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Objective:To evaluate the clinical efficacy of channel screw guided by O-arm navigation for the treatment of type II fragile fracture of pelvis (FFP) in the elderly.Methods:A retrospective cohort analysis was performed on clinical data of 37 patients with type II FFP admitted to Shanghai Pudong Hospital, Fudan University Pudong Medical Center from September 2019 to April 2021. There were 9 males and 28 females, aged 65-82 years [(71.8±10.1)years]. A total of 15 patients receipt channel screw fixation under O-arm navigation (surgical group) and 22 patients were treated conservatively (non-surgical group). The visual analogue scale (VAS) and Majeed functional score were compared between the two groups at emergency visit and at 1 week, 1 month, 3 months, 6 months after treatment. The accuracy of screw insertion and complications were also recorded during treatment and follow-up.Results:All patients were followed up for 6-18 months [(13.2±5.1)months]. There were no significant differences in the VAS and Majeed functional score between the two groups at emergency visit (all P>0.05). In both groups, lower VAS and higher Majeed functional score were found at 6 month after treatment as compared with those at emergency visit (all P<0.01). The VAS in surgical group was 2(1, 4)points at 1 week after treatment, lower than 4(3, 5)points in non-surgical group ( P<0.01). The VAS in surgical group was 1(1, 2)points at 1 month after treatment, lower than 3(2, 5)points in non-surgical group ( P<0.05). The Majeed functional score in surgical group was (50.2±4.2)points at 1 week after treatment, higher than (40.2±5.6)points in non-surgical group ( P<0.01). The Majeed functional score in surgical group was (73.8±5.2)points at 1 month after treatment, higher than (62.4±5.0)points in non-surgical group ( P<0.01). The two groups had no significant differences in VAS and Majeed functional score at 3 months and 6 months after treatment (all P>0.05). The accuracy of screw insertion in surgical group was 93% (14/15). In surgical group, the complication rate was 13%(2/15), including urinary tract infection in 1 patient and intraoperative screw penetration in 1, with no screw loosening or nerve and vascular injuries. In non-surgical group, the complication rate was 50%(11/22), including urinary tract infection in 5 patients, penetrating pneumonia in 5 and deep vein thrombosis in 1. The complication rate was significantly different between the two groups ( P<0.05). Conclusions:Compared with non-surgical treatment, the channel screw insertion guided by O-arm navigation can achieve precise screw placement, relieve pain early, promote functional recovery, realize accurate insertion of the screw and reduce the complication rate for type II FFP in the elderly.
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Objective To evaluate the value of MRS in quantitative assessment of degeneration of lumbar discs.Methods Totally 82 patients with lumbago underwent lumbar MR scanning.All the discs were classified with Pfirrmann grades in the sequences of sagittal T2WI.The area under N-acetyl peak,under water peak and the ratio of N-acetyl/Water were measured by MRS.Correlation between MRS values and Pfirrmann grade,age were analyzed.Results In 82 patients,204 lumbar discs were measured by MRS.There were 89,73,39,3 discs in Pfirrmann Ⅱ,Ⅲ,Ⅳ,V respectively.The areas of N-acetyl,water peak and N-acetyl/Water ratio of nucleus region were positively correlated with Pfirrmann grading,respectively (rs =-0.460,-0.204,-0.526,all P＜0.05).There were 62,25,37,51,29 discs in patients aged ＜30,30-39,40-49,50-59,＞59 years respectively.The ares of N-acetyl peak,N-acetyl/Water ratio of nucleus region was negatively correlated with the age (rs=-0.247,-0.385,both P＜0.05).Conclusion MRS can be used for quantitative assessment of lumbar discs degeneration.
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Objective To understand the drug resistance characteristics of pseudomonas aeruginosa and to guide the selection of clinical antibacterial drugs .Methods The clinically isolated 335 strains of pseudomonas aeruginosa from the Xuzhou Municipal First People′s Hospital in 2013 were collected and performed the drug susceptibility test .The test results and data were analyzed by using the WHONET5 .6 software .Results Clinically isolated 335 strains of pseudomonas aeruginosa had different degrees of re‐sistance to 15 kinds of antibacterial drugs ,in which the sensitivities to piperacillin/tazobactam ,amikacin ,tobramycin ,ciprofloxacin , levofloxacin ,ceftazidine ,cefepime and gentamicin were higher ;the resistance rate to ampicillin/sulbactam ,ceftriaxone ,ampicillin and cefotaxime was up to above 97% .In the same patients with several times of this bacterial detection ,larger volatility existed in the susceptibility results of piperacillin/tazobactam ,ceftazidine ,cefepime ,imipenem and gentamicin .Meanwhile the drug resitance spectrum of Pseudomonas aeruginosa had a certain tendency .Conclusion Strengthening continuous etiology and drug resistance moni‐toring is in response to the occurrence of acute drug resistance and nosocomial infection spread ,meanwhile guides clinical treatment .
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Objective To explore the application value of non‐concentrated urine protein electrophoresis in renal diseases in order to guide to adjust the treatment scheme and judge the prognosis .Methods The clinical data in 152 cases of renal biopsy in the Xuzhou Municipal First People′s Hospital from December 2010 to January 2016 were retrospectively collected ,mainly including the pathological report and the results of urine protein electrophoresis .The classification was performed according to the WHO renal pathology classification standard(Ⅰ ,Ⅱ ,Ⅲ ,Ⅳ) .The relationship between the renal pathological classification with the classification of urine protein electrophoresis and the proportions of various compositions in electrophoresis spectrum was comparatively ana‐lyzed .Results The glomerular lesion rate was higher than the renal tubules‐interstitial lesion rate ,the majority of renal tubules‐in‐terstitial lesion had combining glomerular lesions .The glomerular urine protein level reflected by the urine protein electrophoresis was associated with glomerular damage degree ,with WHO pathological grade (Ⅰ - Ⅳ ) increase ,the proportion of haptoglobin (HAP)and IgG/A in urine protein electrophoresis showed an increasing trend ,the differences were statistically significant (F=2 .237 ,P<0 .05 ;F=7 .269 ,P<0 .05) .Conclusion Detecting the proportion of HAP and IgG/A in urine protein electrophoresis has an important clinical value in reflecting the glomerular damage severity .
