ObjectiveTo explore the clinical value of dual-source CT perfusion imaging (CTPI) in the assessment of cerebral hemodynamic changes in patients with internal carotid atherosclerosis. MethodsThirty patients diagnosed to have internal carotid atherosclerosis by CT angiography examination with various degrees of stenosis or occlusion were treated between January 2012 and May 2013. Whole brain perfusion imaging was performed on all the patients. We rebuilt the CTPI figure parameters respectively, including cerebral blood volume (CBV), blood flow (CBF), mean transit time (MTT) and time to peak (TTP) to assess brain tissue perfusion. ResultsIn the 30 patients with internal carotid atherosclerosis, 8 had mild stenosis lumen, 12 moderate stenosis, 7 severe stenosis and 3 had occlusion. In mild stenosis cases, TTP of stenosis-side vessels was higher than those of coutralateral side (P<0.05), and there were no significant differences in other perfusion parameters between bilateral vessels among mild stenosis cases (P>0.05). MTT and TTP of stenosis-side vessels were higher than those of contralateral side in moderate stenosis cases (P<0.05). In severe stenosis or obstruction cases, MTT and TTP of stenosis-side vessels were higher than those of contralateral side, while CBF and CBV of stenosis-side vessels were lower than contralateral side (P<0.05). Twenty-two in the 30 cases had perfusion abnormalities, and there was a significant difference between the stenosis side cerebral perfusion and the healthy side mirror area (P<0.05). ConclusionCTPI can reflect brain tissue perfusion early and comprehensively, and fully reflect internal carotid atherosclerosis caused by severe stenosis or occlusion of cerebral hemodynamic changes, which provides important information for clinical treatment and helps clinicians to formulate individualized treatment plan.
ObjectiveTo evaluate if intravenous lidocaine can reduce the stress response induced by fiberoptic bronchoscopy in patients under general anesthesia. MethodsSixty patients undergoing fiberoptic bronchoscopy under unconsciousness between November 2013 and July 2014 were randomly divided into two groups: lidocaine group (n=30) and control group (n=30). Patients in the lidocaine group received an intravenous injection of lidocaine for 1 mg/kg during induction and then continuous intravenous infusion of 2% lidocaine with a dose of 3 mg/(kg·h). The same volume of saline was given to patients of the control group in the same way. Laryngeal mask airway was placed after anesthesia induction. Variables of heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and pulse oxygen saturation were observed and recorded at five time points: before induction, immediately after induction, immediately after laryngeal mask airway placement, fiberoptic bronchoscopy across tracheal carina and before leaving examination room. Complications including cough reflex, toxicity reaction of local anesthetics, and injection pain were also observed. ResultsThe examination was successfully completed in all patients. Blood pressure and heart rate increased in all patients when fiberoptic bronchoscopy got across tracheal carina. There were no statistically significant differences in the two groups (P>0.05). Patients in the two groups had no statistic difference in tinnitus and numbness of tongue (P>0.05). Compared with the control group, patients in the lidocaine group had lower incidence of injection pain (P<0.05). ConclusionIntravenous lidocaine cannot suppress stress response induced by fiberoptic bronchoscopy effectively.
ObjectiveTo evaluate clinical value of colon leakage score (CLS), a preoperative predictive scoring system, for risk of anastomotic leakage after left-sided colorectal cancer surgery. MethodsThe clinical data of 310 patients who underwent left-sided colorectal cancer surgery from January 2010 to December 2014 were studied retrospectively. Risk factors for postoperative anastomotic leakage were analyzed by univariate analysis. The sensitivity and specificity of CLS system were determined by receiver operating characteristic (ROC) curve analysis. Resultsa total of 14 patients were diagnosed as anastomotic leakage. The point of CLS for the patients with anastomotic leakage was significantly higher than that for the patients without anastomotic leakage (14.21±5.76 versus 4.43±3.36, t=9.474, P=0.000). The results of ROC curve analysis showed that the sensitivity and specificity of the CLS system were 92.9% and 88.6%, respectively. The area under the curve was 0.957 (95% CI 0.924-0.991). The best cut off value of CLS was 10 (The Youden index was 0.867). The results of univariate analysis showed that the age, preoperative hemoglobin level, status of intestinal obstruction, and blood loss were associated with postoperative anastomotic leakage (P<0.05). ConclusionThe preoperative predictive score system CLS could accurately predict occurrence of anastomotic leakage. While large, multicenter prospective randomized controlled trial is still needed to further confirm it.
