Objective To systematically review the effectiveness and safety of erlotinib for the elderly with Non-small-cell lung cancer (NSCLC). Methods Databases including The Cochrane Library, PubMed, EMbase, CBM, VIP, CNKI and WanFang Data were electronically searched for relevant randomized controlled trails (RCTs). Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality. Then, meta-analysis was performed using RevMan 5.0 software. Results Totally 5 studies were included. The results of meta-analysis showed that, the objective response rate and stable disease rate was similar between the erlotinib group and the control group with no significant difference (RR=0.99, 95%CI 0.34 to 2.93, P=0.99; RR=1.17, 95%CI 0.95 to 1.43, P=0.14). The incidences of Grade Ⅲ-Ⅳ neutropenia and thrombocytopenia were lower in the erlotinib group than those in the control group (OR=0.12, 95%CI 0.03 to 0.52, P=0.005; OR=0.19, 95%CI 0.04 to 0.91, P=0.04); and the incidences of nausea and vomiting as wel as liver impairments were alike between the two groups (OR=0.93, 95%CI 0.12 to 7.08, P=0.95; OR=0.80, 95%CI 0.24 to 2.68, P=0.71); the incidences of diarrhea and skin rashes in the erlotinib group were higher (OR=5.96, 95%CI 1.28 to 27.88, P=0.02; OR=6.77, 95%CI 1.52 to 30.10, P=0.01). Conclusion Current evidence shows that, erlotinib is effective and safe in treating the elderly with NSCLC with better effects and no serious adverse reaction. However, due to the limited quantity and quality of the included studies, more high quality studies with large sample size and long-term follow-up are still needed to verify the above conclusion.
【摘要】 目的 探讨深吸气量（inspiratory capacity，IC）与慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）患者临床特征的相关性。 方法 2009年12月-2010年6月纳入84例稳定期COPD患者，测定6分钟步行试验（6-minute walk test，6MWT）、圣乔治生活问卷评分（St George′s respiratory questionnaire，SGRQ）及肺功能检查:第1秒用力呼气容积（forced expirotovy volume in one second，FEV1）、IC、IC与肺总量（total lung capacity，TLC）比值（IC/TLC）等相关指标，并进行相关性分析。 结果 6MWT值与FEV1无明显直线相关（r=0.14，Pgt;0.1）；6MWT值与FEV1≥60%无明显直线相关（r=0.16，Pgt;0.1）；6MWT值与IC值呈正的直线相关（r=0.317，Plt;0.01）；6MWT值与IC/TLC值呈正的直线相关（r=0.274，Plt;0.01）；SGRQ值与FEV1呈负的直线相关（r=-0.307，Plt;0.01）；SGRQ值与IC值无直线相关（r=-0.001，Pgt;0.25）；SGRQ值与IC/TLC值无直线相关（r=-0.003，Pgt;0.25）。 结论 对COPD患者，IC比FEV1更准确地反映患者的运动耐量的程度，FEV1比IC更准确地反映患者呼吸困难的严重程度。【Abstract】 Objective To explore the relationship between the inspiratory capacity (IC) and clinical characters of stable chronic obstructive pulmonary disease (COPD). Methods Between December 2009 and June 2010, 84 patients with stable COPD were enrolled. Lung function (FEV1, IC, IC/TLC) ,6 minute walk-test (6MWT) and St George′s respiratory questionnaire (SGRQ) were examined. The relationship among FEV1, IC, IC/TLC, and the results of 6MWT and SGRQ by Pearson correlation analysis. Results There was no linear correlation between 6MWT and FEV1 （r=0.14，Pgt;0.1）, and 6MWT and FEV1≥60% （r=0.16，Pgt;0.1）. There was positive correlation between 6MWT and IC （r=0.317，Plt;0.01）, and 6MWT and IC/TLC （r=0.274，Plt;0.01）. There was negative correlation between SGRQ and FEV1 （r=-0.307，Plt;0.01）; and no linear correlation between SGRQ and IC （r=-0.001，Pgt;0.25）, and SGRQ and IC/TLC （r=-0.003，Pgt;0.25）. Conclusion In stable COPD patients, IC may be more accurate than FEV1 in refection of exercise tolerance while FEV1 may be more sensitive than IC in evaluation of dyspnea.
Platelets are rapidly activated by activators and produce a large number of platelet microparticles (PMPs) with high coagulation activity, resulting in coagulation dysfunction. However, the generation mechanism of PMPs is still not clear. Hopping probe ion conductance microscopy (HPICM) has special technical advantages in non-contact, real-time, high-resolution imaging of living cells under physiological conditions. Using HPICM, this study monitored the processes of platelet activation and generation of PMPs in real time in the presence of calcium ionophore A23187 and cytochalasin D (CD), respectively. The results proved that the intracellular calcium concentration and the cytoskeletal proteins played important roles in the platelet activation and the generation of PMPs. Compared with the low density spread shape platelets (LDSS), the high density bubble shape platelets (HDBS) were more sensitive to the calcium ionophore A23187 and cytochalasin D. This research has a guiding significance for the further study on the relationship between platelet activation and coagulation function using HPICM.
