Objective
To assess the long-term results and relevant influencing factors of extended thymectomy and medicine-alone treatment of non-thymomatous myasthenia gravis (MG) patients.
Methods
We retrospectively analyzed the clinical data of 174 patients with non-thymomatous MG diagnosed and treated in our department from December 2009 to April 2017, including 81 males and 93 females, aged 13-88 (47.1±17.8) years. According to the different treatment methods, the patients were divided into two groups: an operation group (91 patients receiving extended thymectomy) and a medicine-alone group (83 patients receiving medical therapy alone). The efficacy was evaluated according to the Myasthenia Gravis Foundation of America (MGFA). Survival curves of the patients were plotted using the Kaplan-Meier method to evaluate the remission rate and survival rate. Cox regression analysis was used to assess the influencing factors of the outcomes.
Results
The patients were followed up for 3 to 94 (39.1±26.9) months. As a result, 29 patients (31.9%) achieved complete remission in the surgery group and 13 patients (15.7%) were completely relieved in the medicine-alone group (P=0.014). Further analysis showed that treatment pattern (P=0.018) and MG type (P=0.021) were the main factors related to the efficacy.
Conclusion
For patients with non-thymomatous MG, extended thymectomy is superior to the medicine-alone in terms of complete remission rate and the postoperative immunosuppression ratio.
【Abstract】 Objective To evaluate the results of glucosamine hydrochloride in the treatment of knee degenerativeosteoarthritis (DOA) . Methods From February 2006 to January 2007, 60 patients with knee DOA were treated with glucosaminehydrochloride,including 15 males and 45 females. The ages of patients ranged from 41 to 67 years with an average ageof 57.5 years. The disease course ranged from 6 months to 3 years. Oral glucosamine hydrochloride was given twice a day, each750 mg, for a 6-week course of treatment; another course of treatment was repeated after 4 months. After two courses of treatment,the international standard DOA score of Lequesne index was used to evaluate the rest of knee pain, sports pain, tenderness,joints activity, morning stiffness and walking abil ity. Results All 60 patients finished treatment, various cl inical symptomsfor DOA disappeared completely in 31 cases and subsided in 27 cases; the cure rate was 51.7% and the total response rate was96.7%. The scores of rest pain, sport pain, tenderness, joints activity, morning stiffness and the abil ity to walk for knee after treatmentwere 0.5±0.2,0.7±0.4,0.8±0.3,0.9±0.4,0.6±0.3 and 0.9±0.4, showing statistically significant differences (P lt; 0.01) whencompared with preoperation (1.6±0.5,2.1±0.4,2.2±0.5,1.8±0.6,1.7±0.4 and 2.0±0.4). Adverse effect occurred in 3 cases (5%)and the patients recovered without special treatment. Conclusion Glucosamine hydrochloride can cure knee DOA withsymptom-rel ieving and joint function-improving action.
ObjectiveTo summarize the current treatment status and progress of neoadjuvant chemotherapy for pancreatic cancer in order to improve the understanding of neoadjuvant chemotherapy and to guide clinical work.MethodThe relevant literatures at home and abroad on neoadjuvant chemotherapy for pancreatic cancer were readed and reviewed.ResultsNeoadjuvant chemotherapy could reduce tumor lesions, increase R0 resection rate, decrease postoperative complication rate, and improve patients’ survival, however, there was currently no high quality evidence-based medicine proof. At present, there was no unified neoadjuvant chemotherapy regimens for pancreatic cancer in the world. FOLFIRINOX, gemcitabine plus S-1, and gencitabine plus Nab-paclitaxel were the three common regimens we used. In addition, the neoadjuvant chemotherapy of pancreatic cancer had no uniform standard, and there were insufficient methods for evaluating therapeutic effects.ConclusionAlthough there are still some core problems need to be solved in neoadjuvant chemotherapy for pancreatic cancer, however, it’s curative effect is gradually recognized and widely used by clinicians, which is beneficial to provide a better prognosis for pancreatic cancer patients.
ObjectiveTo observe the clinical effect of Lacosamide (LCM) in the treatment of children with intractable epilepsy.Methods41 cases of refractory epilepsy patients who received LCM from March to July 2019 in department of Neurology, General Hospital of Henan Province were collected which included 21 males, 20 females, age were 4.6 ~ 15.5 years, average (7.21±3.06) years, And the efficacy of LCM was observed through blank control study.ResultsAfter LCM was added to the blank self-control group, the frequency of epileptic seizures was significantly reduced during the follow-up period of 3 months and 6 months, with statistically significant difference (P<0.05), and the mental state of the children was effectively improved, but there was no statistical significance between focal refractory epileptic seizure and comprehensive refractory epileptic seizure (P>0.05).ConclusionsLCM is a new kind of the third generation of antiepileptic drug. The addition use of LCM can effectively reduce the seizure frequency and improve mental state in children with refractory epilepsy.
