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AIM: To build a nomogram model to improve the evaluation of revascularisation necessity using multi-parameter coronary computed tomography (CT) angiography (CCTA). MATERIALS AND METHODS: In this retrospective study, 335 patients who underwent CCTA and required revascularisation within 1 month were selected and allocated to the revascularisation group; 208 patients who did not undergo revascularisation were allocated to the non-revascularisation group. CCTA parameters, including CCTA stenosis, plaque qualitative-quantitative characteristics, and fractional flow reserve derived from CT angiography (CT-FFR), for both groups were analysed and compared. Independent risk factors for evaluating revascularisation were obtained using univariate and multivariable regression analysis, after which multi-parameter models were built. Finally, a nomogram was created with these independent risk factors using the R programming language. RESULTS: Plaque analysis was performed successfully for 543 patients with 1,072 target plaques. The performance of the multi-parameter model (AUC 0.894, p<0.001) was significantly higher than that of models based on stenosis (AUC 0.804, p<0.001), plaque qualitative/quantitative characteristics (AUC 0.754/0.789, p<0.001), or CT-FFR (AUC 0.848, p<0.001) alone, to evaluate the necessity of revascularisation. The independent risk factors were CCTA stenosis (OR 1.004, p=0.04), positive remodelling (OR 2.474, p<0.001), total plaque volume (OR 1.001, p<0.001), non-calcified plaque volume proportion (OR 1.019, p<0.001), and CT-FFR (OR 0.001, p<0.001). Subsequently, a nomogram based on these factors was created. CONCLUSION: The multi-parameter CCTA model improved performance in evaluating revascularisation necessity. The nomogram based on these factors is shows promise in clinical settings.
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Doença da Artéria Coronariana , Estenose Coronária , Reserva Fracionada de Fluxo Miocárdico , Placa Aterosclerótica , Humanos , Angiografia por Tomografia Computadorizada/métodos , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/cirurgia , Estudos Retrospectivos , Nomogramas , Angiografia Coronária/métodos , Constrição Patológica , Curva ROC , Tomografia Computadorizada por Raios X , Placa Aterosclerótica/complicações , Valor Preditivo dos Testes , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Doença da Artéria Coronariana/complicaçõesRESUMO
AIM: To investigate the performance of multi-parameter coronary computed tomography angiography (CCTA), including stenosis, plaque qualitative-quantitative characteristics, and fractional flow reserve derived from CCTA (FFRct), to predict acute myocardial infarction (AMI) and build a combined model. MATERIALS AND METHODS: Thirty patients with AMI 90 days after CCTA and 120 matched patients without AMI were enrolled retrospectively. Multiple CCTA parameters were analysed and compared. Independent risk factors were obtained through univariate and multivariate regression analyses, after which a multi-parameter model was built. RESULTS: A total of 150 patients were analysed successfully. The multi-parameter CCTA model (area under the curve, 0.944; p<0.001) had a higher predictive value than each single parameter (p<0.001, all). Independent risk factors were intra-plaque dye penetration (IDP; odds ratio [OR], 8.373; p=0.002), lipid plaque volume (LPV; OR, 1.263; p<0.001), and FFRct ≤0.83 (OR, 8.092; p=0.001). CONCLUSION: This one-stop multi-parameter CCTA model, comprising IDP, LPV, and FFRct as independent risk factors, has good performance to predict AMI.
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Doença da Artéria Coronariana , Estenose Coronária , Reserva Fracionada de Fluxo Miocárdico , Infarto do Miocárdio , Humanos , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários , Infarto do Miocárdio/diagnóstico por imagem , Valor Preditivo dos Testes , Estudos RetrospectivosRESUMO
OBJECTIVES: Cigarette smoking is an established risk factor for illness severity and adverse outcomes in patients with COVID-19. Alcohol drinking may also be a potential risk factor for disease severity. However, the combined and interactive effects of drinking and smoking on COVID-19 have not yet been reported. This study aimed to examine the combined and interactive effects of alcohol drinking and cigarette smoking on the risk of severe illness and poor outcomes in patients with COVID-19. STUDY DESIGN: This was a multicentre retrospective cohort study. METHODS: This study retrospectively reviewed the data of 1399 consecutive hospitalised COVID-19 patients from 43 designated hospitals. Patients were grouped according to different combinations of drinking and smoking status. Multivariate mixed-effects logistic regression models were used to estimate the combined and interactive effects of drinking and smoking on the risk of severe COVID-19 and poor clinical outcomes. RESULTS: In the study population, 7.3% were drinkers/smokers, 4.3% were drinkers/non-smokers and 4.9% were non-drinkers/smokers. After controlling for potential confounders, smokers or drinkers alone did not show a significant increase in the risk of severe COVID-19 or poor clinical outcomes compared with non-drinkers/non-smokers. Moreover, this study did not observe any interactive effects of drinking and smoking on COVID-19. Drinkers/smokers had a 62% increased risk (odds ratio = 1.62, 95% confidence interval: 1.01-2.60) of severe COVID-19 but did not have a significant increase in the risk for poor clinical outcomes compared with non-drinkers/non-smokers. CONCLUSIONS: Combined exposure to drinking and smoking increases the risk of severe COVID-19, but no direct effects of drinking or smoking, or interaction effects of drinking and smoking, were detected.
