Background:Nasopharyngeal carcinoma(NPC) shows a high proportion of lymph node metastasis,and treatment guidelines have been developed for positive nodes.However,no irradiation guidelines have been proposed for patien...Background:Nasopharyngeal carcinoma(NPC) shows a high proportion of lymph node metastasis,and treatment guidelines have been developed for positive nodes.However,no irradiation guidelines have been proposed for patients with enlarged neck lymph nodes(ENLNs) that do not meet the radiological criteria of 10 mm in diameter for positive lymph nodes.This study aimed to determine the prognostic value and radiation dose for ENLNs in NO-category NPC patients treated with intensity-modulated radiotherapy(IMRT).Methods:We reviewed the medical data of 251 patients with non-metastatic,NO-category NPC treated with IMRT.Receiver operating characteristic curves were used to calculate the cut-off value of the ENLN diameter for the prediction of disease failure.The biological equivalent dose(BED) for ENLNs was calculated.Patient survival was compared between the small and large ENLN groups.Independent prognostic factors were identified using the Cox proportional hazards model.Results:The estimated 4-year regional relapse-free survival rate was higher in patients with ENLNs ≥5.5 mm than in those with ENLNs <5.5 mm(100%vs.98.8%,P=0.049),whereas disease-free,overall,and distant metastasis-free survival rates were similar between the two groups.After adjusting for various factors,ENLN diameter was not identified as an independent prognostic factor(P > 0.05 for all survival rates).In the subgroup analysis,patients receiving BED ≥72 Gy had a similar prognosis as patients receiving BED <72 Gy in both the small and large ENLN groups.The multivariate analysis also confirmed that BED≥72 Gy was not associated with significantly improved prognosis in patients with NO-category NPC.Conclusions:A BED of 72 Gy to ENLNs is considerably sufficient to provide a clinical benefit to patients with NO-category NPC.Prospective studies are warranted to validate the findings in the present study.展开更多
BACKGROUND:Continuous hemorrhage or hematoma enlargement often occurs following cerebral hemorrhage attacks. OBJECTIVE: To retrospectively analyze the influential factors for hematoma enlargement in patients with hy...BACKGROUND:Continuous hemorrhage or hematoma enlargement often occurs following cerebral hemorrhage attacks. OBJECTIVE: To retrospectively analyze the influential factors for hematoma enlargement in patients with hypertensive cerebral hemorrhage prior to minimally invasive surgery. DESIGN, TIME AND SETTING: A comparative analysis of 90 patients with cerebral hemorrhage undergoing minimally invasive surgery at the Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology between April 2005 and February 2007. PARTICIPANTS: Fifty-eight males and thirty-one females aged (52.7 ± 5.23) years (range, 28-73 years). METHODS: Cranial CT was performed twice to objectively identify hematoma enlargement. Patients with hematoma enlargement prior to surgery were selected as the observation group (n = 30), and those with no obvious hematoma changes served as the control group (n = 60). Following cranial CT localization, the two groups underwent minimally invasive hematoma aspiration and drainage, according to Standardized Treatment Guidelines for Micro-invasive Aspiration and Drainage of Intracranial Hematoma. MAIN OUTCOME MEASURES: Hemorrhage site, coagulation function, diabetes history, and clinical symptoms. RESULTS: There were no significant differences in hemorrhage sites between the two groups (χ2 = 2.262, P 〉 0.05). The percent of intemperance patients in the observation group was significantly larger than the control group (χ2 = 6.923, P 〈 0.01). No significant differences in terms of percent of coagulation dysfunction or diabetes were determined between the two groups (χ2 = 0.03, 0.08, P 〉 0.05). The percent of patients with clinical deterioration was significantly higher in the observation group, compared to the control group (χ2 = 25.57, P 〈 0.01). CONCLUSION: Intemperance and preoperative clinical deterioration may increase incidence of hematoma enlargement prior to minimally invasive surgery in patients with hypertensive cerebral hemorrhage.展开更多
Objectives:Distal segment aortic enlargement(DSAE)is a common complication that influences the long-term prognosis of type B aortic dissection(TBAD)after thoracic endovascular aortic repair(TEVAR).In this study,a mult...Objectives:Distal segment aortic enlargement(DSAE)is a common complication that influences the long-term prognosis of type B aortic dissection(TBAD)after thoracic endovascular aortic repair(TEVAR).In this study,a multivariate analysis was performed to find potential factors predictive of DSAE.Methods:A single-center retrospective study was performed from 1999 to 2016.Included in the study were complicated TBAD patients who underwent TEVAR with uncovered residual tears.Based on the diameter of the distal segment of the uncovered aorta,we assigned patients to an enlargement group and a non-enlargement group.Data extracted from the medical records included demographic and clinical characteristics and followup computed tomography angiography data.The primary endpoints were the all-cause mortality and the presumably aortic-related events that required reintervention during the follow-up period.Results:For the 333 patients,all-cause mortality was 38(11.41%),and 76(22.82%)patients underwent reintervention.A total of 70(21.02%)patients experienced DSAE,among them were 2 patients who died of aortic rupture and 58 patients who accepted reintervention.Multivariate analysis reviewed independent risk factors of postoperative DSAE,including current smoking,the residual length of the patent false lumen,the postoperative number of dissection tears in the thoracic aorta and type III aortic arch;as well as protective factors,including the application of a restrictive bare stent(RBS),the length of covered stent in the descending thoracic aorta,and the distance from the residual first tear to the left subclavian artery(LSA).Conclusion:DSAE after TEVAR for patients with a complicated TBAD can be influenced by their current smoking habit,the residual length of patent false lumen,the postoperative number of dissection tears in the thoracic aorta and the aortic arch type.Meanwhile,RBS usage,the length of the covered stent in the descending thoracic aorta and the distance from the residual first tear to the LSA could have positive effect on the prognosis.展开更多
