Descending necrotizing mediastinitis: a clinical analysis based on 10 years of published data in China / 口腔疾病防治

Objective@#To investigate the clinical characteristics, diagnosis, treatment, and prognosis of descending necrotizing mediastinitis (DNM) to provide a reference for the early diagnosis and timely treatment of DNM.@*Methods@#Data on DNM in China was electronically retrieved from the core databases and comprehensively reviewed from June 2012 to June 2023. The infection, pathogenic microorganisms, main symptoms, comorbidities and treatment methods of DNM were analyzed.@*Results@#The data of a total of 781 DNM patients, with an average age of (52.97 ± 5.64) years, were retrieved, including 554 males and 227 females. Odontogenic source, tonsillitis, pharyngeal abscess, sialoadenitis, upper respiratory tract infection, foreign body injury, or iatrogenic traumatic procedures are common causes. Among these, odontogenic infection is the most common source. Streptococcus sp. (n = 217) and Staphylococcus sp. (n = 82) were most isolated, followed by Klebsiella pneumoniae and Pseudomonas aeruginosa (equally n = 59). A total of 69.4% (542/781) of DNM patients recruited in this study were discovered to have various comorbidities, and more than one-third of these patients (n = 185) had diabetes. Of the broad antibiotics, carbapenem was most frequently used as treatment, and vancomycin was the most frequently coadministered. The mediastinal drainage approach varies widely, and the optimal regimen is still unknown. Seventy-two patients were treated with video-assisted thoracoscopic/mediastinoscopic surgical drainage, 22 patients were treated with percutaneous catheter drainage, 30 underwent the transcervical approach, and 40 underwent thoracotomy. A total of 617 patients who were selected underwent the appropriate combined operation for surgical drainage according to the specific location of the infected focus. The overall mortality rate of all 781 DNM patients included was 11.2%.@*Conclusion@#The most effective diagnosis and treatment of DNM is a high degree of clinical vigilance followed by prompt and adequate drainage with intensive care, including hemodynamic monitoring, nutritional support, computer tomographic scanning repeated as necessary, and combined use of systemic antibiotics.

A retrospective analysis of occupational pneumoconiosis in Zibo City from 1949 to 2021 / 中国职业医学

Objective: To analyze the base incidence, distribution characteristics, survival status and social security of occupational pneumoconiosis (hereinafter referred to as "pneumoconiosis") in Zibo City. Methods: The new pneumoconiosis patients in Zibo City from 1949 to 2021 were selected as the research subjects using a cross-sectional survey. Household survey or telephone follow-up were carried out, and the distribution characteristics, living conditions and social security situation were retrospectively analyzed. Results: A total of 8 910 patients with pneumoconiosis were investigated, and 96.0% of them were male. The stage Ⅰ pneumoconiosis patients accounted for 91.3%. From 1949 to 2021, the number of pneumoconiosis patients showed a stepwise upward trend with time. Most of the patients suffered from coal worker pneumoconiosis and silicosis, which accounted for 48.7% and 38.9%, respectively. The average age of onset was (52.7±11.4) years, and the average length of service exposed to dust was (21.1±9.4) years. The patients were concentrated in Zichuan District, Boshan District and Zhangdian District, that accounted for 87.8%. The industry distribution was mostly mining industry and manufacturing industry, accounting for 61.1% and 31.6% respectively. Among the 8 910 cases of pneumoconiosis, 543 cases were lost in follow-up. A total of 8 367 patients were followed-up, with a follow-up rate of 93.9%. The mortality rate of patients who completed follow-up was 50.5%, and the mortality rate decreased with the increase of the stage of pneumoconiosis (P<0.01). The rate of adoring social security in the 4 138 surviving patients was 98.4%. Conclusion: The situation of prevention and treatment of pneumoconiosis in Zibo City is challenging. It is necessary to strengthen the special control of dust hazards in mining and manufacturing industries in key areas such as Zichuan District, Boshan District and Zhangdian District.

Clinical analysis of patients with oral and maxillofacial infections in oral emergency / 北京大学学报(医学版)

