难治性特发性血小板减少型紫癜脾切除的临床分析

目的:探讨脾切除对难治性特发性血小板减少性紫癜的治疗效果及影响因素.方法:回顾15年中行脾切除术治疗难治性ITP患者62例的临床资料,分析年龄、性别、术前有无出血、术前对激素的反应、脾脏是否肿大、术后血小板峰值与脾切除疗效之间的关系.结果:62例中,显效34例,良效13例,进步10例,无效5例;有效率(显效+良效)为75.8％.性别和脾脏是否肿大与脾切除术疗效无关(均P＞0.05);有无出血症状、年龄、术后血小板峰值、骨髓巨核细胞数等因素分组间差异具有统计学意义(均P＜0.05);多因素分析表明,术前对激素的反应及术前血小板计数对脾切除疗效是主要的影响因素(均P＜0.05).结论:术前对激素的反应及术前血小板计数可作为脾切除术的疗效预测指标.     

RT-nPCR Assays for Amplification and Sequencing of VP1 Genes in Human Enterovirus A-D from Clinical Specimens

ObjectiveTo develop RT-nPCR assays for amplifying partial and complete VP1 genes of human enteroviruses (HEVs) from clinical samples and to contribute to etiological surveillance of HEV-related diseases.MethodsA panel of RT-nPCR assays, consisting of published combined primer pairs for VP1 genes of HEV A–C and in-house designed primers for HEV-D, was established in this study. The sensitivity of each RT-nPCR assay was evaluated with serially diluted virus stocks of five serotypes expressed as CCID₅₀ per μL and copies per μL, and the newly established methods were tested in clinical specimens collected in recent years.ResultsThe sensitivity of RT-nPCR assays for amplifying partial VP1 gene of HEVs was 0.1 CCID₅₀ per μL and 10 virus copies per μL, and for the complete VP1 gene was 1 CCID₅₀ per μL and 100 virus copies per μL, using serially-diluted virus stocks of five serotypes. As a proof-of-concept, 25 serotypes were identified and complete VP1 sequences of 23 serotypes were obtained by this system among 858 clinical specimens positive for HEVs during the past eight surveillance seasons.ConclusionThis RT-nPCR system is capable of amplifying the partial and complete VP1 gene of HEV A–D, providing rapid, sensitive, and reliable options for molecular typing and molecular epidemiology of HEVs in clinical specimens.     

Cohort Study of Oligorecurrent Prostate Cancer Patients: Oncological Outcomes of Patients Treated with Salvage Lymph Node Dissection via Prostate-specific Membrane Antigen–radioguided Surgery

BackgroundIn a subset of patients with recurrent oligometastatic prostate cancer (PCa) salvage surgery with prostate-specific membrane antigen (PSMA)-targeted radioguidance (PSMA-RGS) might be of value.ObjectiveTo evaluate the oncological outcomes of salvage PSMA-RGS and determine the predictive preoperative factors of improved outcomes.Design, setting, and participantsA cohort study of oligorecurrent PCa patients with biochemical recurrence (BCR) after radical prostatectomy and imaging with PSMA positron emission tomography (PET), treated with PSMA-RGS in two tertiary care centers (2014–2020), was conducted.InterventionPSMA-RGS.Outcome measurements and statistical analysisKaplan-Meier and multivariable Cox regression models were used to assess BCR-free (BFS) and therapy-free (TFS) survival. Postoperative complications were classified according to Clavien-Dindo.Results and limitationsOverall, 364 patients without concomitant treatment were assessed. At PSMA-RGS, metastatic soft-tissue PCa lesions were removed in 343 (94%) patients. At 2–16 wk after PSMA-RGS, 165 patients reached a prostate-specific antigen (PSA) level of <0.2 ng/ml. Within 3 mo, 24 (6.6%) patients suffered from Clavien-Dindo complications grade III–IV. At 2 yr, BFS and TFS rates were 32% and 58%, respectively. In multivariable analyses, higher preoperative PSA (hazard ratio [HR]: 1.07, 95% confidence interval [CI]: 1.02–1.12), higher number of PSMA-avid lesions (HR: 1.23, CI: 1.08–1.40), multiple (pelvic plus retroperitoneal) localizations (HR: 1.90, CI: 1.23–2.95), and retroperitoneal localization (HR: 2.04, CI: 1.31–3.18) of lesions in preoperative imaging were independent predictors of BCR after PSMA-RGS. The main limitation is the lack of a control group.ConclusionsAs salvage surgery in oligorecurrent PCa currently constitutes an experimental treatment approach, careful patient selection is mandatory based on life expectancy, low PSA values, and low number of PSMA PET–avid lesions located in the pelvis.Patient summaryWe looked at the outcomes from prostate cancer patients with recurrent disease after radical prostatectomy. We found that surgery may be an opportunity to prolong treatment-free survival, but patient selection criteria need to be very narrow.     

