Adult ; Branchial Region ; Fistula ; surgery ; Humans ; Male ; Neck ; surgery ; Pharynx ; surgery

Objective The aims of this study were to assess the efficacy of video-assisted thoracoscopic extended thymectomy(VATET) as a treatment for non-thymomatous myasthenia gravis (NTMG) and to identify prognostic factors for thymectomy.Methods Retrospectively analyzed clinical datas of 112 patients received VATET for the treatment of NTMG.Clinical efficacy and variables influencing outcome were evaluated by Kaplan-Meier method and Cox proportional hazards regression analysis.Results At 3.2 years averaged (1.5-6.2 years) of follow-up,none of these patients were lost to follow up.According to the MGFA post-intervention status,54 patients(48.2％) obtained complete stable remission during follow-up,21 patients(18.8％) obtained pharmacologic remission,10 patients (8.9％) obtained minimal manifestations,7 patients (6.3％) improved,20 patients(17.8％) unchanged,and none of these patients were worse or died of MG.By multivariate analysis,the chance of complete stable remission was significantly increased when age ＜ 40 years (P ＜ 0.01,OR =3.468),symptom duration ＜ 12 months(P ＜ 0.01,OR =3.203) and the presence of thymic hyperplasia (P ＜ 0.01,OR =3.064).Conclusion Video-assisted thoracoscopic extended thymectomy achieved satisfactory long-term results in patients with nonthymomatous myasthenia gravis,while age,symptom duration,the presence of thymic hyperplasia correlated with response to operation.

Patent documentation is a kind of high-value scientific literature. In this paper, the World Traditional Medicine Patent Database (WTMPD) was used to retrieve patents of the traditional medicines used in the treatment and prevention of alcoholic worldwide in the past 30 years. A total of 3 238 patents were further screened by a se-ries of processes. Finally, multi-angle analysis was carried on the dataset to form a patent analysis report on tradi-tional medicines used in alcoholism, including the distribution of the patents, the application trend, the domestic and foreign geographical layout, the major applicant and so on. From the analysis, we found that China had a rapid in-crease in the number of patent applications, which was in the leading role in the world, though the technology and the number of PCT applicant from China is relatively low. Puerariae Lobate radix and flos are frequently used in al-coholism patents.

Objective To compare the Health Related Quality of Life (HRQOL) of patients with sys temic lupus erythematosus (SLE) with other common chronic diseases (coronary heart disease,diabetes and hypertension).Methods Responses from Short Form-36 (SF-36) questionnaires from outpatients,inpatients with SLE,other common chronic diseases and healthy controls were analyzed in all domains.Results The mean age of patients with SLE was 39+13 years old,while those of patients with coronary heart disease,dia betes and hypertension were 65±16,60±13,59±14 years respectively.All SLE patients were significantly worse in all domains of SF-36 questionnaire,compared with the healthy controls.The responses of inactive patients with SLE,were not significantly worse than those with other chronic diseases in all domains (P＞0.05).On the contrary,the responses of patients with active SLE were significantly worse than those of patients with inactive SLE,as well as patients with other chronic diseases (P＜0.05).Conclusion HRQOL of patients with active SLE is significantly worse when compared to patients with other common chronic diseases.

The results of different interventions administered in 118 cases with impaired fasting glucose (IFG) for 3 years were investigated. The rates of transformation of IFG to diabetes mellitus in metformin treatment groups and rosiglitazone treatment groups were significantly lower than that in life style intervention group. This study suggested that metformin or rosiglitazone treatment could effectively reduce transformation of IFG to diabetes as compared with life style intervention.

Objective To observe the changes in serum vancomycin trough concentration,and explore its optimal dosage in critical patients.Methods A retrospective study was conducted.Data of 66 patients who used vancomycin during July 2010 to May 2012 in surgical intensive care unit (SICU) of the First Affiliated Hospital of Sun Yat-Sen University were collected and analyzed.According to the endogenous creatinine clearance rate (CCr),the patients were divided into two groups:CCr normal group (≥ 70 mL/min) and CCr lowered group (＜70 mL/min).The distribution of vancomycin serum trough concentration between two groups,relationship between vancomycin serum trough concentrations and CCr,and the influence of vancomycin serum trough concentrations on the prognosis was analyzed.The difference between actual dosage and the recommended dosage in guideline was compared between two groups.Results 119 times of vancomycin serum trough concentration in 66 patients were enrolled,and it was found that only 20.17％ (24/119) reached the target concentration (15-20 mg/L),45.38％ (54/119)＜ 15 mg/L and 34.45％ (41/1 19) ＞20 mg/L.Vancomycin serum trough concentration in CCr normal group (55 cases) was (13.11 ± 6.84) mg/L,among them 65.5％ (36/55) attained lower trough concentrations (＜ 15 mg/L).In the subgroup with 15-20 mg/L trough serum concentrations,vancomycin doses were significantly lower than that of recommendation (g/d:1.95 ± 0.61 vs.2.73 ± 0.32,F=1.739,P=0.001).Vancomycin serum trough concentration in CCr lowered group (64 cases) was (20.49 ± 8.12) mg/L,with 51.5％ (33/64) of them showed higher trough concentrations (＞20 rag/L).In the subgroup with 15-20 mg/L vancomycin trough serum concentration,vancomycin doses were higher than that of recommendation (g/d:1.08 ±0.49 vs.0.78 ±0.19,F=11.294,P=0.062).There was no significant difference in 28-day mortality between patients with targeting trough serum concentrations and those without [22.2％ (4/18) vs.18.8％ (9/48),x2=0.009,P=0.924].Serum creatinine [odds ratio (OR)=1.001,95％ confidence interval (95％CI):0.990-1.012,P=0.000],vancomycin doses (OR=0.600,95％CI:0.251-1.434,P=0.003),age (OR=0.985,95％CI:0.955-1.015,P=0.015) and body mass index (OR=1.013,95％CI:0.967-1.062,P=0.022) were found to be correlated to serum trough concentrations by multiple linear regression analysis.Conclusions The rate of vancomycin serum trough concentrations reaching the standard is low in critical patients,so constant monitoring is necessary.Creatinine,vancomycin dosage,age and body mass index show a relatively significant influence on the serum trough concentrations,and they should be taken into consideration in dosage to be given.

