ObjectiveTo explore the clinical efficacy and safety of ultrasound-guided intra-articular injection of platelet-rich plasma (PRP) in the treatment of avascular necrosis of the femoral head.MethodsWe retrospectively collected and analyzed the clinical characteristics, imaging data, and clinical outcomes of patients with femoral head necrosis who received ultrasound-guided intra-articular PRP injection in the Department of Rehabilitation Medicine of Sun Yat-sen Memorial Hospital, Sun Yat-sen University between June 2019 and June 2020. All the patients received 4 injections at one-week intervals. The Visual Analogue Scale (VAS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and Harris Hip Joint Function Scale (HHS) were evaluated before treatment and 1 month, 3 months, and 6 months after the first injections. Adverse events were recorded. The normally distributed data were presented as mean±standard deviation, and analyzed by one-way repeated measures analysis of variance; the non-normally distributed data were presented as median (lower quartile, upper quartile), and analyzed by Friedman test.ResultsA total of 29 patients were included. According to the Association Research Circulation Osseous classification standard, 2 patients were classified as stageⅠ, 11 as stageⅡ, 11 as stage Ⅲ, and 5 as stage Ⅳ. Before treatment and 1 month, 3 months, and 6 months after treatment, the VAS scores were 7.0 (5.5, 8.0), 4.0 (3.0, 5.0), 3.0 (2.0, 3.0), and 3.0 (2.0, 5.0), respectively, the WOMAC scores were 39.27±11.70, 28.34±8.08, 22.82±6.09, and 24.13±7.55, respectively, and the HHS were 46.0 (40.0, 64.0), 71.0 (57.5, 75.0), 78.0 (68.0, 80.5), and 78.0 (64.0, 80.0), respectively. The time effects in VAS (χ2=65.423, P<0.001), WOMAC (F=46.710, P<0.001), and HHS (χ2=66.347, P<0.001) were all statistically significant. There were significant differences in each index between the values 1 month, 3 months, and 6 months after treatment and those before treatment respectively, and there was also a significant difference in each index between the value 1 month after treatment and that 3 months after treatment (P<0.05). There was no significant difference in any indicator between the value 6 months after treatment and that 3 months after treatment (P>0.05). Significant difference was shown between the value 6 months after treatment and that 1 month after treatment in WOMAC (P=0.016), but not in VAS or HHS (P>0.05). No obvious adverse event was reported during the follow-up period.ConclusionsUltrasound-guided intra-articular PRP injection can effectively alleviate the pain and improve the hip joint function of patients with femoral head necrosis for at least 6 months. However, randomized controlled studies with a larger sample size and longer-term follow-up are needed in the future to confirm the efficacy and safety of PRP injection in femoral head necrosis.
Objective To compare outcomes after single versus bilateral lung transplantation in patients with end-stage chronic obstructive pulmonary disease (COPD) with retrospective cohort study, and to provide a reference for surgical selection. Methods One hundred and two patients with end-stage COPD who received lung transplantation in Wuxi People's Hospital affiliated to Nanjing Medical University from January 2010 to May 2019 were evaluated, including 97 males and 5 females, aged from 42 to 82 years, with an average age of (59.8±8.0) years. Recipients were divided into single lung transplantation (SLT) group (31 cases) and bilateral lung transplantation (BLT) group (71 cases). Preoperative characteristics, postoperative outcomes, postoperative complications, functional improvement and survival between the two groups were analyzed retrospectively. Results The SLT group were significantly older than the BLT group [(62.6±8.8) years vs. (58.6±7.4) years, P<0.05], which was consistent with the practice mode of single lung transplantation in the elderly patients in this center. The FEV1% predicted and the six‐minute walk distance (6-MWD) in the BLT group were better than those in the SLT group (P<0.05). The cumulative survival rate in 1, 3 and 5 years after operation in the BLT group was higher than that in the SLT group (70.4%, 63.2%, 61.5%, respectively vs. 67.7%, 58.1%, 54.6%, respectively), but there was no statistical difference (P=0.388). The two groups were comparable in other preoperative clinical data (P>0.05). The cold ischemia time and total operation time were shorter in the SLT group than in the BLT group, and the intraoperative blood loss was less than that in the BLT group, but more patients required intraoperative extracorporeal membrane oxygenation support than the BLT group (P<0.05). There were no significant differences in postoperative ventilator support, reoperation, length of intensive care unit stay, postoperative hospital stay, and perioperative mortality (P>0.05). In terms of postoperative complications, the incidence of primary graft dysfunction grades 3 was higher in the SLT group than in the BLT group (35% vs. 8%, P=0.001). There were no significant differences between the two groups in chest complications, airway complications, acute rejection, infection, and bronchial occlusion syndrome (P>0.05). Nine patients (29%) developed acute native lung hyperinflation in the SLT group. ConclusionsBilateral lung transplantation is superior to single lung transplantation in the treatment of end-stage COPD. The advantage is mainly reflected in the simple perioperative management, better functional improvement after operation. Single lung transplantation as a beneficial supplement to double lung transplantation should still be considered in selected patients.
