BACKGROUND This study evaluated the safety and effectiveness of endoscopic retrograde cholangiopancreatography(ERCP)in pediatric patients with biliary and pancreatic diseases.A retrospective analysis was conducted on ...BACKGROUND This study evaluated the safety and effectiveness of endoscopic retrograde cholangiopancreatography(ERCP)in pediatric patients with biliary and pancreatic diseases.A retrospective analysis was conducted on 57 ERCP procedures performed in 41 children,primarily for treating pancreatic diseases.The overall success rate was 91.2%,with no major complications observed.Post-ERCP pancreatitis(PEP)occurred in 8.8%of cases.Follow-up examinations over one year showed no recurrence of biliary or pancreatic diseases.Notably,endoscopic treatment led to a significant increase in body mass index(BMI).These findings demonstrate the valuable role of ERCP in managing such conditions.AIM To evaluate the safety and efficacy of ERCP for the management of biliary and pancreatic diseases in pediatric patients.METHODS We conducted a retrospective analysis of data from children aged 1-18 years who underwent ERCP for biliary and pancreatic diseases at Beijing Children’s Hospital between January 2021 and December 2022.The collected data included procedure time,endoscopic treatment,success rate,and postoperative complications.RESULTS Forty-one children underwent 57 ERCP procedures,including 14 with biliary duct disease and 27 with pancreatic disease.The mean age of the patients was 7.48±3.48 years.Biliary duct-related treatments were performed 18 times,and pancreatic disease treatments were performed 39 times.ERCP was primarily used to treat pediatric pancreatic diseases[68.4%(39/57)of the procedures].The overall success rate was 91.2%(52/57 patients).PEP was noted in five patients(8.8%,5/57),and no instances of bleeding,perforation,or cholangitis were observed.The patients were followed up for over one year,and no recurrence of biliary or pancreatic diseases was detected.Importantly,BMI significantly increased after endoscopic treatment compared to that before treatment(P=0.001).CONCLUSION The high success rate and lack of major complications support the valuable role of ERCP in the management of pediatric biliary and pancreatic diseases in the pediatric population.展开更多
Objective To investigate the prevalence of peripheral arterial disease (PAD) in China type 2 diabetic patients and to demonstrate the relationships between putative risk factors and PAD. Methods In total 1 397 type 2 ...Objective To investigate the prevalence of peripheral arterial disease (PAD) in China type 2 diabetic patients and to demonstrate the relationships between putative risk factors and PAD. Methods In total 1 397 type 2 diabetic patients aged 50 years and older were enrolled and determined ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) in 15 Class III Grade A hospitals in 7 major cities of China. Results Mean patient age was 63.7±8.2 years and mean duration of diabetes mellitus was 9.39±7.4 years. Two hundreds and seventy-two (19.47%) patients were diagnosed as PAD by ABI <0.9, 122 (18.37%) in male and 150 (20.46%) in female. PAD patients had a significantly longer duration of diabetes mellitus, higher hemoglobin Alc, and a significantly lower mean body mass index than non-PAD ones. Aging, smoking, and systolic blood pressure were found to be positively related with the prevalence of PAD. In terms of lipid profiles, no variable was found to relate with PAD. Notably, baPWV showed as the same significant guiding index for PAD, almost matched with ABI. Conclusions PAD is a common complication in China type 2 diabetic patients. Therefore, PAD screening and treatment should be emphasized for diabetic patients with high risk factors.展开更多
BACKGROUND Currently,rectovaginal fistula(RVF)continues to be a surgical challenge worldwide,with a relatively low healing rate.Unclosed intermittent suture and poor suture materials may be the main reasons for this.A...BACKGROUND Currently,rectovaginal fistula(RVF)continues to be a surgical challenge worldwide,with a relatively low healing rate.Unclosed intermittent suture and poor suture materials may be the main reasons for this.AIM To evaluate the efficacy and safety of stapled transperineal repair in treating RVF.METHODS This was a retrospective cohort study conducted in the Coloproctology Department of The Sixth Affiliated Hospital of Sun Yat-sen University(Guangzhou,China).Adult patients presenting with RVF who were surgically managed by perineal repair between May 2015 and May 2020 were included.Among the 82 total patients,37 underwent repair with direct suturing and 45 underwent repair with stapling.Patient demographic data,Wexner faecal incontinence score,and operative data were analyzed.Recurrence rate and associated risk factors were assessed.RESULTS The direct suture and stapled repair groups showed similar clinical characteristics for aetiology,surgical history,fistula features,and perioperative Wexner score.The stapled repair group did not show superior results over the suture repair group in regard to operative time,blood loss,and hospital stay.However,the stapled repair group showed better postoperative Wexner score(1.04±1.89 vs 2.73±3.75,P=0.021),less intercourse pain(1/45 vs 17/37,P=0.045),and lower recurrence rate(6/45 vs 17/37,P=0.001).There was no protective effect from previous repair history,smaller diameter of fistula(<0.5 cm),better control of defecation(Wexner<10),or stapled repair.Direct suture repair and preoperative high Wexner score(>10)were risk factors for fistula recurrence.Furthermore,stapled repair gave better efficacy in treating complex RVFs(i.e.,multiple transperineal repair history,mid-level fistula position,and poor control of defecation).CONCLUSION Stapled transperineal repair is advantageous for management of RVF,providing a high primary healing rate and low recurrence rate.展开更多
