Pub Date : 2019-12-20DOI: 10.3760/CMA.J.ISSN.1008-1372.2019.12.048
Jiaxun Guo
Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of adult lymphoma and is a group of invasive and heterogeneous diseases. Although rituximab in combination with CHOP regimen (R-CHOP) for DLBCL is better, one third of patients have relapsed/refractory conditions. DLBCL is divided into many subtypes due to its high heterogeneity. Different histological types have different response to treatment. High-risk DLBCL has little effect on R-CHOP treatment. How to further improve the first-line cure rate of high-risk DLBCL has become an important challenge in the field of lymphoma treatment. Currently in the era of precision medicine, in recent years, many new targeted drugs, such as immunosuppressive agents, mammalian target of rapamycin (mTOR) receptor inhibitors and Bruton tyrosine kinase (BTK) inhibitors, have been developed for DLBCL-related pathways and molecular targets, provide more new possibilities for the treatment of DLBCL. Key words: Lymphoma, large B-cell, diffuse; Targeted therapy; Review
{"title":"Progress in targeted therapy for high-risk diffuse large B cell lymphoma","authors":"Jiaxun Guo","doi":"10.3760/CMA.J.ISSN.1008-1372.2019.12.048","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1008-1372.2019.12.048","url":null,"abstract":"Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of adult lymphoma and is a group of invasive and heterogeneous diseases. Although rituximab in combination with CHOP regimen (R-CHOP) for DLBCL is better, one third of patients have relapsed/refractory conditions. DLBCL is divided into many subtypes due to its high heterogeneity. Different histological types have different response to treatment. High-risk DLBCL has little effect on R-CHOP treatment. How to further improve the first-line cure rate of high-risk DLBCL has become an important challenge in the field of lymphoma treatment. Currently in the era of precision medicine, in recent years, many new targeted drugs, such as immunosuppressive agents, mammalian target of rapamycin (mTOR) receptor inhibitors and Bruton tyrosine kinase (BTK) inhibitors, have been developed for DLBCL-related pathways and molecular targets, provide more new possibilities for the treatment of DLBCL. \u0000 \u0000 \u0000Key words: \u0000Lymphoma, large B-cell, diffuse; Targeted therapy; Review","PeriodicalId":15276,"journal":{"name":"中国医师杂志","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75835474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-20DOI: 10.3760/CMA.J.ISSN.1008-1372.2019.12.015
Fang Liu, L. Xue
Objective To explore the value of combined detection of serum cystatin C (CysC), urinary β2-microglobulin (β2-MG), and liver type fatty acid binding protein (L-FABP) in early diagnosis of acute renal injury after cardiac surgery. Methods 126 patients undergoing cardiac surgery in our hospital from April 2015 to August 2016 were selected as the subjects, according to the occurrence of acute renal injury after operation, 48 cases were divided into acute renal injury (AKI) group and 78 cases into non-acute renal injury (non AKI) group, the levels of serum CysC, urine β2-MG, and L-FABP were detected in the two groups. Receiver operating characteristic (ROC) curve was used to analyze the effects of serum CysC, urine β2-MG, L-FABP in the early diagnosis of acute renal injury after cardiac surgery. Results The incidence of AKI after cardiac surgery was 38.10% (48/126); the serum CysC level in group AKI was significantly higher than that in non AKI group (P<0.05); the levels of urine β2-MG and L-FABP were significantly higher than those in non AKI group (P<0.05); the area under curve (AUC) of serum CysC for AKI diagnosis after cardiac surgery was 0.874 (P<0.05), with diagnostic sensitivity 85.7%, and specificity 76.5%; the AUC area of urinary β2-MG for AKI diagnosis after cardiac surgery was 0.754 (P<0.05), with diagnostic sensitivity 92.9%, and specificity 73.5%, respectively; the AUC area of urinary L-FABP for AKI diagnosis after cardiac surgery was 0.834 (P<0.05), with diagnostic sensitivity 92.9%, and specificity 74.1%. The AUC area of combined diagnosis of the three was 0.914 (P<0.05), with the diagnostic sensitivity 92.1%, and specificity 82.4%. Conclusions Serum Cys C, urine β 2-MG and L-FABP levels were significantly increased in patients with AKI. The diagnosis of the three alone has a certain reference value, which is lower than the combined diagnosis. The combined diagnosis of the three can provide an important reference for screening acute renal injury after heart surgery. Key words: Cardiac surgical procedures; Postoperative complications; Acute kidney injury; Cystatin C; beta 2-microglobulin; Liver type fatty acid-binding protein
