Objective To evaluate the relation of human immunodeficiency virus (HIV)-1 ribonucleic acid (RNA) loads in cerebrospinal fluid with central neurological diseases. Methods The inpatients with HIV-1 infection diagnosed by Public Health Clinical Center of Chengdu between January 1st, 2015 and March 1st, 2018 were retrospectively included. The included patients were divided into central neurological disease group and non-central neurological disease group, and high viral load group and low viral load group. The demographic data, CD4+ T lymphocyte count, routine detection of cerebrospinal fluid, HIV RNA load in cerebrospinal fluid and plasma of patients with and without central neurological diseases were observed and compared.Multiple logistic regression analysis was used to identify risk factors for central neurological diseases. Results A total of 367 patients were included. In the central neurological disease group, 210 cases (57.22%) were complicated with central neurological diseases, and cryptococcus infection was the most. Compared with the non-central neurological disease group, the increase rate of cerebrospinal fluid cell counts, cerebrospinal fluid cell counts, cerebrospinal fluid HIV RNA positivity and cerebrospinal fluid HIV RNA load were higher in the central neurological disease group (P<0.05). Logistic regression analysis showed that HIV RNA load in cerebrospinal fluid≥100 000 copies/mL and CD4+ T lymphocyte count<200 cells/mm3 were risk factors for central neurological diseases. Conclusion Cerebrospinal fluid HIV RNA load≥100 000 copies/mL is an independent risk factor for HIV/AIDS patients with central neurological diseases and clinical treatment should take this factor into consideration to reasonably optimize the selection of antiretroviral therapy.
Objective To develop a novel prediction model based on cerebrospinal fluid (CSF) lactate for early identification of high-risk central nervous system (CNS) infection patients in the emergency setting. Methods Patients diagnosed with CNS infections admitted to the Department of Emergency Medicine of West China Hospital, Sichuan University between January 1, 2020 and December 31, 2023 were retrospectively selected. Patients were classified into a survival group and a death group according to their 28-day survival status, and clinical characteristics were compared between groups. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of 28-day mortality, which were subsequently used to construct a nomogram. Results A total of 173 patients were included, comprising 135 in the survival group and 38 in the death group. Multivariate analysis identified the Acute Physiology and Chronic Health Evaluation Ⅳ (APACHE Ⅳ) score [odds ratio (OR)=1.027, 95% confidence interval (CI) (1.002, 1.055), P=0.034], CSF lactate [OR=1.147, 95%CI (1.025, 1.286), P=0.018], and interleukin-6 [OR=1.002, 95%CI (1.001, 1.004), P=0.002] as independent predictors of 28-day mortality. The integrated model combining APACHE Ⅳ score, CSF lactate, and interleukin-6, demonstrated superior predictive performance compared with the APACHE Ⅳ score alone (P=0.020), and showed good calibration (Hosmer-Lemeshow P=0.50). Conclusions This tool may provide a useful instrument for emergency physicians to assess the 28-day mortality risk in patients with CNS infections, potentially facilitating early and targeted interventions for high-risk individuals. However, as the findings of this study are derived from a single-center retrospective dataset, the clinical applicability of this model requires further external validation through large-scale, prospective, multicenter studies to evaluate its generalizability.
ObjectiveTo review the research on the reasons of unplanned reoperation (URP) for degenerative lumbar spine diseases, and to provide new ideas for improving the quality of surgery for degenerative lumbar spine diseases. Methods The literature about the URP of degenerative lumbar spine diseases at home and abroad in recent years was reviewed and analyzed. Results At present, the reasons for URP include surgical site infection (SSI), hematoma formation, cerebrospinal fluid leakage (CSFL), poor results of surgery, and implant complications. SSI and hematoma formation are the most common causes of URP, which happen in a short time after surgery; CSFL also occurs shortly after surgery but is relatively rare. Poor surgical results and implant complications occurred for a long time after surgery. Factors such as primary disease and surgical procedures have an important impact on the incidence of URP. ConclusionThe main reasons for URP are different in various periods after lumbar spine surgery. Interventions should be given to patients with high-risk URP, which thus can reduce the incidence of URP and improve the surgery quality and patients’ satisfaction.
