OBJECTIVES: To explore the efficacy of DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy for management of cancer pain and provide reference for its standardized clinical application. Methods and. RESULTS: Recommendations were formulated based on literature review and expert group discussion, and consensus was reached following expert consultation. The consensus recommendations are comprehensive, covering the entire treatment procedures from preoperative assessment and preparation, surgical operation process, postoperative management and traditional Chinese medicine treatment to individualized treatment planning. The study results showed that the treatment plans combining traditional Chinese with Western medicine effectively alleviated cancer pain, reduced the use of opioid drugs, and significantly improved the quality of life and enhanced immune function of the patients. Postoperative follow-up suggested good treatment tolerance among the patients without serious complications. CONCLUSIONS The formulated consensus is comprehensive and can provide reference for clinicians to use DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy. The combined treatment has a high clinical value with a good safety profile for management of cancer pain.
Humans ; Medicine, Chinese Traditional ; Cancer Pain/therapy* ; Drugs, Chinese Herbal/therapeutic use* ; Drug Delivery Systems ; Pain Management/methods* ; China

Objective To investigate the correlation between vitamin A,E,D and folic acid levels and concomitant preeclampsia(PE)in patients with gestational diabetes mellitus(GDM).Methods A total of 108 patients with GDM complicated with PE were used as the PE group,and another 108 GDM patients without PE were used as the GDM group.A total of 108 normal pregnant women with normal pregnancy test were used as the normal control group.The general information and vitamin A,E,D and folic acid levels were compared between the three groups.According to the severity of the disease,the PE group was subdivided into the mild-moderate PE group(62 cases)and the severe PE group(46 cases),and vitamin A,E,D and folic acid levels were compared between these two groups.Results Systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting blood glucose(FBG),fasting insulin(FINS)were increased in turn in the normal control group,the GDM group and the PE groups(P＜0.05),and vitamins A,E,D and folic acid levels were decreased in turn(P＜0.05).Triglyceride,total cholesterol and glycated haemoglobin were higher in the PE group than those in the GDM group and the normal control,and high density lipoprotein(HDL)cholesterol was lower than that in the GDM group and the normal control group(P＜0.05).Vitamin A,vitamin E,vitamin D and folic acid levels were lower in the severe PE group than those in the mild to moderate PE group(P＜0.05).Higher levels of vitamin A,vitamin E,vitamin D and folate were protective factors for GDM patients with severe PE.Folic acid showed higher predictive efficacy and specificity in single indicator analysis.Vitamin A showed high predictive specificity.The combined prediction of four indicators for severe PE in GDM patients was more effective than each individual indicator.Conclusion Serum vitamin A,E,D and folate levels are significantly lower in patients with GDM complicated with PE,and the combination of all four may improve the predictive value of severe PE complicated with GDM.

Objective:To observe and analyze the clinical characteristics of children who died of intraocular retinoblastoma (RB).Methods:A retrospective clinical study. Fourteen children (23 eyes) with intraocular RB who died after receiving treatment in Beijing Children's Hospital from 2009 to 2017 were included in the study. Among the children, there were 7 males (10 eyes) and 7 females (13 eyes); 5 had unilateral and 9 had bilateral tumor. Age were 17.2±15.5 months. All children underwent RetCam examination. RB was staged according to the international intraocular RB classify. Among the 23 eyes, 1 eye was in stage B, 2 eyes were in stage C, 12 eyes in stage D, and 8 eyes in stage E. Treatment methods included a systemic (vincristine, etoposide and carboplatin) chemotherapy (VEC chemotherapy), enucleation surgery, and vitrectomy. The basic conditions including age, time of diagnosis, pathological diagnosis, treatment and main causes of death were retrospectively analyzed.Results:Among the 14 cases, the first symptom was leukemia in 12 cases, red eye in 1 case, and squintin in 1 case. Systemic VEC chemotherapy was used for 1-6 courses of treatment; 5 cases were enucleated, 3 cases underwent histopathological examination; 3 cases were treated with vitrectomy. Among the 3 cases who underwent histopathological examination, the sclera and optic nerve, optic nerve and optic disc were invasted respectively. Seven patients died of tumor metastasis and/or intracranial lesions (50.0%, 7/14); the median survival time was 19 months. Four patients died of treatment (28.6%, 4/14), including 3 patients died of chemotherapy-related side effects, and 1 died of organ failure after enucleation surgery (7.1%); the median survival time was 3.5 months. Early abandonment of treatment died in 3 cases (21.4%, 3/14); the median survival time was 15 months.Conclusion:Intracranial metastasis is the main cause of death in children with intraocular RB.

