ObjectiveTo discuss the treatment methods and outcome of hilar cholangiocarcinoma. MethodsFrom January 2002 to December 2008, 81 cases of hilar cholangiocarcinoma were retrospectively analyzed. ResultsAmong 81 patients, there were 55 males and 26 females, ages were from 38 to 72 years with an average age 57.5 years. In BismuthCorlette classification, 5 cases were type Ⅰ, 15 cases type Ⅱ, 14 cases type Ⅲa, 14 cases type Ⅲb, 33 cases type Ⅳ, according to the preoperative results of MRCP, but the classification of 15 cases were not consistent to the preoperative results (5 cases type Ⅱ, 8 cases type Ⅲ, 2 cases type Ⅳ) according to the results of intraoperative exploration. The rates of complications of radical operation, palliative operation, internal biliary drainage, and external biliary drainage were 54.5%(12/22), 58.8%(10/17), 23.8%(5/21), and 66.7%(14/21), respectively. The rate of complications of internal biliary drainage was lower than that of the other three methods (Plt;0.01), there were no significant differences among the other three methods. The 1, 2, 3, and 5year survival rates of 22 patients with radical operation, 17 patients with palliative operation, 21 patients with internal biliary drainage, 21 patients with external biliary drainage were 75.0%, 60.0%, 38.3%, 2.6%; 72.7%, 26.5%, 4.2%, 0; 50.5%, 15.8%, 2.2%, 0; 30.6%, 8.5%, 0, 0, respectively. The median survival time was 29.5 months, 13.8 months, 10.5 months, and 8.3 months, respectively. Survival rate of radical operation was higher than that of palliative operation (χ2=14.20, P=0.000 3), palliative operation was higher than that of internal biliary drainage (χ2=4.50, P=0.040 5), and internal biliary drainage was higher than that of external biliary drainage (χ2=4.45, P=0.040 1). ConclusionsThe BismuthCorlette classification is a guide to the required surgery, but the results of intraoperative exploration decides the final classification and operative method. Radical resection is the main related factors influencing the therapy efficacy of hilar cholangiocarcinona. Basinstyle anastomosis and T type supportingtube is the first choice of palliative operation. External drainage, to the full, is avoided.
At present the prediction method of epilepsy patients is very time-consuming and vulnerable to subjective factors, so this paper presented an automatic recognition method of epilepsy electroencephalogram (EEG) based on common spatial model (CSP) and support vector machine (SVM). In this method, the CSP algorithm for extracting spatial characteristics was applied to the detection of epileptic EEG signals. However, the algorithm did not consider the nonlinear dynamic characteristics of the signals and ignored the time-frequency information, so the complementary characteristics of standard deviation, entropy and wavelet packet energy were selected for the combination in the feature extraction stage. The classification process adopted a new double classification model based on SVM. First, the normal, interictal and ictal periods were divided into normal and paroxysmal periods (including interictal and ictal periods), and then the samples belonging to the paroxysmal periods were classified into interictal and ictal periods. Finally, three categories of recognition were realized. The experimental data came from the epilepsy study at the University of Bonn in Germany. The average recognition rate was 98.73% in the first category and 99.90% in the second category. The experimental results show that the introduction of spatial characteristics and double classification model can effectively solve the problem of low recognition rate between interictal and ictal periods in many literatures, and improve the identification efficiency of each period, so it provides an effective detecting means for the prediction of epilepsy.
ObjectiveTo summarize the effect of the multi-disciplinary treatment (MDT) for a patient with giant pancreatic cystic lymphangioma.MethodsThe clinical data of a patient with pancreatic lymphangioma admitted to the Affiliated Hospital of North Sichuan Medical College in March 2020 was retrospectively analyzed, then reviewed the literatures, and summarized the preoperative diagnosis, treatment, and management of perioperative period and long-term period after surgery of this rare disease.ResultsAfter admission, the patient was diagnosed as pancreatic tumor by various imaging and laboratory examinations. The nature was unknown. After discussion by MDT, it was decided to undergo a total pancreatectomy (TP). After the operation, drugs and diet were given to regulate blood glucose. The patient’s tumor disappeared after the operation, and no tumor recurrence was found in the three months after discharge.ConclusionsPancreatic lymphangioma is rare and lacks a clear diagnosis and treatment plan. The MDT mode can bring a clearer diagnosis and more effective treatment for it.
