Effect of early mobilization on the development of pneumonia in patients with traumatic brain injury in the neurosurgical intensive care unit: A historical controls study.

BACKGROUND: Pneumonia has a high incidence in traumatic brain injury (TBI) patients and lacks effective treatments. Early mobilization (EM) may be a potentially effective treatment. AIM: To explore the impact of EM on TBI-related pneumonia in the neurosurgical intensive care unit (NICU). METHOD: This study was a historical control study. 100 TBI patients who received EM intervention were prospectively included as the experimental group (EM cohort), and 250 TBI patients were retrospectively included as the control group. The propensity score matching (PSM) method was employed to balance baseline and minimize potential bias. The relationship between EM and TBI-related pneumonia was investigated by univariate and multivariate logistic regression, then further determined by subgroup analysis. The influence of other variables was excluded by interaction analyses. Finally, the effect of EM on the prognosis of TBI patients was analysed by comparing the Glasgow Coma Scale (GCS) and the hospital stay. RESULTS: After screening, 86 patients were included in the EM cohort and 199 patients were included in the control cohort. There were obvious differences between the two cohorts at baseline, and these differences were eliminated after PSM, when the incidence of pneumonia was significantly lower in the EM cohort than in the control cohort (35.0% vs. 61.9%, p < .001). Multivariate logistic regression showed that EM was an independent risk factor for TBI-related pneumonia and was significantly associated with a decreased incidence of pneumonia. This correlation was present in most subgroups and was not affected by other variables (p for interaction >.05). Patients in the EM cohort had shorter length of ICU stay (6 vs. 7 days, p = .017) and higher GCS at discharge (12 vs. 11, p = .010). CONCLUSION: EM is a safe and effective treatment for TBI patients in NICU, which can reduce the incidence of pneumonia, help to improve prognosis and shorten the length of ICU stay. RELEVANCE TO CLINICAL PRACTICE: Although the utilization rate of EM is low in TBI patients for various reasons, EM is still an effective method to prevent complications. Our study confirms that a scientific and detailed EM strategy can effectively reduce the incidence of pneumonia while ensuring the safety of TBI patients, which is worthy of further research and clinical application.

Prediction of HER2-positive breast cancer recurrence and metastasis risk from histopathological images and clinical information via multimodal deep learning.

HER2-positive breast cancer is a highly heterogeneous tumor, and about 30% of patients still suffer from recurrence and metastasis after trastuzumab targeted therapy. Predicting individual prognosis is of great significance for the further development of precise therapy. With the continuous development of computer technology, more and more attention has been paid to computer-aided diagnosis and prognosis prediction based on Hematoxylin and Eosin (H&E) pathological images, which are available for all breast cancer patients undergone surgical treatment. In this study, we first enrolled 127 HER2-positive breast cancer patients with known recurrence and metastasis status from Cancer Hospital of the Chinese Academy of Medical Sciences. We then proposed a novel multimodal deep learning method integrating whole slide H&E images (WSIs) and clinical information to accurately assess the risk of relapse and metastasis in patients with HER2-positive breast cancer. Specifically, we obtained the whole H&E staining images from the surgical specimens of breast cancer patients, and these images were adjusted to size 512 × 512 pixels. The deep convolutional neural network (CNN) was applied to these images to retrieve image features, which were combined with the clinical data. Based on the combined features. After that, a novel multimodal model was constructed for predicting the prognosis of each patient. The model achieved an area under curve (AUC) of 0.76 in the two-fold cross-validation (CV). To further evaluate the performance of our model, we downloaded the data of all 123 HER2-positive breast cancer patients with available H&E image and known recurrence and metastasis status in The Cancer Genome Atlas (TCGA), which was severed as an independent testing data. Despite the huge differences in race and experimental strategies, our model achieved an AUC of 0.72 in the TCGA samples. As a conclusion, H&E images, in conjunction with clinical information and advanced deep learning models, could be used to evaluate the risk of relapse and metastasis in patients with HER2-positive breast cancer.

Combination of CT imaging and endoscopy in diagnosis of appendicovesical fistula caused by appendiceal adenocarcinoma.

The appendiceal diseases, particularly appendicitis, are the most common disorders in the digestive system localized at the right lower quadrant area. However, appendiceal carcinoma with vesico-appendiceal fistula is a rare clinical phenomenon. Lacking specific symptoms, appendiceal carcinomas with fistula formations are often misdiagnosed as acute appendicitis cases. The purpose of this study is to increase awareness of appendiceal neoplasms and appendicovesical fistulas. We reported our experiences in three complex cases related to digestive and urological systems, and reviewed the literature on diagnosis with various X-ray imaging techniques for this lesion. In this report, the first case failed to be diagnosed. The other two patients with appendicovesical fistulas secondary to appendiceal adenocarcinomas were successfully detected with computed tomography (CT) and cystoscopy. The patients recovered after right hemicolectomies and en bloc partial cystectomies and survived without tumor metastasis up to 7-year follow-up. In conclusion, a combined use of CT imaging and endoscopy techniques provides an accurate diagnostic alternative for appendicovesical fistula secondary to appendiceal adenocarcinoma.

