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@#Objective To discuss the clinical characteristics and the management of major complications after thoracic surgery. Methods Retrospective research was conducted on 15 213 patients who underwent thoracic surgery from January 2008 to September 2018 in our hospital. Thirty-six (0.24%) patients died of postoperative complications. Based on whether major complications such as severe pulmonary pneumonia and other 13 complications were presented postoperatively, the patients were divided into a complication group (n=389, 294 males and 95 females, aged 61.93±10.23 years) and a non-complication group (n=14 785, 8 636 males and 6 149 females, aged 55.27±13.21 years) after exclusion of unqualified patients. The age, gender distribution, diagnosis, surgical approach, postoperative hospital stay, in-hospital costs and other clinical data were analyzed. And the treatment and outcomes of the complications were summarized. Results The age, proportion of male, malignancy and esophageal diseases, postoperative hospital stay and in-hospital costs in the complication group were significantly more or higher than those in the non-complication group (P<0.05). The top three causes of death among the 36 deaths were pulmonary embolism (PE, 25.00%), severe pulmonary pneumonia (16.67%) and acute respiratory failure (16.67%), respectively. The top five complications among the severe complication group were pulmonary pneumonia (24.73%), pleural space (19.83%), anastomotic leak (17.48%), pulmonary atelectasis (11.51%) and PE (6.18%). Conclusion Thoracic surgeons should recognize patients with high risk of severe complications preoperatively based on clinical characteristics and perform multi-disciplinary treatment for severe complications.
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Alteplase (tPA) intravenous thrombolysis is an effective treatment for acute ischemic stroke (AIS) when administered within 4.5 h of initial stroke symptoms. Here, its safety and efficacy were evaluated among AIS patients with a previous history of cerebral hemorrhage. Patients who arrived at the hospital within 4.5 h of initial stroke symptoms and who were treated with tPA intravenous thrombolysis or conventional therapies were analyzed. The 90-day modified Rankin scale (90-d mRS) was used alongside mortality and incidence of symptomatic intracerebral hemorrhage (SICH) rates to evaluate the curative effect of these therapies. Among 1,694 AIS patients, 805 patients were treated with intravenous thrombolysis, including patients with (n=793) or without (n=12) a history of cerebral hemorrhage, and the rate of incidence of SICH significantly differed between them (8.3 vs 4.3%, P=0.039). No significant difference was found in 90-d mRS measurements (41.7 vs 43.6%, P=0.530) and 90-d mortality rates (8.3 vs 6.5%, P=0.946). A total of 76 AIS patients with a history of cerebral hemorrhage received tPA thrombolytic therapy (n=12) or conventional therapy (n=64), and a significant difference was noted in the 90-d mRS scores between the two groups (41.7 vs 23.4%, P=0.029), while no significant difference was found in SICH measurements (8.3 vs 4.6%, P=0.610) and 90-d mortality rates (8.3 vs 9.4%, P=0.227). A history of cerebral hemorrhage is not an absolute contraindication for thrombolytic therapy; tPA intravenous thrombolysis does not increase SICH measurements and mortality rates in patients with a history of cerebral hemorrhage, and they may benefit from thrombolytic therapy.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Brain Ischemia/drug therapy , Tissue Plasminogen Activator/administration & dosage , Intracranial Hemorrhages/etiology , Fibrinolytic Agents/administration & dosage , Thrombolytic Therapy/methods , Brain Ischemia/complications , Treatment Outcome , Administration, IntravenousABSTRACT
It is recognized that prenatal care plays an important role in reducing adverse birth.Chinese pregnant women with medical condition were required to seek additional health care based on the recommended at least 5 times health care visits.This study was to estimate the association between prenatal care utilization (PCU) and preterm birth (PTB),and to investigate if medical conditions during pregnancy modified the association.This population-based case control study sampled women with PTB as cases;one control for each case was randomly selected from women with term births.The Electronic Perinatal Health Care Information System (EPHCIS) and a questionnaire were used for data collection.The PCU was measured by a renewed Prenatal Care Utilization (APNCU) index.Logistic regression models were used to estimate odds ratios (OR) and the 95％ confidence interval (95％ CI).Totally,2393 women with PTBs and 4263 women with term births were collected.In this study,695 (10.5％) women experienced inadequate prenatal care,and 5131 (77.1％) received adequate plus prenatal care.Inadequate PCU was associated with PTB (adjusted OR:1.41,95％ CI:1.32-1.84);the similar positive association was found between adequate plus PCU and PTB.Among women with medical conditions,these associations still existed;but among women without medical conditions,the association between inadequate PCU and PTB disappeared.Our data suggests that women receiving inappropriate PCU are at an increased risk of having PTB,but it does depend on whether the woman has a medical condition during pregnancy.
