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1.
Zhonghua Wei Chang Wai Ke Za Zhi ; 24(3): 230-239, 2021 Mar 25.
Artigo em Chinês | MEDLINE | ID: mdl-34645167

RESUMO

Objective: Peritoneal carcinomatosis refers to a group of heterogeneous (primary or secondary) malignancies in the surface of the peritoneum. Cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) is a comprehensive treatment strategy aiming at peritoneal carcinomatosis. This study analyzed the efficacy and safety of CRS+HIPEC in patients with peritoneal carcinomatosis, and explored prognostic factors. Methods: In this descriptive case-series study, the clinicopathological data of 1384 consecutive patients with peritoneal carcinomatosis treated in Zhongnan Hospital of Wuhan University (330 patients) and Shijitan Hospital of Capital Medical University (1054 patients) from January 2004 to January 2020 were collected retrospectively. Treatment patterns of CRS+HIPEC characteristics (operative time, number of resected organs, number of stripped peritoneum, number of anastomosis, and HIPEC regimens), safety [blood loss volume, postoperative severe adverse event (SAE) and treatment outcome], survival time and prognostic factors influencing survival were analyzed. The SAE was defined as grade III-IV adverse event according to the Peritoneal Surface Oncology Group International Textbook. Perioperative period was defined from the day of CRS+HIPEC to postoperative 30th day. OS was calculated from the day of CRS+HIPEC to the date of death or the last follow-up. Kaplan-Meier method was used for survival analysis, and log-rank test was used for comparison between groups. Cox regression model was used to identify the prognostic factors. Results: Among 1384 peritoneal carcinomatosis patients, 529 (38.2%) were male; median age was 55 (10-87) years old; median body mass index (BMI) was 22.6 kg/m(2); peritoneal carcinomatosis of 164 (11.8%) patients were from gastric cancer, 287 (20.7%) from colorectal cancer, 356 (25.7%) from pseudomyxoma peritonei, 90 (6.5%) from malignant peritoneal mesothelioma, 300 (21.7%) from gynecological cancer or primary peritoneal carcinoma, and 187 (13.5%) from retroperitoneal sarcoma, lung cancer, breast cancer, and other rare tumors. The median duration of CRS+HIPEC was 595 (90-1170) minutes, median number of resected organs was 2 (0-10), median number of resected peritoneal area were 4 (0-9), median peritoneal cancer index (PCI) was 21(1-39). Completeness of cytoreduction (CC) score of 0-1 was observed in 857 cases (61.9%). Regarding HIPEC regimens, there were 917 cases (66.3%) with cisplatin plus docetaxel, 183 cases (13.2%) with cisplatin plus mitomycin, 43 cases (3.1%) with adriamycin plus ifosfamide, and the other 240 cases (17.3%) with modified regimens. Perioperative SAE developed in 331 peritoneal carcinomatosis patients (23.9%) with 500 cases, of whom 21 patients (1.5%) died during the perioperative period due to ineffective treatment, while the others recovered after active treatment. During median follow-up time of 8.6 (0.3-82.7) months, there were 414 deaths (29.9%). The median OS was 38.2 months (95% CI: 30.6-45.8), and the 1-, 3-, 5-year survival rate was 73.5%, 50.4% and 39.3%, respectively. The median OS of peritoneal carcinomatosis patients from gastric cancer, colorectal cancer, pseudomyxoma peritonei, malignant peritoneal mesothelioma and female genital cancer or primary peritoneal carcinomatosis was 11.3 months (95% CI: 8.9-13.8), 18.1 months (95% CI: 13.5-22.6), 59.7 months (95% CI: 48.0-71.4), 19.5 months (95% CI: 6.0-33.0) and 51.7 months (95% CI: 14.6-88.8), respectively, and the difference among groups was statistically significant (P<0.001). Univariate and multivariate analyses revealed that the primary gastric cancer (HR=4.639, 95% CI: 1.692-12.724), primary colorectal cancer (HR=4.292, 95% CI: 1.957-9.420), primary malignant peritoneal mesothelioma (HR=2.741, 95% CI: 1.162-6.466), Karnofsky performance status (KPS) score of 60 (HR=4.606, 95% CI: 2.144-9.895), KPS score of 70 (HR=3.434, 95% CI: 1.977-5.965), CC score of 1 (HR=2.683, 95% CI: 1.440~4.999), CC score of 2-3 (HR=3.661,95% CI: 1.956-6.852) and perioperative SAE (HR=2.588, 95% CI: 1.846-3.629) were independent prognostic factors influencing survival with statistically significant differences (all P<0.05). Conclusions: CRS+HIPEC is an effective integrated treatment strategy for patients with peritoneal carcinomatosis, which can prolong survival with acceptable safety. Preoperative evaluation of patients' general condition is necessary and CRS+HIPEC should be carefully considered to perform for patients with preoperative KPS score <80. During the operation, the optimal CRS should be achieved on condition that safety is granted. In addition, it is necessary to prevent perioperative SAE to reduce the risk of death in peritoneal carcinomatosis patients.

