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Objective: To compare the prognostic evaluation value of preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and systemic immune-inflammation index (SII) in rectal cancer patients. Nomogram survival prediction model based on inflammatory markers was constructed. Methods: The clinical and survival data of 585 patients with rectal cancer who underwent radical resection in the First Affiliated Hospital of Xi'an Jiao tong University from January 2013 to December 2016 were retrospectively analyzed. The optimal cut-off values of NLR, PLR, LMR, and SII were determined by the receiver operating characteristic (ROC) curve. The relationship between different NLR, PLR, LMR and SII levels and the clinic pathological characteristics of the rectal cancer patients were compared. Cox proportional risk model was used for univariate and multivariate regression analysis. Nomogram prediction models of overall survival (OS) and disease-free survival (DFS) of patients with rectal cancer were established by the R Language software. The internal validation and accuracy of the nomograms were determined by the calculation of concordance index (C-index). Calibration curve was used to evaluate nomograms' efficiency. Results: The optimal cut-off values of preoperative NLR, PLR, LMR and SII of OS for rectal cancer patients were 2.44, 134.88, 4.70 and 354.18, respectively. There was statistically significant difference in tumor differentiation degree between the low NLR group and the high NLR group (P<0.05), and there were statistically significant differences in T stage, N stage, TNM stage, tumor differentiation degree and preoperative carcinoembryonic antigen (CEA) level between the low PLR group and the high PLR group (P<0.05). There was statistically significant difference in tumor differentiation degree between the low LMR group and the high LMR group (P<0.05), and there were statistically significant differences in T stage, N stage, TNM stage, tumor differentiation degree and preoperative CEA level between the low SII group and the high SII group (P<0.05). The multivariate Cox regression analysis showed that the age (HR=2.221, 95%CI: 1.526-3.231), TNM stage (Ⅲ grade: HR=4.425, 95%CI: 1.848-10.596), grade of differentiation (HR=1.630, 95%CI: 1.074-2.474), SII level (HR=2.949, 95%CI: 1.799-4.835), and postoperative chemoradiotherapy (HR=2.123, 95%CI: 1.506-2.992) were independent risk factors for the OS of patients with rectal cancer. The age (HR=2.107, 95%CI: 1.535-2.893), TNM stage (Ⅲ grade, HR=2.850, 95%CI: 1.430-5.680), grade of differentiation (HR=1.681, 95%CI: 1.150-2.457), SII level (HR=2.309, 95%CI: 1.546-3.447), and postoperative chemoradiotherapy (HR=1.837, 95%CI: 1.369-2.464) were independent risk factors of the DFS of patients with rectal cancer. According to the OS and DFS nomograms predict models of rectal cancer patients established by multivariate COX regression analysis, the C-index were 0.786 and 0.746, respectively. The calibration curve of the nomograms showed high consistence of predict and actual curves. Conclusions: Preoperative NLR, PLR, LMR and SII levels are all correlated with the prognosis of rectal cancer patients, and the SII level is an independent prognostic risk factor for patients with rectal cancer. Preoperative SII level can complement with the age, TNM stage, differentiation degree and postoperative adjuvant chemoradiotherapy to accurately predict the prognosis of rectal cancer patients, which can provide reference and help for clinical decision.
Subject(s)
Humans , Biomarkers, Tumor , Carcinoembryonic Antigen , Inflammation/classification , Lymphocytes , Neutrophils , Nomograms , Preoperative Period , Prognosis , Rectal Neoplasms/surgery , Retrospective StudiesABSTRACT
OBJECTIVE@#To explore the high-risk factors of deep vein thrombosis (DVT) formation in patients after spinal cord injury (SCI) and to provide some reference value for the prevention of DVT.@*METHODS@#Eighty-five patients with spinal cord injury caused by thoracolumbar burst fracture from January 2016 to December 2017 were selected as subjects. All patients were followed up for 6 months, of which 5 cases were lost and 80 cases were finally included. According to whether there was deep vein thrombosis, the patients were divided into DVT group (35 cases) and control group (45 cases). The clinical data were statistically analyzed by SPSS 22.0 statistical software, and the high-risk factors of spinal cord injury were analyzed by multivariate Logistic regression.@*RESULTS@#Thirty-five of the 80 patients with spinal cord injury developed deep venous thrombosis (incidence rate was about 43.7%). The average age of DVT group [(47.77±10.76) years ] was higher than that of non-DVT group [(37.35±10.20) years ], and there was a significant difference between two groups (=19.56, 45 years [=1.665, 95% CI (1.102-2.516)], diabetes history [=3.273, 95% CI (1.291-8.295)], smoking history [=3.302, 95% CI (1.267-8.605)], spinal cord injury ASIA grade A [=5.736, 95% CI (3.152-11.74)], non-limb air pressure therapy and ankle pump exercise [ OR=3.013, 95% CI (0.116-0.789)] was statistically significant (45 years, history of diabetes, smoking history, and ASIA grade A of spinal cord injury is present, preventive measures should be taken in advance, it is of great significance to prevent the formation of deep vein thrombosis.
