Objective To collect the clinical data of victims with traumatic brain injury (TBI) admitted in the West China Hospital of Sichuan University within 2 weeks after 4.20 Lushan earthquake, and to analyze their clinical characteristics and effects of early rehabilitation, so as to provide baseline data for rescue TBI victims with the early rehabilitation treatment during emergency medical rescue. Methods A total of 392 victims admitted in the hospital from April 20th, 2013 to May 3rd, 2013 were screened, of which the TBI victims were clinically assessed and treated with early rehabilitation. Then both the activities of daily living (ADL) and the Rancho Los Amigos Cognitive Recovery Scale (RLA) before and after the treatment were analyzed. The data were input by Excel software, and the statistical analysis was performed by SPSS softwar. Results A total of 51 TBI victims at age from 3 to 84 years old were included finally. The categories of TBI included subarachnoid hemorrhage (41.2%), intracranial hematoma (33.3%) and mixed type (33.3%), and the severity were associated with the type of TBI. The GCS score of cerebral concussion was higher (13.25 ± 0.62) while that of the diffuse axonal injury was lower (4.50 ± 0.71). All victims (100%) had limited ADL, 74.51% had cognitive dysfunction, 9.80% had speech disorder, and 7.84% had dysphagia. After the early rehabilitation treatment, both ADL (before treatment: 34.82 ± 58.29, after treatment: 69.63 ± 22.29) and RLA (pre-treatment: 4.16 ± 1.24, treatment: 7.20 ± 1.69) were obviously higher than those before treatment, with statistical differences (both P lt;0.05). Conclusion The TBI categories of Lushan earthquake victims are various and mixed, and the severity associated with the type of TBI. All TBI victims are accompanied with more clinical problems and functional limitation. Early rehabilitation treatment is safe and effective to improve ADL and RLA as well.
Objective To investigate infertile inpatients hospitalized in Pingjin Hospital in Tianjin from 2008 to 2010, so as to provide baseline data for further research. Methods According to diagnosis criteria of WHO, we collected demographical characteristics, disease cause and cost constitution of infertility inpatients hospitalized in Pingjin Hospital in Tianjin from 2008 to 2010. The data of each patient were input into ACCESS database and SPSS 13.0 was used for statistical analysis. Results a) From 2008 to 2010, there were 1 452 infertile patients from 33 different areas of mainland China, 79.7% of which was from the north of China. b) The mean age was 31.2±4.3 years old. The percentage of patients aged 30 to 34 years accounted for the most (40.3%). Mental laborers (23.3%) were more than physical laborers (7.2%). 36.7% of patients received education from universities and 83.1% of patients had family income ranging from 20,000 yuan to 190,000 yuan. c) The mean age of the first sexual activity was 21.4±2.9 years old. 53.7% of patients had only one sexual partner and most couples had sexual activities twice every week. The mean age of husbands was 32.9±5.5 years old with the highest percentage of 30 to 35 years old (39.2%). The percent of intellectual work of husband was the highest (35.9%). 64.9% of patients had normal semen analysis results and 23.0% never took related examination. d) 29.9% of patients was primary infertility and 70.1% was secondary infertility, of which 57.6% had either induced or medical abortion. The mean duration of infertility was 5.2±3.5 years (range 1 to 21 year). e) 76.3% of infertile patients had pelvic adhesion and 88.6% suffered from tubal disease. Among the tubal infertile patients, 23.6% had uterine disease, 5.2% had ovarian disease, 5.0% had endometriosis, 6.7% had multiple problems, and 4.8% had unexplained infertility. In patients with tubal infertility, the incidence of distal fimbria atresia (45.8%) was higher than that of proximal block (32.9%). 24.7% of patients with fimbria atresia had hydrosalpinx and among of them, 21.1% had no hydrosalpinx. 15.2% had congenital tubal defects. f) The average hospital stay was 10.5 days and the cost was 14 253.3 yuan per person. The percentage of material cost was 29.1% and that of drugs was 18.2%. Conclusion a) The total number of infertile inpatients was 1 452 in gynecology department of Pingjin Hospital of Tianjin from 2008 to 2010. 79.7% of patient was from North China. Most of them were 30 to 34 years old and 44.3% had no job. The percentage of patients had university education and that of low-middle family income was the highest. Sexual activity was relatively traditional. Most husbands were 30 to 35 years old and intellectual workers, and 23.0% of them had never taken an examination of semen analysis. More patients were secondary infertile, and the duration of infertility was 1 to 21 years. b) 76.3% of patients had pelvic adhesion and 88.6% had tubal disease. The incidence of distal tubal fimbria atresia was higher than proximal tubal occlusion. c) The average hospital stay was 10.5 days and the cost was 14 253.3 yuan per person which was further lower than each cycle cost of assisted reproductive technology. The overall costs included materials and drugs (47.3%), which were mainly at patients’ own expense.
