OBJECTIVETo introduce a simple, fast and universal measuring method used in measurement of the surface area of scalp flap over the cranial defect after decompressive craniectomy.

METHODSThe first step: CT images of the patient with craniocerebral trauma after decompressive craniectomy were obtained and imported into Mimics. The second step: based on the defined threshold, the 3D geometric models of brain and skull were reconstructed after the original Dicom format pictures three-dimensional processed by Mimics. The third step: based on the two builded 3D models, utilizing the segmentation and measurement tools of Mimics to conduct cutting, splitting and measuring operations for the 3D model of brain. The forth step: estimating the surface area of scalp flap over the removed bone flap by using mathematical computation methods.

RESULTSThe application of the introduced method estimated the surface area of scalp flap over the cranial defect of different people with different position of craniocerebral trauma.

CONCLUSIONSThis paper introduces a simple, fast and universal new measuring method. We can conveniently estimate the surface area of scalp flap by using the introduced method.

Objective To introduce a simple, fast and universal measuring method used in measurement of the surface area of scalp flap over the cranial defect after decompressive craniectomy. Methods The first step: CT images of the patient with craniocerebral trauma after decompressive craniectomy were obtained and imported into Mimics. The second step:based on the defined threshold, the 3D geometric models of brain and skul were reconstructed after the original Dicom format pictures three-dimensional processed by Mimics. The third step:based on the two builded 3D models, utilizing the segmentation and measurement tools of Mimics to conduct cutting, splitting and measuring operations for the 3D model of brain. The forth step: estimating the surface area of scalp flap over the removed bone flap by using mathematical computation methods. Results The application of the introduced method estimated the surface area of scalp flap over the cranial defect of different people with different position of craniocerebral trauma. Conclusions This paper introduces a simple, fast and universal new measuring method. We can conveniently estimate the surface area of scalp flap by using the introduced method.

