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The contents recorded in the rotation registration manual is not only the quantitative indicators for evaluating the quality of residency training, but also the important basis for training assessment and issuance of training certificates. In order to solve the problems of data authenticity, information delay, and repeated entry in the rotation registration manual for residency training, Shanghai East Hospital, Tongji University, launched a project to dock the electronic rotation registration manual with the hospital information system. Through the establishment of the project team, the development of working mechanisms, and the implementation of the project, data analysis was used for process reformation and system optimization, so as to continuously improve management efficiency and medical safety while solving problems and form a set of implementation system with reference significance in practice.
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The complex chemical composition and limited research ideas of traditional Chinese medicine (TCM) have led to the unclear material basis and mechanism of the medicinal effects, which is a common problem hindering the modernization of TCM in China. The introduction of computer virtual technology has provided a new perspective for TCM research. In this study, we established the research method of structure-activity omics to study the relationships between the structures and effects of different compounds in TCM based on the chemical structures of TCM components and to analyze and predict the material basis and multitarget synergistic mechanism of TCM. Furthermore, a structure-activity omics study was carried out with the anti-inflammatory and analgesic effects of Qizhi Weitong granules as an example. This study provides support for screening the pharmacodynamic components and analyzing the active ingredients of TCM and gives insights into the research on the material basis and mechanism of compound efficacy and the development of lead compounds of TCM, thus promoting the modern research and the innovative development of TCM.
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ObjectiveTo identify the pharmacodynamic substances for the anti-inflammatory and analgesic effects of Bupleuri Radix by structure-activity omics. MethodA mouse model of pain was established with formaldehyde to examine the anti-inflammatory and analgesic effects of saikosaponins in vivo. The core targets of the active components in Bupleurum Radix for the anti-inflammatory and analgesic effects were screened from the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP), Online Mendelian Inheritance in Man (OMIM), and Search Tool for Recurring Instances of Neighbouring Genes (STRING). The key core targets with high binding affinity were screened based on the comprehensive score in the molecular docking between different types of saikosaponins and core targets. The structure-activity relationship was discussed and analyzed based on the binding of compounds to pharmacodynamic targets. ResultSaikosaponins alleviated the foot swelling induced by formaldehyde and reduced the content of prostaglandin E2 (PGE2) in the mouse model, showcasing a significant inhibitory effect on the inflammatory pain caused by PGE2. Nine components and 39 targets of saikosaponins, as well as 3 074 targets of anti-inflammatory and analgesic effects were screened out, and 22 common targets shared by saikosaponins and the effects were obtained as the direct targets. The protein-protein interaction (PPI) analysis showed that the main active components of Bupleurum Radix were saikosaponins a, b1, b2, b3, c, d, e, f, and v, and the key targets were fms-related receptor tyrosine kinase 1 (FLT1), kinase insert domain receptor (KDR), fibroblast growth factor 2 (FGF2), vascular endothelial growth factor A (VEGFA), and signal transducer and activator of transcription 3 (STAT3). Molecular docking between saikosaponins and the top 5 targets with high degrees in PPI network analysis revealed 25 highly active docks, including 6 docks with scores of 5-6 and 18 docks with scores above 6. ConclusionThis study adopted structural-activity omics to analyze the material basis for the anti-inflammatory and analgesic effects of Bupleuri Radix in vivo, providing new ideas and methods for identifying the pharmacodynamic substances in traditional Chinese medicine.
