Objectives: Large cell lung carcinoma (LCLC) is generally poorly differentiated with a poor prognosis. This study aimed to explore the impact of chemotherapy on the prognosis of patients with stage Ⅱ-Ⅳ LCLC and to construct nomograms to predict overall survival (OS) and cancer-specific survival (CSS). Methods: Propensity score matching (PSM) analysis was used to balance the effects of baseline characteristics. The Kaplan-Meier method was used to analyze the prognostic impact of chemotherapy on LCLC patients. Cox regression analysis was used to identify prognostic risk factors, and then nomograms were constructed and validated. Results: Overall, we identified 2532 patients with LCLC from the Surveillance, Epidemiology, and End Results (SEER) database. The chemotherapy group showed better OS and CSS compared to the non-/unknown chemotherapy group for stage II-IV LCLC patients (p < 0.05). Two nomograms were plotted based on the results of Cox regression analysis. The areas under the curves (AUCs) of 1-, 3-, and 5- years OS were 0.786, 0.824, and 0.837, and the AUCs of CSS were 0.785, 0.821, and 0.836. The calibration curves showed excellent agreement between the prediction and the actual observation, and the decision curve analysis (DCA) demonstrated good clinical utility. Conclusions: Chemotherapy could improve the prognosis among stage II-IV LCLC patients. In addition, the nomograms showed good predictive ability, which could be useful in making clinical decisions.
Background: With the increasing prevalence of Tourette syndrome (TS), the search for alternative therapy for TS is a growing public concern. In recent years, a growing number of randomized controlled trials have revealed the value of acupuncture combined with herbal medicine for the treatment of TS; however, its holistic efficacy and safety remains unclear. This study aimed to evaluate the efficacy and safety of acupuncture combined with herbal medicine and to provide preliminary evidence for clinical practice. Methods: Eight databases were searched from their establishment to November 27, 2022 to collect randomized controlled trials (RCTs) of acupuncture combined with herbal medicine for TS treatment. Two researchers independently completed the study screening, data extraction and risk of bias assessment by using NoteExpress, Excel and Cochrane Risk of Bias Tool 2.0 (RoB 2.0). Stata 15.0 software was applied to conduct meta-analysis. Results: A total of 1400 participants in 18 RCTs were included. Compared with the Western medicine (WM) , acupuncture combined with herbal medicine had better curative effect in the field of effective rate (RR = 1.18, 95% CI [1.12, 1.23], P ＜ 0.05, I²= 0%), Yale Global Tic Severity Scale (YGTSS) total score (MD = -3.91, 95% CI [-5.49, -2.33], P ＜ 0.05, I² = 96.4%), TCM syndrome total score (MD = -2.42, 95% CI [-3.71,-1.13], P ＜ 0.05, I² = 87.1%) and serum IgE negative rate (RR = 3.41, 95% CI [1.69, 6.87], P ＜ 0.05, I² = 0%). Furthermore, acupuncture combined with herbal medicine reduced the adverse reaction rate (RR = 0.20, 95% CI [0.14,0.30], P ＜ 0.05, I² = 0%) and the recurrence rate (RR = 0.27, 95% CI [0.13,0.52], P ＜ 0.05, I² = 0%). Conclusion: This study demonstrated the efficacy and safety of acupuncture combined with herbal medicine, which is probably a better alternative therapy for TS. However, the small number, low quality and potential bias of the included studies caused the limitations of our results. More high-quality RCTs are required to provide supplementary evidence in the future.
From 1957 to 1986, 40 cases of central fracture-dislocation of hip joint, 36 fresh and 4 old, were treated. Classification concerning the lesional patterns, indications for operative and non-operative treatment together with the factors affecting prognosis were discussed. In conclusion firstly, treatment by means of traction, simple and easy to handle, is well suited to most cases, if reduction has been satisfactory and maintained well, permitting early motion, for sufficient period of time for healing. Secondly, operation is only fit for fracture-dislocation, of which reduction has not been good enough and that it would not subject the patient to much surgical risk. Lastly, poor reduction, traction time not long enough, accetabular roof fracture or femoral head fracture and extensive damage or concomitant fracture of the same limb are the recessive factors influencing outcome.
