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Objective:To investigate and summarize the chest CT imaging features of patients with novel coronavirus pneumonia (COVID-19), bacterial pneumonia and other viral pneumonia.Methods:Chest CT data of 102 patients with pulmonary infection due to different etiologies were retrospectively analyzed, including 36 patients with COVID-19 admitted to Hainan Provincial People's Hospital and the Second Affiliated Hospital of Hainan Medical University from December 2019 to March 2020, 16 patients with other viral pneumonia admitted to Hainan Provincial People's Hospital from January 2018 to February 2020, and 50 patients with bacterial pneumonia admitted to Haikou Affiliated Hospital of Central South University Xiangya School of Medicine from April 2018 to May 2020. Two senior radiologists and two senior intensive care physicians were participated to evaluated the extent of lesions involvement and imaging features of the first chest CT after the onset of the disease.Results:Bilateral pulmonary lesions were more common in patients with COVID-19 and other viral pneumonia, and the incidence was significantly higher than that of bacterial pneumonia (91.6%, 75.0% vs. 26.0%, P < 0.05). Compared with other viral pneumonia and COVID-19, bacterial pneumonia was mainly characterized by single-lung and multi-lobed lesion (62.0% vs. 18.8%, 5.6%, P < 0.05), accompanied by pleural effusion and lymph node enlargement. The proportion of ground-glass opacity in the lung tissues of patients with COVID-19 was 97.2%, that of patients with other viral pneumonia was 56.2%, and that of patients with bacterial pneumonia was only 2.0% ( P < 0.05). The incidence rate of lung tissue consolidation (25.0%, 12.5%), air bronchial sign (13.9%, 6.2%) and pleural effusion (16.7%, 37.5%) in patients with COVID-19 and other viral pneumonia were significantly lower than those in patients with bacterial pneumonia (62.0%, 32.0%, 60.0%, all P < 0.05), paving stone sign (22.2%, 37.5%), fine mesh sign (38.9%, 31.2%), halo sign(11.1%, 25.0%), ground-glass opacity with interlobular septal thickening (30.6%, 37.5%), bilateral patchy pattern/rope shadow (80.6%, 50.0%) etc. were significantly higher than those of bacterial pneumonia (2.0%, 4.0%, 2.0%, 0%, 22.0%, all P < 0.05). The incidence of local patchy shadow in patients with COVID-19 was only 8.3%, significantly lower than that in patients with other viral pneumonia and bacterial pneumonia (8.3% vs. 68.8%, 50.0%, P < 0.05). There was no significant difference in the incidence of peripheral vascular shadow thickening in patients with COVID-19, other viral pneumonia and bacterial pneumonia (27.8%, 12.5%, 30.0%, P > 0.05). Conclusions:The probability of ground-glass opacity, paving stone and grid shadow in chest CT of patients with COVID-19 was significantly higher than those of bacterial pneumonia, and it was more common in the lower lungs and lateral dorsal segment. In other patients with viral pneumonia, ground-glass opacity was distributed in both upper and lower lungs. Bacterial pneumonia is usually characterized by single lung consolidation, distributed in lobules or large lobes and accompanied by pleural effusion.
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ObjectiveThe purpose of this study was to evaluate the functional outcomes and satisfaction in periprosthetic knee infection patients after above-the-knee amputation （AKA）. MethodsA review was performed in 13 patients who underwent AKA due to periprosthetic knee infection from October 2010 to August 2022， there were 7 females and 6 males with the median age of 69 （45~ 73） years. The mean number of surgical procedures between primary total knee arthroplasty and AKA was 2.9 times （range： 1 ~ 6）. Patients were segregated into non-elderly group （including patients <65 years old） and elderly group （involving patients ≥65 years old）. Functional outcomes were evaluated by SF-12 and Barthel activities daily living index （Barthel ADL index）. Patient satisfaction was accomplished through a questionnaire. ResultsFour patients died within 6 months after the amputation. Three patients received surgical procedures for recurrent infections after AKA. In the remaining 9 patients，the median time from AKA to the final follow-up was 4.2 （1.9~8.2） years， three patients received surgical procedures for recurrent infections after AKA. Patients in non-elderly group showed better functional outcomes than elderly patients after AKA （both P<0.05）. All patients in non-elderly group were fitted with a prosthesis. Whereas， elderly patients reported a better satisfaction after AKA than young patients. ConclusionYoung PJI patients seemed to have better function and ambulatory ability with high expectation and demand， which made them feel less satisfied about AKA. Meanwhile，despite poor function outcomes due to the less healthy physical condition， the alleviation of financial and psychological burdens resulting from reinfections and multiple surgeries and the less demand in function and daily activities made elderly patients have a good satisfaction after AKA.
