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The condition of patients with severe traumatic brain injury (sTBI) complicated by corona virus 2019 disease (COVID-19) is complex. sTBI can significantly increase the probability of COVID-19 developing into severe or critical stage, while COVID-19 can also increase the surgical risk of sTBI and the severity of postoperative lung lesions. There are many contradictions in the treatment process, which brings difficulties to the clinical treatment of such patients. Up to now, there are few clinical studies and therapeutic norms relevant to sTBI complicated by COVID-19. In order to standardize the clinical treatment of such patients, Critical Care Medicine Branch of China International Exchange and Promotive Association for Medical and Healthcare and Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Chinese expert consensus on clinical treatment of adult patients with severe traumatic brain injury complicated by corona virus infection 2019 ( version 2023) based on the joint prevention and control mechanism scheme of the State Council and domestic and foreign literatures on sTBI and COVID-19 in the past 3 years of the international epidemic. Fifteen recommendations focused on emergency treatment, emergency surgery and comprehensive management were put forward to provide a guidance for the diagnosis and treatment of sTBI complicated by COVID-19.
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Methods:The clinical data and follow-up results of 56 patients with refractory hyperthyroidism who underwent laparoscopy or open surgery in Affiliated Nanhua Hospital of University of South China from January 2019 to August 2020 were retrospectively analyzed.Results:Among the 56 patients, there were 6 men and 50 women. Thirty-six (64.3%) patients underwent endoscopic surgery and twenty (35.7%) patients underwent open surgery. The operation time was (132.0 ± 32.0) minutes. Intraoperative blood loss was (32.4 ± 27.8) mL. Postoperative parathyroid hormone level was (27.8 ± 18.3) ng/L. Forty-nine (87.5%) patients showed benign pathology results after surgery. After surgery, 14 (25.0%) patients had hypothyroidism, including 7 (12.5%) patients with hyperthyroidism combined with thyroid cancer. There were no patients with permanent hypothyroidism or recurrent laryngeal nerve paralysis. All patients had a good prognosis and satisfactory surgical results.Conclusion:With the update of preoperative preparation methods for hyperthyroidism, the increasing maturity of thyroid surgery technology, and the use of new energy instruments and technologies, surgical treatment is undoubtedly a good treatment method for patients with refractory hyperthyroidism or a suspected malignant tumor.Objevtives:To investigate the indications and clinical efficacy of surgical treatment in patients with refractory hyperthyroidism.
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Objective:To investigate the knowledge, attitudes, and practices (KAP) of pulse oximetry among pediatric healthcare providers in China and analyze the factor influencing the KAP.Methods:A self-developed questionnaire was used for an online research on the KAP of 11 849 pediatric healthcare providers from 31 provinces, autonomous regions, and municipalities of China from March 11 to 14, 2022.The factors influencing the KAP of pulse oximetry among pediatric healthcare providers were examined by Logistic regression. Results:The scores of KAP, of pulse oximetry were 5.57±0.96, 11.24±1.25 and 11.19±4.54, respectively.The corresponding scoring rates were 69.61%, 74.95%, and 55.99%, respectively. Logistic regression results showed that the gender and working years of pediatric healthcare providers, the region they were located, and whether their medical institution was equipped with pulse oximeters were the main factors affecting the knowledge score (all P<0.05). Main factors influencing the attitude score of pediatric healthcare providers included their knowledge score, gender, educational background, working years, region, medical institution level, and whether the medical institution was equipped with pulse oximeters (all P<0.05). For the practice score, the main influencing factors were the knowledge score, gender, age, and whether the medi-cal institution was equipped with pulse oximeters (all P<0.05). Conclusions:Chinese pediatric healthcare providers need to further improve their knowledge about and attitudes towards pulse oximetry.Pulse oximeters are evidently under-used.It is urgent to formulate policies or guidelines, strengthen education and training, improve knowledge and attitudes, equip more institutions with pulse oximeters, and popularize their application in medical institutions.
