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[Positive rates and distribution characteristics of pre-existing anti-human-leukocyte-antigen antibodies in patients with different hematological diseases]. [不同血液病患者体内原有抗人白细胞抗原抗体的阳性率和分布特征]。
Q3 Medicine Pub Date : 2024-09-10 DOI: 10.3760/cma.j.cn112137-20240121-00150
K Ji, L Y Chen, L Wang, X J Wu, X J Bao, X N Yuan, J He

Clinical data of 1 494 patients with hematological diseases who were scheduled to receive allogeneic hematopoietic stem cell transplantation and received the anti-human-leukocyte-antigen (HLA) antibody test for the first time at the First Affiliated Hospital of Soochow University from 2016 to 2018 was collected to analyze the positive rates and distribution characteristics of different types of pre-existing anti-HLA antibodies in patients with different hematological diseases. Among 1 494 patients with hematological diseases, there were 849 males and 645 females, aged [31 (17, 45)] years, and included 577 cases of acute myeloid leukemia (AML), 373 cases of acute lymphocytic leukemia (ALL), 234 cases of aplastic anemia (AA), 175 cases of myelodysplastic syndrome (MDS), and 135 cases of other diseases. The total positive rate of pre-existing anti-HLA antibodies was 25.1% (375/1 494), among which the positive rates of anti-HLA class Ⅰ, anti-HLA class Ⅱ, and anti-HLA class Ⅰ+Ⅱ antibodies were 11.2% (168/1 494), 4.9% (73/1 494), and 9.0% (134/1 494), respectively.The total positive rates of pre-existing anti-HLA antibodies in patients with MDS、AA、AML、ALL and other diseases were 40.6% (71/175), 30.8% (72/234), 26.2% (151/577), 12.3% (46/373), and 25.9% (35/135), respectively, with statistically significant difference (P<0.001). The positive rates of anti-HLA class Ⅰ, anti-HLA class Ⅱ, and anti-HLA class Ⅰ+Ⅱ antibodies in patients with different hematological diseases showed statistically significant differences (all P<0.001). Given the varying positive rates and distribution characteristics of pre-existing anti-HLA antibodies among patients with different hematological diseases, anti-HLA antibody test should be performed before receiving hematopoietic stem cell transplantation.

收集2016年至2018年苏州大学附属第一医院首次接受抗人类白细胞抗原(HLA)抗体检测并计划接受异基因造血干细胞移植的1 494例血液病患者的临床资料,分析不同类型的抗HLA抗体在不同血液病患者体内的阳性率及分布特点。1 494例血液病患者中,男849例,女645例,年龄[31(17,45)]岁,其中急性髓性白血病(AML)577例,急性淋巴细胞白血病(ALL)373例,再生障碍性贫血(AA)234例,骨髓增生异常综合征(MDS)175例,其他疾病135例。原有抗-HLA抗体总阳性率为25.1%(375/1 494),其中抗-HLAⅠ类、抗-HLAⅡ类和抗-HLAⅠ+Ⅱ类抗体阳性率分别为11.2%(168/1 494)、4.9%(73/1 494)和9.0%(134/1 494)。MDS、AAA、AML、ALL和其他疾病患者的抗-HLA抗体阳性率分别为40.6%(71/175)、30.8%(72/234)、26.2%(151/577)、12.3%(46/373)和25.9%(35/135),差异有统计学意义(PP<0.05)。
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引用次数: 0
[Effect of Da Vinci robotic transanal minimally invasive surgery for rectal neoplasms]. [达芬奇机器人经肛门微创手术治疗直肠肿瘤的效果]。
Q3 Medicine Pub Date : 2024-09-10 DOI: 10.3760/cma.j.cn112137-20240421-00944
G J Zou, R Ma, X Y Liu, X P Yuan, S J Wang, B Ma, Q Q Chen, C J Zhang

Objective: To investigate the efficacy of Da Vinci robotic transanal minimally invasive surgery (R-TAMIS) for rectal neoplasms. Methods: The patients of rectal neoplasms who underwent R-TAMIS and were regularly followed up at the First Medical Center of Chinese PLA General Hospital from January 2021 to January 2024 were retropectively selected. Follow-up visits were conducted at 1, 2, and 4 weeks postoperatively, and then every 3 months until January 20, 2024. The perioperative situation, postoperative histopathological results, and follow-up status of the patients were observed. Results: A total of 17 patients were included, including 10 males and 7 females, aged 35-80 (59±13) years. Eleven patients underwent surgery using the da Vinci® Si robot, while 6 patients underwent surgery using the da Vinci® Xi robot. The height of the resected tumor from the anal verge [M (Q1, Q3)] was 3.5 (3.0, 3.8) cm. The total operative time was 55.0 (50.0, 55.0) minutes, the platform installation time was 32.5 (30.0, 35.0) minutes. The actual surgical operation time was 22.5 (20.0, 27.5) minutes. Intraoperative blood loss was 9.2 (5.0, 10.0) ml. The postoperative hospital stay was 3.2 (3.0, 3.8) days. The total treatment cost was (29 447±4 765) yuan. Two patients who achieved clinical complete remission after neoadjuvant chemoradiotherapy experienced incision dehiscence one week postoperatively, which was resolved after four weeks of rectal irrigation therapy. All surgical specimens were intact, and all resection margins were negative. A total of 44(31,73) weeks were followed up, without local recurrence or distant metastasis. Conclusion: Da Vinci robotic transanal minimally invasive local resection may be a safe and feasible treatment option for rectal neoplasms.

