医学临床研究
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2016 Vol. 33, No. 9
Published: 2016-09-26
 
 
1665 Diagnostic Value of Enzymelinked Immunospot Assay for Spinal Tuberculosis in the Elderly
LIU Xiangyang,SHENG Bin,ZHOU Lin,et al
【Objective】To evaluate the diagnostic value of enzymelinked immunospot (ELISPOT) assay in detecting spinal tuberculosis (STB) in the elderly. 【Methods】 Fiftysix cases of suspected STB patients from January 2013 to January 2015 were recruited into the Department of Spinal Surgery of Hunan Provincial Hospital. All cases were tested using the ELISPOT detection method, PPD skin test, and serum TB antibody detection. The sensitivity, specificity, positive, and negative predictive rates were compared and analyzed among the three detection methods.【Results】 Among the 56 patients, the overall sensitivity, specificity, positive predictive value, and negative predictive value was 77.14%, 85.71%, 90.00%, and 69.23% using the ELISPOT method, respectively; 37.14%, 71.43%, 68.42%, and 40.54% using the PPD skin test; and 48.57%, 61.90%, 68.00%, and 41.93% in the serum TB antibody test. The sensitivity, specificity, positive predictive value, and negative predictive value of ELISPOT was significantly higher than those of the PPD skin test and antibody detection test. 【Conclusion】 The ELISPOT assay detection method is an effective technique for accurate diagnosis of spinal TB in the elderly.
2016 Vol. 33 (9): 1665-1670 [Abstract] ( 112 ) HTML (1 KB)  PDF  (0 KB)  ( 18 )
1668 Study on the Correlation of Serum Uric Acid in Patients with Primary Hyperthyroidism
WANG Xia，ZHANG Chi
【Objective】To investigate the correlation between serum uric acid (UA) and thyroid function in patients with primary hyperthyroidism.【Methods】Sixtyone cases of primary hyperthyroidism were collected, and were divided into hyperuricemia (HUA) group and normal uric acid (NUA) group according to the blood UA level (male >420 mol / L, female > 360μmol／L). In addition, healthy physical examination population of the same age and gender matched were collected as a healthy control group. The following were detected and compared in the three groups including the thyroid function indicators: free three iodine thyroid gland (FT3), free thyroid hormone (FT4), thyroid stimulating hormone (TSH) level), Fasting blood glucose (FBS); the renal function: blood urea nitrogen (BUN), creatinine (Cr), UA; the liver function: alanine aminotransferase (ALT) and aspartate aminotransferase (AST); the blood lipids: three glycerol (TG), cholesterol (TC), high density lipoprotein (HDLC), low density lipoprotein (LDLC) . The correlation between UA and thyroid function was analyzed.【Results】FT3 and FT4 in the NUA group were significantly higher than the control group (P<0.01), while the TC, HDLC, LDLC, TSH were significantly lower than the control group (P<0.01), but there was no significant difference between the two groups in FBS, AST, TG, BUN, Cr , UA (P>0.05). Compared with NUA group, BUN, UA, Cr, FT3, FT4 of the HUA group were significantly increased (P<0.05), TSH level was significantly decreased, and the difference was statistically significant (P<0.05); there was no significant difference in FBS, ALT, AST, TG, TC, HDLC, LDLC in the two groups (P>0.05). UA was positively correlated with FT3 and FT4 (P<0.05), and was negatively correlated with TSH (P<0.05), Serum Cr was negatively correlated with FT3 and FT4 (P<0.05). 【Conclusion】Patients with primary hyperthyroidism can be easily combined with blood UA elevation. The level of serum UA is closely related to the level of thyroid hormone of patients.