{"title":"The value of combined detection of serum CysC, urinary β2-MG, and L-FABP in early diagnosis of acute renal injury after cardiac surgery","authors":"Fang Liu, L. Xue","doi":"10.3760/CMA.J.ISSN.1008-1372.2019.12.015","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1008-1372.2019.12.015","url":null,"abstract":"Objective \u0000To explore the value of combined detection of serum cystatin C (CysC), urinary β2-microglobulin (β2-MG), and liver type fatty acid binding protein (L-FABP) in early diagnosis of acute renal injury after cardiac surgery. \u0000 \u0000 \u0000Methods \u0000126 patients undergoing cardiac surgery in our hospital from April 2015 to August 2016 were selected as the subjects, according to the occurrence of acute renal injury after operation, 48 cases were divided into acute renal injury (AKI) group and 78 cases into non-acute renal injury (non AKI) group, the levels of serum CysC, urine β2-MG, and L-FABP were detected in the two groups. Receiver operating characteristic (ROC) curve was used to analyze the effects of serum CysC, urine β2-MG, L-FABP in the early diagnosis of acute renal injury after cardiac surgery. \u0000 \u0000 \u0000Results \u0000The incidence of AKI after cardiac surgery was 38.10% (48/126); the serum CysC level in group AKI was significantly higher than that in non AKI group (P<0.05); the levels of urine β2-MG and L-FABP were significantly higher than those in non AKI group (P<0.05); the area under curve (AUC) of serum CysC for AKI diagnosis after cardiac surgery was 0.874 (P<0.05), with diagnostic sensitivity 85.7%, and specificity 76.5%; the AUC area of urinary β2-MG for AKI diagnosis after cardiac surgery was 0.754 (P<0.05), with diagnostic sensitivity 92.9%, and specificity 73.5%, respectively; the AUC area of urinary L-FABP for AKI diagnosis after cardiac surgery was 0.834 (P<0.05), with diagnostic sensitivity 92.9%, and specificity 74.1%. The AUC area of combined diagnosis of the three was 0.914 (P<0.05), with the diagnostic sensitivity 92.1%, and specificity 82.4%. \u0000 \u0000 \u0000Conclusions \u0000Serum Cys C, urine β 2-MG and L-FABP levels were significantly increased in patients with AKI. The diagnosis of the three alone has a certain reference value, which is lower than the combined diagnosis. The combined diagnosis of the three can provide an important reference for screening acute renal injury after heart surgery. \u0000 \u0000 \u0000Key words: \u0000Cardiac surgical procedures; Postoperative complications; Acute kidney injury; Cystatin C; beta 2-microglobulin; Liver type fatty acid-binding protein","PeriodicalId":15276,"journal":{"name":"中国医师杂志","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77093527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-20DOI: 10.3760/CMA.J.ISSN.1008-1372.2019.12.010
Qiang Zhou, P. Lin, L. Chi, Jing Lin, W. Chi
Objective To explore the clinical benefits and risks of intravenous thrombolysis combined with urinary kallidinogenase in the treatment of minor stroke. Methods The clinical data of 86 patients with minor stroke were retrospectively analyzed. Patients who received intravenous thrombolysis combined with urinary kallidinogenase were included in observation group (n=48), and those who received intravenous thrombolysis alone were included in control group (n=38). Before treatment and after 2 weeks of treatment, the imaging blood flow perfusion parameters [cerebral blood flow (CBF), mean transit time (MTT), time to peak (TTP)], and breath holding test indexes [cerebral vascular reactivity (CVR), breath holding index (BHI)] and serum biochemical indicators [vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF)] were compared between the two groups. The occurrence of adverse drug reactions during course of treatment and rehabilitation effects at 3 months after treatment [US National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS)] were analyzed in the two groups. Results After 2 weeks of treatment, the CBF, CVR, BHI and serum levels of VEGF and bFGF in the two groups were significantly higher than those before treatment, and the indexes in observation group were significantly higher than those in control group (P 0.05). At 3 months after treatment, there was no statistically significant difference in the effective rate of rehabilitation between the two groups (P>0.05), but the Mann-Whitney U rank sum test between-groups showed that the overall rehabilitation effects in observation group were significantly better than those in control group (P<0.05). Conclusions Intravenous thrombolysis has certain treatment effects in patients with minor stroke, and its safety is within the clinical controllable range. Combined with urinary kallidinogenase can obtain ideal long-term prognosis, and it is beneficial to the recovery of neurological function. Key words: Stroke; Thrombolytic therapy; Urinary kallidinogenase; Prognosis