Objective To investigate whether plasma big endothelin-1(ET-1) predicts ventricular arrythmias(VAs) and end-stage events in primary prevention implantable cardioverter-defibrillator(ICD) indication patigents. Methods ...Objective To investigate whether plasma big endothelin-1(ET-1) predicts ventricular arrythmias(VAs) and end-stage events in primary prevention implantable cardioverter-defibrillator(ICD) indication patigents. Methods In total, 207 patients fulfilling the inclusion criteria from Fuwai Hospital between January 2013 and December 2015 were retrospectively analyzed. The cohort was divided into three groups according to baseline plasma big ET-1 tertiles: tertile 1(< 0.38 pmol/L, n = 68), tertile 2(0.38–0.7 pmol/L, n = 69), and tertile 3(> 0.7 pmol/L, n = 70). The primary endpoints were VAs. The secondary endpoints were end-stage events comprising all-cause mortality and heart transplantation. Results During a mean follow-up period of 25.6 ± 13.9 months, 38(18.4%) VAs and 78(37.7%) end-stage events occurred. Big ET-1 was positively correlated with NYHA class(r = 0.165, P = 0.018), serum creatinine concentration(Scr;r = 0.147, P = 0.034), high-sensitivity C-reactive protein(hs-CRP;r = 0.217, P = 0.002), Lg NT-pro BNP(r = 0.463, P < 0.001), left ventricular end diastolic diameter(LVEDD;r = 0.234, P = 0.039) and negatively correlated with left ventricular ejection fraction(LVEF;r =-0.181, P = 0.032). Kaplan-Meier analysis showed that elevated big ET-1 was associated with increased risk of VAs and end-stage events(P < 0.05). In multivariate Cox regression models, big ET-1 was an independent risk factor for VAs(hazard ratio(HR) = 3.477, 95% confidence interval(CI): 1.352–8.940, P = 0.010, tertile 2 vs. tertile 1;HR = 4.112, 95% CI: 1.604–10.540, P = 0.003, tertile 3 vs. tertile 1) and end-stage events(HR = 2.804, 95% CI: 1.354–5.806, P = 0.005, tertile 2 vs. tertile 1;HR = 4.652, 95% CI: 2.288–9.459, P < 0.001, tertile 3 vs. tertile 1). Conclusions In primary prevention ICD indication patients, plasma big ET-1 levels can predict VAs and end-stage events and may facilitate ICD-implantation risk stratification.展开更多
Background Intrathoracic impedance monitoring has emerged as a promising new technique for the detection of impending heart failure (HF). Although false positive episodes have been reported in case reports and clinica...Background Intrathoracic impedance monitoring has emerged as a promising new technique for the detection of impending heart failure (HF). Although false positive episodes have been reported in case reports and clinical trials, the efficacy and false positive rate in real-world practice remain unclear. Objective The aim of this study is to investigate the utility and reliability of the OptiVol alert feature in clinical practice. Methods We continuously recruited patients who underwent implantable cardioverter-defibrillator (ICD) or cardiac re-synchronization therapy with defibrillator (CRT-D) implantation with feature of intrathoracic impedance monitoring system in our center from Sep. 2010 to Oct. 2012. Regular in-office follow-up were required of all patients and the following information was collected at each visit: medical history, device interrogation, N-terminal pro-brain natriuretic peptide (NT-proBNP) measurement and an echocardiogram. Worsening HF was defined as hospitalization or the presentation of signs or symptoms of HF. Results Forty three patients (male:76.7%, mean age:57 ± 15 years, left ventricular ejection fraction (LVEF):33%± 14%) were included in this observational study. Fifty four alert events and 14 adjudicated worsening HF were detected within 288 ±163 days follow-up. Eleven (20.4%) alert episodes were associated with acute cardiac decompensation in 9 patients with a positive predictive value of 78.6%. Forty three audible alerts showed no connection to worsening HF. The unexplained alerts rate was 79.6%and 1.27 per person-year. Thirty seven alarm alerts were detected in patients with EF<45%, among which 9 accompanied with HF, 17 alerts detected in patients with LVEF≥45%and 2 associated with HF. There was no sig-nificant difference between the two groups (9/37 vs. 2/17;P=0.47). Conclusions Patients with normal or nearly normal left ventricular systolic function also exhibited considerable alert events. The OptiVol fluid index predicted worsening cardiac events with a high unex-plained detection rate, and any alert must therefore be analyzed with great caution. Efforts to improve the specificity of this monitoring sys-tem represent a significant aspect of future studies.展开更多
OBJECTIVE To evaluate the association of longitudinal changes in physical activity(PA)with long-term outcomes after im-plantable cardioverter-defibrillator(ICD)or cardiac resynchronization therapy defibrillator(CRT-D)...OBJECTIVE To evaluate the association of longitudinal changes in physical activity(PA)with long-term outcomes after im-plantable cardioverter-defibrillator(ICD)or cardiac resynchronization therapy defibrillator(CRT-D)implantation.METHODS Patients with ICD/CRT-D implantation from SUMMIT registry were retrospectively analyzed.Accelerometer-de-rived PA changes over 12 months post implantation were obtained from the archived home monitoring data.The primary end-points were cardiac death and all-cause mortality.The secondary endpoints were the first ventricular arrthymia(VA)and first ap-propriate ICD shock.RESULTS In 705 patients,446(63.3%)patients showed improved PA over 12 months after implantation.During a mean 61.5-month follow-up duration,99 cardiac deaths(14.0%)and 153 all-cause deaths(21.7%)occurred.Compared to reduced/un-changed PA,improved PA over 12 months could result in significantly reduced risks of cardiac death(improved PA≤30 min:hazard ratio(HR)=0.494,95%CI:0.288−0.848;>30 min:HR=0.390,95%CI:0.235−0.648)and all-cause mortality(improved PA≤30 min:HR=0.467,95%CI:0.299−0.728;>30 min:HR=0.451,95%CI:0.304−0.669).No differences in the VAs or ICD shocks were observed across different groups of PA changes.PA changes can predict the risks of cardiac death only in the low baseline PA group,but improved PA was associated with 56.7%,57.4%,and 62.3%reduced risks of all-cause mortality in the low,moderate,and high baseline PA groups,respectively,than reduced/unchanged PA.CONCLUSIONS Improved PA could protect aganist cardiac death and all-cause mortality,probably reflecting better clinical efficacy after ICD/CRT-D implantation.Low-intensity exercise training might be encouraged among patients with different baseline PA levels.展开更多
