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"Zhonghua Yi Xue Za Zhi"[jour]
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1.
Zhonghua Yi Xue Za Zhi. 2020 Mar 3;100(8):624-628. doi: 10.3760/cma.j.issn.0376-2491.2020.08.012.
[A report of six TAFRO syndrome: clinical characteristics, diagnosis and treatment analysis].
[Article in Chinese; Abstract available in Chinese from the publisher]
Abstract
Objective: To explore the clinical characteristics, treatment and prognosis of TAFRO syndrome. Methods: All patients diagnosed as Castleman disease in Peking University People's Hospital between December 2011 and April 2019 were included.Among them,6 patients were diagnosed as TAFRO syndrome. Medical records were studied;the clinical manifestation, laboratory test, pathology, treatment and prognosis were analyzed. Recent related literatures were reviewed. Results: The average age of six TAFRO syndrome patients (5 males)was 41.5 years(range, 27-59 years). The patients presented as acute or subacute onset, manifested as fever, thrombocytopenia, polyserositis including pleural effusion and ascites, organomegaly, anasarca, and renal insuffciency. One patient was accompanied by hemophagocyticsyndrome, one patient was accompanied by hypothyroidism, six patients' serum IL-6 was elevated, four patients had received the test of serum VEGF and results were all elevated, six patients' HIV antibody were negative,four patients had received HHV-8 DNA test and results were all negative. For pathology, threewere plasma cell type, twowere mixed type andonewashyaline vascular type. Renal biopsies were performed in 2 patients, showing that renal thrombotic microangiopathyassociated with subacute tubulointerstitial nephritis and secondary capillary proliferative glomerulonephritis. CHOP chemotherapy wereused in 2 patients, glucocorticoid was used in 1 patient, and glucocorticoid combined with Rituximab or Tocilizumab were used in 3 patients. Among them, one patient died because of disease progression after 5 years, other five patientsare still stable. Conclusion: TAFRO syndrome is a rare disease, early recognition and appropriate treatment may improvethe prognosis.
KEYWORDS:
Castleman diesae; Interleukin 6; TAFRO syndrome; Vascular endothelial growth factor
2.
Zhonghua Yi Xue Za Zhi. 2020 Mar 3;100(8):619-623. doi: 10.3760/cma.j.issn.0376-2491.2020.08.011.
[Application of electrophysiological monitoring in acoustic neuroma resection].
[Article in Chinese; Abstract available in Chinese from the publisher]
Abstract
Objective: To investigate the neuroprotective effect of facial nerve monitoring on acoustic schwannoma resection and its impact on prognosis. Methods: Eighty patients with acoustic schwannomas were enrolled in our study in the past 2 years and randomly divided into a monitoring group and a non-monitoring group. Tumor size was measured by MRI, and the general condition of the patients were analyzed. The preoperative hearing loss was evaluated, and the facial numbness, post-group related symptoms, and facial paralysis grade were also evaluated before surgery. The monitoring group performed facial nerve monitoring during the operation of auditory schwannomas resection, while the non-monitoring group did not. Both groups decided to perform total or subtotal resection according to the actual conditions during the operation. The hearing status, facial numbness, posterior group related symptoms and facial paralysis grade were evaluated 3 days after surgery, and the prognosis Glasgow outcome score (GOS) was evaluated 1 month after surgery. Results: There were no significant differences between two groups in terms of general condition and preoperative evaluation. There was also no significant difference in surgical methods. But the incidence of facial numbness in monitoring group (42.9%, 15/35) was significantly lower than that in non-monitoring group (86.7%, 39/45) (P<0.001). The facial paralysis grade in monitoring group (17/Ⅰ, 9/Ⅱ, 8/Ⅲ, 1/Ⅳ) was also significantly lower than that of non-monitoring group (1/Ⅰ, 18/Ⅱ, 17/Ⅲ, 9/Ⅳ) (P<0.001). The prognostic score (GOS) in monitoring group (4.60±0.55) was significantly higher than that in non-monitoring group (3.78±0.67)(P<0.001). Conclusion: Facial nerve monitoring can provide better neuroprotection on acoustic schwannoma resection, avoid facial nerve injury, and improve the prognosis quality of life significantly.
KEYWORDS:
Acoustic neuroma; Facial nerve; Microsurgery; Neuroprotection
3.
Zhonghua Yi Xue Za Zhi. 2020 Mar 3;100(8):614-618. doi: 10.3760/cma.j.issn.0376-2491.2020.08.010.
[Clinical features and prognosis of pneumocystis pneumonia in patients treated with rituximab for autoimmune diseases].
[Article in Chinese; Abstract available in Chinese from the publisher]
Abstract
Objective: To determine the clinical features and outcomes of pneumocystic pneumonia (PCP) in patients treated with rituximab for autoimmune diseases. Methods: PCP patients with autoimmune diseases as underlying diseases from January 2009 to April 2019 in Peking University First Hospital (male 67 cases, female 35 cases, age 17-79) were retrospectively reviewed. Patients were grouped as rituximab group and non-rituximab group based on the fact if they were treated with rituximab before the onset of PCP. Demographic data, clinical features, and outcomes of the two groups were analyzed. Results: There were 102 cases altogether, and 7 patients were treated with rituximab before the onset of PCP. Patients in rituximab group were relatively younger than that in non-rituximab group [(32.0±18.7) vs (52.4±14.9) years, P=0.010]. Patients in rituximab group had more CD3(+), CD4(+), CD8(+)T lymphocytes in peripheral blood samples than that in non-rituximab group [(1 306±596) vs (546±439)/μl, (674±401) vs (243±232)/μl, (616±249) vs (282±256)/μl, respectively, all P<0.01]. However, the B lymphocyte count and plasma level of IgG and IgM were significantly lower in rituximab group than that in non-rituximab group [0 (0, 0.2) vs 72 (50.0, 124.4)/μl, 4.0 (2.6, 5.8) vs 9.4 (5.3, 12.0) g/L, 0.3 (0.2, 1.0) vs 1.1 (0.6, 1.8) g/L, respectively, all P<0.05]. The incidence of Cytomegalovirus (CMV) pneumonia was significantly lower in rituximab group (0/7 and 57/95, P=0.007). Other demographic data, the use of corticosteroids, the incidence of severe PCP, mechanical ventilation, intubation, pneumothorax and mediastinal emphysema complications, as well as hospital mortality and length of stay in hospital in the two groups were comparable. Conclusions: In patients treated with rituximab for autoimmune diseases, the number of B lymphocytes in peripheral blood and the plasma level of immunoglobulins but not CD3(+), CD4(+), and CD8(+)T lymphocyte counts may play an important role in the pathogenesis of PCP. These patients are not vulnerable to be complicated with CMV pneumonia.
