BACKGROUND:The treatment of calcaneal fractures using open surgery is likely to cause greater trauma. OBJECTIVE:To explore the clinical effect of steinmann pin poking closed reduction axial combined with lateral multiple hol ow screws internal fixation in repair of Sanders II, III type calcaneal fractures. METHODS:The clinical data of 73 patients with Sanders II, III type calcaneal fractures were retrospectively analyzed and divided into conventional group (n=36) and experimental group (n=37) according to the treatment method. Patients in these two groups were respectively treated with conventional open reduction internal fixation and steinmann pin poking closed reduction axial combined with lateral multiple hol ow screws internal fixation. RESULTS AND CONCLUSION:Compared with the conventional group, the hospital stays of patients in experimental group were shorter, hospital costs reduced. There were no obvious changes in the foot rating from the American Association of Ankle Injuries, B?hler angle and Gissane angle. The incidence of complications was significantly decreased. These results demonstrate that the treatment of Sanders II, III type calcaneal fractures with conventional open reduction and bone plate internal fixation and steinmann pin poking closed reduction axial combined with lateral multiple hol ow screws internal fixation can obtain the basic equivalent clinical effect, however, the treatment of steinmann pin poking closed reduction axial combined with lateral multiple hol ow screws internal fixation have more obvious advantages, such as a shorter hospital stays, less hospital costs, and also can effectively control the complications.

OBJECTIVETo evaluate long-term cost effectiveness of telbivudine and lamivudine for the treatment of CHB.

METHODSCost effectiveness was conducted from social health insurance perspective. A Markov model was established based on disease progression pattern and the data from the 2 years GLOBE clinical trial. The information of annual medical expenditure and quality-of-life assessment for different CHB-related diseases was obtained from literature. Incremental cost per life year or quality-adjusted life year gained was measured.

RESULTSCompared with lamivudine, the incremental cost for 1 additional QALY gained with telbivudine in treating HBeAg-positive and -negative CHB were 5403 yuan and 28239 yuan in Beijing, as well 4916 yuan and 29618 yuan in Guangzhou, respectively. According to national economic burden of CHB-related diseases, the ICER with telbivudine vs lamivudine were 1282 yuan and 31565 yuan for HBeAg-positive and -negative CHB.

CONCLUSIONAccording to WHO recommendation for ICER threshold, telbivudine is cost effective in treating HBeAg-positive and -negative CHB, as compared to lamivudine.

Adult ; Antifungal Agents ; economics ; therapeutic use ; China ; epidemiology ; Cost-Benefit Analysis ; DNA, Viral ; blood ; Drug Costs ; statistics & numerical data ; Economics, Pharmaceutical ; Female ; Hepatitis B e Antigens ; blood ; Hepatitis B, Chronic ; complications ; drug therapy ; economics ; epidemiology ; Humans ; Insurance, Long-Term Care ; Lamivudine ; economics ; therapeutic use ; Liver Cirrhosis ; etiology ; prevention & control ; Male ; Markov Chains ; Middle Aged ; Models, Economic ; Nucleosides ; economics ; therapeutic use ; Prescription Drugs ; economics ; Pyrimidinones ; economics ; therapeutic use ; Quality-Adjusted Life Years ; Thymidine ; analogs & derivatives

Apnea test (AT) is a key step in the diagnosis of adult brain death, which provides important basis for the loss of brainstem function in patients with adult brain death. In recent years, with extensive development of adult brain death determination and organ donation transplantation, discussion and research of AT have been gradually promoted. In formulation of adult brain death criteria, countries have paid more attention to the standardization and normalization of AT implementation, and medical staffs have improved the AT implementation process. This article reviews the current AT implementation standards, conventional AT procedures and complications, modified AT exploration, AT implementation with extracorporeal membrane oxygenation, and treatments and auxiliary examinations after AT failure, in order to deepen the understanding and cognition of adult brain death determination physicians on AT, and promote AT development in a more standardized and orderly way.

OBJECTIVEInvestigate the best surgical resection of esophageal cancer by comparing the efficacy and safety between Ivor-Lewis esophagectomy and Sweet esophagectomy.

METHODSThe relevant literatures comparing Ivor-Lewis esophagectomy with Sweet esophagectomy were searched through PubMed, Embase, the Cochrane Library, Google scholar, CNKI, CBM, VIP, WanFang Data. RevMan 5.2 software was used for data analysis.

RESULTSA total of 4106 patients in 15 studies were reviewed and the data were pooled for analysis. Meta-analysis showed that, compared with the Sweet group, Ivor-Lewis operative time was significantly longer(pooled mean difference=57.40; 95%CI:42.43 to 72.38; P=0.000), operative bleeding was significantly higher(pooled mean difference=28.39, 95%CI:4.06 to 52.72, P=0.02); the number of lymph node dissection significantly more(pooled mean difference=4.19, 95%CI:3.06 to 5.32, P=0.000); No significant difference was present in hospital stay, vocal cord paralysis, chylous leakage, pulmonary complications, anastomotic leakage(all P>0.05). The 5-year survival between the two groups showed no significant difference(P=0.52).