Background and aim Hepatic ischemia–reperfusion injury(IRI)is a significant challenge in liver transplantation,trauma,hypovolemic shock,and hepatectomy,with limited effective interventions available.This study aimed ...Background and aim Hepatic ischemia–reperfusion injury(IRI)is a significant challenge in liver transplantation,trauma,hypovolemic shock,and hepatectomy,with limited effective interventions available.This study aimed to investigate the role of leukocyte cell-derived chemotaxin 2(LECT2)in hepatic IRI and assess the therapeutic potential of Lect2-short hairpin RNA(shRNA)delivered through adeno-associated virus(AAV)vectors.Materials and methods This study analyzed human liver and serum samples from five patients undergoing the Pringle maneuver.Lect2-knockout and C57BL/6J mice were used.Hepatic IRI was induced by clamping the hepatic pedicle.Treatments included recombinant human LECT2(rLECT2)and AAV-Lect2-shRNA.LECT2 expression levels and serum biomarkers including alanine aminotransferase(ALT),aspartate aminotransferase(AST),creatinine,and blood urea nitrogen(BUN)were measured.Histological analysis of liver necrosis and quantitative reverse-transcription polymerase chain reaction were performed.Results Serum and liver LECT2 levels were elevated during hepatic IRI.Serum LECT2 protein and mRNA levels increased post reperfusion.Lect2-knockout mice had reduced weight loss;hepatic necrosis;and serum ALT,AST,creatinine,and BUN levels.rLECT2 treatment exacerbated weight loss,hepatic necrosis,and serum biomarkers(ALT,AST,creatinine,and BUN).AAV-Lect2-shRNA treatment significantly reduced weight loss,hepatic necrosis,and serum biomarkers(ALT,AST,creatinine,and BUN),indicating therapeutic potential.Conclusions Elevated LECT2 levels during hepatic IRI increased liver damage.Genetic knockout or shRNA-mediated knockdown of Lect2 reduced liver damage,indicating its therapeutic potential.AAV-mediated Lect2-shRNA delivery mitigated hepatic IRI,offering a potential new treatment strategy to enhance clinical outcomes for patients undergoing liver-related surgeries or trauma.展开更多
Background and objective:Biomarkers are important tools for prompt diagnosis of cancer.This study aimed to identify reliable biomarkers for clinical applications in the diagnosis of gastric cancer and lymph-node(LN)me...Background and objective:Biomarkers are important tools for prompt diagnosis of cancer.This study aimed to identify reliable biomarkers for clinical applications in the diagnosis of gastric cancer and lymph-node(LN)metastasis.Methods:Between 1 December 2014 and 31 December 2015,we prospectively collected samples of gastric-cancer tissues,corresponding matched-pair normal gastric mucosa,and their peri-gastric metastatic and non-metastatic LNs to identify quantitatively reliable genes using quantitative real-time polymerase chain reaction.Relative quantity(RQ)was used to calculate the mRNA expression levels of our target genes.Statistics were calculated using one-way analysis of variance(ANOVA)and Tukey’s multiple comparison test.Analytical graphs were plotted using GraphPad Prism.Results:Of nine assessed genes,the mRNA levels of inhibin beta A(INHBA)and secreted phosphoprotein 1(SPP1)were most consistently highly expressed in tumor tissues by 15.4-and 15.6-fold,respectively,as compared with normal tissues(P<0.001),with 91.3%sensitivity and 95.7%specificity(receiver operating characteristic[ROC]curve area=0.974)for the former and 82.6%sensitivity and 87.0%specificity(ROC curve area=0.924)for the latter.Further analysis revealed no differentiating significance of SPP1 mRNA expression between metastatic and non-metastatic LNs(P=0.470).In contrast,the INHBA mRNA level was up-regulated 4.1-fold in metastatic LNs(P<0.001),with 80.0%sensitivity and 81.5%specificity(ROC curve area=0.857),and was also able to successfully differentiate between more severe disease conditions,T3 and T4(P=0.003),M0 and M1(P=0.043)and different histological variants(intestinal type vs diffuse type,P=0.019).Conclusions:Our results showed that INHBA was the most optimally reliable biomarker for diagnosing gastric cancer and LN metastasis.展开更多
Recently, cardiac resynchronization therapy （CRT） with multipoint left ventricular （LV） pacing in a single coronary sinus branch （MultiPointTM Pacing [MPP], St. Jude Medical, Inc., Sylmar, CA, USA） has been intr...Recently, cardiac resynchronization therapy （CRT） with multipoint left ventricular （LV） pacing in a single coronary sinus branch （MultiPointTM Pacing [MPP], St. Jude Medical, Inc., Sylmar, CA, USA） has been introduced commercially. The CRT system with MPP feature offers a new strategy for physicians to further enhance CRT in patients with heart failure. Early clinical studies have shown that MPP, compared with conventional biventricular （BiV） pacing, provides acute benefits to LV dP/dtmax, LV dyssynchrony, LV peak radial strain, and LV electrical activation, and improves CRT response at 12 months. In this report, we presented two MPP CRT cases in China with acute hemodynamic assessment under various MPP and conventional BiV pacing configurations, demonstrating that MPP can offer further benefits to patients.展开更多
