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1.
Cancer Med ; 2022 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-35470574

RESUMO

BACKGROUND: Transaxillary endoscopic thyroidectomy has been introduced to achieve better cosmetic outcomes. However, the benefits of this technology on the patients' health-related quality of life (HRQoL) remain unclear. We aimed to investigate whether transaxillary endoscopic lobectomy is comparable to conventional open lobectomy in terms of QOL and cosmetic results in order to provide more evidence for establishing appropriate clinical decisions. METHODS: Between August 2019 and May 2020, transaxillary endoscopic lobectomy and conventional open lobectomy were performed in 73 and 99 patients with papillary thyroid microcarcinoma, respectively. HRQoL was assessed at 1, 3, 6, and 12 months after surgery using the Thyroid Cancer-Specific Quality of Life Questionnaire. The cosmetic outcomes were assessed 12 months after surgery using the Patient and Observer Scar Assessment Scale (POSAS). RESULTS: No significant difference was observed in the surgical results between the two groups. However, the data showed that the average operative time and postoperative hospital stay of the transaxillary group were longer than those of the open group (p < 0.001). Both groups showed similar changes in the QOL scores over time. However, the transaxillary group had fewer complaints of the throat or oral problems at 1 month postoperatively than the open group (p < 0.001). During the follow-up, the cosmetic results of scars in the transaxillary group were significantly better than those in the open group (p < 0.05). Patients who underwent transaxillary endoscopic lobectomy had higher overall satisfaction with their scar appearance, determined using POSAS, at 12 months postoperatively. CONCLUSIONS: The current findings suggest that transaxillary endoscopic lobectomy may offer better cosmetic and HRQoL outcomes.

2.
J Clin Oncol ; 40(11): 1206-1219, 2022 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-35044851

RESUMO

PURPOSE: H1-antihistamines (AHs) may exert protective effects against cancer. This study investigated the association of AH use with the risk of hepatocellular carcinoma (HCC) in patients with hepatitis B virus (HBV), hepatitis C virus (HCV), or dual HBV-HCV virus infection. MATERIALS AND METHODS: Patients with HBV, HCV, or dual HBV-HCV infection were enrolled from Taiwan's National Health Insurance Research Database and examined for the period from January 1, 2006, to December 31, 2015. We used the Kaplan-Meier method and Cox proportional hazards regression to evaluate the association between AH use and HCC risk. RESULTS: We included patients with HBV infection (n = 521,071), HCV (n = 169,159), and dual HBV-HCV (n = 39,016). Patients with HBV, HCV, or dual virus infection who used AHs exhibited significantly lower risk of HCC relative to patients who did not use AH, with their adjusted hazard ratio being 0.489 (95% CI, 0.455 to 0.524), 0.484 (95% CI, 0.450 to 0.522), and 0.469 (95% CI, 0.416 to 0.529), respectively. Furthermore, there was a dose-response relationship between AH use and the risk of HCC in the HBV cohort. The adjusted hazard ratios were 0.597 (95% CI, 0.530 to 0.674), 0.528 (0.465 to 0.600), 0.470 (0.416 to 0.531), and 0.407 (0.362 to 0.457) for AH use of 28-42, 43-63, 64-119, and ≥ 120 cumulative defined daily doses, respectively, relative to no AH use. Additionally, there was also a dose-response relationship between AH use and the risk of HCC in the HCV and dual HBV-HCV cohorts. CONCLUSION: AH use may reduce the risk for HCC among patients with HBV, HCV, or dual infection in a dose-dependent manner. Further mechanistic research is needed.


Assuntos
Carcinoma Hepatocelular , Hepatite B , Hepatite C , Neoplasias Hepáticas , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/prevenção & controle , Hepacivirus , Hepatite B/complicações , Hepatite B/tratamento farmacológico , Vírus da Hepatite B , Hepatite C/complicações , Hepatite C/tratamento farmacológico , Antagonistas dos Receptores Histamínicos , Humanos , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/prevenção & controle
3.
Materials (Basel) ; 15(2)2022 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-35057373

RESUMO

Electronic products are ever growing in popularity, and tantalum capacitors are heavily used in small electronic products. Spent epoxy-coated solid electrolyte tantalum capacitors, containing about 22 wt.% of tantalum and 8 wt.% of manganese, were treated with selective leaching by hydrochloric acid and chlorination after removing the epoxy resin, and the products converted, respectively, to Mn(OH)2 and TaCl5. The effects of acid type, acid concentration, liquid-solid ratio, and reaction time were investigated to dissolve the manganese. The optimal selective leaching conditions were determined as 3 mol/L of HCl, 40 mL/g at 25 °C for 32 min. Next, residues of selective leaching after washing and drying were heated with ferrous chloride to convert to pure TaCl5. Mixing 48 wt.% of chloride and 52 wt.% of residues for a total of 5 g was conducted to complete the chlorination process in the tube furnace at 450 °C for 3 h. A total of 2.35 g of Ta was collected and the recovery of Ta achieved 94%. Finally, Mn(OH)2 and TaCl5 were separated and purified as the products.