Objective:To compare the application effects of electric impedance tomography (EIT)-guided positive end-expiratory pressure conventional PEEP and PEEP-fraction of inspired oxygen (FiO 2) table-guided PEEP in the mechanical ventilation of patients with traumatic brain injury (TBI) complicated with acute respiratory distress syndrome (ARDS). Methods:A retrospective cohort study was conducted on the clinical data of 80 TBI patients complicated with ARDS admitted to Zhengzhou Central Hospital Affiliated to Zhengzhou University from July 2020 to December 2022, including 42 males and 38 females, aged 29-59 years [(42.4±7.8)years]. The Glasgow coma scale (GCS) scores were 3-12 points [(7.7±2.2)points]. According to ARDS classification, 33 were mild, 26 moderate and 21 severe. All the patients were treated with mechanical ventilation according to lung protective ventilation strategy, including 42 patients treated with EIT-guided PEEP (EIT group) and 38 treated with conventional PEEP-FiO 2 table-guided PEEP (conventional group). At 12 hours, 1, 3 and 5 days after ventilation, the optimal PEEP, respiratory mechanics [driving pressure (ΔP), static compliance (C St), mechanical power (MP)], pulmonary gas exchange [arterial blood pH value, arterial partial pressure of carbon dioxide (PaCO 2), oxygenation index (P/F)], ventilation distribution [heterogeneity index (GI), regions of interest (ROI)1-4], hemodynamics [heart rate (HR), central venous pressure (CVP), mean arterial pressure (MAP)], cerebral perfusion status [intracranial pressure (ICP), regional cerebral oxygen saturation (rScO 2) grading], and treatment outcomes (mechanical ventilation duration, incidence of ventilator-induced lung injury (VILI), length of ICU stay, 6-month survival rate) separately at their optimal PEEP were compared between the two groups. Results:All the patients were followed up for 6 months. The optimal PEEP of the EIT group was (7.4±1.0)cm, (8.2±1.2)cm, (9.8±0.8)cm and (8.4±0.7)cm respectively at 12 hours, 1, 3 and 5 days after mechanical ventilation, which were higher than (7.0±1.0)cm, (7.6±1.0)cm, (9.0±0.6)cm and (7.2±0.5)cm of the conventional group ( P<0.05 or 0.01). At their optimal PEEP separately, at 12 hours, 1, 3 and 5 days after treatment, the ΔP of the EIT group was (7.1±1.3)cmH 2O, (7.7±1.3)cmH 2O, (9.5±1.1)cmH 2O and (6.1±1.3)cmH 2O respectively, which were all lower than (8.9±1.3)cmH 2O, (10.5±1.3)cmH 2O, (11.2±1.2)cmH 2O and (8.7±1.2)cmH 2O of the conventional group respectively ( P<0.05 or 0.01); the C St of the EIT group was (51.5±4.2)ml/cmH 2O, (52.9±4.6)ml/cmH 2O, (55.1±4.3)ml/cmH 2O and (57.5±3.6)ml/cmH 2O, which were all higher than (46.8±3.9)ml/cmH 2O, (47.6±4.4)ml/cmH 2O, (49.9±4.3)ml/cmH 2O and (53.3±3.6)ml/cmH 2O of the conventional group respectively ( P<0.05); the MP of the EIT group was (7.9±1.8)J/min, (8.8±1.3)J/min, (10.6±1.3)J/min and (7.8±0.9)J/min, which were lower than (8.6±1.5)J/min, (9.5±1.0)J/min, (12.2±1.8)J/min and (8.6±0.9)J/min of the conventional group respectively ( P<0.05 or 0.01); the P/F of the EIT group was (207.1±7.1)mmHg, (213.1±6.9)mmHg, (239.3±13.1)mmHg and (255.5±11.8)mmHg, which were all higher than (179.6±7.2)mmHg, (187.8±9.6)mmHg, (212.8±9.6)mmHg and (228.1±12.3)mmHg of the conventional group respectively ( P<0.05 or 0.01); the GI of the EIT group were 0.381±0.013, 0.387±0.012, 0.392±0.010 and 0.395±0.010, lower than 0.403±0.005, 0.406±0.005, 0.409±0.005 and 0.411±0.004 of traditional group respectively ( P<0.01); there were no significant differences in the arterial blood pH value, PaCO 2, ROI1-4, HR, CVP, MAP, ICP, or rScO 2 grading between the two groups (P>0.05). The ventilation duration of the EIT group was (78.5±9.0)hours, which was shorter than (83.1±7.4)hours of the conventional group ( P<0.05). The incidence of VILI was 0.0% (0/42) in the EIT group, which was lower than 7.8% (3/38) in the conventional group ( P<0.05). There were no significant differences in the ICU stay or 6-month survival rate between the two groups ( P>0.05). Conclusions:In mechanical ventilation treatment of TBI complicated with ARDS, the optimal PEEP guided by EIT was higher than that guided by PEEP-FiO 2 table. At this optimal PEEP, the respiratory mechanics and oxygen supply of the patients can be improved more effectively, making regional lung ventilation more uniform, reducing the mechanical ventilation time and decreasing the incidence of VILI without affecting their hemodynamics and brain perfusion.

