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How to improve the performance of circulating tumor DNA (ctDNA) signal acquisition and the accuracy to authenticate ultra low-frequency mutation are major challenges of minimal residual disease (MRD) detection in solid tumors. In this study, we developed a new MRD bioinformatics algorithm, namely multi-variant joint confidence analysis (MinerVa), and tested this algorithm both in contrived ctDNA standards and plasma DNA samples of patients with early non-small cell lung cancer (NSCLC). Our results showed that the specificity of multi-variant tracking of MinerVa algorithm ranged from 99.62% to 99.70%, and when tracking 30 variants, variant signals could be detected as low as 6.3 × 10 -5 variant abundance. Furthermore, in a cohort of 27 NSCLC patients, the specificity of ctDNA-MRD for recurrence monitoring was 100%, and the sensitivity was 78.6%. These findings indicate that the MinerVa algorithm can efficiently capture ctDNA signals in blood samples and exhibit high accuracy in MRD detection.
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Humans , Carcinoma, Non-Small-Cell Lung/genetics , Lung Neoplasms/genetics , Neoplasm, Residual/pathology , Biomarkers, Tumor/genetics , Computational BiologyABSTRACT
Objective:To investigate the efficacy and safety of 125I seed implantation in the treatment of radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC). Methods:Fourteen patients (8 males, 6 females, age: (62.0±10.7) years) with RAIR-DTC confirmed by pathology or imaging examination in the Central Hospital of Wuhan, Tongji Medical College between July 2017 and March 2021, were retrospectively analyzed. The patients were treated with 125I seed implantation guided by CT. Ultrasound, CT, 125I-SPECT/CT or MRI were performed at 1.5, 3, 6 and 12 months after the implantation to evaluate the changes of lesion volume, and serum thyroglobulin (Tg), as well as symptom relief were monitored and recorded. The paired t-test was used for data analysis. Results:The 125I seeds were successfully implanted (16 operations) in 14 patients with 25 lesions. Patients were followed up for 3-44 months (median: 6.5(4.5, 11.5) months). The total effective rate was 60.0%(15/25) and the total local control rate was 96.0%(24/25). The effective rate for metastatic lymph nodes was 10/17, and the local control rate was 16/17. The effective rate and the local control rate for local recurrence were 1/3 and 3/3 respectively, and those for bone metastasis were both 3/3, those for sinus metastasis were 0/1 and 1/1 respectively, and those for lung metastasis were both 1/1. In 8 patients with clinical symptoms, symtoms of 4 cases were completely relieved, those of 3 cases were partially relieved and 1 case had no remission. The Tg level and the tumor length were both decreased after operation ((245.99±44.85) μg/L vs (330.38±50.78) μg/L, t=2.92, P=0.010; (2.71±0.34) cm vs (3.78±0.27) cm, t=3.13, P=0.007). Conclusions:125I seed implantation, as a supplementary treatment for RAIR-DTC, is safe and effective. It has a good effect against metastatic and local recurrent lesions.