4.
Nanomaterials (Basel) ; 12(1)2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-35010104

RESUMO

Copper thiocyanate (CuSCN) has been gradually utilized as the hole injection layer (HIL) within optoelectronic devices, owing to its high transparency in the visible range, moderate hole mobility, and desirable environmental stability. In this research, we demonstrate quantum dot light-emitting diodes (QLEDs) with high brightness and current efficiency by doping 2,3,5,6-tetrafluoro-7,7,8,8-tetracyanoquinodimethane (F4TCNQ) in CuSCN as the HIL. The experimental results indicated a smoother surface of CuSCN upon F4TCNQ doping. The augmentation in hole mobility of CuSCN and carrier injection to reach balanced charge transport in QLEDs were confirmed. A maximum brightness of 169,230 cd m-2 and a current efficiency of 35.1 cd A-1 from the optimized device were received by adding 0.02 wt% of F4TCNQ in CuSCN, revealing promising use in light-emitting applications.

5.
J Chin Med Assoc ; 85(2): 175-182, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-34882100

RESUMO

BACKGROUND: The real-world outcomes of golimumab (GLM) use have been rarely studied in Asian patients with rheumatoid arthritis (RA). This study assessed the real-world effectiveness and safety of GLM in a Taiwanese cohort. METHODS: One hundred and eight GLM-treated RA patients were enrolled. Predictors of a good European League Against Rheumatism (EULAR) response at 24 months and drug retention were identified through multivariate analyses. RESULTS: After 24 months of GLM treatment, the mean Disease Activity Score using 28 joint counts with the erythrocyte sedimentation rate (DAS28-ESR) decreased from 6.7 to 3.1 (p < 0.001). Up to 58.9% of patients achieved a good EULAR response at 24 months. Multivariate logistic regression analysis revealed that after adjustment for other variables, a higher baseline C-reactive protein was an independent negative predictor of good EULAR responses (odds ratio, 0.82; 95% confidence interval [CI], 0.67-0.99; p = 0.043). During the mean follow-up period of 38.3 months, 15 (13.9%) patients discontinued GLM due to treatment failure. In multivariate analysis, high baseline ESR level, high DAS28-ESR, and the experience of biologic therapy were independent risk factors for GLM discontinuation (adjusted hazard ratio [HR], 1.03; 95% CI, 1.01-1.05; p = 0.003; adjusted HR, 2.93; 95% CI, 1.42-6.08; p = 0.004; and adjusted HR, 5.00; 95% CI, 1.75-14.26; p = 0.003, respectively). In receiver operator characteristic curve analysis, the optimal cutoff values of baseline ESR and DAS28-ESR for predicting drug survival were 52 mm/h (sensitivity: 60.0% and specificity: 77.4%) and 7.7 (sensitivity: 46.7% and specificity: 94.3%), respectively. During the follow-up period, 22 patients (20.4%) developed adverse events. The safety profile of GLM in this study was comparable with that in previous clinical trials. CONCLUSION: GLM was effective and safe for the real-life management of Taiwanese RA patients and showed a high retention rate in biologic-naive patients compared with biologic-experienced patients.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Idoso , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Segurança , Taiwan
6.
ISA Trans ; 121: 147-155, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33840462

RESUMO

This paper designs a novel distributed interval observer for Linear Time Invariant (LTI) systems with additive disturbances. The technique of observer construction relies on the Internal Positive Representations (IPRs) of systems and synchronizing region approach, which ensures that the error system is stably and positive. Each observer estimates the upper and lower bounds (ULBs) of the system states by only using part of the output information and the information interaction with their neighbors. Numerical examples are simulated to demonstrate the effectiveness of the proposed approach.

