BACKGROUND Fracture nonunion represents a challenging complication during fracture repair,often necessitating surgical intervention.Teriparatide,a recombinant human parathyroid hormone,has demonstrated promise in enha...BACKGROUND Fracture nonunion represents a challenging complication during fracture repair,often necessitating surgical intervention.Teriparatide,a recombinant human parathyroid hormone,has demonstrated promise in enhancing fracture healing,although its efficacy in treating established nonunion remains under investigation.CASE SUMMARY We report a case of a 27-year-old male who presented with a right humerus fracture following a traffic accident.Despite undergoing open reduction and internal fixation,the fracture resulted in a delayed union and subsequent nonunion.After 4 years of conservative management,teriparatide treatment was initiated due to persistent nonunion.Teriparatide injections were administered daily for 6 months,resulting in complete fracture healing and resolution of pain.CONCLUSION Our case demonstrates the successful use of teriparatide in treating a prolonged nonunion of a humerus fracture.Teriparatide may provide a valuable therapeutic option for established bone nonunion,even in cases that have not responded to conservative treatments.展开更多
The widespread popularization and application of laser technology have provided a powerful tool for a deeper understanding of the material world and given birth to several emerging research fields.This study mainly fo...The widespread popularization and application of laser technology have provided a powerful tool for a deeper understanding of the material world and given birth to several emerging research fields.This study mainly focuses on the following three key aspects.First,the classical ensemble method is adopted to conduct a comprehensive and in-depth analysis of two-dimensional(2D)matter–wave pulses in Bose–Fermi mixed gases(including linear and nonlinear pulses).Second,under the strict constraints of unitary systems,a coupled Kd V equation is successfully derived,and the prolongation structure theory is skillfully used to carry out detailed calculations and analyses on this equation.Thus,the prolongation algebra of this equation is accurately determined,and the corresponding Lax pair is rigorously derived.Finally,based on the carefully obtained Lax pair from the prolongation structure theory,the soliton solutions of this equation are further analyzed in depth,and intuitive images of each soliton solution are carefully drawn.This lays a solid foundation for subsequent detailed research on these soliton characteristics and provides great convenience.展开更多
BACKGROUND:This study aimed to develop and validate a nomogram to estimate the probability of prolonged intensive care unit(ICU)stays.METHODS:Pediatric patients who underwent cardiac surgery were included,with data co...BACKGROUND:This study aimed to develop and validate a nomogram to estimate the probability of prolonged intensive care unit(ICU)stays.METHODS:Pediatric patients who underwent cardiac surgery were included,with data collected from the pediatric intensive care database.The datasets were randomly divided into a training set(75%)and a testing set(25%).A nomogram model was developed to predict prolonged ICU stays in the training set and then validated in the testing set.RESULTS:A total of 795 patients and 266 patients were assigned to the training and testing sets,respectively,with consistent variables.The nomogram developed from the training set included eight characteristics:age,systolic blood pressure,respiratory rate,bicarbonate,direct bilirubin,high-sensitivity C-reactive protein,international normalized ratio,and operation time.The area under the curve values of the nomogram in the training and testing sets were 0.812 and 0.736,respectively.The nomogram demonstrated excellent discrimination and calibration.Decision curve analysis showed that the use of the nomogram resulted in more favorable outcomes compared with the strategies of treating all or none of the patients.CONCLUSION:This study presents a nomogram that may enable early identification of high-risk patients and facilitates tailored postoperative care and better outcomes after pediatric cardiac surgery.展开更多
Atrial fibrillation(AF)is the most common arrhythmia in clinical setting and has been increasingly prevalent due to the aging population.AF is associated with a three to fivefold increased risk of stroke.Treatment opt...Atrial fibrillation(AF)is the most common arrhythmia in clinical setting and has been increasingly prevalent due to the aging population.AF is associated with a three to fivefold increased risk of stroke.Treatment options include pharmacological and electrical cardioversion,each carrying specific risks.AF may resolve spontaneously,but often recurs,making a“watch-andwait”strategy a reasonable approach to avoid unnecessary antiarrhythmic therapy.展开更多
Poyang Lake,China's largest freshwater lake,is a critical wintering ground for most of the global Siberian Grane(Grus leucogeranus)population.However,increasingly prolonged dry seasons have degraded the natural we...Poyang Lake,China's largest freshwater lake,is a critical wintering ground for most of the global Siberian Grane(Grus leucogeranus)population.However,increasingly prolonged dry seasons have degraded the natural wetlands of Poyang Lake,forcing Siberian Cranes to shift to artificial habitats.From 2015 to 2023,field surveys revealed a substantial increase in the number of Siberian Cranes in artificial habitats,with peak counts reaching 3000individuals,accounting for up to 53%of the species'global population.Satellite telemetry of 13 individuals further confirmed the spatial use of these habitats,highlighting their consistent reliance on artificial sites over multiple years.Seven high-use hotspots were identified outside of Poyang Lake,including two artificial provisioning sites that supported dense foraging flocks for extended periods.Satellite telemetry confirmed this trend,with artificial habitats making up to 64.2%of the occurrence sites in some years.This reliance on artificial habitats was closely linked to the reduced tuber biomass in natural wetlands and low winter water levels in Poyang Lake,which collectively explained 83%of the variance in crane abundance in artificial habitats.Artificial habitat use peaked in December and January,indicating marked seasonal variation.Siberian Cranes also exhibited a pronounced circadian rhythm,foraging in artificial habitats during the day and returning to natural wetlands to roost at night.Despite the shift toward artificial habitats,natural wetlands remain critical for nighttime refuge.The continued dependence on artificial habitats raises concerns about disease transmission owing to dense congregations.Conservation strategies should prioritize both the careful management of artificial provisioning sites and the restoration of natural wetlands to improve food and habitat availability within natural ecosystems,ultimately enabling the return of Siberian Cranes to their traditional natural habitats.展开更多
Prolonged grief disorder(PGD)is characterized by intense and persistent grief that significantly impairs daily functioning.For bereaved parents,the loss of a child represents an unparalleled emotional challenge,placin...Prolonged grief disorder(PGD)is characterized by intense and persistent grief that significantly impairs daily functioning.For bereaved parents,the loss of a child represents an unparalleled emotional challenge,placing them at heightened risk of developing PGD.This review traces the evolution of PGD from early con-ceptualization to current definitions in the International Classification of Diseases,11th revision,and Diagnostic and Statistical Manual of Mental Disorders,5th Edition,Text Revision.Building on this historical foundation,the analysis examined the prevalence,risk factors,and diagnostic criteria of PGD in bereaved parents,with particular attention to sex differences,the nature of the loss,and the time elapsed since the child’s death.Furthermore,this review examines the multidimensional consequences of PGD on parents,including its emotional,physiological,and functional effects.Evidence-based treatments for PGD,such as psychotherapeutic approaches and emerging interventions,are also discussed.By synthesizing existing research,this review provides a comprehensive under-standing of PGD among bereaved parents,highlights the unique challenges they face,and offers practical insights and recommendations for clinicians working with this population.展开更多
