Chinese expert consensus on the diagnosis and treatment of traumatic cerebrospinal fluid leakage in adults (version 2023) / 中华创伤杂志

Traumatic cerebrospinal fluid leakage commonly presents in traumatic brain injury patients, and it may lead to complications such as meningitis, ventriculitis, brain abscess, subdural hematoma or tension pneumocephalus. When misdiagnosed or inappropriately treated, traumatic cerebrospinal fluid leakage may result in severe complications and may be life-threatening. Some traumatic cerebrospinal fluid leakage has concealed manifestations and is prone to misdiagnosis. Due to different sites and mechanisms of trauma and degree of cerebrospinal fluid leak, treatments for traumatic cerebrospinal fluid leakage varies greatly. Hence, the Craniocerebral Trauma Professional Group of Neurosurgery Branch of Chinese Medical Association and the Neurological Injury Professional Group of Trauma Branch of Chinese Medical Association organized relevant experts to formulate the " Chinese expert consensus on the diagnosis and treatment of traumatic cerebrospinal fluid leakage in adults ( version 2023)" based on existing clinical evidence and experience. The consensus consisted of 16 recommendations, covering the leakage diagnosis, localization, treatments, and intracranial infection prevention, so as to standardize the diagnosis and treatment of traumatic cerebrospinal fluid leakage and improve the overall prognosis of the patients.

Corneal confocal microscopy detects small-fiber neuropathy in patients with amyotrophic lateral sclerosis / 中华内科杂志

Objective:To investigate small fiber neuropathy in patients with amyotrophic lateral sclerosis (ALS) by corneal confocal microscopy.Methods:A total of 57 ALS patients were consecutively enrolled in Department of Neurology between June 2015 and February 2016, including 37 men and 20 women with mean age 24-80 (52±11)?years. There were 30 controls including 21 men and 9 women with mean age 23-76 (55±13) years. All subjects underwent corneal confocal microscopy (CCM), contact heat evoked potential (CHEP) and skin sympathetic reflection (SSR) to quantify small nerve fiber pathology. Four parameters, such as nerve fiber length (NFL), nerve branch density (NBD), nerve fiber density (NFD) and nerve fiber tortuosity (NFT) were assessed by corneal confocal microscopy. All statistical calculations were conducted using SPSS version 12.0.Results:Compared with control group, corneal nerve fiber length (NFL),nerve fiber density (NFD) were significantly decreased [(12.2±4.4)mm/mm 2 vs.(15.1±4.5) mm/mm 2, P=0.028;(50.8±24.0)/mm 2 vs. (68.3±16.4)/mm 2, P=0.002],and nerve fiber tortuosity (NFT) were significantly increased [(2.6±1.0)level vs.(1.0±0.5)level, P<0.01)] in SFN group, while nerve branch density (NBD) were comparable ( P=0.700).The course of disease is correlated with NFT ( r=0.25, P=0.030). Conclusions:CCM is a new sensitive noninvasive clinical technique that detects early small fiber nerve damage in patients with ALS.

Analysis of the understanding and application of the knowledge of premature infants in pediatricians participating in the Second Chinese Preterm Infant Academic Conference / 中国基层医药

Objective:To investigate the understanding and application of the knowledge of premature infants in pediatricians participating in the Second Chinese Preterm Infant Academic Conference through questionnaires, and to carry out targeted continuing education for pediatricians in order to better guide the clinical diagnosis and treatment of grassroots pediatricians.Methods:The research was conducted in the form of a questionnaire survey.The survey objects were pediatricians participating in the " Second Chinese Preterm Infant Academic Conference" , and the results of the questionnaire were summarized and analyzed.The questionnaires were designed based on personal education background, employment time, current status of neonatal specialty in the hospital where they were, and knowledge of premature infant nutrition.Results:A total of 554 valid questionnaires were received.Among the pediatricians surveyed, 37.2% had a master's degree or higher; 344(62.1%) pediatricians came from Grade Ⅲ class A hospitals.According to the geographical distribution, age, education, working years, hospital level, hospital nature, annual delivery of obstetrics in hospitals, the number of beds in neonatal specialty wards, and the number of beds in NICU, the respondents were grouped, and the current status of premature births in China and the situation of using the growth curve(Fenton2013) of premature infants in work were compared.It was found that the proportion of those who used the Fenton curve of the 2013 version in Grade Ⅲ class A hospitals was higher than that in Grade Ⅲ class B hospitals and Grade Ⅱ hospitals(χ 2=47.663, P<0.05). The ratio was higher among women and children's health centers and general hospitals(χ 2=8.072, P<0.05). Conclusion:The academic annual conference for the purpose of continuing education, set up a pre-conference questionnaire for the participants during the preparation period, and set the content of the annual conference according to the needs of the target population, which can better solve the clinical problems of primary doctors and promote the improvement of primary doctors' diagnosis and treatment.

