ObjectiveTo evaluate the clinical efficacy and safety of telbivudine (TEV) combined with adefovir dipivoxil (ADV) for chronic hepatitis B (CHB), so as to provide references for clinical practice and research. MethodsWe electronically searched databases including The Cochrane Library (Issue 7, 2013), PubMed, EMbase, Web of Science, CBM, CNKI, VIP, and WanFang Data from inception to August 21st, 2013, for the relevant randomized controlled trials (RCTs). Other sources were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the quality of included studies. Then, meta-analysis was performed using RevMan 5.1 software. ResultsA Total of 11 RCTs involving 1 010 patients were included. The trial group were given TEV combined with ADV, while the control group were given TEV alone or ADV alone. The results of metaanalysis showed that, the combined use was superior to TEV alone or ADV alone in improving HBV-DNA negative rates at 12-, 24-, 48-weeks, HBeAg negative rates at 12-, 24-, 48-weeks, and ALT recovery rates at 12-, 24-weeks (P < 0.05). The results of qualitative analysis showed that, the trial group had a lower drug resistance rate, and both were alike in the incidence of adverse reaction. ConclusionCompared with TEV alone or ADV alone, TEV combined with ADV could improve the clinical efficacy of treating CHB which is also fairly safe. Due to the limited quantity and quality of the included studies, the aforementioned conclusion still needs to be further verified by conducting more large-scale and high quality RCTs.
Objective To investigate the dynamic expression and clinical significance of myoglobin, creatine kinase and inflammatory mediators in the serum of patients with multiple trauma. Methods From May 2013 to March 2015, 56 patients with multiple trauma admitted in EICU were recruited in the study. According to the injury severity, 56 patients were divided into a mild trauma group, a medium trauma group and a severe trauma group. The subjects were further divided into a MODS group and a non-MODS group based on multiple organ dysfunction syndrome (MODS) criteria. Twenty healthy adults undergoing physical examination were recruited as control. Serum myoglobin, creatine kinase, IL-6 and TNF-α levels were measured in the multiple trauma patients (1st day, 3rd day, 7th day and 14th day) and the controls. Results Compared with the controls, the serum levels of myoglobin, creatine kinase, IL-6 and TNF-α in the patients with multiple trauma increased significantly from 1st to 14th day after injury (allP＜0.05). Serum myoglobin, creatine kinase, IL-6 and TNF-α levels on 3rd day after injury reached the peak, then decreased gradually in the mild, medium, and severe trauma groups, among which the changes of serum myoglobin, creatine kinase, IL-6 and TNF-α levels were significant on 3rd day compared with other timepoints (allP＜0.05). On 1st day after injury, serum levels ofmyoglobin, creatine kinase, IL-6 and TNF-α also differed significantly between the MODS group and non-MODS group (allP＜0.05). The AUCs of myoglobin, IL-6 and TNF-α for predicting MODS were 0.527-0.817, 0.641-0.890, and 0.197-0.544, respectively. Conclusions The dynamic changes of serum myoglobin, creatine kinase, IL-6 and TNF-α in patients with multiple trauma are correlated well with the injury severity and prognosis. Serum myoglobin, IL-6 and TNF-α levels may be good markers to predict secondary MODS in multiple trauma patients.
ObjectiveTo investigate the medium-term effectiveness of both side stereo suture for meniscus bucket handle tear under arthroscopy. MethodsBetween January 2009 and December 2012, 38 patients with combined injury of meniscus bucket handle tear underwent arthroscope surgery by the method of both side stereo suture. There were 26 males and 12 females with an average age of 32 years (range, 19-42 years). The injury causes included sports injury in 21 cases, traffic accident injury in 11 cases, and other trauma in 6 cases. The left knee was involved in 15 cases and the right knee in 23 cases. The interval between injury and operation was 2 days to 6 months (mean, 2.5 months). MRI examination showed meniscus injury at grade Ⅲ, including 22 cases of internal injury and 16 cases of lateral injury. The Barrett standard, Lysholm score of knee joint, and joint mobility were used to assess the function recovery of the knee joint. ResultsAll incisions healed primarily with no complication. All cases were followed up 24.5 months on average (range, 18-36 months). Based on the Barrett standard, meniscus bucket handle tear was successfully repaired in all cases. The Lysholm scores and range of motion of the knee at 6 months, 12 months, and last follow-up were significantly better than preoperative ones (P<0.05). ConclusionThe both side stereo suture of meniscus bucket handle tear under arthroscopy has an excellent medium-term effectiveness, with the advantages of firm suture and high healing rate.
