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1.
Phytomedicine ; 108: 154478, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36265255

RESUMO

Activation of mitogen-activated protein kinase (MAPK) and PI3K signaling confers resistance against sorafenib, a mainstay treatment for advanced hepatocellular carcinoma (HCC). Antrocin and ovatodiolide constitute as the most potent secondary metabolites isolated from Antrodia camphorata and Anisomeles indica, respectively. Both natural compounds have recently gained a lot of attention due to their putative inhibition of MAPK and PI3K signaling in various solid cancers. However, whether their combination is effective in HCC remains unknown. Here, we investigated their effect, alone or in various combinations, on MAPK and PI3K signaling pathways in HCC cells. An array of in vitro study were used to investigate anticancer and stemness effects to treat HCC, such as cytotoxicity, drug combination index, migration, invasion, colony formation, and tumor sphere formation. Drug effect in vivo was evaluated using mouse xenograft models. In this study, antrocin and ovatodiolide synergistically inhibited the SNU387, Hep3B, Mahlavu, and Huh7 cell lines. Sequential combination treatment of Huh7 and Mahlavu with ovatodiolide followed by antrocin resulted stronger cytotoxic effect than did treatment with antrocin followed by ovatodiolide, their simultaneous administration, antrocin alone, or ovatodiolide alone. In the Huh7 and Mahlavu cell lines, ovatodiolide→antrocin significantly suppressed colony formation and proliferation as well as markedly downregulated ERK1/2, Akt, and mTOR expression. Inhibition of ERK1/2 and Akt/mTOR signaling by ovatodiolide→antrocin suppressed ribosomal biogenesis, autophagy, and cancer stem cell-like phenotypes and promoted apoptosis in Huh7 and Mahlavu cells. The sorafenib-resistant clone of Huh7 was effectively inhibited by synergistic combination of both compound in vitro. Eventually, the ovatodiolide→antrocin combination synergistically suppressed the growth of HCC xenografts. Taken together, our findings suggested that ovatodiolide→antrocin combination may represent potential therapeutic approach for patients with advanced HCC.


Assuntos
Carcinoma Hepatocelular , Diterpenos , Neoplasias Hepáticas , Animais , Humanos , Camundongos , Apoptose , Carcinoma Hepatocelular/tratamento farmacológico , Carcinoma Hepatocelular/patologia , Linhagem Celular Tumoral , Proliferação de Células , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/patologia , Fosfatidilinositol 3-Quinases/metabolismo , Proteínas Proto-Oncogênicas c-akt/metabolismo , Ribossomos/metabolismo , Ribossomos/patologia , Sorafenibe , Serina-Treonina Quinases TOR/metabolismo , Lactonas/farmacologia , Diterpenos/farmacologia , Sesquiterpenos/farmacologia , Células-Tronco Neoplásicas/efeitos dos fármacos
2.
Ultrasonics ; 128: 106856, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36242803

RESUMO

In this work, a circular statistics vector (CSV) weighting Fourier domain (FD) beamforming for ultrasound plane-wave images was proposed to achieve better image quality with a high frame rate. Firstly, the cosine and sine components of the instantaneous phase are extracted from undelayed RF signals. Secondly, the FD beamformed cosine and sine components are used to establish the CSV. Finally, the FD beamformed amplitude image is weighted by the CSV. The resolution, contrast, and computation complexity were used to assess the performance of the proposed method. The results revealed that FD_CSV could significantly reduce the computational load compared to the conventional DAS_CSV on the equal improvement of image quality. Besides, compared to coherence factor (CF), phase coherence factor (PCF), etc., based on variance calculation, the CSV based on mean resultant vector calculation can effectively preserve the speckle due to the more tolerant to phase errors. The proposed FD_CSV weighting method has successfully conducted high image quality and low computational load.


