Clinical Experience In Treatment Research Articles

Clinical analysis and surgical treatment of congenital external auditory canal stenosis complicated with external auditory canal cholesteatoma

Objective:To investigate the clinical features, diagnosis, and treatment experience of congenital stenosis of an external auditory canal with external auditory canal cholesteatoma. Methods:The clinical data of 152 patients（153 ears） with congenital external auditory canal stenosis complicated with external auditory canal cholesteatoma treated in the Department of Otorhinolaryngology Head and Neck Surgery of Beijing Tongren Hospital affiliated to Capital Medical University from January 2009 to December 2019 were analyzed retrospectively, including the age of onset, clinical manifestations, signs, audiology, high-resolution computed tomography（HRCT） of the temporal bone, mode of operation and so on. According to the preoperative imaging findings, intraoperative findings,and pathological results, 152 patients with congenital external auditory canal stenosis with external auditory canal cholesteatoma were treated with canaloplasty and tympanoplasty while clearing the cholesteatoma. Results:All patients were followed up for 2-2.5 years, there was no recurrence of cholesteatoma, and the reconstructed external auditory canal was spacious. The hearing levels of 108 ears who underwent hearing reconstruction were significantly improved, and the average hearing threshold was reduced by 20-35 dB. Conclusion:The stenosis of the external auditory meatus is easy to be complicated with cholesteatoma of the external auditory canal,and the occurrence of cholesteatoma of the external auditory canal is directly related to the diameter of the external auditory canal meatus.But the time of occurrence of the cholesteatoma is not directly related to the diameter of the external auditory canal. Severe congenital stenosis of the external auditory canal with auricle deformity is easy to be missed and misdiagnosed due to retroauricular redness, swelling, and ulceration. For this kind of patient, cholesteatoma should be treated first, and then plastic surgery such as auricle reconstruction should be performed. Retroauricular incisions should be avoided to create conditions for auricle reconstruction in the future.

Analysis and Treatment Experience of 25 Cases of Primary Gastric Lymphoma with Acute Upper Gastrointestinal Bleeding as the Primary Manifestation

To summarize the clinical characteristics and treatment experience of gastric primary lymphoma with acute upper gastrointestinal bleeding as the primary manifestation, and to provide support for clinical treatment. Information on gastric primary lymphoma patients admitted to the Department of Gastroenterology, West China Hospital of Sichuan University between January 2010 and March 2021 for acute upper gastrointestinal bleeding was retrospectively collected. Data on endoscopic morphology, tumor staging, pathology typing, severity of bleeding, risks of rebleeding, treatment and inhospital prognosis were documented and analyzed. A total of 25 patients with a mean age of 57.2 years were included in the study, all of whom presented clinically with melena (100%), 9 (36%) had hematemesis, and 6 (24%) was accompanied with abdominal pain. Twenty, or 80%, of the gastric lymphoma patients with bleeding as the primary manifestation showed endoscopically a tumor-forming phenotype (Yao Classification), mostly involving the middle and lower parts of the gastric body (44% and 32%, respectively). After conservative treatment with medication, rebleeding occurred in 4 patients during hospitalization. One of them required endoscopic hemostasis, two required surgical resection to stop the bleeding, and one decided not to undergo any further treatment. Only one patient died from infection and no death resulted directly from severe bleeding. Gastric primary lymphoma presenting acute upper gastrointestinal bleeding as the sole clinical manifestation rarely occurs, but when the condition does occur, it shows a wide range of endoscopic involvement. It has a higher risk of rebleeding, and endoscopic or surgical treatment may be attempted when conservative medication treatment for acute upper gastrointestinal bleeding fails.

Clinical Experience of Diagnosis and Surgical Treatment of 6 Cases of Acute Subhepatic Appendicitis.

