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Downstaging after preoperative chemoradiation for locally advanced rectal cancer is associated with better survival than pathologic stage 0-1 disease treated with upfront surgery. Int J Colorectal Dis 2024; 39:16. [PMID: 38189849 PMCID: PMC10774158 DOI: 10.1007/s00384-023-04589-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/24/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND AND OBJECTIVES It is unknown how patients with locally advanced rectal cancer with significant response to preoperative radiotherapy/chemoradiotherapy fare relative to patients with true pathologic 0-1 disease undergoing upfront surgery. We aimed to determine whether survival is improved in locally advanced rectal cancer downstaged to pathologic stage 0-1 disease compared to true pathologic stage 0-1 tumors. METHODS A retrospective review of the National Cancer Database between 2004 and 2016 was conducted. Three groups were identified: (1) clinical stage 2-3 disease downstaged to pathologic stage 0-1 disease after radiotherapy, (2) clinical stage 2-3 disease not downstaged after radiotherapy, and (3) true pathologic 0-1 tumors undergoing upfront surgery. The primary endpoint was overall survival and was compared using Kaplan-Meier and multivariate Cox regression analyses. RESULTS The study population consisted of 59,884 patients. Of the 40,130 patients with locally advanced rectal cancer treated with preoperative radiation, 12,670 (31.5%) had significant downstaging (group 1), while 27,460 (68.4%) had no significant downstaging (group 2). A total of 19,754 had pathologic 0-1 disease treated with upfront resection (group 3). On Kaplan-Meier analysis, downstaged patients had significantly better overall survival compared to both non-downstaged and true pathologic stage 0-1 patients (median 156 vs. 99 and 136 months, respectively, p < 0.001). On multivariate analysis, downstaged patients had significantly better survival (HR 0.88, p < 0.001) compared to true pathologic 0-1 patients. CONCLUSIONS Locally advanced rectal cancer downstaged after preoperative radiotherapy has significantly better survival compared to true pathologic stage 0-1 disease treated with upfront surgery. Response to chemoradiotherapy likely identifies a subset of patients with a particularly good prognosis.
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Novel antibiotic irrigation device versus standard O-ring wound retractor in the prevention of surgical site infection following colorectal resection. Int J Colorectal Dis 2023; 38:252. [PMID: 37819537 DOI: 10.1007/s00384-023-04542-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE We sought to compare the effectiveness of a novel antibiotic irrigation device to the standard O-ring wound retractor in preventing surgical site infections (SSIs) following colorectal resections. METHODS This single-arm clinical trial included patients undergoing colorectal resections utilizing the novel device. A retrospective cohort of patients undergoing the same procedures with the O-ring retractor was selected as the control group. The primary outcome assessed was SSI. Secondary outcomes assessed were overall complications, hospital length of stay (LOS), and 30-day readmission. A univariable and multivariable logistic regression model was built to evaluate the association between SSI as the outcome variable and the use of the novel device as the main independent variable. The model was adjusted for any confounding variables. RESULTS Eighty-six novel device cases and 170 O-ring retractor cases were enrolled. There were no significant differences between the two groups in terms of demographics and preoperative comorbidities. Cases with the novel device had fewer Pfannenstiel incisions (1.2% vs. 14.6%, p < 0.001). There were no other significant differences in intraoperative variables. SSI rates were significantly lower in the novel device group (1.2% vs. 9.1%, p = 0.014). There were no other significant differences in postoperative complications. Multivariable logistic regression with backward elimination showed that the use of the novel device was significantly more effective against SSI by 92.5% compared to the use of the O-ring retractor. CONCLUSION The novel device may contribute to lower SSI rates compared to the O-ring retractor following colorectal resection.
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Identifying gaps in clinical evaluation and treatment of sleep-disordered breathing in women veterans. Sleep Breath 2023; 27:1929-1933. [PMID: 36525174 PMCID: PMC10272283 DOI: 10.1007/s11325-022-02765-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/18/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Sleep-disordered breathing (SDB) is a common sleep disorder in veterans; however, limited research exists in women veterans. We sought to estimate patterns of care in terms of evaluation, diagnosis, and treatment among women veterans with factors associated with elevated SDB risk. METHODS Within one VA healthcare system, women identified through electronic health record data as having one or more factors (e.g., age >50 years, hypertension) associated with SDB, completed telephone screening in preparation for an SDB treatment study and answered questions about prior care related to SDB diagnosis and treatment. RESULTS Of 319 women, 111 (35%) reported having completed a diagnostic sleep study in the past, of whom 48 (43%) were diagnosed with SDB. Women who completed a diagnostic study were more likely to have hypertension or obesity. Those who were diagnosed with SDB based on the sleep study were more likely to have hypertension, diabetes, or be ≥50 years old. Of the 40 women who received treatment, 37 (93%) received positive airway pressure therapy. Only 9 (24%) had used positive airway pressure therapy in the prior week. Few women received other treatments such as oral appliances or surgery. CONCLUSIONS Findings support the need for increased attention to identification and management of SDB in women veterans, especially those with conditions associated with elevated SDB risk.
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[Molecular epidemiological characterization of hypervirulent carbapenem-resistant Klebsiella pneumoniae in a hospital in Henan Province from 2020 to 2022]. ZHONGHUA YU FANG YI XUE ZA ZHI [CHINESE JOURNAL OF PREVENTIVE MEDICINE] 2023; 57:1222-1230. [PMID: 37574316 DOI: 10.3760/cma.j.cn112150-20230320-00204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Objective: The study investigated the clinical distribution, antimicrobial resistance and epidemiologic characteristics of hypervirulent Carbapenem-resistant Klebsiella pneumoniae (hv-CRKP) in a hospital in Henan Province to provide a scientific basis for antibiotic use and nosocomial infection prevention and control. Methods: A retrospective analysis of the clinical data from the cases was carried out in this study. Clinical data of patients infected with the CRKP strain isolated from the clinical microbiology laboratory of Henan Provincial Hospital of Traditional Chinese Medicine from January 2020 to December 2022 were retrospectively analyzed. A string test, virulence gene screening, serum killing, and a G. mellonella infection model were used to screen hv-CRKP isolates. The clinical characteristics of hv-CRKP and the drug resistance rate of hv-CRKP to twenty-five antibiotics were analyzed using WHONET 5.6. Carbapenemase phenotypic characterization of the hv-CRKP was performed by colloidal gold immunochromatographic assay, and Carbapenemase genotyping, multi-locus sequence typing (MLST) and capsular serotyping of hv-CRKP isolates were performed by PCR and Sanger sequencing. Results: A total of non-duplicate 264 CRKP clinical isolates were detected in the hospital from 2020 to 2022, and 23 hv-CRKP isolates were detected, so the corresponding detection rate of hv-CRKP was 8.71% (23/264). The hv-CRKP isolates in this study were mainly from the intensive care unit (10/23) and neurosurgery department (8/23), and the main sources of hv-CRKP isolates were sputum (10/23) and bronchoalveolar lavage fluid (6/23). The hv-CRKP isolates in this study were highly resistant to β-lactam antibiotics, fluoroquinolones and aminoglycosides, and were only susceptible to colistin, tigecycline and ceftazidime/avibactam. The detection rate of the blaKPC-2 among 23 hv-CRKP isolates was 91.30% (21/23) and none of the class B and class D carbapenemases were detected. Results of MLST and capsular serotypes showed that ST11 type hv-CRKP was the dominant strain in the hospital, accounting for 56.52% (13/23), and K64 (9/13) and KL47 (4/13) were the major capsular serotypes. Conclusion: The hv-CRKP isolates from the hospital are mainly from lower respiratory tract specimens from patients admitted to the intensive care department and the drug resistance is relatively severe. The predominant strains with certain polymorphisms are mainly composed of the KPC-2-producing ST11-K64 and ST11-KL47 hv-CRKP isolates in the hospital.
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Does coffee affect bowel recovery following minimally invasive colorectal operations? A three-armed randomized controlled trial. Int J Colorectal Dis 2023; 38:199. [PMID: 37470901 DOI: 10.1007/s00384-023-04494-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE Previous studies have suggested that coffee may shorten the postoperative ileus period. We sought to evaluate the impact of both coffee and caffeine on shortening the return of postoperative bowel function following minimally invasive colectomy. METHODS This was a single-center, randomized controlled clinical trial conducted in a tertiary hospital. Patients undergoing an elective robotic or laparoscopic small or large bowel operation were included in this study. Patients were randomized into one of three groups: warm water, decaffeinated coffee, and caffeinated coffee. Subjects were assigned to drink a 4-oz cup three times daily starting on postoperative day one. The primary endpoint was time to first bowel movement. Secondary endpoints included time to first flatus, length of hospital stay, and postoperative morbidity. RESULTS A total of 99 patients were included in this study: 31 warm water, 31 decaffeinated coffee, and 37 caffeinated coffee. The groups were similar in age and sex (p = 0.51 and 0.91, respectively). Mean (SD) time to the first bowel movement in days was 2.94 (1.4), 2.58 (1.2), and 2.86 (1.3), respectively (p = 0.53). There were no significant differences observed in postoperative morbidity (p = 0.52) between groups. Multivariate linear regression analysis did not reveal a statistically significant association between any interventions and time to first bowel movement or length of hospital stay. CONCLUSIONS Coffee (caffeinated or decaffeinated) does not expedite the return of bowel function following minimally invasive operation. TRIAL REGISTRATION https://classic. CLINICALTRIALS gov/ct2/show/NCT02639728 NCT02639728.
