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Pregnancy-associated pulmonary embolism (PE) is a type of venous thromboembolism (VTE) that seriously threatens the lives of pregnant women and has gained more attention in clinical practice. Due to physiological and anatomical characteristics, the incidence of VTE during pregnancy and postpartum is significantly higher than that during non-pregnancy periods. Currently, guidelines widely acknowledge the exploration of appropriate risk assessment models to evaluate the risk of pregnancy-associated VTE and to take corresponding preventive measures from mechanical to medication methods according to different risk levels. For patients suspected of PE, initial assessments can be made based on whether they exhibit clinical manifestations of deep vein thrombosis, with options including vascular compression ultrasonography or chest X-ray examination. Confirmation relies on CT pulmonary angiography or V/Q imaging. For patients with shock, echocardiography can be quickly used for the diagnosis and differential diagnosis of PE. The management of pregnancy-associated pulmonary embolism PE depends on the patient's hemodynamic status, with options including reperfusion therapy or anticoagulation therapy. Extracorporeal membrane oxygenation may also be beneficial in high risk patients. The overall evidence level for the prevention and management of pregnancy-associated PE is low, and further exploration in clinical practice is still needed to promote the safety of pregnant women.
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Embolia Pulmonar , Humanos , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/prevenção & controle , Embolia Pulmonar/terapia , Gravidez , Feminino , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/terapia , Complicações Cardiovasculares na Gravidez/prevenção & controle , Anticoagulantes/uso terapêutico , Tromboembolia Venosa/prevenção & controle , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/terapia , Tromboembolia Venosa/etiologia , Fatores de Risco , Trombose Venosa/diagnóstico , Trombose Venosa/prevenção & controle , Trombose Venosa/terapia , Ecocardiografia , Oxigenação por Membrana ExtracorpóreaRESUMO
Malignant peripheral nerve sheath tumor (MPNST) frequently metastasizes to the lungs, although pleural metastasis is rare. This article reported a case of pleural metastasis of MPNST. The patient was a young man who presented with 1 week of shortness of breath with dry cough. He had a history of malignant peripheral nerve sheath tumor. The patient was diagnosed with MPNST pleural metastasis after a thoracoscopic pleural biopsy, which revealed short spindle cell hyperplasia, immunohistochemical staining for S-100(+), SOX-10(+), Ki-67(+) with a positive index of 20%, and H3K27Me3(-) in the pleural pathology.
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Neoplasias de Bainha Neural , Neoplasias Pleurais , Humanos , Masculino , Neoplasias Pleurais/secundário , Neoplasias Pleurais/patologia , Neoplasias de Bainha Neural/patologia , Neoplasias de Bainha Neural/secundário , Neoplasias de Bainha Neural/diagnóstico , AdultoRESUMO
Objective: To investigate the effects of cervical cold knife conization (CKC) on preterm delivery, other pregnancy complications and neonatal outcomes, and explore the relationship between preterm delivery risk and the depth and volume of conization. Methods: The clinical data and pregnancy outcomes of 272 women who underwent CKC in Peking Union Medical College Hospital from January 2002 to March 2018 (conization group) and 1 647 pregnant women who gave birth in Peking Union Medical College Hospital during January to December 2019 (control group) were collected. The preterm delivery, premature rupture of membranes, other pregnancy complications and neonatal outcomes of the two groups were compared, and the relationship between the depth and volume of conization and the risk of preterm delivery in postoperative singleton pregnancy was analyzed. Results: (1) There were no significant differences between the two groups in delivery age, parity, proportion of singleton pregnancy, proportion of assisted reproductive technology (all P>0.05). (2) The rate of preterm delivery in the conization group was significantly higher than that in the control group [14.8% (39/264) vs 5.7% (91/1 589); χ2=28.397, P<0.001]. There were still significant differences in preterm delivery rates between the two groups at <34 weeks and 34-37 weeks (all P<0.01). There was no significant difference in the incidence of premature rupture of membrane between the two groups [23.5% (62/264) vs 23.4% (372/1 589); χ2=0.001, P=0.979], but the incidence of preterm premature rupture of membrane in the conization group was significantly higher than that in the control group [11.4% (30/264) vs 2.2% (35/1 589); χ2=56.132, P<0.001]. (3) The rate of cesarean section in the conization group was higher than that in the control group [59.6% (162/272) vs 38.8% (639/1 647); χ2=41.377, P<0.001]. The birth weight of preterm infants in the conization group was significantly higher than that in the control group [(2 409±680) vs (2 150±684) g; t=2.184, P=0.030]. However, there were no statistically significant differences in the incidence of gestational diabetes mellitus, hypertensive disorders in pregnancy, the birth weight of full-term infants, incidence of small for gestational age infant and neonatal intensive care unit admission rate between the two groups (all P>0.05). (4) The preterm delivery rates of coning depth >15 mm, cone size ≥2 cm3 and cone size <2 cm3 were higher than that in the control group (all P<0.05). When the coning depth ≤15 mm, the preterm delivery rate in the conization group was higher than that in the control group, but there was no significant difference (P=0.620). The rate of preterm delivery of pregnant women with coning depth >15 mm was significantly higher than those with coning depth ≤15 mm (RR=3.084, 95%CI: 1.474-6.453; P=0.001). There was no significant difference in the preterm delivery rate between pregnant women with cone size >2 cm3 and those with cone size ≥2 cm3 (RR=1.700, 95%CI: 0.935-3.092; P=0.077). Conclusion: The risk of preterm delivery and preterm premature rupture of membranes in subsequent pregnancies are increased after cervical CKC, and the risk of preterm delivery is positively correlated with the depth of cervical coning.
