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Severe cadmium contamination poses a serious threat to food security and human health. Plant-microbial combined remediation represents a potential technique for reducing heavy metals in soil. The main objective of this study is to explore the remediation mechanism of cadmium-contaminated soil using a combined approach of lawn plants and microbes. The target bacterium Bacillus cereus was selected from cadmium-contaminated soil in mining areas, and two lawn plants (Festuca arundinacea A'rid III' and Poa pratensis M'idnight II') were chosen as the target plants. We investigated the remediation effect of different concentrations of bacterial solution on cadmium-contaminated soil using two lawn plants through pot experiments, as well as the impact on the soil microbial community structure. The results demonstrate that Bacillus cereus promotes plant growth, and the combined action of lawn plants and Bacillus cereus improves soil quality, enhancing the bioavailability of cadmium in the soil. At a bacterial suspension concentration of 105 CFU/mL, the optimal remediation treatment was observed. The removal efficiency of cadmium in the soil under Festuca arundinacea and Poa pratensis treatments reached 33.69% and 33.33%, respectively. Additionally, the content of bioavailable cadmium in the rhizosphere soil increased by up to 13.43% and 26.54%, respectively. Bacillus cereus increased the bacterial diversity in the non-rhizosphere soil of both lawn plants but reduced it in the rhizosphere soil. Additionally, the relative abundance of Actinobacteriota and Firmicutes, which have potential for heavy metal remediation, increased after the application of the bacterial solution. This study demonstrates that Bacillus cereus can enhance the potential of lawn plants to remediate cadmium-contaminated soil and reshape the microbial communities in both rhizosphere and non-rhizosphere soils.
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The long-term efficacy and complications of implantable diaphragm pacer (IDP) in a child with cervical spinal cord injury (CSCI) in the Department of Spinal and Neural Functional Reconstruction, China Rehabilitation Research Center in September 2022 were retrospective analyzed.A male child had quadriplegia without an obvious cause at the age of 12 years, and he was then lived completely with the assistance of mechanical ventilation.At the age of 14 years, he could wean off the ventilator in unilateral diaphragmatic pacing mode.However, mechanical ventilation was re-given for months after 5 years due to pneumonia, and then the IDP was re-given with the self-felt decreased pacing effect.After hospitalization, the patient was examined with mild diaphragmatic atrophy, secondary flat chest, and mild scoliosis.After optimization of the transdiaphragmatic pacing threshold and rehabilitation, his respiratory function improved.IDP can be used in CSCI for long time, while flat chest and scoliosis that limited the expansion of the lungs should be considered.At the meantime, the increased abdominal spasm affected the abdominal compliance, leading to the decrease in the efficiency of the diaphragm.
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Objective To compare endoscopic thyroidectomy via transoral submental approach with open surgery for treating thyroid tumors in terms of the clinical effectiveness.Methods We retrospectively reviewed and analyzed the clinical data and follow-up records of 154 patients in the study,who were hospitalized for thyroidectomy in our hospital from January 2021 to June 2022.Among them,74 cases undergoing endoscopic thyroidectomy via transoral submental approach were assigned to the endoscopic group and 80 cases undergoing traditional open thyroid surgery to the open surgery group.Results All operations were completed successfully and safely in both groups,with no intermediate openings in the endoscopic group.Compared with the open surgery group,the endoscopic group had significantly fewer intraoperative blood losses[(19.46±10.24)mL vs.(32.05±15.87)mL],significantly less incision length[(1.95±0.30)cm vs.(7.05±0.60)cm],significant shorter operative time[(136.66±22.44)min vs.(82.75±15.20)min],and significantly less total postoperative drainage[(111.35±38.92)mL vs.(95.45±36.73)mL](all P＜0.05).Endoscopic patients had superior postoperative pain and cosmetic satisfaction compared to open patients,and the difference was statistically significant(P＜0.05).The two groups had no significant differences in the number of lymph node dissections,parathyroid hormone,and postoperative morbidity between the two groups(P＞0.05).Conclusion The endoscopic thyroidectomy via transoral submental approach can achieve the same clinical effectiveness as the traditional open surgery.However,it is advantageous in reducing intra-operative blood loss,relieving post-operative pain,and achieving a better cosmetic effects of neck incision,thus deserving clinical promotion and application.
