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BACKGROUND: Posterior cervical expansive open-door laminoplasty (EODL) may cause postoperative C5 palsy, and it can be avoided by EODL with bilateral C4/5 foraminotomy. However, prophylactic C4/5 foraminotomy can compromise cervical spine stability. To prevent postoperative C5 palsy and boost cervical stability, We propose a new operation method: EODL combined with bilateral C4/5 foraminotomy and short-segment lateral mass screw fixation. However, there are no studies on the biomechanical properties of this surgery. PURPOSE: Evaluating the biomechanical characteristics of EODL combined with bilateral C4/5 foraminotomy and short-segment lateral mass screw fixation and other three classic surgery. METHODS: An original model (A) and four surgical models (B-E) of the C2-T1 vertebrae of a female patient were constructed. (B) EODL; (C) EODL combined with bilateral C4/5 foraminotomy; (D) C3-6 expansive open-door laminoplasty combined with bilateral C4/5 foraminotomy and short-segment lateral mass screw fixation; (E) C3-6 expansive open-door laminoplasty combined with bilateral C4/5 foraminotomy and C3-6 lateral mass screw system. To compare the biomechanical properties of cervical posterior internal fixation; (E) C3-6 expansive open-door laminoplasty combined with bilateral C4/5 foraminotomy and C3-6 lateral mass screw system. To compare the biomechanical properties of cervical posterior internal fixation methods, six physiological motion states were simulated for the five models using a 100N load force and 1.5Nm torque. The biomechanical advantages of the four internal fixation systems were evaluated by comparing the ranges of motion (ROMs) and maximum stresses. RESULTS: The overall ROM of Model C outperformed the other four models, reaching a maximum ROM in the extension state of 10.59°±0.04°. Model C showed a significantly higher ROMs of C4/5 segment than other four models. Model D showed a significantly lower ROM of C4/5 segment than both Model B and Model C. Model E showed a significantly lower ROM of C4/5 segment than Model D. The stress in the four surgical models were mainly concentrated on the internal fixation systems. CONCLUSION: EODL combined with bilateral C4/5 foraminotomy and short-segment lateral mass screw fixation can maintain the stability of the spine and has minimal effects on the patient's cervical spine ROMs in the extension and flexion state. As a result, it may be a promising treatment option for cervical spondylotic myelopathy (CSM) to prevention of postoperative C5 palsy.
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Tornillos Óseos , Vértebras Cervicales , Análisis de Elementos Finitos , Laminoplastia , Humanos , Vértebras Cervicales/cirugía , Laminoplastia/métodos , Fenómenos Biomecánicos , Femenino , Foraminotomía/métodosRESUMEN
A comparison was conducted between robot-assisted radical prostatectomy (RARP) performed using the Hugo RAS System and the Da Vinci System. We conducted an extensive search of online databases through September 2024. The data from eligible studies were pooled and analyzed with Review Manager 5.4, employing a random effects model. Weighted mean difference (WMD) and odds ratios (OR) with 95% confidence intervals (CI) were used to analyze continuous and categorical variables. A total of eight original studies, involving 1155 patients (HUGO-RARP: 468 vs. da Vinci-RARP: 687), were included. Compared with da Vinci-RARP, HUGO-RARP had a longer docking time (WMD: 6.2 min; 95% CI 4.25-8.14; p < 0.0001), while no significant differences were observed in total operative time, console time, bladder neck dissection time, seminal vesicle dissection time, vesicourethral anastomosis time, or pelvic lymph node dissection time between two systems. There were no significant differences in hospital stay, estimated blood loss, catheter duration, or complication rates. Likewise, oncological and functional outcomes were similar between the two systems. While these results suggest that the Hugo RAS system performs as well as the Da Vinci system in RARP, more randomized controlled studies are needed to further evaluate prognostic outcomes.
