目的:對前路病灶清除取髂骨植骨融合K型鋼板內固定治療胸腰段脊柱結核的臨床療效進行分析。方法:2003年1月至2007年1月,對我科22例患者進行隨訪。結果:20例患者腰痛完全消失,植骨塊完全融合,內固定材料穩定牢固,無松動及斷裂,脊柱后突有效糾正,僅2例患者結核復發。結論:前路病灶清除植骨融合K型鋼板內固定術能有效治療胸腰段脊柱結核,有效糾正脊柱后突畸形,恢復椎體的高度,建立脊柱的穩定性。
Objective To review the methods of metacarpal and phalange lengthening and to point out the problems at present as well as to predict the trend of development in the field. Methods Domestic and abroad l iterature concerning the methods of metacarpal and phalange lengthening in recent years was reviewed extensively and thoroughly analyzed. Results At present, there are many methods to treat the short finger disabil ity, but the methods of metacarpal and phalange lengthening have an advantage, which include closed osteotomy lengthening, callus-lengthening, and modified Il izarovmethod. Each surgical method has its advantages and l imitations. However, the part of osteotomy, the length and speed, and the postoperative compl ications etc. have been disputed. Conclusion The modified Il izarov method has the advantages of simple operation, minimal invasion, and less compl ications, but the long-term results of each treatment method are unknown and need more further studies.
Mitral regurgitation (MR) is one of the most common valvular heart diseases, imposing a significant economic burden on society. Transcatheter mitral valve replacement (TMVR), as an emerging therapeutic strategy for MR, is expected to fill the gap in the treatment of transcatheter edge-to-edge repair in the future. This article reviews the progress of TMVR clinical research both domestically and internationally in the past two years and analyzes the current challenges faced by TMVR research, such as mitral valve anatomy, device access transition, valve design, and mitral valve calcification. Finally, the prospects of mitral valve product research are discussed.
ObjectiveTo systematically review the efficacy and safety of gefitinib versus pemetrexed as second-line treatment for advanced non-small cell lung cancer (NSCLC). MethodsDatabases including PubMed, The Cochrane Library (Issue 4, 2016), EMbase, CNKI, VIP and WanFang Data were searched to collect randomized controlled trials (RCTs) about gefitinib versus pemetrexed as second-line treatment for advanced NSCLC from inception to April 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software. ResultsA total of 11 RCTs involving 1 005 patients were finally included. The results of meta-analysis showed that: the rate of progression free survival (PFS) in the gefitinib group was superior to the pemetrexed group (HR=0.59, 95%CI 0.47 to 0.73, P<0.000 01). However, there were no significant differences between two groups in overall response rate (RR=1.28, 95%CI 0.86 to 1.90, P=0.22), disease control rate (RR=0.92, 95%CI 0.77 to 1.12, P=0.41) and the rate of overall survival (HR=0.75, 95%CI 0.56 to 1.01, P=0.05). The incidences of skin rash (RR=8.72, 95% CI 3.65 to 20.84, P<0.000 01) and diarrhea (RR=2.87, 95% CI 1.29 to 6.38, P=0.01) were significantly higher, but the incidences of neutropenia (RR=0.12, 95%CI 0.05 to 0.26, P<0.000 01) and fatigue (RR=0.46, 95%CI 0.30 to 0.72, P=0.000 6) were lower in the gefitinib group than those in the pemetrexed group. ConclusionGefitinib shows more superiority to pemetrexed, and it can be used as the second-line drug for advanced NSCLC． Due to the limited quality and quantity of included studies, more high quality studies are needed to verify the above conclusion.
Objective To explore the effectiveness and appropriate energy parameters of high-intensity focused ultrasound (HIFU) in treating infant hemangiomas. Methods Between January 2009 and September 2010, 60 infants with hemangioma were treated. There were 23 boys and 37 girls, aged from 3 to 30 months with an average of 10 months. These hemangiomas were located at head and face (24 cases), trunk (15 cases), l imb (16 cases), buttocks (2 cases), perineum (1 case),and multiple lesions (cervix, abdomen, and upper l imbs, 2 cases). The size of hemangiomas ranged from 0.8 cm × 0.6 cm to 6.0 cm × 5.0 cm. The 60 infants were randomly divided into 3 groups: groups A, B, and C (n=20) based on different ultrasound energies used in treatment. The lesion surface was irradiated with 3-5 mm/second for 5 continuously by ultrasonic therapeutic apparatus at a frequency of 9 MHz, impulse of 1 000, and 10% of scanning overlap; the powers of 3.5, 4.0, and 4.5 W were used in groups A, B, and C, respectively, 3 times as a course of treatment with 1 month interval. The effect and ulcer and scar risk in irradiation region were observed after 6 months of treatment. Results All cases were treated for one course. After 6 months of treatment, no significant difference in the effect was found among 3 groups based on hemangioma treatment judging criterion (P gt; 0.05). Neither ulcer nor scar occurred in group A; ulcer occurred in 4 cases (20%) of group B with superficial scars, and in 7 cases (35%) of group C with obvious scars. The rates of ulcer and scar in groups B and C were significantly higher than that in group A (P lt; 0.05). Conclusion HIFU irradiating is one of effective methods for treating infant hemangioma, but the appropriate energy was below 3.5 W.