KEYWORDS:
Autoimmune diseases; Disease attributes; Pneumonia, pneumocystis; Prognosis; Rituximab
4.
Zhonghua Yi Xue Za Zhi. 2020 Mar 3;100(8):610-613. doi: 10.3760/cma.j.issn.0376-2491.2020.08.009.
[Analysis of misdiagnosis causes of suprasellar arachnoid cysts].
[Article in Chinese; Abstract available in Chinese from the publisher]
Abstract
Objective: To investigate the causes of misdiagnosis of suprasellar arachnoid cysts, analyze its characteristics and put forward the diagnostic basis and differential points. Methods: The clinical data fo 97 cases of suprasellar arachnoid cysts diagnosed and treated in the neurosurgery department of Beijing Tiantan Hospital and Hebei General Hospital from March 2015 to March 2019 were analyzed retrospectively. All patients underwent CT and MRI scans with obstructive hydrocephalus. 13 cases were misdiagnosed, including 7 males and 6 females. First visit age 1-31 years old, with an average age of 6.3 years. There were 10 patients younger than 6 years old. The remaining 15-year-old patients, 31-year-old patients and 26-year-old patients each have one case. 11 cases were misdiagnosed as obstructive hydrocephalus, 2 cases as cystic craniopharyngioma. Results: 13 cases were misdiagnosed and mistreated, 11 cases were treated with intraventricular and abdominal shunt, 9 cases were treated with neuroendoscopy and recovered well. One cases of intracranial hematomas underwent craniotomy again, the hematomas were removed again and the bone slise were decompressed. One case had fissured stable after shunt. There were no operative deaths and no complications in this group. After endoscopic reoperation, CT and/or MRI scans showed that the ventricle narrowed in varying degrees, some of them returned to normal size and the flow of cerebrospinal fluid (cerebrospinal fluid) was unobstruct at the end of magnetic resonance cerebrospinal fluid angiography (MRI) fistula after endoscopic reoperation. Conclusions: The incidence of suprasellar arachnoid cysts is low, it is rare in clinic and it is easy to misdiagnose and mistreate. At present, it is recognized that the best treatment methods are partial resection of endoscope cyst wall, cyst ventricle fistula and third ventricle floor fisthla.
KEYWORDS:
Arachnoid cyst; Neuroendosco; Suprasellar cisterna
5.
Zhonghua Yi Xue Za Zhi. 2020 Mar 3;100(8):604-609. doi: 10.3760/cma.j.issn.0376-2491.2020.08.008.
[The study of self-constructed brainstem fiber bundle by neurosurgeon through using 3D-Slicer software].
[Article in Chinese; Abstract available in Chinese from the publisher]
Abstract
Objective: To explore the methods and appliaction value for self-constructing brainstem fiber bundles by neurosurgeon through 3D-Slicer software in neurosurgical preoperative planning. Methods: The DCIOM format imaging data of 31 patients with neurosurgical brainstem lesions were collected who admitted to Neurosurgery Department at the First Affiliated Hospital of Chongqing Medical University from June 2018 to May 2019 and imported into the 3D-Slicer software system. The neurosurgery specialists independently constructed the fiber bundles to generate two-dimensional Fraction Anisotropy maps, Directionally Encoded Color maps and three-dimensional fiber bundle tracing maps. Building a preopertive virtual pathological anatomical imaging system and understanding the three-dimensional pathological anatomical relationship between lesions and brain stem fiber bundles to develop an accurate surgical approach and simulate surgicalprocedures before surgery. Results: All cases were reconstructed by neurosurgeon, and the self-constructed 3D virtual images were used to develop the surgical plan. All the operations were successfully completed under the assistance of microsurgical techniques and neuroendoscopy while avoiding fiber bundles as much as possible, and the total or subtotal tumor was achieved without damage to the fiber bundle. After operation, the symptoms of new brainstem fiber bundle injury were mild. 31 patients were followed up 3 months after operation without obvious symptoms of brainstem fiber bundle injury, and 31 patients were followed up 6 months after operation without obvious symptoms of brainstem fiber bundle injury. Conclusions: Constructing brainstem fiber bundles by neurosurgeon can accurately and purposefully reconstruct the shape of brainstem fiber bundles, so that neurosurgeons can more accurately understand the three-dimensional pathological anatomical relationship between tumor and brain stem fiber bundles. In order to formulate the surgical plan in a more reasonable way, choose the optimal surgical approach, understand the location of the "relative safe area" , and be more confident to avoid damage to the brain stem fiber bundle while achieving subtotal or total resection of the tumor,also the nerve function of the patient is preserved as much as possible.
