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2.
Zhonghua Nei Ke Za Zhi ; 60(11): 987-992, 2021 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-34689520

RESUMO

Objective: To analyze the efficacy and safety of Daratumumab for the treatment of primary AL light chain systemic amyloidosis. Methods: Twenty one patients who were diagnosed as primary AL light chain systemic amyloidosis and treated with Daratumumab from 7 centers were retrospectively analyzed. Daratumumab was administrated as first line therapy in seven patients and 14 patients with relapsed settings. Hematological response, safety and survival were analyzed. Results: All 7 patients achieved very good partial response (VGPR) or better with first-line application of daratumumab. Three patients died, and the other four achieved organ remission. Among 14 relapsed patients, 2 patients had a difference of free light chain (dFLC) less than 20 mg/L before treatment, and 9 with a dFLC of more than 50 mg/L. All patients reached partial response (PR) or better, including 4 patients with complete response (CR), 3 with VGPR and 2 with PR. The response rate was 100% in 3 patients with dFLC 20-50 mg/L at baseline. The organ remission rate was 50% in patients with heart involvement and 58.3% in patients with kidney impairment. The overall median follow-up period was 5.3 months, and 11 months in surviving patients. One patient died of severe infection and disseminated intravascular coagulation (DIC) with stable amyloidosis. One patient switched to other regimens because dFLC elevated but did not fulfill progressive disease after 2 year application. As to safety, no grade 3/4 infusion reaction developed, and grade 1 infusion reaction occurred in 3 cases during the first infusion. Lymphocytopenia was seen in 75% patients including grade 3 or more in 30% patients. Conclusion: Daratumumab is effective to eliminate serum free light chain in both newly diagnosed and relapsed patients with systemic amyloidosis.


Assuntos
Amiloidose de Cadeia Leve de Imunoglobulina , Anticorpos Monoclonais/uso terapêutico , Humanos , Cadeias Leves de Imunoglobulina , Estudos Retrospectivos , Resultado do Tratamento
3.
Environ Pollut ; 291: 118131, 2021 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-34530241

RESUMO

Particulate matter emitted from vehicles (PMvehicle) represents a major air pollution source in urban areas. Ambient measurements of hopanes and elemental carbon have traditionally been coupled with the Chemical Mass Balance (CMB) model to quantify the contributions to fine PM from diesel and gasoline vehicular emissions (VE). The organic carbon part of PMvehicle, however, undergoes gas-particle partitioning and oxidation degradation as VE move from exhaust pipe to receptor sites. This creates an issue of deviation from mass conservation in the utility of CMB. The impact of this issue on quantifying PMvehicle has remained largely uncharacterized. In this study, we incorporate in CMB the gas-particle partitioning of VE organic aerosols and hopane oxidation, which is equivalent to adopting dynamic VE source profiles. The modified version of CMB is applied to quantify primary PMvehicle contributions at a roadside and a general urban site in Hong Kong. For the roadside site, the modified CMB reports predominant PMvehicle by diesel VE, a result consistent with previous studies. For the general urban site, the apportioned gasoline contribution by the modified CMB is tripled (0.8 ± 0.5 vs. 2.7 ± 2.1 µg/m3) while the diesel contribution is reduced by one third (1.7 ± 1.2 vs. 1.1 ± 1.2 µg/m3), producing a gasoline-diesel split significantly different from that by traditional CMB (1:2 vs. 5:2). Our work strongly indicates that a static representation of VE source profiles in CMB modeling would create flawed PMvehicle estimation and demonstrates the necessity of considering gas-particle partitioning of organic aerosol and hopane oxidation degradation.


Assuntos
Poluentes Atmosféricos , Emissões de Veículos , Aerossóis/análise , Poluentes Atmosféricos/análise , Monitoramento Ambiental , Material Particulado/análise , Triterpenos Pentacíclicos , Emissões de Veículos/análise
4.
Zhonghua Fu Chan Ke Za Zhi ; 56(8): 545-553, 2021 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-34420286

