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Objective:To investigate the correlation between triglyceride glucose (TyG) index and severe hypertriglyceridemic pancreatitis (HTGP), and to provide assistance for early evaluation and clinical decision-making of HTGP.Methods:From January 2016 to December 2021, the clinical data of 770 patients diagnosed with HTGP at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine were retrospectively collected. According to severity of pancreatitis, the patients were divided into mild acute pancreatitis (MAP), moderate severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP) groups, and the differences in TyG index among the 3 groups was compared. According to the quartile range of the TyG index, the patients were divided into TyG Q1, Q2, Q3 and Q4 groups, and the distribution of severity of pancreatitis in each TyG index quartile group was calculated. Kruskal-Wallis H test was used for statistical analysis. Spearman correlation analysis was used to analyze the correlation between TyG index quartile range and the severity of pancreatitis. Linear trend chi-square test was used to analyze the trend of SAP incidence among groups. Binary logistic regression was used to analyze the relationship between TyG index quartile range and the risk of SAP, and the trend test was also conducted. Results:A total of 770 patients with HTGP were included, among them 330 (42.9%), 268 (34.8%) and 172 (22.3%) were MAP, MSAP and SAP, respectively. The TyG indices of MAP, MSAP and SAP group were 11.8(11.3, 12.4), 12.5(11.9, 13.2) and 12.7(12.1, 13.4), respectively, and the differences among the 3 groups were statistically significant ( H=121.77, P<0.001). The TyG index was 12.21 (11.57, 12.94) in the 770 patients. There were 192, 193, 193 and 192 patients enrolled in TyG Q1(TyG index <11.57)、 Q2(TyG index ranged from 11.57 to <12.21)、 Q3(TyG index ranged from 12.21 to <12.94) and Q4(TyG index≥12.94) group, respectively.The correlation test showed that the difference between TyG quartile range and the severity of pancreatitis was statistically significant ( ρ=0.372, P<0.001). The incidence of SAP in TyG Q1, Q2, Q3 and Q4 group was 10.9%(21/192), 14.5%(28/193), 27.5%(53/193) and 36.5%(70/192), respectively. The trend test of SAP incidence among the TyG gruops was statistically significant ( χ2 =44.33, P<0.001). After adjusting for confounding factors, taking the TyG Q1 group as a reference, the OR values of SAP risk (95% confidence interval) of the TyG Q2, Q3 and Q4 groups were 1.250 (0.619 to 2.524), 2.882 (1.506 to 5.514) and 6.660 (3.456 to 12.836), respectively, and the trend test of SAP risk showed a significant difference ( OR=2.508, 95%confidence interval 1.883 to 3.341, P<0.001). Conclusions:There is a correlation between TyG index and severity of pancreatitis in patients with HTGP. As the TyG index increases, the risk of SAP increases in HTGP patients. TyG index may be an early predictor of severe HTGP.
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OBJECTIVE@#To construct a three-dimensional (3D) finite element mechanical model of total hip arthroplasty for comparison of biomechanical differences of the hip joint following capsule repair and postoperative rehabilitation.@*METHODS@#Six frozen specimens of hip joint posterior capsule ligament complex were collected in a bone-capsule-bone manner, and the load-strain curve and other mechanical properties of the specimens were tested using a universal material testing machine. Thin-section CT data of the pelvis and lower limbs obtained from a volunteer were imported into Mimics software to construct a 3D model of the hip joint. Digital models of the cup, femoral prosthesis and joint capsule were created in CATIA software and imported into Mimics to simulate total hip arthroplasty; the assembled data were imported into ABAQUS software. The properties of the capsule were set according to results of the mechanical test, anatomical studies, and constitutive equations, and the biomechanics of the anatomically repaired and conventionally repaired capsules were compared during hip flexion.@*RESULTS@#The results of testing on the 6 capsule specimens showed a mean ultimate tensile strain of (39.21±5.23)% and a mean of ultimate tensile strength of 1.65±0.38 MPa. The stress-strain curve of the finite element model was consistent with the results of mechanical test on the specimens and the biochemical characteristics of the capsule. The stress was distributed evenly in the anatomically repaired capsule during hip flexion but not in the capsule repaired through the conventional approach; the tensile stress in the lower part of the conventionally repaired capsule reached the ultimate tensile stress measured on the capsule specimens at a 90° flexion.@*CONCLUSIONS@#The finite element model allows dynamic, quantitative and visual assessment of stress distribution in the hip joint capsule, and compared with the conventional approach, anatomical repair can achieve better biomechanical properties of the capsule.