To summarize the experience of diagnosis and surgical treatment of 6 cases of acute subhepatic appendicitis. The clinical data of 6 patients with subacute appendicitis in Zhejiang Provincial People's Hospital from July 2018 to December 2019 were analyzed retrospectively. Results. There were 5 males and 1 female. All 6 cases were diagnosed as appendicitis by abdominal CT before operation. All patients underwent laparoscopic appendectomy without conversion to laparotomy. One case of ectopic appendix was located under the liver with absence of ascending colon, one case of ectopic appendix was located under the liver with ectopic ascending colon of transverse colon, one case of appendix head was located in the liver cyst, and the resection of liver cyst was performed at the same time, and three cases of retrocolonic appendix head were located under the liver. Postoperative pathology confirmed appendicitis. For patients with right upper abdominal pain and tenderness, the possibility of subhepatic appendicitis should be considered before operation. Emergency abdominal CT has more advantages than ultrasound. Laparoscopy can not only make a definite diagnosis but also perform appendectomy at the same time.

Differentiated approach to the surgical tactics choice in the treatment of patients with bite wounds

Background. Wounds inflicted by the teeth of animals and humans take a special place and have a number of characteristic features. There is still no generally accepted surgical tactics for the bite wounds treatment, and the issues of choosing the timing of wound closure, depending on their localization, remain unresolved.
 Aim. To analyze the clinical experience of bite wounds surgical treatment by applying primary and secondary sutures.
 Material and methods. From 2008 to 2018 409 patients with bite wounds of various localizations (289 female and 120 male) aged 16 to 84 years were under our supervision. The average age of the victims was 52.510.17 years. All patients were prescribed combined therapy, which was based on an urgent surgical care, since we attach a decisive role in the prevention and local treatment of wound infection to full primary or secondary surgical treatment. The analysis of the obtained data was performed using the statistical calculations in R 3.6.3 (R Foundation for Statistical Computing). To compare the average treatment time for primary and secondary sutures nonparametric MannWhitney test was used.
 Results. Analysis of the obtained clinical data showed that the largest number of bite wounds were dog bites (95%), which occured most often in spring (38%) and summer (38.1%), and, as a rule, at home (68%), these results were comparable with statistical data from other sources. The average duration of patients treatment with a primary suture was 13.2 days, and with a secondary suture 19.3 days. The authors proposed a differentiated approach to the choice of surgical tactics in the treatment of patients with bite wounds, depending on the timing of their admission to the hospital and the local status of the wound defect.
 Conclusion. The primary or primary delayed blind suturing should be used in the early stages (not later than in 12 hours after getting a bite), and secondary sutures are shown in late stages (more than 12 hours).

Clinical characteristics and treatment experience of individuals with SCN8A developmental and epileptic encephalopathy (SCN8A-DEE): Findings from an online caregiver survey.

SCN8A developmental epileptic encephalopathy (SCN8A-DEE) is a rare and severe genetic epilepsy syndrome characterized by early-onset developmental delay, cognitive impairment, and intractable seizures. SCN8A gene variants are associated with a broad phenotypic spectrum and variable disease severity. A caregiver survey, solicited by the advocacy group The Cute Syndrome Foundation (TCSF), was conducted to gather information on the demographics/disease presentation, seizure history, and treatment of patients with SCN8A-related epilepsies. A 36-question online survey was developed to obtain de-identified data from caregivers of children with SCN8A-related epilepsy. The survey included questions on genetic diagnosis, disease manifestations/comorbidities, seizure severity/type, current/prior use of antiseizure medicines (ASMs), and best/worst treatments per caregiver perception. In total, 116 survey responses (87 USA, 12 Canada, 12 UK, 5 Australia) were quantitatively analyzed. Generalized tonic/clonic was the most common seizure type at onset and time of survey; absence and partial/focal seizures were also common. Most patients (77%) were currently taking ≥2 ASMs; 50% had previously tried and stopped ≥4 ASMs. Sodium channel blockers (oxcarbazepine, phenytoin, lamotrigine) provided the best subjective seizure control and quality of life. The SCN8A-DEE patient population is heterogeneous in seizure characteristics and ASMs taken and is difficult to treat, with high seizure burden and multiple comorbidities. The high proportion of patients who previously tried and stopped ASMs indicates large unmet treatment need. Further collaboration between families, caregivers, patient advocates, clinicians, researchers, and industry can increase awareness and understanding of SCN8A-related epilepsies, improve clinical trial design, and potentially improve patient outcomes.

Clinical experience in partial thickness burns treatment using LMW-hyaluronic acid topics

Clinical experience in partial thickness burns treatment using LMW-hyaluronic acid topics

Health-Related Quality of Life in 91 Patients with X-Linked Agammaglobulinemia.

