Objective To improve the diagnosis of multiple tuberculosis of bone and joints by analyzing its radiologic findings respectively .Methods 5 cases with multiple tuberculosis of bone and joints were all proved by pathology of them, there were 1 male and 4 female, the age ranged from 15 to 56 years old. X-ray films were all taken in 5 cases. Vertebral canal iodolography was performed in 1 case, 2 cases were undergone biopsy, and operation was done in 3 cases.Results Multiple bones in 5 cases were involved, including 3～5 bones. Of all cases, long bone and short bone were involved together in 3 cases, plat bone and vertebra were involved together in 1 case, long bone, plat bone and vertebra were simultaneously involved in 1 case. And 3 cases involved long bone and short bone simultaneously had pathosis in unilateral limbs, 2 cases involved plat bone had pathosis in bilateral. X-ray plain films demonstrated osteolytic destruction with slight sclerosis at the margin of partial destructive areas, which were round, oval or irregularity. There were soft tissue masses around the involved bones.Conclusion The multiple tuberculosis of bone and joint is of some clinic symptoms and X-ray features, but the confirmed diagnosis of which is entertained by biopsy and pathology.

Objective To investigate the value of galactography in the diagnosis with nipple discharge.Methods 40 cases of galactography with nipple discharge proved by clinic and pathology were analyzed retrospectively.Results There were normal ducts in 7 cases, simple duct dilatation in 17 cases, breast duct dilatation accompanied chronic mastitis in 4 cases, breast duct dilatation accompanied hyperplasia in 2 cases, intraductal papilloma in 8 cases, ductal carcinoma in 1 case and abscess of the breast in 1 case.Conclusion Breast galactography plays important roles in diagnosis and differentiation of the breast disease with nipple discharge, and provides significant information for clinical department.

Objective To study the relationship between X-ray features and pathologic infiltration of early gastric cancer.Methods 19 cases of early gastric cancer were analyzed, which were proved by pneumobarium double-contrast examination, operation and pathology. Results There were 9 cases of mucosa cancer and 10 cases of submucosa cancer in 19 patients of early gastric cancer certified by operation. The main X-ray features of mucosa cancer were: a lessened flexibility of local wall, indistinct outline, small trivialities became small nodes and small ditches became indistinct, they looked like pomegranate seeds. The main X-ray features of submucosa cancer were: the local wall was stiff, the density was high, there were small filling defects and small irregular niches, the rugae in the zone involved by the tumour became stiff, large even disappear, small trivialities and small ditches were destroyed. The X-ray findings of early gastric cancer had functional changes, abnormal contraction, more liquid in stomach.Conclusion Pneumobarium double-contrast examination is a voluable method for the diagnosis of early gastric cancer.

Objective To analyze the association of postnatal weight gain proportion of very low birth weight (BW) preterm babies and the onset of severe retinopathy of prematurity,and investigate the optimal cut-off points and predictive ability of postnatal weight gain (WG) proportion for the onset of retinopathy of prematurity (ROP).Methods A retrospective cohort study.257 preterm infants underwent screening whose weight was less than 1500 g were enrolled in this study.Risk factors include BW,gestational age (GA),history of oxygen inhalation,need for blood transfusions,Apgar score in 1 to 10 minutes,embryo number,delivery mode,in vitro fertilization infants,and WG proportion within 6 weeks after birth and other systemic diseases were recorded.Their correlation with severe ROP is analyzed.Clinical outcomes were divided into severe ROP group (patients who suffered from ROP and required treatment) and mild and no ROP group (patients who suffered from ROP but do not require treatment and-patient without ROP).The severe ROP group included 18 patients and mild and no ROP group included 239 patients.Multiple logistic regression and receiver operating characteristic (ROC) curve were used to determine if the WG proportion was independently related to severe ROP development and if it was capable of predicting severe ROP.This study determines the predict value by comparing the area under the ROC curve (AUC) of independent risk factors.Results GA (t=-4.835,P＜0.001),BW(t=-5.192,P＜0.001),history of oxygen inhalation (x2=6.001,P=0.009),proportion of infants who had oxygen inhalation for more than 10 days(x2 =10.019,P=0.002),postnatal WG proportion at 1 week(t =-3.663,P＜ 0.001),postnatal WG proportion at 2 weeks(t=-3.425,P=0.001) had significant difference between two groups.Multiple logistic regression analysis revealed that GA (β =-0.858,P =0.008),BW (β =-0.005,P =0.010),postnatal WG proportion at 2 weeks (β=-8.745,P =0.035) were correlated to severe ROP significantly.And their area under the ROC were 0.836[95％ confidence interval (CI):0.752-0.920],0.826 (95％CI:0.947-0.903),0.744 (95％CI:0.598-0.891) respectively.The optimal cut-off points of GA,BW,and postnatal WG proportion at 2 weeks were 28.41 weeks,1241.96 g,12.80％ respectively.Conclusion Low WG proportion at 2 weeks of very low BW preterm babies is an important and independent risk factor for severe ROP and has certain predictive value of the onset of severe ROP.

