Western Medicine Hospital Research Articles

Percutaneous endoscopic interlaminar discectomy with patients’ participation : better postoperative rehabilitation and satisfaction

ObjectEvaluation of the impact of patients’ participation on postoperative recovery and satisfaction who underwent the Percutaneous Endoscopic Interlaminar Discectomy(PEID).MethodsWe collected data from sixty-nine patients who underwent PEID surgery at Chuzhou Chinese and Western Medicine Hospital between January 2020 and December 2022. All patients had L5/S1 lumbar disc herniation and met the inclusion and exclusion criteria. The patients were divided into two groups: non-communication group (n = 33) and communication group (n = 36). The division was made based on whether the patients had preoperative surgical video viewing and intraoperative communication. We compared the baseline data, surgical time, VAS score, lumbar JOA score, surgical complications, and patient satisfaction between the two groups.ResultThe communication group showed better pain control and functional recovery in the early postoperative period. The communication group had better VAS scores on the first day and month after surgery, as well as JOA scores on the first week and month after surgery, with statistically significant differences (P < 0.05). There was no significant difference in hospital stay, VAS score, JOA score, and postoperative complications between the two groups of patients at 3 and 6 months after surgery. The communication group had higher patient satisfaction (P < 0.05).ConclusionPreoperative surgical video viewing and intraoperative communication by PEID patients can alleviate pain, accelerate functional recovery, improve symptoms, and increase patients’ satisfaction. We need to do more work to develop this new model.

Selected donor CD34(+) cell boosts for salvage treatment of poor graft function following allogeneic hematopoietic stem cell transplantation in primary myelofibrosis: 3 cases report

A retrospective analysis was conducted on three patients with primary myelofibrosis who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) at Shanghai Zhaxin Traditional Chinese and Western Medicine Hospital from 2020 to 2023. They subsequently developed poor graft function. The patients received selected donor CD34(+) cell boosts as salvage therapy. There were two male patients and one female patient, with a median age of 68 (39-69) years. The median time from allo-HSCT to the selected donor CD34(+) cell boost was 83 (56-154) days. The median infusion of selected donor CD34(+) cells was 7.67 (7.61-9.06) ×10(6)/kg, with a CD34(+) cell purity of 97.76% (96.50%-97.91%) and a recovery rate of 70% (42%-75%) . Hematological recovery was achieved in two cases. No acute GVHD was observed in any of the three patients. One case of moderate oral chronic GVHD was noted. Selected donor CD34(+) cell boosts for the treatment of poor graft function after allo-HSCT in primary myelofibrosis was effective and no severe acute or chronic GVHD was observed.

Bronchial artery chemoembolization in the treatment of refractory central lung cancer with atelectasis.

This study aims to explore the clinical application of bronchial artery chemoembolization (BACE) in managing refractory central lung cancer with atelectasis. The retrospective case series includes patients diagnosed with refractory central lung cancer and atelectasis who underwent BACE treatment at Yueyang Integrated Traditional Chinese and Western Medicine Hospital, affiliated with Shanghai University of Traditional Chinese Medicine, from January 2012 to December 2021. All 30 patients with lung cancer successfully underwent BACE procedures. Their ages ranged from 62 to 88 years, with an average age of 67.53. The treatment interval was 21 days, and the treatment cycle ranged from 2 to 12 times, averaging 4.13 times. During the BACE procedures, the Karnofsky Performance Status (KPS) score after 2 to 3 BACE cycles showed a significant improvement (82.0 ± 10.1 vs 68.3 ± 14.0, P < 0.001) than that of before BACE. Only nutritional support and symptomatic treatment were performed after BACE, and no major hemoptysis were observed. During follow-up, 23 cases resulted in mortality, while seven survived. The median progression-free survival (PFS) and overall survival (OS) were 7.0 (95% CI: 4.6-9.4) and 10.0 (95% CI: 6.2-13.8) months, respectively, with 1-, 2-, and 3-year survival rates of 84.0%, 53.5%, and 11.3%, respectively. Eight cases exhibited bronchial recanalization and relief of atelectasis. According to the RECIST scale, there were 4 cases of complete response (CR), 16 cases of partial response (PR), 9 cases of stable disease (SD), and 1 case of progressive disease (PD). No serious adverse events were reported. BACE might be a safe intervention for refractory central lung cancer accompanied by atelectasis. The procedure exhibits satisfactory outcomes in tumor control, atelectasis relief, and enhancement of quality of life, warranting further investigation.

