Efficacy of partial nephrectomy in patients with localized renal carcinoma: a 20-year experience of 2 046 patients in a single center / 中华外科杂志

Objectives: To analyze the long-term survival of patients with localized renal cell carcinoma after partical nephrectomy. Methods: The clinicopathological records and survival follow-up data of 2 046 patients with localized renal cell carcinoma, who were treated with partial nephrectomy from August 2001 to February 2021 in the Department of Urology, Sun Yat-sen University Cancer Center, were retrospectively analyzed. There were 1 402 males and 644 females, aged (M(IQR)) 51 (19) years (range: 6 to 86 years). The primary end point of this study was cancer-specific survival. Survival curves were estimated using the Kaplan-Meier method, and the difference test was performed by Log-rank test. Univariate and multivariate Cox analysis were fitted to determine factors associated with cancer-specific survival. Results: The follow-up time was 49.2 (48.0) months (range: 1 to 229 months), with 1 974 patients surviving and 72 dying. The median cancer-specific survival time has not yet been reached. The 5- and 10-year cancer specific survival rates were 97.0% and 91.2%, respectively. The 10-year cancer-specific survival rates for stage pT1a (n=1 447), pT1b (n=523) and pT2 (n=58) were 95.3%, 81.8%, and 81.7%, respectively. The 10-year cancer-specific survival rates of patients with nuclear grade 1 (n=226), 2 (n=1 244) and 3 to 4 (n=278) were 96.6%, 89.4%, and 85.5%, respectively. There were no significant differences in 5-year cancer-specific survival rates among patients underwent open, laparoscopic, or robotic surgery (96.7% vs. 97.1% vs. 97.5%, P=0.600). Multivariate analysis showed that age≥50 years (HR=3.93, 95%CI: 1.82 to 8.47, P<0.01), T stage (T1b vs. T1a: HR=3.31, 95%CI: 1.83 to 5.99, P<0.01; T2+T3 vs. T1a: HR=2.88, 95%CI: 1.00 to 8.28, P=0.049) and nuclear grade (G3 to 4 vs. G1: HR=2.81, 95%CI: 1.01 to 7.82, P=0.048) were independent prognostic factors of localized renal cell carcinoma after partial nephrectomy. Conclusions: The long-term cancer-specific survival rates of patients with localized renal cancer after partial nephrectomy are satisfactory. The type of operation (open, laparoscopic, or robotic) has no significant effect on survival. However, patients with older age, higher nuclear grade, and higher T stage have a lower cancer-specific survival rate. Grasping surgical indications, attaching importance to preoperative evaluation, perioperative management, and postoperative follow-up, could benefit achieving satisfactory long-term survival.

Establishment and validation of a novel nomogram to predict overall survival after radical nephrectomy / 中华肿瘤杂志

Objective: To establish a nomogram prognostic model for predicting the 5-, 10-, and 15-year overall survival (OS) of non-metastatic renal cell carcinoma patients managed with radical nephrectomy (RN), compare the modelled results with the results of pure pathologic staging, the Karakiewicz nomogram and the Mayo Clinic Stage, Size, Grade, and Necrosis (SSIGN) score commonly used in foreign countries, and stratify the patients into different prognostic risk subgroups. Methods: A total of 1 246 non-metastatic renal cell carcinoma patients managed with RN in Sun Yat-sen University Cancer Center (SYSUCC) from 1999 to 2020 were retrospectively analyzed. Multivariate Cox regression analysis was used to screen the variables that influence the prognosis for nomogram establishment, and the bootstrap random sampling was used for internal validation. The time-receiver operating characteristic curve (ROC), the calibration curve and the clinical decision curve analysis (DCA) were applied to evaluate the nomogram. The prediction efficacy of the nomogram and that of the pure pathologic staging, the Karakiewicz nomogram and the SSIGN score was compared through the area under the curve (AUC). Finally, patients were stratified into different risk subgroups according to our nomogram scores. Results: A total of 1 246 patients managed with RN were enrolled in this study. Multivariate Cox regression analysis showed that age, smoking history, pathological nuclear grade, sarcomatoid differentiation, tumor necrosis and pathological T and N stages were independent prognostic factors for RN patients (all P<0.05). A nomogram model named SYSUCC based on these factors was built to predict the 5-, 10-, and 15-year survival rate of the participating patients. In the bootstrap random sampling with 1 000 iterations, all these factors occurred for more than 800 times as independent predictors. The Harrell's concordance index (C-index) of SYSUCC was higher compared with pure pathological staging [0.770 (95% CI: 0.716-0.823) vs 0.674 (95% CI: 0.621-0.728)]. The calibration curve showed that the survival rate as predicted by the SYSUCC model simulated the actual rate, while the clinical DCA showed that the SYSUCC nomogram has a benefit in certain probability ranges. In the ROC analysis that included 857 patients with detailed pathological nuclear stages, the nomogram had a larger AUC (5-/10-year AUC: 0.823/0.804) and better discriminating ability than pure pathological staging (5-/10-year AUC: 0.701/0.658), Karakiewicz nomogram (5-/10-year AUC: 0.772/0.734) and SSIGN score (5-/10-year AUC: 0.792/0.750) in predicting the 5-/10-year OS of RN patients (all P<0.05). In addition, the AUC of the SYSUCC nomogram for predicting the 15-year OS (0.820) was larger than that of the SSIGN score (0.709), and there was no statistical difference (P<0.05) between the SYSUCC nomogram, pure pathological staging (0.773) and the Karakiewicz nomogram (0.826). The calibration curve was close to the standard curve, which indicated that the model has good predictive performance. Finally, patients were stratified into low-, intermediate-, and high-risk subgroups (738, 379 and 129, respectively) according to the SYSUCC nomogram scores, among whom patients in intermediate- and high-risk subgroups had a worse OS than patients in the low-risk subgroup (intermediate-risk group vs. low-risk group: HR=4.33, 95% CI: 3.22-5.81, P<0.001; high-risk group vs low-risk group: HR=11.95, 95% CI: 8.29-17.24, P<0.001), and the high-risk subgroup had a worse OS than the intermediate-risk group (HR=2.63, 95% CI: 1.88-3.68, P<0.001). Conclusions: Age, smoking history, pathological nuclear grade, sarcomatoid differentiation, tumor necrosis and pathological stage were independent prognostic factors for non-metastasis renal cell carcinoma patients after RN. The SYSUCC nomogram based on these independent prognostic factors can better predict the 5-, 10-, and 15-year OS than pure pathological staging, the Karakiewicz nomogram and the SSIGN score of patients after RN. In addition, the SYSUCC nomogram has good discrimination, agreement, risk stratification and clinical application potential.