2.
Eur Rev Med Pharmacol Sci ; 25(18): 5597-5609, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34604952

RESUMO

OBJECTIVE: Pyroptosis is correlated with programmed tumor cell death and the tumor microenvironment. However, the prognostic value of pyroptosis-associated long non-coding RNAs (lncRNAs) in skin cutaneous melanoma (SKCM), a malignant tumor with a poor prognosis, has not been established. PATIENTS AND METHODS: In this study, expression profiles and clinical data of patients with SKCM were downloaded from The Cancer Genome Atlas (TCGA) database to identify differentially expressed pyroptosis-related lncRNAs related to overall survival. A lncRNA risk signature was constructed by Cox regression analyses and its prognostic value was evaluated. Associations between the lncRNA signature and immune status, immune microenvironment, tumor stemness, immune checkpoints, and m6A-related genes were further evaluated. RESULTS: Twenty-two pyroptosis-related lncRNAs were identified and incorporated into a prognostic risk signature. The signature was significantly correlated with overall survival, tumor growth, and metastasis in SKCM. The signature demonstrated better diagnostic accuracy than conventional clinicopathological characteristics. A gene set enrichment analysis indicated that the risk signature was enriched in several immune-related pathways. Furthermore, the risk signature was significantly correlated with the immune microenvironment, immune cell infiltration, and immune subtypes, as well as tumor stem cells and some m6A-related genes. The lncRNA expression levels were also significantly related to responses to several anti-tumor drugs. Finally, a nomogram based on the risk score was established. CONCLUSIONS: Overall, a risk signature based on 22 pyroptosis-associated lncRNAs was generated, providing a novel perspective on the determinants of prognosis and survival in SKCM and a basis for the development of individualized treatments.

3.
Zhonghua Yu Fang Yi Xue Za Zhi ; 55(2): 245-252, 2021 Feb 06.
Artigo em Chinês | MEDLINE | ID: mdl-34645187

RESUMO

Objective: To investigate the feasibility of application of non-fasting dyslipidemia cutoff values in community population. Methods: Self-control study was used. 839 physical examinees (292 males and 547 females) were recruited in clinical laboratory of Guang'an men Hospital from January to October 2018. The median (interquartile range) of age was 60 (54, 66) years. Blood samples were collected before and at 4 h after a standard breakfast. Comparison of fasting and postprandial lipoprotein levels was performed using Paired-Samples T Test or Two-Related-Samples Wilcoxon. The changes of 4-hour postprandial blood lipid levels and the percentages of postprandial dyslipidemia according to different stratification of fasting dyslipidemia were performed using one-way ANOVA and χ2 test, respectively. Results: Compared with fasting, 4-hour postprandial total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), non-high density lipoprotein cholesterol (non-HDL-C), apolipoprotein A1 (ApoA1) and apolipoprotein B (ApoB) decreased slightly, postprandial triglyceride (TG) increased by 0.72 mmol/L, and postprandial remnant-like lipoprotein cholesterol (RLP-C) increased by 0.27 mmol/L (t or Z values = 10.26,22.94,24.22,4.71,16.61,26.92,-23.58,-19.35, P<0.05, respectively). According to the non-fasting dyslipidemia cut-off values recommended by the European consensus, there were 10%, 16.6%, 10.1%, 12.3%, 30% and 34.9% of the population in the appropriate levels of fasting TC, LDL-C, HDL-C, non-HDL-C, TG and RLP-C distributed in elevated levels of postprandial, respectively. The changes of 4-hour postprandial TC, LDL-C, non-HDL-C and HDL-C increased with the elevation of fasting level (F=9.50,6.18,8.07,3.86,P<0.01), and the maximum changes of TC≤3.5%, LDL-C≤6.8%, non-HDL-C≤2.9%, HDL-C≤6.3%; the change of 4-hour postprandial TG increased slightly first and then decreased significantly (51.3% vs. 57.9% vs. 39.2%, F=19.05, P<0.01); the change of 4-hour postprandial RLP-C decreased (50.8% vs. 33.2%, F=10.40, P<0.01). The cut-off values of 4-hour postprandial dyslipidemia were TC ≥5.1 mmol/L, LDL-C ≥3.2 mmol/L, HDL-C ≤0.9 mmol/L, non-HDL-C ≥4.0 mmol/L and RLP-C ≥1.0 mmol/L. The cut-off values of borderline elevated and elevated TG levels were ≥2.2 mmol/L and ≥3.4 mmol/L, respectively. Conclusions: The cut-off values of postprandial dyslipidemia including TC, LDL-C, HDL-C, non-HDL-C and RLP-C were preliminarily established in community population, which could be applied to the routine lipid profile evaluation in the physical examination population. And it might be needed that postprandial TG was managed hierarchically according to different cut-off values.