X-linked agammaglobulinemia (XLA) is a primary immunodeficiency (PID) caused by a defect in the gene encoding for Bruton tyrosine kinase (BTK). In the absence of a functional BTK, patients have low or absent circulating B cells and low or absent serum immunoglobulin. Despite gammaglobulin replacement and prompt use of antimicrobial agents, patients with XLA continue to experience infectious and non-infectious complications throughout their lifetime. The purpose of this study was to understand self-perceived health status of US-based patients with XLA, and examine the associations amongst clinical characteristics, treatment experience, and quality of life (QoL). A 46 and 68 question survey, developed by the Immune Deficiency Foundation (IDF) and a Short Form-12item v2® (SF-12v2®) for adults and SF-10™ for children to assess QoL, were mailed by IDF to patients in 2017 and 2018. Those that self-identified as having XLA or males with agammaglobulinemia were selected for analysis. Mean physical and mental composite scores (PCS and MCS) from SF-12v2® and mean physical health component (PHS) and psychological health summary (PSS) from SF-10™ scores were compared to the US normative data. Ninety-one patients completed the surveys: 58 (63.7%) adults and 33 (36.3%) children. For the combined surveys, the overall median age at time of the survey was 28.5years (yrs); Inter-Quartile-Range (IQR) 13-49.5 yrs; the median age at diagnosis was 2 yrs(IQR = 0-4yrs) and the median number of years with XLA diagnosis was 23 (IQR 10.75-40yrs). Amongst adult patients, physical scores were noted to be below the general adult population but did not reach statistical significance. In contrast, 2 or more chronic conditions impacted both physical and mental QoL (p < .001) and hospitalization was associated with significantly decreased physical health QoL (p < .001); three or more infections in the past 12months exhibited impact on physical health although was not found to be statistically significant. Adult patients with public insurance fared worse in mental health domains compared to those with combined public and private or those with private alone (p = 0.001). Employment status did not impact QoL. None of these variables met statistical significance nor demonstrated impact within the pediatric population in either physical or mental domains of health. Our study provides further insight into what factors impact both physical and mental domains of health amongst patients with XLA. Early detection to prevent the development of associated morbidity, as well as vigilant care to prevent hospitalizations and infections, can limit the impact this disease may have on the overall well-being of XLA patients.

LIU Zhi-shun's experience in treatment of infertility with decreasing ovarian reserve with electroacupuncture

To summarize LIU Zhi-shun's clinical experience in treatment of infertility with decreasing ovarian reserve (DOR) with electroacupuncture. LIU Zhi-shun believes that the location of infertility with DOR is the uterus, mainly involving the kidney, thoroughfare and conception vessels. He advocates to select acupoints by combining "disease-symptom-position" with prescription, and selects acupoint prescription of Bushen Tiaochong Zhuyun included Guanyuan (CV 4), Zigong (EX-CA 1), Tianshu (ST 25), Sanyinjiao (SP 6), Ciliao (BL 32) and Zhongliao (BL 33) for electroacupuncture treatment. The key points of operation are accurate positioning and deep acupuncture, focusing on regulating mind and getting qi, adopting electroacupuncture treatment and low frequency stimulation and treating slowly for long-term disease.

ZHANG Wei-hua's experience in clinical treatment of somatalgia with "point-zone-strip stimulation technique" of acupuncture

The clinical experience in treatment of somatalgia with "point-zone-strip stimulation technique" of acupuncture of professor ZHANG Wei-hua was summarized. Professor ZHANG integrates the theories of the cutaneous region of meridian, biaoben, "taking tender point as acupoint" and local holography as a whole in treatment of somatalgia. The "point-stimulation technique" of acupuncture (subcutaneous needling technique) is adopted for the painful site less than 3 cm in diameter, the "zone-stimulation technique" (surrounding needling technique) is for the site larger than 3 cm in diameter and the "strip-stimulation technique" (cubit-tibia needling technique) is for various acute and chronic somatalgia. These three needling techniques are applicable singly or in combination in clinical practice.

Clinical Experience of Acupuncture Treatment for Non-Alcoholic Fatty Liver Disease.

