ABSTRACT
The two most commonly used airway management techniques during general anaesthesia are supraglottic airway devices and tracheal tubes. In older patients undergoing elective non-cardiothoracic surgery under general anaesthesia with positive pressure ventilation, we hypothesised that a composite measure of in-hospital postoperative pulmonary complications would be less frequent when a supraglottic airway device was used compared with a tracheal tube. We studied patients aged ≥ 70 years in 17 clinical centres. Patients were allocated randomly to airway management with a supraglottic airway device or a tracheal tube. Between August 2016 and April 2020, 2900 patients were studied, of whom 2751 were included in the primary analysis (1387 with supraglottic airway device and 1364 with a tracheal tube). Pre-operatively, 2431 (88.4%) patients were estimated to have a postoperative pulmonary complication risk index of 1-2. Postoperative pulmonary complications, mostly coughing, occurred in 270 of 1387 patients (19.5%) allocated to a supraglottic airway device and 342 of 1364 patients (25.1%) assigned to a tracheal tube (absolute difference -5.6% (95%CI -8.7 to -2.5), risk ratio 0.78 (95%CI 0.67-0.89); p < 0.001). Among otherwise healthy older patients undergoing elective surgery under general anaesthesia with intra-operative positive pressure ventilation of their lungs, there were fewer postoperative pulmonary complications when the airway was managed with a supraglottic airway device compared with a tracheal tube.
Subject(s)
Laryngeal Masks , Humans , Aged , Laryngeal Masks/adverse effects , Intubation, Intratracheal/methods , Airway Management/methods , Anesthesia, General/methods , Postoperative Complications/epidemiology , Postoperative Complications/etiology , LungABSTRACT
Objective: To discuss the diagnostic value potential of (18)F-FDG PET/CT and intravoxel incoherent motion (IVIM) in genotype EGFR of lung cancer. Methods: A total of 116 cases proved pathologically pulmonary space occupying lesions (72 males, 44 females; age range was 31-85 years; 37 cases of high differentiation; 53 cases of middle differentiation, 26 cases of low differentiation) were prospectively collected from August 2017 to March 2019 in Henan Provincial People's Hospital. EGFR gene detection was performed in 50 patients (wild type 20 cases, mutant 30 cases). Whole body PET/CT and lung MR-imaging were performed before treatment in all patients. Comparison of PET/CT, IVIM semi-quantitative parameters between positive and negative of EGFR by Student-t test or Mann-Whitney U test. Evaluation diagnostic efficacy of each parameter to EGFR by drawing ROC curves. The optimum diagnostic threshold, specificity, sensitivity, positive predictive value, negative predictive value and the diagnostic accuracy were calculated. The diagnostic accuracy of (18)F-FDG PET/CT combined with IVIM was calculated. Results: The quantitative parameters standard intake(SUV), apparent diffusion coefficient (ADC), true diffusion coefficient (D), pseudo-diffusion coefficient (D(*)), perfusion fraction (f) were 8.7±3.5, (1.59±0.26) ×10(-3) mm(2)/s, (1.04±0.12)×10(-3) mm(2)/s, (3.9±3.0)×10(-2) mm(2)/s, 0.43±0.16 and the above parameters of the wild group were 14.3±3.3, (1.34±0.26)×10(-3) mm(2)/s, (0.89±0.12)×10(-3) mm(2)/s, (3.5±2.5)×10(-2) mm(2)/s, 0.40±0.11, respectively. The difference of quantitative parameters SUV (t=4.196, P=0.0001), ADC (t=2.502, P=0.0018), D (t=3.158, P=0.006) between the EGFR mutant group and the wild group was statistically significant. The difference of quantitative parameters D(*) (t=0.361, P=0.721), f (t=0.627, P=0.536) was not statistically significant. ROC curve was drawn and the area under the curves for diagnosis of EGFR mutations by SUV, ADC, D, D(*), f was 0.880, 0.755, 0.820, 0.575, 0.550. The diagnostic accuracy of these parameters above mentioned was 80.0%, 76.7%, 73.3%, 66.7%, 53.3% respectively. The diagnostic accuracy of SUV combined with ADC, D values was 83.3% and 80.0%. Conclusion: PET/CT and IVIM have certain diagnostic value for EGFR typing of lung cancer gene.