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Objective To investigate the effects of insole parameter changes on biomechanical mechanism of heel pain by finite element methods. Methods The 3D finite element model of foot, crus bones, gastrocnemius muscle and knee joint was reconstructed based on CT images. The plantar pressure distribution and peak pressure were calculated by changing the shape, thickness and hardness of the insole. Results The distribution of plantar pressure calculated by the finite element model was generally consistent with that measured by the pressure plate, and the values were very close. Compared with the barefoot standing, the peak pressure of the heel was decreased by 20.5%, 59.2% and 38.4%, and that of the metatarsal head was decreased by 9.9%, 18.1% and 46.7%, with flat insole, half-contact insole and full-contact insole, respectively. For patients with heel pain, the pressure peak of the heel and the metatarsal head at plantar surface decreased with the conventional thickness of insole increasing and the hardness of insole decreasing. Conclusions The changes in insole parameters have a significant influence on the plantar pressure distribution. Finite element analysis can contribute to discovering the etiology and pathology of heel pain, so as to provide the theoretical basis for clinical treatment.
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Objective To investigate the effects of insole parameter changes on biomechanical mechanism of heel pain by finite element methods.Methods The 3D finite element model of foot,crus bones,gastrocnemius muscle and knee joint was reconstructed based on CT images.The plantar pressure distribution and peak pressure were calculated by changing the shape,thickness and hardness of the insole.Results The distribution of plantar pressure calculated by the finite element model was generally consistent with that measured by the pressure plate,and the values were very close.Compared with the barefoot standing,the peak pressure of the heel was decreased by 20.5％,59.2％ and 38.4％,and that of the metatarsal head was decreased by 9.9％,18.1％ and 46.7％,with flat insole,half-contact insole and full-contact insole,respectively.For patients with heel pain,the pressure peak of the heel and the metatarsal head at plantar surface decreased with the conventional thickness of insole increasing and the hardness of insole decreasing.Conclusions The changes in insole parameters have a significant influence on the plantar pressure distribution.Finite element analysis can contribute to discovering the etiology and pathology of heel pain,so as to provide the theoretical basis for clinical treatment.
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Objective To investigate the effects of gastrocnemius muscle forces on biomechanical mechanism of heel pain. Methods The finite element model of the foot including foot bone, soft tissues, ligaments and plantar fascia was reconstructed based foot CT images by Mimics software. The gastrocnemius force applied on the foot was 40%-90% of half-body weight（320 N） with increment of 5% of half-body weight（16 N）. The plantar surface pressure distribution and peak pressure as well as the plantar fascia stress were calculated. Results The plantar surface pressure distribution was mainly concentrated on the heel and metatarsal head. With the increase of gastrocnemius force, the peak plantar pressure at the heel decreased, while the peak pressure at the front of the foot decreased at first and then increased, which reached the minimum value with the load of 224 N. The plantar fascia stress increased with the gastrocnemius force increasing. Conclusions Gastrocnemius force applied on the foot has a significant influence on the plantar pressure distribution. Finite element analysis can contribute to understanding etiology and pathology of foot diseases, predicting the biomechanical results of the treatment and provide theoretical reference for treatments.
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Objective To investigate the effects from various angles between inferior vein cava (IVC) and right hepatic vein (RHV) on pathogenesis of IVC membranous obstruction for patients with Budd-Chiari syndrome (BCS). Methods The normal 3D solid model of IVC and hepatic veins was reconstructed using MRI angiograms, and the angle between IVC and RHV was 56°. The two models with IVC-RHV angle of 30° and 120° were established, respectively, based on the reconstructed model. The distributions of wall shear stress, static pressure and blood velocity of the 3 models were calculated by numerical simulation. Results The wall shear stresses, static pressure and blood velocity of the 3 models displayed significantly differences. Compared with the normal 56° model, the 30° model showed a higher wall pressure and lower blood velocity, while the 120° model presented a lower wall pressure and blood velocity with turbulence of blood flowing, and such hemodynamic changes would increase the risk of thrombosis. The 56° model had the fastest blood velocity. Conclusions Numerical simulation of the flow in IVC and RHV can promote to discover the pathogenesis of BCS, and help to predict risk of IVC membranous obstruction, and provide theoretical references for BCS treatment.