Background::Hypertension and non-alcoholic fatty liver disease (NAFLD) share several pathophysiologic risk factors, and the exact relationship between the two remains unclear. Our study aims to provide evidence concerning the relationship between hypertension and NAFLD by analyzing data from the National Health and Nutrition Examination Survey (NHANES) 2017-2018 and Mendelian randomization (MR) analyses.Methods::Weighted multivariable-adjusted logistic regression was applied to assess the relationship between hypertension and NAFLD risk by using data from the NHANES 2017-2018. Subsequently, a two-sample MR study was performed using the genome-wide association study (GWAS) summary statistics to identify the causal association between hypertension, systolic blood pressure (SBP), diastolic blood pressure (DBP), and NAFLD. The primary inverse variance weighted (IVW) and other supplementary MR approaches were conducted to verify the causal association between hypertension and NAFLD. Sensitivity analyses were adopted to confirm the robustness of the results.Results::A total of 3144 participants were enrolled for our observational study in NHANES. Weighted multivariable-adjusted logistic regression analysis suggested that hypertension was positively related to NAFLD risk (odds ratio [OR] = 1.677; 95% confidence interval [CI], 1.159-2.423). SBP ≥130 mmHg and DBP ≥80 mmHg were also significantly positively correlated with NAFLD. Moreover, hypertension was independently connected with liver steatosis ( β = 7.836 [95% CI, 2.334-13.338]). The results of MR analysis also supported a causal association between hypertension (OR = 7.203 [95% CI, 2.297-22.587]) and NAFLD. Similar results were observed for the causal exploration between SBP (OR = 1.024 [95% CI, 1.003-1.046]), DBP (OR = 1.047 [95% CI, 1.005-1.090]), and NAFLD. The sensitive analysis further confirmed the robustness and reliability of these findings (all P >0.05). Conclusion::Hypertension was associated with an increased risk of NAFLD.

Objective:To investigate the risk factors for intracranial hematoma progression in patients within 24 h of traumatic brain injury.Methods:A prospective study was performed; 184 patients with traumatic brain injury admitted to our hospital from January 2018 to June 2021 were enrolled. According to the states of intracranial hematoma indicated by head CT within 24 h of injury, these patients were divided into intracranial hematoma progression group ( n=52) and intracranial hematoma stable group ( n=132). The clinical data of patients in the two groups were compared and the independent risk factors for intracranial hematoma progression were screened by multivariate Logistic regression analysis. Results:As compared with intracranial hematoma stable group, patients in the intracranial hematoma progression group had significantly advanced age, significantly higher systolic blood pressure and blood glucose levels, statistically higher proportions of patients with parenchymal hemorrhage, subarachnoid hemorrhage, and multiple hematomas, significantly longer prothrombin time, significantly higher international standardization index and D-dimer level, significantly higher proportion with patients with fibrinogen<2.0 g/L, statistically increased K value (blood coagulation time) of thromboelastic map, proportion of patients with α Angle (blood coagulation angle)<64°, level of vascular endothelial biomarker syndecan-1 (Syn-1), and von willebrand factor (vWF) activity, and significantly decreased Glasgow Coma Scale (GCS) scores at admission and platelet count ( P<0.05). Multivariate Logistic regression analysis showed that age ( OR=1.066, 95%CI: 1.018-1.117, P=0.007), systolic blood pressure ( OR=1.076, 95%CI: 1.041-1.111, P<0.001), multiple hematoma ( OR=6.559, 95%CI: 2.025-21.245, P=0.002), fibrinogen<2.0 g/L ( OR=6.164, 95%CI: 1.586-23.954, P=0.009), K value ( OR=6.500, 95%CI: 1.755-24.082, P=0.005) and Syn-1 level ( OR=1.111, 95%CI: 1.015-1.215, P=0.022) were independent risk factors for intracranial hematoma progression in patients with traumatic brain injury at early stage. Conclusion:Traumatic brain injury patients, at early stage, with advanced age, multiple intracranial hematoma, high systolic blood pressure, low fibrinogen, prolonged K value and high Syn-1 level are trend to have intracranial hematoma progression.

