Objective To study the diagnosis and treatment of the acute medial collateral ligament ruptures of the knee.Methods From August 1998 to August 2003, 87 cases of acute medial collateral ligament ruptures were examined with physical method and MR imaging. Out of them, 35 cases of Ⅰdegree and Ⅱ degree ruptures were treated with non-surgery and 52 cases of Ⅲ degree ruptures were treated surgically. The torn medial collateral ligaments were mended, 21 of which were strengthened with the anterior partial gracilis muscle tendon after the arthroscopy. Results In 35 cases of Ⅰ and Ⅱ degree ruptures, 32 were followed up 13 months on average. According to Lysholm scoring system, the clinical results were classified as excellent or good in 93.7% of the cases. In 52 cases of Ⅲ degree ruptures, 50 were followed up 16 months on average. The excellent or good result was 90%.Conclusion For Ⅰ and Ⅱ degree ruptures, MR imagimg is an important way to definitely- diagnose medial collateral ligament ruptures. Abduction stress test of knee extension shows that the medial direct instability is a main way to definitely diagnose Ⅲ degree ruptures. The results of conservative treatment of Ⅰ degree and Ⅱ degree ruptures are excellent. Surgical therapy are fitfor the cases of Ⅲ degree ruptures.
ObjectiveRecent advancements in the researches on cholangiocarcinoma (CC) related genes methylation in CC were reviewed and the clinical significances of aberrant DNA methylation for the diagnosis and treatment of CC were discussed. MethodsRelevant literatures about the relation between CC-related genes methylation and CC published recently were collected and reviewed. ResultsThe genesis of CC resulted from abnormal expressions of many genes. Many researches had shown that the abnormal methylation of CC-related genes had a close relation with CC. Epigenetic alteration had been acknowledged as an important mechanism contributing to early CC carcinogenesis. ConclusionsAbnormal methylation of CC-related genes is related with CC. The detection of CC-related genes methylation might provide new specific biomarkers for early noninvasive diagnosis of this disease. Using epigenetic agents such as azacytidine to modulate the activities of DNA methyltransferase and reverse the methylation status of CC-related gene might be an attractive strategy for future treatment of CC, which could be combined with conventional therapies.
ObjectiveTo evaluate the quality differences in recommendations generated by large language models (LLM) and clinical practitioners for sarcopenia-related questions. MethodsA sarcopenia knowledge base was constructed based on the latest domestic and international research and consensus guidelines. Using the Python environment, a locally deployed and sarcopenia-focused hybrid vertical LLM (referred to as LC) was implemented via LangChain-LLM. Eight fixed questions covering etiology, diagnosis, and prevention were selected, along with eight virtual patient cases. The evaluation team assessed the quality of answers generated by LC and written by clinical practitioners. Quantitative analysis was performed on the precision, recall, and F1 scores (harmonic mean of precision and recall) of treatment recommendations. ResultsThe responses were generally perceived as "possibly written by humans or AI", with a stronger inclination toward being AI-generated, although the accuracy of such judgments was low. Regarding answer quality attributes, LC's responses were superior to those of clinical practitioners in guideline consistency (P<0.01), exhibited similar acceptability (P>0.05), showed better practicality (P<0.05), and had a lower proportion of "1–2 errors" (P<0.05). Quantitative analysis of treatment recommendations indicated that LC and GPT-4.0 outperformed clinical practitioners in recall and F1 scores (P<0.05), with minimal differences between LC and GPT-4.0. ConclusionThe locally deployed sarcopenia-focused hybrid vertical LLM demonstrates high accuracy and applicability in addressing sarcopenia-related issues, outperforming clinical practitioners and exhibiting strong clinical decision-support capabilities.
In the research process of uveal melanoma (UM), the Collaborative Ocular Melanoma Study (COMS) is a landmark and outstanding clinical study. Its research conclusions are the foundation for today's UM clinical work and guidelines. COMS is the first and largest randomized clinical trials conducted to date, comparing the survival outcomes of two or more treatment regimens for primary malignant intraocular tumors with high reliability. Its research design, methods, and conclusions are still widely cited in this day. Learning from the research experience of COMS, summarizing research data based on Asian populations, and studying treatment methods suitable for Asian UM patients is a powerful supplement to COMS data, but also an expansion of this global research, further improving the level of UM diagnosis and treatment in China.
Abstract: Objective To summarize the clinical experiences of treatment of pulmonary artery dissection, in order to improve the diagnosis and treatment of the disease. Methods We retrospectively analyzed the clinical data of 4 patients including 3 males and 1 female with pulmonary artery dissection who were treated in Fu Wai Hospital between October 1996 and May 2009. Their age ranged from 17 to 45 years with an average age of 31 years. One patient with pulmonary artery dissection with aortic root aneurysm and chronic type Ⅱ aortic dissection was treated with Bentall’s surgery, total arch replacement and pulmonary artery angioplasty under deep hypothermic circulatory arrest. One patient with pulmonary artery dissection with patent ductus arteriosus (PDA) and severe pulmonary hypertension after a failed PDA transcatheter closure was treated with conservative strategy. For the one patient with pulmonary artery dissection with ventricular septal defect (VSD) and severe pulmonary arterial hypertension, VSD was repaired under cardiopulmonary bypass while left pulmonary artery dissection was left untreated. And conservative treatment was carried out for another patient with pulmonary artery dissection with VSD, PDA and Eisenmenger’s syndrome. Results Three patients recovered and 1 patient died of acute pericardial tamponade due to rupture of the dissection within 60 hours after onset of dissection. Followup was done in 3 cases with 1 lost. The followup time was 3 months and 4 years respectively. The New York Heart Association was class Ⅰ and Ⅱ. Conclusion Dissection of the pulmonary artery is a rare disease with a tendency of rupture and bad prognosis. Symptoms of pulmonary artery dissection are nonspecific, which can cause missed diagnosis. In patients with chronic pulmonary hypertension, the sudden seizure of chest pain, exertional dyspnea, and cyanosis, or worsened hemodynamics and cardiac shock may indicate pulmonary artery dissection which can be easily detected with echocardiography, CT scan and magnetic resonance imaging. Corrective surgery or conservative treatment can prevent rupture and possible death based on different causes of pulmonary artery dissection.
