Objective To evaluate the effectiveness and safety of intraluminal brachytherapy (ILBT) in prolonging survival and the period free of symptoms for patients with unresectable bile duct cancer. Methods We searched MEDLINE (1977 to May 2007), CNKI (1979 to May 2007) and CBM Disk (1979 to May 2007). The qual ity of included studies was assessed according to the guidance in the Cochrane Handbook for Systematic Reviews of Interventions. Results One randomized controlled trial involving 42 patients with unresectable bile duct cancer fulfilled the inclusion criteria. This found that the median survival time was longer for patients treated with endoprostheses and ILBT compared to those treated with endoprostheses alone (387.9 days versus 298.0 days, Plt;0.05). The stent patency time in patients who were treated with endoprostheses and ILBT was longer than for those treated with endoprostheses alone (378.4 days versus 245.5 days, Plt;0.01). The reductions in bil irubin (mol/l) and alkal ine phosphatase (kat/l) before and after drainage in patients who were treated with endoprostheses and ILBT were similar to those treated with endoprostheses alone (Mean ±SD of bil irubin: before: 219.3 ± 40.5, after: 23.1 ± 37.1 versus before: 227.3 ± 39.8, after: 22.5 ± 44.2; Mean ± SD of alkal ine phosphatase: before: 10.3 ± 5.1. after: 3.6 ± 2.9 versus before: 11.7 ± 5.8, after: 3.7 ± 2.9). No severe adverse effects were observed in the trial. Conclusion Current evidence suggests that ILBT for unresectable bile duct cancer may improve the survival time of patients, prolong the time they spend symptom free, improve their quality of l ife and reduce the burden of treatment. However, it may increase toxicity in normal tissues, which can be managed by adjusting radiation dosage. No serious adverse effects were observed in the 42 patients in the trial in this review. More randomized controlled trials with large sample size are needed to provide rel iable results.
Objective To review the recent advances in transforming growth factor-β(TGF-β) super family study and its role in new bone formation. Methods The latest original articles related to this subject were retrieved extensively,especially the effect of TGF-β, bone morphogenetic proteins(BMPs) and activin(ACT) on distractionosteogenesis. Results TGF-β, BMPs and ACT play important roles in prompting new bone formation and each of them has different effects. Among them, TGF-β can stimulate the proliferation of osteoblast and synthesis ofextra cellular medium; BMPs can initiate the differentiation of interstitial cell toosteocyte; then ACT displays the combine effect of above two factors. Conclusion TGF-β superfamily can regulate new bone formation and thus shorten the course of mandibular distraction osteogenesis.
Objective To evaluate the clinical and histopathological manifestations of sympathetic ophthalmia after pars plana vitrectomy. Methods The clinical data of 8 patients with sympathetic ophthalmia out of 13 000 who underwent pars plana vitrectomy from Jan 1998 to Dec 2004 were retrospectively analyzed. In the 8 patients, 3 evoked eyes underwent ophthalmectomy and were observed histopathologically. Results The incidence of sympathetic ophthalmia was 0.06%. The time from vitrectomy to the occurrence of sympathetic ophthalmia ranged from 7 to 150 days, with a median of (77.8plusmn;50.8) days. All patients had decrease of visual acuity of the sympathetic eye, visual distortion, red eye, and opthalmalgia. The visual acuity was hand moving to 0.5 in the sympathetic eyes, and no light perception to 0.04 in the evoked eyes. Other clinical manifestations included binocular mutton-fat keratic precipitates, anterior chamber flare and cells, vitreous opacity, optic-disc edema and hyperaemia, and retinal edema at the posterior pole; 2 sympathetic eyes had exudative retinal detachment. The visual acuity increased to 0.4-1.2 in sympathetic eyes and light perception -0.25 in evoked eyes in all of the patients after treatment with oral administration of prednisone 1.0-1.5 mg/kg. In the 3 patients who had undergone ophthalmectomy because of total loss of visual acuity, and the pathological examination revealed infiltrated and thickeduvea due to lymphocytes, epithelioid cell nodules, infiltration of lymphocytes to sclerotic passages, and ocular atrophy were observed. Conclusion The incidence of sympathetic ophthalmia is 0.06%, which happened within 3 months after vitrectomy. The clinical manifestations and results of histological examinations accords with the characteristics of sympathetic ophthalmia. (Chin J Ocul Fundus Dis, 2007, 23: 112-114)
