目的 观察体外冲击波治疗髌腱末端病的效果。 方法 2006年1月－2010年12月67例髌腱末端病患者全部采用非手术治疗，其中38例采用体外冲击波治疗，11例采用手法按摩疗法，5例采用体外擦药酒、药膏，4例注射醋酸泼尼松龙加普鲁卡因，9例采用针灸疗法。观察体外冲击波治疗与其他非手术疗法之间的效果有无差异。 结果 经相同疗程治疗后，采用体外冲击波治疗者显效25例，有效10例，效果不明显3例；采用其他非手术疗法者显效9例，有效12例，效果不明显8例；两组治疗结果差异有统计学意义（Z=?2.966，P=0.003）。 结论 应用体外冲击波治疗髌腱末端病方法简便，操作安全，疗效显著，较其他非手术治疗方法有明显的优势。但对运动员患者应用此方法时，应与训练安排紧密结合起来，才能收到最大的效果。Objective To explore the therapeutic effect of extracorporeal shock wave therapy (ESWT) on patellar tendinopathy (PT). Methods A total of 67 cases who were diagnosed with PT between January 2006 and December 2010 were selected. All of the patients were treated with conservative treatment, including ESWT in 38, massage therapy in 11, ointment in 5, injection with prednisolon acetate and procaine in 4, and acupuncture in 9. The therapeutic effects of ESWT and other treatment were observed and compared. Results After the same treatment duration, the therapeutic effect was excellent in 65.79%, good in 26.32%, and fair in 7.89%, respectively in patients who had undergone ESWT; while the result was excellent in 31.03%, good in 41.38%, and fair in 27.59% , respectively in the patients who had received the other conservative treatments. The difference was significant (Z=?2.966, P=0.003). Conclusions ESWT is easy, safe, and effective for PT. It has more distinct advantages than other conservative treatments. However, it’s better to combine the treatment with training plans when the patients are athletes.
With the development of rehabilitation medicine being promoted as a national strategy, the rehabilitation medicine has developed rapidly in China, and the number of rehabilitation medicine departments in tertiary general hospitals has increased greatly. However, the discipline development faces some problems, such as unreasonable physical condition setting, nonstandard clinical path of rehabilitation technology, inaccurate discipline positioning, loopholes in safety management, inadequate rehabilitation quality control, and imperfect talent construction system. This paper attempts to discuss the strategic thinking of the development of rehabilitation medicine from six dimensions: foundation, technology, system, safety, quality control, and talents, so as to provide a reference for discipline builders.
Objective To summarize the research progress of acute kidney injury after liver transplantation. Method The literatures on acute kidney injury after liver transplantation was collected and reviewed. Results Acute kidney injury after liver transplantation was associated with multiple risk factors. Early prevention and treatment of risk factors in perioperative period was the main measure to reduce acute kidney injury after liver transplantation. Early postoperative diagnosis and timely intervention could reduce the incidence of chronic kidney disease and improve the long-term prognosis of liver transplantation recipients. Conclusion Acute kidney injury is a common complication after liver transplantation which affects prognosis and long-term survival of patients.
To further standardize the clinical diagnosis and treatment behavior of hepatocellular carcinoma, based on evidence-based medical evidence and expert opinion, Chinese Society of Clinical Oncology updated and published guideline of hepatocellular carcinoma. In this paper, the new guideline on the updating of medical treatment strategies for hepatocellular carcinoma was studied.
Objective To compare the effectiveness between the posterolateral approach and the posterolateral combined posteromedial approaches in the treatment of Mason type 2B posterior malleolar fracture. Methods A retrospective analysis was performed on the clinical data of 79 patients with posterior ankle fracture who met the selection criteria between January 2015 and January 2022. There were 62 cases of Mason 2B Pilon subtype and 17 cases of avulsion subtype. Among Mason 2B Pilon subtype patients, 35 were treated with posterolateral approach (group A), 27 patients were treated with combined approach (group B). There was no significant difference in gender, age, injured side, cause of injury, time from injury to operation, preoperative hospital stay, preoperative visualanalogue scale (VAS) score, and intraoperative internal fixation between the two groups (P>0.05). All patients with Mason 2B avulsion subtype were treated by posterolateral approach, including 7 males and 10 females, aged from 25 to 68 years, with an average of 46.1 years. The operation time, intraoperative blood loss, postoperative hospital stay, and complications were recorded. The reduction quality was evaluated by Ovadia deals radiographic score, and the ankle function and pain were evaluated by VAS score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and ankle range of motion. Results Mason 2B Pilon subtype: There was no significant difference in operation time, intraoperative blood loss, postoperative hospital stay, and follow-up time between the two groups (P>0.05). The radiological evaluation of Ovadia deals in group A was significantly worse than that in group B (P<0.05). The VAS score in the two groups significantly improved at each time point after operation, and the VAS score and AOFAS score further improved with the extension of time after operation, and the differences were significant (P<0.05). Except that the AOFAS score of group A was significantly lower than that of group B at last follow-up (P<0.05), there was no significant difference in VAS score and AOFAS score between the two groups at other time points (P>0.05). At last follow-up, the ankle range of motion in group A was significantly less than that in group B (P<0.05). There was no significant difference in the incidence of sural nerve injury, deep tissue infection, limitation of toe movement, and traumatic ankle arthritis between the two groups (P>0.05). Mason 2B avulsion subtype: The operation time was (119.47±20.61) minutes and the intraoperative blood loss was 50 (35, 55) mL. Seventeen patients were followed up 13-25 months, with an average of 18 months. The Ovadia deals score was excellent in 10 cases, good in 6 cases, and poor in 1 case at 1 week after operation, and the excellent and good rate was 94.1%. All fractures healed in 8-18 weeks with an average of 12.35 weeks. There were 1 case of sural nerve injury and 3 cases of traumatic ankle arthritis after operation. No deep tissue infection or limitation of toe movement occurred. The VAS score decreased significantly and AOFAS score increased significantly with time, and the differences were significant between different time points before and after operation (P<0.05). The ankle range of motion at last follow-up was (56.71±2.47)°. ConclusionCompared with the posterolateral approach, the combined approach is a better choice for the treatment of Mason 2B Pilon subtype. If the posteromedial bone block does not affect the reduction of the medial malleolus, the posterolateral approach can achieve good effectiveness for Mason 2B avulsion subtype.