{"title":"Benefits and risks of intravenous thrombolysis in minor stroke and effects of combined urinary kallidinogenase on long-term prognosis of stroke","authors":"Qiang Zhou, P. Lin, L. Chi, Jing Lin, W. Chi","doi":"10.3760/CMA.J.ISSN.1008-1372.2019.12.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1008-1372.2019.12.010","url":null,"abstract":"Objective \u0000To explore the clinical benefits and risks of intravenous thrombolysis combined with urinary kallidinogenase in the treatment of minor stroke. \u0000 \u0000 \u0000Methods \u0000The clinical data of 86 patients with minor stroke were retrospectively analyzed. Patients who received intravenous thrombolysis combined with urinary kallidinogenase were included in observation group (n=48), and those who received intravenous thrombolysis alone were included in control group (n=38). Before treatment and after 2 weeks of treatment, the imaging blood flow perfusion parameters [cerebral blood flow (CBF), mean transit time (MTT), time to peak (TTP)], and breath holding test indexes [cerebral vascular reactivity (CVR), breath holding index (BHI)] and serum biochemical indicators [vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF)] were compared between the two groups. The occurrence of adverse drug reactions during course of treatment and rehabilitation effects at 3 months after treatment [US National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS)] were analyzed in the two groups. \u0000 \u0000 \u0000Results \u0000After 2 weeks of treatment, the CBF, CVR, BHI and serum levels of VEGF and bFGF in the two groups were significantly higher than those before treatment, and the indexes in observation group were significantly higher than those in control group (P 0.05). At 3 months after treatment, there was no statistically significant difference in the effective rate of rehabilitation between the two groups (P>0.05), but the Mann-Whitney U rank sum test between-groups showed that the overall rehabilitation effects in observation group were significantly better than those in control group (P<0.05). \u0000 \u0000 \u0000Conclusions \u0000Intravenous thrombolysis has certain treatment effects in patients with minor stroke, and its safety is within the clinical controllable range. Combined with urinary kallidinogenase can obtain ideal long-term prognosis, and it is beneficial to the recovery of neurological function. \u0000 \u0000 \u0000Key words: \u0000Stroke; Thrombolytic therapy; Urinary kallidinogenase; Prognosis","PeriodicalId":15276,"journal":{"name":"中国医师杂志","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79494765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-20DOI: 10.3760/CMA.J.ISSN.1008-1372.2019.12.017
Ye Wang, Junling Li, Shan Ji, Wei Wang, Yan Li
Objective To investigate the effect of inflammatory stimulation on the biological function of human umbilical cord mesenchymal stem cells (MSCs) and its mechanism. Methods Under sterile condition, 40-60 ml cord blood of normal full-term caesarean section was taken, and the cells were separated by Ficoll Hypaque gradient centrifugation. After 24 hours of conventional culture, the cells were divided into 4 groups: C group (control group), LPSL group, LPSM group and LPSH group. Group C was added with complete culture medium. Group LPSL, group LPSM and group LPSH were added with equal amount of culture medium containing 12.5, 25, 50 μg/ml lipopolysaccharides (LPS) respectively. The effects of different concentrations of LPS on the proliferation and osteogenic differentiation of mesenchymal stem cells were observed. Results After incubation for 24 and 48 hours, the proliferation activity of MSCs in LPSL, LPSM and LPSH groups was higher than that in group C (P<0.05), and the proliferation ability of MSCs induced by low dose LPS for 48 h was the strongest (P<0.05). With the increase of culture time, the expression of nuclear factor kappa B (NF-κB) and Toll-like receptor 4 (TLR4) protein in the four groups increased gradually. The expression of NF-κB and TLR4 protein in the LPSL, LPSM and LPSH groups were higher than that in the control group (P<0.05). With the increase of LPS concentration, the expression of NF-κB and TLR4 protein increased gradually, with statistically significant difference (P<0.05). Alkaline phosphatase (ALP) activity and calcium nodule number in LPSL, LPSM and LPSH group were higher than those in group C; ALP activity and calcium nodule number in LPSM group were higher than those in LPSH group; ALP activity and calcium nodule number in LPSL group were higher than those in LPSM and LPSH, group with statistically significant difference (P<0.05). Conclusions Inflammatory response can stimulate the proliferation and osteogenic differentiation of human umbilical cord mesenchymal stem cells. Low concentration of LPS may be an ideal factor for the osteogenic differentiation of umbilical cord mesenchymal stem cells. It has certain significance and application prospect in the actual clinical disease treatment, but the detailed mechanism of action and whether the effect of lower dose is better still to be further studied. Key words: Lipopolysaccharides; Umbilical cord; Mesenchymal stromal cells; Cell proliferation; In vitro