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Objective:To explore the expression and clinical significance of immunosuppressive receptor T cell immunoglobulin and immunoreceptor tyrosine-based inhibitory motif domain (TIGIT) on the peripheral blood mononuclear cells (PBMC) in silicosis patients with Mycobacterium tuberculosis infection. Methods:August 2018, a total of 78 patients with silicosis (all were quarry workers in Sanmen County, Zhejiang Province) were enrolled and divided into silicosis combined with active pulmonary tuberculosis group (APTB group), silicosis combined with latent tuberculosis infection group (LTBI group), and simple silicosis with non-tuberculosis infection group (non-TB group). Flow cytometry was used to analyze the expressions of TIGIT, programmed death-1 (PD-1) and transcription factor T-bet on PBMC from patients. Mann-Whitney U test and Pearson correlations analysis were used for statistical analysis. Results:Among the 78 patients, eight were in the APTB group, 24 in the LTBI group, and 46 in the non-TB group. The expressions of PD-1 and TIGIT on CD8 + T cells in the APTB group (29.45%(16.78%) and 65.40%(12.12%), respectively) were significantly higher than those in the LTBI group (17.40%(11.17%) and 48.30%(28.75%), respectively; U=23.500 and 43.500, respectively, P=0.000 8 and 0.020 5, respectively) and non-TB group (15.95%(12.46%) and 45.30%(19.75%), respectively; U=64.000 and 69.000, respectively, P=0.002 3 and 0.003 8, respectively), and the differences were all statistically significant. The expression of TIGIT was positively correlated with PD-1 on CD8 + T cells in silicosis patients ( r=0.434 3, P<0.01). The proportion of PD-1 + TIGIT + CD8 + T cells in the APTB group (19.90%(22.67%)) was significantly higher than those in the non-TB group (11.55%(11.29%), U=76.500, P=0.007 1) and LTBI group (11.55%(10.53%), U=41.000, P=0.015 4), while the proportion of PD-1 -TIGIT -CD8 + T cells in the APTB group (30.60%(12.90%)) was significantly lower than non-TB group (48.90%(18.98%), U=58.000, P=0.001 3) and LTBI group (47.20%(24.59%), U=41.000, P=0.015 4). The differences were all statistically significant. The expression of T-bet on the peripheral blood CD8 + T cells in the APTB group (29.45%(16.78%)) was higher than that in the non-TB group (15.95%(12.46%)) and the LTBI group (17.40%(11.17%)), and the differences were both statistically significant ( U=46.500 and 46.000, respectively, P=0.000 3 and 0.028 3, respectively). The expression of T-bet on CD8 + T cells was positively correlated with TIGIT on CD8 + T cells ( r=0.456 7, P<0.01). The expression of T-bet on PD-1 + TIGIT + CD8 + T cells in the APTB group (65.40%(12.12%)) was higher than those in the LTBI group (48.30%(28.75%), U=23.500, P=0.000 8) and non-TB group (45.30%(19.75%), U=65.000, P=0.002 6), and the differences were both statistically significant. Conclusion:The immunosuppressive receptor PD-1 and TIGIT are highly expressed on CD8 + T cells in silicosis patients with active pulmonary tuberculosis, which indicates CD8 + T cells exhaustion in these population, while the highly co-expression of T-bet suggests the exhausted subsets may have reversed potentiality.
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Objective@#To detect the feasibility and efficiency of bone age(BA) artificial intelligence(AI) estimation based on deep learning features from traditional regions of interest(ROI) in hand digital radiographs(DR).@*Methods@#BA dataset of left hand DR with 11 858 subjects aged from 0 to 18 years in Children′s Hospital of Shanghai were split to training(80.0%) and validation (20.0%) set in this study. An improved regression convolutional neural networks and extreme gradient boosting decision tree method were utilized for the BA analysis based on traditional ROIs in the images. Another set of BA data with 1 229 subjects also in the hospital was adopted for test. Mean average precision(mAP) and mean absolute error(MAE) were used to assess model accuracy of detection and BA prediction, respectively.@*Results@#The mAP of ROIs detection of the model was 0.91,and MAE of all male and female subjects was 0.461 and 0.431 years respectively in validation and test sets. The difference less than 1 year in test accounted for 90.07% between BA assessment of the model and of the peadiatric radiologists, with an accuracy rate of 96.67%.The difference over 1 year was 9.03% (with underestimation of 6.43% and overestimation of 2.60%), in which corresponding age data was of being less in training set or sesamoid nearby adductor pollicis or fusion of epiphysis appeared in test set.@*Conclusion@#An AI model based on deep learning of traditional ROIs′ features in hand DR images is initially achieved to automatically predict BA rapidly and effectively, yet it still needs further optimization.