Objective To investigate the characteristics and risk factors of optic nerve atrophy in eyes with complicated retinal detachment after silicone oil tamponade during the procedure of vitreoretinal operation. Methods The clinical data of 97 patients with complicated retinal detachment who had optic nerve atrophy after silicone oil tamponade during the procedure of vitreoretinal operation were an alyzed retrospectively. Logistic regression analysis by SPSS statistical software was used to analyze the factors like age, disease history, primary diseases, preoperative ocular condition, complications in and after the operation, the time taking out the silicone oil, and emulsification of the silicone oil, and Ple;0.05 was considered to be the symbol of significant difference. Results All of the affected eyes had optic discs with clear border, including paler optic disc in 65 eyes, pale one in 21 eyes, and paler optic disc with enlargement of the cup/disc (ge; 0.6) in 11 eyes. The result of logistic regression analysis showed that the intraocular pressure (P=0.022) and the visual acuity (P=0.001) during the silicone oil removal were in the equation. Conclusion The risk factor of optic nerve atrophy is the chronic increase of intraocular pressure after silicone oil tamponade. (Chin J Ocul Fundus Dis, 2006, 22: 305-307)
ObjectiveTo observe the clinical effect of radial optic neurotomy (RON) for central retinal vein occlusion (CRVO).MethodsThe clinical data of 5 patients with CRVO who had undergone RON after a standard three-port vitrectomy were analyzed retrospectively. In the 5 patents, CRVO was diagnosed in 2 before the surgery, and the examination of visual acuity, fundus photography, fundus fluorescein angiography (FFA), color doppler imaging (CDI), and examination of perimeter and optic coherence tomography (OCT) were performed on them before and after the operations, respectively. Three patients underwent the operation because of the vitreous hemorrhage and CRVO was diagnosed during the surgery. All of the 5 patients suffered from severe macular edema. The results of post-operative visual acuities, fundus examination, fundus photography and OCT were compared with those of the pre-operative ones. The follow-up after the surgery was 12 months. ResultsThe visual acuities improved in 4 patients and decreased in 1. The results of fundus photography and (or) FFA, and OCT revealed that the macular edema was evidently alleviated 1 month after the surgery and the retinal hemorrhage was absorbed ultimately 2 months after the surgery. The result of examination of perimeter performed on 1 case showed the improvement of visual field. In addition, vitreous hemorrhage occurred in 1 patient postoperatively and hemorrhage occurred in 2 in the operation puncturing the optic disk.ConclusionsRON is helpful to ameliorate the macular edema, reduce the retinal hemorrhages, prevent the neovascularization and enhance the visual acuity to some extent, which maybe clinically feasible and valuable in treating CRVO，but more prospective, randomized, and multi-center researches are still needed to verify the efficacy.(Chin J Ocul Fundus Dis, 2005,21:6-9)
Objective To investigate the effects and complications of the vitrectomy for Eales′ disease with vitreous hemorrhage or traction retinal detachment. Methods Seventy-seven eyes of 69 cases undergoing vitrectomy for Eales′ disease with vitreous hemorrhage or traction retinal detachment were analyzed retrospectively. Results (1) The postoperative visual acuity was enhanced significantly. (2) Complications during the operation in 11 eyes (14.3%): iatrogenic retinal break in 7 eyes, bleeding in 3 eyes and lens damage in 1 eye. (3) Postoperative complications in 20 eyes (26.0%): rebleeding in 14 eyes, elevated IOP in 6 eyes, retinal detachment in 5 eyes, hyphema in 2 eyes, and exudative membrane in anterior chamber in 1 eye. (4) The main long-term complication was cataract formation (9 eyes) and macular disorder (6 eyes). Conclusion Vitrectomy is an effective method to treat Eales′ disease with vitreous hemorrhage or traction retinal detachment. (Chin J Ocul Fundus Dis, 2002, 18: 215-217)
Objective To evaluate the feasibility and clinical outcomes of laparoscopic total mesorectal excision (TME) in treating mid-low rectal cancer. Methods From March 2005 to July 2008, 74 patients with mid-low rectal cancer undergoing laparoscopic TME in Zhejiang Cancer Hospital were collected. The data of clinicopathologic parameters were analyzed. Results Laparoscopic TME was performed on 74 patients with mid-low rectal cancer. No operative death occurred in this group. No case was converted to open procedure. The mean operation time was 187 min. The mean operative blood loss was 90 ml. The mean postoperative hospital stay was 10 d. Bowel function was restored on 46 h after operation on average. The mean distance between tumor and the section edge was 3.1 cm. The average number of lymph node dissection was 19.7. The sphincter preservation rate was 97% in patients with tumor 6 cm above the anal verge. The follow-up times were 2-44 months, average 25 months. The incidence of complications was 9.5%. No tumor cell port site implantation or distant metastasis happened. One case was pelvic recurrence， no patient was dead.Conclusion Laparoscopic TME is a feasible, safe and minimally invasive technique for the patients with mid-low rectal cancer, achieving the principles of TME.
