简介：AbstractImportance:Staphylococcus lugdunensis (S. lugdunensis) is a coagulase-negative staphylococcus (CoNS), found commonly as skin flora in humans. While most species of CoNS are clinically benign, S. lugdunensis can exhibit a similar virulence to that of S. aureus. However, there is scant data concerning S. lugdunensis infection in the pediatric population.Objective:To ascertain local S. lugdunensis infection rates and sensitivity patterns in the pediatric population.Methods:A retrospective analysis was undertaken of all S. lugdunensis isolates across a 6-year period from 2015 to 2020. Data were collected from electronic patient notes and laboratory records. Matrix-assisted laser desorption ionization and time of flight mass spectrometry were used to identify isolates.Results:Ninety-six isolates of S. lugdunensis were identified from 86 patients. Of these, 34 isolates were treated as an infection. Twenty-three (67.6%) were found to have skin as the primary source of infection. While the observed number was small, central nervous system (CNS) sources of S. lugdunensis infection appear to be a significant source: all three isolates cultured from cerebrospinal fluid were clinically managed as infection. All three were associated with ventriculoperitoneal (VP) shunt infection. No cases of S. lugdunensis infective endocarditis were identified. About 18.6% of S. lugdunensis isolates were resistant to flucloxacillin.Interpretation:S. lugdunensis is an uncommon but significant cause of infection in the pediatric population and appears to be a rising cause of CNS infection, particularly when associated with VP shunts. Flucloxacillin is recommended locally as the first choice of antibiotic.

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简介：Epidemicsofsexuallytransmitteddiseaseshavebecomeworldwideseriousproblems.TheInstituteofDermatologyandVeneologyofWenshanAutonomousPrefectureinYunnanisacenterofpolitical,economical,culturalandsocialactivitiesintheprefecture.ItisalsothelocationoftheCommitteeofWenshananditsgovernment.WenshandataindicatesthatSTDshavebeenspreadingfromtownsofthisprefecturetothecountryside.

简介：Objective:Toanalyzeretrospectivelytheclinicalsymptoms,signs,radiologicalfindingsandresultsoftreatmentofposttraumaticsyringomyelia.Methods:Thedataof7patientswithposttranmaticsyringomyeliaconfirmedbycomputerizedtomography(CT)andmagneticresonanceimaging(MRI)inourhospitalbetween1999and2004werereviewedretrospectively.Thepatientsunderwentdecompressivelaminectomyorsyringo-subarachnoid(S-S)shuntingwithmicrosurgery.Long-termfollow-upwasavailable(range:13-65months).Results:Themajorclinicalmanifestationsofposttraumaticsyringomyefiausuallyincludedtheonsetofincreasingsignsandthedevelopmentofnewsymptomsafteranapparentlystableperiod.Theclinicalsymptomsincludedpain,sensorydisturbance,weakness,andproblemsinautonomicnerves.Syrinxexistedmerelyatthecervicallevelin4casesandextendeddownwardtothethoraciclevelsintheother3cases.Onecaseunderwentdecompressivelaminectomy,6casesweretreatedbyS-Sshunting.Duringtheearlypostoperativeperiod,allthepatientsshowedanimprovementofsymptomsofsyrinxwithoutmajorcomplicationordeath.ThedecreasedsizeorcollapseofthesyrinxwasdemonstratedbypostoperativeMRI.Conclusions:Posttraumaticsyringomyeliaisadisablingsequelaofspinalcordinjury,developingmonthstoyearsafterspinalinjury.MRIisthestandarddiagnostictechniqueforsyringomyelia.Thepatientswithposttraumaticsyringomyeliacombinedwithprogressiveneurologicaldeteriorationshouldbetreatedwithoperations.S-Sshuntingprocedureiseffectiveinsomepatientswithposttraumaticsyringomyelia.Decompressiveproceduremaybeanalternativeprimarysurgicaltreatmentforpatientswithkyphosisandcordcompression.

