National Medical Journal of China
Volume 100 · Issue 47 · 2020
Natl Med J China
Novel coronavirus pneumonia, referred to as "COVID-19" for short, is an acute respiratory infectious disease caused by 2019 novel coronavirus infection. Faced with the normalized prevention and control of the epidemic situation in COVID-19, according to the clinical anti-epidemic experience, a new diagnosis and treatment mode of neurosurgery under the normalized prevention and control of the epidemic situation in COVID-19 is put forward, which mainly involves standardized diagnosis and treatment appointment, three-level verification, nucleic acid detection, transitional ward, online consultation, and one patient, one diagnosis system, among which effective stratification and classification guidance is crucial when receiving patients.
At the beginning of 2020, novel coronavirus pneumonia (COVID-19 for short) showed a concentrated outbreak in Wuhan, Hubei Province. During the epidemic, most hospitals in Wuhan were requisitioned as designated hospitals in COVID-19. Wuhan University People's Hospital (headquarters), as one of only five hospitals in Wuhan that treated critically ill patients, undertook the diagnosis and treatment of a large number of critically ill patients. In this paper, according to the epidemiological characteristics of the virus and the diagnosis and treatment plan of COVID-19 issued by the National Health Commission, the Department of Neurosurgery of Wuhan University People's Hospital timely formulated a standardized diagnosis and treatment process for critically ill patients in neurosurgery during the epidemic period, including: outpatient and emergency management, inpatient management, ward transformation and division, and protection of medical staff. The formulation of this process effectively improves the diagnosis and treatment efficiency and medical experience of critically ill patients in neurosurgery, and at the same time ensures the physical and mental health of medical staff to the greatest extent.
Under the epidemic situation of novel coronavirus, neurosurgical emergency needs not only to effectively prevent the spread of cross-infection in hospital, but also to efficiently treat critically ill patients in neurosurgery due to its special circumstances such as criticality and urgency. This article explains the management strategy of neurosurgery emergency admission in the First Hospital of Harbin Medical University under the epidemic situation of novel coronavirus, so as to share and discuss by peers.
The novel coronavirus pneumonia (referred to as COVID-19 for short) epidemic outbreak has spread all over the country and the world. During the epidemic, the Department of Neurosurgery, tongji hospital affiliated to tongji medical college of huazhong university of science and technology set up an epidemic emergency command team in time to strengthen the prevention and control in the department, implement the diagnosis and treatment decision of "closing, stopping, merging and transferring", and formulate the protection strategy of specialist surgery. In the later stage of the epidemic, measures such as ward functional zoning, isolation and investigation of COVID-19 patients, and graded protection of flat and emergency surgery ensured the safe and orderly restoration of normal diagnosis and treatment order for undergraduates. Through the optimization of prevention and control strategies at the department management level and the clinical diagnosis and treatment level, the clinical diagnosis and treatment work recovered safely and steadily, and none of the medical staff were infected, and none of the hospitalized patients were infected.
This article discusses and analyzes how to carry out neurointerventional surgery during the epidemic of novel coronavirus, how to protect medical staff during the operation, and how to manage patients after treatment, and puts forward some suggestions, hoping to give some guidance to colleagues after the epidemic situation is normalized.
To explore the incidence, clinical characteristics, management strategies and reproductive outcomes of cesarean scar pregnancies (CSP) after in vitro fertilization-embryo transfer (IVF-ET).
The patients who were diagnosed with CSP followed IVF/ET in the Center for Reproductive Medicine of Peking University Third Hospital between April 1, 2010 and March 31, 2020 were included. The clinical data of each patient were analyzed retrospectively.
