Objective To investigate the clinical characteristics and risk factors associated with death in critically ill patients with severe community-acquired pneumonia( CAP) .Methods A retrospective analysis was carried out in 125 hospitalized patients with severe CAP admitted from July 2008 to February 2012. Earlier clinical features were compared between 109 survival patients and 16 dead patients, and logistic regression analysis was conducted. Results The death group had more underlying diseases than the survival group( P lt;0. 05) . The heart rate at admission in the death group was significantly higher than that in the survival group( P lt;0.05) . The ratio and number of complication, the highest temperature before admission, the platelet count, the arterial blood pH, PaO2 and PaO2 /FiO2 in the death group were significantly lower than those in the survival group( P lt; 0. 05) . Logistic regression analysis showed that the number of underlying diseases, heart rate and PaO2 were predictors of death in the patients with severe pneumonia. Conclusion The number of underlying diseases, heart rate and PaO2 has highly predictive value of death for severe CAP.
ObjectiveTo explore the changes of focal adhesion kinase (FAK) in the fibrotic atrium of patients with valvular atrial fibrillation and explore its downstream signaling pathways.MethodsA total of 45 patients with mitral valve disease were included in this study and were divided into a valvular atrial fibrillation group (VAF, ≥6 months, 25 patients) and a sinus rhythm group (SR, 20 patients) based on having atrial fibrillation or not. The atrial appendage tissue was obtained during the operation , histopathological examination and Western blotting were performed. The degree of atrial fibrosis and changes in FAK and its downstream pathways in fibrotic myocardium were observed.ResultsThis study revealed a higher degree of atrial fibrosis in valvular atrial fibrillation and disordered cell arrangement. Expression of fibroblast differentiation marker alpha smooth muscle actin (α-SMA) was significantly increased in atrial fibrillation, and the expression of FAK and downstream AKT/S6K pathway proteins was up-regulated, while the other signal was observed, there was no significant change in ERK1/2 signaling pathway.ConclusionAtrial fibrosis in valvular atrial fibrillation is an important feature of atrial structural remodeling. We found overproduction of collagen fibers disrupted the continuity of atrial myocytes, leading to abnormal conduction and providing a matrix environment for the development of atrial fibrillation. The expression of focal adhesion kinase and downstream AKT/S6K signaling pathway in fibrotic myocardium may be involved in the process of atrial fibrosis, providing a basis for the study of its mechanism.
ObjectivesTo assess the efficacy and safety of 3 dosages (75, 150, and 300 μg) of indacaterol in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) by network meta-analysis.MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) of indacaterol for treating stable COPD patients from inception to December 31st, 2018. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies, and then ADDIS 1.16.8 and Stata 15.1 softwares were used to perform network meta-analysis.ResultsA total of 13 RCTs involving 5 476 patients were included. The results of network meta-analysis showed that: compared to placebo, 3 dosages of indacaterol could improve trough forced expiratory volume in 1 second (trough FEV1), lower St George respiratory questionnaire (SGRQ), and improve transitional dyspnea index (TDI). 150 μg and 300 μg groups were better than placebo group in reducing COPD exacerbation rate. There were no statistically differences between groups in incidence of all adverse effects. Ranking probability table showed that 300 μg group was most likely to be the most effective treatment in improving trough FEV1, SGRQ and TDI, and it ranked second in reducing COPD exacerbation rate.ConclusionsConsidering the network meta-analysis and rankings, 300 μg indacaterol is superior to the other 2 dosages in treating the patients with moderate-to-severe COPD.
The treatment of patients suffering from both severe coronary artery disease (CAD) and malignancy is different from those who have isolated CAD or tumor, because their body condition is poorer and the lesions of coronary artery are severer, which poses severe challenges to doctors. At present, the surgical treatment for these patients mainly includes staged operation and simultaneous surgery. Staged operation, which separates coronary artery revascularization surgery from tumor resection, has a lower incidence of postoperative complications, but tumor progression may occur during the waiting period. Simultaneous surgery combines heart procedure with tumor resection at the same time, shortens the treatment period of patients, overcomes the defect of tumor progression that may occur during the waiting period of the staged surgery, but the incidence of postoperative complications is higher. The progress of surgical treatment in patients with CAD combined with malignant tumor is summarized.
ObjectiveTo systematically review the relationship between T309G polymorphism of murine double minute 2 (MDM2) gene and susceptibility of prostate cancer. MethodsThe PubMed, Embase, WanFang Data, CNKI databases were electronically searched to collect case-control studies related to the objects from inception to May, 2023. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using Stata 14.0 software. ResultsA total of 10 studies involving 5 781 patients and 5 477 healthy controls were included. The results of meta-analysis showed that, the MDM2 gene T309G polymorphism was not associated with preeclampsia (allele model G vs. T: OR=0.89, 95%CI 0.77 to 1.04, P=0.13; homozygote model GG vs. TT: OR=0.86, 95%CI 0.64 to 1.16, P=0.32; heterozygote model TG vs. TT: OR=1.04, 95%CI 0.86 to 1.26, P=0.12; dominant model GG+TG vs. TT: OR=0.96, 95%CI 0.89 to 1.04, P=0.36; recessive model GG vs. TG+TT: OR=0.84, 95%CI 0.63 to 1.14, P=0.27). The results of subgroup analysis based on ethnicity and source of control were similar to the overall results. Sensitivity analysis showed that the results were robust. Conclusion Current evidence shows that the MDM2 gene T309G polymorphism was not associated with prostate cancer susceptibility. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objective To investigate the operative effects of gluteal muscle contracture. Methods A total of 128 cases of gluteal muscle contracture treated with operative methods from February 2001 to May 2009 were reviewed. Results All the patients received operation. Most patients were satisfied with the treatment via function exercise in the early stage. No severe complication was found. The patients were followed up for 6 to 84 months, at the average of 36 months. According to Huang Yaotians criteria, 67.9% (87/128) of the patients were excellent; 27.3% (35/128) were good; 3.9% (5/128) were fair; and 0.8% (1/128) were poor in effectiveness. Conclusion Operation and function exercise after operation have advantages of minitrauma and good function recovery, and it is a satisfactory method to treat the gluteal muscle contracture.