OBJECTIVE@#To analyze the composition, incidence and clinical characteristics of oral and maxillofacial infections in oral emergency.@*METHODS@#A retrospective study on patients with oral and maxillofacial infections who visited the Department of Oral Emergency in Peking University School and Hospital of Stomatology from January 2017 to December 2019 was conducted. General characteristics, such as disease composition, gender, age distribution and position of involved teeth were analyzed.@*RESULTS@#A total of 8 277 patients with oral and maxillofacial infections were finally collected, including 4 378 male patients (52.9%) and 3 899 female patients (47.1%), with gender ratio of 1.12:1. The common diseases were periodontal abscess (3 826 cases, 46.2%), alveolar abscess (3 537 cases, 42.7%), maxillofacial space infection (740 cases, 9.0%), sialadenitis (108 cases, 1.3%), furuncle & carbuncle (56 cases, 0.7%) and osteomyelitis (10 cases, 0.1%). Male patients were more easily affected by periodontal abscess, space infection and furuncle & carbuncle than female patients with the gender ratios 1.24:1, 1.26:1, 2.50:1 individually, while the incidence of alveolar abscess, sialadenitis, furuncle & carbuncle had no significant gender difference. Different diseases were prone to occur at different ages. The peak ages of alveolar abscess were 5-9 and 27-67 years, while the peak age of periodontal abscess was 30-64 years. Space infection tended to occur between 21-67 years. There were 7 363 patients with oral abscess (3 826 patients with periodontal abscess and 3 537 patients with alveolar abscess), accounting for 88.9% of all the patients with oral and maxillofacial infections, involving 7 999 teeth, including 717 deciduous teeth and 7 282 permanent teeth. Periodontal abscess usually occurred in permanent teeth, especially the molar teeth. Alveolar abscess may occur in both primary teeth and permanent teeth. In primary teeth, the most vulnerable sites were primary molar teeth and maxillary central incisors while in permanent teeth the most vulnerable sites were first molar teeth.@*CONCLUSION@#Understanding the incidence of oral and maxillofacial infection was conducive to the correct diagnosis and effective treatment of clinical diseases, as well as targeted education for patients of different ages and genders to prevent the occurrence of diseases.

Early clinical application of Mako robot-assisted total knee arthroplasty in knee osteoarthritis / 中国骨伤

OBJECTIVE@#To investigate the early efficacy of Mako robot-assisted total knee arthroplasty (TKA) in the treatment of knee osteoarthritis (KOA) and summarize the initial application experience.@*METHODS@#Retrospective analysis of 73 patients with KOA treated with Mako robot-assisted TKA from June 2021 to December 2021. There were 16 males and 57 females, aged from 54 to 81 years old with an average of (67.8±6.6) years old. The hip knee and ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), lateral femoral component angle (LFCA) and lateral tibial component angle (LTCA) were recorded and analyzed. WOMAC score and KSS were used to compare the functional recovery of patients preoperatively, 3 and 6 months postoperatively.@*RESULTS@#All the 73 patients were successfully treated without serious complications such as vascular and nerve injury, and all the incisions healed well at stageⅠwithout infection. The patients were followed up from 4 to 11 months with an average of (7.0±2.7) months, and the satisfaction rate of the last follow-up was 90.41% (66/73). WOMAC scores were (23.1±5.4) at 3 months and (14.8±4.1) at 6 months postoperatively. KSS clinical scores were ( 76.1±4.0) at 3 months and (82.1±3.7) at 6 months postoperatively;KSS functional scores were (74.3±3.1) at 3 months and (78.6±2.1) at 6 months after operation. Postoperative imaging showed good position of the prosthesis, HKA angle was (178.5±2.1)°, LDFA was (91.2±1.8)°, MPTA was(89.9±1.5) °, LFCA was (7.6±3.1)°, LTCA was (88.2±1.1)°. The mechanical axis within ±3° in sixty cases(82.2%), and the mechanical axis within ±6° in all the patients.@*CONCLUSION@#Mako robot-assisted TKA is a safe and effective surgery in the treatment of knee osteoarthritis, which exhibited good efficacy in the correction of lower limb alignment, soft tissue balance and improvement of knee function. The long-term efficacy needs further follow-up observation.

Vascular complications in 305 severely ill patients with COVID-19: a cohort study

ABSTRACT BACKGROUND: Although an association has been made between coronavirus disease 2019 (COVID-19) and microvascular disease, data on vascular complications (other than venous thromboembolism) are sparse. OBJECTIVE: To investigate the vascular complications in severely ill patients hospitalized with COVID-19 and their association with all-cause mortality. DESIGN AND SETTING: This cohort study was conducted at the Universidade Federal de São Paulo, Brazil. METHODS: All 305 consecutive patients diagnosed with COVID-19 and hospitalized in the intensive care unit (ICU) of a tertiary university hospital from April 2 to July 17, 2021, were included and followed up for 30 days. RESULTS: Of these, 193 (63.3%) were male, and the mean age was 59.9 years (standard deviation = 14.34). The mortality rate was 56.3% (172 patients), and 72 (23.6%) patients developed at least one vascular complication during the follow-up period. Vascular complications were more prevalent in the non-survivors (28.5%) than in the survivors (17.3%) group and included disseminated intravascular coagulation (DIC, 10.8%), deep vein thrombosis (8.2%), acrocyanosis (7.5%), and necrosis of the extremities (2%). DIC (adjusted odds ratio (aOR) 2.30, 95% confidence interval (CI) 1.01-5.24, P = 0.046) and acrocyanosis (aOR 5.21, 95% CI 1.48-18.27, P = 0.009) were significantly more prevalent in the non-survivors than in the survivors group. CONCLUSION: Vascular complications in critically ill COVID-19 patients are common (23.6%) and can be closely related to the mortality rate (56.3%) until 30 days after ICU admission. Macrovascular complications have direct implications for mortality, which is the main outcome of the management of COVID-19. REGISTRATION: RBR-4qjzh7 (https://ensaiosclinicos.gov.br/rg/RBR-4qjzh7).

