Objective:To compare the efficacy of body posture combined with pharmacotherapy and pharmacotherapy alone in the treatment of chronic subdural hematoma(CSDH).Methods:Firstly, retrospective case series study was conducted. Thirty cases of CSDH that had received body posture combined with pharmacotherapy at Department of Neurosurgery, Huashan Hospital Affiliated to Fudan University from December 2016 to October 2020 were studied retrospectively. Twenty-seven patients were male, and 3 patients were female. The age of patients ( M(IQR)) was 66(16) years (range:28 to 84). Nineteen patients had unilateral hematoma, and 11 patients had bilateral hematoma. All patients received pharmacotherapy and body posture therapy that was to raise their lower limbs 20 to 30 cm with leg lift pad and get abdominal compressed with customized abdominal belt in supine position. Patients were required to maintain the body posture as much as possible, with the maximum to 16 to 18 hours per day. Patients with unilateral hematoma should tilt the head to the affected side and avoid tilting it to the opposite side. For patients with bilateral hematoma, there was no need for head lateralization. Patient were treated with oral dexamethasone and atorvastatin simultaneously. The preliminary efficacy of body posture combined with pharmacotherapy was determined by hematoma improvement rate which was analyzed by Clopper-Pearson method. Then, the multi-center, prospective, randomized controlled trial had carried out in 9 medical centers from August 2020 to November 2021. The stratified block randomization method was adopted. Patients were randomized in a ratio of 1∶1 to either receive pharmacotherapy alone(the control group) or body posture combined with pharmacotherapy(the experiment group) for 3 months and followed up for 6 months. Effective treatment was defined as complete absorption of hematoma, or the hematoma volume decreased by more than 10 ml and Markwalder grading scale score had improved by more than 1 point compared to the baseline. The efficacy rate and surgery conversion rate at 3 months and recurrence at 6 months were observed. Comparison between groups was performed with paired sample t test, Mann-Whitney U test, χ2 test, corrected χ2 test, or Fisher exact probability method. Logistic regression was used to compare the effective rate and operation rate between the two groups. Results:In the respective study, 30 patients completed follow-up 13 to 353 days after treatment. At the last follow-up, the incidence of almost complete absorption or significantly absorption of hematoma (hematoma volume was significantly reduced accompanied by symptom improvement) was 93.3%. The 95% CI for the incidence that analyzed by the Clopper-Pearson method was 77.9% to 99.2%. One hundred and six patients were enrolled in the multicenter study. Fifty-five patients underwent body posture combined with pharmacotherapy. The age was 74(17) years (range:26 to 92). Thirty-nine patients were males and 16 were females. Fifty-one patients underwent pharmacotherapy alone. The age was 69(12) years (range:48 to 84). Thirty-seven patients were males and 14 were females. The length of body posture recorded in diary card was (15.7±2.3) hours(range:7.6 to 19.3 hours). The efficacy rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 83.6% (46/55) and 56.9% (29/51), respectively at 3 months. The result of the logistic regression analysis showed that the efficacy of body posture combined with pharmacotherapy group was better than that of pharmacotherapy alone group ( OR=3.88,95% CI:1.57 to 9.58, P=0.003). Surgery rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 5.5% (3/55) and 21.6% (11/51) respectively. The result of Logistic regression showed that the pharmacotherapy alone group was more likely to be converted to surgery ( OR=0.21,95% CI:0.05 to 0.80, P=0.023). At the 6 months, no recurrence of cases was found in the body posture combined with pharmacotherapy group. However, the recurrence rate of pharmacotherapy alone group was 6.3% (3/48), there was no significant difference between the two groups ( P>0.05). Conclusion:The effect of body posture combined with pharmacotherapy for chronic subdural hematoma is better than that of pharmacotherapy alone.

