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Objective To investigate the characteristics,clinical indicators and risk factors of levofloxacin-induced arrhythmias in large hospitalized populations.Methods Using the"Adverse Event Active Monitoring and Intelligent Assessment Alert System-Ⅱ"(ADE-ASAS-Ⅱ),the electronic medical record of inpatients using levofloxacin in 2019 was monitored to obtain relevant data for patients with arrhythmias.Patients without arrhythmia were selected by propensity score matching,and the risk factors of levofloxacin-induced arrhythmias were analyzed by univariate and multivariate conditional logistic regression.Results The incidence of levofloxacin-induced arrhythmias was 1.64％in 12 879 people who used levofloxacin.The incidence in people over 65 years was 3.22％.The main manifestations of levofloxacin-induced arrhythmias were extrasystole(0.84％),tachycardia(0.63％),QT interval prolongation(0.44％),and no severe arrhythmias such as torsades de pointes and ventricular fibrillation.Multivariate Logistic regression analysis showed that the course of administration(OR=1.030,95％CI 1.009 to 1.050,P=0.004)and intravenous administration(OR=2.392,95％CI 1.478 to 3.870,P＜0.001)independent risk factors for levofloxacin-induced arrhythmias.Conclusion Arrhythmias caused by levofloxacin are common and have various types,among which the occurrence of QT interval prolongation is occasional.We should pay more attention to elderly patients who receive intravenous levofloxacin and try to avoid long courses of medication.
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@#Objective To analyze the influencing factors and management of benign anastomotic stenosis in patients with colorectal cancer after concurrent prophylactic ileostomy.Methods The clinical data of 74 colorectal cancer patients undergoing preventive ileostomy admitted to Quanzhou First Hospital Affiliated to Fujian Medical University from April 2018 to June 2022 were selected,according to the presence or absence of anastomotic stenosis after surgery,patients were divided into anastomotic stenosis group and anastomotic normal group.The influencing factors of stenosis were analyzed using statistical methods,and the management methods for anastomotic stenosis were summarized.Results 15 cases of anastomotic stenosis occurred after surgery,with an incidence rate of 20.3%.Compared with anastomotic normal group,patients in anastomotic stenosis group had a higher proportion of preoperative radiation therapy,preoperative neoadjuvant chemotherapy,and a higher incidence of postoperative anastomotic leakage/pelvic infection,with statistical significance(P<0.05);Multivariate analysis suggests that preoperative radiotherapy,anastomotic leakage/pelvic infection are independent risk factors for anastomotic stenosis.Conclusion Patients with colorectal cancer who undergo preoperative radiotherapy,neoadjuvant chemotherapy,and postoperative anastomotic leakage/pelvic infection should pay attention to the occurrence of anastomotic stenosis after undergoing ileostomy;Postoperative anastomotic stenosis should be treated according to the characteristics of the stenosis.
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Objective:To explore and analyze the selection of surgical methods for supratentorial intracerebral hemorrhage.Methods:A total of 260 patients with spontaneous intracerebral hemorrhage who underwent surgery in Department of Neurosurgery, Suzhou Hospital Affiliated to Nanjing Medical University from January 2017 to December 2021 were included in the study by retrospective case analysis. According to different surgical methods, they were divided into three groups: large bone flap group ( n=116), conventional bone flap group( n=89)and stereotactic group( n=55). The large bone flap group underwent standard supratentorial large bone flap craniotomy, the conventional bone flap group underwent conventional bone flap craniotomy, and the stereotactic group underwent stereotactic hematoma puncture suction + drainage. Clinical indicators such as operation time, intraoperative bleeding, pulmonary infection, length of hospital stay, and Glasgow outcome scale (GOS) at 6 months of postoperative follow-up, and the proportion of good prognosis (GOS 4-5) were calculated. Measurement data with normal distribution were expressed as mean±standard deviation( ± s), count data were expressed as cases and percentages (%). Results:In the large bone flap group, the operation time, intraoperative bleeding, hospital stay, pulmonary infection, postoperative rebleeding were(193±24) min, (625±65) mL, (46±11) d, 102 patients(87%), 9 patients(7.8%), and (124±17) min, (297±35) mL, (32±9) d, 29 patients(33%), 4 patients(4.4%)in the conventional bone flap group, and (73±11) min, (53±15) mL, (21±4) d, 10 patients(18%), 2 patients(3.6%)in stereotactic group. All patients were followed up for 6 months, and 165 patients (63.5%) had good prognosis (GOS 4-5), including 36 patients (31%) in the large bone flap group, 82 patients (93.2%) in the conventional bone flap group, and 47 patients (85.5%) in the stereotactic group.Conclusion:Standard large craniectomy has sufficient effect of decompression, and is suitable for serious life threatening hematoma; Conventional craniotomy has advantages in the treatment of secondary intracerebral hemorrhage. Stereotactic surgery has the characteristics of short operation time, less intraoperative bleeding, short hospital stay and low incidence of pulmonary infection, which is worthy of promotion in the treatment of primary intracerebral hemorrhage.
