【Abstract】ObjectiveTo detect the levels of homocysteine (Hcy) and anti-phospholipid antibodies (APLA) in the hematoplasma of the patients with deep venous thrombosis (DVT), discuss the reason of DVT recurrence and search for the predictors of it. MethodsSixty cases with DVT in our department from January 2001 to April 2003 were collected, which were divided equally into two groups as primary and recurrent, and first degree relative of the 30 DVT recurrent patients were also collected. The author established a control group using 30 cases of outpatient clinic without varicose veins of lower extremity or insufficient venae profundae. Hcy was detected with fluorescence polarization immunoassay (FPIA) and APLA 〔anticardiolipin antibody, ACLA (IgG, IgM); lupus antibody (LA)〕were detected with enzyme linked immunosorbent assay (ELISA). Odds ratios (OR) were also calculated to assess the relative risk of each study group. ResultsThe values of Hcy and ACLA （IgG， IgM） in the primary group and recurrent group were both significantly higher than those of control group and first degree relative group of DVT recurrent patients (Plt;0.01). The values of Hcy in first degree relative group of DVT recurrent patients was were also much higher than that of control group (Plt;0.05). The 90% quantity of Hcy in control group was 13.1 μmol/L and if taking it as the normal value, the number of cases exceeded this value in primary group, recurrent group and first degree relative group of DVT recurrent patients were 14, 21 and 13 and the OR of them were 2.31, 2.20 and 1.90, respectively. The positive rates of LA were not statistically significant in each group. Conclusion The values of Hcy and APLA both rise in the hematoplasma of DVT patients. There are close relationship between the levels of Hcy and APLA and DVT. The recurrence of DVT is related to high level of Hcy and Hcy is possibly a predictor of DVT.
目的总结胰岛细胞增生症的诊治经验，探讨手术范围及手术方式。方法对我科收治的1例胰岛细胞增生症患者的资料并结合文献资料进行分析。结果本例患者首次行胰体尾切除术，术后2个月复发，再次行保留脾脏的胰远端次全切除术。两次术中均快速冰冻切片及术后病检证实为胰岛细胞增生症，随访1年无复发。结论术前诊断为胰源性低血糖但影像学无异常时，应高度怀疑为胰岛细胞增生症。术中快速冰冻切片病检，门静脉连续血糖及免疫反应性胰岛素(IRI)监测可指导诊断和手术切除范围，而胰远端95%次全切除安全可行，疗效肯定。
ObjectiveTo investigate the clinical feasibility of optical surface imaging (OSI) system in guiding thermoplastic body film to fix radiotherapy of pelvic tumors.MethodsFrom January to May in 2019, 20 pelvic tumor patients fixed with thermoplastic films were selected. After the first treatment, cone beam CT (CBCT) was performed to verify and correct the setup errors. OSI was used to collect the patient’s image information as the reference image for the later treatment setup. The later treatment was performed by traditional three-point setup, and OSI was used to record the setup data and monitor the treatment. CBCT scan results were taken as the standard, to calculate the system error (Σ), random error (σ) and margin of three-point and OSI setup. The result of CBCT scan was defined as three-point setup error.ResultsIn lateral-medial, superior-inferior, and anterior-posterior directions, the OSI system errors were 0.14, 0.37, and 0.14 cm, respectively, the random errors were 0.20, 0.57, and 0.23 cm, respectively, and the corresponding margins were 0.49, 1.32, and 0.51 cm, respectively; the three-point setup system errors were 0.13, 0.39, and 0.12 cm, respectively, the random errors were 0.15, 0.43, and 0.13 cm, respectively, and the corresponding margins were 0.43, 1.28, and 0.39 cm, respectively. If the target coverage rate was counted at the 0.8 cm outward margin, the proportions of the three-point setup in lateral-medial, superior-inferior and anterior-posterior were 100.00%, 80.65%, and 100.00%, respectively, and those of the OSI setup were 100.00%, 95.48%, and 99.35%, respectively. Pearson analysis showed that the weakly correlation of lateral-medial, superior-inferior directions had statistical significance (P<0.05), and there was no statistical significance in the other directions (P>0.05).ConclusionsCompared with the traditional three-point setup, OSI cannot improve the setup precision of thermoplastic body film fixation in pelvic tumor radiotherapy. OSI acquired the image of thermoplastic phantom, which is quite different from the actual target location of the patient. OSI application method should be improved in clinical application.