Objective To study the spatial distribution of the incidence of pulmonary tuberculosis in Hubei Province and its influencing factors, so as to improve the theoretical basis for scientific development of tuberculosis prevention and control measures in the future. Methods The data of reported incidence of tuberculosis and related influencing factors in various counties and districts of Hubei Province in 2020 were collected. Global Moran's I index, hotspot analysis and geographically weighted regression (GWR) model analysis were used to calculate the spatial autocorrelation of the incidence of tuberculosis, and to analyze the influencing factors affecting the incidence rate of tuberculosis. Results There were obvious regional differences in the space distribution of the incidence rate of tuberculosis. Hot spot analysis showed positive spatial correlation and obvious clustering. The GWR model (AICc=784.251) in this study had higher AICc value compared to the ordinary least squares regression (OLS) model (AICc=804.2585). The GWR model showed that the increase in the proportion of the population aged 65 and above and the proportion of the ethnic minority population had a significant promoting effect on the increase of the incidence rate of tuberculosis, and there was significant spatial heterogeneity. The effect of PM_2.5 concentration on the incidence rate of pulmonary tuberculosis varied in different regions, and the degree of effect was also different. Conclusion The proportion of people aged 65 and above and the proportion of ethnic minorities may significantly influence the incidence of pulmonary tuberculosis. The effect of PM_2.5 concentration varies in different regions, so targeted measures should be formulated according to the situation in different regions.

Objective:To compare the efficacy of body posture combined with pharmacotherapy and pharmacotherapy alone in the treatment of chronic subdural hematoma(CSDH).Methods:Firstly, retrospective case series study was conducted. Thirty cases of CSDH that had received body posture combined with pharmacotherapy at Department of Neurosurgery, Huashan Hospital Affiliated to Fudan University from December 2016 to October 2020 were studied retrospectively. Twenty-seven patients were male, and 3 patients were female. The age of patients ( M(IQR)) was 66(16) years (range:28 to 84). Nineteen patients had unilateral hematoma, and 11 patients had bilateral hematoma. All patients received pharmacotherapy and body posture therapy that was to raise their lower limbs 20 to 30 cm with leg lift pad and get abdominal compressed with customized abdominal belt in supine position. Patients were required to maintain the body posture as much as possible, with the maximum to 16 to 18 hours per day. Patients with unilateral hematoma should tilt the head to the affected side and avoid tilting it to the opposite side. For patients with bilateral hematoma, there was no need for head lateralization. Patient were treated with oral dexamethasone and atorvastatin simultaneously. The preliminary efficacy of body posture combined with pharmacotherapy was determined by hematoma improvement rate which was analyzed by Clopper-Pearson method. Then, the multi-center, prospective, randomized controlled trial had carried out in 9 medical centers from August 2020 to November 2021. The stratified block randomization method was adopted. Patients were randomized in a ratio of 1∶1 to either receive pharmacotherapy alone(the control group) or body posture combined with pharmacotherapy(the experiment group) for 3 months and followed up for 6 months. Effective treatment was defined as complete absorption of hematoma, or the hematoma volume decreased by more than 10 ml and Markwalder grading scale score had improved by more than 1 point compared to the baseline. The efficacy rate and surgery conversion rate at 3 months and recurrence at 6 months were observed. Comparison between groups was performed with paired sample t test, Mann-Whitney U test, χ2 test, corrected χ2 test, or Fisher exact probability method. Logistic regression was used to compare the effective rate and operation rate between the two groups. Results:In the respective study, 30 patients completed follow-up 13 to 353 days after treatment. At the last follow-up, the incidence of almost complete absorption or significantly absorption of hematoma (hematoma volume was significantly reduced accompanied by symptom improvement) was 93.3%. The 95% CI for the incidence that analyzed by the Clopper-Pearson method was 77.9% to 99.2%. One hundred and six patients were enrolled in the multicenter study. Fifty-five patients underwent body posture combined with pharmacotherapy. The age was 74(17) years (range:26 to 92). Thirty-nine patients were males and 16 were females. Fifty-one patients underwent pharmacotherapy alone. The age was 69(12) years (range:48 to 84). Thirty-seven patients were males and 14 were females. The length of body posture recorded in diary card was (15.7±2.3) hours(range:7.6 to 19.3 hours). The efficacy rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 83.6% (46/55) and 56.9% (29/51), respectively at 3 months. The result of the logistic regression analysis showed that the efficacy of body posture combined with pharmacotherapy group was better than that of pharmacotherapy alone group ( OR=3.88,95% CI:1.57 to 9.58, P=0.003). Surgery rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 5.5% (3/55) and 21.6% (11/51) respectively. The result of Logistic regression showed that the pharmacotherapy alone group was more likely to be converted to surgery ( OR=0.21,95% CI:0.05 to 0.80, P=0.023). At the 6 months, no recurrence of cases was found in the body posture combined with pharmacotherapy group. However, the recurrence rate of pharmacotherapy alone group was 6.3% (3/48), there was no significant difference between the two groups ( P>0.05). Conclusion:The effect of body posture combined with pharmacotherapy for chronic subdural hematoma is better than that of pharmacotherapy alone.

