الملخص
【Objective】 To investigate the association of maternal medication during early pregnancy and cytochrome P450 (CYP450) genetic polymorphisms with the risk of congenital heart disease (CHD) in offspring. 【Methods】 We selected 127 pregnant women with CHD fetuses as the observation group and 132 pregnant women with non-CHD fetuses as the control group. Their characteristics and medication history were investigated, and CYP450 polymorphisms were detected. Logistic regression analysis was used to assess the association between maternal medication, CYP450 gene variations, and offspring CHD risk. 【Results】 The risk of CHD in offspring was higher in the observation group with maternal use of ovulation induction drugs, antihypertensive drugs, antibiotics, antidepressants, miscarriage prevention drugs, and traditional Chinese medicine (P<0.05). The A/T and T/T genotypes in rs1065852 and the C/G and G/G genotypes in rs16947 increased the risk of CHD in offspring compared to their respective genotypes. The risk of CHDs in offspring increased with the presence of risk genotypes (A/T or T/T) at the rs1065852 locus of the maternal CYP450 gene and early pregnancy medication use (P<0.05); the same was observed for risk genotypes (C/G or G/G) at the rs16947 locus (P<0.05). 【Conclusion】 Maternal medication during early pregnancy may be associated with offspring CHD, and the rs1065852 and rs16947 loci of CYP450 are significantly related to the risk of CHD in offspring.
الملخص
This paper reviews some recent studies on the recognition and evaluation of facial paralysis based on artificial intelligence. The research methods can be divided into two categories: facial paralysis evaluation based on artificial selection of patients' facial image eigenvalues and facial paralysis evaluation based on neural network and patients' facial images. The analysis shows that the method of manual selection of eigenvalues is suitable for small sample size, but the classification effect of adjacent ratings of facial paralysis needs to be further optimized. The neural network method can distinguish the neighboring grades of facial paralysis relatively well, but it has a higher requirement for sample size. Both of the two methods have good prospects. The features that are more closely related to the evaluation scale are selected manually, and the common development direction may be to extract the time-domain features, so as to achieve the purpose of improving the evaluation accuracy of facial paralysis.
الموضوعات
Humans , Artificial Intelligence , Face , Facial Paralysis/diagnosis , Neural Networks, Computerالملخص
Objective:To explore the correlation between socioeconomic status (SES) and diabetic kidney disease (DKD) in patients with type 2 diabetes (T2D).Methods:A total of 276 T2D patients admitted to the Second Affiliated Hospital of Nanjing Medical University from January to June 2020 were enrolled in this cross-sectional study. The estimated glomerular filtration rate (eGFR) was calculated according to the urinary albumin/creatinine ratio (UACR) and the chronic kidney disease epidemiology collaboration equation(CKD-EPI formula) based on serum creatinine. The patients were divided into simple T2D group (184 cases) and DKD group (92 cases). Collect demographic and laboratory examination data, record education, income and occupation, and calculate standardized SES scores. According to SES scores, subjects were divided in three levels: SES≤9, SES≥10-≤12, and SES≥13. Student's t test was used for comparison of measurement data with normal distribution between two groups, and one-way ANOVA was used for comparison between multiple groups. Non-normal distribution was represented by M( Q1, Q3), and rank-sum test was used for comparison between groups. Counting data were expressed as frequency or percentage, and chi-square test was used for comparison between groups. Bofferoni test was further used for pairwise comparison of indicators with statistical significance among multiple groups. Spearman correlation analysis was used to analyze the correlation between variables. The risk factors were analyzed by binary Logistic regression. Results:The age of the subjects was (53.37±10.68) years, men accounted for 55.8% (154/276), the duration of diabetes was 60.00 (12.00, 134.00) months, and eGFR was (97.56±21.15) mL/(min·1.73 m 2). In simple T2D group and DKD group, prevalence of hypertension were 39.7% (73/184) and 57.6% (53/92), systolic blood pressure were (129.43±14.92) mmHg and (139.29±17.61) mmHg, diastolic blood pressure were (81.86±10.06) mmHg and (87.74±11.19) mmHg, serum albumin were (45.74±4.15) g/L and (43.99±5.05) g/L, triglycerides were (1.82±1.24) mmol/L and (2.64±2.92) mmol/L, high density lipoprotein cholesterol were (1.17±0.37) mmol/L and (1.07±0.26) mmol/L, serum uric