RESUMO

Objective: To study the risk factors of adverse pregnancy outcomes for induced abortion of cesarean scar pregnancy in midtrimester. Methods: A national multicenter retrospective study was conducted. A total of 154 singletons pregnant women with cesarean scar pregnancy during the second trimester induced abortion by various reasons in 12 tertiary A hospitals were selected, their pregnant outcomes were observed and the risk factors of serious adverse outcomes were analyzed with univariate and multivariate logstic regression; the role of ultrasound and MRI in predicting placenta accreta and severe adverse outcomes was evaluated, the effectiveness of uterine artery embolization (UAE) in preventing hemorrhage in pregnant women with and without placenta accreta was compared. Results: Among 154 subjects, the rate of placenta accreta was 42.2% (65/154), the rate of postpartum hemorrhage≥1 000 ml was 39.0% (60/154), the rate of hysterectomy was 14.9% (23/154), the rate of uterine rupture was 0.6% (1/154). The risk factor of postpartum hemorrhage≥1 000 ml and hysterectomy was placenta accreta (P<0.01). For each increase in the number of parity, the risk of placenta accreta increased 2.385 times (95%CI: 1.046-5.439; P=0.039); and the risk of placenta accreta decreased with increasing ultrasound measurement of scar myometrium thickness (OR=0.033, 95%CI: 0.001-0.762; P=0.033). The amount of postpartum hemorrhage and hysterectomy rate in the group with placenta accreta diagnosed by ultrasound combined with MRI were not significantly different from those in the group with placenta accreta diagnosed by ultrasound only or MRI only (all P>0.05). For pregnant women with placenta accreta, there were no significant difference in the amount of bleeding and hysterectomy rate between the UAE group [median: 1 300 ml; 34% (16/47)] and the non-embolization group (all P>0.05); in pregnant women without placenta accreta, the amount of bleeding in the UAE group was lower than that in the non-embolization group (median: 100 vs 600 ml; P<0.01), but there was no significant difference in hysterectomy rate [2% (1/56) vs 9% (3/33); P>0.05]. Conclusions: (1) Placenta accreta is the only risk factor of postpartum hemorrhage≥1 000 ml with hysterectomy for induced abortion of cesarean scar pregnancy in midtrimester; multi-parity and ultrasound measurement of scar myometrium thickness are risk factors for placenta accreta. (2) The technique of using ultrasound and MRI in predicting placenta accreta of cesarean scar pregnancy needs to be improved. (3) It is necessary to discuss of UAE in preventing postpartum hemorrhage for induced abortion of cesarean scar pregnancy in midtrimester.


Assuntos
Placenta Acreta , Embolização da Artéria Uterina , Cicatriz , Feminino , Humanos , Placenta Acreta/diagnóstico por imagem , Placenta Acreta/epidemiologia , Gravidez , Segundo Trimestre da Gravidez , Estudos Retrospectivos
5.
Zhonghua Yi Xue Za Zhi ; 101(22): 1631-1634, 2021 Jun 15.
Artigo em Chinês | MEDLINE | ID: mdl-34126710

RESUMO

To meet the challenges in the diagnosis and treatment of systemic light chain (AL) amyloidosis, the China Systemic Light Chain Amyloidosis Collaborative Group, together with multidisciplinary experts, developed the "Guideline for the Diagnosis and Treatment of Systemic Light Chain Amyloidosis" in 2016. In order to introduce progress in this field and better guide the clinical practice, the guideline has been updated recently. The in-depth understanding of AL amyloidosis has not only improved the level of diagnosis and treatment of the disease, but also promoted the integration of multiple disciplines, accelerated the development of clinical trials and the improvement of disease diagnosis and treatment modes.


Assuntos
Amiloidose , Amiloidose de Cadeia Leve de Imunoglobulina , Amiloidose/diagnóstico , Amiloidose/terapia , China , Humanos , Amiloidose de Cadeia Leve de Imunoglobulina/diagnóstico , Amiloidose de Cadeia Leve de Imunoglobulina/terapia
6.
Ann Oncol ; 32(4): 512-521, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33453391

RESUMO

BACKGROUND: This study evaluated maintenance treatment with niraparib, a potent inhibitor of poly(ADP-ribose) polymerase 1/2, in patients with platinum-sensitive recurrent ovarian cancer. PATIENTS AND METHODS: In this phase III, double-blind, placebo-controlled study conducted at 30 centers in China, adults with platinum-sensitive recurrent ovarian cancer who had responded to their most recent platinum-containing chemotherapy were randomized 2 : 1 to receive oral niraparib (300 mg/day) or matched placebo until disease progression or unacceptable toxicity (NCT03705156). Following a protocol amendment, patients with a bodyweight <77 kg or a platelet count <150 × 103/µl received 200 mg/day, and all other patients 300 mg/day, as an individualized starting dose (ISD). Randomization was carried out by an interactive web response system and stratified by BRCA mutation, time to recurrence following penultimate chemotherapy, and response to most recent chemotherapy. The primary endpoint was progression-free survival (PFS) assessed by blinded independent central review. RESULTS: Between 26 September 2017 and 2 February 2019, 265 patients were randomized to receive niraparib (n = 177) or placebo (n = 88); 249 patients received an ISD (300 mg, n = 14; 200 mg, n = 235) as per protocol. In the intention-to-treat population, median PFS was significantly longer for patients receiving niraparib versus placebo: 18.3 [95% confidence interval (CI), 10.9-not evaluable] versus 5.4 (95% CI, 3.7-5.7) months [hazard ratio (HR) = 0.32; 95% CI, 0.23-0.45; P < 0.0001], and a similar PFS benefit was observed in patients receiving an ISD, regardless of BRCA mutation status. Grade ≥3 treatment-emergent adverse events occurred in 50.8% and 19.3% of patients who received niraparib and placebo, respectively; the most common events were neutrophil count decreased (20.3% versus 8.0%) and anemia (14.7% versus 2.3%). CONCLUSIONS: Niraparib maintenance treatment reduced the risk of disease progression or death by 68% and prolonged PFS compared to placebo in patients with platinum-sensitive recurrent ovarian cancer. Individualized niraparib dosing is effective and safe and should be considered standard practice in this setting.


