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Zhang YM, Wang GC, Liu YJ, Wang YC, Zhang GQ, Zhang Y, Gao CQ, Wang C, Zhang Z, Yang J, Jin L, Wang YP, Niu ZL. [Exploration of the method and efficacy of treatments for intractable pelvic pain caused by rectal or bladder fistula]. Zhonghua Zhong Liu Za Zhi 2024; 46:263-268. [PMID: 38494773 DOI: 10.3760/cma.j.cn112152-20231024-00219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Objective: To explore the causes and therapeutic effects of pelvic pain caused by rectal fistula or bladder fistula after comprehensive treatment of cervical cancer and rectal cancer (radiotherapy, surgery, chemotherapy, and other treatments). Methods: A retrospective analysis was conducted on the clinical and pathological data of patients with pelvic tumors admitted to the First People's Hospital of Yinchuan City, Ningxia and the Affiliated Cancer Hospital of Zhengzhou University from June 2016 to June 2022. The causes of persistent pelvic pain in patients after comprehensive treatment was investigated, and the corresponding therapeutic effects after clinical treatment was observed. Results: Thirty-two tumor patients experienced persistent pain after comprehensive treatment, including 22 cases of cervical cancer and 10 cases of rectal cancer. The preoperative pain of the entire group of patients was evaluated using the digital grading method, with a pain score of (7.88±1.31) points. Among the 32 patients, there were 16 cases of rectovaginal fistula or ileovaginal fistula, 9 cases of vesicovaginal fistula, 5 cases of rectoperineal fistula, and 2 cases of vesicovaginorectal fistula. Thirty-two patients were initially treated with medication to relieve pain, and according to the ruptured organs, a fistula was made to the corresponding proximal intestinal canal and renal pelvis to intercept the intestinal contents and urine. However, the pain did not significantly be improved. The pain score of treatment with the above methods for one week was (8.13±1.13) points, and there was no statistically significant difference compared to preoperative treatment (P=0.417). In the later stage, based on a comprehensive evaluation of whether the tumor had recurred, the value of organ preservation, the benefits of surgery, the balance between survival time and improving quality of life, pathological organ resection or repair was performed. The surgical methods included repair of leaks, local debridement combined with irrigation of proximal intestinal fluid, distal closure of the sigmoid colon combined with proximal ostomy, posterior pelvic organ resection, anterior pelvic organ resection, and total pelvic organ resection. One week after surgery, the patients' pain completely relieved or disappeared, with the pain score of (1.72±1.37) points, which was significantly divergent from the preoperative and initial surgical treatments (P<0.001). Conclusions: Palliative pyelostomy and proximal enterostomy cannot effectively alleviate persistent pelvic floor pain. The fundamental way to alleviate pain is complete blocking of the inflammatory erosion of the intestinal fluid and urine.
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Affiliation(s)
- Y M Zhang
- Department of Gynecology, the First People's Hospital of Yinchuan, the Second Clinical Medical College of Ningxia Medical University, Yinchuan 750001, China
| | - G C Wang
- Department of Abdominopelvic Oncology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Y J Liu
- Department of General Surgery, Henan Provincial Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Y C Wang
- Department of General Surgery, Henan Provincial Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - G Q Zhang
- Department of General Surgery, Henan Provincial Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Y Zhang
- Department of General Surgery, Henan Provincial Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - C Q Gao
- Department of General Surgery, Henan Provincial Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - C Wang
- Department of General Surgery, Henan Provincial Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Z Zhang
- Department of General Surgery, Henan Provincial Cancer Hospital, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - J Yang
- Department of Gynecology, the First People's Hospital of Yinchuan, the Second Clinical Medical College of Ningxia Medical University, Yinchuan 750001, China
| | - L Jin
- Department of Gynecology, the First People's Hospital of Yinchuan, the Second Clinical Medical College of Ningxia Medical University, Yinchuan 750001, China
| | - Y P Wang
- Department of Gynecology, the First People's Hospital of Yinchuan, the Second Clinical Medical College of Ningxia Medical University, Yinchuan 750001, China
| | - Z L Niu
- Department of Gynecology, the First People's Hospital of Yinchuan, the Second Clinical Medical College of Ningxia Medical University, Yinchuan 750001, China
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Wu QH, Chen Q, Yang T, Chen J, Chen L, Xiang XL, Jia FY, Wu LJ, Hao Y, Li L, Zhang J, Ke XY, Yi MJ, Hong Q, Chen JJ, Fang SF, Wang YC, Wang Q, Li TY. [A survey on the current situation of serum vitamin A and vitamin D levels among children aged 2-<7 years of 20 cities in China]. Zhonghua Er Ke Za Zhi 2024; 62:231-238. [PMID: 38378284 DOI: 10.3760/cma.j.cn112140-20230923-00216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Objective: To investigate serum vitamin A and vitamin D status in children aged 2-<7 years in 20 cities in China. Methods: A cross-sectional study was conducted. A total of 2 924 healthy children aged 2-<7 years were recruited from September 2018 to September 2019 from 20 cities in China, categorized by age groups of 2-<3 years, 3-<5 years, and 5-<7 years. The demographic and economic characteristics and health-related information of the enrolled children were investigated. Body weight and height were measured by professional staff members. The serum vitamin A and vitamin D levels were detected by high-performance liquid chromatography-tandem mass spectrometry. Chi-square test and Logistic regression were applied to analyze the association between vitamin A and vitamin D deficiency and insufficiency as well as their underlying impact factors. Results: The age of the 2 924 enrolled children was 4.33 (3.42, 5.17) years. There were 1 726 males (59.03%) and 1 198 females (40.97%). The prevalences of vitamin A and vitamin D deficiency in enrolled children were 2.19% (64/2 924) and 3.52% (103/2 924), respectively, and the insufficiency rates were 29.27% (856/2 924) and 22.20% (649/2 924), respectively. Children with both vitamin A and vitamin D deficiencies or insufficiencies were found in 10.50% (307/2 924) of cases. Both vitamin A (χ2=7.91 and 8.06, both P=0.005) and vitamin D (χ2=71.35 and 115.10, both P<0.001) insufficiency rates were higher in children aged 3-<5 and 5-<7 years than those in children aged 2-<3 years. Vitamin A and vitamin D supplementation in the last 3 months was a protective factor for vitamin A and D deficiency and insufficiency, respectively (OR=0.68 and 0.22, 95%CI 0.49-0.95 and 0.13-0.40, both P<0.05). The rates of vitamin A and D insufficiency was higher in children with annual household incomes <60 000 RMB than in those with annual household incomes ≥60 000 RMB (χ2=34.11 and 10.43, both P<0.01). Northwest and Southwest had the highest rates of vitamin A and vitamin D insufficiency in children aged 2-<7 yeas, respectively (χ2=93.22 and 202.54, both P<0.001). Conclusions: Among 20 cities in China, children aged 2-<7 years experience high rates of vitamin A and vitamin D insufficiency, which are affected by age, family economic level, vitamin A and vitamin D supplementation, and regional economic level. The current results suggest that high level of attention should be paid to vitamin A and vitamin D nutritional status of preschool children.
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Affiliation(s)
- Q H Wu
- Children's Nutrition Research Center, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Nutrition and Health, Chongqing 400014, China
| | - Q Chen
- Children's Nutrition Research Center, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Nutrition and Health, Chongqing 400014, China
| | - T Yang
- Children's Nutrition Research Center, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Nutrition and Health, Chongqing 400014, China
| | - J Chen
- Children's Nutrition Research Center, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Nutrition and Health, Chongqing 400014, China
| | - L Chen
- Children's Nutrition Research Center, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Nutrition and Health, Chongqing 400014, China
| | - X L Xiang
- Children's Nutrition Research Center, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Nutrition and Health, Chongqing 400014, China
| | - F Y Jia
- Department of Developmental and Behavioral Pediatrics, the First Hospital of Jilin University, Changchun 130031, China
| | - L J Wu
- Department of Children's and Adolescent Health, Public Health College of Harbin Medical University, Harbin 150001, China
| | - Y Hao
- Division of Child Healthcare, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - L Li
- Department of Children Rehabilitation, Hainan Women and Children's Medical Center, Haikou 570206, China
| | - J Zhang
- Children Health Care Center, Xi'an Children's Hospital, Xi'an 710003, China
| | - X Y Ke
- Child Mental Health Research Center, the Affiliated Nanjing Brain Hospital of Nanjing Medical University, Nanjing 210000, China
| | - M J Yi
- Department of Child Health Care, the Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Q Hong
- Department of Child Psychology and Behavior, Maternal and Child Health Hospital of Baoan, Shenzhen 518000, China
| | - J J Chen
- Department of Child Healthcare, Children's Hospital Affiliated to Shanghai Jiao Tong University, Children's Hospital of Shanghai, Shanghai 200000, China
| | - S F Fang
- Department of Child Health Care, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, China
| | - Y C Wang
- National Health Commission Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha 410008, China
| | - Q Wang
- Department of Child Health Care, Deyang Maternity & Child Healthcare Hospital, Deyang 618000, China
| | - T Y Li
- Children's Nutrition Research Center, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Nutrition and Health, Chongqing 400014, China
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Kuo TC, Chen KY, Lai CW, Wang YC, Lin MT, Chang CH, Wu MH. Comparison of safety, efficacy, and patient satisfaction with thermal ablation versus endoscopic thyroidectomy for benign thyroid nodules in a propensity-matched cohort. Int J Surg 2024:01279778-990000000-01099. [PMID: 38376867 DOI: 10.1097/js9.0000000000001201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/04/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Thyroid nodules (TNs) often require intervention due to symptomatic or cosmetic concerns. Radiofrequency ablation (RFA) has shown promise as a treatment option, offering potential advantages without neck scars. Recently, the scarless treatment alternative of transoral endoscopic thyroidectomy vestibular approach (TOETVA) has emerged. When surgery can be performed in a scarless manner, it remains unclear whether ablation is still the preferred treatment choice. This study aims to compare the safety, efficacy, and patient satisfaction of RFA and TOETVA. STUDY DESIGN A retrospective data analysis was conducted on patients treated with RFA or TOETVA for unilateral benign TNs between December 2016 and September 2021. Propensity score matching was employed to create comparable groups. Various clinicopathologic parameters, treatment outcomes, and costs were assessed. RESULTS Of the 2,814 nonfunctional thyroid nodules treated during this period, 642 were benign and unilateral. A total of 121 and 100 patients underwent thermal ablation and transoral endoscopic thyroidectomy, respectively. After matching, 84 patients were selected for each group. Both RFA and TOETVA demonstrated low complication rates, with unique complications associated with each procedure. Treatment time (30.8±13.6 minutes vs. 120.7±36.5 minutes, P<0.0001) was shorter in the RFA group. Patient satisfaction (significant improvement: 89.3% vs. 61.9%, P<0.0001) and cosmetic results (cosmetic score 1-2: 100.0% vs. 54.76%, P<0.0001) favored TOETVA. RFA was found to be less costly for a single treatment, but the cost of retreatment should be considered. The histological diagnoses post-TOETVA revealed malignancies in 9 out of 84 cases, underscoring the significance of follow-up assessments. CONCLUSION Scarless procedures, RFA and TOETVA, are effective for treating unilateral benign TNs, each with unique advantages and drawbacks. While RFA is cheaper for a single treatment, TOETVA offers superior cosmetic results and patient satisfaction. Further research is needed to evaluate long-term safety and cost-effectiveness. It is crucial to remain vigilant about the possibility of malignancy despite benign cytology pre-treatment.
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Affiliation(s)
- Ting-Chun Kuo
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
- Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuen-Yuan Chen
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chieh-Wen Lai
- Department of Surgery, Buddhist Tzu Chi General Hospital, Taipei, Taiwan
| | - Yi-Chia Wang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Tsan Lin
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Hao Chang
- Department of Medical Research, National Taiwan University Hospital & National Taiwan University, Taipei, Taiwan
| | - Ming-Hsun Wu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Li XP, Li Y, Liu L, Yuan ZT, Wang YC, Dong YC, Zhang DS, Feng J, Chen YN, Wang SB. [Clinical study of the efficacies of ruxolitinib plus low-dose PTCY for acute GVHD prevention after haploidentical transplantation in malignant hematological diseases]. Zhonghua Xue Ye Xue Za Zhi 2024; 45:128-133. [PMID: 38604788 DOI: 10.3760/cma.j.cn121090-20230929-00153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Objective: To investigate and verify a novel acute graft versus host disease (aGVHD) prevention protocol in the context of haploidentical hematopoietic stem cell transplantation (haplo-HSCT) . Methods: Patients who underwent haplo-HSCT in our center between January 2022 and December 2022 were included. All patients received reduced doses of cyclophosphamide, Rabbit anti-human tymoglobulin, ruxolitinib, methotrexate, cyclosporine, and MMF to prevent aGVHD. The transplantation outcomes, complications, and survival rate of all patients were investigated. Results: A total of 52 patients with haplo-HSCT were enrolled, 29 (55.8%) male and 23 (44.2%) female, with a median age of 28 (5-59) years. There were 25 cases of acute myeloid leukemia, 17 cases of acute lymphocyte leukemia, 6 cases of myelodysplastic syndrome, 2 cases of chronic myeloid leukemia and 2 cases of myeloproliferative neoplasms. 98.1% of patients had successful engraftment. The incidence of Ⅱ-Ⅳ aGVHD and Ⅲ-Ⅳ aGVHD was 19.2% (95% CI 8.2% -30.3% ) and 7.7% (95% CI 0.2% -15.2% ), respectively. No patients experienced severe gastrointestinal mucositis. The Epstein-Barr virus and CMV reactivation rates were 40.4% and 21.3%, respectively. 9.6% of patients relapsed during followup, with 1-year overall survival, progression-free survival, and non-relapse mortality rates of 86.5% (95% CI 76.9% -96.1% ), 78.8% (95% CI 67.4% -90.3% ) and 11.5% (95% CI 2.6% -20.5% ), respectively. Conclusion: Ruxolitinib combined with a low dose of PTCY is a safe and effective first-line aGVHD prevention strategy.