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Objective To explore the protection effect and mechanism of preoperative ultrasound-guided stellate ganglion block(SGB)on lung in patients undergoing one-lung ventilation(OLV)during thoracoscopic surgery.Methods Eighty-four patients who underwent OLV during thoracoscopic lobectomy at the Affiliated Suzhou Hospital of Nanjing Medical University from January 2021 to April 2022 were selected as research subjects,and the patients were divided into the observation group and control group by using a random number table,with 42 patients in each group.Patients in the observation group received ultrasound-guided SGB before anesthesia induction,while patients in the control group did not undergo puncture procedures.Patients in both groups received the same anesthesia induction and maintenance protocols.Hemodynamic,respiratory and arterial blood gas parameters were recorded at various time points:upon entering the operating room(T0),before OLV(T1),30 minutes after OLV initiation(T2),60 minutes after OLV initiation(T3),completion of surgery(T4),and 30 minutes after extubation(T5).Oxygenation index(OI),intrapulmonary shunt rate(Qs/Qt)and pH values of patients in the two groups were compared at these time points.Venous blood were collected from patients in both groups at T0,T3 and T5,and enzyme-linked immunosorbent assay was employed to measure the levels of surfactant protein-A(SP-A),superoxide dismutase(SOD),malondialdehyde(MDA),interleukin-6(IL-6)and interleukin-10(IL-10).Postoperative SGB-related complications and pulmonary complications within 72 hours were recorded.Results The mean arterial pressure(MAP)and heart rate(HR)in both groups were significantly lower at T,,T2,and T3 compared to T0(P＜0.05);the MAP and HR at T4 and T5 had no statis-tically significant difference compared to those at T0(P＞0.05);there was no significant difference in MAP and HR at other time points(P＞0.05).MAP in the observation group at T1,T2 and T3 was significantly lower than that in the control group(P＜0.05),and HR in the observation group at T2 and T3 was significantly lower than that in the control group(P＜0.05);there were no significant differences in MAP and HR between the two groups at other time points(P＞0.05).There were no significant differences in pulse oxygen saturation(SpO2)between the two groups at T0-T5(P＞0.05).At T2 and T3,peak airway pressure(Ppeak)and respiratory rate(RR)were significantly higher than those at T,and T4,and tidal volume(TV)was significantly lower than that at T,and T4 in both groups(P＜0.05).Ppeak and TV in the observation group at T2 and T3 were significantly lower than those in the control group(P＜0.05);there were no significant differences in Ppeak and TV between the two groups at T1 and T4(P＞0.05).RR and partial pressure of end-tidal carbon dioxide(PetCO2)at T1-T4 showed no significant differences between the two groups(P＞0.05).The pH values at T0-T5 showed no significant differences between the two groups(all P＞0.05).The OI at T,had no significant difference compared to that at T0 in both groups(P＞0.05);OI at T2-T5 in both groups was significantly lower than that at T0(P＜0.05);OI in the observation group at T2-T5 was significantly higher than that in the control group(P＜0.05).Qs/Qt at T2-T5 was significantly higher than that at T0 and T1 in both groups(all P＜0.05);Qs/Qt in the observation group at T2-T5 was significantly lower than that in the control group(P＜0.05).At T3 and T5,serum SP-A and IL-6 levels in both groups were significantly higher than those at T0(P＜0.05);serum SP-A and IL-6 levels in the observation group at T3 and T5 were significantly lower than those in the control group(P＜0.05).At T3 and T5,serum IL-10 level in the control group were significantly lower than that at T0,while serum IL-10 level in the observation group were significantly higher than that at T0(P＜0.05).Serum IL-10 level in the observation group at T3 and T5 were higher than that in the control group(P＜0.05).At T3 and T5,serum MDA level in the control group was significantly higher than that at T0(P＜0.05);serum MDA level in the observation group showed no significant difference compared to that at T0(P＞0.05);serum MDA level in the observation group was significantly lower than that in the control group(P＜0.05).At T3 and T5,serum SOD level in the control group was significantly lower than that at T0,while serum SOD level in the observation group was significantly higher than that at T0(P＜0.05);serum SOD level in the observation group was significantly higher than that in the control group(P＜0.05).Four patients in the observation group experienced symptoms of unilateral recurrent laryngeal nerve block,and one patient experienced brachial plexus nerve block,but all improved within 24 hours after surgery.No other adverse reactions were observed during follow-up.Within 72 hours postoperatively,one patient in the control group experienced hypoxemia.Conclusion Preoperative ultrasound-guided SGB has lung-protective effects on patients undergoing OLV in thoracoscopic surgery,which significantly improves OI,reduces intrapulmonary shunts,and inhibits inflammatory response and oxidative stress.
