Background:Modern acupuncture anesthesia is a combination of Chinese and Western medicine that integrates the theories of acupuncture with anesthesia.However,some clinical studies of acupuncture anesthesia lack specif...Background:Modern acupuncture anesthesia is a combination of Chinese and Western medicine that integrates the theories of acupuncture with anesthesia.However,some clinical studies of acupuncture anesthesia lack specific descriptions of randomization,allocation concealment,and blinding processes,with subsequent systematic reviews indicating a risk of bias.Objective:Clinical trial registration is essential for the enhancement of the quality of clinical trials.This study aims to summarize the status of clinical trial registrations for acupuncture anesthesia listed on the World Health Organization International Clinical Trials Registry Platform(ICTRP).Search strategy:We searched the ICTRP for clinical trials related to acupuncture anesthesia registered between January 1,2001 and May 31,2023.Additionally,related publications were retrieved from PubMed,Cochrane Library,Embase,China National Knowledge Infrastructure,China Science and Technology Journal Database,and Wanfang Data.Registrations and publications were analyzed for consistency in trial design characteristics.Inclusion criteria:Clinical trials that utilized one of several acupuncture-related therapies in combination with pharmacological anesthesia during the perioperative period were eligible for this review.Data extraction and analysis:Data extracted from articles included type of surgical procedure,perioperative symptoms,study methodology,type of intervention,trial recruitment information,and publication information related to clinical enrollment.Results:A total of 166 trials related to acupuncture anesthesia from 21 countries were included in the analysis.The commonly reported symptoms in the included studies were postoperative nausea and vomiting(19.9%)and postoperative pain(13.3%).The concordance between the publications and the trial protocols in the clinical registry records was poor,with only 31.7%of the studies being fully compatible.Inconsistency rates were high for sample size(39.0%,16/41),blinding(36.6%,15/41),and secondary outcome indicators(24.4%,10/41).Conclusion:The volume of acupuncture anesthesia clinical trials registered in international trial registries over the last 20 years is low,with insufficient disclosure of results.Postoperative nausea and vomiting as well as postoperative pain,are the most investigated for acupuncture intervention.展开更多
BACKGROUND Necrotizing enterocolitis(NEC)remains a prominent gastrointestinal emergency among infants,particularly term infants with congenital heart defects(CHD)being at high risk.The molecular processes that contrib...BACKGROUND Necrotizing enterocolitis(NEC)remains a prominent gastrointestinal emergency among infants,particularly term infants with congenital heart defects(CHD)being at high risk.The molecular processes that contribute to NEC have yet to be completely understood.The high mortality rates necessitate an active search for noninvasive biomarkers that can aid in the preclinical diagnosis and prognosis of NEC.MicroRNAs(miRs),which are involved in many biological processes in both health and disease,have been discovered to play an important role in regulating inflammation and immune responses via various signaling pathways.AIM To determine the plasma levels of miR-155,miR-221,miR-223,miR-320a,miR-451a as potential NEC biomarkers in term newborns with CHD.METHODS This prospective cohort study included twenty-tree term newborns with CHD who underwent cardiac surgery on the median day of life(DOL)=7.Nine of them developed NEC(Bell’s stage IIA and IIIA)within 1 week of cardiac surgery(NEC newborns).Blood samples were collected before(median DOL=5)and following(median DOL=13)cardiac surgery.Levels of plasma miR-155-5p,miR-221-3p,miR-223-3p,miR-320a-3p,and miR-451a were determined using real-time polymerase chain reaction.The functional analysis was executed using the DIANA-miRPath v4.0.RESULTS Preoperatively,NEC newborns had significantly lower plasma levels of miR-155(2.70-fold,P=0.020),miR-223(2.42-fold,P=0.030),and miR-320a(3.62-fold,P=0.006)than newborns without NEC.Postoperatively,miR-451a levels differed significantly between the newborn groups,showing a 4.70-fold decrease(P=0.014)in expression when clinical NEC symptoms appeared.According to receiver operating characteristic analysis,miR-320a was found to be the most effective predictive biomarker for NEC[area under the curve(AUC)=0.835,63%sensitivity,100%specificity],while miR-451a was identified as a NEC biomarker(AUC=0.835,85.7%sensitivity,76.9%specificity).Preoperatively,miR-155-5p,miR-223-3p,and miR-320a-3p were differentially expressed and targeted the forkhead box O and Hippo pathways(P<0.01).CONCLUSION Our study demonstrates,for the first time,that plasma miR-320a-3p levels can be used as a preclinical biomarker for NEC in term newborns with CHD.展开更多
Recent clinical trials have demonstrated a protective effect in using traditional Chinese medicine Tongxinluo(TXL)capsule to treat atherosclerosis.However,clinical evidence of the effects of TXL treatment on coronary ...Recent clinical trials have demonstrated a protective effect in using traditional Chinese medicine Tongxinluo(TXL)capsule to treat atherosclerosis.However,clinical evidence of the effects of TXL treatment on coronary plaque vulnerability is unavailable.In response,we developed this study to investigate the hypothesis that on the basis of statin therapy,treatment with TXL capsule may stabilize coronary lesions in patients with acute coronary syndrome(ACS).The TXL-CAP study was an investigator-initiated,randomized,double-blind clinical trial conducted across 18 medical centers in China.Patients with ACS aging from 18 to 80 years old who had a non-intervened coronary target lesion with a fibrous cap thickness(FCT)<100μm and lipid arc>90°as defined by optical coherence tomography(OCT)were recruited.A total of 220 patients who met the selection criteria but did not meet the exclusion criteria will be finally recruited and randomized to receive treatment with TXL(n=110)or placebo(n=110)for a duration of 12 months.The primary endpoint was the difference in the minimum FCT of the coronary target lesion between TXL and placebo groups at the end of the 12-month follow-up.Secondary endpoints included:(1)changes of the maximum lipid arc and length of the target plaque,and the percentage of lipid,fibrous,and calcified plaques at the end of the12-month period;(2)the incidence of composite cardiovascular events and coronary revascularization within the 12 months;(3)changes in the grade and scores of the angina pectoris as assessed using the Canadian Cardiovascular Society(CCS)grading system and Seattle angina questionnaire(SAQ)score,respectively;and(4)changes in hs-CRP serum levels.The results of the TXLCAP trial will provide additional clinical data for revealing whether TXL capsules stabilizes coronary vulnerable plaques in Chinese ACS patients.展开更多
Stroke-induced alterations in cerebral blood flow trigger neurovascular remodeling,as manifested by the blood-brain barrier dysfunction and subs equent neurovascular repair activities such as angiogenesis.This process...Stroke-induced alterations in cerebral blood flow trigger neurovascular remodeling,as manifested by the blood-brain barrier dysfunction and subs equent neurovascular repair activities such as angiogenesis.This process involves neurovascular communication that facilitates the transport of mediators among cerebrovascular endothelial cells,pericytes,glial cells,and neurons,thereby transmitting signals from donor to recipient cells to elicit a collaborative response.展开更多
The study aimed to describe the epidemiological,virological and clinical features of sporadic HEV infection in eastern China.A total of 6112 patient sera were tested for anti-HEV IgG or anti-HEV IgM during one consecu...The study aimed to describe the epidemiological,virological and clinical features of sporadic HEV infection in eastern China.A total of 6112 patient sera were tested for anti-HEV IgG or anti-HEV IgM during one consecutive year(between August 2018 and July 2019).HEV RNA presence was evaluated by RT-PCR and HEV sequences were phylogenetically analyzed.Clinical features of confirmed HEV-infected patients were delineated.The sero-positivity rate of anti-HEV IgG maintained stable around 40%,while an obvious winter spike of anti-HEV IgM prevalence was observed.A total of 111 patients were confirmed of HEV viremia by molecular diagnosis.Subtype 4d was predominant.Phylogenetic analyses suggest that certain strains circulate across species and around the country.Subjects with confirmed current HEV infection had a high median age(58 years)and males were predominant(62.2%).Most patients presented with jaundice(75.7%)and anorexia(68.0%).Significantly elevated levels of liver enzymes and bilirubin were observed.Remarkably,the baseline bilirubin level was positively correlated with illness severity.Pre-existing HBV carriage may deteriorate illness.The clinical burden caused by locally acquired HEV infection is increasing.Surveillance should be enforced especially during the transition period from winter to spring.Patients with higher level of bilirubin at disease onset had slower recovery from HEV infection.展开更多