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Objective: To examine the efficacy and safety of laparoscopic surgery for gallbladder carcinoma. Methods: The data of 197 gallbladder carcinoma patients admitted at Peking Union Medical College Hospital between January 2012 and September 2022 were analyzed retrospectively. There were 86 males and 111 females,with age of (64.4±9.8)years(range:35 to 89 years). Patients were divided into laparoscopic group(n=53) and open group(n=144) according to different surgical methods. The general information of the two groups were matched by propensity score matching,and the clinical data and prognosis were compared between the two groups. Categorical variables were analyzed using χ2 test or Fisher's exact test,as appropriate. Continuous variables with and without normal distribution were analyzed using t-test and Mann-Whitney U test,respectively. Kaplan-Meier curves with Log-rank test were used to analyze the cumulative survival rates. Results: Forty-eight pairs of patients were matched successfully. There was no difference in general information,cholecystolithiasis,partial hepatectomy,and tumor stage between two groups(all P>0.05). The laparoscopic group had shorter operation time(t=-3.987,P<0.01),less bleeding(Z=-4.862,P<0.01),shorter total(Z=-5.009,P<0.01) and postoperative(Z=-5.412,P<0.01) hospital stay. Seventeen patients had postoperative complications. According to the Clavien-Dindo system,there were 4,11,1,and 1 patient with grade Ⅰ,Ⅱ,Ⅲa,and Ⅲb,respectively. All complications were improved after active treatment. After a median follow-up of 24(36) months(range:3 to 130 months),56 patients(58.3%) survived without tumor,7 patients(7.3%) survived with tumor,and 33 patients(34.4%) died. According to the Kaplan-Meier curves,there was no significant difference between laparoscopic and open groups in disease free(χ2=0.399,P=0.528) and overall(χ2=0.672,P=0.412) survival rates. Conclusions: The laparoscopic surgery is safe and effective in selected patients with gallbladder carcinoma. It can reduce surgical trauma and enhance patient recovery without increasing complication. Its prognosis is similar to that of open surgery.
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Objective: To evaluate the short-term outcomes of non-contact low-frequency ultrasonic debridement in treating periprosthetic joint infections(PJI). Methods: The clinical data of patients with PJI who met the eligibility criteria and were treated with non-contact low-frequency ultrasonic debridement from August 2021 to January 2022 at the Department of Orthopaedics,the First Affiliated Hospital of Xinjiang Medical University were prospectively analyzed. PJI was defined according to the modified Musculoskeletal Infection Society criteria in 2016. After mechanical debridement,an 8-mm handheld non-contact low-frequency ultrasound probe was used for ultrasonic debridement in the whole surgical area at a frequency of (25±5)kHz and power of 90% for 5 minutes. Each ultrasound lasted 10 seconds with 3-second intervals. The probe was repeatedly sonicated among all soft tissue,bone interface and metal prosthesis surface(patients underwent debridement,antibiotics and implant retention (DAIR)) in the surgical area. The femoral canal of the hip joint,the distal femoral canal and the posterior capsule of the knee were fully sonicated with a special right-angle probe. Before and after ultrasonic debridement,20 ml of liquid was extracted from each operation area and injected into aerobic and anaerobic culture bottles,respectively,for pathogen culture. Harris hip score and Hospital for Special Surgery (HSS) score were used to evaluate clinical function. Treatment failure was defined as the recurrence of infection in the same joint. The patients were routinely followed up in the outpatient clinic at 1,3,and 6 months postoperatively and then annually with a deadline of August 2022. The paired t-test,rank sum,Mann-Whitney U or χ2 test was used to compare the observed data,and rates among multiple groups were compared using the Bonferroni approach. Results: A total of 45 patients were included in the study,including 21 men and 24 women with age of (65.8±15.2)years(range: 20 to 80 years) and body mass index of (29.3±4.2)kg/m2(range: 20.2 to 38.5 kg/m2). Twenty-eight patients (18 hips and 10 knees) underwent one-stage revision,and 17 cases (5 hips and 12 knees) underwent DAIR. Three of the patients (6.7%) had recurrent infections during follow-up. There were no intraoperative complications related to ultrasonic debridement (neurovascular and muscle injury,poor wound healing and fat liquefaction). Seventeen patients who received DAIR were followed for a median(M(IQR)) of 9(3) months,and two relapsed 3 weeks and 3 months post-operation,respectively. In addition,28 patients who underwent one-stage revision were followed for a median of 9(2) months,and one of the patients (3.6%,1/28) had a recurrence 6 months post-operation. The culture-positive rate of preoperative aspiration was 47.6% (20/42). The data of intraoperative soft tissue culture was 86.7% (39/45). The culture-positive rate of wound liquid before ultrasonic debridement was 46.7% (21/45). And the culture-positive rate after ultrasonic debridement was (75.6% (34/45)). After sonication,the culture-positive rate of explanted prostheses was 88.9% (40/45). There was a significant difference in culture-positive rates among all five cultures (χ2=35.483,P<0.01). Further pairwise comparison showed that the culture-positive rate of wound liquid after ultrasonic debridement was higher than that before ultrasonic debridement (χ2=7.901,P=0.005) but was not significantly different from the positive rates of other cultures (all P>0.05). The median number of colonies 24 hours after ultrasonic debridement(2 240 (1 310) CFU/ml,range: 310 to 3 140 CFU/ml) was significantly higher than that before debridement(450 (550) CFU/ml,range: 10 to 910 CFU/ml) (U=43, P=0.017). The post-operative Harris ((78.6±4.2)points,range:70.5 to 85.3 points) and HSS scores((76.4±4.8)points,range: 68.5 to 84.3 points) were significantly higher than the preoperative scores((46.0±9.8)points,range: 27.5 to 64.3 points;and (45.5±10.3)points,range: 27.6 to 63.1 points) (t=-14.6,t=-12.7;both P<0.01). Conclusions: Non-contact low-frequency ultrasonic debridement can increase the culture-positive rate and lead to a favorable short-term outcome. In addition,no complications are associated with using this new technique to treat PJI.
