To investigate the correlation of the concentrations of valproic acid (VPA) and 2-propyl-4-pentenoic acid (4-ene-VPA) with their adverse reactions, and to guide the clinical safety and rational use of VPA. Methods: We collected 254 epilepsy outpatients who took long-term use of sodium valproate oral solution single or combined with other antiepileptic drugs from Xiangya Hospital. The plasma concentrations of VPA and 4-ene-VPA in patients were determined by gas chromatography-mass spectrometry (GC-MS). The double variable correlation analysis was performed to analyze the effect of plasma 4-ene-VPA and VPA concentrations on adverse reactions. Results: The correlations between the PLT level and the dosage of VPA (P0.05), and the levels of ALT also did not show positive correlation with the concentrations of 4-ene-VPA and VPA (r=-0.064, r=-0.089, all P>0.05). Conclusion: VPA may affect blood routine indexes. Age and combination therapy with the non-enzyme-induced anti-epileptic drugs are risk factors for VPA-related liver dysfunctions and renal impairment. The determination of VPA and 4-ene VPA is not a suitable tool for early warning of the VPA-induced liver dysfunction.
POEMS syndrome is a rare paraneoplastic disorder. A 60-year-old female patient was admitted to the Department of Gastroenterology, Xiangya Hospital of Central South University (Changsha, China), complaining of abdominal distension, severe edema of both lower limbs and shortness of breath for more than 1 year. After intensive and careful medical investigations, the patient manifested with polyneuropathy, M-proteinemia, splenomegaly, lymphadenopathy, hypothyroidism, extravascular volume overload, sclerotic bone lesions, elevated VEGF and pulmonary hypertension. According to the latest diagnostic criteria of POEMS syndrome, this patient met two mandatory major criteria, two other major criteria and three minor criteria, the diagnosis was clear after ruling out differential diagnosis. The patient was treated with dexamethasone and lenalidomide, which relieved her clinical symptoms. The pathogenesis of POEMS syndrome is not fully understood; however, increased levels of vascular endothelial growth factor may contribute to most of the clinical manifestations. This patient had been in physical discomfort for more than 14 months, which seriously affected her quality of life. Clinically, the awareness of early diagnosis and treatment of POEMS syndrome should be improved.
To explore whether transumbilical endoscopic surgery (TUES) can effectively and safely elucidate the causes of ascites of unknown origin. Methods: A total of 23 consecutive patients with ascites of unknown origin who undertook TUES procedures in the Department of Gastroenterology of The Third Xiangya Hospital of Central South University between January 2014 and January 2016 were retrospectively investigated. Clinical manifestations, laboratory examinations and findings from radiological examinations and endoscopic investigations were noted before the procedure. Conditions of the abdominal cavity under endoscope, final diagnosis and outcome of patients were carefully recorded. Results: TUES procedure was successfully performed in all 23 patients with an operation time of (58.2±13.9) min. Twenty-two patients were undertaken biopsy on the nodules or masses that found in the abdominal cavity. Definite diagnoses were established in the overwhelming majority of patients (22/23). The most common causes of ascites for the 23 cases was tuberculosis (8 cases), followed by peritoneal carcinomatosis (6 cases), and pseudomyxoma peritonei (5 cases). Operation-related complications, such as postoperative bleeding, perforation, peritonitis, intraabdominal chronic abscesses, were not observed, except one case showed a transient moderate fever in 24 hours after operation. No mortality related to TUES occurred. We concluded that TUES was a feasible, economic and minimally invasive approach to access the peritoneal cavity. Conclusion: TUES combinated with biopsy can effectively elucidate the causes of ascites of unknown origin.
To explore the relationship between cancer awareness and the survival of the patients with non-small cell lung carcinoma (NSCLC). Methods: A total of 865 NSCLC patients were screened for the risk factors, including age, gender, address, tumor/lymph nodes/metastasis (TNM) stage, and cancer awareness. Survival of the patients was calculated by Kaplan-Meier method and Cox regression analysis. Results: After an average observation time of 304 d (ranging from 0 to 4 718 d), 62 of the 394 patients in the cancer awareness group survived, whereas 26 of the 471 patients in the cancer concealment group survived. Cancer-specific and all-cause survival was poorer in the cancer concealment group (P<0.001 for each, log-rank test). Cox multivariate regression analysis showed that cancer concealment displayed significantly lower cancer-specific survival [hazard ratio (HR)=1.534, 95% confidence interval (CI) 1.320 to 1.784, P<0.001] and all-cause survival (HR=1.558, 95% CI 1.346 to 1.803, P<0.001). Conclusion: Cancer concealment is associated with a poor survival of NSCLC patients, which may prohibit the patients from obtaining the real "right to survival".
