ObjectivesTo investigate the status quo of follow-up services for patients with cervical spondylosis, to explore its influencing factors, and to provide reference for the follow-up management model after postoperative discharge of patients with cervical spondylosis.MethodsA total of 220 patients with cervical spondylosis were selected by using convenient sampling from October 2018 to May 2019, and the general information questionnaire and the follow-up service needs questionnaire were used for the investigation.ResultsThe score of follow-up service content requirement for patients with cervical spondylosis was 54.87±7.56, and the rehabilitation training instruction was the highest. Multiple linear regression analysis showed that the follow-up service content score was influenced by education level [non-standardized partial regression coefficient (b)=3.186, 95% confidence interval (CI) (2.490, 3.882), P<0.001], length of hospital stay [b=5.140, 95%CI (3.914, 6.365), P<0.001], Neck Disability Index [b=1.326, 95%CI (0.189, 2.463), P=0.022], and age [≥75 years as the reference, 45-59 years: b=3.766, 95%CI (0.671, 6.860), P=0.017; 60-74 years: b=4.081, 95%CI(0.849, 7.314), P=0.014]. The method of obtaining follow-up services was mainly based on outpatient follow-up (85.5%), telephone follow-up (50.5%), and established a follow-up service center (40.5%) for discharged patients. The executives were multidisciplinary teams (60.5%) and hospital-community integration teams (48.2%). There were 19.1% of discharged patients who were willing to pay for relevant follow-up services.ConclusionsPatients with postoperative cervical spondylosis have strong demand for post-discharge follow-up services, which are affected by many factors. Medical staff should pay attention to this and develop a personalized follow-up service plan according to patient characteristics to meet different discharged patients and improve the quality of medical services.
Objective To observe the retinoblastoma (RB) reexamination of children with new and recurrence retinoblastoma under special circumstances.MethodsFrom January 2, 2020 to March 15, 2020, 30 children with RB who had fundus examination in Henan Children's Hospital were enrolled in this study. Among them, 14 were male, 16 were female; 18 were monocular and 12 were binocular. The average age was 37.07±18.15 months. The mean age of initial diagnosis was 20.23±13.77 months. Two patients had a family history (6.67%). In 42 eyes, stage B, C, D and E were 7, 8, 20 and 7 eyes, respectively. Twenty-one eyes had finished the treatment course and 21 eyes were during treatment. All the children underwent RetCam fundus examination, orbital MRI, ocular B-ultrasound and so on. Whether the children had new tumor or recurrence at different treatment stages was observed.ResultsAmong 7 eyes in stage B, there was no recurrence or new tumor at the end of treatment or in the process of treatment. Among 8 eyes in stage C, there were 1 eye with new tumor and 1 eye with activity tumor at the end of treatment. Among 20 eyes in stage D, there were 1 eye with recurrence tumor at the end of treatment, 3 eyes with new tumor and 7 eyes with activity tumor at the end of treatment. Among 7 eyes in stage E, 5 eyes had eyeball enucleation and 2 eyes were receiving treatment; there were 1 eye with activity tumor at the end of treatment, 1 eye with recurrence tumor, 1 eye with activity tumor. Among 18 monocular eyes, there were 11 eyes in the treatment process, 2 eyes with new tumor, 1 eye with recurrence tumor and 3 eyes with activity tumor. Of the 24 binocular eyes, 10 were receiving treatment and there were 3 eyes with new tumor, 6 eyes with activity tumor. Twenty-one eyes had finished the treatment course, the average time required for follow-up was 3.71±0.31 months, and the average time delayed for follow-up was 6.43±1.66 weeks. There was a recurrence of tumor in 1 patient who had finished the whole treatment, the incidence was 4.76%. In the course of treatment, 21 eyes were required to have a follow-up time of 3 weeks, and the average delayed follow-up time was 6.00 ± 1.89 weeks. There were 5 eyes with new tumors, with a incidence of 21.74%. Nine eyes still had activity and needed to be treated in time.ConclusionsThe higher the risk of tumor staging, the more relapses and new tumors. The patients who are being treated, the time of delayed follow-up, the higher the recurrence or new tumor than the children who have finished the treatment course and delayed the follow-up. The children who have relapsed or new tumor in the treatment course of binocular are higher than the children who have monocular.