AIM To assess the efficacy and safety of a new treatment modality, cellular immune therapy based on personalized peptide vaccination(PPV-DC-CTL) combined with radiotherapy, for treating advanced hepatocellular carcino...AIM To assess the efficacy and safety of a new treatment modality, cellular immune therapy based on personalized peptide vaccination(PPV-DC-CTL) combined with radiotherapy, for treating advanced hepatocellular carcinoma(HCC). METHODS A total of nine patients with advanced HCC were enrolled. Multidisciplinary consultation confirmed that all the patients definitely had no opportunity of surgery, because four patients had multiple liver metastases(the number of liver lesions > 3), one patient had liver metastases and portal vein tumor thrombosis, one patient had lung and bone metastases, two patients had liver and lung metastases and one patient had liver metastasis and peritoneal metastasis. Patients with metastasis were treated with precise radiotherapy combined with PPV-DC-CTL.RESULTS Following radiotherapy and one to three cycles of PPV-DC-CTL treatment, AFP levels were significantly decreased in six patients and imaging assessment of the lesions showed a partial response(PR) in three patients and stable disease in the other three patients. The response rate was 33% and disease control rate was 66%. This regimen was found to be safe and well tolerated. None of the patients developed liver or kidney side effects. Only one patient developed grade Ⅱ bone marrow suppression and the remaining patients had no significant hematological side effects.CONCLUSION Radiotherapy combined with PPV-DC-CTL provides a new therapeutic strategy for patients with advanced HCC, which is well tolerated, safe, feasible and effective.展开更多
To investigate the therapeutic effects and mechanisms of garlicin for treatment of unstable angina pectoris (UAP), garlicin injectio was intravenously dripped 60 mg/day in 34 cases for 10 days. Nitroglycerine was used...To investigate the therapeutic effects and mechanisms of garlicin for treatment of unstable angina pectoris (UAP), garlicin injectio was intravenously dripped 60 mg/day in 34 cases for 10 days. Nitroglycerine was used in 21 cases of the control group. The results showed that the total effective rates in improving symptoms and electrocardiogram after garlicin treatment were respectively 82% and 62%, and that the plasma endothelin and blood sugar levels were markedly lowered in cases with hyperglycemia.展开更多
AIM：To investigate the clinical characteristics of sibling patients with comitant strabismus. METHODS：Sibling patients who were diagnosed with comitant strabismus from January 2005 to December 2014 were retrospectiv...AIM：To investigate the clinical characteristics of sibling patients with comitant strabismus. METHODS：Sibling patients who were diagnosed with comitant strabismus from January 2005 to December 2014 were retrospectively reviewed. Factors including age, sex, types of strabismus, refractive errors, angle of deviation, and coexistence of other strabismus were analyzed. RESULTS：A total of 62 patients（31 pairs of siblings） were included. Of these, 26 pairs had intermittent exotropia, 3 had accommodative esotropia, and 2 had infantile esotropia. There were no pairs with different subtypes of strabismus. The age at first visit was 3.7±2.6y and the mean follow-up period was 30.5±24.1mo. In siblings with intermittent exotropia, there was no difference in age of onset, age at operation, or refractive errors between the first and second-born children. The 20（77%） pairs of siblings with exotropia showed more than 80% concordance of maximum angle of deviation during follow-up. In the 9 pairs in which both siblings had an operation, the final angle of deviation after the operation was 8.2±8.1 prism diopters（PD） in first-born children and 8.6±6.5 PD in second-born children. CONCLUSION：The subtypes of strabismus are the same in all pairs of siblings and clinical characteristics of strabismus are similar between the first and secondborn children. This similarity could be an indicator for the diagnosis of second-born children. Further prospective study including a larger number of sibling patients is needed.展开更多
BACKGROUND Unicompartmental knee arthroplasty(UKA)and high tibial osteotomy(HTO)are well-established operative interventions in the treatment of knee osteoarthritis.However,which intervention is more beneficial to pat...BACKGROUND Unicompartmental knee arthroplasty(UKA)and high tibial osteotomy(HTO)are well-established operative interventions in the treatment of knee osteoarthritis.However,which intervention is more beneficial to patients with knee osteoarthritis remains unknown and a topic of much debate.Simultaneously,there is a paucity of research assessing the relationship between radiographic parameters of knee joint alignment and patient-reported clinical outcomes,preoperatively and following HTO or UKA.AIM To compare UKAs and HTOs as interventions for medial-compartment knee osteoarthritis:Examining differences in clinical outcome and investigating the relationship of joint alignment with respect to this.METHODS This longitudinal observational study assessed a total of 42 patients that had undergone UKA(n=23)and HTO(n=19)to treat medial compartment knee osteoarthritis.Patient-reported outcome measures(PROMs)were collected to evaluate clinical outcome.These included two disease-specific(Knee Injury and Osteoarthritis Outcome Score,Oxford Knee Score)and two generic(EQ-5D-5L,Short Form-12)PROMs.The radiographic parameters of knee alignment assessed were the:Hip-knee-ankle angle,mechanical axis deviation and angle of Mikulicz line.RESULTS Statistical analyses demonstrated significant(P<0.001),preoperative to postoperative,improvements in the PROM scores of both groups.There were,however,no significant inter-group differences in the postoperative PROM scores of the UKA and HTO group.Several significant correlations associated a more distolaterally angled Mikulicz line with worse knee function and overall health preoperatively(P<0.05).Postoperatively,two clusters of significant correlations were observed between the disease-specific PROM scores and knee joint alignment parameters(hip-knee-ankle angle,mechanical axis deviation)within the HTO group;yet no such associations were observed within the UKA group.CONCLUSION UKAs and HTOs are both efficacious operations that provide a comparable degree of clinical benefit to patients with medial compartment knee osteoarthritis.Clinical outcome has a limited association with radiographic parameters of knee joint alignment postoperatively;however,a more distolaterally angled Mikulicz line appears associated with worse knee function/health-related quality of life preoperatively.展开更多
BACKGROUND Total hip replacements(THR)and total knee replacements(TKR)are effective treatments for severe osteoarthritis(OA).Some studies suggest clinical outcomes following THR are superior to TKR,the reason for whic...BACKGROUND Total hip replacements(THR)and total knee replacements(TKR)are effective treatments for severe osteoarthritis(OA).Some studies suggest clinical outcomes following THR are superior to TKR,the reason for which remains unknown.This study compares clinical outcomes between THR and TKR.AIM To compare the clinic outcomes of THR anad TKR using a comprehensive range of patient reported outcome measures(PROMs).METHODS A prospective longitudinal observational study of patients with OA undergoing THR and TKR were evaluated using a comprehensive range of generic and joint specific PROMs pre-and post-operatively.RESULTS A total of 131 patients were included in the study which comprised the THR group(68 patients)and the TKR group(63 patients).Both groups demonstrated significant post-operative improvements in all PROM scores(P<0.001).There were no significant differences in post-operative PROM scores between the two groups:Hip and Knee Osteoarthritis Outcome scores(P=0.140),Western Ontario and McMaster Universities Osteoarthritis Index pain(P=0.297)stiffness(P=0.309)and function(P=0.945),Oxford Hip and Knee Score(P=0.076),EuroQol-5D index(P=0.386)and Short-Form 12-item survey physical component score(P=0.106).Subgroup analyses showed no significant difference(P>0.05)between cruciate retaining and posterior stabilised prostheses in the TKR group and no significant difference(P>0.05)between cemented and uncemented fixation in the THR group.Obese patients had poorer outcomes following TKR but did not significantly influence the outcome following THR.CONCLUSION Contrary to some literature,THR and TKR are equally efficacious in alleviating the pain and disability of OA when assessed using a comprehensive range of PROMs.The varying knee prosthesis types and hip fixation techniques did not significantly influence clinical outcome.Obesity had a greater influence on the outcome following TKR than that of THR.展开更多