Long-term survival analysis of 1 367 patients treated with radical nephrectomy from a single center / 中华肿瘤杂志

Objective: To report the long-term survival of renal cell carcinoma (RCC) patients treated with radical nephrectomy in Sun Yat-sen University Cancer Center. Methods: We retrospectively analyzed the clinical, pathological and follow-up records of 1 367 non-metastatic RCC patients treated with radical nephrectomy from 1999 to 2020 in this center. The primary endpoint of this study was overall survival rate. Survival curves were estimated using the Kaplan-Meier method, and group differences were compared through Log-rank test. Univariate and multivariate Cox analysis were fit to determine the clinical and pathological features associated with overall survival rate. Results: A total of 1 367 patients treated with radical nephrectomy with complete follow-up data were included in the study. The median follow-up time was 52.6 months, and 1 100 patients survived and 267 died, with the median time to overall survival not yet reached. The 5-year and 10-year overall survival rates were 82.8% and 74.9%, respectively. The 5-year and 10-year overall survival rates of Leibovich low-risk patients were 93.3% and 88.2%, respectively; of Leibovich intermediate-risk patients were 82.2% and 72.3%, respectively; and of Leibovich high-risk patients were 50.5% and 30.2%, respectively. There were significant differences in the long-term survival among the three groups (P<0.001). The 10-year overall survival rates for patients with pT1, pT2, pT3 and pT4 RCC were 83.2%, 73.6%, 55.0% and 31.4%, respectively. There were significant differences among pT1, pT2, pT3 and pT4 patients(P<0.001). The 5-year and 10-year overall survival rates of patients with lymph node metastasis were 48.5% and 35.6%, respectively, and those of patients without lymph node metastasis were 85.1% and 77.5%, respectively. There was significant difference in the long-term survival between patients with lymph node metastasis and without lymph node metastasis. The 10-year overall survival rate was 96.2% for nuclear Grade 1, 81.6% for nuclear Grade 2, 60.5% for nuclear Grade 3, and 43.4% for nuclear Grade 4 patients. The difference was statistically significant. There was no significant difference in the long-term survival between patients with localized renal cancer (pT1-2N0M0) who underwent open surgery and minimally invasive surgery (10-year overall survival rate 80.5% vs 85.6%, P=0.160). Multivariate Cox analysis showed that age≥55 years (HR=2.11, 95% CI: 1.50-2.96, P<0.001), T stage(T3+ T4 vs T1a: HR=2.37, 95% CI: 1.26-4.46, P=0.008), local lymph node metastasis (HR=3.04, 95%CI: 1.81-5.09, P<0.001), nuclear grade (G3-G4 vs G1: HR=4.21, 95%CI: 1.51-11.75, P=0.006), tumor necrosis (HR=1.66, 95% CI: 1.17-2.37, P=0.005), sarcomatoid differentiation (HR=2.39, 95% CI: 1.31-4.35, P=0.005) and BMI≥24kg/m(2) (HR=0.56, 95%CI: 0.39-0.80, P=0.001) were independent factors affecting long-term survival after radical nephrectomy. Conclusions: The long-term survival of radical nephrectomy in patients with renal cell carcinoma is satisfactory. Advanced age, higher pathological stage and grade, tumor necrosis and sarcomatoid differentiation were the main adverse factors affecting the prognosis of patients. Higher body mass index was a protective factor for the prognosis of patients.

Establishment and validation of a novel nomogram to predict overall survival after radical nephrectomy / 中华肿瘤杂志

