目的 了解急性脑卒中患者的病理反射变化与病情变化的关系。 方法 2007年3月-2009年2月对40例急性脑卒中患者进行双下肢病理反射动态观察，结合头部影像学(CT、MRI)跟踪，观察其病情变化。 结果 所有患者病情有不同程度加重，影像学显示脑水肿加重，双下肢病理征阳性。 结论 急性脑卒中患者病理反射变化对病情判断具有重要价值。
Objective To investigate the expression and clinical significance of S100A4 protein in tumorstroma of nonsmall cell lung cancer（NSCLC） to study its correlation with invasion, metastasis and prognosis. Methods Immunohistochemical staining（SP method）for S100A4 protein expression was performed in tissue sections from 130 patients with NSCLC operated and to analyze association of S100A4 protein with clinicopathological parameters in lung cancer and prognosis. Results The total positive expression rates of S100A4 protein in stroma of NSCLC was 72.3%. The positive expression rates of S100A4 protein in stroma of squamous cell carcinoma, adenocarcinoma, adenosquamous carcinoma and large cell lung cancer were 84.3%，59.6%，70.0% and 75% respectively.The expression of S100A4 protein was significantly associated with lymph node metastasis (χ2=18.91, P=0.000), distant metastasis(χ2=5.51, P=0.019) and TNM stage (χ2=21.54, P=0.000). The 3 years survival rates of patients whose tumourstroma stained positive for S100A4 was lower than that of patients whose tumourstroma stained negative (36.2% vs. 63.9%, P=0.003). Cox’ risk ratio model analysis indicated that age ≤50 years (OR=1.866), lymph node metastasis(OR=1.826), distant metastasis(OR=6.224), lower histology differentiation and undifferentiation (OR=1.793), TNM stage Ⅲ-Ⅳ (OR=2.573) and positive expression of S100A4 protein in stroma of NSCLC(OR=1.776) were significantly independent prognostic factors which affected survival. Conclusion Expression of S100A4 protein in stroma of NSCLC is significantly associated with invasion, metastasis, TNM stage and prognosis. S100A4 protein might become a marker for prediction of tumor progression of disease and clinical therapy.
Objective To systematically review the effect of allopurinol on renal function in patients with chronic kidney disease (CKD). Methods The PubMed, EMbase, Cochrane Library, WanFang Data, CNKI, and VIP databases were searched for randomized controlled trials (RCTs) of the effect of allopurinol on renal function in patients with CKD. Databases for articles published between establishment of the database and April 28, 2021 were searched. Two evaluators independently screened the literature, extracted data and evaluated the risk of bias of the included studies. RevMan 5.4 was then used for meta-analysis. Results A total of 20 RCTs comprising 2 338 patients were included. The results of meta-analysis showed that compared with the control group, allopurinol substantially reduced the serum uric acid (MD=−2.48, 95%CI −3.08 to −1.89, P<0.01). In addition, the effect of allopurinol on slowing the decline in eGFR was influenced by the serum uric acid concentration. Participants taking allopurinol whose serum uric acid concentrations were maintained at >6 mg/dL showed a slower decline in eGFR (MD=5.03, 95%CI 1.76 to 8.31, P<0.01). However, there was no difference in the decline in eGFR between the two groups when the serum uric acid concentration of the participants was <6 mg/dL. Among participants with CKD and moderate renal dysfunction at baseline, those taking allopurinol showed a slower decline in eGFR than controls (MD=3.33, 95%CI 1.14 to 5.52, P<0.01). A further subgroup analysis showed that those who maintained their serum uric acid concentration above 6 mg/dL experienced a slower decline in eGFR (MD=5.46, 95%CI 2.06 to 8.86, P<0.01). However, when the serum uric acid concentration was <6 mg/dL, there was no difference between the allopurinol and control groups. Moreover, the serum creatinine concentration of the allopurinol group was lower than that of the control group after the intervention (MD=−0.39, 95%CI −0.58 to −0.19), P<0.01). However, there was no significant difference in the incidence of progression to end-stage kidney disease between the two groups (RR=0.96, 95%CI 0.65 to 1.42, P=0.85). Conclusion Allopurinol can substantially reduce serum uric acid and may protect the kidneys of patients with CKD when the serum uric acid concentration is maintained above 6 mg/dL.
The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) published the first clinical practice guideline for sudden sensorineural hearing loss in 2012 and updated it in 2019. The guideline, which includes 13 expert consensus recommendations and treatment protocols, advocates medication (glucocorticoids are the sole optional medicine) and hyperbaric oxygen therapy. In order to provide references for the formulation of the guidelines for sudden sensorineural hearing loss that are more suitable for our national conditions, this article interprets the treatment regimens of the guideline.