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COVID-19 , Fumar Cigarros , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , COVID-19/epidemiologia , Humanos , Razão de Chances , Estudos RetrospectivosRESUMO
Acute osteofascial compartment syndrome is a series of symptoms and signs caused by acute ischemia of muscles and nerves in osteofascial compartment. If it is not treated in time, it can lead to tissue necrosis. It is rare that it is caused by rodenticide poisoning. Such patients are often difficult to diagnose and treat early and have poor prognosis. In May 2018, a patient with acute osteofascial compartment syndrome caused by anticoagulant rodenticide poisoning was admitted to the Twelfth Hospital of Guangzhou City. After systematic treatment, he finally recovered and discharged. The early manifestations of this patient were mainly coagulation dysfunction, and finally acute osteofascial compartment syndrome. 5 days later, the diagnosis was made, and the operation of incision decompression and vacuum sealing drainage (VSD) was performed.
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Síndromes Compartimentais/induzido quimicamente , Rodenticidas/intoxicação , Síndromes Compartimentais/terapia , Drenagem , Fáscia/patologia , Humanos , MasculinoRESUMO
AIM: To investigate the value of myocardial computed tomography (CT) perfusion imaging (CTP) and atherosclerotic plaque characteristics (APCs) identified on coronary CT angiography (CCTA) for the detection of myocardial ischaemia by using single-photon-emission CT (SPECT) as a reference. MATERIALS AND METHODS: Thirty-six patients (63.9% males) undergoing combined stress dynamic CTP and CCTA were enrolled and analysed. Myocardial blood flow (MBF) from CTP was quantified and compared between normal and abnormal segments. The ability of CTP and APCs to detect ischaemia was compared to that of SPECT. RESULTS: Nineteen patients with 78 segments had perfusion abnormalities on CTP. A significant difference was seen in MBF values between normal (118.51±27.86 ml/100 ml/min) and hypoperfused (79.60±21.35 ml/100 ml/min) segments (t=15.832, p<0.05). The sensitivity and specificity for identifying ischaemia were 90.91% and 94.97%, respectively, on a per-segment basis, resulting in a r value of 0.737 (p<0.05). On a per-vessel basis, the sensitivity and specificity for detecting ischaemia were 86.67% and 84.62%, respectively, for CTP; 93.33% and 58.97%, respectively, for CCTA; and 86.67% and 87.18%, respectively, for CTP combined with CTA, with an area under the receiver-operator characteristic curve (AUC) being 0.87 (p<0.05) and 0.887 (p<0.05) for CTP and its combination with CTA, respectively. On CCTA, 55 vessels with APCs were detected, with an AUC of 0.737 (p<0.05) for APCs combined with CCTA stenosis and 0.802 (p<0.05) for APCs combined with CTP. CONCLUSIONS: Dynamic stress CTP shows good correlation with SPECT for the detection of ischaemia. Additionally, combining APCs with CCTA stenosis has the ability to discriminate ischaemic stenosis.
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Angiografia por Tomografia Computadorizada , Angiografia Coronária , Isquemia Miocárdica/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/métodos , Placa Aterosclerótica/diagnóstico por imagem , Meios de Contraste , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Feminino , Humanos , Iopamidol , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios XRESUMO
Lasing is reported for ridge-waveguide devices processed from a 40-stage InP-based quantum cascade laser structure grown on a 6-inch silicon substrate with a metamorphic buffer. The structure used in the proof-of-concept experiment had a typical design, including an Al0.78In0.22As/In0.73Ga0.27As strain-balanced composition, with high strain both in quantum wells and barriers relative to InP, and an all-InP waveguide with a total thickness of 8 µm. Devices of size 3 mm x 40 µm, with a high-reflection back facet coating, emitted at 4.35 µm and had a threshold current of approximately 2.2 A at 78 K. Lasing was observed up to 170 K. Compared to earlier demonstrated InP-based quantum cascade lasers monolithically integrated onto GaAs, the same laser structure integrated on silicon had a lower yield and reliability. Surface morphology analysis suggests that both can be significantly improved by reducing strain for the active region layers relative to InP bulk waveguide layers surrounding the laser core.
