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Chen L, Wang Y, Liang SY, Shi HF, Zhao YY. [Outcome analysis of pregnancy termination and expectant treatment in pregnant women with suspected invasive placenta accreta spectrum disorders in the second trimester]. Zhonghua Fu Chan Ke Za Zhi 2023; 58:489-494. [PMID: 37474321 DOI: 10.3760/cma.j.cn112141-20230130-00030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Objective: To investigate the maternal and fetal outcomes of expectant treatment and early termination of pregnancy in pregnant women with suspected invasive placenta accreta spectrum disorders (PAS) in the second trimester. Methods: A retrospective cohort study was performed on 51 pregnant women with suspected invasive PAS (ultrasound score ≥10) evaluated by ultrasound with gestational age <26 weeks and confirmed as invasive PAS by intraoperative findings or postoperative pathology in Peking University Third Hospital from January 2015 to January 2022. According to the informed choice of pregnant women and their families, they were divided into expectant treatment group (37 cases) and mid-term termination group (14 cases). The general clinical data and outcome indexes of the two groups were analyzed by χ2 test, Mann-Whitney U rank sum test, logistic regression and linear regression. Results: (1) General clinical data: among 51 pregnant women who were assessed as suspected invasive PAS by ultrasonography in the second trimester, invasive PAS was finally diagnosed by intraoperative findings and postoperative pathology, among which 46 cases (90%) were placenta percreta and 5 cases (10%) were placenta increta. (2) Outcome indicators: univariate analysis showed that there were no statistically significant differences in the intraoperative blood loss (median: 2 200 vs 2 150 ml), the proportion of blood loss >1 500 ml [73% (27/37) vs 9/14], the hysterectomy rate [62% (23/37) vs 8/14], the rate of intensive care unit (ICU) admission [78% (29/37) vs 9/14] between the expectant treatment group and the mid-term termination group (all P>0.05). Multivariate analysis showed that the rate of intraoperative blood loss >1 500 ml (aOR=0.481, 95%CI: 0.017-13.958; P=0.670), hysterectomy (aOR=0.264, 95%CI: 0.011-6.569, P=0.417) and ICU admission (aOR=1.327, 95%CI: 0.048-36.882, P=0.867) between the two groups showed no statistical differences. (3) Outcome analysis: all 37 cases in the expectant treatment group had live births and no early neonatal death. Five pregnant women (14%, 5/37) in the expectant treatment group underwent emergency cesarean section in the course of expectant treatment. In the mid-term termination group, all pregnancies were terminated by operation, including 9 cases of hysterectomy and 5 cases of placental hysterectomy. There was 1 fetal survival (gestational age of termination: 27+4 weeks) and 13 fetal death in the mid-term termination group. Conclusions: Pregnant women who are diagnosed as suspected invasive PAS, especially those with placenta percreta, have the risk of uterine rupture and emergency surgery in the course of expectant treatment. However, early termination of pregnancy does not reduce the risk of intraoperative blood loss and hysterectomy.
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Affiliation(s)
- L Chen
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
| | - Y Wang
- Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China
| | - S Y Liang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
| | - H F Shi
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
| | - Y Y Zhao
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
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Zhang YX, Lan MJ, Liang SY, Han CM. [Advances on the application of physical airway clearance techniques in the treatment of inhalation injury]. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi 2023; 39:475-480. [PMID: 37805758 DOI: 10.3760/cma.j.cn501225-20220608-00226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
Although the treatment of patients with burns combined with inhalation injury has achieved great success, from the perspective of epidemiology, inhalation injury is still the most common cause of death in mass burns. Such patients often suffered burns of large total body surface area, which is difficult to treat, with airway management as one of the core links. Physical airway clearance technique (ACT) acts on a patient's respiratory system by physical means, to discharge secretions and foreign bodies in the airway, achieve airway clearance, and improve gas exchange. In addition, the technique can prevent or alleviate many complications, thereby improving the clinical outcome of patients with inhalation injury. This article reviews the application of physical ACT in the field of inhalation injury, and to provide decision-making basis for clinical medical staff to choose physical ACT corresponding to the patient's condition.
