【摘要】 目的 探讨人工双极股骨头置换术治疗老老年（gt;80岁）股骨颈骨折的临床疗效。 方法 2006年1月－2009年12月采用人工双极股骨头置换术治疗23例老老年股骨颈骨折患者，其中男8例，女15例；年龄81~100岁，平均88岁。左侧10例，右侧13例。致伤原因：走路摔伤20例，交通事故伤3例。骨折按Garden分型：Ⅲ型14例，Ⅳ型9例。均为新鲜骨折，受伤至手术时间3~12 d。术前均合并慢性内科疾病。 结果 术后切口均I期愈合，3例发生肺部感染，1例发生深静脉血栓形成，无切口感染及假体脱位。2例患者分别于术后5个月死于急性心肌梗死及术后1年死于高血压性脑溢血。余21例均获随访，随访时间12~48个月，平均26个月。X线片示假体位置良好。根据Harris髋关节评分标准：优12例，良6例，可2例，差1例，优良率为85.7%。 结论 人工双极股骨头置换术治疗老老年股骨颈骨折手术时间短，可早期髋关节活动，减少了卧床并发症，提高了生存率，改善了患者生活质量，是一种较理想的治疗手段。【Abstract】 Objective To discuss the clinical effects of bipolar hemiarthroplasty for treatment of femoral neck fracture in super-aged patients who were over 80 years old. Methods From January 2006 to December 2009, 23 cases of femoral neck fracture were operated by bipolar hemiarthroplasty. Among the patients, there were 8 males and 15 females, with their age ranged from 81 to 100 years old averaging at 87.5 years. Ten patients had left femoral neck fracture, and 13 had right femoral neck fracture. Twenty patients had the injury because of falling on the ground while walking, and 3 due to car accident. Based on Garden classification, there were 14 cases of type Ⅲ and 9 of type Ⅳ fractures. All fractures were fresh. The interval between the injury and operation was 3 to 12 days. Before operation, all patients had concomitant chronic diseases. Results All incisions healed in the first stage with 3 cases of lung infection and 1 case of deep venous thrombus, and without incision infection or prosthesis dislocation. One patient died of acute myocardial infarction 5 months after operation and the other one died of hypertensive cerebral hemorrhage 1 year after operation. All the remaining 21 patients were followed up for 12 to 48 months averaging at 26 months. X-ray result showed a good location of the prosthesis. According to the Harris scoring system, the results were very good in 12 cases, good in 6 cases, fair in 2 cases and poor in 1 cases, with a total effective rate of 85.7％. Conclusions Bipolar hemiarthroplasty is an ideal method to treat femoral neck fracture in super-aged patients. It can shorten operation time, facilitate early movements of the hip joint, decrease complication rate due to lying in bed, and improve survival rate and quality of life.
Objective To assess the independent risk factors of in-hospital mortality and morbidity after surgical procedure for Stanford type A aortic dissection (TAAD). Methods Between May 2013 and May 2015, 341 TAAD patients were treated with surgical procedure in Fu Wai Hospital. There were 246 males and 95 females with a mean age of 47.42±11.54 years (range 29-73 years). Among them, 87 patients suffered severe complications or death after the procedure (complication group) and the other 254 patients recovered well without any severe complications (no complication group). Perioperative clinical data were compared between the two groups. Results Mean age of patients in the complication group was significantly higher than that of the no complication group (49.91±11.22 yearsvs. 46.57±11.54 years,P=0.019). The incidence of preoperative ischemic organ injury in the complication group was significantly higher than that in the no complication group: cerebral ischemia (18.4%vs. 5.9%,P=0.001), spinal cord injury (16.1%vs. 4.7%,P=0.001), acute kidney injury (31.0%vs. 10.6%,P=0.000). The incidence of branch vessels involvement in the complication group was significantly higher than that in the no complication group: coronary artery involvement (52.9%vs. 17.1%,P=0.000), supra-aortic vessels involvement (73.6%vs. 53.9%,P=0.001), celiac artery involvement (37.9%vs. 22.0%,P=0.003), mesenteric artery involvement (18.4%vs. 9.8%,P=0.030), and unilateral or bilateral renal artery involvement (27.6%vs. 9.8%,P=0.000). Surgical time of patients in the complication group was significantly longer than that of the no complication group, including cardiopulmonary bypass time (205.05±63.65 minvs. 167.67±50.24 min,P<0.05) and cross-clamp time (108.11±34.79 minvs. 90.75±27.33 min,P<0.05). Multiple regression analysis found that age, preoperative concomitant cerebral ischemic injury, preoperative concomitant acute renal injury, preoperative limb sensory and/or motor dysfunction, coronary artery involvement, cardiopulmonary bypass time were independent risk factors of postoperative death and severe complications in TAAD patients. However, risk of postoperative mortality and morbidity significantly decreased after the concomitant coronary artery bypass graft [OR=0.167 (0.060, 0.467),P=0.001]. Conclusion The high risk factors of postoperative complication in TAAD patients are explored to provide an important clinical basis for preoperative identification of patients at high risk and we need pay more attention to the prevention of these postoperative complications.
