallstone-related emergency, the rehospitalization rate). Normally distributed measurement data were expressed as mean±standard deviation( ± s), and comparison between groups were analyzed using t test; Non-normal distribution measurement data were represented by M( Q1, Q3), and comparison between groups were analyzed using Mann-Whitney U test. Comparison between groups were analyzed using chi-square test or Fisher method of count data. Results:There was no statistical difference between the two groups in terms of total bilirubin, white blood cells and pancreatin( P>0.05). There was no significant difference in liver enzyme indexes (ALT, AST, GGT) between the two groups when they were admitted to the hospital ( P>0.05) and 3 days later ( P>0.05). Before treatment, ALT、AST、GGT in surgical group were 161.00(83.75, 237.75) U/L, 63.50(49.50, 257.75) U/L, 245.50(66.75, 549.75) μmol/L, ALT, AST, GGT in control group were 187.00(64.00, 335.50) U/L, 104.00(53.50, 355.00) U/L, 299.00(136.50, 455.00) μmol/L, after 3 days antibiotic therapy and hepatoprotective therapy, ALT, AST, GGT in surgical group were 77.50(52.00, 111.00) U/L, 41.50(33.00, 53.75) U/L, 190.50(65.00, 372.00) μmol/L, ALT, AST, GGT in control group were 67.00(23.50, 129.50) U/L, 37.00(26.00, 61.50) U/L, 187.00(90.50, 337.00) μmol/L, levels of the two groups decreased significantly( P<0.05). There was no statistically significant difference in the length of hospital stay between the surgical group and the control group[(12.89±3.41) d vs (11.05±4.57) d, P>0.05]. After 12 months of follow-up, Gallstone-related events after discharge, the incidence of gallstone-related emergency in the surgical group was lower than that in the control group (5.6% vs 33.3%), the rehospitalization rate in the surgical group was significantly lower than that in the control group (5.6% vs 42.9%), there was statistically significant difference between the two groups ( P<0.05). Conclusion:Hepatoprotective therapy and antibiotic therapy and can effectively reduce the liver enzyme indexes of such patients in a short period of time, early surgical treatment after liver enzymes has decreased is a complete and safe option.

Analysis of clinical effificacy of the pancreatic duct stent for treatment of acute biliary pancreatitis / 国际外科学杂志

Objective:This study was conducted to further investigate the clinical value of ERCP plus EST and pancreatic duct (PD) stent placement in treatment of ABP.Methods:The data of 115 patients with ABP in People′s Hospital of Chongqing Banan District between February 2018 to October 2020 were retrospectively analyzed. Of the patients, 46 cases received ERCP plus EST and PD stent placement(PD stent group), and other 69 cases only received ERCP plus EST(control group), all patients received surgery within 72 h. Outcome measures: preoperative complications, APACHE II score, Glasgow score, preoperative and postoperative laboratory indicators (white blood cell, C-reactive protein, serum amylase, total bilirubin, alanine aminotransferase), postoperative complications, hospitalization time, hospitalization cost. All patients received outpatient or telephone follow-up after discharge, patients were followed up for recurrence of pancreatitis and complications, follow-up ended in June 2021. Continuous data were represented as ( ± s), and comparisons between the two groups were performed using Student′s t tests for normally distributed data with homogeneity of variance. The Mann-Whitney U test was used for nonnormally distributed data. Categorical data are expressed as rates values and were analyzed with the chi-square test or Fisher′s exact test. Results:There were no significant differences between two groups in age, complications, APACHEII score, Glasgow score, preoperative laboratory examination, postoperative CRP, total bilirubin and ALT ( P>0.05). Postoperative WBC[8.5(7.6, 10.3)]×10 9/L, serum amylase [197.5(143.0, 256.0) U/L] in the PD stent group were significantly lower than control group[9.9(8.2, 12.8) 10 9/L, 270.0(168.0, 419.0) U/L]( P<0.05). The overall incidence of complications in the PD stent group (6.5%) was significantly lower than the control group (20.3%), there were statistical differences between groups( P<0.05). Hospitalization time and hospitalization cost were not significantly different between the two groups ( P> 0.05). All patients were followed up, with an average follow-up of 16 months, all recovered well postoperatively in patients with stent group, but a patient who suffered from peripancreatic abscess with severe infection needed hospitalization again in control group, another two patients with pancreatic pseudocyst, 1 case were followed up for 3 months to gradually absorbed, and 1 case underwent another surgical treatment. Conclusion:The placement of temporary pancreatic duct stent provided adequate drainage of pancreatic fluid to reverse the course of ABP, and the complication rate was significantly lower than that of the control group, with superior clinical outcome to ABP patients treated with ERCP+ EST alone.