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Analysis of Mitochondrial Transfer RNA Mutations in Breast Cancer. Balkan J Med Genet 2023; 25:15-22. [PMID: 37265965 PMCID: PMC10230833 DOI: 10.2478/bjmg-2022-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Damage of mitochondrial functions caused by mitochondrial DNA (mtDNA) pathogenic mutations had long been proposed to be involved in breast carcinogenesis. However, the detailed pathological mechanism remained deeply undetermined. In this case-control study, we screened the frequencies of mitochondrial tRNA (mt-tRNA) mutations in 80 breast cancer tissues and matched normal adjacent tissues. PCR and Sanger sequence revealed five possible pathogenic mutations: tRNAVal G1606A, tRNAIle A4300G, tRNASer(UCN) T7505C, tRNAGlu A14693G and tRNAThr G15927A. We noticed that these mutations resided at extremely conserved positions of tRNAs and would affect tRNAs transcription or modifications. Furthermore, functional analysis suggested that patients with these mt-tRNA mutations exhibited much lower levels of mtDNA copy number and ATP, as compared with controls (p<0.05). Therefore, it can be speculated that these mutations may impair mitochondrial protein synthesis and oxidative phosphorylation (OXPHOS) complexes, which caused mitochondrial dysfunctions that were involved in the breast carcinogenesis. Taken together, our data indicated that mutations in mt-tRNA were the important contributors to breast cancer, and mutational analyses of mt-tRNA genes were critical for prevention of breast cancer.
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[Expert consensus on late stage of critical care management]. ZHONGHUA NEI KE ZA ZHI 2023; 62:480-493. [PMID: 37096274 DOI: 10.3760/cma.j.cn112138-20221005-00731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
We wished to establish an expert consensus on late stage of critical care (CC) management. The panel comprised 13 experts in CC medicine. Each statement was assessed based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) principle. Then, the Delphi method was adopted by 17 experts to reassess the following 28 statements. (1) ESCAPE has evolved from a strategy of delirium management to a strategy of late stage of CC management. (2) The new version of ESCAPE is a strategy for optimizing treatment and comprehensive care of critically ill patients (CIPs) after the rescue period, including early mobilization, early rehabilitation, nutritional support, sleep management, mental assessment, cognitive-function training, emotional support, and optimizing sedation and analgesia. (3) Disease assessment to determine the starting point of early mobilization, early rehabilitation, and early enteral nutrition. (4) Early mobilization has synergistic effects upon the recovery of organ function. (5) Early functional exercise and rehabilitation are important means to promote CIP recovery, and gives them a sense of future prospects. (6) Timely start of enteral nutrition is conducive to early mobilization and early rehabilitation. (7) The spontaneous breathing test should be started as soon as possible, and a weaning plan should be selected step-by-step. (8) The waking process of CIPs should be realized in a planned and purposeful way. (9) Establishment of a sleep-wake rhythm is the key to sleep management in post-CC management. (10) The spontaneous awakening trial, spontaneous breathing trial, and sleep management should be carried out together. (11) The depth of sedation should be adjusted dynamically in the late stage of CC period. (12) Standardized sedation assessment is the premise of rational sedation. (13) Appropriate sedative drugs should be selected according to the objectives of sedation and drug characteristics. (14) A goal-directed minimization strategy for sedation should be implemented. (15) The principle of analgesia must be mastered first. (16) Subjective assessment is preferred for analgesia assessment. (17) Opioid-based analgesic strategies should be selected step-by-step according to the characteristics of different drugs. (18) There must be rational use of non-opioid analgesics and non-drug-based analgesic measures. (19) Pay attention to evaluation of the psychological status of CIPs. (20) Cognitive function in CIPs cannot be ignored. (21) Delirium management should be based on non-drug-based measures and rational use of drugs. (22) Reset treatment can be considered for severe delirium. (23) Psychological assessment should be conducted as early as possible to screen-out high-risk groups with post-traumatic stress disorder. (24) Emotional support, flexible visiting, and environment management are important components of humanistic management in the intensive care unit (ICU). (25) Emotional support from medical teams and families should be promoted through"ICU diaries"and other forms. (26) Environmental management should be carried out by enriching environmental content, limiting environmental interference, and optimizing the environmental atmosphere. (27) Reasonable promotion of flexible visitation should be done on the basis of prevention of nosocomial infection. (28) ESCAPE is an excellent project for late stage of CC management.
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Invasive fungal infection is associated with antibiotic exposure in preterm infants: a multi-centre prospective case-control study. J Hosp Infect 2023; 134:43-49. [PMID: 36646139 DOI: 10.1016/j.jhin.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/31/2022] [Accepted: 01/04/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Previous antibiotic exposure is an important risk factor for invasive fungal infection (IFI). Antibiotic overexposure is common in lower-income countries; however, multi-centre studies concerning IFI in relation to antibiotic exposure are scarce. AIM This prospective, multi-centre matched case-control study explored the correlation of IFI and antibiotic exposure in very preterm infants or very-low-birthweight infants admitted to 23 tertiary hospitals in China between 2018 and 2021. METHODS Using a 1:2 matched design for gestational age, birth weight and early-onset sepsis (yes/no), the risk factors between infants diagnosed with IFI and infection-free controls were compared. The antibiotic use rate (AUR) was calculated using calendar days of antibiotic therapy in the 4 weeks preceding IFI onset divided by onset day of IFI. FINDINGS In total, 6368 infants were included in the study, of which 90 (1.4%) were diagnosed with IFI. Median AUR, length of antibiotic therapy (LOT) and days of antibiotic therapy (DOT) within the 4 weeks preceding IFI onset were 0.90, 18 days and 30 days, respectively. Multi-variate analysis showed that a 10% increase in AUR, each additional day of DOT and LOT, and each additional day of third-generation cephalosporins and carbapenems were notably associated with IFI. CONCLUSION Prolonged antibiotic therapy is common before the onset of IFI, and is an important risk factor, especially the use of third-generation cephalosporins and carbapenems. Antibiotic stewardship should be urgently developed and promoted for preterm infants in order to reduce IFI in lower-income countries such as China.
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[The quality control standards and principles of the application and training of critical ultrasonography]. ZHONGHUA NEI KE ZA ZHI 2022; 61:631-643. [PMID: 35673743 DOI: 10.3760/cma.j.cn112138-20220111-00031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Critical ultrasonography is widely used in ICU and has become an indispensable tool for clinicians. However, besides operator-dependency of critical ultrasonography, lack of standardized training mainly result in the physicians' heterogenous ultrasonic skill. Therefore, standardized training as well as strict quality control plays the key role in the development of critical ultrasonography. We present this quality control standards to promote better development of critical ultrasonography.
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0701 STOP-BANG Score, Age, and Body Mass Index Predict Severity of Sleep Disordered Breathing in Women Veterans. Sleep 2022. [DOI: 10.1093/sleep/zsac079.697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Despite increasing evidence that sleep disordered breathing (SDB) is common in women veterans, little is known of how to screen for SDB in this population. Some evidence suggests there are sex-related differences in SDB presentation, where women may be more likely to present with fatigue or depression, compared to men who may present with daytime sleepiness. The goal of this study was to evaluate whether commonly used measures predict SDB in women veterans.
Methods
Women veterans (N=179) without treated SDB, but with 1 or more SDB risk factors (identified from electronic medical records) completed baseline assessment as part of an ongoing controlled trial of treatment for SDB. Measures included: age, body mass index (BMI), Epworth Sleepiness Scale (ESS), Flinders Fatigue Scale (FSS), Insomnia Severity Index (ISI), Patient-Health Questionnaire 9-item (PHQ-9), STOP-BANG score, and apnea-hypopnea index (AHI via WatchPAT home sleep apnea testing). Descriptive statistics and bivariate correlations testing the relationship between AHI and other measures were performed.
Results
Mean age was 49.8 [±13.8] years and BMI 29.6 [±6.0] kg/m2. Mean ESS was 8.1, FFS 13.9, ISI 14.0, PHQ-9 7.1, and STOP-BANG score 2.7. Mean AHI was 15.4 [±13.2], where higher AHI correlated with higher BMI (r=0.3, p<0.001), higher STOP-BANG score (r=0.4, p<0.001) and older age (r=0.4, p<0.001).
Conclusion
These findings support the use of the STOP-BANG score to predict SDB severity in women veterans with risk factors for SDB. Age and BMI may be particularly important predictors of SDB in this population. Sleepiness, depression, insomnia, and fatigue questionnaires were not related to SDB severity. Further work is needed to understand the role of patient-reported symptoms in those at-risk for SDB and to inform guidelines for the recognition of SDB in this important and understudied population.
Support (If Any)
VA HSR&D IIR 16-244 and RCS 20-191; NIH/NHLBI K24 HL143055, HRS&D COIN; VAGLAHS GRECC.
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0767 Clinical implementation of a program to improve PAP acceptance and adherence for sleep disordered breathing among Veterans: Preliminary results. Sleep 2022. [DOI: 10.1093/sleep/zsac079.763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Positive airway pressure (PAP) is the gold standard in treating sleep disordered breathing (SDB); however, consistent use of this therapy has challenges such as comfort and equipment optimization. Despite various educational, technological, psychosocial and pharmacological strategies, the average adherence rate of 34% have changed very little over the past 20 years. A recent study of 3013 US veterans determined a baseline average PAP adherence rate of 50%. We developed and implemented a novel PAP readiness education program (PREP) for veterans newly diagnosed with SDB in a Veterans Administration sleep clinic to promote greater PAP acceptance and adherence.
