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
Objective:Accurate measurement of QT interval,the ventricular action potential from depolarization to repolarization,is important for the early detection of Long QT syndrome.The most effective QT correction(QTc)formul...Objective:Accurate measurement of QT interval,the ventricular action potential from depolarization to repolarization,is important for the early detection of Long QT syndrome.The most effective QT correction(QTc)formula has yet to be determined in the pediatric population,although it has intrinsically greater extremes in heart rate(HR)and is more susceptible to errors in measurement.The authors of this study compare six dif-ferent QTc methods(Bazett,Fridericia,Framingham,Hodges,Rautaharju,and a computer algorithm utilizing the Bazett formula)for consistency against variations in HR and RR interval.Methods:Descriptive Retrospective Study.We included participants from a pediatric cardiology practice of a community hospital who had an ECG performed in 2017.All participants were healthy patients with no past medical history and no regular med-ications.Results:ECGs from 95 participants from one month to 21 years of age(mean 9.7 years)were included with a mean HR of 91 beats per minute(bpm).The two-sample paired t-test or Wilcoxon signed-rank test assessed for any difference between QTc methods.A statistically significant difference was observed between every combination of two QTc formulae.The Spearman’s rank correlation analysis explored the QTc/HR and QTc/RR relationships for each formula.Fridericia method was most independent of HR and RR with the lowest absolute value of correlation coefficients.Bazett and Computer had moderate correlations,while Framingham and Rautaharju exhibited strong correlations.Correlations were positive for Bazett and Computer,reflecting results from prior studies demonstrating an over-correction of Bazett at higher HRs.In the linear QTc/HR regression analysis,Bazett had the slope closest to zero,although Computer,Hodges,and Fridericia had comparable values.Alternatively,Fridericia had the linear QTc/RR regression coefficient closest to zero.The Bland-Altman method assessed for bias and the limits of agreement between correction formulae.Bazett and Computer exhibited good agreement with minimal bias along with Framingham and Rautaharju.To account for a possible skewed distri-bution of QT,all the above analyses were also performed excluding the top and bottom 2%of data as sorted by heart rate ranges(N=90).Results from this data set were consistent with those derived from all participants(N=95).Conclusions:Overall,the Fridericia correction method provided the best rate correction in our pedia-tric study cohort.展开更多
BACKGROUND Patients with diabetes mellitus(DM)are predisposed to an increased risk of infection signifying the importance of vaccination to protect against its potentially severe complications.The Centers for Disease ...BACKGROUND Patients with diabetes mellitus(DM)are predisposed to an increased risk of infection signifying the importance of vaccination to protect against its potentially severe complications.The Centers for Disease Control and Prevention/Advisory Committee on Immunization Practices(CDC/ACIP)issued immunization recommendations to protect this patient population.AIM To assess the adherence of patients with DM to the CDC/ACIP immunization recommendations in Saudi Arabia and to identify the factors associated with the vaccine adherence rate.METHODS An observational retrospective study conducted in 2023 was used to collect data on the vaccination records from 13 diabetes care centers in Saudi Arabia with 1000 eligible patients in phase I with data collected through chart review and 709 patients in phase II through online survey.RESULTS Among participants,10.01%(n=71)had never received any vaccine,while 85.89%(n=609)received at least one dose of the coronavirus disease 2019(COVID-19)vaccine,and 34.83%(n=247)had received the annual influenza vaccine.Only 2.96%(n=21),2.11%(n=15),and 1.12%(n=8)received herpes zoster,tetanus,diphtheria,and pertussis(Tdap),and human papillomavirus(HPV)vaccines,respectively.For patients with DM in Saudi Arabia,the rate of vaccination for annual influenza and COVID-19 vaccines was higher compared to other vaccinations such as herpes zoster,Tdap,pneumococcal,and HPV.Factors such as vaccine recommendations provided by family physicians or specialists,site of care,income level,DM-related hospitalization history,residency site,hemoglobin A1c(HbA1c)level,and health sector type can significantly influence the vaccination rate in patients with DM.Among non-vaccinated patients with DM,the most reported barriers were lack of knowledge and fear of side effects.This signifies the need for large-scale research in this area to identify additional factors that might facilitate adherence to CDC/ACIP vaccine recommendations in patients with DM.CONCLUSION In Saudi Arabia,patients with DM showed higher vaccination rates for annual influenza and COVID-19 vaccines compared to other vaccinations such as herpes zoster,Tdap,pneumococcal,and HPV.Factors such as vaccine recommendations provided by family physicians or specialists,the site of care,income level,DM-related hospitalization history,residency site,HbA1c level,and health sector type can significantly influence the vaccination rate in patients with DM.展开更多
BACKGROUND Although immune checkpoint inhibitor(ICI)therapy has improved the prognosis of unresectable hepatocellular carcinoma(HCC),it has also resulted in unique immune-related adverse events(irAEs).The relationship...BACKGROUND Although immune checkpoint inhibitor(ICI)therapy has improved the prognosis of unresectable hepatocellular carcinoma(HCC),it has also resulted in unique immune-related adverse events(irAEs).The relationship between irAE and treatment outcomes in ICI-treated unresectable HCC patients remains unknown.AIM To elucidate the correlation between immune-related toxic effects and prognosis in patients with unresectable HCC treated with pembrolizumab.METHODS From March 2019 to February 2021,a total of 190 unresectable HCC(Barcelona Clinic Liver Cancer C)patients receiving pembrolizumab treatment were retrospectively reviewed.Overall survival(OS)was the primary endpoint,while objective response rate(ORR),disease control rate(DCR),and time to progression(TTP)were secondary evaluation indexes.We assessed demographics,irAEs,and outcomes by retrospective review.RESULTS One hundred and forty-three males and 47 females were included in the study.The ORR and DCR were 12.1%(23/190)and 52.1%(99/190),respectively.The median OS was 376 d[95%confidence interval(CI):340-411 d]and the median TTP was 98 d(95%CI:75-124 d).The overall incidence of treatment-related adverse events was 72.6%(138/190)and 10.0%of them were severe irAEs(grade≥3).Child-Pugh B class,portal vein tumor thrombus,extrahepatic metastasis,and hypothyroidism were the independent risk factors for survival.Patients with hypothyroidism showed a longer OS[517 d(95%CI:423-562)vs 431 d(95%CI:412-485),P=0.011]and TTP[125 d(95%CI:89-154)vs 87 d(95%CI:61-98),P=0.004]than those without irAEs.CONCLUSION Pembrolizumab-treated patients with unresectable HCC who experienced hypothyroidism have promising ORR and durable response.Hypothyroidism,an irAE,may be used as a clinical evaluation parameter of response to ICIs in unresectable HCC.展开更多
BACKGROUND Most physicians consider molars with chronic apical periodontitis(CAP)lesions as contraindications for immediate implant placement.At the patient’s request,we perform immediate implant placement of the man...BACKGROUND Most physicians consider molars with chronic apical periodontitis(CAP)lesions as contraindications for immediate implant placement.At the patient’s request,we perform immediate implant placement of the mandibular molars with CAP in clinical practice.AIM To retrospectively analyze and compare the 5-year outcomes of immediate implant placement of the mandibular molars with CAP and those without obvious inflammation.METHODS The clinical data of patients with immediate implant placement of the mandibular molars in the Department of Oral and Maxillofacial Surgery,the Affiliated Hospital of Qingdao University,from June 2015 to June 2017 were collected.The patients were divided into CAP(n=52)and no-CAP(n=45)groups.Changes in bone mineral density and bone mass around implants were analyzed 5 years after implant restoration.RESULTS At 5 years after implantation,the peri-implant bone mineral density was 528.2±78.8 Hounsfield unit(HU)in the CAP group and 562.6±82.9 HU in the no-CAP group(P=0.126).Marginal bone resorption around implants did not differ significantly between the two groups,including buccal(P=0.268)or lingual(P=0.526)resorption in the vertical direction or buccal(P=0.428)or lingual(P=0.560)resorption in the horizontal direction.Changes in the peri-implant jump space did not differ significantly between the two groups,including the buccal(P=0.247)or lingual(P=0.604)space in the vertical direction or buccal(P=0.527)or lingual(P=0.707)space in the horizontal direction.The gray value of cone-beam computed tomography measured using Image J software can reflect the bone mineral density.In the CAP area,the gray values of the bone tissue immediately and 5 years after implant placement differed significantly from those of the surrounding bone tissue(P<0.01).CONCLUSION The results of this study suggest that immediate implant placement of the mandibular molars with CAP can achieve satisfactory 5-year clinical results,without significant differences in the complications,survival rate,or bone tissue condition from the no-CAP mandibular molars.展开更多