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Intracranial aneurysms will lead to subarachnoid hemorrhage, which has a high mortality and morbidity risk. Screening high-risk aneurysms for preventive intervention has a positive effect, considering the widespread presence of unruptured aneurysms in the general population, this article reviews the risk factors of aneurysm rupture from the aspects of epidemiology, pathology, morphology and hemodynamics. In terms of epidemiology, smoking history, hypertension, age, gender and family inheritance are all closely related to the risk of aneurysm rupture. In terms of pathology, inflammation on the wall of intracranial aneurysm may be related to the risk of aneurysm rupture. In imaging, the size of intracranial aneurysms, location, the characteristics of the artery wall and some morphological and hemodynamic parameters can be used as evaluation index of fracture risk factors, at the same time the growth of intracranial aneurysm is one of the high risk indicators, the indicators for us in the future to establish intracranial unruptured aneurysms rupture risk factors evaluation model is of great significance.
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Coma caused by craniocerebral trauma is one of the difficulties in the diagnosis and treatment of neurosurgery. Its pathogenesis is complex, and there are some uncertainties in diagnosis and treatment. There are still many questions to be further studied in this field. In this paper, we searched and consulted the literature, combined with the latest clinical guidelines, reviewed pathophysiological mechanism, special clinical symptoms, diagnostic criteria, advanced neuroimaging and electrophysiological techniques in the diagnosis and treatment of consciousness disorders, as well as the latest progress and main achievements in treatment strategies. It is suggested that individualized intervention therapy with neuroimaging and electrophysiological evaluation of functional and structural injury may be one of the important research directions in the future.
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Traumatic craniocerebral injury has been paid close attention by neurosurgeons at home and abroad due to its high morbidity and mortality.Cerebral contusion and intracranial hematoma caused by various injury mechanisms are the main causes of increased intracranial pressure in the acute stage of traumatic brain injury.As a classic surgical method,standard decompressive craniotomy,often together with intracranial hematoma evacuation,brain debridement and internal decompression,has become the main surgical treatment in the acute stage of traumatic brain injury,saving the lives of many patients with severe cerebral injury,the importance of this procedure is irreplaceable.In long-term clinical practice,through the unremitting efforts of first-line neurosurgeons and neuroscientists,a large number of studies have been conducted on the relationship between the details,norms and prognosis of craniotomy,so as to better regulate the treatment of traumatic brain injury and reduce the death and disability rate of patients with severe brain injury.This article systematically reviews and analyzes the pathophysiological mechanism of intracranial hypertension and the mechanism,development history,surgical methods,indications and contraindications,prognosis and prospects of the intracranial hypertension.Through this article,the author hope to have some guidance and suggestions for future clinical work.
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Objectives To research clinical effects of severe brain injury patients treated by acupuncture and herb combine mild hypothermia,discuss the new approach of severe brain injury patients treatment combine Chinese traditional and Western medicine.Methods Investigated 68 severe traumatic brain injured patients,randomly divided into three groups,acupuncture and herb combine mild hypothermia group (n =22),mild hypothermia group (n =24) and normal temperature routine treatment group (n =22).Dynamic intracranial pressure,brain damage index (cytoskeletal protein),immunologic function (IL-6,β2 microglobulin),combine rate of complications (including irritable ulcer,lung infection,epilepsy,sugar metabolism disorder,and so on),and long-term GOS score were analyzed.SPSS12.0 software was used for statistical processing,and the standard deviation of the measurement data were expressed as the standard deviation.The counting data were expressed as apercentage,and the chi-square test was used for the comparison between group.Results There were significant differences between three groups of intracranial pressure,immunologic function,complication occurring rate (P ＜0.05),but there had no significant difference between acupuncture and herb combine mild hypothermia group and mild hypothermia group of brain damage index and GOS,and there have significant difference between these two groups and normal temperature routine treatment group.Conclusions Acupuncture and herb combined mild hypothermia might be better in reducing intracranial pressure,the incidence of complication,and improving immune function of severe brain injury,than mild hypothermia group and normal temperature routine treatment group.