简介：ObjectivesToinvestigatetheclinicalfeatureofacutepulmonaryembolism.MethodsRetrospectiveclinicalanalysiswasperformedaccordingtothedataof38casesofpulmonaryembolism.ResultsThereweregrounddiseasesandpredisposingfactorsin36casesofpulmonaryembolismamong38cases,theratiowas94.7%,amongthetotalpredisposingfactors,tumor,cardiovasculardisease,venousthrombosisoflowerextremity,smokingandlong-termbedwerecommon.Therewasnospecificityinclinicalfeature,physicalsignandroutchestXray,electrocardiography,andtheirappearanceswerediversified.Therewerespecificityandsensitivityinechocardiogram(UCG)andD-dimertosomeextent.But,thefinaldiagnosismustdependonsomespecialexaminations,suchasselectivepulmonaryarteriography,CTPA,MRAandsoon.ConclusionsThespecialexaminationsmustbedonetomakeadefinitediagnosistoconfirmpulmonaryembolismwhenthehighriskfactorsandgrounddiseasesareexisting.Itisnecessarytosomecaseswhentheclinicalfeaturecannotbeexplainedbyotherdiseases.

简介：AbstractObjective:The current study aimed to profile the demographics, hematological index, and extrinsic factors of patients treated for frostbite in a single center in Southwest China.Methods:We collected the clinical data of patients with frostbite admitted to a regional hospital from January 1st, 2009 to January 1st, 2019. The baseline information was summarized, and the causes and hematological indexes of frostbite were analyzed.Results:The study cohort comprised 27 patients. The median patient age was 22 years (range 14-81 years). All frostbite injuries occurred between September 22nd and April 27th. Half of the patients were Tibetans. Cold injuries in Tibetan patients were associated with pilgrimage (70%, 9/13) and grazing (15%, 2/13), while the leading causes of frostbite in Han residents of the Southwest China basin were mandatory fieldwork without protection (36%, 5/14) and loss of consciousness (36%, 5/14). The hematological examination findings did not significantly differ between amputees and those who did not undergo amputation. Several hematological indexes significantly differed between patients with good outcomes versus those with poor outcomes.Conclusion:To avoid severe frostbite damage, routine mandatory activities like pilgrimage should be conducted under proper protection in extreme weather. Hematological indexes such as the red blood cell count, hematocrit, and hemoglobin level should be monitored closely by first-line medical personnel during hospitalization, as these indexes might indicate the outcome of frostbite. Further research is needed to improve the management of patients with frostbite in Southwest China.

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简介：Objective:Toexploretheclinicopathologicalfeatures,surgicaltreatmenttechniques,andprognosticriskfactorsofintrahepaticcholangiocarcinoma(ICC).Methods:Atotalof104ICCcaseswerecollectedfromJanuary2008toDecember2013atTianjinMedicalUniversityCancerInstituteandHospitalanddividedintothehepatichilumlymphadenectomy(HLL,21cases),extendedhepatichilumlymphadenectomy(EHLL,12cases),andnon-lymphadenectomy(NL,71cases)groups.Theclinicaldataofthepatientswereretrospectivelyanalyzed,andtheprognosticdifferenceswerecomparedamongdifferentgroups.Results:The1-,2-,and3-yearoverallsurvival(OS)ratesofallcaseswere72.1%,56.1%,and43.7%,respectively.Themediansurvivaldurationwas34months.The1-,2-,and3-yearOSratesoftheHLLgroup(42.9%,28.6%,and28.6%,respectively)weresignificantlylowerthanthoseoftheNLgroup(78.9%,62.5%,and47.8%,respectively).Meanwhile,the1-,2-,and3-yearOSratesoftheEHLLgroup(75.0%,56.1%,and33.3%,respectively)werenotsignificantlydifferentfromthoseoftheothertwogroups.Univariateanalysisshowedthatage,gender,AmericanJointCommitteeonCancer(AJCC)stage,differentiation,ferritin(Fer),carbohydrateantigen19-9(CA19-9)andcarcinoembryonicantigen(CEA)levels,lymphnodemetastasis(LNM),andlymphnodedissection(LND)wereprognosticfactorsforthelong-termsurvivalofICC.Meanwhile,multivariateanalysisrevealedthatage,AJCCstage,differentiation,Ferlevels,andLNMwereindependentriskfactorsforsurvival.Conclusions:ICCpatientswillnotbenefitfromlymphadenectomyintheabsenceofLNM.However,systematiclymphadenectomymayimproveICCoutcomesifthelocationoflymphaticmetastasisisknown.Age,AJCCstage,differentiation,Ferlevel,andLNMareindependentriskfactorsforsurvivalinICC.

