Chinese expert consensus on clinical treatment of adult patients with severe traumatic brain injury complicated by corona virus disease 2019 (version 2023) / 中华创伤杂志

The condition of patients with severe traumatic brain injury (sTBI) complicated by corona virus 2019 disease (COVID-19) is complex. sTBI can significantly increase the probability of COVID-19 developing into severe or critical stage, while COVID-19 can also increase the surgical risk of sTBI and the severity of postoperative lung lesions. There are many contradictions in the treatment process, which brings difficulties to the clinical treatment of such patients. Up to now, there are few clinical studies and therapeutic norms relevant to sTBI complicated by COVID-19. In order to standardize the clinical treatment of such patients, Critical Care Medicine Branch of China International Exchange and Promotive Association for Medical and Healthcare and Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Chinese expert consensus on clinical treatment of adult patients with severe traumatic brain injury complicated by corona virus infection 2019 ( version 2023) based on the joint prevention and control mechanism scheme of the State Council and domestic and foreign literatures on sTBI and COVID-19 in the past 3 years of the international epidemic. Fifteen recommendations focused on emergency treatment, emergency surgery and comprehensive management were put forward to provide a guidance for the diagnosis and treatment of sTBI complicated by COVID-19.

Effect of BDNF-AS/miR-145-5p axis on renal tubular epithelial cell injury induced by high glucose / 中华医学遗传学杂志

OBJECTIVE@#To investigate the effect and possible mechanism of BDNF-AS on renal tubular epithelial cell injury induced by high glucose.@*METHODS@#Human renal tubular epithelial cells HK-2 were cultured in vitro and transfected with BDNF-AS small interfering RNA or miR-145-5p mimic, or co-transfected with BDNF-AS small interfering RNA and miR-145-5p inhibitor, respectively. The cells were then intervened with 30 mmol/L glucose for 24 hours. The expression of BDNF-AS and miR-145-5p were detected by RT-qPCR. Cell proliferation was detected by CCK-8, and apoptosis was detected by flow cytometry. The expression of Bcl-2 and Bax proteins were detected by Western blotting, and the levels of IL-1β and IL-6 in cell culture supernatant were detected by enzyme-linked immunosorbent assay. Dual luciferase reporter gene experiment was used to verify the regulatory relationship of BDNF-AS with miR-145-5p.@*RESULTS@#High glucose promoted the expression of BDNF-AS in HK-2 cells (P<0.05), but inhibited that of miR-145-5p (P<0.05). Interfering with BDNF-AS or overexpression of miR-145-5p decreased the inhibition rate, apoptosis rate and expression of Bax protein, IL-1β and IL-6 of HK-2 cells induced by high glucose (P<0.05), but promoted the expression of Bcl-2 protein (P<0.05). Interfering with miR-145-5p reversed the effect of interfering with BDNF-AS on the proliferation, apoptosis rate and the expression of IL-1β and IL-6 of HK-2 cells induced by high glucose. BDNF-AS could target and down-regulate miR-145-5p.@*CONCLUSION@#Interfering with BDNF-AS may promote the proliferation of renal tubular epithelial cells induced by high glucose and inhibit cell apoptosis and the expression of inflammatory factor by down-regulating miR-145-5p.

Expression and Clinical Significance of S100A14 and LOXL2 in Papillary Thyroid Carcinoma / 肿瘤防治研究

Objective To investigate the expression and clinical significance of S100A14 and LOXL2 in papillary thyroid carcinoma tissues. Methods Paraffin blocks from 90 cases of thyroid lesion were collected to make tissue microarray. The expression of S100A14 and LOXL2 in 30 cases of nodular goiter (NG), 30 cases of classic papillary thyroid carcinoma (CPTC) and 30 cases of high invasion papillary thyroid carcinoma were detected by immunohistochemistry. The correlation of S100A14 and LOXL2 expression with the clinicopathological characteristics of papillary thyroid carcinoma patients was investigated. Results S100A4 and LOXL2 were highly expressed in papillary thyroid carcinoma. There was a gradually increasing trend from the expression in NG group, CPTC group to high invasive group. The positive rate of S100A14 in papillary thyroid carcinoma with lymph node metastasis was higher than that without lymph node metastasis (P < 0.05). There was significant difference of S100A14 and LOXL2 expression between CPTC group and high invasion group (P < 0.05). S100A14 expression was positively correlated with LOXL2 expression (r=0.332). Conclusion The high expression of S100A14 and LOXL2 may be related to the malignant biological behavior and invasiveness of papillary thyroid carcinoma, and S100A14 may promote lymph node metastasis.

