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Objective: To development the prognostic nomogram for malignant pleural mesothelioma (MPM). Methods: Two hundred and ten patients pathologically confirmed as MPM were enrolled in this retrospective study from 2007 to 2020 in the People's Hospital of Chuxiong Yi Autonomous Prefecture, the First and Third Affiliated Hospital of Kunming Medical University, and divided into training (n=112) and test (n=98) sets according to the admission time. The observation factors included demography, symptoms, history, clinical score and stage, blood cell and biochemistry, tumor markers, pathology and treatment. The Cox proportional risk model was used to analyze the prognostic factors of 112 patients in the training set. According to the results of multivariate Cox regression analysis, the prognostic prediction nomogram was established. C-Index and calibration curve were used to evaluate the model's discrimination and consistency in raining and test sets, respectively. Patients were stratified according to the median risk score of nomogram in the training set. Log rank test was performed to compare the survival differences between the high and low risk groups in the two sets. Results: The median overall survival (OS) of 210 MPM patients was 384 days (IQR=472 days), and the 6-month, 1-year, 2-year, and 3-year survival rates were 75.7%, 52.6%, 19.7%, and 13.0%, respectively. Cox multivariate regression analysis showed that residence (HR=2.127, 95% CI: 1.154-3.920), serum albumin (HR=1.583, 95% CI: 1.017-2.464), clinical stage (stage Ⅳ: HR=3.073, 95% CI: 1.366-6.910) and the chemotherapy (HR=0.476, 95% CI: 0.292-0.777) were independent prognostic factors for MPM patients. The C-index of the nomogram established based on the results of Cox multivariate regression analysis in the training and test sets were 0.662 and 0.613, respectively. Calibration curves for both the training and test sets showed moderate consistency between the predicted and actual survival probabilities of MPM patients at 6 months, 1 year, and 2 years. The low-risk group had better outcomes than the high-risk group in both training (P=0.001) and test (P=0.003) sets. Conclusion: The survival prediction nomogram established based on routine clinical indicators of MPM patients provides a reliable tool for prognostic prediction and risk stratification.
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Humans , Mesothelioma, Malignant , Prognosis , Nomograms , Retrospective Studies , Proportional Hazards ModelsABSTRACT
<p><b>BACKGROUND</b>Interferon-gamma release assay (IGRA) has been used in latent tuberculosis (TB) infection and TB diagnosis, but the results from different high TB-endemic countries are different. The aim of this study was to investigate the value of IGRA in the diagnosis of active pulmonary TB (PTB) in China.</p><p><b>METHODS</b>We conducted a large-scale retrospective multicenter investigation to further evaluate the role of IGRA in the diagnosis of active PTB in high TB-epidemic populations and the factors affecting the performance of the assay. All patients who underwent valid T-SPOT.TB assays from December 2012 to November 2015 in six large-scale specialized TB hospitals in China and met the study criteria were retrospectively evaluated. Patients were divided into three groups: Group 1, sputum culture-positive PTB patients, confirmed by positive Mycobacterium tuberculosis sputum culture; Group 2, sputum culture-negative PTB patients; and Group 3, non-TB respiratory diseases. The medical records of all patients were collected. Chi-square tests and Fisher's exact test were used to compare categorical data. Multivariable logistic analyses were performed to evaluate the relationship between the results of T-SPOT in TB patients and other factors.</p><p><b>RESULTS</b>A total of 3082 patients for whom complete information was available were included in the investigation, including 905 sputum culture-positive PTB cases, 914 sputum culture-negative PTB cases, and 1263 non-TB respiratory disease cases. The positive rate of T-SPOT.TB was 93.3% in the culture-positive PTB group and 86.1% in the culture-negative PTB group. In the non-PTB group, the positive rate of T-SPOT.TB was 43.6%. The positive rate of T-SPOT.TB in the culture-positive PTB group was significantly higher than that in the culture-negative PTB group (χ2 = 25.118, P < 0.01), which in turn was significantly higher than that in the non-TB group (χ2 = 566.116, P < 0.01). The overall results were as follows: sensitivity, 89.7%; specificity, 56.37%; positive predictive value, 74.75%; negative predictive value, 79.11%; and accuracy, 76.02%.</p><p><b>CONCLUSIONS</b>High false-positive rates of T-SPOT.TB assays in the non-TB group limit the usefulness as a single test to diagnose active TB in China. We highly recommend that IGRAs not be used for the diagnosis of active TB in high-burden TB settings.</p>
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Angiogenesis in atherosclerotic plaque plays a critical role in the mechanism of atherosclerotic physiopathology. Present consensus shows that angiogenesis in atherosclerotic plaque is mainly resulted in hypoxia, inflammation and some pro-angiogenic factors. The homeostasis in plaque, which is hypoxic and infiltrated by inflammatory cells, may lead to angiogenesis, increase the plaque instability and the incidence rate of vascular events. This article reviews the progression of pathogenetic mechanism, physiopathological significance, relevant detecting technique and corresponding therapeutic methods of Chinese and Western medicine of angiogenesis in atherosclerotic plaque, so as to provide more theoretical basis for atherosclerotic clinical treatment.
