Objective:To investigate the association of immediate preoperative hyperglycemia (IPH) with postoperative pulmonary complications (PPCs) in patients with diabetes mellitus following video-assisted thoracoscopic partial lung surgery (VATPLS).Methods:This was a retrospective cohort study. The patients with diabetes mellitus who underwent elective VATPLS at the First Affiliated Hospital of Nanjing Medical University from January, 2018 to July, 2020 were recruited. Based on immediate preoperative blood glucose levels (fasting blood glucose within 2 h before surgery), the patients were divided into hyperglycemia group (IPH group, blood glucose concentration ≥7.8 mmol/L) and non-hyperglycemia group (non-IPH group, blood glucose concentration <7.8 mmol/L). The association of IPH with the occurrence of PPCs was analyzed using the prospensity score matching.Results:Data from 438 diabetic patients who underwent VATPLS were ultimately collected in this study. Compared with non-IPH group, the incidence of PPCs was significantly increased in IPH group ( P<0.001). After propensity score matching, 128 cases were assigned to both IPH group and non-IPH group, the risk of PPCs in IPH group was 1.33 times of that in non-IPH group (relative risk 1.33, 95% confidence interval 1.02-1.73, P=0.031). There were no interactions between age factors/preoperative glycated hemoglobin and IPH. Conclusions:IPH (fasting blood glucose within 2 h before surgery ≥7.8 mmol/L) is associated with the occurrence of PPCs to some degree in patients with diabetes mellitus undergoing VATPLS.

Objective To investigate the value of MRI of the sternal end of clavicle in bone age assessment in Chinese population,especially its applicability in the determination of criminal responsible age.Methods A total of 431 patients aged from 10.00 to 29.99 years with neck or chest MRI were retrospectively collected.According to the Schmeling grading method,the epiphyseal development of the clavicle MRI was divided into five grades.The consistency of methods was evaluated.The correlation and general descriptive analysis between MRI grades and age was analyzed.The sex difference was analyzed.Curve fitting was used to establish a nonlinear model between age and grades.Results The grades of clavicle MRI showed a significant age-related trend(Figure 2),and the correlation was 0.861(0.887 in males and 0.840 in females).Except for grade 1,there was no significant difference between males and females in other grades.The minimum age of male grade 3 was greater than 14 years old,and the minimum age of female grade 3 was greater than 16 years old.The minimum age in grade 4 and grade 5 was over 18 years old in both sexes.The best curve fitting model was cubic model for both sexes(R2=0.805 for men and 0.722 for women).Conclusion Clavicle MRI can be used for the assessment of bone age in Chinese population.Complete epiphyseal plate closure can be used as a reliable indicator for the determination of age at 18 years old,and it is expected to achieve radiation-free forensic bone age assessment.

PURPOSE: To analyze risk factors for severe trauma and establish a nomogram for early risk prediction, to improve the early identification of severe trauma. METHODS: This study was conducted on the patients treated in 81 trauma treatment institutions in Gansu province from 2020 to 2022. Patients were grouped by year, with 5364 patients from 2020 to 2021 as the training set and 1094 newly admitted patients in 2020 as the external validation set. Based on the injury severity score (ISS), patients in the training set were classified into 2 subgroups of the severe trauma group (n = 478, ISS scores ≥25) and the non-severe trauma group (n = 4886, ISS scores <25). Univariate and binary logistic regression analyses were employed to identify independent risk factors for severe trauma. Subsequently, a predictive model was developed using the R software environment. Furthermore, the model was subjected to internal and external validation via the Hosmer-Lemeshow test and receiver operating characteristic curve analysis. RESULTS: In total, 6458 trauma patients were included in this study. Initially, this study identified several independent risk factors for severe trauma, including multiple traumatic injuries (polytrauma), external hemorrhage, elevated shock index, elevated respiratory rate, decreased peripheral oxygen saturation, and decreased Glasgow coma scale score (all p < 0.05). For internal validation, the area under the receiver operating characteristic curve was 0.914, with the sensitivity and specificity of 88.4% and 87.6%, respectively; while for external validation, the area under the receiver operating characteristic curve was 0.936, with the sensitivity and specificity of 84.6% and 93.7%, respectively. In addition, a good model fitting was observed through the Hosmer-Lemeshow test and calibration curve analysis (p > 0.05). CONCLUSION This study establishes a nomogram for early risk prediction of severe trauma, which is suitable for primary healthcare institutions in underdeveloped western China. It facilitates early triage and quantitative assessment of trauma severity by clinicians prior to clinical interventions.
Humans ; Nomograms ; Male ; Female ; Wounds and Injuries/diagnosis* ; Risk Factors ; Middle Aged ; Adult ; Injury Severity Score ; Risk Assessment ; ROC Curve ; Aged ; Logistic Models ; China ; Glasgow Coma Scale