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The bulk porous copper structures with three levels of pore size from macro- to micro- to nano-scale were prepared from CuMnAl alloy through a facile one-step dealloying process. The excellent performances, such as hierarchical porosity, ultralow density (theoretical density at 0.53 g/cm3), and stable mechanical properties, were obtained in these copper structures which could be widely applied in many potential industrial applications. In addition, the process and mechanism of the pore formation was well investigated by SEM and EDX in this paper. The experimental results showed that the hierarchical multi-scale porosities in bulk copper structures were successfully fabricated by the one-step dealloying method. The macro-pores (up to 70 µm in major axis) and the micro-pores (about 2Ë5 µm in diameter) in this sample were obtained from the removed high-purity Al phase of the precursor alloy, while the nano-pores (about 70Ë100 nm in diameter) were generated from the dealloyed intermetallic compounds of Al2Cu and Al11Cu5Mn3, respectively.
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Objective: To explore the value of prenatal MRI in the diagnosis of fetal simple expansion of lateral ventricle (ventriculomegaly) , and follow up the nervous system development status after birth. Methods: Simple expansion of the lateral ventricle fetus by prenatal MRI examination were collected in Huzhou Maternal and Child Care Hospital from May 2013 to June 2015, 126 cases of live births in expansion group, 50 normal cases were recruited in the same period as the control group. In expansion group, fetal subgroup analysis was done: (1) unilateral or bilateral lateral ventricle expasion: one group was 98 cases was lateral ventricle expansion (77.8%, 98/126), expansion of bilateral ventricle group was 28 cases (22.2%, 28/126). (2) Prenatal MRI in the diagnosis of the lateral ventricle of expansion: expansion of the lateral ventricle width was greater than 10.0 mm, if both sides were expanding, the expand width was the heavier one side, divided into 3 subgroups: â Expansion in group A (lateral ventricle width 10.0-12.0 mm) were 88 cases (69.8%, 88/126). â¡Expansion in group B (lateral ventricle width 12.1-15.0 mm) were 29 cases (23.0%, 29/126). â¢Expansion of group C (lateral ventricle width> 15.0 mm) were 9 cases (7.12%, 9/126). All 176 cases were followed up after birth at the 3rd, 6th, 12th, 18th month (corrected age was used for premature babies), and Gesell developmental schedules (GDS) were used to evaluate the neurobehavioral development. Results: (1) The MRI results after birth: 21 cases were followed up by MRI after birth. In group A, 11 cases had MRI and 9 were normal (the ventricular width <10.0 mm after birth), the other 2 cases were stable (the ventricular width measured first time after birth was ≥10.0 mm, but the difference was within 2.0 mm from the MRI before birth). In group B, 4 cases had MRI, 1 was normal, 1 was stable, and 2 cases were getting better (the ventricular width measured first time after birth was ≥10.0 mm, but the width decreased more than 2.0 mm from the MRI before birth). In group C, 6 cases had MRI. 3 cases were getting better and 3 cases were stable. (2) Overall GDS results: expansion group after the birth of the 3rd, 6th, 12th, 18th month GDS evaluation results compared with control group, respectively, the differences were not statistically significant (all P>0.05). (3) The GDS results among the subgroups: in each evaluation after birth, there were no statistically significant differences between group A and the control group (all P>0.05). The GDS results of group B at the 3rd and 6th month were lower than those of the control group (P<0.05); while there were no statistically significant differences between the 2 goups at the 12th and 18th month (P>0.05). And for group C, statistically significant differences were found compared to the control group at each follow-up time (all P<0.05). (4) GDS results at different times after birth in the expansion group: there was no statistically significant difference between the results at the 3rd and 6th month (P>0.05). But when the result at the 3rd month was compared to the results of the 12th or 18th month, the differences were statistically significant (P<0.05). GDS result of 6th months after birth compared with 12th and 18th months, respectively, there were no statistically significant differences (P>0.05). There was no statistically significant difference between the results at the 12th and 18th month (P>0.05). (5) The GDS results in unilateral and bilateral ventricle expansion: at the 18th month, among the 98 unilateral cases, 86 (87.8%, 86/98) had normal GDS results(>85 scores); 8 (8.2%, 8/98) had borderline results (75-85 scores); 4 (4.1%, 4/98) had delayed results (<75 scores). Among the 28 bilateral cases, 23 (82.1%, 23/28) had normal GDS results; 3 (10.7%, 3/28) had borderline results; 2 (7.1%, 2/28) had delayed results. There was no statistically significant difference (P>0.05). Conclusions: Among the simple expansion of lateral ventricle, those whose ventricular width are ≤12.0 mm may not need clinical treatment. If the width is between 12.1 to 15.0 mm, closely follow-up and targeted rehabilitation training after birth are recommended. When the width is more than 15.0 mm, the risk of the central nervous system function delay is significantly increased, and early intervention might improve the prognosis.