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Affiliation(s)
- Y X Zhang
- Department of Burns and Wound Repair, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - M J Lan
- Department of Nursing, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
| | - S Y Liang
- Department of Nursing, the First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310003, China
| | - C M Han
- Department of Burns and Wound Repair, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
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Ji YJ, Dong R, Liang SY, Suo LM, Xue JM, Zhao CQ. [Clinical features and management analysis of 11 cases of laryngocele]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2023; 58:470-475. [PMID: 37150993 DOI: 10.3760/cma.j.cn115330-20221008-00596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Objective: To summarize clinical features and our experience of the diagnosis and treatment of laryngocele. Methods: Clinical data of 11 laryngocele patients in department of Otorhinolaryngology Head and Neck Surgery of the Second Affiliated Hospital of Shanxi Medical University from January 2012 to December 2021 were retrospectively reviewed, including 9 men and 2 women, aged from 12 to 75 years, with median age of 56 years. Electronic laryngoscope was performed in 10 of all patients, laryngeal CT in 10 and cervical color ultrasound in 5 before operation.All the operations were performed under general anesthesia, and the external cervical approach was used for external and combined laryngocele. The internal laryngocele was resected by low temperature plasma through transoral endoscopy. Patients were followed up regularly after operation to evaluate the effect. Clinical feature, types of lesions, imaging findings, surgical approaches and follow-up results were analyzed through descriptive statistical method. Results: Eleven laryngocele patients were divided into mixed type (n=6), internal type (n=4) and external type (n=1).Nine patients presented with hoarseness or dysphonia, 7 with cervical mass and 1 with airway obstruction. Surgical resections were done through external cervical approach (n=7)or transoral endoscopic approach (n=4). All the operations were successful and no complication occurred. All cases were followed up from 17 to 110 months. No recurrence was encountered. Conclusions: Laryngocele is a rare lesion with atypical clinical presentation. Preoperative imaging including CT scan and electronic laryngoscope is essential to evaluate the location, and extent of the lesion, and to make the surgical plan.Complete surgical excision is required. Surgical resection is the only effective method for the treatment of laryngocele.
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Affiliation(s)
- Y J Ji
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - R Dong
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - S Y Liang
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - L M Suo
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - J M Xue
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - C Q Zhao
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Shanxi Medical University, Taiyuan 030001, China
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Hefton A, Liang SY, Ni K, Carter V, Ukadike K, Lood C, Mustelin T. Autoantibodies against citrullinated serum albumin in patients with rheumatoid arthritis. J Transl Autoimmun 2020; 2:100023. [PMID: 32743509 PMCID: PMC7388351 DOI: 10.1016/j.jtauto.2019.100023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 11/04/2019] [Indexed: 11/27/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic, potentially debilitating, inflammatory disease that primarily affects synovial joints. While the etiology of RA remains incompletely understood, it is clear that the disease is autoimmune in nature. A hallmark of RA is that the specific epitopes on self-antigens that are targeted by the immune system are often modified by arginine deimination, also referred to as citrullination. In fact, anti-citrullinated protein autoantibodies (ACPA) at high enough titers are diagnostic of RA and appear to have many different targets. Here, we report that RA patients have IgG autoantibodies that react with human serum albumin (HSA) when it had been citrullinated by protein arginine deiminase (PAD) 4, but not by PAD2. Unmodified albumin was not recognized by autoantibodies. In a cohort of 79 RA patients, 38% had anti-citrullinated HSA (anti-cit-HSA) reactivity above the cut-off of the average plus two standard deviations in a healthy subject cohort (n = 16). The titers of these autoantibodies correlated with ACPA status and seropositivity. There was also a trend toward correlation with the presence of radiographic joint erosions, but this did not reach statistical significance. Finally, patients with anti-cit-HSA were more frequently treated with biologics and combination regimens than patients without these autoantibodies. We conclude that ACPA directed against citrullinated albumin exist in a subset of RA patients. Because of the abundance of albumin, its modification by citrullination, as well as autoantibodies binding to it, may have deleterious consequences for the health of affected RA patients. Novel autoantigen in rheumatoid arthritis: citrullinated serum albumin. Anti-citrullinated albumin IgG autoantibodies correlate with clinical parameters. Even a low stoichiometry citrullination of the very abundant albumin may have health consequences. Use of poly(Gly, Lys, Tyr) for blocking to detect citrullinated proteins without high background.