ObjectiveTo systematically review the effects of enteral feeding pump and intermittent bolus nasogastric feeding on gastric retention, diarrhea, regurgitation, and other complications of patients who received enteral nutrition treatment. MethodsWe electronically searched databases including PubMed (1980-2013.9), Wiley Online Library (1990-2013.9), Elsevier (1990-2013.9), CNKI (1990-2013.9), VIP (1989-2013.9) and WanFang Data (1990-2013.9), to collect randomized controlled trials (RCTs) about enteral feeding pump and intermittent bolus nasogastric feeding. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the methodological quality of the included studies, and then meta-analysis was performed using RevMan 5.2.6 software. ResultsA total of 16 trials involving 1 263 patients were finally included. The results of meta-analysis indicated that enteral feeding pump was better than intermittent bolus nasogastric feeding in the incidences of gastric retention (OR=0.27, 95%CI 0.16 to 0.45, P < 0.000 01), diarrhea (OR=0.24, 95%CI 0.16 to 0.34, P < 0.000 01), regurgitation (OR=0.26, 95%CI 0.11 to 0.65, P=0.004), aspiration (OR=0.19, 95%CI 0.11 to 0.32, P < 0.000 01), aspiration pneumonia (OR=0.40, 95%CI 0.23 to 0.68, P=0.000 7), and abdominal distension (OR=0.24, 95%CI 0.10 to 0.57, P=0.001), with significant differences. However, they were alike in the incidence of tub obstruction (OR=0.43, 95%CI 0.14 to 1.29, P=0.13). ConclusionAccording to existing relevant RCTs, enteral feeding pump is better than intermittent bolus nasogastric feeding in reducing enteral nutrition complications to some extent. However, due to the low methodological quality of the included studies, more large-scale, multicentre high quality RCTs are still needed to verify the aforementioned conclusion.
ObjectiveTo analyze the incidence of and prevention strategies for bone cement leakage after percutaneous vertebroplasty (PVP) or kyphoplasty (PKP) for treatment of osteoporotic vertebral compression fractures. MethodsA retrospective analysis was carried out on the clinical data of 178 patients who had 268 thoracolumbar osteoporotic compressions and underwent PVP or PKP from January 2010 to January 2013 in our hospital. We analyzed the causes of and prevention strategies for bone cement leakage. The therapeutic effect was observed after operation. We summarized the causes and prevention strategies for the bone cement leakage. ResultsStatistics showed that 51 vertebrae (19.0%) had bone cement leakage, including 31 vertebrae (29.2%) after PVP and 20 vertebrae (12.3%) after PKP. All patients had back pain relief after operation. One patient with bone cement leakage had the nerve root injured, which was relieved by decompression. Other patients had no reaction. ConclusionThe causes of cement leakage were related to the patients' own factors, but were more related to the operations. Adequate preparation before operation, correct surgical technology during operation, taking necessary precautions and X-ray monitoring are the key to the prevention of cement leakage.
ObjectiveTo introduce and analyze the role of tibial tubercle internal rotation to treat recurrent patellar dislocation associated with trochlear dysplasia. MethodsBetween February 2007 and April 2011, 28 patients with recurrent patellar dislocation underwent tibial tubercle translocation through medial transfer, rotation and elevation of the tibial tuberosity and the medial patellofemoral ligament (MPFL) reconstruction. There were 4 males and 24 females with an average age of 21.8 years (range, 17-28 years). The disease duration ranged from 6 months to 8 years (mean, 4 years). The patients suffered from 3-10 times patellar dislocation. The result of apprehension test was positive; Lysholm score was (51.64±3.79); Kujala score was (56.89±3.79). According to Dejour classification, 11 cases were rated as type B, 14 cases as type C, and 3 cases as type D; the tibial tuberosity-trocholear distance (TT-TG) was (20.53±2.58) mm; and the patellar tilt angle (PTA) was (29.34±2.54)°. ResultsPrimary healing of incision was obtained in the others except 1 case of mild infection. Twenty-seven patients were followed up 41.8 months on average (range, 27-74 months). No recurrent dislocation was found, and the result of apprehension test was negative. The knee range of motion restored to normal totally. The postoperative Kujala score and Lysholm score were significantly improved to 88.97±3.06 and 88.95±2.98 (t=-42.005, P=0.000; t=-43.122, P=0.000) respectively. TT-TG and PTA restored to normal[(11.77±2.24) mm and (7.99±2.57)°], showing significant differences when compared with preoperative ones(t=13.032, P=0.000; t=29.533, P=0.000). ConclusionThe technique of tibial tubercle translocation and MPFL reconstruction is an effective surgical procedure for the treatment of recurrent patellar dislocation associated with trochlear dysplasia. Especially, tibial tubercle internal rotation can improve the patella stability and knee function.