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Female , Humans , Male , Anti-Bacterial Agents , Debridement , Knee Joint , Orthopedic Procedures , Prospective Studies , UltrasonicsABSTRACT
Hemophilia is an X-linked recessive inherited bleeding disorder. Despite the improved treatment in recent years with the advent of replacement therapies, the progression of atherosclerosis is not slowed down after the reduction of clotting factors in hemophilia. As life expectancy increases, more hemophilia patients will suffer from age-related cardiovascular diseases. Since cardiac surgery needs heparinization and cardiopulmonary bypass (CPB), it is extremely challenging to balance hemostasis and coagulation in patients with hemophilia. Here we report three cases of hemophilia patients who underwent cardiac surgery successfully.
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Humans , Cardiac Surgical Procedures/adverse effects , Cardiopulmonary Bypass , Hemophilia A/complicationsABSTRACT
Objective: To investigate the efficacy and safety of enhanced recovery after surgery (ERAS) in perioperative management of patients with gallbladder carcinoma. Methods: The data of the patients with gallbladder carcinoma admitted at Peking Union Medical College Hospital between January 2017 and December 2021 were analyzed retrospectively. There were 69 males(42.1%) and 95 females(57.9%),with age of (64.0±10.3) years(range:37 to 89 years). Patients were divided into ERAS group(n=53) and normal group(n=111) according to whether they were treated with ERAS measures during the perioperative period.The basic characteristics of the two groups were matched by propensity score matching,and then the perioperative information was compared between the two groups. Categorical variables were presented as absolute numbers or frequencies. Differences between study groups were analyzed using χ2 test, Fisher's exact test, t-test, or Mann-Whitney U test, as appropriate. Results: Each group had 45 patients after propensity score matching with well-balanced basic characteristics. There was no difference in basic characteristics, operation time,bleeding,complication,and hospitalization expenses between two groups(all P>0.05). Compared with the normal group,time of ambulation (M(IQR)) (1(1) day vs. 2(2) days;Z=-3.839,P<0.01),postoperative anal exhaust time (2(1) days vs. 3(1) days;Z=-3.013,P=0.003),feeding time(2(1) days vs. 2(1) days;Z=-3.647,P<0.01),postoperative (5(2) days vs. 7(4) days;Z=-3.984,P<0.01) and total(8(4) days vs. 13(6) days;Z=-3.605,P<0.01) hospitalization time were shorter in ERAS group. Postoperative complications occurred in 12 patients. According to the Clavien-Dindo classification,6,4,and 2 patients were classified as grade Ⅰ,Ⅱ,and Ⅲa,respectively. Conclusion: The ERAS measures is safe and effective for perioperative management of patients with gallbladder carcinoma, enhancing patient recovery and shortening hospitalization time without increasing complication or hospitalization cost.
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Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Enhanced Recovery After Surgery , Gallbladder Neoplasms/surgery , Length of Stay , Postoperative Complications , Propensity Score , Retrospective Studies , Treatment OutcomeABSTRACT
Wound repair has always been one of the key issues of clinical concern. In recent years, negative pressure wound therapy (NPWT) has played an increasingly active role in promoting various wound repairs, not only for the treatment of common acute and chronic wounds, but also for closure of surgical incisions, preparation of wounds before skin transplantation, fixation of skin grafts after transplantation, and treatment of some complex thoracic and abdominal trauma. This review aims to summarize the clinical application of NPWT in wound treatment and the related latest research progress, and to preliminarily discuss its future development prospects.
