Objective To study the clinical features of invasive pneumococcus disease (IPD) with resistance to antimicrobial agents in children,and to improve the diagnosis and treatment of this disease.Methods The clinical data from 21 IPD patients younger than 13 years old were collected from January 2008 through December 2010 in Pediatric Intensive Care Unit in Beijing Children's Hospital for retrospective analysis. Specimens of blood,pleural effusion,cerebrospinal fluid and soft tissue aspirated were collected from these children,and 23 strains of streptococcus pneumonia (SP) were cultured,isolated and confirmed,and the antibiotics susceptibility to penicillin and other antibiotics of these strains were assayed.Results Among the 21 IPD children,the ratio of male to female was 0.9∶1,and the age was 5 months to 13 years,with 61.9％ of them under 2 years.Of them,12 patients (57.1％ ) had purulent pleurisy,and 1 (4.8％ )patient had an underlying disease diagnosed to be X - linked agammaglobulinemia (XLA).There was no seasonal difference in the occurrence rate of this disease. Eight (38.1％) patients were cured,11(52.4％ ) were improved,while 2 (9.5％ ) patients not improved without death.There was no statistically significant difference in the annual detection rate of invasive SP (x2 =3.711,P =0.156).The incidences of penicillin-intermediate susceptibility SP (PISP) and penicillin-resistant SP (PRSP) were 47.8％ and 26.1％ respectively.The rate of resistance to multiple antibiotics was 91.3％.Conclusions Children aged less than 5 years,especially younger than 2 years,are prone to IPD,and purulent pleurisy and septicemia are often seen in this disease. Some patients had the underlying diseases.The complications included hemophagocytic syndrome,acute respiratory distress syndrome,septic shock,bronchial pleural fistula and so on.The multidrug resistance rate was 91.3％.It is important to put great emphasis on the monitoring antibiotics resistance to invasive pneumococcal disease.

ObjectiveTo evaluate the mid-term clinical effect of nano-hydroxyapatite and polyamide 66 (n-HA/PA66) intervertebral fusion cage in treatment of thoracolumbar burst fractures.Methods A total of 87 patients with thoracolumbar burst fractures were managed by thoracolumbar body resection combined with n-HA/PA66 intervertebral fusion cage from December 2007 to September 2008.The clinical effect, safety and radiographic outcomes were evaluated.Results No nerve damage was deteriorated in all the patients.The neural function was improved for 1-2 grade except for four patients at Frankel grade A.The patients were followed up for mean 21.3 months (17-24 months).The kyphosis was (14.4 ± 12.6)° preoperatively, (3.7 ± 8.7) ° immediately after surgery and (4.0 ± 8.3)° at final follow-up.The distance between the upper and lower vertebral bodies was (96.9 ± 17.2) mm preoperatively, (109.5 ± 17.1) mm immediately after surgery and (108.3 ± 16.4) mm at final follow-up.No cage replacement, internal fixation breakage or neurologic impairment were observed during follow-up period.There were 58 patients with grade E fusion, 22 with grade D fusion and 7 with grade C fusion.ConclusionsAnterior decompression combined with n-HA/PA66 intervertebral fusion cage is an effective method for treatment of thoracolumbar burst fracture.The kyphosis is rectified and the intervertebral distance is corrected, with a high rate of fusion.

ObjectiveTo compare costs of combined intravenous and inhalation anesthesia (CIIA) and total intravenous anesthesia (TIA) when lower limbs orthopedics (LLO) performed on cerebral palsy children (CPC).MethodsTo analyze data of 49 CPC who received LLO under CIIA and TIA,and compare costs of two anesthetic styles.ResultsTIA had a significantly lower cost than CIIA (P<0.001),and showed a lower incidence of post-operation nausea and vomiting.ConclusionTIA can decrease cost of anesthesia and post-operation nursing compared with CIIA.

OBJECTIVE: To investigate whether serum thyroid-stimulating hormone(TSH) levels are of value in predicting malignancy in patients with nodular thyroid disease. The relationship between TSH levels and thyroid cancer incidence was also investigated. METHOD: One hundred and eight patients with thyroid tumors who underwent surgical treatment were included in this study (25 cases of papillary thyroid cancer and 83 cases of benign tumors). The data of their preoperative serum TSH level, gender, age, number of tumors detected by ultrasonic inspection, and pathological type were retrospectively analyzed, and their association with thyroid cancer incidence was explored. Logistic regression analysis was used to predict thyroid cancer risk factors. RESULT: Patients with malignancy had a higher mean value of TSH than that of the patients with benignancy [(1.94±1.01)mlU/L vs (1.16± 0.85)mIU/L, respectively; P<0.05]. Compared with the patients below the population mean, patients above the population mean had a significantly higher malignancy rate (35.9% vs 15.9%, P<0.05). High serum TSH level (OR=10.913, P=0.001), male (OR=4. 845, P=0.028) and age ≥45 (OR=10.831, P=0.001) are independent risk factors of thyroid cancer. CONCLUSION The preoperative serum TSH level may be useful in predicting the probability of cancer. The high serum TSH level, male, age ≥45 are risk factors of thyroid cancer.
Carcinoma ; pathology ; Carcinoma, Papillary ; Humans ; Incidence ; Male ; Prognosis ; Retrospective Studies ; Risk Factors ; Thyroid Cancer, Papillary ; Thyroid Neoplasms ; pathology ; Thyroid Nodule ; blood ; Thyrotropin ; blood

