Objective To analyze and explain how to treat 1 patient with post-ERCP hemobilia based on best clinical evidence. Methods We used EST and EPBD, ENBD, Hemobilia as key words to search MEDLINE （1978 ～ 2004） and CBMdisc（1978 ～ 2004） to find the best clinical evidence and evaluated the quality of evidence. Results According to the evidence, we found that endoscopic papillary balloon dilation （EPBD） or endoscopic nasobiliary drainage （ ENBD ） may be more effective and better tolerated in the treatment ofpost-ERCP hemobilia. Our patient did not receive sufficient medical treatment after hemobilia. He was not given a general assessment before surgery including liver function tests. As a result, the patient died of liver failure and its complications. Conclusions We should treat such patients promptly and efficiendy after hemobilia. We should also evaluate their general condition properly before the operation.
ObjectiveTo systematically review the efficacy of antibiotics on the outcomes of patients with non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors. MethodsPubMed, EMbase, Web of Science, The Cochrane Library, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect cohort studies on efficacy of antibiotics on the outcomes of patients with NSCLC treated with immune checkpoint inhibitors from inception to August 1st, 2021. Two reviewers independently screened literature, extracted data, and evaluated the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.3 software. ResultsA total of 27 cohort studies involving 7 087 patients were included. The results of meta-analysis showed that antibiotic use was associated with poor overall survival (OS) (HR=2.04, 95%CI 1.68 to 2.49, P<0.000 01) and progression free survival (PFS) (HR=1.63, 95%CI 1.35 to 1.99, P<0.000 01). ConclusionCurrent evidence shows that antibiotic use is associated with poor OS and PFS. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.
ObjectiveTo investigate the effectiveness of minimally invasive plate and medial supporting cannulated screw fixation via tarsal sinus approach in treatment of Sanders type Ⅱ and Ⅲ calcaneal fractures. Methods A clinical data of 46 patients with Sanders type Ⅱand Ⅲ calcaneal fractures met the selective criteria between March 2016 and March 2021 was retrospectively analyzed. The factures were fixed with minimally invasive plate and medial supporting cannulated screws via tarsal sinus approach in 20 cases (group A) and with minimally invasive plate in 26 cases (group B). There was no significant difference between groups in term of the gender, age, injury causes, fracture type and side, the time from injury to operation, and preoperative calcaneal length and width, B?hler angle, Gissane angle, and visual analogue scale (VAS) score (P>0.05). The operation time, intraoperative blood loss, hospital stay, and the interval between operation and full weight-bearing were recorded. The pain improvement of patients was evaluated by VAS scores before operation and at 48 hours after operation. The ankle joint function was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) score at 3 and 12 months after operation. Besides, the calcaneal length and width, B?hler angle, and Gissane angle were measured by X-ray films before and after operation. Furthermore, the difference (loss value) between 3, 12 months and 1 day after operation was calculated. Moreover, the fracture healing and healing time was observed. ResultsAll operations of two groups were successfully completed. The incisions healed by first intention, and no vascular/nerve injury or incision infection occurred. The operation time of group A was significantly longer than that of group B (P<0.05). There was no significant difference in the intraoperative blood loss, hospital stay, and the interval between operation and full weight-bearing (P>0.05). All patients were followed up 12-36 months (mean, 14.8 months). The VAS scores at 48 hours after operation were significantly lower than those before operation in the two groups (P<0.05); there was no significant difference in the difference of pre- and post-operative VAS score between groups (P>0.05). The AOFAS scores at 12 months after operation were significantly higher than those at 3 months after operation in the two groups (P<0.05); and there was no significant difference between groups at 3 and 12 months (P>0.05). X-ray films showed that the fractures of the two groups healed and there was no significant difference in healing time (P>0.05). There was no significant difference in calcaneal length and width and Gissane angle between groups at each time point (P>0.05), but there was significant difference in B?hler angle between groups at 12 months (P<0.05). The imaging indexes of the two groups significantly improved at each time point after operation when compared with those before operation (P<0.05). There was no significant difference between different time points after operation (P>0.05) in the imaging indexes of group A. There were significant differences in the calcaneal length, calcaneal width, and Gissane angle of group B between 12 months and 1 day, 3 months after operation (P<0.05), and there was no significant difference between 1 day and 3 months after operation (P>0.05). The differences in B?hler angle of group B between different time points after operation were significant (P<0.05). There was no significant difference between groups in the loss of all imaging indexes at 3 months after operation (P>0.05). The losses of calcaneal width, B?hler angle, and Gissane angle in group A at 12 months after operation were significantly smaller than those in group B (P<0.05), and there was no significant difference in the loss of calcaneus length between groups (P>0.05). ConclusionCompared with only minimally invasive plate fixation, the combination of minimally invasive plate and medial supporting cannulated screw fixation via tarsal sinus approach for Sanders type Ⅱ and Ⅲ calcaneal fractures has the advantages of less trauma, less incision complications, reliable fracture reduction and fixation, and good long-term stability.
