Clinical Classification and Treatment Strategy of Hamate Hook Fracture

To explore the clinical classification of hamate hook fracture and the treatment strategy for different type of fractures,12 patients who suffered from hamate hook fractures were followed up retrospectively.According to the fracture sites and the prognosis,we classified the hamate hook fractures into 3 types.Type Ⅰ referred to an avulsion fracture at the tip of hamate hook,type Ⅱ was a fracture in the middle part of hamate hook,and type Ⅲ represented a fracture at the base of hamate hook.By the classification,in our series,only 1 fell into type Ⅰ,7 type Ⅱ,and 4 type Ⅲ.The results were evaluated with respect to the functional recovery,recovery time and the association among the clinical classification,pre-operative complications and treatment results.The average follow-up time of this group was 8.4±3.9 months.Two cases were found to have fracture non-union and both of them were type Ⅱ fractures.Six patients had complications before operation.Five cases were type Ⅱ fractures and 1 case type Ⅲ fracture.All the patients were satisfied with the results at the time of the last follow-up.Their pain scale and grip strength improved significantly after treatment.All the pre-operative complications were relieved.The recovery time of hamate hook excision was significantly shorter than that of the other two treatments.The incidences of both pre-operative complications and non-union in type Ⅱ fractures were higher than those in type Ⅰ and type Ⅲ fractures.It was concluded that,generally,the treatment effects with hamate hook fracture are quite good.The complication incidence and prognosis of the fracture are closely related to the clinical classification.Early intervention is critical for type Ⅱ fractures.

Clinical Experience with the Fifth-Generation of a Breast Implant with a Smooth, Fine Surface from a Korean Manufacturer in Asian Women

Background: In this study, we describe our clinical experience with the fifth-generation of a breast implant with a smooth, fine surface from a Korean manufacturer (BellaGel® SmoothFine;HansBiomed Co. Ltd., Seoul, Korea) in Asian women. Methods: We analyzed 223 women (mean age = 35.28 ± 9.45 years and mean follow-up period = 12.03 ± 2.48 months), comprising 118 bilateral cases and 109 unilateral ones, who received breast augmentation using the BellaGel® SmoothFine at our hospital between June 4, 2018 and February 28, 2019. For safety assessment, we analyzed frequencies of postoperative complications and overall survival of the BellaGel® SmoothFine. Results: Postoperatively, complications (12 cases, 5.38%) include asymmetry (3 cases, 1.35%), hematoma (2 cases, 0.90%), hypertrophic scars (2 cases, 0.90%), wound disruption (2 cases, 0.90%), rippling (1 case, 0.45%), capsular contracture (1 case, 0.45%), stretch deformities with skin excess (1 case, 0.45%). In addition, time-to-events were calculated as 10.94 ± 0.64 months (95% CI 9.69 - 12.19) and the survival rate reached 0.290 ± 0.168 (95% CI 0.094 - 0.901) at 12 months postoperatively. Conclusions: Here, we describe our clinical experience with the BellaGel® SmoothFine. Our results are of significance in that this is the first report about the fifth-generation of a breast implant with a smooth, fine surface from a Korean manufacturer for Asian women.

Survivors of COVID-19 exhibit altered amplitudes of low frequency fluctuation in the brain: a resting-state functional magnetic resonance imaging study at 1-year follow-up

Although some short-term follow-up studies have found that individuals recovering from coronavirus disease 2019(COVID-19)exhibit anxiety,depression,and altered brain microstructure,their long-term physical problems,neuropsychiatric sequelae,and changes in brain function remain unknown.This observational cohort study collected 1-year follow-up data from 22 patients who had been hospitalized with COVID-19(8 males and 11 females,aged 54.2±8.7 years).Fatigue and myalgia were persistent symptoms at the 1-year follow-up.The resting state functional magnetic resonance imaging revealed that compared with 29 healthy controls(7 males and 18 females,aged 50.5±11.6 years),COVID-19 survivors had greatly increased amplitude of low-frequency fluctuation(ALFF)values in the left precentral gyrus,middle frontal gyrus,inferior frontal gyrus of operculum,inferior frontal gyrus of triangle,insula,hippocampus,parahippocampal gyrus,fusiform gyrus,postcentral gyrus,inferior parietal angular gyrus,supramarginal gyrus,angular gyrus,thalamus,middle temporal gyrus,inferior temporal gyrus,caudate,and putamen.ALFF values in the left caudate of the COVID-19 survivors were positively correlated with their Athens Insomnia Scale scores,and those in the left precentral gyrus were positively correlated with neutrophil count during hospitalization.The long-term follow-up results suggest that the ALFF in brain regions related to mood and sleep regulation were altered in COVID-19 survivors.This can help us understand the neurobiological mechanisms of COVID-19-related neuropsychiatric sequelae.This study was approved by the Ethics Committee of the Second Xiangya Hospital of Central South University(approval No.2020 S004)on March 19,2020.

