Objective In-hospital mortality rate in patients undergoing percutanous transhepatic biliary drainage for malignant obstructive jaundice remained high.This study aimed to assess pre-,intra-and post-procedure risk factors which were independently associated with increased in-hospital mortality.Methods One hundred and fifty-five consecutive patients with malignant obstructive jaundice received initial PTBD drainage.Twenty-five pre-procedure,4 intra-procedure and 6 post-procedure factors potentially related with in-hospital mortality were assessed by univariate and multivariate analysis.Results In-hospital mortality rate was 16.8％ (26/155).Of 25 pre-procedure variables analysed,Child-Pugh classification C,creatinine (≥ 6.93 μmol/L) and quality of life (≤ 30) were found to be significant in univariate and multivariate analysis.Increased mortality was seen in this study with two or more risk factors,significantly different from patients who had none or one risk factor(P ＜0.01).None of the intra-procedure factors were important in identifying patients at risk of death.Multivariate analysis indicated post-PTBD cholangitis and unsuccessful drainage as post-procedure risk factors that correlated with in-hospital death.Conclusions Three pre-procedure and two post-procedure risk factors were identified associated with in-hospital mortality.

Objective To analysis the imaging features of the chondroblastoma in the tarsal bone. Methods The locations of 134 cases of pathologically confirmed chondroblastoma were retrospectively analyzed. Eleven of them were in tarsal bones and their X-ray and CT findings were analyzed. Results Of the 11 cases of tarsal chondroblastoma, 6 were in talus, 3 were in calcaneus and 2 cases were in navicular bones. They were examined by the X-ray and 5 cases had additional CT scans. The common locations were the posterior portion of the talus and calcaneus. The X-ray findings included expansive destruction (10/11), mild osteosclerosis (11/11), bone ridge (9/11), articular facet destruction (7/11) and spot or patching calcification(6/11). The imaging findings of CT included articular facets destruction (5/5), bone ridge (5/5) and spot or patching calcification (2/5). Conclusion The talus and the calcaneus are the frequently involved location of tarsal chondroblastoma. Its X-ray and CT findings are characteristic but not exclusive.

Objective To understand the family burden of Alzheimer' s disease (AD) and associated factors.Methods The subjects were 168 caregivers of patients with AD selected from two class 3A hospitals and three communities in Taiyuan through cluster sampling.The data were collected by using the Caregiver Burden Inventory (CBI) and the Family Burden Scale (FBS) of diseases.Path analysis was applied to identify the factors associated with the total score of CBI.T-test and One-way analysis of variance were applied to identify the factors associated with the total score of FBS.Multiple linear regression analysis was applied to identify the factors associated with family burden of AD.Results The total score of the caregivers' burden was 52.41 ± 17.07.AD patients' cognitive function had direct (standardized β =-0.280,P＜0.001) and indirect effect on CBI;while daily performance of AD patients had indirect effect on CBI.The total score of family burden was 16.23 ± 9.00.Univariate analysis showed that the sex,age,education level,cognitive function,daily performance,mental status,depression and dementia rating of AD patients might affect the total score of FBS (P ＜ 0.05).Multivariate analysis showed that the factors which affected the total score of FBS included the sex (standardizedβ =0.280,P ＜ 0.01),cognitive function (standardizedβ =-0.158,P =0.033) and daily performance of AD patients (standardizedβ=-0.155,P=0.039).Conclusion The caregiver and family burden of AD was mainly associated with the cognitive function and daily performance of AD patients.It is necessary to take targeted measures to reduce the caregiver and family burden of AD.

OBJECTIVEThis review focuses on current knowledge of traditional Chinese herbs on prevention and treatment of viral respiratory infections, especially caused by Severe Acute Respiratory Syndromes (SARS) virus, respiratory syncytial virus (RSV) and influenza viruses.

DATA SOURCESThe data used in this review were obtained from PubMed and CNKI up to May 2013. Terms of Chinese herbs and infections of respiratory tract were used in the search.

STUDY SELECTIONArticles related that Chinese herbs preventing and treating infections in respiratory tract were retrieved and reviewed. The risk of bias of included studies was assessed by the method in the "Cochrane Handbook of Systematic Reveiws of Interventionsand studies" with high risk of bias were excluded. Four criteria for selections were set as following: randomized controlled trial, particular effective compound or derivative, reproducible result and animal test.

