Objective To explore the advantages of modified Paine point puncture for intraventricular intracranial pressure(ICP)monitoring probe implantation during decompressive craniectomy(DC)for severe traumatic brain injury.Methods The clinical data of 48 patients with severe traumatic brain injury admitted from April 2020 to April 2022 in Jiaxing Second Hospital were retrospectively collected.All patients underwent DC combined with ICP monitoring probe implantation.According to different ICP monitoring methods,they were divided into observation group(23 cases)and control group(25 cases).The observation group underwent the implantation of the intracerebroventricular ICP monitoring probe by puncture at the modified Paine point in the DC incision,while the control group underwent implantation of intracerebroventricular ICP monitoring probe by drilling of the skull through contralateral incision of DC at the Kocher point.The preoperative general data,operation time,postoperative mannitol dose and duration,ICP monitoring duration,postoperative rebleeding rate,intracranial infection rate and Glasgow outcome score(GOS)at 3 months after the operation were compared between the two groups.Results There was no statistical difference between the two groups in general data,mannitol dosage,mannitol duration and ICP monitoring duration(P>0.05).The operation time,postoperative rebleeding rate and intracranial infection rate in observation group were lower than those in control group(P<0.05).In the GOS score at 3 months after the operation,there was no statistical difference between the two groups(P>0.05).Conclusions Compared with the traditional implantation of intraventricular ICP monitoring probe through Kocher point through skull drilling with contralateral incision of DC,the implantation of intraventricular ICP monitoring probe through modified Paine point in the DC incision for severe traumatic brain injury can shorten the operation time and lower the postoperative rebleeding rate and intracranial infection rate.

Gallbladder adenoma,a benign tumor of mucosal epithelial origin,is considered to be a pre-cancer to gallbladder cancer(GBC),and its malignant transformation may occur in a relatively short time.The pathological process and molecular mechanism of gallbladder adenoma carcinogenesis are still controversial;ultrasound and CT are widely used to examine gallbladder diseases,and the application of contrast-enhanced ultrasound(CEUS)and high-frame-rate contrast-enhanced ultrasound(H-CEUS)has improved the diagnostic accuracy.In this paper,we summarize the literature on the clinicopathological features,imaging manifestations,gene expression,treatment,and clinical prognosis of gallbladder adenoma carcinogenesis.

Objective To investigate the incidence and risk factors for acute kidney injury(AKI)in children with primary nephrotic syndrome(PNS),as well as the role of neutrophil gelatinase-associated lipocalin(NGAL)and kidney injury molecule-1(KIM-1)in the early identification of AKI in these children.Methods A prospective collection of clinical data from children hospitalized with PNS at the Children's Hospital of the Capital Institute of Pediatrics from January 2021 to October 2022 was conducted.The children were divided into two groups based on the presence of AKI:the AKI group(47 cases)and the non-AKI group(169 cases).The risk factors for AKI in children with PNS were identified by multivariate logistic regression analysis.Urinary KIM-1 and NGAL levels were compared between the AKI and non-AKI groups,as well as among the different stages of AKI.Results The incidence of AKI in children with PNS was 21.8%.Multivariate logistic regression analysis revealed that steroid-resistant nephrotic syndrome,gastrointestinal infections,and heavy proteinuria were independent risk factors for AKI in these children with PNS(P<0.05).Urinary KIM-1 and NGAL levels were higher in the AKI group compared to the non-AKI group(P<0.05),and the urinary NGAL and KIM-1 levels in the AKI stage 2 and stage 3 subgroups were higher than those in the AKI stage 1 subgroup(P<0.017).Conclusions KIM-1 and NGAL can serve as biomarkers for the early diagnosis of AKI in children with PNS.Identifying high-risk populations for AKI in children with PNS and strengthening the monitoring of related risk factors is of significant importance.

