RESUMO
Objective: Previous studies have indicated that an increase in the number of fat cells is associated with a decrease in bone density and bone mass. During this process, the differentiation of fat cells is closely related to the extracellular signal-regulated kinase (ERK) 1/2 signaling pathway. However, research on the characteristics of lipid metabolism-regulating kinase ERK1/2 expression in osteoporosis patients with different traditional Chinese medicine (TCM) patterns and their correlations is currently limited. Therefore, this study aims to explore the correlation between TCM patterns and lipid metabolism-regulating kinases in elderly osteoporosis patients. Methods: A total of 88 elderly osteoporosis patients with hip joint diseases who underwent total hip arthroplasty at our hospital from October 2017 to October 2022 were selected for this study, and all included patients met the complete inclusion criteria. The 88 patients were divided into groups according to TCM pattern differentiation, with 37 cases of liver and kidney deficiency pattern (Group A), 28 cases of spleen and kidney yang deficiency pattern (Group B), and 23 cases of qi stagnation and blood stasis pattern (Group C). On the second day of hospitalization, 5 ml of morning fasting venous blood was collected from patients in the three groups and used to detect and compare the differences in total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels. Patients underwent 7 days of in-hospital conditioning before undergoing total hip arthroplasty. After surgery, bone specimens were collected from the femoral neck bone defect and preserved for testing. Western blot was used to detect the protein expression levels of ERK1/2 and p-ERK1/2 in bone specimens of patients with osteoporosis. Subsequently, the differences in ERK1/2 and p-ERK1/2 protein expression levels among the three groups were compared. Finally, multifactorial logistics regression analysis was used to determine the correlation between different TCM patterns and blood lipid indicators and lipid metabolism-regulating kinases. Results: There was no significant difference in TC levels among osteoporosis patients with TCM patterns in the three groups (all, P > .05). TG levels in Group B osteoporosis patients were significantly higher than those in Group A and Group C (all, P < .05). HDL-C levels in Group A osteoporosis patients were significantly higher than those in Group B and Group C (all, P < .05). LDL-C levels in Group C osteoporosis patients were significantly lower than those in Group A and Group B (all, P < .05). There was no significant difference in ERK1/GAPDH and ERK2/GAPDH levels among osteoporosis patients with TCM patterns in the three groups (all, P > .05). The levels of p-ERK1 and p-ERK2 in bone specimens of osteoporosis patients in Group C were significantly higher than those in Group A and Group B (all, P < .05). The level of p-ERK2 in bone specimens of osteoporosis patients in Group A was significantly higher than that in Group B (P < .05). There was a significant positive correlation between TCM pattern and TG levels in patients in Group B (r = 0.221, P < .05) and a significant negative correlation with p-ERK1/2 values (r=-0.547, P < .05). Conclusion: Osteoporosis patients with different TCM patterns exhibit significant differences in blood lipid indicators and lipid metabolism-regulating kinase levels. Additionally, there is a close relationship between different TCM patterns of osteoporosis and lipid metabolism-regulating kinases.
RESUMO
BACKGROUND: Osteoporosis is a common phenomenon in HIV patients on tenofovir treatment, but its underlying mechanisms remain to be explored. METHODS: Quantitative real-time PCR was performed to analyze the expression of miR-302, miR-101, miR-145 and osteoclast-specific genes in the serum of HIV patients treated with tenofovir and ZOL. ELISA was used to evaluate the expression of RANKL, SMAD3 and PRKACB in the serum of these patients. Luciferase assay was carried out to explore the inhibitory effects of miR-302, miR-101 and miR-145 on the expression of PRKACB, RANKL and SMAD3, respectively. Western blot was used to examine the expression of genes involved in NFκB and JNK signaling pathways. RESULTS: ZOL treatment significantly suppressed the expression of CTx and osteocalcin in HIV patients treated with tenofovir. The BMD loss of HIV patients treated with tenofovir was effectively hindered by ZOL treatment. Mechanistically, the expression of miR-302, miR-101, miR-145, RANKL, SMAD3 and PRKACB in the serum was remarkably activated by ZOL treatment. Luciferase assays showed that miR-302, miR-101 and miR-145 effectively suppressed the expression of PRKACB, RANKL and SMAD3, respectively, through binding to their 3' UTR. Furthermore, ZOL treatment notably restored the normal expression of osteoclastspecific genes while activating NFκB and JNK signaling pathways. CONCLUSION: The findings of this study demonstrated that administration of ZOL suppressed the expression of RANKL via modulating signaling pathways of miR-101-3p/RANKL, miR-302/PRKACB/RANKL and miR-145/SMAD3/RANKL. Furthermore, down-regulated expression of RANKL by ZOL treatment alleviated osteoporosis in HIV-positive subjects treated with tenofovir.
Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Infecções por HIV/tratamento farmacológico , Osteogênese/efeitos dos fármacos , Osteoporose/tratamento farmacológico , Ligante RANK/metabolismo , Ácido Zoledrônico/uso terapêutico , Adulto , Antirretrovirais/efeitos adversos , Densidade Óssea/efeitos dos fármacos , Conservadores da Densidade Óssea/farmacologia , Proliferação de Células/efeitos dos fármacos , Células Cultivadas , Subunidades Catalíticas da Proteína Quinase Dependente de AMP Cíclico/sangue , Feminino , Infecções por HIV/sangue , Infecções por HIV/metabolismo , Humanos , Sistema de Sinalização das MAP Quinases/efeitos dos fármacos , Masculino , MicroRNAs/sangue , Pessoa de Meia-Idade , Osteoclastos/efeitos dos fármacos , Osteoporose/sangue , Osteoporose/metabolismo , Ligante RANK/sangue , Proteína Smad3/sangue , Tenofovir/efeitos adversos , Ácido Zoledrônico/farmacologiaRESUMO
BACKGROUND: Inflammatory markers are associated with tumor genesis and progression, but their prognostic significance in osteosarcoma remains unclear. Therefore, we discussed the prognostic value of related inflammatory markers in osteosarcoma through a meta-analysis and systematic review. These inflammatory markers include C-reactive protein (CRP), neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), platelet to lymphocyte ratio (PLR), and Glasgow prognostic score (GPS). METHODS: The Chinese National Knowledge Infrastructure (CNKI), Wanfang, Chinese Scientific Journals (VIP), PubMed, Embase, and Cochrane libraries were searched. The design of meta-analysis was made based on the PICOS (population, intervention/exposure, control, outcomes, and study design) principles, and STATA 15.1 was used to analyze the data. The Newcastle-Ottawa scale (NOS) was used to assess the quality of included studies. Hazard ratios (HRs) for overall survival (OS) and disease-specific survival (DPS) were extracted for the investigation of the prognostic value of inflammatory markers. RESULTS: Twelve researches with 2162 osteosarcoma patients were included in total. The pooled results showed that elevated NLR, CRP, and GPS are all greatly related to shortening of OS among patients with osteosarcoma (HR = 1.68, P = 0.007, 95% CI: 1.15-2.45; HR = 1.96, P = 0.002, 95% CI: 1.28-3.00; HR = 2.54, P < 0.0001, 95% CI: 1.95-3.31, respectively), and CRP level is significantly associated with shortening of DPS among patients with osteosarcoma (HR = 2.76, 95% CI:2.01-3.80, P < 0.0001), additionally. However, the correlation between LMR or PLR and the prognosis of osteosarcoma is not statistically significant (HR = 0.60, 95% CI: 0.30-1.18, P = 0.138; HR = 1.13, 95% CI: 0.85-1.49, P = 0.405, respectively). The outcomes of subgroup analysis to NLR and CRP suggested that histology, ethnicity, metastasis, and sample size all have an impact on its prognosis of patients with osteosarcoma. CONCLUSION: Worsened prognosis may be related to high levels of NLR, CRP, and GPS before treatment rather than LMR or PLR, which can provide the basis for clinicians to judge the outcomes of prognosis. Trial Registration. PROSPERO (CRD42021249954), https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=249954.
Assuntos
Neoplasias Ósseas/mortalidade , Proteína C-Reativa/análise , Inflamação/complicações , Osteossarcoma/mortalidade , Biomarcadores , Humanos , Linfócitos , Neutrófilos , PrognósticoRESUMO
BACKGROUND: The diagnosis of Asherman syndrome, or 'intra-uterine adhesions' is often overlooked when the symptoms of amenorrhea and hematometra are missing. AIMS: This audit reviews the clinical data of a large cohort of patients treated by a single operator. MATERIALS AND METHODS: From July 1998 till the end of December 2017, 423 patients with intra-uterine adhesions were treated by a single operator. Clinical information was obtained by review of the medical files and phone interviews. RESULTS: Amenorrhea was recorded in 163/423 patients (38.5%), 225/423 (53.2%) patients did not have amenorrhea and for 35/423 (8.3%) patients the information was missing. A hematometra was documented in 19/423 (4.5%) patients. Pregnancy was achieved in 215/246 (87.4%). Patients with stage II disease did best with a pregnancy rate of 94.5% (P = 0.029). CONCLUSION: Asherman syndrome should be considered in any woman with a history of miscarriage or postpartum curettage who then fails to conceive again.
Assuntos
Ginatresia , Amenorreia/etiologia , Dilatação e Curetagem , Feminino , Ginatresia/epidemiologia , Ginatresia/etiologia , Ginatresia/cirurgia , Humanos , Gravidez , Aderências Teciduais/complicações , Doenças Uterinas/cirurgiaRESUMO
STUDY QUESTION: What are the live birth rate and risks of obstetric complications following the surgical management of intrauterine adhesions (IUA) such as Asherman syndrome (AS)? SUMMARY ANSWER: The live birth rate is 63.7%, and obstetric complications including placentation issues, prematurity and postpartum hysterectomy require that pregnancies in women after treatment for IUA should be considered moderate to high risk. WHAT IS KNOWN ALREADY: Studies reviewing short-term surgical, menstrual and fertility outcomes following hysteroscopic management are reassuring, with success correlated to the severity of IUA. There are limited data reporting live birth, neonatal and maternal complications. STUDY DESIGN, SIZE, DURATION: This retrospective study included all women treated for IUA by hysteroscopic synechiolysis under fluoroscopic guidance in two tertiary University-affiliated hospitals. All women reported at least one pre-treatment symptom including menstrual dysfunction, subfertility or pelvic pain and intended to become pregnant post-treatment. Survival curve analysis was performed for time to pregnancy, and obstetric data were collated from a National Obstetric Database for delivery and neonatal outcomes. PARTICIPANTS/MATERIALS, SETTING, METHODS: A total of 154 women were included in the study. Surgical intervention involved hysteroscopic synechiolysis under fluoroscopic guidance until cavity restoration was confirmed. Questionnaires regarding fertility and its outcomes were sent to all women undergoing surgery, with analysis of menstrual, fertility rates and outcomes of those pregnancies including risks and complications to the woman and the offspring. MAIN RESULTS AND THE ROLE OF CHANCE: Women were followed up for a minimum of 1 year (range: 1-14 years) from index surgery. The chance of pregnancy was 98/124 (79.0% CI: 63.6, 83.1%) in women wishing to conceive and the chance of a live birth was 79/124 (63.7% CI: 51.3, 70.7%). The chance of a miscarriage was 29/124 (23.4% CI: 18.8, 37.1%). There were 93 live births in 79 women following surgery, with detailed obstetric data available for 85 of these births. They were complicated by abnormal placentation in 15/85 (17.6% CI: 13.0, 30.2%), postpartum hysterectomy in 4/85 (4.7% CI: -0.4, 7.0%), and prematurity in 25/85 (29.4% CI: 17.0, 35.3%) women. LIMITATIONS, REASONS FOR CAUTION: The retrospective nature of the study and extended follow-up time may cause selection and recall bias, however, pregnancy and its outcomes-particularly in women with problems of subfertility-are frequently key milestones, with birthdates readily recalled. Menstrual outcomes are more likely to be subject to recall bias. WIDER IMPLICATIONS OF THE FINDINGS: Our surgical data are similar to the published literature with reassuring short-term outcomes for menstruation and cavity reconstruction following surgery for IUA. Long-term outcomes including pregnancy rates were higher than published data, however, the obstetric and neonatal complication rates were increased, indicating a continuation of risk beyond infertility and into pregnancy. An altered biochemical or vascular environment is a possible explanation for impaired implantation resulting in poorer reproductive obstetric and neonatal outcomes. The relative rarity of IUA-particularly severe disease-makes prospective data collection difficult. Our data suggest that women with IUA should be treated as moderate-high risk obstetric patients in subsequent pregnancy and counselled appropriately. STUDY FUNDING/COMPETING INTEREST(S): No funding and no competing interests.