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ObjectiveTo analyze the development status and quality of clinical practice guidelines for the treatment of dominant diseases with Chinese patent medicines （CPMs）. MethodsDatabases were searched from Jan. 2019 to Dec.2023 to collect the published clinical practice guidelines of CPMs for the treatment of dominant diseases. The information about the title， the participants， clinical problems， outcomes， evidence grade， recommendations， and recommendation strength in the included clinical practice guidelines were collected， for which the development status was analyzed， and the quality was evaluated with the Scientific， Transparent and Applicable Rankings （STAR） tool for clinical practice guidelines. ResultsTotally， 34 guidelines were included， involving 273 kinds of CPMs. One to ten （with the medium five） clinical problems were proposed from 29 clinical practice guidelines respectively. All the guidelines divided the evidence into four grades according to Grade of Recommendation Assessment， Deve-lopement an Evaluation. And 28 guidelines had five levels of recommendation strength. A total of 344 recommendations were extracted， including 86 strong-recommendations， 191 weak-recommendations （including 36 weak recommendations only based on expert consensus） and 67 recommendations with unclear recommendation strength. All guidelines had high scores in the three areas of “clinical questions （94.20%）”， “evidence （91.45%）” and “recommendations （89.06%）”， while the scores in the three areas of “registry （22.06%）”， “protocol （19.00%）” and “accessibility （31.51%）” were low. The STAR recommended stars of 8 guidelines were 5.0~4.0 stars， while that of 18 guidelines were 3.5~2.5 stars， and 8 guidelines were 2.0~1.0 stars. The three guidelines with the highest recommended stars were depressive disorder， community-acquired pneumonia， and influenza in adult. ConclusionThere is a certain gap in the quality of the published clinical practice guidelines of CPMs， and the quality of the guidelines could be further improved in registry， protocols， funds， and accessibility.
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Chronic obstructive pulmonary disease(COPD)poses a serious threat to human health and carries a heavy burden of disease.The disease burden mainly includes traditional epidemiological indicators such as morbidity,disability rate,and mortality rate,as well as economic burden evaluation indicators such as direct economic burden,indirect economic burden,and intangible economic burden,as well as social/health burden evaluation indicators such as potential years of life reduction,disability adjusted life years,and quality adjusted life years.It summarized the existing methods for evaluating the burden of COPD diseases and proposed the following suggestions:(1)enriching economic burden research methods to comprehensively and accurately evaluate direct economic burden;(2)expanding the scope of economic burden research and improve the economic burden research of COPD;(3)strengthening information management and enhance the accuracy of disease burden data;(4)exploring multidimensional indicators and establish a COPD disease burden evaluation system;(5)strengthening relevant research and highlight the health economics advantages of traditional Chinese medicine intervention in COPD.It can provide references for establishing a COPD disease burden evaluation system and policy formulation.
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OBJECTIVE: To systematically evaluate the efficacy and safety of Chinese herbal medicine (CHM) combined with conventional Western Medicine (CWM) on acute exacerbation of chronic obstructive pulmonary disease (AECOPD) based on high-quality randomized placebo-controlled trials. METHODS: We searched PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure Database, Chinese Biomedical Literature Database, China Science and Technology Journal Database, and Wanfang databases for randomized placebo-controlled trials of CHM treatment for AECOPD from inception to June 4, 2021. The Cochrane Collaboration's tool and the Grading of Recommendations, Assessment, Development and Evaluation were used to assess the risk of bias and the evidence quality of the included studies. Revman 5.3 software was used for Meta-analysis. RESULTS: A total of 9 trials involving 1591 patients were included. The Meta-analysis showed that based on CWM treatment, CHM group had significant advantages over the placebo group in ameliorating clinical total effective rate [ = 1.29, 95% (1.07, 1.56), = 0.007, low quality] and TCM symptom scores [ = -2.99, 95% (-4.46, -1.53), < 0.0001, moderate quality], improving arterial blood gas results [PaO: = 4.51, 95% (1.97, 7.04), = 0.0005, moderate quality; PaCO: = -2.87, 95% (-4.28, -1.46), < 0.0001, moderate quality], reducing CAT scores [ = -2.08, 95% (-2.85, -1.31), < 0.000 01, moderate quality]ï¼length of hospitalization [ = -1.87, 95% (-3.33, -0.42), = 0.01, moderate quality], and acute exacerbation rate [ = 0.60, 95% (0.43, 0.83), = 0.002, moderate quality]. No serious CHM-related adverse events were reported. CONCLUSIONS: The current evidence indicates that CHM is an effective and well-tolerated adjunct therapy for AECOPD patients receiving CWM. However, considering the high heterogeneity, this conclusion requires confirmation.
