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ObjectiveTo determine prognostic factors and survival patterns for different treatment modalities for nasal cavity (NC) and paranasal sinus (PS) mucosal melanoma (MM).MethodsPatients from 1973 to 2013 were analyzed using the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier method and multivariable cox proportional hazard modeling were used for survival analyses.ResultsOf 928 cases of mucosal melanoma (NC = 632, PS = 302), increasing age (Hazard Ratio [HR]:1.05/year, p < 0.001), T4 tumors (HR: 1.81, p = 0.02), N1 status (HR: 6.61, p < 0.001), and PS disease (HR: 1.50, p < 0.001) were associated with worse survival. Median survival length was lower for PS versus NC (16 versus 26 months, p < 0.001). Surgery and surgery + radiation therapy (RT) improved survival over non-treatment or RT alone (p < 0.001). Adding RT to surgery did not yield a survival difference compared with surgery alone (p = 0.43). Five-year survival rates for surgery and surgery + RT were similar, at 27.7% and 25.1% (p = 0.43).ConclusionSurgery increased survival significantly over RT alone. RT following surgical resection did not improve survival.  相似文献   
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Tympanic membranes (TM) that have healed spontaneously after perforation present abnormalities in their structural and mechanical properties; i.e., they are thickened and abnormally dense. These changes result in a deterioration of middle ear (ME) sound transmission, which is clinically presented as a conductive hearing loss (CHL). To fully understand the ME sound transmission under TM pathological conditions, we created a gerbil model with a controlled 50% pars tensa perforation, which was left to heal spontaneously for up to 4 weeks (TM perforations had fully sealed after 2 weeks). After the recovery period, the ME sound transmission, both in the forward and reverse directions, was directly measured with two-tone stimulation. Measurements were performed at the input, the ossicular chain, and output of the ME system, i.e., at the TM, umbo, and scala vestibuli (SV) next to the stapes. We found that variations in ME transmission in forward and reverse directions were not symmetric. In the forward direction, the ME pressure gain decreased in a frequency-dependent manner, with smaller loss (within 10 dB) at low frequencies and more dramatic loss at high frequency regions. The loss pattern was mainly from the less efficient acoustical to mechanical coupling between the TM and umbo, with little changes along the ossicular chain. In the reverse direction, the variations in these ears are relatively smaller. Our results provide detailed functional observations that explain CHL seen in clinical patients with abnormal TM, e.g., caused by otitis media, that have healed spontaneously after perforation or post-tympanoplasty, especially at high frequencies. In addition, our data demonstrate that changes in distortion product otoacoustic emissions (DPOAEs) result from altered ME transmission in both the forward and reverse direction by a reduction of the effective stimulus levels and less efficient transfer of DPs from the ME into the ear canal. This confirms that DPOAEs can be used to assess both the health of the cochlea and the middle ear.  相似文献   
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Modified-release opioids are often prescribed for the management of moderate to severe acute pain following total hip and knee arthroplasty, despite recommendations against their use due to increasing concerns regarding harm. The primary objective of this multicentre study was to examine the impact of modified-release opioid use on the incidence of opioid-related adverse events compared with immediate-release opioid use, among adult inpatients following total hip or knee arthroplasty. Data for total hip and knee arthroplasty inpatients receiving an opioid analgesic for postoperative analgesia during hospitalisation were collected from electronic medical records of three tertiary metropolitan hospitals in Australia. The primary outcome was the incidence of opioid-related adverse events during hospital admission. Patients who received modified with or without immediate-release opioids were matched to those receiving immediate-release opioids only (1:1) using nearest neighbour propensity score matching with patient and clinical characteristics as covariates. This included total opioid dose received. In the matched cohorts, patients given modified-release opioids (n = 347) experienced a higher incidence of opioid-related adverse events overall, compared with those given immediate-release opioids only (20.5%, 71/347 vs. 12.7%, 44/347; difference in proportions 7.8% [95%CI 2.3–13.3%]). Modified-release opioid use was associated with an increased risk of harm when used for acute pain during hospitalisation after total hip or knee arthroplasty.  相似文献   
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目的分析超长住院患者分布及影响因素,探讨减少超长住院日的措施。方法从江苏省某三甲医院病案管理系统中调取2020年1月1日-2020年12月31日134016例出院患者的住院病案首页资料,对住院时间≥30天的1401例超长住院患者的分布特征进行统计描述,采用Logistic回归模型分析超长住院日的影响因素。结果2020年全院平均住院日为7.13天,其中超长住院患者平均住院日为41.85天。超长住院患者以60岁以上年龄组最多(39.61%);出院科室主要分布在血液科(42.18%)、普通外科(11.85%)、骨科(7.49%)等;疾病类别主要为肿瘤(47.32%)、影响健康状态和与保健机构接触的因素(10.56%)、循环系统疾病(7.07%)等;多因素Logistic回归结果显示,男性(OR=1.188)、离院方式为非医嘱离院或其他(OR=2.046)和死亡病例(OR=3.362)是超长住院的危险因素。结论控制超长住院日对平均住院日影响显著,医院应加强重点人群、重点科室和重点病种管理提高诊疗管理水平,缩短平均住院日。  相似文献   
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作为一种可以替代肺和心脏功能的呼吸循环支持技术,体外膜氧合(extracorporeal membrane oxygenation,ECMO)近年来在各种危重症呼吸、循环衰竭中的应用逐渐增多~([1-2])。ECMO主要包括动力泵、氧合器、各种管路及监测系统等,静脉血通过体外膜肺氧合后再回输给静脉或动脉,实施肺保护性通气,从而使肺脏得到休息,肺功能得以恢复~([3-4])。  相似文献   
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目的探讨小儿肠胃康颗粒联合酪酸梭菌活菌散治疗小儿消化不良性腹泻的临床疗效及安全性。方法104例小儿消化不良性腹泻患儿,依据随机抽签法分为对照组与观察组,各52例。对照组采用小儿肠胃康颗粒治疗,观察组采用小儿肠胃康颗粒联合酪酸梭菌活菌散治疗。对比两组症状改善时间、治疗效果及不良反应发生情况。结果观察组腹泻、腹部疼痛及食欲下降改善时间分别为(1.93±1.05)、(2.05±1.06)、(2.47±1.04)d,均短于对照组的(4.88±1.49)、(3.62±1.55)、(3.63±1.15)d,差异有统计学意义(P<0.05)。观察组治疗总有效率为94.23%,高于对照组的76.92%,差异有统计学意义(P<0.05)。观察组不良反应发生率为1.92%,低于对照组的13.46%,差异有统计学意义(P<0.05)。结论小儿肠胃康颗粒联合酪酸梭菌活菌散治疗小儿消化不良性腹泻疗效显著,且安全性较高,值得临床合理推行实践。  相似文献   
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摘要:微管是细胞骨架重要组成成分,是筛选抗肿瘤药物的重要靶标。海洋生态系统的极端环境使海洋生物具备产生独特 化学结构和生理活性天然产物的能力,为新药发现提供了物质基础。本文主要综述了1972-2021年从海洋生物中分离鉴定的成 药性较好的微管去稳定剂抗肿瘤药物的研究进展,总结了活性化合物来源、构效关系,临床研究进展,化学全合成及衍生物的 研究情况等,以期为医药工作者提供新的研究思路,推进靶向微管海洋抗肿瘤药物的发展。  相似文献   
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