目的研究达芬奇机器人经肛门微创手术(R-TAMIS)治疗直肠肿瘤的疗效。方法回顾性选取2021年1月至2024年1月期间在中国人民解放军总医院第一医学中心接受R-TAMIS手术并定期随访的直肠肿瘤患者。随访时间为术后 1 周、2 周和 4 周,之后每 3 个月随访一次,直至 2024 年 1 月 20 日。观察了患者的围手术期情况、术后组织病理学结果和随访情况。结果:共纳入 17 例患者,其中男性 10 例,女性 7 例,年龄在 35-80 岁(59±13)之间。11例患者使用达芬奇® Si机器人进行手术,6例患者使用达芬奇® Xi机器人进行手术。切除的肿瘤距离肛门边缘的高度[M(Q1,Q3)]为3.5(3.0,3.8)厘米。手术总时间为55.0(50.0,55.0)分钟,平台安装时间为32.5(30.0,35.0)分钟。实际手术时间为 22.5(20.0,27.5)分钟。术中失血量为 9.2 (5.0, 10.0) 毫升。术后住院时间为 3.2(3.0,3.8)天。治疗总费用为(29 447±4 765)元。两名在新辅助化放疗后获得临床完全缓解的患者在术后一周出现切口裂开,经过四周的直肠冲洗治疗后裂口愈合。所有手术标本均完好无损,所有切除边缘均为阴性。随访共 44(31,73)周,无局部复发或远处转移。结论达芬奇机器人经肛门微创局部切除术可能是直肠肿瘤安全可行的治疗方案。
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引用次数: 0
[Application and development of super minimally invasive surgery concept in acoustic neuroma resection]. [超微创手术理念在听神经瘤切除术中的应用与发展]。
Q3 Medicine Pub Date : 2024-09-10 DOI: 10.3760/cma.j.cn112137-20240228-00442
Q J Zhang, G J Wang, D Y Han

With the development of medicine, surgery has also experienced the development and evolution from traditional surgery to minimally invasive surgery, and then to super minimally invasive surgery (SMIS). Meanwhile, reducing surgical trauma and preserving and reconstructing nerve function have gradually become new goals of modern vestibular schwannoma (VS) resection surgery. The surgery of VS can be divided into hearing-preserving surgery (retrosigmoid approach and middle fossa approach) and non-hearing-preserving surgery (traditional translabyrinthine approach), according to whether the patient has practical hearing before operation. Improving the hearing preservation rate of hearing-preserving surgery and reconstructing the hearing of patients with non-hearing-preserving surgery are major challenges and hotspots. The traditional translabyrinthine approach has the highest proportion in the Department of Otolaryngology-Head and Neck Surgery, with the advantages of high facial nerve preservation rate and few intracranial complications. However, due to the resection of the cochlear nerve and labyrinth, the cochlea develops fibrosis, and patients lose the opportunity to reconstruct hearing through cochlear implantation. The new modified translabyrinthine approach can preserve the cochlear nerve and effectively reduce cochlear fibrosis, providing an opportunity for cochlear implantation to reconstruct the hearing. This is another important breakthrough in vestibular schwannoma surgery.

随着医学的发展,外科手术也经历了从传统手术到微创手术,再到超微创手术(SMIS)的发展和演变。同时,减少手术创伤、保留和重建神经功能逐渐成为现代前庭裂隙瘤(VS)切除手术的新目标。根据患者术前是否具有实际听力,前庭裂神经瘤手术可分为保留听力手术(后蚓部入路和中窝入路)和非保留听力手术(传统的迷宫外入路)。提高保留听力手术的听力保留率和重建非保留听力手术患者的听力是一大挑战和热点。在耳鼻咽喉头颈外科中,传统的迷路入路比例最高,具有面神经保留率高、颅内并发症少等优点。然而,由于切除了耳蜗神经和迷宫,耳蜗出现纤维化,患者失去了通过人工耳蜗植入重建听力的机会。新的改良迷宫途径可以保留耳蜗神经,有效减少耳蜗纤维化,为人工耳蜗植入重建听力提供了机会。这是前庭裂隙瘤手术的又一重要突破。
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引用次数: 0
[Application value of domestic single-port robot in nephron sparing surgery]. [国产单孔机器人在肾脏疏通手术中的应用价值]。
Q3 Medicine Pub Date : 2024-09-10 DOI: 10.3760/cma.j.cn112137-20240123-00171
Q B Huang, Z Li, C Peng, H Q Guo, G X Liu, X H Wang, G X Wang, X H Li, J N Xu, B J Wang, X Zhang, X Ma

