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1.
Ann Transl Med ; 8(12): 785, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32647710

RESUMO

Background: Transesophageal echocardiography (TEE) performed by intensivists is increasingly used in critically ill patients. However, TEE is usually not the preferred monitoring tool, especially when transthoracic echocardiography (TTE) appears to have addressed the clinical problems. As a result, it remains largely unknown whether TEE is a clinically valuable replacement or supplement for TTE as a primary tool in evaluating haemodynamic problems in critically ill surgical patients. The purpose of this study was to assess the diagnostic and therapeutic value of TEE instead or in addition to TTE in critically ill surgical patients with hemodynamic instability. Methods: A prospective observational study was conducted. A total of 68 consecutive patients were enrolled from December 2016 to February 2018. TEE was routinely performed in addition to TTE, and the imaging data from TTE and TEE were successively disclosed to two different primary physicians, who reported any resulting changes in management. The two physicians were required to reach a consensus if there was any disagreement. The results of the additional TEE examination were compared with the clinical findings and TTE information. The image quality of TTE views was classified as a good (score 2), suboptimal (score 1) or poor view (score 0). According to the scores of TTE images, the patients were divided into two groups: patients with adequate TTE views (score ≥6) and inadequate TTE views (score <6). Results: The results of additional TEE examination were classified into four categories. TEE failed to provide additional information about the initial diagnosis and therapy (class 1) in 26 patients (38.2%). Of the remaining 42 patients (61.8%), TEE instead or in addition to TTE revealed new findings or led to significant changes in therapy, as TTE supplied inadequate information. TEE used in addition to TTE led to a new diagnosis without therapeutic implications (class 2) in 11 patients (16.2%) and made a major clinical contribution leading to a therapeutic change (class 3) in 23 patients (33.8%). TEE used instead of TTE determined the diagnosis and therapy in 8 patients (11.8%) whose haemodynamic problems could not be addressed by TTE (class 4). In total, TEE had critical therapeutic benefits (class 3 and 4) that was not provided by TTE in 31 patients (45.6%). Of particular concern was that TEE had a higher proportion of therapeutic benefits to patients with inadequate TTE views than those with adequate TTE views (54.3% vs. 27.3%, P=0.036). Conclusions: TEE as a feasible clinical tool is useful for critically ill surgical patients with hemodynamic instability, especially for the patients with inadequate TTE views. TEE instead or in addition to TTE could provide valuable information for diagnosis, which may bring significant therapeutic benefits.

2.
Infect Drug Resist ; 13: 2053-2061, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32636658

RESUMO

Purpose: Although immune dysfunction has been investigated in adult septic patients, early immune status remains unclear. In this study, our primary aim was to assess early immune status in adult patients with sepsis stratified by age and its relevance to hospital mortality. Patients and Methods: A post hoc analysis of a multicenter, randomized controlled trial was conducted; 273 patients whose immune status was evaluated within 48 hours after onset of sepsis were enrolled. Early immune status was evaluated by the percentage of monocyte human leukocyte antigen-DR (mHLA-DR) in total monocytes within 48 hours after onset of sepsis and it was classified as immunoparalysis (mHLA-DR ≤30%) or non-immunoparalysis (>30%). Three logistic regression models were conducted to explore the associations between early immunoparalysis and hospital mortality. We also developed two sensitivity analyses to find out whether the definition of early immune status (24 hours vs 48 hours after onset of sepsis) and immunotherapy affect the primary outcome. Results: Of the 181 elderly (≥60yrs) and 92 non-elderly (<60yrs) septic patients, 71 (39.2%) and 25 (27.2%) died in hospital, respectively. The percentage of early immunoparalysis in the elderly was twice of that in the non-elderly patients (32% vs 16%, p=0.006). For the elderly, hospital mortality was higher in the immunoparalysis ones than the non-immunoparalysis ones (53.4% vs 32.5%, p=0.009). But there was no significant difference in hospital mortality between immunoparalysis non-elderly patients and non-immunoparalysis non-elderly ones (33.5% vs 26.0%, p=0.541). By means of logistic regression models, we found that early immunoparalysis was independently associated with increased hospital mortality in elderly, but not in non-elderly patients. Sensitivity analysis further confirmed the definition of early immune status and immunotherapy did not affect the outcomes. Conclusion: The elderly were more susceptible to early immunoparalysis after onset of sepsis. Early immunoparalysis was independently associated with poor prognosis in elderly, but not in non-elderly patients.