acid were (298.44±90.73) μmol/L and (336.22±94.01) μmol/L, serum creatinine were (62.83±14.45) μmol/L and (87.75±57.37) μmol/L, eGFR were (102.6±14.28) mL/(min·1.73 m 2) and (87.47±28.04) mL/(min·1.73 m 2), UACR were (7.60 (4.63, 13.15)) mg/g and (93.95 (47.25, 310.25)) mg/g. Prevalence of hypertension, systolic blood pressure, diastolic blood pressure, triglycerides, serum uric acid, serum creatinine, UACR in DKD group were higher than those in simple T2D group. Serum albumin, high density lipoprotein cholesterol and eGFR in DKD group were lower than those in simple T2D group. There was significant difference between the two groups ( χ2=7.95, t values were 4.87, 4.40, 3.04, 3.26, 2.30, 3.22, 5.56, 5.95, Z=13.07, P values were 0.005, <0.001, <0.001, 0.003, 0.001, 0.022, 0.001, <0.001, <0.001, and <0.001, respectively). The number of males in the three groups with SES ≥13 group, SES≥10-≤12 group, SES ≤9 group were 61 (81.3%, 61/75), 55 (59.8%, 55/92), 38 (34.9%, 38/109), respectively. The number of cases with smoking history were 42 (56.0%, 42/75), 41 (44.6%, 41/92), 35 (32.1%, 35/109), respectively. The number of cases with drinking history were 38 (50.7%, 38/75), 32 (34.8%, 32/92), 26 (23.9%, 26/109), respectively. The ages were (47.77±10.76), (52.76±11.22), (57.74±7.96) years old, respectively. Body mass index (BMI) were (26.17±3.87), (24.96±3.93), (24.27±4.89) kg/m 2, respectively. High density lipoprotein cholesterol (HDL) were (1.03±1.03), (1.16±0.41), (1.21±0.32) mmol/L, respectively. Serum uric acid were (336.56±82.05), (293.78±94.78), (307.99±96.53) μmol/L, respectively. EGFR were (105.03±19.72), (99.77±19.44), (90.57±21.49) mL/(min·1.73 m 2),respectively.The difference between groups were statistically significant (χ 2=39.79, 10.55, 14.08, F=22.69, 4.03, 6.20, 4.53, 12.02, P values were <0.001, 0.005, 0.001, <0.001, 0.019, 0.002, 0.012, and <0.001, respectively). Pairwise comparison shows that male and eGFR in SES ≤9 group were lower than those in SES ≥13 group and SES≥10-≤12 group, age in SES ≤9 group was higher than that in SES ≥13 group and SES≥10-≤12 group. The difference was statistically significant (all P<0.05). Smoking history, alcohol history and BMI in SES ≤9 group were lower than those in SES ≥13 group, and the high density lipoprotein cholesterol in SES ≤9 were higher than that in SES ≥13 group. The difference was statistically significant (all P<0.05). Male, alcohol history and serum uric acid in SES≥10-≤12 group were lower than those in SES ≥13 group, and age and high density lipoprotein cholesterol in SES≥10-≤12 group were higher than those in SES ≥13 group. The difference was statistically significant (all P<0.05). Spearman correlation analysis showed that SES in T2D was positively correlated with male, smoking history, alcohol history, BMI, serum uric acid and eGFR ( r values were 0.38, 0.20, 0.24, 0.16, 0.13 and 0.31, P values were <0.001, 0.001, <0.001, 0.008, 0.028, and <0.001, respectively), and negatively correlated with age, high density lipoprotein cholesterol and UACR ( r values were -0.35, -0.24 and -0.14, P values were <0.001, <0.001, and 0.017, respectively). Logistic regression analysis showed that SES (OR=2.71,95% CI:1.10-6.68, P=0.031) was associated with T2DM combined with DKD. The risk of developing DKD increased when the SES was ≤9. Conclusion:The SES in patients with type 2 diabetes is closely related to DKD. Low SES may be a new risk factor for DKD in type 2 diabetic patients.
الملخص
The series of YY/T 0987 standards converted from the corresponding ASTM (American Society for Testing and Materials) standards regulate the marking medical devices and testing methods for passive implants in the magnetic resonance environment. Along with the advancement of scientific cognition and the development of technology, the ASTM continuously amends and updates standards. This article studies the new version of ASTM standards and analyzes the advancing parts newly added as compared to the current YY/T 0987-2016 standard and eventually pinpoints some problems that remained to be solved. Except for the standard for image artifacts, this study found out that other standards had also been constantly updated, such as the standard of ASTM F2503 for marking medical devices extends its referenced documents and adds some ISO standards in, meanwhile, the test method on magnetically induced displacement force, radio frequency induced heating and magnetically induced torque also had been significantly adjusted and improved accordingly. This article recommends that domestic standards need to keep pace with the latest edition of ASTM F standards and to supplement new research achievements timely, just in order to provide a better normalization, guidance and support to the development of Chinese passive implants industry.