Objective: To establish a nomogram prognostic model for predicting the 5-, 10-, and 15-year overall survival (OS) of non-metastatic renal cell carcinoma patients managed with radical nephrectomy (RN), compare the modelled results with the results of pure pathologic staging, the Karakiewicz nomogram and the Mayo Clinic Stage, Size, Grade, and Necrosis (SSIGN) score commonly used in foreign countries, and stratify the patients into different prognostic risk subgroups. Methods: A total of 1 246 non-metastatic renal cell carcinoma patients managed with RN in Sun Yat-sen University Cancer Center (SYSUCC) from 1999 to 2020 were retrospectively analyzed. Multivariate Cox regression analysis was used to screen the variables that influence the prognosis for nomogram establishment, and the bootstrap random sampling was used for internal validation. The time-receiver operating characteristic curve (ROC), the calibration curve and the clinical decision curve analysis (DCA) were applied to evaluate the nomogram. The prediction efficacy of the nomogram and that of the pure pathologic staging, the Karakiewicz nomogram and the SSIGN score was compared through the area under the curve (AUC). Finally, patients were stratified into different risk subgroups according to our nomogram scores. Results: A total of 1 246 patients managed with RN were enrolled in this study. Multivariate Cox regression analysis showed that age, smoking history, pathological nuclear grade, sarcomatoid differentiation, tumor necrosis and pathological T and N stages were independent prognostic factors for RN patients (all P<0.05). A nomogram model named SYSUCC based on these factors was built to predict the 5-, 10-, and 15-year survival rate of the participating patients. In the bootstrap random sampling with 1 000 iterations, all these factors occurred for more than 800 times as independent predictors. The Harrell's concordance index (C-index) of SYSUCC was higher compared with pure pathological staging [0.770 (95% CI: 0.716-0.823) vs 0.674 (95% CI: 0.621-0.728)]. The calibration curve showed that the survival rate as predicted by the SYSUCC model simulated the actual rate, while the clinical DCA showed that the SYSUCC nomogram has a benefit in certain probability ranges. In the ROC analysis that included 857 patients with detailed pathological nuclear stages, the nomogram had a larger AUC (5-/10-year AUC: 0.823/0.804) and better discriminating ability than pure pathological staging (5-/10-year AUC: 0.701/0.658), Karakiewicz nomogram (5-/10-year AUC: 0.772/0.734) and SSIGN score (5-/10-year AUC: 0.792/0.750) in predicting the 5-/10-year OS of RN patients (all P<0.05). In addition, the AUC of the SYSUCC nomogram for predicting the 15-year OS (0.820) was larger than that of the SSIGN score (0.709), and there was no statistical difference (P<0.05) between the SYSUCC nomogram, pure pathological staging (0.773) and the Karakiewicz nomogram (0.826). The calibration curve was close to the standard curve, which indicated that the model has good predictive performance. Finally, patients were stratified into low-, intermediate-, and high-risk subgroups (738, 379 and 129, respectively) according to the SYSUCC nomogram scores, among whom patients in intermediate- and high-risk subgroups had a worse OS than patients in the low-risk subgroup (intermediate-risk group vs. low-risk group: HR=4.33, 95% CI: 3.22-5.81, P<0.001; high-risk group vs low-risk group: HR=11.95, 95% CI: 8.29-17.24, P<0.001), and the high-risk subgroup had a worse OS than the intermediate-risk group (HR=2.63, 95% CI: 1.88-3.68, P<0.001). Conclusions: Age, smoking history, pathological nuclear grade, sarcomatoid differentiation, tumor necrosis and pathological stage were independent prognostic factors for non-metastasis renal cell carcinoma patients after RN. The SYSUCC nomogram based on these independent prognostic factors can better predict the 5-, 10-, and 15-year OS than pure pathological staging, the Karakiewicz nomogram and the SSIGN score of patients after RN. In addition, the SYSUCC nomogram has good discrimination, agreement, risk stratification and clinical application potential.

Long-term survival analysis of 1 367 patients treated with radical nephrectomy from a single center / 中华肿瘤杂志

Objective: To report the long-term survival of renal cell carcinoma (RCC) patients treated with radical nephrectomy in Sun Yat-sen University Cancer Center. Methods: We retrospectively analyzed the clinical, pathological and follow-up records of 1 367 non-metastatic RCC patients treated with radical nephrectomy from 1999 to 2020 in this center. The primary endpoint of this study was overall survival rate. Survival curves were estimated using the Kaplan-Meier method, and group differences were compared through Log-rank test. Univariate and multivariate Cox analysis were fit to determine the clinical and pathological features associated with overall survival rate. Results: A total of 1 367 patients treated with radical nephrectomy with complete follow-up data were included in the study. The median follow-up time was 52.6 months, and 1 100 patients survived and 267 died, with the median time to overall survival not yet reached. The 5-year and 10-year overall survival rates were 82.8% and 74.9%, respectively. The 5-year and 10-year overall survival rates of Leibovich low-risk patients were 93.3% and 88.2%, respectively; of Leibovich intermediate-risk patients were 82.2% and 72.3%, respectively; and of Leibovich high-risk patients were 50.5% and 30.2%, respectively. There were significant differences in the long-term survival among the three groups (P<0.001). The 10-year overall survival rates for patients with pT1, pT2, pT3 and pT4 RCC were 83.2%, 73.6%, 55.0% and 31.4%, respectively. There were significant differences among pT1, pT2, pT3 and pT4 patients(P<0.001). The 5-year and 10-year overall survival rates of patients with lymph node metastasis were 48.5% and 35.6%, respectively, and those of patients without lymph node metastasis were 85.1% and 77.5%, respectively. There was significant difference in the long-term survival between patients with lymph node metastasis and without lymph node metastasis. The 10-year overall survival rate was 96.2% for nuclear Grade 1, 81.6% for nuclear Grade 2, 60.5% for nuclear Grade 3, and 43.4% for nuclear Grade 4 patients. The difference was statistically significant. There was no significant difference in the long-term survival between patients with localized renal cancer (pT1-2N0M0) who underwent open surgery and minimally invasive surgery (10-year overall survival rate 80.5% vs 85.6%, P=0.160). Multivariate Cox analysis showed that age≥55 years (HR=2.11, 95% CI: 1.50-2.96, P<0.001), T stage(T3+ T4 vs T1a: HR=2.37, 95% CI: 1.26-4.46, P=0.008), local lymph node metastasis (HR=3.04, 95%CI: 1.81-5.09, P<0.001), nuclear grade (G3-G4 vs G1: HR=4.21, 95%CI: 1.51-11.75, P=0.006), tumor necrosis (HR=1.66, 95% CI: 1.17-2.37, P=0.005), sarcomatoid differentiation (HR=2.39, 95% CI: 1.31-4.35, P=0.005) and BMI≥24kg/m(2) (HR=0.56, 95%CI: 0.39-0.80, P=0.001) were independent factors affecting long-term survival after radical nephrectomy. Conclusions: The long-term survival of radical nephrectomy in patients with renal cell carcinoma is satisfactory. Advanced age, higher pathological stage and grade, tumor necrosis and sarcomatoid differentiation were the main adverse factors affecting the prognosis of patients. Higher body mass index was a protective factor for the prognosis of patients.

