OBJECTIVETo discuss the value of multiple-slice spiral CT diagnosis of atypical intraabdominal hernia.

METHODSThe clinical and CT findings of 16 cases of atypical intraabdominal hernia confirmed surgically were retrospectively analysed.

RESULTSIn all the 16 cases, the contents of hernia were small bowels and the mesentery. Nine cases were caused by the adhesion after abdominal operations or infection, 6 by the mesenteric foramen, and 1 by the gap of pelvic peritoneum. The main CT findings were as follows:(1)the obstructed small bowels gathered abnormally and showed cluster shape(9 cases); the walls of the bowels thickened with edema and showed "target" sign with exudate in the neighboring spaces(5 cases); other part of the abdominal cavity became empty for lack of small bowels(4 cases).(2) Abnormal arrangement of the branches of mesenteric vessel, which appeared gathered or pulled or rigid and displacement of the main branches to left or right(12 cases). Thickened mesenteric vessel (4 cases): torsion of mesentery with "whirlpool" sign (3 cases). (3) With the help of multiplanar reformation, 5 cases showed the evidence of hernia rings. In the ring area, there were gathered or pulled or rigid and radiating mesenteric vessel and the dilated or effusion bowels in cluster arrangement forming "parachute" and "bundle of balloons" sign.

CONCLUSIONCT manifestations of atypical intraabdominal hernia has some specific characteristics, which is of important value for clinical diagnosis and treatment.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Female ; Hernia, Ventral ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Tomography, Spiral Computed ; methods ; Young Adult

Objective:To investigate the predictive value of serum albumin (Alb) levels in the early postoperative period (within 1 hour) for urosepsis after minimally invasive percutaneous nephrolithotomy (mPCNL).Methods:The clinical data of 160 patients treated by single channel holmium laser mPCNL in urolithiasis treatment center of the second hospital of Tianjin Medical University from January 2019 to January 2020 were retrospectively analyzed. The patients were divided into the sepsis group and the non-sepsis group according to whether the patients developed urosepsis after the operation. There were 110 cases of male, and 50 cases of female, with average age of(51.8±11.9), including 68 cases with hypertension, 26 cases with diabetes, 12 patients with history of preoperative fever, 16 cases with history of endoscopic lithotomy surgery, 6 patients with preoperative catheter, 24 patients with positive preoperative urine culture, 12 patients with positive preoperative nitrite volume, 32 cases with preoperative routine urine leucocyte(+ + + ). The operative time and infusion volume were recorded during the operation. Blood samples were collected from all patients within 1 hour after surgery to detect blood routine and serum albumin (Alb), and the change of haemorrhagic white blood cells and serum albumin were calculated. Univariate and multivariate analyses were used to statistically analyze the relevant clinical parameters to identify the independent risk factors for urosepsis after mPCNL surgery. The ROC curve was established and the area under the comparison curve was calculated to analyze the predictive value of independent risk factors for postoperative urosepsis.Results:There were 13 patients (8.1%) in the sepsis group, including 7 males and 6 females, with an average age of (53.1±8.2) years. There were 147 patients (91.9%) in the non-sepsis group, including 103 males and 44 females, with an average age of (51.7±12.1)years. Single factor analysis showed the infectious stones (38.5% and 8.8%), surgery duration [(94.6±26.2)min and(63.6±24.5)min], a positive urine culture (46.2% and 12.2%), positive urinary nitrite (30.8% and 5.4%), strong positive urinary leukocyte (61.5% and 11.3%), postoperative albumin levels [(34.2±2.7)g/L and(40.7±6.2)g/L]and changes of serum albumin levels within one hour after surgery [(18.3±4.6)% and(3.8±14.3)%] between the sepsis group and the non-sepsis group had significant differences ( P<0.05). Multiariable logistic regression analysis showed the strong positive urine leucocyte ( OR=57.704, 95% CI 2.407-1383.427, P=0.012), postoperative blood leucocyte level within one hour after surgery ( OR=2.406, 95% CI 1.154-3.627, P=0.014) and the change of serum albumin levels after surgery ( OR=1.373, 95% CI 1.083-1.740, P=0.009) were independent risk factors for sepsis. ROC curve analysis indicated that the AUC of the change amplitude of serum albumin level was 0.926, which was significantly higher than the AUC of the qualitative results of blood leukocyte and the AUC of urinary leukocyte( P<0.01). Conclusions:The positive urinary leucocyte, the change of serum albumin levels after surgery within one hour and the leucocyte level are independent risk factors for postoperative urosepsis after mPCNL. The change of serum albumin level in the early postoperative period has a strong predictive value for the early diagnosis of postoperative sepsis.