Objective To retrospectively analyze the prevention and control effect and epidemic characteristics of elderly tuberculosis in Hubei Province from 2016 to 2020, and to provide a scientific basis for the prevention and treatment of elderly tuberculosis in Hubei Province． Methods The data on tuberculosis patients aged 60 and above who registered their current address in Hubei Province from 2016 to 2020 were collected and analyzed. The registration rates and composition ratios were analyzed using χ² test and χ² test for trend. Results A total of 135 976 tuberculosis patients were reported in Hubei from 2016 to 2020. The annual average registration rate of elderly tuberculosis among the elderly registered residence population (referring to the registration rate of elderly registered residence population aged 60 and above as the denominator, and tuberculosis patients aged 60 and above as the numerator) was 263.51/100 000. The highest rate was 300.02/100,000 in 2017, and the lowest was 188.19/100,000 in 2020 (χ²=70,227.603, P<0.001). In terms of composition, the average annual proportion of tuberculosis patients in the 60-70 years old group was 59.60%, which decreased year by year (χ²_trend=40.448，P<0.001 ). The average annual proportion of males was 73.35%, which was significantly higher than that of females (26.65%). The average annual proportion of farmers was 62.03%. From the perspective of case management, the annual average proportion of major epidemic online reports was 85.17%. The classification of cases was mainly based on clinical diagnosis, accounting for 48.33% annually and showing a decreasing trend year by year (χ²_trend=740.911, P<0.001). The proportion of confirmed cases was 25.08%, which showed an increasing trend (χ²_trend=380.557, P<0.001). From 2016 to 2019, the delay rate of diagnosis and treatment of elder tuberculosis patients was 49.42% (67 876/135 967), and the delay rate decreased year by year (χ²_trend=323.764, P<0.001). Conclusion The elderly population with pulmonary tuberculosis in Hubei Province shows a downward trend. It is necessary to focus on the efforts of designated hospitals to proactively identify cases, increase the proportion of confirmed cases, maintain a high tracking in place, reduce medical delays, and ensure the effectiveness of tuberculosis prevention and treatment for the elderly.

