Objective To make an evidence-based remedy for a patient with cerebral veins and sinuses thrombosis (CVST), who had an unsatisfactory response to routine treatment. Methods We searched the Cochrane Library (Issue 3, 2005), PubMed (1966 to 2005), CNKI (1979 to 2005) and VIP (1989 to 2005) to identify systematic reviews (SRs), randomized controlled trials (RCTs), controlled clinical trials (CCTs) and prospective cohort studies about efficacy and safety of anticoagulants and thrombolysis therapy for CVST. Results We found 1 systematic review, 3 RCTs and 8 prospective cohort studies about anticoagulation therapy and 2 SRs and 1 CCT about thrombolysis therapy. Routine anticoagulation and thrombolysis for patients with CVST are not recommended due to insufficient evidence. Anticoagulation appeared to be safer and could prevent pulmonary embolism. According to the current evidence, the patient’s status and will, anticoagulants were given. His symptoms relieved and he had no subsequent hemorrhages or pulmonary embolism. Conclusion Patients with CVST should receive anticoagulation treatment with monitoring of de novo hemorrhages and the index of hemostasis and coagulation. Large-sample RCTs comparing the effect and safety of anticoagulant with placebo and RCTs comparing the effect and safety of anticoagulation therapy with that of endovascular thrombolysis therapy in high-risk patients are needed.
目的 探讨显微切除延髓实体性血管母细胞瘤术中电生理监测的意义。 方法 2007年7月-2009年8月，在电生理监测下显微切除13例延髓实体性血管母细胞瘤，观察切除程度、死亡率及术后脑干功能，并对电生理监测下的手术技巧进行讨论总结。 结果 完全切除13例延髓实体性血管母细胞瘤，术后因呼吸功能衰竭死亡1例，6个月脑干机能状态较术前保持或改进10例。 结论 延髓实体性血管母细胞瘤切除术中行神经电生理监测有助于提高手术效果，改善预后。
Objective To investigate the effectiveness of acetabular revision using jumbo cementless cups. Methods Between May 1996 and May 2011, 35 patients (35 hips) underwent an acetabular revision with jumbo cementless cups, and the clinical data were retrospectively analyzed. There were 12 males and 23 females, with an average age of 64.8 years (range, 47-79 years). The time from hip arthroplaty to revision was 1-15 years (mean, 9.7 years). The causes for revision were aseptic loosening in 32 cases, femoral periprosthetic fracture (Vancouver type B3) in 2 cases, and low toxicity infection in 1 case. According to the classification of acetabular bony deficiencies of the American Association of Orthopedic Surgeon (AAOS), 6 cases were classified as type I, 9 cases as type II, and 20 cases as type III; according to the classification proposed by Paprosky, 5 cases were rated as type II A, 9 cases as type II B, 13 cases as type II C, and 8 cases as type III A. The primary hip arthroplasty cups had an outside diameter of 46-52 mm (mean, 49.6 mm), and the revision cups had an outside diameter of 56-68 mm (mean, 60.4 mm). Harris score was used for hip function evaluation, and X-ray films were taken for imaging evaluation. Results Healing of incision by first intention was obtained in all patients; without infection or neurovascular injury. Prosthetic dislocation was observed in 1 case at 20 days after operation, and was cured after expectant treatment. One patient died at 6 years after operation, and the other 34 patients were followed up 2-14 years (mean, 8.4 years). The Harris score was significantly increased from 46.4 ± 13.4 at preoperation to 90.4 ± 3.6 at last follow-up (t=18.76, P=0.00). The distance between acetabular rotation centre and teardrop line was significantly decreased, and the distance between acetabular rotation centre and lateral teardrop was significantly increased when compared with preoperative ones (P lt; 0.05). Only 1 patient received second revision for aseptic loosening after 10 years; no continuous radiolucent line, prosthetic dislocation, and osteolysis was found, and bony ingrowth was shown in the other patients. Conclusion Jumbo cementless cup for acetabular revision can achieve good effectiveness for having the advantages of simple operation, less bone grafts, and good recovery of the acetabular rotation centre.
