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Objective To explore the characteristics of blood uric acid levels and its correlation with calcium and phosphorus levels, and glucose and lipid metabolism in obese adolescents in weight-loss training camps. Methods In this study, 357 obese adolescents aged 12-18 were selected as the research subjects, and 135 normal-weight adolescents were selected as the controls. The body shape and blood uric acid characteristics of the subjects were measured and analyzed. Further, 59 subjects were selected from the obese adolescents for blood calcium, blood phosphorus and glucose and lipid metabolism index tests to analyze the correlation between blood uric acid level and calcium, phosphorus, and glucose and lipid metabolism indicators. Results The average blood uric acid level of obese adolescents was (527.12±122.94)μmol/L, (566.58±122.51)μmol/L for boys, and (468.35±97.79)μmol/L for girls. The blood uric acid level of the obesity group was significantly higher than that of the control group (P<0.001 for boys, P<0.05 for girls), and it was higher in boys than in girls (P<0.01). Obese adolescents with high uric acid accounted for 73.39%. The HOMA-IR of obese adolescents was 5.79±3.04. The blood uric acid level was significantly correlated with blood calcium, total cholesterol, and low-density lipoprotein cholesterol (P<0.05). Gender and low-density lipoprotein cholesterol were the main influencing factors of blood uric acid (P<0.05). Conclusion Obese adolescents have high blood uric acid levels, low calcium and high phosphorus in the body, and a higher incidence of insulin resistance. There exists a positive correlation between the blood uric acid level and the body's calcium and phosphorus metabolism and glucose and lipid metabolism in obese adolescents. Clinical monitoring of lipid metabolism indicators such as low-density lipoprotein has certain reference value for the prevention and treatment of hyperuricemia.
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Objective:To explore the diagnosis process and treatment experience of severe coronavirus disease 2019 (COVID-19) patients with heparin resistance (HR).Methods:The medical team of the First People's Hospital of Lianyungang admitted 2 severe COVID-19 patients with HR in intensive care unit (ICU) during their support to the designated hospital for the treatment of COVID-19 patients in Lianyungang City in November 2021. The clinical features, laboratory examinations, imaging features, treatment and prognosis of the two patients were analyzed.Results:Both severe COVID-19 patients received mechanical ventilation, 1 patient was treated with extracorporeal membrane oxygenation (ECMO) support. Both patients were complicated with lower extremity deep venous thrombosis and HR phenomenon under routine dose anticoagulant therapy. The maximum daily dose of unfractionated heparin exceeded 35 000 U (up to 43 200 U), the 2 patients failed to meet the standard of anticoagulation treatment, and the course of disease was prolonged. After that, argatroban was given 0.4 μg·kg -1·min -1 combined with anticoagulant therapy, the activated partial thromboplastin time (APTT) of patients undergoing ECMO could be maintained at 55-60 seconds and the activated coagulation time (ACT) of them could be maintained at 180-200 seconds. After ECMO support or later sequential mechanical ventilation, both patients recovered and were discharged, and deep venous thrombosis was also effectively controlled. Conclusion:HR phenomenon often occurs during the treatment of severe COVID-19 patients, the anticoagulation regimen should be adjusted in time, and the anticoagulation effect combined with argatroban is clear.
