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BACKGROUND: Splenic injury following endoscopic retrograde cholangiopancreatography (ERCP) is a rare complication. The literature contains around 30 articles reporting various degrees of splenic injuries resulting from ERCP since the first report of splenic rupture after ERCP in 1989. CASE SUMMARY: This report describes a case of splenic hematoma and stent displacement in a 69-year-old male patient who developed these conditions 7 days after undergoing ERCP and stenting. The patient had bile duct stenosis caused by a malignant tumor that was obstructing the bile duct. The diagnosis was confirmed by epigastric computed tomography and magnetic resonance cholangiopancreatography. The patient was successfully treated with percutaneous transhepatic cholangial drainage, endoscopic pyloric stent placement, and conservative management. The causes of splenic injury following ERCP are discussed. CONCLUSION: ERCP has the potential to cause splenic injury. If a patient experiences symptoms such as abdominal pain, decreased blood pressure, and altered hematology after the procedure, it's important to be thoroughly investigated for postoperative bleeding and splenic injury.
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Doxorubicin (Dox), a chemotherapeutic agent frequently used to treat cancer, elicits cardiotoxicity, a condition referred to as Dox-induced cardiotoxicity (DIC), and ferroptosis plays a contributory role in its pathophysiology. Fucoidan, a polysaccharide with various biological activities and safety profile, has potential therapeutic and pharmaceutical applications. This study aimed to investigate the protective effects and underlying mechanisms of fucoidan in DIC. Echocardiography, biomarkers of cardiomyocyte injury, serum creatine kinase, creatine kinase isoenzyme and lactate dehydrogenase, as well as histological staining results, revealed that fucoidan significantly reduced myocardial damage and improved cardiac function in DIC mice. Transmission electron microscopy; levels of lipid reactive oxygen species, glutathione, and malondialdehyde; ferroptosis-related markers; and regulatory factors such as glutathione peroxidase 4 (GPX4), transferrin receptor protein-1, ferritin heavy chain-1, heme oxygenase-1 in the heart tissue were measured to explore the effect of fucoidan on Dox-induced ferroptosis. These results suggested that fucoidan could inhibit cardiomyocyte ferroptosis caused by Dox. In vitro experiments revealed that silencing nuclear factor-erythroid 2-related factor 2 (Nrf2) in cardiomyocytes reduced the inhibitory effect of fucoidan on ferroptosis. Hence, fucoidan has the potential to ameliorate DIC by inhibiting ferroptosis via the Nrf2/GPX4 pathway.
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Cardiotoxicidad , Doxorrubicina , Ferroptosis , Miocitos Cardíacos , Factor 2 Relacionado con NF-E2 , Fosfolípido Hidroperóxido Glutatión Peroxidasa , Polisacáridos , Transducción de Señal , Animales , Polisacáridos/farmacología , Polisacáridos/química , Ferroptosis/efectos de los fármacos , Factor 2 Relacionado con NF-E2/metabolismo , Doxorrubicina/efectos adversos , Doxorrubicina/toxicidad , Ratones , Cardiotoxicidad/tratamiento farmacológico , Fosfolípido Hidroperóxido Glutatión Peroxidasa/metabolismo , Transducción de Señal/efectos de los fármacos , Miocitos Cardíacos/efectos de los fármacos , Miocitos Cardíacos/metabolismo , MasculinoRESUMEN
Colloidal quantum dots are semiconductor nanocrystals endowed with unique optoelectronic properties. A major challenge to the field is the lack of methods for synthesizing quantum dots exhibit strong photo-response in the deep-ultraviolet (DUV) band. Here, a facile solution-processed method is presented for synthesizing ultrawide bandgap aluminium nitride quantum dots (AlN QDs) showing distinguished UV-B photoluminescence. Combined with the strong optical response in solar blind band, a solution-processed, self-powered AlN-QDs/ß-Ga2O3 solar-blind photodetector is demonstrated. The photodetector is characterized with a high responsivity of 1.6 mA W-1 under 0 V bias and specific detectivity 7.60 × 10-11 Jones under 5 V bias voltage with good solar blind selectivity. Given the solution-processed capability of the devices and extraordinary properties of AlN QDs, this study anticipates the utilization of AlN QDs will open up unique opportunities for cost-effective industrial production of high-performance DUV optoelectronics for large-scale applications.