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Affiliation(s)
- X P Li
- Department of Hematology, 920th Hospital of Joint Logistics Support Force, Kunming 650000, China
| | - Y Li
- Department of Hematology, 920th Hospital of Joint Logistics Support Force, Kunming 650000, China
| | - L Liu
- Department of Hematology, 920th Hospital of Joint Logistics Support Force, Kunming 650000, China
| | - Z T Yuan
- Department of Hematology, 920th Hospital of Joint Logistics Support Force, Kunming 650000, China
| | - Y C Wang
- Department of Hematology, 920th Hospital of Joint Logistics Support Force, Kunming 650000, China
| | - Y C Dong
- Department of Hematology, 920th Hospital of Joint Logistics Support Force, Kunming 650000, China
| | - D S Zhang
- Department of Hematology, 920th Hospital of Joint Logistics Support Force, Kunming 650000, China
| | - J Feng
- Department of Hematology, 920th Hospital of Joint Logistics Support Force, Kunming 650000, China
| | - Y N Chen
- Department of Hematology, 920th Hospital of Joint Logistics Support Force, Kunming 650000, China
| | - S B Wang
- Department of Hematology, 920th Hospital of Joint Logistics Support Force, Kunming 650000, China
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Hao R, Wang YC, Zhang TY, Liu Y, Niu R, Yin Z, Zhang W. [Clinical characteristics and surgical outcomes in pediatric progressive restrictive strabismus]. Zhonghua Yan Ke Za Zhi 2024; 60:35-42. [PMID: 38199766 DOI: 10.3760/cma.j.cn112142-20231031-00199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Objective: To investigate the clinical features, imaging manifestations, histopathological characteristics, and surgical outcomes in pediatric progressive restrictive strabismus. Methods: A retrospective case series study was conducted, including data from 9 cases (9 eyes) of pediatric progressive restrictive strabismus treated at Tianjin Eye Hospital from June 2017 to October 2022. The study compared the degree of globe protrusion in both eyes, changes in eyelid fissure height during internal and external rotation in the primary gaze, summarized clinical characteristics, and analyzed intraoperative conditions, surgical outcomes and postoperative histopathological results of strabismus correction surgery. Statistical analysis was performed using Wilcoxon signed-rank test and Friedman two-way analysis of variance. Results: All 9 cases involved unilateral onset, with 4 males and 5 females. Three cases affected the right eye, and six affected the left eye. Onset age ranged from 2 to 40 months. The degree of globe protrusion in the affected eyes was 13.00 (12.00, 13.00) mm for the right eye and 12.00 (12.00, 13.50) mm for the left eye, with no statistically significant difference (Z=-1.00, P=0.317). There were no significant changes in eyelid fissure height during internal rotation [8.00 (7.25, 8.00) mm], primary gaze [7.50 (7.00, 8.00) mm], and external rotation [8.00 (7.75, 8.00) mm] in the affected eyes (χ²=1.00, P=0.607). No apparent abnormalities were observed in head CT or MRI scans, serum, or immunological tests. However, orbital CT or MRI scans indicated thickening of different extraocular muscle bellies. Six out of nine cases underwent strabismus correction surgery, and postoperative examination revealed restriction in eye movement despite achieving orthophoria in the primary gaze. Tissue pathology of three cases showed increased collagen fiber proliferation in one, scattered bundles of smooth muscle fibers amid diffuse collagen fiber proliferation in another, and abnormal proliferation of striated muscle fibers with varying diameters, increased paired box (PAX)7-positive satellite cells expressing slow muscle myosin in the third case. Conclusions: Pediatric progressive restrictive strabismus presents with restrictive changes, without significant alterations in globe protrusion and eyelid fissure height. Imaging examinations reveal thickening of the extraocular muscle bellies in the affected eye. Although strabismus correction surgery improves eye position, postoperative eye movement remains restricted. Histopathological findings in some cases show abnormal proliferation of skeletal muscle fibers or collagen fibers.
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Affiliation(s)
- R Hao
- Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin 300020, China
| | - Y C Wang
- Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin 300020, China
| | - T Y Zhang
- Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin 300020, China
| | - Y Liu
- Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin 300020, China
| | - R Niu
- Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin 300020, China
| | - Z Yin
- Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin 300020, China
| | - W Zhang
- Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin 300020, China
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Wang YC, Li J, Guo YT, Li J, Lin JY. [Clinical pathological and genetic mutation characteristics of conjunctival lymphoepithelial carcinoma]. Zhonghua Yan Ke Za Zhi 2024; 60:64-71. [PMID: 38199770 DOI: 10.3760/cma.j.cn112142-20231013-00136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Objective: To analyze the clinical pathological and genetic mutation characteristics of conjunctival lymphoepithelial carcinoma. Methods: A retrospective case series study was conducted. Data from three patients diagnosed with conjunctival lymphoepithelial carcinoma and treated with tumor resection surgery at Tianjin Eye Hospital from January 2006 to December 2022 were collected. Four paraffin specimens (including one patient undergoing two surgeries) were subjected to immunohistochemical staining for epithelial antigen and lymphocytic antigen. Epstein-Barr virus (EBV)-encoded RNA (EBER) was detected using in situ hybridization, and whole-exome sequencing was performed on three specimens from two patients using next-generation sequencing methods. Results: All three patients were males aged over 65, with a disease duration ranging from 3 to 44 months. The tumors were unilateral, located on the bulbar or limbal conjunctiva, appearing red, with a maximum diameter of 4-20 mm. Imaging examinations revealed anterior location of the tumors with no involvement of the orbital bone, extraocular muscles, optic nerve, or paranasal sinuses. No local lymph node metastasis was observed in any patient. Pathological findings included undifferentiated carcinoma nests with significant reactive lymphocytic and plasma cell infiltration. Tumor cells were positive for pan-cytokeratin (CK-pan), epithelial membrane antigen (EMA), tumor protein 40 (p40), and tumor protein 63 (p63), with a cell proliferation index (Ki67) exceeding 80%. Cluster of differentiation 20 (CD20), CD3, and CD8 were positive for lymphocytes. In situ hybridization showed partial tumor cell expression of EBER in two specimens of one patient. Whole-exome sequencing revealed 58, 50, and 36 mutated genes in the three specimens, with enriched signaling pathways including melanoma signaling pathway, Notch1 signaling pathway, and RHOQ GTP cycle; enriched biochemical processes included amino acid starvation response, programmed cell death, regulation of lipid synthesis, sodium ion transport, and chromosome segregation. The common mutated gene in all three specimens was SZT2, and SZT2 was involved in the amino acid starvation response. One patient underwent a second complete resection surgery 40 months after partial excision, while the other two underwent complete resection surgery without recurrence. Two patients did not undergo radiation or chemotherapy, and one was lost to follow-up. Conclusions: Conjunctival lymphoepithelial carcinoma is associated with prominent lymphocytic and plasma cell infiltration, some cases are associated with EBV infection, and SZT2 mutations are present in conjunctival lymphoepithelial carcinoma.
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Affiliation(s)
- Y C Wang
- Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin 300020, China
| | - J Li
- Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin 300020, China
| | - Y T Guo
- Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin 300020, China
| | - J Li
- Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin 300020, China
| | - J Y Lin
- Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin 300020, China
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Wang GC, Wang GY, Zhao J, Guo LL, Tian KK, Wang T, Gao CQ, Li LJ, Liu YJ, Zhang GQ, Wang YC, Ding LL, Zhang Z, Wang C, Qi ZC. [Clinical application effect of pedunculated rectus abdominis muscle combined with bilateral ureters for repairing refractory bladder-vaginal stump fistula through external vesical drainage]. Zhonghua Zhong Liu Za Zhi 2023; 45:1077-1080. [PMID: 38110316 DOI: 10.3760/cma.j.cn112152-20230605-00223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Objective: To investigate the efficacy and safety of pedunculated rectus abdominis combined with bilateral ureteral extravestheter drainage in the treatment of refractory bladder-vaginal stump fistula. Methods: The clinical data of 8 cases of the refractory bladder-vaginal stump fistula were admitted to the Second Hospital of Hebei Medical University and Henan Cancer Hospital and underwent the clinical treatment of bladder-vaginal stump from December 2019 to December 2022 were collected. The reason of refractory bladder-vaginal stump fistula was analyzed, the operation manner of pedunculated rectus abdominis combined with peduncle and bilateral ureter for the treatment of bladder-vaginal stump through extrabladder drainage was explored. The operation time, bleeding volume and clinical effect were record. Results: The median operation time of 8 patients was 150 minutes(120~180 min), and the median blood loss was 400 ml(200~600 ml). During the perioperative period, there were 2 cases of incision infection, delayed healing by debridement and dressing, 2 cases of incision rupture and suture wound healing after reoperation, and 2 cases of urinary tract infection were cured by anti-infection. When followed up for 6 months, 8 cases of vesicovaginal stump fistula were cured. Conclusion: Bilateral ureteral external drainage of the rectus abdominis muscle, has a practical effect in the treatment of refractory bladder-vaginal stump fistula, which can be one of the clinical repairing treatment.
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Affiliation(s)
- G C Wang
- Department of Abdominopelvic Oncology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - G Y Wang
- Department of Colorectal Surgery, the Second Hospital of Hebei Medical University, Shijiazhuang 050004, China
| | - J Zhao
- Department of Colorectal Surgery, the Second Hospital of Hebei Medical University, Shijiazhuang 050004, China
| | - L L Guo
- Department of Orthopedic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - K K Tian
- Department of Orthopedic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - T Wang
- Department of Abdominopelvic Oncology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - C Q Gao
- Department of Abdominopelvic Oncology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - L J Li
- Department of Abdominopelvic Oncology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Y J Liu
- Department of General Surgery, Henan Cancer Hospital, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - G Q Zhang
- Department of General Surgery, Henan Cancer Hospital, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Y C Wang
- Department of General Surgery, Henan Cancer Hospital, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - L L Ding
- Department of Abdominopelvic Oncology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Z Zhang
- Department of Abdominopelvic Oncology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - C Wang
- Department of Abdominopelvic Oncology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Z C Qi
- Department of General Surgery, Henan Cancer Hospital, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
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Li J, Wang YC, Lin JY. [Clinical pathological characteristics analysis of ocular adnexal follicular lymphoma]. Zhonghua Yan Ke Za Zhi 2023; 59:930-936. [PMID: 37936361 DOI: 10.3760/cma.j.cn112142-20230201-00036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Objective: To investigate the clinical pathological characteristics of ocular adnexal follicular lymphoma (OAFL). Methods: A retrospective case series study was conducted. Clinical data of 10 OAFL patients diagnosed at Tianjin Eye Hospital from January 1990 to May 2022 were collected. The study analyzed general patient information, medical history, site of involvement, imaging, histopathology, and molecular detection. Among them, 7 cases underwent Epstein-Barr virus-encoded small RNA (EBER) and B-cell lymphoma protein 2 (BCL-2)/immunoglobulin heavy chain gene (IgH) translocation gene detection. Treatment and prognosis of patients were followed up. Results: All 10 patients (10 eyes) had unilateral involvement, including 5 males and 5 females, with an age range of 58 (43, 68) years. Clinical manifestations included eyelid swelling, pink conjunctival thickening, painless slow-growing masses in the lacrimal gland area, extraconal muscle cone, conjunctiva, lacrimal sac, or a combination of lacrimal sac and conjunctiva. Among them, 8 cases were primary, and 2 cases were secondary. According to the Ann Arbor staging, 8 cases were stage Ⅰ-Ⅱ E, and 2 cases were stage Ⅲ E. Histopathological grading revealed 6 cases of grade 1-2 and 3 cases of grade 3A. One case showed grade 3B in the lacrimal sac area and grade 1-2 in the conjunctiva. The predominant subtype was follicular in 4 cases, diffuse in 3 cases, and mixed in 2 cases. One case had a mixed subtype involving the lacrimal sac and conjunctiva. All patients expressed positivity for leukocyte differentiation antigens (CD) 20, CD21, and CD23. Nine cases were positive for CD10, with 1 case showing partial CD10 positivity. All patients were positive for B-cell lymphoma protein 6 (BCL-6), and 9 cases were positive for BCL-2. Specific markers CyclinD1 and Multiple Myeloma Oncogene Protein 1 (MUM-1) were negatively expressed in all cases. The Ki-67 proliferation index ranged from 10% to 90%. Molecular detection was performed in 7 patients, with none showing positive EBER in situ hybridization. However, 5 cases exhibited BCL2/IgH gene fusion. Among 7 patients with follow-up data, the median follow-up time was 17 (6, 34) months. Four patients achieved complete remission, 2 had partial remission, and 1 patient died due to lung infection. Conclusions: OAFL is a tumor originating from follicular center B-cells, characterized by positive expression of BCL-2, CD10, and BCL-6. It can involve the lacrimal gland, extraconal muscles, lacrimal sac, and conjunctiva. Patients generally have a favorable prognosis.
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Affiliation(s)
- J Li
- Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin 300020, China
| | - Y C Wang
- Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin 300020, China
| | - J Y Lin
- Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin 300020, China
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Wu CH, Lin FC, Jerng JS, Shin MH, Wang YC, Lee CJ, Lin LM, Lin NH, Kuo YW, Ku SC, Wu HD. Automatic tube compensation for liberation from prolonged mechanical ventilation in tracheostomized patients: A retrospective analysis. J Formos Med Assoc 2023; 122:1132-1140. [PMID: 37169656 DOI: 10.1016/j.jfma.2023.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 04/01/2023] [Accepted: 04/23/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND To analyze the predictability of an automatic tube compensation (ATC) screening test compared with the conventional direct liberation test performed before continuous oxygen support for MV liberation. METHODS This retrospective study analyzed tracheostomized patients with prolonged MV in a weaning unit of a medical center in Taiwan. In March 2020, a four-day ATC test to screen patient eligibility for ventilator liberation was implemented, intended to replace the direct liberation test. We compared the predictive accuracy of these two screening methods on the relevant outcomes in the two years before and one year after the implementation of this policy. RESULTS Of the 403 cases, 246 (61%) and 157 (39%) received direct liberation and ATC screening tests, respectively. These two groups had similar outcomes: successful weaning upon leaving the Respiratory Care Center (RCC), success on day 100 of MV, success at hospital discharge, and in-hospital survival. Receiver operating characteristic curve analysis showed that the ATC screening test had better predictive ability than the direct liberation test for RCC weaning, discharge weaning, 100-day weaning, and in-hospital survival. CONCLUSION This closed-circuit ATC screening test before ventilator liberation is a feasible and valuable method for screening PMV patients undergoing ventilator liberation in the pandemic era. Its predictability for a comparison with the open-circuit oxygen test requires further investigation.
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Affiliation(s)
- Chia-Hao Wu
- Department of Internal Medicine, National Taiwan University Hospital Hsin-chu Branch, Hsin-chu, Taiwan.
| | - Feng-Ching Lin
- Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.
| | - Jih-Shuin Jerng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Ming-Hann Shin
- Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.
| | - Yi-Chia Wang
- Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.
| | - Cheng-Jun Lee
- Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.
| | - Li-Min Lin
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.
| | - Nai-Hua Lin
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.
| | - Yao-Wen Kuo
- Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.
| | - Shih-Chi Ku
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Huey-Dong Wu
- Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.
