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Objective@#To explore the advantages of endoscopy combined with contrast fistulography in the clinical diagnosis and treatment of chronic wound with sinus tract adjacent to body cavity.@*Methods@#Thirty-two patients (14 males and 18 females, aged 17 to 87 years) of chronic wounds with sinus tracts adjacent to body cavity, who underwent endoscopy combined with contrast fistulography (CT or magnetic resonance imaging) for the diagnosis and treatment in the Outpatient Department of Wound Healing Center of our hospital from October 2017 to March 2019, were enrolled in the study. Their diagnosis and treatment results were retrospectively analyzed. The following data were calculated. (1) The incidence rates of sinus wound involving body cavity or fistula. (2) The detection rates of sinus wound involving body cavity detected by routine examination and by endoscopy combined with contrast fistulography. (3) The detection rate of pathological features at deep part of wound by routine examination and by endoscopy combined with contrast fistulography. (4) The proportion of patients who benefited from routine examination and from endoscopy combined with contrast fistulography. Data were processed with paired chi-square test and Fisher′s exact probability test.@*Results@#(1) The incidence rate of sinus wound involving body cavity was 43.75% (14/32); the incidence rate of fistula was 0. (2) The detection rate of sinus wound involving body cavity detected by endoscopy combined with contrast fistulography was 43.75% (14/32), which was obviously higher than that by routine examination [12.50% (4/32), χ2=32.0, P<0.01]. (3) The detection rate of pathological features at deep part of wound by endoscopy combined with contrast fistulography was 37.50% (12/32), which was obviously higher than that by routine examination (0, P<0.01). (4) The proportion of patients who benefited from endoscopy combined with contrast fistulography was 71.43% (20/28), which was obviously higher than that from routine examination [12.50% (4/32), χ2=21.6, P<0.01].@*Conclusions@#Compared with routine examination, endoscopy combined with contrast fistulography is more accurate in detecting chronic wound with sinus tract adjacent to body cavity. The diagnosis and treatment of chronic wound with sinus tract adjacent to the body cavity can benefit from this joint examination.
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The " exploration of treatment technology of chronic wound with sinus tract supported by endoscope and related auxiliary methods" study had been conducted by Wound Healing Center of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. The feasibility and effectiveness of this technique have been confirmed, and good clinic results have been achieved. In order to further promote the new technology and its related research, the theoretical knowledge and technical experience accumulated in the early stage are summarized as diagnosis and treatment standard for treatment with endoscopy technique in chronic wounds with sinus tract, including four parts: the applicable subjects, the diagnosis and treatment procedures and classification criteria, the healing criteria, and the risk assessment and prevention measures. The purpose of this standard is to facilitate the application of standardized endoscopy technique, to make the most of its technological advantages, prevent risks, and provide a reference for the official version of the diagnosis and treatment standard.
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The correct thoughts and principles of diagnosis and treatment of chronic refractory wounds need to be formulated. Through the relevant domestic and international consensus and based on clinical experience, the Thoughts and principles of diagnosis and treatment of chronic refractory wounds in China is proposed. It is considered that in the diagnosis and treatment of chronic refractory wounds, in the case of fully understanding the patient′s medical history, the following thoughts and principles should be complied in order. (1) Pay attention to the cleanliness of the wound after being cleaned. (2) Reasonably perform debridement to avoid being " excessive" or " not thorough". (3) Reasonably perform examination, diagnosis, and differential diagnosis of pathogenic factors. (4) Treat according to etiology. (5) Find comorbidities and prevent adverse outcomes. (6) Select the correct wound treatment method reasonably and timely. When the conservative wound care treatment is considered, pay attention to embodying the concept of etiological treatment, treat the wound according to the principles of safety, phase, selectivity, and effectiveness, and make a reasonable choice of continuing conservative treatment or surgical treatment in time after completing the preparation of the wound bed. When surgical treatment is considered, pay attention to the selection of reasonable surgical method and donor site, pay attention to the healing rate of surgical wound site and the outcome of donor site, and give reasonable protection to the wound site after surgery. (7) Carry out rehabilitation treatment after wound healing and related health education.