OBJECTIVE To observe the effect of administration intranasal corticosteroids on small airway disfunction for allergic rhinitis (AR) patients. METHODS AR patients with small airway disfunction were administrated intranasal corticosteroids for twelve weeks. Before treatment, nasal VAS, RQLQ were recorded, pulmonary function test were given. After therapy, VAS, RQLQ were obtained again at the 4th, 8th and 12th week. Pulmonary function test were performed at the 4th and 12th week. RESULTS VAS, RQLQ were all improved after therapy (P <0.01). The indices of FEV1/FVC%, MMEF pred%, MEF75pred%, MEF50pred%, MEF25pred%were also improved significantly (P<0.05), especially for MMEFpred%, MEF75pred%, MEF50pred% (P<0.01). CONCLUSION Small airway lesions can be obviously improved by the intranasal corticosteroids applied for AR. It has positive significance for preventing AR from developing into asthma.

Objective To investigate the distribution and clinical significance of EGFR mutations in phase Ⅰ non-smallcell lung cancer(NSCLC).Methods We examined 272 consecutive phase Ⅰ NSCLC patients' tumor samples for EGFR mutations in exons 18,19,20 and 21 using the Amplification Refractory Mutation System(ARMS).Results 154 patients (56.62％)were identified with mutations in the series of 272.Of all the mutations identified,2 (1.3％) were aminoacidic substitutions (G719 S) in exon 18,53 (34.4 ％) were in frame deletions (19-del) in exon 19,6 (3.9 ％) were insertional mutations (20-ins) in exon 19 and 97 (63.9 ％) were aminoacidic substitutions (L858 R) in exon 21.There were 11 patients with coexisting mutations in other exons.The probability of the coexisting resistance mutations (20-ins) in exon 21 was significantly higher than that in exon 19 (P ＜ 0.05).Mutations in adenocarcinoma samples (148/223,66.4％) were more frequent than that in squamous carcinoma(2/40,5％),while mutations in adeno-squamous carcinoma were highest in all histologic types (P ＜ 0.05).Conclusion EGFR mutations in phase Ⅰ NSCLC in Shanghai and surrounding areas were 56.62％.Mutations were more frequent in particular histologic types,e.g.adenocarcinoma and adeno-squamous carcinoma.Exon 19 deletion mutations and the substitution mutation L858R in exon 21 are the most frequent in NSCLC.And the probability of coexisting 20-ins mutations in exon 21 was significantly higher than which in exon 19.

Purpose To investigate the clinical value of three-dimensional hysterosalpingo-contrast-sonography (3D-HyCoSy) in the assessment of fallopian tubal patency.Materials and Methods Fallopian tubal patency of 33 infertile women was assessed using transvaginal 3D-HyCoSy, and the results were compared with laparoscopically salpingoraphy, the sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of 3D-HyCoSy were evaluated.Results 3D-HyCoSy showed 20 passable fallopian tubes, 10 partially passable fallopian tubes and 36 obstructed tubes, while lapascopically salpingoraphy showed 23 passable fallopian tubes, 7 partially passable fallopian tubes and 36 obstructed tubes. The total coincidence rate of 3D-HyCoSy to assess the fallopian tubal patency was 86.4% (57/66), with the sensitivity of 93.0% (40/43), specificityof 73.9% (17/23), positive likelihood ratio of 7.15, and negative likelihood ratio of 0.20.Conclusion Tubal patency can be efficiently and accurately assessed using 3D-HyCoSy, but patients with obstructed or partially passable fallopian tubes should undergo laparoscopy to clarify.

Objective To analyze clinical effectiveness of tigecycline for complicated intra abdominal infections (cIAIs) in surgical intensive care units.Methods The clinical data of patients diagnosed as cIAIs from Nov 2011 to Aug 2014 were retrospectively collected.Data of sex, age, severity of disease, bacterial strains and drug resistance, prior antibiotics, dosage of tigecycline were included.Results 1 862 patients were admitted into surgical intensive care unit from Nov 2011 to Aug 2014.54 patients were finally treated by tigecycline among 304 patients diagnosed as cIAIs.Acinetobacter baumannii (23.1％), Klebiella pneumonia (18.5％), Escherichia coli (16.9％) were the top three pathogenic bacteria.41/50 were of multiple bacterial infection.Previously adopted antibiotics were miscellaneous, the number of used antibiotics was up to 13 for one patient.Coverage of tigecycline averaged at 8.9 days.Tigecycline effective rate was 62％, 38％ (19/50) cIAIs were completely controlled and cured,24％ (12/50) patients showed effectiveness of tigercycline that procalcitonin decreased 50％ within 72 h.Logistic regression analysis showed that severity of disease and tigecycline dose contribute to the effectiveness within 72 h.Conclusions Tigecycline is effective alterative for patients diagnosed as complicated intra abdominal infections in surgical intensive care units.