Traditional Chinese medicine (TCM) has some unique advantages in the prevention and treatment of cancer. Due to different ideas and mechanism of between TCM and biomedicine in the prevention and treatment of cancer, the clinial effect evaluation approches of biomedicine could not be used as a beneficial method to scientifically evaluate the effects of TCM. From three angles, this article analyzes the key issues regardsing the evaluation methods of TCM as an adjuvant therapy of cancer. It draws lessons from the idea of quality-adjusted survival (QAS), proposes Two-in-One (TIO) method to evaluate the effects of TCM as adjuvant therapy of cancer, which reflects the combined value of the individual patient dynamic information and provides methodological support for the effect evaluation of TCM.
Objective To investigate the effectiveness of various materials in reconstruction of laryngotracheal framework and to analyze the advantages, disadvantage, and indication of each material. Methods The cl inical data were retrospectively analyzed, from 337 laryngotracheal stenosis patients undergoing laryngotracheal framework reconstruction with various materials between October 1986 and October 2006. There were 229 males and 108 females aged from 2 to 54 years (median, 23.5 years). According to Cotton’s grading criteria for laryngotracheal stenosis, there were 94 cases of grade II, 218 cases of grade III, and 25 cases of grade IV, and all accompanied by laryngotracheal framework defect of 1-5 cm. The costal cartilage autograft was performed in 157 cases, thyroid cartilage graft in 27 cases, nasal septal cartilage graft in 8 cases, sternohyoid myocutaneous rotary door flap graft in 104 cases, hyoid bone flap of sternocleidomastoideus graft in 7 cases, musculo-periosteum flap of sternocleidomastoideus with clavicular periosteum in 21 cases, hydroxyapatite artificial tracheal ring graft in 10 cases, and pedicle myocutaneous flap with “C” shape nickel-titanic alloy net graft in 3 cases. Silastic T-tube was used after reconstruction for 6-12 months. Results Infection occurred in 5 cases and the incisions healed by second intention, the others achieved healing of incision by first intention. Intratracheal granulation formation occurred in 23 cases and choke when taking food in 6 cases; they were all cured after symptomatic treatment. After operation, 4 cases failed to be followed up and 12 cases did not recover, including 6 cases of costal cartilage autograft, 1 case of hyoid bone flap of sternocleidomastoideus graft, and 5 cases of sternohyoid myocutaneous rotary door flap graft. A total of 321 patients were followed up for 1-10 years (mean, 3.5 years). The patients had no laryngotracheal restenosis with good swallowing function and respiratory function. Conclusion Different materials of laryngotracheal framework reconstruction have advantages and disadvantage respectively. The appropriate material should be selected according to the special details of pathological change, and the satisfactory curative effect may be obtained.
Objective To compare the efficacy of plating versus intramedullary nailing in the treatment of adult humeral shaft fracture. Methods We identified eligible studies in PubMed (1950 to September 2007), MEDLINE (1950 to September 2007), OVID CINAHL (1950 to September 2007), OVID EBM (3rd Quarter 2007), CBMdisk (1978 to June 2007) and CNKI (1981 to June 2007). We also handsearched several Chinese orthopedic journals. Data were extracted and evaluated by two reviewers independently. Randomized controlled trials (RCTs) comparing plating versus intramedullary nailing for humeral shaft fracture in adults were included and the quality of these trials was critically assessed. Data analyses were conducted with Stata 10.0. Results Six RCTs involving 425 patients were included, among which the statistical heterogeneity was not significant (Pgt;0.1). Cumulative meta-analyses showed that intramedullary nailing might increase the re-operation rate in studies conducted before the year of 2000 (OR=0.39, 95%CI 0.17 to 0.90, P=0.03), but the difference was not significant in studies conducted after 2000 (OR=0.54, 95%CI 0.27 to 1.08, P=0.08). Intramedullary nailing might increase the incidence of shoulder impingement compared with plating (OR=0.13, 95%CI 0.03 to 0.65, P=0.01). The rates of non-union, deep infection, iatrogenic radial nerve injury and internal fixation failure were similar between plating and intramedullary nailing. Meta-analyses were not conducted for union time, operation time and bleeding (transfusion) volume, because the relevant data were not available from the included trials. Conclusion Intramedullary nailing may increase the incidence of shoulder impingement. The rates of re-operation, non-union, deep infection, iatrogenic radial nerve injury and internal fixation failure are similar between plating and intramedullary nailing. Further well-designed and large-scale randomized controlled trials are required to determine the effects of plating and intramedullary nailing on these outcomes.
