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The evaluation of different stages of TNM in prognosis of appendiceal neuroendocrine tumors

ze Ying XIAO ; jie Dong BAN ; ming Jian WEI ; ning Sheng ZHANG

Tianjin Medical Journal.2017;45(10):1080-1082. doi:10.11958/20170468

Objective To investigate the prognostic value of different stages of TNM in patients with appendiceal neuroendocrine tumors (NETs). Methods The clinical data of 40 cases of NETs were analyzed, and follow-up data were staged by the ENETS and AJCC TNM staging system. Kaplan-Miere survival curves were used to compare survival differences in patients with different stages of TNM. Results Of the 40 patients, no one was diagnosed as appendiceal NETs before surgery. Twenty-one patients were diagnosed as acute appendicitis, 16 were diagnosed as chronic appendicitis and 3 were suspected as appendiceal tumors due to thickening of the lumen before surgery. No clinical manifestations were found in 40 patients before surgery including diarrhea, abdominal pain, facial flushing, asthma-like seizures and other carcinoid syndrome performance. All patients underwent appendectomy, and appendix NETs were diagnosed by pathology after surgery. In 40 appendical NETs patients, 15 cases were classified as stageⅠ(37.5%), 10 cases were classified as stageⅡA (25%), 2 cases were classified as stageⅢA (5%), 13 cases were classified at stageⅢB (32.5%), and no patients were classified as stageⅣ. The median survival times (months) were 27, 22, 21 and 18 for patients with different stages, and there were no significant differences in survival times between four stages (χ2=0.8988,P>0.05). Conclusion The clinical features of appendical NETs are nonspecific. The diagnosis of appendical NETs is based on pathological examination and immunohistochemistry. There are no correlation between different TNM stages and prognosis of patients.

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The peritoneal dialysis efficacy of icodextrin-based solution:a Meta-analysis

Zhi LU ; Fang WEI ; li Ai JIANG

Tianjin Medical Journal.2017;45(10):1108-1112. doi:10.11958/20170716

Objective To compare the efficacy of icodextrin-based solution (ico) and glucose-based solution (GLU) in peritoneal dialysis patients. Methods Pubmed (1996-2016.12), MEDLINE (1996-2016.12), Embase (1974-2016.12) and Cochrane library were searched by two independent investigators who conducted quality assessment and data mining and performed Meta-analysis using RevMan 5.2. Results Ten randomized controlled trials with 825 participants were included in this study, and 661 patients completed the trials at last. The Meta-analysis showed that there were no significant differences in body weight (WMD=-1.88, 95%CI:-4.68-0.93, P=0.19), fasting plasma glucose (WMD=-0.76, 95%CI:-1.79-0.28, P=0.15), plasma triglycerides (WMD=-0.56, 95%CI:-1.18-0.06, P=0.08), plasma total cholesterol (WMD=-0.17, 95%CI:-0.63-0.29, P=0.47) and adverse events (RR=1.06, 95%CI:0.86-1.29, P=0.59) between ICO group and GLU group. The peritoneal creatinine clearance (WMD=0.48, 95%CI:0.27-0.68,P<0.001) and peritoneal urea clearance (WMD=0.44, 95%CI:0.23-0.66, P<0.001) were better in ICO group than those of GLU group. Conclusion ICO can provide a better peritoneal creatinine clearance and peritoneal urea clearance, and which has the same safety compared with GLU.

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Systematic review of mindfulness intervention in improving physical and mental symptoms in diabetic patients

