RESUMEN

BACKGROUND:Establishing a nomogram prediction model for postoperative pulmonary infection in hip fractures and taking early intervention measures is crucial for improving patients'quality of life and reducing medical costs. OBJECTIVE:To construct a nomogram risk prediction model of postoperative pulmonary infection in elderly patients with hip fracture,and provide theoretical basis for feasible prevention and early intervention. METHODS:Case data of 305 elderly patients with hip fractures who underwent surgical treatment at Wuxi Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine between January and October 2020(training set)were retrospectively analyzed.Using univariate and multivariate logistic regression analysis and Hosmer-Lemeshow goodness of fit test,receiver operating characteristic curve was utilized to analyze the diagnostic predictive efficacy of independent risk factors and joint models for postoperative pulmonary infections.Tools glmnet,pROC,and rms in R Studio software were applied to construct a nomogram model for predicting the risk of postoperative pulmonary infection in elderly patients with hip fractures,and calibration curves were further drawn to verify the predictive ability of the nomogram model.Receiver operating characteristic curves,calibration curves,and decision curves were analyzed for 133 elderly patients with hip fractures(validation set)receiving surgery at the same hospital from November 2022 to March 2023 to further predict the predictive ability of the nomogram model. RESULTS AND CONCLUSION:(1)The postoperative pulmonary infection rate in elderly patients with hip fractures in this group was 9.18%(28/305).(2)Single factor and multivariate analysis,as well as forest plots,showed that preoperative hospitalization days,leukocyte count,hypersensitive C-reactive protein,and serum sodium levels were independent risk factors(P<0.05).The Hosmer-Lemeshow goodness of fit test showed good fit(χ2=4.57,P=0.803).Receiver operating characteristic curve analysis was conducted on the independent risk factors and their joint models mentioned above,and the differentiation of each independent risk factor and joint model was good,with statistical significance(P<0.05).(3)The graphical calibration method,C-index,and decision curve were used to validate the nomogram prediction model.The predicted calibration curve was located between the standard curve and the acceptable line,and the predicted risk of the nomogram model was consistent with the actual risk.(4)The validation set used receiver operating characteristic curve,graphic calibration method,and decision curve to validate the prediction model.The results showed good consistency with clinical practice,indicating that the model had a good fit.The nomogram risk prediction model constructed for postoperative pulmonary infection in elderly patients with hip fractures has good predictive performance.The use of the nomogram risk prediction model can screen high-risk populations and provide a theoretical basis for early intervention.

RESUMEN

Long non-coding RNAs (lncRNAs) reportedly function as important modulators of gene regulation and malignant processes in the development of human cancers. The lncRNA JPX is a novel molecular switch for X chromosome inactivation and differentially expressed JPX has exhibited certain clinical correlations in several cancers. Notably, JPX participates in cancer growth, metastasis, and chemoresistance, by acting as a competing endogenous RNA for microRNA, interacting with proteins, and regulating some specific signaling pathways. Moreover, JPX may serve as a potential biomarker and therapeutic target for the diagnosis, prognosis, and treatment of cancer. The present article summarizes our current understanding of the structure, expression, and function of JPX in malignant cancer processes and discusses its molecular mechanisms and potential applications in cancer biology and medicine.

Asunto(s)

