Objective To evaluate the clinical effect of Halo-vest in treatment of unstable upper cervical spine. Methods From March 1997 to October 2002, 16 cases of unstable upper cervical spineswere treated and immobilized by Halovest, aged from 14 to 53 years. There were 3 cases of isolated Jefferson fractures, 4 cases of isolated Hangman fractures and 1 case of Anderson type Ⅱ fracture. The 8 cases were immobilized for 3-4 months by Halovest. There were 3 cases of old odontoid fractures with dislocations treated by occipitocervical plate fixation and fusion, 1 case of C1 malignant tumor by posterior resection and internal fixation, 2 cases of C2 malignant tumor by anterior resection, fusion, and internal fixation; these cases were immobilized by Halo-vest during surgery. There were 1 case of C2,3 tuberculosis were treated by anterior debridement and fusion, and 1 case of gooseneck deformity by anterior decompression, fusion and screw fixation after resection of C2-7 , the 2 cases were immobilized for 3 months by Halo-vest.Of 16 cases, there were 8 cases accompanied with spinal cord syndrome. Results Fifteen cases were followed up 6 months to 5 years. Anterior arch ununion and posteriorarch osseous healing occurred in 1 case of Jefferson fracture. Other fractures and embedded bones became osseous fusion. One case of C2 malignant tumorrecurred 8 months after operation. Spinal cord syndrome of all patients disappeared. Conclusion Halo-vest immobilization is an effective method for conservative treatment and stable reconstruction of unstable upper cervical spine.
Pure native aortic valve regurgitation (NAVR) is one of the common heart valve diseases, and the prognosis of symptomatic chronic NAVR is poor. Although transcatheter aortic valve replacement (TAVR) is currently an "off-label" procedure, it remains the option for patients with high risk for surgery. In this case, an 81-year-old man with multiple comorbidity and high Society of Thoracic Surgeons score, the risk for surgery is rather high. Through the preoperative evaluation by the multidisciplinary heart team, considering that the patient had calcification at the junction of annulus, as well as mild aortic stenosis, after careful consideration, 29# Venus A-Valve was chosen. After the procedure, the symptoms were obviously improved and the follow-up effect was good. Due to various causes of NAVR, great anatomical variation of annulus, little calcification of aortic valve, and lack of anchor point and other problems, the procedure to treat NAVR with TAVR is still difficult. At the same time, there are few valve systems developed for the anatomical characteristics of aortic regurgitation valve. TAVR in the treatment of patients with high risk for surgery still requires long-term practice and technical development.
Objective To develop a machine learning (ML) model to predict the risk of death in intensive care unit (ICU) patients with chronic obstructive pulmonary disease (COPD), explain the factors related to the risk of death in COPD patients, and solve the "black box" problem of ML model. Methods A total of 8088 patients with severe COPD were selected from the eICU Collaborative Research Database (eICU-CRD). Data within the initial 24 hours of each ICU stay were extracted and randomly divided, with 70% for model training and 30% for model validation. The LASSO regression was deployed for predictor variable selection to avoid overfitting. Five ML models were employed to predict in-hospital mortality. The prediction performance of the ML models was compared with alternative models using the area under curve (AUC), while SHAP (SHapley Additive exPlanations) method was used to explain this random forest (RF) model. Results The RF model performed best among the APACHE IVa scoring system and five ML models with the AUC of 0.830 (95%CI 0.806 - 0.855). The SHAP method detects the top 10 predictors according to the importance ranking and the minimum of non-invasive systolic blood pressure was recognized as the most significant predictor variable. Conclusion Leveraging ML model to capture risk factors and using the SHAP method to interpret the prediction outcome can predict the risk of death of patients early, which helps clinicians make accurate treatment plans and allocate medical resources rationally.