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Objective To provide references for human gait analysis and its application in clinical medicine and rehabilitation through research on practical application of piezoelectric gait analysis system in plantar pressure monitoring. Methods Piezoelectric gait analysis system was designed to collect pressure signals of six acquisition points in insole. The signals were transferred by bluetooth, and then analyzed and handled by APP and MATLAB. Results The plantar pressure cloud chart, center of pressure (COP) butterfly diagram were obtained by interpolation and color mapping in MATLAB, the walk cycle was calculated by measuring swing phase of both feet, and real time pressure monitoring was realized by mobile APP to give an accidental fall alarm. Conclusions The system can achieve monitoring of standing posture, state of equilibrium, walk cycle and accidental fall, and the experimental results are coincident with clinical research conclusions. Meanwhile, the wearable structure is more suitable in real walking scene.
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Objective To provide references for human gait analysis and its application in clinical medicine and rehabilitation through research on practical application of piezoelectric gait analysis system in plantar pressure monitoring.Methods Piezoelectric gait analysis system was designed to collect pressure signals of six acquisition points in insole.The signals were transferred by bluetooth,and then analyzed and handled by APP and MATLAB.Results The plantar pressure cloud chart,center of pressure (COP) butterfly diagram were obtained by interpolation and color mapping in MATLAB,the walk cycle was calculated by measuring swing phase of both feet,and real time pressure monitoring was realized by mobile APP to give an accidental fall alarm.Conclusions The system can achieve monitoring of standing posture,state of equilibrium,walk cycle and accidental fall,and the experimental results are coincident with clinical research conclusions.Meanwhile,the wearable structure is more suitable in real walking scene.
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Objective To provide references for human gait analysis and its application in clinical medicine and rehabilitation through research on practical application of piezoelectric gait analysis system in plantar pressure monitoring.Methods Piezoelectric gait analysis system was designed to collect pressure signals of six acquisition points in insole.The signals were transferred by bluetooth,and then analyzed and handled by APP and MATLAB.Results The plantar pressure cloud chart,center of pressure (COP) butterfly diagram were obtained by interpolation and color mapping in MATLAB,the walk cycle was calculated by measuring swing phase of both feet,and real time pressure monitoring was realized by mobile APP to give an accidental fall alarm.Conclusions The system can achieve monitoring of standing posture,state of equilibrium,walk cycle and accidental fall,and the experimental results are coincident with clinical research conclusions.Meanwhile,the wearable structure is more suitable in real walking scene.
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Objective: To assess the efficacy of nasal intermittent positive pressure ventilation with heliox in preterm infants with respiratory distress syndrome. Methods: Premature infants with mild respiratory distress syndrome requiring non-invasive respiratory support were eligible. Infants were randomly assigned to heliox or air-oxygen group. The main outcome was the length of ventilation. Results: Heliox significantly decreased the length of ventilation. The length of ventilation was positively correlated with interleukin-6 at baseline. Carbon dioxide elimination was better in the heliox group. Conclusion: Heliox delivered with nasal intermittent positive pressure ventilation may be effective in reducing length of ventilation and increasing carbon dioxide elimination.
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OBJECTIVE: AO/OTA 31-A3 intertrochanteric femoral fractures have completely different fracture line directions and biomechanical characteristics compared with other types of intertrochanteric fractures. The choice of the fixation method has been a focus of dispute among orthopedic trauma surgeons. The purpose of this study was to review the outcomes of these fractures treated with a percutaneous compression plate at our institute. METHOD: Seventeen patients with AO/OTA 31-A3 intertrochanteric femoral fractures were treated with a percutaneous compression plate at our institute from January 2010 to December 2011. The clinical data and imaging results were retrospectively analyzed. RESULTS: The medical complication of popliteal vein thrombosis occurred in one patient. Sixteen patients were followed up for 12 to 21 months. Two patients had malunion and mild pain. Fracture collapse occurred in two patients, with one having head penetration. These two patients had moderate pain. There were no occurrences of nonunion or reoperation. The mean Harris hip score obtained during the last follow-up was 84.1 (61-97). Patients with a poor quality of reduction were more likely to have pain results (p = 0.001). A trend existed toward the presence of a poor quality of reduction (p = 0.05) in patients with a collapse of fracture. Patients with poor preoperative mobility were more likely to have a lower Harris hip score (p = 0.000). CONCLUSION: The percutaneous compression plate is an alternative device for the treatment of AO/OTA 31-A3 intertrochanteric femoral fractures. Good fracture reduction and an ideal placement position of the neck screw are important in the success of the device. .
