ObjectiveTo explore the role of ssomatosensory evoked potential (SEP) in evaluating and predicting the lower limb motor function of patients with acute cerebral infarction.Methods19 patients (13 male, 6 female) with acute cerebral infarction diagnosed according to the standard of Chinese Classifications of the Cerebral Vascular Disease were chosen as the case group and 18 patients (11 male, 7 female) with non-nerve system injury were taken as the control group. All patients of two groups were received SEP test within 7 days after onset and latency and amplitude values of SEP of two groups were compared. To the case group, SEP was tested again at 30th day after admission, the Fugl-Meyer assessment (FMA) was also carried out at same times of two SEP tests, and the correlation of SEP and FMA scores was analyzed.ResultsThe difference of latency and amplitude value of SEP test between the case group and control group was significantly (P<0.01). The latency value of SEP in lower limb was correlated with FMA scores (P<0.01). But the amplitude value was no difference between the onset and 30th day after admission in the case group.ConclusionSEP is sensitive in the acute stage of stroke. SEP has significant value for predicting the prognosis of patients with acute cerebral infarction and correlates with the clinical FMA scores. The value of amplitude is not sensitive.

Objective： The current study was designed to investigate the diagnosis and the treatment of osteoradionecrosis of the skull base (ORN) in the patients with nasopharyngeal carcinoma (NPC) after radiotherapy. Methods： All patients (n=12) diagnosed as nasopharyneal carcinoma and osteoradionecrosis of the skull base were studied retrospectively with their clinical manifestations, diagnoses, therapies and prognoses. Results： ORN was found with characteristic CT and endoscopic findings, they were never seen in the patients with NPC relapse. The latent periods of ORN in the patients after primary radiotherapy were 3 - 15 years, while the periods were 7 months - 2 years in the patients after reirradiation. Six patients with local ORN were operated, 1 patients was died of exhaustion; Six patients with extensive ORN were treated using conservative methods, 3 patients were died of severe nasopharyngeal bleeding, while one were died of exhaustion. Conclusion： The ORN of the skull base after radiotherapy could be diagnosed by CT and endoscopic findings. The patients with extensive ORN or radiation induced cranial neuropathy were associated with poor prognosis. The most common causes of death were severe nasopharyngeal bleeding and exhaustion.

OBJECTIVETo summarize the experience with surgical treatment of coronary artery disease with severe ischemic mitral valve regurgitation (IMR).

METHODSFrom January 2006 to December 2009, 45 patients (35 males, 10 females aged 32-74 years) with the diagnosis of coronary artery disease complicated by IMR underwent coronary artery bypass grafting (CABG) combined with mitral valve plasty (MVP, 24 cases) or mitral valve replacement (MVR, 21 cases).

RESULTSPerioperative deaths occurred in 2 cases due to multiple organ failure (MOF). Echocardiography showed a significant reduction of the mitral regurgitation area (from 11.80∓2.45 cm(2) to 2.83∓0.98 cm(2), t=22.80, P=0.00) after CABG combined with mitral valve surgery, with also significantly reduced postoperative left ventricular end diastolic diameter (LVEDD) (from 57.61∓10.06 mm to 51.84∓8.98 mm, t=2.85, P=0.005). No significant difference was detected in the left ventricular ejection fraction after the operation [(52.7∓15.4)% vs (53.2∓13.2)%, t=0.16, P=0.87)].

CONCLUSIONSCABG combined with mitral valve surgery can improve early postoperative left ventricular function in patients with ischemic coronary heart disease complicated by severe mitral regurgitation, but further follow-up study is still needed for evaluation of the long-term results.

Adult ; Aged ; Coronary Artery Bypass ; Coronary Disease ; complications ; surgery ; Female ; Humans ; Male ; Middle Aged ; Mitral Valve Insufficiency ; complications ; surgery ; Myocardial Ischemia ; complications ; surgery ; Treatment Outcome

OBJECTIVETo analyze the changes in the cardiac function after St. Jude Regent mechanical valve replacement and assess the prosthesis-patient matching.

METHODSFrom October 2007 to March 2009, 44 patients received implantation of 17 mm St. Jude aortic prostheses in our hospital. The patients were followed up for clinical symptoms, signs, electrocardiogram (ECG), echocardiogram and cardiac functions, and the results were compared with those of randomly selected 44 patients receiving 21 mm St. Jude aortic prostheses.

