Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 64
Filtrar
1.
Front Oncol ; 12: 779251, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35321437

RESUMO

The addition of radiotherapy in neoadjuvant chemotherapy did not improve event-free or overall survival in resectable non-small cell lung carcinoma (NSCLC). Neoadjuvant immunotherapy produced major pathologic response(MPR) rate of up to 45%. The potential synergy between radiotherapy and immunotherapy has been described in several studies. We reported outcomes of three cases of stage III/N2 NSCLC treated with neoadjuvant immunotherapy and stereotactic body radiation therapy (SBRT) in a single center. This explanatory trial included treatment-naive patients with stage III resectable NSCLC who received two doses of the programmed cell death protein 1 (PD-1) inhibitor toripalimab after 1 week of receiving SBRT for lung lesions. Thereafter, surgery was planned 4-6 weeks after the second dose. The primary endpoints were safety and feasibility, while the secondary endpoint was the pathologic response rate. Toripalimab combined with SBRT as a neoadjuvant treatment had well-tolerable side effects and did not lead to a delay in surgery. Among the included patients, one achieved pathologic complete response (PCR), one achieved MPR, and one with 20% residual tumor did not achieve MPR. There were few side effects of toripalimab combined with SBRT as a neoadjuvant treatment, and the treatment did not cause a delay in surgery. This study preliminarily explored the outcomes of a new neoadjuvant treatment.

2.
J Cardiothorac Surg ; 17(1): 41, 2022 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-35305687

RESUMO

BACKGROUND: In recent years, preoperative nutrition has received great attention, especially for patients who received surgical reconstruction of the digestive tract such as esophagectomy. Preoperative nutrition therapy was reported to accelerate the patient's postoperative recovery. In addition, immune suppression, nausea, and vomiting may lead to poor immune and nutritional status of patients with esophageal cancer who underwent neoadjuvant chemotherapy (NAC), which is not conducive to surgery. Therefore, preoperative nutritional treatment is necessary for patients with esophageal cancer who underwent NAC. METHOD: Patients with esophageal cancer who received NAC at Nanjing Jinling Hospital from January 2018 to September 2020 were retrospectively identified. Patients were divided into enteral immunonutrition (EIN) group (those who received a conventional diet and immunonutrition supplement, Peptisorb, Nutricia, 500 mL/day * 7 via oral intake), and control group (those who only received a conventional diet were divided into). The primary outcomes were immune and nutritional indicators changes, including immunoglobulin M (IgM), immunoglobulin A (IgA), immunoglobulin G (IgG), and albumin (ALB), which were measured at preoperative day (PRD) 7, PRD-1, postoperative day (POD) 1 and POD-7. The secondary outcomes were postoperative complications, adverse reactions, and length of hospital stay. RESULTS: A total of 124 eligible patients were included in the study, with 21 patients in EIN group. After 1:2 matching, significant difference in baseline characteristics between the two groups was not observed (EIN: n = 21, Control group: n = 42). Compared with the control group, the IgA is significantly increased in the EIN group at POD-7 (p = 0.017). However, we observed that the IgM level in the control group was significantly higher than those in the EIN group at POD-7 (p = 0.007). The incidence of pneumonia and total complications in the EIN group were significantly lower than those in control group (p = 0.024, p = 0.028, respectively). There is no significant difference in ALB and adverse reactions between two groups (p = 0.303, p = 0.108, respectively). CONCLUSION: Immunonutritional supplement after NAC is an effective strategy to improve the postoperative immune status of esophageal cancer patients and could reduce the incidence of infectious complication. More well-designed prospective studies are needed to verify and update our finding.


Assuntos
Neoplasias Esofágicas , Terapia Neoadjuvante , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/cirurgia , Esofagectomia , Humanos , Período Pós-Operatório , Estudos Retrospectivos
3.
Eur J Surg Oncol ; 48(4): 909-916, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34952748