AIM:To compare the difference between tumorinduced lymph node enlargement and inflammation-induced lymph node enlargement by contrast-enhanced ultrasonography and pathological findings. METHODS:A model of tumor-induce...AIM:To compare the difference between tumorinduced lymph node enlargement and inflammation-induced lymph node enlargement by contrast-enhanced ultrasonography and pathological findings. METHODS:A model of tumor-induced lymph node metastasis was prepared by embedding a VX2 tumor into the hind paws of white rabbits.A model of inflammation-induced enlargement was prepared by injecting a suspension of Escherichia coli into separate hind paws of white rabbits.Then,a solution of SonazoidTM(GE Healthcare,Oslo,Norway)was injected subcutaneously in the proximity of the lesion followed by contrast-enhanced ultrasonography of the enlarged popliteal lymph nodes. RESULTS:In the contrast-enhanced ultrasonography of the tumor-induced metastasis model,the sentinel lymph node was imaged.An area of filling defect was observed in that enlarged lymph node.In the histology examination,the area of filling defect corresponded to the metastatic lesion of the tumor.Contrast-enhanced ultrasonography of the model on inflammation-induced lymph node enlargement,and that of the acute inflam-mation model performed 3-7 d later,revealed dense staining that was comparatively uniform.The pathological findings showed acute lymphadenitis mainly due to infiltration of inflammatory cells.Contrast-enhanced ultrasonography that was performed 28 d post-infection in the acute inflammation model showed speckled staining.Inflammation-induced cell infiltration and fiberization,which are findings of chronic lymphadenitis, were seen in the pathological findings. CONCLUSION:Sentinel lymph node imaging was made possible by subcutaneous injection of SonazoidTM.Contrast-enhanced ultrasonography was suggested to be useful in differentiating tumor-induced enlargement and inflammation-induced enlargement of lymph nodes.展开更多
Let Bt be an Ft Brownian motion and Gt be an enlargement of filtration of Ft from some Gaussian random variables. We obtain equations for ht such that Bt ht is a Gt-Brownian motion.
Enlarged vestibular aqueduct(EVA), the most frequent identifiable cause of congenital hearing loss, is evaluated with high-definition multidetector CT in the axial plane. Our purpose was to determine which reformatted...Enlarged vestibular aqueduct(EVA), the most frequent identifiable cause of congenital hearing loss, is evaluated with high-definition multidetector CT in the axial plane. Our purpose was to determine which reformatted CT measurements are most reproducible. Seven multiplanar reformatted images were created for each of the 64 temporal bones in patients with EVA. Intraclass correlation coefficients(ICC) were used to assess inter-observer variability, and both linear regression and ROC analyses were used to compare the measurements with severity of hearing loss, as assessed by pure tone audiometry. All seven measurements had excellent inter-observer variability, with average-measure ICC ranging from 0.92 to 0.98. There was no statistically significant correlation between the radiologic degree of aqueduct enlargement and severity of hearing loss using any of the seven measurements; ROC analyses revealed areas under the curves ranging from 0.57 to 0.73. Optimal accuracy was obtained with a threshold of 1.75 mm as measured at the aqueductal aperture in the P€oschl plane, with sensitivity of 0.75 and specificity of0.63. Although the radiologic measurement may not serve as a reliable tool for assessing severity of EVA, P€oschl plane reformatting has proven to be better than conventional axial acquisition plane for identifying patients with clinically significant hearing loss.展开更多
BACKGROUND Accurate diagnosis of the depth of gastric cancer invasion is crucial in clinical practice.The diagnosis of gastric cancer depth is often made using endoscopic characteristics of the tumor and its margins;h...BACKGROUND Accurate diagnosis of the depth of gastric cancer invasion is crucial in clinical practice.The diagnosis of gastric cancer depth is often made using endoscopic characteristics of the tumor and its margins;however,evaluating invasion depth based on endoscopic background gastritis remains unclear.AIM To investigate predicting submucosal invasion using the endoscopy-based Kyoto classification of gastritis.METHODS Patients with gastric cancer detected on esophagogastroduodenoscopy at Toyoshima Endoscopy Clinic were enrolled.We analyzed the effects of patient and tumor characteristics,including age,sex,body mass index,surveillance endoscopy within 2 years,current Helicobacter pylori infection,the Kyoto classification,and Lauren’s tumor type,on submucosal tumor invasion and curative endoscopic resection.The Kyoto classification included atrophy,intestinal metaplasia,enlarged folds,nodularity,and diffuse redness.Atrophy was characterized by non-reddish and low mucosa.Intestinal metaplasia was detected as patchy whitish or grayish-white flat elevations,forming an irregular uneven surface.An enlarged fold referred to a fold width≥5 mm in the greater curvature of the corpus.Nodularity was characterized by goosebump-like multiple nodules in the antrum.Diffuse redness was characterized by uniform reddish nonatrophic mucosa in the greater curvature of the corpus.RESULTS A total of 266 gastric cancer patients(mean age,66.7 years;male sex,58.6%;mean body mass index,22.8 kg/m2)were enrolled.Ninety-three patients underwent esophagogastroduodenoscopy for surveillance within 2 years,and 140 had current Helicobacter pylori infection.The mean Kyoto score was 4.54.Fifty-eight cancers were diffuse-type,and 87 cancers had invaded the submucosa.Multivariate analysis revealed that low body mass index(odds ratio 0.88,P=0.02),no surveillance esophagogastroduodenoscopy within 2 years(odds ratio 0.15,P<0.001),endoscopic enlarged folds of gastritis(odds ratio 3.39,P=0.001),and Lauren’s diffuse-type(odds ratio 5.09,P<0.001)were independently associated with submucosal invasion.Similar results were obtained with curative endoscopic resection.Among cancer patients with enlarged folds,severely enlarged folds(width≥10 mm)were more related to submucosal invasion than mildly enlarged folds(width 5-9 mm,P<0.001).CONCLUSION Enlarged folds of gastritis were associated with submucosal invasion.Endoscopic observation of background gastritis as well as the lesion itself may help diagnose the depth of cancer invasion.展开更多
