OBJECTIVE: To improve the efficacy and safety of cyclosporine A through analysis of the relationship between drug monitoring data and its clinical efficacy after heart transplant (HT). METHODS: Four hundred and fifty-eight blood concentration data from 27 HT patients were retrospectively analyzed. The HT patients were divided into normal, toxic, and rejection group. The cyclosporine A blood concentrations among these three groups were compared. The changes of blood concentrations were discussed in different postoperative periods of HT patients grouped by the occurrence of rejection and toxicity respectively. RESULTS: The trend of cyclosporine A blood concentration change was unpredictable in the early postoperative period. The average ρ0 and ρ2 had significant differences among the three groups. ρ0 had no significant difference in most postoperative periods between toxic group and non-toxic group or rejection group and non-rejection group, however, ρ2 had a significant difference in most postoperative periods and ρ0 was also able to predict the cases of malabsorption, indicating that monitoring ρ2 had more clinical significance than monitoring ρ0. CONCLUSION: Blood concentration monitoring can provide a reference for cyclosporine A usage in the clinical practice. For HT patients, ρ2 is more scientific and sensitive than ρ0 as a monitoring index in both preventing acute rejection and toxicity and adjusting dosage. Cyclosporine A blood concentration monitoring should be closely combined with clinical practice to individualize its use and thus achieve a satisfactory immunosuppressive effect.

Object To investigate clinical features,surgical strategy and prognostic factors of bone metastasis from thyroid cancer.Methods A total of 46 patients with bone metastasis from thyroid cancer,who had undergone surgical treatment from January 1999 to July 2011 and had complete follow-up data,were enrolled in this retrospective study.There were 20 males and 26 females,aged from 40 to 87 years (average,56.87 years).Forty two (91.3％) cases of metastatic lesion located in axial skeleton,while 4 (8.7％) in limbs.The tumor histology type was well-differentiated in 35 patients and poorly differentiated in 11 cases.Nineteen patients (41.3％) had an isolated metastatic bone lesion,while other 27 patients (58.7％) had multiple lesions.Kaplan-Meier survival curve and Cox regression model were performed to identify prognostic factors among 19 factors including gender,age,tumor subtype,number of bone metastasis,site of bone metastasis,visceral metastasis,skeletal-related events,timing of metastasis,whether metastatic lesion was detected when thyroid cancer was diagnosed,whether thyroid surgery was performed,whether 131Ⅰ therapy was performed,whether chemotherapy or radiotherapy were performed,preoperative general condition (good or poor),surgical type (excisional surgery or palliative surgery),characteristics of metastatic lesion (osteolytic or mixed),intraoperative blood loss,whether measures were applied to prevent intraoperative bleeding,perioperative complications and long-term complications.Results Excisional surgery was performed in 36 patients (78.3％),while palliative surgery in other 10 patients (21.7％).The average amount of blood loss was 2603.26ml.The postoperative 5-year survival rate and 10-year survival rate were 37.3％ and 12.4％,respectively.Univariate analysis showed the significant prognostic factors include tumor subtype,number of bone metastasis,whether 131Ⅰ therapy was performed,and preoperative general condition (good or poor).Multivariate analysis showed the independent prognostic factors were number of bone metastasis (solitary or multiple) and whether 131Ⅰ therapy was performed.Conclusion For patients with bone metastasis from thyroid cancer,the prognostic factors are useful for determining indications for operation and improving treatment outcome.

Glucocorticoids ; therapeutic use ; Humans ; Olfaction Disorders ; drug therapy ; Treatment Outcome

Adolescent ; Adult ; Aged ; Child ; Female ; Foreign Bodies ; diagnostic imaging ; Head ; Humans ; Male ; Middle Aged ; Neck ; Tomography, Spiral Computed ; Tomography, X-Ray Computed ; Young Adult

Objective To evaluate the surgical procedures and both oncological and functional outcome in patients with bone tumors of the shoulder girdle.Methods Seventy-one patients including 61.pts with malignant tumor and 10 pts with giant cell tumors of the shoulder girdle treated in our department from July 1998 to July 2006 were studied retrospectively.According to the location,there were 15 pts with scapula tumor and 56 pts with proximal humeral tumor.Forty-two male pts and 29 female pts were included in this study with an average age of 36.5 years old ranging from 11.to 62 years old.Surgical procedures:forequarter amputation in 10 pts;Scapulectomy in 3 pts;Scapulectomy and artificial scapular replacement in 3pts;partial scapulectomy and proximal humerus resection with prosthetic reconstruction in 8 pts;proximal humerus resection and prosthesis replacement in 47 pts.Results Due to adequate soft tissue was preserved,the mean functional score was 28 for the pts with giant cell tumor according to MSTS functional scoring system,compared with the functional score 23 for the pts with malignant tumor because the deltoid muscle insertion was resected in the latter group.Among the thirty-seven patients with osteosarcoma,local recurrence occurred in four cases(10.8%),lung metastasis in five and bone metastasis in two.The seven patients died of disease.One patient iagnosed of malignancy in giant cell tumor died after distal metastasis.thtee patients with Ewing sarcoma died of the disease.No recurrence Wag observed in both five humeral chondrosarcoma and five scapular chondrosarcoma.Conclusion Tumot resection and proximal humeral prostbesis replacement is the optimal method for the sarcoma of shoulder girdle in term of preservation of elbow and hand function.Preservation of abductor insertion is necessary for good abduction function.The metastatic rate of proximal humeral osteosarcoma was lower than that of lower extremities.also the prognosis of oncological outcome.Intra-articular and extra-atticular tumor resection produced similar local recurrence rate in the present study,which suggested intra-articular resection may be an altemafive procedure.

