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1.
Pak J Med Sci ; 35(1): 257-261, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30881434

RESUMO

BACKGROUND AND OBJECTIVE: Colorectal serrated polyp is considered as histologically heterogeneous lesions with malignant potential. The aim of the study was to evaluate the endoscopic, clinic and pathologic characteristics of colorectal serrated polyps. METHODS: The endoscopic, clinic and pathologic characteristics of 52 cases with colorectal serrated polyps between January 2014 and May 2018 in our hospital were analyzed. retrospectively. RESULTS: The prevalence of serrated polyps was 0.39% (52/13,346). The proportions of hyperplastic polyp (HP), sessile serrated adenoma/polyp (SSA/P), and traditional serrated adenoma (TSA) of all serrated polyps were 61.5%, 17.3%, and 21.2%, respectively, which showed a lower proportion of TSA and SSA/P and a higher proportion of HP. CONCLUSIONS: The overall detection rate of colorectal serrated polyps was relatively low, and it is necessary to discriminate between SSAPs and HPs during endoscopic examination because of the malignant potential.

2.
ScientificWorldJournal ; 2017: 8636204, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28634596

RESUMO

Hybrid tree harvester with a 60 kW diesel engine combined with a battery pile could be a "green" forest harvesting and transportation system. With the new design, the diesel engine maintains a constant engine speed, keeping fuel consumption low while charging the batteries that drive the forwarder. As an additional energy saving method, the electric motors work as generators to charge the battery pile when the vehicle moves downhill. The vehicle is equipped with six large wheels providing high clearance over uneven terrain while reducing ground pressure. Each wheel is driven via a hub gear by its own alternating current motor, and each of the three wheel pairs can be steered independently. The combination of the diesel engine and six electric motors provides plenty of power for heavy lifting and pulling. The main component parameters of the drive system are calculated and optimized with a set of dynamics and simulated with AVL Cruise software. The results provide practical insights for the fuel tree harvester and are helpful to reduce the structure and size of the tree harvester. Advantage Environment provides information about existing and future products designed to reduce environmental impacts.


Assuntos
Indústrias/instrumentação , Veículos Automotores , Árvores , Eletricidade , Gasolina , Meios de Transporte , Emissões de Veículos
3.
BMC Cancer ; 14: 652, 2014 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-25187159

RESUMO

BACKGROUND: Preoperative jaundice is frequent in gallbladder cancer (GBC) and indicates advanced disease. Resection is rarely recommended to treat advanced GBC. An aggressive surgical approach for advanced GBC remains lacking because of the association of this disease with serious postoperative complications and poor prognosis. This study aims to re-assess the prognostic value of jaundice for the morbidity, mortality, and survival of GBC patients who underwent surgical resection with curative intent. METHODS: GBC patients who underwent surgical resection with curative intent at a single institution between January 2003 and December 2012 were identified from a prospectively maintained database. RESULTS: A total of 192 patients underwent surgical resection with curative intent, of whom 47 had preoperative jaundice and 145 had none. Compared with the non-jaundiced patients, the jaundiced patients had significantly longer operative time (p < 0.001) and more intra-operative bleeding (p = 0.001), frequent combined resections of adjacent organs (23.4% vs. 2.8%, p = 0.001), and postoperative complications (12.4% vs. 34%, p = 0.001). Multivariate analysis showed that preoperative jaundice was the only independent predictor of postoperative complications. The jaundiced patients had lower survival rates than the non-jaundiced patients (p < 0.001). However, lymph node metastasis and gallbladder neck tumors were the only significant risk factors of poor prognosis. Non-curative resection was the only independent predictor of poor prognosis among the jaundiced patients. The survival rates of the jaundiced patients with preoperative biliary drainage (PBD) were similar to those of the jaundiced patients without PBD (p = 0.968). No significant differences in the rate of postoperative intra-abdominal abscesses were found between the jaundiced patients with and without PBD (n = 4, 21.1% vs. n = 5, 17.9%, p = 0.787). CONCLUSIONS: Preoperative jaundice indicates poor prognosis and high postoperative morbidity but is not a surgical contraindication. Gallbladder neck tumors significantly increase the surgical difficulty and reduce the opportunities for radical resection. Gallbladder neck tumors can independently predict poor outcome. PBD correlates with neither a low rate of postoperative intra-abdominal abscesses nor a high survival rate.


Assuntos
Neoplasias da Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/cirurgia , Icterícia/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Drenagem , Feminino , Neoplasias da Vesícula Biliar/mortalidade , Neoplasias de Cabeça e Pescoço/secundário , Humanos , Icterícia/complicações , Icterícia/patologia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Prognóstico , Taxa de Sobrevida
4.
ESC Heart Fail ; 2024 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-39219247