Assuntos
Neoplasias Ovarianas , Inibidores de Poli(ADP-Ribose) Polimerases , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica , China , Método Duplo-Cego , Feminino , Humanos , Indazóis , Quimioterapia de Manutenção , Recidiva Local de Neoplasia/tratamento farmacológico , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/genética , Piperidinas , Inibidores de Poli(ADP-Ribose) Polimerases/efeitos adversos
7.
Zhonghua Yi Xue Za Zhi ; 100(43): 3402-3406, 2020 Nov 24.
Artigo em Chinês | MEDLINE | ID: mdl-33238669

RESUMO

Objective: To explore the imaging features in age-related cerebral small vessel disease (ArCSVD) with idiopathic normal pressure hydrocephalus (INPH). Methods: Ten cases of age-related cerebral small vessel disease (CSVD) with idiopathic normal pressure hydrocephalus admitted to the Third Affiliated Hospital of Sun Yat-sen University from December 2015 to March 2020 were retrospective analyzed, all patients met the inclusion and exclusion criteria, and completed the head Magnetic resonance angiography plain scan, T2 fluid attenuated inversion recovery and Susceptibility Weighted Imaging sequence. Deep marrow venous signs (DMVs), INPH severity (DESH score), cortical/subcortical and deep microhemorrhages (CMBs) statistics, paraventricular and deep white matter damage (WMH) severity and CSVD imaging burden score were acquired, and correlations of DMVs and DESH scores with CMBs, WMH and Burden scores were evaluated using Spearman correlation analysis. Results: DMVs and DESH scores were significantly and positively correlated (r=0.965 9, P<0.000 1). DMVs and DESH scores were not significantly correlated with cortical/subcortical CMBs and deep CMBs. Likewise, DMVs and DESH scores were not significantly correlated with deep WMH. The WMH score of paraventricular of the 10 cases was 3 points, and the Burden score was 4 points. Conclusion: DMVs may be an indicator of the severity of ArCSVD with INPH, due to the small sample size of the current study, more cases are needed for further verification.


Assuntos
Doenças de Pequenos Vasos Cerebrais , Hidrocefalia de Pressão Normal , Substância Branca , Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , Humanos , Hidrocefalia de Pressão Normal/diagnóstico por imagem , Imageamento por Ressonância Magnética , Estudos Retrospectivos
9.
Zhonghua Yi Xue Za Zhi ; 100(13): 1002-1006, 2020 Apr 07.
Artigo em Chinês | MEDLINE | ID: mdl-32294857

RESUMO

Objective: To investigate the effects and value of dynamic contrast-enhanced (DCE) on diffusion-weighted imaging (DWI) score 3 in the prostate imaging data and reporting system version 2(PI-RADS V2)of peripheral zone. Methods: A retrospective study of consecutive 204 cases of prostate disease in peripheral zone was conducted from January 2015 to January 2018, including 169 cases of prostate cancer and 35 cases of non-prostate cancer. All cases were examined multi-parametric MR imaging on a 3-T MR scanner and confirmed by pathology. Images were analyzed according to PI-RADS V2.Inter-reader agreement of scores was evaluated by kappa coefficient. The constituent ratio of clinically significant prostate cancer (csPCa) in PI-RADS V2 overall scores 3, 3+1 and 4 were calculated and analyzed by non-parametric Chi-square test to determine whether the difference in composition ratio was significant. The positive rate of DCE in diffusion weighted imaging (DWI) score 3 and 4 were calculated. Results: There were 68.6%(140/204) cases in 204 patients with peripheral prostate disease who scored PI-RADS V2 overall score of 3,3+1 and 4. Kappa value was higher for the PI-RADS V2 overallscore of 4 than 3 or 3+1 in the PZ (k values of 0.802 vs 0.737 or 0.591, respectively; all P<0.01). The constituent ratio of csPCa in PI-RADS V2 overallscore of 3, 3+1 and 4 were 16.7%(3/18),43.2%(19/44),78.2%(61/78), the difference of which was significant (χ(2)=29.839, P<0.05).There was also a significant difference between the constituent ratio of csPCa in the score of 3+1 and 4 (χ(2)=15.286, P<0.01).The positive rate of DCE in cases of PI-RADS V2 overall score 3,3+1 and 4 was 76.4%(107/140).The positive rate of DCE incases of DWI score 3 and 4 were 71.0%(44/62), 80.8%(63/78),respectively. Conclusion: DCE has a certain value in PI-RADS V2 due to its high positive rate in the detection of prostate cancer in peripheral zone.DCE is helpful to DWI score 3 to improve the detection rate of csPCa.The PI-RADS V2 overall score 3+1 and 4 in the peripheral zone maybe need to be distinguished due to the different detection of csPCa.