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Objective:To analyze the consistency and correlation of indirect calorimetry (IC) and Harris-Benedict estimation method (H-B) in measuring energy consumption in patients with severe acute pancreatitis (SAP), as well as the characteristics of energy metabolism at resting state of SAP patients with different etiologies, and so as to guide the formulation of clinical energy nutrition support program.Methods:From February 1 to December 31, 2019, 61 SAP patients admitted into the intensive care unit of the First Affiliated Hospital of Nanchang University were enrolled. Collected relevant data of patients, such as the etiology of SAP, whether mechanical ventilation was needed, as well as the metabolic status. All SAP patients accepted IC test on the first day after admission to intensive care unit. According to the energy consumption measured by IC (hereinafter referred to as IC value) and the energy consumption measured by H-B (hereinafter referred to as H-B value), SAP patients were determined to be in high, normal or low metabolic state. Bland-Altman method and Pearson linear regression were used to analyze the consistency and correlation of the two methods in measuring energy consumption, and the linear equation was fitted. Paired t test was used for statistical analysis. Results:Among the 61 SAP patients, 13 cases were biliary SAP, 30 cases were hyperlipidemic SAP, 6 cases were alcoholic SAP, and 12 cases were SAP of other causes or unknown causes. Nineteen cases needed mechanical ventilation and 42 cases did not need mechanical ventilation. There were 70.5% (43/61) of SAP patients in high metabolic state, 13.1%(8/61) of SAP patients in normal metabolic state, and 16.4% (10/61) of SAP patients in low metabolic state. The IC value in 61 SAP patients was higher than H-B value((8 604.7±367.8) kJ/d vs. (6 491.2±133.7) kJ/d), and the difference was statistically significant ( t=5.95, P<0.001). The IC value in patients with hyperlipidemic, alcoholic and biliary SAP was (8 815.2±537.9), (7 631.2±890.5), and (8 108.0±933.1) kJ/d, respectively, and the H-B value was (6 869.6±204.5), (5 916.8±153.7), and (5 974.2±200.9) kJ/d, respectively. The IC value in patients with biliary or hyperlipidemic SAP were higher than H-B value, and the differences were statistically significant( t=2.29 and 3.38, both P<0.05). The IC value and H-B value in SAP patients with mechanical ventilation and without mechanical ventilation were (10 485.0±741.1) and (6 462.6±222.8) kJ/d, (6 595.1±364.7) and (6 503.2±166.7) kJ/d, respectively. The IC value in SAP patients with mechanical ventilation was higher than H-B value and the IC value in SAP patients without mechanical ventilation, and the differences were statistically significant ( t=4.71 and 5.20, both P<0.001). The consistency analyzed by Bland-Altman method showed that the two methods had obvious biases, and the average bias value was 92.2 kJ/d. The result of Pearson linear regression analysis indicated that there was a linear relationship between two methods ( r=0.44, P<0.001). The linear equation fitted by the univariate regression was Y=1.240 6 X+ 154.42, in which X was the H-B value and Y was the IC value. Conclusions:SAP patients are mostly in a hypermetabolic state in the early stages of the disease. The IC value is higher than H-B value, and it is recommended to use IC to measure energy consumption in SAP patients.
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Two Diaporthe species isolated from fruit of Citrus sinensis in China were characterized based on morphology and multilocus phylogeny of ITS, tef1, and tub2 gene sequences. The phylogeny indicated that the two species match Diaporthe taoicola and D. siamensis. A critical examination of phenotypic characteristics confirmed the phylogenetic results. Diaporthe taoicola was morphologically characterized by producing Alpha conidia with tapering toward both ends. Meanwhile, D. siamensis produced cylindrical or ellipsoidal Alpha conidia with two oil drops. Pathogenicity tests revealed that both species were pathogenic to fruit of C. sinensis. To our knowledge, the two species were firstly reported on Citrus sinensis in China.
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Two Diaporthe species isolated from fruit of Citrus sinensis in China were characterized based on morphology and multilocus phylogeny of ITS, tef1, and tub2 gene sequences. The phylogeny indicated that the two species match Diaporthe taoicola and D. siamensis. A critical examination of phenotypic characteristics confirmed the phylogenetic results. Diaporthe taoicola was morphologically characterized by producing Alpha conidia with tapering toward both ends. Meanwhile, D. siamensis produced cylindrical or ellipsoidal Alpha conidia with two oil drops. Pathogenicity tests revealed that both species were pathogenic to fruit of C. sinensis. To our knowledge, the two species were firstly reported on Citrus sinensis in China.