Objective To evaluate clinical efficacy of cornu cervi dege-latinatum in treating leucopenia after malignant tumor chemoradiotherapy . Methods Sixty cases with leucopenia after malignant tumor chemoradio-therapy and kidney yang deficiency in Chinese medicine were randomly divided into treatment group and control group ,30 cases in each group. Patients in control group were treated with leucogen 40 mg once, 3 times a day.Patients in treatment group were treated with cornu cervi degelati-natum 100 g once a day .Two weeks for a course , and both groups were treated for 3 courses.The leukocyte account before and after treatment and the clinical effect after treatment of two groups were compared , also the security was evaluated . Results The total effective rate was 86.67%in treatment group , much higher than 73.33%in control group ( P<0.05 ) .The leukocyte number apparently rised after treatment in both groups ( P <0.05 ) , while in treatment group , it rised to much higher than that in control group ( P<0.05 ) .The incidence of adverse drug reactions of the two groups was compared , and the difference was not statistically significant ( P >0.05 ) . Conclusion Compared to leucogen , cornu cervi degelatinatum has better clinical effect on the treatment of leucopenia after malignant tumor chemoradiotherapy with good security , which is worth recommended in clinical .

Objective To explore early postoperative gait characteristics and clinical outcomes after total knee arthroplasty(TKA).Methods From February 2023 to July 2023,26 patients with unilateral knee osteoarthritis(KOA)were treated with TKA,including 4 males and 22 females,aged from 57 to 85 years old with an average of(67.58±6.49)years old;body mass in-dex(BMI)ranged from 18.83 to 38.28 kg·m-2 with an average of(26.43±4.15)kg·m-2;14 patients on the left side,12 pa-tients on the right side;according to Kellgren-Lawrence(K-L)classification,6 patients with grade Ⅲ and 20 patients with grade Ⅳ;the courses of disease ranged from 1 to 14 years with an average of(5.54±3.29)years.Images and videos of standing up and walking,walking side shot,squatting and supine kneeling were taken with smart phones before operation and 6 weeks after operation.The human posture estimation framework OpenPose were used to analyze stride frequency,step length,step length,step speed,active knee knee bending angle,stride length,double support phase time,as well as maximum hip flexion angle and maximum knee bending angle on squatting position.Western Ontario and McMaster Universities(WOMAC)arthritis index and Knee Society Score(KSS)were used to evaluate clinical efficacy of knee joint.Results All patients were followed up for 5 to 7 weeks with an average of(6.00±0.57)weeks.The total score of WOMAC decreased from(64.85±11.54)before op-eration to(45.81±7.91)at 6 weeks after operation(P＜0.001).The total KSS was increased from(101.19±9.58)before opera-tion to(125.50±10.32)at 6 weeks after operation(P＜0.001).The gait speed,stride frequency and stride length of the affected side before operation were(0.32±0.10)m·s-1,(96.35±24.18)steps·min-1,(0.72±0.14)m,respectively;and increased to(0.48±0.11)m·s 1,(104.20±22.53)steps·min-1,(0.79±0.10)m at 6 weeks after operation(P＜0.05).The lower limb support time and active knee bending angle decreased from(0.31±0.38)sand(125.21±11.64)° before operation to(0.11±0.04)s and(120.01±13.35)° at 6 weeks after operation(P＜0.05).Eleven patients could able to complete squat before operation,13 patients could able to complete at 6 weeks after operation,and 9 patients could able to complete both before operation and 6 weeks after operation.In 9 patients,the maximum bending angle of crouching position was increased from 76.29° to 124.11° before operation to 91.35° to 134.12° at 6 weeks after operation,and the maximum bending angle of hip was increased from 103.70° to 147.25° before operation to 118.61° to 149.48° at 6 weeks after operation.Conclusion Gait analysis technology based on artificial intelligence image recognition is a safe and effective method to quantitatively identify the changes of pa-tients'gait.Knee pain of KOA was relieved and the function was improved,the supporting ability of the affected limb was im-proved after TKA,and the patient's stride frequency,stride length and stride speed were improved,and the overall movement rhythm of both lower limbs are more coordinated.

