【摘要】 目的 比较手术及伽马刀治疗lt;3 cm听神经瘤的优劣。 方法 由2名研究人员分别检索1990年1月1日—2010年3月31日四川大学网上图书馆CENTRAL、ISI、Medline、Embase、NLM Gateway、CBMdisc等数据库的相关论文，选择证据级别最高的文献，使用Cochrane图书馆提供的RevMan 5.0软件，对手术和伽马刀治疗小型听神经瘤在面神经、听力功能保留的优劣方面进行Meta分析。 结果 共检索到4篇前瞻性队列研究，排除2篇。剩余的2篇文献共纳入患者173例，分析发现，在1年随访及随访结束时，手术治疗组与伽马刀治疗组相比，在面神经功能完整保留方面，P值及其95%CI分别为0.64（0.53，0.77）、0.67（0.47，0.96）；在保留有用听力方面，P值及其95%CI分别为0.08（0.02，0.27）及0.08（0.02，0.28）。 结论 伽马刀治疗lt;3 cm的听神经瘤，无论在保留有用听力还是面神经功能方面均明显优于手术。【Abstract】 Objective To compare surgery and gamma-knife treatment in treating acoustic neuroma less than 3 cm in diameter through Meta analysis. Methods Two researchers respectively searched relevant papers from such databases as CENTRAL, ISI, Medline, Embase, NLM Gateway, and CBMdisc posted on the online library of Sichuan University. Papers with the highest-grade evidence were selected, and RevMan 5.0 provided by Cochrane Library was used to compare surgery and gamma-knife treatment in the preservation of patients’ facial nerves and useful hearing through Meta analysis. Results Four prospective cohort studies were found, two of which were excluded. The remaining two articles were analyzed, and we compared surgery and gamma-knife treatment during the 1-year and the last follow-up period in facial nerve preservation and useful hearing preservation. The P value and 95% CI of the comparison was respectively 0.64 (0.53, 0.77) and 0.67 (0.47, 0.96) for facial nerve preservation, and 0.08 (0.02, 0.27) and 0.08 (0.02, 0.28) for useful hearing preservation. Conclusion Gamma-knife treatment for acoustic neuroma less than 3 cm in diameter is a much better choice than surgery in preserving hearing and facial nerve function.
Objective To study the relationship between the changes of short-term health-related life quality and the improvement/deterioration of forced expiratory volume in one second (FEV1) in patients with chronic obstructive pulmonary disease (COPD), and explore the feasibility of planning the frequency of pulmonary function test by evaluating the changes of life quality of COPD patients. Methods Based on the change of FEV1 (△FEV1), COPD patients from the standardized COPD and asthma management project database and its extended database of the center for chronic airway disease management, from 2020 to now, who completed pulmonary function tests and St. George's Respiratory Questionnaire (SGRQ) twice with an interval of 28 days, were divided into △FEV1 improvement group, △FEV1 deterioration group and △FEV1 maintenance group. The differences of SGRQ scores in different △FEV1 groups were analyzed, and the high-risk factors of △FEV1 deterioration group and the importance of influencing factors of △FEV1 deterioration were analyzed by neural network. Results A total of 1233 patients were included in the analysis. There were significant differences in △SGRQ total score, △SGRQ symptom, △SGRQ activity and △SGRQ impacts among △FEV1 groups (P<0.05). Compared with the △FEV1 maintenance group, the △FEV1 improvement group showed clinically significant improvement in both the total SGRQ score and each sub score, and the improvement value was more than 4 points. While the △FEV1 deterioration group showed statistically significant difference in the total SGRQ score and each sub score, but only showed clinically significant deterioration in the SGRQ symptom sub evaluation. Logistic regression model showed that the risk factors of △FEV1 deterioration included female (OR=2.11, 95%CI 1.23 - 3.59, P=0.006), baseline FEV1 (OR=2.63, 95%CI 1.92 - 3.60, P<0.001), △SGRQ (OR=1.02, 95%CI 1.01 - 1.03, P<0.001), baseline SGRQ symptom (OR=1.02, 95%CI 1.01 - 1.02, P<0.001) and △SGRQ symptom (OR=1.02, 95%CI 1.01 - 1.03, P<0.001), further neural network analysis showed that the importance orders of the five variables were △SGRQ total score (100.0%), △SGRQ symptom (86.9%), baseline FEV1 (71.4%), baseline SGRQ symptom (56.6%) and gender (29.6%). Conclusions The variables of short-term health-related life quality assessment of COPD patients are helpful to predict the changes of pulmonary function improvement, but the ability to predict the changes of pulmonary function deterioration is limited. For patients with no changes or improvement in short-term health-related life quality assessment, it is still recommended to increase the frequency of pulmonary function test in order to detect the deterioration of pulmonary function early.