ObjectiveTo systematically review the efficacy and safety of chemo-radiotherapy combined with hyperthermia (HCRT) for rectal cancer, and to provide evidence for clinical practice. MethodsWe searched the Cochrane Library (Issue 6, 2014), PubMed, EMbase, Web of Science, CBM, CNKI, VIP and WanFang Data databases from inception to July 2014. All relevant randomized controlled trials (RCTs) of HCRT for rectal cancer were collected. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software. ResultsA total of 9 RCTs involving 663 patients were included. The results of meta-analysis showed that:Compared with the chemo-radiotherapy (CRT) group, the HCRT group were significant superior in complete response (OR=3.74, 95%CI 2.14 to 6.53), total effective rate (OR=4.23, 95%CI 2.69 to 6.66), 3-year survival rate (OR=4.48, 95%CI 1.81 to 11.06) and recurrence rate (OR=0.19, 95%CI 0.09 to 0.42). ②Compared with the radiotherapy (RT) group, the HCRT group was associated with significant improvement in complete response rate (OR=3.01, 95%CI 1.24 to 7.29). ConclusionCurrent evidence shows, HCRT is superior to CRT or RT in the treatment of rectal cancer. However, due to the limited quantity and quality of the included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo observe the effectiveness of the forearm free arterialized venous flap in repairing soft tissue defect of the hand. MethodsBetween December 2008 and January 2013, 49 cases of soft tissue defects of the hand were treated. There were 39 males and 10 females, aged 16-52 years (mean, 34 years). Defect was caused by crush injury in 34 cases, cutting injury in 7 cases, avulsion injury in 5 cases, and hot crush injury in 3 cases. The locations were index finger in 21 cases, middle finger in 14 cases, ring finger in 10 cases, little finger in 1 case, and the first web space and the dorsal palm in 3 cases. The duration of injury and admission was 2-10 hours (mean, 4.5 hours). The size of defects ranged from 2.5 cm×1.5 cm to 6.0 cm×4.5 cm. Of them, 46 cases had fracture of metacarpal or finger bone and/or injury of tendon and nerve. Emergency operation was performed in 43 cases and selective operation in 6 cases. All defects were repaired by free arterialized venous flap from the ipsilateral forearm, in which the proximal ends of veins were anastomosed to artery and vein of the finger. The flap size ranged from 3.5 cm×2.5 cm to 7.5 cm×5.3 cm. The donor site was directly sutured. ResultsSeven flaps survived which was similar to physiological free flap. Mild or medium swelling and blister were observed in 39 flaps and heavy swelling and partial necrosis occurred in 3 flaps after operation. The patients were followed up 6 months-2 years (mean, 13.5 months). The flaps had soft texture, slightly bulky appearance, and deeper color than normal skin. At last follow-up, the two-point discrimination was 16-22 mm (mean, 20 mm). According to the standard for functional evaluation issued by Hand Surgery Association of Chinese Medical Association, the results were excellent in 21 cases, good in 21 cases, fair in 3 cases, and poor in 4 cases. ConclusionIt is an ideal method to repair soft tissue defect of the hand to use forearm free arterialized venous flap. It has the advantages of massive area, no major blood vessel needed to be sacrificed, safe and easy operation, and satisfactory appearance.