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Tempo Operativo , Prostatectomía , Neoplasias de la Próstata , Procedimientos Quirúrgicos Robotizados , Prostatectomía/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos Quirúrgicos Robotizados/instrumentación , Humanos , Masculino , Neoplasias de la Próstata/cirugía , Resultado del Tratamiento , Tiempo de Internación/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiologíaRESUMEN
Background: The utilization of adjuvants such as dexamethasone and dexmedetomidine in combination with local anesthetics has proven effective in extending analgesia duration. We aimed to investigate the potential efficacy of combining dexmedetomidine and dexamethasone in rhomboid intercostal and sub-serratus (RISS) block for prolonging postoperative analgesia in patients undergoing video-assisted thoracoscopic surgery (VATS). Methods: We did this randomized, double-blind, controlled trial in two tertiary-care hospitals. A total of eighty-eight patients undergoing VATS under general anesthesia were enrolled in this study. They were randomly assigned into four groups: ropivacaine (R) group, ropivacaine + dexmedetomidine (RM) group, ropivacaine + dexamethasone (RS) group, or ropivacaine + dexmedetomidine + dexamethasone (RSM) group. The primary outcome measure was the duration of analgesia. Secondary outcomes included Numeric Rating Scale (NRS) scores, cumulative oxycodone consumption, and adverse effects. Results: The RSM group exhibited a significantly prolonged duration of analgesia at 1073.5 min (932.0-1283.3) compared to the R group with a duration of 154.5 min (80.5-199.3) and the RS group with a duration of 282.0 min (195.3-350.0, P < 0 0.001). The cumulative oxycodone consumption during the 0-12 hours and 0-24-hours period was significantly reduced in the RSM group compared to the R group (P < 0.05). There was also a lower incidence of nausea at 48 hours postoperatively in the RSM group compared to the RM group. However, there were no significant differences between the four groups regarding NRS pain scores. Conclusion: The combination of ropivacaine, dexmedetomidine, and dexamethasone in RISS block significantly prolongs the duration of postoperative analgesia following VATS.
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Anestésicos Locales , Dexametasona , Dexmedetomidina , Cirugía Torácica Asistida por Video , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Anestésicos Locales/administración & dosificación , Dexametasona/administración & dosificación , Dexmedetomidina/administración & dosificación , Dexmedetomidina/farmacología , Método Doble Ciego , Bloqueo Nervioso , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/prevención & controlRESUMEN
AIMS AND OBJECTIVE: To investigate the impact of acupuncture on post-stroke cognitive impairment (PSCI). BACKGROUND: PSCI is a major barrier to stroke patients' rehabilitation, and acupuncture is one of the treatments. However, the benefit of acupuncture on PSCI is unclear. DESIGN: A meta-analysis and systematic review of randomized controlled trials (RCTs). METHODS: Up to February 1, 2024, databases in PubMed, MEDLINE, Scopus, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, VIP, and Wanfang Data were searched. The risk of bias was investigated using the Cochrane Handbook for systematic reviews of treatments. Random-effect and fix-effect models were used to report the effects. RESULTS: There were 29 randomized clinical trials with 2477 participants included. The findings demonstrated that the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) scores were higher in the acupuncture group than medicine group (mean difference [MD] = 1.74, 95% confidence interval (CI) CI [1.26, 2.23], I2 = 59%, p < 0.01). Compared to medicine group, the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) score exhibited a significant decrease and demonstrated improvement in the acupuncture group. Statistically significant outcomes were observed in the Barthel Index scores and P300 event-related potential (ERP). According to subgroup analysis, acupuncture was superior to conventional therapy for improving cognitive function in PSCI patients at 4 weeks after treatment. CONCLUSION: Acupuncture therapy has shown promise in ameliorating cognitive deficits and enhancing daily functional abilities in individuals diagnosed with PSCI. But future research should focus on the duration and implement large sample, high-quality RCTs. RELEVANCE TO CLINICAL PRACTICE: Clinical workers in practical clinical work can select appropriate acupoints according to the actual conditions of patients, as well as confirm the treatment course of PSCI patients, while paying attention to observing and evaluating the therapeutic efficacy of acupuncture, to improve the health outcomes of patients in a patient-centered way.
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Terapia por Acupuntura , Disfunción Cognitiva , Accidente Cerebrovascular , Humanos , Terapia por Acupuntura/métodos , Disfunción Cognitiva/etiología , Disfunción Cognitiva/terapia , Disfunción Cognitiva/fisiopatología , Disfunción Cognitiva/rehabilitación , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/terapia , Accidente Cerebrovascular/fisiopatología , Rehabilitación de Accidente Cerebrovascular/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Cognición/fisiologíaRESUMEN
Wearable wristband systems leverage deep learning to revolutionize hand gesture recognition in daily activities. Unlike existing approaches that often focus on static gestures and require extensive labeled data, the proposed wearable wristband with self-supervised contrastive learning excels at dynamic motion tracking and adapts rapidly across multiple scenarios. It features a four-channel sensing array composed of an ionic hydrogel with hierarchical microcone structures and ultrathin flexible electrodes, resulting in high-sensitivity capacitance output. Through wireless transmission from a Wi-Fi module, the proposed algorithm learns latent features from the unlabeled signals of random wrist movements. Remarkably, only few-shot labeled data are sufficient for fine-tuning the model, enabling rapid adaptation to various tasks. The system achieves a high accuracy of 94.9% in different scenarios, including the prediction of eight-direction commands, and air-writing of all numbers and letters. The proposed method facilitates smooth transitions between multiple tasks without the need for modifying the structure or undergoing extensive task-specific training. Its utility has been further extended to enhance human-machine interaction over digital platforms, such as game controls, calculators, and three-language login systems, offering users a natural and intuitive way of communication.
