Safe and effective anticoagulation is the key to successful blood purification. Compared with traditional systemic anticoagulation, regional citrate anticoagulation (RCA) has the advantages of prolonging the life of extracorporeal circulation and reducing bleeding complications. However, the complex protocol, the disorder of electrolyte and acid-base status and the accumulation risk in special populations have dissuaded many clinicians. This review starts with the clinical monitoring of RCA, then analyzes the causes and treatments of complications. The risk assessments in special populations were also introduced in order to the widely promotion of RCA in critically ill patients.
Objective To review the main fixation methods for proximal tibial extra-articular fractures based on clinical and biomechanical results, and to provide evidence for clinical application. Methods Extensive literature search at home and abroad was conducted in recent years, and external fixation systems such as external fixation braces and external locking plates, as well as internal fixation systems such as plates and intramedullary nails, were systematically reviewed regarding their application indications, clinical efficacy, and biomechanical results in proximal tibial extra-articular fractures. Results External fixation systems have advantages in fractures with open or severe soft tissue injury, facilitating wound management and maintaining stability of the fracture site to some extent. However, in proximal tibial extra-articular fractures with good soft tissue conditions, internal fixation systems such as plates and intramedullary nails are still the first choice. Some studies have found that intramedullary nails allow patients to bear weight early, with shorter fracture healing time and higher rate of malunion, while other studies have found that both intramedullary nails and plates have similar clinical efficacy and can achieve satisfactory treatment results. Conclusion The choice of fixation method for proximal tibial extra-articular fractures depends not only on the type of fracture, but also on the surgeon’s habits and operational skills. Larger-scale studies are still needed to clarify the advantages and disadvantages of intramedullary nails and locking plates in the treatment of proximal tibial extra-articular fractures.
Patient-reported outcome (PRO) has been paid increasing attention in lung cancer surgery. It has gradually become an important outcome indicator in clinical research of lung cancer surgery and an important tool for symptom management. Commonly used lung cancer-specific PRO measurement tools include: Lung Cancer Symptom Scale, European Organization for Research and Treatment of Cancer-Core Quality of Life Questionnaire and Lung Cancer module, Functional Assessment of Cancer Therapy-Lung, MD Anderson Symptom Inventory-Lung Cancer module, Postoperative Symptom Scale for Lung Cancer Patients, and Perioperative Symptom Assessment for Lung Surgery. The application of lung cancer-specific scales lacks authoritative implementation norms in the field of lung cancer surgery in terms of scale selection, data collection, and outcome application. This review aimed to analyze the current status of application of PRO scales in lung cancer surgery.
Objective To explore relationship between long non-coding RNA maternally expressed gene 3 (MEG3) polymorphisms and risk of gastric cancer. Methods One hundred and seventy-two Han patients with gastric cancer (gastric cancer group) and 224 Han individuals for physical examination (control group) in the Yunnan Cancer Hospital from March 2013 to October 2017 were selected as subjects. The rs7158663 and rs4081134 polymorphisms of the MEG3 were genotyped by using a TaqMan technique. The associations between the 2 polymorphisms and the risk of the gastric cancer and its clinical features were analyzed using the SPSS software. Results The frequencies of the AG+AA genotype and the A allele of the MEG3 rs7158663 in the gastric cancer group were significantly higher than those in the control group using the GG genotype and G allele as a reference respectively ［adjusted OR=1.71, 95%CI (1.14, 2.56), P=0.010; adjusted OR=1.58, 95%CI (1.15, 2.19), P=0.005］ after the Chi-square test and the adjustment of age and gender. The frequencies of the AG+AA genotype and the A allele of the MEG3 rs4081134 had no significant differences between the gastric cancer group and the control group (P>0.017). Moreover, the polymorphisms of the MEG3 rs7158663 and rs4081134 were not associated with the clinical features of the gastric cancer (P>0.017). Conclusion MEG3 rs7158663 AG+AA genotype might be one of susceptibility gene of gastric cancer in Chinese Han population.