Follow-up study on newly diagnosed occupational pneumoconiosis patients in Guizhou Province, 2006-2021 / 中国职业医学

Objective To analyze the survival status, distribution characteristics and social security of newly diagnosed occupational pneumoconiosis patients in Guizhou Province from 2006 to 2021. Methods The newly diagnosed pneumoconiosis cases reported in Guizhou Province from 2006 to 2021 were collected from the “Occupational Diseases and Hazards Monitoring Information System” under “National Health Insurance Disease Prevention and Control Information System”. Telephone or face-to-face surveys were conducted to investigate these patients. Results A total of 12 413 newly diagnosed pneumoconiosis patients were reported in Guizhou Province from 2006 to 2021, with 11 192 cases included in the follow-up, and 10 631 cases were followed-up successfully. According to the follow-up study, 10 565 cases (accounting for 99.4%) were survived, and 66 cases (accounting for 0.6%) died. The number of pneumoconiosis showed an increasing trend followed by a sharp decline from 2006 to 2021, reaching its peak in 2016. The main industry of the newly pneumoconiosis cases was concentrated in the mining industry (accounting for 90.6%). The top three regions with surviving cases in the follow-up were Bijie City, Zunyi City, and Qiannan Prefecture, accounting for 34.0%, 25.4% and 12.0%, respectively. The main types of pneumoconiosis were coal workers' pneumoconiosis and silicosis, accounting for 67.1% and 30.8%, respectively. Most cases were in the age group of 50 to <60 years old, accounting for 59.1%, and the majority of the workers had worked in dusty environments for 5 to <25 years, accounting for 91.5%. In terms of social security, about 89.5% of cases were in the basic medical insurance for urban and rural residents which was the most popular social security. The employer's compensation rate was 67.7%, and the work-related injury insurance participation rate was 51.5%. Conclusion Pneumoconiosis cases in Guizhou Province exhibit significant regional disparities. It has a high concentration in the industry, a younger age profile, and limited social security coverage. It is necessary to strengthen the special management of dust and industry supervision in mining industry, intensify follow-up work for pneumoconiosis cases, reinforce the construction of pneumoconiosis rehabilitation station in key regions, and improve the quality of life of pneumoconiosis cases.

Clinical characteristics and influencing factors of onset age in inpatients with early- and late-onset obsessive-compulsive disorder inpatients / 四川精神卫生

BackgroundThe obsessive-compulsive disorder （OCD） features complexity in etiological factors and high heterogeneity in clinical manifestations. OCD patients with different ages of onset vary in clinical symptoms and etiology. However， current studies on inpatients with early- and late-onset OCD are limited. ObjectiveTo explore the differences in clinical characteristics between early- and late-onset OCD inpatients as well as the factors affecting the onset age of OCD， so as to provide references for early screening and treatment of OCD patients. MethodsThis study was based on collected medical records of 540 patients with OCD who received inpatient treatments at the Affiliated Brain Hospital of Nanjing Medical University between March 2012 and March 2023. Patients with onset age above 18 were placed into early-onset group （n=310） and the others into late-onset group （n=230）. Then differences in demographic data and clinical symptoms between two groups of patients were compared. Binary logistic regression was used to analyze the factors that affect the onset age of OCD. ResultsObserving the demographic data， there were significant differences between the two groups in the results in gender， marital status， family history of mental illness， ratio of comorbidities with other mental illnesses， occupational composition， education level and types of obsessive-compulsive symptoms （χ2=22.302、170.556， 9.224， 13.624， 242.277， 59.791， 7.231， P<0.05 or 0.01）. Also， the results in ages of onset and hospitalization between two groups were significantly different （Z=-19.915， 16.831， P<0.01）. In terms of clinical symptoms， the early onset group had a higher proportion of symptoms including obsessive thinking （χ2=11.998， P<0.05）， ordering （χ2=7.731， P<0.05） and rituals （χ2=7.714， P<0.05）， while the proportion of obsessive checking （χ2=8.204， P<0.05） and washing （χ2=7.506， P<0.05） symptoms were relatively low. In terms of risk factors， there were several independent risk factors that influence the onset age of OCD inpatients， including comorbid neurodevelopmental disorder， comorbid affective disorder， family history of schizophrenia and family history of affective disorder （OR=19.587， 1.830， 3.065， 4.431， P<0.05）. Among them， comorbid neurodevelopmental disorder was the core influencing factor， and female gender was a protective factor for early-onset patients （OR=0.417， P<0.01）. ConclusionThere are differences in demographic data and clinical symptom characteristics between early- and late-onset OCD inpatients， and comorbid neurodevelopmental disorder plays as a core risk factor affecting the onset age of OCD inpatients. ［Funded by Jiangsu Province Key Research and Development Plan for Social Development Special Project（number， BE2021616） ； Jiangsu Province Social Development General Project （number， BE2022678）； Key Project of Nanjing Medical Science and Technology Development Fund （number， ZKX20029）］

