目的 探讨经皮椎体成形术（percutaneous vertebroplasty，PVP）后新发椎体骨折的发生率及危险因素。 方法 回顾分析2004年1月-2009年1月行经PVP治疗的80例骨质疏松伴椎体压缩骨折的患者的临床资料，随访7～54个月，了解患者的疗效和预后。 结果 术后80例中14例（17.5%）30个椎体新发椎体骨折，其中相邻椎体占46.7%（14/30）。有无新发椎体骨折两组间及相邻和非相邻椎体骨折两组间，体重指数（body mass index，BMI）比较差异均统计学意义（Plt;0.05），而年龄、性别、骨折椎体个数、PVP手术椎体个数、骨水泥注射剂量、身高下降比较差异无统计学意义（Pgt;0.05）。经logistic回归分析发现低体重指数（BMI≤18.5 kg/m2）是PVP术后新发椎体骨折的独立危险因素。术后患者均给予抗骨质疏松药物治疗，58.8%（47/80）的患者能坚持抗骨质疏松药物治疗1年以上。采用KaplanMeier法计算术后第1年新发椎体压缩骨折的发生率为8.6%。低新发椎体骨折发生率与患者术后坚持抗骨质疏松治疗相关。 结论 低体重指数是PVP术后新发椎体骨折的独立危险因素，与PVP手术本身无关。术后坚持抗骨质疏松药物治疗能够降低新发椎体骨折的发生。
ObjectiveTo evaluate the value of blood urea nitrogen to creatinine ratio (UCR) in predicting the condition and prognosis of severe pneumonia patients.MethodsA total of 408 patients with severe pneumonia hospitalized in the intensive care unit (ICU) of Fangcun branch of Guangdong Provincial Hospital of traditional Chinese medicine from January 1, 2017 to August 1, 2020 were retrospectively collected. The patients were divided into a survival group (320 cases) and a death group (88 cases) according to the outcome of hospitalization. This study analyzed the relationship between UCR level and general information, condition, and treatment needs of severe pneumonia patients; and compared UCR, the value of neutrophil to lymphocyte ratio, the levels of hematocrit, C-reactive protein, procalcitonin and D-dimer, and the scores of Acute Physiology and Chronic Health EvaluationⅡ and Pneumonia Severity Index between the survival group and the death group. Receiver operating characteristic (ROC) curve was used to analyze the prognostic value of the above indicators. Logistic regression was used to analyze the risk factors of death of severe pneumonia.ResultsThe age of the patients died of severe pneumonia was higher than that of the survival patients (P<0.05); The mortality rate of severe hospital acquired pneumonia was higher than that of severe community acquired pneumonia (P<0.05); The level of UCR was higher in the patients over 70 years old (P<0.05); UCR level of the severe pneumonia patients with acute exacerbation of chronic obstructive pulmonary disease or multiple organ dysfunction syndrome during hospitalization was higher (P<0.05); The UCR level was higher in the patients with severe pneumonia whose ICU stay was more than 10 days (P<0.05); The UCR level of the severe pneumonia patients with mechanical ventilation longer than 180 hours was higher (P<0.05); UCR level of the severe pneumonia patients who died during hospitalization was higher than that of the survival group (P<0.05); The area under ROC curve of UCR for predicting death in the patients with severe pneumonia was 0.648 (95%CI 0.576 - 0.719), the cut-off value was 108.74, the sensitivity was 47.7%, and the specificity was 77.8% (P<0.05). PSI > level 3 (OR=4.297, 95%CI 2.777 - 6.651) and UCR > 108.74 (OR=0.545, 95%CI 0.332 - 0.896) were independent risk factors for death in the patients with severe pneumonia (P<0.05).ConclusionUCR has certain value in evaluating the condition and prognosis of severe pneumonia patients.
Objective To verify the applicability of AGREE-China and select high-quality clinical practice guidelines (CPGs) or consensus for the management of fragility fractures (FF) in China by evaluating their methodological quality. Methods CBM, CNKI, WanFang Data, VIP databases and related CPGs websites were electronically searched. Two reviewers independently screened literature, extracted data, and checked each other. Quality appraisal of CPGs or consensus were evaluated by AGREE Ⅱ and AGREE-China, and weighted Kappa value and intraclass correlation coefficients (ICC) were calculated to illustrate the consistency of the two tools. Results Nine CPGs and sixteen consensuses were included. Among the six domains in AGREE Ⅱ, "scope and purpose" domain (62.22%) scored higher than "clarity of presentation" domain (45.67%). The "stakeholder involvement" domain (34.89%) and "applicability" domain (38.17%) both exceeded 30%, while "rigor of development" domain (18.79%) and "editorial independence" domain (13.33%) were lower. Among the five domains in AGREE-China, "conflict of interest" domain (72.80%) was higher, followed by "usability/feasibility" domain (49.87%), while "scientificity/preciseness" domain (20.36%), "effectiveness/safety" domain (25.20%) and "economic efficiency" domain (14.40%) were lower. The weighted Kappa value of recommendations from the two tools was 0.694 (P<0.001), showing moderate consistency. ICC values of the same items and two evaluators were all greater than 0.85 (P<0.001) with high consistency. Three high-quality CPGs were consistently selected by the two tools. Conclusion AGREE Ⅱ holds high consistency with AGREE-China; however, AGREE-China is more suitable for the quality appraisal of Chinese CPGs or consensus. The methodological quality of CPGs or consensus for the management of FF in China needs to be further improved.
