Evaluation of Diaphragmatic Thickness and Dysfunction by Ultrasonography in Mechanically Ventilated Children for Assessment of Extubation Success

Objectives: This study aimed to evaluate diaphragm thickness (DT) and diaphragmatic thickening fraction (DTF) in mechanically ventilated children, and study the association of these measurements with extubation success. Methods: Consecutive children aged one month to 18 years, who required mechanical ventilation (MV) for more than 24 hours at our institution, were enrolled between April, 2019 to October, 2020. Ultrasonographic measurements of DT were documented, and DTF was calculated from baseline (within 24 hours of MV) until 14 days of MV, and up to three days post-extubation. Results: Of the 54 childrenenrolled, 40 underwent planned extubation trial, of which 9 (22.5%) had extubation failure. Pre-extubation and post-extubation DTF between children in extubation-success and extubation-failure groups were comparable (P=0.074). There was no significant difference in the diaphragm atrophy rate between the two groups (P=0.819). Binary logistic regression showed significantly decreased probability of successful extubation with total ventilation duration (P=0.012) and mean DTF% before extubation (P=0.033). Conclusion: Despite evidence of diaphragmatic atrophy in critically ill children receiving mechanical ventilation, there was no significant difference in DTF between extubation success and failure groups.

Destete guiado por ecografía / Ultrasound-Guided Extubation

Introducción: La observación del diafragma con el ultrasonido ha sido posible desde hace más de cuatro décadas; recientemente se le ha dado importancia a la valoración ultrasonográfica del diafragma en el proceso de destete del paciente ventilado. Objetivo: Describir la utilización de la ecografía diafragmática en la evaluación del proceso de destete en dos pacientes. Presentación de caso: Se presentan dos casos, el primer caso paciente femenino de 79 años con diagnóstico de infarto cerebral, coma y bronconeumonía; que precisó ventilación mecánica invasiva y previa prueba de ventilación espontánea. Se le realizó ultrasonido de diafragma donde se comprobó alta probabilidad de falla en la extubación, por lo que se modificó el esquema de destete para corregir las causas. El segundo paciente masculino de 68 años con diagnóstico de neumonitis aspirativa por queroseno que necesitó soporte ventilatorio invasivo; cuando presentó mejoría del cuadro inicial y parámetros de oxigenación, se le evaluó la función diafragmática mediante ultrasonografía se comprobó alta probabilidad de éxito en la extubación, se logró sin complicaciones. Conclusiones: Se utilizó la ultrasonografía diafragmática, emerge como una herramienta de fácil acceso y bajo costo, en la evaluación del proceso de destete en los pacientes ventilados, permitió la exploración de la función del diafragma en directo y en pie de cama. La valoración de la excursión diafragmática y la fracción de engrosamiento diafragmático proporcionó una escala predictiva valiosa, para prever que pacientes tendrán una extubación exitosa o no(AU)

Introduction: The observation of the diaphragm with ultrasound has been possible for more than four decades; but only recently has importance been given to the ultra-sonographic assessment of the diaphragm in the weaning process of the ventilated patient. Objective: To describe the use of diaphragmatic ultrasound in the evaluation of the weaning process in two patients. Case presentation: Two cases are presented, the first case is a 79-year-old female patient with a diagnosis of cerebral infarction, coma and bronchopneumonia; that she required invasive mechanical ventilation and after a spontaneous ventilation test, an ultrasound of the diaphragm was performed, where a high probability of failure in extubation was verified, for which the weaning scheme was modified to correct the causes. The second 68-year-old male patient diagnosed with kerosene aspiration pneumonitis that required invasive ventilator support; that when he presented improvement of the initial symptoms and oxygenation parameters, his diaphragmatic function was evaluated by ultrasonography, verifying a high probability of success in extubation, achieved without complications. Conclusions: Diaphragmatic ultrasonography emerges as a tool of easy access and low cost, in the evaluation of the weaning process in ventilated patients, allowing the exploration of the function of the diaphragm in direct and at the foot of the bed. The evaluation of the diaphragmatic excursion and the fraction of diaphragmatic thickening provide us with a valuable predictive scale, to anticipate which patients will have a successful extubation or not(AU)

Achilles tendon thickening does not affect elasticity and functional outcome after surgical repair of Achilles rupture: A retrospective study / 中华创伤杂志(英文版)

