Acute kidney injury: the experience of a tertiary center of Pediatric Nephrology / Insuficiência renal aguda: experiência de um centro terciário de Nefrologia Pediátrica

ABSTRACT Introduction: Acute kidney injury (AKI) is an abrupt deterioration of kidney function. The incidence of pediatric AKI is increasing worldwide, both in critically and non-critically ill settings. We aimed to characterize the presentation, etiology, evolution, and outcome of AKI in pediatric patients admitted to a tertiary care center. Methods: We performed a retrospective observational single-center study of patients aged 29 days to 17 years and 365 days admitted to our Pediatric Nephrology Unit from January 2012 to December 2021, with the diagnosis of AKI. AKI severity was categorized according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. The outcomes considered were death or sequelae (proteinuria, hypertension, or changes in renal function at 3 to 6 months follow-up assessments). Results: Forty-six patients with a median age of 13.0 (3.5-15.5) years were included. About half of the patients (n = 24, 52.2%) had an identifiable risk factor for the development of AKI. Thirteen patients (28.3%) were anuric, and all of those were categorized as AKI KDIGO stage 3 (p < 0.001). Almost one quarter (n = 10, 21.7%) of patients required renal replacement therapy. Approximately 60% of patients (n = 26) had at least one sequelae, with proteinuria being the most common (n = 15, 38.5%; median (P25-75) urinary protein-to-creatinine ratio 0.30 (0.27-0.44) mg/mg), followed by reduced glomerular filtration rate (GFR) (n = 11, 27.5%; median (P25-75) GFR 75 (62-83) mL/min/1.73 m2). Conclusions: Pediatric AKI is associated with substantial morbidity, with potential for proteinuria development and renal function impairment and a relevant impact on long-term prognosis.

RESUMO Introdução: Insuficiência renal aguda (IRA) é uma deterioração abrupta da função renal. A incidência de IRA pediátrica está aumentando em todo o mundo, em ambientes críticos e não críticos. Nosso objetivo foi caracterizar apresentação, etiologia, evolução e desfechos da IRA em pacientes pediátricos internados em um centro de atendimento terciário. Métodos: Realizamos estudo retrospectivo observacional de centro único de pacientes com idade entre 29 dias a 17 anos e 365 dias internados em nossa Unidade de Nefrologia Pediátrica, de janeiro de 2012 a dezembro de 2021, com diagnóstico de IRA. A gravidade da IRA foi categorizada de acordo com os critérios do Kidney Disease Improving Global Outcomes (KDIGO). Os desfechos considerados foram óbito ou sequelas (proteinúria, hipertensão ou alterações na função renal em avaliações de acompanhamento de 3 a 6 meses). Resultados: Incluímos 46 pacientes com idade mediana de 13,0 (3,5-15,5) anos. Cerca de metade (n = 24; 52,2%) apresentou um fator de risco identificável para o desenvolvimento de IRA. Treze pacientes (28,3%) eram anúricos; todos foram classificados como IRA KDIGO 3 (p < 0,001). Quase um quarto (n = 10; 21,7%) dos pacientes necessitaram de terapia renal substitutiva. Aproximadamente 60% (n = 26) apresentou pelo menos uma sequela, sendo proteinúria a mais comum (n = 15; 38,5%; mediana (P25-75) da relação proteína/creatinina urinária 0,30 (0,27-0,44) mg/mg), seguida de taxa de filtração glomerular (TFG) reduzida (n = 11; 27,5%; mediana (P25-75) da TFG 75 (62-83) mL/min/1,73 m2). Conclusões: A IRA pediátrica está associada à morbidade substancial, com potencial para desenvolvimento de proteinúria e comprometimento da função renal e impacto relevante no prognóstico de longo prazo.

Bone aluminum accumulation in the current era / Acúmulo de alumínio no tecido ósseo na era atual

In the last few years, evidence from the Brazilian Registry of Bone Biopsy (REBRABO) has pointed out a high incidence of aluminum (Al) accumulation in the bones of patients with CKD under dialysis. This surprising finding does not appear to be merely a passive metal accumulation, as prospective data from REBRABO suggest that the presence of Al in bone may be independently associated with major adverse cardiovascular events. This information contrasts with the perception of epidemiologic control of this condition around the world. In this opinion paper, we discussed why the diagnosis of Al accumulation in bone is not reported in other parts of the world. We also discuss a range of possibilities to understand why bone Al accumulation still occurs, not as a classical syndrome with systemic signs of intoxication, as occurred it has in the past.

Nos últimos anos, evidências do Registro Brasileiro de Biópsia óssea (REBRABO) apontaram uma alta incidência de intoxicação por alumínio (Al) no tecido ósseo de pacientes com DRC em diálise. Essa surpreendente informação parece representar não apenas um acúmulo passivo deste metal, visto que dados prospectivos do REBRABO sugerem que a presença de Al no tecido ósseo pode estar independentemente relacionada a eventos cardiovasculares adversos maiores. Essas informações contrastam com a percepção mundial do controle epidemiológico dessa condição. Neste artigo de opinião, discutimos por que o diagnóstico de acúmulo ósseo de Al não é relatado em outras partes do mundo, e também discutimos uma gama de possibilidades para entender por que nós acreditamos que o acúmulo de Al no tecido ósseo ainda ocorre, não como se apresentava no passado, ou seja, como uma síndrome com sinais e sintomas sistêmicos de intoxicação.

Pemphigus vulgaris versus Mucous Membrane Pemphigoid: Case Series

Pemphigus vulgaris (PV) and mucous membrane pemphigoid (MMP) are bullous autoimmune diseases that reach the oral mucosa and have common clinical features. The objective of the study was to present and compare the clinical manifestations of PV and MMP and the results of applied treatments. A case series of a stomatology service from 1985 to 2018. Data collection included epidemiological data, comorbidities, medications in use, duration of symptoms before the first visit, previous treatment, symptomatology, clinical description of lesions, presumptive diagnosis, histopathological description, extraoral manifestations, final diagnosis, treatment and follow-up. The medical records of 25 patients were analysed, 19 of whom were diagnosed with MMP and 6 with PV. The female gender was prevalent in MMP (84 %) and the male gender in PV (67 %). More than 60 % of patients complained of pain at their first visit. Patients with MMP took on average 6 months to seek professional help and patients with PV, about 2 months. Desquamative gingivitis was the most common lesion (63 %) in MMP and non-gingival ulcers (67 %) in PV. Minimal therapy was effective in all cases of MMP, and in PV one individual required minimal adjuvant therapy due to worsening of the case. Patients with PV have more intense signs and oral symptoms and may need more intensive treatment than patients with MMP. The use of topical and/or systemic corticosteroids was sufficient for most cases in both diseases.

