ObjectiveTo explore the feasibility and curative effect of gastric pacing on postsurgical gastroparesis. MethodsThe indexes of gastric dynamic of applying gastric pacing to the experimental animal model of acute postsurgical gastroparesis was compared with that of injecting erythromycin (1 mg/kg).ResultsThe pressure of gastric antrum and the pressure gradient between gastric antrum and duodenum were respectively higher than basic pressure in the two experimental groups (P＜0.01); Except duodenal pressure, the indexs of gastric dynamic of pacing group were higher than that of erythromycin group (P＜0.05). The gastric emptying rate of pacing group 〔(66.37±7.21)%〕 was higher than erythromycin group 〔(49.92±9.27)%， (P＜0.01)〕. ConclusionHigherfrequency gastric pacing can improve the indexes of gastric dynamic and be applied to treat postsurgical gastroparesis, its effect may be better than erythromycin.
Objective To improve the knowledge of bone marrow tuberculosis by summarizing the risk factors, clinical features, diagnosis, therapeutic response and prognosis. Methods The medical records of 62 patients with bone marrow tuberculosis from January 2004 to December 2014 were retrospectively analyzed. Results The patients included 34 males and 28 females. Their age ranged from 15 to 80 years with a mean age of 45.3±35.7 years. Among them, 21 cases (33.9%) had one or more risk factors such as advanced kidney disease or liver disease, chronic respiratory disease, rheumatoid immune system disease and diabetes. No specific clinical features were found in patients with bone marrow tuberculosis, and the most common symptom was fever (98.4%). Blood routine examination revealed that variety of hematological abnormalities include leucopenia, thrombocytopenia, anemia or pancytopenia occurred in 59 patients (95.2%). Chest CT scan showed typical disseminated tuberculosis in 22 patients (36.1%), secondary pulmonary tuberculosis in 6 patients (9.8%), and atypical manifestations of tuberculosis in 26 patients (42.6%). The common patterns of abdomen abnormalities on ultrasonic testing or CT scan were hepatosplenomegaly. Bone marrow biopsy was performed in all the 62 patients, among them, the needle-aspirated bone marrow specimens showed granulomatous lesions in 53 patients (85.5%). The acid-fast staining of bone marrow smear was performed in a total of 57 patients, which was positive in 28 patients (49.1%). Twenty-five patients completed phone call follow-up, and 8 patients died from bone marrow tuberculosis and its complications. Conclusions Bone marrow tuberculosis is a rare manifestation of disseminated tuberculosis. The common symptom of this disease is pyrexia . The clinical presentations and laboratory examinations of this disease are nonspecific. Bone marrow biopsy is a major method for diagnosis. Part of patients with bone marrow tuberculosis lack of imaging proof for lung lesion. Therefore, we should heighten vigilance for bone marrow tuberculosis in patients with fever of unknown origin.
ObjectiveTo explore the clinical features, diagnosis, differential diagnosis, pathological characteristics, management and prognosis of airway hemangioma, and improve the level of the diagnosis and therapy.MethodsThe clinical data of a patient with airway hemangioma admitted to West China Hospital of Sichuan University were retrospectively analyzed. The related literatures were reviewed. Databases including PubMed, Ovid Medline, Embase, VIP, Wanfang and Chinese National Knowledge infrastructure were searched using the keywords as " Trachea” OR " Bronchus” AND " Hemangioma” from January 1976 to October 2016.ResultsThe patient was a 32-year-old male presented with hemoptysis and backache more than 10 days. His enhanced chest CT scan revealed thickening of the esophagus wall and narrowing of the lumen of esophagus. A wide range of vascular tumor like changes in the trachea and the two sides of bronchus were found by the fiberoptic bronchoscopy and gastroscope examination suggested esophageal varices. Although the patient had a wide range of airway lesions, the symptom of hemoptysis was relieved after the conservative treatment. The patient’s condition was stable until now. From January 1976 to October 2016, a total of 34 related articles were retrieved and 36 cases of airway hemangioma were reported. The etiology of the disease remains unknown. Recurrent hemoptysis was the common symptoms of airway hemangioma, and imaging changes lacking characteristics. Histopathological examination revealed dilated, thin-walled and different size of vascular or hyperplastic capillary and immunohistochemical staining was positive for vascular endothelial cell specific CD34 and Ⅷ factor.ConclusionsHemangioma is a common benign tumor of head and neck in infants and children. Hemangioma is very rarely occurred in trachea in adults. Clinical and imaging manifestations are not specific, and diagnosis relies on histopathological examination. Fiberoptic bronchoscopy and three dimensional reconstruction of thoracic vessels with CT play important roles in the whole process of diagnosis and treatment of airway hemangioma. It should be differentiated from lymphangioma. The prognosis of airway hemangioma is good.
