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1.
J. bras. pneumol ; 48(1): e20210337, 2022. tab, graf
Article in English | LILACS | ID: biblio-1365042

ABSTRACT

ABSTRACT Objective: VEGF-D is a potential biomarker for lymphangioleiomyomatosis (LAM); however, its diagnostic performance has yet to be systematically studied. Methods: We searched PubMed, EMBASE, Scopus, Web of Science, and Cochrane Library to identify primary studies on VEGF-D in relation to the diagnosis of LAM. The quality of the studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Summary estimates of diagnostic accuracy were pooled using a bivariate random effects model. Subgroup and sensitivity analyses were performed to explore possible heterogeneity. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was applied to rate the quality of evidence and indicate the strength of recommendations. Results: Ten studies involving 945 patients were of high risk in quality, as assessed using the QUADAS-2. The pooled diagnostic parameters were indicated as follows: sensitivity = 0.82 (95% CI, 0.71-0.90); specificity = 0.98 (95% CI, 0.94-0.99); and diagnostic OR = 197 (95% CI, 66-587). The AUC of summary ROC analysis was 0.98. The subgroup and sensitivity analyses revealed that the overall performance was not substantially affected by the composition of the control group, prespecified cutoff value, the country of origin, or different cutoff values (p > 0.05 for all). A strong recommendation for serum VEGF-D determination to aid in the diagnosis of LAM was made according to the GRADE. Conclusions: VEGF-D seems to have great potential implications for the diagnosis of LAM in clinical practice due to its excellent specificity and suboptimal sensitivity.


RESUMO Objetivo: O VEGF-D é um potencial biomarcador para linfangioleiomiomatose (LAM); entretanto, seu desempenho diagnóstico ainda não foi sistematicamente estudado. Métodos: Foram realizadas buscas nos bancos de dados PubMed, EMBASE, Scopus, Web of Science e Cochrane Library para identificar estudos primários sobre o VEGF-D com relação ao diagnóstico de LAM. A qualidade dos estudos foi avaliada por meio da ferramenta Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). As estimativas sumárias de acurácia diagnóstica foram combinadas utilizando um modelo bivariado de efeitos aleatórios. Análises de subgrupo e de sensibilidade foram realizadas para explorar possíveis heterogeneidades. O sistema Grading of Recommendations Assessment, Development, and Evaluation (GRADE) foi aplicado para avaliar a qualidade das evidências e indicar a força das recomendações. Resultados: Dez estudos envolvendo 945 pacientes eram de alto risco em qualidade, segundo a ferramenta QUADAS-2. Os parâmetros diagnósticos combinados foram indicados da seguinte forma: sensibilidade = 0,82 (IC95%: 0,71-0,90); especificidade = 0,98 (IC95%: 0,94-0,99); e OR diagnóstica = 197 (IC95%: 66-587). A ASC da análise summary ROC foi de 0,98. As análises de subgrupo e de sensibilidade revelaram que o desempenho global não foi substancialmente afetado pela composição do grupo controle, valor de corte pré-especificado, país de origem ou diferentes valores de corte (p > 0,05 para todos). Uma forte recomendação para a dosagem de VEGF-D sérico para auxiliar no diagnóstico de LAM foi feita de acordo com o sistema GRADE. Conclusões: O VEGF-D parece ter grandes implicações potenciais para o diagnóstico de LAM na prática clínica em virtude da excelente especificidade e sensibilidade subótima.


Subject(s)
Humans , Lymphangioleiomyomatosis/diagnosis , Biomarkers , ROC Curve , Sensitivity and Specificity , Vascular Endothelial Growth Factor D
2.
Article in Chinese | WPRIM | ID: wpr-911946

