Objective To investigate the effectiveness of sequential plate internal fixation in the correction of Madelung deformity after ulnar osteotomy and shortening. Methods The clinical data of 13 patients with Madelung deformity admitted between September 2015 and July 2021 were retrospectively analyzed. There were 5 males and 8 females with an average age of 18.3 years ranging from 17 to 23 years. The disease duration ranged from 12 to 24 months, with an average of 17 months. Three cases had a clear history of trauma. All patients had external radial deviation deformity and limited movement of the ulnar deviation, and the ulnar impact pain was significant during ulnar deviation movement; 9 patients had limited wrist joint supination movement, and the supination movement was normal. In the first stage, ulnar osteotomy and shortening combined with external fixator were used to correct wrist deformity in 13 patients. After operation, bone transfer was performed 6 times per day, with adjustments made every 4 hours, which was 1 mm per day. After the osteotomy was in place, the ulnar plate internal fixation was performed to reconstruct the ulnar stability in the second stage. The Cooney wrist joint score was used to assess the pain, function, range of motion, flexion and extension range of motion, and grip strength of the wrist joint before operation and before the removal of internal fixator. The subjective feeling and appearance satisfaction of patients were recorded. ResultsAfter the second-stage operation, all the 13 patients were followed up 10-22 months, with an average of 15 months. The deformity of wrist joint disappeared after operation, and the flexion, extension, and ulnar deviation were basically normal. There was no complication such as ulnar impingement sign, nonunion or infection. Wrist function, pain, and range of motion were significantly improved after operation, except for 1 patient who had no significant improvement in rotation and pain. The ulnar internal fixator was removed at 10-18 months after the second-stage operation. The scores of pain, function, range of motion, flexion and extension range of motion, and grip strength in the Cooney wrist score before removal of internal fixator significantly improved when compared with those before operation (P<0.05). Subjective and appearance satisfaction of patients were excellent in 9 cases, good in 3 cases, and fair in 1 case. ConclusionUlnar osteotomy and shortening with sequential plate internal fixation for correction of Madelung deformity, with mild postoperative pain, can effectively avoid bone nonunion, improve wrist joint function, and have significant effectiveness.
Objective To investigate the expression and clinical significance of S100A4 protein in tumorstroma of nonsmall cell lung cancer（NSCLC） to study its correlation with invasion, metastasis and prognosis. Methods Immunohistochemical staining（SP method）for S100A4 protein expression was performed in tissue sections from 130 patients with NSCLC operated and to analyze association of S100A4 protein with clinicopathological parameters in lung cancer and prognosis. Results The total positive expression rates of S100A4 protein in stroma of NSCLC was 72.3%. The positive expression rates of S100A4 protein in stroma of squamous cell carcinoma, adenocarcinoma, adenosquamous carcinoma and large cell lung cancer were 84.3%，59.6%，70.0% and 75% respectively.The expression of S100A4 protein was significantly associated with lymph node metastasis (χ2=18.91, P=0.000), distant metastasis(χ2=5.51, P=0.019) and TNM stage (χ2=21.54, P=0.000). The 3 years survival rates of patients whose tumourstroma stained positive for S100A4 was lower than that of patients whose tumourstroma stained negative (36.2% vs. 63.9%, P=0.003). Cox’ risk ratio model analysis indicated that age ≤50 years (OR=1.866), lymph node metastasis(OR=1.826), distant metastasis(OR=6.224), lower histology differentiation and undifferentiation (OR=1.793), TNM stage Ⅲ-Ⅳ (OR=2.573) and positive expression of S100A4 protein in stroma of NSCLC(OR=1.776) were significantly independent prognostic factors which affected survival. Conclusion Expression of S100A4 protein in stroma of NSCLC is significantly associated with invasion, metastasis, TNM stage and prognosis. S100A4 protein might become a marker for prediction of tumor progression of disease and clinical therapy.