Ethical review and management of serious adverse events in anti-tumor drug clinical trials / 中华医学科研管理杂志

Objective:To discuss ethical review and management of serious adverse events in anti-tumor drug clinical trials in a grade A tertiary cancer hospital for timely and effective protection of subjects.Methods:The main contents and ethical management of ethical review on serious adverse events were retrospectively analyzed including the number, distribution rules, and whether they were reported in time in clinical trials conducted in our hospital in 2021.Results:A total of 1 789 serious adverse events in 259 clinical trials were reported, with more male subjects than female, with an average age of 59.95 years, mainly concentrated in the 50~59 age and 60~69 age groups, accounting for 27.45% and 42.37% respectively. Digestive oncology department, thoracic oncology department and renal cancer melanoma department ranked in the top three for the number of clinical trials and reports of serious adverse events. The highest incidence of serious adverse events was hospitalization at 63.44% and the lowest incidence was disability at 0.39%. The highest proportion of serious adverse events possibly related to clinical trials was 35.72%. Expected serious adverse events accounted for 65.85% versus 34.15% unexpected ones, and the difference between different correlations of serious adverse events whether they were expected or not.was statistically significant. Among the measures taken by the investigator for the test drugs due to serious adverse events, drug discontinuation was the most, accounting for 42.54%, while 3.07% of the trial plans modified the study protocol/informed consent. Serious adverse events reported within 24 hours accounted for 87.20%, and those reported in 24 hours and beyond accounting for 12.80%. A statistically significant difference of the reporting time between the registered and investigator initiated clinical trials was observed.Conclusions:The ethics committee should attach importance to ethical review and management of serious adverse events, pay attention to whether they were reported timely and accurately, strengthen supervision, and effectively protect the safety and interests of the subjects.

Results of radiotherapy in squamous cell laryngeal cancer: A tomotherapy center experience

Background: Laryngeal cancer is a common type of head and neck cancer (HNC). Radiotherapy (RT) is a mainstay for curative treatment. Intensity-modulated RT (IMRT) is a standard technique today, as it provides of higher survival and local control and lower normal tissue toxicity. One of IMRT devices is helical tomotherapy (HT). The HT treatment results of HNC patients have been reported in few studies. We aimed to investigate the results of squamous cell laryngeal carcinoma patients treated with helical tomotherapy. Methods: Forty-five laryngeal cancer patients were selected according to the inclusion criteria. Radiotherapy (RT) plans were set in the Hi-Art HT planning system. Image-gated RT (IGRT) technique was used. Appropriate patients received simultaneous cisplatin. Treatment response rates were evaluated at the post-RT third and sixth months. Survival times were calculated with the Kaplan–Meier method. The factors affecting the treatment results were evaluated using Log-rank and Cox regression tests. A P value of less than 0.05 was accepted as statistically significant. Results: The median age was 65 (28–84) years. The median symptom duration was 6 (1–60) months. The RT dose for the early and the locally advanced disease was median 63 Gy (60.75–66) and 66 Gy (60–70), respectively. The RT interruption was median two (0-20) days. The patients were followed up to 25 (1–45) months. Grade 2 xerostomia and dysphagia rates were 55% and 7%, respectively. The 3-year estimates of overall survival (OS), disease-free survival (DFS), metastasis-free survival (DMFS), and locoregional recurrence-free survival (RRFS) were 71.7%, 60.4%, 84.9%, and 68.5%, respectively. In univariate analysis, the presence of N2 disease was a negative prognostic for DFS (P = 0.05) and DMFS (P = 0.003). RT interruption >2 days was a negative prognostic for OS (P = 0.005), DFS (P = 0.02), and RRFS (P = 0.023). In the multivariate analysis, symptom duration >6 months was found to be the only significant factor for DFS (P < 0.05). Conclusion: Intensity-modulated radiation with HT achieved comparable clinical outcomes with acceptable toxicity in laryngeal carcinoma.