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Affiliation(s)
- Amanda Hefton
- Division of Rheumatology, Department of Medicines, University of Washington, 750 Republican Street, Room E507, Seattle, WA 99108, United States
| | - Shu Ying Liang
- Division of Rheumatology, Department of Medicines, University of Washington, 750 Republican Street, Room E507, Seattle, WA 99108, United States
| | - Kathryn Ni
- Division of Rheumatology, Department of Medicines, University of Washington, 750 Republican Street, Room E507, Seattle, WA 99108, United States
| | - Victoria Carter
- Division of Rheumatology, Department of Medicines, University of Washington, 750 Republican Street, Room E507, Seattle, WA 99108, United States
| | - Kennedy Ukadike
- Division of Rheumatology, Department of Medicines, University of Washington, 750 Republican Street, Room E507, Seattle, WA 99108, United States
| | - Christian Lood
- Division of Rheumatology, Department of Medicines, University of Washington, 750 Republican Street, Room E507, Seattle, WA 99108, United States
| | - Tomas Mustelin
- Division of Rheumatology, Department of Medicines, University of Washington, 750 Republican Street, Room E507, Seattle, WA 99108, United States
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Carter V, LaCava J, Taylor MS, Liang SY, Mustelin C, Ukadike KC, Bengtsson A, Lood C, Mustelin T. High Prevalence and Disease Correlation of Autoantibodies Against p40 Encoded by Long Interspersed Nuclear Elements in Systemic Lupus Erythematosus. Arthritis Rheumatol 2020; 72:89-99. [PMID: 31342656 DOI: 10.1002/art.41054] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/18/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Long interspersed nuclear element 1 (LINE-1) encodes 2 proteins, the RNA binding protein p40 and endonuclease and reverse transcriptase (open-reading frame 2p [ORF2p]), which are both required for LINE-1 to retrotranspose. In cells expressing LINE-1, these proteins assemble with LINE-1 RNA and additional RNA binding proteins, some of which are well-known autoantigens in patients with systemic lupus erythematosus (SLE). This study was undertaken to investigate whether SLE patients also produce autoantibodies against LINE-1 p40. METHODS Highly purified p40 protein was used to quantitate IgG autoantibodies in serum from 172 SLE patients and from disease controls and age-matched healthy subjects by immunoblotting and enzyme-linked immunosorbent assay (ELISA). Preparations of p40 that also contained associated proteins were analyzed by immunoblotting with patient sera. RESULTS Antibodies reactive with p40 were detected in the majority of patients and many healthy controls. Their levels were higher in patients with SLE, but not those with systemic sclerosis, compared to healthy subjects (P = 0.01). Anti-p40 reactivity was higher in patients during a flare than in patients with disease in remission (P = 0.03); correlated with the SLE Disease Activity Index score (P = 0.0002), type I interferon score (P = 0.006), decrease in complement C3 level (P = 0.0001), the presence of anti-DNA antibodies (P < 0.0001) and anti-C1q antibodies (P = 0.004), and current or past history of nephritis (P = 0.02 and P = 0.003, respectively); and correlated inversely with age (r = -0.49, P < 0.0001). SLE patient sera also reacted with p40-associated proteins. CONCLUSION Autoantibodies reacting with LINE-1 p40 characterize a population of SLE patients with severe and active disease. These autoantibodies may represent an early immune response against LINE-1 p40 that does not yet by itself imply clinically significant autoimmunity, but may represent an early, and still reversible, step toward SLE pathogenesis.
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Affiliation(s)
| | - John LaCava
- The Rockefeller University, New York, New York, and European Research Institute for the Biology of Ageing, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin S Taylor
- Massachusetts General Hospital, Boston, and Whitehead Institute, Cambridge, Massachusetts
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Li F, Feng YK, Liang SY, Xu WH, Zhou JZ, Cui DW. [Cervical auricle: report of three cases]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2019; 54:693-694. [PMID: 31550763 DOI: 10.3760/cma.j.issn.1673-0860.2019.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- F Li
- Department of Otorhinolaryngology, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524000, China
| | - Y K Feng
- Department of Otorhinolaryngology, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524000, China
| | - S Y Liang
- Department of Otorhinolaryngology, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524000, China
| | - W H Xu
- Department of Otorhinolaryngology, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524000, China
| | - J Z Zhou
- Department of Pathology, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524000, China
| | - D W Cui
- Department of Otorhinolaryngology, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524000, China
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7
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Peng S, Zheng Y, Liang SY, Li G. [The role of word recognition score in outcomes assessmentof idiopathic sudden sensorineural hearing loss]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2016; 30:1110-1114. [PMID: 29798432 DOI: 10.13201/j.issn.1001-1781.2016.14.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Indexed: 06/08/2023]
Abstract
Objective:To investigate the change of word recognition score(WRS) during the treatment of patients with idiopathic sudden sensorineural hearing loss(ISSNHL) and explore the role of WRS in outcomes assessment of ISSNHL.Method:Thirty-seven patients diagnosed with ISSNHL,whose pure-tone average(PTA) has no change but WRS has improved after treatment,were analyzed retrospectively.The WRS and the test intensity for WRS of pre-treatment and those of post-treatment were compared statistically.Result:There is statistical significance between WRS of post-treatment and that of pre-treatment(P<0.01).The increase of WRS score is consistent with improvement of symptom in these patients.Conclusion:More attention needs to be paid to WRS during treatment of ISSNHL patients,especially those whose PTA has no improvement but patients feel better about their hearing,and WRS could be an important factor in terms of outcome assessment during treatment of ISSNHL patients for the further treatment.