7.
Clin Rheumatol ; 41(1): 115-122, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34455508

RESUMO

OBJECTIVE: Immunoglobulin G4-related disease (IgG4-RD) is a recently recognized heterogeneous, subacute, and usually silent autoimmune disease involving many organs with protean manifestations. However, high IgG4 in serum is not necessarily indicating an IgG4-RD. The aims of this study were to investigate the clinical relevance of high serum IgG4 level in IgG4-RD or non IgG4-RD patients, and to see if IgG4-RD in Taiwan differs from that in other parts of the world. METHODS: Eight hundred forty-five patients with high IgG4 were retrospectively reviewed from January 2002 to May 2020 in Taipei Veteran General Hospital. Two hundred sixty-seven patients fulfilled IgG4-RD criteria and were categorized into pancreato-hepato-biliary disease, retroperitoneal fibrosis and/or aortitis, head/neck-limited disease, classic Mikulicz syndrome with systemic involvement, CNS-limited disease, sclerosing vasculitis, skin-limited disease, and sensorineural hearing disease. These manifestations were correlated to smoking, atopy, hyper-IgE/eosinophilia, aging, malignancies, and hypocomplementemia. Five hundred seventy-eight patients were not fulfilling the criteria but were also analyzed for the prevalence of allergy, malignancy, connective tissue diseases, lung diseases, and infections. RESULTS: In IgG4-RD patients, 124 (46.4%) smoked. Top 4 clinical subtypes included Mikulicz syndrome with systemic involvement (33.3%), pancreato-hepatobiliary disease (31.4%), head/neck disease (19.4%), and retroperitoneal fibrosis/aortitis (12.7%). Top 4 co-morbid conditions included high serum IgE/eosinophilia (46.2%), hypocomplementemia (34%), malignancies (13.4%), and allergy (13.4%). Pancreato-biliary disease was associated with high IgE/eosinophilia (r2 = 0.380, P = 0.025) and malignancy (r2 = 0.211, P = 0.027), Miculicz syndrome with allergy (r2 = 0.396, P < 0.01) and high IgE/eosinophil (r2 = 0.396, P < 0.01), CNS diseases (r2 = 0.973, P = 0.035) and sclerosing vasculitis (r2 = 1, P < 0.01) with advanced age respectively, with the latter being also related to atopy and high IgE/eosinophilia (r2 = 1, p < 0.01). CONCLUSION: Smoking may precipitate IgG4-RD. IgG4-RD with pancreato-hepatobiliary disease is closely related to allergy and neoplasm, and those with Mikulicz syndrome may result from atopy. Elderly IgG4-RD patients tend to develop CNS pathology parallel to advancing of age. The disease may probably be originated from an unknown mechanism that may sporadically evolve into malignancies.


Assuntos
Doenças Autoimunes , Doença Relacionada a Imunoglobulina G4 , Fibrose Retroperitoneal , Idoso , Doenças Autoimunes/epidemiologia , Humanos , Imunoglobulina G , Doença Relacionada a Imunoglobulina G4/epidemiologia , Fibrose Retroperitoneal/epidemiologia , Estudos Retrospectivos
8.
Surgery ; 171(5): 1177-1184, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-34531032

RESUMO

BACKGROUND: Inferior mesenteric artery lymph node (station 253 node) metastasis occurs in approximately 0.3% to 13.9% of rectal cancer patients. This study examined whether carbon nanoparticles could aid in harvesting more station 253 nodes and evaluated the relationship between the number of station 253 nodes retrieved and station 253 node metastasis. METHOD: A total of 480 consecutive rectal cancer patients were enrolled in this prospective cohort study between August 2014 and October 2018. Ninety-one patients (18.96%) received a preoperative submucosal injection of carbon nanoparticles (CN+ group), and 389 patients did not receive an injection (CN- group). The number of lymph node retrievals was analyzed, and the relevant risk factors for station 253 node metastasis were identified using univariate and multivariate analyses. RESULTS: The mean number of station 251, 252, and 253 lymph nodes and total lymph nodes retrieved in the CN+ group were higher than that retrieved in the CN- group. The percentage of patients with ≥4 station 253 nodes retrieved (54.0% vs 28.3%, P = .004) were higher in the CN+ group than in the CN- group. Retrieval of ≥4 station 253 nodes was an independent risk factor for station 253 node metastasis (OR: 2.40, 95% CI: 1.22-4.74, P = .012). CONCLUSION: The preoperative submucosal injection of carbon nanoparticles was helpful for increasing the number of station 253 nodes harvested, and a minimum of 4 examined station 253 nodes was necessary for standard D3 lymph node dissection in rectal cancer.


