调Q Nd:YAG激光治疗颧骨褐青色痣的临床疗效观察

目的了解调Q Nd:YAG激光治疗颧骨褐青色痣的临床效果。方法随机选取33例颧骨褐青色痣患者作对照组,给予调Q Nd:YAG激光低能量大光斑参数治疗;另选取33例作观察组,给予调Q Nd:YAG激光常规高能量参数治疗,对比两组患者各自治疗效果。结果 (1)观察组、对照组病患治疗总有效率分别为96.96%、90.90%,组间比较无统计学差异(P>0.05);(2)观察组、对照组病患所用治疗次数、疗程与停工期比较差异显著(P<0.05);(3)观察组与对照组病患治疗后并发症发生率分别为3.03%、18.18%,组间比较差异显著(P<0.05)。结论调Q Nd:YAG激光两种治疗参数在颧骨褐青色痣治疗中效果均较佳,不过各有优劣,需结合病患实际合理选择。

奥扎格雷用于治疗短暂性脑缺血患者的临床疗效评价

目的:评价奥扎格雷用于治疗短暂性脑缺血患者的临床疗效。方法:选取2010年1月—2012年1月间神经内科门诊就诊并诊断为短暂性脑缺血的患者100例,将其分为对照组患者和观察组患者,每组50例;对照组患者给予基础治疗方法治疗,观察组患者在对照组基础方法治疗上加用奥扎格雷治疗,比较两组患者治疗后发作次数和康复时间。结果:观察组患者治疗后短暂性脑缺血发作次数为1.5次/d明显少于对照组为4.5次/d(P<0.05);观察组患者治疗后的康复时间为(14±1.5)d明显短于对照组为(20±2.5)d(P<0.05)。结论:临床上治疗短暂性脑缺血的患者,在常规治疗方法的基础上加用奥扎格雷治疗优于常规治疗方法,提高了治疗的有效率,缩短了患者的住院时间。

蒙脱石散与抗幽门螺杆菌三联疗法对患儿慢性浅表性胃炎的临床疗效评价

目的:评价蒙脱石散与抗幽门螺杆菌三联疗法对患儿慢性浅表性胃炎的临床疗效。方法:选取2014年1月—2015年12月间收治的慢性浅表性胃炎患儿96例资料,采用随机分组法将其分为对照组48例和观察组48例;对照组患儿给予抗幽门螺杆菌三联疗法(克拉霉素片、阿莫西林胶囊和奥美拉唑肠溶片)治疗,观察组患儿在对照组基础上加用蒙脱石散治疗;比较两组患儿治疗后的总有效率、幽门螺杆菌(Hp)清除率,以及胃黏膜炎症和腹痛改善率的差异。结果:观察组患儿治疗后的总有效率为93.75%高于对照组为75.00%(P<0.05),以及治疗后的Hp清除率、胃黏膜炎症和腹痛改善率均优于对照组(P<0.05)。结论:采用蒙脱石散与抗幽门螺杆菌三联疗法治疗患儿慢性浅表性胃炎的临床疗效较为确切,提高了Hp清除率,有效改善了其临床症状。

Superior Vana Cava Syndrome: A Therapy by Intra-vascular Stenting

Objective To study the techniques and clinical applications of intra-vascular stenting in the treatment of superior vana cava obliteration syndrome (SVS). Methods In 9 cases of SVS, primary lesions were all confirmed as malignancy (primary pulmonary carcinoma of right upper lobe) histolo-pathologically. By route of right femoral vein, SVS catheterization and DSA was made. The length of the strictures and the diameters of normal superior vana cavae (SVC) were measured for the choice of appropriate stents. The option of stemt diameter is 10% larger than that of normal SVCs. The upper and lower ends of the stent should be 1–2 cm protruding from the ends of the stricture. The stent was dilated with a balloon after its successful placement. Therapy of original lesions was continued together with anticoagulant. Stents were observed about their positions by fluoroscopy or chest films, and about patency of SVC by Doppler. Results After the placement of a stent, DSA revealed the contrast media in the SVCs passed along smoothly, diameters of SVCs almost normal, collateral branches diminished remarkably. Average SVC pressure was decreased from 26.4 cmH2O before the placement down to 15.7 cmH2O, with an obvious difference (P<0.01= by statistics. Related clinical symptoms and signs disappeared or relieved. Subsidised were swelling of head and neck, upper extremities and chest. Excretion of urine increased. Gorgeous superficial veins in the chest could not be detected any more. Conclusion The therapy of intra-vascular stenting to treat SVS is microinvasive, simple and effective. Key words superior vana cava syndrome - tumor - stent - image diagnosis - interventional therapy