3.
J Cell Mol Med ; 24(15): 8391-8404, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32614521

RESUMO

Mindin is important in broad spectrum of immune responses. On the other hand, we previously reported that mindin attenuated human colon cancer development by blocking angiogenesis through Egr-1-mediated regulation. However, the mice original mindin directly suppressed the syngenic colorectal cancer (CRC) growth in our recent study and we aimed to further define the role of mindin during CRC development in mice. We established the mouse syngeneic CRC CMT93 and CT26 WT cell lines with stable mindin knock-down or overexpression. These cells were also subcutaneously injected into C57BL/6 and BALB/c mice as well as established a colitis-associated colorectal cancer (CAC) mouse model treated with lentiviral-based overexpression and knocked-down of mindin. Furthermore, we generated mindin knockout mice using a CRISPR-Cas9 system with CAC model. Our data showed that overexpression of mindin suppressed cell proliferation in both of CMT93 and CT26 WT colon cancer cell lines, while the silencing of mindin promoted in vitro cell proliferation via the ERK and c-Fos pathways and cell cycle control. Moreover, the overexpression of mindin significantly suppressed in vivo tumour growth in both the subcutaneous transplantation and the AOM/DSS-induced CAC models. Consistently, the silencing of mindin reversed these in vivo observations. Expectedly, the tumour growth was promoted in the CAC model on mindin-deficient mice. Thus, mindin plays a direct tumour suppressive function during colon cancer progression and suggesting that mindin might be exploited as a therapeutic target for CRC.

4.
Data Brief ; 30: 105626, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32420422

RESUMO

The aim of this research is to degrade organic contaminants in aqueous solution via lead ferrite (PbFe2O4) as a catalyst to activate peroxymonosulfate (PMS). PbFe2O4 was synthesized by a citrate combustion method and analyzed by SEM, TEM and XRD. A simulated solution including thionine were used, with different conditions tested to optimize the degradation process, including comparing PbFe2O4 to other catalysts, PbO and Fe2O3, and tracking active oxygen species. The concentrations of thionine and PMS were tracked with a UV-Vis spectrophotometer in the treatment process. The data are presented as graphs and tables. A detailed analyses of this report can be found in the article "New insight into the mechanism of peroxymonosulfate activation by nanoscaled lead-based spinel for organic matters degradation: a singlet oxygen-dominated oxidation process" published in Journal of colloid and interface science.

5.
J Colloid Interface Sci ; 572: 318-327, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32272310

RESUMO

Crystalline iron-based nanoparticles with spinel structure have received great attention for catalyzing peroxymonosulfate (PMS). This study introduces lead ferrite (PbFe2O4) as a novel, simple, and efficient catalyst to activate PMS for the degradation of organic contaminants in aqueous solution. The results indicated that, under pH 9.0, nearly 100% of 10 µM thionine was removed in 20 min. Operation factors, including pH, oxidant concentrations, catalyst dosage, and coexisting ions, were investigated and found to be influential for the thionine removal. PbFe2O4 showed higher catalytic activity and lower ions leaching than well-crystallized lead oxide (PbO) and ferric oxide (Fe2O3). The results from the characterization of the PbFe2O4 with X-ray diffraction (XRD) before and after reaction suggested that the structure and properties of the catalyst kept stable, and the recovered catalyst exhibited good catalytic performance during the recycling batch experiments. Free radical quenching experiments and electron paramagnetic resonance (EPR) spectra revealed that singlet-oxygen (1O2) is the dominant active oxygen species rather than sulfate radical for thionine degradation in PbFe2O4/PMS system. Meanwhile, the possible pathways of 1O2 generation were proposed: the redox reaction between Pb(Ⅳ)/Pb(II) and PMS may play an key role in PMS activation. This study provides an interesting insight in PMS activation by the high-efficient non-radical process, and the PbFe2O4 could be as efficient and recyclable heterogeneous catalyst for organic degradation.