Effectiveness of co-debriefing to develop clinical skills in basic life support: randomized pilot study / Eficacia del co-debriefing para desarrollo de habilidades clínicas en soporte vital básico: estudio piloto aleatorizado / Efetividade do co-debriefieng para desenvolver competências clínicas no suporte básico de vida: estudo piloto randomizado

ABSTRACT Objective To compare the effectiveness of co-debriefing with debriefing with a facilitator in the development of clinical competences in nursing students in the simulated care of cardiac arrest. Method Randomized pilot study, carried out at a university in Minas Gerais, Brazil, in August 2021, with 17 students, to compare debriefing with a facilitator (control n=8) with co-debriefing (intervention n=9). Pre- and post-test, Objective Structured Clinical Examination and scales were used to assess behavioral skills. Wilcoxon and Mann-Whitney nonparametric comparison tests were used for analysis. Results The intervention group performed better than the control for knowledge about basic life support (control=17.00±2.39 and intervention=19.22 ± 0.66, p=0.021) and psychomotor skills (control=8.12±0.13 and intervention=8.50 ± 0.001, p<0.001). There were no significant differences for behavioral skills. Conclusion Co-debriefing appears to be more effective than debriefing with a facilitator to develop clinical skills in basic life support in nursing.

RESUMEN Objetivo Comparar la efectividad del co-debriefing con el debriefing con facilitador en el desarrollo de competencias clínicas en estudiantes de enfermería en el cuidado simulado de parada cardiaca. Método Estudio piloto aleatorizado, realizado en una universidad de Minas Gerais, Brasil, en agosto de 2021, con 17 estudiantes, para comparar el debriefing con un facilitador (control n=8) con el co-debriefing (intervención n=9). Se utilizaron pruebas previas y posteriores, examen clínico objetivo estructurado y escalas para evaluar las habilidades conductuales. Para el análisis se utilizaron las pruebas de comparación no paramétrica de Wilcoxon y Mann-whitney. Resultados El grupo intervención se desempeñó mejor que el control en conocimientos sobre soporte vital básico (control=17,00±2,39 e intervención=19,22 ± 0,66, p=0,021) y psicomotricidad (control=8, 12±0,13 e intervención=8,50 ± 0,001, p <0,001). No hubo diferencias significativas para las habilidades conductuales. Conclusión El co-debriefing parece ser más efectivo que el debriefing con un facilitador para desarrollar habilidades clínicas en soporte vital básico en enfermería.

RESUMO Objetivo Comparar a efetividade entre co-debriefing com debriefing com facilitador no desenvolvimento de competências clínicas em estudantes de enfermagem no atendimento simulado da parada cardiorrespiratória. Método Estudo-piloto randomizado, realizado em uma universidade de Minas Gerais, Brasil, em agosto de 2021 com 17 estudantes, para comparar o debriefing com um facilitador (controle n=8) e com o co-debriefing (intervenção n=9). Utilizaram-se pré e pós-teste, Exame Clínico Objetivo Estruturado e escalas para avaliar as habilidades comportamentais. Adotaram-se testes de comparação não paramétricos Wilcoxon e Mann-whitney para análise. Resultados O grupo intervenção obteve desempenho superior ao controle para o conhecimento sobre o suporte básico de vida (controle=17,00±2,39 e intervenção=19,22 ± 0,66, p=0,021) e habilidades psicomotoras (controle=8,12±0,13 e intervenção=8,50 ± 0,001, p<0,001). Não houve diferenças significativas para as habilidades comportamentais. Conclusão O co-debriefing parece ser mais efetivo do que o debriefing como um facilitador para desenvolver competências clínicas no suporte básico de vida em enfermagem.

Efficacy of intense pulse light and M22-ResurFx fractional laser on lateral crow＇s feet / 中华医学美学美容杂志

Objective:To evaluate the efficacy and patients＇ satisfaction of the intense pulse light (IPL) and M22-Resur Fx non-ablative fractional laser (NAFL) for the treatment of lateral static crow＇s feet.Methods:A prospective split-face, randomized, controlled study of 60 consecutive patients with lateral static crow＇s feet was performed. The patients aged 30 to 55 years, who were enrolled in the Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University from January 2018 to January 2020. The two sides of each patient＇s face were randomized to receive different treatment, and according to their treatment, the patients were divided into 3 groups with 20 cases each: Group A, in which 20 patients＇ one side face was treated with IPL, and other side was treated with NAFL; Group B, in which one side face was treated with IPL, and another side was treated with IPL immediately followed by NAFL; Group C, in which one side face was treated with NAFL, and another side was treated with IPL immediately followed by NAFL. The improvements including the water content of stratum corneum of skin and the patients＇ satisfaction, as well as the improvement of the lateral static crow＇s feet were evaluated.Results:The IPL plus NAFL combined treatment group and the NAFL treatment group showed the effective rate of the improvement for lateral static crow＇s feet of patients on days 60 and 90 was statistically significant ( P<0.05) compared with that before the treatment. And the improvement for lateral static crow＇s feet of patients on days 60 and 90 in combined treatment side was significantly different from either NAFL side ( P<0.05). 60 days and 90 days after treatment, the satisfaction of combined treatment side was significantly higher than that of either NAFL side or IPL side ( P<0.05). Conclusions:The treatment with an optimized IPL immediately followed by a NAFL is clinically superior to those with the NAFL or IPL alone for improving the lateral static crow＇s feet of patients. The satisfaction treated by NAFL combined with IPL is higher than using the NAFL or IPL alone.