Retrograde Hepatectomy for Difficultly Resected Liver Cancer: A Report of 244 Cases

Objective To report our experience of retrograde hepatectomy in 244 cases of difficultly resected liver cancer. Methods Large, poor-exposure and inferior vena cava (IVC)-involving liver cancers that were difficult to remove by classical hepatectomy, have been resected successfully by retrograde hepatectomy combined with vascular surgical techniques in 244 patients (group A). Thirty one patients with similar circumstances undergoing classical hepatectomy duing the same period served as controls (group B). Results There were no perioperative mortalities in both groups. The comparison between group A and group B, the estimated intraoperative blood loss was 1290±998 ml versus 2286±1363 ml, post-operative pleural effusions occurred in 26/244 versus 10/31, ascites in 72/244 versus 19/31, moderate to severe jaundice in 14/244 versus 5/31, effusion in the operative area in 17/244 versus 7/31, subphrenic infection in 3/244 versus 1/31, bile leakage in 2/244 versus 1/31, wound infection in 3/244 versus 1/31, respectively. The time until ALT normalizaton in the groups A and B was 13.8±5.1 days and 18.9±8.9 days respectively. The difference between the two groups were statistically significant (P<0.01). Conclusion Retrograde hepatectomy is a safe and effective method for difficultly resected liver cancer. Key words cancer - liver - liver surgery - retrograde

Modified Indiana Pouch Following Radical Cystectomy

Objective To investigate the indications, operation techniques and clinical effects of a modified technique of Indiana pouch. Methods A modified technique of Indiana pouch was performed on 5 patients following radical cystectomy. Results 5 cases showed satisfactory therapeutic effects with of follow-up range of 6 to 30 months. All patients were continent day and night with easy catherization. The number of micturations was 5 to 6 times in the daytime and 1 to 3 times in the nighttime. Cystography of 4 cases showed that pouches were spheroidic and volumes were between 400 to 500 ml. Conclusion The advantages of the modified Indiana pouch are as follows: easy manipulation; low tension and high volume in pouches; no reflux; satisfactory urinary continence and few complications. Therefore, it is worthy of clinical popularization.

Liver Resection for Spontaneous Rupture of Primary Hepatocellular Carcinoma

Objective To study the effect of liver resection for spontaneous rupture of primary hepatocellulal carcinoma (PHCC). Methods The clinical data of 12 patients with ruptured PHCC treated by liver resection in Xiangya Hospital since 1970 were analyzed retrospectively. Results There were 10 males and 2 females with mean age of 42 (ranged 22–65) years in this series. Of the 12 patients, 11 underwent emergent hepatectomy and one 2-stage hepatectomy, including left segmental liver resection in 6 patients, left median lobectomy in 1, left hemihepatectomy in 1, partial right hepatectomy in 2, and tumor resection in 2. There was no operative death in 11 patients with liver function in grade A of Child-Paugh classification, but 1 patient with grade B liver function died of liver failure after operation. The operative mortality was 8.3%. In 11 survived patients, the postoperative median survival time was 16.5 months. The 1?, 3?, 5-year survival rate was 72.7%, 18.2%, 9.1% respectively; among them one patient has been alive free of the tumor for 25 years and 9 months. Conclusion Liver resection is the best treatment for ruptured PHCC when possible, which can result in long survival time. Key words liver resection - spontaneous ruptare - primary hepatocellular carcinoma

