简介：AbstractBackground:It is still unclear what the minimal infusion volume is to effectively predict fluid responsiveness. This study was designed to explore the minimal infusion volume to effectively predict fluid responsiveness in septic shock patients. Hemodynamic effects of fluid administration on arterial load were observed and added values of effective arterial elastance (Ea) in fluid resuscitation were assessed.Methods:Intensive care unit septic shock patients with indwelling pulmonary artery catheter (PAC) received five sequential intravenous boluses of 100 mL 4% gelatin. Cardiac output (CO) was measured with PAC before and after each bolus. Fluid responsiveness was defined as an increase in CO >10% after 500 mL fluid infusion.Results:Forty-seven patients were included and 35 (74.5%) patients were fluid responders. CO increasing >5.2% after a 200 mL fluid challenge (FC) provided an improved detection of fluid responsiveness, with a specificity of 80.0% and a sensitivity of 91.7%. The area under the ROC curve (AUC) was 0.93 (95% CI: 0.84-1.00, P < 0.001). Fluid administration induced a decrease in Ea from 2.23 (1.46-2.78) mmHg/mL to 1.83 (1.34-2.44) mmHg/mL (P = 0.002), especially for fluid responders in whom arterial pressure did not increase. Notably, the baseline Ea was able to detect the fluid responsiveness with an AUC of 0.74 (95% CI: 0.59-0.86, P < 0.001), whereas Ea failed to predict the pressure response to FC with an AUC of 0.50 (95% CI: 0.33-0.67, P = 0.086).Conclusion:In septic shock patients, a minimal volume of 200 mL 4% gelatin could reliably detect fluid responders. Fluid administration reduced Ea even when CO increased. The loss of arterial load might be the reason for patients who increased their CO without pressure responsiveness. Moreover, a high level of Ea before FC was able to predict fluid responsiveness rather than to detect the pressure responsiveness.Trial registration:ClinicalTrials.gov, NCT04515511

简介：AbstractEndoscopic drainage of pancreatic fluid collections (PFCs) with fewer complications and less trauma has gradually replaced surgery or percutaneous drainage to become the first-line treatment for PFCs. In recent years, the differential efficacy of various stent techniques to drain different types of PFCs has been controversial. This review summarizes the clinical applications of endoscopic ultrasound-guided stent placement for PFCs drainage.

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简介：AbstractBackground:Recent studies suggest that a healthy diet helps to prevent the development of Alzheimer disease (AD). This study aimed to investigate whether spicy food consumption is associated with cognition and cerebrospinal fluid (CSF) biomarkers of AD in the Chinese population.Methods:We enrolled 55 AD patients and 55 age- and gender-matched cognitively normal (CN) subjects in a case-control study, as well as a cohort of 131 participants without subjective cognitive decline (non-AD) in a cross-sectional study. Spicy food consumption was assessed using the Food Frequency Questionnaire (FFQ). Associations of FFQ scores with cognition and CSF biomarkers of AD were analyzed.Results:In the case-control study, spicy food consumption was lower in AD patients than that in CNs (4.0 [4.0-8.0] vs. 8.0 [4.5-10.0], P < 0.001); FFQ scores were positively associated with Mini-Mental Status Examination scores in the total sample (r = 0.218, P = 0.014). In the cross-sectional study, the association between spicy food consumption and cognition levels was verified in non-AD subjects (r = 0.264, P = 0.0023). Moreover, higher FFQ scores were significantly associated with higher β-Amyloid (1-42) (Aβ42) levels and lower phospho-tau/Aβ42 and total tau/Aβ42 ratios in the CSF of non-AD subjects (P < 0.05).Conclusion:Spicy food consumption is closely related to higher cognition levels and reversed AD biomarkers in the CSF, suggesting that a capsaicin-rich diet might have the potential to modify the cognitive status and cerebral pathologies associated with AD.