Short-term substitution of calcineurin inhibitors (CNI) with recombinant humanized anti-CD25 monoclonal antibody (Basiliximab) as aGVHD prophylaxis in CNI intolerant patients after allogeneic hematopoietic stem cell transplantation

Objectives: To investigate the efficacy of short-term substitution of recombinant humanized anti-CD25 monoclonal antibody (Basiliximab) as acute GVHD (aGVHD) prophylaxis in calcineurin inhibitors (CNI) intolerant patients following allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Methods: This study included 17 patients with refractory malignant hematological disorders who underwent salvage allo-HSCT at the Bone Marrow Transplantation Department of Shanghai Zhaxin Traditional Chinese and Western Medicine Hospital from August 2021 to August 2022 and were treated with Baliximab to prevent aGVHD due to severe adverse reactions to CNI. There were seven men and ten women, with a median age of 43 years (18-67). Following the discontinuation of CNI, Basiliximab was administered at a dose of 1 mg/kg once weekly until CNI or mTOR inhibitors were resumed. Results: Basiliximab was started at an average of 5 (1-32) days after HSCT. The median duration of substitution was 20 (7-120) days. All had neutrophil engraftment within a median of 12 (10-17) days. Thirteen patients had platelet engraftment after a median of 13 (11-20) days. Four patients did not develop stable platelet engraftment. Eight patients (47.1% ) developed Grade Ⅱ-Ⅳ aGVHD, while four (23.6% ) developed Grade Ⅲ/Ⅳ aGVHD. Only one patient died from aGVHD. Before the end of the followup period, seven of 17 patients died. The longest followup period of the survivors was 347 days, and the median survival rate was not met. The overall survival (OS) rate at six months was 62.6%. Among the 17 patients, 13 (76.4% ) experienced cytomegalovirus reactivation, 7 (41.2% ) experienced EB virus activation, and no cytomegalovirus disease was observed. Conclusions: When CNI intolerance occurs during allo-HSCT, short-term replacement with Baliximab can be used as an alternative to prevent aGVHD.

Quantitative PCR-based high-sensitivity detection of HBV-DNA levels reflects liver function deterioration in patients with hepatitis B virus-related cirrhosis.

To investigate the clinical implication of quantitative polymerase chain reaction (PCR)-based high-sensitivity detection of hepatitis B virus (HBV)-DNA levels in patients with HBV-related liver cirrhosis (LC). From January 2020 to December 2022, 100 fasting serum samples were collected and retrospectively analyzed from patients with treated HBV-related LC attending the Suzhou Hospital of Integrated Traditional Chinese and Western Medicine and Suzhou Guangci Cancer Hospital. Patients were divided into a negative group (HBV-DNA < 20 IU/mL) and a positive group (HBV-DNA ≥ 20 IU/mL) according to their high-sensitivity HBV-DNA test results. The clinical characteristics and serological indicators of the two groups were compared, mainly including gender, age, liver function [total protein (TP), albumin (ALB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), total bilirubin (TBIL), direct bilirubin (DBIL), and indirect bilirubin (IBIL)], lipids [total cholesterol (TC) and triglycerides (TG)], platelets (PLT), five serum liver fibrosis markers [cholyglycine (CG), hyaluronic acid (HA), laminin (LN), precollagen type III (PCIII), and type IV collagen (IV-C)], serum gastrointestinal tumor markers [α-fetoprotein (AFP) and carcinoembryonic antigen (CEA)], and hepatitis B surface antigen (HBsAg). The differences between the two groups in terms of liver function Child-Pugh grades and the incidence of hepatocellular carcinoma (HCC) were also compared. There were 39 patients in the positive group, including 29 males and 10 females, and 61 patients in the negative group, including 38 males and 23 females, with no statistically significant differences in gender and age distribution between the two groups (P > 0.05). The levels of serological indicators (TP, ALB, AST, GGT, ALP, TBIL, DBIL, IBIL, TC, TG, PLT, CG, HA, LN, PCIII, IV-C, AFP, CEA, and HBsAg) in both groups showed no significant differences (P > 0.05), but the ALT level in the positive group was higher than that in the negative group (P < 0.0001). The positive group had worse Child-Pugh grades and higher HCC incidence compared to the negative group (P < 0.0001, P = 0.028). Patients with HBV-related LC and HBV-DNA ≥ 20 IU/mL have higher serum ALT levels, worse liver function Child-Pugh grades, and higher HCC incidence than those with HBV-DNA < 20 IU/mL. High-sensitivity HBV-DNA quantification can reflect the deterioration of liver function in patients with HBV-related LC to some extent.

Effects of electroacupuncture on refractory interstitial cystitis/bladder pain syndrome: A one-year follow-up case report

BackgroundPatients with interstitial cystitis/bladder pain syndrome (IC/BPS) commonly face a decline in their quality of life and social functioning upon discontinuation of conventional therapy, which is known for its limited efficacy and the risk of relapse. While the existing evidence is somewhat restricted, acupuncture is being explored as a potential and effective treatment option for IC/BPS. Case presentationA 67-year-old woman, diagnosed with refractory IC/BPS, underwent treatment at the Medical Acupuncture Department of Sanming Integrated Traditional Chinese and Western Medicine Hospital. She reported symptoms of lower urinary system dysfunction, including urgency, frequency, and nocturia, along with chronic pelvic pain, and a persistent feeling of pressure and discomfort lasting over 8 years. The patient's visual analog scale (VAS) score for pelvic pain was 7 points prior to receiving acupuncture treatment. Throughout the day, she had more than 10 urinations, and at night, she urinated about once per hour. The O'Leary-Sant interstitial cystitis symptom index/interstitial cystitis problem index (ICSI/ICPI) score was 34 points, and the pelvic pain and urgency frequency (PUF) score was 19 points. ResultsThe patient's complaints were significantly alleviated after 12 sessions of electroacupuncture treatment at BL32, BL33, BL35, and SP6 over 4 weeks. The patient claimed total relief from pelvic pain, with a VAS score of 0. The patient achieved a PUF score of 4 points and an ICSI/ICPI score of 7 points. In addition, there was a significant reduction in the frequency and urgency of urination. The patient experienced a frequency of 4–5 urinations during the day and 1–2 times at night. Subsequently, the patient's mental state and sleep quality were improved. The patient's symptoms did not change at one-year follow-up. ConclusionElectroacupuncture has proven to be an effective management method for IC/BPS, as evidenced by the patient's alleviated lower urinary system symptoms and reduced pelvic pain.