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Humans , Negative-Pressure Wound Therapy , Skin Transplantation , Surgical Wound , Wound HealingABSTRACT
Objective:To explore the effects of metformin on the prognosis of type Ⅰ endometrial carcinoma (EC) patients complicated with type 2 diabetes mellitus (T2DM).Methods:The clinical data of 45 type Ⅰ EC patients complicated with T2DM (T2DM group) and 147 type Ⅰ EC patients without diabetes mellitus (non-diabetes group) admitted to Qilu Hospital of Shandong University from January 2010 to December 2014 were retrospectively analyzed. The type Ⅰ EC patients with T2DM were divided into two groups, metformin group ( n=23, taking metformin to control blood glucose in normal range) and non-metformin group ( n=22, taking other hypoglycemic drugs or using insulin to control blood glucose in normal range). The clinicopathological characteristics of T2DM group and non-diabetes group were compared, and the effects of metformin on the prognosis of type Ⅰ EC patients with T2DM were analyzed. Results:Compared with non-diabetes group, the type Ⅰ EC patients in T2DM group have the older onset age ( t=4.331, P<0.001), more complicated with hypertension ( χ2=19.252, P<0.001), later surgical pathological stage ( χ2=4.588, P=0.032), higher histological grade ( χ2=6.069, P=0.048), deeper myometrial infiltration ( χ2=7.743, P=0.005) and higher incidence of lymph node metastasis ( χ2=4.885, P=0.027). The median progression-free survival (PFS) (47.0 months vs. 38.0 months) and median overall survival (OS) (52.0 months vs. 41.0 months) in metformin group were significantly longer than those in non-metformin group ( χ2=10.899, P=0.001; χ2=10.090, P=0.001). There was no significant difference in median PFS (47.0 months vs. 46.0 months) and median OS (52.0 months vs. 46.0 months) between metformin group and non-diabetes group ( χ2=0.791, P=0.374; χ2=0.836, P=0.360). Cox multivariate analysis showed that the risk factors of PFS and OS in type ⅠEC patients were old onset age( OR=2.128, 95% CI: 1.361-3.328, P=0.001; OR=4.502, 95% CI: 1.696-11.954, P=0.003), late surgical pathological stage( OR=2.231, 95% CI: 1.437-3.462, P=0.001; OR=4.005, 95% CI: 1.480-10.836, P=0.006), high histological grade( P=0.001; P=0.017; G2 vs.G1: OR=5.660, 95% CI: 3.424-9.357, P=0.001; OR=5.763, 95% CI: 1.666-19.938, P=0.006), deep myometrial invasion( OR=1.531, 95% CI: 1.049-2.235, P=0.027; OR=3.759, 95% CI: 1.890-7.476, P=0.001), positive lymph node metastasis ( OR=11.277, 95% CI: 2.774-45.838, P=0.001; OR=8.451, 95% CI: 1.138-62.767, P=0.037)and T2DM ( OR=1.897, 95% CI: 1.096-3.281, P=0.008; OR=1.813, 95% CI: 1.043-3.151, P=0.012). Metformin was the protective factor of PFS ( OR=0.412, 95% CI: 0.207-0.818, P=0.002) and OS ( OR=0.455, 95% CI: 0.228-0.905, P=0.008) in type Ⅰ EC patients with T2DM. Conclusion:Complication with T2DM is the negative factor on the prognosis of type Ⅰ EC patients. Intake of metformin can significantly improve the PFS and OS of type Ⅰ EC patients complicated with T2DM and improve the prognosis.
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Objective To determine the effect of denticleless E3 ubiquitin protein ligase(DTL)on the proliferation and clone formation of multiple myeloma(MM)cells and investigate the related mechanism. Methods Mononuclear cells were extracted from 34 MM patients.Mononuclear cells harvested from 14 healthy volunteers were used as controls.Quantitative polymerase chain reaction was used to detect the change of DTL at mRNA level.Furthermore,12 MM patients and 2 controls were selected,in whom the change of DTL at protein level was detected by Western blot.Human MM cell line RPMI8226 was divided into control(CON)group and DTL-short hairpin RNA(DTL-shRNA)group,which was infected with the CON and DTL-shRNA virus,respectively,for 48 hours.The infection efficiency was detected by using flow cytometry,the knock-down efficiencies at mRNA and protein levels were detected by quantitative polymerase chain reaction and Western blot,the change of cell counts in the next 0,24,48,72,96 hours were measured with CCK8 assay.The CON and DTL-shRNA cells were cultured in semisolid medium.Ten days later,inverted phase microscopy was used to measure the number of colones that contain more than 50 cells,annexin V/propidium iodide double staining to detect apoptosis,and propidium iodide staning to detect cell cycle.Finally,Western blot was empoyed to detect the phosphorylation of P65 and inhibitory subunit-κBα(IκBα)in nuclear factor-κB(NF-κB)pathway and electrophoretic mobility shift assay(EMSA)to detect the NF-κB transcriptional ability. Results The DTL expression was(1.00±0.12)and(9.36±3.71),respectively in the bone marrow mononuclear cells of healthy volunteers and in the CD138+cells of MM patients(t=3.65,P=0.0024).DTL was also highly expressed in MM CD138+positive cells at protein level.After RPMI8226 was infected by CON and DTL-shRNA virus for 48 hours,green fluorescent protein-positive cells accounted for more than 90%.The relative expression of DTL was(1.00±0.01)and(0.21±0.04)(t=33.19,P<0.0001)at mRNA level and(0.52±0.13)and(0.11±0.02)at protein level(t=5.399,P=0.0057).CCK8 revealed that CON and DTL-shRNA cells proliferated by(1.00±0.03)vs.