Objective: To explore the application value of the domestic precision ®single-port robotic system in nephron sparing surgery. Methods: The clinical data of patients with renal masses underwent nephron sparing surgery using the domestic precision ®single-port robotic system at the PLA General Hospital, Gulou Hospital Affiliated to Nanjing University School of Medicine, Zhongnan Hospital of Wuhan University and the First Affiliated Hospital of Nanchang University from September to November 2023 were retrospectively included. Perioperative clinical data, pathological examination results, and postoperative complications were summarized. Results: A total of 12 patients were included, including 8 males and 4 females, with 26-75 (56±16) years. Body mass index (BMI) was (25.1±2.7) kg/m2. There were 6 cases on the left side and 6 case on the right side. The surgical approach was transabdominal in 9 cases and retroperitoneal in 3 case. The maximum diameter of the lesions was (2.7±0.7) cm, the warm ischemia time [M (Q1, Q3)] was 19 (15, 26) minutes, the surgical time was 180 (149, 216) minutes, and the intraoperative blood loss was 50 (28, 100) ml. Postoperative visual analogue scale (VAS) was (2.9±1.5) points. Postoperative pathology revealed malignant renal clear cell carcinoma in 9 cases, with nuclear grading of 3 cases for Grade 1, 3 cases for Grade 2, and 3 cases for Grade 3. Eight cases of pathological TNM staging were pT1aN0M0 and 1 case was pT3aN0M0, with no cancer at the resection margin. Three cases showed benign renal vascular smooth muscle lipoma. There were no postoperative blood transfusions and no complications such as fever, urine leakage and poor wound healing. Conclusion: The prliminary experience reveals that the domestic precision ®single-port laparoscopic robotic system has good clinical application value in urological nephron sparing surgery.