Assuntos
Colo do Útero , Conização , Ruptura Prematura de Membranas Fetais , Resultado da Gravidez , Nascimento Prematuro , Humanos , Feminino , Gravidez , Conização/efeitos adversos , Conização/métodos , Nascimento Prematuro/epidemiologia , Adulto , Ruptura Prematura de Membranas Fetais/epidemiologia , Complicações na Gravidez/epidemiologia , Estudos Retrospectivos , Recém-Nascido , Neoplasias do Colo do Útero/cirurgia , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/patologia , Displasia do Colo do Útero/cirurgia , Displasia do Colo do Útero/epidemiologiaRESUMO
The FDA (Food and Drug Administration, (USA)) lists ZnO as a material that is widely acknowledged to be safe. ZnO NPs with a range of tiny particle sizes were made using the precipitation process. ZnO nanoparticles' surface is embellished with a tripodal sensor containing naphthol units. The assembly with the same receptor decorated on ZnO NPs is contrasted with the cation detection capabilities of the purified tripodal receptor. The UV-visible spectrophotometric analysis was conducted to study the state transitions of the receptor and the decorated ZnO receptor. A positive selectivity to Al3+ cations is determined by the fluorescence study under ideal circumstances. The particle size and surface morphologies are determined by DLS and SEM analysis for the same receptor - TP1 and embellished with a tripodal receptor TP2. Using a fluorescence switch-on Photoinduced Electron Transfer (PET) mechanism, the receptor coated on ZnO detects the presence of Al3+ ions with specificity. The binding constant value was determined using the B-H plot equation. Binding stoichiometry for [TP1-Al3+, TP2-Al3+] showed a 1:1 ratio. The fluorescence switches ON-OFF process of the ZnO surface adorned - TP2 with Tripodal receptor- TP1 was used to create molecular logic gates, which can function as a module for sensors and molecular switches. The addition of Na2EDTA in the solution of the [TP1; TP2 - Al3+] complex resulted in a noticeable reduction in the emission of fluorescence. This finding offers compelling support for the reversibility of the chemosensor. To enable the practical application of this sensor, we have developed a cassette containing receptors TP1 and TP2. Successfully, it can detect Al3+ metal ions. We performed a comprehensive assessment of the dependability and appropriateness of our approach in measuring the concentration of Al3+ ions in wastewater produced by important industrial procedures.