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ObjectiveTo explain the pharmacodynamic substances of Aurantii Fructus flavonoids that exert anti-inflammatory and analgesic effects using a structure-activity omics approach. MethodOn the basis of the previous in vitro pharmacological screening conducted by the research team, an in vivo pharmacological study of Aurantii Fructus flavonoids was carried out. Core targets of the anti-inflammatory and analgesic active components of flavonoids of Aurantii Fructus were identified using various network databases, including the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP), the Online Mendelian Inheritance in Man (OMIM), and the Search Tool for the Retrieval of Interacting Genes/Proteins (STRING). Computer-aided virtual screening technology was used to dock different types of Aurantii Fructus flavonoids with core targets. The key core targets with high binding activity were selected based on the comprehensive scores of each target and the active structures. Using these targets as bridges, the structures of one or more types of chemical components in Aurantii Fructus were closely linked to pharmacological effects. The structure-activity relationship between the clear pharmacodynamic compounds and their effects was explored through the binding patterns of various structures with pharmacodynamic targets. ResultAurantii Fructus flavonoids demonstrated significant anti-inflammatory and analgesic effects on dextran sulfate sodium (DSS)-induced colitis in mice, which could improve symptoms and significantly reduce the levels of inflammatory factors interleukin-6 (IL-6) and interleukin-1β (IL-1β)(P<0.05). Twelve active components of Aurantii Fructus flavonoids were identified and categorized into nine dihydroflavonoids and three flavonoids based on their structures of the parent nuclei. Through Venn analysis, 167 anti-inflammatory and analgesic targets for Aurantii Fructus were identified. Based on degree value and molecular docking comprehensive scores, prostaglandin-endoperoxide synthase 2(PTGS2) and mitogen-activated protein kinase 3(MAPK3) were selected for further structural analysis. Structural analysis revealed that components containing glycoside structures exhibited higher binding activity with anti-inflammatory and analgesic targets. ConclusionThis study utilized a structure-activity omics approach based on in vivo pharmacodynamic experiments to analyze the material basis of the anti-inflammatory and analgesic effects of Aurantii Fructus flavonoids. The structure-activity omics approach provides new ideas and methods for elucidating the pharmacodynamic substances of Chinese medicine.
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The incidence of occupational injury accidents in the metallurgy and mechanical manufacturing industries remains high, posing risks not only to the safety and health of workers but also causing heavy economic burdens to enterprises and families. The occupational injury accidents in metallurgy and mechanical manufacturing industries were caused by the following six items: human factors, machine factors, building factors, raw material factors, environmental factors, and management factors. The types and body parts of occupational injury accidents varied among different industries due to the nature of the occupation and working environment. Occupational injury accidents were both sudden and preventable. Currently, comprehensive intervention measures for occupational injury accidents at China and abroad included safety education, improving work environments, optimizing building layout and facilities, and enhancing safety management capabilities. Effective and feasible intervention measures for occupational injury accidents should be based on the characteristics and causes of occupational injury accidents in each industry, and should include corresponding interventions for workers, machines, buildings, raw materials, environment, and management.
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ObjectiveTo analyze the results of fit testing and its influencing factors on half-mask respirator among workers exposed to organic solvents. Methods A total of 84 workers exposed to organic solvents were selected as the research subjects using a convenience sampling method. The qualitative fit test apparatus of respiratory protection was tested after the workers had put on the half-mask respirats, and 11 facial indicators of the subjects were measured. Results The overall pass rate of the respirator fit testing was 71.4% (60/84). The lowest pass rate was 63.1% (53/84), which occurred during bending movements of workers. The head width, minimum forehead width, face length, nose length, nose depth, head circumference and head length were higher in workers who passed respirator fit testing, compared with those in the failing group (all P<0.05). The result of binary logistic regression analysis showed that gender and face width were influencing factors of the respirator fit testing (both P<0.05). Female workers had a lower pass rate of the fit testing than male workers, and workers with larger face width had a lower pass rate in the fit testing. Conclusion Drastic movement may lead to a decrease in the seal of half-mask respirator of workers exposed to organic solvents. When providing half-mask respirator to workers exposed to organic solvents, employers need to pay attention to the fit of respirators of female works and those with larger face width to ensure the effectiveness of respiratory protection for workers.