KEYWORDS:
Brainstem; Fiber bundle; Imaging, Three-Dimensional; Microsurgery; Neurosurgeons
6.
Zhonghua Yi Xue Za Zhi. 2020 Mar 3;100(8):599-603. doi: 10.3760/cma.j.issn.0376-2491.2020.08.007.
[Analysis on clinical features of patients with ulcerative colitis associated colorectal cancer].
[Article in Chinese; Abstract available in Chinese from the publisher]
Zhang HM1, Han W2, Yang H1, Wang L2, Bai XY1, Ruan GC1, Wu MX1, Chen XF1, Guo MY1, Zhou RN1, Zhou QY1, Qian JM1.
Abstract
Objective: To analyze the clinical features of ulcerative colitis associated colorectal cancer (UC-CRC). Methods: A total of 869 inpatients with Ulcerative Colitis (UC) in Peking Union Medical Hospital from January 1998 to January 2018 were continuously enrolled. Clinical data and the outcome of colorectal cancer (CRC) were collected via medical records and telephone follow-up. Chi-square test and logistic regression model were used to analyze the data. Results: There were 16 patients in 869 UC inpatients who were diagnosed with CRC during a period of 7 548 person years and the incidence rate of UC-CRC was 1.84%. Compared to UC inpatients without CRC, a longer course of disease (OR=1.087, 95% CI:1.046-1.129) , a lower usage rate of 5-Aminosalicylic Acid(5-ASA) (OR=0.218, 95% CI:0.052-0.915) and a higher incidence rate of intestinal stenosis (OR=16.533, 95% CI:3.824-71.478) were found in UC inpatients with CRC. Conclusions: A long disease course is a risk factor for UC patients developing CRC, while 5-ASA therapy can reduce the risk of suffering from CRC. For UC patients with intestinal stenosis, CRC should be warned for occurring.
KEYWORDS:
Colorectal cancer; Risk factor; Ulcerative Colitis
7.
Zhonghua Yi Xue Za Zhi. 2020 Mar 3;100(8):593-598. doi: 10.3760/cma.j.issn.0376-2491.2020.08.006.
[Analysis on poor efficacy factors in the treatment of recurrent/refractory B-cell lymphoma with CD19 CAR-T cells].
[Article in Chinese; Abstract available in Chinese from the publisher]
Abstract
Objective: To investigate the factors influencing the efficacy of CD19 chimeric antigen receptor T (CAR-T) cells in the treatment of patients with relapsed refractory B cell lymphoma and to provide evidence for further improvement of CAR-T efficacy. Methods: A total of 34 patients with relapsed and refractory B-cell lymphoma were recruited from the Department of Hematology of Tianjin First Central Hospital from February 2017 to January 2019. All patients received CD19 CAR-T cell therapy. These patients were evaluated for efficacy, factors with poor efficacyand adverse effects. Results: The overall response rate was 58.8% (20/34) and the complete remission rate was 41.2% (14/34) after infusion of CD19 CAR-T cells in 34 patients with relapsed refractory B cell lymphoma. According to the efficacy of CAR-T cells, patients were divided into two groups, 20 in the effective group and 14 in the poorly effective group. The median am ount of CD19 CAR-T cell infusions in these two groups were 8.6 (5.0-12.7)×10(6)/kg and 9.7 (5.8-15.0) × 10(6)/kg, respectively, and the difference was not statistically significant (P=0.654). The percentage of CD19 CAR-T cells in the effective group and the poorly treated group was 10.28% (3.92%-44.16%) and 4.05% (0.92%-28.63%), respectively.The effective group had a higher proportion of CAR-T cells than the poorly treated group, but the difference was not statistically significant (P=0.371).The presence of massive mass was an unfavorable factor affecting the efficacy of CD19 CAR-T cells and the difference was statistically significant (P=0.001). Logistic regression multivariate analysis showed that the characteristics of massive tumors were still independent prognostic factors for poor efficacy of CD19 CAR-T cells (P=0.005, OR=0.039). Of all 34 patients, there were 70.6% (24/34) who showed varying degrees of adverse reactions after the infusion of CD19 CAR-T cells, mainly cytokines release syndrome (CRS). The median time of occurrence of fever was on the third day after infusion (0-11th) day. 16 patients were with grade 1 CRS, 7 with grade 2, and 1 with grade 3. After glucocorticoids and support treatment, they all showed improvements. Conclusions: CD19 CAR-T cell therapy has achieved a certain effect in CD19(+)B cell lymphoma, but has poor efficacy on some patients. Large mass tumors may be an adverse factors to CAR-T cell treatment.
KEYWORDS:
B cell lymphoma; Chimeric antigen receptor T cell; Cytokine release syndrome; Efficacy
8.
Zhonghua Yi Xue Za Zhi. 2020 Mar 3;100(8):586-592. doi: 10.3760/cma.j.issn.0376-2491.2020.08.005.
[Detection of CYP21A2 gene mutations and the differences in the levels of hormones in patients with 21-hydroxylase deficiency].