Effects of dietary supplementation on the training of female tennis players in hot climates / Efeitos da suplementação dietética sobre o treino das atletas tenistas em climas quentes / Efectos de la suplementación dietética en el entrenamiento de las atletas tenistas en climas cálidos

ABSTRACT Introduction A tennis match may last up to four hours with long intervals between moves of medium to high exercise intensity for 10 minutes and aerobic characteristic that requires specific sources of energy. Inappropriate diets can negatively impact sports performance and delay the recovery phase. Fortified wheat germ protein powder has the supplementation characteristics required in aerobic activities, although there are no practical studies on its impacts on the work performance of female tennis athletes. Objective Explore the influence of two weeks of training in a warm environment combined with nutritional intervention on the performance of female tennis players. Methods It was observed by testing the immunological indices of elite female tennis players while training their changes and their effects on nutritional intervention. Results The increase in serum CK activity was closely related to the amount of exercise. Many studies have shown that serum CK activity increased significantly after strenuous exercise, and the serum CK value of subjects in the test group was significantly lower than that of the control group, showing better adaptability to exercise. Compared with before the nutritional intervention, the athletes' weight decreased slightly, and the body fat percentage decreased significantly after the nutritional intervention. Compared with before nutritional intervention, sugar and salt supplements in athletes were significantly increased (P<0.05). Sweating rate, hydration rate, and hydration/sudden rate were also significantly increased (P<0.05). Conclusion Strengthening wheat germ protein supplementation may improve the nutritional albumin level in female tennis players, manifested in blood levels and immune function performance. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução Partidas de tênis podem durar até quatro horas com intervalos longos entre jogadas de intensidade de exercício média a alta por 10 minutos, características aeróbicas que requerem fontes específicas de energia. Dietas inapropriadas podem impactar negativamente o desempenho esportivo e retardar o período de recuperação. O pó de proteína de germe de trigo fortificado apresenta as características de suplementação requeridas nas atividades aeróbicas, embora não haja estudos práticos sobre seus impactos no desempenho profissional de atletas do tênis feminino. Objetivo Explorar a influência no treinamento de duas semanas em ambiente quente combinado com a intervenção nutricional sobre o desempenho das atletas tenistas. Métodos Ao testar os índices imunológicos das tenistas de elite durante o treinamento, observamos suas mudanças e seus efeitos na intervenção nutricional. Resultados O aumento da atividade de CK sérico esteve intimamente relacionado à quantidade de exercício. Muitos estudos mostraram que a atividade do soro CK aumentou significativamente após o exercício extenuante, e o valor sérico CK dos sujeitos no grupo de teste foi significativamente menor do que o do grupo controle, mostrando melhor adaptabilidade ao exercício. Em comparação com antes da intervenção nutricional, o peso dos atletas diminuiu ligeiramente e o percentual de gordura corporal diminuiu significativamente após a intervenção nutricional. Em comparação com antes da intervenção nutricional, os suplementos de açúcar e sal em atletas foram significativamente incrementados (P<0,05). A taxa de sudorese, a taxa de hidratação e a taxa de hidratação/sudorese também aumentaram significativamente (P<0,05). Conclusão Fortalecer a suplementação com proteína de germe de trigo pode melhorar o nível nutricional de albumina nas tenistas, manifestadamente nos níveis sanguíneos e desempenho da função imunológica. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción Los partidos de tenis pueden durar hasta cuatro horas con largos intervalos entre jugadas de intensidad de ejercicio media a alta durante 10 minutos, características aeróbicas que requieren fuentes de energía específicas. Las dietas inadecuadas pueden afectar negativamente al rendimiento deportivo y retrasar el periodo de recuperación. La proteína de germen de trigo en polvo enriquecida presenta las características de suplementación requeridas en las actividades aeróbicas, aunque no existen estudios prácticos sobre sus impactos en el rendimiento profesional de las atletas de tenis. Objetivo Explorar la influencia de dos semanas de entrenamiento en un ambiente cálido combinado con una intervención nutricional en el rendimiento de las atletas de tenis. Métodos Mediante el análisis de los índices inmunológicos de las tenistas de élite durante el entrenamiento, observamos sus cambios y sus efectos en la intervención nutricional. Resultados El aumento de la actividad de la CK en suero estaba estrechamente relacionado con la cantidad de ejercicio. Muchos estudios han demostrado que la actividad de la CK en suero aumenta significativamente después de un ejercicio extenuante, y el valor de la CK en suero de los sujetos del grupo de prueba fue significativamente menor que el del grupo de control, lo que demuestra una mejor adaptabilidad al ejercicio. En comparación con antes de la intervención nutricional, el peso de los atletas disminuyó ligeramente y el porcentaje de grasa corporal se redujo significativamente después de la intervención nutricional. En comparación con antes de la intervención nutricional, los suplementos de azúcar y sal en las atletas aumentaron significativamente (P<0,05). La tasa de sudoración, la tasa de hidratación y la tasa de hidratación/sudoración también aumentaron significativamente (P<0,05). Conclusión El refuerzo de la suplementación con proteínas de germen de trigo puede mejorar el nivel nutricional de albúmina en las jugadoras de tenis, manifestándose en los niveles sanguíneos y en el rendimiento de la función inmunitaria. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Esculetin protects against early sepsis via attenuating inflammation by inhibiting NF-κB and STAT1/STAT3 signaling / 中国天然药物