ObjectiveTo review the role of dendritic cells (DC) in immune metabolism of rheumatoid arthritis (RA). MethodsLiterature on the role of DC in the immune metabolism of RA was extensively reviewed in recent years, and the metabolic characteristics of RA, the role of DC in RA, the correlation between the immune metabolism of DC and pathogenesis of RA, and the treatment were summarized and analyzed. Results DC promotes the progression of RA under hypoxia, increased glycolysis, inhibition of oxidative phosphorylation, and decreased lipid metabolism. Moreover, many DCs (especially conventional DC and monocyte-derived DC) have different functions and phenotypic characteristics in RA, which are closely related to the occurrence and development of RA. Conclusion DC plays an important role in the immune metabolism of RA, and immunometabolism therapy based on DC can provide targeted therapy for the treatment of RA.
ObjectiveTo establish and internally validate a predictive model for poorly differentiated adenocarcinoma based on CT imaging and tumor marker results. MethodsPatients with solid and partially solid lung nodules who underwent lung nodule surgery at the Department of Thoracic Surgery, the Affiliated Brain Hospital of Nanjing Medical University in 2023 were selected and randomly divided into a training set and a validation set at a ratio of 7:3. Patients' CT features, including average density value, maximum diameter, pleural indentation sign, and bronchial inflation sign, as well as patient tumor marker results, were collected. Based on postoperative pathological results, patients were divided into a poorly differentiated adenocarcinoma group and a non-poorly differentiated adenocarcinoma group. Univariate analysis and logistic regression analysis were performed on the training set to establish the predictive model. The receiver operating characteristic (ROC) curve was used to evaluate the model's discriminability, the calibration curve to assess the model's consistency, and the decision curve to evaluate the clinical value of the model, which was then validated in the validation set. ResultsA total of 299 patients were included, with 103 males and 196 females, with a median age of 57.00 (51.00, 67.25) years. There were 211 patients in the training set and 88 patients in the validation set. Multivariate analysis showed that carcinoembryonic antigen (CEA) value [OR=1.476, 95%CI (1.184, 1.983), P=0.002], cytokeratin 19 fragment antigen (CYFRA21-1) value [OR=1.388, 95%CI (1.084, 1.993), P=0.035], maximum tumor diameter [OR=6.233, 95%CI (1.069, 15.415), P=0.017], and average density [OR=1.083, 95%CI (1.020, 1.194), P=0.040] were independent risk factors for solid and partially solid lung nodules as poorly differentiated adenocarcinoma. Based on this, a predictive model was constructed with an area under the ROC curve of 0.896 [95%CI (0.810, 0.982)], a maximum Youden index corresponding cut-off value of 0.103, sensitivity of 0.750, and specificity of 0.936. Using the Bootstrap method for 1000 samplings, the calibration curve predicted probability was consistent with actual risk. Decision curve analysis indicated positive benefits across all prediction probabilities, demonstrating good clinical value. ConclusionFor patients with solid and partially solid lung nodules, preoperative use of CT to measure tumor average density value and maximum diameter, combined with tumor markers CEA and CYFRA21-1 values, can effectively predict whether it is poorly differentiated adenocarcinoma, allowing for early intervention.
