Volume 100 ·  Issue 31 ·  2020

The list of members of the expert group for the formulation of this consensus:

In December 2019, cases of novel coronavirus disease 2019 (COVID-19) appeared in Wuhan, Hubei Province, and rapidly spread to other parts of Hubei Province and even the whole country. To this end, the National Health and Wellness Commission has included COVID-19 as a Class B infectious disease stipulated in the Law of the People's Republic of China on the Prevention and Control of Infectious Diseases, and adopted prevention and control measures for Class A infectious diseases. With the deepening of the understanding of clinical manifestations and pathology of the disease and the accumulation of experience in diagnosis and treatment, in order to further strengthen the early diagnosis and treatment of the disease and avoid nosocomial infection as much as possible, on the basis of "Emergency Process Management and Prevention and Control Strategy of Novel Coronavirus Infection" put forward by the Department of Neurosurgery, Wuhan Union Medical College Hospital, Huazhong University of Science and Technology, we widely listened to the opinions and suggestions of experts, especially those in the front line of epidemic prevention, and made targeted supplements and improvements with reference to the latest national and Hubei Provincial relevant prevention and control guidance. The contents are summarized as follows for the reference of peers.

To evaluate the clinical effect of Z-shaped rotating osteotomy of metatarsal diaphysis in patients with moderate and severe hallux valgus with metatarsophalangeal joint incongruency.

We selected 36 patients (38 feet) with moderate and severe hallux valgus with metatarsophalangeal joint incongruency who underwent Z-shaped rotating osteotomy of metatarsal diaphysis in the First Affiliated Hospital of Army Medical University of Chinese PLA from September 2010 to January 2019. There were 2 males and 34 females with an average age of (49±18) years (18-77 years). Hallux valgus angle (HVA), first-second intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), congruency index, length of first metatarsal, and functional scores were evaluated before and 6 weeks after surgery and at the last follow-up. The data were compared by one-way ANONA or t test.

The congruency index was significantly improved from 0.75±0.11 before surgery to 0.95±0.07 at the last follow-up (t=11.728, P<0.01). HVA and IMA improved significantly at 6 weeks after surgery, however, HVA at the last follow-up showed an increased trend compared with that at 6 weeks after the operation, while no significant improvement in IMA. Although DMAA increased slightly 6 weeks after surgery when compared with that before surgery, there was no significant difference in it between the last follow-up and the 6 weeks after surgery, and no significant difference in the length of the first metatarsal at different time points (F=0.991, P>0.05). In terms of functional scores, American Orthopaedic Foot & Ankle Society (AOFAS) score increased from 50±9 before surgery to 80±17 at the last follow-up, while visual analogue scale (VAS) decreased from 5.8±1.1 to 2.7±1.5, Manchester-Oxford Foot Questionnaire (MOXFQ) score decreased from 70±13 to 25±19 ( t=12.024, 13.439, 16.880, all P<0.05).

The treatment of moderate and severe hallux valgus with metatarsophalangeal joint incongruency by Z-shaped rotating osteotomy of metatarsal diaphysis can significantly increase the congruency index of metatarsophalangeal joint and improve the metatarsophalangeal joint matching relations. It will not significantly increase the DMAA. A certain degree of radiographic recurrence occurs during a longtime follow-up, but it doesn′t influence the symptoms and function.

To investigate the application and efficacy of the one-stage total knee arthroplasty (TKA) of intra-articular compensation osteotomy in knee osteoarthritis(KOA) patients with extra-articular deformity (EAD).

A retrospective study of 9 patients with end-stage KOA and EAD undergoing one-stage TKA from January 2014 to December 2017 in the First Affiliated Hospital of Zhejiang Chinese Medical University was performed. There were 3 males and 6 females with an average age of 56 years(range, 19-77 years);5 cases of simple coronal deformity (varus 10°-27°, mean 18.2°), 3 cases of sagittal deformity (recurvatum15°-35°, mean 22.6°), 1 case combined with coronal and sagittal deformity (varus 16°, recurvatum 31°); hemophilia dysplasia in 1 case, fracture malformation in 8 cases. Main outcome measures included the mechanical axis, range of motion (ROM) and Hospital for Special Surgery Knee Score (HSS).