Silybin and the liver: From basic research to clinical practice

Herbal products are increasingly used, mainly in chronic liver disease. Extracts of milk thistle, Silymarin and silybin, are the most prescribed natural compounds, with different indications, but with no definitive results in terms of clinical efficacy. This review analyzes the available studies on the effects of the purified product silybin, both as a free and a conjugated molecule, on liver cells or on experimentally induced liver damage, and in patients with liver disease. We searched PUBMED for articles pertaining to the in vitro and in vivo effects of silybin, its antifibrotic, anti-inflammatory, and antioxidant properties, as well as its metabolic effects, combined with the authors’ own knowledge of the literature. Results indicate that the bioavailability of silybin phytosome is higher than that of silymarin and is less influenced by liver damage; silybin does not show significant interactions with other drugs and at doses < 10 g/d has no significant side effects. Experimental studies have clearly demonstrated the antifibrotic, antioxidant and metabolic effects of silybin; previous human studies were insufficient for confirming the clinical efficacy in chronic liver disease, while ongoing clinical trials are promising. On the basis of literature data, silybin seems a promising drug for chronic liver disease.

Indicators of prognosis after liver transplantation in Chinese hepatocellular carcinoma patients

AIM： To identify prognostic factors of patients with hepatocellular carcinoma （HCC）, who were treated by orthotopic liver transplantation （OLT）. METHODS： From January 2000 to October 2006, 165 patients with HCC underwent OLT. Various clinicopathological risk factors for actuarial and recurrencefree survival were identified using the Kaplan-Meier method with the log-rank test. The Cox proportional hazards model was used to identify independently predictive factors for actuarial and recurrence-free survival, which were used to propose new selection criteria. We compared the outcome of the subgroup patients meeting different criteria. Survival analysis was performed using the Kaplan-Meier method with the log-rank test. RESULTS： The median follow-up was 13.0 mo （2.8-69.5 too）. Overall, 1-, 2-, 3- and 5-year actuarial survival was 73.3%, 45.6%, 35.4% and 32.1%, respectively. One-, 2-, 3- and 5-year overall recurrencefree survival was 67.0%, 44.3%, 34.5% and 34.5%, respectively. In univariate analysis, number of tumors, total tumor size, lobar distribution, differentiation, macrovascular invasion, microvascular invasion, capsulation of the tumor, and lymph node metastasis were found to be associated significantly with actuarial and tumor-free survival. By means of using the multivariate Cox proportional hazards model, total tumor size and macrovascular invasion were found to be independent predictors of actuarial and tumor-free survival. When the selection criteria were expanded into the proposed criteria, there was no significant difference in 1-, 2-, 3- and 5-year actuarial and tumor-free survival of the 49 patients who met the proposed criteria （97.6%, 82.8%, 82.8% and 82.8%, and 90.7%, 82.8%, 68.8% and 68.8%, respectively） compared with that of patients who met the Milan or University of California, San Francisco （UCSF） criteria. CONCLUSION： Macrovascular invasion and total tumor diameter are the strongest prognostic factors. The proposed criteria do not adversely affect the outcome of liver transplantation for HCC, compared with the Milan or UCSF criteria.

Transradial Versus Transfemoral Approach for Percutaneous Coronary Intervention in Elderly Patients in China： A Retrospective Analysis

Objective To compare hospital costs and clinical outcomes between transradial intervention （TRI） and transfemoral intervention （TFI） in elderly patients aged over 65 years. Methods We identified 1229 patients aged over 65 years who underwent percutaneous coronary intervention （PCI） in Fuwai Hospital, Beijing, China, between January 1 and December 31, 2010. Total hospital costs and in-hospital outcomes were compared between TRI and TFI. An inverse probability weighting （IPW） model was introduced to control potential biases. Results Patients who underwent TRI were younger, less often female, more likely to receive PCI for single-vessel lesions, and less likely to undergo the procedure for ostial lesions. TRI was associated with a cost saving of CNY7495 （95%CI： CNY4419-10 420）. Such differences were mainly driven by lower PCI-related costs. TRI patients had shorter length of stay （1.9 days, 95%CI： 1.1-2.7 days）, shorter post-procedural stay （0.7 days, 95%CI： 0.3-1.1 days）, and fewer major adverse cardiac events （adjusted odds ratio = 0.47, 95%CI： 0.31-0.73）. There was no statistical significance in the incidence of post-PCI bleeding between TRI and TFI （P〉0.05）. Such differences remained consistent in clinically relevant subgroups of acute myocardial infarction, acute coronary syndrome, and stable angina. Conclusion The use of TRI in patients aged over 65 years was associated with significantly reduced hospital costs and more favorable clinical outcomes.