无保护左主干病变经皮冠状动脉介入治疗临床分析

目的观察经皮冠状动脉介入治疗(PCI)左主干病变的近中期疗效。方法 2006年3月～2009年4月共有18例无保护左主干病变患者进行了PCI治疗,共植入Firebird支架26枚,观察近中期主要心血管不良事件及复发率。结果患者出院后长期门诊或电话随访,所有患者病情均稳定,心绞痛症状得到不同程度缓解,一般日常活动无心绞痛发作。结论无保护左主干病变药物洗脱支架的植入可以获得满意的临床疗效。

Cystic echinococcosis of the liver: A primer for hepatologists

Cystic echinococcosis(CE) is a complex, chronic and neglected disease with a worldwide distribution. The liver is the most frequent location of parasitic cysts. In humans, its clinical spectrum ranges from asymptom-atic infection to severe, potentially fatal disease. Four approaches exist in the clinical management of CE: surgery, percutaneous techniques and drug treatment for active cysts, and the "watch and wait" approach for inactive cysts. Allocation of patients to these treat-ments should be based on cyst stage, size and location, available clinical expertise, and comorbidities. However, clinical decision algorithms, efficacy, relapse rates, and costs have never been properly evaluated. This paper reviews recent advances in classification and diagnosisand the currently available evidence for clinical deci-sion-making in cystic echinococcosis of the liver.

Clinical features and outcomes of 210 patients with idiopathic pulmonary fibrosis

Background Idiopathic pulmonary fibrosis （IPF） is a lethal chronic interstitial lung disease （ILD） of unknown cause and having a variable and unpredictable course.This study aimed to summarize the clinical features and follow-up outcomes and to identify potential factors useful for the assessment of prognosis in IPF.Methods Two hundred and ten patients hospitalized and diagnosed as IPF in our unit from January 1999 to June 2007 were enrolled into this study.The baseline demographic,clinical,radiologic and physiologic characteristics were summarized.Clinical follow-up data until February 2010 were collected,and the median survival time and 1-,2-,and 5-year survival rates,as well as the influences of the summarized baseline variables on the prognosis were analyzed.Results The age at diagnosis as IPF was （64±10） years,the duration before diagnosis of 106 patients （50％） was shorter than 2 years,and 73％ were males.One hundred and forty-five patients （69％） had a history of smoking with a median pack-year of 18.Eighty-nine patients （42％） had emphysema and 62 patients （29％） pulmonary arterial hypertension （PAH）.One hundred and twenty-four patients were followed up,of which 99 patients died from various causes including respiratory failure related to IPF （93％）.The follow-up period was （21±23） months.The median survival time was 38months.The 1-,2-,and 5-year survival rates were 61％,52％,and 39％,respectively.Multivariate analysis showed clubbing,PAH,duration from initial onset to diagnosis,and forced expiratory volume in 1 second （FEV1）/forced vital capacity （FVC） were independent prognostic indicators of IPF.Conclusion IPF patients who have clubbing,PAH,a higher FEVJFVC,and a short duration from initial onset to diagnosis have a poorer outcome.

Left ventricular reconstruction with no-patch technique：early and late clinical outcomes

Background Few studies have evaluated late clinical outcome of no-patch technique in patients with large left ventricular aneurysms. The objectives of this study were to evaluate a no-patch surgical technique to reconstruct the left ventricle in patients with left ventricular aneurysm and to assess early and late clinical outcomes.Methods In 1995, we began using a no-patch technique in patients with dyskinetic left ventricular aneurysms. A total of 145 patients underwent left ventricular reconstruction with this technique and were followed up for （59±29） months （range,1-127 months）. Risk factors for early mortality were analyzed by bivariate analyses. Cox＇s proportional hazards model was used to calculate risk factors for all-cause mortality and hospital readmission. Kaplan-Meier methodology was used to analyze late survival.Results One week after operation, left ventricular end-diastolic diameter had decreased from （61±8） mm to （55±8）mm, and geometry of the left ventricle was restored to a more normal conical shape. Early mortality was 3% and late mortality 11%. Over a 5-year follow-up period, hospital readmission was 28%. One-, 5-, and 10-year survival estimates were 95% （95% confidence interval （CI） 91%-99%）, 86% （95% CI 78%-94%）, and 74% （95% CI 60%-88%）.Readmission-free survival at 1 and 5 years after operation was 87% （95% CI81%-93%） and 60% （95% CI50%-70%）,respectively.Conclusion The no-patch technique for left ventricular reconstruction is an effective and simple procedure that can achieve satisfactory early and late clinical outcomes in patients with left ventricular aneurysms.