BACKGROUND Dexmedetomidine and propofol are two sedatives used for long-term sedation.It remains unclear whether dexmedetomidine provides superior cerebral protection for patients undergoing long-term mechanical venti...BACKGROUND Dexmedetomidine and propofol are two sedatives used for long-term sedation.It remains unclear whether dexmedetomidine provides superior cerebral protection for patients undergoing long-term mechanical ventilation.AIM To compare the neuroprotective effects of dexmedetomidine and propofol for sedation during prolonged mechanical ventilation in patients without brain injury.METHODS Patients who underwent mechanical ventilation for>72 h were randomly assigned to receive sedation with dexmedetomidine or propofol.The Richmond Agitation and Sedation Scale(RASS)was used to evaluate sedation effects,with a target range of-3 to 0.The primary outcomes were serum levels of S100-βand neuron-specific enolase(NSE)every 24 h.The secondary outcomes were remifentanil dosage,the proportion of patients requiring rescue sedation,and the time and frequency of RASS scores within the target range.RESULTS A total of 52 and 63 patients were allocated to the dexmedetomidine group and propofol group,respectively.Baseline data were comparable between groups.No significant differences were identified between groups within the median duration of study drug infusion[52.0(IQR:36.0-73.5)h vs 53.0(IQR:37.0-72.0)h,P=0.958],the median dose of remifentanil[4.5(IQR:4.0-5.0)μg/kg/h vs 4.6(IQR:4.0-5.0)μg/kg/h,P=0.395],the median percentage of time in the target RASS range without rescue sedation[85.6%(IQR:65.8%-96.6%)vs 86.7%(IQR:72.3%-95.3),P=0.592],and the median frequency within the target RASS range without rescue sedation[72.2%(60.8%-91.7%)vs 73.3%(60.0%-100.0%),P=0.880].The proportion of patients in the dexmedetomidine group who required rescue sedation was higher than in the propofol group with statistical significance(69.2%vs 50.8%,P=0.045).Serum S100-βand NSE levels in the propofol group were higher than in the dexmedetomidine group with statistical significance during the first six and five days of mechanical ventilation,respectively(all P<0.05).CONCLUSION Dexmedetomidine demonstrated stronger protective effects on the brain compared to propofol for long-term mechanical ventilation in patients without brain injury.展开更多
BACKGROUND Prolonged postoperative ileus(PPOI)delays the postoperative recovery of gastrointestinal function in patients with gastric cancer(GC),leading to longer hospitalization and higher healthcare expenditure.Howe...BACKGROUND Prolonged postoperative ileus(PPOI)delays the postoperative recovery of gastrointestinal function in patients with gastric cancer(GC),leading to longer hospitalization and higher healthcare expenditure.However,effective monitoring of gastrointestinal recovery in patients with GC remains challenging because of AIM To explore the risk factors for delayed postoperative bowel function recovery and evaluate bowel sound indicators collected via an intelligent auscultation system to guide clinical practice.METHODS This study included data from 120 patients diagnosed with GC who had undergone surgical treatment and postoperative bowel sound monitoring in the Department of General Surgery II at Shaanxi Provincial People's Hospital between January 2019 and January 2021.Among them,PPOI was reported in 33 cases.The patients were randomly divided into the training and validation cohorts.Significant variables from the training cohort were identified using univariate and multivariable analyses and were included in the model.RESULTS The analysis identified six potential variables associated with PPOI among the included participants.The incidence rate of PPOI was 27.5%.Age≥70 years,cTNM stage(Ⅰ and Ⅳ),preoperative hypoproteinemia,recovery time of bowel sounds(RTBS),number of bowel sounds(NBS),and frequency of bowel sounds(FBS)were independent risk factors for PPOI.The Bayesian model demonstrated good performance with internal validation:Training cohort[area under the curve(AUC)=0.880,accuracy=0.823,Brier score=0.139]and validation cohort(AUC=0.747,accuracy=0.690,Brier score=0.215).The model showed a good fit and calibration in the decision curve analysis,indicating a significant net benefit.CONCLUSION PPOI is a common complication following gastrectomy in patients with GC and is associated with age,cTNM stage,preoperative hypoproteinemia,and specific bowel sound-related indices(RTBS,NBS,and FBS).To facilitate early intervention and improve patient outcomes,clinicians should consider these factors,optimize preoperative nutritional status,and implement routine postoperative bowel sound monitoring.This study introduces an accessible machine learning model for predicting PPOI in patients with GC.展开更多
The Oriental Reed Warbler(Acrocephalus orientalis)is one of the most commonly used hosts for the parasitic Common Cuckoo(Cuculus canorus).However,as hosts that feed unrelated parasitic nestlings may suffer extra repro...The Oriental Reed Warbler(Acrocephalus orientalis)is one of the most commonly used hosts for the parasitic Common Cuckoo(Cuculus canorus).However,as hosts that feed unrelated parasitic nestlings may suffer extra reproductive costs,they may be less willing to care for nestlings that have prolonged nestling periods.To test this hypothesis,the duration of feeding by Oriental Reed Warblers under natural conditions for their own nestlings was compared with the duration of feeding under natural conditions for Common Cuckoo nestlings and for artificially prolonged cuckoo nestlings.The results showed that Oriental Reed Warblers did not starve,drive away,or desert any of the nestlings in the experiment,and neither parent was left alone.Our experimental study indicates that both Oriental Reed Warbler parents were willing to care for nestlings with a prolonged nestling period(up to 30 days,twice the average duration time that the Oriental Reed Warblers fed their own chicks in natural conditions).However,further experiments and observations are required in other host bird species to examine whether both parents or one of the parents may exhibit the behavior of abandoning nestlings with a prolonged nestling period.展开更多
BACKGROUND Cardiac arrest(CA)induced by electric shock is a rare occurrence,particularly in cases of prolonged CA.Currently,there is limited literature on similar incidents,and we present a relevant case report.CASE S...BACKGROUND Cardiac arrest(CA)induced by electric shock is a rare occurrence,particularly in cases of prolonged CA.Currently,there is limited literature on similar incidents,and we present a relevant case report.CASE SUMMARY A 27-year-old Asian male man,experiencing respiratory CA due to electric shock,was successfully restored to sinus rhythm after 50 min of cardiopulmonary resuscitation and 8 electrical defibrillation sessions.In the subsequent stages,the patient received multiple organ function protection measures,leading to a successful recovery and eventual discharge from the hospital.CONCLUSION Prolonging resuscitation time can enhance the chances of survival for patients,this study provide valuable insights into the management of electric shock-induced CA.展开更多
BACKGROUND QTc interval prolongation with an increased risk of torsade de pointes(Tsd)has been described in coronavirus disease 2019(COVID-19)patients treated with hydroxychloroquine(HCQ)and azithromycin(AZI)in Wester...BACKGROUND QTc interval prolongation with an increased risk of torsade de pointes(Tsd)has been described in coronavirus disease 2019(COVID-19)patients treated with hydroxychloroquine(HCQ)and azithromycin(AZI)in Western countries.In the DR Congo,few studies have evaluated the safety of this association or proposed new molecules.AIM To determine the incidence of QTc prolongation and Tsd in COVID-19 patients treated with HCQ-AZIs vs doubase C(new molecule).METHODS In present randomized clinical trial,we have included patients with mild or moderate COVID-19 treated with either HCQ-AZI or doubase C.Electrocardiogram(ECG)changes on day 14 of randomization were determined based on pretreatment tracing.Prolonged QTc was defined as≥500 ms on day 14 or an increase of≥80 ms compared to pretreatment tracing.Patients with cardiac disease,those undergoing other treatments likely to prolong QTc,and those with disturbed ECG tracings were excluded from the study.RESULTS The study included 258 patients(mean age 41±15 years;52%men;3.4%diabetics,11.1%hypertensive).Mild and moderate COVID-19 were found in 93.5%and 6.5%of patients,respectively.At baseline,all patients had normal sinus rhythm,a mean heart rate 78±13/min,mean PR space 170±28 ms,mean QRS 76±13 ms,and mean QTc 405±30 ms.No complaints suggesting cardiac involvement were reported during or after treatment.Only four patients(1.5%)experienced QTc interval prolongation beyond 500 ms.Similarly,only five patients(1.9%)had an increase in the QTc interval of more than 80 ms.QTc prolongation was more significant in younger patients,those with high viral load at baseline,and those receiving HCQ-AZI(P<0.05).None of the patients developed Tsd.CONCLUSION QTc prolongation without Tsd was observed at a lower frequency in patients treated with HCQ-AZI vs doubase C.The absence of comorbidities and concurrent use of other products that are likely to cause arrhythmia may explain our results.展开更多