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Purpose: One-hole Split Endoscopy (OSE) is a newer surgical modality that can be applied to posterior cervical foraminotomy (PCF), lumbar discectomy, laminectomy, and decompression. It incorporates intervertebral foraminotomy, open surgery, and other lumboendoscopic techniques with a wide observation field, free space, and compatibility with various spinal surgical techniques and instruments. This study investigated the clinical efficacy of minimally invasive posterior cervical nucleus pulposus removal for cervical spondylotic radiculopathy (CSR) by OSE-Keyhole technique. Patients and Methods: This was a retrospective study of 63 patients treated with OSE keyhole treatment for CSR between May 2021 and September 2023 at Qilu Hospital of Shandong University, Qilu Hospital of Shandong University (Qingdao, China), and Second Hospital of Shandong University, respectively. Clinical outcomes included patients' preoperative and postoperative visual analogue scale (VAS) - arm and neck, Japanese Orthopaedic Association Assessment Treatment Score (JOA) - cervical spine, which were collected at baseline, two days postoperatively, one month postoperatively, and three months postoperatively after the last follow-up visit for evaluation, and perioperative indicators, including intraoperative bleeding, length of hospital stay, postoperative complications, and reoperations, which were also collected. Results: Statistical analyses were performed for the baseline data and follow-up results of 63 patients. Compared to the preoperative baseline values, the follow-up results two days, one month and three months after surgery showed significant improvements in vas-arm, neck and JOA scores in the operated patients (P<0.05) as well as a reduction in all perioperative-related indices. Conclusion: In the treatment of cervical pain and disability due to radiculopathy, OSE keyhole removal of the posterior cervical nucleus pulposus is a better clinical option as it is less invasive and recovers better postoperatively.
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Kidney Stone Disease (KSD) constitutes a multifaceted disorder, emerging from a confluence of environmental and genetic determinants, and is characterized by a high frequency of occurrence and recurrence. Our objective is to elucidate potential causative proteins and identify prospective pharmacological targets within the context of KSD. This investigation harnessed the unparalleled breadth of plasma protein and KSD pooled genome-wide association study (GWAS) data, sourced from the United Kingdom Biobank Pharma Proteomics Project (UKBPPP) and the FinnGen database version R10. Through Mendelian randomization analysis, proteins exhibiting a causal influence on KSD were pinpointed. Subsequent co-localization analyses affirmed the stability of these findings, while enrichment analyses evaluated their potential for pharmacological intervention. Culminating the study, a phenome-wide association study (PheWAS) was executed, encompassing all phenotypes (2408 phenotypes) catalogued in the FinnGen database version R10. Our MR analysis identified a significant association between elevated plasma levels of proteins FKBPL, ITIH3, and SERPINC1 and increased risk of KSD based on genetic predictors. Conversely, proteins CACYBP, DAG1, ITIH1, and SEMA6C showed a protective effect against KSD, documented with statistical significance (PFDR<0.05). Co-localization analysis confirmed these seven proteins share genetic variants with KSD, signaling a shared genetic basis (PPH3 + PPH4 > 0.8). Enrichment analysis revealed key pathways including hyaluronan metabolism, collagen-rich extracellular matrix, and serine-type endopeptidase inhibition. Additionally, our PheWAS connected the associated proteins with 356 distinct diseases (PFDR<0.05), highlighting intricate disease interrelations. In conclusion, our research elucidated a causal nexus between seven plasma proteins and KSD, enriching our grasp of prospective therapeutic targets.
