Prolonged length of stay after posterior surgery for cervical spondylotic myelopathy in patients over 65 years of age

Prolonged length of stay (PLOS) has been associated with increased hospital resource utilization and worsened patient outcomes in multiple studies. In this study, we defined and identified factors associated with PLOS after posterior surgery for cervical spondylotic myelopathy in patients over the age of 65. PLOS was defined as length of stay beyond the “prolongation point” (that is, the day after which discharge rates begin to decline). Using the United States Nationwide Inpatient Sample database, 2742 patients met inclusion criteria, out of whom 16.5% experienced PLOS (stay beyond 6 days). After multivariate analysis, increasing age was independently associated with PLOS (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.02–1.06). Multiple comorbid conditions were associated with PLOS, including alcohol abuse (OR 3.85, 95% CI 1.87–7.94), congestive heart failure (OR 1.72, 95% CI 1.11–2.64), obesity (OR 1.70, 95% CI 1.14–2.55), and deficiency anemia (OR 1.44, 95% CI 1.01–2.05); the strongest associated operative parameter was blood transfusion (OR 2.39, 95% CI 1.75–3.28). Major complications independently associated with PLOS were deep vein thrombosis (OR 18.32, 95% CI 6.50–51.61), myocardial infarction (OR 8.98, 95% CI 2.92–27.56), pneumonia (OR 6.67, 95% CI 3.17–14.05), acute respiratory failure (OR 6.27, 95% CI 3.43–11.45), hemorrhage/hematoma (OR 5.04, 95% CI 2.69–9.44), and implant-related complications (OR 2.49, 95% CI 1.24–4.98). Average total hospital charges for patients who experienced PLOS were $122,965 US dollars, compared to $76,870 for the control group (p < 0.001). Mortality for patients who experienced PLOS was 2.7% versus 0.5% for patients who did not epxerience PLOS (p < 0.001). In conclusion, patients over the age of 65 who underwent posterior surgery for cervical myelopathy and stayed over 6 days in hospital were defined as having PLOS. Hospital charges and mortality rates were significantly higher for patients who experienced PLOS. Potentially modifiable and/or preventable risk factors were also identified.     

Posterior Reversible Encephalopathy Syndrome: A Comparative Study of Pediatric Versus Adult Patients

BackgroundPosterior reversible encephalopathy syndrome (PRES) is an acute neurotoxic syndrome that, although characteristically reversible, can result in long-term disability. Our aim was to identify the clinical and radiological factors that are unique to children with PRES compared with adults with the syndrome in a single center.MethodsWe retrospectively reviewed the clinical and radiological records of all patients with PRES admitted at a tertiary care medical center from 2007 to 2014. All patients who met the clinical and radiological criteria for PRES were dichotomized into children (less than 18 years) and adults (18 years or older) based on their age groups, and comparison of their baseline variables, clinical, laboratory, and imaging features was performed.ResultsDuring this study period, 19 pediatric patients and 100 adult patients with PRES were identified. On univariate analysis, factors significantly associated with pediatric patients with the syndrome were multiorgan failure (84.2% vs 50%, P = 0.006), temporal lobe involvement (63.3% vs 39%, P = 0.04), restricted diffusion (42.1% vs 18%, P = 0.02), and less likelihood of cerebellar involvement (21.1% vs 57%, P = 0.004). On bivariate logistic regression analysis, all these factors remained significantly associated with pediatric PRES; multiorgan failure (odds ratio: 5.80, 95% confidence interval: 1.45 to 29.41, P = 0.03), temporal lobe involvement (odds ratio: 5.08, 95% confidence interval: 1.17 to 22.17, P = 0.03), restricted diffusion (odds ratio: 2.48, 95% confidence interval: 1.61 to 10.10, P = 0.02), and less likely to have cerebellar involvement (odds ratio: 0.08, 95% confidence interval: 0.002 to 0.39, P = 0.002).ConclusionsFactors unique to PRES in children compared with adults include a greater propensity with multi-organ failure, involvement of the temporal lobe, and restricted diffusion on imaging.     