Therapeutic effect of compound acid, alpha hydroxyl acid and salicylic acid on acne vulgaris: a comparative study / 中华医学美学美容杂志

Objective:To evaluate the curative effect and adverse reactions of compound acid, alpha hydroxyl acid (AHA), and salicylic acid (SA) in the treatment of mild to moderate acne.Methods:A total of 105 patients admitted in Suzhou Municipal Hospital from August 2019 to May 2020 were divided into three groups randomly and treated with compound acid, AHA and SA, once every 3 weeks, 4 times totally. The efficacy was evaluated before treatment, 3 weeks after 1 time, 2 times, 3 times, and 4 times. The number of non-inflammatory lesions (comedos) and inflammatory lesions (papules or pustules) were recorded. VISIA image was used to record the patient＇s facial characteristics before treatment and 3 weeks after 4 times. The occurrence of adverse reactions was recorded.Results:Three groups were all safe and effective. The efficiency of non-inflammatory lesions showed that there was no statistically significant difference between the 3 groups (χ 2= 4.58, P=0.101). The effective rate of inflammatory lesions in the compound acid and SA groups were higher than that of AHA group, and the difference was statistically significant (χ 2=6.45, P=0.040). After 4 times, the clinical data of purpurin, red area, and spot in compound acid and SA groups were higher than those before treatment, and the difference was statistically significant ( P<0.05). While in the AHA group, the purple matter was higher than that before treatment after 4 times, the difference was statistically significant ( t=3.506, P=0.010), and the change in the red area was not statistically significant ( P>0.05). Conclusions:The compound acid is safe and effective in treating mild and moderate acne. It is effective for acne inflammatory and non-inflammatory lesions. It has less adverse reactions and is worthy of clinical application.

Efficacy and safety of noninvasive high-frequency oscillatory ventilation in the treatment of respiratory failure in premature infants / 中国基层医药

Objective:To investigate the efficacy and safety of noninvasive high-frequency oscillatory ventilation in the treatment of respiratory failure in premature infants.Methods:Sixty-one premature infants with respiratory failure who received treatment in Neonatal Intensive Care Unit, Wenzhou Central Hospital from June 2019 to June 2020 were included in this study. They were randomly assigned to undergo either noninvasive high-frequency oscillatory ventilation (observation group, n = 31) or transnasal continuous positive airway pressure ventilation (control group, n = 31). Blood gas indicators, including pH value, oxygen partial pressure (PaO 2), partial pressure of carbon dioxide (PaCO 2), oxygenation index (OI), and respiratory index (RI), were determined before ventilation and 2, 8, 12, and 24 hours after ventilation. At the same time, the incidence of complications post-ventilation, including intracranial hemorrhage, bronchopulmonary dysplasia, air leakage, nasal crush injury, retinopathy of prematurity, abdominal distension, and necrotizing enterocolitis, was recorded in each group. Results:There were no significant differences in pH value, PaO 2, PaCO 2, OI, and RI pre-ventilation between observation and control groups ( t = 0.58, 0.64, 0.85, 0.43, 0.70, all P > 0.05). pH value, PaO 2, and OI measured 2, 8, 12 and 24 hours post-ventilation were significantly higher in the observation group than in the control group (pH value: t2 h = 3.20, t8 h = 4.81, t12 h = 6.39, t24 h = 5.22; PaO 2value:t2 h = 5.80, t8 h = 6.31, t12 h = 7.55, t24 h = 6.97; OI value: t2 h = 6.38, t8 h = 8.37, t12 h = 11.30, t24 h = 9.61). PaCO 2 and RI values were significantly lower in the observation group than in the control group (PaCO 2value:t2 h = 4.29, t8 h = 5.09, t12 h = 6.83, t24 h = 8.30; RI value: t2 h = 3.26, t8 h = 5.81, t12 h = 7.36、 t24 h = 6.54) (all P < 0.05). The incidence of complications was significantly lower in the observation group than in the control group [25.81% (8/31) vs. 46.67% (14/30), χ2 = 8.75, P < 0.05]. Conclusion:Compared with transnasal continuous positive airway pressure ventilation, noninvasive high-frequency oscillatory ventilation leads to better ventilation performance and a greater oxygenation ability, exhibits stronger effects on CO 2 clearance and acidosis correction, and has fewer complications in premature infants with respiratory failure. Therefore, noninvasive high-frequency oscillatory ventilation is suitable for clinical application.