Assuntos
Jejum , Lipídeos , Pequim , HDL-Colesterol , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exame Físico , Triglicerídeos
4.
Artigo em Chinês | MEDLINE | ID: mdl-34666443

RESUMO

Objective: To indicate the clinical features of endoscopic transnasal resection of epidural cholesteatoma at paracentral skull base and to analyze its efficacy. Methods: The total excision rate, postoperative complications and postoperative curative effect of 7 patients (4 males and 3 females, aging from 32 to 63 years old) who underwent middle skull base surgery for epidural cholesteatoma resection under transnasal endoscope at Tianjin Huanhu Hospital between August 2017 and August 2020 were retrospectively reviewed. All patients were followed up for 6 to 36 months. The postoperative MRI, clinical symptoms and recurrence were reviewed. Descriptive statistical methods were used for analysis. Results: Among the 7 patients, there were total resection (complete resection of cyst contents and capsule) in 4 patients, near-total resection (complete resection of cyst contents, incomplete resection of cyst capsule) in 1 patient, and subtotal resection (incomplete resection of cyst contents and capsule) in 2 patients. The clinical symptoms of all patients were improved postoperatively with 1 patient who had no clinical symptoms. One case had postoperative cerebrospinal fluid rhinorrhea, which was cured after lumbar drainage and nasal iodoform gauge packing. Up to now, 7 patients (including patients with partial resection) had no recurrence. Conclusion: Endoscopic transnasal approaches may be effectively used for resection of epidural cholesteatoma in the paracentral skull base in carefully selected cases.

5.
J Crit Care ; 67: 21-25, 2021 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-34624699

RESUMO

The mechanical power (MP) is the energy delivered into the respiratory system over time. It can be computed as a direct measurement of the inspiratory area of the airway pressure and volume loop during the respiratory cycle or calculated by "power equations". The absence of a bedside computation limited its widespread use. Recently, it has been developed an automatic monitoring system inside of a mechanical ventilator. PURPOSE: Our aim was to investigate the repeatability and the accuracy of the measured MP at different PEEP values and tidal volume compared with the calculated MP. MATERIAL AND METHODS: MP was measured and calculated in sedated and paralyzed ARDS patients at low and high tidal volume, at 5-10-15 cmH2O of PEEP both in volume and pressure-controlled ventilation. The same measurements were performed twice. RESULTS: Fifty ARDS patients were enrolled. MP was measured and calculated for a total of 300 measurements. The bias and limits of agreement were 0.38 from -1.31 to 2.0 J/min. The measured and calculated MP were similar in each ventilatory condition. CONCLUSIONS: The mechanical power measured by a new automatic real time system implemented in a mechanical ventilator was repeatable and accurate compared with the computed one.

7.
Eur Rev Med Pharmacol Sci ; 25(16): 5071, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34486679

RESUMO

The article "Regulation by Pink1 on the mitochondrial dysfunction in endothelial cells post the hypoxia mimetic agent CoCl2 treatment, by G.-H. Liu, Y. Wen, P. Yang, G.-F. Liu, published in Eur Rev Med Pharmacol Sci 2018; 22 (17): 5704-5711-DOI: 10.26355/eurrev_201809_15838-PMID: 30229848" has been withdrawn from the authors due to inaccuracies (severe contamination of HeLa cell for A549 and NCI-H460s). The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/15838.