Esculetin, a natural derivative from the traditional and widely-used Chinese medicinal herb Cortex Fraxini, has a variety of pharmacological effects, especially in anti-inflammation. However, it is not clear whether esculetin has a therapeutic effect on sepsis. This study aimed to investigate the anti-inflammatory and protective effects of esculetin on early sepsis. The results showed that the lung injury was significantly relieved with the treatment of esculetin, accompanied with the restrained production of inflammatory factors including IL-1β, IL-6, TNF-α, CCL2 and iNOS during the early phase of E.coli-induced sepsis. Of note, activation of NF-κB and STAT1/STAT3 signals, the main upstream signals of many inflammatory factors, were attenuated by esculetin in both lung tissues from septic mice and LPS-stimulated macrophage. These findings suggested that the protection of esculetin against early sepsis should be related to its anti-inflammatory effect, which was at least partly due to its inhibition on NF-κB and STAT1/STAT3 signaling pathway in macrophage. Thus, esculetin could serve as a potential therapeutic agent by rebalancing innate immune response in macrophage for the treatment of early sepsis.

Impact of hypophosphatemia on weaning from mechanical ventilation / 中华危重病急救医学

Objective:To explore the influence of hypophosphatemia on weaning from mechanical ventilation.Methods:An observational study was conducted. The medical records of 30 mechanical ventilated patients with hypophosphatemia admitted to intensive care unit of Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2018 to August 2020 were analyzed; another 60 mechanical ventilated patients with normophosphatemia around the same time were enrolled as controls by 1∶2 case-control matching based on gender, age, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, sequential organ failure assessment (SOFA) score. And then the duration of invasive mechanical ventilation, times of spontaneous breathing trial (SBT), the diaphragmatic ultrasonography movement indexes, and outcome of weaning and prognosis during hospitalization were compared between the two groups. Receiver operator characteristic curve (ROC curve) was plotted to calculate the areas under ROC curve (AUC) and cut-off values of serum phosphorus for successful weaning and hospital survival. The correlations between the diaphragmatic ultrasonography movement indexes and serum phosphorus were analyzed by Pearson partial correlation analysis.Results:Compared with normophosphatemic group, the duration of invasive mechanical ventilation in hypophosphatemia group was significantly longer [days: 13.0 (7.0, 22.0) vs. 10.0 (5.5, 14.0), P < 0.05], and SBT attempts were more often [times: 3 (0, 5) vs. 1 (1, 2), P < 0.01], while the rate of successful weaning was lower (53.3% vs. 91.7%, P < 0.01), and the hospital mortality was higher (20.0% vs. 1.7%, P < 0.01). ROC curve analysis showed that serum phosphorus could predict successful weaning of mechanical ventilated patients, the AUC was 0.795, and the optimum cut-off value of serum phosphorus was 0.85 mmol/L with sensitivity of 73.2% and specificity of 84.2%. Serum phosphorus could predict hospital survival of mechanical ventilated patients, the AUC was 0.782, and the optimum cut-off value of serum phosphorus was 0.48 mmol/L with sensitivity of 81.9% and specificity of 85.7%. Compared with normophosphatemic group, diaphragm thickness at the end of inspiration (DTei), diaphragm thickness at the end of expiration (DTee), diaphragm thickening fraction (DTF), diaphragm excursion (DE) in hypophosphatemia group were all significantly decreased [DTei (cm): 0.19±0.07 vs. 0.27±0.08, DTee (cm): 0.14±0.05 vs. 0.19±0.06, DTF: (33.55±16.17)% vs. (45.04±18.66)%, DE (cm): 1.17±0.49 vs. 2.28±0.69, all P < 0.01]. Pearson partial correlation analysis showed that linear correlations were found between serum phosphorus and DTei, DTee, DTF, DE ( r values were 0.442, 0.351, 0.293, 0.628 respectively, all P < 0.01). Conclusions:Serum phosphorus may have correlation with the diaphragmatic ultrasonography movement indexes. Hypophosphatemia may impair the contractile properties of diaphragm, induce more SBT attempts and longer duration of invasive mechanical ventilation, and affect outcome of weaning and prognosis.

