Breast cancer is one of the most common malignant tumors among women. Typically, the operation of breast cancer should include breast surgery and axillary lymph node surgery since breast cancer first metastasizes to regional axillary lymph nodes. However, postoperative breast cancer-related lymphedema (BCRL) in upper limb is the most common long-term complication. The injury to upper limb lymphatic system contributes to causing the postoperative BCRL. Therefore, precision medicine in the extent of axillary lymph node surgery plays an important role in preventing BCRL which can improve the quality of life in breast cancer patients.
Objective To produce anatomical theory evidence for treatment of cubital tunnel syndrome with anterior submuscular transposition.Methods Of 32 patients with cubital tunnel syndrome, there were 22 males and 10 females, aged 17-73 years. The distribution of the branches of superior ulnar collateral arteryand the relationship between superior ulnar collateral artery and ulnar nerve were observed; the position, scope and diameter of ulnar nerve lesion were also observed; the volume of new cubit tunnel was measured with dilator. Twenty cubituses of adult cadavers were made the models of anterior subcutaneous transposition and anterior submuscular transposition of ulnar nerve. Length changes of ulnar nerve in different situations were observed.Results Superior ulnar collateral artery could be transposed with ulnar nerve, and new cubit tunnel was wide enough to contain ulnar nerve. In the context of anterior subcutaneous transposition, the ulnar nerve was lengthened by 7.55%±0.52% when compared with that of preoperation in the case of elbow extension, there was significant difference (P＜0.05). In the context of anterior submuscular transposition, there was nosignificant difference in length of the ulnar nerves between preoperation and postoperation(P＞0.05).Conclusion Anterior submuscular transposition can overcome compression and pull of elbow on the ulnar nerve and has sufficient blood supply. New cubital tunnel is wide enough to contain ulnar nerve. Ulnar nerve anterior submuscular transposition is a useful method in treating cubital tunnel syndrome.
Objective To evaluate the efficacy and safety of tetramethylpyrazine (TMP) for diabetic peripheral neuropathy (DPN). Methods Randomized controlled trials were identified from CBM (1978-2003.3), TCMLRS (1980-2003.3), Medline (1970-2003.3), EMbase (1970-2003.3) and Cochrane Library (issue 3, 2003). We handsearched Journal of Traditional Chinese Medicine (1990-2002), New Chinese Medicine (1990-2002), Chinese Journal of Integrated Traditional and Western Medicine (1990-2002) and Research of Traditional Chinese Medicine (1990-2002). Papers of the controlled trials of clinical therapeutic studies on DPN treatment by Chinese medicine herb TMP were included and analyzed according to the criteria of the Cochrane Handbook in 1997. Results Six RCTs involving 669 patients were included, with all trials of low methodological quality. Meta-analysis indicated TMP was more effective than western medicine on pain or numbness of extremities of DPN [The pooled OR = 10.12, 95%CI (6.70 to15.28), P=0.000] and motor nerve conduction velocity change of common peroneal nerves and median nerves . Only one trial reported the side effects of TMP, such as dizziness and headache. Conclusions Based on the review, TMP infusion may have positive effect on DPN. However, the evidence is not b enough due to the general low methodological quality, so we can’t draw a reliable conclusion about the effects of TMP for DPN at the moment. Further large randomized, double blind, placebo-controlled trial are needed.
Objective To systematically evaluate the efficiency of fertility-sparing surgery (FSS) compared with radical comprehensive surgery (RCS) in early stage epithelial ovarian cancer (eEOC). Methods We searched databases including PubMed, EMbase, The Cochrane Library (Issue 8, 2016), Web of Knowledge, CBM, WanFang Data and CNKI to collect the studies about FSS compared with RCS for eEOC from ineaption to August 10th, 2016. Two reviewers independently evaluated the eligibility of identified studies and extracted the data. Then, meta-analysis was performed using Stata 12.0 software. Results Eight studies involving 2 561 patients were included. The results of meta-analysis showed that: compared with RCS, the aggregated RR of overall survival (OS) of FSS (univariate analysis: RR=1.03, 95%CI 0.98 to 1.07,P=0.815; multivariate analysis: RR=0.81, 95%CI 0.52 to 1.28,P=0.255), the cumulative disease free survival (DFS) of FSS (univariate analysis: RR=1.02, 95%CI 0.96 to 1.09,P=0.968; multivariate analysis: RR=1.24, 95%CI 0.65 to 2.39,P=0.115) and the recurrence of FSS (RR=0.86, 95%CI 0.57 to 1.30,P=0.902), there was no significant difference. This pattern also emerged in the subgroup analysis for FIGO IA and IC patients, and the results showed that there was no significant difference between FSS and RCS in IA patients (OS: RR=0.99, 95%CI 0.98 to 1.02,P=0.186; DFS: RR=1.01, 95%CI 0.95 to 1.06,P=0.541); and IC patients (OS: RR=0.95, 95%CI 0.86 to 1.04,P=0.251; DFS: RR=0.94, 95%CI 0.80 to 1.11,P=0.664). Conclusion In eEOC, FSS does not have a negative effect on oncological outcomes compared with RCS. However, well-designed and large-scale trials are needed to verify this outcome in the future.