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Chronic subdural hematoma (CSDH) is a chronic space-occupying lesion formed by blood accumulation between the arachnoid membrane and the dura mater. Atorvastatin is of increasing clinical interest for CSDH. We performed a meta-analysis of published randomized controlled trials (RCTs) and used objective data as the primary outcomes to provide an evidence-based analysis of the efficacy of atorvastatin for CSDH treatment. Databases of MEDLINE (via PubMed), EMBASE, the Cochrane Library, Scopus, Web of Science, ScienceDirect, Chinese National Knowledge Infrastructure (CNKI), Cqvip database (CQVIP), and Wanfang database were systematically searched for RCTs reporting the use of atorvastatin for CSDH treatment. Odds ratio (OR), standard mean difference (SMD), and 95% confidence intervals (CIs) were used as summary statistics. I-square (I2) test was performed to assess the impact of study heterogeneity on the results of the meta-analysis. Nine relevant RCTs with 611 patients were identified for inclusion in this meta-analysis. Compared to controls, atorvastatin treatment had a significantly higher effectiveness (OR: 7.41, 95% CI: 3.32-16.52, P < 0.00001, I2 = 0%), lower hematoma volume (SMD: -0.46. 95% CI: -0.71 to -0.20, P = 0.0005, I2 = 0%), higher activities of daily living-Barthel Index (ADL-BI) (SMD: 2.07, 95% CI: 1.06-3.09, P < 0.0001, I2 = 92%), and smaller Chinese stroke scale (CSS) (SMD: -1.10, 95% CI: -1.72 to -0.48, P = 0.0005, I2 = 57%). In view of these findings, we conclude that the outcomes of experimental group are superior to the control group with respect to effectiveness, hematoma volume, ADL-BI, and CSS based on nine RCTs with 611 patients. Atorvastatin is beneficial to CSDH patients without surgery.
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Gray leaf spot (GLS), caused by the fungal pathogens Cercospora zeae-maydis and Cercospora zeina, is a major foliar disease of maize worldwide (Zea mays L.). Here we demonstrate that ZmWAKL encoding cell-wall-associated receptor kinase-like protein is the causative gene at the major quantitative disease resistance locus against GLS. The ZmWAKLY protein, encoded by the resistance allele, can self-associate and interact with a leucine-rich repeat immune-related kinase ZmWIK on the plasma membrane. The ZmWAKLY/ZmWIK receptor complex interacts with and phosphorylates the receptor-like cytoplasmic kinase (RLCK) ZmBLK1, which in turn phosphorylates its downstream NADPH oxidase ZmRBOH4. Upon pathogen infection, ZmWAKLY phosphorylation activity is transiently increased, initiating immune signaling from ZmWAKLY, ZmWIK, ZmBLK1 to ZmRBOH4, ultimately triggering a reactive oxygen species burst. Our study thus uncovers the role of the maize ZmWAKL-ZmWIK-ZmBLK1-ZmRBOH4 receptor/signaling/executor module in perceiving the pathogen invasion, transducing immune signals, activating defense responses and conferring increased resistance to GLS.
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Sitios de Carácter Cuantitativo , Zea mays , Zea mays/genética , Zea mays/microbiología , Enfermedades de las Plantas/microbiología , Resistencia a la Enfermedad/genéticaRESUMEN
Solid-state self-powered UV detection is strongly required in various application fields to enable long-term operation. However, this requirement is incompatible with conventionally used metal-semiconductor-metal (MSM) UV photodetectors (PDs) due to the symmetric design of Schottky contacts. In this work, a self-powered MSM solar-blind UV-PD was realized using a lateral pn junction architecture. A large built-in electric field was obtained in the MSM-type UV-PD without impurity doping, leading to efficiency carrier separation and enhanced photoresponsivity at zero external bias. The solar-blind UV-PD exhibits a cutoff wavelength of 280â nm, a photo/dark current ratio of over 105, and a responsivity of 425.13â mA/W at -10â V. The mechanism of self-powered UV photodetection was further investigated by TCAD simulation of the internal electric field and carrier distributions.