BACKGROUNDAs a model for both multistep and multipathway carcinogenesis, colorectal neoplastic progression provides paradigms for researching both oncogenes and tumor suppressor genes (TSGs). However, the mechanism of colorectal cancer (CRC) is not completely understood, and many genes may be involved in the colorectal carcinogenesis. The purpose of this study was to screen for the potential TSGs on chromosome 1q31.1-32.1 in Chinese patients with sporadic colorectal cancer, to explore whether colorectal cancer in the Chinese population has unique genetic alterations and determine whether other putative TSGs exist and contribute to colon carcinogenesis.

METHODSSix polymorphic microsatellite markers, at a density of approximately one marker in every 1.6 cM, were chosen for refined loss of heterozygosity (LOH) mapping of 1q31.1-32.1. Eighty-three colorectal cancer patients' tumor and normal DNA were analyzed via polymerase chain reaction (PCR) for these microsatellite markers. PCR products were eletrophoresed on an ABI 377 DNA sequencer. Genescan 3.1 and Genotype 2.1 software were used for LOH scanning and analysis. On the basis of refined LOH mapping results, we undertook a microarray-based expression screening to identify tumor association genes in 19 of the CRC cases.

RESULTSThe average LOH frequency of 1q31.1-32.1 was 24.41%, with the highest frequency of 36.73% (18/49) at D1S2622, and the lowest of 16.42% (11/67) at D1S412. A minimal region of frequent deletion was located within a 2 cM genomic segment at D1S413-D1S2622. There was no significant association between LOH of any marker in the studied regions and the clinicopathological data (patient sex, age, tumor size, growth pattern, or Dukes stage). On the basis of refined mapping results, we chose 25 genes located in the D1S413-D1S2622 (1q31.3-32.1) region and presented a microarray-based high throughput screening approach in 19 sporadic CRC cases to identify candidate CRC related tumor suppressor genes. This study found 4 significantly down-expressed genes, including CSRP1, LMOD1, PPP1R12B and CFHL3. There was no significant association between expression levels of CFHL3, CSRP1, LMOD1, PPP1R12B and the clinicopathological data. By database searching, CSRP1 was hypothesized to be a colorectal cancer related tumor suppressor gene.

CONCLUSIONSThrough detailed deletion mapping, we found that the 1q31.3-32.1 region might harbor one or more colorectal cancer related tumor suppressor gene (s). And by microarray-based high-throughput screening of candidate genes located in this region and by subsequent database searching, we present the first evidence that CSRP1 might be involved in the progression of CRC.

Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Chromosomes, Human, Pair 1 ; genetics ; Colorectal Neoplasms ; genetics ; Female ; Genes, Tumor Suppressor ; physiology ; Humans ; Loss of Heterozygosity ; genetics ; Male ; Microsatellite Repeats ; genetics ; Middle Aged ; Oligonucleotide Array Sequence Analysis ; Polymerase Chain Reaction

OBJECTIVETo retrospectively analysis the treatment characteristics of the systemic situation in patients with crush syndrome after Wenchuan earthquake happened in May 12th, 2008.

METHODSForty-nine patients with crush syndrome and subsequent acute renal failure (ARF) due to the earthquake were treated in West China Hospital. All of patients had been rescued from buildings that collapsed in Wenchuan earthquake. The major associated injuries were in the low extremities and upper extremities. 49 patients developed ARF with increased concentrations of serum creatinine (mean 64 022 U/L) had underwent haemodialysis. Hyperkalaemia was seen in 9 patients and four of them underwent haemodialysis. 49 patients were administered hemodialysis.

RESULTSNo patient died. All patients who suffered from the ARF were weaned from hemodialysis after admitted 7 to 35 days. Forty-five extremities underwent amputations and 52 extremities had fasciotomy.

CONCLUSIONSCrush syndrome requires urgent recognition and prompt surgical treatment with simultaneous measures to control hyperkalemia and ARF. The authors believe that immediate intensive care therapy and multi-subjective coordination would have improved the survival rate.