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Lyu YY, Cao Y, Chen YX, Wang HY, Zhou L, Wang Y, Wang YC, Jiang SY, Lee KLEE, Li L, Sun JH. [Investigation of extrauterine growth restriction in very preterm infants in Chinese neonatal intensive care units]. Zhonghua Er Ke Za Zhi 2023; 61:811-819. [PMID: 37650163 DOI: 10.3760/cma.j.cn112140-20230609-00388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Objective: To comprehensively assess the current status of extrauterine growth restriction (EUGR) in very preterm infants (VPI) and its associated factors in Chinese neonatal intensive care units (NICU). Methods: In this cohort study, 6 179 preterm infants born at <32 weeks' gestation were included, who were admitted to 57 hospitals in the China Neonatal Network in 2019 and hospitalized for ≥7 days. EUGR was evaluated by a cross-sectional definition (weight at discharge<10th percentile for postmenstrual age), a longitudinal definition (decline in weight Z score>1 from birth to discharge), and weight growth velocity. The comparison between infants with and without EUGR was conducted by t-test, Mann-Whitney U test or χ2 test as appropriate. Multivariable Logistic regression models were used to evaluate associations between EUGR with different definitions and maternal and neonatal factors, clinical practices, and neonatal morbidities. Results: A total of 6 179 VPI were enrolled in the study, with a gestational age of (29.8±1.5) weeks and birth weight of (1 365±304) g; 56.2% (3 474) of them were male. Among them, 48.4% (2 992 VPI) were cross-sectional EUGR and 74.9% (4 628 VPI) were longitudinal EUGR. Z score of weight was (0.13±0.78) at birth and decrease to (-1.35±0.99) at discharge. The weight growth velocity was 10.13 (8.42, 11.66) g/(kg·d). Multivariate Logistic regression analysis showed that among the influential factors that could be intervened after birth, late attainment of full enteral feeds (ORadjust=1.01, 95%CI 1.01-1.02, P<0.001; ORadjust=1.01, 95%CI 1.01-1.02, P<0.001), necrotizing enterocolitis≥Ⅱstage (ORadjust=2.64, 95%CI 1.60-4.35, P<0.001; ORadjust=1.62, 95%CI 1.10-2.40, P<0.001) and patent ductus arteriosus (ORadjust=1.94, 95%CI 1.50-2.51, P<0.001; ORadjust=1.63, 95%CI 1.29-2.06, P<0.001) were all associated with increased risks of both cross-sectional and longitudinal EUGR. In addition, late initiation of enteral feeds (ORadjust=1.06, 95%CI 1.02-1.09, P=0.020) and respiratory distress syndrome (ORadjust=1.45, 95%CI 1.24-1.69, P<0.001) were all associated with cross-sectional EUGR. Breast milk feeding (ORadjust=1.33, 95%CI 1.05-1.68, P<0.001) was associated with a higher risk of longitudinal EUGR. Conclusions: The incidence of EUGR in VPI in China is high. Some modifiable risk factors provide priorities to improve postnatal growth for VPI. Nutritional management of VPI and the efforts to decrease the incidence of complications are still the focus of clinical management in China.
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Affiliation(s)
- Y Y Lyu
- Department of Neonatology, Children's Hospital, Experiment Center, Capital Institute of Pediatrics, Beijing 100020, China
| | - Y Cao
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China
| | - Y X Chen
- Department of Neonatology, the First People's Hospital of Yinchuan, Yinchuan 750003, China
| | - H Y Wang
- Department of Neonatology, Changzhou Maternal and Child Health Care Hospital, Changzhou 213004, China
| | - L Zhou
- Department of Neonatology, the First People's Hospital of Yinchuan, Yinchuan 750003, China
| | - Y Wang
- Department of Neonatology, Changzhou Maternal and Child Health Care Hospital, Changzhou 213004, China
| | - Y C Wang
- NHC Key Laboratory of Neonatal Diseases(Fudan University), Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China
| | - S Y Jiang
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China
| | - K L E E Lee
- Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto M5G 1X5, Canada
| | - L Li
- Department of Neonatology, Children's Hospital, Experiment Center, Capital Institute of Pediatrics, Beijing 100020, China
| | - J H Sun
- Division of Neonatology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
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11
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Dai C, Wang YC, Mo LQ, Peng YS, Deng WF, Xia RF, Zeng WL, Xu J, Miao Y. [Correction model of the sampling time error on the blood trough concentration of tacrolimus in non-sustained-release dosage form for renal transplant recipients]. Zhonghua Yi Xue Za Zhi 2023; 103:1526-1530. [PMID: 37246001 DOI: 10.3760/cma.j.cn112137-20221207-02597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Objective: To establish correction model of the sampling time error on the blood trough concentration of tacrolimus in non-sustained-release dosage form for renal transplant recipient and improve the accuracy of drug dose assessment and clinical adjustment in renal transplant recipients. Methods: Visit records of 206 outpatients in the Department of Transplantation, Nanfang Hospital, Southern Medical University were retrospectively collected from October 15, 2022 to October 30, 2022. The distribution of sampling time of tacrolimus blood drug concentration was described and the time range of correction was determined. Twenty inpatients after renal transplantation in the Department of Transplantation, Nanfang Hospital, Southern Medical University from October 1, 2022 to November 30, 2022 were prospectively included, and their demography data, laboratory test results during follow-ups, and CYP3A5 genotype were collected. The patients took tacrolimus in non-sustained-release dosage form every 12 h starting from 19∶30 on the day of admission. Peripheral blood samples were collected from the patients on the second day of admission at 7∶30 and on the third day at 6∶00-10∶00 every 30 minutes to test the blood concentration of tacrolimus. Using the collection time as the independent variable and the blood tacrolimus concentration as the dependent variable, a simple linear regression was performed to fitting a linear model of tacrolimus blood concentration-sampling time. Multiple linear regression was performed to analyze the influencing factors of the tacrolimus metabolic rate within a specific period and generate the regression equation. Results: The 206 outpatients aged (46±13) years, including 131 males (63.6%). The time gap [M (Q1, Q3)] between the sampling time of the follow-up outpatients and standard C12 was 24 (13.0, 46.5) min, and the maximum time gap was 135 min. The 20 enrolled inpatients aged (45±12) years, including 15 males (75.0%). There was no significant difference in the blood concentration of tacrolimus collected at 7∶30 on the second (7.87±2.21)ng/ml and third days (7.84±2.33)ng/ml after admission of the enrolled inpatients (P=0.917), and the blood tacrolimus concentration rhythm was stable in the trial. The plasma concentration of C10.5-C14.5 was linearly related to the time, with R2 [M (Q1, Q3)] 0.88 (0.85, 0.92) and all P<0.05. The metabolic rate of tacrolimus during C10.5-C14.5=0.984+0.090×basic concentration of tacrolimus (ng/ml)-0.036×body mass index+0.489×CYP3A5 genotype-0.007×hemolobin(g/L)-0.035×alanine aminotransferase (U/L)+0.143×total cholesterol (mmol/L)+0.027×total bilirubin (μmol/L), with R2=0.85. Conclusion: This study propose a correction model for tacrolimus (non-sustained-release dosage form) trough concentration around C12, which is helpful for clinicians to easily and accurately assess renal transplant recipients' tacrolimus exposure.
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Affiliation(s)
- C Dai
- Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Y C Wang
- Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - L Q Mo
- Clinical Pharmacy Center, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Y S Peng
- Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - W F Deng
- Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - R F Xia
- Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - W L Zeng
- Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - J Xu
- Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Y Miao
- Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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12
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Kuo TC, Chen KY, Lai CW, Wang YC, Lin MT, Chang CH, Wu MH. Synergic evacuation device helps smoke control during endoscopic thyroid surgery. Surgery 2023:S0039-6060(23)00187-3. [PMID: 37202307 DOI: 10.1016/j.surg.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Surgical plumes in small cavities, such as transoral endoscopic thyroid surgery, have never been satisfactorily resolved. We aimed to study the use of a smoke evacuation system and evaluate its efficacy, including the field of view and operating time. STUDY DESIGN We retrospectively reviewed 327 consecutive patients who underwent endoscopic thyroidectomy. They were separated into 2 groups based on whether the smoke evacuation system was used. To reduce the possible experience bias, only patients 4 months before and after implementing the evacuation system were included. Recorded endoscopic videos were evaluated, including the field of view, the incidence of scope clearance, and time spent during air-pocket creation. RESULTS Overall, there were 64 patients with a median age of 43.59 years and a median body mass index of 22.87 kg/m2, including 54 women, 21 thyroid cancers, and 61 hemithyroidectomies. The operative duration was comparable between the groups. The group where the evacuation system was used scored more as good in terms of endoscopic views (8/32, 25% vs 1/32, 3.13%, P = .01), fewer incidences of endoscope lens pull out for clearance (3.5 vs 6.0 times, P < .01), less time for clear view after energy device activation (2.67 vs 5.00 seconds, P < .01), and less time spent (8.67 vs 12.38 minutes, P < .01) during air-pocket creation. CONCLUSION In conjunction with the synergy function of energy devices, evacuators enhance the field of view and optimize the time spent in the real clinical setting of low-pressure and small-space endoscopic thyroid procedures, in addition to the benefit of reducing smoke harm.
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Affiliation(s)
- Ting-Chun Kuo
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan; Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan. https://twitter.com/tinakuo1204
| | - Kuen-Yuan Chen
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chieh-Wen Lai
- Department of Surgery, Buddhist Tzu Chi General Hospital, Taipei, Taiwan
| | - Yi-Chia Wang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Tsan Lin
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Hao Chang
- Department of Medical Research, National Taiwan University Hospital & National Taiwan University, Taipei, Taiwan
| | - Ming-Hsun Wu
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
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13
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Wang YC, Jin MS, Yi D, Guan BH, Qu LM. [Intrathyroid thymic carcinoma:report of a case]. Zhonghua Bing Li Xue Za Zhi 2023; 52:518-520. [PMID: 37106300 DOI: 10.3760/cma.j.cn112151-20230119-00056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- Y C Wang
- Department of Pathology, the First Hospital of Jilin University, Changchun 130021,China
| | - M S Jin
- Department of Pathology, the First Hospital of Jilin University, Changchun 130021,China
| | - D Yi
- Department of Pathology, the First Hospital of Jilin University, Changchun 130021,China
| | - B H Guan
- Department of Pathology, the First Hospital of Jilin University, Changchun 130021,China
| | - L M Qu
- Department of Pathology, the First Hospital of Jilin University, Changchun 130021,China
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14
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Wang YC, Zheng Q, Wang Y, Yao QL, Zhou XY, Chen TZ, Li Y. [HMGA2-WIF1 rearranged salivary pleomorphic adenoma with trabecular/canalicular adenoma-like morphology: report of a case]. Zhonghua Bing Li Xue Za Zhi 2023; 52:405-407. [PMID: 36973206 DOI: 10.3760/cma.j.cn112151-20230118-00054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Affiliation(s)
- Y C Wang
- Department of Pathology, Fudan University Shanghai Cancer Center;Department of Oncology, Shanghai Medical College, Fudan University;Fudan University Pathology Institute, Shanghai 200032, China
| | - Q Zheng
- Department of Pathology, Fudan University Shanghai Cancer Center;Department of Oncology, Shanghai Medical College, Fudan University;Fudan University Pathology Institute, Shanghai 200032, China
| | - Y Wang
- Department of Pathology, Fudan University Shanghai Cancer Center;Department of Oncology, Shanghai Medical College, Fudan University;Fudan University Pathology Institute, Shanghai 200032, China
| | - Q L Yao
- Department of Pathology, Fudan University Shanghai Cancer Center;Department of Oncology, Shanghai Medical College, Fudan University;Fudan University Pathology Institute, Shanghai 200032, China
| | - X Y Zhou
- Department of Pathology, Fudan University Shanghai Cancer Center;Department of Oncology, Shanghai Medical College, Fudan University;Fudan University Pathology Institute, Shanghai 200032, China
| | - T Z Chen
- Department of Pathology, Fudan University Shanghai Cancer Center;Department of Oncology, Shanghai Medical College, Fudan University;Fudan University Pathology Institute, Shanghai 200032, China
| | - Y Li
- Department of Pathology, Fudan University Shanghai Cancer Center;Department of Oncology, Shanghai Medical College, Fudan University;Fudan University Pathology Institute, Shanghai 200032, China
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15
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Wang GC, Li HL, Liu Y, Gu XH, Liu RX, Feng R, Wang YC, Liu YJ, Zhang GQ, Zhang Z, Wang HL, Wang F, Zhang Y. [Analysis of the causes of long-standing pelvic anterior sacral space infection and discussion of management techniques]. Zhonghua Zhong Liu Za Zhi 2023; 45:273-278. [PMID: 36944549 DOI: 10.3760/cma.j.cn112152-20210217-00136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Objective: To investigate the causes and management of long-term persistent pelvic presacral space infection. Methods: Clinical data of 10 patients with persistent presacral infection admitted to the Cancer Hospital of Zhengzhou University from October 2015 to October 2020 were collected. Different surgical approaches were used to treat the presacral infection according to the patients' initial surgical procedures. Results: Among the 10 patients, there were 2 cases of presacral recurrent infection due to rectal leak after radiotherapy for cervical cancer, 3 cases of presacral recurrent infection due to rectal leak after radiotherapy for rectal cancer Dixons, and 5 cases of presacral recurrent infection of sinus tract after adjuvant radiotherapy for rectal cancer Miles. Of the 5 patients with leaky bowel, 4 had complete resection of the ruptured nonfunctional bowel and complete debridement of the presacral infection using an anterior transverse sacral incision with a large tipped omentum filling the presacral space; 1 had continuous drainage of the anal canal and complete debridement of the presacral infection using an anterior transverse sacral incision. 5 post-Miles patients all had debridement of the presacral infection using an anterior transverse sacral incision combined with an abdominal incision. The nine patients with healed presacral infection recovered from surgery in 26 to 210 days, with a median time of 55 days. Conclusions: Anterior sacral infections in patients with leaky gut are caused by residual bowel secretion of intestinal fluid into the anterior sacral space, and in post-Miles patients by residual anterior sacral foreign bodies. An anterior sacral caudal transverse arc incision combined with an abdominal incision is an effective surgical approach for complete debridement of anterior sacral recalcitrant infections.
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Affiliation(s)
- G C Wang
- Department of General Surgery, Affiliated Cancer Hospital of Zhengzhou University, He'nan Provincial Cancer Hospital, Zhengzhou 450003, China Department of Gneneral Surgery, the Second Hospital of Hebei Medical University, Shijiazhuang 050004, China
| | - H L Li
- Department of General Surgery, Affiliated Cancer Hospital of Zhengzhou University, He'nan Provincial Cancer Hospital, Zhengzhou 450003, China
| | - Y Liu
- Department of General Surgery, Affiliated Cancer Hospital of Zhengzhou University, He'nan Provincial Cancer Hospital, Zhengzhou 450003, China
| | - X H Gu
- Henan Institute of Medical Information, Zhengzhou 450018, China
| | - R X Liu
- Henan Institute of Medical Information, Zhengzhou 450018, China
| | - R Feng
- Henan Institute of Medical Information, Zhengzhou 450018, China
| | - Y C Wang
- Department of General Surgery, Affiliated Cancer Hospital of Zhengzhou University, He'nan Provincial Cancer Hospital, Zhengzhou 450003, China
| | - Y J Liu
- Department of General Surgery, Affiliated Cancer Hospital of Zhengzhou University, He'nan Provincial Cancer Hospital, Zhengzhou 450003, China
| | - G Q Zhang
- Department of General Surgery, Affiliated Cancer Hospital of Zhengzhou University, He'nan Provincial Cancer Hospital, Zhengzhou 450003, China
| | - Z Zhang
- Department of General Surgery, Affiliated Cancer Hospital of Zhengzhou University, He'nan Provincial Cancer Hospital, Zhengzhou 450003, China
| | - H L Wang
- Department of General Surgery, Affiliated Cancer Hospital of Zhengzhou University, He'nan Provincial Cancer Hospital, Zhengzhou 450003, China
| | - F Wang
- Department of General Surgery, Affiliated Cancer Hospital of Zhengzhou University, He'nan Provincial Cancer Hospital, Zhengzhou 450003, China
| | - Y Zhang
- Department of General Surgery, Affiliated Cancer Hospital of Zhengzhou University, He'nan Provincial Cancer Hospital, Zhengzhou 450003, China
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Wang YC, Huang HH, Lin PC, Wang MJ, Huang CH. Hypothermia is an independent risk factor for prolonged ICU stay in coronary artery bypass surgery: an observational study. Sci Rep 2023; 13:4626. [PMID: 36944855 PMCID: PMC10030842 DOI: 10.1038/s41598-023-31889-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/20/2023] [Indexed: 03/23/2023] Open
Abstract
Maintenance of normothermia is a critical perioperative issue. The warming process after hypothermia tends to increase oxygen demand, which may lead to myocardial ischemia. This study explored whether hypothermia was an independent risk factor for increased morbidity and mortality in patients receiving CABG. We conducted a retrospective observational study of CABG surgeries performed from January 2018 to June 2019. The outcomes of interest were mortality, surgical site infection rate, ventilator dependent time, intensive care unit (ICU) stay, and hospitalization duration. Data from 206 patients were analysed. Hypothermic patients were taller (p = 0.012), had lower left ventricular ejection fraction (p = 0.016), and had off-pump CABG more frequently (p = 0.04). Our analysis noted no incidence of mortality within 30 days. Hypothermia was not associated with higher surgical site infection rate or longer intubation time. After adjusting for sex, age, cardiopulmonary bypass duration, left ventricular ejection fraction, and EuroSCORE II, higher EuroSCORE II (p < 0.001; odds ratio 1.2) and hypothermia upon ICU admission (p = 0.04; odds ratio 3.8) were independent risk factors for prolonged ICU stay. In addition to EuroSCORE II, hypothermia upon ICU admission was an independent risk factor for prolonged ICU stay in patients receiving elective CABG.
