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1.
Article in English | WPRIM | ID: wpr-914879

ABSTRACT

Background@#and Purpose Collateral circulation is considered an important factor affecting the risk of stroke, but the factors that affect collateral circulation remain unclear. This study was performed to identify the factors associated with collateral circulation, especially blood lipids. @*Methods@#The study involved patients who had undergone digital subtraction angiography and were confirmed as having severe unilateral stenosis or occlusion of the internal carotid artery (ICA). We classified the collateral circulation status of each patient as good (Grade 3 or 4) or poor (Grade 0, 1, or 2) according to the grading system of the American Society of Interventional and Therapeutic Neuroradiology/American Society of Interventional Radiology. We collected data on patients’ characteristics and identified the factors that affect collateral circulation. @*Results@#This study included 212 patients. The multivariate logistic regression analysis showed that the high-density lipoprotein cholesterol (HDL-C) concentration and a complete anterior half of the circle of Willis were independent protective factors for good collateral circulation, whereas elevated lipoprotein(a) [Lp(a)] and serum creatinine concentrations were independent risk factors for good collateral circulation. The area under the receiver operating characteristics curve (AUC) was 0.68 (95% confidence interval [CI], 0.61–0.76) for HDL-C and 0.69 (95% CI, 0.62–0.76) for Lp(a). A binary logistic regression model analysis of the joint factor of HDL-C and Lp(a) yielded an AUC of 0.77 (95% CI, 0.71–0.84). @*Conclusions@#In patients with severe unilateral ICA stenosis or occlusion, the combination of HDL-C and Lp(a) is a useful predictor of collateral circulation.

2.
Article in Chinese | WPRIM | ID: wpr-909989

ABSTRACT

Objective:To discuss the pathological characteristics and strategy for diagnosis and treatment of the transolecranon fracture-dislocation of the elbow in children.Methods:Retrospectively reviewed were the 15 patients who had been treated at Hospital of Pediatric Orthopedics, Xi'an Honghui Hospital from October 2016 to March 2019 for transolecranon fracture-dislocation of the elbow. They were 11 boys and 4 girls, with an average age of 8.3 years (from 5 to 14 years) and 10 left and 5 right arms injured. Type Ⅰ (simple fracture) was found in 11 cases and type Ⅱ (comminuted fracture) in 4 cases in 3 of which the coronoid process was affected. Of them, 14 were treated successfully with closed reduction and plaster fixation under local anesthesia in emergency but one was unsuccessfully. Of the 11 simple fractures, 10 received tension band fixation with Kirschner wire and a short oblique one underwent bone plate fixation; the 4 comminuted fractures were treated by fixation with a combination of Kirschner wire and bone plate.Results:The 15 patients obtained follow-up for 8 to 15 months (average, 11 months). The final follow-up observed fine anatomical relationship of the elbow in all patients, and no such complications as relapse of radial head dislocation, avascular necrosis of the trochlea or early closure of the epiphyseal plate. The transolecranon fracture-dislocation of the elbow obtained bony union in all patients after 5 to 7 weeks (average, 5.6 weeks). The therapeutic efficacy was evaluated at the final follow-up by the Mayo elbow performance score as excellent in 11 cases, as good in 3 and as fair in one.Conclusions:As a type of complicated fracture-dislocation of the elbow, the transolecranon fracture-dislocation of the elbow is rare in children, mainly manifested as simple ones. Treatment options depend on the type of fracture-dislocation. Only anatomical reduction of the olecranon fracture and restoration of a normal trochlear notch can lead to a stable humeroradial joint and thus fine clinical efficacy.

3.
Cancer Research and Clinic ; (6): 612-617, 2021.
Article in Chinese | WPRIM | ID: wpr-912933

ABSTRACT

Objective:To explore the survival status of rectal cancer patients with liver metastasis after receiving different treatments and its influencing factors.Methods:The clinicopathological characteristics, treatment methods and survival of 211 rectal cancer patients with liver metastasis who received different treatments in Shanxi Provincial Cancer Hospital from January 2012 to December 2016 were retrospectively analyzed. Cox proportional hazards regression model was used to analyze the related factors affecting the prognosis of patients.Results:The median overall survival (OS) time of 211 rectal cancer patients with liver metastasis was 19 months (1-115 months), and the 1-, 3- and 5-year OS rates were 66%, 22% and 10%. The OS of rectal cancer patients with metachronous liver metastasis was better than that of rectal cancer patients with simultaneous liver metastasis ( χ2 = 17.225, P < 0.01). The OS of patients with primary tumor resection was better than that of patients without primary tumor resection ( χ2 = 69.54, P < 0.01). Among patients with primary tumor resection, the OS of patients with untreated liver metastasis was worse than that of patients with interventional treatment of liver metastasis ( χ2 = 7.311, P = 0.007). Among the patients without primary tumor resection, the OS of patients with chemotherapy alone was better than that of untreated patients ( χ2 = 4.123, P = 0.042). The OS of patients with primary tumor resection and untreated liver metastasis and patients with primary tumor resection and liver metastasis intervention therapy was better than that of patients with chemotherapy alone (both P < 0.01). The results of Cox regression analysis showed that the differentiation degree of primary tumor, liver metastasis and carbohydrate antigen 199 level at diagnosis were independent factors influencing the survival of rectal cancer patients with liver metastasis (all P < 0.01). Conclusion:For patients with diagnosed rectal cancer, even if there is liver metastasis before surgery, active surgical resection of the primary tumor and local treatment of liver metastasis can still improve the survival.