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Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Bone Plates , Fracture Fixation, Intramedullary/methods , Hip Fractures/surgery , Bone Nails , Bone Screws , Fracture Healing , Hip Fractures , Operative Time , Pain Measurement , Reproducibility of Results , Retrospective Studies , Treatment OutcomeABSTRACT
Objective: To compare the efficacy and safety of Nasal intermittent positive pressure ventilation (NIPPV) and Nasal continuous positive airway pressure (nCPAP) in neonates. Methods: Standard search strategy for the Cochrane Neonatal Review Group was performed. The participants were both preterm and term infants suffering from neonatal respiratory distress syndrome or experiencing apnea of prematurity. Results: 14 eligible andomized controlled trials involving 1052 newborn infants were included. The study quality and evidence validity was defined as moderate. As compared with nCPAP, NIPPV significantly reduced the incidence of endotracheal ventilation (OR=0.44, 95%CI:0.31–0.63), increased the successful rate of extubation (OR=0.15, 95%CI:0.08–0.31), and had a better outcome indicated by decreased death and/or bronchopulmonary dysplasia (OR=0.57, 95%CI:0.37–0.88). Moreover, NIPPV decreased the number of apneic episodes of prematurity (WMD=-0.48, 95%CI:-0.58–0.37), and marginally decreased the incidence of bronchopulmonary dysplasia (OR=0.63, 95%CI:0.39–1.00). No side effects specifically associated with NIPPV were reported. Conclusions: NIPPV could be used to reduce endotracheal ventilation, increase successful extubation, decrease the rate of apnea of prematurity, and have better outcome indicated by fewer death and/or bronchopulmonary dysplasia in preterm and term newborn infants.
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Objective To observe the levels of Ang - 1 and NF-κB in lung tissue and to aseess the severity of ALI induced by phosgene in order to clarify the mechanism of the protective effect of Ang - 1 on phosgene induced ALI.Method Rats were randomly divided into phosgene group and air group.Another rats were randomly (random number) divided into phosgene group,phosgene + PDTC group and air group.Lung tissue was collected to weigh and calculate the wet / dry weight ratio,measure BALF,white blood cell count,total protein and Ang-1 at given time after exposure to phosgene/air and PDTC.The Ang - 1 and NF-κB levels in lung tissue were measured with Western blot and immunohistochemistry.Data were analyzed by using SPSS 16.0 statistical package and comparisons between groups were carried out byusing One-Way ANOVA analysis and LSD -t test,α ＜ 0.05.Results Serum angiopoietin -1 level became lesser within 48 hours after exposure to Phosgene.The severity of ALI became worser with time elapsing.Ccompare with air group,the severity of ALI in phosgene group was worser with time elapsing ( P ＜ 0.05).Compared with phosgene + PDTC group,the serum angiopoietin -1 and arterial oxygen partial pressure in phosgene group were lower ( P ＜ 0.05).The severity of ALI of rats in phosgene group were worser than that in phosgene + PDTC group ( P ＜ 0.05).Serum angiopoietin -1 and partial pressure of oxygen of rats in phosgene group were higher than those in phosgene + PDTC group ( P ＜ 0.05).Immunohistochemistry test showed that the expression of Ang-1 in lung tissue in air group were normal,and Ang-1 in phosgene group were significantly reduced,and Ang-1 in PDTC intervention group was higher than that in phosgene group and lower than that in air group.The above results were confirmed by Western blot test which was consistent with the results of immunohistochemistry test.Similarly,the levels of NF-κB in lung tissue determined by using both Western - blot and immunohistochemistry were consistant,and results of both methods showed that the expression of NF - κB in air group was normal,and it increased in phosgene group,and the expression of NF-κB in phosgene + PDTC group was lower than that in phosgene group.Conclusions The serum level of Ang-1 was decreasing within 48 hours after ALI.Ang-1 was negatively correlated with the sevfity of phosgene induced ALI.Ang-1 likely had an effect on NF-κB signaling pathway,ameliorating the inflammation mediated by cytokines,reducing lung endothelial permeability and in turn lessening the severity of ALI.