Background:To investigate the clinical medication approach of Professor Guiqi Xuan(Prof.Xuan)in treating pediatric patients with attention-deficit hyperactivity disorder(ADHD)and the potential mechanism of the core he...Background:To investigate the clinical medication approach of Professor Guiqi Xuan(Prof.Xuan)in treating pediatric patients with attention-deficit hyperactivity disorder(ADHD)and the potential mechanism of the core herbal prescription.Methods:Following medical record information pretreatment,the Traditional Chinese Medicine(TCM)inheritance computing platform system V3.0 was utilized to analyze the standardized data.The associate rules were summarized to identify the core prescription for treating ADHD.The extracted core herbal prescription’s active compounds and potential targets were used to establish a protein-protein interaction network of active ingredient-disease targets.Cytoscape 3.9.1 software was used to analyze the network’s topological parameters to obtain the key active ingredients and their targets.The Bioconductor data package of R4.0.2 was used to analyze the gene ontology biological functions and Kyoto Encyclopedia of Genes and Genomes pathways of key targets.Results:Two hundred and twenty-seven entries derived from TCM record information were selected.Through data mining,it was found that 62.5%of pediatric patients had short-tempered behavior,nearly half had sleep problems,and 30%-40%had picky eating and polyphagia issues.The highest-frequency syndrome type was kidney deficiency and liver hyperactivity.Deficiency,fire,phlegm,and dyspeptic food were the main pathological factors for ADHD.Prof.Xuan’s treatment of ADHD mainly focused on replenishing kidney essence and subduing Yang(active,external,ascending,warm,bright,functional and excited pertain to Yang).The core herbal prescription for ADHD included Yuan-zhi,Yi-zhi,Gui-jia,Bai-shao,Long-chi,Ci-shi,Shi-chang-pu,Yu-jin,Fu-shen,and Huang-jing.The protein-protein interaction network showed that MAOA,ADRB2,FOS,MAOB,and SLC6A3 were the five key targets essential in treating ADHD with core herbal prescriptions.The gene ontology biological function of crucial targets mainly involved G protein-coupled amine receptor activity,catecholamine binding,and neurotransmitter transmembrane transporter activity.Analysis of Kyoto Encyclopedia of Genes and Genomes pathways showed that the dopaminergic synapse signaling and neuroactive ligand-receptor interaction pathways were significantly enriched and may be the primary routes for the main treatment of ADHD.Conclusion:Prof.Xuan’s treatment of ADHD has achieved satisfactory clinical effects by supplementing the kidney,replenishing the essence,opening the orifices,nourishing the Yin(static,internal,descending,cold,dim,organic,depressed and pertain to Yin),and subduing the Yang.The major prescription predominantly affects catecholamine binding,neuroactive ligand-receptor interaction,G protein-coupled amine receptor function,and signaling pathways for dopaminergic synapses.Our findings showed that the methodology and software used in this research could explore and analyze the mechanism behind Prof.Xuan’s clinical medication rule for treating ADHD in children.展开更多
Objective:To compare the efficacy and safety of hyperthermic intravesical chemotherapy(HIVEC)and intravesical chemotherapy(IVEC)in patients with intermediate and high risk nonmuscle-invasive bladder cancer(NMIBC)after...Objective:To compare the efficacy and safety of hyperthermic intravesical chemotherapy(HIVEC)and intravesical chemotherapy(IVEC)in patients with intermediate and high risk nonmuscle-invasive bladder cancer(NMIBC)after transurethral resection.Methods:We included 560 patients diagnosed with primary or recurrent NMIBC between April 2009 and December 2015 at 1 of 6 tertiary centers.We matched 364 intermediate or high risk cases and divided them into 2 groups:the HIVEC+IVEC group[chemohyperthermia(CHT)composed of 3 consecutive sessions followed by intravesical instillation without hyperthermia]and the IVEC group(intravesical instillation without hyperthermia).The data were recorded in the database.The primary endpoint was 2-year recurrence-free survival(RFS)in all NMIBC patients(n=364),whereas the secondary endpoints were the assessment of radical cystectomy(RC)and 5-year overall survival(OS).Results:There was a significant difference in the 2-year RFS between the two groups in all patients(n=364;HIVEC+IVEC:82.42%vs.IVEC:74.18%,P=0.038).Compared with the IVEC group,the HIVEC+IVEC group had a lower incidence of RC(P=0.0274).However,the 5-year OS was the same between the 2 groups(P=0.1434).Adverse events(AEs)occurred in 32.7%of all patients,but none of the events was serious(grades 3–4).No difference in the incidence or severity of AEs between each treatment modality was observed.Conclusions:This retrospective study showed that HIVEC+IVEC had a higher 2-year RFS and a lower incidence of RC than IVEC therapy in intermediate and high risk NMIBC patients.Both treatments were well-tolerated in a similar manner.展开更多
BACKGROUND Complex hypospadias is a surgical challenge.AIM To present the long-term outcomes of two-stage repair of complex hypospadias using a scrotal septal flap.METHODS This was a retrospective study of patients wi...BACKGROUND Complex hypospadias is a surgical challenge.AIM To present the long-term outcomes of two-stage repair of complex hypospadias using a scrotal septal flap.METHODS This was a retrospective study of patients with complex hypospadias who were operated on between January 1st,2001,and January 1st,2019,at a single hospital using a scrotal septal flap(two-stage surgery)or prepuce flap(one-stage surgery;control group).In the scrotal group,the urethra was first repaired using oral mucosa;in the second stage,a scrotal septal flap was used as a second impermeable layer.Maximal/average urinary flow rates after surgery were compared.All patients were followed for≥6 mo(range:6-96 mo).RESULTS Ninety-seven patients were included(46 in the scrotal group and 51 in the prepuce group).The maximal urinary flow rate was 15.4±2.1 mL/s in the scrotal group and 14.3±3.0 mL/s in the control group(P=0.035).The average urinary flow rate was 8.4±2.3 mL/s in the scrotal group and 7.5±1.5 mL/s in the control group(P=0.019).The proportion of patients achieving good therapeutic effects was higher in the scrotal group than in the control group[24(52.2%)vs 16(31.4%),P=0.042;34(73.9%)vs 25(49.0%),P=0.014].The scrotal flap two-stage surgery was independently associated with a higher maximal urinary flow rate(OR=2.416,95%CI:1.026-5.689,P=0.044)and with a higher average flow rate(OR=2.484,95%CI:1.054-5.854,P=0.038).CONCLUSION In complex hypospadias,a scrotal septal flap could be a versatile and reliable option for resurfacing the penis.展开更多
BACKGROUND Narrative nursing is an important clinical nursing intervention model.It is the practice of patient storytelling to share the essence of nursing.The current clinical intervention for biliary atresia(BA)main...BACKGROUND Narrative nursing is an important clinical nursing intervention model.It is the practice of patient storytelling to share the essence of nursing.The current clinical intervention for biliary atresia(BA)mainly focuses on disease treatment and does not pay enough attention to the psychological state of family members.AIM To explore the application value of narrative nursing in the families of children with BA.METHODS Sixty-four family members of children with BA in our hospital from December 2017 to October 2020 were retrospectively included and were divided into a study group(n=32)and a control group(n=32).The control group was provided with routine nursing,while the study group was given narrative nursing on the basis of the control group.The scores of mood state(depression and anxiety),family members’nursing ability,perceived stress,and nursing job satisfaction of the children’s families were calculated before and after the intervention.RESULTS Before intervention,there was no significant difference in the self-rating anxiety scale and self-rating depression scale scores between groups(P>0.05).After intervention,the self-rating anxiety scale and self-rating depression scale scores in the study group were lower than those in the control group(both P=0.000).Before intervention,the study group adjusted life to meet care needs,evaluated family members and social resources,dealt with personal emotions,responded to needs,and provided assistance,and the adaptive care role scores were not significantly different from those in the control group(P=0.802,0.819,0.694,0.796,and 0.686,respectively).After intervention,all scores were significantly lower in the study group than in the control group(all P<0.0001).Before intervention,there was no significant difference in the child post-traumatic stress disorder symptom score(CPSS)score between groups(P=0.615).After intervention,the CPSS scores were significantly lower than those before intervention in both groups and lower in the study group than in the control group(P<0.0001).Nursing job satisfaction of the family members of the study group(93.75%)was higher than that of the control group(75.00%)(P=0.039).CONCLUSION Narrative nursing with family members of children with BA can effectively alleviate negative emotions,reduce perceptual pressure,and improve nursing ability.Additionally,family members are more satisfied with nursing work.展开更多