Background The neutrophil-to-lymphocyte ratio(NLR)stands as a valuable marker for assessing inflammation and predicting adverse outcomes post-cardiac surgery.This study aimed to ascertain the prognostic relevance of p...Background The neutrophil-to-lymphocyte ratio(NLR)stands as a valuable marker for assessing inflammation and predicting adverse outcomes post-cardiac surgery.This study aimed to ascertain the prognostic relevance of preoperative NLR concerning prolonged ICU stay among infants undergoing congenital heart surgery employing cardiopulmonary bypass.Methods A retrospective review was conducted involving 187 consecutive infants(≤1 year)who underwent congenital heart disease surgery between January and April 2019,stratified into two groups based on NLR(NLR<0.484,NLR≥0.484).The primary outcome was prolonged intensive care unit(ICU)length of stay,defined patients with ICU stays duration higher than the third quartile.Correlations between preoperative NLR and clinical outcomes were assessed.Receiver operating characteristic curve analysis,multivariable Logistic regression,and restricted cube plots were utilized to gauge the association of preoperative NLR with prolonged ICU stay.Results The area under the receiver operating characteristic curve of NLRpredictive capability for prolonged ICU length of staywas 0.691.Subgroup analyses revealed poorer prognoses among patients with high NLR(≥0.484).Multivariable Logistic regression analysis indicated that heightened preoperative NLR(OR:2.63,95%CI:1.18-5.83,P=0.018)independently was correlated with prolonged ICU length of stay in infants'post-cardiac surgery.Conclusions In summary,the NLR emerges as a significant predictive factor for prolonged ICU stay in infants undergoing cardiac surgery.Nevertheless,further research is warranted to comprehensively grasp the relationship between the NLR and prolonged ICU stay.展开更多
Background Thered cell distribution width(RDW)is a parameter that reflects the heterogeneity of red blood cell volume and size,and it is commonly used in the diagnosis of anemia in patients.RDW may serve as a predicto...Background Thered cell distribution width(RDW)is a parameter that reflects the heterogeneity of red blood cell volume and size,and it is commonly used in the diagnosis of anemia in patients.RDW may serve as a predictor of the postoperative prognosis of surgical patients in the intensive care unit.This study evaluated the predictive capability of RDW for outcomes in infants after cardiopulmonary bypass surgery.Methods A retrospective cohort study was conducted at Guangdong Provincial People's Hospital enrolling infants(≤1 year)who underwent cardiac surgery between January 2019 and April 2019.The infants were divided into two groups based on their preoperative RDW levels(<14.5% and≥14.5%).The primary outcome measured was the prolonged hospital stay post-operation.The association between RDW levels and prolonged hospital length of stay was evaluated using multivariate Logistic regression,presenting the adjusted odds ratio with a 95%confidence interval(CI).Additionally,interaction and subgroup analyses were performed to assess the consistency of these correlations.Results A total of 186 infants were included in the study.After adjusting for potential confounders,multivariate logistic regression models demonstrated a significant association between RDW and prolonged length of stay(LOS)in hospital when treated as a continuous variable(change per 1SD,OR:1.50,95%CI:1.06-2.11,P=0.021).Categorizing RDW as a variable revealed that higher RDW levels(≥14.5%)were significantly associated with an increased risk of prolonged LOS compared to lower levels(<14.5%)(OR:9.72,95%CI:2.87-32.91,P<0.001).Receiver operating curves(ROC)analysis showed that RDW levels exhibited relatively higher diagnostic value for predicting prolonged LOS(AUC=0.697,95%CI:0.617-0.776,P<0.05).Stratified analyses further showed that depending on the variable testing,an association between higher RDW levels and prolonged hospital length of stay in different subgroups was observed.Conclusions Elevated RDW levels in infants undergoing cardiac surgery involving cardiopulmonary bypass may signify prolonged recovery periods.展开更多
Background The prognostic nutritional index(PNI) value has been testified to predict mortality in several cardiovascular diseases. The study aimed to determine the relationship between preoperative prognostic nutritio...Background The prognostic nutritional index(PNI) value has been testified to predict mortality in several cardiovascular diseases. The study aimed to determine the relationship between preoperative prognostic nutritional index and prolonged recovery after cardiac surgery. Methods The PNI values of 315 adult cardiac surgery patients were analyzed. All patients were divided into three groups according to the tertiles of PNI score: low group(PNI <47.4), medium group(47.4 ≤ PNI ≤51.9), and high group(PNI >51.9). Results A total of 315 patients were included in the study. In the multivariate logistic regression analysis, PNI demonstrated a significant association with prolonged recovery when utilized as a continuous variable(change per 1 SD, OR: 0.63, 95% CI: 0.48-0.84, P=0.001). When PNI was evaluated as a categorical variable, the high PNI group was significantly associated with an increased risk of prolonged recovery compared to the low PNI group(OR: 0.41, 95% CI: 0.21-0.78, P=0.007). The receiver operating characteristic(ROC) curve analysis showed that PNI level had a relatively high predictive value for prolonged recovery, with an area under the curve of 0.631(95% CI: 0.567-0.695, P<0.05). Conclusions High prognostic nutritional index levels were significantly associated with an decreased prolonged recovery risk in adult patients after cardiac surgery.展开更多
To evaluate the efficacy and safety of gemcitabine （GEM） at 30 min standard-dose infusion （30 min-SDI） compared with prolonged low-dose infusion （P-LDI） in patients with advanced non-small-cell lung cancer （NS...To evaluate the efficacy and safety of gemcitabine （GEM） at 30 min standard-dose infusion （30 min-SDI） compared with prolonged low-dose infusion （P-LDI） in patients with advanced non-small-cell lung cancer （NSCLC）. Electronic databases including Pubmed, EMbase, Cochrane Library, CNKI, CBM, and VIP were searched using keywords ＂GEM＂, ＂P-LDI＂, and ＂NSCLC＂. Review Manager 5.3 was used to perform the recta-analysis. Primary endpoints were overall response rate （ORR） and 1-year survival rate （1-year SR）. Secondary endpoints were grade 3/4 hematotoxicity and nausea/vomiting. Six randomized controlled trials （RCTs） with a total of 637 patients were included. The results showed that P-LDI was superior in ORR （OR = 1.50, 95% CI： 1.08-2.10, P = 0.02）, but had an equal 1-year SR （OR = 1.27, 95 % CI： 0.90-1.79, P = 0.18） as compared with 30 min-SDl. For grade 3/4 adverse events, there was no significant difference in anemia （OR = 1.84, 95% CI： 0.61-5.57, P = 0.28） and nausea/vomiting （OR = 1.15, 95% CI： 0.63-2.12, P = 0.64） between the two treatments. However, patients with P-LDI experienced less leukopenia （OR = 0.64, 95% CI： 0.43-0.97, P = 0.04） and thrombocytopenia （OR = 0.37, 95% CI： 0.17-0.80, P = 0.01）. P-LDI was superior in terms of ORR, experienced less grade 3/4 thrombocytopenia and leukopenia compared with 30 min-SDI, and could be a viable treatment option for advanced NSCLC.展开更多