Acute Kidney Injury ; etiology ; surgery ; therapy ; Adolescent ; Adult ; Aged ; Amputation ; Child ; Crush Syndrome ; etiology ; surgery ; therapy ; Decompression, Surgical ; Earthquakes ; Female ; Humans ; Male ; Middle Aged ; Renal Replacement Therapy ; Retrospective Studies ; Treatment Outcome ; Wounds and Injuries ; complications

Objective To investigate the infection status and changing trend of hepatitis C virus(HCV)infection in hospitalized patients in medical institutions,and provide reference for formulating HCV infection prevention and control strategies.Methods HCV infection surveillance results from cross-sectional survey data reported to China Healthcare-associated Infection(HAI)Surveillance System in 2020 were summarized and analyzed,HCV positive was serum anti-HCV positive or HCV RNA positive,survey result was compared with the survey results from 2003.Results In 2020,1 071 368 inpatients in 1 573 hospitals were surveyed,738 535 of whom underwent HCV test,4 014 patients were infected with HCV,with a detection rate of 68.93％and a HCV positive rate of 0.54％.The positive rate of HCV in male and female patients were 0.60％and 0.48％,respectively,with a statistically sig-nificant difference(x2=47.18,P＜0.001).The HCV positive rate in the 50-＜60 age group was the highest(0.76％),followed by the 40-＜50 age group(0.71％).Difference among all age groups was statistically signifi-cant(x2=696.74,P＜0.001).In 2003,91 113 inpatients were surveyed.35 145 of whom underwent HCV test,resulting in a detection rate of 38.57％;775 patients were infected with HCV,with a positive rate of 2.21％.In 2020,HCV positive rates in hospitals of different scales were 0.46％-0.63％,with the highest in hospital with bed numbers ranging 600-899.Patients'HCV positive rates in hospitals of different scales was statistically signifi-cant(X2=35.34,P＜0.001).In 2020,12 provinces/municipalities had over 10 000 patients underwent HCV-rela-ted test,and HCV positive rates ranged 0.19％-0.81％,with the highest rate from Hainan Province.HCV posi-tive rates in different departments were 0.06％-0.82％,with the lowest positive rate in the department of pedia-trics and the highest in the department of internal medicine.In 2003 and 2020,HCV positive rates in the depart-ment of infectious diseases were the highest,being 7.95％and 3.48％,respectively.Followed by departments of orthopedics(7.72％),gastroenterology(3.77％),nephrology(3.57％)and general intensive care unit(ICU,3.10％)in 2003,as well as departments of gastroenterology(1.35％),nephrology(1.18％),endocrinology(0.91％),and general intensive care unit(ICU,0.79％)in 2020.Conclusion Compared with 2003,HCV positive rate decreased significantly in 2020.HCV infected patients were mainly from the department of infectious diseases,followed by departments of gastroenterology,nephrology and general ICU.HCV infection positive rate varies with gender,age,and region.

OBJECTIVE: To compare the clinical efficacy of three minimally invasive methods of anterior column screw, plate and screw rod system in the treatment of anterior pelvic ring fracture. METHODS: From December 2015 to September 2018, 77 patients with pelvic anterior ring fracture were treated and followed up, including 45 males and 32 females, aged 19 to 73 years. According to AO / OTA classification, there were 26 cases of type B1, 20 cases of type B2, 17 cases of type B3 and 14 cases of type C. According to the different internal fixation methods, they were divided into three groups:anterior column screw group(35 cases), plate group(20 cases), and screw rod system group(22 cases). The operation time, intraoperative fluoroscopy times, blood loss, fracture reduction quality, complications and curative effect of the three groups were compared. RESULTS: All 77 patients were followed up for 12 to 33 (16.5±5.7) months. The operation time, intraoperative blood loss and incision length of anterior column screw group were significantly shorter than those of plate group and screw rod system group, and intraoperative fluoroscopy times of plate group were significantly less than those of anterior column screw group and screw rod system group ( CONCLUSION Minimally invasive internal fixation with anterior column screw, plate and screw rod system can obtain good clinical effect, but anterior column screw fixation has less trauma and lower incidence of surgicalcomplications.
Adult ; Aged ; Bone Plates ; Bone Screws ; Female ; Fracture Fixation, Internal ; Fractures, Bone/surgery* ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Pelvic Bones/surgery* ; Retrospective Studies ; Treatment Outcome ; Young Adult