简介：我们建议一个回顾的信任区域算法，信任区域为非强迫的优化问题收敛到零。不同于传统的信任区域算法，算法根据回顾的比率更新信任区域半径，它使用最近的模型信息。我们证明算法保存传统的信任区域算法的全球集中。superlinear集中也在一些合适的条件下面被证明。[从作者抽象]

简介：AbstractObjective:No ideal training system exists for pancreaticoduodenectomy (PD). We developed an educational system that uses an objective structured assessment of technical skills.Methods:This retrospective observational study was conducted using the data of consecutive trainees and patients who underwent PD from 2007 to 2013 in Kansai Medical University Hospital. The total score on the task checklist (21 parameters) for measuring technical performance during PD by self assessment and instructor assessment was compared between junior (JN) and hepatobiliary pancreatic (HBP) trainees at a university hospital. Surgical outcomes of 303 PDs (2007-2013) were also compared among JN trainees, HBP trainees, and instructors, and the present position of the trainees was investigated. This study was approved by the institutional review board of Kansai Medical University on May 26, 2020.Results:The self-assessment score on the task checklist was significantly higher for the HBP trainees than for the JN trainees on all parts of PD (P <.001). The discrepancy between self-assessment and instructor assessment improved in 3 JN trainees after experience with the first 5 PDs. Although total score curves rose to the right in the JN group, scores in the HBP group were stable, at 70 or higher, which correlated with the instructor assessment. The 90-day and 30-day mortality rates were 1.6% and 0.3%, respectively. Mortality and morbidity after PD did not differ between the JN and HBP trainees or between the instructors and the trainees. Four of 10 trainees became board-certified expert surgeons of the Japanese Society of Hepatobiliary Pancreatic Surgery.Conclusion:These results indicated good construct validity of the task checklist system. This program was safely and effectively implemented in terms of surgical outcomes and final outcomes of trainees becoming board-certified expert surgeons.

简介：AbstractIn China, brucellosis has spread from the northern provinces to the southern coastal area, and Brucella melitensis has become the overwhelmingly dominant species nationwide. Although human Brucellosis cases have been reported in many parts of Hainan Province, investigations into the source of infection have been rare. In this case, we have used the techniques of bacteriology, genome sequencing, and WGS-SNP to investigate the source of infection on a patient with a traveling history between Hainan and Inner Mongolia autonomous regions. We collected a 5mL blood sample under sterile conditions from this suspected case of Brucellosis infection and incubated it in a culture bottle. A week later, Brucella colonies were purified and identified under the standard bacteriology procedures to show that the strain appeared as B. melitensis bv. 3. Subsequently, a draft genome sequencing of this strain was obtained. A WGS-SNP comparison analysis of Chinese B. melitensis selected (n = 36) from GenBank revealed that the strain in this study was more similar to the strains isolated from China's northern parts, especially those from the Inner Mongolia Autonomous Region. These data indicated that the source of infection of the patient was in the Inner Mongolia Autonomous Region, but the actual location where this patient became infected was unclear. We suggest that travelers from the southern part of China be cautious when visiting the traditional endemic areas of Brucellosis.

