【Abstract】 Objective To evaluate the effects of allogeneic bone graft for reconstructing bone defect of clavicle aftertumor resection. Methods Nine patients received the surgical procedures for repairing and reconstructing bone defect afterresection of clavicle tumor from January 2000 to January 2006. There were 4 males and 5 females aged 12 to 68 years. Two patientswere diagnosed as having benign tumor and tumor-like lesion(stage Ⅲ according to Campanacci grading), and 7 as having primarymalignant tumor and metastatic cancer. Three lesions were located in acromial end, 2 in sternal end and 4 in shaft of clavicle. Twocases was accompanied by pathological fracture. According to Enneking’s functional evalutation, the results were excellent in 3 cases,good in 3 cases, fair in 1 case and poor in 2 cases. Based on the visual analogue scale (VAS), pain was rated as medium rest-pain in4 cases, as medium move-pain in 3 cases and heavy pain in 2 cases preoperatively. The tumor was resected with en bloc. Defectedclavicles were reconstructed by a part of allograft clavicle and plate. The patients with malignant tumor received neo-adjuvant chemotherapyand radiotherapy postoperatively. The results were evaluated according to control of tumor, rel ief of pain, bone healingand shoulder joint function. Results These patients were followed up 12 to 70 months (mean 34.6 months). There were no localrecurrence and metastases in all patients during the follow-up. No complications of immune rejection and deep infection wereseen. The normal shape of the shoulders was restored. Eight of all patients showed primary bone healing between allograft boneand host bone. The mean healing time was 5.4 months (3.2-6.8 months). Loosening of the plate and nonunion were seen in 1 case;and bone grafting was given again. Fracture of allograft occurred in 1 case after removing internal fixation. According to Enneking’s functional evulation, the results were excellent in 6 cases and good in 3 cases at 3 months after operation; excellent in 4 cases, goodin 1 case and fair in 1 case among 6 patients who were followed up for 24 months. The VAS results of postoperation showed l ightmove-pain in 2 cases at 3 months, l ight move-pain and medium move-pain in 1 case respectively and no pain in 7 cases 12 months after operation. Conclusion Allogeneic clavicle is a useful and rel iable reconstructive material for clavicle defect due to tumor resection. The satisfactory shape and favorable function of the shoulder may be recovered after this procedure.
ObjectiveTo investigate the research progress of diagnosis and treatment of iliac vein compression syndrome (IVCS) so as to find the optimal diagnosis and treatment method in clinic. MethodLiterature about etiology, pathophysiology, clinical manifestations, diagnosis and treatment of IVCS in recent years was reviewed. ResultsIVCS was one of the pelvic vein obstructive diseases. The compression of left common iliac vein by right common iliac artery was more common in clinic, and it could also cause partial or complete occlusion of the iliac vein due to other external pressures. Clinical manifestations mainly included venous pain, edema, varicose veins, venous ulcer, skin pigmentation, and other skin nutritional changes. The examination methods mainly included color Doppler ultrasound, computed tomography venography, magnetic resonance venography, intravascular ultrasound, and venography. The treatment method had been changed from the original open venous reconstruction to intravascular treatment. Endovascular treatment was included thrombolysis, thrombectomy, percutaneous mechanical thrombectomy, balloon angioplasty, and endovascular stent treatment or combination treatment according to whether they were combined with iliac-femoral venous thrombosis or not. ConclusionBased on the existing researches, intravascular ultrasound is the first choice to diagnose and guide the intravascular treatment, and iliac vein stenting is an effective method for the treatment of IVCS with a good long-term patency and obvious symptom improvement.
ObjectiveTo compare the improvement of clinical symptoms and patency of stents in patients with left and right non-thrombotic iliac vein compression syndrome (NIVCS) after endovascular stent therapy. MethodsThe clinical data of patients with NIVCS admitted to the First Affiliated Hospital of Chongqing Medical University from January 2016 to January 2021 were analyzed retrospectively. The venous clinical severity score of the patients’ veins before therapy and on month 12 after therapy was analyzed. At the same time, the patencies of stents on month 1, 3, 6, and 12 after stenting were also analyzed. ResultsA total of 164 patients with NIVCS were collected, including 144 left NIVCS and 20 right NIVCS. The surgical technique success rate of endovascular stent therapy was 100% (164/164). There was no statistical difference of the venous clinical severity score between the patients with left and right NIVCS on month 12 after therapy (t=1.265, P=0.208), but the venous clinical severity score of left and right NIVCS patients on month 12 after therapy were lower than those before therapy (t=27.534, P<0.001; t=10.047, P<0.001). The accumulative one-stage stent patency rate on month 12 after therapy was 96.5% and 94.7% in the patients with left and right NIVCS, respectively (χ2=0.160, P=0.689). After the stent was fully supported and completely covered the extent of the lesion, the short-term (within 12 months) stent patency rates of the patients with different compression site of the iliac vein, as well as type, diameter, and length of stent placement had no statistical differences (P>0.05). ConclusionFrom the results of this study, whether left NIVCS or right NIVCS, endovascular stent therapy is safe and effective.