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Hidrocefalia/diagnóstico por imagem , Ventrículos Laterais/anormalidades , Ventrículos Laterais/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Diagnóstico Pré-Natal/métodos , Ultrassonografia Pré-Natal/métodos , Estudos de Casos e Controles , Feminino , Feto/diagnóstico por imagem , Seguimentos , Humanos , Lactente , Recém-Nascido , Gravidez , Resultado da Gravidez , PrognósticoRESUMO
Hoarseness is a common post-operative complication in patients who receive general anesthesia. In most cases, the symptoms are temporary and improve within several days. This report describes two patients with prolonged hoarseness following use of the streamlined liner of the pharyngeal airway (SLIPATM). We present the first case of a 56-year-old female patient who developed arytenoid cartilage dislocation resulting in prolonged hoarseness and dysphagia after using a SLIPA™ during a laparoscopic myomectomy. In the second case, we report on a 65-year-old male patient who was scheduled for a laparoscopic cholecystectomy. Left vocal fold paralysis or paresis resulting from recurrent laryngeal nerve injury associated with use of a SLIPA™ caused persistent hoarseness. It should be noted that recurrent laryngeal nerve injury or arytenoid cartilage dislocation are possible complications associated with use of the SLIPATM in case of persistent hoarseness.
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Rouquidão/etiologia , Máscaras Laríngeas/efeitos adversos , Complicações Pós-Operatórias/etiologia , Idoso , Cartilagem Aritenoide/lesões , Feminino , Decúbito Inclinado com Rebaixamento da Cabeça , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Traumatismos do Nervo Laríngeo/etiologia , Masculino , Pessoa de Meia-Idade , Recuperação de Função FisiológicaRESUMO
AIM: To explore the value of 64-section computed tomography (CT) perfusion imaging (CTPI) in the early diagnosis of acute radiation-induced lung injury (ARILI). MATERIALS AND METHODS: Fifty-one patients with oesophageal cancers or malignant thymomas received postoperative radiation therapy with a 60-62 Gy dose and underwent CTPI at pre- and post-radiation therapy time points (week 0, week 4, week 8, and week 12 respectively). The CTPI values were prospectively compared and analysed in order to evaluate the diagnostic utility of CTPI in the early diagnosis of ARILI. RESULTS: Eighteen cases (18/51) of ARILI were diagnosed. The mean values of relative regional blood flow (rrBF), relative regional volume (rrBV), and relative regional permeability surface (rrPS) in the ARILI group were correspondingly higher than those of the non-ARILI group. At week 4, rrBF, rrBV, and rrPS in the ARILI group were significantly higher than those at pre-radiation (each p < 0.05). In the non-ARILI group, rrBF and rrBV were higher than those at pre-radiation (each p < 0.05); however, rrPS was not statistically different from that of pre-irradiation. Applying the diagnostic threshold value of rrPS = 1.22, the sensitivity, specificity, and positive and negative predictive values of CTPI for early diagnosis of ARILI were better than those of CT. CONCLUSION: CTPI metrics may reflect haemodynamic changes in the post-irradiation lung and can detect cases of early ARILI that appear normal at CT. CTPI is a promising technique for early diagnosis of ARILI.