ABSTRACT

Objective:To explore the role of parental origin verification in chromosomal microarray analysis (CMA) on the determination of the clinical significance of copy number variations (CNVs).Methods:This retrospective study collected clinical information from 73 core families who underwent prenatal diagnosis at Peking University First Hospital from November 2017 to December 2019. Indications for prenatal diagnosis included ultrasound abnormality in 54 cases (including 12 with thickened nuchal translucency (≥2.5 mm), four with fetal growth restriction, seven with abnormal pregnancy history, and 31 with isolated ultrasound abnormality), NIPT indicated high-risk in four cases, advanced age in nine cases, abnormal pregnancy history alone in three cases, intrauterine death in two cases and one with maternal mental retardation. Genomic DNA of amniotic fluid sample, chorionic villi, cord blood, fetal tissues, and fetal heart blood were extracted using genomic DNA extraction kit. The CNVs of prenatal samples in 73 subjects were analyzed using array-based comparative genomic hybridization (array-CGH) analysis and single nucleotide polymorphism array (SNP-array). Peripheral blood DNA of the couples, and relevant families if necessary, were collected and analyzed in the same way. The results of parental origin detection in CMA were summarized.Results:A total of 76 CNVs were detected in these 73 samples, out of which nine were pathogenic and parental origin detection revealed that six were de novo, two were maternally, and one was paternally inherited; six CNVs were likely pathogenic, including three de novo, two maternally inherited and one paternally inherited; 20 CNVs were variants of uncertain significance, including five paternally inherited, three maternally inherited and 12 de novo; 41 CNVs were likely benign, among which 38 were inherited from parents with normal phenotype. Conclusions:Parental origin verification plays an important role in explaining the clinical significance of detected fetal CNVs and thereby can help to analyze its clinical effect and reproductive risk.

3.
Chinese Journal of Dermatology ; (12): 927-930, 2021.
Article in Chinese | WPRIM | ID: wpr-911534

ABSTRACT

Lamotrigine is a new type of drug for the treatment of epilepsy, bipolar affective disorder and neuralgia. Drug eruptions are the common adverse reaction to lamotrigine, such as fixed drug eruption, acute generalized exanthematous pustulosis, toxic epidermal necrolysis, drug-induced hypersensitivity syndrome, etc. The pathogenesis of lamotrigine-induced drug eruptions includes immune and non-immune mechanisms. HLA alleles are related to drug eruptions caused by lamotrigine, and their relationship varies with the race of populations and type of drug eruptions. This review summarizes the etiology, pathogenesis and clinical characteristics of drug eruptions caused by lamotrigine, aiming to guide clinical treatment.

4.
Article in Chinese | WPRIM | ID: wpr-910434

ABSTRACT

Objective:To verify the reliability, accuracy and stability of the machine performance check (MPC) system of Varian′s TrueBeam series accelerator.Methods:After the installation was completed, the acceptance data were compared with the results of the first MPC operation to verify the reliability of the MPC results; the accuracy of the MPC results in the image-guided radiotherapy (IGRT) application was verified by the method of artificially introducing errors. The mechanical performance results of 60 groups of MPC from March 2019 to March 2020 were collected to calculate the mean value and standard deviation and compare the stability differences of each index.Results:The equipment error parameters obtained by MPC were all lower than those obtained by acceptance. The maximum difference between two sets of data was only 2mm and the threshold ratio was less than 20%. MPC had a high sensing accuracy for radiation and imaging position shift, and the r values were more than 90%. The vertical direction of the couch had a poor sense of displacement accuracy, and the r value was less than 73.7%. For this verification project, the angle of the treatment bed was the most stable, and the standard deviation did not exceed 0.01. The stability of other indexes did not significantly differ.Conclusions:MPC can be used as a verification tool for routine quality assurance of IGRT. The verification accuracy of radiation and imaging centers are better than the mechanical accuracy of gantry, collimator and couch.

5.
Psychiatry Investigation ; : 763-769, 2021.
Article in English | WPRIM | ID: wpr-903175

ABSTRACT

Objective@#The connectivity alterations in the putamen were found in revealing the neural correlates of attention-deficit/hyperactivity disorder (ADHD), but whether the effective connectivity of the putamen is atypical in ADHD remains unclear. Investigating this abnormality contributes to describing the neural circuit of ADHD at the level of macrostructural organization. @*Methods@#Data were acquired from thirty-two boys with ADHD and fifty-two matched typically developing controls (TDC) from Peking University (Peking) dataset deposited at the Neuroimaging Informatics Tools and Resources Clearinghouse (NITRC) platform. We examined the effective connectivity of the putamen using Granger causality analysis (GCA) and then determined whether these connections could differentiate ADHD from TDC. @*Results@#Compared with TDC, the ADHD group showed decreased effective connectivity from the left ventral rostral putamen (VRP) to left calcarine (CAL), right medial part of the superior frontal gyrus, left orbital part of superior frontal gyrus and left middle occipital gyrus (MOG). Increased effective connectivity from the left inferior occipital gyrus and right lingual gyrus to left VRP was also found in ADHD. The result of the classification accuracy showed that 72.3% of participants were correctly classified using support vector machine. Moreover, GCA values from the left VRP to left CAL and left MOG were significantly correlated with hyper/impulsive scores of patients with ADHD. @*Conclusion@#The findings may help extend our understanding of the ADHD-related neural loops.