BACKGROUND The liver as a primary site of lymphoma is rarely seen,they are usually misdiagnosed as hepatocellular carcinoma,etc.In 2017,a review of primary hepatic lymphoma(PHL)was done in immunocompetent diffuse larg...BACKGROUND The liver as a primary site of lymphoma is rarely seen,they are usually misdiagnosed as hepatocellular carcinoma,etc.In 2017,a review of primary hepatic lymphoma(PHL)was done in immunocompetent diffuse large B-cell lymphoma(DLBCL)patients.Yet questions that include treatment choosing or susceptibility of immunoincompetent patients remain disputable.AIM To investigate the clinical characteristics of patients with PHL.METHODS We collected PHL cases on PubMed,and extracted demographic and clinicopathological data to perform a systematic analysis.Survival analysis regarding age,lactate dehydrogenase(LDH),liver function abnormality(LFA),and treatment modalities were conducted.The Kaplan-Meier method and Cox regression were used to identify risk factors.RESULTS Of 116 PHL patients with DLBCL(62.1%)as the most common subtype.Biopsy methods before surgery produced a 97%positive rate.Progression-free survival(PFS)was significantly shortened in patients with elevated LDH[Hazard ratio(HR):3.076,95%confidence interval(CI):1.207-7.840,P=0.018]or LFA(HR:2.909,95%CI:1.135-7.452,P=0.026).Univariate Cox regression analysis suggesting that LDH,liver function,B symptom,hepatosplenomegaly,and lesion were significantly associated with PHL patients survival(P<0.05).Heavy disease burden was observed in deceased patients.A few PHL patients(3.4%)have slightly higher tumor markers.CONCLUSION PHL patients with elevated LDH and LFA tend to have shorter PFS.Biopsy before treatment in undecided patients with no tumor markers exceeds upper limits has the most essential clinical significance,especially in immunoincompetent patients.展开更多
BACKGROUND Recent improvements in the prognosis of patients with esophageal cancer have led to the increased occurrence of gastric tube cancer(GTC)in the reconstructed gastric tube.However,there are few reports on the...BACKGROUND Recent improvements in the prognosis of patients with esophageal cancer have led to the increased occurrence of gastric tube cancer(GTC)in the reconstructed gastric tube.However,there are few reports on the treatment results of endoscopic submucosal dissection(ESD)for GTC.AIM To evaluate the efficacy and safety of ESD for GTC after esophagectomy in a multicenter trial.METHODS We retrospectively investigated 48 GTC lesions in 38 consecutive patients with GTC in the reconstructed gastric tube after esophagectomy who had undergone ESD between January 2005 and December 2019 at 8 institutions participating in the Okayama Gut Study group.The clinical indications of ESD for early gastric cancer were similarly applied for GTC after esophagectomy.ESD specimens were evaluated in 2-mm slices according to the Japanese Classification of Gastric Carcinoma with curability assessments divided into curative and non-curative resection based on the Gastric Cancer Treatment Guidelines.Patient characteristics,treatment results,clinical course,and treatment outcomes were analyzed.RESULTS The median age of patients was 71.5 years(range,57-84years),and there were 34 men and 4 women.The median observation period after ESD was 884 d(range,8-4040 d).The median procedure time was 81 min(range,29-334 min),the en bloc resection rate was 91.7%(44/48),and the curative resection rate was 79%(38/48).Complications during ESD were seen in 4%(2/48)of case,and those after ESD were seen in 10%(5/48)of case.The survival rate at 5 years was 59.5%.During the observation period after ESD,10 patients died of other diseases.Although there were differences in the procedure time between institutions,a multivariate analysis showed that tumor size was the only factor associated with prolonged procedure time.CONCLUSION ESD for GTC after esophagectomy was shown to be safe and effective.展开更多
BACKGROUND Accelerated therapeutic treatment should be considered in patients with progressive Crohn’s disease(CD)to prevent complications as well as surgery.Therefore,screening for risk factors and predicting the ne...BACKGROUND Accelerated therapeutic treatment should be considered in patients with progressive Crohn’s disease(CD)to prevent complications as well as surgery.Therefore,screening for risk factors and predicting the need for early surgery are of great importance in clinical practice.AIM To establish a model to predict CD-related early surgery.METHODS This was a retrospective study collecting data from CD patients diagnosed at our inflammatory bowel disease center from January 1,2012 to December 31,2016.All data were randomly stratified into a training set and a testing set at a ratio of 8:2.Multivariable logistic regression analysis was conducted with receiver operating characteristic curves constructed and areas under the curve calculated.This model was further validated with calibration and discrimination estimated.A nomogram was finally developed.RESULTS A total of 1002 eligible patients were enrolled with a mean follow-up period of 53.54±13.10 mo.In total,24.25%of patients received intestinal surgery within 1 year after diagnosis due to complications or disease relapse.Disease behavior(B2:OR[odds ratio]=6.693,P<0.001;B3:OR=14.405,P<0.001),smoking(OR=4.135,P<0.001),body mass index(OR=0.873,P<0.001)and C-reactive protein(OR=1.022,P=0.001)at diagnosis,previous perianal(OR=9.483,P<0.001)or intestinal surgery(OR=8.887,P<0.001),maximum bowel wall thickness(OR=1.965,P<0.001),use of biologics(OR=0.264,P<0.001),and exclusive enteral nutrition(OR=0.089,P<0.001)were identified as independent significant factors associated with early intestinal surgery.A prognostic model was established and further validated.The receiver operating characteristic curves and calculated areas under the curves(94.7%)confirmed an ideal predictive ability of this model with a sensitivity of 75.92%and specificity of 95.81%.A nomogram was developed to simplify the use of the predictive model in clinical practice.CONCLUSION This prognostic model can effectively predict 1-year risk of CD-related intestinal surgery,which will assist in screening progressive CD patients and tailoring therapeutic management.展开更多
BACKGROUND Delayed intracranial hemorrhage(DICH),a potential complication of ventriculoperitoneal(VP)shunts,has been associated with high mortality,but its risk factors are still unclear.AIM To investigate the risk fa...BACKGROUND Delayed intracranial hemorrhage(DICH),a potential complication of ventriculoperitoneal(VP)shunts,has been associated with high mortality,but its risk factors are still unclear.AIM To investigate the risk factors of DICH after VP shunts.METHODS We compared the demographic and clinical characteristics of DICH and non-DICH adult patients with VP shunts between January 2016 and December 2020.RESULTS The 159 adult VP shunt patients were divided into 2 groups according to the development of DICH:the DICH group(n=26)and the non-DICH group(n=133).No statistically significant difference was found in age,sex,laboratory examination characteristics or preoperative modified Rankin Scale(mRS)score between the DICH and non-DICH groups(P>0.05);however,a history of an external ventricular drain(EVD)[P=0.045;odds ratio(OR):2.814;95%CI:1.024-7.730]and postoperative brain edema around the catheter(P<0.01;OR:8.397;95%CI:3.043-23.171)were associated with a high risk of DICH.A comparison of preoperative mRS scores between the DICH group and the non-DICH group showed no significant difference(P=0.553),while a significant difference was found in the postoperative mRS scores at the 3-mo follow-up visit(P=0.024).CONCLUSION A history of EVD and postoperative brain edema around the catheter are independent risk factors for DICH in VP shunt patients.DICH patients with a high mRS score are vulnerable to poor clinical outcomes.展开更多