Background：Contrast dose and radiation dose reduction in computerized tomography （CT） scan for adult has been explored successfully,but there have been few studies on the application of low-concentration contrast i...Background：Contrast dose and radiation dose reduction in computerized tomography （CT） scan for adult has been explored successfully,but there have been few studies on the application of low-concentration contrast in pediatric abdominal CT examinations.This was a feasibility study on the use of dual-energy spectral imaging and adaptive statistical iterative reconstruction （ASiR） for the reduction of radiation dose and iodine contrast dose in pediatric abdominal CT patients with solid tumors.Methods：Forty-five patients with solid tumors who had initial CT （Group B） and follow-up CT （Group A） after chemotherapy were enrolled.The initial diagnostic CT scan （Group B） was performed using the standard two-phase enhanced CT with 320 mgI/ml concentration contrast,and the follow-up scan （Group A） was performed using a single-phase enhanced CT at 45 s after the beginning of the 270 mgI/ml contrast injection using spectral mode.Forty percent ASiR was used for the images in Group B and monochromatic images with energy levels ≥60 keV in Group A.In addition,filtered back-projection （FBP） reconstruction was used for monochromatic images 〈60 keV in Group A.The total radiation dose,total iodine load,contrast injection speed,and maximum injection pressure were compared between the two groups.The 40 keV and 60 keV spectral CT images of Group A were compared with the images of Group B to evaluate overall image quality.Results：The total radiation dose,total iodine load,injection speed,and maximum injection pressure for Group A were decreased by 19%,15%,34.4%,and 18.3%,respectively.The optimal energy level in spectral CT for displaying the abdominal vessels was 40 keV.At this level,the CT values in the abdominal aorta and its three branches,the portal vein and its two branches,and the inferior vena cava were all greater than 340 hounsfield unit （HU）.The abdominal organs of Groups A and B had similar degrees of absolute and relative enhancement （t =0.36 and-1.716 for liver,0.153 and-1.546 for pancreas,and 2.427 and 0.866 for renal cortex,all P 〉 0.05）.Signal-to-noise ratio of the abdominal organs was significantly lower in Group A than in Group B （t =-8.11 for liver,-7.83 for pancreas,and-5.38 for renal cortex,all P 〈 0.05）.However,the subjective scores for the 40 keV （FBP） and 60 keV （40% ASiR） spectral CT images determined by two radiologists were all 〉3,indicating clinically acceptable image quality.Conclusions：Single-phase,dual-energy spectral CT used for children with solid abdominal tumors can reduce contrast dose and radiation dose and can also maintain clinically acceptable image quality.展开更多
Background and aim:Fournier’s gangrene(FG)is a fulminant infection in the external genital region and perineum.The present study explored the clinical features of FG originating from the anorectal region,from primary...Background and aim:Fournier’s gangrene(FG)is a fulminant infection in the external genital region and perineum.The present study explored the clinical features of FG originating from the anorectal region,from primary conditions such as anal fistulas and abscesses.Methods:A retrospective analysis was performed in order to identify the factors associated with clinical outcomes in FG patients derived from two hospitals—the Sixth Affiliated Hospital of Sun Yat-sen University and People’s Hospital Affiliated to Fujian University of Traditional Chinese—over the period from May 2013 to April 2017.Results:Sixty FG patients were included in this study.The common causative microorganisms cultured were Escherichia coli species.Genital and perirectal regional involvement was evident in 52 and 59 cases,respectively,although the perineum was unaffected in 7 cases(12%),as confirmed by imaging examination and surgical exploration.Management with early radical debridement and broad-spectrum antibiotic therapy is effective with an acceptably sepsis mortality(1.7%).Ten patients underwent protective colostomy.No patient underwent an orchidectomy and required urinary diversion.Conclusions:FG originating from the anorectal region can be rapidly progressive and life-threatening.Infection can spread superiorly to the genital region without the involvement in perineal tissue.An aggressive surgical debridement of nonviable tissue is essential for satisfactory outcomes and a protective colostomy is not mandatory.展开更多
Black phosphorus(BP),a layered van der Waals(vdW)crystal,has umique in-plane band anisotropy and many resulting anisotropy properties such as the ffective mass,electron mobility,optical absorp-tion,thermal conductivit...Black phosphorus(BP),a layered van der Waals(vdW)crystal,has umique in-plane band anisotropy and many resulting anisotropy properties such as the ffective mass,electron mobility,optical absorp-tion,thermal conductivity and plasmonie dispersion.However,whether anisotropic or isotropic charge screening exist in BP remains a controversial sse.Based on first-principles calculations,we study the screening properties in both of single-layer and bulk BP,especially conoerning the role of doping.Without charge doping,the single-layer and bulk phase BP show slight anisotropic screening.Electron and hole doping can increase the charge screening of BP and significantly change the relative static dielectric tensor elements along two different in-plane directions.We further study the charge density change induced by potassium(K)adatom near the BP surface,under different levels of charge dop-ing.The calculated two-dimensional(2D)charge redlistribution patterns also confirm that doping can greatly ffect the screening feature and tip the balance between isotropic and anisotropice screening.We corroborate that screening in BP exhibits slight intrinsic anisotropy and doping has significant influenoe on its screening property.展开更多