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Objective To study the flurbiprofen axetil (FA) for postoperative analgesia of gynecological laparoscopic surgery and the changes of interleukin-6 in blood.Methods80 cases were selected for gynecologic laparoscopic surgery,the patients were randomly divided into 4 groups with 20 cases each group.Group A was given FA 50 mg and tramadol 1 mg/kg 30 minutes before the end of surgery.Group B was given FA 50 mg 5 minutes before induction of anesthesia and given tramadol 1 mg/kg 30 minutes before the end of surgery,and group C was given FA 50 mg five minutes before induction of anesthesia.Group D was given tramadol 2 mg/kg 30 minutes before the end of surgery.After the surgery,the VAS was observed in real-time of wake up (T1),and 2 hours (T2),6 hours (T6) and 24 hours (T24) after operating.The blood of each group was taken at the different time points including arriving in the room (T0),waking up (T1) and 6 hours (T6) after operating.The blood samples were hold for 30 minutes and centrifuged (3000 r/min,10 min),and IL-6 was detected using double-antibody sandwich ABC-ELISA.ResultsThe experiments showed that VAS in T1 time point of group A,B,C were lower than that of group D(1.40±0.26,1.67±0.37,1.60±0.42 vs 3.13±2.32).In T24 time point,VAS of group A,B were also lower than that of group D(2.13±1.24,2.00±1.25 vs 3.53±1.87),the differences were significant (P＜0.05).The experiments showed that concentration of IL-6 in group D was higher than that in group A,B,C at the T1 time point (12.26±6.56 vs 2.94±2.55,3.37±2.43 vs 2.93±1.16,P＜0.05).ConclusionsThe postoperative analgesic effect of Flurbiprofen axetil combined with tramadol on the ogynecological laparoscopic was superior to using any of the drug alone.Flurbiprofen axetil could inhibit increasing of IL-6 and have an effect against the inflammatory response induced by surgical trauma,and it has a good analgesic effect.
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Objective To investigate the distribution of polymorphisms of SLC11A1 gene,VDR gene,MBL gene and IFNG gene with susceptibility to tuberculosis (TB) in Chinese Han population suffering from drug-sensitive TB and drug-resistant TB so as to identify the correlation between gene polymorphisms and the development of drug-resistant TB.Methods Single nucleotide polymorphisms (SNP) of VDR gene,SLC11A1 gene,MBL gene,IFNG gene were typed and analyzed by pyrosequencing,Real-time Probe and SNaPshot among 229 patients with drug-sensitive TB and 230 patients with drug-resistant TB.Results The polymorphic foci of VDR gene from the drug-sensitive TB group and the drug-resistant TB group showed no significant difference (P＞0.05).The genotype of INT4 site and allelic frequency of SLC11A1 gene for drug-sensitive TB group were significantly different from those for drug-resistant TB group(P=0.031,0.046).If recessive inheritance was assumed,the genotypes of INT4 site from the two groups were significantly different (0R=5.756,95% CI:1.261-26.269,P=0.011).Considering the relationship between OR values under various combination,our findings confirmed that the genetic mode of INT4 site was in accordance with recessive inheritance.The genotypes of Q/P site and allelic frequencies of MBL gene from drug-sensitive and drug-resistant groups were significantly different (P=0.029,0.033).The difference still existed under the hypothesis of recessive inheritance (OR=9.290,95% CI:1.167-73.949,P=0.011).The polymorphic foci of IFNG gene from the two groups showed no significant difference.Conclusion INT4 sites on SLC11A1 gene and Q/P site on MBL gene were probably associated with the development of drug-resistant TB in Chinese Han population.Further study on this issue would be helpful in locating the population at high risk of drug-resistant TB and exploring the effective intervention to decrease the incidence of this disease.
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Robot assisted catheter insertion (RACI) is one kind of Micro Invasion Surgery (MIS), which is the key technology of Transcatheter Arterial ChemoEmbolization (TACE). The system consists of guide wire feeding and detecting, force feed back, imaging and image processing etc. Currently the active catheter system is much more mature but too expensive to apply in hospital at home in the short term, however, the less researched and cheaper passive catheter system shows a bright future for research and application.
