Rheumatic mitral stenosis is one of the most common cardiac valvulopathies in our country, which is relatively rare in European and American countries. Medical therapy is reserved mainly for the treatment of complications, which can not fundamentally change the valve structure. Only surgical treatments can correct these valve lesions, including closed mitral commissurotomy, percutaneous balloon mitral valvuloplasty, mitral valve repair under direct vision and mitral valve replacement. Numerous studies demonstrate that valve repair provides better long-term results, though it occupies a low proportion clinically. This article reviewed domestic and foreign literature concerning surgical treatments for patients with rheumatic mitral stenosis to provide some reference for the peers.
Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2022 edition) has been published this year. The 2022 edition has been updated in the aspects of lung cancer screening, pathology, standards of thoracic surgery, treatment of metastatic lung cancer. In this study, we tried to introduce those updated aspects in the guideline of 2022 edition.
H7N9, a novel avian influenza A virus that causes human infections emerged in February, 2013 in Anhui and Shanghai, China. The epidemic quickly spread to Zhejiang, Jiangsu and other neighbor provinces. As of May 30th, 2013, WHO had reported 132 cases, 37 (28%) of which died. Aiming at such serious outbreak of epidemic, we retrospectively analyzed its etiology, epidemiology, clinical characteristics, treatment, prevention and control based on data and evidence. Experience and evidence of the risk surveillance and management of such a novel anthropozoonosis lacks in China, or even lacks around the world. Quick and accurate identification of the rules and of the variation and transmission of avian influenza virus becomes a key to prevention, control and treatment. According to current best available evidence around the world, Chinese medicine and biomedicine should be put in to parallel use. Only realizing evidence-based decision making can we effectively prevent and control the epidemic, treat patients, and reduce the loss.
ObjectiveTo analyze the efficacy and safety of immunotherapy and bevacizumab combined with chemotherapy (BIC), bevacizumab combined with chemotherapy (BC), chemotherapy (CT), immunotherapy combined with chemotherapy (IC), bevacizumab combined with immunotherapy (BI), bevacizumab (B) in the first-line treatment of advanced wild-type non-squamous non-small cell lung cancer. MethodsThe PubMed, Embase, Cochrane Library and Web of Science databases were searched to collect phase Ⅱ/Ⅲ randomized controlled trials (RCTs) related to the objectives of the study from January 2010 to December 1, 2022. After two investigators independently screened the literatures, extracted the data and evaluated the risk of bias of the included studies, a reticular meta-analysis was performed using R 3.6.1 software. ResultsA total of 11 RCTs were finally included, including 5 329 patients and six treatment combinations. Meta-analysis results showed that BIC was superior to CT for progression-free survival (PFS) (HR=0.34, 95% CI 0.18 to 0.69), but BIC did not show a significant advantage over the other groups for overall survival (OS). Bayesian ranking results showed that the BIC group had the greatest probability in terms of OS, PFS, and ORR. Among all programmed death ligand 1 (PD-L1) expressing subgroups, there was no significant difference in OS between BIC, BC, IC, CT, BI, and B. Compared with CT, IC was significantly improved in OS (HR=0.68, 95%CI 0.52 to 0.92), PFS (HR=0.58, 95%CI 0.45 to 0.75), and ORR (HR=0.47, 95%CI 0.33 to 0.66). ConclusionIn the first-line treatment of wild-type advanced non-squamous NSCLC, immunotherapy and bevacizumab combined with chemotherapy may improve the efficacy in the short term, but do not change the long-term survival time. Immunotherapy combined with chemotherapy can significantly improve the survival time and prognosis of patients compared with chemotherapy alone. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Objective To provide references for clinical management of patients with orbital blow-out fractures. Methods Evidence was retrieved from The Cochrane Library online (Issue 1, 2009), ACP online, NGC (1998 to March 2009), PubMed (January 1950 to February 2009), and CBM (1994 to February 2009). The collected evidence was then graded. Results After preliminary research, we identified 12 relevant articles: either retrospective studies or comments from specialists. They studied orbital soft tissue entrapment, diplopia, enophthalmos, or severe oculocardiac reflex in the surgical indications of orbital blow-out fractures. Most of the literature suggested less than five days after the injury incursion for children and less than two weeks for adults was the optimal time to undergo operation. However, advanced surgery was still a good option for the patients that could not undergo early surgery. With regard to the use of poly-pdioxanon- foil and titanium-dynamic mesh, two randomized controlled trials suggested that the former was superior to the latter. Conclusion The application of this surgery should be cautious because of low levels of evidence. Individual therapies should be used after close consideration of clinical characteristics.