6.
Psychiatry Investigation ; : 763-769, 2021.
Article in English | WPRIM | ID: wpr-895471

ABSTRACT

Objective@#The connectivity alterations in the putamen were found in revealing the neural correlates of attention-deficit/hyperactivity disorder (ADHD), but whether the effective connectivity of the putamen is atypical in ADHD remains unclear. Investigating this abnormality contributes to describing the neural circuit of ADHD at the level of macrostructural organization. @*Methods@#Data were acquired from thirty-two boys with ADHD and fifty-two matched typically developing controls (TDC) from Peking University (Peking) dataset deposited at the Neuroimaging Informatics Tools and Resources Clearinghouse (NITRC) platform. We examined the effective connectivity of the putamen using Granger causality analysis (GCA) and then determined whether these connections could differentiate ADHD from TDC. @*Results@#Compared with TDC, the ADHD group showed decreased effective connectivity from the left ventral rostral putamen (VRP) to left calcarine (CAL), right medial part of the superior frontal gyrus, left orbital part of superior frontal gyrus and left middle occipital gyrus (MOG). Increased effective connectivity from the left inferior occipital gyrus and right lingual gyrus to left VRP was also found in ADHD. The result of the classification accuracy showed that 72.3% of participants were correctly classified using support vector machine. Moreover, GCA values from the left VRP to left CAL and left MOG were significantly correlated with hyper/impulsive scores of patients with ADHD. @*Conclusion@#The findings may help extend our understanding of the ADHD-related neural loops.

7.
Acta Pharmaceutica Sinica B ; (6): 3105-3119, 2021.
Article in English | WPRIM | ID: wpr-922783

ABSTRACT

Pulmonary fibrosis (PF) is a chronic, progressive, fatal interstitial lung disease with limited available therapeutic strategies. We recently reported that the protein kinase glycogen synthase kinase-3

8.
Korean Journal of Radiology ; : 1841-1849, 2021.
Article in English | WPRIM | ID: wpr-918201

ABSTRACT

Objective@#To prospectively investigate the feasibility of shear wave elastography (SWE) as a new quantitative and objective method for evaluating the stiffness of the gastrocnemius medialis (GM) muscle during passive stretching in patients with Parkinson’s disease (PD). @*Materials and Methods@#SWE of the GM muscle was performed in 28 patients with PD [13 female and 15 male; mean age ± standard deviation (SD): 63.0 ± 8.5 years] and 12 healthy controls (5 female and 7 male; mean age ± SD: 59.3 ± 6.4 years) during passive ankle rotation. A Young’s modulus-ankle angle curve was constructed. The GM slack angle and baseline Young’s modulus (E 0) were compared between the markedly symptomatic and mildly symptomatic sides of patients with PD, and healthy controls. Additionally, the correlation between the GM slack angle and the severity of rigidity, and the observer reproducibility of SWE in determining the GM slack angle were evaluated. @*Results@#The GM slack angle was smaller on both the markedly and mildly symptomatic sides in patients with PD than in healthy controls (mean ± SD of -29.13° ± 3.79° and -25.65° ± 3.39°, respectively, vs. -21.22° ± 3.52°; p < 0.001 and p = 0.006, respectively). Additionally, in patients with PD, the GM slack angle on the markedly symptomatic side was smaller than that on the mildly symptomatic side (p = 0.003). The E 0 value was lower on both the markedly and mildly symptomatic sides in patients with PD than in healthy controls (mean ± SD of 10.11 ± 2.85 kPa and 10.08 ± 1.88 kPa, respectively, vs. 12.23 ± 1.02 kPa; p = 0.012 and p < 0.001, respectively). However, no significant difference was found between the markedly and mildly symptomatic sides in patients with PD (p = 0.634). A negative linear relationship was observed between the GM slack angle and lower limb rigidity score on the markedly symptomatic side in patients with PD (r = -0.719; p < 0.001). The intraclass correlation coefficients for observer reproducibility of SWE ranged from 0.880 to 0.951. @*Conclusion@#The slack angle determined by SWE may be a useful quantitative and reproducible method for evaluating muscle stiffness in patients with PD.