Objective To observe the changes of disease course and the prognosis of visual acuity of Chinese patients with polypoidal choroidal vasculopathy ( PCV).Methods Visual acuity and fundus photochromes of 20 eyes of 15 consec utive patients with PCV were followed up with a mean of 19.1 months (range from 2 to 64 months), in which the fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) of 14 eyes of 10 patients were followed up with a mean of 21.0 (range from 3 to 53) months.Results Among the 20 eyes, the visual acuity was more than 0.3 in 5 eyes (25.0%), between 0.1 and 0.2 in 6 (30%) and less than 0.1 in 9 (45.0%). During the follow-up, the visual acuity was improved in 2 (10.0%), stable in 10 (50.0%)), and regressed in 8 (40.0%). Only 1 eye (5.0 %) developed to macula scar. The result of ICGA revealed the polypoidal lesions that were unchanged in 4 eyes(28.6%), regressed in 2 (14.3%), grew in 6 (42.7%), repeatedly grew and spontaneously regressed in 6 (42.7%).Conclusions There is a large variation in the visual prognosis in Chinese patients with PCV. The polypoidal lesions can repeatedly grow and spontaneously regress in the natural course. (Chin J Ocul Fundus Dis，2004，20：8-11)
ObjectiveTo analyze the clinical features, treatment and prognosis of asymptomatic patients with retinoblastoma.MethodsA retrospective series of case study. Eight asymptomatic patients (11 eyes) with the diagnosis of retinoblastoma by screening enrolled in Department of Ophthalmology of The Eye-ENT Hospital of Fudan University from January 2006 to March 2019 were included. There were 6 males and 3 females ranging from 2 days to 20 months, with a median age of 6 months. Five patients were unilateral retinoblastoma while 3 patients were bilateral. Based on the International Classification of Intraocular Retinoblastoma, 4 eyes were stage A, 3 eyes were stage B and 4 eyes were stage C. One patient had family history. Four patients were evaluated the Rb1 mutation. Routine ophthalmic examinations and ultra-wide field fundus imaging were performed on the 16 parents and 3 siblings of the 8 patients. Systemic intravenous chemotherapy was performed using the Carboplatin, Vincristine, Etoposide protocol, intra-arterial chemotherapy using Carboplatin and Melphalan, and local treatment involved cryotherapy and transpupillary thermotherapy. The mean follow-up time is 47.25 months.ResultsNone of the 8 children had any ocular symptoms. Six patients received intravenous chemotherapy (5-6 times), 1 patient received intra-arterial chemotherapy (3 times), and 1 patient just received local treatment. Among the 11 eyes, 9 eyes were treated with local cryotherapy and 8 eyes were treated with transpupillary thermotherapy. During the follow-up period, 2 patients had new tumor, and the average time was 6.3 months after the last chemotherapy. At the last follow-up, the tumor disappeared in 11 eyes, remained stable in 11 eyes. The eye protection rate was 100% (8/8) for patients without eyeball excision. The best corrected visual acuity was 0.1 for 3 eyes and 1.0 for 5 eyes. Three eyes were not found. One heterozygous mutation of Rb1 gene [1c.35_69del (p.T12fs)] was identified in 1 patient, and the other 3 patients were not detected. One had bilateral bulbar tuberculosis of the 16 parents, 1 had bilateral RB of the 3 siblings. They were the mother and brother of a child with bilateral RB.ConclusionsFundus screening is helpful for the detection of early RB. The eye protection rate is high and the long-term vision prognosis is good after systemic or topical chemical drugs (IVC, IAC) and ocular topical treatment (cryopreservation and transpupillary thermotherapy).
ObjectiveTo summarize the indication and surgical experiences of valve replacement, high-risk factors and long-term results for aortic regurgitation and large left ventricle.
MethodsWe retrospectively analyzed the clinical data of 42 patients with aortic regurgitation and left ventricle end-diastolic diameter (LVEDD) ≥70 mm and left ventricle end-systolic diameter (LVESD) ≥ 50 mm in our hospital from March 2004 through December 2012. There were 38 males and 4 females,aged 16-73 (45.86±14.99) years. The patients underwent aortic valve replacement, who were evaluated by echocardiography at pre-operation, pre-discharge and early follow-up. The follow up period was 12-132 months.
ResultsEarly death occurred in one patient. And five patients died during the follow-up. One week after surgery in 41 patients, LVEDD (62.00±13.21 mm), LVESD (50.71±14.02 mm), indexed LVEDD (35.23±8.58 mm/m2), indexed LVESD (28.92±9.08 mm/m2), LVEF (46.41%±12.49%), were significantly smaller than those before the operation (P<0.01). Heart function grades, preoperative EF, LVEDD and indexed LVEDD were the predictors for left ventricular function recovery. One-year, 5-year, 10-year survival rate was 92.9%, 90.2%, 83.8%, respectively.