الموضوعات
Magnetic Resonance Imaging , Magnetic Resonance Spectroscopy , Prostheses and Implants , Radio Waves , Torque , United Statesالملخص
Staphylococcal protein A (SPA) has a high affinity for human immunoglobulin, and SPA immunoadsorption can specifically reduce the titer of autoantibodies and quickly relieve the clinical symptoms of myasthenia gravis (MG). Recent studies have suggested that immunoadsorption has better clinical efficacy and a lower incidence of adverse reactions than plasma exchange. A case of refractory MG with poor response to corticosteroids, intravenous immunoglobulins and immunosuppressive therapy was reported. The patient had low immune function and progressive pulmonary infection in the later stage of the disease. Respiratory muscle weakness was relieved quickly after four times of immunoadsorption therapy. The value of immunoadsorption in the treatment of refractory MG was explored with literature review.
الملخص
Cryptococcal meningitis has become the largest cause for the death of infectious diseases in the central nervous system infectious disease worldwide. Most patients with cryptococcal meningitis have AIDS, autoimmune diseases, hematologic malignancies, and some other relevant diseases. It is mainly caused by infection with
الموضوعات
Female , Humans , Middle Aged , Antiphospholipid Syndrome/complications , Cryptococcus neoformans , HIV Infections , Meningitis, Cryptococcal/complications , Strokeالملخص
OBJECTIVES@#Human papillomavirus (HPV) is a kind of spherical DNA virus, which is related to many factors such as immune status and pregnancy. Due to the decrease of immunity, pregnant women are more likely to have HPV infection, which causes serious imbalance of vaginal microecology and is not beneficial to pregnancy outcome. Therefore, this study focuses on the impact of HPV infection on vaginal microecology and maternal and neonatal outcomes.@*METHODS@#A total of 140 pregnant women with HPV infection during pregnancy, who received obstetric examination in the First Affiliated Hospital of Hainan Medical College from November 2017 to July 2019, were selected as a HPV infection group, and 150 normal pregnant women with HPV negative in the same period were selected as a control group. Vaginal secretions were collected from all the pregnant women at 28-34 weeks of gestation to evaluate vaginal pH, cleanliness and microecological status, and to record pregnancy outcomes for all pregnant women.@*RESULTS@#The proportions of vaginal pH>4.5, constituent ratio of flora density and diversity of I-II, positive detection rate of vulvovaginal candidiasis (VVC) and bacterial vaginosis (BV) in HPV infected pregnant women were significantly higher than those in the control group (all @*CONCLUSIONS@#Pregnant women with HPV infection during pregnancy are more likely to have vaginal microecological disorders, and can increase the risk of adverse pregnancy outcomes such as premature delivery and chorioamnionitis.
الموضوعات
Female , Humans , Infant, Newborn , Pregnancy , Candidiasis, Vulvovaginal , Cesarean Section , Papillomavirus Infections/epidemiology , Vaginosis, Bacterialالملخص
Objective:To explore the changes of myocardial strain mechanics in healthy rabbits in the physiological condition by using speckle tracking echocardiography (STE) combined with adenosine stress.Methods:Twenty healthy rabbits underwent STE both at rest and during adenosine stress. The dynamic original images of 3 consecutive cardiac cycles of the standard views from the left ventricular (LV) short axis and apical long axis were acquired and analyzed by the Echo PAC workstation. The procedure was performed to obtain LV global longitudinal peak strain, global circumferential peak strain, and global radial peak strain both at rest and during adenosine stress.Results:There were no significant differences in heart rate and LV structural and functional parameters between baseline and adenosine stress ( P>0.05). After adenosine stress, LV global longitudinal peak strain and global circumferential peak strain increased significantly when compared with those at rest ( P<0.001), while LV global radial peak strain did not change significantly( P>0.05). Conclusions:Adenosine stress echocardiography combined with STE can be used to evaluate the characteristics of myocardial strain mechanics in rabbits in the physiological condition. This research provides reference value for the application of adenosine stress echocardiography in rabbit models with cardiovascular disease in future.