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Objective: This study aimed to evaluate the efficacy and safety of venetoclax (VEN) combined with hypomethylating agents (HMA) in the treatment of higher-risk myelodysplastic syndromes (HR-MDS) and analyze the factors influencing their therapeutic effect. Methods: The clinical data of 83 patients with HR-MDS who were diagnosed at the First Affiliated Hospital of Zhengzhou University between November 2019 and May 2023 were retrospectively analyzed. All patients were treated with VEN combined with HMA. The Kaplan-Meier method was used to depict the survival curves, and the log-rank test was used to compare survival between the groups. Results: The median age was 57 (15-82) years old, and 51 patients (61.4%) were male. Forty-five patients (54.2%) were initially treated with HMA, 23 (27.7%) received ≤4 cycles of HMA, and 15 (18.1%) demonstrated HMA failure. At the median follow-up of 10.3 (0.6-34.4) months, the overall response rate (ORR) was 62.7% (52/83), including 18 patients (21.7%) with a complete response (CR), 14 (16.9%) with a bone marrow CR (mCR) with hematological improvement, and 20 (24.1%) with a mCR. The ORR of patients with initial treatment, ≤4 HMA cycles, and HMA failure were 66.7%, 60.9%, and 53.3%, respectively (P=0.641). The median overall survival time was 14.6 (95% CI 7.2-22.0) months, and the median progression-free survival time was 8.9 (95% CI 6.7-11.1) months. The multivariate analysis showed that serum alkaline phosphatase (ALP) ≥90 U/L (OR=14.574, 95% CI 3.036-69.951, P=0.001), TP53 mutation (OR=13.052, 95% CI 1.982-85.932, P=0.008), and U2AF1 mutation (OR=7.720, 95% CI 1.540-38.698, P=0.013) were independent risk factors for poor efficacy of VEN combined with HMA. Hematological toxicity occurred in all patients, and the incidence of treatment-induced grade 3-4 leukopenia was 48.2% (40/83). Infection was the most common non-hematological adverse event, mainly pulmonary infection (31.3%) . Conclusion: VEN combined with HMA had a high response rate in patients with HR-MDS, both at initial treatment and with HMA failure. ALP ≥ 90 U/L, TP53 mutation, and U2AF1 mutation were independent risk factors for non-response to treatment.
Assuntos
Compostos Bicíclicos Heterocíclicos com Pontes , Síndromes Mielodisplásicas , Sulfonamidas , Humanos , Pessoa de Meia-Idade , Masculino , Feminino , Idoso , Síndromes Mielodisplásicas/tratamento farmacológico , Compostos Bicíclicos Heterocíclicos com Pontes/administração & dosagem , Adulto , Sulfonamidas/administração & dosagem , Idoso de 80 Anos ou mais , Adolescente , Estudos Retrospectivos , Adulto Jovem , Resultado do Tratamento , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Metilação de DNARESUMO
An updated key to the currently known species of the subgenus Tarpheion van Achterberg, 1976 (Hymenoptera, Braconidae, Blacus) in China is provided. Nine new species are proposed, B. (T.) adelphius sp. nov., B. (T.) frontalis sp. nov., B. (T.) gilvus sp. nov., B. (T.) hainanensis sp. nov., B. (T.) parilis sp. nov., B. (T.) reticulatus sp. nov., B. (T.) sculptilis sp. nov., B. (T.) tanae sp. nov., and B. (T.) wuyishanensis sp. nov. Eight species, B. (T.) achterbergi Haeselbarth, 1976, B. (T.) albiventris van Achterberg, 1988, B. (T.) angichorus van Achterberg, 1988, B. (T.) antennalis van Achterberg, 1988, B. (T.) apicalis van Achterberg, 1976, B. (T.) artomandibularis van Achterberg, 1976, B. (T.) bicolor van Achterberg, 1988, and B. (T.) soror van Achterberg, 1988, are newly recorded from China.