Assuntos
Coeficiente de Natalidade , Ginatresia/cirurgia , Nascido Vivo/epidemiologia , Aderências Teciduais/cirurgia , Doenças Uterinas/cirurgia , Aborto Espontâneo/epidemiologia , Adulto , Cesárea/estatística & dados numéricos , Dilatação e Curetagem/efeitos adversos , Feminino , Ginatresia/etiologia , Humanos , Histeroscopia/efeitos adversos , Histeroscopia/métodos , Infertilidade Feminina/etiologia , Infertilidade Feminina/cirurgia , Estudos Longitudinais , Pessoa de Meia-Idade , Gravidez , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , Inquéritos e Questionários , Aderências Teciduais/etiologiaRESUMO
OBJECTIVE: To compare the effectiveness of neostigmine induced reversal of rocuronium in neonates, infants, young children and children. METHODS: One hundred and sixty ASA I or II pediatric patients undergoings elective surgical procedures under total intravenous anesthesia were enrolled during July 2014 to April 2015 in Tianjin Children's Hospital. The patients were divided into four groups according to ages: neonate group, infant group, young children group and children group.Then control subgroup and neostigmine reversal subgroup including twenty patients were randomly selected from every different age groups by the method of random number table. After induction of anesthesia, 0.6 mg/kg rocuronium was administered, and 0.2 mg/kg maintenance doses given as required during period of operation. Neuromuscular block was monitored using acceleromyographic train of four (TOF). When T1/control returned to 15%, 0.03 mg/kg neostigmine and 0.01 mg/kg atropine were given to patients of reversal subgroups, and saline 0.1 ml/kg was given to patients of control subgroups. The recovery time of T25, T75, TR0.7, recovery index, blood pressure, heart rate and adverse reactions were observed and recorded. RESULTS: In control subgroups, the recovery time of T75 for neonates, infants, young children and children were (27.10±8.72), (16.70±6.35), (13.05±1.96), (14.40±3.08) min, respectively (F=25.052, P<0.01). The recovery time of TR0.7 were (27.75±8.56), (18.45±5.62), (14.95±2.64), (15.70±3.36) min, respectively (F=22.496, P<0.01). The recovery index were (20.75±7.09), (12.40±5.04), (10.01±2.00), (10.55±2.82) min, respectively (F=22.725, P<0.01). There were no significant difference for the every recovery time and recovery index between infants, young children and children (all P>0.05). But the recovery time of T75, TR0.7 and recovery index in neonate group were longer than other age groups (all P<0.01). In reversal subgroups , the recovery time of T75 for neonates, infants, young children and children were (14.05±3.54), (8.08±3.08), (6.53±0.98), (7.10±1.54) min, respectively (F=37.947, P<0.01). The recovery time of TR0.7 were (14.95±3.19), (9.32±3.44), (7.45±1.40), (8.12±1.67) min, respectively (F=34.744, P<0.01). The recovery index were (11.05±3.26), (5.96±2.46), (4.99±0.95), (5.22±1.39) min, respectively (F=33.542, P<0.01). The recovery time of T75, TR0.7 and recovery index were delayed in neonates compared with other age groups (all P<0.01). Haemodynamics were stable in all groups before or after giving antagonist, and no significant adverse reactions were observed. CONCLUSIONS: The spontaneous recovery time after administrating rocuronium are comparable in infant, young children and children. There are obviously reversal effects in all of age groups when neostigmine is given to antagonize rocuronium. Either spontaneous recovery time or reversal recovery time of neostigmine to rocuronium is longer for neonates than other age's children.