Objective To investigate the effect of caveolion-1 on the growth and proliferation in human breastcancer MCF7 cell in vitro and in vivo and approach its mechanisms. Methods The plasmid pCI-neo-cav-1 and its corres-ponding empty vector （pCI-neo） were transfected into MCF7 cell line. The expressions of caveolin-1 and vascular endoth-elial growth factor （VEGF） in transfectants were subsequently confirmed by Western blot analysis. A pair of monoclonal cell lines， MCF7/cav-1 and MCF7/vec， were chose for future studies. The colony formation ability of tumor cells was detected by anchorage-independent growth assay. Xenograft tumor models in nude mice were established. Immunohisto-chemistry was used to characterize Ki-67 and VEGF levels in the tumors tissues. Results Caveolin-1 expression was up-regulated in the MCF7/cav-1 cell as compared with the MCF7/vec cell （P＜0.01） and the MCF7 cell （P＜0.01）. Caveolin-1 overexpression markedly reduced the capacity of the cells to form colonies in soft agar （P＜0.01）. Compared with the MCF7/vec cell， VEGF protein expression reduced in the MCF7/cav-1 cell （P＜0.01）. In vivo experiments in nude mice， the overexpression of caveolin-1 resulted in significant growth inhibition of the xenograft breast tumors. The Ki-67 staining was weak and the VEGF staining was negative by immunohistochemistry that indicated the caveolin-1 inhibited the proliferation in human breast cancer MCF7 cell. Conclusion The caveolin-1 might inhibit the growth and proliferation in human breast cancer MCF7 cell through suppressing activation of VEGF signaling pathway.
Objective To summarize the genotypes associated with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) induced by methazolamide and to provide references for the diagnosis and treatment of SJS and TEN induced by methazolamide. Methods Databases including PubMed, EMbase, CNKI, and WanFang Data were electronically searched from database inception to September 2021. Two reviewers independently screened literature and extracted data, and then a systematic review was performed. Results A total of 18 studies involving 49 patients were included. HLA genetic testing was performed on 37 patients. HLA-B*59:01 was detected in 27 patients, HLA-C*01:02 was detected in 15 patients, and 14 patients carried both genes. Statistical analysis showed that the positive rate of HLA-B*59:01 was 73% (95% CI 0.58 to 0.88) and that of HLA-C*01:02 was 40.5% (95%CI 0.24 to 0.57). The latent time until the symptoms were observed was 14.08 ± 8.77 days, and the mean dosage of methazolamide administered was 88.95±39.45 mg/d. Glucocorticoid and immunoglobulin were the main treatments prescribed. Conclusion Methazolamide can cause SJS and TEN. As the presence of HLA-B*59:01 or HLA-C*01:02 has been reported as a genetic risk factor for these adverse drug reactions, the implementation of genetic screening can effectively reduce their occurrence. Glucocorticoid and immunoglobulin, anti-infectives, should be administered to control the symptoms.
Recently, many researchers paid more attentions to the association between air pollution and chronic obstructive pulmonary disease (COPD). Haze, a severe form of outdoor air pollution, affected most parts of northern and eastern China in the past winter. In China, studies have been performed to evaluate the impact of outdoor air pollution and biomass smoke exposure on COPD; and most studies have focused on the role of air pollution in acutely triggering symptoms and exacerbations. Few studies have examined the role of air pollution in inducing pathophysiological changes that characterise COPD. Evidence showed that outdoor air pollution affects lung function in both children and adults and triggers exacerbations of COPD symptoms. Hence outdoor air pollution may be considered a risk factor for COPD mortality. However, evidence to date has been suggestive (not conclusive) that chronic exposure to outdoor air pollution increases the prevalence and incidence of COPD. Cross-sectional studies showed biomass smoke exposure is a risk factor for COPD. A long-term retrospective study and a long-term prospective cohort study showed that biomass smoke exposure reductions were associated with a reduced decline in forced expiratory volume in 1 second (FEV1) and with a decreased risk of COPD. To fully understand the effect of air pollution on COPD, we recommend future studies with longer follow-up periods, more standardized definitions of COPD and more refined and source-specific exposure assessments.
Transcatheter aortic valve replacement (TAVR) for severe aortic stenosis is growing rapidly. The use of new heart valves prosthesis has improved surgical safety and efficacy. This report described a 72-year-old male patient with severe aortic stenosis combined with severe aortic regurgitation, who was evaluated at moderate-high risk of surgery and received a transapical TAVR using the Ken-Valve heart valve. The transcatheter operation time was 8 min, and the blood loss was 50 mL. The tracheal intubation was removed immediately after the surgery. Transesophageal echocardiography on the 4th postoperative day showed that the aortic valve leaflets worked well, and there was no valve orifice and paravalvular leakage. The patient was discharged on the 5th day after the surgery without complications. Transapical TAVR using Ken-Valve was an easy surgical procedure for aortic valve disease, and had short operation time.