Poor compliance in clinical studies is a risk factor leading to bias of results of clinical research. However, while the subject compliance has received extensive attention, researcher compliance has not been paid enough attention. The problem of researcher compliance runs through the whole process of clinical research. How to control and evaluate the researcher compliance is the key problem in clinical research. Based on the current situation of poor compliance of clinical researchers, this paper summaried the information of five different dimensions that affects the researcher compliance in clinical research, clarified the relevant factors that may affect the researcher compliance in the process of clinical research, and analyzed the influence of the factors related to the researcher compliance on the quality control of clinical research, hence establishing a foundation for further research on control strategies and evaluation techniques of researcher compliance.
Objective To evaluate the cl inical outcomes of primary anterior focus debridement, bone autograft, and internal fixation via transperitoneal approach in treating tuberculosis of the lumbosacral junction. Methods From February 2002 to April 2007, 16 patients with tuberculosis of the lumbosacral junction underwent anterior radical debridement, autologous il iac bone graft (two pieces of il iac bone, 5 cm × 3 cm in size), and internal fixation via transperitoneal approach, including 4 males and 12 females aged 27-63 years old (average 38 years old). The course of the disease ranged from 6 to 18 months (average 10 months). All patients experienced various degrees of pain in the lumbosacral area and toxic symptoms of thetuberculosis. Nine cases were compl icated with radicular pain in the lower extremities, and 3 cases had saddle area anaesthesia. Two cases were initially diagnosed as lumbar intervertebral disc protrusion and treated accordingly. The segments involved by the tuberculosis were L5-S1 level in all cases. The average erythrocyte sedimentation rate (ESR) was 61 mm/hour. Imaging examination confirmed the diagnosis of spinal tuberculosis. All cases received four antitubercular drugs and nutrition support for nerve before operation. Operation was performed when hepatorenal function was normal, and the toxic symptom of the tuberculosis was under control or ESR was decreased. Results Operation was performed safely in all cases without injuries of abdominal viscera, major blood vessel, cauda equina nerve and ureter. All wounds healed by first intention. No recurrence of tuberculosis and formation of sinuses occurred. All cases were followed up for 12-37 months (average 21 months). No such compl ications as tuberculous peritonitis and intestinal obstruction occurred. No postoperative erectile dysfunction and retrograde ejaculation occurred in the 4 male patients. ESR was recovered to normal 3-6 months after operation, and regular X-ray and CT exams showed no displacement of grafted bone. All patients achieved bony fusion 12 months after operation without the occurrence breakage and loosening of titanium plate and screw. The radical pain in the lower extremities and the saddlearea anaesthesia disappeared. Four patients had pain in the il iac donor site, 2 patients had mild pain in the lumbosacral area, and the pain was el iminated after symptomatic treatment. The therapeutic effect was graded as excellent in 14 cases and good in 2 cases according to the therapeutic effect evaluation criteria of Chen and co-workers. Conclusion The surgical treatment of tuberculosis of the lumbosacral junction with primary anterior focus debridement, bone autograft, and internal fixation via transperitoneal approach can achieve satisfying bony fusion and reconstruct spinal stabil ity.