Clinical characteristics and influencing factors for mortality of patients with intra-abdominal candidiasis: a multicenter retrospective study / 中华消化外科杂志

Objective:To investigate the clinical characteristics and influencing factors of mortality in patients with intra-abdominal candidiasis (IAC).Methods:The retrospective case-control study was conducted. The clinicopathological data of 203 IAC patients who were admitted to 7 medical centers from June 2018 to June 2020 were collected, including 54 cases in Sir Run Run Shaw Hospital of Zhejiang University School of Medicine, 31 cases in Fujian Medical University Union Hospital, 25 cases in Beijing Hospital, 25 cases in the First Affiliated Hospital of Xi'an Jiaotong University, 24 cases in China-Japan Friendship Hospital, 22 cases in General Hospital of Eastern Theater Command of Chinese PLA and 22 cases in Chongqing University Cancer Hospital. There were 130 males and 73 females, aged (64±15)years. Observation indicators: (1) candida infection and treatment of IAC patients; (2) analysis of influencing factors for mortality of IAC patients. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were expressed as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Univariate and multivariate analyses were performed by Logistic regression model. Results:(1) Candida infection and treatment of IAC patients: 134 cases of candida albicans were cultured in the initial abdominal drainage fluid or intraoperative abdominal specimens of 203 patients, and 49 cases were treated with fluconazole. Of 69 cases infected with non candida albicans, 13 cases were treated with fluconazole. The resistance rate of candida albicans to fluconazole was 5.91%(12/203). Of 203 patients, there were 68 cases with infections shock, 53 cases with renal failure, 84 cases with respiratory failure and 63 cases with multiple organ failure, respectively. There were 148 of 203 patients admitted to intensive care unit for 9 days(range, 3-20 days), and the total hospital stay was 28 days(range, 17-50 days). Of 203 patients, 86 cases were cured and discharged, 50 cases were improved and transferred to local hospitals, 32 cases gave up treatment and discharged automatically, 19 cases died, 16 cases had no follow-up data. The mortality was 25.12%(51/203). (2) Analysis of influencing factors for mortality of IAC patients. Results of univariate analysis showed that acute physiology and chronic health evaluation score, sequential organ failure assessment score, the Cr, bilirubin, albumin, procalcitonin, and PLT on the first day of candida positive culture, of the lowest value in a week and the highest in a week, heart disease, diabetes, infections shock, renal failure, respiratory failure, multiple organ failure, anti-fungal therapy were the related factors for mortality of IAC patients ( t=-2.322, Z=-2.550, -2.262, -4.361, t=2.085, Z=-3.734, -5.226, -2.394, -5.542, t=3.462, Z=-4.957, -5.632, 3.670, -5.805, t=3.966, Z=-3.734, -5.727, χ2=4.071, 4.638, 27.353, 18.818, 13.199, 26.251, 13.388, P<0.05). Multivariate analysis showed that the bilirubin, procalcitonin on the first day of candida positive culture and infections shock were independent risk factors for mortality of IAC patients ( odds ratio=1.021, 1.022, 6.864, 95% confidence interval as 1.010-1.033, 1.001-1.044, 1.858-25.353, P<0.05). Conclusions:The common fungus of IAC was candida albicans, and fluconazole can be used as the initial empirical treatment. The prognosis of patients with abdominal candidiasis is poor. Bilirubin, procalcitonin on the first day of candida positive culture and infections shock are indepen-dent risk factors for mortality of IAC patients.