[Article in Chinese; Abstract available in Chinese from the publisher]
Abstract
Objective: To analyze the detection of CYP21A2 gene mutations in 21-hydroxylase deficiency (21-OHD) patients, so as to determine the accuracy of clinical diagnosis. Methods: Totally, 514 patients with 21-OHD who visited Peking Union Medical College Hospital from January 2015 to January 2018 were enrolled and their clinical and biochemical data were collected. DNAs were extracted from peripheral blood leukocytes and CYP21A2 mutations were detected by Sanger sequencing and multiple ligation probe amplification (MLPA) technique. We divided 514 patients into three groups: two mutations of CYP21A2 alleles (group A), one mutation of CYP21A2 (group B), and no mutation of CYP21A2 (group C). Results: Mutation was detected in each allele of CYP21A2 gene in 401 (78.0%) patients, ninety (17.5%) had only one mutant allele and 23 (4.5%) had no mutation. There was no significant difference between the patients with different clinical phenotypes and the number of CYP21A2 gene mutations detected. In male, the cortisol of the patients with simple virilizing 21-OHD in group A [0.04 (0.02, 0.20) nmol/L] was lower than that of group B [0.24 (0.17, 0.28) nmol/L] and the difference was statistically significant (P=0.014). In female, 17-hydroxyprogesterone (17-OHP) of patients with salt wasting 21-OHD in group A [153.7 (90.1, 204.5) nmol/L] was higher than that of group B [38.2 (31.0, 183.3) nmol/L] and C [42.6 (27.8, 48.1) nmol/L] and the differences were statistically significant (both P<0.05). The progesterone of patients with simple virilizing 21-OHD in group C [23.0 (8.6, 33.2) nmol/L] was lower than that of gourp A [57.8 (34.4, 110.2) nmol/L] and B [63.6 (31.4, 110.8) nmol/L] and the difference were statistically significant (both P<0.05). The 17-OHP of patients with non-classical 21-OHD in group C [24.5 (20.4, 54.2) nmol/L] was lower than that of group A [158.7 (59.1, 187.6) nmol/L] and B [147.8 (131.9, 179.3) nmol/L]. The difference were statistically significant (both P<0.05). Conclusions: Mutations of two alleles have not been found in all patients with clinically diagnosed 21-OHD. Other congenital adrenal hyperplasia (CAH) types which can cause similar changes in 17-OHP and other hormones may be misdiagnosed as 21-OHD. Therefore, 21-OHD cannot be diagnosed with help of 17-OHP level only, and gene detection plays a vital role in the differential diagnosis of different CAH types.
KEYWORDS:
17-alpha-hydroxyprogesterone; 21-hydroxylase deficiency; Adrenal hyperplasia, congenital; Mutation
9.
Zhonghua Yi Xue Za Zhi. 2020 Mar 3;100(8):563-565. doi: 10.3760/cma.j.issn.0376-2491.2020.08.002.
[Clinic establishment of blood transfusion department and personnel training].
[Article in Chinese; Abstract available in Chinese from the publisher]
Abstract
10.
Zhonghua Yi Xue Za Zhi. 2020 Mar 3;100(8):561-562. doi: 10.3760/cma.j.issn.0376-2491.2020.08.001.
[New drug therapy for chronic subdural hematoma is changing the treatment mode of the disease].
[Article in Chinese; Abstract available in Chinese from the publisher]
Abstract
11.
Zhonghua Yi Xue Za Zhi. 2020 Feb 25;100(7):546-551. doi: 10.3760/cma.j.issn.0376-2491.2020.07.014.
[Five million wear simulation and particle analysis of carbon-based nano-multilayer coatings titanium alloy femoral head].
[Article in Chinese; Abstract available in Chinese from the publisher]
Abstract
Objective: To analyze the wear debris characteristics ofcarbon-based nano- multilayer coatings on Ti(6)Al(4)V alloys and compared with the cobalt chromium molybdenum alloy (CoCrMo) femoral head to evaluate the friction and wear performance of the new coated femoral head. Methods: Three groups were set up in the wear simulation experiment according to the type of femoral head. Group A: imported Cobalt-Chromium-Molybdenum alloy femoral head (CoCrMo); group B: Titanium alloy femoral head (Ti(6)Al(4)V) with carbon-based nano-multilayer coatings; group C: domestic Cobalt-Chromium-Molybdenum alloy femoral head (CoCrMo). All heads were jointed with an ultra-high molecular weight polyethylene (UHMWPE) acetabular cup. Serum samples were collected and stored in the hip joint simulator. After the sample has been digested and diluted, it was filtered through 5 μm, 1.2 μm and 0.4 μm filters, and the filter paper was collected for testing. Scanning electron microscope (SEM) was used to randomly select regions on the filter to obtain images of wear debris. Energy dispersive X-ray spectroscopy (EDS) was used to determine the elemental type of the particle and to eliminate possible contamination. The composition and structure of the abrasive chips were measured using Fourier transform infrared spectrometer (FTIR). The parameters related to the wear debris includingparticle size, shape, number and volume were calculated. The differences in correlation parameters between the groups were compared to evaluate the friction and wear properties of the new coated joints. Results: The main component of the wear debris produced was UHMWPE, and the particle size was mostly below 1 μm. The submicron particle ratio of group B was 49.4%, which was significantly lower than that of the group A and C (75% and 60%, respectively; χ(2)=66.032, 31.754, both P<0.017). The shape was mainly round, and there was no statistical difference between the groups (χ(2)=0.590, P=0.744). The number of particles in group B was significantly less than that of group C on all filters (t=9.960, 8.019, 5.790, all P<0.01), and less than group A on the 0.4 μm filter (t=7.810, P=0.000). Conclusion: The frictional wear performance of the new carbon-based nano-multilayer coatings femoral head is significantly better than that of the domestic femoral head, and even partially exceeds the imported femoral head level, which helps to reduce the production of particles and prevent osteolysis and aseptic loosening induced by UHMWPE particles.
KEYWORDS:
Particle analysis; Total hip arthroplasty; Ultra high molecular weight polyethylene; Wear
12.
Zhonghua Yi Xue Za Zhi. 2020 Feb 25;100(7):541-545. doi: 10.3760/cma.j.issn.0376-2491.2020.07.013.
[Prognosis analysis of 112 cases with Japanese encephalitis in adults].
