Medicine
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Myasthenia gravis (MG) is an autoimmune disease caused by the transmission of dysfunction in the neuromuscular junction, manifesting partial or systemic skeletal muscle weakness and fatigue, which are exacerbated by activities and relieved after rest. Currently, the conventional therapy is applying cholinesterase inhibitors, steroids, immunosuppressant, and thymectomy. However, these drugs have obvious side effects. According to traditional Chinese medicine (TCM) theory, Buzhong Yiqi decoction (BYD) is a Qi-supplementing formula which is suitable for MG management as MG is generally diagnosed as "flaccidity syndrome" and considered caused by Qi-deficiency. An increasing number of clinical controlled studies also have found that BYD could improve the efficacy and reduced adverse effects in treating MG, but there is no systematic review of it. Therefore, we will use meta-analysis to evaluate the efficacy and safety of BYD for MG. ⋯ PROSPERO CRD42018095241.
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Few studies on gastric tube interposition for esophageal reconstruction in children have assessed the long-term outcomes and quality of life (QoL). The aim of this study is to evaluate the long-term outcomes and QoL after a gastric tube interposition by reviewing our experiences with esophageal reconstruction. Twenty-six patients were included who underwent gastric tube interposition from 1996 to 2011 at our institution. ⋯ QoL was similar to the general population and did not differ between age groups. Gastric tube interposition could be considered for esophageal reconstruction in pediatric patients when native esophageal anastomosis is impossible. Nutritional evaluation and support with consecutive radiological evaluation to assess the anastomosis site stricture are advised.
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The aim of this systematic review is to investigate the effects of perioperative intravenous administration of MgSO4 on postoperative pain, analgesic consumption and adverse effects in patients undergoing orthopedic surgery. ⋯ Perioperative intravenous administration of MgSO4 in orthopedic surgery could reduce postoperative analgesic consumption and adverse effects such as vomiting, nausea, and shivering. These trials do not provide convincing evidence of beneficial effects on postoperative pain intensity and the time to first analgesic request. More trials should be conducted for the roles of MgSO4 in pain management for orthopedic surgery. However, intravenous MgSO4 administration should be considered as a strategy to relieve postoperative pain in orthopedic surgery patients.
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Case Reports
Acute renal failure in a patient with PR3-ANCA and monoclonal immunoglobulin deposition disease: Case report.
Acute renal failure developing over a short period of time with evidence of glomerular disease by urine sediment microscopy characterizes the clinical syndrome of rapidly progressive glomerulonephritis (RPGN), of which the most common causes are ANCA-associated glomerulonephritis (GN), immune-complex mediated GN and anti-GBM disease. ⋯ To our knowledge, the simultaneous occurrence of MIDD, PR3-ANCA and mesangial IgA has not been reported. This case highlights not only the diagnostic but also the therapeutic challenges that such a complex case presentation poses to clinicians, where the culprit may not always be what would seem most obvious (such as ANCA in a patient with RPGN) but may, in fact, be an underlying and unsuspected disease, or possibly a combination of both.
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Endoscopic submucosal dissection (ESD) is a primary treatment for the early gastric cancer (EGC) who have a negligible risk of lymph node metastasis satisfying specific criteria. These criteria are histologically categorized by EGC with differentiated-type histology (EGC-DH) and undifferentiated-type histology (EGC-UH). However, gastric cancer is histologically heterogenous and there has been no specific criteria for EGC with mixed-type histology (EGC-MH). Moreover, therapeutic outcomes of ESD for EGC-MH have not been clearly described. ⋯ This study will provide evidence of ESD for EGC-MH.