Higher Comorbidities and Early Death is Characteristic of Hospitalized African-American Patients with COVID-19

BackgroundAfrican-Americans/Blacks have suffered higher morbidity and mortality from COVID-19 than all other racial groups. This study aims to identify the causes of this health disparity, determine prognostic indicators, and assess efficacy of treatment interventions. MethodWe performed a retrospective cohort study of clinical features and laboratory data of COVID-19 patients admitted over a five-week period at the height of the pandemic in the United States. This study was performed at an urban academic medical center in New York City, declared a COVID-only facility, serving a majority Black population ResultOf the 1,070 consecutive patients who tested positive for COVID-19, 496 critically ill patients were hospitalized and included in the study. 88% of patients were Black; and a majority (53%) were 61-80 years old with a mean body mass index in the "obese" range. 97% had one or more comorbidities. Hypertension was the most common (84%) pre-existing condition followed by diabetes mellitus (57%) and chronic kidney disease (24%). Patients with chronic kidney disease and end-stage renal disease who received hemodialysis were found to have significantly lower mortality, then those who did not receive it, suggesting benefit from hemodialysis (11%, OR, 0.35, CI, 0.17 - 0.69 P=0.001). Age >60 years and coronary artery disease were independent predictors of mortality in multivariate analysis. Cox Proportional Hazards modeling for time to death demonstrated a significantly high ratio for COPD/Asthma, and favorable effects on outcomes for pre-admission ACE inhibitors and ARBs. CRP (180, 283 mg/L), LDH (551, 638 U/L), glucose (182, 163 mg/dL), procalcitonin (1.03, 1.68 ng/mL), and neutrophil / lymphocyte ratio (8.5, 10.0) were predictive of mortality on admission and at 48-96 hrs. Of the 496 inpatients, 48% died, one third of patients died within the first three days of admission. 54/488 patients received invasive mechanical ventilation, of which 87% died and of the remaining patients, 32% died. CONCLUSIONSCOVID-19 patients in our predominantly Black neighborhood had higher mortality, likely due to higher prevalence of comorbidities. Early dialysis and pre-admission intake of ACE inhibitors/ARBs improved patient outcomes. Early escalation of care based on comorbidities and key laboratory indicators is critical for improving outcomes in African-American patients.

Clinical significance of preoperative platelet count in laryngeal squamous cell carcinoma prognosis / 国际肿瘤学杂志

Objective To explore the effect of preoperative platelet (PLT) count on the prognosis of patients with laryngeal squamous cell carcinoma.Methods The clinical data of 286 patients with laryngeal squamous cell carcinoma were retrospectively analyzed to determine the optimal critical value of PLT count for end point of recurrence and death.The effects of preoperative PLT count on the recurrence and 5-year survival rates of patients with laryngeal squamous cell carcinoma after surgery were analyzed.Results The optimal critical value of PLT count for end point of recurrence was 242.5 × 109/L.The patients were divided into PLT ≥242.5 × 109/L group (n =115) and PLT ＜242.5 × 109/L group (n =171).Single factor analysis indicated that the recurrence was not related to age (x2 =0.005,P =0.942),gender (x2 =0.309,P =0.579) and pathological differentiation (Z =2.858,P =0.240),and was related to T staging (x2 =10.509,P =0.001),lymph node metastasis (x2 =7.297,P =0.007),primary tumor site (x2 =16.797,P ＜ 0.001) and preoperative PLT count (x2=12.081,P =0.001).Multivariate analysis indicated that T staging (OR =0.518,95 ％ CI:0.281-0.954,P =0.035),primary tumor site (OR =2.371,95 ％ CI:1.283-4.382,P =0.006),and PLT count (OR =2.885,95％ CI:1.607-5.179,P ＜ 0.001) were the independent factors affecting the recurrence of laryngeal squamous cell carcinoma.The optimal critical value of PLT count for end point of death was 251.5 × 109/L.The patients were divided into PLT≥251.5 × 109/L group (n =94) and PLT ＜ 251.5 ×109/L group (n =192).Single factor analysis indicated that the 5-year survival rate was not related to age (x2 =0.030,P =0.863),gender (x2 =0.000,P =0.945) and pathological differentiation (x2 =4.050,P=0.133),and was related to T staging (x2 =41.630,P ＜ 0.001),lymph node metastasis (x2 =58.110,P ＜0.001),primary tumor site (x2 =36.250,P ＜ 0.001) and preoperative PLT count (x2 =4.790,P =0.029).Multivariate analysis indicated that T staging (HR =0.353,95％ CI:0.193-0.645,P =0.001),primary tumor site (HR =2.151,95 ％ CI:1.312-3.526,P =0.002),lymph node metastasis (HR =2.819,95 ％ CI:1.633-4.867,P＜0.001),and PLT count (HR=1.853,95％CI:1.160-2.960,P=0.010) were the independent factors affecting 5-year survival rates of laryngeal squamous cell carcinoma.Kaplan-Meier survival analysis indicated that the 5-year survival rate of PLT≥251.5 × 109/L group and PLT ＜ 251.5 × 109/L group were 58.23％,67.87％,with significant difference (x2 =4.79,P =0.029).Conclusion Preoperative PLT count is the influence factor of recurrence and 5-year survival rate of laryngeal squamous cell carcinoma patients,which has important significance to the prognosis of laryngeal squamous cell carcinoma patients.