6.
Ophthalmic Physiol Opt ; 39(6): 451-458, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31696541

RESUMO

PURPOSE: To determine the differences in mean ocular dimensions between urban and rural children and identify possible influencing factors. METHODS: This work uses previously published data from the Shandong Children Eye Study, which was based on a random cluster sampling applied to a cross-sectional school-based study design in the rural Guanxian County and Weihai city. All children underwent auto-refractometry and biometry under cycloplegia. RESULTS: The study included 3290 children (aged 9.35 ± 2.93 years), consisting of 888 pairs of boys and 757 pairs of girls matched by sex, age and refractive error (each pair matching one child from urban cohort with one from the rural cohort). Overall urban children were significantly taller and heavier than rural children (t-test; p < 0.001), which was confirmed for all age groups for weight. Urban ocular axial lengths were significantly longer by 0.23 mm compared to the rural population (t-test; p < 0.001), mostly in younger children and boys. Meanwhile, corneal curvatures were flatter in the urban cohort by 0.08 mm (p < 0.001). This association of axial length with urban vs rural region was reduced in magnitude by 69.7% after accounting for height. CONCLUSIONS: For the same, matched refractive error, children from urban regions had significantly longer eyes and flatter corneal curvature than rural children. Since corneal curvature is defined during the first 2 years of life, early environmental factors may be the source of these differences in ocular dimensions.


Assuntos
Biometria/métodos , Córnea/fisiopatologia , Refração Ocular/fisiologia , Erros de Refração/diagnóstico , População Rural , População Urbana , Adolescente , Criança , Pré-Escolar , China/epidemiologia , Córnea/diagnóstico por imagem , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Erros de Refração/epidemiologia , Erros de Refração/fisiopatologia
7.
Oral Oncol ; 98: 141-146, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31586896

RESUMO

OBJECTIVES: This study aimed to validate the 8th edition of American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) TNM staging system for nasopharyngeal carcinoma (NPC) in non-endemic region. MATERIALS AND METHODS: We recruited 607 patients with histology-proven, previously untreated, non-metastatic NPC treated by intensity-modulated radiotherapy (IMRT) at our center. Harrell's concordance index (c-index) and Akaike information criterion (AIC) were applied to compare the prognostic discrimination between the 7th and 8th edition staging system. RESULTS: For T category, the local recurrence-free survival (LRFS) Kaplan-Meier curves of T1, T2 and T3 were well separated in the 8th edition; however, LRFS did not significantly differ between T3 and T4 (P = 0.166). Moreover, the 7th edition achieved higher c-index (0.702 [95% CI, 0.618-0.787] vs. 0.685 [95% CI, 0.604-0.767]) and lower AIC (766.1 vs. 770.8) than 8th edition for LRFS. With regard to N category, the 8th edition achieved higher c-index (0.796 [95% CI, 0.749-0.843] vs. 0.751 [95% CI, 0.696-0.805]) and lower AIC (1439.4 vs. 1471.9) for distant metastasis-free survival. In terms of overall stage, the 8th edition also had higher c-index (0.798 [95% CI, 0.753-0.844] vs. 0.721 [95% CI, 0.672-0.770]) and lower AIC (1963.9 vs. 2007.2) compared with the 7th edition for overall survival. Furthermore, interval validation by bootstrapping the sample randomly for ~100-1000 times also validated above findings. CONCLUSION: The 8th edition of AJCC/UICC TNM staging system achieved significantly better prognostic discrimination than the 7th edition with regard to N category and overall stage but not T category.


Assuntos
Carcinoma Nasofaríngeo/diagnóstico , Estadiamento de Neoplasias/métodos , Guias de Prática Clínica como Assunto , Terapia Combinada , Gerenciamento Clínico , Feminino , Seguimentos , Humanos , Masculino , Imagem Multimodal/métodos , Carcinoma Nasofaríngeo/epidemiologia , Carcinoma Nasofaríngeo/mortalidade , Carcinoma Nasofaríngeo/terapia , Estadiamento de Neoplasias/normas , Prognóstico , Reprodutibilidade dos Testes , Resultado do Tratamento
8.
Patient Educ Couns ; 102(10): 1875-1881, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31113688

RESUMO

OBJECTIVE: Three-dimensional printing may play an important role in patients' education. The objective of this study was to assess the effectiveness of personalized 3D printed models for increasing patient understanding of their medical condition and surgical plan. METHODS: Forty-five patients with degenerative lumbar diseases were randomized by block design into three groups: educational program presented by CT & MRI imaging (care-as-usual), 3D reconstructions, or personalized 3D printed models. Patients' level of understanding and satisfaction were evaluated by two questionnaires one day after education. RESULTS: Patients educated with personalized 3D printed models demonstrated an expanded level of understanding than patients educated with CT & MRI imaging (care-as-usual) (P < 0.05) and 3D reconstructions (P < 0.05). Personalized 3D printed models also resulted in a higher degree of patient satisfaction (P < 0.05). CONCLUSIONS: Personalized 3D printed models and 3D reconstructions can simplify and enhance understanding of lumbar anatomy, physiology, and patients' disease and surgical plan. Personalized 3D printed models also enhance patients' subjective satisfaction. PRACTICE IMPLICATIONS: Personalized 3D printed models for patient education are feasible and could be generalized for degenerative lumbar diseases.