BACKGROUND High-riding nipple is one of the common complications after mastopexty and breast reconstruction.However,to date,a limited number of techniques have concentrated on how to lower the high-riding nipple with ...BACKGROUND High-riding nipple is one of the common complications after mastopexty and breast reconstruction.However,to date,a limited number of techniques have concentrated on how to lower the high-riding nipple with enlarged areola.CASE SUMMARY This is a case report describing a combination of surgical techniques to decrease high-riding nipple.A 26-year-old woman,who previously underwent several breast operations,sought correction for high-riding nipple with enlarged areola.Expanders were used and multi-stage techniques were performed.After one year of follow-up,lowered nipple,reduced areola size,ensured nipple blood supply,and improved breast ptosis were achieved,and the patient was satisfied with the breast contour.CONCLUSION The proposed technique offers a feasible treatment option for postoperative nipple over-elevation combined with areola dilation.展开更多
Based on conformal construction of physical model in a three-dimensional Cartesian grid,an integral-based conformal convolutional perfectly matched layer(CPML) is given for solving the truncation problem of the open...Based on conformal construction of physical model in a three-dimensional Cartesian grid,an integral-based conformal convolutional perfectly matched layer(CPML) is given for solving the truncation problem of the open port when the enlarged cell technique conformal finite-difference time-domain(ECT-CFDTD) method is used to simulate the wave propagation inside a perfect electric conductor(PEC) waveguide.The algorithm has the same numerical stability as the ECT-CFDTD method.For the long-time propagation problems of an evanescent wave in a waveguide,several numerical simulations are performed to analyze the reflection error by sweeping the constitutive parameters of the integral-based conformal CPML.Our numerical results show that the integral-based conformal CPML can be used to efficiently truncate the open port of the waveguide.展开更多
The procedure for the ring enlargement of N-heterocycles with the net result of CH2 insertion was successfully carried out with certain alkaloids such as tetrahydroberberine and strychnine.
In this paper, we present a study on activity functions for an MLNN (multi-layered neural network) and propose a suitable activity function for data enlargement processing. We have carefully studied the training perfo...In this paper, we present a study on activity functions for an MLNN (multi-layered neural network) and propose a suitable activity function for data enlargement processing. We have carefully studied the training performance of Sigmoid, ReLu, Leaky-ReLu and L & exp. activity functions for few inputs to multiple output training patterns. Our MLNNs model has L hidden layers with two or three inputs to four or six outputs data variations by BP (backpropagation) NN (neural network) training. We focused on the multi teacher training signals to investigate and evaluate the training performance in MLNNs to select the best and good activity function for data enlargement and hence could be applicable for image and signal processing (synaptic divergence) along with the proposed methods with convolution networks. We specifically used four activity functions from which we found out that L & exp. activity function can suite DENN (data enlargement neural network) training since it could give the highest percentage training abilities compared to the other activity functions of Sigmoid, ReLu and Leaky-ReLu during simulation and training of data in the network. And finally, we recommend L & exp. function to be good for MLNNs and may be applicable for signal processing of data and information enlargement because of its performance training characteristics with multiple teacher training patterns using original generated data and hence can be tried with CNN (convolution neural networks) of image processing.展开更多
By combining the classical appropriate functions “1, x, x 2” with the method of multiplier enlargement, this paper establishes a theorem to approximate any unbounded continuous functions with modified positive...By combining the classical appropriate functions “1, x, x 2” with the method of multiplier enlargement, this paper establishes a theorem to approximate any unbounded continuous functions with modified positive linear operators. As an example, Hermite Fejér interpolation polynomial operators are analysed and studied, and a general conclusion is obtained.展开更多
Vocabulary is a very important element in English learning.Without a large vocabulary,no one can reach a high English level.However,it is very difficult to enlarge vocabulary.In fact there are many methods to enlarge ...Vocabulary is a very important element in English learning.Without a large vocabulary,no one can reach a high English level.However,it is very difficult to enlarge vocabulary.In fact there are many methods to enlarge vocabulary.展开更多
