OBJECTIVE To evaluate the clinical efficacy of lamivudine on prevention of liver injury in HBV carriers complicating tuberculous exudative pleurisy after use of antituberculosis drugs.METHODS Totally 120 HBV carriers complicating tuberculous exadative pleurisy after use of antituberculosis drugs were randomly divided into lamivudine group and control group.RESULTS The incidence rate of liver injury was 10.0% in lamivudine group vs 1.7% in control group(P0.05).CONCLUSIONS Lamivudine may be good for reducing liver injury in HBV carriers complicating tuberculous exadative pleurisy after use of antituberculosis drugs.

Adolescent ; Adult ; Bone Nails ; Calcaneus ; injuries ; surgery ; Follow-Up Studies ; Fracture Fixation, Internal ; instrumentation ; Fractures, Bone ; physiopathology ; surgery ; therapy ; Humans ; Male ; Manipulation, Orthopedic ; methods ; Middle Aged ; Young Adult

Objective To evaluate the reliability and accuracy of three-dimensional digital fusion anatomy in the preoperative evaluation and therapeutic strategy choice of intracranial tumors.Methods MRI scan,including regular MRI,MRA,MRV and DTI,were performed in 87 case.Then tumor themselves as well as tumor-associated structures were reconstructed and fused through iPlan 2.6 software.Based on the reconstructed images,therapeutic strategy were established,preoperative and intraoperative imags were compared.Results The digital reconstruction were successfully finished in all cases.Meanwhile,digital images,originally radiological images and actual images matched well.No approach-associated complication were met in our series.Among tumors in the convexity,the relationship of the reflux veins and the tumors were divided into three types:anterior(12 cases),posterior(19 cases) and overriding(3 cases).All of the relationships were seen in the preoperative fusion image,and the veins were all effectively protected during operation.The tumor-associated arteries could be pushed or wraped by the tumors,and the three-dimensional fusion image could provided their virtually aberrant pathway as well as their relationship with tumor.During microsurgical managment of tumors in the deep brain parenchyma,safe approach were found with the help of comprehensive understanding of the tumors and their adjacent structures.Conclusion Three-dimensional digital fusion anatomy can vividly and accurately display full rang of information about the tumor,and facilitate tumor treatment safely.

OBJECTIVE: To evaluate the applicative value of multimodal navigation combined with intraoperative magnetic resonance imaging system in the treatment of complex lesions of middle skull base. METHOD: Nineteen consecutive patients undergoing complex lesions resection using multimodal microscopic navigation combined with iMRI were included. Preoperative radiological images were imported into navigation planning system, based on which approach and microsurgical window were designed. Transcranial approach and extracranial approach(include trans-oral-nasal-sphenoidal approach and transsphenoidal approach) were performed in our series. After presumptively total resection were finished, intraoperative magnetic resonance (iMRI)were performed, followed by navigation images updating, and continuing resection if necessary. RESULT: iMRI scan were performed from 1 time to 2 times. In 5 cases with residual seen on iMRI scan, continued resection were carried on in 2 of them. There was no iMRI-associated complications. CONCLUSION Microscopic-based neuronavigation, in combination with intraoperative magnetic resonance, could provide objective basis for resection, and improve the safety level of tumor resection.
Adult ; Aged ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Microsurgery ; methods ; Middle Aged ; Neurosurgical Procedures ; Skull Base ; surgery

Objective:To investigate the application value of high-resolution CT in the diagnosis of early lung adenocarcinoma.Methods:The clinical data of 90 patients with early lung adenocarcinoma who received treatment from January to December 2021 in Quzhou People's Hospital were retrospectively analyzed. These patients were divided into a non-invasive group ( n = 27) and an invasive group ( n = 63) according to whether they had invasive lung adenocarcinoma or not. In the non-invasive group, there were 10 patients with atypical adenomatous hyperplasia and 17 patients with in situ adenocarcinoma. In the invasive group, there were 38 patients with minimally invasive adenocarcinoma and 25 patients with invasive adenocarcinoma. A pathological diagnosis was performed in all patients. All patients underwent a high-resolution CT examination. The incidence of lung adenocarcinoma was compared between different loci. CT signs were compared between the non-invasive group and the invasive group. The receiver operating characteristic curve was used to determine the sensitivity and specificity of high-resolution CT in the differential diagnosis of lung adenocarcinoma prior to invasion. Results:There was no significant difference in the incidence of lung adenocarcinoma among the left upper lobe, right upper lobe, left lower lobe, and right lower lobe of the lung in each group (all P > 0.05). The detection rates of pleural indentation sign, spicule sign, and vascular bundle sign in the invasive group were 28.6% (18/63), 31.57% (20/63), and 27.0% (17/63), respectively, which were significantly higher than 7.41% (2/27), 11.11% (3/27), and 7.41% (2/27) in the non-invasive group ( χ2 = 4.90, 4.23, 4.35, all P < 0.05). There were no significant differences in detection rates in the lobar sign and air bronchogram sign between the two groups (both P > 0.05). The receiver operating characteristic curve analysis results showed that the sensitivity and specificity of high-resolution CT in differentiating pre-invasive lesions were 100.0% and 64.7%, respectively. Conclusion:High-resolution CT has a good diagnostic value for early lung adenocarcinoma. It can clearly display various signs of early lung adenocarcinoma, which is worthy of clinical reference.

