Epidemiological characteristics of elderly pulmonary tuberculosis in Xianning, Hubei Province, 2011-2021 / 中国热带医学

@#Abstract: Objective　To analyze the incidence of pulmonary tuberculosis infection in the elderly(≥ 65 years old) in Xianning City from 2011 to 2021, and to provide scientific basis for formulating strategies and measures for tuberculosis prevention and treatment in the elderly. Methods　Descriptive epidemiological analysis was used to analyze the epidemic characteristics and influencing factors of elderly (this article studies elderly people aged 65 and above) pulmonary tuberculosis in Xianning City, Hubei Province from 2011 to 2021. Results　From 2011 to 2021, the average annual registration rate of elderly patients with pulmonary tuberculosis in Xianning City, Hubei Province was 211.52/100 000 (5 289/2 500 496), which showed a downward trend （χ2 trend=58.06, P<0.05), and significantly higher than the average registration rate of 96.04/100 000 patients with pulmonary tuberculosis (26 463/27 554 195)(χ2=2 896.69, P<0.05). The average proportion of the registered number of elderly patients with pulmonary tuberculosis in the whole population was 19.99% (5 289/26 463), which showed an upward trend (χ2trend=272.05, P<0.05). The average positive rate of etiology in elderly patients with pulmonary tuberculosis was 51.86% (2 743/5 289), which was significantly higher than that in the whole population 46.41% (12 282/26 463) (χ2=52.53, P<0.05). The average proportion of retreated patients in elderly patients with pulmonary tuberculosis was 8.92% (472/5 289), which was significantly higher than that of retreated patients in the whole population 6.33% (1 674/26 463) (χ2=47.23, P<0.05). The sex ratio of male to female in elderly patients with pulmonary tuberculosis was 2.92∶1. Among the six counties (districts) under the jurisdiction of Xianning City, Hubei Province the registration rate of elderly tuberculosis patients in Xian'an district was the highest 262.20/100 000 (1 267/483 220), and that in Tongcheng County was the lowest 123.83/100 000 (575/464 338), with significant differences (χ2=233.67, P<0.05). Conclusion　The overall incidence of tuberculosis in the elderly in Xianning City , Hubei Province showed a downward trend, but the proportion of the incidence of tuberculosis in the elderly in the whole population has increased year by year, suggesting that the elderly are the key population of tuberculosis prevention and control in Xianning City in the future, and comprehensive prevention and control measures should be taken to reduce the incidence of tuberculosis in the elderly population.

[Rapid identification of the different constituents in Fructus Schisandrae Chinensis before and after processing by UHPLC-QTOF/MS~E combining with metabonomics].

This study was performed to use UHPLC-QTOF/MSE technology to rapidly search and identify variations of chemical ingredients between Fructus Schisandrae Chinensis and its processed products. The present study provides a basis for the study of Chinese herbal medicine processing with a focus on the impact of processing on chemical components. Using a time-dependent data scan mode (MSE) couple with metabolomics technology, we acquired accurate data and identified the potential chemical markers. A total of 12 chemical markers were identified in the crude, vinegar-processed and wine-processed Schisandra chinensis fruit; The results showed that the levels of 6-O-benzoylgomisin O, schisantherin B, schisantherin C, schisantherin D and neokadsuranic acid are the highest in crude Schisandra chinensis fruit; thelevels of schizandrin A, schizandrin B, schizandrin C, gomisin D and gomisin T are the highest in wine-processed Schisandra chinensis fruit; the levels of schisantherin A and schisandrin are the highest in vinegar-processed Schisandra chinensis fruit. There were significant changes of chemical components between Fructus Schisandrae Chinensis and their processed products, and these findings may offer a reasonable explanation for variation of efficacy and clinical applications in the processed products of Fructus Schisandrae Chinensis.

Solitary neurofibroma of the pancreas body not associated with type 1 neurofibromatosis.

Neurofibromas arise from peripheral nerve cells. They are rarely found within the pancreas, especially not associated with type I neurofibromatosis. Here, we report a case of a neurofibroma in a 44-year-old woman who initially presented with epigastralgia. Imaging revealed one large cystic mass of 5.7 × 8 × 5.8 cm in the pancreatic body, which was resected with distal pancreatectomy. The postoperative course of treatment was without complication, and no signs of recurrence were observed after 1 year and 6 months' follow-up.

Hypovolemia-induced Cardiac Tamponade in a Patient with Hypothyroidism.