li Yan ZENG ; 四川大学灾后重建与管理学院研究生院 ; fu Guo WANG ; ying Xiu HU

Tianjin Medical Journal.2017;45(10):1099-1107. doi:10.11958/20170706

Objective To evaluate the effect of mindfulness intervention (MBI) on physical and mental symptoms in patients with diabetes mellitus. Methods Data of the relevant MBI in the physical and psychological symptoms were reviewed in patients with diabetes. The quasi-experimental studies or randomized controlled trials were used to retrieval from May 2016, and back into the study of references. According to the inclusion and exclusion criteria, the literature was screened and the quality was evaluated to extract the data. Review Manager 5.3 software was used for Meta-analysis. Results The total of 9 studies and 474 patients were included in this study. Patients were divided into MBI group (n=251) and control group (n=223). Meta-analysis showed that mindfulness therapy was effective in relieving depression, anxiety, stress and diabetes distress symptoms in diabetic patients compared with those of controls [MD=-5.35, 95%CI:-7.11--3.59;MD=-1.91, 95%CI:-3.04--0.79;MD=-4.65, 95%CI:-6.68--2.44;MD=-6.37, 95%CI:-10.84--1.90], the differences were statistical significance (P < 0.05). The improvement of the negative emotions was sustained long-term effect, and patients can benefit from it. The effects of MBI on the quality of life, whether short-term or long-term, were inconsistent and required further verification. The effects of glycemic control were generally better in MBI group than those of the control group. Conclusion Mindfulness intervention shows beneficial non-drug adjuvant therapy in reducing depression, anxiety, stress and diabetes related distress in patients with type 2 diabetes. The effects of MBI on improving the quality of life, blood glucose control need further verification.

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Primary lung mucosa-associated lymphoid tissue type marginal zone B-cell lymphoma:a case report

Jing WANG ; lin Mei XU

Tianjin Medical Journal.2017;45(10):1092-1094. doi:10.11958/20170602

To report a case with primary lung mucosa-associated lymphoid tissue type marginal zone B-cell lymphoma (PMZL-MALT). The patient was admitted in our hospital mainly due to intermittent cough and expectoration for 4 years, and aggravating for 1 year. The anti-infective treatment was given to this patient, and the efficacy was not good. Laboratory tests showed no specific indicators. Chest enhancement CT examination showed pulmonary consolidation lesions. After taking biopsy by tracheoscopy and pathological examination, the diagnosis of mucosa-associated lymphoid tissue type marginal zone B-cell lymphoma was confirmed. After receiving chemotherapy, the patient remains under treatment in a stable condition and regular reexamination.

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Analysis of irrational drug use in patients with stable chronic obstructive pulmonary disease

jing Shui QIU ; juan Li CHEN ; Hui MA ; xiang Yong ZHANG ; Fang ZHAO ; sheng Guang LI ; feng Jian PAN

Tianjin Medical Journal.2017;45(10):1076-1079. doi:10.11958/20170563

Objective To investigate the standard prescription in patients with stable chronic obstructive pulmonary disease (COPD) and to provide a reference for rational drug use. Methods A total of 157 patients with COPD in our hospital were included into the study from June 2016 to January 2017. Of patients, there were 3 patients with mild airflow limitation, 18 patients with moderate airflow limitation, 39 patients with severe airflow limitation and 97 patients with extremely severe airflow limitation. The self-made questionnaire was used to understand the basic situation, complications and irrational drug use. Results Most severe and extremely severe COPD patients were male, and most of them combined with high blood pressure and cardiovascular disease. Of the 157 patients, 12 cases with moderate airflow limitation used inhaled therapy of corticosteroids/bronchodilator medications, 45 cases combined with pneumocardial disease used compound methoxyphenamine, 26 cases used leukotriene receptor antagonist, 14 cases used antibiotics for no obvious infection symptom and 11 cases used systemic corticosteroids in stable COPD. All of them belong to rational drug use. Conclusion There are some unreasonable situations of drug using in patients with stable COPD. The medical staff should strictly control indications, strengthen the education for drug use, guide rational drug use and avoid the occurrence of adverse consequences.