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ObjectiveTo explore the protective effect of hearing protectors worn by noise-exposed workers and its influencing factors. Methods A total of 329 occupational noise-exposed workers were selected as the research subjects by judgment sampling method. A questionnaire survey on the use of ear protectors and individual suitability tests was conducted. Intervention was carried out for those whose personal attenuation rating (PAR) did not pass the baseline standard. Results The median (M) and the 25th and 75th percentiles of baseline PAR were 17.0 (5.0, 22.5) dB. The baseline PAR of the workers who were male, aged 25-<35 years, with a working experience of 5-<15 years, with a college degree or above, wearing ear protectors for 5-<15 years, knowing the right way to wear ear protectors, and workers who wore ear protectors correctly during work was relatively high (all P<0.01). The unqualified rate of baseline PAR of the study subjects was 32.8%. The unqualified rate of baseline PAR of workers in automobile manufacturing enterprises was lower than that of workers in plastic enterprises and textile enterprises (9.2% vs 43.6%, and 9.2% vs 50.0%, both P<0.01). The M of the 108 unqualified worker on baseline PAR was improved after intervention (22.0 vs 1.0 dB, P<0.01). The rates of knowing the right way to wear ear protectors, wearing ear protectors correctly during work, and receiving training on wearing ear protectors correctly for the research subjects were 88.1%, 84.8%, and 86.6%, respectively. Workers in automobile manufacturing enterprises and plastic enterprises had higher rates of knowing the right way to wear ear protectors, wearing ear protectors correctly during work, and receiving training on wearing ear protectors correctly than those in textile enterprises (all P<0.01). Conclusion Gender, age, working experience, education level, duration of wearing ear protectors, knowledge and use of ear protectors correctly are influencing factors of the protective effect of ear protectors for noise-exposed workers.
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OBJECTIVE@#To explore the diagnostic yield of bronchoscopic rapid on-site evaluation (B-ROSE) in patients with severe invasive bronchopulmonary aspergillosis (IBPA) and provide evidence for starting antifungal treatment before microbiological results were available.@*METHODS@#A prospective cohort study was conducted to select patients with severe pneumonia suspected of IBPA admitted to the respiratory intensive care unit (RICU) in the First Affiliated Hospital of Xinjiang Medical University from June 2014 to June 2022, and those who were primarily infected with other pathogens (such as bacteria, Mycobacterium tuberculosis) at admission were excluded. Whether the antifungal treatment was initiated or not on the basis of the bedside B-ROSE, the B-ROSE was administered as soon as possible within 24 hours after admission to RICU. The current international definition of invasive aspergillosis was used as the gold diagnostic standard, the diagnostic accordance rate, the sensitivity and specificity of B-ROSE were calculated respectively, and the receiver operator characteristic curve (ROC curve) was also plotted, to evaluate the predictive value in diagnosing IBPA.@*RESULTS@#A total of 176 patients with severe pneumonia suspected of IBPA were included in the study. According to international diagnostic standards, there were 81 cases of IBPA and 95 cases of non-IBPA. According to the early diagnosis of B-ROSE, there were 89 cases of IBPA and 87 cases of non-IBPA. The diagnostic accordance rate of B-ROSE was 84.09% (148/176), the area under the ROC curve for B-ROSE in diagnosing severe IBPA was 0.844, the 95% confidence interval (95%CI) was 0.782-0.905, the sensitivity was 87.65%, the specificity was 81.05%, the positive predictive value was 79.78%, the negative predictive value was 88.51%, the rate of underdiagnosis was 12.35% (10/81), and the rate of misdiagnosis was 18.95% (18/95). Compared with the true negative group, the proportion of long-term (≥ 14 days) use of glucocorticoid [70.0% (7/10) vs. 9.1% (7/77), P < 0.01] and the proportion of cases with diabetes [40.0% (4/10) vs. 10.4% (8/77), P < 0.05] were significantly higher in the false negative group (underdiagnosis group). However, B-ROSE of both groups showed mucosal bleeding, congestion and edema [100.0% (10/10) vs. 94.8% (73/77), P > 0.05], indicating that acute mucosal inflammation was non-characteristic. Compared with the true positive group, the proportion of long-term (≥ 14 days) use of glucocorticoid in the false positive group (misdiagnosis group) was significantly reduced [33.3% (6/18) vs. 60.6% (43/71), P < 0.05]. The B-ROSE results showed the proportion of cases with mucosal white spots, black plaques and pseudomembrane was significantly reduced [16.7% (3/18) vs. 52.1% (37/71), P < 0.01] in the misdiagnosed group, which suggest that cases of long-term use of glucocorticoid and cases with B-ROSE showing mucosal white spots, black plaques and pseudomembrane were less likely to be misdiagnosed. The main diseases that were easily misdiagnosed as IBPA included pulmonary tuberculosis (38.9%, 7/18), inflammatory lung adenocarcinoma (27.8%, 5/18) and pulmonary vasculitis (16.7%, 3/18).@*CONCLUSIONS@#Before obtaining microbiological evidence, B-ROSE can assist in decision-making of early anti-aspergillus treatment for severe IBPA. This method is prompt, simple, and has high accuracy and reliability. If B-ROSE lacks characteristic manifestations, especially for severe pneumonia in patients with long-term use of glucocorticoid or diabetes, attention should be paid to the underdiagnosis of IBPA. Diseases such as lung tuberculosis, inflammatory lung adenocarcinoma and lung vasculitis should be vigilant against misdiagnosis as IBPA.