9.
J Cancer Res Ther ; 2020 Jan; 15(6): 1435-1449
Article | IMSEAR | ID: sea-213553

ABSTRACT

Molecular target anticancer drugs are commonly used in various forms of cancers. It is a concern that the risk of serious adverse events (SAEs) and fatal adverse events (FAEs) of molecular target drugs are increasing. An up-to-date meta-analysis of all Phase II/III/IV randomized trials of molecular target anticancer drugs was conducted to calculate the increased risk of SAEs and FAEs. A systematic search of PubMed, Web of Science, and Cochrane Library up to April 6, 2017, was conducted. The study enrolled Phase II/III/IV randomized trials of cancer that compared molecular target drugs alone versus placebo or performed single-arm analysis of molecular target drugs. Data on SAEs and FAEs were extracted from the included studies and pooled to compute risk ratio (RR), the overall incidence, and 95% confidence interval (CI). In this meta-analysis, a total of 19,965 and 26,642 patients in randomized 53 and 65 Phase II/II/IV trials were included in the analysis of SAEs and FAEs associated with molecular target anticancer drug, respectively. There were significant differences in the relationship of molecular target anticancer drugs with SAEs (RR = 1.57, 95% CI = 1.35–1.82, P < 0.01, I2 = 81%) and FAEs (RR = 1.51, 95% CI = 1.19–1.91, P < 0.01, I2 = 0%) compared to placebo. The overall incidence of SAEs and FAEs was 0.269 (95% CI = 0.262–0.276, P < 0.01) and 0.023 (95% CI = 0.020–0.025, P < 0.01), respectively. Molecular target anticancer drugs significantly increased the risk of SAEs and FAEs. For patients taking molecular target drugs, efforts are needed to prevent the occurrence of SAEs and FAEs

10.
Article in Chinese | WPRIM | ID: wpr-787722

ABSTRACT

The aim of this study is to investigate the effect of CO2 laser cordectomy on the voice of early glottic carcinoma. A retrospective analysis of 40 patients who underwent CO2 laser treatment early glottis preoperative clinical data of postoperative laryngeal cancer patients, patients with postoperative recurrence rate, survival rate, and the postoperative complications of patients with preoperative and postoperative laryngoscopy, voice disorders index(voice handicap index, VHI) simplified Chinese version(VHI 13) rating scale, affecting the stability sound quality postoperatively in patients with laryngeal cancer were discussed. All patients underwent voice reexamination 8-97 months after surgery, and the survival rate was 100%, no local recurrence and no obvious postoperative complications. Compared with the healthy control group, there were statistically significant differences in the four indicators F0(fundamental frequency), Jitter(fundamental frequency perturbation), Shimmer(amplitude perturbation) and MPT(maximum pronunciation time), suggesting that CO2 laser surgery resulted in significant changes in acoustic parameters. Jitter and Shimmer indexes in the pre involved combined group were statistically significant different from those in the non involved combined group, suggesting that the sound quality of the pre involved combined group was worse in the postoperative stability period. The VHI score indicated that most patients with early glottic cancer were in severe voice disorder before operation and most were in moderate voice disorder after operation. Compared with the healthy control group, the VHI score and total score of the healthy control group were lower in terms of physiology, psychology and emotion. Compared with the healthy control group, the VHI score and physiology of the early glottic laryngeal cancer patients were lower in the early glottic laryngeal cancer patients before and after surgery, and they were statistically significant. CO2 laser surgery for early glottic cancer, the overall survival rate of patients, low recurrence rate, fewer complications, CO2 laser surgery led to significant changes in acoustic parameters, postoperative sound quality and whether the involvement of pre-associated factors; The total score of VHI and physiological score of early glottic carcinoma patients after CO2 laser operation were better than those before operation.