目的探讨国产精密®单孔机器人系统在肾脏疏通手术中的应用价值。方法:回顾性纳入2023年9月至11月在解放军总医院、南京大学医学院附属鼓楼医院、武汉大学中南医院和南昌大学第一附属医院使用国产精密®单孔机器人系统进行肾脏肿块保肾手术患者的临床资料。总结了围手术期的临床资料、病理检查结果和术后并发症。结果共纳入12例患者,其中男性8例,女性4例,年龄26-75(56±16)岁。体重指数(BMI)为(25.1±2.7)kg/m2。左侧 6 例,右侧 6 例。手术方式经腹9例,腹膜后3例。病变最大直径为(2.7±0.7)厘米,温缺血时间[M(Q1,Q3)]为19(15,26)分钟,手术时间为180(149,216)分钟,术中失血量为50(28,100)毫升。术后视觉模拟量表(VAS)为(2.9±1.5)分。术后病理结果显示,9 例为恶性肾透明细胞癌,核分级 1 级 3 例,2 级 3 例,3 级 3 例。8 例病理 TNM 分期为 pT1aN0M0,1 例为 pT3aN0M0,切除边缘无癌。3例为良性肾血管平滑肌脂肪瘤。术后无输血,无发热、漏尿和伤口愈合不良等并发症。结论:初步经验表明,国产精密®单孔腹腔镜机器人系统在泌尿外科肾盂疏通手术中具有良好的临床应用价值。
{"title":"[Application value of domestic single-port robot in nephron sparing surgery].","authors":"Q B Huang, Z Li, C Peng, H Q Guo, G X Liu, X H Wang, G X Wang, X H Li, J N Xu, B J Wang, X Zhang, X Ma","doi":"10.3760/cma.j.cn112137-20240123-00171","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20240123-00171","url":null,"abstract":"<p><p><b>Objective:</b> To explore the application value of the domestic precision ®single-port robotic system in nephron sparing surgery. <b>Methods:</b> The clinical data of patients with renal masses underwent nephron sparing surgery using the domestic precision ®single-port robotic system at the PLA General Hospital, Gulou Hospital Affiliated to Nanjing University School of Medicine, Zhongnan Hospital of Wuhan University and the First Affiliated Hospital of Nanchang University from September to November 2023 were retrospectively included. Perioperative clinical data, pathological examination results, and postoperative complications were summarized. <b>Results:</b> A total of 12 patients were included, including 8 males and 4 females, with 26-75 (56±16) years. Body mass index (BMI) was (25.1±2.7) kg/m<sup>2</sup>. There were 6 cases on the left side and 6 case on the right side. The surgical approach was transabdominal in 9 cases and retroperitoneal in 3 case. The maximum diameter of the lesions was (2.7±0.7) cm, the warm ischemia time [<i>M</i> (<i>Q</i><sub>1</sub>, <i>Q</i><sub>3</sub>)] was 19 (15, 26) minutes, the surgical time was 180 (149, 216) minutes, and the intraoperative blood loss was 50 (28, 100) ml. Postoperative visual analogue scale (VAS) was (2.9±1.5) points. Postoperative pathology revealed malignant renal clear cell carcinoma in 9 cases, with nuclear grading of 3 cases for Grade 1, 3 cases for Grade 2, and 3 cases for Grade 3. Eight cases of pathological TNM staging were pT1aN0M0 and 1 case was pT3aN0M0, with no cancer at the resection margin. Three cases showed benign renal vascular smooth muscle lipoma. There were no postoperative blood transfusions and no complications such as fever, urine leakage and poor wound healing. <b>Conclusion:</b> The prliminary experience reveals that the domestic precision ®single-port laparoscopic robotic system has good clinical application value in urological nephron sparing surgery.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"104 35","pages":"3323-3327"},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296939","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}
引用次数: 0
[Safety and efficacy analysis of a varicose vein sealant kit in the treatment of great saphenous vein dysfunction]. [静脉曲张封堵套件治疗大隐静脉功能障碍的安全性和有效性分析]。
Q3 Medicine Pub Date : 2024-09-10 DOI: 10.3760/cma.j.cn112137-20231208-01323
S L Zou, K K Zhi, Y Hong, L R Guo, Y X Qi, L Zhang, J L Peng, B Ye, G F Zheng, B Hao, H M Xu, B Chen, Y F Pan, Y F Zhu, J J Wu, X J Huang, S C Wen, X Wang, L F Qu
<p><p><b>Objective:</b> To investigate the safety and efficacy of a varicose vein sealant kit in the treatment of great saphenous vein dysfunction. <b>Methods:</b> It was a randomized controlled trial. A total of 180 patients with great saphenous vein dysfunction were enrolled prospectively, and scheduled for surgical treatment in 9 hospitals, including the Second Affiliated Hospital of Naval Medical University, Shanghai Oriental Hospital Affiliated to Tongji University, Xuanwu Hospital Capital Medical University, the First Hospital of Hebei Medical University, Ganzhou People's Hospital, Shanxi Bethune Hospital, the Second Affiliated Hospital of Zhejiang University School of Medicine, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, and Zhongshan Hospital Affiliated to Xiamen University, from June to October 2022. Using a random number table method, the subjects were divided into an experimental group and a control group, with 90 cases in each group. The patients of experimental group received treatment with varicose vein sealant kit, while the patients of control group received radiofrequency ablation. The main outcome measure was the complete closure rate of the great saphenous vein in both groups of patients 3 months after surgery. The secondary outcome measures were the complete closure rate of the great saphenous vein in both groups of patients immediately after surgery and 6 months after surgery, the operation time for closing the main trunk of the great saphenous vein, pain score, venous clinical severity score (VCSS), Aberdeen varicose veins questionnaire (AVVQ) at different times before and after surgery, and the incidence of complications in both groups of patients. The non inferiority threshold for the two treatment methods is set at "-10.00%". <b>Results:</b> A total of 177 patients were ultimately enrolled. There were 89 cases in the experimental group, including 38 males and 51 females, with a median age [<i>M</i> (<i>Q</i><sub>1</sub>, <i>Q</i><sub>3</sub>)] of 59.7(49.6, 66.7) years, and 88 cases in the control group, including 30 males and 58 females, with a median age of 57.2(46.9, 65.9) years. A total of 174 patients completed a 3-month follow-up, and 167 patients completed a 6-month follow-up. The closure time of the main saphenous vein in the experimental group was (22.1±11.1) min, which was longer than the control group, which was (18.7±9.8) min (<i>P</i>=0.031). The complete closure rate of the great saphenous vein immediately after surgery in both the experimental group and the control group was 100%. The complete closure rates of the great saphenous vein at 3 months after surgery were 98.8% (85/86) and 98.9% (87/88), respectively. The lower limit of the 95%<i>CI</i> for the difference between the two groups was -3.19%, which was greater than the non-inferiority threshold of -10.00% (non-inferiority <i>P</i><0.001). The complete closure rates of the great saphenous vein at 6 months after surgery we
目的研究静脉曲张封堵套件治疗大隐静脉功能障碍的安全性和有效性。方法:随机对照试验:这是一项随机对照试验。共有 180 名大隐静脉功能障碍患者被纳入前瞻性研究,并被安排在 9 家医院接受手术治疗,包括海军军医大学第二附属医院、同济大学附属上海东方医院、首都医科大学宣武医院、河北医科大学第一医院、河北省人民医院、河北省人民医院、河北省人民医院、河北省人民医院、河北省人民医院、河北省人民医院、河北省人民医院、河北省人民医院、河北省人民医院、河北省人民医院、河北省人民医院、河北省人民医院、河北医科大学第一医院、赣州市人民医院、山西白求恩医院、浙江大学医学院附属第二医院、浙江大学医学院附属第四医院、厦门大学附属中山医院等 9 家医院的手术治疗。采用随机数字表法将受试者分为实验组和对照组,每组各90例。实验组患者接受静脉曲张封堵包治疗,对照组患者接受射频消融治疗。主要结果指标是两组患者术后 3 个月的大隐静脉完全闭合率。次要指标是两组患者术后即刻和术后 6 个月的大隐静脉完全闭合率、闭合大隐静脉主干的手术时间、术前和术后不同时间的疼痛评分、静脉临床严重程度评分(VCSS)、阿伯丁静脉曲张问卷(AVVQ)以及两组患者的并发症发生率。两种治疗方法的非劣效性阈值设定为"-10.00%"。结果最终共有 177 名患者入选。实验组 89 例,包括 38 名男性和 51 名女性,中位年龄[M(Q1,Q3)]为 59.7(49.6,66.7)岁;对照组 88 例,包括 30 名男性和 58 名女性,中位年龄为 57.2(46.9,65.9)岁。共有 174 名患者完成了 3 个月的随访,167 名患者完成了 6 个月的随访。实验组的主隐静脉闭合时间为(22.1±11.1)分钟,长于对照组的(18.7±9.8)分钟(P=0.031)。实验组和对照组术后大隐静脉完全闭合率均为 100%。术后 3 个月的大隐静脉完全闭合率分别为 98.8%(85/86)和 98.9%(87/88)。两组间差异的95%CI下限为-3.19%,大于非劣效性阈值-10.00%(非劣效性PCI为-5.71%,大于非劣效性阈值-10.00%(非劣效性PP=0.365))。实验组和对照组术后一周的瘀伤发生率分别为 61.2%(52/85)和 67.1%(57/85),差异无统计学意义(P=0.181)。术前、术后1、3和6个月时,各组间的VCSS和AVVQ评分差异无统计学意义(均P>0.05)。术后 3 个月,下肢深静脉血栓、静脉炎、疼痛和皮下血肿等并发症的发生率差异无统计学意义(均为 P>0.05)。结论静脉曲张封堵套件治疗大隐静脉功能障碍安全有效,大隐静脉完全闭合率不低于传统射频消融术。
{"title":"[Safety and efficacy analysis of a varicose vein sealant kit in the treatment of great saphenous vein dysfunction].","authors":"S L Zou, K K Zhi, Y Hong, L R Guo, Y X Qi, L Zhang, J L Peng, B Ye, G F Zheng, B Hao, H M Xu, B Chen, Y F Pan, Y F Zhu, J J Wu, X J Huang, S C Wen, X Wang, L F Qu","doi":"10.3760/cma.j.cn112137-20231208-01323","DOIUrl":"https://doi.org/10.3760/cma.j.cn112137-20231208-01323","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To investigate the safety and efficacy of a varicose vein sealant kit in the treatment of great saphenous vein dysfunction. &lt;b&gt;Methods:&lt;/b&gt; It was a randomized controlled trial. A total of 180 patients with great saphenous vein dysfunction were enrolled prospectively, and scheduled for surgical treatment in 9 hospitals, including the Second Affiliated Hospital of Naval Medical University, Shanghai Oriental Hospital Affiliated to Tongji University, Xuanwu Hospital Capital Medical University, the First Hospital of Hebei Medical University, Ganzhou People's Hospital, Shanxi Bethune Hospital, the Second Affiliated Hospital of Zhejiang University School of Medicine, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, and Zhongshan Hospital Affiliated to Xiamen University, from June to October 2022. Using a random number table method, the subjects were divided into an experimental group and a control group, with 90 cases in each group. The patients of experimental group received treatment with varicose vein sealant kit, while the patients of control group received radiofrequency ablation. The main outcome measure was the complete closure rate of the great saphenous vein in both groups of patients 3 months after surgery. The secondary outcome measures were the complete closure rate of the great saphenous vein in both groups of patients immediately after surgery and 6 months after surgery, the operation time for closing the main trunk of the great saphenous vein, pain score, venous clinical severity score (VCSS), Aberdeen varicose veins questionnaire (AVVQ) at different times before and after surgery, and the incidence of complications in both groups of patients. The non inferiority threshold for the two treatment methods is set at \"-10.00%\". &lt;b&gt;Results:&lt;/b&gt; A total of 177 patients were ultimately enrolled. There were 89 cases in the experimental group, including 38 males and 51 females, with a median age [&lt;i&gt;M&lt;/i&gt; (&lt;i&gt;Q&lt;/i&gt;&lt;sub&gt;1&lt;/sub&gt;, &lt;i&gt;Q&lt;/i&gt;&lt;sub&gt;3&lt;/sub&gt;)] of 59.7(49.6, 66.7) years, and 88 cases in the control group, including 30 males and 58 females, with a median age of 57.2(46.9, 65.9) years. A total of 174 patients completed a 3-month follow-up, and 167 patients completed a 6-month follow-up. The closure time of the main saphenous vein in the experimental group was (22.1±11.1) min, which was longer than the control group, which was (18.7±9.8) min (&lt;i&gt;P&lt;/i&gt;=0.031). The complete closure rate of the great saphenous vein immediately after surgery in both the experimental group and the control group was 100%. The complete closure rates of the great saphenous vein at 3 months after surgery were 98.8% (85/86) and 98.9% (87/88), respectively. The lower limit of the 95%&lt;i&gt;CI&lt;/i&gt; for the difference between the two groups was -3.19%, which was greater than the non-inferiority threshold of -10.00% (non-inferiority &lt;i&gt;P&lt;/i&gt;&lt;0.001). The complete closure rates of the great saphenous vein at 6 months after surgery we","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"104 35","pages":"3334-3341"},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142296945","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}
引用次数: 0
[Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2024 edition)]. [中华医学会肺癌临床诊治指南(2024 年版)》。]
Q3 Medicine Pub Date : 2024-09-03 DOI: 10.3760/cma.j.cn112137-20240511-01092