8.
Zhonghua Yi Xue Za Zhi ; 101(34): 2662-2666, 2021 Sep 14.
Artigo em Chinês | MEDLINE | ID: mdl-34510871

RESUMO

Primary aldosteronism (PA) patients diagnosed with aldosterone-producing adenoma and unilateral adrenal hyperplasia are preferred for surgical treatment.The aim of the operation is to remove the hypersecretory aldosterone tissue of adrenal and to improve the prognosis.Current studies have shown that both partial adrenalectomy and total adrenalectomy can achieve clinical cure for PA, but the choice of surgical methods is still controversial. This paper discusses the efficacy and safety, postoperative changes in cortisol level, postoperative recurrence and surgical techniques of different surgical methods in the treatment of different PA subtypes, so as to find the best surgical methods for different PA subtypes and to maximize the benefits for patients.


Assuntos
Adenoma , Hiperaldosteronismo , Adenoma/cirurgia , Glândulas Suprarrenais , Adrenalectomia , Aldosterona , Humanos , Hiperaldosteronismo/cirurgia , Recidiva Local de Neoplasia
9.
Zhonghua Yi Xue Za Zhi ; 101(34): 2681-2685, 2021 Sep 14.
Artigo em Chinês | MEDLINE | ID: mdl-34510874

RESUMO

Objective: To explore the potential application of a three-dimensional visualization technique in adrenal vein sampling (AVS). Methods: The clinical data were retrospectively analyzed, which included 76 patients with primary aldosteronism (PA) who have undergone AVS in Guizhou Provincial People's Hospital from December 2017 to May 2020. All cases were examined by adrenal thin-section enhanced CT and blood was drawn by bilateral AVS. Among them, the adrenal vein blood of 46 cases was sampled with the help of three-dimensional (3D) visualization processing of CT data, while that of 30 cases was without 3D visualization processing. The rate of the catheter in place, the successful rate of AVS, the time of blood collection, the dosage of the contrast agent, and surgical complications were compared between the two groups. Results: There were 76 cases included, while 38 were male and 38 were female. The average age was 45 (25-57) years. Compared with the patients without the aid of 3D visualization, the success rate of right AVS of the patients with the aid of 3D visualization technology increased from 43% to 78% (P<0.05). The success rate of adrenal vein blood collection increased from 53% to 83%. The dose of contrast agent decreased [the M(Q1,Q3) were78 (59, 89) ml vs 28 (16, 51) ml, P<0.05], and the time of blood sampling from the right adrenal vein approximately decreased [the M(Q1,Q3) were 70 (66, 88) min vs 44 (22, 61) min, P<0.05]. Compared with the case without the aid of 3D visualization, the left adrenal vein catheterization rate of patients in the 3D visualization group increased from 97% to 98%, the success rate of adrenal vein blood collection increased from 97% to 98%, and the differences of the time of blood sampling and the dosage of the contrast were not statistically significant between the two groups. Among all the cases experienced bilateral AVS, only one patient without 3D reconstruction had contrast extravasation, and the others had no obvious complications. Conclusions: Before AVS, 3D visualization processing of adrenal vein from CT data is capable of increasing the success rate of blood sampling from the right adrenal vein, as well as reducing the dosage of contrast agent and the time of adrenal vein blood sampling. Therefore, it has a potential clinical value of the application.


Assuntos
Hiperaldosteronismo , Imageamento Tridimensional , Glândulas Suprarrenais/diagnóstico por imagem , Aldosterona , Coleta de Amostras Sanguíneas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
10.
Nan Fang Yi Ke Da Xue Xue Bao ; 41(8): 1226-1233, 2021 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-34549715

RESUMO

OBJECTIVE: We propose an efficient method to reduce the noise in low-dose cerebral perfusion CT images using prior image constrained diffusion tensor to reduce the radiation dose in brain CT examination. METHODS: By utilizing the redundant information in cerebral perfusion CT images, we embedded the complementary structure information in prior images into lowdose cerebral perfusion CT image restoration process to suppress the image noise and artifacts.We first calculated the diffusion tensor for the low-dose cerebral perfusion CT image and prior image separately and then constructed a prior image constrained diffusion tensor (PICDT) to incorporate the structure information from the prior image into low-dose image restoration process. RESULTS: In experiments with the Shepp-Logan phantom, the SSIM value of CBF map obtained by the proposed algorithm was increased by 63% as compared with that of the FBP algorithm.In analysis of the clinical dataset, the SSIM value of CBF map obtained by the proposed algorithm was increased by 45% as compared with that of FBP algorithm. CONCLUSION: The proposed method can effectively reduce noises and artifacts of low-dose cerebral perfusion CT images while maintaining the structural details to obtain accurate cerebral hemodynamic maps.