[Article in Chinese; Abstract available in Chinese from the publisher]
Abstract
Objective: To analyze the improvement of clinical symptoms and recovery of neurological function in adult Japanese encephalitis, and study the prognostic factors. Methods: Follow-up was conducted for 112 hospitalized patients with Japanese encephalitis (JE) in adults at the Department of Neurology of three hospitals in Gansu province from July to October 2016, from July to October 2017, 6 months and 1 year after onset, respectively. The neurological functional recovery was evaluated by modified Ranking Scale (mRS).The influencing factors were analyzed by logistic regression model. Results: Among the 112 adult patients with JE after 1year follow-up, 57% (64/112) were completely recovered (mRS score=0), and 14%(16/112) had mild neurological dysfunction (mRS score=1 or 2 points), 20% (22/112) had moderate to severe neurological dysfunction (mRS score 3 to 5), and 9% (10/112) died. In 102 survivors, decreased consciousness were fully recovered (100%), 75% of the mental and behavior disorders, 64% of cognitive/memory impairment, 71% of language function disorder, 61% of paralysis, 73% of extrapyramidal symptoms were fully recovered, and 92% of the seizures were controlled. Comparison of clinical data of initial on-set between good prognosis group (mRS score≤2, 80 cases) and poor prognosis group (mRS score>2, 32 cases) showed that initial clinical manifestation with seizures, consciousness (GCS score), cerebrospinal fluid pressure, and lesion of MRI involved in midbrain had statistically significant differences (all P<0.05) . Multivariate analysis demonstrated that cerebrospinal fluid (CSF) pressure>250 mmH(2)O and lesion of midbrain in MRI were independent risk factors of poor prognosis in adult patients with JE. Conclusion: JE is an acute and infectious viral encephalitis of the central nervous system with high disability and mortality. Most patients were completely recovered, and some had neurological sequelae. CSF pressure>250 mmH(2)O and lesion of midbrain in MRI are independent risk factors for poor prognosis.
KEYWORDS:
Cerebrospinal fluid; Encephalitis; Prognosis; Risk factors
13.
Zhonghua Yi Xue Za Zhi. 2020 Feb 25;100(7):538-540. doi: 10.3760/cma.j.issn.0376-2491.2020.07.012.
[Effectiveness and safety of CT-guided percutaneous intrapulmonary injection of indocyanine green for localization of pulmonary nodules and ground glass opacity].
[Article in Chinese; Abstract available in Chinese from the publisher]
Abstract
Objective: To investigate the effectiveness and safety of CT-guided intrapulmonary injection of indocyanine green (ICG) for preoperative localization of small pulmonary nodules and ground glass opacities. Methods: From October 2018 to July 2019, a total of 34 consecutive patients (39 nodules) who were suspected to be lung cancer and underwent thoracoscopic surgery were enrolled. The size of the nodules was 0.3-2.0 (0.9±0.3) cm, including 6 solid nodules, 9 impure ground glass nodules and 24 pure ground glass nodules. Before operation, ICG was injected into the lung under the guidance of CT for localization. The patient's nodules location, operation and pathology were recorded. The main outcome measures were localization success rate and complication rate. Results: Seven patients (20.6%) had mild complications including six pneumothorax and one intrapulmonary hemorrhage,but all these patients need no special treatment. There was no ICG related side effection all patients. ICG fluorescence can be observed in all localized nodules during surgery. In two patients, the fluorescence was diffused in the thoracic cavity, but the lesion can still be found at the brightest spot of fluorescence. Thirty-eight (97.4%) lesions were successfully found under fluorescence guidance, only one nodule was not found because of its small size (0.3 cm). The shortest fluorescence retention time was more than 5 hours. Conclusion: CT-guided intrapulmonary injection of ICG for localization of pulmonary nodules and ground glass opacities is safe and effective.
KEYWORDS:
Fluorescence; Indocyanine green; Solitary pulmonary nodule; Thoracoscopes
14.
Zhonghua Yi Xue Za Zhi. 2020 Feb 25;100(7):533-537. doi: 10.3760/cma.j.issn.0376-2491.2020.07.011.
[Clinical application and efficacy of TIPS combined with AngioJet mechanical thrombectomy for liver cirrhosis with extensive portal vein thrombosis].
[Article in Chinese; Abstract available in Chinese from the publisher]
Abstract
Objective: To assess the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with AngioJet mechanical thrombectomy for liver cirrhosis with extensive portal vein thrombosis. Methods: From March 2018 to April 2019, a total of 11 patients with liver cirrhosis and extensive portal vein thrombosis were treated by TIPS combined with AngioJet mechanical thrombectomy, including 6 males and 5 females, with the age of 37-71 (46±9) years old, 3 cases of Child-Pugh grade A, 8 cases of grade B and 0 cases of grade C. The intraoperative immediate thrombus clearance rate, perioperative complication rate, postoperative thrombus recurrence rate, rebleeding rate, the incidence of hepatic encephalopathy and the rate of stent patency of all cases were collected and analyzed. Results: All the patients were treated successfully. The immediate complete thrombus clearance (grade Ⅲ) rate of portal vein trunk was 9/11, and grade Ⅱ was 2/11, The average dose of urokinase was 30-60 (40±5) ten thousand U, slight puncture point bleeding occurred in 3 cases, and recurrence of PVT in portal vein trunk occurred in 1 case with Ⅱ grade clearance rate after operation, rebleeding occurred in 1 case, hepatic encephalopathy occurred in 2 cases, the primary patency rate of stents was 9 cases. Conclusion: TIPS combined with AngioJet mechanical thrombectomy can treat the liver cirrhosis with extensive portal vein thrombosis effectively and safely, and postoperative portal vein patency rate and intrahepatic shunt patency rate are high.