ConclusionMost of patients with aortic regurgitation and large left ventricle still have indications for surgical treatment, but severe left ventricular dysfunction and ventricular arrhythmia are high risk factors for long-term survival.
The prevention and control of coronavirus disease 2019 is severe. In order to reduce the exposure of high-risk population and help home protection for at-risk population, West China Hospital of Sichuan University actively explored the construction and practice of online monitoring and home control systems, established a follow-up work team for at-risk population, formulated standardized work models and procedures, set up an online standardized follow-up information registration form to collect follow-up data, and controlled the process quality through repeated supervision. During the epidemic period of coronavirus disease 2019, West China Hospital of Sichuan University online follow-up mode can play a positive supporting role in the epidemic prevention and control and promoting this model has certain reference value for various medical institutions.
Objective
To summarize the clinical characteristics of interstitial pneumonia with autoimmune features (IPAF).
Methods
The interstitial lung disease (ILD) patients diagnosed in our department between January 2010 and August 2013 were retrospectively analyzed to screen out the patients with IPAF.The clinical manifestations, laboratory examination, imaging, pulmonary function and treatment were summarized.
Results
In 254 ILD patients, 25 patients met the diagnosis criteria of IPAF, and 26 patients were diagnosed with definite connective tissue diseases associated ILD (DCTD-ILD). There were differences in arthralgia, sicca symptoms, mechanic’s hand, positive antinuclear antibodies, anti-CCP antibodies and residual lung volume between the IPAF patients and the DCTD-ILD patients (all P < 0. 05). Five IPAF patients were revealed hug or “pancake” the diaphragm in their chest high resolution CT radiographs. The microscopic performance showed that diffuse thickened with collagen fiber, alveolar wall thickening with marked interstitial lymphocyte inflammatory cells infiltration, and granulation tissue that filled bronchiolar lumina. The patients were pathologically diagnosed with nonspecific interstitial pneumonia (NSIP) overlap organized pneumonia (OP). During following-up, the progression-free survival time of the IPAF patients was significant longer and that of the DCTD-ILD patients [(14.32±5.74)months vs. (10. 31± 3. 70) months, P < 0. 05].
Conclusions
If an ILD patient has mechanic’s hand, positive antinuclear antibodies or NISP overlap OP in image, the diagnosis of IPAF should be considered. IPAF have slower disease progression and better prognosis than DCTD-ILD.
ObjectiveTo enhance the management of occupational exposure, improve post-exposure reporting, promote post-exposure follow-up, reduce blood-borne infections caused by exposure, and ensure occupational safety among medical staff by using comprehensive measures based on nosocomial infection management system.MethodsAll the reported cases of occupational exposure were retrospectively collected from August 2012 to July 2018. The cases were divided into the control group (from August 2012 to July 2015) in which the data were reported in paper, and the observation group (from August 2015 to July 2018) in which the data were reported by nosocomial infection management system. The report and follow up results of occupational exposure in the two groups were compared and analyzed.ResultsAfter three years application of nosocomial infection management system, the occupational exposure report increased 95.8% (increased from 16.7 cases per year to 32.7 cases per year); the follow-up ratio of occupational exposure after one month,3 months and 6 months increased from 65.0% to 93.3% (χ2=15.184, P<0.001), 45.0% to 73.3% (χ2=9.033, P=0.003), and 25.0% to 53.3% (χ2=8.522, P=0.004), respectively.ConclusionApplication of nosocomial infection management system can increase the report of occupational exposure and the follow-up ratio of occupational exposure significantly.