Objective To review the current status and advances of the correlation between traumatic brain injury (TBI) and fracture healing. Methods The related domestic and abroad literature about the correlation between TBI and fracture healing was extensively reviewed and analyzed. Results There are a variety of studies on the correlation between TBI and fracture healing, which can be divided into two major aspects: revascularization and osteogenesis; the local and systemic changes of the neuropeptide and hormone after TBI. Conclusion TBI facilitates callus formation, the further research is needed to clarify the exact mechanism.
ObjectivesTo evaluate the methodological quality and the reliability of the conclusions of systematic reviews (SRs) on traditional Chinese medicine (TCM) treatment for essential hypertension. MethodsPubMed, EMbase, The Cochrane Library, CNKI, VIP and WanFang Data databases were searched to collect the SRs which focused on the TCM for essential hypertension from January 2015 to June 2019. PRISMA statement, AMSTAR 2 tool and GRADE system were respectively applied to evaluate report quality, methodological quality and evidence quality assessment of included outcomes of SRs.ResultsA total of 25 SRs involving 65 outcomes were included. PRISMA evaluation results showed that the quality of 25 SRs reports was good. However, all studies did not report item 5 " Was an ‘a prior’ design provided?”. AMSTAR 2 tool evaluation results showed that the 25 SRs of quality levels were markedly low, where most problems concerned item 2 " If there is ‘a prior’ published in advance”, item 3 " Were reasons about selection of the study designs explained”, item 7 " Were the list of exclude of studies and justify the exclusions provided”, item 10 " Were the sources of funding for the studies reported”, and item 12 " If meta-analysis was performed, whether the author assesses the potential impact of risk of bias”. The results of grading showed that most outcomes were graded as " low” or " very low” quality. The main factors contributing to downgrading evidence quality were limitations, followed by inconsistencies, inaccuracies and publication bias.ConclusionsCurrent evidences shows that the treatment of essential hypertension by TCM has been supported by low quality evidence-based medical evidence. However, the SRs methodology for the treatment of essential hypertension by TCM is generally poor in quality and the standardization still require improvement.
ObjectiveTo overview the systematic reviews (SRs) on the efficacy of traditional Chinese medicine (TCM) in the treatment of atrial fibrillation.MethodsPubMed, The Cochrane Library, EMbase, CNKI, CBM, WanFang Data and VIP database were electronically searched to collect SRs of TCM in the treatment of atrial fibrillation from inception to July 2019. Two researchers independently screened literature, extracted data and then the methodological quality, reporting quality and evidence quality of the included documents were evaluated by AMSTAR2 tool, PRISMA statement and GRADE method.ResultsA total of 20 SRs were included. In which, 15 SRs evaluated clinical efficacy and 12 SRs analyzed adverse reactions. The methodological quality evaluation by AMSTAR2 was generally low and none of them being high quality, 1 of them being low quality and 19 of them being extremely low quality. The items with poor scores were item 2, 7, 8, 9, 10, 12, 13, 14 and 16. The PRISMA score ranged from 14 to 22.5. The quality question of the report was mainly manifested in the aspects of scheme and registration, data item, other analysis methods and sources of fundings. Evidence quality evaluation of GRADE outcome indicators was generally low.ConclusionTraditional Chinese medicine for atrial fibrillation can improve clinical efficacy and reduce adverse reactions. The overall methodological quality of the included literature is not high, and the quality of evidence is generally low. It suggest that further high-quality clinical studies should be carried out to provide a basis for evaluating the clinical efficacy of traditional Chinese medicine in treatment of atrial fibrillation.
Objective To investigate the relationship between preoperative mean daily step counts and pulmonary complications after thoracoscopic lobectomy in elderly patients. Methods From 2018 to 2021, the elderly patients with pulmonary complications after thoracoscopic lobectomy were included. A 1∶1 propensity score matching was performed with patients without pulmonary complications. The clinical data were compared between the two groups. ResultsTotally, 100 elderly patients with pulmonary complications were enrolled, including 78 males and 22 females, aged 66.4±4.5 years. And 100 patients without pulmonary complications were matched, including 71 males and 29 females aged 66.2±5.0 years. There was no significant difference in the preoperative data between the two groups (P>0.05). Compared to the patients with pulmonary complications, the ICU stay was shorter (8.1±4.4 h vs. 12.9±7.5 h, P＜0.001), the first out-of-bed activity time was earlier (8.8±4.5 h vs. 11.2±6.1 h, P=0.002), and the tube incubation time was shorter (19.3±9.2 h vs. 22.5±9.4 h, P=0.015) in the patients wihout pulmonary complications. There was no statistical difference in other perioperative data between the two groups (P>0.05). The mean daily step counts in the pulmonary complications group were significantly less than that in the non-pulmonary complications group (4 745.5±2 190.9 steps vs. 6 821.1±2 542.0 steps, P＜0.001). The daily step counts showed an upward trend for three consecutive days in the two groups, but the difference was not significant. Conclusion The decline of preoperative mean daily step counts is related to pulmonary complications after thoracoscopic lobectomy in elderly patients. Recording daily step counts can promote preoperative active exercise training for hospitalized patients.
