AIM： To evaluate the efficacy and safety of gastric varices injection with cyanoacrylate in patients with gastric variceal bleeding. METHODS： Twenty-four patients （15 males, 9 females） with gastric variceal bleedi...AIM： To evaluate the efficacy and safety of gastric varices injection with cyanoacrylate in patients with gastric variceal bleeding. METHODS： Twenty-four patients （15 males, 9 females） with gastric variceal bleeding underwent endoscopic treatment with cyanoacrylate injection. Successful hemostasis, rebleeding rate, and complications were retrospectively reviewed. Followed up endoscopy was performed and repeat cyanoacrylate injection was given until gastric varices were obliterated. RESULTS： Seventeen patients achieved definite hemostasis. Of these, 14 patients had primary success after initial endoscopic therapy. Ten patients developed recurrent bleeding. Repeated cyanoacrylate injection stopped rebleeding in three patients. Transjugular intrahepatic portosystemic shunt （TIPS） was performed to control rebleeding in one patient which occured after repeat endoscopic therapy. Six patients died （three from uncontrolled bleeding, two from sepsis, and one from mesenteric vein thrombosis）. Minor complications occurred in 11 patients （six epigastric discomfort and five post injection ulcers）. Cyanoacrylate embolism developed in two patients. One of these patients died from mesenteric vein thrombosis. The other had pulmonary embolism which resolved spontaneously. Advanced drrhosis and hepatocellular carcinoma （HCC） were major risk factors for uncontrolled bleeding. CONCLUSION： Endoscopic treatment for bleeding gastric varices with cyanoacrylate injection is effective for immediate hemostasis. Repeat cyanoacrylate injection has a lower success rate than the initial injection. Cyanoacrylate embolism is not a common serious complication.展开更多
AIM: Hepatocellular carcinoma (HCC) is a common disease in Taiwan. The prevalence of viral hepatitis infection and the subsequent development of HCC are well known to be higher in patients with end-stage renal disease...AIM: Hepatocellular carcinoma (HCC) is a common disease in Taiwan. The prevalence of viral hepatitis infection and the subsequent development of HCC are well known to be higher in patients with end-stage renal disease (ESRD) requiring hemodialysis (HD) or peritoneal dialysis (PD) than among the general population. However, information on hepatic resection for ESRD-HCC patients is limited. METHODS: The clinical features of 26 ESRD-HCC patients who underwent hepatic resection from 1982 to 2001 were retrospectively reviewed. Meanwhile, the clinicopathological features and the outcome of 1 198 HCC patients without ESRD undergoing hepatic resection were used for comparison. RESULTS: Of 1 224 surgically resected HCC patients, 26 (4.2%) were ESRD-HCC. Univariate analysis revealed more associated disease, more physical signs of anemia and postoperative complications, lower hemoglobin, platelet, α-fetoprotein, elevated blood urea nitrogen (BUN) and creatinine levels, smaller tumors, lower HBsAg positivity, higher HCV positivity, and longer hospital stays in the ESRDHCC group compared with the HCC group. Furthermore, multivariate stepwise logistic regression analysis revealed that elevated BUN and creatinine levels were the only two independently significant factors in the patients in the ESRD-HCC group. Overall and disease-free survival rates were similar between the ESRD-HCC and HCC groups.CONCLUSION: Elevated BUN and creatinine were the only two main independent factors differentiating ESRD-HCC from HCC patients. ESRD should not be a contraindication of hepatic resection in HCC patients; however, careful operative techniques and perioperative care are crucial to achieving lower morbidity and mortality. Comparable overall survival and disease-free survival can be achieved in selected ESRD-HCC patients undergoing hepatic resection when compared with conventional HCC patients.展开更多
<strong>Background:</strong> The prevalence of transfusion associated hepatitis B virus (HBV) infection differs across different population geographically. Ascertaining the seroprevalence of HBV infection ...<strong>Background:</strong> The prevalence of transfusion associated hepatitis B virus (HBV) infection differs across different population geographically. Ascertaining the seroprevalence of HBV infection is vital to informing the way of precautionary and control strategies. This study sought to establish the seroprevalence of hepatitis B surface antigen (HBVsAg) among blood donors in Yelewonyan Memorial Hospital Lofa, Liberia. <strong>Methods:</strong> This was a retrospective study which involved reviewing of blood donation records for the year 2020 at Telewonyan Memorial Hospital in Lofa County. The data obtained from the records were analyzed. Data analysis was done using SPSS version 12 for windows.<strong> Results: </strong>A total of 584 voluntary blood donors were screened for donation in 2020. Out of 584, 554 (95.9%) were males while the rest were females. Prevalence of 3.3% was observed among blood donors in Telewonyan Memorial Hospital. There is a significant difference between gender and age with HBV seropositivity among blood donors. <strong>Conclusion:</strong> The findings of this study suggest that the study site is of low endemicity with HBV infection. Usually, males are more probably to be HBVsAg seropositive than their female’s counterpart. Planning more extensive study and educational programs would help minimize the spread of HBV infection among the general population.展开更多
Early stage cancers of tongue are treated traditionally with a wide local excision or hemiglossectomy, but the preservation of normal speech and swallowing are hampered. Most of the patients are treated with external ...Early stage cancers of tongue are treated traditionally with a wide local excision or hemiglossectomy, but the preservation of normal speech and swallowing are hampered. Most of the patients are treated with external beam irradiation to achieve the best locoregional control as only a limited number of tongue cancers can be excised. Underdeveloped nations with finite resources are still dependent on cobalt based external beam radiotherapy and sometimes a Linear Accelerator with two dimensional planning. This treatment has many limitations, as the large radiation fields irradiate not only the tumor but also normal tissue. The sequalae include mucositis, dry mouth, teeth and gum injury, spinal cord damage and rarely mandibular necrosis. Intensity modulated radiotherapy, which can abrogate these side effects, is not available to these patients. Irradiation using implanted solid radioactive sources into the tumor tissue is a viable option in this context. This kind of treatment is termed as brachytherapy and if the implant is introduced into the tissue then it is interstitial brachytherapy. This report details our experience in interstitial implantation, planning, dosimetry and treatment. Diagnosed cancers of anterior 2/3rd of lateral border of tongue with T1 N0M0 or T2 N0M0 stages were subjected to Iridium implantation under general anesthesia. Orthogonal films were taken and planning done with brachyvision treatment planning system. High dose rate radiotherapy was delivered as per the prescription. Excellent local control of the tumor was achieved with no undue morbidity to the adjacent structures. The patients were asked to undergo regular follow up. Surgical salvage was advised in cases of nodal recurrence. Interstitial implantation is a treatment that can be safely administered in early stage cancers of the tongue. This has remarkable efficacy and is also a patient friendly procedure.展开更多
Intrathecal administration of human umbilical cord mesenchymal stem cells may be a promising approach for the treatment of stroke,but its safety,effectiveness,and mechanism remain to be elucidated.In this study,good m...Intrathecal administration of human umbilical cord mesenchymal stem cells may be a promising approach for the treatment of stroke,but its safety,effectiveness,and mechanism remain to be elucidated.In this study,good manufacturing practice-grade human umbilical cord mesenchymal stem cells(5×105 and 1×106 cells)and saline were administered by cerebellomedullary cistern injection 72 hours after stroke induced by middle cerebral artery occlusion in rats.The results showed(1)no significant difference in mortality or general conditions among the three groups.There was no abnormal differentiation or tumor formation in various organs of rats in any group.(2)Compared with saline-treated animals,those treated with human umbilical cord mesenchymal stem cells showed significant functional recovery and reduced infarct volume,with no significant differences between different human umbilical cord mesenchymal stem cell doses.(3)Human umbilical cord mesenchymal stem cells were found in the ischemic brain after 14 and 28 days of follow-up,and the number of positive cells significantly decreased over time.(4)Neuronal nuclei expression in the human umbilical cord mesenchymal stem cell group was greater than that in the saline group,while glial fibrillary acidic protein and ionized calcium binding adaptor molecule 1 expression levels decreased.(5)Human umbilical cord mesenchymal stem cell treatment increased the number of CD31+microvessels and doublecortin-positive cells after ischemic stroke.Human umbilical cord mesenchymal stem cells also upregulated the expression of CD31+/Ki67+.(6)At 14 days after intrathecal administration,brain-derived neurotrophic factor expression in the peri-infarct area and the concentrations of brain-derived neurotrophic factor in the cerebrospinal fluid in both human umbilical cord mesenchymal stem cell groups were significantly greater than those in the saline group and persisted until the 28th day.Taken together,these results indicate that the intrathecal administration of human umbilical cord mesenchymal stem cells via cerebellomedullary cistern injection is safe and effective for the treatment of ischemic stroke in rats.The mechanisms may include alleviating the local inflammatory response in the peri-infarct region,promoting neurogenesis and angiogenesis,and enhancing the production of neurotrophic factors.展开更多