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Catheterization , Methods , Minimally Invasive Surgical Procedures , Methods , Robotics , Surgery, Computer-Assisted , MethodsABSTRACT
T mutation was detected in the 4th propositus at the 9th intron,but any COL1A1 or COL1A2 gene mutation was detected in the third propositus and the other members in the former families.Conclusions The genetic mutation of COL1A1 may result in OI in China,but other mutations may also exist.Moreover,the phenotype was influenced not only by OI genotype,but also by the genetic background,environment and other factors.
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PURPOSE: There have been several recent reports of laparoscopy-assisted procedure for limited, or a laparoscopic, resections of small lesion of the liver. However, there are few reports on total laparoscopic surgery in anatomic resections, which is due to high level of skill required for the procedure and the risk of an air embolism. The aim of this study was to determine the safety of total laparoscopic surgery in anatomic liver resections during our early experiences. METHODS: The 6 patients included in this study were all treated with a totally laparoscopic anatomic resection of the liver at Ewha Womans University, Mokdong Hospital between September 2002 and January 2003. All 6 cases were diagnosed with an intrahepatic duct (IHD) stone, with stricture and/or common bile duct (CBD) stones. Of these 6 cases, 2 underwent a totally laparoscopic left lateral segmentectomy of the liver. In the remaining 4 cases, totally laparoscopic left lobectomies and CBD explorations, with T-tube insertion, were performed. In all cases, 4 trocars were used. During the operation, the intraperitoneal pressure of the pneumoperitoneum was maintained between 8 and 12 mmHg using CO2. The instruments used included Ligasure(R), Autosonix(R), 0 degrees and 30 degrees camera, fan retractor, Endo(vascular)- GIA 30 , and a large LapBag(R). All cases were managed in the supine position, with 15 degrees of left tilting. The specimen were extracted through a 4 to 5 cm extension of the upper trocar site. The T-tube exited through a 12mm site in the right upper port, and a drain was inserted into the sub-hepatic area. RESULTS: The patients comprised of 5 women and a man, with a mean age of 50.2 years old. The mean operative time was 469.2 (+/-141.4) minutes. In one case, 2 pints of packed red blood cells had to be transfused during the operation. The mean time to diet was 3.3 days. The mean postoperaitve hospital stay was 11.7 days. There was no conversion to open surgery, morbidity or mortality. The mean extensional incision size for the extraction of the specimen was 4.3 cm. CONCLUSION: In the anatomic resection of the liver, especially for benign liver disease, a total laparoscopic resection could be another relatively safe option for selected cases.
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Female , Humans , Common Bile Duct , Constriction, Pathologic , Conversion to Open Surgery , Diet , Embolism, Air , Erythrocytes , Laparoscopy , Length of Stay , Liver Diseases , Liver , Mastectomy, Segmental , Mortality , Operative Time , Pneumoperitoneum , Supine Position , Surgical InstrumentsABSTRACT
PURPOSE: The liver is one of the most commonly injured organs in abdominal trauma. Surgery has played a major role in treating traumatic liver injury. Recently, it was reported that conservative treatment could be the first-line management for the hemodynamically stable patients without combined intraabdominal surgical problems. However, the risk of mortality remains high in this type of injury. The aim of this study was to examine the prognostic factors intraumatic liver injury. METHODS: The medical records of 132 patients who were treated for traumatic liver injury at Ewha Womans University, Mokdong Hospital from March 1994 to June 2001 were reviewed. The initial systolic blood pressure, prehospital transportation time, the number of associated organ injury, the level of initial hemoglobin, the grade of liver injury, the treatment method, the preoperative preparation time, the amount of estimated intraoperative blood loss, and the amount of intraoperative transfusion were analyzed with a univariate analysis and a multivariate analysis. RESULTS: Among the 132 patients, 76 cases (57.6%) were managed non-surgically, and 56 cases (42.4%) underwent surgery. Out of the 17 cases (12.9%) of mortality, 14 (82.4%) were encountered in those who underwent surgery and 3 cases (17.6%) were encountered in those who were treated nonsurgically. Univariate analysis revealed that the initial systolic blood pressure, prehospital transportation time, initial hemoglobin level, the number of associated organ injury, the surgical treatment, the grade of liver injury and the amount of intraoperative transfusion were significant prognostic factors for the survival. Multivariate analysis indicated that the initial systolic blood pressure and the extent of associated organ injury were the independent prognostic factors. CONCLUSION: The patients with unstable vital signs initially and multiple associated organ injuries have a poor prognosis. Aggressive management might be helpful for improving the survival rate in these patients.