Objective To analyze the relationship of the lateral angulation with the incision level after anterior approach operation for thoracolumbar fractures by evaluating the Cobb' s angle at different approach levels.Methods A retrospective study was done on 154 patients with thoracolumbar fractures treated consecutively with anterior operation from May 2004 to January 2008.The preoperative,postoperative and follow-up angle of coronal Cobb and the postoperative angle between screws and endplates on the anteroposterior radiograph were measured.According to the relationship between the injury vertebrae and the incision level,the patients were divided into two groups,ie,incision level ≥2 vertebrae group and incision level ≤ 1 vertebra group.Results All patients were followed up for 6-47 months(mean 37 months),which showed significant postoperative lateral angulation(P ＜ 0.01)especially at follow-up (P ＞ 0.05).The coronal Cobb' s angle showed insignificant difference before operation between two groups but it was increased after operation and during the follow-up(P ＜0.01).The screws A or B were more parallel to the endplate in two groups(P ＜ 0.01),while the parallel of the screws C or D to the endplate showed no statistical difference(P ＞ 0.05).Conclusions Compared with the operation with incision level ≥2 vertebrae,the operation with incision level ≤ 1 vertebra can more easily induce postoperative lateral angulation and exert a significant impact on implantation orientation of the vertebral screws A and B,which may indirectly lead to postoperative lateral angulation.

Objective To evaluate cause,treatment and prevention of esophageal fistula caused by anterior cervical spine surgery.Methods Between January 2004 and December 2011,2348 patients underwent anterior cervical spine surgery.Among them,5 patients suffered from esophageal fistula owing to operation,including 3 males and 2 females,with an average age of 34 years (range,14 to 48 years).The diagnosis of these patients included 3 cases of cervi(c)al injury,1 case of cervical spondylosis and 1 case of cervical tuberculosis.There was 1 patient whose esophageal injury was founded during the surgery,and that was directly repaired.For another 4 patients,esophageal fistulas were founded after operation; one case underwent debridement and orificium fistulae repair; one case only underwent debridement; one case underwent debridement and second-stage removal of hardware; and one case underwent debridement and second-stage removal of hardware and esophageal repair with sternocleidomastoid flap.Postoperative treatment included esophageal rest,enteral nutrition,wound drainage,and antibiotic administration.Methylene blue was used to evaluate status of orificium fistulae.Results All patients with esophageal fistula were cured 9 to 61 weeks after treatment,and oral intake was achieved.They were followed up for 6-48 months.There was no recurrence of esophageal fistula,cervical instability and infectious spondylitis in any ease.All patients were satisfied with swallowing function and outcome of cervical spine diseases.The Frankel grade was improved averagely one grade in patients with cervical injury,and the JOA score was improved from preoperative 9 points to postoperative 15 points in patients with cervical spondylosis.Conclusion Successful management of esophageal fistula caused by anterior cervical spinal surgery depends on primary closure of the perforation with or without muscle flaps,surgical drainage,esophageal rest and nutrition support,and removal of hardware if necessary.Prevention consists of the careful operation and gentle tissue handling.

OBJECTIVETo summary the characteristics of cervicothoracic junction (C7T1) fracture-dislocation,and explore the surgical treatment of combined anterior-posterior procedure.

METHODSFrom January 2005 to March 2010,8 cases of cervicothoracic junction (C7T1) fracture-dislocation were treated by stage I operation through anterior and posterior approacheg, supplemented by non-structural bone graft. All patients were male with a mean age of 45.0 years old ranging from 32 to 68 years. Six cases were diagnosed clearly by CT scan but with normal cervical spine X-ray film at admission. According to AO classification, 4 cases were of type B, 4 cases of type C, with unilateral locked articular process in 2 cases, bilateral in 2 cases. Preoperative MRI showed intervertebral disc injury in 6 cases.

RESULTSThe average operation time was 246.3 min ranging from 150 to 320 min. The blood loss was with an average of 307.5 ml (150 to 600 ml). One patient got hoarseness but recovered without special treatment 6 months later; No other complications happened. One patient of preoperative Frankel grade A died, the remaining patients were followed up from 12 to 63 months (38.6 months in average). These fracture-dislocations were completely reduction after operation, healed with bony union 12 months later, and no pseudoarthrosis. The function of the spinal cord improved obviously at the final follow-up, 1 patient of preoperative grade A had died,and the spinal cord function of the other one had no significant changes,the 2 cases of grade B recovered to C and D respectively, 1case recovered from grade C to D, and 3 case recovered from D to E.