Risk factors for pneumonia in children with Epstein-Barr virus infectious mononucleosis / 中华实用儿科临床杂志

Objective To investigate the risk factors for pneumonia in children with Epstein-Barr virus (EBV) infectious mononucleosis(IM).Methods The clinical data of children with EBV-IM from March 2015 to February 2018 in Children's Hospital of Chongqing Medical University were retrospectively analyzed.The patients were divided into a pneumonia group and a non-pneumonia group.The difference between 2 groups was analyzed,including gender,age,duration of fever,the maximum temperature in disease duration,the size of liver,the size of spleen,tonsillopharyngitis,cervical lymphadenopathy,edema of the eyelids,white blood cell (WBC),lymphocyte,atypical-lymphocytes,C-reactive protein (CRP),procalcitonin (PCT),alanine transaminase (ALT),glutamic oxalacetic transaminas (AST),lactic dehydrogenase (LDH),cytomegalovirus (CMV) antibody,the titer of mycoplasma (MP) antibody,EBV DNA,length of stay,and hospitalization expenses.The single factor analysis was performed to analyze the above data between 2 groups,and the data with statistical significance were analyzed by the multifactor Logistic regression.The receiver operator characteristic (ROC) curve was drawn to evaluate the predicting ability of the indicators for IM combined with pneumonia.Results Among 923 cases,133 cases(14.4％) EBV-IM patients were complicated with pneumonia.The findings of single factor analysis indicated that the risk factors were the duration of fever,the size of liver,the size of spleen,and the titer of MP antibody (all P ＜ 0.05).The multifactor Logistic regression showed that the duration of fever,the size of liver,the titer of MP antibody were the risk factors for EBV-IM children with pneumonia (P =0.013,0.028,0.014).The area under curve (AUC) of the duration of fever was 0.624,and the critical value was 7.5 d (P =0.000);the AUC of the size of liver was 0.590,and the critical value was 2.65 cm (P =0.003).Conclusions The incidence rate of EBV-IM children combined with pneumonia was high.With the presence of the titer of MP antibody ≥ 1:160,the duration of fever ≥7.5 days,and the size of liver ＞ 2.65 cm,it may be independent risk factors for pneumonia in IM children with EBV infection,which requires special attention clinically and earlier chest imageological examination are needed.

Hybrid surgical technique for the treatment of complex cerebrovascular diseases / 中国脑血管病杂志

The clinical application of hybrid surgical technique for treatment of cerebrovascular diseases has gone through a course of more than 10 years. From intraoperative angiography in the treatment of intracranial aneurysms and cerebral arteriovenous malformations at the begining to various applications for more complicated cases at present, hybrid operation has become a new world in the treatment of cerebrovascular diseases. At the same time we notice that the clinical application of hybrid surgery is lack of large-scale multicenter clinical control studies, and there are still different opinions on the indication, technical process,quality control,team building and so on. As a new technique and clinical hotspot,hybrid operation for cerebrovascular diseases has a good prospect,and need to be further standardized.

