Clinical features and diagnostic approaches for abdominal tuberculosis: five-year experience from a non-tuberculosis-designated hospital in China

Background and purpose: abdominal tuberculosis (TB) is a common form of extrapulmonary TB but it is still a diagnostic dilemma in clinical practice. This study aimed to highlight the clinical features and diagnostic approaches for abdominal TB.Methods: seventy cases of diagnosed abdominal TB were retrospectively collected between August 1st, 2015 and June 30th, 2020. They were classified as peritoneal TB, lymph node TB, gastrointestinal TB, visceral TB or mixed TB.Results: eighteen patients were diagnosed with peritoneal TB, nine with lymph node TB, five with gastrointestinal TB, two with visceral TB and 36 with mixed TB. More than 65 % of the patients had tuberculosis of other sites except the abdomen. The median diagnosis time was 60 days. Ascites (58.6 %), abdominal distension (48.6 %), weight loss (44.3 %) and fever (42.9 %) were the most common symptoms. The overall microbiological and histological detection rates were 70.0 % and 38.6 %, respectively. The non-ascite samples yielded a higher microbiological confirmation rate (63.6 %) than the total samples (40.8 %). Diagnosis was confirmed histologically in 18 patients (69.2 %). Forty-five cases (64.3 %) were clinically diagnosed. Invasive procedures such as surgery (6/7), percutaneous biopsy (7/7) and endoscopy in lymph node TB (4/5) had high confirmation rates.Conclusions: the diagnosis of abdominal TB should be reached by a combination of clinical, laboratory, radiological, microbiological and pathological findings. (AU)

Clinical features and diagnostic approaches for abdominal tuberculosis: five-year experience from a non-tuberculosis-designated hospital in China.

BACKGROUND AND PURPOSE: abdominal tuberculosis (TB) is a common form of extrapulmonary TB but it is still a diagnostic dilemma in clinical practice. This study aimed to highlight the clinical features and diagnostic approaches for abdominal TB. METHODS: seventy cases of diagnosed abdominal TB were retrospectively collected between August 1st, 2015 and June 30th, 2020. They were classified as peritoneal TB, lymph node TB, gastrointestinal TB, visceral TB or mixed TB. RESULTS: eighteen patients were diagnosed with peritoneal TB, nine with lymph node TB, five with gastrointestinal TB, two with visceral TB and 36 with mixed TB. More than 65 % of the patients had tuberculosis of other sites except the abdomen. The median diagnosis time was 60 days. Ascites (58.6 %), abdominal distension (48.6 %), weight loss (44.3 %) and fever (42.9 %) were the most common symptoms. The overall microbiological and histological detection rates were 70.0 % and 38.6 %, respectively. The non-ascite samples yielded a higher microbiological confirmation rate (63.6 %) than the total samples (40.8 %). Diagnosis was confirmed histologically in 18 patients (69.2 %). Forty-five cases (64.3 %) were clinically diagnosed. Invasive procedures such as surgery (6/7), percutaneous biopsy (7/7) and endoscopy in lymph node TB (4/5) had high confirmation rates. CONCLUSIONS: the diagnosis of abdominal TB should be reached by a combination of clinical, laboratory, radiological, microbiological and pathological findings.

Efficacy and complications of different viscosities of high-dose bone cement applied in percutaneous vertebroplasty / 中国组织工程研究

