Objective The aim of this study is to review the molecular landscape of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Method The relevant literatures about molecular profiling of NIFTP were retrospectively analyzed and summarized. Results The most common mutation in NIFTP was rat sarcoma viral oncogene homolog (RAS) mutation. B-type RAF (BRAFK601E) mutation, PPARG fusion, and THADA fusion also could be seen. There was usually no BRAFV600E mutation. miRNAs also were found to be differentially expressed in NIFTP. Conclusion The molecular profiling of NIFTP may become a new molecular marker for the diagnosis of NIFTP.
Based on the noninvasive detection indeices and fuzzy mathematics method, this paper studied the noninvasive, convenient and economical cardiovascular health assessment system. The health evaluation index of cardiovascular function was built based on the internationally recognized risk factors of cardiovascular disease and the noninvasive detection index. The weight of 12 indexes was completed by the analytic hierarchy process, and the consistency test was passed. The membership function, evaluation matrix and evaluation model were built by fuzzy mathematics. The introducted methods enhanced the scientificity of the evaluation system. Through the Kappa consistency test, McNemer statistical results (P = 0.995 > 0.05) and Kappa values (Kappa = 0.616, P < 0.001) suggest that the comprehensive evaluation results of model in this paper are relatively consistent with the clinical, which is of certain scientific significance for the early detection of cardiovascular diseases.
Objective To investigate the physiological effects of different oxygen injection site on ventilatory status and oxygenation during noninvasive positive pressure ventilation ( NPPV) with portable noninvasive ventilators. Methods A prospective crossover randomized study was performed. Oxygen injection site was randomized into the outlet of the ventilator, the connection site between mask and circuit, and the mask under the condition of leak port immobilized in the mask. Oxygen flow was retained in the baseline level at the initial 5 to 10 minutes, and adjusted to obtain arterial oxygen saturation measured by pulse oximetry ( SpO2 ) ranging from 90% to 95% after SpO2 remains stable. SpO2 at the initial 5 to 10 minutes, oxygen flow, ventilatory status, oxygenation, hemodynamics and dyspnea indexes at0. 5 hour, 1 hour, and 2 hours of NPPV were compared between different oxygen injection sites. Results 10 patients were recruited into the study. Under the condition of the same oxygen flow, SpO2 with oxygen injection site in the outlet of the ventilator was significantly higher than that with oxygen injection site in the connection site between mask and circuit [ ( 98.9 ±0.9) % vs. ( 96.9 ±1.1) % , P =0. 003] , whereas SpO2 with oxygen injection site in the connection site between mask and circuit was significantly higher than that with oxygen injection site in the mask [ ( 96.9 ±1.1) % vs. ( 94.1 ±1.6) %, P = 0.000] . Oxygen flow with oxygen injection site in the mask was statistically higher than that with oxygen injection site at other sites ( P lt; 0.05) . Arterial oxygen tension/ oxygen flow with oxygen injection site in the outlet of the ventilator was significantly higher than that with oxygen injection site in the connection site between mask and circuit ( 67.9 ±31.1 vs. 37.0 ±15.0, P =0.007) , and than that with oxygen injection site in the mask ( 67.9 ± 31.1 vs. 25.0 ±9.1, P = 0.000) . pH, arterial carbon dioxide tension, hemodynamics and dyspnea indexes were not significantly different between different oxygen injection sites ( P gt; 0.05) .Conclusions When portable noninvasive ventilator was applied during NPPV, oxygen injection site significantly affects improvement of oxygenation, and shows a trend for affecting ventilatory status and work of breathing. When the leak port was immobilized in the mask, the nearer oxygen injection site approaches the outlet of the ventilator, the more easily oxygenation is improved and the lower oxygen flow is demanded.