BACKGROUNDThrombolysis with recombinant tissue plasminogen activator (rt-PA) has gained international recognition, clinical outcomes following this thrombolytic therapy varied from patient to patient. Factors affecting clinical outcomes have not been well understood yet, so this retrospective case-control study aimed to investigate factors that may influence clinical outcomes of acute ischemic stroke treated with intravenous rt-PA.

METHODSOne hundred and one patients with acute ischemic stroke who received intravenous rt-PA thrombolysis within 4.5 hours from disease onset were included. Patients were divided into good or poor outcome group according to modified Rankin Scale (mRS) score, good outcome group: mRS score of 0-1; poor outcome group: mRS of 2-6. Stroke characteristics were compared between the two groups. Factors for stroke outcomes were analyzed via univariate analysis and Logistic regression.

RESULTSOf the 101 patients studied, patients in good outcome group (n = 55) were significantly younger than patients in poor outcome group (n = 46, (62.82 ± 14.25) vs. (68.81 ± 9.85) years, P = 0.029). Good outcome group had fewer patients with diabetic history (9.09% vs. 28.26%, P = 0.012), fewer patients with leukoaraiosis (7.27% vs. 28.26%, P = 0.005) and presented with lower blood glucose level ((5.72 ± 1.76) vs. (6.72 ± 1.32) mmol/L, P = 0.012), lower systolic blood pressure level ((135.45 ± 19.36) vs. (148.78 ± 19.39) mmHg, P = 0.003), lower baseline NIHSS score (12.02 ± 5.26 vs. 15.78 ± 4.98, P = 0.002) and shorter onset-to-treatment time (OTT) ((2.38 ± 1.21) vs. (2.57 ± 1.03) hours, P = 0.044) than poor outcome group. Logistic regression analysis showed that absence of diabetic history (odds ratio (OR) 0.968 (95% CI 0.941-0.996)), absence of leukoaraiosis (OR 0.835 (95% CI 0.712-0.980)), lower baseline NIHSS score (OR 0.885 (95% CI 0.793-0.989)), lower pre-thrombolysis systolic blood pressure (OR 0.962 (95% CI 0.929-0.997)), and lower blood glucose level (OR 0.699 (95% CI 0.491-0.994)) before thrombolysis were significantly associated with better outcome.

CONCLUSIONPatients with no history of diabetes, no leukoaraiosis, low blood glucose level, low systolic blood pressure level and low baseline NIHSS score before thrombolysis have a better outcome.

Aged ; Blood Pressure ; Case-Control Studies ; Female ; Fibrinolytic Agents ; therapeutic use ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stroke ; drug therapy ; Thrombolytic Therapy ; Tissue Plasminogen Activator ; therapeutic use ; Treatment Outcome

Objective To explore the validity of two-staged revision for hip periprosthetic joint injection and intermediate-term clinical effects.Methods The clinical data of 31 cases who were underwent two-staged revision for unilateral hip periprosthetic joint infection in Department of Orthopaedics,Beijing Friendship Hospital,Capital Medical University from March 2014 to September 2016 were analyzed retrospectively.There were 13 males and 18 females,aged (67.5 ±7.8) years,with an age range of 52-79 years.All patients underwent two-staged revision,taking preoperative and intraoperative joint puncture fluid,intraoperative infection of soft tissue for bacterial culture was to clear medication.In first stage,prosthesis removed,debridement performed and antibiotic spacer implanted were performed.Antibiotics were used for 8 to 12 weeks for infection.In second stage,total hip arthroplasty revision was performed while infection was controlled.Harris hip scores,Short form 36 health status scores (SF-36),white blood cell counts,C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)were compared between preoperative and postoperative follow-up in all patients,and postoperative complications were recorded.Postoperative outpatient follow-up was 30.1 to 59.3 months,and reviewed every 12 months after 3 months,6 months,and 12 months.The follow-up deadline was April 2019.Measurement data were expressed as mean ± standard deviation (Mean ± SD).The t test was used to compare the preoperative and postoperative follow-up.Results All 29 patients were followed up for follow-up except 2 patients were lost to follow-up.Preoperative Harris hip score,SF-36,white blood cell count,CRP and ESR were (39.4 ± 5.6) scores,(398.8 ± 39.2) scores,(12.5 ± 0.6) × 109/L,(63.3 ± 10.1) mg/L and (83.7 ± 12.5) mm/h,respectively.The last follow-up oftbe above indicators were (76.9 ±9.3) scores,(649.3 ±67.5) scores,(9.1 ±0.5) × 109/L,(5.3 ± 1.7) mg/L and (10.2 ± 1.6) mm/h,respectively.The results of final followed-up were much better than the preoperative results and there were significant differences between postoperation and preoperation for all indexes.One patient developed postoperative hip dislocation and was treated with manual reduction under general anesthesia.The two patients were diagnosed hip periprosthetic joint infection of joint at 8 months and 15 months respectively after two-staged revision and treated by removing the hip prosthesis.One patient was performed revision again and the other was not performed any operation for poor health condition.The remaining 26 patients had no complications.Conclusions Two-staged revision for periprosthetic joint infection of hip joint can not only treat infection effectively but also can recover hip function significantly.The early and intermediate-term clinical effects of the surgical treatment is satisfied.