Assuntos
Algoritmos , Tomografia Computadorizada por Raios X , Artefatos , Circulação Cerebrovascular , Processamento de Imagem Assistida por Computador , Imagens de Fantasmas , Doses de Radiação
11.
Zhonghua Er Ke Za Zhi ; 59(7): 582-587, 2021 Jul 02.
Artigo em Chinês | MEDLINE | ID: mdl-34405641

RESUMO

Objective: To investigate the risk factors for death in children with acute necrotizing encephalopathy (ANE) in pediatric intensive care unit (PICU). Methods: This was a multicenter retrospective study. Thirty-nine children with ANE were from PICUs in 4 centers from December 1, 2014 to December 1, 2020. The 4 participating centers were Beijing Children's Hospital, Shengjing Hospital of China Medical University, Hebei Children's Hospital, and Bao'an Maternity & Child Health Hospital. Patients were divided into survival and non-survival groups by the outcome at discharge, and the differences in clinical data between the two groups were compared. Risk factors for death in children with ANE and the odds ratios (OR) were analyzed by univariable Logistic regression. Results: Thirty-nine children with ANE were included. There were 18 males and 21 females. The median onset age was 30 months. The mortality at discharge was 41% (16/39). The onset age of most patients (74%, 29/39) was younger than 4 years old. Influenza virus was the most common precursor infection (80%, 20/25). Patients with shock at PICU admission were more common in the non-survival group (12/16 vs. 17% (4/23), P=0.001). Glasgow coma score (GCS) at PICU admission was significantly lower in the non-survival group than survival group (3 (3, 6) vs. 6 (5, 7), Z=-2.598, P=0.009). The optimal cut-off value was 4. The proportion of patients with GCS ≤ 4 at PICU admission was higher in the non-survival group (10/16 vs. 22% (5/23), P=0.018). ANE severity score (ANE-SS) at PICU admission was significantly higher in the non-survival group (5 (2, 6) vs. 2 (1, 4), Z=-2.436, P=0.015). The proportion of patients with high risk ANE-SS was higher in non-survival group than the survival group (9/16 vs. 22% (5/23), P=0.043). The proportion of application of high-dose methylprednisolone (20 mg/(kg·d)) was significantly higher in survival group than non-survival group (43% (10/23) vs. 1/13, P=0.031). Univariable Logistic regression indicated that risk factors for death in children with ANE were shock (OR=14.250, 95%CI 2.985-68.018, P=0.001), GCS≤4 (OR=6.000, 95%CI 1.456-24.733, P=0.013) and high risk ANE-SS (OR=4.629, 95%CI 1.142-18.752, P=0.032) at PICU admission. Conclusions: ANE usually occurs in children under 4 years old after influenza infection. Shock, GCS≤4 and high risk ANE-SS at PICU admission were risk factors for death in children with ANE. High-dose methylprednisolone may improve the prognosis of children with ANE.


Assuntos
Encefalopatias , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica , Masculino , Gravidez , Prognóstico , Estudos Retrospectivos , Fatores de Risco
13.
Zhonghua Yu Fang Yi Xue Za Zhi ; 55(8): 973-977, 2021 Aug 06.
Artigo em Chinês | MEDLINE | ID: mdl-34445835

RESUMO

Objective: To analyze the carriage characteristics of Neisseria meningitidis (Nm) among healthy population of epidemic cerebrospinal meningitis in Shandong province. Methods: From April 2008 to April 2020, a total of 16 848 healthy population were recruited from Lixia District of Jinan City, Gaomi City of Weifang City, Jiaxiang County of Jining City, Wendeng District of Weihai City, Tancheng County of Linyi City and Linyi County of Dezhou City for the investigation.Throat swab samples were collected, Nm was isolated, cultured and identified, and Nm carrying characteristics of healthy population with different characteristics were analyzed. Results: Among the 16 848 healthy population, male accounted for 51.86% (8 737). A total of 136 Nm strains were isolated, and the carriage rate was 0.81%. Among the 136 Nm strains, serogroup B (60.29%) and ungroupable strains (23.53%) were dominant. Analysis of the Nm carriage rate, that were higher in the healthy population of Linyi (1.39%) and Jinan (1.14%), higher in 13-16 years old (1.60%) and 17-19 years old (1.10%) healthy population, and higher in male (1.02%). Conclusion: The Nm carriage rate of healthy population is relatively low in Shandong Province, and the proportion of serogroup B and ungroupable Nm is relatively high.