Background The incidence of coronary heart disease （CHD） is higher in Northern than that in Southern China, however differences in traditional CHD risk factors do not fully explain this. No study has examined the di...Background The incidence of coronary heart disease （CHD） is higher in Northern than that in Southern China, however differences in traditional CHD risk factors do not fully explain this. No study has examined the differences in subclinical atherosclerosis that may help explain the differences in incidence. This study examined these differences in subclinical atherosclerosis using coronary computed tomography （CT） for calcification between the Northern and Southern China. Methods We selected a random sample of participants in a large multi-center ongoing epidemiologic study for coronary calcium scanning in one northern city （North） （Beijing, n = 49） and in two southern cities （South） （Shanghai, n = 50, and Guangzhou, n = 50）. Participants from the three field centers （mean age 67 years） underwent coronary risk factor evaluation and cardiac CT scanning for coronary calcium measurement using the Multi-Ethnic Study of Atherosclerosis scanning protocol. Results Adjusted log-transformed coronary artery calcium score in North China （Beijing） was 3.1 ±0.4 and in South China （Shanghai and Guangzhou） was 2.2 ＋_ 0.3 （P = 0.04）. Mean calcium score for the northern city of Beijing was three times higher than that of the southern city of Guangzhou （P = 0.01） and 2.5 times higher than for the southern city of Shanghai （P = 0.03）. Conclusions The extent of subclinical atherosclerosis is significantly higher in the northern city of Beijing than that in the two southern cities of Guangzhou and Shanghai, even after adjusting for standard cardiac risk factors. This finding suggests that standard risk factors do not fully explain north south differences in clinical CHD incidence.展开更多
AIM To identify risk factors for clinically relevant complications after spleen-preserving distal pancreatectomy(SPDP). No previous studies explored potential predictors of morbidity after SPDP.METHODS The data of 41 ...AIM To identify risk factors for clinically relevant complications after spleen-preserving distal pancreatectomy(SPDP). No previous studies explored potential predictors of morbidity after SPDP.METHODS The data of 41 patients who underwent a SPDP in a single surgical center between 2000 and 2015 were retrospectively reviewed from a prospectively maintained electronic database established in our Department of Surgery. The database included demographic, clinical, bioumoral, pathological, intraoperative and postoperative parameters. Uni-and multivariate ana-lyses were performed to assess potential predictors of clinically relevant morbidity. Postoperative morbidity was defined as in-hospital complications and mortality was assessed at 90 d. Clinically relevant morbidity was defined as complication ≥ grade 2 Dindo.RESULTS Overall morbidity rate was 34.1%(14 patients): grade Ⅰ(6 patients, 14.6%), grade Ⅱ(2 patients, 4.8%), grade Ⅲa(1 patient, 2.4%), and grade Ⅲb(5 patients, 12.2%). A number of 5 patients(12.2%) required re-laparotomy for postoperative complications. There was no postoperative mortality. Thus, at least one clinically relevant complication occurred in 8 patients(19.5%). Univariate analysis identified male gender(P = 0.034), increased body mass index(P = 0.002) and neuroendocrine pathology(P = 0.013) as statistically significant risk factors. Multivariate analysis identified male gender [odds ratio(OR): 1.29, 95%CI: 1.07-1.55, P = 0.005] and increased body mass index(OR: 23.18, 95%CI: 1.72-310.96, P = 0.018) as the only independent risk factors of clinically relevant morbidity after SPDP.CONCLUSION Male gender and increased body mass index are independently associated with increased risk of clinically relevant morbidity after SPDP. These findings may assist a surgeon in clinical decision-making to better select patients suitable for SPDP.展开更多
BACKGROUND Laparoscopic rectal cancer radical surgery is a complex procedure affected by various factors.However,the existing literature lacks standardized parameters for the pelvic region and soft tissues,which hampe...BACKGROUND Laparoscopic rectal cancer radical surgery is a complex procedure affected by various factors.However,the existing literature lacks standardized parameters for the pelvic region and soft tissues,which hampers the establishment of consistent conclusions.AIM To comprehensively assess 16 pelvic and 7 soft tissue parameters through computerized tomography(CT)-based three-dimensional(3D)reconstruction,providing a strong theoretical basis to address challenges in laparoscopic rectal cancer radical surgery.METHODS We analyzed data from 218 patients who underwent radical laparoscopic surgery for rectal cancer,and utilized CT data for 3D pelvic reconstruction.Specific anatomical points were carefully marked and measured using advanced 3D modeling software.To analyze the pelvic and soft tissue parameters,we emp-loyed statistical methods including paired sample t-tests,Wilcoxon rank-sum tests,and correlation analysis.RESULTS The investigation highlighted significant sex disparities in 14 pelvic bone parameters and 3 soft tissue parameters.Males demonstrated larger measurements in pelvic depth and overall curvature,smaller measurements in pelvic width,a larger mesorectal fat area,and a larger anterior-posterior abdominal diameter.By contrast,females exhibited wider pelvises,shallower depth,smaller overall curvature,and an increased amount of subcutaneous fat tissue.However,there were no significant sex differences observed in certain parameters such as sacral curvature height,superior pubococcygeal diameter,rectal area,visceral fat area,waist circumference,and transverse abdominal diameter.CONCLUSION The reconstruction of 3D CT data enabled accurate pelvic measurements,revealing significant sex differences in both pelvic and soft tissue parameters.This study design offer potential in predicting surgical difficulties and creating personalized surgical plans for male rectal cancer patients with a potentially“difficult pelvis”,ultimately improving surgical outcomes.Further research and utilization of these parameters could lead to enhanced surgical methods and patient care in laparoscopic rectal cancer radical surgery.展开更多
Background:Infants undergoing cardiac surgery with cardiopulmonary bypass(CPB)frequently receive intraoperative methylprednisolone(MP)to suppress CPB-related inflammation;however,the optimal dosing strategy and effica...Background:Infants undergoing cardiac surgery with cardiopulmonary bypass(CPB)frequently receive intraoperative methylprednisolone(MP)to suppress CPB-related inflammation;however,the optimal dosing strategy and efficacy of MP remain unclear.Methods:We retrospectively analyzed all infants under 90 days-old who received intra-operative MP for cardiac surgery with CPB from 2014–2017 at our institution.We combined real-world dosing data from the electronic health record(EHR)and two previously developed population pharmacokinetic/pharmacodynamic models to simulate peak concentration(Cmax)and area under the concentration-time curve for 24 h(AUC24)for MP and the inflammatory cytokines interleukin-6(IL-6)and interleukin-10(IL-10).We evaluated the relationships between post-operative,safety,and other clinical outcomes obtained from the EHR with each predicted exposure using non-parametric tests.Results:A total of 142 infants with median post-natal age 8(interquartile range[IQR]:5,37)days received a total dose of 30(19,49)mg/kg of MP.Twelve(8%)died,37(26%)met the composite post-operative outcome,114(80%)met the composite safety outcome,and 23(16%)had a major complication.Predicted median Cmax and AUC24 IL-6 exposure was significantly higher for infants meeting the composite post-operative outcome and those with major complications.Predicted median Cmax and AUC24 MP exposure was significantly higher for infants requiring insulin.No exposure was associated with death or other safety outcomes.Conclusions:Pro-inflammatory IL-6,but not MP exposure,was associated with post-operative organ dysfunction,suggesting current MP dosing may not adequately suppress IL-6 or increase IL-10 to impact clinical outcomes.Prospective study will be required to define the optimal exposure-efficacy and exposure-safety profiles in these infants.展开更多
