铜绿假单胞菌( Pseudomonas aeruginosa) 属于非发酵类假单胞菌, 广泛存在于自然界中, 也可广泛定植于人体消化道、呼吸道、皮肤及泌尿道等部位。20 世纪70 年代, 铜绿假单胞菌仅被认为是导致粒细胞缺乏患者发生致死性菌血症的病原体, 而到上世纪末及本世纪初, 铜绿假单胞菌已是医院获得性感染的主要病原体[ 1] 。在皮肤黏膜发生破坏( 如气管插管、烧伤、机械通气) , 免疫功能低下( 如中性粒细胞缺乏、细胞免疫功能缺陷) , 以及菌群失调的患者, 铜绿假单胞菌感染的发生率相当高。汪复等[ 2] 对国内主要地区的12所教学医院临床分离细菌资料的统计发现在所分离的革兰阴性菌中铜绿假单胞菌占16. 4% , 仅次于大肠埃希菌。在铜绿假单胞菌临床感染率不断增加的同时, 铜绿假单胞菌耐药率逐渐增加, 特别是耐多药( MDR) 或者泛耐药( PDR) 铜绿假单胞菌的出现, 给临床治疗铜绿假单胞菌感染带来了更大的挑战。本文主要对目前临床上铜绿假单胞菌肺部感染治疗中的难点及临床处理的过度与不足进行阐述。
目的 总结超选择性肾动脉栓塞治疗经皮肾镜取石术后严重出血的临床经验。 方法 回顾分析2009年10月－2012年11月行经皮肾镜取石术后发生严重出血的6例（2.74%）患者的临床资料和对其进行超选择性肾动脉栓塞术的血管造影表现和栓塞疗效。 结果 患者平均年龄67岁，经皮肾镜取石术后急性出血1例，迟发出血5例，均有体外冲击波碎石史或糖尿病、高血压病史。肾动脉造影显示损伤动脉为肾后下段动脉、肾下段动脉分支，表现为假性动脉瘤5例，动静脉瘘1例。使用弹簧圈或聚乙烯醇颗粒超选择性栓塞，栓塞后出血无一例复发。随访6个月，5例肾功能未见下降，1例受损。 结论 经皮肾镜术后严重出血与术中动脉损伤有关，采用超选择性肾动脉栓塞术能够达到迅速止血、尽可能保全患肾功能、有效挽救生命的诊疗效果。
ObjectiveTo compare the effectiveness of magnetic resonance spectroscopy (MRS) and Dynamic Contrast-enhancement (DCE-MRI) with 1.5 T MR scanner in diagnosing prostate cancer. MethodsFrom April 2011 to December 2012, based on the results of biopsy, we measured 216 regions of interest (ROIs) in images of MRS and DCE-MRI, comprised of 131 ROIs from cancer zone and 85 ROIs from non-cancer zone. The data were analyzed with statistical methods, including receiver operating characteristic (ROC) curve. ResultsThere were significant differences between the malignant group and the benign group (P<0.05) in Cit integral, Cho integral, CC/Cit ratio, the type of time-signal intensity curve, initial value, enhancement rate and ratio of enhancement. According to ROC curve, the area under curve (AUC) of CC/Cit and enhancement rate was 0.853 and 0.719, respectively. AUC of time to peak, time difference, enhancement rate and Cit integral was lower than 0.400. The optimal operating point (OOP) of CC/Cit was 0.775, with a specificity of 0.85 and a sensitivity of 0.79, and the AUC was 0.853. The OOP of the ratio of enhancement was 60.89, with a specificity of 0.66 and a sensitivity of 0.71, and the AUC was 0.719. ConclusionMRS is more sensitive and specific than DCE-MRI to diagnose prostate cancer when an 1.5 T MR scanner is used. On the other hand, MRS is susceptible to interference, but DCE-MRI can make up for these deficiencies.