Objective To explore the regularity of time-dependent changes in morphology and biomechanical properties of brain tissues in pigs, and value the feasibility of deducing the postmortem interval (PMI). Methods Brain tissues were taken from 42 pigs and kept in an artificial climate chamber with the temperature of 25 ℃ and humidity of 75%. The samples were collected from telencephalon at sequential time intervals (0, 12, 24, 36, 48, 60 h；n=6) according to the principle of predefined time, position, direction, ratio, quantity and shape. The samples fixed with formaldehyde were then immediately tested by mechanical testing machine to obtain their biomechanical parameters and the histological sections were prepared. Results With the extension of PMI (0-60 h), brain tissues gradually became discolored, weak, mudding and liquefied under the influence of autolysis and putrefaction. Both clearance area of the white matter and its integrated optical density (IOD) significantly increased during 0-48 h. Biomechanical properties of brain tissues including the limit load, average force, elastic modulus and fracture energy all presented a declining tendency at the interval of 12-60 h. The limit load was considered highly statistically significant, and statistical differences were found in average force, elastic modulus and fracture energy. Conclusions There exists a significantly negative structure-activity relationship between the morphology of brain tissues and biomechanical properties. The limit load of postmortem brain tissues in 60 h is the optimum in the window period, which can be used as a new method for estimating PMI.

Objective: To understand the prevalence, diagnosis and treatment of chronic critical illness (CCI) in China. Methods: The clinical data of 472 adult patients admitted to ICU in 53 hospitals, including basic information, disease-related data, nutrition program, etc., were collected on May 10, 2019, by means of multi-center cross-sectional study. If surgical intervention was needed or the occurrence of the disease was directly related to the surgery, ICU patients were regarded as surgical ICU cases (n=211). In this study, the diagnostic criteria for CCI were: (1) admission to ICU >14 days;(2) combined with persistent organ dysfunction. The prevalence,distribution and treatment of CCI and surgery-related CCI were recorded and analyzed. The Mann-Whitney U test, chi-square test or Fisher exact test were used for comparative analysis. Results: Among the 472 ICU patients from 53 hospitals, 326 were male (69.1%) and 146 were female (30.9%). The prevalence of CCI was 30.7% (145/472). Among 211 surgery-related ICU patients, 57 developed CCI with a prevalence of 27.0%. As compared to non-CCI patients, higher APACHE II score [median (IQR) 13.5 (10.0, 18.3) vs. 11.0 (7.0, 16.0), U=2970.000, P=0.007], higher Charlson comorbidity index [median (IQR) 4.0 (2.0, 7.0) vs. 3.0 (1.0, 5.0), U= 3570.000, P=0.036] and higher ratio of breath dysfunction [68.4% (39/57) vs. 48.1% (74/154), χ²=6.939, P=0.008] and renal dysfunction [42.1% (24/57) vs. 18.2% (28/154), χ²=12.821, P<0.001] were found in surgery-related CCI patients. While SOFA score, Glasgow coma score and other visceral function were not significantly different between surgery-related CCI and non-CCI patients (all P>0.05). NUTRIC score showed that surgery-related CCI patients had higher nutritional risk [43.9% (25/57) vs. 26.6%(41/154), U=5.750, P=0.016] and higher ratio of mechanical ventilation [66.7% (38/57) vs. 52.3% (79/154), χ²=3.977, P=0.046] than non-CCI patients. On the survey day, the daily caloric requirements of 50.2% (106/211) of surgery-related ICU patients were calculated according to the standard adult caloric intake index (104.6 to 125.5 kJ·kg^-1·d^-1, 1 kJ=0.239 kcal), and the daily caloric requirements of 46.4% (98/211) of patients were calculated by physicians according to the severity of the patient′s condition. 60.2% (127/211) of nutritional support therapy was enteral nutrition (including a combination of enteral and parenteral nutrition), while the remaining patients received parenteral nutrition (24.6%, 52/211), simple glucose infusion (9.0%, 19/211), or oral diet (6.2%, 13/211). The target calorie of CCI group was 104.6 (87.9, 125.5) kJ·kg^-1·d^-1, and the actual calorie intake accounted for 0.98 (0.80, 1.00) of the target calory. In the non-CCI group, the target calorie was 104.6 (87.9, 125.5) kJ·kg^-1·d^-1, and the actual calorie consumed accounted for 0.91 (0.66, 1.00) of the target calorie. There was no statistically significant difference between two groups (P=0.248, P=0.150). Conclusion The prevalence of CCI and surgery-related CCI in ICU is high, along with severe complications, respiratory and renal dysfunction and mechanical ventilation. Surgical patients admitted to ICU are at high nutritional risk, and active and correct nutritional support is essential for such patients.