[Technical specification for clinical application of critical ultrasonography].

Critical ultrasonography(CUS) is different from the traditional diagnostic ultrasound, the examiner and interpreter of the image are critical care medicine physicians. The core content of CUS is to evaluate the pathophysiological changes of organs and systems and etiology changes. With the idea of critical care medicine as the soul, it can integrate the above information and clinical information, bedside real-time diagnosis and titration treatment, and evaluate the therapeutic effect so as to improve the outcome. CUS is a traditional technique which is applied as a new application method. The consensus of experts on critical ultrasonography in China released in 2016 put forward consensus suggestions on the concept, implementation and application of CUS. It should be further emphasized that the accurate and objective assessment and implementation of CUS requires the standardization of ultrasound image acquisition and the need to establish a CUS procedure. At the same time, the standardized training for CUS accepted by critical care medicine physicians requires the application of technical specifications, and the establishment of technical specifications is the basis for the quality control and continuous improvement of CUS. Chinese Critical Ultrasound Study Group and Critical Hemodynamic Therapy Collabration Group, based on the rich experience of clinical practice in critical care and research, combined with the essence of CUS, to learn the traditional ultrasonic essence, established the clinical application technical specifications of CUS, including in five parts: basic view and relevant indicators to obtain in CUS; basic norms for viscera organ assessment and special assessment; standardized processes and systematic inspection programs; examples of CUS applications; CUS training and the application of qualification certification. The establishment of applied technology standard is helpful for standardized training and clinical correct implementation. It is helpful for clinical evaluation and correct guidance treatment, and is also helpful for quality control and continuous improvement of CUS application.

[Analysis of the characteristic of clinical symptoms and cone-beam CT imaging changes in temporomandibular joint osteoarthritis patients with chewing side preference].

Objective: To investigate the clinical symptoms and cone-beam CT (CBCT) imaging characteristics of temporomandibular joint osteoarthritis (TMJOA) with chewing side preference (CSP). Methods: One hundred patients with TMJOA diagnosed in the Department of Stomatology, General Hospital of the Chinese PLA from January 2018 to December 2020 were enrolled, including 32 males and 68 females, with an median age of 27.5 years (16-71 years). According to the habit of CSP, 100 cases were divided into 71 cases of TMJOA with CSP group and 29 cases of TMJOA without CSP group. The clinical symptoms were observed, including pain, TMJ sounds, limited mouth opening as well as the radiograph imaging changes of condylar bone. When analyzing the radiograph imaging changes of condylar, the cases with bilateral TMJ symptoms were excluded and the remaining cases were divided into symptomatic sides and asymptomatic sides with CSP or without CSP according to the symptoms of the chief complaint. SPSS 25.0 was used to analyze the statistical data. Age data did not conform to normal distribution so that median and quartile spacing were used for description, and Mann-Whitney U test was used for nonparametric test. Qualitative data such as gender, clinical symptoms and condylar lesion types were described by composition ratio and Chi-Square test was performed. Results: There was no statistical significance in age and gender of TMJOA patients in the group with or without CSP (P>0.05). There incidence of pain in CSP group [83.1% (59/71)] was margina uy higher than that in non-CSP group but without statistical difference[65.5% (19/29)] (χ²=3.71, P=0.054). There was also no significant difference in TMJ sounds and limitation of mandibular movement between the two groups(χ²=0.11, P=0.742; χ²=0.48, P=0.489). Among all of joints, the most common types of TMJOA were articular flattening and shortening and erosion. CBCT showed that erosion [65.0% (130/200)], flattening and shortening [73.0% (146/200)], subcortical sclerosis [42.0% (84/200)], osteophyte [30.5% (61/200)] and subcortical cystic [15.5% (31/200)]. According to the different groups of chief complaint sides, intra-group comparisons show that the proportion of erosion in symptomatic sides of CSP group [80.0% (40/50)] was significantly higher than that in asymptomatic sides of CSP group [50.0% (25/50)] (χ²=9.89, P=0.002). Inter-group comparisons show that the proportion of condyle flattening and shortening in symptomatic sides of CSP group [84.0% (42/50)] was significantly higher than that in bilateral joint of non-CSP group (8/15) (χ²=8.81, P=0.032). There was no significant difference in the proportion of subcortical sclerosis, osteophyte and subcortical cystic between the group with or without CSP (P>0.05). Conclusions: TMJOA patients with CSP may be more prone to clinical symptoms of pain and CBCT imaging changes of condyle erosion as well as flattening and shortening. CSP may be a promoting factor for the development of TMJOA.