Adenocarcinoma of esophagogastric junction (AEG) has attracted more attention in recent years. Surgical method of Siewert type Ⅱ AEG is especially controversial, mainly focusing on the scope of lymph node dissection, safety of surgical margin, and digestive tract reconstruction. The abdominal transhiatal approach and right thoracoabdominal Ivor-Lewis approach are the main surgical approaches of totally laparoscopic or thoracoscopic surgery for Siewert type Ⅱ AEG, which not only need close teamwork, but also require rich experience in laparoscopic surgery. The authors has started to choose these two totally minimally invasive surgical approaches, the feasibility and safety of which are proved. The key surgical details are presented in this article for reference.

A classical Monteggia fracture is defined as an ulnar fracture with dislocation of the proximal radioulnar joints. If combined with posterior dislocation of the radial head (posterior dislocation of the radiocapitellar joints), it is called a posterior Monteggia fracture. And for those without dislocation of the proximal radioulnar joints, it should not be defined as the posterior Monteggia fracture, but as the posterior dislocation of the proximal ulna fracture. For dislocation of the proximal radioulnar joints, the Monteggia fractures, clinical are relatively rare. The coronoid process fracture is comminuted, the proximal radioulnar joints are destroyed, the membrane and the annular ligament is injured. After restoring osseous structure and repairing the lateral ligament complex, we must also pay attention to the stability of proximal radioulnar joints, and the prognostic efficacy not sure. However, posterior dislocation of proximal ulna fractures is relatively common in clinical practice, and the coronal process fracture is usually complete, with the annular ligament and interosseous membrane intact. In treatment, the bone structure is mainly restored, and the lateral ligament complex of elbow joint is treated at the same time, with good prognosis. Through anatomical basis, imaging characteristics, injury characteristics, treatment and prognosis, we can distinguish with the posterior Monteggia fracture and posterior dislocation of proximal ulna fracture.

Objective To analezk thk altkrations in blood urka nitrogkn( BRN)and skrum crkatinink( Scr) in childrkn with rktinoblastoma( Ab)bkfork and aftkr chkmothkrape and thk clinical significanck of thk chkmothkrape kffkct,and to providk thk kvidknck for thk furthkr improvkmknt of thk safkte of trkatmknt. Methods L total of 280 chil-drkn with Ab wkrk knrollkd in thk stude,and kach of thkm was trkatkd with CEV( Carboplatin+Etoposidk+Vincris-tink)mkthods. Thkrk subjkcts includkd 153 malks and 127 fkmalks,with a mkan trkatmknt of 4. 5 ceclks(rangk 2 to 12 ceclks)and a mkan agk of 21. 5 months(rangk 1 to 84 months). Lmong thkm,149 casks wkrk diagnoskd clinicalle,131 casks wkrk diagnoskd pathologicalle. Eight casks wkrk in thk kxtraocular stagk,3 casks wkrk in glaucoma and 269 casks in intraocular pkriod(101 casks of singlk keks and 168 casks of doublk keks). BRN and Scr wkrk dktkctkd bkfork thk first coursk of chkmothkrape and aftkr thk last coursk of chkmothkrape. ResuIts BRN and Scr valuks wkrk analezkd bk-fork and aftkr chkmothkrape. BRN was 3. 05 mmol╱F bkfork chkmothkrape and 3. 46 mmol╱F aftkr chkmothkrape in thk group agkd from 4 months to lkss than 12 months(73 casks),thk valuks of BRN aftkr chkmothkrape was highkr than that bkfork chkmothkrape,and onle in this group thk changk was statisticalle diffkrknt(t﹦ -2. 829,P﹦0. 006),but all BRN valuks in this group wkrk not bkeond thk highkst rkfkrknck valuk(1. 70 mmol╱F-7. 10 mmol╱F). Bkfork initial chkmothkrape,149 patiknts( 53. 2﹪)had Scr bklow thk rkfkrknck rangk( malk:30 -104 μmol╱F,fkmalk:30 -84 μmol╱F),and 20 casks(7. 0﹪)had thk BRN bklow thk rkfkrknck valuk. In 2 casks,BRN(7. 25 mmol╱F and 7. 34 mmol╱F, rkspkctivkle)bkfork thk initial chkmothkrape was slightle highkr than thk normal valuk,but thk valuk was normal(5. 01 mmol╱F and 4. 98 mmol╱F,rkspkctivkle)aftkr thk last chkmothkrape. In onk cask,thk BRN(5. 62 mmol╱F)was normal bkfork thk initial chkmothkrape,but it was klkvatkd(7. 33 mmol╱F)aftkr thk last chkmothkrape. In anothkr onk cask,thk BRN was normal bkfork and aftkr chkmothkrape,but thk valuk aftkr chkmothkrape was 4. 69 timks highkr than that bk-fork chkmothkrape. ConcIusions Aknal function of Ab childrkn bkfork trkatmknt is normal. Skvkn pkrcknt of thksk patiknts havk BRN undkr thk BRN rkfkrknck rangk,and 53. 2﹪ of thksk patiknts havk Scr undkr thk Scr rkfkrknck rangk. It suggkstkd that thk rkfkrknck valuks of BRN and Scr nkkd to bk adjustkd. BRN of infant Ab mae incrkask signifi-cantle aftkr chkmothkrape,but it doks not mkkt thk currknt diagnostic critkria of mild nkphrotoxicite. Still,thk karle rknal damagk nkkds to bk notickd.