Objective
To explore the influencing factors of palliation efficacy in malignant obstructive jaundice.
Methods
Clinical data of 107 patients with malignant obstructive jaundice who treated in Department of General Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, from March 2014 to December 2017, were retrospectively collected to analyze the influencing factors of palliation efficacy in 1 week and1 month after operation.
Results
Multivariate analysis results showed that, hilar obstruction and preoperative albumin level were influencing factors of palliation efficacy in 1 week after operation (P<0.05), patients with hepatic portal obstruction, and low preoperative albumin level had poor effect; hilar obstruction, preoperative albumin and total bilirubin level were influencing factors of palliation efficacy in 1 month after operation (P<0.05), patients with hepatic portal obstruction, low preoperative albumin level, and high total bilirubin level had poor effect.
Conclusions
The obstruction location, preoperative albumin level, and total bilirubin level are the independent influencing factors of palliation efficacy which played an important role in prognostic assessment.
Objective To explore the clinical effect of intramuscular injection of methotrexate on hysteroscopic treatment of endogenous cesarean scar pregnancy (CSP). Methods A prospective analysis was conducted on 94 patients diagnosed with endogenous CSP who visited the Department of Gynecology in Liuzhou Workers’ Hospital between January 2013 and January 2018, and they were randomly divided into two groups, the intramuscular injection of methotrexate followed by hysteroscopic surgery group (the methotrexate group, n=39) and the direct hysteroscopic surgery group (the non-methotrexate group, n=55). The operation time, intraoperative blood loss, surgical complications, length of hospital stay, hospitalization expenses, the recovery time of blood human chorionic gonadotropin (HCG) and treatment outcomes of the two groups were compared. The normally distributed data were expressed as mean±standard deviation, and the non-normally distributed data were expressed as median (lower quartile, upper quartile). Results There was no statistically significant difference in age, gestational sac diameter, uterine scar thickness, number of cesarean sections, time from cesarean section to present, time of menopause, or preoperative blood HCG value between the two groups (P>0.05). There was no statistically significant difference in intraoperative blood loss [75 (35, 120) vs. 65 (35, 130) mL, P=0.821], incidence of complications (5.1% vs. 5.5%, P=1.000), postoperative blood HCG recovery time [(5.22±2.17) vs. (4.96±1.81) weeks, P=0.559] or the effective rate of treatment (94.9% vs. 90.9%, P=0.747) between the two groups. The methotrexate group had longer operation time [43 (34, 55) vs. 32 (28, 35) min, P=0.001], longer length of hospital stay [(10.89±1.42) vs. (5.82±1.47) d, P<0.001], and higher hospitalization cost [(8596.46±3336.59) vs. (7058.84±2638.49) yuan, P=0.014]. Conclusion For patients with endogenous CSP, intramuscular injection of methotrexate before hysteroscopic surgery is not necessary, for it has no significant impact on the treatment effect, instead, it may prolong the operation time and length of hospital stay, and increase the hospitalization cost.
ObjectiveTo evaluate the mid-term clinical outcomes of covered endovascular reconstruction of aortic bifurcation (CERAB) for the treatment of complex aortoiliac occlusive disease and to evaluate the efficacy and safety of this technique. MethodsA total of 12 patients with complex aortoiliac occlusive lesions [Trans-Atlantic Inter-Society Consensus (TASC) Ⅱ C and D] who underwent CERAB reconstruction at West China Hospital of Sichuan University, from December 2020 to December 2024 were prospectively enrolled and analyzed. Baseline and procedural data and follow-up data at 1, 6, 12, and 24 month(s) were collected. Technical success and 30-day complications as well as overall survival were evaluated. Patency and freedom from target lesion revascularization rates were analyzed using Kaplan-Meier curve. ResultsAll patients were male, with an age of (66.1±8.3) years; 10 cases were TASC Ⅱ C and 2 were TASC Ⅱ D. Technical success was achieved in all procedures. There were 2 cases of the procedure-related complications: one patient developed acute ischemia of the left lower limb postoperatively and recovered after emergency thrombectomy and endarterectomy; another patient died of a cerebrovascular event on day 3 after surgery. No bleeding, renal failure, pseudoaneurysm, or dissection occurred. The cumulative overall survival rates at 6, 12, and 24 months after surgery calculated by the Kaplan-Meier method were all 91.7%, with the cumulative primary patency rates being 86.7%, 73.4%, and 73.4% respectively, and the cumulative secondary patency rates being 100%, 100%, and 92.9% respectively. No amputations occurred during follow-up. ConclusionsThe results of this cohort suggest that CERAB induces favorable mid-term efficacy and safety in the treatment of complex aortoiliac occlusive lesions (TASC Ⅱ C and D). However, the further research is required to explore its suitability for the juxtarenal lesions of TASC Ⅱ D.
