Objective To evaluate the curative effect of ultra-early microtrauma drainage in the treatment of hypertensive cerebral hemorrhage. Methods Sixty-one cases of hypertensive cerebral hemorrhage were divided into two groups: the ultra-early group (31 cases; received surgery within 6 hours after the onset) and the control group (30 cases; received surgery between 24 hours and 1 week after the onset).All these cases underwent microtrauma drainage for cleaning the hematoma. Results The effective rate and the marked effective rate in the ultra-early group were 83 9% (26/31) and 67 7% (21/31),respectively,both of which were higher than those in the control group (60% and 40%; ? 2=4 322,4 725;P =0 038, 0 030).The death rate in the ultra-early group (16 1%,5/31) was lower than that in the control group (40%,12/30; ? 2=4 322,P =0 038).Of the life quality of survivors,the values of ADL Ⅰ～Ⅲ accounted for 84 6% (22/26) in the ultra-early group and 55 6% (10/18) in the control group ( ? 2=3 182;P =0 074). Conclusions Ultra-early microtrauma drainage for hypertensive cerebral hemorrhage provides better curative effect and lower death rate than postponed operation.

Objective:To identify potential risk factors of suicide among schizophrenic inpatients,in order to provide basis of how to prevent suicide in psychiatric inpatients.Method:A retrospective analysis among inpatients with mental disorders in Guangzhou psychiatric hospital from 1956 to 2005,the first psychiatric hospital,in China.Using a case-control design,sixty four schizophrenic inpatients(suicide group) who committed suicide in psychiatric hospital and the same number of randomly selected control subjects(control group) who had no incident of suicide were selected and their psychiatric records were compared.Results:The rate of suicide was 133.1(95% CI 103.4-62.9) per 100 000 admissions.Sixty four cases(83.1%) were diagnosed as schizophrenia,fifty nine(76.6%) were hung by themselves,and fifty two(67.5%) happened in wards.The numbers of hospitalization and the suicide attempts before and duration of hospitalization were significantly higher in suicide group than that in control group(P=0.001,0.017,0.003),and guilty thoughts,depressive mood were significantly higher in suicide group than that in control group(P=0.006,0.004).Both suicidal ideation and suicide attempts one month before and during hospitalization were significantly higher in suicide group than that in control group(P

Objective:To correlate N-terminal pro-B-type natriuretic peptide (NT-proBNP) and heart type fatty acid binding protein (H-FABP) levels with the prognosis of patients with heart failure.Methods:Forty-nine patients with severe heart failure who received treatment in Tongde Hospital from December 2017 to June 2019 were included in the observation group. Forty-nine healthy subjects who concurrently received health examination were included in the control group. The heart function of the 49 patients was graded by the New York Heat Association (NYHA) classification. The levels of NT-proBNP and H-FABP were measured in different NYHA grades of patients and the healthy controls. The value of NT-proBNP and H-FABP levels in the diagnosis of heart failure was investigated and NT-proBNP and H-FABP levels were correlated with prognosis of heart failure.Results:In the observation group, NT-proBNP and H-FABP levels were (341.52 ± 12.74) pg/mL and (69.01 ± 11.45) ng/mL, respectively, which were significantly higher than (189.60 ± 12.73) pg/mL and (37.25 ± 11.44) ng/mL, respectively, in the control group ( t = 59.047 and 13.735, both P < 0.001). In patients with NYHA III grade severe heart failure, NT-proBNP and H-FABP levels were (295.62 ± 42.38) pg/mL and (75.09 ± 19.15) ng/mL, respectively, which were significantly higher than (120.43 ± 21.69) pg/mL and (21.76 ± 5.22) ng/mL, respectively in patients with NYHA I grade severe heart failure, (203.51 ± 42.77) pg/mL and (44.92 ± 10.85) ng/mL in patients with NYHA Ⅱ grade severe heart failure ( F = 55.100, 46.040, both P < 0.001). NT-proBNP and H-FABP levels in patients with NYHA I grade severe heart failure were significantly lower than those in patients with NYHA Ⅱ grade severe heart failure ( t = 7.231, 8.130, both P < 0.001). The sensitivity and accuracy of detecting NT-proBNP and H-FABP levels alone in the diagnosis of heart failure (76.92%, 78.85%, 84.69%, 86.73%) were significantly lower than those of detecting NT-proBNP and H-FABP levels in combination (98.08%, 97.96%, χ2 = 75.760, 10.913, both P < 0.001). NT-proBNP and H-FABP levels were positively correlated with the prognosis of heart failure ( r = 0.362, 0.611, both P < 0.05). Conclusion:NT-proBNP and H-FABP levels are positively correlated with the prognosis of severe heart failure in older adult patients. Detecting NT-proBNP and H-FABP levels in combination can increase the sensitivity and accuracy in the diagnosis of severe heart failure.