Objective:To investigate distribution and drug resistance of pathogens of bloodstream infection in patients with hematological malignancies,in order to provide reference for clinical infection control and treatment.Methods:The clinical information of blood culture patients in the hematology department of our hospital from January 2016 to December 2021 was reviewed.They were divided into transplantation group and non-transplantation group according to whether they had undergone hematopoietic stem cell transplantation.The types of pathogens and their drug resistance were analyzed.Results:Two hundred and ninety-nine positive strains of pathogenic bacteria were detected.In the transplantation group,Gram-negative bacteria accounted for 68.5％(50/73),Gram-positive bacteria accounted for 6.8％(5/73),and fungi accounted for 24.7％(18/73).The resistance rate of Escherichia coli to the third-generation cephalosporins was 77.8％,and 11.5％to carbapenems.The resistance rate of Klebsiella pneumoniae to the third-generation cephalosporins was 50.0％,and 56.2％to carbapenems.In the non-transplantation group,Gram-negative bacteria accounted for 64.1％(145/226),Gram-positive bacteria accounted for 31.0％(70/226),and fungi accounted for 4.9％(11/226).Gram-positive bacteria were mainly Enterococcus faecium(6.6％,15/226)and Coagulase-negative Staphylococci(6.2％,14/226).The fungi were all Candida tropicalis.The resistance rate of Escherichia coli to the third-generation cephalosporins was 63.8％,and 10.3％to carbapenems.The resistance rate of Klebsiella pneumoniae to the third-generation cephalosporins was 46.3％,and 26.8％to carbapenems.Conclusion:The types of pathogenic bacteria in bloodstream infection in patients with hematological malignancies are varied.Gram-negative bacteria is the main pathogenic bacteria.The resistance of pathogenic bacteria to antibiotics is severe.Antibiotics should be used scientifically and reasonably according to the detection and resistance of pathogenic bacteria.

Objective: Narrative exposure therapy (NET) has been used in various contexts for the treatment of the effects of trauma, with promising results in clinical trials. However, its effects on anxiety and depression are still unclear. The present study is a systematic review and meta-analysis of the effects of NET on depression and anxiety. Methods: The Embase, Cumulative Index of Nursing and Allied Health Literature, PubMed, Web of Science core collection, Cochrane Library, Chinese National Knowledge Infrastructure, Chinese Biomedical Database, and Wangfang databases were searched from the earliest records to March 2023. Two researchers independently screened the literature, extracted data, evaluated the risk of bias, and cross-checked the data. Meta-analysis was performed using the program RevMan 5.3. Results: Eleven randomized controlled trials with a total of 754 participants were included in the study. The results showed that NET reduced both the depression (standard mean difference [SMD]=-0.51, 95% confidence interval [CI] -0.73–-0.29, p<0.00001) and anxiety (SMD=-0.65, 95% CI -1.13–-0.18, p=0.007) scores of the patients. Furthermore, NET was found to alleviate negative emotions associated with guilt (mean difference [MD]=-3.60, 95% CI -5.52–-1.68, p=0.0005) and negative change (MD=-5.80, 95% CI -9.76–-1.83, p=0.004). Conclusion This analysis showed that NET can alleviate depression and anxiety. It may thus be used in clinical settings to alleviate patients’ negative feelings and aid their overall recovery.