RESUMO

BACKGROUND: A survival benefit from esophagectomy was observed in elderly patients. But it's unclear how to identify specific patients who can benefit. Thus, we aimed to establish a predictive model to identify optimal candidates for esophagectomy. METHODS: Patients (age ≥75 years) with esophageal cancer in Surveillance, Epidemiology and End Results (SEER) database were used to establish the predictive model. Propensity-score matching (PSM) was applied to eliminate the imbalance between esophagectomy group and non-esophagectomy group. We hypothesized that elderly patients could benefit from esophagectomy with longer cancer specific survival (CSS) time than those who did not receive esophagectomy. Patients received surgery were divided into beneficial group and non-beneficial group according to the median CSS time of non-esophagectomy group. Prognostic factors affecting patients' long-term survival were identified. Among esophagectomy group, a logistic regression model based on these factors was established to build a nomogram. RESULTS: A total of 7,025 eligible patients were extracted from the SEER database, with 831 patients received esophagectomy. Surgery was independently associated with better long-term survival (median CSS time in the matched population: 35 vs. 8 months, p < 0.001). As a result, 361 (68.6%) patients were divided into beneficial group (CSS >8 months). Factors including age, tumor site, histology, differentiation grade, TNM stage, and tumor size were used to formulate the nomogram, which was named as esophagectomy candidates screening score (ECSS). The validation from two aspects showed the model a useful and stable one. CONCLUSION: A predictive model was established to distinguish optimal candidates for esophagectomy among elderly patients with EC.


Assuntos
Esofagectomia , Nomogramas , Idoso , Humanos , Prognóstico , Pontuação de Propensão , Programa de SEER
4.
Comput Methods Programs Biomed ; 212: 106464, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34736166

RESUMO

BACKGROUND AND OBJECTIVE: Recognizing different tissue components is one of the most fundamental and essential works in digital pathology. Current methods are often based on convolutional neural networks (CNNs), which need numerous annotated samples for training. Creating large-scale histopathological datasets is labor-intensive, where interactive data annotation is a potential solution. METHODS: We propose DELR (Deep Embedding-based Logistic Regression) to enable rapid model training and inference for histopathological image analysis. DELR utilizes a pretrained CNN to encode images as compact embeddings with low computational cost. The embeddings are then used to train a Logistic Regression model efficiently. We implemented DELR in an active learning framework, and validated it on three histopathological problems (binary, 4-category, and 8-category classification challenge for lung, breast, and colorectal cancer, respectively). We also investigated the influence of active learning strategy and type of the encoder. RESULTS: On all the three datasets, DELR can achieve an area under curve (AUC) metric higher than 0.95 with only 100 image patches per class. Although its AUC is slightly lower than a fine-tuned CNN counterpart, DELR can be 536, 316, and 1481 times faster after pre-encoding. Moreover, DELR is proved to be compatible with a variety of active learning strategies and encoders. CONCLUSIONS: DELR can achieve comparable accuracy to CNN with rapid running speed. These advantages make it a potential solution for real-time interactive data annotation.


Assuntos
Redes Neurais de Computação , Área Sob a Curva , Processamento de Imagem Assistida por Computador , Modelos Logísticos
5.
Curr Drug Targets ; 22(11): 1222-1231, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33845736

RESUMO

Gut microbiota is a complex microecosystem, which is called the second genome of the human body. Herbal medicine can balance tumor-suppressing bacteria and tumor-promoting bacteria and exert its anti-cancer effect by regulating gut microbiota. Traditional Chinese medicine (TCM) has a history of thousands of years in prevention and treatment of diseases in China. In recent decades, TCM has been shown to have an obvious advantage in prolonging the survival time and improving the living quality of patients with cancer. Notably, gut microbiota has become a new pathway to understanding TCM. In this review, we will focus on gut microbiota and tumor progression, especially the diversity, functionality and metabolites of gut microbiota affected by TCM in various cancer. We will also discuss the potential mechanism of gut microbiota for exploring TCM in anti-cancer effect. This article aims to comprehensively review the anti-cancer research of TCM by regulating gut microbiota, and address future perspectives and challenges of gut microbiota in TCM intervention for cancer.


