Analysis of risk factors for autonomic reflex dysfunction hypotension of acute spinal cord injury / 中华创伤杂志

Objective:To investigate the incidence and risk factors of autonomic reflex dysfunction hypotension in patients with acute spinal cord injury.Methods:A retrospective case control study was made on the data of 191 patients with acute spinal cord injury admitted to Seventh Medical Center of PLA General Hospital from January 2011 to December 2016, including 164 males and 27 females, aged 18-60 years with an average age of 46.4 years. The injury mechanisms of injuries were traffic accidents in 97 patients, high falling injury in 55, heavy pound injury in 30 and fall injury in 9. The injured segments included 98 patients with cervical spinal cord injury, 52 with thoracic spinal cord injury, 19 with lumbar spinal cord injury and 22 with cone injury. According to the American Spinal Injury Association (ASIA), 61 patients were classified as grade A, 52 as grade B, 38 as grade C and 40 as grade D. Autonomic reflex dysfunction hypotension was defined as a systolic blood pressure below 90 mmHg and heart rate below 60 beat/min. There were 35 patients in hypotension group and 156 patients in non-hypotension group. Incidence of autonomic reflex dysfunction hypotension was observed. The data of sex, age, body mass index, injury mechanism, fracture type, spinal cord injury segment, spinal cord injury grade, blood pressure, heart rate, combined injury and length of hospital stay were collected. Univariate analysis was used to observe the correlation between each factor and the occurrence of autonomic reflex dysfunction hypotension, to screen the suspected related factors, and then Logistic regression analysis was used to identify the independent correlation factors related to autonomic reflex dysfunction hypotension.Results:Autonomic reflex dysfunction hypotension was found in patients with acute spinal cord injury at the cervical and thoracic regions. In 98 patients with cervical spinal cord injury, 26 patients (27%) had autonomic reflex dysfunction hypotension; in 54 patients with thoracic spinal cord injury, 9 patients (17%) had autonomic reflex dysfunction hypotension. All of them showed T 5 segment or above injury. Univariate analysis showed significant differences in spinal cord injury segment and spinal cord injury grading between the two groups( P<0.01), but not in gender, age, body mass index, injury mechanism, fracture type, combined injury or not, and length of hospital stay ( P>0.05). Logistic regression analysis showed that spinal cord injury segment( OR=0.185, 95% CI 0.081-0.424) and spinal cord injury grade ( OR=0.108, 95% CI 0.048-0.244) were independent factors related to autonomic reflex dysfunction hypotension ( P<0.01). Conclusions:Spinal cord injury segment and spinal cord injury grading are independently correlated to autonomic reflex dysfunction hypotension. The higher the injury segment is and the severer the injury is, the more likely autonomic reflex dysfunction hypotension is to occur.

The value of lung ultrasound score for therapeutic effect assessment of ventilator-associated pneumonia / 中华内科杂志

To study the value of lung ultrasound score (LUS) in assessing the clinical outcome of patients with ventilator-associated pneumonia (VAP).A total of 99 VAP patients were enrolled in a prospective study.All patients met the diagnostic criterion of VAP based on the 2013 guidelines and admitted into our ICU from Jun 2013 to Jun 2015.All parameters were recorded on the diagnostic day (day 1) and day 5,including LUS,clinical pulmonary infection score (CPIS),chest X ray (CXR),Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score,Sequential Organ Failure Assessment (SOFA) score,etc.According to the CPIS,patients were divided into 2 groups(CPIS less than 6 and more or equal to 6).CPIS and LUS were similar on day 1 between two groups (P ＞ 0.05).However,on day 5,significant differences of CPIS and LUS were found between groups with CPIS ＜ 6 and CPIS≥6 (P =0.019 and P ＜ 0.001 respectively).LUS decreased on day 5 in CPIS ＜ 6 group and increased in CPIS ≥6 group.In CPIS ＜ 6 group,there was a positive correlation between LUS and CPIS on day 1 (r =0.375,P =0.003) and day 5 (r =0.590,P ＜ 0.001).CPIS ≥6 groupshowed the same trend on day 1 (r =0.484,P =0.002) and day 5 (r =0.407,P =0.011).LUS can be used to dynamically evaluate the clinical outcome of VAP.

