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This article reports a patient with hepatic coma who underwent artificial liver support therapy and liver transplantation successfully， and the patient recovered well in the later stage after active treatment. This article also discusses the timing of liver transplantation.
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Objective:To investigate the clinical therapeutic efficacy and safety of domestic imatinib mesylate in treatment of chronic myeloid leukemia (CML).Methods:The clinical data of 87 CML-chronic phase patients treated by domestic imatinib between December 2013 and March 2018 in the Affiliated Hospital of the Southwest Medical University were retrospectively analyzed. The clinical therapeutic efficacy and safety of imatinib was analyzed.Results:The completely hematologic reaction (CHR) rate was 95.4% (83/87), 97.7% (85/87) and 100.0% (87/87), respectively after treatment at 3, 6 and 12 months. The completely cytogenetic reaction (CCyR) rate was 31.0% (27/87), 42.5% (37/87) and 64.4% (56/87), respectively at 3, 6 and 12 months. At 3-month, BCR-ABL/ABL IS value was equal to or less than 10% in 44 patients (50.6%), BCR-ABL/ABL IS value was equal to or less than 0.1% in 4 patients (4.6%). At 6-month, BCR-ABL/ABL IS value was equal to or less than 1% in 39 patients (44.8%), BCR-ABL/ABL IS value was equal to or less than 0.1% in 13 patients (14.9%). The major molecular response rate at 12-month was 35.6% (31/87). The major hematologic adverse reaction was grade Ⅰ-Ⅱ hemacytopenia. The common non-hematology adverse reactions were edema, muscular and joints soreness, nausea and vomiting and diarrhea. Most patients didn't have severe adverse reactions. Conclusions:The clinical efficacy of CML patients treated with domestic imatinib is sure; CML patients are well-tolerated and the adverse reactions are mild. It is worthy of wide application in clinical treatment.
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Objective To study the clinical features and prognostic factors of patients with acute paraquat poisoning.Methods The clinical data of 108 patients with acute paraquat poisoning in Affiliated Hospital of Southwest Medical University from June 2013 to June 2015 were collected and followed up for half a year.The clinical features and prognostic factors were analyzed.Results Of 108 patients,about 90.00％ cases were from the rural areas,the married population accounted for 81.48％.Among them,53 people were living,55 cases were dead,and the death rate was 51.00％.The average amount of poison,average hospitalization time,poison to gastric lavage time interval in the survival group were (22.08 ±5.32) mL,(16.5 ± 3.72) d,(2.00 ±0.49) h,respectively,which in the death group were (88.12 ± 14.96) mL,(5.50 ± 1.20) d,(8.56 ± 1.65) h,respectively.The average amount of poison in the death group was far greater than that of the survival group,about 3.6 times,and the average hospitalization time was significantly reduced,only 1/3 of the survival group.The gastric lavage time interval was also lengthened 1.7 times than that of the survival group,the differences were statistically significant (all P ＜ 0.05).The proportions of fever,increased serum creatinine,liver function damage and pulmonary fibrosis in the death group were significantly higher than those in the survival group,the differences were statistically significant (x2 =12.20,8.35,8.84,50.68,all P ＜ 0.05).Conclusion Mortality rates are still high in patients with acute paraquat poisoning.The amount of poison is still the key factor of death in patients.Early gastric lavage and blood purification,as soon as possible to clear the poison,as far as possible to reduce the absorption of the toxic chemical and aggressive treatment can significantly improve the prognosis of patients.Early fever,liver and kidney function damage and pulmonary fibrosis may predict the poor prognosis of patients.