Takayasu arteritis (TA) is a chronic nonspecific inflammation that commonly occurs in the aorta and its main branches. Most patients with TA are lack of clinical manifestations, leading to misdiagnosis. When the TA is correctly diagnosed, the patients may already have stenosis or occlusion in the involved arteries, resulting in arterial ischemia and hypoxia symptoms, and in severe cases it will be life-threatening. Contrast-enhanced ultrasonography (CEUS) is an emerging method for assessing TA, but the assessment relies heavily on experiences of radiologists performing manual and qualitative analyses, so the diagnostic results are often not accurate. To overcome this limitation, this paper presents a computer-assisted quantitative analysis of TA carotid artery lesions based on CEUS. First, the TA lesion was outlined on the carotid wall, and one homogeneous rectangle and one polygon were selected as two reference regions in the carotid lumen. The temporal and spatial features of the lesion region and the reference regions were then calculated. Furthermore, the difference and ratio of the features between the lesion and the reference regions were computed as new features (to eliminate interference factors). Finally, the correlation was analyzed between the CEUS features and inflammation biomarkers consisting of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The data in this paper were collected from 34 TA patients in Zhongshan Hospital undergoing CEUS examination with a total of thirty-seven carotid lesions, where two patients were with two lesions before and after treatment and one patient was with left and right bilateral lesions. Among these patients, 13 were untreated primary patients with a total of 14 lesions, where one patient was with bilateral lesions. The results showed that for all patients, the neovascularization area ratio in the 1/3 inner region of a lesion (ARi1/3) achieved a correlation coefficient (r) of 0.56 (P=0.001) with CRP, and for the primary patients, the neovascularization area ratio in the 1/2 inner region of a lesion (ARi1/2) had an r-value of 0.76 (P=0.001) with CRP. This study indicates that the proposed computer-assisted method can objectively and semi-automatically extract quantitative features from CEUS images, so as to reduce the effect on diagnosis due to subjective experiences of the radiologists, and thus it is expected to be used for clinical diagnosis and severity evaluation of TA carotid lesions.
Objective To summarize clinical features, imaging findings, diagnosis, treatment, and prognosis of patients with hepatic focal nodular hyperplasia. Method The clinical data of patients with hepatic focal nodular hyperplasia who underwent hepatectomy from July 2014 to July 2016 in the Xiangya Hospital of Central South University were analyzed retrospectively. Results There were 12 males and 19 females in the 31 patients with hepatic focal nodular hyperplasia, the male-to-female ratio was 1∶1.58. The age was from 15 to 67 years old with (39.7±11.5) years old. Physical examination found 21 cases, there were symptoms in 10 cases. Laboratory examination: only 2 patients with long-term drinking history had mild AST abnormality, HBsAgs of 6 cases were positive, CA19-9 level of one patient was slightly increased (40.54 kU/L). Thirteen patients with hepatic focal nodular hyperplasia were diagnosed by imaging examination, the diagnostic rate of MRI was significantly higher than that of color Doppler ultrasound (P<0.05) or CT (P<0.05). The diameter of the lesions ranged from 2 cm to 11 cm with (4.6±2.1) cm. All lesions were resected, including 13 cases by laparoscopic hepatectomy, and 18 cases by laparotomy. Compared with by the laparotomy, the intraoperative blood loss was less (P<0.05), the hospital stay and intestinal exhaust time were shorter (P<0.05) by the laparoscopic hepatectomy. Twenty-nine patients were followed up from 3 to 24 months, no patient died, the quality of life was better, no recurrence and metastasis happened. Conclusions Hepatic focal nodular hyperplasia is benign lesion, it has a good prognosis, generally without clinical symptoms, its laboratory feature has no abnormality. The combination of multiple imagings and pathological diagnosis could improve diagnosis rate. Surgical resection should be performed for suspected malignant tumor or other hepatic occupying lesions. Laparoscopic surgery has some advantages of quick recovery and less bleeding for it.