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Humans , Arthroplasty, Replacement, Hip , Biomechanical Phenomena , Finite Element Analysis , Hip Joint/surgery , Prognosis , Stress, MechanicalABSTRACT
BACKGROUND:Reducing blood loss could help to prevent the complications of total knee arthroplasty, relieve the swelling and discomfort postoperatively and accelerate the rehabilitation. OBJECTIVE:To explore the methods for reducing blood loss during total knee arthroplasty. METHODS:Totally 63 patients undergoing primary unilateral total knee arthroplasty were divided into two groups. Group 1 included 27 patients who received the conventional surgical techniques using tourniquet during the whole procedure with wound drainage, as control group. Group 2 included 36 patients who received the modified procedure only using tourniquet during prosthesis implantation without wound drainage, as experimental group. In the experimental group, we stitched the capsule closely. The preoperative and postoperative hemoglobin, decrease of hemoglobin, knee pain score, range of motion blood transfusion rate and wound healing were compared between the two groups. RESULTS AND CONCLUSION:(1) There was no significant difference in preoperative hemoglobin between the two groups. At 1, 4 and 7 days postoperatively, the hemoglobins were significantly lower in the control group than in the experimental group, and the decreases of hemoglobins were significantly lower in the control group than in the experimental group. (2) Knee pain score was not significantly different between the two groups. (3) The range of motion of the knee was significantly larger in the experimental group than in the control group at 7 days. (4) Blood transfusion rate was 18.5%in the control group, and wound healing was poor in one patient. There was no transfused case and wound problem in the experimental group. All wounds were healed normally. (5) There was no infection or hematoma in two groups. (6) With the modified procedure, we could reduce blood loss during total knee arthroplasty without blood transfusion after surgery, which was helpful to postoperative rehabilitation.
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Objective To expand the influence and promotion effect of the grassroots health demonstration base of appropriate technology at county level,explore the practice model for full coverage.Methods Four consortium and eight units in the county were engaged into the whole process,the whole cycle,synchronous implementation;the promotion practices were divided into different stages with different focuses based on priority setting;Stratified training,classified promotion strategies were involved to carry out the appropriate technology for all 11 items covered.Results The technical promotion training,technical promotion applications were completed with full coverage in the county,gained high satisfaction from both medical staff and public.Enhanced the technology radiation ability,also the base's annual development was increasing year by year.Conclusions The base construction full coverage promotion experiences can be shared and learned by other areas which aims for the promotion of fit health techniques.