CONCLUSIONCervicothoracic junction (C7T1) fracture-dislocation is a rare clinical spine trauma, and missed easily. The CT is a necessary complement to these patients highly suspected C7T1 fracture-dislocation but with negative cervical spine X-ray film. The patients diagnosed clearly could receive stage I operation of anterior and posterior approaches, supplemented with non-structural bone graft.

Adult ; Aged ; Cervical Vertebrae ; injuries ; surgery ; Female ; Humans ; Joint Dislocations ; surgery ; Male ; Middle Aged ; Spinal Fractures ; diagnostic imaging ; surgery ; Thoracic Vertebrae ; injuries ; surgery ; Tomography, X-Ray Computed

Objective To study the clinical,cardiopulmonary functional and hemodynamic profiles of systemic sclerosis patients with pulmonary hypertension (SSc-PAH) compared with those of idiopathic pulmonary hypertension (IPAH).Methods Patients diagnosed with SSc-PAH or IPAH by right heart catheterization were consecutively enrolled into the study between 2011 and 2013 in Peking Union Medical College Hospital (PUMCH).Cases with pulmonary hypertension related to other diseases were excluded.Demographic data,laboratory parameters,6 minutes walk distance (6MWD),pulmonary function and hemodynamic variables at the time of diagnosis were collected and compared between the two groups.Results A total of 20 SSc-PAH patients including 19 females and one male with age of (43.1 ± 12.2) years,and 18IPAH patients including 16 females and 2 males with age of (38.4 ± 12.4) years were enrolled in this study.Subjects in both groups had similar mean pulmonary arterial pressure,cardiac index and pulmonary vascular resistance (PVR) when recruited.Compared with IPAH patients,SSc-PAH patients showed significantly decreased all parameters including forced vital capacity (FVC)％ [(77.1 ± 13.2)％ vs (88.6 ± 14.9)％,P =0.026],diffusing capacity of the lung for carbon monoxide (DLCO) ％ [(46.2 ±13.1) ％ vs (66.6± 13.3)％,P ＜0.001],DLCO/alveolar ventilation(VA) [(55.1 ± 14.3)％ vs (75.1 ± 11.5)％,P ＜0.001],and 6MWD [(365.6 ±85.1) m vs (454.3 ± 136.8) m,P =0.034].In subgroup analysis of SSc-PAH patients,elevated PVR (OR 2.122,95％ CI 1.093-4.119,P =0.026) and decreased DLCO％ (OR 0.916,95％ CI 0.842-0.996,P =0.040) were independently associated with reduced 6MWD.Conclusions Under the similar hemodynamic condition,SSc-PAH patients had more severe restrictive ventilation dysfunction and diffusion capacity dysfunction.Decreased 6MWD in SSc-PAHpatients was probably related to the impairment of pulmonary function.

objecfive To analyze ventricular myocardial function in patients with systemic sclerosis (SSc).Methods Thirtv female SSc patients and fifteen age-and sex-comparable healthy subjects underwent standard echo and tissue Doppler imaging(TDI)examination.T-test and Pearson's analysis were used.Results Both left and right atrial and ventricular diameters,left ventricular eiection fraction and right ventricular fraction of area change were comparable between the two groups.Mitral and tricuspid inflow E/A ratio was almost the same in both groups,while systolic pulmoHary pressure was increased in SSc [(38±16)vs (23.9±4.8)mm Hg,P=0.008].TDI detected impaired right ventricular myocardial function in SSc:eartydiastolic peak velocity Em [(10.7±4.8)vs(15.0±2.1)cm/s,P=0.01],peak systolic strain[(-16.3±3.9)%vs (-20.9±2.0)%,P=0.001]and strain rate[(-1.4±0.4) vs(-2.4±0.5)/s,P<0.01] were reduced significantly.Left ventricular myocardial function was not impaired in SSc patients.Conclusion TDI iS a valuable noninvasive tool for early detecting of ventricular myocardial involvement caused by SSc.

Objective To explore the association between Doppler echocardiography parameters and pulmonary capillary wedge pressure (PCWP) obtained by right heart catheterization (RHC) in patients with pulmonary hypertension (PH).Methods RHC and a simultaneous echocardiography were performed in 86 PH patients.The correlation between the echocardiographic parameters and PCWP was analyzed.Results The early diastolic velocity(E) of mitral valve blood flow was significantly correlated with PCWP ( γ =0.36,P ＜0.01 ).Tissue Doppler imaging measured the diastolic velocity of mitral annulus on the lateral(E'L)and the septal (E'S) wall.Then the average E'M was calculated.The ratio of E to E'L,E'S and E'M showed a strong correlation with PCWP ( γ =0.62,0.34 and 0.47 respectively,P ＜ 0.01 ).E/E'L ＜ 6 accurately predicted 100％ PCWP≤ 15 mm Hg (1 mm Hg =0.133 kPa),and E/E'L ＞ 15 could predict PCWP ＞ 15 nun Hg with specificity of 98.5％.Conclusion There are positive correlation between E/E' and PCWP obtained by RHC in PH patients.