简介：AbstractObjective:To describe the procedure and results of an adapted closure and reconstruction technique for translabyrinthine surgery that focuses on identifying and managing potential pathways for CSF egress to the middle ear and Eustachian tube.Methods:Retrospective review of a cohort of translabyrinthine acoustic neuroma cases that were reconstructed using this technique.Results:In addition to meticulous packing of potential conduits using soft tissue, hydroxyapatite cement is used to seal opened air cell tracts prior to obliteration of the mastoid defect using adipose tissue. Early results of a small patient cohort using this technique are encouraging and there were no wound infections. There was a single case of CSF rhinorrhea associated with incomplete sealing of opened petrous apex cells, with no recurrence after appropriate implementation of the described protocol during revision surgery.Conclusion:Proactive management of potential conduits of CSF egress including opened air cell tracts has a high likelihood of reducing rates of rhinorrhea and need for revision surgery after the translabyrinthine approach to the posterior fossa.

简介：AbstractObjective:To describe and assess the repair technique and perioperative management for cerebrospinal fluid (CSF) leak resulting from extensive anterior skull base fracture via extradural anterior skull base approach.Methods:This was a retrospective review conducted at the Department of Neurosurgery of the Shanghai Tenth People's Hospital from January 2015 to April 2020. Patients with traumatic CSF rhinorrhea resulting from extensive anterior skull base fracture treated surgically via extended extradural anterior skull base approach were included in this study. The data of medical and radiological records, surgical approaches, repair techniques, peritoperative management, surgical outcome and postoperative follow-up were analyzed. Surgical repair techniques were tailored to the condition of associated injuries of the scalp, bony and dura injuries and associated intracranial lesions. Patients were followed up for the outcome of CSF leak and surgical complications. Data were presented as frequency and percent.Results:Thirty-five patients were included in this series. The patients’ mean age was 33 years (range 11-71 years). Eight patients were treated surgically within 2 weeks; while the other 27 patients, with prolonged or recurrent CSF rhinorrhea, received the repair surgery at 17 days to 10 years after the initial trauma. The mean overall length of follow-up was 23 months (range 3-65 months). All the patients suffered from frontobasal multiple fractures. The basic repair tenet was to achieve watertight seal of the dura. The frontal pericranial flap alone was used in 20 patients, combined with temporalis muscle and/or its facia in 10 patients. Free fascia lata graft was used instead in the rest 5 patients. No CSF leak was found in all the patients at discharge. There was no surgical mortality in this series. Bilateral anosmia was the most common complication. At follow-up, no recurrent CSF leak or meningitis occurred. No patients developed mucoceles, epidural abscess or osteomyelitis. One patient ultimately required ventriculoperitoneal shunt because of progressive hydrocephalus.Conclusion:Traumatic CSF rhinorrhea associated with extensive anterior skull base fractures often requires aggressive treatment via extended intracranial extradural approach. Vascularized tissue flaps are ideal grafts for cranial base reconstruction, either alone or in combination with temporalis muscle and its fascia—fascia lata sometimes can be opted as free autologous graft. The approach is usually reserved for patients with traumatic CSF rhinorrhea in complex frontobasal injuries.

简介：AbstractBackground:Cerebrospinal fluid (CSF) has been demonstrated as a better source of circulating tumor DNA (ctDNA) than plasma for brain tumors. However, it is unclear whether whole exome sequencing (WES) is qualified for detection of ctDNA in CSF. The aim of this study was to determine if assessment of ctDNA in CSF by WES is a feasible approach to detect genomic alterations of glioblastoma.Methods:CSFs of ten glioblastoma patients were collected pre-operatively at the Department of Neurosurgery, Sun Yat-sen University Cancer Center. ctDNA in CSF and genome DNA in the resected tumor were extracted and subjected to WES. The identified glioblastoma-associated mutations from ctDNA in CSF and genome DNA in the resected tumor were compared.Results:Due to the ctDNA in CSF was unqualified for exome sequencing for one patient, nine patients were included into the final analysis. More glioblastoma-associated mutations tended to be detected in CSF compared with the corresponding tumor tissue samples (3.56 ± 0.75 vs. 2.22 ± 0.32, P = 0.097), while the statistical significance was limited by the small sample size. The average mutation frequencies were similar in CSF and tumor tissue samples (74.1% ± 6.0% vs. 73.8% ± 6.0%, P = 0.924). The R132H mutation of isocitrate dehydrogenase 1 and the G34V mutation of H3 histone, family 3A (H3F3A) which had been reported in the pathological diagnoses were also detected from ctDNA in CSF by WES. Patients who received temozolomide chemotherapy previously or those whose tumor involved subventricular zone tended to harbor more mutations in their CSF.Conclusion:Assessment of ctDNA in CSF by WES is a feasible approach to detect genomic alterations of glioblastoma, which may provide useful information for the decision of treatment strategy.