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Study on survival status and pathogens in adult patients with severe community-acquired pneumonia for the past ten years

hua Zhao GU ; jun Dong ZHANG ; guo Jian HU

Tianjin Medical Journal.2017;45(10):1072-1076. doi:10.11958/20170601

Objective To investigate the survival status and pathogens in adult patients with severe community-acquired pneumonia (SCAP) for the past ten years in our hospital. Methods A total of 159 adult patients with SCAP were enrolled for this study from January 2007 to December 2016 in our hospital. Patients were divided into early stage group (from January 2007 to December 2011, n=71) and late stage group (from January 2012 to December 2016, n=88). The clinical data, pathogen distribution and prognosis were compared between two groups. Results (1) The proportion of patients with blood urea nitrogen (BUN) > 7.1 mmol/L was significantly higher in late stage group than that of early stage group (P<0.05). There were no significant differences in baseline data, vital signs, imaging findings and other laboratory examinations between the two groups (P>0.05). (2) For distribution of pathogens, 42 and 49 cases were detected pathogens in early stage group and late stage group. The detection rate of Legionella pneumophila was significantly higher in late stage group than that in early stage group (26.5% vs. 7.1%, P<0.05). (3) For complications, the incidence of septic shock was significantly higher in late stage group than that in the early stage group (22.7%vs. 9.9%, P<0.05). The fatality rate within 30 d after admission was significantly higher in late stage group than that of early stage group (43.2%vs. 25.4%, P<0.05). Results of multi-factor Cox proportional hazard regression analysis showed that septic shock and respiratory acidosis were independent risk factors of mortality in early stage group (P<0.05) while septic shock, chronic obstructive pulmonary disease (COPD) and multi-lobar infiltrates were independent risk factors of mortality in late stage group ( P<0.05). Conclusion In the past ten years, basic clinical characteristics of adult patients with SCAP in our hospital have changed little, but detection rate of legionella has showed increasing trend, and the short-term mortality rate has increased. Whether or not patients are combined with septic shock is a key factor affecting the prognosis.

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Analysis of the clinical effect of vaginal ovarian cystectomy on ovarian reserve

Jing HUANG ; hui Ya LUO ; Nan WANG

Tianjin Medical Journal.2017;45(10):1057-1060. doi:10.11958/20170710

Objective To compare the clinical efficacy between the vaginal ovarian cystectomy and the laparoscopic ovarian cystectomy. Methods A total of 104 patients with ovarian cyst hospitalized in our hospital during June 2013-June 2016 were selected and divided into observation group (vaginal ovarian cystectomy, n=55) and control group (laparoscopic ovarian cystectomy, n=49). There were no significant differences in mean age, body mass index (BMI), abdominal surgical history, cyst diameter and cyst type between the two groups. The operation time, blood loss in operation, hospitalization expenses and average hospital stay were observed in the two groups. The ovarian reserve function before and after the operation was also observed. Results The operation time [(46.9±18.4 min)], hospitalization cost [(8165.3±951.8) yuan] and the average length of hospital stay (4.5 ± 1.9 days) were significantly less in the observation group than those of the control group [(62.3 ± 26.5) min], [(12543.9 ± 1464.4) yuan] and [(6.8 ± 2.3) days], (P<0.05). Before the operation, there were no significant differences in estradiol (E2), follicle stimulating hormone (FSH)/luteinizing (LH), FSH and antral follicle count (AFC) between the two groups. After the operation, the values of FSH/LH (1.4±0.4 vs. 1.8±0.6) and FSH [(9.2±2.9) U/L vs. (13.6±4.3) U/L] were significantly decreased in the observation group than those of the control group. The AFC (7.2±1.6 vs. 6.0±1.3) was significantly more in the observation group than that of the control group (P<0.05). Conclusion The vaginal ovarian cystectomy is of little damage to ovarian reserve function, which is suitable for women of child-bearing age and conforms to the requirement of"value medicine".

