Objective To summarize and explore the clinical features, diagnosis and treatment of severe pulmonary tuberculosis (TB). Methods One death case of pulmonary TB in The First Affiliated Hospital of Soochow University was analyzed, related publications of case reports and articles relevant on the analysis and study of pulmonary tuberculosis deaths from Pubmed between January 2012 and March 2022 were also reviewed. Results A 25-year-old female patient was admitted for "intermittent cough with sputum for more than 1 year, aggravated with chest tightness and shortness of breath for 5 days". She had no underlying disease. Pulmonary TB was diagnosed by TB bacterium smear and next-generation sequencing of bronchoalveolar lavage fluid. The patient was in shock compensation period and developed acute respiratory distress syndrome immediately after admission. Through active anti-tuberculosis, invasive mechanical ventilation, intra-aortic balloon counterpulsation and continuous renal replacement therapy, the disease continued to deteriorate and she died on the third day after admission. A total of 269 pulmonary TB deaths were retrieved. An analysis of 244 patients' past medical history showed that human immunodeficiency virus co-infection was the most common among young people and chronic diseases were the most common among the elderly. All 269 patients died of septic shock, respiratory failure and multiple organ dysfunction syndrome (MODS), among which hyponatremia was also a significant complication. The shortest time from admission to death was 7 days, while the longest average time was only 35 days. Conclusions Pulmonary TB could develop into septic shock and MODS with poor prognosis and high mortality. Health education on TB should be strengthened.
Objective To evaluate the current status of classification and repair methods for dural injury caused by spinal surgery or trauma, providing new strategies and ideas for the clinical repair of dural injury and the development of related materials. MethodsThe literature related to dural injury both at home and abroad in recent years was thoroughly reviewed and analyzed in order to draw meaningful conclusions. ResultsThere have been numerous retrospective studies on dural injury, but there is a scarcity of prospective and multi-center studies, resulting in a low level of evidence-based research. The incidence and risk factors of dural injury have primarily been studied in relation to common degenerative spinal diseases of the cervical and lumbar spine, with insufficient research on thoracic spine-related diseases. Currently, a universally recognized method for grading and classifying dural injury has not been established, which hampers the development of clinical guidelines for their repair. Furthermore, although there are repair materials and surgical strategies available to address clinical issues such as suture leakage and surgical repair of dural injury in complex locations, there is a lack of comprehensive clinical research and evidence-based data to validate their scientificity and reliability. ConclusionRegardless of the classification of dural injury, suture remains the most important repair method. It is important to further develop new patches or sealants that can meet clinical needs and reduce the difficulty of repair.
Objective To investigate the clinical characteristics of patients with COVID-19 associated pulmonary aspergillosis (CAPA). Methods The clinical data of patients diagnosed with CAPA admitted to the First Affiliated Hospital of Soochow University from December 16, 2022 to February 2, 2023 were collected and analyzed. Results Among the 43 enrolled patients,16 patients required invasive mechanical ventilation, 44.19% (19/43) of them with critical novel coronavirus pneumonia, and 86.05% (37/43) had underlying diseases. The peak period of CAPA was 14 - 28 days after SARS-CoV-2 infection (48.84%, 21/43). In the laboratory results, 86.05% (37/43) of patients had varying degrees of lymphocyte reduction, with a lymphocyte count of 0.63 (0.33, 0.96) × 109/L, the median levels of procalcitonin, CRP, and erythrocyte sedimentation rate were all higher than the reference values. 38.89% (14/36) of patients tested positive for serum GM test, and 75.00% (9/12) of patients tested positive for bronchoalveolar lavage fluid GM test. Aspergillus fumigatus is the most common strain. Voriconazole is the most commonly used antifungal drug (86.05%), and other drugs used include caspofungin, posaconazole, isavuconazonium, and amphotericin B. Two patients received local treatment with amphotericin B under bronchoscopy. After treatment, 27 patients improved and were discharged. Conclusions The symptoms, signs, and imaging manifestations of CAPA are not significantly specific, and are prone to misdiagnosis and missed diagnosis. The mortality rate is high. For patients suspected of CAPA and those with CAPA risk factors, relevant examinations should be promptly improved to improve diagnosis and treatment efficiency.
