Suining Central Hospital Research Articles

Macroscopic hematuria in wasp sting patients: a retrospective study

Background Macroscopic hematuria after wasp sting has been reported in Asia to occur before acute kidney injury (AKI), and is often used by clinicians as a sign indicating the need for intensive care and blood purification therapy. However, there is no study on the clinical characteristics and prognosis of this symptom. Methods The clinical data of 363 patients with wasp sting admitted to Suining Central Hospital from January 2016 to December 2018 were retrospectively analyzed. At admission, the poisoning severity score (PSS) was used as the criterion for severity classification. According to the presence of macroscopic hematuria, the patients were divided into macroscopic hematuria and non-macroscopic hematuria group. Results Of the 363 wasp sting patients, 219 were male and 144 were female, with a mean age of 55.9 ± 16.3 years. Fifty-one (14%) had macroscopic hematuria, 39 (10.7%) had AKI, 105 (28.9%) had rhabdomyolysis, 61 (16.8%) had hemolysis, 45 (12.4%) went on to received hemodialysis, and 14 (3.9%) died. The incidence of AKI in macroscopic hematuria group was 70.6%, and oliguric renal failure accounted for 72.2%. Patients with macroscopic hematuria had significantly higher PSS (2.2 ± 0.5 vs. 1.1 ± 0.3, p < .001). Conclusion Macroscopic hematuria can be regarded as a surrogate marker of deteriorating clinical outcome following wasp stings. In wasp sting patients with symptoms of macroscopic hematuria or serum LDH higher than 463.5 u/L upon admission, the risk of AKI increases significantly, therefore hemodialysis should be considered. The PSS is helpful in early assessment of the severity of wasp sting patients.

Development of an artificial intelligence diagnostic model based on dynamic uncertain causality graph for the differential diagnosis of dyspnea.

Dyspnea is one of the most common manifestations of patients with pulmonary disease, myocardial dysfunction, and neuromuscular disorder, among other conditions. Identifying the causes of dyspnea in clinical practice, especially for the general practitioner, remains a challenge. This pilot study aimed to develop a computer-aided tool for improving the efficiency of differential diagnosis. The disease set with dyspnea as the chief complaint was established on the basis of clinical experience and epidemiological data. Differential diagnosis approaches were established and optimized by clinical experts. The artificial intelligence (AI) diagnosis model was constructed according to the dynamic uncertain causality graph knowledge-based editor. Twenty-eight diseases and syndromes were included in the disease set. The model contained 132 variables of symptoms, signs, and serological and imaging parameters. Medical records from the electronic hospital records of Suining Central Hospital were randomly selected. A total of 202 discharged patients with dyspnea as the chief complaint were included for verification, in which the diagnoses of 195 cases were coincident with the record certified as correct. The overall diagnostic accuracy rate of the model was 96.5%. In conclusion, the diagnostic accuracy of the AI model is promising and may compensate for the limitation of medical experience.

Inflammation and Endothelial Function Relevant Genetic Polymorphisms and Carotid Plaque in Chinese Population

Background: Inflammation and endothelial function play important roles in the pathogenesis of atherosclerosis. The genetic influence on carotid atherosclerotic plaque is mostly unclear. The aim of current study was to examine the association of carotid plaque with variants in genes involved in inflammation and endothelial function. Methods: This was a multi-center, cross sectional survey in southwestern China from May 2015 to September 2015. The residents aged ≥ 40 years volunteered to participate in face-to-face survey in 8 communities at random. A total of 2377 subjects with high stroke risk population were enrolled. Carotid plaque and plaque phenotype were assessed by carotid ultrasound. Genotypes of 19 variants in 10 genes related to inflammation and endothelial function were examined. Gene-gene interaction was analyzed by generalized multifactor dimensionality reduction (GMDR). Finding: Carotid plaques were found in 852 (35.8%) subjects, 454 (53.3%) had stable plaques, 398 (46.7%) had vulnerable plaques. PPARA rs4253655, HABP2 rs7923349 and IL1A rs1609682 were associated with the carotid plaque presence, and NOS2A rs2297518 and PPARA rs4253655 were associated with vulnerable plaque in univariate analysis. GMDR analysis observed that there was a significant gene-gene interaction among HABP2 rs7923349, ITGA2 rs1991013, IL1A rs1609682 and NOS2A rs8081248, and the high-risk interactive genotype among the 4 variants was independently associated with a higher risk for carotid vulnerable plaque after adjusting the covariates (OR, 2.86, 95% CI: 1.32-7.13, P = 0.003). Interpretation: Prevalence of carotid plaque was very high in the high risk stroke population in southwestern China. Variants in genes involved in endothelial function and inflammation were associated with the carotid plaque and plaque vulnerability. The high-risk interactive genotype among rs7923349, rs1991013, rs1609682 and rs8081248 was independently associated with a higher risk for vulnerable plaque, and might be potential markers for plaque vulnerability. Funding Statement: This study was supported in part by grants from the Scientific Research Foundation of Sichuan Provincial Health Department (Grant No. 16ZD046), the Sichuan Science and Technology Agency Research Foundation (Grant No.2018JY0164), and Universal Application Program, Health and Family Planning Commission of Sichuan Province in China (Grant No.17PJ084). Declaration of Interests: The authors stated: None. Ethics Approval Statement: The survey protocol was reviewed and approved by the Ethics Committee of the participating hospitals (People’s Hospital of Deyang City, Suining Central Hospital, and the Affiliated Hospital of Southwest Medical University), and informed consent was obtained from all participants during recruitment.