Methods
Patients (N=63, Mean age 62.2±12.4 years) with newly diagnosed SDB were offered a 1-hour telehealth session prior to initiating PAP therapy that included psychoeducation about SDB and PAP treatment expectations, with troubleshooting techniques (i.e. scheduled practice, mindfulness). A 1-week follow-up call was conducted to communicate PAP data and address treatment barriers. PAP use reports were downloaded and analyzed at 1-7 days (first week), 1-30 days (first month), and 31-60 days (60-days) post-PAP initiation. PAP acceptance was defined as ≥1 day of use and adherence as ≥4 hours of use at each timepoint.
Results
Among 63 Veterans offered PREP, 66.6% (n=42) participated in PREP. Among participants, acceptance of PAP was as follows: 57.1% used ≥1 day in the first week, 64.3% used ≥1 day in the first month, and 45.2% used ≥1 day at 60-days post-PAP initiation. Percent of days with use ≥4 hours was 28.9% ±30.4 in the first week and 24.9% ±30.0 in the first month. PAP adherence at 60-days post-PAP initiation was 34.3% ±38.5 at 60-days.
Conclusion
Implementation of a 1-session plus 1-week follow-up call PAP readiness education program within a sleep medicine clinic was well received by patients and resulted in PAP acceptance by 2/3 of veterans in the first month post-PAP initiation. PAP adherence results may have reflected the impact of a nationwide PAP device recall that occurred during the study period. Further work is needed to test this intervention in a clinical population and to identify predictors of PAP acceptance and adherence in real-world clinical settings.
Support (If Any)
AASM Foundation #211-FP-19, VAGLAHS GRECC and CSHIIP
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Bilateral Gluteal Fasciocutaneous Advancement Flaps With and Without Tie-Over Sutures in Treatment of Chronic Pilonidal Disease: A Prospective Case Series. Am Surg 2022:31348221075731. [PMID: 35580246 DOI: 10.1177/00031348221075731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Flap procedures following pilonidal excision have high recurrence and dehiscence rates. We present a cosmetic, outpatient technique to reconstruction via bilateral gluteal fasciocutaneous advancement flaps with and without tie-over sutures. METHODS This is a prospective case series of 51 patients (40 males and 11 females). Following elliptical excision of pilonidal disease, gluteal fasciocutaneous advancement flaps were elevated circumferentially using blunt, discontinuous dissection, and a multilayered closure was performed. The resulting scar was midline. Thirty-five patients (68.6%) also had two full-thickness, compressing sutures tied over rolled up gauze. RESULTS Patients had a mean age of 28.2 and body mass index of 26.8. Eight (15.9%) were smokers and 11 (21.6%) were obese. At a mean follow-up of 38.7 months, there were no recurrences and 19 (37.3%) patients had wound dehiscence. There was no significant difference in dehiscence between patients with and without tie-over sutures (31.4% vs 50%, P = 0.20). There was no significant difference in dehiscence between smokers and non-smokers, (62.5% vs 41.9%, P = 0.47), or between obese and non-obese patients (36.4% vs 46.3%, P = 0.51). Obese patients with tie-over sutures had significantly less dehiscence compared to obese patients without tie-over sutures (14% vs 75%, P = 0.03). CONCLUSION Bilateral gluteal fasciocutaneous advancement flap with consideration of tie-over sutures is an outpatient treatment for chronic pilonidal disease with resultant midline scar and with no recurrence in our series.
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[Effects of cortical bone trajectory screw in adjacent-segment disease after posterior lumbar interbody fusion]. ZHONGHUA YI XUE ZA ZHI 2021; 101:3724-3729. [PMID: 34856700 DOI: 10.3760/cma.j.cn112137-20210416-00919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the effect of the cortical bone trajectory (CBT) screw fixation combined with midline lumbar fusion (MIDLF) for adjacent spondylopathy after posterior lumbar interbody fusion. Methods: A retrospective analysis was conducted in 16 patients, including 9 males and 7 females, with a mean age of (68±6) years, who underwent revision surgery for adjacent spondylopathy after posterior lumbar fusion surgery using CBT combined with MIDLF technology in Sir Run Run Shaw Hospital, Zhejiang University from May 2013 to August 2019. The reasons for revision were radiculalgia in 4 cases, intermittent claudication in 10 cases and protrusive dissociate in 2 cases. Eleven cases had 1 segment fused in the first operation, while the other 5 cases received fusion in 2 segments. The average interval time between the first operation and the revision operation was (7.5±2.0) years. For the levels underwent revision, 1 case was L2/3, 6 cases were L3/4, 7 cases were L4/5 and 2 cases were L5/S1. Before the operation, all the patients took X-rays scans of the thoracic and lumbar spine. CT and MRI scans were also performed. The operation time, intraoperative bleeding, surgical complications, visual analog scale (VAS) of low back and leg pain before the operation and at each follow-up were all recorded. Oswestry disability index (ODI) questionnaire was used to evaluate the functional improvement of patients after the operation. Results: All operations were completed successfully. The operation time was 120-240 (170±30) mins, intraoperative bleeding was 100-280 (220±45) ml. One case had a slight split in the isthmus, and the screw was inserted smoothly after adjusting the insertion point. In one case, the cerebrospinal fluid leaked during the operation and was successfully treated with conservative methods including no pillow supine treatment and strengthened anti-infection. The average follow-up time was of (19.5±1.3) months. The VAS of low back pain was 2.9±1.7 before the operation and it was 1.8±0.5 at the last follow-up, and the difference was statistically significant (P<0.01). The VAS of leg pain was 5.9±1.5 before the operation and it was 1.5±0.4 at the last the follow-up (P<0.01). The ODI score was 34.5±3.2 preoperatively and it decreased to 12.6±4.2 at the last follow-up, the difference was statistically significant (P<0.01). Conclusion: CBT technique combined with MIDLF for the adjacent-segment disease after posterior lumbar interbody fusion is minimally invasive and convenient, with good clinical effects. This technique can be used as an option for the revision of adjacent spondylopathy.
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The Predictive Power of a Deep-Learning Segmentation Based Prognostication (DESEP) Model in Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Targeted deletion of PAC1 receptors in retinal neurons enhances neuron loss and axonopathy in a model of multiple sclerosis and optic neuritis. Neurobiol Dis 2021; 160:105524. [PMID: 34610465 DOI: 10.1016/j.nbd.2021.105524] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 08/26/2021] [Accepted: 10/01/2021] [Indexed: 01/24/2023] Open
Abstract
Chronic inflammation drives synaptic loss in multiple sclerosis (MS) and is also commonly observed in other neurodegenerative diseases. Clinically approved treatments for MS provide symptomatic relief but fail to halt neurodegeneration and neurological decline. Studies in animal disease models have demonstrated that the neuropeptide pituitary adenylate cyclase-activating polypeptide (PACAP, ADCYAP1) exhibits anti-inflammatory, neuroprotective and regenerative properties. Anti-inflammatory actions appear to be mediated primarily by two receptors, VPAC1 and VPAC2, which also bind vasoactive intestinal peptide (VIP). Pharmacological experiments indicate that another receptor, PAC1 (ADCYAP1R1), which is highly selective for PACAP, provides protection to neurons, although genetic evidence and other mechanistic information is lacking. To determine if PAC1 receptors protect neurons in a cell-autonomous manner, we used adeno-associated virus (AAV2) to deliver Cre recombinase to the retina of mice harboring floxed PAC1 alleles. Mice were then subjected to chronic experimental autoimmune encephalomyelitis (EAE), a disease model that recapitulates major clinical and pathological features of MS and associated optic neuritis. Unexpectedly, deletion of PAC1 in naïve mice resulted in a deficit of retinal ganglionic neurons (RGNs) and their dendrites, suggesting a homeostatic role of PAC1. Moreover, deletion of PAC1 resulted in increased EAE-induced loss of a subpopulation of RGNs purported to be vulnerable in animal models of glaucoma. Increased axonal pathology and increased secondary presence of microglia/macrophages was also prominently seen in the optic nerve. These findings demonstrate that neuronal PAC1 receptors play a homeostatic role in protecting RGNs and directly protects neurons and their axons against neuroinflammatory challenge. SIGNIFICANCE STATEMENT: Chronic inflammation is a major component of neurodegenerative diseases and plays a central role in multiple sclerosis (MS). Current treatments for MS do not prevent neurodegeneration and/or neurological decline. The neuropeptide pituitary adenylate cyclase-activating polypeptide (PACAP) has been shown to have anti-inflammatory, neuroprotective and regenerative properties but the cell type- and receptor-specific mechanisms are not clear. To test whether the protective effects of PACAP are direct on the PAC1 receptor subtype on neurons, we delete PAC1 receptors from neurons and investigate neuropathologigical changes in an animal model of MS. The findings demonstrate that PAC1 receptors on neurons play a homeostatic role in maintaining neuron health and can directly protect neurons and their axons during neuroinflammatory disease.
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Predictors of lymph node metastases in patients with malignant adenomatous polyps of the colon. Am J Surg 2021; 223:753-758. [PMID: 34340861 DOI: 10.1016/j.amjsurg.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 07/01/2021] [Accepted: 07/03/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND We sought to describe predictors of lymph node positivity in patients with malignant colon polyps to identify low risk patients who may potentially avoid radical surgery. DESIGN The National Cancer Database (2010-2015) was queried for all patients with malignant colonic polyps who underwent formal colonic resection. Univariate and multivariate methods were used to determine independent predictors of lymph node metastasis. RESULTS 14,663 patients were identified. Lymph node disease was present in 9% of patients. High-grade disease, LVI, PNI, younger age, and left sided location were univariate predictors of lymph node disease. High-grade disease (OR 1.84), left sided location (OR 1.31), LVI (OR 5.79), and PNI (OR 1.70) were independent predictors, while elderly age (OR 0.64) was protective (all p-values <0.001). Elderly patients with low grade disease of the right/transverse colon without LVI/PNI had a 4.4% risk of lymph node disease. High grade, left-sided tumors with LVI, non-elderly age, had a 30% risk. CONCLUSION Non-elderly age, left-sided location, LVI, PNI and high-grade histology are independent predictors of lymph node metastasis in malignant colonic polyps.