(1.00±0.02),(2.19±0.28)vs.(1.47±0.13),(3.50±0.14)vs.(2.24±0.19),(5.43±0.41)vs.(3.08±0.14),(7.42±0.17)vs.(4.29±013)after 0,24,48,72,and 96 hours(F=24.58,P=0.001).The number of colone containing more than 50 cells was in 76±4 in CON group and 0 in DTL-shRNA group(P<0.01).The proportion of G1 stage cells was(28.61±8.64)% in CON group and(57.25±10.37)% in DTL-shRNA group(t=3.675,P=0.0213).The proportion of annexin V+in CON and DTL-shRNA groups was(3.21±0.89)% vs.(34.71±18.68)%(t=2.895,P=0.0443).After RPMI8226 was infected with CON or DTL-shRNA virus for 48 hours,the relative expression of phosphorylation P65 was(1.52±0.14)vs.(0.82±0.11)(t=6.81,P=0.0024),the P65 relative expression was(0.25±0.04)vs.(0.24±0.08)(t=0.19,P=0.85),the CON and DTL-shRNA phosphorylation-IκBα relative expression was(0.19±0.03)vs.(0.13±0.02)(t=2.882,P=0.0449),and the IκBα was(0.22±0.05)vs.(1.01±0.06)(t=17.52,P<0.0001).Detection of the transcriptional ability of DTL-shRNA NF-κB by EMSA further confirmed the down-regulation of DTL suppressed the NF-κB transcriptional ability. Conclusions DTL is highly expressed in MM cells,and down-regulation of DTL suppresses the cell proliferation,inhibit the colony formation,and induce cell apoptosis and cell cycle arrest.The effect of DTL on the biological functions of MM cells is related to the change of NF-κB pathway.
Subject(s)
Humans , Apoptosis , Case-Control Studies , Cell Line, Tumor , Cell Proliferation , Multiple Myeloma , Pathology , NF-kappa B , Metabolism , Signal Transduction , Tumor Cells, Cultured , Ubiquitin-Protein Ligases , MetabolismABSTRACT
Plasma protein products are also called blood products. At present, more than 30 kinds of blood prod-ucts have been issued worldwide. Because of their particular source of raw materials as well as the safety, reliability and irreplaceability in the treatment of some diseases, many blood products are in short supply in the market. Rare diseases are usually caused by genetic deficiency, autoimmunity, allergy and so on, which imposes a huge burden on patients and their families. Orphan drugs generally include the products of diagnostic reagents, vaccines, medicines and medical devices used for the prevention, diagnosis and treatment of rare diseases and rare conditions. Since the adoption of the Orphan Drug Act(ODA)in the United States in 1983, many countries or regions have passed the relevant laws aiming to encourage enterprises to develop orphan drugs by means of the research funding, tax relief, priority approval and market monopoly. The pass of ODA has greatly promoted the development of related blood product enterprises. This paper sum-marizes the plasma protein products approved by the pharmaceutical regulatory departments of the United States, the Eu-ropean Union, Japan and Australia as orphans, including four categories and 18 varieties, accounting for 56% of all plas-ma protein products in the world. At present, China has not yet enacted legislation to define rare diseases and orphan drugs, which has restricted to a certain extent the development of domestic blood product enterprises. The policy divi-dends from ODA will help the development of domestic blood product enterprises and narrow the gap between the domes-tic enterprises and the international blood product giants.
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Objective To explore the current sources of stress for medical graduates, their personality characteris-tics and social support. Methods 208 postgraduates of Peking Union Medical College were surveyed by question-naire with the Graduate Student Stressor Scale, Symptom Checking List ( SCL-90) , NEO Five-Factor Inventory and Perceived Social Support Scale ( PSSS) . Results According to the five common stressors such as academic, economic, employment, physical and mental health, and tutor relationship, single-factor analysis of variance ( ANOVA) showed that there were significant differences in the composition of pressure sources between different sexes and grades. Univariate correlation analysis showed that all five dimensions of stressors had a significant posi-tive correlation with anxiety and depression symptom. There was a positive correlation between stressor and neurotic personality, and significant negative correlation with extroversion and rigorous personality. Furthermore, the stressors were significant negative correlation with perceived social support. Conclusions Medical graduate students are under various pressures at present. It is necessary to pay more attention to the education and training in the fu-ture and adopt diversified measures to rationalize them.