Assuntos
Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/anatomia & histologia , Modelos Anatômicos , Educação de Pacientes como Assunto/métodos , Impressão Tridimensional , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Inquéritos e Questionários , Tomografia Computadorizada por Raios X
9.
J Cell Mol Med ; 23(5): 3402-3416, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30869196

RESUMO

Mindin has a broad spectrum of roles in the innate immune system, including in macrophage migration, antigen phagocytosis and cytokine production. Mindin functions as a pattern-recognition molecule for microbial pathogens. However, the underlying mechanisms of mindin-mediated phagocytosis and its exact membrane receptors are not well established. Herein, we generated mindin-deficient mice using the CRISPR-Cas9 system and show that peritoneal macrophages from mindin-deficient mice were severely defective in their ability to phagocytize E  coli. Phagocytosis was enhanced when E  coli or fluorescent particles were pre-incubated with mindin, indicating that mindin binds directly to bacteria or non-pathogen particles and promotes phagocytosis. We defined that 131 I-labelled mindin binds with integrin Mac-1 (CD11b/CD18), the F-spondin (FS)-fragment of mindin binds with the αM -I domain of Mac-1 and that mindin serves as a novel ligand of Mac-1. Blockade of the αM -I domain of Mac-1 using either a neutralizing antibody or si-Mac-1 efficiently blocked mindin-induced phagocytosis. Furthermore, mindin activated the Syk and MAPK signalling pathways and promoted NF-κB entry into the nucleus. Our data indicate that mindin binds with the integrin Mac-1 to promote macrophage phagocytosis through Syk activation and NF-κB p65 translocation, suggesting that the mindin/Mac-1 axis plays a critical role during innate immune responses.


Assuntos
Proteínas da Matriz Extracelular/metabolismo , Antígeno de Macrófago 1/metabolismo , Macrófagos/citologia , Macrófagos/metabolismo , Fagocitose , Receptores de Reconhecimento de Padrão/metabolismo , Quinase Syk/metabolismo , Fator de Transcrição RelA/metabolismo , Animais , Sequência de Bases , Núcleo Celular/metabolismo , Células HEK293 , Humanos , Antígeno de Macrófago 1/química , Camundongos , Camundongos Knockout , Fosforilação , Ligação Proteica , Domínios Proteicos , Transporte Proteico , Células RAW 264.7
10.
Clin Genet ; 95(2): 277-286, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30298696

RESUMO

The majority of men with defects in spermatogenesis remain undiagnosed. Acephalic spermatozoa is one of the diseases causing primary infertility. However, the causes underlying over half of affected cases remain unclear. Here, we report by whole-exome sequencing the identification of homozygous and compound heterozygous truncating mutations in PMFBP1 of two unrelated individuals with acephalic spermatozoa. PMFBP1 was highly and specifically expressed in human and mouse testis. Furthermore, immunofluorescence staining in sperm from a normal control showed that PMFBP1 localizes to the head-flagella junction region, and the absence of PMFBP1 was confirmed in patients harboring PMFBP1 mutations. In addition, we generated Pmfbp1 knock-out (KO) mice, which we found recapitulate the acephalic sperm phenotype. Label-free quantitative proteomic analysis of testicular sperm from Pmfbp1 KO and control mice showed 124 and 35 proteins, respectively, increased or decreased in sperm from KO mice compared to that found in control mice. Gene ontology analysis indicates that the biological process of Golgi vesicle transport was the most highly enriched in differentially expressed proteins, indicating process defects related to Golgi complex function may disturb formation of the head-neck junction. Collectively, our data indicate that PMFBP1 is necessary for sperm morphology in both humans and mice, and that biallelic truncating mutations in PMFBP1 cause acephalic spermatozoa.