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s] Objective To detect the feasibility and efficiency of bone age(BA) artificial intelligence(AI) estimation based on deep learning features from traditional regions of interest(ROI) in hand digital radiographs(DR). Methods BA dataset of left hand DR with 11 858 subjects aged from 0 to 18 years in Children′s Hospital of Shanghai were split to training(80.0%) and validation (20.0%) set in this study. An improved regression convolutional neural networks and extreme gradient boosting decision tree method were utilized for the BA analysis based on traditional ROIs in the images. Another set of BA data with 1 229 subjects also in the hospital was adopted for test. Mean average precision(mAP) and mean absolute error(MAE) were used to assess model accuracy of detection and BA prediction, respectively. Results The mAP of ROIs detection of the model was 0.91,and MAE of all male and female subjects was 0.461 and 0.431 years respectively in validation and test sets. The difference less than 1 year in test accounted for 90.07% between BA assessment of the model and of the peadiatric radiologists, with an accuracy rate of 96.67%.The difference over 1 year was 9.03% (with underestimation of 6.43% and overestimation of 2.60%), in which corresponding age data was of being less in training set or sesamoid nearby adductor pollicis or fusion of epiphysis appeared in test set. Conclusion An AI model based on deep learning of traditional ROIs′features in hand DR images is initially achieved to automatically predict BA rapidly and effectively, yet it still needs further optimization.
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To establish the experts consensus on the management of delirium in critically ill patients.A special committee was set up by 15 experts from the Chinese Critical Hypothermia-Sedation Therapy Study Group.Each statement was assessed based on the GRADE (Grading of Recommendations Assessment,Development,and Evaluation) principle.Then the Delphi method was adopted by 36 experts to reassess all the statements.(1) Delirium is not only a mental change,but also a clinical syndrome with multiple pathophysiological changes.(2) Delirium is a form of disturbance of consciousness and a manifestation of abnormal brain function.(3) Pain is a common cause of delirium in critically ill patients.Analgesia can reduce the occurrence and development of delirium.(4) Anxiety or depression are important factors for delirium in critically ill patients.(5) The correlation between sedative and analgesic drugs and delirium is uncertain.(6) Pay attention to the relationship between delirium and withdrawal reactions.(7) Pay attention to the relationship between delirium and drug dependence/ withdrawal reactions.(8) Sleep disruption can induce delirium.(9) We should be vigilant against potential risk factors for persistent or recurrent delirium.(10) Critically illness related delirium can affect the diagnosis and treatment of primary diseases,and can also be alleviated with the improvement of primary diseases.(11) Acute change of consciousness and attention deficit are necessary for delirium diagnosis.(12) The combined assessment of confusion assessment method for the intensive care unit and intensive care delirium screening checklist can improve the sensitivity of delirium,especially subclinical delirium.(13) Early identification and intervention of subclinical delirium can reduce its risk of clinical delirium.(14) Daily assessment is helpful for early detection of delirium.(15) Hopoactive delirium and mixed delirium are common and should be emphasized.(16) Delirium may be accompanied by changes in electroencephalogram.Bedside electroencephalogram monitoring should be used in the ICU if conditions warrant.(17) Pay attention to differential diagnosis of delirium and dementia/depression.(18) Pay attention to the role of rapid delirium screening method in delirium management.(19) Assessment of the severity of delirium is an essential part of the diagnosis of delirium.(20) The key to the management of delirium is etiological treatment.(21) Improving environmental factors and making patient comfort can help reduce delirium.(22) Early exercise can reduce the incidence of delirium and shorten the duration of delirium.(23) Communication with patients should be emphasized and strengthened.Family members participation can help reduce the incidence of delirium and promote the recovery of delirium.(24) Pay attention to the role of sleep management in the prevention and treatment of delirium.(25) Dexmedetomidine can shorten the duration of hyperactive delirium or prevent delirium.(26) When using antipsychotics to treat delirium,we should be alert to its effect on the heart rhythm.(27) Delirium management should pay attention to brain functional exercise.(28) Compared with non-critically illness related delirium,the relief of critically illness related delirium will not accomplished at one stroke.(29) Multiple management strategies such as ABCDEF,eCASH and ESCAPE are helpful to prevent and treat delirium and improve the prognosis of critically ill patients.(30) Shortening the duration of delirium can reduce the occurrence of long-term cognitive impairment.(31) Multidisciplinary cooperation and continuous quality improvement can improve delirium management.Consensus can promote delirium management in critically ill patients,optimize analgesia and sedation therapy,and even affect prognosis.