الملخص
Objective:To explore the therapeutic effects of biofeedback therapy of perineal surface on stress urinary incontinence(SUI) in elderly women.Methods:A total of 87 elderly women with SUI treated at the outpatient clinics of Beijing Hospital and Yunnan First People's Hospital between January 2018 and December 2019 were recruited in this prospective cohort study.All participants were therapeutically divided into the perineal BF group(n=53)and the intravaginal BF group(n=34), based on the voluntary selection.In the intravaginal BF group, 3/34 cases dropped out of the study, and finally in 31 cases the treatment was completed.All patients were treated with biofeedback for 8 weeks with twice treatment per week.The quality of life was assessed by the incontinence impact questionnaire scores.Patients underwent the 1-hour pad-weighing test, pelvic floor muscle assessment and quality of life assessment by incontinence impact questionnaire(ⅡQ-7)scores before and after treatment.The effective rate of treatment, adverse reactions and treatment satisfaction scores were compared between the two groups.Results:The urine leakage and scores of ⅡQ-7 questionnaire were significantly improved after versus before 8 weeks of treatment in the perineal BF group[(4.65±2.33) g vs.(11.02±4.85) g, (7.96±5.11) scores vs.(4.34±2.66) scores, t=8.62 and 4.58, P<0.001], and in the intravaginal BF group[(3.85±1.89) g vs.(12.43±3.96) g, (3.81±1.23) scores vs.(8.29±5.01) scores, t=10.89 and 4.84, P<0.001]. Compared with before treatment, the grading of pelvic floor muscle strength was improved after treatment, but had no significant difference in the perineal BF group(3.93±2.77 vs.2.98±2.10, t=1.99, P=0.056)and in the intravaginal BF group(4.51±3.38 vs.3.07±2.02, t=2.04, P=0.051). There was no significant difference in the urine leakage, grading of pelvic floor muscle strength and scores of ⅡQ-7 questionnaire between two groups( P>0.05). The effective rate of treatment had no significant difference between the perineal and intravaginal BF groups(81.13% or 43/53 vs.83.87% or 26/31, χ2=0.10, P=0.750). The incidences of adverse effects were higher(20.59% or 7/34 vs.1.89% or 1/53, χ2=8.68, P=0.003)and the comfort levels during treatment assessed by visual analog scale(VAS)scores were lower in the intravaginal BF group than in the perineal BF group[(8.11±2.93) scores vs.(9.88±3.84) scores, t=2.95, P=0.004]. The main adverse effects included pain or discomfort, vaginal bleeding and increased vaginal discharge in the intrasvaginal BF treatment group. Conclusions:The perineal BF method is as effective as intravaginal BF in female stress urinary incontinencetreatmentin elderly women, and has fewer adverse effects.
الملخص
The complex electromagnetic field environments in magnetic resonance imaging system(MRI) can have a significant impact on patients carrying implants, the RF heating problems being particularly important. To ensure the safety of the patients, it is necessary to understand the distribution of tissue temperature in the MRI environment and its changes over time. Based on the analysis of tissue temperature rise in MRI, this paper constructs a bird cage coil for generating RF field in MRI system, and constructs ASTM standard/improved phantom and single-cavity pacemaker finite element models, use time-domain finite difference (FDTD) to simulate. Firstly, the correctness of the simulation software and simulation method was validated according to the method of ISO. Then the distribution of the electric field, SAR and temperature field and the temperature change with time were calculated in the environment of 64 MHz, 2 W/kg. The difference in temperature rise with blood heat exchange and no blood heat exchange (standard/improved phantom) was specifically compared. The simulation results show that there are electric field and SAR hotspots near the electrode tip, the wire tail and the case of pacemaker. There are high SAR values on both sides of the phantom, and the shorter the distance from the coil, the higher the SAR. The temperature field distribution is similar to the SAR distribution; the temperature is higher in the area around the end of the wire and the case of pacemaker because the heat accumulation is higher around this area. At the same time, blood heat exchange can reduce the temperature rise to a certain extent.
الموضوعات
Humans , Electromagnetic Fields , Magnetic Resonance Imaging , Models, Theoretical , Phantoms, Imaging , Prostheses and Implants , Temperatureالملخص
Coronary atherosclerotic heart disease is a heart disease caused by coronary artery stenosis or obstruction, resulting in myocardial ischemia, hypoxia or necrosis. Its examination methods include electrocardiogram, hematological examination, coronary CT, coronary angiography and intravascular imaging technology, etc. In recent years, blood Fractional Flow Reserve(FFR) has been widely used to measure the degree of coronary artery stenosis in the treatment of coronary heart disease. Based on the related literature at home and abroad, elaborated the FFR measurements of coronary artery stenosis degree background significance, basic principle and implementation method, on the basis of inductive expounds the FFR examination of clinical research and the advantages and disadvantages, at the same time a preliminary prospect on the development of technology of FFR iFR-the future instantaneous waveform ratio and the functional SYNTAX score has a broad space for development.