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Objective@#To assess clinical and radiographic outcomes of short implants (length six mm) in the posterior region and early-loading with splinted fixed dental prostheses.@*Methods@#Forty-five patients were recruited at 3 centers and 2-3 implants (diameter 4 mm, length 6 mm) were implanted in each case. Totally, ninty-five implants were placed, using one-stage surgery protocol and loaded with a screw-retained splinted fixed prosthesis 6 weeks later. Clinical and radiographic examinations were performed preoperatively, post-surgery, at loading, and 6, 12 and 24 months after prosthesis placement.@*Results@#Four implants were removed before loading. A total of 36 patients with 76 implants completed the whole treatment and 2 year follow-up according to the research design. No implant was lost after loading, and the 2-year survival rate of the implant was 100%(76/76). In all cases, the response of swelling and pain after operation was mild, and the bone resorption around the implants was not obvious at 6 months [(0.04±0.29) mm], 1 year [(-0.11±0.44) mm], and 2 years [(0.00±0.53) mm] after loading. Bone loss less than 1.00 mm was found only in 26% (18/69) implants after 2 years of loading, and the height of the alveolar bone around 17% (12/69) of the implant increased. During 2-year follow-up, the probing depth of the implants increased by nearly 0.50 mm, but there was no clinical significance (P>0.05).@*Conclusions@#The 2-year results of this study showed that the 6-mm-long implants can be a predictable procedure, especially in situations with limited bone height in posterior edentulous regions.
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Objective@#To explore the application value of endoscope in probing the chronic wound with sinus tract in clinic.@*Methods@#Twenty-eight chronic wounds with sinus tracts from 27 patients conforming to the inclusion criteria admitted to Outpatient Department of Wound Healing Center of Ruijin Hospital from December 2017 to March 2018 were investigated in a prospective and self-controlled trial. After being cleaned, the diameter of the opening of sinus tract was measured with a rule. A probe was used to measure the depth of a sinus tract according to the touch from the probe extremity in operation, and to measure the depth of a sinus tract that could be observed with naked eyes with the help of a pair of hemostatic forceps. Five minutes later, a probe was inserted deeply into the sinus tract to measure the depth under the endoscopic view combined with touch from the probe extremity in operation. Afterwards, the sinus tract was observed with endoscope, and the depth of the tract which could be observed under the endoscopic view was measured using a probe inserted deeply into the sinus tract. After completion of the above exploration, the sinus tract was infused with contrast agent Omnipaque 350 and scanned by computed tomography (CT) later to obtain its depth. The following indicators were calculated: the ratio of the depth of the sinus tract measured by CT to the diameter of the opening of the sinus tract (hereinafter referred to as the depth/diameter ratio of the sinus tract), the deviation rate comparing the depth of the sinus tract measured by conventional method (measured by probe only) and by endoscope (measured by probe under the endoscope view) with the depth of the sinus tract measured by CT (hereinafter referred to as the deviation rate of the measured depth of the sinus tract), the deviation rate comparing the depth of the sinus tract that could be observed measured by conventional method and by endoscope with the depth of the sinus tract measured by CT (hereinafter referred to as the deviation rate of the depth of the sinus tract that could be observed). Data were processed with paired t test. Pearson correlation analysis was applied to analyze the correlation between the depth/diameter ratio of the sinus tract and the deviation rate of the measured depth of the sinus tract and the deviation rate of the depth of the sinus tract that could be observed by conventional method and by endoscope.@*Results@#The depth/diameter ratio of the sinus tract of this group of wounds was 1-32 (8±7). The deviation rate of the measured depth of the sinus tract and the deviation rate of the depth of the sinus tract that could be observed by conventional method were (19±14)% and (79±18)%, respectively, both obviously larger than (9±9)% and (25±25)% by endoscope (t=3.837, 13.626, P<0.01). Positive correlation existed between the depth/diameter ratio of the sinus tract and the deviation rate of the measured depth of the sinus tract by conventional method, and between the depth/diameter ratio of the sinus tract and the deviation rate of the depth of the sinus tract that could be observed by conventional method and by endoscope (r=0.514, 0.585, 0.651, P<0.01). However, there was no obvious correlation between the depth/diameter ratio of the sinus tract and the deviation rate of the measured depth of the sinus tract by endoscope (r=0.113, P>0.05).@*Conclusions@#Compared with the conventional method, application of endoscope is able to get more accurate data of chronic wounds with sinus tracts and observe the wounds with wider range.