Objective
To explore the effect of multi-disciplinary treatment of the Graves’ disease (GD) with huge-size thyroid during perioperative period.
Methods
Retrospectively analyzed the clinical data of 8 GD patients with huge-size thyroid who got treatment in Pekin Union Medical College Hospital during Jan. 2006 to Dec. 2016. All patients underwent comprehensive preparation before operation and underwent total thyroidectomy. To explore the changes of thyroid function and culture after anti-thyroid drug (ATD)/iodine preparation/arterial embolization before operation, and to summarize situation of the bleeding loss intraoperation, neck-drainage, thyroid function, and relapses after operation.
Results
All cases got a satisfactory operation result after standard ATD, iodine preparation (Lugol’s solution 10–15 drops for 3–4 weeks, combined with ATDs for 2–3 weeks ), and main arterial embolization of thyroid in 24 h preoperation. They got shorter operative time (2.5–4.5 h), less bleeding intraoperation (4 cases≤100 mL), less neck-drainage, and almost normal retention time. No severe or permanent complications, for example thyroid storm, abnormal voice, and hypoparathyroid occurred. They were followed as outpatients for 18–133 months, and were found a perfect long-term effect without complication and relapse.
Conclusions
Perioperative period management is very important to those GD patients with huge-sized thyroid, and multi-disciplinary treatment can decrease theintraoperation bleeding, as well as occurrence of thyroid storm effectively. In addition, operated subtly during surgery can protect the recurrent laryngeal nerve and parathyroid effectively.
ObjectiveTo summarize the relationship between exosome and thyroid diseases.MethodThe literatures reports on exosomes and the physiology, pathology and diseases of thyroid were collected and reviewed.ResultsExosomes were secreted by cells and could be found in various body fluids, which could mediate the normal physiological development of the thyroid gland and play an important role in the progression of Graves’ disease. Exosomes could be used as diagnostic and differential diagnostic biomarkers for thyroid cancer and affect the growth, invasion, and metastasis of thyroid cancer. As a drug carrier for anti-thyroid cancer, exosome had a good targeting ability.ConclusionExosomes play an important role in the development of various diseases of the thyroid gland, which have good application prospects in biomarkers for early diagnosis and prognostic evaluation, as well as targeted drug carriers for thyroid cancer.
ObjectiveTo explore the effect of Ketogenic diet (KD) in patients with Dravet syndrome (DS).MethodsThe seizures, electroencephalogram (EEG) and cognitive function of 26 DS patients receiving treatment of KD from June 2015 to October 2019 in the Epilepsy Centre of Guangdong 999 Brain Hospital were analyzed retrospectively. Modified Johns Hopkins protocol was used to initiate KD, blood glucose and urinary ketone bodies were monitored in the patients. The effect was evaluated by Engel outcome scale. And the EEG, cognition, language and motor function of the patients were assessed.Results26 DS patients (20 boys, 6 girls) received treatment of KD more than 4 weeks, the seizure of epilepsy were reduced above 50% in 15 patients (57.7%), 2 patients were seizure free. Among them, the effcet of KD can be observed in 7 patients within one week and 3 patients within two weeks, accounting for 66.7% (10/15). 26 cases (100%), 24 cases (92.3%), 20 cases (76.9%), 11 cases (42.3%) were reserved in 4, 12, 24, 28 weeks respectively. 26 patients achieved Engel Ⅰ ,Ⅱ,Ⅲ,Ⅳgrade effect, accounting for 38.5% (10/25), 54.2% (13/23), 65.0% (12/19), 81.8% (9/11) respectively according to Engel scale. The back ground rhythm of EEG showed obvious improvement in 14 patients wthin 16 patients who revieved EEG after KD. 17 patients assessed cognitive, language and motor function after KD, cognitive function was improved in 10 patients, language was enhanced in 11 patients, motor function of 8 patients was enhanced. The main adverse reactions of KD in the treatment process were mainly gastrointestinal symptoms and metabolic disorders.ConclusionKD treatment in DS has many advantages, such as fast acting, being effective in more than half of the DS patients and tolerable adverse reactions. Cognitive, language and motor function were improved in some patients. Drug resistant DS patients are suggested to receive KD treatment early.