Based on the authors' clinical experience, the acupuncture treatment of non-alcoholic fatty liver disease mainly includes the following three aspects. (1) The etiology and pathogenesis of non-alcoholic fatty liver disease are based on “deficiency in origin and excess in superficiality.” The deficiency in origin means deficiency of the spleen and stomach, and the excess in superficiality is caused by hepatobiliary disorders. (2) The application of the theory of strengthening the spleen and mobilizing transportation should be considered for the treatment of non-alcoholic fatty liver disease by acupuncture and moxibustion. Therefore, the use of “treatment from the spleen” often has miraculous effects. (3) Skillful use of acupuncture, shallow acupuncture, acupoint thread embedding, and other traditional Chinese medicine therapies are used to regulate the liver and spleen. In addition, warm acupuncture is reused to warm the Yang and strengthen the body.

CLINICAL EXPERIENCE IN THE TREATMENT OF PANCREATORRHAGHIA IN PATIENTS WITH COMPLICATED CHRONIC PANCREATITIS

Bleeding, the source of which is in the pancreas or adjacent structures, is a rare, usually fatal manifestation of chronic pancreatitis.&#x0D; The aim of the study was to analyze the clinical experience of treatment of patient with chronic pancreatitis complicated by late pancreatorrhaghia (hemosuccus pancreaticus). &#x0D; Materials and methods. During 2000-2021, surgical treatment of 249 patients with complicated chronic pancreatitis was performed. Pancreatorrhaghia occurred in 6 (2.4%) patients.&#x0D; Discussion. A presentation of a clinical case of bleeding in the lumen of the gastrointestinal tract in a patient who underwent pancreatoduodenal resection a year ago for complicated fibro-degenerative chronic pancreatitis. Bleeding arose from the inferior pancreatoduodenal artery, which was cut through the mattress suture after heavy exercise, which caused severe pancreatorrhaghia.&#x0D; Conclusions. To prevent the occurrence of pancreatorrhaghia in the postoperative period, the most effective way is to suture the vessels in the parenchyma of the pancreas polydioxanon and filling the defects of the pancreatic duct with fibrin or cyanoacrylic glue. Although this issue needs further study.

Professor YANG Ji-guo's experience in treatment of functional gastrointestinal diseases with acupuncture combined with umbilicus moxibustion

Professor YANG Ji-guo's clinical experience in treatment of functional gastrointestinal diseases was summerized. Professor YANG Ji-guo believes that this disease is caused by the deficiency of six fu organs. Dysfunction of six fu organs in descending transportation is the basic pathogenesis. The principle of acupoint selection includes benefiting gastrointestinal functions, unblocking and purging six fu, soothing liver qi and calming down the mind. In treatment, acupuncture is combined with umbilicus moxibustion. In acupuncture, the deqi promoting technique by rotating and trembling needle is adopted. Focusing on the deficiency of six fu organs, umbilicus moxibustion is adopted to benefit the spleen and stomach and harmonize the functions of six fu organs for both biao (symptoms) and ben (root cause).

Clinical Experience of Surgical Treatment of Clavicle Fracture

Clinical Experience of Surgical Treatment of Clavicle Fracture

Professor LIN Guo-hua's clinical experience in staging treatment for post-stroke dysphagia

The paper summarizes professor LIN Guo-hua's clinical experience in staging treatment for post-stroke dysphagia. Professor LIN Guo-hua adheres to "essence and marrow deficiency and primary yang decline" as the pathogenesis and "conducting yin from yang " as the treating principle. By regulating the conception vessel and the governor vessel and focusing on yang meridians, in association with meridian differentiation and the location differentiation, professor LIN provides the staging treatment for post-stroke dysphagia. At the oral phase, yangming is dysfunction, manifested as facial paralysis and flaccid tongue. In treatment, reducing method is predominated at yangming meridian specially. At the pharyngeal phase, shaoyang is invaded by pathogens, manifested as pivoting dysfunction. The treatment focuses on communicating the exterior with the interior and promoting shaoyang meridian. At the esophageal phase, yangming meridian is deficiency and the turbid qi fails to descend, thus the reinforcing method is dominated to promote and tonify yangming. Additionally, the kinesiotherapy of acupuncture is assisted and the Lingnan fire needling therapy is used particularly. All of the summaries above provide the reference for the clinical treatment of post-stroke dysphagia.