KEYWORDS:
AngioJet; Portasystemic shunt, transjugular intrahepatic; Radiology, interventional; Thrombectomy
15.
Zhonghua Yi Xue Za Zhi. 2020 Feb 25;100(7):527-532. doi: 10.3760/cma.j.issn.0376-2491.2020.07.010.
[Effect of supraorbital foramen variation on radiofrequency treatment of primary trigeminal neuralgia V1].
[Article in Chinese; Abstract available in Chinese from the publisher]
Abstract
Objective: To compare the effect of different supraorbital foramen variations on the clinical efficacy of radiofrequency treatment of primary trigeminal neuralgia V1. Methods: The clinical data of 62 patients with primary trigeminal neuralgia (V1 branch) from February 2011 to August 2017 in the first hospital of Jiaxing were analyzed retrospectively. According to the shape of supraorbital foramen, the patients were divided into foramen group (n=28) and incisional group (n=34). The age, sex, course time, CT scan times of the two groups were recorded, and the mean rank of NRS scores and effective rates (NRS≤1) before operation, 1 day after operation, 6 months after operation, 1 year after operation and 2 years after operation were statistically analyzed, as well as the difference of numbness degree in 1 day and 2 years after operation. The short-term and long-term complications were recorded. Results: There was no significant difference in age, gender, course time, CT scan times, preoperative NRS and postoperative NRS between the two groups (P>0.05). Compared with the preoperative, the mean rank of NRS in the two groups decreased significantly at each postoperative time point, and the difference was statistically significant (all P<0.05). Foramen group of postoperative 1 d Ⅰ, Ⅱ, Ⅲ, Ⅳ numbness rate were 0, 53.6%, 46.4% and 0 respectively, after 2 years were 42.9%, 46.4%, 10.7% and 0 respectively. Incisional group of postoperative 1 d Ⅰ, Ⅱ, Ⅲ, Ⅳ numbness rate were 0, 29.4%, 67.6% and 2.9% respectively, after 2 years were 55.9%, 38.2%, 5.9% and 0 respectively. The degree of numbness 2 years after the operation was reduced in both groups compared with that 1 day after the operation, and the difference was statistically significant (all P<0.05). The effective rates of the foramen group and the incisional group were 78.6% and 52.9%, respectively, with statistically significant differences (χ(2)=4.406, P<0.05) . The patient had no other serious complications in the near and long term except for the swelling of puncture point. Conclusion: The short and long-term effective rates of supraperitoneal foramen in anatomical variants for the radiofrequency treatment of primary trigeminal neuralgia V1 are higher. The supraorbital foramen have higher long-term effective rates, there are no other serious adverse reactions excepting numbness, and the patients have a higher acceptability.
KEYWORDS:
Radio frequency; Supraorbital foramen; Trigeminal neuralgia
16.
Zhonghua Yi Xue Za Zhi. 2020 Feb 25;100(7):521-526. doi: 10.3760/cma.j.issn.0376-2491.2019.07.009.
[Effects of ultrasonic bone curettes combined with high-speed drills in posterior laminectomy and decompression procedure for severe thoracic spinal stenosis].
[Article in Chinese; Abstract available in Chinese from the publisher]
Abstract
Objective: To evaluate the safety and efficacy of the combined use of ultrasonic bone curette with the high-speed drill in posterior laminectomy and decompression procedure for severe thoracic spinal stenosis, and propose the optimal cutting position for ultrasonic bone curette during the laminectomy. Methods: By observing and measuring the parameters of thoracic pedicle, lamina, inner wall of the vertebral canal and their relation with the surrounding structures on cadavers, we provided a morphological marker for laminectomy by an ultrasonic bone curette. Data of 19 patients with severe thoracic spinal stenosis treated by posterior laminectomy and decompression were collected from June 2017 to June 2018 in Shanghai Changzheng Hospital. There were 11 males and 8 females, aged (50±6) years. The patients received laminectomy with the combined use of ultrasonic bone curette and the high-speed drill (Group A, n=10) or the use of ultrasonic bone curette alone (Group B, n=9). Operational time of decompressive laminectomy, blood loss, as well as perioperative complications such as durotomy, cerebrospinal fluid leak, injury of the nerve root and spinal cord were recorded in these two groups. The improvement of symptoms and the decompression width of the spinal canal were evaluated after operation. Two independent samples t-test was used for the comparison of two sets of continuous normal distribution data. Results: We had done the measurement in 6 cadavers. The mean distance between the boundary of cancellous-cortical bone of lamina and the inner wall of spinal canal was (0.9±0.4) mm, and the distance between the boundary of cancellous-cortical bone of pedicle and the inner wall of the spinal canal was (1.2±0.6) mm. For the surgeries in groups A, the mean laminectomy time for each segment was (4.4±0.5) min, the mean width of posterior laminectomy was (21.8±0.5) mm; and for the surgeries in group B, the mean laminectomy time for each segment was (5.0±0.5) min, the mean width of posterior laminectomy was (19.9±1.0) mm; there were significant differences in laminectomy time for each segment and the width of posterior laminectomy between the two groups (t=-2.391, 3.491, both P<0.05). There was one case of dura injury and one case of thoracic nerve root injury during the operation in group B. Conclusions: It is safer and more reliable for the combined use of ultrasonic bone curette with the high-speed drill in posterior laminectomy and decompression procedure for the severe thoracic spinal stenosis. The interface between the cortical bone and the medial edge of cancellous bone of the pedicle could be identified as the cutting mark for ultrasonic bone curette in this procedure.
KEYWORDS:
Anatomy; High-speed drills; Spinal stenosis; Thoracic vertebra; Ultrasonic bone curette
17.