BACKGROUND: Pericardial effusion occurs frequently in patients with hypothyroidism and is typically mild. Although extremely uncommon, massive pericardial effusion can compromise hemodynamics and cause cardiac tamponade. Reduced plasma volume has been reported to induce cardiac tamponade in massive pericardial effusion, but to our knowledge, hypovolemia-induced cardiac tamponade has not been reported in cases of hypothyroidism with pericardial effusion. OBJECTIVES: We describe a case of hypothyroidism with cardiac tamponade due to an uncommon cause that, to our knowledge, has never been reported. CASE REPORT: A 64-year-old woman with untreated hypothyroidism presented with acute abdominal pain and watery diarrhea. The patient experienced shock and cardiac arrest during the examination. Massive pericardial effusion was detected and cardiac tamponade was diagnosed. We suspected that the pericardial effusion was pre-existing due to an 11-year history of untreated hypothyroidism. On presentation, there was no hemodynamic compromise. Watery diarrhea persisted and intravenous fluid supplementation may have been inadequate. Hypovolemia developed and induced cardiac tamponade in the presence of the massive pericardial effusion. Successful resuscitation was achieved after cardiopulmonary resuscitation, aggressive intravenous fluid supplementation, and immediate pericardiocentesis. CONCLUSION: Pericardiocentesis is indicated for hypothyroid patients with cardiac tamponade. We recommend the use of small, multi-hole catheters and daily measurement of drainage fluid. If the pericardial effusion does not resolve, a pericardial window with chest tube drainage should be performed.

Anatomic study of the axillary nerve in a Chinese cadaveric population: correlation of the course of the nerve with proximal humeral fixation with intramedullary nail or external skeletal fixation.

INTRODUCTION: The axillary nerve can be injured during external skeletal fixation with Schanz screws or proximal locking screws of intramedullary nails. Being aware of the axillary nerve's anatomic relationship to the proximal humerus is vital for avoiding complications. METHODS: We investigated the relationship of the axillary nerve to surrounding bony landmarks by studying 88 axillary nerves in 44 embalmed cadaveric adult Chinese males. These measurements were then compared with the results from a similar study among Caucasians using the same reference points. RESULTS: We identified three significantly different parameters between our Chinese and the previously studied Caucasian subjects (P ≤ 0.05): the distances from the superior aspect of the humeral head to the axillary nerve (D1) (5.2 ± 0.7 vs. 6.09 ± 0.65 cm, respectively); surgical neck to axillary nerve (D2) (2.0 ± 0.7 vs. 1.72 ± 0.84 cm); and humeral length (D3) (29.0 ± 2.2 vs. 35.25 ± 5.7 cm). The D1 distance ranged from 4.0 to 6.7 cm; the D2 distance ranged from 1.0 to 4.1 cm; and the entire humeral length (D3) ranged from 23.3 to 33.3 cm. Iatrogenic injury to the axillary nerve could be reduced by placing pins and screws in proper directions using portable C-arm fluoroscopic guidance, drill-guided protective systems, and a mini-open-incision with muscle spreading and drill protective systems directly placed on the bone. CONCLUSION: Because of physical variability among individual patients and populations, surgeons should consider the possible courses of the axillary nerve when treating proximal humeral fractures.

Aortic perforation caused by friction of a chest tube after coronary artery bypass surgery.

Aortic perforation caused by the friction of a chest tube is a rare but life-threatening complication of coronary artery bypass grafting (CABG). We report a case involving CABG for triple-vessel disease and unstable angina. Reexploration was necessary 24 hours after the operation because of the sudden onset of pronounced bleeding. Perforation of the ascending aorta caused by friction of the chest tube was found. Bleeding was controlled by means of a purse string suture with 4-0 Prolene. Use of pericardium membrane between the heart and the chest tube and the choice of smaller and more flexible Silastic chest tubes in high-risk patients can probably reduce the incidence of this complication.

Pseudoaneurysm of the iliac artery secondary to Aspergillus infection after kidney transplantation.

Infectious complications are the top causes of morbidity and mortality in patients who undergo renal transplantation. We report a patient who received a cadaveric renal transplant in Mainland China. One year post-transplantation, the patient had right buttock pain with radiation to the leg. Swelling and tenderness over the right groin was also found. Magnetic resonance imaging revealed a multilobulated cystic lesion, about 8 x 7 cm, at the right iliac fossa and presacral region extending to the posterior aspect of the graft kidney and up to the right psoas muscle. Drainage of the intra-abdominal abscess was performed. The abscess culture showed presence of Aspergillus spp. The patient had received steroids, tacrolimus and mycophenolate mofetil, which could be a risk factor for fungal infection. The cause of Aspergillus infection in our patient remains unclear. It may have been due to immune system insufficiency of the patient rendering the patient prone to infection. Pseudoaneurysm formation of the internal iliac artery following Aspergillus infection after kidney transplantation is rarely reported. Although it is a dilemma, once a severe situation such as pseudoaneurysm with aspergillosis presents, graft removal is suggested.

