Objective To investigate the role of expression of T cell costimulatory molecule CD28 and variance of T cell subpopulations in the development and prognosis of gastric cancer and colorectal cancer. Methods The peripheral blood lymphocytes were tested for T cell subpopulations and T cell costimulatory molecule CD28 by flow cytometry in 38 patients with gastric cancer, 42 patient s with colorectal cancer , and 21 healthy peoples as control group . Results Expressions of T cell costimulatory molecule CD28 in patients with gastric cancer and colorectal cancer were (25. 80 ±10. 56) % and (28. 95 ±9. 29) % , and significantly higher than that of control group 〔(0. 82 ±0. 98) % , Plt; 0. 01〕. Expression percentage of total T cell (CD3 + ) in patient s with gastric cancer and colorectal cancer were significantly lower than that of control group 〔(53. 61 ±13. 84) % and (55. 96 ±10. 68) % vs (72. 07 ±7. 83) % , Plt; 0. 01〕. Expression percentage of CD4 + T cell (CD4 + CD3 + ) in patients with gastric cancer and colorectal cancer were significantly lower than that of control group 〔( 29. 84 ±9. 71) % and ( 33. 75 ±9. 04) % vs (38. 79 ±5. 08) %; Plt; 0. 01 , Plt; 0. 05〕; Expression percentage of CTL cell (CD8 + CD28 + CD3 + ) in patient s with gastric cancer and colorectal cancer were significantly higher than that of control group 〔( 1. 57 ±1. 99) % and (1. 93 ±2. 61) % vs (0. 02 ±0. 04) %; P lt; 0. 01〕; Expression percentage of CD8 + inhibitory T cell (CD8 + CD28 -CD 3 + ) and CD4 / CD8 ratio in patient s with gastric cancer were significantly lower than that of control group 〔(16. 06 ±6. 94) % vs (20. 56 ±6. 54) % , Plt; 0. 05 ; (1. 10 ±0. 51) % vs (1. 36 ±0. 31) % , P lt; 0. 05〕; Expression of regulatory T cell (CD4 + CD25 + CD3 + ) of patients with colorectal cancer was (19. 74 ±6. 89) % , which was significantly higher than that of control group 〔(13. 72 ±3. 08) % , Plt; 0. 01〕. No difference of expression was found in peripheral T cell subpopulations of postoperative patients with gastric cancer and colorectal cancer after one week ( Pgt; 0. 05) . Conclusion T cell number is fall ,T cell costimulatory molecule CD28 useless expression is increase in patient s with gastric cancer and colorectal cancer. CD4 + T cell subpopulation is significantly decreased in patient s with gast ric cancer. The regulatory T cell of patient s with colorectal cancer is significantly increased.
Objective To evaluate the sonographic characteristics of peripheral focal inflammation of lung, and to improve the diagnosis and differential diagnosis potency of sonography for pulmonary peripheral lesions. Methods The sonogram of 44 patients with peripheral focal inflammation of lung were retrospectively analyzed and compared with the sonogram of other lesions. Independent variables included lesion’s margin, echotype, the secondary change of visceral pleura, the angulation of lesion’s inner surface and air bronchogram. Lesion’s nature was as dependent variable. The data was analyzed by Logistic regression analysis. Pathological results were confirmed by biopsy. Results The angulation of lesion’s inner surface and air bronchogramwere significant factors affecting the diagnosis of peripheral focal inflammation of lung( P lt;0. 01) . Compared to the pathological yield by biopsy, angulation of lesion’s inner surface being acute angle for diagnosis of peripheral focal inflammation of lung had an accuracy rate of 82. 6% , a sensitivity of 72. 7% , a specificity of 84. 7% , a positive predictive value of 51. 0% , and a negative predictive value of 93. 4%. Conclusions The acute angle of lesion’s inner surface and air bronchogram are sonographic characteristics of peripheral focal inflammation of lung. Bedside lung ultrasound is useful to the diagnosis of peripheral focal inflammation of lung.
Skin aging is the most intuitive and obvious sign of the human aging processes. Qualitative and quantitative determination of skin aging is of particular importance for the evaluation of human aging and anti-aging treatment effects. To solve the problem of subjectivity of conventional skin aging grading methods, the self-organizing map (SOM) network was used to explore an automatic method for skin aging grading. First, the ventral forearm skin images were obtained by a portable digital microscope and two texture parameters, i.e., mean width of skin furrows and the number of intersections were extracted by image processing algorithm. Then, the values of texture parameters were taken as inputs of SOM network to train the network. The experimental results showed that the network achieved an overall accuracy of 80.8%, compared with the aging grading results by human graders. The designed method appeared to be rapid and objective, which can be used for quantitative analysis of skin images, and automatic assessment of skin aging grading.