Objective To explore the manifestation and diagnostic value of CT in retinoblastoma. Methods Twentythree cases of retinoblastomas proven by operation and pathologic examination were collected. Their CT images, clinical symptoms and pathologic results were retrospectively analyzed. Results Twentythree patients of retinoblastomas aged from 4 months to 9 years (mean 2.4 years). CT images showed soft tissue mass (shaped as node, crescentshaped or occupied the entire space of the eyeball) was in the globe of all cases. There was calcification in 19 cases (82.6%), including “small pinch” in 12 cases or “patches” in 7 cases. Five cases were found the optic nerve thickened (21.7%), and 1 case of intracranial invasion through the optic nerve canal (1/23), and 6 cases of retina detachment (6/23). The lesion showed mild or moderate enhancement after intravenous contrast medium were performed. Conclusion CT has an advantage on showing the size, shapes, intrastructures and invasive degree of the lesion, and is meaningful to the diagnosis and differential diagnosis of retinoblastoma.

Objective To study retrospectively the efficacy and complications of different surgery approaches used to treat primary spinal tumors and to discuss the surgical strategy in treating them. Methods 135 patients with primary spinal tumors had been treated between July 1998 and July 2005. The following diagnoses were made based on histopathological findings: multiple myeloma in 25 patients, giant cell tumor in 17, neurofibroma or neurilemmoma in 23, chondrosarcoma in 7, osteoblastoma in 6, aneurysmal bone cyst in 4, lymphoma in 9, eosinophilic granuloma in 6, hemangioma in 15, osteosarcoma in 3, Ewing sarcoma in 5, and other different tumors in 15. Anterior approach and posterior approach was used in 73 cases and 31 cases respectively. Posterolateral approach was used in 13 cases and combination of anterior and posterior approach was used in 18 cases. Results Pain relief was obtained in 126 of the 135 patients(93.3%). Improved neurological function was seen in 86 of 92 patients who had suffered from impaired neurological function. No severe complications were found in the follow-up period. Cerebrospinal fluid leakage was observed in 11 patients, and which was successfully treated using antibiotics therapy and raising the foot of the bed. 3 patients suffered from stress ulcer after operation, but they recovered soon after blood transfusion and anti-acid treatment. Other complications included subcutaneous emphysema (in 3 patients), superficial wound infection (in 3 patients),nerve root injury (in 2 patients), implant loosening (in 2 patients), and neurological morbidity due to surgery (in 1 patient). Conclusion When single or two adjacent vertebrae are involved by spinal tumors such as giant cell tumor and chondrosarcoma, tumor resection should be performed through combination of anterior and posterior approach. Aggressive resection based on the Tomita or WBB staging system is the treatment most likely to achieve long-term local control.

Objective: To review the problems existing in the development and application of current electroacupuncture (EA) apparatuses, and provide reference for the development of EA apparatuses. Methods: Related literatures about EA apparatus were derived from China National Knowledge Infrastructure (CNKI), Wanfang Academic Journal Full-text Database (Wanfang) and Chongqing VIP Database (CQVIP) between 2013 and 2017. Literatures about the development of EA apparatuses and the application for experimental research and clinical treatment published in Chinese journals were retrieved, and the development and application of EA apparatuses were summarized. Results: Among the 107 selected literatures, 48 types of EA apparatuses were used, of which only 11 models could be found in the registration list and within the validity period. There was no registration information for the EA apparatus newly developed in the past 5 years. The EA parameters used in experimental research and clinical treatment in Chinese medicine were different, and the combination of stimulation parameters was diverse. Conclusion: At present, most of the new EA products are still in the experimental or research stage, and the transformation of results has not yet been achieved. Moreover, there is no unified standard for the use of EA apparatus and its stimulation parameters in experimental research and clinical treatment, which is not conducive to the standardization process of EA stimulation.

The present of atlanto-axial pedicle screw fixation through posterior approach provide a new remedy for treating instability of pillow and cervical. A lot of researches have reported feasibility of atlanto-axial pedicle screw fixation, the results showed that it had advantages of easily exposure, less blood loss, shorter operative time, especially in treating as remedy fixation for atlanto-axial joint screw, atlas lateral mass screws and pedicle screw caused by injuries of tumor,inflammation and trauma. If not done properly, it can cause serious complications, such as iatrogenic fracture,injuries of vertebral artery and cervical spinal cord. Therefore,the safty and effectiveness of atlanto-axial pedicle screw fixation may be focus of research.
Atlanto-Axial Joint ; surgery ; Bone Screws ; utilization ; Cervical Atlas ; surgery ; Fracture Fixation, Internal ; instrumentation ; methods ; trends ; Humans ; Spinal Fractures ; surgery

Adipates ; analysis ; Air Pollutants, Occupational ; analysis ; Esters ; analysis ; Gas Chromatography-Mass Spectrometry ; methods ; Phthalic Acids ; analysis ; Workplace