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BACKGROUND@#Patients with N2 stage non-small cell lung cancer have prognostic heterogeneity, and this study attempted to explore the prognostic factors among those patients.@*METHODS@#Patients with N2 stage undergoing radical resection in Department of Thoracic Surgery, West China hospital, Sichuan University between January 2007 and December 2016 were included. Cox proportional hazard regression model was used to explore the prognostic value of clinicopathological features. Survival curves were plotted by Kaplan-Meier method. Subgroup analyses considering the situation of lymph node involvement were performed.@*RESULTS@#In total, 773 patients were included. The median follow-up time was 57.2 months, and the 5-year overall survival rate was 34.8%. Tumor-node-metastasis (TNM) stage, number of involved lymph node stations, skip metastasis, lymphatic or vascular invasion and adjuvant chemotherapy were independent prognostic factors. The patients with stage T1-3 had similar prognosis, while the patients with stage T4 had worse survival. In addition, the patients with single station involvement and skip metastasis had the best prognosis with a 5-years overall survival rate of 48.9%.@*CONCLUSIONS@#T4 stage patients had worse survival in N2 group. To get a more precisely stratification, skip metastasis and number of involved lymph node stations should be considered in future N stage classification.
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Objective@#To estimate the incidence, mortality and characteristics of cancer in Pearl River Delta Area of Guangdong Province between 2009-2013.@*Methods@#Based on five population-based cancer registration data from Guangzhou, Shenzhen, Zhongshan, Jiangmen and Sihui spanning from 2009 to 2013, along with those corresponding population data, the incidence and mortality rates were estimated by gender and age groups. Chinese standard population derived from the 2000 Population Census and Segi′s standard population were used for age-standardized incidence and mortality rates.@*Results@#Between 2009 and 2013, the crude cancer incidence rate was 262.50/100 000, 274.76/100 000 in male and 249.49/100 000 in female. After adjusting for Chinese and Segi′s standard population, the age-standardized incidence rates were 225.63/100 000 and 219.88/100 000, respectively. The crude mortality rate was 175.51/100 000, 222.92/100 000 in male and 127.46/100 000 in female, respectively. After adjusting for Chinese and Segi′s standard population, the age-standardized mortality rates were 116.02 /100 000 and 114.31/100 000, respectively. The incidence rates were at low levels in the population less than 40 years old, thereafter went up rapidly with age especially in male, and then reached the peak in the population aged 80 and above. As with incidence, the mortality rates kept at low levels in the population before their 50 s and then rose up steadily with age until peaking in the 85+ age group. The most common cancers were female breast cancer, lung cancer, colorectal cancer, liver cancer and nasopharyngeal cancer with descending incidence rate. Lung cancer, liver cancer, colorectal cancer, female breast cancer and nasopharyngeal cancer were the top five cancer-attributable causes of death.@*Conclusions@#Currently, Pearl River Delta Area were faced with huge cancer burden. Lung cancer, colorectal cancer, nasopharyngeal cancer, female breast cancer and male liver cancer are predominant cancers and more efforts should be made to fight against them.
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Objective To clarify the accuracy of APACHEⅡ, Ranson, BISAP and CTSI scoring systems for predicting the progression of mild acute pancreatitis ( MAP ) to moderate acute pancreatitis ( MSAP) and severe acute pancreatitis ( SAP ) , and death risk of patients with acute pancreatitis ( AP ) . Methods All data from 2080 consecutive adult patients who were admitted within 3 days of disease onset were selected from AP database between 2014 and 2017. The severity was classified according to the revised Atlanta classification systems. Patients who died during hospitalization or discharged automatically were defined as patients at risk of death. The predictive accuracies for MSAP, SAP and death risk were compared using receiver operating characteristic ( ROC) curves. Results The 2080 patients with AP were divided into MAP (n=857, 41. 2％), MSAP ( n =892, 42. 9％), and SAP ( n =331, 15. 9％) according to the revised Atlanta classification system. ROC curve analysis showed APACHEⅡ score, Ranson score, BISAP score and the CT severity index ( CTSI) had no predictive value for MSAP, but have predictive value for SAP and death risk. APACHEⅡ score had the highest accuracy in predicting SAP with area under the curve ( AUC) values of 0. 785 and 0. 746 on the 1st and 2nd day after admission, respectively, and the APACHEⅡscore on admission day 1 had the highest accuracy in predicting death risk (AUC =0. 845). Conclusions Various scoring systems had predictive value only for SAP and death risk, and APACHEⅡ score had the highese accuracy in predicting SAP and death risk.