Zhonghua Yi Xue Za Zhi. 2020 Feb 25;100(7):516-520. doi: 10.3760/cma.j.issn.0376-2491.2020.07.008.
[Common peroneal nerve "pre-release" to avoid nerve palsy in total knee arthroplasty for severe valgus deformities].
[Article in Chinese; Abstract available in Chinese from the publisher]
Abstract
Objective: To investigate the clinical efficacy of common peroneal nerve "pre-release" to avoid nerve palsy in total knee arthroplasty for severe valgus deformities. Methods: Twenty patients (22 knees) with severe valgus deformities were prospectively and continuously included in Fujian Province Hospital from January 2010 to January 2016. Medial parapatellar arthrotomy, femoral distal resection using the intramedullary cutting guide with 3° to 5° of valgus and the common peroneal nerve "pre-release" was performed, the patella was routinely resurfaced. A common peroneal nerve checking was performed (LSUHSC system), then, these outcomes were collected independently using visual analogue scale (VAS) of pain, Knee Society Score (KSS), Hospital for Special Surgery Knee Score (HSS), range of motion of knees (ROM), femorotibial angle (FTA), hip-knee-ankle angle (HKA), condylar-hip angle (CHA), plateau- ankle angle (PAA). The paired t test was used to compare the data before and after the operation. Results: Patients were followed up for 18 to 55 (mean, (38±8) months). According to Krackow's classification, all cases were typed Ⅱ. All the patients had a completely normal motor (grade 5) and sensory (LSUHSC score was 5) nerve function of common peroneal nerve postoperatively. No decrease or loss in muscle strength and cutaneous sensation associated with common peroneal nerve was found. The VAS of pain, KSS, HSS, ROM, HKA, CHA, and PAA were all improved after the operation when compared with those before the operation (t=21.602, -70.238, -82.455, -20.560, 16.058, 9.682, 3.439, all P<0.05). The alignment of lower limbs was corrected basically, and the FTA decreased from 31.7°±8.0° before operation to 5.0°±2.0° at the last follow-up, the differences was statistically significant (t=16.725, P<0.05). No common peroneal nerve palsy and transient or late-onset palsy occurred, and no revision was needed for instability during the follow-up in all the patients. Conclusion: Common peroneal nerve "pre-release" for severe valgus knees may be an effective method in protecting the nerve.
KEYWORDS:
Common peroneal nerve; Release; Total knee arthroplasty; Valgus knees
18.
Zhonghua Yi Xue Za Zhi. 2020 Feb 25;100(7):513-515. doi: 10.3760/cma.j.issn.0376-2491.2020.07.007.
[Clinical analysis of 7 cases with anti-Caspr2 antibody-associated autoimmune encephalitis].
[Article in Chinese; Abstract available in Chinese from the publisher]
Abstract
Objective: To investigate the clinical features, laboratory tests, imaging features, electroencephalogram (EEG) manifestations, treatment and prognosis of anti-CASPR2 antibody-associated autoimmune encephalitis with the purpose to improve the understanding of the disease. Methods: Seven patients diagnosed with CASPR2 antibody-associated encephalitis in the Fifth and first Affiliated Hospital of Zhengzhou University from January 2017 to January 2019 were selected. The clinical manifestations, course of disease, imaging, treatment plan and prognosis of the patients were retrospectively analyzed. Results: Of the 7 patients, 4 were male and 3 were female. The median age of onset was 34 years old (range, 11-66 years). Seizures (6/7), memory decline(5/7), and neuropsychiatric disorders (4/7) were common clinical manifestations. CASPR2 antibody was detected in the CSF of 3 patients (3/7) and the serum of all patients (7/7). Notable imaging changes were observed in 5 patients (5/7). All patients received immunotherapy and were followed up for 1 month to 2 years. One patient was diagnosed with rectal cancer with a poor prognosis; all the others got a good prognosis. Conclusions: CASPR2 antibody-related encephalitis is a rare autoimmune disease. It is considered to present with seizures, memory loss, psychiatric symptoms, dizziness and sleep disorders as the main clinical manifestations. Early identification and treatment of the disease can help the patients achieve a good prognosis.
KEYWORDS:
Autoimmune encephalitis; Caspr2 antibody; Epilepsy; Immunotherapy
19.
Zhonghua Yi Xue Za Zhi. 2020 Feb 25;100(7):509-512. doi: 10.3760/cma.j.issn.0376-2491.2020.07.006.
[The humor characteristics of young epileptic patients and its correlation with depression].
[Article in Chinese; Abstract available in Chinese from the publisher]
Abstract
Objective: To explore the characteristics of humor in young adult epileptic patients and examine the relationship between humor and depression. Methods: We recruited 55 young adult epileptic patients who visited outpatient clinic of the Department of Neurology of Yijishan Hospital of Wannan Medical College between October 2018 and March 2019 and 44 healthy controls to complete the multidimensional humor scale (MSHS), humor style questionnaire (HSQ) and Beck depression scale-Ⅱ (BDI-Ⅱ), and compared their differences between the two groups. Results: The results showed that the young adult patients with epilepsy (PWEs) were affected in humor creation, coping with humor and the totally scores of MSHS. The scores of humor creation, coping with humor and the totally scores of MSHS in the young epilepsy patients were 25.3±5.9, 16.7±5.0 and 61±10, which were significantly lower than those in the control group 29.8±6.1, 21.1±2.6 and 71±8. As for the humor style, self-defeating humor scores in PWEs were higher than controls 14±5 vs 9±3, and the self-enhancing humor scores were lower than controls 18±7 vs 23±6. The scores of BDI-Ⅱ in PWEs were significantly higher than those of normal controls 13±7 vs 6±4. Pearson's correlation test showed that the scores of BDI-Ⅱ were negatively correlated with humor creation, coping with humor, the totally scores of MSHS and self-enhancing humor scores (r=-0.566--0.721, P<0.05), while it was positively correlated with self-defeating humor scores (r=0.818, P<0.05). Among the clinically relevant factors, the scores of BDI-Ⅱ were correlated with seizure control and gender. Multiple stepwise linear regression showed that coping with humor, self-defeating and self-enhancing humor scores were closely related with depression in young epileptic adults. Conclusion: The young adults with epilepsy are affected in sense of humor and humor style, which are closely related with depression.
