Uniportal thoracoscopic thorough debridement for tubercular empyema with abscess of the chest wall / 中华外科杂志

Objective: To examine the feasibility and technical considerations of thorough debridement using uniportal thoracoscopic surgery for tuberculous empyema complicated by chest wall tuberculosis. Methods: A retrospective analysis was conducted on 38 patients who underwent comprehensive uniportal thoracoscopy debridement for empyema complicated by chest wall tuberculosis in the Department of Thoracic Surgery, Shanghai Pulmonary Hospital, from March 2019 to August 2021. There were 23 males and 15 females, aged (M(IQR)) 30 (25) years (range: 18 to 78 years). The patients were cleared of chest wall tuberculosis under general anesthesia and underwent an incision through the intercostal sinus, followed by the whole fiberboard decortication method. Chest tube drainage was used for pleural cavity disease and negative pressure drainage for chest wall tuberculosis with SB tube, and without muscle flap filling and pressure bandaging. If there was no air leakage, the chest tube was removed first, followed by the removal of the SB tube after 2 to 7 days if there was no obvious residual cavity on the CT scan. The patients were followed up in outpatient clinics and by telephone until October 2022. Results: The operation time was 2.0 (1.5) h (range: 1 to 5 h), and blood loss during the operation was 100 (175) ml (range: 100 to 1 200 ml). The most common postoperative complication was prolonged air leak, with an incidence rate of 81.6% (31/38). The postoperative drainage time of the chest tube was 14 (12) days (range: 2 to 31 days) and the postoperative drainage time of the SB tube was 21 (14) days (range: 4 to 40 days). The follow-up time was 25 (11) months (range: 13 to 42 months). All patients had primary healing of their incisions and there was no tuberculosis recurrence during the follow-up period. Conclusion: Uniportal thoracoscopic thorough debridement combined with postoperative standardized antituberculosis treatment is safe and feasible for the treatment of tuberculous empyema with chest wall tuberculosis, which could achieve a good long-term recovery effect.

Nation-Wide Observational Study of Cardiac Arrests Occurring in Nursing Homes and Nursing Facilities in Singapore

INTRODUCTION@#Nursing home (NH) residents with out-of-hospital cardiac arrests (OHCA) have unique resuscitation priorities. This study aimed to describe OHCA characteristics in NH residents and identify independent predictors of survival.@*MATERIALS AND METHODS@#OHCA cases between 2010-16 in the Pan-Asian Resuscitation Outcomes Study were retrospectively analysed. Patients aged <18 years old and non-emergency cases were excluded. Primary outcome was survival at discharge or 30 days. Good neurological outcome was defined as a cerebral performance score between 1-2.@*RESULTS@#A total of 12,112 cases were included. Of these, 449 (3.7%) were NH residents who were older (median age 79 years, range 69-87 years) and more likely to have a history of stroke, heart and respiratory diseases. Fewer NH OHCA had presumed cardiac aetiology (62% vs 70%, <0.01) and initial shockable rhythm (8.9% vs 18%, <0.01), but had higher incidence of bystander cardiopulmonary resuscitation (74% vs 43%, <0.01) and defibrillator use (8.5% vs 2.8%, <0.01). Non-NH (2.8%) residents had better neurological outcomes than NH (0.9%) residents ( <0.05). Factors associated with survival for cardiac aetiology included age <65 years old, witnessed arrest, bystander defibrillator use and initial shockable rhythm; for non-cardiac aetiology, these included witnessed arrest (adjusted odds ratio [AOR] 3.8, <0.001) and initial shockable rhythm (AOR 5.7, <0.001).@*CONCLUSION@#Neurological outcomes were poorer in NH survivors of OHCA. These findings should inform health policies on termination of resuscitation, advance care directives and do-not-resuscitate orders in this population.

Situation and reasons for missed follow-up services among newly reported HIV/AIDS cases transmitted by homosexual behavior in China, 2008-2015 / 中华流行病学杂志