ObjectiveTo strengthen the understanding to hypersensitivity pneumonitis and make early diagnosis and standard treatment by analyzing the clinical features, the diagnosis and treatment of a patient diagnosed as hypersensitivity pneumonitis presenting as progressive fibrotic interstitial lung disease in combination with literature review.MethodsThe diagnosis and treatment process and relevant clinical data of the patient were analyzed retrospectively and literatures were reviewed. Based on 282 relevant literatures, the diagnostic methods, treatment and prognostic factors of hypersensitivity pneumonitis were summarized.ResultsThe patient, female, 45 years old, self-employed, was admitted to the hospital due to "cough, sputum for 9 years, dyspnea for more than 6 months" without obvious extrapulmonary clinical manifestations. Creaks at the bottom of the lungs and clubbed toes were found through physical examination. High-resolution computed tomography indicated that the main manifestations were ground glass and grid-like shadows, presenting characteristics of interstitial pneumonia. The pulmonary lesions aggravated gradually, and part of the lung lobe presented honeycomb lung at the time of diagnosis. Eight years ago, she performed fibrobronchoscopy in other hospital revealing an increased lymphocyte proportion (39%) in bronchoalveolar lavage fluid. Lung function suggested very severe restrictive ventilation dysfunction. She was given prednisone for a short time, and the drug was stopped by herself with uncertain efficacy. Later, she performed frozen lung biopsy suggesting peribronchiolar metaplasia interstitial broadening with lymphocytic infiltration, without granuloma or fibroblast lesions. No obvious abnormity was seen in makers of infections and immunology. At this point, the patient was clearly diagnosed as hypersensitivity pneumonitis. Meanwhile, the patient's pulmonary lesions were still mainly made of ground glass and plaques, partly with changes like honeycomb. Poor response was obtained with anti-inflammatory treatment of prednisone for 3 months and anti-fibrosis treatment of pirfenidon for more than 2 months. Literature review resulted in 87 patients, including 39 males (44.82%) and 48 females (55.18%), with an average age of (47.0±18.4) years. Seventy patients (80.46%) had clear allergens. 3.45% patients' lymphocyte percentage in bronchoalveolar lavage fluid ranged from 20% to 39%, and 19.54% patients' lymphocyte percentage was more than 40%. 4.60% of the patients achieved remission through detachment from allergens; 71.27% of the patients achieved remission with glucocorticoid treatment, 14.94% improved with glucocorticoid treatment, and 1.15% died; 6.89% of the patients achieved remission after receiving anti-allergy therapy. Patients with chronic hypersensitivity pneumonia were found with poor prognosis.ConclusionsIn patients with diffuse interstitial pulmonary fibrosis with unknown cause, transbronchoscope freezing lung biopsy as early as possible is a feasible method for early diagnosis and improving prognosis. Patients with hypersensitivity pneumonitis with a long course of pulmonary fibrosis have a poor response to glucocorticoid and other classic treatments, and most of them have a poor prognosis.