ObjectiveTo compare the effectiveness of T2 weighted image (T2WI) and some compounded MRI techniques, including T2WI combined with magnetic resonance spectroscopy (T2WI+MRS), T2WI combined with diffusion weighted imaging (T2WI+DWI) and T2WI combined with dynamic contrast-enhancement [T2WI+(DCE-MRI)] respectively, with 1.5 T MR scanner in diagnosing prostate cancer through a blinding method. MethodsBetween March 2011 and April 2013, two observers diagnosed 59 cases with a blinding method. The research direction of radiologist A was to diagnose prostate cancer. The observers diagnosed and scored the cases with T2WI, T2WI+(DCE-MRI), T2WI+MRS, T2WI+DWI and compositive method respectively. The data were statistically analyzed with receiver operating characteristic (ROC) curve. ResultsAccording to the ROC curve, both observers got the sequence of area under curve (AUC) as T2WI+DWI > T2WI+(DCE-MRI) > T2WI+MRS > T2WI. On the basis of the result from observer A, the AUC from each technique was similar. The AUC of T2+DWI was slightly bigger than others. The specificity of single T2WI was the lowest; the sensitivity of T2WI was slightly higher. The AUC of the compositive method was marginally larger than T2WI+DWI. According to the result from observer B, the AUC of T2WI+DWI was obviously larger than the others. The AUC of single T2WI was much smaller than the other techniques. The single T2WI method had the lowest sensitivity and the highest specificity. The AUC of T2WI+DWI was slightly larger than the compositive method. The AUC of T2WI+(DCE-MRI), T2WI+MRS, single T2WI methods from observer A was obviously higher than those from the score of observer B. The AUC of T2WI+DWI from the two observers was similar. ConclusionThe method of combined T2WI and functional imaging sequences can improve the diagnosing specificity when a 1.5 T MR scanner is used. T2WI+DWI is the best method in diagnosing prostate cancer with least influence from the experience of observers in this research. The compositive method can improve the diagnosis of prostate cancer effectively, but when there are contradictions between different methods, the T2WI+DWI should be considered as a key factor.
ObjectiveTo investigate the classification and clinical value of unilateral cervical lateral mass fracture (C3-7).MethodsFrom January 2008 to December 2017, 68 patients with unilateral cervical lateral mass fracture who had received treatment in Affiliated Hospital of Southwest Medical University, were included. According to the position of fracture, the fractures were classified into three types: articular process fractures (type A), isthmus fracture (type B), and comminution (type C). Two subtypes of articular process fractures were type A1 and type A2. Type A1 refered to articular process fracture with no or slight displacement. Type A2 refered to articular process fractures result in foraminal stenosis and nerve root compression. Single-level anterior cervical disectomy and fusion (ACDF) or anterior cervical corpectomy and fusion (ACCF) or conservative treatment was used in type A1. Posterior decompression, fixation and fusion or the method of posterior decompression associated with ACDF were suited to A2. Single-level ACDF was used in type B as well. Type C underwent two-level ACDF or ACCF or posterior procedure.ResultsThere were 35 cases of Type A1, of which 31 patients underwent single-level ACDF, 2 patients underwent ACCF, and 2 patients received conservative treatment, but one of the two underwent ACDF due to delayed cervical instability. Among the 7 cases of type A2, 4 underwent posterior foraminal decompression and posterior fusion with pedicure screw fixation, 2 underwent single-level ACDF and posterior decompression, and 1 underwent single section ACDF and posterior decompression combined with pedical screw fixation. Type C accounted for 21 cases of all targets. Fourteen performed two-level ACDF, 6 performed ACCF, and 1 performed posterior fixation with pedicure screw and expansive open-door laminoplasty. Six patients showed postoperative complications, including C5 root palsy in one case, incision hematoma in two and pulmonary infection in three. There were no case with incision infection or aggravating nervous injury. Sixty-two patients (91.2%) were followed up with a mean duration of 14 months. All the patients obtained bony fusion and no internal fixation failure or kyphosis was found.ConclusionsAccording to fracture position and CT, the unilateral cervical lateral mass fracture can be classified as type A1, type A2, type B, and type C. A satisfied clinical result can be obtained when choosing an appropriate treatment in accordance with different fracture types.