ObjectiveTo develop and validate a nomogram for predicting overall survival among patients with breast apocrine carcinoma (BAC). MethodsThe patients diagnosed with BAC from 2010 to 2016 were selected from the Surveillance, Epidemiology, and End Results (SEER) database and then randomly divided into a training set and a validation set by a 7∶3 ratio. Additionally, external validation of the nomogram was conducted on BAC patients admitted to the Dongfeng Hospital Affiliated to Hubei Medical College from January 1, 2010 to December 31, 2018. The risk factors affecting the overall survival of BAC patients were determined by univariate and multivariate Cox regression analyses, which were used to develop the nomogram prediction model. The discriminative abilities of the nomogram for the 3- and 5-year overall survival rates were evaluated by the C-index and area under receiver operating characteristic curve (AUC), and the fit of actual data and nomogram-predicted data for calibrators should be evaluated. ResultsA total of 649 BAC patients who met the included criterion for this study were enrolled from the SEER database (including 454 in the training set and 195 in the internal validation set), and 21 BAC patients from the Dongfeng Hospital (external validation set) were included. The multivariate Cox regression analysis showed that the age, T stage, M stage, S stage, surgical method, and chemotherapy were the risk factors affecting the overall survival of BAC patients. The C-index values of the nomogram prediction model based on these risk factors was 0.76, 0.77, and 0.88 in the training set, internal validation set, and external validation set, respectively. The calibration curves of the actual 3- and 5-year overall survival rates and nomogram-predicted 3- and 5- year overall survival rates were close to the ideal curve. The AUCs (95%CI) of the nomogram prediction model for evaluating the 3-year and 5-year overall survival rates of BAC patients were 0.84 (0.78, 0.89) and 0.76 (0.71, 0.83) in the training set, 0.81 (0.73, 0.91) and 0.84 (0.77, 0.91) in the internal validation set, and 0.80 (0.70, 0.91) and 0.84 (0.76, 0.91) in the external validation set, respectively. ConclusionNomogram based on the SEER database to predict the overall survival of BAC patients has a good predictive effect for BAC patients.
ObjectiveTo explore effect of preoperative prognostic nutritional index (PNI) on clinically related postoperative pancreatic fistula (CR-POPF) after distal pancreatectomy (DP) and analyze its influencing factors in order to provide a basis for clinical prediction of CR-POPF. MethodsThe clinicopathologic data of patients who successfully completed DP in the Affiliated Hospital of Xuzhou Medical University and met the inclusion and exclusion criteria of this study from January 1, 2017 to January 31, 2021 were collected retrospectively. The preoperative PNI value was calculated and the optimal cut-off value was obtained according to the receiver operative characteristic (ROC) curve. The patients were divided into low and high PNI based on the optimal cut-off value. The clinicopathologic characteristics were compared between the patients with low and high PNI and CR-POPF or not. At the same time, multivariate logistic regression was used to analyze the influencing factors of CR-POPF. ResultsA total of 143 patients who met the inclusion and exclusion criteria were included in this study. The CR-POPF occurred in 33 cases (23.08%) after DP, and the average preoperative PNI was 52.26 (39.20–65.10), the optimal cut-off value of PNI was 50.55, with 49 cases in the low PNI group and 94 cases in the high PNI group. In patient with low PNI, the proportions of patients aged ≥65 years and with CR-POPF were higher than those with high PNI (P<0.05). In the patients with CR-POPF, the proportions of patients with soft pancreatic texture and with low preoperative PIN were higher than those without CR-POPF (P<0.05). Further, the multivariate logistic regression showed that the the preoperative low PNI (OR=5.417, P<0.001) and soft pancreatic texture (OR=4.126, P=0.002) increased the risk of CR-POPF. ConclusionLow preoperative PNI and soft pancreatic texture increase risk of CR-POPF after DP, and it is necessary to preoperatively evaluate PNI status of patients.
ObjectiveTo explore the relationship between the natural environment of residential areas and subjective well-being of the elderly and the role of the elderly’s evaluation of the environmental protection work in both. MethodsBased on the China social survey database (CSS) in 2019, Rstudio and Stata software were used to process the data screened according to the restricted conditions, and multi-classification logistic regression analysis and Bootstrap mediation effect test were used to test the effect relationship among variables. ResultsAir pollution, water pollution, noise pollution, land pollution, electromagnetic ionizing radiation pollution and other pollution in residential areas have no direct effect on the subjective well-being of the elderly (P>0.05). The evaluation of the elderly on the environmental protection work had a positive impact on the elderly’s subjective well-being (P<0.01) and played a completely mediating role in the impact of the natural environment in the residential area on the elderly’s subjective well-being. ConclusionThe government should continue to play a leading role in coordinating environmental protection and pollution control work. In addition, establish an open and transparent environmental protection information disclosure system and strengthen communication with the elderly.