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Objective To clarify the relationship between intracranial pressure monitoring and prognosis of patients with traumatic brain injury after decompressive craniectomy.Methods From December 2015 to December 2017,48 head-injured patients in Affiliated Suzhou Hospital of Nanjing Medical University were enrolled,who were underwent decompressive craniectomy in this retrospective study.The patients were subdivided into 2 groups based on whether postoperative was monitored (n =19) or not (n =29).The prognosis was evaluated by Glasgow Outcome Scale score,with 1 point of prognosis death,2 to 3 points of poor prognosis,and 4 to 5 points of good prognosis.Count data were expressed as a percentage (％).Count data were expressed as percentage (％).The chi-square test was used to compare the difference in the rate of good prognosis and mortality between the two groups.Results The mortality of monitoring group (10.5％) was significantly lower than that of control group (37.9％) (x2 =4.365 5,P =0.036 7) during hospitalization,The rate of good prognosis in the monitoring group (68.4％) and the control group (44.8％) was not statistically significant (x2 =2.573 8,P =0.108 6).Condusion The study showed that continuous monitoring in patients with severe craniocerebral injury could reduce the mortality of patients during hospitalization,but had no significant effect on the improvement of prognosis.
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Objective To retrospectively analyze the postoperative morbidity of patients with complex intracranial aneurysms treated by stent-assisted coiling and investigate the causes and treatment strategy of postoperative morbidity. Methods 62 SAH patients with intracranial aneurysm were treated by stent-assisted coiling, 53 cases of single aneurysms, 9 cases of multi-aneurysms (8 cases of 2 aneurysms, 1 cases of 3 aneurysms), amount to 72 aneurysms, 71 aneurysms were treated by stent-assisted coiling. Results Completed embolization 53 cases were completed with embolization partial embolization (74.64％), Nearly all embolization 17 cases were nearly all embolization (23.94％), partial embolization and 1case was s (1.42％) . According to GOS, 52 patients with a score of GOS 5, 6 patients with a score of GOS 4, 3 patients with a score of GOS 3, 2 patients with a score of GOS 1. 58 (93.5％) patients survived favorably. 9 patients with complications (14.5％), 3 patients with acute thrombosis; 2 patients with rupture of aneurysms during surgery; 3 patients with cerebral angiospasm; There was no obvious abnormality during the surgery in 1 patient, and there was a focal ischemic change followed by a mild neurological deficiency. Conclusions Stent assisted coil embolization of intracranial ruptured aneurysm is safe, effective and feasible, but we should improve clinical skills, summarize the analysis in the clinical operation experience of clinical treatment so as to reduce complications. Timely and correct treatment is also very important when complications occur.
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Objective To investigate the clinical value of combined detection of serum human epididymis protein 4(HE4),carbo-hydrate antigen 125(CA125)and tumor marker(CEA)in the diagnosis and staging of ovarian cancer.Methods 90 cases of ovarian cancer(ovarian cancer group),120 cases of benign ovarian disease(ovarian benign group)and 60 cases of healthy women(healthy control group)were selected from March 2014 to 2016 March in our hospital.The levels of HE4 and CA125 and CEA were detected by immunochemiluminescence assays,the results of the three groups were compared and analyzed.Results The positive rate of 3 indicators in the ovarian cancer group was significantly higher than that of the ovarian benign group and the healthy control group (P <0.05).The positive rates of combined detection of Ⅰ-Ⅳ in ovarian cancer were 81.2%,92.1%,97.4% and 100.0%,and CEA,CA125 and HE4 joint inspection in different stages of ovarian cancer positive rate is significantly higher than that of single in-dex positive detection rate.Conclusion The clinical value of HE4,CA125,CEA combined test for the diagnosis and staging of ovar-ian cancer is significant,it is worth to be further promoted.
