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ObjectiveTo evaluate the Chinese guidelines and consensus of rehabilitation medicine published in the medical journals in 2022 using Scientific, Transparent and Applicable Rankings (STAR). MethodsGuidelines and consensus which were developed by Chinese institutions or led by Chinese scholars were retrieved in databases of CNKI, Wanfang Data, CBM, Chinese Medical Journal Network, PubMed and Web of Science, in 2022, followed by screening for rehabilitation medicine field. The literature were rated with STAR. ResultsSeven guidelines and eleven consensuses were included. The STAR scores ranged from 11.7 to 69.6, with a median score of 25.9 and mean score of 28.3. There was a significant difference in the total score between guidelines and consensus (U = 12.000, P = 0.014). The score ratio was high in the domains of recommendations (73.6%), evidence (39.5%) and others (33.3%), while it was low in the domains of protocol (1.4%), clinical questions (12.5%) and conflicts of interest (13.9%). The score ratio was high in the items of listing the institutional affiliations of all individuals involved in developing the guideline (94.4%), identifying the references for evidence supporting the main recommendations (94.4%), indicating the considerations (e.g., adverse effects) in clinical practice when implementing the recommendations (88.9%), and making the recommendations clearly identifiable, e.g., in a table, or using enlarged or bold fonts (75%); and it was low in the items of describing the role of funder(s) in the guideline development (0), indicating information about the evaluation and management of conflicts of interest (0), providing tailored editions of the guidelines for different groups of target users (0), presenting the guideline or recommendations visually, such as with figures or videos (0), providing details of the guideline protocol (2.8%), assessing the risk of bias or methodological quality of the included studies (2.8%), describing the responsibilities of all individuals or sub-groups involved in developing the guideline (5.6%), indicating how the clinical questions were selected and sorted (5.6%), formating clinical questions in PICO or other formats (5.6%), making the guideline accessible through multiple platforms (5.6%), and declaring that the funder(s) did not influence the guideline's recommendations (8.3%). ConclusionThe quality of current clinical practice guidelines and consensus of rehabilitation medicine is poor, which should be developed in accordance with the relevant standards.
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@#The implant-supported prosthesis has gradually become the preferred treatment for patients with partial edentulous or complete edentulous. Causes for the implant failure have been discussed in the majority of studies conducted in recent years, while their risk factors are still controversial. Patient factors (gender, age, smoking, osteoporosis, diabetes, medication, periodontitis and bruxism), clinical parameters (implant area, bone quality, implant size) and doctor factors (surgical-related factors, prosthesis-related factors) will all affect implant failure. This article presents typical clinical cases and reviews the potential risk factors for dental implant failure, in order to provide guidance for clinical practice.
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Objective:To evaluate pelvic floor holistic theory used in the treatment of complete rectal prolapse (CRP).Methods:Forty-two CRP patients at No. 989 Hospital between Oct 2015 and Jun 2019 were divided into group A ( n=23) treated by laparoscopic rectopexy associated with the procedure for PPH, and group B ( n=19), by Altemeier precedure. The degree of rectal prolapse, Wexner fecal incontinence score and Wexner constipation score were evaluated before operation and at the 6th,12th and 24th months after operation Results:The operation time of the two groups were (53±6) and (90±9) min; intraoperative blood loss was (14±5) and (80±19) ml; the hospital stay was (8.9±1.7) and (13.5±2.1)d, all P<0.05. There was no significant difference in postoperative recurrence between the two groups ( P>0.05). The degree of rectal prolapse in group A and B were (9.5±1.7) and (8.7±1.5)cm; the 6 th, 12 th and 24 th months after operation were [(-1.0±1.6), (-0.2±1.8)cm; (-1.0±1.3), (-0.3±1.5)cm; (-0.8±1.2), (-0.5±1.6)cm], all P<0.05. The preoperative constipation in group A and group B was (6.4±1.7) and (6.4±1.5) respectively; the 6 th, 12 th and 24 th months after operation were [(2.8±1.0) vs. (3.0±1.3); (2.6±1.1) vs. (2.8±1.3); (2.0±0.9) vs. (2.3±1.1)], all P<0.05. The preoperative fecal incontinence score of group A and group B were (7.6±1.7) vs. (7.1±1.5); the 6 th, 12 th and 24 th months after operation were [(3.7±1.7) vs. (3.4±1.2); (3.5±1.8) vs. (3.1±1.1); (3.4±1.9) vs. (2.6±1.3)], all P<0.05. Conclusion:Pelvic floor holistic theory help improve the treatment of complete rectal prolapsed.
