Objective　To investigate the efficacy and safety of edaravone dexcamphenol in the treatment of acute cerebral infarction.Methods　Patients with acute cerebral infarction were randomly divided into observation group (edaravone dexborneol+conventional treatment) and control group (conventional treatment) for 14 days.Neurological function was assessed by the National Institutes of Health Stroke Scale (NIHSS) at admission and the modified Rankin Scale (mRS) at 14 days after treatment,respectively.C-reactive protein (CRP) level was detected simultaneously.Furthermore,the occurrence of adverse drug reactions during treatment was observed.Results　NIHSS score,mRS score and CRP levels in experimental group were significantly lower than those in control group (all P<0.05).No adverse drug reactions in the two groups were observed during treatment.Conclusion　Edaravone dexborneol has a significant clinical effect in the treatment of acute cerebral infarction,and the safety of this treatment is relatively high.

OBJECTIVE: Study for surgical approaches on anterior skull base tumors. METHOD: All 37 cases with anterior skull base tumors were surgically treated. Twenty-one cases were treated with anterior craniofacial approaches: Frontal subcranial combined with total maxillectomy in 8 cases or/with orbital exenteration in 5 cases, combined with lateral rhinotomy in 1 cases, combined with naso translocation with medial maxillectomy in 7 cases. Partial or total maxillary swing combined with naso pyramid translocation in 13 cases. Frontonasal, fronto-orbital and midface degloving in one case respectively. RESULT: Of the 27 malignant cases the 3 and 5-year survival rates were 81.9% (22/27) and 62.9% (17/27) respectively, and one tumor free case living well more than 9 years. There were no recurrence in 10 cases with benign tumor. CONCLUSIONS Various craniofacial approaches except lateral rhinotomy provide directly satisfactory tumor exposure and facilitate enbloc resection of the naso paranasal sinus tumor with intracranial extension. Partial or total maxillary swing combined with naso pyramid translocation is good for tumor involving the skull base without intracranial invasion. The fronto-nasal pyramid translocation is good for removal of the upper part of nasal tumor with intracranial extension on well developed frontal sinus. The fronto orbital approach is proper for removal of fronto-sphenoid tumor and midface degloving may be used in selected cases.
Adolescent ; Adult ; Aged ; Craniotomy ; methods ; Female ; Frontal Bone ; surgery ; Humans ; Male ; Middle Aged ; Nose ; surgery ; Skull Base ; surgery ; Skull Base Neoplasms ; surgery ; Young Adult

OBJECTIVETo study the anatomical and biomechanical features of sacral pedicle and lateral mass so as to provide reference for clinical screw fixation technology of sacral pedicle and lateral mass.

METHODSA total of 60 adult patients'spiral CT images of the sacrum and coccyx were selected randomly. The entry points of sacral pedicle and lateral mass screws were determined, and the screw trajectory was measured using the three dimensional reconstruction method. Meanwhile, the gross anatomy was scrutinized in 15 adult cadaver specimens to determine the sacral pedicle and lateral mass screw entry points. The length, width and angle of sacral pedicle and lateral mass screw trajectory were measured. Eight of 15 cadaver specimens were selected to test the maximal extraction force of sacral pedicle and lateral mass screws. The clinical data of 15 cases treated by pedicle and lateral mass screw technology were collected and analyzed.

RESULTSThe diameter and length of S(1)-S(5) sacral pedicle and lateral mass screw trajectory were regular, with about 20 degree inclination angle. The S(1) pedicle screw entry point was located at the intersection point of the basal lateral part of articular process and median line of transverse process, and no significant difference was found for the maximal extraction force between pedicle and lateral mass screws (P larger than 0.05). The entry points of S(2)-S(5) pedicle screws were located at the intersection point of the line connecting adjacent posterior sacral foramina and median line of the transverse process. The lateral mass screw entry point of S(2)-S(5) was on the median side of intersection point between median line of the transverse process and lateral sacral crest. The maximal extraction force of pedicle screws was significantly greater than that of lateral mass screws (P less than 0.05).

CONCLUSIONBoth the sacral pedicle and the lateral mass screw fixation techniques can offer effective fixation and reconstruction for fracture of the sacrum and coccyx, but pedicle screw fixation may be more convenient, safe and reliable than lateral mass screw fixation.

