Volume 102 ·  Issue 17 ·  2022

Compared with younger and younger older adults, elderly patients (>75 years old) have more special problems such as multi-morbidity coexistence, multiple medication, and decline in multiple organ functions, resulting in increased difficulty in surgical decision-making, high intraoperative risk, high incidence of serious postoperative complications and mortality, and slow recovery process. In order to standardize the clinical path of perioperative multidisciplinary evaluation of elective spinal surgery patients, experts from the geriatric surgery expert group of the National Clinical Medical Research Center for Geriatric Diseases, the geriatric group of the orthopedic branch of Beijing Medical Association and the geriatric anesthesiology group of the anesthesiology branch of Chinese Medical Association reached the expert consensus on perioperative multidisciplinary evaluation of elderly spinal surgery patients for clinical reference after repeated demonstration based on evidence-based medicine.

Hypertonic saline therapy for cerebral edema and intracranial hypertension has increased in recent years, but there is a lack of expert consensus. In view of this, the consensus formulation group invited more than 30 domestic first-line neurosurgery critical care experts to screen out preliminary recommendations based on the clinical evidence level grading and recommendation level of Oxford University Evidence-based Medicine Center, focusing on the therapeutic effect, contraindications, adverse reactions, precautions, dosage, frequency and administration mode of hypertonic saline in the treatment of cerebral edema and intracranial hypertension, and then finally determined 19 recommendations based on the Delphi method evaluation opinions, so as to further standardize the application of hypertonic saline therapy in the field of neurosurgery.

Compared with traditional botulinum toxin injection, CT-guided radiofrequency treatment of hemifacial spasm is safer, more convenient and more economical than craniotomy for microvascular decompression. In order to realize the homogeneous development of CT-guided radiofrequency treatment of hemifacial spasm with stylomastoid facial nerve, this article elaborates the diagnosis and differential diagnosis of hemifacial spasm, the pathogenesis and principle of radiofrequency treatment, indications and contraindications of radiofrequency treatment, preoperative preparation and specific operation methods, efficacy judgment and radiofrequency end criteria, complication management and matters needing attention, and formulates this technical specification in detail.

Behcet's uveitis (BU) is a common type of uveitis with high blindness in China, and its diagnosis and treatment face many challenges. On the one hand, there is a shortage of uveitis specialists in China, and most ophthalmologists are not familiar with the systemic use of BU. On the other hand, it is also difficult for rheumatologists to grasp the clinical manifestations, diagnostic points and evaluation methods of BU. In order to improve the diagnosis and treatment level of BU in China, an interdisciplinary group composed of experts in uveitis and rheumatology and immunology has written this diagnosis and treatment recommendation on the basis of drawing lessons from domestic and foreign diagnosis and treatment experience and guidelines, covering the clinical manifestations, diagnosis and differential diagnosis, treatment and evaluation of BU, etc., for the reference of ophthalmologists and rheumatology and immunology doctors.

To explore the clinical value of four dimensional computed tomography (4 D CT) guided combined with deep inhalation and breath hold (DIBH) technique in the preoperative localization of solitary pulmonary nodules.

The data of a total of 106 patients with solitary pulmonary nodules from March 2018 to May 2021 in the Ningbo First Hospital were collected retrospectively. Among them, there were 26 males and 80 females aged from 21 to 83 (47.4±14.2) years. According to different localization methods, 53 cases were divided into the control group, as the pulmonary nodules were located by CT guided injection of indocyanine green under calm breathing and 53 cases were divided into in the experimental group, as those patients were treated with indocyanine green injection under the guidance of 4 D CT combined with DIBH technology to locate pulmonary nodules. The three-dimensional distance deviation between pulmonary nodules and indocyanine green injection points was compared between the two groups to obtain the accuracy of pulmonary nodule localization. The preoperative positioning time of the two groups was compared by timing.

Among the 106 patients, there were 46 pure ground glass nodules, 32 sub solid nodules and 28 solid nodules, all of which were successfully localized before operation, with a success rate of 100%. The size of pulmonary nodules in the control group was (9.1±2.3) mm and the three-dimensional deviation[M(Q₁, Q₃)]between indocyanine green injection site and pulmonary nodules was X axis [7.0 (3.7, 12.6)] mm, Y axis [6.6 (2.9, 11.2)] mm, Z axis [3.0 (2.0, 6.0)]mm, respectively, and the preoperative positioning time was (11.4±3.8) min. The size of pulmonary nodules in the experimental group was (8.9±2.1) mm, and the deviations in 3 D direction were X axis [4.8 (3.0, 7.9)]mm, Y axis [3.8 (1.3, 7.5)]mm, Z axis [4.0 (2.0, 6.0)] mm, respectively. The preoperative positioning time was (9.3±3.0) min. There were statistically significant differences in preoperative positioning time and deviation of X and Y axis between the experimental group and the control group (P<0.05), but no statistically significant differences was found in deviation of Z axis (P>0.05).