Identification of IRF1 as a Novel Pyroptosis-Related Prognostic Biomarker of Atopic Dermatitis.

Purpose: The aim of this study was to characterize key biomarkers associated with pyroptosis in atopic dermatitis (AD). Materials and methods: To identify the differentially expressed pyroptosis-related genes (DEPRGs), the gene expression profiles GSE16161 and GSE32924 from the Gene Expression Omnibus (GEO) database were utilized. Gene Ontology (GO) enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were conducted to determine the potential biological functions and involved pathways. Furthermore, protein-protein interaction network analyses were performed to identify hub genes. The types and proportions of infiltrating immune cells were detected by immune filtration analysis using CIBERSORT. A 12-axis competing endogenous RNA (ceRNA) network was constructed utilizing the miRNet database. Immunohistochemistry (IHC) further validated the differential expression of a key gene IRF1 in the skin tissues collected from AD patients. The collection of skin tissue from human subjects in this study were reviewed and approved by the IRB of Yueyang Integrated Chinese and Western Medicine Hospital (KYSKSB2020-125). Results: The study identified a total of 76 DEPRGs, which were enriched in genes associated with the inflammatory response and immune regulation. There was a higher percentage of activated dendritic cells and a lower percentage of resting mast cells in AD samples. PVT1 expression was associated with upregulation of hub genes including CXCL8, IRF1, MKI67, and TP53 in the ceRNA network and was correlated with activated dendritic cells in AD. As a transcription factor, IRF1 could regulate the production of downstream inflammatory factors. The IHC study revealed that IRF1 was overexpressed in the skin tissues of AD patients, which were consistent with the results of the bioinformatic study. Conclusions: IRF1 and its related genes were identified as key pyroptosis-related biomarkers in AD, which is a crucial pathway in the pathogenesis of AD.

Application of machine learning models in predicting insomnia severity: an integrative approach with constitution of traditional Chinese medicine.

This study sought to explore the utility of machine learning models in predicting insomnia severity based on Traditional Chinese Medicine (TCM) constitution classifications, with an aim to discuss the potential applications of such models in the treatment and prevention of insomnia. We analyzed a dataset of 165 insomnia patients from the Shanghai Minhang District Integrated Traditional Chinese and Western Medicine Hospital. TCM constitution was assessed using a standardized Constitution in Chinese Medicine (CCM) scale. Sleep quality, or insomnia severity, was evaluated using the Spiegel Sleep Questionnaire (SSQ). Machine learning models, including Random Forest Classifier (RFC), Support Vector Classifier (SVC), and K-Nearest Neighbors (KNN), were utilized. These models were optimized using Grid Search algorithm and were trained and tested on stratified patient data, with the TCM constitution classifications serving as primary predictors. The RFC outperformed others, achieving a weighted average accuracy, precision, recall, and F1-score of 0.91, 0.94, 0.92, and 0.92 respectively, it also effectively classified the severity of insomnia with high area under receiver operating characteristic curve (AUC-ROC) values. Feature importance analysis demonstrated the Damp-heat constitution as the most influential predictor, followed by Yang-deficiency, Qi-depression, Qi-deficiency, and Blood-stasis constitutions. The results demonstrate the potent utility of machine learning, specifically RFC, coupled with TCM constitution classifications in predicting insomnia severity. Notably, the constitution classifications such as Damp-heat and Yang-deficiency emerged as crucial determinants, emphasizing its potential in guiding targeted insomnia treatments. This approach enables the development of more personalized and efficient interventions, thereby enhancing patient outcomes.

Computed Tomography-Guided Percutaneous Stylomastoid Foramen Puncture and Radiofrequency Thermocoagulation for Treatment of Hemifacial Spasm via Mandibular Angle Approach