Assuntos
Alelos , Proteínas do Citoesqueleto/genética , Estudos de Associação Genética , Predisposição Genética para Doença , Mutação , Teratozoospermia/diagnóstico , Teratozoospermia/genética , Animais , Análise Mutacional de DNA , Modelos Animais de Doenças , Homozigoto , Humanos , Masculino , Camundongos , Linhagem , Proteoma , Análise do Sêmen , Espermatozoides/metabolismo , Sequenciamento Completo do Exoma
11.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 49(5): 700-705, 2018 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-30378329

RESUMO

OBJECTIVE: To investigate the role of SRC kinase inhibitor PP2 in drug resistance to adriamycin (ADM) in breast cancer cells and invasion, metastasis of cells. METHODS: MTT assay was used to detect the inhibitory effect of ADM on MCF-7 and MCF-7/ADM cells. The 50% inhibitory concentration (IC50) and resistance index (RI) of cells were calculated. The expression of MDR1, connexin 43 (Cx43) and SRC proteins in breast cancer cells were detected by Western blot assay. Transwell experiment and cell scratch test were used to determine the invasion and migration of cells respectively [MCF-7, MCF-7/ADM, PP2 (1, 2, 4 µmol/L)]. Standard colony formation assay was used to detect the cytotoxicity effect of 4 µmol/L PP2 pretreatment on ADM. RESULTS: ADM inhibited the proliferation of MCF-7 more than MCF-7/ADM cells (P<0.01). The IC50 of MCF-7/ADM cells was 24.55 µmol/L, the IC50 of MCF-7/ADM cells was 770.57 µmol/L, the RI was 31. Compared with MCF-7 cells, expressions of the multidrug resistance proteins MDR1 and SRC were significantly increased (P<0.01). The invasion and migration ability of the MCF-7/ADM cells was stronger than that of the sensitive cells (P<0.01). When MCF-7/ADM was exposed to SRC inhibitor PP2, the invasion and metastasis ability of cells were inhibited (P<0.01) and the rate of colony formation was decreased, that is, more sensitivity to ADM (P<0.01). CONCLUSION: The resistance of MCF-7 to ADM is accompanied by increased expression of SRC. SRC inhibitor PP2 can reduce the cell resistance, ability of invasion and metastasis.


Assuntos
Neoplasias da Mama/enzimologia , Doxorrubicina/metabolismo , Resistencia a Medicamentos Antineoplásicos , Pirimidinas/farmacologia , Quinases da Família src/metabolismo , Subfamília B de Transportador de Cassetes de Ligação de ATP/metabolismo , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Linhagem Celular Tumoral , Conexina 43/metabolismo , Humanos , Células MCF-7 , Invasividade Neoplásica , Metástase Neoplásica
12.
Mol Med Rep ; 18(2): 1524-1530, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29845275

RESUMO

Autophagy, part of the innate immune defense mechanisms, is activated during the initial phase of septic insult. Previous studies indicated that micro (mi)RNAs are additionally involved in the host response to sepsis; however, the association between miRNAs and autophagy during this process is not fully understood. To study the role of miRNA (miR)­23a in autophagy initiated by sepsis, macrophages treated with lipopolysaccharides, in addition to blood samples from patients, were evaluated for miR­23a expression levels. Cell viability, inflammatory mediators and autophagic markers were investigated following overexpression or inhibition of miR­23a. The results suggested that miR­23a was suppressed subsequent to septic insult, promoting autophagy and suppressing a hyper inflammatory response, leading to enhanced cell viability. A luciferase assay and western blot analysis confirmed ubiquitin­like protein ATG12 to be the target of miR­23a. The present study revealed that the downregulation of miR­23a regulates an inflammatory response during septic insult via autophagy promotion.


Assuntos
Proteína 12 Relacionada à Autofagia/genética , Autofagia/genética , MicroRNAs/genética , Sepse/genética , Idoso , Animais , Antagomirs/genética , Antagomirs/metabolismo , Proteína 12 Relacionada à Autofagia/imunologia , Sequência de Bases , Sobrevivência Celular/efeitos dos fármacos , Feminino , Regulação da Expressão Gênica , Genes Reporter , Humanos , Lipopolissacarídeos/farmacologia , Luciferases/genética , Luciferases/metabolismo , Masculino , Camundongos , MicroRNAs/antagonistas & inibidores , MicroRNAs/imunologia , Pessoa de Meia-Idade , Oligorribonucleotídeos/genética , Oligorribonucleotídeos/metabolismo , Células RAW 264.7 , Sepse/imunologia , Sepse/patologia , Transdução de Sinais
13.
J Cancer ; 9(9): 1642-1651, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29760803