{"title":"Effect of inflammatory stimulation on biological function of human umbilical cord mesenchymal stem cells and its mechanism","authors":"Ye Wang, Junling Li, Shan Ji, Wei Wang, Yan Li","doi":"10.3760/CMA.J.ISSN.1008-1372.2019.12.017","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1008-1372.2019.12.017","url":null,"abstract":"Objective \u0000To investigate the effect of inflammatory stimulation on the biological function of human umbilical cord mesenchymal stem cells (MSCs) and its mechanism. \u0000 \u0000 \u0000Methods \u0000Under sterile condition, 40-60 ml cord blood of normal full-term caesarean section was taken, and the cells were separated by Ficoll Hypaque gradient centrifugation. After 24 hours of conventional culture, the cells were divided into 4 groups: C group (control group), LPSL group, LPSM group and LPSH group. Group C was added with complete culture medium. Group LPSL, group LPSM and group LPSH were added with equal amount of culture medium containing 12.5, 25, 50 μg/ml lipopolysaccharides (LPS) respectively. The effects of different concentrations of LPS on the proliferation and osteogenic differentiation of mesenchymal stem cells were observed. \u0000 \u0000 \u0000Results \u0000After incubation for 24 and 48 hours, the proliferation activity of MSCs in LPSL, LPSM and LPSH groups was higher than that in group C (P<0.05), and the proliferation ability of MSCs induced by low dose LPS for 48 h was the strongest (P<0.05). With the increase of culture time, the expression of nuclear factor kappa B (NF-κB) and Toll-like receptor 4 (TLR4) protein in the four groups increased gradually. The expression of NF-κB and TLR4 protein in the LPSL, LPSM and LPSH groups were higher than that in the control group (P<0.05). With the increase of LPS concentration, the expression of NF-κB and TLR4 protein increased gradually, with statistically significant difference (P<0.05). Alkaline phosphatase (ALP) activity and calcium nodule number in LPSL, LPSM and LPSH group were higher than those in group C; ALP activity and calcium nodule number in LPSM group were higher than those in LPSH group; ALP activity and calcium nodule number in LPSL group were higher than those in LPSM and LPSH, group with statistically significant difference (P<0.05). \u0000 \u0000 \u0000Conclusions \u0000Inflammatory response can stimulate the proliferation and osteogenic differentiation of human umbilical cord mesenchymal stem cells. Low concentration of LPS may be an ideal factor for the osteogenic differentiation of umbilical cord mesenchymal stem cells. It has certain significance and application prospect in the actual clinical disease treatment, but the detailed mechanism of action and whether the effect of lower dose is better still to be further studied. \u0000 \u0000 \u0000Key words: \u0000Lipopolysaccharides; Umbilical cord; Mesenchymal stromal cells; Cell proliferation; In vitro","PeriodicalId":15276,"journal":{"name":"中国医师杂志","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81711166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-20DOI: 10.3760/CMA.J.ISSN.1008-1372.2019.12.007
P. Zhou, Yaqian Wang, Bingqing Li, Xiaowei Chen, Yi Jin, Zhanlin Guo
Objective To study the effect of different doses of low molecular weight heparin on coagulation mechanism after thoracic surgery. Methods A prospective randomized controlled study was conducted to select patients who underwent thoracic cancer surgery (lung cancer, esophageal cancer, cardiac cancer) from February 2015 to October 2018. According to the Caprini risk assessment model, 101 patients with high risk of deep venous thrombosis were randomly assigned to groups A, B and C. Control group A (34 cases) did not use low molecular weight heparin; group B (34 cases) used prophylactic low molecular weight heparin calcium after operation; group C (33 cases) used therapeutic low molecular weight heparin calcium after operation. The platelet count (PLT), fibrinogen (FIB), prothrombin time (PT), D-dimer (D-D), postoperative thoracic drainage and lower extremity deep vein ultrasound were observed before and after operation. Results The incidence of deep venous thrombosis (DVT) was 11.76% in group A, 2.94% in group B and 3.03% in group C, with significant difference between group B and C and group A (P 0.05). The levels of FIB and D-D after operation were significantly higher than those before operation (P<0.05), but the levels of indexes in group B and C were significantly lower than those in group A (P<0.05). Conclusions Low molecular weight heparin calcium does not increase bleeding and thoracic drainage, which is beneficial to improve the hypercoagulable state of patients and has good safety. However, the use of low molecular weight heparin calcium in different doses (prevention amount and treatment amount) has no significant effect on the occurrence of lower extremity deep vein thrombosis and coagulation index. Key words: Thoracic neoplasms; Thoracic surgical procedures; Heparin, low-molecular-weight; Blood coagulation tests