ObjectiveTo systematically evaluate the risk prediction models of acute kidney injury in patients with acute coronary syndrome (ACS) based on machine learning, providing a reference for clinical selection of appropriate risk assessment tools. MethodsClinical studies using machine learning methods for predicting the risk of acute kidney injury in ACS patients were retrieved from PubMed, Cochrane Library, EMbase, Web of Science core database, CNKI, Wanfang Database, Chinese Biomedical Literature Database, and VIP Journal Database. The retrieval time was from the establishment of the database to May 24, 2025, and the quality of the model was evaluated using the prediction model bias risk assessment tool. ResultsNine articles were included, using 20 machine learning methods to construct 58 prediction models. The area under the receiver operating characteristic curve ranged from 0.740 to 0.894. The most commonly used predictors were age and creatinine. The overall bias risk of the included studies was relatively high, but the applicability was good. Conclusion: Machine learning models can identify the risk of acute kidney injury in ACS patients. All models have good predictive potential, but they are still in the development stage. It is recommended that future studies adopt prospective research and external validation to improve the stability and predictive accuracy of the model.
The purpose of our study is to evaluate the diagnostic performance of radiomics in multi-class discrimination of lymphadenopathy based on elastography and B-mode dual-modal ultrasound images. We retrospectively analyzed a total of 251 lymph nodes (89 benign lymph nodes, 70 lymphoma and 92 metastatic lymph nodes) from 248 patients, which were examined by both elastography and B-mode sonography. Firstly, radiomic features were extracted from multimodal ultrasound images, including shape features, intensity statistics features and gray-level co-occurrence matrix texture features. Secondly, three feature selection methods based on information theory were used on the radiomic features to select different subsets of radiomic features, consisting of conditional infomax feature extraction, conditional mutual information maximization, and double input symmetric relevance. Thirdly, the support vector machine classifier was performed for diagnosis of lymphadenopathy on each radiomic subsets. Finally, we fused the results from different modalities and different radiomic feature subsets with Adaboost to improve the performance of lymph node classification. The results showed that the accuracy and overall F1 score with five-fold cross-validation were 76.09%±1.41% and 75.88%±4.32%, respectively. Moreover, when considering on benign lymph nodes, lymphoma or metastatic lymph nodes respectively, the area under the receiver operating characteristic curve of multi-class classification were 0.77, 0.93 and 0.84, respectively. This study indicates that radiomic features derived from multimodal ultrasound images are benefit for diagnosis of lymphadenopathy. It is expected to be useful in clinical differentiation of lymph node diseases.
Objective To investigate the inhibition effect of silence of a disintegrin and metalloproteinase 17 (ADAM17) gene on proliferation and apoptosis of HT29 colon cancer cells and its possible mechanism. Methods HT29cells were divided into 3 groups: cells of interference group were transfected with recombinant lentivirus vector, cells of negative control group were transfected with negative recombinant lentivirus vector, and cells of blank control group were treated with PBS. The expression of ADAM17 mRNA was detected by real-time PCR, the expressions of ADAM17 protein, caspase3, protein kinase B (Akt), glycogen synthase kinase-3β (GSK3β), phospho-protein kinase B (P-Akt), phospho-glycogen synthase kinase-3β (P-GSK3β) protein were detected by Western blot method, the cell proliferation was detected by MTT assay, and the apoptosis rate was detected by Annexin V-FITC/PI cell death detection kit. Results Compared with the control group and the negative control group, the interference group was related to low expressions of ADAM17 mRNA and its protein, low optical density value at the same time point (24, 48, and 72 h), high apoptosis rate, high expression level of caspase3 protein, but low expression levels of P-Akt and P-GSK3β protein (P<0.05). Conclusion Silent ADAM17 gene could significantly induces apoptosis and inhibits the proliferation of HT29 cells, which maybe via inhibiting Akt/GSK3β signaling pathway.
Objective To investigate the association between types of rapid eye movements during sleep and ICD-10 as a mothod for diagnosing depression. Methods Depression was diagnosed according to ICD-10 and changes of 9 variables of REM sleep in 120 psychiatric outpatients and inpatients by calculating the Kappa values. Results In 120 psychiatric patients, 52 depressive patients were diagnosed by using ICD-10, and 58 patients were diagnosed as depression according to decreased REM sleep latency and increased REM activity, REM intensity, REM density, and increasing amount of REM sleep. Kappa value was 0.73, Plt;0.05, which implied that these two diagnosing ways were significantly consistent. Conclusions Measuremen of REM sleep variable should be investigated further as a supplementary method for diagnosing depression.