Percutaneous fetal surgery using epidural catheter: preliminary experience acquired from 24 cases

Objective The objective of the following study is to report the experience acquired from 24 percutaneous fetal surgeries for cavity drainage using epidural catheter instead of the commercially available catheter. Methods Twenty-four percutaneous fetal surgeries for cavity drainage were performed, due to the following anomalies: 13 cases of lower urinary tract obstruction, nine cases of pleural effusion, and two cases of pulmonary cystic adenomatoid malformation type I. In order to verify that catheter adequacy, technical and obstetric complications derived from its use were assessed. Technical complications were difficulty in inserting the catheter and/or its functionality; and obstetric complications were the presence of bleeding, amniotic infection, preterm labor or premature rupture of membranes. Results The technical complications were the following: difficulty in passing the catheter through epidural needle in one case; one case of catheter drawn back with the needle; two cases of catheter dislodgment; and four cases of non-functionality of the catheter. Among the obstetric complications, there was only one case of preterm labor, and except from one fetus with chromosomal pathology, all the other 23 newborns were alive after 1 week. Conclusions The use of the epidural catheter can be seen as a viable alternative to percutaneous surgeries of fetal cavity shunting, due to its low cost and similar complications to the use of the conventional catheter.     

血清超敏C反应蛋白与尿碘水平联合预测先兆流产患者保胎结局的研究

目的观察血清超敏C反应蛋白(hs-CRP)与尿碘水平联合对先兆流产患者保胎结局的预测效能。方法前瞻性选取海南医学院第二附属医院2018年1月至2020年1月收治的112例先兆流产患者作为研究对象,根据保胎结局将患者分为保胎失败组(n=20)与保胎成功组(n=92)。检测两组入院时各主要指标[甲状腺功能相关指标、血清孕酮(P)、β-人绒毛膜促性腺激素(β-HCG)、hs-CRP、尿碘水平],采用Logistic回归分析各主要指标与先兆流产患者保胎结局的关系,并分析入院时血清hs-CRP、尿碘水平对先兆流产患者保胎结局的预测效能。结果保胎失败组P、β-HCG水平低于保胎成功组,hs-CRP水平高于保胎成功组,合并甲状腺功能异常、尿碘水平异常占比高于保胎成功组(P<0.05)。经Logistic回归分析结果显示,先兆流产患者甲状腺功能异常、hs-CRP表达上调、尿碘水平异常是保胎成功的危险因素(OR>1,P<0.05);先兆流产患者P、β-HCG表达上调是保胎成功的保护因素(OR<1,P<0.05);绘制受试者工作特征(ROC)曲线发现,先兆流产患者hs-CRP...     

Does chronic kidney disease affect the complications and prognosis of patients after primary colorectal cancer surgery?

BACKGROUNDThe effect of chronic kidney disease (CKD) on the outcomes of colorectal cancer (CRC) patients after primary CRC surgery is controversial.AIMTo analyze whether CKD had specific effect on the outcomes after CRC surgery.METHODSWe searched the PubMed, Embase, Cochrane Library databases and CNKI, from inception to March 14, 2022. Newcastle-Ottawa Scale was used for the quality assessment in this meta-analysis, and we used RevMan 5.3 was used for data analysis.RESULTSA total of nine studies including 47771 patients were eligible for this meta-analysis. No significant difference was found in terms of overall postoperative complications [odds ratio (OR) = 1.78, 95%CI: 0.64-4.94, P = 0.27]. We analyzed the specific complications and found that the CKD group had higher rates of pulmonary infection (OR = 2.70, 95%CI: 1.82-4.00, P < 0.01), cardiovascular complications (OR = 3.39, 95%CI: 2.34-4.91, P < 0.01) and short-term death (OR = 3.01, 95%CI: 2.20-4.11, P < 0.01). After pooling the hazard ratio (HR), the CKD group had worse overall survival (OS) (HR = 1.51, 95%CI: 1.04-2.20, P = 0.03). We performed subgroup analyses of the dialysis and non-dialysis groups, and no significant difference was found in the non-dialysis group (HR = 1.20, 95%CI: 0.98-1.47, P = 0.08). The dialysis group had worse OS (HR = 3.36, 95%CI: 1.92-5.50, P < 0.01) than the non-dialysis group. The CKD group had worse disease-free survival (DFS) (HR = 1.41, 95%CI: 1.12-1.78, P < 0.01), and in the subgroup analysis of the dialysis and non-dialysis groups, no significant difference was found in the non-dialysis group (HR = 1.27, 95%CI: 0.97-1.66, P = 0.08). The dialysis group had worse OS (HR = 1.95, 95%CI: 1.23-3.10, P < 0.01) than the non-dialysis group.CONCLUSIONPreexisting CKD was associated with higher rates of pulmonary infection, higher rates of short-term death, and worse OS and poorer DFS following CRC surgery.     