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Objective To investigate the protective effects of 17β-estradiol on human lens epithelial (HLE) cells in oxidative damage induced by H2 O2 and its involved mechanisms.Methods HLE cells cultured in vitro were collected and divided into 4 groups;cells in negative control group were cultured with normal medium,cells with 80％ fusion in n2O2 damage group was treated with 100 μmol · L-1 H2O2 for 12 h,cells in 17β-estradiol low dose group were incubated with 10 μmol · L-1 17β-estradiol for 24 h then subjected to 100 μmol · L-1 H2O2 for 12 h and ceEs in 17β-estradiol high dose group were cultured in 100 μmol · L-1 17β-estradiol for 24 h then treated with 100 μrnol · L-1 H2O2 for 12h.Next,cell viability was tested by CCK-8 colorimetric assay,while apoptotic rate was detected by flow cytometry,and intracellular reactive oxygen species (ROS) level was detected by H2 DCFDA fluorescence probe labeling method,as well as the contents of catalase (CAT),superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were determined by 721 D spectrophotometer.Results When compared with the negative control group,the survival rate of HLE ceils in the H2 O2 damage group was significantly decreased,and there was significantly different between both groups (P ＜0.05).Moreover,the survival rate of the 17β-estradiol low dose group (67.44％) and high dose group (78.52％) was obviously higher than that of the H2O2 damage group (59.34％),and the difference was statistically significant (P ＜ 0.05).After H2O2-induced injury,there was significant difference in the apoptotic rate of HLE cells between the H2O2 damage group (41.30 ±3.21)％ and the negative control group (1.67+0.32)％.In addition,the apoptotic rates of the 17β-estradiol low dose group and high dose group was (20.97 + 1.13)％ and (14.27 + 0.90)％ respectively,which was statistically different from the H2 O2 damage group (all P ＜ 0.05).H2 DCFDA fluorescent labeling test results showed that ROS fluorescence signal intensity gradually weakened after treated with 17β-estradiol.Besides,17β-estradiol significantly increased the expression of CAT、SOD and GSH-Px in HLE cells.Conclusion 17β-estradiol has obvious protective effects on HLE cells from the damage induced by H2O2.
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Objective To investigate the protective effects of 17β-estradiol on human lens epithelial (HLE) cells in oxidative damage induced by H2 O2 and its involved mechanisms.Methods HLE cells cultured in vitro were collected and divided into 4 groups;cells in negative control group were cultured with normal medium,cells with 80％ fusion in n2O2 damage group was treated with 100 μmol · L-1 H2O2 for 12 h,cells in 17β-estradiol low dose group were incubated with 10 μmol · L-1 17β-estradiol for 24 h then subjected to 100 μmol · L-1 H2O2 for 12 h and ceEs in 17β-estradiol high dose group were cultured in 100 μmol · L-1 17β-estradiol for 24 h then treated with 100 μrnol · L-1 H2O2 for 12h.Next,cell viability was tested by CCK-8 colorimetric assay,while apoptotic rate was detected by flow cytometry,and intracellular reactive oxygen species (ROS) level was detected by H2 DCFDA fluorescence probe labeling method,as well as the contents of catalase (CAT),superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were determined by 721 D spectrophotometer.Results When compared with the negative control group,the survival rate of HLE ceils in the H2 O2 damage group was significantly decreased,and there was significantly different between both groups (P ＜0.05).Moreover,the survival rate of the 17β-estradiol low dose group (67.44％) and high dose group (78.52％) was obviously higher than that of the H2O2 damage group (59.34％),and the difference was statistically significant (P ＜ 0.05).After H2O2-induced injury,there was significant difference in the apoptotic rate of HLE cells between the H2O2 damage group (41.30 ±3.21)％ and the negative control group (1.67+0.32)％.In addition,the apoptotic rates of the 17β-estradiol low dose group and high dose group was (20.97 + 1.13)％ and (14.27 + 0.90)％ respectively,which was statistically different from the H2 O2 damage group (all P ＜ 0.05).H2 DCFDA fluorescent labeling test results showed that ROS fluorescence signal intensity gradually weakened after treated with 17β-estradiol.Besides,17β-estradiol significantly increased the expression of CAT、SOD and GSH-Px in HLE cells.Conclusion 17β-estradiol has obvious protective effects on HLE cells from the damage induced by H2O2.