【摘要】 目的 评价亚洲骨质疏松自我评价工具（OSTA）和我国妇女骨质疏松筛选工具（OSTC）与四川地区围绝经期和绝经后汉族妇女骨密度的关系，比较两种工具对骨质疏松症的筛检能力，探讨其临床应用价值。 方法 2010年7—10月筛选获得356名45岁以上妇女的双能X线骨密度仪腰椎、股骨颈和全髋骨密度数据，利用体重和年龄分别计算OSTA指数与OSTC指数，并进行比较。 结果 OSTA指数与OSTC指数和各部位骨密度值均呈正相关（r=0.458~0.593和r=0.440~0.599，Plt;0.001），两种筛选指数之间呈正相关（r=0.956，Plt;0.001）。按两级危险程度分类界值进行判定，OSTA和OSTC的灵敏度分别为78.2%、93.5%，特异度为67.2%、43.0%，受试者工作特征曲线下面积为0.792、0.798，Kappa系数为0.452、0.357。 结论 OSTA与OSTC应用于四川地区围绝经期和绝经后妇女骨质疏松症的筛查效果均不理想，临床应用价值受限。【Abstract】 Objective To evaluate the relationship between osteoporosis self-assessment tool for asians (OSTA), osteoporosis self-assessment tool for Asians (OSTC) and bone mineral density in Sichuan perimenopausal and postmenopausal women of Han nationality, and discuss the value of their clinical application through comparison of the screening ability of the two tools in predicting osteoporosis and low bone mass. Methods With the data of bone mineral density at lumbar spine, femoral neck and total proximal femur measured by DXA of 356 women aged 45 years old and above, OSTA and OSTC risk indexes of each subject were calculated based on their weight and age, and were then compared. Results The bone mineral density of above-mentioned locations were positively correlated with OSTA and OSTC indexes (r=0.458-0.593 and r=0.440-0.599,Plt;0.001), and these two indexes were also correlated positively (r=0.956, Plt;0.001). According to the two risk levels by these cutoffs, OSTA and OSTC indexes could diagnose osteoporosis with the sensitivity of 78.2% and 93.5%, the specificity of 67.2% and 43%, the area under ROC curve of 0.792 and 0.798, and the Kappa value of 0.452 and 0.357, respectively. Conclusion Both OSTA and OSTC were not ideal tools for screening osteoporosis in perimenopausal and postmenopausal women in Sichuan province.
ObjectiveTo introduce implantation methods of different types of congenital heart disease occluder for the treatment of bronchopleural fistula (BPF) and its preliminary efficacy.MethodsThree patients who diagnosed with BPF and treated by congenital heart disease occluder were reviewed. The clinical data was analyzed after comprehensively reviewing of relevant literature.ResultsAll the three patients were treated with postoperative BPF and empyema. The diameter of the fistula ranged from 3 to 8 mm. We used occlusive devices for congenital heart diseases such as atrial septum (ASD), ventricular septum (VSD) defect or patent ductus arteriosus (PDA), respectively. After treatment, all three patients were cured of BPF and empyema caused by BPF in a short time, and the thoracic drainage tube was successfully removed. During the follow-up period from 7 to 25 months, no significant long-term complications were observed.ConclusionThe use of ASD, VSD and PDA occluder for the treatment of BPF with a fistula more than 3 mm is effective and safe.
Feature extraction methods and classifier selection are two critical steps in heart sound classification. To capture the pathological features of heart sound signals, this paper introduces a feature extraction method that combines mel-frequency cepstral coefficients (MFCC) and power spectral density (PSD). Unlike conventional classifiers, the adaptive neuro-fuzzy inference system (ANFIS) was chosen as the classifier for this study. In terms of experimental design, we compared different PSDs across various time intervals and frequency ranges, selecting the characteristics with the most effective classification outcomes. We compared four statistical properties, including mean PSD, standard deviation PSD, variance PSD, and median PSD. Through experimental comparisons, we found that combining the features of median PSD and MFCC with heart sound systolic period of 100–300 Hz yielded the best results. The accuracy, precision, sensitivity, specificity, and F1 score were determined to be 96.50%, 99.27%, 93.35%, 99.60%, and 96.35%, respectively. These results demonstrate the algorithm’s significant potential for aiding in the diagnosis of congenital heart disease.
ObjectiveTo investigate the efficacy of vagus nerve stimulation (VNS) in the treatment of refractory epilepsy in children and the key factors affecting its efficacy. MethodsThe clinical data of 22 children with drug-resistant epilepsy who received VNS treatment in the Second People's Hospital of Hunan Province from January 2016 to April 2023 were analyzed. The average seizure reduction rate, effective rate and McHugh grade were used to evaluate the efficacy of VNS after at least 1 year follow-up. Patients with an attack reduction rate of ≥50% were defined as respondents, and Mann-Witney U test and χ2 test were used, respectively, to conduct univariate and multifactor Logistics regression analysis with statistically significant indicators (P<0.05). ResultsAmong the 22 patients, the average attack reduction rate was 12.66% at 1 month, 26.10% at 3 months, 37.47% at 6 months, 48.18% at 9 months and 54.38% at 12 months. The effective rate was 5.00%, 9.00%, 36.00%, 50.00% and 68.00%, respectively. 12 months after operation, there were 3 cases of grade I, 12 cases of grade II, 7 cases of grade III, and 0 cases of grade V. Unifactorial and multivariate Logistic regression analysis showed that the curative effect of epilepsy in children was related to the seizure type, among which the curative effect of general seizure was better than that of focal seizure (OR=0.062, P=0.014), and the curative effect of myoclonic seizure and tonic seizure was better than that of other types in general seizure. ConclusionThe clinical effect of VNS in the treatment of refractory epilepsy in children is time cumulative, and the surgical effect of myoclonic seizures and tonic seizures in general seizures is better.