BACKGROUND: Hemifacial spasm (HFS) is characterized by progressive, paroxysmal, and involuntary convulsions on one side of the face. We have conducted in-depth exploration on the puncture approach through the mandibular angle, which is an important supplement to the first 2 approaches (i.e., premastoid approach and the postmastoid approach), especially for patients who cannot find a suitable way before and after the mastoid process. OBJECTIVES: To investigate the effect of computed tomography (CT)-guided percutaneous mandibular angle radiofrequency thermocoagulation (RFT) of facial nerve through the stylomastoid foramen in treating HFS. STUDY DESIGN: A retrospective, observational study. SETTING: Pain Department, Jiaxing and Hangzhou, China. METHODS: A total of 89 patients with HFS who underwent CT-guided RFT in the Pain Department of Zhejiang Integrated Traditional Chinese and Western Medicine Hospital and the Pain Department of Jiaxing First Hospital, from June 2020 to June 2022, were retrospectively analyzed, including 29 men and 60 women, aged 34~88 (59.8 ± 11.1). They were divided into 3 groups: anterior mastoid approach group (Group A, n = 38), posterior mastoid approach group (Group P, n = 26), and mandibular angle approach group (Group M, n = 25), according to the different puncture approaches. Puncture time, minimum stimulating current triggering facial muscle twitches, temperature at the end of RFT and duration time of RFT at this temperature, and total treatment time, as well as degree of facial paralysis and complications one-day postoperation, were compared among the 3 groups. RESULTS: The puncture times (mean ± SD) of Group A, Group P, and Group M were (30.63 ± 4.88), (31.35 ± 5.89), and (35.08 ± 5.76), respectively, and the differences were statistically significant (P = 0.006). The puncture time of Group M was longer than that of Groups A and P (P &lt; 0.05). The minimum stimulating current triggering facial muscle twitches in the 3 groups were (0.49 ± 0.16), (0.43 ± 0.14), and (0.28 ± 0.09), respectively, with a statistically significant difference (P = 0.000). The minimum stimulation current in Group M was less than that in Groups A and P (P &lt; 0.05). The temperature at the end of RFT of the 3 groups was (78.29 ± 7.91), (76.54 ± 8.10), and (66.60 ± 8.00), respectively, and the differences were statistically significant (P &lt; 0.001). The temperature of Group M was lower than Groups A and P (P &lt; 0.05). There were no significant differences among the 3 groups in the total operation time or the degree of facial paralysis one-day postoperation (P &gt; 0.05). No hematoma, infection, hearing impairment, or other complications were reported in any patients. LIMITATIONS: The nonrandomized nature, small sample size, and retrospective design are limitations of this study. CONCLUSIONS: CT-guided RFT through the stylomastoid foramen is an effective treatment of HFS. Compared to the poster and anterior mastoid approaches, the mandibular angle approach was found to be more effective in terms of reduced minimum stimulating current and reduced-end RFT temperature, which means fewer potential complications to the patient postsurgery. KEY WORDS: Hemifacial spasm, radiofrequency thermocoagulation, stylomastoid foramen, CT-guided

Short-term efficacy of digitally-assisted traditional Chinese medicine manual reduction combined with 3D printed splint in the treatment of AO type-A distal radius fractures

Objective To explore the short-term efficacy of digitally-assisted traditional Chinese medicine manual reduction combined with 3D printed splint in the treatment of AO type-A distal radius fractures, and explore the quantification of traditional Chinese medicine manual reduction and personalized improvement of splinting. Methods The clinical data of 50 patients with AO type-A distal radius fractures, who received treatment at the outpatient department of Cangzhou Integrated Traditional Chinese and Western Medicine Hospital in Hebei Province, were retrospective analyzed. The patient cohort included 22 females and 28 males, with ages ranging from 25 to 75 years old. Among them, 27 cases presented with distal radius fractures on the left side, and 24 cases on the right side. The patients were categorized into two groups: treatment group (n=25) and control group(n=25). There were 13 males and 12 females in the treatment group, with an average age of (56.2±5.5) years old. Treatment approach for this group involved several steps. Initially, Mimics Research software was used to conduct comprehensive analysis of complete CT data from the affected limb, resulting in the creation of a three-dimensional model. Subsequently, 3D models of the bones and skin contours, stored as STL format files, were imported into the Materialise Magics 23.0 software for model processing and repair. This facilitated the simulation of reduction and recording of displacement data, effectively generating a "digital prescription" to guide and quantify traditional Chinese medicine manipulation procedures. Finally, a personalized 3D printed splint was applied for fixation treatment. There were 15 males and 10 females in the control group, with an average age of (53.32±5.28) years old. These patients were treated with manualreduction combined with traditional splinting. The clinical efficacy of the two groups was assessed in terms of fracture reduction quality, fracture healing time, Gartland-Werley wrist joint score and X-ray parameters (palminclination angle, ulnar deviation angle, radius height) at 6 weeks post-operatively. Results The treatment group exhibited a shorter duration for achieving clinical healing compared to the control group (P<0.05). Six weeks post-operatively, the treatment group demonstrated higher wrist joint function scores, and a higher proportion of excellent and good outcomes than the control group(P<0.05). The treatment group was superior to the control group in terms of imaging parameters 6 weeks post-operatively (P<0.05). Conclusion By quantifying skin contours through digital simulation prescription reduction, a personalized 3D printed splint is developed to effectively stabilize fractures, enhancing localized fixation while ensuring greater adherence, stability, and comfort. This innovative approach offers personalized treatment for AO type-A distal radius fractures and presents a novel, precise treatment strategy for consideration.