Objective To analyze the correlation between the polymorphism on interleukin 6 (IL-6) gene promoter region-174 locus and adolescent idiopathic scoliosis (AIS), including the susceptibility, the bracing effectiveness, and the possible mechanism. Methods The 182 AIS patients and 210 healthy controls who met the inclusion criteria between January 2013 and January 2016 were collected as research objects. The genotype of IL-6 gene promoter region-174 locus, the serum IL-6, the bone mineral density (BMD) of femoral neck and vertebrae (L1–4), and the bone metabolism parameters, including bone alkaline phosphatase (BALP), bone gla protein (BGP), tartrate resistant acid phosphatase 5b (TRACP-5b), urine Ca, and urine Ca/Cr, were detected. All research objects were divided into the AIS group and the control group according to whether they had AIS, the GG, CG, CC groups according to their genotype, and progression-free group and progression group according to the therapeutic effectiveness of 1-year bracing treatment. Statistical analysis for the indexes were conducted respectively. Results There were significant differences in AIS history, BMD of femoral neck and lumbar vertebrae between the AIS group and control group (P<0.05). According to the therapeutic effecitveness of 1-year bracing treatment, 182 AIS patients were divided into progression-free group in 110 cases and progression group in 72 cases. The results of single factor analysis showed that there were significant differences in the genotype and allele distribution of IL-6 gene promoter region-174 locus, BMD of femoral neck and lumbar vertebrae, IL-6, TRACP-5b, urine Ca, and urine Ca/Cr between the progression-free group and progression group (P<0.05). The results of multivariable analysis showed that the BMD of lumbar vertebrae, TRACP-5b, and urine Ca were the influencing factors of bracing efficacy (P<0.05). According to the results of genotype detection, all research objects were divided into GG group in 264 cases, CG group in 104 cases, and CC group in 24 cases. The IL-6, TRACP-5b, urine Ca, and urine Ca/Cr of GG type carriers were higher and BMD of femoral neck and lumbar vertebrae were lower when compared with the CG and CC type carriers (P<0.05). The BMD of lumbar vertebrae of CG type carriers was lower than that of CC type carriers (P<0.05). Conclusion The polymorphism of IL-6 genepromoter region-174 locus wasn’t correlated with the AIS susceptibility, but it was correlated (not independently correlated) with the scoliosis progression under bracing treatment, and the risk for G-carried patients was higher. The mechanism may be that the polymorphism affected the IL-6 expression level and eventually affected the BMD of AIS patients through the bone metabolism.
ObjectiveTo explore the relationship between myocardial viability in patients with coronary artery disease who underwent elective coronary artery bypass grafting (CABG) and early application of intra-aortic balloon pump (IABP) after coronary revascularization, and to provide relevant clinical reference for the pre-implantation of 16G single-lumen catheter in the femoral artery of high-risk patients to facilitate the addition of IABP after operation.MethodsThis retrospective study included 521 patients (414 males and 107 females, aged 62.50±8.82 years) who underwent positron emission tomography (PET)-computed tomography (CT) perfusion-metabolism imaging prior to CABG surgery in our institution from December 2015 to August 2020. The myocardial viability information and left ventricular functional parameters were measured, including the proportion of non-viable myocardium (perfusion-metabolic imaging match), hibernating myocardium (perfusion-metabolic imaging mismatch) and dysfunctional myocardium (non-viable+viable myocardium), left ventricular ejection fraction, left ventricular end-diastolic volume and left ventricular end-systolic volume (LVESV). The patients were divided into an IABP group and a non-IABP group according to whether they received IABP treatment after revascularization. The clinical data were reviewed and compared to explore significant impact factors between the two groups. And the multivariate logistic regression analysis was performed to investigate the correlation between preoperative myocardial viability and early use of IABP after CABG.ResultsIn multivariate logistic regression analysis, the amount of non-viable, dysfunctional myocardium and LVESV value were identified as the independent predictors for the probability of IABP use in the initial postoperative period. Receiver operating characteristic analysis showed that 9.5% non-viable myocardium, 19.5% dysfunctional myocardium, and LVESV of 114.5 mL were the optimal cutoff for predicting early IABP implantation during CABG.ConclusionThe myocardial survival status displayed by preoperative PET-CT myocardial perfusion-metabolism imaging can predict the possibility of applying IABP in CABG perioperative period. In addition to routine pre-anesthesia assessment, anesthesiologists can conduct risk stratification assessment for patients with CABG according to the results of preoperative myocardial viability imaging, which is of great significance to ensure the perioperative safety of high-risk patients with CABG.