The 2020 ACC/AHA Guideline for the Management of Patients with Valvular Heart Disease not only updates aortic valve stenosis, mitral regurgitation, prosthetic valves, infective endocarditis and antithrombotic treatment on the basis of the 2017 guidelines update for valvular heart disease, but also involves aortic valve regurgitation, bicuspid aortic valve, mitral stenosis, tricuspid regurgitation, combined valve disease, pregnancy with valvular disease, valve disease complicated with coronary heart disease, valve disease complicated with non-cardiac surgery and the prospect of comprehensive management of valve disease. It covers a wide range of contents, which are introduced in detail and comprehensively. This paper interprets some highlights and core issues, including the top 10 take-home messages, the severity of valvular heart disease, and the updates in the management of aortic valve stenosis, aortic valve regurgitation, bicuspid aortic valve, mitral stenosis and mitral regurgitation.
ObjectiveTo develop and validate a Nomogram for predicting severe immune-related adverse events (irAEs) in patients with advanced non-small cell lung cancer (NSCLC) undergoing immunotherapy based on clinical features and inflammatory indicators. MethodsA total of 423 patients with advanced NSCLC treated with immunotherapy between January 2023 and January 2025 at Tianjin Fourth Center Hospital and Tianjin Cancer Hospital Airport Hospital were enrolled. Patients were divided into a severe irAEs group (≥grade 3, n=76) and a non-severe irAEs group (n=347), then randomly allocated into training and validation cohorts (7:3 ratio) . Clinical data, neutrophil-to-lymphocyte ratio (NLR), and interleukin-6/C-reactive protein (IL-6/CRP) levels were collected. Independent risk factors for severe irAEs during immunotherapy in advanced NSCLC were identified through logistic regression analysis, and a nomogram model was constructed accordingly. The discriminative ability, accuracy, and clinical utility of the model were evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). ResultsAmong the 423 included patients [274 males, 149 females, aged 44-78 (60.77±5.91) years], the overall incidence of irAEs was 57.92% (245/423), with severe irAEs occurring in 17.97% (76/423). Multivariate analysis revealed that Eastern Cooperative Oncology Group (ECOG) performance score ≥2, programmed death-ligand 1 (PD-L1) expression [tumor proportion score (TPS) ≥50%], combination therapy regimen, low NLR values, and high IL-6/CRP ratio were independent risk factors for severe irAEs during immunotherapy in advanced NSCLC (P<0.05). The area under the ROC curve (AUC) was 0.948 [95%CI (0.912, 0.985)] in the training cohort and 0.946 [95%CI (0.917, 0.976)] in the validation cohort. Calibration curves and DCA demonstrated good consistency and clinical net benefit of the model. ConclusionThe nomogram integrating clinical features and inflammatory markers effectively predicts the risk of severe irAEs in advanced NSCLC patients receiving immunotherapy, exhibiting excellent discrimination, calibration, and clinical practicality.
ObjectiveTo systematically review the predictive factors of new-onset conduction abnormalities(NOCAs) after transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BAV) patients. MethodsThe CNKI, VIP, WanFang Data, PubMed, Cochrane Library and EMbase databases were electronically searched to collect the relevant studies on NOCAs after TAVR in patients with BAV from inception to December 5, 2022. Two researchers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.4 software. ResultsSix studies involving 758 patients with BAV were included. The results of the meta-analysis showed that age (MD=?1.48, 95%CI ?2.73 to ?0.23, P=0.02), chronic kidney disease (OR=0.14, 95%CI 0.06 to 0.34, P<0.01), preoperative left bundle branch block (LBBB) (OR=2.84, 95%CI 1.11 to 7.23, P=0.03), membranous septum length (MSL) (MD=0.93, 95%CI 0.05 to 1.80, P=0.04), implantation depth (ID) (MD=?2.06, 95%CI ?2.96 to ?1.16, P<0.01), the difference between MSL and ID (MD=3.05, 95%CI 1.92 to 4.18, P<0.01), and ID>MSL (OR=0.27, 95%CI 0.15 to 0.49, P<0.01) could be used as predictors of NOCAs. ConclusionCurrent evidence shows that age, chronic kidney disease, LBBB, MS, ID, the difference between MSL and ID, and ID>MSL could be used as predictors of NOCAs. Due to the limited quantity and quality of included studies, more high-quality studies are required to verify the above conclusion.