Observations on 73 Vaccine breakthrough COVID-19 infected patients and its individualized homeopathic treatment

Since the initiation of vaccine rollout, breakthrough COVID-19 infections have been reported. While conventional therapy is the accepted mode of treatment, there has been little recognition of the role played by the alternative therapies like homeopathy. The purposes of this study were to identify the clinico-symptomatic profile of the vaccine breakthrough covid-19 infections and to assess the response of individualized homoeopathic treatment in these breakthrough cases. A retrospective data analysis of patients treated with homoeopathic medicines who confirmed the breakthrough infection criteria: positive infection ≥14 days after completion of both the recommended doses of an authorized COVID-19 vaccine was conducted. IBM SPSS Statistics 21.0 was used for data analysis with a p-value below 0.05 defined as significant. WHO Clinical Progression Scale and Outcome in Relation to Impact on Daily Living score were used as outcome measures. In total 73 cases were reported to be vaccine breakthrough infections. The median recovery time reported in the data set was 9 ± 2 days. While 5 patients dropped out, 68 (93.15%) patients responded positively to homeopathic treatment, and 55 (75.34%) recovered completely with normalized serological markers/ nasal swabs/ HRCT Chest. About 29 (39.72%) of these presented with mild clinical manifestations, 26 (35.61%) moderate, 17 (23.28%) severe and 1 (1.36%) was critical. 10 homeopathic remedies were prescribed to these 73 patients. Majority of the patients attained an ORIDL score of 4. Maximum patients reported a WHO clinical Progression score of 3. Statistical analysis showed a significant response to homeopathic treatment in the study group. Vaccine breakthrough cases occur in a fraction of vaccinated people. Despite the limited number of study subjects, homoeopathy showed some promising results in the present setup. The response rate was highest in the moderate and severe cases which suggest the importance of consideration of alternative medicine in the current pandemic. Further exploratory research studies and comparative clinical trials may be encouraged.

Medulloblastoma outcomes in tertiary care set?up in India using contemporary treatment protocols ? A retrospective study

Background: Medulloblastoma is the commonest embryonal brain tumor in children. It has shown improved outcomes with combined modality treatment. We aimed to study patient characteristics and survival outcomes of patients with this disease across two tertiary care centers in India. Methods: We analyzed data of patients with histological diagnosis of medulloblastoma treated from January 2010 to January 2016. Patient characteristics and follow-up data were retrieved from hospital records. Descriptive statistics were used to describe clinical and pathological characteristics. Overall survival (OS) was calculated from date of diagnosis to death due to any cause. Relapse-free survival (RFS) was calculated from date of diagnosis to occurrence of relapse or death. Result: Out of 26 patients treated, 24 were children and 2 were adults. Median age was 10 years (range = 0.8–22 years). Twenty (76.9%) patients were male. Fifteen (57.7%) patients were stratified as high-risk (HR), rest 11 (42.3%) were categorized as average risk (AR). Histopathology showed classical variety in majority of patients except for 4 (15%) cases, 3 with desmoplastic and 1 with anaplastic subtype. Median follow-up was 49.7 months (range= 4.2–102.5 months). Overall, eight (30.8%) patients relapsed and six (23%) deaths occurred. Five (33.3%) patients in HR category and 3 (27.3%) patients in AR group showed relapse. Median RFS and OS were not yet reached. Five-year RFS was 69.2% whereas five-year OS was 76.9%. Conclusion: This study highlighted patient characteristics and treatment outcomes in Indian patients. With adherence to standard treatment, high remission rates and improvement in mortality rates were achieved.

Retrospective analysis of extracorporeal cardiopulmonary resuscitation in 40 out-of-hospital cardiac arrest adults / 中华急诊医学杂志

Objective:To summarize the experience and effect of extracorporeal cardiopulmonary resuscitation (ECPR) in the treatment of out-of-hospital cardiac arrest (OHCA) in adults.Methods:The data of 40 adults with OHCA-ECPR in Emergency Department of the First Affiliated Hospital of Nanjing Medical University from April 2015 to April 2022 were retrospectively analyzed. The patients were grouped by discharge survival/in-hospital death, with/without bystander resuscitation, and with/without interhospital transport. Age, sex, Charlson comorbidity index, initial rhythm, no-flow time, time from cardiac arrest to extracorporeal membrane oxygenation (ECMO) initiation (CA-Pump On time), ECMO evacuation success rate, survival rate, ECMO treatment time, time-to-death, and length of hospital stay were analyzed.Results:①Among the 40 patients with OHCA-ECPR, 9 patients (22.5%) survived upon discharge, 7 (77.8%) of whom had good neurological outcomes.②The no-flow time in the survival group was significantly shorter than that in the death group, and the proportion of shockable initial rhythm was higher.③Bystander resuscitation greatly shortened the no-flow time.④The regional OHCA-ECPR interhospital transport extended the CA-Pump On time, without affecting patients’ prognosis.Conclusions:ECPR improves the prognosis of patients with OHCA. Bystander resuscitation greatly shortens the no-flow time. ECPR is significantly effective in patients with short no-flow time and shockable initial rhythm. Regional interhospital transport ECPR is recommended to benefit more patients with OHCA.