In recent years, anti-vascular endothelial growth factor (VEGF) therapy has become first line treatment for a variety of clinical conditions, including wet age related macular degeneration, macular edema secondary to retinal vein occlusion, diabetic macular edema and proliferative diabetic retinopathy. With the successive launch of new formulations such as high-dose anti-VEGF drugs and gene therapy in China, sterile intraocular inflammation (SIOI) after intraocular drug delivery has gradually come into public view and warranted attention. On the other hand, a variety of drugs that have been used in ophthalmic clinics for years, including prophylactic anti-infective drugs (such as vancomycin) and glucocorticoids (such as dexamethasone implants), have also been reported of SIOI occurrence. To avoid and alleviate the negative impact of SIOI on the visual function of the affected eyes, a systematic and standardized SIOI management system is urgently needed. For this reason, the Fundus Disease Group of Ophthalmological Society of Chinese Medical Association, Fundus Disease Committee of Ophthalmologist Branch of Chinese Medical Doctor Association, and Expert Group of Expert consensus for the diagnosis and treatment of sterile intraocular inflammation after intraocular drug delivery (2025) put forward recommended opinions on seven key clinical issues. Based on the latest evidence based medical evidence, combined with international guidelines/consensuses and the current situation of social and economic development in China, they made recommendations on aspects of SIOI, including the incidence and timing, clinical manifestations, related factors and population identification, perioperative monitoring measures, and intervention strategies and prognosis after the occurrence of SIOI, thus forming the Expert consensus for the diagnosis and treatment of sterile intraocular inflammation after intraocular drug delivery (2025). The formulation of this consensus aims to enhance the awareness and understanding of SIOI among ophthalmologists specializing in retinal diseases, provide evidence-based guidance and decision-making references for the early identification and standardized management of SIOI in clinical practice, and further improve the quality control system of intraocular injection therapy in China, thereby ensuring patient safety.
Abstract： Currently, there are two significant tendencies in the advancement and progress of video-assisted thoracoscopic surgery（VATS）, firstly, the widening surgical indications for VATS techniques, and secondly, the use of single-port VATS which is less invasive and more cosmetic. This article focuses in particular on four aspects of single-port VATS, including；（1）the individualized incision approach and its characteristics of single-port VATS；（2）single-port VATS for the treatment of pneumothorax and the development of related techniques and equipment；（3）single-port VATS for the diagnosis and treatment of thoracic diseases such as lung lobectomy；（4）the advantages and disadvantages of single-port VATS in clinical practice.
Vaccine-associated uveitis (VAU) usually refers to a rare adverse reaction that occurs after vaccination. The clinical manifestations of VAU are most often anterior with mild symptoms and responded promptly to topical corticosteroids. However, more severe forms of posterior and panuveitis may also occur, such as multiple evanescent white dot syndrome, Vogt-Koyanagi-Harada syndrome, and acute posterior multifocal placoid pigment epitheliopathy. The pathogenesis of VAU is still unclear. Currently, it mainly includes vaccine Shoenfeld syndrome, type Ⅲ hypersensitivity reaction caused by immune complex deposition, direct infection with live attenuated vaccine, and molecular mimicry theory. VAU is self-limiting, and most patients heal without treatment. In the future, it is recommended to ask all patients with uveitis about their recent vaccination history in the clinic. For patients with inactivated vaccine or recombinant/subunit vaccination history, the possibility of developing Shoenfeld syndrome should be considered, and the history, signs and symptoms related to autoimmune diseases should be carefully looked for.
To reduce the infection risk of 2019-novel coronavirus and to protect medical staffs, “Graded personal protection scheme for preventing medical staffs from 2019-novel coronavirus infection in West China hospital” was formulated according to the guidance and notice issued by the National Health Commission combined with the actual situation of West China Hospital. This scheme could provide reference for preventing such disease for medical staffs.
Severe/massive ischaemic stroke is difficult to treat and has poor prognosis. There are limited studies for specific treatment of these conditions and no consensus on their definitions. This proposal suggests definitions and a flowchart for the diagnosis and treatment of these conditions. We focus on predicting and preventing malignant oedema at an early stage, monitoring the level of consciousness and vital signs, and the prevention and management of complications (eg. pulmonary infections). We particularly provide suggestions for the treatment with intravenous thrombolysis, endovascular treatment, antiplatelet and anticoagulation. More studies are warranted to support individualised management of infarct swelling, intracranial hypertension and early rehabilitation for severe/massive ischaemic stroke.