Objective： Advances in high-throughput genomic profiling and the development of new targeted therapies improve patient＇s survival. In gastrointestinal （GI） malignancies, the concept of personalized medicine （PM）...Objective： Advances in high-throughput genomic profiling and the development of new targeted therapies improve patient＇s survival. In gastrointestinal （GI） malignancies, the concept of personalized medicine （PM） was not investigated so far. The aim of this prospective study was to evaluate the efficacy of a personalized treatment in GI patients who failed standard treatment. Methods： Out of the original prospective clinical phase II EXACT trial, 21 （38%） GI cancer patients who had no further treatment options were identified. A molecular profile （MP） via a 50 gene next generation sequencing （NGS） panel in combination with immunohistochemistry （IHC） was conducted using real-time biopsy tumor material. Results were discussed by a multidisciplinary team （MDT） to translate the individual MP in an experimental treatment. Results： Of the 55 patients originally included in the EXACT trial, 21 （38%） suffered from GI malignancies. The final analysis showed that 15 （71%） patients had experienced a longer progression-free survival （PFS） upon experimental targeted treatment （124 d, quartiles 70/193 d）, when compared with the PFS achieved by the previous conventional therapy （62 d, quartiles 55/83 d） （P=0.014）. Thirteen （62%） patients receiving targeted treatment experienced a disease control according to Response Evaluation Criteria in Solid Tumors （RECIST）. Median overall survival （OS） from the start of experimental therapy to time of censoring or death was 193 d （quartiles 115/374 d）. Conclusions： PM was not investigated in GI malignancies so far in a prospective trial. This study shows that treatment based on real-time molecular tumor profiling led to a superior clinical benefit, and survival as well as response was significantly improved when compared with previous standard medications.展开更多
AIM：To compare the effectiveness of combined fenofibrate and spironolactone with fenofibrate alone for treatment of central serous chorioretinopathy（CSCR）.METHODS： Totally 60 patients（60 eyes） with a history of ...AIM：To compare the effectiveness of combined fenofibrate and spironolactone with fenofibrate alone for treatment of central serous chorioretinopathy（CSCR）.METHODS： Totally 60 patients（60 eyes） with a history of acute CSCR were randomed into two groups： group A with combination of fenofibrate（200 mg） and spironolactone（100 mg）,and group B with only fenofibrate（200 mg）.They were taken half an hour before meals and once per day for 8wk.The changes of the visual acuity,subjective symptom,ocular surface disease index（OSDI）,the tear film and optical coherence tomography were observed at 2,4,6,and 8wk before and after treatment.RESULTS： The best corrected visual acuity（BCVA,log MAR） was improved to 0.22 and 0.27 after treatment from baseline of 0.35 and 0.36 in groups A and B（P 〈0.05）,respectively.After 8wk treatment,the central subfield thickness（CST）,and subretinal fluid volumn（SFV） decreased significantly to 49.5% and 78.8% in group A,37.0% and 57.2% in group B.There were significant differences of CST and SFV in both groups（all P 〈0.05）.CONCLUSION：Fenofibratecombinedwithspironolactone may have more clinical efficacy in the treatment of CSCR than fenofibrate only.展开更多
BACKGROUND Patient reported outcome measures(PROMs)can be used to assess knee function following anterior cruciate ligament(ACL)reconstruction.Intra-operatively,femoral and tibial tunnels are created to accommodate th...BACKGROUND Patient reported outcome measures(PROMs)can be used to assess knee function following anterior cruciate ligament(ACL)reconstruction.Intra-operatively,femoral and tibial tunnels are created to accommodate the new ACL graft.It is postulated that there is an optimum position and orientation of these tunnels and that outcomes from this procedure are affected by their position.AIM To evaluate the influence of graft tunnel position on early to mid-term clinical outcomes following ACL reconstruction.METHODS Six PROMs were collected following ACL reconstruction which included the Knee Injury and Osteoarthritis Outcome Score(KOOS),International Knee Documentation Committee,Lysholm,Tegner,EuroQol-5 Dimension-5 level,and Short Form 12-item Health Survey.A total of 8 radiological parameters were measured from post-operative X-rays relating to graft tunnel positions.This data was analysed to assess for any correlations between graft tunnel position and postoperative PROMs.RESULTS A total of 87 patients were included in the study with a mean post-operative follow-up of 2.3 years(range 1 to 7 years).Posterior position of tibial tunnel was associated with improved KOOS quality of life(rho=0.43,P=0.002)and EQ-5D VAS(rho=0.36,P=0.010).Anterior position of EndoButton femoral tunnel was associated with an improved EQ-5D index(rho=-0.38,P=0.028).There were no other significant correlations between any of the other radiological parameters and PROM scores.CONCLUSION Overall,graft tunnel position had very little correlation with clinical outcomes following ACL reconstruction.A few(posterior)tibial tunnel and(anterior)EndoButton femoral tunnel measurements were associated with better PROMs.展开更多
INTRODUCTION Artificial intelligence(AI)has brought about revolutionary changes in the medical field,including clinical practice,basic research and health monitoring.The powerful computing capabilities and intelligent...INTRODUCTION Artificial intelligence(AI)has brought about revolutionary changes in the medical field,including clinical practice,basic research and health monitoring.The powerful computing capabilities and intelligent algorithms enable it to process and analyse largescale medical data.展开更多
Background and aims:Idiopathic premature ventricular contractions(PVCs)may cause subtle changes in left atrium(LA)structure and function.Here,we investigated whether serum sodium,body mass index(BMI),N-terminal pro-B-...Background and aims:Idiopathic premature ventricular contractions(PVCs)may cause subtle changes in left atrium(LA)structure and function.Here,we investigated whether serum sodium,body mass index(BMI),N-terminal pro-B-type natriuretic peptide(NT-proBNP)and other characteristics might be associated with LA in these patients.Methods:A total of 268 consecutive patients diagnosed with idiopathic PVCs were retrospectively analyzed.We assessed associations of enlarged LA and with the clinical features obtained from 24-hour Holter monitoring,electro-cardiography and serum data in patients with PVCs.Results:Patients with an enlarged LA(n=101),compared with a normal LA(n=167),had significantly lower serum sodium(140.9±3.0 mmol/L vs 141.7±2.8 mmol/L;P=0.022),higher BMI(24.5±2.7 kg/m2 vs 21.7±2.5 kg/m2;P<0.001),higher NT-proBNP[99.3(193.6)pg/mL vs 77.8(68.8)pg/mL;P<0.001]and lower average heart rates(73.0±8.0 bpm vs 75.3±7.6 bpm;P=0.019).No significant differences were observed in P-wave dispersion,QRS duration,PVC coupling interval,pleomorphism,circadian rhythm,non-sustained ventricular tachycardia,serum potassium,serum magnesium,hypersensitive C-reactive protein,low-density lipoprotein cholesterol,symptoms and PVC duration.Conclusions:Beyond the burden of PVCs,attributes such as serum sodium,BMI,NT-proBNP and average heart beats may potentially correlate with LA enlargement in individuals with idiopathic PVCs.展开更多
