Preoperative neutrophil-to-lymphocyte ratio predicts symptomatic anastomotic leakage in elderly colon cancer patients: Multicenter propensity score-matched analysis

BACKGROUND The neutrophil-to-lymphocyte ratio(NLR),a composite inflammatory biomarker,is associated with the prognosis in patients with colorectal tumors.However,whether the NLR can be used as a predictor of symptomatic postoperative ana-stomotic leakage(AL)in elderly patients with colon cancer is unclear.AIM To assess the role of the NLR in predicting the occurrence of symptomatic AL after surgery in elderly patients with colon cancer.METHODS Data from elderly colon cancer patients who underwent elective radical colectomy with anastomosis at three centers between 2018 and 2022 were retrospectively analyzed.Receiver operating characteristic curve analysis was performed to determine the best predictive cutoff value for the NLR.Twenty-two covariates were matched using a 1:1 propensity score matching method,and univariate and multivariate logistic regression analyses were used to determine risk factors for the development of postoperative AL.RESULTS Of the 577 patients included,36(6.2%)had symptomatic AL.The optimal cutoff value of the NLR for predicting AL was 2.66.After propensity score matching,the incidence of AL was significantly greater in the≥2.66 NLR subgroup than in the<2.66 NLR subgroup(11.5%vs 2.5%;P=0.012).Univariate logistic regression analysis revealed statistically significant correlations between blood transfusion intraoperatively and within 2 d postoper-atively,preoperative albumin concentration,preoperative prognostic nutritional index,and preoperative NLR and AL occurrence(P<0.05);multivariate logistic regression analysis revealed that an NLR≥2.66[odds ratio(OR)=5.51;95%confidence interval(CI):1.50-20.26;P=0.010]and blood transfusion intraoperatively and within 2 d postoperatively(OR=2.52;95%CI:0.88-7.25;P=0.049)were risk factors for the occurrence of symptomatic AL.CONCLUSION A preoperative NLR≥2.66 and blood transfusion intraoperatively and within 2 d postoperatively are associated with a higher incidence of postoperative symptomatic AL in elderly patients with colon cancer.The preoperative NLR has predictive value for postoperative symptomatic AL after elective surgery in elderly patients with colon cancer.

心血管疾病患者运动恐惧评估工具测量属性的系统评价

目的系统评价心血管疾病患者运动恐惧评估工具的测量学特性及方法学质量,为医护人员选择高质量的评估工具提供参考。方法系统检索Embase、the Cochrane Libranry.PubMed.Web of Science、中国知网、万方数据库、中国生物医学文献数据库、CINAHL和维普数据库中有关心血管疾病患者运动恐惧量表测量属性的研究,检索时限为建库至2023年4月1日,并追溯纳人文献的参考文献以补充相关文献。两名研究员按照纳人排除标准,独立筛选文献、提取数据,并使用COSMIN偏倚风险检查表独立评估量表的方法学质量,使用COSMIN标准评估量表评价测量学特性,使用改良版定量系统评价证据分级评估证据等级。结果共纳人17项研究,对6个心血管疾病患者运动恐惧评估工具(包含不同语言版本)的心理测量学特性进行了评价,仅有2项研究报告的量表内容效度方法学质量为很好,其余研究报告的量表内容效度方法学质量为模糊。关于跨文化有效性/测量不变性、测量误差和反应性的信息较少。瑞典语版及中文版坦帕运动恐惧症量表(the Tampa Scale for Kinesiophobia Heart,TSK Heart)为A类推荐,其他工具为B类推荐。结论现有研究中报告的瑞典语版和中文版TSKHeart的方法学及测量学属性质量相对较高,可被推荐使用,其余量表的测量学特性有待进--步验证。

Fibroblast-derived CXCL12/SDF-1α promotes CXCL6 secretion and co-operatively enhances metastatic potential through the PI3K/Akt/m TOR pathway in colon cancer

