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改良背带缝合术防治难治性产后出血

APPLICATION OF ISLAND MYOCUTANEOUS FLAP FOR REFRACTORY WOUND IN CERVICOTHORACICREGION

Objective To introduce experiences in the application of island myocutaneous flap for refractory wound in cervicothoracic region. Methods From August 1994 to December 2004, 98 cases of refractory wound in cervicothoracic region were treated; there 42 males and 56 females, aging 2168 years.The course of disease was 3 hours to 13 months. The locations were anterior pectorial region(29 cases), cervical part (28 cases), nuchal region (18 cases), subaxillary and axillary region (15 cases), and thoracic wall (8 cases). The defect area ranged from 6 cm×4 cm to 20 cm×15 cm. According to location, peculiarity and etiological factor of wound, various island myocutaneous flaps were selected: 28 pectoralis major island myocutaneous flaps,34 latissimus dorsi island myocutaneous flaps, 19 trapizius island myocutaneousflaps and 17 rectus abdominis island myocutaneous flap. The sizes of the dissected flap ranged from 8 cm×6 cm to 35 cm×15 cm. Results Of 98 patients, the woundhealed by first intention and the flap survived completely in 92 and the flap necrosed partially in 6. The good function and cosmetic results were obtained without severe complication. Eightythree cases were followed up from 2 weeks to 5 years. The flap obtained satisfactory appearance, good function and cosmetic results. Conclusion Repairing refractory wound in cerviconuchal region may selectpectoralis major island myocutaneous flap, latissimus dorsi island myocutaneousflap, and trapizius island myocutaneous flap; repairing refractory wound on thoracic region may select latissimus dorsi island myocutaneous flap and rectus abdominis island myocutaneous flap. According to specific condition of wound, using suitable island myocutaneous flap for refractory wound in cervicothoracic region may obtain satisfactory functional and cosmetic results.

大麻二酚在儿童和成人耐药性癫痫的长期安全性和治疗效果评价：基于扩大受试试验的结果

自 2014 年以来，该研究小组进行了一项扩大受试研究（Expanded‐access program，EAP），对难治性癫痫（Treatment‐resistant epilepsies，TRE）患者添加使用了大麻二酚（Cannabidiol，CBD）药物。报告截至 2016 年 12 月关于 CBD 的安全性和有效性的中期结果。研究纳入了 25 个位于美国的医学中心，这些中心招募了服用稳定剂量抗癫痫药物（AEDs）的难治性癫痫患者。在 4 周的基线期内，患者 1 监护人记录所有可计数的癫痫发作类型和次数。患者口服 CBD 的起始剂量为 2～10 mg /（kg·d），最大剂量定为 25～50 mg /（kg·d）。在初始的 16 周内每 2～4 周对患者进行一次访视，此后每 2～12 周进行一次访视。研究数据包括每月惊厥性癫痫和总癫痫发作频率与基线相比的百分比变化，以及与基线相比癫痫发作减少≥50%、≥75% 和 100% 的患者百分比。最后对数据进行描述性分析，使用末次观测值结转法（LOCF 法）来分析丢失的数据。每次访视均记录不良事件（Adverse events，AEs）。安全性分析囊括了 607 例患者，其中有 146 例（24%）退出；最常见的原因是缺乏疗效［89（15%）］和 AEs［32（5%）］。患者的平均年龄为 13 岁（范围为 0.4～62）。联用 AEDs 的数量为 3 种（范围为 0～10）。CBD 的中位剂量为 25 mg /（kg·d）；中位治疗时间为 48 周。联用 CBD 后，在第 12 周时，每月惊厥发作的中位数减少了 51%，总癫痫发作减少了 48%，结果与随访 96 周后的发作次数相似。在第 12 周，惊厥性癫痫发作减少百分比≥50%、≥75% 和 100% 患者比例分别为 52%、31% 和 11%，此结果与 96 周时相似。CBD 的耐受性一般；最常见的 AEs 为腹泻（29%）和嗜睡（22%）。

Pharmacoeconomic evaluation model for relapsed or refractory B-cell acute lymphoblastic leukemia therapies: a systematic review

