ObjectiveTo systematically review the effect of selective oropharyngeal decontamination (SOD) on the prevention of ventilator-associated pneumonia (VAP). MethodsWe electronically searched PubMed, EMbase, CBM, Wanfang, CNKI and Cochrane Central Register of Controlled Trials from the date of its establishment to September 2013. We also hand-searched some relevant references of included studies. Two independent reviewers screened the studies for inclusion, extracted data, and assessed trial quality. Meta-analysis was performed using the Cochrane Collaboration's RevMan 5.1 software. ResultsTen randomized controlled trials involving 2 791 patients were included. Results of meta-analysis showed that, compared with control group, SOD could reduce the incidence of VAP[RR=0.53, 95% CI (0.43, 0.65), P<0.000 01]. No statistical differences between the two groups were found for all cause mortality, average duration of receiving mechanical ventilatory assistance or length of stay in intensive care unit. No severe adverse event related to study participation was identified. ConclusionSOD can reduce the occurrence of VAP effectively and safely. Consequently, it may be considered as a good choice in the prevention of VAP.
Online Mendelian Inheritance in Man (OMIM) is a knowledge source and data base for human genetic diseases and related genes. Each OMIM entry includes clinical synopsis, linkage analysis for candidate genes, chromosomal localization and animal models, which has become an authoritative source of information for the study of the relationship between genes and diseases. As overlap of disease symptoms may reflect interactions at the molecular level, comparison of phenotypic similarity may indicate candidate genes and help to discover functional connections between genes and proteins. However, the OMIM has used free text to describe disease phenotypes, which does not suit computer analysis. Standardization of OMIM data therefore has important implications for large-scale comparison of disease phenotypes and prediction of phenotype-genotype correlations. Recently, standard medical language systems, term frequency-inverse document frequency and the law of cosines for document classification have been introduced for mining of OMIM data. Combined with Gene Ontology and various comparison methods, this has achieved substantial successes. In this article, we have reviewed various methods for standardization and similarity comparison of OMIM data. We also predicted the trend for research in this direction.
Objective To evaluate the therapeutic effects of different airway management strategies early used for patients after abdominal surgery in general anesthesia. Methods According to gender, age,and operation location,200 patients after abdominal surgery in general anesthesia were randomly assigned to four groups, ie. a conventional treatment group ( Group A) , an incentive spirometry ( IS) therapy group ( Group B) , an aerosol inhalation group ( Group C) , a combination of inhalation and IS therapy group ( Group D) . Inhalation drugs included Budesonide, Terbutaline, and Ambroxol. The index of pulmonary function test ( FVC, FEV1 , PEF) and arterial blood gases analysis ( ABG) were measured, and the effect of secretions clearance and the improvement of respiratory symptoms were evaluated at 0.5 h,24 h, 48 h after extubation.Intratracheal intubation of the patients after leaving ICUwas followed up. Results FVC, FEV1 , PEF, ABG,sputumvolume, the effect of secretions clearance, clinical efficacy, and intratracheal intubation rate in group B, C and D were improved more significantly than those in group A. And the therapeutic effect was best in group D ( P lt;0. 05) . The secretions clearance was improved more better in group C and D, especially in those high-risk patients with advanced age, smoking history, and pulmonary cormobidities ( P lt; 0. 05) .Conclusions The combined use of IS training and inhalation therapy can improve airway secretions clearance and pulmonary function particularly for those patients after abdominal surgery in general anesthesia, especially for those high-risk patients.
Lung segmentation is the premise of the computer aided diagnosis of lung cancer. The traditional segmentation method based on local low-level features can not get the correct result when a tumor is connected with pleura due to their similar computed tomography (CT) values. Moreover, because the big size of tumor leads to the loss of a large part of lung area, the traditional segmentation methods of lung with juxta-pleural nodule whose diameter is less than 3 cm are not suitable. Acitve shape model (ASM) combined with prior shape and low level features might be appropriate. But the search steps in conventional ASM is an optimization method based on the least square, which is sensitive to outlier marker points, and it makes profile update to the transition area of normal lung tissue and tumor rather than a true lung contour. To solve the problem, we proposed an improved ASM algorithm. Firstly, we identified these outlier marker points by distance, and then gave the different searching functions to the abnormal and normal marker points. And the search processing should be limited in volume of interesting (VOI). We selected 30 lung images with juxta-pleural tumors, and got the overlap rate with the gold standard as 93.6%. The experimental results showed that the improved ASM could get good segmentation results for the lungs with juxta-pleural tumors, and the running time of the algorithm could be tolerated in clinical.