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Background: Certain drugs can cause intrinsic or extrinsic tooth discoloration, which is not only a clinical issue but also an esthetic problem. However, limited investigations have focused on drug-induced tooth discoloration. The present work aimed to determine the drugs causing tooth discoloration and to estimate their risks of causing tooth discoloration. Methods: An observational, retrospective, and pharmacovigilance analysis was conducted, in which we extracted adverse event (AE) reports involving tooth discoloration by using the data of the US Food and Drug Administration's Adverse Event Reporting System (FAERS) from the first quarter (Q1) of 2004 to the third quarter (Q3) of 2021. Disproportionality analyses were performed to examine risk signals for tooth discoloration and determine the drugs inducing tooth discoloration. Results: Based on predefined inclusion criteria, 1188 AE reports involving 302 suspected drugs were identified. After data mining, 25 drugs generated positive risk signals for tooth discoloration, of which 10 were anti-infectives for systemic use. The top reported drug was tetracycline (n = 106), followed by salmeterol and fluticasone (n = 68), amoxicillin (n = 60), chlorhexidine (n = 54), and nicotine (n = 52). Cetylpyridinium (PRR = 472.2, ROR = 502.5), tetracycline (PRR = 220.4, ROR = 277), stannous fluoride (PRR = 254.3, ROR = 262.8), hydrogen peroxide (PRR = 240.0, ROR = 247.6), and chlorhexidine (PRR = 107.0, ROR = 108.4) showed stronger associations with tooth discoloration than the remaining drugs. Of 625 AE reports involving 25 drugs with positive risk signals, tooth discoloration was mostly reported in patients aged 45-64 (n = 110) and ≤18 (n = 95), and 29.4% (192/652) of the reports recorded serious outcomes. Conclusion: This study revealed that certain drugs are significantly associated with tooth discoloration. Caution should be exercised when using these drugs, especially during pregnancy and early childhood.
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KEY MESSAGE: We identified a quantitative trait locus, qPss3, and fine-mapped the causal locus to a 120-kb interval in maize. This locus inhibits the photoperiod sensitivity caused by ZmCCT9 and ZmCCT10, resulting in earlier flowering by 2 ~ 4 days without reduction in stalk-rot resistance in certain genotypes. Photoperiod sensitivity is a key factor affecting the adaptation of maize (Zea mays L.) to high-latitude growing areas. Although many genes associated with flowering time have been identified in maize, no gene that inhibits photoperiod sensitivity has been reported. In our previous study, we detected large differences in photoperiod sensitivity among maize inbred lines with the same photoperiod-sensitive allele at the ZmCCT10 locus. Here, we used two segregating populations with the same genetic backgrounds but different ZmCCT10 alleles to perform quantitative trait locus (QTL) analysis. We identified a unique QTL, qPss3, on chromosome 3 in the population carrying the sensitive ZmCCT10 allele. After sequential fine-mapping, we eventually delimited qPss3 to an interval of ~ 120 kb. qPss3 behaved as a dominant locus and caused earlier flowering by 2-4 days via inhibiting ZmCCT10-induced photoperiod sensitivity under long-day conditions. qPss3 also inhibited the photoperiod sensitivity induced by another flowering-related gene, ZmCCT9. For application in agriculture, an F1 hybrid heterozygous at both qPss3 and ZmCCT10 loci constitutes an optimal allele combination, showing high resistance to stalk rot without a significant delay in flowering time. Moreover, qPss3 is of great value in regulating the flowering time of tropical maize grown at high-latitude regions.