ObjectiveTo systematic review the incidence rate of enuresis in Chinese children and adolescents through, to offer objective evidence for the prevention and treatment of enuresis. MethodsA computer search was conducted for epidemiological research on the prevalence of enuresis among Chinese children and adolescents in databases including CNKI, WanFang Data, VIP, SinoMed, PubMed, Embase, and Web of Science. Two researchers independently carried out literature screening, data extraction, and quality evaluation. Meta-analysis was executed using R language, with baujat plots and subgroup analysis to investigate heterogeneity sources, and leave-one-out for sensitivity analysis. ResultsA total of 38 papers were included, encompassing 327 065 participants, with 18 392 children suffering from enuresis. The aggregate prevalence rate was 5.59% (95%CI 4.58% to 6.81%). The prevalence rate showed a significant decreasing trend with increasing age, with rates at ages 5, 12, and 18 being 12.30% (95%CI 9.96% to 15.11%), 2.07% (95%CI 1.68% to 2.56%), and 1.95% (95%CI 0.90% to 4.20%), respectively. The incidence rate in male children was notably higher at 6.36% (95%CI 5.49% to 7.36%) than in female children at 4.30% (95%CI 3.57% to 5.16%). Using DSM-IV as the diagnostic criteria, the prevalence rate was 3.78% (95%CI 2.58% to 5.52%), while it was 5.99% (95%CI 4.75% to 7.52%) using ICCS as the criteria. ConclusionThe incidence of enuresis among Chinese children and adolescents is affected by factors such as region, age, gender, and diagnostic standards. The prevalence is higher in South China, decreases with age, and is significantly higher in males compared to females.
Objective To evaluate the clinical role of video-assisted mediastinoscopy and its safety and effectiveness in the diagnosis of thoracic disease. Methods We reviewed the clinical data of consecutive 40 patients (25 males and 15 females with an average age of 54.6 years) who received video-assisted mediastinoscopic surgery in our department of thoracic surgery from December 2011 to November 2016, including mediastinal lymph node biopsy in 27 patients, mediastinal primary lesions biopsy in 8, bronchial cystectomy in 3 and esophageal dissection in 2. Results The histological results were positive in 20 patients (73.1%) in mediastinal lymph node biopsy, including granulomatous mediastinitis in 14 and metastasis in 6 (non-small cell lung cancer in 4, Ewing sacoma in 1 and small cell lung cancer in 1) and reactive proliferation in 7 (26.9%). In mediastinal primary lesions biopsy, the accuracy rate of diagnosis was 100.0%. The pathologic results were malignant in all patients, including small cell lung cancer in 5, adenoid cystic carcinoma in 1, squamous carcinoma in 1 and adenocarcinoma in 1. In patients who received the bronchial cystectomy, no recurrence was found during at least 2 years follow-up. There was one patient with severe complication (innominate artery injury). Two patients suffered transient laryngeal recurrent nerve palsy with hoarseness and two patients incision secretion. Conclusion Video-assisted mediastinoscopic surgery is effective and safe and dissection should be careful in granulomatous mediastinitis to avoid the great vessel injures.
ObjectiveTo explore the characteristics of induced sputum microbiome in the patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).MethodsInduced sputum samples from 55 patients with AECOPD and 45 patients with stable COPD were analyzed by sequencing of 16S rRNA gene. Microbiota was measured by alpha diversity, beta diversity and LDA effect size analysis (LefSe).ResultsThe microbiome diversity of induced sputum in the AECOPD group was lower than that in the stable COPD group. The microbiome richness in the AECOPD group was higher than that in the stable COPD group. The microbiome structure changed in the AECOPD group compared with the stable COPD group. The proportion of some common pathogens got enriched. The levels of hypersensitive C reactive protein (hs-CRP), interleukin-8 (IL-8), tumor necrosis factor alpha (TNF-α) and Global Initative for Chronic Obstructive Lung Disease (GOLD) grade were negatively related to the diversity of microbiome in the AECOPD group.ConclusionsThe microbiome diversity of induced sputum in AECOPD patients is decreased, and is negatively correlated with the levels of hs-CRP, IL-8, TNF-α and GOLD grade. There are differences in the microbiome structure between AECOPD and stable COPD patients. Some enrichment of common pathogens are found in the induced sputum of patients with AECOPD. These results suggest that there is a significant bacterial dysbiosis in patients with AECOPD.