Pénfigo vulgar (PV) y Penfigoide de la Membrana Mucosa (PMM) son enfermadades autoinmunes ampollosas que llegan a la mucosa oral y tienen características clínicas comunes. El objetivo de este estudio fue presentar y comparar las manifestaciones clínicas de PV y PMM y los resultados de los tratamientos aplicados. En el análisis se incluyó una serie de casos de un servicio de estomatología de 1985 a 2018. La recolección de información incluyó datos epidemiológicos, comorbilidades, medicamentos en uso, duración de los síntomas antes de la primera visita, tratamientos previos, sintomatología, descripción clínica de las lesiones, diagnóstico presuntivo, descripción histopatológica, manifestaciones extraorales, diagnóstico final, tratamiento y seguimiento. Se analizaron las historias clínicas de 25 pacientes, 19 de los cuales fueron diagnosticados de PMM y 6 de PV. El sexo feminino fue prevalente en PMM (84 %) y el sexo masculino en PV (67 %). Más del 60 % de los pacientes se quejaron de dolor durante la primera consulta. Los pacientes con PMM tardaron en promedio 6 meses en buscar ayuda profesional y los pacientes con PV, alrededor de 2 meses. La gingivitis descamativa fue la lesion más común (63 %) en PMM y las úlceras non gengivales (67 %) en PV. La terapia mínima fue efectiva en todos los casos de PMM, y en PV un individuo requirió terapia adyuvante mínima debido al empeoramiento del caso. Los pacientes con PV tienen signos y síntomas orales más intensos y pueden necesitar un tratamiento más intensivo que los pacientes con PMM. El uso de corticosteroides tópicos y/o sistémicos fue suficiente para la mayoría de los casos en ambas enfermedades.

Experiencia de la histeropexia vaginal, usando prótesis de polipropileno / Experience of vaginal hysteropexy, using polypropylene prosthesis

Introducción: El prolapso de órganos pélvicos (POP) o distopia genital, es el descenso o desplazamiento de los órganos del suelo pélvico a través del canal vaginal o fuera de este. Objetivo: Evaluar los resultados de la histeropexia vaginal en la corrección quirúrgica del prolapso genital apical grado III o IV, usando prótesis de polipropileno; además describir la tasa de éxito, recurrencias y complicaciones. Método: Estudio de cohorte, en 42 mujeres sometidas a histeropexia vaginal (histero-cistopexia ortotópica) mediante prótesis de polipropileno (Splentis®), entre 2016 y 2021. Se realizaron tres evaluaciones postoperatorias (tres, seis y 12 meses). Se hizo muestreo no probabilístico. Se utilizó estadística descriptiva. Resultados: La edad media fue de 56,19 ± 9,27 años. El tiempo quirúrgico de 58,95 ± 13,74 minutos, el sangrado quirúrgico de 119,85 ± 68,73 ml. La tasa de éxito a los 12 meses fue del 90,47%. La recurrencia del prolapso apical fue del 4,76% a los seis meses y del 9,52% a los 12 meses; el de compartimento anterior a los seis meses arrojó un 7,14%, frente al 11,9% a los 12 meses. El 14,28% de las pacientes presentaron complicaciones menores. La incidencia de incontinencia urinaria de esfuerzo a los 12 meses fue del 16,66%. Conclusiones: la histeropexia vaginal es un procedimiento efectivo y seguro, con bajas tasas de recurrencias o complicaciones. Es importante que se sigan haciendo estudios con mejores diseños estadísticos.

Introduction: Pelvic organ prolapse (POP), or genital dystopia, is the descent or displacement of pelvic floor organs through the vaginal canal or outside of it. Objective: To evaluate the results of vaginal hysteropexy in the surgical correction of grade III or IV apical genital prolapse, using polypropylene prosthesis; also describe the success rate, recurrences and complications. Method: Cohort study in 42 women undergoing vaginal hysteropexy (orthotopic hystero-cystopexy) using a polypropylene prosthesis (Splentis®); between 2016 and 2021. Three postoperative evaluations were carried out (three, six and twelve months). Non-probabilistic sampling was done. Descriptive statistics were used. Results: The mean age was 56.19 ± 9.27 years. Surgical time of 58.95 ± 13.74 minutes, surgical bleeding of 119.85 ± 68.73 ml. The success rate after twelve months was 90.47%. Apical prolapse recurrence was 4.76% at six months and 9.52% at twelve months; that of the previous compartment, after six months it showed 7.14%, compared to 11.9% after twelve months; 14.28% of the patients presented minor complications. The incidence of stress urinary incontinence, at twelve months, was 16.66%. Conclusions: Vaginal hysteropexy is an effective and safe procedure, with low rates of recurrence or complications. It is important that studies continue to be carried out with better statistical designs.