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Objective:To explore the diagnostic value of mechanical power (MP) in patients with moderate to severe acute respiratory distress syndrome (ARDS) based on the Medical Information Mart for Intensive Care-Ⅲv1.4 (MIMIC-Ⅲ v1.4).Methods:The information of ARDS patients undergoing invasive mechanical ventilation for no less than 48 hours who were hospitalized at Beth Israel Deaconess Medical Center in Boston, Massachusetts from June 2001 to October 2012 in the MIMIC-Ⅲ v1.4 were collected. The demographics of patients, disease severity scores, ARDS etiology, prognostic indicators, pre-ventilation arterial blood gas analysis and respiratory parameters within 48 hours of ventilation were extracted. According to the lowest oxygenation index (PaO 2/FiO 2) before ventilation, the patients were divided into mild to moderate ARDS group (> 150 mmHg, 1 mmHg≈0.133 kPa) and moderate to severe ARDS group (≤ 150 mmHg), and the differences in baseline characteristics between the two groups were compared. The independent predictors associated with the severity of ARDS were analyzed using Logistic regression. The receiver operator characteristic curve (ROC curve) was plotted. The area under ROC curve (AUC) was calculated to evaluate the diagnostic value of MP for moderate to severe ARDS. The Youden index was used to determine the diagnostic threshold of MP for moderate to severe ARDS. According to the cut-off value of MP based on Youden index, all ARDS patients were divided into high and low MP groups. Kaplan-Meier survival curve was used to analyze the 28-day survival status of patients. Results:A total of 403 ARDS patients were enrolled in the study, including 107 subjects with mild to moderate ARDS and 296 with moderate to severe ARDS. There were significant differences in age, sequential organ failure assessment (SOFA) score, the lowest PaO 2/FiO 2 before ventilation, the last PaO 2/FiO 2 before ventilation, 28-day mortality, the length of intensive care unit (ICU) stay, duration of mechanical ventilation, lung dynamic compliance (Cdyn) in the second 24 hours of ventilation and positive end-expiratory pressure (PEEP), plateau pressure (Pplat), driving pressure (ΔP), respiratory rate (RR), lung static compliance (Cst), MP, inspired fraction of oxygen (FiO 2) within 48 hours of ventilation between the two groups. After adjusting variables such as age, SOFA score, the last PaO 2/FiO 2 before ventilation, and related respiratory mechanics parameters, multivariate Logistic regression analysis showed that higher ΔP, PEEP and MP, and lower last PaO 2/FiO 2 before ventilation were independently associated with moderate to severe ARDS [odds ratio ( OR) and 95% confidence interval (95% CI) was 1.137 (1.032-1.252), 1.333 (1.139-1.561), 1.102 (1.030-1.179), and 0.996 (0.993-0.998), respectively, all P < 0.01]. The ROC curve analysis showed that the best cut-off value of MP for the diagnosis of moderate to severe ARDS was 18.1 J/min with sensitivity of 81.42% and specificity of 60.75%, and the AUC was 0.745 (95% CI was 0.690-0.799). According to the cut-off value of MP obtained by ROC curve, all ARDS patients were divided into high MP group (> 18.1 J/min) and low MP group (≤ 18.1 J/min). The Kaplan-Meier survival curve showed that the 28-day cumulative survival rate in the high MP group was significantly lower than that in the low MP group (73.8% vs. 85.1%; Log-Rank test: χ2 = 5.660, P = 0.017). Conclusion:MP is an independent predictor of the severity of ARDS, and it can be used to diagnose moderate to severe ARDS.
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Chronic refractory pain is an excruciating pain caused by various reasons, which is easily recurrent and barely responded to multiple drugs. It affects more than 10% of the global population and thus causes a huge burden on the society and the economy. With the development of neuroscience, neuromodulation technologies have been well concerned, which guide a novel direction in the treatment of chronic refractory pain. This review summarizes the research progresses on repetitive transcranial magnetic stimulation, transcranial direct current stimulation, transcranial focused ultrasound stimulation, optogenetics and other non-invasive neuromodulations in the treatment of chronic refractory pain.
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@#To investigate the effects and possible molecular mechanism of S-oxiracetam(S-ORC) on learning and memory impairment in mice, mice were divided into 5 groups, control group, model group, high-dose of S-ORC (0.96 g/kg), medium-dose of S-ORC (0.48 g/kg) and low-dose of S-ORC (0.24 g/kg) treatment groups.Step-down test and Y-maze test were used to investigate the effects of S-ORC on the brain.The results of step-down test revealed that the mice in high and medium-dose groups could significantly decrease the reaction time, fault times and prolong the incubation periods of memory compared with the model group.Compared with the model group, the fault times of mice in high and medium-dose groups decreased significantly and the right times to find the safety increased significantly in Y-maze test.Furthermore, through treatment with S-ORC (high and medium-dose groups), the content of Ach in mice brain was significantly higher than that in model group, and the level of AChE decreased significantly.The above results suggest that the underlying mechanism of S-ORC on learning and memory impairment in mice may include the amelioration of the central cholinergic nervous system.
