【摘要】 目的 探讨影响糖皮质激素治疗特发性血小板减少性紫癜疗效的主要因素。 方法 回顾分析2008年1月-2010年7月173例特发性血小板减少性紫癜患者的临床资料，采用χ2检验及Logistic回归分析影响糖皮质激素疗效的相关临床因素。 结果 单因素χ2检验分析显示性别、骨髓巨核细胞计数水平、骨髓产板巨核细胞比例、乙型肝炎表面抗原（HBsAg）、血清免疫球蛋白水平对糖皮质激素疗效的影响有统计学意义（Plt;0.05）。脾脏长大、抗核抗体（ANA）阳性、补体C3水平降低与糖皮质激素疗效无关。多因素Logistic回归分析显示性别、HBsAg是影响糖皮质激素疗效的相关因素。 结论 男性、骨髓巨核细胞计数增多、产板巨比例降低者对糖皮质激素治疗反应较好。女性、血清免疫球蛋白水平异常、骨髓巨核细胞不增多者及HBsAg阳性的患者对糖皮质激素治疗反应相对较差。性别、HBsAg是影响糖皮质激素疗效的主要因素。【Abstract】 Objective To discuss the influencing factors associated with the efficacy of glucocorticoid for idiopathic thrombocytopenic purpura. Methods We retrospectively analyzed the clinical data of 173 patients with idiopathic thrombocytopenic purpura who accepted their first treatment in West China Hospital between January 2008 and July 2010. The affecting factors on the efficacy of the treatment were analyzed by means of Chi-square test and binary logistic regression analysis. Results The results of Chi-square test showed that gender, bone marrow megakaryocyte count, the percentage of platelet-producing megakaryocytes, HBsAg, and the level of serum immunoglobulin could have a significant influence on the outcome of glucocorticoid treatment (Plt;0.05), while splenomegaly, positive ANA and decreasing of the level of complement C3 were not correlated with the outcome of glucocorticoid treatment. The results of multivariate logistic regression analysis showed that gender and HBsAg were correlated with the glucocorticoid treatment for patients with idiopathic thrombocytopenic purpura. Conclusion Male patients, patients with increasing bone marrow megakaryocytes and patients with decreasing percentage of platelet-producing megakaryocytes have better responses to glucocorticoid, while female patients, patients with abnormal serum immunoglobulin level and patients with non-increasing number of bone marrow megakaryocytes have poor responses toward glucocorticoid treatment. Gender and HBsAg are the main influencing factors for the response to glucocorticoid.
Fetal electrocardiogram signal extraction is of great significance for perinatal fetal monitoring. In order to improve the prediction accuracy of fetal electrocardiogram signal, this paper proposes a fetal electrocardiogram signal extraction method (GA-LSTM) based on genetic algorithm (GA) optimization with long and short term memory (LSTM) network. Firstly, according to the characteristics of the mixed electrocardiogram signal of the maternal abdominal wall, the global search ability of the GA is used to optimize the number of hidden layer neurons, learning rate and training times of the LSTM network, and the optimal combination of parameters is calculated to make the network topology and the mother body match the characteristics of the mixed signals of the abdominal wall. Then, the LSTM network model is constructed using the optimal network parameters obtained by the GA, and the nonlinear transformation of the maternal chest electrocardiogram signals to the abdominal wall is estimated by the GA-LSTM network. Finally, using the non-linear transformation obtained from the maternal chest electrocardiogram signal and the GA-LSTM network model, the maternal electrocardiogram signal contained in the abdominal wall signal is estimated, and the estimated maternal electrocardiogram signal is subtracted from the mixed abdominal wall signal to obtain a pure fetal electrocardiogram signal. This article uses clinical electrocardiogram signals from two databases for experimental analysis. The final results show that compared with the traditional normalized minimum mean square error (NLMS), genetic algorithm-support vector machine method (GA-SVM) and LSTM network methods, the method proposed in this paper can extract a clearer fetal electrocardiogram signal, and its accuracy, sensitivity, accuracy and overall probability have been better improved. Therefore, the method could extract relatively pure fetal electrocardiogram signals, which has certain application value for perinatal fetal health monitoring.