OBJECTIVETo study the correlation between brainstem auditory evoked potential (BAEP) and serum neuron-specific enolase (NSE) in neonates with asphyxia and explore the role of NSE in the evaluation of hearing impairment following asphyxia.

METHODSFifty-two term neonates with asphyxia, including 38 cases of simple asphyxia (mild: 23 cases; severe: 15 cases) and 14 cases of asphyxia complicated by hypoxic-ischemic encephalopathy (HIE), were enrolled. In the double-blind trial, BAEP and NSE were simultaneously detected 7 days after birth. The patients who did not pass BAEP test received another BAEP and NSE examinations 3 months after birth. Thirty healthy term neonates served as normal control group.

RESULTSOf the 52 neonates with asphyxia, 50.0% and 21.2% of patients failed the initial and the second BAEP tests, respectively. The detection rates of BAEP anomalies in the simple severe asphyxia group in the initial and the second tests (63.3% and 26.3%, respectively) were significantly higher than those in the simple mild asphyxia group (36.9% and 5.9%, respectively)(P<0.05). The neonates with asphyxia complicated by HIE showed a higher detection rate of BAEP anomalies in the second test compared with the asphyxiated neonates without HIE (31.3% vs 16.7%; P<0.05). Mean serum NSE levels in asphyxiated neonates were significantly higher than those in normal controls (<0.01). There were significant differences in serum NSE levels between the neonates with mild and severe asphyxia (26.70+/-2.34 microg/L vs 17.18+/-3.16 microg/L; P<0.01). The asphyxiated neonates with HIE had serum NSE levels similar to the simple severely asphyxiated neonates. Serum NSE levels in patients who failed the initial BAEP test were significantly higher than those who passed the test (25.69+/-4.12 microg/L vs 17.15+/-3.09 microg/L; <0.01). Serum NSE levels had a positive correlation with wave V reaction threshold detected in the BAFP test (<0.05).

CONCLUSIONSThe serum level of NSE is closely correlated with BAEP, and it may be useful to the evaluation of the hearing impairment and the outcome in neonates with asphyxia.

Asphyxia Neonatorum ; blood ; complications ; physiopathology ; Double-Blind Method ; Evoked Potentials, Auditory, Brain Stem ; Hearing Disorders ; etiology ; Humans ; Hypoxia-Ischemia, Brain ; etiology ; Infant ; Infant, Newborn ; Phosphopyruvate Hydratase ; blood

Drug Resistance, Bacterial ; Gram-Positive Bacteria ; isolation & purification ; Humans ; Infant, Newborn ; Microbial Sensitivity Tests ; Sepsis ; diagnosis ; drug therapy ; microbiology

OBJECTIVEVentilator-associated pneumonia (VAP) is a common nosocomial infection and is responsible for a very high mortality in neonatal intensive care unit (NICU) patients. This study was designed to investigate the etiology and high risk factors of neonatal VAP.