To discuss clinical practice, efficacy and surgical techniques for ear reconstruction with Medpor. Methods: Medpor ear reconstructions were used to treat 19 microtia in 17 patients (including 2 bilateral patients) in Xiangya Hospital, Central South University from January 2011 to December 2015. Reconstructions included 2 patients with one-stage ear reconstruction with temporoparietal fascial flap, 2 patients with one-stage operation implanting Medpor directly into skin pocket, and 13 patients with two-stage ear reconstruction. Results: After 1-3 years of follow-up, 16 microtia in 14 patients gained ideal appearance. Scaffold exposure occurred in 3 unilateral cases, among which one patient who underwent debridement, removal of superficial exposed scaffold and transposition of local flap to salvage exposure was not significantly influenced, and the other 2 patients' scaffolds were still exposed after repairs and finally removed. One stent was removed at the patient's urging because it induced an exacerbation of periarthritis of the right shoulder. Conclusion: Medpor ear scaffold has advantages, such as easy assembly, good immunologic compatibility, fast vascular ingrowth, simple operation, short operative time and ideal appearance of the reconstructed ear. Medpor is an alternative for microtia repair when patients are unwilling to use autologous rib cartilage or costal cartilages are calcified. However, the relatively high incidence of scaffold exposure reminds us that the indications of Medpor should be taken seriously, and measures to avoid skin necrosis and scaffold exposure should be implemented. Long-term follow-up efficacy needs to be proved.
Lung-protective ventilation (such as low tidal volume and application of positive end-expiratory pressure) is beneficial for patients with acute lung injury or acute respiratory distress syndrome (ARDS) and has become the standard treatment in intensive care unit (ICU). However, some experts now question whether the protective ventilation strategy for ARDS patients in the ICU is equally beneficial for patients after surgery, especially for most patients without any pre-existing lung lesions. This review will discuss preoperative, intraoperative, and postoperative lung protection strategies to reduce the risk of complications associated with anesthesia.
This article reviews the indications, contraindications, functionality, and complications for various percutaneous devices that can be used to support the left ventricular failure. We also reviews the anesthetic effect for these devices. A literature review was performed using PubMed. When the heart experiences end-stage systolic ventricular failure, it is generally unable to restore its practical function with pharmacological therapy alone. Percutaneous ventricular support devices have been introduced and used successfully to support a failing ventricle in a variety of settings. These devices include intra-aortic balloon pump, TandemHeart, and Impeller, as well as veno-arterial extracorporeal membrane oxygenation for left ventricular support. These devices are typically accessed percutaneously through the femoral vessels and/or the jugular vein(s), although other sites are possible in unique cases.
Liver cancer is the second leading cause of cancer-related death worldwide, so early detection and prediction for response to treatment is of great benefit to hepatocellular carcinoma (HCC) patients. Currently, needle biopsy and conventional medical imaging play a significant and basic role in HCC patients' management, while those two approaches are limited in sample error and observer-dependence. Radiomics can make up for this deficiency because it is an emerging non-invasive technic that is capable of getting comprehensive information relevant to tumor situation across spatial-temporal limitation. The basic procedure for radiomics includes image acquisition, region of interest segmentation and reconstruction, feature extraction, selection and classification, and model building and performance evaluation. The current advances and potential prospect of radiomics in HCC studies are involved in diagnosis, prediction for response to treatment, prognosis evaluation and radiogenomics.
The article entitled "Differential expression of exosomal miRNAs in osteoblasts in osteoarthritis" published on Journal of Central South University (Medical Science), in Volume 43, Issue 12, 2018 (DOI: 10.11817/j.issn.1672-7347.2018.12.003) may have an unclear risk of bias due to insufficient understanding for some results. Further experimental studies are needed. We all agree to retract this article, and apologize to the Journal and readers for the possible negative impact.