Assuntos
Medicamentos de Ervas Chinesas , Microbioma Gastrointestinal , Neoplasias , Plantas Medicinais , Medicamentos de Ervas Chinesas/uso terapêutico , Humanos , Medicina Tradicional Chinesa , Neoplasias/tratamento farmacológico
6.
Ann Transl Med ; 9(6): 458, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33850855

RESUMO

BACKGROUND: Esophagogastric anastomotic leak (AL) is a severe complication following esophageal resection. This study aims to explore preliminarily whether the ratio of the gastric conduit length to the thorax length can be regarded as a potential prognostic variable for AL, and if so, a cut-off value can be found to divide the patients into distinct risk groups. METHODS: We retrospectively reviewed the clinical data of 273 patients who underwent esophagectomy. The gastric conduit length, the thorax length, and other covariates were collected. Logistic regression was first conducted to probe the rationality of the ratio as a risk indicator of AL. Then the dichotomizing analysis was applied to find the optimal cut-off value. RESULTS: The incidence of AL was 12.5% (34/273). The coefficient of the ratio in the logistic regression equation was -7.901 with P<0.001, which indicated that the larger the ratio, the smaller the risk of AL. Further smoothed scatter plots revealed that a potential step function of the ratio of AL incidence exists, of which the steep part ranges from 1.74 to 1.90. Results of the accurate cut-off value search through a minimum P value approach give the optimal dichotomization point of 1.79. CONCLUSIONS: The ratio of the gastric conduit length to the thorax length can reflect the tension in the anastomosis. The research proposes that surgeons can control the length of the gastric conduit during reconstruction to reduce the tension in the anastomosis and thus lead to a decrease in the incidence of AL.

7.
J Hum Nutr Diet ; 34(6): 926-934, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-33788349

RESUMO

BACKGROUND: Malnutrition is highly prevalent in critically ill patients. The modified Nutrition Risk in the Critically ill (mNUTRIC) score has been introduced to evaluate the nutritional risk of patients in an intensive care unit (ICU). The mNUTRIC score is a predictive factor of mortality for patients in a medical or mixed ICU, whereas the relationship between mNUTRIC and prognosis of patients in a cardiothoracic surgery recovery unit (CSRU) is unclear and related researches are limited. METHODS: We conducted this retrospective cohort study to explore the value of mNUTRIC score in CSRU patients. We identified totally 4059 patients from the Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC III) database. RESULTS: The optimal cut-off value of mNUTRIC score was 4 and a total of 1498 (36.9%) patients were considered to be at high nutritional risk (mNUTRIC ≥ 4). A multivariate logistic regression model indicated that patients at high nutritional risk have higher hospital mortality compared to those at low nutritional risk (odds ratio = 2.49, 95% confidence interval (CI) = 1.32-4.70, p = 0.005]. Furthermore, a Cox regression model was established adjusted for age, white blood cell and body mass index. The Kaplan-Meier curve indicated that patients at high nutritional risk have poorer 365-days [hazard ratio (HR) = 1.76, 95% CI = 1.30-2.37, p < 0.001] and 1000-days (HR = 2.30, 95% CI = 1.87-2.83, p < 0.001) overall survival. CONCLUSIONS: The mNUTRIC score could not only predict hospital mortality, but also be an independent prognostic factor for long-term survival in CSRU patients. More well-designed clinical trials are needed to verify and update our findings.


Assuntos
Desnutrição , Avaliação Nutricional , Estado Terminal , Humanos , Unidades de Terapia Intensiva , Desnutrição/diagnóstico , Estado Nutricional , Prognóstico , Estudos Retrospectivos , Medição de Risco
8.
Ann Palliat Med ; 10(4): 3896-3905, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33548999

RESUMO

BACKGROUND: Nowadays, controlling nutritional status (CONUT) has been used as a prognostic factor in variety of cancers. However, no consensus has been reached on the prognostic value of CONUT in lung cancer. In this study, we aim to investigate the role of CONUT in survival of patients with lung cancer. METHODS: EMBASE, web of science, and Medline were used to search articles in English-language journals. The association between CONUT score and survival of patients with lung cancer was evaluated by using pooled HRs and their 95% CIs. Chi-square test and I-Square was used to test heterogeneity among studies. Analyses were all performed using Stata 13.0 (Stata Corporation, College Station, TX). RESULTS: Eight studies with 1,836 patients were eventually included in this meta-analysis. The pooled results showed that high CONUT score had an unfavorable impact on OS (HR =1.63, 95% CI: 1.30-2.04), DFS (HR =1.75, 95% CI: 1.35-2.26), CSS (HR =1.45, 95% CI: 1.01-2.07) and PFS (HR =1.67, 95% CI: 0.99-2.35), compared with those with low-CONUT. CONCLUSIONS: CONUT can be used as a predictor of prognosis in patients with lung cancer. High-CONUT score was significantly associated with poor OS, DFS, CSS and PFS.


