Nowadays, one of the most challenging aspects of retinoblastoma (RB) therapy is how to control the resistant or recurrent viable vitreous seeds, for which intravenous chemotherapy appears to be ineffective. Recently, intravitreal chemotherapy offers another option to control advanced stage and vitreous seeds of RB, and may be a promising new approach to RB therapy. However, intravitreal injection for RB patients raises considerable controversy due to concerns of possible extraocular extension along the injection route, and should not replace the primary standard of care for bilateral RB or group E eyes of RB. Close follow-up and further studies are needed to determine appropriate indications, to determine the effective drugs and concentrations, to optimize RB therapy protocols and to investigate the relationship between long-term efficacy and toxicities.
Objective To observate the influencing factors on circuit life during continuous renal replacement therapy (CRRT) with regional citrate anticoagulation (RCA), so as to provide data support for further optimization of RCA anticoagulation strategy. MethodsPatients who underwent CRRT with RCA in West China Hospital of Sichuan University between March 2021 and April 2022 were retrospectively selected. Analyze the basic information of patients and the impact of relevant indicators before or within 12 hours of treatment on the circuit life. Results A total of 116 patients were included. Among the included patients, a total of 225 cases were treated with CRRT for 11 051.7 hours, the median circuit life was 57.0 (25.4, 72.0) h. 142 cases (63.1%) were terminated due to coagulation, the median circuit life was 30.3 (20.5, 52.8) h. The results of multivariate Cox regression analysis showed that pH value [hazard ratio (HR)=0.002, 95% confidence interval (CI) (0.0001, 0.127), P=0.003], the maximam postfilter ionized calcium [HR=0.039, 95%CI (0.004, 0.437), P=0.008], blood flow [HR=1.051, 95%CI (1.027, 1.075), P<0.001] and catheter dysfunction [HR=5.701, 95%CI (3.777, 8.605), P<0.001] were the four influential factors affected circuit life. Kaplan Meier survival curve showed that RCA had the best effect when the postfilter ionized calcium was in the range of 0.25 ~ 0.35 mmol/L. Conclusions During CRRT treatment of RCA, pH value, postfilter ionized calcium, blood flow and catheter function are the independent influencing factors of circuit life. The above parameters should be carefully monitored and optimized in the treatment process to minimize the risk of coagulation, prolong the circuit life and maintain the continuty of CRRT treatment. The postfilter ionized calcium was recommended to be maitained at 0.25-0.35mmol/L, pH value maintained above 7.38, blood flow no more than 145 mL/min and catheter maitained patency to ensure the adequate anticoagulation.
【Abstract】Objective To investigate a more rational modality which is in the treatment of severe acute pancreatitis (SAP) and effective in preventing liver from damages due to SAP. Methods SAP model was established by retrograde injection of 5% sodium taurocholate (1.0 ml) in the subserosa of pancreas in rats (n=80) weighting 200-250 g.The rats were catheterized using PE-50 angiocatheter from femoral artery to celiac trunk. Then they were randomly divided into four groups. Twenty animals served as controls (A group) and received only fluid infusion. The 40 animals, B and C group (20 animals in each one group) received continuous regional arterial infusion (CRAI) of somatostatin （4 μɡ/kg） and the medicines improving microcirculatory (dextran-40 1.5 ml, dopamine hydrochloride 5 μg/kg, anisodaminum 1.5 ml/kg) respectively. The other 20 animals (D group) were treated by somatostatin combined with the medicine improving microcirculatory through CRAI simultaneously with the induction of pancreatitis. The AST, ALT, ALP and serum amylase were recorded, the liver and pancreas tissue were observed pathologicaly after 6 hours. Results There were a ignificant decrease in the serum amylase in B group (Plt;0.05) and D group (Plt;0.05). The AST, ALT, ALP was decreased in B and D group (Plt;0.05). The damage to liver and pancreas were reduced in D group. Conclusion CRAI is effective in preventing liver damages due to SAP and is an effective way in the treatment of SAP.