Outcomes of twin neonates and association with chorionicity and modes of conception / 中华围产医学杂志

Objective@#To investigate the pregnancy and neonatal outcomes in twin pregnancies and the association with chorionicity and modes of conception in order to provide evidence for early prevention and reduction of complications and life quality improvement of twin neonates.@*Methods@#This study retrospectively enrolled 756 women with twin pregnancies who gave birth at Peking University Third Hospital from January 1, 2014 to December 31, 2015. Clinical features of the mothers and newborns were collected, the pregnancy and neonatal outcomes were analyzed. Impacts of chorionicity and different modes of conception on the outcomes were also evaluated. Two independent-sample t test and Chi-square test were used as statistical methods.@*Results@#Twin pregnancies accounted for 6.7% (756/11 169) of all deliveries in the hospital during the study period and the preterm birth rate was 59.4% (449/756). Twenty five women underwent fetal reduction (3.3%, 25/756) and intrauterine death occurred in 85 pregnancies (11.2%, 85/756). Eventually 1 400 babies were born alive (92.6%, 1 400/1 512). Subgroup analysis suggested that compared with dichorionic diamniotic (DCDA) pregnancies, monochorionic diamniotic (MCDA) cases showed younger maternal age at conception [(30.5±4.2) vs (32.9±4.0) years, t=-7.412], smaller gestational age at delivery [(34.1±3.1) vs (35.7±2.2) weeks, t=-7.325] and higher preterm birth rate [78.4% (174/222) vs 51.5% (263/511), χ2=46.554], all P<0.05. Moreover, the incidence of neonatal complications, including respiratory distress syndrome [18.3% (40/219) vs 8.0% (21/261), χ2=11.210], neonatal pneumonia [18.3% (40/219) vs 8.8% (23/261), χ2=9.331] and sepsis [6.8% (15/219) vs 1.5% (4/261), χ2=8.854], etc. was higher in the MCDA group than those in the DCDA group, resulting in a higher mortality rate [7.8% (17/219) vs 1.1% (3/261), χ2=13.042] in the MCDA pregnancies, all P<0.05. Compared with spontaneously conceived twin pregnancies, women underwent in vitro fertilization-embryo transfer were older at conception [(33.4±3.8) vs (30.6±4.4) years, t=-6.095], delivered at a greater gestational age [(35.8±2.1) vs (35.2±2.6) weeks, t=-2.452] and had a lower preterm birth rate [49.2% (206/419) vs 63.5% (54/85), χ2=5.838] in the DCDA group, all P<0.05. No significant differences in the incidence of neonatal diseases were observed between the two subgroups.@*Conclusions@#The incidence of preterm birth is high in twin pregnancies. Compared with DCDA twin pregnancies, MCDA twin pregnancies are associated with more adverse outcomes due to higher incidence of neonatal diseases. In vitro fertilization-embryo transfer does not increase the incidence of preterm birth and the neonatal outcomes were comparable to those of spontaneously conceived ones.

Outcomes of twin neonates and association with chorionicity and modes of conception / 中华围产医学杂志