Subject(s)
Lung Neoplasms , Adult , Aged , Aged, 80 and over , Diffusion Magnetic Resonance Imaging , ErbB Receptors , Female , Fluorodeoxyglucose F18 , Humans , Male , Middle Aged , Motion , Positron Emission Tomography Computed Tomography , Positron-Emission Tomography , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
Objective: To investigate the value of spectral computed tomography quantitative parameters in the assessment of pathological grade of esophageal squamous cell carcinoma before operation. Methods: The imaging findings of 52 patients with confirmed esophageal squamous cell carcinoma by surgery and pathology were prospectively analyzed in Henan Provincial People's Hospital from June 2016 to May 2017.There were 43 males and 9 females, aged 49-76 years, with an average age of (66±8) years.All the patients were divided into three groups based on the pathological finding: well-differentiated group (n=12), moderately-differentiated group (n=20), poorly-differentiated group (n=20). All the patients received chest plain scan and double phase enhanced scan of gemstone spectral computed tomography.The enhancement attenuation (HU), the average of the slope of the spectral Hounsfield Unit curve (λ(HU)), normalized iodine concentration (NIC), normalized effective atomic number (Z(eff-a)) were measured and calculated.The difference in HU, λ(HU), NIC, Z(eff-a) among different grades were statistically analyzed.The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficiency of single and combined parameters in the differentiation of poorly-differentiated and well-moderately differentiated esophageal squamous cell carcinoma. Results: There were significant differences in HU, λ(HU), NIC, Z(eff-a) among different pathological grading of the esophageal squamous cell carcinoma in arterial phase and venous phase (F=4.496-9.056, H=23.204, 20.724, all P<0.05). The best single parameter to differentiate poorly-differentiated from well-moderately differentiated esophageal squamous cell carcinoma was NIC in arterial phase with areas under the ROC curve (AUC), the cutoff value, sensitivity, specificity, accuracy of 0.860, 0.197, 65.0%, 96.9%, 84.6%, respectively; the best combination of parameters was HU+ NIC+ λ(HU) in arterial phase with AUC, the threshold of predicted probability, sensitivity, specificity, accuracy of 0.913, 0.380, 85.0%, 81.3%, 82.7%, respectively. Conclusion: Gemstone spectral imaging quantitative parameters can be used to evaluate the pathological grading of esophageal squamous cell carcinoma, the NIC and HU+ NIC+ λ(HU) in arterial phase have the highest differential diagnostic efficiency.
Subject(s)
Carcinoma, Squamous Cell/diagnostic imaging , Esophageal Neoplasms/diagnostic imaging , Tomography, X-Ray Computed , Aged , Contrast Media , Diagnosis, Differential , Esophageal Squamous Cell Carcinoma , Female , Humans , Iodine , Male , Middle Aged , ROC Curve , Sensitivity and SpecificityABSTRACT
Osteosarcoma represents an aggressive type of bone malignancy that poses a significant health threat. The objective of the current study was to analyze the effect and mechanism of dihydroartemisinin (DHA) on the proliferation, metastasis and apoptosis of human osteosarcoma cells. A gradient concentration of DHA (15, 25 and 35 µmol.L-1) was used to stimulate the cells, along with control and Dimethyl sulfoxide (DMSO). The phenotypic outcomes were characterized using MTT assay, clone formation assay, Hoechst 33258 staining assay, luciferase reporter plasmid assay, Western blot and wound healing assay. In addition, IBM SPSS Statistics 18.0 software was applied for statistical analysis and all experimental data were expressed as mean ± s.d. Analysis of variance (ANOVA) was applied to compare the differences among multiple groups. Our results demonstrated that DHA inhibited the proliferation and metastasis of osteosarcoma cells and promoted the apoptosis in the cytomorphosis.
Subject(s)
Apoptosis/drug effects , Artemisinins/pharmacology , Bone Neoplasms/drug therapy , Osteosarcoma/drug therapy , Bone Neoplasms/pathology , Cell Line, Tumor , Cell Proliferation/drug effects , Humans , Osteosarcoma/pathology , Osteosarcoma/secondaryABSTRACT
Modern Bai Jiu(liquor) was called Shao Jiu in ancient times.By consulting ancient books, it was found that there was a distillation and preparation process of Shao Jiu before the Ming Dynasty, but due to its high toxicity, the scope of application was limited, and there were few records of its medicinal use.However many records of its medicinal use was found in the Compendium of Materia Medica(«¼).By comparing the medical books that recorded Shao Jiu in previous dynasties, it is found that the Compendium of Materia Medica comprehensively records the relevant cognition and application of the medicinal use of Shao Jiu for the first time. The book lists in detail the causes of the toxicity of Shao Jiu and the methods to avoid it, comprehensively expounds its characteristics, efficacy and indications, lists a variety of ways to use it, skillfully uses Shao Jiu to treat syphilis sores, and proposes that high-concentration Shao Jiu can be used as a solvent for medical liquor.The record of Shao Jiu in the Compendium of Materia Medica had a profound impact on the medical liquor of later generations.The use of Shao Jiu in the Qing Dynasty continued to expand, and the types of medicinal liquor were also constantly enriched. The record of Shao Jiu in the Compendium of Materia Medica can also provide a reference for the medicinal use of modern liquor.