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Humains , Études prospectives , Antifongiques , Glucocorticoïdes , Évaluation rapide sur place , Reproductibilité des résultats , Aspergillose pulmonaire , Pneumopathie infectieuse , Diabète , Adénocarcinome pulmonaire , Vascularite , Études rétrospectivesRésumé
The standardized residency training is an important stage in the training of physicians. Shanghai East Hospital has explored the system of the whole-process tutor management in the residency training. To explore the specific methods of carrying out the whole-process tutor training for residents in the whole hospital, gradually the whole-process tutor system is built with qualification certification, mutual selection of teachers and students, tutor empowerment, plan implementation and assessment and evaluation. Meanwhile, a supporting informatization platform is being developed to provide necessary tool support for the implementation and promotion of the whole-process tutor of residency training. And information tools are used to carry out implementation management, process optimization and quality monitoring, so as to form a closed management loop.
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Objective:To compare the effect of luteal-phase support administration of gonadotrophin-releasing hormone agonist(GnRH-a)on the outcomes of fresh embryo transfer in GnRH antagonist cycles,and explore a more appropriate protocol of luteal-phase support.Methods:A retrospective analysis was performed on the infer-tility patients who receiving in vitro fertilization or intracytoplasmic sperm injection embryo transfer(IVF/ICSI-ET)in the Reproductive Medicine Center of our hospital from January 2018 to December 2021.Our study collected clini-cal data from 674 cycles of infertility patients undergoing fresh cycle transplantation using antagonist regimens.The patients were divided into the control group(n =348)and the observation group(n =326)according to if Gn-RH-a was added to the luteal phase.The patients in control group were given standard luteal support treatment,while the patients in observation group were given multiple-dose GnRH-a 0.1mg to standard luteal support treat-ment after egg retrieval.The general data,ovulation induction and clinical outcome were compared between the two groups.Results:Between the two groups of patients,there was no statistically significant difference in age,years of infertility,body mass index(BMI),basal follicle stimulating hormone(bFSH),days and total amount of gonadotropin(Gn),chorionic gonadotropin(HCG),luteinizing hormone(LH),estradiol(E2)and progesterone(P),the number of retrieved oocytes,MII oocytes,number of embryos,normal fertilization rate,moderate to se-vere ovarian hyperstimulation syndrome(OHSS)rate,abortion rate,live birth rate,multiple pregnancy rate,inci-dence of pregnancy complications,birth weight of offspring,preterm birth rate,and birth defect rate(P>0.05).The implantation rate and clinical pregnancy rate were significantly higher in the observation group compared with control group(P<0.05).Multivariate Logistic regression analysis indicated that age and number of transferred embryos could influence the clinical pregnancy rate(OR 0.958,95%CI 0.917-1.000;OR 1.857,95%CI 1.173-2.942).Conclusions:In fresh embryo transfer cycles with GnRH antagonist protocol,on the basis of conventional luteal support,multi-dose intermittent short-acting GnRH-a for luteal support can achieve a good clin-ical outcome,and may be a suitable luteal support scheme for GnRH antagonist protocol in fresh embryo transfer cycles.
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OBJECTIVE To standardize the English translations of the current Chinese patent medicine (CPM) instructions in order to increase its English translation quality and improve its readability. METHODS In an attempt to standardize its English translation, 64 CPM instructions were collected as samples for translation projects in Trados, using its two core functions of translation memory and terminology, combined with pre-editing (PRE) and post-editing (PE) skills. RESULTS The results showed that translation projects had up to 21.65% perfect match. Based on translation project practice, it is proposed to use the free translation or transcreation plus transliteration method to translate product names of CPM, and apply two human-computer interaction translation modes:“ machine translation (MT)+computer-assisted translation (CAT)+PE” and “PRE+MT+CAT+PE”, which are adopted in the translation of weak literary sections and strong literary sections, respectively. CONCLUSIONS The application of CAT not only improves the translation quality and the translation mode, reduces the translation cost, and maintains the consistency and style of the translation, but also accumulates language assets for future use, providing a novel reference for translating traditional Chinese medicine literature.