Risk factors for pneumonia in children with Epstein-Barr virus infectious mononucleosis / 中华实用儿科临床杂志

Objective@#To investigate the risk factors for pneumonia in children with Epstein-Barr virus (EBV) infectious mononucleosis(IM).@*Methods@#The clinical data of children with EBV-IM from March 2015 to February 2018 in Children′s Hospital of Chongqing Medical University were retrospectively analyzed.The patients were divided into a pneumonia group and a non-pneumonia group.The difference between 2 groups was analyzed, including gender, age, duration of fever, the maximum temperature in disease duration, the size of liver, the size of spleen, tonsillopharyngitis, cervical lymphadenopathy, edema of the eyelids, white blood cell (WBC), lymphocyte, atypical-lymphocytes, C-reactive protein (CRP), procalcitonin (PCT), alanine transaminase (ALT), glutamic oxalacetic transaminas (AST), lactic dehydrogenase (LDH), cytomegalovirus (CMV) antibody, the titer of mycoplasma (MP) antibody, EBV DNA, length of stay, and hospitalization expenses.The single factor analysis was performed to analyze the above data between 2 groups, and the data with statistical significance were analyzed by the multifactor Logistic regression.The recei-ver operator characteristic (ROC) curve was drawn to evaluate the predicting ability of the indicators for IM combined with pneumonia.@*Results@#Among 923 cases, 133 cases(14.4%) EBV-IM patients were complicated with pneumonia.The findings of single factor analysis indicated that the risk factors were the duration of fever, the size of liver, the size of spleen, and the titer of MP antibody (all P<0.05). The multifactor Logistic regression showed that the duration of fever, the size of liver, the titer of MP antibody were the risk factors for EBV-IM children with pneumonia (P=0.013, 0.028, 0.014). The area under curve (AUC) of the duration of fever was 0.624, and the critical value was 7.5 d (P=0.000); the AUC of the size of liver was 0.590, and the critical value was 2.65 cm (P=0.003).@*Conclusions@#The incidence rate of EBV-IM children combined with pneumonia was high.With the presence of the titer of MP antibody ≥1∶160, the duration of fever≥7.5 days, and the size of liver>2.65 cm, it may be independent risk factors for pneumonia in IM children with EBV infection, which requires special attention clinically and earlier chest imageological examination are needed.

Analysis of correlated factors of cervical lymphatic metastasis of T3 and T4 glottic carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze the correlated factors of cervical lymphatic metastasis of T3 and T4 glottic carcinoma.@*METHOD@#We did a retrospective analysis of 91 glottic carcinoma patients' clinical data to analyze cervical lymph node metastasis on different T stage, pathologic degree and the tumor sites.@*RESULT@#The cervical lymph node metastasis rate of 91 cases of T3 and T4 glottic carcinoma was 21.98%. T3 group's metastasis rate was 18.06% (13/72), T4 group's metastasis rate was 36.84% (7/19), P > 0.05. Grouped according to the degree of pathological differentiation, well-differentiated squamous cell carcinoma metastasis rate is 13.89% (5/36), middle-differentiated squamous cell carcinoma metastasis rate is 26.00% (13/50), and poorly-differentiated squamous cell carcinoma metastasis rate is 40.00% (2/5), P > 0.05. Cervical lymph node metastasis rate was 16.22%, when the tumor invading supraglottic region. Cervical lymph node metastasis rate was 15.38%, when the tumor invading subraglottic region. Cervical lymph node metastasis rate was 46.15%, when the tumor invading supraglottic and subraglottic region (P < 0.01).@*CONCLUSION@#Cervical lymph node metastasis in cN0 patient with supraglottic carcinoma is effected by T classification, cervical lymphatic metastasis of T3 and T4 glottic carcinoma is not entirely effected by T stage and pathologic degree. When the tumor invades supraglottic and subraglottic region, cervical lymph node metastasis is significantly higher. Therefore, the area of tumor invasion is an important factor for lymph node metastasis.

The related factors analysis of difficult laryngeal exposure under retaining laryngoscope / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze the related factors of difficult laryngeal exposure under retaining laryngoscope.@*METHOD@#We did a retrospective analysis of 287 retaining laryngoscope surgery patients' clinical datas to observe the relationship between difficult glottis exposure and patients' gender, degree of mouth opening, BMI, neck circumference, head and neck flexion, TMD, HMD and SMD.@*RESULT@#By ROC curve analysis, we determine the optimal threshold for TMD was 7.35 cm, HMD was 6.33 cm, SMD was 14.75 cm. Univariate analysis showed that gender, and glottis exposure had no significant correlation with difficult laryngeal exposure under retaining laryngoscope. Degree of mouth opening, BMI, neck circumference, head and neck flexion, TMD, HMD and SMD had correlation with difficult laryngeal exposure. Multivariate analysis showed that neck circumference, head and neck flexion, TMD, SMD were independent factors of difficult laryngeal exposure under retaining laryngoscope.@*CONCLUSION@#Measurement of neck circumference, head and neck flexion, TMD, SMD before the operation is important for the prediction of difficult laryngeal exposure under retaining laryngoscope.