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Estudio de Asociación del Genoma Completo , Análisis de la Aleatorización Mendeliana , Proteoma , Humanos , Nefrolitiasis/genética , Nefrolitiasis/sangre , Nefrolitiasis/metabolismo , Fenotipo , ProteómicaRESUMEN
Ferroptosis is an iron-dependent form of cell death that was discovered in 2012. It encompasses the coordinated orchestration of three fundamental biological pathways: Iron homeostasis, glutathione regulation and lipid metabolism. Head and neck cancer (HNC) is a heterogeneous group of cancers occurring on the mucosal surfaces of the upper respiratory and digestive tracts. Head and neck squamous cell carcinoma is the most common type of HNC, accounting for >90% of HNC cases, and has high morbidity and mortality rates. Despite improvements in diagnosis and treatment, the 5-year survival rate hovers at a dismal 50-60%, with recurrence afflicting nearly 30% of patients, highlighting the inadequacies of currently available treatments. Of note, research exploring the nexus between ferroptosis and HNC remains scarce; however, the present review endeavors to synthesize current knowledge surrounding ferroptosis. The present review elaborated on the normal physiological role of ferroptosis and discussed its potential involvement in HNC pathogenesis. Therapeutic strategies and prognostic paradigms for HNC that target ferroptosis were also reviewed. This review aims to provide direction to catalyze future investigations into ferroptosis in HNC.
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Purpose: In children, obstructive sleep apnea (OSA) is associated with growth hormone level abnormalities and chronic systemic inflammation. This study was performed to investigate the relationship of the degree of OSA with insulin-like growth factor 1 (IGF-1) and inflammatory cytokines in pediatric OSA and the inter-relationship between inflammatory cytokines and growth hormones. Methods: Children with OSA and controls without OSA participated in the study. Information included polysomnography followed by measurement of IGF-1 and inflammatory marker levels. In total, 226 patients aged 2 to 12 years were divided into 4 groups: non-OSA, n = 57 (25.2%); mild OSA, n = 116 (51.3%); moderate OSA, n = 23 (10.2%); and severe OSA, n = 30 (13.3%). Results: Body height was not significantly different among the 4 groups. However, the minimum oxygen saturation and IGF-1 significantly differed among the different OSA groups (P = .0001 and P = .036, respectively). IGF-1 was significantly higher in the non-OSA group (P < .05) and mild OSA group (P < .01) than in the severe OSA group. As the severity of OSA increased, the interleukin-5 level significantly increased, which caused a difference between mild OSA and moderate OSA (P < .05) and between mild OSA and severe OSA (P < .001). In the univariate quantile regression analysis of IGF-1, there was a negative relationship between IGF-1 and IL-5 (P < .001). IGF-1 was positively correlated with age, height, and minimum oxygen saturation. Furthermore, there was a negative correlation between the IGF-1 level and the severity of OSA. Quantile regression analysis on the multivariable analysis of the IGF-1 association showed that height, sex, and severity of OSA played important roles in affecting IGF-1 levels. Conclusion: High IL-5 levels may lead to the low secretion of growth hormone level (IGF-1) in children, thus affecting growth and development.
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BACKGROUND: Robot-Assisted Gait Training (RAGT) is a novel technology widely employed in the field of neurological rehabilitation for patients with subacute stroke. However, the effectiveness of RAGT compared to conventional gait training (CGT) in improving lower extremity function remains a topic of debate. This study aimed to investigate and compare the effects of RAGT and CGT on lower extremity movement in patients with subacute stroke. METHODS: Comprehensive search was conducted across multiple databases, including PubMed, Web of Science, Cochrane Library, EBSCO, Embase, Scopus, China National Knowledge Infrastructure, Wan Fang, SinoMed and Vip Journal Integration Platform. The database retrieval was performed up until July 9, 2024. Meta-analysis was conducted using RevMan 5.4 software. RESULTS: A total of 24 RCTs were included in the analysis. The results indicate that, compared with CGT, RAGT led to significant improvements in the Fugl-Meyer Assessment for Lower Extremity [MD = 2.10, 95%CI (0.62, 3.59), P = 0.005], Functional Ambulation Category[MD = 0.44, 95%CI (0.23, 0.65), P < 0.001], Berg Balance Scale [MD = 4.55, 95%CI (3.00, 6.11), P < 0.001], Timed Up and Go test [MD = -4.05, 95%CI (-5.12, -2.98), P < 0.001], and 6-Minute Walk Test [MD = 30.66, 95%CI (22.36, 38.97), P < 0.001] for patients with subacute stroke. However, it did not show a significant effect on the 10-Meter Walk Test [MD = 0.06, 95%CI (-0.01, 0.14), P = 0.08]. CONCLUSIONS: This study provides evidence that RAGT can enhance lower extremity function, balance function, walking ability, and endurance levels compared to CGT. However, the quality of evidence for improvements in gait speed remains low.