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Sleep apnea in women veterans: results of a national survey of VA health care users. J Clin Sleep Med 2021; 17:555-565. [PMID: 33124975 PMCID: PMC7927345 DOI: 10.5664/jcsm.8956] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The goals of this study were to estimate rates of undiagnosed, diagnosed, and treated sleep apnea in women veterans and to identify factors associated with diagnosis and treatment of sleep apnea in this population. METHODS A large nationwide postal survey was sent to a random sample of 4,000 women veterans who had received health care at a Veterans Health Administration (VA) facility in the previous 6 months. A total of 1,498 surveys were completed. Survey items used for the current analyses included: demographics; sleep apnea risk, diagnostic status, and treatment; symptoms of other sleep disorders (eg, insomnia); mental health symptoms; and comorbidities. RESULTS Among responders, 13% of women reported a prior sleep apnea diagnosis. Among women who reported a diagnosis of sleep apnea, 65% reported using positive airway pressure therapy. A sleep apnea diagnosis was associated with older age, higher BMI, non-Hispanic African American/Black racial/ethnic identity, being unemployed, other sleep disorder symptoms (eg, insomnia), depression and post-traumatic stress disorder symptoms, and multimorbidity. Among women without a sleep apnea diagnosis, 43% scored as "high risk" on the STOP (snoring, tiredness, observed apneas, blood pressure) questionnaire. High risk scores were associated with older age, higher BMI, African American/Black identity, other sleep disorder symptoms (eg, insomnia), mental health symptoms, and multimorbidity. Only BMI differed between women using vs not using positive airway pressure therapy. CONCLUSIONS Women veterans with diagnosed sleep apnea were commonly treated with positive airway pressure therapy, which is standard first-line treatment; however, many undiagnosed women were at high risk. Efforts to increase screening, diagnosis, and treatment of sleep apnea in women with comorbid mental and physical health conditions are needed.
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[The value and challenges of autopsy in the education of pathology]. ZHONGHUA BING LI XUE ZA ZHI = CHINESE JOURNAL OF PATHOLOGY 2020; 49:996-998. [PMID: 32992411 DOI: 10.3760/cma.j.cn112151-20200506-00360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Screen time and sleep disorder in preschool children: identifying the safe threshold in a digital world. Public Health 2020; 186:204-210. [PMID: 32861085 DOI: 10.1016/j.puhe.2020.07.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 06/23/2020] [Accepted: 07/19/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Sleep disorder is a common problem in children that can jeopardize their health and well-being. With the popularity of electronic devices such as portable tablets and smartphones in the 21st century, children are spending much more time on screen, but the impact of such change on children's sleep disorder has been less investigated so far. This study aims to examine the dose-response association between time spent on different electronic devices and children's sleep disorder. STUDY DESIGN The design of this study is a cross-sectional study. METHODS We randomly selected 2278 children aged 3-6 years from 15 kindergartens in Tongling, China. The potentially non-linear association between screen-viewing time (i.e. television [TV], computer, iPad, Phone) and the risk of sleep disorder was examined using a logistic generalized additive model. RESULTS We observed a J-shaped association between TV viewing time and the risk of sleep disorder, with a threshold of 1 h/day. For each 1 h/day increment in TV viewing time over the threshold, the risk of sleep disorder increased by 12.35% (95% confidence interval: 1.87-23.92%). This association seemed to be greater for girls than boys and for TV viewing at weekend than on weekdays, but the difference was not statistically significant (P-value>0.05). We did not find adequate evidence of an adverse effect of more time spent on computer, iPad and Phone. CONCLUSIONS This study suggests a positive but non-linear relationship between time spent on watching TV and sleep disorder in Chinese preschool children. Setting the TV viewing time limit less than 1 h/day may help reduce the risk of developing sleep disorder. Further investigation is also needed to examine and compare the effects of heavy use of other electronic devices on sleep disorder.
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Adenosquamous carcinoma: An aggressive histologic sub-type of colon cancer with poor prognosis. Am J Surg 2020; 221:649-653. [PMID: 32862977 DOI: 10.1016/j.amjsurg.2020.07.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/21/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Studies have reported worse overall survival (OS) for adenosquamous carcinoma (ASC) compared to adenocarcinoma (AC) of the colon, but none have analyzed a national dataset for over 30 years. METHODS The National Cancer Database was queried from 2004 to 2016 for patients with ASC and AC of the colon. Kaplan-Meier survival analysis was performed to assess OS. Descriptive variables were evaluated using independent T-test and Chi-square analyses. RESULTS 332 ASC patients were compared to 496,950 AC patients. AC patients were older than ASC patients (68.6 vs. 64.4 years); p < 0.001. Most ASC cancers presented with stage IV (41.3%) and poorly-differentiated disease (57.5%) compared to AC (22.4% and 17.7%). OS of the ASC cohort was 13.9 months. Median OS for stage IV AC versus stage IV ASC was significantly better (14.1 vs. 8.0 months); p < 0.0001. CONCLUSION This is the largest national database study to compare ASC with AC. Our findings confirm that unlike AC, ASC most frequently presents late stage, as poorly-differentiated lesions, and have worse OS.
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0581 Characteristics of US Women Veterans with Sleep Apnea: Results of a National Survey of VA Healthcare Users. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Sleep apnea (SA) is the most commonly diagnosed sleep disorder among patients in the US Veterans Administration (VA). The dramatic rise in women receiving VA care makes it essential to understand the presentation and treatment of SA in women Veterans. We performed a nationwide survey about sleep among US women Veterans and compared characteristics of respondents with and without a self-reported history of SA diagnosis and treatment.
Methods
A survey was mailed to a random sample of 4000 women VA healthcare users. The survey included demographics, Insomnia Severity Index (ISI), Patient Health Questionnaire-4 (PHQ-4 depression/anxiety), Primary Care-Post-Traumatic Stress Disorder (PC-PTSD), RLS symptom presence, SA symptoms (snore loudly, observed breathing pauses), diagnosis of SA, and use of PAP therapy (APAP, BPAP, CPAP). We compared women with and without SA, and (among those with SA) women who did and did not use PAP, using Chi-square and t-tests.
Results
1,498 completed surveys were returned (mean age 51.6 years, range 18-105 years, 62% non-Hispanic White). 200 respondents (13.4%) reported diagnosed SA. Women with SA were older (p<.001), likely to be employed (p=.013), more likely to snore loudly (p<.001) and to have breathing pauses while asleep (p<.001). They also had higher ISI (p<.001), were more like to report RLS (p<.001) nightmares (p=.027), and had higher PHQ-4 (p<.001) and PC-PTSD (p<.001) scores. Among women with SA, 130 (65%) used PAP. Loud snorers (p<.001) and those with observed breathing pauses were more likely to use PAP (p<.001).
Conclusion
One in 7 women who receive VA care report diagnosed SA. Women with SA had more mental health symptoms and comorbid sleep problems. Most reported using PAP therapy, although the amount of use is unknown. Those with SA symptoms were more likely to use PAP. Future work is needed to understand barriers to diagnosis and treatment of SA among women Veterans.
Support
Funding: VA Quality Enhancement Research Initiative RRP12-189 (Martin); NIH/NHLBI K24 HL143055 (Martin).
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0537 Cognitive Functioning Before and After Insomnia Treatment in Women Veterans. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Women are at higher risk for cognitive impairment and dementia compared to men. Identifying potentially treatable risk factors such as insomnia is an important clinical goal. In a trial comparing two behavioral treatments for insomnia in women veterans, we hypothesized that 1) worse baseline insomnia severity would be associated with poorer cognitive function, and 2) improvement in insomnia severity with treatment would be associated with improvement in cognitive functioning.
Methods
347 women veterans with insomnia disorder [mean age 48.3 (12.9) years] completed baseline testing. Of these, 149 women were randomized to receive cognitive behavioral therapy for insomnia (CBT-I) or acceptance and commitment (ACT) based insomnia treatment (both treatments included sleep restriction, stimulus control, and sleep hygiene). Insomnia Severity Index (ISI) was assessed at baseline, post-treatment, and 3-month follow-up. Cognitive functioning was measured with Symbol Digit Coding (SDC) and Trail Making Test A and B (TMTA and TMTB). Pearson correlations were used to examine associations between insomnia severity and cognitive functioning at baseline and changes in both insomnia severity and cognitive functioning from before to after treatment.
Results
At baseline (N=347), mean ISI was 14.1 (5.3). Worse baseline ISI was associated with worse baseline cognitive functioning on TMTA (r=-.15, p<.01) and SDC (r=-.12, p<.05). In the randomized sample (N=149), ISI scores improved at post-treatment (mean ISI change= -9.0; p<.001) and 3-month follow-up (mean change= -8.0; p<.001) relative to baseline. Improvement in ISI from baseline to post-treatment was significantly associated with improvement in SDC from baseline to post-treatment (r=-.18, p<.05), but not improvement in TMTA and TMTB. Change in ISI was not significantly related to change in cognitive tasks from baseline to 3-month follow-up.
Conclusion
More severe insomnia is associated with worse cognitive functioning in women veterans. The magnitude of improvement in insomnia symptoms may be associated with improvement in cognition.
Support
NIH/NIA K23AG049955 (PI: Dzierzewski); VA/HSR&D IIR-HX002300 (PI: Martin), NIH/NHLBI K24HL143055 (PI: Martin).