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Objective:To explore the role of SIRT3 down-regulation in skeletal muscle injury through the changes of sirtuin 3 (SIRT3) expression in mouse skeletal muscle under iron excess in vitro or in vivo.Methods:Murine preosteoblast myoblast C2C12 cells were incubated in a medium supplemented with ferric ammonium citrate (FAC). The proliferation, apoptotic were assessed, the cell morphology was observed, and the expression of SIRT3 mRNA, protein and activity were detected. ICR mice were randomly divided into control group, FAC group and FAC+ deferrioxamine (deferoxamine, DFO) group. Normal saline was injected in the control group. FAC followed by injection of normal saline in the FAC group; and FAC followed by DFO in the FAC+ DFO group. The non-heme iron level, content of SIRT3 protein and in situ apoptosis were detected, morphology of skeletal muscle was observed.Results:Proliferation of C2C12 cells was inhibited, and the apoptotic rate were increased by FAC ( P<0.05). The mRNA, protein and activity of SIRT3 decreased by FAC ( P<0.05). The cells gradually shrank, and the length and number of myotubes were decreased by FAC. Both control and FAC+ DFO groups showed lower levels of non-heme iron in skeletal muscle compared with FAC group ( P<0.05). The levels of SIRT3 protein were decreased in FAC group compared with control group, while increased in FAC+ DFO group with FAC group ( P<0.05). The apoptotic indexes in control and FAC+ DFO groups were lower than that in FAC group. Compared with the control group, the disordered cell arrangement, fat deposition and inflammatory cell infiltration were presented in FCA group, and the change was alleviated in FAC+ DFO group. Conclusion:Iron excess can lead to the decrease of skeletal muscle mass in mice, and the mechanism may be related to the down-regulation of SIRT3 level.
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Objective:To evaluate the effect of melatonin preconditioning on hepatic ischemia-reperfusion (I/R) injury in rats with non-alcoholic fatty liver disease (NAFLD).Methods:Forty-eight SPF male Sprague-Dawley rats, aged 10-12 weeks, weighing 200-230 g, were divided into 4 groups ( n=12 each) using a random number table method: control group (Con group), NAFLD group, NAFLD + hepatic I/R group (NAFLD+ HIR group), and NAFLD + hepatic I/R + melatonin treatment group (NAFLD+ HIR+ MT group). The NAFLD model was developed by a high-fat and high-glucose diet (10% glucose, 10% fat) for 8 consecutive weeks in NAFLD, NAFLD+ HIR and NAFLD+ HIR+ M groups, and rats were fed with common chow and freely drank water in the other groups.Melatonin 10 mg/kg was given intragastrically daily for 2 consecutive weeks before developing the model in group NAFLD+ HIR+ MT.The model of liver I/R injury was developed by clipping the hepatic artery and portal vein for 20 min, opening for 5 min, and re-clamping for 20 min followed by restoration of perfusion.Blood samples from inferior vena cava were collected and liver tissues were obtained at 6 h of reperfusion to detect serum levels of insulin, blood glucose, free fatty acid (FFA), triglyceride (TG), alanine aminotransferase (ALT), aspartate amino transferase (AST) and ferritin, and insulin resistance index was calculated.The levels of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), reactive oxygen species (ROS) and Fe 2+ in liver tissues were detected by enzyme-linked immunosorbent assay, the pathological changes of liver tissues were examined with a light microscope after hematoxylin-eosin staining.The expression of nuclear factor E2-related factor 2 (Nrf2), lysophosphatidylcholine acyltransferase 3 (LPCAT3), long-chain fatty acyl-CoA synthase 4 (ACSL4) and glutathione peptide peroxidase 4 (GPX4) was detected by Western blot. Results:Compared with Con group, the levels of serum FFA, TG, ALT, AST and ferritin and insulin resistance index were significantly increased, the levels of ROS and Fe 2+ in liver tissues were increased, the levels of GSH-Px and SOD were decreased, the expression of ACSL4 and LPCAT3 was up-regulated, and the expression of Nrf2 and GPX4 was down-regulated in NAFLD group ( P<0.05). Compared with NAFLD group, the serum levels of FFA, TG, ALT, AST and ferritin and insulin resistance index were significantly increased, the levels of ROS and Fe 2+ were decreased, the levels of GSH-Px and SOD were increased, the expression of ACSL4 