Clinical observation of apatinib combined with docetaxel in treatment of advanced serum alpha-fetoprotein-positive gastric cancer

Objective To observe the efficacy and safety of apatinib combined with docetaxel in the third line and above treatment of advanced serum alpha-fetoprotein-positive gastric cancer (AFPGC). Methods A total of 41 patients with AFPGC from February 2015 to April 2018 in Suining Central Hospital of Sichuan Province were retrospectively analyzed. The patients were divided into experimental group and control group according to different treatment methods, 15 patients in the experimental group received with apatinib combined with docetaxel, and 26 patients in the control group received chemotherapy alone or optimal nutritional support. The short-term efficacy, long-term efficacy and adverse reactions were evaluated by Response Evaluation Criteria in Solid Tumours (RECIST) version 1.1, progression-free survival (PFS), overall survival (OS) and National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) version 4.0. Results After 2 cycles of treatment, no complete remission (CR) was achieved in either group, 4 partial remission (PR), 7 stable disease (SD), 4 progressive disease (PD) in the experimental group, and 2 PR, 7 SD, 17 PD in the control group. The objective response rate (ORR) was 26.67% (4/15) and 7.69% (2/26) respectively in the experimental group and the control group, with no significant difference (χ2=1.433, P=0.231). The disease control rate (DCR) was 73.33% (11/15) and 34.62% (9/26) respectively in the two groups, with significant difference (χ2=5.707, P=0.017). The median PFS of the experimental group and the control group were both 3.0 months, and there was no significant difference between the two groups (χ2=4.425, P=0.350). The median OS were 6.0 months and 4.0 months respectively, and the difference was statistically significant (χ2=5.727, P=0.017). The occurrence rates of leukopenia of the experimental group and the control group were 73.33% (11/15) and 30.77% (8/26), the occurrence rates of hypertension were 40.00% (6/15) and 0 (0/26), the occurrence rates of proteinuria were 26.67% (4/15) and 0 (0/26), the occurrence rates of poor appetite were 80.00% (12/15) and 38.46% (10/26), and the occurrence rates of hemorrhage were 33.33% (5/15) and 3.85% (1/26). The occurrence rates of the above adverse reactions in the experimental group were significantly higher than those in the control group (χ2=6.930, P=0.008; χ2=9.191, P=0.002; χ2=4.953, P=0.026; χ2=6.600, P=0.010; χ2=4.471, P=0.034), and the differences were statistically significant. There was no significant difference in the incidence of thrombocytopenia, anemia, nausea and vomiting, diarrhea, fatigue and hand-foot syndrome between the two groups (all P>0.05). Conclusion The DCR of apatinib combined with docetaxel in the third-line and above treatment of advanced AFPGC patients is higher. This scheme can prolong survival period, and the adverse reactions are more serious, but they are basically tolerable. Key words: Stomach neoplasms; alpha-Fetoproteins; Apatinib; Docetaxel

Associations between the expression of MTA1 and VEGF-C in esophageal squamous cell carcinoma with lymph angiogenesis and lymph node metastasis.