2016 Vol. 33 (9): 1668-1670 [Abstract] ( 73 ) HTML (1 KB)  PDF  (0 KB)  ( 20 )
1671 Application Values of 3.0T MRI on Bone Infarction of the Knee
DONG Jin,HAN Rui,ZHANG Dongyou,et al
【Objective】To explore the value of 3.0 T MRI in the diagnosis of bone infarctions of the knee. 【Methods】Twentyfive patients with bone infarction in the knee, who were confirmed by pathological examination, were enrolled in the study. All patients underwent a 3.0T MRI scan. The MRI features of all patients' images were analyzed. 【Results】In 28 knee joints with bone infarctions, 55 total lesions were detected. Of them, 39 lesions involved both the distant femur and proxial tibia, 11 lesions only involved the distant femur, and 5 lesions involved only the proxial tibia. Fifteen lesions demonstrated the "three ring sign", in which the center of lesion equal or slightly longer than T1, equal or slightly longer than T2, with long T1 and long T2 signal bands around. Ten lesions demonstrated the "double line sign", in which the center of lesion was equal or slightly longer than T1, equal or slightly longer than T2, with the line equal lengths with long T1 and long T2 signals in the proximity. Ten lesions of late bone infarctions demonstrated the "single ring sign", in which both the lesion's center and edge showed low signals in MR. Calcification was also found in some lesions, which demonstrated lower signals. 【Conclusion】Examination of bone infarction characteristics using the 3.0T MRI can signal changes directly, issue multilevel responses of bone infarction range, and determine location by application of different MRI sequences. It provides important clinical implications in diagnosis and treatment of knee joint bone infarctions. 
2016 Vol. 33 (9): 1671-1673 [Abstract] ( 88 ) HTML (1 KB)  PDF  (0 KB)  ( 23 )
1674 Efficacy and Safety of HomoharringtonineContained Regimen in Patients with Acute Myeloid Leukemia
TIAN Huaiping，ZONG Yunlong，TAO Rong， et al
【Objective】To evaluate the efficacy, complications and adverse reactions of HHT (homoharringtonine)contained regimen in patients with acute myeloid leukemia (AML) by meta analysis.【Methods】 A collection of clinical trials for the treatment of AML HHT was performed through searching the PubMed, the Cochrane Library, EMbase, VIP, WanFang Data, CBM and CNKI databases from inception to January 2015. According to the inclusion and exclusion criteria, two researchers were selected to carry out the research of literature selection, data extraction and evaluation. The Meta analysis was conducted by using RevMan 5.2 software.【Results】 Seven trials involving in a total of 1,051 patients were included. The results of metaanalysis showed that: the HHT group was superior to the DA group in terms of CR（complete remission） rate and 3years EFS（event free survival）rate(P<0.05), but the difference of complications such as white blood cell reduction, bleeding, and infection rates was not statistically significant compared with the DA group (P>0.05); The incidence of adverse reactions such as cardiac injury was significantly lower than that of the DA group. 【Conclusion】 HHT containing regimen is safe and effective for the treatment of AML, and does not increase the incidence of complications. With easy access and low prices, HHT is a good choice for the treatment of AML and is worthy of clinical application.
2016 Vol. 33 (9): 1674-1680 [Abstract] ( 115 ) HTML (1 KB)  PDF  (0 KB)  ( 35 )
1678 Curative effect of Minimally Invasive Percutaneous Plate Osteosynthesis on Proximal Humeral Fractures with Closed Reduction
HE Jiahai,CHEN Liansuo LIU Xibin,et al
【Objective】To investigate the therapeutic effect of closed reduction and minimally invasive percutaneous plate osteosynthesis (MIPPO) in the treatment of proximal humeral fractures.【Methods】Sixty cases of proximal humeral fractures were randomly divided into two groups, 30 cases in each group. The observation group was treated with MIPPO; the control group was treated with routine operation incision and internal fixation. The operation time, blood loss, incision size, and Xray fracture reduction in 3 months after operation,incidence of complications 12 months after operation and the Neer score of shoulder joint were compared between the two groups.【Results】The operation time of the observation group was (50.6±9.7) min, which was significantly shorter than that of the control group (71.9±9.2) min; The amount of bleeding in the observation group was (149.7±37.1) mL, which was significantly less than that of the control group (245.4±46.1) mL; The incision diameter of the observation group was (7.8±0.7) cm, significantly smaller than that of the control group (15.2±1.4) cm. The postoperative excellent rate of observation group was 93.3% (28/30), significantly higher than the control group 80% (24/30), the difference was statistically significant (mean P<0.05). In the observation group, 12 months after surgery, no necrosis of the humeral head and axillary nerve injury were found; in the control group, no necrosis of the humeral head was found in 12 months after operation, but there was only 1 case with axillary nerve injury, and all the fractures healed.【Conclusion】Compared with the conventional open reduction and internal fixation, MIPPO treatment of proximal humerus fractures has the advantages of shorter operation time, less blood loss, smaller incision, better reduction and fewer complications. It is worth of clinical application.