CONCLUSIONSThe two kinds of operation have the same long term effect. Compared with Ivor-Lewis operation, Sweet operation is easier to perform, less time consuming and more tolerable. Ivor-Lewis operation can dissect more lymph nodes than Sweet operation, without increased complications.

Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Humans ; Lymph Node Excision ; Lymph Nodes ; pathology

Objective Investigate the best surgical resection of esophageal cancer by comparing the efficacy and safety between Ivor-Lewis esophagectomy and Sweet esophagectomy. Methods The relevant literatures comparing Ivor-Lewis esophagectomy with Sweet esophagectomy were searched through PubMed, Embase, the Cochrane Library, Google scholar, CNKI, CBM, VIP, WanFang Data. RevMan 5.2 software was used for data analysis. Results A total of 4106 patients in 15 studies were reviewed and the data were pooled for analysis. Meta-analysis showed that, compared with the Sweet group, Ivor-Lewis operative time was significantly longer (pooled mean difference=57.40; 95%CI:42.43 to 72.38;P=0.000), operative bleeding was significantly higher (pooled mean difference=28.39, 95%CI:4.06 to 52.72, P=0.02); the number of lymph node dissection significantly more (pooled mean difference=4.19, 95%CI:3.06 to 5.32, P=0.000); No significant difference was present in hospital stay, vocal cord paralysis, chylous leakage, pulmonary complications, anastomotic leakage (all P>0.05). The 5-year survival between the two groups showed no significant difference (P =0.52). Conclutions The two kinds of operation have the same long term effect. Compared with Ivor-Lewis operation, Sweet operation is easier to perform, less time consuming and more tolerable. Ivor-Lewis operation can dissect more lymph nodes than Sweet operation , without increased complications.

Objective Investigate the best surgical resection of esophageal cancer by comparing the efficacy and safety between Ivor-Lewis esophagectomy and Sweet esophagectomy. Methods The relevant literatures comparing Ivor-Lewis esophagectomy with Sweet esophagectomy were searched through PubMed, Embase, the Cochrane Library, Google scholar, CNKI, CBM, VIP, WanFang Data. RevMan 5.2 software was used for data analysis. Results A total of 4106 patients in 15 studies were reviewed and the data were pooled for analysis. Meta-analysis showed that, compared with the Sweet group, Ivor-Lewis operative time was significantly longer (pooled mean difference=57.40; 95%CI:42.43 to 72.38;P=0.000), operative bleeding was significantly higher (pooled mean difference=28.39, 95%CI:4.06 to 52.72, P=0.02); the number of lymph node dissection significantly more (pooled mean difference=4.19, 95%CI:3.06 to 5.32, P=0.000); No significant difference was present in hospital stay, vocal cord paralysis, chylous leakage, pulmonary complications, anastomotic leakage (all P>0.05). The 5-year survival between the two groups showed no significant difference (P =0.52). Conclutions The two kinds of operation have the same long term effect. Compared with Ivor-Lewis operation, Sweet operation is easier to perform, less time consuming and more tolerable. Ivor-Lewis operation can dissect more lymph nodes than Sweet operation , without increased complications.

Objective:To summarize the clinical and pathological features of intravascular NK and T cell lymphoma for better understanding of such disease to reduce misdiagnosis and miss-diagnosis.Methods:Clinical and pathological features were analyzed retrospectively in one case of intravascular peripheral T-cell lymphoma, not otherwise specified (IVPTCL, NOS) , with literatures review.Results:The case presented in this study was a 66-year-old man. PET/CT scan showed multiple lymph nodes enlargement throughout the body. Normal lymph node structure could not be observed by tissue biopsy, while lymph follicles were partially disrupted. High-power light microscope revealed a large number of blood vessels with diffuse proliferation and dilation, where atypical lymphoid cell mass was restricted in the lumen and partially infiltrated the large blood vessel wall. These tumor cells were medium to large with moderate cytoplasm. The nucleus was irregular, single or multiple nucleoli could be seen, chromatin was condensed, some were empty and bright, and mitotic figures could be seen. Immunohistochemical staining showed that the neoplastic cells were positive for expression of CD3, CD43, CD8, GrB, TIA-1 and perforin. EBER in situ hybridization result was negative. Polymerase chain reaction test identified a clonal gene rearrangement of T-cell receptor γ. The patient was treated with CHOP in combination with chidamide, but died of infection and cardiopulmonary failure within 2 months. 56 cases of intravascular NK/T cell lymphoma with definite classification were collected from relevant literatures, including 47 cases with nasal type of extranodal NK/T cell lymphoma (27 were male and 20 were female) , 8 cases with anaplastic large cell lymphoma (3 males and 5 females) , and only one case with de nova IVPTCL, NOS in brain. We report the second case of IVPTCL,NOS, and notably originated from lymph node for the first time.Conclusions:Intravascular NK/T cell lymphoma is a highly aggressive disease with no effective treatment at present. Involvement of Lymph node has rarely been reported, and further studies on more cases are necessary.