الملخص
Objective:To investigate the feasibility and clinical efficacy of percutaneous anterior column screwing assisted by blocking screws for pelvic and acetabular fractures.Methods:A retrospective analysis was conducted of the 13 patients who had been admitted from July 2019 to April 2022 for pelvic and acetabular fractures. There were 8 males and 5 females with an age of (49.1±13.3) years, 7 acetabular fractures (6 on one side and 1 on both sides; by the Letournel-Judet classification: 5 anterior column fractures on 6 sides, and 2 transverse and posterior wall fractures on 2 sides), and 6 pelvic fractures (5 complicated with pelvic posterior ring fracture; by the Tile classification: 1 case of type B2, 3 cases of type C1, and 2 cases of type C2). According to the anatomic zones of the anterior column, 5 fractures were at zone Ⅲ, 3 ones at zone Ⅳ, and 6 ones at zone Ⅴ. The time from injury to surgery ranged from 3 to 14 days, averaging (8.2±2.9) days. Anterograde anterior column screwing assisted by blocking screws was performed for all the 13 patients; the posterior ring was fixated with percutaneous sacroiliac joint screws for the 5 patients complicated with pelvic posterior ring fracture. The surgical time, intraoperative fluoroscopy frequency, and intraoperative bleeding volume for insertion of anterior column screws, fracture reduction quality, and hip joint function at the last follow-up were recorded.Results:A total of 14 anterior column screws were inserted percutaneously in the 13 patients. For insertion of anterior column screws, the surgical time was (65.0±10.2) min, the intraoperative fluoroscopy frequency (63.5±14.5) times, and the intraoperative bleeding volume for each screw less than 30 mL. All the incisions healed primarily after surgery, without such complications as iatrogenic neurovascular injury or poor wound healing. All the 13 patients were followed up for (11.1±2.2) months after surgery. In the patient with bilateral acetabular anterior column fractures for which 2 anterior column screws had been inserted, one screw had to be removed due to its displacement at 1 month after surgery; no such complications as loosening of internal fixation or fracture re-displacement was found in the other patients. All fractures healed after (10.2±2.1) months. According to the Matta scoring for quality of fracture reduction, 7 sides were excellent, 5 sides good, and 2 sides poor; according to the Majeed scoring for the 6 patients with pelvic fracture at the last follow-up, the efficacy was rated as excellent in 4 cases and as good in 2 ones; according to the modified Merle d'Aubigné & Postel scoring for the 7 patients with 8 acetabular fractures at the last follow-up, the efficacy was rated as excellent in 4 hips, as good in 3 hips, and as fair in 1 hip.Conclusion:For pelvic and acetabular fractures, minimally invasive percutaneous anterior column screwing assisted by blocking screws can result in fine clinical efficacy, in addition to its easy procedures, safety and reliability.
الملخص
Objective:To investigate the timing of rivaroxaban re-administration after upper gastrointestinal bleeding in patients with lower extremity deep venous thrombosis.Methods:The clinical data of 176 patients who suffered from lower limb deep vein thrombosis due to trauma or surgery and upper gastrointestinal bleeding due to oral rivaroxaban and received treatment in the Third Hospital of Hebei Medical University from May 2018 to October 2021 were retrospectively analyzed. These patients were divided into an early group (≤ 7 days) ( n = 84 cases) and a late group (> 7 days) ( n = 92 cases) according to the timing of rivaroxaban re-administration. All patients were followed up for 2 months to record hemoglobin, D-dimer, and platelet values. The progression of deep venous thrombosis of the lower extremities was observed. The rebleeding rate, progression of lower extremity deep venous thrombosis, and mortality were analyzed. Results:There were no significant differences in hemoglobin and D-dimer levels between the two groups on admission (both P > 0.05). After admission, the D-dimer level in the late group was (4.1 ± 2.3) mg/L, which was significantly higher than (3.1 ± 1.9) mg/L in the early group ( t = 3.17, P < 0.05). After admission, hemoglobin level in each group was significantly decreased compared with that on admission (both P < 0.05). The lowest hemoglobin level in the late group was (78.7 ± 8.3) g/L, which was significantly higher than (75.6 ± 8.2) g/L in the early group ( t = 2.32, P < 0.05). There was no significant difference in rebleeding rate between early and late groups [5.95% (5/84) vs. 1.08% (1/92)] (log-rank 3.07, P > 0.05). Lower extremity deep venous thrombosis progressed more slowly in the early group compared with the late group [2.38% (2/84) vs. 10.86% (10/92)] (log-rank = 4.61, P < 0.05). Conclusion:Rivaroxaban should be re-administered as soon as possible after upper gastrointestinal bleeding in patients with lower extremity deep venous thrombosis.