RESUMO

AIMS: The aim of this study was to develop a simple, fast and efficient clinical diagnostic model, composed of exercise stress echocardiography (ESE) indicators, of the exercise capacity of patients with chronic heart failure (CHF) by comparing the effectiveness of different classifiers. METHODS AND RESULTS: Eighty patients with CHF (aged 60 ± 11 years; 78% male) were prospectively enrolled in this study. All patients underwent both cardiopulmonary exercise test (CPET) and ESE and were divided into two groups according to the VE/VCO2 slope: 30 patients with VE/VCO2 slope ventilation classification (VC)1 (i.e., VE/VCO2 slope < 30) and 50 patients with VC2 (i.e., VE/VCO2 slope ≥ 30). The analytical features of all patients in the four phases (rest, warm-up, peak and recovery phases) of ESE included the following parameters: left ventricular (LV) systolic function, LV systolic function reserve, LV diastolic function, LV diastolic function reserve and right ventricular function. Logistic regression (LR), extreme gradient boosting trees (XGBT), classification regression tree (CART) and random forest (RF) classifiers were implemented in a K-fold cross-validation model to distinguish VC1 from VC2 (LVEF in VC1 vs. VC2: 44 ± 8% vs. 43 ± 11%, P = 0.617). Among the four models, the LR model had the largest area under the curve (AUC) (0.82; 95% confidence interval [CI]: 0.73 to 0.92). In the multiple-variable LR model, the differences between the peak-exercise-phase and resting-phase values of E (ΔE), s'peak and sex were strong independent predictors of a VE/VCO2 slope ≥ 30 (P value: ΔE = 0.002, s'peak = 0.005, sex = 0.020). E/e'peak, ΔLVEF, ΔLV global longitudinal strain and Δstroke volume were not predictors of VC in the multivariate LR model (P > 0.05 for the above). CONCLUSIONS: Compared with the LR, XGBT, CART and RF models, the LR model performed best at predicting the VE/VCO2 slope category of CHF patients. A score chart was created to predict VE/VCO2 slopes ≥ 30. ΔE, s'peak and sex are independent predictors of exercise capacity in CHF patients.

5.
Oncologist ; 17(7): 963-9, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22653882

RESUMO

BACKGROUND: Postoperative extrahepatic metastasis (EHM) contributes to a poor prognosis in patients with hepatocellular carcinoma (HCC) after hepatectomy. This study was aimed to develop a practical method that can be used to predict postoperative EHM. METHODS: In total, 578 patients were enrolled. We analyzed the clinicopathological features of the tumors and did a long-term follow-up to observe HCC recurrence. Postoperative EHM was detected in 136 patients, and multivariate analysis was used to confirm independent risk factors for postoperative EHM. After the factors were identified, a predictive scoring system was constructed as a weighted sum of these factors. The cutoff value that determines a high risk for EHM was defined by maximizing the Youden's index of the receiver operating characteristic curve. RESULTS: Microvascular invasion, incomplete capsule, and larger tumor diameter were the three independent factors predictive for a high risk for EHM. The scoring system was derived with an area under the curve (AUC) of 0.81 for postoperative 10-year EHM prediction. A cutoff value of 43 was derived and validated with a sensitivity >90% and specificity >60% to predict the development of EHM. This system was further verified in a subgroup of Barcelona Clinic Liver Cancer stage 0-A patients with an AUC of 0.82. When the cutoff value was set at 43, the sensitivity and specificity were 90.38% and 64.88%, respectively. CONCLUSIONS: Our predictive scoring system may be used to identify HCC patients who have a high risk for EHM following curative hepatectomy.


Assuntos
Carcinoma Hepatocelular/cirurgia , Neoplasias Hepáticas/cirurgia , Adolescente , Adulto , Idoso , Carcinoma Hepatocelular/patologia , Criança , Estudos de Coortes , Feminino , Hepatectomia/métodos , Humanos , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Prognóstico , Fatores de Risco , Adulto Jovem
6.
Front Physiol ; 13: 1068824, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36741807

RESUMO

Purpose: Under the influence of COVID-19 and the in-hospital cost, the in-home detection of cardiovascular disease with smart sensing devices is becoming more popular recently. In the presence of the qualified signals, ballistocardiography (BCG) can not only reflect the cardiac mechanical movements, but also detect the HF in a non-contact manner. However, for the potential HF patients, the additional quality assessment with ECG-aided requires more procedures and brings the inconvenience to their in-home HF diagnosis. To enable the HF detection in many real applications, we proposed a machine learning-aided scheme for the HF detection in this paper, where the BCG signals recorded from the force sensor were employed without the heartbeat location, and the respiratory effort signals separated from force sensors provided more HF features due to the connection between the heart and the lung systems. Finally, the effectiveness of the proposed HF detection scheme was verified in comparative experiments. Methods: First, a piezoelectric sensor was used to record a signal sequences of the two-dimensional vital sign, which includes the BCG and the respiratory effort. Then, the linear and the non-linear features w.r.t. BCG and respiratory effort signals were extracted to serve the HF detection. Finally, the improved HF detection performance was verified through the LOO and the LOSO cross-validation settings with different machine learning classifiers. Results: The proposed machine learning-aided scheme achieved the robust performance in the HF detection by using 4 different classifiers, and yielded an accuracy of 94.97% and 87.00% in the LOO and the LOSO experiments, respectively. In addition, experimental results demonstrated that the designed respiratory and cardiopulmonary features are beneficial to the HF detection (LVEF ≤ 49 % ). Conclusion: This study proposed a machine learning-aided HF diagnostic scheme. Experimental results demonstrated that the proposed scheme can fully exploit the relationship between the heart and the lung systems to potentially improve the in-home HF detection performance by using both the BCG, the respiratory and the cardiopulmonary-related features.