METHODSThe clinical data of 106 critical neonates who were treated with mechanical ventilator between 2003 and 2005 were studied retrospectively.

RESULTSOf the 106 neonates, 84 received mechanical ventilation for > or = 48 hrs. Thirty-five (41.7%) out of the 84 patients developed VAP. Univariate analysis showed that gestational age, duration of mechanical ventilation, reintubation, birth weights, primary lung disease and gamma globulin administration were associated with the development of VAP (P < 0.05). Multivariate stepwise logistic regression analysis showed that primary lung disease (OR=3.671, 95% CI=1.0-13.45, P < 0.05), duration of mechanical ventilation (OR=4.945, CI=1.51-16.21, P < 0.01), reintubation (OR=7.721, 95% CI=2.31-25.85, P < 0.01) and high-dose gamma globulin administration (OR=5.520, 95%CI=2.08-16.26, P < 0.01) were predicted factors for the development of VAP. The detection rate of gram negative bacilli (76.9%) was the highest, followed by gram positive coccus (17.9%) in VAP patients.

CONCLUSIONSOpportunistic drug-resistant bacteria are common pathogens for neonatal VAP. The risk of VAP is multifactorial, including external medical environments and patients' internal agents.

Anti-Bacterial Agents ; therapeutic use ; Female ; Humans ; Infant, Newborn ; Logistic Models ; Male ; Microbial Sensitivity Tests ; Pneumonia, Ventilator-Associated ; drug therapy ; etiology ; Retrospective Studies ; Risk Factors

Objective:To study the feasibility of preserving the subvalvular structure during mitral valve replacement and whether it is more conducive to the recovery of cardiac function.Methods:The clinical data of 205 patients who underwent mitral valve replacement due to mitral insufficiency in Enshi Central Hospital from January 2017 to December 2020 were analyzed retrospectively. According to whether the subvalvular structure of mitral valve was preserved during operation, they were divided into three groups: group A was to preserve all the subvalvular structures of anterior and posterior mitral valve, group B retained all or part of the subvalvular structure of the posterior valve, in group C, all anterior and posterior subvalvular structures were removed. The operation time, cardiopulmonary bypass time and aortic occlusion time of patients in each group were counted. Postoperative ventilator use time, ICU stay time and incidence of complications; mitral flow velocities (MVE), left ventricular end diastolic dimension (LVED), left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) were rechecked by echocardiography at 1 week, 3 months and 6 months after operation.Results:There were no significant differences in operation time, cardiopulmonary bypass time, aortic occlusion time, ventilator use time and ICU stay time among the three groups before surgery ( P>0.05). There were no death cases in perioperative period, and all patients were cured and discharged from hospital. The results of cardiac color ultrasound showed that MVE, LVED, LVEF and LVFS were improved compared with those before operation. Postoperative ultrasound results showed no significant difference in MVE at 1 week, 3 months and 6 months ( P>0.05). At 1 week after surgery, LVED in group A was lower than that in group B and C: (44.90 ± 5.59) mm vs. (46.13 ± 6.15) mm, (48.33 ± 5.59) mm. The difference was statistically significant ( P<0.05). Three months after operation, LVED and LVFS in group A were higher than those in group B and group C: (43.37 ± 5.61) mm vs. (44.69 ± 5.45) mm and (53.42 ± 5.35) mm, (33.92 ± 3.34)% vs. (31.67 ± 3.20)% and (30.37 ± 6.96)%, respectively. The differences were statistically significant ( P<0.05). At 6 months after operation, LVED in group A was lower than that in group B and group C: (41.86 ± 3.27) mm vs. (47.85 ± 6.93) mm and (53.42 ± 8.17) mm. LVFS was higher than that in group B and group C: (33.42 ± 2.64) % vs. (32.18 ± 5.98) % and (32.28 ± 2.58) %, and the differences were statistically significant ( P<0.05). Conclusions:Preserving the whole subvalvular structure of mitral valve will not lead to prosthetic valve dysfunction and increase surgical complications. After operation, it showed better reduction of left ventricular end diastolic diameter and better left ventricular shortening rate, which was more conducive to the recovery of cardiac function.