Unusual presentation of localized gingival enlargement associated with a subjacent tumoural pathology is reported.The patient was a55-year-old black male,whose chief complaint was a progressive gingival overgrowth for...Unusual presentation of localized gingival enlargement associated with a subjacent tumoural pathology is reported.The patient was a55-year-old black male,whose chief complaint was a progressive gingival overgrowth for more than ten years,in the buccal area of the anterior left mandible.According to the clinical features and the radiological diagnosis of odontogenic keratocyst,a conservative surgery with enucleation and curettage was performed.Tissue submitted for histopathological analysis rendered the diagnosis of odontogenic myxoma.After 12-month of follow-up,no evidence of recurrence was found.Clinicians should be cautious when facing any gingival enlargement to avoid diagnostic pitfalls and to indicate the appropriate treatment.展开更多
BACKGROUND: It has been reported that cerebrovascular disease causes changes in electrocardiogram results. OBJECTIVE: To investigate changes in electrocardiogram results in patients with intracerebral bematoma enlar...BACKGROUND: It has been reported that cerebrovascular disease causes changes in electrocardiogram results. OBJECTIVE: To investigate changes in electrocardiogram results in patients with intracerebral bematoma enlargement. DESIGN, TIME AND SETTING: The present case-retrospective analysis study was performed at the Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2005 to October 2006. PARTICIPANTS: A total of 225 intracerebral hemorrhage patients (142 males and 83 females) that were hospitalized at the Department of Neurology were enrolled the present study. The patient selection was in accordance with diagnostic criteria from the Fourth National Cerebrovascular Disease Congress of China in 1995, and diagnosis was confirmed using computed tomography. All patients underwent computed tomography twice within 24 hours following intracerebral hemorrhage, and were subjected to electrocardiogram examination after admission. METHODS: According to hematoma enlargement following intracerebral hemorrhage, all patients were divided into hematoma enlargement (n = 20) and non-hematoma enlargement (n = 205) groups. Because of the large patient number difference between the two groups, the hematoma enlargement group was matched with the non-hematoma enlargement group. Patients meeting these conditions were included in the non-hematoma enlargement group. Finally, 75 patients were included in the final analysis, 19 in the hematoma enlargement group and 56 in the non-hematoma enlargement group. Clinical data from the two groups were statistically analyzed. MAIN OUTCOME MEASURES: The incidence of electrocardiographic abnormalities between the hematoma enlargement and non-hematoma enlargement groups. RESULTS: In the hematoma enlargement group, 15 patients (79%) developed electrocardiographic abnormafities. In the non-hematoma enlargement group, 24 patients (43%) presented with electrocardiographic abnormalities. There were significant differences in electrocardiographic abnormalities between the groups (P 〈 0.01). CONCLUSION: Patients with electrocardiographic abnormalities suffered from hematoma enlargement following admission.展开更多
It is of vital importance to enlarge students' vocabulary in English teaching. The methods are: letting students realize theimportance of words; teaching English word formation knowledge in class,for example, affi...It is of vital importance to enlarge students' vocabulary in English teaching. The methods are: letting students realize theimportance of words; teaching English word formation knowledge in class,for example, affixation, conversion, composition, blend-ing,backformation,shortening;teaching synonyms and antonyms,teaching words similar in spelling;words association, letting stu-dents reading widely;memorizing word lists and so on.展开更多
AIM: To study the relationship between platelet count-to-spleen diameter ratio and post-gastrectomy esopha-geal varices (EVs) development in patients without liver cirrhosis or hepatitis. METHODS: We retrospectively s...AIM: To study the relationship between platelet count-to-spleen diameter ratio and post-gastrectomy esopha-geal varices (EVs) development in patients without liver cirrhosis or hepatitis. METHODS: We retrospectively studied 92 patients who underwent gastrectomy. They were divided into 2 groups on the basis of the surgical treatment: the distal gastrectomy (DG) group and total gastrectomy (TG) group. The incidence of EVs was determined and postoperative platelet counts, spleen diameters, and platelet count-to-spleen diameter ratios were com-pared between the 2 groups. RESULTS: EVs were not detected during the first 6 mo after surgery in either group; however, at 12 mo after surgery, EVs were detected in 2 patients (3%) in the DG group and in 1 patient (3.6%) in the TG group; their mean platelet count-to-spleen diameter ratio was 2628 ± 409, and 2604 ± 360, respectively.CONCLUSION: Endoscopy should be performed to detect EVs when the platelet count-to-spleen diameter ratio is < 2600.展开更多
PRKAG2 cardiac syndrome(PS)is a rare inherited disease due to PRKAG2 gene mutation and characterized by Wolff-Parkinson-White syndrome(WPWs),conduction system lesions and myocardial hypertrophy.It can also lead to ser...PRKAG2 cardiac syndrome(PS)is a rare inherited disease due to PRKAG2 gene mutation and characterized by Wolff-Parkinson-White syndrome(WPWs),conduction system lesions and myocardial hypertrophy.It can also lead to serious consequences,such as sudden death.But the genetic and clinical heterogeneity makes the early diagnosis of PS difficult.Here we studied a family with familial hypertrophic cardiomyopathy and other diverse manifestations.Gene analysis identified a missense mutation(Arg302Gln)in the five affected subjects of the family.The electrocardiograph performance of the five was composed of sinus bradycardia(SB),WPWs,right bundle branch block(RBBB),atrioventricular block(AVB),left bundle branch block(LBBB),supraventricular tachycardia(SVT)and atrial premature beat(APB).Among them,the youngest one began to show paroxysmal palpitation at the age of nine and was confirmed to have WPWs at 17 years old;two members progressed over time to serious conduction damage,and the proband received a pacemaker at the age of 27 due to AVB.Besides,according to cardiac magnetic resonance and echocardiography,the youngest one showed symmetric hypertrophy;three older members showed asymmetric myocardial hypertrophy characterized with a diffuse pattern of middle-anterior-lateral-inferior wall hypertrophy and especially interventricular septal hypertrophy;all five affected patients showed atrial enlargement regardless of myocardial hypertrophy at an earlier stage.In conclusion,the conduction system disorder,familial atrial enlargement and symmetric cardiac hypertrophy may occur in the early stage of PRKAG2 R302Q mutation.展开更多