Indirect spinal canal decompression in adult patients with thoracolumbar burst fracture / 中华创伤骨科杂志

Today pedicle screw instrumentation system and short-segment fixation have been commonly used for treatment of thoracolumbar burst fractures because pedicle screw fixation allows 3-column fixation and facilitates simultaneous application of axial compression or distraction and rotational forces.Indirect decompression and direct decompression are the two ways to deal with canal compromise when pedicle screw instrumentation is used.Indirect decompression is achieved to correct the canal compromise due to ligamentotaxis and hyperextension.The present study reviews the current research on indirect spinal canal decompression in adult patients with thoracolumbar burst fracture.

Different types of fixation for posterior pilon fractures / 中华创伤骨科杂志

Objective To explore the mechanisms of posterior pilon fractures and evaluate the curative effects of different types of fixation on the treatment of posterior pilon fractures.Methods We included in this retrospective study 20 patients with posterior pilon fracture who had been treated from January 2012 to January 2015 at our department.They were 10 men and 10 women,from 23 to 77 years of age (average,50.6 years).According to the classification by Yu Guangrong,5 cases belonged to type Ⅰ,3 to type Ⅱa,4 to type Ⅱb,and 7 to type Ⅲ.One was not indentified because of lacking CT examination.The mechanisms included ground level fall in 2 cases,motor vehicle accident in 7,fall off stairs in 5,sport injury in 2,fall from a bike in one and fall from a height in 3.More than 25％ of the articular surface was involved in 13 patients.Syndesmosis injury was identified in 6 patients by Cotton test during operation.Internal fixation varied accordingly.We recorded the mechanism,classification,proportion of the articular surface involved (more or less than 25％),and syndesmosis injury to figure out the characteristics of posterior pilon fractures.We used the Burwell-Charnley radiographic criteria to assess the postoperative reduction of the articular surface,and the Olerud-Molander scoring scale and visual analogue scale (VAS) to assess the ankle function.The curative effects of different types of fixation on the treatment of posterior pilon fractures were compared.Results Of the 20 patients,17 were available for follow-up for 6 to 36 months (average,17.8 months).Two patients received reoperation because of implant failure after cannulated screw fixation from anterior to posterior.The Burwell-Charnley radiographic evaluation revealed 12 anatoinical reducations and 8 fair reductions.The mean Olerud-Molander score for the 17 patients at the final follow-ups was 81.5 (range,from 35 to 100) and the mean walking VAS was 1 (from 0 to 3).Conclusions Posterior pilon fractures are mostly caused by medium to high energy violence,resulting from a combination of rotational and vertical forces.Since there is a high risk of implant failure,the cannulated screw fixation from anterior to posterior is not recommended.Good clinical outcomes are observed in the cannulated screw fixation from posterior to anterior and the plate/cannulated screw fixation for posterior pilon fractures.

Dementia and hip fractures / 中华创伤骨科杂志

Dementia,with a poor outcome,is a syndrome characterized by persistent impairment in cognitive function or behavioral abnormalities as evidenced by deficits in memory,attention,language,and motor activity.Hip fractures represent a widespread morbidity among the geriatric population,and fall is the main cause of osteoporotic fracture.The mortality after hip fracture reaches from 20％ to 40％ within one year after operation.Co-occurrence of dementia and hip fracture is a common challenge for orthopedic surgeons and other clinicians involved in hip fracture care.Until recently,dementia in patients with hip fracture has been an issue that has received scant recognition compared with conditions considered to represent a more immediate threat to life,such as cardiopulmonary and thromboembolic diseases.This article reviews the current issues and available evidence concerning dementia in patients with hip fracture.