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Objective:To identify the clinical correlations between the cross-sectional area loss of the erector spinae muscle (ESMcsa Loss) and serum growth differentiation factor-15 (GDF-15) in mechanically ventilatied patients in ICU. In addition, to investigate their diagnostic value for ICU-acquired weakness (ICU-AW) and their predictive value for 60-day survival in mechanically ventilated patients.Methods:Ninety-two patients with acute respiratory failure, who required mechanical ventilation therapy, were randomly selected among hospitalized patients from June 2018 to November 2019. The serum GDF-15 level was detected by ELISA, the total cross-sectional area of the right and left erector spinae muscles was calculated by CT images, and the patient's muscle strength was assessed using the British Medical Research Council (MRC) muscle strength score on day 1 and day 7. The patients were divided into the ICU-AW group and the non-ICU-AW group according to the MRC-score on the 7th day of ICU admission. The correlations between plasma GDF-15 level, ESMcsa loss, and MRC score on day 7 were investigated. The receiver operating characteristic (ROC) curve was used to calculate the predictive value of serum GDF-15, ESMcsa loss, and ESMcsa loss ratio on day 7 of mechanically ventilated patients in the diagnosis of ICU acquired muscle weakness. Moreover, the predictive value of GDF-15 and ESMcsa loss ratio on the 90-day survival status of the patients was assessed using survival curves.Results:Ninety-two patients were enrolled. According to whether the MRC-score on the 7th day was less than 48, 49 cases were included in the ICU-AW group and 43 cases in the non-ICU-AW group. The mechanical ventilation time, length of ICU stay and length of hospital stay in the ICU-AW group were higher than those in the non-ICU-AW group, and there were no significant differences in other baseline indicators. There were no significant differences in serum GDF-15, ESMcsa and MRC-score between the two groups on day 1. The GDF-15 level in the ICU-AW group was significantly higher than that in the non-ICU-AW group while ESMcsa and MRC-score were significantly lower than those in the non-ICU-AW group on day 7 [GDF-15 (pg/mL): 2529.53±625.67 vs. 1614.21±567.18; ESMcsa (cm 2): 23.76±6.85 vs. 29.15±6.5; MRC-1score: 41.10±3.35 vs. 51.23±2.84; all P <0.001]. ESMcsa loss and ESMcsa loss ratio were significantly positively correlated with serum GDF-15 levels on day 7 ( r = 0.2355 and 0.3192, respectively). ESMcsa loss and ESMcsa loss ratio were significantly negatively correlated with MRC-score ( r = -0.3072 and -0.3527, respectively). The ROC curve analysis showed that plasma GDF-15 level, ESMcsa loss, and ESMcsa loss ratio on day 7 had predictive value for ICU-AW diagnosis in mechanically ventilated patients [Areas under the ROC curve (AUC) were 0.904, 0.835, and 0.889, all P <0.001]. The 60-day survival curve demonstrated that the survival rate was 60.0% in the high GDF-15 group, while was 77.8% in the low GDF-15 group; and was 60.0% in the high ESMcsa loss ratio group, while was 80.0% in the low ESMcsa loss ratio group (all P<0.05). Conclusions:There was a significant correlation between the cross-sectional area loss of the erector spinae muscle and the increase of serum GDF-15 level after 7 days of mechanical ventilation in ICU, suggesting the acute muscle wasting and skeletal muscle hypofunction, which has certain diagnostic value for ICU-AW, and can predict the 60-day survival status of mechanically ventilated patients in ICU.
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@#To investigate the neuroprotective effect and possible molecular mechanism of PNU-282987 on rats subjected to ischemia and reperfusion. In this study, middle cerebral artery occlusion/reperfusion(MCAO/R)in rats was used as the animal model. The 44 Sprague-Dawley(SD)rats were divided into 4 groups, sham group, model group, low-dose of PNU-282987(1. 2 mg/kg)and high-dose of PNU-282987(2. 4 mg/kg)treatment group. Y-maze test was tested for the learning and memory abilities of rats, and we also examined the brain infarct size, brain edema and neurological dysfunction in rats. Furthermore, HE staining was used to evaluate the neuronal injury and TUNEL assay was used to evaluate the neuronal apoptosis in the rat brain. The results revealed that the learning and memory abilities of rats in treatment group improved significantly, and treatment with PNU-282987 reduced brain infarct size, lessoned brain edema, lessened neurological dysfunction, ameliorated pathological injury and prevented neuronal apoptosis. The above results suggest that the underlying mechanism of PNU-282987 on improving learning and memory abilities of rats after cerebral ischemia and reperfusion may include the inhibition of neuronal apoptosis.