Resolutividad del tratamiento con Jusvinza en pacientes confirmados de COVID-19. Santiago de Cuba, 2021

Fundamento la infección por SARS-CoV-2 es la enfermedad emergente más importante del presente siglo. En dicho contexto, el Grupo de las Industrias Biotecnológica y Farmacéutica Cubanas (BioCubaFarma) creó alternativas terapéuticas para combatir la COVID-19, entre ellas el uso de Jusvinza, la cual forma parte del protocolo utilizado en el país. Objetivo determinar la resolutividad terapéutica de Jusvinza en pacientes confirmados de COVID-19. Métodos se realizó un estudio descriptivo, durante el periodo de enero a septiembre de 2021, en el Hospital Militar Dr. Joaquín Castillo Duany, de Santiago de Cuba. El universo estuvo constituido por 166 confirmados de COVID-19, a quienes se administró Jusvinza. Se analizaron algunas variables clínicas (estado clínico, enfermedades no transmisibles asociadas, progresión clínica), epidemiológicas (edad, sexo) y farmacológicas (resolutividad, duración en días). Se utilizó una planilla de vaciamiento de datos, los cuales fueron tomados de las historias clínicas. Resultados la morbimortalidad por COVID-19 fue superior en el sexo masculino, asociado a comorbilidades y edad mayor de 60 años; el sexo femenino resultó el de mayor resolutividad al tratamiento con Jusvinza (71,7 %), la cual incrementó su porcentaje en ausencia de enfermedades crónicas no transmisibles asociadas (81,4 %). Los pacientes de alto riesgo fueron los de más baja mortalidad (15,8 %). Conclusiones la resolutividad en pacientes confirmados de COVID-19 tratados con Jusvinza fue más elevada en casos de alto riesgo que en graves y críticos.

Foundation SARS-CoV-2 infection is the most important emerging disease of this century. In this context, the Cuban Biotechnology and Pharmaceutical Industries Group (BioCubaFarma) created therapeutic alternatives to combat COVID-19, including the use of Jusvinza, which is part of the protocol used in the country. Objective to determine the Jusvinza therapeutic resolution in confirmed COVID-19 patients. Methods a descriptive study carried out from January to September 2021, at the Dr. Joaquín Castillo Duany Military Hospital, in Santiago de Cuba. The universe consisted of 166 confirmed COVID-19 cases, to whom Jusvinza was administered. Some clinical variables (clinical status, associated non-communicable diseases, clinical progression), epidemiological (age, sex) and pharmacological (resolving, duration in days) were analyzed. A data extraction form was used, which was taken from the medical records. Results morbidity and mortality from COVID-19 was higher in males, related to comorbidities and age over 60 years; The female sex was the one with the greatest response to treatment with Jusvinza (71.7%), which increased its percentage in the absence of associated chronic non-communicable diseases (81.4%). High-risk patients had the lowest mortality (15.8%). Conclusions resolution in confirmed COVID-19 patients treated with Jusvinza was higher in high-risk cases than in severe and critical cases.

Improvement effect of acupuncture combined with rehabilitation training on neurological and motor functions in patients with acute cerebral infarction / 中国基层医药

Objective:To investigate the improvement effect of acupuncture combined with early rehabilitation training on clinical efficacy, traditional Chinese medicine syndrome score, and neurological and motor functions of patients with acute cerebral infarction.Methods:A total of 76 patients with acute cerebral infarction who received treatment in the Department of Neurology at Jinhua Municipal Central Hospital from June 2019 to June 2022 were included in this prospective study. These patients were randomly divided into an observation group and a control group using the random number table method, with 38 patients in each group. The control group received early rehabilitation training, while the observation group received acupuncture combined with early rehabilitation training. The clinical efficacy was compared between the two groups. Pre- and post-treatment traditional Chinese medicine symptom scores and neurological and motor functions were compared between the two groups.Results:The overall response rate in the observation group was 89.47% (34/38), which was significantly higher than 67.59% (25/38) in the control group ( Z = 2.41, P = 0.016). After treatment, the scores of hemiplegia, mouth and eye deviation, and speech difficulty in both groups were significantly decreased compared with before treatment, and the observation group showed a greater degree of decline in these indices than the control group ( t = 4.73, P < 0.001; t = -10.58, P < 0.001; t = 6.42, P < 0.001). After treatment, the neurological deficit scale scores in each group were decreased compared with before treatment, and the observation group showed a greater degree of decline compared with the control group ( t = -7.33, P < 0.001). After treatment, the Fug-Meyer motor function scale and Barthel index scores in each group were significantly increased compared with before treatment, and the observation group showed a greater degree of increases compared with the control group ( t = 3.72, P < 0.001; t = -5.02, P < 0.001). After treatment, the bare hand muscle strength scores of the core muscles in both groups of patients were increased compared with before treatment, and the observation group showed a greater improvement compared with the control group ( t = 3.31, P < 0.001). Conclusion:Acupuncture combined with rehabilitation training can enhance clinical efficacy, improve traditional Chinese medicine syndrome scores, enhance neurological and motor functions, and strengthen core muscle strength in patients with acute cerebral infarction. This treatment approach is worthy of being further promoted in clinical practice.

Effect of amlodipine combined with different statins on hypertension complicated by atherosclerosis / 中国基层医药

Objective:To explore the effects of amlodipine combined with different doses of atorvastatin and simvastatin on hypertension complicated by atherosclerosis.Methods:A retrospective analysis was conducted on the clinical data of 100 patients with hypertension complicated by atherosclerosis who were diagnosed and treated at Jinan 2 nd People's Hospital from August 2019 to August 2020. These patients were divided into control group ( n = 32, amlodipine combined with simvastatin), study group 1 ( n = 34, amlodipine combined with 10 mg/day atorvastatin), and study group 2 ( n = 34, amlodipine combined with 20 mg/day atorvastatin) according to different treatment schemes. All three groups were treated for 6 months. The clinical efficacy, blood lipid level, blood pressure, oxidative stress level, carotid intima-media thickness and plaque area were compared among the three groups. Results:The overall response rates of the control group, study group 1, and study group 2 were 71.88% (23/32), 82.35% (28/34), and 91.18% (31/34), respectively. The difference in overall response rate among the three groups was statistically significant ( χ2 = 4.16, P < 0.05). After treatment, total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, 24-hour dynamic blood pressure, diurnal blood pressure, nighttime blood pressure, malondialdehyde, superoxide dismutase, glutathione peroxidase, carotid intima-media thickness and plaque area were statistically different among the three groups ( F = -19.54, -76.61, 11.15, -56.83, -147.35, -23.10, -11.47, -11.65, -128.36, -15.60, -24.52, 25.61, 118.99, -59.23, -81.64, all P < 0.05). The incidence rates of adverse reactions in the control group, study group 1, and study group 2 were 12.50% (4/32), 8.82% (3/34), and 11.76% (4/34), respectively. There was no statistically significant difference among the three groups ( χ2 = 0.25, P = 0.611). Conclusion:Amlodipine combined with atorvastatin is more effective in the treatment of hypertension complicated by atherosclerosis than the amlodipine combined with simvastatin. High-dose atorvastatin is more effective in reducing lipid, controlling blood pressure, improving the level of oxidative stress and clinical symptoms compared with low-dose atorvastatin.