PURPOSE@#Previous studies have confirmed that Achilles tendon occurs Achilles thickening after repair surgery of the rupture. Although this mechanism has been elucidated in the laboratory, there are few reports on its impact on clinical function. We designed a retrospective study to investigate the Achilles thickening after Achilles tendon rupture repair and its correlation between the elasticity and postoperative function.@*METHODS@#In this retrospective analysis, patients who underwent surgical treatment for acute Achilles tendon rupture from April 2016 to April 2020 were included. All the patients were regularly followed up at 3 months, 1 year, and 2 years after surgery. American Orthopaedic Foot Ankle Surgeon (AOFAS) scale and Leppilahti score were used to evaluate functional outcomes. Achilles elasticity was measured by ultrasound shear wave of elasticity. Achilles thickening was calculated as maximal transverse and longitudinal diameter in cross-sectional plane of magnetic resonance scan. Sample t-tests was used for different follow-up periods. Correlation between Achilles thickening and other factors were analyzed using Pearson's method. p < 0.05 indicates a statistically significant difference.@*RESULTS@#AOFAS scale and Leppilahti score at 1 year were significantly higher than at 3 months postoperatively (both p < 0.001). These functional scales were also improved at 2-year follow-up significantly (both p < 0.001). The dorsiflexion difference showed gradually recovery in each follow-up period (t = -17.907, p < 0.001). The elasticity of the Achilles appeared to continuously decreases during the postoperative follow-up period in all position sets (p < 0.001). In thickening evaluation, the cross-sectional area of the thickest plane of Achilles was significantly higher at 1 year postoperatively (310.5 ± 25.2) mm2 than that at 3 months postoperatively ((278.0 ± 26.2) mm2, t = -8.219, p < 0.001) and became thinner in 2-year magnetic resonance scan ((256.1 ± 15.1) mm2, t = 16.769, p < 0.001). The correlations between Achilles thickening, elasticity, and functional outcome did not show statistical significance (p > 0.05) in every follow-up period.@*CONCLUSION@#Achilles tendon thickens after surgery in the 1st year, but begins to gradually return to thinning about 2 years after surgery. There was no significant correlation between the increase and decrease of thickening and the patients' clinical function scores, Achilles elasticity, and bilateral ankle dorsiflexion difference.

Effect of early off-bed mobility on diaphragm function in intensive care unit patients undergoing mechanical ventilation / 中华危重病急救医学

Objective:To explore the improvement of diaphragm function after early off-bed mobility intervention in intensive care unit (ICU) patients undergoing mechanical ventilation.Methods:A randomized controlled trial was conducted. A total of 147 adult patients undergoing mechanical ventilation admitted to ICU of Affiliated Hospital of Zunyi Medical University from October 2019 to March 2022 were enrolled. The patients were divided into control group and observation group by convenient sampling. Except for the different intervention programs of early mobility, other treatment and nursing of the patients in the two groups were carried out according to ICU routine. Progressive early activities were performed in the control group, while early off-bed mobility was performed in the observation group. The changes of diaphragm thickness at the end of inspiratory (DTei), diaphragm thickness at the end of expiratory (DTee) and diaphragm thickening fraction (DTF) before and 24, 48, 72 and 96 hours of intervention, and the duration of mechanical ventilation, length of ICU stay and 24-hour re-intubation rate after intervention were compared between the two groups.Results:Among the 147 patients, there were 4 cases of detachment in the control group and 5 cases of detachment in the observation group. Finally, 138 patients were enrolled, 69 cases in the control group and 69 cases in the observation group. There was no significant difference in gender, age, diagnosis of ICU, sedatives, muscle strength, ventilator model, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and DTei, DTee, DTF before intervention between the two groups. The DTei, DTee and DTF in both groups were increased gradually with the extension of intervention time, especially in the observation group [DTei (cm) at 24, 48, 72 and 96 hours of intervention in the observation group were 0.247±0.014, 0.275±0.016, 0.300±0.013 and 0.329±0.013, while in the control group were 0.242±0.015, 0.258±0.013, 0.269±0.014, and 0.290±0.017, effect of time: F = 993.825, P = 0.000, effect of intervention: F = 82.304, P = 0.000, interaction effect between intervention and time: F = 84.457, P = 0.000; DTee (cm) of the observation group were 0.213±0.014, 0.227±0.013, 0.243±0.016, 0.264±0.010, while in the control group were 0.213±0.016, 0.218±0.013, 0.224±0.013, 0.234±0.014, effect of time: F = 385.552, P = 0.000, effect of intervention: F = 28.161, P = 0.000, interaction effect between intervention and time: F = 45.012, P = 0.000; DTF of the observation group were (15.98±4.23)%, (21.35±4.67)%, (24.09±4.44)% and (25.24±3.74)%, while in the control group were (14.17±4.66)%, (18.11±3.92)%, (20.22±4.19)% and (20.98±4.12)%, effect of time: F = 161.552, P = 0.000, effect of intervention: F = 49.224, P = 0.000, interaction effect between intervention and time: F = -4.507, P = 0.000]. The duration of mechanical ventilation and length of ICU stay in the observation group were significantly shorter than those in the control group [duration of mechanical ventilation (hours): 112.68±12.25 vs. 135.32±22.10, length of ICU stay (days): 7.84±1.78 vs. 10.23±2.43, both P < 0.01]. However, there was no significant difference in 24-hour re-intubation rate between the observation group and the control group (0% vs. 2.90%, P > 0.05). Conclusions:Both early off-bed mobility and progressive early activities can prevent diaphragm weakness in ICU patients undergoing mechanical ventilation, and the effect of early off-bed mobility is better. Early off-bed mobility can significantly shorten the duration of mechanical ventilation and length of ICU stay, and it is safe and feasible.