Objective To evaluate the effects of two filtration fraction formulas on extracorporeal circulation life of continuous renal replacement therapy (CRRT) under regional citrate anticoagulation. Methods Patients with acute kidney injury who received CRRT treatment with regional citrate anticoagulation and the estimated CRRT duration was greater than 24 h at West China Hospital of Sichuan University between June 2022 and April 2023 were selected. They were randomly divided into continuous veno-venous hemofiltration (CVVH), continuous veno-venous hemodialysis (CVVHD) and continuous veno-venous hemodiafiltration (CVVHDF) groups using Prismaflex machines. The life of the CRRT extracorporeal circulation in the three groups of patients was compared, and the reasons for replacing the extracorporeal circulation after 72 h were not used, and the filtration fraction score of the three groups was calculated according to the two filtration score calculation formulas (Formula 1 and Formula 2) currently used in the world. The filtration value obtained by the two filtration fraction calculation formulas was taken as the test variable, and whether the median life of the group with the longest extracorporeal circulation life was taken as the state variable, and the receiver operating characteristic curve was drawn, and the area under the curve was calculated. Results A total of 121 patients were included, including 40 patients in the CVVH group, 40 patients in the CVVHD group, and 41 patients in the CVVHDF group. The extracorporeal circulation life of CVVH group, CVVHD group and CVVHDF group was 64 (46, 71) h, 47 (31.5, 54) h and 70 (65, 72) h, respectively, with statistical difference (log-rank P=0.036). A total of 94 cases were replaced due to filter or venous pot clotting after 72 h after the filter was not used, including 30 cases in the CVVH group, 39 cases in the CVVHD group, and 25 cases in the CVVHDF group. The difference between the three groups was statistically significant (χ2=15.83, P<0.001). According to Formula 1, the filtration fraction of CVVH group, CVVHD group and CVVHDF group was 15.8% (15.2%, 17.0%), 1.1% (0.7%, 2.1%) and 16.2% (14.9%, 17.6%), respectively, and the difference among the three groups was statistically significant (H=69.402, P<0.001). According to Formula 2, the filtration fraction of CVVH group, CVVHD group and CVVHDF group was 33.1% (32.4%, 35.7%), 4.0% (3.6%, 4.9%) and 19.1% (17.7%, 20.7%), respectively, and the differences among the three groups and pairwise comparison between groups were statistically significant (P<0.001). The area under the receiver operating characteristic curvec calculated by the Formula 1 and 2 for the influence of filtration fraction on extracorporeal circulation life were 0.539 and 0.668, the sensitivity were 43.18% and 82.22%, and the specificity were 80.65% and 56.25%, respectively. Conclusions When using Prismaflex machine, the filter life of CVVHD is shorter than CVVH and CVVHDF modes. The filtration fraction calculated by Formula 2 is more sensitive but less specific in predicting CRRT extracorporeal circulation life. Filtration fraction as a CRRT extracorporeal circulation risk assessment has limitations, especially for the CVVH model with pre and post replacement.