Objective To systematically evaluate the efficacy of adjuvant radiotherapy after thymoma resection. Methods The PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang, VIP, CNKI databases were systematically searched to find relevant literature comparing the efficacy and effectiveness of thymoma resection and thymoma resection+postoperative radiation therapy (PORT) for treating thymoma published from inception to January 2024. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of included retrospective studies, and Review Manager 5.4 software was used to perform meta-analysis. Results A total of 23 articles were included, all of which were retrospective studies. There were a total of 13742 patients, including 6980 patients in the simple surgery group, with 3321 males and 3659 females, and an average age of 54.08 years; 6762 patients in the surgery+PORT group, with 3385 males and 3377 females, and an average age of 53.76 years. The NOS scores of the included literature were all≥7 points. The results of the meta-analysis showed that compared with the simple surgery group, the surgery+PORT group had higher 1-year overall survival rate [OR=0.32, 95%CI (0.25, 0.42), P<0.001], 3-year overall survival rate [OR=0.55, 95%CI (0.48, 0.64), P<0.001], 5-year overall survival rate [OR=0.66, 95%CI (0.58, 0.75), P<0.001], 10-year overall survival rate [OR=0.71, 95%CI (0.57, 0.88), P=0.002], 1-year disease-free survival rate [OR=0.47, 95%CI (0.23, 0.93), P=0.030], 5-year disease-free survival rate [OR=0.61, 95%CI (0.45, 0.84), P=0.003], 3-year disease-specific survival rate [OR=0.44, 95%CI (0.35, 0.55), P<0.001], 5-year disease-specific survival rate [OR=0.53, 95%CI (0.44, 0.63), P<0.001] and 10-year disease-specific survival rate [OR=0.53, 95%CI (0.35, 0.82), P=0.004]. But there was no statistically significant difference between the two groups in terms of 3-year disease-free survival rate [OR=0.86, 95%CI (0.61, 1.22), P=0.400], 10-year disease-free survival rate [OR=0.70, 95%CI (0.47, 1.05), P=0.080] and 1-year disease-specific survival rate [OR=0.83, 95%CI (0.55, 1.26), P=0.380]. Conclusion PORT after thymoma resection has more advantages than simple surgical treatment in terms of 1-, 3-, 5-, and 10-year overall survival, 1- and 5-year disease-free survival, and 3-, 5- and 10-year disease-specific survival.

Objective:To analyze high-risk behaviors related to HIV infection in men who have sex with men (MSM) recruited by different methods in Zhenjiang city, and to provide a reference for precise prevention and control of acquired immunodeficiency syndrome (AIDS) .Methods:From April to June in 2020, MSM in Zhenjiang city were recruited as research subjects through the center for disease control and prevention (CDC) voluntary counseling and testing (VCT) clinic and community-based organizations (CBOs) . Information such as demographic characteristics, drug abuse, HIV testing history and high-risk sexual behavior were collected through a unified questionnaire survey. Chi-square test or Fisher′s exact test was used to analyze differences in relevant characteristics of MSM recruited by different methods.Results:A total of 641 MSM were recruited by the two methods, including 442 (68.95%) recruited from CBOs and 199 (31.05%) from CDC; the proportion of MSM aged under 20 years was significantly higher in the CBO group (6.56%) than in the CDC group (1.01%, χ2 = 9.20, P = 0.002) ; the proportions of MSM receiving health education information on potential hazards of drug use from professional health institutions and new network media were significantly higher in the CDC group (7.54% [15/199], 16.58% [33/199], respectively) than in the CBO group (3.39% [15/442], χ2 = 5.28, P = 0.022; 9.50% [42/442], χ2 = 6.66, P = 0.010) . In terms of characteristics of sexual behavior, the CBO group showed significantly increased proportions of individuals having group sex (25.21%, 30 cases) and those having unprotected sexual intercourse with women (47.51%, 210 cases) compared with the CDC group (7.50% [6 cases], χ2 = 10.13, P = 0.001; 27.64% [55 cases], χ2 = 22.35, P < 0.001, respectively) , but significantly decreased proportions of heterosexuals (2.04%, 9 cases) , individuals unknowing about the HIV status of sexual partners (22.40%, 99 cases) and those having unprotected anal sex with men (39.82%, 176 cases) compared with the CDC group (6.53% [13 cases], χ2 = 8.37, P = 0.004; 39.70% [79 cases], χ2 = 20.48, P < 0.001; 57.29% [114 cases], χ2 = 16.90, P < 0.001, respectively) . Compared with the CDC group, the CBO group showed significantly decreased proportions of individuals ever having an HIV test (74.43% [329 cases] vs. 80.90% [161 cases], χ2 = 3.19, P = 0.074) and those getting the latest HIV test from CDC (23.10% [76 cases] vs. 57.14% [92 cases], χ2 = 99.41, P < 0.001) , as well as decreased prevalence of HIV infection (5.20% [23 cases] vs. 13.07% [26 cases], χ2 = 21.85, P < 0.001) . Conclusions:The MSM recruited from CBO and CDC are complementary in terms of demographics and behaviors, and can represent the general MSM population. Specific prevention and control measures for AIDS should be taken according to different characteristics of the MSM population.