OBJECTIVE: To evaluate the efficacy and safety of Shexiang Tongxin Dropping Pill (STDP) in treating stable angina patients with phlegm-heat and blood-stasis syndrome by exercise duration and metabolic equivalents. METHODS: This multicenter, randomized, double-blind, placebo-controlled clinical trial enrolled stable angina patients with phlegm-heat and blood-stasis syndrome from 22 hospitals. They were randomized 1:1 to STDP (35 mg/pill, 6 pills per day) or placebo for 56 days. The primary outcome was the exercise duration and metabolic equivalents (METs) assessed by the standard Bruce exercise treadmill test after 56 days of treatment. The secondary outcomes included the total angina symptom score, Chinese medicine (CM) symptom scores, Seattle Angina Questionnaire (SAQ) scores, changes in ST-T on electrocardiogram and adverse events (AEs). RESULTS: This trial enrolled 309 patients, including 155 and 154 in the STDP and placebo groups, respectively. STDP significantly prolonged exercise duration with an increase of 51.0 s, compared to a decrease of 12.0 s with placebo (change rate: -11.1% vs. 3.2%, P<0.01). The increase in METs was significantly greater in the STDP group than in the placebo group (change: -0.4 vs. 0.0, change rate: -5.0% vs. 0.0%, P<0.01). The improvement of total angina symptom scores (25.0% vs. 0.0%), CM symptom scores (38.7% vs. 11.8%), reduction of nitroglycerin consumption (100.0% vs. 11.3%), and all domains of SAQ, were significantly greater with STDP than placebo (all P<0.01). The changes in Q-T intervals at 28 and 56 days from baseline were similar between the two groups (both P>0.05). Twenty-five participants (16.3%) with STDP and 16 (10.5%) with placebo experienced AEs (P=0.131), with no serious AEs observed. CONCLUSION STDP could improve exercise tolerance in patients with stable angina and phlegm-heat and blood stasis syndrome, with a favorable safety profile. (Registration No. ChiCTR-IPR-15006020).
Humans ; Double-Blind Method ; Drugs, Chinese Herbal/adverse effects* ; Male ; Female ; Middle Aged ; Angina, Stable/physiopathology* ; Aged ; Syndrome ; Treatment Outcome ; Placebos ; Tablets

Objective:To investigate the association of immediate preoperative hyperglycemia (IPH) with postoperative pulmonary complications (PPCs) in patients with diabetes mellitus following video-assisted thoracoscopic partial lung surgery (VATPLS).Methods:This was a retrospective cohort study. The patients with diabetes mellitus who underwent elective VATPLS at the First Affiliated Hospital of Nanjing Medical University from January, 2018 to July, 2020 were recruited. Based on immediate preoperative blood glucose levels (fasting blood glucose within 2 h before surgery), the patients were divided into hyperglycemia group (IPH group, blood glucose concentration ≥7.8 mmol/L) and non-hyperglycemia group (non-IPH group, blood glucose concentration <7.8 mmol/L). The association of IPH with the occurrence of PPCs was analyzed using the prospensity score matching.Results:Data from 438 diabetic patients who underwent VATPLS were ultimately collected in this study. Compared with non-IPH group, the incidence of PPCs was significantly increased in IPH group ( P<0.001). After propensity score matching, 128 cases were assigned to both IPH group and non-IPH group, the risk of PPCs in IPH group was 1.33 times of that in non-IPH group (relative risk 1.33, 95% confidence interval 1.02-1.73, P=0.031). There were no interactions between age factors/preoperative glycated hemoglobin and IPH. Conclusions:IPH (fasting blood glucose within 2 h before surgery ≥7.8 mmol/L) is associated with the occurrence of PPCs to some degree in patients with diabetes mellitus undergoing VATPLS.