Portal hypertension (PHT) is a common complication of liver cirrhosis, which could be measured by the means of portal vein pressure (PVP). However, there is no report about an effective and reliable way to achieve noninvasive assessment of PVP so far. In this study, firstly, we collected ultrasound images and echo signals of different ultrasound contrast agent (UCA) concentrations and different pressure ranges in a low-pressure environment based on an in vitro simulation device. Then, the amplitudes of the subharmonics in the echo signal were obtained by ultrasound grayscale image construction and fast Fourier transform (FFT). Finally, we analyzed the relationship between subharmonic amplitude (SA) and bionic portal vein pressure (BPVP) through linear regression. As a result, in the pressure range of 7.5–45 mm Hg and 8–20 mm Hg, the linear correlation coefficients (LCC) between SA and BPVP were 0.927 and 0.913 respectively when the UCA concentration was 1∶3 000, and LCC were 0.737 and 0.568 respectively when the UCA concentration was 1∶6 000. Particularly, LCC was increased to 0.968 and 0.916 respectively while the SAs of two UCA concentrations were used as the features of BPVP. Therefore, the results show a good performance on the linear relationship between SA and BPVP, and the LCC will be improved by using SAs obtained at different UCA concentrations as the features of BPVP. The proposed method provides reliable experimental verification for noninvasive evaluation of PVP through SA in clinical practice, which could be a guidance for improving the accuracy of PVP assessment.
ObjectiveTo summarize the research progress of magnetic resonance imaging (MRI) for diagnosis of nonalcoholic steatohepatitis (NASH).MethodRelevant literatures at home and abroad were collected to make an review, then summarized the research status and progress of MRI for diagnosis of NASH. Their advantages and disadvantages were summarized.ResultsA variety of MRI techniques, including MR elastography, gadolinium-ethoxybenzyldiethylenetriaminepentaacetic acid (Gd-EOB-DTPA) enhanced MRI, diffusion-weighted MR imaging, and quantitative MR imaging of fat and iron, had been widely used in diagnosing NASH and shown to have some value. However, there were currently no effective MRI techniques recommended for diagnosing NASH.ConclusionsMRI plays an important role in noninvasive assessment of NASH. Future studies are needed to investigate more efficient noninvasive biomarkers and models consisting of imaging and non-imaging biomarkers for diagnosing NASH, to reduce unnecessary biopsies.
ObjectiveTo analyze the effect of different nebulization methods in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) requiring non-invasive ventilators (NIV). MethodsOne hundred and two patients with AECOPD were selected according to the standard, and randomly divided into a control group, a trial group I, and a trial group II according to the random number table. The patients in the control group received NIV intermittent oxygen-driven nebulization; the patients in the trial group I received NIV simultaneous oxygen-driven nebulization; and the patients in the trial group II received NIV simultaneous air-driven nebulization. The dynamic fluctuations of transcutaneous partial pressure of carbon dioxide (PtCO2), arterial blood gas indexes (PaCO2, PaO2, pH), vital signs and pulse oxygen saturation (SpO2) fluctuations were compared. ResultsPtCO2 at 15min of nebulization in the trial group II were lower than the other groups (P<0.05). PtCO2 at 15min of nebulization was higher than the other time points in the control group (P<0.05); there was no statistical difference of PtCO2 at different time points in the trial group I (P>0.05); PtCO2 gradually decreased with time in the trial group II (P<0.05). The difference before and after nebulization of PtCO2 (dPtCO2) was larger in trial group II than the other groups (P<0.05). PtCO2 at 0min and 5min after the end of nebulization in trial group II were lower than the other groups (P<0.05); there were no statistical differences of PtCO2 at 10min and 15min after the end of nebulization among three groups (P>0.05). There were statistical differences of the PtCO2 at each time point in the control group except for the PtCO2 at 10 min and 15min after the end of nebulization, all of which decreased with time; PtCO2 at each time points of nebulization decreased with time in the trial group I (P<0.05). PtCO2 only at 5min after the end of nebulization was lower than that at 0min after the end of nebulization in trial group II (P< 0.05), there were no statistical differences in other times (P>0.05). PaCO2, pH at the 4th day of treatment was lower than the pre-treatment in the control group (P<0.01); there were statistical differences of PaCO2 between the pre-treatment and the rest time points in the trial group I and group II (P<0.05). The number of abnormal fluctuations in vital signs and SpO2 during nebulization in three groups was not statistically different (P>0.05). ConclusionsThree groups can achieve good therapeutic effects. NIV intermittent oxygen-driven nebulization can make PtCO2 rise during nebulization; NIV simultaneous oxygen-driven nebulization can make PtCO2 remain stable during nebulization; NIV simultaneous air-driven nebulization can make PtCO2 fall during nebulization.