Impact of immunosuppression intensified conditioning regimen for patients with strong positive pre-transplantation donor-specific anti-HLA antibodies (DSAs) undergoing haploidentical hematopoietic stem cell transplantation

Objective: To explore the efficacy of immunosuppression intensified conditioning regimen in patients who have strongly positive donor-specific Anti-HLA antibodies (DSAs) and received a haploidentical hematopoietic stem cell transplantation (haplo-HSCT) . Methods: Clinical data of 10 patients with strongly positive pretransplant DSAs (defined as MFI ≥10000) were retrospectively analyzed in this study. All of them received a haplo-HSCT in the Hematology Department of Shanghai Zhaxin Traditional Chinese & Western Medicine Hospital. Results: ① Of all ten patients, three were males, and seven were females, with a median age of 53.5 (36-64) years. Of the 10 patients, three were diagnosed with acute myeloid leukemia, two were myelodysplastic syndromes (MDS), two were chronic myelomonocytic leukemia (CMML), two were in an accelerated phase of chronic myeloid leukemia (CML-AP), and one was primary myelofibrosis (PMF). ② Conditioning regimen consisted of fludarabine (Flu) /busulfan (Bu) combined with whole-body irradiation (TBI) /cyclophosphamide (Cy). ③ On the seventh day after transplantation, the median pretransplant DSA level was MFI 15 999 (10 210-23 417) and 10 787 (0-22 720). ④ Eight patients acquired hematopoietic reconstitution; the median time of neutrophil engraftment was 14 (10-16) days; and 18 (14-20) days for platelet engraftment. After a median follow-up of 12.5 (1.5-27) months, primary graft failure was found in one patient and another with poor graft function. Seven patients remained in a disease remission state, and all were DSA-negative. Conclusions: An intensified immunosuppression conditioning regimen can efficiently decrease the level of donor-specific anti-HLA antibodies (DSAs), leading to good short-term efficacy.

Management strategy of femoral artery pseudoaneurysm combined with infectious wounds

Objective: To investigate the surgical treatment methods of femoral artery pseudoaneurysm combined with infectious wounds and to evaluate the clinical effects. Methods: The retrospective observational research method was used. Twelve patients with femoral artery pseudoaneurysm combined with infectious wounds who met the inclusion criteria were admitted to Nanjing University of Chinese Medicine Wuxi Integrated Traditional Chinese and Western Medicine Hospital (Affiliated Hospital of Jiangnan University) from October 2014 to September 2022, including 6 males and 6 females, aged from 46 to 78 years. In the primary operation, debridement, tumor resection, and artery suture/venous grafting to repair the artery/artery ligation were performed, and the wound area after tumor resection ranged from 4.0 cm×1.5 cm to 12.0 cm×6.5 cm. Wounds that could be sutured were treated with tension reduction suture and extracutaneous continuous vacuum sealing drainage (VSD), while large wounds that could not be sutured were treated with VSD to control infection. In the secondary operation, tension reduction suture was performed to repair the wounds that could be sutured; large wounds were repaired with adjacent translocated flaps with area of 9.0 cm×5.0 cm to 15.0 cm×7.0 cm. Additionally, when the length of the exposed femoral artery was equal to or over 3.0 cm, the wounds were repaired with additional rectus femoris muscle flap with length of 15.0 to 18.0 cm. The donor areas of the flaps were directly sutured. The wound with artery ligation was treated with stamp skin grafting and continuous VSD. The bacterial culture results of the wound exudate samples on admission were recorded. The intraoperative blood loss, the location of femoral artery rupture, the artery treatment method, and the wound repair method in the primary operation were recorded, and the durations of catheter lavage, catheter drainage, and VSD treatment, and the drainage volume after the operation were recorded. The repair method of wounds in the secondary operation, the durations of catheter drainage and VSD treatment, and the total drainage volume after the operation were recorded. The survivals of flap/muscle flap/stamp skin grafts were observed, and the wound healing time was recorded. Follow-up after discharge was performed to evaluate the quality of wound healing and the walking function and to check whether the pulsatile mass disappeared. B-ultrasound or computed tomography angiography (CTA) was performed again to observe potential pseudoaneurysm recurrence and evaluate the patency of blood flow of the femoral artery. Results: The bacterial culture results of wound exudate samples of all the patients were positive on admission. The blood loss was 150 to 750 mL in the primary operation. The arterial ruptures were located in the femoral artery in 8 cases, in the external iliac artery in 2 cases, and in the femoral arteriovenous fistula in 2 cases. Six cases received direct artery suture, 4 cases received autologous great saphenous vein grafting to repair the artery, 1 case received autologous great saphenous vein bypass surgery, and 1 case received artery ligation. The primary wound suture was performed in 4 cases, along with catheter lavage for 3 to 5 days, catheter drainage for 4 to 6 days, VSD treatment for 5 to 7 days, and a total drainage volume of 80 to 450 mL after the surgery. In the secondary operation, the wounds were sutured directly in 3 cases along with catheter drainage for 2 to 3 days, the wound was repaired with scalp stamp skin graft and VSD treatment for 5 days in 1 case, the wounds were repaired with adjacent translocated flaps in 2 cases with catheter drainage for 2 to 3 days, and the wounds were repaired with rectus femoris muscle flaps+adjacent translocated flaps in 2 cases with catheter drainage for 3 to 5 days . The total drainage volume after the secondary operation ranged from 150 to 400 mL. All the skin flaps/muscle flaps/skin grafts survived after operation. The wound healing time ranged from 15 to 36 days after the primary operation. Follow-up of 2 to 8 months after discharge showed that the wounds of all patients healed well. One patient who underwent femoral artery ligation had calf amputation due to foot ischemic necrosis, and the rest of the patients regained normal walking ability. The pulsatile mass disappeared in inguinal region of all patients. B-ultrasound or CTA re-examination in 6 patients showed that the blood flow of femoral artery had good patency, and there was no pseudoaneurysm recurrence. Conclusions: Early debridement, tumor resection, and individualized artery treatment should be performed in patients with femoral artery pseudoaneurysm combined with infected wounds. Besides, proper drainage and personalized repair strategy should be conducted according to the wound condition to achieve a good outcome.