Imaging study of the mandibular forward canal in adults based on cone beam CT / 口腔疾病防治

Objective @#To explore the imaging characteristics of the mandibular nerve canal in adults to provide a reference for clinical mandibular surgery.@*Methods@# One thousand adult patients in Guiyang Stomatological Hospital from January 2018 to January 2021 were randomly selected. Cone beam CT (CBCT) was used to observe the anterior mandibular canal and other branches, and the incidence of anterior canal in the mandibular ramus area, posterior molar area and molar area and the distance to each point of the mandible were measured.@*Results@#Of the 901 patients (1 802 sides) included in the study, 386 patients (42.84%) found branches of the mandibular canal, and 182 patients (97 males and 85 females) found the Anterograde Canal 20.20% (182/901). In total, 225 mandibles were found to have anterior canals. There were 101 cases of left mandible and 124 cases of right mandible. The forward canal mainly occurred in the molar area, the molar posterior area and the ascending branch area, and the ascending branch area was the best starting point of the forward canal and the molar stopping point (P < 0.05). The average length of the forward canal (L1) was (10.364 ± 3.833) mm, the average height of the forward canal to the main trunk of the mandibular nerve (L2-RRB) was (3.623 ± 2.035) mm, and the average height of the forward canal to the crest of the alveolar ridL3 (l3) was (9.280 ± 3.240) mm.@*Conclusion@#Mandibular nerve canal branches are common, and there were no differences in male, female and lateral distribution. In this study, the incidence of mandibular anterior canal was the highest, and it often occurred in the molar area.

Microwave ablation of early-stage hepatocellular carcinoma affects survival prognostic factors / 中华超声影像学杂志

Objective:To identify the risk factors for survival prognosis of patients with early-stage hepatocellular carcinoma (HCC) after ultrasound-guided percutaneous microwave ablation (US-PMMA), and to compare the overall survival (OS), cancer specific survival (CSS) and disease-free survival (DFS) between different early-stage HCC patients.Methods:A total of 1 563 patients with early-stage hepatocellular carcinoma (HCC) who underwent MWA in the interventional ultrasound department of the Chiese PLA General Hospital from January 2002 to December 2017 were retrospectively analyzed. Propensity score matching (PSM) balanced the baseline parameters between the elderly group (≥60 years) and the young group (<60 years). Multivariate Cox regression analysis was used to identify the risk factors of OS, CSS and DFS. OS, CSS and DFS probabilities for different patients stratified by respective predictors were calculated with Kaplan-Meier method and compared using the Log-Rank test.Results:All parameters were balanced except for age after PSM.Tumor diameter(95% CI=1.1-1.4, P<0.001), number of tumors(95% CI=1.2-1.9, P<0.001), γ-GT (95% CI=1.0-1.0, P<0.001) and AFP (HR=1.5, 95% CI=1.2-1.8, P<0.001) were shared predictors for OS, CSS and DFS. Age (95% CI=1.2-1.8, P<0.001) and neutrophile to lymphocyte ratio (NLR) (95% CI=1.0-1.0, P=0.043) were another two predictors for both OS and CSS. Albumin predicted OS only, and sex and cirrhosis just predicted DFS. Over the follow-up period (12-156 months), log-rank tests showed that all predictors significantly affected the corresponding OS, CSS or DFS(all P<0.01). Among them, multiple tumors had the greatest impact on OS, CSS and DFS. Compared with patients with single lesion, OS, CSS and DFS in patients with multiple lesions decreased by 9.2%, 2.5% and 4.1% respectively at the 12 years of follow-up, and the median survival time was shortened by 12.3 months, 25.0 months and 11.3 months, respectively (log-rank P=0.049 for OS; P=0.007 for CSS; P<0.001 for DFS). Conclusions:The prognostic benefits from MWA treating early-stage HCC in patients with different survival risk factors are different. Clinically feasible correction of hypoproteinemia and liver disfunction are of great significance to improve the prognosis of early-stage HCC patients after US-PMMA.

