Objective To explore the methods of evidence-based individualized treatment for a patient with oral pemphigus. Methods According to chnical problems, we searched The Coehrane Library （Issue 1,2005 ） , MEDLINE （1966 -Jan. 2005 ）, SUMSEAR.CH （Jan. 2005 ）, TRIPDATABASE （1997 - 2005 ）, CMCC （1994 - 2004 ）and handsearched four Chinease journals （starting pubhcation -2004）. Results No Systematic review was found. Six randomised controlled trials, two reviews of high quality and one guidehne were identified. We found that corticosteroid was the firsthne medicine in the treatment of pemphigus. However, corticosteroid at higher dose did not work more effectively than that at lower dose. Corticosteroid at middle-dose was preferred in treating oral pemphigus. Additionally, corticosteroid combined with immunosuppressants led to lower mortality. Among them, cyclophosphamide and azathioprine were recommended, and methopterin should be avoided. Plasma exchange in combination with corticosteroid at lowor middle-dose should not be recommended in conventional therapy. Chinese traditional treatment combined with Western medicine might work. A treatment with prednisone at the dose of 60 mg/d and in combination with azathioprine 100mg/d was made based on the evaluation of the data available and was proved optimal by 6 months following-up. Conclusions The therapeutic effect of pemphigus has been improved by evidence-based treatment.
At present, coronavirus disease 2019 has become the most serious public health emergency in the world. The disease is still spreading around the world. The disease progresses rapidly and is highly contagious, causing great harm to the public health security of the world. Based on the research evidence published at home and abroad, this article systematically summarizes the biological structure of severe acute respiratory syndrome coronavirus 2, and the pathogenesis, transmission routes and susceptible populations, clinical features and treatment methods of coronavirus disease 2019. It aims to help medical workers understand coronavirus disease 2019 in order to better diagnose and treat the disease, and provide references for future research.
In order to verify the effectiveness of neural stump buried into the muscle in the prevention and treatment of neuroma, 17 cases were reported, in which 8 cases having 19 painful neuromas and 9 cases having 13 amputated meural stumps, buried into muscle. They wese followed up for 6 months to 40 months, It was shown that good and excellent results were obtained and no evidence of neuroma was observed in all cases except in one which had painful neuroma occurred from the failure of embedment of the neural stump into the muscle. The conclusion was that the neural stump buried into muscle was an effective method for the prevention and treatment of neuroma.
In recent years, the diagnosis and treatment of hepatocellular carcinoma (HCC) has entered a brand-new era due to the advancement of diagnosis methods and the emergence of targeted drugs and immunotherapy drugs. The author described and summarized in detail the screening program, diagnostic thought and procedure, clinical staging, mechanism of targeted and immune therapy and application range of HCC.
Objective To summarize the clinical experience in the treatment of refractory decubitus ulcers.Methods From May 1998to March 2005, 22 patients with decubitus ulcers(29 decubitus ulcers) were admitted, whose age was 3692 years. The lesion size was 4 cm×2 cm to 18 cm×15 cm. The locations of decubitus ulcers were the sacrococcygeal region(18 cases), the tuber ischiadicum region (6 cases) and the trochanter major region(5 cases).Enteral nutrientwas given orally and the wound was treated with Wuhuangyihao 8-15 days. Three diabetic patients were injected with insulin. According to patient’s age, ulcer position, ulcer extent and ulcer degree, the flap type was determined. Three wounds were repaired by local flaps, the flap size was 6 cm×4 cm-12 cm×10 cm; 10 by fasciocutaneous flaps, 10 cm×7 cm-20 cm×17 cm; 9 by gluteus maximusmyocutaneous flaps, 13 cm×11 cm-17 cm×14 cm; and 6 by longhead of biceps femoris flaps,11 cm×6 cm-14 cm×7 cm. One was sutured directly. After operation, the patients were placed on airflow suspended bed 7-14 days.Results General nutritional status was improved, hemoglobin was greaterthan 100 g/L, albumen was greater than 30 g/L. Necrosis tissue was removed, granulation tissue turned into fresh, secretion reduced and no redness and swelling occurred in wound. All flaps survived and the wounds healed by first intention. After a followup of 6 months to 5 years, no patient had a recurrence, the color and texture of the flaps were good, the appearance was satisfactory.Conclusion Applying the technique of combined treatment can accelerate the healing of refractory decubitus ulcers and improves the success of operation.
ObjectiveTo investigate misdiagnosis of primary squamous cell carcinoma of liver (PSCCL) as cholangiocarcinoma before operation and its clinical manifestations, imaging manifestations, etiology, histological origin, pathological characteristics, diagnosis and differential diagnosis, selection of treatment methods, and prognosis, so as to improve understanding and reasonable diagnosis and treatment of disease.MethodThe clinicopathologic data of a case of PSCCL misdiagnosed as cholangiocarcinoma in the West China Hospital of Sichuan University were analyzed retrospectively.ResultsThe patient was admitted to the West China Hospital of Sichuan University with the right hepatic space occupying. The preoperative imaging examination showed that the patient had the imaging characteristics of hepatic cholangiocarcinoma, then the right hemihepatectomy was performed. The postoperative pathological diagnosis was the PSCCL.ConclusionsPreoperative diagnosis of PSCCL is extremely difficult and it is difficult to differentiate it from primary liver cancer, and it is easy to overlook liver metastasis’s occurrence in other parts of the squamous cell carcinoma, which leads to liver metastasis. It is usually diagnosed by pathological diagnosis after operation, and then original lesions in other parts are excluded by various examinations. PSCCL is treated in a variety of ways, but it’s prognosis is not good. At present, there is no unified treatment principle, most of which are surgery, followed by postoperative radiotherapy and chemotherapy. In most cases, because PSCCL’s etiology is unknown and mechanism is not clear, clinicians can only implement individualized treatment according to patient’s condition.
