简介：AbstractTwo cases of type II odontoid fractures were reported to share our experience in surgery treatment of such cases. A 33-year-old woman with comminuted type II odontoid fracture and a 42-year-old man with fracture end hardened type II odontoid fracture received surgical treatment in our hospital. Though imaging examination suggested that these two patients were suitable for anterior screw fixation, we encountered difficulties during the operation. The two patients eventually underwent posterior C1-C2 fusion surgery and recovered well. According to the experience of these two cases, we found that the fracture line angle and the degree of comminution are two important factors affecting surgical decision-making. Although anterior screw fixation is the ideal choice for type II odontoid fractures with anterior superior to posterior inferior fracture line, it may not be the best choice for comminuted or fracture end hardened type II odontoid fractures.

简介：Facialparalysisisacommonlyencountereddiseaseintheclinic.ItisknowninWesternmedicineasBell'sparalysisandintraditionalChinesemedicine(TCM)asdeviationoftheeyeandmouth.Currently,thereareavarietyoftherapiesfortreatingfacialparalysisbothinTCMandWesternmedicine,eachtherapyhasitsadvantages.Inrecenttwoyearstheauthorhastriedacupointinjectiontherapyfortreatmentof82casesofperipheryfacialparalysis(attributedtowind-coldpattern)andachievedagoodtherapeuticeffect.Hereisthereport.

简介：AbstractBackground:Loiasis is an uncommon and poorly understood parasitic disease outside endemic areas of Africa. The aim of this study was to describe the clinical and biological patterns and treatment of imported loiasis by sub-Saharan migrants diagnosed in Madrid, Spain.Methods:A retrospective study was conducted with sub-Saharan immigrants seen at the Tropical Medicine Unit of the Carlos III Hospital in Madrid, Spain, a reference center, over 19 years. Categorical variables were expressed as frequency counts and percentages. Continuous variables were expressed as the mean and standard deviation (SD) or median and interquartile range (IQR: Q3-Q1). Chi-square tests were used to assess the association between categorical variables. The measured outcomes were expressed as the odds ratio (OR) with a 95% confidential interval. Continuous variables were compared by Student's t-tests or Mann-Whitney U tests. Binary logistic regression models were used. P < 0.05 was considered a statistically significant difference.Results:One hundred thirty-one migrants from tropical and subtropical areas with loiasis were identified. Forty-nine patients were male (37.4%). The migrants' mean age (±SD) was 42.3 ± 17.3 years, and 124 (94.7%) were from Equatorial Guinea. The median time (IQR) between arrival in Spain and the first consultation was 2 (1-7) months. One hundred fifteen migrants had eosinophilia, and one hundred thirteen had hyper-IgE syndrome. Fifty-seven patients had pruritus (43.5%), and thirty patients had Calabar swelling (22.9%). Seventy-three patients had coinfections with other filarial nematodes (54.2%), and 58 migrants had only Loa loa infections (45.8%). One hundred two patients (77.9%) were treated; 45.1% (46/102) patients were treated with one drug, and 54.9% (56/102) patients were treated with combined therapy. Adverse reactions were described in 14 (10.7%) migrants.Conclusions:Our patients presented early clinical manifestations and few atypical features. Thus, physicians should systematically consider loiasis in migrants with a typical presentation. However, considering that 72.5% of the patients had only positive microfilaremia without any symptoms, we suggest searching for microfilaremia in every migrant from endemic countries for loiasis presenting with eosinophilia.

简介：Epigastricpain,alsoknownasstomachpain,ispresentedwithfrequentlyrecurrentpainintheupperabdomenorstomacharea,whichismainlycausedbyexogenouspathogen,improperdietorinternalinjuriesduetosevenemotions.All45caseswithepigastricpaincausedbyvariousfactorsweretreatedwithmainlyneedlingHegu(LI4)betweenNovember2010andNovember2012,andthereportisgivenasfollows.

简介：ObjectivesTodeterminethesafetyandvalueofesophagealradiographyasameansoflocatingtransseptalpuncture.Methods486patientswhounderwenttransseptalpuncturewererandomizedintotwogroups.Anesophagusradiographicmethodoflocatingtansseptalpuncturesitewasappliedinthestudygroup(n=243)andmodified-Rosslocatingmethodwasusedinthecontrolgroup(n=243).Aftersuccessfullocation,transseptalpuncturewasmade.Weobservedthesuccessrateandincidencecomplicationsinthe2groups.ResultsLeftatriumimpressioninthestudygroupwasclearlyseen.Nonethelessin120casesofcontrolgroup,theleftatriasilhouettewasnotclearlyvisualised.Thesuccessrateoflocatingtransseptalpuncturesiteinthestudygroupandcontrolgroupwere100%and50.6%respectively(P<0.001).Thesuccessrateoftransseptalpunctureinthestudygroupandcontrolgroupwas99.6%and45.7%respectively(P<0.001).Therewerenocomplicationsassociatedwithpunctureinthestudygroupandpericardialtamponadeoccurredin1controlpatient.ConclusionsTheesophagusradiographicmethodoflocatingtransseptalpuncturesiteisaccurate,safeandsimpletoperform.Transseptalpuncturehasahighsuccessratewithfewcomplications.