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Affiliation(s)
- Yi-Chia Wang
- Department of Anesthesiology, National Taiwan University College of Medicine and National University Hospital, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan, 10002
| | - Hsing-Hao Huang
- Department of Anesthesiology, National Taiwan University College of Medicine and National University Hospital, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan, 10002
| | - Pei-Ching Lin
- Department of Anesthesiology, National Taiwan University College of Medicine and National University Hospital, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan, 10002
| | - Ming-Jiuh Wang
- Department of Anesthesiology, National Taiwan University College of Medicine and National University Hospital, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan, 10002
- National Taiwan University Cancer Center, No. 57, Ln. 155, Sec. 3, Keelung Rd., Da'an Dist., Taipei City, 106, Taiwan
| | - Chi-Hsiang Huang
- Department of Anesthesiology, National Taiwan University College of Medicine and National University Hospital, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei, Taiwan, 10002.
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Hu DH, Wang YC. [Pay more attention to the management of burn wounds of special causes and sites]. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi 2023; 39:209-214. [PMID: 37805715 DOI: 10.3760/cma.j.cn501225-20230206-00034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
The treatment of burn wounds of special causes and sites is a very challenging clinical work. In this paper, we briefly discussed the incidence rates of chemical burns, electric burns, facial burns, hand burns, and perineal burns, as well as the complexity and severity of pathological injury of the corresponding wound tissue. In addition, we briefly discussed the main principles and methods of clinical treatment, as well as the difficult problems to be solved. It is hoped to attract attention and provide reference for further improving the overall treatment ability of burns.
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Affiliation(s)
- D H Hu
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
| | - Y C Wang
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
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18
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Li J, Wang YC, Chen LX, Lin JY. [Clinical and pathological analysis of 35 cases of ocular adnexal solitary fibrous tumor]. Zhonghua Yan Ke Za Zhi 2023; 59:207-212. [PMID: 36860108 DOI: 10.3760/cma.j.cn112142-20220407-00160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Objective: To analyze the clinical and pathological characteristics and prognosis of 35 cases of solitary fibrous tumor of ocular adnexal (SFT). Methods: This was a retrospective case series study. The clinical data of 35 cases of ocular adnexal SFT was collected in Tianjin Eye Hospital from January 2000 to December 2020. The clinical manifestations, imaging examination results, pathological characteristics, treatment of patients were analyzed, and patients were followed up. All cases were classified according to the 2013 classification of World Health Organization of tumors of soft tissue and bone. Results: There were 21 males (60.0%) and 14 females (40.0%). The age range was 17 to 83 years, and the median age was 44 (35, 54)years. All patients were unilateral, with 23 (65.7%) in the right eye and 12 (34.3%) in the left eye. The course of disease ranged from 2 months to 11 years, with an a median duration of 12(6,36)months. Clinical manifestations included exophthalmos, limited eye movements, diplopia, and tearing. All patients underwent surgical treatment of complete resection of the tumor. Ocular adnexal SFT mostly occurred in the upper orbit (19 cases, 73.1%). On imaging examination, the tumor showed well-circumscribed space occupying lesion that heterogeneously enhanced with contrast, and abundant blood flow signals in the tumors. MRI showed isointensity or low signal on T1WI, and significantly enhanced on T2WI, presenting intermediate-to-high heterogeneous signals. The tumor diameter was 2.1 (1.5, 2.6) cm. There were 23 cases (65.7%) of classic subtype, 2 cases (5.7%) of giant cell subtype, 8 cases (22.9%) of myxoid subtype, and 2 cases (5.7%) of malignancy. Immunohistochemical staining showed that Vimentin, CD34 and STAT6 were positively expressed in all patients. Twenty-one cases (60.0%) showed positive expression of BCL-2, and Ki-67 positive index ranged from 1.0% to 10.0%. Tumors in this group were all low-risk according to the Demicco risk stratification. Follow-up was available for 25 patients with a duration of 2 years to 14 years and 7 months, and the median follow-up time was 88 (61, 124) months. Two patients relapsed, and no distant metastasis or death was observed. Conclusions: Ocular adnexal SFT mainly presents as a painless, slow-growing mass. And most of them are typical SFT. The imaging manifestations are varied Ocular adnexal SFT generally follows a benign course, with a good prognosis after complete excision. Recurrence could occur many years after surgery which requiring careful and long-term follow-up.
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Affiliation(s)
- J Li
- Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin 300020, China
| | - Y C Wang
- Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin 300020, China
| | - L X Chen
- Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin 300020, China
| | - J Y Lin
- Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin 300020, China
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Qi WW, Wang YC, Xu FF, Wang HQ, Fu R, Shao ZH. [Abnormal expression of CXCR5 +CD8 + T cells and CXCL13 in severe aplastic anemia patients and their correlation with hematological parameters]. Zhonghua Yi Xue Za Zhi 2023; 103:658-664. [PMID: 36858365 DOI: 10.3760/cma.j.cn112137-20221107-02335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Objective: To analyze the expression of C-X-C chemokine receptor 5 (CXCR5)+CD8+ T cells and plasma C-X-C motif chemokine 13 (CXCL13) in severe aplastic anemia (SAA) patients and their correlations with hematological parameters. Methods: The clinical data of 35 SAA patients in the Hematology Department of Tianjin Medical University General Hospital from January 2018 to September 2021 were retrospectively analyzed. The patients were divided into two groups according to whether they had received the medication: untreated SAA group and recovery SAA group. In untreated group, there were 18 patients who had not received any medication, with 9 males and 9 females, and aged 51 (18-76) years. In recovery SAA group, there were 17 patients who were separated from component blood transfusion after the immunosuppressive treatment with anti-thymocyte globulin (ATG) combined with cyclosporine A (CsA), with 7 males and 10 females, and aged 46 (16-70) years. Meanwhile, 20 healthy controls were also selected, including 8 males and 12 females, and aged 45(15-72) years. Peripheral blood and bone marrow samples were collected from SAA patients, while peripheral blood samples were obtained from healthy controls. Flow cytometry was used to detect the percentage of CXCR5+CD8+ T cells in peripheral blood and bone marrow samples. The concentration of plasma CXCL13 was measured by enzyme-linked immunosorbent assay (ELISA). The correlations between the percentage of CXCR5+CD8+ T cells and the concentration of CXCL13, as well as the correlations between these two parameters and the hematological parameters were analyzed by Spearman correlation analysis. Results: The proportion of CXCR5+CD8+ T cells in the bone marrow of untreated SAA group was (4.9±2.9)%, which was higher than that of recovery SAA group (2.7±1.5)%, with a statistically significant difference (t=2.34, P=0.027). The proportion of CXCR5+CD8+ T cells in peripheral blood of untreated SAA group, recovery SAA group and healthy control group was (8.4±4.2)%, (3.8±2.3)% and (2.6±2.0)% respectively. The proportion of CXCR5+CD8+ T cells in peripheral blood of untreated SAA group was higher than that of recovery SAA group and healthy control group (both P<0.05). The plasma CXCL13 concentration in untreated SAA group was (97.2±46.8) ng/L, which was significantly higher than that in recovery SAA group [(54.9±20.9) ng/L] and healthy control group [(47.6±17.3) ng/L] (both P<0.05). The proportion of CXCR5+CD8+ T cells in peripheral blood of SAA patients was positively correlated with the concentration of plasma CXCL13 (r=0.545, P<0.001). The proportion of peripheral blood CXCR5+CD8+ T cells in SAA patients was negatively correlated with white blood cell count, platelets count, percentage of neutrophils, absolute neutrophils count, percentage of reticulocytes, absolute reticulocytes count, bone marrow myeloid cells, bone marrow erythroid cells and megakaryocytes count (r=-0.556, -0.392, -0.617, -0.615, -0.395, -0.543, -0.432, -0.484 and -0.523, all P<0.05). The proportion of peripheral blood CXCR5+CD8+ T cells was positively correlated with the percentage of peripheral blood lymphocytes and bone marrow lymphoid cells (r=0.593 and 0.556, both P<0.05). Meanwhile, the concentration of plasma CXCL13 in SAA patients was negatively correlated with white blood cell count, absolute neutrophils count, percentage of reticulocytes, absolute reticulocytes count and bone marrow myeloid cells (r=-0.447, -0.446, -0.498, -0.407 and -0.456, all P<0.05), but positively correlated with bone marrow lymphoid cells (r=0.384, P<0.05). Conclusions: The proportion of CXCR5+CD8+ T cells and the concentration of plasma CXCL13 increases in SAA patients. The proportion of CXCR5+CD8+ T cells in peripheral blood is positively correlated with the concentration of CXCL13. Moreover, the proportion of CXCR5+CD8+ T cells and the concentration of CXCL13 are correlated with many hematological parameters, which may play a critical role in the immune pathogenesis of SAA.
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Affiliation(s)
- W W Qi
- Department of Hematology, General Hospital of Tianjin Medical University, Tianjin 300052, China
| | - Y C Wang
- Department of Hematology, General Hospital of Tianjin Medical University, Tianjin 300052, China
| | - F F Xu
- Department of Hematology, General Hospital of Tianjin Medical University, Tianjin 300052, China
| | - H Q Wang
- Department of Hematology, General Hospital of Tianjin Medical University, Tianjin 300052, China
| | - R Fu
- Department of Hematology, General Hospital of Tianjin Medical University, Tianjin 300052, China
| | - Z H Shao
- Department of Hematology, General Hospital of Tianjin Medical University, Tianjin 300052, China
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Wang YC, Chou HW, Chen YS, Huang SC. Biventricular Repair for Aortic Atresia, Ventricular Septal Defect, and Type C Interrupted Aortic Arch. World J Pediatr Congenit Heart Surg 2023; 14:248-250. [PMID: 36823971 DOI: 10.1177/21501351221145162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Interrupted aortic arch is a rare congenital heart defect. Among patients with interrupted aortic arch, an interruption between the innominate artery and left common carotid artery (type C) is the rarest. Herein, we report the case of a neonate with aortic atresia, ventricular septal defect, type C interrupted aortic arch, and aberrant right subclavian artery who underwent Norwood stage I operation and staged biventricular repair. Due to aortic atresia, coronary artery perfusion was retrograde from the right common carotid artery. The surgical technique and special considerations for cardiopulmonary bypass are presented.
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Affiliation(s)
- Yi-Chia Wang
- Department of Anesthesiology, 38006National Taiwan University Hospital, Taipei
| | - Heng-Wen Chou
- Department of Surgery, 38006National Taiwan University Hospital, Taipei
| | - Yih-Sharng Chen
- Department of Surgery, 38006National Taiwan University Hospital, Taipei
| | - Shu-Chien Huang
- Department of Surgery, 38006National Taiwan University Hospital, Taipei
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21
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Liu HF, Huang Y, Wu CY, Li Y, Wang YC, Zhang LP, Hou LK, Xie HK. [Pulmonary granular cell tumors: a clinicopathological analysis of five cases]. Zhonghua Bing Li Xue Za Zhi 2023; 52:136-141. [PMID: 36748133 DOI: 10.3760/cma.j.cn112151-20220628-00556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objective: To investigate the clinicopathological features of pulmonary granular cell tumors (pGCTs) and to improve the diagnostic accuracy of the tumor. Methods: A total of 5 pGCTs were diagnosed from February 2016 to January 2022 at Shanghai Pulmonary Hospital, Tongji University School of Medicine and Fudan University Shanghai Cancer Center, China. Immunohistochemical staining, and analysis of the clinicopathological characteristics were performed. Results: The average age of the pGCTs patients was 46 years (ranging from 24 to 54 years), with 3 females and 2 males. One case occurred in the bronchus with multiple nodules in the lung, 2 cases occurred in the bronchial opening, and 2 cases were solitary nodules in the lung. The maximum diameter of the tumors ranged from 12 to 15 mm (mean size 14 mm). Microscopically, the tumor showed infiltrative growth and consisted of round, oval or polygonal cells. Abundant eosinophilic cytoplasm was noted, and the nucleoli were prominent. None of the 5 cases showed any mitosis or necrosis. Immunohistochemical and histochemical study showed positive staining for S-100 (5/5), SOX10 (5/5), Vimentin (5/5), TFE3 (4/5), PAS (3/5), and amylase-digested-PAS (3/5), while 4 cases were negative for CD68. TFE3 FISH analyses on 2 cases showed that no signal abnormality was detected in these 2 cases. The average proliferation index of Ki-67 was 2.2% (range 0-5%). There was no recurrence in 4 cases of pGCTs with a follow-up time ranging from 2 months to 60 months. Conclusions: pGCTs are very rare tumors, most likely originating from Schwann cells. Immunohistochemical staining is the conventional diagnostic tool for pGCTs diagnosis. Recognition of this entity is essential for pathologists to avoid misdiagnosis and unnecessary treatments.
