Objective:To assess the value of spiral CT in diagnosis and treatment of chronic otitis media.Methods:The spiral CT findings of 74 cases including 93 ears proved by operation and pathology were studied.Results:The lesions such as the disruption of the ossicular chain showed in spiral CT or three-dimensional image were in accord with those seen in the operation,the accuracy was 95.7%,the disruption of the ossicular chain and bony erosion in the tympanic cavity and antrum were severe in the typeⅢ chronic otitis media.Conclusion:Spiral CT is helpful to diagnose and definite the chronic otitis media,three-dimensional image can provide valuable information for surgery.

Objective To analyze the correlation of serum creatinine(Cr)/cystatin C(Cys C)ratio and monocyte/high-density lipoprotein-cholesterol(HDL-C)ratio with hypertension complicated with coronary heart disease(CHD).Methods A total of 200 hypertension patients with concomi-tant CHD admitted in our hospital from August 2021 to August 2023 were recruited and served as the observation group,and another 100 patients with hypertension during the same period served as the control group.Based on the number of vascular lesions,the patients in the observation group were divided into single-,double-and multi-vessel disease subgroups(104,75 and 21 cases).According to their Gensini score(＜30,30-90,＞90),they were also assigned into mild,moderate and severe stenosis subgroup(98,78 and 24 cases).After the fasting venous blood sam-ples were harvested from all subjects,the serum levels of Cys C,Cr and HDL-C were measured,and monocyte count was calculated,and Spearman correlation analysis was used to determine the correlation of serum Cr/Cys C ratio and monocyte/HDL-C ratio with number and severity of cor-onary artery lesions.Results The observation group had significantly higher Cr and Cys C levels,monocyte count and monocyte/HDL-C ratio,while lower Cr/Cys C ratio and HDL-C level than the control group(P＜0.01).The conditions of above indicators were more severe in the multi-vessel lesion subgroup than the single-and double-vessel lesion subgroups(P＜0.05).Similar re-sults were observed in the severe stenosis subgroup when compared with the mild and moderate stenosis subgroups(P＜0.05).Spearman correlation analysis showed that the Cr/Cys C ratio was negatively correlated with the number of coronary artery lesions and the severity of coronary ar-tery stenosis(r=-0.743,P＜0.05;r=-0.673,P＜0.05),and the monocyte/HDL-C ratio was positively correlated with the number of coronary artery lesions and the degree of coronary artery stenosis(r=0.692,P＜0.05;r=0.611,P＜0.05).Conclusion The serum Cr/Cys C ratio and monocyte/HDL-C ratio are closely associated with hypertension combined with concomitant CHD.And the Cr/Cys C ratio is negatively correlated with the severity of the disease,and the monocyte/HDL-C ratio is positively correlated with the severity of the disease in the patients.