Assuntos
Meningite Meningocócica , Neisseria meningitidis , Adolescente , Portador Sadio/epidemiologia , Cidades , Nível de Saúde , Humanos , Masculino , Meningite Meningocócica/epidemiologia , Sorogrupo
14.
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
15.
Zhonghua Er Ke Za Zhi ; 59(8): 633-639, 2021 Aug 02.
Artigo em Chinês | MEDLINE | ID: mdl-34333914

RESUMO

Objective: To analyze the characteristics and prognosis of hearing loss in children with bacterial meningitis. Methods: This was a single-center retrospective cohort study. Patients diagnosed with bacterial meningitis who were hospitalized in Beijing Children's Hospital between 2010 and 2016 and older than 28 days and younger than 18 years at symptom onset were included in this study (n=573). All clinical information including hearing assessment results during hospitalization were reviewed. All patients with hearing loss were followed up to repeat their hearing test and assess their hearing condition with parents' evaluation of aural and (or) oral performance of children (PEACH). Patients were grouped according to their hearing assessment results, and Logistic regression analysis was used to analyze the risk factors for hearing loss in patients with bacterial meningitis. Results: Five hundred and seventy-three patients were enrolled in this study, including 347 males and 226 females. The onset age ranged from 29 days to 15.8 years. Two hundred and forty-six patients had identified causative pathogens, among whom 92 cases (37.4%) were pneumococcal meningitis cases. Hearing loss was found in 160 cases (27.9%) during hospitalization, involving 240 ears. Permanent hearing loss was found in 20 cases (16.9%), involving 32 ears. In the patients with permanent hearing loss, 87.5% (28/32) of ears were identified as severe or profound hearing loss during hospitalization. Logistic regression analysis showed that dystonia, the protein concentration level in cerebrospinal fluid>1 g/L, glucose concentration level lower than 1 mmol/L and subdural effusion were independent risk factors for hearing loss (OR=2.426 (1.450-4.059), 1.865 (1.186-2.932), 1.544 (1.002-2.381) and 1.904 (1.291-2.809)). Conclusions: Hearing loss is a common sequela of bacterial meningitis in children. Most patients have transient hearing loss, but patients with severe or profound hearing impairment have a higher risk of developing permanent hearing loss.


Assuntos
Surdez , Perda Auditiva , Meningites Bacterianas , Meningite Pneumocócica , Adulto , Criança , Feminino , Perda Auditiva/epidemiologia , Perda Auditiva/etiologia , Humanos , Lactente , Masculino , Meningites Bacterianas/complicações , Meningites Bacterianas/epidemiologia , Estudos Retrospectivos
16.
Zhonghua Yi Xue Za Zhi ; 101(29): 2288-2292, 2021 Aug 03.
Artigo em Chinês | MEDLINE | ID: mdl-34333943

RESUMO

Objective: To investigate the emergency management process of ruptured abdominal aortic aneurysm (RAAA), and analyze the perioperative mortality factors of different surgical methods. Methods: The emergency data and hospitalization data of 91 patients with ruptured abdominal aortic aneurysm in Xiangya Hospital of Central South University from June 2010 to June 2019 were retrospectively analyzed.Twelve of the patients died preoperatively due to excessive blood loss, and the remaining 79 patients were hospitalized for open surgery (OSR) or endovascular repair (EVAR).The differences in age, time to hospital arrival, emergency preparation time, first creatinine value, emergency infusion volume, preoperative drop in blood pressure, preoperative use of vasoactive drugs and iliac artery involvement were compared between preoperative death group (n=12) and preoperative survival group (n=79), OSR group (n=50) and EVAR group (n=29), postoperative death group (n=23) and postoperative survival group (n=56). Results: Seventy-nine patients received open surgery or endovascular repair, and 23 died after operation. Age, time to hospital arrival, first creatinine value and emergency infusion volume were (77±11) years, (18±5)h, (469±150) µmol/L, (4 140±1 743) ml in the preoperative death group and (70±10) years, (12±8) h, (228±174) µmol/L, (1 358±1 211) ml in the preoperative survival group, respectively, and the differences were statistically significant (all P<0.05). There were no significant differences in preoperative data, intraoperative treatment and postoperative perioperative mortality between the open surgery group and the endovascular repair group (all P>0.05). The intraoperative blood loss, operation time and aortic occlusion rate in the endovascular repair group were 100 (50, 175) ml, (3.2±0.9) h, 13.8%, respectively, which were better than that in the open surgery group 1700 (600, 3425) ml, (5.2±1.1) h, 100%. The differences were statistically significant (all P<0.05). Age, emergency preparation time, first creatinine value, emergency infusion volume, blood pressure decline rate and vasoactive drug utilization rate in the death group were (77±8) years, (4.1±1.7) h, (456±172) µmol/L, (2 024±1 687) ml, 100%, 100%, respectively, and (68±10) years, (2.7±2.2) h, (135±26) µmol/L, (1 085±825) ml, 21.4%, 12.5% in the survival group, respectively. The differences were statistically significant (all P<0.05). Conclusions: Age, emergency preparation time, first creatinine value, emergency infusion volume, decreased blood pressure and use of vasoactive drugs are all associated with perioperative death in patients with ruptured abdominal aortic aneurysm. EVAR surgery is a better choice if conditions exist.