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Distinct clinical features and serum cytokine pattern of elderly atopic dermatitis in China. J Eur Acad Dermatol Venereol 2020; 34:2346-2352. [PMID: 32163633 DOI: 10.1111/jdv.16346] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 02/25/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Elderly atopic dermatitis (AD) is a newly defined subtype of AD stratified by age-related clinical pictures. OBJECTIVES To analyse the clinical features and molecular profile of elderly AD patients in China, comparing with infantile, childhood and adolescent/adult AD. METHODS A total of 1312 patients diagnosed by Hanifin and Rajka diagnostic criteria of AD from Huashan Hospital, Shanghai, China, were divided into four groups by age (2-18, 19-40, 41-60 and >60 years), and clinical features were evaluated by questionnaire and physical examination. Serum total IgE, eosinophil counts and various cytokines were further analysed in some of the patients and healthy controls. RESULTS Elderly AD showed significantly higher male/female ratio and rural/urban ratio than other age groups, and more than half of elderly AD first appeared after 60 years old. Skin lesions of elderly AD were more often seen in the trunk and extensor sites of the extremities. Level of serum IgE and eosinophil counts were significantly lower in elderly AD than those in other age groups. Serum levels of IL-4, TARC, IL-17A, IL-6, IL-22, IL-33 and TSLP were significantly higher in elderly AD patients than those of healthy controls, indicating a mixed Th2/Th17/Th22 inflammation. CONCLUSIONS Elderly AD demonstrated unique clinical characteristics compared with other age groups and showed mixed Th2/Th17/Th22 skewing, indicating a unique pathogenesis for elderly AD.
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The operation and improvement of CSNS front end. RADIATION DETECTION TECHNOLOGY AND METHODS 2020. [DOI: 10.1007/s41605-019-00159-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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[A Chinese consensus statement on the clinical application of transesophageal echocardiography for critical care (2019)]. ZHONGHUA NEI KE ZA ZHI 2019; 58:869-882. [PMID: 31775449 DOI: 10.3760/cma.j.issn.0578-1426.2019.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Transesophageal echocardiography(TEE) is valuable in intensive care unit (ICU) because its application meets the requirements of diagnosis and treatment of critically ill patients.However, the current application has not fully adapted to the specialty of critical care. TEE could be more valuablein ICU when used with a new way that under the guidance of the theory of critical care and embedded into the treatment workflow. We have expanded and improved the application of traditional TEE and integrated the concept of critical care, established the concept of transesophageal echocardiography for critical care (TEECC). Chinese Critical Ultrasound Study Group (CCUSG) organized experts in the area to form the consensus based the previous studiesand the long term practice of critical care ultrasound and TEE, aiming at clarifying the nature and characteristics of TEECC, promoting the rational and standardized clinical application and the coming researches.The consensus of Chinese experts on clinical application of TEECC (2019) were 33 in total, of whichthe main items were as follows: (1) TEECC is a significant means, which is expanded and improved from the traditional transesophageal echocardiography according to characteristics of critically ill patients and is applied in ICU based on critically clinical scenarios and requirements by the critical care physician, to promote visualized, refined and precisely management of critically ill patients.(2) TEE possesses distinctive superiority in implementation in ICU. It has characteristics of images with good quality, operations with good stability and low-dependent of operators, monitoring with continuity, and visualization with all-dimensional and detail of heart and blood vessels.(3)As a means of refined monitoring that could resulted in precise diagnosis and treatment, TEECC expands the dimension of intensive monitoring and improves the performance of critical care. (4) Indications of TEECC application include clinical etiological searching and invasive procedures guiding when it acted as a traditional role; and also refined hemodynamic monitoring based on critical care rationale and over-all management under specific critical clinical scenarios. (5) TEE and TTE assessments are complementary; they are not alternative. Integrated assessment of TTE and TEE is required under many critical clinical scenarios.(6) TEE should be a necessary configuration in ICU. (7) All-round and significant information regarding to the mechanism of acute circulatory disorders can be provided by TEECC; it is a non-substitutable means of identifying the causes of shock under some special clinical scenarios. (8) Focal extracardiac hematoma can be accurately and rapidly detected by TEE in patients with open-thoracic cardiac surgery or severe chest trauma when highly suspected pericardial tamponade.(9) The priority of pathophysiologic mechanism of septic shock can be rapidly and accurately identified by TEE; even if its pathophysiological changes are complex, including hypovolemia and/or vasospasm and/or left and right heart dysfunction. (10) Causes of hemodynamic disorders can be rapidly and qualitatively evaluated so that the orientation of treatment can be clarified by TEECC. (11) A full range of quantitative indicators for refined hemodynamic management in critically ill patients can be provided by TEECC. (12) TEECC helps to accurately assess volume status and predict fluid responsiveness.(13) TEECC is specially suitable for accurate quantitative assessment of cardiac function.(14) Mini TEE provides long-term continuous hemodynamic monitoring. (15) Standard views are easy to be acquired by TEECC, which is a premise for accurate and repeatable measurements, and a guarantee for assessment of effect and risk of therapy. (16) Compared with invasive hemodynamic monitoring, TEECC is minimally invasive, with low infection risk and high safety.(17) In patients with acute cor pulmonale (ACP) under condition of right ventricular dysfunction and low cardiac output, TEECC is a key tool for assessment. (18) TEECC should be implemented actively when suspicious of left to right shunt in critically ill patients who occurred hypotension that hard to explain the cause. (19) TEECC should be implemented actively when suspicious of right to left shunt in critically ill patients who occurred hypoxemia that hard to explain the cause. (20) TEECC is preferred in hemodynamics monitoring under prone position of ventilated patients.(21) TEECC is an imperative means to achieve over-all management of extracorporeal membrane oxygenation (ECMO) therapy, especially for all-round hemodynamic monitoring. (22) Three basic views is recommended to be used to simplify TEE assessment during cardiac arrest so that reversible causes could be identified, and resuscitation could be guided. (23) The flow related echodynamic evaluation (TEECC-FREE) workflow is preferred in refined hemodynamics monitoring and therapy. (24) Simple workflow of TEECC could be implemented in special critical clinical scenarios. (25) Application of TEECC is highly secure; however, impairments of procedure should also be alert by operators. (26) Pitfalls in application of TEE should be paid attention to by the critical care physician. (27) Timely and rationally application of TEECC is in favor of diagnosis and treatment of critically ill patients and may improve the prognosis.
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[Effect of clinical characteristics on relapse of alcohol dependence: a prospective cohort study]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:519-524. [PMID: 31209425 DOI: 10.19723/j.issn.1671-167x.2019.03.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To investigate whether craving and demographic factors to predict relapse in alcohol dependence. METHODS This study was a prospective cohort study. From August 2017 to August 2018, 158 Han male inpatients who met the diagnositic and statistical manual disorders-fourth version(DSM-IV) alcohol dependence diagnostic criteria were recruited from three mental hospitals in China. The participants were interviewed at baseline and followed up by telephone after 3 months for assessment. The baseline assessment after the acute withdrawal period included demographic data and alcohol-related data, clinical institute withdrawal assessment-advanced revised (CIWA-Ar), withdrawal and cue-induced craving on visual analog scale (VAS), Michigan alcoholism screening test (MAST), self-rating anxiety scale (SAS), self-rating depression scale (SDS) and alcohol urge questionnaire (AUQ). According to the follow-up results, "relapse" was defined as the consumption of beverages containing ethanol at any time during the follow-up study, and "time to relapse" was defined as the number of days from the first drinking to the baseline. Whether relapse occurred and the time to relapse were the primary endpoints. Cox proportional hazard regression model was used to analyze the factors affecting the relapse of alcohol dependence. RESULTS In the study, 158 alcohol dependence patients were finally included, age from 21 to 60 years, with the mean age of (40.31±9.14) years. The relapse rate was 63.7% three months after baseline assessment. According to Cox univariate analysis and multivariate analysis, the age (OR=0.975, P=0.030) and CIWA-Ar scores (OR=1.126, P=0.010) significantly predicted relapse. And there was no significant difference in education level, marital status, withdrawal and cue-induced craving on VAS, SAS and SDS between the relapse group and the non-relapse group (P>0.05). CONCLUSION Age and severity of alcohol-dependent withdrawal symptoms during hospitalization are significantly related to relapse for alcohol in alcohol-dependent patients. To be exact, the older age is a protective factor, that is to say, the younger patients are prone to relapse, while the risk of relapse is raised by the higher severity of withdrawal symptoms. However, neither cue-induced nor withdrawal craving can predict relapse of alcohol-dependent patients.
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Role of right hemicolectomy in patients with low-grade appendiceal mucinous adenocarcinoma. Am J Surg 2019; 218:1239-1243. [PMID: 31399196 DOI: 10.1016/j.amjsurg.2019.07.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/17/2019] [Accepted: 07/23/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND There is little consensus with regards to the most appropriate surgical management for low-grade appendiceal mucinous adenocarcinomas (LAMA), though right hemicolectomy is usually recommended. METHODS The SEER database was queried for all patients with non-metastatic LAMA. Disease specific and overall survival was compared by surgery type: 1) appendectomy, 2) formal right hemicolectomy 3) non-formal colectomy (including ileocecectomy). RESULTS A total of 579 patients with non-metastatic LAMA were identified. 133 (23%), 404 (70%), and 42 (7%) of patients had stage I, II, and III disease, respectively. 99 (17.1%) had appendectomy, 87 (15%) had non-formal colectomy, and 302 (52.2%) had formal right hemicolectomy. We observed no significant differences in disease specific or overall survival by surgery type. Controlling for age and stage, surgery type was not a significant predictor of disease specific or overall survival. CONCLUSION In patients with localized LAMA, right hemicolectomy did not increase disease specific or overall survival. Right hemicolectomy should be reserved for LAMA patients with positive margins post appendectomy.
