Laparoscopic vs computerized tomography-guided radiofrequency ablation for large hepatic hemangiomas abutting the diaphragm

AIM: To compare safety and therapeutic efficacy of laparoscopic radiofrequency(RF) ablation vs computed tomography(CT)-guided RF ablation for large hepatic hemangiomas abutting the diaphragm.METHODS: We retrospectively reviewed our sequential experience of treating 51 large hepatic hemangiomas abutting the diaphragm in 51 patients by CT-guided or laparoscopic RF ablation due to either the presence of symptoms and/or the enlargement of hemangioma.Altogether, 24 hemangiomas were ablated via a CTguided percutaneous approach(CT-guided ablation group), and 27 hemangiomas were treated via a laparoscopic approach(laparoscopic ablation group).RESULTS: The mean diameter of the 51 hemangiomas was 9.6 ± 1.8 cm(range, 6.0-12.0 cm). There was nodifference in the diameter of hemangiomas between the two groups(P > 0.05). RF ablation was performed successfully in all patients. There was no difference in ablation times between groups(P > 0.05). There were 23 thoracic complications in 17 patients: 15(62.5%, 15/24) in the CT-guided ablation group and2(7.4%, 2/27) in the laparoscopic ablation group(P< 0.05). According to the Dindo-Clavien classification,two complications(pleural effusion and diaphragmatic rupture grade Ⅲ) were major in two patients. All others were minor(grade Ⅰ). Both major complications occurred in the CT-guided ablation group. The minor complications were treated successfully with conservative measures, and the two major complications underwent treatment by chest tube drainage and thoracoscopic surgery, respectively. Complete ablation was achieved in 91.7%(22/24) and 96.3%(26/27) in the CT-guided and the laparoscopic ablation groups,respectively(P > 0.05).CONCLUSION: Laparoscopic RF ablation therapy should be used as the first-line treatment option for large hepatic hemangiomas abutting the diaphragm.It avoids thermal injury to the diaphragm and reduces thoracic complications.

TREATMENT OF TRIGEMINAL NEURALGIA WITH ACUPUNCTURE AT RENYING POINT -A Report of 7 Cases

Trigeminal neuralgia refers to repeated paroxysmal, transient, and severe pain in the innervation area of the trigeminal nerve. The cause of this disease has not yet been fully elucidated. There is no special therapeutic measure to treat it. The authors have achieved relatively satisfactory curative effect in seven patients with trigeminal neuralgia by acupuncture at Renying point (St 9). This is reported as follows.

TREATMENT OF 18 CASES OF TRIGEMINAL NEURALGIA WITH ELONGATED NEEDLE

In this paper, a total of 18 cases of primary trigeminal neuralgia were treated with elongated needle. Of the 18 cases, 5 were male and 15 female, ranging in age from 27 to 58 years and in disease duration from 3 days to 8 years. Main acupoints used were Taiyang (EX-HN 5) to Xiaguan (ST 7, for penetration needling), Xiajiache, Fengchi (GB 20), Yanglingquan (GB 34) and Taichong (LR 3). The treatment was given once daily, with 12 sessions being a therapeutic course. After 2 courses of treatment, of the 18 cases, 10 cases were cured, 7 experienced improvement in pain and one failed in the treatment, with an effective rate of 94.4%. The key point for treating trigeminal neuralgia is applying penetrative needling from EX-HN 5 to ST 7 to achieve ideal needling sensations.

An investigation on compiling opinions on and suggestions for a biochemistry textbook from nursing undergraduates

Objective： To compile nursing undergraduates＇ opinions and suggestions for biochemistry textbook to improve the readability and applicability of a textbook of biochemistry. Methods： This investigation involved 279 nursing undergraduates through delivery of a self-made questionnaire, which was to be used to analyze and study the students＇ suggestions and opinions on the content of the biochemistry textbook. Results： The investigation revealed that the textbook＇s difficulty was associated negatively with stu- dents＇ interest （P 〈 0.05）, and the textbook＇s importance was associated positively with students＇ interest （P 〈 0.05）. Students suggested that the textbook should be closely related to nursing. The contents, difficulty, structure and charts of the textbook should be adjusted properly. Conclusions： The content of the nursing version of the biochemistry textbook should be driven by the needs of the nursing major and should focus on simplifying the textbook＇s content, and making it practical. This will make the textbook vivid and readable, enhancing the interest of students to accept and benefit from the textbook.

