Objective: To evaluate the efficacy and safety of plasma exchange (PE) in thymoma-associated myasthenia gravis (MG), thereby to provide theoretical support for its application in the treatment of thymoma-associated MG. Methods: A total of 133 patients with thymoma-associated MG admitted from January 2018 to September 2024 were retrospectively analyzed. Patients were matched using propensity score to reduce selection bias, yielding 22 matched pairs for both PE group (n=22) and non-PE group (n=22). Patient characteristics including gender, age of disease onset, course of disease, history of thymoma resection, clinical absolute scores [clinical absolute scores (CAS) and clinical relative scores (CRS)], and synchronized immunotherapy regimen of the two groups were analyzed. The CAS scores before and after treatment were compared between the two groups, and the CRS was used to assess the treatment efficiency. Safety of the two treatment regimens were also compared. Continuous variables were compared using the t-test or ANOVA, while categorical data were compared by the chi-square test. Results: A total of 133 patients were included and divided into two groups according to whether they underwent plasma exchange treatment: the PE group (n=22) and the non-PE group (n=111). To exclude bias caused by large difference in the number of cases between the two groups, we performed propensity score matching. After matching, the number of cases in both groups was 22. There was no significant difference in baseline clinical characteristics between the two groups (P>0.05), including gender, age of onset, duration of disease course, history of thymectomy and baseline CAS score before treatment. Compared to the non-PE group, patients in the PE group showed more significant improvement in CAS score (5.09±1.95 vs 3.59±1.50, P<0.05) and a higher CRS score (75.00% vs 50.00%, P<0.001). Compared to the non-PE group, PE group had significantly longer ICU stay, longer hospital stay and higher hospitalization cost (P<0.05). There was no statistically significant difference in adverse events between the two groups during treatment (P>0.05). During long-term follow-up, both the PE and non-PE groups showed relatively low 1-, 3-, and 5-year recurrence rate, with no significant difference between the two groups (P>0.05). Conclusion: This study indicates that plasma exchange has clear value in the treatment of patients with thymoma-associated myasthenia gravis. It can not only significantly improve patients' muscle strength to alleviate motor dysfunction and enhance quality of life, but also does not significantly increase the incidence of adverse reactions. Therefore, it can be regarded as one of the preferred treatment options that achieve a "balance between efficacy and safety" for such patients, and provides an important basis for optimizing treatment strategies, improving prognosis, and promoting the application of subsequent treatment regimens.

The correspondence between prescription and syndrome is the advantage and characteristic of traditional Chinese medicine(TCM)treatment.However,the pathogenesis of clinical diseases is complex and the condition is changeable,and the clinical application is difficult to achieve the maximum effect under the existing cognition of the correspondence between prescription and syndrome.In this paper,the five categories of physiological characteristics,pathological characteristics,constitution,syndrome,and disease of the longitudinal classification of"TCM state"are introduced into the correspondence of prescription and syndrome.Under the vertical perspective of"TCM state",the theoretical connotation of the correspondence between prescription and syndrome is interpreted as"correspondence between prescription and state",namely correspondence of"prescription-physiological characteristics",correspondence of"prescription-pathological characteristics",correspondence of"prescription-constitution",correspondence of"prescription-syndrome",and correspondence of"prescription-disease".It is hoped to accurately grasp the corresponding connotation of the correspondence between prescription and syndrome,in order to deepen the clinical thinking mode of TCM.

Based on the"You Gu Wu Yun"theory in traditional Chinese medicine(TCM),this paper believes that"Gu"in"You Gu Wu Yun"is extended to"state"from the perspective of"TCM state".In order to avoid the adverse reactions of TCM,the macro,meso,and micro three views should be used together,and macro,meso,and micro parameters should be integrated.We should also carefully identify the physiological characteristics,pathological characteristics,constitution,syndrome,and disease of human body by combining qualitative and quantitative method,highlighting the relationship between the prescription and the"state".The correspondence between prescription and the"state"will reduce the risk of adverse reactions of TCM.In this paper,we hope to focus on the guiding role of the"You Gu Wu Yun"theory in TCM research,to give full play to the characteristics and advantages of TCM,and to dialectically treat the role of TCM.