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Current treatments for cancer and the central nervous system diseases are limited,partly due to the difficulties posed by the insolubility,poor distribution of drugs among cells and lack of selectivity of drugs,the inability of drugs to cross cellular barriers and blood brain barrier (BBB).Carbon nanotubes (CNTs) possess many distinct properties including good electronic properiies,remarkably penetrating capability on the cell membrane,high drug-loading and pH-dependent therapeutic unloading capacities,thermal properties,large surface area and easy modification with molecules,which render them as a suitable candidate to deliver drugs to cancer and brain.CNTs as a drug delivery could achieve a high efficacy,enhance specificity and diminish side effects.Whereas CNTs have been primarily employed in cancer treatment,a few studies have focused on the treatment and diagnosis of the central nervous system diseases using CNTs.Here,we review the current progress of in vitro and in vivo researches of CNTs-based drug delivery to cancer involving CNTs-based tumor-targeted drug delivery systems (DDS),photodynamic therapy (PDT) and photothermal therapy (PTT).Meanwhile,we also review the current progress of in vitro and in vivo researches of CNTs-based drug delivery to brain.
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Objective To investigate the influences of loading time and loading angle on the stress, displacement of human periodontal ligament in dynamic jaw. Methods The three-dimensional assembly model of the mandible front teeth, periodontal ligament and alveolar bone was reconstructed by using the reverse engineering technology. The thickness of periodontal membranes was 0.2 mm. The stress, displacement at different positions of the periodontal ligaments during different jaw cycles were analyzed under dynamic load in the direction from bucca to tongue side with 0°, 15°, 30°, 45°, 60°, 75°, 90° angle to the long axis of the tooth. Results During one jaw cycle, the ratio of the maximum to minimum value of the maximum residual stress due to different loading angles was 5.5, and the ratio of the maximum to minimum value of the maximum displacement was 8.1. The ratio of the maximum to minimum value of the maximum displacement which was caused by five jaw cycles was increased in the range from 1.02 to 1.35 with the increase of loading angles. The ratio of the maximum to minimum value of the maximum residual stress which was caused by different loading angles was increased in the range from 1.86 to 3.00 with the increase of jaw cycles. The location of the maximum stress was at the tongue side of the cervical margin at different loading angles, and the location of the maximum residual stress was distributed at different positions of the cervical margin. Most stress was accumulated at the root of the periodontal ligament under the 0° dynamic load. Conclusions The situation of the accumulated residual stresses and the uncertainties in the distribution of the maximum residual stresses should be observed in the clinical choice of mandible incisors fixed by bridge abutments; large angle force applied to the tooth was harmful to the periodontal ligament and rapid succession of chewing hard food should be avoided as much as possible during the clinical treatment.