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Venous thromboembolism (VTE) is a common perioperative complication in patients with thoracic malignant tumor. Once it occurs, it will not only affect the prognosis of patients, but also occupy a lot of medical resources, which is gradually causing our widespread attention. However, the understanding of VTE in thoracic surgery in our country is relatively late, and the recognition and attention are not enough, and there is still a lack of guidance support for perioperative VTE. Based on the current understanding and preventive measures of VTE in thoracic surgery in China, The China National Research Collaborative Group released the first edition of Chinese experts consensus on the perioperative VTE prophylaxis in 2018. This article will interpret the high-risk patients with perioperative VTE in patients with thoracic malignant tumors, in order to provide a better understanding of Chinese experts consensus for readers.
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Objective To establish the expression profiles of differentially expressed miRNA and mRNA in oral squamous cell carcinoma(OSCC)and to investigate the roles of miRNA and mRNA associated with the occurrence and development of OSCC. Methods The expression profiles of miRNA and mRNA were constructed using a new generation of high-throughput sequencing techniques. The miRNA and mRNA associated with the occurrence and development of OSCC were predicted by Gene Ontology enrichment analysis and KEGG pathway analysis. Results We successfully constructed the differentially expressed miRNA and mRNA profiles of Chinese hamster buccal pouch squamous cell carcinoma. 11 known and 3 novel significantly differentially expressed miRNAs and 194 differentially expressed mRNAs were found. A miRNA can regulate multiple mRNAs, and multiple miRNAs can control one mRNA. Conclusions Differential expression of miRNA play a an important role in the carcinogenesis and development of OSCC through regulating mRNA and forming a complex regulatory network. It provides theoretical data for the occurrence,pathogenesis,clinical treatment and prognosis of OSCC.
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Objective To explore the relationship between serum sialic acid(SA),high-sensitivity C-reactive protein(hs-CRP) and prehypertension and their clinical significance.Methods According to the blood pressure range,160 residents who received physical examination were divided into three groups:normal group (40 cases),prehypertension group (60 cases) and hypertension group (60 cases).The blood pressure,height and weight were measured in all subjects,and the serum levels of SA,hs-CRP,serum total cholesterol (TC),low density lipoprotein (LDL),high density lipoprotein(HDL),triacylglycerol(TG) and fasting plasma glucose(FBG) were detected on the same day.Multiple linear regression was used to investigate the relationship between serum SA and hs-CRP levels and systolic blood pressure(SBP) and diastolic blood pressure(DBP).Results The levels of DBP,SBP,body mass index(BMI),SA,hs-CRP,TC,LDL,HDL and FBG among the three groups were statistically significant (F =1 102.039,2 690.642,9.163,116.511,103.634,5.431,4.267,67.352,4.236,all P ＜ 0.05).The levels of BMI,SA and hs-CRP increased gradually with the increase of blood pressure,while the level of HDL decreased (P ＜ 0.05).The levels of TC and LDL in the hypertension group were higher than those in the normal blood pressure group,but there were no statistically significant differences in TC and LDL levels between the pre hypertension group and normal blood pressure group (all P ＞ 0.05).Multiple linear regression showed that the levels of BMI,SA,hs-CRP and FBG were positively correlated with SBP(r =3.66,2.61,3.24,2.39,all P ＜ 0.05),and the levels of BMI,SA,hs-CRP and LDL were positively correlated with DBP (r =2.20,2.34,3.48,2.28,P all ＜ 0.05).Conclusion The levels of serum SA and hs-CRP are positively correlated with blood pressure,which can be used as assessment criteria for prehypertension.