Objective To analyze the distribution and antimicrobial resistance profile of clinical bacterial strains isolated from blood culture in China.Methods Clinical bacterial strains isolated from blood culture from participating hospitals of Blood Bacterial Resistance Investigation Collaborative System (BRICS) during January 2014 to December 2015 were collected.Antibiotic susceptibility tests were conducted with agar dilution or broth dilution methods as recommended by US Clinical and Laboratory Standards Institute(CLSI)2018.The data were analyzed with Whonet 5.6 software.Results During the study period,4 801 clinical bacterial isolates were collected from 26 hospitals,of which 1 798 (37.5％) were Gram-positive bacteria and 3 003 (62.5％) were gram-negative bacteria.The top 10 isolates were Escherichia coli (33.8％),coagulase-negative Staphylococcus (19.0％),Klebsiella pneumoniae (11.9％),Staphylococcus aureus (10.1％),Acinetobacter baumannii (4.0％),Pseudomonas aeruginosa (3.8％),Streptococcus (3.0％),Enterobacter sulcus (2.9％),Enterococcus faecium (2.8％) and Enterococcus faecalis (1.8％).Methicillin-resistant Staphylococcus aureus (MRSA) and methicillinresistant coagulase-negative Staphylococcus (MRCNS) accounted for 33.9％ (165/487) and 56.9％ (520/913) of Staphylococcus aureus and coagulase-negative Staphylococcus respectively.No vancomycinresistant Staphylococcus was detected.The resistance rate of Enterococcus faecium to vancomycin was 0.7％ (1/135),and no vancomycin-resistant Enterococcus faecaliss was detected.The positive rates of extendedspectrum β-1actamases(ESBLs)-producing Escherichia coli,Klebsiella pneumoniae and Proteus were 56.9％ (923/1 621),30.1％ (172/572) and 29.2％ (7/24),respectively.The positive rates of carbapenemresistant Escherichia coli,Klebsiella pneumoniae,Enterobacter,Salmonella and Citrobacter were 1.2％ (20/1 621),7.2％ (41/572),4.3％ (6/141),1.5％ (1/67) and 2.9％ (1/34),respectively.The resistance rates of Acinetobacter baumannii to polymyxin and tegacycline were 2.6％ (5/190) and 8.9％ (17/190)respectively,and that of Pseudomonas aeruginosa to polymyxin and fosfomycin were 1.1％ (2/183)and 0.6％ (1/183),respectively.Conclusions The surveillance results from 2014 to 2015 show that the main pathogens of blood stream infection in China are Gram-negative bacteria,while Escherichia coli is the most common pathogen,the detection rate of MRSA is lower than other surveillance data in the same period in China;carbapenem-resistant Klebsiella pneumoniae and Escherichia coli are at a low level as shown in this surveillance.

Objective:To compare the efficacy of the combination of abidol, lopinavir/ritonavir plus recombinant interferon α-2b (rIFNα-2b) and the combination of lopinavir/ritonavir plus rIFNα-2b for patients with COVID-19 in Zhejiang province.Methods:A multicenter prospective study was carried out to compare the efficacy of triple combination antiviral therapy and dual combination antiviral therapy in 15 medical institutions of Zhejiang province during January 22 to February 16, 2020. All patients were treated with rIFNα-2b (5 million U, 2 times/d) aerosol inhalation, in addition 196 patients were treated with abidol (200 mg, 3 times/d) + lopinavir/ritonavir (2 tablets, 1 time/12 h) (triple combination group) and 41 patients were treated with lopinavir/ritonavir (2 tablets, 1 time/12 h) (dual combination group). The patients who received triple combination antiviral therapy were further divided into three subgroups: <48 h, 3-5 d and >5 d according the time from the symptom onset to medication starting. The therapeutic efficacy was compared between triple combination group and dual combination group, and compared among 3 subgroups of patients receiving triple combination antiviral therapy. SPSS 17.0 software was used to analyze the data.Results:The virus nucleic acid-negative conversion time in respiratory tract specimens was (12.2±4.7) d in the triple combination group, which was shorter than that in the dual combination group [(15.0±5.0) d] ( t=6.159, P<0.01). The length of hospital stay in the triple combination group [12.0 (9.0, 17.0) d] was also shorter than that in the dual combination group [15.0 (10.0, 18.0) d] ( H=2.073, P<0.05). Compared with the antiviral treatment which was started within after the symptom onset of in the triple combination group, the time from the symptom onset to the viral negative conversion was 13.0 (10.0, 17.0), 17.0 (13.0, 22.0) and 21.0 (18.0, 24.0) d in subgroups of 48 h, 3-5 d and >5 d, respectively ( Z=32.983, P<0.01), while the time from antiviral therapy to viral negative conversion was (11.8±3.9), (13.5±5.1) and (11.2±4.3) d, respectively( Z=6.722, P<0.05). Conclusions:The triple combination antiviral therapy of abidol, lopinavir/litonavir and rIFNα-2b shows shorter viral shedding time and shorter hospitalization time, compared with the dual combination antiviral therapy; and the earlier starting triple combination antiviral therapy will result in better antiviral efficacy.