Clinical outcome and predictors of survival after TIPS insertion in patients with liver cirrhosis

AIM： To determine the clinical outcome and predictors of survival after transjugular intrahepatic portosystemic stent shunt （TIPS） implantation in cirrhotic patients. METHODS： Eighty-one patients with liver cirrhosis and consequential portal hypertension had TIPS implanta- tion （bare metal） for either refractory ascites （RA） （n = 27） or variceal bleeding （VB） （n = 54）. Endpoints for the study were： technical success, stent occlusion and stent stenosis, rebleeding, RA and mortality. Clini- cal records of patients were collected and analysed. Baseline characteristics [e.g., age, sex, CHILD score and the model for end-stage liver disease score （MELD score）, underlying disease] were retrieved. The Kaplan- Meier method was employed to calculate survival from the time of TIPS implantation and comparisons were made by log rank test. A multivariate analysis of factors influencing survival was carried out using the Cox pro- portional hazards regression model. Results were ex- pressed as medians and ranges. Comparisons between groups were performed by using the Mann-Whitney U-test and the4,2 test as appropriate. RESULTS： No difference could be seen in terms of age, sex, underlying disease or degree of portal pressure gradient （PPG） reduction between the ascites and the bleeding group. The PPG significantly decreased from 23.4 ± 5.3 mmHg （VB） vs 22.1± 5.5 mmHg （RA） be- fore TIPS to 11.8 ±4.0 vs 11.7 ± 4.2 after TIPS im- plantation （P = 0.001 within each group）. There was a tendency towards more patients with stage CHILD A in the bleeding group compared to the ascites group （24 vs 6, P = 0.052）. The median survival for the ascites group was 29 mo compared to 〉 60 mo for the bleed- ing group （P = 0.009）. The number of radiological con- trols for stent patency was 6.3 for bleeders and 3.8 for ascites patients （P = 0.029）. Kaplan-Meier calculation indicated that stent occlusion at first control （P = 0.027）, ascites prior to TIPS implantation （P = 0.009）, CHILD stage （P = 0.013）, MELD score （P = 0.001） and those patients not having undergone liver transplantation （P = 0.024） were significant predictors of survival. In the Cox regression model, stent occlusion （P = 0.022）, RA （P = 0.043）, CHILD stage （P = 0.015） and MELD score （P = 0.004） turned out to be independent prognostic factors of survival. The anticoagulation management （P = 0.097）, the porto-systemic pressure gradient （P= 0.460） and rebleeding episodes （P = 0.765） had no significant effect on the overall survival. CONCLUSION： RA, stent occlusion, initial CHILD stage and MELD score are independent predictors of survival in patients with TIPS, speaking for a close follow-up in these circumstances.

Differential expression of Rab27A/B correlates with clinical outcome in hepatocellular carcinoma

AIM:To investigate the association of Rab27A and Rab27B expression with clinicopathological characteristics and prognosis of hepatocellular carcinoma(HCC).METHODS:We used reverse transcription polymerase chain reaction(RT-PCR),real-time PCR,and Western blotting to detect Rab27A and Rab27B mRNA and protein expression in 5 human HCC lines and the immortalized hepatic HL-7702 cell line.We further examined 148 primary HCC samples matched with adjacent normal tissue and 80 non-HCC specimens by immunohistochemistry to evaluate the correlation of Rab27A and Rab27B expression with clinicopathological features and prognosis.RESULTS:Our data showed that Rab27A and Rab27Bwere differentially expressed in cell lines and primary HCC tumors.Rab27A mRNA and protein were detected in 67%(4/6)of human cell lines and 80%(4/5)of HCC cell lines,while Rab27B was found in 50%(3/6)of human lines and 40%(2/5)of HCC lines.Rab27A expression was higher in primary HCC(46.2%,66/143)than in matched adjacent tissue(24.3%,33/136,P<0.001),whereas immunopositivity for Rab27B was lower in primary HCC(57.4%,81/141)than in matched adjacent tissue(87.5%,119/136,P<0.001).Analysis of clinicopathological characteristics of 148 HCC specimens revealed significant correlations between Rab27A and Rab27B expression and tumor tumor-node-metastasis(TNM)classification(P=0.046 and P=0.027,respectively),and between strong Rab27A expression and tumor differentiation grade(P=0.008).Survival analyses revealed that patients with Rab27A+or Rab27B+tumors had significantly reduced overall survival compared with that of patients with Rab27A-or Rab27B-tumors(P= 0.015 and P=0.005,respectively).Risk analyses revealed that Rab27B+and TNMⅢ-Ⅳwere independent poor prognosis factors associated with a 3.36-and 3.37fold higher relative risk of death,respectively.CONCLUSION:Rab27A and Rab27B expression were closely correlated with tumor progression and can be valuable prognostic indicators for HCC patients.