and LPCAT3 was up-regulated, and the expression of Nrf2 and GPX4 was down-regulated in NAFLD+ HIR group ( P<0.05). Compared with NAFLD+ HIR group, the serum levels of FFA, TG, ALT, AST and ferritin and insulin resistance index were significantly increased, the levels of ROS and Fe 2+ were decreased, the levels of GSH-Px and SOD were increased, the expression of ACSL4 and LPCAT3 was down-regulated, and the expression of Nrf2 and GPX4 was up-regulated in NAFLD+ HIR+ MT group ( P<0.05). Conclusions:Melatonin preconditioning can alleviate hepatic I/R injury in rats with NAFLD, and the mechanism may be related to activation of Nrf2 signaling pathway, reduction of lipid peroxidation and inhibition of ferroptosis.
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Objective:To analyze the influential factors of hypothermia in congenital heart disease (CHD) after cardiopulmonary bypass (CPB) rewarming using the decision tree model, thus providing theoretical basis for medical staff.Methods:A total of 711 CHD children who underwent surgery in the Shanghai Children′s Medical Center from January 1, 2019 to April 30, 2019 were retrospectively analyzed.A decision tree model was established to predict the risk factors for hypothermia in CHD children following CPB.Results:The decision tree model showed that CPB program, preoperative nutrition score and body surface area were the high-risk factors for hypothermia in CHD children after CPB rewarming.The accuracy, sensitivity, specificity of the decision tree model were 86.45%, 77.14% and 90.97%, respectively, and the area under the receiver operating characteristic curve was 0.851(95% CI: 0.798-0.904). Conclusions:Decision tree model has a high application value in predicting hypothermia in CHD children following CPB.It contributes to identify the influential factors of hypothermia, and provides references for performing preventive treatment and nursing measures to control the risk of hypothermia.
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Objective:To analyze the influenza vaccination status of chronic disease management patients in Qingpu district of Shanghai and the vaccination characteristics of different characteristic populations, so as to provide scientific basis for improving the influenza vaccination rate of chronic disease patients in the community.Methods:By comparing the data of Shanghai chronic disease management information system, immunization planning information system and medical association platform, 89 453 subjects who met the inclusion and exclusion criteria in Qingpu district were selected as the research objects. The vaccination coverage rate of the study subjects was calculated according to gender, age group, urban and rural distribution, occupation, chronic disease type and quantity, and the vaccination coverage rate of different subgroups was compared to analyze the influencing factors of vaccination coverage rate.Results:Most of the 89 453 patients with chronic diseases were 60 years old and above (71.93%). Patients with hypertension, diabetes, chronic obstructive pulmoriary disease (COPD) and three chronic diseases accounted for 87.12%, 28.67%, 8.71% and 1.83%, respectively. Influenza vaccination coverage in the 2016/2017 flu season was low, at 0.32%. Influenza vaccination coverage rate of women (0.37%) was higher than that of men (0.27%), which was 1.41 times respectively(95% CI: 1.16, 1.72) that of men patients. The coverage rate of influenza vaccination for the 70-79 year-old group was the highest (0.74%), which was 1.74 times respectively(95% CI: 1.39, 2.19) that of 60-69 year-old patients. The vaccination coverage rate of government departments and institutions was the highest (1.14%), which was 12.58 times respectively(95% CI: 4.52, 34.99) that of retirees. The vaccination rate of COPD patients (3.68%) was 2.50 times (95% CI: 1.66, 3.77) higher than that of patients without COPD.Conclusions:Influenza vaccination rate for chronic disease management patients in Qingpu district of Shanghai is low. Gender, occupation, age and types of chronic diseases are the influencing factors. Patients with chronic disease management should be included in the priority vaccination targets for influenza vaccines, and vaccination intervention for occupational chronic diseases such as non-retired agriculture and forestry patients, especially male patients, should be strengthened to improve influenza vaccination coverage rate.