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Lesão Pulmonar/diagnóstico por imagem , Lesões por Radiação/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Doença Aguda , Adulto , Idoso , Análise de Variância , Diagnóstico Precoce , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Pulmão/irrigação sanguínea , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fluxo Sanguíneo Regional , Sensibilidade e EspecificidadeRESUMO
OBJECTIVES: The present study was undertaken to evaluate the long-term health-related quality of life (HRQOL) as well as the employment status in survivors of severe sepsis up to 6 years afterwards. MATERIAL AND METHODS: From January 2003 to December 2008 a total of 112 severe sepsis and 112 age, gender and Charlson comorbidity index-matched non-septic critically ill patients from 4 university hospital intensive care units (ICU) were enrolled in the study and 126 age and gender-matched community residents were interviewed as the community control group. RESULTS: A total of 66 (58.9 %) severe sepsis and 80 (71.4 %) non-sepsis critically ill patients survived during the long-term follow-up time. Between August and December 2010 a total of 75 patients including 42 survivors of severe sepsis and 33 critically ill controls completed the face-to-face interview. There were no differences in the long-term HRQOL in terms of Short-Form 36 criteria between severe sepsis and non-sepsis critically ill survivors. However, when compared with the community controls, HRQOL in survivors of severe sepsis showed a significantly and clinically meaningful decrease, with a lower physical functioning (p = 0.016), vitality (p = 0.037), role-emotional (p = 0.043), mental health (p = 0.038) and mental component scores (p = 0.042). In addition, the criteria returning to work at 1 year and at the time of interview in severe sepsis survivors were similar with those in critically ill survivors (60.5 % vs. 70.0 %, p = 0.41 and, 71.1 % vs. 76.7 %, p = 0.602). CONCLUSIONS: The HRQOL in survivors of severe sepsis was impaired even up to 6 years after hospital discharge.
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Qualidade de Vida , Sepse/terapia , Sobreviventes/estatística & dados numéricos , Atividades Cotidianas , Adulto , Idoso , Povo Asiático , Estudos de Casos e Controles , China/epidemiologia , Estudos de Coortes , Estado Terminal , Coleta de Dados , Emprego , Feminino , Seguimentos , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sepse/psicologia , Fatores Socioeconômicos , Inquéritos e Questionários , Sobreviventes/psicologia , Resultado do TratamentoRESUMO
To explore the digital manufacturing process of distal extension removable partial denture. From November 2021 to December 2022, 12 patients (7 males and 5 females) with free-ending situation were selected from the Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University. Three-dimensional model of the relationship between alveolar ridge and jaw position was obtained by intraoral scanning technique. After routine design, manufacturing and try-in of metal framework for removable partial denture, the metal framework was located in the mouth and scanned again to obtain the composite model of dentition, alveolar ridge and metal framework. The free-end modified model is obtained by merging the digital model of free-end alveolar ridge with the virtual model with the metal framework. The three-dimensional model of artificial dentition, and base plate was designed on the free-end modified model, and the resin model were made by digital milling technology. The removable partial denture was made by accurately positioning the artificial dentition and base plate, bonding metal framework with injection resin, grinding and polishing the artificial dentition and resin base. Compared with the design data after clinical trial, the results showed that there was an error of 0.4-1.0 mm and an error of 0.03-0.10 mm in the connection between the resin base of artificial dentition and the connecting rod of the in-place bolt and the connection between artificial dentition and resin base. After denturen delivery, only 2 patients needed grinding adjustment in follow-up visit due to tenderness, and the rest patients did not find any discomfort. The digital fabrication process of removable partial denture used in this study can basically solve the problems of digital fabrication of free-end modified model and assembly of artificial dentition with resin base and metal framework.
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The Sunong black pig is a new composite breed under development generated from Chinese indigenous pig breeds (i.e., Taihu and Huai) and intensive pig breeds (i.e., Landrace and Berkshire), which is an important genetic material for studying breeding mechanisms. However, there is currently limited knowledge about the genetic structure and germplasm characteristics of Sunong black pigs. To comprehensively understand their genetic composition and ancestry proportions, we performed population structure and local ancestry inference analysis based on whole-genome sequencing information. The results showed that Sunong black pigs could be clustered independently into a group, whose pedigree was intermediate between indigenous and commercial pig breeds, but closer to commercial pigs. Furthermore, local ancestry inference analysis revealed that Sunong black pigs inherited immune and reproductive traits from indigenous pig breeds, including CC and CXC chemokine family, Toll-like receptor family, IFN gene family, ESR1, AREG and EREG gene, while growth and development-related traits were inherited from commercial pig breeds, including IGF1 and GSY2 gene. Overall, Sunong black pigs have formed a relatively stable genome structure with some advantageous traits inherited from their ancestral breeds. This study deepened the understanding of the breeding mechanism of Sunong black pigs and provided a reference for cross-breeding programmes in livestock.