Objective To investigate the assessment and treatment methods for unilateral spatial agnosia as well as its influence on the functional recovery of patients after stroke, so as to comprehensively understand unilateral spatial agnosia and formulate an effective treatment plan to improve the effect of rehabilitation for stroke patients. Methods A total of 86 patients with unilateral spatial agnosia were analyzed and a pre-treatment and post-treatment comparison was done. Results Of the 86 patients, 21% suffered from unilateral spatial agnosia. The occurrence of unilateral spatial agnosia was related to the location of the stroke lesion. The treatment group witnessed significant improvement after rehabilitation training of correcting unilateral spatial agnosia (Plt;0.05). Conclusion The correct rehabilitation method is beneficial for an early improvement in a patient’s cognitive ability. This also lays a foundation for the recovery of function in their limbs.
ObjectiveTo evaluate the effectiveness of a new type of sutured titanium wire combined with titanium nail internal fixation in correction of serious old medial canthus deformity.MethodsBetween March 2012 and June 2015, 18 patients with unilateral serious old medial canthus deformity were treated. There were 14 males and 4 females. The patient’s age ranged from 23 to 62 years (mean, 42 years). The causes of deformity included accident injury in 10 cases, boxing injury in 4 cases, sharp device scratching in 3 cases, and animal bite in 1 case. All patients had been treated with suture or steel wire fixation in other hospitals to correct the medial canthus deformity and the deformity recurred. The interval between this operation and the first operation was 6 months to 2 years (mean, 16 months). The nasal root or medial canthus skin scar incision was used as the operative approach, and the adhesion of the medial canthus ligament to the adjacent tissues was fully loosened, then the tail end of the new type sutured titanium wire was fixed to the residual end of the medial canthus ligament. After passing through the scar tissue, the needle end of wire was fixed on the titanium nail in the bone wall of anterior lacrimal crest. The position and shape of the medial canthus angle was determined by adjusting the tightness of titanium wire.ResultsAll incisions healed by first intention. All patients were followed up 6-12 months (mean, 10 months). In 16 cases, the medial canthus deformity was obviously corrected, and the appearances of bilateral eyes were basically symmetrical, without exposure of titanium nail and titanium wire. The medial canthus was retreated at 2 mm after 6 months in 2 cases, who were satisfied with their appearance without reoperation.ConclusionApplication of the new type of suture titanium wire combined with titanium nail in the correction of serious old medial canthus deformity can achieve good effectiveness with the low recurrence rate.
