Zhonghua yi xue za zhi
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Zhonghua yi xue za zhi · Jun 2019
[Evaluation of different staging systems and prognostic analysis of 110 primary gastrointestinal diffuse large B cell lymphoma].
Objective: To compare the prognostic efficiency of Lugano staging, TNM staging and Musshoff staging systems in patients with primary gastrointestinal diffuse large B-cell lymphoma(PGI-DLBCL) and investigate its clinical features and prognosis. Methods: The clinical data of 110 patients with PGI-DLBCL in Tianjin Medical University Cancer Institute and Hospital from May 2008 to August 2017 was retrospectively analyzed. The stage of lymphoma was assessed following Lugano staging, TNM staging and Musshoff staging systems respectively. ⋯ Conclusions: Compared with TNM staging and Musshoff staging systems, Lugano staging system provides the best prognostic value in PFS and OS for patients with PGI-DLBCL. Accompany with B-sympto, higher ECOG PS score, more extranodal lesions, increased LDH, higher IPI score and later period are negative factors for PG-DLBCL. Increased β2-MG and LDH, lower ALB level and later period are negative factors of PI-DLBCL.
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Zhonghua yi xue za zhi · Jun 2019
Randomized Controlled Trial[Comparison of ultrasound-guided serratus anterior plane block and erector spinae plane blockperioperatively in radical mastectomy].
Objective: To compare the perioperative effects of ultrasound-guided serratus anterior plane block (SAPB) and erector spinae plane block (ESPB) in radical mastectomy. Methods: One hundred and fifty patients,undergoing radical mastectomy from May 2016 to Jan 2019,the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, were randomly divided into SAPB group, ESPB group and control group. Patients in SAPB group and ESPB group were received corresponding blocks before induction of general anesthesia. ⋯ The incidences of skin itching and nausea in ESPB and SAPB groups were lower than those in control group (P<0.05). There was no difference in the incidence of vomiting among the three groups (P>0.05). Conclusions: Both SAPB and ESPB can provide good and safe analgesia for radical mastectomy,with equivalent performances in analgesia and adverse effect.
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Zhonghua yi xue za zhi · Jun 2019
[Risk factors for acute kidney injury after pediatric congenital heart surgery].
Objective: To investigate the clinical characteristics and risk factors of acute kidney injury (AKI) after pediatric congenital heart surgery among children aged<4 years old. Methods: A total of 410 children<4 years old with congenital heart disease who underwent cardiac pulmonary bypass (CPB) surgery from Guizhou Provincial People's Hospital between January 2017 and December 2018 were analyzed retrospectively. The patients were divided into two groups:AKI group (n=42) and non-AKI group (n=368) according to whether AKI occurred after surgery. ⋯ Results: Compared with non-AKI group, children in AKI group had lower weight [(8.2±3.3) kg vs (9.9±2.6) kg,P=0.023] and mean arterial pressure (MAP) [(101.3±18.1) mmHg vs (118.2±15.6) mmHg,P<0.001], but longer duration of surgery [(210.3±74.8) min vs (149.1±52.2) min, P<0.001], CPB [(107.2±49.9) min vs (60.2±29.2) min,P<0.001],aortic clamping [62.0(50.0,88.0) min vs 34.5(18.3,52.3) min,P<0.001],mechanical ventilation duration, ICU stay, hospital stay, and higher mortality. Multivariate logistic regression analysis showed that lower weight (OR=0.489, 95%CI:0.298-0.802, P=0.005), lower MAP (OR=0.929, 95%CI: 0.891-0.969, P=0.001), longer duration of surgery (OR=1.035, 95%CI: 1.016-1.054, P<0.001) were the independent risk factors for AKI. Conclusion: Children with lower weight, longer duration of surgery, lower MAP are at higher risk of getting AKI after congenital heart surgery.
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Zhonghua yi xue za zhi · Jun 2019
[Effects of modified posteromedial approach combined raft technique for posterior Pilon fractures with collapsed articular surface].
Objective: To evaluate the effects of modified posteromedial approach combined raft technique in the treatment of posterior Pilon fractures with collapsed articular surface. Methods: A retrospective analysis was conducted on the clinical data of 51 patients with posterior Pilon fractures combined with collapsed articular surface treated in West China Hospital between January 2014 and June 2017. There were 30 males and 21 females with an average age of 49 years (range, 19-66 years). ⋯ The preoperative VAS score was 7.5±1.1, and the postoperative score was 0.3±0.7, in which the difference was statistically significant (t=31.231, P=0.000). At the last follow-up, the angle of injured side were 13.3°±3.4° in dorsal extension, 33.5°±4.7° in plantar flexion, and 46.9°±6.1° in the range, while angel of uninjured side were 19.8°±2.3°, 36.0°±5.7° and 55.6°±2.7°, respectively; there were significant differences in the up-mentioned indexes between the both sides (t=78.932, 121.231, 113.432, all P<0.05). Conclusion: Excellent short-term effectiveness can be achieved through the modified medial approach in patients with posterior Pilon fractures, which can be used to restore the ankle joint surface under direct vision; and with the raft technique, a small plate is used to fix small fragments firmly with less soft tissue complications.
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Zhonghua yi xue za zhi · May 2019
[Value of intravoxel incoherent motion diffusion weighted imaging in evaluating the microstructure changes in white matter hyperintensities].
Objective: To investigate the value of intravoxel incoherent motion diffusion weighted imaging (IVIM DWI) in evaluating microstructure changes in elderly white matter hyperintensities (WMH) patients and to analyze the correlation between IVIM parameters and severity grading and cognitive scores. Methods: Sixty-two WMH patients in Zhejiang Hospital were collected from December 2014 to March 2018 and underwent conventional magnetic resonance (MR) plain scan and diffusion weighted imaging with different b values. The age was 60-92(74±10) years with 37 males, 25 females. ⋯ Only f in PWMH were positively associated with the MMSE scores (r=0.326 5,P<0.05). Conclusions: IVIM DWI can noninvasively assess the variation of microstructure diffusion and perfusion in WMH in one sequence,which may objectively reflect the severity of these lesions. This method has important clinical significance for better assessment and management of this disease.