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Fotoperiodo , Sitios de Carácter Cuantitativo , Zea mays/genética , Genotipo , Flores/genéticaRESUMEN
OBJECTIVES: To compare the prognostic values of three lymph node staging systems in renal cell carcinoma (RCC), including the number of positive lymph nodes (NPLN), lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS). DESIGN: A retrospective cohort study using data from the Surveillance, Epidemiology and End Results (SEER) database. SETTING AND PARTICIPANTS: 1904 patients with pathological N1 RCC, diagnosed from 2004 to 2015 and underwent nephrectomy combined with lymph node dissection, were identified from the SEER database. PRIMARY OUTCOME MEASURE: The primary outcome of this study was overall survival (OS). Restricted cubic spline functions and multivariable Cox regression analyses were employed to characterise the associations of OS with NPLN, LNR and LODDS, respectively. RESULTS: Data of 1904 eligible RCC patients were extracted from the SEER database. The mortality risks of RCC patients increased with the increasing of NPLN, LNR and LODDS. NPLN (NPLN3 vs NPLN1, HR 1.22, 95% CI 1.05 to 1.43, p=0.001), LNR (LNR3 vs LNR1, HR 1.46, 95% CI 1.28 to 1.67, p<0.001; LNR2 vs LNR1, HR 1.28, 95% CI 1.09 to 1.50, p=0.002) and LODDS (LODDS3 vs LODDS1, HR 1.48, 95% CI 1.28 to 1.72, p<0.001; LODDS2 vs LODDS1, HR 1.34, 95% CI 1.17 to 1.53, p<0.001) were all independent prognostic factors of OS. The predictive abilities of LNR (Akaike information criterion, AIC: 19576.3, optimism-corrected C-index: 0.677) and LODDS (AIC: 19579.2, optimism-corrected C-index: 0.676) were comparable, superior to NPLN (AIC: 19603.7, optimism-corrected C-index: 0.673). In subgroup analyses, the LODDS classification could better stratify survival of RCC patients, in particular for those with the number of dissected lymph nodes <13 or NPLN≤2. CONCLUSIONS: NPLN, LNR and LODDS were all independent predictors of OS in RCC. When compared with NPLN and LNR, LODDS had a better performance in survival prediction and risk stratification. The three metrics all had the potential to be integrated into future versions of the American Joint Committee on Cancer staging manual.
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Carcinoma de Células Renales , Neoplasias Renales , Humanos , Carcinoma de Células Renales/cirugía , Carcinoma de Células Renales/patología , Estadificación de Neoplasias , Estudios Retrospectivos , Metástasis Linfática/patología , Ganglios Linfáticos/patología , Pronóstico , Neoplasias Renales/cirugía , Neoplasias Renales/patologíaRESUMEN
In this study, we propose an approach to stretch or translate images using gradient-index (GRIN) elements with a rotationally symmetric shape in lens systems. In this method, the GRIN material, instead of optical surfaces, are utilized to enable a breaking of rotational symmetry for the two image translations. GRIN expression with anamorphic and tilting terms is introduced. A pair of GRIN elements in front of the given system alters the magnification in two orthogonal directions using the anamorphic terms in the expression, which realizes image stretching. A pair of GRIN elements with tilting terms is used after the given system tilts the optical path to achieve a transverse displacement of the image. The structure of the given system remains unchanged when these translations are performed. A design method for the GRIN elements is presented. Additionally, a design example is presented whose image is stretched by 1.33 times in one direction and displaced to one side of its axis to demonstrate the feasibility of the proposed approach. The approach in this study may enable novel imaging GRIN lens system designs with flexible image positions or special optical functions.
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Objective: As an extension of optical coherence tomography (OCT), optical coherence tomographic angiography (OCTA) provides information on the blood flow status at the microlevel and is sensitive to changes in the fundus vessels. However, due to the distinct imaging mechanism of OCTA, existing models, which are primarily used for analyzing fundus images, do not work well on OCTA images. Effectively extracting and analyzing the information in OCTA images remains challenging. To this end, a deep learning framework that fuses multilevel information in OCTA images is proposed in this study. The effectiveness of the proposed model was demonstrated in the task of diabetic retinopathy (DR) classification. Method: First, a U-Net-based segmentation model was proposed to label the boundaries of large retinal vessels and the foveal avascular zone (FAZ) in OCTA images. Then, we designed an isolated concatenated block (ICB) structure to extract and fuse information from the original OCTA images and segmentation results at different fusion levels. Results: The experiments were conducted on 301 OCTA images. Of these images, 244 were labeled by ophthalmologists as normal images, and 57 were labeled as DR images. An accuracy of 93.1% and a mean intersection over union (mIOU) of 77.1% were achieved using the proposed large vessel and FAZ segmentation model. In the ablation experiment with 6-fold validation, the proposed deep learning framework that combines the proposed isolated and concatenated convolution process significantly improved the DR diagnosis accuracy. Moreover, inputting the merged images of the original OCTA images and segmentation results further improved the model performance. Finally, a DR diagnosis accuracy of 88.1% (95%CI ± 3.6%) and an area under the curve (AUC) of 0.92 were achieved using our proposed classification model, which significantly outperforms the state-of-the-art classification models. As a comparison, an accuracy of 83.7 (95%CI ± 1.5%) and AUC of 0.76 were obtained using EfficientNet. Significance. The visualization results show that the FAZ and the vascular region close to the FAZ provide more information for the model than the farther surrounding area. Furthermore, this study demonstrates that a clinically sophisticated designed deep learning model is not only able to effectively assist in the diagnosis but also help to locate new indicators for certain illnesses.