ObjectiveTo explore the effect of comprehensive nursing service in patients with autoimmune encephalitis (AE).Methods32 patients with AE were selected and treated in our hospital from January 2017 to January 2019. There are 16 patients in the observation group and the control group respectively. The observation group received comprehensive nursing service and the control group received routine nursing intervention. Total satisfaction of clinical nursing was compared between the two groups.ResultsCompared with 10 cases (62.50%) in the control group, 15 cases (93.75%) in the observation group had better overall nursing satisfaction, and the difference between the two groups was significant (P<0.05).ConclusionsFor patients with AE, comprehensive nursing service can significantly improve the quality of life of patients, which has clinical application value.
Objective To explore the actual experience of epileptic patients in video electroencephalogram (VEEG) examination, and to provide reference basis for formulating corresponding nursing strategies and coping methods. MethodsIn this descriptive analysis study, 18 patients (11 males and 7 females, average age 37.78±18.7 years) receiving VEEG from January to April 2022 in the Second Affiliated Hospital of Guangzhou Medical University, underwent a semi-structural interview. Information obtained from the interview was analyzed using the Colaizzi 7-step method. ResultsThe actual experience of epileptic patients in video EEG examination can be summarized into two aspects: the medical experience and the need for nursing care. The medical experience includes positive and negative experience. The positive experience includes good service attitude, professional medical services, good endurance, and being hopeful. The negative experience includes a weird feeling in the head, insomnia, inconvenience in life, eye discomfort, psychological pressure, and pain. The need for nursing care includes needs for knowledge, strong needs for communicating with doctors, needs for humanistic care and female needs for female implementing the equipment. Conclusion Epileptic patients suffer from different degrees of discomfort and psychological pressure during VEEG examination. Both negative and positive experience exist. Medical staff should improve the content of nursing services according to the nursing needs of patients and provide professional VEEG examination services to patients.
Objective To analyze the clinical efficacy of left subclavian artery (LSA) revascularization combined with thoracic endovascular repair (TEVAR) in the treatment of Stanford type B aortic dissection (AD). MethodsA retrospective analysis was conducted on patients treated with TEVAR combined with LAS reconstruction surgery at Wuhan Central Hospital in Hubei Province from 2017 to 2021. The patients were divided into a reconstruction group and a simple stent group. The reconstruction group was subdivided into a hybrid reconstruction group and a chimney reconstruction group according to the different methods of reconstruction surgery. Perioperative data of different groups were compared. A total of 144 patients were included, including 108 males and 36 females. There were 113 patients in the simple group and 31 patients in the reconstruction group. There were statistically significant differences in surgical time, hospital stay, preoperative lesion area diameter, and postoperative right vertebral artery diameter between the reconstruction group and the simple group (P<0.05). There was no statistically significant difference in postoperative complications between the simple group and the reconstruction group within 1 year (P>0.05). There was no statistically significant difference in surgical time between different surgical procedures in the reconstruction group (P>0.05). During the follow-up period, there were no deaths. A total of 12 (10.6%) patients in the simple group experienced complications, which was lower than that in the reconstruction group (8 patients, 25.8%). Among them, the most common complication in the follow-up of patients in the simple group was internal leakage (5 patients), and there was no statistical difference compared to patients in the reconstruction group (2 patients). The most common complication in the follow-up of patients in the reconstruction group was hoarseness (2 patients), while in the simple group, 1 patient occurred. Conclusion Both different surgeries have good effects on the treatment of type B aortic dissection, and multi center, large sample, and long-term studies are needed.