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Polimorfismo de Nucleotídeo Único , Sus scrofa , Suínos/genética , Animais , Sus scrofa/genética , Linhagem , Genoma , Análise de Sequência de DNA/veterinária , Variação GenéticaRESUMO
AIM: To describe computed tomography (CT) imaging and histopathological manifestations of renal epithelioid angiomyolipomas (EAMLs) for better understanding and cognition in the diagnosis of this new category of renal tumours. MATERIALS AND METHODS: Clinical data and CT images from 10 cases of EAML were retrospectively analysed. All patients underwent CT with and without contrast medium administration, with multiplanar reconstruction (MPR) when needed. RESULTS: Plain CT manifestations of EAMLs were a higher density of mass (10-25 HU) than renal parenchyma, bulging contour of the involved kidney, absence of fat, distinct edges without a lobulate appearance. Contrast-enhanced CT features were markedly heterogeneous enhancement (from rapid wash-in to slow wash-out), large tumour size without lobular appearance, complete capsule with distinct margins and frequent mild necrotic areas. Histopathological features were epithelioid cells with eosinophilic cytoplasm, large and deeply stained nuclei, and dense arrangement of tumour cells with patchy necrosis; diffuse sheets of epithelioid cells were positive for HMB-45 (melanoma-associated antigen) and negative for epithelial membrane antigen (EMA) staining. CONCLUSION: Multiple specific CT features correlated well with the histopathology and may play an important role in the primary diagnosis of EAMLs.
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Angiomiolipoma/diagnóstico por imagem , Células Epitelioides/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Angiomiolipoma/patologia , Meios de Contraste , Diagnóstico Diferencial , Células Epitelioides/patologia , Feminino , Humanos , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Interpretação de Imagem Radiográfica Assistida por Computador , Estudos RetrospectivosRESUMO
WHAT IS KNOWN AND OBJECTIVE: Clinical investigations into postoperative intravenous patient-controlled analgesia (PCA) have indicated interindividual differences in fentanyl consumption. Cytochrome P450 3A4 (CYP3A4) is the main metabolism enzyme of fentanyl, and single nucleotide polymorphisms within the CYP3A4 gene may contribute to the variability of fentanyl analgesic efficacy. The aim of this study was to investigate whether the most common genetic variation in Chinese, CYP3A4*1G, has an impact on the fentanyl consumption for intravenous PCA in Chinese Han women undergone abdominal total hysterectomy. METHODS: A total of 79 female patients (American Society of Anesthesiologist physical status I or II) scheduled to undergo elective abdominal total hysterectomy were enrolled. All patients received combined spinal-epidural anaesthesia with bupivacaine. Intravenous fentanyl PCA was provided postoperatively for satisfactory analgesia. The doses of fentanyl consumption were recorded 2, 4, 24 and 48 h after the initiation of PCA postoperatively. Pain at rest and adverse effects were measured with rating scales. CYP3A4*1G was screened by means of direct sequencing and further confirmed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS AND DISCUSSION: Forty-six patients were GG homozygotes, 27 patients were GA heterozygotes, and six patients were AA homozygotes, respectively. The distribution of the CYP3A4*1G allele was consistent with Hardy-Weinberg equilibrium (P>0·05). At 2 and 4 h, the doses of fentanyl required for patients with GA/AA genotypes were 80·0 (45·0, 112·5) µg and 120·0 (80, 173·8)µg, respectively, and significantly lower than those for GG homozygotes [91·3 (80·0, 125·0) µg and 169·0 (112·5, 226·3) µg, respectively, P<0·05]. There was trend of decreasing fentanyl consumption at 24 and 48h in patients with GA/AA genotypes, relative to GG homozygotes, but the difference was not statistical significant (P>0·05). WHAT IS NEW AND CONCLUSIONS: CYP3A4*1G has an impact on the analgesic effect of fentanyl in Chinese Han subjects. Further validation of our results in a well-powered study would be helpful.
