We searched The Cochrane Library（Issue 3, 2005）, MEDLINE（1996-2005） ,CMCC（1996-2005）, VIP（1996-2005） ,CNKI（1996-2005） to summarize the available evidence of topiramate for an intractable epilepsy. After scanning all these articles, we identified 11 articles including meta-analysis, randomised controlled trials and systematic reviews to evaluate. Topiramate offered an alternative in the treament for intractable epilepsy, especially for partial epilepsy, and its efficacy was proven. Patients had good tolerance. And no intercross effects with the traditional anti-epileptic drugs were found. So topiramate had broad clinical value. The primary dosage of topiramate was 200mg/d. The sustaining dosage was 400-600mg/d. And we didn＇t recommend the dosage of more than 600mg/d.
Endoscopic and robotic surgeries feature small incision and reducing surgical trauma, and minimized incision scars. However, the oncological safety of their application in breast-conserving surgery and breast reconstruction for breast cancer has always been a focal clinical concern. The breast-conserving surgery and breast reconstruction using the suspension, insufflation, and lipolysis methods could achieve precise tumor resection in the selected patients and under the specific surgical conditions, with the support of appropriate instruments. Meanwhile, the innovative application of the reverse-sequence method and auxiliary port technique has further enhanced surgical efficiency and the precision of tumor resection. Current studies suggest that endoscopic and robotic-assited breast-conserving surgery and breast reconstruction yield in terms of oncological outcomes comparable to those of conventional open breast-conserving surgery, including positive margins, local recurrence, regional recurrence, distant metastasis, and overall survival. These approaches offered advantages in minimally invasive techniques and aesthetic outcomes. However, existing research was limited by short follow-up period and small sample sizes. Future large-scale, long-term prospective randomized controlled trials are needed to further validate their oncological safety and long-term efficacy. These studies could help establish novel techniques as standard surgical approaches for breast cancer, particularly the efficient and streamlined reverse-sequence endoscopic and auxiliary port-assisted techniques.
ObjectiveTo evaluate the safety and effectiveness of total hip arthroplasty (THA) in patients with hypothyroidism.MethodsSixty-three patients with hypothyroidism (hypothyroidism group) and 63 euthyroid patients without history of thyroid disease (control group) who underwent primary unilateral THA between November 2009 and November 2018 were enrolled in this retrospective case control study. There was no significant difference between the two groups in gender, age, body mass index, hip side, reason for THA, American Society of Anesthesiology (ASA) classification, preoperative hemoglobin (Hb) level, and preoperative Harris score (P>0.05). The perioperative thyroid stimulating hormone (TSH) and thyroxine (T4) levels, the hypothyroidism-related and other complications during hospitalization, the decrease in Hb, perioperative total blood loss, blood transfusion rate, length of hospital stays, and 90 days readmissions rate in the two groups were recorded and evaluated. The periprosthetic joint infection, aseptic loosening of the prosthesis, and hip Harris score during follow-up were recorded.ResultsThe differences in the TSH and T4 of hypothyroidism group between pre- and 3 days post-operation were significant (P>0.05) and no hypothyroidism-related complications occurred after THA. The decrease in Hb and perioperative total blood loss in the hypothyroidism group were significantly higher than those in the control group (P<0.05), but there was no significant difference between the two groups in terms of transfusion rate, length of hospital stays, and 90 days readmission rates (P>0.05). No significant difference in the rate of complications (liver dysfunction, heart failure, pulmonary infection, urinary infection, and wound complication) between the two groups was found (P>0.05) except for the rate of intramuscular vein thrombosis which was significantly lower in the hypothyroidism group, and the rate of postoperative anemia which was significantly higher in the hypothyroidism group (P<0.05). The two groups were followed up 1.0-9.9 years (mean, 6.5 years). At last follow-up, Harris score in both groups were significantly higher than those before operation (P<0.05). An increase of 39.5±12.3 in hypothyroidism group and 41.3±9.3 in control group were recorded, but no significant difference was found between the two groups (t=0.958, P=0.340). During the follow-up, 1 case of periprosthetic joint infection occurred in the hypothyroidism group, no loosening or revision was found in the control group.ConclusionWith the serum TSH controlled within 0.5-3.0 mU/L and T4 at normal level preoperatively, as well as the application of multiple blood management, hypothyroid patients can safely go through THA perioperative period and effectively improve joint function, quality of life, and obtain good mid-term effectiveness.