文摘BACKGROUND This study evaluated the safety and effectiveness of endoscopic retrograde cholangiopancreatography(ERCP)in pediatric patients with biliary and pancreatic diseases.A retrospective analysis was conducted on 57 ERCP procedures performed in 41 children,primarily for treating pancreatic diseases.The overall success rate was 91.2%,with no major complications observed.Post-ERCP pancreatitis(PEP)occurred in 8.8%of cases.Follow-up examinations over one year showed no recurrence of biliary or pancreatic diseases.Notably,endoscopic treatment led to a significant increase in body mass index(BMI).These findings demonstrate the valuable role of ERCP in managing such conditions.AIM To evaluate the safety and efficacy of ERCP for the management of biliary and pancreatic diseases in pediatric patients.METHODS We conducted a retrospective analysis of data from children aged 1-18 years who underwent ERCP for biliary and pancreatic diseases at Beijing Children’s Hospital between January 2021 and December 2022.The collected data included procedure time,endoscopic treatment,success rate,and postoperative complications.RESULTS Forty-one children underwent 57 ERCP procedures,including 14 with biliary duct disease and 27 with pancreatic disease.The mean age of the patients was 7.48±3.48 years.Biliary duct-related treatments were performed 18 times,and pancreatic disease treatments were performed 39 times.ERCP was primarily used to treat pediatric pancreatic diseases[68.4%(39/57)of the procedures].The overall success rate was 91.2%(52/57 patients).PEP was noted in five patients(8.8%,5/57),and no instances of bleeding,perforation,or cholangitis were observed.The patients were followed up for over one year,and no recurrence of biliary or pancreatic diseases was detected.Importantly,BMI significantly increased after endoscopic treatment compared to that before treatment(P=0.001).CONCLUSION The high success rate and lack of major complications support the valuable role of ERCP in the management of pediatric biliary and pancreatic diseases in the pediatric population.
文摘Objective To investigate the prevalence of peripheral arterial disease (PAD) in China type 2 diabetic patients and to demonstrate the relationships between putative risk factors and PAD. Methods In total 1 397 type 2 diabetic patients aged 50 years and older were enrolled and determined ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) in 15 Class III Grade A hospitals in 7 major cities of China. Results Mean patient age was 63.7±8.2 years and mean duration of diabetes mellitus was 9.39±7.4 years. Two hundreds and seventy-two (19.47%) patients were diagnosed as PAD by ABI <0.9, 122 (18.37%) in male and 150 (20.46%) in female. PAD patients had a significantly longer duration of diabetes mellitus, higher hemoglobin Alc, and a significantly lower mean body mass index than non-PAD ones. Aging, smoking, and systolic blood pressure were found to be positively related with the prevalence of PAD. In terms of lipid profiles, no variable was found to relate with PAD. Notably, baPWV showed as the same significant guiding index for PAD, almost matched with ABI. Conclusions PAD is a common complication in China type 2 diabetic patients. Therefore, PAD screening and treatment should be emphasized for diabetic patients with high risk factors.
基金The Sixth Affiliated Hospital,Sun Yat-sen University Clinical Research 1010 Program,No.1010PY(2020)-18Science and Technology Program of Guangzhou,China,No.202002020081+1 种基金National Natural Science Foundation of China,No.81973847Natural Science Foundation of Guangdong Province of China,No.2020A1515011254.
文摘BACKGROUND Currently,rectovaginal fistula(RVF)continues to be a surgical challenge worldwide,with a relatively low healing rate.Unclosed intermittent suture and poor suture materials may be the main reasons for this.AIM To evaluate the efficacy and safety of stapled transperineal repair in treating RVF.METHODS This was a retrospective cohort study conducted in the Coloproctology Department of The Sixth Affiliated Hospital of Sun Yat-sen University(Guangzhou,China).Adult patients presenting with RVF who were surgically managed by perineal repair between May 2015 and May 2020 were included.Among the 82 total patients,37 underwent repair with direct suturing and 45 underwent repair with stapling.Patient demographic data,Wexner faecal incontinence score,and operative data were analyzed.Recurrence rate and associated risk factors were assessed.RESULTS The direct suture and stapled repair groups showed similar clinical characteristics for aetiology,surgical history,fistula features,and perioperative Wexner score.The stapled repair group did not show superior results over the suture repair group in regard to operative time,blood loss,and hospital stay.However,the stapled repair group showed better postoperative Wexner score(1.04±1.89 vs 2.73±3.75,P=0.021),less intercourse pain(1/45 vs 17/37,P=0.045),and lower recurrence rate(6/45 vs 17/37,P=0.001).There was no protective effect from previous repair history,smaller diameter of fistula(<0.5 cm),better control of defecation(Wexner<10),or stapled repair.Direct suture repair and preoperative high Wexner score(>10)were risk factors for fistula recurrence.Furthermore,stapled repair gave better efficacy in treating complex RVFs(i.e.,multiple transperineal repair history,mid-level fistula position,and poor control of defecation).CONCLUSION Stapled transperineal repair is advantageous for management of RVF,providing a high primary healing rate and low recurrence rate.