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Objective To evaluate the clinical feature,diagnosis,and treatment of epithelioid hemangioendothelioma(EHE).Methods Data of 30 EHE patients admitted from January 2001 to December 2017 were retrospectively analyzed. The auxiliary examinations,treatment method,pathological findings,and prognoses were analyzed.Results There were 10 male patients and 20 females aged(47.9±16.1)years. The lesions sized(5.8±2.8)cm. Seventeen cases(56.7%)were asymptomatic and 17(56.7%)had no positive sign. The most common locations of EHE were scalp and spine,followed by liver. Nineteen patients underwent surgical operation(surgery group)and 11 only accepted needle biopsy(biopsy group). EHE was pathologically confirmed in all cases. CD34 and CD31 showed the highest positive rates in immunohistochemical stains. Twenty-three cases were followed up by(74.1±56.8)months. Seventeen cases survived and 6 died. The 1-,3-,and 5-year cumulative survival rates were 95.7%,86.3%,and 73.6%,respectively. The metastasis(14.3% vs. 77.8%,P=0.007)and mortality(7.1% vs. 55.6%,P=0.018)rates were significantly lower in surgery group than in biopsy group.Conclusions EHE is a rare tumor without specific symptom or sign. It can occur in any system of the body. Diagnosis depends mainly on pathology. The prognosis is acceptable. Complete surgical resection reduces distant metastases and mortality.
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Objective To systematically review the value of ultrasonography in predicting difficult airway.Methods Databases including PubMed,Embase,Cochrane Library and CNKI were searched for trials involving the value of ultrasonography in predicting difficult airway.Outcome parameters were true positive,false positive,true negative and false negative.The pooled estimates and heterogeneity among the included studies were performed with Meta-DiSc 1.4 software.The evaluation indexes including sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic odds ratio and the 95％ confidence interval (CI) were calculated according to true positive,false positive,true negative and false negative extracted from selected studies.The receiver operating characteristic curves were plotted according to sensitivity and specificity,and the area under the curve was calculated.The overall pooled sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic odds ratio,95％ CI and area under the curve were used to assess the value of ultrasonography in predicting difficult airway.Results Nine trials involving 3 525 patients were included in this meta-analysis.The overall pooled sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and diagnostic odds ratio of the included studies were 0.69 (95％ CI 0.63-0.74),0.84 (95％ CI 0.82-0.85),5.79 (95％ Cl 3.67-9.14),0.36 (95％ CI 0.27-0.46),22.04 (95％ CI 10.68-45.45),respectively.The area under the curve was 0.89 (95％ CI 0.84-0.94).Conclusion Ultrasonography can accurately predict difficult airway.
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@# Objective Toexploretheapplicationvalueof3.0TMRIinthepreoperativestagingandassessmentof rectal cancer. Methods Data of 103 patients with rectal cancer diagnosed by biopsy was collected. The T staging, situationsofparacoliclymphaticmetastasisandfasciainvolvement,anddistanceoftumoredgetoanalvergewereestimated bypreoperativeMRI.ThestageandassessmentofpreoperativeMRIandpostoperativepathologywerecompared. Results MRIshowedthattherewere5patientswithstageT1-2,72patientswithstageT3,and26patientswithstageT4.And pathologicaldiagnosisshowedthattherewere5patientswithstageT1,16patientswithstageT2,60patientswithstageT3, and22patientswithstageT4.ThesensitivityandspecificityofstageT1-2,T3,andT4were23.8%and100%,96.7%and 67.4%,90.9%and92.6%,respectively.ResultsofMRIwerebroadlyconsonantwiththeresultsofpathology(Kappa=0.748, P＜0.01).MRIshowedthattherewere74patientswithparacoliclymphaticmetastasis.Pathologicaldiagnosisaftersurgery showedthattherewere66patientswithparacoliclymphaticmetastasis.ThesensitivityandspecificityforMRIdiagnosis were92.4%and64.9%,respectively(Kappa=0.601,P＜0.01).Amongthe18patientsreceivedanalresection,thedifferent valueofdistanceoftumoredgetoanalvergewaslessthanorequalto6mmbetweenMRIandpostoperativespecimen,with nosignificantdifference(P＞0.05).Totally65patientswithoutfasciainvolvementdiagnosedbyMRIwereconsonantwith theresultsofpostoperativepathology.Amongthe38patientswithfasciainvolvementdiagnosedbyMRI,12patientswere false-positive.Thesensitivityandspecificitywere100.0%and84.4%,respectively(Kappa=0.732, P=0.000).Conclusion 3.0TMRIcanprovideaccuratepreoperativestagingandevaluationforpatientswithrectalcancerbeforetheoperation,and helpinclinicaldiagnosisandtreatment.
