Objective To investigate the impact of tibial tunnel position on postoperative knee function and stability in patients undergoing artificial posterior cruciate ligament (PCL) reconstruction. Methods A retrospective analysis was conducted on patients who underwent single knee artificial PCL reconstruction between January 2018 and September 2024 and met the inclusion criteria. Based on postoperative three-dimensional (3D)-CT measurements of the tibial tunnel position, the patients were allocated into a low tunnel group (n=35) and a high tunnel group (n=30). Except for gender, there was no significant difference between groups (P>0.05) in age, body mass index, injury side, time from injury to operation, preoperative posterior drawer test grade, knee range of motion (ROM), Tegner score, Lysholm score, International Knee Documentation Committee (IKDC) score, or the composition ratio of combined meniscus and cartilage injuries. The tibial tunnel positions were compared. Postoperative recovery of knee function was evaluated using the IKDC score, Lysholm score, Tegner score, and knee ROM. The differences between pre- and post-operative values (change values) for these indicators were calculated and compared between groups. Posterior knee stability was assessed using the posterior drawer test and the side-to-side difference (SSD) in tibial posterior translation measured on stress radiographs. Patient satisfaction was evaluated using the visual analogue scale (VAS) score. Postoperative complications such as graft failure were recorded. Results The relative proximal-distal position of the tibial tunnel was significantly lower in the low tunnel group than in the high tunnel group (P<0.05), while no significant difference was found in the relative medial-lateral position between groups (P>0.05). All operations were successfully completed, and incisions healed by first intention. All patients were followed up 12-86 months, with a median follow-up of 23.0 months. The low tunnel group demonstrated superior posterior stability compared to the high tunnel group, showing a significantly lower SSD and lower posterior drawer test grade at last follow-up (P<0.05). At last follow-up, the change value in the Tegner score and the VAS score for patient satisfaction were significantly higher in the low tunnel group than in the high tunnel group (P<0.05). No significant difference was found between groups in the change values for IKDC score, Lysholm score, or knee ROM (P>0.05). Two patients in the high tunnel group underwent revision surgery due to graft failure, whereas no such adverse events occurred in the low tunnel group. The difference in the incidence of complications between groups was not significant (P>0.05). Conclusion Compared with a high tibial tunnel, the low tibial tunnel technique can effectively reduce the graft’s turning angle at the proximal tibia and lower the risk of graft failure, thereby significantly improving posterior knee stability and function recovery after artificial PCL reconstruction.
ObjectiveTo discuss the current status and progress of delayed gastric emptying (DGE) after pancreaticoduodenectomy (PD).MethodThe related researches about DGE after PD in recent year were searched and reviewed.ResultsThe etiology and pathogenesis of DGE had not yet been fully elucidated. There were various risk factors, such as the surgical trauma, advanced age, diabetes, and with other abdominal complications. The pylorus preserving PD didn’t increase the risk of DGE. The pylorus ring resection, anterior colon, Braun anastomosis, and minimally invasive surgery were beneficial for reducing DGE. Although there was no obvious progress in the treatment of DGE at home and abroad, the majority of patients could be cured by the symptomatic conservative treatment.ConclusionsPrevention is a main strategy for DGE after PD. Application of enhanced recovery after surgery might be a key to solve problem in clinical, but further research is needed.
ObjectiveTo observe repairing process of trachea epithelium cells in chlorine-induced airway epithelial injury.MethodsTwelve mice were exposed to chlorine gas and prepared the mice model of airway damage. Three mice were executed respectively on 2nd, 4th, 7th, 10th day after exposure to chlorine gas, and tracheal tissues were collected. In addition 3 normal mice served as control. Airway repair and cell proliferation were detected by EdU labeling method. The basal cell markers keratin 5 (K5), keratin 14 (K14) were adopted as the tracheal epithelial markers for locating the position of the proliferation of repairing cells. Morphological analysis was adopted to measure the proliferation rate as well as the recovery of the false stratified epithelium.ResultsIn the control group, cell proliferation rate was very low, all basal cells expressed K5, and most basal cells did not express K14. Most of epithelial cells shed from the trachea epithelium after exposure to chlorine gas. 2-4 days after chlorine exposure, K5 and K14 expression basal cells increased, K14 expression cells increased greatly. In the peak period of cell proliferation, only a small number of ciliated cells appeared in the repairing trachea area. Epithelial cells repaired fast and widely at the bottom of the trachea.ConclusionThe trachea residual basal cells play roles of progenitor cells and repair the airway epithelium after chlorine damage in mice.