Independent prognostic value of the congestion and renal index in patients with acute heart failure

BACKGROUND Clinical outcomes are poor if patients with acute heart failure(AHF)are discharged with residual congestion in the presence of renal dysfunction.However,there is no single indication to reflect the combined effects of the two related pathophysiological processes.We,therefore,proposed an indicator,congestion and renal index(CRI),and examined the associations between the CRI and one-year outcomes and the incremental prognostic value of CRI compared with the established scoring systems in a multicenter prospective cohort of AHF.METHODS We enrolled AHF patients and calculated the ratio of thoracic fluid content index divided by estimated glomerular filtration rate before discharge,as CRI.Then we examined the associations between CRI and one-year outcomes.RESULTS A total of 944 patients were included in the analysis(mean age 63.3±13.8 years,39.3%women).Compared with patients with CRI≤0.59 mL/min per kΩ,those with CRI>0.59 mL/min per kΩhad higher risks of cardiovascular death or HF hospitalization(HR=1.56[1.13-2.15])and all-cause death or all-cause hospitalization(HR=1.33[1.01-1.74]).CRI had an incremental prognostic value compared with the established scoring system.CONCLUSIONS In patients with AHF,CRI is independently associated with the risk of death or hospitalization within one year,and improves the risk stratification of the established risk models.

Association of Overlapped and Un-overlapped Comorbidities with COVID-19 Severity and Treatment Outcomes: A Retrospective Cohort Study from Nine Provinces in China

Objective Several COVID-19 patients have overlapping comorbidities. The independent role of each component contributing to the risk of COVID-19 is unknown, and how some non-cardiometabolic comorbidities affect the risk of COVID-19 remains unclear.Methods A retrospective follow-up design was adopted. A total of 1,160 laboratory-confirmed patients were enrolled from nine provinces in China. Data on comorbidities were obtained from the patients’ medical records. Multivariable logistic regression models were used to estimate the odds ratio(OR) and 95% confidence interval(95% CI) of the associations between comorbidities(cardiometabolic or non-cardiometabolic diseases), clinical severity, and treatment outcomes of COVID-19.Results Overall, 158(13.6%) patients were diagnosed with severe illness and 32(2.7%) had unfavorable outcomes. Hypertension(2.87, 1.30–6.32), type 2 diabetes(T2 DM)(3.57, 2.32–5.49),cardiovascular disease(CVD)(3.78, 1.81–7.89), fatty liver disease(7.53, 1.96–28.96), hyperlipidemia(2.15, 1.26–3.67), other lung diseases(6.00, 3.01–11.96), and electrolyte imbalance(10.40, 3.00–26.10)were independently linked to increased odds of being severely ill. T2 DM(6.07, 2.89–12.75), CVD(8.47,6.03–11.89), and electrolyte imbalance(19.44, 11.47–32.96) were also strong predictors of unfavorable outcomes. Women with comorbidities were more likely to have severe disease on admission(5.46,3.25–9.19), while men with comorbidities were more likely to have unfavorable treatment outcomes(6.58, 1.46–29.64) within two weeks.Conclusion Besides hypertension, diabetes, and CVD, fatty liver disease, hyperlipidemia, other lung diseases, and electrolyte imbalance were independent risk factors for COVID-19 severity and poor treatment outcome. Women with comorbidities were more likely to have severe disease, while men with comorbidities were more likely to have unfavorable treatment outcomes.

Effectiveness and safety of Jiawei Xiaoyao pill(加味逍遥丸)in the treatment of premenstrual syndrome(liver depression,spleen deficiency,and blood-heat syndrome):a multi-center,randomized,placebo-controlled trial

OBJECTIVE:To investigate the effectiveness and safety of Jiawei Xiaoyao pill(加味逍遥丸,JXP)in the treatment of symptoms associated with premenstrual syndrome(PMS).METHODS:A total of 144 regularly menstruating women with PMS were recruited at 8 sites in China from August 2017 to December 2018,and randomized to receive either a JXP or a matching placebo(12 g/d,6 g twice a day)for 3 menstrual cycles.The primary indicator was the reduced Daily Record of Severity of Problems(DRSP)scores in the luteal phase after 3 months of treatment.The safety outcomes included clinical adverse events(AEs),adverse reactions(ARs),changes in vital signs,and laboratory tests.RESULTS:JXP surpassed the placebo in reducing DRSP scores(psychological/somatic dysfunction)in the luteal phase over 3 menstrual cycles of treatment(PFAS=0.002,PPPS=0.001).Additionally,there were no significant differences in the incidence of AEs,severe AEs,withdrawal due to AEs and ARs between the two groups(all P>0.05),and no clinically significant adverse medical events related to the test drug observed.CONCLUSIONS:JXP was superior to the placebo in relieving the symptoms associated with PMS,which signified that JXP may be effective,safe,and welltolerated as an alternative therapy.