Efficacy and Safety of Pantoprazole and Ranitidine in Treating Patients with Gastroesophageal Reflux Disease:A Meta-analysis / 医药导报

Objective To systematically review the effectiveness and safety of pantoprazole ( PAN ) vs. ranitidine (RAN) for patients with gastroesophageal reflux disease (GERD). Methods PubMed,Medline,EMbase,The Cochrane Library and three Chinese literature databases (CNKI,VIP and Wan fang) were retrieveed.Randomized controlled trials (RCTs) which compared the clinical outcomes of PAN group vs. RAN group for GERD were included. Two reviewers independently screened literatures in accordance with the inclusion and exclusion criteria, extracted the data and assessed the methodological quality of included studies.Then,meta-analysis was performed using RevMan 5.2 software. Results A total of 8 RCTs involving 1 590 patients were included.The results of meta-analysis showed that the PAN group was significantly superior to RAN group in terms of the healing rates and the relief rates of chief symptom for GERD of gradeⅠ-Ⅲ. While there was no significant difference in the incidence of adverse events between the two groups [GradeⅠ,RR=1.17,95%CI (0.80,1.70),P=0.43;GradeⅡorⅢ, RR=0.76,95%CI (0.43,1.36);P=0.36]. Conclusion Current evidence indicates that,pantoprazole is more effective than ranitidine for GERD of grade Ⅰ-Ⅲ,but both treatments are safe and well tolerated.

Pharmacoeconomic Evaluation of Pantoprazole and Ranitidine in the Treatment of Gastricesophagitis Reflux Disease / 中国药房

OBJECTIVE:To evaluate the pharmacoeconomics of pantoprazole vs. ranitidine in the treatment of gastricesophagitis reflux disease(GERD). METHODS:Retrieved from PubMed,EMBase,The Cochrane Library,CNKI,VIP and Wanfang database, RCTs about pantoprazole vs. ranitidine in the treatment of GERD were selected until Sept. 2014. Two reviewers independently screened literature in accordance with the inclusion and exclusion criteria,and extracted the data of included studies. Stata 12.0 soft-ware was used to estimate therapeutic efficacy index and cost,and cost-effectiveness analysis was performed with the decision tree model. RESULTS:A total of 7 RCTs were included,involving 1 389 patients. Cost-effectiveness analysis showed that for gradeⅠ-Ⅲ(by Savary-Miller standard)GERD,cost-effectiveness ratios of ranitidine were all lower than those of pantoprazole(gradeⅠ:18.86 vs. 57.93;gradeⅡorⅢ:35.58 vs. 146.13);gradeⅠ,Ⅱ,Ⅲincremental cost-effectiveness ratio(ICER)were 335.53,349.85,349.85. Sensitivity analysis supported this conclusion. CONCLUSIONS:Ranitidine is more economic therapy plan for gradeⅠ-Ⅲ GERD, but its ICER fluctuates greatly. Individual therapy plan should be formulated according to disease condition and economic condition.

The value of lung ultrasound score on evaluating clinical severity and prognosis in patients with acute respiratory distress syndrome / 中华危重病急救医学

ObjectiveTo evaluate the value of lung ultrasound score (LUS) on assessing the severity and prognosis in patients with acute respiratory distress syndrome (ARDS), and to investigate its correlation with oxygenation index, acute physiology and chronic health evaluationⅡ (APACHEⅡ) score, sequential organ failure assessment (SOFA) score, and clinical pulmonary infection score (CPIS), and other traditional parameters.Methods A prospective double-blind cohort study was conducted. Sixty-two ARDS patients conformed to the Berlin diagnostic criteria admitted to intensive care unit (ICU) of Beijing Huaxin Hospital from October 2013 to December 2014 were enrolled, including 14 cases with mild, 18 moderate, and 30 severe ARDS; among them 37 cases were of ARDS with pulmonary origin, and 25 non-pulmonary ARDS; 35 patients survived, and 27 died. The clinical data and scores of all patients were recorded by one specialized observer, including baseline data, hemodynamic parameters, lactate, respiratory parameters, and APACHEⅡ, SOFA and CPIS scores. Another observer of recording was responsible for the results of lung ultrasound, LUS, and echocardiogram. The correlation between LUS and oxygenation index as well as APACHEⅡ, SOFA and CPIS scores was analyzed by bivariate correlation analysis. Receiver operator characteristic curve (ROC) was plotted, and the predictive value, sensitivity and specificity of mild ARDS, moderate ARDS, severe ARDS and mortality by LUS were calculated. Results LUS had a negative correlation with oxygenation index (r = -0.755,P 19.0 had a high mortality, sensitivity for predicting death was 84.0%, and specificity of 89.0%.Conclusion Bedside LUS, which is simple and easily available, could evaluate the changes in pulmonary ventilation area of ARDS, and its degree of severity, and prognosis including prediction of mortality of the patients.