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Objective To compare the clinical effect between percutaneous nephrolithotomy (PCNL) and retroperitoneal laparoscopic pyelolithotomy (RLP) in the treatment of renal pelvis calculus,so as to provide evidence for the treatment of renal pelvis calculus.Methods A total of 108 patients with renal pelvis calculus were selected from January 2012 to December 2016 in Zhumadian Central Hospital.The patients were divided into PCNL group (n =59) and RLP group (n =49) according to the therapeutic method.The operation time,intraoperative blood loss,intraoperative blood transfusion rate,operative success rate,stone clearance rate,postoperative hemoglobin reduction,postoperative analgesia time,postoperative hospitalization time and the incidence of complications were compared between the two groups.Results The success rate of operation in PC-NL group and RLP group was 94.9％ (56/59) and 100.0％ (49/49) respectively,there was no significant difference in the success rate of operation between the two groups (x2 =1.026,P ＞ 0.05).The stone clearance rate in PCNL group and RLP group was 94.9％ (56/59) and 98.0％ (48/49) respectively,there was no significant difference in the stone clearance rate between the two groups (x2 =0.140,P ＞ 0.05).The intraoperative blood transfusion rate in PCNL group and RLP group was 5.1％ (3/59) and 2.0％ (1/49) respectively,there was no significant difference in the intraoperative blood transfusion rate between the two groups (x2 =0.105,P ＞ 0.05).There was no significant difference in operation time and postoperative analgesia time between the two groups (P ＞ 0.05).Compared with the PCNL group,the blood loss and postoperative hemoglobin reduction were less,and the postoperative hospitalization time was shorter in the RLP group (P ＜ 0.05).The incidence of postoperative urinary leakage,urinary tract infection and secondary hemorrhage in PCNL group was 3.4％ (2/59),8.5％ (5/59)and 6.8％ (4/59) respectively;the incidence of postoperative urinary leakage,urinary tract infection and secondary hemorrhage in RLP group was 8.2％ (4/49),4.1％ (2/49) and 4.1％ (2/49) respectively;there was no significant difference in the incidence of postoperative urinary leakage,urinary tract infection and secondary hemorrhage between the two groups (x2 =2.975,1.064,1.811;P ＞ 0.05).Conclusion The clinical effect of PCNL and RLP in the treatment of renal pelvis calculus is fairly,and their safety is high.However,RLP has the advantages of less intraoperative bleeding,quick postoperative recovery and short hospitalization time.
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Objective To observe the changes of potassium ion (K+), lactic acid (Lac) and glucose (Glu) in swine with traumatic hemorrhagic shock (THS) inside the dry-heat environment and to explore its possible mechanism. Methods A total of 40 local Landrace piglets were randomly(random number) divided equally into 4 groups: the normal temperature sham operation group (NS), the normal temperature traumatic hemorrhagic shock group (NTHS), the dry-heat sham operation group (DS group) and the dry-heat traumatic hemorrhagic shock group (DTHS). The experiment was carried out in the artifi cia climate cabin simulated the special environment of northwest of China. After exposed to their respective environment[dry-heat environment: (40.5±0.5), plus(10±2)% humidity; normal temperature environment: (25±0.5), plus(35±5)% humidity] for 3 h. Laparotomy were performed in swine of all groups, and then splenectomy and partial hepatectomy were performed only in NTHS and DTHS. The process of exsanguination from the external iliac artery was established to make the MAP reaching to 40-50 mmHg, and thus the traumatic hemorrhagic shock model of swine was successfully made. Blood samples were collected from external iliac artery at different intervals including the time just after exposure for 3 h and the successful establishment of traumatic hemorrhagic shock model (0 h) and then every 30 min after 0 h, serum levels of K+, Lac and Glu were detected. The features of varied serum K+, Lac and Glu were observed in each group. All data were statistically analyzed using One-way ANOVA and Pearson correlation analysis. Results After exposed , the level of serum K+inside the dry-heat environment was higher than that of swine inside the normal temperature group ( P<0.01), however the Glu level was lower in the swine inside dry-heat environment than that of swine inside the normal temperature ( P<0.01).The level of serum K+and Lac of DTHS group were rapidly increased from the establishment of the model to the death in about 3 h, while those of NTHS group were increased slowly. The level of K+and Lac were positively correlated in the two groups amd the correlation coeffi cient were rDTHS=0.927 (P<0.01) and rNTHS=0.539 (P<0.01),respectively. The level of Glu was progressively decrease in DTHS group, while in NTHS group, it was not noticeable. The level of K+and Glu were negatively correlated in the two group, the correlation coeffi cient were rDTHS=-0.804 (P<0.01) and rNTHS=0.420 (P<0.01),respectively. Conclusions The changes of serum K+, Lac and Glu occurred sooner and more obvious in traumatic hemorrhagic shock models inside dry heat environment (DTHS) group than those in NTHS group. The level of serum K+positively correlated with Lac, however, negatively correlated with Glu, which suggested that hyperkalemia and acidosis should be paid more attention to the treatment of traumatic hemorrhagic shock inside the dry heat environment, and the hypoglycemia should be treated at the same time.