Assuntos
Algoritmos , Ondas Ultrassônicas , Imagens de Fantasmas , Ultrassonografia/métodos , Processamento de Imagem Assistida por Computador/métodos
3.
Pediatr Blood Cancer ; 70(1): e30034, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36326745

RESUMO

BACKGROUND: Childhood cancer survivors (CCS) have increased risk of premature cardiovascular disease. Whether they respond similarly to lifestyle changes for elevated blood pressure (BP), body mass index (BMI), and dyslipidemia to those without history of childhood cancer is unknown. PROCEDURE: This retrospective cohort study included CCS and 3:1 age- and sex-matched controls treated at Boston Children's Hospital Preventive Cardiology (2010-2019) using lifestyle management based on National Heart, Lung, and Blood Institute (NHLBI) guidelines. Change in BMI, BP, and lipids were analyzed. RESULTS: We included 52 CCS and 162 controls with a median age of approximately 16 years. More CCS (84.3%) had elevated baseline fasting triglycerides (TG) than controls (49.4%) (p < .001). More CCS (62.5%) also had abnormal baseline high-density lipoprotein cholesterol (HDL-C) compared to controls (35.2%) (p = .001). Baseline BMI, BP, total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) were similar between groups. Over 15 weeks [IQR: 10.5-26], CCS had greater decrease in TG than controls (72.5 vs. 17 mg/dl decrease, p = .095). BP improved in 5% of CCS versus 38% of controls (p = .008). For both, BMI, TC, LDL-C, and HDL-C remained stable. CCS with stem cell transplantation (SCT) had a TC increase of 5% (6 mg/dl) compared to a decrease of 9% (19 mg/dl) among CCS without SCT (p = .02). CONCLUSIONS: CCS demonstrated similar improvement in lipids, but impaired BP lowering in response to lifestyle management compared to controls. Further prospective studies are needed to determine if earlier pharmaceutical treatment is warranted in this higher risk population and for the long-term risk reductions of these approaches.


Assuntos
Sobreviventes de Câncer , Dislipidemias , Hipertensão , Neoplasias , Criança , Humanos , Adolescente , LDL-Colesterol , Estudos Retrospectivos , Pressão Sanguínea , Lipídeos , Neoplasias/terapia , Dislipidemias/etiologia , Dislipidemias/terapia , HDL-Colesterol , Estilo de Vida , Aconselhamento , Triglicerídeos
4.
Lancet Oncol ; 23(12): e544-e551, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36455583

RESUMO

The effects of the COVID-19 pandemic continue to constrain health-care staff and resources worldwide, despite the availability of effective vaccines. Aerosol-generating procedures such as endoscopy, a common investigation tool for nasopharyngeal carcinoma, are recognised as a likely cause of SARS-CoV-2 spread in hospitals. Plasma Epstein-Barr virus (EBV) DNA is considered the most accurate biomarker for the routine management of nasopharyngeal carcinoma. A consensus statement on whether plasma EBV DNA can minimise the need for or replace aerosol-generating procedures, imaging methods, and face-to-face consultations in managing nasopharyngeal carcinoma is urgently needed amid the current pandemic and potentially for future highly contagious airborne diseases or natural disasters. We completed a modified Delphi consensus process of three rounds with 33 international experts in otorhinolaryngology or head and neck surgery, radiation oncology, medical oncology, and clinical oncology with vast experience in managing nasopharyngeal carcinoma, representing 51 international professional societies and national clinical trial groups. These consensus recommendations aim to enhance consistency in clinical practice, reduce ambiguity in delivering care, and offer advice for clinicians worldwide who work in endemic and non-endemic regions of nasopharyngeal carcinoma, in the context of COVID-19 and other airborne pandemics, and in future unexpected settings of severe resource constraints and insufficiency of personal protective equipment.


Assuntos
COVID-19 , Infecções por Vírus Epstein-Barr , Neoplasias Nasofaríngeas , Humanos , Pandemias/prevenção & controle , Herpesvirus Humano 4 , SARS-CoV-2 , Carcinoma Nasofaríngeo/terapia , DNA , Neoplasias Nasofaríngeas/diagnóstico , Neoplasias Nasofaríngeas/terapia
5.
J Oncol ; 2022: 7913067, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36457717

RESUMO

Breast cancer is one of the most frequently diagnosed cancer in women and is the major cause of most cancer-related deaths. We previously reported that Brachyury, as a sensitive and specific marker, has been verified to involve in the process of carcinogenesis and progression of breast cancer, but the mechanism by which Brachyury promotes breast cancer cells proliferation and migration still remains less clear. In this study, we identified that Brachyury was markedly increased in breast cancer compared with the adjacent tissues. We have also shown that Brachyury knockdown could decrease the proliferation and migration capability in breast cancer cells both in vitro and in vivo. Finally, we found an important transcriptional factor, E2F3, which is a direct downstream target gene of Brachyury by chromatin immunoprecipitation (ChIP) analysis. Knockdown of E2F3 also decreased breast cancer cell proliferation and migration. Taken together, we reported that Brachyury may act as an oncogenic role in the progression of breast cancer by positively-regulating E2F3 expression.