This study was conducted to evaluate the incidence of avian coccidiosis and its associated various risk factors such as age,type of birds and season in a private veterinary clinic in Bukuru,Plateau State Ngeria.A tota...This study was conducted to evaluate the incidence of avian coccidiosis and its associated various risk factors such as age,type of birds and season in a private veterinary clinic in Bukuru,Plateau State Ngeria.A total of 9406 cases during 2013–2017 were analysed and 1556 of them were positive for coccidiosis.There are several reports on the prevalence of avian coccidiosis by previous researchers;however,in this study we evaluated the prevalence of avian coccidiosis in the study area and its economic impacts.Total prevalence of 12.14%in 2013,18.78%in 2014,18.21%in 2015,16.82%in 2016 and 19.07%in 2017 were reported.An overall prevalence of 85.02%was recorded.The average prevalence of coccidiosis based on this five years study is 17%.The association between coccidiosis and age of the birds was determined and age 5-8 weeks becomes most effective period with wet season having high percentage prevalence of coccidiosis.Based on the type of birds,coccidiosis is prevalence almost in equal proportion in both broilers and layers.The losses caused by avian coccidiosis could be both direct and indirect components which may include the cost of control measures,inadequate good hygiene practices,production losses and lack of prophylaxis treatment.The control of avian coccidiosis can be achieved through good sanitary measures by avoiding water spillage on the pen floor,overcrowded stocking density,the use of prophylaxis-anticoccidials and proper good vaccination practices.展开更多
Objective To study the clinical issues of progressive epidural hematoma ( PEDH ) Methods The incidence,impacts on clinical course and short term outcomes and predictors of PEDH were retrospectively studied. Results PE...Objective To study the clinical issues of progressive epidural hematoma ( PEDH ) Methods The incidence,impacts on clinical course and short term outcomes and predictors of PEDH were retrospectively studied. Results PEDH occurred in 20. 3% of the patients. The rates of neurological deterioration and展开更多
Objective:To assess the risk of aristolochic acid(AA)-associated cancer in patients with AA nephropathy(AAN).Methods:A retrospective study was conducted on patients diagnosed with AAN at Peking University First Hospit...Objective:To assess the risk of aristolochic acid(AA)-associated cancer in patients with AA nephropathy(AAN).Methods:A retrospective study was conducted on patients diagnosed with AAN at Peking University First Hospital from January 1997 to December 2014.Long-term surveillance and follow-up data were analyzed to investigate the influence of different factors on the prevalence of cancer.The primary endpoint was the incidence of liver cancer,and the secondary endpoint was the incidence of urinary cancer during 1 year after taking AA-containing medication to 2014.Results:A total of 337 patients diagnosed with AAN were included in this study.From the initiation of taking AA to the termination of follow-up,39 patients were diagnosed with cancer.No cases of liver cancer were observed throughout the entire follow-up period,with urinary cancer being the predominant type(34/39,87.17%).Logistic regression analysis showed that age,follow-up period,and diabetes were potential risk factors,however,the dosage of the drug was not significantly associated with urinary cancer.Conclusions:No cases of liver cancer were observed at the end of follow-up.However,a high prevalence of urinary cancer was observed in AAN patients.Establishing a direct causality between AA and HCC is challenging.展开更多
BACKGROUND For children and adolescents,deliberate self-harm(DSH)is becoming a mental health problem of concern.Despite several studies on the prevalence and factors of DSH in the world,there is little information on ...BACKGROUND For children and adolescents,deliberate self-harm(DSH)is becoming a mental health problem of concern.Despite several studies on the prevalence and factors of DSH in the world,there is little information on DSH among children and adolescents in China.This study explores the prevalence,types,associated risk factors and tendency of DSH in pediatric psychiatric inpatients in China.AIM To understand the situation of DSH among hospitalized children and adolescents and its related factors.METHODS In this study,we retrospectively studied 1414 hospitalized children and adolescents with mental illness at Xiamen Mental Health Center from 2014 to 2019,extracted the demographic and clinical data of all patients,and analyzed clinical risk factors of DSH.RESULTS A total of 239(16.90%)patients engaged in at least one type of DSH in our study.Cutting(n=115,48.12%)was the most common type of DSH.Females(n=171,71.55%)were more likely to engage in DSH than males(n=68,28.45%).DSH was positively associated with depressive disorders[OR=3.845(2.196-6.732);P<0.01],female[OR=2.536(1.815-3.542);P<0.01],parental marital status[OR=5.387(2.254-12.875);P<0.01]and negative family history of psychiatric illness[OR=7.767(2.952-20.433);P<0.01],but not with occupation,substance use and history of physical abuse.CONCLUSION Our findings suggest that for patients with depression,females,an abnormal marriage of parents,and no history of mental illness,attention should be paid to the occurrence of DSH.展开更多
OBJECTIVE:To investigate the antipyretic effect of early treatment with Traditional Chinese Medicine(TCM) on coronavirus disease 2019(COVID-19) patients.METHODS:We retrospectively analyzed 369 patients from January 26...OBJECTIVE:To investigate the antipyretic effect of early treatment with Traditional Chinese Medicine(TCM) on coronavirus disease 2019(COVID-19) patients.METHODS:We retrospectively analyzed 369 patients from January 26th,2020 to April 15th,2020,who had been diagnosed with COVID-19.Among 92 eligible cases,45 cases were identified as treatment group Ⅰ(n = 45) and 47 cases were identified as treatment group Ⅱ.Patients in the treatment group Ⅰ were treated with TCM herbal decoction within 5 d after admission.Patients in the treatment group Ⅱ were treated with TCM herbal decoction after the 6th admission day.The onset time of antipyretic effect,the antipyretic time,the time of negative oropharyngeal swab nucleic acid conversion,and the changes of cell count in blood routine test were compared.RESULTS:The treatment group Ⅰ showed shorter average antipyretic duration(4 vs 7 d;P < 0.05),and shorter average time for polymerase chain reaction(PCR) nucleic acid test results to turn negative(7 vs 11 d;P < 0.05) than the treatment group II.For patients(n = 54) with body temperature > 38 ℃,patients in the treatment group I had shorter median onset time of antipyretic effect than those in the treatment group Ⅱ(3 vs 4 d;P < 0.05).The absolute lymphocyte(LYMPH) count and absolute eosinophil(EOS) count on the 3rd day after admission and the neutrophil/lymphocyte ratio on the 6th day after admission of patients in the treatment group I were notably different from those in the treatment group Ⅱ at the same time point(P < 0.05).Based on Spearman’s rank correlation analysis,the change of body temperature on the 3rd day after admission was positively correlated with the increase of EOS count and the increase of EOS count and LYMPH counts on the 6th day after admission(P < 0.01).CONCLUSIONS:Early TCM intervention within 5 d after hospital admission shortened the onset time of antipyretic effect and fever duration of COVID-19 patients,reduced the time required for PCR test results to turn negative.Moreover,early TCM intervention also improved the results of inflammatory markers for COVID-19 patients.LYMPH and EOS counts can be used as indicators of TCM antipyretic effect.展开更多
Background:The outbreak of coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus 2 in India has been declared a public health emergency.Many patients with COVID-19 experience cardia...Background:The outbreak of coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus 2 in India has been declared a public health emergency.Many patients with COVID-19 experience cardiac injury.Patients with COVID-19 admitted to the intensive care unit(ICU)with acute myocardial injury showed increased high-sensitivity troponin levels.Abnormal troponin levels may indicate myocardial injury and are commonly associated with COVID-19.Methods:We conducted a retrospective observational study of 44 patients with severe COVID-19 in ICU during the second wave.The primary end point of our retrospective study was 28-day mortality,and the time of ICU admission was designated as day 0.We extracted and analyzed cardiac biomarkers,such as creatine kinase(CK),creatine kinase-MB(CK-MB),B-type natriuretic peptide(BNP),and high-sensitivity cardiac troponin I(hs-cTnI),and various inflammatory markers such as C-reactive protein(CRP)level,interleukin 6(IL-6),D-dimer,ferritin,lactate dehydrogenase,IL-6,and procalcitonin in patients with severe COVID-19 at ICU admission and 72 hours after ICU admission from our electronic medical record system.Results:The best cutoff of BNP were 326.8 and 398.5 pg/mL,CK were 195.95 and 180.12 U/L,CK-MB were 112.10 and 108.5 U/L,and hs-cTnI were 0.035 and 0.025 ng/mL,at ICU admission and 72 hours after ICU admission for predicting 28-day mortality among nonsurvivors.Conclusion:In patients with severe COVID-19,CK and hs-cTnI may be considered effective and valuable predictive cardiac biomarkers among nonsurvivors and predict poor prognosis.展开更多
Dear Editor,Infectious bronchitis(IB),one of the most common and difficult poultry diseases,is caused by a gammacoronavirus named infectious bronchitis virus(IBV).IBV frequently causes respiratory and/or renal disease...Dear Editor,Infectious bronchitis(IB),one of the most common and difficult poultry diseases,is caused by a gammacoronavirus named infectious bronchitis virus(IBV).IBV frequently causes respiratory and/or renal diseases in chickens and egg production losses in hens.IB has展开更多
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.