[Clinical and pathologic features of tubulocystic carcinoma of kidney].

OBJECTIVE: To investigate clinicopathological features and differential diagnosis of tubulocystic carcinoma of the kidney. METHODS: The clinical features, histological and immunohistochemical findings were analyzed in 3 cases of tubulocystic carcinoma of the kidney, along with review of the related literatures. RESULTS: Three patients were males with a mean age of 59 years old (range from 44 to 71 years). All presented with no symptom and their tumors were found during routine examination. The tumor size ranged from 1.5 to 5.0 cm in greatest dimension. The tumors were grossly well-circumscribed without capsules and exhibited a spongy cut surface. Microscopically, all three tumors were composed of tubules and cysts of varying sizes separated by thin fibrous septa. The epithelial lining cells were flat, cuboidal and columnar, with often a hobnail-like appearance characterized by abundant eosinophilic cytoplasm with prominent nucleoli. Two cases showed focal clear cytoplasm. One of the three cases coexisted with a papillary renal cell carcinoma. Immunohistochemically, all 3 cases showed positivity for pan-CK, vimentin, CK19, CD10, P504S, and focal positivity for 34ßE12. Two cases showed focal positivity for CK7. CONCLUSIONS: Tubulocystic carcinoma of the kidney is a rare kidney neoplasm and occurs predominantly in males. The tumor is characterized by gross spongy appearance and microscopic cysts and tubules often lined by hobnail-like cells and separated by thin fibrotic stroma. The differential diagnosis mainly includes other lesions of the kidney that have a multicystic growth pattern.

Endometriotic implants regress in rat models treated with puerarin by decreasing estradiol level.

Phytoestrogens, which have a weak estrogenic effect, bind to estrogen receptors (ERs), thereby competing with estradiol, have an antiestrogenic effect on women of reproductive age with high estrogenic level. Herein, we examined the ability of the phytoestrogen Puerarin to treat endometriosis in rat models of endometriosis. In total, 75 adult, mature female Sprague-Dawley rats in which endometriotic implants were successfully induced by transplanting autologous endometrial tissue to ectopic sites were used in this study. Oral gavage of Puerarin (at doses of 600, 200, or 60 mg/kg per day) or Danazol (80 mg/kg per day) started 4 weeks after implantation. Control model rats received vehicle alone. After administration for 4 weeks, the weight of the ectopic implants, estradiol concentration, as well as ER-α and Aromatase P450 (P450arom) expression in different groups of rat tissues were evaluated after treatment. The endometriotic tissue weight and serum estrogen levels were significantly lower in high, medium, low dose of Puerarin and Danazol treatment groups than that in control group (P < .05 or P < .01). Low-dose Puerarin inhibited P450arom expression and significantly reduced estrogen levels in endometriotic tissue (P < .01). Three doses of Puerarin had no adverse effects on liver, kidney, and ovary, whereas high-dose Puerarin administration caused thinner bone trabecula with distortion and breakage and Danazol administration caused mild or moderate hepatic cell damage. These data demonstrate that Puerarin was able to effectively suppress the growth and development of ectopic endometrium in the rat endometriosis model, even at low doses, suggesting it may be an effective treatment for endometriosis.

[Primary culture and morphologic observation of eutopic and ectopic endometrial cells from patients with endometriosis].

OBJECTIVE: To explore the method of primary culture for endometriotic cells and to find out the differences in morphological manifestations among endometriotic cells and eutopic endometrial cells sampled from patients with endometriosis and endometriosis-free women. METHODS: Endometriotic and eutopic endometrial cells were cultured by modified method of primary culture. The endometriotic cell types were observed and differentiated under optical and electron microscopes. RESULTS: The success rates for culture of eutopic endometrial cells from endometriosis-free women and patients with endometriosis were 91.67% and 93.75% respectively. The success rate for culture of endometriotic cells was 75.00%. The size of endometriotic glandular cells was similar to those of eutopic endometrial glandular cells from endometriosis-free women and patients with endometriosis. The chromatin was manifold and the nucleus was augmented in the endometriotic glandular cells. The endometriotic stromal cells were smaller than the eutopic endometrial stromal cells from endometriosis-free women and patients with endometriosis. Many tiny villi and protuberances on plasma membrane could be seen in the endometriotic stromal cells. CONCLUSION: The success rate for culture of endometriotic cells can be elevated through improving the method of primary culture. The ultrastructures of endometriotic glandular and stromal cells are obviously different from those of eutopic endometrial glandular and stromal cells from endometriosis-free women and patients with endometriosis.