【Abstract】 Objective To investigate the effect of massage on quadriceps femoris repair and the expressions of Desmin and α-Actin in rabbits so as to explore the possible molecular mechanisms of massage in repair of muscle injury. Methods Twenty-seven New Zealand white rabbits, weighing (2.0 ± 0.5) kg, were randomly divided into 3 groups: groups A (n=3), B (n=12), and C (n=12). In group A, the rabbits were not treated as controls; in groups B and C, the rabbit models of quadriceps femoris injury were prepared by self-made beater. In group B, no massage therapy was given as nature recovery controls; in group C, RT-N2 intelligent massage device was used for massage therapy at 8 days after injury, at 3 000-3 100 r/min for 15 minutes, every day for 7 days or for 14 days. The quadriceps femoris specimens were taken from 6 rabbits of groups B and C at 14 days and 21 days, respectively. HE staining was employed to detect the histomorphological change. Immunohistochemistry staining and Western blot were used to detect Desmin and α-Actin expressions. The massage therapy effect was evaluated by the histomorphological change and Desmin and α-Actin expressions. Results All rabbits survived to the end of experiment in groups B and C. No histological change was found with regular order of muscle fibers and no connective tissue in group A; obvious tissue necrosis was seen with broken muscular fibers, muscle atrophy, and irregular order in group B; and in group C, the skeletal muscle morphology and muscle atrophy were obviously improved with regenerated muscle fibers when compared with group B. Immunohistochemistry staining showed that the Desmin and α-Actin expressions obviously reduced in groups B and C, which were significantly weaker than that in group A (P lt; 0.05); the Desmin and α-Actin expressions were significantly ber in group C than in group B (P lt; 0.05), and at 21 days than at 14 days in group C (P lt; 0.05). Western blot results showed that the Desmin and α-Actin expressions were significantly higher in group A than in groups B and C (P lt; 0.05), and the expressions were lowest at 14 days in group B. Conclusion The histomorphology and cytoskeletal structure can be significantly improved after massage, which may help to repair muscle injury by up-regulation of Desmin and α-Actin expressions.
Objective To explore the feasibility and operation points of establishing duodenal-jejunal bypass （DJB）surgery animal model in Goto-Kakizaki （GK） rats. Methods Sixteen GK rats were randomly divided into experimental group （n=8） and control group （n=8）. In a standardized preoperative， intraoperative， and postoperative operation， the rats of experimental group and control group received DJB and sham surgery respectively. The fasting plasma glucose and body mass were observed before operation， and 1， 2， 3， and 4 weeks after operation in order to evaluate whether the models were established successfully. Survival situation of rats were observed too. Results All experimental rats survived at 4 weeks after the operation. Compared with the levels before operation， the fasting plasma glucose levels of experimental group decreased significantly （P＜0.05） at 1 week after operation， and remained stable at 2， 3， and 4 weeks after operation.The fasting plasma glucose levels of control group did not change statistically at all time points after operation （P＞0.05）. Compared with control group at the same time point， the fasting plasma glucose level of experimental group was lower （P＜0.05）， indicating that DJB models were established successfully. After 4 weeks， the value of body mass added in experimental group was significantly lower than those of control group （P＜0.05）. Conclusions DJB is a feasible， safe， and effective hypoglycemic surgery. The application of this set of experimental operating procedures can reduce the risk of intraoperative and postoperative mortality， and can develop a stable DJB model in Goto-Kakizaki rats.
Objective To determine the role of multi-slice spiral computed tomography (MSCT) compared with transrectal ultrasound (TRUS) in preoperative staging of rectal cancer. Methods Patients with rectal cancer from January to May 2009 in Department of Anal-Colorectal Surgery of West China Hospital were enrolled. All patients were preoperatively examined by both MSCT and TRUS for T and N staging, which were compared with postoperative pathological findings. Results The study population consisted of 81 patients. Regarding depth of tumor invasion, the accuracy of TRUS (88.89%) was not significantly higher than that of MSCT (77.78%), P=0.168. Regarding lymph node metastasis, the result of MSCT was more accurate than that of TRUS (66.67% vs. 48.15%, P=0.034). Conclusions Although TRUS remains the advantages in evaluating local invasion, the gap between MSCT and TRUS are significantly diminished. MSCT is superior to TRUS in evaluation of lymph node metastasis, however, further improvement on the diagnostic accuracies would be warranted in both modalities.
Objective To investigate the clinical characteristics of interstitial pneumonia patients with positive anti-signal recognition particle antibody (SRP-IP), and compare those with interstitial pneumonia patients with positive anti-Jo-1 antibody (Jo1-IP). Methods Clinical data of SRP-IP patients admitted to Department of Respiratory and Critical Care Medicine of Drum Tower Hospital affiliated to Nanjing University Medical School from May 2017 to May 2021, including clinical manifestations, laboratory examinations, pulmonary function tests and radiographic types, were retrospectively analyzed. The results were compared with those of Jo1-IP patients admitted during the same period. Results The SRP-IP patients were older than Jo1-IP patients (P=0.044). There were no significant differences in clinical manifestations or pulmonary function tests results between the two groups. The proportion of SRP-IP patients combined with positive anti-EJ antibody (P<0.001) or perinuclear anti-neutrophil cytoplasmic antibody (P=0.028) was significantly higher than that of Jo1-IP patients, while the proportion of SRP-IP patients combined positive anti-Ro-52 antibody was significantly lower than that of Jo1-IP patients (P=0.009). The erythrocyte sedimentation rate (ESR) of SRP-IP patients was faster than that of Jo1-IP patients (P=0.026). The serum IgM level (P=0.039) and peripheral NK cell counts (P=0.013) of SRP-IP patients were significantly lower than those of Jo1-IP patients. The most common chest CT findings in SRP-IP patients were organizing pneumonia and the proportion of usual interstitial pneumonia in SRP-IP patients was higher than that of Jo1-IP patients (P=0.032). The levels of creatine kinase (P=0.010), creatine kinase myocardial brand (P=0.025) and alanine aminotransferase (P=0.045) in interstitial pneumonia patients with high titer (++~+++) SRP antibody were higher than those in interstitial pneumonia patients with low titer (+) SRP antibody. SRP-IP and Jo1-IP patients were mainly treated with glucocorticoids combined with or without immunosuppressants, and there was no significant difference in the choice of treatment between the two groups. The proportion of patients with Jo1-IP evaluated as improved was significantly higher than that of patients with SRP-IP (p=0.005), while the proportion of patients with SRP-IP evaluated as stable was significantly higher than that of patients with Jo1-IP (P=0.035). The mortality of SRP-IP patients within 3 months was significantly higher than that of Jo1-IP patients (P=0.028). Conclusion Compared with Jo1-IP patients, SRP-IP patients are older, have faster ESR, are more likely to be combined with other autoantibodies, have lower serum IgM level and peripheral blood NK cell count, have more UIP imaging manifestations, and have a worse short-term prognosis.