7.
Langenbecks Arch Surg ; 394(6): 1033-9, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19421771

RESUMO

PURPOSE: This study retrospectively compared different therapy modalities in patients with hepatocellular carcinoma (HCC) complicated by bile duct thrombi (BDT). METHODS: A total of 184 patients with BDT were selected from a pool of 12,114 patients with HCC, and their cases were reviewed in this study. RESULTS: The occurrence rate of BDT was 1.84% (223/12,114) in our study. The radical resection rate in types I, II, III, and IV was 70% (7/10), 38.46% (10/26), 20.4% (29/142), 33.3% (2/6), respectively. The mean survival time in patients who underwent radical hepatic resection and BDT removal (group A), palliative hepatectomy and BDT removal (group B), palliative hepatectomy and BDT removal plus unilateral liver artery ligation or postoperative transcatheter arterial chemoembolization (TACE; group C), TACE (group D), drainage to relieve the jaundice by ERCP or PTCD (group E), and conservative treatment (group F) was 37, 6, 16, 11, 3.0, 3.0 months, respectively. The survival rate of patients in group A was significantly greater than in other group (P < 0.0001); the rate in groups C and D was significantly higher than that in groups B, E, and F (P < 0.001). In group A, 1-year recurrence rate was 20.8% (10/48). One patient with severe jaundice suffered chronic liver failure after right lobe resection and died 2 months after operation. In groups B, C, D, E, and F, in ten cases, cholangitis occurred, in eight cases, hemobilia occurred, and 72 of 136 patients suffered liver failure and died within 6 months. Five patients underwent orthotopic liver transplantation; at the time of writing, three patients are still alive, and the longest survivor has now survived for 37 months since undergoing transplantation. CONCLUSIONS: Radical hepatic resection and removal of BDT, combined with TACE, are the best approach for treating HCC patients with BDT. Biliary drainage to relieve the jaundice is critical.


Assuntos
Neoplasias dos Ductos Biliares/secundário , Neoplasias dos Ductos Biliares/terapia , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/administração & dosagem , Carcinoma Hepatocelular/mortalidade , Colestase Extra-Hepática/etiologia , Colestase Extra-Hepática/patologia , Colestase Extra-Hepática/terapia , Estudos de Coortes , Feminino , Hepatectomia , Humanos , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Células Neoplásicas Circulantes , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
8.
Arch Med Sci ; 15(2): 457-466, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30899299

RESUMO

INTRODUCTION: A large number of basic and clinical studies have confirmed that fluoride produces toxic effects on multiple organ systems in the body including the nervous system. MATERIAL AND METHODS: One hundred twenty Wistar rats were randomly divided into 4 groups with 30 in each group: a high fluoride group (drinking 200 mg/l fluoridated water, 24 weeks); a high fluoride control group (drinking distilled water, 24 weeks); a fluoride removal group (drinking fluoridated water, 12 W; then distilled water, 12 W) and a defluorination control group (drinking distilled water, 24 weeks). RESULTS: The high fluoride and fluoride removal groups had spinal cord astrocyte edema. The apoptosis rate of spinal nerve cells in the high fluoride group and fluoride removal group were significantly higher (p < 0.01) than in the fluoride control and defluorination control group. The Evans blue (EB) content, matrix metalloproteinase-9 (MMP-9) and p53 expression in the high fluoride group and fluoride removal group were higher (p < 0.01) than in the fluoride control and defluorination control group. CONCLUSIONS: The apoptosis of spinal cord nerve cells is obviously higher in rats with chronic fluoride exposure. Chronic fluoride exposure leads to high expression of MMP-9, and results in increased damage of the blood-spinal cord barrier. Increased p53 may be one of the factors causing damage. Short-term removal of fluoride has no obvious recovery in apoptosis of spinal cord nerve cells; highly expressed MMP-9 and p53 may be one of the reasons for unrecovered function.

9.
Artigo em Zh | WPRIM | ID: wpr-1039008

RESUMO

Endo-beta-N-acetylglucosaminidase (ENGase) is widely distributed in various organisms. The first reported ENGase activity was detected in Diplococcus pneumoniae in 1971. The protein (Endo D) was purified and its peptide sequence was determined in 1974. Three ENGases (Endo F1-F3) were discovered in Flavobacterium meningosepticum from 1982 to 1993. After that, the activity was detected from different species of bacteria, yeast, fungal, plant, mice, human, etc. Multiple ENGases were detected in some species, such as Arabidopsis thaliana and Trichoderma atroviride. The first preliminary crystallographic analysis of ENGase was conducted in 1994. But to date, only a few ENGases structures have been obtained, and the structure of human ENGase is still missing. The currently identified ENGases were distributed in the GH18 or GH85 families in Carbohydrate-Active enZyme (CAZy) database. GH18 ENGase only has hydrolytic activity, but GH85 ENGase has both hydrolytic and transglycosylation activity. Although ENGases of the two families have similar (β/α)8-TIM barrel structures, the active sites are slightly different. ENGase is an effective tool for glycan detection andglycan editing. Biochemically, ENGase can specifically hydrolyze β‑1,4 glycosidic bond between the twoN-acetylglucosamines (GlcNAc) on core pentasaccharide presented on glycopeptides and/or glycoproteins. Different ENGases may have different substrate specificity. The hydrolysis products are oligosaccharide chains and a GlcNAc or glycopeptides or glycoproteins with a GlcNAc. Conditionally, it can use the two products to produce a new glycopeptides or glycoprotein. Although ENGase is a common presentation in cell, its biological function remains unclear. Accumulated evidences demonstrated that ENGase is a none essential gene for living and a key regulator for differentiation. No ENGase gene was detected in the genomes of Saccharomyces cerevisiae and three other yeast species. Its expression was extremely low in lung. As glycoproteins are not produced by prokaryotic cells, a role for nutrition and/or microbial-host interaction was predicted for bacterium produced enzymes. In the embryonic lethality phenotype of the Ngly1-deficient mice can be partially rescued by Engase knockout, suggesting down regulation of Engase might be a solution for stress induced adaptation. Potential impacts of ENGase regulation on health and disease were presented. Rabeprazole, a drug used for stomach pain as a proton inhibitor, was identified as an inhibitor for ENGase. ENGases have been applied in vitro to produce antibodies with a designated glycan. The two step reactions were achieved by a pair of ENGase dominated for hydrolysis of substrate glycoprotein and synthesis of new glycoprotein with a free glycan of designed structure, respectively. In addition, ENGase was also been used in cell surface glycan editing. New application scenarios and new detection methods for glycobiological engineering are quickly opened up by the two functions of ENGase, especially in antibody remodeling and antibody drug conjugates. The discovery, distribution, structure property, enzymatic characteristics and recent researches in topical model organisms of ENGase were reviewed in this paper. Possible biological functions and mechanisms of ENGase, including differentiation, digestion of glycoproteins for nutrition and stress responding were hypothesised. In addition, the role of ENGase in glycan editing and synthetic biology was discussed. We hope this paper may provide insights for ENGase research and lay a solid foundation for applied and translational glycomics.