To further standardize lung cancer prevention and treatment measures in China, enhance the quality of diagnosis and treatment, improve patient prognosis, and provide evidence-based medical guidance for clinicians at all levels, the Chinese Medical Association convened experts from respiratory medicine, oncology, thoracic surgery, radiotherapy, imaging, and pathology to develop the Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2024 edition). This consensus resulted in several updates from the 2023 edition. The 2024 guidelines highlight that the risk of lung cancer in smokers remains higher than that of non-smokers even 15 years after quitting. Additionally, a new lung cancer incidence risk model is expected to become a critical tool for screening high-risk groups. In pathology, the guidelines now include pathological evaluation of surgically resected lung cancer specimens following neoadjuvant therapy and suggest that immunohistochemical staining of certain transcription factors may aid in the classification of small cell lung cancer (SCLC). In molecular detection, the guidelines propose simultaneous detection of driver gene variations based on both RNA and DNA from specimens. The new edition also provides detailed descriptions of patient selection and surgical requirements for thoracic sub-lobectomy, aligned with the 9th TNM staging. Moreover, the guidelines expand treatment options, approving more therapies for immunoadjuvant and EGFR-TKI resistant lung cancer patients, as well as additional drug options for advanced non-small cell lung cancer (NSCLC) patients with EGFR mutations, EGFR 20 insertions, ALK fusions, and MET exon 14 skipping. These recommendations are based on state-approved drug applications, international guidelines, and current clinical practices in China, integrating the latest evidence-based medical research in screening, diagnosis, pathology, genetic testing, immune molecular marker detection, treatment methods, and follow-up care. The goal is to provide comprehensive and reasonable recommendations for clinicians, imaging specialists, laboratory technicians, rehabilitation professionals, and other medical staff at all levels.