In China, chronic respiratory diseases (CRD) are characterized by high prevalence, disability rate, and mortality rate, imposing a severe disease burden. Home non-invasive ventilation (HNIV) therapy can improve ventilation, alleviate respiratory muscle fatigue, enhance oxygenation and carbon dioxide retention, delay the progression of various CRD, and even improve survival. However, there is currently a lack of long-term management standards and standardized guidance for patients receiving HNIV therapy in China. The Respiratory Therapy Group of the Chinese thoracic Society and Chinese Association of Rehabilitation Medicine, has summarized 11 questions related to HNIV for different diseases, answered various questions, and put forward modification suggestions. This consensus aims to provide references for frontline clinical staff, promote the standardization of HNIV application in China, and improve the level of treatment.Summary of recommendationsQuestion 1. For which patients is HNIV suitable?Recommendation: HNIV is recommended for patients with ventilatory dysfunction due to various causes, such as: obstructive sleep apnea syndrome [high-quality evidence, strong recommendation], chronic obstructive pulmonary disease [high/moderate-quality evidence, strong recommendation], obesity hypoventilation syndrome [moderate/low-quality evidence, strong recommendation], and neuromuscular diseases [low-quality evidence, strong recommendation].Question 2. When should HNIV be initiated?Recommendation: The timing for initiating HNIV therapy should be based on a comprehensive assessment of disease diagnosis, severity, symptoms, and comorbidities. Early standardized intervention is a crucial measure for improving prognosis and reducing long-term disease burden. Specific recommended indications are listed in Table 2. [high/moderate quality evidence, strong recommendation]Question 3. How should health education on HNIV be conducted?Recommendation: All HNIV patients should receive educational training. The five-step training method is recommended as the preferred approach for educating HNIV patients and their families. [Moderate-quality evidence, weak recommendation]Question 4. How to properly select a home non-invasive ventilator?Recommendations: When selecting a home non-invasive ventilator, patients should first consult a professional physician or respiratory therapist to obtain specialized advice based on their specific condition. Physicians should make decisions by comprehensively considering the patient’s disease type and severity, ventilator modes and parameters, synchrony, comfort, remote monitoring requirements, and financial circumstances. Refer to Table 3 for ventilation mode selection based on different diseases.Question 5. How should accessories for HNIV be selected?Recommendation: Mask selection should be based on disease type, dynamic assessment of the patient’s breathing pattern, and patient preference, with regular reassessment of fit during follow-up [High/moderate-quality evidence, strong recommendation]. Active heated humidifiers are recommended as the first choice for HNIV patients [Low-quality evidence, weak recommendation].Question 6. How should HNIV parameters be set and adjusted?Recommendation: Parameter adjustments should be performed in hospital and community settings. Long-term home use should only commence after confirming appropriate and safe settings. Avoid patients or caregivers making arbitrary adjustments that may cause adverse events. [Moderate-quality evidence, strong recommendation]Pressure settings for NIV should be tailored to the patient’s underlying disease and clinical objectives. Additional parameters including backup rate, inspiratory sensitivity, pressure rise time, and expiratory sensitivity must also be configured. The setup process is summarized in Figure 1. [Moderate-quality evidence, strong recommendation]Question 7. What is the recommended daily usage duration for HNIV?Recommendation: For patients using HNIV due to sleep apnea or sleep-related hypoventilation, it is recommended to use the device for at least 4 hours daily on more than 70% of nights, with usage duration covering sleep periods as much as possible. For patients using HNIV due to chronic hypercapnia, daily use of at least 5 - 6 hours is required, with priority given to