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Objective:To explore the diagnostic value of magnetic resonance imaging (MRI) for patients with pathologic nipple discharge.Methods:A retrospective analysis was made on patients with nipple discharge who underwent breast MRI and surgical excision between Oct 2010 to Oct 2020. Sensitivity, speci?city, positive predictive value, and negative predictive value of MRI were calculated.Results:A total of 184 patients fulfilled our selection criteria, including breast cancer in 43 cases (23.4%), intraductal papilloma in 96 cases (52.2%) and other benign diseases in 45 cases (24.5%). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MRI for intraductal lesions of pathologic nipple discharge were respectively 76.8%, 52.2%, 82.8% and 42.9%. The sensitivity, specificity, PPV and NPV of MRI for pathologic malignant nipple discharge were respectively 97.7%, 41.1%, 33.6% and 98.3%. Among the 43 cases of breast cancer, 10 cases (23.3%) were occult malignancy with negative ultrasound and mammography and malignant lesions were detected by MRI. The sensitivity, specificity, PPV and NPV of MRI for occult malignancy were 81.8%, 53.7%, 24.4%, and 97.3%.Conclusion:MRI is a valuable additional diagnostic tool for the evaluation of pathologic nipple discharge, especially when conventional imaging is negative .
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Objective:To investigate the effect of ferroptosis on hepatic ischemia reperfusion injury in diabetic rats model.Methods:Forty Sprague Dawley rats were randomly divided into four groups: sham operation group (Sham), hepatic ischemia reperfusion group (HIRI), diabetes mellitus group (DM), diabetes mellitus + hepatic ischemia reperfusion group (DM+ HIRI). The diabetic rat model was established by feeding the rats with high-fat and high-sugar feed for four consecutive weeks combined with intraperitoneal injection of 50 mg/kg 1% streptozotocin, and on this basis, the hepatic ischemia reperfusion injury model was established by local hepatic blood flow occlusion. ELISA assay was used to detect insulin content, liver function and serum lipid metabolism biomarkers. Chemiluminescence method was used to detect liver superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), polyunsaturated fatty acids (PUFA) and lipoxygenase (LOX-1) contents. HE staining was used to evaluate the pathological changes of liver tissue structure, and Western blotting was used to detect the ferroptosis-related protein expression of ACSL4 and GPX4.Results:Compared with Sham group, the level of fasting blood glucose, insulin, insulin resistance index, serum TC, TG and liver PUFA content of DM group were increased significantly ( P<0.05), HE staining showed there were a large number of fatty degeneration of hepatocytes in DM group, and extensive ballooning and necrosis of hepatocytes in DM+ HIRI group. Compared with HIRI group, level of serum TC, TG, ALT, AST and the liver PUFA and LOX-1 in DM+ HIRI group were significantly increased [TC (5.87±0.76) vs (1.34±0.2) mmol/L, TG (2.93±0.47) vs (0.71±0.34) mmol/L, ALT (339.5±40.09) vs (155.17±18.53) U/L, AST (325.50±37.52) vs (102.39±22.68) U/L, PUFA (21.58±3.01) vs (8.12±0.94) mg/g, LOX-1 (200.81±26.03) vs (73.34±10.66) U/m ] ( P<0.05). Compared with HIRI group, the protein expression of ACSL4 in DM+ HIRI group was up-regulated [(0.46±0.06) vs (1.02±0.11)], while the expression of GPX4 was down-regulated [(0.43±0.07) vs (0.14±0.02)] significantly ( P<0.05). Conclusion:The tolerance of DM rats to hepatic ischemia reperfusion injury was significantly reduced, which may be related to hepatic abnormal lipid metabolism and ferroptosis.