Objective To investigate the value of MRI of the sternal end of clavicle in bone age assessment in Chinese population,especially its applicability in the determination of criminal responsible age.Methods A total of 431 patients aged from 10.00 to 29.99 years with neck or chest MRI were retrospectively collected.According to the Schmeling grading method,the epiphyseal development of the clavicle MRI was divided into five grades.The consistency of methods was evaluated.The correlation and general descriptive analysis between MRI grades and age was analyzed.The sex difference was analyzed.Curve fitting was used to establish a nonlinear model between age and grades.Results The grades of clavicle MRI showed a significant age-related trend(Figure 2),and the correlation was 0.861(0.887 in males and 0.840 in females).Except for grade 1,there was no significant difference between males and females in other grades.The minimum age of male grade 3 was greater than 14 years old,and the minimum age of female grade 3 was greater than 16 years old.The minimum age in grade 4 and grade 5 was over 18 years old in both sexes.The best curve fitting model was cubic model for both sexes(R2=0.805 for men and 0.722 for women).Conclusion Clavicle MRI can be used for the assessment of bone age in Chinese population.Complete epiphyseal plate closure can be used as a reliable indicator for the determination of age at 18 years old,and it is expected to achieve radiation-free forensic bone age assessment.

Objective To analyze the characteristics of drug resistance in patients with disseminated pulmonary tuberculosis,and provide references for the clinical development of individualized treatment plans.Methods A retrospective analysis was conducted on 71 hospitalized patients with disseminated pulmonary tuberculosis treated at the Beijing Chest Hospital,Capital Medical University from January 2015 to January 2024.The susceptibility of Mycobacterium tuberculosis from these patients to 16 anti-tuberculosis drugs was detected using the microplate method for mycobacterial drug susceptibility testing.The study analyzed the culture results of Mycobacterium tuberculosis,drug susceptibility test results,initial treatment or re-treatment status,drug resistance,and differences in drug resistance types between initial and re-treated patients.Results Among the 71 patients with disseminated pulmonary tuberculosis,there were 51 males(71.8%),and 58 cases(81.7%)of acute disseminated pulmonary tuberculosis,with an overall drug resistance rate to 16 anti-tuberculosis drugs of 38.0%.There was no statistically significant difference in the total drug resistance rate between re-treated patients and those undergoing initial treatment[52.2%(12/23)vs.31.3%(15/48),P=0.089].The top 7 drugs to which patients were resistant were streptomycin(Sm)and isoniazid(INH)with 13 cases each(18.3%),rifapentine(Rft)and isoniazid aminosalicylate(Pa)with 10 cases each(14.1%),rifampicin(RFP),rifabutin(Rfb),and capreomycin(Cm)with 9 cases each(12.7%).The top 6 drugs to which initially treated patients were resistant were Cm with 6 cases(12.5%),Sm with 5 cases(10.4%),Pa with 4 cases(8.3%),INH,clarithromycin(Clr),and p-aminosalicylic acid(PAS)with 3 cases each(6.3%).The top 7 drugs to which re-treated patients were resistant were INH with 10 cases(43.5%),Sm,RFP,and Rft with 8 cases each(34.8%),Rfb with 7 cases(30.4%),Pa and levofloxacin(Lfx)with 6 cases each(26.1%).The overall mono-resistance rate,poly-drug resistance rate,and multidrug-resistant rate to 16 anti-tuberculosis drugs were 9.9%,7.0%,and 11.3%,respectively;all mono-resistance patients were initially treated;there was no statistically significant difference in the poly-drug resistance rate between re-treated and initially treated patients(13.0%vs.4.2%,P=0.591),but the multidrug-resistant rate was significantly higher in re-treated patients(30.4%vs.2.1%,P=0.002).Conclusion Drug resistance in disseminated pulmonary tuberculosis is severe.Clinical physicians can develop personalized anti-tuberculosis treatment plans based on drug susceptibility test results.