10.
J Insect Sci ; 8: 1-7, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-20331401

RESUMO

A Bombyx mori L. (Lepidoptera: Bombycidae) gene encoding tryptophan oxygenase has been molecularly cloned and analyzed. The tryptophan oxygenase cDNA had 1374 nucleotides that encoded a 401 amino acid protein with an estimated molecular mass of 46.47 kDa and a PI of 5.88. RT-PCR analysis showed that the B. mori tryptophan oxygenase gene was transcribed in all examined stages. Tryptophan oxygenase proteins are relatively well conserved among different orders of arthropods.


Assuntos
Bombyx/enzimologia , Bombyx/genética , Triptofano Oxigenase/genética , Sequência de Aminoácidos , Animais , Sequência de Bases , Bombyx/classificação , Clonagem Molecular , Perfilação da Expressão Gênica , Regulação Enzimológica da Expressão Gênica , Dados de Sequência Molecular , Filogenia , Estrutura Secundária de Proteína , Alinhamento de Sequência , Triptofano Oxigenase/química
11.
Artigo em Zh | WPRIM | ID: wpr-993372

RESUMO

Intrahepatic cholangiocarcinoma (ICC) refers to adenocarcinoma originating from the secondary bile ducts and their branches within the liver, with high malignancy and poor prognosis. Radical surgical resection is currently the only possible way to cure ICC, but only some patients meet the surgical standards, and even with surgical resection, about 60% of patients will relapse within 1~2 years. Neoadjuvant therapy and adjuvant therapy are important perioperative treatment methods for ICC, with the aim of reducing postoperative recurrence and improving postoperative survival. This article aims to elaborate on the current status and research progress of neoadjuvant therapy and adjuvant therapy for ICC.

12.
Artigo em Zh | WPRIM | ID: wpr-1019841

RESUMO

Primary liver cancer(PLC)is one of the most common malignant tumors of digestive system in clinic.TCM plays an important role in the treatment of PLC.After sorting out the medical records and literatures related to the syndrome types of primary liver cancer in recent years,it was found that the syndrome type of qi stagnation and blood stasis was one of the important syndrome types of primary liver cancer.This article discusses and supplements the syndrome type of qi stagnation and blood stasis from the aspects of etiology and pathogenesis,proportion of syndrome types,staging of liver cancer,objective indicators of liver cancer,etc.It provides a new understanding for the treatment of primary liver cancer based on syndrome differentiation,so as to improve the clinical cure rate of liver cancer,alleviate the clinical symptoms of patients,improve the quality of life,and prolong the survival period.

13.
Virus Res ; 255: 24-35, 2018 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-29913251

RESUMO

As one of nine piscine viruses recognized by the International Office of Epizootics, spring viraemia of carp virus (SVCV) is an important pathogen bringing high mortality to cyprinids. Up to now, there is no approved therapy on SVCV, making them strong public health threat in aquaculture. In this study, the anti-SVCV activities of 12 plant crude extracts were investigated by using epithelioma papulosum cyprini (EPC) cells. Among these plants, Psoralea corylifolia Linn. showed the highest inhibition on SVCV replication, with an inhibitory percentage of 67.98%. Further studies demonstrated that bavachin (BVN), one of the major constituents of Psoralea corylifolia Linn., was also highly effective to SVCV infection. The half maximal inhibitory concentrations (IC50) of BVN on SVCV glycoprotein and nucleoprotein expression were 0.46 (0.29-0.73) and 0.31 (0.13-0.55) mg/L, respectively. In addition, SVCV-induced apoptosis which may be negative to SVCV replication was inhibited by BVN. The apoptotic cells were decreased 21.42% for BVN compared with SVCV group. These results indicated that the inhibition of BVN on SVCV replication was, in some extent, via blocking SVCV induced apoptosis. Furthermore, cellular morphological damage induced by SVCV was also blocked by BVN treatment. Mechanistically, BVN did not affect SVCV infectivity and cannot be used for prevention of SVCV infection. Time-of-addition and viral binding assays revealed that BVN mainly inhibited the early events of SVCV replication but did not interfere with SVCV adsorption. In conclusion, BVN was considered to develop as a promising agent to treat SVCV infection.