The mean follow-up period was 33.2 months (range, 25-47 months). The mechanical axis angle was restored from 12.4°±4.1°to 1.4°±0.9°(t=7.954, P<0.01). The HSS was improved from 28±14 preoperatively to 87±7 postoperatively (t=-11.174, P=0.013). The ROM increased from 56°±22°to 99°±8° (t=-5.480, P=0.010). There was no complications such as joint instability, infection, fracture, common peroneal nerve injury and early prosthesis loosening.

For KOA patients with femoral EAD, one-stage TKA with intra-articular compensatory osteotomy can effectively restore the mechanical axis and obtain satisfying joint function. Through a series of measures such as preoperative measurement, soft tissue evaluation and 3D printing, the accuracy of surgery can be improved and the difficulty of surgery can be reduced.

To compare clinical outcomes of microsurgical bilateral decompression via unilateral approach (MBDU) between trans longissimus and iliocostalis approach, a novel lateral paraspinal approach(LPA), and classic Wiltseapproach for single level degenerative lumbar stenosis.

LPA approach was researched by imaging measurement and cadaver anatomy. Retrospective analysis of a total 124 cases(male/female 75/49, aged(55±14) years) received single-level MBDU due to degenerative lumbar stenosis from 2016 to 2018 in Beijing Tiantan Hospital. Patients were categorized into two groups according to spinal canal morphology. Group A: trefoil shape (n=48), received MBDU via LPA; Group B: round & oval shape ( n=76), received MBDU via Wiltse approach. Clinical parameters, including visual analogue scale (VAS) of pain, OswestryDability Index (ODI), satisfaction rate were assessed before the operation and at the latest follow-up. The internal fixation and intervertebral fusion were evaluated by X-ray and CT.The data were compared with single sample t test between the two groups.

The feasibility of trans longissimus and iliocostalis approach was proved by imaging measurement and anatomic study. The tube′s maximum tilt angle in LPA group was 65°, and it was 40°in Wiltse group. There was no significantly difference in the operating time, bleeding and drainage volume between the two groups((120±27) min vs (115±32) min, (104±31) ml vs (110±41) ml, (50±15) ml vs (47±18) ml, respectively, t=1.246,-1.917,1.730,all P>0.05). In both groups, VAS and ODI scores significantly improved at the latest follow-up when compared with those before the operation (all P<0.05), but those were all comparable between the two groups(all P>0.05). The excellent rate of subjective satisfaction for the clinical efficacy in group A and B was 89.6%(43/48) and 86.8%(66/76) respectively (χ²=0.208,P>0.05).

LPA approachfor microsurgical bilateral decompression via unilateral approach (MBDU) in degenerative lumbar stenosis is safe and effective, it has advantages in direct vison of contralateral nerve root canal decompression for trefoil shaped spinal canal.

To investigate the characteristics of monosodium urate (MSU) deposition in patients with the first-episode of acute gouty arthritis (Gout) by using dual energy CT (DECT) imaging technique.

A total of 70 first-episode patients with acute Gout diagnosed in Peking University Third Hospital in 2019 were collected as the case group, including 69 males and 1 female, aged 17-65 (39±14) years. During the same period, a total of 15 male patients aged 19-56 (33±12) years were collected as the control group. They were admitted to the hospital due to sports injuries and were excluded from gout. The DECT data of the first-affected or the most painful joints of gout in the case group and the surgical ankle joints in the control group were retrospectively analyzed. The crystal morphology, volume and deposition location of MSU in the measured joints were evaluated and recorded, and the degree of MSU deposition in the joints of the first-episode patients with Gout and its coincidence with clinical symptoms were summarized. The χ ² test, and Kruskal-walls were used for statistical analysis.

The detection rate of MSU by DECT in the case group was 97.1% (68/70), and 0 in the control group. The first-affected joints of Gout included 52 cases of ankles (74.3%), 13 cases of knees (18.6%), and 5 cases of wrists (7.1%). The three joints were mainly deposited with scattered submillimeter MCU. There was no significant difference in MSU morphology and volume between the three joints. The locations with the most MCU deposits among the three joints were 78.8% (41/52) of the posterior calf tendons (including Achilles tendon), 76.9% (10/15) of the knee articular cartilages, and 60.0% (3/5) of the palmaris tendons, while the distribution of the first metatarsophalangeal joint was less than 13.5% (7/52). The number of MSU deposited joints detected by DECT was 37 cases more than that of symptomatic joints, accounting for 52.8%.