Objective To investigate the short-term effects of intra-articular injection of hyaluronan on proprioception of the knee in gerontal patients with osteoarthritis (OA). Methods The 53 gerontal patients were included in this study. The study included treatment group (n=35) and the placebo group (n=18). Hyaluronan was intra-articularly injected into both knees of the subjects in treatment group, whereas physiological saline was intra-articularly injected in the placebo group. Proprioception test was performed, and Western Ontario and McMaster Universities(WOMAC) scales were used to evaluate pain and physical function. Results Statistical analysis was performed on 100 knees of 50 patients who completed the trial. Compared with the placebo group,the average absolute angular error (AAAE) value in the treatment group was detected to be statistically lower one week after the 4th injection (1.8±0.9 vs.2.9±1.1,t=2.42,P=0.02),and WOMAC was lower in the treatment group after one week (8.7±3.1 vs.11.5±4.0, t=0.73,P＜0.05). Conclusions Intra-articular injection of hyaluronan in gerontal patients with knee OA leads to a short-term increase in proprioception, and significant improvement in the functional conditions of patients.

Objective To investigate the etiological characteristics of diarrhea patients visiting enteric disease clinics in Beijing .Methods A total of 595 stool samples were collected among outpatients with diarrhea vistiting enteric disease clinics at two sentinel hospitals from July 2013 to June 2014 . Diarrheagenic Escherichia coli (E . coli) , Vibrio parahemolyticus , O1 or O139 Vibrio cholerae , Salmonella and Shigella were isolated according to standard methods . And rotavirus , norovirus , astrovirus and enteric adenovirus were identified by molecular techniques .The characteristics of population and temporal distribution , and serotypes of these pathogens were analyzed using descriptive epidemiological method .Chi‐square test was used for comparison between groups .Results Totally 128 bacterial strains were isolated from 595 samples ,and the detection rate was 21 .5% .Diarrheagenic E .coli was most common pathogenic bacteria (11 .4% ,68/595) ,followed by Vibrio parahemolyticus (6 .9% , 41/595) ,Salmonella (2 .4% ,14/595) and Shigella (2 .2% ,13/595) .No V ibrio cholerae was detected . One hundred and twelve viral strains were detected from all samples ,and the positive rate was 18 .8% . Norovirus was most common viral pathogen (9 .1% ,54/595) ,followed by rotavirus (8 .7% ,52/595) , astrovirus (1 .8% , 11/595 ) and enteric adenovirus (0 .7% , 4/595) . Enteropathogenic E .coli , enterotoxigenic E .coli and enteroadhesive E .coli were the most common types of diarrheagenic E .coli . The most common serotype of Vibrio parahaemolyticus was O4∶K8 .The detection rate of bacterial pathogens reached the peak from June to September ,while the highest detection rate of viral pathogens was found from November to the next March .Conclusion Norovirus and rotavirus are also the main pathogens of the diarnhea patients visiting enteric clinics ,which should be paid enough attention .