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<p><b>OBJECTIVE</b>To examine the associations of apparent diffusion coefficient (ADC) value from MR diffusion-weighted imaging (DWI) with Ki-67 expression and differentiation grade in gastric cancer.</p><p><b>METHODS</b>Images and pathologic data of 68 gastric cancer patients between September 2013 and February 2015 in Affiliated Changshu Hospital of Soochow University were analyzed retrospectively. The expression of Ki-67 antigen in cancer tissue sample was determined by immunohistochemistry. Ki-67 labeling index(LI) was calculated to divide the cases into low Ki-67 group(Ki-67 LI <50%) and high Ki-67 group (Ki-67 LI ≥ 50%). Associations of ADC value with differentiation grade and Ki-67 LI were examined.</p><p><b>RESULTS</b>Mean ADC value of low Ki-67 LI group was significantly higher than that of high Ki-67 LI group [(0.977 ± 0.100) × 10(-3) mm(2)/s vs. (0.859 ± 0.064) × 10(-3) mm(2)/s, P=0.000]. The ADC value was negatively correlated with Ki-67 LI (r=-0.685, P=0.000). Mean ADC value of well differentiated adenocarcinoma, moderately differentiated adenocarcinoma, poorly differentiated adenocarcinoma, and signet-ring cell carcinoma was (1.124 ± 0.080) × 10(-3) mm(2)/s, (0.950 ± 0.064) × 10(-3) mm(2)/s, (0.899 ± 0.091) × 10(-3) mm(2)/s, and (0.894 ± 0.081) × 10(-3) mm(2)/s respectively. Difference of ADC value among differentiation grades was significantly different (F=11.405, P=0.000). Difference of ADC value between well differentiated adenocarcinoma and non-well differentiated adenocarcinoma was significantly different(P=0.000).</p><p><b>CONCLUSION</b>ADC value is associated with differentiation grade and Ki-67 LI of gastric cancer, which may be used as a noninvasive predictor for evaluating the proliferation and differentiation grade of gastric cancer.</p>
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Humans , Adenocarcinoma , Diagnosis , Diffusion Magnetic Resonance Imaging , Ki-67 Antigen , Metabolism , Retrospective Studies , Stomach Neoplasms , DiagnosisABSTRACT
Objective To evaluate the predictive performance of diaphragm thickening fraction ( DTF) assessed by ultrasound in the feasibility of weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease ( COPD ) . Methods Forty-three patients with COPD were enrolled for prospective study.All patients were ventilated mechanically for more than 48 hours and were expected to be weaned when they met clinical criteria in the intensive care unit from February 2015 to August 2015.Patients received a spontaneous breathing trial under pressure support for 1 h.At the end of spontaneous breathing trial, the right hemi-diaphragm was visualized in the zone of apposition using a 6-13 MHz linear ultrasound probe. Diaphragm thickness was recorded at end-inspiration (DTei) and end-expiration (DTee), and the DTF was calculated as percentage from the following formula:(DTei -DTee) /DTee.Also the rapid shallow breathing index ( RSBI ) was calculated.Patients meeting weaning criteria were extubated.Weaning successfully was defined as spontaneous breathing for >48 h without any form of ventilation support.Results Twenty-five patients were weaned successfully and failure of weaning was found in 18 patients.A significant differences in DTF ( 39.66 ±13.22 )%vs.( 23.84 ±8.85 )%, P <0.05 and RSBI ( 62.74 ±26.05 ) vs.( 98.89 ± 35.44) , P <0.05 were observed between patients with successful weaning and patients with failure.The sensitivity and specificity of DTF≥30 % for successful weaning were 84% and 83.88 %, respectively.The area under the receiver operating characteristic curve was 0.872 ( 95 % CI: 0.759-0.985 ) for DTF.By comparison, when RSBI was ≤105, there was a sensitivity of 92 %, and a specificity of 38.89 % for determining successful weaning.The area under the receiver operating characteristic curve was 0.804 ( 95 %CI: 0.669-0.940) for RSBI. Conclusions This study shows that in a cohort of COPD patients, the assessment of DTF using diaphragm ultrasound may be useful to predict success weaning or failure during spontaneous breathing trial.
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Objective To investigate the morphologic characteristics of gonococcal inflammation of paraurethral glands in males. Methods Eleven male patients with gonococcal inflammation of paraurethral glands were examined by both real-time ultrasound imaging (Siemens Acuson X300) and 3.0 T magnetic resonance imaging (MRI, Philips Achieva). Results High-frequency ultrasound imaging revealed tubular echoic areas with well-defined borders and smooth margins in all the patients. The inside of these tubular areas was weak-echoic. These tubular echoic areas were blind in one end, but open in the other end, and ran in parallel with the urethra. The mean lumen diameter was 1.1 ± 0.2 mm (range, 0.7 - 1.3 mm) , and the mean lumen length was 8.4 ± 0.6 mm (range, 7.0 - 12.0 mm). Anechoic liquid-filled areas were seen in the tubular echoic areas in two patients. Paraurethral ducts were not detected by 3.0 T MRI in these patients. Conclusions High-frequency ultrasound imaging can clearly show the morphologic characteristics of gonococcal inflammation of paraurethral glands in males, and provide valuable ultrasound images for surgery.