ObjectiveTo explore the effectiveness of the usage of artificial bone of tricalcium phophate in sellar floor reconstruction after transsphenoidal microsurgery for pituitary adeoma. MethodsBetween January and December 2014, 85 patients with pituitary adema underwent transsphenoidal microsurgery, and the clinical data were retrospectively analyzed. "Sandiwich" was used for sellar floor reconstruction in 46 cases (control group), and "sandiwich" combined with the artificial bone of tricalcium phophate in 39 cases (trial group). There was no significant difference in gender, age, disease duration, size of tumor, invasiveness, and the degree of damage to the sellar floor between 2 groups (P>0.05). ResultsTotal removal and subtotal removal of tumors were achieved in 39 cases and 7 cases of the control group, and in 33 cases and 6 cases of the trial group, showing no significant difference between 2 groups (Z=-1.303, P=0.193). Cerebrospinal leakage occurred in 8 cases of the control group and in 10 cases of the trial group during operation, showing no significant difference (Z=-1.748, P=0.080). The case number of cerebrospinal leakage in the control group (4 cases) was significantly more than that in the trial group (0) after operation (P=0.020). The time of gauze removal in the trial group (3 days) was significant shorter than that in the control group[(4.3±1.6) days] (t=2.236, P=0.033). The patients were followed up 3-14 months in the control group and 5-13 months in the trial group. No cerebrospinal leakage occurred during follow-up. ConclusionSellar floor reconstruction with artificial bone of tricalcium phophate is safe, and it can reduce cerebrospinal leakage and shorten the time of gauze removal.
目的：研究脑脊液置换术治疗蛛网膜下腔出血的效果。方法：蛛网膜下腔出血79例为治疗组及30例对照组，给予常规药物治疗，治疗组在此基础上增加脑脊液置换疗法。结果：治疗组疗效优于对照组、治疗有效率及死亡率上差异均有显著。 结论：脑脊液置换术对蛛网膜下腔出血具有较好的疗效，值得进一步推广。
From January, 1994 through March, 1995, 20 cases of CSF rhinorrhea happened during operation. The ages ranged from 20 to 76 years old. The types of tumors were: communicating craniofacial malignant tumors in 3 and pituitary adenoma in 17.The CSF fistulas were all repaired with autogeneous free muscle flaps, fat grains and gel foam, "threeinone" method. The defects of sphenoid and ethmoid bones and the dura mater ranged from 1.5 to 3.5cm and the filling materials used were 2 to 3 grams of fat grains and a muscle flap of 24cm in length, 1.82.5cm in width and 0.50.8cm in thickness. The survival rate from the implantation was 100 per cent, with satisfactory results. The patients were followed up for 1 to 14 months without any ill effect and recurrence of CSF rhinorrhea. The selection of the implanted material and its preparation were discussed. The main points in the surgical technique were introduced, and the mechanism of the implanted tissue was discussed preliminarily.
ObjectiveTo compare and analyze the differences of bacterial resistance of 3 different strains of bacteria isolated from Mohnarin cerebrospinal fluid (CSF), blood and bile of literature published in China, to provide the basis for clinical rational drug use. MethodsWe searched databases including CNKI and WanFang Data for reports about bacterial resistance from Mohnarin CSF, blood and bile from 2006 to 2014. Two reviewers independently screened literature, extracted data, and analyzed the differences of bacterial resistance from CSF, blood and bile by SPSS 19.0 software. ResultsComposition ratio of the gram positive bacteria from CSF specimens was much higher than those of the blood and the bile (χ2=383.118, P<0.001). The separation of E. coli, K. pneumoniae, E. cloacae, P. aeruginosa, A. baumannii, E. faecium and E. faecalis from CSF exhibited multi-drug resistance, and their resistance rates to commonly used antimicrobial agents were significantly higher than those from blood and bile (P<0.001), especially the A. baumannii, K. pneumoniae, E. cloacae and E. faeciu, and their overall resistance rates to commonly used antimicrobial drugs were 68.1%, 60.5%, 59.8%, and 59.4%, respectively. The top three antibiotics with higher resistance rate were piperacillin, sulfamethoxazole/trimethoprim and cefotaxime in A. baumannii, piperacillin, ceftriaxone and cefotaxime in K. pneumoniae, cefoxitin, Ampicillin/sulbactam and cefuroxime in E. cloacae, penicillin G, ampicillin and erythromycin in E. faecium. The resistant rates of quinolone in E. coli, E. cloacae, A. baumannii and E. faecium from CSF specimens were high, but low in K. pneumoniae, P. aeruginosa and E. faecalis. ConclusionThere are differences for drug resistance of the bacteria from different specimens from Mohnarin, the bacteria from CSF specimens exhibits multi-drug resistance, the resistances are significantly higher than those from blood and bile.