Assuntos
Androstanóis/farmacologia , Anestesia Geral , Atropina , Criança , Procedimentos Cirúrgicos Eletivos , Humanos , Monitorização Fisiológica , Neostigmina , Bloqueio Neuromuscular , RocurônioRESUMO
Objective: To explore the short-term effectiveness of hip revision surgery guided by artificial intelligence preoperative planning (AIHIP) system. Methods: The clinical data of 22 patients (23 hips) who were admitted between June 2019 and March 2023 and met the selection criteria were retrospectively analyzed. There were 12 males and 10 females with an average age of 69.7 years (range, 44-90 years). There were 19 hips in the first revision, 3 hips in the second revision, and 1 hip in the third revision. The causes of revision included 12 hips with prosthesis loosening, 4 hips with acetabular cup loosening, 3 hips with osteolysis, 2 hips with acetabular dislocation, 1 hip with postoperative infection, and 1 hip with prosthesis wear. There were 6 hips in stage â ¡A, 9 hips in stage â ¡B, 4 hips in stage â ¡C, 3 hips in stage â ¢A, and 1 hip in stage â ¢B according to Paprosky staging of acetabular bone defect. The replacement of prosthesis type, operation time, hospitalization stay, ground active condition, and postoperative infection, fracture, prosthesis loosening, and other adverse events were recorded. The function of the affected limb was evaluated by Harris score before operation, at 1 week and 6 months after operation, and the range of motion of the hip joint was compared before operation and at 6 months after operation. Results: The operation time was 85-510 minutes, with an average of 241.8 minutes; the hospitalization stay was 7-35 days, with an average of 15.2 days; the time of disassociation from the walker was 2-108 days, with an average of 42.2 days. All the 22 patients were followed up 8-53 months (mean, 21.7 months). No adverse events such as prosthesis loosening or infection occurred in the rest of the patients, except for postoperative hematoma of the thigh in 1 patient and dislocation of the hip in 1 hip. The matching degree of acetabular cup was completely matched in 22 hips and mismatched in 1 hip (+2), the matching rate was 95.65%. The matching degree of femoral stem was completely matched in 22 hips and generally matched in 1 hip (-1), and the matching rate was 100%. The Harris scores were 55.3±9.8 and 89.6±7.2 at 1 week and 6 months after operation, respectively, which significantly improved when compared with before operation (33.0±8.6, P<0.05), and further improved at 6 months after operation than at 1 week after operation ( P<0.05). The function of hip joint was evaluated by Harris score at 6 months after operation, and 21 hips were good and 2 hips were moderate, which could meet the needs of daily life. The range of motion of hip joint was (111.09±10.11)° at 6 months after operation, which was significantly different from (79.13±18.50)° before operation ( t=-7.269, P<0.001). Conclusion: AIHIP system can improve the accuracy of revision surgery, reduce the difficulty of surgery, and achieve good postoperative recovery and satisfactory short-term effectiveness.
Assuntos
Artroplastia de Quadril , Prótese de Quadril , Luxações Articulares , Masculino , Feminino , Humanos , Idoso , Falha de Prótese , Reoperação , Estudos Retrospectivos , Inteligência Artificial , Seguimentos , Resultado do Tratamento , Articulação do Quadril/cirurgia , Acetábulo/cirurgia , Complicações Pós-Operatórias , Luxações Articulares/cirurgiaRESUMO
BACKGROUND: Early detection of solid pancreatic masses through contrast-enhanced harmonic endoscopic ultrasound (CH-EUS) is important. But CH-EUS is difficult to learn. PURPOSE: To design a deep learning-based CH-EUS diagnosis system (CH-EUS MASTER) for real-time capture and segmentation of solid pancreatic masses and to verify its value in the training of pancreatic mass identification under endoscopic ultrasound (EUS). METHODS: We designed a real-time capture and segmentation model for solid pancreatic masses and then collected 4530 EUS images of pancreatic masses retrospectively, used for training and testing of this model at a ratio of 8:2. The model is loaded into the EUS host computer to establish the CH-EUS MASTER system. A crossover trial was then conducted to evaluate the model's value in EUS trainee training by successfully conducting two groups of EUS trainees in model learning and trainer-guided training. The intersection over union (IoU) and the time to find the lesion were used to evaluate the model performance metrics, and the Mann-Whitney test was used to compare the IoU and the time to find the lesion in different groups of subjects. Paired t-test was used to compare the effects before and after training. When α ≤ 0.05, it is considered to have a significant statistical difference. RESULTS: The model test showed that the model successfully captured and segmented the pancreatic solid mass region in 906 EUS images. The real-time capture and segmentation model had a Dice coefficient of 0.763, a recall rate of 0.941, a precision rate of 0.642, and an accuracy of 0.842 (when the threshold is set to 0.5), and the median IoU of all cases was 0.731. For the AI training effect, the average IoU of eight trainees improved from 0.80 to 0.87 (95% CI, 0.032-0.096; p = 0.002). The average time for identifying lesions in the pancreatic body and tail improved from 22.75 to 17.98 s (95% CI, 3.664-5.886; p < 0.01). The average time for identifying lesions in the pancreatic head and uncinate process improved from 34.21 to 25.92 s (95% CI, 7.661-8.913; p < 0.01). CONCLUSION: CH-EUS MASTER can provide an effect equivalent to trainer guidance in training pancreatic solid mass identification and segmentation under EUS.
Assuntos
Aprendizado Profundo , Neoplasias Pancreáticas , Humanos , Neoplasias Pancreáticas/diagnóstico por imagem , Estudos Retrospectivos , Endossonografia/métodos , Pâncreas/diagnóstico por imagemRESUMO
BACKGROUND AND AIMS: Distinguishing pancreatic cancer from nonneoplastic masses is critical and remains a clinical challenge. The study aims to construct a deep learning-based artificial intelligence system to facilitate pancreatic mass diagnosis, and to guide EUS-guided fine-needle aspiration (EUS-FNA) in real time. METHODS: This is a prospective study. The CH-EUS MASTER system is composed of Model 1 (real-time capture and segmentation) and Model 2 (benign and malignant identification). It was developed using deep convolutional neural networks and Random Forest algorithm. Patients with pancreatic masses undergoing CH-EUS examinations followed by EUS-FNA were recruited. All patients underwent CH-EUS and were diagnosed both by endoscopists and CH-EUS MASTER. After diagnosis, they were randomly assigned to undergo EUS-FNA with or without CH-EUS MASTER guidance. RESULTS: Compared with manual labeling by experts, the average overlap rate of Model 1 was 0.708. In the independent CH-EUS video testing set, Model 2 generated an accuracy of 88.9% in identifying malignant tumors. In clinical trial, the accuracy, sensitivity, and specificity for diagnosing pancreatic masses by CH-EUS MASTER were significantly better than that of endoscopists. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were respectively 93.8%, 90.9%, 100%, 100%, and 83.3% by CH-EUS MASTER guided EUS-FNA, and were not significantly different compared to the control group. CH-EUS MASTER-guided EUS-FNA significantly improved the first-pass diagnostic yield. CONCLUSION: CH-EUS MASTER is a promising artificial intelligence system diagnosing malignant and benign pancreatic masses and may guide FNA in real time. TRIAL REGISTRATION NUMBER: NCT04607720.