Objective To compare the effectiveness of Achillon Achilles tendon suture guide combined with circuit suture under the perineural channel and Krachow suture with posterolateral incision of Achilles tendon in the treatment of Kuwada type Ⅱ acute closed Achilles tendon rupture. Methods The clinical data of 38 patients with Kuwada type Ⅱ acute closed Achilles tendon rupture who met the selection criteria between January 2020 and December 2023 were retrospectively analyzed. Krachow suture via posterolateral incision was used in 24 cases (traditional group), and Achillon Achilles tendon suture guide combined with circuit suture via perineural channel was used in 14 cases (minimally invasive group). There was no significant difference in baseline data such as age, gender, body mass index, cause of injury, time from injury to operation, characteristics of Achilles tendon injury (broken end distance, stump length), and preoperative Achilles tendon total rupture score (ATRS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot function score between the two groups (P>0.05). The operation time, incision length, hospital stay, and complications (re-tear, incision infection, sural nerve irritation, deep venous thrombosis) were recorded. ATRS score and AOFAS ankle and hindfoot function score were used to evaluate the effectiveness before operation and at 3 and 6 months after operation. Results All patients successfully completed the operation. The operation time, incision length, and hospital stay in the minimally invasive group were significantly shorter than those in the traditional group (P<0.05). Patients in both groups were followed up 8-16 months, with an average of 12.7 months. There was no sural nerve injury or re-tear of Achilles tendon in both groups. In the traditional group, 1 case had incision infection,1 case had suture rejection, and 1 case had intermuscular venous thrombosis; in the minimally invasive group, no incision healing complication, suture knot discomfort, or thrombosis occurred. There was no significant difference in the incidence of complications between the two groups (P=0.283). The ATRS score and AOFAS ankle and hindfoot function score of the two groups were improved after operation, but there was no significant difference (P>0.05). Except that there was no significant difference in AOFAS ankle and hindfoot function scores between the two groups at 6 months after operation (P>0.05), the ATRS scores and AOFAS ankle and hindfoot function scores in the minimally invasive group were significantly better than those in the traditional group at other time points (P<0.05).Conclusion The treatment of Kuwada type Ⅱ acute closed Achilles tendon rupture with Achillon Achilles tendon suture guide combined with circuit suture via the perineural channel has similar ankle function comparable to traditional operation, but the incision is smaller and the incidenc of incision infection is lower, which is beneficial for patients to recover early ankle function.
【Abstract】 Objective To investigate the feasibil ity of contralateral C7 nerve transfer via posterior spinal route fortreatment of brachial plexus root avulsion injury by anatomical study. Methods Ten cadaveric specimens of 7 men and3 women were selected, who had no obvious deformity and no tissue defect in neck neutral position. By simulating surgical exploration of brachial plexus injury, the length of contralateral C7 nerve root was elongated by dissecting its anterior and posterior divisions to the distal end, while the length of C7 nerve from the intervertebral foramen to the branching point and the length of the anterior and posterior divisions were measured. By simulating cervical posterior approach, the C7 vertebral plate and T1 spinous process were fully exposed; the hole was made near vertebral body; and the C7 nerve root lengths by posterior vertebra path to the contralateral upper trunk and lower trunk were measured. Results C7 nerve root length was (58.62 ± 8.70) mm; the length of C7 nerve root plus posterior or anterior division was (65.15 ± 9.11) mm and (70.03 ± 10.79) mm, respectively. By posterior spinal route, the distance was (72.12 ± 10.22) mm from the end of C7 nerve to the contralateral upper trunk of brachial plexus, and was (95.21 ± 12.50) mm to the contralateral lower trunk of brachial plexus. Conclusion Contralateral C7 nerve can be transferred to the contralateral side through posterior spinal route and it only needs short bridge nerve or no. The posterior spinal route can effectively prevent from neurovascular injury, so it might be the best surgery approach for the treatment of brachial plexus root avulsion injury.
目的 评价凋亡相关基因bcl-2、p53的表达与乳腺癌新辅助化学疗法（化疗）疗效的关系。 方法 计算机检索Cochrane、Pubmed、Embase、中国知网、万方、维普等数据库，2003年4月－2013年4月bcl-2、p53蛋白与乳腺癌新辅助化疗的病例对照研究，应用RevMan 4.2统计软件进行定量分析。 结果 共纳入15篇病例对照研究，bcl-2与乳腺癌新辅助化疗6篇，治疗有效279例，其中bcl-2表达阳性159例；治疗无效115例，其中bcl-2表达阳性57例。p53与乳腺癌新辅助化疗13篇，治疗有效679例，其中p53表达阳性249例；治疗无效341例，其中p53表达阳性195例。Meta分析结果显示，bcl-2表达的阳性率与乳腺癌新辅助化疗疗效无统计学意义[OR=1.40，95%CI（0.89，2.18），P=0.14]，而p53表达的阳性率与乳腺癌新辅助化疗疗效有统计学意义[OR=0.46，95%CI（0.26，0.80），P=0.007]。 结论 p53可以作为乳腺癌新辅助化疗疗效敏感性的一个指标，对乳腺癌新辅助化疗有提示作用。