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Objective To evaluate the clinical implication of circulating endothelial microparticles in severe burned patients in burn shock resuscitation period and in patients with severe infection.Methods A retrospective case control study was conducted on 90 burned patients from January 2009 to December 2015.The patients were divided into burn shock group (n =57) and infection group (n =33).The infection group was further divided into sepsis group (n =18) and non sepsis group (n=15).There were 17 healthy controls.The numbers of CD31 +,CD51 +,CD144 +,CD54 +,and CD62E + EMPs in plasma were measured by flow cytometry immediately thereafter.The numbers and ratios of EMPs in plasma of the 16 patients from burn shock group were compared before and after fluid resuscitation.The numbers and ratios of EMPs in plasma were compared among groups.Sequential Organ Failure Assessment (SOFA) scores were used to assess the burn severity in patients at enrollment.The numbers and ratios of EMPs in plasma were compared between sepsis and non sepsis group.The correlations of SOFA with the numbers of EMPs and with the burn size were analyzed.Results Compared with control group,the numbers of CD31 +,CD51 +,CD144 +,CD54 +,and CD62E + EMPs were increased significantly in both burn shock group and infection group (P ＜0.05 or ＜0.01);the ratios of CD31 + EMPs,CD51 + EMPs,and CD54 + EMPs in plasma were significantly higher in burn shock group (P＜O.05 or ＜0.01);the ratios of CD31 + EMPs and CD54 + EMPs were significantly higher in infection group (P ＜ 0.05 or ＜ 0.01).The number of CD62E + EMPs,the ratios of CD144 + EMPs and CD62E + EMPs were higher in burn shock group than those in infection group (P ＜0.05 or ＜0.01).The ratio of CD31 + EMPs in plasma was significantly higher before resuscitation than that after resuscitation in burn shock period patients (8.8 ± 1.7 vs.5.2 ±0.9) (P ＜0.05).The ratios of CD31 + EMPs and CD54 + EMPs were significantly higher in sepsis group than those in non-sepsis group (8.0± 1.3 vs.4.5 ± 1.0;18.3 ± 2.2 vs.8.9 ± 1.4) (P ＜ 0.05 or ＜ 0.O1).The number of antigen-positive EMPs correlated significantly with SOFA score (P ＜0.05 or ＜0.01).The ratio of CD54 + EMPs correlated significantly with SOFA score (P ＜0.01).The number and the ratio of CD54 + EMPs as well as the ratio of CD144 + EMPs was correlated with bum size (P ＜ 0.05).SOFA score was positively correlated with the burn size (P ＜ 0.01).Conclusions Expressions of CD31,CD54,CD144,CD62E antigens EMPs might play a role in burn pathological damage and serve as an indicator of endothelium function change after bums.Expression of CD54 of EMPs plays a role in assessing the function and severity of burned organs.
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Objective To investigate the value of the apparent diffusion coefficient (ADC)measurement in assessment of tumor grade and myometrial invasion of endometrial carcinoma (EC).Methods 80 EC patients and 28 cervical cancer patients with normal endometrium were studied retrospectively.1.5T conventional MRI and DWI (b=0,1 000 s/mm2)were performed,and ADC values were calculated by two radiologists.Statistical analyses were performed by using SPSS 19.0 and Medcalc software.Results The mean ADC values (×10-3mm2/s)were 0.851±0.131,0.752±0.099,0.681±0.089 for G1,G2 and G3 EC,respectively.Significant statistical differences were achieved for the three groups (G1 vs G2:P=0.005;G2 vs G3:P=0.03;G1 vs G3:P< 0.000 1).For the prediction of G3,the area under the curve (AUC)of 0.851 and the cut-off value of ≤0.742×10-3mm2/s were identified,with the sensitivity, specificity and accuracy of 88.24%,76.19% and 85%,respectively.Conclusion There are significant statistical differences between histologic grades of EC.ADC measurement may have the potential to select G3 EC patients.