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Objective To explore the influence on intraoperative hemorrhage and relative complications of temporary balloon occlusion of the abdominal aorta in cesarean section for the pernicious placenta previa and placenta accreta.Methods One hundred and thirty-four cases of pernicious placenta previa and placenta accrete from January 2011 to January 2016 were analyzed retrospectively.Before the cesareans,temporary balloon occlusion in abdominal aorta was carried out in 69 patients (observation group).The other 65 patients didnt get the balloon occlusion in abdominal aorta (control group).The situation during and after the operation and relative complications were compared.Results The operation duration [(65.2 ± 6.3)min vs (93.2 ±8.8)min],postpartum hemorrhage [(923.2 ± 188.6)ml vs (2 791.8 ±336.2)ml],intraoperative blood transfusion [(423.7 ±59.3)ml vs (1 581.6 ±68.3)ml],the prothrombin time during the operation [(9.3 ± 1.1) s vs (12.4 ± 1.5) s],the hysterectomy rate [0 vs 7.7％ (5/65)],hospitalization time [(5.2 ±0.9)d vs (6.8 ± 1.1)d],and the rate of transferring to intensive care unit [1.4％ (1/69) vs 12.3％ (8/65)] in the observation group were lower than control group,with a statistical significant difference (P ＜ 0.05).There was no significant difference between two groups in Apgar score and birth weight of the neonate (P ＞ 0.05).Conclusions Temporary balloon occlusion of the abdominal aorta in cesarean section is a safe and effective technique,which can reduce the relative complications,such as the volume of bleeding and the risk of hysterectomy.
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Objective The aim of our study was to examine the clinical value of neuroendoscopic surgery in hypertensive cerebellar hemorrhage.Methods The clinical data from 38 patients with cerebellar hemorrhage were retrospectively analyzed.Thirty-eight patients included 18 cases with neuroendoscopic hematoma evacuation (neuroendoscopic group) and 20 cases with craniotomy hematoma evacuation (craniotomy group).The perioperative parameters and clinical outcome were statistically analyzed.Results Compared with craniotomy group,the mean operative time was shorter [(82.9±17.0)min vs.(177.9±28.8)min,t=12.545,P=0.000],the loss of mean blood volume was smaller [(45.1±15.6)mL vs.(197.9±29.5)mL,t=20.237,P=0.000]ml,ventricle drainage time [(3.5±1.5)d vs.(5.3±1.4)d,t=3.751,P=0.001],ICU stay time [(2.9±1.0)d vs.(4.7±1.5)d,t=4.146,P=0.000] and hospital stay time [(7.4±1.5)d vs.(9.9±2.8)d,t=3.348,P=0.002] were shorter (P＜0.05).Two weeks after surgery,1 cases died in neuroendoscopic group and 2 cases died in craniotomy group (P=1.000,P＞0.05).Three months after surgery,GOSE was greater than 4 in 14 cases in neuroendoscopic group and in 13 cases in craniotomy group and the difference was not significant (2=0.752,P=0.386,P＞0.05).Conclusion Although there are no differences in mortality and clinical outcomes between neuroendoscopic hematoma evacuation and occipital craniotomy hematoma evacuation for hypertensive cerebellar hemorrhage patients,neuroendoscopic hematoma evacuation can significantly reduce the mean operative time,the loss of mean blood volume,ventricle drainage time,ICU stay time and hospital stay time.Thus,neuroendoscopic hematoma evacuation in hypertensive cerebellar hemorrhage is safe and effective,which has a great value of application in the future.