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<p><b>OBJECTIVE</b>To investigate the value of diffusion-weighted imaging (DWI) in the diagnosis of T staging for rectal cancer.</p><p><b>METHODS</b>Clinicopathologic data and MR images of 46 patients with rectal cancer in our hospital from July 2013 to September 2014 were retrospectively analyzed. The diagnostic sensitivity, specificity and accuracy of T2WI were compared with those of T2WI plus DWI in T staging for rectal cancer. The relationship of mean apparent diffusion coefficient (ADC) value with different T stages of rectal cancer was analyzed.</p><p><b>RESULTS</b>There were no significant differences in the diagnostic sensitivity, specificity and accuracy between T2WI and T2WI plus DWI (all P>0.05). The mean ADC value of DWI performed in pathologic T2, T3a, T3b, T3c and T4 stage was (1.110 ± 0.117) × 10⁻³ mm²/s, (1.035 ± 0.121) × 10⁻³ mm²/s, (0.948 ± 0.109) × 10⁻³ mm²/s, (0.932 ± 0.122) × 10⁻³ mm²/s and (0.843 ± 0.050) × 10⁻³ mm²/s, respectively (F=6.972, P=0.000).</p><p><b>CONCLUSION</b>DWI can serve as a complement for T2WI in the diagnosis of T stage patients with rectal cancer, and its ADC value presents a downward trend with the advance of T stage.</p>
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Humans , Diffusion Magnetic Resonance Imaging , Neoplasm Staging , Rectal Neoplasms , Retrospective StudiesABSTRACT
Objective To investigate the detection rate of contrast-enhanced ultrasound (CEUS) for iso-echo liver cancers, and to evaluate the application of CEUS in treating iso-echo liver cancers with radiofrequency ablation (RFA). Methods A total of 27 patients with liver cancers (31 lesions in total) were enrolled in this study. Of the 27 patients, hepatocellular carcinoma (HCC) was seen in 11 (11 lesions) and hepatic metastasis in 16 (20 lesions). In all patients the diagnosis was detected by contrast-enhanced CT or contrast-enhanced MRI and was clinically confirmed. Under real-time CEUS guidance, RFA was carried out for all the 31 lesions. The ablated extent was evaluated by CEUS, and CEUS findings were used to guide the further treatment. Results All 31 lesions were detected by CEUS and were treated with RFA. No serious complications occurred after RFA. Both CEUS and CECT performed one month after RFA showed that complete tumor necrosis was seen in all the 31 lesions. After RFA the serum AFP levels in all 11 HCC patients fell to normal range, and the serum CEA, CA-199 as well as CA-153 levels in patients with hepatic metastasis decreased significantly(P<0.01). Conclusion CEUS can markedly increase the detection rate of iso-echo liver cancers. Besides, CEUS plays an important role in guiding the performance of RFA for iso - echo liver lesions.