RESUMEN

Objective:To analyze the risk factors of postoperative bleeding after CT-guided percutaneous fly biopsy, and to construct a nomogram model for predicting postoperative bleeding.Methods:A total of 328 patients with CT-guided percutaneous fly biopsy who were admitted to the Affiliated Hospital of Ningbo University School of Medicine from June 2019 to March 2021 were selected, and the general clinical data of the patients were retrospectively analyzed. The patients were divided into observation group and control group according to postoperative bleeding. Statistical analysis was performed on clinical data of patients with statistical significance, receiver operating characteristic (ROC) curve analysis on continuous variables with statistical significance, and Logistic multiple regression analysis on all variables with statistical significance. The risk factors of bleeding complications in CT-guided percutaneous lung biopsy were obtained, and a Nomogram model for predicting bleeding after percutaneous lung biopsy was constructed using the R language software 4.0 "rms" package.Results:The results of the study showed that the size of the mass , the depth of the mass, the number of punctures, the number of cases with inflammation around the lesion , and the number of cases with chronic lung lesions in the observation group were greater than those in the control group: (5.20 ± 1.20) cm vs. (4.30 ± 0.90) cm, (4.30 ± 0.60) cm vs. (2.90 ± 0.30) cm, (2.70 ± 0.60) times vs. (2.30 ± 0.50) times, 38(14, 70) cases vs. 17(24, 60) cases, 102(39, 40) cases vs. 41(59, 40) cases; while the number of normal preoperative prothrombin time (PT) in the observation group was less than that in the control group: 4(5, 80) cases vs. 151(58, 30) cases ( P<0.05). ROC curve analysis was performed on the continuous variables with statistical significance in the control table of patients′general clinical data. The results showed that the area under the curve for swelling size, swelling depth, number of punctures, and number of tissue blocks cut were 0.563, 0.714, 0.680, and 0.559, respectively; the optimal cut-off values were 53.00 cm, 5.56 cm, 2.00 times, and 1.00 blocks ( P<0.05). The univariate indicators were included in the Logistic multiple regression model, and the results showed that tumor depth, puncture times, inflammation around the lesion, and abnormal preoperative PT were the risk factors for complications of percutaneous lung biopsy under CT ( P<0.05). The internal validation results showed that the Nomogram model predicted the risk of bleeding complicated by percutaneous lung biopsy under CT, with a C index of 0.687 (95% CI 0.241 - 1.988). The calibration curve showed good agreement between the observed and predicted values. The Nomogram model predicted percutaneous lung biopsy under CT with a bleeding risk threshold of >0.16, and the Nomogram model provided a clinical net benefit; in addition, the Nomogram model had a higher clinical net benefit than independent indicators. Conclusions:In conclusion, patients with poor coagulation function, inflammation around tumor lesions, deeper lesions, and more puncture times are more prone to bleeding. The Nomogram model constructed in this study has a high clinical application value for predicting the bleeding complications of CT-guided percutaneous lung biopsy.

RESUMEN

Purpose@#To evaluate the effectiveness of advanced practice nurse–guided home-based rehabilitation exercise program (HREPro) among patients with lower limb spasticity post-stroke. @*Methods@#This randomized controlled study recruited 121 patients with lower limb spasticity post-stroke. Intervention (n = 59) and control (n = 62) groups underwent 12-month HREPro and conventional rehabilitation, respectively, after discharge. The Fugl–Meyer assessment of spasticity measurement, modified Ashworth scale of motor function, 10-Meter Walk Test of walking ability, and Barthel index of activities of daily living (ADL) were evaluated at 0, 3, 6, and 12 months after discharge. @*Results@#Significant differences were found in spasticity degree, motor function, walking ability, and ADL at 6 and 12 months after discharge between the control and intervention groups. Lower limb spasticity and ADL in the intervention group were significantly improved. @*Conclusion@#HREPro is effective for rehabilitation of patients with lower limb spasticity post-stroke and has favorable home application.

RESUMEN

Purpose@#To evaluate the effectiveness of advanced practice nurse–guided home-based rehabilitation exercise program (HREPro) among patients with lower limb spasticity post-stroke. @*Methods@#This randomized controlled study recruited 121 patients with lower limb spasticity post-stroke. Intervention (n = 59) and control (n = 62) groups underwent 12-month HREPro and conventional rehabilitation, respectively, after discharge. The Fugl–Meyer assessment of spasticity measurement, modified Ashworth scale of motor function, 10-Meter Walk Test of walking ability, and Barthel index of activities of daily living (ADL) were evaluated at 0, 3, 6, and 12 months after discharge. @*Results@#Significant differences were found in spasticity degree, motor function, walking ability, and ADL at 6 and 12 months after discharge between the control and intervention groups. Lower limb spasticity and ADL in the intervention group were significantly improved. @*Conclusion@#HREPro is effective for rehabilitation of patients with lower limb spasticity post-stroke and has favorable home application.