Objective To investigate the clinical features of non-small cell lung cancer (NSCLC) patients with long-term survival and the related factors for treatment. Methods A retrospective analysis of clinical features, treatment factors, and survival was performed for 963 patients with pathologically confirmed stage Ⅳ NSCLC between January 2010 and December 2015 from Department of Thoracic Oncology, West China Hospital, Sichuan University. Results The median overall survival (OS) of the 963 patients was 20.8 months, and the 1-, 3-, 5-, and 7-year survival rates were 72.0%, 21.4%, 15.2%, and 4.8%, respectively. There were 81 patients in the long-term survival group (OS>60 months) and 882 in the non-long-term survival group (OS<60 months). Previous surgery, thoracic radiotherapy and epidermal growth factor receptor (EGFR) gene positive significantly increased the 5-year actual survival rate, reducing the risk of death by 62.0%, 58.8%, and 58.1%, respectively. Compared with the non-long-term survival group, more patients in the long-term survival group received two or more means of treatment including surgery, thoracic radiotherapy, and targeted therapy (28.4% vs. 11.6%, P<0.001) and more patients benefited from fourth- or further-line treatment (24.7%vs. 11.1%, P<0.001). Cox multivariate regression analysis indicated that performance status [hazard ratio (HR)=1.388, 95% confidence interval (CI) (1.199, 1.608), P<0.001] , N stage [HR=1.160, 95%CI (1.058, 1.272), P=0.002] , EGFR gene status [HR=0.588, 95%CI (0.469, 0.738), P<0.001] , previous surgery [HR=0.626, 95%CI (0.471, 0.832), P=0.001] , and thoracic radiotherapy [HR=0.592, 95%CI (0.480, 0.730), P<0.001] were independent prognostic factors of OS. Conclusions Good performance status, early N staging, EGFR mutation, previous surgery, and thoracic radiotherapy are important prognostic factors affecting the survival of advanced NSCLC patients. Long-term survival benefits from combined treatment and effective further-line therapies.
ObjectiveTo investigate the diagnostic value and safety of electromagnetic navigation bronchoscopy combined with radial endobronchial ultrasound in peripheral pulmonary nodules.MethodsThe clinical imaging, surgical and pathological data of 60 patients with 76 peripheral pulmonary nodules who underwent electromagnetic navigation bronchoscopy combined with radial endobronchial ultrasound guided biopsy in the Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School from June 2020 to June 2021 were retrospectively analyzed. The diagnosis rate and complications were analyzed and summarized. The 76 pulmonary nodules were divided into a small pulmonary nodules group (10 nodules, diameter≤1 cm) and a pulmonary nodules group (1 cm<diameter≤3 cm, 66 nodules) according to diameter. The two groups were compared in terms of operation and diagnosis rate.ResultsPulmonary nodules diameter was 1.8±0.6 cm, operation time 29.8±8.6 min, navigation 2.9±0.9 times, biopsy 9.5±1.9 pieces. In the 76 pulmonary nodules, 55 were confirmed by pathology, with a total diagnosis rate of 72.4%, including 32 of malignant lesions and 23 of benign lesions. In the 76 pulmonary nodules, 59 had grade 0 hemorrhage, 17 had grade 1 hemorrhage, and none had grade 2 or more serious hemorrhage. Eight patients developed pneumothorax after surgery, and the degree of lung compression was less than 30%, which was improved after symptomatic treatment with oxygen inhalation. The operation time in the small pulmonary nodules group was significantly longer than that in the pulmonary nodules group, and there was no significant difference in diagnosis rate or complications between the two groups.ConclusionElectromagnetic navigation bronchoscopy combined with radial endobronchial ultrasound is a safe and effective method for the diagnosis of periphery pulmonary nodules, and it also has a high diagnostic rate for small pulmonary nodules (≤1 cm), which is worthy of clinical promotion and application.