RESUMO

Background: This study aimed to compare concurrent chemoradiotherapy (CCRT) plus cetuximab (C) with CCRT alone in locoregionally advanced nasopharyngeal carcinoma(NPC). Methods: A total of 682 locoregionally advanced NPC patients who had undergone chemoradiotherapy with or without cetuximab were included. Propensity score-matching method was used to match patients. Progression-free survival (PFS), overall survival (OS), locoregional relapse-free survival (LRFS), and distant metastasis-free survival (DMFS) were compared between the two treatment arms. Results: After matching, 225 patients were identified for the analysis. Compared to CCRT, CCRT plus C was associated with significantly improved 3-year PFS (83.7% vs 71.9%, P = 0.036), LRFS (98.6% vs 90.2%, P = 0.034) but not OS (91.4% vs 85.4%, P = 0.117). Among patients with T4 and/or N3 category, CCRT plus C significantly prolonged 3-year PFS (81.0% vs 61.4%, P = 0.022) and increased 3-year OS (88.0% vs 77.9%, P = 0.086). No significant differences were observed between CCRT plus C and CCRT alone groups with regard to 3-year PFS, OS, LRFS and DMFS rates in stage III patients. Acute oral and oropharyngeal mucositis during radiotherapy were more common in the CCRT plus C than that in CCRT, but late toxicities were comparable. Conclusions: This study reveals that patients with locoregionally advanced NPC could benefit from the addition of cetuximab to CCRT, and this therapeutic gain mainly originated from T4 and/or N3 subgroup although suffering more acute moderate to severe toxicities.

14.
Chin Med J (Engl) ; 131(3): 253-261, 2018 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-29363638

RESUMO

BACKGROUND: Passive leg raising (PLR) represents a "self-volume expansion (VE)" that could predict fluid responsiveness, but the influence of systolic cardiac function on PLR has seldom been reported. This study aimed to investigate whether systolic cardiac function, estimated by the global ejection fraction (GEF) from transpulmonary-thermodilution, could influence the diagnostic value of PLR. METHODS: This prospective, observational study was carried out in the surgical Intensive Care Unit of the First Affiliated Hospital of Sun Yat-sen University from December 2013 to July 2015. Seventy-eight mechanically ventilated patients considered for VE were prospectively included and divided into a low-GEF (<20%) and a near-normal-GEF (≥20%) group. Within each group, baseline hemodynamics, after PLR and after VE (250 ml 5% albumin over 30 min), were recorded. PLR-induced hemodynamic changes (PLR-Δ) were calculated. Fluid responders were defined by a 15% increase of stroke volume (SV) after VE. RESULTS: Twenty-five out of 38 patients were responders in the GEF <20% group, compared to 26 out of 40 patients in the GEF ≥20% group. The thresholds of PLR-ΔSV and PLR-Δ cardiac output (PLR-ΔCO) for predicting fluid responsiveness were higher in the GEF ≥20% group than in the GEF <20% group (ΔSV: 12% vs. 8%; ΔCO: 7% vs. 6%), with increased sensitivity (ΔSV: 92% vs. 92%; ΔCO: 81% vs. 80%) and specificity (ΔSV: 86% vs. 70%; ΔCO: 86% vs. 77%), respectively. PLR-Δ heart rate could predict fluid responsiveness in the GEF ≥20% group with a threshold value of -5% (sensitivity 65%, specificity 93%) but could not in the GEF <20% group. The pressure index changes were poor predictors. CONCLUSIONS: In the critically ill patients on mechanical ventilation, the diagnostic value of PLR for predicting fluid responsiveness depends on cardiac systolic function. Thus, cardiac systolic function must be considered when using PLR. TRIAL REGISTRATION: Chinese Clinical Trial Register, ChiCTR-OCH-13004027; http://www.chictr.org.cn/showproj.aspx?proj=5540.


Assuntos
Débito Cardíaco/fisiologia , Hidratação , Coração/fisiopatologia , Hipovolemia/diagnóstico , Posicionamento do Paciente , Sístole , Adulto , Idoso , Feminino , Hemodinâmica , Humanos , Hipovolemia/fisiopatologia , Unidades de Terapia Intensiva , Perna (Membro) , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Estudos Prospectivos , Respiração Artificial , Volume Sistólico
15.
World Neurosurg ; 108: 498-505, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28927914