2016 Vol. 33 (9): 1678-1680 [Abstract] ( 63 ) HTML (1 KB)  PDF  (0 KB)  ( 26 )
1681 Curative Effect of Straight Incision and Small Bone Window Craniotomy Debridement for Treatment of Epidural Hematoma
WANG Jiaqing
【Objective】To investigate the curative effect of straight incision and small bone window craniotomy debridement for treatment of epidural hematoma.【Methods】One hundred and fourteen cases of epidural hematoma in our hospital were selected and divided into the observation group and the control group according to the operation method , the observation group of 59 cases were treated with straight incision and small bone window craniotomy debridement, the control group of 55 cases were treated with routine flap craniotomy, the differences of perioperative indicators between the two groups were compared; the differences of awareness, physical activity, language, GCS score before and after the treatment between the two groups were compared; The differences of GOS score after treatment in two groups were compared.【Results】The operation time, blood loss, blood transfusion, heart rate (HR) and respiratory rate in the observation group were lower than those in the control group, the blood oxygen saturation in the observation group was higher than that in the control group, the difference was statistically significant (mean P<0.05); Compared with the control group, the difference of the mean arterial pressure in the observation group was not statistically significant (P>0.05). Consciousness, physical activity, language, GCS scores of the two groups of patients after treatment were higher than those before treatment, and the difference was statistically significant (P<0.05); consciousness, physical activity, language, GCS scores of the observation group after the treatment were higher than those in the control group, the difference was statistically significant (both P<0.05). After treatment, there was no significant difference in the efficacy of GOS score between the two groups (P>0.05).【Conclusion】Straight incision and small bone window craniotomy debridement can effectively remove the hematoma and reduce the intracranial pressure, which is superior to the conventional bone flap craniotomy in the improvement of the consciousness of the patients and the improvement of the nerve function.
2016 Vol. 33 (9): 1681-1687 [Abstract] ( 55 ) HTML (1 KB)  PDF  (0 KB)  ( 33 )
1684 Curative Effects and Safety of Rosuvastatin Combined with Ezetimibe in Hyperlipidemia Elderly Patients with Acute Cerebral Infarction
CAO Lihua,XIA Chengcai,YU Lizhi,et al
【Objective】To study the effects and safety of the combination of ezetimibe and rosuvastatin on the levels of bloodlipids in elderly patients with acute cerebral infarction. 【Methods】A total of 89 patients with acute cerebral infarction were recruited and randomly assigned to group A (rosuvastatin 10mg/d，ezetimibe 10 mg/d，n=46) and group B(rosuvastatin 10 mg/d，n=43)．The observation targets of all patients were assessed after 2 weeks and 12 weeks of treatment. The changes of bloodlipids, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and creatine kinase (CK) were compared before and after treatment．【Results】 Compared to before treatment, the levels of lowdensity lipoproteins (LDLC) after 2 weeks of treatment in both groups were decreased, dropping at ratios of 32.7% and 17.3%, respectively. However, after 12 weeks of treatment, the decreasing ratios were 48.4% and 27.2%. respectively; the levels of LDLC in group A dropped earlier and more quickly than in group B. There was a statistically significant difference (P<0.001). No correlation existed between improvement of liver enzyme level (ALT and AST) and muscle enzyme level (CK). The rate of reaching guideline target of LDLC 12 weeks after treatment was 56.5% (26 cases) in group A and 20.9% (9 cases) in group B; there was a statistically significant difference (P=0.002). The levels of total cholesterol (TC) fell by about 45% and 28% after 12 weeks of treatment, with significant difference between group A and group B (P=0.003). After 12 weeks of treatment the levels of triglycerides (TG) decreased, while levels of highdensity lipoproteins (HDLC) increased, but showed no statistical significance compared to before treatment. 【Conclusion】Our study demonstrated that it is feasible to initiate combination therapy in elderly patients with acute cerebral infarction，which can shorten the time it takes for LDLC levels to reach the guideline target and increase the rate of reaching the guideline target while not increasing liver or muscle toxicity. 