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Objective The present study was designed to investigate the risk factors affecting bleeding during percutaneous nephrolithotomy. Methods The records of 218 patients with percutaneous nephrolithotomy procedure by a single surgeon were retrospectively reviewed.The mean age was 48 years ( range,19 -70).One hundred and forty six patients had staghore stones,and 7 patients had previous open or percutaneous nephrolithotomy histories.Forty-one patients had concomitant diabetes mellitus,and 89 cases had hypertension.The following factors including age,sex,BMI,diabetes status,hypertension status,stone type,calix of puncture,previous open or percutaneous nephrolithotomy history,number of accesses,size of accesses,operative time,and surgeon experience were analyzed.Univariate analysis and multivariate step regression analysis were used for statistical assessment. Results 207 procedures were successfully performed,and 11 patients failed because of difficulty to establish the accesses.Single-tract was used in 176 cases and multiple-tract was used in 31 cases.163 cases were performed via a 18 F access and 44 cases via a 24 F access.The mean operative time was 78.4 min.The overall blood transfusion rate was 7.7％,and stone type ( P =0.034),diabetes ( P =0.030),number of accesses ( P =0.019 ),size of accesses ( P =0.008) and operative time (P =0.001 ) were the risk factors affecting blood transfusion requirement.The average hemoglobin (Hb) drop after percutaneous nephrolithotomy procedures was 11.2 g/L,and stone type ( P ＜ 0.001 ),diabetes ( P =0.015 ),number of accesses ( P =0.016),size of accesses ( P ＜ 0.001 ) and operative time ( P ＜ 0.001 ) were the risk factors affecting Hb drop.The following covariates including Hb drop:age,sex,BMI,previous open or percutaneous nephrolithotomy history,hypertension status,calix of puncture and surgeon experience were not risk factors affecting blood transfusion requirement and Hb drop.Multivariate stepwise regression analysis showed that diabetes ( OR =1.75 ),stone type ( OR =1.92),number of accesses ( OR =2.45 ),size of accesses ( OR =1.32) and operative time ( OR =1.66) significantly increased risk of bleeding. Conclusions Stone type,diabetes,number of accesses,size of accesses and operative time were the risk factors affecting blood loss during percutaneous nephrolithotomy.
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Objective To study the expression of enhancer of zeste homolog 2 (EZH2) gene in transitional cell carcinoma (TCC) of the bladder celt lines, carcinoma tissues and normal bladder tis-sues and to evaluate the roles of EZH2 in the development and progression of bladder carcinoma. Methods RT-PCR, Western-blot and immunocytochemistry were used to analyze the expression of EZH2 of the bladder cell lines (T24, EJ, MGH-U1, BIU-87). The prostate cancer cell line PC-3M was used as an EZH2-positive cell line. EZH2 gene expressions in 45 cases of bladder carcinoma and 12 cases of normal bladder mueosa were detected by RT-PCR. Of cancer cases, 31 were superficial tumors and 14 were invasive tumors; 13 were G1, 21 were G2 and 11 were G3. Results EZH2 was detected in the 4 TCC cell lines. The EZH2 expression rate of TCC (82.2%) was significantly higher than that of normal bladder tissues (8.3%, P<0.05). The expression rate in superficial tumors was 74.2% and in invasive tumors was 100.0%, but there was no significant difference (P>0.05). The expression rates increased with tumor cell grade increase, but there was no significant difference (P> 0.05). Conclusions EZH2 could play an important role in the development and progression of blad-der carcinoma. It could be used as a potential gene therapy target of bladder cancer.
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Objective To analyze the imaging characteristics and the diagnostic value of conventional MRI and indirect MR arthrography in shoulder joint injury.Methods MR imaging in90 patients with shoulder joint disease were retrospectively analyzed by two musculoskeletal radiologist based on the results of arthroseopic examination,including 57 cases of rotator cuff disease and 33 cases of recurrent shoulder instability.The result of the indirect MR arthrography and conventional MR was statistically compared by Fisher exact probability test.Results (1)In the group of rotator cuff disease,37 patients underwent indirect MRA,demonstrating 10 cases of partial-thickness rotator cuff tear and 1 case of missed diagnosis;demonstrating 17 cases of full-thickness rotator cuff tear and 2 cases of misdiagnosis.For partialthickness rotator cuff tear,the sensitivity,specificity and accuracy of indirect MR arthrography were 90.9%(10/11),92.3%(24/26),and 91.9%(34/37),respectively;for full-thickness rotator cuff tear,the sensitivity,specificity and accuracy of indirect MR arthrography were 89.5%(17/19),94.4%(17/18),and 91.9%(34/37),respectively.Indirect MR arthrography in the diagnosis of partial and full thickness rotator cuff was significantly better than conventional MR(P＜0.05).(2)In the group of recurrent shoulder instability,labium tear was found in 26 cases,Hill-sachs lesion in 27,reverse Hill-sachs in 2,bony Bankart lesion in 7,and capsular tear in 18 cases,respectively.Twenty patients underwent indirect MRA,demonstrating 14 cases of labrum tear,1 case of missed diagnosis,and 5 cases of normal labrum.For labrum tear,the sensitivity,specificity and accuracy of indirect MR arthrography were 93.3%(14/15),100.0%(5/5),and 95.0%(19/20),respectively.Indirect MR arthrography in the diagnosis of labrum tear was significantly better than conventional MR(P＜0.05).Conclusion MRI,especially indirect MR arthrography,is the most helpful method for the diagnoses of shoulder joint injury.