Efficacy of Huangqin decoction combined with western medicine in the treatment of pediatric ulcerative colitis / 中国基层医药

Objective:To investigate the clinical efficacy of Huangqin decoction combined with western medicine in the treatment of pediatric ulcerative colitis. Methods:A total of 100 children with ulcerative colitis who received treatment at the Longyou People's Hospital from January 2020 to January 2022 were included in this case-control study. They were divided into a control group ( n = 50) and an observation group ( n = 50) according to different treatment methods. Children in the control group were treated with routine western medicine, while those in the observation group were treated with routine western medicine plus Huangqin decoction. Both groups of children were treated for 14 days. The two groups of children were compared in terms of traditional Chinese medicine syndrome score, clinical efficacy, inflammatory factor levels, intestinal mucosal improvement score, and incidence of adverse reactions. Results:After treatment, the level of decrease in traditional Chinese medicine syndrome score in the observation group was significantly greater than that in the control group ( P < 0.05). The total response rate in the observation group was 98% (49/50), which was significantly higher than that in the control group [82% (41/50), χ2 = 7.11, P < 0.05]. The levels of tumor necrosis factor α, interleukin-6, and C-reactive protein in the observation group were (12.83 ± 4.53) ng/L, (8.55 ± 1.44) ng/L, and (6.35 ± 0.99) mg/L, respectively, which were significantly lower than those in the control group [(24.41 ± 5.38) ng/L, (13.14 ± 1.51) ng/L, (10.03 ± 1.05) mg/L, t = 13.21, 7.52, 5.15, all P < 0.05]. The improvement scores for ulcer, congestion, erosion, and edema in the observation group were (1.43 ± 0.20) points, (1.24 ± 0.27) points, (1.36 ± 0.34) points, and (1.02 ± 0.21) points, respectively, which were significantly better than those in the control group [(2.48 ± 0.52) points, (2.19 ± 0.37) points, (2.45 ± 0.32) points, and (2.35 ± 0.40) points, t = 5.12, 4.52, 3.73, 4.84, all P < 0.05]. The incidence of adverse reactions in the observation group was 4% (2/50), which was significantly lower than that in the control group [18% (9/50), χ2 = 5.01, P < 0.05]. Conclusion:The combination of Huangqin decoction and western medicine for the treatment of pediatric ulcerative colitis can effectively decrease traditional Chinese medicine symptom score and intestinal mucosal score, with a low incidence of adverse reactions, good clinical effect, and high safety.

The value of ultrasonography combined with serum thyroglobulin levels in preoperative N staging and therapeutic effect evaluation in patients with thyroid cancer / 中国基层医药

Objective:To investigate the clinical value of ultrasonography combined with serum thyroglobulin (Tg) levels in preoperative N staging and therapeutic effect evaluation in patients with thyroid cancer.Methods:A retrospective analysis was conducted on the clinical data of 125 patients with thyroid cancer who underwent total thyroidectomy at The 903 Hospital of PLA Joint Logistics Support Force between January 2016 and December 2021. Based on the pathological results, the patients were divided into stages N0, N1a, and N1b. Consistency testing was performed to assess the consistency between ultrasonographic and pathological findings. The serological markers were compared between stage N0 and stage N1. A multivariate logistic regression analysis was conducted to investigate the correlation between antithyroid peroxidase antibodies (TPOAb) and Tg and lymph node metastasis. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of serum Tg, ultrasonography, and the combination of serum Tg with ultrasonography for lymph node metastasis.Results:Among the 125 patients, 51 cases were diagnosed with stage N1, including 36 cases of stage N1a and 15 cases of stage N1b. The pathological examination confirmed stage N0 in 74 cases. Ultrasonography results showed stage N0 in 96 cases, stage N1a in 7 cases, and stage N1b in 22 cases. The preoperative N staging of thyroid cancer patients by ultrasonography was moderately consistent with the pathological staging ( Kappa = 0.44, P < 0.001). Serum free triiodothyronine and Tg levels were higher in stage N1 compared with stage N0 ( P < 0.001), while serum TPOAb levels were lower in stage N1 than in stage N0 ( P = 0.017). Multivariate logistic regression analysis was performed with lymph node metastasis as the dependent variable and the factors FT3, TPOAb, and Tg levels as independent variables. The analysis revealed that Tg was associated with lymph node metastasis ( OR = 1.02, P < 0.001). The ROC curve analysis showed that the area under the ROC curve for serum Tg level and ultrasonography for the diagnosis of lymph node metastasis were 0.67 and 0.65, respectively, which were significantly lower than the area under the curve (0.76) for the combined detection ( P < 0.001). Conclusion:The combined utilization of ultrasonography and serum Tg levels in the preoperative staging of thyroid cancer patients holds distinct clinical relevance. Notably, this combined approach offers a more precise diagnosis of lymph node metastasis compared with ultrasonography alone. Consequently, when making clinical judgments regarding preoperative lymph node metastasis, it is advisable to consider the results of both ultrasonography and serum Tg testing to facilitate surgical planning and evaluate surgical outcomes.