Assuntos
Aneurisma da Aorta Abdominal , Ruptura Aórtica , Implante de Prótese Vascular , Procedimentos Endovasculares , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/cirurgia , Ruptura Aórtica/cirurgia , Tratamento de Emergência , Humanos , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
17.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 56(8): 753-758, 2021 Aug 09.
Artigo em Chinês | MEDLINE | ID: mdl-34404140

RESUMO

Objective: To analyze the clinical symptoms and types of disc displacement of patients with anterior disc displacement (ADD) of temporomandibular joint (TMJ) and to explore the correlation between chewing side preference (CSP) and the clinical symptoms and types of disc displacement of ADD patients. Methods: This was a cross-sectional study of the ADD patients diagnosed by clinical symptoms and MRI findings of TMJ in the Department of Stomatology, General Hospital of Chinese PLA from January 2018 to December 2019. A total of 111 ADD patients [33 males and 78 females, aged(31.0±10.9) years old] were included. The patients were divided into two groups according to whether they had CSP: non-CSP group (n=40) and CSP group (n=71). The clinical symptoms and types of ADD were observed and recorded. According to the specific side of CSP in the CSP group, the patients were further divided into the ipsilateral side and the contralateral side of CSP. The pain, TMJ sounds and the ADD types were also observed. Chi square test was used to compare the pain, TMJ sounds, limited mouth opening and ADD types of the two groups. Binary Logistic regression model was used to analyze the correlation between CSP and clinical symptoms and ADD characteristics. Results: The incidence of pain in the CSP group [89% (63/71)] was significantly higher than that in the non-CSP group [70% (28/40)] (P<0.05). In CSP patients, the incidences of pain and joint sounds on the ipsilateral side of CSP were significantly higher than that on the contralateral side (P<0.05). MRI showed that the incidence of bilateral ADD in the CSP group [58%(41/71)] was significantly higher than that in the non-CSP group [37%(15/40)] (P<0.05).There were significant differences in the incidences of no disc displacement (DD), anterior disk displacement with reduction(ADDwR) and anterior disk displacement without reduction (ADDwoR) between ipsilateral and contralateral joints of the CSP patients (P<0.05). There were no significant differences in the incidences of no DD, ADDwR and ADDwoR between left and right joints of the non-CSP patients (P>0.05). The incidence of ADDwoR in ipsilateral side of the CSP patients was significantly higher than that in contralateral side (P<0.05). Pain (OR=3.375) and the side of disc displacement (OR=2.278) in patients with ADD were positively correlated with CSP (P<0.05). Conclusions: The clinical symptoms and types of disc displacement between patients with and without CSP were significantly different. The incidences of pain and bilateral disc displacement in the CSP group were significantly higher than those in the non-CSP group. In addition, the incidences of pain, TMJ sounds and anterior disk displacement without reduction on the ipsilateral side of patients with CSP were significantly higher than those on the contralateral side. The pain symptoms and side of disc displacement were positively related to CSP.

18.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 56(8): 785-790, 2021 Aug 09.
Artigo em Chinês | MEDLINE | ID: mdl-34404145