Assuntos
Imageamento por Ressonância Magnética , Neoplasias da Próstata , Imagem de Difusão por Ressonância Magnética , Humanos , Masculino , Estudos Retrospectivos
10.
Eur Rev Med Pharmacol Sci ; 24(4): 1593-1601, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32141525

RESUMO

OBJECTIVE: Lid wiper epitheliopathy (LWE) has received more attention during the diagnosis and treatment of the dry eye. However, its causes and pathogenesis remain unclear. We aimed to explore the etiology of LWE by analyzing the association between the severity of LWE and different anatomical and tissue morphological examination characteristics using confocal microscopy on eyes with dry eye syndrome. PATIENTS AND METHODS: We recruited 350 patients with LWE and dry eye syndrome (350 eyes). We examined the eyes with lid-wiper staining, conjunctival staining, a comprehensive ocular surface exam using the OCULUS keratography 5M, conjunctival impression cytology, and confocal microscopy observations. We analyzed the associations between each indicator and the LWE staining score. RESULTS: According to the Spearman's analysis, the LWE staining score was weakly associated with thickness of the lipid layer (r=0.1737, p=0.0005) and severity of Meibomian gland dysfunction (r=0.2026, p<0.0001); and strongly associated with staging of conjunctival impression cytology (r= -0.7694, p<0.0001). Pearson's correlation analysis indicated that, LWE staining score was moderately associated with age (r=0.4165, p<0.0001), tear meniscus height (r=0 -0.4019, p<0.0001), and NIKBUT-first (noninvasive keratography tear film breakup time) (r= -0.5108, p<0.0001); and strongly associated with NIKBUT-average (r= -0.7820, p<0.0001) and ocular staining score (r=0.6113, p<0.00001). Some patients presented abnormal blinking. We observed deeper lesion depths and more holes and fissures in the lid wipers of patients with more severe LWE than in patients with milder LWE. CONCLUSIONS: Abnormal friction factors caused by insufficient lubrication between the lid wiper area and the ocular surface seem to influence the development and/or the severity of LWE. Aggravation of LWE further increases the frictional damage between the lid wiper and the ocular surface.


Assuntos
Síndromes do Olho Seco/diagnóstico , Adulto , Idoso , Túnica Conjuntiva/patologia , Córnea/patologia , Síndromes do Olho Seco/patologia , Pálpebras , Feminino , Humanos , Masculino , Microscopia Confocal , Pessoa de Meia-Idade , Adulto Jovem
12.
Sci Total Environ ; 672: 776-788, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-30974367

RESUMO

Vehicular emissions (VE) are among the major sources of airborne fine particulate matter (PM2.5) in urban atmospheres, which adversely impact the environment and public health. Receptor models are widely used for estimating PM2.5 source contributions from VE (PMvehicle), but often give inconsistent results due to different modelling principles and assumptions. During December 2015-May 2017, we collected nine-months of hourly organic carbon (OC) and elemental carbon (EC) data, as well as 24-h PM2.5 speciation data including major species and organic tracers on select days from an ad hoc roadside site in Hong Kong. The weekday vs. holiday and diurnal variations of EC tracked closely with those of traffic flow volume, indicating EC as a reliable tracer for PMvehicle in this area. We applied multiple approaches to estimate the PMvehicle, including the EC-tracer method with the hourly OC-EC data, and chemical mass balance (CMB) and positive matrix factorization (PMF) analyses with the filter-based speciation data. Considering source profile variability, CMB gave the lowest PMvehicle estimate among the three approaches, possibly due to the degradation of organic markers (i.e., hopanes). The PMvehicle derived from the EC-tracer method and PMF were comparable, accounting for ~12% (3.4-4.0 µg/m3) of PM2.5 averaged across 20 samples in both approaches, but a larger sample size is needed for a more robust PMF solution. The monthly PMvehicle derived from the EC-tracer method was in the range of 3.2-6.6 µg/m3. The continuous measurement reveals a decreasing trend in PMvehicle throughout the entire sampling period, indicating the effectiveness of a recent vehicle control measures implemented by the Government in phasing out pre-Euro IV diesel commercial vehicles. This work implies that hourly OC-EC monitoring at strategically located spots is an effective way of monitoring vehicle control measures. It provides reasonable estimate of PMvehicle through comparing with other more sophisticated receptor models.