Objective To explore the pathogens and clinical features of immunocompromised hosts with septicaemia.Methods The data including underlying diseases, peripheral blood granulocyte count, temperature at blood sampling, management and prognosis)of 160 immunocompromised hosts with septicaemia were analyzed retrospectively．Results 8 patients had twice septicaemia in hospital stay and 3 patients had plural pathogenic septicaemia.171 strains of microorganisms were isolated from blood cultured of 160 septic immuno- compromised hosts in which 156 strains (91.2%) were bacteria, 37 strains(21.6%) were gram positive cocci, 6 strains(3.5%) were gram positive bacilli, 113 strains (66.1%) were gram negative bacilli and 15 strains (8.8%) were fungi. Staphylococcus spp (17 strains) and Streptococcus spp (14 strains) were the predominant pathogens among gram positive cocci and Corynebacteria (5 strains ) were the main pathogen in gram positive bacilli while Escherichia coli (60 strains), Klebsiella pneumoniae (20 strains) and Pseudomonas aeruginosa (15 strains) were the most common bacteria in gram negative bacilli. There were 12 strains of Staphylococcus aureus among the 17 strains of Staphylococcus spp, all of them were methicillin sensitive (MSSA). 17 strains of Escherichia coli, 2 strains of Klebsiella pneumoniae and 1 strain of Klebsiella oxytoca produced ESBLs. Candida was the only pathogens of fungemia in this study in which 4 strains of Candida albicans and 11 strains of non-albicans Candida were detected. There were 120 patients(75%) with granulocytopeniain which 103 patients were agranulocytosis. 70% of the 160 paitents had hyperpyrexia. All patients received broad spectrum antibiotics therapy in the study while 58.8% received antifungal drugs at the same time. 20 patients died of septicaemia and 19 patients gave up therapy because of their conditions deteriorated.The overall improvement rate were 75.6%. Conclusions Bacteria are the main pathogens in septicaemia of immunocom- promised host and fungemia is increasing in recent years.Agranulocytosis is a risk factor of septicaemia in immunocompromised hosts. Hyperpyrexia is one of characteristic signs of these patients.
Objective To evaluate the fixation strength of expansive pedicle screw (EPS) at different bone mineral density (BMD) levels, further to provide theoretical evidence for the clinical application of the EPS in patients with osteoporosis. Methods Fresh human cadaver spines (T12-L5 spines) were divided into 4 levels: normal BMD, osteopenia, osteoporosis, and severe osteoporosis according to the value of BMD, 12 vertebra in each level. Conventional pedicle screw (CPS) or EPS was implanted into the bilateral vertebra in CPS group and EPS group, respectively, 12 screws in each group per BMD level. Screw pullout tests were conducted. The maximum pullout strength, stiffness, and energy absorption were determined by an AG-IS material testing machine with constant rate of loading in a speed of 5 mm/ min. Results With the decline of BMD from normal to severe osteoporosis level, the maximum pullout strength and the stiffness correspondingly declined (P lt; 0.05). In CPS group, the energy absorption gradually decreased (P lt; 0.05); in EPS group, significant difference was found between other different BMD levels (P lt; 0.05) except between normal BMD and osteopenia and between osteoporosis and severe osteoporosis (P gt; 0.05). At the same BMD level, the maximum pullout strength of EPS group was significantly larger than that of CPS group (P lt; 0.05); the stiffness of EPS group was significantly higher than that of CPS group (P lt; 0.05) except one at normal BMD level; and no significant difference was found in the energy absorption between 2 groups (P gt; 0.05) except one at osteopenia level. No significant difference was found in maximum pullout strength, stiffness, and energy absorption between EPS group at osteoporosis level and CPS group at osteopenia level (P gt; 0.05); however, the maximum pullout strength, stiffness, and energy absorption of EPS group at severe osteoporosis level were significantly lower than those of CPS group at osteopenia level (P lt; 0.05). Conclusion Compared with CPS, the EPS can significantly improve the fixation strength, especially in patients with osteopenia or osteoporosis.