The aim of the present study was to investigate the association between the expression levels of metastasis-related gene 1 (MTA1) and vascular endothelial growth factor C (VEGF-C) in esophageal squamous cell carcinoma (ESCC) with lymph angiogenesis and lymph node metastasis. The paraffin-embedded tissue samples of 107 cases of ESCC and 56 cases of normal esophageal tissues were collected from the Department of Cardiothoracic Surgery, Suining Central Hospital from March 2013 to January 2014. Immunohistochemical assays were performed to detect the expression levels of MTA1, VEGF-C and D2-40 in ESCC, and the micro-lymphatic vessel density (LVD) was evaluated. Their associations with various clinicopathological parameters were also analyzed. The protein expression levels of MTA1 and VEGF-C in ESCC were significantly higher compared with those in normal esophageal tissues (P<0.05); the high protein expression levels of MTA1 and VEGF-C in ESCC tissues at various tumor-node-metastasis stages exhibited statistically significant differences, as revealed by the Kruskal-Wallis test (P<0.05). The protein expression levels of MTA1 and VEGF-C in ESCC exhibited positive correlations (Spearman's ρ, r=0.512; P=0.000); the LVD level in the group with high expression of MTA1 and VEGF-C was significantly higher compared with in the low expression group (P<0.05). The comparison between MTA1 and VEGF-C protein expression levels in the group with a high rate of lymph node metastasis demonstrated statistically significant differences when compared with in the low lymph node metastasis group (P<0.05). The expression levels of MTA1 and VEGF-C in ESCC exhibited a positive correlation in ESCC, which may co-promote lymph angiogenesis and lymph node metastasis in ESCC; therefore, they may be used as biomarkers for determining the prognosis of ESCC.

Effective ablation therapy of adenomyosis with ultrasound-guided high-intensity focused ultrasound

ObjectiveTo evaluate the effects of ultrasound-guided high-intensity focused ultrasound (HIFU) on adenomyosis. MethodsIn a retrospective analysis, data were reviewed from 202 patients with adenomyosis who underwent ultrasound-guided HIFU between November 2010 and June 2012 at Suining Central Hospital, Sichuan, China. Among these patients, 120 and 82 were classified as having focal adenomyosis and diffuse adenomyosis, respectively. All patients underwent pre-treatment and post-treatment magnetic resonance imaging by a standardized protocol to evaluate the treatment. All adverse effects were recorded. ResultsAll patients completed the ultrasound-guided HIFU treatment in 1 session. A non-perfused volume ratio of 71.6%±19.1% was achieved. Compared with baseline data, the average menorrhagia severity score and the average dysmenorrhea severity pain score decreased significantly after ultrasound-guided HIFU (both P<0.001). The proportion of women with complete relief of dysmenorrhea at the 3-month follow-up was significantly higher among women with focal adenomyosis than among those with diffuse adenomyosis (P=0.02). No other significant differences were observed between the 2 patient groups. ConclusionUltrasound-guided HIFU was found to be an effective technique for treating both focal and diffuse adenomyotic lesions to alleviate the symptoms of menorrhagia or dysmenorrhea.

Clinical utility of a microbubble-enhancing contrast (“SonoVue”) in treatment of uterine fibroids with high intensity focused ultrasound: A retrospective study

PurposeTo evaluate the clinical value of the contrast agent SonoVue in the treatment of uterine fibroids with ultrasound-guided high intensity focused ultrasound (HIFU) therapeutic ablation. Materials and MethodsA total of 291 patients with solitary uterine fibroid from three centers were treated with ultrasound-guided HIFU. Among them, 129 patients from Suining Central Hospital of Sichuan were treated without using SonoVue. 162 patients from the First Hospital of Chongqing Medical University and Chongqing Haifu Hospital were treated with using SonoVue before, during and after HIFU procedure to assess the extent of HIFU. ResultsThe non-perfused volume (indicative of successful ablation) was observed in all treated uterine fibroids immediately after HIFU ablation; median fractional ablation, defined as non-perfused volume divided by the fibroid volume immediately after HIFU treatment, was 86.0% (range, 28.8–100.0%) in the group with using SonoVue, and 83.0% (8.7–100.0%) without SonoVue. The rate of massive gray scale changes was higher with SonoVue than without the agent. The sonication time to achieve massive gray scale changes was shorter with SonoVue than without. The sonication time for ablating 1cm3 of fibroid volume was significantly shorter with using SonoVue than without. No major complications were observed in any patients. ConclusionsBased on our results, SonoVue may enhance the outcome of HIFU ablation and can be used to assess the extent of treatment.