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Objective@#To investigate the value of mechanical power (MP) to predict the potential of the lung recruitment maneuver and assess prognoses in patients with acute respiratory distress syndrome (ARDS).@*Methods@#Patients with moderate-to-severe ARDS who required mechanical ventilation therapy longer than 24 hours were randomly selected April 2017 to April 2019. The lung recruitment maneuver (RM) protocol was performed according to the patient's condition, their MP, lung ultrasound score (LUS), oxygenation index (P/F), and dead volume ratio (Vd/Vt), which were monitored before the RM and one hour after the RM. The patients were divided into the lung recruitment maneuver potential positive group (RMP-P group) and lung recruitment maneuver potential negative group (RMP-N group) according to whether the variation in the patient's RM aeration score (ΔLUS) was≥5. Differences in MP between the two groups were compared and correlations between MP variation (ΔMP), aeration score variation (ΔLUS), oxygenation index variation (ΔP/F), and dead volume ratio variation (ΔVd/Vt) were analyzed. The receiver operating characteristic curve (ROC) was used to calculate the predictive value of MP for the potential of RM and the prognosis (28-day mortality) of patients with moderate or severe ARDS.@*Results@#Eighty-three patients were enrolled in the study, 45 in the RMP-P group and 38 in the RMP-N group. There was no statistical difference in the baseline levels between the two groups (P>0.05). After RM treatment, MP, LUS scores, and Vd/Vt for each patient in the two groups decreased significantly compared to the pre-RM values, whereas, the P/F increased significantly (P<0.05). The MP, LUS scores, and Vd/Vt in the RMP-P group were significantly lower than those in the RMP-N group (P<0.05), whereas there was no difference in the P/F between the two groups after RM treatment (P>0.05). The ΔMP, ΔLUS, and ΔVd/Vt in the RMP-P group were significantly higher than those in the RMP-N group (P<0.05). There was no difference in the ΔP/F between the two groups (P>0.05). There was a significant positive correlation between ΔMP and ΔLUS and ΔVd/Vt in all patients (r=0.4746, 0.3995, P<0.01) and no significant correlation withΔP/F (r=0.0314, P>0.05). The area under the ROC curves of ΔMP for predicting the potential of RM was 0.856, with a sensitivity of 91.1% and a specificity of 63.2%. The AUC of the 28-day survival status was 0.788, with a sensitivity of 84.3% and a specificity of 62.5% (P<0.05).@*Conclusions@#Mechanical power monitoring before and after RM can be used to predict the potential of the lung recruitment maneuver and assess the prognosis in patients with moderate-to-severe ARDS.
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Objective@#To investigate the expression of nucleolar and spindle-associated protein 1 (NUSAP1) in non-small cell lung cancer (NSCLC) and analyze its relationship with the prognosis of NSCLC patients.@*Methods@#Real-time fluorescent quantitative PCR and immunohistochemical staining were performed to determine the expression of NUSAP1 in NSCLC tissues and adjacent tissues collected from hospital. The relationship between NUSAP1 expression and prognosis of NSCLC patients was analyzed by online database.@*Results@#The expression level of NUSAP1 mRNA in tumor tissues was significantly higher than that of adjacent tissues (P<0.05). The high expression rate of NUSAP1 protein in NSCLC tissues was 58.0% (29/50), significantly higher than 22.0% (11/50) of adjacent tissues (P<0.05). The high expression of NUSAP1 protein in NSCLC tissues was closely correlated with tumor size, lymph node metastasis and TNM stage (P<0.05), but was not related to age and gender. The data showed that the expression level of NUSAP1 mRNA was inversely associated with the overall survival (OS) of NSCLC patients (P<0.001). The expression of NUSAP1 mRNA was significantly correlated with the pathological grade, clinical stage, gender, chemotherapy, smoking history, and histological type of NSCLC patients (P<0.05).@*Conclusions@#The expression of NUSAP1 is up-regulated in NSCLC, which is correlated with the growth and development of NSCLC and prognosis of the patients. These results indicate that NUSAP1 can be used as a potential prognostic marker for NSCLC.
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Objective@#To analyze and discuss the clinical value of single photon emission computed tomography(SPECT)/CT fusion imaging in differentiating benign and malignant spinal lesions.@*Methods@#From January 2017 to January 2018, 70 cases with benign and malignant spinal lesions in Shanxida Hospital were studied.SPECT/CT fusion imaging and SPECT examination were used to compare the diagnosis results between the two groups.@*Results@#After SPECT diagnosis, a total of 98 bone metastatic lesions were detected, including 10 false positive lesions, 60 benign lesions and 28 false negative lesions.After SPECT/CT fusion imaging, there were 100 lesions, including 4 false positive lesions, 59 benign lesions and 37 false negative lesions.In this study, a total of 145 lesions were found in 70 patients with benign and malignant spinal lesions, including 95 benign lesions and 50 malignant lesions.The specificity, sensitivity and accuracy of SPECT/CT fusion imaging [95.79%(91/95), 92.00%(46/50), 93.79%(136/145)] were higher than those of the control group [82.11%(78/95), 64.00%(32/50), and 82.76%(120/145)], the differences were statistically significant(χ2=9.048, 11.422, 9.578, all P<0.05).@*Conclusion@#In the diagnosis of benign and malignant spinal diseases, SPECT/CT fusion imaging can accurately distinguish benign and malignant lesions, and clearly reflect the development of the disease, which lay a solid foundation for good treatment in the future.