Assuntos
Nanopartículas , Neoplasias Retais , Carbono , Humanos , Excisão de Linfonodo , Linfonodos/patologia , Linfonodos/cirurgia , Artéria Mesentérica Inferior/patologia , Artéria Mesentérica Inferior/cirurgia , Estudos Prospectivos , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia
9.
Iran J Kidney Dis ; 16(2): 135-146, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35489082

RESUMO

INTRODUCTION: Secondary hyperparathyroidism may cause an increase in blood pressure among maintenance hemodialysis (MHD) patients. The objective of this study were to observe the effects of different treatment modalities of hyperparathyroidism on blood pressure among MHD patients with secondary hyperparathyroidism. METHODS: This retrospective cohort study was conducted on 69 patients divided into three groups, based on the therapeutic strategies (parathyroidectomy, n = 22; cinacalcet, n = 14; calcitriol, n = 33). Changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP) from pre- to post-treatment visits at 1st, 3rd, 6th, and 12th month were analyzed by mixed-effects repeated-measures model. Serum levels of the renin-angiotensin system (RAS) mediators (renin and aldosterone), endothelin, and echocardiography were compared before and after one year of treatment within the three groups. RESULTS: Changes in blood pressure were significantly different among the three groups (SBP: P for group < 0.05; DBP: P for group < .05; both P for group × time interaction < .05). SBP and DBP showed a significant downward trend in the surgery group (P for change in SBP < .05, P for change in DBP < .001, adjusted mean change of SBP = -12.16 (-19.70 to -4.62) mmHg and of DBP = -6.82 (-10.58 to -3.06) mmHg in the surgery group on the 12th month). Diastolic BP showed a significant upward trend in the cinacalcet group (P for change in DBP < .05, adjusted mean change of DBP = 6.03 (2.08 to 9.98) mmHg in cinacalcet group in the 12th month). No significant change in BP was observed in the calcitriol group. The levels of serum RAS mediators, endothelin, or cardiac ultrasonography didn't change and almost remained consistent during the treatment course. CONCLUSION: Blood pressure decreased significantly over a year in patients with parathyroidectomy, while DBP increased significantly over time by cinacalcet treatment.  DOI: 10.52547/ijkd.6686.


Assuntos
Hiperparatireoidismo Secundário , Hipertensão , Pressão Sanguínea , Calcitriol , Cinacalcete/farmacologia , Cinacalcete/uso terapêutico , Humanos , Hiperparatireoidismo Secundário/tratamento farmacológico , Hiperparatireoidismo Secundário/etiologia , Hiperparatireoidismo Secundário/cirurgia , Paratireoidectomia , Diálise Renal/efeitos adversos , Estudos Retrospectivos
10.
Sci Rep ; 11(1): 23431, 2021 12 06.
Artigo em Inglês | MEDLINE | ID: mdl-34873244

RESUMO

Heterogeneity of cell phenotypes remains a barrier in progressing cell research and a challenge in conquering cancer-related drug resistance. Cell morphology, the most direct property of cell phenotype, evolves along the progression of the cell cycle; meanwhile, cell motility, the dynamic property of cell phenotype, also alters over the cell cycle. However, a quantifiable research understanding the relationship between the cell cycle and cell migration is missing. Herein, we coordinate the migratory behaviours of NIH 3T3 fibroblasts to their corresponding phases of the cell cycle, the G1, the S, and the G2 phases, and explain the relationship through the spatiotemporal arrangements between the Rho GTPases' signals and cyclin-dependent kinase inhibitors, p21Cip1, and p27Kip1. Taken together, we demonstrate that both cell morphology and the dynamic subcellular behaviour are homogenous within each stage of the cell cycle phases but heterogenous between phases through quantitative cell analyses and an interactive molecular mechanism between the cell cycle and cell migration, posing potential implications in countering drug resistance.