nighttime use. [Low-quality evidence, weak recommendation]Question 8. When should respiratory support be adjusted during HNIV?Recommendation: Assess the efficacy of HNIV based on clinical and physiological criteria to determine whether to continue ventilatory support [Moderate-quality evidence, strong recommendation]. If disease progression or complications arise, and HNIV can no longer maintain effective ventilation, discontinue HNIV and seek hospital care promptly [Low-quality evidence, strong recommendation]. HNIV should not be discontinued in patients requiring intermittent or continuous HNIV during exercise [Moderate-quality evidence, strong recommendation].Question 9. How should complications associated with HNIV be managed?Recommendation: Common complications of noninvasive ventilation include skin pressure injury, air leak, patient-ventilator asynchrony, and thick sputum. These should be actively prevented and managed during HNIV. [Moderate-quality evidence, strong recommendation]Question 10. How should the effectiveness of HNIV be assessed and followed up?Recommendation: Close monitoring and follow-up are recommended for patients receiving home noninvasive ventilation. Monitoring indicators and follow-up frequency are summarized in Table 6. [Moderate-quality evidence, GPS]Question 11. How should the management pathway for HNIV be established and optimized?Recommendations: Establish a tiered, dynamic, and individualized HNIV management pathway based on patient condition characteristics, technical support availability, and home care capabilities: ① For high-risk acute exacerbation/unstable patients: Primarily use the traditional "hospital-community-home" model supplemented by self-management; for low-risk acute exacerbation/stable patients: Primarily use self-management with IoT-based remote monitoring where feasible. ② Dynamically adjust based on disease stage: intensify in-person training during the initial phase and gradually transition to remote monitoring during the stable phase; ③ Promote multidisciplinary collaboration, utilize smart devices for real-time monitoring, and ensure data security; ④ Enhance patient self-management capabilities through standardized education and regular follow-ups. [Low-quality evidence, GPS]
Objective To investigate the clinical significance of lateral position ventilation in the treatment of invasive ventilation in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Methods From October 2014 to December 2016, 60 eligible patients with AECOPD who meeting the inclusion criteria were randomly assigned to an intervention group (n=30) or a control group (n=30). Expectorant, antiasthmatic, anti-infective, invasive ventilation, bronchoscopy, analgesic sedation, invasive-noninvasive sequential ventilation, nutritional support, intensive care and other treatment were conducted in two groups, but lateral position ventilation was subsequently performed in the intervention group and the control group used half lateral position. Outcome measurements included pH, PaO2/FiO2, arterial partial pressure of carbon dioxide (PaCO2), heart rate (HR), respiratory rate (R) and air way resistance (Raw) before and one day after invasive ventilation, and duration of control of pulmonary infection (PIC), invasive mechanic ventilation (IMV), mechanic ventilation (MV) and intensive care unit (ICU) stay. Results Compared with before ventilation, the levels of PaO2/FiO2, PaCO2, HR, R and Raw were significantly changed in two groups after ventilation (P<0.05). One day later after ventilation, pH [interventionvs. control: (7.43±0.07) vs. (7.37±0.11)], PaO2/FiO2[(253.52±65.33) mm Hg (1 mm Hg=0.133 kPa) vs. (215.46±58.72) mm Hg] and PaCO2 [(52.45±7.15) mm Hg vs. (59.39±8.44) mm Hg] were statistically significant (P<0.05), but no significant difference was found in HR, R or Raw between two groups (P>0.05). Compared with the control group, PIC [(3.7±1.4) daysvs. (5.3±2.2) days], IMV [(4.0±1.5) days vs. (6.1±3.0) days], MV [(4.7±2.0) days vs. (7.3±3.7) days] and ICU stay [(6.2±2.1) days vs. (8.5±4.2) days] were significantly decreased (P<0.05) in the intervention group. Conclusions In AECOPD patients, invasive ventilation using lateral position ventilation can significantly improve arterial blood gas index, decrease Raw, shorten the time of PIC, IMV, MV and ICU stay.