Adult ; Biomechanical Phenomena ; Bone Screws ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Imaging, Three-Dimensional ; Male ; Sacrum ; anatomy & histology ; physiology ; surgery ; Tomography, X-Ray Computed

Objective To analyze the main causes of death among elderly residents aged 60 and above in Huangdu, Jiading District, Shanghai, and to provide evidence for disease prevention and control of the elderly. Methods The mortality rate, potential years of life lost (PYLL), years of life lost rate (PYLLR), and average years of life lost (AYLL) were calculated to evaluate the death characteristics and life loss of the elderly over 60 years old in Huangdu. Results From 2012 to 2019, there were 1 648 deaths among elderly people over 60 years old, and the death rate was 22.56‰. The mortality rate of residents was basically stable over time (P = 0.315). The top five causes of death were tumor, cerebrovascular disease, cardiovascular disease, respiratory diseases, and injury and poisoning, accounting for 81.67% of all deaths. The mortality of tumors and respiratory diseases was higher in males than in females, and the differences were statistically significant (both P<0.001). There were no significant differences in mortality between men and women in cardiovascular, cerebrovascular, and injury and poisoning diseases (P>0.05). Among the causes of death of residents aged 60 and above, the number of years of life lost caused by all causes of death was 5,512.5 (person-years), the rate of years of life lost was 88.69‰, and the average number of years of life lost was 8.14 (years/person). Conclusion Tumor and cardiovascular and cerebrovascular diseases were the main causes of death in the elderly in Huangdu area. Family doctors should be used to strengthen the prevention and control measures for cancer, cardiovascular and cerebrovascular diseases to improve the quality of life of the elderly in the area.

Objective To analyze the audiologic results of cochlear implantation in bilateral severe to profound sensorineural hearing loss following head trauma.Methods A retrospective study of our cochlear implantation cases in bilateral severe to profound sensorineural hearing loss following head trauma (with or without temporal bone fractures).Four patients in second hospital of shandong university were analyzed in this study.Results All the patients received unilateral cochlear implantation and gained openset speech perception ranging from 92％ to 100％.The aided hearing threshold ranged from 30 dBHL to 35 dBHL.None of them experienced a decrease in the hearing performance in the follow-up(1-2 years).Conclusion With sufficient preoperative assessment,cochlear implantation is an effective management for hearing rehabilitation in bilateral severe to profound sensorineural hearing loss following head trauma.

ObjectiveTo determine the risk factors associated with hypoglycemia in community patients with type 2 diabetes mellitus（T2DM）. MethodsA case-control study was performed among 914 patients with T2DM and no medical history of hypoglycemia were selected in the Diabetes Unit of Tongji University School of Medicine Affiliated Anting Community Health Center in 2018. A total of 196 patients with T2DM who had ≥1 hypoglycemia event in the past 12 months were presented as the case group， and 718 patients who did not have any hypoglycemia event during the same period were included as the control group. Medical history， medication， life style， and related factors were collected. Multivariate logistic regression analysis was used to determine the risk factors associated with hypoglycemia. ResultsHistory of coronary heart disease ［adjusted odds ratio（aOR）=2.077， 95% CI： 1.293-3.337］， renal disease （aOR=4.775， 95% CI： 1.537-14.830）， and previous insulin use （aOR =1.765， 95%CI： 1.147-2.716） significantly increased the risk of hypoglycemia， while angiotensin converting enzyme inhibitors（ACEI）（aOR =0.127， 95%CI： 0.044-0.366） and β-receptor blockers （aOR =0.271， 95%CI： 0.119-0.616） decreased the risk of hypoglycemia among diabetic patients. ConclusionIncidence of hypoglycemia in community patients with diabetes is high. History of coronary heart disease and kidney disease， and previous insulin use may increase the risk of hypoglycemia， which warrants further attention by community general practitioners.

From April 2017 to September 2019, the START (standardized reception, teaching, analysis, research, training) method was adopted to train 50 general practitioners at the community general practice teaching clinic of Shanghai Huangdu Community Health Service Center. After 3 months of training, the progress of clinical competence and teaching ability were assessed. After training, the scores of clinical skills and communication skills were significantly higher than those before training (P<0.01). The scores of medical history taking, clinical thinking and health education were higher than before (all P<0.01). But there was no significant difference in record writing and reception time management between those before and after training (all P>0.05). The scores of the ability for building physician-patient relationship, collecting information and providing feedback, understanding complaints from patients′ perspective, sharing information and obtaining informed consents were higher than that before training (all P<0.01). The teaching ability of plan design and teaching method were significantly improved compared with that before training (all P<0.01). The satisfaction rate of START method was 96.0%(48/50). The START method applied in community teaching clinic can significantly improve the clinical competency and teaching ability of general practitioners.