Purpose: Inhaled triple therapy (TT) comprising a long-acting muscarinic antagonist, long-acting β 2 agonist, and inhaled corticosteroid is recommended for symptomatic chronic obstructive pulmonary disease (COPD) patients, or those at risk of exacerbation. However, it is not well understood which patient characteristics contribute most to future exacerbation risk. This study assessed patient predictors associated with future exacerbation time following initiation of TT. Patients and Methods: This retrospective cohort study used data from the Optum™ Clinformatics™ Data Mart, a large health claims database in the United States. COPD patients who initiated TT between January 2008 and March 2018 (index) were eligible. Patients were required to be aged ≥ 18 years at index and have continuous enrollment for the 12 months prior to index (baseline) and the 12 months following index (follow-up). Patients who had received TT during baseline were excluded. Data from eligible patients were analyzed using a reverse engineering forward simulation machine learning platform to predict future COPD exacerbation time. Results: Data from 73,625 patients were included. The model found that prior exacerbation was largely correlated with post-index exacerbation time; patients who had ≥ 4 exacerbation episodes during baseline had an average increase of 32.4 days post-index exacerbation, compared with patients with no exacerbations during baseline. Likewise, ≥ 2 inpatient visits (effect size 27.1 days), the use of xanthines (effect size 11.5 days), or rheumatoid arthritis (effect size 6.4 days) during baseline were associated with increased exacerbation time. Conversely, diagnosis of anemia (effect size – 5.68 days), or oral corticosteroids in the past month (effect size – 3.43 days) were associated with reduced exacerbation time. Conclusion: Frequent prior exacerbations, healthcare resource utilization, xanthine use, and rheumatoid arthritis were the strongest factors predicting the future increase of exacerbations. These results improve our understanding of exacerbation risk among COPD patients initiating triple therapy. Keywords: Bayesian modeling, chronic obstructive pulmonary disease, exacerbation, triple therapy, predictive modeling
To study the surgical approach for cranial base tumors removal.Ten cases of cranial base tumors were thoroughly resected via pre-auriculal temporo-sphenoidal approach. Among them, 9 cases with defects of cranial base or nasopharynx were reconstructed with the temporal muscle and fascia in the same operative field.Patients were followed up from 21 months to 7 years. In 2 cases with recurrent cranial base tumors 1 died of recurrence, 1 lived with the tumor. Eight cases achieved good clinical results without severe complications except 1, who got necrosis of temporal muscle.The preauricular temporo-sphenoidal approach not only provides an excellent exposure to the compartments of the skull base with a limited injury to the normal tissues, but also offers a convenient way in reconstructing defects with temporal muscle in the same operative field. The incision scar is hidden and the eosmetic affect small. It has been shown that the approach can offer some advantages in surgical treatment of cranial base tumors selectively.
Objective To study the value of surgical management of advanced gastric cancer (AGC) with pancreatic invasion.Methods 390 patients with AGC were estimated preoperatively by electronic gastroscopy and epigastric B-ultrasound (BUS) and spiral CT scan.60(15.38%) out of 390 AGC patients with pancreatic invasion were confirmed by intraoperative and postoperative pathological diagnosis.Of them,33 patients underwent simultaneous pancreatectomy combined with gastric cancer radical operation,and the remaining 27 did non-radical intervention.Results The preoperative diagnostic rate of spiral CT scan and BUS in AGC patients with pancreatic invasion was 72.41% and 38.33% respectively. There was a significant difference in the survival time between the patients undergoing radical operation combined with simultanecus pancreatomy and those subject to non-radical intervention(P0.05).Conclusion Spiral CT scan and BUS are helpful in the preoperative diagnosis of AGC with pancreatic invasion.The active surgical management of AGC with pancreatic invasion can prolong the survival of some patients.The prognosis of the AGC patients with pancreatic invasion not undergoing segment-pancreatectomy is worse.
Objective To summarize and to explore the period of hypertensive cerebral hemorrhage cerebral hernia surgical methods and efficacy.Methods Retrospective analysis of 38 cases of bleeding have occurred in patients with hypertensive cerebral hernia using cranial hematoma,decompressive craniectomy after the surgical treatment,concluding judge its efficacy.Results Of tentorial Herniation in 29 cases,postoperative survival in 25 cases,accounting for 86%,the foramen magnum herniation in 9 cases survived for 2 cases accounted for 22%.Conclusion Hernia hypertensive putamen hemorrhage period,if not enter the foramen magunm herniation period,surgical treatment should be positive,but occurs after the foramen magnum herniation,then be selective surgery.
Objective To investigate the relationship with carotid artery plaque and hsCRP,D-dimer in patients who had coronary artery disease(CAD).Methods 80 cases who were diagnosed with CAD were collected,and 30 cases who had no CAD were regarded as the control group.CAD group was divided into three subgroups,they were acute myocardial infarction(AMI)subgroup,unstable angina pectoris(UAP) subgroup and stable angina pectoris(SAP) subgroup.Detect bilateral carotid artery IMT,Crouse score by ultrasound,and plasma levels of hsCRP and D-dimer in patients were also detected.The data obtained were analyzed using statistical methods.Results ①IMT,hsCRP and D-dimer in the control group were remarkable difference with CAD groups(P0.05).②There were no notable difference in IMT,Crouse score in the three subgroups of CAD(P0.05).In SAP group,UAP group and AMI group,hsCRP levels increased successively,the statistical difference was significant(P0.05).Compared with SAP group,the D-dimer in UAP and AMI group were apparently increased,a significant difference(P0.05).The level of hsCRP in AMI group was higher than in UAP group(P0.05),but D-dimer in the two groups were no significant difference(P0.05).③By linear correlation analysis,D-dimer,hs-CRP was positively correlated with the IMT and Grouse score.There was a good correlation between D-dimer with hsCRP,the correlation coefficient r=0.682(P0.05).Conclusion By carotid ultrasound,high-risk CAD patients can be identified,which conducive to the secondary prevention in CAD patients.D-dimer and hsCRP are reliable dicators which can reflect the plaque stability in CAD patients.There are certain diagnostic value in different ischemia state in CAD patients by detecting hsCRP,D-dimmer and carotid ultrasound.