ObjectiveTo summarize and analyze the clinical characteristics of patients with acute diffuse lung changes and respiratory failure.MethodsThe clinical data of patients in the Department of Critical Care Medicine, Dazhou Central Hospital between January 2016 and December 2018 were retrospectively collected, whose main clinical manifestation was acute respiratory distress syndrome with acute onset (<3 weeks) and main imaging manifestation was diffuse changes in both lungs. The clinical characteristics of patients were summarized, and the causes of the disease were explored.ResultsA total of 65 patients with acute diffuse lung changes and respiratory failure were enrolled, including 42 males (64.6%) and 23 females (35.4%). The average age was (57.1±18.4) years, the average time from onset to treatment was (7.5±5.9) d, and the average length of stay in the intensive care unit was (8.9±4.1) d. A total of 23 cases died, with a case-fatality rate of 35.4%. Among the 65 patients, there were 50 case (76.9%) of infectious diseases, including 36 cases of bacterial infections (including 4 cases of tuberculosis), 8 cases of viral infections (all were H1N1 infections), and 6 cases of fungal infections (including 1 case of pneumocystis infection); and there were 15 cases (23.1%) of non-infectious diseases, including 4 cases of acute left heart failure, 2 cases of interstitial pneumonia, 2 cases of vasculitis, 1 case of myositis dermatomyositis, 1 case of aspiration pneumonia, 1 case of acute pulmonary embolism, 1 case of acute drug lung injury, 1 case of neurogenic pulmonary edema, 1 case of drowning, and 1 case of unknown origin.ConclusionsInfectious diseases are the main cause of acute diffuse lung changes and respiratory failure, while among non-infectious diseases, acute heart failure and immune system diseases are common causes.
Lung cancer is one of the most malignant common tumor worldwidely and it's the most popular cancer in China. Both the prevalence and mortality of it are higher than other cancers. And its 5-year survival rate is 15%. Non-small cell lung cancer(NSCLC) accounts for about 85% lung cancer and its pathogenesis has not been elucidated. Therefore, early prediction and detection are very important for improving the effect of treatment and prognosis. Recently, dysregulation and excessive activity of the C4.4A as a member of the LY6/uPAR family of membrane proteins has been shown to associate with multiple cancer types. And previous studies suggest that the C4.4A participates in the invasion and metastasis of NSCLC. At the same time, circumstantial evidence proves that C4.4A and liver kinase B1(LKB1) tumor suppressor gene have a negative regulatory relationship. This article will briefly summarize the recent research progresses of C4.4A in NSCLC.
In recent years, the computer science represented by artificial intelligence and high-throughput sequencing technology represented by omics play a significant role in the medical field. This paper reviews the research progress of the application of artificial intelligence combined with omics data analysis in the diagnosis and treatment of non-small cell lung cancer (NSCLC), aiming to provide ideas for the development of a more effective artificial intelligence algorithm, and improve the diagnosis rate and prognosis of patients with early NSCLC through a non-invasive way.
Objective To investigate the prognostic value of ERBB2 Exon20ins (Exon20ins) in advanced non-small cell lung cancer (NSCLC) patients receiving first-line chemotherapy combined with immunotherapy. Methods A retrospective analysis was conducted on clinical data from ERBB2-mutant stage IV NSCLC patients who received first-line chemotherapy combined with immunotherapy at West China Hospital of Sichuan University between 2020 and 2024. ERBB2 wild-type patients were matched using propensity score matching. Clinical pathological characteristics, distant metastatic sites, and treatment outcomes were compared among patients with different mutation statuses. The primary endpoint was progression-free survival (PFS), and Kaplan-Meier method was used to plot survival curves. Cox regression analysis was performed to adjust for confounding factors. Results This study included 41 ERBB2-mutant stage IV NSCLC patients, of whom 22 had Exon20ins mutations, and 19 had other ERBB2 mutations. Forty-one ERBB2 wild-type patients were matched for comparison. The mean age of all patients was 60.0±9.3 years, with 61 males (74.4%). A total of 67 patients (81.7%) received chemotherapy combined with immunotherapy, and 15 patients (18.3%) received chemotherapy combined with immunotherapy and anti-angiogenesis therapy. The Exon20ins group showed a higher incidence of lymph node metastasis compared with the ERBB2 other mutation group and the wild-type group (36.4% vs. 15.8% vs. 9.8%, P=0.045). The median PFS in the Exon20ins group was significantly shorter than in the other mutation