Objective To study the the feasibility of intestinal derotation maneuver in the resection of gastrointestinal neoplam localized in the vicinity of the ligament of Treitz.Method Intestinal derotation maneuver was applied in all the 9 case of gastrointestinal neoplasms near the ligament of Treitz,from January 2014 to January 2016,at the Second Hospital of Jilin University.The clinical date were retrospectively analyzed.Results Intestinal derotation maneuver were applied without failure in all the nine patients,the mean operation time were (195 ± 50) min,and the mean intestinal derotation maneuver time were (19 ±5) min;No derotation procedure-related injury occured,and the mean estimated blood loss were (132 ±94) ml.Early postoperative ileus developed in one case and gastroparesis in two cases.All were recovered by conservative treatment.The follow-up period were 3-24 month,tumor recurrence occurred in two cases and one case died.One case lossed to follow-up after postoperative 3 month.Conclusion The present data suggest that clinical use of intestinal derotation maneuver was feasible for surgical management of gastrointestinal neoplasms near the ligament of Treitz.

OBJECTIVETo observe the treatment and prognosis of optic nerve invasion in retinoblastoma (RB).

METHODThe children who had been diagnosed with unilateral RB and had received enucleation from January 2006 to December 2013 in our hospital were recruited. Tumor extension into the optic nerve were disclosed. Optic nerve involvement was classified into four grades according to the degree of invasion. Grade I is superficial invasion of the optic nerve head only, grade II is involvement up to and including the lamina cribrosa, grade III is involvement beyond the lamina cribrosa, and grade IV is involvement up to and including the surgical margin. Grade I and II are called invasion of the optic nerve before the sieve plate. Grade III and IV are called invasion of the optic nerve after the sieve plate. Other high-risk factors included extensive invasions of the choroid, sclera, anterior chamber, iris, and ciliary body. They were divided into two groups according to whether the merger of other high histopathologic risk factors. Treatment was delivered accordingly, and the prognosis of different degrees of optic nerve invasion was observed. The subjects were followed up for 6 months to 7 years (average: 43 months).

RESULTThere were 465 subjects in this study, including 279 boys and 186 girls. The right eye was affected in 260 patients and the left eye in 205 patients. The average time from onset of symptoms to visit was 2.7 months (range 1 day-24 months). Twenty-five patients died, resulting in an overall survival rate of 94.6%. The mortality rate of patients with optic nerve involvement with grade I was 0.4%, grade II was 1.0%, grade III was 8.7% was and grade IV was 60.9%. Of the 338 with invasion of the optic nerve before the sieve plate, two died of recurrence, with a survival rates of 99.4% (336/338). Of the 127 patients who had invasion of the optic nerve after the sieve plate, twenty-three died of recurrence, with a survival rate of 81.9% (104/127) , the difference was statistically significant (χ² = 52.299, P = 0.000). A total of 379 patients did not have any other merged pathology high-risk factors, 8 died, the mortality rate was 2.1%. Of the 86 patients who had complicated with other high-risk factors, 17 died, the mortality rate was 19.8%, the difference was statistically significant (χ² = 42.955, P = 0.000). Of the 338 patients, 304 had invasion of the optic nerve before the sieve plate had not merged other pathology high-risk factors, none died, of the 34 patients who had complicated with other pathology high-risk factors, 2 had died, the mortality rate was 5.9%, the difference was statistically significant (P = 0.010). Of the 127 patients with invasion of the optic nerve after the sieve plate, 76 had not complicated with other pathological high-risk factors, 9 of whom had died, the mortality rate was 11.8%, 51 had complicated with other pathological high-risk factors, 14 of whom had died, the mortality rate was 27.5%, outcomes did significantly differ between the two subgroups (χ² = 5.014, P = 0.025). Cox multivariate analysis showed that invasion of the retrolaminar optic nerve, surgical margin of the optic nerve and sclera were influential factors of colorectal cancer.