Objective To study the anatomical and biomechanical features of sacral pedicle and lateral mass to provide evidence for clinical sacral pedicle and lateral mass screw fixation technology. Method 60 adult patient's spiral CT images of sacrum and coccyx were selected randomly. The sacral pedicle and lateral mass screw entry point was determined, and the crew trajectory were measured using the three dimensional reconstruction. Meanwhile, the gross anatomy was done for 15 adult cadavers to determine the sacral pedicle and lateral mass screw entry point. The length, width and angle of sacral pedicle and lateral mass screw trajectory was measured. 8 of 15 cadaver specimens were selected to test for the maximal extraction force for sacral pedicle and lateral mass screws. ResultsThe diameter and length of S1～S5 sacral pedicle and lateral mass screw trajectory are significantly regular, with inclination angle is about 20°. The S1 pedicle screw entry point is located at intersection point of basal lateral part of articular process and median line of transverse process, no significant difference is found between the maximal extraction force of pedicle and lateral mass screws (P>0.05）. The entry points of S2～5 pedicle screws are located at the intersection point of the line connecting adjacent posterior sacral foramina and median line of transverse process. The lateral mass screw entry point of S2～5 is on the median side of intersection point between median line of transverse process and lateral sacral crest. The maximal extraction force of pedicle screws are significantly different from the lateral mass screws（P<0.05）. Conclusions Both the sacral pedicle and the lateral mass screw fixation technology can offer effective fixation and reconstruction for the fracture of sacrum and coccyx, but the pedicle screw fixation may be more convenient, safe and reliable than the lateral mass screw fixation technology.

Objective To quantify the setup errors for the different anatomical sites of patients who received intensity-modulated radiotherapy (IMRT) with linear accelerator on-board kilovolt fan beam CT(kV-FBCT) as non-isocenter IGRT and megavolt cone beam CT (MV-CBCT) as isocenter IGRT. Methods A retrospective analysis was performedon 70 patients who underwent radiotherapy, kV-FBCT, and/or MV-CBCT scans after each routine setup prior to IMRT. The average displacement (M), systematic error (Σ), and random error (б) at different treatment sites in the left-right, anterior-posterior, and cranial-caudal directions were calculated according to the individual displacements. The formula 2.5Σ+0.7б was used to estimate the PTV margin in respective direction. For each single patient, the root mean square in three directions was used as 3D displacement. Results A total of 1130 displacements were recorded in the 70 patients. The PTV margin was estimated to be 1.9-3.1 mm in head and neck cancer, 2.8-5.1 mm in thoracic cancer, 4.6-5.1 mm in breast cancer, 3.0-5.5 mm in upper abdominal cancer, and 3.5-6.8 mm in pelvic tumor. For the 3D mean displacements, the head and neck, thoracic, breast, upper abdominal, and pelvic cancer were 2.4±1.0, 4.0±1.6, 4.1±2.0, 4.6±2.1, and 4.6±2.1 mm, respectively. The average 3D displacement obtained by kV-FBCT and MV-CBCT were 4.1 and 3.4 mm, respectively (P=0.212). Conclusion The quantitative setup-error data can be obtained using linear accelerator on-board FBCT, and the non-isocenter IGRT induced set-up error cannot be negligible.

Objective: To observe the position of the electrode in the cochlea following cochlear implantation by cone beam computed tomography (CBCT). Methods: Twenty-five children who received cochlear implantation and CBCT examinations in the Department of Otorhinolaryngology Head and Neck Surgery from the Second Hospital of Shandong University between January 2016 and December 2017 were selected. There were 15 males (17 ears) and 10 females (10 ears). The age ranged from 0.5 to 7.0 years old, with a median age of 1.6 years. 23 patients with unilateral implantation and two patients with bilateral implantation. The implants were all Med-El standard 12-electrode contact arrays. The CBCT was used to determine the position of the electrode in the cochlea, the distance between the electrode contacts and modiolus, and intracochlear insertion length of the electrode arrays. SPSS Statistics, version 22.0 was used for data processing and statistical analysis. Results: CBCT images could clearly demonstrate the structure of round window, oval window, modiolus, osseous cochlear duct, osseous spiral lamina, and electrodes. The electrode arrays of all the children were fully implanted into the cochlea. 26 of the electrode arrays were located in the scala tympani and one of them was inserted into the scala vestibular. The mean intracochlear insertion length of the electrode arrays was 30.23 (95%CI, 30.04-30.71) mm. The distance between the electrode contacts and modiolus gradually increased at the 1-4th electrode contacts and reached the maximum at the 4th electrode contacts with an average of 1.10 mm (95%CI, 1.02 to 1.18 mm), and then gradually decreased from the 5th electrode contacts. Conclusions CBCT can clearly show cochlear fine structures and therefore accurately assess the electrode position following cochlear implantation.