Assuntos
Carpas/virologia , Doenças dos Peixes/virologia , Flavonoides/farmacologia , Psoralea/química , Infecções por Rhabdoviridae/veterinária , Rhabdoviridae/efeitos dos fármacos , Animais , Apoptose/efeitos dos fármacos , Linhagem Celular , Sobrevivência Celular/efeitos dos fármacos , Regulação para Baixo/efeitos dos fármacos , Regulação para Baixo/genética , Doenças dos Peixes/patologia , Flavonoides/isolamento & purificação , Concentração Inibidora 50 , Plantas Medicinais/química , Rhabdoviridae/fisiologia , Infecções por Rhabdoviridae/patologia , Infecções por Rhabdoviridae/virologia , Carga Viral/efeitos dos fármacos , Proteínas Virais/genética , Replicação Viral/efeitos dos fármacos
14.
Artigo em Zh | WPRIM | ID: wpr-990641

RESUMO

Hepatocellular carcinoma (HCC) is the most common primary hepatic malign-ancy in clinic. The prognosis of patients remains extremely poor because of the high malignancy and easy recurrence and metastasis of HCC. In recent years, the roles of platelets in promoting the malignant progression of HCC have increasingly attracted much attention. It is known that platelets could promote HCC cells proliferation and invasion through tumor microenvironment. On the other hand, platelets are capable to promote HCC cells distant metastasis by facilitating tumor cells evasion of immune surveillance. Besides, the platelet-derived growth factors and proangiogenic factors are also involved in the proliferation, invasiveness, and neovascularization of HCC. In addition, patients with HCC normally have a background of cirrhosis, and it is still controversial that whether the thrombocytopenia by portal hypertension and hypersplenism can promote the malignant progress of HCC. In view of this, the diagnostic and prognostic value of platelet levels, as well as platelet-associated scores in HCC have increasingly become research focus. The authors elaborate the detailed mechanisms of platelets in malignant progression of HCC, and discuss the recent research progress of platelets as effective diagnostic or prognostic tools for the assessment of HCC, which is of great importance to optimize the current treatment regimen and explore novel therapeutic strategies against HCC.

15.
Artigo em Zh | WPRIM | ID: wpr-991980

RESUMO

Objective:To analyze the factors influencing pulmonary infections in elderly neurocritical patients in the intensive care unit (ICU) and to explore the predictive value of risk factors for pulmonary infections.Methods:The clinical data of 713 elderly neurocritical patients [age ≥ 65 years, Glasgow coma score (GCS) ≤ 12 points] admitted to the department of critical care medicine of the Affiliated Hospital of Guizhou Medical University from 1 January 2016 to 31 December 2019 were retrospectively analyzed. According to whether or not they had HAP, the elderly neurocritical patients were divided into hospital-acquired pneumonia (HAP) group and non-HAP group. The differences in baseline data, medication and treatment, and outcome indicators between the two groups were compared. Logistic regression analysis was used to analyze the factors influencing the occurrence of pulmonary infection.The receiver operator characteristic curve (ROC curve) was plotted for risk factors and a predictive model was constructed to evaluate the predictive value for pulmonary infection.Results:A total of 341 patients were enrolled in the analysis, including 164 non-HAP patients and 177 HAP patients. The incidence of HAP was 51.91%. According to univariate analysis, compared with the non-HAP group, mechanical ventilation time, the length of ICU stay and total hospitalization in the HAP group were significantly longer [mechanical ventilation time (hours): 171.00 (95.00, 273.00) vs. 60.17 (24.50, 120.75), the length of ICU stay (hours): 263.50 (160.00, 409.00) vs. 114.00 (77.05, 187.50), total hospitalization (days): 29.00 (13.50, 39.50) vs. 27.00 (11.00, 29.50), all P < 0.01], the proportion of open airway, diabetes, proton pump inhibitor (PPI), sedative, blood transfusion, glucocorticoids, and GCS ≤ 8 points were significantly increased than those in HAP group [open airway: 95.5% vs. 71.3%, diabetes: 42.9% vs. 21.3%, PPI: 76.3% vs. 63.4%, sedative: 93.8% vs. 78.7%, blood transfusion: 57.1% vs. 29.9%, glucocorticoids: 19.2% vs. 4.3%, GCS ≤ 8 points: 83.6% vs. 57.9%, all P < 0.05], prealbumin (PA) and lymphocyte count (LYM) decreased significantly [PA (g/L): 125.28±47.46 vs. 158.57±54.12, LYM (×10 9/L): 0.79 (0.52, 1.23) vs. 1.05 (0.66, 1.57), both P < 0.01]. Logistic regression analysis showed that open airway, diabetes, blood transfusion, glucocorticoids and GCS ≤ 8 points were independent risk factors for pulmonary infection in elderly neurocritical patients [open airway: odds ratio ( OR) = 6.522, 95% confidence interval (95% CI) was 2.369-17.961; diabetes: OR = 3.917, 95% CI was 2.099-7.309; blood transfusion: OR = 2.730, 95% CI was 1.526-4.883; glucocorticoids: OR = 6.609, 95% CI was 2.273-19.215; GCS ≤ 8 points: OR = 4.191, 95% CI was 2.198-7.991, all P < 0.01], and LYM, PA were the protective factors for pulmonary infection in elderly neurocritical patients (LYM: OR = 0.508, 95% CI was 0.345-0.748; PA: OR = 0.988, 95% CI was 0.982-0.994, both P < 0.01). ROC curve analysis showed that the area under the ROC curve (AUC) for predicting HAP using the above risk factors was 0.812 (95% CI was 0.767-0.857, P < 0.001), with a sensitivity of 72.3% and a specificity of 78.7%. Conclusions:Open airway, diabetes, glucocorticoids, blood transfusion, GCS ≤ 8 points are independent risk factors for pulmonary infection in elderly neurocritical patients. The prediction model constructed by the above mentioned risk factors has certain predictive value for the occurrence of pulmonary infection in elderly neurocritical patients.