4.
Chinese Journal of Urology ; (12): 414-422, 2021.
Article in Chinese | WPRIM | ID: wpr-911043

ABSTRACT

Objective:To assess the efficacy and safety of 100 units of botulinum toxin A (BTX-A) intradetrusor injection in patients with overactive bladder.Methods:From April 2016 to December 2018, 17 tertiary hospitals were selected to participate in this prospective, multicenter, randomized, double-blind, placebo-controlled study. Two phases of study were conducted: the primary phase and the extended phase. This study enrolled patients aged 18 to 75 years who had been inadequately managed by anticholinergic therapy (insufficient efficacy or intolerable side effects) and had spontaneous voiding with overactive bladder. Exclusion criteria included patients with severe cardiac, renal and hepatic disorders, patients with previous botulinum toxin treatment for 6 months or allergic to BTX-A, patients with urinary tract infections, patients with urinary stones, urinary tract tumors, diabetes mellitus, and bleeding tendency. Eligible patients were randomly assigned to BTX-A group and placebo control group in a ratio of 2∶1. Two groups of patients received 20 intradetrusor injections of BTX-A 100U or placebo at the depth of the submucosal muscle layer respectively under cystoscope, including 5 injections at the base of the bladder, 3 injections to the bladder triangle, 5 injections each to the left and right walls and 2 injections to the top, sparing the bladder neck. As a placebo control group, patients received same volume of placebo containing no BTX-A and only adjuvant freeze-dried preparations for injection with the same method. A combination of gelatin, sucrose, and dextran served as adjuvants. Average micturition times per 24 hours, urinary incontinence (UI) episodes per day, average micturition volume per day, OAB symptom score(OABSS), and quality of life (QOL) score were recorded at baseline and the 2nd, 6th and 12th week after treatment. The primary efficacy endpoint was the change from baseline in the average micturition times per 24 hours at the 6th week after treatment. The secondary efficacy endpoints included the change from baseline in the average micturition times per 24 hours at 2nd and 12th week, as well as the change from baseline in the OABSS, QOL score, average frequency of urgency and UI episodes per day, urgency score, average micturition volume per day at 2nd, 6th and 12th week after treatment. Patients were followed for 12 weeks to assess adverse events (AEs). After assessed at week 12, if the micturition times has decreased less than 50% compared to baseline and the patient is willing to receive retreatment, then patients could enter the extended trial phase. In that phase, patients in both groups were injected with 100 units BTX-A from 12th week onwards and then followed up the same indicators for 12 weeks.Results:216 patients were enrolled in this trial (144 cases in the BTX-A group and 72 cases in the placebo control group). Baseline characteristics such as age (47.75±14.20 in the BTX-A group and 46.39±15.55 in the control group), sex (25 male/117 female in the BTX-A group and 10/61 in the control group), and disease duration (0.51 years in the BTX-A group and 0.60 years in the control group) were balanced between the two groups( P>0.05). A marked reduction from baseline in average micturition times per 24 hours was observed in all treatment groups at the 6th week and the reduction of the two groups was statistically different ( P<0.001 and P=0.008 respectively). Compared with the baseline, the average micturition times per 24 hours at the 6th week decreased from baseline by 2.40(0.70, 4.60)times for the BTX-A group and 0.70(-1.00, 3.30) times for the placebo control group respectively, and the difference between the two groups was considered to be statistically significant ( P=0.003). The change rates of average micturition times per 24 hours from baseline at the 6th week of the two groups were (16±22)% and (8±25)% respectively, and the difference between the two groups was statistically significant ( P=0.014). Compared with the baseline, the average micturition times per 24 hours at 2nd and 12th week decreased by 2.00(0.00, 4.00)and 3.30(0.60, 5.03)for the BTX-A group, 1.00(-1.00, 3.00)and 1.70(-1.45, 3.85)for the placebo control group respectively. The difference between two groups was considered to be statistically significant ( P=0.038 and P=0.012); the changes of average urgency times per day for the BTX-A group and the control group at the 2nd, 6th and 12th week were 2.00(0.00, 4.30)and 2.40(0.30, 5.00), 3.00(0.30, 5.70)and 0.70(-1.30, 2.70), 0.70(-1.30, 3.00) and 1.35(-1.15, 3.50), respectively. There were significant differences between two groups at the 2nd, 6th and 12th week, ( P=0.010, P=0.003 and P=0.025, respectively). The OABSS of the BTX-A group and the control group at the 6th week decreased by 1.00(0.00, 4.00)and 0.50(-1.00, 2.00) compared with the baseline, and the difference between the two groups was statistically significant ( P=0.003). 47 cases of BTX-A group and 34 cases of placebo control group entered the extended trial phase, and 40 and 28 cases completed the extended trial phase, respectively. The average micturition volume per 24 hours changed by -16.60(-41.60, -0.60)ml and -6.40(-22.40, 13.30)ml, (-35.67±54.41)ml and(-1.76±48.69)ml, (-36.14±41.51)ml and (-9.28±44.59)ml, (-35.85±43.35)ml and(-10.41±40.29)ml for two groups at the 12th, 14th, 18th and 24th week, and the difference between two groups was statistically significant at each follow-up time ( P=0.01, 0.006, 0.012 and 0.016, respectively). There was no significant difference in other parameters( P>0.05). However, adverse reactions after intradetrusor injection included increased residual urine volume (27 in the BTX-A group and 3 in the control group), dysuria (21 in the BTX-A group and 6 in the control group), urinary infection (19 in the BTX-A group and 6 in the control group), bladder neck obstruction (3 in the BTX-A group and 0 in the control group), hematuria (3 in the BTX-A group and 1 in the control group), elevated alanine aminotransferase (3 in the BTX-A group and 0 in the control group), etc. During the follow-up period, there was no significant difference in the other adverse events between two groups except the increase of residual urine volume( P<0.05). In the primary trial phase, among the 27 cases with increased residual urine volume in BTA group, only 1 case (3.70%) with PVR more than 300 ml; the PVR of 3 patients in the placebo group was less than 100 ml. The increase of residual urine volume caused by the injection could be improved or disappeared with the passage of time. Conclusions:Intradetrusor injection of Chinese BTX-A improved the average micturition times per 24 hours, the average daily urgent micturition times, OABSS, and average micturition volume per time, and reduced the adverse effects in patients with overactive bladder.Chinese BTX-A at dose of 100U demonstrated durable efficacy and safety in the management of overactive bladder.