Study of plasma matrix metalloproteinase-2 and matrix metalloproteinase-9 level during concurrent chemoradiotherapy and clinicopathologic significance in patients with nasopharyngeal carcinoma / 中国医师杂志

Objective:To investigate the changes of the plasma matrix metalloproteinase (MMP)-2 and MMP-9 levels and their clinical significances during the course of concurrent chemoradiotherapy (CCRT) in nasopharyngeal carcinoma (NPC) patients.Methods:From January 2018 to June 2019, 46 patients with nasopharyngeal carcinoma were treated in the department of oncology, Changsha Central Hospital Affiliated to Nanhua University. All patients were confirmed by pathology. They were divided into early NPC group ( n=32) and invasive NPC group ( n=16) according to the degree of invasion. The early NPC group was treated with concurrent chemoradiotherapy alone, and the invasive NPC group was treated with neoadjuvant chemotherapy combined with concurrent chemoradiotherapy. Blood samples were collected at four stages of the treatment, and the concentrations of MMP-2 and MMP-9 were detected by enzyme linked immunosorbent assay (ELISA). Results:The longer the treatment time, the lower the concentration of MMP-9 ( P=0.007) in early NPC group; There was no significant difference in MMP-9 level before treatment, after neoadjuvant chemotherapy, after concurrent chemoradiotherapy, at the end of treatment and the first follow-up ( P>0.05) in invasive NPC group. There was no significant difference in the content of MMP-2 between the two groups before and after treatment ( P>0.05). There was no correlation between serum MMP-2 and MMP-9 levels and tumor stage, lymph node metastasis, tumor invasion and response rate ( P>0.05) in invasive NPC patients, while the level of MMP-9 was positively correlated with white blood count (WBC) and neutrophil count ( r=0.85, P=0.004, r=0.82, P=0.003); The ratio of MMP-9/MMP-2 was positively correlated with WBC and neutrophil count ( r=0.86, P=0.003, r=0.83, P=0.001). Conclusions:Synchronous radiotherapy and chemotherapy can reduce the serum MMP-9 level in early stage NPC patients, but it has no effect on the serum MMP-9 level in patients with invasive NPC, which suggests that synchronous radiotherapy and chemotherapy can not prevent the proliferation and distant metastasis of cancer cells in patients with invasive NPC.

Analysis of classical prescription Jinshui Liujun Jian based on ancient literature / 中国中药杂志

To provide the ancient literary evidence support for the clinical application and development of classical prescription based on systematical collection and analysis of the ancient Chinese medical literature containing Jinshui Liujun Jian, including its origin and development. Bibliometric analysis was used and information of Jinshui Liujun Jian in ancient Chinese medical literature was then collected for statistical analysis of formula compositions, main indications, dosage, preparation methods, etc. A total of 151 valid items of data were obtained from 48 ancient Chinese medicine books. Jinshui Liujun Jian was first recorded in Jingyue Quanshu written by ZHANG Jiebin. This prescription consisted of Rehmanniae Radix Praeparata, Angelicae Sinensis Radix, Pinelliae Rhizome, Citri Reticulatae Pericarpium, Poria and Glycyrrhizae Radix et Rhizome Praeparata cum Melle, and it was mainly used to treat the deficiency of lung and kidney, edema and excess production of phlegm, or Yin deficiency in the old, insufficient blood-qi, wind-cold evil, cough and disgusting, asthma and excessive phlegm. Doctors in later dynasties mostly followed the prescription compositions, dosages and indications in Jingyue Quanshu, and extended the clinical application of this prescription.

Uric acid transporter and the balance of serum uric acid / 国际药学研究杂志

During the uric acid production, excretion and reabsorption in the liver, kidney and intestine, several uric acid transporter proteins are involved in these processes. A large number of studies have shown that glucose transporter 9 plays an important role in the uric acid transport in the liver, kidney and intestine, and participates in the uric acid reabsorption. The ATP-binding cassette superfamily G member 2 is mainly expressed in the apical membrane of the proximal tubular epithelial cells of the kidney, which is involved in the uric acid secretion. The multidrug resistant protein 4 is expressed in the apical membrane of the renal tubular epithelial cells, which transfers uric acid from the renal tubular epithelial cells into the renal tubular lumen. The urate-anion transporter 1 as well as the organic anion transporters 1 and 3 are all the organic anion transporters belonging to the SLC22 A family of transmembrane transporters, and all participate in the uric acid transport in the kidney, especially the uric acid secretion and excretion. In this review, we summarize the research progress of these uric acid transporters, focusing on their effects on the regulation of the serum uric acid balance.

The Characteristics of Auditory Event-related Potential in Presbycusis Patients / 听力学及言语疾病杂志

Objective To investigate the characteristics of auditory event-related potentials(AERP) mismatch negativity and P300 in presbycusis patients.Methods Auditory event-related potentials were recorded from 20 presbycusis patients, 20 normal hearing elderly subjects and 20 normal young volunteers(the control group) in the Oddball stimulus paradigm.Mismatch negativity(MMN) was tested under the status of reading.P300 was tested under the status of concentrating.The latencies and amplitudes of 3 groups were compared.Results The latency of MMN in the presbycusis patient group(187.38±29.63ms) was significantly longer than those of the normal hearing older group(160.10±23.21±ms)and the control group(148.22±19.30 ms)(P0.05).The latency of P300 in the presbycusis patient group (369.83±27.09 ms) was significantly longer than those of the normal hearing older group(332.89±25.60 ms)and the control group(318.51±22.32ms)(P0.05).Conclusion The presbycusis patients show some central auditory processing dysfunction and cognitive impairment.MMN and P300 might be used as objective methods for evaluating central auditory processing and cognitive function in presbycusis patients.