Effect of thymalfasin combined with ganciclovir eye drops (gel) on herpes simplex virus epithelial keratitis / 中国基层医药

Objective:To investigate the efficacy of thymalfasin combined with ganciclovir eye drops (gel) in the treatment of herpes simplex virus epithelial keratitis.Methods:This study enrolled 80 patients with herpes simplex virus epithelial keratitis who were treated at the Department of Ophthalmology, Fenyang Hospital, between January 2019 and December 2020. These patients were randomly divided into a control group and an observation group, with 40 patients in each group using the random number table method. All patients were treated with ganciclovir eye drops (gel) for 3 weeks. The control group received conventional treatment, while the observation group received both conventional treatment and thymalfasin treatment. All patients were followed up for 2 years. The proportion of patients who achieved a significant response and an effective response within 10 days of treatment, as well as the recurrence rate, were compared between the two groups. Additionally, the changes in cellular immune function were compared between the two groups.Results:In the control group, there were 10 cases that achieved a significant or effective response within 10 days of treatment, while in the observation group, there were 28 cases. The therapeutic effect of the observation group was superior to that of the control group, and the difference was statistically significant ( χ2 = 16.24, P < 0.001). The recurrence rate of the observation group within 2 years was significantly lower than that of the control group (10.00% vs. 30.00%, χ2 = 5.00, P < 0.05). After treatment, the counts of CD3 +, CD4 +, CD4 +/CD8 +, and natural killer cells, which are indices of cellular immune function, were significantly increased in the observation group compared with both their pre-treatment levels and the levels measured concurrently in the control group ( tbetween-group= 19.27, 20.85, 11.32, 15.82, all P < 0.001). Conclusion:The combination of thymalfasin and ganciclovir eye drops (gel) for the treatment of herpes simplex virus epithelial keratitis can improve both the therapeutic effect and the immune function of patients, which helps to reduce the recurrence rate.

Apparent diffusion coefficient for evaluating short-term efficacy of TACE for treating colorectal cancer liver metastases / 中国介入影像与治疗学

Objective To observe the value of apparent diffusion coefficient(ADC)for evaluating short-term efficacy of TACE for treating colorectal cancer liver metastases(CRLM).Methods Data of 60 liver metastases in 28 CRLM patients who underwent TACE were retrospectively analyzed.Based on MRI after the first TACE,according to the response evaluation criteria of solid tumors,the liver metastases were divided into response group(n=38)and non-response group(n=22).ADC parameters obtained with diffusion weighted imaging(DWI)before and after TACE,including ADC before TACE(ADCpre),after the first TACE(ADCpost1)and after the second TACE(ADCpost2)were compared between groups,while ADC change value(ΔADC)and the percentage of ΔADC were calculated.The maximum diameter of the target foci were measured,and the correlation between ΔADCpost1 and the change of the maximum diameter of target foci were analyzed.Receiver operating characteristic curve was drawn,the area under the curve(AUC)was calculated to observe the efficacy of ΔADCpost1 for evaluating short-term efficacy of TACE for CRLM.Results No significant difference of ADCpre was found between groups(P=0.484).After the first TACE,ADCpost1,ΔADCpost1 and percentage of ΔADCpost1 in response group were all higher than those in non-response group(all P＜0.05).After the second TACE,no significant difference of ADCpost2,ΔADCpost2 nor percentage of ΔADCpost2 was found between groups(all P＞0.05).The maximum diameter change of the target foci after the first TACE was(-0.48±0.93)cm,which was negatively correlated with ΔADCpost1(rs=-0.347,P=0.007).AUC of ΔADCpost1 for evaluating short-term efficacy of TACE for CRLM was 0.717.Conclusion ADC had good efficacy for evaluating short-term efficacy of TACE for treating CRLM.

Progress of Multi-Parameter Magnetic Resonance Imaging in Evaluating the Efficacy of Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer / 中国医学影像学杂志

Neoadjuvant chemoradiotherapy is a part of the current standard treatment mode for locally advanced rectal cancer,which enables a certain proportion of patients to achieve complete tumor response,improving the surgical resection rate and anal retention rate,and then prolonging the disease-free survival period of patients.MRI is the preferred imaging examination to evaluate the efficacy of neoadjuvant therapy.With the development of functional MRI,quantitative parameters derived from different imaging principles can provide more biological information about tumors,improving the clinical application value of MRI.Multi-parameter MRI combining conventional MRI sequences and functional sequences can more comprehensively evaluate the efficacy of neoadjuvant therapy,which is conducive to developing individualized treatment plans for patients in clinical practice and realize precision medicine.

Effect of the impaction of posterior wall on the prognosis following open reduction and internal fixation for fractures of acetabular posterior wall / 中华创伤骨科杂志

Objective:To evaluate the effect of the impaction of posterior wall on the prognosis following open reduction and internal fixation for fractures of acetabular posterior wall.Methods:A retrospective study was conducted to analyze the data from the 83 patients with fracture of acetabular posterior wall who had been consecutively treated by open reduction and internal fixation at Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital from January 2017 to December 2020. The patients were divided into 2 groups based on involvement of posterior wall impaction. In the impaction group of 33 cases, there were 26 males and 7 females with an age of (47.4±11.6) years; in the non-impaction group of 50 cases, there were 43 males and 7 females with an age of (41.3±12.0) years. The quality of postoperative fracture reduction, the function of the affected hip at the last follow-up, and the complication rate during follow-up were compared between the 2 groups. Multifactorial binary logistic regression and age subgroups were used to analyze the effects of posterior wall impaction on functional outcomes.Results:The age, rate of associated injuries in other body parts, and rate of posterior wall comminution in the impaction group were significantly higher than those in the non-impaction group ( P<0.05), but there was no statistically significant difference in other general data of patients between the 2 groups ( P>0.05). All patients were followed up for (44.5±13.3) months after surgery. The rate of anatomical reduction in the non-impaction group (96.0%, 48/50) was significantly higher than that in the impaction group (57.6%, 19/33) ( P<0.05), and the good and excellent rate by the modified Merle d'Aubigné & Postel scale at the last follow-up in the non-impaction group (84.0%, 42/50) was significantly higher than that in the impaction group (51.5%, 17/33) ( P<0.05). There was no significant difference in the incidence of complications between the 2 groups ( P>0.05). After adjusting for age and gender, the difference in hip function was still significantly different between the 2 groups ( OR=0.23, 95% CI: 0.06 to 0.79, P=0.020). The effect of posterior wall impaction on functional outcomes was statistically significant in patients aged ≥50 years ( P=0.008), whereas the difference was not statistically significant in patients aged <50 years ( P=0.194). Conclusions:Compared with non-impaction ones, acetabular fractures of posterior wall impaction tend to lead to poorer quality of reduction, which in turn affects the postoperative recovery of hip joint function. The impact of impaction fractures on functional recovery is more significant in patients aged 50 years and above.