الموضوعات
Humans , Coronary Artery Disease , Fractional Flow Reserve, Myocardialالملخص
To investigate the effects of different wavelet filters on correlation and diagnostic performance of radiomics features. Methods: A total of 143 colorectal cancer (CRC) patients (64 positive in lymph node metastasis and 79 negative) with contrast-enhanced CT examination were recruited. After labeling the tumor area by experienced radiologists, radiomics wavelets features based on 48 different wavelets were extracted using in-house software coded by Matlab. The correlation coefficients of the features with same names between different wavelets were calculated and got the distribution of high-correlation features between each wavelet. The least absolute shrinkage and selection operator (LASSO) was used to build signatures between lymph node metastasis and wavelet features data set based on different wavelets. The numbers of features in signatures and diagnostic performance were compared using Delong's test. Results: With the difference of wavelet order increased, the number of high-correlation features between two wavelets decreased. Some features were prone to high correlation between different wavelets. When building radiomics signature based on single wavelet, signatures built from 'rbio2.2', 'sym7' and 'db7' did well in predicting lymph node metastasis. The signature based on Daubechies wavelet feature set had the highest performance in predicting lymph node metastasis, while the signature from Biorthogonal wavelet features was worst. Improvement was significant in diagnostic performance after excluding the high-correlation features in the whole features set (P=0.004). Conclusion: In order to reduce the data redundancy of features, it is recommended to select wavelets with large differences in wavelet orders when calculating radiomics wavelet features. It is necessary to remove high correlation features for improving the diagnostic performance of radiomics signature.
الموضوعات
Humans , Colorectal Neoplasms , Lymphatic Metastasis , Retrospective Studiesالملخص
Objective@#To investigate the cause of massive hemoptysis in critical patients, and to evaluate the effect of bronchial artery embolization (BAE) on critical patients with massive hemoptysis.@*Methods@#A retrospective controlled analysis was conducted. The clinical data of 35 patients with life-threatening massive hemoptysis admitted to intensive care unit (ICU) of the First Hospital Affiliated to Guangzhou Medical University from January 2009 to December 2017 were analyzed. The patients were divided into BAE and non-BAE group according to whether receiving BAE or not. BAE patients were subdivided into subgroups: hemoptysis after ventilation and hemoptysis before ventilation subgroups, as well as survival and non-survival subgroups. The etiology of all massive hemoptysis was analyzed. The gender, age, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, amount of hemoptysis, whether presence of pleural thickening in chest CT, the length of ICU stay, total length of hospital stay, the duration of mechanical ventilation (MV), clinical effective and prognostic indicators of patients were recorded. The correlation between variables was analyzed by Spearman correlation analysis.@*Results@#All 35 patients were enrolled in the finally analysis. The main cause of critical patients with massive hemoptysis was fungal infection [37.1% (13/35)], followed by pneumonia and abnormal coagulation [17.1% (6/35)], bronchiectasis [11.4% (4/35)], tumor [8.6% (3/35)], etc. In all 35 patients, 27 were treated with BAE and 8 were treated without BAE. There was no difference in gender, age, the length of ICU stay, total length of hospital stay, the duration of MV, amount of hemoptysis, APACHEⅡ score, whether use antiplatelet agents or anticoagulants, or whether presence of pleural thickening in chest CT between the two groups. The rate of hemoptysis remission in BAE group was significantly higher than that of non-BAE group [92.6% (25/27) vs. 25.0% (2/8), P < 0.01], but there was no statistically significant difference in hospital survival as compared with that of non-BAE group [48.1% (13/27) vs. 25.0% (2/8), P > 0.05]. Subgroup analysis showed that 64.3% (9/14) of patients with hemoptysis after ventilation was caused by pulmonary fungal infection, which was significantly higher than those with hemoptysis before ventilation [15.4% (2/13), P = 0.018]. Compared with hemoptysis after ventilation group, the length of ICU stay and the duration of MV in hemoptysis before ventilation group were significantly shortened [the length of ICU stay (days): 12.0 (14.0) vs. 30.0 (81.8), the duration of MV (days): 10.0 (16.0) vs. 25.0 (68.3)], the patients using antiplatelet drugs or anticoagulant drugs was decreased significantly (case: 1 vs. 9, all P < 0.05). However, there was no statistically significant difference in gender, age, total length of hospital stay, amount of hemoptysis, APACHEⅡ score, whether presence of pleural thickening in chest CT, the rate of hemoptysis remission, the incidence of secondary BAE or hospital survival rate between the two groups. Compared with the survival subgroup (n = 13), more patients in the non-survival subgroup (n = 14) were treated with antiplatelet or anticoagulants (P < 0.05); and Spearman correlation analysis showed that the survival of the patients with BAE was negatively correlated with the use of antiplatelet or anticoagulants (r = -0.432, P = 0.024). There was no significant difference in the gender, age, the length of ICU day, total length of hospitalization, duration of MV, estimated hemoptysis, APACHE Ⅱ score, or the proportion of pleural thickening between the two groups.@*Conclusions@#The study indicated that the etiology of massive hemoptysis in critical patients was complicated. Fungal infection was the main cause in patients with hemoptysis after ventilation. BAE was effective in the control of massive hemoptysis in ICU, but it was not ideal for patients with abnormal coagulation function or abnormal platelet count or platelet dysfunction from antiplatelet or anticoagulant drugs, the overall survival rate was still low.