Objective To compare the differences of flow and volume responses in patients with mild to very severe chronic obstructive pulmonary disease（COPD） in bronchodilatation test. Methods The different changes of FEV1 and FVC in 217 patients with mild to very severe COPD（GOLD stage Ⅱ-Ⅳ） after inhaling salbutamol were analyzed retrospectively. Results FEV1 and FVC of the patients with COPD at stage Ⅱ-Ⅳ increased remarkably after inhaling β2 agonist，while there were significant differences between the changes of FEV1 and FVC. Increment of FEV1 and FVC (ΔFEV1 and ΔFVC)，representing flow and volume responses respectively，showed a normal distribution. The majority of patients fell in the range of ΔFEV1 from 0.00 to 0.04，0.05 to 0.09 and 0.10 to 0.14 liter，and ΔFVC from 0.00 to 0.09，0.10 to 0.19 and 0.20 to 0.29 liter. There was significant difference of ΔFEV1 among stage Ⅱ-Ⅳ patients with COPD （Plt;0.01），namely more severe the disease less ΔFEV1 got.In the other hand ΔFVC increased along with the progression of COPD，although no significant difference of ΔFVC among stage Ⅱ-Ⅳ patients with COPD was found. Though different changes of ΔFEV1 and ΔFVC were revealed，there was a positive correlation between ΔFEV1 and ΔFVC in patients at each GOLD stage and the correlation became more insignificant with the progression of COPD. Conclusions There are significant differences between post-bronchodilator flow and volume responses in patients with COPD.Flow response decreases remarkably along with the progression of COPD，whereas volume response increases along with the progression of COPD.
Objective To investigate the clinical characteristics of upper airway cough syndrome ( UACS) and the relationship of UACS with upper airway diseases, cough variant asthma ( CVA) , and gastroesophageal reflux disease ( GERD) . Methods 92 subjects with chronic cough and throat symptoms and signs were included in the study. The medical records were collected fromall subjects, and 49 subjects suspected for CVA undertook bronchial provocation test. Then the efficacy was evaluated and etiology were analyzed based on the efficacy of targeted treatment. Results Bronchial provocation test yielded positive results in 14 subjects suspected of CVA, accounting for 15. 2% of all cases ( 14/92) . 18. 5% ( 17 /92) of patients had a history of chronic gastritis or combined symptoms of GERD, of whom anti-gastroesophagealreflux treatment was effective. The patients with rhinitis, sinusitis history and/ or symptoms accounted for 33. 7% of cases ( 31 cases) . 51. 1% ( 47/92) of patients had only signs and symptoms of chronic pharyngitis. Conclusions UACS is not only due to the rhinitis and/ or sinusitis but also chronic pharyngitis. Chronic pharyngitis may be secondary to chronic rhinitis/ sinusitis with post nasal drip and gastroesophageal reflux, also may be an independent cause of chronic cough.
Objective To investigate the different clinical features of chronic cough induced by rhinitis /sinusitis or gastro-esophageal reflux, and its significance for etiological diagnosis of chronic cough.Methods Chronic cough patients were recruited from respiratory medicine clinic in Chongqing Xinqiao Hospital from December 2009 to December 2010. Medical history, symptoms and signs were recorded from all selected patients. The patients with chronic rhinitis / sinusitis, but without gastro-esophageal reflux symptoms were suspected upper airway cough syndrome ( UACS) , and given chlorpheniramine, nasal decongestant, and corticosteroid treatment for 1 week. The patients with clinical symptoms associated with gastroesophageal reflux or with history of gastric diseases were suspected gastroesophaged reflux-related cough ( GERC) , were given esomeprazole ( 40 mg, bid) , combined prokinetic agent for 2 weeks. The patients were confirmed the diagnosis of UACS or GERC when their cough was relieved after the above targeted treatment.Results 114 patients were enrolled in this study. 47 patients were suspected GERC, of which 32 were confirmed, and 67 patients were suspected UACS, of which 43 were confirmed. There was no significant difference in age, duration of disease, severity of cough, proportion of night cough, proportion of clear throat symptom, or proportion of cobblestone sign between the UACS patients and the GERC patients ( P gt;0. 05) .There were more females in the GERC patients and more males in the UACS patients ( P lt; 0. 05) . Cough with sputum, throat symptoms and signs were more common in the UACS patients ( P lt;0. 05) . The hoarseness and sore throat symptoms were found only in the GERC patients, but postnasal drip symptoms were found only in the UACS patients. Conclusions Throat signs and symptoms are not completely similiar in the GERC and the UACS patients. Comprehensive judgments combining with patient history,characteristics of concurrent cough, throat symptoms, and signs can provide important references for the clinical diagnosis of chronic cough caused by rhinitis/ sinusitis or gastro-esophageal reflux.
Stepped wedge cluster randomized trials (SW-CRT) is a kind of cluster randomized controlled trial mainly applied in the field of public health policy that has emerged in recent years, which has gradually attracted the attention of workers in the field of health and wellness. At present, this trial method is not widely used at home and abroad, and there are various ways of sample size calculation and statistical analysis. This paper describes the principles, categories, and differences between SW-CRT and traditional randomized controlled trials, and outlines sample size calculation and statistical analysis methods. In general, SW-CRT is characterized by clustering, cross-design, and measurement of results at multiple time points. In terms of sample size calculation, it is necessary to distinguish between clusters with the same and different sizes, and commonly used sample size calculation procedures can be implemented in Stata, R, and SAS software, as well as in fixed online websites, including the "Steppedwedge" program, the "swCRTdesign" program, the "Swdpwr" program, the "CRTpowerdist" program, and the "Shiny CRT Calculator" tool and so on. Based on the design characteristics of SW-CRT, the researcher should also consider the confounding factors of time effects and repeated measurements of result. Therefore, the statistical analysis methods are often based on generalized linear mixed model (GLMM) and generalized estimating equations (GEE). However, most of the above models have been proposed based on cross-sectional studies, there is a lack of statistical methods for queue design and SW-CRT with transitional period now, and more comprehensive methodological exploration is still needed in the future.