RESULTSInfectious respiratory tract diseases cause most mortality among infectious illnesses around the world. As traditional medicines, Chinese herbs have been widely used to deal with diseases for centuries and have been proved effective in practice. The administration of some Chinese herbs stimulates, suppresses or regulates the activity of immune system, thus protecting the respiratory tract or relieving infections of pathogens. Many herbs have remarkable antiviral effects, therefore they are used as substitutes of antimicrobial drugs. Based on the theory of traditional Chinese medicine, mix-using herbs provide a synergistic benefit on preventing and healing respiratory tract infections. Many commercial herbal medicines containing one or more compounds have been successfully applied to prevent and treat viral infections of respiratory tract clinically.

CONCLUSIONSTraditional Chinese herbs could directly inhibit pathogens infecting respiratory tract, or coordinate the activity of immune system to avoid or relieve infections. With the emergence of antidrug pathogens or new variants, Chinese herbs give strong evidence to protect human health.

The early accurate diagnosis of burn depth is of great significance in determining the corresponding clinical intervention methods and judging the prognosis quality of burn patients. However, the current diagnostic method of burn depth still relies mainly on the empirical subjective judgment of clinicians, with low diagnostic accuracy. Especially for deep partial-thickness burn wounds, the error of early diagnosis is pretty big. In recent years, with the rapid development of artificial intelligence technology, deep learning algorithm combined with image analysis technology can better identify and analyze the information of medical images. This article reviews the research progress of artificial intelligence technology in the diagnosis of burn depth.

Objective To explore the predictive value of cognitive function trend after ACI for the recurrence risk of cerebral infarction.Methods A total of 256 ACI patients admitted to our hospi-tal from January 2021 to December 2023 were enrolled retrospectively.Based on their MoCA score at 3 months after onset,they were assigned into 96 cases of no PSCI,51 cases of improved PSCI,17 cases of delayed PSCI and 92 cases of persistent PSCI.According to the results of MoCA at 2 weeks after onset,they were divided into 133 cases of PSCI group and 123 cases of non-PSCI group.The clinical data of the ACI patients were compared between the two groups,and their cog-nitive function trends were analyzed.Results Advanced age,and larger proportions of female,du-al antiplatelet therapy and PSQI＞5 were observed in the PSCI group than the non-PSCI group(P＜0.05,P＜0.01).There were significant differences in the incidences of recurrence and poor prognosis in the ACI patients with different cognitive function trends(P＜0.01).The persistent PSCI was associated with the increased risk of recurrence of cerebral infarction and poor prognosis(P＜0.05).The AUC value of persistent PSCI in predicting the recurrence and poor prognosis of cerebral infarction was 0.703(95％CI:0.631-0.767)and 0.595(95％CI:0.521-0.666),respec-tively.Conclusion Persistent PSCI can be used as a predictor of recurrence of cerebral infarction,and it also increases the risk of cognitive dysfunction in ACI patients.

Objective To investigate the effects of Ligustilide on the withdrawal syndromes syn-dromes and monoamine neurotransmitters of hypothalamus and nucleus accumbens in morphine-dependent rats. Methods Totally 60 SD rats were divided into control group,model group,clonidine group and Ligust-ilide high(80 mg/kg),medium(40 mg/kg) and low(20 mg/kg) dose group according to the random number table with 10 in each group. Rats were given in gradual increasing doses of morphine to produce physical de-pendence. Morphine withdrawal syndrome was precipitated by naloxone and withdrawal symptoms were evalu-ated by Ryuta Tomoji score. The level of norepinephrine ( NE), dopamine ( DA) and 5-hydroxytryptamine (5-HT) in rats were tested with enzyme-linked immunosorbent assay(ELISA). Results The total score of somatic withdrawal syndromes in the control group,model group,clonidine group and Ligustilide low,medium and high dose group were 0,(31. 83±7. 33),(17. 92±6. 88),(25. 58±5. 99),(19. 88±4. 82) and (16. 75 ±4. 01) . Compared with the model group,the morphine withdrawal syndromes scores of Ligustilide low,me- dium and high dose groups and clonidine group were reduced(all P<0. 05). The level of NE,DA and 5-HT in hypothalamus and nucleus accumbens were increased compared with that of control group. Compared with the model group,the level of NE,DA and 5-HT in hypothalamus and nucleus accumbens of Ligustilide low, medium and high dose groups and clonidine group were significantly reduced (P<0. 05). Conclusion Ligu-stilide can effectively alleviate the symptoms in morphine-withdrawal rats,which may be related to the inhibi-tion of excessive release of monoamine neurotransmitters in hypothalamus and nucleus accumbens.