13.
Zhonghua Fu Chan Ke Za Zhi ; 54(3): 166-172, 2019 Mar 25.
Artigo em Chinês | MEDLINE | ID: mdl-30893717

RESUMO

Objective: To explore the relationship between different types of female reproductive system dysplasia and age of visit, clinical manifestations, common types of combined malformations and endometriosis. Methods: The patient's medical records in the Second Hospital of Hebei Medical University from December 2002 to June 2016 were collected and retrospectively analyzed. Results: Among 924 cases of genital tract dysplasia, uterine dysplasia (65.3%, 824/1 261) was the most common, followed by vaginal dysplasia (28.3%, 357/1 261), hymen atresia and urogenital fistula (3.7%, 47/1 261), and cervical dysplasia (2.6%, 33/1 261). (1) The youngest age was in patients with hymen atresia and urogenital fistula, with a median of 14.5 years old, while the older age were in patients with uterine, vaginal and cervical dysplasia, with median age of 25.0, 24.0 and 23.0 years old, respectively. (2) The clinical manifestations were lack of specificity, mainly abnormal findings of physical examination or accessory examination, primary amenorrhea, lower abdominal pain, infertility, adverse pregnancy history. (3) About other systemic malformations, urological malformations were the most common (4.8%, 44/924), followed by spinal malformations (0.5%, 5/924), inguinal hernia (0.4%, 4/924), heart malformations (0.2%, 2/924), cleft lip and palate (0.2%, 2/924). Oblique vaginal septal syndrome and MRKH syndrome were the most likely to be associated with other system malformations. (4) About combination with endometriosis, there was no significant difference between obstructive genital tract malformations (2.3%, 9/385) and non obstructive genital tract malformations (1.7%, 9/539; P=0.469). Conclusions: Female reproductive system dysplasia is the most common in uterine dysplasia, followed by vaginal dysplasia, hymen atresia and urogenital fistula, and cervical dysplasia. The age of visit is generally older, often found by abnormal findings of physical examination or accessory examination, primary amenorrhea, lower abdominal pain, infertility, adverse pregnancy history;and could be combined with a variety of other system malformations, most seen by urinary system malformations,there is also the risk of endometriosis.


Assuntos
Genitália Feminina/anormalidades , Anormalidades Urogenitais , Adolescente , Feminino , Humanos , Hímen/anormalidades , Gravidez , Estudos Retrospectivos , Útero/anormalidades , Útero/cirurgia , Vagina/anormalidades
14.
J Hazard Mater ; 365: 53-63, 2019 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-30408687

RESUMO

Using molecularly imprinted polymer as a selective adsorbent for gaseous toxicants is a novel attempt. In present work, a nicotine surface-imprinted monolith (MIM) was used for the selective removal of nicotine from smoke. First, the retention capacity and selectivity for this MIM was tested by using it as the stationary phase in gas chromatography and chromatographic conditions optimized. Then, the gas phase adsorption isotherms of MIM were constructed and the adsorption thermodynamics explored. At last, the applicability for MIM in the removal of nicotine in smoke was explored. Results indicated a stronger retention capacity and a higher selectivity of MIM toward the template vapor, with a capacity factor (87.88) and a selectivity factor (10.15) under the optimized conditions. A higher standard adsorption enthalpy change for this MIM toward the template (ΔHa0 = 65.53 kJ mol-1) than that for the non-imprinted monolith (NIM) column (ΔHa0 = 47.46 kJ mol-1) was observed. The adsorption isotherm for MIM appears the BET type II shape, while that for the NIM was approximately linear. When this MIM was used as the adsorbent, it exhibited a high performance in the selective removal of nicotine from the main stream smoke, with an adsorption percentage of 99.43%.