11.
Rev Assoc Med Bras (1992) ; 66(Suppl 2): 41-47, 2020. graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1136384

ABSTRACT

SUMMARY Since the outbreak of a cluster of patients with pneumonia of unknown cause in Wuhan, Hubei Province, China, in December 2019, the disease was later officially named coronavirus disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2), quickly spreading globally. Pregnant women and children are particularly vulnerable during disasters and emergencies. Comprehensive and applicable emergency preparedness and response are definitely important methods to prevent and contain the COVID-19 pandemic. The rational allocation of pharmaceutical resources plays an important role in the medical emergency plan. This paper aimed to share experiences for the allocation of pharmaceutical resources in hospitals focusing primarily on women and children during the COVID-19 pandemic.


RESUMO Desde o aparecimento de um aglomerado de doentes com pneumonia de causa desconhecida em Wuhan, província de Hubei, China, em dezembro de 2019, a doença foi mais tarde oficialmente nomeada doença do coronavírus 2019 (Covid-19), causada pelo novo vírus da síndrome respiratória aguda grave coronavírus (Sars-CoV-2), que rapidamente se espalhou em nível mundial. As mulheres grávidas e as crianças são particularmente vulneráveis durante catástrofes e emergâncias. A preparação e a resposta de emergência abrangentes e aplicáveis são métodos definitivamente importantes para prevenir e conter a pandemia de Covid-19. A alocação racional dos recursos farmacêuticos desempenha um papel importante no plano de emergência médica. Este documento objetivou compartilhar experiências para a alocação de recursos farmacêuticos em hospitais focando principalmente mulheres e crianças durante a pandemia de Covid-19.


Subject(s)
Humans , Female , Pregnancy , Child , Pneumonia, Viral , Pharmaceutical Preparations/supply & distribution , Coronavirus , Resource Allocation/statistics & numerical data , Maternal-Child Health Centers/organization & administration , China , Coronavirus Infections , Pandemics , Betacoronavirus
12.
Article in Chinese | WPRIM | ID: wpr-870004

ABSTRACT

Objective:To evaluate the association between NLRP2(NLR Family Pyrin Domain Containing 2) gene polymorphisms and classical type 1 diabetes mellitus(T1DM) in Chinese Han population.Methods:A case-control study was conducted in 510 classical T1DM patients from the Department of Metabolism and Endocrinology in the Second Xiangya Hospital affiliated to Central South University and 531 healthy controls in this region. The polymorphisms of rs1043673 in NLRP2 gene were analyzed by MassARRAY. Mann- Whitney U test and χ2 test were used to compare the differences between patients and controls. Logistic regression analysis and χ2 test were performed to compare the distributions of the alleles and genotypes between T1DM patients and controls. Kruskal- Wallis H test was used to compare the clinical characteristics of different genotypes in T1D patients. Results:The differences of the allele and genotype distributions in rs1043673 of NLRP2 gene were not significant between patients and controls. The polymorphisms of rs1043673 were associated with fasting C-peptide( P=0.029), postprandial 2-h C-peptide( P=0.017), and titer of GADA( P=0.043) in T1DM patients. Conclusion:The polymorphisms of NLRP2 gene were associated with the characteristics of T1DM patients.

13.
Article in Chinese | WPRIM | ID: wpr-868895

ABSTRACT

Disulfiram, a drug that has been used for alcohol dependence. As an approved drug in clinical medicine, disulfiram can be used as the anticancer drug in the treatment of breast cancer, prostate cancer, glioblastoma, lung cancer, etc. This paper summarized the mechanism of disulfiram for anticancer treatment and the function for liver cancer therapy, and we also analyzed the potential mechanism of disulfiram for the treatment of liver cancer and its’ value in the clinical application.

14.
Article in Chinese | WPRIM | ID: wpr-865942

ABSTRACT

With the development of social economy and the transformation of modern medical models as the background, this paper expounds the importance of improving medical students' doctor-patient communication ability in terms of that doctor-patient communication can be helpful for doctors to deeply understand the illness, make accurate diagnosis, improve doctor-patient relationship, and reduce medical disputes. By analyzing the current situation and existing problems of doctor-patient communication teaching at home and abroad, the paper puts forward some suggestions on strengthening the training of medical students' doctor-patient communication ability from four aspects: cultivating professional communication skills, establishing multi-disciplinary teaching teams, adopting diversified teaching forms and formulating systematic evaluation system.