There were a total of 1 441 patients with secondary infertility complicated with a history of cesarean section and achieved clinical pregnancy after IVF-ET treatments, of which CSP accounted for 1.94% (28/1 441). The average age of CSP patients was (34±3) years old, and 50.0% (14/28) of the patients had a history of artificial abortion. The incidence of CSP in embryo transfers at the cleavage stage had no significantly difference from transfers at the blastocyst stage (1.74% vs 2.20%, χ 2=0.408, P=0.523), and the incidence of CSP in fresh embryo transfers had no significantly difference from frozen-thawed embryo transfers (1.77% vs 2.23%, χ 2=0.372, P=0.542). The average gestational age at diagnosis was (47±6) days. According to the classification based on imaging examination during early pregnancy, a case of type Ⅰ CSP received expectant treatment and achieved live birth at third trimester of pregnancy. Two cases of heterotopic cesarean scar pregnancy underwent transvaginal selective reduction of CSP, and intrauterine pregnancies were followed by live births at third trimester of pregnancy. One case of type Ⅲ CSP underwent laparoscopic CSP excision and uterine repair, and 24 patients with type Ⅰ or type Ⅱ CSP underwent hysteroscopic CSP excision with/without uterine artery embolization. After CSP treatment, 5 patients achieved clinical pregnancy through embryo transfer, all of which were normal intrauterine pregnancy followed by term live birth.
Color ultrasonography should be performed during early pregnancy to confirm the occurrence of CSP in patients receiving IVF-ET after previous cesarean section. Treatment of CSP should be individualized, and patients with Type Ⅰ CSP who are strictly selected have the opportunity for expectant treatment.
To provide a portable electroencephalograph that can facilitate long-term monitoring of epilepsy patients outside the hospital, and establish a medical platform for epilepsy data monitoring and treatment.
From June 2018 to October 2019, twenty-nine patients from Huashan Hospital (superior hospital) and Jing′an District Central Hospital (subordinate hospital) of Fudan University were enrolled in the study. Among them, twenty-eight cases were diagnosed with epilepsy and 1 case was epileptic seizure. Electroencephalogram (EEG) was collected by portable electroencephalograph once a week and followed up for three months. The seizure frequency, seizure form, medication type, EEG lead number and positive rate were recorded. Patients′ medical records and EEG data were uploaded to the cloud database to build a medical alliance platform. Doctors of different levels of hospitals couldobtain diagnosis and achieve resource sharing based on the platform. The data was statistically analyzed using SPSS 18.0.
The EEG data collected by the portable electroencephalograph hadfewer artifacts, complete sleep cycle, and could record the interictaldischarges. Twenty-nine patientsunderwent a total of 148 EEG monitoring during the three-month follow-up. Eighty-five cases of epileptic discharges were detected, and the EEG positive rate was 57.4%. The positive rate of EEG in patients with generalized seizures (84.9%) was higher than that in patients with focal seizures (42.1%) (P<0.01); the positive rate of EEG in patients with 2-3 antiepileptic drugs and patients with frequent seizures within three months were also higher (P<0.05). Doctors in the superior hospital in the platform make diagnosis and treatment suggestions according to the above data. Elevenseizure-free patients and four patients with fewer seizures and discharges were diverted to the community hospital for follow-up. Fourteen patients with poor seizure control and/or continuous epileptic discharges were diverted to the superior hospitalto adjust the medication. Doctors of subordinate hospital acquired the diagnosis and treatment suggestions through the platform, and then strengthened the daily care and follow-up.
Combined with a portable electroencephalograph, the current study establishs a medical platform for patients with epilepsy to achieve long-term monitoring and rational use of medical resources.
To explore the improvement of emergency admission screening and perioperative management protocols in the scenario of the coronavirus disease 2019 (COVID-19) pandemic and its regular prevention and control for patients with ruptured intracranial aneurysms, which are the most common emergency cases with the most urgent needs for emergent surgery.
The response protocol of the emergency surgical management of ruptured intracranial aneurysm during the epidemic period (from January to March, 2020) at Beijing Tiantan Hospital, Capital Medical University was reviewed. The prognosis of emergent aneurysm surgery under different levels of protection or during the same period of 2019 and 2020 was further compared to describe the operation and prognosis under the new management protocol.