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Analgésicos Opioides/administração & dosagem , Citocromo P-450 CYP3A/genética , Fentanila/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Adulto , Analgesia Controlada pelo Paciente/métodos , Analgésicos Opioides/uso terapêutico , Povo Asiático/genética , China , Feminino , Fentanila/uso terapêutico , Humanos , Histerectomia/métodos , Infusões Intravenosas , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Polimorfismo de Fragmento de Restrição , Polimorfismo de Nucleotídeo Único , Fatores de TempoRESUMO
Platycodon grandiflorum is currently mainly used in the treatment of lung issues such as ventilating the lung, resolving phlegm, benefiting pharynx and discharging pus in modern clinical practice. However, in Shennong Materia Medica Classic, the main applications of Platycodon grandiflora were for chest and hypocholic pain, abdominal fullness, intestinal ringing and anxiety palpitations. The considered efficacy of platycodon grandiflorum had changed dramatically since the Han Dynasty. Combing the records of platycodon grandiflorum in the literature of traditional Chinese herbs and comparing it with the clinical application of platycodon grandiflorum in the past dynasties, this paper found that the clinical application is the main factor affecting the effect change of platycodon grandiflorum and that the description of the efficacy of platycodon grandiflorum in the literature of Herbology is different from the actual application because of the complex interaction between the efficacy of prescription and drug efficacy. Therefore, there is a necessity to carry out a comparative study between one single traditional Chinese medicine and efficacy of medicine compatibility, so as to provide a theoretical basis for precise clinical application.
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Platycodon , Medicina Tradicional Chinesa , Raízes de PlantasRESUMO
Drosophila affinidisjuncta and Drosophila hawaiiensis are closely related species that display distinct tissue-specific expression patterns for their homologous alcohol dehydrogenase genes (Adh genes). In Drosophila melanogaster transformants, both genes are expressed at high levels in the larval and adult fat bodies, but the D. affinidisjuncta gene is expressed 10-50-fold more strongly in the larval and adult midguts and Malpighian tubules. The present study reports the mapping of cis-acting sequences contributing to the regulatory differences between these two genes in transformants. Chimeric genes were constructed and introduced into the germ line of D. melanogaster. Stage- and tissue-specific expression patterns were determined by measuring steady-state RNA levels in larvae and adults. Three portions of the promoter region make distinct contributions to the tissue-specific regulatory differences between the native genes. Sequences immediately upstream of the distal promoter have a strong effect in the adult Malpighian tubules, while sequences between the two promoters are relatively important in the larval Malpighian tubules. A third gene segment, immediately upstream of the proximal promoter, influences levels of the proximal Adh transcript in all tissues and developmental stages examined, and largely accounts for the regulatory difference in the larval and adult midguts. However, these as well as other sequences make smaller contributions to various aspects of the tissue-specific regulatory differences. In addition, some chimeric genes display aberrant RNA levels for the whole organism, suggesting close physical association between sequences involved in tissue-specific regulatory differences and those important for Adh expression in the larval and adult fat bodies.
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Álcool Desidrogenase/genética , Drosophila/genética , Regulação da Expressão Gênica , Genes , Sequências Reguladoras de Ácido Nucleico , Álcool Desidrogenase/biossíntese , Animais , Drosophila/enzimologia , Drosophila/crescimento & desenvolvimento , Indução Enzimática , Corpo Adiposo/enzimologia , Genes Sintéticos , Intestinos/enzimologia , Larva , Túbulos de Malpighi/enzimologia , Especificidade de Órgãos , Filogenia , Regiões Promotoras Genéticas , Proteínas Recombinantes de Fusão/biossíntese , Proteínas Recombinantes de Fusão/genética , Especificidade da EspécieRESUMO
The use of celecoxib is associated with a significant decrease in breast cancer risk. However, the long-term use of high-dose celecoxib might be limited owing to cardiovascular side effects. In this study, we found that acetylbritannilactone (ABL), extract from a Chinese medicinal herb, could reduce celecoxib dose and potentiate the growth-inhibitory effect in breast cancer cells. ABL enhanced the apoptotic effect of celecoxib in COX-2-expressing cells, but had little effect in COX-2-negative cells. The apoptosis induced by the combination treatment disappeared when COX-2 was knocked down, whereas the lack of apoptotic effects in COX-2-negative cells was reversed after COX-2 transfection. However, the combination treatment induced a G(0)/G(1) phase arrest independent of whether or not the cells expressed COX-2. The G(0)/G(1) arrest was attributed to a decreased expression of cyclinD1, cyclinE, CDK2 and CDK6, especially the upregulation of p21. In addition, inhibition of Akt and p38 signaling pathways was required by the synergism, as the constitutively active Akt and p38 protected cells against apoptosis and cell cycle arrest induced by the combination treatment. In vivo, administration of celecoxib and ABL were more effective than the individual agents against xenograft tumor growth. Thus, our data suggested that the combinatorial approach of celecoxib and ABL might be helpful for breast cancer treatment.