الملخص
Objective:To preliminarily observe the clinical efficacy of microwave hyperthermia combined with intensity-modulated radiotherapy (IMRT) and chemotherapy for patients with locally advanced gastric cancer.Methods:Forty patients who could not been operated or refused operation were enrolled in this clinical trial, who were confirmed as locally advanced proximal or distal gastric cancer by gastroscopy pathology and imaging. Radiotherapy was delivered by IMRT technology for 5 times per week with a total dose of 46 to 56 Gy (median dose of 50 Gy) in 25 to 28 fractions. Synchronous hyperthermia was given at 42 to 44℃ twice a week, 45 min/time. S-1 or capecitabine-based synchronous chemotherapy was performed, d1-14/3 weeks. The symptom remission rate, adverse reactions, objective remission rate (complete and partial remission) and survival were observed.Results:A total of 40 patients, aged between 56 and 83 years (median age of 71 years), were enrolled in this study. The male-to-female ratio was 7: 1. Among them, 38 cases (95%) showed symptom remission. The most common adverse reactions were grade 1-2 gastrointestinal reactions and leukopenia. The objective remission rate was 87.5%, the 2-year progression-free survival and overall survival rates were 68.6% and 70.5%, respectively.Conclusion:Preliminary findings demonstrate that microwave hyperthermia combined with chemoradiotherapy achieve satisfactory outcomes and yield tolerable toxicity in patients with locally advanced gastric cancer.
الملخص
Objective:To analyze the implementation of medical emergency team (MET) in Fuxing Hospital of Capital Medical University, and to investigate the characteristics such as the time, department, disease, cause of the MET calls, in order to provide a basis for the improvement of MET's implementation.Methods:A retrospective study was conducted. MET calls that received between January 1st, 2015 and December 31st, 2018 at Fuxing Hospital were collected. The calls' information included the quarter, time, and the patients' gender, age, admission time, department, admission diagnosis, the reason for the calls, the operation and outcome of the MET upon arrival.Results:A total of 846 MET calls were occurred during 4 years from 2015 to 2018. The frequencies of the first and third quarter were relatively high with 28.0% (237/846) and 26.5% (224/846), respectively. The events mainly occurred during the day (08:00-19:59) with 611 calls (72.2%). There were more men [64.3% (544/846)] than women [35.7% (302/846)]. The calls were mainly from the elderly over 60 years old, and gradually increased with age, which distributed the most in patients aging 80-89 years old, accounting for 51.5% of all calls (436/846). Among all the MET events, 80.5% (681/846) were from department of internal medicine, 18.8% (159/846) were from department of surgery, and 0.7% (6/846) were from department of gynecology and obstetrics. The top 3 diseases reported in the calls were respiratory diseases [31.6% (267/846)], nervous system diseases [20.8% (176/846)] and circulatory diseases [9.9% (84/846)]. The reason of MET calls showed that abnormal pulse oxygen saturation [SpO 2, 27.8% (235/846)] were the most among 4 vital signs. After MET rescue, 7.3% (62/846) of the patients died, 48.7% (412/846) were transferred to intensive care unit (ICU) for further treatment, and 41.9% (354/846) remained under observation. Conclusions:The frequency of MET calls in Fuxing Hospital of Capital Medical University was relatively stable over the years, mostly received in the daytime (08:00-19:59) of the first and third quarter. Most of the patients were male aged 80-89 years old. The most MET calls were from department of internal medicine and due to respiratory disease. SpO 2 was the most common abnormal indicator. According to the above characteristics, MET can focus on them in the future.