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Objective The aim of this study is to build a risk prediction model for the recurrence and metastasis of thoracic esophageal squamous cell carcinoma after radical surgery,and to analyze the factors affecting the disease free survival (DFS).Methods Conducted analysis of 1 191 patients with thoracic esophageal squamous cell carcinoma,who received radical resection from January 2007 to December 2011.The VaR boundary value of the risk prediction model was obtained by receiver operating characteristic (ROC) curve,and the boundary value was verified.The factors that affected DFS were analyzed by univariate analysis and Cox multiple factor prognosis analysis.Results There were 472 cases had recurrence and metastasis after treatment.There was a significant difference in VaR between patients with and without failure (t =-5.307,P ≤ 0.001).The VaR boundary value was 0.30 according to ROC curve analysis.The recurrence rate of the patients in the VaR ≤ 0.30 group was 27.5％,which was significantly lower than 48.2％ in the ≥0.30 groups (x2 =51.659,P ≤ 0.001).The univariate analysis showed that the patient's sex,the length of the lesion,the degree of tissue differentiation and the VaR value were all factors that significantly affected the recurrence and metastasis of the patients (x2 =13.460,21.111,17.540,39.175,P ≤0.001).Multivariate analysis showed that tissue differentiation and VaR were independent factors affecting recurrence and metastasis of patients (P ≤ 0.001).Conclusions The model can be applied to predict the recurrence and metastasis risk of patients with thoracic esophageal squamous cell carcinoma after radical surgery.
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Objective To study the application effect of ENCOR vacuum-assisted breast minimally invasive polypectomy system in the diagnosis and treatment of breast tumors. Methods Totally 86 breast cancer patients treated in the General Hospital of Yangmei Group from January 2017 to October 2017 were randomly divided into study group and control group,with 43 cases in each group. The study group was treated with ENCOR vacuum-assisted minimally invasive rotational atherectomy system,while the control group was treated by traditional breast excision. The operative conditions, postoperative complications and postoperative recurrence were observed and compared between the two groups. Results The intraoperative bleeding volume,operation time,scar length and postoperative recovery time in the study group were (5.1 ±1.2)mL,(15.9 ±3.5)min,(0.3 ±0.1)cm,(2.7 ±0.4)d,respectively, which in the control group were (12.7 ±2.3)mL,(26.8 ±4.6)min,(3.2 ±1.1)cm and (5.1 ±0.8)d,respectively, the differences between the two groups were statistically significant ( t=15. 579,14. 297,14. 108,13. 597,all P<0. 05). The total incidence rate of postoperative complications in the study group was 11. 63％,which was significantly lower than 30. 23％ in the control group (χ2 =5. 187,P<0. 05). During the follow-up of 12 months,in the study group,2 patients (4. 65％) had residual tumor,1 patient (2. 33％) developed recurrence; in the control group, 3 patients (6. 98％) had residual tumor,2 patients (4. 65％) developed recurrence. There was no statistically significant difference between the two groups (χ2 =1. 013,P >0. 05). Conclusion ENCOR vacuum - assisted breast minimally invasive revolving system in the treatment of breast tiny tumors has advantages of less trauma and pain,rapid recovery,etc,it is safe and effective.