An Analysis of Common Gene Mutation Spots of 222 Sensorineural Hearing Loss Patients in Guangxi Province / 听力学及言语疾病杂志

Objective To investigate the characteristics of common deafness genes mutation from 222 sensori-neural hearing loss patients in Guangxi province.Methods A deafness-related gene mutations detection kit was used to detect 15 mutation sites in four deafness-associated genes.A total of 222 hearing impaired patients,who were selected from January 2015 to April 2016,were tested.The samples that could not be diagnosed with DNA mi-croarray were subjected to PCR and sequenced to detect other mutations.Results Among the 222 patients with sen-sorineural deafness,the total mutation rate was 10.36% (23/222),including GJB2 235delC homozygous in 3 cases (1.35%),235delC single heterozygous mutation in 8 cases (3.60%),35delG single heterozygous mutation in 2 cases (0.90%),GJB2 235delC and 109 A>G mutations in 2 cases (0.90%),SLC26A4 1229C>T homozygous in 2 case (0.90%),IVS7-2 A>G heterozygous mutation in 2 cases (0.90%);IVS7-2A>G,IVS11+47T>C and 1548 insC mutations in 2 cases (0.90%);GJB3 538C>T heterozygous mutation in 1 cases (0.45%);Mitochondrial 12S rRNA gene heterogeneous mutations in 1 case (0.45%).One of them carry both two mutations:GJB2 235 del C and SLC26A4 1226 G>A.Conclusion The results indicate that GJB2 and SLC26A4 were the main genes in this study,and in Guangxi province the mutation rate is significantly lower than the national average level.3 new muta-tions (SLC26A4 IVS11+47T ! C,1548insC and GJB2 109A>G)were found.There may be some rare mutations among sites or genes caused deafness in Guangxi.

Expression of miR-133b in prostate cancer and its effect on the proliferation of tumor cells / 临床检验杂志

Objective To investigate the expression level of miR-133b in cancer tissues of patients with prostate cancer and its effect on the proliferation of prostate cancer cells.Methods The total RNAs in resected prostate cancer tissues and adjacent tissues from 30 patients with prostate cancer were extracted and reversely transcripted into cDNA,and then the expression levels of miR-133b were detected by real-time quantitative PCR.The correlations between the expression levels of miR-133b and the patients' clinicopathological features were analyzed.The expression of positive regulatory domain I-binding factor 16 (PRDM16) and proliferation of PC-3 cells transfected with miR-133b mimics by LipofectamineTM 3000 were determined by real-time quantitative PCR and the CCK8 method,respectively.Results The expression levels of miR-133b in prostate cancer tissues [(16.85 ± 0.94) × 10-4] was significantly lower than that in adjacent tissues [(22.95 ± 1.567) × 10-4,t =3.335,P ＜ 0.01].The expression levels of PRDM16 in PC-3 cells transfected with miR-133b mimics were significantly lower than that in the control group (0.371 ±0.031 vs 1.000 ±0.022,t =12.53,P ＜ 0.01).The proliferation ability of PC3 cells transfected with miR-133b mimics for 72 hours was significantly lower than that in the control group (t =6.811,P ＜ 0.01).Similarly,the proliferation ability of PC-3 cells transfected with PRDM16 inhibitor for 72 hours was also significantly lower than that in the control group (t =9.048,P ＜0.01).Conclusion The expression levels of miR-133b in prostate cancer tissues are significantly down-regulated,which regulate the proliferation of prostate cancer cells possibly through PRDM16.

Clinical characteristics and etiological analysis of lung nodules in 98 children / 临床儿科杂志

Objective To analyze the clinical features and common etiology of lung nodules in children. Methods The etiology, diagnosis, radiological features from 98 hospitalized children of lung nodules were analyzed. Results Of them, 58 were male and 40 were female aged from 0.2 years old to 14.8 years old. Pulmonary infection were found in 41 cases (41.8%) including tuberculosis in 15 cases (15.3%), pulmonary fungal infection in 13 cases (13.3%), pneumonia in 11 cases (11.2%), lung trematode in 2 cases (2.0%). Pulmonary metastases were found in 28 cases (28.6%), multiple pulmonary arteriovenous fistula in 1 case (1.0%), and pulmonary contusion in 1 case (1.0%) and unknown etiology in 27 cases (27.6%). Conclusions The etiology of lung nodules is complicated, in which infectious diseases are the most commonly seen, followed by pulmonary metastases. Biopsy is the golden standard of diagnosis.

A retrospective study on the clinical characteristics of patients with growth-hormone adenoma / 解放军医学杂志