Assuntos
Neoplasias Pulmonares , Estado Nutricional , Humanos , Prognóstico , Estudos Retrospectivos
9.
J Craniomaxillofac Surg ; 49(3): 177-183, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33451942

RESUMO

BACKGROUND: Anterior Disc Displacement without Reduction (ADDwoR) in adolescence can result in condylar resorption which produces mandibular retrusion/deviation (MR/D) in adulthood. This study aims to analyze the therapeutic effect of simultaneous genioplasty and temporomandibular joint (TMJ) anchorage surgery on ADDwoR with MR/D patients. METHODS: During 2016-2018, ADDwoR with MR/D cases were included and underwent TMJ anchorage surgery and genioplasty guided by digital design. Pre-/Post-surgical clinical manifestations, facial photography, radiographic data, facial shape satisfaction of clinicians/patients/third-party were recorded and analyzed. RESULTS: A total of 32 cases (52 joints) were included. The average age was 24.09. Ratio of male/female was 4/28. Visual analog pain scale (VAS) score pre-/post-surgical ranged from 3 to 9 and 0-3, with an average of 6.03 and 1.18 (p < 0.01). Maximal mouth opening pre-/post-surgical ranged from 16 to 33 mm and 33-40 mm, with an average of 22.43 mm and 36.46 mm (p < 0.01). MRI was completed and showed stable disc reduction without recurrence 1 year postoperatively. MR/D was corrected and a better face shape was obtained. The satisfaction rate of clinicians, patients and third-parties was 92.375%, 94.156% and 94.218%, with an average of 93.583%. CONCLUSION: For ADDwoR with MR/D patients, simultaneous TMJ anchorage surgery and genioplasty can improve TMJ symptoms/functions, correct facial appearance, and enhance the degree of satisfaction. The postoperative effect is stable, safe and reliable, which is worthy of clinical promotion.


Assuntos
Luxações Articulares , Transtornos da Articulação Temporomandibular , Adolescente , Adulto , Feminino , Mentoplastia , Humanos , Imageamento por Ressonância Magnética , Masculino , Articulação Temporomandibular/diagnóstico por imagem , Articulação Temporomandibular/cirurgia , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/cirurgia , Resultado do Tratamento , Adulto Jovem
10.
J Nanosci Nanotechnol ; 21(4): 2196-2202, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33500034

RESUMO

ZrC was produced by the combustion synthesis technology using Cu, Zr, and graphite as the starting element powders. The synthesis mechanism of ZrC was investigated by the combustion wave quenching experiment. Furthermore, the effects of sizes of C and Cu on the combustion synthesis behavior and products were also explored. Results revealed that ZrC was fabricated through the displacement reaction between C and Cu-Zr liquid. The Cu size hardly affected the combustion temperature and resultant products, indicating that the preparation cost of ZrC could be decreased by employing coarse Cu powders. With increasing C size, the burning temperature and ceramic particle size reduced. Graphite with size of 2.6 µm was used as the C source, and only ZrC nanoparticles and Cu were obtained. The products could be employed to prepare nano-sized ZrC/Cu composites without the elimination of by-products.