Predictive value of diaphragm thickening fraction and intra-abdominal pressure monitoring-oriented risk prediction model for weaning failure in patients with severe acute pancreatitis / 中华危重病急救医学

Objective:To establish a risk prediction model dominated by diaphragm thickening fraction (DTF) and intra-abdominal pressure (IAP) monitoring, and to explore the predictive value of the model for weaning failure in patients with severe acute pancreatitis (SAP).Methods:A prospective research was conducted. Sixty-three patients undergoing invasive mechanical ventilation treatment who diagnosed with SAP admitted to intensive care unit of the First Affiliated Hospital of Jinzhou Medical University from August 2020 to October 2021 were enrolled. The spontaneous breathing trial (SBT) was carried out when the clinical weaning criteria was met. The stable cardiovascular status, good pulmonary function, no chest and abdominal contradictory movement, and adequate oxygenation were defined as successful weaning. Otherwise, it was defined as failure weaning. The clinical indicators such as SBT 30-minure DTF, IAP, tidal volume (VT), respiratory rate (RR), body mass index (BMI), and blood lactic acid (Lac) were compared between the weaning success group and the weaning failure group. The indicators with statistically significant differences in the single-factor analysis were included in the secondary multivariable Logistic regression analysis to establish a risk prediction model. The correlation between the DTF and IAP at 30 minutes of SBT was analyzed. Receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of the risk prediction model for SAP patient withdrawal failure at 30 minutes of SBT.Results:Finally, 63 patients with SAP were enrolled. Among the 63 patients, 42 were successfully weaned and 21 failed. There were no significant differences in age, gender, and oxygenation index (PaO 2/FiO 2), sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score at admission between the two groups, indicating that the data in the two groups were comparable. Compared with the weaning success group, IAP, RR, BMI and Lac at 30 minutes of SBT in the weaning failure group were significantly increased [IAP (mmHg, 1 mmHg≈0.133 kPa): 14.05±3.79 vs. 12.12±3.36, RR (times/min): 25.43±8.10 vs. 22.02±5.05, BMI (kg/m 2): 23.71±2.80 vs. 21.74±3.79, Lac (mmol/L): 5.27±1.69 vs. 4.55±1.09, all P < 0.05], while DTF and VT were significantly decreased [DTF: (29.76±3.45)% vs. (31.86±3.67)%, VT (mL): 379.00±98.74 vs. 413.60±33.68, both P < 0.05]. Secondary multivariable Logistic regression analysis showed that DTF [odds ratio ( OR) = 0.758, 95% confidence interval (95% CI) was 0.584-0.983, P = 0.037], IAP ( OR = 1.276, 95% CI was 1.025-1.582, P = 0.029), and RR ( OR = 1.145, 95% CI was 1.014-1.294, P = 0.029) were independent risk factors for SBT withdrawal failure in 30 minutes in SAP patients. The above risk factors were used to establish the risk prediction model of aircraft withdrawal failure at 30 minutes of SBT: Logit P = -0.237-0.277×DTF+0.242×IAP+0.136×RR. Pearson correlation analysis showed that SBT 30-minute DTF was significantly correlated with IAP in SAP patients, and showed a significant positive correlation ( r = 0.313, P = 0.012). The ROC curve analysis results showed that area under the ROC curve (AUC) of the risk prediction model for SAP patient withdrawal failure at 30 minutes of SBT was 0.716, 95% CI was 0.559-0.873, P = 0.003, with the sensitivity of 85.7% and the specificity of 78.6%. Conclusions:DTF, IAP and RR were independent risk factors for SBT withdrawal failure in 30 minutes in SAP patients. The DTF and IAP monitoring-oriented risk prediction model based on the above three variables has a good predictive value for weaning failure in patients with SAP.

Efficacy of modified Park method in blepharoplasty / 中华医学美学美容杂志

Objective:To investigate the modified application of orbicularis oculi muscle-levator aponeurosis composite tissue flap fixation technique (modified Park method) in double-eyelid surgery.Methods:From June 2019 to March 2021, 823 patients included 92 males and 731 females, aged from 18 to 45 years with mean (31.4±7.9) years, in which 142 patients with slightly ptosis were selected to receive the treatment in the Department of Plastic Surgery of the Affiliated Hospital of Nangjing University of TCM. The symmetry of bilateral double eyelids after operation was evaluated by the third party. The marginal reflex distance (MRD1) was measured before and 6 months after operation, and the difference between preoperative and postoperative MRD1 (ΔMRD1) was calculated. And the postoperative complications were counted. The patients were followed up from 6 to 12 months after surgery to evaluate the long-term results.Results:The patients were followed up for 4-22 months (mean 10 months) after operation. And the incisions of all the 823 cases had primary healling. Most patients had smooth upper eyelid crease, upturned lashes and dynamic fold. The skin tended to spread evenly without dimple. The symmetry evaluation by the third party showed that there were 764 patients with symmetry and basic symmetry after operation, the symmetry rate was 92.8%; 59 patients with asymmetry, the asymmetry rate was 7.2%. The data of MRD1 increased significantly 6 months after operation, from (3.25±0.72) mm to (3.64±0.61) mm, and the ΔMRD1 was (0.38±0.76) mm ( t=-20.41, P<0.05). The difference between the two groups was statistically significant. The double eyelid line became shallow in 8 cases and disappeared completely in 3 cases. The double eyelid curve of the patients was natural and smooth after the operation. And there was no obvious sunken scar and pretarsal fullness. Conclusions:The " modified Park technique" blepharoplasty can obtain a more firm, symmetrical and natural appearance. And the mild ptosis could be corrected by this method. The anatomical structure can be identified clearly, and the surgical results are highly repeatable. It is worth promoting.