基金This study was reviewed and approved by the New York-Presbyterian Brooklyn Methodist Hospital Institutional Review Committee.The study follows the guidelines outlined in the Declaration of Helsinki.
文摘Objective:Accurate measurement of QT interval,the ventricular action potential from depolarization to repolarization,is important for the early detection of Long QT syndrome.The most effective QT correction(QTc)formula has yet to be determined in the pediatric population,although it has intrinsically greater extremes in heart rate(HR)and is more susceptible to errors in measurement.The authors of this study compare six dif-ferent QTc methods(Bazett,Fridericia,Framingham,Hodges,Rautaharju,and a computer algorithm utilizing the Bazett formula)for consistency against variations in HR and RR interval.Methods:Descriptive Retrospective Study.We included participants from a pediatric cardiology practice of a community hospital who had an ECG performed in 2017.All participants were healthy patients with no past medical history and no regular med-ications.Results:ECGs from 95 participants from one month to 21 years of age(mean 9.7 years)were included with a mean HR of 91 beats per minute(bpm).The two-sample paired t-test or Wilcoxon signed-rank test assessed for any difference between QTc methods.A statistically significant difference was observed between every combination of two QTc formulae.The Spearman’s rank correlation analysis explored the QTc/HR and QTc/RR relationships for each formula.Fridericia method was most independent of HR and RR with the lowest absolute value of correlation coefficients.Bazett and Computer had moderate correlations,while Framingham and Rautaharju exhibited strong correlations.Correlations were positive for Bazett and Computer,reflecting results from prior studies demonstrating an over-correction of Bazett at higher HRs.In the linear QTc/HR regression analysis,Bazett had the slope closest to zero,although Computer,Hodges,and Fridericia had comparable values.Alternatively,Fridericia had the linear QTc/RR regression coefficient closest to zero.The Bland-Altman method assessed for bias and the limits of agreement between correction formulae.Bazett and Computer exhibited good agreement with minimal bias along with Framingham and Rautaharju.To account for a possible skewed distri-bution of QT,all the above analyses were also performed excluding the top and bottom 2%of data as sorted by heart rate ranges(N=90).Results from this data set were consistent with those derived from all participants(N=95).Conclusions:Overall,the Fridericia correction method provided the best rate correction in our pedia-tric study cohort.
文摘BACKGROUND Patients with diabetes mellitus(DM)are predisposed to an increased risk of infection signifying the importance of vaccination to protect against its potentially severe complications.The Centers for Disease Control and Prevention/Advisory Committee on Immunization Practices(CDC/ACIP)issued immunization recommendations to protect this patient population.AIM To assess the adherence of patients with DM to the CDC/ACIP immunization recommendations in Saudi Arabia and to identify the factors associated with the vaccine adherence rate.METHODS An observational retrospective study conducted in 2023 was used to collect data on the vaccination records from 13 diabetes care centers in Saudi Arabia with 1000 eligible patients in phase I with data collected through chart review and 709 patients in phase II through online survey.RESULTS Among participants,10.01%(n=71)had never received any vaccine,while 85.89%(n=609)received at least one dose of the coronavirus disease 2019(COVID-19)vaccine,and 34.83%(n=247)had received the annual influenza vaccine.Only 2.96%(n=21),2.11%(n=15),and 1.12%(n=8)received herpes zoster,tetanus,diphtheria,and pertussis(Tdap),and human papillomavirus(HPV)vaccines,respectively.For patients with DM in Saudi Arabia,the rate of vaccination for annual influenza and COVID-19 vaccines was higher compared to other vaccinations such as herpes zoster,Tdap,pneumococcal,and HPV.Factors such as vaccine recommendations provided by family physicians or specialists,site of care,income level,DM-related hospitalization history,residency site,hemoglobin A1c(HbA1c)level,and health sector type can significantly influence the vaccination rate in patients with DM.Among non-vaccinated patients with DM,the most reported barriers were lack of knowledge and fear of side effects.This signifies the need for large-scale research in this area to identify additional factors that might facilitate adherence to CDC/ACIP vaccine recommendations in patients with DM.CONCLUSION In Saudi Arabia,patients with DM showed higher vaccination rates for annual influenza and COVID-19 vaccines compared to other vaccinations such as herpes zoster,Tdap,pneumococcal,and HPV.Factors such as vaccine recommendations provided by family physicians or specialists,the site of care,income level,DM-related hospitalization history,residency site,HbA1c level,and health sector type can significantly influence the vaccination rate in patients with DM.
文摘BACKGROUND Although immune checkpoint inhibitor(ICI)therapy has improved the prognosis of unresectable hepatocellular carcinoma(HCC),it has also resulted in unique immune-related adverse events(irAEs).The relationship between irAE and treatment outcomes in ICI-treated unresectable HCC patients remains unknown.AIM To elucidate the correlation between immune-related toxic effects and prognosis in patients with unresectable HCC treated with pembrolizumab.METHODS From March 2019 to February 2021,a total of 190 unresectable HCC(Barcelona Clinic Liver Cancer C)patients receiving pembrolizumab treatment were retrospectively reviewed.Overall survival(OS)was the primary endpoint,while objective response rate(ORR),disease control rate(DCR),and time to progression(TTP)were secondary evaluation indexes.We assessed demographics,irAEs,and outcomes by retrospective review.RESULTS One hundred and forty-three males and 47 females were included in the study.The ORR and DCR were 12.1%(23/190)and 52.1%(99/190),respectively.The median OS was 376 d[95%confidence interval(CI):340-411 d]and the median TTP was 98 d(95%CI:75-124 d).The overall incidence of treatment-related adverse events was 72.6%(138/190)and 10.0%of them were severe irAEs(grade≥3).Child-Pugh B class,portal vein tumor thrombus,extrahepatic metastasis,and hypothyroidism were the independent risk factors for survival.Patients with hypothyroidism showed a longer OS[517 d(95%CI:423-562)vs 431 d(95%CI:412-485),P=0.011]and TTP[125 d(95%CI:89-154)vs 87 d(95%CI:61-98),P=0.004]than those without irAEs.CONCLUSION Pembrolizumab-treated patients with unresectable HCC who experienced hypothyroidism have promising ORR and durable response.Hypothyroidism,an irAE,may be used as a clinical evaluation parameter of response to ICIs in unresectable HCC.
文摘BACKGROUND Most physicians consider molars with chronic apical periodontitis(CAP)lesions as contraindications for immediate implant placement.At the patient’s request,we perform immediate implant placement of the mandibular molars with CAP in clinical practice.AIM To retrospectively analyze and compare the 5-year outcomes of immediate implant placement of the mandibular molars with CAP and those without obvious inflammation.METHODS The clinical data of patients with immediate implant placement of the mandibular molars in the Department of Oral and Maxillofacial Surgery,the Affiliated Hospital of Qingdao University,from June 2015 to June 2017 were collected.The patients were divided into CAP(n=52)and no-CAP(n=45)groups.Changes in bone mineral density and bone mass around implants were analyzed 5 years after implant restoration.RESULTS At 5 years after implantation,the peri-implant bone mineral density was 528.2±78.8 Hounsfield unit(HU)in the CAP group and 562.6±82.9 HU in the no-CAP group(P=0.126).Marginal bone resorption around implants did not differ significantly between the two groups,including buccal(P=0.268)or lingual(P=0.526)resorption in the vertical direction or buccal(P=0.428)or lingual(P=0.560)resorption in the horizontal direction.Changes in the peri-implant jump space did not differ significantly between the two groups,including the buccal(P=0.247)or lingual(P=0.604)space in the vertical direction or buccal(P=0.527)or lingual(P=0.707)space in the horizontal direction.The gray value of cone-beam computed tomography measured using Image J software can reflect the bone mineral density.In the CAP area,the gray values of the bone tissue immediately and 5 years after implant placement differed significantly from those of the surrounding bone tissue(P<0.01).CONCLUSION The results of this study suggest that immediate implant placement of the mandibular molars with CAP can achieve satisfactory 5-year clinical results,without significant differences in the complications,survival rate,or bone tissue condition from the no-CAP mandibular molars.
