Clinical guideline for surgical treatment of symptomatic chronic osteoporotic vertebral fractures / 中华创伤杂志

According to the pathological characteristics of symptomatic chronic thoracic and lumbar osteoporotic vertebral fracture (SCOVF), the different clinical treatment methods are selected, including vertebral augmentation, anterior-posterior fixation and fusion, posterior decompression fixation and fusion, and posterior correction osteotomy. However, there is still a lack of a unified understanding on how to choose appropriate treatment method for SCOVF. In order to reflect the new treatment concept and the evidence-based medicine progress of SCOVF in a timely manner and standardize its treatment, the clinical guideline for surgical treatment of SCOVF is formulated in compliance with the principle of scientificity, practicability and advancement and based on the level of evidence-based medicine.

The predictive value of extra pulmonary multiple factors including creatine kinase-isoenzyme MB in prognosis of patients with acute paraquat poisoning / 中华急诊医学杂志

Objective To investigate the predictive value of extra pulmonary multiple factors including creatine kinase-isoenzyme MB (CK-MB) for the prognosis of patients with acute paraquat poisoning.Methods A retrospectively analysis were conducted on 641 patients who were treated at the First Affiliated Hospital of Zhengzhou University due to oral paraquat poisoning from October 2002 to April 2017.The observation end point was that the patients died from paraquat poisoning within 3 months after admission or were still alive within 3 months after paraquat poisoning.The patients' data were retrieved,including general information,the dose of poison,urinary paraquat concentration,arterial blood gas analysis,alanine transaminase (ALT),total bilirubin (TBIL),uric acid (UA),aspartate transaminase (AST),creatine kinase (CK),CK-MB,B type natriuretic peptide (BNP),lactic dehydrogenase (LDH),high sensitivity troponin T (hsTnT),C-reaction protein (CRP) and procaicitonin (PCT).According to the patient's prognosis within 3 months,the patients were divided into a survival group and a non-survival group.The above indicators were compared between the two groups and the diagnostic value of CK-MB for acute paraquat poisoning was analyzed according to the receiver operating characteristics (ROC) curve.Collect the last arterial blood gas analysis,and laboratory test results were analyzed by binary logistic regression analysis to determine the risk factors for death in patients with acute paraquat poisoning.Results Among the 641 patients with acute paraquat poisoning,315 (49.1％) patients survived and 326 (50.9％) died.Compared with the survival group,patients in the non-survival groupthere were older,had a shorter hospital stay,and had a higher oral paraquat dose and urinary paraquat concentration;Lac,TBIL,UA,AST,CK,CK-MB,BNP,LDH,CRP and PCT were higher,while blood gas analysis index were lower in the non-survival group (P＜0.05).Binary logistic regression analysis showed that the dose of paraquat,CK-MB and AST were closely related to the prognosis of patients with acute paraquat poisoning.The optimal cut-off value of ingestion dose,the first urinary paraquat concentration on admission and CK-MB in predicting the prognosis of patients with acute paraquat poisoning were 7 g (AUC=0.918,sensitivity 80.6％,specificity 87.5％,Yoden index 0.681,P＜0.01),5.16 μg/mL (AUC=0.879,sensitivity 93.8％,specificity 70.1％,Yoden index 0.639,P＜0.01),and 18.2 U/L (AUC=0.846,sensitivity 83.9％,specificity 71.9％,Yoden index 0.558,P＜0.01),respectively.Binary logistic regression analysis of the last biochemical indicators of paraquat poisoning showed that the dose of poison,the last CK-MB,the last SCr,urinary paraquat concentration,and the last blood Na+ were closely related to the prognosis of patients with acute paraquat poisoning.Among them,the last CK-MB＞18.05 U/L often indicated poor prognosis (AUC=0.808,sensitivity 79.7％,specificity 65.8％,Yoden index 0.455,P＜0.01).Conclusions In the treatment of patients with acute paraquat poisoning,there are significant differences in extra pulmonary factors such as heart,liver,kidney,electrolytes and inflammatory markers in patients with different prognosis,so the monitoring and follow-up should be improved,in addition to focusing on the presence and treatment of pulmonary fibrosis.In particular,CK-MB is an independent risk factor for the prognosis of acute paraquat poisoning.In the late stage of poisoning,CK-MB,SCr,and blood Na+ have a strong predictive value for the prognosis of the patients,and we should pay attention to the regular follow-up of the above mentioned laboratory items.