Objective To explore the positive rate of emphysema in groups under Low-dose CT screening, then take the regression analysis on related risk factors for emphysema. Methods A total of 1 175 volunteers involved in low-dose CT screening and completing the questionnaire were collected and taken the CT quantitative assessment for emphysema, then the positive rate of emphysema was calculated. Questionnaire data were collected and non-conditional Logistic regression was used to analyze the factors in the questionnaire. Results Ninety-seven cases of emphysema had been detected in 1 175 volunteers, and the positive rate was 8.26%. The positive rate for the males and the females was 9.90% (71/717) and 5.68% (26/458), respectively. Three risk factors (smoking, second-hand smoking, history of chronic bronchitis) were screened out by Logistic regression. Conclusions According to the results of the regression analysis, smoking, second-hand smoking and history of chronic bronchitis are main risk factors for emphysema. Some effective measures could be made against emphysema in high risk population. In that way the morbidity and perniciousness of emphysema could be reduced.
ObjectiveTo compare the current status of clinical studies regarding lung cancer between China and the United States in 2019, and to indicate the weakness, trend and future development direction of clinical studies drug treatment in China.MethodsThe data of lung cancer clinical studies from January 1st to November 30th, 2019 in China and the United States were retrieved and analyzed through Informa pharmaprojects database.ResultsThe United States was superior on the number of projects (128 vs. 156) and research institutions (743 vs. 2 250). Compared with the United State, there were more phase Ⅲ confirmatory researches (19.5% vs. 10.3%), bioequivalent drug researches (3.1% vs. 0%), and researches initiated by academic institutions (39.8% vs. 28.1%) in China. The United States exhibited advantages in phaseⅠ andⅠ/Ⅱstudies (25.8% vs. 60.3%), immunodrugs (49.2% vs. 60.3%), primary tested drug ratio (61.7% vs. 93.6%), targets abundance (32.9% vs. 69.6%), and chimeric antigen receptor-T (CAR-T, 0.7% vs. 7.1%).ConclusionCompared with the United States, China should pay more attention to innovative drug investigations in early phase of clinical studies, especially novel immune agents, vaccines, and CAR-T.
Objectives To assess the relationship between subclinical hyperthyroidism and the incidence of coronary heart disease (CHD). Methods PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, VIP, WanFang Data and CBM databases were searched for studies on the relationship between subclinical hyperthyroidism and the incidence of CHD from inception to October 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 and Stata 12.0 software. Results In total, 14 cohort studies were included. The results of meta-analysis showed that subclinical hyperthyroidism was associated with the incidence of coronary heart disease (RR=1.19, 95%CI 1.01 to 1.40, P=0.04) and all-cause mortality (RR=1.36, 95%CI 1.11 to 1.67, P=0.003). Conclusions Subclinical hyperthyroidism is associated with an increased risk of CHD and all-cause mortality. Due to the limitation of quality and quantity of the studies, the above conclusions are required to be verified by large-scale and high quality research.
ObjectiveTo explore the application value of “Project Work Mode of West China” in the online prevention and control of new coronavirus (2019-nCoV).MethodBased on the rich experience of earthquake relief and project management in West China Hospital of Sichuan University, the “Project Work Mode of West China” was continuously optimized by PDCA cycle.ResultsThe “Project Work Mode of West China” could be applied to the 2019-ncov public health emergency, and the closed loop of rapid response had been established. The whole project team ran well and the system operation and maintenance were stable.ConclusionsThe “Project Work Mode of West China” provides a working path for the online epidemic prevention and control. The use of internet remote cooperative office effectively promotes the scientific emergency management of the epidemic and plays an active role in the online epidemic prevention and control.
The prevention and control of coronavirus disease 2019 is severe. In order to reduce the exposure of high-risk population and help home protection for at-risk population, West China Hospital of Sichuan University actively explored the construction and practice of online monitoring and home control systems, established a follow-up work team for at-risk population, formulated standardized work models and procedures, set up an online standardized follow-up information registration form to collect follow-up data, and controlled the process quality through repeated supervision. During the epidemic period of coronavirus disease 2019, West China Hospital of Sichuan University online follow-up mode can play a positive supporting role in the epidemic prevention and control and promoting this model has certain reference value for various medical institutions.