Objective:To investigate the distribution and antimicrobial resistance profile of clinical bacteria isolated from blood culture in China.Methods:The clinical bacterial strains isolated from blood culture from member hospitals of Blood Bacterial Resistant Investigation Collaborative System (BRICS) were collected during January 2018 to December 2019. Antibiotic susceptibility tests were conducted with agar dilution or broth dilution methods recommended by US Clinical and Laboratory Standards Institute (CLSI). WHONET 5.6 was used to analyze data.Results:During the study period, 14 778 bacterial strains were collected from 50 hospitals, of which 4 117 (27.9%) were Gram-positive bacteria and 10 661(72.1%) were Gram-negative bacteria. The top 10 bacterial species were Escherichia coli (37.2%), Klebsiella pneumoniae (17.0%), Staphylococcus aureus (9.7%), coagulase-negative Staphylococci (8.7%), Pseudomonas aeruginosa (3.7%), Enterococcus faecium (3.4%), Acinetobacter baumannii(3.4%), Enterobacter cloacae (2.9%), Streptococci(2.8%) and Enterococcus faecalis (2.3%). The the prevalence of methicillin-resistant S. aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus were 27.4% (394/1 438) and 70.4% (905/1 285), respectively. No glycopeptide-resistant Staphylococcus was detected. More than 95% of S. aureus were sensitive to amikacin, rifampicin and SMZco. The resistance rate of E. faecium to vancomycin was 0.4% (2/504), and no vancomycin-resistant E. faecalis was detected. The ESBLs-producing rates in no carbapenem-resistance E. coli, carbapenem sensitive K. pneumoniae and Proteus were 50.4% (2 731/5 415), 24.6% (493/2001) and 35.2% (31/88), respectively. The prevalence of carbapenem-resistance in E. coli and K. pneumoniae were 1.5% (85/5 500), 20.6% (518/2 519), respectively. 8.3% (27/325) of carbapenem-resistance K. pneumoniae was resistant to ceftazidime/avibactam combination. The resistance rates of A. baumannii to polymyxin and tigecycline were 2.8% (14/501) and 3.4% (17/501) respectively, and that of P. aeruginosa to carbapenem were 18.9% (103/546). Conclusions:The surveillance results from 2018 to 2019 showed that the main pathogens of bloodstream infection in China were gram-negative bacteria, while E. coli was the most common pathogen, and ESBLs-producing strains were in majority; the MRSA incidence is getting lower in China; carbapenem-resistant E. coli keeps at a low level, while carbapenem-resistant K. pneumoniae is on the rise obviously.