基金This work was supported by the Hangzhou XUANs’Pediatric School Inheritance Studio Construction Project(No.[2012]228).
文摘Background:To investigate the clinical medication approach of Professor Guiqi Xuan(Prof.Xuan)in treating pediatric patients with attention-deficit hyperactivity disorder(ADHD)and the potential mechanism of the core herbal prescription.Methods:Following medical record information pretreatment,the Traditional Chinese Medicine(TCM)inheritance computing platform system V3.0 was utilized to analyze the standardized data.The associate rules were summarized to identify the core prescription for treating ADHD.The extracted core herbal prescription’s active compounds and potential targets were used to establish a protein-protein interaction network of active ingredient-disease targets.Cytoscape 3.9.1 software was used to analyze the network’s topological parameters to obtain the key active ingredients and their targets.The Bioconductor data package of R4.0.2 was used to analyze the gene ontology biological functions and Kyoto Encyclopedia of Genes and Genomes pathways of key targets.Results:Two hundred and twenty-seven entries derived from TCM record information were selected.Through data mining,it was found that 62.5%of pediatric patients had short-tempered behavior,nearly half had sleep problems,and 30%-40%had picky eating and polyphagia issues.The highest-frequency syndrome type was kidney deficiency and liver hyperactivity.Deficiency,fire,phlegm,and dyspeptic food were the main pathological factors for ADHD.Prof.Xuan’s treatment of ADHD mainly focused on replenishing kidney essence and subduing Yang(active,external,ascending,warm,bright,functional and excited pertain to Yang).The core herbal prescription for ADHD included Yuan-zhi,Yi-zhi,Gui-jia,Bai-shao,Long-chi,Ci-shi,Shi-chang-pu,Yu-jin,Fu-shen,and Huang-jing.The protein-protein interaction network showed that MAOA,ADRB2,FOS,MAOB,and SLC6A3 were the five key targets essential in treating ADHD with core herbal prescriptions.The gene ontology biological function of crucial targets mainly involved G protein-coupled amine receptor activity,catecholamine binding,and neurotransmitter transmembrane transporter activity.Analysis of Kyoto Encyclopedia of Genes and Genomes pathways showed that the dopaminergic synapse signaling and neuroactive ligand-receptor interaction pathways were significantly enriched and may be the primary routes for the main treatment of ADHD.Conclusion:Prof.Xuan’s treatment of ADHD has achieved satisfactory clinical effects by supplementing the kidney,replenishing the essence,opening the orifices,nourishing the Yin(static,internal,descending,cold,dim,organic,depressed and pertain to Yin),and subduing the Yang.The major prescription predominantly affects catecholamine binding,neuroactive ligand-receptor interaction,G protein-coupled amine receptor function,and signaling pathways for dopaminergic synapses.Our findings showed that the methodology and software used in this research could explore and analyze the mechanism behind Prof.Xuan’s clinical medication rule for treating ADHD in children.
基金supported by the National Natural Science Foundation of China(Grant No.81972918)the Guangzhou Key Medical Discipline Construction Project Fund+1 种基金the Guangzhou Major Clinical Technology Program(Grant No.2019ZD16)the Guanzhou Municipal Special Clinical Technology Project(Grant No.2019TS40)。
文摘Objective:To compare the efficacy and safety of hyperthermic intravesical chemotherapy(HIVEC)and intravesical chemotherapy(IVEC)in patients with intermediate and high risk nonmuscle-invasive bladder cancer(NMIBC)after transurethral resection.Methods:We included 560 patients diagnosed with primary or recurrent NMIBC between April 2009 and December 2015 at 1 of 6 tertiary centers.We matched 364 intermediate or high risk cases and divided them into 2 groups:the HIVEC+IVEC group[chemohyperthermia(CHT)composed of 3 consecutive sessions followed by intravesical instillation without hyperthermia]and the IVEC group(intravesical instillation without hyperthermia).The data were recorded in the database.The primary endpoint was 2-year recurrence-free survival(RFS)in all NMIBC patients(n=364),whereas the secondary endpoints were the assessment of radical cystectomy(RC)and 5-year overall survival(OS).Results:There was a significant difference in the 2-year RFS between the two groups in all patients(n=364;HIVEC+IVEC:82.42%vs.IVEC:74.18%,P=0.038).Compared with the IVEC group,the HIVEC+IVEC group had a lower incidence of RC(P=0.0274).However,the 5-year OS was the same between the 2 groups(P=0.1434).Adverse events(AEs)occurred in 32.7%of all patients,but none of the events was serious(grades 3–4).No difference in the incidence or severity of AEs between each treatment modality was observed.Conclusions:This retrospective study showed that HIVEC+IVEC had a higher 2-year RFS and a lower incidence of RC than IVEC therapy in intermediate and high risk NMIBC patients.Both treatments were well-tolerated in a similar manner.
基金Special Research Fund for Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,No.B2018009Beijing Municipal Science&Technology Commission-Functional Urethral Reconstruction of Hypospadias by Tissue Transplantation,No.Z161100000516015.
文摘BACKGROUND Complex hypospadias is a surgical challenge.AIM To present the long-term outcomes of two-stage repair of complex hypospadias using a scrotal septal flap.METHODS This was a retrospective study of patients with complex hypospadias who were operated on between January 1st,2001,and January 1st,2019,at a single hospital using a scrotal septal flap(two-stage surgery)or prepuce flap(one-stage surgery;control group).In the scrotal group,the urethra was first repaired using oral mucosa;in the second stage,a scrotal septal flap was used as a second impermeable layer.Maximal/average urinary flow rates after surgery were compared.All patients were followed for≥6 mo(range:6-96 mo).RESULTS Ninety-seven patients were included(46 in the scrotal group and 51 in the prepuce group).The maximal urinary flow rate was 15.4±2.1 mL/s in the scrotal group and 14.3±3.0 mL/s in the control group(P=0.035).The average urinary flow rate was 8.4±2.3 mL/s in the scrotal group and 7.5±1.5 mL/s in the control group(P=0.019).The proportion of patients achieving good therapeutic effects was higher in the scrotal group than in the control group[24(52.2%)vs 16(31.4%),P=0.042;34(73.9%)vs 25(49.0%),P=0.014].The scrotal flap two-stage surgery was independently associated with a higher maximal urinary flow rate(OR=2.416,95%CI:1.026-5.689,P=0.044)and with a higher average flow rate(OR=2.484,95%CI:1.054-5.854,P=0.038).CONCLUSION In complex hypospadias,a scrotal septal flap could be a versatile and reliable option for resurfacing the penis.
基金the Huai’an Maternal and Child Hospital Ethics Committee(Approval No.2020038).
文摘BACKGROUND Narrative nursing is an important clinical nursing intervention model.It is the practice of patient storytelling to share the essence of nursing.The current clinical intervention for biliary atresia(BA)mainly focuses on disease treatment and does not pay enough attention to the psychological state of family members.AIM To explore the application value of narrative nursing in the families of children with BA.METHODS Sixty-four family members of children with BA in our hospital from December 2017 to October 2020 were retrospectively included and were divided into a study group(n=32)and a control group(n=32).The control group was provided with routine nursing,while the study group was given narrative nursing on the basis of the control group.The scores of mood state(depression and anxiety),family members’nursing ability,perceived stress,and nursing job satisfaction of the children’s families were calculated before and after the intervention.RESULTS Before intervention,there was no significant difference in the self-rating anxiety scale and self-rating depression scale scores between groups(P>0.05).After intervention,the self-rating anxiety scale and self-rating depression scale scores in the study group were lower than those in the control group(both P=0.000).Before intervention,the study group adjusted life to meet care needs,evaluated family members and social resources,dealt with personal emotions,responded to needs,and provided assistance,and the adaptive care role scores were not significantly different from those in the control group(P=0.802,0.819,0.694,0.796,and 0.686,respectively).After intervention,all scores were significantly lower in the study group than in the control group(all P<0.0001).Before intervention,there was no significant difference in the child post-traumatic stress disorder symptom score(CPSS)score between groups(P=0.615).After intervention,the CPSS scores were significantly lower than those before intervention in both groups and lower in the study group than in the control group(P<0.0001).Nursing job satisfaction of the family members of the study group(93.75%)was higher than that of the control group(75.00%)(P=0.039).CONCLUSION Narrative nursing with family members of children with BA can effectively alleviate negative emotions,reduce perceptual pressure,and improve nursing ability.Additionally,family members are more satisfied with nursing work.
