The Medical Administration and Hospital Administration of the National Health Commission released the "2021 China Chest Pain Center Quality Control Report" in January 2022. This report analyzes the construction ratio of chest pain centers in the second-level and above medical institutions nationwide in 2021 and the construction of standard and basic chest pain centers, mainly from the way of coming to the hospital, symptom onset to first medical contact time, door to wire time, reperfusion therapy ratio, in-hospital mortality, proportion of discharges with medication recommended by the guidelines and average length and cost of hospital stay of ST-segment elevation myocardial infarction patients to comprehensively describe the current status of the construction of the national chest pain centers. This article interprets the report in detail by reviewing relevant literature.
ObjectivesTo evaluate the improvement of symptoms in patients with moderate to severe asthma aged 5-18 years treated with GINA (Global Initiative for Asthma) guidelines by network meta-analysis. Methods Randomized controlled trials (RCTs) about asthma patients aged 5 to 18 years with reported asthma symptom scores were collected from PubMed, Embase, Cochrane Library, CNKI, WanFang Data, VIP, SinoMed and clinical trial registry platform (ClinicalTrials.gov). The search time limit was from the inception to August 26, 2023. After two researchers independently screened literature, extracted data and evaluated the risk of bias of included studies, Stata 15.0 software was used for network meta-analysis. ResultsA total of 23 studies were included, 23 of which reported daytime asthma symptom scores. Compared with symptom scores in the low-dose ICS group, there was a statistically significant difference in improvement of daytime symptoms between low-dose ICS+LABA+LTRA (SMD=−1.4, 95%CI −1.99 to −0.81) and low-dose ICS+LABA+SABA (SMD=−1.43, 95%CI −2.48 to −0.39). Symptom scores for nighttime asthma were reported in 20 RCTs, and there was a statistically significant difference in symptom scores for low-dose ICS+LABA+LTRA (SMD=−1.20, 95%CI −2.20 to −0.21) compared with the low-dose ICS group. After the ranking of efficacy, the number one asthma symptom score in both daytime and nighttime was low-dose ICS+LABA+LTRA group. ConclusionLow dose ICS+LABA+LTRA has the best efficacy in improving daytime and nighttime asthma symptom scores.
ObjectiveTo investigate the risk factors of axial symptoms after single door laminoplasty for cervical myelopathy. MethodsA retrospective analysis was made on the clinical data of 102 patients with cervical myelopathy who underwent single door laminoplasty and were accorded with selective standard between February 2009 and October 2011. There were 59 males and 43 females, aged 35 to 72 years (mean, 58 years). The disease duration was 1-70 months (mean, 18 months). The operated segments included C3-7 in 58 cases, C3-6 in 23 cases, C4-7 in 15 cases, and C3-5 in 6 cases. The visual analogue scale (VAS) was used to determine whether the patient had axial symptoms (group A) or not (group B). The logistic regression analysis was used to analyze the risk factors of postoperative axial symptoms by assessing the following indexes:preoperative VAS score, preoperative Japanese Orthopaedic Association (JOA) score, gender, age, disease duration, operated segment, operation time, intraoperative blood loss, wearing collar time, preoperative encroachment rate of anterior spinal canal, preoperative cervical curvature, and preoperative cervical range of motion. ResultsA total of 102 cases were followed up 18-26 months (mean, 24 months). And no postoperative spinal cord injury, cerebrospinal fluid leakage, or infection occurred. Of 102 cases, 50 had axial symptoms (group A) and 52 had no axial symptoms (group B). There were significant differences in age, wearing collar time, preoperative cervical range of motion, preoperative cervical curvature, and preoperative encroachment rate of anterior spinal canal between 2 groups (P<0.05), but no significant difference was found in preoperative JOA score and VAS score, blood loss, gender, disease duration, operated segment, and operation time (P>0.05). The logistic regression analysis showed that the increased preoperative encroachment rate of anterior spinal canal, reduced preoperative cervical curvature, and preoperative cervical range of motion loss were the risk factors for cervical axial symptoms. ConclusionAge, wearing collar time, preoperative cervical range of motion, preoperative encroachment rate of anterior spinal canal, and preoperative cervical curvature are relevant factors of axial symptoms; increased preoperative encroachment rate of anterior spinal canal, reduced preoperative cervical curvature, and preoperative cervical range of motion loss are risk factors for cervical axial symptoms.
