ObjectiveTo explore the surgical technique and preliminary safety and aesthetics results of immediate prepectoral implant-based breast reconstruction (BR) with titanium-coated polypropylene mesh (TiLoop Bra) after skin-sparing mastectomy (SSM) or nipple-areola-complex-sparing mastectomy (NSM) for breast cancer patients. MethodsThe clinical data of consecutive patients who underwent immediate prepectoral implant-based BR with TiLoop Bra after SSM or NSM in West China Hospital from January to July 2022 were retrospectively analyzed. The operation time, intraoperative blood loss, early complication were collected. The preliminary aesthetics results were assessed with the Ueda score and Harris score. Results All the patients were female with a mean age of 39.0±6.8 years. One patient had bilateral breast malignant tumors, and the others had unilateral malignant tumors. Six patients received neoadjuvant chemotherapy before surgery. The mean diameter of the tumors was 24.4±11.9 mm under the color ultrasound before the neoadjuvant chemotherapy. The mean operation time was 153.9±49.4 min. The mean intraoperative blood loss was 29.2±18.3 mL. There were 3 patients with tumor stage 0, 10 patients with stage Ⅰ, 6 patients with stage Ⅱ, 3 patients with stage Ⅲ and 1 patient was found no residual cancer after neoadjuvant chemotherapy. All the patients were successfully followed up with a median follow-up time of 4.8 (3.0-9.2) months. There were 2 (8.3%) patients with major complications, including 1 wound dehiscence and 1 hematoma, and 4 (16.7%) minor complications, including 2 wound dehiscence and 2 infection. The patients with excellent and good Ueda score and Harris score accounted for 82.6% and 87.0%, respectively. None of the patients had animation deformity, capsular contracture, nipple-areola or skin flaps necrosis, or implant loss. During the follow-up period, no local/regional recurrence or distant metastasis was found. Conclusion For selected reliable patients, immediate prepectoral implant-based BR with TiLoop Bra after SSM or NSM for breast cancer patients is safe and has good aesthetics results in the early postoperative period. It has broad application space in patients with suitable indications, and can be promoted as a routine operation.
目的 分析主動脈夾層的臨床及病理特點。 方法 回顧性分析1998年1月－2011年10月26例主動脈夾層致死的臨床及法醫尸檢病理資料，對其發病、死亡經過、診斷、死因進行總結。 結果 26例主動脈夾層平均發病年齡為39.2歲，男女比例為3.3︰1；26例中6例無臨床診斷，17例誤診，3例疑似診斷。26例主動脈夾層中，夾層破裂致心包填塞死亡20例，夾層破裂致失血性休克死亡5例，主動脈夾層未破裂1例系心衰致死；26例按DeBakey分類標準9例為Ⅰ型，14例為Ⅱ型，3例為Ⅲ型。 結論 臨床應警惕主動脈夾層的特殊臨床表現并采取必要的輔助檢查，有助于主動脈夾層的診治和減少醫療糾紛的發生。
ObjectiveTo observe the efficacy and safety of lacosamide (LCM) as a monotherapy or as an add-on in the treatment of focal epilepsy in children aged 4 months to 4 years. MethodsThe study included 20 children with focal epilepsy who received oral LCM monotherapy or add-on therapy in Children's Hospital Affiliated to Soochow University from March 2022 to September 2022, including 9 males and 11 females with an average age of (22.4±13.0) months. The curative effects and adverse reactions at 1, 2, 3, 4, and 6 months after LCM treatment were analyzed. The initial dose of LCM was 2 mg/(kg·d) and increased by 2 mg/(kg·d) every week, maintenance dose 6 ~ 12mg/(kg·d). Results During the follow-up period of this study, the total effective cases were 17 (85.00%), and the number of control-free cases was 15 (75.00%). Conclusion LCM can effectively reduce the frequency of epileptic seizures in the monotherapy or add-on treatment of infants and young children with focal epilepsy, with few adverse reactions and high retention rate, which has high clinical application value.