5.
Article in Chinese | WPRIM | ID: wpr-883795

ABSTRACT

Objective:To investigate the application value of multi-slice spiral CT angiography in the clinical diagnosis of aortic dissection.Methods:The clinical data of 78 patients with aortic dissection diagnosed by digital subtraction angiography and treated between January 2015 and December 2019 in Putuo District People's Hospital of Zhoushan and Zhoushan Hospital were retrospectively analyzed. All patients underwent multi-slice spiral CT angiography and digital subtraction angiography. The type of aortic dissection, the number of aortic lacunas, the distance between the lacuna and the left subclavian artery, the involved branches, the percentage of artery wall calcification, and arterial dissection thrombosis determined by multi-slice spiral CT angiography and digital subtraction angiography were compared.Results:All 78 patients were diagnosed with aortic dissection by digital subtraction angiography, and 75 (96.2%) were diagnosed with aortic dissection by multi-slice spiral CT angiography. The same type of aortic dissection was detected by multi-slice spiral CT angiography and digital subtraction angiography, but three patients were misdiagnosed with pericarditis by multi-slice spiral CT angiography. There were no significant differences in the number of aortic lacunas and the distance between the lacuna and the left subclavian artery between the two methods ( t = 1.02, 0.57, both P > 0.05). The involved branches [61.3% (46/78),] the percentage of artery wall calcification [26.7% (20/78)], and the percentage of arterial dissection thrombosis [78.7% (59/78)] determined by multi-slice spiral CT angiography were significantly higher than 43.6% (34/75), 12.8% (10/75), and 62.8% (49/75) respectively determined by digital subtraction angiography ( χ2 = 4.83, 4.65, 4.62, all P < 0.05). Conclusion:Multi-slice spiral CT angiography exhibits a similar capacity to identify aortic dissection to digital subtraction angiography. It can accurately determine the number and location of aortic lacunas, display the calcification and thrombosis of vascular wall, and is minimally invasive and simply operated. Therefore, multi-slice spiral CT angiography is of high application value in the clinical diagnosis and preoperative evaluation of aortic dissection.

6.
Article in Chinese | WPRIM | ID: wpr-828565

ABSTRACT

OBJECTIVE@#To investigate the clinical outcome of patients with moderate type of corona virus disease 2019 (COVID-19) after discharge by retesting viral nucleic acid.@*METHODS@#Seven patients with moderate COVID-19 met the discharge criteria enacted by National Health Commission were quarantine in hospital for 7 days, then continuously quarantined at home for 4 weeks after discharged. During the three weeks of quarantined period, the symptoms and signs were documented; and sputum or nasal swab and feces samples were collected to test SARS-COV-2 nucleic acid by RT-PCR method.@*RESULTS@#There were no symptoms and signs during the quarantine period in all 7 patients. However, respiratory swabs from 3 patients were confirmed positive of SARS-COV-2 nucleic acid at 5 to 7 days after they met the discharge criteria.@*CONCLUSIONS@#The study indicates that there is a relatively high incidence of positive viral nucleic acid in patients met the discharge criteria, and it is suggested that patients met the current discharge criteria should be quarantined in hospital for another 7 days and the follow-up viral testing is necessary.


Subject(s)
Asymptomatic Diseases , Betacoronavirus , Genetics , China , Clinical Laboratory Techniques , Coronavirus Infections , Diagnosis , Virology , Follow-Up Studies , Humans , Pandemics , Patient Discharge , Reference Standards , Pneumonia, Viral , Diagnosis , Virology , Quarantine , Reverse Transcriptase Polymerase Chain Reaction , Time Factors
7.
Article in Chinese | WPRIM | ID: wpr-828541

ABSTRACT

OBJECTIVE@#To investigate the clinical outcome of patients with moderate type of coronavirus disease 2019 (COVID-19) after discharge by retesting viral nucleic acid.@*METHODS@#Seven patients with moderate COVID-19 met the discharge criteria enacted by National Health Commission were quarantined in hospital for 7 days, then continuously quarantined at home for 4 weeks after discharged. During the quarantined period, the symptoms and signs were documented, and sputum or nasal swab and feces samples were collected to test SARS-CoV-2 nucleic acid by RT-PCR method.@*RESULTS@#There was no symptoms and signs during the quarantine period in all 7 patients. However, respiratory swabs from 3 patients were confirmed positive of SARS-CoV-2 nucleic acid at 5 to 7 days after they met the discharge criteria.@*CONCLUSIONS@#There is a relatively high incidence of positive viral nucleic acid in patients met the discharge criteria, and it is suggested that patients met the current discharge criteria should be quarantined in hospital for another 7 days and the follow-up viral testing is necessary.


Subject(s)
Betacoronavirus , Coronavirus Infections , Diagnosis , Feces , Chemistry , Virology , Follow-Up Studies , Humans , Pandemics , Patient Discharge , Pneumonia, Viral , Diagnosis , Quarantine , RNA, Viral , Reverse Transcriptase Polymerase Chain Reaction , Time Factors
8.
Article in Chinese | WPRIM | ID: wpr-872114

ABSTRACT

Objective To find the facial soft tissue measured indexes related to esthetic evaluation.Methods Thirty women were selected and scanned with CBCT;all individuals showed normal jaw,and lateral profile was taken in natural head posture.All the data measured including E line were imported with software Winceph 8.0 and overlapped,acquiring lateral cephalometric radiographs in natural head posture.29 orthodontists and 85 laypersons were invited to evaluate the attractiveness of this 30 profile silhouettes.18 esthetic indexes including E line were measured by Winceph 8.0.Paired t-tests were carried out for measured values of aesthetic indexes from two groups.Then Pearson correlation analysis was used to each silhouette score and values of aesthetic indexes were analyzed.Results Orthodontists group had average 0.05 points higher than laypersons.The aesthetic evaluation was different between orthodontists and laypersons with statistical significance.The measured indexes were correlated with measured values of two groups,including TLL-TVL,B'-TVL,Pos'-TVL (P<0.05).Conclusions There are differences between orthodontists and laypersons in soft-tissue profile esthetic evaluation.The value of TLL-TVL,B'-TVL and Pos TVL are three key soft-tissue measurements that influence the esthetic indexes both for orthodontists and laypersons.The head position is an element that influences esthetic evaluation.