الملخص
OBJECTIVE@#To investigate the cause of massive hemoptysis in critical patients, and to evaluate the effect of bronchial artery embolization (BAE) on critical patients with massive hemoptysis.@*METHODS@#A retrospective controlled analysis was conducted. The clinical data of 35 patients with life-threatening massive hemoptysis admitted to intensive care unit (ICU) of the First Hospital Affiliated to Guangzhou Medical University from January 2009 to December 2017 were analyzed. The patients were divided into BAE and non-BAE group according to whether receiving BAE or not. BAE patients were subdivided into subgroups: hemoptysis after ventilation and hemoptysis before ventilation subgroups, as well as survival and non-survival subgroups. The etiology of all massive hemoptysis was analyzed. The gender, age, acute physiology and chronic health evaluation II (APACHE II) score, amount of hemoptysis, whether presence of pleural thickening in chest CT, the length of ICU stay, total length of hospital stay, the duration of mechanical ventilation (MV), clinical effective and prognostic indicators of patients were recorded. The correlation between variables was analyzed by Spearman correlation analysis.@*RESULTS@#All 35 patients were enrolled in the finally analysis. The main cause of critical patients with massive hemoptysis was fungal infection [37.1% (13/35)], followed by pneumonia and abnormal coagulation [17.1% (6/35)], bronchiectasis [11.4% (4/35)], tumor [8.6% (3/35)], etc. In all 35 patients, 27 were treated with BAE and 8 were treated without BAE. There was no difference in gender, age, the length of ICU stay, total length of hospital stay, the duration of MV, amount of hemoptysis, APACHE II score, whether use antiplatelet agents or anticoagulants, or whether presence of pleural thickening in chest CT between the two groups. The rate of hemoptysis remission in BAE group was significantly higher than that of non-BAE group [92.6% (25/27) vs. 25.0% (2/8), P < 0.01], but there was no statistically significant difference in hospital survival as compared with that of non-BAE group [48.1% (13/27) vs. 25.0% (2/8), P > 0.05]. Subgroup analysis showed that 64.3% (9/14) of patients with hemoptysis after ventilation was caused by pulmonary fungal infection, which was significantly higher than those with hemoptysis before ventilation [15.4% (2/13), P = 0.018]. Compared with hemoptysis after ventilation group, the length of ICU stay and the duration of MV in hemoptysis before ventilation group were significantly shortened [the length of ICU stay (days): 12.0 (14.0) vs. 30.0 (81.8), the duration of MV (days): 10.0 (16.0) vs. 25.0 (68.3)], the patients using antiplatelet drugs or anticoagulant drugs was decreased significantly (case: 1 vs. 9, all P < 0.05). However, there was no statistically significant difference in gender, age, total length of hospital stay, amount of hemoptysis, APACHE II score, whether presence of pleural thickening in chest CT, the rate of hemoptysis remission, the incidence of secondary BAE or hospital survival rate between the two groups. Compared with the survival subgroup (n = 13), more patients in the non-survival subgroup (n = 14) were treated with antiplatelet or anticoagulants (P < 0.05); and Spearman correlation analysis showed that the survival of the patients with BAE was negatively correlated with the use of antiplatelet or anticoagulants (r = -0.432, P = 0.024). There was no significant difference in the gender, age, the length of ICU day, total length of hospitalization, duration of MV, estimated hemoptysis, APACHE II score, or the proportion of pleural thickening between the two groups.@*CONCLUSIONS@#The study indicated that the etiology of massive hemoptysis in critical patients was complicated. Fungal infection was the main cause in patients with hemoptysis after ventilation. BAE was effective in the control of massive hemoptysis in ICU, but it was not ideal for patients with abnormal coagulation function or abnormal platelet count or platelet dysfunction from antiplatelet or anticoagulant drugs, the overall survival rate was still low.