Abstract： Objective To study the spinal cord protection effect of cerebrospinal fluid drainage （CSFD）for patients undergoing thoracoabdominal aortic aneurysm surgery. Methods We randomly allocated 30 patients undergoing thoracoabdominal aortic aneurysm surgery in Beijing Anzhen Hospital from December 2008 to August 2009 into a CSFD group with 15 patients（12 males, 3 females; average age of 45.0 years） and a control group with 15 patients（11 males, 4 females; average age at 45.8 years）by computer. All the patients underwent replacement of ascending aorta and aortic arch, implantation of descending aorta stent, or thoracoabdominal aorta replacement. Some patients underwent Bentall operation or replacement of half aortic arch. Patients in the CSFD group also underwent CSFD. Serum S100B, glial fibrillary acidic protein and neuron-specific enolase were measured at set intraoperative and postoperative times. All the patients were scored preoperatively, 72 hours postoperatively, and before discharge according to the National Institutes of Health Stroke Scale and International Standards for Neurological Classification of Spinal Cord Injury. Results Central nervous system injury occurred in four patients in the control group： one died of both brain damage and spinal cord damage; one patient had spinal cord injury and became better after treatment by early CSFD; two patients had brain damage（one patient died, another patient had concomitant acute renal failure and acute respiratory failure, recovered and was discharged after treatment）. In the CSFD group, only one patient died of acute respiratory failure and subsequent multiple organ system failure, and all other patients recovered very well. There was no late death during three months follow-up in both groups. The average serum S100B, glial fibrillary acidic protein，and neuron-specific enolase concentrations of the CSFD group patients were significantly lower than those of the control group （F=7.153，P=0.012；F=3.263，P=0.082；F=4.927，P=0.035）. Conclusion Selected CSFD is a safe, effective and feasible procedure to protect the spinal cord from ischemic damage during the perioperative period of thoracoabdominal aortic aneurysm surgery.
Objective To investigate the therapeutic effect of artificial dura mater on the prevention and treatment of cerebrospinal fluid (CSF) leakage associated with thoracolumbar fracture and dislocation. Methods A total of 58 patients with thoracolumbar fracture and dislocation combined with dura mater injury and CSF leakage were treated in Affiliated Hospital of Southwest Medical University from January 2011 to December 2016, including 30 males and 28 females, aged from 15 to 86 years, with an average of (51.8±16.3) years. All patients were treated with posterior pedicle screw system for decompression, reduction fixation and fusion, dura mater and spinal cord injury were investigated, and external nerve roots or caudate nerves were exposed. At the same time; the dura mater was sutured and repaired and partially covered with gelatinous sponge (group A, 24 cases), or after dura mater was sutured and repaired, the artificial dura mater was partially covered (group B, 34 cases). The curative effect and complications of the two different treatment methods were evaluated. Results All operations were successfully completed. The operative time was 110–340 minutes, with an average of (195.0±10.4) minutes; the intraoperative blood loss was 200–2 800 mL, with an average of (845.0±26.5) mL. In group A, 13 patients (54.1%) acquired wound healing, and the average CSF leakage duration was (13.4±1.6) days postoperatively, among whom 3 cases were complicated with pseudomeningocele; 11 cases (45.9%) failed and necessitated additional management. Among the 11 cases, 6 case had no decreasing tendency of CSF leakage after 10-day drainage, and after subarachnoid drainage was performed, CSF leakage disappeared about 15 days after operation; 3 (12.5%) with wound infection underwent operative incision debridement, after the repair of the dura sac, the subarachnoid CSF was drainage at the lumbar part combined with the systemic situation with antibiotics and other symptomatic treatment, and the patients were cured about 16 days after the operation; 2 (8.3%) with spinal meningitis underwent subarachnoid CSF drainage and administration of antibiotics, and the CSF leakage ceased about 14 days after operation. In group B, 27 patients (79.4%) acquired wound healing, and the average CSF leakage duration was (9.1±1.7) days postoperatively; among whom, 4 cases were complicated with pseudomeningocele; 7 cases (20.6%) failed and necessitated additional management. Among the 7 cases, 5 cases had no decreasing tendency of CSF leakage after 10-day drainage, and CSF leakage disappeared around 12 days after treatment; 1 case (2.9%) with wound infection and 1 case (2.9%) with spinal meningitis, both were cured after the treatment as in group A. Conclusion Dural suture repair combined with artificial dura mater mulch repair can more effectively repair the dura tears associated with thoracolumbar vertebral fracture dislocation and reduce the incidence of CSF leakage.