Objective: To summary the clinical presentation and prognosis of primary nephrotic syndrome (PNS) in teenagers. Methods: The clinical data, renal pathological types and prognosis of 118 children over 10-year-old with PNS treated in the Department of Nephrology of the Children's Hospital Affiliated to Capital Institute of Pediatrics from January 2010 to December 2020 were retrospectively analyzed, with 408 children ≤10-year-old as control group synchronously. Chi-square test was used to compare the difference of clinical types, pathologic types, response to steroids and tubulointerstitial changes between the groups. The teenagers with steroid resistant nephrotic syndrome (SRNS) were divided into initial non-responder group and late non-responder group. Kaplan-Meier method was used to compare the difference of persistent proteinuria, and Fisher's exact test for the histological types. Results: There were 118 children >10-year-old, including 74 males and 44 females, with the onset age of 12.1 (10.8, 13.4) years; and 408 children ≤10-year-old with the onset age of 4.5 (3.2, 6.8) years. The proportion of SRNS was significantly higher in patients >10-year-old than those ≤10-year-old (24.6% (29/118) vs. 15.9% (65/408), χ²=4.66, P=0.031). There was no statistical difference in the pathological types between >10-year-old and ≤10-year-old (P>0.05), with minimal change disease the most common type (56.0% (14/25) vs. 60.5% (26/43)). The percentage of cases with renal tubulointerstitial lesions was significantly higher in children >10-year-old compared to those ≤10-year-old (60.0% (15/25) vs. 23.3% (10/43), χ²=9.18, P=0.002). There were 29 cases presented with SRNS in PNS over 10-year-old, including 19 initial non-responders and 10 late non-responders. Analyzed by Kaplan-Meier curve, it was shown that the percentage of persistent proteinuria after 6 months of immunosuppressive treatments was significantly higher in initial non-responders than those of the late non-responders ((22±10)% vs. 0, χ²=14.68, P<0.001); the percentage of minimal change disease was significantly higher in patients of late non-responders than those of the initial non-responders (5/6 vs. 3/13, P=0.041). Of the 63 >10-year-old with steroid-sensitive nephrotic syndrome followed up more than one year, 38 cases (60.3%) had relapse, and 14 cases (22.2%) were frequent relapse nephrotic syndrome and steroid dependent nephrotic syndrome. Among the 45 patients followed up over 18-year-old, 22 cases (48.9%) had recurrent proteinuria continued to adulthood, 3 cases of SRNS progressed to kidney insufficiency, and one of them developed into end stage kidney disease and was administrated with hemodialysis. Conclusions: Cases over 10-year-old with PNS tend to present with SRNS and renal tubulointerstitial lesions. They have a favorable prognosis, but are liable to relapse in adulthood.
Male ; Female ; Adolescent ; Child ; Humans ; Nephrotic Syndrome/pathology* ; Retrospective Studies ; Nephrosis, Lipoid/drug therapy* ; Prognosis ; Proteinuria/etiology* ; Recurrence

Objective To explore the value of diffusion-tensor imaging(DTI)of different gray matter nuclei in the diagnosis and assessment of prodromal Parkinson's disease(pPD)under logistic regression model.Methods A total of 20 patients with pPD were collected as case group and 28 healthy people as control group(HC group).All patients were examined by MRI plain scan and DTI.DSI studio was used to post-process the DTI images of all patients.Parameters(FA,MD,AD,RD)of basal ganglia,midbrain and brainstem of patients with pPD and HC group were automatically extracted and statistically analyzed.Logistic regression analysis was used to draw the Receiver Operating Characteristic(ROC)curve to analyze and compare the diagnostic efficacy of individual diagnosis and combined diagnosis of each parameter.And the correlation between the parameters of each group and MMSE score was analyzed.Results There were statistical differences in basal ganglia,midbrain and brain stem in PPD and HC group(P<0.05).Under Logistic regression equation model,when the optimal threshold was 0.63,the AUC of PPD was 0.964.The sensitivity and specificity of differential diagnosis were 85.0%and 100%respectively(P<0.001).There was correlation between DTI parameters and MMSE score in locus coeruleus in PPD group(P<0.05),and the correlation coefficient of FA value in locus coeruleus(r =-0.646,P = 0.002)was the highest.Conclusions The lesions of basal ganglia,midbrain and brainstem correlated gray matter nuclei in pPD were extensive and differ-ent in degree.AD value of locus coeruleus was valuable for quantitative diagnosis of pPD,FA value of locus coeruleus could be used as a characteristic sensitive index for recognition of the severity of dysfunction in pPD patients.Multi-parameter combined diagnosis of DTI under Logistic regression model could effectively improve the diagnostic efficiency,and provide valuable reference for early diagnosis and intervention of pPD.