RESUMO

OBJECTIVE: C1-C2 pedicle screw fixation has become popular for providing excellent bony purchase and avoiding neurovascular complications. However, it may be technically challenging in children. The objective of this study is to investigate the safety and efficacy of C1-C2 pedicle screw fixation for atlantoaxial dislocation (AAD) in pediatric patients younger than 5 years and to evaluate the preliminary clinical and radiographic results. METHODS: During a 7-year period, 15 patients with a mean age of 3.4 years (range, 2-5 years) underwent C1-C2 pedicle screw fixation for AAD; at least 1 C1 pedicle screw was incorporated as part of the posterior atlantoaxial fusion construct. The cause, surgical technique, instrumentation, and clinical and radiographic results were analyzed. RESULTS: Five patients had preoperative neurologic deficits and no neurovascular injury occurred during surgery. Anterior release using a retropharyngeal approach was performed in 4 cases. Fixation of 55 C1 and C2 pedicle screws was performed successfully without neurovascular complications. Anatomic and partial reductions occurred in 12 and 3 cases, respectively. Solid fusion was achieved in 14 patients (96.9%) during a mean follow-up of 37.6 months (range, 12-111 months). Two patients (13%) experienced complications: one had prolonged immobilization for a loose C1 pedicle screw, and one had unintended fusion caused by allograft absorption. All patients showed radiographic stability and symptom resolution. CONCLUSIONS: C1-C2 pedicle screw fixation for AAD is safe and effective even in children younger than 5 years.


Assuntos
Articulação Atlantoaxial/lesões , Articulação Atlantoaxial/cirurgia , Luxações Articulares/cirurgia , Parafusos Pediculares , Fusão Vertebral , Articulação Atlantoaxial/diagnóstico por imagem , Vértebra Cervical Áxis/diagnóstico por imagem , Vértebra Cervical Áxis/cirurgia , Atlas Cervical/diagnóstico por imagem , Atlas Cervical/cirurgia , Pré-Escolar , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Luxações Articulares/complicações , Luxações Articulares/diagnóstico por imagem , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento
16.
Crit Care Med ; 45(12): e1218-e1225, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28902121

RESUMO

OBJECTIVES: Data about the critical care resources in China remain scarce. The purpose of this study was to investigate the variation and distribution of critical care resources in Guangdong province from 2005 to 2015. DESIGN: Data in regard to critical care resources were collected through questionnaires and visits every 5 years from 2005. SETTING: All hospitals in Guangdong province were screened and hospitals that provide critical care services were enrolled. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: One hundred eleven, 158, and 284 hospitals that provide critical care services were enrolled in the three consecutive surveys respectively. The number of ICUs, ICU beds, intensivists, and nurses increased to 324, 3,956, 2,470, and 7,695, respectively, by 2015. Adjusted by population, the number of ICU beds per 100,000 (100,000) population increased by 147.7% from 2005 to 2015, and the number of intensivists and nurses per 100,000 population increased by 35.3% and 55.1% from 2011 to 2015. However, the numbers in the Pearl River Delta, a richer area, were higher than those in the non-Pearl River Delta area (ICU beds: 4.64 vs 2.58; intensivists: 2.90 vs 1.61; nurses: 9.30 vs 4.71 in 2015). In terms of staff training, only 17.85% of intensivists and 14.29% of nurses have completed a formal accredited critical care training program by 2015. CONCLUSIONS: Our study was the first one to investigate the trend and distribution of critical care resources in China. The quantity of ICU beds and staff has been increasing rapidly, but professional training for staff was inadequate. The distribution of critical care resources was unbalanced. Our study can be beneficial for healthcare policymaking and the allocation of critical care resources in Guangdong province and other provinces in China.


Assuntos
Cuidados Críticos/estatística & dados numéricos , Unidades de Terapia Intensiva/provisão & distribução , China , Equipamentos e Provisões/provisão & distribução , Produto Interno Bruto , Número de Leitos em Hospital/estatística & dados numéricos , Humanos , Recursos Humanos em Hospital/provisão & distribução
17.
Oral Oncol ; 69: 26-32, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28559017