Objective To evaluate the clinical application value of four inflammatory indices [monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR)] in predicting postoperative mortality risk in patients with Siewert type Ⅱ esophagogastric junction adenocarcinoma, and to explore the predictive performance of four inflammatory indices. Methods This retrospective study collected clinical data from 310 patients with Siewert typeⅡ esophagogastric junction adenocarcinoma who were admitted to the Second Hospital of Lanzhou University between October 2016 and March 2023, and met the inclusion and exclusion criteria. Univariate analysis was used to initially screen variables related to postoperative mortality risk. The variance inflation factor (VIF) analysis was performed to assess multicollinearity issues, and multivariate regression analysis was used to further reveal the independent effects of key variables on postoperative mortality risk. The performance of the predictive models was evaluated using receive operatior characteristic curves and Kaplan-Meier survival analysis, and the effects of different inflammatory indices on patient survival were explored. Finally, machine learning methods such as Light GBM, random forest, support vector machine (SVM), and XGBoost were used to evaluate the predictive performance of the four inflammatory indices. Results The four inflammatory indices were significantly associated with postoperative mortality risk in patients with Siewert type Ⅱ esophagogastric junction adenocarcinoma (MLR: HR=2.6884, 95% CI 1.4559 to 4.9642, P=0.002; PLR: HR=1.0022, 95% CI1.0001 to 1.0043, P=0.041; SII: HR=1.0003, 95% CI1.0001 to 1.0006, P=0.002; NLR: HR=1.0697, 95% CI 1.0277 to 1.1134, P=0.001). Machine learning model results showed that NLR had the best performance in the random forest model, with an AUC of 0.863 in the training set and an AUC of 0.834 in the test set. Conclusion Preoperative clinical indicators, especially the NLR inflammatory factor, are of significant importance in predicting the postoperative mortality risk of patients with Siewert typeⅡ esophagogastric junction adenocarcinoma.
Objective To systematically review the rate of sleep deprivation in children and adolescents in China from 2004 to 2019. Methods PubMed, The Cochrane Library, EMbase, Web of Science, CBM, CNKI and WanFang Data databases were searched to collect cross-sectional studies on the sleep deprivation rate of children and adolescents in China from inception to July 15th, 2021. Two researchers independently screened literature, extracted data and evaluated the risk of bias of the included studies. Meta-analysis was then performed by using Stata 15.0 software. Results A total of 45 cross-sectional studies were included, with a total sample size of 769 918 participants, of whom 587 457 reported sleep deprivation. The results of meta-analysis showed that the sleep deprivation rate of Chinese children and adolescents was 61% (95%CI 55% to 68%). Subgroup analysis indicated that the sleep deprivation rates were 62% for female children and 59% for male children. The rate was 84% in junior high school, 80% in high school and 64% in primary school. The rates in south China, southwest China, northwest China, north China, east China and central China were 68%, 62%, 61%, 57%, 57% and 54%, respectively. The rate of sleep deficiency based on "health requirements for daily study time of primary and junior school students" was the highest at 74% (95% CI 70% to 79%). The cumulative meta-analysis by time showed that the sleep deprivation rate had gradually stabilized and approached 60% since 2011. Conclusion Current evidence shows that the sleep deprivation rate of Chinese children and adolescents is high. Due to the limited quality and quantity of included studies, more high-quality studies are needed to verify the above conclusion.