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Affiliation(s)
- H F Liu
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Y Huang
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - C Y Wu
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Y Li
- Department of Pathology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Y C Wang
- Department of Pathology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - L P Zhang
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - L K Hou
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - H K Xie
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
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22
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Wang YC, Ye N, Bian WJ, Cheng H. [Impact of different types of heart failure on long-term renal prognosis in patients with renal insufficiency and heart failure]. Zhonghua Gan Zang Bing Za Zhi 2023; 39:1-7. [PMID: 36776008 DOI: 10.3760/cma.j.cn441217-20220608-00608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Objective: To investigate the effects of different types of heart failure on long-term renal prognosis in patients with renal insufficiency and heart failure. Methods: The patients with renal insufficiency [baseline estimated glomerular filtration rate < 60 ml·min-1·(1.73 m2)-1] and heart failure followed-up for more than 2 years and hospitalized in Beijing Anzhen Hospital, Capital Medical University from January 1, 2018 to June 30, 2019 were enrolled in this retrospective cohort study. The patients were divided into three groups based on the baseline left ventricular ejection fraction (LVEF): heart failure with reduced ejection fraction (HFrEF, LVEF < 40%) group, heart failure with mildly reduced ejection fraction (HFmrEF, 40% ≤ LVEF < 50%) group, and heart failure with preserved ejection fraction (HFpEF, LVEF ≥ 50%) group. Clinical data were collected and endpoint events (adverse renal outcome: the composite outcome of all-cause death or worsening renal function) were recorded through the electronic medical record system. Kaplan-Meier survival curve was used to analyze the incidence of endpoint events of different heart failure subgroups. Cox regression model was performed to analyze the risk factors of endpoint events. Results: A total of 228 patients with renal insufficiency complicated with heart failure were included, with age of (68.14±14.21) years old and 138 males (60.5%). There were 85 patients (37.3%) in the HFrEF group, 40 patients (17.5%) in the HFmrEF group, and 103 patients (45.2%) in the HFpEF group. There were statistically significant differences in age, proportion of age > 65 years old, sex distribution, systolic blood pressure, pulmonary artery pressure, serum sodium, serum calcium, hemoglobin, serum cholesterol, low-density lipoprotein cholesterol, serum uric acid, troponin I, hypersensitive C-reactive protein, LVEF, ventricular septal thickness, left ventricular end-diastolic diameter, B-type natriuretic peptide, estimated glomerular filtration rate, and proportions of using beta blockers, using spirolactone, myocardial infarction, hypertension, cardiomyopathy and atrial fibrillation (all P < 0.05). During the median follow-up of 36.0 (28.0, 46.0) months, 73 patients (32.0%) had adverse renal outcomes. The total incidences of adverse renal outcomes were 32.9% (28/85) in the HFrEF group, 35.0% (14/40) in the HFmrEF group, and 30.1% (31/103) in the HFpEF group. Kaplan-Meier survival curve showed that there was no significant difference in the incidence of endpoint events among the three groups (log-rank test χ2=0.17, P=0.680). Multivariate Cox regression analysis showed that HFpEF (HFrEF as reference, HR=2.430, 95% CI 1.055-5.596, P=0.037) was an independent influencing factor of endpoint events. Conclusions: The long-term renal prognosis of patients with renal insufficiency and heart failure is poor. Compared with HFrEF, HFpEF is an independent risk factor of poor long-term renal prognosis in renal insufficiency patients with heart failure.
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Affiliation(s)
- Y C Wang
- Department of Nephrology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - N Ye
- Department of Nephrology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - W J Bian
- Department of Nephrology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - H Cheng
- Department of Nephrology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
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Wang YC, Lin PL, Huang CH. Perioperative Echocardiographic Prediction of Pulmonary Hypertension by Pulmonary Artery Acceleration Time during Cardiac Surgery with Cardiopulmonary Bypass. J Am Soc Echocardiogr 2023:S0894-7317(23)00013-5. [PMID: 36646231 DOI: 10.1016/j.echo.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/01/2023] [Accepted: 01/02/2023] [Indexed: 01/15/2023]
Affiliation(s)
- Yi-Chia Wang
- Department of Anaesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Lin Lin
- Department of Anaesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Hsiang Huang
- Department of Anaesthesiology, National Taiwan University Hospital, Taipei, Taiwan
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Chou NK, Wang YC, Huang CH, Chi NH. Robotic mitral valve repair in National Taiwan University Hospital: 10-year results. Ann Cardiothorac Surg 2022; 11:605-613. [DOI: 10.21037/acs-2022-rmvs-29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/18/2022] [Indexed: 11/29/2022]
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Fu HY, Chou HW, Wang YC, Chou NK, Chen YS. Extreme size mismatch: bronchus compression by an oversized donor heart in small children. Heliyon 2022; 8:e11095. [PMID: 36281381 PMCID: PMC9586907 DOI: 10.1016/j.heliyon.2022.e11095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/05/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
Studies have suggested that a more liberal criterion of donor–recipient weight ratio (DRWR) is associated with superior waitlist survival without compromising posttransplant outcomes in selected critically ill patients. Successful transplantation of an extremely oversized donor heart into a small recipient is herein described. A 2-year-old girl accepted a size-mismatched adult donor heart offer (DRWR of 4.4) due to frequent complications with a left ventricular assist device. During the immediate postoperative period, spatial constraints within the thoracic cavity compromised graft function. Computed tomography revealed severe compression of the left bronchus due to the oversized allograft with lobar collapse of the left lung. With temporary extracorporeal membrane oxygenation support, graft function improved within 1 month after transplantation. Subsequent adaptive size remodeling of the transplanted heart with concomitant left bronchus re-expansion was observed within 6 months after transplantation. Despite a complicated posttransplant recovery, the patient was discharged home with minimal respiratory sequelae. Our report describes an alternative strategy for managing early morbidities related to an oversized graft and supports extending the criteria of size matching in pediatric heart transplantations.
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Affiliation(s)
- Hsun-Yi Fu
- Department of Cardiac Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Heng-Wen Chou
- Department of Cardiac Surgery, National Taiwan University Hospital, School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Chia Wang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Nai-Kuan Chou
- Department of Cardiac Surgery, National Taiwan University Hospital, School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yih-Sharng Chen
- Department of Cardiac Surgery, National Taiwan University Hospital, School of Medicine, National Taiwan University, Taipei, Taiwan,Corresponding author.
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Wang YC, Chen D, Ding X, Li Y. [A case report of SMILE for refractive regression nine years after myopia correction with laser in situ keratomileusis]. Zhonghua Yan Ke Za Zhi 2022; 58:815-818. [PMID: 36220657 DOI: 10.3760/cma.j.cn112142-20220303-00091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
A myopic patient with self-reported photorefractive keratectomy 9 years ago requested small incision lenticule extraction (SMILE) as retreatment. The presence of interface bubbles while creating a corneal cap of the right eye revealed that the previous refractive surgery was laser in situ keratomileusis (LASIK). Therefore, the SMILE procedure was resumed in the right eye, but flap-lift LASIK was performed in the left eye. Postoperative follow-up showed that the vision in both eyes reached the preoperative best corrected level. SMILE may be a potential option for refractive regression after LASIK.
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Affiliation(s)
- Y C Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - D Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - X Ding
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Y Li
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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Wang YC, Li J, Lin JY. [The clinicopathological features of adult orbital xanthogranulomatous disease with lacrimal gland reactive lymphoid hyperplasia]. Zhonghua Yan Ke Za Zhi 2022; 58:682-687. [PMID: 36069088 DOI: 10.3760/cma.j.cn112142-20220128-00037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To investigate the clinicopathological features of adult orbital xanthogranulomatous disease (AOXGD) with lacrimal gland reactive lymphoid hyperplasia. Methods: Retrospective case series study. The clinical and pathological data of AOXGD cases diagnosed and treated in Tianjin Eye Hospital from January 2002 to December 2021 was reviewed, and the clinical characteristics, radiologic findings and pathological characteristics of periocular and lacrimal gland lesions of 5 cases were retrospectively analyzed. The expression of IgG4 and IgG protein in periocular and lacrimal gland lesions was detected by immunohistochemical staining, and the role of IgG4 in AOXGD was preliminarily studied. Results: There were four females and one male with an average age of 53.8 years (39 to 77 years). Among the five AOXGD cases, there were three cases of adult-onset xanthogranuloma, one case of adult-onset asthma and periocular xanthogranuloma, and one case of necrobiotic xanthogranuloma. All cases involved both eyes. The swelling of eyelids was observed in five cases, and the yellow or pale yellow eyelid skin was found in two cases. Imaging examinations showed the tumor mainly involved the eyelids, subcutaneous tissues, anterior orbit and lacrimal gland. A large number of foam cells and typical Touton giant cells were found in the periorbital lesions, accompanied by different degrees of fibrosis. The fibrinoid necrosis was detected in one case of necrobiotic xanthogranuloma. The lacrimal gland lesions showed different types of reactive lymphoid hyperplasia, including IgG4-related disease in two cases, follicular lymphoid hyperplasia in two cases and focal lymphoid hyperplasia in one case. IgG4 levels of periorbital and lacrimal gland lesions were elevated in four cases. Asthma and elevated serum IgG4 were found in one case of adult-onset periocular xanthogranuloma. Three patients underwent surgical resection and adjuvant hormone or immunosuppressive therapy, and two patients underwent simple surgical resection. The patients were followed up for 1.5 to 10.0 years, one patient was lost, and four patients had no recurrence. Conclusions: AOXGD with lacrimal gland reactive lymphoid hyperplasia is a group of rare diseases. The periorbital lesions of that are characterized by proliferation of foamy histiocytes and Touton giant cells, and the lacrimal gland lesions of that manifest as IgG4-related disease in some cases.
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Affiliation(s)
- Y C Wang
- Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin 300020, China
| | - J Li
- Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin 300020, China
| | - J Y Lin
- Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin 300020, China
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Wang YC, Chen YS, Hsieh ST. Neuroprotective Effects of a Cardioplegic Combination (Adenosine, Lidocaine, and Magnesium) in an Ischemic Stroke Model. Mol Neurobiol 2022; 59:7045-7055. [PMID: 36074233 DOI: 10.1007/s12035-022-03020-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 08/26/2022] [Indexed: 11/26/2022]
Abstract
Adenosine, lidocaine, and magnesium (ALM) are clinically available cardioplegic solutions. We examined the effects of low-dose ALM on ischemic stroke in cell and animal models. Cobalt chloride (CoCl2)-treated SH-SY5Y cells were used as a surrogate model to mimic oxygen-glucose deprivation conditions. The cells were incubated with different dilutions of ALM authentic solution (1.0 mM adenosine, 2.0 mM lidocaine, and5 mM MgSO4 in Earle's balanced salt solution). At a concentration of 2.5%, ALM significantly reduced CoCl2-induced cell loss. This protective effect persisted even when ALM was administered 1 h after the insult. We used transient middle cerebral artery occlusion to investigate the therapeutic effects of ALM in vivo. Rats were randomly assigned to two groups-the experimental (ALM) and control (saline) groups-and infusion was administered during the ischemia for 1 h. The infarction area was significantly reduced in the ALM group compared with the control group (5.0% ± 2.0% vs. 23.5% ± 5.5%, p = 0.013). Neurological deficits were reduced in the ALM group compared with the control group (modified Longa score: 0 [0-1] vs. 2 [1-2], p = 0.047). This neuroprotective effect was substantiated by a reduction in the levels of various neuronal injury markers in plasma. These results demonstrate the neuroprotective effects of ALM and may provide a new therapeutic strategy for ischemic stroke.
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Affiliation(s)
- Yi-Chia Wang
- Department of Anesthesiology, National Taiwan University College of Medicine and National University Hospital, Taipei, Taiwan
- Graduate Institutes of Anatomy and Cell Biology, National Taiwan University College of Medicine, 1 Jen-Ai Road, Section 1, Taipei, 100233, Taiwan
| | - Yih-Sharng Chen
- Department of Surgery, National Taiwan University College of Medicine and National University Hospital, Taipei, Taiwan
| | - Sung-Tsang Hsieh
- Graduate Institutes of Anatomy and Cell Biology, National Taiwan University College of Medicine, 1 Jen-Ai Road, Section 1, Taipei, 100233, Taiwan.
- Department of Neurology, National Taiwan University College of Medicine and National University Hospital, Taipei, Taiwan.
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Yu WK, Wang YC, Li YP, Gao Y, Zong C, Xu YM, Li YS. [The correlation between plasma heat shock proteins 90α levels and white matter hyperintensity in patients with cerebral small vessel disease]. Zhonghua Yi Xue Za Zhi 2022; 102:2602-2606. [PMID: 36058685 DOI: 10.3760/cma.j.cn112137-20211215-02795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To investigate the relationship between plasma heat shock proteins 90α(Hsp90α) levels and the white matter hyperintensity(WMH) in patients with cerebral small vessel disease(SVD). Methods: Patients admitted to the Department of Neurology, the First Affiliated Hospital of Zhengzhou University from March to August 2021 and diagnosed with WMH by magnetic resonance examination (MRI) were selected as the case group, matched with physical examination patients who visited the Department of Medical Examination during the same period and showed no WMH on MRI and no history of neurological diseases as the control group, and the level of plasma Hsp90α was quantitatively detected by enzyme-linked immunosorbent assay. Mann-Whitney U test was used to compare whether there was a difference in plasma Hsp90α levels between the control group and the case group.Multivariate logistic regression analysis was used to explore the related factors of WMH in patients with SVD. Results: Of the 183 subjects, the control group (n=73) consisted of 28 males and 45 females, aged (54±10) years, while the case group (n=110) consisted of 71 males and 39 females, aged (64±10) years old. Plasma Hsp90α level was higher in the case group than that of the control group [53.33(35.33, 70.09) ng/ml vs 35.02(18.51, 54.95) ng/ml, P<0.001]. After adjusting for confounding factors by multivariate analysis, the results showed that plasma Hsp90α levels greater than 58.34 ng/ml was associated with WMH (P=0.002, OR=5.931, 95%CI:1.955-17.995). Conclusion: Higher level of plasma Hsp90α is associated with WMH in patients with SVD.