4 D CT guided DIBH technology could improve the accuracy of preoperative localization of pulmonary nodules and save operation time, which is worthy of popularization.

To construct a novel prognostic nomogram model based on more comprehensive variables for patients with small-cell lung cancer (SCLC).

The data of 722 patients with SCLC confirmed by pathology in Affiliated Cancer Hospital of Shanxi Medical University from January 2015 to December 2018 were retrospectively analyzed [including 592 males and 130 females, aged from 23 to 82(61±9) years]. A random seed count of 133 was used to divide those patients into training set (n=422) and validation set (n=300). Kaplan-Meier was used for survival curves analysis and univariate Log-rank test was used for evaluating the influence of clinical variables on the prognosis of sclc, variables with P<0.05 in univariate analysis were included in a multivariate Cox regression model. The nomogram was constructed based on the variables which P<0.05 in multivariate analysis. Receiver operating characteristic (ROC) curve, calibration by Integrated Brier score (IBS) and clinical net benefit by decision curve analysis (DCA) were used to evaluate model discriminative power, prediction error value, and clinical net benefit, and compared with the American Joint Committee on Cancer 8^th TNM.

Male, abnormal monocyte (MON) counts, abnormal neuron specific enolase (NSE), abnormal cytokeratin 19 fragment (Cyfra211), M1a stage, M1b stage, M1c stage, radiotherapy (RT), chemotherapy ≥4 cycles and prophylactic cranial irradiation (PCI) were prognostic factors for SCLC[HR(95%CI)=1.39(1.00-1.92), 1.29(1.02-1.63), 1.41(1.11-1.80), 2.02(1.48-2.76), 1.09(0.77-1.55), 1.44(0.94-2.22), 2.01(1.49-2.71), 0.75(0.57-0.98), 0.40(0.31-0.51)and 0.42(0.26-0.68), respectively, all P<0.05]. The area under ROC curve (AUC) of the nomogram in training set and validation set were 0.814(95%CI: 0.765-0.862)and 0.787 (95%CI: 0.725-0.849), which were higher than TNM [0.616(95%CI: 0.558-0.674) and 0.648(95%CI: 0.581-0.715)].The calibration curve showed a good correlation between the nomogram prediction and actual observation for the 2-year overall survival (OS). IBS indicted a lower prediction error rate (training set: 0.132 vs 0.169; validation set: 0.138 vs 0.169). DCA showed a wider threshold range than TNM (training set: 0.01-0.96 vs 0.01-0.85, validation set: 0.01-0.94 vs 0.01-0.86) and a greater improvement of the clinical net benefit (in training set the nomogram had a greater clinical benefit than TNM in the range of 0.19-0.96, and remained in validation set in the range of 0.19-0.94).

The established nomogram model for predicting 2-year OS in patients with SCLC based on 8 variables, including gender, MON, NSE, Cyfra211, M stage, RT, CT cycles and PCI can be used for an more accurately prognosis prediction and reference for therapeutic regimen selection.

To explore the application values of right atrial (RA) volume, myocardial strain and strain rate in evaluating right atrial functions in patients with essential hypertension (EHT) with normal left ventricular ejection fraction (LVEF).

We retrospectively collected a total of 126 EHT patients with normal LVEF, including 66 males and 60 females, age from 18 to 83(48±15) years from the Affiliated Changzhou No.2 People′s Hospital with Nanjing Medical University from March, 2018 to May, 2020. According to the left ventricular mass index, those patients were divided into without left ventricle hypertrophy (LVH) group (n=66) and LVH group (n=60), and 83 healthy volunteers were enrolled as control group, which including 42 males and 41 females, age from 14 to 88 (48±16) years. The total, passive and active RA emptying fraction (total RAEF, passive RAEF and active RAEF) were measured by using RA volumes method. The RA strain (S-reservoir, S-conduit, S-booster pump) and the strain rate (SR-reservoir, SR-conduit, SR-booster pump) were measured by two-dimensional speckle tracking echocardiography. Total RAEF, S-reservoir, and Sr-reservoir represented the reservoir function, while passive RAEF, S-conduit, and Sr-conduit represented the conduit function, and active RAEF, S-booster pump and Sr-booster pump represented the booster pump function, respectively. Than the values between the EHT patients and normal subjects, and the values among the EHT patients without LVH, EHT patients without LVH and normal subjects were compared.