Adenosine activated protein kinase (AMPK) is a serine/threonine protein kinase that can sense the change of intracellular energy. AMPK plays a critical part in the occurrence and development of tumors. According to the difference of AMPK catalytic subunits, it is divided into AMPKα1 and AMPKα2. The AMPKα1 subunit is the catalytic subunit of AMPK and is extensively distributed in the various tissues and organs. This review focuses on the structural, activated and functional aspects of AMPKα1 and the involvement of AMPKα1 in the regulation of intracellular substance metabolism, and summarizes the respective performances of AMPKα1 in different cancers and the corresponding potential applications of AMPKα1 as a drug target in the relevant cancers. AMPKα1 can be used as a diagnostic marker or drug target for cancer diagnosis and therapy, providing an idea for cancer treatment, which has importance clinical significance.
Objective To evaluate the value of preoperative B-type natriuretic peptide （BNP） level in predicting new onset atrial fibrillation （AF） in patients after coronary artery bypass grafting （CABG）. Methods We electronically searched PubMed，EMbase，Cochrane library，CNKI and VIP databases from the establishment of those databases to November 2012. Evaluation standard of diagnostic tests was used to identify and screen literatures which investigated correlations between preoperative BNP levels and new onset AF of patients after CABG. Quality Assessment of Diagnostic Accuracy Studies （QUADAS） was used to evaluate study quality of included literatures. RevMan 5.0 was used for heterogeneity test. Meta-Disc 1.4 software was used for meta-analysis. Included studies were weighted and then combined. Sensitivity，specificity，diag- nostic odds ratio （DOR），positive likelihood ratio，negative likelihood ratio and corresponding 95% confidence interval（95% CI）were calculated. Summary receiver operating characteristic （SROC） curve was drawn，and the area under the SROC curve （AUC） was analyzed. Results A total of 236 studies were identi?ed，and 5 studies met the eligibility criteria including 802 patients for analysis. There were 228 patients with postoperative new onset AF，and 574 patients without postoperative AF. The quality of the included literature was relatively high. DOR of preoperative elevated BNP level with postoperative new onset AF was 4.15 with 95% CI 2.90 to 5.95. Pooled sensitivity was 0.78 with 95% CI 0.72 to 0.83，pooled specificity was 0.58 with 95% CI 0.54 to 0.58，pooled positive likelihood ratio was 1.91 with 95% CI 1.42 to 1.56，pooled negative likelihood ratio was 0.42 with 95% CI 0.32 to 0.54，and the AUC of SROC was 0.79 （Q=0.72）. Conclusion Preoperative elevated BNP level is significantly correlated with new onset AF after CABG，is a powerful predictor of postoperative AF，and can be used to predict new onset AF after CABG to a certain extent of reliability.