Objective To investigate the optimal diagnosis and treatment strategy of occult carcinoma of the thyroid (OCT) with neck lymph node metastasis as the first symptom. Method In order to discuss the optimal diagnosis and treatment strategy of OCT with neck lymph node metastasis as the first symptom, we collected 35 cases and analyzed their characteristics, diagnostic methods, operative schemes, metastasis situation, and death situation. Results Of the 35 cases, 28 cases went to hospital because of swollen lymph nodes, and other 7 cases were discovered by color Doppler ultrasound in medical examination. Thyroid nodules were found by color Doppler ultrasound in 32 cases, 3 cases were found no thyroid nodule. Lymph node of 23 cases were determined by ultrasound-guided fine-needle aspiration biopsy (US-FNAB), and 16 cases (69.56%) were diagnosed as metastasis of thyroid carcinoma or suspicious metastasis by US-FNAB. Thyroid biopsy were done in 21 cases, and 11 cases (52.38%) were diagnosed as thyroid carcinoma or suspicious thyroid carcinoma by fine needle aspiration biopsy. Of the 35 cases, 19 cases were performed total thyroidectomy and functional neck lymph node dissection, 11 cases were performed resection of unilateral thyroid and isthmus and regional neck lymph node dissection, 5 cases were performed nonstandard operations. All cases were followed up for 3–10 years after operation, and the median time was 7-year. During follow up period, 10 cases suffered from reccurrence. Among them, 3 cases reoccurred in the nonstandard operation group, 5 cases reoccurred in resection of unilateral thyroid and isthmus and regional neck lymph node dissection group, 3 cases reoccurred in total thyroidectomy and functional neck lymph node dissection group. There were 3 cases died. Among them, there was 1 case in each group of nonstandard operation group, resection of unilateral thyroid and isthmus and regional neck lymph node dissection group, and total thyroidectomy and functional neck lymph node dissection group. The recurrence rate of total thyroidectomy and functional neck lymph node dissection group was markedly lower than those of resection of unilateral thyroid and isthmus and regional neck dissection group (χ2=4.751,P<0.05) and nonstandard operation group (χ2=5.874,P<0.05). While there was no significance difference of the recurrence rate between the resection of unilateral thyroid and isthmus and regional neck dissection group and nonstandard operation group (χ2=0.291,P>0.05). There was no significance difference in the mortality among the three groups (P>0.05). Conclusion US-FNAB and intraoperation rapid frozen pathological section are important methods for diagnosis of OCT with neck lymph node metastasis as the first symptom, and standard operation is an principal treatment method for it.
ObjectiveTo observe intervention effect of Shenlingcao oral liquid on asymptomatic chronic hepatitis B virus carriers (AsC). MethodsA self control before-after trial was conducted in the First Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine and the Ninth People's Hospital of Nanchang City from November 2011 to May 2012. A total of 64 AsCs were treated by Shenlingcao oral liquid (1 bottle/d, 200 mL, once daily for 6 months). Serum HBV viral load, six specific serum markers of HBV and 11 liver function index were tested and recorded before and at the 1th, 3th, 6th months of the treatment. Analysis of variance of repeated data was conducted. ResultsAfter one month of the treatment, 35/57 (61.40%) AsCs' serum HBV-DNA loads decreased, 1 log decrease was observed in 15 cases, 2 log decrease was observed in 4 cases, and decrease under the detection limit was observed in 12 cases. 41/57 (71.93%) AsCs' serum HBV-DNA loads decreased after 3 months of treatment, 1 log decrease was observed in 21 cases, 2 log decrease was observed in 5 cases, and decrease under the detection limit was observed in 15 cases. 31/49 (63.26%) AsCs' serum HBV-DNA loads decreased after 6 months of the treatment, 1 log decrease was observed in 19 cases, decrease more than 2 log was observed in 7 cases, and decrease under the detection limit was observed in 12 cases. The serum HBV viral loads at different time points of the treatment were significantly different (P<0.001). As medication time went, AsCs' serum HBV viral loads presented a decrease trend after taking Shenlingcao oral liquid, especially obvious at the 3th month. ConclusionShenlingcao oral liquid could help promote AsCs' ability of clearing virus and controlling serum HBVDNA loads.
ObjectiveTo introduce the hiatal hernia (HH) and to summarize the research development of relationship between HH and respiratory symptoms. MethodsLiteratures in recent years which about relationship between HH and respiratory symptoms at home and abroad were collected and reviewed. ResultsGastroesophageal reflux disease (GERD), which always be caused by laryngeal airway and other esophageal symptoms, was a common illness and easily be misdiagnosed. One common symptom of the GERD was the HH. For those patients with reflux-associated esophageal symptoms, many of them suffered from HH. The treatment results showed that the endoscopic surgery could relieve the reflux symptom and effectively control the respiratory symptoms. ConclusionsThe HH can increase the risk of respiratory symptoms; an active treatment on the HH can relieve the respiratory symptoms, which is caused by the reflux symptom.