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Extremidad Inferior , Robótica , Rehabilitación de Accidente Cerebrovascular , Humanos , Terapia por Ejercicio/métodos , Terapia por Ejercicio/instrumentación , Marcha/fisiología , Trastornos Neurológicos de la Marcha/rehabilitación , Trastornos Neurológicos de la Marcha/fisiopatología , Trastornos Neurológicos de la Marcha/etiología , Robótica/métodos , Robótica/instrumentación , Accidente Cerebrovascular/fisiopatología , Rehabilitación de Accidente Cerebrovascular/métodos , Rehabilitación de Accidente Cerebrovascular/instrumentaciónRESUMEN
Objectives: Hip involvement is an important reason of disability in patients with ankylosing spondylitis (AS). Unveiling the potential phenotype of hip involvement in AS remains an unmet need to understand its biological mechanisms and improve clinical decision-making. Radiomics, a promising quantitative image analysis method that had been successfully used to describe the phenotype of a wide variety of diseases, while it was less reported in AS. The objective of this study was to investigate the feasibility of radiomics-based approach to profile hip involvement in AS. Methods: A total of 167 patients with AS was included. Radiomic features were extracted from pelvis MRI after image preprocessing and feature engineering. Then, we performed unsupervised machine learning method to derive radiomics-based phenotypes. The validation and interpretation of derived phenotypes were conducted from the perspectives of clinical backgrounds and MRI characteristics. The association between derived phenotypes and radiographic outcomes was evaluated by multivariable analysis. Results: 1321 robust radiomic features were extracted and four biologically distinct phenotypes were derived. According to patient clinical backgrounds, phenotype I (38, 22.8%) and II (34, 20.4%) were labelled as high-risk while phenotype III (24, 14.4%) and IV (71, 42.5%) were at low risk for hip involvement. Consistently, the high-risk phenotypes were associated with higher prevalence of MRI-detected lesion than the low-risk. Moreover, phenotype I had significant acute inflammation signs than phenotype II, while phenotype IV was enthesitis-predominant. Importantly, the derived phenotypes were highly predictive of radiographic outcomes of patients, as the high-risk phenotypes were 3 times more likely to have radiological hip lesion than the low-risk [27 (58.7%) vs 16 (28.6%); adjusted odds ratio (OR) 2.95 (95% CI 1.10, 7.92)]. Conclusion: We confirmed for the first time, the clinical actionability of profiling hip involvement in AS by radiomics method. Four distinct phenotypes of hip involvement in AS were identified and importantly, the high-risk phenotypes could predict structural damage of hip involvement in AS.
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Aprendizaje Automático , Imagen por Resonancia Magnética , Fenotipo , Espondilitis Anquilosante , Humanos , Espondilitis Anquilosante/diagnóstico por imagen , Masculino , Femenino , Proyectos Piloto , Adulto , Imagen por Resonancia Magnética/métodos , Persona de Mediana Edad , RadiómicaRESUMEN
To compare perioperative outcomes of robot-assisted radical cystectomy (RARC) using a single-port (SP) or multi-port (MP) robotic platform. We conducted a comprehensive search of the PubMed, Web of Science, Scopus, and Google Scholar databases until June 2024. For a combined analysis of the data using random effects, Review Manager 5.4 was employed. To compare continuous and categorical variables, the weighted mean difference (WMD) and odds ratio (OR) were employed, respectively. Three original studies were included, comprising a total of 170 patients (SP-RARC: 73 versus MP-RARC: 93).Recovery of bowel function was faster in SP-RARC (WMD -1.02 days, 95% CI - 1.33 to - 0.17; p < 0.001), and lymph-node yield was lower than in MP-RARC patients (WMD - 6.32, 95% CI - 8.90 to - 3.75; p < 0.00001).There were no significant differences between the SP-RARC and MP-RARC groups in terms of other perioperative outcomes such as surgery duration, length of hospital stay, estimated blood loss, major complication rate, positive surgical margin rate, readmission rate, and recurrence rate. The SP robot offers a safe alternative surgical approach to RARC, providing similar postoperative outcomes compared to the MP robot. The SP system remains an attractive option that will require longer follow-up and cohort validation in the future.