Objective To investigate the pregnancy and neonatal outcomes in twin pregnancies and the association with chorionicity and modes of conception in order to provide evidence for early prevention and reduction of complications and life quality improvement of twin neonates.Methods This study retrospectively enrolled 756 women with twin pregnancies who gave birth at Peking University Third Hospital from January 1,2014 to December 31,2015.Clinical features of the mothers and newborns were collected,the pregnancy and neonatal outcomes were analyzed.Impacts of chorionicity and different modes of conception on the outcomes were also evaluated.Two independent-sample t test and Chi-square test were used as statistical methods.Results Twin pregnancies accounted for 6.7％ (756/11 169) of all deliveries in the hospital during the study period and the preterm birth rate was 59.4％ (449/756).Twenty five women underwent fetal reduction (3.3％,25/756) and intrauterine death occurred in 85 pregnancies (11.2％,85/756).Eventually 1 400 babies were born alive (92.6％,1 400/1 512).Subgroup analysis suggested that compared with dichorionic diamniotic (DCDA) pregnancies,monochorionic diamniotic (MCDA) cases showed younger maternal age at conception [(30.5 ±4.2) vs (32.9±4.0) years,t=-7.412],smaller gestational age at delivery [(34.1±3.1) vs (35.7±2.2) weeks,t=-7.325] and higher preterm birth rate [78.4％ (174/222) vs 51.5％ (263/511),x2=46.554],all P＜0.05.Moreover,the incidence of neonatal complications,including respiratory distress syndrome [1 8.3％ (40/219) vs 8.0％ (21/261),x2=11.210],neonatal pneumonia [18.3％ (40/219) vs 8.8％ (23/261),x2=9.331] and sepsis [6.8％ (15/219) vs 1.5％ (4/261),~=8.854],etc.was higher in the MCDA group than those in the DCDA group,resulting in a higher mortality rate [7.8％ (17/219) vs 1.1％ (3/261),x2=13.042] in the MCDA pregnancies,all P＜0.05.Compared with spontaneously conceived twin pregnancies,women underwent in vitro fertilization-embryo transfer were older at conception [(33.4±3.8) vs (30.6±4.4) years,t=-6.095],delivered at a greater gestational age [(35.8±2.1) vs (35.2±2.6) weeks,t=-2.452] and had a lower preterm birth rate [49.2％(206/419) vs 63.5％ (54/85),x2=5.838] in the DCDA group,all P＜0.05.No significant differences in the incidence of neonatal diseases were observed between the two subgroups.Conclusions The incidence of preterm birth is high in twin pregnancies.Compared with DCDA twin pregnancies,MCDA twin pregnancies are associated with more adverse outcomes due to higher incidence of neonatal diseases.In vitro fertilization-embryo transfer does not increase the incidence of preterm birth and the neonatal outcomes were comparable to those of spontaneously conceived ones.

Impact of hypertensive disorder complicating pregnancy on neonatal mortality and major complications in preterm infants / 中华实用儿科临床杂志

Objective@#To investigate the effect of hypertensive disorder complicating pregnancy (HDCP) on the mortality and early complications of premature infants.@*Methods@#The general clinical data of preterm infants with gestational age 24-36+ 6 weeks were collected from the cooperative units in the task group from January 1, 2013 to December 31, 2014.According to the severity of HDCP, the infants were divided into 4 groups: HDCP group, preeclampsia group, eclampsia group and non HDCP group, the mortality and major complications of preterm infants were compared, and the influencing factors were analyzed.@*Results@#The mortality rate of preterm in the HDCP group was significantly higher than that of non HDCP group, and there was statistical significance (χ2=9.970, P=0.019). Eclampsia had a highest fatality rate (4.8%) in the early stage, compared with non HDCP group (2.2%), and the difference was statistically significant.Comparison of HDCP group (1.8%) and eclampsia group (3.2%) suggested that there was no statistically significant difference.The incidence of respiratory distress syndrome (RDS) in preterm in HDCP group was significantly higher than that of non HDCP group, and there was statistical significance (χ2=13.241, P=0.004). Eclampsia group showed the highest incidence (35.4%), compared with non HDCP group (16.2%), the difference was statistically significant, but compared with HDCP group (19.9%), preeclampsia group (17.1%), there was no significant diffe-rence.The incidence of bronchopulmonary dysplasia (BPD) in preterm in HDCP group was significantly higher than that of non HDCP group (χ2=9.592, P=0.022), the highest incidence showed up in eclampsia group (9.7%), compared with non HDCP group (2.0%) and HDCP group (1.7%), the difference was statistically significant.But there was no statistically significant difference, compared with preeclampsia group.As the degree of HDCP aggravated, the incidence of BPD gradually rose.There was no significant impact on necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH) and sepsis of HDCP (χ2=7.054, 7.214, 0.358, 3.852; P=0.070, 0.065, 0.949, 0.278). Considering the overall outcome of the child, that was, whether the child died or survived, he had at least one complication, and HDCP had an effect on it (χ2=15.697, P=0.001), so the incidence increased while the degree of HDCP rose gradually.After adjusting gestational age, birth weight, sex, way of delivery, placental abruption and front placenta, prenatal hormonal, gestational diabetes, neonatal asphyxia and other factors, the results displayed that HDCP was the factor leading to the death of premature baby (OR=2.159, 95%CI: 1.093-4.266), and comparison between preeclampsia and eclampsia showed no statistical difference (P=0.714, 0.389); HDCP had no significant influence on RDS, BDP, ICH, NEC, ROP and sepsis.@*Conclusions@#HDCP leads to increased risk of premature death, but also leads to the increased incidence of RDS and BPD, but it had no obvious effect on NEC, ROP, IVH, sepsis and other complications.

