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Severe community-acquired pneumonia(SCAP) is one of the leading causes of death in children.Early identification of risk factors in children with SCAP,accurate assessment of disease conditions and reduction of mortality in children with SCAP are important tasks at present.The death risk factors of SCAP in children are affected by many factors,which are different among countries,regions and families.At present,the relevant prospective studies and retrospective studies are not comprehensive.This review summarized the literatures on the risk factors of SCAP death in children at home and abroad in recent years,to provide the basis for the diagnosis of childhood SCAP.
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Objective:To investigate the clinical efficacy of satellite rod revision surgery via a combined anterior and posterior approach for rod fracture after posterior vertebral column resection (PVCR) in patients with severe thoracolumbar kyphosis.Methods:A retrospective case series study was conducted on the clinical data of 11 patients with rod fracture after PVCR for severe thoracolumbar kyphosis, who were treated in Henan Provincial People′s Hospital from January 2013 to January 2021. There were 6 males and 5 females, with the age range of 21-62 years [(35.4±13.0)years]. Among them, 4 patients had traumatic kyphosis, 4 presented congenital kyphosis and 3 showed tuberculous kyphosis. All the patients had obvious low back pain. According to the American Spinal Injury Association (ASIA) score, 2 patients were found with grade C, 2 with grade D and 7 with grade E. All the patients underwent revision surgery for internal fixation using satellite rod via a combined anterior and posterior approach. The operation time, intraoperative blood loss and postoperative hospital stay were recorded. The imaging parameters such as kyphosis Cobb angle, scoliosis Cobb angle, distance between C 7 plumb line and central sacral vertical line (C 7-CSVL), and distance between C 7 plumb line and sagittal vertical axis (SVA) were measured preoperatively, at 1 week postoperatively and at latest follow-up. At the same time, the visual analogue scale (VAS), Oswestry dysfunction index (ODI), and simplified Chinese version of the scoliosis research society-22 (SRS-22) questionnaire were used to evaluate the clinical efficacy. At the latest follow-up, the osteotomy fusion was evaluated by Suk criterion and ASIA score was used to evaluate the recovery of neurological function. The complications were also recorded for the patients. Results:All the patients were followed up for 24-84 months [(47.5±16.2)months]. The operation time was 100-220 minutes [(149.4±37.6)minutes], with the intraoperative blood loss of 150-350 ml [(246.3±64.6)ml] and the postoperative hospital stay of 5-8 days [(6.1±1.1)days]. The kyphosis Cobb angles [(18.5±3.2)° and (19.3±2.9)°] and the scoliosis Cobb angles [(11.8±2.2)°, (11.1±2.2)°] at 1 week post-operation and at the latest follow-up were all improved significantly compared with the preoperative ones [(60.4±6.3)°, (21.7±5.5)°] (all P<0.01), with the average correction rates being 69.4% and 45.6%, respectively, with no significant differences between 1 week post-operation and latest follow-up (all P>0.05). The C 7-CSVL was reduced from preoperative (21.2±4.3)mm to (15.7±2.4)mm at 1 week post-operation, and to (15.9±2.2)mm at the latest follow-up (all P<0.01). The SVA was improved from preoperative (51.0±6.8)mm to (16.6±3.6)mm at 1 week post-operation, and to (15.3±3.9)mm at the latest follow-up (all P<0.01). There were no significant differences in C 7-CSVL or SVA at 1 week post-operation or at the latest follow-up (all P>0.05). The VAS [(2.5±0.9)points, (1.9±0.9)points], ODI (20.1±5.4, 18.4±5.2) and SRS-22 [(83.4±5.8)points, (85.0±4.1)points] at 1 week post-operation and at the latest follow-up were significantly improved compared with the preoperative ones [(6.0±1.4)points, 57.2±8.7, (62.0±9.1)points] (all P<0.01), but no significant differences were found between 1 week post-operation and latest follow-up (all P>0.05). At the latest follow-up, the bone grafts achieved osseous fusion in all the patients, and the ASIA grade was improved from grade C to grade D in 2 patients and from grade D to grade E in 2 patients. No complications such as serious neurological or vascular injury occurred during perioperative period. No pseudoarthrosis formation, internal fixation loosening or fracture occurred during follow-up. Conclusion:Satellite rod revision surgery via a combined anterior and posterior approach for rod fracture after PVCR in patients with severe thoracolumbar kyphosis has the advantages of less trauma and faster convalescence, excellent results of deformity correction, significant pain relief, functional improvement, and fewer complications.