Assuntos
Ciclo Celular , Resistencia a Medicamentos Antineoplásicos , Animais , Proteínas de Ciclo Celular/metabolismo , Movimento Celular , Biologia Computacional/métodos , Progressão da Doença , Fibroblastos/metabolismo , Citometria de Fluxo , Processamento de Imagem Assistida por Computador/métodos , Camundongos , Microscopia de Fluorescência , Proteínas Associadas aos Microtúbulos/metabolismo , Células NIH 3T3 , Fenótipo , Prognóstico
11.
BMC Nephrol ; 22(1): 398, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34852774

RESUMO

BACKGROUND: Estimation of phosphate load in hemodialysis patients is always controversial in clinical practice. The aim of this study was to verify individual achievement rate of serum phosphate as the evaluation of phosphate load through investigating its impact on cardiovascular mortality in hemodialysis patients. METHODS: This was a single-center, retrospective cohort study. A total of 251 maintenance hemodialysis patients were enrolled. The individual achievement rate of serum phosphate was defined as the times of tests within the target range divided by total times of tests over a period of time. Cox regression model was used to examine the relationship between individual achievement rate of serum phosphate and cardiovascular mortality. RESULTS: The mean age of the study population was 61 ± 13 years old. A total of 44 (17.5%) patients died from cardiovascular disease (CVD) during a median follow-up of 65 months. Multivariable Cox analysis showed that one-year serum phosphate achievement rate of 0% (HR = 4.117, P = 0.016) and 25% (HR = 3.343, P = 0.023) increased the risk of cardiovascular mortality while the achievement rate of 50% (HR = 2.129, P = 0.162) and 75% (HR = 1.080, P = 0.902) did not, compared to the rate of 100%. Urea reduction ratio (URR) was positively, while serum intact parathyroid hormone (iPTH), alkaline phosphatase (ALP), normalized protein catabolic rate (nPCR), and total phosphate-binding capacity of drug were negatively associated with achievement in target of serum phosphate. CONCLUSIONS: Keeping one-year achievement rate of serum phosphate higher than 50% provides significant clinical benefits in reducing cardiovascular mortality.


Assuntos
Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/mortalidade , Fosfatos/sangue , Diálise Renal , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
12.
J Cancer Res Ther ; 17(5): 1141-1156, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34850761

RESUMO

The Expert Consensus reviews current literatures and provides clinical practice guidelines for thermal ablation of pulmonary subsolid nodules or ground-glass nodule (GGN). The main contents include the following: (1) clinical evaluation of GGN; (2) procedures, indications, contraindications, outcomes evaluation, and related complications of thermal ablation for GGN; and (3) future development directions.


Assuntos
Hipertermia Induzida/métodos , Neoplasias Pulmonares/cirurgia , Nódulos Pulmonares Múltiplos/cirurgia , Lesões Pré-Cancerosas/cirurgia , Nódulo Pulmonar Solitário/cirurgia , Consenso , Prova Pericial , Humanos
13.
Ther Adv Musculoskelet Dis ; 13: 1759720X211058502, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34840609

RESUMO

INTRODUCTION: Infections are a leading cause of mortality in patients with systemic lupus erythematosus (SLE). Among various infections, invasive fungal infections (IFIs) have a particularly high mortality rate; however, studies examining IFIs in patients with SLE are limited. METHODS: Patients diagnosed as having SLE between 1997 and 2012 were enrolled from Taiwan's National Health Insurance Research Database along with age- and sex-matched non-SLE controls at a ratio of 1:10. IFIs were identified based on International Classification of Diseases, Ninth Revision, Clinical Modification codes and validated by the prescriptions of systemic antifungal agents. The incidence rate (IR), incidence rate ratio (IRR), and all-cause mortality rate of IFIs and its subtypes were analyzed. A Cox multivariate regression model with time-dependent covariates was applied to analyze independent risk factors for IFIs. RESULTS: A total of 24,541 patients with SLE and 245,410 non-SLE controls were included. We observed 445 IFI episodes in the SLE cohort, with an all-cause mortality rate of 26.7%. Candida spp. (52.8%) was the most common pathogen, followed by Cryptococcus spp. (18.2%) and Aspergillus spp. (18.2%). The IR of IFIs in the SLE cohort was 20.83 per 10,000 person-years, with an IRR of 11.1 [95% confidence interval (CI): 9.8-12.6] relative to the non-SLE controls. Juvenile patients with SLE aged ⩽18 years had the highest IRR of 47.2 (95% CI: 26.9-86.8). Intravenous steroid therapy administered within 60 days (hazard ratio: 29.11, 95% CI: 23.30-36.37) was the most critical risk factor for overall IFIs and each of the three major fungal pathogens. Distinct risk factors were found among different IFI subtypes. CONCLUSION: Patients with SLE had a higher risk of IFIs, especially juvenile patients. Intravenous steroid therapy is the most critical risk factor for IFIs. This study provides crucial information for the risk stratification of IFIs in SLE. PLAIN LANGUAGE SUMMARIES: Patients with systemic lupus erythematosus and physicians treating this patient group should be aware of the risk of invasive fungal infections.Invasive fungal infections (IFIs) are a severe complication with a high mortality rate among patients with systemic lupus erythematosus (SLE); however, studies on this topic are scant. We performed a nationwide population-based study in Taiwan to estimate the incidence and mortality of and risk factors for IFIs. We found an incidence rate of 20.83 per 10,000 person-years for IFIs, with a mortality rate of 26.7%. Juvenile patients aged ⩽18 years had the highest relative risk of IFIs. Although candidiasis was the most common IFI, cryptococcosis and aspergillosis should be concerned in juvenile patients as well. Intravenous steroid therapy was the most critical risk factor for all IFIs, and different immunosuppressive agents posed different risks in patients for acquiring certain fungal pathogens.Our findings provide pivotal epidemiological information and indicate risk factors for IFIs in patients with SLE. Age and exposure to specific immunosuppressants and steroids might help predict the risk of IFIs. Because the manifestation of these infections is sometimes indistinguishable from a lupus flare, physicians should be aware of this fatal complication, especially when patients are not responsive to immunosuppressive therapy. Early recognition, implication of diagnostic tools, and empirical antimicrobial agents can be the key to treating patients with IFIs. Additional studies are required to develop a risk management program for patients with SLE.