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Objective To investigate the clinical correlations between mechanical power (MP) and lung ultrasound score (LUS), and analyze their evaluation value of prognosis in patients with acute respiratory distress syndrome (ARDS). Methods Patients with moderate to severe ARDS, who underwent invasive mechanical ventilation admitted to intensive care unit (ICU) of the Lianyungang Affiliated Hospital of Xuzhou Medical University from January 2017 to March 2019 were enrolled. The MP and LUS were recorded 0, 24, 48 and 72 hours after ICU admission. The patients were divided into death group and survival group according to the 28-day prognosis. The trends of MP and LUS in the two groups and their differences between groups were analyzed. Then the MP and LUS were analyzed by bivariate correlation analysis, and their correlations with acute physiology and chronic health evaluationⅡ (APACHEⅡ), sequential organ failure assessment (SOFA), oxygenation index (PaO2/FiO2), and blood lactate (Lac) were also analyzed. The predictive value of MP and LUS 0 hour and 72 hours in ICU for 28-day mortality in patients with moderate to severe ARDS was analyzed by receiver operating characteristic (ROC) curve. Results At the end, 83 patients were enrolled, with 32 died and 51 survived in 28-day. The Lac level, APACHEⅡ and SOFA in the death group were significantly higher than those in the survival group, while PaO2/FiO2 was significantly lower than the survival group, and the other baseline indicators were not statistically significant between the two groups. As the treatment time increased, the MP and LUS of the survival group showed a significant decrease trend, while the death group showed a significant upward trend. The MP and LUS of the death group 0, 24, 48, 72 hours after ICU admission were significantly higher than those of the survival group [MP (J/min): 20.97±3.34 vs. 17.20±4.71, 21.56±3.48 vs. 16.87±3.85, 22.72±2.97 vs. 16.13±3.52, 25.81±3.46 vs. 15.24±3.78; LUS: 19.17±3.31 vs. 16.27±4.28, 20.28±3.65 vs. 15.27±3.23, 21.53±4.32 vs. 13.63±3.71, 23.94±3.82 vs. 12.53±2.94, all P < 0.05]. There was a significant positive correlation between MP and LUS 0, 24, 48, 72 hours after ICU admission (r value was 0.547, 0.577, 0.754, and 0.783, respectively, all P < 0.01). The MP and LUS at 0 hour of ICU admission were significantly positively correlated with SOFA and PaO2/FiO2 (r value was 0.421, 0.450, and 0.409, 0.536, respectively, all P < 0.01), but no correlation with Lac and APACHEⅡ was found. The ROC curve analysis showed that the MP and LUS at 0 hour and 72 hours had predictive value for the 28-day mortality [the area under the ROC curve (AUC) of MP was 0.836, 0.867; and the AUC of LUS was 0.820, 0.891, all P < 0.01]. Conclusions There was a significant correlation between MP and LUS in patients with moderate to severe ARDS. The MP and LUS could be used early to evaluate the 28-day prognosis of patients with moderate to severe ARDS.
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Objective To analyze and discuss the clinical value of single photon emission computed tomography(SPECT)/CT fusion imaging in differentiating benign and malignant spinal lesions.Methods From January 2017 to January 2018,70 cases with benign and malignant spinal lesions in Shanxida Hospital were studied.SPECT/CT fusion imaging and SPECT examination were used to compare the diagnosis results between the two groups.Results After SPECT diagnosis,a total of 98 bone metastatic lesions were detected,including 10 false positive lesions,60 benign lesions and 28 false negative lesions.After SPECT/CT fusion imaging,there were 100 lesions,including 4 false positive lesions,59 benign lesions and 37 false negative lesions.In this study,a total of 145 lesions were found in 70 patients with benign and malignant spinal lesions,including 95 benign lesions and 50 malignant lesions.The specificity,sensitivity and accuracy of SPECT/CT fusion imaging [95.79％ (91/95),92.00％ (46/50),93.79％ (136/145)] were higher than those of the control group [82.11％ (78/95),64.00％ (32/50),and 82.76％ (120/145)],the differences were statistically significant (x2 =9.048,11.422,9.578,all P ＜0.05).Conclusion In the diagnosis of benign and malignant spinal diseases,SPECT/CT fusion imaging can accurately distinguish benign and malignant lesions,and clearly reflect the development of the disease,which lay a solid foundation for good treatment in the future.