For the wounds caused by burns and other various reasons, the key of therapy is to close the open wounds in time by surgical operation. One of the most important methods is autologous skin grafting. However, for large area and long-term chronic trauma, the lack of autologous skin makes the treatment a huge challenge. For this reason, clinical medical workers have gradually developed miniature free skin grafting through continuous research. This paper reviews the relevant skin grafting techniques, including pinch free skin grafting, stamp free skin grafting, meek grafting, microne free skin grafting, etc.

Objective:To analyze the clinical diagnosis, treatment ，and surgical timing of otogenic intracranial complications. Methods:The clinical data of 11 patients with intracranial complications with ear symptoms as the first manifestation in Department of Otorhinolaryngology Head and Neck Surgery, Qilu Hospital of Shandong University（Qingdao） from December 2014 to June 2022 were collected, including 8 males and 3 females, aged from 4 to 69 years. All patients had complete otoendoscopy, audiology, imaging and etiology examination, and the diagnosis and treatment plan was jointly developed through multidisciplinary consultation according to the critical degree of clinical symptoms and imaging changes. Among the 11 patients, 5 cases were treated with intracranial lesions first in neurosurgery department and middle ear lesions later in otolaryngology, 3 cases of meningitis, were treated with middle ear surgery after intracranial infection control, 1 case was treated with middle ear lesions and intracranial infection simultaneously, and 2 cases were treated with sigmoid sinus and transverse sinus thrombosis conservatively. They were followed up for 1-6 years. Descriptive statistical methods were used for analysis. Results:All the 11 patients had ear varying symptoms, including ear pain, pus discharge and hearing loss, etc, and then fever appeared, headache, disturbance of consciousness, facial paralysis and other intracranial complication. Otoendoscopy showed perforation of the relaxation of the tympanic membrane in 5 cases, major perforation of the tension in 3 cases, neoplasia in the ear canal in 1 case, bulging of the tympanic membrane in 1 case, and turbidity of the tympanic membrane in 1 case. There were 4 cases of conductive hearing loss, 4 cases of mixed hearing loss and 3 cases of total deafness. Imaging examination showed cholesteatoma of the middle ear complicated with temporal lobe brain abscess in 4 cases, cerebellar abscess in 2 cases, cholesteatoma of the middle ear complicated with intracranial infection in 3 cases, and sigmoid sinus thrombophlebitis in 2 cases. In the etiological examination, 2 cases of Streptococcus pneumoniae were cultured in the pus of brain abscess and cerebrospinal fluid, and 1 case was cultured in streptococcus vestibularis, Bacteroides uniformis and Proteus mirabilis respectively. During the follow-up, 1 patient died of cardiovascular disease 3 years after discharge, and the remaining 10 patients survived. There was no recurrence of intracranial and middle ear lesions. Sigmoid sinus and transverse sinus thrombosis were significantly improved. Conclusion:Brain abscess, intracranial infection and thrombophlebitis are the most common otogenic intracranial complications, and cholesteatoma of middle ear is the most common primary disease. Timely diagnosis, multidisciplinary collaboration, accurate grasp of the timing in the treatment of primary focal and complications have improved the cure rate of the disease.
Female ; Humans ; Male ; Brain Abscess/therapy* ; Cholesteatoma ; Deafness/etiology* ; Hearing Loss/etiology* ; Lateral Sinus Thrombosis/therapy* ; Retrospective Studies ; Thrombophlebitis/therapy* ; Child, Preschool ; Child ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Aged ; Cholesteatoma, Middle Ear/therapy* ; Central Nervous System Infections/therapy* ; Sinus Thrombosis, Intracranial/therapy* ; Ear Diseases/therapy*