In recent years, the diagnosis and treatment of hepatocellular carcinoma (HCC) has entered a brand-new era due to the advancement of diagnosis methods and the emergence of targeted drugs and immunotherapy drugs. The author described and summarized in detail the screening program, diagnostic thought and procedure, clinical staging, mechanism of targeted and immune therapy and application range of HCC.
Objective To study the methodology of Chinese literature retrieval. Methods The manual review of the literature was served as the “gold standard” against database search strategies (the diagnostic tests). We selected original articles about treatment, rehabilitation and randomized controlled trials from 31 journals. The articles were downloaded from the Chinese Biomedical Database (CBM). We selected potentially useful words through a word frequency analysis and determined the frequency of all the words in the titles, abstracts, and subject indexes. All the selected journals functioned as a closed database. The sensitivity, specificity and precision of all the high frequency words were calculated and the high frequency words of large sensitivity×precision were considered as final searching words. All the searching strategies were produced by computer programe which consisted of all searching words, title field and abstract field. Meanwhile, the sensitivity, specificity, precision and NNR (number needed to read) were calculated. Among the strategies, those comprised of all searching words would be used in CBM disc database, those of title and abstract words in Chinese Web Databases. The best strategies were those of high sensitivity and high specificity. Results 2 570 articles were selected and 45 articles met the gold standard. The strategies emphasized sensitivity were “therapeutic use OR random OR control(for CBM disc) and multicenter OR therapeutic outcome OR random (for Chinese online databases)”. The strategies emphasized specificity were “placebo OR prospective study(MH) OR double blind OR random controled trial (MH) (for CBM disc) and placebo OR prospective) OR double blind OR efficiency (for Chinese online databases).”Conclusions The method is optimal for Chinese literature databases
Objective To analyze the clinical information of COVID-19 patients of Shanghai National Exhibition and Convention Center cabin hospital, and to explore the medical management strategy to provide thoughtful suggestions for other cabin hospitals and governments as valuable references. Methods The clinical data of 174 308 patients confirmed COVID-19 in Shanghai National Exhibition and Convention Center cabin hospital from April 9 to May 31, 2022 were retrospectively reviewed. There were 103 539 male and 70 769 female patients, with an average age of 41.50±15.30 years. Medical and nursing management strategy was summarized. Results Among the 174 308 patients, 71.5% (124 630 patients) were asymptomatic. The vaccination rate of patients with COVID-19 in the cabin hospital was 76.5% (133 338 patients), and the majority of none vaccinated patients were children under the age of 10 years and the elderly over the age of 60 years, the vaccination rate of whom was only 25.0% (1 322 patients) and 63.9% (13 715 patients), respectively. In addition, the proportion of mild symptom type in the patients not vaccinated was significantly higher than that in the vaccinated patients (P≤0.01). The average hospitalization time of patients in cabin hospital was 7.39±0.53 days, which was 7.01±2.12 days for patients under 60 years and 8.21±0.82 days for patients over 60 years. The hospitalization time of elderly patients was significantly longer (P≤0.01), and the hospitalization time of elderly patients at age over 60 years without vaccination was 8.94±1.71 days, which was significantly longer than the average hospitalization time and the time of elderly patients vaccinated (P≤0.01). The number of patients combined with basic diseases was 27 864 (16.0%), of which cardiovascular diseases accounted for 81.3% (22 653 patients). A total of 2 085 patients were transferred and treated in designated hospitals. Conclusion Large scale cabin hospitals are helpful to cut off the source of infection. Attention shall be paid to the sorting of admission and timely transfer to other hospital during the patients management. Most of the patients have a good prognosis after treatment. The vaccination of key population and community-based screening will be the next step of focus.