14.
Ther Clin Risk Manag ; 17: 1177-1186, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34803381

RESUMO

PURPOSE: Previous research on incremental hemodialysis transition has mainly focused on one or two benefits or prognoses. We aimed to conduct a comprehensive analysis by investigating whether incremental hemodialysis was simultaneously associated with adequate dialysis therapy, stable complication indicators, long-lasting arteriovenous vascular access, and long-lasting preservation of residual kidney function (RKF) without increasing mortality or hospitalization. PATIENTS AND METHODS: Incident hemodialysis patients from Huashan Hospital in Shanghai, China, over the period of 2012 to 2019, were enrolled and followed every three months until death or the time of censoring. Changes in complication indicators from baseline to all post-baseline visits were analyzed by mixed-effects models. The outcomes of RKF loss, arteriovenous vascular access complications, and the composite of all-cause mortality and cardiovascular events were compared between incremental and conventional hemodialysis by Cox proportional hazards model. RESULTS: Of the 113 patients enrolled in the study, 45 underwent incremental and 68 conventional hemodialysis. There were no significant differences in the changes from baseline to post-baseline visits in complication indicators between the two groups. Incremental hemodialysis reduced the risks of RKF loss (HR, 0.33; 95% CI, 0.14-0.82), de novo arteriovenous access complication (HR, 0.26; 95% CI, 0.08-0.82), and recurrent arteriovenous access complications under the Andersen-Gill (AG) model (HR, 0.27; 95% CI, 0.10-0.74) and the Prentice, Williams and Peterson Total Time (PWP-TT) model (HR, 0.31; 95% CI, 0.12-0.80). There were no significant differences in all-cause hospitalization or the composite outcome between groups. CONCLUSION: Incremental hemodialysis is an effective dialysis transition strategy that preserves RKF and arteriovenous access without affecting dialysis adequacy, patient stability, hospitalization risk and mortality risk. Randomized controlled trials are warranted.

15.
IEEE Trans Cybern ; PP2021 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-34731083

RESUMO

This article concentrates on adaptive tracking control of strict-feedback uncertain nonlinear systems with an event-based learning scheme. A novel neural network (NN) learning law is proposed to design the adaptive control scheme. The NN weights information driven by the prediction-error-based control process is intermittently transmitted in the event-triggered context to the NN learning law mainly for signal tracking. The online stored sampled data of NN driven by the tracking error are utilized in the event context to update the learning law. With the adaptive control and NN learning law updated via the event-triggered communication, the improvements of NN learning capability, tracking performance, and system computing resource saving are guaranteed. In addition, it is proved that the minimum time interval for triggering errors of the two types of events is bounded and the Zeno behavior is strictly excluded. Finally, simulation results illustrate the effectiveness and good performance of the proposed control method.