2016 Vol. 33 (9): 1684-1687 [Abstract] ( 73 ) HTML (1 KB)  PDF  (0 KB)  ( 34 )
1688 Osteosarcoma Tissue and Plasma and Its Clinical Diagnostic Significance
XIAO Zhi,ZANG Xiaofang,WANG Weiguo
【Objective】To further investigate the mechanism involved in pathogenesis of osteosarcoma and to discuss the feasibility of methylation status in plasma as a biomarker for clinical detection of osteosarcoma.【Methods】 Methylationspecific PCR (MSP) was applied to determine RASSF1A methylation in 30 cases of osteosarcoma tissues and plasma from the same patient and 15 cases of normal bone tissues and plasma from healthy volunteers. The correlation between methylation of RASSF1A gene and clinicalpathological features such as gender, age, tumor location, tumor differentiation and tumor distant metastasis was analyzed. 【Results】 RASSF1A methylation was not detected in normal bone tissue and plasma. Hypermethylation of RASSF1A was present in 26.7% (8/30) of the osteosarcoma plasma samples and 40% (12/30) of the osteosarcoma tissues, and of the 12 cases of positive RASSF1A methylation, 8 cases were found with RASSF1A methylation both in the cancer tissues and plasma from the same patient, with a positive consistent rate of 66.7% (8/12), and 18 cases were observed with negative methylation both in the cancer tissues and plasma. Kappa consistency check showed that methylation of RASSF1A gene in osteosarcoma tissue and plasma had consistency (Kappa value was 0.133, P<0.05). In addition, analysis showed that RASSF1A methylation in osteosarcoma tissue and plasma was significantly higher than that in the normal tissue and plasma (P<0.05). The methylation of RASSF1A in plasma and cancer tissue had no obvious relationship with gender, age, or tumor location (P>0.05), but had relationship with tumor differentiation and tumor distant metastasis (P<0.05).【Conclusion】RASSF1A methylation in plasma can partly represent similar changes in cancer tissue from the same patient and may be a promising biomarker for clinical detection of osteosarcoma.
2016 Vol. 33 (9): 1688-1691 [Abstract] ( 58 ) HTML (1 KB)  PDF  (0 KB)  ( 33 )
1692 Analysis of the Clinical Features of Mycoplasmal Pneumonia in Children of Different Ages
SHI Qingkang,LU Zhaodong,YUAN Jinjing
【Objective】 To investigate the clinical features of mycoplasmal pneumonia in children of different ages. 【Methods】A total of 156 cases of mycoplasma pneumonia (MP) in our hospital from January 2012 to December 2014 were selected and divided according to age into an infant group (6 months ~ 3 years old) with 69 cases (group A) and a children group (3~14 years old) with 87 cases (group B). The clinical features of MP in these children of different ages were analyzed. 【Results】 In group A, fever in patients was mild to moderate, the positive rate of pulmonary rales was high, and the chest radiograph primarily showed small, patchy shadows. In group B, fever in patients was moderately severe, the positive rate of pulmonary rales was low, and the chest radiograph primarily showed large shadows. In both groups, white blood cells (WBC), creactive protein (CRP), and neutrophils (NEU) were elevated, although the increase in CRP was more significant (P<0.05). 【Conclusion】The xrays, clinical symptoms, and pulmonary auscultations of patients of different ages were significantly different. Although blood tests for the diagnosis of MP lacks specificity, creactive protein has great significance in the diagnosis of the disease. Clinical diagnoses must be conducted according to the comprehensive situation analysis in order to reduce the misdiagnosis rate.