OBJECTIVE: To assess the clinical efficacy of minimally invasive technology with trajectory screw fixation for fragility fractures of pelvic(FFP). METHODS: A retrospective case control study was performed to analyze the clinical data of 35 patients with FFP who were treated and followed up between January 2016 and December 2019. There were 12 males and 23 females, aged from 65 to 99 years with an average of(75.4±7.8) years old. There were 13 cases of type Ⅱb, 7 cases of type Ⅱc, 8 cases of type Ⅲa, 2 cases of type Ⅲb, 2 cases of type Ⅲc, 1 case of type Ⅳb, and 2 cases of type Ⅳc according to Rommens FFP comprehensive classification. All patients received the treatment of minimally invasive technology with trajectory screws fixation. According to the different methods of anterior pelvic ring fixation, FFP patients were divided into two groups:12 cases were fixed with the pedicle screw rod system in the anterior pelvic subcutaneous internal fixator (INFIX) group;23 cases were fixed with hollow screws of the pubic symphysis, superior ramus of pubis or acetabular anterior column in the screw group. The operation time, intraoperative blood loss, intraoperative fluoroscopy times, length of hospital stay, cost of internal fixation, pre- and post-operative visual analogue scale(VAS) were compared between the two groups. The fracture reduction quality was evaluated according to the Matta criteria, and the clinical function was evaluated by the Majeed functional scoring system respectively. RESULTS: All patients were followed up for 12 to 39(16.5±5.4) months after surgery. There was no statistically significant difference in the operation time, intraoperative blood loss, intraoperative fluoroscopy time, and length of hospital stay between the two groups(P>0.05). As for the cost of internal fixation, the cost of internal fixation in the screw group [2 914 (2 914, 4 371) yuan] was significantly lower than that of the INFIX group [6 205 (6 205, 6 205) yuan] (P<0.05). No significant difference was observed in the incidence of postoperative complications between the two groups (P>0.05). There was no significant difference in VAS assessment at admission, 1 week, and 3 months after surgery between the two groups(P>0.05). However, the VAS assessment at 1 week and 3 months after surgery of the two groups were significantly better than those at admission(P<0.05). There was no significant difference in the quality of fracture reduction after the operation and the efficacy evaluation at the last follow-up between the two groups(P>0.05). CONCLUSION For the treatment of fragility fractures, minimally invasive technology with trajectory screw fixation can achieve good clinical efficacy. It has the advantages of being relatively minimally invasive, less bleeding, relieving the pain. It deserves clinical application.
Aged ; Aged, 80 and over ; Blood Loss, Surgical ; Case-Control Studies ; Female ; Fractures, Bone/surgery* ; Humans ; Male ; Pelvic Bones/surgery* ; Retrospective Studies

OBJECTIVE: To evaluate the efficacy of iliolumbar fixation in the treatment of U-shaped sacral fractures. METHODS: A retrospective study was conducted on the 14 complex U-shaped sacral fractures which had been treated from January 2014 to December 2019, involved 10 males and 4 females, aged 24 to 48 (35.4±6.5) years. Fracture healing time, nerve function, clinical function and complications were observed in the patients. RESULTS: All patients were followed up for 9 to 16(26.0±5.9) months. The complete weight-bearing time for bone healing was(12.4±2.0) weeks. One case of surgical incision infection occurred after operation, and one case of sacrum nailspenetrated to the outer plate of sacrum. No complications such as pressure ulcers, loosening or rupture of internal fixation occurred. According to Gibbons scoring, the neurological function recovered from preoperative 2.9±0.9 to postoperative 2.1±1.1, there were statistically significant differences between preoperative and postoperative ( CONCLUSION Sacral lumbar fixation is an effective method for the treatment of U-shaped sacrum fractures. It has the advantages of strong internal fixation and satisfactory functional recovery.
Bone Screws ; Female ; Fracture Fixation, Internal ; Humans ; Male ; Retrospective Studies ; Sacrum/surgery* ; Spinal Fractures/surgery* ; Treatment Outcome