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Affiliation(s)
- W K Yu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Y C Wang
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Y P Li
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Y Gao
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - C Zong
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Y M Xu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Y S Li
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
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Yin CY, Wang YC, Du WC, Liu YF. [Analysis of 18 cases of malignant rhabdoid tumor in children]. Zhonghua Er Ke Za Zhi 2022; 60:908-914. [PMID: 36038300 DOI: 10.3760/cma.j.cn112140-20220323-00241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To investigate the clinical characteristics, treatment and prognosis of malignant rhabdoid tumor (MRT) in children. Methods: Clinical data total of 18 children with MRT treated in the Department of Hematology and Oncology, Children's Hospital, the First Affiliated Hospital of Zhengzhou University between June 2015 to June 2021 were analyzed retrospectively. The patients were grouped according to age, gender, tumor type, clinical stage and other factors.Progression free survival (PFS) and overall survival (OS) were calculated by Kaplan-Meier method, survival differences among different groups were compared by Log-rank test, and prognostic factors were analyzed by Cox regression model. Results: Among the 18 patients, there were 5 males and 13 females. The age of disease onset was 30.5 (12.0, 75.0) months, the tumor diameter was (80±29) mm, and no integrase interactor 1 (INI-1) expression was detected by immunohistochemistry. There were 7 cases of malignant rhabdoid tumor of the kidney (MRTK), 6 cases of atypical teratoid rhabdoid tumor (ATRT) and 5 cases of extrarenal extracranial rhabdoid tumor (EERT). At the time of early diagnosis, 12 patients were clinically stage Ⅲ-Ⅳ, 11 patients had local or distant metastasis, and 4 patients had metastasis during treatment. Surgical excision is the preferred treatment. There were 3 cases with preoperative puncture biopsy, 13 cases with complete resection, 4 cases with partial resection, and 1 case without operation. Thirteen patients were treated with the domestic conventional chemotherapy regimen for Wilms' tumor, medulloblastoma and rhabdomyosarcoma, and 5 patients were treated with the international conventional chemotherapy regimen. Nine patients received radiotherapy, including 1 case of MRTK, 4 cases of ATRT and 4 cases of EERT. By the end of follow-up in January 2022, 7 patients survived and 11 patients died. The 3-year PFS and OS rates were (8±8) % and (14±12) %. Log-rank test showed that the 5-year OS of EERT group was higher than ATRT and MRTK groups (χ²=16.31, P<0.001), the tumor diameter <80 mm group was higher than that of the ≥80 mm group (χ²=4.49, P=0.034), and the radiotherapy group was higher than no radiotherapy group (χ²=3.97, P=0.046). The differences were statistically significant. There was no significant difference in the influence of tumor type, age, tumor diameter, radiotherapy and chemotherapy on OS by Cox regression model (all P>0.05). Log-rank test showed that the 3-year PFS of EERT group was higher than ATRT and MRTK groups (χ²=11.14, P=0.004),>3 years group was higher than ≤3 years group (χ²=10.10, P=0.001), the differences were statistically significant. Tumor type, clinical stage, tumor diameter, age, tumor rupture and radiotherapy were included in the Cox regression model, and the results showed that clinical stage (HR=0.49, 95%CI 0.26-0.94, P=0.031), tumor diameter (HR=8.67, 95%CI 1.84-40.89, P=0.006), age (HR=0.01, 95%CI 0.00-0.15, P=0.001) had statistical significance on PFS. Conclusions: MRT is one of the most aggressive and fatal cancers in early childhood and infancy. There is no standard treatment and the prognosis is extremely poor. Clinical stage, tumor size and age are risk factors for disease progression.
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Affiliation(s)
- C Y Yin
- Department of Hematology and Oncology, Children's Hospital, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Y C Wang
- Department of Hematology and Oncology, Children's Hospital, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - W C Du
- Department of Hematology and Oncology, Children's Hospital, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Y F Liu
- Department of Hematology and Oncology, Children's Hospital, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
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Lin YJ, Wang YC, Huang HH, Huang CH, Lin PL. Efficacy and safety of remifentanil for endoscopic ultrasound-guided tissue acquisition: a single center retrospective study. Surg Endosc 2022; 36:6516-6521. [PMID: 35041053 PMCID: PMC9402747 DOI: 10.1007/s00464-021-09006-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 12/31/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Remifentanil is a rapid onset and rapid recovery opioid. The combination of remifentanil and propofol for deep sedation decreases the incidents of movement, cough, and hiccup. We evaluated the efficacy and safety of remifentanil during endoscopic ultrasound-guided tissue acquisition. METHODS We retrospectively reviewed patients in whom endoscopic ultrasound-guided tissue acquisition was performed for solid mass lesions of the upper gastrointestinal tract and adjacent organs. All patients were premedicated with midazolam (2 mg), and target-controlled infusion of propofol, opioid, and Bispectral Index (BIS) monitoring were administered as necessary to maintain moderate-to-deep sedation. The opioids used were a bolus of alfentanil or remifentanil infusion. The discharge time, consumption of propofol and opioid, adverse events, diagnostic accuracy, and sensitivity and specificity for malignancy, were compared. RESULTS Tissue acquisition was achieved in 123 patients (alfentanil group, n = 64; remifentanil group, n = 59). The discharge time of the remifentanil group (16.5 ± 3.2 min) was significantly shorter than that of the alfentanil group (19.0 ± 4.9 min, P = 0.001). The consumption of propofol, adverse events, diagnostic accuracy, sensitivity, and specificity for malignancy in the alfentanil group were not significantly different from those in the remifentanil group. CONCLUSIONS Use of alfentanil or remifentanil for target-controlled infusion of propofol-BIS monitoring can provide good sedative and diagnostic quality for endoscopic ultrasound-guided tissue acquisition. However, remifentanil resulted in faster recovery than alfentanil.
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Affiliation(s)
- Yueh-Juh Lin
- Department of Cardiology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Yi-Chia Wang
- Department of Anesthesiology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100225, Taiwan
| | - Hui-Hsun Huang
- Department of Anesthesiology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100225, Taiwan
| | - Chi-Hsiang Huang
- Department of Anesthesiology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100225, Taiwan
| | - Pei-Lin Lin
- Department of Anesthesiology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100225, Taiwan.
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Yuan SQ, Wang YC, Lei L, Hong JY, Yi TY, Hong YY. First Report of Pestalotiopsis microspora Causing Leaf Spot on Moyeam in China. Plant Dis 2022; 106:PDIS04210859PDN. [PMID: 34775813 DOI: 10.1094/pdis-04-21-0859-pdn] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- S Q Yuan
- Hunan Provincial Key Laboratory for Biology and Control of Plant Pests, College of Plant Protection, Hunan Agricultural University, Changsha, 410128, China
| | - Y C Wang
- Hunan Provincial Key Laboratory for Biology and Control of Plant Pests, College of Plant Protection, Hunan Agricultural University, Changsha, 410128, China
| | - L Lei
- Hunan Provincial Key Laboratory for Biology and Control of Plant Pests, College of Plant Protection, Hunan Agricultural University, Changsha, 410128, China
| | - J Y Hong
- Orient Science and Technology College of Hunan Agricultural University, Changsha 410128, China
| | - T Y Yi
- Hunan Provincial Key Laboratory for Biology and Control of Plant Pests, College of Plant Protection, Hunan Agricultural University, Changsha, 410128, China
| | - Y Y Hong
- Hunan Provincial Key Laboratory for Biology and Control of Plant Pests, College of Plant Protection, Hunan Agricultural University, Changsha, 410128, China
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Shi LB, Chu SY, Wang YC, Solheim E, Schuster P, Chen J. Thawing plateau time indicating the duration of phase transition from ice to water is the strongest predictor for long-term durable pulmonary vein isolation after cryoablation for atrial fibrillation. Europace 2022. [DOI: 10.1093/europace/euac053.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Helse Vest, Norway (LBS), and the Research Council of Norway (SYC).
Background
Cryoballoon ablation is an important method for pulmonary vein (PV) isolation in treatment of atrial fibrillation (AF). Previous studies have shown that thawing time, but not freezing time or temperature, impacts PV reconnection during long-term follow-up. However, it is unknown whether the entire or only part of the thawing stage plays a critical role.
Purposes
This study aimed to clarify the relationship between the durability of PV isolation and the time of phase transition from ice to water indicated by thawing plateau (TP) time during a cryoballoon ablation.
Methods
In this retrospective study, 241 PVs from 71 patients who underwent a repeat AF ablation 526 (IQR: 412, 675) days after a cryoballoon ablation were analyzed. The predictive value of procedural parameters for the durability of PV isolation were evaluated. Definitions of different phases of the temperature-time curve are shown in Figure 1. TP Time is defined as the time from 0 to 10°C inside the balloon in the thawing period (the plateau on the curve).
Results
Reconnection was observed in 101 (41.9%) PVs of 53 patients (74.6%). Durable PV isolation was associated with significantly longer TP Time compared with PV reconnection (26.0 vs. 11.0 s, P<0.001). The proportion of durable PV isolations increased with TP Time in a dose-proportional manner (Figure 2). The cut point for PV reconnection was TP Time <15 s with a positive predictive value of 82.1% (sensitivity=63.4%, specificity=90.0%) while for durable PV isolation the cut point was TP Time >25 s with a positive predictive value of 84.6% (sensitivity=55.0%, specificity=86.1%). After the analysis of multivariable logistic regression, location of PV (P<0.01), and TP Time (P<0.05) were shown as independent predictors for durable PV isolation. None of nadir temperature, initial cooling time, effective freezing time, initial thawing time, or late warming time was independent predictor. Accumulated TP Time for all PVs showed a positive linear correlation with the plasma level of troponin T (ρ=0.624, P<0.01).
Conclusions
TP Time is an independent predictor for the durability of PV isolation, and it presents in a dose-proportional manner. TP Time <15 s predicts long-term reconnection while TP Time >25 s predicts durable PV isolation.
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Affiliation(s)
- LB Shi
- Haukeland University Hospital, Department of Heart Disease, Bergen, Norway
| | - SY Chu
- Peking University First Hospital, Department of cardiology, Beijing, China
| | - YC Wang
- Peking University First Hospital, Department of cardiology, Beijing, China
| | - E Solheim
- Haukeland University Hospital, Department of Heart Disease, Bergen, Norway
| | - P Schuster
- Haukeland University Hospital, Department of Heart Disease, Bergen, Norway
| | - J Chen
- Haukeland University Hospital, Department of Heart Disease, Bergen, Norway
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Peng JL, Xie HB, Wang YC, Huang H, Zhu QX. [The role of ROS/TXNIP/NLRP3 pathway in the skin injury of trichloroethylene sensitized mice]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2022; 40:241-247. [PMID: 35545588 DOI: 10.3760/cma.j.cn121094-20210413-00200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To explore the mechanism of reactive oxygen species/thioredoxin-interacting protein/nucleotide-binding oligomerization domain-like receptor 3 (ROS/TXNIP/NLRP3) pathway in the skin injury of trichloroethylene (TCE) sensitized mice. Methods: In August 2020, 40 female BALB/c mice were randomly divided into control group (n=5) , solvent control group (n=5) , TCE treatment group (n=15) and TCE+(2-(2, 2, 6, 6-Tetrameyhylpiperidin-1-oxyl-4-ylamino)-2-oxoethyl) triphenylphosphonium chloride (Mito TEMPO) treatment group (n=15) . The TCE sensitization model was established. Mice in the TCE treatment group and TCE+Mito TEMPO treatment group were divided into the sensitized positive group and the sensitized negative group according to the skin erythema and edema reactions on the back of the mice 24 h after the last stimulation. The mice were sacrificed 72 h after the last stimulation, the back skin of the mice was taken, and the skin lesions were observed. Immunohistochemistry (IHC) was used to detect the expression level of NLRP3, and the Western Blot was performed to detect the expression levels of NLRP3, apoptosis-associated speck-like protein containing a CARD (ASC) , cysteinyl aspartate specific proteinase 1 (Caspase 1) , Interleukin-1β (IL-1β) and TXNIP proteins in the skin of the mice, the reactive oxygen species (ROS) kit was used to detect the level of intracellular ROS in the back skin tissue. Results: The sensitization rates of TCE treatment group and TCE+Mito TEMPO treatment group were 40.0% (6/15) and 33.3% (5/15) , respectively, and there was no significant difference between the two groups (P>0.05) . The back skin of the mice in the TCE sensitized positive group was thickened and infiltrated by a large number of inflammatory cells. The number of mitochondria in the epidermis cells was significantly reduced, the mitochondrial crest disappeared and vacuolar degeneration occurred. TCE+Mito TEMPO sensitized positive group had less damage, more mitochondria and relatively normal cell structure. Compared with the solvent control group and corresponding sensitized negative groups, the expression levels of NLRP3, ASC, Caspase 1, IL-1β, TXNIP proteins and the content of ROS in the TCE sensitized positive group and TCE+Mito TEMPO sensitized positive group were significantly increased (P<0.05) . Compared with TCE sensitized positive group, the expression levels of NLRP3, ASC, Caspase 1, IL-1β, TXNIP proteins and the content of ROS in the TCE+Mito TEMPO sensitized positive group were significantly decreased (P<0.05) . Conclusion: ROS/TXNIP/NLRP3 pathway was activated and then encouraged the release of IL-1β, finally aggravated the TCE-induced skin injury.
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Affiliation(s)
- J L Peng
- Department of Occupational and Environmental Health, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - H B Xie
- Institute of Dermatology, the First Affiliated Hospital of Anhui Medical University, Hefei 230032, China
| | - Y C Wang
- Department of Occupational and Environmental Health, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - H Huang
- Department of Occupational and Environmental Health, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Q X Zhu
- Department of Occupational and Environmental Health, School of Public Health, Anhui Medical University, Hefei 230032, China Institute of Dermatology, the First Affiliated Hospital of Anhui Medical University, Hefei 230032, China
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Wang YC, Chen YS, Chi NH, Huang SC. Bidirectional Glenn shunt with tricuspid valve resection in patients with infective endocarditis. JTCVS Tech 2022; 13:58-61. [PMID: 35711237 PMCID: PMC9196930 DOI: 10.1016/j.xjtc.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/30/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Yi-Chia Wang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yih-Sharng Chen
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Nai-Hsin Chi
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Chien Huang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
- Address for reprints: Shu-Chien Huang, MD, PhD, Department of Surgery, National Taiwan University College of Medicine and National University Hospital, 7 Chung-Shan South Rd, Taipei, 10002, Taiwan.
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Hung WT, Wang YC, Huang HH, Tai JH, Wu ET, Shih JC, Hsu WM. Surgical resection for congenital lung malformation: Lessons learned from thoracotomy to biportal thoracoscopy under one-lung ventilation. J Formos Med Assoc 2022; 121:2152-2160. [DOI: 10.1016/j.jfma.2022.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/12/2021] [Accepted: 03/03/2022] [Indexed: 11/28/2022] Open
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Kuo TC, Chen KY, Lai CW, Wang YC, Lin MT, Chang CH, Wu MH. Transcutaneous Laryngeal Ultrasonography for Assessing Vocal Cord Twitch Response in Thyroid Operation during Predissection Vagus Nerve Stimulation. J Am Coll Surg 2022; 234:359-366. [PMID: 35213499 PMCID: PMC8834163 DOI: 10.1097/xcs.0000000000000053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/28/2021] [Accepted: 10/13/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND In this study, we aimed to report our experience with the use of intraoperative transcutaneous laryngeal ultrasonography (TLUSG) to evaluate the vocal cord twitch response during predissection vagus nerve stimulation in thyroid surgeries and examine the reliability of this technique when compared with that of laryngeal twitch palpation (LTP). STUDY DESIGN The prospective data collection of consecutive patients who underwent open thyroidectomy with intraoperative neuromonitoring (IONM) was reviewed retrospectively. We recorded the electromyographic activity and assessed the vocal cord twitch response on LTP, TLUSG. We compared the accessibility, sensitivity, and specificity of the techniques. RESULTS A total of 110 patients (38 men and 72 women) with 134 nerves at risk were enrolled. The vocal cord was assessable by TLUSG in 103 (93.6%) patients and by LTP in 64 (59.1%) patients. Two patients showed negative predissection IONM signal but positive on TLUSG and the presence of laryngeal twitch response confirmed by laryngoscopy. Fourteen patients showed positive IONM signals and presence of the vocal cord twitch response on TLUSG but not on LTP. The sensitivity and specificity were 70.21% and 100%, respectively, for LTP, and those both were 100% for TLUSG. For patients who could be assessed using both techniques, TLUSG had better accuracy than LTP (100% vs 80.33%, p = 0.0005). CONCLUSIONS The innovative intraoperative application of TLUSG is better for evaluating the laryngeal twitch response than LTP. This technique provides practical troubleshooting guidance for patients with no IONM signals during predissection vagus nerve stimulation.