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To study the interaction between C4b-binding protein (C4BP) and Riemerella anatipestifer (RA), we cloned duck C4BPα, conducted prokaryotic expression and prepared the polyclonal antibody by immunizing mice. Then indirect immunofluorescence assay and dot blotting hybridization assay were used to verify the interaction between C4BP and RA. The full length of duck C4BPα nucleotide sequence was 1 230 bp, with the highest similarity to chicken C4BPα (82.1%). Phylogenetic tree analysis showed that duck C4BPα and chicken C4BPα were on the same phylogenetic tree branch and the genetic evolution relationship between them was the closest. C4BPα was efficiently expressed in Escherichia coli BL21 (DE3). The recombinant proteins existed in intracellular soluble form. The titer of polyclonal antibody was more than 1:10 000 and polyclonal antibodies could specifically recognize the recombinant proteins. The results of indirect immunofluorescence assay and dot blot hybridization assay showed that RA could interact with duck C4BP. The results provide a basis to further reveal the pathogenesis of RA.
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Animales , Ratones , Clonación Molecular , Proteína de Unión al Complemento C4b , Química , Genética , Metabolismo , Patos , Clasificación , Genética , Microbiología , Regulación de la Expresión Génica , Filogenia , Riemerella , MetabolismoRESUMEN
Recently, unsupervised deep learning methods have shown great potential in image processing. Compared with a large-amount demand for paired training data of supervised methods with a specific task, unsupervised methods can learn a universal and explicit prior information on data distribution and integrate it into the reconstruction process. Therefore, it can be used in various image reconstruction environments without showing degraded performance. The importance of unsupervised learning in MRI reconstruction appears to be growing. Nevertheless, the establishment of prior formulation in unsupervised deep learning varies a lot depending on mathematical approximation and network architectures. In this work, we summarized basic concepts of unsupervised deep learning comprehensively and compared performances of several state-of-the-art unsupervised learning methods for MRI reconstruction.
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Recently, unsupervised deep learning methods have shown great potential in image processing. Compared with a large-amount demand for paired training data of supervised methods with a specific task, unsupervised methods can learn a universal and explicit prior information on data distribution and integrate it into the reconstruction process. Therefore, it can be used in various image reconstruction environments without showing degraded performance. The importance of unsupervised learning in MRI reconstruction appears to be growing. Nevertheless, the establishment of prior formulation in unsupervised deep learning varies a lot depending on mathematical approximation and network architectures. In this work, we summarized basic concepts of unsupervised deep learning comprehensively and compared performances of several state-of-the-art unsupervised learning methods for MRI reconstruction.
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Objective To investigate the clinicopathological features of solid papillary carcinoma of the breast.Methods A retrospective study was performed to analyze the clinical and histopathologic manifestations in 44 cases of SPC in Peking University People's Hospital from 2013.7 to 2017.10.Results All the patients were female and mean age was 66.5 years.17 cases complained of nipple discharge and 27 cases had breast mass.Pathologically tumors were of solid-papillary growth pattern.The tumor cells were polygonal or oval with mucin production and neuroendocrine differentiation.22 cases were associated with invasive carcinoma,among which 15 cases were non-special invasive carcinomas.7 cases were mucinous carcinoma.Six cases underwent modified radical mastectomy and axillary lymph nodes excision with two metastasis in an axillary lymph node.38 cases underwent breast conserving surgery or mastectomy.There were no local recurrence or distant metastasis during the follow-up periods of 12-48 months.Conclusion Solid papillary carcinoma of breast is a rare pathology type with predilection in older women.The postoperative prognosis is fair.