简介：AbstractImportance:In children, anesthesia dosages are based on population pharmacokinetics and patient hemodynamics rather than patient-specific brain activity. Brain function is highly susceptible to the effects of anesthetics.Objective:The primary objective of this retrospective pilot study was to assess the prevalence of electroencephalography (EEG) burst suppression—a sign of deep anesthesia—in children undergoing general anesthesia.Methods:We analyzed EEG in patients aged 1-36 months who received sevoflurane or propofol as the primary anesthetic. Patient enrollment was stratified into two age groups: 1-12 months and 13-36 months. Burst suppression (voltage ≤ 5.0 mV, lasting > 0.5 seconds) was characterized by occurrence over anesthesia time. Associations with patient demographics and anesthetics were determined.Results:In total, 54 patients (33 males and 21 females) were included in the study [age 11.0 (5.0-19.5) months; weight 9.2 (6.5-11.0) kg]. The total prevalence of burst suppression was 56% (30/54). Thirty-three percent of patients experienced burst suppression during the surgical phase. The greatest proportion of burst suppression occurred during the induction phase. More burst suppression event occurrences (18/30) were observed in the patient under sevoflurane anesthesia (P = 0.024). Virtually all patients who received propofol boluses had burst suppression (P = 0.033). More burst suppression occurred in patients with hypotension (P < 0.001). During the surgical phase, a younger age was associated with more burst suppression (P = 0.002).Interpretation:EEG burst suppression was associated with younger age, inhalation anesthetics, propofol bolus, and lower arterial pressure.

简介：Objective:Acommoncavitydeformity(CCD)isadeformedinnerearinwhichthecochleaandvestibuleareconfluentformingacommonrudimentarycysticcavitythatresultsinprofoundhearingloss.Therearefewstudiespayingattentiontocommoncavity.Ourgroupisengrossedinobservingtheimprovementofauditoryandverbalabilitiesinchildrenwhohavereceivedcochlearimplantation(CI),andcomparingthesetargetsbetweenchildrenwithcommoncavityandnormalinnerearstructure.Materialandmethods:Aretrospectivestudywasconductedin12patientswithprofoundhearinglossthatweredividedintoacommoncavitygroupandacontrolgroup,sixineachgroupmatchedinsex,ageandtimeofimplantation,basedoninnerearstructure.CategoriesofAuditoryPerformance(CAP)andspeechintelligibilityrating(SIR)scoresandaidedhearingthresholdswerecollectedandcomparedbetweenthetwogroups.AllpatientsworeCIformorethan1yearattheCochlearCenterofAnhuiMedicalUniversityfrom2011to2015.Results:PostoperativeCAPandSIRscoreswerehigherthanbeforeoperationinbothgroups(p<0.05),althoughthescoreswerelowerintheCCDgroupthaninthecontrolgroup(p<0.05).TheaidedthresholdwasalsolowerinthecontrolgroupthanintheCCDgroup(p<0.05).Conclusion:EventhoughaudiologicalimprovementinchildrenwithCCDwasnotasgoodasinthosewithoutCCD,CIprovidesbenefitsinauditoryperceptionandcommunicationskillsinthesechildren.

简介：AbstractObjective:Acute pancreatitis (AP) results in systemic inflammatory responses and activates coagulation pathways. We intend to investigate the risk and hospital outcomes of acute venous thromboembolisms (VTE) in patients with AP.Methods:We retrospectively analyzed patients with AP from 2016 to 2019 using the National Inpatient Sample database. Primary outcome was the effect of VTE on the length of stay, inpatient costs, and mortality. Hierarchical multivariate logistic regression models were built using univariate screens.Results:The study included 909,354 weighted discharges with AP. 2.1% of cases had an acute VTE. The length of stay was 5.9 days longer in the hospital of AP patients with VTE compared to AP with no VTE (P <.001). Total hospital charge per patient was $71,914 in patients with VTE compared to AP with no VTE (P < .001). Mortality was higher in AP patients with VTE compared to AP with no VTE (adjusted odds ratio [AOR] 4.2, 95% confidence interval [CI]: 3.4-5.3, P <.001). AP was associated with an increased VTE risk during inpatient stay (AOR 1.06, 95% CI 1.04-1.1, P <.001) There was an increased association of lower and upper extremity deep venous thrombosis with AP without necrosis (AOR 6.9, 95% CI 6.4-7.4, P <.001) and AP with infected necrosis (AOR 12.2, 95% CI 10.6-14.1, P <.001) but not in AP without necrosis (AOR 0.77, 95% CI 0.74-0.81, P <.001).Conclusion:VTE in AP increases length of stay and inpatient costs. The prognosis is poor in such patients, with increased inpatient mortality compared to no VTE. AP with necrosis can increase chances of all VTE subtypes; however, AP without necrosis does not increase upper and lower extremity VTE risk.