ObjectiveTo analyze clinical features and surgical strategies of Ebstein's anomaly (EA) in adults. MethodsSeventy-eight adult patients with EA underwent surgical treatment in Fu Wai Hospital from January 2008 to December 2011. There were 24 males and 54 females with their age of 18-54 (33.0±9.5) years. Preoperatively, 72 patients were in NYHA class Ⅰ or Ⅱ, and 6 patients were in NYHA class Ⅲ or Ⅳ. Clinical presentations mainly included exercise capacity deterioration and exertional dyspnea. Preoperative echocardiography showed downward displacement of the septal leaflet (SL) of the tricuspid valve (TV) of 34.8±12.7 (20-60) mm. Three patients had severe dysplasia or agenesis of tricuspid SL. Downward displacement of the posterior leaflet (PL) of TV was 46.8±11.6 (20-70) mm, and 1 patient had agenesis of tricuspid PL. Average TV annulus was significantly enlarged with 60±10 (37-70) mm. Mean atrialized portion of the right ventricle was about 40%. There were 18 patients with moderate tricuspid regurgitation (TR) and 60 patients with moderate-to-severe TR. Seventy-five patients received tricuspid valvuloplasty (TVP). Fifty-six patients received plication of the atrialized right ventricle (ARV), 20 patients received ARV resection, and 2 patients didn't receive any specific management of ARV. Thirty-two patients received TVP with a prosthetic ring. Three patients underwent tricuspid valve replacement. ResultsTwo patients died posto-peratively, and in-hospital mortality was 2.5%. Postoperative recovery of the survival patients was good. There was no severe atrioventricular block or other complication. Echocardiography before discharge showed good function of TV without moderate or more severe TR. Mean follow-up was 26 months. None of the patients needed re-operation. ConclusionThe incidence of acute heart failure in EA adults is low. TVP is the main surgical procedure to achieve main goals of surgical treatment including improvement in heart function, exercise capacity and quality of life.
ObjectiveTo investigate therapeutic strategy of acute pulmonary embolism. MethodsClinical data of 48 patients with acute pulmonary embolism who were treated in Affiliated Hospital of North Sichuan Medical College form January 2009 to May 2014 were analyzed retrospectively. ResultsOf the 48 cases, 14 cases of low risk (low risk group) were treated with anticoagulation, 24 cases of middle risk (middle risk group) were treated with anticoagulation and systematic thrombolysis or interventional therapy (local thrombolysis after thrombus fragmentation or thrombolytic catheter placement in pulmonary artery), 10 cases of high risk (high risk group) were treated with anticoagulation and interventional therapy. In low risk group, 12 cases (85.7%) were cured and 2 cases (14.3%) were markedly effective, and total effective rate was 100%. In middle risk group, 16 cases (66.7%) were cured and 8 cases (33.3%) were markedly effective, and total effective rate was 100%. In high risk group, 1 case died, 3 cases were cured, 2 cases were markedly effective, and 4 cases were better, and the total effective ratio was 9/10. All cases suffered from no complication such as hemorrhage of cerebral and digestive system. Forty-eight cases were followed up for 3-12 months, with a median time of 8 months. During the follow-up period, there was no complication occurred such as dyspnea, pulmonary embolism, placement change of filter net, and thrombosis. ConclusionsCorresponding therapeutic strategy would be taken according to risk stratification of the acute pulmonary embolism.
Giant thoracic tumor is currently one of the diagnostic and therapeutic challenges of thoracic surgery, with no established guideline or standard for diagnosis and treatment. The quality control of individualized surgical strategy and perioperative management with multi-disciplinary participation is the key to ensure the safety and improve the prognosis of patients. Based on the clinical experience of our institution and others, we hereby discussed and summarized the basic principles, surgical strategies and perioperative management of giant thoracic tumor, aiming to provide a reference of quality control.