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Objectives To explore the route of ESBL producing bacteria in neonatal faeces, and to investigate the gene and drug resistance of ESBL producing bacteria in intestinal tract of neonates. Methods Fecal samples of healthy newborns and their mothers were collected, and bacterial cultures were carried out using selective ESBL medium. The positive strains were identified by Time-of-flight mass spectrometry. ESBL genotyping and resistance gene detection were performed by whole genome sequencing technique. Results In 146 neonatal fecal specimens, the positive rate of ESBL producing bacteria was 8.90％,and the positive rate in the first time stool was 3.23％. Seventy-two hours after birth, the positive rate of fecal ESBL producing bacteria was 13.10％. Among the 13 ESBL producing strains, there were 9 strains of CTX type, 3 strains of TEM type and 1 strain of SHV type. Nine strains of CTX include five types such as CTX-M-24, CTX-M-18, CTX-M-27, CTX-M-42 and CTX-M-15. The positive rate of ESBL producing bacteria was 21.6％ in 167 mothers' fecal specimens. The ESBL genotype included 24 strains of CTX type, 6 strains of TEM type, 4 strains of SHV type and 2 strains of QnrS type. Twenty-four strains of CTX include CTX-M-24, CTX-M-14, CTX-M-18, CTX-M-27, CTX-M-42 and CTX-M-15. There were 2 or 3 ESBL genotypes in 12 maternal and neonatal specimens. It was detected to have 6 types of resistance gene such as aadA5, strA, strB, sul1, sul2 and dfrA17 in 49 strains of ESBL producing bacteria in maternal and neonatal strains. Resistance genes were exactly the same in the neonates as in mothers who were detected to have ESBL producing bacteria. A variety of resistance genes were detected in feces in 7 neonates and 23 mothers. Conclusions The neonates in hospital may be detected to have ESBL produing bacteria in the intestinal tract at the same time as their mothers or separately. However, there are many ways for neonates to have ESBL producing bacteria in intestinal tract. There are many genotypes and resistance genes of ESBL producing bacteria.
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Objective To study the expression and significance of EGFR, PDCD4, TGF-β1, Smad3, Smad7 in oral normal mucosa, oral simple hyperplasia, oral epithelial dysplasia and oral squamous cell carcinomas(OSCC).Methods Serum levels of EGFR, PDCD4 were measeured with ELISA in Chinese hamster during the oral mucosa carcinogenesis;The expressions of TGF-β1, Smad3, Smad7 in oral normal mucosa, oral simple hyperplasia, oral epithelial dysplasia and OSCC tissues were examined by immunohistochemistry.Results In the process of oral carcinogenesis,the expression level of EGFR increased significantly,while the expression of PDCD4 was decreased, the negatively correlation was evident between expression of these two proteins in ED and SCC.The expression of TGF-β1, Smad7 was higher in OSCC than in oral normal mucosa, oral simple hyperplasia, oral epithelial dysplasia(P < 0.05), while the expression of Smad3 was decreased.Further analysis showed the expression of TGF-β1 was correlated with the expression of Smad7.Conclusions The expressions of EGFR, PDCD4, TGF-β1, Smad3, Smad7 are closely related with the biological behaviors of oral squamous cell cancinoma.This experiment provides a theoretical basis for the study of oral squamous cell carcinomas mechanism research.So it has important significance for the development and prognosis of oral squamous carcinomaare.
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Objective To observe the changes of Th1 / Th2 inflammatory factors in the aqueous humor of tree shrews with fusarium solani keratitis,as well as to explore the relationship between Thl / Th2 inflammatory factors and inflammatory response in fusarium solani keratitis.Methods Forty healthy tree shrews were randomly divided into experimental group(n =30) and control group (n =10).Fusarium solani was inoculated into sabina culture medium and cultured at 26 ℃ for 7 days,and then the fungal suspension was collected and the density of spores was adjusted to 10 × 109 CFU · mL-1.In the experimental group,50 μL fungal spore suspension was injected into the center of the cornea stroma,while the control group received the same amount of saline.Next the levels of cytokines including interleukin (IL)-1 β,IL-6,IL-4 and IL-10 were analyzed by flow cytometry on day 3,day 7,day 14 after successful modeling,and the changes in types of infiltrating cells were observed by histopathological examination.Results The expression level of IL-1 β and IL-6 (Th1 type cytokines) was the highest on day 7,and the difference was statistically significant at each time point when compared with the control group (all P ＜ 0.05).The expression level of IL-10 (Th2 type cytokines) was the highest on day 14,and the difference was statistically significant at each time point when compared with the control group (all P ＜ 0.05).The difference in IL-4 expression was statistically significant on day 7 (P ＜ 0.05).In addition,histopathological examination showed that the number of infiltration cell reached its peak on day 7,mainly neutrophils,and fungal hyphae were observed to be parallel to the matrix fibers at each time point.Conclusion The proinflammatory cytokines IL-1β and IL-6 and the anti-inflammatory cytokines IL-10 may play an important role in the molecular mechanism of inflammatory response of fusarium solani keratitis in tree shrews.