为进一步规范我国肺癌防治措施,提高诊疗质量,改善患者预后,为各级临床医师提供循证医学指导,中华医学会召集呼吸内科、肿瘤科、胸外科、放疗科、影像科、病理科等科室专家,制定了《中华医学会肺癌临床诊治指南(2024年版)》。这一共识在 2023 年版的基础上进行了多项更新。2024 年版指南强调,即使在戒烟 15 年后,吸烟者罹患肺癌的风险仍高于非吸烟者。此外,新的肺癌发病风险模型有望成为筛查高危人群的重要工具。在病理学方面,指南新增了对新辅助治疗后手术切除的肺癌标本进行病理学评估的内容,并建议对某些转录因子进行免疫组化染色,以帮助对小细胞肺癌(SCLC)进行分类。在分子检测方面,指南建议根据标本中的 RNA 和 DNA 同时检测驱动基因变异。新版指南还详细介绍了胸腔下叶切除术的患者选择和手术要求,并与第9版TNM分期保持一致。此外,指南还扩大了治疗选择范围,批准了更多针对免疫佐剂和表皮生长因子受体-TKI耐药肺癌患者的疗法,以及针对表皮生长因子受体突变、表皮生长因子受体20插入、ALK融合和MET外显子14跳变的晚期非小细胞肺癌(NSCLC)患者的更多药物选择。这些建议基于国家批准的药物申请、国际指南和中国目前的临床实践,整合了筛查、诊断、病理、基因检测、免疫分子标记物检测、治疗方法和随访护理等方面的最新循证医学研究。目的是为临床医生、影像学专家、实验室技术人员、康复专业人员和其他各级医务人员提供全面合理的建议。
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引用次数: 0
[Two cases of Dent disease type 1 with Bartter-like phenotype and literature review]. [两例具有 Bartter 样表型的 Dent 病 1 型病例及文献综述]。
Q3 Medicine Pub Date : 2024-09-03 DOI: 10.3760/cma.j.cn112137-20240315-00587
M Cheng, X Meng, M Liu, C X Gong

The clinical presentation, treatment, and follow-up of two boys with type 1 Dent disease who exhibited a Bartter-like phenotype were retropectively analysed. The related literature of pediatric patients with type 1 Dent disease who had hypokalemia and metabolic alkalosis was screened through databases such as PubMed, CNKI, and Wanfang until February 1, 2024, and common features among these patients were summarized through literature review. A total of 7 literatures were included, and 9 children were included in the analysis. All patients were male, presenting with significant low molecular weight proteinuria and hypercalciuria. Other prominent characteristic phenotypes included short stature (7/8), hypophosphatemia (8/9), and rickets (6/8). Seven previously reported patients had missense or nonsense mutations, while 2 patients in this study carried possible pathogenic mutations in the CLCN5 gene, c.315+2T>A (p.?) and c.584dupT (p.I196Yfs*6), respectively. Five patients were able to maintain blood potassium levels around 3 mmol/L with oral potassium chloride solution combined with non-steroidal anti-inflammatory drugs (ibuprofen or indomethacin). The follow-up showed that 2 patients developed chronic kidney disease stage 4 and stage 3 at the age of 13 and 21 years, respectively. The phenotypic overlap between Dent disease and Batter syndrome is considerable,with the distinguishing feature being the presence of significant low molecular weight proteinuria. Patients with type 1 Dent disease presenting with the Bartter-like phenotype have a high prevalence of short stature, hypophosphatemia, and rickets. Non-steroidal anti-inflammatory drugs can be used to correct hypokalemia in patients under periodic renal function assessment.