Objective To investigate the use of glucocorticoids in patients with severe community-acquired pneumonia (SCAP) in the intensive care unit (ICU) of Hospitals in Zhejiang Province and to provide a reference for guiding clinical use of SCAP patients. Methods To draw up a questionnaire with reference to the Chinese and international guidelines, and to investigate the knowledge of community-acquired pneumonia (CAP) related guidelines and the use of glucocorticoids in patients with SCAP by doctors in hospitals above secondary level in Zhejiang Province by Email. Then the valid questionnaire was analyzed. Results In June 2016, 340 questionnaires were distributed, and all were returned after 2 months, with 333 of valid; 333 doctors from 45 ICUs in Zhejiang Province participated in the survey. ① The knowledge of CAP-related guidelines in ICU doctors: 79.58% (265/333) of the doctors had read the CAP guidelines, and those who work over 10 years had a higher reading rate than those with 1-5 years and 6-10 years [93.07% (94/101) vs. 74.00% (111/150), 73.17% (60/82), both P < 0.05]. Post-graduates and above had higher reading rates than undergraduates [85.35% (134/157) vs. 74.43% (131/176), P < 0.05]. Senior doctors had higher reading rates than the junior and intermediate doctors [93.07% (94/101) vs. 71.43% (80/112), 75.83% (91/120), both P < 0.05]. The rate of understanding the clinical application of glucocorticoids was 13.81% (46/333). The doctors who work over 10 years and the seniorshad a relatively high awareness rate, 23.76% (24/101) and 20.79% (21/101) respectively. However, there was no significant difference in the awareness rate between doctors with different degrees and different levels of hospitals. ② For the use of glucocorticoids in different causes of pneumonia, 44.74% (149/333) of doctors routinely used glucocorticoids in severe viral pneumonia. The proportion of glucocorticoids used in severe bacterial pneumonia, severe fungal pneumonia, severe pneumocystis pneumonia, chronic obstructive pulmonary disease (COPD) and severe pneumonia were 22.82% (76/333), 9.31% (31/333), 22.52% (75/333) and 18.32% (61/333), respectively. ③ The way of glucocorticoid usage: 79.58% (265/333) of doctors chose methylprednisolone, 4.20% (14/333) chose hydrocortisone, 1.20% (4/333) chose dexamethasone, and 15.02% (50/333) had not use glucocorticoids. The proportion of physicians who chose to use glucocorticoids within 24 hours of admission and 1-7 days after admission were 52.65% (149/283) and 47.35% (134/283), respectively. Glucocorticoids were used more in doctors with lower academic qualifications and hospitals within 24 hours. The undergraduate degree was 61.39% (97/158), and the second-grade class hospital was 67.50% (27/40). Among the doctors who chose methylprednisolone, 60.75% (161/265) prescribe the dose ≤80 mg/d;79.15% (224/283) chose the course of ≤7 days. The number of years of work, education, professional title and hospital grade had no significant effect on the choice of methylprednisolone and the course of treatment. Conclusions ICU doctors of 45 hospitals in Zhejiang Province have a high degree of heterogeneity in the understanding of the use and guidelines of glucocorticoids in SCAP. It is necessary to strengthen the ICU doctor's study of clinical guidelines at home and abroad and to develop a glucocorticoid use plan according to the specific conditions of patients, so that SCAP patients can benefit more.

Objective:To analyze the clinical features, risk factors and prognosis of IPA combined with lung infection, aiming to further improve clinicians' understanding and diagnosis and treatment of it.Methods:Patients with IPA admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2013 to October 2021 were retrospectively enrolled, and their clinical data was collected from the electronic medical record, including demographic information, clinical characteristics, biochemical indicators, auxiliary examination, microbial data and prognostic indicators. Patients were divided into two groups of IPA with pulmonary infection and IPA alone, and the clinical features, risk factors and prognosis of IPA patients with pulmonary infection were compared and analyzed in comparison with IPA patients alone.Results:A total of 156 IPA patients were finally recruited, with an average age of (67.12±12.89) years old and a main male proportion of 69.20%. Among them, there were 86 cases (55.13%) with IPA with pulmonary infection and 70 cases (44.87%) with IPA alone. Half of the IPA patients with pulmonary infection were mixed with one pathogen. The main pathogen of mixed infection was bacteria (82.72%), whereas acinetobacter baumannii accounted for the most common pathogen(25.93%, 42/162). Multivariate logistic regression analysis found that mechanical ventilation ( OR 4.89, 95% CI 2.23-10.70) and prior neutropenia ( OR 6.41, 95% CI 1.33-30.93) were independent risk factors for the occurrence of IPA with pulmonary infection. Compared with IPA alone, IPA patients with pulmonary infection were more likely to develop septic shock(69.80% vs. 32.90%, P <0.05), and have longer lengthes of hospital stay [16.00(8.00,36.50) vs.13.50 (7.00,20.50)] and ICU stay[11.50(6.00,31.25) vs.8.50(1.75,11.00)], and mechanical ventilation days [12.00(6.75, 25.25) vs.8.00(2.00,10.00)], as well as a higher 28-day mortality (55.80% vs.35.70%) and in-hospital mortality (64.00% vs. 35.70%). Conclusions:IPA patients with pulmonary infection accounts for more than half of IPA patients. The main respiratory etiology of IPA with pulmonary infection is acinetobacter baumannii. The independent risk factors of IPA patients with pulmonary infection are mechanical ventilation and neutropenia. The prognosis of IPA patients with pulmonary infection is worse than patients with IPA alone, which is worthy for the attention of physicians.