11.
Dis Esophagus ; 34(2)2021 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-32582945

RESUMO

Although robotic techniques have been used for oesophagectomy for many years, whether robot-assisted minimally invasive oesophagectomy (RAMIE) can actually improve outcomes and surpass thoraco-laparoscopic minimally invasive oesophagectomy (MIE) in the success rate of lymph node dissection remains to be empirically demonstrated. Therefore, we performed this systematic review and meta-analysis of case-control studies to systematically compare the effect of lymph node dissection and the incidence of vocal cord palsy between RAMIE and MIE. The PubMed, EMBASE, and Web of Science databases were systematically searched up to December 1, 2019, for case-control studies that compared RAMIE with MIE. Thirteen articles were included, with a total of 1,749 patients with esophageal cancer, including 866 patients in the RAMIE group and 883 patients in the MIE group. RAMIE yielded significantly larger numbers of total dissected lymph nodes (WMD = 1.985; 95% CI, 0.448-3.523; P = 0.011) and abdominal lymph nodes (WMD = 1.686; 95% CI, 0.420-2.951; P = 0.009) as well as lymph nodes along RLN (WMD = 0.729; 95% CI, 0.348-1.109; P < 0.001) than MIE. Additionally, RAMIE could significantly decrease estimated blood loss (WMD = -11.208; 95% CI, -19.358 to -3.058; P = 0.007) and the incidence of vocal cord palsy (OR = 0.624; 95% CI, 0.411-0.947; P = 0.027) compared to MIE. Compared with MIE, RAMIE resulted in a higher total lymph node yield and a higher lymph node yield in the abdomen and along RLN, along with reduced blood loss during surgery and the incidence of vocal cord palsy. Therefore, RAMIE could be considered to be a standard treatment, with less blood loss, lower incidence of vocal cord palsy, and more radical lymph node dissection, exhibiting superiority over MIE.


Assuntos
Neoplasias Esofágicas , Esofagectomia/métodos , Excisão de Linfonodo/métodos , Estudos de Casos e Controles , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Esofagectomia/normas , Humanos , Laparoscopia , Procedimentos Cirúrgicos Minimamente Invasivos , Procedimentos Cirúrgicos Robóticos , Toracoscopia , Resultado do Tratamento , Paralisia das Pregas Vocais/etiologia
12.
Dis Esophagus ; 34(9)2021 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-33150401

RESUMO

The long-term outcomes of robotic-assisted McKeown esophagectomy (RAME) compared to thoraco-laparoscopic McKeown esophagectomy (TLME) for the patients with esophageal squamous cell carcinoma (ESCC) remain unclear. The aim of this study was to compare the number of dissected lymph nodes and long-term survival between RAME and TLME using a propensity score-matched (PSM) analysis. A total of 721 patients undergoing minimally invasive McKeown esophagectomy at our department from February 2015 to October 2019 were analyzed, including 310 patients in RAME group and 411 in TLME group. The exact numbers of lymph nodes including those among thoracic and abdominal categories as well as those along the recurrent laryngeal nerve (RLN) were all recorded. PSM analysis was applied to generate matched pairs for further comparison. All patients with R0 resection were followed with a strict follow-up period which range from 1 to 56 months. The effect of lymphadenectomy was compared between all patients in unmatched and matched groups. Long-term outcomes consisting of overall survival (OS), disease-free survival (DFS) and recurrence rate (including regional recurrence rate, systemic recurrence rate and mediastinal lymph nodes recurrence rate) were compared in R0 resection patients. Finally, 292 patients were identified for each cohort after PSM. RAME was found to yield significantly more left RLN lymph nodes (mean: 2.27 ± 0.90 vs. 2.09 ± 0.79; P = 0.011) and more thoracic lymph nodes (mean: 12.60 ± 4.22 vs. 11.83 ± 3.12, P = 0.012) compared with TLME after PSM analysis. There was no significant difference in the OS and DFS between the RAME and TLME group. Besides, total recurrences were recognized in 33 (11.7%) patients in the RAME group and 36 (12.9%) in the TLME group (P = 0.676). The mediastinal lymph nodes recurrence rate in the RAME group was tended to be lower than that in the TLME group (2.5% vs. 5.4%, P = 0.079). Therefore, RAME might be an alternative approach for the treatment of ESCC with more lymph nodes dissected and similar long-term survival outcomes compared to TLME.


Assuntos
Neoplasias Esofágicas , Carcinoma de Células Escamosas do Esôfago , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Neoplasias Esofágicas/cirurgia , Carcinoma de Células Escamosas do Esôfago/cirurgia , Esofagectomia , Humanos , Excisão de Linfonodo , Recidiva Local de Neoplasia , Complicações Pós-Operatórias , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento
13.
J Hazard Mater ; 407: 124798, 2021 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-33348205