BACKGROUND The incidence of diabetic atherosclerosis(DMA)is increasing worldwide,but its pathogenesis remains incompletely understood.In addition to cardiovascular complications,bladder dysfunction is one of the commo...BACKGROUND The incidence of diabetic atherosclerosis(DMA)is increasing worldwide,but its pathogenesis remains incompletely understood.In addition to cardiovascular complications,bladder dysfunction is one of the common comorbidities associated with DMA but is often refractory to current treatments.AIM To investigate the therapeutic effect of human amniotic fluid stem cell-derived extracellular vesicles(hAFSC-EVs)on the recovery of bladder dysfunction in DMA rats.METHODS Eighty rats were divided into normal control,streptozotocin-induced diabetic rats,diabetic rats subjected to arterial balloon endothelial injury of common iliac artery(DMA),and DMA rats treated with hAFSC-EVs(DMA+hAFSC-EVs).At 4 weeks and 12 weeks after DMA induction,levels of blood glucose,total cholesterol,triglyceride,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,homeostasis model assessment(HOMA)-insulin resistance,and HOMA-βwere measured.Cystometry,common iliac artery wall thickness,and bladder tumor necrosis factor(TNF)-α,interleukin(IL)-6,transforming growth factor(TGF)-β1,Smad3,connective tissue growth factor(CTGF)and fibronectin were also evaluated.RESULTS Bladder weight and blood glucose,triglyceride,HOMA-insulin resistance,common iliac artery intima thickness,voided volume,intercontraction interval,bladder capacity,and mRNA expression of TNF-α,IL-6,TGF-β1,Smad3,CTGF and fibronectin were significantly increased at 4 weeks and 12 weeks after induction,while the HOMA-βlevel decreased at 4 weeks and 12 weeks,and the high-density lipoprotein cholesterol level decreased at 12 weeks.hAFSC-EVs treatment in DMA rats significantly reduced bladder weight and blood glucose,thickness of common iliac arterial intima,voided volume,intercontraction interval and bladder capacity at 4 weeks.The mRNA expression of TNF-α,TGF-β1,and CTGF in DMA rats treated with hAFSC-EVs were significantly decreased at 4 weeks,while the mRNA expressions of IL-6 and Smad3 were significantly decreased 12 weeks.CONCLUSION hAFSC-EVs treatment can help restore DMA-induced bladder dysfunction,which is associated with lowered blood glucose levels,reduced arterial wall thickness,and decreased TNF-α,IL-6,TGF-β1,Smad3,and CTGF expression.展开更多
Background:A significant proportion of patients still cannot benefit from existing targeted therapies and immunotherapies,making the search for new treatment strategies extremely urgent.In this study,we combined integ...Background:A significant proportion of patients still cannot benefit from existing targeted therapies and immunotherapies,making the search for new treatment strategies extremely urgent.In this study,we combined integrate public data analysis with experimental validation to identify novel prognostic biomarkers and therapeutic targets for lung adenocarcinoma(LUAD).Methods:We analyzed RNA and protein databases to assess the expression levels of cytochrome C oxidase 5B(COX5B)in LUAD.Several computational algorithms were employed to investigate the relationship between COX5B and immune infiltration in LUAD.To further elucidate the role of COX5B in LUAD,we utilized multiple experimental approaches,including quantitative reverse transcription PCR assays,western blot,immunohistochemistry,electron microscopy,flow cytometry,and EdU proliferation assays.Results:We revealed that COX5B was significantly elevated in LUAD and positively correlated with poor prognosis of LUAD patients.Analysis of co-expression network indicated that COX5B may take part in the intracellular adenosine triphosphate(ATP)synthesis through the oxidative phosphorylation pathway.There was a negative correlation between COX5B expression and immune infiltration in LUAD.Furthermore,we validated that COX5B levels were significantly elevated in both LUAD tissues and cell lines.Specifically,immunohistochemistry(IHC)assays revealed a 2.32-fold increase of COX5B in tumor tissues compared to that in adjacent normal tissues(p=0.0044).Additionally,COX5B knockdown disrupted the redox homeostasis,ultimately suppressed the proliferation of LUAD cells.Subsequent investigations demonstrated that berberine effectively targeted COX5B,diminishing its protein expression and consequently inhibiting cell proliferation and tumor growth in LUAD.Conclusions:This study established that upregulated COX5B was positive associated with poor patient prognosis in LUAD,elucidating the mechanisms by which berberine targets COX5B to inhibit tumor growth,thereby providing a novel therapeutic target and strategy for the clinical management of LUAD.展开更多
AIM： To analyze the characteristics of multiple primary malignancies （MPMs） of digestive system; including incidence, types of tumor combinations, time intervals between development of multiple tumors, clinical cou...AIM： To analyze the characteristics of multiple primary malignancies （MPMs） of digestive system; including incidence, types of tumor combinations, time intervals between development of multiple tumors, clinical course,and prognostic factors affecting survival and mortality.METHODS： Data from a total of 129 patients treated from January 1991 to December 2000 for pathologically proved MPMs, including at least one originating from the digestive system, were reviewed retrospectively.RESULTS： Among 129 patients, 120 （93.02%） had two primary cancers and 9 （6.98%） had three primary cancers. The major sites of MPMs of the digestive system were large intestine, stomach, and liver. Associated nondigestive cancers included 40 cases of gynecological cancers, of which 31 were carcinoma of cervix and 10 cases of genitourinary cancers, of which 5 were bladder cancers. Other cancers originated from the lung, breast,nasopharynx, larynx, thyroid, brain, muscle, and skin.Reproductive tract cancers, especially cervical, ovarian,bladder, and prostate cancers were the most commonlyassociated non-G! cancers, followed by cancer of the lung and breasts. Forty-three cases were synchronous, while the rest （86 cases） were metachronous cancers. Staging of MPMs and treatment regimes correlated with the prognosis between survival and non-survival groups.CONCLUSION： As advances in cancer therapy bring about a progressively larger percentage of long-term survivors, the proportion of patients with subsequent primary lesions will increase. Early diagnosis of these lesions, based on an awareness of the possibility of second and third cancers, and multidiscipiinary treatment strategies will substantially increase the survival of these patients.展开更多
BACKGROUND Infections and associated morbidity and mortality may be more frequent in children who have undergone liver transplant than in healthy children.Immunization strategies to prevent vaccine-preventable infecti...BACKGROUND Infections and associated morbidity and mortality may be more frequent in children who have undergone liver transplant than in healthy children.Immunization strategies to prevent vaccine-preventable infections(VPIs)can effectively minimize this infection burden.However,data on age-appropriate immunization and VPIs in children after liver transplant in Asia are limited.AIM To evaluate the immunization status,VPIs and non-VPIs requiring hospitalization in children who have undergone a liver transplant.METHODS The medical records of children who had a liver transplant between 2004 and 2018 at King Chulalongkorn Memorial Hospital(Bangkok,Thailand)were retrospectively reviewed.Immunization status was evaluated via their vaccination books.Hospitalization for infections that occurred up to 5 years after liver transplantation were evaluated,and divided into VPIs and non-VPIs.Hospitalizations for cytomegalovirus and Epstein-Barr virus were excluded.Severity of infection,length of hospital stay,ventilator support,intensive care unit requirement,and mortality were assessed.RESULTS Seventy-seven children with a mean age of 3.29±4.17 years were included in the study,of whom 41(53.2%)were female.The mean follow-up duration was 3.68±1.45 years.Fortyeight children(62.3%)had vaccination records.There was a significant difference in the proportion of children with incomplete vaccination according to Thailand’s Expanded Program on Immunization(52.0%)and accelerated vaccine from Infectious Diseases Society of America(89.5%)(P<0.001).Post-liver transplant,47.9%of the children did not catch up with ageappropriate immunizations.There were 237 infections requiring hospitalization during the 5 years of follow-up.There were no significant differences in hospitalization for VPIs or non-VPIs in children with complete and incomplete immunizations.The risk of serious infection was high in the first year after receiving a liver transplant,and two children died.Respiratory and gastrointestinal systems were common sites of infection.The most common pathogens that caused VPIs were rotavirus,influenza virus,and varicella-zoster virus.CONCLUSION Incomplete immunization was common pre-and post-transplant,and nearly all children required hospitalization for non-VPIs or VPIs within 5 years posttransplant.Infection severity was high in the first year post-transplant.展开更多
AIM: To study the "hospital type-outcome" and "volumeoutcome" relationships in patients with esophageal cancer who receive non-surgical treatments.METHODS: A total of 6106 patients with esophageal ...AIM: To study the "hospital type-outcome" and "volumeoutcome" relationships in patients with esophageal cancer who receive non-surgical treatments.METHODS: A total of 6106 patients with esophageal cancer diagnosed between 2008 and 2011 were identified from a national population-based cancer registry in Taiwan. The hospital types were defined as medical center and non-medical center. The threshold for high-volume hospitals was based on a median volume of 225 cases between 2008 and 2011(annual volume, > 56 cases) or an upper quartile(> 75%) volume of 377 cases(annual volume > 94 cases). Cox regression analyses were used to determine the effects of hospital type and volume outcome on patient survival.RESULTS: A total of 3955 non-surgically treated patients were included in the survival analysis. In the unadjusted analysis, the significant prognostic factors included c T, c N, c M stage, hospital type and hospital volume(annual volume, > 94 vs ≤ 94). The 1- and 3-year overall survival rates in the non-medical centers(36.2% and 13.2%, respectively) were significantly higher than those in the medical centers(33.5% and 11.3%, respectively; P = 0.027). The 1- and 3-year overall survival rates in hospitals with an annual volume of ≤ 94(35.3% and 12.6%, respectively) were significantly higher than those with an annual volume of > 94(31.1% and 9.4%, respectively; P = 0.001). However, in the multivariate analysis, the hospital type was not statistically significant. Only c T, c N, and c M stages and hospital volume(annual volume > 94 vs ≤94) were independent prognostic factors.CONCLUSION: Whether the treatment occurs in medicalcenters is not a significant prognostic factor. Highvolume hospitals were not associated with better survival rates compared with low-volume hospitals.展开更多