Anesthetic safety evaluation of Enflurane on pregnant dogs and their fetuses

The safety and feasibility of anesthesia during pregnancy are the public concern to human and veterinary medicines,respiratory and cardiac suppression is the most serious side effect of anesthetic. In order to evaluate the effects of Enflurane on pregnant dogs their fetuses,we established the animal model of the artery catheterization,and investigated the maternal and fetal anesthetic concentrations as well as blood gases in the pregnant dogs anesthetized by inhalation of Enflurane. In this experiment,the femoral artery catheterization of 12 pregnant dogs and their 12 fetuses were performed through the anterior tibia artery by using 17 G and 18 G arterial puncture needle,4F expanded tube,3 F induction tube and the C-arm monitoring system. The results showed that the fetuses survived in uterus for 36 h (two cases),4 ~ 5 d (two cases),6 ~7 d (three cases),8 ~10 d (three cases) and 12 ~14 d (two cases) after operation,respectively. 10 fetuses that survived over 4 days in uterus after the operation were successfully delivered. The fetuses were healthy and their catheters were kept well,the other two pregnant dogs aborted their fetuses. After establishing the model successfully,Atropine sulfate in dose of 0. 04 mg/kg bw were injected into cutaneous muscle of dogs in right clinostatism. 15 minutes later after application of Atropine sulfate,the induced anesthesia was carried out by vein injection of 2. 5% Pentothal sodium (10 mg/kg/bw). The tracheal cannula was performed and the dogs were anesthetized for 10 min by Enflurane inhalation from anesthetic machine. Subsequently,the respiratory rate of experimental animals was controlled to 20-22 times/min by a mechanical ventilator,and the tidal volume was 13 ~ 15 mL/kg/bw. The maternal and fetal arterial anesthetic concentrations and blood gases including pH,PO 2,PCO 2,TCO 2,HCO 3-,SB,BEb and Sat. O 2 were measured after Enflurane inhalation anesthesia. The results showed Enflurane can cross placenta and reach fetal blood. The arterial anesthetic concentrations in fetuses were lower than that in their mothers,but the changes of anesthetic concentrations in fetuses were very similar to their mothers. The pH and BEb in the maternal and fetal blood were significantly lower (P 【 0. 01 or 0. 05),PO 2,PCO 2,and Sat. O 2 were significantly higher (P 【 0. 01 or 0. 05),compared to the prior anesthesia. SB decreased,HCO 3-and T-CO 2 increased (P 】 0. 05) in the early stage of anesthesia,but there were no significant difference after and before anesthesia. These results indicated that Enflurane crosses the placenta very quickly in dogs and is characterized by the quick induction anesthesia and elimination in the body. There were slight respiratory and metabolic acidosis in the period of anesthesia in both pregnant dogs and their fetus and the state were gradually restored to normal with the elimination of the Enflurane in blood. Taken together,Enfluence should be considerated the candidate for the induction and maintenance anesthesia for veterinary and human medicine.

Delivery room resuscitation and short-term outcomes of extremely preterm and extremely low birth weight infants: a multicenter survey in North China

Background:Delivery room resuscitation assists preterm infants,especially extremely preterm infants(EPI)and extremely low birth weight infants(ELBWI),in breathing support,while it potentially exerts a negative impact on the lungs and outcomes of preterm infants.This study aimed to assess delivery room resuscitation and discharge outcomes of EPI and ELBWI in China.Methods:The clinical data of EPI(gestational age[GA]<28 weeks)and ELBWI(birth weight[BW]<1000 g),admitted within 72 h of birth in 33 neonatal intensive care units from five provinces and cities in North China between 2017 and 2018,were analyzed.The primary outcomes were delivery room resuscitation and risk factors for delivery room intubation(DRI).The secondary outcomes were survival rates,incidence of bronchopulmonary dysplasia(BPD),and risk factors for BPD.Results:A cohort of 952 preterm infants were enrolled.The incidence of DRI,chest compressions,and administration of epinephrine was 55.9%(532/952),12.5%(119/952),and 7.0%(67/952),respectively.Multivariate analysis revealed that the risk factors for DRI were GA<28 weeks(odds ratio[OR],3.147;95%confidence interval[CI],2.082–4.755),BW<1000 g(OR,2.240;95%CI,1.606–3.125),and antepartum infection(OR,1.429;95%CI,1.044–1.956).The survival rate was 65.9%(627/952)and was dependent on GA.The rate of BPD was 29.3%(181/627).Multivariate analysis showed that the risk factors for BPD were male(OR,1.603;95% CI,1.061–2.424),DRI(OR,2.094;95% CI,1.328–3.303),respiratory distress syndrome exposed to≥2 doses of pulmonary surfactants(PS;OR,2.700;95%CI,1.679–4.343),and mechanical ventilation≥7 days(OR,4.358;95% CI,2.777–6.837).However,a larger BW(OR,0.998;95% CI,0.996–0.999),antenatal steroid(OR,0.577;95%CI,0.379–0.880),and PS use in the delivery room(OR,0.273;95%CI,0.160–0.467)were preventive factors for BPD(all P<0.05).Conclusion:Improving delivery room resuscitation and management of respiratory complications are imperative during early management of the health of EPI and ELBWI.