The effect of noninvasive ventilation with the helmet compared with facial mask in patients with acute respiratory failure: a randomized controlled study / 中华急诊医学杂志

Objective To explore the effect of noninvasive ventilation (NIV) with helmet or facial mask on clinical efficacy, tolerability, and prognosis in patients with acute respiratory failure. Methods Fifty patients with acute respiratory failure according to the inclusion criteria were recruited from January 2018 to July 2018 in Emergency Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University. Included patients were randomly allocated into the helmet group or facial mask group. Based on conventional drug therapy, pressure support mode was performed with the interface of the helmet or facial mask. Oxygenation index, arterial carbon dioxide partial pressure, and respiratory rates were measured before and after the treatment, and the data were compared and analyzed by the repeated measures ANOVA. Tolerance score, complication rate, tracheal intubation rate, and mortality rate were recorded at each observation time point of the two groups. Results The oxygenation index before NIV, at 4 h and at the end of NIV treatment of the helmet group were significantly increased from (160.29±50.32) mmHg to (249.29±83.47) mmHg and (259.24±87.09) mmHg; the oxygenation index of the facial mask group were increased from (168.63±38.63) mmHg to (225.00±74.96) mmHg and (217.69±77.80) mmHg, and there was no significant difference within the two groups (P <0.05). The respiratory rates before NIV, at 4 h and at the end of NIV treatment of the helmet group were obviously decreased from (27.60±7.64) breaths/min to (17.92±4.55) breaths/min and (16.88±3.90) breaths/min; the respiratory rates of the facial mask group were decreased from (24.68±6.14) breaths/min to (20.36±4.25) breaths/min and (19.68±3.34) breaths/min, and the differences within the two groups were statistically significant (P <0.05). However, there were no significant differences on oxygenation index and respiratory rates between the helmet group and facial mask group (P >0.05). Patients in the helmet was better tolerated than those in the facial mask group [ratio of good tolerance 96％ (24/25) vs 56％ (14/25) (P = 0.001) and fully tolerance 80％ (20/25) vs 36％ (9/25) (P =0.002)] and had less complications (1/25 vs 10/25, P = 0.002). 84％ patients in the helmet group and 76％ patients in the facial mask group were successfully weaned and discharged after NIV treatment (P =0.480). Conclusions Similar clinical efficacy in improving blood gas exchange and relieving dyspnea were observed in the helmet group and the facial mask group in patients with acute respiratory failure. However, the helmet is better tolerant, and had lower complication rate, which is especially suitable for patients with chest trauma combined with facial injuries.

Effect of hemoperfusion combined with continuous veno-venous hemofiltration on acute paraquat poisoning:a Meta-analysis / 中华危重病急救医学

Objective To comprehensively evaluate the clinical efficacy of hemoperfusion (HP) combined with continuous veno-venous hemofiltration (CVVH) on acute paraquat poisoning (APP).Methods Literatures of Chinese and English randomized controlled trials (RCTs), case control and cohort study on HP combined with CVVH in the treatment of APP from the PubMed, Embase, Wanfang, and CNKI up to November 2017 were enrolled (the subjects were > 16 years old). The obtained literatures were strictly screened and evaluated in quality, and data such as mortality, the life time of dead patients, inefficiency rate, incidence of multiple organ dysfunction syndrome (MODS) and acute respiratory distress syndrome (ARDS) were extracted. Meta-analysis was performed by RevMan 5.3. Results Twenty-one studies were included with 2222 subjects, among whom 976 subjects were in HP combined with CVVH group (experimental group) and 1246 subjects in HP group (control group). Compared with control group, the mortality in experimental group were significantly decreased [43.77％ (362/827) vs. 55.26％ (604/1093), odds ratio (OR) =0.68, 95％ confidential interval (95％CI) = 0.56-0.82,P = 0.0001], the life time of death patients was significantly prolonged [mean difference (MD) = 4.63, 95％CI = 2.60-6.66,P < 0.00001], incidence of MODS [25.93％ (70/270) vs. 55.36％ (155/280),OR = 0.26, 95％CI = 0.14-0.49,P< 0.0001], and incidence of ARDS [30.37％ (82/270) vs. 51.07％(143/280),OR = 0.42, 95％CI = 0.30-0.61,P < 0.00001], and inefficiency rate [8.72％ (13/149) vs. 34.64％ (53/153),OR=0.17, 95％CI = 0.09-0.34, P < 0.00001] were significantly reduced. Funnel chart showed that except the publication bias of mortality rate, there were less publication bias about other indicators among studies.Conclusion HP combined with CVVH can significantly reduce the mortality of patients with APP compared with HP alone on the whole, prolong the life time and reduce the occurrence of MODS and ARDS, thus improving the treatment efficiency.