BACKGROUND Cyclosporine is an immunosuppressive agent used effectively for treatment of a rare haematological disorder known as medullary aplasia.This drug prevents several side effects,including gingival enlargement(...BACKGROUND Cyclosporine is an immunosuppressive agent used effectively for treatment of a rare haematological disorder known as medullary aplasia.This drug prevents several side effects,including gingival enlargement(GE)which compromises aesthetics,phonetics and chewing,and also predisposes patients to periodontitis.CASE SUMMARY This clinical case reports a 41-year-old woman who presented with cyclosporineinduced GE with underlying periodontitis and medullary aplasia.The management of the disease was approached through multidisciplinary strategy which allowed for accurate diagnosis and a strategic treatment based on the systemic condition and severity of oral pathology.The diagnosis was confirmed through histopathological analysis.The treatment was carried out in phases:Initial(oral hygiene motivation,mechanical supragingival plaque control,and non-surgical therapy);systemic treatment,corrective treatment,and maintenance.CONCLUSION Multidisciplinary management of cyclosporine-induced GE and medullary aplasia allows for correct diagnosis and effective treatment of this pathological expression through a phased therapeutic approach.展开更多
基金supported by grants from the Health & Medical Collaborative Innovation Project of Guangzhou City,China(No.201400000001)the Sun Yat-sen University Clinical Research 5010 Program(No.2012011)+1 种基金the Science and Technology Project of Guangzhou City,China(No.14570006)the Planned Science and Technology Project of Guangdong Province,China(No. 2013B020400004)
文摘Background:Nasopharyngeal carcinoma(NPC) shows a high proportion of lymph node metastasis,and treatment guidelines have been developed for positive nodes.However,no irradiation guidelines have been proposed for patients with enlarged neck lymph nodes(ENLNs) that do not meet the radiological criteria of 10 mm in diameter for positive lymph nodes.This study aimed to determine the prognostic value and radiation dose for ENLNs in NO-category NPC patients treated with intensity-modulated radiotherapy(IMRT).Methods:We reviewed the medical data of 251 patients with non-metastatic,NO-category NPC treated with IMRT.Receiver operating characteristic curves were used to calculate the cut-off value of the ENLN diameter for the prediction of disease failure.The biological equivalent dose(BED) for ENLNs was calculated.Patient survival was compared between the small and large ENLN groups.Independent prognostic factors were identified using the Cox proportional hazards model.Results:The estimated 4-year regional relapse-free survival rate was higher in patients with ENLNs ≥5.5 mm than in those with ENLNs <5.5 mm(100%vs.98.8%,P=0.049),whereas disease-free,overall,and distant metastasis-free survival rates were similar between the two groups.After adjusting for various factors,ENLN diameter was not identified as an independent prognostic factor(P > 0.05 for all survival rates).In the subgroup analysis,patients receiving BED ≥72 Gy had a similar prognosis as patients receiving BED <72 Gy in both the small and large ENLN groups.The multivariate analysis also confirmed that BED≥72 Gy was not associated with significantly improved prognosis in patients with NO-category NPC.Conclusions:A BED of 72 Gy to ENLNs is considerably sufficient to provide a clinical benefit to patients with NO-category NPC.Prospective studies are warranted to validate the findings in the present study.
文摘BACKGROUND:Continuous hemorrhage or hematoma enlargement often occurs following cerebral hemorrhage attacks. OBJECTIVE: To retrospectively analyze the influential factors for hematoma enlargement in patients with hypertensive cerebral hemorrhage prior to minimally invasive surgery. DESIGN, TIME AND SETTING: A comparative analysis of 90 patients with cerebral hemorrhage undergoing minimally invasive surgery at the Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology between April 2005 and February 2007. PARTICIPANTS: Fifty-eight males and thirty-one females aged (52.7 ± 5.23) years (range, 28-73 years). METHODS: Cranial CT was performed twice to objectively identify hematoma enlargement. Patients with hematoma enlargement prior to surgery were selected as the observation group (n = 30), and those with no obvious hematoma changes served as the control group (n = 60). Following cranial CT localization, the two groups underwent minimally invasive hematoma aspiration and drainage, according to Standardized Treatment Guidelines for Micro-invasive Aspiration and Drainage of Intracranial Hematoma. MAIN OUTCOME MEASURES: Hemorrhage site, coagulation function, diabetes history, and clinical symptoms. RESULTS: There were no significant differences in hemorrhage sites between the two groups (χ2 = 2.262, P 〉 0.05). The percent of intemperance patients in the observation group was significantly larger than the control group (χ2 = 6.923, P 〈 0.01). No significant differences in terms of percent of coagulation dysfunction or diabetes were determined between the two groups (χ2 = 0.03, 0.08, P 〉 0.05). The percent of patients with clinical deterioration was significantly higher in the observation group, compared to the control group (χ2 = 25.57, P 〈 0.01). CONCLUSION: Intemperance and preoperative clinical deterioration may increase incidence of hematoma enlargement prior to minimally invasive surgery in patients with hypertensive cerebral hemorrhage.
基金supported by the National Nature Science Foundation of China[grant number 81800403].