Analysis of disease composition and outcome of patients in intensive care department of 3A hospitals: analysis of 3 249 cases in the department of Liaocheng People's Hospital from 2019 to 2021 / 中华危重病急救医学

Objective:To provide the basis and direction for the establishment of the database of severe patients by analyizing of the disease composition and outcome of patients in the department of critical care medicine of the 3A hospital.Methods:The clinical data of 3 249 patients admitted to the department of critical care medicine of Liaocheng People's Hospital from January 1, 2019 to December 31, 2021 were retrospectively analyzed, including gender, age, admission time, admission route, diagnosis, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score 24 hours after admission, outcome and other information.Results:The mean age of 3 249 patients was (61.99±18.29) years old, and the proportion of young and old patients aged 60-74 years accounted the largest (34.01%). There were more males (1 800 cases) than females (1 449 cases). The most patients were admitted in January (119 cases) and the least in March (75 cases). The top eight diseases in the department of critical care medicine were respiratory system diseases (21.88%), multiple injuries (12.65%), cardiovascular system diseases (11.48%), gastrointestinal surgery diseases (9.42%), pathological obstetrics (7.76%), digestive system diseases (7.63%), urinary system diseases (5.69%) and nervous system diseases (5.23%). Among 3 249 critically ill patients, 54.36% (1 766 cases) were transferred to the general ward for treatment after improvement, with APACHE Ⅱ score was 17.99±5.51. 15.91% (517 cases) returned to local hospital for further treatment after improvement, APACHE Ⅱ score was 22.48±6.57. 1.51% (49 cases) were transferred to superior hospitals, APACHE Ⅱ score was 21.71±5.18. 24.22% (787 cases) were discharged automatically, APACHE Ⅱ score was 25.64±5.45. 4.00% (130 cases) died in intensive care unit (ICU), APACHE Ⅱ score was 29.08±8.10. The APACHE Ⅱ score of patients who died in ICU was higher than that of patients who were transferred to another department, another hospital or discharged automatically after their condition improved, and the differences were statistically significant (all P < 0.001). Among 3 249 patients, a total of 1 265 patients were admitted to ICU for sepsis caused by aggravated infection, and 44.43% (562 cases) of the 1 265 patients improved to the general ward after treatment, with APACHE Ⅱ score was 18.99±5.46. 19.21% (243 cases) returned to local hospital after treatment with APACHE Ⅱ score was 22.79±6.74. 1.50% (19 cases) were transferred to superior hospitals for further treatment with APACHE Ⅱ score was 21.21±4.81. 31.54% (399 cases) were discharged automatically with APACHE Ⅱ score was 25.55±4.84; 3.32% (42 cases) died in ICU with APACHE Ⅱ score was 27.69±7.92. The APACHE Ⅱ score of patients who died in ICU was higher than that of patients who were transferred to another department, another hospital or discharged automatically after their condition improved, and the difference was statistically significant (all P < 0.001). Conclusions:Among the patient admitted to ICU 2019-2021 in Liaocheng People's Hospital, respiratory system diseases accounted for the first, multiple injuries accounted for the second place, followed by cardiovascular system diseases, gastrointestinal surgery diseases, pathological obstetrics, etc. Males and elderly patients aged 60-74 years have a higher proportion of severe cases. APACHE Ⅱ scores were associated with patients' prognosis.

Clinical efficacy of gradual decompression in the treatment of severe traumatic brain injury and its effects on the improvement of intracranial pressure / 中国基层医药

Objective:To investigate the clinical efficacy of gradual decompression in the treatment of severe traumatic brain injury and its effects on the improvement of intracranial pressure.Methods:The clinical data of 120 patients with severe traumatic brain injury who received treatment in the General Hospital of Taiyuan Iron and Steel (Group) Co., Ltd. from January 2015 to January 2020 were retrospectively analyzed. The included patients were divided into decompressive craniectomy group (control group, n = 64) and gradual decompression group ( n = 56). Intracranial pressure was compared between the two groups at different time points (before surgery, during the surgery, immediately after surgery, 3 and 6 months after surgery). The patient's self-care ability, coma degree, and neurological deficits pre-surgery and 6 months after surgery were evaluated in each group. The incidence of complications throughout the surgery and within 6 months after surgery was calculated to evaluate the quality of life. Results:There was no significant difference in intracranial pressure pre-surgery between the two groups ( P > 0.05). Intracranial pressure in the gradual decompression group was (30.74 ± 2.51) mmHg, (25.11 ± 2.06) mmHg, (21.34 ± 2.01) mmHg, and (16.74 ± 1.54) mmHg respectively during the surgery, immediately after surgery, and 3 and 6 months after surgery, which was significantly lower than that in the control group [(34.31 ± 3.06) mmHg, (30.64 ± 2.57) mmHg, (26.33 ± 2.35) mmHg, (22.64 ± 1.95) mmHg, t = 12.88, 19.03, 12.40, 18.20, all P < 0.001]. There were no significant differences in scores of the Modified Barthel Index (MBI), the Glasgow Coma Scale (GCS), the National Institutes of Health Stroke Scale (NIHSS) pre-surgery between the two groups (all P > 0.05). At 6 months after surgery, the MBI and GCS scores increased and the NIHSS score decreased in each group. There were significant differences in the NIHSS, MBI, and GCS scores between the two groups ( t = 7.61, 6.26, 13.07, all P < 0.001). During the surgery and 6 months after surgery, the incidences of cerebral infarction, delayed cerebral hematoma, and acute encephalocele were significantly lower in the gradual decompression group than in the control group ( χ2 = 4.23, 4.35, 4.83, all P < 0.05). The Generic Quality of Life Inventory-74 Questionnaire scores in environment, psychological health, social relationship, and psychological health domains were significantly higher in the gradual decompression group than in the control group ( t = 8.16, 9.80, 8.68, 7.76, all P < 0.001) Conclusion:This study is the first to analyze the feasibility of gradual decompression for the treatment of severe traumatic brain injury in terms of intracranial pressure, quality of life, and short- and medium-term complications. Findings from this study confirm that gradual decompression can effectively lower intracranial pressure of patients with severe traumatic brain injury, improve neurological function, reduce complications, and improve patients' self-care ability and quality of life.