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Objective:To investigate the clinicopathological characteristics, treatments, and survival of patients with esophageal adeno-squamous carcinoma (EASC). Methods:A total of 494 patients with EASC were selected from the clinical information databases of 500, 000 cases with esophageal and gastric cardiac carcinomas in the Henan Key Laboratory for Esophageal Cancer Research. Among the 494 EASC cases, 361 were males with an average age of 61.47 ± 8.32 years, and 133 were females with an average age of 65.56 ± 8.06 years. SPSS 21.0 software was applied to determine the statistical differences among the different groups. A life-table method was also used to calculate the five-year survival rate. A linear regression model was used to analyze the correlation of changes at different peri-ods. Results:The incidence of EASC in our database was 0.196%(494/251707). EASC occurred predominantly in male patients (male:female=2.71:1.00). The peak age was within 60-69 years in both males and females (39.6%vs. 40.6%). Notably, the incidence of male patients showed a downward trend (R2=0.063), whereas that of female patients showed an upward trend (R2=0.004). The prevalence of EASC was obviously higher in low-incidence areas for esophageal cancer than in high-incidence areas (53.1%vs. 46.9%, P<0.001). Ac-cording to the TNM staging criteria for esophageal cancer, phases II and III patients comprised the majority of cases, which accounted for 40.8%(173/424). The positive lymph node metastasis rate was 47.0%(206/438), and the number of positive lymph node metasta-ses ranged within 1-2 (48.5%, 100/206). In addition, preoperative biopsy was performed in 467 cases, and more than half of the pa-tients (53.96%, 252/467) were diagnosed before the operation. Surgical resection was the predominant treatment method for EASC (88.8%, 419/472). Only 1.9%patients (9/472) underwent radiotherapy and chemotherapy. The five-year survival rate of male patients who were neither smoking nor drinking of alcohol was higher than that of male smokers (26.5%vs. 12.1%). In patients with stagesⅠ,Ⅱ, andⅢ+Ⅳcarcinomas with surgery as lone treatment, the three-year survival rates were 64.7%, 50.9%, and 48.5%, respectively. Correspondingly, these rates were 51.7%, 47.8%, and 33.1%after adjuvant radiotherapy and chemotherapy. Conclusion:EASC is a rare type of esophageal malignant tumor. The preoperative biopsy pathological diagnosis has high misdiagnosis rate. Smoking and drinking of alcohol can influence the prognosis of patients. In EASC patients, lymph node metastasis easily occurs, and a simple surgery is bet-ter than other cancer treatments.
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Esophageal cancer is a unique malignant disease in China. A fundamental difference exists between the Chinese population and the western population on esophageal cancer in terms of epidemiology, histogenesis, and carcinogenic risk factors. Therefore, ap-plying the western academic achievements to Chinese is difficult. Thus, Chinese scientists have the responsibility to conquer esopha-geal cancer in China. This article reviews the progress of esophageal cancer focused on the molecular mechanism for interactions of ge-netic and environmental risk factors and human esophageal multistage carcinogenesis.
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Objective: To compare the peri-implant tissue stability between immediate implant and delayed implant in maxillary anterior region after loading 2 years.Methods: In the study, 38 patients with single anterior tooth loss in the Second Clinical Division of Peking University School and Hospital of Stomatology from October 2010 to December 2011 were enrolled , and 43 implants were inserted .The gin-gival contour was induced using implant-supported temporary crowns prior to restoration till permanent prostheses delivered .The gingival papilla height , labial gingival margin level and peri-implant bone level were measured immediately after the permanent restoration and 2 years later .Results: In the study , 16 patients were treated by immediate implant for 17 implants;22 patients were treated by delayed im-plant for 26 implants .The implant stability quotient ( ISQ ) value of the 2 groups showed no significant difference before permanent restoration (P>0.05).In all the cases after loading 2 years, the average mesial gingival papilla height in the implant area of the immediate group and delayed group increased by (0.15 ±0.42) mm and (0.06 ±0.65) mm, respectively;the distal gingival papilla height increased by (0.06 ±0.50) mm and (0.02 ±0.57) mm respectively;while the labial gingival margin level shrinka-ges were (0.15 ±0.23) mm and (0.15 ±0.46) mm, respectively.The peri-implant bone losses in the mesial side were (0.67 ±0.35) mm and (0.69 ±0.49) mm, respectively, while in the distal side were (0.73 ±0.31) mm and (0.75 ±0.48) mm, respectively.All these indicators showed no significant difference between the 2 groups ( P>0 .05 ) .Conclusion:Both the cases obtained optimizer results after loading 2 years, and the soft and hard tissues around the implant were very stable , which means that both the protocols can achieve reliable therapeutic effects .If we can handle the indications , immediate implant for anterior teeth shows similar efficacy with delayed implant in the short term .But immediate implant in terms of shortening the course of treatment is clearly superior to delayed implant .