Objective To observe the value of contrast-enhanced ultrasound(CEUS)for evaluating blood supply pattern of pancreatic ductal adenocarcinoma(PDAC).Methods A total of 210 single PDAC patients proved by pathology who underwent CEUS and contrast enhanced CT(CECT)examination were retrospectively enrolled.Blood supply patterns of PDAC,i.e.deficient or rich blood supply were evaluated based on findings of CEUS 25 s(CEUS-25 s)and 35 s(CEUS-35 s)after contrast agents injection and CECT,respectively.The evaluation results were compared among different methods.Disease free survival(DFS)and overall survival(OS)of patients with deficient and rich blood supply PDAC shown on CEUS-25 s were followed up and compared.Results CEUS-25 s found 60.00％(126/210)PDAC with deficient blood supply(poor blood supply group),while 40.00％(84/210)with rich blood supply(rich blood supply group).CEUS-35 s showed that the proportion deficient blood supply PDAC increased to 70.48％(148/210,P＜0.05),22 lesions changed from rich blood supply pattern on CEUS-25 s to deficient blood supply pattern.CECT displayed deficient blood supply in 91.90％(193/210)PDAC but rich blood supply in 8.10％(17/210)PDAC,both being significant different compared with results of CEUS-25 s and CEUS-35 s(both P＜0.05).Fifteen-five cases in deficient blood supply group and 39 in rich blood supply group completed 12(8,25)months'follow-up,and the median DFS of patients in deficient blood supply group and rich blood supply group was 8(6,10)and 12(7,17)months,respectively,with the median OS of 14(9,17)and 19(16,24)months,respectively.The median DFS and OS in poor blood supply group were both shorter than those in rich blood supply group(x2=17.227,27.166,both P＜0.001).Conclusion CEUS had important clinical value for evaluating blood supply pattern of PDAC.

Objective To observe the value of contrast-enhanced ultrasound(CEUS)for evaluating blood supply pattern of pancreatic ductal adenocarcinoma(PDAC).Methods A total of 210 single PDAC patients proved by pathology who underwent CEUS and contrast enhanced CT(CECT)examination were retrospectively enrolled.Blood supply patterns of PDAC,i.e.deficient or rich blood supply were evaluated based on findings of CEUS 25 s(CEUS-25 s)and 35 s(CEUS-35 s)after contrast agents injection and CECT,respectively.The evaluation results were compared among different methods.Disease free survival(DFS)and overall survival(OS)of patients with deficient and rich blood supply PDAC shown on CEUS-25 s were followed up and compared.Results CEUS-25 s found 60.00％(126/210)PDAC with deficient blood supply(poor blood supply group),while 40.00％(84/210)with rich blood supply(rich blood supply group).CEUS-35 s showed that the proportion deficient blood supply PDAC increased to 70.48％(148/210,P＜0.05),22 lesions changed from rich blood supply pattern on CEUS-25 s to deficient blood supply pattern.CECT displayed deficient blood supply in 91.90％(193/210)PDAC but rich blood supply in 8.10％(17/210)PDAC,both being significant different compared with results of CEUS-25 s and CEUS-35 s(both P＜0.05).Fifteen-five cases in deficient blood supply group and 39 in rich blood supply group completed 12(8,25)months'follow-up,and the median DFS of patients in deficient blood supply group and rich blood supply group was 8(6,10)and 12(7,17)months,respectively,with the median OS of 14(9,17)and 19(16,24)months,respectively.The median DFS and OS in poor blood supply group were both shorter than those in rich blood supply group(x2=17.227,27.166,both P＜0.001).Conclusion CEUS had important clinical value for evaluating blood supply pattern of PDAC.

AIM:To observe the effect of implantable collamer lens V4c(ICL V4c)implantation on high myopia, and the changes in anterior segment morphology.METHODS:A prospective study was conducted on 100 patients(200 eyes)with high myopia who were treated with ICL V4c implantation in the hospital from February 2018 to March 2021. The best corrected visual acuity(BCVA), uncorrected visual acuity(UCVA), intraocular pressure, higher-order aberration, anterior segment morphology [iridocorneal angle(ICA), central anterior chamber depth(ACD), anterior chamber volume(ACV), central corneal thickness(CCT)and K-value(K)], photopic and scotopic contrast sensitivity before operation and 6 and 12mo after operation were comparatively analyzed.RESULTS:All patients were followed-up. UCVA and BCVA were significantly improved at 6 and 12mo after operation(P<0.05). Total higher-order aberration, horizontal coma and vertical coma showed no significant difference before and after operation(P>0.05). Spherical aberration, ICA, ACD and ACV at 6 and 12mo after operation were significantly smaller than those before operation(P<0.05). Under photopic state, the contrast sensitivity of 3.0 and 6.0 c/d was significantly higher at 6 and 12mo after operation when compared with that before operation(P<0.05). Under scotopic state, the contrast sensitivity of 6.0 c/d was significantly higher at 6 and 12mo after operation when compared with that before operation(P<0.05); there was no significant difference in CCT, K, or intraocular pressure before and after operation(P>0.05).CONCLUSION:Although ICA, ACD and ACV in patients with high myopia are reduced after ICL V4c implantation, the operation can effectively improve visual acuity and visual quality.