摘要
With the optimization of surgical technologies and postoperative management regimens, the number of lung transplantation has been significantly increased, which has become an important treatment for patients with end-stage lung disease. However, due to the impact of comprehensive factors, such as bronchial ischemia and immunosuppression, the incidence of airway stenosis after lung transplantation is relatively high, which severely affects postoperative survival and quality of life of lung transplant recipients. In recent years, with the improvement of perioperative management, organ preservation and surgical technologies, the incidence of airway stenosis after lung transplantation has been declined, but it remains at a high level. Early diagnosis and timely intervention play a significant role in enhancing clinical prognosis of patients with airway stenosis. In this article, the general conditions, diagnosis, treatment and prevention of airway stenosis after lung transplantation were reviewed, aiming to provide reference for comprehensive management of airway stenosis after lung transplantation and improving clinical prognosis of lung transplant recipients.
摘要
Objective:To establish a risk assessment model for recurrence and metastasis in patients with advanced nasopharyngeal carcinoma.Methods:A survival follow-up study was conducted using a COX regression model to analyze 242 patients with advanced nasopharyngeal carcinoma who were treated for the first time in the Fudan University Shanghai Cancer Center from March 1, 2012 to August 31, 2020. The mean age was (48.33±11.13) years, with 178 males and 64 females. The mean survival was (3.39±1.42) years. According to the random number table method, the enrolled subjects were divided into two groups, including 192 cases in the modeling group and 50 cases in the validation group. Venous blood was collected from patients before treatment, after the first treatment and during the follow-up period after treatment. The blood cell classification and blood biochemical indicators were analyzed. T test and Chi-square test were used to analyze the difference in indicators in prognosis of patients with recurrence and metastasis as the outcome of the study. Multivariate COX regression analysis was used to screen out the independent prognostic factors affecting the recurrence and metastasis of nasopharyngeal carcinoma patients, and the Nomogram models of recurrence and metastasis risk of patients in 2 years, 4 years and 6 years were constructed. The model C-Index of the modeling group and the validation group were calculated to evaluate the performance of the predictive model.Results:White blood cells ( P=0.028), lymphocyte counts ( P<0.001), neutrophils ( P=0.001), platelets ( P=0.046), albumin ( P<0.001), neutrophil/lymphocyte ratio ( P<0.001), platelet/lymphocyte ratio ( P<0.001), lymphocyte/monocyte ratio ( P<0.001), systemic immune inflammatory response index ( P<0.001), systemic inflammatory response index ( P<0.001), and prognostic nutritional index ( P=0.004) had statistically significant differences in the efficacy monitoring of patients; through multivariate COX regression analysis, it was found that the platelet/lymphocyte ratio ( HR 2.537, 95% CI 1.439-4.473) and the prognostic nutritional index ( HR 0.462, 95% CI 0.236-0.903) are important factors to predict the risk of recurrence and metastasis of patients. Combining the above indicators, the Nomogram risk assessment model was established. The C index of the modeling group was 0.698, and the C index of the validation group was 0.739. The calibration curves of the two groups showed good consistency. Conclusion:The Nomogram evaluation model can accurately predict the risk of recurrence and metastasis in patients with nasopharyngeal carcinoma, and provide a theoretical basis for evaluating the prognosis of clinical treatment.
摘要
Objective To investigate the application of fundamental cause in the preparation of surgical instruments.Methods The fundamental cause analysis method was used to analyze the situations of improper preparation of surgical instruments in the operation room to analyze the fundamental causes and work out countermeasures.The preparation of surgical instruments before and after the implementation was compared.Result The qualification rate of surgical instruments increased from 96.0％ before the implementation to 98.6％ after the implementation,with statistically significant difference (P＜0.001).Conclusion The fundamental cause analysis can help the operation room to find out the problems in the surgical equipment preparation process so as to improve the working procedures and the qualification rate of prepared surgical instruments.
摘要
OBJECTIVE@#To identify the subtype of transient receptor potential (TRPs) channel involved in stretch-induced injury of human brain microvascular endothelial cells (HBMEC) and to explore the mechanism responsible for eNOS expression. @*METHODS@#TRPs expression was examined by Western blot and immunocytofluoresence in the cultured HBMEC. Mechanical stretch was performed by mini-type multi-functional bio-impact machine. The levels of free calcium ion in cells were examined by the flow cytometry. The eNOS expression was detected by Western blot. @*RESULTS@#The mRNA and protein expression of TRPV4 was detected in HBMEC by qRT-PCR, Western blot and immunocytofluoresence. The levels of free calcium ion in the stretch-treated HBMEC was significantly decreased in the presence of TRPV4 specific inhibitor (P0.05). @*CONCLUSION@#The eNOS expression is up-regulated under the condition of mechanic stretch, which is related to the activation of TRPV4, resulting in the influx of calcium.
Subject(s)
Humans , Brain , Cell Biology , Calcium , Metabolism , Cells, Cultured , Endothelial Cells , Physiology , Nitric Oxide Synthase Type III , Metabolism , Stress, Mechanical , TRPV Cation Channels , Physiology摘要
Objective To investigate the therapeutic effect and safety of microneurosurgery associated with Gamma Knife radiosurgery on the large meningiomas in sellar region, and to clarify its clinical curative effect. Methods The clinical data of 34 patients with large meningiomas in sellar region underwent microsurgery were retrospectively analyzed.All of them underwent microsurgery,and then treated with Gamma Knife radiosurgery in one month after operation if there were residual tumors.The tumor removal of situation,complication,rate of symptom remission,and recurrence rate were analyzed.Results Among the 34 patients,total resection (7 cases of Simpson grade Ⅰ and 12 cases of Simpson grade Ⅱ)was achieved in 19 cases (55.9%),subtotal resection (Simpson grade Ⅲ )in 14 cases (41.2%), and partial resection (Simpson grade Ⅳ )was achieved in 1 case (2.9%).The major complications were cranial nerve injuries (such as oculomotor nerve, trochlear nerve and abducens nerve,n=6),the contralateral limb paresis (n = 2),postoperative bleeding (n = 1),CSF leak with infection (n=3),and secondary epilepsy (n = 3 ); no death occurred postoperatively. All these patients were followed up for about 3 to 48 months.Postoperative headache disappeared in 24 cases (80%),and 6 cases were alleviated (20%);postoperative vision improved in 12 cases (80%),remained unchanged in 2 cases (13.3%)and deteriorated in 1 case (6.7%); postoperative olfactory function improved in 5 cases (62.5%) and 3 cases unchanged (37.5%); 5 cases recoverd from the ocular motility disorder (71.4%), and 2 cases unchanged (28.6%);7 cases recoverd from thehemiplegia (100%).One of the total resection cases (5.2%)and two of the non-total resection (13.3%)suffered from tumor recurrence.All of the non-total resection cases were treated with Gamma Knife radiosurgery.Conclusion The clinical effect of microneurosurgery associated with Gamma Knife radiosurgery in treatment of large meningiomas in sellar region is satisfactory.