基金supported by Natural Science Foundation of China(81470466)。
文摘Objective To investigate whether plasma big endothelin-1(ET-1) predicts ventricular arrythmias(VAs) and end-stage events in primary prevention implantable cardioverter-defibrillator(ICD) indication patigents. Methods In total, 207 patients fulfilling the inclusion criteria from Fuwai Hospital between January 2013 and December 2015 were retrospectively analyzed. The cohort was divided into three groups according to baseline plasma big ET-1 tertiles: tertile 1(< 0.38 pmol/L, n = 68), tertile 2(0.38–0.7 pmol/L, n = 69), and tertile 3(> 0.7 pmol/L, n = 70). The primary endpoints were VAs. The secondary endpoints were end-stage events comprising all-cause mortality and heart transplantation. Results During a mean follow-up period of 25.6 ± 13.9 months, 38(18.4%) VAs and 78(37.7%) end-stage events occurred. Big ET-1 was positively correlated with NYHA class(r = 0.165, P = 0.018), serum creatinine concentration(Scr;r = 0.147, P = 0.034), high-sensitivity C-reactive protein(hs-CRP;r = 0.217, P = 0.002), Lg NT-pro BNP(r = 0.463, P < 0.001), left ventricular end diastolic diameter(LVEDD;r = 0.234, P = 0.039) and negatively correlated with left ventricular ejection fraction(LVEF;r =-0.181, P = 0.032). Kaplan-Meier analysis showed that elevated big ET-1 was associated with increased risk of VAs and end-stage events(P < 0.05). In multivariate Cox regression models, big ET-1 was an independent risk factor for VAs(hazard ratio(HR) = 3.477, 95% confidence interval(CI): 1.352–8.940, P = 0.010, tertile 2 vs. tertile 1;HR = 4.112, 95% CI: 1.604–10.540, P = 0.003, tertile 3 vs. tertile 1) and end-stage events(HR = 2.804, 95% CI: 1.354–5.806, P = 0.005, tertile 2 vs. tertile 1;HR = 4.652, 95% CI: 2.288–9.459, P < 0.001, tertile 3 vs. tertile 1). Conclusions In primary prevention ICD indication patients, plasma big ET-1 levels can predict VAs and end-stage events and may facilitate ICD-implantation risk stratification.
文摘Background Intrathoracic impedance monitoring has emerged as a promising new technique for the detection of impending heart failure (HF). Although false positive episodes have been reported in case reports and clinical trials, the efficacy and false positive rate in real-world practice remain unclear. Objective The aim of this study is to investigate the utility and reliability of the OptiVol alert feature in clinical practice. Methods We continuously recruited patients who underwent implantable cardioverter-defibrillator (ICD) or cardiac re-synchronization therapy with defibrillator (CRT-D) implantation with feature of intrathoracic impedance monitoring system in our center from Sep. 2010 to Oct. 2012. Regular in-office follow-up were required of all patients and the following information was collected at each visit: medical history, device interrogation, N-terminal pro-brain natriuretic peptide (NT-proBNP) measurement and an echocardiogram. Worsening HF was defined as hospitalization or the presentation of signs or symptoms of HF. Results Forty three patients (male:76.7%, mean age:57 ± 15 years, left ventricular ejection fraction (LVEF):33%± 14%) were included in this observational study. Fifty four alert events and 14 adjudicated worsening HF were detected within 288 ±163 days follow-up. Eleven (20.4%) alert episodes were associated with acute cardiac decompensation in 9 patients with a positive predictive value of 78.6%. Forty three audible alerts showed no connection to worsening HF. The unexplained alerts rate was 79.6%and 1.27 per person-year. Thirty seven alarm alerts were detected in patients with EF<45%, among which 9 accompanied with HF, 17 alerts detected in patients with LVEF≥45%and 2 associated with HF. There was no sig-nificant difference between the two groups (9/37 vs. 2/17;P=0.47). Conclusions Patients with normal or nearly normal left ventricular systolic function also exhibited considerable alert events. The OptiVol fluid index predicted worsening cardiac events with a high unex-plained detection rate, and any alert must therefore be analyzed with great caution. Efforts to improve the specificity of this monitoring sys-tem represent a significant aspect of future studies.
基金supported by Natural Science Foundation of China (81470466)the National Science&Technology Pillar Program during the12th Five-Year Plan Period (2011BAI11B02)
文摘OBJECTIVE To evaluate the association of longitudinal changes in physical activity(PA)with long-term outcomes after im-plantable cardioverter-defibrillator(ICD)or cardiac resynchronization therapy defibrillator(CRT-D)implantation.METHODS Patients with ICD/CRT-D implantation from SUMMIT registry were retrospectively analyzed.Accelerometer-de-rived PA changes over 12 months post implantation were obtained from the archived home monitoring data.The primary end-points were cardiac death and all-cause mortality.The secondary endpoints were the first ventricular arrthymia(VA)and first ap-propriate ICD shock.RESULTS In 705 patients,446(63.3%)patients showed improved PA over 12 months after implantation.During a mean 61.5-month follow-up duration,99 cardiac deaths(14.0%)and 153 all-cause deaths(21.7%)occurred.Compared to reduced/un-changed PA,improved PA over 12 months could result in significantly reduced risks of cardiac death(improved PA≤30 min:hazard ratio(HR)=0.494,95%CI:0.288−0.848;>30 min:HR=0.390,95%CI:0.235−0.648)and all-cause mortality(improved PA≤30 min:HR=0.467,95%CI:0.299−0.728;>30 min:HR=0.451,95%CI:0.304−0.669).No differences in the VAs or ICD shocks were observed across different groups of PA changes.PA changes can predict the risks of cardiac death only in the low baseline PA group,but improved PA was associated with 56.7%,57.4%,and 62.3%reduced risks of all-cause mortality in the low,moderate,and high baseline PA groups,respectively,than reduced/unchanged PA.CONCLUSIONS Improved PA could protect aganist cardiac death and all-cause mortality,probably reflecting better clinical efficacy after ICD/CRT-D implantation.Low-intensity exercise training might be encouraged among patients with different baseline PA levels.