[Analysis of the correlation between chewing side preference and disc displacement types and clinical symptoms in patients with anterior disc displacement of temporomandibular joint].

Objective: To analyze the clinical symptoms and types of disc displacement of patients with anterior disc displacement (ADD) of temporomandibular joint (TMJ) and to explore the correlation between chewing side preference (CSP) and the clinical symptoms and types of disc displacement of ADD patients. Methods: This was a cross-sectional study of the ADD patients diagnosed by clinical symptoms and MRI findings of TMJ in the Department of Stomatology, General Hospital of Chinese PLA from January 2018 to December 2019. A total of 111 ADD patients [33 males and 78 females, aged(31.0±10.9) years old] were included. The patients were divided into two groups according to whether they had CSP: non-CSP group (n=40) and CSP group (n=71). The clinical symptoms and types of ADD were observed and recorded. According to the specific side of CSP in the CSP group, the patients were further divided into the ipsilateral side and the contralateral side of CSP. The pain, TMJ sounds and the ADD types were also observed. Chi square test was used to compare the pain, TMJ sounds, limited mouth opening and ADD types of the two groups. Binary Logistic regression model was used to analyze the correlation between CSP and clinical symptoms and ADD characteristics. Results: The incidence of pain in the CSP group [89% (63/71)] was significantly higher than that in the non-CSP group [70% (28/40)] (P<0.05). In CSP patients, the incidences of pain and joint sounds on the ipsilateral side of CSP were significantly higher than that on the contralateral side (P<0.05). MRI showed that the incidence of bilateral ADD in the CSP group [58%(41/71)] was significantly higher than that in the non-CSP group [37%(15/40)] (P<0.05).There were significant differences in the incidences of no disc displacement (DD), anterior disk displacement with reduction(ADDwR) and anterior disk displacement without reduction (ADDwoR) between ipsilateral and contralateral joints of the CSP patients (P<0.05). There were no significant differences in the incidences of no DD, ADDwR and ADDwoR between left and right joints of the non-CSP patients (P>0.05). The incidence of ADDwoR in ipsilateral side of the CSP patients was significantly higher than that in contralateral side (P<0.05). Pain (OR=3.375) and the side of disc displacement (OR=2.278) in patients with ADD were positively correlated with CSP (P<0.05). Conclusions: The clinical symptoms and types of disc displacement between patients with and without CSP were significantly different. The incidences of pain and bilateral disc displacement in the CSP group were significantly higher than those in the non-CSP group. In addition, the incidences of pain, TMJ sounds and anterior disk displacement without reduction on the ipsilateral side of patients with CSP were significantly higher than those on the contralateral side. The pain symptoms and side of disc displacement were positively related to CSP.

Reevaluating the Role of Corticosteroids in Septic Shock: An Updated Meta-Analysis of Randomized Controlled Trials.