目的 分析骨科醫療糾紛的原因及特點，為醫療糾紛的防范提供參考。 方法 收集2010年1月－2011年12月四川華西法醫學鑒定中心涉及四川省各級醫療機構的骨科醫療糾紛鑒定案例55例，進行回顧性分析。 結果 55例骨科醫療糾紛中2010年25例，2011年30例；醫源性醫療糾紛41例（74.5%），非醫源性醫療糾紛14例（25.5%）。醫源性醫療糾紛中醫療機構存在的問題主要以手術操作不當及失誤為主（15例，占27.3%），其次為醫患溝通不到位（8例，占14.5%）。 結論 骨科醫療糾紛防范的關鍵在于醫務人員認真履行其診療義務。
ObjectiveTo observe the clinical efficacy and safety of Lacosamide (LCM) monotherapy in treating Benign epilepsy with centro-temporal spikes (BECT) at children. MethodsThe present research included 57 children with BECT who were treated with LCM monotherapy in the Children's Hospital Affiliated to Soochow University from June 2020 to June 2021. Among them, 26 were males and 31 were females, with an average age of (7.5±2.3) years. Analyze the efficacy and adverse reactions of 1, 2, 4, 6, 9 and 12 months after LCM treatment. The starting dose of LCM was 2 mg/(kg·d); increased 2 mg/(kg·d) every seven days; and titrated up to 4 ~ 8 mg/(kg·d) in children with weight ≥30 kg and <50 kg; titrated up to 6 ~ 12 mg/(kg·d) in children with weight ≥11 kg and <30 kg.ResultThe total effective rate was 94.12%; the cumulative control rate after 12-month medication was 86.27%; and the retention rate was 89.47%. Those all showed a higher rate. ConclusionLCM is significantly effective to BECT with less adverse reactions and more safety. It has high clinical application value.
【摘要】 目的 從法醫病理學角度分析引起醫療糾紛的孕產婦死亡原因、醫療糾紛發生原因并提出相關防范措施。 方法 對1999年1月-2008年12月間46例引起醫療糾紛的孕產婦死亡案例進行回顧性分析。 結果 孕產婦死亡年齡以30歲以上多見，死亡時妊娠時間以圍產期居多（87.0%）。死亡原因中產科失血性休克死亡21例（45.7%），栓塞類疾病死亡8例（17.4%），感染性疾病死亡5例（10.8%），其他原因死亡12例（26.1%）。46例中屬非醫療過失性醫療糾紛8例（17.4%），醫療過失性糾紛38例（82.6%），醫療過失的原因主要為搶救不及時、處理不當、誤診誤治等。涉及糾紛的醫院以縣區級醫院居多（54.3%）。 結論 通過法醫病理學司法鑒定查明死亡原因，明確醫療責任及醫療糾紛原因，已成為解決孕產婦死亡醫療糾紛的重要手段。【Abstract】 Objective To analyze the causes of maternal death with medical disputes, the causes of medical disputes, and to recommend the related preventions through a forensic pathological angle. Methods We retrospectively analyzed 46 cases of maternal death with medical disputes which were collected by West China Center of Forensic Medicine Service in Sichuan between January 1999 and December 2008. Results Most maternal deaths occurred over 30 years old. They most frequently happened during the peri-natal period (87.0%). The causes of death included obstetric hemorrhagic shock in 21 cases (45.7%), embolism-like diseases in 8 cases (17.4%), infectious diseases in 5 cases (10.8%) and other reasons in 12 cases (26.1%). Among all the 46 cases of medical disputes, 8 (17.4%) were not due to medical malpractices, while the other 38 cases (82.6%) had something to do with such medical malpractices as delayed or inappropriate treatment, misdiagnosis and so on. Most of the malpractices in these cases involved medical institutions at a county level (54.3%). Conclusion Forensic judicatory appraisal is important to resolve medical disputes of maternal death by finding out the cause of death, clarifying the medical responsibility and clearing the cause of medical disputes.