RESUMO

Two-dimensional (2D) heterojunction photocatalysts can shorten the carrier transfer pathway. In this study, CoS nanoparticles were deposited on the surface of 2D BiOBr nanosheets to fabricate novel ultrathin and intimate-contact 2D heterojunction photocatalysts by a two-step solvothermal route. Under visible-light (λ > 400 nm) irradiation, the apparent reaction rate constant of glyphosate degradation over 10%CoS/BiOBr reaches 0.0074 min-1 (74.7% glyphosate was degraded within 3 h), which is about 5.3 times that of pure BiOBr (0.0014 min-1). The extraordinary photocatalytic performance is attributed to the strong visible-light absorption, the effective charge separation and low charge transfer resistance. The possible photocatalytic reaction process and mechanism over CoS/BiOBr heterojunctions are proposed. Moreover, the 10%CoS/BiOBr sample shows good reusability and stability. This work could provide a new insight for the design and development of 2D heterojunction photocatalysts.

14.
Ann Palliat Med ; 10(2): 1351-1361, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33222455

RESUMO

BACKGROUND: In recent years, immunonutrition has been introduced and proposed to have a positive modulatory effect on inflammatory and immune responses and gut function for surgical patients, especially for patients undergoing gastrointestinal cancer resection. We conducted this parallel-group, randomized and double-blind clinical controlled trial to investigate the efficacy of perioperative enteral immunonutrition (EIN) on clinical and immunological outcomes of patients undergoing esophageal resection. METHODS: A randomized, parallel-group, double-blind, clinical trial was conducted between December 1, 2017 and March 1, 2018. This study enrolled 120 patients with esophageal cancer. And 112 patients were divided into two groups randomly: EIN group and enteral nutrition (EN) group. The EIN contained extra immunonutritional substrates, including a consistent combination of arginine, RNA and the omega-3 fatty acids compared with EN. Immune indicators were measured at preoperative day 7, postoperative day (POD) 1, 3, 7 and post-discharge day (PDD) 30. RESULTS: There were 56 participants randomized to each group. Finally, 53 patients in EIN and 50 patients in EN were analyzed. Immune indicator was the primary outcome in this study. EIN yielded a significantly lower rate of CD8/CD3 (%) at POD 3 compared with EN group (P=0.005). The rate of CD4/CD8 (%) in EIN group was higher than that in EN group at POD3 (P=0.004). The serum levels of IgM at POD 3 and 7 were significantly higher in EN group compared with EIN group (P=0.025 and P=0.009, respectively). The rate of NK (%) and the serum level of IgA were significantly higher in EIN group compared with EN group at PDD 30 (P=0.022 and P=0.041, respectively). No significant differences were found in 2-year progressionfree survival and overall survival. CONCLUSIONS: Immunonutrition is a safe and feasible nutritional treatment, which has a positive modulatory impact on immune responses after esophagectomy. Although no significant difference was found in clinical and survival outcomes between EIN and EN groups, immunonutrition could still have a positive effect on immunological function of patients undergoing esophagectomy.


Assuntos
Neoplasias Esofágicas , Esofagectomia , Assistência ao Convalescente , Nutrição Enteral , Neoplasias Esofágicas/cirurgia , Humanos , Alta do Paciente , Complicações Pós-Operatórias/prevenção & controle
15.
Front Cardiovasc Med ; 8: 724183, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-35083295

RESUMO

Deep neural networks have become the mainstream approach for analyzing and interpreting histology images. In this study, we established and validated an interpretable DNN model to assess endomyocardial biopsy (EMB) data of patients with myocardial injury. Deep learning models were used to extract features and classify EMB histopathological images of heart failure cases diagnosed with either ischemic cardiomyopathy or idiopathic dilated cardiomyopathy and non-failing cases (organ donors without a history of heart failure). We utilized the gradient-weighted class activation mapping (Grad-CAM) technique to emphasize injured regions, providing an entry point to assess the dominant morphology in the process of a comprehensive evaluation. To visualize clustered regions of interest (ROI), we utilized uniform manifold approximation and projection (UMAP) embedding for dimension reduction. We further implemented a multi-model ensemble mechanism to improve the quantitative metric (area under the receiver operating characteristic curve, AUC) to 0.985 and 0.992 on ROI-level and case-level, respectively, outperforming the achievement of 0.971 ± 0.017 and 0.981 ± 0.020 based on the sub-models. Collectively, this new methodology provides a robust and interpretive framework to explore local histopathological patterns, facilitating the automatic and high-throughput quantification of cardiac EMB analysis.