Assuntos
Aprendizado Profundo , Neoplasias Pancreáticas , Humanos , Inteligência Artificial , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/patologia , Estudos ProspectivosRESUMO
OBJECTIVE: To examine the evolution of pain and the duration of numbness after neural blockade of the pudendal nerve in women with pudendal neuralgia and correlate with clinical and historical data. DESIGN: Prospective, single arm, open label study. SETTING: University hospital and outpatient clinic. SUBJECTS: Eighty-two adult female patients were recruited from November 8, 2008 to February 14, 2010. Patients were selected based on the presence of spontaneous or provoked pain in the distribution of the pudendal nerve. INTERVENTIONS: Subjects underwent a standardized pudendal nerve block. OUTCOME MEASURES: Visual analog pain scores and the presence of numbness were recorded before and for 64 hours after the pudendal nerve block. A complete clinical history and examination were documented. RESULTS: Sixty-six patients completed the study. About 86.9% had a reduction in one or more pain symptom, while 44.3% found that more than one of their pain symptoms did not return. About 69.7% of patients reported numbness lasting up to 16 hours or longer. Previous gynecological surgery was recorded in 75.8%, previous traumatic obstetric events in 47.0% of cases. Prolonged history of pain correlated with a reduced chance of positive outcome of the pudendal nerve block. CONCLUSION: In patients with pudendal neuralgia, the pudendal nerve block has a variable response, but may have a beneficial effect in a subset of women. Surgical and obstetrical trauma are common historical antecedents.
Assuntos
Bloqueio Nervoso/métodos , Nervo Pudendo/efeitos dos fármacos , Nervo Pudendo/fisiopatologia , Neuralgia do Pudendo/tratamento farmacológico , Neuralgia do Pudendo/fisiopatologia , Adolescente , Adulto , Idoso , Candidíase Vulvovaginal/complicações , Candidíase Vulvovaginal/fisiopatologia , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Nervo Pudendo/lesões , Neuralgia do Pudendo/etiologia , Fatores de Tempo , Adulto JovemRESUMO
OBJECTIVE: To apply ultrasonic technology in positioning and monitoring for pediatric caudal blocks and compare it with traditional landmark approach and Swoosh test. METHODS: After obtaining the approval of hospital ethics committee and written parental informed consent, a total of 102 American Society of Anesthesiologists (ASA) I-II pediatric patients aged from 1 month to 8 years and scheduled for urologic or perineal surgery were recruited. Patients were randomly divided into 2 groups: ultrasound group (n = 52) and control group (n = 50). The sites of sacral cornu and sacral hiatus were determined by ultrasonic imaging or classic method of anatomical surface landmarks. Patients of two groups were punctured according to the scheduled site. Local anesthetic was injected slowly into caudal space after a successful caudal puncture and the positive reaction in caudal space was monitored simultaneously by ultrasound and classic swoosh test. The observational results and relevant date were recorded. RESULTS: In ultrasound and control groups, the number of puncture attempts was 1.10 ± 0.30 vs 1.56 ± 0.63, the duration of puncture (1.40 ± 0.39) vs (3.23 ± 1.23) min, the success rate at the first puncture attempt 90.4% vs 66% and the total puncture success rate 100% vs 92% respectively. After the injection of local anesthetic, the positive reaction rate of ultrasonography and swoosh test was 97.96% vs 62.24% respectively. All of above results in ultrasound group were superior to those in control group or with classic test. And the difference had statistical significance (P < 0.01). CONCLUSION: Ultrasonic positioning and monitoring for pediatric caudal block is both scientific and reasonable. The positioning detected by ultrasonic imaging is accurate and the monitoring results of ultrasound are reliable. It is obviously superior to traditional method and has clinical application values for caudal block in children.
Assuntos
Anestesia Caudal/métodos , Sacro , Ultrassonografia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , MasculinoRESUMO
Background: Pediatric patients often experience severe pain after thoracic surgery, especially in the early postoperative period. Recently, the focus has been on regional analgesia with the introduction of ultrasound-guided erector spinae plane blocks. We assumed that preoperative erector spinae plane block (ESPB) in children undergoing video-assisted thoracoscopic surgery (VATS) would reduce the consumption of perioperative opioids. Methods: This randomized, double-blind study enrolled 60 children aged 1-3 years who underwent thoracoscopic lung lesion resection. The patients were enrolled in the study and randomly divided into two groups. The general anesthesia (GA) group received GA alone, and the GA + ESPB group received ESPB. The consumptions of remifentanil and sufentanil were recorded, and the children's face, legs, activity, cry, consolability (FLACC) scores were assessed after awakening. The time to first rescue analgesia, length of hospital stay, parental satisfaction and adverse events were also recorded. Results: The consumptions of remifentanil and sufentanil in the GA + ESPB group were significantly lower than those in the GA group, mean difference [95% confidence interval (CI)]: -26.57 (-31.98 to -21.17) and -0.21 (-0.27 to -0.17), respectively, (both P<0.001); while the time to first rescue analgesia and parental satisfaction scores were significantly longer and higher, respectively, in the GA + ESPB group than those in the GA group, mean difference (95% CI): 2.37 (1.77 to 2.97) and 2.47 (1.79 to 3.15), respectively, (both P<0.001). The FLACC scores in the GA + ESPB group were significantly lower than those in the GA group 1 to 24 hours postoperatively (P=0.023 at 1 h, and P<0.001 at 3 h, 6 h, 12 h, 18 h, 24 h), but not at immediate admission to the post-anesthesia care unit (PACU) (P=0.189 at 0 h). The GA + ESPB group had significantly lower incidence rates of postoperative nausea and vomiting (P=0.037 and P=0.020). Conclusions: In pediatric Thoracoscopic surgery, the results of this study confirm our hypothesis that ESPB decreases the consumptions of intraoperative remifentanil and postoperative sufentanil in 24 hours and demonstrates better postoperative analgesia compared with a control group. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200056166.