DECT is highly sensitive in detecting MCU in the first-episode of acute Gout, which helps to improve the early diagnosis rate of gout.

To explore the characteristics of executive function in children with attention-deficit/hyperactivity disorder comorbid with high functioning autism.

A total of 165 children with attention-deficit/hyperactivity disorder (ADHD group), 65 children with attention-deficit/Hyperactivity disorder comorbid with high functioning autism (ADHD-HFA group), and 84 healthy controls (control group) (based on the criteria of DSM-5) were recruited from the Outpatient Clinic of Child Healthcare Department of Shen Zhen Children’s Hospital. The Rey complex figure test (RCFT), trail making test (TMT), Stroop color-word test were used to assess working memory, shifting and inhibition.

ADHD group (2.1±1.9, 7±5, 2.1±2.0 and 7±5) and ADHD-HFA group (2.0±2.0, 7±6, 2.0±2.1 and 6±5) performed worse than control group (3.4±2.0, 10±5, 3.4±2.0 and 10±6) in Rey complex figure test (all P<0.05). ADHD group ((171±8) s, (27.40±0.82) s and (52.29±1.62) s) and ADHD-HFA group ((197±11) s, (29.7±1.1) s and (58.6±2.1) s) group took longer time on the TMT-2, Stroop2 and Stroop4 test than control group ((135±18) s, (22.4±1.9) s and (38.7±3.8) s) (allP<0.05). In children with low intelligence quotient (IQ), ADHD group ((30±8) s) and ADHD-HFA group ((34±9) s) performed worse on Stroop3 test than control group ((20±4) s) (allP<0.05). In children with average IQ, ADHD group ((19±5) s and (24±8) s) took longer time on the Stroop1 and Stroop3 test than control group ((16±3) s and (19±4) s) (allP<0.05). In children with high IQ, ADHD-HFA group ((20±8) s) spent more time on Stroop1 than control group ((15±4) s) (P<0.05). Inattention symptoms were associated with the time on TMT-2 of ADHD-HFA group (r=0.275 and 0.329, all P<0.05). The score of item 1 in autism spectrum screening questionnaire (ASSQ) was negatively correlated with immediate recall structure and detail scores as well as delay structure scores of Rey complex figure test (r=-0.358, -0.326 and -0.306, all P<0.05). The score of item 4 was positively correlated with errors of Stroop4 (r=0.296, P<0.05). The score of item 22 was positively correlated with time of color interference (r=0.279, P<0.05).

Children with ADHD-HFA are likely to demonstrate the spatial working memory, shifting and inhibition deficits associated with ADHD alone. Some domains of executive function impairment in ADHD-HFA group are related with symptoms of inattention/hyperactivity and autism.

To investigate the clinical value of holographic multimodal real-time three-dimensional navigation (3D-HMRN) technology for navigation and localization of pulmonary micro lesions.

A total of 152 patients who underwent thoracoscopic partial resection of small pulmonary nodules in the Department of Thoracic Surgery of the First Medical Center of Chinese PLA General Hospital from June 2017 to December 2019 were retrospectively collected and were divided into two groups by computer random number. The experimental group consists of 76 patients (31 males and 45 females) with a mean age of (47±17) years. CT scan in lateral position navigation mode and 3D reconstruction of the surgical area were performed on all patients. Before the operation, holographic multimodal real-time 3D navigation technology was used to guide the puncture of the lesion. After the operation was completed, the intraoperative CT was used to verify the location of the puncture and determine the accuracy and error rang of the puncture. The control group consists of 76 patients (34 males and 42 females) with a mean age of (50±19) years. Intraoperative CT positioning was directly subjected to the patients. And then, the localization data of the two groups were compared and statistically analyzed.

Seventy-six cases of positioning puncture using navigation technology, the first success rate was 97.4%, the error was (3.9±0.9) mm, and the average operation time was (4.4±1.2) min; while the success rate of one-time CT positioning during routine surgery was 98.7%, the error was (3.5±1.0) mm, and the average operating time was (10.7±2.6) min. Compared with intraoperative CT positioning, the success rate and positioning accuracy of 3D-HMRN were not statistically significant (both P>0.05), however the operation time was significantly shortened (P<0.01).

The holographic multi-modal real-time 3D navigation technology saves time and has accurate positioning, which may be used as an effective method for localization of pulmonary micro nodules during surgical treatment.