回顾性分析了两名表现为巴特样表型的1型登特病男孩的临床表现、治疗和随访情况。在PubMed、CNKI和万方等数据库中筛选了截至2024年2月1日患有低钾血症和代谢性碱中毒的1型登特病患者的相关文献,并通过文献综述总结了这些患者的共同特征。共纳入 7 篇文献,9 名儿童被纳入分析。所有患者均为男性,表现为明显的低分子量蛋白尿和高钙尿症。其他突出的特征性表型包括身材矮小(7/8)、低磷血症(8/9)和佝偻病(6/8)。之前报道的 7 例患者存在错义或无义突变,而本研究中的 2 例患者的 CLCN5 基因可能存在致病突变,分别为 c.315+2T>A (p.?) 和 c.584dupT (p.I196Yfs*6)。5 名患者在口服氯化钾溶液和非甾体抗炎药物(布洛芬或吲哚美辛)后,血钾水平维持在 3 mmol/L 左右。随访结果显示,2 名患者分别在 13 岁和 21 岁时发展为慢性肾病 4 期和 3 期。Dent 病与巴特综合征的表型有很大的重叠,其显著特点是存在大量低分子量蛋白尿。表现为巴特综合征样表型的 1 型登特病患者中,身材矮小、低磷血症和佝偻病的发病率很高。非甾体类抗炎药可用于纠正定期接受肾功能评估的患者的低钾血症。
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引用次数: 0
[Expert consensus on the clinical application of aromatase inhibitors to improve adolescent height]. [关于临床应用芳香化酶抑制剂改善青少年身高的专家共识]。
Q3 Medicine Pub Date : 2024-08-20 DOI: 10.3760/cma.j.cn112137-20240317-00597

Aromatase inhibitors have been widely used to improve height in the world and China. However, due to their off-label use and relatively short application time, there is a lack of consistent understanding and expert consensus on the indications, efficacy, and side effects of the drugs at home and abroad. Therefore, the Growth and Development and Gonadal Diseases Committee of Chinese Aging Well Association and the Adolescent Medicine and Health Professional Committee of the Chinese Medical Doctor Association organized 28 domestic experts in growth and development, based on the clinical evidence level classification and recommendation level of the Oxford University Evidence-Based Medicine Center to establish some preliminary recommendations on the efficacy, adverse reactions, precautions, dosage, and course of use of aromatase inhibitors in treating children with short stature and improving their year-end height. Combined with the Delphi method evaluation, 14 recommendations were finally formulated to standardized the clinical application of aromatase inhibitors in improving adolescent height.

在世界和中国,芳香化酶抑制剂已被广泛用于改善身高。但由于其标签外使用和应用时间较短,国内外对其适应症、疗效、副作用等缺乏一致的认识和专家共识。为此,中国老年保健协会生长发育与性腺疾病专业委员会和中国医师协会青少年医药卫生专业委员会组织了国内28位生长发育方面的专家,依据牛津大学循证医学中心的临床证据水平分类和推荐水平,对芳香化酶抑制剂治疗儿童矮身材、改善儿童年终身高的疗效、不良反应、注意事项、用量、疗程等方面提出了一些初步建议。结合德尔菲法评估,最终制定了14条建议,以规范芳香化酶抑制剂在改善青少年身高方面的临床应用。
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引用次数: 0
[Construction of competitive endogenous RNA regulatory network and clinical verification for repeated implantation failure]. [竞争性内源性 RNA 调控网络的构建及反复植入失败的临床验证]。
Q3 Medicine Pub Date : 2024-08-20 DOI: 10.3760/cma.j.cn112137-20240622-01385
T Chu, T Yu, F Wang, H L An, H Shi, K Huang, Y P Liu, J Zhai

Objective: To construct a repetitive implantation failure (RIF)-related competitive endogenous RNA (ceRNA) regulatory network and validate with clinical samples. Methods: RIF-related long non-coding RNA (lncRNA), microRNA (miRNA) and messenger RNA (mRNA) from the high-throughput gene expression omnibus (GEO) database Expression profile data set were obtained to construct a ceRNA regulatory network of lncRNA-miRNA-mRNA. At the same time, weighted gene co-expression network analysis (WGCNA) was used to explore hub genes in the network. This retrospective study collected RIF patients and controls (at least one pregnancy history after assisted conception) who underwent in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) for assisted pregnancy from 2020 to 2021 at the Reproductive Medicine Center of the First Affiliated Hospital of Zhengzhou University. In the endometrial tissue of patients with 1 pregnancy history, real-time fluorescence quantitative polymerase chain reaction (qRT-PCR) was used to verify the mRNA expression levels of RIF-related hub genes, and Western blotting and immunohistochemistry were used to verify protein expression levels of vascular cell adhesion molecule-1 (VCAM1). Results: A RIF-related ceRNA regulatory network consisting of 32 lncRNAs, 31 miRNAs and 88 mRNAs was constructed, and 7 RIF-related hub genes were identified using WGCNA. By intersecting 88 mRNAs and hub genes in the ceRNA network, two RIF-related key genes were obtained, i.e., VCAM1 and interleukin-2 receptor α (interleukin-2 receptor α, IL-2RA). In clinical verification, the ages of the control group and RIF group [M (Q1, Q3)] were 26.50 (25.00, 34.00) and 30.50 (25.75, 35.25) years old, respectively (P>0.05). Compared with the control group, the mRNA [0.30 (0.15, 0.42) vs 0.99 (0.69, 1.34), P=0.001] and protein expression [0.44 (0.16, 1.27) vs 2.39 (1.58, 2.58), P<0.001] of VCAM1 in the endometrium of the RIF group were both reduced. Conclusions: This study uses bioinformatics analysis methods to construct a RIF-related ceRNA regulatory network, and it is confirmed through clinical samples that the expression level of VCAM1 in the endometrial tissue of RIF patients is significantly reduced.