RESUMO
Objective: To analyze the similarities and differences of bone microstructure and apoptosis phenotype of lateral column, middle column, and medial column in type L2 and L3 osteonecrosis of the femoral head (ONFH) specimens classified by China-Japan Friendship Hospital (CJFH) classification, so as to carry out a quantitative study of ONFH "three-columns structure theory" and to provide research support for the treatment of ONFH by rotational osteotomy through the base of femoral neck. Methods: Discarded femoral head specimens from 16 patients (16 hips) with CJFH type L2 and L3 ONFH undergone total hip arthroplasty between April 2020 and February 2021 were selected as the research objects. First, the "three-column structure" of the femoral head was three-dimensionally segmented by Micro-CT, and the bone volume to total volume (BV/TV), bone surface area to bone volume ratio (BS/BV), trabecular spacing/separation (Tb.Sp), trabecular thickness (Tb.Th), and trabecular number (Tb.N) in the lateral column, middle column, and medial column were analyzed to compare the similarities and differences of parameters related to bone mass and trabecular structure among the three columns. Then, the specimens were cut with a oscillating saw and made into paraffin sections for HE staining and immunohistochemical staining of B-cell lymphoma-2 (Bcl-2) and Bcl-2 associated X protein (Bax). The differences of apoptosis phenotype between the three columns of ONFH samples of CJFH type L2 and L3 were evaluated by comparing the rate of empty lacunae and the rate of positive cells of immunohistochemical staining. Results: There were significant differences in BV/TV, Tb.Th, and Tb.N among the three columns of CJFH type L2 ONFH femoral head ( P<0.05), with the largest in the medial column and the smallest in the lateral column; BS/BV and Tb.Sp of the lateral column were significantly greater than those of the medial column and middle column ( P<0.05), no significant difference was found between the middle column and medial column ( P>0.05). There was no significant difference in the bone parameters between the three columns of the CJFH type L3 ONFH femoral head ( P>0.05). There was no significant difference in the rate of empty lacunae between the three columns of the CJFH type L2 and L3 ONFH femoral head ( P>0.05). Immunohistochemical staining showed that a large number of tissue sections were detached, and only a small amount of non-specific staining was found in the sections without detachment, so the positive cell rate could not be calculated. Conclusion: The middle and medial columns of the CJFH type L2 ONFH has better trabecular structures than the lateral column, and there is no significant difference in trabecular structures among the three columns of the CJFH type L3 ONFH.
Assuntos
Necrose da Cabeça do Fêmur , Osteonecrose , China , Cabeça do Fêmur/patologia , Necrose da Cabeça do Fêmur/cirurgia , Amigos , Hospitais , Humanos , Japão , Proteínas Proto-Oncogênicas c-bcl-2RESUMO
OBJECTIVE: To explore the feasibility and effectiveness of the modified transtrochanteric curved varus osteotomy in the treatment of osteonecrosis of the femoral head (ONFH), clarify the key points of the operation, and then explore the effectiveness of modified transtrochanteric curved varus osteotomy in the treatment of ONFH assisted by virtual reality (VR) technology. METHODS: A 70-year-old adult female cadaver without formaldehyde fixation was taken. It was confirmed by anatomical study and simulated operation that the modified transtrochanteric curved varus osteotomy was suitable for type C1 (patients with involvement of the lateral column of the femoral head but partial integrity) classified by the Japanese Osteonecrosis Investigation Committee (JIC). Between October 2018 and August 2020, 11 patients (17 hips) with ONFH who met the selection criteria were treated with modified transtrochanteric curved varus osteotomy. VR technology was used to simulate varus osteotomy before operation to predict the angle of valgus of lower limbs and pronation of femoral head. Osteotomy, valgus, and pronation were performed according to the results of preoperative planning. After operation, X-ray films were used to evaluate the changes of varus and neck-shaft angle after VR assisted surgery, and Harris score was used to evaluate the hip function. RESULTS: The anteroposterior pelvic X-ray film was rechecked at 2 days after operation, of which 3 hips were consistent with the planned varus angle of VR preoperative planning, and the error value of varus angle of the remaining 14 hips was 1°-4°. The difference between VR preoperative planning and 2 days after operation was 6°-16°. All 11 patients were followed up 11-28 months, with an average of 19.2 months. All incisions healed by first intension. During the follow-up, 1 case (1 hip) developed greater trochanter fracture at 2 months after operation and was treated with open reduction and plate and screw internal fixation; 1 case (1 hip) had delayed healing at osteotomy at 4 months after operation and healed at 3 months after local injection of platelet rich plasma and oral supplementation of kidney blood-strengthening soup. At last follow-up, 17 hip osteotomies healed. The Harris score was 84.0±5.6, which was significantly higher than that before operation (57.2±5.5) ( t=-14.107, P=0.000); hip function was excellent in 2 hips, good in 13 hips, and fair in 2 hips. CONCLUSION: The modified transtrochanteric curved varus osteotomy for the treatment of ONFH is theoretically feasible, and the short-term effectiveness of this operation combined with VR technology is satisfactory.