OBJECTIVE: To evaluate the efficacy and safety of Cidan Capsule combined with adjuvant transarterial chemoembolization (TACE) in patients with a high risk of early recurrence after curative resection of hepatocellular carcinoma (HCC). METHODS: A multicenter, randomized controlled trial was conducted in patients with high-risk recurrence factors after curative resection of HCC from 9 medical centers between July 2014 and July 2018. Totally 249 patients were randomly assigned to TACE with or without Cidan Capsule administration groups by stratified block in a 1:1 ratio. Postoperative adjuvant TACE was given 4-5 weeks after hepatic resection in both groups. Additionally, 125 patients in the TACE plus Cidan group were administrated Cidan Capsule (0.27 g/capsule, 5 capsules every time, 4 times a day) for 6 months with a 24-month follow-up. Primary endpoints included disease-free survival (DFS) and tumor recurrence rate (TRR). Secondary endpoint was overall survival (OS). Any drug-related adverse events (AEs) were observed and recorded. RESULTS: As the data cutoff in July 9th, 2018, the median DFS was not reached in the TACE plus Cidan group and 234.0 days in the TACE group (hazard ratio, 0.420, 95% confidence interval, 0.290-0.608; P<0.01). The 1- and 2-year TRR in the TACE plus Cidan and TACE groups were 31.5%, 37.1%, and 60.8%, 63.4%, respectively (P<0.01). Median OS was not reached in both groups. The 1- and 2-year OS rates in TACE plus Cidan and TACE groups were 98.4%, 98.4%, and 89.5%, 87.9%, respectively (P<0.05). The most common grade 3-4 AEs included fatigue, abdominal pain, lumbar pain, and nausea. One serious AE was reported in 1 patient in the TACE plus Cidan group, the death was due to retroperitoneal mass hemorrhage and hemorrhagic shock, and was not related to study drug. CONCLUSIONS Cidan Capsule in combination with TACE can reduce the incidence of early recurrence in HCC patients at high-risk of recurrence after radical hepatectomy and may be an appropriate option in postoperative anti-recurrence treatment. (Registration No. NCT02253511).

OBJECTIVE: To compare clinical effects of the improved interface screw fixation of femoral end of anterior cruciate ligament with classic femoral lateral loop plate fixation. METHODS: A retrospective analysis of 65 patients who underwent arthroscopic anterior cruciate ligament reconstruction from January 2019 to September 2021 were performed. According to the different fixation methods of the femoral side, 35 patients were divided into loop plate fixation(loop plate group), including 27 males and 8 females, aged from 18 to 50 years old with an average of (35.00±7.60) years old;30 patients in interface screw fixation(interface screw group), including 20 males and 10 females, aged from 18 to 50 years old with an average of (32.00±8.50) years old. Hospital stay, hospital expenses, operation time, complications, C-reactive protein at 1, 3, 6 days after operation, and postoperative Lysholm score and International Knee Documentation Committee(IKDC) score at 18 months were compared between two groups. RESULTS: All patients were successfully operated, and obtained follow-up from 18 to 36 months with an average of (25.16±4.50) months. Anterior drawer test and Lachman test of all patients turned to negative. There were no statistical differences in hospital stay, hospital expenses and complications between two groups(P>0.05);operation time in loop plate group was (74.00±6.84) min, and (91.67±6.34) min in interface screw group, and had difference between two groups(P<0.05). C-reactive protein on the 1st and 3rd day after operation was (40.00±10.10), (20.00±8.23) mg·L^-1 in loop plate group, and (60.00±8.93), (30.00±8.66) mg·L^-1 in interface nail group, had statistical difference between two groups (P<0.05);while there was no difference in C-reactive protein on the 6th day after operation(P>0.05). At 18 months after operation, Lysholm and IKDC scores showed no significant difference between two groups (P>0.05). In loop plate group, medullary enlargement on coronal and sagittal views were (2.75±0.19) mm, (1.55±0.25) mm, and (2.81±0.22) mm, (1.61±0.20) mm in interface screw group, and had statistical difference between two groups(P<0.05). CONCLUSION In the reconstruction of anterior cruciate ligament, the common interface screw on the femoral side is changed to the sheath interface screw, and intramedullary screw is changed to the compression and fixation of tendon from outside to inside of joint. Although the operation procedure is relatively complicated and operation time is slightly longer, it has advantages of no residual metal foreign body after operation, and clinical effect is no different from classical loop plate suspension fixation, which is still a good choice.
Female ; Male ; Humans ; Adolescent ; Young Adult ; Adult ; Middle Aged ; C-Reactive Protein ; Retrospective Studies ; Femur ; Anterior Cruciate Ligament Reconstruction ; Bone Screws