Mortality rates under the care of junior and senior surgery residents in a surgical intensive care unit/neurologic intensive care unit: a 5-year retrospective cohort study at Taoyuan Armed Forces General Hospital.

BACKGROUND: The quality and outcome of health care administered in intensive care units (ICUs) of teaching hospitals are dependent on a myriad of factors; however, few studies have assessed mortality rates and length of stay in surgical intensive care and neurologic intensive care units (SICU/NICU) in relation to the experience of junior and senior surgery residents. OBJECTIVE: The aim of this study was to determine whether there were differences in the outcomes of ICU patients cared for by junior surgery residents or senior surgery residents by assessing mortality rates and length of stay in the SICU/NICU. DESIGN: This was a retrospective cohort analysis. Mortality rates, length of SICU/NICU stay, and baseline characteristics were assessed in 2 patient groups: group 1, patients managed by junior surgical residents; group 2, patients managed by senior surgical residents. Categorical variables were compared by chi(2)/Fisher exact test, and continuous data (age and ICU stay) were compared using the Mann-Whitney U test. Acute Physiology and Chronic Health Evaluation II score was used for ICU prognostic models. SETTING: The Taoyuan Armed Forces General Hospital (Taoyuan, Taiwan, ROC) consists of an 8-bed SICU and an 8-bed NICU. PATIENTS: Data were collected from 2274 patients from January 1, 2002, to December 31, 2006, from the intensive care units (SICU/NICU) of the department of surgery. INTERVENTIONS: None. RESULTS: Significant differences between the 2 groups were found in total patient mortality and the duration of intensive care unit stay. Of 1806 patients in group 1, 446 (24.7%) died, whereas 83 (17.7%) of 468 in group 2 died (P = .002). The major difference of mortality rate was in the division of neurology surgery; 291 (26.6%) of 1092 patients in group 1 died, whereas 55 (19.2%) of 287 in group 2 died (P = .009), with most deaths due to spontaneous intracranial hemorrhage (P = .012) and central nervous system tumors (P = .048). Median length of SICU/NICU stay for group 1 was 3.0 days vs 3.5 days for group 2 (P = .003). CONCLUSIONS: The quality of care of critically ill patients is improved when more experienced residents are providing care. We suggest that residents rotated into the special units such as SICU/NICU for care of critically ill patients should be at least at third year of training.

Biliopleural fistula: a rare complication of percutaneous transhepatic gallbladder drainage.

A 79-year-old previously healthy man presented with acute acalculous cholecystitis with obstruction of the biliary tract. He was successfully treated with antibiotics and percutaneous transhepatic gallbladder drainage, but returned to the hospital two days after discharge with a rare complication of this technique, biliopleural fistula. A thoracostomy tube was inserted to drain the pleural effusion, and the patient's previous antibiotics reinstated. After two weeks of drainage and antibiotics, the fistula healed spontaneously without the need for further intervention.

Congenital coronary artery fistulas: clinical considerations and surgical treatment.

BACKGROUND: Coronary artery fistulas are uncommon abnormalities that can cause significant cardiac morbidity. Indications for operation vary, particularly, for asymptomatic patients. Early surgical correction is indicated because of the high incidence of late symptoms and complications. METHODS: From January 1981 to December 2001, all 15 patients who underwent surgical management of congenital coronary artery fistulas at the Tri-Service General Hospital, Taipei, Taiwan, China were included in the present retrospective study. RESULTS: Twelve patients were symptomatic at the time of the diagnosis. Coronary artery fistulas involved the right coronary artery in five patients, left coronary artery in nine, and both the right and the left coronary arteries in one. Coronary artery fistula drained into the right ventricle in seven patients, right atrium in three, pulmonary artery in two, left ventricle in one, left atrium in two, and coronary venous sinus in one. The value of pulmonary blood flow/systemic blood flow ranged from 0.98 to 2.1. Six patients had associated cardiac anomalies. All patients received surgical correction. Nine patients received cardiopulmonary bypass during operation. There was zero operative mortality and operative morbidity was low. All patients had a stable condition and were asymptomatic during a mean postoperative follow-up of 13.3 years. CONCLUSIONS: Early surgical treatment for coronary artery fistulas is safe and effective. The risk of operative correction appears to be considerably less than the potential for development of serious and potentially fatal complications, even in asymptomatic patients.