BACKGROUND: Percutaneous vertebroplasty has been extensively applied In the treatment of senile osteoporotic vertebral compression fracture with pain. However, the appropriate dose of bone cement remains controversial. OBJECTIVE: To compare the efficacy and complications of different viscosities of high-dose bone cement applied In the treatment of osteoporotic vertebral compression fractures by percutaneous vertebroplasty. METHODS: One hundred and sixty-nine patients with single-segment osteoporotic fractures at thoracolumbar level (T12-L2) admitted at Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine from February 2014 to December 2018 were Included. All patients were treated by percutaneous vertebroplasty with high-dose (> 4 mL) bone cement at low viscosity (n=85, control group) and high viscosity (n=84, observation group). The Visual Analogue Scale score, anterior vertebral height, Cobb angle and bone cement leakage were recorded before and 2 days after surgery. The study was approved by the Medical Ethics Committee of Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, China (approval No. SH9H-2019-T90-1). RESULTS AND CONCLUSION: (1) The Visual Analogue Scale score at postoperative 2 days in both groups were significantly lower than that at baseline (P 0.05). (2) The anterior vertebral height at postoperative 2 days in both groups was significantly higher than that at baseline (P 0.05). (3) Compared with the baseline level, the Cobb angle at postoperative 2 days in both groups was significantly decreased (P 0.05). (4) The incidence of bone cement leakage in the observation group (36/84,42.9%) was significantly lower than that in the control group (57/85, 67.1 %) (P < 0.05). The incidence of leakage In paravertebral vessels and spinal canal in the observation group was significantly lower than that in the control group (P < 0.05). (5) Peri-Implant Infection, allergic reaction, Immune and rejection reactions occurred in neither groups. (6) These results Indicate that treatment of senile osteoporotic vertebral compression fractures with high dose of low- and high-viscosity bone cement can result In good clinical outcomes. However, the Incidence of leakage is higher in the low-viscosity bone cement, and high-viscosity bone cement can significantly reduce the risk of leakage, especially the leakage of paravertebral blood vessels and spinal canal.

Application of a modified puncture cannula to prevent bone cement leakage during percutaneous vertebroplasty / 中华创伤骨科杂志

Objective@#To investigate the effect of a modified puncture cannula on prevention of bone cement leakage in percutaneous vertebroplasty (PVP).@*Methods@#From January 2014 to February 2018, 243 patients with single-segmental osteoporotic vertebral fracture were treated with PVP at Department of Orthopedics, Shanghai Ninth People's Hospital. Their clinical data were retrospectively analyzed. Of them, a common puncture cannula was used in 169 cases (control group) and a modified puncture cannula in 74 (modified group). In the control group, there were 41 men and 128 women with an age of 71.6±9.5 years, and the fracture was distributed from T5 to T10 in 7 cases, from T11 to L2 in 132 and from L3 to L5 in 30. In the modified group, there were 20 men and 54 women with an age of 73.6±9.3 years, and the fracture was distributed from T5 to T10 in 3 cases, from T11 to L2 in 63 and from L3 to L5 in 8. The 2 groups were compared in terms of postoperative recovery of vertebral height, reduction in visual analogue scale(VAS) and bone cement leakage.@*Results@#There were no significant differences between the 2 groups in age, gender, distribution of fractured vertebral bodies, compression degree, condition of vertebral posterior wall, or bone cement volume injected (P>0.05). There were no significant differences either between the control and modified groups in the postoperative recovery of vertebral height (7.43%±7.82% versus 6.20%±7.84%) or reduction in VAS score (5.83±0.99 versus 5.81±0.89) (P>0.05). Bone cement leakage occurred in 93 cases (55.0%) in the control group but in 26 cases (35.1%) in the modified group, showing a significant difference (P<0.05). The incidences of bone cement leakage in the paravertebral vessels [13.5% (10/74)], paravertebral soft tissue [9.5%(7/74)] and spinal canal [4.1%(3/74)] in the modified group were all significantly lower than those in the control group [25.4%(43/169), 20.1%(34/169) and 15.4%(26/169)](P<0.05).@*Conclusion@#Application of the modified end-to-side puncture cannula is an optional scheme to prevent bone cement leakage in PVP, because it can reduce the incidence of bone cement leakage without compromising postoperative short-term outcomes, especially in the spinal canal, paraspinal vessels and paraspinal soft tissue.