6.
Omega (Westport) ; : 302228221143687, 2022 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-36460356

RESUMO

To explore people's intentions to opt for a good death when planning for their end-of-life care, this study examined the type of end-of-life care preferred by patients receiving advance care planning (ACP) consulting services for five specified clinical and disability conditions and possible factors affecting their decision-making. This cross-sectional study analyzed 1303 hospital patients and 1032 nonhospital patients who attended a clinic providing ACP consulting services. This study revealed the following two results. First, patients who were older, were female, did not have an appointed surrogate decision-maker, and were nonhospital patients had a higher intention of not receiving life-sustaining treatments (LST) or artificial nutrition and hydration (ANH) under the five specified clinical and disability conditions. Second, people who were the least willing to receive LST or ANH under the following conditions (in descending order): permanent vegetative state, severe dementia, irreversible coma, other disease conditions recognized by the central competent authority, and end-of-life stage.

7.
Nat Commun ; 13(1): 7456, 2022 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-36460656

RESUMO

Physicians write clinical notes with abbreviations and shorthand that are difficult to decipher. Abbreviations can be clinical jargon (writing "HIT" for "heparin induced thrombocytopenia"), ambiguous terms that require expertise to disambiguate (using "MS" for "multiple sclerosis" or "mental status"), or domain-specific vernacular ("cb" for "complicated by"). Here we train machine learning models on public web data to decode such text by replacing abbreviations with their meanings. We report a single translation model that simultaneously detects and expands thousands of abbreviations in real clinical notes with accuracies ranging from 92.1%-97.1% on multiple external test datasets. The model equals or exceeds the performance of board-certified physicians (97.6% vs 88.7% total accuracy). Our results demonstrate a general method to contextually decipher abbreviations and shorthand that is built without any privacy-compromising data.


Assuntos
Esclerose Múltipla , Médicos , Trombocitopenia , Humanos , Privacidade , Aprendizado de Máquina , Redação
8.
J Neuroradiol ; 2022 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-36462648

RESUMO

BACKGROUND AND PURPOSE: Endovascular treatment (EVT) is the best treatment for acute ischemic stroke with large vessel occlusion (LVO) and makes it possible to analyze the blood contents from the occluded vascular compartments. In this study, we attempted to evaluate regional changes in blood gas values and electrolytes in the occluded vessels, aiming to determine whether these changes can predict outcomes in LVO patients receiving EVT. MATERIALS AND METHODS: We prospectively observed 45 consecutive ischemic stroke patients with LVO of the anterior circulation who underwent EVT. We collected the arterial blood proximal to the occlusion site before and after EVT, and the blood within the core of the occluded vascular compartment (distal to the thrombus) and evaluated the labs for blood gas values and electrolytes. Femoral samples were obtained under physiological flow conditions to represent systemic arterial blood. RESULTS: Compared with the femoral arterial blood samples, significant decreases in K+, Ca2+, HCO3-, BE, HCT, tHbc, and TCO2 levels were observed in the proximal luminal blood before EVT. Decreases in K+ and Ca2+ levels were also observed in the proximal luminal blood after EVT. Proximal/femoral ratio of pH and Na+ was associated with short-term clinical outcomes at 72 hours after EVT. A higher proximal/femoral Na+ ratio was associated with successful recanalization. Further analysis after propensity score matching showed significant changes in blood gas and electrolyte among different arterial locations in ICA and MCA LVO participants. Linear regression analyses indicated that the proximal/femoral ratio of pH, Na+, pCO2, HCO3, and TCO2 before EVT were associated with decrease in NIHSS score at 72 hours in ICA-LVO group. CONCLUSIONS: Obvious changes in several parameters of arterial blood gas and electrolyte from the ischemic vasculature occur during hyperacute stroke. Proximal/femoral pH and Na+ ratio before EVT may be associated with short-term clinical outcome, which deserve to be further investigated.