Additional manual thrombus aspiration for ST-segment elevation myocardial infarction during percutaneous coronary intervention： an updated meta- analysis

Background The clinical efficacy and safety of adjunctive thrombus aspiration （TA） in patients with ST-segment elevation myocardial infarction （STEMI） during percutaneous coronary intervention （PCI） remain controversial. Methods Twenty five eligible randomized controlled trials were included to compare the use of thrombus aspiration （TA） with PCI and PCI-only for STEMI. The primary endpoint was all-cause mortality and death. The secondary endpoints were major adverse cardiac events （MACE）, recurrent infarction （RI）, target vessel revascularization （TVR）, stent thrombosis （ST）, perfusion surrogate markers and stroke. Results TIMI flow grade 3 and MBG 2-3 were significantly increased in the TA plus PCI arm compared with the PCI-only arm [relative risk （RR）： 1.05, 95% confidence intervals （CI）： 1.02-1.09, P = 0.004] and （RR： 1.68, 95% CI： 1.40-2.00, P 〈 0.001）, respectively. There were no significant differences in all-cause mortal- ity, MACEs, TVR and ST rates between the two groups. The RI rate was lower in the TA plus PCI arm than that in the PCI-only arm with short-term follow-up duration （RR： 0.60, 95% CI： 0.38-0.96, P = 0.03）, but there was no significant difference in RI incidence over the me- diumor long-term follow-up periods （RR： 1.00, 95% CI： 0.77-1.29, P = 0.98）, and （RR： 0.96, 95% CI： 0.81-1.15, P = 0.69）, respectively. There were statistically significant differences in the rates of crude stroke and stroke over the medium- or long-term follow-up periods and the crude stroke rate in the TA plus PCI （RR： 1.60, 95% CI： 1.08-2.38, P = 0.02） and （RR： 1.43, 95% CI： 1.03-1.98, P = 0.03）, respectively; this was not observed between the two arms during the short-term follow-up period （RR： 1.47, 95% CI： 0.97-2.21, P = 0.07）. Conclusions Routine TA-assisted PCI in STEMI patients can improve myocardial reperfusion and get limited benefits related to the clinical endpoints, which may be associated with stroke risk.

Impact of concomitant use of proton pump inhibitors and clopidogrel or ticagrelor on clinical outcomes in patients with acute coronary syndrome

Background There is great debate on the possible adverse interaction between proton pump inhibitors （PPIs） and clopidogrel. In ad- dition, whether the use of PPIs affects the clinical efficacy of ticagrelor remains less known. We aimed to determine the impact of concomi- tant administration of PPIs and clopidogrel or ticagrelor on clinical outcomes in patients with acute coronary syndrome （ACS） after percuta- neous coronary intervention （PCI）. Methods We retrospectively analyzed data fi＇om a ＂real world＂, international, multi-center registry between 2003 and 2014 （n = 15,401） and assessed the impact of concomitant administration of PPIs and clopidogrel or ticagrelor on 1-year composite primary endpoint （all-cause death, re-infarction, or severe bleeding） in patients with ACS after PCI. Results Of 9429 patients in the final cohort, 54.8% （n = 5165） was prescribed a PPI at discharge. Patients receiving a PPI were older, more often female, and were more likely to have comorbidities. No association was observed between PPI use and the primary endpoint for patients receiving clopidogrel （ad- justed HR： 1.036; 95% CI： 0.903-1.189） or ticagrelor （adjusted HR： 2.320; 95% CI： 0.875-45.151） （Pinteraction = 0.2004）. Similarly, use of a PPI was not associated with increased risk of all-cause death, re-infarction, or a decreased risk of severe bleeding for patients treated with either clopidogrel or ticagrelor. Conclusions In patients with ACS following PCI, concomitant use of PPIs was not associated with in- creased risk of adverse outcomes in patients receiving either clopidogrel or ticagrelor. Our findings indicate it is reasonable to use a PPI in combination with clopidogrel or ticagrelor, especially in patients with a higher risk of gastrointestinal bleeding.