RESULTSIn 17 mm St Jude Medica Regent valve group, 8 patients presented with ECG ST segment changes, 3 complained of chest tightness, 3 had occasional chest pain and discomfort, and 8 had grade II and 4 grade III cardiac function. In 21 mm St Jude Medical Regent valve group, 6 patients had ECG ST segment changes, 2 complained of chest tightness, 2 reported occasional chest pain and discomfort, 11 had grade II and 2 grade III cardiac function. No significant differences were found in these indices between the two groups (P=0.32). Compared with those before operation, the two groups showed significant improvements in the left ventricular end-diastolic diameter, left ventricular posterior wall thickness, left ventricular mass index, and aortic pressure gradient (P<0.05). A significant increase in the left ventricular ejection fraction occurred 6-12 months after operation, but without statistical difference between the two groups (P>0.05).

CONCLUSIONFor underweight patients (<60 kg) and those with small body surface area (<1.6 cm(2)), 17 mm St. Jude Medical Regent valve prosthesis may produce good therapeutic effect, and some indices are even close to those after placement of 21 mm St. Jude Medical Regent valve prosthesis. No obvious prosthesis-patient mismatch occurs after the placement of the 17 mm valve prosthesis and aortic valve ring expansion is not necessary.

Adolescent ; Adult ; Aortic Valve ; diagnostic imaging ; surgery ; Aortic Valve Stenosis ; diagnostic imaging ; surgery ; Child ; Child, Preschool ; China ; epidemiology ; Female ; Follow-Up Studies ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation ; adverse effects ; methods ; Humans ; Male ; Middle Aged ; Postoperative Complications ; epidemiology ; Treatment Outcome ; Ultrasonography ; Young Adult

BACKGROUND: Surgical site infection is the main complication after posterior lumbar surgery, which not only increases the patient's hospitalization time, financial burden and physical pain, but also increases the difficulty for the clinical medical staff, delays the recovery of postoperative patients, even leads to deaths. Therefore, it is important to analyze the factors related to the infection of the surgical site after posterior lumbar surgery. OBJECTIVE: To analyze the risk factors of the surgical site infection after lumbar posterior approach in China. METHODS: Studies about the surgical site infection after lumbar posterior approach were retrieved by computer. The quality of the studies was evaluated by reading the full text. Heterogeneity was analyzed using RevMan 5.3 software. Meta analysis was used to analyze the combined effect. RESULTS AND CONCLUSION: (1) Totally 20 studies with 423 cases of surgical site infection and 13 995 cases of non-infection were included. (2)Meta-analysis univariate analysis results:body mass index ≥ 27 kg/m2[OR=3.82,95%CI(2.47,5.91),P<0.000 01],age ≥ 60 years [OR=1.99,95%CI(1.44,2.76),P<0.000 1],intraoperative blood loss ≥ 300 mL[OR=3.98,95%CI(2.50,6.33),P<0.000 01],subcutaneous fat thickness[MD=5.35,95%CI(3.58,7.12),P<0.000 01],number of segments ≥ 3[OR=3.83,95%CI(2.02,7.26),P<0.000 1],operation time ≥180 minutes[OR=2.96,95%CI(2.06,4.27),P<0.000 01],preoperative serum protein<35 g/L[OR=2.37,95%CI(1.63,3.46),P<0.000 01],and diabetes[OR=2.88,95%CI(2.22,3.74),P<0.000 01]were risk factors for surgical site infection after lumbar posterior approach.(3)Multivariate analysis results:body mass index ≥ 27 kg/m2[OR=3.21,95%CI(1.97,5.22),P<0.000 01],subcutaneous fat thickness[MD=5.35,95%CI(3.58, 7.12),P<0.000 01],preoperative serum protein<35 g/L[OR=3.73,95%CI(2.30,6.04),P<0.000 01],and diabetes[OR=3.35,95%CI(1.75,6.42), P=0.003]were independent risk factors for surgical site infection after lumbar posterior surgery.(4)Results showed that body mass index ≥27 kg/m2, subcutaneous fat thickness, preoperative serum protein < 35 g/L, and diabetes are independent risk factors for surgical site infection after lumbar posterior approach in China. Due to the number of cases of surgical site infection and its methodological quality during the study, the above conclusions still need to be confirmed by more large-scale, high-quality studies to provide reliable evidence for perioperative management.

PURPOSE: The purpose of this study was to investigate the survival trends and patterns of failure in patients with stage II nasopharyngeal carcinoma (NPC) treated with radiotherapy (RT) and chemotherapy over the last 20 years. MATERIALS AND METHODS: Thirty-eight hundred and eight patients diagnosed with stage II NPC between January 1990 and December 2012 were involved in this retrospective cohort study. All patients were treated with RT. According to the main imaging techniques and RT technology, we categorized these patients into four calendar periods: 1990-1996, 1997-2002, 2003-2007, and 2008-2012. Overall survival (OS), progression-free survival (PFS), locoregional relapse-free survival (LRFS), and distant metastasis–free survival (DMFS) were served as the clinical outcome. RESULTS: After a median follow-up period of 84.7 months, we observed increasing trends in survival and disease control. The 3- and 5-year OS rates increased from 87.1% and 78.7% in the first calendar period to 97.4% and 94.5% in the last calendar period, respectively (p<0.001). Additionally, significant increasing trends could be seen in the PFS and LRFS during the four calendar periods. In the subgroup analysis, the LRFS in patients older than 50 years at diagnosis showed greater improvement than younger patients. However, the rate of distant metastasis was stable and relatively low, as the 5-year DMFS ranged from 90.5% to 94.7% among the four calendar periods. CONCLUSION: The survival rates in patients with stage II NPC showed increasing trends from 1990 to 2012. The advance of RT provided excellent locoregional control and enhanced OS.
Cohort Studies ; Diagnosis ; Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Prognosis ; Radiotherapy ; Retrospective Studies ; Survival Rate