Objective To investigate the current prevalence of cerebral stroke and hypertension in Ganzi Tibetan state, so as to control stroke and hypertension in future. Methods A representative people sample of Kangding, Dege, Ganzi, Litang and Batang county was selected through randomized cluster sampling. Data of demographic characteristics, hypertension and stroke status were collected by face-to-face interview. Results 5 049 people were included, of which 48.6% were male, and 51.4% were female. The prevalence rate of hypertension and stroke were 23.4% and 1 894/100 000 respectively. The population with hypertension had high prevalence of stroke. The prevalence increased along with the age. Conclusions The prevalence of hypertension and stroke is high in Ganzi Tibetan state. The causes may be ascribed to special geography surroundings and life style. It is very important to pay more attention to prevent and control of hypertension and stroke in this area.
Objective To evaluate the efficacy of mycophenolate Mofetil (MMF) and azathioprine (AZA) after renal transplantation. Method Searching: Medline, Embase, Cochrane library and Chinese Biomedicine database (CBM); identified the randomized controlled trials (RCTs) and applied Revman 4.11 for statistical analyses. Results Twenty-two RCTs were identified, involving MMF and AZA for anti-rejection after renal transplantation. The data shown that MMF (2 g/d) was more beneficial than AZA in improving the graft survival rate of short periods and the long-term patient survival rate, but there was no statistical differences between MMF (3 g/d) with AZA. Whether in 6 months or in 1 year after renal transplantation, the use of MMF (2 g/d) or MMF (3 g/d) could markedly reduce the incidence of biopsy-proven rejection. Conclusions Comparing with AZA, MMF is a more potent immunosuppressive drug, and more efficient in reducing the acute rejection after renal transplantation. MMF can improve the graft and patient survival rate. The 2 gram per day is more acceptable.
ObjectiveTo analyze the difference of expression of B7 superfamily member 1 (B7S1) in gastric cancer and adjacent cancer tissues, and to explore the relationship between B7S1 expression and the clinicopathological characteristics and the prognosis of gastric cancer patients.MethodsReverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry were performed to investigate the expression of B7S1 in 78 cases of gastric cancer tissues and adjacent tissues. The correlation of B7S1 expressions with the clinicopathological characteristics and prognosis of the patients was analyzed.ResultsThe results showed that cancer tissues relative expression of B7S1 mRNA was higher than that of adjacent tissues, and the difference was statistically significant (P<0.05). The results showed that positive rate of B7S1 protein expression in gastric cancer tissues was significantly higher than that of adjacent tissues, 74.36% and 11.54%, the difference was statistically significant (P=0.001). Chi-square analysis showed that the expression of B7S1 protein was associated with tumor diameter (P=0.006), pathological-stage (P=0.002), T-stage (P=0.011), and lymph node metastasis (P=0.001). There were no relationship with gender, age, tumor site, and M-stage (P>0.05). B7S1 protein expression was correlated with the overall survival rate for gastric cancer patients. Both univariate and Cox multivariate survival analysis suggested that B7S1 positive expression was a risk factor for poor prognosis in patients with gastric cancer.ConclusionsThe relative expression level of B7S1 mRNA and the positive rate of protein expression in gastric cancer tissues are higher than those in adjacent tissues. The positive expression of B7S1 is correlated with the poor clinicopathological characteristics and prognosis. We speculate that B7S1 may be involved in the malignant progression of gastric cancer.
Objective To evaluate the predictive effect of three machine learning methods, namely support vector machine (SVM), K-nearest neighbor (KNN) and decision tree, on the daily number of new patients with ischemic stroke in Chengdu. Methods The numbers of daily new ischemic stroke patients from January 1st, 2019 to March 28th, 2021 were extracted from the Third People’s Hospital of Chengdu. The weather and meteorological data and air quality data of Chengdu came from China Weather Network in the same period. Correlation analyses, multinominal logistic regression, and principal component analysis were used to explore the influencing factors for the level of daily number of new ischemic stroke patients in this hospital. Then, using R 4.1.2 software, the data were randomly divided in a ratio of 7∶3 (70% into train set and 30% into validation set), and were respectively used to train and certify the three machine learning methods, SVM, KNN and decision tree, and logistic regression model was used as the benchmark model. F1 score, the area under the receiver operating characteristic curve (AUC) and accuracy of each model were calculated. The data dividing, training and validation were repeated for three times, and the average F1 scores, AUCs and accuracies of the three times were used to compare the prediction effects of the four models. Results According to the accuracies from high to low, the prediction effects of the four models were ranked as SVM (88.9%), logistic regression model (87.5%), decision tree (85.9%), and KNN (85.1%); according to the F1 scores, the models were ranked as SVM (66.9%), KNN (62.7%), decision tree (59.1%), and logistic regression model (57.7%); according to the AUCs, the order from high to low was SVM (88.5%), logistic regression model (87.7%), KNN (84.7%), and decision tree (71.5%). Conclusion The prediction result of SVM is better than the traditional logistic regression model and the other two machine learning models.