Objective To analyze surgical treatment and clinicopathologic features of remnant gastric cancer,and to recognize the strategies of treatment. Methods The clinical data of 26 cases patients with remnant gastric cancer diagnosed by endoscopy and pathological examination and underwent surgical treatment were retrospectively analyzed in our hospital between January 2004 and March 2011.In this study,14 cases of remnant gastric cancer from benign disease （RGCB） and 12 cases of remnant gastric cancer after stomach cancer operation （RGCC） were included.The clinical findings,Helicobacter pylori （HP） infection,surgical methods, histopathological features,and prognosis were analyzed.Results The patients developed a carcinoma in the gastric remnant about 15-44 years after operation for benign disease （median 26.3 years） and about 1-10.5 years after gastric cancer operation （median 4 years）,and there was significant differences of the two groups（P＜0.05）.HP infection of the gastric remnant was found in 73.1%（19/26） patients,and infection rate of patients was 71.4%（10/14） in RGCB and 75.0%（9/12） in RGCC, but there was no statistical different in two groups （P＞0.05）.All 26 patients underwent surgical procedure,and the rate of radical resection was 46.2% （12/26）, which was 57.1% （8/14） in RGCB and 33.3% （4/12） in RGCC respectively,there was no statistical different （P＞0.05）.Among the 12 cases underwent radical resection, the highest lymphatic metastasis rate was in No.3 group （83.3%， 10/12）,which came in second in lymph node of mesojejunum or splenic hilum （33.3%， 4/12）.Postoperative pathological staging was as follows：stageⅠin 3 cases, stageⅡ in 2 cases, stage Ⅲ in 14 cases and stage Ⅳ in 7 cases. In 18 patients underwent tumor excision,the metastasis of lymph node occurred in 13 cases （72.2%）,and the pancreas,transverse colon,or spleen were invaded in 13 cases according to histopathological results. Meanwhile,peritoneal metastasis were founded in 8 cases patients,and the peritoneal metastasis rate of patients with RGCB （14.3%；2/14） was significantly lower than that with RGCC （50.0%， 6/12）, P＜0.05.The overall one-year survival rate and three-year survival rate was 54.5% and 38.5%,respectively, and the survival time was 2-61 months （median 12 months）.Survival analysis indicated that pathological stage and radical resection were significant prognostic factors for patients with remnant gastric cancer（P＜0.01）,and radical resection was an independent prognostic factor （P＜0.05）,while age,gender,disease of first operation, degree of differentiation and HP infection were not （P＞0.05）. Conclusions Early detection and standard radical resection are the key factor to improve the prognosis of patients with remnant gastric cancer and laparoscopic exploration may minimize unnecessary injures of surgery.Because of the different clinical characteristics,strategy of treatment for RGCC and RGCB shall be discriminatory.
Objective To explore the clinical epidemiologic characteristics and tendency of gastric cancer during recently ten years in northern Henan province. Methods The clinical data of 1 090 patients with gastric cancer in our department were collected from January 1998 to May 2008. The ten-year period was divided into two groups: previous 5 years group (n=433) and post 5 years group (n=657). The age, gender, pathologic characteristics and the relationship between age and pathologic features were analyzed retrospectively. Results ①The patient’s age was 15-83 years old 〔mean （57.60±10.84） years old〕 and men-momen ratio was 3.71∶1 in previous 5-year group. The patient’s age was 18-82 years old 〔mean （58.95±10.81）years old〕 and men-momen ratio was 2.84∶1 in post 5-year group. There was no significant difference in age or gender between two groups （Pgt;0.05）. ②Gastric cancer arised in cardia and gastric fundus more common and for the incidence of the site no change was found in two groups. The incidence of gastric antrum cancer descended but that of gastric body arised. ③The mean age of patients with gastrocardiac cancer was significantly different (Plt;0.05) between two groups. No significant difference occurred on the mean age of patients with gastric antrum (Pgt;0.05) or gastric body cancer (Pgt;0.05). The mean age of patients with highly malignant tumor (signet ring cell cancer, poorly differentiated adenocarcinoma and undifferentiated carcinoma) was significantly different compared with that of patients with lowly malignant tumor (well differentiated and moderately differentiated adenocarcinoma) (Plt;0.05). ④The proportion of patients with highly and lowly malignant tumor presented significantly different between the previous 5 years and the post 5 years (Plt;0.05). ⑤The proportion of early gastric cancer was very low and no correlation was found between infiltrating depth and age in all patients (Pgt;0.05). Conclusion Cardia and gastric fundus is the most common site of gastric cancer in northern Henan province. The patients with gastrocardiac cancer are often older but gastric antrum and gastric body cancer patients are younger. Highly malignant gastric cancer is often found in youths, however, lowly malignant gastric cancer occurred predominantly in elderly. The proportion of gastric cancer found early is very low in northern Henan province.