Objective To investiget the necessity of carrying out the education of Tobacco Hazards and Prevention and Control in Chinese universities, and explore the teaching mode of Tobacco Hazards and Prevention and Control suitable for college students, so as to improve the teaching quality and the awareness level of Chinese college students on tobacco hazards. Methods A public elective course on Tobacco Hazards and Prevention and Control was set up in Sichuan University with the teaching mode of scientific popularization education, combining theory and practice. The 43 college students who had completed the public elective course on Tobacco Hazards and Prevention and Control in the autumn semester of 2022 were retrospectively included as the research group (the elective group), and 43 college students who did not take this course in the same period were included as the control group (the non-elective group) by the method of quota sampling. Questionnaire survey was adopted to investigate the basic information, personal and family smoking situation of the two groups of students, evaluate the purpose of taking this course, satisfaction with the course, and mastery of knowledge related to tobacco epidemiology of the students who had completed the course, and compare the awareness of tobacco hazards and the attitude toward tobacco prevention and control between the two groups. Results There was no significant difference in age, gender, education level, place of student source, personal smoking situation, family smoking situation, or secondhand smoking exposure between the two groups (P>0.05). In the elective group, 58.1% of the students chose the course due to their personal interests, and 74.4% of the students were very satisfied with the course. The awareness rates of smoking causing myocardial infarction (97.7% vs. 72.1%) and stroke (97.7% vs. 81.4%), secondhand smoking causing heart disease in adults (97.7% vs. 76.7%), and “low tar not equaling to low hazard” (86.0% vs. 37.2%) in the elective group were significantly higher than those in the non-elective group (P<0.05). The rates of awareness of E-cigarettes being harmful to health and supportive attitude toward smoking being forbidden in public places were high in both groups (P>0.05). Conclusion Carrying out the public elective course on Tobacco Hazards and Prevention and Control in comprehensive universities with the teaching mode of popularizing science education and combining theory and practice can improve the theoretical knowledge and awareness level of college students related to tobacco, which is of great significance to improving the tobacco prevention and control awareness of college students.
Objectives To evaluate the effect and safety of mycobacterium vaccae in the treatment of recurrent treated pulmonary tuberculosis. Methods We searched PubMed (1997 to 2006), VIP (1997 to 2006), Wanfang database (1997 to 2006), The Cochrane Central Register of Controlled Trials (Issue 4, 2006) and the National Research Register (1996 to 2006). Randomized controlled trials comparing the mycobacterium vaccae immunotherapy group and the control group were included. Two reviewers independently performed data extraction and quality assessment. Data were analyzed using RevMan 4.2.2 software by The Cochrane Collaboration. Results Eleven high quality trials were included. Meta-analyses showed that mycobacterium vaccae immunotherapy plus chemotherapy resulted in higher sputum negative conversion rate (RR=1.36, 95%CI 1.21 to 1.54), higher lesion absorption rate (RR=1.39, 95%CI 1.13 to 1.72), and lower lesion non-absorption rate (RR=0.46, 95%CI 0.36 to 0.60), compared with the control group. These differences were all statistically significant. No serious adverse events were reported. Conclusion As an adjunct to chemotherapy, mycobacterium vaccae is helpful for patients with recurrent treated pulmonary tuberculosis in terms of improving cell-medicated immunity, sputum negative conversion and X-ray manifestation. More high quality studies are needed for further analysis.
ObjectivesTo investigate residents’ sensitivity towards basic public health services in Sichuan province, so as to provide advice on future improvement.MethodsUsing multistage stratified sampling and through consultation of the Sichuan province's basic public health service regulatory platform to select 40 equidistant samples from the five key population groups. Specifically, 200 individuals from each of the 21 cities were enrolled. Telephone survey was conducted to acquire residents’ awareness rate, satisfaction and compliance. Technique for order preference by similarity to an ideal solution (TOPSIS) was applied to comprehensively evaluate residents’ sensitivity of basic public health services.ResultsA total of 4 200 community residents who have accepted health managements in basic health care institutions were enrolled. The mean Cj value was 0.523 6. The No.4 city had the highest Cj value of 0.751 9, and the No.10 city had the lowest value of 0.276 3.ConclusionsThe residents’ sensitivity to basic public health services varies in 21 cities of Sichuan province. We should improve the quality of medical services in primary health care institutions and provide wide publicity to enhance the well-being and satisfaction of community residents. Government should improve the quality of medical services in primary health care institutions, and narrow the gap between different cities, so as to improve residents’ experience.