Objective To explore the application of regional citrate anticoagulation (RCA) in continuous renal replacement therapy (CRRT) for patients with sepsis and hyperlactacidemia, and to provide a basis for the clinical application of RCA in such patients. Methods Sepsis patients who underwent RCA-CRRT at West China Hospital of Sichuan University between May 2021 and May 2023 were retrospectively included. Patients were divided into a normal lactate group (≤2.0 mmol/L) and a hyperlactacidemia group (>2.0 mmol/L) based on their initial lactate levels before CRRT, and subgroup analysis was performed on patients with moderate hyperlactacidemia (2 mmol/L<lactate level<4 mmol/L) and severe hyperlactacidemia (≥4.0 mmol/L). Propensity score matching (PSM) was used, and baseline characteristics and outcome measures of different groups of patients were compared. Results A total of 441 patients were included, with 228 in the normal lactate group and 213 in the hyperlactacidemia group. Before PSM, there were statistically significant differences in the proportion of liver failure, proportion of chronic kidney disease, mean arterial pressure, bicarbonate, total bilirubin, creatinine, activated partial thromboplastin time, international standardized ratio, procalcitonin, and interleukin-6 between the normal lactate group and the hyperlactacidemia group (P<0.05). After PSM, there were 162 patients in both the normal lactate group and the hyperlactacidemia group. There was no statistically significant difference in baseline characteristics between the two groups of patients (P>0.05). The incidence of citric acid accumulation in the normal lactate group and the hyperlactacidemia group was 13.0% and 25.9%, respectively (P<0.05). There was no statistically significant difference in the incidence of metabolic acidosis, metabolic alkalosis, hypernatremia, filter coagulation events, or in-hospital mortality between the two groups (P>0.05). Kaplan-Meier survival analysis showed that there was no statistically significant difference in the first extracorporeal circulation lifespan between the normal lactate group and the hyperlactacidemia group (P>0.05). Among 213 patients with hyperlactacidemia, 186 had moderate hyperlactacidemia and 27 had severe hyperlactacidemia. Before PSM, there were statistically significant differences in the proportion of male, proportion of diabetes, albumin level, international standardized ratio, and interleukin-6 between moderate and severe hyperlactacidemia groups (P<0.05). After PSM, there were 22 patients in both the moderate and severe hyperlactacidemia groups. There was no statistically significant difference in baseline characteristics between the two groups of patients (P>0.05). The incidence of citric acid accumulation was 18.2% and 50.0% in the moderate and severe hyperlactacidemia groups, respectively (P<0.05). There was no statistically significant difference in the incidence of metabolic acidosis, metabolic alkalosis, hypernatremia, filter coagulation events, or in-hospital mortality between the two groups (P>0.05). Kaplan-Meier survival analysis showed that there was no statistically significant difference in the first extracorporeal circulation lifespan between the moderate and severe hyperlactacidemia groups (P>0.05). Conclusion When RCA is used for CRRT anticoagulation in patients with sepsis and hyperlactacidemia, the incidence of citric acid accumulation is high (especially in patients with severe hyperlactacidemia), and should be closely monitored.
Primary vitreoretinal lymphoma (PVRL) is a rare type of non-Hodgkin's lymphoma with poor prognosis and the optimal treatment has yet to be determined. Its treatment has evolved from enucleation to ocular radiotherapy, systemic chemotherapy and intravitreal chemotherapy. Radiotherapy can effectively eradicate tumor cells but ocular recurrences are common. Systemic chemotherapy has become the mainstream option but there are problems with only-partial response of PVRL and high rate of recurrence. Intravitreal chemotherapy, primarily used as adjunctive to systemic chemotherapy, has achieved high remission rate and low rate of recurrence as well as with limited ocular complications. The tumor cells were cleared and the visual function preserved. However, issues about the drug applied, treatment protocols and goals of intravitreal chemotherapy, whether for visual preservation or survival improvement, are worthy for further study.
Facial complex regional pain syndrome (CRPS) is a CRPS that occurs around the periorbital and/or orofacial region, showing regional chronic pain accompanied by motor and autonomic nervous dysfunction. At present, the pathogenesis of CRPS is not clear, which may include inflammatory reaction, sympathetic nerve, spinal cord, supraspinal and other mechanisms. It is related to the hemisensory disturbances of CRPS, and closely associated with facial allodynia and migraine with trigeminal nerve. This article reviews the possible mechanisms of facial CRPS and connects the limb pain with facial pain, in order to provide some reference for the study of the pathogenesis of CRPS.