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Drugs, Chinese Herbal , Pulmonary Disease, Chronic Obstructive , Humans , Drugs, Chinese Herbal/therapeutic use , Phytotherapy , Treatment Outcome , Pulmonary Disease, Chronic Obstructive/drug therapy , Pulmonary Disease, Chronic Obstructive/chemically induced , ChinaABSTRACT
This paper summarized the current status of the commonly used quality of life assessment scales of bronchiectasis （BE） at home and abroad， and compared the characteristics and differences of each scale from the basic framework， domain， item pool， application status and quality assessment， so as to provide a basis for the development and application of scales based on the mode of combination of disease and syndrome. There are currently 12 assessment tools for evaluating the quality of life in BE with good reliability， validity， and responsiveness， but only quality of life - bronchiectasis （QOL-B） and bronchiectasis health questionnaire （BHQ） are specifically developed for BE patients. The development process of these scales is mostly rooted in western culture and modern medicine， making it difficult to highlight the characteristics and advantages of traditional Chinese medicine （TCM）. The content of the scales lacks the outcome indicators that BE patients are most concerned about， and cannot fully reflect the subjective feelings of patients. The development and assessment of scales lacks clinical research data and methodological support. Under the guidance of TCM syndrome differentiation and treatment， the development of scales based on the mode of combination of disease and syndrome can emerge the characteristics of TCM， reflect the true feelings of patients， and make up for the limitations of the existing scales of BE. Therefore， based on domestic and international scales， factors of China's national conditions and cultural characteristics of TCM should be considered to develop the scale suitable for Chinese people， which requires the construction of a theoretical model for the combination of disease and syndrome， by taking patients as the center and evaluating the performance and quality of the scale.
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Objective:To investigate the application of modified mini-clinical evaluation exercise (Mini-CEX) in the probationary teaching of dermatology and venereology for eight-year program students.Methods:From 2019 to 2020, a modified Mini-CEX was used to grade 58 eight-year program students at the Third Affiliated Hospital of Sun Yat-Sen University at the early, middle, and late stages of the probationary teaching of dermatology and venereology. The modifications included refining various evaluation indicators. Specifically, medical history collection involved dynamic changes in rashes, negative symptoms with differential diagnostic significance, past history/personal history/family history, and other important medical history; physical examination involved the specialized condition of rashes, systematic physical examination, and negative signs with differential diagnostic significance; humanistic care involved caring for patients, health education, and privacy protection; clinical judgment involved principles of diagnosis, differential diagnosis, and treatment; communication skills involved proficiency, prioritization, and body language; organizational effectiveness involved time allocation, patient compliance, and preparation work; overall performance involved calmness and fluency, neat writing, and preliminary clinical thinking. SPSS 20.0 was used to perform the t test. Results:Compared with the early stage of probation, the 58 eight-year program students improved their scores in clinical comprehensive ability evaluation and scores in each specific evaluation at the middle and late stages of probation ( P < 0.001). The dynamic changes in rashes and the specialized situation of rashes (identification and description of rashes) were specific to this discipline. Conclusion:The modified Mini-CEX is an objective, comprehensive, concise, and efficient assessment tool, which meets the needs of teaching reform and practice of dermatology and venereology.