A total of 127 emergency cases with aneurysmal subarachnoid hemorrhage were referred to Beijing Tiantan Hospital, Capital Medical University from January 20 to March 25, 2020, and 42 cases(33.1%) underwent emergent aneurysm clipping after multi-desciplinary consultation. Admissions of emergency cases required epidemiological, laboratory, and imaging screenings for COVID-19, with additional throat swab virus nucleic acid screening afterwards. During the same period, 9 cases of COVID-19 were confirmed in the emergency screening, and no false negative cases were found. Compared with the same period in 2019, the interval between emergency visits and emergency craniotomy did not increase significantly due to the preoperative screening ((37±17) hours during the epidemic period versus (29±12) hours at the same period in 2019, P=0.058). There was no significant difference in the incidence of perioperative adverse events and postoperative neurological dysfunction (P=0.779). According to the screening results, the corresponding operative and postoperative management protocol and protection standards were adopted. There was no significant difference in the prognosis of emergent surgery between patients with a negative initial screening and those who were to be excluded or suspected in the initial screening (P=0.678). Although viral nucleic acid screening tended to prolong the time interval before surgical intervention ((36±15) hours before nucleic acid screening versus (40±20) hours after nucleic acid screening, P=0.453), there was no statistically significant difference in the preoperative adverse events and postoperative neurological function (P=0.653).
The current protocol of COVID-19 screening and stratified emergent surgery management based on screening results can effectively identify suspected and confirmed COVID-19 cases, thereby ensuring timely, safe and effective emergent surgery and prohibiting nosocomial spread.
To investigate the spectrum and antimicrobial resistance of major pathogens causing nosocomial infections in China, 2018.
Non-duplicated nosocomial cases as well as pathogens causing bloodstream infections (BSI), hospital-acquired pneumonia (HAP) and intra-abdominal infections (IAI) from 11 teaching hospitals across China were collected. The minimum inhibitory concentrations (MICs) of clinically significant strains were determined by agar dilution method or broth microdilution method. The Clinical and Laboratory Standards Institute (CLSI) M100-S29 criteria were used for interpretation, and the WHONET-5.6 software was used in data analysis.
A total of 1 590 cases were collected, including 831 cases from BSI, 450 cases from HAP and 309 cases from IAI. The most prevalent pathogens causing BSI were Escherichia coli (29.2%, 243/831), Klebsiella pneumoniae (16.2%, 135/831) and Staphylococcus aureus (10.1%, 84/831); the most prevalent pathogens causing IAI were E. coli (26.2%, 81/309), Enterococcus faecium (15.5%, 48/309) and K. pneumoniae (13.3%, 41/309); while Acinetobacter baumanii (24.7%, 111/450), Pseudomonas aeruginosa (20.7%, 93/450) and K. pneumoniae (16.2%, 73/450) were dominated in HAP. All S. aureus were susceptible to tigecycline, linezolid, daptomycin and glycopeptides; 77.8% (105/135) of S. aureus strains were susceptible to ceftaroline. Methicillin-resistant S. aureus (MRSA) accounted for 29.6% (40/135) of all the S. aureus, and was lower than the accounted rate of methicillin-resistant coagulase-negative Staphylococcus (MRCNS) (83.7%, 41/49). One E. faecium strain (1.1%, 1/95) resistant to vacomycin and teicoplanin and one E. faecalis strain (2.3%, 1/43) resistant to linezolid was found. The prevalence of extended-spectrum β-lactamase (ESBL) was 56.1% (193/344) in E. coli and 22.1% (55/249) in K. pneumonia; the rate of carbapenem resistant E. coli and K. pneumonia was 4.1% (14/344) and 22.9% (57/249), respectively; the percentage of ceftazidime/avibactam resistant E. coli and K. pneumonia was 2.3% (8/344) and 2.0% (5/249), respectively; the percentage of colistin resistant E. coli and K. pneumonia was 1.5% (5/344) and 7.6% (19/249), respectively; no E. coli and K. pneumonia strains were found resistant to tigecycline. The rate of carbapenem resistant A. baumanii and P. aeruginosa were 78.9% (146/185) and 36.7% (66/180), respectively. A. baumanii showed low susceptibility to the antimicrobial agents except colistin (99.5%, 184/185) and tigecycline (91.4%, 169/185). Colistin, amikacin and ceftazidime/avibactam demonstrated high antibacterial activity against P. aeruginosa with susceptility rate of 100% (180/180), 93.3% (168/180) and 85.6% (154/180), respectively.
Nosocomial Gram-negative pathogens show high susceptibilities to tigecycline, colistin and ceftazidime/avibactam in vitro. Antimicrobial resistance in A. baumannii is a serious problem. The prevalence of carbapenem-resistant Enterobacteriaceae has increased, which should be monitored continuously in China.
To investigate the effect of laparoscopic modified with two different sutures on the cesarean incision diverticulum repair.
