OBJECTIVE: To estimate the minimal clinically important difference (MCID) of the frequency of bowel movement for the patients with chronic severe functional constipation treated with acupuncture so as to provide the evidence for the clinical decision. METHODS: In this study, 813 patients with chronic severe functional constipation treated with acupuncture in two previous randomized controlled trials were included. Through the anchor-based method (anchored by the item 28 "satisfaction with previous treatment" of the patient assessment of constipation-quality of life [PAC-QOL]) and the distribution-based method, the MCID of the weekly frequency of complete spontaneous bowel movement (CSBM) and spontaneous bowel movement (SBM) was analyzed statistically in the patients. RESULTS: The MCID of the mean weekly frequency of CSBM and SBM was 1.3 times and 1.6 times in patients with chronic severe functional constipation treated with acupuncture, respectively. CONCLUSION The mean increase of the weekly CSMB is ≥ 1.3 times and that of SBM is ≥ 1.6 times after treatment when compared with the baseline respectively, suggesting the clinical significance.
Humans ; Quality of Life ; Minimal Clinically Important Difference ; Treatment Outcome ; Constipation/therapy* ; Acupuncture Therapy

In recent years， with the change in life style， social environment， and national childbearing policy， the proportion of high-risk pregnant women has increased significantly， triggering the spectrum of obstetric diseases to constantly change， which has brought new challenges to the diagnosis and treatment of obstetrics. Traditional Chinese medicine （TCM） has been proved effective in dealing with a variety of obstetric diseases， and various treatment methods are available， which can serve as alternative means for solving refractory obstetric diseases. However， most obstetric clinicians are currently less aware of the therapeutic effects of TCM， which has significantly hindered its participation in clinical treatment. Therefore， the China Association of Chinese Medicine （CACM） organized the outstanding young obstetricians of TCM and western medicine to discuss 15 obstetric diseases responding specifically to TCM or integrated TCM and western medicine， including hyperemesis gravidarum， threatened abortion， ectopic gestation， cough during pregnancy， pregnancy-induced hypertension syndrome， maternal-fetal ABO incompatibility， postpartum hypogalactia， residual pregnancy tissue in uterine cavity， puerperal infection， pantalgia after childbirth， hematoma/undesirable healing after caesarean section， postpartum urinary retention， ileus after cesarean section， pelvic floor dysfunction， and postnatal depression. The suggestions for their treatment with TCM or integrated TCM and western medicine were also proposed， aiming to provide patients with effective and personalized treatments in clinical practice and improve the diagnosis and treatment effects of obstetric diseases， thus benefiting the public. At the same time， more obstetrical clinicians are expected to understand the therapeutic effects and advantages of TCM and draw on the strengths of both TCM and western， thereby promoting the establishment of an obstetric diagnosis and treatment system with Chinese characteristics.

Objective:To understand the X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) imaging features of Brucella spondylitis (BS) in non-pasture areas. Methods:The medical records of 21 patients with BS diagnosed and treated in the Second Affiliated Hospital, Dalian Medical University from December 2013 to November 2020 were collected. There were 14 males and 7 females. The age was (52.4 ± 15.8) years old, ranging from 21 to 77 years old. They all came from non-pasture areas. The diagnostic criteria refered to the "Diagnosis for Brucellosis" (WS 269-2019). The results of imaging examinations (including X-ray, CT and MRI, 19, 16 and 21 cases respectively) were retrospectively analyzed.Results:In 21 patients with BS, the main lesion site was lumbar vertebrae (16 cases, 76.2%). In 19 cases of X-ray examination, 9 cases (47.4%) showed "Bird's Beak" hyperostosis, and 7 cases (36.8%) had vertebral bone destruction. Among the 16 cases of CT examination, 10 cases (62.5%) had hyperosteosclerosis and 8 cases (50.0%) had vertebral bone destruction, they had been showed the characteristic change of "Lace Like" sign. There were 7 cases (43.8%) of intervertebral disc lesions, 1 case (6.2%) of paravertebral abscess and 1 case (6.2%) of psoas major abscess. In 21 patients with MRI examination, 10 cases (47.6%) showed hyperostosis and 11 cases (52.4%) showed bone destruction; 13 cases (61.9%) had signal changes of intervertebral disc. There were 1 case (4.8%) of prevertebral abscess, 1 case (4.8%) of paravertebral abscess and 1 case (4.8%) of psoas major abscess. Sixteen patients underwent CT and MRI examinations at the same time, MRI was superior to CT in detecting intervertebral disc lesions (13 vs 7 cases, χ 2 = 4.800, P < 0.05). Conclusion:The X-ray, CT and MRI imaging features of BS patients in non-pasture areas are varied, and the lesion site mainly involves the lumbar vertebrae, and MRI is superior to CT in detecting intervertebral disc lesions.

OBJECTIVETo evaluate the clinical role of dilation and curettage (DC) in the diagnosis of ectopic pregnancy (EP).

METHODSWe retrospectively reviewed the clinical data of 108 patients with pregnancy of unknown location who underwent a DC with an abnormal rise in β-human chorionic gonadotropin (β-HCG) level and without visible intrauterine pregnancy (IUP) on transvaginal ultrasound and 24 patients who did not receive DC with β-HCG>5 000 IU/L.The final diagnosis depended on β-HCG trend review after DC and the pathologic and laparoscopic findings.

RESULTSOverall, 65.3% of the patients were finally diagnosed with EP and 34.7% were found to have a nonviable IUP.Those with EP had significantly higher initial β-HCG than those with nonviable IUP.IUP patients were more likely to have had a history of delivery.Among the patients with β-HCG<2 000 IU/L, 40.0% of EP and 11.0% of IUP had endometrial echo complex no more than 5 mm (P=0.035). In β-HCG<2 000 IU/L and 2 000 IU/L<β-HCG<5 000 IU/L groups, the diagnostic rate of EP was 42.6% and 68.3% respectively (P=0.012). Among the patients with β-HCG>5 000 IU/L, there was no significant difference between those with DC and those without DC (96.7% vs.96%, P=0.915).

CONCLUSIONSUltrasound findings such as a thin endometrial echo complex and the presence of pelvic mass are associated with but are not diagnostic of an ectopic pregnancy.The patients with the suspected diagnosis of EP are 2 000 IU/L<β-HCG<5 000 IU/L, whereas DC remains important valuable to differentiate EP from nonviable IUP and to avoid misdiagnosis and unnecessary exposure to methotrexate. Because EP is the common final diagnosis in most of the patients with β-HCG>5 000 IU/L and pelvic mass and without intrauterine gestational sac, the value of DC decreases and laparoscopy can be considered directly.

Adult ; Curettage ; Female ; Humans ; Pregnancy ; Pregnancy, Ectopic ; pathology ; Retrospective Studies ; Young Adult