Growth characteristics of Aspergillus isolated from clinical infective cornea / 中华实验眼科杂志

Objective To analyze the growth characteristics of the clinical isolates of Aspergillus compared to standard strains in vitro.Methods The sabourauds agar medium (SDA),yeast extract medium(YG) and potato dextrose agar medium (PDA) were used to test two clinical isolates and one standard strain.The strains were incubated at 29 ℃C for 96 hours.In liquid medium,the optical density (OD) values at 0 hour,4,8,12,24,36,48,60,72 and 96 hours after culture were recorded to generate growth curves for each strain and culture medium.Meanwhile,on solid medium,the features of colony morphology were recorded.Results In liquid medium,the growth curves were not significantly different between clinical isolates and standard strain in PDA medium (all at P＜0.05),while the differences were obvious in SDA medium and YG medium (P＜0.05).The clinical isolates showed shorter lag phase and higher growth rate than standard strain.On solid medium,all strains appeared the best growth state on PDA medium and the poorest state on SDA medium.Color change time was later on YG medium than that on the other medium.The clinical isolates performed better on the aspects of colony sizes and color change than standard strain when growed on the same medium,especially on SDA medium.Conclusions Compared with standard strain,the clinical isolates of Aspergillus have higher adaptive capacity to poor nutrition condition.

Repair effect of human acellular dermal matrix on filtering blebs leakage in rabbit eye / 中华实验眼科杂志

Background Package and tissue patch implantation are common methods for repair of filtering bleb leaking after anti-glaucoma surgery.But the scarring or re-leakage of filtering bleb probably occur again.Objective This study was to investigate the repair effect of acellular dermal matrix (ADM) on filtering bleb leaking in rabbit model and compare the effectiveness among ADM,amniotic membrane and conjunctival overlap.Methods Trabeculectomy was performed on 48 eyes of 24 New Zealand rabbits,and models of filtering bleb leaking were established.The models were randomized into ADM group,amniotic membrane group and conjunctival covering group based on randomized number table.ADM patches with 4 mm×4 mm were implanted across lamellar cornea and sclera at a bridge in the ADM group,and the same size of amniotic membranes were used in the amniotic membrane group,and conjunctiva was sutured to limbus in the conjunctiva overlap group.The intraocular pressure (IOP) was measured before surgery and 1 day,1 week,1 month,3 months and 6 months after surgery.The biocompatibility of materials above was assessed under the slit lamp microscope,and the status of filtering bleb was evaluated and compared with anterior segment optical coherent tomography (AS-OCT) 1 day,1 week,1 month,3 months and 6 months after surgery.Results Before surgery and 1 day,1 week,1 month,3 months and 6 months after surgery,the IOP was (26.9±4.3),(16.6±5.1),(22.1 ±6.2),(18.3±6.5),(22.7±2.5),(23.4±1.4) mmHg in the AMD group,(29.9±5.4),(14.9 ± 6.4),(21.6 ± 7.8),(26.3 ± 4.1),(26.0 ± 4.2) and (23.0 ± 5.3) mmHg in the amniotic membrane group,and (28.7 ±4.3),(15.7 ±7.0),(22.0±6.3),(28.2±4.1),(24.7 ±4.1),(23.0±2.7) mmHg in the conjunctival overlap group,showing significant differences among different groups and various time points (Fgroup =8.419,P=0.011 ;Ftme =15.543,P=0.000).The IOPs were significantly lower from 1 day through 3 months after operation than those before operation in the AMD group (P =0.000,0.000,0.006,0.045) ; while the IOPs were reduced only from 1 day through 1 week after operation in comparison with before operation in the amniotic membrane group and the conjunctival overlap group (P =0.000,0.001).One month after surgery,the IOPs were significantly declined in the ADM group compared with the amniotic membrane group and the conjunctival overlap group (P =0.001,0.000).The grafts were clear under the slit lamp microscope and exhibited the valid filtering bleb until 3 months after operation under the AS-OCT in the ADM group.However,the valid filtering bleb remained only 1 month after surgery in the amniotic membrane group and the conjunctival overlap group.Neovascularization on the filtering bleb was found 3 months in the AMD group but 1 month in the amniotic membrane group and the conjunctival overlap group.Conclusions Compared with amniotic membrane and conjunctival tissue,ADM patch for the repair of filtering bleb leakage can increase the survival duration of filtering bleb and remain lower IOP.