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Objective To investigate the relationship between corneal hysteresis(CH)and retinal nerve fiber layer(RNFL)thickness in patients with glaucoma.Methods In this study,186 eyes of 133 patients with open-angle glaucoma who attended the ophthalmology department of our hospital were included,with a follow-up of(3.8±0.8)years and an average of 9 visits.The CH measurements were acquired using the Ocular Response Analyzer,and RNFL thickness was measured at each follow-up using spectral domain optical coherence tomography.All statistical analyses were performed with Stata software.Univariate and multivariable linear regression models were used to investigate the relationship between age,baseline CH,intraocular pressure(IOP),central corneal thickness(CCT)and RNFL thickness.Results The aver-age baseline CH was(9.2±1.8)mmHg(1 kPa=7.5 mmHg),average baseline RNFL thickness was(76.4±18.1)μm,the average baseline IOP was(13.8±3.7)mmHg,and the average baseline CCT was(533±42)μm.Univariate model analysis showed that the baseline CH had a positive correlation with RNFL thickness(P<0.05).The lower the CH,the thinner the RNFL.For every 1 mmHg reduction in CH,the thickness of RNFL was reduced by 0.13 μm,indicating that CH may be involved in the occurrence and development of glaucoma.The univariate model analysis also showed that there was a negative correlation between IOP and RNFL thickness(P<0.05).The higher the IOP,the thinner the RNFL.However,there was no significant correlation between age,CCT and RNFL thickness(both P>0.05).The multivariate model analy-sis showed that there was a positive correlation between baseline CH and RNFL thickness during the follow-up,excluding the influence of age,IOP and CCT(P<0.05).For every l mmHg reduction in CH,the thickness of RNFL was reduced by 0.13 μm.Conclusion There is a positive correlation between baseline CH and RNFL thickness in glaucoma.The lower the CH,the thinner the RNFL.Low CH may be a risk factor for the progression of glaucoma.
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Objective:This study aimed to evaluate the clinical features and treatment outcomes of the value of response-adapted treatment following radiotherapy and induction chemotherapy follwing subsequent comprehensive therapy in patients with resectable locally advanced hypopharyngeal carcinoma. Methods:This cohort study was conducted from September 2010 to September 2020 in our hospital, 231 patients pathologically confirmed stage Ⅲ and ⅣB resectable locally advanced hypopharyngeal carcinoma included. For the IC-directed ART strategy, IC is used to select good candidates to receive radical RT or CCRT, and others undergo surgery. He response-adapted strategy was determined based on the primary tumor response, which was evaluated at a dose of 50 Gy. If the response reached complete response or partial response(more than 80% tumor regression), patients received radical RT or CCRT; otherwise, they received surgery, if possible, at 4 to 6 weeks after RT. The end points of the study were OS(overall survival), progression free survival(PFS), locoregional recurrence-free survival(LRRFS) and LDFS. Results:In IC-directed group, 75.0%(57/76) patients reached PR after 2 cycles of induction chemotherapy. While in RT-directed group, 70.3%(109/155) patients reached large PR at dose of 50 Gy. The median interquartile range follow-up period of the whole cohort was 63.8 months. The 5-year OS, PFS, LRRFS and SFL of the whole cohort were 47.9%、39.6%、44.3% and 36.2%, respectively. In evaluations based on the different treatment strategies, the 5-year OS and SFL were 51.3% versus 37.0%(HR 0.67; 95%CI 0.43-1.05; P=0.07) and 27.8% versus 39.8%(HR 0.68; 95%CI 0.46-0.99; P=0.04) between IC-directed and RT-directed groups. In additional, surgery complications did not significantly differ between these two groups. Conclusion:In this cohort study, the response-adapted strategy based on an early RT response facilitated better treatment tailoring, and higher laryngeal preservation compared with IC-directed strategies. This approach could provide a feasible laryngeal preservation strategy in patients with resectable locally advanced hypopharyngeal carcinoma.