目的 总结肾移植术后肺部感染的临床表现、病原学及救治措施，以提高其治愈率。 方法 对四川大学华西医院50例次肾移植术后肺部感染住院患者的病历资料进行回顾性分析。 结果 共收集42例（50例）次肾移植肺部感染患者，痰培养检出病原体38例次（76%），未检出12例次，其中细菌感染17例次（44.7%），真菌感染7例次（18.4%），巨细胞病毒感染19例次（38%），支原体感染6例次（12%），混合感染10例次（20%）。肺部感染发生在肾移植术后1个月以内者3例（7%），1～6个月者16例（38%），6个月以后者23例（55%）。50例次感染患者中48例次经积极治疗抢救后好转出院，有2例患者死亡。 结论 肾移植术后肺部感染患者的病原体与肾移植术后时间有一定的规律性。对于肾移植术后肺部感染，救治成功的关键是早期病原体及CT检查，及时给予综合治疗措施，包括经验性抗生素治疗措施，及时调整免疫抑制剂方案，加强全身支持。
ObjectiveTo investigate the diagnostic value of lateral chromatography for cryptococcal capsular polysaccharide antigen in cryptococcal infection.MethodsThe data of patients who detected cryptococcal capsular polysaccharide antigen in West China Hospital of Sichuan University in 2018 were collected. The sensitivity, specificity, positive predictive value and negative predictive value of cryptococcal capsular polysaccharide antigen detected by lateral chromatography were analyzed. The samples with positive lateral chromatography and definite clinical diagnosis were compared with the results of ink staining and fungal culture.ResultsA total of 721 cases were detected. The sensitivity, specificity, positive predictive value and negative predictive value of lateral chromatography detection were 100.00%, 99.39%, 93.93%, 100.00%, respectively. The positive rates of ink staining, fungal culture and cryptococcal capsular polysaccharide antigen for cryptococcal infection were 63.46%, 48.00% and 100.00%, respectively. Sixty-two patients were clinically diagnosed, including 45 cases of cryptococcal meningitis (72.58%), 16 cases of cryptococcal pneumonia (25.81%), and 1 case of bone cryptococcal infection (1.61%).ConclusionsLateral chromatography detection for cryptococcal capsular polysaccharide antigen shows well performing sensitivity and specificity in the diagnosis of cryptococcal infection. Considering its rapid and simple pre-operation, cryptococcal capsular polysaccharide antigen detection with lateral chromatography has good application value for early diagosis of cryptococcal infection.
ObjectiveTo understand the drug resistance of Mycobacterium tuberculosis complex in West China Hospital, Sichuan University, analyze its drug resistance characteristics, and provide reference for the monitoring of drug-resistant tuberculosis.MethodsFrom January 2016 to March 2018, Mycobacterium tuberculosis drug susceptibility testing kit was used to detect the drug susceptibility of Mycobacterium tuberculosis culture-positive strains in Department of Laboratory Medicine, West China Hospital, Sichuan University. The tested drugs included four of the first-line anti-tuberculosis drugs: rifampicin, isoniazid, ethambutol, and streptomycin, and ten of the second-line anti-tuberculosis drugs: capreomycin, ofloxacin, ethionamide, p-aminosalicylic acid, levofloxacin, moxifloxacin, rifabutin, amikacin, kanamycin, and chlorine phenazine.ResultsA total of 130 patients (130 strains) were enrolled, including 82 newly diagnosed patients (82 strains) and 48 re-treated patients (42 strains). The drug resistance rate of the 130 patients was 37.69%. The drug resistance rate of the newly diagnosed patients (28.05%) was significantly lower than that of the re-treated patients (54.17%), and there was a statistical difference (χ2=8.794, P=0.003). The multi-drug resistance rate of the newly diagnosed patients (6.10%) was significantly lower than that of the re-treated patients (25.00%), and the difference was statistically significant (χ2=9.517, P=0.002). The resistance rate of isoniazid, rifampicin, and streptomycin in newly diagnosed patients (23.17%, 8.54%, and 7.32%, respectively) were significantly lower than those in the re-treated patients (45.83%, 41.67%, and 29.17%, respectively), and the differences were statistically significant (P<0.05). The resistance rate of ofloxacin, moxifloxacin, rifabutin and ethionamide in the newly diagnosed patients (9.76%, 8.54%, 7.31%, and 4.88%, respectively) were significantly lower than those in the re-treated patients (39.58%, 27.08%, 25.00%, and 22.92%, respectively), and the differences were statistically significant (P<0.05).ConclusionIt is necessary to strengthen the standardized treatment of patients with newly diagnosed tuberculosis, increase the treatment and management of re-treated tuberculosis patients, and prevent the generation and spread of drug-resistant patients, especially multidrug-resistant patients.