9.
Article in Chinese | WPRIM | ID: wpr-870587

ABSTRACT

Objective:To summarize the patient profiles and therapeutic efficacies of ABO-incompatible living-related kidney transplantations at 19 domestic transplant centers and provide rationales for clinical application of ABOi-KT.Methods:Clinical cases of ABO-incompatible/compatible kidney transplantation (ABOi-KT/ABOc-KT) from December 2006 to December 2009 were collected. Then, statistical analyses were conducted from the aspects of tissue matching, perioperative managements, complications and survival rates of renal allograft or recipients.Results:Clinical data of 342 ABOi-KT and 779 ABOc-KT indicated that (1) no inter-group differences existed in age, body mass index (BMI), donor-recipient relationship or waiting time of pre-operative dialysis; (2) ABO blood type: blood type O recipients had the longest waiting list and transplantations from blood type A to blood type O accounted for the largest proportion; (3) HLA matching: no statistical significance existed in mismatch rate or positive rate of PRA I/II between two types of surgery; (4) CD20 should be properly used on the basis of different phrases; (5) hemorrhage was a common complication during an early postoperative period and microthrombosis appeared later; (6) no difference existed in postoperative incidence of complications or survival rate of renal allograft and recipients at 1/3/5/10 years between ABOi-KT and ABOc-KT. The acute rejection rate and serum creatinine levels of ABOi-KT recipients were comparable to those of ABOc-KT recipients within 1 year.Conclusions:ABOi-KT is both safe and effective so that it may be applied at all transplant centers as needed.

10.
Article in Chinese | WPRIM | ID: wpr-870559

ABSTRACT

Objective:To explore the relationship between new biomarkers in donor blood and delayed graft function after kidney transplantation and evaluate the clinical value of new biomarkers in the diagnosis of DGF (delayed graft function).Methods:For recipients of donor kidney transplantation from August 2016 to December 2017, blood samples were collected from operations of donor organ resection within 12 hours of the day. Enzyme-linked immunosorbent assay (ELISA) was employed for detecting neutrophil gelatinase-associated lipocalin (NGAL), L-type fatty acid binding protein (L-FABP), kidney injury molecule-1 (KIM-1) and interleukin-18(IL-18). They were divided into DGF and EGF (early graft function) groups according to the diagnosis of DGF. The inter-group differences of four new biomarkers were calculated. Receiver operating characteristic curve (ROC curve) was plotted for finding the best positive cutoff value and the sensitivity and specificity of new donor blood marker for diagnosing delayed graft function were calculated.Results:Among them, 8 had postoperative DGF and 62 had none. The overall incidence of DGF was 11.43%. The serum concentration of NGAL was 521.01±132.84 ng/ml in DGF group versus (299.99±100.03) ng/ml in EGF group ( P<0.001). The ROC curve was plotted. With a NGAL concentration >425.15 ng/ml, the sensitivity and specificity for diagnosing DGF were 87.5% and 90.3% respectively. The area under the curve (AUC) was 0.891. The serum concentration of IL-18 was (14.10±12.36) ng/ml in DGF group and (4.61±1.83) ng/ml in EGF group ( P=0.047). With a IL-18 concentration of >5.345 ng/ml, the sensitivity and specificity for diagnosing DGF were 100% and 64.5% respectively. The AUC was 0.914. No significant inter-group difference existed in serum L-FABP/KIM-1. The sensitivity of donor creatinine in the diagnosis of DGF was 62.5%, specificity 75.8% and AUC 0.692. Conclusions:With an excellent level of sensitivity and specificity, an elevated concentration of NGAL/IL-18 in donor blood is superior to traditional creatinine in the diagnosis of DGF after renal transplantation.

11.
Article in Chinese | WPRIM | ID: wpr-870090

ABSTRACT

Objective:To quantify the fat of extraocular muscle in TAO patients with MRI fat-water separation technique.Methods:66 patients (129 eyes) with TAO were included in this study from November 2017 to July 2019. The age, gender, course of disease, disease activity and severity were collected. Fat fraction(FF) of the heaviest inflamed extraocular muscle was used as FFmax, the average FF of each orbital was recorded as FFmean. FF differences between groups of severity and activity were compared, the correlation between FF and clinical characteristics was also analyzed. Meanwhile, the changes of FF in follow-up patients before and after treatment were compared.Results:FFmean and FFmax of mild group were higher than moderate-to-severe as well as sight-threatening group. In male patients, active group′s FFmean and FFmax were lower. FF was different in groups which based on disease course ( P<0.05). Spearman correlation analysis showed a positive correlation between FF and disease course. Besides, there was a negative correlation between FF, disease activity, and disease severity ( P < 0.05). FF increased after treatment(FFmean: 34.03%±6.75% vs 32.26%±6.06%, P=0.040; FFmax: 33.43%±9.44% vs 29.04%±8.45%, P=0.006). Conclusion:MRI fat fraction can quickly and objectively quantify the fat of extraocular muscle, providing a new reference index for TAO′s disease evaluation.