الموضوعات
Humans , APACHE , Bronchial Arteries , Hemoptysis , Intensive Care Units , Prospective Studies , Retrospective Studiesالملخص
Objective To compare the clinical efficacy and safety of two kinds of surgical method including Milligan-Morgan haemorrhoidectomy and automatic ligation of hemorrhoids in the treatment of mixed hemorrhoids forⅢ-Ⅳstage combined with internal rectal mucosal prolapse.Methods From March 2013 to July 2015,100 patients with mixed hemorrhoids for Ⅲ-Ⅳstage combined with internal rectal mucosal prolapse were chosen in the Traditional Chinese Medicine Hospital of Qingyuan County,and they were randomly divided into two groups according to the digital table,with 50 patients in each group.A group received Milligan-Morgan haemorrhoidectomy,and B group received automatic ligation of hemorrhoids.The clinical effect,the level of clinical indicators in peri-operative period,the scores of pain,bleeding,anal edema and dysuria after treatment and the skin tag formation rate of the two groups were compared.Results The short-term effective rates of A group and B group were 76.00％,96.00％,respectively.The clinical effect of B group was better than that of A group,and the difference was statistically significant(χ2 =7.73,P<0.05).The operation time,blood loss volume,wound healing time and total hospitalization time of A group were(20.97 ±4.52)min,(12.47 ±1.65)mL,(25.48 ±3.76)d,(15.55 ±4.38)d,respectively,which of B group were(12.01 ±2.54)min,(7.29 ±1.02)mL,(20.24 ±2.18)d,(12.02 ±3.82)d,respectively.The levels of clinical indicators in peri-operative period of B group were better than those of A group,and the differences were statistically significant(t=2.74,3.02,2.84,3.46,all P<0.05).The scores of pain,bleeding,anal edema and dysuria after treatment of B group were lower than those in A group and before treatment,the differences were statistically significant(t=2.67,2.50,3.04,2.76,all P<0.05).The skin tag formation rate of B group was lower than that of A group and before treatment,and the difference was statistically significant(χ2 =8.77,P<0.05).Conclusion Com-pared with Milligan-Morgan haemorrhoidectomy,automatic ligation of hemorrhoids in the treatment of mixed hemorrhoids for III-IV stage combined with internal rectal mucosal prolapse can efficiently relieve the clinical symptoms and signs,promote wound healing and is helpful to reduce the postoperative complications risk.
الملخص
Atrial Fibrillation(AF) and its complications are serious threat to human health and the radio frequency ablation (RFA) becomes one of the main therapies of AF. Conventionally, the RFA is performed by unipolar ablation mode. Because the unipolar ablation mode is point-to-point and incomplete linear lesion formation, the success rates of treatment on AF decline and the procedures are time consuming. In order to solve these shortcomings, the bipolar ablation mode and the multichannel frequency ablation method that facilitate the easy creation of linear lesion are presented, especially kinds of multichannel frequency ablation technique and applications are introduced in this paper.
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This paper realized an electromagnetic tracking system based on electrically-controlled rotating magnetic field. A tracking system using the digital signal processor (DSP) as the control processing device was developed, including a controllable constant current source module, a magnetic field source module, a three-axis magnetic sensor and ADC interface circuit. The experimental results verified that each time the system could be stable positioning, average error of position was 0.282 cm, the average error of orientation was 0.696o, the positioning time was 1.572 s. Through calibration and further improvement of the hardware circuit, the performance of the system is expected to further improve.
الموضوعات
Calibration , Electromagnetic Phenomena , Equipment Design , Magnetic Fieldsالملخص
OBJECTIVE@#To observe and verify the key anatomies of DeLancey's three levels of vaginal support theory through laparoscopic surgery by space dissection technique.@*METHODS@#The features and stress performance of related anatomies were observed and analyzed in laparoscopic type C hysterectomy and pelvic lymphadenectomy for cervical cancer by natural space exposures.@*RESULTS@#The main ligament-like structure at level Ⅰ was the uterosacral ligament, which acted as the main apical fixation in the sacral direction, while the cardinal ligament was mainly composed of vascular system, lymph-vessels and loose connective tissue around them, lacking the tough connective tissue structures, which was connected to the internal iliac vascular system. There were no strong ligaments connected to the tendinous arch of pelvic fascia (ATFP) at the lateral side of vaginal wall at level Ⅱ. ATFP was the edge of the superior fascia of pelvic diaphragm, which was bounded by the fascia of the obturator. Its surface was smooth and close to the levator ani muscle and fuses with the vaginal fascia in about one thirds of middle lower segments of the vagina. When the ureter tunnel is separated, dense connective structures can be found in both anterior and posterior walls near the intersection of the ureter across uterine artery, fixing the bilateral angle of the bladder triangle, starting from the cervix and vagina and ending in the tunica muscularis vesicae urinariae.@*CONCLUSIONS@#Based on the laparoscopic anatomy, the pelvic floor fascia ligament support above the levator ani muscle can be considered mainly around the vagina, and fascial ligament above the levator ani muscle can be simply considered as two parallel planes forming a "double hammock" structure, which may provide more anatomic data for pelvic floor reconstruction.