15.
Zhonghua Yi Xue Za Zhi ; 98(28): 2242-2245, 2018 Jul 24.
Artigo em Chinês | MEDLINE | ID: mdl-30078278

RESUMO

Objective: To discover frequently mutated new gastric cancer-related genes by exome sequencing technology and to analyze mutated their relationships with different clinicopathological phenotypes of gastric cancer. Methods: Tumor samples of gastric cancers and preoperative peripheral blood samples from 30 patients were collected respectively from January to March, 2016 in the department of general surgery, Chinese PLA General Hospital. Exome sequencing on samples were performed. Using peripheral bloods as control, mutations in tumor samples were discovered by Mutect and Varscan. Frequently mutated gastric cancer-related genes were defined as genes mutated more frequently than TP53. Difference between the mutant and wild-type of certain genes were compared on common clinicopathological phenotypes, such as age, gender, tumor position, differentiation, metastasis lymph nodes, etc. Results: There were 27 frequently mutated genes were founded, most of which showed no relationship with clinicopathological phenotypes of gastric cancer. Cases with mutant and wild-type TAS2R43 showed statistically significant difference in gastric body cancer(55.6% vs 9.5%, P=0.022). Cases with mutant and wild-type ANKRD36C showed statistically significant difference in gastric body cancer (62.5% vs 9.1%, P=0.005). Cases with mutant and wild-type ANKRD36 showed statistically significant difference in proximal gastric cancer (8.33% vs 44.4%, P=0.049). Cases with mutant SYNE1 suffer from less metastatic lymph nodes than those with wild types(2.1±2.4 vs 8.8±9.5, P=0.006). Cases with mutant ADAR are younger than those with wild types(50.7±11.5 year vs 64.0±9.8 year, P=0.006). Conclusion: Mutant TAS2R43, ANKRD36 and ANKRD36C were related to location of gastric cancer. Mutant SYNE1 was related to gastric cancer with less lymph nodes metastasis. Mutant ADAR may lead to gastric cancers in younger groups.


Assuntos
Exoma , Humanos , Metástase Linfática , Mutação , Fenótipo , Neoplasias Gástricas
16.
Zhonghua Wai Ke Za Zhi ; 56(1): 47-51, 2018 Jan 01.
Artigo em Chinês | MEDLINE | ID: mdl-29325353

RESUMO

Objective: To compare the short-term and long-term outcome between robotic gastrectomy and laparoscopic gastrectomy. Methods: The clinical data of 517 patients who had received robotic gastectomy and laparoscopic gastrectomy between December 2011 and December 2013 at Department of General Surgery, Chinese People's Liberation Army General Hospital was collected. After propensity score matching, 70 patients in robotic gastectomy and 70 patients in laparoscopic gastectomy were identified. Perioperative outcome and overall survival were compared between the two groups using t test, χ(2) test, Kaplan-Meier curve and Log-rank test, respectively. Prognosis factors were analyzed by Cox's proportional hazards regression. Results: There were comparable baseline characteristics between patients in robotic group (RG) and those in laparoscopic group (LG). The conversion rate for RG and LG were 5.7% and 4.3% respectively (P=1.000). Compared with LG, RG had similar lymph node retrieval (25.5±7.2 vs. 24.5±8.3, t=0.770, P=0.443) and less blood loss ((147.0±96.8) ml vs. (188.0±111.2) ml, t=-2.326, P=0.021). There were also similar complications (χ(2)=0.233, P=0.629) and severity of complications (W=70.500, P=0.053). Although there tended to be early mobility, early flatus and less hospital stay for patients in RG group, the difference between RG and LG was not statistically significant. The 3-year survival rate was 72.9% and 60.0% for patients in RG and patients in LG (P=0.578). Multivariable analysis revealed gender (HR=2.529, 95% CI: 1.042 to 6.140, P=0.040), neoadjuvant chemotherapy (HR=0.272, 95% CI: 0.104 to 0.710, P=0.008) and vascular invasion (HR=2.135, 95% CI: 1.027 to 4.438, P=0.042) were independent prognostic factors. Conclusion: Compared with laparoscopic gastrectomy, robotic gastectomy could achieve similar short-term and long-term outcomes.


Assuntos
Gastrectomia , Procedimentos Cirúrgicos Robóticos , Neoplasias Gástricas , Gastrectomia/métodos , Humanos , Laparoscopia , Pontuação de Propensão , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia , Resultado do Tratamento
17.
J Clin Pharm Ther ; 43(3): 414-421, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29247451