Effects of bilateral subthalamic nucleus deep brain stimulation on motor symptoms in Parkinson’s disease: a retrospective cohort study

Deep brain stimulation of the bilateral subthalamic nucleus(STN)is a therapeutic option for patients with Parkinson’s disease(PD)in whom medical therapies have been ineffective.This retrospective cohort study analyzed the motor function of 27 patients with advanced PD,from the First Affiliated Hospital of Guangzhou Medical University,China,who received deep brain stimulation of the bilateral subthalamic nucleus and evaluated its therapeutic effects.The 10-year follow-up data of patients was analyzed in Qingyuan People’s Hospital,Sixth Affiliated Hospital of Guangzhou Medical University,China.The follow-up data were divided into two categories based on patients during levodopa treatment(on-medication)and without levodopa treatment(off-medication).Compared with baseline,the motor function of onmedication PD patients improved after deep brain stimulation of the bilateral subthalamic nucleus.Even 2 years later,the motor function of off-medication PD patients had improved.On-medication PD patients exhibited better therapeutic effects over the 5 years than offmedication PD patients.On-medication patients’akinesia,speech,postural stability,gait,and cognitive function worsened only after 5 years.These results suggest that the motor function of patients with advanced PD benefitted from treatment with deep brain stimulation of the bilateral subthalamic nucleus over a period up to 5 years.The overall therapeutic effects were more pronounced when levodopa treatment was combined with deep brain stimulation of the bilateral subthalamic nucleus.This study was approved by Institutional Review Board of Qingyuan People’s Hospital,The Sixth Affiliated Hospital of Guangzhou Medical University,China(approval No.QPH-IRB-A0140)on January 11,2018.

Analysis of 54 cases of COVID-19

Objective:The clinical features and test results of 2019-nCoV pneumonia(COVID-19)were analyzed retrospectively in order to understand the diagnostic significance of clinical test index,and to summarize the experience of clinical treatment.Methods:From February 10thto February 28th,2020,54 patients with COVID-19 from Wuhan Red Cross hospital were included,whose clinical data were analyzed and integrated.The clinical manifestation and laboratory examination were analyzed by descriptive statistical analysis.Results:The average age of the patients was 63.9 years(40–84 years).The median time from onset to diagnosis was 6.5 days(2–20 days),and the median time from onset to first hospitalization was 8 days(3–20 days).The main manifestations were that the percentage of neutrophil increased and the number of lymphocyte decreased in most cases.Most of them were combined with liver damage and myocardial cell damage,and chest CT showed lesion of bilateral lung.Conclusion:In addition to the nucleic acid test of 2019-nCoV,some laboratory tests may indicate COVID-19 in the early stages.The clinician may conduct repeated follow-up examinations to assess the progress and outcome of the disease.

The infl uence of national guidelines on soft tissue sarcoma patient outcome: a single center experience

Aim:The aim was to study the impact of nationwide clinical practice guidelines for soft tissue sarcomas(STS),introduced in 1994 and again in 2005 in North Savo,Finland.Methods:We retrospectively reviewed all the patients whose sarcoma was treated by a multidisciplinary team between the years 2000 and 2009 with mean follow-up time of 68 months.The patients were divided into 2 groups according to years:Group A(2000–2005,72 patients)and Group B(2006–2009,64 patients).Primary outcomes were local recurrence,metastases,and overall survival.Results:Fifty-five percent were men with an average age of 59 years.The most common sarcomas were pleomorphic sarcoma(37%)and liposarcoma(26%).Although there were significantly less amputations in Group B(A:15%,B:3%),there were more metastases(A:10%,B:23%)with an overall lower overall survival rate(A:70%,B:58%)than in Group A.Conversely,Group A had a higher 1st year survival rate(A:100%,B:87%).We found that upper limb sarcomas were more likely to be diagnosed with incisional biopsies,but there was no correlation between incisional biopsy and recurrence,metastases or survival.Conclusion:Due to nonadherence of the 2005 national treatment recommendations,there has been no improvement either in management or survival.The importance of educating guidelines to doctors referring patients to specialized units cannot be overemphasized to affect successful management in the treatment of STS.