Objective To explore application of preoperative examination in the colorectal cancer patients. Methods The preoperative examination data of patients diagnosed definitely as colorectal cancer at West China Hospital of Sichuan University from November 2006 to June 2007 was retrospectively study, and the application situation and relationship among all preoperative examination in the colorectal cancer patients were analyzed. Results According to the inclusion criteria, 438 colorectal cancer patients were included which involved 260 males and 178 females. Preoperative examinations included two to sixteen items, with an average of 10.61 items. According to correlation analysis, positive correlation existed among lung function and blood type ( r =0.161, P =0.001), tumor marker ( r =0.118, P =0.014), chest X-ray ( r =0.113, P =0.018), routine electrocardiogram ( r =0.198, P =0.000) , while lung function and immune and stress reaction exhibit a negative correlation ( r =-0.106, P = 0.027) with preoperative examinations. At the same time, immune and stress reaction had positive correlation to CT examinations of abdomen ( r =0.151, P =0.001) as well as endorectal ultrasound ( r =0.330, P =0.000). Using univariate analysis, the influence of tumor location ( P =0.012) and operative method ( P =0.004) on the number of examination items was significant. Conclusion Preoperative examination of colorectal tumor surgery mainly includes routine examination, neoplasm-related examination and important organs function detection. And three levels of preoperative menu can be set up in early stage. Establishment of normalization preoperative combined examination may be helpful to consummate preoperative evaluation and improve medical quality.
Objective For the dispute on the superiority of the pemetrexed compared with the docetaxel for treating advanced non-small-cell lung cancer (NSCLC), this study is conducted to evaluate the efficacy and safety of pemetrexed versus docetaxel for patients with NSCLC. Methods Such databases as The Cochrane Library, PubMed, EMBASE, SCI, CBM, CNKI, and VIP were searched to collect the randomized controlled trials (RCTs) about pemetrexed versus docetaxel for the treatment of NSCLC published before November of 2010. Two reviewers independently screened the studies, extracted the data and assessed the methodology quality. RevMan 5.0 software was used for meta-analyses. Results Five studies involving 847 patients were included. The results of meta-analyses showed that, in the aspect of efficacy, there was no significant difference between the two groups in the effective rate (OR=1.09, 95%CI 0.7 to 1.70), the disease control rate (OR=0.99, 95%CI 0.75 to 1.31), and the one-year survival rate (OR=1.11, 95%CI 0.56 to 2.18); in the aspect of safety, compared with docetaxel, pemetrexed could reduce the neutropenia (OR=0.09, 95%CI 0.05 to 0.15), the febrile neutropenia (OR=0.13, 95%CI 0.06 to 0.29) and the alopecia (OR=0.20, 95%CI 0.12 to 0.33), but no significant difference was found in haemoglobin (OR=1.45, 95%CI 0.23 to 9.06), thrombocytopenia (OR=1.46, 95%CI 0.59 to 3.59), nausea and vomiting (OR=1.23, 95%CI 0.53 to 2.83) and fatigue and debilitation (OR=0.73, 95%CI 0.40 to 1.30). Conclusion As the current evidence shows, pemetrexed has similar efficacy to docetaxel for advanced NSCLC patients, but it has fewer side effects of neutropenia, febrile neutropenia and alopecia.
Acute respiratory distress syndrome is one of the forms of respiratory failure that seriously threaten human life. It has the characteristics of very high morbidity, mortality and hospitalization costs. How to treat acute respiratory distress syndrome to improve the quality of life of patients is particularly important. Mechanical ventilation is an important treatment for acute respiratory distress syndrome. This article will review the progress in mechanical ventilation therapy for acute respiratory distress syndrome, including non-invasive mechanical ventilation and invasive mechanical ventilation (tidal volume, lung recruitment, positive end-expiratory pressure, prone position ventilation, and high-frequency oscillatory ventilation), aiming to provide basis and reference for future exploration of the treatment direction of acute respiratory distress syndrome.