15.
Article in Chinese | WPRIM | ID: wpr-799334

ABSTRACT

Objective@#To evaluate the association between NLRP2(NLR Family Pyrin Domain Containing 2) gene polymorphisms and classical type 1 diabetes mellitus(T1DM) in Chinese Han population.@*Methods@#A case-control study was conducted in 510 classical T1DM patients from the Department of Metabolism and Endocrinology in the Second Xiangya Hospital affiliated to Central South University and 531 healthy controls in this region. The polymorphisms of rs1043673 in NLRP2 gene were analyzed by MassARRAY. Mann-Whitney U test and χ2 test were used to compare the differences between patients and controls. Logistic regression analysis and χ2 test were performed to compare the distributions of the alleles and genotypes between T1DM patients and controls. Kruskal-Wallis H test was used to compare the clinical characteristics of different genotypes in T1D patients.@*Results@#The differences of the allele and genotype distributions in rs1043673 of NLRP2 gene were not significant between patients and controls. The polymorphisms of rs1043673 were associated with fasting C-peptide(P=0.029), postprandial 2-h C-peptide(P=0.017), and titer of GADA(P=0.043) in T1DM patients.@*Conclusion@#The polymorphisms of NLRP2 gene were associated with the characteristics of T1DM patients.

16.
Article in Chinese | WPRIM | ID: wpr-821528

ABSTRACT

Objective@#The aim of this study is to investigate the effect of CO2 laser cordectomy on the voice of early glottic carcinoma. @*Method@#A retrospective analysis of 40 patients who underwent CO2 laser treatment early glottis preoperative clinical data of postoperative laryngeal cancer patients, patients with postoperative recurrence rate, survival rate, and the postoperative complications of patients with preoperative and postoperative laryngoscopy, voice disorders index(voice handicap index, VHI) simplified Chinese version(VHI 13) rating scale, affecting the stability sound quality postoperatively in patients with laryngeal cancer were discussed. @*Result@#All patients underwent voice reexamination 8-97 months after surgery, and the survival rate was 100%, no local recurrence and no obvious postoperative complications. Compared with the healthy control group, there were statistically significant differences in the four indicators F0(fundamental frequency), Jitter(fundamental frequency perturbation), Shimmer(amplitude perturbation) and MPT(maximum pronunciation time), suggesting that CO2 laser surgery resulted in significant changes in acoustic parameters. Jitter and Shimmer indexes in the pre involved combined group were statistically significant different from those in the non involved combined group, suggesting that the sound quality of the pre involved combined group was worse in the postoperative stability period. The VHI score indicated that most patients with early glottic cancer were in severe voice disorder before operation and most were in moderate voice disorder after operation. Compared with the healthy control group, the VHI score and total score of the healthy control group were lower in terms of physiology, psychology and emotion. Compared with the healthy control group, the VHI score and physiology of the early glottic laryngeal cancer patients were lower in the early glottic laryngeal cancer patients before and after surgery, and they were statistically significant. @*Conclusion@#CO2 laser surgery for early glottic cancer, the overall survival rate of patients, low recurrence rate, fewer complications, CO2 laser surgery led to significant changes in acoustic parameters, postoperative sound quality and whether the involvement of pre-associated factors; The total score of VHI and physiological score of early glottic carcinoma patients after CO2 laser operation were better than those before operation.