From July 2018 to July 2019, 35 patients with refertility requirements who were confirmed the diagnosis of caesarean incision diverticulum by hysteroscopy combined with ultrasound, and the muscle layer thickness at the top of diverticulum was less than 3 mm, received modified laparoscopic combined with hysteroscopic surgery in department of gynecological minimally invasive center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Ten patients with history of secondary repair and multiple pelvic operations were excluded. The remaining 25 patients were divided into group A (n=8): underwent laparoscopic "folding suture" , preserving the integrity of the diverticulum of the cesarean incision; Group B ( n=17): underwent laparoscopic incision and complete excision of the scar of the diverticulum. The operation time, bleeding volume, postoperative exhaust time, improvement of symptoms and the thickness of muscle layer were compared between the two groups.
All patients underwent surgery without complications. 25 patients were followed up one month, three months and half a year after operation, and followed up by telephone for 6-18 months. The operation time of group A and B was (56±12) min, (72±15) min, and the bleeding volume was (40±9) ml and (66±10) ml respectively. The cure rate was 87.5% and 58.8% respectively, the differences were statistically significant (t=6.778, 4.057, χ 2=5.651, P<0.05). But the postoperative exhaust time was (16±6) h, (18±7) h, and the effective rate was 100.0% and 94.1% respectively, with no significant difference(t=1.967, χ 2=0.725, P>0.05).
Two different suture repair methods under laparoscope are safe and effective for the treatment of diverticulum in cesarean section incision. Among them, the laparoscopic "folding suture" method has a short operation time and preserves the integrity of the myometrium. It is worth popularizing for the elderly patients who has an urgent need for fertility.
To compare the clinical and laboratory characteristics and therapy methods of elderly onset rheumatoid arthritis (EORA) and younger onset rheumatoid arthritis (YORA).
The clinical, laboratory and therapeutic data of 481 RA patients in the Department of Rheumatology and Immunology in Peking University Third Hospital from January 2013 to December 2018 were collected and used to analyze the difference of characteristics between EORA group and YORA group, which might be useful for better diagnosis and treatment of EORA patients. Quantitative data of normal distribution were compared with t test between the two groups.
There were 481 patients in this cohort, of which 137(28.5%) were EORA, 344(71.5%) were YORA, with a mean age of (59±14) years (19-87 years). There were 358 females (74.4%) and 123 males (25.6%). The percentage of male patients was obviously higher in EORA group (36.5% vs 21.2%, χ 2=12.012, P<0.01), and the average disease course was obviously shorter (Z=-7.985, P<0.01). Disease Activity Score 28 (DAS28) score was higher in EORA group (5.6±1.3 vs 5.2±1.6, t=2.549, P<0.05), meanwhile the incidences of pleural effusion and interstitial lung disease (ILD) were higher (6.6% vs 1.7%, 29.9% vs 18.3%, respectively; χ 2=7.550, 7.797, both P<0.05). The incidences of venous thrombosis, primary hypertension, diabetes mellitus, cerebrovascular disease, coronary heart disease (CHD), peripheral atherosclerosis and cataract in EORA group were all significantly higher than those in YORA group (all P<0.05). Erythrocyte sedimentation rate (ESR) and D-Dimer in EORA group were all remarkably higher (both P<0.05). The rate of using glucocorticoid in EORA group was higher but the rate of using methotrexate and anti-tumor necrosis factor-α agents were lower (χ2=5.271, 8.407, 9.356, all P<0.05).
Compared to YORA group, the percentage of male patients and disease activity of EORA group are higher. The occurrence of pleural effusion, ILD, venous thrombosis, primary hypertension, diabetes mellitus, cerebrovascular disease, CHD, peripheral atherosclerosis and cataract in EORA group are higher than those in YORA group.
To investigate the effect of oral administration of branched-chain amino acids (BCAA) supplementation on the mortality of patients with hepatocellular carcinoma (HCC) after treatment.
Computer searching of PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, and Chinese Biomedical Literature Database was conducted to search for clinical controlled trials and randomized controlled trials (RCTs) on the effect of oral administration of BCAA on the mortality of patients with HCC. The retrieval time limit was from the time of the establishment of each database to December 30, 2019. Two researchers independently screened the literature and extracted the data. Another researcher assessed the risk of bias in the included studies and then used RevMan 5.3 software for meta-analysis.