ObjectiveTo analyze the factors affecting the prognosis of patients with primary tracheal malignancy, and establish a nomogram model for prediction its prognosis.MethodsA total of 557 patients diagnosed with primary tracheal malignancy from 1975 to 2016 in the Surveillance, Epidemiology, and End Results Data were collected. The factors affecting the overall survival rate of primary tracheal malignancy were screened and modeled by univariate and multivariate Cox regression analysis. The nomogram prediction model was performed by R 3.6.2 software. Using the C-index, calibration curves and receiver operating characteristic (ROC) curve to evaluate the consistency and predictive ability of the nomogram prediction model.ResultsThe median survival time of 557 patients with primary tracheal malignancy was 21 months, and overall survival rates of the 1-year, 3-year and 5-year were 59.1%±2.1%, 42.5%±2.1%, and 35.4%±2.2%. Univariate and multivariate Cox regression analysis showed that age, histology, surgery, radiotherapy, tumor size, tumor extension and the range of lymph node involvement were independent risk factors affecting the prognosis of patients with primary tracheal malignancy (P<0.05). Based on the above 7 risk factors to establish the nomogram prediction model, the C-index was 0.775 (95%CI 0.751-0.799). The calibration curve showed that the prediction model established in this study had a good agreement with the actual survival rate of the 1 year, 3 year and 5 years. The area under curve of 1-year, 3-year and 5-year predicting overall survival rates was 0.837, 0.827 and 0.836, which showed that the model had a high predictive power.ConclusionThe nomogram prediction model established in this study has a good predictive ability, high discrimination and accuracy, and high clinical value. It is useful for the screening of high-risk groups and the formulation of personalized diagnosis and treatment plans, and can be used as an evaluation tool for prognostic monitoring of patients with primary tracheal malignancy.
In order to achieve the automatic identification of liver cancer cells in the blood, the present study adopted a principal component analysis (PCA) and back propagation (BP) algorithm of feedforward neural networks to identify white blood cells and red blood cells in mice and human liver cancer cells, HepG2. The present paper shows the process in which PCA was carried out after obtaining spectral data by fiber confocal back-scattering spectrograph, selecting the first two principal components as spectral features, and establishing a neural network pattern recognition model with two input layer nodes, eleven hidden layer nodes and three output nodes. In order to verify whether the model would give accurate identification of cells, we chose 195 object data to train the model with 150 sets of data as training set and 45 sets as test set. According to the results, the overall recognition accuracy of the three cells was above 90% with the average relative deviation only 4.36%. The results showed that PCA+BP algorithm could automatically identify liver cancer cells from erythrocyte and white blood cells, which will provide a useful tool for the study of metastasis and biological metabolism characteristics of liver cancer.