What Is Known and Objective. To reevaluate the benefits and risks of corticosteroid treatment in adult patients with septic shock. Methods. This study was performed based on PRISMA guidelines. Randomized controlled trials (RCTs) of corticosteroids versus placebo were retrieved from PubMed, MEDLINE, EMBASE, Web of Science, the Cochrane Central RCTs, and ClinicalTrials.gov from January 1980 to April 2018. We also conducted a trial sequential analysis to indicate the possibility of type I or II errors and calculate the information size. Grading of Recommendations, Assessment, Development and Evaluation approach (GRADE) was applying to assess the certainty of evidence at the primary outcome level. Results. Twenty-one RCTs were identified and analyzed. Patients treated with corticosteroid had a 7% reduction in relative risk in 28-day all-cause mortality compared to controls (RR 0.93, 95% CI 0.88 to 0.99). However, there were no significant differences for the intensive care unit (ICU) mortality (RR 0.97, 95% CI 0.86 to 1.09) or in-hospital mortality (RR 1.01, 95% CI 0.92 to 1.11). Corticosteroids shortened the length of ICU stay by 1.04 days (RR -1.04, 95% CI -1.72 to -0.36) and the length of hospital stay by 2.49 days (RR -2.49, 95% CI -4.96 to -0.02). Corticosteroids increased the risk of hyperglycemia (RR 1.11, 95% CI 1.06 to 1.16) but not gastroduodenal bleeding (RR 1.06, 95% CI 0.82 to 1.37) or superinfection (RR 1.04, 95% CI 0.94 to 1.15). However, some date on secondary outcomes were unavailable because they were not measured or not reported in the included studies which may cause a lack of power or selective outcome reporting. The information size was calculated at 10044 patients. Trial sequential analysis showed that the meta-analysis was conclusive and the risk of type 2 error was minimal. What Is New and Conclusion. Corticosteroids are likely to be effective in reducing 28-day mortality and attenuating septic shock without increasing the rate of life-threatening complications. TSA showed that the risk of type II error in this meta-analysis was minimal and the result was conclusive.

Measures of vocal function during changes in vocal effort level.

The purpose of this article is to present the results of a controlled study of the day-to-day variabilities of three acoustic parameters (jitter, shimmer, and normalized noise energy), and two electroglottographic parameters (contact quotient and contact quotient perturbation) for vowels produced at three vocal efforts (low, normal, high). Data were obtained with use of a sophisticated bilinear interpolation pitch detection method. A repeated measures design required subjects to produce the vowels /ae/ and /a/ five times a day over 3 days at each vocal effort level. The jitter, shimmer, and normalized noise energy values from acoustic measures and contact quotient and contact quotient perturbation values varied significantly among the three vocal effort levels. The clinical implication of this finding is that vocal effort must be controlled in order to obtain consistent clinical measures. Furthermore, day-to-day variability must be taken into account if representative measures are to be obtained for clinical use.

[Preparation of digoxigenin labelled probe and detection of HBV DNA in liver and extrahepatic tissue with in situ hybridization].

A new rapid technique for intrahepatic and extrahepatic HBV DNA detection by using digoxigenin (dig) labelled probe with in situ hybridization was developed. This technique has the advantage of being non-radioactive and a quick procedure yielding stable results and showing a clear background. 45 liver specimens were tested with this technique. Among the patients with positive intrahepatic HBsAg and HBcAg, positive detection of HBV DNA was highest (77.27%, 17/22). Some results were confirmed by PCR test. 19 extrahepatic specimens were detected with in situ hybridization. HBV DNA was seen clearly in the nuclei of myocardial cells, pancreatic islet cell, renal tubule epithelial cells and testicular spermatogenic cells. The results of this study might contribute to the study of molecular mechanism of HBV-induced injury in liver cells and extrahepatic tissue.

[Detection of HBV DNA in extrahepatic tissue with PCR comparison with immunohistochemistry and in situ hybridization].