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Affiliation(s)
- S Peng
- Hearing Center,Department of Otorhinolaryngology,West China Hospital,Sichuan University,Chengdu,610041,China
| | - Y Zheng
- Hearing Center,Department of Otorhinolaryngology,West China Hospital,Sichuan University,Chengdu,610041,China
| | - S Y Liang
- Hearing Center,Department of Otorhinolaryngology,West China Hospital,Sichuan University,Chengdu,610041,China
| | - G Li
- Hearing Center,Department of Otorhinolaryngology,West China Hospital,Sichuan University,Chengdu,610041,China
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Chen TE, Xu XM, Liu P, Liang SY, Lv WX. Elucidating the function and tolerance mechanism of gamma delta (γ δ) T cells in a Helicobacter pylori infection model. Genet Mol Res 2015; 14:10543-52. [PMID: 26400286 DOI: 10.4238/2015.september.8.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2023]
Abstract
In this study, the functions and mechanisms of γ δ T cells were analyzed in patients infected with Helicobacter pylori. Peripheral blood was collected from gastritis patients in the Gastroenterology Department of Ningbo No. 2 Hospital. Preliminary analyses revealed 24 H. pylori-positive and 17 H. pylori-negative patients. The wild-type and γ δ T knockout mice were infected with cultured H. pylori cells (obtained from the H. pylori-positive patients). H. pylori in mice was quantified by polymerase chain reaction; gastritis was confirmed by hematoxylin and eosin staining. The TCR-δ(-/-) mice were treated with vein adoptive immunotherapy 24 h prior to H. pylori inoculation; the same method was used to detect the extent of gastritis and bacterial colonization. The γ δ T knockout mice showed high levels of H. pylori infection than the wild-type mice; in addition, the knockout mice showed severe disease pathology. γ δ T knockout mice also displayed increased matrix metalloproteinase-9 (MMP-9) and decreased MMP-7 expression in the gastric mucosa. γ δ T cells play a protective role in patients infected with H. pylori. γ δ T cell [responsible for the production of interleukin-17 (IL-17) and IL-22] expression was increased in H. pylori-positive patients, indicating statistical significance. However, there was no significant difference in interferon-gamma + γ δ T expression between the positive and negative patients. This study demonstrated the probable involvement of γ δ T cells in the immune response of an organism, via the secretion of IL-17 and IL-22.