Objective To explore the effects of aggressive lipid lowering therapy and its influence on cardiovascular events using lipitor (20 mg daily) for Chinese people after percutaneous coronary intervention (PCI). Methods We did a double-blind and randomized controlled trial. From July 2005 to June 2006, 120 patients with PCI procedure who were discharged from the Shanghai Chest Hospital were randomly divided into aggressive lipid lowering group (atorvastatin 20 mg daily, n=60) and an ordinary lipid lowering group (atorvastatin 10 mg daily, n=60). The trial treatment was administered from the day of PCI to the third month after PCI. Atorvastatin at 10 mg daily was then used until one year after PCI. Blood biochemistry, cardiovascular events and drug adverse reactions were compared between the two groups. Results Among the 120 patients, 5 discontinued treatment and 4 more withdrew from the study. Therefore 115 and 111 were included in our main analyses [Comment from Mike: it is not ITT if the 5 who discontinued treatment are excluded] and a per-protocol (PP) analysis, respectively. Baseline clinical characteristics were comparable between the two groups. The reduction in TG and the increase in HDL-C were similar between the two groups (Pgt;0.05), but the reductions in LDL-C and TC were significantly different between the two groups (Plt;0.05). This was observed from the beginning of follow-up to the third month after PCI. In the PP analysis, the percentage of patients whose LDL-C met the predefined requirement at the third month in the 20 mg group was significantly higher than in the group receiving the lower dose (87.03% vs. 70.17%, P=0.031). A similar result was also obtained if the patients who withdrew were retained in the analysis (P=0.044). The change in C reaction protein (CRP) from baseline at the first and the third month was significantly different between the two groups (Plt;0.05), but become relatively stable at the sixth month (Pgt;0.05). The mean follow-up duration was 6.5±3.0 months in the higher dose group, with 1 case of recurring angina pectoris and 1 case of revascularization were identified. It was 7.2±3.6 months in the 10 mg daily group, with 3 cases of recurring angina pectoris, 1 case of nonfatal myocardial infarction, 2 cases of revascularization and 1 case of sudden cardiogenic death. The difference in the Kaplan-Meier event curves was of borderline statistical significance from the fourth month (P=0.048). Drug adverse reactions were mild and myopathy was not identified in any patients. Conclusions After PCI procedure, the use of atorvastatin 20 mg daily for aggressive lipid lowering was safe and effective.
Objective To introduce a simple preoperative risk score for esophageal cancer (PRSEC) and its relationship with the prognosis of patients who underwent resection of esophageal carcinoma. Methods We retrospectively analyzed the clinical data of 498 patients receiving resection of esophageal carcinoma between 2005 and 2015 in our hospital. They were divided into three groups (PRSEC1, PRSEC2 and PRSEC3 groups) according to the results of PRSEC (revised cardiac risk index, model for end-stage liver disease score and pulmonary function test). Their overall survival (OS) and disease-free survival (DFS) were measured to find the relationship between the PRSEC and prognosis of patients. Results The mortality, morbidity, DFS and OS were correlative with the PRSEC. Therefore the PRSEC can be used to predict the short-term outcome. The patients with score 2 or 3 had higher risk of mortality and morbidity than those with score 1. In addition, the DFS and OS of patients with higher score were shorter (P<0.001). Conclusion The PRSEC is easy and efficient and can predict the morbidity, mortality, and long-term outcomes for the patients with resection of esophageal carcinoma.
ObjectiveThis study aims to study the effects and mechanism of resveratrol on hepatocellular carcinoma (HCC) cells through phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt) axis.MethodsHepG2 cells at logarithmic growth stage were treated with different concentrations (0, 12.5, 25.0, and 50.0 μmol/L) of resveratrol, respectively. Then the proliferation of HepG2 cells was detected by the CCK8 method and real time cell anaIysis (RTCA) system, the expressions of signal molecules associated with PI3K/Akt axis was detected by the Western blot method, including PI3K p58, phosphorylation protein kinase B (p-Akt), total protein kinase B (t-Akt), and CyclinA2 protein.ResultsResveratrol had a significant inhibitory effect on the growth of HepG2 cells in a time and dosage dependent manner. After 48 h treatment of resveratrol to HepG2 cells, 50.0 μmol/L resveratrol inhibited the growth of HepG2 cells most significantly. Further, the RTCA system studies also found that resveratrol had a time and concentration dependent effect on the reduction of normalized cell index (NCI) in HepG2 cells. Flow cytometry results showed that, apoptosis rates of 12.5, 25.0, and 50.0 μmol/L group were higher than that of 0 μmol/L group. Compard with 0 μmol/L group, the expressions of PI3K p85, p-Akt, and CyclinA2 protein in HepG2 cells of 12.5, 25.0, and 50.0 μmol/L resveratrol group was significantly higher (P<0.05), although there was no significant effect of resveratrol on the expression of t-Akt in HepG2 cells (P>0.05).ConclusionsResveratrol might have anti-proliferation effects on HepG2 cells through PI3K p85/Akt signaling axis. This study could provide a novel idea for the treatment to HCC.