Efficacy and safety of TBI+rATG-based conditioning regimen for haploidentical allogeneic hematopoietic stem cell transplantation in 11 cases of chemotherapy-resistant advanced peripheral T-cell lymphoma

Objective: To evaluate the clinical outcomes and safety of haploidentical hematopoietic stem cell transplantation (haplo-HSCT) using a conditioning regimen based on total body irradiation (TBI) and rabbit anti-human thymocyte globulin (rATG) in the management of chemotherapy-resistant advanced peripheral T-cell lymphoma (PTCL) . Methods: Clinical data of 11 patients with chemotherapy-resistant advanced PTCL who underwent haplo-HSCT with a TBI+rATG-based conditioning regimen at the Department of Hematology, Shanghai Liquan Hospital and Shanghai Zhaxin Integrated Traditional Chinese and Western Medicine Hospital, from September 2019 to December 2022 were retrospectively analyzed. Results: ①Among the 11 patients (six males and five females), with a median age of 40 years (range: 22-58 years), there were six cases of PTCL, not otherwise specified (PTCL-NOS), three cases of angioimmunoblastic T-cell lymphoma (AITL), one case of large-cell transformation of mycosis fungoides (MF-LCT), and one case of T-cell large granular lymphocytic leukemia (T-LGLL). According to the Lugano staging system, all patients were in stage Ⅲ or Ⅳ, and eight patients had B symptoms. Before transplantation, the median number of prior lines of chemotherapy was 4 (range: 2-10), and all patients had progressive disease (PD). The median time from diagnosis to transplantation was 17 months (range: 6-36 months). ②The conditioning regimen consisted of a TBI dose of 10 Gy, administered at 2 Gy on day -8 and 4 Gy from day -7 to day -6, rATG was administered at a daily dose of 2.5 mg/kg from day -5 to day -2. Etoposide (VP-16) was given at a dose of 15 mg/kg/d from day -5 to day -4, while cyclophosphamide (CTX) was administered at a dose of 50 mg/kg/d from day -3 to day -2. In patients with central nervous system involvement, etoposide and cyclophosphamide were replaced with thiotepa (TT) at a dose of 5 mg/kg/d from day -5 to day -4. Additionally, cytarabine (Ara-C) was added at a dose of 2.0 g/m(2) twice a day from day -3 to day -2 into the conditioning. ③Successful engraftment was achieved in all patients, with a median time to neutrophil engraftment of 14.5 d (range: 11-16 d) and a median time to platelet engraftment of 13 days (range: 8-18 days). Acute graft-versus-host disease (aGVHD) occurred in one patient (grade Ⅰ-Ⅱ), and another patient experienced grade Ⅲ-Ⅳ aGVHD. Among the eight survivors, four developed chronic GVHD (cGVHD). ④Post-transplantation, nine patients achieved complete response (CR). ⑤Hematopoietic suppression occurred in all patients after conditioning, with three experiencing diarrhea, four developing mucositis, three exhibiting elevated transaminase/bilirubin levels, and seven developing infectious complications. These non-hematologic adverse events were effectively managed. ⑥At one year post-transplantation, the non-relapse mortality (NRM) was (22.5±14.0) %, the cumulative incidence of relapse (CIR) was (20.2±12.7) %, and overall survival (OS) rate was (72.7±13.4) %, and disease-free survival (DFS) rate was (63.6±14.5) % . Conclusion: TBI+rATG-based conditioning regimen for haplo-HSCT is an effective and safe treatment approach for patients with chemotherapy-resistant advanced PTCL.

Clinical efficacy of belimumab in central nervous system demyelinating syndromes with systemic lupus erythematosus: A case series.

Systemic lupus erythematosus (SLE) is a complex autoimmune disease involving multiple systems. Central nervous system (CNS) demyelinating syndromes are one of the rare neurological manifestations of SLE, whose diagnosis, treatment, and prognosis are rarely reported. Belimumab, an anti-BAFF monoclonal antibody, has been approved by the FDA for the treatment of SLE. We aimed to assess the effects of belimumab on demyelinating syndromes in patients with SLE. Six patients with demyelination in SLE who were managed at Traditional Chinese and Western Medicine Hospital of Wuhan from March 2021 to March 2023, who received belimumab ≥ 5 times, were enrolled. Ten age- and sex-matched SLE patients with noutneuropsychiatric systemic lupus erythematosus (NPSLE) and normal controls were recruited to analyze potential biomarkers. All patients were diagnosed with SLE based on the 2012 Systemic Lupus International Collaborating Clinics (SLICC) SLE classification criteria or the 2019 EULAR/ACR classification criteria. All SLE patients with CNS demyelinating syndromes were diagnosed by rheumatologists, neurologists, and radiologists. These patients were administered belimumab combined with standard treatment (glucocorticoids and/or antimalarials and/or immunosuppressants [cyclophosphamide, mycophenolate, methotrexate, etc.]). Six patients were included in the study (100% female, mean [range] age at first demyelinating episode 42.8 [24-66] years). The most common extra-CNS features in these patients were rash, arthritis, alopecia, leukopenia, and hypocomplementemia. After Belimumab treatment, 3 of 6 (50%) patients achieved complete remission with decreased prednisone, 2 improvements, and 1 relapsed with uterine surgery. Compared with the baseline, 3.5 months post belimumab treatment, the disease activity score SLEDAI (21.5-5.5, P < .001), C3 and C4 increased, and extra-CNS symptoms improved rapidly. Moreover, The expression of lupus susceptibility gene PBX1 in CD19+ B cells was lowest in demyelinating syndromes with lupus patients compared with healthy volunteers and lupus patients without demyelination, and its relative expression negatively correlated with SLE disease activity. Belimumab could be an effective and safe option for the treatment of SLE demyelination. In addition, PBX1 might be a potential biomarker for the clinical diagnosis of lupus in patients with demyelinating syndrome.