{"title":"Effect of different doses of low molecular weight heparin on coagulation mechanism in thoracic cancer surgery","authors":"P. Zhou, Yaqian Wang, Bingqing Li, Xiaowei Chen, Yi Jin, Zhanlin Guo","doi":"10.3760/CMA.J.ISSN.1008-1372.2019.12.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1008-1372.2019.12.007","url":null,"abstract":"Objective \u0000To study the effect of different doses of low molecular weight heparin on coagulation mechanism after thoracic surgery. \u0000 \u0000 \u0000Methods \u0000A prospective randomized controlled study was conducted to select patients who underwent thoracic cancer surgery (lung cancer, esophageal cancer, cardiac cancer) from February 2015 to October 2018. According to the Caprini risk assessment model, 101 patients with high risk of deep venous thrombosis were randomly assigned to groups A, B and C. Control group A (34 cases) did not use low molecular weight heparin; group B (34 cases) used prophylactic low molecular weight heparin calcium after operation; group C (33 cases) used therapeutic low molecular weight heparin calcium after operation. The platelet count (PLT), fibrinogen (FIB), prothrombin time (PT), D-dimer (D-D), postoperative thoracic drainage and lower extremity deep vein ultrasound were observed before and after operation. \u0000 \u0000 \u0000Results \u0000The incidence of deep venous thrombosis (DVT) was 11.76% in group A, 2.94% in group B and 3.03% in group C, with significant difference between group B and C and group A (P 0.05). The levels of FIB and D-D after operation were significantly higher than those before operation (P<0.05), but the levels of indexes in group B and C were significantly lower than those in group A (P<0.05). \u0000 \u0000 \u0000Conclusions \u0000Low molecular weight heparin calcium does not increase bleeding and thoracic drainage, which is beneficial to improve the hypercoagulable state of patients and has good safety. However, the use of low molecular weight heparin calcium in different doses (prevention amount and treatment amount) has no significant effect on the occurrence of lower extremity deep vein thrombosis and coagulation index. \u0000 \u0000 \u0000Key words: \u0000Thoracic neoplasms; Thoracic surgical procedures; Heparin, low-molecular-weight; Blood coagulation tests","PeriodicalId":15276,"journal":{"name":"中国医师杂志","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88616034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-20DOI: 10.3760/CMA.J.ISSN.1008-1372.2019.12.003
B. Yan, Yongquan Gu, Ziqiang Sun, Chunmei Wang, Chengchao Zhang
Objective To study the effect of warfarin individualized drug regimen based on gene detection on anticoagulation in patients with acute deep vein thrombosis (DVT). Methods From January 2016 to June 2017, 62 patients with DVT diagnosed for the first time in vascular surgery of the Affiliated Hospital of Jining Medical College were analyzed retrospectively, including 33 in the individualized group and 29 in the experience group. All patients were diagnosed by Color Doppler Ultrasound (CDUS). Gender, age, the results of the initial international standardized ratio (INR) measurement, the time from the first dose to the INR standard, and whether the INR exceeds the standard in the process of increasing the dose were collected. Results There was no significant difference in sex, age and initial INR between the two groups (P>0.05). The time of reaching the standard in the individualized group was significantly lower than that in the experience group [(13.8±6.8)d vs (17.6±7.5)d, P<0.05]; There was no significant difference in INR between the two groups (P=0.377). Conclusions For the patients with DVT for the first time, the individualized drug regimen of warfarin based on the guidance of gene detection can shorten the time of reaching the standard without increasing the risk of bleeding. Key words: Warfarin; Genetic testing; Lower extremity deep vein thrombosis; International normalized ratio