12.
Chinese Journal of Urology ; (12): 724-730, 2020.
Article in Chinese | WPRIM | ID: wpr-869749

ABSTRACT

Objective:To investigate the 2 years’ efficacy of intravesical instillation of domestic BCG versus epirubicin in the prevention of recurrence of intermediate-risk or high-risk non-muscular invasive bladder cancer and predictive factors of BCG instillation.Methods:From July 2015 to June 2020, 18-75 years old patients with moderate to high-risk non muscle invasive bladder cancer (NMIBC) confirmed by pathological examination were involved. The ECOG score was 0-2. Exclusion criteria included ①immune deficiency or impairment (such as AIDS), using immunosuppressive drugs or radiotherapy, suspected allergic to BCG or epirubicin or excipients of the two drugs, fever or acute infectious diseases including active tuberculosis or receiving anti tuberculosis treatment, with severe chronic cardiovascular and cerebrovascular diseases or chronic kidney disease; ②combined with other urogenital system tumors or other organ tumors; ③combined with muscle invasive bladder urothelial carcinoma (≥T 2); ④undergoing chemotherapy, radiotherapy or immunotherapy within 4 weeks (immediate instillation after surgery not included); ⑤ pregnant or lactating women; ⑥ comfirmed or suspected bladder perforation; ⑦gross hematuria; ⑧cystitis with severe bladder irritation that may affect the evaluation; ⑨participat in other clinical trials within 3 months; ⑩alcohol or drug addiction; ?any risk factors that may increasing the risk of patients. Epirubicin 50 mg was irrigated immediately after the operation(TURBT or laser resection). The patients were randomly divided into BCG15 group, BCG19 group and epirubicin group by the ratio of 2∶2∶1, and the patients were maintained intravescical instillation for 1 year. The recurrence and adverse events of the three groups were compared. Univariate and multivariate analysis was performed to predict the risk factors of BCG irrigated therapy failure. Result:By June 15, 2020, the median follow-up duration was 22.1 months(12.1, 32.3), and there was no statistical difference between the groups ( P=0.9024). There were 274 patients enrolled in BCG19 group, 277 patients enrolled in BCG15 group and 130 patients enrolled in the epirubicin group. The drop-off rate was 16.6%(113 cases)and made no difference between groups( P=0.6222). There were no significant difference in age, gender, BMI, or ECOG score( P>0.05). During the follow-up, 116 cases was detected recurrence or progression. The recurrence rate of the three groups was 14.2% and 14.8% in BCG19 group and BCG15 group, and 27.7% in the epirubicin group. There was no difference in recurrence rate between BCG19 and BCG15 group( P=0.9464). The recurrence rate of BCG19 group was lower than that of the epirubicin group ( P=0.0017). The recurrence rate of BCG15 group was lower than that of the epirubicin group ( P=0.0020). There was no difference in the cumulative recurrence free survival rate between BCG19 and BCG15 group (95% CI0.57-1.46, P=0.7173). The cumulative recurrence free survival rate of BCG 19 group was better than that of the epirubicin group( HR=0.439, 95% CI0.26-0.74, P=0.0006), and the cumulative recurrence free survival rate of BCG15 group was better than that of the epirubicin group ( HR=0.448, 95% CI0.29-0.80, P=0.0021). The total incidence of adverse events in 19 BCG19, BCG15 and epirubicin group were 74.5%, 72.6% and 69.8% respectively. There was no difference in the incidence of adverse events between BCG19 and BCG15 group( P=0.6153). The incidence of adverse events in epirubicin group was lower than that of BCG19( P=0.0051) and BCG15( P=0.0167) groups.There was no significant difference in the incidence of serious adverse events (SAE) among the three groups ( P=0.5064). Log rank test univariate analysis and Cox risk regression model multivariate analysis showed that the history of bladder cancer recurrence( HR=6.397, 95% CI1.95-20.94, P=0.0001)was independent risk factor for BCG irrigation failure. Conclusions:The 2 years’ efficacy of intravesical instillation of domestic BCG is better than than of epirubicin with good tolerance and safety. There is no difference between BCG19 and BCG15 group. BCG doesn’t increase SAE compared with epirubicin. Recurrence status was an independent prognostic factor regarding recurrence-free survival.

13.
Chinese Journal of Geriatrics ; (12): 418-423, 2020.
Article in Chinese | WPRIM | ID: wpr-869398

ABSTRACT

Objective:To investigate the safety and efficacy of sacral neuromodulation(SNM)therapy for the treatment of lower urinary tract dysfunction(LUTD)in elderly patients.Methods:Clinical data of 91 elderly patients with LUTD from multiple medical institutions who received SNM during the period from January 2012 to December 2016 were retrospectively analyzed.Patients were divided into four groups: the interstitial cystitis(IC)group(n=28), the neurogenic bladder(NB)group(n=36), the overactive bladder syndrome(OAB)group(n=13)and the idiopathic dysuria(ID)group(n=14). Different sets of evaluation parameters were used for different diseases.Patients’ baseline data and data in stage I(test phase)and stage Ⅱ(permanent SNM)were recorded, statistically analyzed and compared.Results:Ninety-one people underwent SNM treatment.Of them, 53 patients received permanent implants(stage Ⅱ), and the total conversion rate of stage I to stage Ⅱ was 58.2%(53/91). Patients receiving permanent implants(stage Ⅱ)had a preoperative period ranging from 3 months to 30 years, and were followed up for 2 to 58 months after treatment, with an average follow-up of 19.6 months.The improvement rates in stage I for urinary urgency, daily urination frequency, daily nocturnal urination frequency, maximum urine volume, daily average urine volume, daily urine leakage frequency, and quality of life score were 35.4%, 31.6%, 33.7%, 32.6%, 49.2%, 43.2% and 13.2%, respectively.The improvement rates in stage Ⅱ for urinary urgency, daily urination frequency, daily nocturnal urination frequency, maximum urine volume, daily average urine volume, daily urine leakage frequency, and quality of life score were 43.2%, 40.0%, 37.8%, 50.5%, 70.5%, 70.4% and 43.2%, respectively.Three adverse events occurred, including 1 case of recurrent symptoms, 1 case of moderate infection, and 1 case of electrical lead dislocation.Conclusions:Sacral nerve stimulation has definitive and consistent curative effects on LUTD in elderly people.The follow-up time should be extended to further study the safety of sacral nerve stimulation.