Objective To investigate the effects of normal saline flushing and its frequency on extracorporeal circuit lifespan and solute removal in continuous renal replacement therapy (CRRT) without anticoagulation. Methods Patients undergoing continuous veno-venous hemodiafiltration (CVVHDF) without anticoagulation between June and September 2021 were prospectively collected. The patients were randomly divided into three groups by envelope method, namely 30 min-flushing group (flushing every 30 minutes for extracorporeal circulation), 2 h-flushing group (flushing every 2 hours for extracorporeal circulation), and non-flushing group (no flushing for extracorporeal circulation during treatment). All patients were treated with Prismaflex V8.0 CRRT machine and matched AN69ST-ST150 extracorporeal circuit, through either femoral or internal jugular venous double-lumen catheter. CVVHDF was adopted, the blood pump rate was 200 mL/min, and the rates of replacement fluid and dialysate were both 1 000 mL/h. The replacement fluid was pre-post dilution. Extracorporeal circuit lifespan, treatment time delayed by flushing, overall treatment time of CRRT, actual treatment time of CRRT, proportion of actual treatment time achieved, delayed daily treatment time, and small molecule solute removal efficiency before and after treatment were recorded. Results A total of 83 patients were included, including 24 in the 30 min-flushing group, 30 in the 2 h-flushing group, and 29 in the non-flushing group. There were significant differences in the indexes of extracorporeal circuit lifespan and various treatment time indicators among the three groups (P<0.05). Compared with the 2 h-flushing group and the non-flushing group, the 30 min-flushing group significantly shortened the extracorporeal circuit lifespan, delayed more treatment time by flushing, and delayed the longest daily treatment time (P<0.05). The proportion of actual treatment time in the non-flushing group was significantly higher than that in the 30 min-flushing group and the 2 h-flushing group (P<0.05), and in the 2 h-flushing group was also higher than that in the 30 min-flushing group (P<0.05). There was no significant difference in the blood urea nitrogen clearance rate among the three groups (P=0.570), but the serum creatinine clearance rate was significantly different among the three groups (P=0.020). Compared with the 30 min-flushing group, the 2 h-flushing group had a higher serum creatinine clearance rate, and there was statistical significance (P<0.05). Twenty-five patients had hypotension during treatment. The frequency of 30 min-flushing caused a higher risk of coagulation during cardiopulmonary bypass (hazard ratio=2.502, P=0.001). Conclusion For CVVHDF without anticoagulation, longer extracorporeal circuit lifespan and longer effective treatment time can be achieved without using normal saline flush.
ObjectiveTo compare the therapeutic efficacy of biliary tract stent placing for malignant obstruction of biliary tract by percutaneous transhepatic cholangiography (PTC) or endoscopic retrograde cholangiography (ERC). MethodsPTC approach: choosing the expansion intrahepatic bile duct which had a large angle traveling with common bile duct at the ultrasound-guided, we performed bile duct puncture and inserted the drainage pipe into it, then stent was placed with 68 cases (2 cases among the total were failure of ERC approach) after a week drainage. ERC approach: inserting drainage tube into the common bile duct by duodenal endoscopic retrogradely, the angiography showed obstruction site, the guide wire inserted through the obstruction site, then stent was placed along the guide wire with 53 cases. ResultsThe achievement ratio of stent placing by PTC was 100%(68/68), and which by ERC was 96.2%（51/53）. The complications (bleeding, bile leakage) didn’t happen in two groups. 1-18 months (average 12.4 months) of follow-up, the died cases of PTC group and ERC group were 7 and 5 cases within 6 months, respectively; the survive cases of which were 17 and 9 cases after 18 months of treatment, respectively. ConclusionsThe biliary tract stent placing is a safe and effective method to the malignant obstruction of biliary tract patients who can not drainage tube be treated by operation. It can relieve biliary obstruction efficiency, and can increase live time and life quality for patients. We can choose the stent placing method by ERC for cases whose obstruction site is at the inferior of common bile duct or duodenal ampulla, and the cases whose obstruction site is at the above of hepatic porta should be chosen by PTC.