Objective:To investigate the difference in efficacy between transsylvian-transinsular approach and transcortical-transtemporal approach for hematoma evacuation in the treatment of severe basal ganglia intracerebral hemorrhage in young adults.Methods:Young adult patients with severe intracerebral hemorrhage in the basal ganglia region underwent craniotomy hematoma removal in Ankang Central Hospital from February 2012 to February 2021 were retrospectively enrolled. The Glasgow Outcome Scale score was used to evaluate the outcome at 6 months after onset. 4-5 were defined as good outcome and 1-3 were defined as poor outcome. Multivariate logistic regression analysis was used to determine the independent influencing factors of the poor outcomes. Results:A total of 51 patients were enrolled. Their median age was 41 (interquartile range 39-43) years, and 29 were men (56.8%). The median Glasgow Coma Scale score at admission was 6.0 (interquartile range 5.5-7.0), and the median baseline hematoma volume was 38.0 ml (34.5-47.5 ml). Twenty-one patients (41.2%) were in the transsylvian-transinsular approach group and 30 (58.8%) were in the transcortical-transtemporal approach group. There were no significant differences in demographics, vascular risk factors and baseline clinical data between the transsylvian-transinsular approach group and the transcortical-transtemporal approach group. Compared with the transcortical-transtemporal approach group, the amount of intraoperative bleeding and hematoma residue in the transsylvian-transinsular approach group were less, the proportion of patients requiring decompressive craniectomy was lower (33.3% vs. 63.3%; χ2=4.449, P=0.035), and the duration of dehydration medication and hospital stay were shorter (all P<0.05). However, there was no significant difference in the good outcome rate between the two groups (66.7% vs. 56.7%; χ2=0.518, P=0.472). Multivariate logistic regression analysis showed that lower scores of Glasgow Coma Scale at admission (odds ratio 0.128, 95% confidence interval 0.017-0.977; P=0.047) and longer hospital stay (odds ratio 1.402, 95% confidence interval 1.065-1.844; P=0.016) were independently associated with the poor outcomes. Conclusion:For young adult patients with severe basal ganglia intracerebral hemorrhage who underwent hematoma removal, although there was no significant difference between the outcomes of patients with transsylvian-transinsular approach and transcortical-transtemporal approach, the former had more advantages.

OBJECTIVES: To evaluate curative effects of coronavirus disease 2019 (COVID-19) patients by the transfusion of other convalescent plasma. METHODS: Retrospective analysis of the clinical data of 18 patients with severe and critical COVID-19, who were hospitalized in the ICU of Xianghu Branch of the First Affiliated Hospital of Nanchang University from February 1 to March 15, 2020. Patients were subdivided into an experimental group (=6, who had transfused the plasma) and an observation group (=12, who had no plasma transfusion). Basic clinical data and prognosis indexes of these two groups were compared. Moreover, for the experimental group, the dynamic changes of blood oxygen saturation before and after the transfusion, the changes of lymphocyte absolute value 48 hours after the transfusion, and the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid were analyzed. RESULTS: There were no significant differences in age, gender, blood type and other basic clinical data between the two groups (all >0.05).There were no significant differences in ventilator machine weaning time, extracorporeal membrane oxygenation (ECMO) weaning time, body temperature recovery to normal time, and hospitalization days between these two groups (all >0.05). For the experimental group, before, during and after the convalescent plasma transfusion, the blood oxygen saturation of all 6 patients at all time (1, 6, 8, 12, 24, 36, and 48 h) was more than 90%, and there was no significant fluctuation. There were 3 patients whose absolute value of lymphocyte was increased 48 hours after the transfusion, and the remaining was decreased. There were 5 patients whose SARS-CoV-2 nucleic acid detection turned negative 48 hours after the transfusion, accounting for 83.3%. CONCLUSIONS Transfusion of convalescent plasma will not affect outcomesof COVID-19 patients, which can neutralize SARS-CoV-2 in patients and reduce the loading capacity of SARS-CoV-2.
Betacoronavirus ; Blood Component Transfusion ; China ; Coronavirus Infections ; therapy ; Humans ; Immunization, Passive ; Pandemics ; Plasma ; Pneumonia, Viral ; therapy ; Retrospective Studies