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Himenópteros , Vespas , Animais , ChinaRESUMO
Three subgenera Microchelonus Szpligeti, 1908 s. str., Parachelonus Tobias, 1995 and Stylochelonus Helln, 1958 are newly recorded from China, 21 new species, viz., C. (M.) adiazetos sp. nov., C. (M.) aequus sp. nov., C. (M.) brachykeraiatus sp. nov., C. (M.) bullatus sp. nov., C. (M.) clivus sp. nov., C. (M.) crassitibialis sp. nov., C. (M.) cyclotus sp. nov., C. (M.) erugatus sp. nov., C. (M.) illatus sp. nov., C. (M.) leious sp. nov., C. (M.) linzhiensis sp. nov., C. (M.) maculovittatus sp. nov., C. (M.) melanochromus sp. nov., C. (M.) platyetrus sp. nov., C. (M.) recavus sp. nov., C. (M.) ruficorpus sp. nov., C. (M.) scirpophagae sp. nov., C. (M.) staurorhytis sp. nov., C. (P.) hirsutus sp. nov., C. (S.) acaretrus sp. nov., and C. (S.) punctulosus sp. nov. are described and illustrated. Also, eleven species are reported as new to China: C. (M.) alticinctus (Tobias, 1989), C. (M.) alveatus (Tobias, 1989), C. (M.) calcaratus (Tobias, 1989), C. (M.) flagellaris (Tobias, 1989), C. (M.) insidiatrix (Tobias, 1989), C. (M.) milkoi (Tobias, 2003), C. (M.) moskovitus (Tobias, 1997), C. (M.) semilunaris (Tobias, 2000), C. (M.) temporalis (Tobias, 1986), C. (M.) varus (Tobias, 2000) and C. (M.) zaitzevi (Tobias, 1972). Four new combinations are proposed: C. (P.) compressor (Chen & Ji, 2003) comb. nov., C. (P.) macrocorpus (Ji & Chen, 2003) comb. nov., C. (P.) polycolor (Chen & Ji, 2003) comb. nov. and C. (Baculonus) rubriventris (Tobias, 1988) comb. nov. The following new names are proposed: C. (M.) jiae nom. nov. for C. (M.) bimaculatus (Chen & Ji, 2003) and C. (M.) substernatus nom. nov. for C. (M.) tobiasi (Yuldashev, 2011). Microchelonus (Carinichelonus) cavifrons Tobias, 2000 is synonymized with C. (Ca.) tabonus Sonan, 1932. A key to the Chinese species of the subgenus Microchelonus is provided together with keys to the currently known species of the subgenera Carinichelonus, Stylochelonus and Parachelonus.
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Himenópteros , Animais , ChinaRESUMO
The subgenus Chelonus Panzer, 1806 of genus Chelonus Panzer, 1806 is revised for China and 73 (of which 31 are illustrated) species are recognized. Twenty-one new species, namely, C. (C.) akinakes sp. nov., C. (C.) ameterion sp. nov., C. (C.) angustivertex sp. nov., C. (C.) apicoretusus sp. nov., C. (C.) argoskeles sp. nov., C. (C.) aspros sp. nov., C. (C.) bouommatus sp. nov., C. (C.) brochus sp. nov., C. (C.) columnatus sp. nov., C. (C.) ferrugineus sp. nov., C. (C.) gilvus sp. nov., C. (C.) glomerosus sp. nov., C. (C.) hadrosetron sp. nov., C. (C.) longipectus sp. nov., C. (C.) notochinensis sp. nov., C. (C.) pedinos sp. nov., C. (C.) perspicillatus sp. nov., C. (C.) tanyaisthema sp. nov., C. (C.) transversus sp. nov., C. (C.) truncatus sp. nov. and C. (C.) wuyiensis sp. nov., are described and illustrated. Nine species are recorded from China for the first time, i.e., C. (C.) breviventris Thomson, 1874, C. (C.) capsa Tobias, 1972, C. (C.) cesa Kocak & Kemal, 2013, C. (C.) dauricus Telenga, 1941, C. (C.) fumarius Tobias, 2000, C. (C.) pannonicus Szpligeti, 1896, C. (C.) praepusillus Tobias, 2000, C. (C.) subseticornis Tobias, 1971 and C. (C.) wullii Kittel, 2016. A key to the Chinese species of the subgenus Chelonus Panzer, 1806 is provided.
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Vespas , Animais , ChinaRESUMO
The subgenus Hysterobolus Viereck, 1913 (Hymenoptera, Braconidae, Blacus) is newly recorded from China. Nine new species are proposed, B. (H.) baishanzuensis sp. nov., B. (H.) flaviceps sp. nov., B. (H.) laculaticornis sp. nov., B. (H.) longiapicalis sp. nov., B. (H.) melanoapicalis sp. nov., B. (H.) niger sp. nov., B. (H.) variegatus sp. nov., B. (H.) xui sp. nov., B. (H.) yunnanensis sp. nov., and one species, B. (H.) chabarovi Belokobylskij, 1995, is newly recorded from China. An updated key to the currently known species of the subgenus Hysterobolus in China is provided.
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The subgenus Contochorus van Achterberg, 1976 (Hymenoptera, Braconidae, Blacus) is newly recorded from China. Two new species are proposed, B. (C). capillosus sp. nov., B. (C). planus sp. nov., and two species are newly recorded in China, B. (C). mellitarsis van Achterberg, 1988 and B. (C). turbidus Papp, 1985. An updated key to the currently known species of the subgenus Contochorus in the world is provided.