OBJECTIVE: To explore the therapeutic effect of multiple small diameter drilling combined with extracorporeal shock wave therapy (ESWT) under C-arm X-raylocalization in patients with early osteonecrosis of the femoral head (ONFH). METHODS: A total of 106 cases of early ONFH patients admitted from May 2015 to May 2017 were retrospectively selected as the study subjects. According to different treatment methods, the patients were divided into observation group and control group, 53 cases in each group. The observation group was treated with multiple small-diameter drilling combined with ESWT under C-arm positioning in the observation group, including 41 males and 12 females with an age of (45.85±6.01) years old (22 to 70 years old);and the control group was treated with ESWT, including 34 males and 19 females with an age of (45.12±5.83) years old(20 to 68 years old) in the control group. The modified Harris hip scores(mHHS), visual analog scale(VAS), hip flexion range, hip abduction and adduction range, ONFH area ratio and clinical efficacy were compared between twe groups before and after treatment. Kaplan-Meier method was used to draw a survival curve to compare the femoral head survival rate between two groups during the 3-year follow-up period after treatment. RESULTS: There were no complications such as poor wound healing and infection. All of 106 patients were followed up for 28 to 36 months with an average of (31.06±4.28) months. MHHS score, hip flexion range and hip abduction and adduction range in the observation group were increased from (63.85±5.42) scores, (23.79±2.21) °, (32.40±4.19) ° before treatment to (85.51±5.69) scores, (34.65±2.73)°, (43.32±5.71)° at 2 years after treatment, respectively(P<0.05). The above indicators in the control group increased from (64.73±5.64)°, (23.82±2.18)°, (32.45±4.13)° before treatment to (81.65±5.48) scores, (32.79±2.87)°, (39.75±5.68)°at two years after treatment, respectively(P<0.05). VAS score and ONFH area ratio in the observation group decreased from (5.76±1.41) scores and (35.07±4.96)% before treatment to (3.39±1.02) scores and (22.04±3.23)% at 2 years after treatment, respectively(P<0.05). The above indicatiors in control group decreased from (5.73±1.45) scores and (35.24±5.18)% before treatment to (4.43±1.21) scores and (28.32±3.76)% at 2 years after treatment, respectively(P<0.05), and the improvement in the observation group was significantly higher than that in the control group(P<0.05). At 3 years after treatment, the femoral head survival rate in the observation group was higher than that in the control group (P<0.05). CONCLUSION Multiple small diameter drilling combined with ESWT under C-arm positioning can significantly improve the clinical symptoms of patients with early ONFH, relieve pain and improve clinical efficacy.
Male ; Female ; Humans ; Adult ; Middle Aged ; Young Adult ; Aged ; Femur Head ; Retrospective Studies ; Femur Head Necrosis/diagnosis* ; Extracorporeal Shockwave Therapy/methods* ; Treatment Outcome