This study examined regional prolonged low temperature （PLT） events in China from the observational station data for the period 1960–2008 using the new criteria. The new definition of a site PLT event is that the d...This study examined regional prolonged low temperature （PLT） events in China from the observational station data for the period 1960–2008 using the new criteria. The new definition of a site PLT event is that the daily minimum temperature does not exceed the 10th percentile threshold of the local daily minimum temperature climatology for at least 5 days at a station. The regional PLT event is defined as at least five adjacent stations exhibiting site PLT simultaneously for 5 d. Under the new definition, 552 regional PLT events were identified, and three indices： duration, extent, and intensity, as well as a comprehensive index （CI） were used to quantify the event severity. In addition, geographical patterns and temporal variations of regional PLT events were investigated using three event categories： strong, moderate, and weak. Spatially, strong events were mainly located in the north of Xinjiang and along the Yangtze River to the south of the Yangtze River; moderate events occurred in Xinjiang and south of the Yangtze River; and weak events occurred south of the Yellow River. The variation for the annual frequency of regional PLT events in China in the last 49 years showed a significant decreasing trend with a rate of-1.99 times per decade, and the significant transition decade was the 1980s.展开更多
Objective:To discuss the effect of prolonged second stage of labor on maternal and neonatal outcomes.Methods:A total of 101 primiparas with the length of second stage of labor longer than 2 h were selected and pregnan...Objective:To discuss the effect of prolonged second stage of labor on maternal and neonatal outcomes.Methods:A total of 101 primiparas with the length of second stage of labor longer than 2 h were selected and pregnant women with the length less than 2 h served as control.The maternal and neonatal outcomes of two groups were observed and compared.Results:A total of 62.1%(18/11) with the length of second stage of labor between 120 min and 180 min,46.7%(28/32) between 181 min and 240 min and 12 longer than 241 min underwent vaginal delivery.The longer the length of second stage of labor,the lower score of Apgar scale for infants in 1 min,and the higher the incidence of asphyxia.But there was no difference in scale in 5 min.As second stage of labor prolonged,the incidences of cesarean section and of postpartum hemorrhage increased. Conclusions:Almost half of puerperas with the length of second stage of labor longer than 2 h underwent vaginal delivery.The prolonged second stage of labor can decrease the score of Apgar scale in 1 min,increase the incidence of asphyxia,but has no effect on scale in 5 min.It still need more evidence from evidence medicine to definition of time and treatment of second stage of labor.展开更多
BACKGROUND Prolonged postoperative ileus(PPOI)is one of the common complications in gastric cancer patients who underwent gastrectomy.Evidence on the predictors of PPOI after gastrectomy is limited and few prediction ...BACKGROUND Prolonged postoperative ileus(PPOI)is one of the common complications in gastric cancer patients who underwent gastrectomy.Evidence on the predictors of PPOI after gastrectomy is limited and few prediction models of nomogram are used to estimate the risk of PPOI.We hypothesized that a predictive nomogram can be used for clinical risk estimation of PPOI in gastric cancer patients.AIM To investigate the risk factors for PPOI and establish a nomogram for clinical risk estimation.METHODS Between June 2016 and March 2017,the data of 162 patients with gastrectomy were obtained from a prospective and observational registry database.Clinical data of patients who fulfilled the criteria were obtained.Univariate and multivariable logistic regression models were performed to detect the relationship between variables and PPOI.A nomogram for PPOI was developed and verified by bootstrap resampling.The calibration curve was employed to detect the concentricity between the model probability curve and ideal curve.The clinical usefulness of our model was evaluated using the net benefit curve.RESULTS This study analyzed 14 potential variables of PPOI in 162 gastric cancer patients who underwent gastrectomy.The incidence of PPOI was 19.75%in patients with gastrectomy.Age older than 60 years,open surgery,advanced stage(III–IV),and postoperative use of opioid analgesic were independent risk factors for PPOI.We developed a simple and easy-to-use prediction nomogram of PPOI after gastrectomy.This nomogram had an excellent diagnostic performance[area under the curve(AUC)=0.836,sensitivity=84.4%,and specificity=75.4%].This nomogram was further validated by bootstrapping for 500 repetitions.The AUC of the bootstrap model was 0.832(95%CI:0.741–0.924).This model showed a good fitting and calibration and positive net benefits in decision curve analysis.CONCLUSION We have developed a prediction nomogram of PPOI for gastric cancer.This novel nomogram might serve as an essential early warning sign of PPOI in gastric cancer patients.展开更多
We examined the possible multiple defects induced by acute and prolonged exposure to high levels of manganese（Mn） solution by monitoring the endpoints of lifespan,development,reproduction,and stress response.Our dat...We examined the possible multiple defects induced by acute and prolonged exposure to high levels of manganese（Mn） solution by monitoring the endpoints of lifespan,development,reproduction,and stress response.Our data suggest that acute exposure（6 h） to Mn did not cause severe defects of life span,development,and reproduction,similarly,no significant defect could be found in animals exposed to a low concentration of Mn（2.5 μmol/L） for 48 h.In contrast,prolonged exposure（48 h） to high Mn concentrations（75 and 200 μmol/L） resulted in significant defects of life span,development,and reproduction,as well as the increase of the percentage of population with hsp-16.2：：gfp expression indicating the obvious induction of stress responses in exposed animals.Moreover,prolonged exposure（48 h） to high concentrations（75 and 200 μmol/L） of Mn decreased the expression levels of antioxidant genes of sod-1,sod-2,sod-3,and sod-4 compared to control.Therefore,prolonged exposure to high concentrations of Mn will induce the severe defects of life span,development,and reproduction in nematodes possibly by affecting the stress response and expression of antioxidant genes in Caenorhabditis elegans.展开更多
BACKGROUND Prolonged postoperative ileus(PPOI) is a prolonged state of "pathological"gastrointestinal(GI) tract dysmotility. There are relatively few studies examining the influence of preoperative nutrition...BACKGROUND Prolonged postoperative ileus(PPOI) is a prolonged state of "pathological"gastrointestinal(GI) tract dysmotility. There are relatively few studies examining the influence of preoperative nutritional status on the development of PPOI in patients who underwent GI surgery. The association between preoperative albumin and PPOI has not been fully studied. We hypothesized that preoperative albumin may be an independent indicator of PPOI.AIM To analyze the role of preoperative albumin in predicting PPOI and to establish a nomogram for clinical risk evaluation.METHODS Patients were drawn from a prospective hospital registry database of GI surgery.A total of 311 patients diagnosed with gastric or colorectal cancer between June 2016 and March 2017 were included. Potential predictors of PPOI were analyzed by univariate and multivariable logistic regression analyses, and a nomogram for quantifying the presence of PPOI was developed and internally validated.RESULTS The overall PPOI rate was 21.54%. Advanced tumor stage and postoperative opioid analgesic administration were associated with PPOI. Preoperative albumin was an independent predictor of PPOI, and an optimal cutoff value of 39.15 was statistically calculated. After adjusting multiple variables, per unit or per SD increase in albumin resulted in a significant decrease in the incidence of PPOI of 8%(OR = 0.92, 95%CI: 0.85-1.00, P = 0.046) or 27%(OR = 0.73, 95%CI:0.54-0.99, P = 0.046), respectively. Patients with a high level of preoperative albumin(≥ 39.15) tended to experience PPOI compared to those with low levels(< 39.15)(OR = 0.43, 95%CI: 0.24-0.78, P = 0.006). A nomogram for predicting PPOI was developed [area under the curve(AUC) = 0.741] and internally validated by bootstrap resampling(AUC = 0.725, 95%CI: 0.663-0.799).CONCLUSION Preoperative albumin is an independent predictive factor of PPOI in patients who underwent GI surgery. The nomogram provided a model to screen for early indications in the clinical setting.展开更多
基金Supported by National Natural Science Foundation of China,No.82172441Suzhou City Major Disease Multicenter Clinical Research Project,No.DZXYJ202312+2 种基金Special Funding for Jiangsu Province Science and Technology Plan(Key Research and Development Program for Social Development),No.BE2023737Gusu Health Talent Plan Scientific Research Project,No.GSWS2022109Postgraduate Research and Practice Innovation Program of Jiangsu Province,No.SJCX24_2446.