Objective To compare the safety and efficacy of minimally invasive coronary artery bypass grafting (MICS CABG) and traditional CABG in patients with coronary heart disease (CHD) and diabetes mellitus (DM). Methods From 2019 to 2021, the patients who received CABG by the same medical group in the Minimally Invasive Cardiac Surgery Center of Beijing Anzhen Hospital were retrospectively enrolled. According to the surgery methods, the patients were divided into two groups: a MICS CABG group and a conventional group. The perioperative and postoperative follow-up data of patients were collected. The main observation results included all cause death events, myocardial infarction, cerebrovascular, revascularization, and adverse wound healing. Results According to the inclusion and exclusion criteria, 140 patients were enrolled, including 66 patients in the MICS CABG group [56 males and 10 females, aged (61.83±8.94) years], and 74 patients in the conventional group [55 males and 19 females, aged (58.61±8.26) years]. Compared with the conventional group, patients in the MICS CABG group had longer median surgical time (4.50 h vs. 4.00 h, P=0.005), less intraoperative bleeding (600.00 mL vs. 700.00 mL, P=0.020), and a lower rate of secondary debridement and suturing of surgical wounds (4.5% vs. 16.2%, P=0.023). The median follow-up time was 2.54 years. There was no statistically significant difference in the cumulative incidence of major adverse cardiac and cerebrovascular events (7.6% vs. 5.4%), all-cause mortality (0.0% vs. 0.0%), myocardial infarction (3.0% vs. 2.7%), cerebrovascular events (4.5% vs. 2.7%), or revascularization (0.0% vs. 0.0%) between the two groups of patients during the postoperative follow-up (P>0.05). Conclusion MICS CABG can achieve the same revascularization effect as traditional CABG in patients with CHD and DM. MICS CABG can effectively reduce adverse clinical outcomes or complications such as adverse chest wound healing and slow postoperative recovery of body function in patients with DM.
Objective This study aimed to provide data about the clinical features of first seizure in the Ganzi Tibetan Autonomous Prefecture to improve the strategies for epilepsy prevention and control in this region. Methods We reviewed the clinical record of patients with first seizure in Neurology Department, Ganzi Tibetan Autonomous Prefecture People’s Hospital between January 2015 and October 2017 and summarised their clinical features. Results One hundred and one patients were included in this study with the average age of (43.0±18.4) years. Twenty-nine cases were diagnosed as statusepilepticus, 5 (17.2%) of whom died in 30 days. Among the 45 patients diagnosed with acute symptomatic seizure, 22 cases (48.9%) were caused by cerebral infection, including neurocysticercosis (n=4, 8.9%), tuberculous infection (n=8, 17.7%) and viral infection (n=7, 15.6%). Other causes of acute symptomatic seizure included cerebrovascular diseases (n=13, 28.8%), high altitude (n=3, 6.7%) and alcohol related or alcohol withdrawl (n=3, 6.7%). Conclutions These data suggest that the control of cerebral infections is essential for the prevention and treatment of seizures in the Ganzi Tibetan Autonomous Prefecture. Education of local primary doctors about status epilepticus will enable better management of seizures in this population.
Objective To probe the clinical character,the histopathological classification and misdiagnoses of intraocular tumors. Methods The clinical and pathological data of 359 patients with intraocular tumor diagnosed clinically between 1980～2000 were retrospectively analyzed. Results There were 300 cases of malignant tumor and 23 cases of benign tumor respectively. Non-oncologic malady and benign tumor misdiagnosed as tumor or malignant tumor were 40 cases. The two leading malignant tumors were retinoblastoma and melanoma. Conclusion The clinical and pathological analysis of intraocular tumor is beneficial to the correct clinical diagnosis and treatment. (Chin J Ocul Fundus Dis,2002,18:28-30)
目的 总结胸部创伤流行病学及临床特征，为创伤的预防和救治提供科学依据。 方法 回顾性分析 2005～2015 年我院胸心外科连续收治 1 250 例胸部创伤患者的临床资料。根据患者伤情，分别采用无创性保守治疗、胸腔闭式引流术、开胸探查止血术、肋骨内固定术及其他胸部及心脏创伤的修补术。观察创伤患者致伤类型、创伤部位、治疗方式与临床预后以及 2012 年前后时间分布及其相关性。 结果 全组男 999 例（79.9%）、女 251 例（20.1%），平均年龄（44.0±17.7）岁。非穿透性损伤 885 例（70.8%），穿透性损伤 365 例（29.2%），死亡 8 例（0.64%）。肋骨骨折 766 例，骨折内固定手术干预占 16.1%（123/766），手术复位内固定患者平均住院时间明显短于保守治疗患者（9.55 dvs. 16.38 d，t=6.574，P=0.000）。2012 年后非穿透性损伤较 2012 年前有所升高（81.8%vs. 66.3%），而穿透性损伤较前明显下降（18.2%vs. 33.7%）（χ2=28.9，P=0.000）。2012 年前后创伤部位中肋骨骨折（P=0.000）、肺挫伤（P=0.000）、气胸（P=0.000）和胸腹联合伤（P=0.001）均发生了明显变化。 结论 2012 年是我院 10 年期间胸部创伤类型及创伤部位发生明显变化趋势的重要时间截点，对我院下一步胸部创伤救治侧重点转变带来了新的思考和考验。
【摘要】 目的 探讨研究静脉滴注丹参注射液发生不良反应的类型及因素，为临床用药提供依据。 方法 对2007年1月-2010年12月82例因静脉滴注丹参注射液发生不良反应的患者资料进行回顾分析，并对其相关因素进行分析。 结果 男性的不良发生率高于女性，不良反应发生年龄多为中、老年患者，并且不良反应多发生在输液30 min内，多为Ⅰ型过敏反应。 结论 对丹参注射液应严格控制生产工艺流程，临床用药要掌握适应证，以避免不良反应的发生。【Abstract】 Objective To investigate the types and factors of adverse reactions caused by intravenous infusion of Danshen injection, in order to provide basis for clinical drug application. Methods We retrospectively analyzed the clinical records of 82 patients with adverse reaction to intravenous infusion of Danshen injection from January 2007 to December 2010. Results Adverse reaction incidence was higher in males than females, and it mainly occurred in patients of middle or old ages. Most of the adverse reactions happened within 30 minutes of the infusion. Type-I allergic reaction was more commonly observed. Conclusion In order to avoid the occurrence of adverse reactions, Danshen injection production process should be strictly controlled, and indications should be considered carefully in clinical medication.