Surgical outcomes of acetabular posterior wall fractures in patients aged 50 and above: a retrospective study / 中华创伤骨科杂志

Objective:To investigate the surgical outcomes of acetabular posterior wall fractures in patients aged 50 and above.Methods:A retrospective study was conducted to analyze the clinical data of 67 patients with acetabular posterior wall fracture who had been treated through the Kocher-Langenbeck approach and fully followed up from August 2003 to November 2021. There were 54 males and 13 females, aged 59.0 (54.0, 63.0) years. The time from injury to surgery was 8.0 (5.0, 13.0) days. Open reduction and internal fixation was performed for 63 cases and hip arthroplasty for 4 cases by one stage. The operation time, intraoperative bleeding, quality of postoperative fracture reduction, recovery of hip function at the last follow-up, and incidence of complications during the follow-up period were recorded.Results:The operation time for the 67 patients was 90.0 (67.5, 101.3) min, and the intraoperative bleeding 350.0 (300.0, 450.0) mL. According to the Matta criteria, 63 patients with internal fixation achieved anatomical reduction. All the 67 patients were followed up for (112.8±62.4) months. According to the modified Merle d'Aubigné & Postel scoring system, the function of the affected hip was assessed at the last follow-up in the 63 patients with internal fixation as excellent in 56 cases, as good in 3 cases, as fair in 2 cases, and as poor in 2 cases, giving an excellent and good rate of 93.6% (59/63). The prostheses survived in all the 4 patients who underwent one-stage hip replacement, with hip Harris scores of 94, 92, 91, and 93, respectively. Complications included 15 cases (23.8%, 15/63) of heterotopic ossification and 1 case (1.6%, 1/63) of transient sciatic nerve palsy. Femoral head ischemic necrosis and traumatic arthritis occurred in 2 patients (3.2%, 2/63) who had to receive total hip arthroplasty 3 years after surgery.Conclusion:Open reduction and internal fixation is still the main treatment method for acetabular posterior wall fractures in patients aged 50 and above, because it can achieve good clinical outcomes and help the patients recover joint function and quality of life at an early stage.

Oncological outcomes of laparoscopic radical trachelectomy for early stage cervical cancer / 中华妇产科杂志

Objective:To analyze and summarize the oncological outcomes after laparoscopic radical trachelectomy (LRT) for early stage cervical cancer.Methods:The clinical data and follow-up results of 148 patients with early stage cervical cancer who underwent LRT in Renji Hospital, School of Medicine, Shanghai Jiao Tong University from July 2014 to June 2023 were collected, while tumor outcomes and postoperative pregnancy were analyzed retrospectively.Results:(1) General situation: the median age of 148 patients with LRT was 33 years (range: 19-42 years). Pathological type: 111 cases of squamous cell carcinoma, 36 cases of adenocarcinoma, 1 case of adenosquamous carcinoma. International Federation of Gynecology and Obstetrics (2018) stage: 17 cases of stage Ⅰa1 with lympho-vascular space invasion, 25 cases of stage Ⅰa2, 102 cases of stage Ⅰb1, and 4 cases of stage Ⅰb2. (2) Tumor outcomes: 148 patients were followed up regularly after LRT, and the median follow-up time was 59 months (range: 2-104 months). During the follow-up period, 5 cases of tumor recurred (including 1 death), and the median recurrence time was 10 months (range: 4-33 months). Among them, there were 3 cases of pelvic metastasis, 1 case of distant metastasis, and 1 case of both pelvic and distant metastasis. Both 3-year and 5-year disease-free survival rates of 148 patients were 94.5%, and the 5-year overall survival rate was 98.9%. (3) Postoperative pregnancy: among 148 patients with LRT, 67 patients had pregnancy requirements, followed up for 1 year, and 20 of them were pregnant, with a pregnancy rate of 29.9% (20/67). Among the 20 pregnant patients, 2 cases early abortion, 1 case mid-term abortion, and 17 cases gave birth (including 4 cases of premature birth and 13 cases of full-term birth).Conclusion:Under the condition of strict control of surgical indications, guaranteed surgical scope and tumor-free operation, LRT in patients with early cervical cancer has a good outcome.

Clinical value of focused ultrasound ablation surgery in the treatment of abdominal wall endometriosis / 中华妇产科杂志

Objective:To explore the effectiveness and safety of focused ultrasound ablation surgery (FUAS) for abdominal wall endometriosis.Methods:From November 2019 to October 2022, a total of 34 patients with abdominal wall endometriosis who underwent FUAS were collected, and their clinical features, imaging features, intraoperative treatment and side effects after treatment were analyzed retrospectively, and the improvement of symptoms and re-intervention were followed up.Results:(1) Characteristics of clinical data: the average age of 34 patients with abdominal wall endometriosis was (32.8±3.8) years old. The largest diameter of the lesion was 48 mm, and the median lesion diameter was 24 mm. Thirty cases (88%, 30/34) had moderate to severe periodic pain in abdominal incision before FUAS. All patients were diagnosed by preoperative magnetic resonance imaging, including 19 cases (56%, 19/34) of superficial type, 8 cases (24%, 8/34) of intermediate type and 7 cases (21%, 7/34) of deep type. (2) FUAS treatment parameters: ablation was completed with average operation time of (64±18) minutes, average sonication time was (385±108) s, (103±11) W of average power, (38 819±16 309) J of average total energy, the average treatment area volume of (3.11±1.42) cm 3, and (377.79±106.34) s/h of average treatment intensity. (3) Efficiency: the pain of patients after FUAS was significantly relieved, and the pain scores of patients after 1 month, 3 months, 6 months and 1 year after FUAS were significantly decreased ( Z=-4.66, -5.13, -5.11 and -4.91, all P<0.01). One year after FUAS, the near relief and effective pain relief rate was 74% (25/34), and the clinical effective rate was 85% (29/34). Five patients recurred after one year, including 3 patients who underwent abdominal wall endometriosis lesion resection and 2 patients who received drug treatment. One month after FUAS, the size of the lesion did not change significantly compared with that before FUAS ( P>0.05), and the size of the lesion decreased significantly after FUAS at 3 months, 6 months and 1 year ( Z=-2.15, -2.67 and -3.41, all P<0.05). It has no difference in pain relief among different types ( P>0.05), but has significant difference in focus reduction among three types ( P<0.01). (4) Safety: there were 34 cases (100%, 34/34) of skin burning sensation, 19 cases (56%, 19/34) of pain in the treatment area and 2 cases (6%, 2/34) of hematuria. All patients got better after corresponding treatments. Conclusion:FUAS is safe and effective for the treatment of abdominal wall endometriosis, which has clinical application value.