AIM: To share clinical pattern of presentation, the modalities of surgical intervention and the one month postsurgical outcome of rhino-orbito-mucormycosis(ROCM) cases.METHODS: All COVID associated mucormycosis(CAM) p...AIM: To share clinical pattern of presentation, the modalities of surgical intervention and the one month postsurgical outcome of rhino-orbito-mucormycosis(ROCM) cases.METHODS: All COVID associated mucormycosis(CAM) patients underwent comprehensive multidisciplinar y examination by ophthalmologist, otorhinolaryngologist and physician. Patients with clinical and radiological evidence of orbital apex involvement were included in the study. Appropriate medical and surgical intervention were done to each patient. Patients were followed up one-month post intervention. RESULTS: Out of 89 CAM patients, 31(34.8%) had orbital apex syndrome. Sixty-six(74.2%) of such patients had pre-existing diabetes mellitus, 18(58%) patients had prior documented use of steroid use, and 55(61.8%) had no light perception(LP) presenting vision. Blepharoptosis, proptosis, complete ophthalmoplegia were common clinical findings. Seventeen(19.1%) of such patients had variable amount of cavernous sinus involvement. Endoscopic debridement of paranasal sinuses and orbit with or without eyelid sparing limited orbital exenteration was done in most cases, 34(38.2%) patients could retain vision in the affected eye. CONCLUSION: Orbital apex involvement in CAM patients occur very fast. It not only leads to loss of vision but also sacrifice of the eyeball, orbital contents and eyelids. Early diagnosis and prompt intervention can preserve life, vision and spare mutilating surgeries.展开更多
AIM To evaluate rates and predictors of hospital readmission and care fragmentation in patients hospitalized with gastroparesis.METHODS We identified all adult hospitalizations with a primary diagnosis of gastroparesi...AIM To evaluate rates and predictors of hospital readmission and care fragmentation in patients hospitalized with gastroparesis.METHODS We identified all adult hospitalizations with a primary diagnosis of gastroparesis in the 2010-2014 National Readmissions Database,which captures statewide readmissions.We excluded patients who died during the hospitalization,and calculated 30 and 90-d unplanned readmission and care fragmentation rates.Readmission to a non-index hospital(i.e.,different from the hospital of the index admission) was considered as care fragmentation.A multivariate Cox regression model was used to analyze predictors of 30-d readmissions.Logistic regression was used to determine hospital and patient factors independently associated with 30-d care fragmentation.Patients readmitted within 30 d were followed for 60 d post discharge from the first readmission.Mortality during the first readmission,hospitalization cost,length of stay,and rates of 60-d readmission were compared between those with and without care fragmentation.RESULTS There were 30064 admissions with a primary diagnosis of gastroparesis.The rates of 30 and 90-d readmissions were 26.8% and 45.6%,respectively.Younger age,male patient,diabetes,parenteral nutrition,≥ 4 Elixhauser comorbidities,longer hospital stay(> 5 d),large and metropolitan hospital,and Medicaid insurance were associated with increased hazards of 30-d readmissions.Gastric surgery,routine discharge and private insurance were associated with lower 30-d readmissions.The rates of 30 and 90-d care fragmentation were 28.1% and 33.8%,respectively.Younger age,longer hospital stay(> 5 d),self-pay or Medicaid insurance were associated with increased risk of 30-d care fragmentation.Diabetes,enteral tube placement,parenteral nutrition,large metropolitan hospital,and routine discharge were associated with decreased risk of 30-d fragmentation.Patients who were readmitted to a non-index hospital had longer length of stay(6.5 vs 5.8 d,P = 0.03),and higher mean hospitalization cost($15645 vs $12311,P < 0.0001),compared to those readmitted to the index hospital.There were no differences in mortality(1.0% vs 1.3%,P = 0.84),and 60-d readmission rate(55.3% vs 54.6%,P = 0.99) between the two groups.CONCLUSION Several factors are associated with the high 30-d readmission and care fragmentation in gastroparesis.Knowledge of these predictors can play a role in implementing effective preventive interventions to highrisk patients.展开更多
Patients with diabetes are increasingly common in hospital settings where optimal glycemic control remains challenging.Inpatient technology-enabled support systems are being designed,adapted and evaluated to meet this...Patients with diabetes are increasingly common in hospital settings where optimal glycemic control remains challenging.Inpatient technology-enabled support systems are being designed,adapted and evaluated to meet this challenge.Insulin pump use,increasingly common in outpatients,has been shown to be safe among select inpatients.Dedicated pump protocols and provider training are needed to optimize pump use in the hospital.Continuous glucose monitoring(CGM)has been shown to be comparable to usual care for blood glucose surveillance in intensive care unit(ICU)settings but data on cost effectiveness is lacking.CGM use in non-ICU settings remains investigational and patient use of home CGM in inpatient settings is not recommended due to safety concerns.Compared to unstructured insulin prescription,a continuum of effective electronic medical record-based support for insulin prescription exists from passive order sets to clinical decision support to fully automated electronic Glycemic Management Systems.Relative efficacy and cost among these systems remains unanswered.An array of novel platforms are being evaluated to engage patients in technology-enabled diabetes education in the hospital.These hold tremendous promise in affording universal access to hospitalized patients with diabetes to effective self-management education and its attendant short/long term clinical benefits.展开更多
Background Objective:To investigate the perioperative precautions,surgical methods and early clinical efficacy of patients with valvular heart disease complicated by coronary atherosclerotic heart disease treated with...Background Objective:To investigate the perioperative precautions,surgical methods and early clinical efficacy of patients with valvular heart disease complicated by coronary atherosclerotic heart disease treated with coronary artery bypass grafting at the same time as heart valve replacement and to analyze the relevant factors affecting the death of patients during hospitalization after surgery.Methods:Between January 2020 and September 2021,a total of 103 patients who underwent simultaneous heart valve replacement and coronary artery bypass grafting for heart valve disease in conjunction with coronary atherosclerotic heart disease at the Department of cardiac surgery,Guangdong Cardiovascular Institute were retrospectively evaluated for clinical data,and a systematic review and summary of all preoperative data,surgical methods,intraoperative data,and major complications were performed.The variations in each cardiotocography indicator were examined before and after surgery to determine surgical effectiveness and statistical perioperative patient mortality.After integrating the Sino SCORE risk assessment system and analyzing the case features included in this data,12 alternative risk variables for mortality were identified and submitted to univariate and multivariate analysis using logistic regression.After performing a univariate analysis of the alternative risk factors,the option of P<0.05 was considered a risk factor and included in the multivariate analysis,followed by a multivariate logistic regression analysis in which the factors were determined to be independent risk factors with P<0.05,and their OR values and 95 percent confidence intervals(CIs)were calculated to analyze the associated factors affecting patients’early prognosis systematically.Results:Of the 103 patients,91 were successfully discharged from the hospital,12 died,11.7%of the deaths were due to the following causes:postoperative low cardiac output syndrome,multiple organ failure,and severe infection;Among all the 103 patients,7 patients underwent rebleeding and hemostasis after surgery,6 patients required dialysis after surgery,28 patients underwent IABP supportive care after surgery because of the occurrence of low cardiac output syndrome,1 patient assisted by ECMO after surgery,and patients discharged successfully had significantly less LVEDD and LVESD in the early postoperative period,compared with those before surgery(P=0.000;P=0.000).Age>70 years,preoperative combined hyperlipidemia,and history of the cerebrovascular accident were the three independent risk factors that may have contributed to in-hospital mortality in patients undergoing CABG valve replacement.Conclusions:1.The diastolic function of the majority of patients with valvular heart disease and coronary atherosclerotic heart disease improved significantly in the early stages after coronary artery bypass grafting and heart valve replacement.2.Age>70 years,preoperative combined hyperlipidemia,and a history of the cerebrovascular accident were three independent risk factors for in-hospital death in patients receiving CABG valve replacement.展开更多
Background Diabetes mellitus （DM） is the major risk factor of coronary artery disease （CAD）, and the control status of blood sugar has direct effect on the prognosis of CAD. HbAlc is the important parameter reflec...Background Diabetes mellitus （DM） is the major risk factor of coronary artery disease （CAD）, and the control status of blood sugar has direct effect on the prognosis of CAD. HbAlc is the important parameter reflect- ing control status of blood sugar, however, it is unclear about the value of in-hospital HbAlc in patients with a- cute coronary syndrome （ACS）. Methods A retrospective analysis was performed for 236 in-hospital diabetic patients with ACS. Patients were stratified into two groups according to HbAlc level when admission （Well con- trolled group （HbAlc ~〈7.0%） and High HbAlc group （HbAlc 〉 7.0%）; major adverse cardiovascular events （MACE） group and Non-MACE group）. In-hospital MACE and mortality were set as the observation target. Results 282 patients （112 in Well controlled group and 170 in High HbAlc group） were enrolled, of which 146 （51.77%）, 63 （23.34%）, and 73 （25.89%） patients respectively had unstable angina （UA）, non-ST-seg- ment elevation myocardial infarction （NSTEM[）, and ST-segment elevation myocardial infarction （STEMI）. In- hospital all-cause mortality and in-hospital MACE were both similar in Well controlled group and High HbAlc group （6.25% vs. 7.06% and 15.18% vs. 16.47%, P 〉 0.05）. In MACEs, cardiac death （4.46% vs. 5.29%）, recurrent myocardial infarction （2.68% vs. 2.94%）, hemorrhage events （5.35% vs. 5.29%）, malignant arrhyth- mia （6.25% vs. 5.29%）, cardiac shock （4.46% vs. 4.12%）, acute heart failure （8.93% vs. 10.0%）, revascu- larization （4.46% vs. 5.29%） were also all similar in both two groups. In addition, there were no significant dif- ference in HbAlc level between MACE group and Non-MACE group. Single-factor logistic regression analysis showed that HbAlc was not a risk factor for in-hospital MACE （P 〉 0.05）. Conclusion The present study suggests that admission HbAlc is not the risk factor of in-hospital MACE in ACS patients with diabetes.展开更多