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Correction to: Rehmanniae Radix Preparata suppresses bone loss and increases bone strength through interfering with canonical Wnt/β-catenin signaling pathway in OVX rats. Osteoporos Int 2019; 30:1537-1540. [PMID: 31214751 DOI: 10.1007/s00198-019-05028-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
There was a mistake in the part of OVX rats model and RRP intervention in the original publication.
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016 Creation of a Vaginal Canal for De Novo Vaginoplasty and Salvage Vaginal Replacement For Transgender and Cisgender Women: A Proposed Novel Technique Using Right Ascending Colon. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.03.473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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[A reevaluation of diagnostic efficacy of International Society of Thrombosis and Haemostasis and Japanese Association for Acute Medicine criteria for the diagnosis of sepsis disseminated intravascular coagulation]. ZHONGHUA NEI KE ZA ZHI 2019; 58:355-360. [PMID: 31060143 DOI: 10.3760/cma.j.issn.0578-1426.2019.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Objective: To reevaluate the diagnostic efficacy of International Society of Thrombosis and Haemostasis (ISTH) and Japanese Association for Acute Medicine (JAAM) criteria for sepsis disseminated intravascular coagulation (DIC). Methods: A total of 769 patients diagnosed as sepsis were enrolled in our study. Blood samples were collected within the first hour in ICU and the index of coagulation was detected. The correlation between the conventional coagulation index and the acute physiology and chronic health evaluation (APACHE Ⅱ) and sequential organ failure assessment (SOFA) scores was analyzed. The sensitivity and specificity of diagnostic efficacy were analyzed by receiver operating characteristic (ROC) curve. Results: In the 769 cases, 95 cases (12.35%) conformed to the standard of ISTH and 271 cases (35.24%) were in accordance with the standard of JAAM. Prolonged prothrombin time (PT) was seen in 726 cases (94.41%). Activated partial thromboplastin time (APTT) was prolonged in 434 cases (56.44%). Plasma fibrinogen (Fib) was decreased in 94 cases (12.22%) and increased in 365 cases(47.46%). Platelet (PLT) count decreased in 158 cases (20.55%). D-dimer was elevated in 759 cases (98.70%). Fibrin degradation product (FDP) was increased in 724 cases (94.15%). PT, APTT, D-dimer, FDP, PLT were correlated with APACHE Ⅱ(r value were 0.259, 0.348, 0.319, 0.289,-0.275, all P values<0.05) and SOFA score(r values were 0.409, 0.445, 0.407, 0.411,-0.526, respectively, all P values<0.05). The areas under the curve (AUCs) in the ISTH standard from high to low were accordingly PT (0.813), FDP (0.792), PLT (0.746), Fib (0.563). The AUCs from high to low were FDP (0.844), PLT (0.716), and PT (0.660), respectively in the JAAM standard. Under the criteria of ISTH, the diagnostic sensitivities of PT, PLT, Fib and FDP were 92.63%, 67.37%, 9.47%, 98.95%, respectively, and specificities as 53.56%, 86.05%, 99.26% and 33.38%% respectively. As to the JAAM criteria, the diagnostic sensitivities of PT, PLT, and FDP were 74.54%, 52.77%, 91.51% and specificities as 51.61%, 84.94%, 40.76% respectively. Conclusions: According to the ISTH and JAAM diagnostic criteria, the diagnostic efficacy of PT and PLT is relatively high, which is associated with the severity of DIC. D-dimer and FDP have the high sensitivity but the specificity is poor. The diagnostic specificity of Fib is good, yet with low sensitivity and poor overall efficacy.
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Elevated aspartate aminotransferase and monocyte counts predict unfavorable prognosis in patients with malignant pleural mesothelioma. Neoplasma 2019; 64:114-122. [PMID: 27881012 DOI: 10.4149/neo_2017_114] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Limited biomarkers predicting prognosis of malignant pleural mesothelioma (MPM) have been identified. The present study aims to assess potential laboratory prognostic factors of MPM. We retrospectively reviewed the clinical data of 105 patients with MPM. The overall survival and prognostic factors were assessed by Kaplan-Meier curves and Cox regression analysis. A receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off values. The mean age of the 105 patients (62 men, 43 women) was 56.0 years. The major clinical presentations were dyspnea, cough and chest pain. The most common laboratory abnormalities were thrombocytosis and elevated monocyte count. Significant prognostic factors on univariate analysis were performance status (PS), serum albumin, aspartate aminotransferase (AST), lactate dehydrogenase (LDH), alkaline phosphatase (ALP), monocyte, platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR) and treatment strategy. Multivariate analysis showed PS, AST, monocyte, and treatment strategy were statistically significant (p<0.05). Higher AST level and monocyte count were both related to the presence of anemia (p=0.001 and 0.010, respectively) and higher ALP level (p=0.049 and 0.001, respectively). A higher AST level was also associated with higher alanine aminotransferase (ALT) and LDH level (p<0.05). A higher monocyte count was also correlated with male patients, higher white blood cell (WBC), platelet, neutrophil counts, lower red blood cell (RBC) and LMR counts (p<0.05). In conclusion, our data show that PS<2, normal AST level, lower monocyte count, and multimodality treatment are independent positive prognostic factors of MPM. The elevated AST and monocyte levels represent unfavorable prognostic biomarkers of MPM.
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Rehmanniae Radix Preparata suppresses bone loss and increases bone strength through interfering with canonical Wnt/β-catenin signaling pathway in OVX rats. Osteoporos Int 2019; 30:491-505. [PMID: 30151623 DOI: 10.1007/s00198-018-4670-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 08/13/2018] [Indexed: 12/17/2022]
Abstract
UNLABELLED Rehmanniae Radix Preparata (RRP) improves bone quality in OVX rats through the regulation of bone homeostasis via increasing osteoblastogenesis and decreasing osteoclastogenesis, suggesting it has a potential for the development of new anti-osteoporotic drugs. INTRODUCTION Determine the anti-osteoporotic effect of RRP in ovariectomized (OVX) rats and identify the signaling pathway involved in this process. METHODS OVX rats were treated with RRP aqueous extract for 14 weeks. The serum levels of tartrate-resistant acid phosphatase (TRAP), receptor activator of nuclear factor kappa-Β ligand (RANKL), alkaline phosphatase (ALP), and osteoprotegerin (OPG) were determined by ELISA. Bone histopathological alterations were evaluated by H&E, Alizarin red S, and Safranin O staining. Bone mineral density (BMD) and bone microstructure in rat femurs and lumbar bones were determined by dual-energy X-ray absorptiometry and micro-computed tomography. Femoral bone strength was detected by a three-point bending assay. The expression of Phospho-glycogen synthase kinase 3 beta (p-GSK-3β), GSK-3β, Dickkopf-related protein 1 (DKK1), cathepsin K, OPG, RANKL, IGF-1, Runx2, β-catenin, and p-β-catenin was determined by western blot and/or immunohistochemical staining. RESULTS Treatment of OVX rats with RRP aqueous extract rebuilt bone homeostasis demonstrated by increasing the levels of OPG as well as decreasing the levels of TRAP, RANKL, and ALP in serum. Furthermore, RRP treatment preserved BMD and mechanical strength by increasing cortical bone thickness and epiphyseal thickness as well as improving trabecular distribution in the femurs of OVX rats. In addition, RRP downregulated the expression of DKK1, sclerostin, RANKL, cathepsin K, and the ratio of p-β-catenin to β-catenin, along with upregulating the expression of IGF-1, β-catenin, and Runx2 and the ratio of p-GSK-3β to GSK-3β in the tibias and femurs of OVX rats. Echinacoside, jionoside A1/A2, acetoside, isoacetoside, jionoside B1, and jionoside B2 were identified in the RRP aqueous extract. CONCLUSION RRP attenuates bone loss and improves bone quality in OVX rats partly through its regulation of the canonical Wnt/β-catenin signaling pathway, suggesting that RRP has the potential to provide a new source of anti-osteoporotic drugs.
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Effect of Methylprednisolone on Liver Injury and Endotoxin Levels Following Brain Death in Rats. Transplant Proc 2018; 50:3845-3850. [PMID: 30577276 DOI: 10.1016/j.transproceed.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/18/2018] [Accepted: 08/03/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM Brain death impairs liver function in potential donors and is associated with inflammatory activation. Methylprednisolone treatment after brain death has been shown to reduce inflammatory activity. The aim of the present study was to evaluate the effects of methylprednisolone on liver injury and endotoxin levels in brain-dead rats. METHODS Thirty-two rats were randomly divided into 4 groups: a sham-operation group (Sham group), a brain death with methylprednisolone treatment group (Methy group), a brain death with saline treatment group (Saline group), and a brain death group (BD group). The rats were anesthetized and induced by gradually increasing the intra-cranial pressure using a Fogarty catheter balloon for brain death. All of the animals were observed and ventilated for 6 h prior to being euthanized. Hepatic pathologic histology (Knodell histology activity index), liver inflammatory cytokine levels, liver function and endotoxin levels were assessed. RESULTS After brain death, methylprednisolone markedly alleviated the Knodell histology activity index of liver injury (P < .05). Additionally, significant reductions in the levels of TNF-α, IL-1β, and IL-10 were observed in the Methy group compared to those in the Saline and BD groups (P < .01), whereas no significant differences were found between the Saline and BD groups (P > .05). Interestingly, although the rate of liver injury after brain death in the methylprednisolone treatment group improved, the endotoxin level did not decline in the Methy group compared to the levels in the Saline and BD groups (P > .05). CONCLUSION The present study verified that methylprednisolone was protective for liver injury in rats subjected to brain death. This protection appeared to be due to reduced inflammatory activity with no influence on the endotoxin level.