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Aprendizaje Profundo , Diabetes Mellitus , Retinopatía Diabética , Retinopatía Diabética/diagnóstico por imagen , Angiografía con Fluoresceína/métodos , Humanos , Vasos Retinianos/diagnóstico por imagen , Tomografía de Coherencia Óptica/métodosRESUMEN
The electromagnetic (EM) scattering characteristics of the rough sea surface is very important for target surveying and detection in a sea environment. This work proposes a scaled sea surface designing method based on a rough thin-film medium. For the prototype sea surface, the permittivity is calculated with the seawater temperature, salinity, and EM wave frequency according to the Debye model. The scale film material is mixed with carbon black and epoxy, whose volume ratio is optimized with the genetic algorithm through the existing electromagnetic parameter library. This method can overcome the previous difficulties of adjusting the same permittivity of the prototype sea water. According to the EM scaled theory, the scaled geometric sample is numerically generated with the D-V spectrum for the given wind speed, and is fabricated using 3D printing to keep the similar seawater shape. Then, the sample is sprayed with a layer of film material for EM scattering measurement. The simulated and measured radar cross-section (RCS) results show good consistency for the prototype seawater and scaled materials, which indicates the proposed scaled method is a more efficient method to get the seawater scattering characteristics.
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Lower reaches of the Amu Darya River Basin (LADB) is one of the typical regions which is facing the problem of water shortage in Central Asia. During the past decades, water resources demand far exceeds that supplied by the mainstream of the Amu Darya River, and has resulted in a continuous decrease in the amount of water flowing into the Aral Sea. Clarifying the dynamic relationship between the water supply and demand is important for the optimal allocation and sustainable management of regional water resources. In this study, the relationship and its variations between the water supply and demand in the LADB from the 1970s to 2010s were analyzed by detailed calculation of multi-users water demand and multi-sources water supply, and the water scarcity indices were used for evaluating the status of water resources utilization. The results indicated that (1) during the past 50 years, the average total water supply (TWS) was 271.88 × 108 m3/y, and the average total water demand (TWD) was 467.85 × 108 m3/y; both the volume of water supply and demand was decreased in the LADB, with rates of -1.87 × 108 m3/y and -15.59 × 108 m3/y. (2) percentages of the rainfall in TWS were increased due to the decrease of inflow from the Amu Darya River; percentage of agriculture water demand was increased obviously, from 11.04% in the 1970s to 44.34% in 2010s, and the water demand from ecological sector reduced because of the Aral Sea shrinking. (3) the supply and demand of water resources of the LADB were generally in an unbalanced state, and water demand exceeded water supply except in the 2010s; the water scarcity index decreased from 2.69 to 0.94, indicating the status changed from awful to serious water scarcity. A vulnerable balanced state has been reached in the region, and that water shortages remain serious in the future, which requires special attention to the decision-makers of the authority.
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Ríos , Abastecimiento de Agua , Asia Central , Agua , Recursos HídricosRESUMEN
We report a GaN-based self-powered metal-semiconductor-metal (MSM)-type ultraviolet (UV) photodetector (PD) by employing a "lateral polarity structure (LPS)" grown on the sapphire substrate. An in-plane internal electric field and different Schottky barrier heights at a metal/semiconductor interface lead to efficient carrier separation and self-powered UV detection. A dark current of 6.8nA/cm2 and detectivity of 1.0×1012 Jones were obtained without applied bias. A high photo-to-dark current ratio of 1.2×104 and peak responsivity of 933.7 mA/W were achieved for the lateral polarity structure-photodetector (LPS-PD) under -10V. The enhanced performance of the LPS-PD was ascribed to the polarization-induced carrier separation as demonstrated by the lateral band diagram.