Objective:To investigate the clinical value of integrated traditional Chinese and Western medicine based on the concept of enhanced recovery after surgery (ERAS) in the perioperative period of total knee arthroplasty.Methods:Sixty patients who underwent primary unilateral total knee arthroplasty in Tonglu Hospital of Traditional Chinese Medicine from July 2018 to June 2019 were included in this study. They were randomized as odd numbers to the control group ( n = 30) and even numbers to the observation group ( n = 30). The control group was treated with conventional rehabilitation treatment, while the observation group was subjected to integrated traditional Chinese and Western medicine based on the concept of ERAS in the perioperative period of total knee arthroplasty. The perioperative pain, related complications, hospitalization expenses and length of hospital stay were recorded in each group. The Visual Analogue Scale (VAS) was used to evaluate the degree of pain and range of motion of the knee joint. The Hospital for Special Surgery (HSS) knee score was also measured to evaluate the curative effects. Results:At 3 and 7 days, 2 and 6 weeks after surgery, knee range of motion score was (63.40 ± 2.80) points, (86.20 ± 4.40) points, (90.30 ± 6.48) points, (100.5 ± 3.39) points, respectively, and at 6 weeks after surgery, HSS knee score was (89.40 ± 5.18) points, in the observation group, which were significantly higher those in the control group [(48.50 ± 4.20) points, (55.40 ± 3.58) points, (77.50 ± 4.38) points, (87.60 ± 4.58) points, (70.50 ± 6.44) points, t = 0.029, 0.013, 0.032, 0.039, 0.042, all P < 0.05]. In the observation group, the VAS score in resting state at 6, 12, 24 and 48 hours after surgery were (3.62 ± 0.40) points, (2.41± 0.52) points, (2.05 ± 0.62) points, (1.93 ± 0.28) points respectively, and the VAS score in active state at 24 and 48 hours were (2.15 ± 0.21) points and (1.71 ± 0.39) points, respectively, which were significantly lower than those in the control group [(5.71 ± 0.63) points, (4.60 ± 0.31) points, (3.84 ± 0.22) points, (3.30 ± 0.21) points, (5.50 ± 0.49) points, (4.80 ± 0.21) points, t = 0.040, 0.035, 0.046, 0.042, 0.027, 0.024, all P < 0.05]. The proportions of patients experiencing postoperative urinary retention, mental disorder, or blood transfusion, length of hospital stay, and hospitalization expenses in the observation group were lower or shorter than those in the control group ( χ2 = 0.003, 0.005, 0.017, t = 0.040, 0.048, all P < 0.05). Conclusion:Integrated traditional Chinese and Western medicine based on the concept of ERAS can mitigate postoperative pain, reduce perioperative complications, and promote the recovery of knee joint function, and thereby deserves clinical application.

OBJECTIVE： To provide reference for strengthening clinical application of key monitoring drugs and promoting rational drug use in clinic. METHODS： Based on evidence-based medicine， taking key monitoring drugs Shuxuetong injection as example， clinical evidence of domestic and foreign clinical studies were collected. The included literatures were graded according to the quality of GRADE evidence and recommended strength system. Evidence-based medicine evidence for the indications of Shuxuetong injection were evaluated， and criterion for clinical use of Shuxuetong injection was formulated in Huaihua First People’s Hospital （our hospital）. RESULTS： The main content of criterion for clinical application of Shuxuetong injection formulated by our hospital was that there was A-level evidence support for acute ischemic cerebral infarction， but it was weakly recommended and only used for adjuvant therapy； there was B-level evidence support for anticoagulation （for preventing DVT）， diabetic peripheral nerve lesion， but it was weakly recommended； there was only C-level or D-level evidence support for other indications， it was strongly recommendation against use. CONCLUSIONS： Clinical pharmacists formulate the criterion for clinical application of Shuxuetong injection by evidence quality evaluation method， provide reference for clinical application management of key monitoring drug and play an important effect on rational drug use in clinic.