ObjectiveTo conduct an analysis and identify potential risk factors associated with postoperative complications in patients diagnosed with malignant gastrointestinal tumors who underwent laparoscopic surgery. MethodsFrom January 2023 to October 2023, 500 patients with malignant gastrointestinal tumors who underwent laparoscopic surgery at the Department of General Surgery, the First Medical Center of PLA General Hospital were prospectively selected as the research objects. The incidence of postoperative complications (Clavien-Dindo gradeⅡ and higher) was observed, and then 500 patients were divided into a complication group and a non-complication group. The preoperative physical conditions, operative time and bleeding volume related to the operation were compared and analyzed between the two groups. According to the analysis results and clinical experience, appropriate variables were selected to be included in the multivariate binary logistic regression model for analysis, in order to determine the risk factors for postoperative complications in patients with malignant gastrointestinal tumors. ResultsOf the 500 patients, 453 had no postoperative complications (non-complication group), and 47 had postoperative complications (complication group), with an incidence of 9.4%. Univariate analysis showed that there were significant differences between the complication group and the non-complications group in gender, abdominal girth, preoperative hypoalbuminemia, drinking history, protein diet habits, primary diseases, operative time and intraoperative blood loss (P<0.05), while there were no significant differences between the two groups in age, body mass index, preoperative grip strength, 6 m walking test time, preoperative anemia, hypertension, diabetes, cardiovascular and cerebrovascular diseases, smoking history, education level, exercise habits and preoperative NRS 2002 nutritional score (P>0.05). Multivariate binary logistic regression analysis showed that gender, daily protein diet and exercise frequency, operation time >200 min and intraoperative blood loss >150 mL could be used as independent predictors of postoperative complications in patients with malignant gastrointestinal tumors (P<0.05). ConclusionFor female malignant gastrointestinal tumor patients with low daily protein intake, inadequate physical activity, prolonged operation duration, and massive intraoperative bleeding, perioperative management should be taken in advance and the occurrence of postoperative complications should be vigilant.
Objective To establish the three-dimensional (3D) finite element model of the knee joint including posterolateral complex (PLC), and to simulate the reconstruction biomechanical analysis in this model. Methods The knee of a 26-year-old healthy man was scanned by MRI to obtain the image data of the knee in the coronal, sagittal, and axial position. First, Mimics10.01 and Hyperworks 8.0 softwares were used to extract each slice profile data of the knee joint in a two-dimensional image data respectively and to establish 3D geometric model of bone, meniscus, articular cartilage, and ligament. Second, Unigraphics software NX 4.0 was used to establish a 3D finite element model of knee joint, which had the functions of Mesh, material properties, component connection, and contact definition. Third, displacement measurement on the model and reconstructing biomechanical analysis for PLC simulation were performed. Results The 3D finite element model of the knee joint including PLC was established successfully. Under 134 N forward force, the tibia forward displacement was 4.83 mm. PLC simulation reconstruction biomechanical analysis of the 3D finite element model of the knee joint showed that under 10 N·m varus and external rotation torque conditions, the knee varus and external rotation angles of simulation reconstruction were greater than those of the intact knee, and less than those of PLC missing. Conclusion The 3D finite element model of the knee joint including PLC can be established by the reverse engineering, and it is valid and can be used as the basis for the biomechanical properties to analog reconstruction of PLC.
We aimed to establish an optical coherence tomography (OCT) system to measure the strain of blood vessels. A general OCT system was constructed firstly and its reliability was confirmed by comparing the OCT imaging of the porcine coronary and the corresponding histological slices. The strain of the porcine coronary was induced by static flow pressure and correlation algorithm was used to calculate the strain field of blood vessels within OCT images. The results suggest that bright-dark stratification of blood vessels displayed in OCT images is consistent with the intima and media layers of histological image. Furthermore, the strain of media layer is greater than that of the intima layer under the same static pressure. The optical coherence imaging system could not only measure the histological structure of the blood vessels, but also qualify the vessel strain under flow pressure.
ObjectiveTo review the research progress of different surgical approaches in the treatment of acetabular both-column fractures.MethodsThe domestic and foreign related research literature on surgical approaches for acetabular both-column fractures was extensively consulted. The anatomical characteristics, exposure ranges, advantages, disadvantages, and indications of various common surgical approaches for both-column fractures were mainly summarized.ResultsThe ilioinguinal approach is more suitable for both-column fractures if the anterior column fracture is complicated or combined with the anterior wall fracture while the posterior column fracture is simple and stable. The modified Stoppa approach or the lateral (para) rectus abdominal approach is the preferred choice when both-column fractures are combined with a quadrilateral fracture or femoral head dislocation. What’s more, the Kocher-Langenbeck approach is required when the posterior column fractures are complicated or combined with posterior wall fractures. In addition, the simultaneous ilioinguinal and Kocher-Langenbeck approaches are the first choices when the both-column fractures possessing extremely severe and obvious displacement.ConclusionThe reasonable choice of surgical approach is extremely important for acetabular both-column fractures. Each surgical approach has its advantages and limitations. It is necessary to take the precise reposition of the acetabular joint surface as the principle, and comprehensively judge the fracture types and severity of anterior column, posterior column, and square area, and then select the optimal surgical approach for surgical treatment.