BACKGROUND Acute liver failure(ALF)in dengue is rare but fatal.Early identification of patients who are at risk of ALF is the key strategy to improve survival.AIM To validate prognostic scores for predicting ALF and i...BACKGROUND Acute liver failure(ALF)in dengue is rare but fatal.Early identification of patients who are at risk of ALF is the key strategy to improve survival.AIM To validate prognostic scores for predicting ALF and in-hospital mortality in dengue-induced severe hepatitis(DISH).METHODS We retrospectively reviewed 2532 dengue patients over a period of 16 years(2007-2022).Patients with DISH,defined as transaminases>10 times the normal reference level and DISH with subsequent ALF,were included.Univariate regre-ssion analysis was used to identify factors associated with outcomes.Youden’s index in conjunction with receiver operating characteristic(ROC)analysis was used to determine optimal cut-off values for prognostic scores in predicting ALF and in-hospital death.Area under the ROC(AUROC)curve values were compared using paired data nonparametric ROC curve estimation.RESULTS Of 193 DISH patients,20 developed ALF(0.79%),with a mortality rate of 60.0%.International normalized ratio,bilirubin,albumin,and creatinine were indepen-dent predictors associated with ALF and death.Prognostic scores showed excel-lent performance:Model for end-stage liver disease(MELD)score≥15 predicted ALF(AUROC 0.917,sensitivity 90.0%,specificity 88.4%)and≥18 predicted death(AUROC 0.823,sensitivity 86.9%,specificity 89.1%);easy albumin-bilirubin(ALBI)score≥-30 predicted ALF and death(ALF:AUROC 0.835,sensitivity80.0%,specificity 72.2%;death:AUROC 0.808,sensitivity 76.9%,specificity 69.3%);ALBI score≥-2 predicted ALF and death(ALF:AUROC 0.806,sensitivity 80.0%,specificity 77.4%;death:AUROC 0.799,sensitivity 76.9%,specificity 74.3%).Platelet-ALBI score also showed good performance in predicting ALF and death(AUROC=0.786 and 0.699,respectively).MELD and EZ-ALBI scores had similar performance in predicting ALF(Z=1.688,P=0.091)and death(Z=0.322,P=0.747).CONCLUSION MELD score is the best predictor of ALF and death in DISH patients.EZ-ALBI score,a simpler yet effective score,shows promise as an alternative prognostic tool in dengue patients.展开更多
Objective: Few studies have focused on factors influencing outcomes of patients with in-hospital cardiac arrest (IHCA) in general wards. The goal of this study was to report the outcomes of adult patients with IHCA in...Objective: Few studies have focused on factors influencing outcomes of patients with in-hospital cardiac arrest (IHCA) in general wards. The goal of this study was to report the outcomes of adult patients with IHCA in the general wards and identified the prognostic factors. Methods: Adult patients with IHCA having received cardiopulmonary resuscitation in general wards from January 2008 to December 2011 were retrospectively reviewed from our registry system. The primary outcome was survival to hospital discharge, while the secondary outcome was sustained return of spontaneous circulation (ROSC). Results: A total of 544 general ward patients were analyzed for event variables and resuscitation results. The rate of establishing a ROSC was 40.1% and the rate of survival to discharge was 5.1%. Ventricular tachycardia/ventricular fibrillation (VT/VF) was the initial rhythm in 3.9% of patients. Pre-arrest factors including a high Charlson comorbidity index (CCI) ≥ 9 (OR 0.251, 95% CI 0.098 - 0.646), cardiac comorbidity (OR 0.612, 95% CI 0.401 - 0.933), and arrest time on the midnight shift (OR 0.403, 95% CI 0.252 - 0.642) were independently associated with a low possibility of ROSC. The initial VT/VF presenting rhythms (OR 0.135, 95% CI 0.030 - 0.601) were independently associated with a high survival rate, whereas patients with deteriorated disease course were independently associated with a decreased hospital survival (OR 3.902, 95% CI 1.619 - 9.403). Conclusions: We demonstrated that pre-arrest factors can predict patient outcome after IHCA in general wards, including the association of a CCI ≥ 9 and cardiac comorbidity with poor ROSC, and deteriorated disease course as an independent predictor of a low survival rate.展开更多
Introduction: The goal of Prevention of Mother to child Transmission (PMTCT) is to minimize new HIV infection with PMTCT interventions which can reduce to as low as 2%. Gusii region is number 5 among counties that con...Introduction: The goal of Prevention of Mother to child Transmission (PMTCT) is to minimize new HIV infection with PMTCT interventions which can reduce to as low as 2%. Gusii region is number 5 among counties that contribute to 65% of new HIV (Human Immunodeficiency Virus) in infections in Kenya. The study was to determine the prevalence of new HIV infections among infants (3 - 18 months) born of HIV positive mothers on PMTCT follow up at Kisii Teaching and Referral Hospital (KTRH). Method: This was a descriptive cross sectional study involving 96 infants born of HIV positive mothers on PMTCT programme at Kisii Teaching and Referral Hospital (KTRH) was conducted. The infants were between 3 to 18 months of age. The infants were investigated for their HIV status and factors associated with prevalence. The data collection was done during postnatal checkups, antiretroviral treatment follow up and immunization schedule. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 20. Results: 13.5% (95% C.I = 10.1% to 16.9%) were found to be positive despite their mothers being on PMTCT program. There was no significant difference between gender and status of the infant (χ2 = 0.758, df = 1, p-value = 0.0384). Conclusion: The study confirms that there are still new HIV infections despite being followed up in the PMTCT program. The new HIV infections were associated with mixed feeding. Recommendation: Counseling on Infant feeding, use of ant-retroviral treatment and support from partners should be strengthen in the PMTCT program to ensure reduction of new HIV infections.展开更多
Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death.China has the largest population of patients with traumatic spinal cord injury.Previous studies of traumatic ...Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death.China has the largest population of patients with traumatic spinal cord injury.Previous studies of traumatic spinal cord injury in China have mostly been regional in scope;national-level studies have been rare.To the best of our knowledge,no national-level study of treatment status and economic burden has been performed.This retrospective study aimed to examine the epidemiological and clinical features,treatment status,and economic burden of traumatic spinal cord injury in China at the national level.We included 13,465 traumatic spinal cord injury patients who were injured between January 2013 and December 2018 and treated in 30 hospitals in 11 provinces/municipalities representing all geographical divisions of China.Patient epidemiological and clinical features,treatment status,and total and daily costs were recorded.Trends in the percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department and cost of care were assessed by annual percentage change using the Joinpoint Regression Program.The percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department did not significantly change overall(annual percentage change,-0.5%and 2.1%,respectively).A total of 10,053(74.7%)patients underwent surgery.Only 2.8%of patients who underwent surgery did so within 24 hours of injury.A total of 2005(14.9%)patients were treated with high-dose(≥500 mg)methylprednisolone sodium succinate/methylprednisolone(MPSS/MP);615(4.6%)received it within 8 hours.The total cost for acute traumatic spinal cord injury decreased over the study period(-4.7%),while daily cost did not significantly change(1.0%increase).Our findings indicate that public health initiatives should aim at improving hospitals’ability to complete early surgery within 24 hours,which is associated with improved sensorimotor recovery,increasing the awareness rate of clinical guidelines related to high-dose MPSS/MP to reduce the use of the treatment with insufficient evidence.展开更多
In 2012-2013, CMH （Community Memorial Hospital） had a 10.5% 30-day readmission rate from SNFs （skilled nursing facilities）. The focus of the Connections of Care Coalition was to review the medication reconciliatio...In 2012-2013, CMH （Community Memorial Hospital） had a 10.5% 30-day readmission rate from SNFs （skilled nursing facilities）. The focus of the Connections of Care Coalition was to review the medication reconciliation process and to involve pharmacists in the transition of patients to SNFs. The objective of the project was to work as an interdisciplinary team to improve the communication during transitions of care from our hospital to local SNFs by identifying key issues and initiating pharmacy practice change. This quality improvement project had a pre-post study design. Patients older than 18 years of age discharged to SNFs and/or readmitted from SNFs within 30 days were included. Baseline data was collected, specific pharmacist interventions were identified, educated on and implemented, and post-implementation data was collected. The number of interventions made and documented by pharmacists for patients being discharged from CMH to local SNFs did not significantly change during this quality improvement study. Clinically significant interventions were made on high risk medications, such as warfarin. Finally, a newly redesigned SNF workflow was implemented to include pharmacy, nursing, social work/case management to improve patient care and safety for discharges to SNFs.展开更多
文摘AIM： To evaluate the efficacy and safety of gastric varices injection with cyanoacrylate in patients with gastric variceal bleeding. METHODS： Twenty-four patients （15 males, 9 females） with gastric variceal bleeding underwent endoscopic treatment with cyanoacrylate injection. Successful hemostasis, rebleeding rate, and complications were retrospectively reviewed. Followed up endoscopy was performed and repeat cyanoacrylate injection was given until gastric varices were obliterated. RESULTS： Seventeen patients achieved definite hemostasis. Of these, 14 patients had primary success after initial endoscopic therapy. Ten patients developed recurrent bleeding. Repeated cyanoacrylate injection stopped rebleeding in three patients. Transjugular intrahepatic portosystemic shunt （TIPS） was performed to control rebleeding in one patient which occured after repeat endoscopic therapy. Six patients died （three from uncontrolled bleeding, two from sepsis, and one from mesenteric vein thrombosis）. Minor complications occurred in 11 patients （six epigastric discomfort and five post injection ulcers）. Cyanoacrylate embolism developed in two patients. One of these patients died from mesenteric vein thrombosis. The other had pulmonary embolism which resolved spontaneously. Advanced drrhosis and hepatocellular carcinoma （HCC） were major risk factors for uncontrolled bleeding. CONCLUSION： Endoscopic treatment for bleeding gastric varices with cyanoacrylate injection is effective for immediate hemostasis. Repeat cyanoacrylate injection has a lower success rate than the initial injection. Cyanoacrylate embolism is not a common serious complication.