Background: With the development of globalization, the rising cost of clinical trials in Europe and the United States, and the huge drug consumption market in developing countries, multinational pharmaceutical giants ...Background: With the development of globalization, the rising cost of clinical trials in Europe and the United States, and the huge drug consumption market in developing countries, multinational pharmaceutical giants have set their sights on emerging developing countries. As a leader in developing countries, China has unparalleled advantages, so more and more clinical trials are registered and carried out in China. Objective: The objective of the study is to understand the current practice of informed consent in clinical trials in public hospitals in Xuzhou. Methods: In this study, a 15-question questionnaire was distributed to 369 subjects in the affiliated hospital of Xuzhou medical university. Each question was graded on a 3-point scale (1 = no, 2 = unsure, 3 = yes). The sum of the scores for the 15 questions represented the level of awareness of clinical trials. Results: Valid questionnaires were received from 300 subjects. A considerable number of subjects still had insufficient understanding of clinical trials, especially concerning the nature of clinical trials, understanding of informed consent forms, contact with researchers, and ethics committee. (The “yes” rate was around or below 50%). Factors associated with responses to the survey include education, occupation, and source of medical expenses. Conclusion: Overall, this study showed that the implementation of informed consent in China remained room for improvement. Legislators, ethics officers, and researchers should work together to protect the interests of subjects.展开更多
基金supported by grants from Shanghai Municipal Health Commission and Shanghai Municipal Administration of TCM—Standardization of TCM in 2023“Clinical Practice Guide for Combined Acupuncture-Drug Anesthesia”(No.2023JS05)Shanghai Clinical Medical Research Center of Acupuncture and Moxibustion(No.20MC1920500)+1 种基金Shanghai master Chinese medicine practitioners academic experience research studio construction project(No.SHGZS-202212)Shanghai Key Clinical Specialties 2019 Accreditation Program(No.shslczdzk04701)。
文摘Background:Modern acupuncture anesthesia is a combination of Chinese and Western medicine that integrates the theories of acupuncture with anesthesia.However,some clinical studies of acupuncture anesthesia lack specific descriptions of randomization,allocation concealment,and blinding processes,with subsequent systematic reviews indicating a risk of bias.Objective:Clinical trial registration is essential for the enhancement of the quality of clinical trials.This study aims to summarize the status of clinical trial registrations for acupuncture anesthesia listed on the World Health Organization International Clinical Trials Registry Platform(ICTRP).Search strategy:We searched the ICTRP for clinical trials related to acupuncture anesthesia registered between January 1,2001 and May 31,2023.Additionally,related publications were retrieved from PubMed,Cochrane Library,Embase,China National Knowledge Infrastructure,China Science and Technology Journal Database,and Wanfang Data.Registrations and publications were analyzed for consistency in trial design characteristics.Inclusion criteria:Clinical trials that utilized one of several acupuncture-related therapies in combination with pharmacological anesthesia during the perioperative period were eligible for this review.Data extraction and analysis:Data extracted from articles included type of surgical procedure,perioperative symptoms,study methodology,type of intervention,trial recruitment information,and publication information related to clinical enrollment.Results:A total of 166 trials related to acupuncture anesthesia from 21 countries were included in the analysis.The commonly reported symptoms in the included studies were postoperative nausea and vomiting(19.9%)and postoperative pain(13.3%).The concordance between the publications and the trial protocols in the clinical registry records was poor,with only 31.7%of the studies being fully compatible.Inconsistency rates were high for sample size(39.0%,16/41),blinding(36.6%,15/41),and secondary outcome indicators(24.4%,10/41).Conclusion:The volume of acupuncture anesthesia clinical trials registered in international trial registries over the last 20 years is low,with insufficient disclosure of results.Postoperative nausea and vomiting as well as postoperative pain,are the most investigated for acupuncture intervention.
基金Supported by The Russian Science Foundation,No.19-75-20076.
文摘BACKGROUND Necrotizing enterocolitis(NEC)remains a prominent gastrointestinal emergency among infants,particularly term infants with congenital heart defects(CHD)being at high risk.The molecular processes that contribute to NEC have yet to be completely understood.The high mortality rates necessitate an active search for noninvasive biomarkers that can aid in the preclinical diagnosis and prognosis of NEC.MicroRNAs(miRs),which are involved in many biological processes in both health and disease,have been discovered to play an important role in regulating inflammation and immune responses via various signaling pathways.AIM To determine the plasma levels of miR-155,miR-221,miR-223,miR-320a,miR-451a as potential NEC biomarkers in term newborns with CHD.METHODS This prospective cohort study included twenty-tree term newborns with CHD who underwent cardiac surgery on the median day of life(DOL)=7.Nine of them developed NEC(Bell’s stage IIA and IIIA)within 1 week of cardiac surgery(NEC newborns).Blood samples were collected before(median DOL=5)and following(median DOL=13)cardiac surgery.Levels of plasma miR-155-5p,miR-221-3p,miR-223-3p,miR-320a-3p,and miR-451a were determined using real-time polymerase chain reaction.The functional analysis was executed using the DIANA-miRPath v4.0.RESULTS Preoperatively,NEC newborns had significantly lower plasma levels of miR-155(2.70-fold,P=0.020),miR-223(2.42-fold,P=0.030),and miR-320a(3.62-fold,P=0.006)than newborns without NEC.Postoperatively,miR-451a levels differed significantly between the newborn groups,showing a 4.70-fold decrease(P=0.014)in expression when clinical NEC symptoms appeared.According to receiver operating characteristic analysis,miR-320a was found to be the most effective predictive biomarker for NEC[area under the curve(AUC)=0.835,63%sensitivity,100%specificity],while miR-451a was identified as a NEC biomarker(AUC=0.835,85.7%sensitivity,76.9%specificity).Preoperatively,miR-155-5p,miR-223-3p,and miR-320a-3p were differentially expressed and targeted the forkhead box O and Hippo pathways(P<0.01).CONCLUSION Our study demonstrates,for the first time,that plasma miR-320a-3p levels can be used as a preclinical biomarker for NEC in term newborns with CHD.
基金National Key Research and Development Program of China(2017YFC1700502)Ministry of Science and Technology of China。
文摘Recent clinical trials have demonstrated a protective effect in using traditional Chinese medicine Tongxinluo(TXL)capsule to treat atherosclerosis.However,clinical evidence of the effects of TXL treatment on coronary plaque vulnerability is unavailable.In response,we developed this study to investigate the hypothesis that on the basis of statin therapy,treatment with TXL capsule may stabilize coronary lesions in patients with acute coronary syndrome(ACS).The TXL-CAP study was an investigator-initiated,randomized,double-blind clinical trial conducted across 18 medical centers in China.Patients with ACS aging from 18 to 80 years old who had a non-intervened coronary target lesion with a fibrous cap thickness(FCT)<100μm and lipid arc>90°as defined by optical coherence tomography(OCT)were recruited.A total of 220 patients who met the selection criteria but did not meet the exclusion criteria will be finally recruited and randomized to receive treatment with TXL(n=110)or placebo(n=110)for a duration of 12 months.The primary endpoint was the difference in the minimum FCT of the coronary target lesion between TXL and placebo groups at the end of the 12-month follow-up.Secondary endpoints included:(1)changes of the maximum lipid arc and length of the target plaque,and the percentage of lipid,fibrous,and calcified plaques at the end of the12-month period;(2)the incidence of composite cardiovascular events and coronary revascularization within the 12 months;(3)changes in the grade and scores of the angina pectoris as assessed using the Canadian Cardiovascular Society(CCS)grading system and Seattle angina questionnaire(SAQ)score,respectively;and(4)changes in hs-CRP serum levels.The results of the TXLCAP trial will provide additional clinical data for revealing whether TXL capsules stabilizes coronary vulnerable plaques in Chinese ACS patients.
基金supported by the National Natural Science Foundation of China,Nos.82171344(to ZY),82471313(to CKT)the Guangdong Basic and Applied Basic Research Foundation,China,Nos.2023B1515120035,2024A1515012035(to CKT)The Science and Technology Projects in Guangzhou Nos.2025A03J4169(to ZY)。
文摘Stroke-induced alterations in cerebral blood flow trigger neurovascular remodeling,as manifested by the blood-brain barrier dysfunction and subs equent neurovascular repair activities such as angiogenesis.This process involves neurovascular communication that facilitates the transport of mediators among cerebrovascular endothelial cells,pericytes,glial cells,and neurons,thereby transmitting signals from donor to recipient cells to elicit a collaborative response.