Objective: To determine the prevalence and relative factors on those who missed the follow-up service among newly reported HIV/AIDS cases that were infected by homosexual behavior. Methods: Data were extracted from both HIV/AIDS case-reporting and follow-up cards on HIV/AIDS in the Comprehensive Response Information Management System, between December 2008 and December 2015. Data was analyzed, using the generalized estimating equations (GEE) to explore the relative factors of influence. Results: Among the newly reported HIV infection among MSM, the proportion of those who missed the follow-up services was 5.06% (6 037/119 358), and decreased dramatically, from 37.57% (1 261/3 356) to 0.84% (267/31 935) (trend χ(2)=103.43, P<0.01). In MSM population, the younger than 20-year olds (OR=1.30, 95%CI: 1.11-1.52), 20-year olds (OR=1.52, 95%CI: 1.36-1.69), 30-year olds (OR=1.22, 95%CI: 1.12-1.34), 40-year olds (OR=1.10, 95%CI: 1.01-1.20) were receiving less follow-up services than those 50-year olds. Those who had received either junior (OR=1.52, 95%CI: 1.37-1.69) or senior high school education (OR=1.35, 95%CI: 1.23-1.49) were receiving less follow-up service than those who were more educated. MSM with the following characteristics as unspecified occupation (OR=2.06, 95%CI: 1.49-2.87),unemployed (OR=1.54, 95%CI: 1.30-1.83), working in commercial service (OR=1.31, 95%CI: 1.15-1.49) or being student (OR=1.34, 95%CI: 1.18-1.52) were more difficult to be traced or followed than the cadres. Cases being identified on site (OR=2.99, 95%CI: 2.26-3.95) or under special investigation (OR=1.43, 95%CI: 1.29-1.59) had received less follow-up service than those being identified through voluntary counsel testing service. Floating population (OR=1.46, 95%CI: 1.28-1.66) were getting less follow-up service than local residents. Conclusions: The prevalence of those who had missed the follow-up services in the newly discovered MSM HIV cases declined dramatically. Among the MSM HIV cases, those having the following characteristics as: younger than 50-year old, with less school education, with unspecified occupation or unemployment, working in commercial service, being student, having history of incarceration, recruited from special investigation, and floating population were prone to miss the follow-up program, suggesting that the follow-up service should be targeting on these patients.

Programs on mobility, status of follow-up and CD(4)(+)T cell testing among people living with HIV/AIDS, in China 2011-2015 / 中华流行病学杂志

Objective: To analyze the mobility, status of follow-up and CD(4)(+)T cell testing (CD(4) testing) programs among people living with HIV (PLHIV) between 2011 and 2015 and to improve the prevention program on HIV secondary transmission. Methods: Data were collected from both Case Reporting Cards and Follow-up Cards through the National HIV/AIDS Comprehensive Control and Prevention data system. Changes of residence among the newly reported cases and survival cases between 2011 and 2015 were analyzed by SPSS 24.0 software. Results: The number of newly reported inter-provincial mobile PLHIV had been increasing, with proportions of the total reported cases from 10.0% (5 576/55 805) in 2011 to 13.3% (15 348/115 231) in 2015. After adjusting for related confounders, percentages of follow-up and CD(4) testing were lower in inter-provincial and inter-prefectural mobile cases than those without. Conclusion: Service regarding the follow-up and CD(4) testing programs was affected by mobility of people living with HIV/AIDS. Programs on communication and personal contact should be strengthened in the follow-up management services for PLHIV. Information on potential mobility of PLHIV should be gathered timely by health workers during the subsequent follow-up period to avoid the loss of follow-up and CD(4) testing on patients.

Application of Bernoulli Process Model fitting the effect of intervention measures on sexual transmission among HIV sero-discordant couples / 中华流行病学杂志

Objectives: To undersand the outcomes of major intervention measures on sexual transmission among HIV sero-discordant couples. Methods: Bernoulli Process Model was applied to model the major influencing factors of HIV transmission among HIV sero-discordant couples. The major influencing factors appeared as consistent condom use, antiretroviral therapy, frequency of sexual behavior. These parameters were from the HIV sero-discordant couples in 30 counties in 4 provinces (Guangxi Zhuang Autonomous Region, Yunnan Province, Xinjiang Uygur Autonomous Region and Henan provinces) from January 1, 2011 to December 31, 2012. According to the main factors, modeling-intervention strategies and measures on reduction HIV transmission among serodiscordant couples were formed. Results: Data from the present proportion of consistent condom use (85%) modeling and the coverage of antiretroviral treatment (60%) showed that, the proportion of cumulative seroconversion among the spouses was 1.76%. Results from the sensitivity analysis on modeling the consistent condom use and the antiretroviral treatment showed that, when the coverage of antiretroviral treatment was as 90% and the proportion of consistent condom use increased from 50% to 90%, with 80.7% of the risk of spouse seroconversion could be reduced. Or, when the proportion of consistent condom use was as 90% and the coverage of antiretroviral treatment increased from 50% to 90%, with 64.5% of the risk of spouse seroconversion could be reduced. Conclusions: With measures as consistent condom use plus provision of timely antiretroviral therapy to HIV positive index spouses, the risk of sexual transmission among sero-discordant couples could be greatly reduced.