骨化性气管支气管病( tracheobronchopathia osteochondroplastica,TPO 或TO) , 是一种罕见的气管内膜系统的良性病变, 主要以气管和主支气管黏膜下多发性骨和软骨组织结节状增生为特征, 通常引起气道狭窄[ 1] 。大多数患者没有临床症状, 因此易被误诊和漏诊。本文将TO 的临床特征做一综述, 以提高对该病的认识。
Objective To investigate the clinical characteristics of neutrophilic asthma ( NA) .Methods NA patients were collected from the out-patient and in-patient departments of Respiratory Diseases of Xinqiao Hospital between January 2010 and December 2010. The results of the medical records,pulmonary function tests, and induced sputum cytology were analyzed retrospectively. Results The NA patients with neutrophil percent ≥ 61% accounted for 33. 1% ( 51 /154 ) of all the asthmatics patients detected by induced sputumin the same period, and 45 cases with complete records were included. Of the 45 cases recruited, 20 cases ( 44. 4% ) were in-patients,2 cases ( 4. 4% ) were with controlled asthma, 3 cases ( 6. 7% ) were with cough variant asthma, 30 cases ( 66. 7% ) were female, 12 cases ( 26. 7% ) were atopic patients, and 27 cases ( 60% ) had acute exacerbation. The age of onset of 35 patients ( 77. 8% ) were after 12 years. FEV1% pred lt; 60% and gt; 80% was obtained in 55. 9% ( 19/34) and 14. 7% ( 5 /34) of patients respectively. The result of bronchodilator test was positive in 64% ( 16/25) of patients, and mean increase in FEV1 was 11. 7% . The percentage of neutrophil and eosinophil was ( 74. 5 ±9. 1) % and ( 2. 4 ±2. 5) % respectively in induced sputum, and 35. 6% ( 16/45) of the patients had increased eosinophil percentage ( gt;3% ) . Conclusions In our study, most of NA is severe and acute exacerbation asthma, and its clinical features are various. The mechanismand clinical significance of increased neutrophils in asthmatic patients are unclear and more studies are needed.
Objective To explore the clinical features of microscopic polyangiitis ( MPA )complicated with pulmonary involvement in comparison with idiopathic pulmonary fibrosis ( IPF) . Methods Clinical and laboratory data of 27 patients with MPA and 56 patients with IPF in the Drum Tower Hospital from2006 to 2010 were analyzed retrospectively. The differences were compared between the MPA patients with pulmonary fibrosis manifestation ( MPA/PF patients) and those without pulmonary fibrosis manifestation( MPA/NPF patients) , and the IPF patients. Results The differences between the MPA/PF patients and the MPA/NPF patients were rarely found in terms of respiratory symptoms, ANCA positive rate, and multiple organ involvement, but the proportions of suffering severe renal damage and severe pulmonary hypertension in the MPA /PF patients were relatively high ( P lt; 0. 05) . Furthermore, there were significant differences between the MPA/PF patients and the IPF patients in terms of dyspnea, incidence of renal damage, ANCA positive rate, incidence of serious pulmonary hypertension, and multiple organ involvement. The IPF patients were more prone to develop dyspnea while MPA patients were more prone to develop renal damage, high ANCA positive rate, high incidence of serious PAH and multiple organ involvement, such as rush, joint pain,weight loss, fever and gastrointestinal symptoms ( P lt;0. 05) . Conclusions When patients have respiratory symptoms complicated with renal failure, skin damage, fever, and joint pain, the diagnosis of MPA should be considered. For patients who were clinically suspected as interstitial pneumonitis or pulmonary fibrosis,measurement of serumantineutrophil cytoplasmic antibodies and creatinine test are essential for diagnosis.