Application of a modified puncture cannula to prevent bone cement leakage during percutaneous vertebroplasty / 中华创伤骨科杂志

Objective To investigate the effect of a modified puncture cannula on prevention of bone cement leakage in percutaneous vertebroplasty (PVP).Methods From January 2014 to February 2018,243 patients with single-segmental osteoporotic vertebral fracture were treated with PVP at Department of Orthopedics,Shanghai Ninth People's Hospital.Their clinical data were retrospectively analyzed.Of them,a common puncture cannula was used in 169 cases (control group) and a modified puncture cannula in 74 (modified group).In the control group,there were 41 men and 128 women with an age of 71.6 ± 9.5 years,and the fracture was distributed from T5 to T10 in 7 cases,from T11 to L2 in 132 and from L3 to L5 in 30.In the modified group,there were 20 men and 54 women with an age of 73.6 ± 9.3 years,and the fracture was distributed from T5 to T10 in 3 cases,from T11 to L2 in 63 and from L3 to L5 in 8.The 2 groups were compared in terms of postoperative recovery of vertebral height,reduction in visual analogue scale (VAS) and bone cement leakage.Results There were no significant differences between the 2 groups in age,gender,distribution of fractured vertebral bodies,compression degree,condition of vertebral posterior wall,or bone cement volume injected (P ＞ 0.05).There were no significant differences either between the control and modified groups in the postoperative recovery of vertebral height (7.43％ ± 7.82％ versus 6.20％ ±7.84％) or reduction in VAS score (5.83 ± 0.99 versus 5.81 ± 0.89) (P ＞ 0.05).Bone cement leakage occurred in 93 cases (55.0％) in the control group but in 26 cases (35.1％) in the modified group,showing a significant difference (P ＜ 0.05).The incidences of bone cement leakage in the paravertebral vessels [13.5％(10/74)],paravertebral soft tissue [9.5％ (7/74)] and spinal canal [4.1％ (3/74)] in the modified group were all significantly lower than those in the control group [25.4％ (43/169),20.1％ (34/169) and 15.4％ (26/169)] (P ＜ 0.05).Conclusion Application of the modified end-to-side puncture cannula is an optional scheme to prevent bone cement leakage in PVP,because it can reduce the incidence of bone cement leakage without compromising postoperative short-term outcomes,especially in the spinal canal,paraspinal vessels and paraspinal soft tissue.

Relationship between the serum level and its change of N-terminal pro-B-type natriuretic peptides and prognosis of acute decompensated heart failure with preserved ejection fraction in the elderly / 中华老年医学杂志

Objective To assess the prognostic value of the serum level and its change of N-terminal pro-B-type natriuretic peptides(NT-proBNP)in the elderly with acute decompensated heart failure with preserved ejection fraction(HFpEF). Methods A total of 138 consecutive patients(≥ 65 years old) admitted in Geriatrics and Gerontology Department at Beijing Friendship Hospital were enrolled from June 2013 to June 2015.Demographic characteristics,combination of diseases,medication administration, laboratorial and echocardiographic data were recorded.Meanwhile,NT-proBNP levels at admission,7thday after admission,changes over 7 days were also recorded and calculated.At the end of 1 year follow up,all patients were divided into events group(n=72)with,and control group(n=66)without,adverse outcomes of heart failure death,heart failure readmission and all-cause death.The differences in NT-proBNP level at admission,7thday after admission,and its changed value and rate over 7 days were compared between the two groups.Logistic regression was used for analysis of independent risk factors for prognosis.And the cut-off points of NT-proBNP values to predict adverse events were determined by receiver operating characteristic (ROC)curve. Results NT-proBNP values were significantly higher at admission and at 7thdays after admission in the events group than in control group(P=0.000).There were no significantly differences in NT-proBNP level and its changes over 7 days between two groups(P= 0.370 and P= 0.272).Logistic regression analysis showed that NT-proBNP values at admission and 7thdays after admission,and NYHA functional classification were independent risk factors for adverse outcomes in 1 year in the elderly with HFpEF(all P<0.05).Furthermore,by the ROC curve,NT-proBNP values at admission and 7thdays after admission could predict adverse outcomes including composite endpoints of heart failure,re-admission,heart failure associated death,and all-cause mortality in 1 year. Conclusions Both the plasma NT-proBNP levels at admission and at 7thdays after admission have a correlation with prognosis in elderly patients with acute decompensated HFpEF,while changes of NT-proBNP concentration over 7 days could not predict adverse outcomes in this cohort.

