目的:探讨难治性鼻出血的临床出血特点及治疗方法。方法:回顾性地分析了2000至2008年我科收治的鼻出血病例中住院时间在8～20 d,鼻出血次数多达6次以上15例临床病例资料,其中男性10例,女性5例(1例系孕妇,妊娠达5月),男女比例2∶1,其中右侧鼻腔出血5例,左侧出血4例,双侧出血6例,最大年龄64岁,最小年龄17岁,出血次数4～10次,平均7次,鼻内镜下止血次数为2～5次,平均3次,全麻5例,局麻10例,双极电凝止血5例,电凝后行金霉素眼膏25 g /支+皮康霜10 g/支混合侵纱条填塞鼻腔5例,明胶海绵+金霉素眼膏25 g /支+皮康霜10 g/支混合侵纱条前鼻腔填塞6例,金霉素眼膏25 g /支+皮康霜10 g/支纱条前鼻腔填塞+鼻后孔填塞4例,双鼻腔出血处止血纱布碎片贴盖1例,行颈外动脉结扎术5例(右侧3例,左侧2例),住院时间为8～20 d,平均住院12 d,其中输血5人,小量多次输血次数为2～3次,平均2次,输血量为300～900 mL，平均400 mL。结果:15例患者中有明确病因3例,无明确病因12例,全部病例经全身和局部等多种方法综合治疗全部治愈,治愈率100%。结论:难治性鼻出血是一种严重危害人体健康的急症,临床特点：(1)难以明确病因,出血频繁、反复无常,出血范围广泛,无明确的固定出血部位。(2) 出血时间长、出血频率高,出血量大,止血次数多,止血方法繁多,止血效果差。(3) 住院时间长,医疗费用高,患者痛苦大、紧张焦虑、情绪不稳定。
Neurofibromatosis type 1 (NF1) is an autosomal dominant neoplastic disease caused by mutations in the NF1 gene and one of the most challenging diseases to treat. Patients have a characteristic phenotype with neurofibromas as the main features in different forms, including numerous cutaneous neurofibromas, plexiform neurofibromas involving the primary nerves, or malignant peripheral nerve sheath tumors with a very short survival period after malignant transformation. NF1 patients also suffer from multi-system involvement, with a high rate of deformity and disability, making complete surgical resection more difficult. Currently, there is no consensus on the diagnosis and treatment of NF1 in China, and different disciplines have different understandings of NF1. Multidisciplinary systematic evaluations and cooperative treatments are the keys to improve the treatment, quality of life, and prognosis of NF1 patients. In 2020, the Department of Plastic Surgery of the Ninth People’s Hospital of Shanghai Jiaotong University School of Medicine led the establishment of the first multi-center collaboration group for NF1 in China. Furthermore, the group had worked with renowned experts from the various departments including surgical oncology, medical oncology, dermatology, reproductive medicine, et al. in China to formulate the “Expert consensus on diagnosis and management of neurofibromatosis type 1 (2021 edition)”, aiming to promote standardized and homogeneous treatment covering the whole life cycle of NF1 patients and improve the treatment level and outcome of NF1 patients in China.
MicroRNA-92a (miR-92a) is an evolutionarily highly conserved pathogenic microRNA that is a member of the microRNA-17-92 gene cluster and is involved in the regulation of biological activities such as cell proliferation, apoptosis and differentiation. Recent studies have revealed that disorders of miR-92a expression are associated with disease development and exert pathogenic effects mainly through the regulation of target genes or target proteins. The current research related to miR-92a is mainly focused on malignant tumors, and its high expression has been found to be associated with cancer cell malignancy and reduced sensitivity of tumors to radiotherapy. miR-92a targeting target genes or target proteins to cause disease and its relationship with radiotherapy has been a hot research topic in recent years. Based on this, This article reviews the latest research on miR-92a target gene or target protein pathogenesis and its impact on chemotherapy in order to provide targets for clinical disease treatment.
Amanitin-containing mushroom poisoning is one of the most harmful and lethal types of mushroom poisoning events. Its basic medical and clinical medical knowledge has not been fully understood and mastered, so the basic and clinical diagnosis and treatment of amanitin-containing mushroom poisoning has always been a hot research field of acute mushroom poisoning. This article focuses on the new progress in the epidemiology, toxicological properties, poisoning mechanism, clinical diagnosis and treatment of amanitin-containing mushroom poisoning, in order to provide the basis for further study, diagnosis and treatment of amanitin-containing mushroom poisoning for basic researchers and clinical medical staff.
ObjectiveExplore the impact of a digital-intelligence-based quality control platform for thyroid cancer on the effectiveness of clinical diagnosis and treatment quality management. MethodsThe digital-intelligence-based quality control platform for thyroid cancer at Zhejiang Provincial People’s Hospital was launched at the end of July 2022. In its initial phase, six quality control indicators related to the standardized diagnosis and treatment of thyroid cancer were deployed. This study analyzed the changes in these six quality control indicators between January 2022 and November 2023, comparing data before and after the platform’s implementation. ResultsCompared with the period from January to July 2022 (prior to the platform’s launch), the rates of preoperative cytopathological examination (t=–8.490, P<0.001) and postoperative pTNM staging for thyroid cancer patients (t=–3.027, P=0.013) increased from July to November 2023 (one year post-launch). However, the proportion of minimally invasive surgeries among thyroid cancer patients (t=4.085, P=0.002) decreased. The linear regression model results indicated that, following the platform’s launch, there was a gradual increase over time in both the preoperative cytopathological examination rate for thyroid cancer (standard β=0.765, P=0.001) and the postoperative pTNM staging rate (standard β=0.499, P=0.049). ConclusionPreliminary results of this study suggest that the thyroid cancer digital-intelligence-based quality control platform developed by our team can effectively enhance the standardized quality control of clinical diagnosis and treatment for thyroid cancer.