文摘BACKGROUND Fracture nonunion represents a challenging complication during fracture repair,often necessitating surgical intervention.Teriparatide,a recombinant human parathyroid hormone,has demonstrated promise in enhancing fracture healing,although its efficacy in treating established nonunion remains under investigation.CASE SUMMARY We report a case of a 27-year-old male who presented with a right humerus fracture following a traffic accident.Despite undergoing open reduction and internal fixation,the fracture resulted in a delayed union and subsequent nonunion.After 4 years of conservative management,teriparatide treatment was initiated due to persistent nonunion.Teriparatide injections were administered daily for 6 months,resulting in complete fracture healing and resolution of pain.CONCLUSION Our case demonstrates the successful use of teriparatide in treating a prolonged nonunion of a humerus fracture.Teriparatide may provide a valuable therapeutic option for established bone nonunion,even in cases that have not responded to conservative treatments.
基金Project supported by the National Natural Science Foundation of China(Grant No.12261072)。
文摘The widespread popularization and application of laser technology have provided a powerful tool for a deeper understanding of the material world and given birth to several emerging research fields.This study mainly focuses on the following three key aspects.First,the classical ensemble method is adopted to conduct a comprehensive and in-depth analysis of two-dimensional(2D)matter–wave pulses in Bose–Fermi mixed gases(including linear and nonlinear pulses).Second,under the strict constraints of unitary systems,a coupled Kd V equation is successfully derived,and the prolongation structure theory is skillfully used to carry out detailed calculations and analyses on this equation.Thus,the prolongation algebra of this equation is accurately determined,and the corresponding Lax pair is rigorously derived.Finally,based on the carefully obtained Lax pair from the prolongation structure theory,the soliton solutions of this equation are further analyzed in depth,and intuitive images of each soliton solution are carefully drawn.This lays a solid foundation for subsequent detailed research on these soliton characteristics and provides great convenience.
基金supported by the National Natural Science Foundation of China(82230074,81971809 and 82372159)the Liangshan Prefecture Science and Technology Plan Project(23ZDYF0180 and 24YYYJ0043).
文摘BACKGROUND:This study aimed to develop and validate a nomogram to estimate the probability of prolonged intensive care unit(ICU)stays.METHODS:Pediatric patients who underwent cardiac surgery were included,with data collected from the pediatric intensive care database.The datasets were randomly divided into a training set(75%)and a testing set(25%).A nomogram model was developed to predict prolonged ICU stays in the training set and then validated in the testing set.RESULTS:A total of 795 patients and 266 patients were assigned to the training and testing sets,respectively,with consistent variables.The nomogram developed from the training set included eight characteristics:age,systolic blood pressure,respiratory rate,bicarbonate,direct bilirubin,high-sensitivity C-reactive protein,international normalized ratio,and operation time.The area under the curve values of the nomogram in the training and testing sets were 0.812 and 0.736,respectively.The nomogram demonstrated excellent discrimination and calibration.Decision curve analysis showed that the use of the nomogram resulted in more favorable outcomes compared with the strategies of treating all or none of the patients.CONCLUSION:This study presents a nomogram that may enable early identification of high-risk patients and facilitates tailored postoperative care and better outcomes after pediatric cardiac surgery.
文摘Atrial fibrillation(AF)is the most common arrhythmia in clinical setting and has been increasingly prevalent due to the aging population.AF is associated with a three to fivefold increased risk of stroke.Treatment options include pharmacological and electrical cardioversion,each carrying specific risks.AF may resolve spontaneously,but often recurs,making a“watch-andwait”strategy a reasonable approach to avoid unnecessary antiarrhythmic therapy.
基金supported by the National Natural Science Foundation of China(No.32260275)Fundamental Research Funds of CAF(CAFYBB2024ZA033)。
文摘Poyang Lake,China's largest freshwater lake,is a critical wintering ground for most of the global Siberian Grane(Grus leucogeranus)population.However,increasingly prolonged dry seasons have degraded the natural wetlands of Poyang Lake,forcing Siberian Cranes to shift to artificial habitats.From 2015 to 2023,field surveys revealed a substantial increase in the number of Siberian Cranes in artificial habitats,with peak counts reaching 3000individuals,accounting for up to 53%of the species'global population.Satellite telemetry of 13 individuals further confirmed the spatial use of these habitats,highlighting their consistent reliance on artificial sites over multiple years.Seven high-use hotspots were identified outside of Poyang Lake,including two artificial provisioning sites that supported dense foraging flocks for extended periods.Satellite telemetry confirmed this trend,with artificial habitats making up to 64.2%of the occurrence sites in some years.This reliance on artificial habitats was closely linked to the reduced tuber biomass in natural wetlands and low winter water levels in Poyang Lake,which collectively explained 83%of the variance in crane abundance in artificial habitats.Artificial habitat use peaked in December and January,indicating marked seasonal variation.Siberian Cranes also exhibited a pronounced circadian rhythm,foraging in artificial habitats during the day and returning to natural wetlands to roost at night.Despite the shift toward artificial habitats,natural wetlands remain critical for nighttime refuge.The continued dependence on artificial habitats raises concerns about disease transmission owing to dense congregations.Conservation strategies should prioritize both the careful management of artificial provisioning sites and the restoration of natural wetlands to improve food and habitat availability within natural ecosystems,ultimately enabling the return of Siberian Cranes to their traditional natural habitats.
文摘Prolonged grief disorder(PGD)is characterized by intense and persistent grief that significantly impairs daily functioning.For bereaved parents,the loss of a child represents an unparalleled emotional challenge,placing them at heightened risk of developing PGD.This review traces the evolution of PGD from early con-ceptualization to current definitions in the International Classification of Diseases,11th revision,and Diagnostic and Statistical Manual of Mental Disorders,5th Edition,Text Revision.Building on this historical foundation,the analysis examined the prevalence,risk factors,and diagnostic criteria of PGD in bereaved parents,with particular attention to sex differences,the nature of the loss,and the time elapsed since the child’s death.Furthermore,this review examines the multidimensional consequences of PGD on parents,including its emotional,physiological,and functional effects.Evidence-based treatments for PGD,such as psychotherapeutic approaches and emerging interventions,are also discussed.By synthesizing existing research,this review provides a comprehensive under-standing of PGD among bereaved parents,highlights the unique challenges they face,and offers practical insights and recommendations for clinicians working with this population.