Objective To systematically review the pharmacoeconomic evaluation related to relapsed or refractory B-cell acute lymphoblastic leukemia (r/r B-ALL), and to summarize its model structure, parameter inclusion and other methodological parts for future r/r B-ALL-related interventions, and to provide references for conducting pharmacoeconomic evaluations. Methods PubMed, EMbase, The Cochrane Library, CNKI and WanFang Data databases were electronically searched to collect relevant literature on the pharmacoeconomic evaluation model of r/r B-ALL from inception to August 6th, 2021. Two reviewers independently screened literature, extracted data, and assessed the quality of the included studies. The data on the model structure, methods, and parameter inclusion were then summarized. Results A total of 10 studies using different modeling methods were included. Due to the lack of head-to-head trials, most of the efficacy parameters for the intervention and control groups were derived from different clinical trials and compared indirectly. All studies used quality-adjusted life years (QALYs) as output indicators, and some used life years (LYs) as output indicators and reported the incremental cost effectiveness ratio (ICER). All studies measured the cost of treatment and hematopoietic stem cell transplantation; a few studies also conducted subgroup analysis. Conclusion The number of studies on the economic evaluation of r/r B-ALL is relatively small, and there are large differences in model types, health status, and parameter inclusion. It is suggested that researchers should guarantee the integrity of the report format and normative according to available data choice drug economics evaluation model and establish the reasonable hypothesis under the condition of the patient population heterogeneity uncertainty, perform subgroup analysis especially on the subgroup which did not receive salvage therapy. In the absence of head-to-head clinical trials, appropriate indirect comparison methods are adopted according to the data obtained to reduce methodological differences and improve the quality of relevant pharmacoeconomic research in China.

Analysis of the Relationship between Prognosis of Different Intractable Epilepsy Surgery and the Disease Course

【摘要】　目的　探讨难治性癫痫不同类型手术的预后与病程长短有无相关关系。　方法　回顾性分析2005年1月-2009年12月在四川大学华西医院神经外科进行难治性癫痫手术的143例患者，根据Engel分级对预后进行评估，分别分析各类型手术不同病程时间之间的预后差异以及相关关系。　结果　不同病程组颞叶手术和颞叶合并颞叶外手术的预后差异无统计学意义（Pgt;0.05），两者之间无相关关系；颞叶外手术的预后在不同病程组间差异有统计学意义（Plt;0.05），两者之间呈负相关。　结论　颞叶外癫痫手术的预后与病程存在相关关系；病程越短，预后越好。【Abstract】　Objective　To discuss the relationship between prognosis of different intractable epilepsy surgeries and the disease course.　Methods　A total of 143 patients who had undergone surgeries for intractable epilepsy in the Neurosurgery Department of West China Hospital of Sichuan University from 2005 to 2009 were enrolled, and the prognosis with different disease course were assessed based on the Engel classification.　Results　Between different disease duration groups, the difference between the prognosis of the temporal surgery and the surgery of temporal lobe combined with other lobes was not statistically significant (Pgt;0.05), which indicated no relationship between the disease course and the prognosis. However, the difference between the prognosis of the surgeries outside the temporal lobe was statistically significant (Plt;0.05), which showed that patients with a longer disease course had a worse prognosis.　Conclusion　The prognosis of the epilepsy surgery outside the temporal lobe is correlated with the disease course. The shorter course has a better prognosis after surgery.