16.
Artigo em Zh | WPRIM | ID: wpr-986880

RESUMO

OBJECTIVE@#To investigate the association between short-term exposure to indoor total volatile organic compounds (TVOC) and nocturnal heart rate variability (HRV) among young female adults.@*METHODS@#This panel study recruited 50 young females from one university in Beijing, China from December 2021 to April 2022. All the participants underwent two sequential visits. During each visit, real time indoor TVOC concentration was monitored using an indoor air quality detector. The real time levels of indoor temperature, relative humidity, noise, carbon dioxide and fine particulate matter were monitored using a temperature and humidity meter, a noise meter, a carbon dioxide meter and a particulate counter, respectively. HRV parameters were measured using a 12-lead Holter. Mixed-effects models were used to evaluate the association between the TVOC and HRV parameters and establish the exposure-response relationships, and two-pollutant models were applied to examine the robustness of the results.@*RESULTS@#The mean age of the 50 female subjects was (22.5±2.3) years, and the mean body mass index was (20.4±1.9) kg/m2. During this study, the median (interquartile range) of indoor TVOC concentrations was 0.069 (0.046) mg/m3, the median (interquartile range) of indoor temperature, relative humidity, carbon dioxide concentration, noise level and fine particulate matter concentration were 24.3 (2.7) ℃, 38.5% (15.0%), 0.1% (0.1%), 52.7 (5.8) dB(A) and 10.3 (21.5) μg/m3, respectively. Short-term exposure to indoor TVOC was associated with significant changes in time-domain and frequency-domain HRV parameters, and the exposure metric for most HRV parameters with the most significant changes was 1 h-moving average. Along with a 0.01 mg/m3 increment in 1 h-moving average concentration of indoor TVOC, this study observed decreases of 1.89% (95%CI: -2.28%, -1.50%) in standard deviation of all normal to normal intervals (SDNN), 1.92% (95%CI: -2.32%, -1.51%) in standard deviation of average normal to normal intervals (SDANN), 0.64% (95%CI: -1.13%, -0.14%) in percentage of adjacent NN intervals differing by more than 50 ms (pNN50), 3.52% (95%CI: -4.30%, -2.74%) in total power (TP), 5.01% (95%CI: -6.21%, -3.79%) in very low frequency (VLF) power, and 4.36% (95%CI: -5.16%, -3.55%) in low frequency (LF) power. The exposure-response curves showed that indoor TVOC was negatively correlated with SDNN, SDANN, TP, and VLF when the concentration exceeded 0.1 mg/m3. The two-pollutant models indicated that the results were generally robust after controlling indoor noise and fine particulate matter.@*CONCLUSION@#Short-term exposure to indoor TVOC was associated with significant negative changes in nocturnal HRV of young women. This study provides an important scientific basis for relevant prevention and control measures.


Assuntos
Humanos , Feminino , Adulto , Adulto Jovem , Poluentes Atmosféricos/análise , Frequência Cardíaca/fisiologia , Compostos Orgânicos Voláteis/análise , Dióxido de Carbono , Material Particulado/efeitos adversos , Poluentes Ambientais
17.
Chinese Critical Care Medicine ; (12): 638-642, 2023.
Artigo em Zh | WPRIM | ID: wpr-982646

RESUMO

OBJECTIVE@#To investigate the prevalence, risk factors, duration and outcome of delirium in intensive care unit (ICU) patients.@*METHODS@#A prospective observational study was conducted for critically ill patients admitted to the department of critical care medicine, the Affiliated Hospital of Guizhou Medical University from September to November 2021. Delirium assessments were performed twice daily using the Richmond agitation-sedation scale (RASS) and confusion assessment method of ICU (CAM-ICU) for patients who met the inclusions and exclusion criteria. Patient's age, gender, body mass index (BMI), underlying disease, acute physiologic assessment and chronic health evaluation (APACHE) at ICU admission, sequential organ failure assessment (SOFA) at ICU admission, oxygenation index (PaO2/FiO2), diagnosis, type of delirium, duration of delirium, outcome, etc. were recorded. Patients were divided into delirium and non-delirium groups according to whether delirium occurred during the study period. The clinical characteristics of the patients in the two groups were compared, and risk factors for the development of delirium were screened using univariate analysis and multivariate Logistic regression analysis.@*RESULTS@#A total of 347 ICU patients were included, and delirium occurred in 57.6% (200/347) patients. The most common type was hypoactive delirium (73.0% of the total). Univariate analysis showed statistically significant differences in age, APACHE score and SOFA score at ICU admission, history of smoking, hypertension, history of cerebral infarction, immunosuppression, neurological disease, sepsis, shock, glucose (Glu), PaO2/FiO2 at ICU admission, length of ICU stay, and duration of mechanical ventilation between the two groups. Multivariate Logistic regression analysis showed that age [odds ratio (OR) = 1.045, 95% confidence interval (95%CI) was 1.027-1.063, P < 0.001], APACHE score at ICU admission (OR = 1.049, 95%CI was 1.008-1.091, P = 0.018), neurological disease (OR = 5.275, 95%CI was 1.825-15.248, P = 0.002), sepsis (OR = 1.941, 95%CI was 1.117-3.374, P = 0.019), and duration of mechanical ventilation (OR = 1.005, 95%CI was 1.001-1.009, P = 0.012) were all independent risk factors for the development of delirium in ICU patients. The median duration of delirium in ICU patients was 2 (1, 3) days. Delirium was still present in 52% patients when they discharged from the ICU.@*CONCLUSIONS@#The prevalence of delirium in ICU patients is over 50%, with hypoactive delirium being the most common. Age, APACHE score at ICU admission, neurological disease, sepsis and duration of mechanical ventilation were all independent risk factors for the development of delirium in ICU patients. More than half of patients with delirium were still delirious when they discharged from the ICU.