The value of active RAEF was significantly lower in EHT patient than normal controls (40.1%±10.5% vs 45.4%±11.1%,P=0.001). There were significant differences among EHT patients without LVH, EHT patients with LVH and normal subjects in passive RAEF and active RAEF (passive RAEF: 40.2%±9.3% vs 36.4%±10.7% vs 36.5%±9.4%, P=0.038, active RAEF: 39.8%±10.6% vs 40.4%±10.4% vs 45.4%±11.1%, P=0.002). There were significant differences in S-reservoir, S-conduit, S-booster pump, SR-reservoir, SR-conduit and SR-booster pump between EHT patients and normal subjects [S-reservoir: 34.8%±13.7% vs 45.0%±13.3%, S-conduit: 18.3%±9.4% vs 26.5%±9.6%, S-booster pump: 16.4%±7.3% vs 18.6%±7.1%, SR-reservoir: (1.6±0.6)/s vs (2.0±0.6)/s, SR-conduit: (-1.2±0.5)/s vs (-1.6±0.6)/s, SR-booster pump: (-1.7±0.6)/s vs (-2.3±0.6)/s; all P<0.05]. The trend tests showed normal controls achieved the largest the absolute values of S-reservoir, S-conduit, SR-reservoir, SR-conduit, SR-booster pump, followed by EHT patients without LVH and EHT patients with LVH(all P<0.001).

Using RA volume, myocardial strain and strain rate can detect the RA impaired reservoir, conduit, and the booster pump functions in EHT patients with normal LVEF, and the RA functions were damaged more significantly in EHT patients with LVH.

To explore the application of cortical bone trajectory screw (CBTS) and sacral alar screw (SAS) internal fixation in the treatment of lumbar adjacent segment degeneration (ASD) and evaluate its clinical effect.

Data of 24 patients who were diagnosed with ASD and treated by CBTS or SAS in Beijing Chaoyang Hospital were retrospectively reviewed. There were 14 males and 10 females with a mean age of (67.9±8.2) years. The patients were followed-up for (2.6±0.4) years. Perioperative parameters including operation time, intraoperative blood loss and postoperative time on the ground were counted. All patients were followed-up for at least 2 years. Visual analogue scale (VAS) and the Oswestry disability index (ODI) were compared between pre-operation and at the last follow-up. The internal fixation-related complications, pseudarthrosis and adjacent re-degeneration were evaluated in the follow-up.

There were 14 proximal ASD patients, 8 distal ASD patients, 1 both ends ASD patient and 1 ASD patient in between the fusion surgeries. Bone mineral density (BMD) T score of the adjacent vertebrae was -1.98±0.91 on average. The ASD patients were re-operated with CBTS and SAS internal fixation technique. A small incision was made in the revision surgery and the original fixation was not completely cut open and removed. The mean operation time was (125±36) min, mean blood loss was (85±33) ml. The postoperative ambulation time was (3.1±1.9) days, and the hospitalization time was (9.0±2.6) days. Before the operation, the average VAS (back pain) score was 5.2±1.0, the average of VAS (leg pain) score was 6.8±1.9 and ODI was 56.6%±12.8%. VAS score was reduced to 1.4±0.6 (waist pain) and 0.9±0.4 (leg pain). ODI was improved to 13.8%±6.3%. All the difference between preoperative and the last follow-up was statically significant (all P<0.01). No internal fixation failure, pseudarthrosis and adjacent re-degeneration were observed in the final follow-up.

The application of CBTS and SAS internal fixation techniques in the surgical treatment of lumbar ASD has the advantages of less trauma, faster postoperative recovery, reliable internal fixation, and fewer complications, especially in patients with low bone mineral density.

To establish a diagnostic model for alpha-fetoprotein-negative hepatocellular carcinoma (AFP-NHCC) by combining multiple laboratory hematological indicators and explore its clinical diagnostic efficiency.

A total of 124 inpatients, including 110 males and 14 females, aged 57 (51, 66) years, who were first diagnosed with AFP-NHCC in the PLA General Hospital were included from December 2011 to June 2017. Meanwhile, 331 cases of non-HCC were enrolled as the control group, including 279 males and 52 females, aged 58 (51, 63) years old, with 47 cases of hepatitis B virus (HBV) infection, 40 cases of liver cirrhosis, 64 cases of hepatic hemangioma or cysts, 7 cases of liver nodules, 8 cases of fatty liver, 146 cases of non-liver disease and 19 health controls. Subjects in the AFP-NHCC group and the control group were divided into a training group and a validation group. A total of 196 subjects were involved in the training group, including 103 AFP-NHCC patients and 93 non-HCC patients (19 healthy controls, 25 patients with HBV infection, 22 patients with liver cirrhosis, 23 patients with hepatic hemangioma or cyst, and 4 patients with liver nodules). The differences in laboratory parameters were analyzed, and a diagnostic model of AFP-NHCC under different AFP levels was established. Likewise, 259 subjects, including 113 patients with liver disease, were involved in the validation group to verify the diagnostic efficiency of the model for AFP-NHCC. The receiver operating characteristic (ROC) curve was used to analyze the sensitivity and specificity of different models, and the area under the curve (AUC) was calculated to evaluate the diagnostic performance of different models.