Objective This study analyzed the medical expenditure and its influential factors, and compared the clinical effectiveness and medical expenditure of three major drugs. Methods We designed the cohort study to compare the difference of medical and pharmaceutical expenditures between patients with and without underlying diseases. Multi-linear regression was applied to analyze the influential factors. Incremental expenditure-effectiveness ratio was applied to study three clinically important drugs. Results The curing rate of non-critical patients was statistically significant than critical patients (73.68%, 99.38%, P=0.000) .The curing rate of non-critical patients without underlying diseases was statistically significant than those with underlying diseases in the cohort (96%, 99.66%, P=0.001 6). No significance was identified in the critical patients cohort. The medical expenditure of non-critical patients with and without underlying diseases were 7 879.22 and 7 172.23 RMB per capita, respectively. Accordingly, the medical expenditure in critical patients was 24 912.89 and 26 433.53 RMB per capita. No significance was identified in the two cohorts. Medical expenditure was positively correlated with age and disease severity, with its equation y=4585.71+79.04X1+17188.87X2 (X1: age, X2: disease severity). Regarding the clinical effectiveness and medical expenditure, no significance was identified in critical patients who administered small and medium dose of Methylprednisolone. The expenditure-effectiveness ratios of Ribavirin that was administered by non-critical patients without underlying dissuades were 6 107 and 4 225 RMB, respectively. Accordingly, the expenditure-effectiveness ratios of Thymosin were 11 651 and 6 107 RMB. Conclusions The curing rate of non-critical patients without underlying diseases was higher than the counterpart in the cohort. No influence of underlying diseases was found in the critical patient cohort. Medical expenditure was positively correlated with age and disease severity. Small-and-medium dose of Methylprednisolone might not influence the curing rate and medical expenditure in critical patients. The effectiveness of Thymosin for non-critical patients with and without underlying diseases was not significantly different. However, additional 5 877 RMB occurred if Thymosin was administrated. Likewise, the effectiveness of Ribavirin for non-critical patients remains the same. However, additional 1 082 RMB was consumed in Ribavirin-administrated patient.
ObjectiveTo systematically review the efficacy and safety of hemihepatic blood flow occlusion versus Pringle's maneuver during hepatectomy. MethodsWe electronically searched The Cochrane Library (Issue 8, 2013), PubMed, EMbase, CBM, CNKI, VIP and WanFang Data for randomized controlled trials (RCTs) about hemihepatic blood flow occlusion versus Pringle's maneuver during hepatectomy. The duration of search was from the inception of the databases to August 2013. Meanwhile, references of the included studies were also retrieved. After literature selection, data extraction and quality assessment conducted by two reviewers independently, meta-analysis was conducted using RevMan 5.2 software. ResultsSeven studies involving 624 patients were finally included. The results of meta-analysis showed that: a) for safety, Pringle's maneuver was shorter than hemihepatic blood flow occlusion in operation time (SMD=0.34, 95%CI 0.02 to 0.66, P=0.04). But they were alike in intraoperative blood loss, transfusion requirements, hospitalization time, and complications. b) For effectiveness, Pringle's maneuver was lower than hemihepatic blood flow occlusion in the levels of 3rd day ALT (SMD=-0.71, 95%CI-1.28 to-0.14, P=0.02), 7th day ALT (SMD=-1.73, 95%CI-2.85 to-0.62, P=0.002), 1st day AST (SMD=-0.74, 95%CI-1.38 to-0.09, P=0.03), 7th day AST (SMD=-0.99, 95%CI-1.26 to-0.71, P < 0.000 01), 3rd day TBIL (SMD=-0.34, 95%CI-0.57 to-0.10, P=0.005), and 7th day TBIL (SMD=-0.52, 95%CI-1.02 to-0.01, P=0.04). ConclusionCompared to the Pringle's maneuver, hemihepatic blood flow occlusion during hepatectomy could promote the recovery of liver function. However, the number of the included RCTs in the review is small and the quality is low, some of the main information is not reported and the information for analysis lacks. Therefore, the aforementioned conclusion needs to be verified by conducting more large-scale, multicenter and high-quality RCTs.
Objective To summarize primary clinical data from Xiao Tang Shan Hospital (XTSH) Information System, to provide evidence for clinical data of emerging diseases. Method The primary data were extracted from XTSH information system, which related to demographic and background information, case history, prescriptions, laboratory tests, physical examination, vital sign, surgery, diagnostics and expenditures. The software for data verification was developed by Delphi language program. The information of SARS management was developed by Oracle Developer. Results XTSH information system for SARS management collected 1.09 million pieces of information covering 680 SARS cases. The database was functionally divided into inquiry window, conditional case list window and case details spread window, which provided information of SARS management and shaped a platform for further investigation. Quality control of clinical data was done by the software of SARS Information Real Control.Conclusions XTSH information system collected complete data of SARS management, which made healthcare, research and policy-making on SARS accessible, and made it possible to share resources and train the professionals.