文摘BACKGROUND Dexmedetomidine and propofol are two sedatives used for long-term sedation.It remains unclear whether dexmedetomidine provides superior cerebral protection for patients undergoing long-term mechanical ventilation.AIM To compare the neuroprotective effects of dexmedetomidine and propofol for sedation during prolonged mechanical ventilation in patients without brain injury.METHODS Patients who underwent mechanical ventilation for>72 h were randomly assigned to receive sedation with dexmedetomidine or propofol.The Richmond Agitation and Sedation Scale(RASS)was used to evaluate sedation effects,with a target range of-3 to 0.The primary outcomes were serum levels of S100-βand neuron-specific enolase(NSE)every 24 h.The secondary outcomes were remifentanil dosage,the proportion of patients requiring rescue sedation,and the time and frequency of RASS scores within the target range.RESULTS A total of 52 and 63 patients were allocated to the dexmedetomidine group and propofol group,respectively.Baseline data were comparable between groups.No significant differences were identified between groups within the median duration of study drug infusion[52.0(IQR:36.0-73.5)h vs 53.0(IQR:37.0-72.0)h,P=0.958],the median dose of remifentanil[4.5(IQR:4.0-5.0)μg/kg/h vs 4.6(IQR:4.0-5.0)μg/kg/h,P=0.395],the median percentage of time in the target RASS range without rescue sedation[85.6%(IQR:65.8%-96.6%)vs 86.7%(IQR:72.3%-95.3),P=0.592],and the median frequency within the target RASS range without rescue sedation[72.2%(60.8%-91.7%)vs 73.3%(60.0%-100.0%),P=0.880].The proportion of patients in the dexmedetomidine group who required rescue sedation was higher than in the propofol group with statistical significance(69.2%vs 50.8%,P=0.045).Serum S100-βand NSE levels in the propofol group were higher than in the dexmedetomidine group with statistical significance during the first six and five days of mechanical ventilation,respectively(all P<0.05).CONCLUSION Dexmedetomidine demonstrated stronger protective effects on the brain compared to propofol for long-term mechanical ventilation in patients without brain injury.
基金Supported by Key Research and Development Program of Shaanxi,No.2020GXLH-Y-019,No.2022KXJ-141,and No.2023-GHYB-11Innovation Capability Support Program of Shaanxi,No.2019GHJD-14 and No.2021TD-40Science and Technology Program of Xi'an,No.23ZDCYJSGG0037-2022.
文摘BACKGROUND Prolonged postoperative ileus(PPOI)delays the postoperative recovery of gastrointestinal function in patients with gastric cancer(GC),leading to longer hospitalization and higher healthcare expenditure.However,effective monitoring of gastrointestinal recovery in patients with GC remains challenging because of AIM To explore the risk factors for delayed postoperative bowel function recovery and evaluate bowel sound indicators collected via an intelligent auscultation system to guide clinical practice.METHODS This study included data from 120 patients diagnosed with GC who had undergone surgical treatment and postoperative bowel sound monitoring in the Department of General Surgery II at Shaanxi Provincial People's Hospital between January 2019 and January 2021.Among them,PPOI was reported in 33 cases.The patients were randomly divided into the training and validation cohorts.Significant variables from the training cohort were identified using univariate and multivariable analyses and were included in the model.RESULTS The analysis identified six potential variables associated with PPOI among the included participants.The incidence rate of PPOI was 27.5%.Age≥70 years,cTNM stage(Ⅰ and Ⅳ),preoperative hypoproteinemia,recovery time of bowel sounds(RTBS),number of bowel sounds(NBS),and frequency of bowel sounds(FBS)were independent risk factors for PPOI.The Bayesian model demonstrated good performance with internal validation:Training cohort[area under the curve(AUC)=0.880,accuracy=0.823,Brier score=0.139]and validation cohort(AUC=0.747,accuracy=0.690,Brier score=0.215).The model showed a good fit and calibration in the decision curve analysis,indicating a significant net benefit.CONCLUSION PPOI is a common complication following gastrectomy in patients with GC and is associated with age,cTNM stage,preoperative hypoproteinemia,and specific bowel sound-related indices(RTBS,NBS,and FBS).To facilitate early intervention and improve patient outcomes,clinicians should consider these factors,optimize preoperative nutritional status,and implement routine postoperative bowel sound monitoring.This study introduces an accessible machine learning model for predicting PPOI in patients with GC.
基金supported by the National Natural Science Foundation of China(Nos.32270526 to WL,32260253 to LW and 32101242 to LM)。
文摘The Oriental Reed Warbler(Acrocephalus orientalis)is one of the most commonly used hosts for the parasitic Common Cuckoo(Cuculus canorus).However,as hosts that feed unrelated parasitic nestlings may suffer extra reproductive costs,they may be less willing to care for nestlings that have prolonged nestling periods.To test this hypothesis,the duration of feeding by Oriental Reed Warblers under natural conditions for their own nestlings was compared with the duration of feeding under natural conditions for Common Cuckoo nestlings and for artificially prolonged cuckoo nestlings.The results showed that Oriental Reed Warblers did not starve,drive away,or desert any of the nestlings in the experiment,and neither parent was left alone.Our experimental study indicates that both Oriental Reed Warbler parents were willing to care for nestlings with a prolonged nestling period(up to 30 days,twice the average duration time that the Oriental Reed Warblers fed their own chicks in natural conditions).However,further experiments and observations are required in other host bird species to examine whether both parents or one of the parents may exhibit the behavior of abandoning nestlings with a prolonged nestling period.
文摘BACKGROUND Cardiac arrest(CA)induced by electric shock is a rare occurrence,particularly in cases of prolonged CA.Currently,there is limited literature on similar incidents,and we present a relevant case report.CASE SUMMARY A 27-year-old Asian male man,experiencing respiratory CA due to electric shock,was successfully restored to sinus rhythm after 50 min of cardiopulmonary resuscitation and 8 electrical defibrillation sessions.In the subsequent stages,the patient received multiple organ function protection measures,leading to a successful recovery and eventual discharge from the hospital.CONCLUSION Prolonging resuscitation time can enhance the chances of survival for patients,this study provide valuable insights into the management of electric shock-induced CA.