Over-expression of small ubiquitin-like modifier proteases 1 predicts chemo-sensitivity and poor survival in non-small cell lung cancer / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Non-small cell lung cancer (NSCLC) is one of the most common malignant tumors. Despite the advances in therapy over the years, its mortality remains high. The aim of this study was to evaluate the expression of small ubiquitin-like modifier (SUMO) proteases 1 (SENP1) in NSCLC tissues and its role in the regulation of vascular endothelial growth factor (VEGF) expression. We also investigated the association between the expression level of SENP1 and the clinicopathological features and survival of the patients.</p><p><b>METHODS</b>A SENP1 small interfering RNA (siRNA) was constructed and transfected into the NSCLC cells. VEGF gene expression was analyzed by real-time polymerase chain reaction (RT-PCR). Immunohistochemistry staining was used to assess the expression of SENP1 in 100 NSCLC patients and its association with the clinicopathological features and survival was analyzed.</p><p><b>RESULTS</b>VEGF expression was significantly higher in NSCLC tissues than in normal lung tissues. Inhibition of SENP1 by siRNA was associated with decreased VEGF expression. SENP1 was over-expressed in 55 of the 100 NSCLC samples (55%) and was associated with a moderate and low histological tumor grade (3.6%, 38.2%, and 58.2% in high, moderate and low differentiated tumors, respectively, P = 0.046), higher T stage (10.9% in T1, and 89.1% in T2 and T3 tumor samples, P < 0.001) and TNM stage (10.9% in stage I, and 89.1% in stages II and III tumor samples, P < 0.001). The rate of lymph node metastasis was significantly higher in the SENP1 over-expression group (76.4%) than that in the SENP1 low expression group (33.3%, P < 0.001). Sixty three patients received postoperative chemotherapy, including 34 with SENP1 over-expression and 29 with SENP1 low expression. Among the 34 patients with SENP1 over-expression, 22 (64.7%) patients developed recurrence or metastasis, significantly higher than those in the low expression group 27.6% (8/29) (P = 0.005). Multivariate Cox regression analysis showed that lymph node metastasis (P = 0.015), TNM stage (P = 0.001), and SENP1 expression level (P = 0.002) were independent prognostic factors for the survival of NSCLC patients.</p><p><b>CONCLUSIONS</b>SENP1 may be a promising predictor of survival, a predictive factor of chemo-sensitivity for NSCLC patients, and potentially a desirable drug target for lung carcinoma target therapy.</p>

Effect of edaravone on serum CRP in patients with cerebral infarction after thrombolytic therapy / 中国基层医药

ObjectiveTo investigate the therapeutic effect and the level of C-reactive protein of Edaravone on acute cerebral infarction after thrombolytic therapy in urokinase,and to discuss edaravone on brain tissue protective effect of thrombolytic. Methods41 patients with cerebral infarction were,divided into 2 groups randomly:treatment group(19cases) and control group(22 cases). Control group received thrombolytic therapy,and treatment group was treated with Edaravone at a dose of 30mg,twice a day,for 14 days. Clinical outcomes and neurological deficit score were evaluated before and after treatment. At the same time, serum CRP levels in patients were determend by immune turbidimetry. ResultsThe treatment group whose neurological deficit score better than the control group ( P ＜ 0.05),the total effective rate was significantly higher( P ＜ 0.01 ) ,compared with the control group, the treatment group CRP levels were significantly lower ( P ＜ 0. 05 ). ConclusionEdaravone on acute cerebral infarction in patients after thrombolysis can significantly improve the clinical efficacy, reduce serum CRP levels, recovery and prognosis of cerebral infarction is important, Edaravone can significantly improve neurological function in patients with acute cerebral infarction,protects against cerebral ischemia after thrombolysis in metabolic poisons further damage.

Effect of delayed rapid fluid resuscitation on blood viscosity in burn shock dogs / 第三军医大学学报

Objective　To investigate the effect of rapid fluid replacement on hemorheology in delayed resuscitation after burn. Methods　A total of 32 dogs inflicted with 40%TBSA full thickness scalding were randomly divided into 4 groups: scald control group(C group), delayed Gelofusion even replacement group (GE group), rapid fluid replacement group (GR group), and delayed plasma rapid fluid replacement group (PR group). The femoral arterial pressure, viscosity of blood and plasma, packed cell volume and aggregation of RBC were detected at the intervals of before and 2, 6, 8, 12, 24, 36 and 48 hours after scalding. Results　The viscosity of blood markedly increased at 2 hours after scalding, and the hemorheology parameters decreased after fluid resuscitation. The hemorheologic parameters were obviously lower in GR group than in GE group at 2 hours after rapid resuscitation, the viscosity of blood and RBC aggregation in GR group were obviously lower than those in PR group. Conclusion　Under the condition of delayed resuscitation after burn, rapid fluid replacement can quickly decreased the state of blood high viscosity and may play a role in improving microcirculation and treating burn shock.