Assuntos
Neoplasias da Mama/tratamento farmacológico , Inibidores de Ciclo-Oxigenase 2/toxicidade , Ciclo-Oxigenase 2/metabolismo , Medicamentos de Ervas Chinesas/toxicidade , Lactonas/toxicidade , Pirazóis/toxicidade , Sulfonamidas/toxicidade , Animais , Apoptose/efeitos dos fármacos , Celecoxib , Linhagem Celular Tumoral , Ciclina D1/metabolismo , Ciclina E/metabolismo , Quinase 2 Dependente de Ciclina/metabolismo , Quinase 6 Dependente de Ciclina/metabolismo , Inibidor de Quinase Dependente de Ciclina p21/metabolismo , Ciclo-Oxigenase 2/química , Ciclo-Oxigenase 2/genética , Inibidores de Ciclo-Oxigenase 2/uso terapêutico , Medicamentos de Ervas Chinesas/uso terapêutico , Feminino , Fase G1 , Humanos , Lactonas/uso terapêutico , Camundongos , Camundongos Nus , Proteínas Proto-Oncogênicas c-akt/metabolismo , Pirazóis/uso terapêutico , Fase de Repouso do Ciclo Celular , Transdução de Sinais , Sulfonamidas/uso terapêutico , Transplante Heterólogo , Proteínas Quinases p38 Ativadas por Mitógeno/metabolismoRESUMO
AIM: To evaluate the value of magnetic resonance (MR) diffusion-weighted imaging (DWI) and apparent diffusion coefficients (ADC) maps in the diagnosis of intraparenchymal epidermoid cysts (ECs). MATERIALS AND METHODS: Six cases of histopathologically proven intraparenchymal ECs were studied. All patients were examined with conventional MR (T1WI, T2WI, contrast-enhanced T1WI) and DWI sequences. Along with the mean ADC values (mADC) of the ECs, the cerebrospinal fluid (CSF) and grey matter (GM) were measured. Qualitative and quantitative assessments, as well as MRI findings, were retrospectively analysed using a double blind method by three radiologists in consensus. RESULTS: Four lesions were located in the cerebellum, among them, one was accompanied by an arachnoid cyst; one huge lesion crossed the parenchyma of the frontal and temporal lobes; the other was located in the left temporal lobe. Two lesions had a homogeneous CSF-like intensity on both T1WI and T2WI. The other four were of mixed-intensity on both T1WI and T2WI. All lesions were strikingly hyperintense on DWI, and iso- or slightly hypointense on ADC (relative to the brain). The mADCs of the ECs were significantly higher than that of GM, but significantly lower than that of CSF. Three cases (3/6) were accurately diagnosed using conventional MR sequences without DWI, but in the remaining three cases, correct diagnosis could only be made with help of DWI. CONCLUSION: DWI sequences can facilitate the diagnosis of intraparenchymal ECs, thus alerting surgeons of the risk of chemical meningitis at surgery. The MR findings of intraparenchymal ECs are basically as the same as those of extracerebral ECs, but the former is likely to have a mixed signal. The hyperintense signal of ECs on DWI is probably caused by the T2 shine-through effect in tumour tissue.
Assuntos
Encefalopatias/diagnóstico , Imagem de Difusão por Ressonância Magnética/métodos , Cisto Epidérmico/diagnóstico , Adulto , Idoso , Encefalopatias/patologia , Meios de Contraste , Método Duplo-Cego , Cisto Epidérmico/patologia , Feminino , Gadolínio DTPA , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Sepsis is a systemic inflammatory response syndrome to infection. Human beta-defensin 1 (DEFB1) is a multifunctional mediator in infection and inflammation, which has been largely explored in ex vivo studies. The present case-control study was designed to investigate whether DEFB1 genomic variations are associated with the susceptibility to and the outcome of severe sepsis in 211 patients with severe sepsis and 157 ethnic-matched healthy controls. After correcting for multiple testing, the -44G/C was the only polymorphism found to show significant associations with both the susceptibility to and the fatal outcome of severe sepsis (P=0.0049, odd ratio (OR) 1.971 and P=0.002, OR 2.406, respectively). Haplotype -20A/-44C/-52G showed a protective role against severe sepsis (P=0.0066, OR 0.6751), whereas haplotype -20G/-44G/-52G served as a risk factor for the fatal outcome of severe sepsis (P=0.0052, OR 2.427). These findings provide further evidence that beta-defensin 1 may play a role in the pathogenesis of severe sepsis.