14.
Chinese Journal of Radiology ; (12): 869-873, 2020.
Article in Chinese | WPRIM | ID: wpr-868348

ABSTRACT

Objective:To develop and validate a cascaded deep learning algorithm for kidney stone detection on plain CT images.Methods:Plain CT images of the patients with kidney stones were retrospectively archived from January 2018 to July 2018 in Peking University First Hospital. The cases were divided into two datasets according to the date of the CT scanning: training dataset ( n=30) and held-out test dataset ( n=29). The development of the kidney stone detection method consisted of three steps. First, a U-Net model was trained on the training dataset for kidney segmentation, and the model′s performance was estimated with the dice coefficient. Second, the thresholding and region growing methods were used to detect the stones in the renal region predicted by the trained U-Net model. Third, the stones′ lengths (maximal, middle and minimal length) and CT attenuation were calculated and integrated into a structured report automatically. Using the radiologist′s labels and measurements (maximal, middle, minimal length and CT attenuation) as ground truth, the stone detection algorithm performance was evaluated with sensitivity, specificity and precision, and the stone measurement algorithm performance was evaluated with Bland-Altman plots. Results:The held-out test dataset consisted of 29 cases, containing 58 kidneys and 11 358 CT slices. The 38 kidneys containing 56 stones and 20 kidneys did not contain stones. The U-Net model showed good performance, with a mean dice coefficient of 0.96. And 10 945 of 11 358 CT slices had a dice coefficient no less than 0.90. The sensitivity, precision, and specificity of stone detection were 100% (38/38), 100% (38/38) and 100% (20/20) in the organ-level. The sensitivity and precision of stone detection were 100% (56/56) and 96.6% (56/58) in the lesion-level.Conclusion:A cascaded algorithm is constructed and can be used to detect kidney stones in plain CT images. The algorithm can improve efficiency with results automatically integrated into the structured report in clinical practice.

15.
Chinese Journal of Urology ; (12): 561-566, 2019.
Article in Chinese | WPRIM | ID: wpr-755487

ABSTRACT

Objective To evaluate the efficacy and safety of urinary diversion in patients with refractory interstitial cystitis/bladder pain syndrome (IC/BPS).Methods Clinical data of 15 female patients who underwent urinary diversion treatment for IC/BPS in our hospital from January 2008 to July 2018 were retrospectively analyzed.The mean age of the subjects was 64 years old (range 29-79),and the mean disease history of IC/BPS was 5 years (range 2-15).Behavior therapy,oral medicine therapy,intravesical instillation,bladder submucosal injection of botulinum toxin type A and sacral neuromodulation showed unsatisfied outcomes in these patients.Before the surgical intervention,the average urinary frequency was (30.7 ± 11.6) per day,the median visual analogue scale (VAS) was 95 (range 50-100),the O'Leary-Sant Index was 35 (range 31-36) [all the interstitial cystitis problem index (ICPI) was 16],the pelvic pain and urgency/frequency patient symptom scale (PUF) was 35 (range 32-36) [the bother score was 12 (range 11-12)],all the quality of life (QOL) was 6,and the average serum creatinine was (81.1 ± 13.5) μmol/L.Two patients underwent cutaneous ureterostomy without cystectomy,1 patient underwent ileal conduit urinary diversion without cystectomy,and the other 12 patients underwent laparoscopic ileal conduit urinary diversion with cystectomy.The differences of the Global Response Assessment (GRA),complications,VAS,ICPI,PUF,QOL and the serum creatinine before and after the operation were compared.Results The mean postoperative follow-up period was 24 months (range 6-110).The last follow-up showed that all the GRA was 7,the median VAS was 0 (range 0-30),all the ICPI was 0,all the PUF(bother score)was 0,and the median QOL was 2 (1-4),which were significantly different with those before the surgery (all P < 0.01).The last follow-up showed that the average serum creatinine was (83.8 ± 12.5)μ mol/L,which were not significantly different with that before the surgery (P =0.22).Postoperative adhesive intestinal obstruction occurred in 3 subjects.Conclusions Urinary diversion might be an effective and adequate treatment for refractory IC/BPS to eliminate pain or lower urinary tract symptom and improve quality of life of the patients.

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Chinese Journal of Urology ; (12): 485-491, 2019.
Article in Chinese | WPRIM | ID: wpr-755476