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SIRT is a family of highly conserved nicotine adenine dinucleotide ( NAD+)-dependent protein deacetylase which regulates several processes including cell gene stability , metabolism , aging and apoptosis . Studies have shown that SIRT has protective effects on intestinal barrier , which influences the structure and function of intestinal barrier by controlling the release of inflammatory cytokines , regulating the expression of tight junction protein in intestinal epithelial , and changing the number of Paneth and goblet cells in the intestine .
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Sudden sensorineural hearing loss (SSHL),which is a common and frequently encountered disease,is considered to be a medical emergency in otolaryngology.The prevalence of SSHL is increasing in China.The pathogenesis of SSHL is not clear yet.Microcirculatory disorder of inner ear is considered as one of the most important causes of SSHL.In recent years,several reports have found the levels of serum lipids were changed in patients affected by SSHL.The relationship between SSHL and serum lipids was reviewed to provide new ideas for the diagnosis and treatment of SSHL.
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Heatstroke is a critical disease which usually catches in the hot environment in summer and abundant exercise that could bring about multiple organ dysfunction.The process of the occurrence and development of heatstroke includes of the compensatory phase,acute reaction stage and decompensation stage.The recent researches have shown that the mechanism of liver injury induced by heatstroke might be related to the direct action of heat,mitochondrial dysfunction in liver cells and cascade of inflammatory response,and each link promoted each other,finally caused liver injury.In addition,a cascade of inflammatory responses in the hepatic sinusoid might play a predominant role in liver injury induced by heatstroke.This paper aims to review the mechanism of liver damage caused by heatstroke in terms of the physiology and pathology,so as to provide perspectives for clinical prevention and treatment of liver injury.
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Objective To investigate the therapeutic effect of levosimendan on acute decompensated heart failure and its effect on SDNN and SDANN values.MethodsThe clinical data of patients with acute decompensated heart failure treated in Zhejiang Greentown Cardiovascular Hospital from January 2014 to August 2016 were retrospectively analyzed.According to their treatment methods, they were divided into control group and observation group.There were 49 cases in the control group and 71 cases in the observation group.The control group was given conventional drug treatment, the observation group was given levosimendan treatment on the basis of the control group.The therapeutic effects of the two groups were observed.The difference of cardiac function, SDNN, SDANN value and adverse reaction between the two groups were compared before and after treatment.ResultsAfter treatment, the observation group efficiency was 98.59%, significantly higher than the control group;the observation group LAD, RAD, LVESD, LVEDD and BNP lower than the control group, the level of LVEF was higher than the control group, the difference was statistically significant (P<0.05);the observation group SDNN, SDANN, RMSSD and PNN50 (%) was higher than that of the control group, the difference was statistically significant (P<0.05).ConclusionLevosimendan has good therapeutic effect on acute decompensated heart failure, can significantly improve the level of SDNN, SDANN, and the incidence of adverse reactions is low.