Formalin-fixed paraffin-embedded tissue, including gallbladder, kidney, spleen, adrenal gland, heart, testicle, pancreas, and liver from eighteen autopsied cases with HBV infection were studied with nested polymerase chain reaction (PCR) for detection of HBV DNA. The DNA sequence representing HBV infection was detected in the tissue of liver (100%), gallbladder (6 from 7, 85.7%), spleen (6 from 8, 75.0%), kidney (8 from 11, 72.7%) adrenal gland (4 from 6, 66.7%), heart (10 from 18, 55.6%), testicle (10 from 18, 55.6%), pancreas (6 from 11, 54.5%) respectively. The DNA sequence representing HBV replication was detected in 5 cases of liver tissue only. The findings of PCR was correlated with the result of immunohistochemistry and in situ hybridization. It is shown that HBV can infect extrahepatic tissue but do not replicate in it. We think these findings may explain that the harboring of hepatitis virus in extrahepatic tissue could serve as one of extrahepatic infective sources, but have little pathological consequence on the infected extrahepatic organs.

[Hepatitis D virus RNA in serum from patients with hepatitis B].

To clarify the correlation of hepatitis D virus (HDV) infection and viral replication in liver diseases, the authors detected HDV RNA and serological HDV markers in serum from 285 patients with hepatitis B and 45 asymptomatic carriers of HBsAg. With dot blot hybridization, serum HDV RNA was detected in 8.8% (29/330) of the patients with HBV infection. The positive rate of HDV RNA in fulminant hepatitis was higher than that in benign hepatitis (15/74 vs 3/47, P less than 0.05). 10 of the 139 patients with chronic active hepatitis and 1 of the 6 cases with cirrhosis were positive for HDV RNA. However, all of the 19 cases with chronic persistent hepatitis and 45 asymptomatic carriers of HBsAg were negative fo, HDV RNA. Serological HDV markers, HDAgr anti-HD and IgM-anti-HD, were determined with ELISA. HDV RNA was detected in all of the serum samples with positive HDAg and/or IgM-anti-HD, in 15 of the 26 cases with positive-anti-HD and in 8 cases without HDV markers. Our results showed that 40 of the 330 patients with HBsAg were infected by HDV. This investigation suggests that HDV is one of the etiological factors for fulminant hepatitis and chronic active hepatitis.

[Detection of HBV DNA in kidney by PCR].

Nested polymerase chain reaction (PCR) in two groups of primer was performed in formalin-fixed, paraffin-embedded kidney and liver tissues from 11 autopsies of HBV infected patients for HBV DNA detection. DNA sequence representing HBV infection was detected in all the 11 liver tissue specimens (100%) and in 8 kidney tissue specimens (72.7%). DNA sequence representing HBV replication was detected in only 5 liver tissue specimens. The PCR findings correspond with those obtained in immunohistochemistry studies and in situ hybridization, suggesting that HBV can infect the kidney but does not replicate in this organ and that the kidney pathology in HBV infected patients may be the result of immuno-intermediate injury from immunocomplex deposited in glomeruli.

Dendrolimiasis: an analysis of 58 cases.

Contact with pine caterpillars in China may result in dendrolimiasis. In this review of 58 cases the disease is considered from several aspects. Five types of disease are described, depending on the pathogenic site. Three stages could be recognized in relation to the time of onset. On the basis of an analysis of prominent theories, multiple factors are believed to be involved in the pathogenesis which involves damage to bones and joints. The radiographic features are outlined and the diagnosis and differential diagnosis discussed.

[The antibacterial efficacy to obligate anaerobes isolated from the infected root canal of deciduous teeth]

TMJ osteoarthrosis(OA) is frequently seen in the Oral and Maxillofacial Surgery clinics.In order to investigate cellular and molecular basis of the pathogenesis of TMJOA,the levels of IL-1 and IL-6 in synovial aspirates from different stages of TMJOA patients were determined and analysed.It was found that both of them were highly correlated with the severity of TMJOA(P<0.0001).A positive linear correlation was also found between IL-1 and IL-6(P<0.0001).The balance and imbalance between MMPs and TIMPS and the modulatory mechanism of cytokines were introduced and their possible roles in the pathogenesis of TMJOA were discussed.