文摘Background and aim Hepatic ischemia–reperfusion injury(IRI)is a significant challenge in liver transplantation,trauma,hypovolemic shock,and hepatectomy,with limited effective interventions available.This study aimed to investigate the role of leukocyte cell-derived chemotaxin 2(LECT2)in hepatic IRI and assess the therapeutic potential of Lect2-short hairpin RNA(shRNA)delivered through adeno-associated virus(AAV)vectors.Materials and methods This study analyzed human liver and serum samples from five patients undergoing the Pringle maneuver.Lect2-knockout and C57BL/6J mice were used.Hepatic IRI was induced by clamping the hepatic pedicle.Treatments included recombinant human LECT2(rLECT2)and AAV-Lect2-shRNA.LECT2 expression levels and serum biomarkers including alanine aminotransferase(ALT),aspartate aminotransferase(AST),creatinine,and blood urea nitrogen(BUN)were measured.Histological analysis of liver necrosis and quantitative reverse-transcription polymerase chain reaction were performed.Results Serum and liver LECT2 levels were elevated during hepatic IRI.Serum LECT2 protein and mRNA levels increased post reperfusion.Lect2-knockout mice had reduced weight loss;hepatic necrosis;and serum ALT,AST,creatinine,and BUN levels.rLECT2 treatment exacerbated weight loss,hepatic necrosis,and serum biomarkers(ALT,AST,creatinine,and BUN).AAV-Lect2-shRNA treatment significantly reduced weight loss,hepatic necrosis,and serum biomarkers(ALT,AST,creatinine,and BUN),indicating therapeutic potential.Conclusions Elevated LECT2 levels during hepatic IRI increased liver damage.Genetic knockout or shRNA-mediated knockdown of Lect2 reduced liver damage,indicating its therapeutic potential.AAV-mediated Lect2-shRNA delivery mitigated hepatic IRI,offering a potential new treatment strategy to enhance clinical outcomes for patients undergoing liver-related surgeries or trauma.
基金This work was supported by the Natural Science Foundation of Guangdong Province(Grant number 2015A030313089,2018A030313631)Guangzhou University-Institute-Industry Collaborative Innovation Major Projects(Grant number 201508030042,201604020038)+1 种基金Center for Nasopharyngeal Carcinoma Research,Hong Kong(Grant number AoE/M-06/08)Shenzhen Dept.of Science and Information(Grant number JCYJ20130329110752138).
文摘Background and objective:Biomarkers are important tools for prompt diagnosis of cancer.This study aimed to identify reliable biomarkers for clinical applications in the diagnosis of gastric cancer and lymph-node(LN)metastasis.Methods:Between 1 December 2014 and 31 December 2015,we prospectively collected samples of gastric-cancer tissues,corresponding matched-pair normal gastric mucosa,and their peri-gastric metastatic and non-metastatic LNs to identify quantitatively reliable genes using quantitative real-time polymerase chain reaction.Relative quantity(RQ)was used to calculate the mRNA expression levels of our target genes.Statistics were calculated using one-way analysis of variance(ANOVA)and Tukey’s multiple comparison test.Analytical graphs were plotted using GraphPad Prism.Results:Of nine assessed genes,the mRNA levels of inhibin beta A(INHBA)and secreted phosphoprotein 1(SPP1)were most consistently highly expressed in tumor tissues by 15.4-and 15.6-fold,respectively,as compared with normal tissues(P<0.001),with 91.3%sensitivity and 95.7%specificity(receiver operating characteristic[ROC]curve area=0.974)for the former and 82.6%sensitivity and 87.0%specificity(ROC curve area=0.924)for the latter.Further analysis revealed no differentiating significance of SPP1 mRNA expression between metastatic and non-metastatic LNs(P=0.470).In contrast,the INHBA mRNA level was up-regulated 4.1-fold in metastatic LNs(P<0.001),with 80.0%sensitivity and 81.5%specificity(ROC curve area=0.857),and was also able to successfully differentiate between more severe disease conditions,T3 and T4(P=0.003),M0 and M1(P=0.043)and different histological variants(intestinal type vs diffuse type,P=0.019).Conclusions:Our results showed that INHBA was the most optimally reliable biomarker for diagnosing gastric cancer and LN metastasis.
文摘Recently, cardiac resynchronization therapy （CRT） with multipoint left ventricular （LV） pacing in a single coronary sinus branch （MultiPointTM Pacing [MPP], St. Jude Medical, Inc., Sylmar, CA, USA） has been introduced commercially. The CRT system with MPP feature offers a new strategy for physicians to further enhance CRT in patients with heart failure. Early clinical studies have shown that MPP, compared with conventional biventricular （BiV） pacing, provides acute benefits to LV dP/dtmax, LV dyssynchrony, LV peak radial strain, and LV electrical activation, and improves CRT response at 12 months. In this report, we presented two MPP CRT cases in China with acute hemodynamic assessment under various MPP and conventional BiV pacing configurations, demonstrating that MPP can offer further benefits to patients.