HIV Ag-Abdetection by ELISA: a retrospective analysis / 中国输血杂志

【Objective】 To conduct a retrospective analysis of HIV Ag-Ab detection by ELISA in our blood center, so as to provide reference for continuous improvement. 【Methods】 The reactive rate of HIV by each reagent, reactive rate of both reagents, re-test rate, concordance rate of initial-repeat test, and reagent utilization rate were counted, and the external quality assessment results were analyzed by PT score and z-ratio. 【Results】 The total reactive rate of HIV was 0.15%. The reactive rate by both reagents was 0.02%. The re-test rates, reactive rates, concordance rates and reagent utilization rates of the two reagents were 0.09% vs 0.08%, 0.07% vs 0.06%, 75.86% vs 78.21%, and 114.54% vs 113.92%, respectively. PT score was 100%, and z-ratio of 7 negative samples and 1 positive sample was less than 2, and of 2 positive samples was more than 3. 【Conclusion】 The laboratory quality monitoring indicators and external quality assessment can effectively monitor the operation of blood testing laboratory.

Analysis of NSFC funding in Stomatology from 2010 to 2019 / 中华医学科研管理杂志

Objective:To analyze the basic research projects in stomatology funded by the National Natural Science Foundation of China(NSFC) in the past 10 years, providing references for the development of Stomatology.Methods:This article collected information on NSFC-funded projects in Stomatology from 2010 to 2019, including title, year, project type, discipline code, funded institutions, keywords, etc., and conducted a multi-dimensional analysis.Results:In the past 10 years, NSFC funded 2 821 projects in the field of Stomatology, with funding of 1 229.44 million yuan, increasing year by year. The funding covered 116 sub-disciplines, with oral cancer and periodontal disease as the key funding areas. The funded institutions and regions were relatively concentrated. The research theme took stem cells and signaling pathways as the core, and multiple fields were gradually cross-integrated.Conclusions:NSFC′s long-term and continuous funding promoted the development of Stomatology, resulting in increasing diversity and convergence of research directions. At the same time, it is suggested that institutions develop policies based on their characteristics, NFSC provides balanced funding for different branches of disciplines, and underdeveloped areas strengthen cooperation and exchange, thereby further improving the overall research level of Stomatology.

A retrospective analysis based on the investigation and handling results of 310 medical research integrity cases / 中华医学科研管理杂志

Objective:to understand the current situation of academic research misconduct by analyzing the investigation results of a number of medical scientific research integrity cases, to strengthen the construction of scientific research integrity in medical institutions.Methods:Select the investigation and handling results of 310 medical scientific research integrity cases disclosed by the National Health Commission in 2021, and analyze the basic information of the case papers, the types and characteristics of misconduct behaviors involved, and the handling results of each institution.Results:This batch of problematic papers was widely distributed, including particular hospitals from a certain region or city level hospitals. Identified misconduct included fabrication of the research process, falsification of research data, purchasing, ghost-writing, third-party submission, and inappropriate authorship. Responsible persons were severely punished.Conclusions:Long-term mechanism for the prevention of academic misconduct should be established with collaboration among administrative department, medical institutions and research personnel, to deal with academic misconduct more systematically.

A retrospective analysis of the funding of respiratory projects supported by the National Natural Science Foundation of China from 2009 to 2019 / 中华医学科研管理杂志

Objective:To understand the status quo of basic research projects on respiratory diseases in China.Methods:Descriptive statistical methods were used to review the project number, funding input, funding categories and distribution of National Natural Science Foundation of China (NSFC) respiratory disease funding projects from 2009 to 2019.Results:according to the research, the number of NSFC respiratory projects and funding increased significantly, which promoted the development of respiratory science. However, due to the heavy burden of respiratory diseases, it is still necessary to increase the investment in respiratory diseases.Conclusions:taking into account of the importance of respiratory science, this paper suggests that NSFC should increase investment and support for respiratory diseases projects, strengthen the development of existing respiratory advantages, encourage cross-cutting and frontier research on respiration, cultivate a group of internationally influential scientists and research teams, and promote academic innovation in respiratory science.