9.
Front Cardiovasc Med ; 9: 956023, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36465451

RESUMO

Objectives: To investigate the feasibility of the vector flow imaging (V Flow) technique to measure peripheral arterial hemodynamic parameters, including wall shear stress (WSS) and turbulence index (Tur) in healthy adults, and compare the results in different arteries. Materials and methods: Fifty-two healthy adult volunteers were recruited in this study. The maximum and mean values of WSS, and the Tur values at early-systole, mid-systole, late-systole, and early diastole for total 156 normal peripheral arteries [common carotid arteries (CCA), subclavian arteries (SCA), and common femoral arteries (CFA)] were assessed using the V Flow technique. Results: The mean WSS values for CCA, SCA, and CFA were (1.66 ± 0.68) Pa, (0.62 ± 0.30) Pa, and (0.56 ± 0.27) Pa, respectively. The mean Tur values for CCA, SCA, and CFA were (0.46 ± 1.09%), (20.7 ± 9.06%), and (24.63 ± 17.66%), respectively. The CCA and SCA, as well as the CCA and CFA, showed statistically significant differences in the mean WSS and the mean Tur (P < 0.01). The mean Tur values had a negative correlation with the mean WSS; the correlation coefficient between log(Tur) and WSS is -0.69 (P < 0.05). Conclusion: V Flow technique is a simple, practical, and feasible quantitative imaging approach for assessing WSS and Tur in peripheral arteries. It has the potential to be a useful tool for evaluating atherosclerotic plaques in peripheral arteries. The results provide a new quantitative foundation for future investigations into diverse arterial hemodynamic parameters.

10.
Sci Rep ; 12(1): 20749, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36456624

RESUMO

We applied a new idea that the potential effect can change the ion adsorption structure on the cell surface to explore the mechanism of digoxin poisoning and the regulation of ion channels. The effects of digoxin on the electrophoretic mobility and behaviors (non-contraction or contraction or autorhythmicity) of cardiomyocytes were observed by single-cell electrophoresis technique (imitate the opening method of in vivo channel) and the method of decomposing surface potential components on the cells. As well as affect the association with electrical activity. The results suggested that the increase of cardiomyocytes transmembrane potential and the Na+-K+ exchange on the cell surface of the action potential phase 4 caused by the poisoning dose of digoxin, leading to the oscillation of adsorbed ions on the cell surface and the incomplete channel structure, which were the mechanism of cardiac ectopic beats. The results revealed that the opening of ion channels is regulated by the surface electric double layer of the cell membrane.


Assuntos
Digoxina , Miócitos Cardíacos , Canais Iônicos , Membranas , Membrana Celular
11.
BMC Med Educ ; 22(1): 827, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36457021

RESUMO

BACKGROUND: Standardized residency training is an essential aspect of enhancing the ability of cancer prevention and screening of residents. The current study was performed to investigate tumor prevention, screening literacy and the training demands of standardized training residents and explore related influencing factors. METHODS: A cross-sectional survey was conducted among 320 residents of The First Hospital of Lanzhou University. An online, self-designed questionnaire was employed to investigate tumor prevention and screening, training status, and the requirements of residents. Data were analyzed using Fisher's exact test. RESULTS: The mean age of the 320 participants was 26.04 ± 1.85 years;133, 83, and 104 were in the 1st, 2nd and 3rd year of standardized training, respectively. Among the common carcinogenic factors, smoking, infectious agents, and drinking were more correlated with tumors by 72.19, 66.57, and 64.38% of the physicians, respectively. Excess body weight, an insufficient intake of fruits and dietary fiber, and a lack of exercise were correlated with tumors by only 26.56, 25, and 23.44% of the physicians, respectively. The proportion of physicians providing an accurate answer to the tumor screening question ranged from 23.13 to 93.13%. The lowest accuracy was 23.13% for the initial age of regular breast cancer screening in general-risk women. The maximum rate of the primary liver cancer screening methods was 93.13%. Postgraduates and residents of oncology practitioners considered excess body weight and the insufficient intake of fruits and dietary fiber more relevant to cancer (P < 0.05). Male residents viewed more associations between tumors and a lack of exercise and air pollution (P < 0.05). Overall, 71.26% of participants felt that their tumor prevention and screening knowledge was poor and 95.31% thought they needed standardized tumor prevention and screening training. CONCLUSION: Tumor prevention and screening literacy of standardized training residents should be further improved. There is a huge knowledge demand for tumor prevention and screening. Therefore, it is vital to build a training program in line with the requirements of cancer prevention and control efforts that focus on improving literacy among residents.