Objective:To investigate the distribution and antimicrobial resistance profile of clinical bacteria isolated from blood culture in China.Methods:The clinical bacterial strains isolated from blood culture from member hospitals of Blood Bacterial Resistant Investigation Collaborative System (BRICS) were collected during January 2016 to December 2017. Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by US Clinical and Laboratory Standards Institute (CLSI) 2019. WHONET 5.6 was used to analyze data.Results:During the study period, 8 154 bacterial strains were collected from 33 hospitals, of which 2 325 (28.5%) were Gram-positive bacteria and 5 829 (71.5%) were Gram-negative bacteria. The top 10 bacterial species were Escherichia coli (34.7%), Klebsiella pneumoniae (15.8%), Staphylococcus aureus (11.3%), coagulase-negative Staphylococci (7.4%), Acinetobacter baumannii (4.6%), Pseudomonas aeruginosa (3.9%), Enterococcus faecium (3.8%), Streptococci (2.9%), Enterobacter cloacae (2.7%) and Enterococcus faecalis (2.5%). Methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus (MRCNS) accounted for 34.2%(315/922) and 77.7%(470/605), respectively. No vancomycin-resistant Staphylococcus was detected. The resistance rate of Enterococcus faecium to vancomycin was 0.6%(2/312), and no vancomycin-resistant Enterococcus faecium was detected. The ESBLs-producing rates in Escherichia coli, Klebsiella pneumoniae and Proteus were 55.7%(1 576/2 831), 29.9%(386/1 289) and 38.5%(15/39), respectively. The incidences of carbapenem-resistance in Escherichia coli, Klebsiella pneumoniae were 1.2%(33/2 831), 17.5%(226/1 289), respectively. The resistance rates of Acinetobacter baumannii to polymyxin and tigecycline were 14.8%(55/372) and 5.9%(22/372) respectively, and those of Pseudomonas aeruginosa to polymyxin and carbapenem were 1.3%(4/315) and 18.7%(59/315), respectively. Conclusion:The surveillance results from 2016 to 2017 showed that the main pathogens of blood stream infection in China were gram-negative bacteria, while Escherichia coli was the most common pathogen; the MRSA incidence was lower than other surveillance data in the same period in China; carbapenem-resistant Escherichia coli was at a low level during this surveillance, while carbapenem-resistant Klebsiella pneumoniae is on the rise.

Objective: Comparing the benefit of Abidor, lopinavir/ritonavir and recombinant interferon α-2b triple combination antiviral therapy and lopinavir/ritonavir and interferon dual combination antiviral therapy to hospitalized novel coronavirus pneumonia 2019 in Zhejiang province. Methods: A multi-center prospective study was carried out to compare the effect of triple combination antiviral therapy with dual combination antiviral therapy in 15 medical institutions of Zhejiang Province. All patients were treated with recombinant interferon α-2b (5 million U, 2 times/d) aerosol inhalation. 196 patients were treated with abidol (200 mg, 3 times/d) + lopinavir / ritonavir (2 tablets, 1 time/12 h) as the triple combination antiviral treatment group. 41 patients were treated with lopinavir / ritonavir (2 tablets, 1 time/12 h) as the dual combination antiviral treatment group. The patients who received triple combination antiviral therapy were divided into three groups: within 48 hours, 3-5 days and > 5 days after the symptom onset. To explore the therapeutic effects of triple combination antiviral drugs and dual combination antiviral drugs, as well as triple combination antiviral drugs with different antiviral initiate time. SPSS17.0 software was used to analyze the data. Results: The time of virus nucleic acid turning negative was (12.2 ± 4.7) days in the triple combination antiviral drug group, which was shorter than that in the dual combination antiviral drug group [(15.0 ± 5.0) days] (t = 6.159, P < 0.01 ). The length of hospital stay [12 (9, 17) d] in the triple combination antiviral drug group was also shorter than that in the dual combination antiviral drug group [15 (10, 18) d] (H = 2.073, P < 0.05). Comparing the antiviral treatment which was started within 48 hours, 3-5 days and > 5 days after the symptom onset of triple combination antiviral drug group, the time from the symptom onset to the negative of viral shedding was 13 (10,16.8), 17 (13,22) and 21 (18-24) days respectively (Z = 32.983, P < 0.01), and the time from antiviral therapy to the negative of viral shedding was (11.8±3.9) , (13.5±5.1) and (11.2±4.3) d. The differences among the three groups were statistically significant (Z=32.983 and 6.722, P<0.01 or<0.05). Conclusions The triple combination antiviral therapy of Abidor, Lopinavir/Litonavir and recombinant interferon α-2b showed shorter viral shedding time and hospitalization time compared with the dual combination antiviral therapy. The earlier the time to initiate triple antiviral treatment, the shorter the time of virus shedding.