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Objective To discuss the correlation between Medical basic research and clinical research papers with domestic medical institutions rank.Methods 35 medical institutions,ranked as top 5 of the comprehensive strength among seven districts in the hospital ranking list published by Fudan University,were chosen to collect all the basic medical research and clinical research papers published during 2006-2015.The publication number and compositions of such papers were analyzed to study the correlation of hospital ranking data that published latest by Fudan University in 2015.Results The ranking of domestic medical institutions was positively correlated with the published papers (both basic research papers and clinical research papers),which was negatively correlated with the proportion of basic research papers and was positively correlated with the proportion of clinical research papers,and the quality of both basic research and clinical research papers have Positive correlation,while only with the IF＞ 5 basic research class weight was positively correlated with the clinical study of Q3 partition the proportion of the paper was negatively correlated.Conclusions The scientific research management departments of domestic medical institutions should encourage clinical-front-line researchers to make full use of clinical resources to carry out clinical research and improve the proportion of clinical research papers.At the same time to encourage the publication of high-quality research papers (including:basic medical research and clinical research papers),especially high-tech zoning research papers.
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A 7-year-old female patient presented with frontal bossing and exophthalmos complicated by skin pigmentation all over the body for 7 years.Pigmentation was seen on the flexor aspects of the bilateral elbows 1 week after birth,and skin pigmentation gradually appeared at multiple body sites 1 year later.She had suffered from lacrimal duct obstruction since childhood,and repeated dredging of the duct was ineffective.Parents of the child were healthy and non-consanguineous marriage,and had no family history of the same disease.Physical examination showed square-shaped skull,frontal bossing,maxillary hypoplasia,mandibular prognathism,exophthalmos,ocular hypertelorism,depressed nasal bridge,dental malocclusion,and irregular dentition.Skin examination showed dark brown skin all over the body,coarse skin on the neck,axillary and inguinal regions,papillomatous cutaneous thickening,with velvet-like appearance.The patient was diagnosed with Crouzon syndrome complicated by acanthosis nigricans (CAN).Polymerase chain reaction (PCR)and DNA sequencing were performed to detect mutations in the FGFR3 gene in the patient with CAN,her parents and 100 unrelated healthy controls.A heterozygous missense mutation (C.1172 C ＞ A) was identified in the FGFR3 gene in the proband,but not in her parents or the 100 unrelated healthy controls.The missense mutation in the FGFR3 gene may be a causative mutation leading to the clinical manifestations of the patient.
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Objective To investigate the diagnosis and surgical treatment strategies of intravenous leiomyomatosis(IVL)extending through inferior vena cava into the right cardiac cavities. Methods Thirty patients of IVL extending through inferior vena cava into the right cardiac cavities were treated in Peking Union Medical College Hospital from November 2002 to January 2015.The following variables were studied: age,cardiopulmonary bypass time,deep hypothermic circulatory arrest time,origins of IVL,blood loss,duration of post-operative hospital stay,hospitalization expenses,edema of lower extremity,blood transfusion,postoperative complication,residual IVL,and re-grow or recurrence. Results Thirteen of 30 patients reported double lower limb edema. The cardiopulmonary bypass was applied in 27 cases,and the average duration of cardiopulmonary bypass was(106.9±53.7)min. Then,21 patients were treated with the deep hypothermic circulatory arrest,and the mean time was(28.2±11.6) min. The tumors originated from the genital veins in 9 cases,the iliac vein in 13 cases,and both veins in 8 cases. The average intra-operative blood loss volume was (2060.5±2012.3)ml,and 21 patients received blood transfusion. The average hospitalization time was(18.9±8.3)days and the average hospitalization expenses was (80 840.4±28 264.2)RMB yuan. While 14 patients had postoperative complications,there was no serious postoperative complication or death.All patients have shown a favorable outcome.Conclusions Tumor embolus extending through inferior vena cava into the right cardiac cavities should be suspected in patients with multiple hysteromyoma. Successful therapy for IVL with right cardiac cavities extension is dependent on reasonable surgical treatment strategies. Surgical removal of the ovaries is vital to avoid IVL re-grow or recurrence.