文摘BACKGROUND QTc interval prolongation with an increased risk of torsade de pointes(Tsd)has been described in coronavirus disease 2019(COVID-19)patients treated with hydroxychloroquine(HCQ)and azithromycin(AZI)in Western countries.In the DR Congo,few studies have evaluated the safety of this association or proposed new molecules.AIM To determine the incidence of QTc prolongation and Tsd in COVID-19 patients treated with HCQ-AZIs vs doubase C(new molecule).METHODS In present randomized clinical trial,we have included patients with mild or moderate COVID-19 treated with either HCQ-AZI or doubase C.Electrocardiogram(ECG)changes on day 14 of randomization were determined based on pretreatment tracing.Prolonged QTc was defined as≥500 ms on day 14 or an increase of≥80 ms compared to pretreatment tracing.Patients with cardiac disease,those undergoing other treatments likely to prolong QTc,and those with disturbed ECG tracings were excluded from the study.RESULTS The study included 258 patients(mean age 41±15 years;52%men;3.4%diabetics,11.1%hypertensive).Mild and moderate COVID-19 were found in 93.5%and 6.5%of patients,respectively.At baseline,all patients had normal sinus rhythm,a mean heart rate 78±13/min,mean PR space 170±28 ms,mean QRS 76±13 ms,and mean QTc 405±30 ms.No complaints suggesting cardiac involvement were reported during or after treatment.Only four patients(1.5%)experienced QTc interval prolongation beyond 500 ms.Similarly,only five patients(1.9%)had an increase in the QTc interval of more than 80 ms.QTc prolongation was more significant in younger patients,those with high viral load at baseline,and those receiving HCQ-AZI(P<0.05).None of the patients developed Tsd.CONCLUSION QTc prolongation without Tsd was observed at a lower frequency in patients treated with HCQ-AZI vs doubase C.The absence of comorbidities and concurrent use of other products that are likely to cause arrhythmia may explain our results.
文摘Background The neutrophil-to-lymphocyte ratio(NLR)stands as a valuable marker for assessing inflammation and predicting adverse outcomes post-cardiac surgery.This study aimed to ascertain the prognostic relevance of preoperative NLR concerning prolonged ICU stay among infants undergoing congenital heart surgery employing cardiopulmonary bypass.Methods A retrospective review was conducted involving 187 consecutive infants(≤1 year)who underwent congenital heart disease surgery between January and April 2019,stratified into two groups based on NLR(NLR<0.484,NLR≥0.484).The primary outcome was prolonged intensive care unit(ICU)length of stay,defined patients with ICU stays duration higher than the third quartile.Correlations between preoperative NLR and clinical outcomes were assessed.Receiver operating characteristic curve analysis,multivariable Logistic regression,and restricted cube plots were utilized to gauge the association of preoperative NLR with prolonged ICU stay.Results The area under the receiver operating characteristic curve of NLRpredictive capability for prolonged ICU length of staywas 0.691.Subgroup analyses revealed poorer prognoses among patients with high NLR(≥0.484).Multivariable Logistic regression analysis indicated that heightened preoperative NLR(OR:2.63,95%CI:1.18-5.83,P=0.018)independently was correlated with prolonged ICU length of stay in infants'post-cardiac surgery.Conclusions In summary,the NLR emerges as a significant predictive factor for prolonged ICU stay in infants undergoing cardiac surgery.Nevertheless,further research is warranted to comprehensively grasp the relationship between the NLR and prolonged ICU stay.
基金supported by the Guangdong Provincial People's Hospital Climb Plan Project(No.DFJH2021020)。
文摘Background Thered cell distribution width(RDW)is a parameter that reflects the heterogeneity of red blood cell volume and size,and it is commonly used in the diagnosis of anemia in patients.RDW may serve as a predictor of the postoperative prognosis of surgical patients in the intensive care unit.This study evaluated the predictive capability of RDW for outcomes in infants after cardiopulmonary bypass surgery.Methods A retrospective cohort study was conducted at Guangdong Provincial People's Hospital enrolling infants(≤1 year)who underwent cardiac surgery between January 2019 and April 2019.The infants were divided into two groups based on their preoperative RDW levels(<14.5% and≥14.5%).The primary outcome measured was the prolonged hospital stay post-operation.The association between RDW levels and prolonged hospital length of stay was evaluated using multivariate Logistic regression,presenting the adjusted odds ratio with a 95%confidence interval(CI).Additionally,interaction and subgroup analyses were performed to assess the consistency of these correlations.Results A total of 186 infants were included in the study.After adjusting for potential confounders,multivariate logistic regression models demonstrated a significant association between RDW and prolonged length of stay(LOS)in hospital when treated as a continuous variable(change per 1SD,OR:1.50,95%CI:1.06-2.11,P=0.021).Categorizing RDW as a variable revealed that higher RDW levels(≥14.5%)were significantly associated with an increased risk of prolonged LOS compared to lower levels(<14.5%)(OR:9.72,95%CI:2.87-32.91,P<0.001).Receiver operating curves(ROC)analysis showed that RDW levels exhibited relatively higher diagnostic value for predicting prolonged LOS(AUC=0.697,95%CI:0.617-0.776,P<0.05).Stratified analyses further showed that depending on the variable testing,an association between higher RDW levels and prolonged hospital length of stay in different subgroups was observed.Conclusions Elevated RDW levels in infants undergoing cardiac surgery involving cardiopulmonary bypass may signify prolonged recovery periods.
文摘Background The prognostic nutritional index(PNI) value has been testified to predict mortality in several cardiovascular diseases. The study aimed to determine the relationship between preoperative prognostic nutritional index and prolonged recovery after cardiac surgery. Methods The PNI values of 315 adult cardiac surgery patients were analyzed. All patients were divided into three groups according to the tertiles of PNI score: low group(PNI <47.4), medium group(47.4 ≤ PNI ≤51.9), and high group(PNI >51.9). Results A total of 315 patients were included in the study. In the multivariate logistic regression analysis, PNI demonstrated a significant association with prolonged recovery when utilized as a continuous variable(change per 1 SD, OR: 0.63, 95% CI: 0.48-0.84, P=0.001). When PNI was evaluated as a categorical variable, the high PNI group was significantly associated with an increased risk of prolonged recovery compared to the low PNI group(OR: 0.41, 95% CI: 0.21-0.78, P=0.007). The receiver operating characteristic(ROC) curve analysis showed that PNI level had a relatively high predictive value for prolonged recovery, with an area under the curve of 0.631(95% CI: 0.567-0.695, P<0.05). Conclusions High prognostic nutritional index levels were significantly associated with an decreased prolonged recovery risk in adult patients after cardiac surgery.
文摘To evaluate the efficacy and safety of gemcitabine （GEM） at 30 min standard-dose infusion （30 min-SDI） compared with prolonged low-dose infusion （P-LDI） in patients with advanced non-small-cell lung cancer （NSCLC）. Electronic databases including Pubmed, EMbase, Cochrane Library, CNKI, CBM, and VIP were searched using keywords ＂GEM＂, ＂P-LDI＂, and ＂NSCLC＂. Review Manager 5.3 was used to perform the recta-analysis. Primary endpoints were overall response rate （ORR） and 1-year survival rate （1-year SR）. Secondary endpoints were grade 3/4 hematotoxicity and nausea/vomiting. Six randomized controlled trials （RCTs） with a total of 637 patients were included. The results showed that P-LDI was superior in ORR （OR = 1.50, 95% CI： 1.08-2.10, P = 0.02）, but had an equal 1-year SR （OR = 1.27, 95 % CI： 0.90-1.79, P = 0.18） as compared with 30 min-SDl. For grade 3/4 adverse events, there was no significant difference in anemia （OR = 1.84, 95% CI： 0.61-5.57, P = 0.28） and nausea/vomiting （OR = 1.15, 95% CI： 0.63-2.12, P = 0.64） between the two treatments. However, patients with P-LDI experienced less leukopenia （OR = 0.64, 95% CI： 0.43-0.97, P = 0.04） and thrombocytopenia （OR = 0.37, 95% CI： 0.17-0.80, P = 0.01）. P-LDI was superior in terms of ORR, experienced less grade 3/4 thrombocytopenia and leukopenia compared with 30 min-SDI, and could be a viable treatment option for advanced NSCLC.