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Objective To understand the relationship of anxiety and depression with AIDS knowledge,cognition of risk and sex behavior among young men who have sex with men(YMSM).Methods The study was conducted by the snowballs sampling method for the recruitment and serological examination of YMSM aged 15-24 in Mianyang city,Sichuan province.The anxiety and depressive symptoms were assessed by the self-rating anxiety scale (SAS) and the self-rating depression scale (SDS).Chi-square test was used to implement single-factor analysis and non-conditional logistic regression for multiple-factor analysis.Results Totally 356 cases completed the SAS and 355 cases completed the SDS.And the total scores of SAS and SDS were (42.96± 10.81) and (45.63± 12.40).The detection rates of anxiety and depressive symptoms were 23.60％ and 33.24％ respectively.There was no statistical difference in the incidence of HIV infection with or without anxiety and depression (x2=2.235,1.718,both P＞0.05),and there was a statistical difference in the incidence of syphilis infection (x2 =6.840,P＜0.05).Multi-factor analysis results showed that HIV infection risk awareness(β=1.101,P=0.015),number of anal sex in nearly 1 week (β=1.111,P=0.005),and the diagnosis of STD in nearly 1 year(β=1.996,P=0.010) were independent factors influencing anxiety symptoms,meanwhile occasional sex in nearly six months (β=0.692,P=0.037),and the number of anal sex in nearly one week (β=0.969,P=0.012) were independent factors in depressive symptoms (P＜0.05).Conclusion The detection rate of anxiety and depressive symptoms among YMSM is high.Anxiety and depressive symptoms are related to AIDS related factors,which has certain characteristics to the YMSM sex behavior and is of great health risk.AIDS prevention should combine behavior with psychological intervention.
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Objective To understand the status of Knowledge-Attitude-Practice(KAP) and analyze the affecting factors in postoperative patients with arteriosclerosis obliterans (ASO) of lower extremity. Methods The clinical data of 169 postoperative patients with ASO from October 2017 to March 2018 were analyzed. The patients′ knowledge, behavior, attitude and compliance of four dimensions as the dependent variable, general data and disease data as independent variables through single factor analysis of variance. Multivariate statistical analysis was carried out with statistical significance to analysis the status of KAP and influencing factors of ASO patients. Results ASO patients′ four dimensions of knowledge, behavior, attitude and compliance were (6.33 ± 3.33), (58.80 ± 6.36), (14.39 ± 4.22) and (10.67 ± 2.49) points, respectively. Univariate analysis of variance showed that place of residence, education level, family economic level, diabetes, course of disease, social support, self-assessment of depression, self-assessment of anxiety and self-efficacy of symptom management were all risk factors in ASO patients. Conclusions Strengthen the health management of ASO postoperative patients, so that patients get continuous health guidance, thereby improving their quality of life and long-term patency rate.
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Objective@#To investigate the clinicopathological features of solid papillary carcinoma of the breast.@*Methods@#A retrospective study was performed to analyze the clinical and histopathologic manifestations in 44 cases of SPC in Peking University People′s Hospital from 2013.7 to 2017. 10.@*Results@#All the patients were female and mean age was 66.5 years. 17 cases complained of nipple discharge and 27 cases had breast mass .Pathologically tumors were of solid-papillary growth pattern. The tumor cells were polygonal or oval with mucin production and neuroendocrine differentiation. 22 cases were associated with invasive carcinoma, among which 15 cases were non-special invasive carcinomas. 7 cases were mucinous carcinoma.Six cases underwent modified radical mastectomy and axillary lymph nodes excision with two metastasis in an axillary lymph node.38 cases underwent breast conserving surgery or mastectomy. There were no local recurrence or distant metastasis during the follow-up periods of 12-48 months.@*Conclusion@#Solid papillary carcinoma of breast is a rare pathology type with predilection in older women. The postoperative prognosis is fair.
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From November 2015 to January 2016, two patients with multiple maxillofacial fractures were chosen to undergo CT scanning and maxillofacial three-dimensional (3D) imaging reconstruction. The data were input to 3D printer in order to yield rapid prototyping model with the same size of patients′ maxillofacial regions. Simulated fracture surgery and reconstruction of the Ti-palate were performed on the models. The operations were conducted with the guidance of navigation system. The consistency of simulated model and real fractures was compared. The results show the complex maxillofacial fracture could make the operation more accurate and shorten the operation time. Moreover, the facial features and masticatory function of both patients were improved. The 3D printing technique combined with computer-assisted navigation could be applied to complex maxillofacial fractures surgery, in order to improve the surgical accuracy and achieve effective reconstruction.