Construction and validation of a nomogram for hepatocellular carcinoma patients treated by traditional Chinese medicine based on inflammation, nutrition, and blood lipid indicators.

To establish a nomogram for hepatocellular carcinoma (HCC) patients treated by traditional Chinese medicine (TCM). Clinical cases of HCC patients treated by TCM at Hunan Integrated Traditional Chinese and Western Medicine Hospital, and it was randomly divided into the training cohort (n = 222) and the validation cohort (n = 95). In the training cohort, independent risk factors were determined by Cox regression analysis and a nomogram was constructed. The efficiency and clinical applicability of nomograms were evaluated using time-dependent curves, calibration, and the decision curve (DCA), and the patients were divided into high-risk, middle-risk and low-risk groups using X-tile software. Multivariate Cox regression analysis screened 6 independent risk factors to construct a nomogram of HCC patients, including TNM stage, treatment methods, high-density lipoprotein (HDL), neutrophil-to-lymphocyte ratio (NLR), albumin-to-globulin ratio (AGR), and prognostic nutritional index (PNI). The consistency index (C-index) of the nomogram of the training was 0.811 (0.794-0.829) and the validation cohort was 0.825 (0.800-0.849). The time dependency showed the AUC values of the nomogram for 3 and 5years in training cohort were 0.894 (95% CI 0.840-0.948) and 0.952 (95% CI 0.914-0.990), and the validation cohort were 0.928 (95% CI 0.865-0.990) and 0.96 3(95% CI 0.916-1.010). The calibration plot showed the nomogram fits well onto perfect curves, and the DCA curve showed the net benefit of the nomogram at a certain probability threshold is significantly higher than the net benefit of the TNM stage at the same threshold probability. Finally, all the patients were divided into high-risk, middle-risk and low-risk groups based on the total score of nomogram, and it showed effectively how to identify to high-risk patients. The nomogram established by the independent risk factors of TNM stage, treatment methods, HDL, AGR, NLR and PNI can predict the prognosis of HCC patients treated by TCM, providing an effective tool to clinical workers to evaluate the prognosis and survival time of HCC patients.

Trends in healthcare utilisation of patients with migraine in South Korea: a retrospective observational study using Health Insurance Review and Assessment Service National Patient Sample data from 2010 to 2018

ObjectiveThis study used 2010–2018 Health Insurance Review and Assessment Service National Patient Sample data to analyse the distribution and healthcare utilisation of patients with migraine in South Korea.DesignRetrospective, observational study...

Exploring the Application Effect of Flipped Classroom Combined with Problem-Based Learning Teaching Method in Clinical Skills Teaching of Standardized Training for Resident Doctors of Traditional Chinese Medicine

Objective: To explore the application effect of flipped classroom combined with problem-based learning teaching method in clinical skills teaching of standardized training for resident doctors of traditional Chinese Medicine. Methods: The study used the experimental control method. The study lasted from September to November 2022. The subjects of this study were 49 students of standardized training for resident doctors of traditional Chinese Medicine from grades 2020, 2021 and 2022 of Dazhou integrated TCM & Western Medicine Hospital. They were randomly divided into experiment group (25) and control group (24). The experiment group adopted flipped classroom combined with problem-based learning teaching method, and the control group adopted traditional teaching method. The teaching content was 4 basic clinical skill projects, including four diagnoses of traditional Chinese Medicine, cardiopulmonary resuscitation, dressing change procedure, acupuncture and massage. The evaluation method was carried out by comparing the students’ performance and a self-designed questionnaire was used to investigate the students’ evaluation of the teaching method. Results: The test scores of total scores in the experimental group (90.12 ± 5.89) were all higher than those in the control group (81.47 ± 7.96) (t = 4.53, P P < 0.01). Conclusions: The teaching process of the flipped classroom combined with problem-based learning teaching method is conducive to improving the efficiency of classroom teaching, cultivating students’ self-learning ability, and enhancing students’ willingness to learn.