A total of 14 studies were included with 1 179 patients. The overall results showed that oral administration of BCAA had no significant effect on the mortality of HCC patients at 1 year after treatment (RR=0.85, 95%CI:0.68-1.06, P=0.16), while the mortalities of patients at 3 years (RR=0.73, 95%CI: 0.61-0.88, P=0.000 7) and 5 years (RR=0.57, 95%CI:0.34-0.96, P=0.03) after treatment were significantly lower than those of the control group. The subgroup analysis showed that for radiofrequency ablation (RFA) patients, there was no significant difference in 1-year mortality between the BCAA group and the control group (RR=0.96, 95%CI:0.14-6.5, P=0.97), while 3-year mortality was significantly reduced (RR=0.59, 95%CI:0.43-0.81, P=0.001); for hepatectomy patients, there was no significant differences in 1 -and 3-year mortality between the two groups (RR=0.90, 95%CI:0.44-1.88, P=0.79; RR=0.97, 95%CI:0.71-1.33, P=0.85, respectively). In addition, as for albumin levels, BCAA supplementation significantly increased albumin levels without considering the treatment of HCC (SD=0.45, 95%CI: 0.29-0.90; P=0.000 1), but had no significant effect on hepatectomy patients (SD=0, 95%CI: -0.41-0.41, P=0.99).
BCAA supplementation might improve liver reserve function and long-term prognosis of HCC patients, which was related to the surgical method. Supplementing BCAA reduced the long-term mortality of RFA patients, but had no significant effect on hepatectomy patients.
To investigate the feasibility and advantages of establishing percutaneous nephrolithotomy pathway guided by C-arm CT.
The data of 258 patients who were established a percutaneous nephrolithotomy pathway under the guidance of C-arm CT in the Department of Interventional Medicine of the First Affiliated Hospital of Zhengzhou University from January 2012 to December 2019 were retrospectively analyzed, including168 males and 90 females, and aged 19-88 (60±11) years. There were 84 cases of single stone, 174 cases of multiple stone, and 18 cases of cast stone. The stone size was 9-42 (22±6) mm. Among them, dual access was established in 18 cases, and nephrolithotomy access was established in 276 cases. The three-dimensional guiding function of C-arm CT was used to puncture the target calyces and establish the percutaneous nephrolithotomy pathway.
The pathway was successfully established in 258 cases at the first time, with a success rate of 93.5%; successfully established in 15 cases at the second time, with a success rate of 98.9%; and unable to establish in 3 cases, with a failure rate of 1.1%. The operation time was (7.9-32.5) min, with an average of (16±5) min. The lithotripsy time was (25-115) min, with an average of (43±8) min. The intraoperative blood lose was (45-420) ml, with an average of (75±11) ml. There were 23 cases with postoperative calculus residual (8.3%). Postoperative complications included fever in 86 cases (33.3%), which improved after symptomatic treatment. Postoperative hematuria was observed in 128 patients (49.6%) with varying degrees of gross hematuria, among which 2 patients (0.72%) were treated with arterial embolization due to excessive bleeding and ineffective conservative treatment, while the hematuria disappeared after symptomatic treatment in the rest of the patients.
The method of establishing percutaneous nephrolithotomy pathway under the guidance of C-arm CT was simple to operate. Especially for patients without hydronephrosis, this method had a high success rate and low complications, which was worthy of clinical promotion and reference.
A total of 39 patients with subarachnoid hemorrhage who underwent cerebral arteriography at the Neurointerventional Center of Tiantan Hospital during the novel coronavirus pneumonia (COVID-19) pandemic from January 20 to March 20, 2020 were retrospectively enrolled. There were no confirmed cases of COVID-19 from the emergency screening to the end of the diagnosis and treatment process, and there were no confirmed cases of COVID-19 among the medical staff involved in the treatment.
During the COVID-19 epidemic period, patients with ruptured intracranial aneurysm can be treated safely, timely and effectively.