Objective:To study the clinical efficacy of botulinum toxin type A injection in the treatment of upper facial dynamic wrinkles.Methods:A total of 35 patients with upper facial dynamic wrinkles treated in our hospital from February 2016 to October 2016 were selected as research objects.All the patients were treated with botulinum toxin type A.The excellence rate of 30min after treatment,3 d after treatment and 7 d after treatment were evaluated and compared.The facial wrinkles severity index of the patients were evaluated by the facial wrinkles scale (FWS),and the differences of the FWS index before treatment,4 weeks after treatment and 6 months after treatment were compared.The adverse reactions,like upper facial tension,fatigue and local injection of ecchymosis after treatment were observed and compared.Results:The excellence rate of the patients after treatment of 30 min,3 d and 7 d were gradually increased.The excellence rate of the patients after treatment of 3 d and 7 d were significantly higher than that of after treatment of 30 min,and the excellence rate of the patients after treatment of 7 d were significantly higher than that of after treatment of 3 d (P＜0.05).The FWS index of the patients after treatment of 4 weeks and 6 months were significantly lower than those of before treatment,and the FWS index of the patients after treatment of 4 weeks were significantly lower than that of 6 months after treatment(P＜0.05).After treatment,only 4 patients had slight discomfort and all of these symptoms were disappeared after 3-4 days,there was no effect on their normal work and life.Conclusion:Botulinum toxin type A injection has a remarkable clinical curative effect in the treatment of patients with upper facial dynamic wrinkles,can maintain tor a long time,and also has good safety,it is worthy clinical application.

Objective:To investigate the curative effect of botulinum toxin type A combined with plastic operation of pouches on patients with eye skin relaxation and its impact on patients' satisfaction,and to provide reference for clinical application.Methods:A total of 60 patients with eye skin relaxation,who were treated in Baoji Central Hospital from June 2015 to June 2016,were selected as subjects and divided into control group (n=28) and treatment group (n=32) according to the patients' choices.The patients of control group were treated with plastic operation of pouches,while the patients of treatment group were treated with botulinum toxin type A combined with plastic operation of pouches.The two groups were followed up for 6 months.The improvement of crow's feet,the relief of pouches and the improvement of eye skin gloss of the patients after operation were observed and recorded.The incidence of complications were also observed.At the end of the follow-up,the satisfaction degrees of the patients were investigated with the self-made questionnaire.Results:After treatment,the improvement rate(100％) of crow's feet of the treatment group was significantly higher than that(60.71％) of the control group;the improvement rate (96.88％) of pouches of the treatment group was significantly higher than that (32.14％) of the control group;the improvement rate (87.50％) of eye skin gloss of the treatment group was significantly higher than that (53.57％) of the control group,and the differences were statistically significant (all P＜0.05).After treatment,there was no significant difference in the incidence of incision swelling,small amount of secretions and small hematoma between the two groups (P＞0.05),the operation eye swelling and incision bruises outer canthus in the control group were more than those in the treatment group (P＜0.05).The total satisfaction rate [93.75％ (30/32)] of the treatment group was significantly higher than that[67.86％ (19/28)] of the control group,the difference was statistically significant (P＜0.05).Conclusion:Botulinum toxin type A combined with plastic operation of pouches in the treatment of eye skin relaxation has a better efficacy and safety,which can significantly reduce the incidence of operation eye swelling and incision bruises outer canthus,and improve patients' satisfaction rate.It is worthy of clinical application.