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The fungal-resistance factors BmSPI38 and BmSPI39 predominantly exist as tetramers, not monomers, in Bombyx mori. INSECT MOLECULAR BIOLOGY 2018; 27:686-697. [PMID: 29845671 DOI: 10.1111/imb.12504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Previous studies have indicated that trypsin inhibitor-like cysteine-rich domain (TIL)-type protease inhibitors, BmSPI38 and BmSPI39, suppress conidial germination and integument penetration of entomopathogenic fungi by inhibiting their cuticle-degrading proteases and might functions as fungal-resistance factors in the silkworm. To date, the physiological forms and functional significance of multimerization of BmSPI38 and BmSPI39 remain unknown. In this study, we investigated the physiological forms of BmSPI38 and BmSPI39 in Bombyx mori silkworms using multiple complementary methods, including activity staining, reducing and nonreducing sodium dodecyl sulfate polyacrylamide gel electrophoresis, matrix-assisted laser desorption ionization time-of-flight mass spectrometry, western blotting and immunofluorescence. We found that recombinant BmSPI38 and BmSPI39 tend to form homologous multimers, and their dimers, trimers and tetramers possessed intense inhibitory activity against subtilisin A from Bacillus licheniformis. In contrast, their monomers showed no detectable inhibitory activity. Both BmSPI38 and BmSPI39 also exist mainly as stable tetramers in silkworm tissues, and they also predominantly function as a tetramer in these tissues. This study is the first to demonstrate this preferred quaternary form of a TIL-type protease inhibitor and will likely help to elucidate the mechanisms of BmSPI38 and BmSPI39 in the innate immune response of the silkworm.
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Correction to: PACAP/PAC1 Regulation of Inflammation via Catecholaminergic Neurons in a Model of Multiple Sclerosis. J Mol Neurosci 2018; 68:452. [PMID: 30362069 DOI: 10.1007/s12031-018-1196-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The original version of this article unfortunately contained mistakes. The captured article title and corresponding author were incorrect.
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CONGENITAL MUSCULAR DYSTROPHIES. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Wave propagation in tunable lightweight tensegrity metastructure. Sci Rep 2018; 8:11482. [PMID: 30065300 PMCID: PMC6068147 DOI: 10.1038/s41598-018-29816-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 07/16/2018] [Indexed: 11/09/2022] Open
Abstract
Lightweight metastructures are designed consisting of prismatic tensegrity building blocks which have excellent strength-to-weight ratio and also enable unique compression-torsion coupling. A theoretical model with a coupled axial-torsional stiffness is first developed to study the band structures of the proposed lightweight metastructures. Then, various unit cell designs are investigated for bandgap generations at desired frequency ranges. Broadband full-wave attenuation is found in the tensegrity metastructure with special opposite-chirality. Furthermore, tunable stiffness in the prismatic tensegrity structure is investigated and 'small-on-large' tunability is achieved in the metastructure by harnessing the geometrically nonlinear deformation through an external control torque. Prestress adjustment is also investigated for fine tuning of the band structure. Finally, frequency response tests on the finite metastructures are preformed to validate their wave attenuation ability as well as their wave propagation tunability. The proposed tensegrity metastructures could be very useful in various engineering applications where lightweight and tunable structures with broadband vibration suspension and wave attenuation ability are in high demand.
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PACAP/PAC1 Regulation of Inflammation via Catecholaminergic Neurons in a Model of Multiple Sclerosis. J Mol Neurosci 2018; 68:439-451. [PMID: 30058008 DOI: 10.1007/s12031-018-1137-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/20/2018] [Indexed: 12/30/2022]
Abstract
The sympathetic nervous system (SNS) serves to maintain homeostasis of vital organ systems throughout the body, and its dysfunction plays a major role in human disease. The SNS also links the central nervous system to the immune system during different types of stress via innervation of the lymph nodes, spleen, thymus, and bone marrow. Previous studies have shown that pituitary adenylate cyclase-activating polypeptide (PACAP, gene name adcyap1) exhibits anti-inflammatory properties in the experimental autoimmune encephalomyelitis (EAE) model of multiple sclerosis. Because PACAP is known to regulate SNS function, we hypothesized that part of the immunoprotective action of PACAP is due to its neuromodulatory effects on sympathetic neurons. To examine this, we used an inducible, targeted approach to conditionally disrupt not only the PACAP-preferring PAC1 receptor gene (adcyap1r1) in dopamine β-hydroxylase-expressing cells, which includes postganglionic sympathetic neurons, but also catecholaminergic neurons in the brain and adrenomedullary chromaffin cells. In contrast to our previous EAE studies using PACAP global knockout mice which developed severe and prolonged EAE, we found that mice with conditional loss of PAC1 receptors in catecholaminergic cells developed a delayed time course of EAE with reduced helper T cell type 1 (Th1) and Th17 and enhanced Th2 cell polarization. At later time points, similar to mice with global PACAP loss, mice with conditional loss of PAC1 exhibited more severe clinical disease than controls. The latter was associated with a reduction in the abundance of thymic regulatory T cells (Tregs). These studies indicate that PAC1 receptor signaling acts in catecholaminergic cells in a time-dependent manner. At early stages of disease development, it enhances the ability of the SNS to polarize the Th response towards a more inflammatory state. Then, after disease is established, it enhances the ability of the SNS to dampen the inflammatory response via Tregs. The lack of concordance in results between global PACAP KO mice and mice with the PAC1 deletion targeted to catecholaminergic cells during early EAE may be explained by the fact that PACAP acts to regulate inflammation via multiple receptor subtypes and multiple targets, including inflammatory cells.
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[Technical specification for clinical application of critical ultrasonography]. ZHONGHUA NEI KE ZA ZHI 2018; 57:397-417. [PMID: 29925125 DOI: 10.3760/cma.j.issn.0578-1426.2018.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Critical ultrasonography(CUS) is different from the traditional diagnostic ultrasound, the examiner and interpreter of the image are critical care medicine physicians. The core content of CUS is to evaluate the pathophysiological changes of organs and systems and etiology changes. With the idea of critical care medicine as the soul, it can integrate the above information and clinical information, bedside real-time diagnosis and titration treatment, and evaluate the therapeutic effect so as to improve the outcome. CUS is a traditional technique which is applied as a new application method. The consensus of experts on critical ultrasonography in China released in 2016 put forward consensus suggestions on the concept, implementation and application of CUS. It should be further emphasized that the accurate and objective assessment and implementation of CUS requires the standardization of ultrasound image acquisition and the need to establish a CUS procedure. At the same time, the standardized training for CUS accepted by critical care medicine physicians requires the application of technical specifications, and the establishment of technical specifications is the basis for the quality control and continuous improvement of CUS. Chinese Critical Ultrasound Study Group and Critical Hemodynamic Therapy Collabration Group, based on the rich experience of clinical practice in critical care and research, combined with the essence of CUS, to learn the traditional ultrasonic essence, established the clinical application technical specifications of CUS, including in five parts: basic view and relevant indicators to obtain in CUS; basic norms for viscera organ assessment and special assessment; standardized processes and systematic inspection programs; examples of CUS applications; CUS training and the application of qualification certification. The establishment of applied technology standard is helpful for standardized training and clinical correct implementation. It is helpful for clinical evaluation and correct guidance treatment, and is also helpful for quality control and continuous improvement of CUS application.
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The Profile of Angiogenic Factors in Vitreous Humor of the Patients with Proliferative Diabetic Retinopathy. Curr Mol Med 2018; 17:280-286. [PMID: 29110608 DOI: 10.2174/1566524017666171106111440] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 10/14/2017] [Accepted: 10/30/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To explore the expression profile of angiogenic factors associated with proliferative diabetic retinopathy (PDR). METHODS Undiluted vitreous humor samples were obtained from 10 diabetic patients with PDR (10 eyes) and 9 non-diabtic patients (9 eyes). The concentrations of 60 angiogenic factors in the vitreous humor samples were measured by RayBio Angiogenic Cytokine Antibody Array. Some differentially expressed factors were further confirmed in vitreous humor by enzyme-linked immunosorbent assay (ELISA). RESULTS Compared with the non-diabetic controls, 20 differentially expressed factors with more than 1.50 fold changes were detected in patients with PDR. The median concentration of vascular endothelial growth factor (VEGF), interleukin 6 (IL-6), angiopoietin (ANG)-1, ANG-2, urokinase-type plasminogen activator receptor (uPAR), Follistatin and matrix metalloproteinases 9 (MMP-9) was significantly increased in vitreous samples from PDR compared to controls (P < 0.05). However, (MCP)-1, Angiogenin and Leptin was significantly lower in PDR eyes compared to controls (P < 0.05). In the verification assay using ELISA, ANG-1, ANG-2, IL-6, VEGF, MMP-9, hepatocyte growth factor (HGF) and placenta growth factor (PIGF) concentration were increased in patients with PDR compared to controls (all P-values < 0.05). CONCLUSION This is the first report of a comprehensive multiplex analysis to identify angiogenic factors associated with PDR. These angiogenic factors may contribute to the pathogenesis of PDR and may be targets for therapeutic strategies of PDR.