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Long non-coding RNAs (lncRNAs) were reported to be related to microvascular dysfunction in diabetic retinopathy (DR), but the potential mechanism remains unknown. This study was designed to elucidate the effects of lncRNA small nucleolar RNA host gene 1 (SNHG16) in proliferative DR progression. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to measure the levels of SNHG16 and miR-20a-5p from peripheral blood samples of different participants. Pearson's correlation analysis was applied to the plasma data to detect correlations between SNHG16 and miR-20a-5p. Finally, the interactions of miR-20a-5p and SNHG16 or E2F1 were assessed by luciferase reporter assays. SNHG16 and E2F1 were increased and miR-20a-5p was decreased in proliferative DR both in vivo and in vitro when compared with control or non-proliferative DR. E2F1 was identified as the target of miR-20a-5p. The miR-20a-5p interacted with SNHG16 and E2F1 and was controlled by SNHG16. The regulation of SNHG16 on E2F1 was mediated by miR-20a-5p. Cells transfected with SNHG16 overexpression plasmid markedly increased cell apoptosis and vessel-like formation, whereas the miR-20a-5p mimic partially reversed these effects. Transfection with gene silencing E2F1 plasmid rescued SNHG16 overexpression-aggravated proliferative DR. This study indicated that SNHG16 regulated E2F1 expression by sponging miR-20a-5p and aggravating proliferative DR.
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Retinopatía Diabética/genética , Retinopatía Diabética/patología , Factor de Transcripción E2F1/genética , Factor de Transcripción E2F1/metabolismo , Regulación de la Expresión Génica/genética , MicroARNs/genética , MicroARNs/metabolismo , ARN Largo no Codificante/genética , ARN Largo no Codificante/fisiología , Células Cultivadas , Retinopatía Diabética/terapia , Humanos , Terapia Molecular Dirigida , Regulación hacia Arriba/genéticaRESUMEN
Various factors affect the prognosis of patients with colon cancer. Complicated factors are found to be conducive to accurate assessment of prognosis. In this study, we developed a series of prognostic prediction models for survival time of colon cancer patients after surgery. Analysis of nine clinical characteristics showed that the most important factor was the positive lymph node ratio (LNR). High LNR was the most important clinical factor affecting 1- and 3-year survival; M0&age < 70 was the most important feature for 5 years. The performance of the model was improved through the integration of clinical characteristics and four types of molecule features (mRNA, lncRNA, miRNA, DNA methylation). The model provides guidance for clinical practice. According to the high-risk molecular features combined with age ≥ 70&T3, poorly differentiated or undifferentiated, M0&well differentiated, M0&T2, LNR high, T4&poorly differentiated, or undifferentiated, the survival time may be less than 1 year; for patients with high risk of molecular features combined with M0&T2, M0&T4, LNR 0& M0, LNR median &T3, and LNR high, the survival is predicted less than 3 years; and the survival of patients with M1&T3, M0 and high risk molecular features is less than 5 years. Using multidimensional and complex patient information, this study establishes potential criteria for clinicians to evaluate the survival of patients for colon cancer.