Optimal decentralized control of a wind turbine and diesel generator system

This article presents a decentralized optimal controller design technique for the frequency and power control of a coupled wind turbine and diesel generator. The decentralized controller consists of two proportional-integral (PI)-lead controllers which are designed and optimized simultaneously using a quasi-Newton based optimization technique, namely, Davidon–Fletcher–Powell algorithm. The optimal PI-lead controllers are designed in such a way that there are no communication links between them. Simulation results show the superior performance of the proposed controller with a lower order structure compared to the benchmark decentralized linear-quadratic Gaussian integral controllers of orders 4 and 11. It is also shown that the proposed controller demonstrates an effective performance in damping the disturbances from load and wind power, as well as a robust performance against the parameter changes of the power system.     

Outcomes according to treatment using an established protocol in patients with bilateral Wilms' tumor: A national Canadian population-based study

BackgroundBilateral Wilms tumor (BWT) is a rare entity. The goal of this study is to report outcomes (overall and event-free survival, OS/EFS) of BWT in a large cohort representative of the Canadian population since 2000. We focused on the occurrence of late events (relapse or death beyond 18 months), as well as outcomes of patients treated following the only protocol specifically designed for BWT to date, AREN0534, compared to patients treated following other therapeutic schemes.MethodsData was obtained for patients diagnosed with BWT between 2001 and 2018 from the Cancer in Young People in Canada (CYP-C) database. Demographics, treatment protocols, and dates for events were collected. Specifically, we examined outcomes of patients treated according to the Children's Oncology Group (COG) protocol AREN0534 since 2009. Survival analysis was performed.Results57/816 (7%) of patients with Wilms tumor had BWT during the study period. Median age at diagnosis was 2.74 years (IQR 1.37–4.48) and 35 (64%) were female; 8/57 (15%) had metastatic disease. After a median follow-up of 4.8 years (IQR 2.8–5.7 years, range 0.2–18 years), OS and EFS were 86% (CI 73–93%) and 80% (CI 66–89%), respectively. Less than 5 events were recorded after 18 months from diagnosis. Since 2009, patients treated according to the AREN0534 protocol had a statistically significant higher OS compared to patients treated with other protocols.ConclusionsIn this large Canadian cohort of patients with BWT, OS and EFS compared favorably to the published literature. Late events were rare. Patients treated according to a disease-specific protocol (AREN0534) had improved overall survival.Type of studyOriginal article.Level of evidenceLevel IV.     

Stature estimation from sternum length using computed tomography–volume rendering technique images of western Chinese

The objective of the present investigation was to generate linear regression models for stature estimation on the basis of sternum length derived from computed tomography–volume rendering technique (CT–VRT) images for Western Chinese. The study sample comprised 288 individuals of Western Chinese, including 124 females and 164 males, with documented ages between 19 and 78 years, and was randomly divided into two subgroups. The linear regression analysis for the calibration sample data yielded the following formulae: male stature (cm) = 137.28 + 1.99*combined length of manubrium and mesosternum and female stature (cm) = 111.59 + 3.51* combined length of manubrium and mesosternum. Pearson's correlation coefficients for the regression models were r = 0.459 and r = 0.541 for the male and female formulae, respectively. The standard errors of the estimate (SEE) were 4.76 cm for the male equation and 6.73 cm for the female equation. The 95% confidence intervals of the predicted values encompassed the correct stature of all specimen in the validation sample. The regression equations derived from the sternum length in the present study can be used for stature estimation and the length of the sternum is a reliable predictor of stature in Chinese when better predictors of stature like the long bones are not available, and the CT–VRT method may be a practical method for stature estimation.     