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Objective To investigate the value of laboratory testing in kidney diseases and to assess whether these marks can predict the renal histological lesions for screening the best clinical test combination.Methods The main clinical data,pathological types and laboratory examination indexes in 117 patients with renal biopsy in our hospital from December 2010 to March 2014 were collected and graded according to the WHO renal pathological classification standard and the Katafuchi semi-quantitative score standard classification (Ⅰ,Ⅱ,Ⅲ,Ⅳ).The differences in serum CysC,urine NAG,urine alpha 1-MG,urine mAlb and 24 h urine total protein (24h-UTP)level were compared among the various groups and their relations with the glomerulus was analyzed;the correlation and the statistical significance of each index in different groups was analyzed.Results NAG,alpha 1-MG and CysC had statistical differences between in the grade Ⅳgroup and the gradeⅠ,Ⅱ,Ⅲ groups (P <0.05),24h-UTP and mAlb had significant correlation in reflecting the kidney diseases (r=0.565,P =0.000);NAG and alpha 1-MG also had significant correlation in reflec-ting renal tubular interstitial disease (r=0.509,P =0.000).Conclusion The detection results of various detection indicators when rising to a certain height can be used for judging the progression of the patients clinical and pathological condition,illustrating the serious condition of illness;at the same time according to the correlation among the indexes and the detection efficiency,three indi-cators of Cys C,mAlb,alpha 1 - MG are screened out for conducting the combination detection,the detection efficiency could be greatly improved.
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Objective To analysis the effect of axial loading to ADC value, FA of lumbar intervetebral discs. Methods Forty five patients with low back pain (age range, 25 to 54 years) were evaluated with MR T2WI, MR T1WI and diffusion tensor imaging (DTI) of the lumbar spine. Following axial loading with 40% to 50% body weight for 10 minutes, a repeat DTI was performed. DTI were obtained by using an echo-planar imaging ( EPI ) sequence, TE 89 ms, TR 2500 ms, b value of 400 s/mm2,6 noncollinear diffusion directions. Scan time was approximately 4 min 10 s. An isotropic ADC map, FA map and bo map were calculated from DTI sequence. The mean ADC value, FA prior to and following axialloading were analyzed with t test and Rank Sum test. Results Forty five patients with 225 discs were evaluated and 223 discs were included in the study except for 2 calcified discs. The Pfirrmann grading results were as following: 100 Grade Ⅱ , 48 Grade Ⅲ, 59 Grade Ⅳ, and 16 Grade Ⅴ. No significant difference existed in the mean ADC value before [ ( 1666 ± 252 ) × 10-3 mm2/s ] and after [ ( 1662 ± 253 ) ×10 -3 mm2/s ] axial loading ( Z = - 1.363, P ＞ 0.05 ), but the mean FA [ ( 301 ± 104 ) × 10 -3, ( 316 ±112) × 10-3 ] value increased ( Z = - 2.794, P ＜ 0.05 ). The paired-samples t test show that the mean ADC value [ ( 1685 ± 190) × 10-3 mm2/s, ( 1624 ± 180) × 10-3mm2/s] of Grade Ⅲ discs decreased after axial loading, t=3.513, P＜0. 05, Grade Ⅲ, Ⅳdiscs mean FA value [(300±87) ×10-3, (326±87) ×10-3 for Grade Ⅲ and (348 ±67) × 10-3, (351 ± 71 ) × 10-3 for Grade Ⅳ ] increased, t = - 2. 210,- 2.006, P ＜ 0.05. No significant difference existed in Grade Ⅱ , Ⅳ and Ⅴ discs ADC value, all the P ＞0.05. No significant difference existed in Grade Ⅱ and Ⅴ discs FA value, both the P ＞ 0.05. Conclusions Short time axial loading mainly affect the mildly degenerated discs, the ADC value decreases and the disc diffusion ability decreases. No obvious change in ADC value or disc diffusion ability existed in the normal and severely degenerated discs.
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Objective To analyze the effect of a combined strategy of enteral nutrition in the prevention and treatment of patients with severe bum sepsis. Methods 46 cases were random divided into combined group (group C) and routine group (group R). Besides general supportive treatment,group C was treated with early enteral feeding (EEF) ,recombinant human growth hormone (rhGH) and gluta-mine (Gln), while group R was given general supportive treatment only. The plasma concentration levels of pre-albumin (PA) , C-reactive protein (CRP), procalcitonin (PCT) and tumor necrosis factora (TNFα) were measured immediately after hospitalization and postbum day (PBD)7, 14,28. Results The survival rate of group C was significantly higher than group R. The incidence of sepsis, the complication of heart and gastrointestin in group C was significantly lower than group R ( P < 0. 01 ～ 0.05). The days in hospitalization of group C was shorter than that of group R. Plasma PA levels was decreased in two groups and was markedly decreased in the group R( P < 0. 01 ～ 0.05). Plasma CRP, PCT and TNFαlevels were both increased in two groups and markedly increased in the group R ( P < 0.001 ～ 0.05). Conclusions We have shown that a combined method including rhGH, EEF, Gln and anisodamin can effectively reduce the morbidity and mortality rates of burn sepsis and improve prognosis.