group (5.8 months vs. 10.3 months, P=0.025) and the wild-type group (5.8 months vs. 8.3 months, P=0.023). Univariate Cox regression analysis indicated that the ERBB2 Exon20ins mutation was an adverse prognostic factor (Exon20ins vs. other ERBB2 mutations, HR=2.9, 95%CI 1.18 - 7.1, P=0.014; Exon20ins vs. wild-type, HR=2.6, 95%CI 1.25 - 5.6, P=0.014). The combination with anti-angiogenesis therapy did not significantly affect the prognosis of PFS (HR=0.66, 95%CI 0.28 - 1.6, P=0.363). Multivariate Cox regression analysis revealed that the ERBB2 Exon20ins mutation was an independent adverse prognostic factor for PFS (Exon20ins vs. other ERBB2 mutations, HR=3.3, 95%CI 1.27 - 8.3, P=0.015; Exon20ins vs. wild-type, HR=2.7, 95%CI 1.2 - 5.88, P=0.014). For the 67 patients receiving chemotherapy combined with immunotherapy, Cox regression analysis showed that the ERBB2 Exon20ins mutation was still associated with poor prognosis in advanced NSCLC (Exon20ins vs. other ERBB2 mutations, HR=3.2, 95%CI 1.12 - 9.1, P=0.030; Exon20ins vs. wild-type, HR=2.5, 95%CI 1 - 5.88, P=0.040). Conclusions Advanced NSCLC patients with ERBB2 Exon20ins mutation have a worse prognosis compared with those with other ERBB2 mutation subtypes or ERBB2 wild-type when treated with first-line chemotherapy combined with immunotherapy. This suggests that ERBB2 Exon20ins mutation, as a particularly refractory mutation, requires the exploration of new combination strategies based on molecular subtyping to improve survival outcomes.
ObjectiveTo investigate the effects of closed thoracic drainage with single tube or double tubes after video-assisted thoracoscopic lung volume reduction surgery.MethodsRetrospective analysis was performed on 50 patients (39 males, 11 females) who underwent three-port thoracoscopic lung volume reduction surgery in our hospital from January 2013 to March 2019. Twenty-five patients with single indwelling tube after surgery were divided into the observation group and 25 patients with double indwelling tubes were divided into the control group.ResultsThere was no significant difference in pulmonary retension on day 3 after surgery, postoperative complications, the patency rate of drainage tube before extubation, retention time or postoperative hospital stay (P>0.05). Postoperative pain and total amount of nonsteroidal analgesics use in the observation group was less than those in the control group (P<0.05). ConclusionIt is safe and effective to perform closed thoracic drainage with single indwelling tube after video-assisted thoracoscopic lung volume reduction surgery, which can significantly reduce the incidence of related adverse drug reactions and facilitate rapid postoperative rehabilitation with a reduction of postoperative pain and the use of analgesic drugs.
Objective To evaluate the clinical relationship between serum carcinoembryonic antigen (CEA) and mortality of anti-melanoma differentiation associated gene 5 (MDA5) antibody positive dermatomyositis with interstitial lung disease (ILD). MethodsThe consecutive clinical data of 214 patients with anti MDA5 antibody positive dermatomyositis from West China Hospital of Sichuan University from February 2017 to September 2019 were collected retrospectively, including demographic, laboratory examination and imaging examination data. Patients were divided into CEA elevated group (CEA≥4.63 ng/mL) and CEA normal group (CEA<4.63 ng/mL) according to CEA level. R4.1.2 software was used for statistical analysis of all data, and Kaplan Meier method was used to draw the survival curve. Cox proportional hazard model was used to analyze the survival of patients with ILD, and to explore the risk factors associated with the survival of patients with anti-MDA5 antibody positive dermatomyositis with ILD. Results There were 180 patients with ILD who met the inclusion and exclusion criteria, 57 patients with rapidly progressive pulmonary interstitial fibrosis (RPILD), and 123 patients without RPILD; 121 women and 59 men, with an average age of 50.2±10.7 years; The average follow-up was 23.5 months, and 52 patients died. Univariable analysis suggested that CEA≥4.63 ng/mL, smoking, RPILD, lactate dehydrogenase (LDH) ≥321 IU/L, albumin<30 g/L and dyspnea were risk factors associated with death in patients with anti MDA5 dermatomyositis combined with ILD. Multivariable Cox regression analysis showed that CEA≥4.63 ng/mL [hazard ratio (HR) =3.01, 95% confidence interval (CI) 1.23 - 7.32, P=0.015], RPILD (HR=3.87, 95%CI 2.09 - 7.19, P<0.001), smoking (HR=2.37, 95%CI 1.25 - 4.47, P=0.008), LDH≥321 IU/L (HR=2.47, 95%CI 1.23 - 4.96, P=0.011), albumin<30 g/L (HR=2.57, 95%CI 1.38 - 4.78, P=0.003) were independent predictors for mortality. ConclusionsSerum CEA level can be used as a clinical prognostic predictor in patients with anti-MDA5 positive dermatomyositis and ILD. RPILD, smoking, LDH≥321 IU/L, and albumin<30 g/L are independent predictors for mortality.