ObjectiveTo compare the satisfaction and safety of patients undergoing prepectoral breast reconstruction (PBR) versus subpectoral dual-plane breast reconstruction (SBR) with implants combined with mesh after open total mastectomy for breast cancer. MethodsA prospective cohort study on clinical data of breast cancer patients who underwent open total mastectomy and received either PBR or SBR with implants and mesh for immediate breast reconstruction from June 2021 to October 2022 at West China Hospital of Sichuan University were performed. The pain scores on postoperative days 1, 3, 7, and 14, the postoperative use of analgesics within 14 days, and the incidence of postoperative complications, breast satisfaction, and quality of life during follow-up periods were compared between the two groups. ResultsA total of 62 female patients were included, with 35 in the PBR group, having an average age of (39.6±6.5) years, and 27 in the SBR group, having an average age of (41.5±9.9) years. The pain scores of the SBR group on postoperative days 3 (P=0.032), 7 (P＜0.001), and 14 (P＜0.001) were significantly higher than those of the PBR group, and a higher proportion of patients in the SBR group used analgesics within postopeartive 14 days (P=0.001). The median follow-up time was 28.4 months for the PBR group and 34.9 months for the SBR group. There was no statistical difference in the overall (P=0.583), major (P=0.526), or minor (P=0.532) complication rates between the two groups during follow-up. One (2.9%) patient in the PBR group and 2 (7.4%) patients in the SBR group lost their implants (P=0.575). There were 4 patients of movement deformities and 4 patients of chest muscle pain in the SBR group, whereas no patients in the PBR group had these complications (P=0.031). Encapsular contracture occurred in 5 (14.3%) patients in the PBR group and 11 (40.7%) patients in the SBR group (P=0.023). The incidences of ripple sign (25.7% vs. 3.7%, P=0.047) and implant contour visibility (40.0% vs. 11.1%, P=0.020) were significantly higher in the PBR group than those in the SBR group. At 24 months post-surgery, breast satisfaction scores [(67.9±13.1) points vs. (52.6±16.9) points, P=0.025] and chest function satisfaction [(70.7±13.4) points vs. (58.7±14.3) points, P=0.035] were higher in the PBR group. No local recurrence, distant metastasis, or deaths occurred in the PBR group during the follow-up period, while 1 patient of local recurrence and distant metastasis occurred in the SBR group, with no deaths. ConclusionCompared to SBR, PBR is more in line with the physiological and anatomical levels of the breast, effectively avoiding postoperative movement deformities and chest muscle pain, with a lower incidence of capsular contracture, and higher postoperative breast satisfaction and chest function satisfaction. It is a safe and feasible reconstruction method. For some specific patients, especially those with higher physical activity demands, it is a better reconstruction choice.
目的 分析心臟手術相關醫療糾紛的臨床及法醫學特點，并就發生原因進行剖析及提出相應防范措施。 方法 對2002年1月－2011年12月四川華西法醫學鑒定中心受理的四川省各級醫療機構發生的17例與心臟手術相關的醫療糾紛法醫學鑒定資料進行回顧性分析。 結果 17例心臟手術相關醫療糾紛中，12例進行了尸體解剖死因鑒定，死亡原因有心臟傳導系統出血，術后感染，低心排量綜合癥、肺動脈高壓、失血性休克致死等。其余5例加上尸體解剖2例在內共7例進行了醫療過錯鑒定，存在的醫療過錯包括術前檢查不完善，告知不充分，手術操作不細致，術后觀察、處理不足，醫療記錄不完整等。 結論 心臟手術相關醫療糾紛與術后并發癥關系密切，醫護人員應重視對心臟術后并發癥的防治。尸體解剖對解決心臟術后死亡引起的醫療糾紛具有重要意義。
ObjectiveIn order to evaluate the efficacy, safety and tolerability of adjunctive perampanel in children with refractory epilepsy. MethodsThis study collected medical records of 34 children with refractory epilepsy, who were admitted to Children’s Hospital of Soochow University from January 2020 to January 2021. By comparing the baseline status with the status at 4, 8, 12, 24, 36, and 48 weeks of follow-up, the efficacy and adverse reactions of perampanel were evaluated. ResultsThe mean age of the patients treated with perampanel was 8.1±4.1 years. The male-to-female ratio was 1: 1. After the addition of perampanel, the average responder rate at the 4th, 8th, 12th, 24th, 36th, 48th weeks were 37.5%, 46.7%, 50.0%, 47.4%, 53.8%, 42.9%. The adverse events were reported by 32.4%, and the retention rate was 88.2%. ConclusionsPerampanel has good efficacy, safety and tolerability in the treatment of refractory epilepsy. Moreover, personalized treatment and better baseline seizure control may increase the effectiveness and retention rate of perampanel.
目的 觀察可調節負壓引流技術聯合局部氧療治療腹部切口感染創面的臨床效果。 方法 對2009年5月－2012年9月28例腹部切口感染創面患者使用可調節負壓引流技術聯合局部氧療治療，創口內填入負壓吸附墊，持續輸氧0.5～1 L/min，可調節負壓采用連續工作模式，使密閉創面保持60～120 mm Hg（1 mm Hg=0.133 kPa）的負壓狀態，3～7 d更換負壓吸附墊和引流管。 結果 28例切口創面感染得到控制。8例經一次治療創面愈合，15例經2～4次治療創面愈合，2例行Ⅱ期縫合，3例患者對貼膜過敏，治療一次后改為換藥治療。28例患者創面愈合時間4～28 d，平均14 d，隨訪1～18個月無切口裂開，7例有凹陷瘢痕，余瘢痕平整。 結論 可調節負壓引流技術聯合局部氧療治療腹部切口感染創面，具有操作簡便、安全可靠、療效明顯的優點，可加快創面愈合，縮短住院時間，提高切口的愈合質量，減輕患者痛苦及醫務人員的工作量。