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Affiliation(s)
- Ting-Chun Kuo
- From the Department of Surgery (Kuo, Chen, Lin, Wu), National Taiwan University Hospital, Taipei, Taiwan
- Department of Traumatology (Kuo), National Taiwan University Hospital, Taipei, Taiwan
| | - Kuen-Yuan Chen
- From the Department of Surgery (Kuo, Chen, Lin, Wu), National Taiwan University Hospital, Taipei, Taiwan
| | - Chieh-Wen Lai
- the Department of Surgery, Buddhist Tzu Chi General Hospital, Taipei, Taiwan (Lai)
| | - Yi-Chia Wang
- Department of Anesthesiology (Wang), National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Tsan Lin
- From the Department of Surgery (Kuo, Chen, Lin, Wu), National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Hao Chang
- the Department of Medical Research, National Taiwan University Hospital and National Taiwan University, Taipei, Taiwan (Chang)
| | - Ming-Hsun Wu
- From the Department of Surgery (Kuo, Chen, Lin, Wu), National Taiwan University Hospital, Taipei, Taiwan
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Zhao P, Gu XY, Jiang SY, Wang YC, Cao Y, Zhou WH, Lee K, Zhang Q, Wang J. [Non-erythrocyte blood products transfusion in very preterm and extremely preterm infants in Chinese neonatal intensive care units]. Zhonghua Er Ke Za Zhi 2022; 60:94-100. [PMID: 35090224 DOI: 10.3760/cma.j.cn112140-20210625-00532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objective: To describe the use of non-erythrocyte blood products transfusion in very preterm and extremely preterm infants in the neonatal intensive care units (NICU) of the Chinese Neonatal Network (CHNN) in 2019, to explore the disparity between different centers, and to further investigate the rationality and standardability of non-erythrocyte blood products transfusion. Methods: This was a cross-sectional study based on the CHNN cohort of very preterm and extremely preterm infants. All 6 598 infants with gestational age (GA)<32 weeks and admitted to the 57 NICU of CHNN within 24 h of life in 2019 were enrolled. Non-erythrocyte blood products included platelet, plasma, albumin, immunoglobulin, cryoprecipitate and prothrombin complex. Infants who received at least one type of non-erythrocyte blood products were defined in transfusion group. The comparison between infants with and without transfusion was done by t-test, rank-sum test or χ2 test as appropriate. Linear regression model was used to generate adjusted transfusion rate of each center, and to investigate the correlation between adjusted rate and center-level characteristics. Results: A total of 6 598 infants were enrolled in the study, with gestational age of 30.0 (28.7, 31.0) weeks and birth weight of (1 353±312) g, and 43.6 % (2 877) of them were female. Among them, 42.7% (2 816) infants were enrolled in transfusion group, with the times of transfusion as 3 (1, 6) times. Compared to the infants without any transfusion of non-erythrocyte blood products, those infants received transfusion had lower gestational age (Z=17.62, P<0.01), lower birth weight (t=18.64, P<0.01), higher proportion of small-for-gestation age (χ2=31.06, P<0.01), multiple birth (χ²=12.82, P<0.01) and intensive resuscitation in delivery room (χ²=287.52, P<0.01), as well as lower proportion of females (χ²=10.68, P<0.01) and even lower proportion of infants born in this hospital (χ²=78.23, P<0.01). Among the entire study population, albumin (25.4%, 1 674 cases), immunoglobulin (21.5%, 1 417 cases) and plasma (18.9%, 1 245 cases) were the most commonly used non-erythrocyte blood products. Overall, 60.4% (544/901) infants with gestational age <28 weeks received transfusion 4 (2, 8) times. A total of 39.9% (2 272/5 697) infants between 28-31weeks received non-erythrocyte blood products 3 (1, 6) times. The non-erythrocyte blood products transfusion rates of critically-ill and non-critically-ill infants were 62.2% (1 693/2 723) and 29.0% (1 123/3 875) respectively, and the transfusion times were 4 (2,7) and 2 (1,4) times. The transfusion rates varied significantly among different NICU, and the disparities remained obvious after adjustment (adjusted χ²=153.48, P<0.01). Conclusion: Near half of very preterm and extremely preterm infants admitted to Chinese NICU in 2019 receive non-erythrocyte blood products during hospitalization with significant disparities among different hospitals.
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Affiliation(s)
- P Zhao
- Department of Neonatology, Shaanxi Provincial People's Hospital, Xi'an 710068, China
| | - X Y Gu
- NHC Key Laboratory of Neonatal Diseases (Fudan University), Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China
| | - S Y Jiang
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China
| | - Y C Wang
- NHC Key Laboratory of Neonatal Diseases (Fudan University), Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China
| | - Y Cao
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China
| | - W H Zhou
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China
| | - K Lee
- the Maternal Infant Care Research Center (MiCARE), Mount Sinai Hospital, Toronto M5G 1X5, Canada
| | - Q Zhang
- Department of Neonatology, Shaanxi Provincial People's Hospital, Xi'an 710068, China
| | - Jin Wang
- Department of Neonatology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China
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Yeh YC, Chen SH, Wang YC, Chao A, Liu CM, Chiu CT, Wang MJ. Early prediction of survival at different time intervals in sepsis patients: A visualized prediction model with nomogram and observation study. Tzu Chi Med J 2022; 34:55-61. [PMID: 35233357 PMCID: PMC8830554 DOI: 10.4103/tcmj.tcmj_3_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/22/2021] [Accepted: 03/12/2021] [Indexed: 11/08/2022] Open
Abstract
Objectives: Sepsis is a major cause of death around the world. Complicated scoring systems require time to have data to predict short-term survival. Intensivists need a tool to predict survival in sepsis patients easily and quickly. Materials and Methods: This retrospective study reviewed the medical records of adult patients admitted to the surgical intensive care units between January 2009 and December 2011 in National Taiwan University Hospital. For this study, 739 patients were enrolled. We recorded the demographic and clinical variables of patients diagnosed with sepsis. A Cox proportional hazard model was used to analyze the survival data and determine significant risk factors to develop a prediction model. This model was used to create a nomogram for predicting the survival rate of sepsis patients up to 3 months. Results: The observed 28-day, 60-day, and 90-day survival rates were 71.43%, 52.53%, and 46.88%, respectively. The principal risk factors for survival prediction included age; history of dementia; Glasgow Coma Scale score; and lactate, creatinine, and platelet levels. Our model showed more favorable prediction than did Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment at sepsis onset (concordance index: 0.65 vs. 0.54 and 0.59). This model was used to create the nomogram for predicting the mortality at the onset of sepsis. Conclusion: We suggest that developing a nomogram with several principal risk factors can provide a quick and easy tool to early predict the survival rate at different intervals in sepsis patients.
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Wang YC, Chi NH, Wang YC, Chen YS, Huang CH. Retrograde arterial perfusion and its outcome in robotic mitral valve surgery. Asian J Surg 2021; 45:1849-1854. [PMID: 34840044 DOI: 10.1016/j.asjsur.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/14/2021] [Accepted: 10/25/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Retrograde arterial perfusion is frequently used in minimally invasive cardiac surgery. However, there are concerns about its safety. METHODS A prospective observational cohort study was conducted in a tertiary university affiliated medical center during 2016-2018. Right side femoral artery and femoral vein are used for bypass route. We set cardiopulmonary bypass flow to 2.5-3.0 L/min/m2, and adjust pump flow rate to achieve adequate cerebral oxygenation. The upper limit of arterial cannula pressure was 250 mmHg. We divided our patients into four groups by average pump flow 2.2 L/min/m2 and average mean arterial pressure 45 mmHg. Compared outcomes included surgical mortality, hospital stay, ventilator use, neurological outcomes, acute kidney injury, distal limb saturations, and post-operative clinical complications. RESULTS We included 117 patients in this study, and all participants had successful mitral valve repair or replacement. Our longest CPB duration was 210 minutes. Surgical mortality was 1.7%. Hemorrhagic stroke rate was 1.7%, and there was no ischemic stroke event. CPB flow did not affect survival rate, hospital stay, intensive care unit stay, or serum lactate in post-operative day 1, but serum creatinine (mg/dL) level increased transiently in patients with low pump flow group(0.9 ± 0.4 vs 1.3 ± 0.7,p < 0.05). Cannulation limb had decreased oxygenation during CPB, but their oxygenation all recovered after surgery. No limb ischemia event happened. CONCLUSION Retrograde arterial perfusion is a safe method for minimally invasive cardiac surgery less than 3.5 hours under mild hypothermic status.
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Affiliation(s)
- Yi-Chia Wang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, 10002, Taiwan
| | - Nai-Hsin Chi
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, 10002, Taiwan
| | - Ya-Chen Wang
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, 10002, Taiwan
| | - Yih-Sharng Chen
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, 10002, Taiwan.
| | - Chi-Hsiang Huang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, 10002, Taiwan.
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Sang D, Zhou H, Zong H, Yang H, Lu QR, Fan SM, Wang YC, Song LH, Yuan P. [Multi-center real world study of the efficacy and safety of albumin-bound paclitaxel in the treatment of advanced breast cancer]. Zhonghua Zhong Liu Za Zhi 2021; 43:1114-1121. [PMID: 34695904 DOI: 10.3760/cma.j.cn112152-20201118-01001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To observe the efficacy and safety of albumin-bound paclitaxel in the treatment of metastatic breast cancer. Methods: Multi-center data of patients who accepted single-drug albumin-bound paclitaxel or combination regimens from 2013 to 2019 were collected and the efficacy and safety were evaluated. Kaplan-Meier method was used for survival analysis, while Log-rank test was used to compare the survival rates. Results: A total of 203 advanced breast cancer cases were enrolled. The median progression-free survival time (PFS) lasted for 4 months, the median overall survival(OS)was 14 months, objective response rate (ORR) was 36.0% while the disease control rate (DCR) was 81.3%. The ORRs of Luminal, human epidermal growth factor receptor 2 (HER2) overexpression and triple-negative breast cancer patients underwent albumin-bound paclitaxel treatment were 37.3%, 45.5% and 31.0%, respectively, the DCRs were 85.5%, 68.2% and 78.9%, respectively. The OS of patients with relapse or metastasis who accepted less than two and more than two chemotherapy regimens were 22 months and 11 months (P<0.000 1), the ORRs were 44.9% vs 30.4%, DCRs were 87.2% vs 77.6% (P=0.018). The ORR and DCR of patients who accepted traditional paclitaxel treatment before the albumin-bound paclitaxel treatment were 35.8% and 82.1%, respectively. The common adverse reaction of these patients was numbness of limbs, which incidence rate was 64.5% (131/203), and 61.1% (124/203) were degree 1 to 2. Other adverse reactions including decreased white blood cells, which incidence rate was 56.1% (114/203); nausea and vomit, which incidence rate was 36.9% (75/203); anemia, which incidence rate was 21.2% (43/203); decreased platelet, which incidence rate was 18.7% (38/203); hepatic dysfunction, which incidence rate was 18.2% (37/203). Conclusions: Albumin-bound paclitaxel single or combination regimen is still significant efficient for various molecular subtypes of breast cancer patients or patients with traditional paclitaxel resistance or multi-line chemotherapy failure. Early usage has better prognosis, controllable adverse reaction and prominent clinical application value.
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Affiliation(s)
- D Sang
- Department of Medical Oncology, Beijing Sanhuan Cancer Hospital, Beijing 100122, China
| | - H Zhou
- Department of Medical Oncology, Beijing Sanhuan Cancer Hospital, Beijing 100122, China
| | - H Zong
- Department of Medical Oncology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - H Yang
- Department of Medical Oncology, Affiliated Hospital of Hebei University, Hebei Key Laboratory of Cancer Radiotherapy and Chemotherapy, Baoding 071000, China
| | - Q R Lu
- Department of Medical Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, China
| | - S M Fan
- Department of Medical Oncology, Beijing Sanhuan Cancer Hospital, Beijing 100122, China
| | - Y C Wang
- Department of Medical Oncology, Beijing Sanhuan Cancer Hospital, Beijing 100122, China
| | - L H Song
- Department of Medical Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, China
| | - P Yuan
- Special Medical Department, National Cancer Center /National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Zhang GQ, Wang GC, Li HL, Gu XH, Liu RX, Feng R, Wang YC, Liu YJ, Zhang Z, Wang HL. [Reoperation and perioperative management of residual cyst wall with perineal intractable sinus after resection of presacral cyst tumors]. Zhonghua Zhong Liu Za Zhi 2021; 43:973-978. [PMID: 34530582 DOI: 10.3760/cma.j.cn112152-20200914-00821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the reoperation and perioperative management of residual cyst wall with perineal intractable sinus after resection of presacral cyst tumors. Methods: The clinical data of 29 patients with residual cyst wall and perineal intractable sinus after resection of presacral cyst tumors in Affiliated Cancer Hospital of Zhengzhou University from January 2014 to August 2019 were reviewed, including the characteristics of the residual cyst wall with perineal intractable sinus after resection of presacral cyst tumors, surgical method, and perioperative management. Results: Twenty-nine patients with residual cyst wall and perineal intractable sinus after resection of presacral cyst tumors, including 9 cases of epidermoid cysts, 7 cases of dermoid cysts, 10 cases of mature teratomas and 3 cases of malignant cysts (including malignant transformation of caudate cyst and teratoma); The 29 patients underwent posterior approaches for cyst resection in other hospital before, of whom 1 patient underwent posterior combined with transabdominal approach. All of thes patients underwent resection of residual presacral cyst wall and perineal intractable sinus in our hospital, of whom 25 patients underwent a transperineal approach through an arc-shaped incision anterior to the apex of the coccyx, and the other 4 patients underwent transperineal arc-shaped incision combined with transabdominal approach. All of the patients were cured without serious complications occurring, postoperative pathological and the magnetic resonance imaging diagnosis showed that the residual cyst wall and perineal intractable sinus were all completely removed. Conclusion: Appropriate surgical approache and perioperative treatment for the patients with residual cyst wall and perineal intractable sinus are very important to promote the resection of residual cyst wall and the healing of perineal intractable sinus.
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Affiliation(s)
- G Q Zhang
- Department of General Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Provincial Cancer Hospital, Zhengzhou 450000, China
| | - G C Wang
- Department of General Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Provincial Cancer Hospital, Zhengzhou 450000, China
| | - H L Li
- Department of General Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Provincial Cancer Hospital, Zhengzhou 450000, China
| | - X H Gu
- Henan Medical Information Research Institute, Zhengzhou 450016, China
| | - R X Liu
- Henan Medical Information Research Institute, Zhengzhou 450016, China
| | - R Feng
- Henan Medical Information Research Institute, Zhengzhou 450016, China
| | - Y C Wang
- Department of General Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Provincial Cancer Hospital, Zhengzhou 450000, China
| | - Y J Liu
- Department of General Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Provincial Cancer Hospital, Zhengzhou 450000, China
| | - Z Zhang
- Department of General Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Provincial Cancer Hospital, Zhengzhou 450000, China
| | - H L Wang
- Department of General Surgery, Affiliated Cancer Hospital of Zhengzhou University, Henan Provincial Cancer Hospital, Zhengzhou 450000, China
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43
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Wang YC, Zhang JX, Zhu QX. [Research progress on the immunological pathogenesis of occupational medicamentosa-like dermatitis due to trichloroethylene]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2021; 39:628-631. [PMID: 34488279 DOI: 10.3760/cma.j.cn121094-20200727-00427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Occupational exposure to trichloroethylene can induce a series of immune diseases which include systemic rash, multiple system and organ damage, which are defined as occupational medicamentosa-like dermatitis due to trichloroethylene (OMLDT) . This article reviews the research progress of the role of T cell immunity, humoral immunity and complement system in the immunological pathogenesis of OMLDT to provide theoretical basis for the diagnosis and treatment of OMLDT.
