Status of diagnosis and management of acute appendicitis in 2017: a national multi-center retrospective study / 中华胃肠外科杂志

OBJECTIVE@#To analyze the current status of diagnosis and management of acute appendicitis (AA) in China.@*METHODS@#Questionnaire survey was used to retrospectively collect data of hospitalized patients with AA from 43 medical centers nationwide in 2017 (Sort by number of cases provided: Jinling Hospital of Medical School of Nanjing University, The First Affiliated Hospital of Xinjiang Medical University, Lu'an People's Hospital, Tengzhou Central People's Hospital, Dalian Central Hospital, The Affiliated Hospital of Xuzhou Medical University, Dongying People's Hospital, Jinjiang Hospital of Traditional Chinese Medicine, Huangshan Shoukang Hospital, Xuyi People's Hospital, Nanjing Jiangbei People's Hospital, Lanzhou 940th Hospital of PLA, Heze Municipal Hospital, The First College of Clinical Medical Science of China Three Gorges University, Affiliated Jiujiang Hospital of Nanchang University, The Second People's Hospital of Hefei, Affiliated Central Hospital of Shandong Zaozhuang Mining Group, The Third People's Hospital of Kunshan City, Xuzhou First People's Hospital, The 81st Group Army Hospital of PLA, Linyi Central Hospital, The General Hospital of Huainan Eastern Hospital Group, The 908th Hospital of PLA, Liyang People's Hospital, The 901th Hospital of Joint Logistic Support Force, The Third Affiliated Hospital of Chongqing Medical University, The Fourth Hospital of Jilin University, Harbin Acheng District People's Hospital, The First Affiliated Hospital of Zhengzhou University, Nanjing Luhe People's Hospital, Taixing Municipal People's Hospital, Baotou Central Hospital, The Affiliated Hospital of Nantong University, Linyi People's Hospital, The 72st Group Army Hospital of PLA, Zaozhuang Municipal Hospital, People's Hospital of Dayu County, Taixing City Hospital of Traditional Chinese Medicine, Suzhou Municipal Hospital, Beijing Guang'anmen Hospital, Langxi County Hospital of Traditional Chinese Medicine, Nanyang Central Hospital, The Affiliated People's Hospital of Inner Mongolia Medical University).The diagnosis and management of AA were analyzed through unified summary. Different centers collected and summarized their data in 2017 and sent back the questionnaires for summary.@*RESULTS@#A total of 8 766 AA patients were enrolled from 43 medical centers, including 4 711 males (53.7%) with median age of 39 years and 958 (10.9%) patients over 65 years old. Of 8 776 patients, 5 677 cases (64.6%) received one or more imaging examinations, and the other 3 099 (35.4%) did not receive any imaging examination. A total of 1 858 (21.2%) cases received medical treatment, mainly a combination of nitroimidazoles (1 107 cases, 59.8%) doublet regimen, followed by a single-agent regimen of non-nitroimidazoles (451 cases, 24.4%), a nitroimidazole-free doublet regimen (134 cases, 7.2%), a triple regimen of combined nitroimidazoles (116 cases, 6.3%), nitroimidazole alone (39 cases, 2.1%) and nitroimidazole-free triple regimen (3 cases, 0.2%). Of the 6 908 patients (78.8%) who underwent surgery, 4 319 (62.5%) underwent laparoscopic appendectomy and 2589 (37.5%) underwent open surgery. Ratio of laparotomy was higher in those patients under 16 years old (392 cases) or over 65 years old (258 cases) [15.1%(392/2 589) and 10.0%(258/2 589), respectively, compared with 8.5%(367/4 316) and 8.0%(347/4 316) in the same age group for laparoscopic surgery, χ²=91.415, P<0.001; χ²=15.915,P<0.001]. Patients with complicated appendicitis had higher ratio of undergoing open surgery as compared to those undergoing laparoscopic surgery [26.7%(692/2 589) vs. 15.6%(672/4 316), χ²=125.726, P<0.001].The cure rates of laparoscopic and open surgery were 100.0% and 99.8%(2 585/2 589) respectively without significant difference (P=0.206). Postoperative complication rates were 4.5%(121/2 589) and 4.7%(196/4 316) respectively, and the difference was not statistically significant (χ²=0.065, P=0.799). The incidence of surgical site infection was lower (0.6% vs. 1.7%, χ²=17.315, P<0.001), and hospital stay was shorter [6(4-7) days vs. 6(5-8) days, U=4 384 348.0, P<0.001] in the laparoscopic surgery group, while hospitalization cost was higher (median 12 527 yuan vs. 9 342 yuan, U=2 586 809.0, P<0.001).@*CONCLUSIONS@#The diagnosis of acute appendicitis is still clinically based, supplemented by imaging examination. Appendectomy is still the most effective treatment at present. Laparoscopic appendectomy has become the main treatment strategy, but anti-infective drugs are also very effective.

The analysis of pschological status of patients with oral lichen planus / 实用口腔医学杂志

Objective: To investigate the pschological status of the patients with oral lichen planus disease (OLP) . Methods: 100 patients with OLP and 100 healthy controls were included. The self-rating anxiety scale (SAS), self-rating depression scale (SDS), neuroticism extraversion openness (NEO) and WHOQOL-BREF were used to analyze the life quality and pschology of the subjects.Andrenocor-cicotropin (ACTH) and cortisol (CORT) in serum were measured. The relationship between OLP and mental illness, stress, personality traits and life quality was analyzed. Results: There were no significant differences of gender and age between the case group and the control group (P＞ 0. 05) . There were significant differences of the SAS score, SDS score, NEO score, WHOQOLBREF score and the level of ACTH and CORT (P ＜ 0. 05) in serum between the 2 groups. Logistic regression analysis showed that anxiety, depression, personality and life quality were the influencing factors of OLP prevalence. Conclusion: The development of OLP may be related to psychological status, depression, stress, anxiety and so on.

Hybridization technique in the surgical treatment of coronary heart disease / 中国基层医药

Objective To explore the clinical effect of myocardial laser revascularization combined with minimally invasive coronary artery bypass grafting(referred to as hybridization)in the treatment of coronary heart disease.Methods 90 cases with coronary heart disease were divided into using conventional coronary artery bypass grafting in the control group(45 cases),using hybridization observation group(45 cases),postoperative troponin(cTn),myoglobin(MYOG),creatine kinase isoenzyme(CK-MB)level,after 1 year follow up of heart failure,angina pectoris,re-stenosis rate were compared between the two groups.Results The two groups of cTn,MYOG,CK-MB levels had significant differences(t=6.12,5.21,6.22,P＜0.01);after 1 year of follow-up,two groups of heart failure,angina pectoris,again stenosis rate had significant differences(x2=6.15,5.11,5.65,all P＜0.05).Conclusion The hybrid operation in the treatment of coronary heart disease can significantly improve cardiac function,reduce complications,prognosis is better.