Evaluating prognosis of hospital-acquired pneumonia in elderly patients by using T cell subsets and clinical pulmonary infection score / 中华急诊医学杂志

Objective To explore the prognosis of elderly patients suffered from hospital-acquired pneumonia (HAP) by T cell subsets and clinical pulmonary infection score (CPIS).Methods A cohort of 125 elderly patients admitted in ICU & ED (Emergency Department) from Aug,2012 to Jul,2013 were enrolled for a prospective and observational study.The patients were divided into 3 groups:HAP survival group (n =50,group A),HAP death group (n =40,group B) and non-HAP group (n =35,control group).The criteria of exclusion were patients with auto-immune diseases,immunodeficiency,allergic disorders,malignancies,diabetes,trauma,surgical diseases,or patients with recent use of immunosuppressive agents or cyclooxygenase-inhibitors (Aspirin etc.).In the control group,patients with nosocomial pneumonia and other diseases afecting the CPIS were excluded.APACHE Ⅱ scores of all patients were recorded.Blood T cell subsets (including values of CD3,CD4 +,CD8 +,and CD4 +/CD8 +)were measured on the admission day,the 1st day of HAP onset and the 5th day after onset of HAP in HAP patients whereas these measurements were tested only on the admission day in controls.Meanwhile,the CPISs were recorded on the admission day,the 1st day of HAP onset and the 5th day after onset of HAP in HAP patients.Flow cytometer (FCM) was used to detect T cell subsets.Data of statistical analysis were represented as Mean ± SD.The significant differences in T cell subsets and CPIS between survival group and death group were analyzed by independent t test.The paired samples t test was employed in survival group and death group.Linear correlation analysis was made between CD4 +/CD8 + ratio and CPIS in survival and death groups,respectively.Results There were no significant differences in demographics and clinical features (including age,sex,length of stay,APACHE Ⅱ scores) of patients in survivors and non-survivors (P ＞ 0.05).The values of CDs (CD3,CD4 + and CD4 +/CD8 + ratio) between patients of control group and patients of HAP groups were not significantly different on the admission day (P ＞ 0.05).The values of CDs on the admission day were much lower than those on the 1 st day of HAP onset in both survivors and nonsurvivors (P ＜ 0.05).The values of CDs on the 5th day after onset of HAP were higher than those on the 1 st day of HAP onset in the survival group (P ＜ 0.05),while there were no significant differences in CDs between different intervals after HAP onset in the death group (P ＞ 0.05).There were no significant changes in values of CD8 + in any group (P ＞ 0.05).Both survivors and non-survivors had much higher CPIS values on the 1st day of HAP onset than those on the admission day (P ＜0.01).The survival group had higher CPIS on the 5th day after onset of HAP compared to the 1st day of HAP onset (P ＜0.01),while there was no significant change in the death group.Linear correlation analysis showed negative correlation between CD4 +/CD8 + ratio and CPIS on both the 1 st day of HAP onset (survival group:R =-0.740,P =0.004 ; death group:R =-0.613,P =0.035) and the 5th day after onset of HAP (survival group:R =-0.639,P =0.009; death group:R=-0.686,P=0.021).Conclusions The hospital-acquired pneumonia appears as an immune imbalance disorder.The difference in CDs is a promising objective tool,aiding in prediction of prognosis of HAP in the elderly,the lower the CDs,the higher severity.The CD4 + / CD8 + ratio showed a negative correlation with CPIS.Monitoring of T cell subsets and CPIS may provide clinical value for the treatment of hospital-acquired pneumonia in the elderly.

