Objective To investigate clinical effects of arthroscopic synovectomy combined with radiofrequency vaporization for the treatment of rheumatoid synovitis of the knee joint.Methods In 36 cases of rheumatoid gonarthritis with chronic synovitis of the knee joint,with simultaneous administration of regular medication,we had applied arthroscopic synovectomy combined with radiofrequency vaporization to remove the hyperplastic synovium and pannus through standard anteromedial and anterolateral approaches, and superolateral and superomedial approaches.In 21 out of 36 cases,diseased synovium in the posterior compartment was resected via additional posteromedial and posterolateral approaches.A systematic rehabilitation program was practiced 3 days after operation. Results All the 36 cases were followed for 4~26 months(mean,16 months).Clinical effects evaluation showed "excellent" in 21 cases,"good" in 13 cases,and "fair" in 2,with a total excellent-or-good rate of 94.4%(34/36).The knee joint function scores were significantly elevated from 58.6?5.3 preoperatively to 91.6?5.8 postoperatively(t=2.723,P=0.003).The Lysholm scores were significantly elevated from 42.3?3.8 preoperatively to 90.2?4.4 postoperatively(t=2.437,P=0.001).Conclusions Combined use of arthroscopic synovectomy with radiofrequency vaporization for the treatment of rheumatoid gonarthritis has advantages of minimal trauma,little blood loss,and rapid recovery of joint function.The procedure can effectively control the progression of rheumatoid arthritis and restore the knee joint function to the greatest possible extent.

Objective To study the application of accreditation standards for trainers of general practitioners (GPs) in community health centers.Methods The questionnaire was designed according to the accreditation standards for GP trainers in community health centers,which involved professional quality,clinical competence in primary care and teaching abilities.According to typical sampling,583 trainers from 56 community teaching bases in Shanghai were selected for the survey.Results Among 583 participants,the effective respondents were 505 with a response rate of 86.6％.The professional quality was highly recognized by the participants,and more than 80％ of trainers met the requirement.For the ability of primary care,81.4％ (411/505),79.8 ％ (403/505) and 69.5 ％ (351/505) of participants were well qualified with the abilities of management for hypertension,type 2 diabetes and coronary heart disease,respectively,while only about 40％ had abilities of management for epilepsy,hypothyroidism and chronic mental diseases.75.4％ (381/505) participants fully mastered the principle of first aid skills and CPR,while only 24.8％ (125/505) had abilities of management for conjunctival foreign body and nasal foreign body,34.5％ (174/505) had the abilities of debridement and gastrolavage.For the index of teaching abilities,most trainers had insufficient teaching capacity and experience in the community.Only 48.5％ (245/505) and 40.2％ (203/505) of trainers were familiar with the teaching methods of cased-based learning and problem-based learning,respectively.Significant difference was found in the scores of teaching abilities among trainers from community health centers in different locations (P ＜ 0.05),such as using appropriate teaching methods (F =3.45,P =0.033),monthly assessment and feedback to students (F =5.14,P =0.006) and ensure at least 4 hours of teaching time every week(F =4.96,P =0.007).No significant differences were found in the scores of professional quality and clinical competences in primary care (P ＞ 0.5).Conclusion The trainers of general practitioners in community health centers meet the requirement of accreditation standards in the aspects of professional quality and clinical competences in primary care,while the teaching abilities remained to be improved and should be strengthened in the future.

ObjectiveTo compare the clinical effect of percutaneous iliosacral screws osteosynthesis (PISO) and open reduction internal reconstruction plate fixation in treating unstable pelvic fractures combined with sacroiliac joint dislocation,and evaluate their safety and practicality.MethodsFrom March 2004 to October 2010,37 patients with vertical unstable pelvic fractures were admitted to our department.Twenty cases were treated with percutaneous sacroiliac screw fixation and 17 cases were performed opened reduction and internal reconstruction plate fixation under C-arm X-ray's guide.The perioperative parameters and postoperative imaging indexes were compared and analyzed.ResultsAll patients were followed up for 6 months to 26 months,with an average of 15 months.There were statistical significances between the PISO group and open reduction internal fixation group in operation time,blood loss,postoperative pain,mean fever time and hospital stay.The two groups showed no significant difference on postoperative X-evaluation of reduction effect.The average healing time was 3.2 months and the difference was not statistically significant between two groups.PISO group had no complications such as infection,bent nails or broken nails.ConclusionThrough compared and analyzed the two groups in treating unstable pelvic fractures,the percutaneous sacroiliac screw fixation has been proved for a kind of ideal minimally invasive surgery method because of locating exactly,less damage and blood loss,milder pain and quicker recovery.But it demands higher operation techniques.Adequate preoperative preparation and postoperative patients' cooperation can reduce complications incidence.The second group of anterior reconstruction plate or T-shape plate to fix vertically unstable pelvic fractures at same time shows a good result of stabilization.