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Cistectomía , Tiempo de Internación , Procedimientos Quirúrgicos Robotizados , Neoplasias de la Vejiga Urinaria , Humanos , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Cistectomía/métodos , Tiempo de Internación/estadística & datos numéricos , Tempo Operativo , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Recuperación de la Función , Procedimientos Quirúrgicos Robotizados/métodos , Resultado del Tratamiento , Neoplasias de la Vejiga Urinaria/cirugíaRESUMEN
BACKGROUND: Tai chi has been used to treat different forms of osteoporosis and increase bone density without the use of pharmaceuticals. OBJECTIVE: The purpose of this study was to use bibliometric analysis to methodically examine trends and hotspots of tai chi treatment for osteoporosis in order to generate references for further investigation. METHODS: The articles on Tai Chi to treat osteoporosis was obtained from China National Knowledge Infrastructure (CNKI), Wan Fang, Web of Science (WOS) and PubMed between inception and November 8,2023. The annual publication volume, authors, institutions, and keywords, along with co-citation, clustering, and burst analysis, were analyzed using CiteSpace. RESULTS: Totally, 328 publications were included. The number of annual publications has been rising rapidly in recent years. Beijing University of Chinese Medicine and Shanghai University of Sport are two of the best universities for Tai Chi treatment in osteoporosis. This area of research is dominated by Zhou, Y; Yu, DH; Pence, BC and Qin,L. Core authors and core institutions having a relatively low level of collaboration indicates that there may be limited interaction and cooperation between these key players in the field. China had the highest volume of publications, followed by the United States. Furthermore, the majority of the study subjects and influence mechanism are the focus of current research in this field. CONCLUSION: Tai Chi in osteoporosis research field is in a stage of stable development. Universities and higher education institutions are the leading institutions in this field. China and the United States emerging as high productivity nations. The study of Tai Chi in osteoporosis not only focuses on the applicable population, effects and intervention methods, but also gradually shifts to the mechanism study such as "secretion of beneficial factors", "physical exercise load" and "oxidative stress status".
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Bibliometría , Osteoporosis , Taichi Chuan , Osteoporosis/terapia , Humanos , China , Investigación BiomédicaRESUMEN
BACKGROUND: The effectiveness and safety of induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) in elderly patients with locoregionally advanced nasopharyngeal carcinomas (LANPCs) remain subjects of debate. This study evaluated the efficacy of IC+CCRT compared to CCRT alone in elderly LANPC patients. MATERIALS AND METHODS: This retrospective, single-center study analyzed 335 elderly patients diagnosed with stage III or IVa NPC who received CCRT with or without IC between 2010 and 2016. Kaplan-Meier analysis and log-rank tests were used to estimate and compare survival rates. Multivariate analysis using Cox proportional hazards regression model was conducted to assess prognostic risk factors. Toxicities were compared using the χ2 test. RESULTS: The median follow-up duration was 69.3 months (interquartile range: 42.7-72.6). Baseline clinical characteristics were well-balanced between groups. No significant differences were observed between IC+CCRT and CCRT for any survival-related endpoints, including overall survival (hazard ratio [HR] = 1.26, 95 % confidence interval [CI]: 0.89-1.77, p = 0.188), locoregional relapse-free survival (HR=1.03, 95 % CI: 0.56-1.91, p = 0.913), distant metastasis-free survival (HR=1.39, 95 % CI: 0.90-2.16, p = 0.139), and failure-free survival (HR = 1.25, 95 % CI: 0.85-1.83, p = 0.255). However, the incidence and severity of acute and late toxicities were significantly higher in the IC+CCRT group compared to the CCRT group. CONCLUSION: In elderly LANPC patients, the addition of IC to CCRT did not improve survival outcomes, but was associated with significant toxicities.