BACKGROUND:At present, biological agent-involved immunologic induction therapy gradual y became a key component in immunosuppression therapy of kidney transplantation. It can effectively prevent acute rejection and avoid the appearance of complications. OBJECTIVE:To evaluate the effect of different biological agents on immune state and functional status of transplanted kidney in immunologic induction therapy. METHODS:Clinical data of 110 recipients with kidney transplantation were retrospectively analyzed. In accordance with the conditions of immunologic induction therapy, recipients in the monoclonal antibody group (n=35) received basiliximab. Recipients in the polyclonal antibody group (n=43) underwent rabbit anti-human antithymocyteglobulin. Recipients in the control group (n=32) did not receive immunologic induction therapy. Absolute value of lymphocytes and the number of CD4+T lymphocyte subsets in peripheral blood were comparatively analyzed among three groups at 1, 4 and 12 weeks after kidney transplantation. Functional status of the transplanted kidney and complications of infection were evaluated at 12 weeks after transplantation.RESULTS AND CONCLUSION:The incidence of acute rejection was lower in the monoclonal antibody group and polyclonal antibody group than in the control group (P<0.05). The incidence of infectious complications was higher in the polyclonal antibody group than in the monoclonal antibody group and control group (P<0.05). The absolute value of lymphocytes was lower in the monoclonal antibody group and polyclonal antibody group at 1, 4 and 12 weeks after transplantation than in the control group (P<0.05). The number of CD4+T lymphocyte subsets in peripheral blood was lower in the polyclonal antibody group than in the monoclonal antibody group and control group at 1, 4 and 12 weeks after transplantation (P<0.05). These results suggested that biological agents participate in immunologic induction therapy of kidney transplantation, can effectively suppress the functional status of activated T lymphocytes, and decrease the occurrence of early acute rejection of the transplanted kidney. However, the incidence of infectious complications was higher after the use of rabbit anti-human antithymocyteglobulin.

OBJECTIVE: To provide anatomic evidence for choosing medial calcaneal nerve(MCN ) as recipient cutaneous nerve to rebuild heel sensation. METHODS: We chose 20 adult cadavers' lower limbs, dissected the MCNs, observed their original sites, shapes, courses and distribution, and measured the perpendicular distance from original sites of MCNs from tibial nerve, original sites of their branches to the tip of medial malleolus, and the external diameters of their main trunks and branches. RESULTS: The frequency of the MCN was 95% in this array. All the MCNs arose from the tibial nerve at 3.3 cm up the horizontal plane of the tip of medial malleolus. They sent out anterior branches and posterior branches from 0.3 cm below the horizontal plane of the tip of medial malleolus on average. The anterior branch dominated the cutaneous sensation of the anterior part of the medial calcaneal and heel weight loading field, while the posterior branch dominated the sensation of the posterior and median part. The shape of MCNs, main trunks, anterior branches and posterior branches was like circular cylinder. At the origination, the external diameter of the MCN, the anterior branch and the posterior branch was 1.58, 1.13 and 0.90 mm on average, respectively. CONCLUSION The anatomical position of MCN is relatively constant, and its external diameter is suitable. The initiation is not close to the heel weight loading area. Its anatomic characteristics meet the requirements of sensation recovery of the heel, especially the heel weight loading field.
Adult ; Cadaver ; Calcaneus ; innervation ; Heel ; innervation ; Humans ; Peripheral Nerves ; anatomy & histology ; Tibial Nerve ; anatomy & histology