To analyze the clinical efficacy and safety of cyberknife in the treatment of patients with primary large hepatocellular carcinoma over 70 years old.

A total of 82 patients (58 males and 24 females) with large hepatocellular carcinoma aged over 70 years (70 to 85 years, (75±4) years) with a median tumor diameter of 6.7 cm (5.0~10.0 cm) were retrospectively collected. All patients were diagnosed by pathology or radiography in the Cancer Radiotherapy Center of the Fifth Medical Center of the PLA General Hospital from March 2014 to December 2018, and treated with cyberknife stereotactic radiotherapy. Progression free survival rate (PFS), local control rate (LC), overall survival rate (OS) and adverse reactions were observed at 1, 2 and 3 years. Kaplan-Meier was used for survival analysis, and Cox regression model was used to analyze survival-related factors.

All 82 patients successfully completed radiation therapy with a median survival time of 20 months, a median PFS of 10 months, an objective response rate of 64.63% (53/82), and a disease control rate of 85.37% (70/82). After treatment, the PFS at 1, 2, and 3 years were 39.0% (32/82), 22.1% (18/82), and 17.1% (14/82), respectively; the LC at 1, 2, and 3 years were 95.1% (78/82), 92.3% (76/82), and 92.3% (76/82), respectively; and the OS at 1, 2, and 3 years were 68.3% (56/82), 48.8% (40/82) and 31.7% (26/82), respectively. Nine patients suffered from radiation-induced liver disease (RILD), and there were no deaths due to RILD. Cox regression analysis showed that alpha-fetoprotein (AFP) was an independent risk factor for OS (HR=2.304, 95%CI 1.118-4.747;P<0.05).

Cyberknife treatment for patients with primary large hepatocellular cancer over 70 years old has higher LC and OS, better curative effect, and less treatment-related adverse reactions.

To investigate the protective mechanism of ginsenoside Rb-1 on the brain in a rat model of Alzheimer's disease.

Fifty-six male Sprague-Dawley rats were randomly divided into control group, model group, low-dose Rb-1 group (Rb-1: 25 mg•kg^-1•d^-1) and high-dose Rb-1 group (Rb-1:50 mg•kg^-1•d^-1). Morris water maze was designed to observe the changes of learning and memory ability in rats. Flow cytometry was used to detect the apoptosis of hippocampal neurons. Immunohistochemistry and Western blot were employed to detect the expression levels of apoptosis-related genes (p53, Bax, cytochrome C (Cyto C), Caspase-3 and caspase-9) and anti-oxidative stress-associated genes (nuclear Factor-E2-related factor 2 (Nrf2), kelch-like ECH-associated protein 1 (keap-1), heme oxygenase 1(HO-1) and NADPH quinone dehydrogenase 1 (NQO1)).The activities of catalase (CAT), glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) were detected by relevant kits. ANOVA and Tukey-Kramer test were used for statistical analysis.

The learning and memory ability of rats in the model group was lower than that of the control group (P<0.01).The learning and memory ability of rats in the high-dose Rb-1 treatment group was significantly higher than that of the model group [(80±8) s vs (100±11) s,t=5.390, P<0.01]. The expression levels of apoptosis-related genes (p53, Bax, Cyto C, caspase-3 and caspase-9) in the model group were significantly higher than those in the control group (P<0.01), while the expression levels of these genes in low-dose and high-dose Rb-1 groups were significantly lower than those of the model group (P<0.01). The expression levels of Nrf2, HO-1 and NQO1 genes in the model group were significantly lower than those in the control group (P<0.05), while the expression of these genes in low-dose and high-dose Rb-1 groupswere significantly higher than those of the model group (P<0.01). The activities of CAT, GSH-Px and SOD in the model group were lower than those in the control group (P<0.01), however the activities of CAT, GSH-Px and SOD in low-dose and high-dose Rb-1 groups were higher than those of model group (P<0.05).

Both low-dose and high-dose Rb-1 have protective effect on memory and cognitive function of Alzheimer's disease rats by reducing the damage and apoptosis of hippocampal neurons, down-regulating the expression levels of p53, Bax, Cyto C, caspase-3 and caspase-9, up-regulating the expression of Nrf2, HO-1 and NQO1 genes, and increasing the activities of CAT, GSH-Px and SOD. Moreover, the protective effect of Rb-1 on rat brain may be dose-dependent.

To investigate the application of a modified scalp retractor in the craniotomy for intracranial aneurysms withlateral supraorbital approach.