Subject(s)
Female , Humans , Cardiopulmonary Bypass , Circulatory Arrest, Deep Hypothermia Induced , Heart Neoplasms , General Surgery , Leiomyomatosis , General Surgery , Length of Stay , Neoplasm Recurrence, Local , Ovary , Postoperative Complications , Vascular Neoplasms , General Surgery , Veins , Pathology , Vena Cava, Inferior , PathologyABSTRACT
<p><b>OBJECTIVE</b>To determine the effect of medicated serum of Chinese herbal compound Naofucong (, NFC) on the microglia BV-2 cells viability and the transcription and expression of interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α) in microglia BV-2 cells to further explore the mechanisms underlying the protective effect of NFC on inflammatory process induced by high glucose.</p><p><b>METHODS</b>The microglia BV-2 cells incubated in vitro were divided into different groups: the control group (25 mmol/L glucose), the model group (75 mmol/L glucose), high glucose media containing different dose medicated serum of NFC. After being cultured for 24 h, changes in IL-6 and TNF-α were measured by quantitative real-time polymerase chain reaction and enzyme-linked immunosorbent assay. The expression of surface marker CD11b of activated microglia was measured by confocal laser scanning microscope and Western blot. Nuclear factor-κB (NF-κB) p-p65 expression was analyzed by Western blot.</p><p><b>RESULTS</b>The model group obviously increased the expression of microglial surface marker CD11b and NF-κB p-p65 (all P<0.01), induced a signifificant up-regulation of release and the mRNA expression of IL-6 and TNF-α (P<0.01 or P<0.05). The medicated serum of NFC could obviously down-regulate the transcription and expression of surface marker CD11 b and NF-κB p-p65 (all P<0.01), and inhibit the mRNA and protein expression (P<0.01 or P<0.05) of inflflammatory cytokines, such as IL-6 and TNF-α, in microglia BV-2 cells cultured with high glucose for 24 h.</p><p><b>CONCLUSIONS</b>The inhibition of microglial activation and IL-6 and TNF-α expression induced by high glucose may at least partly explain NFC therapeutic effects on diabetes-associated cognitive decline diseases. Its underlying mechanism could probably be related to the inhibition of NFC on NF-κB phosphorylation.</p>
Subject(s)
Animals , Male , Mice , Biomarkers , Metabolism , Blotting, Western , CD11b Antigen , Genetics , Metabolism , Cell Line , Cell Shape , Cell Survival , Drugs, Chinese Herbal , Pharmacology , Therapeutic Uses , Enzyme-Linked Immunosorbent Assay , Fluorescent Antibody Technique , Glucose , Toxicity , Inflammation , Drug Therapy , Pathology , Interleukin-6 , Genetics , Metabolism , Microscopy, Confocal , RNA, Messenger , Genetics , Metabolism , Rats, Wistar , Real-Time Polymerase Chain Reaction , Transcription Factor RelA , Metabolism , Tumor Necrosis Factor-alpha , Genetics , MetabolismABSTRACT
Objective To compare the safety of dexmedetomidine-versus remifentanil-based topical anesthesia for awake intubation.Methods PubMed,EMBASE,Web of Science,Cochrane Library,Chinese Biomedical Database,CNKI and Wanfang Database were searched from January 1990 to April 2016 for randomized controlled trials involving the safety of dexmedetomidine-and remifentanil-based topical anesthesia for awake intubation.The following data were extracted:the rate of successful intubation at first attempt and development of hypertension,hypotension,bradycardia,tachycardia,respiratory depression,bucking,body movement,sore throat,hoarseness and postsurgical memory of intubation.Meta-analysis was conducted using the RevMan 5.3 software.Results Ten studies involving 528 patients were included in this meta-analysis,and there were 262 cases in dexmedetonidine group and 266 cases in remifentanil group.Compared with remifentanil group,the incidence of respiratory depression and postsurgical memory of intubation were significantly decreased (P＜0.05),and no significant change was found in the rate of successful intubation at first attempt and incidence of hypertension,hypotension,bradycardia,tachycardia,bucking,body movement,sore throat and hoarseness in dexmedetomidine group (P＞0.05).Conclusion Dexmedetomidine-based topical anesthesia provides higher safety than remifentanil-based topical anesthesia when used for awake intubation.
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<p><b>OBJECTIVE</b>To investigate whether endoscopic saphenous vein harvesting (EVH )reduces leg wound morbidity and improves rehabilitation of lower extremity as compared to open vein harvesting (OVH) in patients with coronary artery disease.</p><p><b>METHODS</b>The clinical data of 333 patients who underwent isolated coronary artery bypass graft surgery (CABG) between January 2007 and December 2011 were retrospectively analyzed.These patients were divided into EVH group (n=210) and OVH group (n=123). Parameters including age,sex,with/without diabetes mellitus,leg wound complications rate,postoperative hospital stay,hospitalization expense,and vein graft patency were analyzed.</p><p><b>RESULTS</b>The age,sex,with/without diabetes mellitus were not significantly different between two groups (P>0.05). However,the incidences of leg wound complications, poor wound healing, wound infections, wound pain,wound numbness, and edema of lower extremity were significantly lower in the EVH group than the OVH group (P<0.05). The ecchymoma and deep vein thrombosis incidences were not significantly different between these two groups (P>0.05). The postoperative hospital stay showed no significant difference (P>0.05), while the hospitalization expense was significantly higher in the EVH group than in the OVH group (P<0.05). There was no statistical difference of vein graft patency (P>0.05).</p><p><b>CONCLUSION</b>The EVH system is a safe and effective alternative to OVH because it can markedly reduce postoperative leg wound morbidity and the EVH vein graft has good patency.</p>