Assuntos
Humanos , Prevalência , Cuidados Críticos , Fatores de Risco , Sepse , Unidades de Terapia Intensiva
18.
Chinese Critical Care Medicine ; (12): 746-751, 2023.
Artigo em Zh | WPRIM | ID: wpr-982666

RESUMO

OBJECTIVE@#To compare and analyze the effect of unplanned versus planned admission to the intensive care unit (ICU) on the prognosis of high-risk patients after surgery, so as to provide a clinical evidence for clinical medical staff to evaluate whether the postoperative patients should be transferred to ICU or not after surgery.@*METHODS@#The clinical data of patients who were transferred to ICU after surgery admitted to the Affiliated Hospital of Guizhou Medical University from January to December in 2021 were retrospectively analyzed, including gender, age, body mass index, past history (whether combined with hypertension, diabetes, pulmonary disease, cardiac disease, renal failure, liver failure, hematologic disorders, tumor, etc.), acute physiology and chronic health evaluation II (APACHE II), elective surgery, pre-operative hospital consultation, length of surgery, worst value of laboratory parameters within 24 hours of ICU admission, need for invasive mechanical ventilation (IMV), duration of IMV, length of ICU stay, total length of hospital stay, ICU mortality, in-hospital mortality, and survival status at 30th day postoperative. The unplanned patients were further divided into the immediate transfer group and delayed transfer group according to the timing of their ICU entrance after surgery, and the prognosis was compared between the two groups. Cox regression analysis was used to find the independent risk factors of 30-day mortality in patients transferred to ICU after surgery.@*RESULTS@#Finally, 377 patients were included in the post-operative admission to the ICU, including 232 in the planned transfer group and 145 in the unplanned transfer group (42 immediate transfers and 103 delayed transfers). Compared to the planned transfer group, patients in the unplanned transfer group had higher peripheral blood white blood cell count (WBC) at the time of transfer to the ICU [×109/L: 10.86 (7.09, 16.68) vs. 10.11 (6.56, 13.27)], longer total length of hospital stay [days: 23.00 (14.00, 34.00) vs. 19.00 (12.00, 29.00)], and 30-day post-operative mortality was higher [29.66% (43/145) vs. 17.24% (40/232)], but haemoglobin (Hb), arterial partial pressure of carbon dioxide (PaCO2), oxygenation index (PaO2/FiO2), and IMV requirement rate were lower [Hb (g/L): 95.00 (78.00, 113.50) vs. 98.00 (85.00, 123.00), PaCO2 (mmHg, 1 mmHg ≈ 0.133 kPa): 36.00 (29.00, 41.50) vs. 39.00 (33.00, 43.00), PaO2/FiO2 (mmHg): 197.00 (137.50, 283.50) vs. 238.00 (178.00, 350.25), IMV requirement rate: 82.76% (120/145) vs. 93.97% (218/232)], all differences were statistically significant (all P < 0.05). Kaplan-Meier survival curve showed that the 30-day cumulative survival rate after surgery was significantly lower in the unplanned transfer group than in the planned transfer group (Log-Rank test: χ2 = 7.659, P = 0.006). Univariate Cox regression analysis showed that unplanned transfer, APACHE II score, whether deeded IMV at transfer, total length of hospital stay, WBC, blood K+, and blood lactic acid (Lac) were associated with 30-day mortality after operation (all P < 0.05). Multifactorial Cox analysis showed that unplanned transfer [hazard ratio (HR) = 2.45, 95% confidence interval (95%CI) was 1.54-3.89, P < 0.001], APACHE II score (HR = 1.03, 95%CI was 1.00-1.07, P = 0.031), the total length of hospital stay (HR = 0.86, 95%CI was 0.83-0.89, P < 0.001), the need for IMV on admission (HR = 4.31, 95%CI was 1.27-14.63, P = 0.019), highest Lac value within 24 hours of transfer to the ICU (HR = 1.17, 95%CI was 1.10-1.24, P < 0.001), and tumor history (HR = 3.12, 95%CI was 1.36-7.13, P = 0.007) were independent risk factors for patient death at 30 days post-operative, and the risk of death was 2.45 times higher in patients unplanned transferred than in those planned transferred. Subgroup analysis showed that patients in the delayed transfer group had significantly longer IMV times than those in the immediate transfer group [hours: 43.00 (11.00, 121.00) vs. 17.50 (2.75, 73.00), P < 0.05].@*CONCLUSIONS@#The 30-day mortality, WBC and total length of hospital stay were higher in patients who were transferred to ICU after surgery, and PaO2/FiO2 was lower. Unplanned transfer, oncology history, use of IMV, APACHE II score, total length of hospital stay, and Lac were independent risk factors for patient death at 30 days postoperatively, and patients with delayed transfer to ICU had longer IMV time.