2016 Vol. 33 (9): 1692-1696 [Abstract] ( 80 ) HTML (1 KB)  PDF  (0 KB)  ( 34 )
1694 Logistic Regression Analysis of the Independent Risk Factors of Abnormal Neonatal Cerebrospinal Fluid in Febrile Infants
XIAO Yong，PENG Xiaoming,YAN Weiqun,et al
【Objective】To investigate the independent risk factors of neonatal cerebrospinal fluid abnormalities in febrile infants. 【Methods】 According to the result of cerebrospinal fluid examination, 325 febrile infants were divided into an observation group of infants with abnormal indexes (n=79) and a control group of patients with normal indexes (n=246). The clinical data of neonatal indicators of patients in the two groups were collected and analyzed using Logistic regression analysis. 【Results】  (1) Single factor analysis showed that amniotic fluid turbidity, method of childbirth, sex, Apgar(Appearance,Pluse,Grimace,Activity,Respiration) score, basic diseases, nervous system symptoms, the result of urine routine, stool routine, and blood culture showed no statistically significance difference between the two groups (P>0.05). However, the difference between the two groups of children in premature rupture of membranes, birth weight, highest temperature, time of fever occurring , duration of fever, and infection type were statistically significant (P<0.05). Premature rupture of membranes. (2) Logistic regression analysis showed that premature rupture of membranes, highest temperature ≥38.5 ℃, age at time of fever is 14 days or less, heating duration ≥ 3 d, and bacterial infection are independent risk factors for neonatal cerebrospinal fluid abnormalities (P<0.05). Birth weight 2.5 Kg or less is not an independent risk factor for neonatal cerebrospinal fluid abnormalities (P>0.05). 【Conclusion】 For febrile newborns, when premature rupture of membranes occurs during the mother's pregnancy, age at time of fever is 14 days or less,  highest temperature is ≥38.5℃, fever duration ≥3 d, or diagnosis of bacterial infection, the clinical doctors should give cerebrospinal fluid examination as soon as possible for the early diagnosis and treatment of intracranial infection.
2016 Vol. 33 (9): 1694-1696 [Abstract] ( 73 ) HTML (1 KB)  PDF  (0 KB)  ( 17 )
1697 Logistic Regression Analysis of Risk Factors of Hepatitis Cirrhosis（HC）Complicated With Hepatocellular Carcinoma (HCC)
ZHAN Chunling

【Objective】 To investigate the risk factors of the hepatitis cirrhosis（HC）complicated with hepatocellular carcinoma (HCC).【Methods】 One hundred and thirtythree cases of HC complicated HCC patients admitted in our hospital were selected from May 2011 to May 2016 as the observation group,  and another 133 cases of HC noncomplicated HCC patients (HC course more than 10 years) as the control group. The clinical data of two groups were collected and sorted; the risk factors of HC complicated with HCC were screened by multi factor Logistic regression analysis.【Results】 Single factor analysis showed that the proportion of patients in the observation group was significantly higher than that in the control group in the fields of family history of liver cancer (first degree relatives), drinking history, smoking history, alcoholic fatty liver, nonalcoholic fatty liver, diabetes history, HBVDNA>104 copies/mL and not anti viral treatment, the difference was statistically significant (P<0.05).The independent risk factors of HC complicated with HCC were:  family history of liver cancer (firstdegree relatives) （OR=4.173,95%CI 1.673～9.602，P=0.000） ; alcohol drinking index 3～7（OR=3.282, 95%CI 1.265～5.273，P=0.001）; alcohol drinking index 8～16（OR=4.732，95%CI 1.644～8.574，P=0.000） ; smoking index 8～16（OR=4.121, 95%CI 1.543～5.288，P=0.000）; alcoholic fatty liver（OR=4.763, 95%CI 1.442～7.219，P=0.000）; diabetes mellitus（OR=3.982, 95%CI 1.743～6.182，P=0.000）; HBeAg positive（OR=3.172,95%CI 1.543～5.182，P=0.001）；HBVDNA（104～105 copies/mL）（OR=5.874,95%CI 2.382～9.104，P=0.000）；HBVDNA（105～106 copies/mL）（OR=7.473, 95%CI 2.874～12.129，P=0.000）；HBVDNA（106～107 copies/mL）（OR=10.393,95%CI 6.182～34.645，P=0.000）；HBVDNA（≥107 copies/ml）（OR=12.475, 95%CI 6.987～39.543，P=0.000）; no anti viral treatment（OR=6.122,95%CI 2.884～8.138，P=0.000）.【Conclusion】HBeAg positive, HBVDNA>104 copies/ml, nonantiviral treatment, a long history of drinking, smoking, diabetes history, family history of liver cancer (firstdegree relatives) are the high risk factors of HC complicated with HCC.
2016 Vol. 33 (9): 1697-1701 [Abstract] ( 74 ) HTML (1 KB)  PDF  (0 KB)  ( 36 )
1702 Evaluation of the Imaging Quality of Dynamic ThreeDimensional ContrastEnhanced Ultrasonography in the Diagnosis of Hepatocellular Carcinoma
WANG Xin,LI ling
【Objective】To investigate the value of dynamic threedimensional contrastenhanced ultrasonography (3DCEUS) in the diagnosis of hepatocellular carcinoma. 【Methods】Clinical and imaging data of 50 patients with hepatocellular carcinoma admitted in our hospital from June 2014 to December 2015 were retrospectively analyzed. Each patient underwent 3DCEUS and contrastenhanced computed tomography (CECT). The image quality of the two methods, including the internal display of the arterial phase (enhancement mode, the internal blood vessels of the tumor), the blood vessels of the tumor vessels, and the display of the tumor boundary were comprehensively scored.【Results】 After the injection of the contrast agent, 50 cases of tumor 3DCEUS were given different degrees of enhancement. The results showed that: According to 3DCEUS, 3 cases received scores of 0, 10 cases received scores of 1, and 37 cases received scores of 2 while according to CECT, no cases received scores of 0, 9 cases received scores of 1, and 41 cases received scores of 2. Further analysis of internal display of tumor of the 32 cases of patients receiving an average score of 2 using the two methods showed that there was no statistical difference between the 3DCEUS and CECT images in the enhancement mode (P>0.05); the Kappa value of the consistency score was 0.88. In the aspect of blood vessels in the tumor, 3DCEUS was superior to CECT (P<0.05). In the aspect of arteries, the two methods were not completely consistent. Images with scores of 0 and 1 showed no statistically significant difference between 3DCEUS and CECT (P>0.05), while for images with scores of 2, 3DCEUS was superior to CECT (P<0.05). In the aspect of relationship between peripheral tissues, the two methods showed no significant difference (P>0.05).【Conclusion】Dynamic 3DCEUS had high imaging quality in hepatocellular carcinoma diagnosis, and shows the enhancement way and boundary of hepatocellular carcinoma clearly as well as CECT does. In addition, the ability of 3DCEUS in displaying tumor internal vessels and supplying vessels was superior to that of CECT.
2016 Vol. 33 (9): 1702-1707 [Abstract] ( 71 ) HTML (1 KB)  PDF  (0 KB)  ( 31 )
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