简介：AbstractThis study aims to investigate cases of human plague in the Inner Mongolia Autonomous Region (IMAR), China, and to inform the development of plague prevention and control strategies. On 12th of November 2019, two herdsmen from Sunitezuo Banner, Xilingol League were diagnosed with pneumonic plague in Beijing, China. On November 16th, one resident of Xianghuang Banner, Xilingol League was diagnosed with bubonic plague in Huade County Hospital, Ulanqab, China. On 27th of November, one resident of Siziwang Banner was diagnosed with bubonic plague. In total, 78 close contacts were monitored over a period, but none of them developed symptoms. Plague outbreaks in animals had been reported in Sunitezuo Banner, Xianghuang Banner, and Siziwang Banner in 2019. Two of the four cases were related (husband and wife), but not the other two. All the cases may be associated with contact with rodents (hare) or infected fleas. The cases highlight the importance of early identification of plague cases in humans in order to stop further infection. This demonstrates the value of monitoring and ongoing vigilance on endemic diseases, the importance of updating medical training and raising public awareness about infectious diseases that even have not been observed over decades.

简介：AbstractImportance:As the most common subtype of pediatric rhabdomyosarcoma (RMS), the prognosis of embryonal RMS has rarely been investigated solely.Objective:To perform a population-based study to characterize the prognosis of embryonal RMS in children and adolescents.Methods:Demographic and clinical features were retrospectively evaluated in selected patients with embryonal RMS registered in the Surveillance, Epidemiology, and End Results (SEER) program from 1988 to 2016. Survival curves were compared using the log-rank test. A multivariate Cox proportional hazards model was developed to assess the impact of each factor on the overall survival. A nomogram was constructed based on the results of Cox regression model.Results:A total of 464 patients were included in the analysis, among which 64.6% were male and 70.2% were white patients. About 38.6% and 26.3% of the patients were at 1-4 years and 5-9 years, respectively. Cox analysis showed that patients at age group 5-9 years had the lowest risk of mortality (hazard ratio [HR], 0.277; 95% confidential interval [CI], 0.123-0.620), compared with patients diagnosed at less than 1-year-old, and age group 1-4 years had the second-best prognosis. Patients having distant tumors had significantly higher mortality risk (HR, 4.842; 95% CI, 2.804-8.362) than the patients with localized tumor. Compared with receiving no surgery or radiotherapy, receiving any combination of surgery and radiotherapy would lower the risk of mortality significantly (for surgery without radiotherapy: HR, 0.418; for radiotherapy without surgery: HR, 0.405; and for surgery plus radiotherapy: HR, 0.410).Interpretation:Age, stage at diagnosis, and treatment received were found to be the most important predictors of the overall survival of pediatric embryonal RMS.

简介：Extragonadalprimaryyolksactumoroftheintestinaltractoriginisexceedinglyrare.Throughamultipledisciplinaryteam,thediagnosisandtreatmentofprimaryintestinalyolksactumorwerefurtherdefined.Wereport2suchcaseswithdetailedhistologicandimmunohistochemicalanalysis.Thetwopatientswerea7-year-oldgirlanda29-year-oldwoman.Bothofthempreoperativelyhadanelevatedserumalphafetoprotein(AFP)level(≥1,210ng/mL).Thetumorsarelocatedintheintestineandimagingexaminationindicatedtherectumastheprimarysite.Grosslythemasswasgrey-whiteandcrisptexture.Microscopicexaminationfeaturedreticular,microcystic,macrocystic,papillary,solid,andsomeglandularpatterns.Immunohistochemically,tumorcellsofbothcaseswerepositiveforSALL4,AFP,pan-cytokeratin(AE1/AE3),andglypican-3.Simultaneously,astainforEMA,OCT4,CD30,HCG,vimentinandCK20werenegativeinall2neoplasms.Thefeaturesofmorphology,immunohistochemistry,laboratoryexaminationsandimagingstudiesconsistofthediagnosisofprimaryyolksactumoroftheintestine.