ABSTRACT

Objective To investigate the efficacy and safety of intravesical instillation of BCG vaccine in the prevention of early recurrence of middle and high risk non-muscle invasive bladder cancer.Methods From July 2015,patients with non-muscle invasive bladder cancer aged 18-75 years with informed consent were screened and underwent transurethral resection of bladder tumor (TURBT).Immediately intravesical instillation of epirubicin 50 mg was given postoperatively.After pathology was comfirmed,patients was enrolled in group 1 (BCG15) or group 2 (BCG 19) or the control group (epirubicin 18) randomly with SAS 9.3 software.Data of follow-up and Adverse event was collected and analyzed.Results By May 31,2019,531 patients were enrolled in the study.The drop-off rate was 20.1%.167 patients (143 males and 24 females)in group 1,172 patients (141 males and 31 females)in group2 and 84(75 males and 9 females) in the control group with follow-up data were analyzed.There were no significant differences in age,gender,BMI,ECOG score,risk stratification between the three groups (P =0.8641,P =0.2906,P =0.9384,P =0.6126).The median follow-up time makes no statistical difference between the groups (P =0.9251),12.0 (6.0,22.5) months,13.0 (6.0,22.3) months,and 13.0 (7.0,22.3) months.The median recurrence time of the three groups was 4.0 (3.0,6.0) months,4.5 (3.0,9.8) months,4.5 (3.0,8.8) months.There was no statistical difference between the three groups (P =0.2852).Risk stratification in the patients got no significant difference between the three groups (P > 0.05).The 1-year recurrence-free survival rates were 80.0% in the group 1 and 88.3% in the group 2 and 73.7% in the control group.The group 2 was superior to the group 1 and the control group (P =0.0281,P =0.0031).There was no significant difference between group 1 and control group (P =0.2951).There was no significant difference in the cumulative recurrence-free survival between the experimental group 1 and the experimental group 2,(95% CI 0.80-2.43,P =0.2433).The cumulative recurrence-free survival in the group 1 and the group 2 was better than the control group (95 % CI 0.31-0.92,P =0.0266;95 % CI 0.20-0.65,P =0.0008).All the cases underwent instillation were analyzed for adverse events.The incidence of overall AE(adverse events) in group 1 was 68.5% (152/222),the incidence of grade Ⅰ-Ⅱ AE was 53.2% (118/222),the incidence of grade Ⅲ-Ⅳ AE was 15.3% (32/222).The incidence of overall AE in the group 2 was 71.8% (160/223),the incidence of grade Ⅰ-Ⅱ AE was 60.1% (134/223),and the incidence of grade Ⅲ-Ⅳ AE was 11.7% (26/223).The overall AE rate in the control group was 53.2% (59/111),of which the incidence of grade Ⅰ-Ⅱ AE was 42.4% (47/111),and the incidence of grade Ⅲ-Ⅳ AE was 10.8% (12/111).There was no difference in the incidence of overall AE between the group 1 and the group 2 (P =0.4497).The incidence of AE in the two experimental groups was higher than that in the control group (P =0.0062,P =0.0008).There was no difference in the incidence of grade Ⅲ-Ⅳ AE between the three groups (P =0.3902).Conclusions BCG(19 instillation schedule) has a better effect on preventing recurrence after 1 year of bladder surgery,which is superior to epirubicin group.The long-term efficacy of BCG in preventing recurrence and the efficacy of different schedules need to be further followed up.The lower urinary tract symptoms,which are mainly urinary frequency,are one of the causes of case fallout and should be fouced in future.Compared with epirubicin,BCG perfusion does not increase the incidence of grade Ⅲ-Ⅳ adverse reactions,and is safe to use.

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Article in Chinese | WPRIM | ID: wpr-752980

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Objective To investigate the relationship of lymph node metastasis rate (LNR) with prognosis of esophageal squamous cell carcinoma after radical resection and postoperative adjuvant chemotherapy.Methods The retrospective case-control study was conducted.The clinicopathological data of 121 patients who underwent radical resection of esophageal squamous cell carcinoma in the Peking University Cancer Hospital from January 2012 to September 2016 were collected.There were 105 males and 16 females,aged from 42 to 76 years,with a median age of 58 years.All patients underwent radical resection of esophageal cancer with at least two-field lymph nodes dissection.Some patients underwent corresponding chemotherapy and radiotherapy.The thoracic and abdominal lymph nodes were grouped according to the 7th edition standard of Americau Joint Committee on Cancer (AJCC).The lymph nodes dissected were labeled in groups,and all the lymph nodes were examined by pathology test.Observation indicators:(1) follow-up;(2) effects of LNR on prognosis of patients in different AJCC N staging;(3) relationship between LNR and postoperative adjuvant chemotherapy.Follow-up was conducted by outpatient examination,telephone interview and hospital statistical office to detect postoperative survival of patients up to February 2017.The disease-free survival time was from surgery date to date of confirmation of tumor recurrence,and the overall survival time was from surgery date to death of the patient or the last follow-up date.Measurement data with skewed distribution were expressed by M (range).The Kaplan-Meier method was used to calculate the survival rate and draw the survival curve.The Log-rank test was used for survival analysis.Results (1) Follow-up:121 patients were followed up for 3.0-94.2 months,with a median follow-up time of 27.1 months.During the follow-up,98 of 121 patients had tumor recurrence and metastasis (including 64 deaths),22 had no metastasis,and 1 had unknown tumor metastasis.The mean overall survival time of patients was 30.8 months.The 1-,3-,5-year disease-free survival rates were 47.1%,20.3%,and 5.9%,respectively.The 1-,3-,5-year overall survival rates were 93.1%,48.7%,and 35.3%,respectively.(2) Effects of LNR on prognosis of patients in different AJCC N staging:of 121 patients,46 were in N0 stage,42 were in N1 stage,28 were in N2 stage,and 5 were in N3 stage.Of 42 patients in N1 stage,35 with 0 < LNR ≤ 0.15 had a disease-free survival time of 12.2 months (range,1.2-82.3 months),and 7 with LNR > 0.15 had a disease-free survival time of 6.9 months (range,2.1-23.1 months);the difference between the two groups was statistically significant (x2 =3.888,P<0.05).Of the 28 patients in N2 stage,12 with 0 < LNR ≤ 0.15 had a disease-free survival time of 8.5 months (range,1.2-38.8 months),and 16 with LNR > 0.15 had a disease-free survival time of 4.4 months (range,1.0-52.7 months);the difference was not statistically significant (x2 =0.007,P>0.05).Forty-six patients in N0 stage were detected no lymph node metastasis,and only 5 cases were in N3 stage,with no analysis.(3) Relationship between LNR and postoperative adjuvant chemotherapy:of the 121 patients,56 underwent postoperative adjuvant chemotherapy,which was mainly constituted by pactitaxel,platinum,and 5-fluorouracilbased regimens,58 didn't undergo postoperative adjuvant chemotherapy,and 7 had unknown data of postoperative adjuvant chemotherapy.Of 121 patients,46 had LNR =0,47 had 0 < LNR ≤ 0.15,28 had LNR > 0.15.Of the 46 patients with LNR =0,17 who underwent postoperative adjuvant chemotherapy had a disease-free survival time of 8.1 months (range,3.9-66.7 months) and a overall survival time of 34.0 months (range,4.7-76.0 months);29 who didn't undergo postoperative adjuvant chemotherapy had a disease-free survival time of 18.8 months (range,1.6-53.2 months),and a overall survival time of 48.6 months (range,8.3-94.2 months);there was no significant difference in the disease-free survival time and overall survival time between the two groups (x2=0.311,0.858,P>0.05).Of the 47 patients with 0 < LNR ≤ 0.15,27 who underwent postoperative adjuvant chemotherapy had a disease-free survival time of 13.3 months (range,5.0-82.3 months),and a overall survival time of 53.1 months (range,5.7-82.3 months);20 without postoperative adjuvant chemotherapy had a disease-free survival time of 8.4 months (range,1.2-39.2 months),and a overall survival time of 26.5 months (range,5.9-52.6 months).There were significant differences in the disease-free survival time and overall survival time between the two groups (x2 =10.322,4.971,P<0.05).Of the 28 patients with LNR > 0.15 (7 had unknown data of postoperative adjuvant chemotherapy),12 who underwent adjuvant chemotherapy had a diseasefree survival time of 10.3 months (range,2.9-52.7 months),and a overall survival time of 29.5 months (range,11.2-58.5 months);9 without postoperative adjuvant chemotherapy had a disease-free survival time of 2.9 months (range,1.4-35.7 months),and a overall survival time of 14.5 months (range,3.0-62.3 months);there was a significant difference in the disease-free survival time between the two groups (x2 =6.687,P<0.05),and no significant difference in the overall survival time between the two groups (x2=2.938,P> 0.05).Conclusions LNR can be used as a supplementation of AJCC N staging system.In patients with 0< LNR ≤ 0.15,postoperative adjuvant chemotherapy can improve disease-free survival time and overall survival time.