{"title":"Warfarin individualized medication in the treatment of first acute deep venous thrombosis of lower extremity","authors":"B. Yan, Yongquan Gu, Ziqiang Sun, Chunmei Wang, Chengchao Zhang","doi":"10.3760/CMA.J.ISSN.1008-1372.2019.12.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1008-1372.2019.12.003","url":null,"abstract":"Objective \u0000To study the effect of warfarin individualized drug regimen based on gene detection on anticoagulation in patients with acute deep vein thrombosis (DVT). \u0000 \u0000 \u0000Methods \u0000From January 2016 to June 2017, 62 patients with DVT diagnosed for the first time in vascular surgery of the Affiliated Hospital of Jining Medical College were analyzed retrospectively, including 33 in the individualized group and 29 in the experience group. All patients were diagnosed by Color Doppler Ultrasound (CDUS). Gender, age, the results of the initial international standardized ratio (INR) measurement, the time from the first dose to the INR standard, and whether the INR exceeds the standard in the process of increasing the dose were collected. \u0000 \u0000 \u0000Results \u0000There was no significant difference in sex, age and initial INR between the two groups (P>0.05). The time of reaching the standard in the individualized group was significantly lower than that in the experience group [(13.8±6.8)d vs (17.6±7.5)d, P<0.05]; There was no significant difference in INR between the two groups (P=0.377). \u0000 \u0000 \u0000Conclusions \u0000For the patients with DVT for the first time, the individualized drug regimen of warfarin based on the guidance of gene detection can shorten the time of reaching the standard without increasing the risk of bleeding. \u0000 \u0000 \u0000Key words: \u0000Warfarin; Genetic testing; Lower extremity deep vein thrombosis; International normalized ratio","PeriodicalId":15276,"journal":{"name":"中国医师杂志","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80959398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-20DOI: 10.3760/CMA.J.ISSN.1008-1372.2019.12.004
Z. Tong, Yongquan Gu, Lianrui Guo, Yang Li, Liqiang Li, Fei Wang, Jian Zhang
Re-use of contrast agent during endovascular treatment in patients with contrast agent allergy may lead to severe allergic reaction. For patients with localized stenosis of external iliac artery, endovascular therapy (stenting) is the first choice. Whether patients with severe iliac artery stenosis with contrast allergy can be treated with endovascular therapy is unknowed. A case of iliac artery stenting without contrast agent is reported in this paper. The successful implementation of this operation requires adequate preoperative and intraoperative preparation, and the accurate determination of the stenosis site and the presence or absence of residual stenosis during the operation. Key words: Angioplasty; Contrast media; Self expandable metallic stents; Iliac artery stenosis
{"title":"A case of severe iliac artery stenosis treated by stenting without contrast agent","authors":"Z. Tong, Yongquan Gu, Lianrui Guo, Yang Li, Liqiang Li, Fei Wang, Jian Zhang","doi":"10.3760/CMA.J.ISSN.1008-1372.2019.12.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1008-1372.2019.12.004","url":null,"abstract":"Re-use of contrast agent during endovascular treatment in patients with contrast agent allergy may lead to severe allergic reaction. For patients with localized stenosis of external iliac artery, endovascular therapy (stenting) is the first choice. Whether patients with severe iliac artery stenosis with contrast allergy can be treated with endovascular therapy is unknowed. A case of iliac artery stenting without contrast agent is reported in this paper. The successful implementation of this operation requires adequate preoperative and intraoperative preparation, and the accurate determination of the stenosis site and the presence or absence of residual stenosis during the operation. \u0000 \u0000 \u0000Key words: \u0000Angioplasty; Contrast media; Self expandable metallic stents; Iliac artery stenosis","PeriodicalId":15276,"journal":{"name":"中国医师杂志","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89537140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-20DOI: 10.3760/CMA.J.ISSN.1008-1372.2019.12.020
Yanlin Su, Liping Xu
Objective To analyze the risk factors of multidrug-resistant bacteria (MDRO) infection in patients in Neurosurgical intensive care unit (NSICU), and to provide reference for clinical prevention and treatment. Methods 1 251 patients with NSICU in our hospital from January 2012 to March 2018 were selected as the study subjects. The bacterial specimens were extracted. 380 patients with MDRO infection were the observation group, and 871 patients with non-MDRO infection in NSICU were the control group. The patients' medical records and clinical information were retrospectively analyzed, and multivariate logistic regression analysis was used to analyze the risk factors of MDRO infection in NSICU patients. Results There was no significant difference in the gender, age and body mass index (BMI) between the observation group and the control group (P>0.05). There was statistical significance in the proportion of hospitalization time, operation, use of urethra tube, mechanical ventilation, serious basic diseases and rational use of antibiotics between the observation group and the control group (P<0.05). According to the analysis on proportion of colony samples, the highest proportion in the observation group was sputum samples, accounted for 45.00%, followed by urine samples (21.58%), and the lowest