Williams syndrome is a congenital multisystem disease. Cardiovascular abnormality caused by elastin deficiency is the main cause of morbidity and mortality in Williams syndrome patients. Recent studies have found that 80% of Williams syndrome patients have cardiovascular abnormalities, most of which are arterial stenosis, especially the aortic valve stenosis and pulmonary artery stenosis. Operation is the main method to treat the stenosis of the artery, and the results of the operation on the aortic valve stenosis in most centers are good, but the effect of transcatheter intervention is still not obvious, pulmonary artery reconstruction has a good effect on the treatment of peripheral pulmonary artery stenosis. Advances in genetic diagnosis, surgical techniques and treatment regimens are expected to significantly improve cardiovascular outcomes in these patients. This article reviews the latest research progress of Williams syndrome combined with cardiovascular disease.
Objective To explore the diagnostic methods, therapy and the prognostic factors for the ruptured abdominal aortic aneurysm (RAAA). Methods The clinical data of 23 patients (males 15, females 8, age range 35-78, mean age 65) with RAAA below the level of renal arteries, who were treated with surgery, were collected from April 1999 to December 2005 and were analyzed retrospectively. Seven cases had a history of RAAA, 6 cases had pulsating abdominal masses; 15 cases were diagnosed by emergency Doppler ultrasonic examination or CT. All of the patients underwent emergency surgical operation: The ruptures of the abdominal aorta below the level of renal arteries were obstructed by using clamp ring or using transluminal ballon according to conditions of each patient. The aritficial vascular graft was then taken after the control of hemorrhage. Results There were 9 (39%) patients died within 30 d after the emergency operation. The causes of death included acute renal failure because of hemorrhagic shock (4 cases), multiple organ failure (3 cases), and respiratory-circulatory failure (2 cases).Conclusion Surgery may be an effective treatment for RAAA. The critical step of the operation was to control hemorrhage by obstructing the proximal end of the aortic rupture according to the conditions of each patient. The main postoperative complications and causes of death include acute cardiovascular and cerebrovascular diseases, renal failure and pneumonia.
摘要:目的: 评价生长抑素(somatostatin,商品名Stilamin,思他宁) 和甲磺酸加贝酯(gabexate mesilate,GM)治疗急性胰腺炎患者的疗效,及这两种药物对急性出血坏死型胰腺炎的临床疗效。 方法 :采用随机对照研究,按是否出血坏死型随机分为治疗组和对照组,在常规治疗的基础上,分别接受思他宁或甲磺酸加贝酯治疗,并观察疗效。 结果 : 思他宁用于治疗急性水肿型胰腺炎,总有效率达100 0 %,痊愈率达789 %,略高于对照组加贝酯(636 %),但差异无显著性(〖WTBX〗 P gt;0 05)。腹痛、上腹胀等症状均能在3～5 d 内基本缓解或消失。思他宁用于治疗急性出血坏死型胰腺炎,总有效率90 %,高于对照组加贝酯667％,差异有显著性( 〖WTBX〗P ＜005)。治疗过程中仅2 例丙氨酸转氨酶轻度升高,未发现过敏、皮疹、白细胞明显下降等明显不良反应,肝、肾功能和电解质等生化指标和血常规监测显示其具有较好的安全性。 结论 :思他宁和加贝酯用于治疗急性水肿型胰腺炎和出血坏死型胰腺炎均有较好的疗效,不良反应较少。在急性水肿型胰腺炎治疗中,二者总有效率无显著性差异;在出血坏死型胰腺炎治疗中,思他宁总有效率高于加贝酯。Abstract: Objective: To assess the effectiveness of somatostatin (Stilamin) and gabexate mesilate(GM) in the treatment of patients with acute edematic pancreatitis (AEP) and acute hemorragic and necrotic pancreatitis (AHNP). Methods :Patients were randomly alloccated into the treatment group (with Stilamin) and control group (with gabexate ) which were stratified by AHNP or AEP. All the side effects were recorded during the whole process. Results :Totally 57 acute pancreatitis patients were enrolled (male 31,female 26). Among them,41 cases were mild,16 cases were severe. The study showed that total ef2 fectiveness of Stilamin in treating acute pancreatitis was 100 %,while the cured rate was 789 %,a little bit higher than control group with cabexate (636 %),but no statistical significance existed. Total effectiveness of Stilamin in treating AHNP was similar as that of sandostatin (900 % vs 667 %, 〖WTBX〗P = 0 031). The main complication after treating AHNP was pancreatic pseudocyst. Only two case showed increase of ALT. No side effects of hypersensitivity,skin rash,WBC decrease were noted. Safety had been proved by monitoring of liver and renal function,eletrolytes and blood RT. Conclusion :Stilamin and gabexate showed effectiveness in treating AEP and AHNP with fewer side effects. The total effectiveness of Stilamin in treating AHNP was higher than control group with gabexate, and statistical significance existed.