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OBJECTIVE To evaluate the distribution of pathogens causing infection and current status of antimicrobial resistance in order to offer experimental data for clinical administration.METHODS The resistance tests were performed using K-B method.WHONET5.2 and EXCEL were used to analyze bacteria distribution and resistance.RESULTS From 119 cases of patients were earned the routine bacteria culture results,the tested rate was 96.75%,the positive specimens were 379 and the postitive rate was 83.85%.The strains of Pseudomonas aeruginosa were the most frequent organisms isolated then were the strains of Streptococcus pyogenes,coagulase-negative Staphylococcus,Nesseria spp,and Stenotrophomonas maltophilia.CONCLUSIONS It is important to strengthen antibiotics administration,bacteria isolation and resistance surveillance.
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OBJECTIVE To analyze the application of antibacterials in liver transplanted patients of our hospital in order to improve the rational use of antibacterials in perioperative period of liver transplantation.METHODS According to the criteria of DDD and DUI recommended by WHO,a retrospective study of the application of antibacterials in 82 patients with liver transplantation who discharged hospital during from Jun 2003 to Jun 2005 was made.RESULTS Among the 82 patients,100.0% patients had received antibacterials and 48 patients received combined medication,in which 45.10% used two kinds and 13.41% used three kinds.The longest medication time was 49 days while the shortest was 10 days.Nineteen antibacterials′ DUI were all less than one except meropenem whose DUI was 1.03.CONCLUSIONS This study proved that patients with liver transplantation in our hospital received rational antibacterials.
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Objective To evaluate the diagnostic value of indirect MR arthrography(MRA) and conventional MR for shoulder instability.Methods 24 cases of shoulder instability were retrospectively analyzed.13 patients underwent conventional MR,11 patients underwent indirect MRA.Based on the results of arthroscopic examination,the efficacy of indirect MRA images and conventional MR images in diagnosis of the labrum,the capsule, and the bone structure injury.Results Indirect MRA in diagnosis of labrum tear was signifiantly better than conventional MR(P0.05).Conclusion Indirect MRA is more helpful to diagnose the labrum tear than conventional MR.Further study should be taken for capsule and ligament injury.
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[Objective] To observe the inhibitory effect of acupuncture combined with herbal medicine on hyperplasia of mammary glands in rats. [Methods] Rats were randomized into 6 groups: A (normal) , B (model) , C (acupuncture) , D ( herbal medicine), E (acupuncture combined with herbal medicine) and F (triphenyloxamine) . Rat models of hyperplasia of mammary glands in Group B, C, D, E and F were established by intramuscular injection of estradial benzoate and progesterone. Nipple height in rats were detected before and after treatment. The number of acini in each lobule, the diameter of acinar cavity and duct in the second pair of mammary glands were calculated under light microscope. The expression of estrogen receptor (ER) and progesterone receptor (PR) in the tissues of mammary gland were examined by immunohistochemical method after treatment. [Results] Nipple height in group B was more than that in group A and the scores of ER and PR expressions were also higher (P
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The content of carboxylate ions in marine sulfate polysaccharide 911 was determined by conductometric titration. In the mean while, the sample was transformed with cation exchange resin,the molar ratio of sufate ions to carboxylate ions was determined. The results showed that conductometric titration is a simple,rapid and accurate method.