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Mâle , Humains , Études de cohortes , Chimioradiothérapie , Carcinomes , Tumeurs de l'hypopharynx/thérapie , Chimiothérapie d'inductionRésumé
OBJECTIVE@#Hypertrophic scars (HS) are a variety of skin tissue fibrosis disease that occurs in human skin, the effective therapeutic method of which is still inaccessible up to now. As a bioactive constituent of a well-known medical plant, Salvia miltiorrhiza (Danshen in Chinese), tanshinone IIA (TSA) is reported to inhibit cell proliferation in HS. Therefore, the aim of this study was to prepare TSA self-soluble microneedles to strengthen its dermal retention and break through the difficulty of significantly thickening epidermal connective tissue and stratum corneum at the HS site. The possible mechanism of action in suppressing HS was studied using human skin fibroblasts (HSF).@*METHODS@#Tanshinone IIA self-dissolving microneedles (TSA-MN) was prepared using a negative mold casting method. The prescription process of microneedle was optimized by Box-Behnken effect surface method. Different media were selected to investigate the ability of transdermal absorption and in vitro release. Furthermore, according to Cell Counting Kit-8 (CCK8) method as well as the Western blot method, the effect of TSA-MN on the biological characteristics of HSF was investigated.@*RESULTS@#With remarkable slow release effect and dermal retention, the release and transdermal properties of TSA-MN in vitro were better than both TSA and ordinary dosage forms. Its effect of HSF confirmed the essential decrease in cell motility during cell proliferation and cell migration in vitro, which plays a significant role in down-regulating the secretion of transforming growth factor-β1 (TGF-β1) in HSF and increasing the expression level of Smad7.@*CONCLUSION@#The prepared TSA self-soluble microneedles is helpful in solving the problem of hypertrophic scars, with a stable dermal retention effect after process optimization.
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@#Biomimetic nano formulations of biofilms have low immunogenicity, high targeting, and good biocompatibility, and can avoid being cleared by the endothelial reticular system, thus with in longer blood circulation time in the body.This article mainly reviews the main types as well as advantages and disadvantages of biomimetic nano formulations of biofilms, including tumor cell membranes, red blood cell membranes, platelet membranes, white blood cell membranes, stem cell membranes, extracellular vesicles (exosomes, microvesicles, and apoptotic bodies), endoplasmic reticulum membranes, and composite biofilms, with also a prospect of the challenges facing biomimetic nano formulations of biofilms and their future development based on their current research status, aiming to provide some insight for further research on biomimetic nano formulations of biofilms.
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Objective:To evaluate the incidence, clinical characteristics and prognosis of second primary malignancies (SPMs) among patients with hypopharyngeal carcinoma (HPC) in real-world analysis.Methods:A total of 594 HPC patients admitted to Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from 2010 to 2018 were retrospectively analyzed.The incidence and clinical characteristics of HPC patients complicated with SPMs were analyzed. Clinical efficacy was compared among different groups.Results:With a median follow-up time of 66.9 months, SPMs were present in 36.4% (216/594) of HPC patients: 22.2% (132/594) were synchronous and 14.1% (84/594) were metachronous. The upper aerodigestive tract was the most common involved region. Compared with patients without SPMs, patients with synchronous and metachronous carcinoma in situ had similar 5-year overall survival (OS) of 42.2% vs. 44.5% ( P=0.958) and 62.2% vs. 44.5% ( P=0.240), respectively. Patients with synchronous invasive SPMs had a worse 5-year OS of 27.2% vs. 44.5% in their counterparts without SPMs ( P=0.001). Patients with metachronous invasive SPMs had similar 5-year OS of 50.2% vs. 44.5% in their counterparts without SPMs ( P=0.587). SPMs accounted for 42.5% of total death in metachronous invasive SPMs group. Conclusions:Patients with HPC have a high probability of developing SPMs. Moreover, the incidence of complicated with esophageal/gastric carcinoma in situ or metachronous SPMs exerts no effect on prognosis, while the occurrence of synchronous SPMs significantly affectes the prognosis of patients. However, the incidence of SPMs is still one of the main death causes in metachronous invasive SPMs group.