RESUMO

Objective: To provide clinical references for the diagnosis and treatment of hemophilic pseudotumor (HPT) in maxillofacial region. Methods: Fourteen cases of HPT in maxillofacial region from the Department of Stomatology, Beijing Children's Hospital from Jan 2009 to Jan 2019 were collected. Two cases were lost for follow-up and 12 patient,all boys, were finally followed up and included in the study. The patients aged from 13 months to 10 years old. The medical history, clinic manefestitions and the features of the radiology examination were recorded. The patients were treated by using replacement treatment first. If the conservative treatment was not effective, the patients then received operation combined with pereoperation replacement thearapy. The patients were followed up for 13 months to 10 years.There were 11 cases of hemophilia A, and 1 case of hemophilia B. Two cases were severe type, the others (10/12) were mild and moderate types. Only 1 case was diagnosed as hemophilia initially. Nine cases (9/12) were misdiagnosed as malignant tumors, 1 case was misdiagnosed as osteomyelitis and 1 case was misdiagnosed as hemangioma. Only 3 cases had identified history of trauma before. Results: All cases were treated with replacement therapy first, among which 10 cases were effective, 8 cases were cured by conservative therapy, 1 case had residual soft tissue fistula after conservative treatment and 1 case recurrented after conservative treatment for 8 months. Two patients with poor efficacy to the replacement treatment were performed operations and finally were cured. Conclusions: The misdiagnosis rate of HPT in maxillofacial region was high. The conservative factor replacement therapy could achieve good results in most children and could be used as the preferred treatment. If the conservative treatment was not effective, the surgical treatment was also a safe option.

19.
Zhonghua Wai Ke Za Zhi ; 59(9): 780-784, 2021 Sep 01.
Artigo em Chinês | MEDLINE | ID: mdl-34404177

RESUMO

Objective: To examine the effect of adjuvant radiotherapy on postoperative complications of immediate deep inferior epigastric artery perforator (DIEP) flap breast reconstruction. Methods: Data was collected from 185 patients underwent immediate DIEP reconstruction during November 2006 to March 2020 Department of Breast surgery, Fudan University shanghai Cancer Center. All the patients were female, aging (43.0±7.8) years (range: 29 to 61 years). The series included with a total of 187 flaps (2 bilateral, 183 unilateral). Included patients were divided into 2 groups: immediate DIEP reconstruction requring or not requring post-mastectomy radiation therapy (71 cases (71 flaps) in PMRT group, 114 cases (116 flaps) in control group). The aesthetic outcome were measured by Kroll score system and compared between the groups by t test. The complications included partial flap loss, minor necrosis were analyzed between the groups by χ2 test, while the influence of the other correlation factors on complication occurrence was analyzed by Logistic analysis. Results: The controll groups showed higher aesthetic results (2.21±0.55 vs. 2.47±0.82, t=-2.593, P=0.010). Complication rate in PMRT group was higher than that in control group (19.7% (15/71) vs. 4.2% (4/116), χ²=15.079,P<0.01). The complication rate was not correlated with age, body mass index, perforator number, neoadjuvant chemotherapy and adjuvant chemotherapy. Conclusions: Correlation was observed between adiuvant radiotherapy and post-operative complication of the DIEP flap. However, the complication occurrence and aesthetic results remain in the acceptable range. The other factors such as age, body mass index, perforator number, neoadjuvant chemotherapy and adjuvant chemotherapy should not be considered as prognosis factor of post-operative complication of the DIEP flap.

20.
Poult Sci ; 100(10): 101389, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34428646

RESUMO

This study was conducted to evaluate the effect of supplementing hydroxy selenomethionine (OH-SeMet) on performance, selenium (Se) deposition in the breast muscle, quality and oxidative stability, and expression of selenoprotein encoding genes of breast meat of the native slow-growing yellow-feathered broiler birds. A total of 375 one-day-old local yellow male birds were randomly assigned into 5 dietary treatments, supplemented with Se 0.0, 0.2, 0.4, 0.6, and 0.8 mg/kg in the form of OH-SeMet. Each treatment consisted of 5 replicates and each replicate had 15 birds, the birds were fed on basal diet containing corn and soybean meal, and the experiment lasted for 63 d. The results showed that dietary Se supplementation linearly increased (P < 0.001) Se contents in both serum and muscle, no significant changes (P > 0.05) were observed on growth performance, yield of breast, meat color, and intramuscular fat deposition of the breast muscle. Dietary Se addition improved water-holding capacity, the pH24h value, and tenderness of breast muscle, evidenced by a linear decreases of shear force (P < 0.05), accompanied by lower thiobarbituric acid reactive substances and higher glutathione reductase activity. The mRNA abundance of selenoprotein encoding genes also responded to dietary Se levels. It is concluded that, dietary supplementation with OH-SeMet improved muscular Se deposition and meat quality of the native yellow birds, with enhanced antioxidant capability and regulation in selenogenome.


Assuntos
Antioxidantes , Selenometionina , Ração Animal/análise , Animais , Galinhas , Dieta/veterinária , Suplementos Nutricionais , Masculino , Carne/análise
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