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Objective To evaluate the long-term safety of sentinel lymph node biopsy mapped by combination of indocyanine green and methylene blue in breast cancer patients.Methods 198 breast cancer patients with clinical negative axillary lymph node received sentinel lymph node biopsy mapped by combination of indocyanine green and methylene blue.Patients were followed up and regional lymph node recurrence,disease free survival(DFS) and overall survival(OS) were analyzed.Results After a median follow-up of 70 months,2 patients had ipsilateral lymph node recurrence with a regional lymph node recurrence rate of 1％ (2/198).14 patient had recurrence or metastasis and 6 patients died of distant metastasis.The estimated 6 years DFS was 94.4％ and OS was 96.5％.The incidence of arm lymphoedema within patients who received axillary lymph node dissection was 4.5％ and it was 2.5％ in patients who received sentinel lymph node biopsy.Conclusions The sentinel lymph node biopsy mapped by combination of indocyanine green and methylene blue was safe and reliable method for further staging axillary lymph node stastus.
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Objective To determine whether thyroid hormone (TH) level could also be an independent and incremental predictor of adverse events in patients with hypertrophic cardiomyopathy (HCM).Methods A total of 982 consecutive patients with HCM at the National Center for Cardiovascular Diseases (China) from October 2009 to December 2013 were included in the present study,and followed up till the end of December 2016.The patients were divided into three groups according to the levels of free triiodothyronine (FT3):the group 1 (FT3≤4.28 pmol/L,n=335),the group 2 (FT3＞4.28-＜4.79 pmol/L,n=310),and the group 3 (FT34.79-6.30 pmol/L,n=337).Results After a follow-up period of (53.8 ± 14.1) months,39 patients (4.0％) either suffered death with all causes or received a cardiac transplantation (7.8％,2.9％ and 1.2％ of the patients in the group 1,group 2 and group 3,respectively).A multivariable Cox regression analysis revealed that FT3≤4.28 pmol/L was associated with a significantly higher risk of all-cause mortality or cardiac transplantation (HR 8.83,95％ CI 1.115-69.905,P=0.039) in HCM patients.Conclusions Low levels of FT3 is a risk factor of adverse events for patients with HCM,indicting a role of FT3 as a marker for assessing the risk of long-term adverse events in these patients.
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Objective@#To determine the value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) on predicting the long-term outcome of patients with hypertrophic cardiomyopathy (HCM) .@*Methods@#NT-proBNP was measured in 831 consecutive patients with HCM at Fuwai Hospital from October 2009 to December 2013 and patients were followed up clinically for (53.3±15.4) months. Patients were divided into 3 groups according to NT-proBNP values: NT-proBNP<860 pmol/L (n=276) , 860 pmol/L≤NT-proBNP≤1 905 pmol/L (n=278) , NT-proBNP>1 905 pmol/L (n=277) . The related baseline data, laboratory examination and echocardiographic results were compared among groups. The primary endpoints of this study were all-cause mortality and cardiac transplantation. Cox proportional hazards model was used to estimate hazard ratio (HR) . Kaplan-Meier analysis was used to evaluate the survival status of patients among the 3 groups.@*Results@#During a median follow-up of (53.3±15.4) months, all-cause mortality or cardiac transplantation occurred in 37 patients (4.5%) , event rate was 1.4% (4/276) , 4.0% (11/278) and 7.9% (22/277) in patients with NT-proBNP<860 pmol/L, 860 pmol/L≤NT-proBNP≤1 905 pmol/L and NT-proBNP>1 905 pmol/L, respectively. Multivariable Cox regression analysis identified that age (HR 1.066, 95%CI 1.027-1.107) and NT-proBNP (HR 1.026, 95% CI 1.010-1.042) were independent predictors of all-cause mortality or cardiac transplantation. Among the 3 groups, the survival rate of the NT-proBNP<860 pmol/L group was the highest,and that of the NT-proBNP>1 905 pmol/L group was the lowest (P<0.01) .@*Conclusions@#The level of NT-proBNP provides clinically relevant information for long-term adverse events risk stratification in patients with HCM.