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Objective To evaluate the clinical and imaging features of the sellar region lesions in children.Methods The clinical and imaging features of 112 cases with sellar region lesions were analyzed retrospectively,which were confirmed by pathology.Results 37 cases were craniopharyngiomas, which had two main symptoms of intracranial hypertension(57%)and diabetes insipidus(11%).On imaging it demonstrated as a calcified cystic tumor(81%).18 cases were gliomas, the main clinical feature of which was decreased visual acuity,13 of them were pilocytic astrocytoma, which manifested as a solid tumor with significantly enhancement(94%).16 cases were germ cell tumors,the main complaint was diabetes insipidus (75%),13 of them were germinoma, which showed iso-high density on CT and moderate enhancement after administration of contrast.And it showed high signal intensity on DWI.7 cases were hamartoma,86% patients of which showed gelasmus epilepsy,the imaging showed iso-signal masses with no enhacement in the hypothalamic papillary region.5 cases were LCH,80% of which had the complaint of diabetes insipidus,imaging findings manifested as thinkened pituitary stalk and loss of hyperintensity of posterior pituitary on T1WI.3 cases were pituitary tumors.23 cases were Rathke's cleft cysts,3 cases were arachnoid cyst.Most of the patients presented with headache.Conclusion The clinical and imaging features shows some specific features, which is helpful to improve the correct rate of diagnosis and provide the basis for further treatment.
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Objective To investigate the effect of different doses of ambroxol on efficacy and lung function of elderly patients with chronic obstructive pulmonary disease.Methods 200 patients with COPD were selected.They were divided into two groups randomly.The high dose group (102 cases) were given anmbroxol hydrochloride in high doses.The low dose group (98 cases) were given anmbroxol hydrochloride in low doses.The effect of different doses of ambroxol on efficacy and lung function of elderly patients with chronic obstructive pulmonary disease was evaluated by the efficacy,TNF-α,CRP,pulmonary function indexes and adverse reaction during treatment.Results The effective rate was 89.2％ in the high dose group and 75.5％ in the low dose group.The effective rate of high dose group was higher than that of the low dose group (P ＜ 0.05).Before treatment,there were no statistical significance on CRP and TNF-α between two groups.After treatment,the CRP and TNF-α were decreased in two groups and lower in the high dose group (P ＜ 0.05).Before treatment,there were no statistical significance on FVC,FEV1 and FEV1/FVC％ between two groups.After treatment,FVC,FEV1 and FEV1/FVC were increased and higher in the high dose group (P ＜ 0.05).During treatment,there were no statistical significance on adverse reaction between two groups.Conclusion High dose of ambroxol was effective and safe for COPD.It could reduce inflammation and improve pulmonary ventilation with clinical use.
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Objective To study the expression and significance of apoptosis-related genes caspase-3,caspase-9,Bax and Bcl-2 in oral normal mucosa,oral simple hyperplasia,oral epithelial dysplasia and oral squamous cell carcinomas (OSCC) in Chinese hamsters.Methods The expressions of mRNA and protein of caspase-3,caspase-9,Bax and Bcl-2 in the oral normal mucosa,oral simple hyperplasia,oral epithelial dysplasia and OSCC tissues in Chinese hamsters were examined by immunohistochemistry and RT-PCR.Results During the process of oral carcinogenesis,the expression of Bcl-2 protein was significantly higher in OSCC than in oral normal mucosa,oral simple hyperplasia,and oral epithelial dysplasia (P<0.05).In dysplastic epithelia,the protein expressions of caspase-3,caspase-9 and Bax were more than that of normal epithelia,and along with the increased dysplasis,the expression level was decreased.Further analysis showed that expression of Bcl-2 was negatively related with the expressions of Bax,caspase-3 and caspase-9 (P<0.05).The result of RT-PCR showed that Bcl-2 was significantly increased in OSCC compared with normal mucosa,while the expressions of caspase-3,caspase-9 and Bax were decreased (P<0.05).Conclusions In the Chinese hamster squamous carcinoma,the expressions of caspase-3,caspase-9 and Bax are reduced and the Bcl-2 expression are increased,indicating that the expressions of caspase-3,caspase-9,Bax and Bcl-2 are closely related with the occurrence and development of oral squamous cell cancinoma.This study can offer some clues for gene therapy of OSCC,or can provide a reference for evaluating the biological characteristics and prognosis of OSCC.