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Objective To compare the efficacy of common clinical interventions in the treatment of cervical high-risk (HR) HPV infection based on Bayesian network meta-analysis. Methods Randomized controlled trials (RCTs) about common clinical interventions for cervical HR-HPV infection were searched in PubMed, Web of Science, Embase, The Cochrane Library, CBM, CNKI, Wanfang Data, and VIP databases from inception to July 31, 2021 using specific inclusion and exclusion criteria. The quality of the included studies was evaluated in accordance with the Cochrane systematic review manual. Meta-analysis was performed with Stata16 and RevMan5.3 software. Results Seventy-three RCTs were included, involving 3642 patients and eight treatment methods. Network meta-analysis showed that in the three months after treatment, the negative conversion rate was in the order: PTL > anti-HPV BPD > ALA-PDT > Nr-CWS > BFKS > CSJZS > rhIFNα-2b > FUO. In the six months after treatment, the negative conversion rate was in the order: Nr-CWS > ALA-PDT > PTL > anti-HPV BPD > BFKS > rhIFNα-2b > FUO > CSJZS. In the nine months after treatment, the negative conversion rate was in the order: PTL > ALA-PDT > BFKS > anti-HPV BPD > rhIFNα-2b > FUO. IN the 12 months after treatment, the negative conversion rate was in the order: Nr-CWS > ALA-PDT > anti-HPV BPD > PTL > BFKS > rhIFNα-2b > FUO > CSJZS. Conclusion In terms of HPV negative conversion rate, Nr-CWS and PTL are more effective and currently ideal compared with the other treatments. Owing to the quality of the evidence, the above conclusions must be confirmed by future high-quality studies.
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Given the important position and function of the hypopharynx, the preservation of organ function and survival improvement are equally important. The optimal role of multi-disciplinary combined treatment modality becoming increasingly important. The optimal laryngeal preservation strategy for hypopharyngeal cancer is under continuous exploration. With the constant research of surgery, radiotherapy, chemotherapy, and molecular targeted therapy, new laryngeal preservation strategies continue to emerge. Herein, we primarily summarize the advances in multi-disciplinary combined treatment and the future direction in the treatment of hypopharyngeal carcinoma.
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Objective:To investigate the influencing factors of endotracheal intubation and mechanical ventilation (ETI-MV) in patients with acute respiratory distress syndrome (ARDS) caused by viral pneumonia, and to provide evidence for individualized use of ETI-MV.Methods:Patients with ARDS due to viral pneumonia admitted to the respiratory intensive care unit (RICU) of the First Affiliated Hospital of Xinjiang Medical University were retrospectively analyzed from November 2017 to March 2022. The gender, age, concomitant diseases, clinical symptoms and signs, complications, lab results, ARDS severity, infectious virus type, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), respiratory support methods and prognosis-related variables were collected. Univariate analysis was performed on each factor, and the variables with statistical significance in the univariate analysis were subjected multivariate logistic regression analysis. The receiver operating characteristic curve (ROC curve) was drawn to evaluate the predictive value of each index for the implementation of ETI-MV.Results:A total of 117 patients were enrolled in the study, including 61 patients in the ETI-MV group, and 3 patients (4.9%), 39 patients (63.9%) and 19 patients (31.1%) with mild, moderate and severe ARDS, respectively. There were 56 patients in non-ETI-MV group, and the mild, moderate and severe ARDS cases were 16 cases (28.6%), 38 cases (67.8%) and 2 cases (3.6%), respectively. There was significant difference between the two groups ( P < 0.05). Univariate analysis showed that during 24 hours admitted to RICU, the levels of interleukin-6 [IL-6 (ng/L): 104.0±90.0 vs. 62.4±76.0], oxygenation index [PaO 2/FiO 2 (mmHg, 1 mmHg≈0.133 kPa): 123.9±30.9 vs. 173.6±28.5], the proportion of cases with pulmonary infiltrating opacity distribution range ≥ 3/4 lung fields [85.3% (52/61) vs. 21.5% (12/56)], APACHE Ⅱ score ≥ 16.5 [67.2% (41/61) vs. 