Novel use of a Sengstaken–Blakemore tube during a neck exploration of a carotid injury: A case report

Penetrating neck trauma can injure the major blood vessels, airway, gastrointestinal system, and neurological system. We present a case where a Sengstaken–Blakemore tube was emergently placed during surgical exploration of a stab wound to the neck to tamponade bleeding until surgical control was obtained and the vascular injuries were managed.     

Cyclosporin A therapy for severe Henoch-Schönlein nephritis with nephrotic syndrome

To evaluate the efficacy of cyclosporin A (CyA) for treating severe Henoch-Schönlein nephritis (HSN), seven patients with nephrotic syndrome, aged 3.9–13.8 years (mean 6.5 years), were analyzed retrospectively. Mean follow-up times were 5.5 years (range 2–9 years). All underwent renal biopsy before treatment, and follow-up renal biopsy was performed in six of the seven patients. All patients improved, with 24-h protein declining from a mean of 9.2 g/m²/day (range 1.5–16 g/m²/day) to 0.3 g/m²/day (range 0.03–1.2 g/m²/day) (p=0.016) and serum albumin increasing from a mean of 2.1 g/dl (range 1.5–2.4 g/dl) to 4.6 g/dl (range 3.5–5.3 g/dl) (p=0.016) after CyA therapy. The activity index decreased significantly at the second renal biopsies obtained at a mean interval of 11.7 months after the first (6.4±3.3 vs 3.5±1.2, p=0.042, respectively), while the chronicity index and the tubulointerstitial scores did not change. On the immunofluorescent findings at the second biopsies, the degree of deposits of immunoglobulins such as IgA, IgM, C3, and fibrinogen decreased in five of the six patients. Although this case series is without controls, our study suggests that CyA may be beneficial to a subset of HSN patients with nephrotic syndrome.     

Excavation of the chest due to railway mishap

Injuries sustained due to railway mishaps are well documented. In these mishaps, ascertaining the cause of death is usually not difficult, but frequently circumstances do raise questions as to the manner of death. It is a real challenge for an autopsy surgeon to correlate the alleged history with injuries present on the body, thereby helping the investigating officer to come to a conclusion on the manner of death. Here, we present a case of an unusual excavation injury to the chest due to train impact, and discuss the mechanism of causation of this injury and the manner of death.     

Assessment of the test–retest reliability of a foot placement accuracy protocol in assisted-living older adults

IntroductionThis study assessed the test–retest reliability of a foot placement accuracy protocol in a population of assisted-living elderly. The goal was to evaluate the execution of foot placement performance with increasing complexity of the walking condition.MethodsTwenty-five elderly participants (5 males, 20 females, 80.4 ± 8.6 years) were assessed by one observer in two sessions with 48 h between the measurements. Participants walked at self-selected pace along a pathway with three different walking conditions composed of two rectangular foam target locations and an obstacle on the walking surface. The main outcome measures were foot placement distance error, intra-class correlation coefficients (ICC), and the smallest detectable difference (SDD).ResultsMean absolute values of the foot placement distance errors were 14.0 ± 4.5 mm for medio-lateral deviation and 27.2 ± 2.1 mm for anterior–posterior deviation, respectively. ICC values for test–retest reliability showed ‘fair to good’ to ‘excellent’ reliability across all conditions with values ranging from 0.63 to 0.94. SDD values were between 3.6 and 37.3 mm.ConclusionThe protocol showed good reliability for test–retest measurements of foot placement accuracy, thus making this protocol a reliable and location-independent tool to assess performance of foot placement in elderly in assisted-living settings. In the future, measurements with elderly fallers and non-fallers should be conducted to assess validity of the protocol.