16.
J Thorac Dis ; 12(8): 4115-4125, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32944323

RESUMO

BACKGROUND: Paravertebral block (PVB) conducted by epidural catheter is a prevalent pain management for patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy. The aim of this study was to assess the efficacy and safety of paravertebral block with a modified PVB (MPVB) catheter under surgeon's direct vision after video-assisted thoracoscopic lobectomy. METHODS: Three hundred fifty-six patients undergoing VATS lobectomy were retrospectively reviewed and divided into two groups consecutively according to the catheter applied in PVB procedure (PVB group and MPVB group). In the MPVB group, a modified catheter with a flexible forepart and more apertures distributing along the forepart than the conventional epidural catheter was introduced. An infusion pump containing of 150 mL mixture was connected to the catheter to provide sustained regional analgesia. Intramuscular dezocine 10 mg was administered as a rescue medication when necessary. Postoperative pain management effect was assessed by visual analog scale (VAS) at rest and on coughing. Spirometry values and blood gas analysis were monitored and recorded for the first 3 postoperative days (PODs). Analgesia-related adverse events, characteristics of PVB procedure and postoperative major complication were also compared between the two groups. RESULTS: There were 172 patients who received PVB with conventional epidural catheter in the PVB group, and 184 patients were performed PVB with modified paravertebral catheter in the MPVB group. Significantly lower pain score at rest was found in MPVB group at 24 h postoperatively (P=0.006). The pain score on coughing in MPVB group was significantly lower than that in PVB group at 12 and 24 h postoperatively (P=0.037 and P<0.001, respectively). Patients needing for rescue medication was significantly lower in the MPVB group (P=0.028). The incidence of pleural perforation was lower in the MPVB group (P=0.020). Postoperative spirometry values revealed comparable pulmonary function between the two groups, and arterial blood gas analysis showed a normal range of pH and PaCO2 in both groups. There was no significant difference of analgesia-related adverse events as well as major complications between the two groups. CONCLUSIONS: PVB with modified catheter under surgeon's direct vision was effective and safe after video-assisted thoracoscopic lobectomy.

17.
Thorac Cancer ; 11(10): 2909-2915, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32833352

RESUMO

BACKGROUND: According to previously published studies, esophagectomy with modified Collard anastomosis has been reported to have low incidences of anastomotic leak and stricture. However, the optional anastomotic method after esophagectomy is still controversial. We conducted this study to compare the incidence of postoperative anastomotic stricture formation and dysphagia over three years after an esophagectomy with modified Collard anastomosis (MC) or end-to-side (ETS) hand-sewn anastomosis. Meanwhile, the early postoperative anastomotic leakage and other complications, hospital stay and 30- and 90-day mortality were also evaluated. METHODS: The clinical data of 905 patients undergoing McKeown esophagectomy were retrospectively reviewed. The rate of postoperative stricture formation after three years was demonstrated by stricture-free survival which is the primary end-point of this study. The incidence of dysphagia, first time of onset of stricture and number of dilatations were also recorded during follow-up. RESULTS: The incidence of anastomotic leak tended to be higher in the MC group compared with that in the ETS group (13.0% vs. 8.7%, P = 0.064). The rates of anastomotic stricture in the MC group were significantly less than in the ETS group (P = 0.004). The number of dilatations in the MC group were significantly greater than those in the ETS group (2.34 vs. 2.46, P = 0.011). CONCLUSIONS: A modified Collard cervical esophagogastric anastomosis was associated with lower rates of anastomotic stricture and dysphagia, compared with ETS hand-sewn anastomosis. However, the modified Collard anastomosis is accompanied by an increased anastomotic leakage rate.