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Objective To investigate curative efficacy of ginkgo biloba extract dripping pills in treatment of acute coronary syndrome(ACS) after percutaneous coronary intervention(PCI) and its effects on platelet aggregation rate(PAR), activated clotting time(ACT) and antithrombin(AT)Ⅲ. Methods 90 patients of ACS treated with PCI who received therapy from January 2014 to October 2016 in Zhejiang green town cardiovascular hospital were selected and randomly divided into the observation group and the control group , 45 cases in each group.The control group was treated with routine treatment after PCI, while the observation group was combined with ginkgo biloba extract dripping pills.After treatment of seven days, the changed of PAR, ACT, ATⅢ and adverse cardiovascular events were compared, after treatment three months, the seattle angina scale were compared. Results After treatment, the levels of PAR in the observation group were significantly lower than that of the control group, and the levels of ACT and ATⅢ were significantly higher than that of the control group, the difference was statistically significant (P<0.05), the total incidence of adverse cardiovascular events in the observation group was significantly lower than that of the control group , the difference was statistically significant ( P<0.05), in the seattle angina scale, the scores of stable state of angina pectoris, the attack of angina pectoris, physical activity limitation, treatment satisfaction in the observation group were significantly better than that of the control group, the difference was statistically significant (P<0.05). Conclusion Ginkgo biloba extract dripping pill is well for ACS after PCI, which can effectively relieve clinical symptoms, to improve the expression of PAR, ACT and ATⅢ, helps to reduce the incidence of adverse cardiovascular events.
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Based on the dominant fluctuation rates, the speech information in temporal domain could be divided into temporal envelope, periodic fluctuation information and temporal fine structure. Temporal envelope cues are essential for speech recognition, which could be transmitted to cochlear implanters by cochlear imlpants. The roles of temporal envelope cues from various frequency regions in speech recognition are diverse. Influenced by the testing materials, research methods, listening backgrounds and the parameters used to extract temporal envelope, the relative weights of temporal envelope across frequency regions would change accordingly. The research methods as well as their advantages or disadvantages and research results of relative weights of temporal envelope cues in different frequency regions are reviewed, and the possible reasons why the relative weights of temporal envelope cues in different frequency regions for non-tonal language and tonal language were different were discussed simply.
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Objective To investigate the clinical therapeutic effects of lung protective ventilation and sequential recruitment maneuver (RM) on treatment of patients with severe acute pancreatitis (SAP) complicated with acute respiratory distress syndrome (ARDS). Methods Sixty patients with SAP complicated with ARDS admitted to the Department of Critical Care Medicine of the First Affiliated Hospital of Nanchang University from April 2014 to March 2016 were enrolled. They were divided into control group and experimental group by random number table, 30 patients in each group. On the basis of comprehensive treatment, the patients in control group were treated with lung protective ventilation mode: low tidal volume ventilation (6 mL/kg) + optimal end-expiratory positive pressure (PEEP) ventilation mode, when the intra-abdominal pressure (IAP) was essentially returned to a normal level (Ⅰ grade intra-abdominal hypertension), the patients in experimental group were treated by the combination with RM therapy, and the rest treatment was the same as the control group. Under the two types of ventilation strategies, the clinical effects, respiratory mechanics, hemodynamics and arterial blood gas indexes were compared between the two groups. Results The mechanical ventilation time (days: 13.82±4.40 vs. 19.87±7.40), the length of ICU stay (days:22.67±4.40 vs. 26.43±5.39) and incidence of ventilator associated pneumonia [VAP: 16.67% (5/30) vs. 26.67% (8/30)] of the experimental group were lower than those of the control group (all P < 0.05), the mortality rate of the experimental group was slightly lower than that of the control group [26.67% (8/30) vs. 30.00% (9/30)] without statistical significance (P > 0.05). Plateau pressure (Pplat) and the peak airway pressure (PIP) at each time point were decreased after treatment in both groups, while the static lung compliance (Cst), the arterial partial pressure of oxygen (PaO2) and oxygenation index (PaO2/FiO2) were increased compared with those