基金This study was funded by grants from the National Natural Science Foundation of China(No.81501733)the Shanghai Municipal Key Clinical Specialty(shslczdzk01103)Key Projects in the National Science&Technology Pillar Program during the Thirteenth Five-year Plan Period(2017ZX10203201-008,2018ZX09201016-003-001,2017ZX10202202-005-004).
文摘The study aimed to describe the epidemiological,virological and clinical features of sporadic HEV infection in eastern China.A total of 6112 patient sera were tested for anti-HEV IgG or anti-HEV IgM during one consecutive year(between August 2018 and July 2019).HEV RNA presence was evaluated by RT-PCR and HEV sequences were phylogenetically analyzed.Clinical features of confirmed HEV-infected patients were delineated.The sero-positivity rate of anti-HEV IgG maintained stable around 40%,while an obvious winter spike of anti-HEV IgM prevalence was observed.A total of 111 patients were confirmed of HEV viremia by molecular diagnosis.Subtype 4d was predominant.Phylogenetic analyses suggest that certain strains circulate across species and around the country.Subjects with confirmed current HEV infection had a high median age(58 years)and males were predominant(62.2%).Most patients presented with jaundice(75.7%)and anorexia(68.0%).Significantly elevated levels of liver enzymes and bilirubin were observed.Remarkably,the baseline bilirubin level was positively correlated with illness severity.Pre-existing HBV carriage may deteriorate illness.The clinical burden caused by locally acquired HEV infection is increasing.Surveillance should be enforced especially during the transition period from winter to spring.Patients with higher level of bilirubin at disease onset had slower recovery from HEV infection.
基金Supported by National Natural Science Foundation of China,No.81401969Jiangsu Provincial Medical Youth Talent,No.QNRC2016043the Key Medical Science and Technology Development Project of Nanjing,No.ZKX16032
文摘AIM To assess the efficacy and safety of a new treatment modality, cellular immune therapy based on personalized peptide vaccination(PPV-DC-CTL) combined with radiotherapy, for treating advanced hepatocellular carcinoma(HCC). METHODS A total of nine patients with advanced HCC were enrolled. Multidisciplinary consultation confirmed that all the patients definitely had no opportunity of surgery, because four patients had multiple liver metastases(the number of liver lesions > 3), one patient had liver metastases and portal vein tumor thrombosis, one patient had lung and bone metastases, two patients had liver and lung metastases and one patient had liver metastasis and peritoneal metastasis. Patients with metastasis were treated with precise radiotherapy combined with PPV-DC-CTL.RESULTS Following radiotherapy and one to three cycles of PPV-DC-CTL treatment, AFP levels were significantly decreased in six patients and imaging assessment of the lesions showed a partial response(PR) in three patients and stable disease in the other three patients. The response rate was 33% and disease control rate was 66%. This regimen was found to be safe and well tolerated. None of the patients developed liver or kidney side effects. Only one patient developed grade Ⅱ bone marrow suppression and the remaining patients had no significant hematological side effects.CONCLUSION Radiotherapy combined with PPV-DC-CTL provides a new therapeutic strategy for patients with advanced HCC, which is well tolerated, safe, feasible and effective.
文摘To investigate the therapeutic effects and mechanisms of garlicin for treatment of unstable angina pectoris (UAP), garlicin injectio was intravenously dripped 60 mg/day in 34 cases for 10 days. Nitroglycerine was used in 21 cases of the control group. The results showed that the total effective rates in improving symptoms and electrocardiogram after garlicin treatment were respectively 82% and 62%, and that the plasma endothelin and blood sugar levels were markedly lowered in cases with hyperglycemia.
文摘AIM：To investigate the clinical characteristics of sibling patients with comitant strabismus. METHODS：Sibling patients who were diagnosed with comitant strabismus from January 2005 to December 2014 were retrospectively reviewed. Factors including age, sex, types of strabismus, refractive errors, angle of deviation, and coexistence of other strabismus were analyzed. RESULTS：A total of 62 patients（31 pairs of siblings） were included. Of these, 26 pairs had intermittent exotropia, 3 had accommodative esotropia, and 2 had infantile esotropia. There were no pairs with different subtypes of strabismus. The age at first visit was 3.7±2.6y and the mean follow-up period was 30.5±24.1mo. In siblings with intermittent exotropia, there was no difference in age of onset, age at operation, or refractive errors between the first and second-born children. The 20（77%） pairs of siblings with exotropia showed more than 80% concordance of maximum angle of deviation during follow-up. In the 9 pairs in which both siblings had an operation, the final angle of deviation after the operation was 8.2±8.1 prism diopters（PD） in first-born children and 8.6±6.5 PD in second-born children. CONCLUSION：The subtypes of strabismus are the same in all pairs of siblings and clinical characteristics of strabismus are similar between the first and secondborn children. This similarity could be an indicator for the diagnosis of second-born children. Further prospective study including a larger number of sibling patients is needed.
文摘BACKGROUND Unicompartmental knee arthroplasty(UKA)and high tibial osteotomy(HTO)are well-established operative interventions in the treatment of knee osteoarthritis.However,which intervention is more beneficial to patients with knee osteoarthritis remains unknown and a topic of much debate.Simultaneously,there is a paucity of research assessing the relationship between radiographic parameters of knee joint alignment and patient-reported clinical outcomes,preoperatively and following HTO or UKA.AIM To compare UKAs and HTOs as interventions for medial-compartment knee osteoarthritis:Examining differences in clinical outcome and investigating the relationship of joint alignment with respect to this.METHODS This longitudinal observational study assessed a total of 42 patients that had undergone UKA(n=23)and HTO(n=19)to treat medial compartment knee osteoarthritis.Patient-reported outcome measures(PROMs)were collected to evaluate clinical outcome.These included two disease-specific(Knee Injury and Osteoarthritis Outcome Score,Oxford Knee Score)and two generic(EQ-5D-5L,Short Form-12)PROMs.The radiographic parameters of knee alignment assessed were the:Hip-knee-ankle angle,mechanical axis deviation and angle of Mikulicz line.RESULTS Statistical analyses demonstrated significant(P<0.001),preoperative to postoperative,improvements in the PROM scores of both groups.There were,however,no significant inter-group differences in the postoperative PROM scores of the UKA and HTO group.Several significant correlations associated a more distolaterally angled Mikulicz line with worse knee function and overall health preoperatively(P<0.05).Postoperatively,two clusters of significant correlations were observed between the disease-specific PROM scores and knee joint alignment parameters(hip-knee-ankle angle,mechanical axis deviation)within the HTO group;yet no such associations were observed within the UKA group.CONCLUSION UKAs and HTOs are both efficacious operations that provide a comparable degree of clinical benefit to patients with medial compartment knee osteoarthritis.Clinical outcome has a limited association with radiographic parameters of knee joint alignment postoperatively;however,a more distolaterally angled Mikulicz line appears associated with worse knee function/health-related quality of life preoperatively.
文摘BACKGROUND Total hip replacements(THR)and total knee replacements(TKR)are effective treatments for severe osteoarthritis(OA).Some studies suggest clinical outcomes following THR are superior to TKR,the reason for which remains unknown.This study compares clinical outcomes between THR and TKR.AIM To compare the clinic outcomes of THR anad TKR using a comprehensive range of patient reported outcome measures(PROMs).METHODS A prospective longitudinal observational study of patients with OA undergoing THR and TKR were evaluated using a comprehensive range of generic and joint specific PROMs pre-and post-operatively.RESULTS A total of 131 patients were included in the study which comprised the THR group(68 patients)and the TKR group(63 patients).Both groups demonstrated significant post-operative improvements in all PROM scores(P<0.001).There were no significant differences in post-operative PROM scores between the two groups:Hip and Knee Osteoarthritis Outcome scores(P=0.140),Western Ontario and McMaster Universities Osteoarthritis Index pain(P=0.297)stiffness(P=0.309)and function(P=0.945),Oxford Hip and Knee Score(P=0.076),EuroQol-5D index(P=0.386)and Short-Form 12-item survey physical component score(P=0.106).Subgroup analyses showed no significant difference(P>0.05)between cruciate retaining and posterior stabilised prostheses in the TKR group and no significant difference(P>0.05)between cemented and uncemented fixation in the THR group.Obese patients had poorer outcomes following TKR but did not significantly influence the outcome following THR.CONCLUSION Contrary to some literature,THR and TKR are equally efficacious in alleviating the pain and disability of OA when assessed using a comprehensive range of PROMs.The varying knee prosthesis types and hip fixation techniques did not significantly influence clinical outcome.Obesity had a greater influence on the outcome following TKR than that of THR.