الملخص
Objective To explore the application value of comparative imaging combined with multimedia teaching in the five-year undergraduate intemship teaching of nuclear medicine.Metbods 70 undergraduates internship in the nuclear medicine department of our hospital from June 2017 to February 2018 were divided into the control group and experimental group,35 in each group.The control group adopted traditional teaching method,and the experimental group adopted comparative imaging combined with multimedia teaching for internship teaching.The theoretical test scores,the evaluation of the self-perception of the teaching process and the teaching feedback of the two groups were compared.Results The theoretical test scores of the experimental group students were significantly higher than those of the control group,including the noun explanation [(26.60 ± 0.51) vs.(22.20 ± 0.58)],the short-answer question [(26.80 ± 0.37) vs.(22.40 ± 0.60)],the essay question [(36.00 ± 0.71) vs.(27.40 ± 1.03)] and total score [(92.40 ± 0.93) vs.(71.80 ± 0.37)].The satisfactions with the evaluation of the self-perception in the teaching process and the teaching feedback in the experimental group were also much better than those of the control group.Conclusion The application of comparative imaging combined with multimedia teaching in the practice teaching for undergraduate students in nuclear medicine could effectively improve the clinical practice teaching quality and actively promote the development of the teaching of nuclear medicine.
الملخص
Objective To investigate the effect of long-term proton pump inhibitor on osteoporosis in elderly patients.Methods A total of 150 patients with peptic ulcer treated in our hospital from January 2011 to January 2015 were selected as the observation group.150 healthy subjects were selected as the control group.The age,height,body weight and PPI time of the two groups were recorded.The changes of bone mineral density before and after treatment were measured by bone mineral density analyzer,ineluding lumbar L1-4,radial density and ulna density.The changes of bone mineral density were observed and recorded in the observation group before treatment,six months,1 year and 2 years after treatment.Results After treatment,the levels of gastrin were significantly increased in the observation group,and the serum calcium concentration and bone mineral density were significantly decreased (P＜0.05).The density of lumbar vertebrae,radius and ulna was significantly lower in observation group than those of control group (P＜0.05).With the prolongation of PPIs,lumbar vertebrae,radius and ulna density in observation group showed a decreasing trend.Conclusion Long-term application of proton pump inhibitors in elderly patients can cause bone loss.
الملخص
Objective To investigate the correlation between the drug resistance of Helicobacter pylori (H .pylori )and clinical eradication efficacy of bismuth-based quadruple therapies,and to guide clinical rational drug use in the region.Methods A total of 260 patients with H .pylori infections were collected.H .pylori from biopsied gastric mucosa tissues were isolated and cultured.Drug resistant rates of isolated H .pylori to metronidazole,clarithromycin,amoxicillin,levofloxacin and furanzolidone were tested.Patients were randomly divided into clarithromycin,levofloxacin,furanzolidone and metronidazole groups by completely randomized design.All patients received bismuth potassium 220 mg,esomeprazole 20 mg and amoxicillin 1 000 mg twice daily,and according to group received clarithromycin 500 mg, levofloxacin 200 mg,furanzolidone 100 mg and metronidazole 400 mg,twice daily,espectively.The treatment course was 10 days.At least four weeks after treatment,13 Curea breath test or 14 Curea breath test was taken.According to the intention to treat (ITT)and per-protocal (PP),the eradication rate of each group was caculated.Chi square test was performed to compare the differences between groups. Results The drug resistant rate of H .pylori to metronidazole,clarithromycin,amoxicillin,levofloxacin and furanzolidone was 94.2% (146/155 ), 21 .3% (33/155 ), 2.6% (4/155 ), 5 .8% (9/155 ) and 1 .9%(3/155),respectively.According to ITT analysis,the eradication rate of clarithromycin group, levofloxacin group,furanzolidone group and metronidazole group was 81 .5 %(53/65 ),90.8%(59/65 ), 93.8% (61/65 )and 75 .4%(49/65),respectively.And according to PP analysis which was 84.1 %(53/63),92.2%(59/64),95 .3%(61/64)and 79.0%(49/62 ),respectively.The differences between furanzolidone group and metronidazole group,clarithromycin group were staistcally significant (χ2ITT =8.509 and 4.561 ;χ2PP = 7.592 and 4.323,all P < 0.05 ).There was no statistical significance in the H .pylori eradication rate between resistant strains and sensitive strains of each group.Conclusion Bismuth-based quadruple therapy can overcome antibiotic resistance,the eradication rate of protocal with furanzolidone is higher and with good safety,which can be the first-line treatment for H .pylori eradication.