Assuntos
Anastomose Cirúrgica/métodos , Fístula Anastomótica/cirurgia , Esofagectomia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
18.
J Thorac Dis ; 12(6): 3065-3072, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32642229

RESUMO

BACKGROUND: Robot-assisted thoracic surgery (RATS) has an increasing usage throughout the world. This retrospective cohort study aimed to objectively compare the surgical results between video-assisted thoracic surgery (VATS) and RATS in posterior mediastinal neurogenic tumors (PMNT). METHODS: We retrospectively reviewed the clinical data of 130 patients diagnosed with posterior mediastinal neurogenic tumor between 2015 and 2018. Magnetic resonance imaging (MRI) or enhanced computed tomography scan (CT-scan) was used to locate the tumor and investigate the Adamkiewicz's artery preoperatively. The individual surgical approach was determined by both tumor size and patient's willings. RESULTS: The surgical time in RATS (43.2±12.6 min) was tended to be less than that in VATS (47.4±11.9 min) (P=0.054). Meanwhile, the estimated blood loss in RATS group (85.8±22.6 mL) was significantly less than that in VATS group (95.3±28.4 mL) (P=0.040). However, the duration of chest tube (days) and volume of drainage (mL) had no significant difference between two groups (P=0.12 and P=0.68, respectively). The postoperative hospital stay (days) of patients in RATS group (2.2±0.4 days) was significantly shorter than that in VATS group (2.4±0.6 days) (P=0.031). There were no significant differences between two groups in the incidence of the postoperative complications and adverse reactions. CONCLUSIONS: RATS has the superiorities in terms of surgical blood loss and postoperative hospital stay over VATS for posterior mediastinal neurogenic tumor. In conclusion, RATS could be a feasible and safe way for resecting posterior mediastinal neurogenic tumor.

19.
Biochem Biophys Res Commun ; 527(2): 545-552, 2020 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-32423800

RESUMO

Angiogenesis is a core hallmark of advanced cancers, especially in lung adenocarcinoma (LUAD). However, the underlying functions and mechanisms of lncRNAs in tumor angiogenesis remain largely unknown. Here we found that linc00665 depletion could markedly depressed proliferation and capillary tube formation of HUVECs in vitro. Mechanistically, linc00665 directly interacted with YB-1 protein, enhanced its stability through inhibiting ubiquitination-dependent proteolysis and stimulated its nuclear translocation in LUAD cells. The accumulated nuclear YB-1 activated expression of ANGPT4, ANGPTL3 and VEGFA by binding to their promoters, contributing to tumor-related angiogenesis in vitro and in vivo. Collectively, we conclude that linc00665 induces tumor-related angiogenesis in LUAD by directly interacting with YB-1 and activating YB-1-ANGPT4/ANGPTL3/VEGFA axis, which provides promising anti-angiogenic targets for cancer therapy.


Assuntos
Adenocarcinoma de Pulmão/genética , Regulação Neoplásica da Expressão Gênica , Neoplasias Pulmonares/genética , Neovascularização Patológica/genética , RNA Longo não Codificante/genética , Proteína 1 de Ligação a Y-Box/genética , Adenocarcinoma de Pulmão/metabolismo , Adenocarcinoma de Pulmão/patologia , Linhagem Celular Tumoral , Células Endoteliais da Veia Umbilical Humana , Humanos , Neoplasias Pulmonares/metabolismo , Neoplasias Pulmonares/patologia , Neovascularização Patológica/metabolismo , Neovascularização Patológica/patologia , RNA Longo não Codificante/metabolismo , Proteína 1 de Ligação a Y-Box/metabolismo
20.
Medicine (Baltimore) ; 99(19): e19915, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384436

RESUMO

BACKGROUND: This study will assess the effectiveness and safety of extracorporeal shock wave lithotripsy (ESWL) for patients with kidney stones (KS). METHODS: A comprehensive and systematic literature records search for studies will be conducted in MEDLINE, EMBASE, Cochrane Library, WANGFANG, VIP, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. All these databases will be searched from inception to the present without language limitation. Cochrane risk of bias tool will be used to assess the methodological quality for all included studies. Statistical analysis is performed using RevMan 5.3 software. RESULTS: This study will provide synthesis of current evidence of ESWL for patients with KS through assessing primary outcomes of overall stone-free rate, and secondary outcomes of mean stone size (mm), pain intensity, urinary biochemical variables, mean hospital stay (day), quality of life, and adverse events. CONCLUSION: This study will provide recommendations for the effectiveness and safety of ESWL for patients with KS, which may help to guide clinician. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42019157243.


Assuntos
Tratamento por Ondas de Choque Extracorpóreas/métodos , Cálculos Renais/terapia , Litotripsia/métodos , Humanos , Metanálise como Assunto , Avaliação de Resultados em Cuidados de Saúde , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...