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<p><b>OBJECTIVES</b>To investigate the expression of P120 catenin in pancreatic carcinoma and to explore the association between P120 catenin gene polymorphism at T755G position and pancreatic carcinoma.</p><p><b>METHODS</b>The expression of P120 catenin in 52 cases of pancreatic carcinoma and normal pancreatic tissues on the mRNA and protein levels were evaluated by RT-PCR and Western Blot methods respectively. P120 catenin gene polymorphism at T755G position of in 52 patients and 60 healthy controls were examined by PCR-restriction fragment length polymorphism (PCR-RFLP) technique.</p><p><b>RESULTS</b>The mRNA and protein expressions of P120 catenin in pancreatic carcinoma tissues were significantly lower than normal pancreatic tissues (P=0.000, P=0.002). Reduced expression of P120 catenin mRNA was significantly correlated with differentiated (P=0.033), lymph node metastasis (P=0.004), vascular invasion (P=0.022), and pTNM stage (P=0.003). Additionally, there were significant difference of P120 catenin gene polymorphism genotypes and alleles at T755G position between patients and healthy controls (P=0.008, P=0.016). The GG genotype of P120 catenin gene was associated with higher risk of incidence for pancreatic carcinoma compared with the TT genotype (OR=2.765, 95%CI=1.312-3.958).</p><p><b>CONCLUSIONS</b>The reduced expressions of both P120 catenin mRNA and protein in pancreatic carcinoma suggest its association with pancreatic carcinoma development. Polymorphism of P120 catenin gene at T755G situation might be a risk factor for pancreatic carcinoma, and it may be used to diagnosis and prevent pancreatic carcinoma early.</p>
Subject(s)
Female , Humans , Male , Middle Aged , Case-Control Studies , Catenins , Genetics , Metabolism , Pancreatic Neoplasms , Genetics , Metabolism , Polymorphism, GeneticABSTRACT
<p><b>OBJECTIVE</b>To analyze the surgical treatment result and clinical characteristics of hilar cholangiocarcinoma in order to improve the rate of early diagnosis and radical resection.</p><p><b>METHODS</b>Between 1986 and 2004,84 hilar cholangiocarcinoma patients underwent surgery, and their data were retrospectively reviewed.</p><p><b>RESULTS</b>According to the Bismuth-Corlette staging system, 7 were type I, 18 type II, 22 type II a, 12 type IlI b, 20 type IV and 5 unclassified. 32 patients (38.1%) had had the history of operation for cholelithiasis before or were found to have cholelithiasis simultaneously at the time of diagnosis. The rate of making correct diagnosis by ultrasound, CT and MRCP was 71.4% , 84.0% and 91.4% , respectively. Of these 84 patients, 24 (28.6%) underwent radical resection, 14 (16.7%) palliative resection and 30 (35.7%) only internal or external drainage, while 16 patients was found to have contraindication for any further surgical intervention. The overall operation rate was 81.0% (68/84) with a radical resection rate of 35.3% (24/68). The 1-, 3- and 5-year survival rates was 70.8%, 50.0% and 20.8% in the radical resection group, and 50.0%, 21.4% and 0 in the palliative resection group, respectively. There was a statistically significant difference in the survival between two groups. Whereas in the internal or external drainage group, the 1-, 3- and 5-year survival rates was 20.0% ,10.0% and 0. All of the patients who did not undergo surgical intervention died within one year.</p><p><b>CONCLUSION</b>Cholelithiasis may play an important role in the pathogenesis of hilar cholangiocarcinoma. Early diagnosis and radical resection are two important factors to improve the prognosis of hilar cholangiocarcinoma. Skeletonization of hepatoduodenal ligament with partial liver resection can improve the rate of radical resection for hilar cholangiocarcinoma.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Adenocarcinoma , Diagnosis , General Surgery , Adenocarcinoma, Mucinous , Diagnosis , General Surgery , Bile Duct Neoplasms , Diagnosis , General Surgery , Bile Ducts, Intrahepatic , Biliary Tract Surgical Procedures , Methods , Cholangiocarcinoma , Diagnosis , General Surgery , Drainage , Methods , Retrospective Studies , Survival AnalysisABSTRACT
<p><b>OBJECTIVE</b>The aim of this study is to investigate the changes of hard tissue profile in anterior-posterior and vertical direction in bimaxillary protrusion patients after orthodontic treatment.</p><p><b>METHODS</b>A total of 24 bimaxillary protrusion patients (male 8, female 16), aged from 11.2 to 29.0 (average 16.9 years old), were selected to be treated with standard edgewise technique consisted of 4 first premolars extraction. Cephalometrics were taken before and after treatment. The changes of hard tissue profile were studied using the computer-aid X-ray cephalometric analysis.</p><p><b>RESULTS</b>1. The length of the maxillary and the mandible increased significantly, but the anterior-posterior relationship of the maxillary and the mandible did not change significantly. 2. The anterior and posterior facial height increased significantly, but the ratio of anterior and posterior facial height and the angle of MP-FH which reflected the inclination of the mandible plane did not change significantly. 3. The height of the upper and lower first molar increased significantly along with the increase of the anterior and posterior facial height. 4. The height of the upper incisors increased significantly, but the height of the lower incisors decreased significantly.</p><p><b>CONCLUSION</b>The anchorage in anterior-posterior and vertical direction were controlled preferably, the patients did not manifest disadvantageous vertical growth trend.</p>