proportion was other types of samples, accounted for 1.84%. The results of MDRO test showed that the highest proportion of pathogens was methicillin-resistant staphylococcus aureus (MRSA), accounted for 33.69%, followed by pseudomonas aeruginosa (PA), carbapenem-resistant acinetobacter baumannii (CR-AB), and the lowest proportion was stenotrophomonas maltophilia (SM), accounted for 1.58%. Logistic regression analysis showed that surgery, catheterization, mechanical ventilation, serious basic diseases and abuse of antibiotics were risk factors for MDRO infection in NSICU patients (P<0.05). Conclusions Invasive manipulation and antimicrobial abuse are the main risk factors for MDRO infection in NSICU patients, among which respiratory tract infection is the most serious and MRSA strain infection is the most common. The management of drugs and therapeutic devices should be scientific, rational and standardized in order to reduce the infection rate of MDRO. Key words: Intensive care units; Neurosurgery; Drug resistance, multiple, bacterial; Factor analysis, statistical
{"title":"Analysis on risk factors for multidrug-resistant bacterial infections in patients in neurosurgical intensive care unit","authors":"Yanlin Su, Liping Xu","doi":"10.3760/CMA.J.ISSN.1008-1372.2019.12.020","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1008-1372.2019.12.020","url":null,"abstract":"Objective \u0000To analyze the risk factors of multidrug-resistant bacteria (MDRO) infection in patients in Neurosurgical intensive care unit (NSICU), and to provide reference for clinical prevention and treatment. \u0000 \u0000 \u0000Methods \u00001 251 patients with NSICU in our hospital from January 2012 to March 2018 were selected as the study subjects. The bacterial specimens were extracted. 380 patients with MDRO infection were the observation group, and 871 patients with non-MDRO infection in NSICU were the control group. The patients' medical records and clinical information were retrospectively analyzed, and multivariate logistic regression analysis was used to analyze the risk factors of MDRO infection in NSICU patients. \u0000 \u0000 \u0000Results \u0000There was no significant difference in the gender, age and body mass index (BMI) between the observation group and the control group (P>0.05). There was statistical significance in the proportion of hospitalization time, operation, use of urethra tube, mechanical ventilation, serious basic diseases and rational use of antibiotics between the observation group and the control group (P<0.05). According to the analysis on proportion of colony samples, the highest proportion in the observation group was sputum samples, accounted for 45.00%, followed by urine samples (21.58%), and the lowest proportion was other types of samples, accounted for 1.84%. The results of MDRO test showed that the highest proportion of pathogens was methicillin-resistant staphylococcus aureus (MRSA), accounted for 33.69%, followed by pseudomonas aeruginosa (PA), carbapenem-resistant acinetobacter baumannii (CR-AB), and the lowest proportion was stenotrophomonas maltophilia (SM), accounted for 1.58%. Logistic regression analysis showed that surgery, catheterization, mechanical ventilation, serious basic diseases and abuse of antibiotics were risk factors for MDRO infection in NSICU patients (P<0.05). \u0000 \u0000 \u0000Conclusions \u0000Invasive manipulation and antimicrobial abuse are the main risk factors for MDRO infection in NSICU patients, among which respiratory tract infection is the most serious and MRSA strain infection is the most common. The management of drugs and therapeutic devices should be scientific, rational and standardized in order to reduce the infection rate of MDRO. \u0000 \u0000 \u0000Key words: \u0000Intensive care units; Neurosurgery; Drug resistance, multiple, bacterial; Factor analysis, statistical","PeriodicalId":15276,"journal":{"name":"中国医师杂志","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74982264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-20DOI: 10.3760/CMA.J.ISSN.1008-1372.2019.12.046
Yanhu Liang, Long Yuan, Xuesong Li, Chunyang Meng
Lumbar disc herniation (LDH) is one of the most common degenerative spinal diseases in adults and less common in adolescents. The age of onset is less than 21 years old and is defined as adolescent lumbar disc herniation (ALDH). The incidence of ALDH is only 1%-5%. However, with the accelerated pace of life, the incidence of ALDH is increasing. In recent years, the rapid development of endoscopic technology has been widely used in spinal surgery. ALDH's percutaneous endoscopic technique has achieved good results. Compared with open surgery, percutaneous endoscopic treatment can preserve more normal lumbar structures, such as ligaments, muscles, lamina and facets, minimizing the impact on pubertal growth. This article reviews the characteristics of ALDH and endoscopic treatment as an entry point. Key words: Diskectomy, percutaneous; Endoscopy; Adolescent; Review