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<p><b>OBJECTIVE</b>To investigate the method and result of arthroscopic trans-septal approach (ATS).</p><p><b>METHODS</b>Ten fresh cadaveric knees were prepared for anatomical study about the posterior septum, and 65 posterior compartment arthroscopy of the knees were performed to view the structure of the posterior septum. The initial diagnosis included: rheumatoid arthritis, pigmented villonodular synovitis, osteoarthritis, loose body or foreign body in the posterior compartment, posterior cruciate ligament (PCL) injury or avulsion fracture, posterior horn tear of meniscus, undiagnosed swollen knee with pain and effusion, osteochondritis dissecans, pyogenic arthritis, gout. From January 2002 to June 2005, 22 cases of ATS were applied. Anterolateral portal was initially created, followed by posterolateral portal under the viewing of arthroscopy which was located at the anterolateral portal. Anteromedial and posteromedial portals were also created using the same technique. Arthroscopy was then transferred to the posteromedial portal, and blade was introduced from the anteromedial portal to gradually remove the synovium covering PCL. Arthroscopy was relocated to the anteromedial portal, Wissinger rod was introduced from the posteromedial portal and pointed to the posterior septum adjacent to the posterior edge of the midportion of PCL. The Wissinger rod was pushed carefully to pierce through the posterior septum under the sight of arthroscopy which was located at the posterolateral portal. ATS was finally created.</p><p><b>RESULTS</b>The posterior septum was in the middle of posterior compartment of the knee, which was film screen-like at the sagittal plane and sandwich-like at the transverse plane. The synovium covered the posterior septum at arthroscopic inspection. Twenty-two cases of ATS were successfully created, amounting to 34% (22/65) of all cases at the same period which had received the arthroscopy of posterior compartments of the knees. Synovectomy of the posterior compartments of the knees was performed in 7 cases, loose body removal was in 6 cases, PCL reconstruction was in 4 cases, reduction and fixation of PCL avulsion fracture was in 2 cases. Chondroplasty, inflammatory synovectomy, and meniscectomy were performed accordingly in 6 osteoarthritis cases. No vascular or nervous injury was encountered. At an average of 20 months follow-up (range, 4 to 45 months), 9 cases still had mild knee pain or swelling, 2 cases had severe pain and were recommended for total knee replacement, the other 11 cases had no recurrence of knee pain or swelling.</p><p><b>CONCLUSIONS</b>ATS has no blind area under arthroscopic vision and facilitate trans-septal operation. It is a safe and effective method to treat the diseases of the posterior compartment of the knee. The direction of inside to outside to create ATS is comparatively reliable, and PCL could be identified as an interior landmark during the passage of Wissinger rod through posterior septum to create ATS.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Arthroscopy , Methods , Follow-Up Studies , Joint Diseases , General Surgery , Knee Injuries , General Surgery , Knee Joint , Pathology , General Surgery , Posterior Cruciate Ligament , Pathology , Reproducibility of Results , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To investigate the formula for TCM syndrome pattern differentiation in patients with posthepatitic cirrhosis.</p><p><b>METHODS</b>Factors analysis, C mean clustering and fuzzy comprehensive assessment were used for analyzing the basic information, including clinical symptoms and signs, obtained from 900 patients with posthepatitic cirrhosis to establish the formula for syndrome pattern differentiation through collecting the syndromic factors.</p><p><b>RESULTS</b>Multivariate statistic analysis showed the syndromic factors could be classified into two categories: the common characteristics related factors, which reflected the basic pathology of cirrhosis as qi deficiency and blood stasis, and the factors for differentiating 5 syndrome patterns (Gan-Shen yin-deficiency, dampness-heat accumulation, stasis-heat accumulation, Gan-qi stagnation with Pi-deficiency, and Pi-Shen qi-deficiency), which reflected the different pathological features of different syndrome patterns, showing the complexity and polymorphism of syndrome construction. And the functional formula for differentiating syndrome pattern was established.</p><p><b>CONCLUSION</b>The differentiating formula of TCM syndrome pattern could provide a quantified criterion for syndrome pattern differentiation in posthepatitic cirrhosis patients.</p>