Comparison of the effects of different analgesic methods after UPPP / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the effects of different analgesia methods after UPPP.@*METHOD@#Ninety cases of patients uvulopalatopharyngoplasty were divided into 3 groups randomly, and 30 cases in each group. The group A was the blank control group without any analgesia measures. The cases in group B were treated with intramuscular injection of parecoxib sodium 40 mg after surgery immediately, and continued injecting 40 mg after 12 hours, 24 hours and 36 hours respectively. 100 mg tramadol replaced 40 mg parecoxib sodium in group C. The VAS scoring was performed after surgery 12, 24, 36, 48, 72, 96 hours in 3 groups, and we observed adverse reaction such as lethargy, nausea, vomiting, dizziness, skin rash and so on.@*RESULT@#The group B and C reduced the pain significantly compared with blank control group. The pain scores in group B were significantly decreased than that in group C (P<. 05).@*CONCLUSION@#The analgesic effect of parecoxib sodium after UPPP is significant and better than tramadol. It is worthy to use widely in clinical due to its better effect and less side effect.

The Vertebral Artery and Basilar Artery Haemodynamics of Sudden Deafness / 听力学及言语疾病杂志

Objective To explore different characteristics of the vertebral artery and basilar artery haemody-namics in different frequencies to provide a theoretical basis for clinical treatment .Methods 90 cases of sudden deaf-ness were induded and according to hearing curve ,the cases were divided into three groups with 30 cases for each while the control group had 30 subjects .All cases were examined by TCD ,the VA ,BA test .Results Compared with group of median and low frequency sudden deafness ,the abnormal blood flow rate were found with decreased hearing(P0 .05) .High frequency hearing loss compared with the con-trol group patients with sudden deafness had a clear abnormal velocity (P<0 .05) ,characterized by high velocity . There was no statistically significant difference in blood flow rate among low and median frequency group ,full-fre-quency group and control group except for Vs of BA in low and median frequency group .Conclusion Vertebral and basilar arterial circulation disorders had present more significance in the incidence of sudden deafness ,evident espe-cially in high and all frequency sudden deafness .Early initiation of TCD examination can understand the change of the vertebral and basilar artery hemodynamics ,providing high clinical application values .

Evaluate the related factors of recurrence after carbon dioxide laser in treatment of early glottic carcinoma / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To analyze the recurrencerelative factors of early glottic carcinoma after carbon dioxide laser treatment.@*METHOD@#A retrospective analysis of 134 early glottic carcinoma patients' clinical data was taken to analyze the relationships between recurrence and gender, age, pathologic degree, T stage, involvement of anterior commissure and involvement of thyroarytenoid muscle.@*RESULT@#Recurrent ratio of well-differentiated, middle-differentiated and poorly-differentiated squamous cell carcinoma were 11.83%, 18.42% and 33.33% (P > 0.05) respectively. Recurrent ratio of T1a, T1b, T2 were 13.24%, 18.92%, 23.08% (P > 0.05) respectively. The recurrent rate was 33.33% of tumors offended the anterior commissure, versus 5.43% with no involvement of anterior commissure (P < 0.01). The recurrent rate was 59.09% of tumors offended the thyroarytenoid muscle, versus 5.36% with no involvement of thyroarytenoid muscle (P < 0.01). Unvaried and multivariate analysis indicated that the involvement of anterior commissure and the involvement of thyroarytenoid muscle were the factors of recurrence.@*CONCLUSION@#Recurrence of early glottic carcinoma after carbon dioxide laser treatment is effected by the involvement of anterior commissure and the involvement of thyroarytenoid muscle. Resection can be performed conservatively according to evaluation of macroscopic tumour extension.