Assuntos
Necrose da Cabeça do Fêmur , Realidade Virtual , Adulto , Idoso , Feminino , Cabeça do Fêmur/cirurgia , Necrose da Cabeça do Fêmur/cirurgia , Humanos , Osteotomia , Estudos Retrospectivos , Tecnologia , Resultado do TratamentoRESUMO
OBJECTIVE: To investigate the early effectiveness of artificial intelligence (AI) assisted total hip arthroplasty (THA) system (AIHIP) in the treatment of patients with Crowe type â £ developmental dysplasia of the hip (DDH). METHODS: The clinical data of 23 patients with Crowe type â £ DDH who met the selection criteria between May 2019 and December 2020 were retrospectively analyzed. There were 3 males and 20 females, the age ranged from 44 to 74 years, with an average of 52.65 years. The absolute value of the lower limbs discrepancy before operation was (15.17±22.17) mm. The preoperative Harris score was 62.4±7.2. The AIHIP system was used for preoperative planning, and the operations were all performed via conventional posterolateral approach. Thirteen patients with difficulty in reduction during operation underwent subtrochanteric shortening osteotomy (SSOT). The operation time, hospital stay, and adverse events were recorded; Harris score was used to evaluate the function of the affected limb at 1 day before operation and 1 week and 6 months after operation; pelvic anteroposterior X-ray film was taken at 1 day after operation to evaluate the position of the prosthesis. The matching degree of prosthesis was evaluated according to the consistency of intraoperative prosthesis model and preoperative planning. RESULTS: The matching degree of acetabular cup model after operation was 16 cases of perfect matching, 4 cases of general matching (1 case of +1, 3 cases of -1), and 3 cases of mismatch (all of them were +2), the coincidence rate was 86.96%. The matching degree of femoral stem model was perfect matching in 22 cases and general matching in 1 case of -1, and the coincidence rate was 100%. One patient had a periprosthesis fracture during operation, and was fixed with a wire cable during operation, and walked with the assistance of walking aid at 6 weeks after operation; the rest of the patients walked with the assistance of walking aid at 1 day after operation. The operation time was 185-315 minutes, with an average of 239.43 minutes; the hospital stay was 8-20 days, with an average of 9.96 days; and the time of disengagement from the walking aid was 2-56 days, with an average of 5.09 days. All patients were followed up 6 months. All incisions healed by first intension, and there was no complication such as infection, dislocation, refracture, and lower extremity deep venous thrombosis; X-ray films at 1 day and 6 months after operation showed that the acetabular and femoral prostheses were firmly fixed and within the safe zone; the absolute value of lower limbs discrepancy at 1 day after operation was (11.96±13.48) mm, which was not significantly decreased compared with that before operation ( t=0.582, P=0.564). All osteotomies healed at 6 months after operation. The Harris scores at 1 week and 6 months after operation were 69.5±4.9 and 79.2±5.7 respectively, showing significant differences between pre- and post-operation ( P<0.05). At 6 months after operation, the hip function was evaluated according to Harris score, and 13 cases were good, 9 cases were fair, and 1 case was poor. CONCLUSION: AIHIP system-assisted THA (difficult to reposition patients combined with SSOT) for adult Crowe type â £ DDH has high preoperative planning accuracy, easy intraoperative reduction, early postoperative landing, and satisfactory short-term effectiveness.
Assuntos
Artroplastia de Quadril , Displasia do Desenvolvimento do Quadril , Luxação Congênita de Quadril , Adulto , Idoso , Inteligência Artificial , Feminino , Seguimentos , Luxação Congênita de Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
INTRODUCTION: Gastrointestinal endoscopic quality is operator-dependent. To ensure the endoscopy quality, we constructed an endoscopic audit and feedback system named Endo.Adm and evaluated its effect in a form of pretest and posttest trial. METHODS: Endo.Adm system was developed using Python and Deep Convolutional Neural Ne2rk models. Sixteen endoscopists were recruited from Renmin Hospital of Wuhan University and were randomly assigned to undergo feedback of Endo.Adm or not (8 for the feedback group and 8 for the control group). The feedback group received weekly quality report cards which were automatically generated by Endo.Adm. We then compared the adenoma detection rate (ADR) and gastric precancerous conditions detection rate between baseline and postintervention phase for endoscopists in each group to evaluate the impact of Endo.Adm feedback. In total, 1,191 colonoscopies and 3,515 gastroscopies were included for analysis. RESULTS: ADR was increased after Endo.Adm feedback (10.8%-20.3%, P < 0.01, Assuntos
Adenoma/diagnóstico por imagem
, Competência Clínica
, Colonoscopia/normas
, Aprendizado Profundo
, Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos
, Adenoma/epidemiologia
, Adulto
, China
, Detecção Precoce de Câncer
, Retroalimentação
, Feminino
, Humanos
, Masculino
, Pessoa de Meia-Idade
, Melhoria de Qualidade
, Fatores de Risco
RESUMO
Hip preserving procedures are still a challenge in late-stage osteonecrosis of femoral head (ONFH) patients. We aimed to compare the clinical outcomes of surgical dislocation and impaction bone graft and surgical dislocation and rotational osteotomy for treatment of ONFH in Association Research Circulation Osseous (ARCO) stage III patients.We retrospectively reviewed 30 ARCO stage III patients (33 hips) who had surgical dislocation and impaction bone graft or surgical dislocation and rotational osteotomy in our center from June 2012 to December 2017. Baseline characteristics, clinical evaluation using Harris score and radiologic evaluation up to 12 months after surgery were recorded and compared.Fifteen patients (17 hips) were in the surgical dislocation and impaction bone graft group and 15 patients (16 hips) were in the surgical dislocation and rotational osteotomy group. No significant differences in age, gender, etiology, ARCO stage, duration of illness, operation time, and length of hospitalization were observed between the 2 groups. Compared to preoperation Harris score, the Harris score of 6 months postoperation and 12 months postoperation significantly improved. At 12 months postoperation, the excellent and good rate was 76.5% in the impaction bone graft group and 87.5% in the rotational osteotomy group. No significant difference in Harris scores was detected in the 2 groups.Surgical dislocation and impaction bone graft and surgical dislocation and rotational osteotomy had satisfactory 1-year efficacy for ARCO III ONFH patients. Surgical dislocation and rotational osteotomy had better short-term efficacy than surgical dislocation and impaction bone graft.