Objective:To analyze the influencing factors of achieving textbook outcome (TO) after pancreaticoduodenectomy (PD) in patients with pancreatic ductal adenocarcinoma, and to construct a nomograph model to explore its predictive value in TO.Methods:The clinical data of 205 patients with pancreatic ductal adenocarcinoma treated by PD in Henan University People's Hospital from January 2019 to December 2022 were analyzed retrospectively, including 88 males and 117 females with the age of (61.3±9.8) years old. Patients were divided into two groups based on whether they achieved TO after surgery: TO group ( n=113) and non-TO group ( n=92). Clinical data such as age, gender, intraoperative blood loss, operation time, blood transfusion volume, pancreatic CT value, and tumor differentiation degree were collected. Logistic regression analysis screened the influencing factors of PD postoperative TO and built a nomogram model. The performance of the nomogram model was evaluated using receiver operating characteristic (ROC) curve, calibration diagram, and decision curve analysis. Results:Multivariate logistic regression analysis showed that the higher the degree of tumor differentiation was in patients with pancreatic ductal adenocarcinoma (high differentiation to medium differentiation: OR=7.20, 95% CI: 1.20-43.28; high differentiation to low differentiation: OR=16.55, 95% CI: 2.01-136.11), CT value>38.45 Hu ( OR=0.29, 95% CI: 0.13-0.65), blood transfusion volume ≤350 ml ( OR=8.05, 95% CI: 2.94-22.01) and operative time ≤407.5 min ( OR=10.88, 95% CI: 3.90-30.41), the easier it was to achieve TO after PD (all P<0.05). Based on the above influencing factors, a nomogram model of the postoperative effect of PD on TO was established, and the consistency index of this column graph model was 0.863 (95% CI: 0.816-0.911). The sensitivity and specificity of ROC curve were 0.804 and 0.752, respectively. The calibration diagram showed that the calibration curve fits well with the ideal curve, and the decision curve showed that the model had obvious positive net benefit. Conclusion:The degree of tumor differentiation, CT value, blood transfusion volume, and operation time are independent influencing factors for the achievement of TO after PD in patients with pancreatic ductal adenocarcinoma, and the nomogram model constructed based on which has good predictive performance for TO.

Objective:To analyze the effect of sarcopenia on the prognosis of patients with hepatocellular carcinoma (HCC) after laparoscopic radical resection.Methods:Clinical data of 165 patients with HCC undergoing laparoscopic radical resection in Henan University People's Hospital from January 2018 to December 2021 were retrospectively analyzed, including 122 males and 43 females, aged (55.5±11.4) years. Patients were divided into sarcopenia group ( n=79) and control group (non-sarcopenia, n=86) according to the skeletal muscle index. The survivals were analyzed using the Kaplan-Meier method, and were compared by the log-rank test. Univariate and multivariate Cox regression were utilized to analyze the effect of sarcopenia on the prognosis of HCC after laparoscopic radical surgery. Results:The 1- and 3-year cumulative survival rates of control group were 96.4% and 81.2%, which were higher than those of the sarcopenia group (83.2% and 48.9%, respectively, χ2=19.67, P<0.001). The 1- and 3-year recurrence-free survival (RFS) rates of control group were 88.4% and 66.1%, which were higher than those of sarcopenia group (70.9% and 37.7%, respectively, χ2=18.80, P<0.001). Multivariate Cox regression analysis showed that the risk of recurrence ( HR=1.35, 95% CI: 1.20-1.59, P<0.001) and the risk of death ( HR=2.21, 95% CI: 1.23-3.41, P=0.001) after laparoscopic radical resection for HCC in patients with sarcopenia rises compared to non-sarcopenic patients. Conclusion:Sarcopenia is a risk factor for the survival and recurrence of HCC after laparoscopic radical surgery.