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Affiliation(s)
- Y C Wang
- Department of Occupational and Environmental Health, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - J X Zhang
- Department of Occupational and Environmental Health, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Q X Zhu
- Institute of Dermatology, the First Affiliated Hospital of Anhui Medical University, Hefei 230032, China
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Fu HY, Wang YC, Tsao CI, Yu SH, Chen YS, Chou HW, Chi NH, Wang CH, Hsu RB, Huang SC, Yu HY, Chou NK. Outcome of urgent desensitization in sensitized heart transplant recipients. J Formos Med Assoc 2021; 121:969-977. [PMID: 34340891 DOI: 10.1016/j.jfma.2021.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/16/2021] [Accepted: 07/15/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND/PURPOSE Sensitization, the presence of preformed anti-human antibody in recipients, restricts access to ABO-compatible donors in heart transplant. Desensitization therapy works by reducing preformed antibodies to increase the chances of a negative crossmatch or permit safe transplantation across positive crossmatch. There is no consensus regarding the desensitization protocol in cardiac patients, and the outcome of desensitization remains under debate. METHODS Twenty-five consecutive sensitized heart transplant recipients received perioperative desensitization in our institution from 2012 to 2019. One-year patient survival and graft rejection rate were analyzed and compared between sensitized recipients and non-sensitized recipients. RESULTS Within the first year after transplant, patient survival in sensitized recipients was 76%. Infection was the major cause of death. The cumulative incidence of rejection was 8% for antibody-mediated rejection and 16% for acute cellular rejection. No significant difference in 1-year survival or rejection rate could be demonstrated between sensitized and nonsensitized recipients. CONCLUSION Acceptable early outcomes in patient survival and graft rejection could be anticipated in sensitized heart transplant recipients under a perioperative algorithm using complement-dependent cytotoxicity crossmatch- or panel-reactive antibody-directed urgent immunomodulation strategies, while infection remains the major concern.
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Affiliation(s)
- Hsun-Yi Fu
- Department of Cardiac Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Yi-Chia Wang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chuan-I Tsao
- Department of Cardiac Surgery, National Taiwan University Hospital, School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Sz-Han Yu
- Department of Cardiac Surgery, National Taiwan University Hospital, School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yih-Sharng Chen
- Department of Cardiac Surgery, National Taiwan University Hospital, School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Heng-Wen Chou
- Department of Cardiac Surgery, National Taiwan University Hospital, School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Nai-Hsin Chi
- Department of Cardiac Surgery, National Taiwan University Hospital, School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Hsien Wang
- Department of Cardiac Surgery, National Taiwan University Hospital, School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ron-Bin Hsu
- Department of Cardiac Surgery, National Taiwan University Hospital, School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shu-Chien Huang
- Department of Cardiac Surgery, National Taiwan University Hospital, School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsi-Yu Yu
- Department of Cardiac Surgery, National Taiwan University Hospital, School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Nai-Kuan Chou
- Department of Cardiac Surgery, National Taiwan University Hospital, School of Medicine, National Taiwan University, Taipei, Taiwan.
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Jia YH, Liu JQ, Wang YC, Wang HT, Tao K, Zheng Z, Hu DH. [Research advances on the regulation of interleukin-17 signal transduction and the implication of interleukin-17 in sepsis]. Zhonghua Shao Shang Za Zhi 2021; 37:675-680. [PMID: 34304410 DOI: 10.3760/cma.j.cn501120-20200515-00266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Sepsis remains a leading cause of death in critical patients. Both excessive inflammatory response and long-term immunosuppression can lead to the death of sepsis patients. As a key pro-inflammatory cytokine, interleukin-17 (IL-17) plays an important role in the body's inflammatory response and immune system. The signal transduction of IL-17 is a key link in maintaining the body's health and participating in the onset and development of sepsis. This review mainly summarizes and discusses the regulation of IL-17 signal transduction and pathogenic and protective role of IL-17 in sepsis.
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Affiliation(s)
- Y H Jia
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
| | - J Q Liu
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
| | - Y C Wang
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
| | - H T Wang
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
| | - K Tao
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
| | - Z Zheng
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
| | - D H Hu
- Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
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Zhang SQ, Bao YN, Lv LY, Du XH, Wang YC. Conophylline Suppresses Angiotensin II-Induced Myocardial Fibrosis In Vitro via the BMP4/JNK Pathway. Bull Exp Biol Med 2021; 171:305-311. [PMID: 34302205 DOI: 10.1007/s10517-021-05217-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Indexed: 11/29/2022]
Abstract
We studied the effects and mechanisms of action of conophylline in different concentrations in the original in vitro model of myocardial fibrosis (treatment of cardiac fibroblasts isolated form the hearts of newborn rats with angiotensin II). Viability, collagen content, and expression of related protein in cardiac fibroblasts were assessed using the MTT-test, Sircol assay, and Western blotting, respectively. Conophylline markedly protected the cultured cells against the development of angiotensin II-induced fibrosis, which was seen from reduced viability of fibroblasts, decreased collagen content, and down-regulation of the expression of α-smooth muscle actin (α-SMA). Conophylline did not affect the TGF-β pathway altered by angiotensin II, but markedly decreased the level of bone morphogenetic protein-4 (BMP4) enhanced by angiotensin II and BMP4 itself. Conophylline produced no effect on phosphorylation of α-SMA and Smad homologue-1/5/8, the classic BMP4 downstream pathway elements, but reduced the level of c-Jun N-terminal kinase (JNK) elevated by BMP4. Conophylline did not inhibit the development of myocardial fibrosis in the presence of JNK activator anisomycin. Thus, conophylline inhibited angiotensin II-provoked myocardial fibrosis via the BMP4/JNK pathway.
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Affiliation(s)
- S Q Zhang
- Qiqihar Medical University, Qiqihar, Heilongjiang, China
| | - Y N Bao
- Qiqihar Medical University, Qiqihar, Heilongjiang, China
| | - L Y Lv
- Qiqihar Medical University, Qiqihar, Heilongjiang, China
| | - X H Du
- Qiqihar Medical University, Qiqihar, Heilongjiang, China
| | - Y C Wang
- Qiqihar Medical University, Qiqihar, Heilongjiang, China.
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Wang S, Wang YC, Dong KL. Overexpression of miR-522 facilitates gastric cancer progression and predicts poor prognosis. J BIOL REG HOMEOS AG 2021; 35:745-750. [PMID: 33910319 DOI: 10.23812/20-704-l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S Wang
- Department of Second Ward of Gastroenterology, Yidu Central Hospital of Weifang, Weifang, Shandong, China
| | - Y C Wang
- Department of First Ward of Gastroenterology, Yidu Central Hospital of Weifang, Weifang, Shandong, China
| | - K L Dong
- Department of Anorectal Surgery, Zhucheng People's Hospital, Weifang, Shandong, China
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Li J, Wang YC, Chen LX, Lin JY. [Clinical and pathological analysis of ocular adnexal diffuse large B-cell lymphoma]. Zhonghua Yan Ke Za Zhi 2021; 57:366-371. [PMID: 33915640 DOI: 10.3760/cma.j.cn112142-20200703-00446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To summarize the clinical and pathological characteristics of diffuse large B-cell lymphoma of ocular adnexal (OA-DLBCL). Methods: A retrospective case series study. Twenty-three cases of OA-DLBCL were collected in Tianjin Eye Hospital from January 2005 to December 2018. The clinical manifestations and imaging examination results were analyzed. The pathological characteristics and immune subtypes were analyzed with hematoxylin and eosin staining and immunohistochemistry. Eighteen patients completed the follow-up. Overall survival (OS) time was from the date of diagnosis to the date of death or the final follow-up (April 30, 2020). Clinical stages were analyzed by the Ann Arbor classification; Kaplan-Meier plots were used to visualize survival outcomes. The different risk groups were compared using Log-rank test. Results: There were 13 males and 10 females. The median age was 65 years (range, 43 to 82 years). Twenty-two patients had unilateral lymphoma (14 left eyes, 8 right eyes), and one patient had bilateral lymphoma. The OA-DLBCL was in the orbit in 14 patients, in the lacrimal gland in two patients, in both the lacrimal gland and the orbit in three patients, in both the lacrimal sac and the orbit in one patient, in the conjunctiva in one patient, in both the conjunctiva and the orbit in one patient, and in the skin of eyelids in one patient. Imaging examinations showed the tumors were of irregular soft tissue density. MRI showed the tumors were close to the extraocular muscles or ectocinerea. Centroblastic morphology was present in 21 specimens, and 2 specimens had immunoblastic morphology. Six patients were of germinal center B cell-like (GCB) type, and 17 were of non-GCB type. There were 2 patients with double expression of cellular-myelocytomatosis viral oncogene and B-cell lymphoma 2. The follow-up time ranged from 25 to 156 months, and the median follow-up time was 48 months. Five of them had primary OA-DLBCL, and 13 patients had secondary OA-DLBCL. Five patients were at the Ann Arbor clinical stage ⅠE, one was at stage ⅢE, and 12 were at stage ⅣE. During the follow-up, 8 patients survived, and 10 died. The 1-, 3-, and 5-year OS rates were 88.9%, 71.4% and 41.7%, respectively. Log-rank analysis indicated that the Ann Arbor clinical stage and age were related to the OS of OA-DLBCL (χ²=7.448, 8.804; both P<0.01). The gender, tumor size, molecular typing, Ki-67 index, and bone invasion were not related to the OS of OA-DLBCL (all P>0.05). Conclusions: OA-DLBCL mainly occurrs in the elderly population, unilaterally, and in the orbit. Most molecular types are non-GCB subtypes. The Ann Arbor clinical stage and age are associated with prognosis. (Chin J Ophthalmol, 2021, 57: 366-371).
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Affiliation(s)
- J Li
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin 300020, China
| | - Y C Wang
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin 300020, China
| | - L X Chen
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin 300020, China
| | - J Y Lin
- Tianjin Eye Hospital, Tianjin Key Laboratory of Ophthalmology and Visual Science, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin 300020, China
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Huang CH, Wang YC, Chou HW, Huang SC. Near-Infrared Spectroscopy Assessment of Tissue Oxygenation During Selective Cerebral Perfusion for Neonatal Aortic Arch Reconstruction. Front Med (Lausanne) 2021; 8:637257. [PMID: 33996851 PMCID: PMC8119641 DOI: 10.3389/fmed.2021.637257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/11/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Optimal selective cerebral perfusion (SCP) management for neonatal aortic arch surgery has not been extensively studied. We induced mild hypothermia during SCP and used the tissue oxygenation monitor to ensure adequate perfusion during the cardiopulmonary bypass (CPB). Methods: Eight cases were recruited from September 2018 to April 2020. SCP was maintained at 30°C, and CPB was adjusted to achieve a mean right radial artery pressure of 30 mmHg. The near-infrared tissue saturation (NIRS) monitor was applied to assess the right and left brain, flank, and lower extremity during the surgery. Results: During surgery, the mean age was 4.75 days, the mean body weight was 2.92 kg, the CPB duration was 86.5 ±18.7 min, the aortic cross-clamp time was 46.1 ± 12.7 min, and the SCP duration was 14.6±3.4 min. The brain NIRS before, during, and after SCP was 64.2, 67.2, and 71.5 on the left side and 67.9, 66.2, and 70.1 on the right side (p = NS), respectively. However, renal and lower extremity tissue oxygenation, respectively decreased from 61.6 and 62.4 before SCP to 37.7 and 39.9 after SCP (p < 0.05) and then increased to 70.1 and 90.4 after full body flow resumed. No stroke was reported postoperatively. Conclusion: SCP under mild hypothermia can aid in efficient maintenance of brain perfusion during neonatal arch reconstruction. The clinical outcome of this strategy was favorable for up to 20 min, but the safety duration of lower body ischemia warrants further analysis.
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Affiliation(s)
- Chi-Hsiang Huang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Chia Wang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hen-Wen Chou
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Chien Huang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
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50
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Yao QH, Wang YC, Wang D, Liu YF. [Childhood acute promyelocytic leukemia complicated with thrombosis: four cases and literatures review]. Zhonghua Er Ke Za Zhi 2021; 59:407-411. [PMID: 33902226 DOI: 10.3760/cma.j.cn112140-20201104-01004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the clinical characteristics and prognosis of children with acute promyelocytic leukemia (APL) complicated with thrombosis. Methods: The clinical profiles of four APL patients complicated with thrombosis treated at the First Affiliated Hospital of Zhengzhou University between January 2012 and December 2019 were reviewed. Literature search and review covered the China national knowledge infrastructure, Wanfang database, China biology medicine disc and PubMed using the key words of "acute promyelocytic leukemia" and "thrombosis" up to June 2020. Results: Four patients included one male and three females with an age range of 4-13 years. In two patients, thrombosis occurred intracranially, both patients presented with seizure and hemiplegia. In one patient, thrombosis occurred in spleen, the patient presented with severe abdominal pain. In the last patient, thrombosis occurred in liver, the patient presented with abdominal pain, distension and ascites. Thrombosis occurred during the course of retinoic acid treatment in three patients, it occurred before the initiation of the treatment in one patient. Thrombosis was confirmed by imaging examination in all four patients. After thrombolytic and anticoagulation treatment, the vessels were recanalized and the symptoms were alleviated in 3 cases, the fourth patient died of hepatic venous thrombosis. Literature search identified no similar reports in Chinese journals, 11 case reports were found in English journals. In these 15 patients, 9 were male and 6 females with an age range of 3-16 years. Thrombus located in brain in 6 cases, in lower limbs for 3 cases, in liver for 3 cases, in spleen in 2 cases and in coronary artery for 1 case. In 10 cases thrombosis occurred before the induce treatment and in 5 cases occurred during the induction treatment. After surgery, thrombolytic and anticoagulation treatment vascular recanalization was observed in 10 patients, and in those patients, the symptoms were relieved, death occurred in 5 patients, including three patients with hepatic venous thrombosis. Conclusions: Thrombosis may occur before or during the treatment for APL. Both arterial and venous thrombosis may occur in patients with APL. Imaging examination is a reliable method for its diagnosis. After treatment, most patients had good prognosis with recanalization of blood vessels, but the mortality rate was high for patients with hepatic venous thrombosis.
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Affiliation(s)
- Q H Yao
- Department of Hematology and Oncology, Children's Hospital, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Y C Wang
- Department of Hematology and Oncology, Children's Hospital, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - D Wang
- Department of Hematology and Oncology, Children's Hospital, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Y F Liu
- Department of Hematology and Oncology, Children's Hospital, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
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