KEYWORDS:
Depression; Epilepsy; Humor style; Sense of humor
20.
Zhonghua Yi Xue Za Zhi. 2020 Feb 25;100(7):504-508. doi: 10.3760/cma.j.issn.0376-2491.2020.07.005.
[Correlation between swallowing function and pulmonary ventilation function and respiratory muscles strength in patients with dysphagia after stroke].
[Article in Chinese; Abstract available in Chinese from the publisher]
Abstract
Objective: To observe the difference of pulmonary function among patients with dysphagia after stroke, patients without dysphagia and normal people, and to explore the correlation between swallowing function and pulmonary function. Methods: From September 2018 to April 2019, 310 stroke patients were enrolled from the rehabilitation department and neurology department of sun yat-sen memorial hospital, sun yat-sen university, of which 60 were selected as standard stroke patients. Pulmonary function of the three groups was assessed by pulmonary function detector and further compared. The swallowing function of the dysphagia group after stroke was examined by using videofluroscopic swallowing study (VFSS). The swallowing function was quantitatively assessed by Rosenbek penetration-aspiration scale (PAS), dysphagia outcome and severity scale (DOSS) and videofluoroscopy dysphagia scale (VDS), and the correlation between swallowing function and respiratory function was analyzed. Results: There were significant differences in pulmonary function among three groups (P<0.05). Besides the FEF25,FVC, FIVC between patients with dysphagia after stroke and patients without dysphagia, the FEF75 between patients without dysphagia and normal people (all P>0.05), there were significant differences in the pairwise comparison of other indicators (all P<0.05). There were correlations between PAS and MIP (r=-0.618, P=0.001),PAS and MEP (r=-0.410, P=0.038), PAS and PEF (r=-0.443, P=0.024), DOSS and MIP (r=0.602, P=0.000),DOSS and MEP (r=0.496, P=0.005), DOSS and PEF (r=0.553, P=0.002), VDS and MEP (r=-0.483, P=0.012),VDS and PEF (r=-0.494, P=0.010), respectively. Conclusion: The pulmonary function of dysphagia patients after stroke decrease significantly, and the severity of dysphagia is correlated with the decrease of pulmonary function.
KEYWORDS:
Dysphagia; Pulmonary ventilation; Respiratory muscles; Stroke
21.
Zhonghua Yi Xue Za Zhi. 2020 Feb 25;100(7):498-503. doi: 10.3760/cma.j.issn.0376-2491.2020.07.004.
[Effects of different treatment and prevention regimens on myelin oligodendrocyte glycoprotein antibody-related optic neuritis].
[Article in Chinese; Abstract available in Chinese from the publisher]
Abstract
Objective: To compare the effects of different treatment and prevention regimens on recovery and relapse rate in patients with myelin oligodendrocyte glycoprotein antibody-related optic neuritis (MOG-ON). Methods: Retrospective study of the records of 37 patients with MOG-ON in ZhongShan Ophthalmology Center from January 2014 to December 2018. Patients with first-ever MOG-ON (first-ever group) were subdivided into intravenous methylprednisolone pulse group (Pulse group) and high dose methylprednisolone without pulse regimen group (non-pulse group). Comparisons were taken on visual acuity (VA), visual field (VF), visual evoked potential amplitude (VEP) and retinal nerve fiber layer thickness (RNFLT). Effect of different prevention regimens, either low dose prednisone or low dose of prednisone (2.5-10 mg/Day) combined with mycophenolate mofetil (MMF) (0.5-1 g/Day) , as well as the annual relapse rate (ARR) were compared. Results: Among 25 patients of first-ever MOG-ON group (19 patients in pulse group and 6 patients in non-pulse group), VF of pulse group showed significant recovery, with MD value of (-7±8) dB at 1 m after onset and (-26±11) dB at onset (P<0.01), while non-pulse group showed significant VF recovery only at 6 m after onset, with MD value of (-9±9) dB at 6 m and (-22±11) dB at onset (P<0.01). However, no significant difference of VA, VF, VEP and RNFL could be found between the two groups on at all follow-up time points (P>0.05). Among 12 patients with at least one relapse (relapse group), 9 patients (75%) were given low-dose of prednisone plus MMF for relapse prevention. The ARR was 0.77 (0.21-4.5) before and 0 (0-0.41) after the regimen, respectively (P<0.05). Conclusion: Intravenous methylprednisolone pulse therapy in acute phase of MOG-ON may accelerate the recovery of visual function and improve the prognosis. Low-dose of prednisone combined with MMF may reduce the recurrence rate of MOG-ON.
KEYWORDS:
Myelin oligodendrocyte glycoprotein antibody related optic neuritis; Prevention; Treatment
22.
Zhonghua Yi Xue Za Zhi. 2020 Feb 25;100(7):481-483. doi: 10.3760/cma.j.issn.0376-2491.2020.07.001.
[No ruly practice, no satisfied outcomes: final countdown for launching standardization of extracorporeal membrane oxygenation in China].
[Article in Chinese; Abstract available in Chinese from the publisher]
Hou XT1.
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