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BACKGROUND: This work sought to (1) establish a reliable gunshot model of junctional femoral artery rupture in swine that accurately simulates field rescue conditions and (2) use the gunshot model to compare the efficacy and ease of application of zeolite nanometer hemostatic gauze with other hemostatic materials. METHODS: Thirty-six healthy landrace swine (body weight 50 ± 5 kg) were randomly divided into three groups which were treated with Combat Gauze (CG), FeiChuang hemostatic gauze (FG), or standard medical gauze (SG). A gunshot model of femoral artery hemorrhage in landrace swine was used with portable ultrasound to accurately position the wound. After the shooting, when mean arterial pressure of swine decreased by at least 30% for 10 s, wounds were pressed with standard packing (39 g) of gauze materials for 3 min to stop bleeding, then bandaged with pressure. Blood samples were taken 15 min before injury, then 10 min, 30 min, and 60 min after injury to determine hemodynamic, coagulation, and arterial blood gas indexes. Wound temperatures were taken at 5 min, 10 min, 30 min, and 60 min after injury, and survival times were recorded. The volume of blood loss and survival time were used to evaluate hemostatic effect, whereas the fill time, wound temperature, and physiological indexes were used to evaluate the safety and operation of the product. RESULTS: The CG (11.15 ± 3.09 mL/kg) and FG (12.19 ± 3.5 mL/kg) groups had significantly less blood loss than the SG group (16.8 ± 5.14 mL/kg) (P = 0.04; P = 0.039, respectively). After gauze packing, bleeding in CG (5.85 ± 1.17 mL/kg) and FG (5.37 ± 0.93 mL/kg) groups remained significantly lower than that of the SG group (6.93 ± 1.03 mL/kg) (P = 0.011; P = 0.003, respectively). Wound temperature rose with time for all groups (P < 0.001). The wound temperatures in the FG group and the CG group were significantly higher than that of the SG group (P = 004 and 0.009, respectively). Survival rates and times were not significantly different among the three groups, although the FG group had the longest average survival time (standard deviation [SD] 204.8 s), compared with the SG group (SD 177.8 s) and CG (SD 187.5 s) groups. No significant differences in hemodynamics, blood gas, and coagulation were observed among the three groups. CONCLUSIONS: The gunshot model of junctional femoral arterial hemorrhage guided by ultrasound had high accuracy for femoral arterial rupture by bullet wound and provided consistent and reproducible field-simulation conditions for comparison of hemostatic materials. FeiChuang zeolite hemostatic gauze effectively controlled bleeding as well as combat gauze, without excessive heat as found in other zeolite-based products. However, improvements to application technique, such as a packing device, are needed to improve operating time.
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Hemorragia/terapia , Técnicas Hemostáticas , Hemostáticos/administración & dosificación , Heridas por Arma de Fuego/terapia , Zeolitas/administración & dosificación , Animales , Modelos Animales de Enfermedad , Arteria Femoral/lesiones , Hemorragia/etiología , Humanos , Sus scrofa , Heridas por Arma de Fuego/complicacionesRESUMEN
OBJECTIVES: We sought to investigate the prognostic value of serum lactate on survival in patients postcardiac arrest. BACKGROUND: Patients who experience cardiac arrest, in- or out-of-hospital, may have a poor outcome. Initial electrocardiograms may suggest ischemia as an underlying cause and urgent referral for catheterization occurs. It remains unclear which of these patients may suffer a poor outcome. METHODS: We retrospectively reviewed all patients at our institution taken for urgent catheterization after cardiac arrest between January 2014 and September 2018. Three hundred and eighty four patients were referred urgently to the cath lab during this period, 50 with prior arrest. RESULTS: Sixty six percent underwent coronary intervention. The mean age of the entire cohort was 57 years. Thirty four percent were female, 40% had a history of coronary artery disease, and 94% were intubated at the time of cardiac catheterization. Overall survival to discharge was 40%. Survival in patients who underwent coronary intervention compared with those who did not was similar (45.5 vs. 29.4%, p = .27). Mean lactate level in survivors versus nonsurvivors was 4.7 ± 3.8 and 9.8 ± 4.7 mmol/L, respectively (p < .05). When divided into tertiles by serum lactate (< 4.5, 4.5-9, 9 mmol/L), survival to discharge was 75, 29.4, and 17.6%, respectively (p < .05). Initial serum lactate and age were independent predictors of in-hospital mortality. CONCLUSIONS: In patients undergoing cardiac catheterization following cardiac arrest, routine measurement of serum lactate is a useful and available laboratory test that may help identify patients at risk for a poor outcome.