Objective To evaluate the clinical characteristics of patients with growth-hormone adenoma (GHA) and summarize the diagnosis and treatment experience.Methods The clinical data of 338 GHA cases at the General Hospital of PLA from Jan. 1990 to Dec. 2016 were collected, of which 252 cases with more complete clinical data were retrospectively analyzed including their general situation, medical history, laboratory tests and auxiliary examinations, and treatment modalities and outcomes. Parts of the patients were followed up.Results The cases of hospitalized GHA patients have increased year by year since 1990, and the number of patients admitted in the last 3 years accounted for 56.2% of the total number of cases. The sex ratio for GHA patients was nearly 1:1. Age of visiting followed Gaussian distribution while the 41-50 age group occupied the largest part. The most typical sign is hand and foot enlargement (60.7%), followed by the hypertrophy of nasal ala. The most common symptoms are headache (42.5%), hypopsia, visual field defect and diplopia. More than half of GHA patients were complicated with prediabetes and diabetes (72.6%), sleep apnea (69.5%), goiter or thyroid nodularity (56.4%), cardiac insufficiency (57.0%) and colon polyp (54.1%); while the percentages of cases undergone the relevant examination in the total number of cases were as follows: 75g OGTT test (42.1%), polysomnography (23.4%), thyroid ultrasound (37.3%), echocardiogram (47.6%) and colonoscopy (14.7%); GHA was 23.37±1.42μg/L and IGF-1 was 804.28±273.93ng/ml on average; 85.0% of somatotroph tumors are macroadenoma. Surgery remains the mainstay of therapy to GHA, while medical therapy was selected by less patients. During the follow-up, only 38.0%of GHA patients can be contacted, among them the remission rate decreased to 40.5%. The positive rate of long-term remission evaluated by early postoperative GHA level was consistent with that confirmed by the long-term follow-up (χ2=3.368,P>0.05). Conclusions The number of hospitalized GHA patients have increased recent years. The common clinical signs and symptoms are somatic enlargement and nonspecific headache. Due to uncompleted screening, GHA associated complications are always misdiagnosed; It is essential to establish a sound model of follow-up to improve patients' quality of life. The early postoperative GHA levels may predict the prognosis of surgery.

Investigation of Chinese Medicine Hospital Nurses' Requirement on Effect Evaluation of Traditional Chinese Medicine Nursing Program / 世界科学技术-中医药现代化

This study was aimed to investigate the requirement of our hospital nurses in the effect evaluation of fifteen traditional Chinese medicine (TCM) nursing programs,and to make it as the basis for making feasible evaluation tables of TCM nursing programs.The investigation survey was given among 78 nurses from the internal medicine ward,surgical ward and the department of orthopedics in our hospital.The questionnaire was graded according to the Likert 5 scoring method,including 3 themes and 11 items.The SPSS 17.0 package was used for statistical processing.The results showed that 93％ nurses participated in the training of effect evaluation table of unified TCM nursing program in the hospital or department,but the overall attitude was negative in terms of the operability and objectivity on the effect evaluation of the program.Requirements of guidelines for effectiveness evaluation of TCM nursing program showed that most nurses agreed that the new TCM nursing program needed to increase quantifiable indicators and to increase its objectivity and reproducibility.It was concluded that nurses generally considered that the evaluation system of nursing program of TCM had no quantitative indicators,but with strong subjective.In the clinical practice,it is in urgent need of an objective TCM nursing program with quantitative indicators and strong operability.

Safety and Curative Effect of Moxa Box Moxibustion Treatment with FMEA Methods / 世界科学技术-中医药现代化

This paper was aimed to study the safety of moxibustion with FMEA method.Failure mode and effects analysis (FMEA) were used in every aspect of the operation process of moxibustion.And the local skin temperature was measured in 80 patients treated with moxa box moxibustion.The results showed that the skin temperature reached the highest when the moxibustion was given for 15 min,which was in consistence with the patients' chief complaints and their tolerances.It indicated that moxibustion for 15 min was the best moxibustion amount.Meanwhile,inspection should be made to avoid burning.After the application of FMEA,the RPN of the inspection activities,the temperature and distance of moxibustion were significantly decreased (P ＜ 0.05).It was concluded that the application of FMEA management mode strengthened the risk management of moxibustion treatment,standardized treatment process,provided the basis for the temperature and distance of moxibustion,and ensured the safety and efficacy of treatment.

Efficacy of Mirabilite External Application in Treatment of Lower Limb Edema / 世界科学技术-中医药现代化

This study was aimed to evaluate the apocatastasis effect and adverse reaction of external application of mirabilite in the treatment of patients with renal edema.Randomized controlled trials (RCTs) were conducted.Patients in the control group were treated with routine treatment plus prescribed diuretics.In the test group,patients were treated with routine nursing,prescribed diuretics,and the external application of mirabilite.The results showed that there was significant difference in the changes of body weight and circumference of the leg.There was no significant difference in the change of urine volume.In the experimental group,2 patients had adverse reactions of the lower limb pruritus,which may be related to the sensitivity of the bag material.It was concluded that a noninvasive external therapy of TCM,mirabilite had quickly apocatastasis effect in the treatment of renal edema patients.Meanwhile,it does not affect the treatment effect of diuretics.The adverse reaction is less.It is an effective method which should be promoted to use.

The value of otolith function test in the prognosis of sudden sensorineural hearing / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To evaluate the characteristics and prognosis of sudden sensorineural hearing loss through vestibular evoked myogenic potentials.@*METHOD@#Fifty patients with unilateral sudden hearing loss underwent an ear test battery, including audiometry, cervical vestibular evoked myogenic potential (cVEMP) and ocular vestibular evoked myogenic potential(oVEMP). The cVEMP and oVEMP in patients with sudden sensorineural hearing loss were investigated. Their associations with initial hearing threshold, the type of audiogram, the results of coloric test and hearing recovery were also accessed.@*RESULT@#After one-month treatment, the average threshold declined significantly in affected ears, with normal VEMP rates improved significantly (P < 0.05). Initial hearing threshold and hearing recovery were significantly associated with the results of coloric test and the results of VEMP test (P < 0.05).@*CONCLUSION@#Our study indicated that vestibular evoked myogenic potential examination was not only a useful additional diagnostic tool in the neurotological evaluation of patients suffering sudden hearing loss, but also very valuable in the prognosis of sudden sensorineural hearing loss.