RESUMEN

Postoperative cerebral embolism after left upper or lower lobectomy caused by the thrombus in the pulmonary vein stump (PVS) is a rare complication. However, it is still unclear how the cerebral embolism develop after lobectomy, and how can we prevent further embolism after thrombus removal. We present a case of a 55-year-old man without cardiovascular disease history suffering cerebral embolism 2 days after left upper lobectomy. Patient underwent endovascular thrombectomy and discharged hospital 10 days later with proper recovery. No thrombus was detected in an enhanced pulmonary CT after 1 month of aspirin intake, but the length of PVS was measured.

Asunto(s)

RESUMEN

Objective To explore the clinical efficacy and safety of CT-guided radiofrequency ablation plus intratumoral chemotherapy in patients with stage Ⅲ non-small cell lung cancer (NSCLC).Methods From February 2014 to May 2015,38 patients with stage Ⅲ NSCLC who did not receive systematic chemotherapy due to advanced age were selected in our hospital.The patients were divided into experimental group (n =19) and control group (n =19) by stratified random method.The patients in experimental group received CT-guided radiofrequency ablation plus Lobaplatin intratumoral chemotherapy,and the patients in control group only received CT-guided radiofrequency ablation.The adverse events,Karnofsky performance system (KPS) scores,1-year overall survival rates and short-term curative effects of patients in the two groups were observed.Results All 38 patients completed the course of therapy successfully.The 3-month response rates and 6-month response rates in experimental group and control group were 89.5％ vs.63.2％ and 78.9％ vs.52.6％,with no significant differences (P =0.124;P =0.170).The KPS score improvement rates were 42.1％ (8/19) and 31.6％ (6/19) in experimental group and control group,the KPS score stable rates were 52.6％ (10/19) and 52.6％ (10/19) in the two groups,and the KPS score deterioration rates were 5.3％ (1/19) and 15.8％ (3/19) in the two groups,with no significant differences (P =0.737;P =1.000;P =0.290).The 1-year survival rate of patients in experimental group was higher than that in control group (89.5％ vs.73.7％),with a significant difference (x2 =5.573,P =0.034).The rates of less than or equal to grade 3 pain (31.6％ vs.42.1％),low fever (21.1％ vs.26.3％),aerothorax (31.6％ vs.42.1％),gastrointestinal reaction (15.8％ vs.31.6％) and bone marrow depression (5.3％ vs.15.8％) in experimental group were lower than those in control group,but the differences were not statistically significant (P =0.501;P =0.703;P =0.501;P =0.252;P =0.290).Conclusion CT-gnided radiofrequency ablation plus intratumoral chemotherapy for stage Ⅲ NSCLC can improve short-term survival rate,and it does not increase the adverse reaction.While,the long-term overall survival rate has yet to be followed up.

RESUMEN

Objective To explore the methods of therapy in lung cancer patients with bone metastases, and evaluate the effects and side effects of Strontium-89 palliative therapy in lung cancer patients with bone metastases. Methods About 56 cases of bronchiogenic cancer patients with bone metastases who did not receive any radiotherapy, according to 1.48×10~7 Bq/person/time, using standard intravenous injection ~(89)Sr as treatment. Follow-up 6 months, assess according to the following parameters: pain and frequency of pain were given quantized value and got pain score, using T test for comparing the pain score. According to before and after treatment bone imaging showed the size of focus and change of the number, upgrade focus therapy effect. Examine (CEA) and (NSE), using T test for changes before and after treatment. Using T test for changes of LEU and platelet after treatment. Results After treatment for 6 months, for 77 % patients are alleviating pain (43/56), the pain went off of 13 patents, account for 23 percent of the total. The pain score from 7.3±3.6 before treatment decrease to 5.3±3.4 after treatment, dropping obviously. After treatment, the focus regressed in 14 cases, decreased in 5 cases, total efficiency is 34 %. Before and after treatment, CEA from (33.64±18.15)μg/L obviously decreased to (t=4.26, P<0.01) to (21.36±11.65) μg/L, NSE from (27.16±10.12) μg/L obviously decreased to (t=4.26, P<0.05) to (12.56±4.23) μg/L. After treatment, LEU and platelet decreased to the lowest, LEU decreased about 27.9 %, platelet decreased about 19.7 %, after 3 months,normal rate of blood picture is 75 %(42/56). Conclusion The method of strontium-89 palliative therapy in lung cancer patients with bone metastases is good, safe and has little side effects, it can improve the quality of patients life.