Objective To investigate the effects of different levels of intra-abdominal pressure ( IAP) on respiration and hemodynamics in a porcine model of acute lung injury( ALI) .Methods A total of 8 domestic swine received mechanical ventilation. Following baseline observations, oleic acid 0. 1mL/kg in 20mL of normal saline was infused via internal jugular vein. Using a nitrogen gas pneumoperitongum, the IAP increased from0 to 15 and 25mmHg, and the groups were named IAP0 , IAP15 and IAP25 , respectively. During the experimental period, hemodynamic parameters including heart rate ( HR) , cardiac output ( CO) , mean arterial pressure( MAP) , central venous pressure( CVP) , intrathoracic blood volume index( ITBVI) and so on were obtained by using thermodilution technique of pulse induced continuous cardiac output( PiCCO) . The esophageal pressure( Pes) was dynamicly monitored by the esophageal catheter. Results Pes and peak airway pressure( Ppeak) increased and static lung compliance( Cstat) decreased significantly in IAP15 and IAP25 groups compared with IAP0 group( all P lt;0. 01) . Transpulmonary pressure( Ptp) showed a downward trend( P gt;0. 05) . PO2 and oxygenation index showed a downward trend while PCO2 showed a upward trend ( P gt;0. 05) . HR and CVP increased significantly, cardiac index( CI) and ITBV index decreased significantly ( all P lt;0. 05) ,MAP didn′t change significantly( P gt;0. 05) . The changes in Pes were negatively correlated with the changes in CI( r = - 0. 648, P = 0. 01) . Conclusion In the porcine model of ALI, Pes increases because of a rise in IAP which decreased pulmonary compliance and CI.
Objective The management of pulmonary nodules is a common clinical problem, and this study constructed a nomogram model based on FUT7 methylation combined with CT imaging features to predict the risk of adenocarcinoma in patients with pulmonary nodules. Methods The clinical data of 219 patients with pulmonary nodules diagnosed by histopathology at the First Affiliated Hospital of Zhengzhou University from 2021 to 2022 were retrospectively analyzed. The FUT7 methylation level in peripheral blood were detected, and the patients were randomly divided into training set (n=154) and validation set (n=65) according to proportion of 7:3. They were divided into a lung adenocarcinoma group and a benign nodule group according to pathological results. Single-factor analysis and multi-factor logistic regression analysis were used to construct a prediction model in the training set and verified in the validation set. The receiver operating characteristic (ROC) curve was used to evaluate the discrimination of the model, the calibration curve was used to evaluate the consistency of the model, and the clinical decision curve analysis (DCA) was used to evaluate the clinical application value of the model. The applicability of the model was further evaluated in the subgroup of high-risk CT signs (located in the upper lobe, vascular sign, and pleural sign). Results Multivariate logistic regression analysis showed that female, age, FUT7_CpG_4, FUT7_CpG_6, sub-solid nodules, lobular sign and burr sign were independent risk factors for lung adenocarcinoma (P<0.05). A column-line graph prediction model was constructed based on the results of the multifactorial analysis, and the area under the ROC curve was 0.925 (95%CI 0.877 - 0.972 ), and the maximum approximate entry index corresponded to a critical value of 0.562, at which time the sensitivity was 89.25%, the specificity was 86.89%, the positive predictive value was 91.21%, and the negative predictive value was 84.13%. The calibration plot predicted the risk of adenocarcinoma of pulmonary nodules was highly consistent with the risk of actual occurrence. The DCA curve showed a good clinical net benefit value when the threshold probability of the model was 0.02 - 0.80, which showed a good clinical net benefit value. In the upper lobe, vascular sign and pleural sign groups, the area under the ROC curve was 0.903 (95%CI 0.847 - 0.959), 0.897 (95%CI 0.848 - 0.945), and 0.894 (95%CI 0.831 - 0.956). Conclusions This study developed a nomogram model to predict the risk of lung adenocarcinoma in patients with pulmonary nodules. The nomogram has high predictive performance and clinical application value, and can provide a theoretical basis for the diagnosis and subsequent clinical management of pulmonary nodules.