文摘Background：Contrast dose and radiation dose reduction in computerized tomography （CT） scan for adult has been explored successfully,but there have been few studies on the application of low-concentration contrast in pediatric abdominal CT examinations.This was a feasibility study on the use of dual-energy spectral imaging and adaptive statistical iterative reconstruction （ASiR） for the reduction of radiation dose and iodine contrast dose in pediatric abdominal CT patients with solid tumors.Methods：Forty-five patients with solid tumors who had initial CT （Group B） and follow-up CT （Group A） after chemotherapy were enrolled.The initial diagnostic CT scan （Group B） was performed using the standard two-phase enhanced CT with 320 mgI/ml concentration contrast,and the follow-up scan （Group A） was performed using a single-phase enhanced CT at 45 s after the beginning of the 270 mgI/ml contrast injection using spectral mode.Forty percent ASiR was used for the images in Group B and monochromatic images with energy levels ≥60 keV in Group A.In addition,filtered back-projection （FBP） reconstruction was used for monochromatic images 〈60 keV in Group A.The total radiation dose,total iodine load,contrast injection speed,and maximum injection pressure were compared between the two groups.The 40 keV and 60 keV spectral CT images of Group A were compared with the images of Group B to evaluate overall image quality.Results：The total radiation dose,total iodine load,injection speed,and maximum injection pressure for Group A were decreased by 19%,15%,34.4%,and 18.3%,respectively.The optimal energy level in spectral CT for displaying the abdominal vessels was 40 keV.At this level,the CT values in the abdominal aorta and its three branches,the portal vein and its two branches,and the inferior vena cava were all greater than 340 hounsfield unit （HU）.The abdominal organs of Groups A and B had similar degrees of absolute and relative enhancement （t =0.36 and-1.716 for liver,0.153 and-1.546 for pancreas,and 2.427 and 0.866 for renal cortex,all P 〉 0.05）.Signal-to-noise ratio of the abdominal organs was significantly lower in Group A than in Group B （t =-8.11 for liver,-7.83 for pancreas,and-5.38 for renal cortex,all P 〈 0.05）.However,the subjective scores for the 40 keV （FBP） and 60 keV （40% ASiR） spectral CT images determined by two radiologists were all 〉3,indicating clinically acceptable image quality.Conclusions：Single-phase,dual-energy spectral CT used for children with solid abdominal tumors can reduce contrast dose and radiation dose and can also maintain clinically acceptable image quality.
基金supported by the National Key Clinical Discipline Medical Scientific Research Foundation of Guangdong Province,China(Grant number A2015180)the National Natural Science Foundation of China(Grant number 81603628)Sun Yat-Sen University Clinical Research 5010 Program(Grant number 2017017).
文摘Background and aim:Fournier’s gangrene(FG)is a fulminant infection in the external genital region and perineum.The present study explored the clinical features of FG originating from the anorectal region,from primary conditions such as anal fistulas and abscesses.Methods:A retrospective analysis was performed in order to identify the factors associated with clinical outcomes in FG patients derived from two hospitals—the Sixth Affiliated Hospital of Sun Yat-sen University and People’s Hospital Affiliated to Fujian University of Traditional Chinese—over the period from May 2013 to April 2017.Results:Sixty FG patients were included in this study.The common causative microorganisms cultured were Escherichia coli species.Genital and perirectal regional involvement was evident in 52 and 59 cases,respectively,although the perineum was unaffected in 7 cases(12%),as confirmed by imaging examination and surgical exploration.Management with early radical debridement and broad-spectrum antibiotic therapy is effective with an acceptably sepsis mortality(1.7%).Ten patients underwent protective colostomy.No patient underwent an orchidectomy and required urinary diversion.Conclusions:FG originating from the anorectal region can be rapidly progressive and life-threatening.Infection can spread superiorly to the genital region without the involvement in perineal tissue.An aggressive surgical debridement of nonviable tissue is essential for satisfactory outcomes and a protective colostomy is not mandatory.
基金Y.X.Feng was supported by the National Basic Research Programs of China with grant No.2016YFA0300901the National Natural Science Foundation of China with grant Nos.11974105 and 11634001.
文摘Black phosphorus(BP),a layered van der Waals(vdW)crystal,has umique in-plane band anisotropy and many resulting anisotropy properties such as the ffective mass,electron mobility,optical absorp-tion,thermal conductivity and plasmonie dispersion.However,whether anisotropic or isotropic charge screening exist in BP remains a controversial sse.Based on first-principles calculations,we study the screening properties in both of single-layer and bulk BP,especially conoerning the role of doping.Without charge doping,the single-layer and bulk phase BP show slight anisotropic screening.Electron and hole doping can increase the charge screening of BP and significantly change the relative static dielectric tensor elements along two different in-plane directions.We further study the charge density change induced by potassium(K)adatom near the BP surface,under different levels of charge dop-ing.The calculated two-dimensional(2D)charge redlistribution patterns also confirm that doping can greatly ffect the screening feature and tip the balance between isotropic and anisotropice screening.We corroborate that screening in BP exhibits slight intrinsic anisotropy and doping has significant influenoe on its screening property.