Plating versus intramedullary nail fixation for the treatment of humeral shaft fractures in adults:A systematic review update / 中国组织工程研究

BACKGROUND:There is controversial on which method is preferred for the treatment of humeral shaft fractures, plate or intramedul ary nail fixation? Some studies have compared the effect of those two methods, but the results are different. While the results of the systematic research and the Meta-analysis on the comparative studies is also different due to the differences in the number and the extraction of the researches. OBJECTIVE:To systematical y evaluate the efficacy of plating versus intramedul ary nail fixation in the treatment of adult humeral shaft fracture. METHODS:A computer-based retrieve was conducted in PubMed database, MEDLINE database, Cumulative Index to Nursing&Al ied Health Literature, Evidence-Based Medicine database, CBM database, Wanfang database and CNKI database for the randomized or quasi-randomized control ed trials on the comparison of plating and intramedul ary nail fixation in the treatment of adult humeral shaft fracture. The quality of these trials was critical y assessed according to Jadad. The effective data were extracted for Meta-analysis by Stata 12.0 software. RESULTS AND CONCLUSION:Total y, 15 randomized or quasi-randomized control ed trials were col ected including four quasi-randomized control ed trials and 11 randomized control ed trials. The results showed that intramedul ary nail fixation may increase the risk of complications (odds ratio=0.37(0.19, 0.59), P=0.00). Bias Egger’s test of P=0.91 showed there was no significant publication bias. The risk of re-operation of intramedul ary nail fixation was increased (odds ratio=0.28(0.14, 0.57), P=0.00) with the Egger’s test of P=0.69. The incidence of shoulder impingement of intramedul ary nail fixation was significantly higher than that of pate fixation (odds ratio=0.13(0.05, 0.35), P=0.00), and there were no significant differences in postoperative infection, nonunion, implant failure, iatrogenic nerve palsy, operation time and bone union time between two methods. The results showed that compared with plate fixation, intramedul ary nail fixation may increase the incidence of shoulder impingement, complications and re-operation, while there were significant differences in postoperative infection, nonunion, implant failure, iatrogenic nerve palsy, operation time and bone union time between two methods.

Progress in Research of Electrigens in Microbial Fuel Cell / 微生物学通报

Electricigens play an important role in microbial fuel cell(MFC) . This review provides an introduction of different electricigens on theirs taxonomical group,biochemical,physiological and morphological characteristics. The ability of electricity production of electricigens and electron transfer mechanisms in microbial fuel cells are also concluded. The prospect of waste water treatment and bio-electricity production is underlined,it is point out in this review that the future research of microorganism for MFC should be focused on enrichment,adaptation,modification and optimization by multi-strains application to improve the performances of MFC.

Comparison of TPS, CEA, CYFRA21-1 and STNFR in diagnosis of lung cancer / 中国肺癌杂志

<p><b>BACKGROUND</b>In recent years, new progress has been made in research of tumor markers. And namely tissue polypeptide specific antigen (TPS), cytokeratin 19-fragments (CYFRA21-1) and soluble tumor necrosis factor receptor (STNFR) are new tumor markers that have been used in clinical application. The aim of this study is to determine and compare the diagnostic value of 4 kinds of tumor markers, TPS, carcinoembryonic antigen (CEA), CYFRA21-1 and STNFR in patients with lung cancer.</p><p><b>METHODS</b>The serum levels of TPS, CEA, CYFRA21-1 and STNFR were determined in 72 patients with lung cancer, 54 patients with pulmonary benign diseases and 32 healthy adults by enzyme-linked immunosorbent assay (ELISA).</p><p><b>RESULTS</b>The levels of the four tumor markers in lung cancer group were significantly higher than those in benign disease group (P < 0.005) and healthy control group (P < 0.001). Among the four markers, STNFR had the highest sensitivity (81.9%), CYFRA21-1 had the highest specificity (91.5%) and TPS had the highest accuracy (83.5%).</p><p><b>CONCLUSIONS</b>TPS, CYFRA21-1 and STNFR can be used as very useful and sensitive tumor markers in the diagnosis of lung cancer, in which CYFRA21-1 may be the most useful tumor marker for clinical application.</p>