Subject(s)
Materia Medica , Books , China , Medicine, Chinese TraditionalABSTRACT
The North China Medical College typically represented medical colleges for traditional Chinese medicine in the 1930s when many of them were set up. It was based on the principles of centring on traditional Chinese medicine, following western medicine and integrated medicine in teaching. This led to the emergence of a great number of people with a high level of traditional Chinese medicine and strong belief in it. In terms of the textbooks and handouts for western medicine, compared to similar textbooks in other medical colleges, such as the Medical College of Xie He, at that time, the textbooks in the North China Medical College covered a variety of perspectives and categories. It was found that 20 textbooks for western medicine in the North China Medical College were designed reasonably in content and were simple and applicable in teaching. More importantly, it contained some traditional Chinese medicine in different degrees, with its typical characteristics. The course design and textbook compilation provided references for the teaching in contemporary medical universities.
Subject(s)
Medicine , Humans , Universities , China , Medicine, Chinese TraditionalABSTRACT
OBJECTIVE: To investigate the application value of double exponential model diffusion weighted imaging (IVIM-DWI) and dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) in the diagnosis of early esophageal cancer. PATIENTS AND METHODS: 30 cases of patients with early esophageal cancer confirmed by pathology were collected. They were performed MRI plain scan, IVIM-DWI and DCE-MRI scan. The normal esophageal tissue, SlowADC value in tumor focus, FastADC value, F value, Ktrans, Kep and Ve values were measured. The difference between cancer tissue and normal tissue was compared using two independent sample t test. The prediction parameters and diagnostic threshold were compared by drawing receiver operating characteristic curve (ROC). RESULTS: The average F, Ktrans and Kep values in esophageal cancer and normal esophageal tissue were: (0.48 ± 0.19), (0.64 ± 0.08); (0.45 ± 0.19)/min, (0.14 ± 0.04)/min and (1.14 ± 0.42)/min, (0.56 ± 0.25)/min respectively. Compared with normal esophageal tissue, esophageal cancer F value decreased, Ktrans value increased, Kep value increased, and the difference was statistically significant (p < 0.05); There was no difference in SlowADC, FastADC, Ve values of esophageal cancer and those in normal esophageal tissues (p > 0.05). The areas under ROC curve F, Ktrans and Kep values were 0.90, 0.98 and 0.92 respectively. They had the higher diagnostic efficiency. CONCLUSIONS: IVIM-DWI and DCE-MRI can be used as the imaging method to diagnose esophageal malignant tumor, which has the higher diagnostic value.
Subject(s)
Diffusion Magnetic Resonance Imaging/methods , Esophageal Neoplasms/diagnosis , Image Enhancement/methods , Aged , Aged, 80 and over , Early Detection of Cancer , Female , Humans , Male , Middle AgedABSTRACT
BACKGROUND AND PURPOSE: DTI can provide in vivo information about the pathology of optic nerve disease, but there is no study of DTI in the setting of ION, the most frequent acute optic neuropathies in patients over 50 years of age. Our aim was to investigate the potential of DTI in the diagnosis of subacute AION at 3T. MATERIALS AND METHODS: Twenty-six patients with unilateral AION and 15 healthy controls were enrolled in this study. DTI and pattern VEP were performed on the ONs of all subjects. The mean ADC, FA, and eigenvalue maps were obtained for quantitative analysis. Quantitative electrophysiology was also performed on all subjects. RESULTS: The mean ADC and orthogonal eigenvalue λ(â¥) in affected nerves increased, and the mean FA was reduced compared with clinically unaffected contralateral nerves (P < .001) and control nerves (P < .001). However, no significant changes of the mean principal eigenvalue λ(â) in affected nerves compared with unaffected contralateral nerves (P = .13) and control nerves (P = .14) were seen. There was a significant correlation of whole-field VEP amplitude with ADC (r = -0.63, P = .001) and λ(â¥) (r = -0.47, P = .015) but no correlation with FA (P = .06) and λ(â) (P = .06). CONCLUSIONS: DTI measurement of ischemic ONs provides in vivo information about pathology and may serve as a biomarker of axonal and myelin damage in AION.