ObjectiveTo investigate the blood pressure level and prevalence of hypertension in middle-aged people with positive family history of hypertension in Chengdu area, compare the differences between middle-aged people with positive family history of hypertension and middle-aged people with negative family history of hypertension, and explore the influencing factors of hypertension in middle-aged people with positive family history of hypertension.MethodsFrom September 2013 to March 2014, the stratified sampling method was used to survey 3 096 middle-aged people aged 40-59 years in Chengdu. Their height, weight, blood pressure, blood glucose, and blood lipids were measured. Questionnaire surveys were conducted using a uniformly designed questionnaire. The blood pressure levels and hypertension prevalences were compared between people with and without positive family history of hypertension. The influencing factors of hypertension in middle-aged people with positive family history of hypertension were analyzed using multiple logistic regression.ResultsThere were significant differences between the middle-aged people with positive family history of hypertension and the ones with negative family history of hypertension in systolic blood pressure [(137.4±22.4) vs. (118.0±11.3) mm Hg (1 mm Hg=0.133 kPa), P<0.001], diastolic blood pressure [(84.1±12.2) vs. (73.9±7.7) mm Hg, P<0.001], and prevalence of hypertension (28.6% vs. 22.2%, P<0.001). Ageing [odds ratio (OR)=1.107, 95% confidence interval (CI) (1.071, 1.144), P<0.001], monthly personal income ≥3 000 yuan [OR=1.566, 95%CI (1.003, 2.445), P=0.048], and abdominal obesity [OR=1.658, 95%CI (1.091, 2.520), P=0.018] were the risk factors for hypertension in middle-aged males with positive family history. Ageing [OR=2.257, 95%CI (1.202, 4.025), P=0.026] and overweight or obesity [OR=2.365, 95%CI (1.653, 3.385), P<0.001] were the risk factors, and physical exercise [OR=0.529, 95%CI (0.304, 0.918), P=0.024] was the protective factor for hypertension in middle-aged females with positive family history.ConclusionsThe prevalence of hypertension is high in middle-aged population with positive family history of hypertension in Chengdu and is significantly higher than that in the ones with negative family history of hypertension. Strengthening health education on hypertension-related knowledge, and reasonably controlling waist circumference and body weight may have positive significance in preventing or delaying the occurrence of hypertension in people with positive family history of hypertension.
Objective To evaluate efficacy and safety of domestic Nateglinide tablet in comparison with domestic Repaglinide in Type 2 diabeties. Methods A multi-centre, double-blind, dummy trial was conducted.Two hundred and thirty type 2 diabetic patients recuited from 5 clinical centers were randomly allocated into Group A (domestic Repaglinide, 1.0 mg tid, n =115) and Group B (domestic Nateglinide, 90 mg tid, n =115).The trial consisted of a 4 weeksequilibrated period followed by 12 weeks treatment course. Results Ninety seven percent of patients(223) completed the trial (110 in Group A and 113 in Group B). The mean of fasting blood glucose (FBG) in both Group A and B was decreased statistically (P＜ 0.000 1) after 2, 6 and 12 weeks duration. At week 12, the mean FBG in Group A and B was reduced by 1.68±1.81 mmol/L (17.27%) and 1.17±1.67 mmol/L (12.53%) respectively with statistically significant difference between the two groups (P=0.017 7). The mean of 120 minutes postprandial blood glucose (PBG) also lowered markedly in 2, 6, and 12 weeks in both groups. At the end of therapy, PBG of 30, 60, 120 minutes were reduced significantly, mean of 120 minutes PBG was reduced 3.95±3.25 mmol/L (26.12%), and 3.81±3.05 mmol/L (26.22%) respectively in Group A and B , the differences in reduction between Group A and B had no statistical significance (P =0.726 9). In Group A and B, the mean of Alc was reduced significantly after 12 weeks duration. At week 12, the mean of Alc in Group A and B was lowered by 1.21% and 0.68% respectively, with statistical difference between the two groups (P =0.002 3). Though fasting insulin level in both groups had no change after 12 weeks duration, the insulin level at 30, 60 and 120 min increased significantly in both groups (P＜0.000 1). It suggested that both Nateglinide and Repaglinide promoted insulin secretion in early phase with maximal value at 60 min in Repaglinide group and 30 min in Nateglinide group, respectively. The adverse reaction rate in Group A including hypoglycemic reaction, thrombocytopenia and recrudescence of HBV was 4.5% when compared to only one case of thrombocytopenia in Group B (0.87%). Conclusions Both domestic Nateglinide and Repaglinide have similar effect on reducing postprandial blood glucose, but Repaglinide has ber effect on reducing FBG and A1c than Nateglinide. The results suggest that both domestic Nateglinide and Repaglinide are safe and generally well-tolerated in type 2 diabetic patients.