Backgroud Chronic hepatitis is the major infectious disease of liver. There is no effective drug for it up to now. Clinical trials have showed that glycyrrhizin have potentional effective for chronic hepatitis. Objective To evaluate the effectiveness, safety and economics of glycyrrhizin for chronic hepatitis B and C. Search strategy The search terms include glycyrrhizin and its products’ name, chronic hepatitis and chronic carrier status. The thais registers of the Cochrane Hepato-Biliary Group, the Cochrane Complementary Medicine Field, and the central database of The Cochrane Library as well as MEDLINE, EMBASE and Chinese Biomedical CD Database were searched from their date of inception onward. And the free Internet search was operated to find ongoing and unpublished researches. Twenty Chinese medical journals and relevant academic conference proceedings have been searched by manual method. The reference lists of identified documents were checked as the complementary search. Inclusion criteria All randomized trials that tested glycryyhizin for chronic hepatitis B virus or hepatitis C virus infection were included in this review. Method of the review According to the principle of Cochrane systematic review, selection of thai for inclusion, assessment of methodological quality, data extraction and data syntheses were conducted by two reviewers.
摘要:醫院有效事前監測、管控醫療不良事件，是保障患者安全、提高醫療質量的管理措施之一。超大型醫院對醫療不良事件管理的實戰中，建立、實施醫療安全隱患事件關鍵監測指標、醫療安全隱患事件篩查程序指標，積極開展醫療不良事件后臺監管工作，切斷醫療安全隱患事件向醫療風險事件演變、醫療風險事件向醫療糾紛事件演變的環節，保障患者安全。Abstract: Effective supervision in advance to the medical adverse event, is one of measures which hospital adopt to guarantee patient safety and enhance medical quality. The actual combat of supervision to the medical adverse event in super sized hospital, set up and put in practice on the key target of supervising the medical adverse event and the key target of ridding procedure, remain in the background and work actively on supervision on the medical adverse event, shut off the road from the medical safety issue to the medical risk issue and the road from the medical risk issue to the medical dissension in order to guarantee the patient safety.
Objective To explore the feasibility and safety of Frey operation under laparoscopy in the treatment of chronic pancreatitis. Methods The clinical data of chronic pancreatitis patients who underwent laparoscopic Frey procedure in Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University from 2021-2023 were retrospectively analyzed. Results Eleven patients with chronic pancreatitis complicated with pancreatic duct stones were included in the study, 7 of whom had a history of diabetes and (or ) impaired glucose tolerance, suggesting that pancreatic endocrine function was impaired. The median diameter of the main pancreatic duct measured by imaging method was 8 mm (4–20mm). The median operative time was 188 min (120–368 minutes), and the total intraoperative bleeding volume was 50 mL (20–100 mL). Postoperative pancreatic fistula did not occur, one case of postoperative abdominal fluid accumulation and hypoproteinemia improved after symptomatic supportive treatment such as anti infection, acid and enzyme inhibition, and nutritional rehydration. Postoperative bleeding occurred in 3 cases, including 1 case of intestinal anastomotic bleeding, which was sutured again under emergency laparoscopic intestinal anastomosis to stop bleeding. The other two cases improved after conservative management such as blood transfusion, plasma, vitamin K, acid inhibition, enzyme inhibition and hemostatic drugs. The median postoperative hospitalization time was 7 days (4–18 days), and no patient mortality happened within 90 days after surgery. Conclusion Laparoscopic Frey operation is feasible and a relatively safe and effective method for the treatment of chronic pancreatitis.
In order to evaluate the safety performance of self-expandable NiTi alloy stents systematically, the dynamic safety factor drawn up by International Organization for Standardization, was used to quantitatively reflect the safety performance of stents. Based on the constitutive model of super-elastic memory alloy material in Abaqus and uniaxial tensile test data of NiTi alloy tube, finite element method and experiments on accelerated fatigue life were carried out to simulate the self-expansion process and the shape change process under the action of high and low blood pressure for three L-type stents of Φ8×30 mm, Φ10×30 mm, Φ12×30 mm. By analyzing the changes of stress and strain of self-expanding NiTi alloy stent, the maximum stress and strain, stress concentration position, fatigue strength and possible failure modes were studied, thus the dynamic safety factor of stent was calculated. The results showed that the maximum stress and plastic strain of the stent increased with the increase of grip pressure, but the maximum stress and strain distribution area of the stent had no significant change, which were all concentrated in the inner arc between the support and the connector. The dynamic safety factors of the three stents were 1.31, 1.23 and 1.14, respectively, which indicates that the three stents have better safety and reliability, and can meet the fatigue life requirements of more than 10 years, and safety performance of the three stents decreases with the increase of stent’s original diameter.