文摘BACKGROUND The liver as a primary site of lymphoma is rarely seen,they are usually misdiagnosed as hepatocellular carcinoma,etc.In 2017,a review of primary hepatic lymphoma(PHL)was done in immunocompetent diffuse large B-cell lymphoma(DLBCL)patients.Yet questions that include treatment choosing or susceptibility of immunoincompetent patients remain disputable.AIM To investigate the clinical characteristics of patients with PHL.METHODS We collected PHL cases on PubMed,and extracted demographic and clinicopathological data to perform a systematic analysis.Survival analysis regarding age,lactate dehydrogenase(LDH),liver function abnormality(LFA),and treatment modalities were conducted.The Kaplan-Meier method and Cox regression were used to identify risk factors.RESULTS Of 116 PHL patients with DLBCL(62.1%)as the most common subtype.Biopsy methods before surgery produced a 97%positive rate.Progression-free survival(PFS)was significantly shortened in patients with elevated LDH[Hazard ratio(HR):3.076,95%confidence interval(CI):1.207-7.840,P=0.018]or LFA(HR:2.909,95%CI:1.135-7.452,P=0.026).Univariate Cox regression analysis suggesting that LDH,liver function,B symptom,hepatosplenomegaly,and lesion were significantly associated with PHL patients survival(P<0.05).Heavy disease burden was observed in deceased patients.A few PHL patients(3.4%)have slightly higher tumor markers.CONCLUSION PHL patients with elevated LDH and LFA tend to have shorter PFS.Biopsy before treatment in undecided patients with no tumor markers exceeds upper limits has the most essential clinical significance,especially in immunoincompetent patients.
文摘BACKGROUND Recent improvements in the prognosis of patients with esophageal cancer have led to the increased occurrence of gastric tube cancer(GTC)in the reconstructed gastric tube.However,there are few reports on the treatment results of endoscopic submucosal dissection(ESD)for GTC.AIM To evaluate the efficacy and safety of ESD for GTC after esophagectomy in a multicenter trial.METHODS We retrospectively investigated 48 GTC lesions in 38 consecutive patients with GTC in the reconstructed gastric tube after esophagectomy who had undergone ESD between January 2005 and December 2019 at 8 institutions participating in the Okayama Gut Study group.The clinical indications of ESD for early gastric cancer were similarly applied for GTC after esophagectomy.ESD specimens were evaluated in 2-mm slices according to the Japanese Classification of Gastric Carcinoma with curability assessments divided into curative and non-curative resection based on the Gastric Cancer Treatment Guidelines.Patient characteristics,treatment results,clinical course,and treatment outcomes were analyzed.RESULTS The median age of patients was 71.5 years(range,57-84years),and there were 34 men and 4 women.The median observation period after ESD was 884 d(range,8-4040 d).The median procedure time was 81 min(range,29-334 min),the en bloc resection rate was 91.7%(44/48),and the curative resection rate was 79%(38/48).Complications during ESD were seen in 4%(2/48)of case,and those after ESD were seen in 10%(5/48)of case.The survival rate at 5 years was 59.5%.During the observation period after ESD,10 patients died of other diseases.Although there were differences in the procedure time between institutions,a multivariate analysis showed that tumor size was the only factor associated with prolonged procedure time.CONCLUSION ESD for GTC after esophagectomy was shown to be safe and effective.
基金Supported by the National Natural Science Foundation of China,No.81900490,No.81670477,and No.81600419
文摘BACKGROUND Accelerated therapeutic treatment should be considered in patients with progressive Crohn’s disease(CD)to prevent complications as well as surgery.Therefore,screening for risk factors and predicting the need for early surgery are of great importance in clinical practice.AIM To establish a model to predict CD-related early surgery.METHODS This was a retrospective study collecting data from CD patients diagnosed at our inflammatory bowel disease center from January 1,2012 to December 31,2016.All data were randomly stratified into a training set and a testing set at a ratio of 8:2.Multivariable logistic regression analysis was conducted with receiver operating characteristic curves constructed and areas under the curve calculated.This model was further validated with calibration and discrimination estimated.A nomogram was finally developed.RESULTS A total of 1002 eligible patients were enrolled with a mean follow-up period of 53.54±13.10 mo.In total,24.25%of patients received intestinal surgery within 1 year after diagnosis due to complications or disease relapse.Disease behavior(B2:OR[odds ratio]=6.693,P<0.001;B3:OR=14.405,P<0.001),smoking(OR=4.135,P<0.001),body mass index(OR=0.873,P<0.001)and C-reactive protein(OR=1.022,P=0.001)at diagnosis,previous perianal(OR=9.483,P<0.001)or intestinal surgery(OR=8.887,P<0.001),maximum bowel wall thickness(OR=1.965,P<0.001),use of biologics(OR=0.264,P<0.001),and exclusive enteral nutrition(OR=0.089,P<0.001)were identified as independent significant factors associated with early intestinal surgery.A prognostic model was established and further validated.The receiver operating characteristic curves and calculated areas under the curves(94.7%)confirmed an ideal predictive ability of this model with a sensitivity of 75.92%and specificity of 95.81%.A nomogram was developed to simplify the use of the predictive model in clinical practice.CONCLUSION This prognostic model can effectively predict 1-year risk of CD-related intestinal surgery,which will assist in screening progressive CD patients and tailoring therapeutic management.
基金Supported by Shantou Medical Healthcare Science and Technology Program,No.~([2019])70Natural Science Foundation of Guangdong Province of China,No. 2022A1515010407Guangdong Provincial Science and Technology Fund ("major special project+Task list") for high-level hospital construction,No. STKJ2021119
文摘BACKGROUND Delayed intracranial hemorrhage(DICH),a potential complication of ventriculoperitoneal(VP)shunts,has been associated with high mortality,but its risk factors are still unclear.AIM To investigate the risk factors of DICH after VP shunts.METHODS We compared the demographic and clinical characteristics of DICH and non-DICH adult patients with VP shunts between January 2016 and December 2020.RESULTS The 159 adult VP shunt patients were divided into 2 groups according to the development of DICH:the DICH group(n=26)and the non-DICH group(n=133).No statistically significant difference was found in age,sex,laboratory examination characteristics or preoperative modified Rankin Scale(mRS)score between the DICH and non-DICH groups(P>0.05);however,a history of an external ventricular drain(EVD)[P=0.045;odds ratio(OR):2.814;95%CI:1.024-7.730]and postoperative brain edema around the catheter(P<0.01;OR:8.397;95%CI:3.043-23.171)were associated with a high risk of DICH.A comparison of preoperative mRS scores between the DICH group and the non-DICH group showed no significant difference(P=0.553),while a significant difference was found in the postoperative mRS scores at the 3-mo follow-up visit(P=0.024).CONCLUSION A history of EVD and postoperative brain edema around the catheter are independent risk factors for DICH in VP shunt patients.DICH patients with a high mRS score are vulnerable to poor clinical outcomes.
文摘This study was conducted to evaluate the incidence of avian coccidiosis and its associated various risk factors such as age,type of birds and season in a private veterinary clinic in Bukuru,Plateau State Ngeria.A total of 9406 cases during 2013–2017 were analysed and 1556 of them were positive for coccidiosis.There are several reports on the prevalence of avian coccidiosis by previous researchers;however,in this study we evaluated the prevalence of avian coccidiosis in the study area and its economic impacts.Total prevalence of 12.14%in 2013,18.78%in 2014,18.21%in 2015,16.82%in 2016 and 19.07%in 2017 were reported.An overall prevalence of 85.02%was recorded.The average prevalence of coccidiosis based on this five years study is 17%.The association between coccidiosis and age of the birds was determined and age 5-8 weeks becomes most effective period with wet season having high percentage prevalence of coccidiosis.Based on the type of birds,coccidiosis is prevalence almost in equal proportion in both broilers and layers.The losses caused by avian coccidiosis could be both direct and indirect components which may include the cost of control measures,inadequate good hygiene practices,production losses and lack of prophylaxis treatment.The control of avian coccidiosis can be achieved through good sanitary measures by avoiding water spillage on the pen floor,overcrowded stocking density,the use of prophylaxis-anticoccidials and proper good vaccination practices.