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Objective:To identify the pathogenic characteristics of a suspected gonadal mosaicism Becker muscular dystrophy (BMD) family, and provide provide basis for pregnancy selection of similar families.Methods:A BMD family admitted to Hunan Jiahui Genetics Hospital from June 2012 to September 2019 was systematically reviewed. The medical history and family history of the proband were checked, and multiplex ligation-dependent probe amplification was used to detect the deletion/duplication of 79 exons of the Duchenne muscular dystrophy (DMD) gene in the proband, fetuses, and parents. Moreover, potential variants were verified by combining PCR amplification, short tandom repeat polymorphic linkage analysis, and real-time fluorescence quantitative PCR. High-quality embryos are screened for transplantation after preimplantation genetic testing for monogenic (PGT-M). And amniotic fluid was collected in the second trimester for prenatal diagnostic verification.Results:According to the phenotype analysis of the proband, the initial clinical diagnosis was BMD, and the exon 45-50 deletion in DMD gene was detected. The mutation was not detected in the mother′s peripheral blood, but when she was pregnant again, the prenatal diagnosis showed that the fetus had the same deletion mutation as the proband. Neither of two vitro embryos tested by PGT-M has the deletion mutation, then single embryo transfer was performed nor was pregnancy successful. After confirmation of prenatal diagnosis during pregnancy, a normal baby girl was born by full-term cesarean section.Conclusions:This BMD family was a family with two consecutive BMD homodeletion mutations, and the mutation of the DMD gene was not detected in the peripheral blood of the proband′s mother and two embryonic cells, suggesting that the mother may be a gonad chimeric carrier of this deletion mutation. The combined application of prenatal diagnosis and PGT-M provides a reference approach to effectively avoid the birth of similar children.
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Objective:To investigate the risk factors of bone cement leakage after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture (OVCF).Methods:A multi-center, large-sample, case-control study was carried out to analyze the clinical data of 2 273 OVCF patients (2 689 vertebrae) undergone PVP at four hospitals between May 2018 and October 2021, including 994 males and 1 279 females, with the age of 52-91 years [(69.1±3.1)years]. Of all, 581 patients (604 vertebrae) were allocated to leakage group and 1 692 patients (2 085 vertebrae) to no leakage group according to the occurrence of bone cement leakage. The gender, age, fracture sites, vertebral compression degree, endplate integrity of fractured vertebrae, surgical segments, surgical approaches and bone cement injection volume were recorded. Univariate analysis was used to investigate the correlation between those indicators with bone cement leakage. Multivariate Logistic regression analysis was used to identify the independent risk factors for bone cement leakage.Results:Univariate analysis showed that gender, age, fracture sites, vertebral compression degree, bone cement injection volume were related to bone cement leakage after PVP ( P<0.05 or 0.01), but no correlation was found in the endplate integrity of fractured vertebrae, surgical segments and surgical approaches (all P>0.05). Multivariate Logistic regression analysis showed that fracture sites ( OR=1.68, 95% CI 1.11-2.55, P<0.05), vertebral compression degree more than 40% ( OR=1.98, 95% CI 1.29-3.02, P<0.01), bone cement injection volume greater than or equal to 5.5 ml ( OR=1.55, 95% CI 1.07-2.26, P<0.05) were significantly associated with bone cement leakage after PVP. Conclusion:Thoracic vertebral fracture, vertebral compression degree more than 40% and bone cement injection volume greater than or equal to 5.5 ml are independent risk factors for bone cement leakage after PVP in OVCF.
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Epoxyeicosatrienoic acids (EETs) are mainly from intracellular arachidonic acids catalyzed by cytochrome P450 cyctooxygenase and degraded to lower active dihydroxyeicosapentaenoic acids by soluble epoxide hydrolase.In recent years,EETs have been found to be a new target for prevention and treatment of various nervous system diseases,such as anti-inflammatory reaction,anti-atherosclerosis,anti-cell apoptosis and angiogenesis.Intracerebral hemorrhage is a kind of serious acute cerebrovascular disease.Cerebral hemorrhage is a kind of acute cerebrovascular disease;secondary injury is one of the important mechanisms of cerebral hemorrhage;the present studies have confirmed that EETs have protective role in brain tissues after cerebral hemorrhage,thus,become new hotspot in the research of cerebral hemorrhage.This review focuses on the role and mechanism of EETs in intracerebral hemorrhage,hoping to provide some references for exploration of new research directions and therapeutic targets in the treatment ofintracerebral hemorrhage.
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Intracerebral hemorrhage (ICH) is a serious acute cerebrovascular disease,and secondary injury is one of the important mechanisms of injury after ICH.Studies have confirmed that regulatory T cells (Tregs) play important protective roles after ICH by modulating microglial phenotype and inhibiting inflammation,and other pathways.This article reviews the protective mechanism of Tregs in the secondary injury,in order to provide a new therapeutic target for ICH.