From January 2019 to April 2020, a total of 32 patients with anterior circulation aneurysms clipping by superior lateral orbital approach were selected from Beijing Tiantan Hospital and Peking University International Hospital. The subjects were randomly divided into the traditional scalp retractor group and the modified scalp retractor group utilizing a random number table, with 16 patients in each group. The number of intraoperative retractor adjustment, incision length, postoperative scalp necrosis rate, postoperative wound healing grade, postoperative neurosurgical satisfaction score and patients′ satisfaction score for incision were compared between the two groups.

The number of retractor adjustment in the modified scalp retractors group was significantly less than that in the traditional scalp retractor group (10.1±2.2 vs 14.2±3.6, P<0.05) . Incision length was also significantly shorter than that of the conventional scalp retractor group ( (10.1±1.0) cm vs (13.9±0.9) cm, P<0.05) .Neurosurgeons were significantly more satisfied with modified scalp retractors than the traditional scalp retractors (8.1±0.9 vs 6.0±0.9, P<0.05). There was no significant difference in postoperative scalp necrosis rate between two groups (P>0.05).

The modified scalp retractor group is superior to the traditional scalp retractor group in the craniotomy for intracranial aneurysms with later supraorbital approach, with shorter in cision, less retractor adjustment and shorter surgical time.

At present, the incidence of pulmonary micronodules and early lung cancer is on the rise. Surgery is the first choice for the treatment of early lung cancer at present, and accurate localization of early microlung cancer is the key to successful surgery. At present, there are many surgical localization methods in clinical application and each has its own advantages and disadvantages. In order to study the localization value of preoperative CT-guided radiotracing technique in palpation-negative pulmonary nodules, this study was applied in 47 lesions [confirmed by positron emission computed tomography (PET-CT) or increased at follow-up] in 44 patients admitted from November 2007 to February 2010⁹⁹mTc isotope combined with iodine contrast agent for CT-guided local injection labeling, all nodules meet at least 1 of the following, 1: diameter<1 cm; 2: Subsolid nodule; 3: Distance from visceral pleura>1 cm. The results showed that the mean size of localized nodules was 11 mm (mean 5-24 mm); 24 nodules were non-solid; Fifteen nodules were partially solid, and eight nodules had solid morphology; The average distance from the visceral pleura was 11 mm (0 to 35 mm); Localization complications included 13 cases of asymptomatic mild pneumothorax; Minor bleeding in 9 cases; 1 case of allergic reaction to contrast medium; Chest pain after puncture in 2 cases; Nine patients had pleural leakage with tracer; 2 cases of obvious tracer pleural cavity leakage; Thirty patients underwent thoracoscopic biopsies; 2 cases converted to thoracotomy; Direct thoracotomy was performed in 12 patients. The asymptomatic suspected pulmonary micronodules found by screening or CT physical examination have non-solid morphology, which increases the difficulty of thoracoscopic biopsy or resection, but it is very suitable for radiotracer localization technology. It is a safe, universal and simple technical means for minimally invasive biopsy of pulmonary nodules with negative palpation.

In recent years, dual-energy CT imaging studies of gout have found that urate deposition can occur in patients with asymptomatic hyperuricemia, which indicates that subclinical urate deposition occurs in gout patients earlier than the onset of clinical symptoms of gout. However, there is no clear explanation in the industry for the reason why such patients have no clinical symptoms, which may be related to the location, quantity and volume of urate deposition. In this study, 25 patients with asymptomatic hyperuricemia and 33 patients with symptomatic gout were examined by dual-energy CT of foot and ankle gout, and the differences in the detection rate, deposition location and urate volume of dual-energy CT were compared between the two groups. Among them, the blood uric acid level of asymptomatic hyperuricemia patients was ≥540 μ mol/L, and the symptomatic gout patients had no tophi visible on the body surface. The results showed that the detection rates of urate deposition in dual-energy CT were 24% (6/25), 79% (11/14) and 84% (16/19) in asymptomatic hyperuricemia patients and gout patients with a course of 3 years and over 3 years, respectively (P<0.001）。 Urate deposition was detected in joints and tendons of asymptomatic hyperuricemia patients, but the detection rate and volume of urate in joints and tendons were lower than those of symptomatic gout patients (P<0.001）。 There was no statistically significant difference in urate volume between gout patients within 3 years and over 3 years.