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Stress ulceration are common occurrence in patients with severe traumatic brain injury, which can result in alimentary tract hemorrhage, perforation and obviously increase mortality. To prevent the occurrence of stress ulceration and control upper gastrointestinal hemorrhage is meaningful for prognosis of critical disease. This article reviews pathogenesis of stress ulceration as well as the relationships preventive treatment, early enteral nutrition, hospital acquired pneumonia and related complications.
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OBJECTIVE: Lumbar spinal stenosis is conventionally treated with surgical decompression. However, bilateral decompression and laminectomy is more invasive and may not be necessary for lumbar stenosis patients with unilateral radiculopathy. We aimed to report the outcomes of unilateral laminectomy and bilateral pedicle screw fixation with fusion for patients with lumbar spinal stenosis and unilateral radiculopathy. METHODS: Patients with lumbar spinal stenosis with unilateral lower extremity radiculopathy who received limited unilateral decompression and bilateral pedicle screw fixation were included and evaluated using visual analog scale (VAS) pain and the Oswestry Disability Index (ODI) scores preoperatively and at follow-up visits. Ligamentum flavum thickness of the involved segments was measured on axial magnetic resonance images. RESULTS: Twenty-five patients were included. The mean preoperative VAS score was 6.6+/-1.6 and 4.6+/-3.1 for leg and back pain, respectively. Ligamentum flavum thickness was comparable between the symptomatic and asymptomatic side (p=0.554). The mean follow-up duration was 29.2 months. The pain in the symptomatic side lower extremity (VAS score, 1.32+/-1.2) and the back (VAS score, 1.75+/-1.73) significantly improved (p=0.000 vs. baseline for both). The ODI improved significantly postoperatively (6.60+/-6.5; p=0.000 vs. baseline). Significant improvement in VAS pain and ODI scores were observed in patients receiving single or multi-segment decompression fusion with fixation (p<0.01). CONCLUSION: Limited laminectomy and unilateral spinal decompression followed by bilateral pedicle screw fixation with fusion achieves satisfactory outcomes in patients with spinal stenosis and unilateral radiculopathy. This procedure is less damaging to structures that are important for maintaining posterior stability of the spine.
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Humans , Back Pain , Constriction, Pathologic , Decompression , Decompression, Surgical , Follow-Up Studies , Laminectomy , Leg , Ligamentum Flavum , Lower Extremity , Radiculopathy , Retrospective Studies , Spinal Stenosis , Spine , Visual Analog ScaleABSTRACT
Abstract?AlM: To assess the efficacy and safety of trypan blue and indocyanine green ( lCG ) for continuous curvilineal capsulorrhexis ( CCC ) in mature or hypermature phacoemulsification.?METHODS: A total of 122 eyes of 122 cases with cataracts in mature and hypermature were randomly divided into three groups, trypan blue staining group was 46 eyes of 46 cases as group A, lCG staining group was 40 eyes of 40 cases as group B, control group was 36 eyes of 36 cases as group C. Staining groups were used to 0. 2mL trypan blue or lCG injected into the anterior chamber during operation, respectively. The success rate of CCC, lens posterior capsule rupture and implanted intraocular lens pouch were observed and compared during operation. Anterior chamber inflammation was observed after operation, and compared with the control group to observe and analysis.? RESULTS: The success rate of CCC, implanted intraocular lens pouch were statistically significant difference in trypan blue staining group ( group A ) than that in control group (group C) (P 0. 05 ) . Anterior chamber inflammation was no significant difference in the postoperative reaction among the three groups.?CONCLUSlON:The application of trypan blue or lCG for lens capsule staining before CCC in lack of red reflective mature and hypermature cataracts is safe and effective, both results are comparable. lt guarantees a complete CCC and improves the success rate of phacoemulsification.
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Orbital surgery is one of the most complex surgeries in ophthalmology, with many clinical ethics issues.This paper aims to analyze the implementation process of all kinds of orbital surgeries in the view of ethics, and to explore the relevant clinical ethical issues and countermeasures during the orbital surgery.