文摘Objectives:Distal segment aortic enlargement(DSAE)is a common complication that influences the long-term prognosis of type B aortic dissection(TBAD)after thoracic endovascular aortic repair(TEVAR).In this study,a multivariate analysis was performed to find potential factors predictive of DSAE.Methods:A single-center retrospective study was performed from 1999 to 2016.Included in the study were complicated TBAD patients who underwent TEVAR with uncovered residual tears.Based on the diameter of the distal segment of the uncovered aorta,we assigned patients to an enlargement group and a non-enlargement group.Data extracted from the medical records included demographic and clinical characteristics and followup computed tomography angiography data.The primary endpoints were the all-cause mortality and the presumably aortic-related events that required reintervention during the follow-up period.Results:For the 333 patients,all-cause mortality was 38(11.41%),and 76(22.82%)patients underwent reintervention.A total of 70(21.02%)patients experienced DSAE,among them were 2 patients who died of aortic rupture and 58 patients who accepted reintervention.Multivariate analysis reviewed independent risk factors of postoperative DSAE,including current smoking,the residual length of the patent false lumen,the postoperative number of dissection tears in the thoracic aorta and type III aortic arch;as well as protective factors,including the application of a restrictive bare stent(RBS),the length of covered stent in the descending thoracic aorta,and the distance from the residual first tear to the left subclavian artery(LSA).Conclusion:DSAE after TEVAR for patients with a complicated TBAD can be influenced by their current smoking habit,the residual length of patent false lumen,the postoperative number of dissection tears in the thoracic aorta and the aortic arch type.Meanwhile,RBS usage,the length of the covered stent in the descending thoracic aorta and the distance from the residual first tear to the LSA could have positive effect on the prognosis.
文摘AIM:To compare the difference between tumorinduced lymph node enlargement and inflammation-induced lymph node enlargement by contrast-enhanced ultrasonography and pathological findings. METHODS:A model of tumor-induced lymph node metastasis was prepared by embedding a VX2 tumor into the hind paws of white rabbits.A model of inflammation-induced enlargement was prepared by injecting a suspension of Escherichia coli into separate hind paws of white rabbits.Then,a solution of SonazoidTM(GE Healthcare,Oslo,Norway)was injected subcutaneously in the proximity of the lesion followed by contrast-enhanced ultrasonography of the enlarged popliteal lymph nodes. RESULTS:In the contrast-enhanced ultrasonography of the tumor-induced metastasis model,the sentinel lymph node was imaged.An area of filling defect was observed in that enlarged lymph node.In the histology examination,the area of filling defect corresponded to the metastatic lesion of the tumor.Contrast-enhanced ultrasonography of the model on inflammation-induced lymph node enlargement,and that of the acute inflam-mation model performed 3-7 d later,revealed dense staining that was comparatively uniform.The pathological findings showed acute lymphadenitis mainly due to infiltration of inflammatory cells.Contrast-enhanced ultrasonography that was performed 28 d post-infection in the acute inflammation model showed speckled staining.Inflammation-induced cell infiltration and fiberization,which are findings of chronic lymphadenitis, were seen in the pathological findings. CONCLUSION:Sentinel lymph node imaging was made possible by subcutaneous injection of SonazoidTM.Contrast-enhanced ultrasonography was suggested to be useful in differentiating tumor-induced enlargement and inflammation-induced enlargement of lymph nodes.
文摘Let Bt be an Ft Brownian motion and Gt be an enlargement of filtration of Ft from some Gaussian random variables. We obtain equations for ht such that Bt ht is a Gt-Brownian motion.
文摘Enlarged vestibular aqueduct(EVA), the most frequent identifiable cause of congenital hearing loss, is evaluated with high-definition multidetector CT in the axial plane. Our purpose was to determine which reformatted CT measurements are most reproducible. Seven multiplanar reformatted images were created for each of the 64 temporal bones in patients with EVA. Intraclass correlation coefficients(ICC) were used to assess inter-observer variability, and both linear regression and ROC analyses were used to compare the measurements with severity of hearing loss, as assessed by pure tone audiometry. All seven measurements had excellent inter-observer variability, with average-measure ICC ranging from 0.92 to 0.98. There was no statistically significant correlation between the radiologic degree of aqueduct enlargement and severity of hearing loss using any of the seven measurements; ROC analyses revealed areas under the curves ranging from 0.57 to 0.73. Optimal accuracy was obtained with a threshold of 1.75 mm as measured at the aqueductal aperture in the P€oschl plane, with sensitivity of 0.75 and specificity of0.63. Although the radiologic measurement may not serve as a reliable tool for assessing severity of EVA, P€oschl plane reformatting has proven to be better than conventional axial acquisition plane for identifying patients with clinically significant hearing loss.
