Patients with locally advanced thyroid cancer often face challenges in achieving radical surgery during initial diagnosis. This has become a significant hurdle in the treatment of thyroid cancer. With the continuous development of systemic therapy for thyroid cancer, several studies have demonstrated that neoadjuvant therapy can shrink tumors in some patients, thereby increasing the chances of complete resection and improving prognosis. Targeted therapy plays a crucial role as a core component of neoadjuvant treatment. Simultaneously, the potential efficacy of immunotherapy has gained attention, showing promising prospects. We aim to summarize the research progress and existing issues regarding neoadjuvant therapy for locally advanced thyroid cancer. We look forward to more high-quality clinical studies providing robust evidence for neoadjuvant therapy in locally advanced thyroid cancer, expanding the breadth of treatment options.
The rotary left ventricular assist device (LVAD) has been an effective option for end-stage heart failure. However, while clinically using the LVAD, patients are often at significant risk for ventricular collapse, called suction, mainly due to higher LVAD speeds required for adequate cardiac output. Some proposed suction detection algorithms required the external implantation of sensors, which were not reliable in long-term use due to baseline drift and short lifespan. Therefore, this study presents a new suction detection system only using the LVAD intrinsic blood pump parameter (pump speed) without using any external sensor. Three feature indices are derived from the pump speed and considered as the inputs to four different classifiers to classify the pumping states as no suction or suction. The in-silico results using a combined human circulatory system and LVAD model show that the proposed method can detect ventricular suction effectively, demonstrating that it has high classification accuracy, stability, and robustness. The proposed suction detection system could be an important part in the LVAD for detecting and avoiding suction, while at the same time making the LVAD meet the cardiac output demand for the patients. It could also provide theoretical basis and technology support for designing and optimizing the control system of the LVAD.
Objective To review the research progress of C terminal propeptide of collagen type II (CTX-II), a osteoarthritis (OA) biomarker. Methods Domestic and international l iterature about CTX-II was reviewed extensively and summarized. Results CTX-II is investigated broadly and has the best performance of all currently available biomarkers. CTX-II is a truly useful biomarker for early diagnosis, prognosis, and measurement of treatment response in OA. Conclusion Single CTX-II may be not sufficient for early diagnosis and prognosis of OA, so a combination of CTX-II and other biomarkers or diagnosis methods is needed.
Objective To review the research progress of cartilage ol igomeric matrix protein (COMP). Methods Domestic and abroad l iterature about COMP was reviewed and summarized. Results COMP was one of the osteoarthritis (OA) biomarkers of being widely studied. Most studies in recent years could draw the conclusion that COMP was associated with OA. COMP was the foremost biomarker among investgated biomarkers. It could been continuously expressed and predicted knee OA progression. Conclusion Precisely what role COMP plays in OA pathogenesis remains unclear, using COMP as a tool to early diagnose OA more studies would be needed.
ObjectiveTo explore the effect of gastric bypass (GBP) on metabolic syndrome (MS) and the related mechanisms. MethodsThe literatures addressed the effect of GBP on glucose metabolism and blood pressure were retrospectively analyzed. ResultsIt showed that GBP achieved durable level of blood glucose, remission of dylipidemia and hypertension, however, which occurred before significant weight loss. The changes of many factors such as food intake, gastrointestinal hormones, adipocytokines, fat distribution might be involved in GBP to improve MS. ConclusionGBP seems to achieve the control of MS as a primary and independent effect, rather than secondary to the treatment of overweight.
【摘要】 目的 探讨腰硬联合麻醉复合丙泊酚恒速输注清醒镇静的可行性、理想的药物剂量、术中知晓情况以及麻醉质量和效果。 方法 收集2009年3-12月480例美国麻醉医师协会（ASA）Ⅰ～Ⅲ级拟在腰硬联合麻醉下行下腹部、会阴部、下肢手术的患者480例，随机分为咪达唑仑组（M组）、丙泊酚Ⅰ组（PA组）、丙泊酚Ⅱ组（PB组）、丙泊酚Ⅲ组（PC组），每组各120例。四组患者均于腰2-3或腰3-4行腰硬联合麻醉，蛛网膜下腔注入轻比重0.2 %布比卡因12～15 mg，麻醉平面确切后，M组予以咪达唑仑0.04~0.06 mg/kg，PA组先予以负荷量丙泊酚0.50 mg/kg再以2.00 mg/（kg•h）剂量持续泵注，PB组予以负荷量丙泊酚0.75 mg/kg再以3.00 mg/（kg•h）剂量持续泵注，PC组予以负荷量丙泊酚1.00 mg/kg再以3.75 mg/（kg•h）剂量持续泵注。观察患者给药前（T0）、给药1（T1）、3（T2）、5（T3）、10（T4）、30（T5）、60 min（T6）各时点血流动力学平均动脉血压（MAP）、心率（HR）的变化、脑电双频指数（BIS）值及镇静评分、术中所看到的图片的回忆及不良反应。 结果 各组在给予镇静药后MAP、HR均有所下降，但测量值的变化在正常范围内；在T3时间点，各组BIS值及镇静/警醒OAA/S评分降低，与T0比较，差异有统计学意义（Plt;0.05）；与其他3组比较，在T4、T5、T6时点PC组BIS值与OAA/S评分降低，差异有统计学意义（Plt;0.05），PC组的镇静遗忘满意率高于其他3组；各组间未见发生严重的舌后坠、呼吸暂停和血氧饱和度（SpO2）lt;90%。 结论 在下腹部、下肢手术中，应用腰硬联合麻醉复合1.00 mg/kg负荷量的丙泊酚继而以3.75 mg/（kg•h）剂量持续泵注，可取得良好的镇静效果，不良反应小。