Objective To discuss the main points of technique and the range of fusion in posterior operation of spinal stenosis associated with lumbar degenerative kyphosis (LDK). Methods The cl inical data were retrospectively analysedfrom 20 cases of spinal stenosis associated with LDK which were performed posterior operation from February 2001 to February 2008. There were 1 male and 19 females, aged 52-81 years old with an average of 64 years old. The course of disease was 6-10 years. All patients had severe low back pain. According to Frankel’s neurologic function classification, there were 18 cases of grade E and 2 cases of grade D before operation. The apex of LDK included L1 in 3 cases, L2 in 10 and L3 in 7. The operational method was decided according to different characteristics of LDK. All patients were divided into three groups. Group 1 included 6 cases of sciatica and intermittent claudication with worse physical status, the segmental decompression of spinal canal, posterior intervertebral fusion and short transpedical instrument fixation were performed. Group 2 included 8 cases whose Cobb angle of LDK was less than 20°, the segmental decompression of spinal canal, posterior intervertebral fusion and one-level or multilevel lamina osteotomy were performed, instrumentation-assisted correction was used. Group 3 included 6 cases whose Cobb angle of LDK was more than 20°, the canal decompression and one-level transvertebral wedge osteotomy were performed, instrumentation-assisted correction, intervertebral fusion and posterior-lateral fusion were used. Results Incision healedby first intention in all patients. One patient suffered from superior mesenteric artery syndrome at 6 hours after operationand healed after symptomatic management. The neurologic function was improved to grade E at 2 weeks after opeartion. All patients were followed-up 24-54 months (average 26 months). At last follow-up，the Oswestry Disabil ity Index of all patients was 30.5% ± 9.6%; showing significant difference when compared with preoperation (55.9% ± 11.8%, P lt; 0.05). The back pain scoring and leg pain scoring were 2.8 ± 1.6 and 2.4 ± 1.6, respectively according to the Numeric Rating Scale score; showing significant differences when compared with preoperation (7.5 ± 0.5 and 7.3 ± 0.7, P lt; 0.05). The Numeric Rating Scale score and Oswestry Disabil ity Index in all patients were improved obviously when compared with before operation (P lt; 0.05). During the follow-up period, there was no instrumentation failure or correction loss and the fusion rate was up to 100%. Conclusion For spinal stenosis associated with LDK patients, the most important therapic purpose is to improve cl inical symptom through reconstruction lumbar stabil ization and spinal biomechanics l ine in sagittal plane. Overall estimate of the cl inical appearance and imageology character is necessary when making decision of which segments needed to be fixation and fusion. Individual ized treatment strategy may be the best choice.
Poly(styrene-block-isobutylene-block-styrene) (SIBS) and its crosslinked product crosslinked polyisobutylene (xPIB) are a kind of novel thermoplastic elastomer. They have excellent biocompatibility and stability, which are suitable for long-term implantation in human body. At present, SIBS is widely used in cardiovascular diseases, and also has preliminary application in ophthalmology. This article reviews the application and research progress of SIBS and xPIB in ophthalmic glaucoma minimally drainage tube material, intraocular lens material, new sclera buckle material and orbital defect filler, with a view of providing reference for the clinical application of such biomedical materials in ophthalmology.
ObjectiveTo explore the clinical characteristics and long term mortality of patients with eosinophilic and neutrophilic chronic obstructive pulmonary disease (COPD) exacerbations requiring hospital admission.MethodsA retrospective review of the clinical data and long-term follow up was performed for 510 patients with first diagnosis of acute exacerbation of COPD (AECOPD) requiring hospital admission between January 2015 and December 2016. The follow-up was completed in January 1, 2020. These patients were divided into three groups according to routine blood test: an eosinophilic exacerbation group, with peripheral blood eosinophils >2%; a neutrophilic exacerbation group, with peripheral blood neutrophils >65% or leukocytes >11×109/L; a paucigranulocytic exacerbation group, any case did not belong to the above two groups. The differences of clinical characteristics were compared among three groups. Cox regression model was used for analysis of independent risk factors of all-cause mortality of AECOPD patients.ResultsA total of 510 AECOPD patients were enrolled (180 eosinophilic, 273 neutrophilic and 57 paucigranulocytic, respectively). Compared with the neutrophilic exacerbation group, the eosinophilic exacerbation group had shorter time since onset of symptoms, the lower proportion of comorbid heart failure, the lower proportion of mechanical ventilation, dual antibiotics and systematic corticosteroid treatment, the shorter length of hospitalization and lower hospital mortality (all P<0.05). The average follow-up duration was 41 months for 485 AECOPD patients who completed long term follow-up. Compared with the eosinophilic exacerbation group, the neutrophilic exacerbation group was associated with a higher long-term mortality of AECOPD (HR=1.691, 95%CI 1.205 - 2.373, P=0.002).ConclusionCOPD patients with neutrophilic exacerbations have more serious clinical features and higher mortality than those with eosinophilic exacerbations.