before treatment, especially the changes at 72 hours after recruitment in the experimental group were more significant than those in the control group [Pplat (cmH2O, 1 cmH2O = 0.098 kPa):15.6±4.0 vs. 21.2±5.6, PIP (cmH2O): 18.3±5.0 vs. 25.1±5.4, Cst (mL/cmH2O): 41.2±4.8 vs. 31.2±6.0, PaO2 (mmHg, 1 mmHg = 0.133 kPa): 90.93±6.45 vs. 80.27±4.51, PaO2/FiO2 (mmHg): 238.33±18.31 vs. 185.83±11.14]. Heart rate [HR (bpm): 110.23±7.92 vs. 98.23±8.44] and the central venous pressure [CVP (mmHg): 8.62±1.52 vs. 6.32±1.42] were significantly higher than those before treatment, the mean arterial pressure [MAP (mmHg): 86.74±7.65 vs. 94.92±10.93] and cardiac output [CO (L/min): 5.32±1.36 vs. 6.42±1.32] were significantly reduced compared with those before treatment (all P < 0.05). The values of HR, MAP, CVP, CO at 5 minutes after recruitment were (97.87±5.77) bpm, (94.54±6.87) mmHg, (6.33±1.44) mmHg, (6.32±1.41) L/min, respectively. The changes of these parameters were not significant when compared with those of the basal conditions (P > 0.05) Conclusions Based on the lung protective ventilation in the early stage, sequential RM is applied in treatment of patients with SAP complicated with ARDS, after the IAP is essentially returned to a normal, which is beneficial to improving lung compliance, promoting oxygenation, shortening the time of mechanical ventilation, reducing the length of ICU stay, and decreasing the incidence of VAP without any obvious hemodynamic influence.
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Objective To investigate the clinical therapeutic effects of lung protective ventilation and sequential recruitment maneuver (RM) on treatment of patients with severe acute pancreatitis (SAP) complicated with acute respiratory distress syndrome (ARDS). Methods Sixty patients with SAP complicated with ARDS admitted to the Department of Critical Care Medicine of the First Affiliated Hospital of Nanchang University from April 2014 to March 2016 were enrolled. They were divided into control group and experimental group by random number table, 30 patients in each group. On the basis of comprehensive treatment, the patients in control group were treated with lung protective ventilation mode: low tidal volume ventilation (6 mL/kg) + optimal end-expiratory positive pressure (PEEP) ventilation mode, when the intra-abdominal pressure (IAP) was essentially returned to a normal level (Ⅰ grade intra-abdominal hypertension), the patients in experimental group were treated by the combination with RM therapy, and the rest treatment was the same as the control group. Under the two types of ventilation strategies, the clinical effects, respiratory mechanics, hemodynamics and arterial blood gas indexes were compared between the two groups. Results The mechanical ventilation time (days: 13.82±4.40 vs. 19.87±7.40), the length of ICU stay (days:22.67±4.40 vs. 26.43±5.39) and incidence of ventilator associated pneumonia [VAP: 16.67% (5/30) vs. 26.67% (8/30)] of the experimental group were lower than those of the control group (all P < 0.05), the mortality rate of the experimental group was slightly lower than that of the control group [26.67% (8/30) vs. 30.00% (9/30)] without statistical significance (P > 0.05). Plateau pressure (Pplat) and the peak airway pressure (PIP) at each time point were decreased after treatment in both groups, while the static lung compliance (Cst), the arterial partial pressure of oxygen (PaO2) and oxygenation index (PaO2/FiO2) were increased compared with those before treatment, especially the changes at 72 hours after recruitment in the experimental group were more significant than those in the control group [Pplat (cmH2O, 1 cmH2O = 0.098 kPa):15.6±4.0 vs. 21.2±5.6, PIP (cmH2O): 18.3±5.0 vs. 25.1±5.4, Cst (mL/cmH2O): 41.2±4.8 vs. 31.2±6.0, PaO2 (mmHg, 1 mmHg = 0.133 kPa): 90.93±6.45 vs. 80.27±4.51, PaO2/FiO2 (mmHg): 238.33±18.31 vs. 185.83±11.14]. Heart rate [HR (bpm): 110.23±7.92 vs. 98.23±8.44] and the central venous pressure [CVP (mmHg): 8.62±1.52 vs. 6.32±1.42] were significantly higher than those before treatment, the mean arterial pressure [MAP (mmHg): 86.74±7.65 vs. 94.92±10.93] and cardiac output [CO (L/min): 5.32±1.36 vs. 6.42±1.32] were significantly reduced compared with those before treatment (all P < 0.05). The values of HR, MAP, CVP, CO at 5 minutes after recruitment were (97.87±5.77) bpm, (94.54±6.87) mmHg, (6.33±1.44) mmHg, (6.32±1.41) L/min, respectively. The changes of these parameters were not significant when compared with those of the basal conditions (P > 0.05) Conclusions Based on the lung protective ventilation in the early stage, sequential RM is applied in treatment of patients with SAP complicated with ARDS, after the IAP is essentially returned to a normal, which is beneficial to improving lung compliance, promoting oxygenation, shortening the time of mechanical ventilation, reducing the length of ICU stay, and decreasing the incidence of VAP without any obvious hemodynamic influence.