ObjectiveTo systematically assess the quality of evidence-based clinical guidelines and to compare the differences and similarities between recommendations, so as to provide references for clinical application. MethodsDatabases such as the TRIP, PubMed, CNKI, VIP, WanFang Data, CBM, National Guideline Clearinghouse and Guidelines International Network were searched to collect evidence-based guidelines on medication therapy for children with rheumatic fever. Methodological quality of included guidelines was assessed according to the AGREE Ⅱ instrument, and differences and similarities among recommendations were compared. ResultsOnly one evidence-based clinical guideline from Australia was included. Among 6 domains which were rated using the AGREE Ⅱ instrument, "scope and purpose", "stakeholder involvement", "rigor of development", "clarity and presentation" and "applicability" were scored more than 50%; while "editorial independence" was scored less than 50%. ConclusionThe included guideline is of relatively high quality; however, its application among Chinese population still has limitations. Thus, the development of national guidelines is urgently needed.
ObjectiveTo systematically assess the quality of evidence-based clinical guidelines on the treatment of children with juvenile idiopathic arthritis and to compare the differences and similarities between recommendations, so as to provide references for clinical application. MethodsDatabases such as the TRIP, PubMed, CNKI, VIP, WanFang Data, CBM, U.S National Guideline Clearinghouse and Guidelines International Network were searched to collect evidencebased guidelines on medication therapy for children with juvenile idiopathic arthritis. Methodological quality of included guidelines was assessed according to the AGREE Ⅲ instrument, and differences and similarities among recommendations were compared. ResultsTwo evidence-based clinical guidelines from Australia and China were included. Among 6 domains of the Australian guideline which were rated using AGREE Ⅲ instrument, "scope and purpose", "stakeholder involvement", "rigor of development", "clarity and presentation", "applicability" and "editorial independence" were scored more than 50%. As for Chinese guideline, "scope and purpose", "stakeholder involvement", "rigor of development", "clarity and presentation" and "editorial independence" was all scored more than 50%, but "applicability" was scored less than 50%. ConclusionThe included guidelines are of high quality and strongly recommended, but the recommendations might exist limitation for Chinese children. Thus, the development of relevant Chinese evidence-based guidelines are urgently needed.
ObjectiveTo investigate the relation between colonic adenomatous polyps and Helicobacter pylori infection. MethodsA case-control study was conducted to collect clinical data of patients with colonic adenomatous polyps in People's Hospital of Zhongjiang County from February 2014 to September 2015. Patients with healthy colon of the corresponding period of the hospital were collected as a control group. The difference of positive rate of Hp infection was compared between the colonic adenomatous polyps group and the control group. According to the age, gender, living condition, location, type of pedicle, pathological type and number, the colonic adenomatous polyps group was divided into subgroups and the differences of positive rate of Hp infection were compared among the subgroups. ResultsA total of 219 patients involving 119 cases and 100 controls were included. The positive rate of Hp infection in the colonic adenomatous polyps group was significantly higher than that in the control group (69.7% vs. 52.0%) with a significant difference (χ2=7.239, P=0.007). Among 119 patients with colonic adenomatous polyps, no statistical differences were found in the positive rate of Hp infection among subgroups of different age, gender, living condition, location, type of pedicle, pathological type and number (all P values>0.05). ConclusionHp infection may increase the risk of developing colonic adenomatous polyps.
ObjectiveTo systematically evaluate the effects of nine different dressings in the treatment of diabetic foot (DF). MethodsDatabases including PubMed, The Cochrane Library (Issue 2, 2016), Web of Science, EMbase, CBM, CNKI and WanFang Data were searched to collect randomized control trials (RCTs) about the effects of dressings for the DF from inception to April 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then network meta-analysis was performed using WinBugs 1.4.3 and Stata 13.0 softwares. ResultsA total of 29 RCTs involving 2 393 patients were included. The network meta-analysis showed that silver ion was superior to alginate, hydrogel, honey, sterile gauze and povidone-iodine gauze; Alginate was superior to sterile gauze and povidone-iodine gauze; Hydrogel was superior to povidone-iodine gauze; Honey was superior to sterile gauze and povidone-iodine gauze; Foam was superior to silver ion, alginate, hydrogel, honey, sterile gauze, povidone-iodine gauze and antibacterials gauze; Chitosan was superior to hydrogel, sterile gauze and povidone-iodine gauze; Antibacterials gauze was superior to sterile gauze and povidone-iodine gauze. All of the differences were statistically significant. Probability ranking according to SUCRA showed that there was a great possibility for foam and chitosan in the treatment of DF. ConclusionBased on the results of network meta-analysis and rank, foam dressing and chitosan dressing are superior to other dressings in the treatment of DF. More attentions should be made regarding comparisons directly of different dressing and reporting of cost-effective analysis.