Objective To investigate the clinical characteristics of neutrophilic asthma ( NA) .Methods NA patients were collected from the out-patient and in-patient departments of Respiratory Diseases of Xinqiao Hospital between January 2010 and December 2010. The results of the medical records,pulmonary function tests, and induced sputum cytology were analyzed retrospectively. Results The NA patients with neutrophil percent ≥ 61% accounted for 33. 1% ( 51 /154 ) of all the asthmatics patients detected by induced sputumin the same period, and 45 cases with complete records were included. Of the 45 cases recruited, 20 cases ( 44. 4% ) were in-patients,2 cases ( 4. 4% ) were with controlled asthma, 3 cases ( 6. 7% ) were with cough variant asthma, 30 cases ( 66. 7% ) were female, 12 cases ( 26. 7% ) were atopic patients, and 27 cases ( 60% ) had acute exacerbation. The age of onset of 35 patients ( 77. 8% ) were after 12 years. FEV1% pred lt; 60% and gt; 80% was obtained in 55. 9% ( 19/34) and 14. 7% ( 5 /34) of patients respectively. The result of bronchodilator test was positive in 64% ( 16/25) of patients, and mean increase in FEV1 was 11. 7% . The percentage of neutrophil and eosinophil was ( 74. 5 ±9. 1) % and ( 2. 4 ±2. 5) % respectively in induced sputum, and 35. 6% ( 16/45) of the patients had increased eosinophil percentage ( gt;3% ) . Conclusions In our study, most of NA is severe and acute exacerbation asthma, and its clinical features are various. The mechanismand clinical significance of increased neutrophils in asthmatic patients are unclear and more studies are needed.
ObjectiveTo analyze the clinical efficacy of right minithoracotomy approach in the treatment of patients with regurgitation after left-sided valve surgery (LSVS).MethodsThe clinical data of 77 patients who suffered tricuspid regurgitation (TR) after LSVS and received surgical treatment in the Heart Center of Henan Provincial People's Hospital from 2012 to 2019 were selected. According to the operation method, the patients were divided into a right minithoracotomy group (n=32), including 13 (40.6%) males, aged 57.3±5.3 years and a median sternotomy group (n=45), including 17 (37.8%) males, aged 55.7±6.6 years. Preoperative and postoperative clinical data of the two groups were compared and analyzed.ResultsThere was no significant difference in preoperative data between the two groups. There were 24 patients of tricuspid valvuloplasty (TVP) and 8 patients of tricuspid valve replacement (TVR) in the right minithoracotomy group. There were 29 patients of TVP and 16 patients of TVR in the median sternotomy group. The operation time, postoperative hospitalization time, intubation time and ICU stay time of the right minithoracotomy group were shorter than those of the median sternotomy group (P<0.001). The operative bleeding, postoperative drainage in 24 hours, postoperative blood transfusion rate and incision poor healing of the right minithoracotomy group were significantly decreased compared with those of the median sternotomy group (P<0.05). The extracorporeal circulation time between the two groups was not significantly different (P=0.382). The postoperative complications and mortality of the righ minithoracotomy group were significantly lower than those of the median sternotomy group (P<0.05).ConclusionThe procedure of right minithoracotomy access can reduce perioperative morbidity and mortality compared with the median sternotomy, and results in satisfied clinical efficacy.
Objective To investigate the cognition degree and clinical use of new COPD classification system of 2011 GOLD in respiratory specialists, and further analyze the reasons of failing to clinical use. Methods Respiratory specialists from 42 hospitals in Chongqing were investigated through questionnaire survey. The questionnaire contains two parts. The first part contains nine questions about the knowledge of 2011 GOLD new COPD classification system and its clinical use. The second part contains six questions about the reasons of failing to clinical use of the COPD classification system. Results A total of 204 valid questionnaires were recovered. More than 90% respiratory specialists had understood the new COPD classification system with different degree, and believed it is suitable for clinical use. More than twothirds respiratory specialists knew well the ways about CAT and mMRC, but only 24% specialists were using these ways. The main reasons of failing to clinical use were as follows: 60% specialists believed the pulmonary function test can evaluate the COPD classification, and 66. 7% specialists were limited by short visit time. The cognition degree and clinical use of the new COPD classification systemin the specialists from third grade A class hospitals was better than those from the other hospitals. But the difference was not significant among specialists with different professional title.Conclusion Respiratory specialists in Chongqing knew well about the new COPD classification systemin 2011 GOLD, but did not use it widely in clinical works due to the complicated operation of the new COPD classification system.