ObjectiveTo investigate the method and effectiveness of selectively upward placement of acetabular implants in patients with anatomically abnormal acetabulum during total hip arthroplasty (THA). MethodsTwenty-six cases (26 hips) of anatomically abnormal acetabulum received THA between January 2005 and December 2010, including 22 cases of developmental dysplasia of the hip, 3 cases of osteonecrosis of the femoral head, and 1 case of post-traumatic arthritis. There were 5 males and 21 females with an average age of 52.3 years (range, 35-67 years). The left hip was involved in 11 cases and the right hip in 15 cases. The preoperative Harris score was 45.85±10.04. The anteroposterior X-ray films and CT scan of the pelvis, anteroposterior and lateral X-ray films of the femur, and TraumaCad analysis were performed routinely before operation. The principles of acetabular implants were that more than 70% of the bone-implant interface was covered, and the upward distance of acetabular implant was less than 15 mm. ResultsAcetabular implants were placed within 5 mm from the anatomical rotation center in 11 cases. The upward distance of acetabular implant was 5-10 mm in 8 cases and was 10-15 mm in 7 cases. No bone fracture or nerve injury was observed intraoperatively. All incisions healed by first intention, and no infection or lower limb deep venous thrombosis occurred. One case had dislocation at 3 days after operation, and was cured after reduction and conservative treatment. The follow-up time ranged from 15 to 71 months (mean, 34 months). The Harris score was 91.42±3.59, showing significant difference when compared with preoperative score (t=20.099, P=0.000). The Harris scores were 92.09±4.04 in patients having less than 5 mm upward distance, 91.25±2.82 in patients having 5-10 mm upward distance, and 90.57±3.95 in patients having 10-15 mm upward distance, showing no significant difference (F=0.377, P=0.690). No loosening or subsidence of the implant was observed by X-ray film during the follow-up. ConclusionThe acetabular implants should be placed as close to anatomical rotation center as possible according to the principle. However, appropriate upward distance of the acetabular implants (≤15 mm) could be acceptable to meet 70% coverage of bone-implant interface and the implant stability. A satisfactory mid-term effectiveness can be obtained, but long-term effectiveness should be further investigated.
ObjectiveTo investigate the microRNA (miRNA) expression profile during chondrogenic differentiation of human adipose-derived stem cells (hADSCs), and assess the roles of involved miRNAs during chondrogenesis. MethodshADSCs were harvested and cultured from donors who underwent elective liposuction or other abdominal surgery. When the cells were passaged to P3, chondrogenic induction medium was used for chondrogenic differentiation. The morphology of the cells was observed by inverted phase contrast microscopy. Alcian blue staining was carried out at 21 days after induction to access the chondrogenic status. The expressions of chondrogenic proteins were detected by ELISA at 0, 7, 14, and 21 days. The miRNA expression profiles at pre- and post-chondrogenic induction were obtained by microarray assay, and differentially expressed miRNAs were verified by real-time quantitative PCR (qRT-PCR). The targets of the miRNAs were predicted by online software programs. ResultshADSCs were cultured successfully and induced with chondrogenic medium. At 21 days after chondrogenic induction, the cells were stained positively for alcian blue staining. At 7, 14, and 21 days after chondrogenic induction, the levels of collogen type Ⅱ, Col2a1, aggrecan, Col10a1, and chondroitin sulfate in induced hADSCs were significantly higher than those in noninduced hADSCs (P<0.05). Eleven differentially expressed miRNAs were found, including seven up-regulated and four down-regulated. Predicted target genes of the differentially expressed miRNAs were based on the overlap from three public prediction algorithms, with the known functions of regulating chondrogenic differentiation of stem cells, selfrenewal, signal transduction, intracellular signaling cascade, and cell cycle control. ConclusionA group of miRNAs and their target genes are identified, which may play important roles in regulating chondrogenic differentiation of hADSCs. These results will facilitate the initial understanding of the molecular mechanism of chondrogenic differentiation in hADSCs and subsequently control hADSCs differentiation, and provide high performance seed cells for cartilage tissue engineering.
ObjectiveTo investigate the influence of the degree of acetabular deformity and the learning-curve on the acetabular cup positions in total hip arthroplasty (THA) for adults with developmental dysplasia of hip (DDH). MethodsBetween January 2008 and December 2015, 130 patients (144 hips) with DDH underwent primary THA, and the clinical data were analyzed retrospectively. Fifty-three patients (59 hips) were admitted before 2012, and 77 patients (85 hips) were treated after 2012. There were 32 males and 98 females, aged from 31 to 83 years (mean, 61). Unilateral replacement was performed in 116 cases and bilateral replacement in 14 cases. Of 144 hips, 48 hips were rated as Crowe type I, 57 hips as type II, and 39 hips as type of III/IV. The standard pelvic radiograph was taken within 1 week after operation. The mediCAD software was adopted to measure the angle of anteversion and abduction, bony coverage, and the distance between true rotating center and optimal rotating center to the connection of teardrops and the horizontal distance between two centers to evaluate the qualified rate of acetabular cup positions. ResultsCompared with the patients with the same type in 2013-2015 group, the anteversion angle and qualified rate of acetabular cup position significantly decreased in patients with Crowe I (P < 0.05); the horizontal distance significantly increased and qualified rate of acetabular cup position significantly decreased in patients with Crowe II (P < 0.05); and the anteversion angle significantly decreased and the horizontal distance significantly increased in patients with Crowe III/IV (P < 0.05) in 2008-2012 group. But no significant difference was shown in the other indexes (P > 0.05). In all Crowe types, the vertical distance between the true rotating center and the optimal rotating center increased with the degree of acetabular deformity in both 2008-2012 group and 2013-2015 group, showing significant difference (P < 0.05), but no significant difference was found in the other indexes (P > 0.05). ConclusionFor adults with acetabular dysplasia, there are high potential risks for unsatisfactory acetabular cup positions during primary THA. So it is necessary to evaluate acetabular deformities and to sum up operative experience so as to improve the accuracy of cups installation.