【Abstract】 Objective To investigate the feasibility, ideal dose, intra-operative awareness as well as the quality and effectiveness of constant infusion of propofol under combined spinal-epidural anesthesia (CSEA) for conscious sedation. Methods A total of 480 patients at ASA grade Ⅰ-Ⅲ to be operated in the lower abdomen, perineum and lower limbs under CSEA from March to December 2009 were randomly divided into four groups: midazolam group (M group), propofol group Ⅰ (PA group), propofol group Ⅱ (PB group), and propofol group Ⅲ (PC group), with 120 patients in each group. All four groups of patients underwent CSEA at L2-3 or L3-4 and accepted pinal injection of 12-15 mg of 0.2% hypobaric bupivacaine. After the anesthetic plane was confirmed, patients in M group accepted 0.04-0.06 mg/kg of midazolam; patients in PA group accepted propofol at a loading dose of 0.50 mg/kg followed by continuous infusion at a dose of 2.00 mg/(kg•h); patients in PB group accepted propofol at a loading dose of 0.75 mg/kg followed by continuous infusion at a dose of 3.00 mg/(kg•h); patients in PC group accepted propofol at a loading dose of 1.00 mg/kg followed by continuous infusion at a dose of 3.75 mg/(kg•h). The change of hemodynamics including the mean arterial pressure (MAP) and the heart rate (HR), bispectral index (BIS) values, sedation scores, memory of pictures seen during operation and adverse effects before drug administration (T0), at minute 1 (T1), 3 (T2), 5 (T3), 10 (T4), 30 (T5) and 60 (T6) after drug administration were observed. Results MAP and HR decreased in all the four groups after administration of sedatives, but the changes of measured values were within normal ranges. BIS value and the Observer’s Assessment of Alertness and Sedation (OAA/S) scale decreased in all groups at T3, compared with those at T0 (Plt;0.05). Compared with the other 3 groups, BIS valueand OAA/S scale were significantly lower in PC group at T4, T5 and T6 (Plt;0.05), and the satisfaction rate of sedation and amnesia was much higher. No serious glossocoma, apnea and SpO2 below 90% was observed in all the four groups. Conclusion During the surgery of lower abdomen and lower limbs, application of CSEA combined with propofol at a loading dose of 1.00 mg/kg followed by continuous infusion at a dose of 3.75 mg/(kg•h) can achieve a good sedative effect, with little side effect.
ObjectiveTo investigate the role of Aspergillus in the severe refractory exacerbations of chronic obstructive pulmonary disease (COPD).MethodsThe clinical data of two COPD patients suffering from refractory acute exacerbations were analyzed and the relevant literature were reviewed.ResultsTwo patients were male, aging 72 and 64 years respectively. Both of them had a history of frequent acute exacerbations with severe COPD recently. Meanwhile, they received intravenous use of antibiotics repeatedly, one of them took oral corticosteroids to control wheezing, but failed. Their serum Aspergillus-specific IgG antibody was weakly positive. Besides traditional treatment, they received additional antifungal therapy, and the symptoms alleviated. There was no acute exacerbation in the half a year follow-up period after appropriate therapy.ConclusionsAspergillus colonization, sensitization, infection should be considered in patients with severe COPD. When Aspergillus-associated evidence are acquired, antifungal therapy will be unexpected helpful.
Objective To study the effect of p38MAPK activity on tumor necrosis factor-α （TNF-α） mRNA and intercellular adhesion molecule 1 （ICAM1） mRNA expressions of isolated rabbit liver during early stage of cold preservation and reperfusion period. Methods Based on the cold preservation and reperfusion model of isolated rabbit liver, the animals were divided into inhibition group （n=12） with 3 μmol/L SB202190 (p38MAPK specificity inhibitor) in perfusate and control group （n=12） with no SB202190 in perfusate. Liver tissue samples were harvested at the time points of before resection, end of cold preservation, and different reperfusion period (10, 30, 60 and 120 min). Protein expression and activity of p38MAPK were detected by Western blot and immunoprecipitation respectively, expression of TNF-α mRNA was detected by RT-PCR, and expression of ICAM1 mRNA was detected by in situ hybridization. Results There was no obvious change of expression of p38MAPK protein in liver tissue both in two groups during the total period （P＞0.05）， and there was no statistically significant difference between two groups （P＞0.05）. At time points of end of cold preservation, 10, 30 and 60 min of reperfusion, the activity of p38MAPK in control group was significantly higher than that at the time points of before resection and 120 min of reperfusion (P＜0.01), and was also significantly higher than that in inhibition group at the same time points (P＜0.01). There was no significant difference in activity of p38MAPK among all time points in inhibition group (P＞0.05). The expressions of TNF-α mRNA and ICAM1 mRNA at the time points of before resection, end of cold preservation, and 10 and 30 min of reperfusion were significantly lower than those in 60 and 120 min of reperfusion in both two groups (P＜0.05, P＜0.01); The expressions of TNF-α mRNA and ICAM1 mRNA in inhibition group were significantly lower than those in control group at the time points of 60 and 120 min of reperfusion (P＜0.01). The activity of p38MAPK of liver tissue during cold preservation and reperfusion period was significantly correlated with the level of TNF-α mRNA and level of ICAM1 mRNA expression （r=0.996, P＜0.01； r=0.985, P＜0.01）. Conclusions These results suggest that p38MAPK pathway may regulate the expressions of TNF-α and ICAM1 at the level of transcription and the activation of p38MAPK can up-regulate TNF-α and ICAM1 expressions, which may be one of the important mechanisms to cause ischemia-reperfusion injury of isolated liver during cold preservation and reperfusion period.