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The clinical observation on the treatment of acute cerebral infarction by combining Solitaire stent arterial embolectomy with multi-mode vascular recanalization

lin Mao FU ; zheng Wei DAI ; gang Yong ZHANG ; ling Xue XIAO ; hu Shuang WANG ; qin Wen HE

Tianjin Medical Journal.2017;45(10):1053-1057. doi:10.11958/20170293

Objective To explore the efficacy and safety of Solitaire stents and the multi-mode vascular recanalization in the treatment of acute cerebral infarction. Methods Twenty-two patients with acute cerebral infarction, who were treated by Solitaire stents and the multi-mode vascular recanalization (research group) in our hospital from November 2014 to February 2017, were included in this study. Among them, 16 cases were combined with balloon dilation after arterial thrombosis, 4 cases were given stent implantation (3 cases were given Solitair stent and 1 case was given Apollo stent), and 2 cases were given arterial catheter directed thrombolysis. Eighteen patients with acute cerebral infarction who were treated only by Solitaire stent artery occlusion from October 2011 to October 2014 were used as control group. Data of the onset to the vagina vasorum time, the onset to the recanalization time, the revascularization of interventional therapy, the NIHSS scores at admission and discharge, mRS score after 90-day treatment, incidence rate and the mortality were compared between two groups. Results There were no significant differences in the durations from onset to the vagina vasorum and from the onset to the recanalization between the two groups. The recanalization was better in research group than that of control group (P<0.05). There were no significant differences in scores of NIHSS at hospital discharge and admission between two groups. The near-term treatment efficacy was similar in two groups. However, mRS score was significantly lower in the research group than that in control group after 90-day treatment (P<0.05). There were no significant differences in the symptomatic intracranial hemorrhage, high perfusion encephalopathy, the incidence rate and the mortality rate of the complications related to the operation between two groups of patients. Conclusion Solitaire stents and the multi-mode vascular recanalization can significantly improve the revascularization, the further clinical prognosis and the quality of survival in patients with acute cerebral infarction, which are safe and efficacy without increasing incidence rate and mortality rate of complications.

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CT imaging analysis of superior mesenteric artery calcification in elderly patients

feng Xun ZOU ; hui Teng GU ; hua Jian GU ; jun Zhi TAN

Tianjin Medical Journal.2017;45(10):1049-1052. doi:10.11958/20170511

Objective To retrospectively analyze the relationship between the atherosclerosis plaques in abdominal aorta and superial mesenterial artery (SMA) and the development of ischemia bowel disease (IBD) in elderly patients. Methods Elderly patients diagnosed as IBD (n=20) and non-IBD elderly patients with coronary heart disease (n=20) were selected in our hospital from January 2010 to December 2015. Data of CT imaging of abdominal aorta and SMA were evaluated by Syngo.Via software in two groups. Results The calcified plaques were dominated by dots in control group, while they were the annular lesions in IBD group, according to the CT imaging data. The mean sum of calcification in SMA was significantly increased in IBD group than that in control group (χ2=5.010,P=0.025). The stenosis of SMA was more significant in IBD group compared to that of control group (Z=3.370,P=0.001). The degree of SMA lesion was positively correlated with its opening stenosis in the IBD group (rs=0.650,P=0.002). Conclusion The basic vascular lesion is dot calcification in elderly patients with coronary heart disease, and the opening stenosis in SMA induced by mass calcification is the main cause of atherosclerosis-induced ischemic intestinal disease in elderly people.

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A study on memory disorder after marginal division of the striatum stroke

jun Liu XUE ; Ming WEI ; long Jin ZHENG

Tianjin Medical Journal.2017;45(10):1033-1035. doi:10.11958/20170642

Objective To explore the effects of marginal division of the striatum (MrD) stroke on associative learning and memory. Methods A total of 21 cases with marginal division of the striatum stroke were used as stroke group. The control group consisted of 21 healthy volunteers matched with the stroke group for sex, age and education. The clinical memory scale edited by Psychological research institute, Chinese academy of sciences was used to evaluate data of learning and memory. Results The score was significantly lower in stroke group compared with that of control group (17.71±5.59 vs. 24.80±5.05, P<0.01). The score was significantly lower in patients with lesions on left than that in patients with lesions on right (11.78 ± 1.48 vs. 22.17 ± 2.17, P<0.01). There was no significant difference in the score between hemorrhagic stroke group (16.50±6.59) and ischemic stroke group (18.46±5.01,P>0.05). Conclusion Marginal division of the striatum stroke can cause the associative learning and memory disorder, which is more serious in patients with lesions on left than that in patients with lesions on right.

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