Objective To investigate the role and mechanisms of trimetazidine (TMZ) in intensive care unit-acquired weakness (ICU-AW). Methods Seventy wild-type male C57BL/6 mice were selected and the ICU-AW mouse model was constructed by intraperitoneal injection of different concentrations of lipopolysaccharide (LPS). The body weights, grip strengths, and 96-hour survival rates of each group were observed, and the optimal concentration of LPS and time of sampling were screened out, the mRNA and protein expression of the gastrocnemius muscle atrophic proteins Atrogin-1 and muscle-specific RING finger protein 1 (MuRF1) were further detected to verify the success of modelling, and LPS (12 mg/kg) was used as the subsequent modelling concentration according to the preliminary results. After successful modelling, another 70 mice were randomly divided into normal control group (Normal group), LPS solvent (Vehicle) group, LPS group, LPS+TMZ solvent group, LPS+TMZ group, LPS+TMZ+AC-YVAD-CMK (AC) solvent group, and LPS+TMZ+AC group, with 10 mice in each group. The Normal group did not have any intervention; the Vehicle group was injected intraperitoneally with an equal volume of saline with LPS; the remaining groups were injected intraperitoneally with LPS (12 mg/kg); after the completion of the LPS injection, the LPS+TMZ group, the LPS+TMZ+AC solvent group, and the LPS+TMZ+AC group were given TMZ (5 mg/kg) by gastric gavage once a day for 4 days. The LPS+TMZ solvent group was given TMZ equivalent saline gavage once a day for 4 days. The LPS+TMZ+AC group was injected intraperitoneally with the cysteinyl aspartate specific proteinase 1 (Caspase-1) inhibitor AC-YVAD-CMK (AC, 6.5 mg/kg) 1 h before LPS injection, and the LPS+TMZ+AC solvent group was injected with an equal amount of AC solvent phosphate buffer. At the end of TMZ treatment, body weight, grip strength, 96-hour survival rate, mRNA and protein expression of MuRF1, Atrogin-1, Caspase-1, and gasdermin D (GSDMD) in gastrocnemius muscle, as well as serum IL-1β and IL-18 concentrations in mice were detected in each group, and the gastrocnemius muscle was stained with HE to observe histopathological changes. Results Compared with the Normal group, mice in the LPS (12 mg/kg) and LPS (14 mg/kg) groups showed significant decreases in body weight and grasping strength and the weakening was most obvious at 3 - 5 d (P<0.05), but the survival rate of the LPS (12 mg/kg) group was higher than that of the LPS (14 mg/kg) group (P<0.05), the HE staining of gastrocnemius muscle showed that the mice in the LPS (12 mg/kg) group was significantly atrophied compared with that of the Normal group, and the gene and protein expression of MuRF1 and Atrogin-1 were significantly elevated (P<0.05), and the mice injected with LPS (12 mg/kg) for 4 days (96 h) were finally selected as the conditions for subsequent experimental modelling and sampling.The mRNA and protein expression of Caspase-1 and GSDMD in skeletal muscle was significantly higher in the LPS group compared with the Normal and Vehicle groups (P<0.01), and the concentrations of serum IL-1β and IL-18 were significantly higher(P<0.01). Mice in the TMZ group showed significant improvement in body weight, grip strength, survival rate, and degree of muscle atrophy compared with the LPS and TMZ solvent groups (P<0.05); gene and protein levels of MuRF1, Atrogin-1, Caspase-1, and GSDMD in the gastrocnemius muscle were significantly reduced (P<0.05); and levels of serum IL-1β and IL-18 were significantly reduced (P<0.05) ); the mice in the LPS+TMZ+AC group had significantly improved body weight, grip strength, survival rate, and muscle atrophy compared with the LPS+TMZ group and the LPS+TMZ+AC solvent group (P<0.05), and the gene and protein contents of MuRF1, Atrogin-1, Caspase-1, and GSDMD in the gastrocnemius muscle were reduced (P<0.05), and the serum IL-1β and IL -18 concentrations were reduced (P<0.05). Conclusion TMZ is able to exert a skeletal muscle protective effect by inhibiting Caspase-1/GSDMD-mediated pyroptosis, which is an important reference for the prevention and treatment of ICU-AW.