ObjectiveTo compare the safety and efficacy of powered anastomosis versus mechanical anastomosis in gastrointestinal surgery. MethodsComputerized searches were conducted in PubMed, EMbase, Web of Science, CNKI, and CBM databases to collect studies comparing the safety and efficacy of powered versus mechanical anastomosis in gastrointestinal surgery. The search period was from the inception of each database to March 2025. Literature was screened according to inclusion and exclusion criteria, data were extracted, and the risk of bias was assessed. The quality of the included studies was evaluated using the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using the Metan package in Stata/MP 17.0 software. ResultsA total of 15 observational studies (13 retrospective and 2 prospective) involving 21,424 patients were finally included, with 9 823 patients in the experimental group (powered anastomosis) and 11 601 patients in the control group (mechanical anastomosis). The NOS scores of all included studies were ≥5 points. Meta-analysis results showed that, compared to the mechanical anastomosis group, the powered anastomosis group had significantly lower incidence rates of anastomotic leakage [RR=0.60, 95%CI (0.37, 0.96), P=0.031], postoperative complications [RR=0.68, 95%CI (0.53, 0.86), P<0.01], intraoperative bleeding rate [RR=0.29, 95%CI (0.15, 0.56), P<0.01], and 30-day readmission rate [RR=0.62, 95%CI (0.39, 0.97), P<0.05]. No statistically significant differences were found in anastomotic stenosis [RR=0.53, 95%CI (0.18, 1.57), P=0.25], intraoperative blood loss [SMD=?0.03, 95%CI (?0.15, 0.08), P=0.57], operation time [SMD=?0.00, 95%CI (?0.08, 0.07), P=0.90], or postoperative hospital stay [SMD=?0.05, 95%CI (?0.13, 0.02), P=0.15]. ConclusionIn gastrointestinal surgery, powered anastomosis may offer potential advantages over traditional mechanical anastomosis in improving the aforementioned safety and efficacy outcomes.
Objective To compare the clinical efficacy and safety of suturesuspension single hole laparoscopic cholecystectomy and traditional laparoscopic cholecystectomy (LC) in the treatment of gallbladder disease. Methods A total of 86 cases who got treatment in our hospital from February 2014 to July 2015 were collected prospectively, and then 86 cases were divided into 2 groups: 43 cases of control group underwent LC and 43 cases of experimental group underwent suturesuspension single hole laparoscopic cholecystectomy. Clinical efficacy and safety of the two groups were compared. Results ① Complication. No one suffered from bile duct injury, bile leakage, bile duct stricture, and umbilical hernia; but there were 2 cases suffered from complications in control group, including 1 case of abdominal pain and 1 case of bloating, and the morbidity was 4.65% (2/43). The morbidity of experimental group was 0, there was no significant difference between the 2 groups in the morbidity (P>0.05). During the follow-up period, 1 case suffered from long-term compilation in experimental group, and 2 cases in normal group, there was no significant difference in the long-term complication between the 2 groups (P>0.05). ② Operation and hospitalization. The blood loss and operation time in the experimental group were lower than those of the control group (P<0.05), but there was no significant difference in the hospital stay and hospitalization cost between the 2 groups (P>0.05). ③ Postoperative electrolytes, liver and kidney function. The levels of Na+ and K+ in the experimental group were higher than those of the control group (P<0.05), and the levels of alanine aminotransferase and aspartate aminotransferase were lower than those of control group (P<0.01), but there was no significant difference in the blood urea nitrogen and serum creatinine between the 2 groups (P>0.05). ④ The recovery of gastrointestinal function after surgery. The anal exhaust time and bowel sounds recovery time in experimental group were shorter than those of the control group (P<0.01). Conclusion Suturesus-pension single hole laparoscopic cholecystectomy in the treatment of gallbladder disease is safe, effective, and minimally invasive, and it has little disturbance on gastrointestinal function and liver function, which is worthy of clinical application.
Facial filling injection is one of the technologies to achieve facial rejuvenation in a non-surgical way. With the application of emerging cosmetic filler preparations and the development of new technologies, there are more and more options to achieve facial rejuvenation. Complications may result from the use of new materials whose safety has not been proven in studies. This article describes common facial filler choices, facial risk areas and vascular complications, and discusses how to improve the safety of facial injections. The purpose is to enable operators to fully understand the facial risk area, select the appropriate filling injection, and be able to identify the symptoms of vascular complications as early as possible, thereby improving the safety of facial filling injection.