文摘AIM: Hepatocellular carcinoma (HCC) is a common disease in Taiwan. The prevalence of viral hepatitis infection and the subsequent development of HCC are well known to be higher in patients with end-stage renal disease (ESRD) requiring hemodialysis (HD) or peritoneal dialysis (PD) than among the general population. However, information on hepatic resection for ESRD-HCC patients is limited. METHODS: The clinical features of 26 ESRD-HCC patients who underwent hepatic resection from 1982 to 2001 were retrospectively reviewed. Meanwhile, the clinicopathological features and the outcome of 1 198 HCC patients without ESRD undergoing hepatic resection were used for comparison. RESULTS: Of 1 224 surgically resected HCC patients, 26 (4.2%) were ESRD-HCC. Univariate analysis revealed more associated disease, more physical signs of anemia and postoperative complications, lower hemoglobin, platelet, α-fetoprotein, elevated blood urea nitrogen (BUN) and creatinine levels, smaller tumors, lower HBsAg positivity, higher HCV positivity, and longer hospital stays in the ESRDHCC group compared with the HCC group. Furthermore, multivariate stepwise logistic regression analysis revealed that elevated BUN and creatinine levels were the only two independently significant factors in the patients in the ESRD-HCC group. Overall and disease-free survival rates were similar between the ESRD-HCC and HCC groups.CONCLUSION: Elevated BUN and creatinine were the only two main independent factors differentiating ESRD-HCC from HCC patients. ESRD should not be a contraindication of hepatic resection in HCC patients; however, careful operative techniques and perioperative care are crucial to achieving lower morbidity and mortality. Comparable overall survival and disease-free survival can be achieved in selected ESRD-HCC patients undergoing hepatic resection when compared with conventional HCC patients.
文摘<strong>Background:</strong> The prevalence of transfusion associated hepatitis B virus (HBV) infection differs across different population geographically. Ascertaining the seroprevalence of HBV infection is vital to informing the way of precautionary and control strategies. This study sought to establish the seroprevalence of hepatitis B surface antigen (HBVsAg) among blood donors in Yelewonyan Memorial Hospital Lofa, Liberia. <strong>Methods:</strong> This was a retrospective study which involved reviewing of blood donation records for the year 2020 at Telewonyan Memorial Hospital in Lofa County. The data obtained from the records were analyzed. Data analysis was done using SPSS version 12 for windows.<strong> Results: </strong>A total of 584 voluntary blood donors were screened for donation in 2020. Out of 584, 554 (95.9%) were males while the rest were females. Prevalence of 3.3% was observed among blood donors in Telewonyan Memorial Hospital. There is a significant difference between gender and age with HBV seropositivity among blood donors. <strong>Conclusion:</strong> The findings of this study suggest that the study site is of low endemicity with HBV infection. Usually, males are more probably to be HBVsAg seropositive than their female’s counterpart. Planning more extensive study and educational programs would help minimize the spread of HBV infection among the general population.
文摘Early stage cancers of tongue are treated traditionally with a wide local excision or hemiglossectomy, but the preservation of normal speech and swallowing are hampered. Most of the patients are treated with external beam irradiation to achieve the best locoregional control as only a limited number of tongue cancers can be excised. Underdeveloped nations with finite resources are still dependent on cobalt based external beam radiotherapy and sometimes a Linear Accelerator with two dimensional planning. This treatment has many limitations, as the large radiation fields irradiate not only the tumor but also normal tissue. The sequalae include mucositis, dry mouth, teeth and gum injury, spinal cord damage and rarely mandibular necrosis. Intensity modulated radiotherapy, which can abrogate these side effects, is not available to these patients. Irradiation using implanted solid radioactive sources into the tumor tissue is a viable option in this context. This kind of treatment is termed as brachytherapy and if the implant is introduced into the tissue then it is interstitial brachytherapy. This report details our experience in interstitial implantation, planning, dosimetry and treatment. Diagnosed cancers of anterior 2/3rd of lateral border of tongue with T1 N0M0 or T2 N0M0 stages were subjected to Iridium implantation under general anesthesia. Orthogonal films were taken and planning done with brachyvision treatment planning system. High dose rate radiotherapy was delivered as per the prescription. Excellent local control of the tumor was achieved with no undue morbidity to the adjacent structures. The patients were asked to undergo regular follow up. Surgical salvage was advised in cases of nodal recurrence. Interstitial implantation is a treatment that can be safely administered in early stage cancers of the tongue. This has remarkable efficacy and is also a patient friendly procedure.
基金supported by the Medicine-Engineering Interdisciplinary Project of Sun Yat-sen Memorial Hospital,China,No.YXYGRH202203(to YW)Key-Area Research and Development Program of Guangdong Province,China,No.2023B1111050003(to HC)Guangzhou Science and Technology Talent Project of China,No.201909020006(to HC).
文摘Intrathecal administration of human umbilical cord mesenchymal stem cells may be a promising approach for the treatment of stroke,but its safety,effectiveness,and mechanism remain to be elucidated.In this study,good manufacturing practice-grade human umbilical cord mesenchymal stem cells(5×105 and 1×106 cells)and saline were administered by cerebellomedullary cistern injection 72 hours after stroke induced by middle cerebral artery occlusion in rats.The results showed(1)no significant difference in mortality or general conditions among the three groups.There was no abnormal differentiation or tumor formation in various organs of rats in any group.(2)Compared with saline-treated animals,those treated with human umbilical cord mesenchymal stem cells showed significant functional recovery and reduced infarct volume,with no significant differences between different human umbilical cord mesenchymal stem cell doses.(3)Human umbilical cord mesenchymal stem cells were found in the ischemic brain after 14 and 28 days of follow-up,and the number of positive cells significantly decreased over time.(4)Neuronal nuclei expression in the human umbilical cord mesenchymal stem cell group was greater than that in the saline group,while glial fibrillary acidic protein and ionized calcium binding adaptor molecule 1 expression levels decreased.(5)Human umbilical cord mesenchymal stem cell treatment increased the number of CD31+microvessels and doublecortin-positive cells after ischemic stroke.Human umbilical cord mesenchymal stem cells also upregulated the expression of CD31+/Ki67+.(6)At 14 days after intrathecal administration,brain-derived neurotrophic factor expression in the peri-infarct area and the concentrations of brain-derived neurotrophic factor in the cerebrospinal fluid in both human umbilical cord mesenchymal stem cell groups were significantly greater than those in the saline group and persisted until the 28th day.Taken together,these results indicate that the intrathecal administration of human umbilical cord mesenchymal stem cells via cerebellomedullary cistern injection is safe and effective for the treatment of ischemic stroke in rats.The mechanisms may include alleviating the local inflammatory response in the peri-infarct region,promoting neurogenesis and angiogenesis,and enhancing the production of neurotrophic factors.