ObjectiveTo assess the reliability, effectiveness, and the safety of full endoscopic transforaminal decompression (FETD) under local anesthesia guided by the classification of lateral region of the lumbar spinal canal (CLLSC) in treating lumbar spinal stenosis (LSS) in geriatric patients.MethodsThe clinical data of 63 geriatric patients with LSS met the inclusion criteria underwent FETD surgery between June 2015 and July 2017 were retrospectively analyzed. There were 37 males and 26 females, with a median age of 76 years [interquartile range (IQR), 73-80 years], and a median symptomatic duration of 55 months (IQR, 16-120 months). There were 17 cases of grade B and 46 cases of grade C based on the Schizas morphological grading system. CLLSC was used for imaging evaluation for the stenotic condition, and intra-class correlation coefficients (ICC) were used to test intra-observer and inter-observer reliability of CLLSC. The stenotic condition of patients was re-evaluated by the surgeon after operation, and the results were compared with the findings of preoperative CLLSC. The visual analogue scale (VAS) score for low back pain and leg pain recorded before operation, and at 1 day, 3 months, and 6 months after operation, and last follow-up were used to assess the pain relieving; the functional improvement was evaluate by Oswestry disability index (ODI); the modified Macnab criteria were used to self-evaluate the surgical satisfaction.ResultsThe operation were successfully performed for all patients, with a median operation time of 75 minutes (IQR, 65-85 minutes), postoperative hospitalization stay of 48 hours (IQR, 48-72 hours), and the time to ambulation after operation of 24 hours (IQR, 24-24 hours). Sixty-three patients were followed-up and with a median follow-up time of 18 months (IQR, 13-20 months). Based on preoperative CLLSC classification, there were 72 stenotic zones, distributed 16 in zone 1, 6 in zone 2, 3 in zone 3, 2 in zone 4, 7 in zone 5, 34 in zones 1+2, 2 in zones 3+4, and 2 in zones 4+5. Perioperative complications occurred in 4 cases (6.3%), including 2 cases of intraoperative dural sac tear, 1 of preoperative numbness symptom aggravation, and 1 of postoperative urinary retention. VAS score of leg pain and ODI score at each time point after operation were significantly improved compared with those before operation (P<0.05). VAS scores of low back pain showed no significant difference between pre- and post-operation (P>0.05). At last follow-up, based on the modified Macnab criteria, 19 cases were excellent, 37 were good, 6 were fair, and 1 was poor, and the excellent and good rate was 88.9%. The reliability analysis showed that CLLSC had substantial intra-observer reliability in the geriatric population, with an average ICC of 0.78. There was also a substantial inter-observer reliability, with an average ICC of 0.73. While comparing the preoperative CLLSC results with the postoperative CLLSC results, 53 patients (73.6%) were in full agreement, 15 patients (20.8%) were in partial agreement, and 4 patients (5.6%) were not.ConclusionCLLSC has high reliability in the diagnosis of LSS in the geriatric patients. Combined FETD with CLLSC, accurate diagnosis, and minimal invasion can be performed to achieve safe and effective result.
Assembling medical aid teams (MATs) from the provinces outside Hubei was an important China-specific approach to dealing with public health emergencies during the coronavirus disease 2019 (COVID-19) pandemic in Hubei. In integrally taking over the COVID-19 intensive care wards in Wuhan, the Joint 7th and 8th Sichuan COVID-19 MATs applied the methods of modern hospital management to complete the medical task, concerning four key points as guidance by the Communist Party of China, system and regulation establishment, organization construction, and discipline persistence. This paper makes a theoretical summary on the basic management of the Joint 7th and 8th Sichuan COVID-19 MATs, and it is hoped that more COVID-19 MATs could summarize and share their successful management experiences in order to enrich and improve the management theory of MAT.
Objective To review the research progress in the treatment of high-grade spondylolisthesis (HS), in order to provide a reference for clinical treatment decision-making. Methods The literature related to the treatment of HS at home and abroad in recent years was widely reviewed. The methods of conservative treatment, in situ fusion, and spondylolisthesis reduction were analyzed and summarized. Results Surgical treatment is the main treatment of HS, but which method is the best is still controversial. The advantages, disadvantages, and applicability of various operations are also different, so individualized analysis is needed in clinic. Conclusion The treatment plan of HS needs to be considered comprehensively according to the individual condition of the patient. It will be an important research direction to further compare the existing treatment methods and develop more safe and effective new technology.