Chondroblastoma ; pathology ; Chondroma ; pathology ; Chondrosarcoma ; metabolism ; pathology ; surgery ; Cricoid Cartilage ; Diagnosis, Differential ; Humans ; Laryngeal Neoplasms ; metabolism ; pathology ; surgery ; Laryngectomy ; Lymph Node Excision ; Male ; Middle Aged ; Osteoblastoma ; pathology ; Osteosarcoma ; pathology ; S100 Proteins ; metabolism ; Sarcoma, Clear Cell ; metabolism ; pathology ; surgery ; Vimentin ; metabolism

BACKGROUNDStudies have shown that irinotecan can improve survival in patients with advanced or recurrent gastric cancer, but the overall benefit of irinotecan in the treatment of advanced or recurrent gastric cancer remains controversial. The aim of this study was to evaluate the benefits and risks of irinotecan for survival in patients with advanced or recurrent gastric cancer. Method We searched PubMed, EmBase, the Cochrane Central Register of Controlled Trials, reference lists of articles, and proceedings of major conferences for relevant clinical trials. We included randomized controlled trials that reported on the efficacy and safety of irinotecan in patients with advanced or recurrent gastric cancer. Outcomes were analyzed by survival rate, objective response rate (ORR), and toxicity. Furthermore, the analysis was further stratified by factors that could affect the treatment effects.

RESULTSEight trials recruiting 1 546 patients with advanced or recurrent gastric cancer were included in the analysis. Overall, irinotecan therapy was associated with a 6% improvement in survival rate, but this difference was not statistically significant (odds ratio (OR) 0.94; 95% confidence interval (95% CI) 0.70-1.27; P = 0.69). However, irinotecan therapy had more frequent ORR than irinotecan-free arm (OR 1.70; 95% CI 1.34-2.17; P < 0.001). Furthermore, irinotecan therapy was associated with a clinically and statistically significant increase in the risk for declined hemoglobin, hyponatremia, and diarrhea, but it also protected against thrombocytopenia risk when compared with irinotecan-free therapy.

CONCLUSIONSThere is no evidence to support the use of irinotecan therapy in patients with advanced or recurrent gastric cancer; however, given the significant advantage in ORR irinotecan therapy using combination regimens may be considered for further evaluation in subsets of patients who may benefit from this treatment.

Antineoplastic Agents, Phytogenic ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; Camptothecin ; analogs & derivatives ; therapeutic use ; Humans ; Neoplasm Recurrence, Local ; drug therapy ; Stomach Neoplasms ; drug therapy ; Treatment Outcome