17.
Rev. Assoc. Med. Bras. (1992) ; 65(3): 355-360, Mar. 2019. graf
Article in English | LILACS | ID: biblio-1003039

ABSTRACT

SUMMARY OBJECT: To explore the treatment effect of the anterior medial neurovascular interval approach to coronal shear fractures of the distal humerus. METHODS: This prospective study included two female patients who were 30-64 years old, with a mean age of 47 years. Fractures were caused by falling from a bicycle. The time between the injury and operation was 1-2 days, with a mean time interval of 1.5 days. Two patients with coronal shear fracture of the distal humerus were treated with open reduction and internal fixation using anterior neurovascular interval approach. RESULTS: There were no intraoperative and postoperative neurological and vascular complications or infections, and the fracture was united. At 12 months after the surgery, the patient returned to work without pain, and with a normal range of motion for elbow and forearm rotation. The X-rays revealed excellent fracture union, no signs of heterotopic ossification, and no traumatic arthritis. According to Mayo's evaluation standards for elbow function, a score of 100 is excellent. CONCLUSIONS: The application of the anterior neurovascular interval approach of the elbow in the treatment of shear fracture of the articular surface of the distal humerus, particularly the trochlea of the humerus, can reduce the stripping of the soft tissue.


RESUMO OBJETIVO: Explorar o efeito do tratamento com uma abordagem anterior do intervalo neurovascular médio para fraturas de cisalhamento coronal da porção distal do úmero. METODOLOGIA: Este estudo prospectivo incluiu duas pacientes do sexo feminino de 30-64 anos de idade, com idade média de 47 anos. As fraturas foram causadas por quedas de bicicleta. O tempo entre a lesão e a operação foi de 1-2 dias, com um intervalo de tempo médio de 1,5 dias. Duas pacientes com cisalhamento coronal da porção distal do úmero foram tratadas com redução aberta e fixação interna utilizando a abordagem anterior do intervalo neurovascular. RESULTADOS: Não houve complicações neurológicas e vasculares intra e pós-operatórias, nem complicações ou infecções, e a fratura foi unida. Após 12 meses da cirurgia, as pacientes retornaram ao trabalho sem dor e com uma amplitude normal de movimento de rotação do antebraço e cotovelo. Os raios-X revelaram excelente união das fraturas, sem sinais de ossificação heterotópica e sem artrite traumática. De acordo com as diretrizes da clínica Mayo para avaliação da função do cotovelo, uma pontuação de 100 é considerada excelente. CONCLUSÃO: A aplicação da abordagem anterior do intervalo neurovascular do cotovelo no tratamento de uma fratura de cisalhamento da superfície articular da porção distal do úmero, especificamente da tróclea do úmero, pode reduzir o desgaste do tecido mole.


Subject(s)
Humans , Female , Adult , Vascular Surgical Procedures/methods , Neurosurgical Procedures/methods , Elbow Joint/surgery , Fracture Fixation, Internal/methods , Humeral Fractures/surgery , Humerus/injuries , Time Factors , Prospective Studies , Reproducibility of Results , Follow-Up Studies , Treatment Outcome , Humeral Fractures/physiopathology , Humerus/physiopathology , Medical Illustration , Middle Aged
18.
Frontiers of Medicine ; (4): 365-377, 2019.
Article in English | WPRIM | ID: wpr-771270

ABSTRACT

Invasive fungal disease (IFD) is a major infectious complication in patients with hematological malignancies. In this study, we examined 4889 courses of chemotherapy in patients with hematological diseases to establish a training dataset (n = 3500) by simple random sampling to develop a weighted risk score for proven or probable IFD through multivariate regression, which included the following variables: male patients, induction chemotherapy for newly diagnosed or relapsed disease, neutropenia, neutropenia longer than 10 days, hypoalbuminemia, central-venous catheter, and history of IFD. The patients were classified into three groups, which had low (0-10, ~1.2%), intermediate (11-15, 6.4%), and high risk ( > 15, 17.5%) of IFD. In the validation set (n = 1389), the IFD incidences of the groups were ~1.4%, 5.0%, and 21.4%. In addition, we demonstrated that antifungal prophylaxis offered no benefits in low-risk patients, whereas benefits were documented in intermediate (2.1% vs. 6.6%, P = 0.007) and high-risk patients (8.4% vs. 23.3%, P = 0.007). To make the risk score applicable for clinical settings, a pre-chemo risk score that deleted all unpredictable factors before chemotherapy was established, and it confirmed that anti-fungal prophylaxis was beneficial in patients with intermediate and high risk of IFD. In conclusion, an objective, weighted risk score for IFD was developed, and it may be useful in guiding antifungal prophylaxis.