RESUMO

WHAT IS KNOWN AND OBJECTIVE: The primary objective of this study was to compare the pharmacokinetics of dexmedetomidine in patients with end-stage renal failure and secondary hyperparathyroidism with those in normal individuals. METHOD: Fifteen patients with end-stage renal failure and secondary hyperparathyroidism (Renal-failure Group) and 8 patients with normal renal and parathyroid gland function (Control Group) received intravenous 0.6 µg/kg dexmedetomidine for 10 minutes before anaesthesia induction. Arterial blood samples for plasma dexmedetomidine concentration analysis were drawn at regular intervals after the infusion was stopped. The pharmacokinetics were analysed using a nonlinear mixed-effect model with NONMEM software. The statistical significance of covariates was examined using the objective function (-2 log likelihood). In the forward inclusion and backward deletion, covariates (age, weight, sex, height, lean body mass [LBM], body surface area [BSA], body mass index [BMI], plasma albumin and grouping factor [renal failure or not]) were tested for significant effects on pharmacokinetic parameters. The validity of our population model was also evaluated using bootstrap simulations. RESULTS AND DISCUSSION: The dexmedetomidine concentration-time curves fitted best with the principles of a two-compartmental pharmacokinetic model. No covariate of systemic clearance further improved the model. The final pharmacokinetic parameter values were as follows: V1  = 60.6 L, V2  = 222 L, Cl1  = 0.825 L/min and Cl2  = 4.48 L/min. There was no influence of age, weight, sex, height, LBM, BSA, BMI, plasma albumin and grouping factor (renal failure or not) on pharmacokinetic parameters. Although the plasma albumin concentrations (35.46 ± 4.13 vs 44.10 ± 1.12 mmol/L, respectively, P < .05) and dosage of propofol were significantly lower in the Renal-failure Group than in the Control Group (81.68 ± 18.08 vs 63.07 ± 13.45 µg/kg/min, respectively, P < .05), there were no differences in the context-sensitive half-life and the revival time of anaesthesia between the 2 groups. WHAT IS NEW AND CONCLUSION: The pharmacokinetics of dexmedetomidine were best described by a two-compartment model in our study. The pharmacokinetic parameters of dexmedetomidine in patients with end-stage renal failure and hyperparathyroidism were similar to those in patients with normal renal function. Further studies of dexmedetomidine pharmacokinetics are recommended to optimize its clinical use.


Assuntos
Dexmedetomidina/farmacocinética , Hiperparatireoidismo Secundário/fisiopatologia , Hipnóticos e Sedativos/farmacocinética , Falência Renal Crônica/complicações , Adulto , Anestesia Geral/métodos , Estudos de Casos e Controles , Dexmedetomidina/administração & dosagem , Feminino , Meia-Vida , Humanos , Hipnóticos e Sedativos/administração & dosagem , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Dinâmica não Linear , Propofol/administração & dosagem
18.
Zhonghua Xin Xue Guan Bing Za Zhi ; 45(10): 848-851, 2017 Oct 24.
Artigo em Chinês | MEDLINE | ID: mdl-29081173

RESUMO

Objective: To evaluate the clinical characteristics and prognosis of patients with mitral valve prolapse (MVP). Methods: We retrospectively analyzed the clinical characteristics and prognosis of 148 MVP patients who underwent mitral valve surgery in Fuwai hospital from January 2012 to December 2015.The patients were divided into mucoid degeneration group (52 cases) and without mucoid degeneration group(19 cases) according to pathological examination of leaflets and chordate. Results: The clinical symptoms of MVP patients included dyspnea (59.5%(88/148)), chest distress and pain (52.7%(78/148)), and palpitations (36.5% (54/148)). Mitral valve repair was performed in 144 cases (97.3%), and mitral valve replacement was performed in 4 cases (2.7%). Posterior leaflet prolapse was the most common form of MVP (68.9%, 102/148). Pathological examination revealed myxomatous degeneration in 73.2% patients (52/71), fibrosis in 8.5% patients (6/71), and fibrinoid necrosis in 8.5% patients (6/71). Patients with mucoid degeneration had less atrial fibrillation before surgery (5.8%(3/52) vs. 42.1%(8/19), P<0.01), smaller preoperative left atrium diameter ((43.2±6.5) mm vs. (48.2±8.9) mm, P<0.05), more posterior leaflet prolapse (94.2%(49/52) vs. 63.2%(12/19), P<0.01), redundant chordae (26.9%(14/52) vs. 0, P<0.05) and leaflet thickening (76.9%(40/52) vs. 52.6%(10/19), P<0.05) when compared with patients without mucoid degeneration.Echocardiography examination at the postoperative follow-up of 39.0(22.3, 57.0) months revealed smaller left atrium diameter((38.5±7.1) mm vs. (45.3±8.3) mm, P<0.01), left ventricular end-diastolic diameter ((48.9±6.2) mm vs. (57.5±7.6) mm, P<0.01), reduced left ventricular ejection fraction ((61.2±7.1)% vs. (65.1±6.2)%, P<0.01) and less moderate or severe mitral regurgitation (1.4%(2/148) vs. 100.0%(148/148), P<0.01) compared with the corresponding preoperative values. Conclusions: Dyspnea is the main symptom, and mucoid degeneration characterized by redundant chordae and leaflet thickening are the main pathological features of MVP patients.The surgical treatment of MVP patients is related with satisfactory outcome results.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Ecocardiografia , Prolapso da Valva Mitral , Diástole , Seguimentos , Humanos , Valva Mitral , Insuficiência da Valva Mitral , Prolapso da Valva Mitral/patologia , Prolapso da Valva Mitral/cirurgia , Prognóstico , Estudos Retrospectivos , Função Ventricular Esquerda
19.
Environ Sci Technol ; 51(12): 6791-6801, 2017 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-28549212