简介：AbstractAlbumin solutions derived from human plasma have demonstrated clinical benefits as intravenous fluid therapy in clinical settings such as liver disease, sepsis, intensive care, and surgery. For all plasma-derived medicinal products, there is a potential risk from pathogens, including relevant blood-borne viruses, emerging viruses, and prion proteins. To minimize the risk of transmissible infections, the production of human albumin solutions includes rigorous donor selection and plasma testing, and effective pathogen removal and inactivation methods such as fractionation and pasteurization. Compliance with international pharmacopeial standards for purity and prekallikrein activator and aluminum content is crucial, as is post-marketing pharmacovigilance for the continuous monitoring of adverse events. This review focuses on the effectiveness of manufacturing methods in the production of plasma-derived albumin, to ensure the safety of hyperoncotic solutions for volume expansion. We evaluated evidence identified through online database (PubMed) searches and from unpublished sources, on the manufacturing and pathogen safety of plasma-derived albumin solutions. The results confirmed the already established and evolving pathogen reduction capacity of the reviewed manufacturing methods. Up-to-date post-marketing pharmacovigilance data and log10 reduction factors for known and emerging pathogens during albumin production are included. Towards the goal of ever-increasing clinical safety, potential areas of improvement, such as compliance rates for the completion of donor health questionnaires, are also discussed. Taken together, the current manufacturing and pathogen reduction steps result in albumin products of greater purity than previous-generation products, with a high margin of pathogen safety against known and emerging pathogens, such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

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简介：摘要目的掌握甘肃省大骨节病病情变化趋势，为大骨节病防治提供科学依据。方法以甘肃省37个大骨节病病区县（区）选择监测点7 ~ 12或7 ~ 16岁儿童作为对象，收集其2004 - 2018年大骨节病临床及X线监测结果，分析大骨节病流行趋势。结果2004 - 2018年，甘肃省临床累计检查儿童97 190人，X线累计检查94 180人，检出临床阳性病例428人，检出率为0.44%；X线阳性病例649人，检出率为0.69%；干骺端阳性病例435人，检出率为0.46%；骨端阳性病例214人，检出率为0.23%。临床阳性检出率2004年最高（7.17%，58/809），其次为2007年（4.60%，51/1 109）和2005年（4.48%，187/4 173），其余年份检出率均< 3%；X线阳性检出率2004年最高（9.59%，58/605），其次为2005年（5.10%，213/4 173）、2008年（3.66%，45/1 228）和2006年（3.04%，125/4 107），其余年份检出率均< 3%。结论甘肃省儿童大骨节病临床阳性检出率和X线阳性检出率均为迅速下降后维持低位波动，综合防治措施效果显著。

简介：摘要目的分析云南省急性职业中毒流行病学特征，为制定全省的急性职业中毒防控措施提供依据。方法于2019年12月，收集云南省2004至2019年报告的急性职业中毒事件信息，对事件流行病学分布、事件分级、行业特点、毒物种类和中毒原因等要素进行描述性分析。结果云南省2004至2019年累计报告47起急性职业中毒事件，中毒病例562例，死亡51例（病死率为9.07%）。报告事件数最多的地区为昆明市和曲靖市，分别为12起（25.53%）和10起（21.28%）；以较大级别的事件居多（31起，65.96%），行业主要分布在化工（19起，40.43%）和冶金业（15起，31.91%）。引起中毒最多的毒物是一氧化碳（10起，21.28%）和砷化氢（9起,19.15%），导致中毒的主要原因包括未使用个人防护设备或设备效果不好（25起，53.19%）、未制定或违反安全操作规程（15起，31.91%）。结论云南省急性职业中毒事件时有发生，病死率较高，应对重点地区和重点行业加强监管。