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During coronavirus disease 2019 epidemic, the treatment of severe trauma has been impacted. The Consensus on emergency surgery and infection prevention and control for severe trauma patients with 2019 novel corona virus pneumonia was published online on February 12, 2020, providing a strong guidance for the emergency treatment of severe trauma and the self-protection of medical staffs in the early stage of the epidemic. With the Joint Prevention and Control Mechanism of the State Council renaming "novel coronavirus pneumonia" to "novel coronavirus infection" and the infection being managed with measures against class B infectious diseases since January 8, 2023, the consensus published in 2020 is no longer applicable to the emergency treatment of severe trauma in the new stage of epidemic prevention and control. In this context, led by the Chinese Traumatology Association, Chinese Trauma Surgeon Association, Trauma Medicine Branch of Chinese International Exchange and Promotive Association for Medical and Health Care, and Editorial Board of Chinese Journal of Traumatology, the Chinese expert consensus on emergency surgery for severe trauma and infection prevention during coronavirus disease 2019 epidemic ( version 2023) is formulated to ensure the effectiveness and safety in the treatment of severe trauma in the new stage. Based on the policy of the Joint Prevention and Control Mechanism of the State Council and by using evidence-based medical evidence as well as Delphi expert consultation and voting, 16 recommendations are put forward from the four aspects of the related definitions, infection prevention, preoperative assessment and preparation, emergency operation and postoperative management, hoping to provide a reference for severe trauma care in the new stage of the epidemic prevention and control.
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Objective:To investigate the effect of ultrasound-guided stellate ganglion block (SGB) on cerebral oxygen metabolism and serum S100B protein during carotid endarterectomy (CEA).Methods:Patients aged 40-75 years old, classified as Grade Ⅱ-Ⅲ by the American Society of Anesthesiologists (ASA), and underwent elective CEA under general anesthesia at the Affiliated Suzhou Hospital of Nanjing Medical University from June 2021 to April 2023 were prospectively enrolled. They were randomly divided into an SGB group and a control group. Before anesthesia induction, the SGB group underwent ipsilateral SGB under the ultrasound guidance, while the control group did not undergo SGB. The right subclavian vein catheterization was performed under the ultrasound guidance during the general anesthesia. The mean arterial pressure (MAP) and heart rate (HR) were recorded before induction of general anesthesia (T0), during tracheal intubation (T1), before vascular occlusion (T2), after vascular opening (T3), and at the end of surgery (T4), as well as the pressure of the jugular vein bulb at each time point from T1 to T4. Arterial blood and jugular venous bulb blood were collected at various time points for blood gas analysis. Jugular venous bulb oxygen saturation (SjvO 2), arteriovenous oxygen content difference (AVDO 2), cerebral oxygen extraction rate (COER), lactate production rate (LPR) and lactate oxygen index (LOI) were calculated. The serum S100B concentration in the jugular vein bulb blood at various time points was detected with enzyme-linked immunosorbent assay. The incidence of postoperative hoarseness, hematoma, dizziness, diaphragmatic nerve block, nausea, and vomiting were recorded. Results:A total of 82 patients conducted CEA were included, with 41 patients in the SGB group and 41 in the control group. During anesthesia induction and surgery in the SGB group, HR was significantly lower than that in the control group, and the MAP and HR during tracheal intubation and at the beginning of surgery were also more stable than those in the control group (all P<0.05). In the SGB group, the changes in SjvO 2, AVDO 2, and COER were relatively smaller from T1 to T3, while SjvO 2 increased, and AVDO 2 and CEOR decreased at T4. In contrast, the control group showed a decrease in SjvO 2, AVDO 2, and COER at T3 and a slight increase at T4. At all time points, SjvO 2 in the SGB group was significantly higher than that in the control group ( P<0.05). AVDO 2 and COER in both groups gradually decreased over time, and the control group was significantly higher than the SGB group at all time points (all P<0.05). LPR and LOI increased at T1 to T4 in both groups, reaching their highest value at T3 and decreasing at T4. There was statistically significant difference at T4 and at T2 in the control group (all P<0.05). The LPR and LOI of the control group were significantly higher than those of the SGB group at all time points (all P<0.05). In addition, the serum S100B levels in both groups increased first and then decreased, but the T2-T4 levels in the SGB group were significantly lower than those in the control group at all time points (all P<0.05). The incidence of perioperative adverse events in the SGB group was significantly lower than that in the control group ( P<0.05). Conclusion:Performing ipsilateral SGB before CEA surgery can effectively inhibit stress response, maintain intraoperative hemodynamic stability, improve brain tissue oxygen supply, and have a certain neuroprotective effect.
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Aim To study the effect of salidroside (SAL) on cerebral vascular endothelial cells of rats with ischemic brain injury and its mechanism of action. Methods Twenty-four healthy adult SD male rats were prepared by bolt plugging method to prepare MCAO models,and randomly divided into sham surgery group ( Sham ) , model group ( MCAO ) , and SAL administration group (MCAO + SAL) ,and the concentration of SAL was 50 mg • kg ~ , with a continuous administration for six days. Western blot was used to detect the protein expression of ICAM-1, VCAM-1 , E-se-lectin,and P-selectin in injured brain tissue of rats. In vitro cell experiments using HUVECs were subjected to different concentrations of salidroside (0. 1,1,10 jjunol • L ) and LPS (100
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Aim To investigate the effect of heroin use in male rats of F0 generation on heroin addiction and relapse in rats of Fl generation and the underlying mechanism. Methods Male rats of F0 generation were treated with different doses of heroin (1, 3, 9 mg • kg
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Pulmonary fibrosis(PF)is a progressive,interstitial fibrotic lung disease characterized by persistent scar formation in the lung parenchyma,and a reduced quality of life and poor prognosis for patients.The pathogenesis of PF is unknown and there is a lack of effective therapeutic agents;however,animal models are currently the main tool used to explore the pathogenesis of the disease and to find effective therapeutic agents.PF can be induced by various factors and to different degrees according to known etiologies.Among these,bleomycin-induced models are widely used because of their reproducibility and the similarity between the fibrosis pathology and clinical conditions.The main induction method include intratracheal drip,intratracheal nebulization,tail vein injection,intraperitoneal injection,and transnasal inhalation,and these can be classified into single and multiple doses,according to the frequency of induction.Based on the relevant literature,the current review summarizes the characteristics of the bleomycin-induced PF model using different induction frequencies and method,to provide a basis for the application of this model.
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Objective To investigate the effects of butylphthalide soft capsule on the expression of uric acid and the pathological changes of white matter in patients with moderate and severe leukoaraiosis.Methods A total of 60 patients with moderate to severe leukoosteoporosis admitted to the department of neurology of People's Hospital of Hai'an City,Jiangsu province from May 2021 to November 2022 were selected and divided into a study group and a control group by random number table method.The control group was treated with conventional basic treatment,and the study group was treated with butylphthalein softgel based on the control group.The score of mini-mental state examination(MMSE)scale,montreal cognitive assessment(MoCA)scale,hachinski ischemia score(HIS)scale,total decline scale(GDS),the levels of plasma factors[homocysteine(Hcy),total cholesterol(TC),central nervous specific protein(S100β)and uric acid(UA)]and improvement in leukoencephalopathy[as measured by arterial flow velocity at peak systolic flow rate(Vs),end-diastolic peak flow rate(Vd),and mean peak flow rate(Vm)]before and after treatment were compared between the two groups.Results A total 60 patients with leukoaraiosis were included,with 30 cases in the study group and 30 cases in the control group,respectively.Before treatment,there were no significant differences in scores of MMSE,MoCA,HIS and GDS,levels of Hcy,TC,S100β and UA,Vs,Vd,and Vm between the two groups(P＞0.05).After treatment,the scores of MMSE and MoCA scores,Vs,Vd,and Vm on both sides were significantly higher than those before treatment(P＜0.05),and those in the study group was significantly higher than those in the control group(P＜0.05);the scores of HIS and GDS,and the levels of Hcy,TC,S100β and UA were significantly lower than those before treatment(P＜0.05),and those in the study group was significantly lower than those in the control group(P＜0.05).Conclusions Butylphthalide soft capsule in the treatment of moderate and severe leukoaraiosis can effectively reduce the cognitive impairment,restore the cognitive function,reduce the levels of plasma factors,improve the cerebral blood flow,and improve the condition of leukoaraiosis.