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Objective To investigate the value of mechanical power(MP)to predict the potential of the lung recruitment maneuver and assess prognoses in patients with acute respiratory distress syndrome(ARDS).Methods Patients with moderate-to-severe ARDS who required mechanical ventilation therapy longer than 24 hours were randomly selected April 2017 to April 2019.The lung recruitment maneuver(RM)protocol was performed according to the patient's condition,their MP,lung ultrasound score(LUS),oxygenation index(PIF),and dead volume ratio(Vd/Vt),which were monitored before the RM and one hour after the RM.The patients were divided into the lung recruitment maneuver potential positive group(RMP-P group)and lung recruitment maneuver potential negative group(RMP-N group)according to whether the variation in the patient's RM aeration score(ΔLUS)was ≥ 5.Differences in MP between the two groups were compared and correlations between MP variation(Δ MP),aeration score variation(Δ LUS),oxygenation index variation(Δ P/F),and dead volume ratio variation(Δ V d/Vt)were analyzed.The receiver operating characteristic curve(ROC)was used to calculate the predictive value of MP for the potential of RM and the prognosis(28-day mortality)of patients with moderate or severe ARDS.Results Eighty-three patients were enrolled in the study,45 in the RMP-P group and 38 in the RMP-N group.There was no statistical difference in the baseline levels between the two groups(P＞0.05).After RM treatment,MP,LUS scores,and Vd/Vt for each patient in the two groups decreased significantly compared to the pre-RM values,whereas,the P/F increased significantly(P＜0.05).The MP,LUS scores,and Vd/Vt in the RMP-P group were significantly lower than those in the RMP-N group(P＜0.05),whereas there was no difference in the PIF between the two groups after RM treatment(P＞0.05).The Δ MP,Δ LUS,and Δ V d/Vt in the RMP-P group were significantly higher than those in the RMP-N group(P＜0.05).There was no difference in the Δ P/F between the two groups(P＞0.05).There was a significant positive correlation between Δ MP and Δ LUS and Δ Vd/Vt in all patients(r=0.4746,0.3995,P＜0.01)and no significant correlation with Δ P/F(r=0.0314,P＞0.05).The area under the ROC curves of Δ MP for predicting the potential of RM was 0.856,with a sensitivity of 91.1％and a specificity of 63.2％.The AUC of the 28-day survival status was 0.788,with a sensitivity of 84.3％and a specificity of 62.5％(P＜0.05).Conclusions Mechanical power monitoring before and after RM can be used to predict the potential of the lung recruitment maneuver and assess the prognosis in patients with moderate-to-severe ARDS.
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Viral infections cause at least 10%-15% of all human carcinomas. Over the last century, the elucidation of viral oncogenic roles in many cancer types has provided fundamental knowledge on carcinogenetic mechanisms and established a basis for the early intervention of virus-related cancers. Meanwhile, rapidly evolving genome-editing techniques targeting viral DNA/RNA have emerged as novel therapeutic strategies for treating virus-related carcinogenesis and have begun showing promising results. This review discusses the recent advances of genome-editing tools for treating tumorigenic viruses and their corresponding cancers, the challenges that must be overcome before clinically applying such genome-editing technologies, and more importantly, the potential solutions to these challenges.
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Antiviral Agents , Therapeutic Uses , CRISPR-Cas Systems , Carcinoma , Genetics , Therapeutics , Virology , Gene Editing , Genetic Predisposition to Disease , Genetic Therapy , Methods , Humans , Tumor Virus InfectionsABSTRACT
Objective To clarify the significance of chest radiotherapy in the treatment of oligometastatic stage Ⅳ non-small cell lung cancer ( NSCLC ) and to explore the optimal time of interventional therapy during chest radiotherapy. Methods A total of 192 patients with oligometastatic stage Ⅳ NSCLC admitted to Shanxi Provincial Cancer Hospital from 2008 to 2014 were randomly and evenly divided into the chemotherapy alone, radiotherapy+ early intervention, radiotherapy+ middle intervention and radiotherapy+ late intervention groups. Survival analysis was performed with Kanplan-Meier method. Results The median survival of 192 patients with oligometastatic stage Ⅳ NSCLC was 14. 50 months, and the 1-,2-and 3-year survival rates were 57. 4％,24. 0％ and 10. 7％, respectively. The median survivalin the chemotherapy alone, radiotherapy+ early intervention, radiotherapy+ middle intervention and radiotherapy+late intervention groups was 10,21,18 and 13 months, respectively. The 1-year survival rates were 34％, 73％,71％ and 51％,10％,40％,32％ and 13％ for the 2-year survival rates, and 0％,24％,16％ and 3％for the 3-year survival rates ( P=0. 000) . The median survival of patients with radiotherapy dose ≥ 60 Gy and< 60 Gy was 21 and 13 months, 76％ and 53％ for the 1-year survival rates, 34％ and 21％ for the 2-year survival rates, and 17％ and 10％ for the 3-year survival rates ( P=0. 002 ) . Conclusion Early interventional therapy and high-dose radiotherapy can improve the local control rate and prolong the survival time of patients with oligometastatic stage Ⅳ NSCLC.