Objective To summarize our clinical experience of endovascular repair of aortic pseudoaneurysms，andexplore the etiology of the disease，treatment indications，and early and midterm results of the procedure. Methods From November 2009 to May 2012，52 patients with aortic pseudoaneurysms received endovascular aortic repair （EVAR） in FuWai Hospital. There were 44 male and 8 female patients with their age of （53.8±13.5 ） years. Their onset syndromes includedchest or back pain in 46 patients and hoarseness in 5 patients. There were 23 acute patients and 29 chronic patients. Aortic pseudoaneurysms located at the descending thoracic aorta in 51 patients and the abdominal aorta in 1 patient. The meandiameter of the aortic pseudoaneurysms was （45.1±33.8） mm. All the patients were diagnosed using enhanced CT scan of the aorta. Three patients received emergency EVAR. All the patients received EVAR through the femoral arteries under general anesthesia. Forty-six patients underwent isolated EVAR，5 patients received hybrid technique for EVAR via the neck，and 1 patient received hybrid technique including EVAR and total arch replacement via median sternotomy under normothermia. The average diameter of stent-grafts was （34.2±3.3） mm and the average length was （157.7±20.3） mm. Enhanced CT scan of the aorta was performed before discharge，3 months and 1 year after EVAR during follow-up. Results There was no in-hospital death and EVAR was 100% successful. All the patients （100%） were followed up for 1-31 （12.6±7.9）months after discharge. Their chest or back pain symptoms all significantly improved. Their hoarseness improved too duringfollow-up. One patient’s hoarseness disappeared early after EVAR but recurred 5 months after EVAR. Enhanced CT scan showed enlargement of the stent-graft without endoleak. One patient underwent emergency EVAR for sudden onset of massivehemoptysis，recovered well before discharge，and was readmitted to hospital 5 months after EVAR because of fetid sputum and hemoptysis，who was diagnosed as Behcet’s disease and cured after anti-infection and immunosuppressive therapy. One patient had recurrent fever before and 6 months after EVAR and was cured by antibiotic therapy. Intraoperative angiographyshowed trivial typeⅠendoleak in 4 patients right after stent-graft deployment，which disappeared in enhanced CT scan 3-6 months after EVAR. Intraoperative angiography showed no endoleak in all the other patients，and their enhanced CT scans 3 months and 1 year after EVAR showed complete sealing between the stent-grafts and the aortic wall，thrombus in the pseudoaneurysm sac and decreased diameters of the pseudoaneurysms without endoleak. Two patients had hemiplegia 1 dayand 6 days after EVAR respectively，1 patient was cured and discharged and the other patient survived with hemiplegicsequelae. One patient with an abdominal aortic pseudoaneurysm died of sudden onset of cerebral infarction at home 3 monthsafter EVAR. Conclusions Endovascular repair of descending aortic pseudoaneurysms is safe and effective with good early and midterm results，and longer follow-up is needed for its long-term outcomes. Individualized treatment plan is basedon the location of the pseudoaneurysms. Preoperative meticulous medical history and physical examination are both importantfor the differentiation of the etiology of aortic pseudoaneurysms. Postoperative treatment based on the etiology and close follow-up are also needed to ensure long-term results.
Objective To evaluate the function of the reconstructed thumbs and the donor feet after thumb reconstructions with modified wrap-around flap. Methods A total of 65 patients who accepted thumb reconstruction with the modified wrap-around flap between January 2003 and October 2007 were followed up, including 54 males and 11 females with an average age of 33 years (range 15-46 years). There were 12 cases of skin degloving injury and late class I B defect, 44 cases of class II defect and 9 cases of class III A defect. The reconstructed thumbs and donor feet were examined andevaluated. Foot function index-verbal rating scales (FFI-5pt), American Orthopaedic Foot and Ankle Society (AOFAS) forhallux metatarsophalangeal-interphalangeal score, gait analysis and dynamic pedobarography were conducted to 20 patients who were followed up recently. Results Sixty-five patients were followed up 6-60 months with an average of 22 months. The reconstructed thumbs had aesthetic appearance and satisfactory range of motion. The two-point discrimination was (9.7 ± 2.8) mm, showing statistically significant difference (P lt; 0.05) when compared with that of the contralateral normal thumb [(4.2 ± 1.1) mm]. Full or most length of the donor toes were preserved in 63 patients. The width of remaining plantar strip skin that covered the plantar weight-bearing area was (24.5 ± 3.7) mm, and its two-point discrimination was (9.0 ± 2.6) mm; showing no statistically significant difference (P gt; 0.05) when compared with that of contralateral normal one [(8.1 ± 1.9) mm]. Of the 20 patients who were followed up recently, the evaluation of the FFI-5pt score showed that the pain scale score was 5.6 ± 4.5, the disabil ity scale score was 1.2 ± 2.7, and the FFI-5pt total scale score was 3.2 ± 2.9. The results of AOFAS cl inical rating scale showed that the pain scale score was 34.0 ± 5.0, the function scale score was 38.7 ± 4.2, the al igment scale score was 15.0 ± 0, and the total AOFAS scale score was 87.7 ± 7.4. There was no statistically significant difference (P gt; 0.05) in the durations of subphases of the gait cycle between the donor foot and the contralateral normal foot, and in the peak force and force-time integral of the two whole foot. The peak force of the donor toe was significantly smaller than that of the contralateral normal toe (P lt; 0.05), but there was no significant difference in the peak pressure (P gt; 0.05); and there were no significant differences in the peak forcesand peak pressures of other six anatomical sites of the two feet (P gt; 0.05). Conclusion Using the modified wrap-around flap for thumb reconstruction, aesthetic and functional thumbs can be obtained, and most of the function of the donor feet can be preserved.