生长抑素联合垂体后叶素治疗肝硬化并发上消化道大出血的疗效分析

目的：观察生长抑素联合垂体后叶素治疗肝硬化并发上消化道大出血的疗效。方法：随机将64例患者分为治疗组32例和对照组32例，两组均禁食、安置胃管，同时运用泮托拉唑40mg静滴。治疗组用生长抑素首推250μg，后以250Iμg／h持续微量泵人，垂体后叶素50u加人生理盐水维持静滴0．1u／min，对照组用生长抑素首推250μg，后以250μg／h持续微量泵人，观察疗效。结果：治疗组总有效率93．75％，对照组为84．4％，两组比较差异具有统计学意义（P〈0．05）。结论：生长抑素联合垂体后叶素治疗肝硬化上消化道大出血具有较好疗效。     

Sloping ABR baselines and the ECG myogenic artefact

Objective: To investigate the possibility that a sloping baseline in an ABR recording has its origins in cardiac activity and if so, identify how it is expressed. Design: The effect of ECG removal on the averaged ABR was investigated at two artefact rejection levels. Study sample: Ten 1-minute records of raw EEG containing ABR responses but contaminated with cardiac activity were recorded from babies under 12 weeks of age and re-averaged using two artefact rejection levels. The slope of the ABR recording was measured. The measurements were repeated after removing effectively the cardiac activity from the records. Results: A sloping baseline was observed at one or both artefact rejection levels in all records. The slope varied as the artefact rejection level was changed, suggesting this may be implicated in slope generation. The slope effectively disappeared when the cardiac activity was removed from the record. Conclusions: Cardiac activity has the potential to cause a sloping ABR baseline. A possible explanation for this effect is offered, together with suggestions for tester strategy when a sloping ABR baseline is seen in a clinical setting.     

1H-MRS检测帕金森病伴轻度认知障碍患者后扣带回代谢物

目的 探讨¹H-MRS波谱技术联合线性拟合模型（LCmodel）软件在帕金森病（PD）伴认知障碍中的诊断价值。方法 选取PD患者35例（PD组）和健康体检者22名（对照组）,并根据是否伴有认知功能障碍,将PD组分为PDN亚组和PDMCI亚组。采用¹H-MRS波谱技术联合LCmodel软件获取PD组与对照组后扣带回（PCG）区域的波谱及代谢物的绝对浓度。比较2组各代谢物绝对浓度,并分析各代谢物绝对浓度与认知功能评分的相关性。结果 PDN亚组各代谢物绝对浓度与对照组差异均无统计学意义（P均>0.05）,PDMCI亚组总肌酸（tCr）、N-乙酰天门冬氨酸（NAA）、肌醇（mI）和胆碱复合物（tCho）的绝对浓度均较对照组降低（P均<0.05）;PDMCI亚组tCr绝对浓度较PDN亚组降低（P<0.05）。tCr（r=0.444,P=0.01）、谷胱甘肽（GSH;r=0.393,P=0.024）绝对浓度与MMSE评分存在相关性;tCr（r=0.367,P=0.035）、GSH（r=0.376,P=0.031）及tCho（r=0.375,P=0.031）绝对浓度与MoCA评分存在相关性。结论 ¹H-MRS技术联合LCmodel软件可定量分析PCG区域代谢物变化,有助于评估PD伴认知障碍。     

CT评估成人后髁导静脉及其骨管

目的 基于头颈部CTA评估成人后髁导静脉的解剖学特征。方法 分析254例受检者（508侧）的头颈部CTA资料,经多平面重建后评估后髁导静脉的发生情况、走行、长度、截面积、内口连接位置及其与静脉回流优势和颈静脉球窝高位的关系。结果 254例（508侧）中,后髁导静脉发生率为50.98%（259/508）,性别、侧别间差异均无统计学意义,其中双侧37.40%（95/254）;走行为S型者175侧,直线型14侧,不规则型70侧;后髁导静脉中位长度为2.14（1.04,2.97） cm,中位截面积7.55（4.93,11.68） mm²;后髁导静脉内口与乙状窦下曲段连接43侧（43/259,16.60%）,与颈静脉球连接149侧（149/259,57.53%）,与二者交界处连接67侧（67/259,25.87%）;脑静脉回流优势侧（116/218,53.21%）与非优势侧（143/290,49.31%）间同侧后髁导静脉的出现率差异无统计学意义（P=0.759）;在19侧粗大后髁导静脉中,14侧脑静脉回流为同侧优势型,粗大与非粗大后髁导静脉间静脉回流优势侧所占比差异有统计学意义（P=0.021）;颈静脉球窝高位侧后髁导静脉出现率（158/288,54.86%）高于无高位侧（101/220,45.91%;P=0.028）。结论 后髁导静脉不同个体间变化差异大,CT可清晰显示其解剖学特征。     

分子医学影像研究进展(上)

分子医学影像技术应用影像学的方法对活体状态下的生物过程进行细胞和分子水平的定性与定量研究,极大地改变着我们对于生理作用机制、药物研发、疾病诊断与评估方面的认识角度和研究方法。本文综述了其核心技术的研究进展与应用分析,指出分子医学影像技术在生物医学工程研究和临床诊断中的重要性。