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Objective To explore the effect of lncRNA of growth arrest-specific 5 (lncRNA GAS5) on the radiosensitivity of colon cancer cells by targeting miR-223.Methods The expressions of lncRNA GAS5 in a few of colon cancer cell lines were detected by real-time quantitative PCR (qPCR).The cell lines with low expression level of lncRNA GAS5 were selected for subsequent study.The effect of overexpression of lncRNA GAS5 on the radiosensitivity of colon cancer SW480 cells was detected by cell cloning experiments.The target gene miR-223 of lncRNA GAS5 was predicted and validated by the bioinformatics database starBase and dual luciferase reporter assays.qPCR was used to detect the expression of miR-223 in various colon cancer cell lines and the influence of lncRNA GAS5 overexpression on the expression of miR-223 in SW480 cells.Results Compared with normal human colonic epithelial cells (NCM460),the expressions of lncRNA GAS5 in the colon cancer SW480,LOVO,HT-29 and SW620 cell lines were significantly lower(t =15.25,8.69,14.42,11.62,P ＜ 0.05),with the lowest level in SW480 cells.Both overexpression of lncRNA GAS5 and down-regulation of miR-223 significantly increased the radiosensitivity of colon cancer cells by decreasing cell survival fraction (at 8 Gy,lncRNA GAS5,t =13.51,P ＜ 0.05;anti-miR-223,t =14.93,P ＜ 0.05)and promoting apoptosis (lncRNA GAS5,t =8.30,P ＜ 0.05;anti-miR-223,t =7.32,P ＜ 0.05).Bioinformatics analysis showed that the 3'sequence of lncRNA GAS5 contained the binding sites with miR-223.After overexpression or downregulation of lncRNA GAS5,the expression of miR-223 was enhanced or reduced.Conclusions The lncRNA GAS5 promotes the apoptosis of colon cancer cells and inhibits its survival by targeting miR-223 expression,thereby increases the radiosensitivity of colon cancer cells.
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Objective To analyze the treatment effect and influencing factors of salvage therapy for postoperative recurrence and metastasis patients with pT3N0M0 stage thoracic esophageal squamous cell carcinoma. Methods The clinical data of 174 postoperative recurrence and metastasis patients with pT3N0M0 stage thoracic esophageal squamous cell carcinoma from January 2008 to December 2011 were retrospectively analyzed. The location of recurrence or metastasis, effect of salvage therapy and influencing factors were specifically focused. Results The 1-, 3-and 5-year overall survival rates after recurrence and metastasis in patients with pT3N0M0 stage thoracic esophageal squamous cell carcinoma were 35.0% , 19.3% and 13.3% respectively, and the median survival time was 7 months (95% CI 5.2 to 8.8). Single factor analysis results showed that the gender, age, location of recurrence or metastasis, distant metastasis time and salvage therapy were related to the prognosis in postoperative recurrence and metastasis patients with pT3N0M0 stage thoracic esophageal squamous carcinoma (P＜0.05 or＜0.01), but the weight loss (≥ 5 kg), lesion extent, lesion location, number of lymph node dissection, postoperative adjuvant treatment method and intrathoracic recurrence time were not related to the prognosis in postoperative recurrence and metastasis patients with pT3N0M0 stage thoracic esophageal squamous carcinoma (P＞0.05). Multivariate analysis result showed that the distant metastasis time and salvage therapy were the independent risk factors of prognosis in postoperative recurrence and metastasis patients with pT3N0M0 stage thoracic esophageal squamous carcinoma (P＜0.01). Conclusions Salvage therapy and distant metastasis time are independent risk factors of prognosis in postoperative recurrence and metastasis patients with pT3N0M0 stage thoracic esophageal squamous carcinoma, and chemoradiotherapy or radiotherapy after postoperative recurrence and metastasis in some extent could prolong the survival time.
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Objective@#To investigate relationship between the clinicopathological features and prognosis of T1 esophageal carcinoma.@*Methods@#Data from 212 T1 primary esophageal cancer patients, who underwent radical surgery in The Fourth Hospital of Hebei Medical University from Jan 2001 to Dec 2009 were enrolled. There were 148 males and 64 females. There were 91 patients with stage pT1a and 121 patients with stage pT1b.@*Results@#The survival of the 212 patients was 27~108 months, and the median survival was 80.8 months. The 1, 3, and 5 year survival rates of patients with stage T1a were 100%, 97.8% and 94.5%, respectively, and the median survival was 86.8 months. The 1, 3, and 5 year survival rates of patients with stage T1b were 100%, 95.9% and 74.4%, respectively, and the median survival was 76.2 months. The rate of lymph node metastasis in 121 patients with stage T1b was 26.4% (32/121). The lymph node metastasis rates in patients with stage sm1, sm2 and sm3 were 11.6% (3/26), 15.0% (6/40) and 41.8% (23/55), respectively. There was no significant difference in lymph node metastasis between stage sm1 patients and stage sm2 patients (P=0.973). Lymph node metastasis rates in patients with stage sm3 were higher than those in stage sm1 and sm2 (P<0.05).@*Conclusion@#Radical resection of esophageal carcinoma with peripheral lymph node dissection is recommended for patients with T1b esophageal carcinoma.