Assuntos
Necrose da Cabeça do Fêmur/cirurgia , Fratura-Luxação/cirurgia , Osteotomia/efeitos adversos , Adulto , Transplante Ósseo/métodos , Feminino , Cabeça do Fêmur/lesões , Cabeça do Fêmur/fisiopatologia , Cabeça do Fêmur/cirurgia , Necrose da Cabeça do Fêmur/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia/métodos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Osteonecrosis of the femoral head (ONFH) is a common disorder that may be idiopathic, caused by trauma, or associated with alcohol or glucocorticoid use. The goals of early treatment include delaying or avoiding hip replacement, but there are no effective treatments for early-stage disease. The aim of the present study was to evaluate the effects of treatment with 3D-printed porous titanium alloy scaffold combined with daily intraperitoneal trans-cinnamaldehyde (TCA) in a dog model of ONFH. Four weeks after creation of the ONFH model, MRI examination of the femoral head showed the characteristic "double line sign" of ONFH, verifying the validity of our model. After another 12 weeks, femoral head specimens were harvested and examined by gross inspection; micro-computed tomography; histologic staining (hematoxylin and eosin; Masson); immunohistochemical analysis and quantitative real-time polymerase chain reaction analysis. Gross inspection of the femoral head in untreated ONFH animals at 16 weeks after model creation showed pale, exfoliating articular cartilage and disordered trabecular bone. Treatment with 3D-printed titanium alloy porous scaffold combined with TCA ameliorated the pathologic ONFH changes and significantly reduced inmature bone tissue as well as imature collagen in the femoral head, as shown by Masson staining. This treatment also increased VEGF, BMP2, ß-catenin, b-FGF, and RUNX2 expression and decreased PPARγ expression, compared with untreated ONFH. In conclusion, 3D-printed titanium alloy porous scaffold combined with TCA can effectively improve ONFH, which may be related to local repair. This provides the theoretical basis for a new treatment strategy for ONFH.
RESUMO
Kallikrein (KLK) 5 and KLK7 were reported to be overexpressed in several cancers, but underexpressed in prostate and breast cancers. However, the expression levels of KLK5 and KLK7 in benign breast tissues and metastases, and the relationship between KLK5 and KLK7, have not been reported. In addition, the value of KLK5 and KLK7 in the diagnosis and prognosis prediction of breast cancer patients is far from clear. To further determine their role and clinical significance in breast cancer and to explore the relationship between KLK5 and KLK7, the mRNA levels of KLK5 and KLK7 in normal breast tissues, benign breast tissues, primary tumors, and lymph node metastases were detected by real-time reverse transcription-polymerase chain reaction and microarray. The relationship between KLK5 and KLK7 expression and clinicopathological parameters, and the correlation between the mRNA levels of KLK5 and KLK7 as well as the 5'-uncoding regions of KLK5 and KLK7 were analyzed. The mRNA levels of KLK5 and KLK7 were both downregulated in breast cancers relative to normal and benign tissues, and downregulated in metastases compared to primary cancers. Underexpression of KLK5 and KLK7 was correlated with postmenopausal status and positive estrogen receptor status. The mRNA levels of KLK5 and KLK7 were positively correlated in breast malignancies. Moreover, four homologous sequences and 10 transcription factors as potential regulators were found on the control regions of both KLK5 and KLK7. Thus, KLK5 and KLK7 were underexpressed in parallel, potentially with the same regulation pathways, in breast malignancies, which might contribute to the carcinogenesis and development of breast cancer. They are potential biomarkers for breast cancer.
Assuntos
Neoplasias da Mama/genética , Regulação Neoplásica da Expressão Gênica , Calicreínas/genética , Distribuição por Idade , Neoplasias da Mama/patologia , Estudos de Casos e Controles , Feminino , Humanos , Calicreínas/metabolismo , Pós-Menopausa , Pré-Menopausa , RNA Mensageiro/análise , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Estudos RetrospectivosRESUMO
OBJECTIVE: To compare effectiveness between sequestrum clearance and impacting bone graft and rotational osteotomy on the base of femoral neck via surgical hip dislocation approach for avascular necrosis of femoral head (ANFH) at Association Research Circulation Osseous (ARCO ) stage â ¢. METHODS: A clinical data of 24 patients (27 hips) with ANFH at ARCO stage â ¢, who met the inclusion criteria between June 2012 and November 2017, was retrospectively analysed. Of all patients, 12 patients (14 hips) were treated with sequestrum clearance and impacting bone graft via surgical hip dislocation approach (group A); and 12 patients (13 hips) were treated with rotational osteotomy on the base of femoral neck via surgical hip dislocation approach (group B). There was no significant difference in gender, age, disease duration, and affected side, type, and stage of the ANFH between 2 groups ( P>0.05). The operation time of each hip and hospitalization stays of each patient in 2 groups were recorded and compared. Imaging examination was performed to observe the blood supply around femoral head, healing of the osteotomy, and the femoral head collapsed. The function of the hip was evaluated by Harris score. RESULTS: There was no significant difference in operation time and hospitalization stays ( t=-0.262, P=0.797; t=-0.918, P=0.411). All patients were followed up, the follow-up time of group A was 12-28 months (mean, 19.7 months), and the follow-up time of group B was 14-24 months (mean, 17.8 months). The Harris score in groups A and B increased significantly at 6 months and 12 months after operation when compared with preoperative ones ( P<0.05). There was no significant difference between 2 groups at 6 months and 12 months ( P>0.05). At 12 months after operation, according to the Harris scoring, there were 3 hips of excellent, 7 hips of good, and 4 hips of poor, with the excellent and good rate of 71.4% in group A; there were 5 hips of excellent, 7 hips of good, and 1 hip of poor, with the excellent and good rate of 92.3% in group B. Digital substraction angiography was performed at 1 week after operation and indicated that the blood supply around the femoral head was not destroyed during the operation. Imaging examination after operation showed that the osteotomy of the greater trochanter all healed in 2 groups and the osteotomy of the femoral neck healed in group B. Hip collapse occurred in 2 patients (2 hips) of group A at 12 months after operation. No hip collapse occurred in group B. CONCLUSION: The rotational osteotomy on the base of femoral neck via surgical hip dislocation approach is superior to sequestrum clearance and impacting bone graft in delaying the collapse and improving the hip function for patients with ANFH at ARCO stage â ¢.