OBJECTIVE: To analyze the current status of diagnosis and management of acute appendicitis (AA) in China. METHODS: Questionnaire survey was used to retrospectively collect data of hospitalized patients with AA from 43 medical centers nationwide in 2017 (Sort by number of cases provided: Jinling Hospital of Medical School of Nanjing University, The First Affiliated Hospital of Xinjiang Medical University, Lu'an People's Hospital, Tengzhou Central People's Hospital, Dalian Central Hospital, The Affiliated Hospital of Xuzhou Medical University, Dongying People's Hospital, Jinjiang Hospital of Traditional Chinese Medicine, Huangshan Shoukang Hospital, Xuyi People's Hospital, Nanjing Jiangbei People's Hospital, Lanzhou 940th Hospital of PLA, Heze Municipal Hospital, The First College of Clinical Medical Science of China Three Gorges University, Affiliated Jiujiang Hospital of Nanchang University, The Second People's Hospital of Hefei, Affiliated Central Hospital of Shandong Zaozhuang Mining Group, The Third People's Hospital of Kunshan City, Xuzhou First People's Hospital, The 81st Group Army Hospital of PLA, Linyi Central Hospital, The General Hospital of Huainan Eastern Hospital Group, The 908th Hospital of PLA, Liyang People's Hospital, The 901th Hospital of Joint Logistic Support Force, The Third Affiliated Hospital of Chongqing Medical University, The Fourth Hospital of Jilin University, Harbin Acheng District People's Hospital, The First Affiliated Hospital of Zhengzhou University, Nanjing Luhe People's Hospital, Taixing Municipal People's Hospital, Baotou Central Hospital, The Affiliated Hospital of Nantong University, Linyi People's Hospital, The 72st Group Army Hospital of PLA, Zaozhuang Municipal Hospital, People's Hospital of Dayu County, Taixing City Hospital of Traditional Chinese Medicine, Suzhou Municipal Hospital, Beijing Guang'anmen Hospital, Langxi County Hospital of Traditional Chinese Medicine, Nanyang Central Hospital, The Affiliated People's Hospital of Inner Mongolia Medical University).The diagnosis and management of AA were analyzed through unified summary. Different centers collected and summarized their data in 2017 and sent back the questionnaires for summary. RESULTS: A total of 8 766 AA patients were enrolled from 43 medical centers, including 4 711 males (53.7%) with median age of 39 years and 958 (10.9%) patients over 65 years old. Of 8 776 patients, 5 677 cases (64.6%) received one or more imaging examinations, and the other 3 099 (35.4%) did not receive any imaging examination. A total of 1 858 (21.2%) cases received medical treatment, mainly a combination of nitroimidazoles (1 107 cases, 59.8%) doublet regimen, followed by a single-agent regimen of non-nitroimidazoles (451 cases, 24.4%), a nitroimidazole-free doublet regimen (134 cases, 7.2%), a triple regimen of combined nitroimidazoles (116 cases, 6.3%), nitroimidazole alone (39 cases, 2.1%) and nitroimidazole-free triple regimen (3 cases, 0.2%). Of the 6 908 patients (78.8%) who underwent surgery, 4 319 (62.5%) underwent laparoscopic appendectomy and 2589 (37.5%) underwent open surgery. Ratio of laparotomy was higher in those patients under 16 years old (392 cases) or over 65 years old (258 cases) [15.1%(392/2 589) and 10.0%(258/2 589), respectively, compared with 8.5%(367/4 316) and 8.0%(347/4 316) in the same age group for laparoscopic surgery, χ²=91.415, P<0.001; χ²=15.915,P<0.001]. Patients with complicated appendicitis had higher ratio of undergoing open surgery as compared to those undergoing laparoscopic surgery [26.7%(692/2 589) vs. 15.6%(672/4 316), χ²=125.726, P<0.001].The cure rates of laparoscopic and open surgery were 100.0% and 99.8%(2 585/2 589) respectively without significant difference (P=0.206). Postoperative complication rates were 4.5%(121/2 589) and 4.7%(196/4 316) respectively, and the difference was not statistically significant (χ²=0.065, P=0.799). The incidence of surgical site infection was lower (0.6% vs. 1.7%, χ²=17.315, P<0.001), and hospital stay was shorter [6(4-7) days vs. 6(5-8) days, U=4 384 348.0, P<0.001] in the laparoscopic surgery group, while hospitalization cost was higher (median 12 527 yuan vs. 9 342 yuan, U=2 586 809.0, P<0.001). CONCLUSIONS The diagnosis of acute appendicitis is still clinically based, supplemented by imaging examination. Appendectomy is still the most effective treatment at present. Laparoscopic appendectomy has become the main treatment strategy, but anti-infective drugs are also very effective.
Acute Disease ; Adolescent ; Adult ; Aged ; Anti-Bacterial Agents ; therapeutic use ; Appendectomy ; Appendicitis ; diagnosis ; therapy ; China ; Female ; Health Care Surveys ; Humans ; Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult