ABSTRACT
Background: Esophageal carcinoma accompanied by a right aortic arch (RAA) is very rare. When combined with Kommerell diverticulum (KD), a right aortic arch forms a vascular ring encircling both the esophagus and trachea. Due to abnormal anatomy of the upper mediastinum, it is very difficult to dissociate the esophagus and its surrounding tissues, especially the left recurrent laryngeal nerve. Herein, we report a case of successful thoracoscopic esophagectomy in an esophageal cancer patient concurrent with a RAA and KD. Case presentation: A 62-year-old male patient was diagnosed with esophageal squamous carcinoma in the middle esophagus at clinical stage I (cT1N0M0) according to UICC-TNM classification 8th edition. Further examinations revealed RAA and KD. Based on the three-dimensional CT (3D-CT) reconstruction, a Mckeown esophagectomy via a left thoracoscopic approach in semi-prone position was performed. During the operation, the left recurrent laryngeal nerve was accurately exposed and well protected. Postoperatively, severe complications, including anastomotic leakage and recurrent laryngeal nerve palsy, were not observed. The patient was discharged 12 days after the surgery. Conclusion: Preoperative 3D-CT reconstruction is useful to clarify the vascular malformation in esophageal cancer patients with RAA, and helpful to formulate a reasonable surgical approach.
ABSTRACT
To develop a nomogram prediction model capable of early identification of high-risk infective endocarditis (IE) patients. We retrospectively analyzed the clinical data of 383 patients with IE and divided them into survival and non-survival groups according to different hospitalization outcomes. Univariate and multivariate logistic regression methods were used to screen independent risk factors affecting the survival outcome of IE, and a Nomogram prediction model was constructed by these factors. The Hosmer-Lemeshow goodness-of-fit test was applied to assess the model fit, the discrimination and calibration of the model were evaluated by plotting ROC curves and calibration curves. Advanced age, embolic symptoms, abnormal leukocyte count, low hemoglobin level and double-sided IE were associated with higher in-hospital mortality in patients with IE (P < 0.05). The Hosmer-Lemeshow goodness-of-fit test for the model was χ2 = 7.107, P = 0.311. The AUC of the ROC curve of the model was 0.738 (95% CI 0.677-0.800). The bootstrap method was used to validate the prediction model. The results showed that the prediction accuracy of the model in the validation cohort was 0.842. The nomogram prediction model can accurately predict the in-hospital mortality risk of IE and can help clinicians identify high-risk IE patients early.
Subject(s)
Endocarditis, Bacterial , Endocarditis , Endocarditis/diagnosis , Hemoglobins , Humans , Nomograms , Prognosis , Retrospective StudiesABSTRACT
Aim: The aim of this study was to develop a nomogram based on early clinical features and treatment options for predicting in-hospital mortality in infective endocarditis (IE). Methods: We retrospectively analyzed the data of 294 patients diagnosed with IE in our hospital from June 01, 2012 to November 24, 2021, determined independent risk factors for in-hospital mortality by univariate and multivariate logistic regression analysis, and established a Nomogram prediction model based on these factors. Finally, the prediction performance of nomogram is evaluated by C-index, bootstrapped-concordance index, and calibration plots. Results: Age, abnormal leukocyte count, left-sided IE, right-sided IE, and no surgical treatment were independent risk factors for in-hospital mortality in patients with IE, and we used these independent risk factors to construct a nomogram prediction model to predict in-hospital mortality in IE. The C-index of the model was 0.878 (95% CI: 0.824-0.931), and the internal validation of the model by bootstrap validation method showed a prediction accuracy of 0.852 and a bootstrapped-concordance index of 0.53. Conclusion: Our nomogram can accurately predict in-hospital mortality in IE patients and can be used for early identification of high-risk IE patients.
ABSTRACT
Benign prostatic hyperplasia (BPH) is the most common benign disease of the prostate gland and is caused by benign hyperplasia of the smooth muscle cells and stromal cells in this important gland. BPH is also the most common disease underlying lower urinary tract symptoms (LUTS). The incidence of BPH increases with age and affects more than half of all men 50 years or older. BPH mainly exerts effects on urinary function and can seriously reduce a patient's quality of life. At present, treatment for BPH aims primarily to improve the quality of life and reduce the risk of BPH-related complications. Pharmacological therapy is recommended for moderate-to-severe cases of LUTS that are suggestive of BPH. A range of drugs is currently available to treat this condition, including α1-adrenoceptor antagonists, 5α-reductase inhibitors (5-ARIs), phosphodiesterase type 5 inhibitors (PDE5Is), muscarinic receptor antagonists (MRAs), ß3-adrenoceptor agonists, and plant extracts. Of these, the most commonly used drugs in the clinic are α1-adrenoceptor antagonists, 5-ARIs, and combination therapy. However, these drugs exert their effects via various mechanisms and are associated with adverse reactions. The purpose of this review is to provide current comprehensive perspectives on the mechanisms of action, efficacy, and adverse reactions associated with the drugs most commonly used for the treatment of BPH.
ABSTRACT
Objective: To evaluate the hemostasis and coagulation effect of Hemocoagulase Bothrops Atrox in benign prostatic hyperplasia (BPH) patients undergoing transurethral bipolar plasmakinetic prostatectomy (TUPKP). Methods: This study adopted a multicenter, prospective, and real world design. BPH patients undergoing TUPKP were divided into two groups according to whether they adopted Hemocoagulase Bothrops Atrox (group B) or not (group A) during perioperative period. The electronic clinical data on every included subject, including the international prostate symptom score (IPSS) and the quality of life scale (QoL), maximum urinary flow rate (Qmax), complete blood count, coagulation screening test and adverse events, were measured and compared between the two groups. Results: Finally, 695 patients, 443 in group A and 252 in group B were included. Baseline characteristics showed no significant difference between two groups. In group A, compared with baseline, IPSS decreased 15.66 (95% CI = -16.45 to -14.87), QoL decreased 3.08 (95% CI = -3.30 to -2.87), prothrombin time prolonged 1.02 s (95% CI = 0.56 to 1.48), while white blood cells, neutrophils, lymphocytes, and hemoglobin also significantly changed; white blood cells, neutrophils and platelets increased, while lymphocytes decreased by 0.14×109/L (95% CI = -0.21 to -0.08) before discharge. In group B, compared with baseline, IPSS decreased 16.12 (95% CI = -17.02 to -15.21), QoL decreased 3.32 (95% CI = -3.56 to -3.07), and white blood cells, neutrophils, lymphocytes, and hemoglobin were also significantly changed, along with white blood cells and lymphocytes that tested before discharge (p < 0.01); however, prothrombin time was not significant prolonged (MD= 0.48, 95% CI = -0.05 to 1.01). When compared with group A and group B, the average hospitalization time in group A was longer than group B (p < 0.01), transfusion risk was similar in the two groups (OR = 1.582, 95% CI = 0.552 to 4.538). Parameters had no substantial difference between the two subgroups whether prostate volume was more than 80 mL or not. Conclusion: Our study indicated that Hemocoagulase Bothrops Atrox can shorten the prothrombin time, hospitalization time and is probably safe among BPH patients undergoing TUPKP, exhibiting fine hemostasis and coagulation efficacy, and would not be influenced by prostate volume.