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Background: Atrial appendage tachycardia (AAT) originating from the atrial appendage (AA) is extremely difficult to eliminate using radiofrequency catheter ablation (RFCA). The optimal management strategy for AAT refractory to RFCA remains unclear. Objective: This study aims to investigate the long-term result of ablative therapy and the optimal alternative management for AAT refractory to RFCA. Methods: A total of 51 patients with AAT originating from the AA undergoing RFCA were recruited. Video-assisted atrial appendectomy and oral ivabradine were performed on those with AATs refractory to RFCA, and this study aimed to evaluate their safety and long-term efficacy. Results: We included 51 patients (51/586, 8.7%) with AATs confirmed by activation mapping and contrast venography. Among them, there were 28 (54.9%) AATs originating from the distal AA. In total, 14 (27.4%) AATs were refractory to RFCA, including 13 originating from the distal AA and one arising from the proximal AA. Ten of 11 (90.9%) AATs originating from the distal AA were eliminated after an atrial appendectomy, and the other three AATs were suppressed using oral ivabradine. Origins from the distal AA refractory to RFCA and early age of AAT onset ≤26.5 years indicated the need for atrial appendectomy. No major complications occurred, and nine patients with tachycardia-induced cardiomyopathy fully recovered. Long-term success was achieved in 98.0% of patients with multiple treatment managements. Conclusion: AATs originating from the distal AA were more refractory to RFCA. RFCA was the cornerstone of AAT catheter ablation. Video-assisted thoracoscopic atrial appendectomy was an effective strategy for those origins at the distal AA and the age of AAT onset ≤26.5 years. Ivabradine represents a promising treatment for AAT temporarily in pediatric and young adult patients.
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AIMS: To investigate the implications of soluble programmed cell death-ligand 1 (sPD-L1) in hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization (TACE) and to evaluate the potential value of sPD-L1 to guide selection of the optimal time to begin combination therapy with TACE and immune checkpoint inhibitors (ICIs). MATERIALS AND METHODS: Thirty-one HCC patients suitable for TACE and 55 healthy volunteers were enrolled in this study. Three milliliters of peripheral venous blood of patients were collected on 1 day before TACE and 3, 7, and 30 days after TACE respectively for assay of sPD-L1 using enzyme-linked immunosorbent assay. The associations of the sPD-L1 level with the clinical features, outcomes, and the fluctuation of sPD-L1 during the treatment were analyzed. RESULTS: The initial sPD-L1 level of patients was significantly higher than that of the control group. And it was significantly associated with BCLC stage, portal venous invasion, tumor size, and number of foci. The sPD-L1 levels of 3 and 7 days after TACE were both significantly higher than the initial level. And that of 30 days after TACE was lower than the initial level, but the difference was not statistically significant. There was no significant difference of sPD-L1 level after embolization with embolic beads of different size. The level of sPD-L1 of CR patients was lower than that of PR, SD patients, but the differences were not significant. CONCLUSION: The level of sPD-L1 was associated with tumor aggressiveness and outcomes, suggesting its role as a possible predictive biomarker. The increases in sPD-L1 after TACE suggests that combined treatment with TACE and ICIs may be a promising therapeutic strategy in HCC. One week after TACE might be a suitable time to begin the administration of immunotherapy.
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Carcinoma, Hepatocellular , Chemoembolization, Therapeutic , Liver Neoplasms , B7-H1 Antigen , Carcinoma, Hepatocellular/pathology , Humans , Immune Checkpoint Inhibitors , Ligands , Liver Neoplasms/pathologyABSTRACT
Spatial agglomeration phenomena on the earth permeate in various fields of the natural and human world, yet their researches in human society are relatively few with the focus mainly on the economic concept of "industrial clusters". Precise quantitative descriptions, in-depth logical analyses and proper application approaches for urban planning are lacked in various intra-urban spatial agglomeration phenomena. By using over 10 million POIs in the mainland China, 18 grid network models with two varieties of spatial relationships (co-location/adjacent) are constructed in this article. 23 typical place communities are extracted based on complex network analysis, and four types of agglomeration driving forces are summarized. A comprehensive demonstration displaying the application process of co-location/adjacent place matrices in auxiliary decision of the implanted place types is carried out with the example of the revitalization project of Taoxichuan Area in the city of Jingdezhen.