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WS09.4 Targeting αENaC with an epithelial RNAi trigger delivery platform for the treatment of cystic fibrosis. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30170-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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[Primary carcinoid of ovary: a clinicopathologic analysis of 17 cases]. ZHONGHUA BING LI XUE ZA ZHI = CHINESE JOURNAL OF PATHOLOGY 2018; 47:339-343. [PMID: 29783799 DOI: 10.3760/cma.j.issn.0529-5807.2018.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To study the clinicopathologic feature, diagnostic strategy and prognostic significance of primary carcinoid of the ovary (PCOTO). Methods: A series of 17 patients previously diagnosed as PCOTO at Department of Pathology, Peking Union Medical College Hospital during the period from 2002 to 2017 were evaluated with clinical data analysis, histopathology and immunohistochemistry, and the patients were followed up and the relevant literatures were reviewed. Results: The age of patients ranged from 24 to 64 years (mean, 42 years). Fourteen patients were found a pelvic mass for a health check-up, and only 3 patients presented with pain in the lower abdomen. The left ovary was involved initially in ten patients, and the right in seven. The major axis of the tumor ranged from 2 to 14 cm. The surface of these tumors was smooth. Seven of the tumors were solid-cystic, 6 were cystic and 4 were solid. Under light microscope, 6 cases were diagnosed as strumal carcinoid, 4 cases were insular carcinoid, 4 cases were trabecular carcinoid, 3 cases were insular and trabecular mixed type carcinoid and 1 case was mucinous carcinoid. The mitotic figures were no more than 1/10 HPF.There were 11 cases complicated with other ovarian tumors, including 10 cases with teratoma, and 1 case with mucinous cystic adenoma. The paraffin-embedded tissues of all cases showed immunoreactivity for NSE and Syn, and the positive propotion of CgA was 10/17. TTF1 was positive in thyroid follicles and negative in strumal carcinoid. The positive index of Ki-67 was no more than 2%. Follow-up of 13 to 188 months showed 16 patients without recurrence and 1 patients were loss to follow-up. Conclusions: PCOTO is very rare. Most of the patients are found with a mass during health check-up in unilateral ovary and without obvious clinical symptoms. Histologically, the tumor always exists with other ovarian tumors, including teratoma and mucinous cystic adenoma, with relatively good prognosis.
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Multivariate computational analysis of biosensor's data for improved CD64 quantification for sepsis diagnosis. LAB ON A CHIP 2018; 18:1231-1240. [PMID: 29564463 DOI: 10.1039/c8lc00108a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Sepsis, as a leading cause of death worldwide, relies on systemic inflammatory response syndrome (SIRS) criteria for its diagnosis. SIRS is highly non-specific as it relies on monitoring of patients' vitals for sepsis diagnosis, which are known to change with many confounding factors. Changes in leukocyte counts and CD64 expression levels are known specific biomarkers of pro-inflammatory host response at the onset of sepsis. Recently, we have developed a biosensor chip that can enumerate the leukocyte counts and quantify the neutrophil CD64 expression levels from a drop of blood. We were able to show improved sepsis diagnosis and prognosis in clinical studies by measuring these parameters during different times of the patients' stay in hospital. In this paper, we investigated the rate of cell capture with CD64 expression levels and used this in a multivariate computational model using artificial neural networks (ANNs) and showed improved accuracy of quantifying CD64 expression levels from the biosensor (n = 106 whole blood experiments). We found a high coefficient of determination and low error between biosensor- and flow cytometry-based neutrophil CD64 expression levels using multiple ANN training methods in comparison to those of univariate regression commonly employed. This approach can find many applications in biosensor data analytics by utilizing multiple features of the biosensor's data for output determination.
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Abstract
Background The glycosylation of proteins on the surface of corneocytes is believed to play an important role in cellular adhesion in the stratum corneum (SC) of human skin. Mapping with accuracy the localization of glycans on the surface of corneocytes through traditional methods of immunohistochemistry and electron microscopy remains a challenging task as both approaches lack enough resolution or need to be performed in high vacuum conditions. Materials and methods We used an advanced mode of atomic force microscope (AFM), with simultaneous topography and recognition imaging to investigate the distribution of glycans on native (no chemical preparation) stripped samples of human SC. The AFM cantilever tips were functionalized with anti‐heparan sulfate antibody and the lectin wheat germ agglutinin (WGA) which binds specifically to N‐acetyl glucosamine and sialic acid. Results From the recognition imaging, we observed the presence of the sulfated glycosaminoglycan, heparan sulfate, and the glycans recognized by WGA on the surface of SC corneocytes in their native state. These glycans were found associated with bead‐like domains which represent corneodesmosomes in the SC layers. Glycan density was calculated to be ~1200 molecules/μm2 in lower layers of SC compared to an important decrease, (~106 molecules/μm2) closer to the surface due probably to corneodesmosome degradation. Conclusion Glycan spatial distribution and degradation is first observed on the surface of SC in native conditions and at high resolution. The method used can be extended to precisely localize the presence of other macromolecules on the surface of skin or other tissues where the maintenance of its native state is required.
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Kirigami-based Elastic Metamaterials with Anisotropic Mass Density for Subwavelength Flexural Wave Control. Sci Rep 2018; 8:483. [PMID: 29323177 PMCID: PMC5764965 DOI: 10.1038/s41598-017-18864-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 12/18/2017] [Indexed: 11/21/2022] Open
Abstract
A novel design of an elastic metamaterial with anisotropic mass density is proposed to manipulate flexural waves at a subwavelength scale. The three-dimensional metamaterial is inspired by kirigami, which can be easily manufactured by cutting and folding a thin metallic plate. By attaching the resonant kirigami structures periodically on the top of a host plate, a metamaterial plate can be constructed without any perforation that degrades the strength of the pristine plate. An analytical model is developed to understand the working mechanism of the proposed elastic metamaterial and the dispersion curves are calculated by using an extended plane wave expansion method. As a result, we verify an anisotropic effective mass density stemming from the coupling between the local resonance of the kirigami cells and the global flexural wave propagations in the host plate. Finally, numerical simulations on the directional flexural wave propagation in a two-dimensional array of kirigami metamaterial as well as super-resolution imaging through an elastic hyperlens are conducted to demonstrate the subwavelength-scale flexural wave control abilities. The proposed kirigami-based metamaterial has the advantages of no-perforation design and subwavelength flexural wave manipulation capability, which can be highly useful for engineering applications including non-destructive evaluations and structural health monitoring.
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HMPA-Catalyzed One-Pot Multistep Hydrogenation Method for the Synthesis of 1,2,3-Trisubstituted Indolines. Synlett 2017. [DOI: 10.1055/s-0036-1590953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A convenient and facile method was developed for the synthesis of 1,2,3-trisubstituted indolines. Starting from indole derivatives and ketones/aldehydes, the corresponding indoline products could be obtained with high yield by the hexamethylphosphoramide (HMPA) catalyzed indole Friedel–Crafts reaction, reduction and direct reductive amination process.
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Recognition of Core- and Polymerase-derived immunogenic peptides included in novel therapeutic vaccine by T cells from Chinese chronic hepatitis B patients. J Viral Hepat 2017; 24 Suppl 1:66-74. [PMID: 29082648 DOI: 10.1111/jvh.12791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 08/24/2017] [Indexed: 12/09/2022]
Abstract
Chronic hepatitis B (CHB) is one of the major public health challenges in the world. Due to a strong interplay between specific T-cell immunity and elimination of hepatitis B virus (HBV), efforts to develop novel immunotherapeutics are gaining attention. TG1050, a novel immunotherapy, has shown efficacy in an animal study. To support the clinical development of TG1050 in China, specific immunity to the fusion antigens of TG1050 was assessed in Chinese patients. One hundred and thirty subjects were divided into three groups as CHB patients, HBV spontaneous resolvers, and CHB patients with HBsAg loss after antiviral treatment. HBV-specific T-cell responses to pools of HBV Core or Polymerase genotype D peptides included in TG1050 were evaluated. HBV Core- or Polymerase-specific cells were detected in peripheral blood mononuclear cells (PBMCs) from the different cohorts. The frequencies and intensities of HBV Core-specific immune responses were significantly lower in CHB patients than in HBsAg loss subjects. In CHB patients, a dominant pool derived from Polymerase (Pol1) was the most immunogenic. CHB patients with low viral loads (<106 IU/mL) were more likely to have a positive response specific to the Core peptide pool. Overall, genotype D-derived peptides included in TG1050 could raise broad and functional T-cell responses in PBMCs from Chinese CHB patients infected with genotype B/C isolates. Core-specific immunogenic domains appeared as "hot spots" with the capacity to differentiate between CHB vs HBsAg loss subjects. These observations support the extended application and associated immune monitoring of TG1050 in China.
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Abstract
Objective: To investigate the epidemiological and clinical features of 20 patients with neurobrucellosis (NB) . Methods: The epidemiological, clinical, laboratory and treatment data of patients diagnosed with NB from 2010 to 2016 in Peking Union Medical College Hospital were retrospectively analyzed. Results: Twelve (60%) patients reported the history of contact with infected animals and intake of raw milk product. The common manifestations included headache (85%, 17/20), fatigue (85%, 17/20), fever (80%, 16/20), weight loss (70%, 15/20), the signs included pathological reflection (70%, 15/20), decreased muscle strength(45%, 9/20). The mean time to diagnosis was 7.9 months. All patients were diagnosed by positive serum antibody against Brucella. Body fluid culture revealed positive blood Brucella in 5 (31.2%, 5/16) patients and positive cerebrospinal fluid in 3 (16.7%, 3/18) patients. The medication consisted of rifampicin and minocycline based regimens or combined with ceftriaxone, fluroquinolone, streptomycin or trimethoprim-sulfamethoxazole (TMP-SMX). Ninety percent(18/20) patients obtained clinical improvement, whereas mild sequelae were observed in 5 patients. Conclusions: Clinical features of NB are heterogeneous. Carefully seek for epidemiological clues and early tests for Brucella may lead to well outcome. Combination therapy with two or more active antimicrobial agents is suggested.
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