Objective To evaluate the significance of the ultrasound elastography (UE) strain ratio (SR) in the diagnosis of breast nodule by meta-analysis. Methods A computer-based online search was conducted in PubMed, The Cochrane Library (Issue 6, 2017), EMbase, CNKI, VIP, CBM, WanFang data databases, and so on (establishment time to June 2017), to collect the relevant diagnostic trials of the SR for breast nodules. Two reviewers independently screened literatures, extracted data, and evaluated the methodological quality of included studies. The meta-analysis was performed by using Stata 12.0 and Meta-Disc 1.4 software, and the combined indexes included sensitivity (Sen), specificity (Spe), positive likelihood ratio (LR+), negative likelihood ratio (LR–), and diagnostic odds ratio (DOR). Results A total of 26 studies were finally included. The results of meta-analysis showed that, the pooled Sen, Spe, LR+, LR–, and DOR was 0.88 (95% CI was 0.87 to 0.90), 0.85 (95% CI was 0.84 to 0.86), 6.66 (95% CI was 5.26 to 8.43), 0.14 (95% CI was 0.11 to 0.17), and 53.37 (95% CI was 34.96 to 81.49), respectively, P<0.000 1. Conclusion SR has high diagnostic accuracy in the differential diagnosis of benign and malignant breast nodules, it is worthy of widely utilized in the clinic.
ObjectiveTo evaluate the scientificity, transparency and applicability of the Chinese consensuses on urological diseases published in 2021. MethodsPubMed, CBM, CNKI, WanFang Data databases and related websites were electronically searched to collect Chinese consensuses on urological diseases from January 1 to December 31, 2021. Each consensus was scored with the scientific, transparent, and applicable rating (STAR) tools, and analyzed by using descriptive methods. ResultsA total of 28 Chinese consensuses were included. The STAR scores ranged from 9.9 to 32.3 with a mean of 17.3±6.3. The included consensus had a high score ratio in the items such as listing participants and institutions, providing identifiable recommendations, explaining the precautions for implementation of recommendations, having corresponding references for recommendations, and reporting future research directions. However, only 14.3% reported the methodology of consensus formation, and the record of consensus process and consideration of patient preferences, values and costs were not noted. No consensus reported responsibilities of panel specialists in the method section or included experts in the field of guideline methodology or evidence-based medicine. No consensus reported detailed information in managing conflicts of interest. Few reported no affection by funding. No consensus reported methods for collecting and selecting clinical questions, or evaluating, summarizing and grading evidence. Research gaps were not reported in a clear or standardized way. ConclusionAs a medical guidance document, expert consensus still plays an important role now in China. The quality of consensus on urological diseases can be further improved in methods of consensus formation, working groups, conflicts of interest, funding, accessibility, clinical questions, retrieval and evaluation of evidence, research gap, etc.
Objective To analyze the drug resistance genes, virulence genes and homologies of carbapenem-resistant Klebsiella pneumoniae (CRKP) colonized and infected patients in surgical intensive care unit based on whole genome sequencing. Methods Whole genome sequencing analysis was performed on CRKP infected strains isolated from the Department of General Surgery Intensive Care Unit and the Department of Liver Surgery Intensive Care Unit of Zhongshan Hospital, Fudan University in March 2021 and CRKP colonized strains isolated from the above departments between January and March 2021. The drug resistance genes, virulence genes and homologies of the strains were analyzed. ResultsA total of 16 CRKP strains were included, including 10 colonized strains and 6 infected strains. Except for the β-lactamase drug resistance gene CTX (16.7% vs. 100.0%, P<0.05), there was no significant difference in the detection rate of other drug resistance genes between CRKP infected strains and colonized strains (P>0.05). The cluster analysis of drug resistance genes of some strains was relatively close. Whole genome sequencing analysis showed that CRKP strains carried a variety of virulence genes, and the detection rates of entB, irp2, iroN, and rmpA genes were 100.0%, 87.5%, 37.5%, and 62.5%, respectively. There was no significant difference in the detection rate of virulence genes between CRKP infected strains and colonized strains (P>0.05). Homology analysis showed that some strains had close homologous relationships, and there was the possibility of cross transmission. Conclusions Some of CRKP infection strains and colonization strains in surgical intensive care unit patients have the risk of cross transmission. In the future, we should strengthen the prevention and control of nosocomial infection to reduce the incidence of infection.