文摘Background The incidence of coronary heart disease （CHD） is higher in Northern than that in Southern China, however differences in traditional CHD risk factors do not fully explain this. No study has examined the differences in subclinical atherosclerosis that may help explain the differences in incidence. This study examined these differences in subclinical atherosclerosis using coronary computed tomography （CT） for calcification between the Northern and Southern China. Methods We selected a random sample of participants in a large multi-center ongoing epidemiologic study for coronary calcium scanning in one northern city （North） （Beijing, n = 49） and in two southern cities （South） （Shanghai, n = 50, and Guangzhou, n = 50）. Participants from the three field centers （mean age 67 years） underwent coronary risk factor evaluation and cardiac CT scanning for coronary calcium measurement using the Multi-Ethnic Study of Atherosclerosis scanning protocol. Results Adjusted log-transformed coronary artery calcium score in North China （Beijing） was 3.1 ±0.4 and in South China （Shanghai and Guangzhou） was 2.2 ＋_ 0.3 （P = 0.04）. Mean calcium score for the northern city of Beijing was three times higher than that of the southern city of Guangzhou （P = 0.01） and 2.5 times higher than for the southern city of Shanghai （P = 0.03）. Conclusions The extent of subclinical atherosclerosis is significantly higher in the northern city of Beijing than that in the two southern cities of Guangzhou and Shanghai, even after adjusting for standard cardiac risk factors. This finding suggests that standard risk factors do not fully explain north south differences in clinical CHD incidence.
文摘AIM To identify risk factors for clinically relevant complications after spleen-preserving distal pancreatectomy(SPDP). No previous studies explored potential predictors of morbidity after SPDP.METHODS The data of 41 patients who underwent a SPDP in a single surgical center between 2000 and 2015 were retrospectively reviewed from a prospectively maintained electronic database established in our Department of Surgery. The database included demographic, clinical, bioumoral, pathological, intraoperative and postoperative parameters. Uni-and multivariate ana-lyses were performed to assess potential predictors of clinically relevant morbidity. Postoperative morbidity was defined as in-hospital complications and mortality was assessed at 90 d. Clinically relevant morbidity was defined as complication ≥ grade 2 Dindo.RESULTS Overall morbidity rate was 34.1%(14 patients): grade Ⅰ(6 patients, 14.6%), grade Ⅱ(2 patients, 4.8%), grade Ⅲa(1 patient, 2.4%), and grade Ⅲb(5 patients, 12.2%). A number of 5 patients(12.2%) required re-laparotomy for postoperative complications. There was no postoperative mortality. Thus, at least one clinically relevant complication occurred in 8 patients(19.5%). Univariate analysis identified male gender(P = 0.034), increased body mass index(P = 0.002) and neuroendocrine pathology(P = 0.013) as statistically significant risk factors. Multivariate analysis identified male gender [odds ratio(OR): 1.29, 95%CI: 1.07-1.55, P = 0.005] and increased body mass index(OR: 23.18, 95%CI: 1.72-310.96, P = 0.018) as the only independent risk factors of clinically relevant morbidity after SPDP.CONCLUSION Male gender and increased body mass index are independently associated with increased risk of clinically relevant morbidity after SPDP. These findings may assist a surgeon in clinical decision-making to better select patients suitable for SPDP.
基金2021 Zhejiang Province Public Welfare Technology Application Research Funding Project,No.LGC21H160002Basic Scientific Research Projects in Wenzhou City in 2022,No.Y20220885Wenzhou Medical University 2021 Higher Education Teaching Reform Project,No.JG2021167.
文摘BACKGROUND Laparoscopic rectal cancer radical surgery is a complex procedure affected by various factors.However,the existing literature lacks standardized parameters for the pelvic region and soft tissues,which hampers the establishment of consistent conclusions.AIM To comprehensively assess 16 pelvic and 7 soft tissue parameters through computerized tomography(CT)-based three-dimensional(3D)reconstruction,providing a strong theoretical basis to address challenges in laparoscopic rectal cancer radical surgery.METHODS We analyzed data from 218 patients who underwent radical laparoscopic surgery for rectal cancer,and utilized CT data for 3D pelvic reconstruction.Specific anatomical points were carefully marked and measured using advanced 3D modeling software.To analyze the pelvic and soft tissue parameters,we emp-loyed statistical methods including paired sample t-tests,Wilcoxon rank-sum tests,and correlation analysis.RESULTS The investigation highlighted significant sex disparities in 14 pelvic bone parameters and 3 soft tissue parameters.Males demonstrated larger measurements in pelvic depth and overall curvature,smaller measurements in pelvic width,a larger mesorectal fat area,and a larger anterior-posterior abdominal diameter.By contrast,females exhibited wider pelvises,shallower depth,smaller overall curvature,and an increased amount of subcutaneous fat tissue.However,there were no significant sex differences observed in certain parameters such as sacral curvature height,superior pubococcygeal diameter,rectal area,visceral fat area,waist circumference,and transverse abdominal diameter.CONCLUSION The reconstruction of 3D CT data enabled accurate pelvic measurements,revealing significant sex differences in both pelvic and soft tissue parameters.This study design offer potential in predicting surgical difficulties and creating personalized surgical plans for male rectal cancer patients with a potentially“difficult pelvis”,ultimately improving surgical outcomes.Further research and utilization of these parameters could lead to enhanced surgical methods and patient care in laparoscopic rectal cancer radical surgery.
基金Funded by the National Institute of General Medical Sciences(NIGMS)T32 UNCDuke Collaborative Clinical Pharmacology Postdoctoral Training Program(5T32GM086330-08)C.Hornik was funded by Grant Number is R01HD106588.
文摘Background:Infants undergoing cardiac surgery with cardiopulmonary bypass(CPB)frequently receive intraoperative methylprednisolone(MP)to suppress CPB-related inflammation;however,the optimal dosing strategy and efficacy of MP remain unclear.Methods:We retrospectively analyzed all infants under 90 days-old who received intra-operative MP for cardiac surgery with CPB from 2014–2017 at our institution.We combined real-world dosing data from the electronic health record(EHR)and two previously developed population pharmacokinetic/pharmacodynamic models to simulate peak concentration(Cmax)and area under the concentration-time curve for 24 h(AUC24)for MP and the inflammatory cytokines interleukin-6(IL-6)and interleukin-10(IL-10).We evaluated the relationships between post-operative,safety,and other clinical outcomes obtained from the EHR with each predicted exposure using non-parametric tests.Results:A total of 142 infants with median post-natal age 8(interquartile range[IQR]:5,37)days received a total dose of 30(19,49)mg/kg of MP.Twelve(8%)died,37(26%)met the composite post-operative outcome,114(80%)met the composite safety outcome,and 23(16%)had a major complication.Predicted median Cmax and AUC24 IL-6 exposure was significantly higher for infants meeting the composite post-operative outcome and those with major complications.Predicted median Cmax and AUC24 MP exposure was significantly higher for infants requiring insulin.No exposure was associated with death or other safety outcomes.Conclusions:Pro-inflammatory IL-6,but not MP exposure,was associated with post-operative organ dysfunction,suggesting current MP dosing may not adequately suppress IL-6 or increase IL-10 to impact clinical outcomes.Prospective study will be required to define the optimal exposure-efficacy and exposure-safety profiles in these infants.