End-stage renal disease is a late complication of chronic kidney disease (CKD) and one of the leading causes of high mortality worldwide. Over the years, the impacts of gut microbiota and their associated uremic toxins on kidney diseases through the intricate “gut-kidney axis” have been extensively studied. However, translation of microbiome-related omics results into specific mechanisms is still a significant challenge. In this paper, we review the interaction between gut microbiome and blood purification, as well as the current microbiota-based therapies in CKD. Additionally, the current sequencing technologies and progresses in the gut microbiome research are also discussed.
ObjectivesTo systematically review the influence of single-stent versus double-stent strategy for coronary bifurcation lesions prognosis.MethodsPubMed, The Cochrane Library, EMbase, Web of Science, CBM, WanFang Data, VIP and CNKI databases were searched online to collect randomized controlled trials (RCTs) of single-stent versus double-stent strategy for coronary bifurcation lesions from inception to March, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 23 RCTs involving 7 391 patients were included. The results of meta-analysis showed that: compared to the double-stent strategy, the single-stent strategy significantly reduced the myocardial infarction rate (RR=0.61, 95%CI 0.50 to 0.73, P<0.001). There were no significant differences between two groups in all cause mortality, cardiac mortality, main adverse coronary event (MACE), target lesion revascularization (TLR) and stent thrombosis. The results of subgroup analysis showed that: single-stent strategy for coronary bifurcation lesions was associated with lower all-cause mortality at five-years follow-up (RR=0.59, 95%CI 0.40 to 0.88,P=0.01).ConclusionsCurrent evidence shows that single-stent strategy for coronary bifurcation lesions could reduce the myocardial infarction rate and five-year mortality compared to double-stent strategy. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.
Objective To evaluate and summarize the relevant evidence of oxygenation strategies with tracheal intubation after extubation for adult in intensive care unit (ICU), and to provide evidence-based practice for the development of scientific and effective strategies tracheal intubation after extubation for ICU adult patients. Methods Evidence-based databases, related guideline websites, association websites and original databases were searched by computer for literature about oxygenation strategies with tracheal intubation after extubation for ICU adults patients was extracted. The retrieval time was from the establishment of the databases to May 2023. Two researchers trained in evidence-based practice evaluated the quality of the included literature and extracted evidence from the literature that met the quality evaluation criteria. Results A total of 18 articles were included, including 7 guidelines, 4 clinical decisions, 2 expert consensus, 4 systematic reviews and 1 randomized controlled trial. A total of 22 pieces of best evidence were formed, including 7 aspects of basic principles, evaluation, selection, parameter setting, withdrawal, effect evaluation and precautions. ConclusionThe medical staff should select the best evidence based on the actual clinical situation and the patient’s own needs, and adjust the oxygenation strategies to reduce the rate of tracheal intubation and improve the prognosis of patients.
Objective To understand the basis and status of setting up the dispensing fee at home and abroad, and to ascertain the scope of dispensing service, so as to offer references to the setting up and implement of dispensing fee in China. Methods According to the evidence-based principle, the descriptive method was adopted to demonstrate the basis of setting up the dispensing fee. The different definition, payment mode and standard were compared at home and abroad. Results Separation of prescribing and dispensing was the basis of setting up the dispensing fee. In western countries, the charge of dispensing fee was almost at the same level, though its definition and scope were different among countries. It was more reasonable to determine the level of dispensing fee according to the visiting frequency, compared with the price, the number and the type of drugs in the prescription. Conclusion China’s calculation of dispensing fee should be based on the prescription fee, the cost of drug administration and store. Dispensing fee should be implemented in the pilot hospitals firstly. Institutions providing primary health care services (rural health clinics, community health service centers etc) which follow a policy of “separating revenue from expenditures” may not adopt the dispensing fee temporarily. In urban hospitals, it is advisable to promote the separation of prescribing and dispensing gradually and bring pharmacists to provide prescription auditing, dispensing and advisory services. For retail pharmacies, pharmacists should be gradually fully staffed as one of the necessary conditions for operating. Performance evaluation of pharmacist’s services and pharmacy administration also should be developed.