Interpretation of the Gallbladder reporting and data system (GB-RADS) for risk stratification of gallbladder wall thickening on ultrasonography: an international expert consensus / 中华消化外科杂志

In February 2022, the world′s first gallbladder reporting and data system (GB-RADS) for the assessment of gallbladder wall thickening on ultrasonography was published in the form of an international expert consensus. The GB-RADS system classifies gallbladder wall thickening into six levels (GB-RADS 0?5), with gradually increasing risk of malignancy. It is mainly based on the following features: symmetry and extent (focal versus circumferential) of involvement, layered appearance, intramural features (including intramural cysts and echogenic foci), and interface with the liver. The proposed system is important for the standardized diagnosis and treatment of gallbladder diseases. The authors interpret the consensus, introduce the evaluation points and classification standards, and suggest the future applications and research directions.

Effect of acupuncture on diaphragmatic function in patients with AECOPD typeⅡ respiratory failure evaluated by ultrasound detection / 中国针灸

OBJECTIVE@#To observe the therapeutic effect of acupuncture combined with western conventional therapy on type Ⅱ respiratory failure of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and evaluate the effect of acupuncture on diaphragmatic function and prognosis by bedside ultrasound.@*METHODS@#A total of 111 patients with AECOPD type Ⅱ respiratory failure were randomized into an acupuncture group, a conventional treatment group and a non-acupoint acupuncture group, 37 cases in each one. The routine AECOPD nursing care and treatment with western medicine were provided in the 3 groups. Additionally, in the acupuncture group, acupuncture was applied at Dingchuan (EX-B 1), Feishu (BL 13), Taiyuan (LU 9), Danzhong (CV 17) and Zhongwan (CV 12), etc. In the non-acupoint acupuncture group, acupuncture was given at the points 5 to 10 mm lateral to each of the acupoints selected in the acupuncture group. Acupuncture was given once every day, 30 min each time, consecutively for 10 days in the above two groups. Separately, before treatment, on day 3, 7 and 10 of treatment, arterial partial pressure of oxygen (PaO@*RESULTS@#On day 3, 7 and 10 of treatment, PaO@*CONCLUSION@#Acupuncture as adjunctive therapy achieves significant therapeutic effect on AECOPD type Ⅱ respiratory failure. It improves diaphragmatic function, promotes oxygenation and relieves carbon dioxide retention of artery, alleviates clinical symptoms and reduces the time of mechanic ventilation and hospitalization. Besides, the bedside ultrasound detection can objectively reflect the effect of acupuncture on diaphragmatic function in the patients with AECOPD complicated with typeⅡrespiratory failure.

Complications and residual pleural thickening after intrapleural instillation of streptokinase with pigtail catheter drainage of tuberculous pleural effusion

Background: Tuberculosis is the most common cause of exudative lymphocytic pleural effusion in India. Residual pleural thickening (RPT) is observed in about 50 percent of patients even after proper treatment with ATT. Pleural fluid drainage either with simple aspiration or with intercostal drainage and addition of corticosteroids along with antitubercular drugs have not shown to influence the incidence of RPT. The present study was undertaken to study the complications and residual effects of tubercular pleural effusion on the patients during the follow up period following intrapleural streptokinase instillation.Methods: Clinical profile, hospital course and outcome of tuberculous pleural effusion patients at the end of six months of anti-tubercular treatment of 50 patients from January 2009 to June 2010 were analyzed. These patients were randomly divided into two groups. One group (n=25) received intrapleural streptokinase via pigtail catheter and the other group (n=25) received intercostal drainage without intrapleural streptokinase instillation. All the patients received standard daily anti TB regimen of 2HERZ/4HR for a total duration of six months. All the patients were followed up for a total duration of 1 year for evidence of any residual pleural thickening.Results: Majority of the patients were above 40 years of age (60%). The male to female ratio was 2.3:1. The major symptoms of the patients were, fever in 44 patients (88%), cough in 42 patients (84%), breathlessness in 33 patients (66%), loss of appetite in 25 patients (50%) and chest pain in 25 patients (50%). Most of the patients had ADA levels between 40-70IU/L (48%) and only 6% had ADA levels below 40IU/L. The incidence of residual pleural thickening in the study group was less as compared to the control group (2.36�49mm vs 9.28�50mm) (p <0.0001).Conclusion: Intrapleural streptokinase instillation with pigtail catheter drainage less number of complications associated with study group and is successful with the decreased incidence of residual pleural thickening during the follow up period.