16.
Oral Oncol ; 123: 105567, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34710736

RESUMO

BACKGROUND: To evaluate the relationship between lymph node yield (LNY) from the initial central neck dissection (CND) and the risk of recurrence in patients undergoing reoperative CND for papillary thyroid cancer (PTC). METHOD: We reviewed clinical data from all patients with pathologically proven PTC who underwent central neck and/or lateral neck dissection reoperations at Nanfang Hospital between 2012 and 2020. Patient demographics, tumor characteristics, clinical data and follow-up information were obtained. In the initial CND, the total number of lymph nodes removed (LNY), total positive nodes removed, and the percentage of positive lymph nodes to the number of lymph nodes removed (PLN%) were determined. RESULTS: A total of 162 patients were included in the study, with a median follow-up of 44 months. 62 had central neck disease recurrence. The optimal LNY and PLN% cut-off values for recurrence were 11 and 65%, respectively. Group 2 (LNY ≥ 11, PLN% < 65%) showed a significantly higher RFS rate than group 1 (LNY < 11 and PLN% < 65%; P < 0.001), group 3 (LNY < 11, PLN% ≥ 65%; P < 0.001), and group 4 (LNY ≥ 11, PLN% ≥ 65%; P = 0.038). Furthermore, group 4 had a higher RFS rate than group 1 (P = 0.008) and group 3 (P = 0.001). Multivariate analysis revealed that LNY < 11 in the central neck was an independent risk factor for recurrence/persistence in the initial surgery (P < 0.001). CONCLUSION: Higher LNY in central and neck dissections is associated with lower papillary thyroid cancer recurrence rates, which was confirmed by a reoperative CND procedure. To minimize the risk of recurrence and the need for secondary therapy, surgeons should perform compartment-oriented CNDs when indicated.


Assuntos
Carcinoma Papilar , Neoplasias da Glândula Tireoide , Carcinoma Papilar/patologia , Carcinoma Papilar/cirurgia , Estudos de Coortes , Humanos , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática/patologia , Esvaziamento Cervical/métodos , Recidiva Local de Neoplasia/patologia , Estudos Retrospectivos , Câncer Papilífero da Tireoide/patologia , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos
17.
Am J Cancer Res ; 11(9): 4259-4276, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34659886

RESUMO

BACKGROUND: Sintilimab is a humanized monoclonal antibody against the programmed cell death 1 (PD-L1). We aimed to assess the safety and activity of sintilimab monotherapy or in combination with chemotherapy in advanced solid tumors. METHODS: This phase Ib study included six cohorts. Cohort A-C were sintilimab monotherapy settings, and enrolled pretreated patients (2/3 L cohorts). Cohort D-F were treatment-naïve patients (1 L cohorts), and received sintilimab plus different chemotherapies. The primary endpoints were safety and objective response rate (ORR). Exploratory endpoints were potential biomarkers for the prognosis after treatment, such as tumor mutation burden scores (TMB), PD-L1 and lymphocyte-to-monocyte ratio (LMR). RESULTS: The ORR was 14.6% in the 2/3 L cohorts (n=146), and 73.2% in the 1 L cohorts (n=61). The incidence of grade 3-4 adverse events occurred in 55 patients (37.7%) in 2/3 L cohorts, and in 38 (62.3%) in 1 L cohorts. 157 patients had available TMB scores, and in 2/3 L cohorts, patients in the high TMB groups (TMB≥10) showed a longer progression-free survival (PFS) and overall survival (OS) than those in the low TMB groups (TMB<10). No significant differences in PFS and OS were observed across different PD-L1 groups in both 1 L and 2/3 L cohorts. A high LMR was significantly associated with an improved PFS in 1 L cohorts (P=0.022). CONCLUSION: Sintilimab alone or combined with chemotherapy had a tolerable safety profile in solid tumors. The combination therapy showed a favorable activity with advanced non-small cell lung cancer and gastric or esophagogastric junction adenocarcinoma. LMR might be a prognostic factor for the combination regimen in these patients. TRIAL REGISTRATION: ClinicalTrials.gov, number NCT02937116. Registered 18 October 2016.

18.
PLoS One ; 16(10): e0257345, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34597308

RESUMO

Infrasonic signals measured before an earthquake carry information about the size and development speed of the source fracture, the stress at the fracture site and the elastic properties of the geologic medium. The infrasonic signal has a stable time scale, and compared with other precursors, infrasound has a unique sensitivity to earthquake disasters. However, to date, there has been no relevant theoretical research on the mechanism of infrasonic anomalies, and information on the development of fracture sources cannot be obtained from these characteristics, which makes the application of this anomaly in earthquake prediction challenging. In this study, we obtained the characteristics of short-term and impending infrasonic anomalies based on the infrasound data of more than 100 strong earthquakes. With a range of elastic medium models with a large number of fractures, we completed the theoretical simulation of the formation process of infrasonic precursors during the formation of the main fractures, analyzed the physical evolution of acoustic signals when cracks are generated, and quantitatively described the stages of large fracture formation caused by the initiation and propagation of seismic cracks. Specifically, this study revealed the causes of various and complex forms of infrasonic precursors near the critical point and the causes of the time- and space-dependent characteristics of these precursors, such as a noticeable attenuation of the pulse number, a low frequency and a large amplitude, which verified the effectiveness of infrasonic anomalies as strong earthquake precursors.