الملخص
Objective To study the protective effect and mechanism of Inonotus obliquus polysaccharide on liver injury induced by isoniazid( INH) combined with rifampicin( RFP) in mice. Methods Forty-eight mice were randomly divided into six groups ( control, model, huganpian, Inonotus obliquus polysaccharide at low, middle, and high dose ) . The mice were administered orally with isoniazid and rifampicin simultaneously except the control. After 2 h,the control and model groups were administered with normal saline,and others were treated with huganpian and Inonotus obliquus polysaccharide,respectively,once a day for 2 weeks. The liver index and serum levels of ALT and AST,malondialdehyde(MDA),superoxide dismutase(SOD) and glutathione peroxidase( GPx) were measured. Pathology examination of liver tissue was performed. Results The activities of ALT and AST, liver index, content of MDA in liver homogenate of mice treated with Inonotus obliquus polysaccharide and huganpian decreased obviously, while the liver SOD activity increased. Histopathological exzamination showed that Inonotus obliquus polysaccharide alleviated the degeneration and necrosis of hepatic cells. Conclusion Inonotus obliquus polysaccharide shows protective effects on mice with hepatic toxic injury induced by isoniazid and rifampicin,which maybe due to its antioxidation effect.
الملخص
Objective To evaluate the efficacy and safety of different bismuth-based quadruple therapies for Helicobacter pylori (H.pylori) eradication.Methods From December 2012 to October 2013,240 patients with H.pylori infection were collected and evenly divided into clarithromycin group,levofloxacin group,furanzolidone group and metronidazole group.Each group received bismuth potassium citrate 220 mg,esomeprazole 20 mg and amoxicillin 1 000 mg twice daily.In addition,each group received clarithromycin 500 mg,levofloxacin 200 mg,furanzolidone 100 mg,and metronidazole 400 mg,respectively.The course of treatment was 10 days.At least four weeks after the end of therapy and withdrawal the medicine,patients underwent fasting 13C-urea breath test or 14C-urea breath test.The negative result indicated as successful H.pylori eradication.The adverse effects were observed and recorded during treatment.The rate of H.pylori eradication was analyzed by the intention to treat (ITT) analysis and per protocol (PP) analysis.Chi-square test was performed for eradication rate comparison among groups.Results According to ITT analysis,the eradication rate of clarithromycin group,levofloxacin group,furanzolidone group and metronidazole group was 81.67％ (49/60),88.33％ (53/60),93.33％ (56/60) and 73.33％ (44/60),respectively,and according to PP analysis which was 85.96％ (49/57),89.83％ (53/59),94.92％ (56/59) and 75.86％ (44/58),respectively.The differences among four groups were statistically significant (x2 ＝10.13 and 9.89,both P＜0.05).The differences between furanzolidone group and metronidazole group were statistically significant (x2 =8.64 and 8.55,both P＜0.01).There were no statisticaly significant differences in adverse effects among the four groups (x2 =0.47,P＞0.05).Conclusion The H.pylori eradication rate is high in furanzolidone contained bismuth based quadruple therapy and with good safety,which could be the first line treatment for H.pylori eradication.