Objective To evaluate the effectiveness of microplate fixation in open-door cervical expansive laminoplasty (ELP) by comparing with anchor fixation. Methods Between January 2005 and October 2008, 35 patients with multi-segment cervical spondylotic myelopathy were treated. Of them, 15 patients underwent ELP by microplate fixation (microplate group) and 20 patients underwent ELP by anchor fixation (anchor group). In microplate group, there were 10 malesand 5 females with the age of (51.2 ± 11.5) years; the disease duration ranged from 6 to 60 months (mean, 14 months); and the preoperative Japanese Orthopoaedic Association (JOA) score was 7.7 ± 2.5. In anchor group, there were 13 males and 7 females with the age of (50.7 ± 10.8) years; the disease duration ranged from 3 to 58 months (mean, 17 months); and the preoperative JOA score was 7.8 ± 2.9. There was no significant difference in the general data, such as gender, age, and JOA score between 2 groups (P gt; 0.05). Results All incisions healed by first intention. Thirty-five cases were followed up 24-68 months (mean, 32 months). The operation time was (113 ± 24) minutes in anchor group and (111 ± 27) minutes in microplate group, showing no significant difference (t=0.231 3, P=0.818 5). The rate of spinal canal expansion in microplate group (60% ± 24%) was significantly higher than that in anchor group (40% ± 18%) (t=2.820, P=0.008). The JOA scores of 2 groups at 3 months and 24 months after operation were significantly higher than the preoperative scores (P lt; 0.01). There was no significant difference in JOA score between 2 groups at 3 months after operation (t=1.620 5, P=0.114 6), but the JOA score of microplate group was significantly higher than that of anchor group at 24 months after operation (t=3.454 3, P=0.001 5). X-ray film, MRI, and CT scan at 3-6 months after operation displayed that door spindle reached bony fusion. There was no occurrence of ‘‘re-close of door’’ in 2 groups. The rate of compl ication in microplate group (13.3%, 2/15) was significantly lower than that in anchor group (25.0%, 5/20) (χ2=7.160 0, P=0.008 6). Conclusion ELP by microplate fixation can achieve the stabil ity quickly after operation, which can help patients to do functional exercises early, and has satisfactory effectiveness and less complications.
Objective The study was performed to compare the efficacy and effect on quality of life of sodium valproate (VPA) sustained-release tablets versus topiramate (TPM) in newly diagnosed adult symptomatic epilepsy. Methods This is aprospective, randomized controlled trial on 200 patients newly diagnosed as adult symptomatic epilepsy in Sichuan Province People’s Hospital druing September 2014 to December 2016. The patients were randomly divided into VPA group (n=110) and TPM group (n=90). Then we evaluated the efficacy, retention rate, adverse reactions, and quality of life of the two groups after one year of treatment. Results The total effective rate of VPA group was 69.1%, and the rate of no seizures was 38.2%; the total effective rate of TPM was 62.2%, and the rate of no seizures was 42.2%. No statistically significant difference in the effective rate and no seizure rate was found between the two groups. There was no statistical difference in the retention rate between the two groups(69.1% vs. 65.6%, P>0.05) . The incidence of adverse reactions of VPA was significantly lower than that of TPM (9.1%vs. 20%, P<0.05). The quality of life of the two groups was significantly improved from baseline before treatment. VPA group showed significantly better performance than TPM group on mood and cognitive improvement (P<0.05). Conclusion ① There was no significant difference in efficacy and retention rate between VPA sustained-release tablet and TPM on adult patients with symptomatic epilepsy after one year's treatment; ② The incidence of adverse reactions of TPM group was significantly higher than that of VPA group; ③ VPA sustained-release tablets and TPM can significantly improve the overall quality of life of patients, and VPA sustained-release tablets is significantly better than topiramate on the improvement of emotional and cognitive function.
ObjectiveTo summarize the research progress of black cohosh root extract in the treatment of menopausal symptoms for patients with breast cancer. MethodsDomestic and foreign literatures about the effect of black cohosh root extract in the treatment of menopausal symptoms for patients with breast cancer were collected to make a review. ResultsBlack cohosh root extract was a kind of herbal preparations. In the treatment of menopausal symptoms in breast cancer patients, it not only had significantly curative effect but also had less adverse reactions. ConclusionsIn the treatment of menopausal symptoms in breast cancer patients, black cohosh root extract gives people a new treatment idea. It has significant side effect and can be widely promoted and applied in clinical.
ObjectiveTo summarize basic research progress and current status of clinical diagnosis and therapy for gastroesophageal reflux disease. MethodRelated literatures were collected to review the pathogenesis, clinical manifestations, diagnosis and therapy of gastroesophageal reflux disease. ResultsGastroesophageal reflux disease was caused by many factors, such as hiatus hernia, hypotensive lower esophageal sphincter pressure, acid pocket, prolonged esophageal clearance, and delayed gastric emptying. Extra-esophageal symptoms was a common clinical presentation to gastroesophageal reflux disease. The diagnosis methods for gastroesophageal reflux disease included the symptom observation, gastroscopy examination, 24 h pH monitoring of esophageal, proton pump inhibitor test, questionnaire of gastroesophageal reflux disease and so on. The laparoscopic fundoplication could essentially treat the pathophysiologic abnormalities of gastroesophageal reflux disease, which had an obvious curative effect and wide application prospect. ConclusionPathogenesis, diagnosis, and therapy of gastroesophageal reflux disease are associated with multiple factors, which is still controversial and remains to be further studied.