The SPIO labeling of mature dogs BMSCs in vitro / 中华显微外科杂志

Objective To explore labeling efficiency and appropriate conditions of Superpara magnetic iron exide nanopaticles (SPIO) nanoparticles for Bone marrow stromal cells(BMSCs). Methods BMSCs were aquired from skeletally mature dogs via iliac crest aspiration and separated by adherent cell cytopheresis.BMSCs were cultured and incubated with SPIO at different concentrations in vitro. The labeling efficiency of BMSCs with different labeling concentrations SPIO nanoparticles as well as detection of characteristics and signal attenuation rules were evaluated by MRI at 1.5T in vitro. Results BMSCs were efficiently labeled by SPIOin vitro and has no alterations to viability and proliferation profiles at this labeling concentration. BMSCs loaded with SPIO can be detected by MRI at certainly cell quantity in vitro(5 × 104). The quantity of SPIO in cells gradually reduced as cell culture time prolonged, with no statistically significant changes in cell death(P＞ 0.05). Conclusion The results demonstrated the potential application of SPIO as a wonderful cell tracer in vitro.

Advance in study of electric impedance tomography of human head tissues / 国际生物医学工程杂志

Brain diseases and brain activities are always accompanied by the conductivity changes of the head tissues.Electrical impedance imaging (EIT) is used in diagnosing brain diseases and monitoring brain functional activities.The basic concept of non-invasive electrical impedance imaging on human head and its aplication potential are introduced in this paper.Several EIT techniques based on magnetic field measurement are introduced.The existing problems and foreground of the related research are also discussed.

Advances in meshless methods and applications to ECG forward problem / 国际生物医学工程杂志

Meshless methods are recently developed numerical methods which require only node informa- tion. This paper introduces the basic principles and history of meshless methods, the principles and implementation of the moving least square method taking Galerkin method as an example. Finite points mixed method (FPMM) and its application in solving electrocardiogram(ECG) forward problem is also introduced. Foreground and problems need to be solved concerning the application of meshless methods in the study of ECG forward problem are discussed.

Natural history of the mild adolescent idiopathic scoliosis / 中华骨科杂志

Objective To investigate the natural history of mild adolescent idiopathic scoliosis in a period of 15 years and search for the risk factors of progress as well as to recommend the modification program of school screening for scoliosis. Methods From a group of 204 patients with adolescent idiopathic scoliosis who were detected from school screening for scoliosis among 20 418 school children in Beijing from May 1985 to January 1986, 90 of the patients were reevaluated 15 years later. The follow-up items of the therapeutic history, physical examination and standing spinal X-ray films were carried out. The late data were compared statistically with the original data at the time of school screening. The final results were divided into four groups: 1)Resolved group with a current curve less than 10 degrees; 2)Reduced group with a current curve more than 10 degrees but reducing less than 5 degrees regarding to the original status; 3)Unchanged group with a current curve more than 10 degrees while progressing less than 5 degrees compared to the original data; 4)Progressed group with a current curve was more than 10 degrees and aggravating more than 5 degrees than the original curve. Results Of 204 patients, 111 patients were followed up, and X-ray films were taken in 90. The follow-up results suggested that 29 cases showed resolved(32.2%), 21 cases reduced (23.3%), 30 cases unchanged (33.3%) and 10 cases progressed (11.1%). In 10 cases of progressed group, there were 8 females and 2 males, furthermore, 6 patients were found with the cobbs angle of curve between 10 and 19 degrees and 4 patient with the cobbs angle of curve more than 20 degrees when school screening. The curve pattern of the 10 progressed patients consisted of double thoracic curves in 2, double thoracic and lumbar curves in 2, right thoracic curve in 3, thoraco-lumbar curve in 2 and lumbar curve in 1. Conclusion Most of cases with less than 20 degrees curve are of no progress. The high risks of progress are as followed: curve more than 20 degrees, female, double thoracic curve, double thoracolumbar curve, right thoracic scoliosis and top vertebral rotation more than grade Ⅱ. The school screening for scoliosis should be carried out by school medical team who were trained by orthopaedists. The specialists should reexamine the suspected children and monitor the patients with high risk of progress.