Clinical analysis of 12 cases of ovarian yolk sac tumor / 中华妇产科杂志

Objective:To investigate the diagnosis, treatment and prognosis of ovarian yolk sac tumor (OYST).Methods:The clinicopathological data and follow-up data of 12 patients with OYST admitted to the Affiliated Hospital of Qingdao University from January 2013 to December 2020 were retrospectively analyzed, and the diagnosis, treatment and prognosis of OYST patients were summarized.Results:(1) The age of 12 patients with OYST ranged from 11 to 37 years, with a median age of 20 years. At the first visit, all 12 patients had pelvic masses. Reasons for seeing a doctor: 6 cases of abdominal distension and abdominal pain, 4 cases of mass in the lower abdomen, 1 case of vaginal bleeding, and 1 case of appendicitis. International Federation of Obstetrics and Gynecology (FIGO) 2014 staging: 4 cases in stage Ⅰa, 2 cases in stage Ⅰc, 1 case in stage Ⅱc, 4 cases in stage Ⅲc, and 1 case in stage Ⅳb. (2) All 12 patients were examined by color Doppler ultrasound before operation, among which 10 cases showed unilateral adnexal masses and 2 cases bilateral adnexal masses. The median maximum diameter of tumor was 16.5 cm (range: 6.0-28.0 cm). The preoperative levels of alpha fetoprotein (AFP) in 12 patients (all >1 210 μg/L) were significantly higher than normal (<25 μg/L). Among the 11 patients with cancer antigen 125 (CA 125) detection results, 9 patients showed elevated serum CA 125 levels. (3) Among the 12 patients, 8 young infertile patients who needed to preserve their reproductive function underwent appendectomy, 3 infertile patients underwent staged surgery for ovarian malignant germ cell tumor, and only one bilateral lesion and infertile patient underwent unsatisfactory staged surgery for ovarian malignant germ cell tumor. Of the 12 patients, 11 patients were given combined chemotherapy regimen of bleomycin, cisplatin, and etoposide (BEP) after operation. One patient without chemotherapy developed metastasis 3 months after operation, and was given BEP chemotherapy, and her condition was controlled. (4) The deadline for follow-up was December 31st, 2022, and the median follow-up time was 60 months (range: 25-115 months). All the 12 patients survived without tumor during the follow-up period, and the median disease-free survival time was 84.5 months (range: 25-115 months). Conclusions:OYST mostly occurs in children and young women. Color Doppler ultrasound examination and serum AFP and CA 125 detection have diagnostic value for OYST. Surgical treatment after diagnosis of OYST includes surgery to preserve reproductive function and timely and standardized chemotherapy after operation. The prognosis of patients is good regardless of stage.

Clinical analysis of 54 cases of lung cancer treated by domestic carbon ion system / 中华放射肿瘤学杂志

Objective:To evaluate clinical prognosis and prognostic factors of patients with early stage (Ⅰ stage) and locally advanced (Ⅱ/Ⅲ stage) lung cancer treated with carbon ion radiotherapy (CIRT).Methods:Clinical data, treatment, adverse reactions, survival and so on of 54 lung cancer patients who received CIRT and follow-up in the Heavy Ion Center of Wuwei Cancer Hospital of Gansu Province from March 2020 to September 2022 were retrospectively analyzed. The survival curve was plotted using Kaplan-Meier method. Difference tests were performed using log-rank test. Logistic regression analysis was used to identify prognostic factors.Results:According to inclusion and exclusion criteria, 54 patients were enrolled in the study, including 10 patients with early stage lung cancer and 44 patients with locally advanced lung cancer. The median follow-up time for 10 patients with early stage lung cancer was 11.0 (6.75, 17.25) months, and the median dose of irradiation was 60 Gy [relative biological effect (RBE)]. Upon the last follow-up, 3 patients had complete response (CR) and 3 patients had partial response (PR). Four patients had stable disease (SD) and no progressive disease (PD). The 1-year and 2-year local control rates (LCR), progression-free survival (PFS) rates and overall survival (OS) rates were 100%. During treatment and follow-up, 2 patients developed grade 1 radiation pneumonia, 1 case of grade 2 radiation pneumonia, 1 case of chest wall injury (chest wall pain), and there were no adverse reactions greater than grade 2. The median follow-up time of 44 patients with locally advanced stage was 12.5 (4.25, 21.75) months, and the median irradiation dose was 72 Gy (RBE). Thirty-two (73%) patients received concurrent chemotherapy during treatment, 20 (45%) patients received sequential chemotherapy after treatment, 14 (32%) patients received immune maintenance therapy and 3 (7%) patients obtained PD and received targeted drugs. Upon the last follow-up, 3 (7%) patients had CR, 17 (39%) patients had PR, 19 (43%) patients obtained SD, and 5 (11%) patients had PD. The 1-year and 2-year LCR were 96.0% and 87.3%, 90.9% and 84.1% for the 1-year and 2-year PFS rates, and 93.2% and 86.4% for the 1-year and 2-year OS rates, respectively. The median OS and PFS of patients were not reached. Multivariate logistic regression analysis showed that maintenance therapy after radiotherapy ( P=0.027) and clinical target volume (CTV) irradiation volume ( P=0.028) were the factors affecting PFS. Simultaneous chemoradiotherapy ( P=0.042) and maintenance therapy after radiotherapy ( P=0.020) were the factors affecting OS. And gross tumor volume (GTV) ≥215 ml ( P=0.068) might be an independent risk factor for grade 2 and above radiation pneumonia. Conclusions:The domestic carbon ion system has definite clinical effect and controllable toxic and side effects in the treatment of early stage and locally advanced lung cancer. The combination of synchronous chemotherapy and further maintenance treatment can significantly improve clinical prognosis of patients without significantly increasing the risk of toxic and side effects.