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Himenópteros , Vespas , Animais , ChinaRESUMO
Antimicrobial resistance in Mycobacterium tuberculosis is a serious threat to global tuberculosis(TB) control. WHO listed bedaquiline as one of the first-choice drugs for the treatment of MDR/RR-TB in 2018. Bedaquiline is marketed for adult patients with MDR-TB and XDR-TB. However, there are few studies of bedaquiline in adolescents, pregnant women, the elderly, and other special populations with drug-resistant TB. This paper aimed to review the effectiveness and safety of bedaquiline in the treatment of special populations of drug-resistant TB for the clinical use.
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Tuberculose Extensivamente Resistente a Medicamentos , Mycobacterium tuberculosis , Tuberculose Resistente a Múltiplos Medicamentos , Adolescente , Adulto , Idoso , Feminino , Humanos , Gravidez , Antituberculosos/efeitos adversos , Diarilquinolinas/efeitos adversos , Tuberculose Extensivamente Resistente a Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológicoRESUMO
Objective: To exploring the clinical features of SF3B1-mutated myelodysplastic syndrome with excess blasts (MDS-EB) and analyzing the association between SF3B1 mutation, and efficacy and prognostic significance for patients with MDS-EB. Methods: This was a retrospective case series study. The clinical data of 266 patients with MDS-EB diagnosed in the First Affiliated Hospital of Zhengzhou University between April 2016 and November 2021 were analyzed. The observed indicators included blood routine counts, mutated genes, overall response rate (ORR), overall survival (OS), progression-free survival (PFS), and leukemia-free survival (LFS). The Kaplan-Meier method was used to depict the survival curves. The Log-rank test method was equally used to compare survival across groups and performed the Cox proportional hazard regression model for prognostic analysis. Results: In 266 patients with MDS-EB, 166 (62.4%) were men, and the median age was 57 (17-81) years. Moreover, there were included 26 and 240 patients in the SF3B1-mutated and SF3B1 wild-type groups. Patients in the SF3B1-mutated group were older [median age 65 (51, 69) years vs. 56 (46, 66) years, P=0.033], had higher white blood cell (WBC) counts [3.08 (2.35, 4.78) × 109/L vs. 2.13 (1.40, 3.77) × 109/L], platelet (PLT) counts [122.5 (50.5, 215.0) ×109/L vs. 49.0 (24.3, 100.8) × 109/L], absolute neutrophil counts (ANC) [1.83 (1.01, 2.88) × 109/L vs. 0.80 (0.41, 1.99) × 109/L]and occurrence of DNMT3A mutation [23.1% (6/26) vs. 6.7% (16/240)] (all P<0.05). The ORR were similar in both groups after 2 and 4 cycles of therapy (P=0.348, P=1.000). Moreover, the LFS (P=0.218), PFS (P=0.179) and OS (P=0.188) were similar across the groups. Univariate Cox analysis revealed that SF3B1 mutation did not affect the prognosis of patients with MDS-EB (OS: P=0.193; PFS: P=0.184). Conclusions: Patients with SF3B1 mutation were older, with greater WBC, PLT, and ANC, and SF3B1 mutation easily co-occurred with DNMT3A mutation. From this model, there were no significant differences in efficacy and survival of MDS-EB with or without SF3B1 mutation.