RESUMO

OBJECTIVES: Intensity-modulated radiotherapy (IMRT) has been applied in nasopharyngeal carcinoma (NPC) for nearly twenty years, while little is known about the ten-year survival outcomes. This study aimed at evaluating the 10-year survival outcomes for patients with NPC receiving IMRT. MATERIALS AND METHODS: Data on 614 patients with newly diagnosed, non-disseminated NPC treated by IMRT between 2004 and 2008 were retrospectively reviewed. Survival outcomes stratified by tumor stage were compared. RESULTS: The median follow-up duration was 112.7months (range, 7.6-156.8months) for the entire cohort. The 10-year local relapse-free survival rates for T1, T2 and T3 were 94.2%, 92.5% and 91.4% (P>0.05), respectively, and significantly higher than that of T4 disease (79.3%, P<0.05 for all rates). As N category increased from N0 to N3, the 10-year distant metastasis-free survival rates significantly decreased accordingly (P<0.01 for all rates). Furthermore, the 10-year overall survival rates were 100%, 87.1%, 75.5% and 55.6% for stage I, II, III and IV, respectively (P<0.05 except stage I and II). Multivariate analysis established tumor stage and age as independent prognostic factors. Late toxicities were assessable for 495 (80.6%) patients and most were Grade I/II damages. Xerostomia (387 of 489, 79.1%) and hearing impairment (212 of 495, 42.8%) remained the most troublesome. CONCLUSION: IMRT could achieve satisfactory survival outcomes for NPC patients with acceptable late toxicities. However, distant control still remains poor, especially for patients with N3 disease.


Assuntos
Neoplasias Nasofaríngeas/radioterapia , Radioterapia de Intensidade Modulada , Taxa de Sobrevida , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Nasofaríngeas/tratamento farmacológico , Prognóstico , Adulto Jovem
19.
Medicine (Baltimore) ; 96(16): e6634, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28422860

RESUMO

RATIONALE: Primary spinal glioblastoma multiforme (GBM) is a rare clinical entity with an aggressive course and an invariably dismal prognosis. Its clinical characteristics, radiologic and pathologic findings, and treatment protocols have been discussed in a few cases. PATIENT CONCERNS: A 15-year-old female was admitted to the neurology department with a chief complaint of progressive numbness and weakness in her left upper extremity for 3 months and neck pain for 1 month. DIAGNOSES: Spinal magnetic resonance imaging showed an intramedullary expansile mass localized between C4 and C7. The diagnosis of GBM was determined on the basis of the histopathological findings after operation. INTERVENTIONS: Laminotomy and laminoplasty between C4 and C7 were performed, and the tumor was partially resected. The patient was administered focal adjuvant radiotherapy concomitantly with oral chemotherapy following the surgery. OUTCOMES: With severe neurologic deficits at 13 months after the diagnosis, the patient expired. LESSONS: Although therapeutic options have been improving, the prognosis of the primary spinal GBM remains poor. The treatment of primary spinal GBM entered into a central registry and multiple-center cooperation is important in establishing future therapeutic strategies.


Assuntos
Vértebras Cervicais/patologia , Glioblastoma/patologia , Neoplasias da Medula Espinal/patologia , Adolescente , Terapia Combinada , Feminino , Glioblastoma/terapia , Humanos , Neoplasias da Medula Espinal/terapia
20.
EBioMedicine ; 17: 134-144, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28256400

RESUMO

To examine the mechanism of ocular axial elongation in myopia, guinea pigs (age: 2-3weeks) which either underwent unilateral or bilateral lens-induced myopization (group 1) or which were primarily myopic at baseline (group 2) received unilateral intraocular injections of amphiregulin antibody (doses: 5, 10, or 15µg) three times in intervals of 9days. A third group of emmetropic guinea pigs got intraocular unilateral injections of amphiregulin (doses: 0.25, 0.50 or 1.00ng, respectively). In each group, the contralateral eyes received intraocular injections of Ringer's solution. In intra-animal inter-eye comparison and intra-eye follow-up comparison in groups 1 and 2, the study eyes as compared to the contralateral eyes showed a dose-dependent reduction in axial elongation. In group 3, study eyes and control eyes did not differ significantly in axial elongation. Immunohistochemistry revealed amphiregulin labelling at the retinal pigment epithelium in eyes with lens-induced myopization and Ringer's solution injection, but not in eyes with amphiregulin antibody injection. Intraocular injections of amphiregulin-antibody led to a reduction of lens-induced axial myopic elongation and of the physiological eye enlargement in young guinea pigs. In contrast, intraocularly injected amphiregulin in a dose of ≤1ng did not show a significant effect. Amphiregulin may be one of several essential molecular factors for axial elongation.


Assuntos
Anfirregulina/farmacologia , Anticorpos/farmacologia , Miopia/prevenção & controle , Anfirregulina/administração & dosagem , Anfirregulina/imunologia , Anfirregulina/uso terapêutico , Animais , Anticorpos/administração & dosagem , Anticorpos/imunologia , Anticorpos/uso terapêutico , Cobaias , Injeções Intraoculares , Miopia/tratamento farmacológico , Retina/efeitos dos fármacos , Retina/crescimento & desenvolvimento
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