The diagnosis of spinal dural arteriovenous fistulas.

STUDY DESIGN: Retrospective consecutive case series. OBJECTIVE: To review and analyze clinical presentations and radiological imaging of 326 consecutive patients with spinal dural arteriovenous fistula (SDAVF) from 2 institutions. SUMMARY OF BACKGROUND DATA: The clinical presentations of SDAVF are nonspecific. Patients may be initially diagnosed with other spinal diseases. Magnetic resonance imaging (MRI) can reveal spinal cord changes associated with the disorder, but neurosurgeons often overlook these changes. METHODS: From 1989 to 2009, 326 patients were diagnosed with SDAVF and treated at Qilu Hospital of Shandong University and the Xuanwu Hospital of the Capital University of Medical Sciences. We retrospectively reviewed the clinical records and radiological images of all patients, and collected and analyzed the related data. RESULTS: Two hundred eighty-two males and 44 females (male/female ratio 6.4:1; mean age, 53.9 yr; SD, 12.1) were included in the study. Fistulas were located at the T7 spinal segment (41, 12.6%), but were more typically found at T5 to L5 (273, 82.5%). The most common initial symptoms were lower extremity weakness (234, 71.8%), sensory disturbance (229, 70.2%), and sphincter disturbance (87, 26.7%). These percentages increased to, 85.6%, 80.8%, and 52.5%, respectively, until patients were properly diagnosed. The mean diagnostic time to SDAVF was 19.9 months (SD, 25.2). Two major changes noted on magnetic resonance images were intramedullary T2-weighted signal hyperintensity (284, 87.1%) and perimedullary dilated vessels (251, 77%). Fistulas were often located outside of the vertebral segments of T2-weighted signal change (P = 0.005). Magnetic resonance angiography and computed tomography angiography of 33 (71.7%) patients revealed perimedullary dilated vessels and precisely located fistulas in 19 (41.3%) patients. Magnetic resonance angiography and computed tomography angiography studies of the perimedullary vessels also led to identification of a second fistula through angiography. Degenerative disc disease and myelitis were the most common misdiagnoses, and the patients were often treated incorrectly. CONCLUSION: "Worsening" and "symptoms combination" are progression characteristics of SDAVF. Patients should undergo spinal magnetic resonance imaging when they are first suspected to have SDAVF. Magnetic resonance angiography and computed tomography angiography as noninvasive angiography are helpful for diagnosis.

Characterization of vinflunine tartrate liposomes in vitro and in vivo / 药学学报

Vinflunine tartrate-loaded liposomes (VT-L) with two drug-to-lipid ratios were prepared by pH gradient method. Vesicle size and zeta potential were determined by the Zetasizer Nano ZS. Entrapment efficiency was evaluated by cation exchange resin centrifugalization method. The toxicity and tumor inhibition to nude mouse administrated by VT-L with different drug-to-lipid ratios were investigated and compared with the vinflunine tartrate injection (VT-I). The results showed that the mean particle size, zeta potential and entrapment efficiency of the VT-L with drug-to-lipid ratios of 1 : 5 and 1 : 10 were 124.6 nm and 128.3 nm, -25.3 mV and -22.8 mV, 94.46% and 97.31%, respectively. The VT-L with two different drug-to-lipid ratios has significantly higher anti-tumor effect to nude mouse transplanted human non-small cell lung carcinoma A549 and lower toxicity than VT-I. While there were no significant differences in anti-tumor effect and toxicity between VT-L with two different drug-to-lipid ratios.

Is antimicrobial susceptibility testing necessary before first-line treatment for Helicobacter pylori infection? Meta-analysis of randomized controlled trials.