Complex Pathophysiology of Abusive Head Trauma with Poor Neurological Outcome in Infants

Abusive head trauma (AHT) in infants, especially acute subdural hematoma, has an extremely poor outcome. The most decisive and important finding is the appearance of a widespread low-density area on head computed tomography. This phenomenon was traditionally thought to be caused by cerebral ischemia. However, many other pathophysiological abnormalities have been found to be intricately involved. Recent studies have found that status epilepticus and hyperperfusion injures are the major causes. Another serious problem associated with AHT is cardiopulmonary arrest (CPA). Many infants are reported to visit to the hospital with CPA, and its pathophysiology has not been fully elucidated. This paper examines the background of these pathological conditions and associated factors and elucidate the pathophysiological mechanisms resulting in poor outcomes in AHT. In addition to the intensity of assault on the head, the peculiar pathophysiological characteristics in infants, as well as the social background specific to child abuse, are found to be associated with poor outcome.     

急性脊柱创伤诊断及治疗的临床研究

目的研究急性脊柱创伤诊断及急性脊柱创伤手术治疗方法。方法回顾34例脊柱创伤的患者的临床及影像学资料,均采用短节段椎弓根钉固定治疗。术后1月复诊,观察骨折的恢复情况,神经功能恢复按Frankel评分。结果患者术后恢复情况良好,Frankel评分有显著改变。结论手术方法的选择应参考患者骨折类型,内固定器的特点,适合的手术方法,对患者的恢复及术后并发症的减少是很有意义的。     

The Sensational Hand: Clinical Assessment after Nerve Repair

Following the transection and repair of major nerve trunks in the forearm, the functional outcome is influenced by mechanisms in the peripheral, as well as in the central nervous system. In the present thesis the interest is focused on assessment of the outcome after nerve repair, central nervous factors influencing the outcome, and sense substitution to compensate for sensory loss. A new model instrument for routine documentation of the outcome after repair of a peripheral nerve is identified. The model includes assessments reflecting sensory, motor and pain/discomfort domains. Investigations of frequently used assessment instruments led to the construction and evaluation of a new test instrument for assessment of discriminative sensibility (tactile gnosis) to fit in the model. The summarised outcome, calculated from the model instrument and with a numerical scoring system, conforms well with the patient's opinion on the influence on activities of daily living resulting from the nerve injury, and demonstrates good reliability and validity. A reference interval for the outcome is presented, with the estimated 95% predicted values for the outcome up to five years after the nerve repair. Brain plasticity is a factor sensibility - tactile gnosis - in the adaptive process after a nerve injury, when the mind has to interpret new signal patterns, when objects are touched. For better understanding of the sensory outcome after nerve repair, central nervous factors were examined. Specific cognitive capacities, such as verbal learning and visuo-spatial logic capacity could be identified as being of importance for recovery of tactile gnosis. For patients with temporary or permanent sensory loss, a new principle for artificial sensibility based on sense substitution is presented. The hearing sense substitutes the sense of touch. The resemblance in perceptual experience between sound and touch is bridged by the stereophonic friction sound generated by touching objects, which is then amplified and transmitted to earphones. The delicate capacity of the sense of hearing to discriminate between the complex pattern of frequencies makes it reasonable to assume that hearing is able to take over functions normally devoted to touch. This is demonstrated in the thesis.     

Practical selection criteria for unenhanced cranial CT in patients with acute headache

We studied clinical predictors of cranial computed tomography (CT) abnormalities in patients with acute or acutely worsened headache. Data were collected from chart review of 333 consecutive patients presenting to an emergency department and who were clinically selected for cranial CT. Patients with a positive neurologic examination were at 10.7 times greater risk for a positive CT than the rest of the sample (p<1.5 – 10⁻¹⁰). Using only neurologic examination to select patients for CT would have missed 30.3% of the positive scans. The amnesia, depressed sensorium, and hypertension variables had CT yields approximating 10% or greater even in the presence of a negative neurologic examination. Together with a positive neurologic examination, these variables detected 87.9% of the patients in this sample with positive scans; their absence had a negative predictive value of 98.0%. Of the four patients with positive scans who would have been missed using this strategy, one was discharged directly from the emergency department anyway and the other three developed positive neurologic examinations within 24 hours. One died of causes unrelated to the intracranial pathology. Positive neurologic examination, hypertension, history of amnesia, or a depressed sensorium provide reasonable initial guidelines to select for CT patients with an acute headache.