Association between impaired fasting glucose and cognitive impairment in community elderly residents / 中华老年心脑血管病杂志

Objective To study the association between impaired fasting glucose (IFG) and cognitive impairment in community elderly residents.Methods A total of ≥60 years old 1223 people were divided into normal fasting glucose (NFG) group (n=981) and IFG group (n=242).Their baseline data were recorded,their cognitive function was assessed according to the MMSE score.Results The education level,BMI,serum FBG,TG,LDL-C levels,incidence of hypertension and hyperlipidemia were significantly higher while the serum HDL-C level was significantly lower in IFG group than in NFG group (P＜0.05,P＜0.01).The incidence of cognitive impairment was significantly higher while the score of MMSE,orientation,attention and calculation,immediate recall and language was significantly lower in IFG group than in NFG group (40.50％ vs 21.51％,24.76±5.38 vs 26.60±4.26,9.07±1.81 vs 9.48±1.15,3.39±2.00 vs 3.88±1.81,2.93±0.41 vs 2.98±0.24,6.74±1.51 vs 7.18±1.15,P＜0.01).Age,female sex,LDL-C and IFG were risk factors for cognitive impairment in the elderly (P＜0.01,P＜0.05) while the education level was a protective factor for cognitive impairment in the elderly (P=0.000).Conclusion IFG is an independent risk factor for cognitive impairment in the elderly.Early diagnosis and intervention can improve cognitive function in the elderly.

White matter lesions in patients with ischemic stroke / 国际脑血管病杂志

White matter lesions (WMLs) are a common neuroimaging finding.With the aging of the population and the development of imaging technology,the detection rate of WMLs in the elderly increased gradually.WMLs are closely associated with ischemic stroke.This article reviews the pathophysiological mechanism,imaging evaluation,clinical manifestation of WMLs,and its relationship with ischemic stroke as well as its prevention and treatment.

Effects of ischemic postconditioning on myocardial infarction sizes and protein kinase C expression in aged rats with post-ischemia reperfusion injury / 中华老年医学杂志

Objective To observe the effects of ischemic postconditioning (IPTC) on myocardial infarction sizes (IS) and protein kinase Cα (PKCα) expression in aged rats with post-ischemia reperfusion injury,and to explore the mechanism.Methods A total of 120 male Wistar rats were divided into aged group and adult group.The aged group was randomly divided into control group (n=12,30-min ischemia and 3-h reperfusion),5 s,10 s,30 s and 60 s IPTC groups [n= 12,each;after 30 min occlusion of left coronary artery (LCA),three cycles of 5 s,10 s,30 s,60 s reperfusion respectively followed by the same interval LCA re-occlusion were applied at the beginning of reperfusion].The IS was measured with TTC dye,and PKC expression was investigated by immunohistochemistry.Results Different IPTC intervals had different effects on IS and PKC expression,10 s and 30 s IPTC could reduce IS both in aged rats and adult rats [(55.9±6.0)% and (47.4±5.5)%],IS in 10 s IPTC group in aged rats was (48.1±5.3)%,in adult rats was (39.2±5.7) %;IS in 30 s IPTC group in aged rats was (48.8 ± 6.8) %,in adult rats was (40.2 ± 6.1 ) %.PKCα expression increased in aged and adult rats (all P<0.05).5 s IPTC could increase IS [IS in 5 s IPTC group in aged rats was (63.5±5.4)%,and PKCα expression reduced in aged rats (all P<0.05)].Conclusions IPTC has cardio-protective effect in aged rats suffering from acute myocardial injury during reperfusion,the effect of IPTC is related to reperfusion-reocclusion interval.