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Quimioradioterapia , Quimioterapia de Inducción , Carcinoma Nasofaríngeo , Neoplasias Nasofaríngeas , Humanos , Quimioradioterapia/efectos adversos , Masculino , Femenino , Anciano , Carcinoma Nasofaríngeo/terapia , Carcinoma Nasofaríngeo/mortalidad , Carcinoma Nasofaríngeo/patología , Estudios Retrospectivos , Neoplasias Nasofaríngeas/terapia , Neoplasias Nasofaríngeas/mortalidad , Neoplasias Nasofaríngeas/patología , Tasa de Supervivencia , Estimación de Kaplan-Meier , Estadificación de NeoplasiasRESUMEN
Robotic pyelolithotomy continues to gain attention as an alternative to percutaneous nephrolithotomy (PCNL) for managing complex renal stones. We performed a single-arm meta-analysis and systematically searched the English-language literature published in PubMed, Web of Science, Scopus, and Google Scholar databases up to June 2024. The risk of non-randomized bias was assessed using ROBINS-I, and the quality of the literature was assessed using MINORS (Methodological Index for Non-Randomized Studies). Merger parameters were calculated using Stata16/SE under a random-effects model. Five non-comparative single-arm studies were included in the meta-analysis. Results showed that the operative time for robotic pyelolithotomy was 168.10 min (95% CI 133.63, 202.56). The hospital stay was 2.63 days (95% CI 0.96, 4.29), and blood loss was 44.13 ml (95% CI 19.76, 68.51). The stone clearance rate was 87% (95% CI 79-93%). The incidence of minor postoperative complications (Clavien grade I-II) was 23.7% (95% CI 13.4-35.8%), and the incidence of major complications (Clavien grade ≥ III) was 7% (95% CI 0.3-20.7%).The safety and efficacy of robotic pyelolithotomy in treating complex renal stones are acceptable, but future large prospective cohort studies are needed to validate the treatment.
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Cálculos Renales , Tempo Operativo , Procedimientos Quirúrgicos Robotizados , Humanos , Cálculos Renales/cirugía , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Resultado del Tratamiento , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Nefrolitotomía Percutánea/métodos , Nefrolitotomía Percutánea/efectos adversos , Tiempo de Internación/estadística & datos numéricos , Pelvis Renal/cirugía , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Femenino , MasculinoRESUMEN
The objective of this study was to perform a comprehensive pooled analysis aimed at comparing the efficacy and safety of percutaneous ablation (PCA) versus minimally invasive partial nephrectomy (MIPN), including robotic and laparoscopic approaches, in patients diagnosed with cT1 renal tumors. We conducted a comprehensive search across four major electronic databases: PubMed, Embase, Web of Science, and the Cochrane Library, targeting studies published in English up to April 2024. The primary outcomes evaluated in this analysis included perioperative outcomes, functional outcomes, and oncological outcomes. A total of 2449 patients across 17 studies were included in the analysis. PCA demonstrated superior outcomes compared to MIPN in terms of shorter hospital stays (WMD: - 2.13 days; 95% Confidence Interval [CI]: - 3.29, - 0.97; p = 0.0003), reduced operative times (WMD: - 109.99 min; 95% CI: - 141.40, - 78.59; p < 0.00001), and lower overall complication rates (OR: 0.54; 95% CI: 0.40, 0.74; p = 0.0001). However, PCA was associated with a higher rate of local recurrence when compared to MIPN (OR: 3.81; 95% CI: 2.45, 5.92; p < 0.00001). Additionally, no significant differences were observed in major complications, estimated glomerular filtration rate decline, creatinine variation, overall survival, recurrence-free survival, and disease-free survival between the two treatment modalities. PCA presents a notable disadvantage regarding local recurrence rates in comparison to MIPN. However, PCA offers several advantages over MIPN, including shorter durations of hospital stay, reduced operative times, and lower complication rates, while achieving similar outcomes in other oncologic metrics.
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Neoplasias Renales , Nefrectomía , Procedimientos Quirúrgicos Robotizados , Humanos , Nefrectomía/métodos , Neoplasias Renales/cirugía , Neoplasias Renales/patología , Resultado del Tratamiento , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Tiempo de Internación/estadística & datos numéricos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Tempo Operativo , Laparoscopía/métodos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estadificación de Neoplasias , Recurrencia Local de NeoplasiaRESUMEN
ESKAPE pathogens are a panel of most recalcitrant bacteria that could "escape" the treatment of antibiotics and exhibit high incidence of drug resistance. The emergence of multidrug-resistant (MDR) ESKAPE pathogens (particularly Gram-negative bacteria) accounts for high risk of mortality and increased resource utilization in health care. Worse still, there has been no new class of antibiotics approved for exterminating the Gram-negative bacteria for more than 50 years. Therefore, it is urgent to develop novel antibacterial agents with low resistance and potent killing efficacy against Gram-negative ESKAPE pathogens. Herein, we present a class of fluoropolymers by mimicking the amphiphilicity of cationic antimicrobial peptides. Our optimal fluoroamphiphilic polymer (PD45HF5) displayed selective antimicrobial ability for all MDR Gram-negative ESAKPE pathogens, low resistance, high in vitro cell selectivity, and in vivo curative efficacy. These findings implied great potential of fluoroamphiphilic cationic polymers as promising antibacterial agents against MDR Gram-negative ESKAPE bacteria and alleviating antibiotic resistance.