Assuntos
Humanos , Estudos Retrospectivos , Respiração Artificial , Hospitalização , Prognóstico , Unidades de Terapia Intensiva
19.
Hepatogastroenterology ; 54(74): 499-502, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17523307

RESUMO

BACKGROUND/AIMS: To evaluate the benefits of the tumor thrombus types system on determining treatments and prognosis of hepatocellular carcinoma patients (HCC) with tumor thrombi in the portal vein. METHODOLOGY: According to anatomic features of the portal vein in the liver and tumor thrombus of HCC developing modes, a uniform tumor thrombus types system (types I-IV) was first recommended. 84 HCC patients with portal vein tumor thrombi, which from January 2000 to January 2003 in the Eastern Hepatobiliary Surgery Hospital, were divided into I-IV groups according to types I-IV of the tumor thrombus system. The median survival periods and effectiveness of surgical resection or non-resection for I-IV groups were retrospectively observed. RESULTS: The median survival periods for patients of group I (n=17), II (n=26), III (n=35) and group IV (n=6) were 10.1, 7.2, 5.7 and 3.0 months, respectively (p = 0.0001). From tumor thrombus type I to type III, the patients received surgical resection were better than that of non-resection (P = 0.0006). Among the patients receiving resection treatment, resection of tumor thrombus type I had the best effects, while for patients with tumor thrombus type IV, the results were not good. In case of non-resection treatments, the survival periods of patients with tumor thrombi type I, II and III were similar, which supposed that TACE may be of little effects on tumor thrombi. CONCLUSIONS: Types of tumor thrombus system suggested may be helpful to determine the treatments and prognosis of HCC patients with tumor thrombi in the portal vein.


Assuntos
Carcinoma Hepatocelular/mortalidade , Neoplasias Hepáticas/mortalidade , Células Neoplásicas Circulantes/classificação , Veia Porta , Adulto , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/cirurgia , Feminino , Humanos , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Células Neoplásicas Circulantes/patologia , Veia Porta/patologia , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida
20.
Chinese Critical Care Medicine ; (12): 693-698, 2022.
Artigo em Zh | WPRIM | ID: wpr-956037

RESUMO

Objective:To analyze the risk factors of prolonged mechanical ventilation (PMV) in patients with sepsis complicated by abdominal surgery, and to evaluate the predictive value of risk factors for PMV.Methods:A retrospective case-control study was conducted. The clinical data of patients with postoperative abdominal sepsis complicated with invasive mechanical ventilation who were admitted to the intensive care unit (ICU) of the Affiliated Hospital of Guizhou Medical University from January 1, 2018 to December 31, 2020 were collected. The patients were divided into PMV group (duration of mechanical ventilation longer than 48 hours) and non-PMV group (duration of mechanical ventilation shorter than 48 hours) according to the duration of mechanical ventilation in ICU. The patient's gender, age, body mass index (BMI), underlying diseases, mean arterial pressure (MAP), complete blood count, blood biochemistry, arterial blood gas, cardiac function indicators, procalcitonin (PCT) at admission to the ICU, the acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) and the sequential organ failure assessment (SOFA) scores in the first 24 hours of admission to the ICU, and other clinical information were recorded. Univariate and multivariate Logistic regression models were used to analyze the risk factors for PMV. Receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of related indicators for PMV.Results:A total of 195 patients with sepsis after abdominal surgery who received invasive mechanical ventilation were enrolled, including 127 males (65.1%) and 68 females (34.9%), with the median age of 65 (21, 93) years old. There were 91 patients (46.7%) in the non-PMV group and 104 patients (53.3%) in the PMV group. Univariate analysis showed that the APACHEⅡ score, SOFA score, cardiac troponin T (cTnT), N-terminal pro-B type natriuretic peptide (NT-proBNP) in the PMV group were significantly higher than those in the non-PMV group. Oxygenation index (PaO 2/FiO 2), total protein (TP) and prealbumin (PA) in the PMV group were all lower than those in the non-PMV group when admitted to ICU. In the PMV group, serum creatinine (SCr), blood urea nitrogen (BUN), cystatin C (Cys C) were significantly increased, prothrombin time (PT) was significantly prolonged, the proportion of patients with septic shock and hypertension were significantly increased as compared with those in the non-PMV group. Multivariate analysis showed that low PaO 2/FiO 2 at ICU admission [odds ratio ( OR) = 0.995, 95% confidence interval (95% CI) was 0.992-0.999, P = 0.010], high ln PCT ( OR = 1.301, 95% CI was 1.088-1.555, P = 0.004), high ln cTnT ( OR = 1.562, 95% CI was 1.079-2.261, P = 0.018) and septic shock ( OR = 4.967, 95% CI was 2.461-10.026, P = 0.000) were the independent risk factors for PMV in patients with sepsis after abdominal surgery. ROC curve analysis showed that the PaO 2/FiO 2, ln cTnT, ln PCT and septic shock had certain predictive value for PMV, the area under the ROC curve (AUC) of the four variables were 0.607, 0.638, 0.690 and 0.711, the sensitivity was 50.0%, 62.5%, 86.5% and 74.0%, and the specificity was 71.4%, 62.6%, 48.3% and 68.1%, respectively. The AUC for the joint prediction of the four variables was 0.803, with a sensitivity of 76.0% and a specificity of 78.0%. It suggested that the multivariate joint prediction of PMV was more accurate. Conclusions:Decreased PaO 2/FiO 2, increased PCT, increased cTnT and the occurrence of septic shock are independent risk factors for PMV in patients with sepsis complicated by abdominal surgery. The combination of above four indices was more accurate than one single variable in predicting PMV and had higher diagnostic value.

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