文摘BACKGROUND Accurate diagnosis of the depth of gastric cancer invasion is crucial in clinical practice.The diagnosis of gastric cancer depth is often made using endoscopic characteristics of the tumor and its margins;however,evaluating invasion depth based on endoscopic background gastritis remains unclear.AIM To investigate predicting submucosal invasion using the endoscopy-based Kyoto classification of gastritis.METHODS Patients with gastric cancer detected on esophagogastroduodenoscopy at Toyoshima Endoscopy Clinic were enrolled.We analyzed the effects of patient and tumor characteristics,including age,sex,body mass index,surveillance endoscopy within 2 years,current Helicobacter pylori infection,the Kyoto classification,and Lauren’s tumor type,on submucosal tumor invasion and curative endoscopic resection.The Kyoto classification included atrophy,intestinal metaplasia,enlarged folds,nodularity,and diffuse redness.Atrophy was characterized by non-reddish and low mucosa.Intestinal metaplasia was detected as patchy whitish or grayish-white flat elevations,forming an irregular uneven surface.An enlarged fold referred to a fold width≥5 mm in the greater curvature of the corpus.Nodularity was characterized by goosebump-like multiple nodules in the antrum.Diffuse redness was characterized by uniform reddish nonatrophic mucosa in the greater curvature of the corpus.RESULTS A total of 266 gastric cancer patients(mean age,66.7 years;male sex,58.6%;mean body mass index,22.8 kg/m2)were enrolled.Ninety-three patients underwent esophagogastroduodenoscopy for surveillance within 2 years,and 140 had current Helicobacter pylori infection.The mean Kyoto score was 4.54.Fifty-eight cancers were diffuse-type,and 87 cancers had invaded the submucosa.Multivariate analysis revealed that low body mass index(odds ratio 0.88,P=0.02),no surveillance esophagogastroduodenoscopy within 2 years(odds ratio 0.15,P<0.001),endoscopic enlarged folds of gastritis(odds ratio 3.39,P=0.001),and Lauren’s diffuse-type(odds ratio 5.09,P<0.001)were independently associated with submucosal invasion.Similar results were obtained with curative endoscopic resection.Among cancer patients with enlarged folds,severely enlarged folds(width≥10 mm)were more related to submucosal invasion than mildly enlarged folds(width 5-9 mm,P<0.001).CONCLUSION Enlarged folds of gastritis were associated with submucosal invasion.Endoscopic observation of background gastritis as well as the lesion itself may help diagnose the depth of cancer invasion.
文摘BACKGROUND High-riding nipple is one of the common complications after mastopexty and breast reconstruction.However,to date,a limited number of techniques have concentrated on how to lower the high-riding nipple with enlarged areola.CASE SUMMARY This is a case report describing a combination of surgical techniques to decrease high-riding nipple.A 26-year-old woman,who previously underwent several breast operations,sought correction for high-riding nipple with enlarged areola.Expanders were used and multi-stage techniques were performed.After one year of follow-up,lowered nipple,reduced areola size,ensured nipple blood supply,and improved breast ptosis were achieved,and the patient was satisfied with the breast contour.CONCLUSION The proposed technique offers a feasible treatment option for postoperative nipple over-elevation combined with areola dilation.
基金supported by the National Natural Science Foundation of China(Grant No.61231003)
文摘Based on conformal construction of physical model in a three-dimensional Cartesian grid,an integral-based conformal convolutional perfectly matched layer(CPML) is given for solving the truncation problem of the open port when the enlarged cell technique conformal finite-difference time-domain(ECT-CFDTD) method is used to simulate the wave propagation inside a perfect electric conductor(PEC) waveguide.The algorithm has the same numerical stability as the ECT-CFDTD method.For the long-time propagation problems of an evanescent wave in a waveguide,several numerical simulations are performed to analyze the reflection error by sweeping the constitutive parameters of the integral-based conformal CPML.Our numerical results show that the integral-based conformal CPML can be used to efficiently truncate the open port of the waveguide.
文摘The procedure for the ring enlargement of N-heterocycles with the net result of CH2 insertion was successfully carried out with certain alkaloids such as tetrahydroberberine and strychnine.
文摘In this paper, we present a study on activity functions for an MLNN (multi-layered neural network) and propose a suitable activity function for data enlargement processing. We have carefully studied the training performance of Sigmoid, ReLu, Leaky-ReLu and L & exp. activity functions for few inputs to multiple output training patterns. Our MLNNs model has L hidden layers with two or three inputs to four or six outputs data variations by BP (backpropagation) NN (neural network) training. We focused on the multi teacher training signals to investigate and evaluate the training performance in MLNNs to select the best and good activity function for data enlargement and hence could be applicable for image and signal processing (synaptic divergence) along with the proposed methods with convolution networks. We specifically used four activity functions from which we found out that L & exp. activity function can suite DENN (data enlargement neural network) training since it could give the highest percentage training abilities compared to the other activity functions of Sigmoid, ReLu and Leaky-ReLu during simulation and training of data in the network. And finally, we recommend L & exp. function to be good for MLNNs and may be applicable for signal processing of data and information enlargement because of its performance training characteristics with multiple teacher training patterns using original generated data and hence can be tried with CNN (convolution neural networks) of image processing.
文摘By combining the classical appropriate functions “1, x, x 2” with the method of multiplier enlargement, this paper establishes a theorem to approximate any unbounded continuous functions with modified positive linear operators. As an example, Hermite Fejér interpolation polynomial operators are analysed and studied, and a general conclusion is obtained.
文摘Vocabulary is a very important element in English learning.Without a large vocabulary,no one can reach a high English level.However,it is very difficult to enlarge vocabulary.In fact there are many methods to enlarge vocabulary.
文摘Unusual presentation of localized gingival enlargement associated with a subjacent tumoural pathology is reported.The patient was a55-year-old black male,whose chief complaint was a progressive gingival overgrowth for more than ten years,in the buccal area of the anterior left mandible.According to the clinical features and the radiological diagnosis of odontogenic keratocyst,a conservative surgery with enucleation and curettage was performed.Tissue submitted for histopathological analysis rendered the diagnosis of odontogenic myxoma.After 12-month of follow-up,no evidence of recurrence was found.Clinicians should be cautious when facing any gingival enlargement to avoid diagnostic pitfalls and to indicate the appropriate treatment.