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Objectives: The purpose of this study is to understand the relationships among plasma glucose, blood pressure level and Traditional Chinese Medicine (TCM) syndromes in Shanghai community residents, and provide a theoretical basis for the prevention of community chronic disease based on TCM syndrome differentiation.Methods: Residents above35 years old will attend the Type 2 Diabetes Mellitus (T2 DM) risk assessment at Community Health Center. By distributing questionnaires and performing glucose testing, we screened the residents at high risk of T2 DM, and conducted a physical examination of them. Further, a body constitution questionnaire was required to be completed by the residents. Results: In total, 933 residents were screened. The plasma glucose and blood pressure levels related to age, waist circumference, hip circumference, body mass index (BMI) and waist-to-height ratio (WHtR) . Residents with increasing blood pressure have an increased risk of T2 DM (P ＜ 0.01) . Total 529 questionnaires were completed, and 129 subjects (24.4％) have single TCM syndromes, 75 subjects (14.2％) have at least two TCM syndromes and 325 subjects (61.4％) have no TCM syndromes. Conclusion: Plasma glucose and blood pressure are associated and interacted with several physical indexes. TCM syndromes distribution was found no significant change among subjects with different plasma glucose and blood pressure.
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Objective To analyze the clinical features and risk factors for mortality of patients with severe fever with thrombocytopenia syndrome (SFTS) in Zhoushan, the eastern coastal of China with high incidence of severe fever with thrambocytopenia syndrome bunyavirus infection, to provide reference for reducing the mortality rate of SFTS.Methods Clinical data of 107 cases of SFTS from Zhoushan Hospital during June 2011 to June 2016 were retrospectively analyzed.According to the prognosis, patients were divided into survival group and death group.The clinical features and the laboratory results were analyzed with a case-control method to analyze the prognostic factors.Normal distribution data were compared with the independent t test.Kolmogorov-Smirnov Z test were used in data with skewness distribution.Categorical data were analyze by chi-square test.The related risk factors were analyzed with the receiver-operating characteristic (ROC) curve and multivariate unconditioned logistics regression analysis.Results Seventeen cases among 107 STFs patients died, yielding the mortality rate of 15.9%.The proportion of patients suffering from two or more underlying diseases, with disorders of consciousness, activated partial thromboplastin time (APTT), the level of creatine kinase (CK), lactate dehydrogenase (LDH) as well as sepsis-related or sequential organ failure assessment (SOFA) score in death group were all significantly higher than those in the survival group (all P73.45 s, SOFA scores >9 were the independent risk factors for mortality of SFTS (OR=6.947, 8.459 and 11.770, respectively, all P<0.05).Conclusion Ca2+, APTT and SOFA score are the independent risk factors for prognosis of SFTS, which provide reference for prognostic evaluation of SFTS.
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Objective To observe the character of amplitude of myoelectric activity with surface electromyography (sEMG) on pharyn-geal swallowing in healthy middle-aged and elderly people. Methods From January, 2015 to January, 2016, 78 healthy subjects were separat-ed into middle-aged group (38~60 years old, n=38) and elderly group (61~82 years old, n=40). The amplitudes of sEMG activity of related muscles under different swallowing modes were recorded by sEMG technique and analysis system. The root mean square (RMS) was ana-lyzed. Results There was significant difference in RMS among different swallowing modes (F>105.120, P0.05). There was no difference between two groups in both muscles under relax and dry swallow (t0.05), and was different under water swallow and continuous drinking (t>2.700, P<0.05). Conclusion sEMG could be used for analyzing the characteristics of amplitude of myoelectric activity in healthy mid-dle-aged and elderly people during pharyngeal swallowing in different swallowing modes, that can be used to evaluate and screen swallow-ing and dysphagia in clinic.
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Objective To explore the influence of Chinese Qigong--Baduanjin on mild cognitive impairment (MCI) in elderly diabetic patients.Methods A total of 78 elderly type 2 diabetic patients complicated with MCI were divided into intervention group and control group by random digits table method.The control group with 41 patients was received routine treatment and discharged guidance after discharging from hospital.The intervention group with 37 patients was received Baduanjin exercise for 12 months based on the routine treatment in control group.Montreal Cognitive Assessment (MoCA) and Activity of Daily Living (ADL) scores in two groups were compared before intervention and 1,3,6,9 and 12 months after intervention.Results In intervention group,MoCA scores were significantly increased at different times after intervention compared with those before intervention,F=72.782,the differences were statistically significant,P＜0.05.At the same time,MoCA scores were all significantly higher in intervention group than those in control group,F=2.231,2.972,4.362,5.085,5.373,the differences were statistically significant,P＜ 0.05.In intervention group,ADL scores had significantly improved since 6 months after intervention compared with those before intervention,F=93.126,the differences were statistically significant,P＜0.05,and compared with those in control group,the scores were significantly higher since 6 months after intervention,F=3.853,4.561,7.162,the differences were statistically significant,P＜0.05.Conclusion Chinese Qigong--Baduanjin in treatment of elderly diabetic patients complicated with MCI can delay the MCI progress and improve ADL of the patients.