Clinical guidelines for maxillary sinus floor elevation with sinus membrane lesions / 口腔疾病防治

@#Maxillary sinus membrane lesions have been broadly detected before implant surgery in the posterior maxilla region, resulting in uncertainty regarding maxillary sinus floor elevation surgery. In this context, we composed this commentary article based on the current literature and the clinical experience of our department. We discuss the common lesion types shown by CBCT including membrane pathological thickening, polyps/cystic lesions and air-liquid level in the sinus. Maxillary sinus floor elevation surgery can be conducted in patients with membrane thickening of 2-5 mm or with polyps/cysts of less than half of the sinus height (because the above symptoms have little influence on the outcome of surgery). Membrane thickening of more than 5 mm with ostium obstruction, antrochoanalpolyps, mucoceles and cysts of more than half of the sinus height should be carefully treated. Different treatments can be performed such as conducting elevation surgery while retaining the cyst, removing the cyst before surgery or removing the cyst during surgery based on the cyst type and size, inflammation, patency of the ostium, etc. Antibiotics-anti-inflammatory-aspiration, surgical debridement and oral lesions eliminations are generally used for treating post-operative sinusitis. Presurgical radiographic evaluation is the key to diagnosing and treating these membrane lesions. We highly advocate collaboration between our dentists and otolaryngologists on this issue.

Factores de riesgo para la aparición de aterosclerosis en pacientes con artritis reumatoide / Risk factors for the development of atherosclerosis in patients with rheumatoid arthritis

Introducción: la artritis reumatoide es una enfermedad sistémica, de etiología desconocida, caracterizada por provocar inflamación crónica, cursa con manifestaciones articulares, extrarticulares y comportamiento clínico variable. Objetivo: caracterizar los factores de riesgo para la aparición de aterosclerosis en pacientes con artritis reumatoide e identificar su relación con el tiempo de diagnóstico, actividad inflamatoria y tratamiento. Método: se realizó estudio descriptivo transversal, en pacientes con artritis reumatoide atendidos en el Centro de Reumatología del Hospital Docente Clínico Quirúrgico 10 de Octubre entre febrero 2016 y junio 2017. Resultados: la mayor frecuencia fue para el sexo femenino, el rango etario 45-54 años. Se observó placa ateromatosa en 37.2 por ciento y engrosamiento complejo íntima media en el 15.4 por ciento. Los factores de riesgo que mostraron asociación con la presencia de placa fueron: hipertrigliceridemia (p= 0.000), hipercolesterolemia (p= 0.000), Diabetes Mellitus (p= 0.027) y los niveles elevados de proteína C Reactiva (p= 0.003). Conclusiones: los factores de riesgo tradicionales que presentaron significación estadística fueron la hipercolesterolemia, hipertrigliceridemia y la Diabetes Mellitus. La presencia de más de un factor elevó la frecuencia de alteraciones en el eco doppler; existió asociación entre la elevación de los niveles de PCR y la presencia de alteraciones del eco doppler. Se constató en aquellos pacientes con alteraciones eco doppler carotídeo relación con el tiempo de evolución, actividad de la enfermedad y dosis acumulada de esteroides(AU)

Introduction: rheumatoid arthritis is a systemic disease, of unknown etiology, characterized by chronic inflammation; It presents with joint, extra-articular manifestations and variable clinical behavior. Objective: to characterize the risk factors for the appearance of atherosclerosis in patients with rheumatoid arthritis and to identify their relationship with the time of diagnosis, inflammatory activity and treatment. Method: a cross-sectional, descriptive study was conducted in patients with rheumatoid arthritis treated at the Rheumatology Center of the Surgical Clinical Teaching Hospital 10 de Octubre in the period between February 2016 and June 2017. Results: the highest frequency was for the female sex, the age range 45-54 years. Atheromatous plaque was observed in 37.2 percent and intimal complex thickening in 15.4 percent. The risk factors that showed association with the presence of plaque were: hypertriglyceridemia (p= 0.000), hypercholesterolemia (p= 0.000), Diabetes Mellitus (p= 0.027) and high levels of C-reactive protein (p= 0.003) Conclusions: the traditional risk factors that presented statistical significance were hypercholesterolemia, hypertriglyceridemia and Diabetes Mellitus. The presence of more than one traditional risk factor increased the frequency of alterations in Doppler echo; There was an association between the elevation of C-Reactive Protein levels and the presence of Doppler echo alterations. It was found in those patients with carotid echo Doppler alterations, relationship with the time of evolution, activity of the disease and cumulative dose of steroids(AU)

Gastropatía hiperplásica de tipo foveolar con Coinfección por Helicobacter pylori / Hyperplastic Gastropathy of the Foveolar Type with Helicobacter Pylori Coinfection