Kidney tumor is one of the diseases threatening human health. Ultrasound is widely applied in kidney tumor diagnosis due to its high popularization, low price and no radiation. Accurate segmentation of kidney tumor is the basis of precise treatment. Kidney tumors often grow in the middle of cortex, so that segmentation is easy disturbed by nearby organs. Besides, ultrasound images own low contrast and large speckle, leading to difficult segmentation. This paper proposed a novel kidney tumor segmentation method in ultrasound images using adaptive sub-regional evolution level set models (ASLSM). Regions of interest are firstly divided into subareas. Secondly, object function is designed by integrating inside and outside energy and gradient, in which the ratio of these two parts are adjusted adaptively. Thirdly, ASLSM adapts convolution radius and curvature according to centroid principle and similarity inside and outside zero level set. Hausdorff distance (HD) of (8.75 ± 4.21) mm, mean absolute distance (MAD) of (3.26 ± 1.69) mm, dice-coefficient (DICE) of 0.93 ± 0.03 were obtained in the experiment. Compared with traditional ultrasound segmentation method, ASLSM is more accurate in kidney tumor segmentation. ASLSM may offer convenience for doctor to locate and diagnose kidney tumor in the future.
ObjectiveTo investigate the effectiveness of cervical pedicle screw implantation technique under regional method.MethodsThe clinical data of 85 patients who met the selection criteria between April 2010 and May 2018 were retrospectively analyzed. There were 57 males and 28 females, aged 35-68 years, with an average of 57.6 years. Among them, there were 10 cases of ossification of posterior longitudinal ligament, 68 cases of cervical spondylosis with multilevel stenosis, 3 cases of cervical tumor, 1 case of congenital malformation, and 3 cases of cervical trauma; the lower cervical spine lesions involved C3-C7. Preoperative Frankel spinal cord injury grading: 2 cases of grade C, 51 cases of grade D, and 32 cases of grade E. Cervical pedicle screw implantation technique under regional method was performed with a total of 618 pedicle screws. Postoperative changes in neurological symptoms were observed; cervical mouth opening anteroposterior and lateral X-ray films and cervical CT examinations were performed to evaluate the pedicle screws position.ResultsThe operation time was 2.5-4.0 hours, with an average of 3.0 hours. The intraoperative blood loss was 180-550 mL, with an average of 345 mL. No intraoperative vascular or nerve injury occurred. The patients with neurological symptoms were relieved to varying degrees. There were 2 cases of superficial incision infection after operation, the wound healed after enhanced dressing change. The postoperative hospital stay was 5-14 days, with an average of 8.4 days. At discharge, Frankel neurological grading was grade D in 26 patients and grade E in 59 patients. All the patients were followed up 6-24 months, with an average of 13 months. At last follow-up, cervical X-ray films showed the good pedicle screw fixation without loosening. Cervical CT evaluated the position of pedicle screws: 523 pedicle screws (84.7%) in grade Ⅰ, 80 (12.9%) in grade Ⅱ, and 15 (2.4%) in grade Ⅲ; the accuracy rate of the screw position was 97.6%.ConclusionCervical pedicle screw implantation technique under regional method can significantly improve the success rate of screw implantation. It is easy to operate, does not destroy the bone cortex, and has stable fixation.
Retinoblastoma (RB) is the most serious eye disease that causes blindness, disability and death in infant. Loss of tumor suppressor gene RB1 leads to tumorigenesis of RB. With continuous innovation and development of new methods, the management of retinoblastoma has experienced a dramatic change from enucleation, external radiotherapy, intravenous chemotherapy, to intra-arterial chemotherapy combined with local treatment, enabling a more favorable outcome for survival, salvage and vision. However, the pathogenesis of RB is unclear in many aspects, the rate of eyeball removal in children with advanced RB remains high, and the innovation of new treatment are needed to be further promoted. Therefore, the key to improve the overall treatment level of RB is to pay attention to the study on pathogenesis, early diagnosis and treatment, as well as strengthen multi-center clinical trials and translational medicine research.