Objective To introduce a simple preoperative risk score for esophageal cancer (PRSEC) and its relationship with the prognosis of patients who underwent resection of esophageal carcinoma. Methods We retrospectively analyzed the clinical data of 498 patients receiving resection of esophageal carcinoma between 2005 and 2015 in our hospital. They were divided into three groups (PRSEC1, PRSEC2 and PRSEC3 groups) according to the results of PRSEC (revised cardiac risk index, model for end-stage liver disease score and pulmonary function test). Their overall survival (OS) and disease-free survival (DFS) were measured to find the relationship between the PRSEC and prognosis of patients. Results The mortality, morbidity, DFS and OS were correlative with the PRSEC. Therefore the PRSEC can be used to predict the short-term outcome. The patients with score 2 or 3 had higher risk of mortality and morbidity than those with score 1. In addition, the DFS and OS of patients with higher score were shorter (P<0.001). Conclusion The PRSEC is easy and efficient and can predict the morbidity, mortality, and long-term outcomes for the patients with resection of esophageal carcinoma.
ObjectiveTo investigate the situation of off-label drug use in dose (OLDUD) of ambroxol hydrochloride injection (AHI) in perioperative period among patients for stanford type A aortic dissection in Guangdong General Hospital, so as to provide references for the rational application of AHI in clinical practice. MethodsAll medical orders of AHI for patients had aortic arch replacement for Stanford type A aortic dissection in Guangdong General Hospital between January 2005 and December 2014 were included. The patients were divided into a mild OLDUD ( < 450 mg) group, a moderate OLDUD (450 mg≤OLDUD < 900 mg) group, and a high OLDUD (≥900 mg)group. The preoperative and postoperative features, incidence of PPCs, mortality, incidence of reintubation, time of mechanical ventilation, time stay in ICU, time stay in hospital and the overall costs among three groups were compared by SPSS 22.0 software. Resultsa) A total of 549 patients were included. The incidence of OLDUD was 99.82%. The most common PMDDs were 450 mg (n=358) and 900 mg (n=88). b) The three groups were well matched for perioperative and operative variables. c) The incidence of preoperative drug use was 8.6%. The incidences (5.5% vs. 7.7% vs. 15.7%, P=0.022) and maximum doses (180 mg vs. 300 mg vs. 450 mg, P=0.014) of preoperative drug use were statistically different in mild OLDUD, moderate OLDUD and high OLDUD groups. The days of preoperative drug use were not different (3 d vs. 2.5 d vs. 2 d, P=0.307). The days of postoperative drug use (9.5 d vs. 13 d vs. 19 d, P < 0.001) and postoperative drug use in maximum doses (7 d vs. 8 d vs. 7 d, P=0.005) were different. d) The incidence of PPCs was 100%, and the mortality (8.2% vs. 6.6% vs. 9.0%, P=0.696) was not statistically different among mild OLDUD, moderate OLDUD and high OLDUD groups. However the incidence of reintubation (14.3% vs. 13.8% vs. 27%, P=0.009), time of mechanical ventilation (37 h vs. 50 h vs. 114 h, P < 0.001), time stay in ICU (138 h vs. 178.5 h vs. 316 h, P < 0.001), time stay in hospital (25 d vs. 27 d vs. 34 d, P=0.001) and the overall costs (¥ 0.17 million vs. ¥ 0.19 million vs. ¥ 0.25 million, P < 0.001) were different among three groups. Moreover, they were all increasing along with the dose of AHI. ConclusionAHI cannot improve the prognosis of patients having aortic arch replacement for Stanford Type A Aortic Dissection in a dose-dependent manner. Further well-designed prospective studies should be conducted to verification or falsification.