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Objective The clinical manifestations of Parkinson''s disease (PD) are divided into non-motor symptoms and motor symptoms.Constipation is one of the common symptoms of non-motor symptoms of the disease.Constipation symptoms in PD generally occur earlier for 5~20 years, while drug treatment for PD constipation can lead to gastrointestinal damage.This study investigated the improvement in the treatment of anorectal dynamics and constipation symptoms in Parkinson''s disease by oral mosapride and press-needle therapy of Shu-Mu point.Methods 60 patients diagnosed as constipation of Parkinson''s disease were randomly divided into control group and treatment group, 30 cases in each group;patients in the control group were treated with oral mosapride tablets, while patients in the treatment group received press-needle therapy, three times per week.The observation course in both groups last for three months and follow-up visits were conducted before and after the course.Efficacy evaluation, PAC-QOL scale and anorectal dynamic examination were applied in the follow-up visit.Results The efficiency of treatment group was 81.7%, significantly higher than control group (70%), representing significant difference between the two groups (P0.05).As to the anorectal dynamics, significant difference was found before and after the treatment in both groups (P0.05).Conclusion Both oral mosapride and press-needle can improve the quality of life and anorectal dynamics for PD patients, representing no significant difference.However, compared with mosapride, the overall efficacy of press-needle is better in improving the symptoms of constipation in PD, featuring more convenience, higher safety, less pain and no side effect, and it is worthy of clinical application.
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Objective@#To analyze the clinical characteristics of community-acquired pneumonia (CAP) in children under five years of age and analyze the safety and efficiency of nasal continuous positive airway pressure (NCPAP) ventilation for CAP in this population.@*Method@#This was a prospective multicenter study. Children who were admitted to these six centers with CAP and met the NCPAP ventilation indications, aged from 29 d to 5 years, were continuously included during November 2013 to October 2015. The baseline data were collected and NCPAP ventilation were then followed up by operation standards, and the vital signs and arterial blood gas change at special time points were observed and recorded. Any side effect associated with NCPAP were recorded. For categorical variables, comparisons were performed using Fisher test. Rank-sum test and t test were performed respectively for abnormal and normal distribution continuous variables. The variables pre-NCPAP and post-NCPAP were analyzed by repeated measures ANOVA analysis.@*Result@#Totally 145 children were included, and 13 children were excluded due to incomplete data. One hundred and two children(77.3%)were ≤12 months; 91 children (68.9%) were from rural area. NCPAP ventilation was effective in 123 children, with a response rate of 93.2%, were all discharged with a better condition; it was ineffective in 9 children(6.8%), and they were all intubated and went on mechanical ventilation, 5 were discharged with a better condition, and 4 died after gaving up treatment. The gender, age, body weight, residence, main symptoms, main signs, imaging diagnosis, medications, partial pressure of oxygen(PaO2), breath and heart rate before NCPAP treatment of two groups had no significant differences(allP>0.05). The rates of combining underlying diseases, trouble with feeding and cyanosis, and the partial pressure of carbon dioxide(PaCO2 ) before NCPAP ventilation were higher in NCPAP ineffective group ((59±11 )vs.( 49±11) mmHg, 1 mmHg=0.133 kPa, t=-2.597, P=0.028); while the PaO2/fraction of inspiration O2 (FiO2 ) before NCPAP was lower((150±37) vs. (207±63) mmHg, t=2.697, P=0.008). The breathing, heart rate and PaCO2 of NCPAP effective group decreased significantly, while the PaO2 and PaO2/FiO2 increased significantly after 2, 8, 24 h of NCPAP ventilation(all P=0.000). PaCO2 in children with hypercapnia before NCPAP ventilation in NCPAP effective group decreased significantly ((48±9), (47±12), (45±11)vs.(58±7)mmHg, all P=0.000). All children tolerated well to NCPAP ventilation, and there were no severe side effects or complications associated with NCPAP ventilation.@*Conclusion@#NCPAP ventilation is safe and effectively improved the oxygenation and hypercapnia in infants with CAP. But it may not work well in children with underlying diseases, manifest as difficulty in feeding/cyanosis and extremely high PaCO2 or low PaO2/FiO2, and they may need early intubation.