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Objective To investigate the association between non-Hodgkin lymphoma (NHL) and hepatitis B virus (HBV). Methods The serum HBV markers in 305 NHL patients who were diagnosed in the Affiliated Hospital of Southwest Medical University from January 2014 to December 2016 was detected by automatic chemiluminescence immunoassay. The infection rate of HBV in NHL patients was compared with that in 312 colorectal cancer patients and the national general population (81775 peoples). Results The positive rates of hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb) and hepatitis B core antibody (HBcAb) in 305 patients of NHL were compared with the general population [19.0 ％ (58/305) vs. 7.2 ％ (5888/81775), 44.3 ％ (135/305) vs. 50.1 ％ (40969/81775), 45.9 ％ (140/305) vs. 34.1 ％(27885/81775)], and the differences were statistically significant (χ2 values were 63.1, 4.1, 18.8, all P<0.05). The positive rate of HBsAg in NHL patients was compared with colorectal cancer patients and the general population, and the differences were statistically significant (χ2= 65.7, P< 0.01). The positive rate of HBsAg in B-cell NHL was statistically different from T-cell NHL [21.3％(51/239) vs. 10.6％(7/66),χ2=3.869, P<0.05]. But the positive rate of HBcAb and HBsAb in B-cell NHL were compared with T-cell NHL, and there was no statistically significant difference (both P> 0.05). Among 133 NHL patients, the HBV DNA positive rate was 33.1 ％ (44/133), and 74.1 ％ (43/58) in 58 cases of HBsAg-positive NHL, while 4.2 ％ (1/24) in 24 cases of HBsAg-negative but HBcAb-positive NHL. Conclusions The infection rate of HBV in NHL patients is higher than that in colorectal cancer patients and the general population, in which the occult HBV infection is worthy of much attention. The positive rate of HBsAg in T-cell NHL patients is lower than that in B-cell NHL patients. For NHL patients with HBV infection, anti-HBV treatment to prevent reactivation of the virus should be given before the anti-tumor treatment.
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Objective To investigate feasibility and clinical application value of improved percutaneous transhepatic biliary internal-external drainage (PTBIED).Methods Consecutive patients from April 2007 to April 2010 with malignant obstructive jaundice were diagnosed by medical imaging or pathological confirmation whenever possible.The patients with proximal malignant biliary obstruction and intact inferior common bile ducts ＞ 3 cm in length,and a bilirubin of 70 μmol/L or higher,were included in the experimental group.The control group included patients with low malignant biliary obstruction,and those who met the criteria for the experimental group but refused to receive the altered method of PTBIED.The patients underwent traditional PTBIED in control group.The patients in the experimental group received the procedure as following:according to percutaneous transhepatic cholangiography,a biliary external drainage catheter was modified by adding side-holes.Then under fluoroscopic guidance,the loop tip of the modified biliary drainage catheter was positioned in the inferior common hepatic duct/common bile duct,while the additional side-holes were located in the expanded hepatic duct.Technical success rate,complications,hepatic function and white cell count (WBC) were recorded pre- and post-procedure.All patients were followed-up until death.A t-test was used to compare continuous variable data changes,the Chi-square test was used to compare categorical variable data in two groups,and survival time was assessed using the Kaplan-Meier method.Results Forty-six patients were included in the study,with 21 in the experimental group and 25 in the control group.The procedures were successfully performed in all patients in the two groups.There was no procedure-related death in the two groups.Symptoms were improved similarly after procedures in the two groups.The mean quantity of drained bile per day [experimental group (521 +136) ml/d,control group (606 + 159 ) ml/d,t =1.930,P ＞ 0.05],decrease of the serum total bilirubin after the procedures [ experimental group (87 ± 51 ) μmol/L,control group( 105 ± 66 ) μmol/L ( t =1.061,P ＞ 0.05 ) ] and the median survival time ( experimental group 7.7 months,control group 6.9 months,x2 =0.610,P ＞0.05 ) of the patients showed no statistically significant difference between two groups.The mean WBC amount of patients was higher after the traditional procedure [ ( 10.9 ±5.2) × 109/L] than before the procedure [ (7.8 ±2.9) × 109/L] in the control group ( t =3.606,P ＜ 0.05 ),but the converse change occurred in the experimental group [ pre-procedure (8.2 ± 3.4) × 109/L ],post-procedure [ (7.4 ± 2.6) × 109/L] ( t =2.649,P ＜ 0.05 ).No reflux of duodenal juice was observed in all patients of the experimental group,and 1 patient had infection of biliary tract.The reflux was observed in 11 patients of the control group after conventional PTBIED.Of them,8 patients had infection of biliary tract.Incidence rate of infection of biliary tract in the control group was higher than that in the experimental group( x2 =5.381,P ＜ 0.05 ).Conclusions Improved PTBIED is convenient and feasible,and compared with traditional PTBIED,it can reduce the complications of infection of biliary tract.