AIM To investigate the underlying mechanism by which CXCL12 and CXCL6 influences the metastatic potential of colon cancer and internal relation of colon cancer and stromal cells. METHODS Western blotting was used to detect the expression of CXCL12 and CXCL6 in colon cancer cells and stromal cells. The co-operative effects of CXCL12 and CXCL6 on proliferation and invasion of colon cancer cells and human umbilical vein endothelial cells(HUVECs) were determined by enzyme-linked immunosorbent assay,and proliferation and invasion assays. The angiogenesis of HUVECs through interaction with cancer cells and stromal cells was examined by angiogenesis assay. We eventually investigated activation of PI3K/Akt/m TOR signaling by CXCL12 involved in the metastatic process of colon cancer.RESULTS CXCL12 was expressed in DLD-1 cancer cells and fibroblasts. The secretion level of CXCL6 by colon cancer cells and HUVECs were significantly promoted by fibroblasts derived from CXCL12. CXCL6 and CXCL2 could significantly enhance HUVEC proliferation and migration(P < 0.01). CXCL6 and CXCL2 enhanced angiogenesis by HUVECs when cultured with fibroblast cells and colon cancer cells(P < 0.01). CXCL12 also enhanced the invasion of colon cancer cells. Stromal cell-derived CXCL12 promoted the secretion level of CXCL6 and co-operatively promoted metastasis of colon carcinoma through activation of the PI3K/Akt/m TOR pathway.CONCLUSION Fibroblast-derived CXCL12 enhanced the CXCL6 secretion of colon cancer cells,and both CXCL12 and CXCL6 co-operatively regulated the metastasis via the PI3K/Akt/m TOR signaling pathway. Blocking this pathway may be a potential anti-metastatic therapeutic target for patients with colon cancer.

An Automated Detection Approach of Protective Equipment Donning for Medical Staff under COVID-19 Using Deep Learning

Personal protective equipment(PPE)donning detection for medical staff is a key link of medical operation safety guarantee and is of great significance to combat COVID-19.However,the lack of dedicated datasets makes the scarce research on intelligence monitoring of workers’PPE use in the field of healthcare.In this paper,we construct a dress codes dataset for medical staff under the epidemic.And based on this,we propose a PPE donning automatic detection approach using deep learning.With the participation of health care personnel,we organize 6 volunteers dressed in different combinations of PPE to simulate more dress situations in the preset structured environment,and an effective and robust dataset is constructed with a total of 5233 preprocessed images.Starting from the task’s dual requirements for speed and accuracy,we use the YOLOv4 convolutional neural network as our learning model to judge whether the donning of different PPE classes corresponds to the body parts of the medical staff meets the dress codes to ensure their self-protection safety.Experimental results show that compared with three typical deeplearning-based detection models,our method achieves a relatively optimal balance while ensuring high detection accuracy(84.14%),with faster processing time(42.02 ms)after the average analysis of 17 classes of PPE donning situation.Overall,this research focuses on the automatic detection of worker safety protection for the first time in healthcare,which will help to improve its technical level of risk management and the ability to respond to potentially hazardous events.

Clinical Outcomes of Artificial Total Hip Arthroplasty for Proximal Femoral Bone Tumors

Objective:To investigate the clinical outcome of artificial hip replacement for proximal femoral bone tumors.Methods:One hundred patients with proximal femur bone tumors admitted to the hospital for treatment from June 2018 to May 2020 were selected and divided into a control group and an experimental group of 50 patients each using central randomization.The control group received conventional treatment and the experimental group underwent artificial total hip arthroplasty,and the results of treatment were compared between the two groups.Results:The operative time and hospitalization time of the experimental group were shorter than that of the control group,and the blood loss was less than that of the control group;after the replacement surgery,the range of flexion and extension,internal and external rotation activity and abduction activity scores were better than those of the control group;and the total incidence of adverse reactions in the experimental group was 6.0%,which was significantly lower than that of the control group(14.0%).By comparing the treatment effects of the two groups,the differentiation was significant,and P<0.05 was statistically significant.Conclusion:Artificial hip arthroplasty can effectively treat proximal femoral tumors,shorten operative time,hospitalization time and intraoperative bleeding,and alleviate patients’therapeutic pain,which has good promotion value in clinical practice.