Objective To review the research background, biomechanical characteristics, and clinical application of fenestrated pedicle screw (FPS). Methods The recent literature about the study and application of FPS was reviewed, analyzed, and summarized. Results Compared with the technique of conventional pedicle screw augmentation, FPS can be augmented with polymethyl methacrylate (PMMA) through inner central pore and side holes. Hence, the augmentation process of FPS is more convenient during operation. The biomechanics of PMMA augmented FPS is strong enough for instrumentation in osteoporotic vertebra body and the way of FPS PMMA augmentation can reduce the risk of PMMA leakage. Conclusion FPS is an innovation in the technology of spinal instrumentation, which is expected to improve the clinical outcome of PMMA augmented pedicle screw in osteoporotic vertebra body fixation.
Objective To investigate the biomechanical properties of porous bioactive bone cement (PBC) in vivo and to observe the degradation of PBC and new bone formation histologically. Methods According to the weight percentage (W/ W, %) of polymethylmethacrylate (PMMA) to bioglass to chitosan, 3 kinds of PBS powders were obtained: PBC I (50 ︰ 40 ︰ 10), PBC II (40 ︰ 50 ︰ 10), and PBC III (30 ︰ 60 ︰ 10). The bilateral femoral condylar defect model (4 mm in diameter and 10 mm in depth) was established in 32 10-month-old New Zealand white rabbits (male or female, weighing 4.0-4.5 kg), which were randomly divided into 4 groups (n=8); pure PMMA (group A), PBC I (group B), PBC II (group C), and PBC III (group D) were implanted in the bilateral femoral condylar defects, respectively. Gross observation were done after operation. X-ray films were taken after 1 week. At 3 and 6 months after operation, the bone cement specimens were harvested for mechanical test and histological examination. Four kinds of unplanted cement were also used for biomechanical test as control. Results All rabbits survived to the end of experiment. The X-ray films revealed the location of bone cement was at the right position after 1 week. Before implantation, at 3 months and 6 months after operation, the compressive strength and elastic modulus of groups C and D decreased significantly when compared with those of group A (P lt; 0.05), but no significant difference was found between groups C and D (P gt; 0.05); the compressive strength at each time point and elastic modulus at 3 and 6 months of group B decreased significantly when compared with those of group A (P lt; 0.05). Before implantation and at 3 months after operation, the compressive strength and elastic modulus of groups C and D decreased significantly when compared with those of group B (P lt; 0.05); at 6 months after operation, the compressive strength of group C and the elastic modulus of group D were significantly lower than those of group B (P lt; 0.05). The compressive strength and elastic modulus at 3 and 6 months after operation significantly decreased when compared with those before implantation in groups B, C, and D (P lt; 0.05), but no significant difference was found in group A (P lt; 0.05). At 3 months after operation, histological observation showed that a fibrous tissue layer formed between the PMMA cement and bone in group A, while chitosan particles degraded with different levels in groups B, C, and D, especially in group D. At 6 months after operation, chitosan particles partly degraded in groups B, C, and D with an amount of new bone ingrowth, and groups C and D was better than group B in bone growth; group A had no obvious change. Quantitative analysis results showed that the bone tissue percentage was gradually increased in the group A to group D, and the bone tissue percentage at 6 months after operation was significantly higher than that at 3 months within the group. Conclusion According to the weight percentage (W/W, %) of PMMA to bioglass to chitosan, PBCs made by the composition of 40 ︰ 50 ︰ 10 and 30 ︰ 60 ︰ 10 have better biocompatibility and biomechanical properties than PMMA cement, it may reduce the fracture risk of the adjacent vertebrae after vertebroplasty.