基金the Ministry of Science and Technology Taiwan,No.MOST 109-2314-B-182A-091,No.NSTC 112-2314-B-182A-062, No.NSTC 113-2314-B-182A-125.
文摘BACKGROUND The incidence of diabetic atherosclerosis(DMA)is increasing worldwide,but its pathogenesis remains incompletely understood.In addition to cardiovascular complications,bladder dysfunction is one of the common comorbidities associated with DMA but is often refractory to current treatments.AIM To investigate the therapeutic effect of human amniotic fluid stem cell-derived extracellular vesicles(hAFSC-EVs)on the recovery of bladder dysfunction in DMA rats.METHODS Eighty rats were divided into normal control,streptozotocin-induced diabetic rats,diabetic rats subjected to arterial balloon endothelial injury of common iliac artery(DMA),and DMA rats treated with hAFSC-EVs(DMA+hAFSC-EVs).At 4 weeks and 12 weeks after DMA induction,levels of blood glucose,total cholesterol,triglyceride,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,homeostasis model assessment(HOMA)-insulin resistance,and HOMA-βwere measured.Cystometry,common iliac artery wall thickness,and bladder tumor necrosis factor(TNF)-α,interleukin(IL)-6,transforming growth factor(TGF)-β1,Smad3,connective tissue growth factor(CTGF)and fibronectin were also evaluated.RESULTS Bladder weight and blood glucose,triglyceride,HOMA-insulin resistance,common iliac artery intima thickness,voided volume,intercontraction interval,bladder capacity,and mRNA expression of TNF-α,IL-6,TGF-β1,Smad3,CTGF and fibronectin were significantly increased at 4 weeks and 12 weeks after induction,while the HOMA-βlevel decreased at 4 weeks and 12 weeks,and the high-density lipoprotein cholesterol level decreased at 12 weeks.hAFSC-EVs treatment in DMA rats significantly reduced bladder weight and blood glucose,thickness of common iliac arterial intima,voided volume,intercontraction interval and bladder capacity at 4 weeks.The mRNA expression of TNF-α,TGF-β1,and CTGF in DMA rats treated with hAFSC-EVs were significantly decreased at 4 weeks,while the mRNA expressions of IL-6 and Smad3 were significantly decreased 12 weeks.CONCLUSION hAFSC-EVs treatment can help restore DMA-induced bladder dysfunction,which is associated with lowered blood glucose levels,reduced arterial wall thickness,and decreased TNF-α,IL-6,TGF-β1,Smad3,and CTGF expression.
基金supported by grants from the Guangxi Natural Science Foundation(2024GXNSFAA010150)the Guangdong Basic and Applied Basic Research Foundation(2022A1515111167).
文摘Background:A significant proportion of patients still cannot benefit from existing targeted therapies and immunotherapies,making the search for new treatment strategies extremely urgent.In this study,we combined integrate public data analysis with experimental validation to identify novel prognostic biomarkers and therapeutic targets for lung adenocarcinoma(LUAD).Methods:We analyzed RNA and protein databases to assess the expression levels of cytochrome C oxidase 5B(COX5B)in LUAD.Several computational algorithms were employed to investigate the relationship between COX5B and immune infiltration in LUAD.To further elucidate the role of COX5B in LUAD,we utilized multiple experimental approaches,including quantitative reverse transcription PCR assays,western blot,immunohistochemistry,electron microscopy,flow cytometry,and EdU proliferation assays.Results:We revealed that COX5B was significantly elevated in LUAD and positively correlated with poor prognosis of LUAD patients.Analysis of co-expression network indicated that COX5B may take part in the intracellular adenosine triphosphate(ATP)synthesis through the oxidative phosphorylation pathway.There was a negative correlation between COX5B expression and immune infiltration in LUAD.Furthermore,we validated that COX5B levels were significantly elevated in both LUAD tissues and cell lines.Specifically,immunohistochemistry(IHC)assays revealed a 2.32-fold increase of COX5B in tumor tissues compared to that in adjacent normal tissues(p=0.0044).Additionally,COX5B knockdown disrupted the redox homeostasis,ultimately suppressed the proliferation of LUAD cells.Subsequent investigations demonstrated that berberine effectively targeted COX5B,diminishing its protein expression and consequently inhibiting cell proliferation and tumor growth in LUAD.Conclusions:This study established that upregulated COX5B was positive associated with poor patient prognosis in LUAD,elucidating the mechanisms by which berberine targets COX5B to inhibit tumor growth,thereby providing a novel therapeutic target and strategy for the clinical management of LUAD.
文摘AIM： To analyze the characteristics of multiple primary malignancies （MPMs） of digestive system; including incidence, types of tumor combinations, time intervals between development of multiple tumors, clinical course,and prognostic factors affecting survival and mortality.METHODS： Data from a total of 129 patients treated from January 1991 to December 2000 for pathologically proved MPMs, including at least one originating from the digestive system, were reviewed retrospectively.RESULTS： Among 129 patients, 120 （93.02%） had two primary cancers and 9 （6.98%） had three primary cancers. The major sites of MPMs of the digestive system were large intestine, stomach, and liver. Associated nondigestive cancers included 40 cases of gynecological cancers, of which 31 were carcinoma of cervix and 10 cases of genitourinary cancers, of which 5 were bladder cancers. Other cancers originated from the lung, breast,nasopharynx, larynx, thyroid, brain, muscle, and skin.Reproductive tract cancers, especially cervical, ovarian,bladder, and prostate cancers were the most commonlyassociated non-G! cancers, followed by cancer of the lung and breasts. Forty-three cases were synchronous, while the rest （86 cases） were metachronous cancers. Staging of MPMs and treatment regimes correlated with the prognosis between survival and non-survival groups.CONCLUSION： As advances in cancer therapy bring about a progressively larger percentage of long-term survivors, the proportion of patients with subsequent primary lesions will increase. Early diagnosis of these lesions, based on an awareness of the possibility of second and third cancers, and multidiscipiinary treatment strategies will substantially increase the survival of these patients.
基金Supported by Thai Pediatric Gastroenterology,Hepatology and Immunology Research Unit,King Chulalongkorn Memorial Hospital,Faculty of Medicine,Chulalongkorn UniversityThe 100th Anniversary Chulalongkorn University Fund for Doctoral Scholarship,Chulalongkorn Universityand the Thailand Research Fund Thailand Science Research and Innovation,No.MRG6280190.
文摘BACKGROUND Infections and associated morbidity and mortality may be more frequent in children who have undergone liver transplant than in healthy children.Immunization strategies to prevent vaccine-preventable infections(VPIs)can effectively minimize this infection burden.However,data on age-appropriate immunization and VPIs in children after liver transplant in Asia are limited.AIM To evaluate the immunization status,VPIs and non-VPIs requiring hospitalization in children who have undergone a liver transplant.METHODS The medical records of children who had a liver transplant between 2004 and 2018 at King Chulalongkorn Memorial Hospital(Bangkok,Thailand)were retrospectively reviewed.Immunization status was evaluated via their vaccination books.Hospitalization for infections that occurred up to 5 years after liver transplantation were evaluated,and divided into VPIs and non-VPIs.Hospitalizations for cytomegalovirus and Epstein-Barr virus were excluded.Severity of infection,length of hospital stay,ventilator support,intensive care unit requirement,and mortality were assessed.RESULTS Seventy-seven children with a mean age of 3.29±4.17 years were included in the study,of whom 41(53.2%)were female.The mean follow-up duration was 3.68±1.45 years.Fortyeight children(62.3%)had vaccination records.There was a significant difference in the proportion of children with incomplete vaccination according to Thailand’s Expanded Program on Immunization(52.0%)and accelerated vaccine from Infectious Diseases Society of America(89.5%)(P<0.001).Post-liver transplant,47.9%of the children did not catch up with ageappropriate immunizations.There were 237 infections requiring hospitalization during the 5 years of follow-up.There were no significant differences in hospitalization for VPIs or non-VPIs in children with complete and incomplete immunizations.The risk of serious infection was high in the first year after receiving a liver transplant,and two children died.Respiratory and gastrointestinal systems were common sites of infection.The most common pathogens that caused VPIs were rotavirus,influenza virus,and varicella-zoster virus.CONCLUSION Incomplete immunization was common pre-and post-transplant,and nearly all children required hospitalization for non-VPIs or VPIs within 5 years posttransplant.Infection severity was high in the first year post-transplant.