基金supported jointly by the National Natural Science Foundation of China (GrantNo. 40975039)the Key Technologies R&D Program(Grant No. 2009BAC51B00)
文摘This study examined regional prolonged low temperature （PLT） events in China from the observational station data for the period 1960–2008 using the new criteria. The new definition of a site PLT event is that the daily minimum temperature does not exceed the 10th percentile threshold of the local daily minimum temperature climatology for at least 5 days at a station. The regional PLT event is defined as at least five adjacent stations exhibiting site PLT simultaneously for 5 d. Under the new definition, 552 regional PLT events were identified, and three indices： duration, extent, and intensity, as well as a comprehensive index （CI） were used to quantify the event severity. In addition, geographical patterns and temporal variations of regional PLT events were investigated using three event categories： strong, moderate, and weak. Spatially, strong events were mainly located in the north of Xinjiang and along the Yangtze River to the south of the Yangtze River; moderate events occurred in Xinjiang and south of the Yangtze River; and weak events occurred south of the Yellow River. The variation for the annual frequency of regional PLT events in China in the last 49 years showed a significant decreasing trend with a rate of-1.99 times per decade, and the significant transition decade was the 1980s.
文摘Objective:To discuss the effect of prolonged second stage of labor on maternal and neonatal outcomes.Methods:A total of 101 primiparas with the length of second stage of labor longer than 2 h were selected and pregnant women with the length less than 2 h served as control.The maternal and neonatal outcomes of two groups were observed and compared.Results:A total of 62.1%(18/11) with the length of second stage of labor between 120 min and 180 min,46.7%(28/32) between 181 min and 240 min and 12 longer than 241 min underwent vaginal delivery.The longer the length of second stage of labor,the lower score of Apgar scale for infants in 1 min,and the higher the incidence of asphyxia.But there was no difference in scale in 5 min.As second stage of labor prolonged,the incidences of cesarean section and of postpartum hemorrhage increased. Conclusions:Almost half of puerperas with the length of second stage of labor longer than 2 h underwent vaginal delivery.The prolonged second stage of labor can decrease the score of Apgar scale in 1 min,increase the incidence of asphyxia,but has no effect on scale in 5 min.It still need more evidence from evidence medicine to definition of time and treatment of second stage of labor.
基金Supported by the National Nature Science Foundation of China,No.81672319,No.81602507,and No.81773135the National Key Research and Development Plan,No.2017YFC0908300Beijing Nova Program,No.Z181100006218011
文摘BACKGROUND Prolonged postoperative ileus(PPOI)is one of the common complications in gastric cancer patients who underwent gastrectomy.Evidence on the predictors of PPOI after gastrectomy is limited and few prediction models of nomogram are used to estimate the risk of PPOI.We hypothesized that a predictive nomogram can be used for clinical risk estimation of PPOI in gastric cancer patients.AIM To investigate the risk factors for PPOI and establish a nomogram for clinical risk estimation.METHODS Between June 2016 and March 2017,the data of 162 patients with gastrectomy were obtained from a prospective and observational registry database.Clinical data of patients who fulfilled the criteria were obtained.Univariate and multivariable logistic regression models were performed to detect the relationship between variables and PPOI.A nomogram for PPOI was developed and verified by bootstrap resampling.The calibration curve was employed to detect the concentricity between the model probability curve and ideal curve.The clinical usefulness of our model was evaluated using the net benefit curve.RESULTS This study analyzed 14 potential variables of PPOI in 162 gastric cancer patients who underwent gastrectomy.The incidence of PPOI was 19.75%in patients with gastrectomy.Age older than 60 years,open surgery,advanced stage(III–IV),and postoperative use of opioid analgesic were independent risk factors for PPOI.We developed a simple and easy-to-use prediction nomogram of PPOI after gastrectomy.This nomogram had an excellent diagnostic performance[area under the curve(AUC)=0.836,sensitivity=84.4%,and specificity=75.4%].This nomogram was further validated by bootstrapping for 500 repetitions.The AUC of the bootstrap model was 0.832(95%CI:0.741–0.924).This model showed a good fitting and calibration and positive net benefits in decision curve analysis.CONCLUSION We have developed a prediction nomogram of PPOI for gastric cancer.This novel nomogram might serve as an essential early warning sign of PPOI in gastric cancer patients.
基金supported by the National Natural Science Foundation of China (No. 30771113, 30870810)the Program for New Century Excellent Talents in University
文摘We examined the possible multiple defects induced by acute and prolonged exposure to high levels of manganese（Mn） solution by monitoring the endpoints of lifespan,development,reproduction,and stress response.Our data suggest that acute exposure（6 h） to Mn did not cause severe defects of life span,development,and reproduction,similarly,no significant defect could be found in animals exposed to a low concentration of Mn（2.5 μmol/L） for 48 h.In contrast,prolonged exposure（48 h） to high Mn concentrations（75 and 200 μmol/L） resulted in significant defects of life span,development,and reproduction,as well as the increase of the percentage of population with hsp-16.2：：gfp expression indicating the obvious induction of stress responses in exposed animals.Moreover,prolonged exposure（48 h） to high concentrations（75 and 200 μmol/L） of Mn decreased the expression levels of antioxidant genes of sod-1,sod-2,sod-3,and sod-4 compared to control.Therefore,prolonged exposure to high concentrations of Mn will induce the severe defects of life span,development,and reproduction in nematodes possibly by affecting the stress response and expression of antioxidant genes in Caenorhabditis elegans.
基金the National Nature Science Foundation of China,No.81672319 and No.81972790Beijing Nova Program,No.Z181100006218011。
文摘BACKGROUND Prolonged postoperative ileus(PPOI) is a prolonged state of "pathological"gastrointestinal(GI) tract dysmotility. There are relatively few studies examining the influence of preoperative nutritional status on the development of PPOI in patients who underwent GI surgery. The association between preoperative albumin and PPOI has not been fully studied. We hypothesized that preoperative albumin may be an independent indicator of PPOI.AIM To analyze the role of preoperative albumin in predicting PPOI and to establish a nomogram for clinical risk evaluation.METHODS Patients were drawn from a prospective hospital registry database of GI surgery.A total of 311 patients diagnosed with gastric or colorectal cancer between June 2016 and March 2017 were included. Potential predictors of PPOI were analyzed by univariate and multivariable logistic regression analyses, and a nomogram for quantifying the presence of PPOI was developed and internally validated.RESULTS The overall PPOI rate was 21.54%. Advanced tumor stage and postoperative opioid analgesic administration were associated with PPOI. Preoperative albumin was an independent predictor of PPOI, and an optimal cutoff value of 39.15 was statistically calculated. After adjusting multiple variables, per unit or per SD increase in albumin resulted in a significant decrease in the incidence of PPOI of 8%(OR = 0.92, 95%CI: 0.85-1.00, P = 0.046) or 27%(OR = 0.73, 95%CI:0.54-0.99, P = 0.046), respectively. Patients with a high level of preoperative albumin(≥ 39.15) tended to experience PPOI compared to those with low levels(< 39.15)(OR = 0.43, 95%CI: 0.24-0.78, P = 0.006). A nomogram for predicting PPOI was developed [area under the curve(AUC) = 0.741] and internally validated by bootstrap resampling(AUC = 0.725, 95%CI: 0.663-0.799).CONCLUSION Preoperative albumin is an independent predictive factor of PPOI in patients who underwent GI surgery. The nomogram provided a model to screen for early indications in the clinical setting.