文摘Objective To study the clinical issues of progressive epidural hematoma ( PEDH ) Methods The incidence,impacts on clinical course and short term outcomes and predictors of PEDH were retrospectively studied. Results PEDH occurred in 20. 3% of the patients. The rates of neurological deterioration and
基金Supported by National Key Technology R&D Program(No.2018zX09101002-001-002)Innovation Team and Talents Cultivation Program of National Administration of Traditional Chinese Medicine(No.ZYYCXTD-C-202005)the Science and Technology Project Affiliated to the Education Department of Chongqing Municipality(No.KJQN202215119)。
文摘Objective:To assess the risk of aristolochic acid(AA)-associated cancer in patients with AA nephropathy(AAN).Methods:A retrospective study was conducted on patients diagnosed with AAN at Peking University First Hospital from January 1997 to December 2014.Long-term surveillance and follow-up data were analyzed to investigate the influence of different factors on the prevalence of cancer.The primary endpoint was the incidence of liver cancer,and the secondary endpoint was the incidence of urinary cancer during 1 year after taking AA-containing medication to 2014.Results:A total of 337 patients diagnosed with AAN were included in this study.From the initiation of taking AA to the termination of follow-up,39 patients were diagnosed with cancer.No cases of liver cancer were observed throughout the entire follow-up period,with urinary cancer being the predominant type(34/39,87.17%).Logistic regression analysis showed that age,follow-up period,and diabetes were potential risk factors,however,the dosage of the drug was not significantly associated with urinary cancer.Conclusions:No cases of liver cancer were observed at the end of follow-up.However,a high prevalence of urinary cancer was observed in AAN patients.Establishing a direct causality between AA and HCC is challenging.
基金Supported by Shenzhen Fund for Guangdong Provincial High-level Clinical Key Specialties,No.SZGSP013Shenzhen Key Medical Discipline Construction Fund,No.SZXK042+2 种基金Sanming Project of Medicine in Shenzhen,No.SZSM202311025Natural Science Fund of Fujian Province,No.2023J011622Natural Science Fund of Xiamen City,No.3502Z20224ZD1259.
文摘BACKGROUND For children and adolescents,deliberate self-harm(DSH)is becoming a mental health problem of concern.Despite several studies on the prevalence and factors of DSH in the world,there is little information on DSH among children and adolescents in China.This study explores the prevalence,types,associated risk factors and tendency of DSH in pediatric psychiatric inpatients in China.AIM To understand the situation of DSH among hospitalized children and adolescents and its related factors.METHODS In this study,we retrospectively studied 1414 hospitalized children and adolescents with mental illness at Xiamen Mental Health Center from 2014 to 2019,extracted the demographic and clinical data of all patients,and analyzed clinical risk factors of DSH.RESULTS A total of 239(16.90%)patients engaged in at least one type of DSH in our study.Cutting(n=115,48.12%)was the most common type of DSH.Females(n=171,71.55%)were more likely to engage in DSH than males(n=68,28.45%).DSH was positively associated with depressive disorders[OR=3.845(2.196-6.732);P<0.01],female[OR=2.536(1.815-3.542);P<0.01],parental marital status[OR=5.387(2.254-12.875);P<0.01]and negative family history of psychiatric illness[OR=7.767(2.952-20.433);P<0.01],but not with occupation,substance use and history of physical abuse.CONCLUSION Our findings suggest that for patients with depression,females,an abnormal marriage of parents,and no history of mental illness,attention should be paid to the occurrence of DSH.
基金Supported by Foundation of Shanghai Science and Technology Committee,Clinical Study on the Treatment of COVID-19 with Traditional Chinese Medicine(No.2041195020002)Shanghai Infectious Disease Prevention and Treatment Ability Cultivation Project of Traditional Chinese Medicine(ZYYB-NLPY-09, ZYYBNLPY-15)+2 种基金Shanghai Key Clinical Specialty(No.shslczdzk05101)Shanghai Key Clinical Laboratory of Traditional Chinese Medicine(No.20dz2272200)Shanghai Health Commission,Shanghai Chinese Medicine Administration Emergency Scientific Research Project,Clinical Study on Prevention and Treatment of New Coronavirus Pneumonia with Integrated Chinese And Western Medicine(2020YJ01)。
文摘OBJECTIVE:To investigate the antipyretic effect of early treatment with Traditional Chinese Medicine(TCM) on coronavirus disease 2019(COVID-19) patients.METHODS:We retrospectively analyzed 369 patients from January 26th,2020 to April 15th,2020,who had been diagnosed with COVID-19.Among 92 eligible cases,45 cases were identified as treatment group Ⅰ(n = 45) and 47 cases were identified as treatment group Ⅱ.Patients in the treatment group Ⅰ were treated with TCM herbal decoction within 5 d after admission.Patients in the treatment group Ⅱ were treated with TCM herbal decoction after the 6th admission day.The onset time of antipyretic effect,the antipyretic time,the time of negative oropharyngeal swab nucleic acid conversion,and the changes of cell count in blood routine test were compared.RESULTS:The treatment group Ⅰ showed shorter average antipyretic duration(4 vs 7 d;P < 0.05),and shorter average time for polymerase chain reaction(PCR) nucleic acid test results to turn negative(7 vs 11 d;P < 0.05) than the treatment group II.For patients(n = 54) with body temperature > 38 ℃,patients in the treatment group I had shorter median onset time of antipyretic effect than those in the treatment group Ⅱ(3 vs 4 d;P < 0.05).The absolute lymphocyte(LYMPH) count and absolute eosinophil(EOS) count on the 3rd day after admission and the neutrophil/lymphocyte ratio on the 6th day after admission of patients in the treatment group I were notably different from those in the treatment group Ⅱ at the same time point(P < 0.05).Based on Spearman’s rank correlation analysis,the change of body temperature on the 3rd day after admission was positively correlated with the increase of EOS count and the increase of EOS count and LYMPH counts on the 6th day after admission(P < 0.01).CONCLUSIONS:Early TCM intervention within 5 d after hospital admission shortened the onset time of antipyretic effect and fever duration of COVID-19 patients,reduced the time required for PCR test results to turn negative.Moreover,early TCM intervention also improved the results of inflammatory markers for COVID-19 patients.LYMPH and EOS counts can be used as indicators of TCM antipyretic effect.
文摘Background:The outbreak of coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus 2 in India has been declared a public health emergency.Many patients with COVID-19 experience cardiac injury.Patients with COVID-19 admitted to the intensive care unit(ICU)with acute myocardial injury showed increased high-sensitivity troponin levels.Abnormal troponin levels may indicate myocardial injury and are commonly associated with COVID-19.Methods:We conducted a retrospective observational study of 44 patients with severe COVID-19 in ICU during the second wave.The primary end point of our retrospective study was 28-day mortality,and the time of ICU admission was designated as day 0.We extracted and analyzed cardiac biomarkers,such as creatine kinase(CK),creatine kinase-MB(CK-MB),B-type natriuretic peptide(BNP),and high-sensitivity cardiac troponin I(hs-cTnI),and various inflammatory markers such as C-reactive protein(CRP)level,interleukin 6(IL-6),D-dimer,ferritin,lactate dehydrogenase,IL-6,and procalcitonin in patients with severe COVID-19 at ICU admission and 72 hours after ICU admission from our electronic medical record system.Results:The best cutoff of BNP were 326.8 and 398.5 pg/mL,CK were 195.95 and 180.12 U/L,CK-MB were 112.10 and 108.5 U/L,and hs-cTnI were 0.035 and 0.025 ng/mL,at ICU admission and 72 hours after ICU admission for predicting 28-day mortality among nonsurvivors.Conclusion:In patients with severe COVID-19,CK and hs-cTnI may be considered effective and valuable predictive cardiac biomarkers among nonsurvivors and predict poor prognosis.
基金supported in part through BattelleMemorial Institute’s prime contract with the US National Institute of Allergy and Infectious Diseases(NIAID)under Contract No.HHSN272200700016I
文摘Dear Editor,Infectious bronchitis(IB),one of the most common and difficult poultry diseases,is caused by a gammacoronavirus named infectious bronchitis virus(IBV).IBV frequently causes respiratory and/or renal diseases in chickens and egg production losses in hens.IB has