BACKGROUND: With the wide use of antibiotics, antibiotic-resistant Helicobacter pylori strains are becoming increasingly prevalent. It has been hypothesized that culture-guided therapy might help to increase treatment success. But the effects and the costs still remain controversial. AIMS: To systematically review the efficacy and the cost of culture-guided triple therapy, compared to standard triple regimen for first-line treatment of Helicobacter pylori infection. METHODS: A search of the Cochrane Library, PubMed, EMBASE, Science Citation Index Expanded and CBM was performed. Randomized controlled trials comparing culture-guided triple therapy to standard triple therapy in the first-line treatment of Helicobacter pylori infection were selected for meta-analysis. Relative risk was used as a measure of the effect of two regimens mentioned above with a fixed-effects model using the methods of DerSimonian and Laird. RESULTS: Five randomized controlled trials totaling 701 patients were included. The meta-analysis showed that culture-guided triple therapy was superior referring to a higher eradication rate from intention-to-treat analyses (RR, 0.84; 95% CI,0.77, 0.90; p<0.00001) and a lower overall cost. CONCLUSION: Culture-guided triple therapy was more effective than standard triple therapy for first-line treatment of Helicobacter pylori infection. Based on the only paper focused on the overall cost, the culture-guided triple therapy was also more cost saving. Antimicrobial susceptibility testing is necessary before first-line treatment for Helicobacter pylori infection.

Moxifloxacin-based triple therapy versus clarithromycin-based triple therapy for first-line treatment of Helicobacter pylori infection: a meta-analysis of randomized controlled trials.

BACKGROUND: Moxifloxacin-based triple therapy has been suggested as an alternative first line therapy to clarithromycin-based triple therapy for Helicobacter pylori infection. AIMS: To systematically review the efficacy and tolerance of moxifloxacin-based triple therapy, and to conduct a meta-analysis of studies comparing this regimen with clarithromycin-based triple therapy. METHODS: A search of The Cochrane Library, PUBMED, EMBASE, EBM Review databases, Science Citation Index Expanded, and CMB (Chinese Biomedical Literature Database) was performed. Randomized controlled trials comparing moxifloxacin-based triple therapy to gold standard triple therapy in the first-line treatment of Helicobacter pylori infection were selected for meta-analysis. Relative risk was used as a measure of the effect of the two above-mentioned regimens with a fixed-effects model using the methods of DerSimonian and Laird. RESULTS: Four randomized controlled trials totaling 772 patients were included. The meta-analysis showed that the mean eradication rate was 84.1 (318/378) in the moxifloxacin-based triple therapy group and 73.6 (290/394) in the clarithromycin-based triple therapy group; there was statistical significance between the two groups (RR, 1.13; 95% CI, 1.01, 1.27; P=0.04). There were no statistically significant difference in the overall side effects (RR, 0.61; 95% CI, 0.25, 1.48; P<0.28). CONCLUSIONS: Moxifloxacin-based triple therapy is more effective and does not increase the incidence of overall side effects compared to clarithromycin-based triple therapy in the treatment of H. pylori infection.

Practice and Pondering on Management Mode of General Pharmacy / 中国药房

OBJECTIVE: To explore a new hospital pharmacy management mode. METHODS: The tradition pharmacy management model undergone reformation by integrating the original outpatient pharmacy, out - patient traditional Chinese pharmacy (excluding cut crude drug section) and inpatient pharmacy into one general pharmacy. RESULTS: The operation of general pharmacy not only reduced the personnel, the storing space and the stock of drugs, but also simplified the management flow - sheet. CONCLUSION: Under permitted condition, hospitals might take into account general pharmacy management mode.

Intracranial Arachnoid Cysts:CT Cisternography and Its Clinical Significance / 实用放射学杂志

Objective To explore the classification of intracranial arachroid cysts(IAC) in CT cisternography(CTC) and its clinicalapplication.Methods 22 cases of IAC diagnosed by plain CT underwent CTC exminaton. IACs were classified into noncommnicatingintracranial arachnoid cyst (NCIAC) and commnicating intracranial arachnoid cyst (CIAC) by wheather or not filled with contrast media in cysts on CTC. NCIAC cases were selected and treated with neuroendoscopic fenestration.Results 15 cases of NCIAC were found by CTC examination. All the NCIAC patients had definite neurologic findings. Postoperatively, all the patients were improved or cured. Follow-upplain CT scan of 9 NCIAC cases showed the cysts were decreased markedly in size, most of the space around the cysts were replaced bynormal cerebral tissue.Conclusion (1)CTC is simple ,safe and specific for making a final diagnosis of IAC. IACs can be classified into CIAC and NCIAC by CTC findings.(2)Neurosurgical indication for IAC is NCIAC patients with symptoms.