Assuntos
Síndromes Mielodisplásicas , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Leucócitos , Mutação , Síndromes Mielodisplásicas/genética , Síndromes Mielodisplásicas/diagnóstico , Fosfoproteínas/genética , Prognóstico , Estudos Retrospectivos , Fatores de Processamento de RNA/genética , Adolescente , Adulto Jovem , Adulto , Idoso de 80 Anos ou maisRESUMO
AIMS: Gonadotropin-releasing hormone (GnRH) agonists and antagonists, critical medications for prostate cancer (PCa) treatment, may differ in cardiovascular safety. This prospective cohort study aimed to compare the long-term cardiovascular risks between GnRH agonists and antagonists. MATERIALS AND METHODS: Patients with PCa receiving GnRH agonists or antagonists during 2013-2021 in Hong Kong were identified. Patients with <6 months' prescriptions, who were switching between drugs, had missing baseline prostate-specific antigen level or had a prior stroke or myocardial infarction were excluded. Patients were followed up until September 2021. The primary outcome was major adverse cardiovascular events (MACE) as in the PRONOUNCE trial (MACEPRONOUNCE), i.e. a composite of all-cause mortality, stroke and myocardial infarction. The secondary outcome was MACECVM, i.e. a composite of cardiovascular mortality, stroke and myocardial infarction. Inverse probability treatment weighting was used to balance covariates between groups. The Log-rank test was used to compare the cumulative freedom from the primary outcome between groups. RESULTS: In total, 2479 patients were analysed (162 GnRH antagonist users and 2317 agonist users; median age 75.0 years, interquartile range 68.0-81.6 years). Inverse probability treatment weighting achieved good covariate balance between groups. Over a median follow-up duration of 3.0 years (interquartile range 1.7-5.0 years), 1115 patients (45.0%) had MACEPRONOUNCE and 344 (13.9%) had MACECVM. GnRH agonist users had lower risks of MACEPRONOUNCE (Log-rank P < 0.001) and MACECVM (Log-rank P = 0.027). However, no differences were observed within 1 year of follow-up (MACEPRONOUNCE: Log-rank P = 0.308; MACECVM: Log-rank P = 0.357). Among patients without cardiovascular risk factors at baseline, GnRH agonist users had lower risks of MACEPRONOUNCE (Log-rank P < 0.001) and MACECVM (Log-rank P = 0.001), whereas no differences were observed in those with such risk factor(s) (MACEPRONOUNCE: Log-rank P = 0.569; MACECVM: Log-rank P = 0.615). CONCLUSIONS: GnRH antagonists may be associated with higher long-term, but not short-term, cardiovascular risks than agonists in Asian patients with PCa, particularly in those without known cardiovascular risk factors.
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Doenças Cardiovasculares , Infarto do Miocárdio , Neoplasias da Próstata , Acidente Vascular Cerebral , Masculino , Humanos , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/induzido quimicamente , Doenças Cardiovasculares/epidemiologia , Hormônio Liberador de Gonadotropina/uso terapêutico , Fatores de Risco , Estudos Prospectivos , Estudos de Coortes , Antagonistas de Androgênios/uso terapêutico , Infarto do Miocárdio/induzido quimicamente , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/tratamento farmacológico , Neoplasias da Próstata/terapia , Acidente Vascular Cerebral/induzido quimicamente , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/tratamento farmacológico , Fatores de Risco de Doenças CardíacasRESUMO
Objective: Retrospective analysis of the efficacy and influencing factors of bladder preservation integrated therapy for unresectable invasive bladder cancer confined to the pelvis was done, also including the bladder function preservation and adverse effects analysis. Methods: Sixty-nine patients with unresectable locally invasive bladder cancer who received radiotherapy-based combination therapy from March 1999 to December 2021 at our hospital were selected. Among them, 42 patients received concurrent chemoradiotherapy, 32 underwent neoadjuvant chemotherapyand 43 with transurethral resection of bladder tumors (TURBT) prior to radiotherapy. The late adverse effect of radiotherapy, preservation of bladder function, replase and metastasis and survival were followed-up. Cox proportional hazards models were applied for the multifactorial analysis. Results: The median age was 69 years. There were 63 cases (91.3%) of uroepithelial carcinoma, 64 of stage â ¢ and 4 of stage â £. The median duration of follow-up was 76 months. There were 7 grade 2 late genito urinary toxicities, 2 grade 2 gastrointestinal toxicities, no grade 3 or higher adverse events occurred. All patients maintained normal bladder function, except for 8 cases who lost bladder function due to uncontrolled tumor in the bladder. Seventeen cases recurred locally. There were 11 cases in the concurrent chemoradiotherapy group with a local recurrence rate of 26.2% (11/42) and 6 cases in the non-concurrent chemoradiotherapy group with a local recurrence rate of 