目的构建与重复性植入失败(RIF)相关的竞争性内源性 RNA(ceRNA)调控网络,并用临床样本进行验证。方法:从高通量基因表达总库(GEO)数据库表达谱数据集中获取与RIF相关的长非编码RNA(lncRNA)、microRNA(miRNA)和信使RNA(mRNA),构建lncRNA-miRNA-mRNA的ceRNA调控网络。同时,利用加权基因共表达网络分析(WGCNA)探索网络中的枢纽基因。这项回顾性研究收集了2020年至2021年在郑州大学第一附属医院生殖医学中心接受体外受精(IVF)/卵胞浆内单精子显微注射(ICSI)辅助妊娠的RIF患者和对照组(至少有一次辅助受孕后妊娠史)。在1次妊娠史患者的子宫内膜组织中,采用实时荧光定量聚合酶链反应(qRT-PCR)检测RIF相关枢纽基因的mRNA表达水平,采用Western印迹和免疫组化检测血管细胞粘附分子1(VCAM1)的蛋白表达水平。结果构建了由32个lncRNA、31个miRNA和88个mRNA组成的RIF相关ceRNA调控网络,并利用WGCNA鉴定了7个RIF相关枢纽基因。通过ceRNA网络中88个mRNA与枢纽基因的交叉,得到了两个与RIF相关的关键基因,即VCAM1和白细胞介素-2受体α(interleukin-2 receptor α, IL-2RA)。在临床验证中,对照组和 RIF 组[M(Q1,Q3)]的年龄分别为 26.50(25.00,34.00)岁和 30.50(25.75,35.25)岁(P>0.05)。与对照组相比,mRNA [0.30 (0.15, 0.42) vs 0.99 (0.69, 1.34), P=0.001] 和蛋白质表达 [0.44 (0.16, 1.27) vs 2.39 (1.58, 2.58), PConclusions:本研究利用生物信息学分析方法构建了RIF相关的ceRNA调控网络,并通过临床样本证实VCAM1在RIF患者子宫内膜组织中的表达水平显著降低。
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引用次数: 0
[Chinese expert consensus for nomenclature, isolation and detection of bacterial extracellular vesicles]. [细菌胞外囊泡的命名、分离和检测的中国专家共识]。
Q3 Medicine Pub Date : 2024-08-13 DOI: 10.3760/cma.j.cn112137-20240104-00030

Bacterial extracellular vesicles (BEVs), considered to mediate interactions between bacteria, and bacteria-host interactions, play a crucial role in the development and progression of diseases. However, there is currently no unified standard for the nomenclature, isolation, and detection of BEVs. Consequently, inconsistencies are observed in the results of related research, preventing a more comprehensive and objective analysis of BEVs. Therefore, it is imperative to establish an expert consensus based on fundamental research methods for the nomenclature, isolation, and detection of BEVs to facilitate their clinical translation and applications. This consensus statement was written by a working group composed of experienced experts in the fields of medical diagnostics, microbiology, and materials biology. It provides an overview of commonly used techniques and basic methods for the isolation and detection of BEVs. The statement offers recommendations and considerations to improve the feasibility and reproducibility of BEVs research, emphasizing pivotal issues and challenges in the transition of BEVs towards clinical applications, with the aim of serving as a reference for subsequent studies.

细菌胞外囊泡(BEVs)被认为是细菌之间以及细菌与宿主之间相互作用的媒介,在疾病的发生和发展过程中起着至关重要的作用。然而,目前还没有统一的标准来命名、分离和检测 BEV。因此,相关研究结果不一致,无法对 BEV 进行更全面、更客观的分析。因此,当务之急是在对 BEV 进行命名、分离和检测的基础研究方法上达成专家共识,以促进其临床转化和应用。本共识声明由医疗诊断、微生物学和材料生物学领域的资深专家组成的工作组撰写。它概述了分离和检测 BEV 的常用技术和基本方法。声明提出了提高 BEVs 研究可行性和可重复性的建议和注意事项,强调了 BEVs 向临床应用过渡过程中的关键问题和挑战,旨在为后续研究提供参考。
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引用次数: 0
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