42.9% (24/56)], the rate of nosocomial invasive aspergillus infection [14.8% (9/61) vs. 3.6% (2/56)], the percentage of nosocomial bacterial infection [16.4% (10/61) vs. 3.6% (2/56)], and the lowest CD4 + T lymphocyte count in the course of the disease [cells/mm 3: 192.2±35.8 vs. 215.0±58.3] had significant differences between ETI-MV and non-ETI-MV group (all P < 0.05). Multivariate Logistic regression analysis showed that during 24 hours admitted to RICU the distribution range of pulmonary infiltrating opacity ≥ 3/4 the lung fields [odds ratio ( OR) = 12.527, 95% confidence interval (95% CI) = 3.279-47.859, P < 0.001], APACHE Ⅱ score ≥ 16.5 ( OR = 30.604, 95% CI = 4.318-216.932, P = 0.001), PaO 2/FiO 2 ( OR = 0.948, 95% CI = 0.925-0.972, P < 0.001), CD4 + T lymphocytes cell count ( OR = 0.975, 95% CI = 0.955-0.995, P = 0.015), and nosocomial bacterial infection ( OR = 38.338, 95% CI = 1.638-897.158, P = 0.023) were independent risk factors for ETI-MV. The area under the ROC curve (AUC) of ROC showed that PaO 2/FiO 2 had the greatest predictive value for ETI-MV, with AUC of 0.903, sensitivity of 91.1% and specificity of 95.1% in case of cutoff value of 151 mmHg. The AUC of pulmonary infiltrating opacity distribution range was 0.809, the sensitivity of 85.2%, specificity of 78.6% when the cutoff value was ≥ 3/4 lung field. APACHE Ⅱ scores had the lowest predictive value for selecting ETI-MV, with AUC of 0.704, sensitivity of 83.6% and specificity of 57.1% under the cutoff value was 16.5. Conclusions:For patients with ARDS caused by viral pneumonia, PaO 2/FiO 2 is still the classic reference for selecting ETI-MV, however, the distribution range of pulmonary infiltrating opacity and the systemic severity of the disease during 24 hours admitted to the RICU may provide supplemental helpful information to determine whether the patients choose ETI-MV, especially for moderate ARDS.
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Objective:To investigate the relationship between the level of anti Mullerian hormone (AMH) and antral follicle count (AFC) and oocytes number in patients with in vitro fertilization (IVF). Methods:372 patients with primary infertility who received IVF and embryo transfer (IVF-ET) treatment in the Affiliated Hospital of Guizhou Medical University from January 2020 to December 2020 were prospectively selected as the study subjects. According to the oocytes obtained, the patients were divided into low ovarian response group (LOR group, the number of oocytes obtained ≤5, n=37), normal group (NOR group, the number of oocytes obtained was 6-15, n=292) and high ovarian response group (HOR group, the number of oocytes obtained >15, n=43). The levels of AMH and AFC in the three groups were observed. The relationship between AMH, AFC with LOR and HOR was observed by multivariate logistic analysis. The sensitivity, specificity, optimal cut-off value and area under the curve (AUC) of AMH and AFC for predicting LOR and HOR were calculated by receiver operating characteristic (ROC) curve. Results:There were significant difference in AMH, AFC and oocyte number among the three groups (all P<0.05). The AMH, AFC and oocyte number in NOR group were higher than those in LOR group, and AMH, AFC and oocyte number in HOR group were higher than those in LOR and NOR group (all P<0.05). The results of binary multivariate analysis showed that AFC and AMH were protective factors of LOR (all P<0.05), while AFC and AMH were risk factors of HOR ( P<0.05). The sensitivity and specificity of AMH and AFC in predicting LOR were 83.8% and 75.7%, 65.7% and 84.2%, respectively. The sensitivity of AMH or AFC positive as the standard for predicting LOR was 94.6%, and the specificity of AMH and AFC was 91.6%. The sensitivity and specificity of positive AMH and AFC in predicting HOR were 69.8% and 74.4%, 69.6% and 83.6%, respectively. The sensitivity of AMH or AFC positive as the standard for predicting HOR was 93.0%, and the specificity of AMH and AFC positive as the standard for predicting HOR was 93.0%. Conclusions:AMH and AFC are significantly correlated with oocyte number in patients with primary infertility. Flexible application of AMH and AFC is beneficial to better predict the number of oocytes obtained, which provides a reference for clinical development of individualized ovarian stimulation program.