{"title":"Recent research on percutaneous endoscopic treatment of lumbar disc herniation in adolescents","authors":"Yanhu Liang, Long Yuan, Xuesong Li, Chunyang Meng","doi":"10.3760/CMA.J.ISSN.1008-1372.2019.12.046","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1008-1372.2019.12.046","url":null,"abstract":"Lumbar disc herniation (LDH) is one of the most common degenerative spinal diseases in adults and less common in adolescents. The age of onset is less than 21 years old and is defined as adolescent lumbar disc herniation (ALDH). The incidence of ALDH is only 1%-5%. However, with the accelerated pace of life, the incidence of ALDH is increasing. In recent years, the rapid development of endoscopic technology has been widely used in spinal surgery. ALDH's percutaneous endoscopic technique has achieved good results. Compared with open surgery, percutaneous endoscopic treatment can preserve more normal lumbar structures, such as ligaments, muscles, lamina and facets, minimizing the impact on pubertal growth. This article reviews the characteristics of ALDH and endoscopic treatment as an entry point. \u0000 \u0000 \u0000Key words: \u0000Diskectomy, percutaneous; Endoscopy; Adolescent; Review","PeriodicalId":15276,"journal":{"name":"中国医师杂志","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75427603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-20DOI: 10.3760/CMA.J.ISSN.1008-1372.2019.12.006
Zhihui Wang, Xiaokun Geng
Objective To explore the long-term effect of neuroendoscopy followed by radiotherapy on cystic craniopharyngiomas. Methods Cystic craniopharyngiomas in 9 patients were treated with neuroendoscopic cyst aspiration and fenestration, followed by fractionated stereotactic radiotherapy (FSRT). The neuroendoscopic procedure focused on widening of cyst fenestration and extensive irrigation of the cyst contents. The collimator of FSRT ranged from 2.5 cm to 3.0 cm, and the target volume 1.1-43.8 cm3, dose per fraction 1.8 Gy, total dose 50.4 Gy. Results The median follow-up period was 72.9 months. Tumor control was achieved in 8 of 9 patients. Marked tumor volume reduction was obtained with the neuroendoscopic procedure alone at 6 months, 1 year, and 2 years. One recurrent case showed multilobulated cysts, and a second surgery was required 1 year after the treatment. Clinical symptoms such as headache and visual disruption were rapidly alleviated after the neuroendoscopic procedure. No new visual disturbances, endocrinopathy, or hypothalamic dysfunction was observed during follow up. Conclusions Stereotactic radiotherapy for cystic craniopharyngioma after endoscopic fenestration can effectively control the tumor for a long period of time, improve the clinical symptoms and avoid endocrine diseases. Key words: Craniopharyngioma; Neuroendoscopy; Stereotaxic techniques; Radiotherapy
{"title":"Long-term effect of neuroendoscopy followed by radiotherapy on cystic craniopharyngiomas","authors":"Zhihui Wang, Xiaokun Geng","doi":"10.3760/CMA.J.ISSN.1008-1372.2019.12.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1008-1372.2019.12.006","url":null,"abstract":"Objective \u0000To explore the long-term effect of neuroendoscopy followed by radiotherapy on cystic craniopharyngiomas. \u0000 \u0000 \u0000Methods \u0000Cystic craniopharyngiomas in 9 patients were treated with neuroendoscopic cyst aspiration and fenestration, followed by fractionated stereotactic radiotherapy (FSRT). The neuroendoscopic procedure focused on widening of cyst fenestration and extensive irrigation of the cyst contents. The collimator of FSRT ranged from 2.5 cm to 3.0 cm, and the target volume 1.1-43.8 cm3, dose per fraction 1.8 Gy, total dose 50.4 Gy. \u0000 \u0000 \u0000Results \u0000The median follow-up period was 72.9 months. Tumor control was achieved in 8 of 9 patients. Marked tumor volume reduction was obtained with the neuroendoscopic procedure alone at 6 months, 1 year, and 2 years. One recurrent case showed multilobulated cysts, and a second surgery was required 1 year after the treatment. Clinical symptoms such as headache and visual disruption were rapidly alleviated after the neuroendoscopic procedure. No new visual disturbances, endocrinopathy, or hypothalamic dysfunction was observed during follow up. \u0000 \u0000 \u0000Conclusions \u0000Stereotactic radiotherapy for cystic craniopharyngioma after endoscopic fenestration can effectively control the tumor for a long period of time, improve the clinical symptoms and avoid endocrine diseases. \u0000 \u0000 \u0000Key words: \u0000Craniopharyngioma; Neuroendoscopy; Stereotaxic techniques; Radiotherapy","PeriodicalId":15276,"journal":{"name":"中国医师杂志","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90312925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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