Recurrent chronic pancreatitis with intractable pancreatolithiasis.

Due to low incidence rate of pancreatic duct stones，Authoritative consensus has not been reached regarding therapeutic choices in clinical practice. This article reports the treatment of a young woman with chronic pancreatitis complicated with refractory multiple pancreatic duct stones, which provides clinical experience for treatment and provides a new way to study the pathogenesis of chronic pancreatitis complicated with pancreatic duct stones.

Psychosocial impacts, perceived stress, and learning effects during the transition from preclinical to clinical dental education: Validation and translation of a questionnaire

During the first experiences of clinical treatment, dental students face various challenges. The purpose of the study is to standardize the questionnaire as a suitable tool for quantitative and qualitative evaluation of psychosocial impact, stress levels, and learning effect of dental students during the transition from preclinical to clinical education in Persian. In this cross-sectional study a questionnaire including three areas of psychosocial impact, perceived stress, and learning effect was systematically translated. In the group of experts, face validity was examined. Then, the content validity ratio (CVR) and the content validity index (CVI) were determined. The reliability of the questionnaire was determined by the test-retest method and the Cohen's Kappa coefficient. In a cross-sectional study, the psychosocial impact, stress levels, and learning effect of all students newly admitted to the endodontic, prosthetics, periodontics, and restorative dentistry departments of Shahid Beheshti Dental School (128 people) were measured. Mann-Whitney and Spearman-Rho were used for statistical analysis (P = 0.05). During the CVR and CVI evaluation, 12 statements were removed from the questionnaire, and one statement was changed. All valid statements of the questionnaire were considered reliable. The initial questionnaire was finally developed in the form of 27 items. Interest in clinical treatment and collaboration between students and faculty had the greatest psychosocial effects. The highest level of stress among students was seen in the endodontic ward (mean = 3.8). The greatest effect of learning was seen in different sections in infection control (mean >4). This study provided a standardized tool in Persian to evaluate the psychosocial impacts, perceived stress, and learning effect of dental students during the transition to clinical education and focused on the first clinical treatment experiences. One important psychosocial factor was collegiality between teachers and students. The ability to communicate well with the patient is thought to reduce stress.

Narrative evidence-based medicine:a strategy for evaluation of clinical efficacy of Chinese medicine

Rich experience of clinical diagnosis and treatment has been accumulated in the developmental history of Chinese medicine, and the efficacy has been increasingly accepted by the public. However, the evaluation of clinical efficacy is currently based more on scientific evidence instead of merely the changes of patient symptoms. In Chinese medicine, the changes of major disease indicators, patient symptoms, and pathogenesis are the major criteria for the evaluation of clinical efficacy. The lack of well-accepted and uniform criteria and the uncertainty of subjective evaluation limit the development of clinical Chinese medicine. Evidence-based medicine combines clinical skills with the current best evidence. Narrative medicine, utilizing people's narratives in clinical practice, emphasizes patient feelings, willingness, and value orientation. The introduction of both evidence-based medicine and narrative medicine into the evaluation of clinical efficacy refers to the construction of the clinical efficacy evaluation system in a paradigm of participatory diagnosis and treatment. It can fully reflect the characteristics of Chinese medicine, respect the values of patients, and achieve universal clinical evidence. Therefore, it helps to improve the diagnosis and treatment, the relationship between doctors and patients, patients' life quality and decision-making awareness, and finally the new evaluation model of clinical efficacy of Chinese medicine.

Clinical experience of tocilizumab treatment among a cohort of patients with COVID-19 infection from Western India.