The efficacy of hip arthroscopy for concurrent femoroacetabular and subspine impingement / 中华骨科杂志

Objective:To assess the clinical outcomes of hip arthroscopy in patients with concurrent femoroacetabular impingement (FAI) and subspine impingement (SSI).Methods:Data were retrospectively reviewed for patients with both FAI and SSI who underwent hip arthroscopy surgery from August 2021 to May 2022. A total of 23 patients (23 hips) followed up for more than 1 year, including 10 males and 13 females, 9 left hips and 14 right hips, with an average age of 31.3±4.6 years (range, 25-45 years). Subspine decompression by anterior inferior spine (AIIS) shaping for SSI was performed during hip arthroscopy in addition to labral repair and bony correction for FAI in the patients with concurrent FAI and SSI. Clinical outcomes were evaluated using preoperative and 1-year postoperative measures: lateral center-edge (LCE) angle, α angle on 45° Dunn view X-rays, maximum hip flexion angle, hip flexion and knee extension strength, visual analogue scale (VAS) for pain, modified Harris Hip Scores (mHHS), and International Hip Outcome Tool-12 (iHOT-12).Results:Of the 23 patients, 20 had type 2 AIIS and 3 had type 3 AIIS. At 1-year follow-up after surgery, there were significant improvements: LCE angle decreased (33.3°±6.1° to 31.7°±4.1°, t=1.076, P=0.288), α angle reduced (63.7°±8.5° to 50.0°±6.6°, t=6.116, P<0.001), hip flexion angle increased (107.4°±6.0° to 120.2°±4.4°, t=8.269, P<0.001), VAS scores decreased (4.0±1.1 to 1.0±1.1, t=9.591, P<0.001), mHHS improved (62.6±4.9 to 87.5±8.1, t=12.700, P<0.001), and iHOT-12 scores rose (51.4±4.9 to 75.7±7.7, t=12.593, P<0.001). There was no significant difference in the strength of hip flexion and knee extension between preoperative and follow-up ( t=0.930, P=0.357 and t=0.050, P=0.960, respectively). There were no reports of traction-related complications (such as skin necrosis and nerve paralysis), severe adverse events (such as femoral neck fractures, deep vein thrombosis in the lower limbs, intra-articular infections, ectopic ossification and hip instability), or the need for revision surgery. Conclusion:Subspine decompression by anterior inferior spine (AIIS) shaping for SSI during conventional hip arthroscopy is safe and effective, enhancing hip function and alleviating pain at 1-year follow-up without significant complications.

Analysis of the efficacy of arthroscopic transverse release of iliotibial band through peritrochanteric space for the treatment of external snapping hip / 中华骨科杂志

Objective:To analyze the clinical efficacy of arthroscopic transverse release of the iliotibial band through peritrochanteric space for the treatment of external snapping hip.Methods:A total of 30 patients (12 males and 18 females) with bilateral external snapping hip underwent arthroscopic transverse release of the iliotibial band through peritrochanteric space in Department of Sports Medicine, Senior Department of Orthopaedics, the Fourth Medical Center, Chinese PLA General Hospital were retrospectively analyzed from May 2021 and June 2022. The average age was 32.5±8.2 years (range, 17-51 years). At the same time, 30 patients who underwent arthroscopic external release of the iliotibial band through the external surface of the iliotibial band (external iliotibial band group) were selected as control group, including 13 males and 17 females, aged 29.5±6.8 years (range, 11-45 years). The visual analogue scale (VAS), modified Harris hip score (mHHS), and gluteal muscle contracture disability scale (GDS) were compared between the two groups at preoperative, 6 months postoperative, and final follow-up.Results:All patients successfully completed the operation and were followed up for 17.5±3.3 months (range, 12-25 months). The VAS scores of the two groups at the last follow-up were lower than those before operation ( P<0.05). The mHHS scores before operation, 6 months after operation and at the last follow-up in the peritrochanteric space group were 76.5 (67.0, 85.5), 98.5 (94.8, 100.0) and 100.0 (97.0, 100.0), respectively, and those in the external iliotibial band group were 80.5 (70.0, 86.0), 100.0 (96.0, 100.0) and 100.0 (99.5, 100.0). The differences in mHHS scores between the two groups were statistically significant for intragroup comparisons ( P<0.05); of these, 6 months postoperatively and at the last follow-up were greater than preoperatively, with statistically significant differences ( P<0.05); the differences at 6 months postoperatively and at the last follow-up were not statistically significant ( P>0.05). There was no significant difference in mHHS scores between groups at different time points ( P>0.05). The GDS before operation, at 6 months after operation and at the last follow-up were 47.0 (35.8, 64.5), 90.0 (81.0, 94.0) and 93.5 (89.8, 98.0) in the peritrochanteric space group, and 51.0 (38.0, 64.5), 50.0 (81.0, 94.0) and 93.5 (89.8, 98.0) in the external iliotibial band group, respectively. The differences in GDS between the two groups were statistically significant for intragroup comparisons ( P< 0.05); of these, 6 months postoperatively and at the last follow-up were greater than preoperatively, with statistically significant differences ( P<0.05); the differences at 6 months postoperatively and at the last follow-up were not statistically significant ( P>0.05). There was no significant difference in GDS between groups at different time points ( P>0.05). Conclusion:Arthroscopic transverse release of the iliotibial band through peritrochanteric space for the treatment of external snapping hip can effectively reduce hip pain and improve hip function, with satisfactory clinical results, and can be used as an alternative treatment to transverse release through the external surface of the iliotibial band.