Objective To investigate the different clinical features of chronic cough induced by rhinitis /sinusitis or gastro-esophageal reflux, and its significance for etiological diagnosis of chronic cough.Methods Chronic cough patients were recruited from respiratory medicine clinic in Chongqing Xinqiao Hospital from December 2009 to December 2010. Medical history, symptoms and signs were recorded from all selected patients. The patients with chronic rhinitis / sinusitis, but without gastro-esophageal reflux symptoms were suspected upper airway cough syndrome ( UACS) , and given chlorpheniramine, nasal decongestant, and corticosteroid treatment for 1 week. The patients with clinical symptoms associated with gastroesophageal reflux or with history of gastric diseases were suspected gastroesophaged reflux-related cough ( GERC) , were given esomeprazole ( 40 mg, bid) , combined prokinetic agent for 2 weeks. The patients were confirmed the diagnosis of UACS or GERC when their cough was relieved after the above targeted treatment.Results 114 patients were enrolled in this study. 47 patients were suspected GERC, of which 32 were confirmed, and 67 patients were suspected UACS, of which 43 were confirmed. There was no significant difference in age, duration of disease, severity of cough, proportion of night cough, proportion of clear throat symptom, or proportion of cobblestone sign between the UACS patients and the GERC patients ( P gt;0. 05) .There were more females in the GERC patients and more males in the UACS patients ( P lt; 0. 05) . Cough with sputum, throat symptoms and signs were more common in the UACS patients ( P lt;0. 05) . The hoarseness and sore throat symptoms were found only in the GERC patients, but postnasal drip symptoms were found only in the UACS patients. Conclusions Throat signs and symptoms are not completely similiar in the GERC and the UACS patients. Comprehensive judgments combining with patient history,characteristics of concurrent cough, throat symptoms, and signs can provide important references for the clinical diagnosis of chronic cough caused by rhinitis/ sinusitis or gastro-esophageal reflux.
Objective To determine whether B-type natriuretic peptide （BNP） levels combined with Spontaneous breathing trial (SBT) could improve the weaning outcome. Methods Eighty-three patients who were ready to undergo a 90-minute weaning trial （low-pressure support level） were enrolled .Weaning was considered to be successful if the patient passed the trial and sustained spontaneous breathing for more than 48 h after extubation. Plasma BNP was measured just before and at the end of the trial. All patients were divided into a weaning success group and a weaning failure group according to the outcomes of weaning. Categorical variables，expressed as percentages，were analyzed with a chi-square test or a Fisher’s exact test. Continuous variables were expressed as median （25th-75th percentile） and were compared using the Wilcoxon paired test （for related samples） or the Kolgomorov-Smirnov test （for independent samples）. A two-tailed p value of less than 0.05 was taken to indicate statistical significance. Receiver operating characteristic （ROC） curve analysis was performed to assess plasma BNP’s ability to discriminate the subjects who weaned succesfully or failed. Results Overall，13 patients （16.7%） failed the weaning process （6 patients passed the trial but failed extubation）. At the end of SBT，the BNP levels of the weaning failure group were significantly higher than the weaning success group. The BNP levels of the weaning failure group were significantly higher than the weaning success group （Plt;0.001）. The area under cure （AUC） of the ROC curve of BNP to predict the failure of weaning was 0.94±0.03 （Plt;0.001）.At a cut-off level of 123 pg/mL,BNP had a predictive efficiency in weaning outcome as Yourdon’s index of 0.837，sensitivity of 92.3%，and specificity of 91.4%. Conclusion Monitoring the change of BNP during a SBT may improve weaning outcome.
Objective To analyze the data from patients with pathologically proved granulomatous lung disease, including etiology, clinical, radiological features and laboratory results. Methods 36 patients with granulomatous lung disease confirmed by lung biopsy in Shanghai First People’s Hospital of Shanghai Jiao Tong University from January 2008 to June 2012 were retrospectively reviewed. The clinical presentation, radiological features and laboratory results were collected and statistically analyzed.Results After haematoxylin and eosin stain combined with special stain, the diagnoses were comfirmed, ie.13 cases of mycobacterial infection, 5 cases of aspergillar infection, 4 cases of cryptococcal infection, 6 cases of sarcoidosis, 4 cases of Wegener’s granulomatosis, 4 cases of unknown causes. Cough was the most common clinical symptom, followed by expectoration. Some patients also developed fever, chest tightness and weight loss. The lesions were widely distributed, of which the right upper lung was the common lesion of mycobacterial infection, inferior lobe of right lung was the common lesion of aspergillar infection. The common lesion of cryptococcal infection was uncertain. The common lesions of sarcoidosis and Wegener ’s granulomatosis were in left upper lung. Small nodule was the most common shapes of lesion, while mass and consolidation were present sometimes. Cavity, air bronchogram, pleural effusion, hilar and mediastinal lymph node enlargement could be found in the chest CT. Interferon gamma release assay, galactomannan antigen assay and latex agglutination test were helpful in the diagnosis of mycobacterial infection, aspergillar infection and cryptococcal infection induced granuloma. Conclusions The clinical presentations and radiological features of granulomatous lung disease are nonspecific. Histopathology obtained through biopsy is the key for the diagnosis. Immunological examination, test of new antigens to microorganism and clinical microorganism detection are valuble in the diagnosis and differential diagnosis of granulomatous lung disease.