Objective To explore and summarize the application of minimally invasive technique to every stage of severe acute pancreatitis (SAP). Methods The treatment of 101 SAP patients admitted to our hospital between January 1995 and December 2008 were retrospectively analyzed. After calculi were removed by endoscopic retrograde cholangiopancreatograpy (ERCP) and endoscopic sphincterotomy (EST), endoscopic nasobiliary drainage (ENBD) were applied, then rhubarb liquid was perfused into gut with a nutrient canal and ultrasound-guided abdominal drainage tube were simultaneously placed at the early stage. Some patients received continuous renal replacement therapy (CRRT) at the same time. Laparoscopic cholecystectomy (LC) was performed at the subacute stage, and choledochoscope was introduced to remove parapancreatic necrotic tissues at the late stage of SAP.Results Of all the 101 cases treated by the method mentioned above, 75 cases received ERCP (or EST) and ENBD, and 31 cases underwent rhubarb liquid perfusion with a nutrient canal. Eight cases underwent continuous renal replacement therapy (CRRT). Forty-eight cases underwent LC and ultrasoundguided abdominal drainage. Thirtysix cases with infected peripancreatic tissue or abscess underwent debridement under choledochoscope 3 to 14 times at the later stage. Five cases died of multiple organ failure (MOF) and acute respiratory distress syndrome (ARDS). The hemobilia ocurred in 2 patients during choledochoscopy and was cured under direct visualization by electric coagulation. Intestinal fistula happened in 3 cases and cured by drainage. Pancreatic pseudocyst was latterly seen in 3 cases and treated by the anastomosis of cyst with jejunum through selective operation. After the hospitalization of 9-132 d (mean 24 d), 96 cases completely recovered. Conclusion Timely application of minimally invasive technique to every stage of SAP can avoid the defects of traditional operations, decrease the injury and interference to the maximum, and raise the cure rate.
ObjectiveTo investigate the clinical features and changes of EEG in children with late onset epilepsy spasm. MethodsThe clinical data, treatment, follow-up and outcome of 13 patients with late-onset epilepsy spasms were analyzed retrospectively from June 2010 to August 2015 in Bo ai Hospital of Zhong Shan City.Affiliated Southern Medical University ResultsThirteen cases of children were enrolled in the group, including 9 males and 4 females, the onset of age were 1 year 3 months to 5 years 7 months, duration of treatment were 1 year 5 months to 4 years 8months.Seven cases of children had clear cause in 13 patients: 2 cases of viral encephalitis, 3 cases of HIE, 1 case of neonatal sepsis, ARDS, and 1 case of methylmalonic acid hyperchomocysteinemia.Six cases did not clear the cause.Spasm is still the main type of Seizures.Seven cases had seizures with partial origin.the most onset time were awake period and wake up for the time, and coexisted with other types of seizures.EEG in Epileptic seizures period was a broad range of high amplitude slow wave, slow bursts, complex or non-composite low amplitude fast wave, sometimes with the burst after the voltage attenuation of a few seconds, string or isolation occurs.Synchronous bilateral deltoid EMG monitoring showed bilateral or unilateral synchronous EMG 1 ~ 2s Bilateral or unilateral synchronous EMG outbreak1-2s.Intermittent EEG showed multifocal and extensive epileptic discharge, still sharp (spine) slow wave continuous release based.Treatment: All children underwent ACTH or methylprednisolone immunoregulation treatment, 3 cases underwent ketone diet therapy.At the same time choice valproic acid, topiramate, clonazepam, lamotrigine, levarabesilan and other anti-broad-spectrum antiepileptic drugs, according to the history.all children were taken in combination with the way.Prognosis: 13 patients'seizures reduced or controled after the end of the ACTH or methylprednisolone immunotherapy course.followed-up 3 to 12 months, the clinical attack control were failed 3 cases had relatively good prognosis, treated with Ketogenic diet (Lasted for 1 year 3 mothes~2 years 5 mothes), one case of attack control, mental improvement significantly, Another 2 cases, the numbers of episodes were reduced and the level of intelligence were significantly improved. ConclusionPerinatal factors and acquired brain injury are the most common cause of pathogenesis.Spasm as a major form of attack, and other forms of coexistence.EEG is not typical of high degree of performance.Simultaneous EMG monitoring shows bilateral or unilateral synchronous EMG outbreaks.The treatment of various antiepileptic drugs were ineffective.The vast majority of patients developed refractory epilepsy.Ketogenic diet treatment may be a relatively good choice.