CONCLUSIONPatients with optic nerve invasion have an excellent outcome with current therapy. But for those whose resection margin was invaded, which has a high incidence of recurrence, chemotherapy is recommended for patients with postlaminar optic nerve involvement.

Child ; Female ; Humans ; Male ; Multivariate Analysis ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local ; Optic Nerve Neoplasms ; pathology ; surgery ; Prognosis ; Retinoblastoma ; pathology ; surgery ; Retrospective Studies ; Survival Rate

BACKGROUNDThe use of post-enucleation adjuvant therapy to decrease the extraocular relapse rate is frequently considered, but there is much controversy about the indications for adjuvant therapy. The aim of this retrospective study was to observe the treatment and prognosis for different degrees of invasion of eye tissue in retinoblastoma (RB) and identify the indications for post-enucleation adjuvant therapy.

METHODSWe recruited 537 children who had been diagnosed with unilateral RB and had received enucleation from January 2006 to December 2012 in our hospital, and divided them into three groups according to their number of histopathologic risk factors: 0 factor, 1 factor, or ≥2 factors. Histopathologic high-risk factors included invasion of the optic nerve posterior to the ethmoid plate (including optic nerve stumps) and extensive invasions of the choroid, sclera, anterior chamber, iris, and ciliary body. Treatment was delivered accordingly, and the prognosis of different degrees of histopathologic invasion was observed. The subjects were followed up for 6 months to 7 years (average follow-up time: 35 months). Statistical analysis was analyzed using χ(2) test. P < 0.05 was considered significant.

RESULTSOf the 537 RB patients who received enucleation, 25 died (overall survival: 95.3%). Of the 369 (68.7%) with no histopathologic risk factors, 1 died of recurrence, with a mortality rate of 0.3%, whereas of the 168 (31.3%) with histopathologic risk factors, 26 had recurrences and 24 died (mortality rate: 14.3%; P = 0.000). Of the 93 patients (17.3%), each of whom had a single risk factor, nine had recurrences, 16 died (8.6%). Of the 75 patients (14%) with two or more high-risk factors, 16 died (21.3%). These differences were statistically significant between the three (P = 0.000).

CONCLUSIONChemotherapy is recommended for patients with histopathologic risk factors, especially those with two or more histopathologic risk factors.

Antineoplastic Agents ; therapeutic use ; Child ; Child, Preschool ; Humans ; Infant ; Infant, Newborn ; Prognosis ; Retinoblastoma ; drug therapy ; pathology ; Risk Factors

Objective To investigate the feasibility of Narcotrend-guided application of small dose of dexmedetomidine ( DEX) for sedation during combined spinal-epidural anesthesia for elderly patients. Methods Fifty cases of ASA II or Ⅲelderly patients were randomly divided into treatment group and control group (25 patients of each group). After combined spinal-epidural anesthesia, both groups received continuous intravenous infusion of DEX, at 0. 4 μg·kg-1 in 10 min, and then the rate was lowered to 0. 4 μg·kg-1 per hour. For the treatment group, infusion rate was adjusted to reach a Narcotrend Index (NTI) of 75-85, and for the control group, infusion rate was adjusted to reach an OAA/S score of level 3-4. MAP, HR, RR, SpO2 , NTI and OAA/S score were recorded at the beginning of DEX treatment ( t0 ) , 10 min ( t1 ) , 20 min ( t2 ) , 30 min ( t3 ) , and 60 min ( t4 ) after the beginning of DEX treatment, and at the end of surgery ( t5 ) . The incidence rates of adverse events including bradycardia, hypotension, low oxygenation, and respiratory depression were also recorded. The patients were followed up until 24 h after surgery to record loss of memory about the surgical events. Results In comparison with t0 , NTI and MAP of both groups significantly decreased at t1-t5(P<0. 01). Comparison between the two groups showed no difference in MAP at each time point, and NTI of treatment group was higher than that of control group at t2-t5(P<0. 05). In comparison with t0, OAA/S of both groups significantly decreased at t1-t5(for t1, P<0. 05;for t2-t5, P<0. 01). Comparison between the two groups showed no difference in OAA/S at each time point (P>0. 05). Follow-up at 24 h after surgery observed total amnesia in 72. 0% of DEX group patients and in 76. 0% of the control group, without significant difference (P>0. 05). Conclusion Sedating elderly patients undergoing spinal-epidural anesthesia with DEX under the guidance of Narcotrend is safe and feasible, and the patients can be sedated properly.