In the training group, the indicators of AFP-NHCC diagnostic model included platelet (PLT), prothrombin activity (PTA), serum albumin (ALB), prothrombin time (PT) and carbohydrate antigen 19-9 (CA19-9), and the AUC of the model was 0.848 (95%CI: 0.786-0.911) when AFP≤5 μg/L. Similarly, the indicators of AFP-NHCC diagnostic model included PLT, PTA, ALB, PT and hematocrit (HCT), and the AUC of the model was 0.839 (95%CI: 0.780-0.897) when AFP≤10 μg/L. When AFP≤20 μg/L, the indicators of AFP-NHCC diagnostic model contained PLT, PTA, ALB, PT, HCT and AFP, and the AUC of the model was 0.866 (95%CI: 0.815-0.917). The AUC values of these three models were higher than those of AFP and CA19-9 alone for the diagnosis of AFP-NHCC [0.634 (95%CI: 0.560-0.709), 0.691 (95%CI:0.620-0.761), all P<0.05]. The indicators screened by these three models were combined to establish the final diagnostic model, and the AUC of the model was 0.873 (95%CI: 0.824-0.923), with the sensitivity of 78.6% (81/103) and the specificity of 81.7% (76/93). In the validation group, the predictive AUC of the final model in liver disease patients was 0.892 (95%CI: 0.832-0.951), with the sensitivity of 100% (21/21) and the specificity of 71.7% (66/92), while in the total validation population, the predictive AUC was 0.931 (95%CI: 0.890-0.972), with the sensitivity of 100.0% (21/21) and the specificity of 75.6% (180/238).

The final diagnostic model includes PLT, PTA, ALB, PT, HCT, CA19-9 and AFP, which has higher sensitivity and specificity, and has good diagnostic efficiency for the clinical diagnosis of AFP-NHCC.

The retrospective study included 122 cases of multiple glioma and 183 cases of single glioma. Of these, there were 74 males and 48 female with multiple gliomas, aged 18 to 83 (53±13) years, and 104 males and 79 females with single gliomas, aged 10 to 84 (51±14) years. A standard spatial-based lesion analysis method was used for constructing a spatially distributed frequency heatmap of multiple gliomas, to observe the characteristics of their white matter invasion sites. The spatial distribution was more frequent in the subventricular zone, corpus callosum and cingulate gyrus in the multiple glioma group compared to the single glioma group (P<0.001).The white matter areas of multiple gliomas were more extensively involved, with more frequent involvement of the conjoined fibers (corpus callosum, P<0.05) and contact fibers (cingulate, dome, 0.05<P<0.10) areas.The spatial distribution of the brain and the white matter invasion of multiple gliomas have certain site specificity.

In this paper, a case of lung cancer was treated with radiofrequency ablation of thoracic sympathetic nerve chain guided by CT. After 1 month follow-up, the burning symptoms of upper limbs and whole body did not appear again.

Sepsis is a serious disease with acute onset and high mortality. Acute kidney injury (AKI) is a common complication of sepsis patients. At present, the specific pathogenesis of sepsis-related AKI (S-AKI) is not fully understood, and there is still a lack of specific diagnosis and treatment methods in clinic. Exosomes are vesicles with lipid bilayer structure and carrying various signaling molecules, which play an important role in sepsis and S-AKI. This paper briefly describes the involvement mechanism of exosomes in S-AKI, introduces the potential application value of exosomes as novel biomarkers and their progress in the treatment of S-AKI, and analyzes and prospects some existing problems.

The World Health Organization classifies precapillary pulmonary hypertension caused by lung disease as category 3 of pulmonary hypertension. The pulmonary diseases that most commonly cause class 3 pulmonary hypertension include chronic obstructive pulmonary disease (COPD) and interstitial pulmonary disease (ILD). ILD-related pulmonary hypertension has a high global prevalence and poor clinical prognosis. There are currently no approved marketed drugs to treat this disease. Previous studies have shown improved exercise capacity after 12 weeks of inhaled treprostinol in patients with class 1 pulmonary hypertension. At the same time, studies have shown that inhaled treprostinol can improve hemodynamics in patients with class 3 pulmonary hypertension. Therefore, further evaluation of the efficacy and safety of inhaled treprostinol in the treatment of ILD-associated pulmonary hypertension is needed.

Thoracic height is considered a key outcome measure for the treatment of early-onset scoliosis (EOS) as it has been reported to be associated with pulmonary function test results (PFT). At present, studies have proposed the thoracic height of 18 cm as a threshold for predicting respiratory function, but for different individual situations with different etiologies and degrees of malformation, it may be too simplistic to use this single parameter to evaluate EOS treatment outcomes.