文摘AIM: To study the "hospital type-outcome" and "volumeoutcome" relationships in patients with esophageal cancer who receive non-surgical treatments.METHODS: A total of 6106 patients with esophageal cancer diagnosed between 2008 and 2011 were identified from a national population-based cancer registry in Taiwan. The hospital types were defined as medical center and non-medical center. The threshold for high-volume hospitals was based on a median volume of 225 cases between 2008 and 2011(annual volume, > 56 cases) or an upper quartile(> 75%) volume of 377 cases(annual volume > 94 cases). Cox regression analyses were used to determine the effects of hospital type and volume outcome on patient survival.RESULTS: A total of 3955 non-surgically treated patients were included in the survival analysis. In the unadjusted analysis, the significant prognostic factors included c T, c N, c M stage, hospital type and hospital volume(annual volume, > 94 vs ≤ 94). The 1- and 3-year overall survival rates in the non-medical centers(36.2% and 13.2%, respectively) were significantly higher than those in the medical centers(33.5% and 11.3%, respectively; P = 0.027). The 1- and 3-year overall survival rates in hospitals with an annual volume of ≤ 94(35.3% and 12.6%, respectively) were significantly higher than those with an annual volume of > 94(31.1% and 9.4%, respectively; P = 0.001). However, in the multivariate analysis, the hospital type was not statistically significant. Only c T, c N, and c M stages and hospital volume(annual volume > 94 vs ≤94) were independent prognostic factors.CONCLUSION: Whether the treatment occurs in medicalcenters is not a significant prognostic factor. Highvolume hospitals were not associated with better survival rates compared with low-volume hospitals.
文摘AIM: To share clinical pattern of presentation, the modalities of surgical intervention and the one month postsurgical outcome of rhino-orbito-mucormycosis(ROCM) cases.METHODS: All COVID associated mucormycosis(CAM) patients underwent comprehensive multidisciplinar y examination by ophthalmologist, otorhinolaryngologist and physician. Patients with clinical and radiological evidence of orbital apex involvement were included in the study. Appropriate medical and surgical intervention were done to each patient. Patients were followed up one-month post intervention. RESULTS: Out of 89 CAM patients, 31(34.8%) had orbital apex syndrome. Sixty-six(74.2%) of such patients had pre-existing diabetes mellitus, 18(58%) patients had prior documented use of steroid use, and 55(61.8%) had no light perception(LP) presenting vision. Blepharoptosis, proptosis, complete ophthalmoplegia were common clinical findings. Seventeen(19.1%) of such patients had variable amount of cavernous sinus involvement. Endoscopic debridement of paranasal sinuses and orbit with or without eyelid sparing limited orbital exenteration was done in most cases, 34(38.2%) patients could retain vision in the affected eye. CONCLUSION: Orbital apex involvement in CAM patients occur very fast. It not only leads to loss of vision but also sacrifice of the eyeball, orbital contents and eyelids. Early diagnosis and prompt intervention can preserve life, vision and spare mutilating surgeries.
文摘AIM To evaluate rates and predictors of hospital readmission and care fragmentation in patients hospitalized with gastroparesis.METHODS We identified all adult hospitalizations with a primary diagnosis of gastroparesis in the 2010-2014 National Readmissions Database,which captures statewide readmissions.We excluded patients who died during the hospitalization,and calculated 30 and 90-d unplanned readmission and care fragmentation rates.Readmission to a non-index hospital(i.e.,different from the hospital of the index admission) was considered as care fragmentation.A multivariate Cox regression model was used to analyze predictors of 30-d readmissions.Logistic regression was used to determine hospital and patient factors independently associated with 30-d care fragmentation.Patients readmitted within 30 d were followed for 60 d post discharge from the first readmission.Mortality during the first readmission,hospitalization cost,length of stay,and rates of 60-d readmission were compared between those with and without care fragmentation.RESULTS There were 30064 admissions with a primary diagnosis of gastroparesis.The rates of 30 and 90-d readmissions were 26.8% and 45.6%,respectively.Younger age,male patient,diabetes,parenteral nutrition,≥ 4 Elixhauser comorbidities,longer hospital stay(> 5 d),large and metropolitan hospital,and Medicaid insurance were associated with increased hazards of 30-d readmissions.Gastric surgery,routine discharge and private insurance were associated with lower 30-d readmissions.The rates of 30 and 90-d care fragmentation were 28.1% and 33.8%,respectively.Younger age,longer hospital stay(> 5 d),self-pay or Medicaid insurance were associated with increased risk of 30-d care fragmentation.Diabetes,enteral tube placement,parenteral nutrition,large metropolitan hospital,and routine discharge were associated with decreased risk of 30-d fragmentation.Patients who were readmitted to a non-index hospital had longer length of stay(6.5 vs 5.8 d,P = 0.03),and higher mean hospitalization cost($15645 vs $12311,P < 0.0001),compared to those readmitted to the index hospital.There were no differences in mortality(1.0% vs 1.3%,P = 0.84),and 60-d readmission rate(55.3% vs 54.6%,P = 0.99) between the two groups.CONCLUSION Several factors are associated with the high 30-d readmission and care fragmentation in gastroparesis.Knowledge of these predictors can play a role in implementing effective preventive interventions to highrisk patients.
文摘Patients with diabetes are increasingly common in hospital settings where optimal glycemic control remains challenging.Inpatient technology-enabled support systems are being designed,adapted and evaluated to meet this challenge.Insulin pump use,increasingly common in outpatients,has been shown to be safe among select inpatients.Dedicated pump protocols and provider training are needed to optimize pump use in the hospital.Continuous glucose monitoring(CGM)has been shown to be comparable to usual care for blood glucose surveillance in intensive care unit(ICU)settings but data on cost effectiveness is lacking.CGM use in non-ICU settings remains investigational and patient use of home CGM in inpatient settings is not recommended due to safety concerns.Compared to unstructured insulin prescription,a continuum of effective electronic medical record-based support for insulin prescription exists from passive order sets to clinical decision support to fully automated electronic Glycemic Management Systems.Relative efficacy and cost among these systems remains unanswered.An array of novel platforms are being evaluated to engage patients in technology-enabled diabetes education in the hospital.These hold tremendous promise in affording universal access to hospitalized patients with diabetes to effective self-management education and its attendant short/long term clinical benefits.
基金supported in part by the Research Team Project of Natural Science Foundation of Guangdong Province of China(No.2017A030312007)the Key Program of Guangzhou science research plan(No.201904020047)the Special Project of Dengfeng Program of Guangdong Provincial People’s Hospital(No.DFJH201812,No.KJ012019119,No.KJ012019423)。
文摘Background Objective:To investigate the perioperative precautions,surgical methods and early clinical efficacy of patients with valvular heart disease complicated by coronary atherosclerotic heart disease treated with coronary artery bypass grafting at the same time as heart valve replacement and to analyze the relevant factors affecting the death of patients during hospitalization after surgery.Methods:Between January 2020 and September 2021,a total of 103 patients who underwent simultaneous heart valve replacement and coronary artery bypass grafting for heart valve disease in conjunction with coronary atherosclerotic heart disease at the Department of cardiac surgery,Guangdong Cardiovascular Institute were retrospectively evaluated for clinical data,and a systematic review and summary of all preoperative data,surgical methods,intraoperative data,and major complications were performed.The variations in each cardiotocography indicator were examined before and after surgery to determine surgical effectiveness and statistical perioperative patient mortality.After integrating the Sino SCORE risk assessment system and analyzing the case features included in this data,12 alternative risk variables for mortality were identified and submitted to univariate and multivariate analysis using logistic regression.After performing a univariate analysis of the alternative risk factors,the option of P<0.05 was considered a risk factor and included in the multivariate analysis,followed by a multivariate logistic regression analysis in which the factors were determined to be independent risk factors with P<0.05,and their OR values and 95 percent confidence intervals(CIs)were calculated to analyze the associated factors affecting patients’early prognosis systematically.Results:Of the 103 patients,91 were successfully discharged from the hospital,12 died,11.7%of the deaths were due to the following causes:postoperative low cardiac output syndrome,multiple organ failure,and severe infection;Among all the 103 patients,7 patients underwent rebleeding and hemostasis after surgery,6 patients required dialysis after surgery,28 patients underwent IABP supportive care after surgery because of the occurrence of low cardiac output syndrome,1 patient assisted by ECMO after surgery,and patients discharged successfully had significantly less LVEDD and LVESD in the early postoperative period,compared with those before surgery(P=0.000;P=0.000).Age>70 years,preoperative combined hyperlipidemia,and history of the cerebrovascular accident were the three independent risk factors that may have contributed to in-hospital mortality in patients undergoing CABG valve replacement.Conclusions:1.The diastolic function of the majority of patients with valvular heart disease and coronary atherosclerotic heart disease improved significantly in the early stages after coronary artery bypass grafting and heart valve replacement.2.Age>70 years,preoperative combined hyperlipidemia,and a history of the cerebrovascular accident were three independent risk factors for in-hospital death in patients receiving CABG valve replacement.