Objective Risk factors for real-word immune checkpoint inhibitor-related pneumonitis in patients with lung cancer were analyzed by systematic analysis. Methods Computerized retrieval of PubMed, EMbase, Web of Science, the Cochrane Library , WanFang Data, CNKI and VIP databases was carried out. Studies were collected from the database establishment to March 2023. Three researchers independently screened the literature, extracted data, and evaluated the risk of bias in the included studies. Meta-analysis was performed using RevMan5.4.1software. Results A total of 18 studies were included with a total of 4 990 patients. The results of meta-analysis showed that, interstitial pneumonia [odds ratio (OR)=9.32, 95% confidence interval (CI) 4.66 - 18.67, P<0.01], smoking history (OR=2.39, 95%CI 1.29 - 4.45, P<0.01), chronic obstructive pulmonary disease (COPD) (OR=5.54, 95%CI 2.96 - 10.36, P<0.01), chest radiotherapy (OR=2.74, 95%CI 1.80 - 4.19, P<0.01), pulmonary fibrosis (OR=7.46, 95%CI 4.25 - 13.09, P<0.01), high programmed death ligand 1 (PD-L1) expression (OR=2.98, 95%CI 1.71 - 5.22, P<0.01), high absolute eosinophil count (AEC) (OR=3.92, 95%CI 2.17 - 7.08, P<0.01) and pembrolizumab (OR=2.90, 95%CI 1.56 - 5.37, P<0.01) were independent risk factors for immune checkpoint inhibitor-related pneumonitis in lung cancer patients. Conclusions Interstitial pneumonia, smoking history, COPD, Chest radiotherapy, pulmonary fibrosis, high PD-L1expression, high AEC and pembrolizumab are independent risk factors for immune checkpoint inhibitor-related pneumonitis in lung cancer patients. Due to insufficient evidence on the risk factors of low albumin, more studies are needed to further identify it.
Objective To explore the efficacy of endovascular therapy in elderly patients with acute ischemic stroke. Methods The acute ischemic stroke patients who received endovascular therapy between January 2020 and January 2023 were retrospectively enrolled. According to age, patients were divided into the elderly group (≥ 80 years old) and other age groups (<80 years old). The baseline data, green channel data, nerve function deficit, recanalization and complication information were collected, and the patients were followed up. Modified Rankin Scale (mRS) was used to evaluate patients prognosis at 3 months after onset. Score less than or equal to 2 points was defined as good prognosis and over 2 points was defined as poor prognosis. Results A total of 138 patients were included, and 7 patients were lost to follow-up. Finally, 131 patients were included. Among them, there were 50 cases in the elderly group and 81 cases in the other age group. There were statistically significant differences in age, hypertension, atrial fibrillation, and vascular recanalization between the elderly group and the other age group (P<0.05). There was no statistically significant difference in the other baseline data, complications, 3-month prognosis, or mortality between the two groups (P>0.05). The results of multivariate logistic regression analysis showed that the National Institute of Health Stroke Scale score at admission [odds ratio (OR)=1.150, 95% confidence interval (CI) (1.033, 1.281), P=0.011], pulmonary infection [OR=2.933, 95%CI (1.109, 7.758), P=0.030], and hypoproteinemia [OR=3.716, 95%CI (1.226, 11.264), P=0.020] affected the mRS score at 3 months after onset. Conclusions Among the patients with acute ischemic stroke undergoing endovascular therapy, there is no difference in the occurrence of complications or short-term prognosis between elderly patients and other age patients. However, the attention should still be paid to reducing the occurrence of complications in patients, strengthening their nutritional support, and thereby improving their prognosis.