19.
Article in English | WPRIM | ID: wpr-773387

ABSTRACT

OBJECTIVE@#This study aimed to characterize the diagnostic and vaccine potential of a novel Mycobacterium tuberculosis antigen Rv0674.@*METHODS@#To evaluate the diagnostic potential and antigenicity of Rv0674, IgG was evaluated using ELISA and interferon (IFN)-γ was done by using ELISpot assay among TB patients and healthy donors. For immunogenicity evaluation, BALB/c mice were immunized with Rv0674. Cytokine production was determined by cytokine release assay using an ELISA kit, and the antibodies were tested using ELISA.@*RESULTS@#The results of serum Elisa tests showed that Rv0674 specific immunoglobulin G (IgG) response was higher in TB patients than negative controls. And Rv0674 had good performance in serological test with sensitivity and specificity of 77.1% and 81.1%, respectively. While it shows poor sensitivity and specificity of 26.23% and 79.69% for IFN-γ tests. In BALB/c mice, Rv0674 adjuvant by DDA/Poly I:C could also induce a high level of IFN-γ, interleukin-2 and interleukin-6 as well as a high IgG titer in both high- and low-dose groups indicating that Rv0674 is essential in humoral and cellular immunity. Moreover, the cytokine profile and IgG isotype characterized Rv0674 as a Th1/Th2-mixed-type protective immunity with the predominance of Th1 cytokines.@*CONCLUSION@#Rv0674 may be a good potential candidate for the development of TB serological diagnosis and a new TB vaccine.


Subject(s)
Adult , Aged , Animals , Antigens, Bacterial , Allergy and Immunology , Female , Humans , Immunity, Cellular , Immunity, Humoral , Male , Mice , Mice, Inbred BALB C , Middle Aged , Tuberculosis , Diagnosis , Allergy and Immunology , Young Adult
20.
Article in English | WPRIM | ID: wpr-772938

ABSTRACT

The activation mechanism of chimeric antigen receptor (CAR)-engineered T cells may differ substantially from T cells carrying native T cell receptor, but this difference remains poorly understood. We present the first comprehensive portrait of single-cell level transcriptional and cytokine signatures of anti-CD19/4-1BB/CD28/CD3ζ CAR-T cells upon antigen-specific stimulation. Both CD4 helper T (T) cells and CD8 cytotoxic CAR-T cells are equally effective in directly killing target tumor cells and their cytotoxic activity is associated with the elevation of a range of T1 and T2 signature cytokines, e.g., interferon γ, tumor necrotic factor α, interleukin 5 (IL5), and IL13, as confirmed by the expression of master transcription factor genes TBX21 and GATA3. However, rather than conforming to stringent T1 or T2 subtypes, single-cell analysis reveals that the predominant response is a highly mixed T1/T2 function in the same cell. The regulatory T cell activity, although observed in a small fraction of activated cells, emerges from this hybrid T1/T2 population. Granulocyte-macrophage colony stimulating factor (GM-CSF) is produced from the majority of cells regardless of the polarization states, further contrasting CAR-T to classic T cells. Surprisingly, the cytokine response is minimally associated with differentiation status, although all major differentiation subsets such as naïve, central memory, effector memory, and effector are detected. All these suggest that the activation of CAR-engineered T cells is a canonical process that leads to a highly mixed response combining both type 1 and type 2 cytokines together with GM-CSF, supporting the notion that polyfunctional CAR-T cells correlate with objective response of patients in clinical trials. This work provides new insights into the mechanism of CAR activation and implies the necessity for cellular function assays to characterize the quality of CAR-T infusion products and monitor therapeutic responses in patients.


Subject(s)
Antigens , Metabolism , CTLA-4 Antigen , Metabolism , Cell Differentiation , Cell Line , Cytokines , Metabolism , Cytotoxicity, Immunologic , Granulocyte-Macrophage Colony-Stimulating Factor , Pharmacology , Humans , Lymphocyte Activation , Allergy and Immunology , Lymphocyte Subsets , Metabolism , Phenotype , Proteomics , Receptors, Chimeric Antigen , Metabolism , Single-Cell Analysis , Methods , T-Lymphocytes, Regulatory , Metabolism , Th1 Cells , Cell Biology , Th2 Cells , Cell Biology , Transcription, Genetic , Up-Regulation
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