简介：AbstractBackground:The fetal growth charts in widest use in China were published by Hadlock >35 years ago and were established on data from several hundred of American pregnant women. After that, >100 fetal growth charts were published around the world. We attempted to assess the impact of applying the long-standing Hadlock charts and other charts in a Chinese population and to compare their ability to predict newborn small for gestational age (SGA).Methods:For this retrospective observational study, we reviewed all pregnant women (n = 106,455) who booked prenatal care with ultrasound measurements for fetal biometry at the Shenzhen Maternity and Child Healthcare Hospital between 2012 and 2019. A fractional polynomial regression model was applied to generate Shenzhen fetal growth chart ranges for head circumference (HC), biparietal diameter (BPD), abdominal circumference (AC), and femur length (FL). The differences between Shenzhen charts and published charts were quantified by calculating the Z-score. The impact of applying these published charts was quantified by calculating the proportions of fetuses with biometric measurements below the 3rd centile of these charts. The sensitivity and area under the receiver operating characteristic curves of published charts to predict neonatal SGA (birthweight <10th centile) were assessed.Results:Following selection, 169,980 scans of fetal biometry contributed by 41,032 pregnancies with reliable gestational age were analyzed. When using Hadlock references (<3rd centile), the proportions of small heads and short femurs were as high as 8.9% and 6.6% in late gestation, respectively. The INTERGROWTH-21st standards matched those of our observed curves better than other charts, in particular for fat-free biometry (HC and FL). When using AC<10th centile, all of these references were poor at predicting neonatal SGA.Conclusions:Applying long-standing Hadlock references could misclassify a large proportion of fetuses as SGA. INTERGROWTH-21st standard appears to be a safe option in China. For fat-based biometry, AC, a reference based on the Chinese population is needed. In addition, when applying published charts, particular care should be taken due to the discrepancy of measurement methods.

简介：客观：为了在对待多重损伤探索技工al通风(MV)的重要性，主要与服的损害伴随了并且改进治疗水平。方法：受不了伴有主要服的损害的多重损伤的所有116个病人被分析。等级相关和Chi平方测试与GCS在MV之间被做，ISS，并且是否震惊。结果：MV与GCS被相关，ISS分数，并且是否显著地震惊。而且，什么时候GCSor=35，MV的比率是大约85%。结论：在伴有服的损害的多重损伤的治疗期间，原则“早MV，早撤退”并且“个人主义”应该被坚持。为伴有吃惊的病人，最佳偷看是很重要的。合适、活跃的MV是很重要的并且能显著地改进治疗水平。

简介：AbstractObjective:Few reports have described intracranial hemangiomas and structural brain and/or arterial anomalies in patients with infantile hemangiomas. This study was performed to examine the magnetic resonance imaging findings of intracranial abnormalities in a group of infants with hemangiomas in the head and neck regions.Methods:We reviewed our hemangioma treatment center database from January 2010 to July 2018 to assess the prevalence of intracranial abnormalities in infants with hemangiomas in the head and neck regions. Clinical and electronic magnetic resonance imaging data were also retrieved from the patients’ medical charts.Results:Of 436 patients with infantile hemangiomas in the head and neck regions, 23 (5%) had intracranial abnormalities, including 20 (23%) with segmental hemangiomas and 3 (1 %) with focal hemangiomas. In total, 14 patients had intracranial hemangiomas located within the ventricle and cisterns or ipsilateral lesions involving the extradural space. Eight patients had intracranial structural abnormalities, such as cerebellar dysplasia, Dandy-Walker malformation, and hydrocephalus. Five patients had intracranial arterial anomalies, and three patients had arteriovenous malformations.Conclusions:These findings support the hypothesis that intracranial hemangiomas are commonly associated with segmental infantile hemangiomas in the head and neck regions.

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