简介：摘要目的分析2004-2016年我国结核病登记病例的时空分布特征，探测聚集区域，为结核病防控提供理论依据。方法利用ArcGIS 10.0软件作为数据管理和呈现的平台，建立我国2004-2016年结核病空间分析数据库，对结核病疫情进行空间自相关分析，采用SaTScan 9.6软件进行时空扫描分析。结果2004-2016年全国共登记结核病病例13 157 794例，全国年均登记率为75.90/10万（27.95/10万~180.82/10万）。全局空间自相关结果显示结核病发病呈聚集性分布，局部Moran’s I自相关分析结果表明，新疆、西藏、贵州、广西和海南（省、自治区）为高-高聚集区域，北京、河北、天津、山东、江苏、上海（省、直辖市）为低-低聚集区域；局部G统计量热点分析结果显示，全国结核病疫情存在15个"热点"区域，其中3个"正热点"区域分别为新疆、西藏和海南（省、自治区），12个"负热点"区域分别为北京、天津、辽宁、内蒙古、河北、山东、江苏、安徽、上海、山西、河南和吉林（省、自治区、直辖市）。利用SaTScan 9.6软件进行分阶段时空扫描分析，3个阶段共探测出12个聚集区域，每个聚集区域差异均有统计学意义（均P<0.05）。结论2004-2016年我国结核病疫情呈现逐年下降的趋势，各省（自治区、直辖市）的年均登记率并非随机分布，呈明显的空间聚集性，分阶段时空扫描聚集区域逐渐减少，结核病防治工作取得一定进展，但高风险地区仍持续存在，需重点关注并采取针对性防控措施。

简介：摘要目的分析2004-2018年甘肃省甲型肝炎（甲肝）时空分布与聚集性特征，为甲肝防控工作提供依据。方法利用中国疾病预防控制信息系统传染病报告信息管理系统收集2004-2018年甘肃省各县（区）甲肝病例报告数据，描述甲肝疫情流行特征，采用SaTScan 9.1软件进行时空扫描分析、ArcGIS 10.3软件实现扫描结果可视化。结果2004-2018年甘肃省甲肝年均报告发病率为10.91/10万，报告发病率呈现下降趋势，周期性和季节性均不明显；实施扩大国家免疫规划（EPI）后，年均报告发病率异常高值的7个县（区）位于临夏回族自治州和甘南藏族自治州；2004-2012年各年龄组发病RR值均低于0~9岁组（P=0.000）。除2015年0~9岁组外，2013-2018年各年龄组发病RR值低于≥60岁组（P=0.000）；年均报告发病率的趋势由北向南逐渐升高，由西向东逐渐升高；时空扫描结果显示：2004-2018年甘肃省甲肝发病存在时空聚集性。2004-2008年探测出1个一级聚集区，聚集半径为91.95 km，时间为2004-2005年，主要分布在临夏回族自治州和陇南市。2009-2018年探测出1个一级聚集区，聚集半径为183.26 km，时间为2009-2012年，主要分布在甘南藏族自治州、临夏回族自治州、定西市和陇南市。结论2004-2018年甘肃省甲肝发病呈现显著的下降趋势，流行模式有了很大的变化，周期性和季节性均不明显。0~9岁组儿童甲肝报告发病率显著下降且低于其他年龄组，≥60岁人群发病率最高应被重点关注。甲肝存在时空聚集性，重点防控区域在甘肃省西南部地区。

简介：摘要目的了解我国新发HIV感染者的时空流行特点，为HIV防控提供科学指导。方法2004—2017年我国新发HIV感染者数据来源于中国疾病预防控制中心公共卫生科学数据中心和国家统计局，利用Joinpoint软件分析2004—2017年HIV发病趋势，季节自回归综合移动平均（SARIMA）模型预测HIV发病率，并使用Arcgis10.2软件观察HIV空间分布。结果Joinpoint最终选择模型为1分段点模型（P=0.87），分段点为2006年。2004—2017年，14年的年平均百分比变化率为14.82（95%CI：11.74~18.02）。最佳SARIMA模型为（0，1，1）（0，1，1）12，可写成（1-B）（1-B12）Xt=εt（1-0.704 74B）（1-0.275 82B12）。剔除季节效应和不规则噪声对HIV的影响后，HIV发病曲线变得更加平滑。我国HIV发病率较高的地区主要分布在新疆以及西南地区（云南、四川、贵州和重庆等地）。HIV传播热点主要集中在我国西南地区，包括广西、云南、贵州、四川和重庆，该区域主要为高-高聚集。结论目前中国HIV发病率较高且仍处于快速上升的阶段，HIV发病率较高的地区主要集中在新疆和西南地区，形成了广西、云南、贵州、四川和重庆地区高-高空间聚集性的特点。在今后的防控中，应重点关注这些重点地区。