Assuntos
Neoplasias , Médicos , Masculino , Feminino , Humanos , Adulto Jovem , Adulto , Detecção Precoce de Câncer , Estudos Transversais , Oncologia , Peso Corporal , Neoplasias/diagnóstico , Neoplasias/prevenção & controle
12.
Front Surg ; 9: 985292, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36468076

RESUMO

Objective: The purpose of the study was to evaluate the predictive value of prognostic nutritional index (PNI) on early complications (within 30-day) after robot-assisted radical cystectomy (RARC) and urinary diversion. Patients and methods: Patients underwent RARC and urinary diversion between November 2018 and December 2021 in our centre were screened in this retrospective study. Baseline characteristics and perioperative data were recorded. Early complications after surgery were classified according to Clavien-Dindo system. Univariate and multivariate logistic analysis were performed to decide the potential factors associated with post-RARC complications. The receiver operating characteristic (ROC) curve was conducted to determine the predictive value of PNI on early overall and major complications after RARC. Results: Overall 139 men and 13 women with a median age of 69 years and mean BMI of 24.4 kg/m2 were included in this study. As for urinary diversion, most patients (n = 111, 73%) received cutaneous ureterostomy, 36 patients (23.7%) underwent orthotopic neobladder and 5 patients (3.3%) received ileal conduit. The incidence of postoperative complication rate was 44.7%, which included 82.2% minor complications and 17.8% major complications. Further univariate and multivariate logistic analyses demonstrated that hypertension (OR = 2.96, 95% CI: 1.24-7.07, P = 0.015), PNI (OR = 0.73, 95% CI: 0.62-0.86, P < 0.001), and CCI (OR = 1.44, 95% CI: 1.01-2.06, P = 0.047) were independent risk factors of early complications after RARC. Moreover, PNI (OR = 0.72, 95% CI: 0.60-0.86, P < 0.001) was also the predictor of major complications after RARC. The ROC curve demonstrated that PNI (AUC = 0.829; AUC = 0.840) has a great predictive value in early overall and major complications after RARC. Conclusion: PNI can be an early alert for RARC patients thus aiding in closer monitoring and postoperative management.

13.
Nat Aging ; 2(8): 686-687, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36471785

RESUMO

Using single-cell whole-genome sequencing, we identified and characterized the landscape of somatic single-nucleotide variants (sSNVs) in single cardiomyocytes from individuals across the human lifespan. Aged cardiomyocytes were found to have a higher burden of sSNVs and show mutational signatures that suggest failed repair of oxidative DNA damage.

14.
Natl Sci Rev ; 9(11): nwac225, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36452428

RESUMO

In the past few years, wireless communications based on digital coding metasurfaces have gained research interest owing to their simplified architectures and low cost. However, in most of the metasurface-based wireless systems, a single-polarization scenario is used, limiting the channel capacities. To solve the problem, multiplexing methods have been adopted, but the system complexity is inevitably increased. Here, a space-frequency-polarization-division multiplexed wireless communication system is proposed using an anisotropic space-time-coding digital metasurface. By separately designing time-varying control voltage sequences for differently oriented varactor diodes integrated on the metasurface, we achieve frequency-polarization-division multiplexed modulations. By further introducing different time-delay gradients to the control voltage sequences in two polarization directions, we successfully obtain space-frequency-polarization-division multiplexed modulations to realize a wireless communication system with a new architecture. The new communication system is designed with compact dual-polarized meta-elements, and can improve channel capacity and space utilization. Experimental results demonstrate the high-performance and real-time transmission capability of the proposed communication system, confirming its potential application in multiple-user collaborative wireless communications.