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简介：针刺百会和双侧太冲穴，治疗巅顶痛患者35例，痊愈14例，显效13例，好转6例，无效2例，总有效率94．3％。

简介：150casesofprolapseoflumbarintervetebraldiscwererandomlydividedintotreatmentandcontrolgroups.80casesintreatmentgroupweretreatedwithcombinationofacupuncture,oraladministrationofChinesemedicinalherbs,traction,point-injectionandintravenousdripofenergydehydrationmixture;70casesincontrolgroupweremanagedbycombinationofacupuncture,oraladministrationofherbalmedicines,traction,acupoint-injection(withoutenergydehydrationmixture).Theresultsshowedthatthecurativerateandthetotaleffectiverateofthetreatmentgroupwere91.25%and98.75%separately,whilethoseofthecontrolgroup62.86%and92.86%respectively.Comparisonofthecurativeratebetweenthe2groupsshowedaremarkablesignificance(P＜0.01).TheobservationdemonstratedthatcombinedtreatmentofprolapseoflumbarintervertebraldiscwithtraditionalChineseandWesternmedicineisaneffectiveapproach.

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简介：Atpresent,fortreatmentofnarcoticsabstinence,methadonereplacementdecrementalremedyismostcommenlyapplied.Butifusedforalongertime,itwillleadtoanewpsychologicaldependenceandtolerance.Foravoidingthis,weadoptedacupunctureplusadministrationofmethadonetotreat50casesofheroinadditionpatientsfromJulytoSeptemberof2000andachievedagoodtherapeuticeffect.Hereisthereport.

简介：Totreat50casesofchronicdiarrheabylaserpoint-radiationonShenque(CV8),Tianshu(ST25),Zusanli(ST36)andPointAnti-diarrheawithlowpowerHe-Nelaser.Thetotaleffectiveratewas96%.

简介：AbstractBackground:The 2019 novel coronavirus has caused the outbreak of the acute respiratory disease in Wuhan, Hubei Province of China since December 2019. This study was performed to analyze the clinical characteristics of patients who succumbed to and who recovered from 2019 novel coronavirus disease (COVID-19).Methods:Clinical data were collected from two tertiary hospitals in Wuhan. A retrospective investigation was conducted to analyze the clinical characteristics of fatal cases of COVID-19 (death group) and we compare them with recovered patients (recovered group). Continuous variables were analyzed using the Mann-Whitney U test. Categorical variables were analyzed by χ2 test or Fisher exact test as appropriate.Results:Our study enrolled 109 COVID-19 patients who died during hospitalization and 116 recovered patients. The median age of the death group was older than the recovered group (69 [62, 74] vs. 40 [33, 57] years, Z = 9.738, P < 0.001). More patients in the death group had underlying diseases (72.5% vs. 41.4%, χ2 = 22.105, P < 0.001). Patients in the death group had a significantly longer time of illness onset to hospitalization (10.0 [6.5, 12.0] vs. 7.0 [5.0, 10.0] days, Z = 3.216, P = 0.001). On admission, the proportions of patients with symptoms of dyspnea (70.6% vs. 19.0%, χ2 = 60.905, P < 0.001) and expectoration (32.1% vs. 12.1%, χ2 = 13.250, P < 0.001) were significantly higher in the death group. The blood oxygen saturation was significantly lower in the death group (85 [77, 91]% vs. 97 [95, 98]%, Z= 10.625, P < 0.001). The white blood cell (WBC) in death group was significantly higher on admission (7.23 [4.87, 11.17] vs. 4.52 [3.62, 5.88] × 109/L, Z = 7.618, P < 0.001). Patients in the death group exhibited significantly lower lymphocyte count (0.63 [0.40, 0.79] vs. 1.00 [0.72, 1.27] ×109/L, Z= 8.037, P < 0.001) and lymphocyte percentage (7.10 [4.45, 12.73]% vs. 23.50 [15.27, 31.25]%, Z = 10.315, P < 0.001) on admission, and the lymphocyte percentage continued to decrease during hospitalization (7.10 [4.45, 12.73]% vs. 2.91 [1.79, 6.13]%, Z= 5.242, P < 0.001). Alanine transaminase (22.00 [15.00, 34.00] vs. 18.70 [13.00, 30.38] U/L, Z = 2.592, P = 0.010), aspartate transaminase (34.00 [27.00, 47.00] vs. 22.00 [17.65, 31.75] U/L, Z = 7.308, P < 0.001), and creatinine levels (89.00 [72.00, 133.50] vs. 65.00 [54.60, 78.75] μmol/L, Z = 6.478, P < 0.001) were significantly higher in the death group than those in the recovered group. C-reactive protein (CRP) levels were also significantly higher in the death group on admission (109.25 [35.00, 170.28] vs. 3.22 [1.04, 21.80] mg/L, Z = 10.206, P < 0.001) and showed no significant improvement after treatment (109.25 [35.00, 170.28] vs. 81.60 [27.23, 179.08] mg/L, Z = 1.219, P = 0.233). The patients in the death group had more complications such as acute respiratory distress syndrome (ARDS) (89.9% vs. 8.6%, χ2 = 148.105, P < 0.001), acute cardiac injury (59.6% vs. 0.9%, χ2 = 93.222, P < 0.001), acute kidney injury (18.3% vs. 0%, χ2 = 23.257, P < 0.001), shock (11.9% vs. 0%, χ2 = 14.618, P < 0.001), and disseminated intravascular coagulation (DIC) (6.4% vs. 0%, χ2 = 7.655, P = 0.006).Conclusions:Compared to the recovered group, more patients in the death group exhibited characteristics of advanced age, pre-existing comorbidities, dyspnea, oxygen saturation decrease, increased WBC count, decreased lymphocytes, and elevated CRP levels. More patients in the death group had complications such as ARDS, acute cardiac injury, acute kidney injury, shock, and DIC.