简介：摘要目的通过Joinpoint回归模型描述分析2004—2019年中国城乡人群心脏病死亡率的时间变化趋势。方法收集并整理《中国卫生健康统计年鉴》中2004—2019年中国城乡心脏病死亡率数据，描述其死亡率和标化率的特征，采用Joinpoint回归模型计算死亡率和年龄别死亡率的年度变化百分率(APC)、年平均变化百分率(AAPC)，并分析时间变化趋势。结果2004—2019年间中国城乡人群心脏病死亡率随时间呈波动式上升，其中，城市以平均每年2.70%的年度变化百分率上升(P＝0.000)，农村以平均每年6.95%的年度变化百分率上升(P＝0.000)，农村平均上升速度约为城市的2.6倍。2004—2019年间心脏病年龄别死亡率分析结果显示，城市以>85岁人群上升速度最为迅速，平均每年上升3.72%，其次是30~34岁(1.90%)、60~64岁(1.87%)(P<0.05)；农村以10~14岁、25~29岁、30~34岁及>85岁年龄组上升速度最为迅速，分别以每年5.96%、5.96%、5.61%、5.42%的速度上升(P<0.05)；城乡均在<1岁、15~19岁年龄组以相同速度下降(分别为7.72%、2.80%)(P＝0.000)。结论2004—2019年间中国城乡心脏病死亡率明显上升，农村较城市有更大涨幅，需加强农村地区人群心脏病健康教育及防控工作。

简介：摘要目的分析上海市核医学质量控制(简称质控)中心体外分析室间质评结果，以进一步加强体外分析实验室的检测质控及管理。方法对2004至2018年参加上海市核医学质控中心室间质评活动的41家单位的质评结果进行回顾性汇总分析，分别计算历年所有项目[总三碘甲状腺原氨酸(TT3)、总甲状腺素(TT4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、甲胎蛋白(AFP)、癌胚抗原(CEA)、总前列腺特异抗原(TPSA)]总体合格率和单项指标合格率。结果2004至2018年，室间质评所有项目的总体合格率依次为84.0%(356/424)、90.1%(381/423)、94.8%(399/421)、94.8%(291/307)、96.6%(308/319)、97.2%(280/288)、96.6%(224/232)、97.8%(225/230)、98.7%(224/227)、100.0%(221/221)、99.5%(218/219)、98.6%(215/218)、99.5%(217/218)、99.5%(189/190)、100.0%(90/90)；各年单项指标合格率也呈上升趋势，但仍有体外分析实验室室间质评未达"合格"，检测过程中可能存在影响检测结果的潜在风险因素。结论2004至2018年上海市核医学体外分析室间质评项目合格率逐年上升，对质评结果进行分析有助于发现实验室潜在的风险，提高实验室的检测能力。

简介：摘要目的分析宁夏艾滋病患者(AIDS)免费抗病毒治疗现状及影响因素。方法利用全国艾滋病防治信息系统的工作数据，采用描述性及趋势检验分析宁夏HIV/AIDS抗病毒治疗历年变化趋势和主要特征，logistic回归分析影响该人群入组治疗因素。结果2004—2017年宁夏入组治疗人数共计1 365例，男女比平均为4.1∶1，以青壮年为主，>60岁人群治疗维持在9%的比例，≤20岁人群治疗比例由无增长至5%，婚姻状态以已婚/同居状态居多，未婚呈现增长趋势；传播途径以性传播为主，且同性性行为增加趋势明显；治疗开始时CD4＋T淋巴细胞计数(CD4)M(P25～P75)为346.0(251.0～564.0)个/μl，2004—2008年，治疗时均出现相关体征，2009—2017年逐步减少，HIV确诊阳性时间与开始治疗时间间隔M(P25～P75)为1(0～13)月。"发现即治疗"影响因素分析，患者性别、年龄、传播途径、WHO分期、CD4值是"发现即治疗"的影响因素，其中临床分期III/IV期是"发现即治疗"危险因素。结论宁夏AIDS"发现即治疗"的影响因素较多，其中临床分期中III/IV期是"发现即治疗"策略实施的危险因素；治疗人群趋于年轻化，提示本地区在贯彻"发现即治疗"防治措施同时应针对不同年龄、不同人群开展更加精准的干预措施为抗病毒服务。