15.
Neoplasia ; 35: 100856, 2022 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-36442297

RESUMO

PURPOSE: Immune checkpoint inhibitors (ICIs) alone or in combination with chemotherapy can improve the limited efficacy of colorectal cancer (CRC) immunotherapy. CX-5461 causes substantial DNA damage and genomic instability and can increase ICIs' therapeutic efficacies through tumor microenvironment alteration. RESULTS: We analyzed whether CX-5461 enhances ICIs' effects in CRC and discovered that CX-5461 causes severe DNA damage, including cytosolic dsDNA appearance, in various human and mouse CRC cells. Our bioinformatics analysis predicted CX-5461-based interferon (IFN) signaling pathway activation in these cells, which was verified by the finding that CX-5461 induces IFN-α and IFN-ß secretion in these cells. Next, cGAMP, phospho-IRF3, CCL5, and CXCL10 levels exhibited significant posttreatment increases in CRC cells, indicating that CX-5461 activates the cGAS-STING-IFN pathway. CX-5461 also enhanced PD-L1 expression through STAT1 activation. CX-5461 alone inhibited tumor growth and prolonged survival in mice. CX-5461+anti-PD-1 or anti-PD-L1 alone exhibited synergistic growth-suppressive effects against CRC and breast cancer. CX-5461 alone or CX-5461+anti-PD-1 increased cytotoxic T-cell numbers and reduced myeloid-derived suppressor cell numbers in mouse spleens. CONCLUSIONS: Therefore, clinically, CX-5461 combined with ICIs for CRC therapy warrants consideration because CX-5461 can turn cold tumors into hot ones.

16.
Sci Rep ; 12(1): 20566, 2022 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-36446802

RESUMO

This study analyzed learning curve and the surgical outcome of robotic assisted colorectal surgery with ERAS program. The study results serve as a reference for future robotic colorectal surgeon who applied ERAS in clinical practice. This was a retrospective case-control study to analyze the learning curve of 141 robotic assisted colorectal surgery (RAS) by Da Vinci Xi (Xi) system and compare the surgical outcomes with 147 conventional laparoscopic (LSC) surgery in the same team. Evaluation for maturation was performed by operation time and the CUSUM plot. Patients were recruited from 1st February 2019 to 9th January 2022; follow-up was conducted at 30 days, and the final follow-up was conducted on 9th February 2022. It both took 31 cases for colon and rectal robotic surgeries to reach the maturation phase. Teamwork maturation was achieved after 60 cases. In the maturation stage, RAS required a longer operation time (mean: colon: 249.5 ± 46.5 vs. 190.3 ± 57.3 p < 0.001; rectum 314.9 ± 59.6 vs. 223.6 ± 63.5 p < 0.001). After propensity score matching, robotic surgery with ERAS program resulted in significant shorter length of hospital stay (mean: colon: 5.5 ± 4.5 vs. 10.0 ± 11.9, p < 0.001; rectum: 5.4 ± 3.5 vs. 10.1 ± 7.0, p < 0.001), lower minor complication rate (colon: 6.0% vs 20.0%, p = 0.074 ; rectum: 11.1% vs 33.3%, p = 0.102), and no significant different major complication rate (colon: 2.0% vs 6.0%, p = 0.617; rectum: 7.4% cs 7.4%, p = 1.0) to conventional LSC. Learning curve for robotic assisted colorectal surgery takes 31 cases. Robotic surgery with ERAS program brings significant faster recovery and fewer complication rate compared to laparoscopy in colorectal surgery.


Assuntos
Besouros , Cirurgia Colorretal , Procedimentos Cirúrgicos Robóticos , Humanos , Animais , Curva de Aprendizado , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Estudos Retrospectivos , Estudos de Casos e Controles , Resultado do Tratamento
17.
BMC Public Health ; 22(1): 2200, 2022 11 28.
Artigo em Inglês | MEDLINE | ID: mdl-36443706