RESUMO

Monoterpenes, a major class of biogenic volatile organic compounds, are known to produce oxidation products that further react with sulfate to form organosulfates. The accurate quantification of monoterpene-derived organosulfates (OSs) is necessary for quantifying this controllable aerosol source; however, it has been hampered by a lack of authentic standards. Here we report a unified synthesis strategy starting from the respective monoterpene through Upjohn dihydroxylation or Sharpless asymmetric dihydroxylation followed by monosulfation with the sulfur trioxide-pyridine complex. We demonstrate the successful synthesis of four monoterpene-derived OS compounds, including α-pinene OS, ß-pinene OS, limonene OS, and limonaketone OS. Quantification of OSs is commonly achieved using liquid chromatography-mass spectrometry (LC-MS) by either monitoring the [M-H]- ion or through multiple reaction monitoring (MRM) of mass transitions between the [M-H]- and m/z 97 ions. Comparison between the synthesized standards and previously adopted quantification surrogates reveals that camphor-10-sulfonic acid is a better quantification surrogate using [M-H]- as the quantification ion, while the highly compound-specific nature of MRM quantification makes it difficult to choose a suitable surrogate. Both could be rationalized in accordance to their respective MS quantification mechanisms. The in-house availability of the authentic standards enables us to discover that ß-pinene OS, due to the sulfate group at the primary carbon, partially degrades to a dehydrogenated OS compound during LC/MS analysis and a hydroperoxy OS over a prolonged storage period (>5 month) and forms a regioisomer through intermolecular isomerization. Limonene OS was positively identified for the first time in ambient samples and found to be more abundant than α-/ß-pinene OS in the Pearl River Delta, China. This work highlights the critical importance of having authentic standards in advancing our understanding of the interactions between biogenic VOC emissions and anthropogenic sulfur pollution.


Assuntos
Aerossóis , Monoterpenos , Monoterpenos Bicíclicos , Compostos Bicíclicos com Pontes , China , Monitoramento Ambiental
20.
Zhonghua Nei Ke Za Zhi ; 56(3): 184-187, 2017 Mar 01.
Artigo em Chinês | MEDLINE | ID: mdl-28253598

RESUMO

Objective: To evaluate the clinical characteristics and risk factors for atrial fibrillation(AF)in patients with obstructive hypertrophic cardiomyopathy(OHCM). Methods: Patients with OHCM hospitalized in Fuwai Hospital from March 2011 to January 2016 were enrolled in the present study. Each patient underwent examinations including transthoracic echocardiography, body surface electrocardiograph or dynamic electrocardiogram (Holter). Cardiac troponin I (cTNI) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP)levels were tested and clinical profiles were collected.The subjects were divided into two groups (the AF group and non-AF group). Risk factors for AF in patients with OHCM were assessed by multivariate logistic regression analysis. Results: A total of 309 patients were evaluated in the study. Among them, 17.5%( 54/309) patients were with AF.Age[(51.2±10.1)years vs (43.1 ± 14.4)years], New York Heart Association class(NYHA class)(2.8±0.5 vs 2.6±0.6), disease duration[6.0(4.0, 10.0)years vs 3.0(1.0, 6.0)years], left atrial (LA) dimension[(45.1±7.0)mm vs(42.6 ± 7.4)mm]and NT-pro-BNP levels[2 007(1 565, 3 199)pmol/L vs 1 509(729, 2 921)pmol/L]in the AF group were significantly higher than those in the non-AF group (all P<0.05). Multivariate logistic regression analysis indicated that advanced age(OR=1.04, 95% CI 1.01-1.08, P<0.01), higher NYHA class(OR=2.00, 95% CI 1.08-3.70, P<0.05)and longer disease duration(OR=1.08, 95% CI 1.01-1.15, P<0.05)were independent risk factors for AF in patients with OHCM, in which advanced age(OR=1.05, 95% CI 1.02-1.09, P<0.01), higher NYHA class(OR=3.39, 95% CI 1.53-7.54, P<0.01), LA dimension(OR=1.06, 95% CI 1.01-1.12, P<0.05)and longer clinical course(OR=1.12, 95% CI 1.04-1.20, P<0.01)were associated with AF in male patients, and advanced age (OR=1.05, 95% CI 1.01-1.09, P<0.05)and longer disease duration(OR=1.14, 95% CI 1.01-1.28, P<0.01)were associated with AF in female patients when stratified by gender. Conclusion: Advanced age , higher NYHA class and longer clinical duration are independent risk factors for AF in OHCM patients.


Assuntos
Fibrilação Atrial/sangue , Cardiomiopatia Hipertrófica/sangue , Ecocardiografia , Eletrocardiografia , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Idoso , Doenças Cardiovasculares , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
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