ObjectiveTo analyze the surgical efficacy and influencing factors of myasthenia gravis (MG) patients with thymic atrophy after thymectomy. MethodsThe clinical data of MG patients with thymic atrophy undergoing thymectomy between October 2014 and May 2018 in Daping Hospital of Army Medical University and Shijiazhuang People Hospital were retrospectively analyzed. ResultsA total of 71 patients were collected, including 40 males and 31 females with a mean age of 45.17±12.42 years. All patients received the surgery successfully. After the surgery, 20 (28.17%) patients were stable remission, 12 (16.90%) patients were minimal manifestation status,19 (26.76%) patients were improved, 5 (7.04%) patients showed no change, 3 (4.23%) patients were worsened, 10 (14.08%) patients were exacerbated and 2 (2.82%) patients were dead. Multivariate logistic regression analysis showed that the preoperative illness duration (OR=4.61, 95%CI 1.13-18.85, P=0.03), and postoperative pyridostigmine combined with immunosuppressive (OR=0.12, 95%CI 0.03-0.45, P=0.00) were independent risk factors for long-term efficacy of thymectomy for MG patients with thymic atrophy. ConclusionEarly surgery after diagnosis of MG and postoperative pyridostigmine combined with immunosuppressive treatment is beneficial to the prognosis of MG patients with thymic atrophy.
摘要:目的: 觀察瑞格列奈、阿卡波糖聯合治療老年性2型糖尿病患者的臨床療效及安全性。 方法 :觀察58例2型糖尿病患者服用瑞格列奈及阿卡波糖,療程12周,監測治療前后空腹及餐后2 h血糖(FBG、PBG)、糖化血紅蛋白(HbAlc)、肝功、腎功。 結果 :FBG、PBG及HbAlc較治療前顯著下降(Plt;005),尤其是餐后血糖更為明顯(Plt;001)。無一例肝腎功能損害,也無嚴重低血糖及其它嚴重不良反應發生。 結論 :瑞格列奈聯合阿卡波糖治療2型糖尿病降糖作用確切,而且安全性、耐受性良好。Abstract: Objective: To observe the clinical efficacy and safety of combined treatment of repaglinide and acarbose in aged patients with diabetes type 2 Methods : After oral administration of repaglinide and acarbose for 12 weeks, 58 patients with type 2 diabetes were observed. The concentrations of fasting blood glucose (FBG), 2 h postprandial blood glucose (PBG), glycosylated hemoglobin (HbAlc), liver and kidney functions were monitored before and after treatment. Results : The levels of FBG, PBG and HbAlc were significantly decreased compared with pretreatment (Plt;005), especially PBG (Plt;001). No case of liver and kidney dysfunction was found, without serious hypoglycemia and other serious adverse events as well. Conclusion : Repaglinide and acarbose have the precise function in the treatment of type 2 diabetes, with good security and good tolerance.
ObjectiveTo evaluate the safety and efficacy of simultaneous surgical resection combined with thermal ablation in sequential treatment of patients with multiple primary lung cancer (MPLC). MethodsPatients with MPLC who underwent simultaneous, sequential surgical resection combined with thermal ablation at Shangjin Branch of West China Hospital of Sichuan University from April 2023 to May 2024 were retrospectively included, and their perioperative and follow-up data were analyzed. ResultsA total of 23 patients with MPLC were enrolled, including 4 males and 19 females, with a mean age of (51.61±12.38) years. Cumulatively, 48 lesions were resected and 23 lesions were ablated. About half of the patients (52.17%) had surgery and ablation treatment located in the same lung. All patients completed the combined treatment without intraoperative complications. Four patients had postoperative complications, and were effectively managed and successfully discharged. The median postoperative hospital stay was 4.00 (4.00, 4.00) days. The average follow-up duration was (11.78±4.90) months, with a local control rate of 100.00% at 6 months postoperatively. No deaths or tumor occurred during the follow-up. Conclusion Simultaneous surgery with thermal ablation in sequential treatment for MPLC is safe, flexible and effective, providing a new option for this group of patients, but further studies are needed to evaluate its long-term efficacy.