La Gastropatía hiperplásica de tipo foveolar o Enfermedad de Ménétrier es una gastropatía hipertrófica premaligna rara. Se caracteriza por un engrosamiento de los pliegues gástricos, secundario a una hiperplasia de las células mucosas foveolares frecuentemente asociada con pérdida de proteínas entéricas e hipoalbuminemia y síntomas tracto gastrointestinal superior como dolor epigástrico, malestar, náuseas y vómitos. Se ha relacionado con infecciones en la mayoría de los casos publicados, Citomegalovirus (CMV) y Helicobacter pylori (Hp). Se presenta el caso de adolescente con antecedente de epilepsia refractaria, quien ingresa por status convulsivo y durante hospitalización presenta sangrado digestivo alto con compromiso hemodinámico. Diagnosticándose enfermedad de Ménétrier por hallazgos endoscópicos y biopsia. Realizamos revisión de la literatura

Ménétrier's disease is a rare premalignant hypertrophic gastropathy. It is characterized by a thickening of the gastric folds, secondary to a hyperplasia of the foveolar mucosal cells, frequently associated with loss of enteric proteins and hypoalbuminemia and upper gastrointestinal tract symptoms such as epigastric pain, malaise, nausea and vomiting. It has been associated with infections in most of the published cases, Cytomegalovirus (CMV) and Helicobacter pylori (Hp).We present the case of a teenager with a history of refractory epilepsy, who is admitted due to convulsive status and during hospitalization he presents with high digestive bleeding with hemodynamic compromise. Diagnosing Ménétrier's disease by endoscopic findings and biopsy. We review the literature

Serial pulmonary function test abnormality in tuberculous pleural effusion

Background: Pleural effusion is a common clinical problem that frequently causes dyspnoea and poor ventilatory function. In addition to fluid, pleural thickening, septations and calcifications can add to the functional deterioration of lungs. The drainage of pleural effusion is very effective in improving the functionality of lungs. Large volume pleural fluid tapping results in immediate hemodynamic improvement and relief from dyspnoea.Methods: The aim of the present study was to estimate the impact of tubercular pleural effusion on the ventilatory function of the lungs and to find out the correlation between the effect of pleural tapping and functional effect on the lungs. The study comprised of thirty tubercular pleural effusion cases. They were observed for six months by doing serial chest X-rays and pulmonary function test.Results: It was observed that tuberculous pleural effusion causes a restrictive abnormality and small airway obstruction. These abnormalities improve gradually over a period of six months when the patient is on anti-tubercular treatment. The role of any therapeutic intervention towards decreasing these lung function abnormalities will be subject of separate large-scale prospective study.Conclusions: Functional defects and residual pleural thickening has no correlation with the initial severity of pleural effusion.

Ultrasound guided fine needle aspiration cytology of gall bladder mass and mural thickening: a radio-pathological correlation

Background: Carcinoma of the gall bladder (GB) is the commonest malignancy of the biliary tract. Ultrasound (US) guided Fine Needle Aspiration Cytology (FNAC) plays a major role in early detection of malignancy in a suspicious GB lesion. The aim of this study was to evaluate the safety and diagnostic accuracy of US guided FNAC in detection of GB malignancy, to find the association of gall stones with GB malignancy, to study the ultrasound pattern of GB malignant mass and demographic profile of the disease in North eastern India.Methods: The study was conducted retrospectively in Dr. B. Borooah Cancer Institute, Guwahati from January 2016 to December 2017. A total number of 173 patients suspected to have GB malignancy were subjected to US guided FNAC.Results: Total 161 patients were positive for malignancy with significant female majority. There were 124 female (77.02%) and 37 males (22.98%) in the range of 29 to 82 years. Male female ratio was 1:3.5. One was diagnosed as xanthogranulomatous cholecystitis and another was chronic cholecystitis. FNAC remained inconclusive in 2 patients. There was no major procedure related complication. Adenocarcinoma was the most common malignancy found in 146 patients (98.68%). Cholelithiasis was associated in 88.19% of malignant lesions.Conclusions: US-guided FNAC is a safe, highly accurate and reliable procedure for early detection of GB malignancy.

Effectiveness of remold eyelid structure method of blepharoplasty for thickening eyelid / 中华医学美学美容杂志

Objective To explore the method and efficacy of using "Y" flap formed to remold double eyelid structure of blepharoplasty for thickening eyelid.Methods A total of 97 cases of single eyelids and thickening eyelid were treated with surgery,to release the space before tarsus fascia and levator palpebrae aponeurosis to form a continuous interspace of the orbicularis oculi muscle.Then joint fascia was reconstructed to format "Y" flap,on which both sides of the levator aponeurosis and orbital septum fascia were tightened and the redundant fat and fascial organization removed.The lateral fat pad under the orbicular muscle were wedge-shaped sheared along the orbital margin after double eyelid was formed.Few patients presented acrimal glands prolapse,which suspended to return the lower margin of the orbital bone.Finally according to the upper eyelid anatomy suture each layer of incision was closed.Results The 97 cases underwent surgical treatment and the incisions were healed by first intention,in which 3 cases had slight skin ptosis at the lateral double crease due to the conservative tissue removal and 2 cases had the double eyelid width asymmetry due to the tissue was removed unevenly.They were adjusted satisfiedly 3 months later.All cases were followed up for more than 3 months and acquired satisfactory improvement and beautification.Incision was healed hiddenly.Conclusions This method can be used to tease and adjust the upper eyelid levels clearly and completely,which makes redundant tissues removed in place and double eyelid located accurately.By this method single eyelid combined thickening eyelid could be solved aestheticly at the same time and get a natural,popular and natural shape.