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AIM: To investigate the effect of lowering intraocular pressure ( IOP ) and side effect of travoprost ( TA ) on phacoemulsification and intraoclular lens ( IOL ) implantation in primary open-angle glaucoma ( POAG) . METHODS: Patients with POAG already received surgery of phacoemulsification and IOL implantation were selected by randomized, single - blind, parallel group trial. TA was applied once a day in 43 patients (43 eyes) of treatment group and brinzolamide was used twice in 43 patients ( 43 eyes ) of control group. All patients were observed for 12wk. IOP, ocular symptom and adverse reaction etc. were observed. RESULTS: The daily average IOP ( mean ± standard deviation) in the treatment group decreased from (24. 20±3.01)mmHg (1mmHg=0.133kPa) to (16.77±2.89)mmHg and that in the control group was from ( 23. 87±3. 47 ) mmHg to ( 18. 81± 3. 07 ) mmHg. IOP pre- and pro-treatment within two groups had significant difference ( P CONCLUSION: It is demonstrated that travoprost is highly effective and safe in reducing IOP in POAG already received surgery of phacoemulsification and IOL implantation.
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Nutcracker syndrome occurs when the left renal vein (LRV) is compressed between the superior mesenteric artery and the aorta, and this syndrome is often characterized by venous hypertension and related pathologies. However, invasive studies such as phlebography and measuring the reno-caval pressure gradient should be performed to identify venous hypertension. Here we present a case of Nutcracker syndrome where the LRV and intra-renal varicosities appeared homogeneously hyperintense on magnetic resonance (MR) fast-spin-echo T2-weighted imaging, which suggested markedly stagnant intravenous blood flow and the presence of venous hypertension. The patient was diagnosed and treated without obtaining the reno-caval pressure gradient. The discomfort of the patient lessened after treatment. Furthermore, on follow-up evaluation, the LRV displayed a signal void, and this was suggestive of a restoration of the normal LRV flow and a decrease in LRV pressure.
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Adult , Humans , Male , Young Adult , Abdominal Pain/etiology , Constriction, Pathologic , Diagnosis, Differential , Follow-Up Studies , Kidney Diseases/complications , Magnetic Resonance Imaging/methods , Renal Veins/pathology , Stents , Syndrome , Vascular Diseases/complicationsABSTRACT
The publisher and authors would like to draw the reader's attention to an error in the following article. The Usefulness of Fast-Spin-Echo T2-Weighted MR Imaging in Nutcracker Syndrome: a Case Report. Korean J Radiol 2010;11:373-377. On page 373, the first author's name has been incorrectly spelled as Heong-Leng Wong. The correct spelling is Heong-Ieng Wong.
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<p><b>OBJECTIVE</b>To observe the impact of specific short hairpin RNA (shRNA) targeting survivin gene on tumorigenesis and angiogenesis of human brain glioblastoma U251 cells in vivo of nude mice.</p><p><b>METHODS</b>U251 cells, U251-SR cells transfected stably with shRNA eukaryotic expression vector pWH1-SR targeting survivin gene, and U251-P cells transfected stably with blank pWH1 vector, were inoculated respectively into subcutaneous tissue in flank of 15 nude mice (each group 5 mice), and the tumor growth status was observed and measured. Protein expressions of survivin, proliferating cell nuclear antigen (PCNA) and factor VIII related antigen (F VIII RAg) were investigated by immunohistochemistry SABC method, apoptotic cells were screened by TUNEL method, furthermore proliferative index (PI), apoptotic index (AI) and microvessel density (MVD) were measured respectively in each group of tumor specimens.</p><p><b>RESULTS</b>Comparing with those in U251 and U251-P groups, in U251-SR group, the tumorigenesis time delayed, tumor grew slowly, both tumor volume and tumor weight decreased significantly (P < 0.01 for both); Survivin protein expression was down-regulated markedly; PI and MVD decreased significantly, whereas AI increased remarkably (P < 0.01 for all).</p><p><b>CONCLUSIONS</b>The specific shRNA targeting survivin gene can inhibit significantly tumorigenesis and angiogenesis of U251 cells in vivo.</p>