难治性黄斑裂孔的改良视网膜下注射技术

儿童症状性局灶性癫痫和可疑症状性局灶性癫痫：一个观察性的前瞻性多中心研究

描述新诊断的症状性局灶性癫痫 (Symptomatic focalepilepsies，FS) 和可疑症状性局灶性癫痫 (Presumed symptomatic focalepilepsies，FCE) 患儿入组时及入组后1个月以内的临床、神经心理学和心理病理学特征。将对这些患者入组后随访2~5年，以探究癫痫的病程和药物难治性癫痫的早期预测因素。在这个观察性的多中心全国性研究中，新诊断的FS或者FCE儿童 (年龄1个月~12.9岁) 在15个意大利儿童癫痫高级研究中心被连续纳入。纳入标准如下：①后天或发育因素导致的FS，以及FCE；②首次诊断为癫痫的年龄>1个月并且 < 13岁；③签署书面的知情同意书。临床、脑电图、神经影像以及神经心理资料都用于统计分析。最终纳入259例儿童 (女116例，男143例)。年龄中位数为4.4岁 (范围：1个月~12.9岁)，46.0%(n=119)≤3岁，24%(n=61)>3~6岁，30%(n=79)>6岁。71.8%的患儿神经系统检查正常。59.9%头部核磁共振 (MRI) 检查异常。年龄≤3岁组的患儿入组后第一个月发作的频率最高 (P < 0.000 1)。67.2%的患儿第一个月为单药治疗。在基线期，30%的患儿认知功能检查异常；21%存在行为问题。多因素分析发现，年幼儿和颞叶癫痫患儿起病后第一个月内发作频率>5次的几率更大。该项前瞻性的队列研究发现，儿童期起病的FS和FCE患者的许多特征与起病的年龄以及致痫灶的部位有关。

Clinical efficacy and benefit-risk network Meta-analysis of ketogenic diet in the treatment of refractory epilepsy in children

ObjectiveAnalyze and compare the differences in the efficacy and adverse reactions of various ketogenic diet (KD) in the treatment of refractory epilepsy in children.MethodsSystematic search of electronic databases, including PubMed, Embase, Ovid MEDLINE, Web of Science and the Central Register of Cochrane Controlled Trials, published in English January 2000 Relevant research from January to August 2020. Results: Finally, 11 articles were included and 781 cases were included. Meta-analysis (NMA) method was used to compare 6 classic ketogenic diets (Classic ketogenic diet, CKD), Gradual ketogenic diet initiation (GRAD-KD), and the first modified Atkins diet of 20 g carbohydrates/d (Initial 20 g of carbohydrate/day of modified Atkins diet, IMAD), modified Atkins diet (MAD), low glycemic index diet (LGID) and medium-chain fatty acid diet (Medium-chain triglyceride diet, MCT) Therapeutic effect and adverse reactions of 3, 6, and 12 months.ResultsFrom the results of the direct comparative analysis, CKD and MAD showed superior clinical efficacy in 50% seizure reduction at 3 months to CAU, and the difference was statistically significant [OR=10.58, 95%CI (3.47, 32.40), P<0.05; OR=11.31, 95%CI (5.04, 25.38), P<0.05]; the clinical efficacy of 90% seizure reduction at 3 months for MAD was superior to that of CAU with statistical significance [OR=4.95, 95%CI (1.90, 12.88), P<0.05]. The results of further network meta-analysis suggested that for the comparison of 50% seizure reduction at 3 months, IMAD, GRAD-KD, CKD, MAD, and MCT were superior to CAU, and the difference was statistically significant [OR=0.03; 95%CI (0.00, 0.30), P<0.05; OR=0.07; 95%CI (0.01, 0.76), P<0.05; OR=0.11; 95%CI (0.03, 0.35), P<0.05; OR=0.11; 95%CI (0.04, 0.35), P<0.05; OR=0.13; 95%CI (0.03, 0.67), P<0.05; OR=0.11; 95%CI (0.03, 0.35), P<0.05; OR=0.11; 95%CI (0.04, 0.35), P<0.05]. For the comparison of 90% seizure reduction at 3 months, CKD, GRAD-CK, IMAD, MAD, and MCT were superior to CAU, and the differences were statistically significant [OR=0.05; 95%CI (0.00, 0.31), P<0.05; OR=0.22; 95%CI (0.00, 0.39), P<0.05; OR=0.03; 95%CI (0.00, 0.62), P<0.05; OR=0.12; 95%CI (0.01, 0.60), P<0.05; OR=0.09; 95%CI (0.00, 0.91), P<0.05]. It is suggested in the cumulative probability plot that: the optimal clinical regimen for 50% seizure reduction at 3 months was IMAD (Rank1=0.91), the optimal clinical regimen for 50% seizure reduction at 6 months was CKD (Rank1=0.40), the optimal clinical regimen for 50% seizure reduction at 12 months was MCT (Rank1=0.64); the optimal clinical regimen for 90% seizure reduction at 3 months was IMAD (Rank1=0.94), the optimal clinical regimen for 90% seizure reduction at 6 months was LGIT (Rank1=0.44), and the optimal clinical regimen for 90% seizure reduction at 12 months was MCT (Rank1=0.41); the optimal clinical regimen for seizure reduction at 3 months was GRAD-CK (Rank1=0.46), the optimal clinical regimen for seizure reduction at 6 months was LGIT (Rank1=0.58), and the optimal clinical regimen for seizure reduction at 12 months was CKD (Rank1=0.56). It is suggested in the benefit-risk assessment that among the three KDs (CKD, MAD, MCT) with better 50% and 90% seizure reduction at 3 months and 6 months, combining with the incidence of adverse reactions, CKD was the optimal treatment regimen (CF=0.47, CF=0.86); among the two KDs (CKD, MAD) with better seizure reduction at 3 months and 6 months, combining with the incidence of adverse reactions, CKD was the optimal treatment regimen (CF=0.45); among the two KDs (CKD, MCT) with better 50% and 90% seizure reduction at 12 months, combining with the incidence of adverse reactions, CKD was the optimal treatment regimen (CF=0.65).ConclusionsIn this study, IMAD showed the optimal clinical efficacy at 3 months and MCT at 12 months. With stable efficacy and low incidence of adverse reactions in 12 months, CKD was the optimal treatment regimen for children with refractory epilepsy after the comprehensive evaluation.