A 47-year-old female with an 11-year history of non-Langerhans histiocytosis (Erdheim-Chester disease) was reported. She presented with lower limb edema, exophthalmos and chest tightness. Imaging showed perirenal fascia thickening, arterial wall thickening, massive pericardial effusion, serum IgG4 elevation, and pathological examination of orbital mass showed IgG4+ plasma cell infiltration. She was suspected to be diagnosed as "IgG4-related disease", and the efficacy of hormones and immunosuppressants was not good. Histiocytes, CD68 (+), S-100 (-) were found in pathological examination of posterior pericardial effusion, and long bone sclerosis was found in lower limb CT, confirming Erdheim-Chester disease.
A patient with collagen-related myopathy type VI diagnosed by gene and paravertebral muscle immunohistochemistry was reported. Scoliosis was the only phenotype in this patient. This case suggests that the potential etiology of some patients with scoliosis in clinic may be a special type of neuromuscular disease, which provides an important entry point for the etiological study of scoliosis.
This paper reports a case of malignant solitary fibrous tumor of the liver, which is rare in clinical practice. Due to physical examination, the patient found that the liver occupied space, and enhanced CT showed a huge soft tissue mass rich in blood supply in the liver. Open hepatic lesion resection was performed under general anesthesia, and it was confirmed by pathological diagnosis as malignant solitary fibrous tumor of the liver. After 6 months follow-up, no signs of tumor recurrence were found.
Rheumatoid arthritis (RA) is a common chronic inflammatory autoimmune disease with unknown pathogenesis, in which immune system, especially lymphocyte dysfunction, plays a dominant role. Recent studies have found that neutrophil/lymphocyte ratio and platelet/lymphocyte ratio can be used as novel biomarkers to monitor RA disease activity, judge the prognosis of treatment and RA-related pulmonary interstitial disease.
The novel coronavirus pneumonia (COVID-19 for short) pandemic has brought significant changes to residents' educational lives and daily work. However, there is no literature describing and assessing the impact of the pandemic on neurosurgery residents in the United States. The study investigated the impact of the COVID-19 pandemic on the workflow, burnout, and career satisfaction of neurosurgery residents in the United States. By e-mail, the researchers sent a survey assessing factors associated with career satisfaction and burnout to 1 374 American Association of Neurosurgeons (AANS) residents, along with binary and multivariate (logistic) regression analyses of predictors of burnout and career satisfaction. The survey received a total of 167 valid questionnaires with a response rate of 12.2%, similar to the response rate of similar studies. After excluding incomplete responses, a total of 111 valid questionnaires were obtained. The majority of respondents were male (65.8%) and Caucasian (75.7%). Residents reported reduced hours (67.6%) and concerns that COVID-19 would affect their completion of learning about neurosurgery (65.8%). Twenty-nine respondents (26.1%) had burnout and 82 respondents (73.9%) were satisfied with their careers. In multiple regression analysis, burnout and rotation/furlough changes (P=0.013) and the decision to no longer practise neurosurgery with the opportunity to choose (P<0.001) significantly correlated. The higher graduate seniority, the lower the degree of burnout (P=0.011）。 Residents showed higher career satisfaction when they focused their clinical work on neurosurgical care (P=0.065）。 Factors related to COVID-19 have contributed to changes in the workflow of neurosurgery residents in the United States.
SARS-CoV-2 infection has caused the novel coronavirus pneumonia (COVID-19) pandemic. Although there are many problems in the United States, such as a large number of patients infected with the epidemic and very tight medical resources, emergency neurosurgery still needs to be carried out normally during the epidemic. Based on the experience of epidemic prevention in many medical institutions in the United States, this study summarized the best practices of neurosurgery for neurosurgical emergency patients under the COVID-19 epidemic. The researchers gathered neurosurgeons from 13 different health systems across the United States, including those in outbreak areas, to explain their specific practices for neurosurgical emergency treatment of patients amid the COVID-19 pandemic. Patients experiencing neurosurgical emergencies should be treated as "respondents" (PUIs), and physicians should wear maximum personal protective equipment (PPE) during admission and patient transport. Manipulations such as intubation and extubation also require the anesthesiologist to perform the maximum PPE in a negative pressure environment. After the particulate matter in the air is removed, the relevant personnel can enter the operating room. Certain operating rooms should be designated as "COVID-19/PUI patient-only operating rooms" for the conduct of neurosurgical procedures for covid/PUI patients, which will require a post-processing procedure for terminal cleaning. Each dedicated operating room should be connected to a negative pressure chamber with a high-efficiency particulate filter so that PPE can be put on and off without contaminating the clean area.