الملخص
Objective To identify two suspected Legionella pneumophila (L.pneumophila) strains isolated from environmental water and air conditioning cooling water systems in Guangzhou city.Methods The two strains were identified by their cultural characteristics,biochemical test,Legionella-specific primer PCR identification,PCR-enzymatic digestion analysis,16S rRNA,mip and rpoB gene sequencing analysis.Results The two suspected L.pneumophila isolates were identified as gram-negative bacillus appeared as white colonies on BCYEα-agar after incubation for 48 hours at 36℃.Both isolates were positive for oxidase,gelatinase and hydrolysis of hippurate,and negative for urease activity and nitrate reduction.Their phenotypic characteristics were similar to those of L.pneumophila strains.Results of PCR identification by using Legionella-specific primer were positive.Enzymatic digestion analysis showed that the 226 bp PCR products of two isolates were not digested by Taa Ⅰ.The two strains were classified as Legionella busanensis as indicated by gene sequencing analysis of 16S rRNA,mip and rpoB gene.Conclusion Two L.busanensis strains were first isolated from environmental and air conditioning cooling water systems in China.Due to their biochemical characteristics,L.busanensis strains were commonly misidentified as L.pneumophila,but could be effectively identified by PCR-enzymatic digestion analysis and multiple genes identification.
الملخص
Objective: To determine the distribution of CD4~+CD25~+FOXP3~+regulatory T cells (Treg) and Treg subsets in human colorectal carcinoma microenvironment and to explore their correlation with conventional clinico-pathological features.Methods: Frozen sections and Immunohistochemistry (IHC) were used to detect FOXP3~+ Treg in flesh specimen collected from 42 patients with colorectal carcinoma.The number of FOXP3~+ Treg was evaluated in terms of its association with clinico-pathological feature in tumor and peri-cancer tissue.Double staining was performed to determine the expression of ICOS and FOXP~3.Results:The number of FOXP3~+ Treg in the colorectal carcinoma (mean 24.1) was significantly higher than that in peri-cancer tissue (mean 0.7).A higher number of tumor infiltrating FOXP3~+ Tregs was found in the patient groups with poor differentiation,lymphatic metastasis and non-distant metastasis as compared to the patient groups with well differentiation,non-lymphatic metastasis and distant metastasis.The percentage of FOXP3~+ ICOS~+ Treg was higher in colorectal carcinoma(81% ) than that in peri-cancer tissue(10% ).Condusion: Increased FOXP3~+ Treg may influence the occurrence and development of colorectal carcinoma.Our data support the hypothesis that tumor infiltrating FOXP3~+ Tregs attenuate the immune response against cancer and suggest that strategy to overcome FOXP3~+ Treg function may be beneficial in the treatment of human colorectal cancer.
الملخص
Objective:To determine the distribution of CD4+CD25+FOXP3+ regulatory T cells (Treg) and Treg subsets in human colorectal carcinoma microenvironment and to explore their correlation with conventional clinico-pathological features.Methods:Frozen sections and Immunohistochemistry (IHC) were used to detect FOXP3+ Treg in fresh specimen collected from 42 patients with colorectal carcinoma.The number of FOXP3+ Treg was evaluated in terms of its association with clinico-pathological feature in tumor and peri-cancer tissue.Double staining was performed to determine the expression of ICOS and FOXP3.Results:The number of FOXP3+ Treg in the colorectal carcinoma (mean 24.1) was significantly higher than that in peri-cancer tissue (mean 0.7).A higher number of tumor infiltrating FOXP3+ Tregs was found in the patient groups with poor differentiation,lymphatic metastasis and non-distant metastasis as compared to the patient groups with well differentiation,non-lymphatic metastasis and distant metastasis.The percentage of FOXP3+ ICOS+ Treg was higher in colorectal carcinoma(81%) than that in peri-cancer tissue(10%).Conclusion:Increased FOXP3+ Treg may influence the occurrence and development of colorectal carcinoma.Our data support the hypothesis that tumor infiltrating FOXP3+ Tregs attenuate the immune response against cancer and suggest that strategy to overcome FOXP3+ Treg function may be beneficial in the treatment of human colorectal cancer.