Observation on effect of differentiated teaching based on LEARNS model in patients with lumbar disc herniation

To explore the effectiveness of differentiated instruction based on The LEARNS mode in the treatment of lumbar disc herniation. 86 patients in total with lumbar disc herniation who were hospitalized in the orthopedics Department of Nanjing Integrated Traditional Chinese and Western Medicine Hospital from March 2022 to February 2023 were randomly divided into the observation group and the control group with 43 cases in each one. Patients in the control group were routinely taught with conventional syndrome differentiation, while those in the observation group adopted patient-centered LEARNS model to carry out syndrome differentiation teaching. The exercise of self-care agency (ESCA), short form health survery (SF-36) and satisfaction levels before intervention and 90 days after intervention were compared between the two groups. There were no significant differences found in ESCA, SF-36 and satisfaction before intervention between the two groups (p>0.05). Ninety days after intervention, the ESCA, SF-36 and satisfaction in the observation group were significantly higher than those in the control group (p<0.05). The differentiated teaching based on LEARNS model has good application effect on lumbar disc herniation patients, and it is an effective alternative method of traditional Chinese medicine nursing health education in clinical practice.

Correlation between Helicobacter pylori enrichment and clinical and pathological characteristics of colorectal adenoma

Objective: Aim to observe the enrichment of Helicobacter pylori (Hp) in adenoma tissue of patients with colorectal adenoma and analyze its effect on the clinical and pathological characteristics of colorectal adenoma. Methods: The data of 1 622 cases of gastroenteroscopy in the Endoscopy Center of Wenzhou Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine from January 2019 to June 2021 were collected retrospectively. The general data, gastric HP infection, clinical and pathological features, HP methyl blue special staining, HP immunohistochemical staining and toll-like receptor5(TLR5) protein immunofluorescence of colorectal adenomas were compared between the colorectal adenoma group (743 cases) and the control group (879 cases). Results: There were 743 cases in the colorectal adenoma group, aged (54.5±12.3) years, and 56.0% were male. There were 879 cases in the control group, aged (55.6±12.1), and 58.4% were male. Gastric Hp was positive in 361 cases in the colorectal adenoma group with a positive rate of 48.6% and in 331 cases in the control group with a positive rate of 37.7%. The difference was statistically significant (P<0.001). Gastric HP infection significantly increased the risk of Hp enrichment in colorectal adenomas (OR=28.590;95%CI:18.554-44.055; P<0.001). At the same time, Hp enrichment in colorectal adenomas was the promoting factor of positive events in adenoma diameter, pathological adenoma type, and adenoma malignancy (RR=0.804,3.163,3.089,2.463, P<0.001). It was also found that the expression of TLR5 protein was increased in HP-enriched adenomas. Conclusion: There is a positive correlation between gastric HP infection and intestinal HP enrichment. The effect of intestinal HP enrichment on the clinical and pathological characteristics of colorectal adenoma is statistically significant, and its tumor-promoting effect may be related to the upregulation of mucosal TLR5 protein.

Efficacy of CT-guided percutaneous stylomastoid foramen puncture through the mandibular angle approach and radiofrequency ablation of facial nerve for the treatment of hemifacial spasm

Objective: To investigate the efficacy of CT-guided percutaneous mandibular angle radiofrequency thermocoagulation (RFT) of facial nerve through stylomastoid foramen for the treatment of hemifacial spasm. Methods: A total of 82 patients with primary facial spasm who underwent CT-guided RFT in the Department of Pain Medicine of Zhejiang Integrated Traditional Chinese and Western Medicine Hospital and Department of Pain Medicine of the First Hospital of Jiaxing from January 2019 to June 2021 were retrospectively analyzed, including 27 males and 55 females, aged 24-85 (59±11) years. All patients were divided into three groups according to the different puncture approaches: anterior mastoid approach group (Group A, n=35), posterior mastoid approach group (Group P, n=25) and mandibular angle approach group (Group M, n=22). The puncture time, the minimum stimulating current inducing the twitch of facial muscles on the affected side, the temperature at the end of RFT and the duration of RFT at this temperature, the total treatment time, as well as the degree of facial paralysis and complications 1 day after operation were compared among the three groups. Results: The puncture time of the Group A, Group P and Group M was (31.0±4.9) min, (31.9±6.5) min and (35.3±5.9) min, respectively, and the difference was statistically significant (P=0.020). The puncture time of the Group M was longer than that of the Group A and P (both P<0.05). The minimum stimulation current inducing the twitch of the affected facial muscle in the three groups was (0.5±0.2) mA, (0.4±0.1) mA and (0.3±0.1) mA, respectively, with a statistically significant difference (P=0.000). The minimum stimulation current in the Group M was less than that in the Group A and P (both P<0.05). The temperature at the end of RFT of the three groups was (78.6±8.1) ℃, (76.6±8.3) ℃ and (67.0±8.4) ℃, respectively, and the difference was statistically significant (P<0.001). The temperature of the Group M was lower than that of the Group A and P (both P<0.05). There were no significant differences among the three groups in the duration of RFT at the final temperature, the total treatment time, and the degree of facial paralysis 1 day after operation (all P>0.05). No hematoma, infection, hearing impairment and other complications occurred in all patients. Conclusion: CT-guided percutaneous RFT through stylomastoid foramen is efficacious in the treatment of hemifacial spasm, and the mandibular angle approach provides better performance.