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Reanimación Cardiopulmonar , Paro Cardíaco Extrahospitalario , Cateterismo Cardíaco/efectos adversos , Femenino , Humanos , Ácido Láctico , Paro Cardíaco Extrahospitalario/diagnóstico , Paro Cardíaco Extrahospitalario/terapia , Pronóstico , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Heterogeneity of metastatic renal cell carcinoma (RCC) constraints accurate prognosis prediction of the tumor. We therefore aimed at developing a novel nomogram for accurate prediction of overall survival (OS) of patients with metastatic RCC. METHODS: We extracted 2010 to 2016 data for metastatic RCC patients in the Surveillance, Epidemiology, and End Results (SEER) database, and randomly stratified them equally into training and validation sets. Prognostic factors for OS were analyzed using Cox regression models, and thereafter integrated into a 1, 3 and 5-year OS predictive nomogram. The nomogram was validated using the training and validation sets. The performance of this model was evaluated by the Harrell's concordance index (C-index), calibration curve, integrated discrimination improvement (IDI), category-free net reclassification improvement (NRI), index of prediction accuracy (IPA), and decision curve analysis (DCA). RESULTS: Overall, 2315 metastatic RCC patients in the SEER database who fulfilled our inclusion criteria were utilized in constructing a nomogram for predicting OS of newly diagnosed metastatic RCC patients. The nomogram incorporated eight clinical factors: Fuhrman grade, lymph node status, sarcomatoid feature, cancer-directed surgery and bone, brain, liver, and lung metastases, all significantly associated with OS. The model was superior to the American Joint Committee on Cancer (AJCC) staging system (7th edition) both in training (C-indices, 0.701 vs. 0.612, P < 0.001) and validation sets (C-indices, 0.676 vs. 0.600, P < 0.001). The calibration plots of the nomogram corresponded well between predicted and observed values. NRI, IDI, and IPA further validated the superior predictive capability of the nomogram relative to the AJCC staging system. The DCA plots revealed reliable clinical application of our model in prognosis prediction of metastatic RCC patients. CONCLUSIONS: We developed and validated an accurate nomogram for individual OS prediction of metastatic RCC patients. This nomogram can be applied in design of clinical trials, patient counseling, and rationalizing therapeutic modalities.
Asunto(s)
Carcinoma de Células Renales/mortalidad , Neoplasias Renales/mortalidad , Nomogramas , Factores de Edad , Anciano , Carcinoma de Células Renales/secundario , Carcinoma de Células Renales/cirugía , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Renales/patología , Neoplasias Renales/cirugía , Masculino , Persona de Mediana Edad , Pronóstico , Distribución Aleatoria , Estudios Retrospectivos , Factores de Riesgo , Programa de VERF , Tasa de SupervivenciaRESUMEN
PURPOSE: This study aimed to establish a nomogram to predict the long-term overall survival (OS) for patients with penile squamous cell carcinoma (PSCC). METHOD: The PSCC patients receiving regional lymph node dissection (RLND) were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015. The dataset of all eligible patients were used to develop the predictive model. The significant independent predictors were identified through Cox regression modeling based on the Bayesian information criterion and then incorporated into a nomogram to predicted 1-, 3-, and 5-year OS. Internal validation was performed using the bootstrap resampling method. The model performance was evaluated using Harrell's concordance index (C-index), calibration plots, integrated discrimination improvement (IDI), net reclassification improvement (NRI), and decision curve analysis (DCA). RESULTS: Totally, 384 eligible PSCC patients were enrolled from the SEER database. A nomogram for OS prediction was developed, in which three clinical variables significantly associated with OS were integrated, including age, N classification, and log odds of positive lymph nodes (LODDS). The C-index of the nomogram (0.746, 95% CI: 0.702-0.790) was significantly higher than that of the American Joint Committee on Cancer (AJCC) staging system (0.692, 95% CI: 0.646-0.738, P = .020). The bootstrap optimism-corrected C-index for the nomogram was 0.739 (95% CI: 0.690-0.784). The bias-corrected calibration plots showed the predicted risks were in good accordance with the actual risks. The results of NRI, IDI, and DCA exhibited superior predictive capability and higher clinical use of the nomogram compared with the AJCC staging system. CONCLUSION: We successfully constructed a simple and reliable nomogram for OS prediction among PSCC patients receiving RLND, which would be beneficial to clinical trial design, patient counseling, and therapeutic modality selection.