In order to investigate whether critically ill and acute patients can access the medical services they urgently need, the study provides a summary description of the current situation of patients with neurological emergencies that emerged during the first phase of the novel coronavirus pneumonia (COVID-19) pandemic. In this observational longitudinal cohort study, all neurosurgical hospitalized patients admitted to the Berlin Neurosurgery and Stroke Research Center (CSB) of Charité Medical University Berlin, Germany during the COVID-19 pandemic from February 1 to April 15, 2020 were included, and were identified and classified according to the neurosurgical admission route, management mode and disease category. In addition, the researchers also investigated the clinical visits of patients with aneurysmal subarachnoid hemorrhage (ASAH) and chronic subdural hematoma (CSDH), respectively, to more fully understand the various symptoms caused by cerebrovascular events or acute trauma. During the pandemic, the proportion of neurosurgical emergencies among all neurosurgical hospitalizations was comparable to usual, but the proportion of visits via the emergency department was significantly higher than the proportion of visits via outpatient or referral (P=0.009）。 Among the various types of neurological disorders, the total number of patients admitted via the neuroemergency route is greatly reduced (P=0.000 7), not only vascular emergencies (P=0.036) was significantly reduced in the number of patients visited, and spinal spinal emergencies (P=0.007) and hydrocephalus (P=0.048) were also significantly reduced, among which patients with spinal emergencies were mostly admitted to hospital for treatment 48 h after the onset of symptoms (P=0.001）。 The number of cases of acute ASAH, ASAH grade, location of aneurysm rupture, and treatment modalities were not significantly changed from previous. Although elderly patients with chronic subdural hematoma present less frequently than in previous years, symptoms are more severe (P=0.046), the likelihood of a good prognosis at discharge (P=0.003) is lower.
Alzheimer's disease (AD) has great genetic complexity, and risk genes related to AD can be found through genome-wide association analysis (GWAS). Most of the previous reports are GWAS studies conducted in European and American countries, which are still blank in China. Moreover, genes found abroad are rarely verified in Chinese populations, and there is a lack of genetic prediction models that can predict the risk of AD. For this purpose, the study conducted a two-phase GWAS study with a total of 11,506 subjects from several research centers across the country. Whole genome genotyping of 4 187 subjects was performed in the first stage, and 34 loci of 7 319 subjects were genotyped in the second stage. Through two-stage consistency test and meta-analysis, it was found that 13 loci reached the GWAS significance boundary (P<5.0×10-8), containing 4 new sites (rs3777215, rs6859823, rs234434, and rs2255835) and 9 points within the APOE region. In addition, it was found through the risk prediction model that the area under the curve predicted for AD can reach up to 0.73. This predictive model can carry out genetic screening for young people and give early warning to positive people, which has important clinical significance for preventing the occurrence of AD.
Maintaining normal liver function after radiofrequency ablation (RFA) for hepatocellular carcinoma is essential to improve prognosis. To investigate the effects of oral branched chain amino acids (BCAA) on liver function, intrahepatic recurrence rate and complication rate after RFA in patients with hepatocellular carcinoma, patients with cirrhosis who underwent RFA from August 2009 to April 2012 were randomly divided into oral branched chain amino acid group (BCAA group) and diet alone group (control group), and the changes of serological parameters and health status were observed. Patients in the BCAA group were given BCAA orally (1 pack twice daily). The Concise Quality of Life Scale-8 was used to assess the physical and psychological state of patients. Oral BCAA was started 2 weeks before RFA, and enhanced CT examination was performed every 3 months to assess the recurrence of liver cancer. The final number of cases enrolled in the study was 25 in the BCAA group and 26 in the control group, and the median follow-up time was 3.9 years (736 to 1 818 d). There was no statistically significant difference between the two groups at the baseline level. The results showed that the incidence of complications was lower in the BCAA group than in the control group (P=0.03）。 Event-free survival was significantly higher in the BCAA group than in the control group, while the intrahepatic recurrence rate was significantly lower than in the control group (Pvalues of 0.040 and 0.036, respectively). The Concise Quality of Life Scale-8 psychological score was significantly improved in the BCAA group (P<0.01）。
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