22.2% (6/27), and the difference in local recurrence rate between the two groups was not statistically significant (P=0.709). There were 23 cases of distant metastasis (including 2 cases of local recurrence with distant metastasis), including 10 cases in the concurrent chemoradiotherapy group with a distant metastasis rate of 23.8% (10/42) and 13 cases in the non-concurrent chemoradiotherapy group with a distant metastasis rate of 48.1% (13/27), and the distant metastasis rate in the non-concurrent chemoradiotherapy group was higher than that in the concurrent chemoradiotherapy group (P=0.036). The median 5-year overall survival (OS) time was 59 months and the OS rate was 47.8%. The 5-year progression-free survival (PFS) time was 20 months and the PFS rate was 34.4%. The 5-year OS rates of concurrent and non-concurrent chemoradiotherapy group were 62.9% and 27.6% (P<0.001), and 5-year PFS rates were 45.4% and 20.0%, respectively (P=0.022). The 5-year OS rates of with or without neoadjuvant chemotherapy were 78.4% and 30.1% (P=0.002), and the 5-year PFS rates were 49.1% and 25.1% (P=0.087), respectively. The 5-year OS rates with or without TURBT before radiotherapy were 45.5% and 51.9% (P=0.233) and the 5-year PFS rates were 30.8% and 39.9% (P=0.198), respectively. Multivariate Cox regression analysis results showed that the clinical stage (HR=0.422, 95% CI: 0.205-0.869) was independent prognostic factor for PFS of invasive bladder cancer. The multivariate analysis showed that clinical stages (HR=0.278, 95% CI: 0.114-0.678), concurrent chemoradiotherapy (HR=0.391, 95% CI: 0.165-0.930), neoadjuvant chemotherapy (HR=0.188, 95% CI: 0.058-0.611), and recurrences (HR=10.855, 95% CI: 3.655-32.638) were independent prognostic factors for OS of invasive bladder cancer. Conclusion: Unresectable localized invasive bladder cancer can achieve satisfactory long-term outcomes with bladder-preserving combination therapy based on radiotherapy, most patients can retain normal bladder function with acceptable late adverse effects and improved survival particularly evident in patients with early, concurrent chemoradiotherapy and neoadjuvant chemotherapy.
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Quimiorradioterapia , Neoplasias da Bexiga Urinária , Humanos , Idoso , Resultado do Tratamento , Estudos Retrospectivos , Terapia Combinada , Quimiorradioterapia/métodos , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/radioterapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Estadiamento de NeoplasiasRESUMO
Objective: To explore the clinical features, laboratory examination and imaging features of microscopic polyangiitis (MPA)-associated interstitial lung disease (ILD), and to perform survival analysis. Methods: The records of 28 patients with MPA-ILD who were treated at the Affiliated Hospital of Medical School of Ningbo University were reviewed retrospectively from August 2014 to November 2021. The patients' clinical features, laboratory parameters, pulmonary function test, echocardiography, chest CT scan findings and therapeutic regimen were analyzed, and the relevant data were statistically analyzed. Results: There were 18 males and 10 females, with an average age of (70.1±9.3) years. Among them, 13 patients had a history of smoking. The main clinical manifestations were cough (14/28), fever (12/28), chest tightness, shortness of breath (12/28) and hemoptysis (3/28). Sixteen patients had renal involvement, and 78.57% (22/28) and 89.28% (25/28) of the patients had elevated C-reactive protein (CRP) and ESR respectively. Sixteen (16/28) patients had increased rheumatoid factor (RF), and the positive rate of myeloperoxidase antineutrophil cytoplasmic antibodies (MPO-ANCA) was 82.12% (23/28). 96.43% (27/28) of ILDs were diagnosed before or at the same time as MPA. The chest radiological pattern was mainly usual interstitial pneumonia (UIP) or UIP-like (15/28), followed by nonspecific interstitial pneumonia (NSIP) (8/28). Compared with non-UIP-like patients, UIP or UIP-like patients were older (P=0.018), and had higher serum LDH level (P=0.041), but serum creatinine level was significantly lower (P=0.041). Univariate and multivariate survival analysis showed that inappropriate treatment (HR=9.81, 95%CI: 1.68-57.29, P=0.011) and elevated serum LDH (HR=4.11, 95%CI: 0.99-17.00, P=0.051) were independent risk factors for shortened survival of MPA-ILD, while elevated RF (HR=0.22, 95%CI: 0.06-0.91, P=0.037) was a protective factor for prolonged survival. Conclusions: MPA-ILD patients had fewer systemic vasculitis symptoms. Most of the ILD patients were diagnosed before or at the same time as MPA. The chest radiological pattern was mainly UIP or UIP-like, followed by NSIP. Early use of glucocorticoids combined with immunosuppressant or rituximab could improve the survival rate of MPA-ILD. The elevated serum LDH was an independent risk factor for shortened survival of MPA-ILD, while elevated RF was a protective factor for prolonged survival.