PURPOSE: The measuring Epstein-Barr virus (EBV) DNA is an important predictor of nasopharyngeal carcinoma (NPC). This study evaluated the predictive value of pretreatment serum amyloid A (SAA) and C-reactive protein (CRP) comparing with EBV DNA in patients with NPC. MATERIALS AND METHODS: In an observational study of 419 non-metastatic NPC patients, we prospectively evaluated the prognostic effects of pretreatment SAA, CRP, and EBV DNA on survival. The primary end-point was progress-free survival (PFS). RESULTS: The median level of SAA and CRP was 4.28 mg/L and 1.88 mg/L, respectively. For the high-SAA group (> 4.28 mg/L) versus the low-SAA (≤ 4.28 mg/L) group and the high-CRP group (> 1.88 mg/L) versus the low-CRP (≤ 1.88 mg/L) group, the 5-year PFS was 64.5% versus 73.1% (p=0.013) and 65.2% versus 73.3% (p=0.064), respectively. EBV DNA detection showed a superior predictive result, the 5-year PFS in the EBV DNA ≥ 1,500 copies/mL group was obviously different than the EBV DNA < 1,500 copies/mL group (62.2% versus 77.8%, p < 0.001). Multifactorial Cox regression analysis confirmed that in the PFS, the independent prognostic factors were including EBV DNA (hazard ratio [HR], 1.788; p=0.009), tumour stage (HR, 1.903; p=0.021), and node stage (HR, 1.498; p=0.049), but the SAA and CRP were not included in the independent prognostic factors. CONCLUSION: The results of SAA and CRP had a certain relationship with the prognosis of NPC, and the prognosis of patients with high level of SAA and CRP were poor. However, the predictive ability of SAA and CRP was lower than that of EBV DNA.
C-Reactive Protein* ; DNA* ; Herpesvirus 4, Human* ; Humans ; Observational Study ; Prognosis ; Prospective Studies* ; Serum Amyloid A Protein* ; Survival Analysis

Objective: To investigate the clinical characteristics, treatment experiences and prognostic factors for descending necrotizing mediastinitis (DNM). Methods: A retrospective analysis was performed on the data of 22 patients with DNM diagnosed and treated in Henan Provincial People's Hospital from January 2016 to August 2022, including 16 males and 6 females, aged 29-79 years. After admission, all patients underwent CT scanning of the maxillofacial, cervical, and thoracic regions to confirm their diagnoses. Emergency incision and drainage were performed. The neck incision was treated with continuous vacuum sealing drainage. According to the prognoses, the patients were divided into cure group and death group, and the prognostic factors were analyzed. SPSS 25.0 software was used to analyze the clinical data. Rusults: The main complaints were dysphagia (45.5%, 10/22) and dyspnea (50.0%, 11/22). Odontogenic infection accounted for 45.5% (10/22) and oropharyngeal infection accounted for 54.5% (12/22). There were 16 cases in the cured group and 6 cases in the death group, with a total mortality rate of 27.3%. The mortality rates of DNM typeⅠand typeⅡwere respectively 16.7% and 40%. Compared with the cured group, the death group had higher incidences for diabetes, coronary heart disease and septic shock (all P<0.05). There were statistically significant differences between the cure group and the death group in procalcitonin level (50.43 (137.64) ng/ml vs 2.92 (6.33) ng/ml, M(IQR), Z=3.023, P<0.05) and acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score (16.10±2.40 vs 6.75±3.19, t=6.524, P<0.05). Conclution: DNM is rare, with high mortality, high incidence of septic shock, and the increased procalcitonin level and APACHE Ⅱ score combined diabetes and coronary heart disease are the poor prognostic factors for DNM. Early incision and drainage combined with continuous vacuum sealing drainage technique is a better way to treat DNM.
Male ; Female ; Humans ; Mediastinitis/diagnosis* ; Shock, Septic/complications* ; Retrospective Studies ; Procalcitonin ; Prognosis ; Drainage/adverse effects* ; Necrosis/therapy*