الموضوعات
Female , Humans , Laparoscopy , Ligaments , Pelvic Floor , Urinary Bladder , Vagina , General Surgeryالملخص
Programmed cell death-1 (PD-1), as a member of cytotoxic T lymphocyte-associated antigen-4 (CTLA-4), is ex-pressed on the membrane of activated T cells , B cells and macrophages.Combining with programmed cell death-ligand 1 (PD-L1), PD-1 will inhibit the proliferation of T cells and further involve in T cell receptor signaling negative feedback regulation .As the signifi-cant relationship between PD-1 /PD-L1 expression and prognosis in tumor cells , monocytes and T cells of ovarian cancer patients , this review focuses on the biological significance , influencing factors , advances of related drugs and clinical application of PD-1 /PD-L1 in ovarian cancer .
الملخص
Objective To investigate the antimicrobial resistance ,molecular phenotypes ,virulence gene profiles of Salmonella A gona (S .A gona) isolated from patients with acute diarrhea ,and to better understand its epidemic trend ,prevention and treatment .Methods Clinical data and stool samples of patients with acute diarrhea during April to October in 2013 and 2014 from the Second Hospital of Tianjin Medical University were collected .Enrichment culture ,biochemical identification and serotyping analysis were used to isolate and identify S .A gona strains .The isolated strains were further analyzed with antibiotics susceptibility test ,pulsed field gel electrophoresis (PFGE) ,multiple locus sequence typing (MLST ) , Quinolone resistance determining region (QRDR) .Plasmid-mediated quinolone resistance (PMQR) and β-lactamases genes (TEM ,SHV ,OXA ,and CTX-M) were amplified by polymerase chain reaction (PCR) and sequencing .The representative genes carried by Salmonella pathogenicity islands (SPI) 1 — 6 ,9 — 12 and virulence plasmids were amplified by PCR .And the clinical characteristics of S .Agona infection were analyzed .Results Among 119 non-repetitive (non-typhoidal salmonella ,NTS) isolates during the two years ,eight isolates (6 .7％ ) of S .A gona were identified . The resistance rate of S .A gona strains to streptomycin was 100 .0％ , those to ampicillin and gentamicin were 62 .5％ ,to levofloxacin ,ciprofloxacin and nalicixic acid were 25 .0％ ,to chloramphenicol ,amoxillin/clavulanic acid and piperacillin tazobactam were 12 .5％ .The strains were susceptible to other drugs .All 8 isolates had the identical ST13 genotype .PFGE showed 5 clones ,and 4 out of 5 isolates had the exact same patterns of PFGE and drug susceptibility .Two (fluoroquinolones ,FQ) resistant strains carried gyrA mutation leading to amino acid substitutions at position 87 in GyrA ,and no PMQR genes was detected ,while one of which was sensitive to ciprofloxacin by K-B method .All five ampicillin-resistant isolates were positive for TEM-1b gene and one isolate of them was resistant to β-lactam/β-lactamase inhibitor complex .The representative genes carried by SPI 1 — 6 , 9 ,11 ,12 (hilA ,sseL ,mgtC ,siiE ,sopB ,pagN ,bapA ,pagC and sspH2) were 100 .0％ positive ,while the genes carried by SPI10 (sef A ) virulence plasmids (spvB , prot6E) were negative . Two patients with FQ resistant strains infection were clinically diagnosed with bacillary dysentery ,and the remaining six cases with FQ susceptible strains infection were clinically diagnosed with acute gastroenteritis .Conclusions FQs-resistant and multi-drug resistant S .A gonaisolates have emerged in clinical settings .These isolates carry a variety of virulence genes .Resistance to FQ of S .Agonamay cause more severe illness .ST13 might be the dominant genotype of S . A gona in China ,and we should try to prevent the infection outbreak of S .A gona .