Effect of enteral nutrition quantity on diaphragmatic thickness and prognosis of mechanical ventilation patients with acute exacerbation of chronic obstructive pulmonary disease / 中国中西医结合急救杂志

Objective To investigate the effect of early adequate enteral nutrition (EN) on diaphragmatic thickness and prognosis of mechanical ventilation (MV) patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) by ultrasound. Methods Sixty-two MV patients with AECOPD and feasible to receive early EN were admitted to the Department of Intensive Care Unit (ICU) of Wenling Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University from April 2017 to March 2018, and they were divided into an observation group and a control group according to random number table, 31 cases in each group. Besides conventional treatment, both groups started EN (EN) within 2 days, in the observation group, the EN was adequately treated, and the target calories were gradually reached within 3 days; in the control group, nourishing feeding was given, and the target calories were gradually reached after 7 days. Ultrasound was used to measure the diaphragmatic end-expiratory muscle thickness (DTee) and end-inspiratory muscle thickness (DTei) before and after treatment for 3 days, 7 days, and the diaphragmatic thickening fraction (DTF) were calculated; in addition, the MV time, ICU time of stay, 14-day success rate of off-line and incidence of ventilator associated pneumonia (VAP) were compared between the two groups. Results There were no statistical significant differences in the comparisons of age, arterial blood gas analysis and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score etc general status, and the parameters of DTee, DTei and DTF between the two groups before treatment (all P > 0.05). No statistical significant differences in DTee were found after treatment for 3 days, 7 days and after off-line in the comparisons between the two groups (mm: 3 days was 2.69±0.12 vs. 2.68±0.15, 7 days was 2.70±0.14 vs. 2.70±0.13, off-line was 2.71±0.15 vs. 2.70±0.10, all P > 0.05); while the DTei of the two groups were decreased after treatment for 3 days of treatment, the difference between the two groups being not statistically significant (mm: 3.27±0.13 vs. 3.26±0.12, P > 0.05), but the levels of DTei in the two groups were significantly increased after treatment for 7 days and after off-line, the differences between the two groups being statistically significant (7 days: 27.26±5.25 vs. 28.74±6.39, off-line: 34.19±4.78 vs. 30.10±2.90, both P < 0.01). There was no significant difference in MV time and ICU time of stay between the two groups [MV time (days): 7.8±1.0 vs. 8.5±1.2, ICU time of stay (days): 11.4±2.6 vs. 12.1±2.8, both P > 0.05], the 14-day success rate of off-line and incidence of VAP were similar in the two groups, and the difference were not statistically significant [14-day success rate off-line: 77.42% (24/31) vs. 70.98% (22/31), incidence of VAP: 6.45% (2/31) vs. 9.68% (3/31), both P > 0.05]. Conclusion The early adequate EN therapy can improve diaphragmatic function and prognosis in MV patients with AECOPD.

Beh(c)et's disease complicated with meningeal thickening: a case report and literature review / 中华风湿病学杂志

Objective To explore the characteristics of diagnosis and treatment of Behset's disease (BD) with meningeal thickening and to improve doctors" awareness of such diseases.Methods We reported a missed diagnosis of a patient with BD complicated with diffuse meningeal thickening,and reviewed the related literature.Results A 25-year-old young man,manifested mainly as recurrent headache,fever,recurrent oral ulcer,erythema skin nodules and folliculitis,and his cranial radiology revealed diffuse meningeal thickening and intracranial venous sinus thrombosis.We diagnosed him as neuropathy associated with BD.After the treatment with steroids,cyclophosphamide,infliximab and anti-coagulants,his symptoms improved rapidly.Conclusion In clinical,BD complicated with meningeal thickening is rare,which is easily misdiagnosed or miss-diagnosed.For the patients with unexplained meningeal thickening,the symptoms of BD,such as recurrent oral or genital ulcers,ophthalmitis and skin lesions,should be acquired in detail.In addition to steroids and immunosuppressive agents,anti tumor necrosis factor (TNF)-alpha can also be used in the treatment of BD with meningeal thickening.

The value of conventional ultrasound combining with contrast-enhanced ultrasound in the diagnosis of xanthogranulomatous cholecystitis / 中华超声影像学杂志