文摘Background Diabetes mellitus （DM） is the major risk factor of coronary artery disease （CAD）, and the control status of blood sugar has direct effect on the prognosis of CAD. HbAlc is the important parameter reflect- ing control status of blood sugar, however, it is unclear about the value of in-hospital HbAlc in patients with a- cute coronary syndrome （ACS）. Methods A retrospective analysis was performed for 236 in-hospital diabetic patients with ACS. Patients were stratified into two groups according to HbAlc level when admission （Well con- trolled group （HbAlc ~〈7.0%） and High HbAlc group （HbAlc 〉 7.0%）; major adverse cardiovascular events （MACE） group and Non-MACE group）. In-hospital MACE and mortality were set as the observation target. Results 282 patients （112 in Well controlled group and 170 in High HbAlc group） were enrolled, of which 146 （51.77%）, 63 （23.34%）, and 73 （25.89%） patients respectively had unstable angina （UA）, non-ST-seg- ment elevation myocardial infarction （NSTEM[）, and ST-segment elevation myocardial infarction （STEMI）. In- hospital all-cause mortality and in-hospital MACE were both similar in Well controlled group and High HbAlc group （6.25% vs. 7.06% and 15.18% vs. 16.47%, P 〉 0.05）. In MACEs, cardiac death （4.46% vs. 5.29%）, recurrent myocardial infarction （2.68% vs. 2.94%）, hemorrhage events （5.35% vs. 5.29%）, malignant arrhyth- mia （6.25% vs. 5.29%）, cardiac shock （4.46% vs. 4.12%）, acute heart failure （8.93% vs. 10.0%）, revascu- larization （4.46% vs. 5.29%） were also all similar in both two groups. In addition, there were no significant dif- ference in HbAlc level between MACE group and Non-MACE group. Single-factor logistic regression analysis showed that HbAlc was not a risk factor for in-hospital MACE （P 〉 0.05）. Conclusion The present study suggests that admission HbAlc is not the risk factor of in-hospital MACE in ACS patients with diabetes.
基金Supported by the Fatty Liver Unit,Foundation of the Faculty of Medicine,Chulalongkorn University.
文摘BACKGROUND Acute liver failure(ALF)in dengue is rare but fatal.Early identification of patients who are at risk of ALF is the key strategy to improve survival.AIM To validate prognostic scores for predicting ALF and in-hospital mortality in dengue-induced severe hepatitis(DISH).METHODS We retrospectively reviewed 2532 dengue patients over a period of 16 years(2007-2022).Patients with DISH,defined as transaminases>10 times the normal reference level and DISH with subsequent ALF,were included.Univariate regre-ssion analysis was used to identify factors associated with outcomes.Youden’s index in conjunction with receiver operating characteristic(ROC)analysis was used to determine optimal cut-off values for prognostic scores in predicting ALF and in-hospital death.Area under the ROC(AUROC)curve values were compared using paired data nonparametric ROC curve estimation.RESULTS Of 193 DISH patients,20 developed ALF(0.79%),with a mortality rate of 60.0%.International normalized ratio,bilirubin,albumin,and creatinine were indepen-dent predictors associated with ALF and death.Prognostic scores showed excel-lent performance:Model for end-stage liver disease(MELD)score≥15 predicted ALF(AUROC 0.917,sensitivity 90.0%,specificity 88.4%)and≥18 predicted death(AUROC 0.823,sensitivity 86.9%,specificity 89.1%);easy albumin-bilirubin(ALBI)score≥-30 predicted ALF and death(ALF:AUROC 0.835,sensitivity80.0%,specificity 72.2%;death:AUROC 0.808,sensitivity 76.9%,specificity 69.3%);ALBI score≥-2 predicted ALF and death(ALF:AUROC 0.806,sensitivity 80.0%,specificity 77.4%;death:AUROC 0.799,sensitivity 76.9%,specificity 74.3%).Platelet-ALBI score also showed good performance in predicting ALF and death(AUROC=0.786 and 0.699,respectively).MELD and EZ-ALBI scores had similar performance in predicting ALF(Z=1.688,P=0.091)and death(Z=0.322,P=0.747).CONCLUSION MELD score is the best predictor of ALF and death in DISH patients.EZ-ALBI score,a simpler yet effective score,shows promise as an alternative prognostic tool in dengue patients.
文摘Objective: Few studies have focused on factors influencing outcomes of patients with in-hospital cardiac arrest (IHCA) in general wards. The goal of this study was to report the outcomes of adult patients with IHCA in the general wards and identified the prognostic factors. Methods: Adult patients with IHCA having received cardiopulmonary resuscitation in general wards from January 2008 to December 2011 were retrospectively reviewed from our registry system. The primary outcome was survival to hospital discharge, while the secondary outcome was sustained return of spontaneous circulation (ROSC). Results: A total of 544 general ward patients were analyzed for event variables and resuscitation results. The rate of establishing a ROSC was 40.1% and the rate of survival to discharge was 5.1%. Ventricular tachycardia/ventricular fibrillation (VT/VF) was the initial rhythm in 3.9% of patients. Pre-arrest factors including a high Charlson comorbidity index (CCI) ≥ 9 (OR 0.251, 95% CI 0.098 - 0.646), cardiac comorbidity (OR 0.612, 95% CI 0.401 - 0.933), and arrest time on the midnight shift (OR 0.403, 95% CI 0.252 - 0.642) were independently associated with a low possibility of ROSC. The initial VT/VF presenting rhythms (OR 0.135, 95% CI 0.030 - 0.601) were independently associated with a high survival rate, whereas patients with deteriorated disease course were independently associated with a decreased hospital survival (OR 3.902, 95% CI 1.619 - 9.403). Conclusions: We demonstrated that pre-arrest factors can predict patient outcome after IHCA in general wards, including the association of a CCI ≥ 9 and cardiac comorbidity with poor ROSC, and deteriorated disease course as an independent predictor of a low survival rate.
文摘Introduction: The goal of Prevention of Mother to child Transmission (PMTCT) is to minimize new HIV infection with PMTCT interventions which can reduce to as low as 2%. Gusii region is number 5 among counties that contribute to 65% of new HIV (Human Immunodeficiency Virus) in infections in Kenya. The study was to determine the prevalence of new HIV infections among infants (3 - 18 months) born of HIV positive mothers on PMTCT follow up at Kisii Teaching and Referral Hospital (KTRH). Method: This was a descriptive cross sectional study involving 96 infants born of HIV positive mothers on PMTCT programme at Kisii Teaching and Referral Hospital (KTRH) was conducted. The infants were between 3 to 18 months of age. The infants were investigated for their HIV status and factors associated with prevalence. The data collection was done during postnatal checkups, antiretroviral treatment follow up and immunization schedule. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 20. Results: 13.5% (95% C.I = 10.1% to 16.9%) were found to be positive despite their mothers being on PMTCT program. There was no significant difference between gender and status of the infant (χ2 = 0.758, df = 1, p-value = 0.0384). Conclusion: The study confirms that there are still new HIV infections despite being followed up in the PMTCT program. The new HIV infections were associated with mixed feeding. Recommendation: Counseling on Infant feeding, use of ant-retroviral treatment and support from partners should be strengthen in the PMTCT program to ensure reduction of new HIV infections.
基金supported by the National Key Research and Development Project,No.2019YFA0112100(to SF).
文摘Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death.China has the largest population of patients with traumatic spinal cord injury.Previous studies of traumatic spinal cord injury in China have mostly been regional in scope;national-level studies have been rare.To the best of our knowledge,no national-level study of treatment status and economic burden has been performed.This retrospective study aimed to examine the epidemiological and clinical features,treatment status,and economic burden of traumatic spinal cord injury in China at the national level.We included 13,465 traumatic spinal cord injury patients who were injured between January 2013 and December 2018 and treated in 30 hospitals in 11 provinces/municipalities representing all geographical divisions of China.Patient epidemiological and clinical features,treatment status,and total and daily costs were recorded.Trends in the percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department and cost of care were assessed by annual percentage change using the Joinpoint Regression Program.The percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department did not significantly change overall(annual percentage change,-0.5%and 2.1%,respectively).A total of 10,053(74.7%)patients underwent surgery.Only 2.8%of patients who underwent surgery did so within 24 hours of injury.A total of 2005(14.9%)patients were treated with high-dose(≥500 mg)methylprednisolone sodium succinate/methylprednisolone(MPSS/MP);615(4.6%)received it within 8 hours.The total cost for acute traumatic spinal cord injury decreased over the study period(-4.7%),while daily cost did not significantly change(1.0%increase).Our findings indicate that public health initiatives should aim at improving hospitals’ability to complete early surgery within 24 hours,which is associated with improved sensorimotor recovery,increasing the awareness rate of clinical guidelines related to high-dose MPSS/MP to reduce the use of the treatment with insufficient evidence.
文摘In 2012-2013, CMH （Community Memorial Hospital） had a 10.5% 30-day readmission rate from SNFs （skilled nursing facilities）. The focus of the Connections of Care Coalition was to review the medication reconciliation process and to involve pharmacists in the transition of patients to SNFs. The objective of the project was to work as an interdisciplinary team to improve the communication during transitions of care from our hospital to local SNFs by identifying key issues and initiating pharmacy practice change. This quality improvement project had a pre-post study design. Patients older than 18 years of age discharged to SNFs and/or readmitted from SNFs within 30 days were included. Baseline data was collected, specific pharmacist interventions were identified, educated on and implemented, and post-implementation data was collected. The number of interventions made and documented by pharmacists for patients being discharged from CMH to local SNFs did not significantly change during this quality improvement study. Clinically significant interventions were made on high risk medications, such as warfarin. Finally, a newly redesigned SNF workflow was implemented to include pharmacy, nursing, social work/case management to improve patient care and safety for discharges to SNFs.