RESUMO

BACKGROUND: Enterobius vermicularis (pinworm) is a common intestinal parasitic infection in children. A gradual decrease in the prevalence of pinworm infection has been noted in resource-rich settings, such as Taiwan. However, the influence of sociodemographic factors on the temporal trend in pinworm infection rates in children under the current pinworm infection prevention policy in Taiwan is not well characterized. This study aimed to evaluate the trend of pinworm infection prevalence and the associated factors among children in Hualien County, Taiwan. METHODOLOGY: In this retrospective cross-sectional study, we included a total of 56,197 students (aged 6-10 years) in grades 1 and 4 in Hualien in 2009-2018. Children were screened for pinworm infection using adhesive cellophane perianal swabs in the routine student health examination. Logistic regression was conducted to evaluate the factors associated with pinworm infection. Associations between dependent and independent variables were measured by odds ratios. The Cochran-Armitage test was used to assess whether there were significant trends in different stratifications. Variables with P-values < 0.05 were considered statistically significant. RESULTS: A total of 56,197 school-age children from grades 1 and 4 during 2009-2018 were included. Young age and male sex were risk factors for pinworm infection (P < 0.001). A negative correlation between body mass index and enterobiasis was observed, and decreased pinworm infection was noted during the study reference period. Children living in suburban and rural areas had higher odds of having a pinworm infection than those living in urban areas (P < 0.001). A significant decrease in the overall prevalence rate of pinworm infection was observed among children in 2009-2018 (P < 0.001). However, there was no obvious change in the pinworm infection rate in rural areas during this period (P = 0.953), and it was higher than that in urban and suburban areas. CONCLUSIONS: The overall prevalence of pinworm infection gradually decreased from 2009 to 2018 among school-age children in Hualien. However, there was no declining trend in pinworm infection in rural areas. Young age, male sex, and rural residence were significantly associated with pinworm infection. Pinworm infection remains a major public health concern among children in rural areas of Hualien.


Assuntos
Enterobíase , Criança , Animais , Masculino , Humanos , Enterobíase/epidemiologia , Enterobius , Estudos Transversais , Prevalência , Estudos Retrospectivos , Saúde Pública , Taiwan/epidemiologia
18.
J Chin Med Assoc ; 85(11): 1044-1050, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36343272

RESUMO

BACKGROUND: Overall survival of systemic lupus erythematosus (SLE) patients significantly increased in recent decades, however, the relative risk of mortality is still high. Long-term survival outcome of pediatric SLE remains unclear. This study aims to explore the long-term survival rate and its predictors in patients with systemic lupus erythematosus (SLE). METHODS: A retrospective, hospital-based cohort study was performed between 2004 and 2018 in a tertiary referral medical center in Taiwan. Data on comorbidities, medications, and causes of admission were collected for risk factor analysis using time-dependent multivariate Cox proportional hazards models. RESULTS: A total of 2392 adults and 115 pediatric SLE patients were enrolled (female, n = 2157 and 95, respectively). The 10-year survival rates were 93.2%, 90.2%, 98.9%, and 100% in adult women, adult men, girls, and boys with SLE, respectively. The overall mortality rate was 2.09 case/100 patient-years (PY) for male SLE and 1.39 case/100 PY for female SLE patients. Male SLE patients did not have a statistically significantly higher mortality rate than female SLE patients in each age stratification. Infectious disease (n = 119), heart failure (n = 21), and cerebrovascular accident (n = 14) were the leading causes of death in adult SLE patients. Advanced age (hazard ratio [HR]: 1.04, 95% confidence interval [CI]: 1.03-1.05), treatment with mean dosage of systemic glucocorticoid equivalent to >10 mg/d of prednisolone (HR: 1.71, 95% CI: 1.14-2.57), comorbidities with malignancy (HR: 1.94, 95% CI: 1.22-3.09), chronic kidney disease (HR: 1.86, 95% CI: 1.25-2.77), hypertension (HR: 1.42, 95% CI: 1.01-1.98), and admission due to bacterial pneumonia (HR: 1.92, 95% CI: 1.12-3.31) and sepsis (HR: 2.78, 95% CI: 1.51-5.13) were independent risk factors for mortality in SLE patients. CONCLUSION: SLE patients with advanced age, malignancy, chronic kidney disease, hypertension, treated with a higher average dosage of glucocorticoids, and admission due to bacterial pneumonia and sepsis have an increased risk of mortality.