Objective:To analyze the epidemiological characteristics and influencing factors of venous thrombosis in elderly patients with severe trauma.Methods:A retrospective study was conducted to collect and statistically analyze general information[sex, age, body mass index(BMI)], causes of trauma, injury severity score(ISS), Glasgow coma score(GCS), coagulation function[prothrombin time(PT), international normalized ratio(INR), D-dimer], B-type natriuretic peptide(BNP), liver function(alanine aminotransferase, aspartate aminotransferase), creatinine, Caprini score, surgical approach, immobilization mode, days of hospitalization, and treatment cost.Results:Totally 179 elderly patients with severe trauma were enrolled, including 130 men(72.6%), aged(67.6±6.4)years.The BMI, ISS and GCS scores of elderly patients with severe trauma were(22.9±3.4)kg/m 2, 28.4±10.5 and 10.2±4.6, respectively.The Caprini score was 11.7±4.0.Of these patients, 32(17.9%)had VTE events.Compared with the VTE negative group, the VTE positive group was older( t=-2.214, P=0.028), with a higher Caprini score( t=-2.684, P=0.008)and more lower limb fractures( P=0.008)and pelvic fractures( P=0.001). There were no significant differences in coagulation function, liver function, atrial natriuretic peptide levels, creatinine levels and surgical approaches between the VTE negative group and the VTE positive group(all P<0.05). No significant difference was found in the proportion of patients receiving surgical treatment between the two groups( P=0.563). In the VTE positive group, 18.8% had no fracture, 50.0% had one fracture, and 31.2% had two or more fractures, and the difference was statistically significant compared with the VTE negative group( P=0.029). However, VTE events had no significant effect on the average length of stay and hospitalization costs in elderly trauma patients(all P<0.05). Conclusions:For elderly patients with severe trauma, VTE is more likely to occur with increased age, a high Caprini score, multiple fracture sites and pelvic fracture.In addition, pelvic fracture is an independent risk factor for VTE in very old trauma patients.Attention should be paid to prevention and treatment to achieve steady improvement in the overall prognosis of trauma in these patients.

Objective To evaluate the clinical value of ankle arthroscopy in diagnosis and treatment of Danis-Weber type B ankle fracture associated with injury to the distal tibiofibular syndesmosis.Methods A retrospective study was conducted of the 35 patients who had been treated at Department of Orthopaedics,Ruijin Hospital North for Danis-Weber type B ankle fracture from February 2014 to December 2016.They were 23 males and 12 females,with an average age of 43.1 years (from 18 to 65 years).Each of them underwent 4 examinations to detect whether injury to the distal tibiofibular syndesmosis was complicated or not:preoperative CT and MRI,C-ann roentgenography and ankle arthroscopy before and after internal fixation of the ankle.The diagnostic rates of the complicated injury by the 4 examinations were compared.The patients complicated with injury to the distal tibiofibular syndesmosis received surgical repair of the injury using TightRope in addition to internal fixation of the ankle,and injury to the deltoid ligament was repaired simultaneously using 3.5 mm anchor nails in case the injury was concomitant.The repair and stability of the distal tibiofibular syndesmosis were observed using ankle arthroscopy again.Results The Cotton and external rotation tests under C-arm roentgenography before surgery and after internal fixation of the ankle demonstrated that 13 cases were complicated with injury to the distal tibiofibular syndesmosis.Of the other 22 patients who had not been diagnosed with the injury by C-arm roentgenography,6,13 and 11 were diagnosed with the injury respectively by CT,MRI and ankle arthroscopy.The diagnostic rates of Danis-Weber type B ankle fracture associated with injury to the distal tibiofibular syndesmosis were 37.1％ (13/35),54.3％ (19/35),74.3％ (26/35) and 68.6％ (24/35) respectively by C-arm roentgenography,CT,MRI and ankle arthroscopy.In the sensitivity to the injury,MRI ＞ ankle arthroscopy ＞ CT ＞ C-arm roentgenography,with significant differences between them (P ＜ 0.05).The ankle arthroscopy confirmed the repair efficacy in the 24 patients complicated with injury to the distal tibiofibular syndesmosis and negative results of Cotton and external rotation tests in them.Additionally,ankle arthroscopy revealed 16 cases of injury to the deltoid ligament at the medial ankle.Conclusions Ankle arthroscopy can provide evidence for correct diagnosis and treatment of Type B ankle fracture complicated with injury to the distal tibiofibular syndesmosis,because it allows direct observation of the medial deltoid ligament of the ankle and the distal tibiofibular syndesmosis.It can be also used to assess the stability of the tibiofibular syndesmosis after repair of the injury.