Objective To explore the feasibility and effect of infusion pump potassium supplementation in continuous renal replacement therapy (CRRT). Methods Patients who underwent CRRT were randomly divided into infusion pump group and traditional way group between March and May 2018. In infusion pump group, 10% potassium chloride was supplemented with infusion pump. In traditional way group, 10% potassium chloride was supplemented in the traditional way, which meant adding potassium in the replacement solution. The peripheral blood potassium level, the potassium well-controlled rate, the incidence of adverse events, the average frequency of replacement liquid bags change, the average pump stopping time, and the delivery dose and potassium supplement dose between the two groups were compared. Results A total of 60 patients were randomly divided into two groups, with 30 cases in each group. The infusion pump group was treated with an average of 6.90 mL/h potassium supplement dose by infusion pump, and in traditional way group, potassium was added to the replacement solution by an average of 9.29 mL/h; there were significant differences between the two groups (P<0.05). When compared with traditional way group, there was no significant differences (P>0.05) in the peripheral blood potassium level and the potassium well-controlled rate of the patients at 0, 2, 8, 12 and 24 hours after CRRT (P>0.05). As for the adverse events rate, average frequency of replacement liquid bags change, average pump stopping time, and potassium supplement dose, there were significant differences between the two groups (P<0.05). Conclusions The application of infusion pump to supply potassium in CRRT is feasible and safe, and is superior to the traditional potassium supplement method. It could be further applied in clinical practice.
Objective To investigate the effectiveness of arthroscopic anterior cruciate ligament (ACL) reconstruction via transtibial (TT) and transportal (TP) techniques after 10 years follow-up. Methods A clinical data of 103 patients who underwent arthroscopic ACL reconstruction with a single bundle of autologous hamstring tendon between March 2006 and March 2009 was retrospectively analyzed, among which 57 patients were reconstructed with TT technique (TT group) and 46 patients were reconstructed with TP technique (TP group). There was no significant difference in gender, age, cause of injury, interval between injury and operation, preoperative pivot shift test, preoperative International Knee Documentation Committee (IKDC) score, Lysholm score, and KT-2000 side-to-side difference (SSD) between the two groups (P>0.05). At 10 years after operation, Lachman test was used to evaluate the forward joint stability and pivot shift test to evaluate the rotational stability of the knee; KT-2000 SSD was used to measure tibial anterior displacement; IKDC score and Lysholm score were used to evaluate knee function; MRI examination was performed to observe graft healing and measure coronal inclination angles of the tibia and femoral tunnels. The rate of return to sports was also calculated. Results The incisions healed by first intention in the two groups, and no early complication occurred after operation. All patients were followed up 10-13 years, with an average of 11.5 years. During the follow-up period, there was no limitation of knee extension and flexion, no discomfort of donor site or graft failure in either group. MRI examination showed that the graft healed well. The IKDC score, Lysholm score, and KT-2000 SSD in the two groups were significantly improved after 10 years (P<0.05), and there was no significant difference between the two groups at 10 years after operation (P>0.05). There were significant differences in coronal inclination angles of femoral tunnel and tibial tunnel between the two groups (P<0.05). There was no significant difference in Lachman test and pivot shift test between the two groups (P>0.05). The rate of return to sports of patients was 61.40% (35/57) in TT group and 63.04% (29/46) in TP group, showing no significant difference between the two groups (χ2=0.29, P=0.87). Conclusion TT and TP techniques can both achieve good effectiveness in ACL reconstruction.
Kidney tumor is one of the diseases threatening human health. Ultrasound is widely applied in kidney tumor diagnosis due to its high popularization, low price and no radiation. Accurate segmentation of kidney tumor is the basis of precise treatment. Kidney tumors often grow in the middle of cortex, so that segmentation is easy disturbed by nearby organs. Besides, ultrasound images own low contrast and large speckle, leading to difficult segmentation. This paper proposed a novel kidney tumor segmentation method in ultrasound images using adaptive sub-regional evolution level set models (ASLSM). Regions of interest are firstly divided into subareas. Secondly, object function is designed by integrating inside and outside energy and gradient, in which the ratio of these two parts are adjusted adaptively. Thirdly, ASLSM adapts convolution radius and curvature according to centroid principle and similarity inside and outside zero level set. Hausdorff distance (HD) of (8.75 ± 4.21) mm, mean absolute distance (MAD) of (3.26 ± 1.69) mm, dice-coefficient (DICE) of 0.93 ± 0.03 were obtained in the experiment. Compared with traditional ultrasound segmentation method, ASLSM is more accurate in kidney tumor segmentation. ASLSM may offer convenience for doctor to locate and diagnose kidney tumor in the future.