文摘Objective： Advances in high-throughput genomic profiling and the development of new targeted therapies improve patient＇s survival. In gastrointestinal （GI） malignancies, the concept of personalized medicine （PM） was not investigated so far. The aim of this prospective study was to evaluate the efficacy of a personalized treatment in GI patients who failed standard treatment. Methods： Out of the original prospective clinical phase II EXACT trial, 21 （38%） GI cancer patients who had no further treatment options were identified. A molecular profile （MP） via a 50 gene next generation sequencing （NGS） panel in combination with immunohistochemistry （IHC） was conducted using real-time biopsy tumor material. Results were discussed by a multidisciplinary team （MDT） to translate the individual MP in an experimental treatment. Results： Of the 55 patients originally included in the EXACT trial, 21 （38%） suffered from GI malignancies. The final analysis showed that 15 （71%） patients had experienced a longer progression-free survival （PFS） upon experimental targeted treatment （124 d, quartiles 70/193 d）, when compared with the PFS achieved by the previous conventional therapy （62 d, quartiles 55/83 d） （P=0.014）. Thirteen （62%） patients receiving targeted treatment experienced a disease control according to Response Evaluation Criteria in Solid Tumors （RECIST）. Median overall survival （OS） from the start of experimental therapy to time of censoring or death was 193 d （quartiles 115/374 d）. Conclusions： PM was not investigated in GI malignancies so far in a prospective trial. This study shows that treatment based on real-time molecular tumor profiling led to a superior clinical benefit, and survival as well as response was significantly improved when compared with previous standard medications.
基金Supported by National Natural Science Foundation of China(No.81160118No.81400372+4 种基金No.81660158)Jiangxi Province Voyage Project(No.2014022)Youth Science Foundation of Jiangxi Province(No.20151BAB215016)Technology and Science Foundation of Jiangxi Province(No.20151BBG70223)Health Development Planning Commission Science Foundation of Jiangxi Province(No.20155154)
文摘AIM：To compare the effectiveness of combined fenofibrate and spironolactone with fenofibrate alone for treatment of central serous chorioretinopathy（CSCR）.METHODS： Totally 60 patients（60 eyes） with a history of acute CSCR were randomed into two groups： group A with combination of fenofibrate（200 mg） and spironolactone（100 mg）,and group B with only fenofibrate（200 mg）.They were taken half an hour before meals and once per day for 8wk.The changes of the visual acuity,subjective symptom,ocular surface disease index（OSDI）,the tear film and optical coherence tomography were observed at 2,4,6,and 8wk before and after treatment.RESULTS： The best corrected visual acuity（BCVA,log MAR） was improved to 0.22 and 0.27 after treatment from baseline of 0.35 and 0.36 in groups A and B（P 〈0.05）,respectively.After 8wk treatment,the central subfield thickness（CST）,and subretinal fluid volumn（SFV） decreased significantly to 49.5% and 78.8% in group A,37.0% and 57.2% in group B.There were significant differences of CST and SFV in both groups（all P 〈0.05）.CONCLUSION：Fenofibratecombinedwithspironolactone may have more clinical efficacy in the treatment of CSCR than fenofibrate only.
文摘BACKGROUND Patient reported outcome measures(PROMs)can be used to assess knee function following anterior cruciate ligament(ACL)reconstruction.Intra-operatively,femoral and tibial tunnels are created to accommodate the new ACL graft.It is postulated that there is an optimum position and orientation of these tunnels and that outcomes from this procedure are affected by their position.AIM To evaluate the influence of graft tunnel position on early to mid-term clinical outcomes following ACL reconstruction.METHODS Six PROMs were collected following ACL reconstruction which included the Knee Injury and Osteoarthritis Outcome Score(KOOS),International Knee Documentation Committee,Lysholm,Tegner,EuroQol-5 Dimension-5 level,and Short Form 12-item Health Survey.A total of 8 radiological parameters were measured from post-operative X-rays relating to graft tunnel positions.This data was analysed to assess for any correlations between graft tunnel position and postoperative PROMs.RESULTS A total of 87 patients were included in the study with a mean post-operative follow-up of 2.3 years(range 1 to 7 years).Posterior position of tibial tunnel was associated with improved KOOS quality of life(rho=0.43,P=0.002)and EQ-5D VAS(rho=0.36,P=0.010).Anterior position of EndoButton femoral tunnel was associated with an improved EQ-5D index(rho=-0.38,P=0.028).There were no other significant correlations between any of the other radiological parameters and PROM scores.CONCLUSION Overall,graft tunnel position had very little correlation with clinical outcomes following ACL reconstruction.A few(posterior)tibial tunnel and(anterior)EndoButton femoral tunnel measurements were associated with better PROMs.
文摘INTRODUCTION Artificial intelligence(AI)has brought about revolutionary changes in the medical field,including clinical practice,basic research and health monitoring.The powerful computing capabilities and intelligent algorithms enable it to process and analyse largescale medical data.
文摘Background and aims:Idiopathic premature ventricular contractions(PVCs)may cause subtle changes in left atrium(LA)structure and function.Here,we investigated whether serum sodium,body mass index(BMI),N-terminal pro-B-type natriuretic peptide(NT-proBNP)and other characteristics might be associated with LA in these patients.Methods:A total of 268 consecutive patients diagnosed with idiopathic PVCs were retrospectively analyzed.We assessed associations of enlarged LA and with the clinical features obtained from 24-hour Holter monitoring,electro-cardiography and serum data in patients with PVCs.Results:Patients with an enlarged LA(n=101),compared with a normal LA(n=167),had significantly lower serum sodium(140.9±3.0 mmol/L vs 141.7±2.8 mmol/L;P=0.022),higher BMI(24.5±2.7 kg/m2 vs 21.7±2.5 kg/m2;P<0.001),higher NT-proBNP[99.3(193.6)pg/mL vs 77.8(68.8)pg/mL;P<0.001]and lower average heart rates(73.0±8.0 bpm vs 75.3±7.6 bpm;P=0.019).No significant differences were observed in P-wave dispersion,QRS duration,PVC coupling interval,pleomorphism,circadian rhythm,non-sustained ventricular tachycardia,serum potassium,serum magnesium,hypersensitive C-reactive protein,low-density lipoprotein cholesterol,symptoms and PVC duration.Conclusions:Beyond the burden of PVCs,attributes such as serum sodium,BMI,NT-proBNP and average heart beats may potentially correlate with LA enlargement in individuals with idiopathic PVCs.
文摘Background: With the development of globalization, the rising cost of clinical trials in Europe and the United States, and the huge drug consumption market in developing countries, multinational pharmaceutical giants have set their sights on emerging developing countries. As a leader in developing countries, China has unparalleled advantages, so more and more clinical trials are registered and carried out in China. Objective: The objective of the study is to understand the current practice of informed consent in clinical trials in public hospitals in Xuzhou. Methods: In this study, a 15-question questionnaire was distributed to 369 subjects in the affiliated hospital of Xuzhou medical university. Each question was graded on a 3-point scale (1 = no, 2 = unsure, 3 = yes). The sum of the scores for the 15 questions represented the level of awareness of clinical trials. Results: Valid questionnaires were received from 300 subjects. A considerable number of subjects still had insufficient understanding of clinical trials, especially concerning the nature of clinical trials, understanding of informed consent forms, contact with researchers, and ethics committee. (The “yes” rate was around or below 50%). Factors associated with responses to the survey include education, occupation, and source of medical expenses. Conclusion: Overall, this study showed that the implementation of informed consent in China remained room for improvement. Legislators, ethics officers, and researchers should work together to protect the interests of subjects.