Hemi-semi Laminectomy Approach for the Microsurgical Treatment of Spinal Schwannomas

Objective To evaluate the safety and efficiency of hemi-semi laminectomy approach for the micro- surgical treatment of spinal schwannomas. Methods A total of 22 patients underwent hemi-semi laminectomy for the microsurgical removal of spinal schwannomas during a period of 2009 and 2011 in Affiliated Hospital of Nantong University. We ret- rospectively analyzed the clinical outcomes of these patients. Results Of them, 5 cases were diagnosed with cervical schwannomas, 9 with thoracic schwarmomas, and 8 with lumbar schwannomas. All the tumors including two dumbbell schwannomas were totally removed without major complications. Postoperatively, all patients were followed up from 6 to 36 months. The symp- toms and signs were obviously improved, and no tumor recurrence or spinal deformity occurred. Conclusion Hemi-semi laminectomy is a safe and effective method for resection of spinal schwan- nomas

Transarterial injection of H101 in combination with chemoembolization overcomes recurrent hepatocellular carcinoma

Transcatheter arterial chemoembolization (TACE) has become the standard treatment modality for unresectable hepatocellular carcinoma (HCC). Nonetheless, the clinical outcomes in patients with unresectable HCC are often unsatisfactory, especially in those with recurrent HCC. H101, an E1B gene deleted adenovirus, is known to have a significant antitumor activity. In addition, local injection of H101 can enhance the effect of antitumor therapies (chemotherapy and radiotherapy). Transarterial H101 gene injection in combination with TACE may help to control refractory and recurrent HCC. In this study, we report a 55-year-old patient with recurrent HCC which was treated with transarterial injection of H101 in combination with TACE, leading to a good clinical prognosis of the patient.

Acupuncture and the Elevation Manipulation of Massage for Treatment of Frozen Shoulder

The authors have treated 50 cases of frozen shoulder in recent years with electro-acupuncture and the elevation manipulation. The results were satisfactory and reported as follows.

OBSERVATION OF THE EFFICACY OF ACUPUNCTURE AND MOXIBUSTION IN 62 CASES OF CHRONIC COLITIS

62 patients with chronic colitis were randomly divided into two groups. Acupuncture and moxibustion at acupoints such as Tianshu (St 25), Guanyuan (Ren 4) were applied in the treatment group, and western drugs were applied in the control group. The results showed that acupuncture and moxibustion had a marked curative effective with few side effects, and therefore was readily acceptable to the patients.

Antimicrobial management of intra-abdominal infections:Literature's guidelines

Antimicrobial management of severe intra-abdominal infections (IAIs) involves a delicate balance of optimizing empirical therapy,which has been shown to improve clinical outcomes,while simultaneously reducing unnecessary antimicrobial use.Two sets of guidelines for the management of intra-abdominal infections were recently published.In 2010,the Surgical Infection Society and the Infectious Diseases Society of America (SIS-IDSA) created guidelines for the diagnosis and management of complicated IAIs.The new SIS-IDSA guidelines replace those previously published in 2002 and 2003.The World Society of Emergency Surgery (WSES) guidelines represent additional contributions,made by specialists worldwide,to the debate regarding proper antimicrobial drug methodology.These guidelines represent the conclusions of the consensus conference held in Bologna,Italy,in July 2010 during the first congress of the WSES.

Pulmonary and cerebral lipiodol embolism after transcatheter arterial hemoembolization in hepatocellular carcinoma

Pulmonary and cerebral lipiodol embolism after transcatheter arterial chemoembolization (TACE) of hepatocellular carcinoma is rare. To our knowledge, only 7 cases have been reported in the literature. We present a case of pulmonary and cerebral lipiodol embolism, and analyzed retrospectively the imaging and clinical data of the patient and conclude the most probable mechanism of pulmonary and cerebral lipiodol embolism, which is different from that of the cases reported previously.