Lenalidomide plus Dexamethasone for Relapsed or Refractory Multiple Myeloma: A Systemic Review

Objcetive　To assess the efficacy and safety of lenalidomide plus dexamethasone (LD) compared with placebo plus dexamethasone (PD) for relapsed or refractory multiple myeloma. Methods　Data were searched in The Cochrane Library (Issue 3, 2010), MEDLINE (with PubMed, 1966 to Nov. 2010), EMbase (1984 to Nov. 2010), CBMdisc (1978 to Nov. 2010), and CNKI (1979 to Nov. 2010), and also searched in clinical trials register for ongoing studies and completed studies with unpublished data. The references of the included studies and relevant supplement or conference abstracts were handsearched. Randomized controlled trials were included. The data were extracted, and then the quality of the included studies was assessed by two reviewers independently. RevMan 5.0 software was used for meta-analyses for studies with low heterogeneity. Results　Two studies involving 704 participants were included. One was high quality study, while the other was unclear about randomization and allocation concealment. The adverse outcomes of LD, such as mortality (RR=0.78, 95%CI 0.62 to 0.97, P=0.03) and incidence of disease progression (RR=0.16, 95%CI 0.08 to 0.34, Plt;0.000 01), were better than those of PD, which had significant differences. The overall response rate was higher in the LD group than in the PD group (RR=2.75, 95%CI 2.22 to 3.41, Plt;0.000 01). The incidence of thrombotic event (RR=3.20, 95%CI 1.78 to 5.73, Plt;0.000 1), the Grade Three and Grade Four neutropenia (RR=10.20, 95%CI 5.76 to 18.08, Plt;0.000 01), the Grade Three and Grade Four thrombocytopenia (RR=2.08, 95%CI 1.28 to 3.38, P=0.003), and the incidence of drug withdrawal or dosage reduction due to adverse reactions (RR=1.34, 95%CI 1.21 to 1.49, Plt;0.000 01) were all higher in the LD group than in the PD group. Conclusion　The efficacy of LD is superior to that of PD for relapsed or refractory multiple myeloma, but the incidence of drug adverse events, such as thrombosis, Grade Three or Grader Four neutropenia or thrombocytopenia, is also higher than that of PD, which has to be prevented positively.

真空采血管在老年难治性窦道伤口治疗中的应用

【摘要】　目的　总结真空采血管在老年难治性窦道伤口治疗中的应用效果。　方法　回顾性分析2009年12月—2010年9月收治因肾癌和神经源膀胱手术后4例老年难治性窦道伤口患者的病例资料，总结采用真空采血管进行伤口治疗的方法及疗效。　结果　患者经过12～14 d后伤口闭合，上皮覆盖，达到伤口全部愈合。　结论　采用真空采血管治疗老年难治性窦道伤口，方法简便，费用低廉，可有效促进伤口愈合。