Asunto(s)
Antibacterianos , Farmacorresistencia Bacteriana Múltiple , Bacterias Gramnegativas , Pruebas de Sensibilidad Microbiana , Polímeros , Farmacorresistencia Bacteriana Múltiple/efectos de los fármacos , Bacterias Gramnegativas/efectos de los fármacos , Antibacterianos/farmacología , Antibacterianos/química , Polímeros/química , Polímeros/farmacología , Humanos , Animales , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/microbiologíaRESUMEN
This investigation sought to conduct a comprehensive meta-analysis to assess the comparative effectiveness and safety of percutaneous ablation (PCA) versus robotic-assisted partial nephrectomy (RAPN) among individuals diagnosed with cT1 renal tumors. This study rigorously followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to conduct a systematic review and meta-analysis. A systematic search was carried out in the PubMed, Embase, Web of Science, and Cochrane Library databases, focusing on studies published in English through February 2024. We focused on evaluating primary outcomes, specifically perioperative outcomes, functional outcomes, and oncological outcomes. In this analysis, data from 1534 patients across 13 studies were evaluated. PCA was found to have advantageous outcomes in comparison to RAPN regarding hospital stay durations, with a Weighted Mean Difference (WMD) of - 2.03 days (95% Confidence Interval [CI]: -3.78 to - 0.27; p = 0.02), operative times (WMD: -106.75 min; 95% CI: - 170.78 to - 42.72; p = 0.001), and overall complication rates (Odds Ratio [OR]: 0.61; 95% CI: 0.42 to 0.89; p = 0.01). Conversely, PCA showed a higher incidence of local recurrence compared to RAPN, with an OR of 3.20 (95% CI: 1.91 to 5.35; p < 0.00001). Moreover, there were no statistically significant differences between the two treatments in terms of major complications, declines in estimated glomerular filtration rates (eGFR), variations in creatinine levels, overall survival rates, and recurrence-free survival. While PCA exhibits higher local recurrence rates than RAPN, it also presents significant advantages, such as shorter hospital stays, decreased operative durations, and lower complication rates. This juxtaposition underscores the urgent need for further, more rigorous research to substantiate these findings.
Asunto(s)
Carcinoma de Células Renales , Neoplasias Renales , Nefrectomía , Procedimientos Quirúrgicos Robotizados , Humanos , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Nefrectomía/métodos , Neoplasias Renales/cirugía , Carcinoma de Células Renales/cirugía , Resultado del Tratamiento , Tempo Operativo , Tiempo de Internación/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiologíaRESUMEN
Endoplasmic reticulum (ER)-associated degradation (ERAD) plays key roles in controlling protein levels and quality in eukaryotes. The Ring Finger Protein 185 (RNF185)/membralin ubiquitin ligase complex was recently identified as a branch in mammals and is essential for neuronal function, but its function in plant development is unknown. Here, we report the map-based cloning and characterization of Narrow Leaf and Dwarfism 1 (NLD1), which encodes the ER membrane-localized protein membralin and specifically interacts with maize homologs of RNF185 and related components. The nld1 mutant shows defective leaf and root development due to reduced cell number. The defects of nld1 were largely restored by expressing membralin genes from Arabidopsis thaliana and mice, highlighting the conserved roles of membralin proteins in animals and plants. The excessive accumulation of ß-hydroxy ß-methylglutaryl-CoA reductase in nld1 indicates that the enzyme is a membralin-mediated ERAD target. The activation of bZIP60 mRNA splicing-related unfolded protein response signaling and marker gene expression in nld1, as well as DNA fragment and cell viability assays, indicate that membralin deficiency induces ER stress and cell death in maize, thereby affecting organogenesis. Our findings uncover the conserved, indispensable role of the membralin-mediated branch of the ERAD pathway in plants. In addition, ZmNLD1 contributes to plant architecture in a dose-dependent manner, which can serve as a potential target for genetic engineering to shape ideal plant architecture, thereby enhancing high-density maize yields.