Assuntos
Simulação por Computador , Desastres , Terremotos , Acústica , Planejamento em Desastres
19.
Front Immunol ; 12: 736036, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34659225

RESUMO

Background: Previous study revealed proton pump inhibitors (PPIs) have an effect on gut microbiota. Alteration of the microbiome causes changes of the host immune system and then induces the development of autoimmune diseases (ADs). This study aimed to explore the possible association between PPIs use and ADs. Methods: This study was conducted using data from the Taiwan National Health Insurance Research Database in the period between 2002 and 2015. We performed multivariate and stratified analysis through the Kaplan-Meier method and Cox proportional hazard models to estimate the association between proton pump inhibitor use and the risk of autoimmune diseases. Results: Of the 297,099 patients treated with PPI identified, the overall mean (SD) age was 49.17 (15.63) years and 56.28% of the subjects was male. As compared with the non-PPI group, the adjusted hazard ratio (aHR) were higher for incident organ specific ADs such as Graves disease (aHR=3.28), Hashmoto thyroiditis (aHR=3.61), autoimmune hemolytic anemia (aHR=8.88), immune thrombocytopenic purpura (aHR=5.05) Henoch-Schonlein pupura (aHR=4.83) and Myasthenia gravis (aHR=8.73). Furthermore, the adjusted hazard ratio (aHR) were also higher for incident systemic ADs such as ankylosing spondylitis (aHR=3.67), rheumatoid arthritis (aHR=3.96), primary Sjogren syndrome (aHR=7.81), systemic lupus erythemtoasus (aHR=7.03). systemic vasculitis (aHR=5.10), psoriasis (aHR=2.57), systemic scleroderma (aHR=15.85) and inflammatory myopathy (aHR=37.40). Furthermore, we observed no dose-dependent effect between PPI use and the risk of ADs. Conclusions: Our retrospective population-based cohort study showed that the prescription of proton pump inhibitors is associated with a higher risk of ADs.


Assuntos
Doenças Autoimunes/epidemiologia , Inibidores da Bomba de Prótons/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Autoimunes/diagnóstico , Bases de Dados Factuais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Taiwan/epidemiologia , Fatores de Tempo , Adulto Jovem
20.
Artigo em Inglês | MEDLINE | ID: mdl-34534283

RESUMO

OBJECTIVES: RA damages the joints and increases the risks of total knee replacement (TKR) and total hip replacement (THR). However, the benefits of biologics in preventing TKR or THR remain unclear. METHODS: This retrospective nationwide study used the 2000-2013 claims-based National Health Insurance dataset. Biologics are reimbursed for refractory cases. The risks of TKR and THR in the biologic cohort were compared with those of age- and sex-matched csDMARD cohort. A multivariate Cox regression model was used to investigate the benefits of bDMARDs for TKR and THR. RESULTS: TKR was performed in 5979 biologic cases and 11,958 matched controls, of which 249(4.16%) and 871(7.28%) cases received TKR, respectively. THR was performed in 6245 biologic cases and 12,490 matched controls, of which 159(2.55%) and 516(4.13%) cases had THR, respectively. The biologic cohort had significantly lower incidence rates of TKR (11.73 vs. 16.33/1000 person-years, P < 0.001) and THR (7.09 vs. 9.16/1000 person-years, P < 0.001). After adjustment for confounding factors, the regular bDMARD subgroup (average dose >0.95 defined daily dose/day) had significantly lower risks of TKR (aHR: 0.55, 95% CI: 0.38-0.81) and THR (aHR: 0.63, 95% CI: 0.40-0.98). Those without methotrexate use, with steroid use, with biologic switch, and overlapping antiphospholipid syndrome had significantly higher risks of TKR and THR. CONCLUSIONS: Compared with the csDMARD cohort, the risks of TKR and THR in the bDMARD cohort were the same as those in the low to moderate dose subgroups and significantly lower in those with regular bDMARD use.

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