Objective To explore the value of contrast-enhanced ultrasound (CEUS) in improving the diagnosis ability for xanthogranulomatous cholecystitis ( XGC ) and wall-thickening gallbladder cancer ( GBC) . Methods Forth-three patients with XGCs and 31 patients with wall-thickening GBCs proved by pathology were enrolled in this study ,the features on conventional ultrasound and CEUS were recorded ,and the preliminary diagnosis before and after CEUS were given by doctors . Results Significant differences were found in continuous gallbladder inner wall and arterial blood supplement on conventional ultrasound , 58 .1％ (25/43) had continuous inner wall and 34 .9％ (15/43) had arterial blood flow in XGCs compared to 19 .4％ (6/31) and 100％ in GBCs . On CEUS ,72 .1％ (31/43) demonstrated continuous gallbladder inner wall and 48 .8％ (21/43) had hypoechoic nodules in the wall in XGCs compared to 16 .1％ (5/31) and 19 .4％ (6/31) in GBCs ,respectively ( P <0 .05) . No significant difference was found in intra-calcification , infiltration to adjacent organs ,gallbladder stones and fast-in and fast-out enhanced pattern( P >0 .05) . The area under ROC curve was improved from 0 .701 to 0 .899 after combining with CEUS ( P < 0 .05 ) . Conclusions Conventional ultrasound combining with CEUS could help acquiring more effective ultrasonic information and may improve the differential diagnosis ability of XGCs and GBCs .

Prognostic factors for maxillary sinus mucosal thickening following Le Fort I osteotomy: a retrospective analysis / 대한악안면성형재건외과학회지

BACKGROUND: Le Fort I osteotomy is one of the surgical procedures now routinely and safely performed. It is possible to move the maxilla in three dimensions, but it is necessary to separate the bones around the maxillary sinus. Therefore, with surgery, maxillary sinus mucosal thickening occurs. By knowing the changes in the sinus mucosa after surgery and the factors affecting it, it is possible to better predict the outcomes of surgery and contribute to safer surgery. In this study, thickening of maxillary sinus mucosa before and after surgery in Le Fort I osteotomy was evaluated using multidetector-row computed tomography (MDCT) images, and the changes in mucosal thickening and the related factors were examined. METHODS: Using MDCT images, the maxillary sinus mucosa of 125 patients who had undergone Le Fort I osteotomy was retrospectively evaluated before surgery, 1 month after surgery, and 1 year after surgery. On the MDCT images, the maxillary sinus was judged as mucosal thickening and classified into three grades according to the proportion occupying the maxillary sinus. In the evaluation of factors related to mucosal thickening, the following eight factors were examined: sex, age, diagnosis, operating time, amount of postoperative bleeding, with/without bone graft, with/without multisegmental osteotomy, and with/without macrolide therapy after surgery. RESULTS: The mean age at the time of surgery was 25.6 ± 8 years. Of all 125 patients, 66 had bilateral thickening, 19 had unilateral thickening, and 40 had no thickening. Factors that were significantly related to mucosal thickening were the operative time for the maxilla, bone grafts, and macrolide therapy after surgery. CONCLUSIONS: Operative time for the maxilla, bone grafts, and macrolide therapy after surgery were found to be related to mucosal thickening. In addition, MDCT scanning 1 month after surgery was considered to be appropriate for evaluation of maxillary sinus mucosal thickening.

Optimization of Prescription of Lycii Fructus Polysaccharide Buccal Tablets by Central Composite Design-response Surface Methodology and Investigation of Its Immunomodulatory Effect / 中国实验方剂学杂志

Objective:To prepare Lycii Fructus polysaccharide buccal tablets and investigate its immunomodulatory effect. Method:Taking the appearance, taste, hardness and disintegration time of the tablets as comprehensive evaluation index, based on single factor tests, central composite design-response surface methodology was adopted to optimize the prescription of Lycii Fructus polysaccharide buccal tablets with mass ratio of dextrin to mannitol, mass ratio of cyclamate to malic acid and dosage of sodium carboxymethyl starch (CMS-Na) as factors. Kunming mice were randomly divided into 5 groups, namely the Lycii Fructus polysaccharide buccal tablets low (100 mg·kg-1·d-1), medium (200 mg·kg-1·d-1) and high (300 mg·kg-1·d-1) dose groups, the normal group (0.9% normal saline, 300 mg·kg-1·d-1) and the positive medicine group (Cinengsu group, 300 mg·kg-1·d-1). The immunomodulatory effect of the buccal tablets were investigated by calculating immune organ index, monocyte-macrophage phagocytic index, serum hemolysin antibody level, and the voix pedis thickness difference of delayed hypersensitivity (DTH) of mice. Result:Optimal prescription for the buccal tablets was 80% of Lycii Fructus extract, 11.5% of dextrin-mannitol (1.2:1), 1% of cyclamate-malic acid (1:1), 0.5% of cream essence, 6.5% of CMS-Na, 0.5% of magnesium stearate, and appropriate amount of 80% ethanol. Under the optimal condition, the hardness of the buccal tablets was 11.83 kg, its disintegration time was 13.21 min, both of which were in line with the relevant provisions of the 2015 edition of Chinese Pharmacopoeia, and the buccal tablets had good appearance and taste. Compared with the normal group, medium and high dose groups of Lycii Fructus polysaccharide buccal tablets significantly increased thymus index, spleen index and phagocytic index of mice (PPPPPConclusion:The formulation process of the buccal tablets optimized by central composite design-response surface methodology is stable and feasible, and Lycii Fructus polysaccharide buccal tablets can improve the immune regulation function of normal mice, and this study can provide experimental basis for the development, utilization and clinical application of Lycii Fructus and Lycii Fructus polysaccharides.