Assuntos
Hipertensão , Lúpus Eritematoso Sistêmico , Insuficiência Renal Crônica , Sepse , Adulto , Humanos , Feminino , Masculino , Criança , Estudos de Coortes , Estudos Retrospectivos , Taiwan/epidemiologia , Análise Multivariada , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Fatores de Risco , Modelos de Riscos Proporcionais , Glucocorticoides/uso terapêutico
19.
J Clin Med ; 11(21)2022 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-36362831

RESUMO

Background: Concurrent acute cholecystitis and acute cholangitis is a unique clinical situation. We tried to investigate the optimal timing of cholecystectomy after adequate biliary drainage under this condition. Methods: From January 2012 to November 2017, we retrospectively screened all in-hospitalized patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and then identified patients with concurrent acute cholecystitis and acute cholangitis from the cohort. The selected patients were stratified into two groups: one-stage intervention (OSI) group (intended laparoscopic cholecystectomy at the same hospitalization) vs. two-stage intervention (TSI) group (interval intended laparoscopic cholecystectomy). Interrogated outcomes included recurrent biliary events, length of hospitalization, and surgical outcomes. Results: There were 147 patients ultimately enrolled for analysis (OSI vs. TSI, 96 vs. 51). Regarding surgical outcomes, there was no significant difference between the OSI group and TSI group, including intraoperative blood transfusion (1.0% vs. 2.0%, p = 1.000), conversion to open procedure (3.1% vs. 7.8%, p = 0.236), postoperative complication (6.3% vs. 11.8%, p = 0.342), operation time (118.0 min vs. 125.8 min, p = 0.869), and postoperative days until discharge (3.37 days vs. 4.02 days, p = 0.643). In the RBE analysis, the OSI group presented a significantly lower incidence of overall RBE (5.2% vs. 41.2%, p < 0.001) than the TSI group. Conclusions: Patients with an initial diagnosis of concurrent acute cholecystitis and cholangitis undergoing cholecystectomy after ERCP drainage during the same hospitalization period may receive some benefit in terms of clinical outcomes.

20.
Ren Fail ; 44(1): 1938-1947, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36354059

RESUMO

OBJECTIVES: Coagulation factors participates in the inflammatory cascade, known to play a crucial role in the development of acute kidney injury (AKI). Thus, it's likely that some factors may be associated with AKI. Among them, low levels of fibrinogen and antithrombin III (ATIII) activity have been proved to increase mortality in patients with sepsis. Moreover, they are also reported to be associated with higher incidence of AKI. However, the association between coagulation parameters, especially fibrinogen and ATIII, and prognosis of AKI has not been examined. METHODS: Data were acquired from Multiparameter Intelligent Monitoring in Intensive Care Database IV (MIMIC-IV) version 1.0. Cox proportional hazards regression model was used to estimate the relationship between coagulation parameters and in-hospital mortality in critically ill patients with AKI. Subgroup analysis was also conducted to assess the robustness of the association. Restricted cubic spline (RCS) curve was utilized to examine the nonlinear relationships between fibrinogen or ATIII and in-hospital mortality. Kaplan-Meier method was used to estimate cumulative incidence of mortality by fibrinogen or ATIII levels. Receiver-operating characteristic (ROC) curve was plotted and area under curve was calculated to evaluate predictive ability of fibrinogen or ATIII. RESULTS: A total of 5914 eligible patients were enrolled in fibrinogen cohort study and 115 patients were eligible for ATIII cohort study. The baseline of low fibrinogen (<150 mg/dL) or ATIII (<80%) activity was associated with significantly higher in-hospital mortality (fibrinogen HR [95% CIs] 2.01 [1.79, 2.27]; ATIII 3.73 [1.11, 12.54]). The HR [95% CIs] of low fibrinogen remained significant 1.29 (1.13, 1.48) in multivariate analysis. The RCS curve showed nearly linear relationship. Subgroup analysis also proved the robustness of the association between fibrinogen and in-hospital mortality. Kaplan-Meier survival curve and ROC demonstrated the predictive capability of fibrinogen and ATIII. CONCLUSION: Low fibrinogen is an independent predictor of in-hospital mortality in critically ill patients with AKI. Low ATIII activity is also likely to impact the risk of in-hospital death.


Assuntos
Injúria Renal Aguda , Estado Terminal , Humanos , Mortalidade Hospitalar , Antitrombina III , Fibrinogênio , Estudos de Coortes , Injúria Renal Aguda/etiologia , Prognóstico , Anticoagulantes , Estudos Retrospectivos
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