ObjectiveTo investigate the anticoagulant drug treatment decision for patients with renal contusion and acute pulmonary embolism, and to enhance the level of treatment for this disease. MethodsA retrospective analysis of the clinical data of a patient with renal contusion and acute pulmonary embolism treated at the West China Hospital of Sichuan University, along with a relevant literature review. Databases including PubMed, Ovid Medline, Embase, VIP, Wanfang and Chinese National Knowledge infrastructure were searched using the keywords as “Pulmonary embolism” AND “Hemorrhage”from January 1983 to December 2023. ResultThe patient was a 21-year-old male who presented with right kidney contusion for 5 days and dyspnea for 1 day. The abdominal CT scan revealed a ruptured right kidney accompanied by hemorrhage and hematoma in the surrounding tissue. Abdomen ultrasound: a low echogenic area measuring approximately 10.6 cm×2.8 cm is noted around the right kidney. The CT pulmonary angiography (CTPA) demonstrated filling defects at the bifurcation of the pulmonary trunk, as well as within the upper and lower lobes of both lungs and their respective branches. The blood gas analysis of patient indicated (face mask oxygen therapy at 10 L/min, oxygenation index of 120): pH 7.456, PCO2 24.9 mm Hg, PO2 73.2 mm Hg. His myocardial markers were Myoglobin: 79.21 ng/ml, Troponin T: 58.7 ng/L, BNP: 2062 ng/L. The patient was diagnosed with renal contusion and pulmonary embolism, and was treated with subcutaneous heparin（initial dose is given as an 80 IU/kg intravenous bolus, followed by a continuous infusion of 12-18 IU/kg/h） and low-molecular-weight heparin at a dose of 0.8 ml every 12 hours one after another for anticoagulation, along with symptomatic treatment. Following the intervention, the patient's respiratory distress showed significant improvement, and subsequent arterial blood gas analysis indicated enhanced oxygenation. Then, the anticoagulant medication was adjusted to oral rivaroxaban anticoagulation for 6 months, follow-up CTPA scan revealed complete resolution of the pulmonary embolism and the abdominal CT scan indicated a reduction in the extent of patchy low-density shadows surrounding the right kidney, leading to the discontinuation of anticoagulation therapy. After searching the above-mentioned databases, total of 26 articles were identified that reported on 30 patients diagnosed with high-risk bleeding and acute pulmonary embolism; among these, 3 patients succumbed while 27 exhibited clinical improvement. ConclusionsPatients with renal contusion and acute pulmonary embolism can be safely and effectively treated with low-dose heparin anticoagulation under close monitoring. High-risk bleeding patients with acute pulmonary embolism present a significant challenge in clinical practice. After weighing the risks of bleeding disorders and the adverse outcomes of pulmonary embolism, it is necessary to find the optimal balance between anticoagulation and bleeding. Consequently, the formulation of personalized treatment strategies in accordance with established guidelines can enhance patient outcomes.
ObjectiveTo investigate the effectiveness of epidermal growth factor receptor antagonist (AG-1478) on chronic proliferative cholangitis (CPC), so as to investigate new treatment approach for hepatolithiasis associated with CPC. MethodsForty-six SD rats were divided into 5 groups: CPC model group (n=10), only made models. AG-1478 treatment group (divided into 3 mg/kg， 6 mg/kg， and 12 mg/kg groups, n=10 per group), the common bile ducts in CPC animal model received an intralumenal administration of AG-1478 at the meantime of modeling, followed by intraperitoneal AG-1478 injection of 1.5 mg/(kg·d) for 7 days. Sham operation group (SO group, n=6). Subsequently, histopathological observation, immunohistochemistry, real time PCR， and Western blot were used to evaluate the mRNA expression and influence of AG-1478 on the hyperplasia （EGFR， ki-67， BrdU， collagen Ⅰ protein） and lithogenic potential (Mucin 5AC) of CPC. ResultsCompared with CPC model group, the expressions of EGFR, ki-67， and BrdU were obviously decreased in the AG-1478 treatment group. Also, the inhibition of hyperplasia of biliary epithelium and collagen fibers were confirmed by histopathological observation. Additionally, the expressions of Mucin 5AC mRNA and collagen Ⅰ protein remarkable decreased in the AG-1478 treatment group (Plt;0.05). Conclusions EGFR inhibitor (AG-1478) could shows inhibitory effectivenss on the CPC-mediated hyperplasia and lithogenic potential, and therefore holds promise as the new treatment approach for CPC.