Background:Initiation of tocilizumab (TCZ) treatment in patients with coronavirus disease 2019 (COVID-19) during the early phases of cytokine storm is crucial. This study evaluated the clinical experience of TCZ use in the treatment of patients with COVID-19.Methods:This retrospective observational study included patients (>18 years) with confirmed COVID19 treated with TCZ alone/in combination with other drugs. Data related to demographics, clinical characteristics, radiological parameters, oxygen/ventilator/vasopressor support, treatment parameters, laboratory investigations pre- and post-TCZ treatment, and clinical outcomes were retrieved from medical records.Results:Out of 95 patients (mean age, 55 years), 68.4% and 31.6% of patients had moderate and severe COVID-19 disease, respectively. The mean time to TCZ administration from symptom onset was 8.7 days. At the time of admission, the mean oxygen saturation (SpO2) was 90.4% and mean concentration of fraction of inspired oxygen (FiO2) was 80.6%. The most commonly received dose of TCZ was 400 mg (84.2%) intravenously. The mean concentration of FiO2 and SpO2 improved significantly during the treatment (P < 0.001) compared to before TCZ initiation. The change in median levels of C-reactive protein (CRP) from baseline to post-treatment (63.0 vs. 4.5 mg/dL; P < 0.001) was significant. Post TCZ treatment, 73.6% of patients improved; whereas 26.4% of patients died. Acute respiratory distress syndrome (23.2%) and elevated transaminases (12.6%) were the most commonly reported adverse events.Conclusion:Tocilizumab administration during earlier phase of cytokine storm syndrome leads to reversal of abnormal SpO2 and FiO2 concentrations to normal levels and rapid decline of elevated CRP levels in patients with COVID-19.

Study on Intelligent Traditional Chinese Medicine Fumigation for Treating Lumbar Intervertebral Disc Herniation Based on Medical Big Data Mining.

With the improvement of the traditional Chinese medicine fumigation (TCMF), more and more people are studying lumbar intervertebral disc herniation (LIDH) by TCMF. In order to clarify the thermodynamic mechanism of TCMF to LIDH and provide a model reference for individualized diagnosis, the lower control system is compiled by the microprocessor, and the upper control system is compiled by computer technology of VB. In this new system, the medical information of patients is recorded in the databases by the upper control system, and clinical diagnosis and treatment experience are packaged in the lower control system. The simulation results and clinical examples show that the new control system of TCMF has better clinical efficacy for LIDH patients, which not only effectively improves the pain symptoms of LIDH patients but is also economical and safe.

COVID-19 pandemic in children of Сhernivtsi region: clinical features and annual treatment experience

Background. The pandemic of coronavirus disease (COVID-19) has been going on for more than a year and is a problem for the health care system worldwide. At the same time, there are few studies on the peculiarities of COVID-19 in children, in particular how clinical symptoms have changed during the year with the change of types of coronavirus SARS-CoV-2. Objective was to conduct a retrospective generalized analysis of the clinical course, laboratory markers and features of treatment in pediatric cases of COVID-19 in Chernivtsi region. Materials and methods. Using the retrospective cohort method, 263 clinical cases of COVID-19 in children of the Chernivtsi region hospitalized for the period of March 2020 — March 2021 were analyzed. Results. In this work, a dynamic analysis was performed of the clinical features of COVID-19 course in the population of children of Chernivtsi region, who were hospitalized during March 2020 — March 2021 at inpatient departments with signs of infection caused by SARS-CoV-2. The first group included 65 patients who were treated in the second quarter of 2020, the second group consisted of 90 children who underwent inpatient treatment in the third quarter of 2020, the third group included 87 children who were treated in the fourth quarter of 2020, and the fourth group consisted of 21 children who underwent inpatient treatment in the first quarter of 2021. It was found that the frequency of complaints of malaise was due to infectious-inflammatory, intoxication and catarrhal symptom complexes, although in contrast to the onset of the pandemic, the complaints and signs of intoxication and asthenic syndromes, infectious-inflammatory syndromes, nonspecific neurological symptoms increased with a relatively stable rate of lesions of the upper respiratory tract. In the first quarter of 2021, there was an increase in cases of multisystem inflammatory syndrome (odds ratio = 6.5) and community-acquired pneumonia (odds ratio = 2.7). Conclusions. A dynamic analysis of the course of COVID-19 in children has demonstrated phenotypic deviations of the disease with torpidity to the prescribed treatment for nonspecific symptoms of disorders of the nervous system and gastrointestinal tract with a decrease in duration and severity of fever, increased incidence of pneumonia (odds ratio = 2.7) and multisystem inflammatory syndrome (odds ratio = 6.5).