基金the National Natural Science Foundation of China, No. 30570628, 30770751
文摘BACKGROUND: It has been reported that cerebrovascular disease causes changes in electrocardiogram results. OBJECTIVE: To investigate changes in electrocardiogram results in patients with intracerebral bematoma enlargement. DESIGN, TIME AND SETTING: The present case-retrospective analysis study was performed at the Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2005 to October 2006. PARTICIPANTS: A total of 225 intracerebral hemorrhage patients (142 males and 83 females) that were hospitalized at the Department of Neurology were enrolled the present study. The patient selection was in accordance with diagnostic criteria from the Fourth National Cerebrovascular Disease Congress of China in 1995, and diagnosis was confirmed using computed tomography. All patients underwent computed tomography twice within 24 hours following intracerebral hemorrhage, and were subjected to electrocardiogram examination after admission. METHODS: According to hematoma enlargement following intracerebral hemorrhage, all patients were divided into hematoma enlargement (n = 20) and non-hematoma enlargement (n = 205) groups. Because of the large patient number difference between the two groups, the hematoma enlargement group was matched with the non-hematoma enlargement group. Patients meeting these conditions were included in the non-hematoma enlargement group. Finally, 75 patients were included in the final analysis, 19 in the hematoma enlargement group and 56 in the non-hematoma enlargement group. Clinical data from the two groups were statistically analyzed. MAIN OUTCOME MEASURES: The incidence of electrocardiographic abnormalities between the hematoma enlargement and non-hematoma enlargement groups. RESULTS: In the hematoma enlargement group, 15 patients (79%) developed electrocardiographic abnormafities. In the non-hematoma enlargement group, 24 patients (43%) presented with electrocardiographic abnormalities. There were significant differences in electrocardiographic abnormalities between the groups (P 〈 0.01). CONCLUSION: Patients with electrocardiographic abnormalities suffered from hematoma enlargement following admission.
文摘It is of vital importance to enlarge students' vocabulary in English teaching. The methods are: letting students realize theimportance of words; teaching English word formation knowledge in class,for example, affixation, conversion, composition, blend-ing,backformation,shortening;teaching synonyms and antonyms,teaching words similar in spelling;words association, letting stu-dents reading widely;memorizing word lists and so on.
文摘AIM: To study the relationship between platelet count-to-spleen diameter ratio and post-gastrectomy esopha-geal varices (EVs) development in patients without liver cirrhosis or hepatitis. METHODS: We retrospectively studied 92 patients who underwent gastrectomy. They were divided into 2 groups on the basis of the surgical treatment: the distal gastrectomy (DG) group and total gastrectomy (TG) group. The incidence of EVs was determined and postoperative platelet counts, spleen diameters, and platelet count-to-spleen diameter ratios were com-pared between the 2 groups. RESULTS: EVs were not detected during the first 6 mo after surgery in either group; however, at 12 mo after surgery, EVs were detected in 2 patients (3%) in the DG group and in 1 patient (3.6%) in the TG group; their mean platelet count-to-spleen diameter ratio was 2628 ± 409, and 2604 ± 360, respectively.CONCLUSION: Endoscopy should be performed to detect EVs when the platelet count-to-spleen diameter ratio is < 2600.
文摘PRKAG2 cardiac syndrome(PS)is a rare inherited disease due to PRKAG2 gene mutation and characterized by Wolff-Parkinson-White syndrome(WPWs),conduction system lesions and myocardial hypertrophy.It can also lead to serious consequences,such as sudden death.But the genetic and clinical heterogeneity makes the early diagnosis of PS difficult.Here we studied a family with familial hypertrophic cardiomyopathy and other diverse manifestations.Gene analysis identified a missense mutation(Arg302Gln)in the five affected subjects of the family.The electrocardiograph performance of the five was composed of sinus bradycardia(SB),WPWs,right bundle branch block(RBBB),atrioventricular block(AVB),left bundle branch block(LBBB),supraventricular tachycardia(SVT)and atrial premature beat(APB).Among them,the youngest one began to show paroxysmal palpitation at the age of nine and was confirmed to have WPWs at 17 years old;two members progressed over time to serious conduction damage,and the proband received a pacemaker at the age of 27 due to AVB.Besides,according to cardiac magnetic resonance and echocardiography,the youngest one showed symmetric hypertrophy;three older members showed asymmetric myocardial hypertrophy characterized with a diffuse pattern of middle-anterior-lateral-inferior wall hypertrophy and especially interventricular septal hypertrophy;all five affected patients showed atrial enlargement regardless of myocardial hypertrophy at an earlier stage.In conclusion,the conduction system disorder,familial atrial enlargement and symmetric cardiac hypertrophy may occur in the early stage of PRKAG2 R302Q mutation.
文摘BACKGROUND Cyclosporine is an immunosuppressive agent used effectively for treatment of a rare haematological disorder known as medullary aplasia.This drug prevents several side effects,including gingival enlargement(GE)which compromises aesthetics,phonetics and chewing,and also predisposes patients to periodontitis.CASE SUMMARY This clinical case reports a 41-year-old woman who presented with cyclosporineinduced GE with underlying periodontitis and medullary aplasia.The management of the disease was approached through multidisciplinary strategy which allowed for accurate diagnosis and a strategic treatment based on the systemic condition and severity of oral pathology.The diagnosis was confirmed through histopathological analysis.The treatment was carried out in phases:Initial(oral hygiene motivation,mechanical supragingival plaque control,and non-surgical therapy);systemic treatment,corrective treatment,and maintenance.CONCLUSION Multidisciplinary management of cyclosporine-induced GE and medullary aplasia allows for correct diagnosis and effective treatment of this pathological expression through a phased therapeutic approach.