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Objective@#To investigate the brain function and their correlation with sleep beliefs and attitudes in adolescents with drug naive insomnia by using fractional amplitude of low frequency fluctuation, so as to provide a reference for the mechanism and treatment of insomnia.@*Methods@#An insomnia group ( n =21) recruited first episode, drug naive, adolescents with insomnia who met the diagnostic criteria of the American Diagnostic and Statistical Manual of Mental Disorders(DSM-V). Healthy subjects matched with age, gender, and educational background were selected as the control group ( n =20). Pittsburgh Sleep Quality Index Scale (PSQI), Brief Version of Dysfunctional Beliefs and Attitudes about Sleep (DBAS-16), 24 Items Hamilton Depression Scale (HAMD-24), 14 Items Hamilton Anxiety Scale (HAMA-14) were evaluated. Fractional amplitude of low frequency fluctuation was used for analysis, and Pearson correlation analysis was employed to quantify the correlation between peak values of brain regions with significant differences and the clinical scale scores of the two groups.@*Results@#Compared with the control group, ractional amplitude of low frequency fluctuation(fALFF) values in the insomnia group were significantly decreased ( P <0.01, Alphaism corrected) in the left dorsolateral prefrontal lobe (L-DLPFC, MNI coordinates: -12, 60, 21, t =-3.85, K =495) and the left precuneus (MNI coordinates: -3, -54, 51, t =-4.29, K =417). The fALFF value of L-DLPFC in the insomnia group was positively correlated with DBAS-16 score ( r= 0.47 , P = 0.04 ).@*Conclusion@#Abnormalities in the L-DLPFC region suggest that adolescents with insomnia may suffer from impaired regulation of emotional and cognitive activities related to sleep.
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Objective:To develop a neural network model for the evaluation of glomerular filtration rate (GFR) based on multilayer perceptual neural network, and to compare with the improved Chinese based creatinine GFR evaluation formula (C-GFR cr) and the evaluation formula (EPI-GFR cr) of the American Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) for the clinical applicability of multilayer perceptual neural network model in evaluating GFR. Methods:A total of 684 chronic kidney disease (CKD) patients used for developing a modified version of China′s based creatinine GFR evaluation formula were taken as the research object. The data of 454 patients were randomly selected as the development group and the data of the other 230 patients were as the verification group. The multilayer perceptual neural network GFR evaluation model (M-GFR cr) was established. With the double plasma GFR as the reference value (rGFR), the correlation, mean difference, mean absolute difference, precision and accuracy of C-GFR cr, EPI-GFR cr and M-GFR cr were compared. Results:Among the 684 CKD patients, there were 352 males and 332 females, with age of (49.9±15.8) years. The correlation between M-GFR cr and rGFR was the highest (Pearson correlation =0.93, P<0.001). The mean difference of M-GFR cr was lower than that of C-GFR cr ( Z=9.929, P<0.001) and EPI-GFR cr ( Z=10.573, P<0.001). The mean absolute difference of M-GFR cr was also lower than that of C-GFR cr ( Z=3.953, P<0.001) and EPI-GFR cr ( Z=4.210, P<0.001). The accuracy of ±15% of M-GFR cr was higher than that of C-GFR cr ( χ2=26.068, P<0.001) and EPI-GFR cr ( χ2=23.154, P<0.001). The accuracy of ±30% of M-GFR cr was also higher than that of C-GFR cr ( χ2=8.264, P=0.001) and EPI-GFR cr ( χ2=11.963, P=0.001). The results of different stages of CKD showed that in the early stage of CKD (CKD 1-2), the mean difference of M-GFR cr was lower than that of C-GFR cr ( Z=7.401, P<0.001) and EPI-GFR cr ( Z=8.096, P<0.001); the mean absolute difference of M-GFR cr was also lower than that of C-GFR cr ( Z=4.723, P<0.001) and EPI-GFR cr ( Z=4.946, P<0.001); the accuracy of ±15% of M-GFR cr was higher than that of C-GFR cr ( χ2=23.547, P<0.001) and EPI-GFR cr ( χ2=26.421, P<0.001); the accuracy of ±30% of M-GFR cr was also higher than that of C-GFR cr ( χ2=12.089, P=0.001) and EPI-GFR cr ( χ2=16.168, P<0.001). But there was no significant difference in the applicability among C-GFR cr, EPI-GFR cr and M-GFR cr in the advanced stages of CKD (CKD 3-5). Conclusion:Compared with the improved Chinese based creatinine GFR evaluation formula C-GFR cr and CKD-EPI evaluation formula EPI-GFR cr, the accuracy of multilayer perceptual neural network model to evaluate GFR in CKD patients has been significantly improved, especially in CKD 1-2 stage.