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Article in Chinese | WPRIM | ID: wpr-751867

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Objective To compare the value of presepsin,procalcitonin (PCT) and C-reactive protein (CRP) in differentiating different types of pathogenic bacteria in septic patients.Methods A prospective study was conducted to collect 322 septic patients who met the diagnostic criteria of "sepsis 3.0"in the Emergency ICU of the First Affiliated Hospital of Dalian Medical University from July 2016 to January 2018.According to the results of blood culture,patients were divided into the positive blood culture group (n=114) and negative blood culture group (n=208).Patients in the positive blood culture group were further divided into four subgroups:Gram-positive coccus (G+),Gram-negative bacilli (G-),mixed bacteria,and fungi groups.Healthy volunteers were selected as the control group (n=45).The differences in presepsin,PCT and CRP levels were compared among the groups,and the curves of the subjects' working characteristic curve (ROC) were drawn.Results Presepsin,PCT,and CRP were significantly increased in the positive blood culture and negative blood culture groups compared with the control group (all P<0.05);Presepsin and PCT were significantly higher in the positive blood culture group than those in the negative blood culture group (both P<0.05).There was no significant difference in Presepsin among the four subgroups in the positive blood culture group (all P>0.05),but PCT was significantly higher in the G-and mixed bacteria groups than that in the G+ and fungi groups (all P<0.05).Presepsin predicted a positive blood culture with area under ROC curve of 0.680,which was higher than PCT (AUC=0.599).Conclusions Presepsin is more valuable than PCT in early predicting positive blood culture in septic patients,but only PCT has an ability to differentiate pathogenic bacteria in septic patients with positive blood culture.It suggested that a combination of Presepsin and PCT should be more meaningful in clinical practice.

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Article in Chinese | WPRIM | ID: wpr-745903

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Clinical data of 24 patients with acute kidney injury (AKI) induced by hypothyroidism myopathy admitted in our hospital from January 2014 to December 2016 were analyzed retrospectively.There were 9 patients classified as AKI stage Ⅰ and 15 patients as AKI stage Ⅱ according to the Kidney Disease Improving Global Outcomes (KDIGO),21 hypothyroidism myopathy patients without AKI were selected as control group.ANOVA and chi-square test were used to compare the general data and laboratory results among three groups;artificial neural network analysis and multi-factor stepwise regression method were used to analyze the factors related to AKI.There were significant differences in serum creatinine (Scr) (F=34.3,P<0.01),BUN(F=29.1,P<0.01),ALB(F=5.27,P=0.01),CK(F=8.61,P=0.01),creatin kinase isoenzyme(CK-MB)(F=33.1,P<0.01),LDH(F=7.78,P=0.01),ALT(F=34.3,P<0.01) and AST (F=28.1,P<0.01) among three groups.Artificial neural network analysis showed that myoglobin was closely related to serum creatinine,suggesting its importance for AKI in patients with primary hypothyroidism myopathy.Multivariate regression analysis showed that serum creatinine was correlated with CK-MB(B=2.10,SE=0.38,β=0.96,t=5.52),LDH(B=0.18,SE=0.06,β=0.34,t=3.00)and AST(B=0.16,SE=0.09,β=0.32,t=2.62).This study indicates that hypothyroidism myopathy may be one of the causes of AKI,and the severity of AKI might be closely related to the severity of hypothyroidism myopathy.

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Article in Chinese | WPRIM | ID: wpr-743889

ABSTRACT

BACKGROUND: Calcium phosphate bone cement exhibits great commercial potential as bone filling materials in the field of clinical biomedical engineering; however, due to some existing technical and theoretical challenges, its wide spread application is hindered. It is therefore necessary to search existing patents to explore various potential improvements in modification of calcium phosphate bone cement. OBJECTIVE: To analyze the patent information of calcium phosphate bone cement for better understanding of the development of the calcium phosphate bone cement technology, and for early warning of patent infringement.METHODS: Based on the manual screening of Incopat patent database, we analyzed 2 711 patent documents from four aspects — the application trend, patent layout, competitor analysis, and efficacy matrix. In combination with technology development and industrialization, this paper also shows some important Chinese patents selectively. RESULTS AND CONCLUSION: The United States is in the leading position in the calcium phosphate bone cement field, while this technology is developing rapidly in China. Various components and methods are developed for modifying calcium phosphate bone cement, which are the focus of patent development and layout. Although some of the fundamental patents have expired, patent infringement risks need to be tested and mitigated for the development and industrialization by Chinese enterprises as there are some important patents in China arranged by foreign companies. At the same time, Chinese patent holders need to master international patent layout and develop their intellectual properties for the future international marketplace.

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