Perioperative Use of Antibiotics in Some Departments of Our Hospital / 中国药房

OBJECTIVE:To probe into the perioperative use of antibiotics in some clinical department of our hospital.METHODS:780 medical records of the patients(discharged from our hospital between Oct.2007 and Oct.2008)were sampled randomly for statistical analysis regarding the utilization of antibiotics.RESULTS:Of the 780 cases reviewed,778 cases(99.74%)received antibiotics versus 2 didn't.In terms of the application variety of antibiotics,Cephalosporins were predominantly used,followed in turn by penicillins and quinolones.289 cases used one kind of antibiotics,279 used two kinds and 210 used at least three kinds of antibiotics concomitantly.Only 19 cases received etiologic test and susceptibility test during antibiotic use.CONCLUSION:The perioperative use of antibiotics in some clinical departments of our hospital is somewhat irrational,thus monitoring on which should be tightened to promote their rational use.

Prevention and Treatment of Chronic Pyelonephritis with Yishenkang Granule:Clinical Immunology Study / 中国药房

OBJECTIVE: To study the links between chronic pyelonephritis (CPN) and immune function, and the action mechanism of Yishenkang granule on CPN. METHODS: A total of 120 CPN cases were randomly assigned to Yishenkang granule group, Sanjing tablet group and western medicine group, which were compared with healthy control group. The levels of the peripheral blood T lymphocyte subsets, serum immunoglobulin, complement, secretory IgA in urine and the cell factor IL-2 in CPN cases before and after treatment were detected by monoclonal antibody method, agar diffusion method, radioimmunoassay, radioimmune balancing method and compared with those in healthy control group. RESULTS: In CPN cases compared with healthy control group, the levels of serum immunoglobulin, complement, secretory IgA in urine were significantly lower while the level of cell factor IL-2 were significnatly higher (P

Effect of Sorbaria Sorbifolia extract on anti-oxidative activities in rats with precancerosis induced by diethylnitrosamine / 中西医结合学报

To study the effect of Sorbaria Sorbifolia extract on anti-oxidative activities in rats with precancerosis induced by diethylnitrosamine.

Treatment of infected total knee arthroplasty / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the treatment of infected total knee arthroplasty (TKA).</p><p><b>METHODS</b>Between 1983 and 2000, 6 patients with infection after TKAs were treated, including 2 men and 4 women, aged on average 63 years (44 - 75 years). Initial knee arthroplasty was performed for osteoarthritis in 4 patients and for rheumatoid arthritis in 2 knees. The timing of diagnosis of infection after knee arthroplasty averaged 50 months (range, 1 month-11 years). Simple debridement and antibiotic treatment were prescribed for 3 patients, debridement and one-stage reimplantation for 1, debridement and two-stage reimplantation for 1, and athrodesis for 1.</p><p><b>RESULTS</b>Of the 3 patients with simple debridement, one was cured, one failed but underwent athrodesis later, and one lost to follow up. Two patients with reimplantation were cured and had good function recovery. All of the 6 patients were followed up on average for 4 years. No infection recurred except one who lost to follow-up.</p><p><b>CONCLUSIONS</b>Management of infection after total knee arthroplasty includes antibiotic suppression and debridement with prosthesis retention, insertion of another prosthesis as a one-stage or two-stage exchange technique, knee arthrodesis and amputation. These treatments have specific indications. To treat infection after total knee arthroplasty, suitable method should be taken according to patient's condition. Arthrodesis is the best salvage operation, though it may handicap patients' daily life. Reimplantation of another prosthesis could maintain a functional joint.</p>