Objective To observe the effect of You Gui Yin and MSCs interventional therapy on the early stage of avascular necrosis of the femoral head (ANFH) and its role of improving revascularization and reossification. Methods Twenty-four adult Beagle dogs weighing (10.0 ± 0.5) kg were divided into 4 groups (n=6): group A (model group), group B (You Gui Yin group), group C (MSCs intervention group), group D(You Gui Yin and MSCs intervention group). The model of ANFH at early stage was establ ished by l iquid-nitrogen cryopreservation method, and MSCs were isolated, cultured and labeled by BrdU. Three weeks after model ing, groups C and D received 1 mL MSCs with artery perfusion [(0.5-1.0) × 106/mL)], groups B and D received intragastric administration of 100 mL You Gui Yin per day, groups A and C received intragastric administration of 100 mL distilled water. Gross observation on femoral head was conducted 4 and 8 weeks after continuous treatment. Meanwhile, DSA and MRI were adopted to observe the quantity and the diameter of femoralhead blood vessel, histology and immunohistochemistry staining were performed to observe the expression of VEGF and BrdU, and the expression of VEGF mRNA was detected by real-time fluorescence quantitative RT-PCR. Results At 4 and 8 weeks after treatment, the figuration of the femoral head in group A was flat and mushroom-shaped, while it was relatively normal in groups B, C and D. DSA observation: the number and the diameter of blood vessel in groups C and D were increased, and the obstructed blood vessel was open. At 4 and 8 weeks after treatment, significant differences between group C and group D were evident in the number and the diameter of blood vessel (P lt; 0.05); compared with before treatment, the diameter of blood vessel in two groups were significantly improved (P lt; 0.05) and the number of blood vessel in group D was significantly increased (P lt; 0.05). MRI observation: compared with group A, groups B, C and D were obviously improved, especially group D, T1W showed lower signal, T2W and STIR showed no abnormal changes of signal. Histopathology and immunohistochemistry staining: compared with group A, the structure of groups B, C and D were obviously improved, the positive expression of VEGF in group D was significantly higher than that of other groups (P lt; 0.05), the positive rate of BrdU, the number of positive osteoblast and the number of positive blood vessel in group D was obviously higher than that of group C (P lt; 0.05). Real-time fluorescence quantitative RT-PCR detection: the expression of VEGF mRNA in group D was significantly higher than that of other groups (P lt; 0.05), the expression of VEGF in groups B, C and D was higher than that of group A (P lt; 0.05). Conclusion The combination of You Gui Yin and MSCs interventional treatment has significant therapeutic effects on the early-stage ANFH, can improve the blood supply of the necrotic femoral head, promote repair and prevent collapse.
Transcatheter aortic valve implantation (TAVI) has become the main treatment for elderly patients with middle and high risk aortic stenosis. However, coronary artery occlusion (CAO) related to TAVI is a very serious complication, which often leads to poor prognosis. Therefore, active preoperative prevention is particularly important. Preoperative computed tomography evaluation, bioprosthetic or native aortic scallop intentional laceration and chimney stent implantation technology can prevent TAVI-related coronary orifice obstruction. Ensuring commissural alignment during operation can reduce the occurrence of coronary occlusion, but its long-term prognosis needs further study. In addition, percutaneous coronary intervention is the main treatment, but there are problems such as difficult coronary access after TAVI. This article summarized the research progress in the mechanism, prevention and treatment of CAO related to TAVI.
The body is at a hypo-coagulation status after the heart mechanic valve prosthesis replacement operation, and the incidence of anticoagulation complications is rather high because of that administration of warfarin may result in “anticoagulation vacuum” at an early stage. Moreover, the necessary application of other anticoagulation methods assisting the employment of warfarin have still not been scientifically normalized. Blood coagulation factor Ⅱ,Ⅶ, prothrombin fragment1+2 (F1+2 ), urine fibrimopeptide A (UFPA) , and International Normalized Ratio(INR), could exactly reflect the anticoagulation intensity 48-72 hours after the replacement operation,reasonable use of anticoagulant therapy as well as accurate and in-time monitoring methods is significant to reduce complications,elevate survival rate, and improve quality of life.
Objective To analyze the perioperative outcomes of uniportal thoracoscopic lobectomy compared with three-port thoracoscopic lobectomy. Methods Data were extracted from the Western China Lung Cancer Database, a prospectively maintained database at the Department of Thoracic Surgery, West China Hospital, Sichuan University. Perioperative outcomes of the patients who underwent uniportal or three-port thoracoscopic lobectomy for lung cancer during January 2014 through April 2021 were analyzed by using propensity score matching. Altogether 5 817 lung cancer patients were enrolled who underwent thoracoscopic lobectomy (uniportal: 530 patients; three-port: 5 287 patients). After matching, 529 patients of uniportal and 1 583 patients of three-port were included. There were 529 patients with 320 males and 209 females at median age of 58 (51, 65) years in the uniportal group and 1 583 patients with 915 males and 668 females at median age of 58 (51, 65) years in the three-port group. Results Uniportal thoracoscopic lobectomy was associated with less intraoperative blood loss (20 mL vs. 30 mL, P<0.001), longer operative time (115 min vs. 105 min, P<0.001) than three-port thoracoscopic lobectomy. No significant difference was found between the two groups regarding the number of lymph node dissected, rate of conversion to thoracotomy, incidence of postoperative complication, postoperative pain score within 3 postoperative days, length of hospital stay, or hospitalization expenses. Conclusion Uniportal video-assisted thoracoscopic lobectomy is safe and effective, and the overall perioperative outcomes are comparable between uniportal and three-port strategies, although the two groups show differences in intraoperative blood loss.