简介：在督脉，双侧膀胱经经脉线上施拔、摩、啄、捏、拍5种手法，并根据辨证分型，分为肝郁化火、疲热内扰、阴虚火旺、心脾两虚和心虚胆怯5个证型，施以不同手法，治疗32例失眠患者。2个疗程后，治愈25例，显效7例，未愈0例，有效率100％。

简介：AbstractBackground:Invasive sphenoid sinus aspergillosis is a rare but life-threatening condition usually found in immunocompromised patients. When involving cavernous sinus and surrounding structures, patients are frequently misdiagnosed with a neoplasm or sellar abscess. Timely diagnosis and intervention are crucial to patients’ outcomes. The objective of this study is to review cases of invasive sphenoid sinus aspergillosis to describe disease manifestations, imaging features, treatment, and outcome.Case presentation:We describe four patients with invasive sphenoid sinus aspergillosis misdiagnosed as sellar tumors preoperatively. The mass was completely removed in three patients and partially removed in one patient microscopically. Pathological examinations confirmed Aspergillus in all cases. All four patients received anti-fungal agents postoperatively. There was no recurrence at the time of each patient’s follow-up date. One patient with complete resection was lost to follow-up while the other three patients’ neurologic function improved. Additionally, we performed a systematic review regarding invasive sphenoid sinus aspergillosis of existing English literature.Conclusion:With regard to clinical symptoms, headache, vision impairment, and ophthalmoplegia were observed in over half of the patients in the literature. A sellar mass with bone destruction on CT and involvement of cavernous sinus is highly suggestive of invasive fungal sphenoid sinusitis. Immediate surgical removal of the lesion is recommended for invasive sphenoid sinus aspergillosis to preserve nerve function and increase the likelihood of survival.

简介：AbstractIntroduction:Postherpetic neuralgia (PHN) is a painful condition that occurs after herpes zoster skin lesions have subsided and that lasts for more than 1 month. PHN is usually difficult to treat.We herein present two cases of PHN comorbid with spinal metastasis of a malignant tumor. Both patients responded well to an epidural block.Case presentation:Patient 1 was a 54-year-old woman who had PHN for 35 days. Patient 2 was a 74-year-old woman who had PHN for 65 days. Both patients were treated with an epidural block and found to have spinal metastasis from a malignant tumor.Discussion:The routinely used dermatological medications for the treatment of herpes zoster and PHN have slow and unsatisfactory analgesic effects. Epidural block treatment provides a new approach for patients who cannot tolerate or do not respond to these commonly used drugs. Physicians should pay special attention to patients who have a history of a malignant tumor or are suspected to have spinal disease. Computed tomography or magnetic resonance imaging of the spine is recommended for such patients, and epidural block treatment should be performed after a spinal tumor or other lesions have been excluded.Conclusion:Epidural block treatment provides a new approach for patients of herpes zoster or PHN, but the treatment should be performed after a spinal tumor or other spinal lesions have been excluded.

简介：目的:观察针药结合治疗中风后抑郁症的疗效.方法:采用针刺与中药相结合治疗42例中风后抑郁症患者,并与30例西药对照组进行临床对照.结果:治疗后两组Hamilton抑郁量表积分明显下降,与治疗前比较有显著的统计学意义;针药结合组总有效率与西药对照组比较,无统计学意义.结论:针药结合治疗中风后抑郁症疗效显著,安全、无副作用.