Assuntos
Pneumonias Intersticiais Idiopáticas , Fibrose Pulmonar Idiopática , Doenças Pulmonares Intersticiais , Poliangiite Microscópica , Idoso , Anticorpos Anticitoplasma de Neutrófilos , Proteína C-Reativa , Creatinina , Feminino , Humanos , Imunossupressores , Pulmão , Doenças Pulmonares Intersticiais/diagnóstico , Masculino , Poliangiite Microscópica/complicações , Pessoa de Meia-Idade , Peroxidase , Estudos Retrospectivos , Fator Reumatoide , Rituximab , Análise de SobrevidaRESUMO
The subgenus Arichelonus Viereck, 1913 of genus Chelonus Panzer, 1806 is newly recorded from China and five new species belonging to three different subgenera are described and illustrated from China, i.e., Chelonus (Arichelonus) allokotosus sp. nov., Chelonus (Arichelonus) kenosetrus sp. nov., Chelonus (Megachelonus) irilaminatus sp. nov., Chelonus (Megachelonus) macrodontus sp. nov., and Chelonus (Scabrichelonus) nigrifemoratus sp. nov. Keys to the currently known species of the subgenera Arichelonus, Megachelonus and Scabrichelonus are provided.
Assuntos
Himenópteros , Animais , ChinaRESUMO
BACKGROUND: Artificial intelligence (AI) techniques are promising in early diagnosis of skin diseases. However, a precondition for their success is the access to large-scaled annotated data. Until now, obtaining this data has only been feasible with very high personnel and financial resources. OBJECTIVES: The aim of this study was to overcome the obstacle caused by the scarcity of labelled data. METHODS: To simulate the scenario of label shortage, we discarded a proportion of labels of the training set. The training set consisted of both labelled and unlabelled images. We then leveraged a self-supervised learning technique to pretrain the AI model on the unlabelled images. Next, we fine-tuned the pretrained model on the labelled images. RESULTS: When the images in the training dataset were fully labelled, the self-supervised pretrained model achieved 95.7% of accuracy, 91.7% of precision and 90.7% of sensitivity. When only 10% of the data were labelled, the model could still yield 87.7% of accuracy, 81.7% of precision and 68.6% of sensitivity. In addition, we also empirically verified that the AI model and dermatologists are consistent in visually inspecting the skin images. CONCLUSIONS: The experimental results demonstrate the great potential of the self-supervised learning in alleviating the scarcity of annotated data.
Assuntos
Inteligência Artificial , Aprendizado Profundo , Humanos , PeleRESUMO
A new subgenus of the genus Chelonus Panzer, 1806 (Braconidae: Cheloninae), Mirachelonus subgen. nov. (type species: Chelonus (Mirachelonus) miraventris sp. nov.) with deeply incurved apex of carapace, is described and illustrated from southwest China. A key to the subgenera currently recognized in Chelonus is included to facilitate future identifications.
Assuntos
Himenópteros , Animais , ChinaRESUMO
Objective: To systematically evaluate the impact of psychological intervention on nursing staff' compassion fatigue. Methods: From March to May 2020, PubMed, Cochrane Library, EMbase, Web of Science, CNKI, VIP, Wanfang and other databases were electronically searched to collect randomized controlled trials (RCTs) on the influence of psychological intervention on nursing staff' compassion fatigue with the main search terms including compassion fatigue, nurs*, psychological intervention, mental intervention, RCT and so on from inception to March 31, 2020. Screened literature, extracted data and assessed the risk of bias of included studies. The Stata 16.0 software was used to calculate the pooled effectiveness of psychological intervention on nursing staff' compassion fatigue. Results: All 13 RCTs were enrolled, including 940 nursing staff. Meta-analysis results demonstrated that the psychological intervention group was superior to the control group in the improvement of the compassion fatigue score (SMD=-0.96, 95%CI: -1.17-0.74, P=0.001) , compassion satisfaction score (SMD=0.61, 95%CI: 0.45-0.77, P=0.002) , burnout score (SMD=-0.46, 95%CI: -0.62-0.29, P=0.006) , secondary trauma score (SMD=-0.40, 95%CI: -0.68-0.12, P=0.020) , and the difference was statistically significant. Subgroup analysis found that the psychological intervention group was more effective than the control group in improving compassion satisfaction score, reducing burnout score and secondary trauma score, and the differences were statistically significant (P<0.05) in different intervention time (<8 weeks and ≥8 weeks) and intervention methods. Conclusion: The psychological intervention can improve the level of compassion satisfaction, and reduce the compassion fatigue among nursing staff, and have a certain preventive effect on compassion fatigue.