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Objective To compare the discrepancy between the new (2012) and the old (1992) Atlanta classification criteria for defining severity, organ failure and local complications in patients with acute pancreatitis (AP).Methods Demographic, clinical and laboratory data of 2 305 consecutive AP patients with onset less than 3 days, were collected between January 2005 to December 2013 in the First Affiliated Hospital of Nanchang University.Severity, organ failure and pancreatic local complications were respectively classified by the old Atlanta classification and the new revised Atlanta classification.Multi-factor scoring system and single serum marker were recorded and calculated using the acute pancreatitis database.Results In 2 305 patients with AP, there were 301 cases (13.1％) diagnosed with acute respiratory failure, 136 cases (5.9％) with shock, 105 cases (4.6％) with acute renal failure, 296 cases (12.8％) with gastrointestinal bleeding, based on the old Atlanta classification criteria.According to the severity, 900 cases (39.0％) were classified as mild acute pancreatitis (MAP), 1 405 cases (61.0％) as severe acute pancreatitis (SAP).However, based on the new Atlanta classification criteria, there were 686 cases (29.8％) with acute respiratory failure, 129 cases (5.6％) with acute renal failure, 107 cases (4.6％) with circulatory failure.Consequently, 998 cases (43.3％) were classified as MAP, 937 cases (40.7％) as moderately severe acute pancreatitis (MSAP), 370 cases (16.1％) as SAP.The incidence of respiratory failure was lower than that of the old standard.In SAP patients by new criteria, the discharge rate in critical condition and mortality were not only higher than those in MSAP patients (17.0％ vs 4.1％, 4.1％ vs 1.5％, respectively , all P ＜ 0.001), but also higher than those in SAP patients by the old classification (17.0％ vs 7.2％ ,4.1％ vs 2.1％, all P ＜ 0.001).Conclusions The diagnostic criteria of organ failure are different between the new and old Atlanta classification.The SAP patients classified by the new standard have worse outcome than those by the old standard.More attention needs to be paid to critical patients stratified by the new standard.
ABSTRACT
Estrogen receptor (ER) and progesterone receptor (PR) are two important members of steroid receptors family, an evolutionarily conserved family of transcription factors. Upon binding to their ligands, ER and PR enter cell nucleus to interact with specific DNA element in the context of chromatin to initiate the transcription of diverse target genes, which largely depends on the timely recruitment of a wide range of cofactors. Moreover, the interactions between steroid hormones and their respective receptors also trigger post-translational modifications on these receptors to fine-tune their transcriptional activities. Besides the well-known phosphorylation modifications on tyrosine and serine/threonine residues, recent studies have identified several other covalent modifications, such as ubiquitylation and sumoylation. These post-translational modifications of steroid receptors affect its stability, subcellular localization, and/or cofactor recruitment; eventually influence the duration and extent of transcriptional activation. This review is to focus on the recent research progress on the transcriptional activation of nuclear ER and PR as well as their physiological functions in early pregnancy, which may help us to better understand related female reproductive diseases.