OBJECTIVES: To explore the influential factors and titer trend of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) specific IgG antibody in convalescent patients with coronavirus disease 2019 (COVID-19), and to provide theoretical basis for the feasibility of clinical treatment of convalescent plasma. METHODS: Colloidal gold immunochromatography assay was used to detect the SARS-CoV-2 specific IgG antibody and its titer in 113 convalescent patients with COVID-19 who were followed up from February 19, 2020 to April 6, 2020. The basic characteristics and treatment factors of patients in the high titer group (antibody titer≥1꞉160, RESULTS: The difference in the clinical type of COVID-19, onset time, first admission C-reactive protein, absolute value of lymphocyte, absolute value of CD19 CONCLUSIONS Male COVID-19 patients might be more likely to produce high titer SARS-CoV-2 specific IgG antibodies than female. The peak level of SARS-CoV-2 specific IgG antibody in convalescent patients is maintained for a short period. Using plasma from convalescent COVID-19 patients for treatment should be within 28 d after discharge.
Antibodies, Viral ; Betacoronavirus ; COVID-19/therapy* ; Female ; Humans ; Immunization, Passive ; Immunoglobulin G ; Male ; Pandemics ; Pneumonia, Viral/epidemiology* ; SARS-CoV-2

Objective:To summarize the clinical features of clear cell sarcoma of the kidney (CCSK) in children and to evaluate the effica-cy and safety of the WT-2009 chemotherapy protocol. Methods:Clinical data of children with CCSK recorded between January 2009 and December 2014 were retrospectively analyzed. Follow-ups were conducted to monitor the postoperative conditions of the pa-tients. Results:Nine cases of CCSK were recruited, and another three cases were excluded for the analysis because of incomplete clini-cal data. All patients achieved complete remission when the treatment was finished. The estimated 3-year overall survival rate was 100％, and the estimated 3-year event-free survival rate was 83.3％. No report is available on the significant side effects associated with this treatment. Conclusion:CCSK is rare in children and is easily misdiagnosed. The chemotherapy based on the WT-2009 proto-col can produce a favorable prognosis and a high tolerance for patients with CCSK. However, the treatment for high-risk patient needs to be further explored, and follow-ups must be intensified.

Objective To compare the effect of thin-sliced enhanced CT scanning and 3D-DSA data sources in the 3 D printing data reconstruction of intracranial arteriovenous malformation (AVM ). Methods Five patients with AVM were selected prospectively,3 were Spetzler-Martin grade II and 2 were grade III. Two of them used 256-slice spiral CT thin slice enhanced scanning. Three used the 3D-DSA rotating imaging,and the DICOM raw data of the examination results were extracted. Digital processing was performed by using the Mimics software,and the 3 D printing was performed according to the ratio of 1∶1 obtaining the solid model and the effects were compared. Results Using the data source 3 D printing of 256 slice spiral CT thin-slice enhanced scan could obtained skull and blood vessel image information and could reveal the smallest diameter of 0. 9 mm vessel,however,the fine branch structures of the vessel were difficult to distinguish. The 3D printing based on 3D-DSA data,although the digital subtraction did not have the skull data information,the vascular branches showed more abundant. It could reveal the smallest diameter of 0. 9 mm vessel. Conclusions Using the CT thin-slice enhanced scan or 3D-DSA data source can obtain reconstruction images of AVM nidus,and 3D-DSA shows that the better effect for spatial structure of AVM nidus. It is helpful to the design of preoperative treatment scheme and the development of corresponding auxiliary tools.

This commentary begins with standards and the key elements of case management in western countries, and summarized the current situation and problems of case management in China .Foreign countries have established the standards of practice for case management , which included the national self assessment for case management practice , the national code of ethics for case management , and the national skill set for effective case management .The authors believe that the cooperation of multiple disciplines and institutions is the key element , the needs of patients are the orientation , and case managers are the central coordinator .The main problems of case management in our country includes the misunderstanding of concepts of case management , limited resource and information , lack of training and assessments of case managers , and lack of quality control and outcome evaluation system .

OBJECTIVETo investigate the application of 3D printing and digital technology in preoperative assessment and planning of internal fixation surgery for complex tibial plateau fracture.

METHODSComplex tibial plateau fractures and commonly used plates for tibial plateau were imaged using computed tomography (CT) to reconstruct the 3D fracture and plate models. The 3D models were used to perform virtual reduction and preoperative planning of internal fixation surgery with the most appropriate plates assisted by the 3D library of plates. According to the optimal plan, the 3D physical models of tibial plateau fractures and plates were 3D printed to simulate internal fixation operation. The effects of internal fixation were compared between the virtual surgery and the simulated surgery based on the 3D models.

RESULTSThe effects of internal fixation in the simulated surgery based on the 3D models were consistent with those of the virtual surgery. No significant difference was found in the screw length between the two surgeries.

CONCLUSIONThe combination of 3D printing and digital design can improve the effects of internal fixation for complex tibial plateau fractures.