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Objective To assess the correlation between magnetic resonance imaging (MRI)and clinical staging of pelvic organ prolapse (POP)by using pubococcygeal line (PCL)and midpubic line (MPL)respectively.And to determine which(MRI)reference line for staging pelvic organ prolapse had the highest agreement with clinical staging.Methods A retrospective study of 32 women with pelvic organ prolapse who underwent dynamic pelvic MRI from Jan 2013 to May 2013 was conducted.One radiologist staged descent on MRI for each pelvic compartment (anterior,middle,posterior),using PCL and MPL lines.Agreement between MRI and clinical staging was estimated respectively.Results Thirty-two women were included.Agreement between clinical and MPL staging was morderate in the anterior (κ=0.44,SE=0.13)and middle compartment (κ=0.46,SE=0.12),but fair in the posterior com-partment (κ=0.23,SE=0.10).Agreement between clinical and PCL staging was poor in all compartments of pelvic.Conclusion MPL appeared more reliable and simple than the PCL for the evaluation of pelvic prolapse on MRI.
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Objective To improve the awareness of the treatment and mechanisms of the gastric mucosa-associated lymphoid tissue lymphoma with secondary thrombocytosis. Methods One case of gastric MALT lymphoma with secondary thrombocytosis was reported and reviewed the literatures. Results The patient received anti-Hp therapy,with remission of gastric MALT lymphoma, platelet count also will return to normal levels. Conclusion It is shown that anti-Hp therapy of gastric MALT lymphoma with secondary thrombocytosis is an effective treatment.
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Objective To detect serum CA125 and VEGF in patients of non-Hodgkin lymophoma (NHL) involved in bone marrow and analyse prognostic criteria for NHL. Methods The clinical data of 97 patient were chosen as research objects. They were all first-visit patients. Bone marrow infiltrated with lymphoma cell leukemia of 50 patients were identified by bone marrow aspiration or bone marrow biopsy 46 cases of normal bone marrow were used as controls. The serum CA125 and VEGF were detected by ELISA before treatment. Results Among 97 cases of non-Hodgkin disease, there were 50 cases of bone marrow infiltrated lymphoma cells with a incidence rate of 51.5 %. CA125 and VEGF level in the patients whose bone marrow or lymphoma cell leukemia existed NHL cells was much higher than that of NHL with negative bone marrow infutration (P <0.05). Conclusion CA125 and VEGF can be concluded clinical markers which decide bone marrow or lymphoma cell leukem of the NHL patients whether existed NHL cells or not.
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Objective:To evaluate the treatment effects of the half-columnar shaped mandibular block bone onlay grafting technique for augmentation of the resorbed maxillary anterior alveolar ridge after single tooth missing.Methods: A total of 15 sites of 14 patients received ridge augmentation surgeries.The recipient sites were prepared with trephines,the half-columnar shaped bone blocks were harvested from the ramus and external oblique ridges with trephines according to diameters of the recipient sites.The bone blocks were placed as lateral onlay grafts on recipient beds and secured by means of titanium screws.Particulate bone was added and absorbable membranes were used to stabilize and protect the grafts.After a mean interval of 4.5 months of healing the flaps were re-opened,the screws were removed and non-submerged implants were placed.The width and height of the alveolar ridges were recorded.After 3 months,implant-supported crowns were provided to the patients.One year later,the peri-impant condition and the marginal bone resorption on the proximal sites were observed.Results: Mean lateral augmentation obtained at the time of bone grafting was(3.8?0.8) mm(x?s),5 out of 15 sites exhibited a mean of 3 mm of vertical augmentation.The mean healing time was 4.5 months,the mean percentage of horizontal and vertical bone resorption in the mean time were 8% and 7% respectively.No major complications were recorded at donor sites.No implant was lost during the study period.Clinical parameters and probing depth(≤4 mm) demonstrated the presence of a healthy peri-implant mucosa after 1 year of prosthetic reconstruction.The clinical and radiographic bone observations showed no more than 1.2 mm of resorption after bone graft and implant placement.Conclusion: The half-columnar shaped mandibular bone graft(from the ramus and external oblique ridge) is a promising technique for bone augmentation in localized alveolar ridge defects after single tooth missing.This procedure offers easy access,good bone quantity for localized repair,low morbidity,decreased complaints of postoperative sensory disturbances or discomfort,minimal graft resorption,and a shorter healing time as compared with other methods for bone repair.