摘要: 目的: 探讨小儿先天性心脏病（CHD）部分性房室间隔缺损（PAVSD）的外科治疗方法，以期提高疗效。方法: 对1999年6月至2009年8月收治27例PAVSD临床资料进行分析，男16例，女11例，年龄1.3~14岁,平均6.08岁。术前均经彩色多普勒超声心动图（Echo）和部分心导管检查确诊。手术全部在中低温体外循环（CPB）下行根治术。结果: 无手术死亡。22例获1个月~10年随访，1例术后3个月因重度二尖瓣返流（MR）,心力衰竭死亡，1例Ⅱ°房室传导阻滞（AVB）6个月后自行恢复，2例仍有轻度二尖瓣关闭不全; 余生活、学习正常，心功能Ⅰ级。结论: 一旦确诊应尽早手术治疗。修补原发孔缺损，注意避免损伤传导束，二尖瓣裂修复完善是手术成功和减少并发症的关键。Abstract: Objective: To discuss the surgical treatment of congenital heart disease as partial atrioventricular septal defect（PAVSD）to improve the therapeutic effect. Methods: From June1999 to December2008, the clinical data of 27 children suffering from PAVSD were analyzd. Male：16,female: 11. The ages ranged from 1.3 to 14 years, the average age is 6.08±3.73 years.All the children were final diagnosised by color Doppler echocardiogram and right catheterization.All underwent the radical correction under moderate hypothermic cardiopulmonary bypass. Results: There was no operative mortality. 25 cases were followed up for 6 months to 10 years, 1 case died of heart failure secondary to severe mitral regurgitation 3 months after the operation, 1 case had Ⅱdegree atrioventricular block , recovered 6 months later. 2 cases still had mild mitral regurgitation. Other cases lived and studied normally, their heart function is first class. Conclusion: Surgical treatment should be taken as soon as the diagnosis is confirmed. Shallow suturing repairing primum atrial defect and complete repairing mitral valve cleft are the key points of success and avoiding complications.
Objective To compare the clinical characteristics and treatment of patients with chronic obstructive pulmonary disease (COPD) in the year of 2018, 2019, 2020, and 2021. Methods A cross-sectional multicenter study was conducted on patients with stable COPD from 13 hospitals of China south area in year of 2018, 2019, 2020 and 2021. The demographic data, pulmonary function, COPD assessment test (CAT), exacerbation in the past year and treatment regimens were collected. Results The CAT scores of the COPD patients in the year of 2018, 2019, 2020 and 2021 were (16.5±6.7), (14.5±6.7), (14.1±6.2) and (13.4±6.6), respectively. The CAT scores decreased year by year (P<0.05). The forced expiratory volume in one second percentage predicted value (FEV1%pred) of the COPD patients in the year of 2018, 2019, 2020 and 2021 were (52.8±21.4)%, (51.3±19.2)%, (53.4±21.5)% and (56.6±21.7)%, respectively. Compared with year of 2018, the patients in 2019, 2020 and 2021 had higher FEV1%pred. Compared with year of 2019 and 2020, the patients 2021 had higher FEV1%pred (P<0.05). The median of exacerbation in the past year of the COPD patients in the year of 2018, 2019, 2020 and 2021 were 1, 1, 0 and 0, respectively. Compared with year of 2018 and 2019, the median of exacerbation in the past year in 2020 and 2021 were lower (P<0.05). The proportion of double [long-acting β2-agonist (LABA)+long-acting muscarinic antagonist (LAMA)] and triple inhaled [LAMA+LABA+ inhaled corticosteroid (ICS)] drugs were 0%, 0.7%, 3.5% and 17.0%, as well as 47.9%, 41.2%, 27.8% and 26.0%. Compared with year of 2018 and 2019, the proportion of double inhaled drugs in 2020 and 2021 was higher, while triple inhaled drugs was lower (P<0.05). In addition, the proportion of influenza vaccine/pneumonia vaccine was 0%, 0.1%, 3.5% and 4.3%, respectively. Compared with year of 2018 and 2019, the proportion of influenza vaccine/pneumonia vaccine in year of 2020 and 2021 was higher (P<0.05). Conclusions Symptoms and exacerbation burden of patients with COPD tend to be less in China in recent years and the time of patients visited hospital tends to move forward. Furthermore, the proportion of patients with double inhaled drugs (LABA+LAMA) increased, while triple inhaled (LAMA+LABA+ICS) decreased. In addition, the proportion of patients vaccinated with influenza/pneumonia is increased but the overall proportion is still low.