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MESH Headings
- Animals
- Gastric Mucosa/immunology
- Gastric Mucosa/microbiology
- Gastric Mucosa/pathology
- Gastritis/genetics
- Gastritis/immunology
- Gastritis/microbiology
- Gastritis/therapy
- Gene Expression Regulation
- Helicobacter Infections/genetics
- Helicobacter Infections/immunology
- Helicobacter Infections/microbiology
- Helicobacter Infections/therapy
- Helicobacter pylori/immunology
- Helicobacter pylori/pathogenicity
- Humans
- Immune Tolerance
- Immunotherapy, Adoptive
- Interferon-gamma/genetics
- Interferon-gamma/immunology
- Interleukin-17/genetics
- Interleukin-17/immunology
- Interleukins/genetics
- Interleukins/immunology
- Matrix Metalloproteinase 7/genetics
- Matrix Metalloproteinase 7/immunology
- Matrix Metalloproteinase 9/genetics
- Matrix Metalloproteinase 9/immunology
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Receptors, Antigen, T-Cell, gamma-delta/deficiency
- Receptors, Antigen, T-Cell, gamma-delta/genetics
- Receptors, Antigen, T-Cell, gamma-delta/immunology
- Severity of Illness Index
- T-Lymphocytes/immunology
- T-Lymphocytes/microbiology
- T-Lymphocytes/pathology
- T-Lymphocytes/transplantation
- Interleukin-22
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Affiliation(s)
- T E Chen
- Critical Care Medical Center, Ningbo No. 2 Hospital, Ningbo, China
| | - X M Xu
- Department of Microbiology, Ningbo No. 2 Hospital, Ningbo, China
| | - P Liu
- Critical Care Medical Center, Ningbo No. 2 Hospital, Ningbo, China
| | - S Y Liang
- Department of Microbiology, Ningbo No. 2 Hospital, Ningbo, China
| | - W X Lv
- Critical Care Medical Center, Ningbo No. 2 Hospital, Ningbo, China
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Reno HEL, Dretler A, Cooper B, Trolard A, Liang SY, O’Neil R, Stoner BP. P09.29 High prevalence of neisseria gonorrhoeaeamong emergency department “super-users” in a large urban medical centre. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Esteva FJ, Hortobagyi GN, Sahin AA, Smith TL, Chin DM, Liang SY, Pusztai L, Buzdar AU, Bacus SS. Expression of erbB/HER receptors, heregulin and P38 in primary breast cancer using quantitative immunohistochemistry. Pathol Oncol Res 2002; 7:171-7. [PMID: 11692142 DOI: 10.1007/bf03032345] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to investigate the frequency of expression of the erbB/HER family of growth factor receptors, their ligand heregulin, and the two different signaling pathways p38 and mitogen-activated protein kinase (MAPK), as well as the status of HER-2 phosphorylation in tumor specimens from patients with primary breast cancer. The level of expression of these proteins was measured by quantitative immunohistochemistry combined with microscope-based image analysis in paraffin-embedded breast cancer tissue from 35 patients. The frequency of expression was: EGFR (51%), HER-2 (54%), P-HER-2 (48%), HER-3 (48%), HER-4 (57%), heregulin (48%), p38 (17%), MAPK (48%). There was evidence of associations among the coexpression of heregulin, EGFR, HER-2, and HER-3. Also, there was evidence of a positive association between P-MAPK and HER-4. HER-3 was expressed at high levels in patients younger than 50 years of age. There was a trend for expression of higher levels of HER-4 in tumors larger than 2 cm. The expression of EGFR, HER-2, heregulin, p38 and MAPK was independent of age, tumor size, number of lymph nodes involved or hormone receptor status. The HER family of growth factor receptors appear to be regulated independently in invasive breast cancer. Assessing the expression of multiple tumor markers by quantitative immuno-histochemistry is feasible. Further research is needed to determine the prognostic and predictive roles of the various associations between HER receptors, their ligands and signal transduction molecules in patients with early-stage breast cancer.
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Affiliation(s)
- F J Esteva
- Department of Breast Medical Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030-4095, USA
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Tufano J, Conrad DA, Sales A, Maynard C, Noren J, Kezirian E, Schellhase KG, Liang SY. Effects of compensation method on physician behaviors. Am J Manag Care 2001; 7:363-73. [PMID: 11310191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
OBJECTIVE To examine physician and leader perceptions of the relationship between physician compensation and the productivity of physicians practicing in medical groups. STUDY DESIGN Key informant interviews identified subjects' perceptions of factors influencing physician productivity and the behavioral effects of individual financial incentives. Interview transcripts were analyzed by a team of physicians, economists, and other researchers. STUDY POPULATION Physicians, medical leaders, and group practice administrators (n = 114) representing 46 medical group practices in California, Oregon, Washington, and Wisconsin were interviewed. RESULTS Five major themes emerged: (1) Most physicians reported that financial incentives did not substantially affect their own behavior, except for productivity. However, they suggested that specific compensation models do lead to certain seemingly undesirable physician behaviors. (2) By contrast, medical group leaders reported that financial incentives do affect a variety of physician behaviors. (3) Four productivity drivers emerged: financial incentives, demand-side factors, systems and infrastructure, and other individual or group attributes. (4) Physician compensation systems are evolving toward a blend of production-based and production-neutral incentives, plus new metrics aligned with the demands of managed care. (5) Culture, size, and specialty mix are significant determinants of group physician compensation systems. CONCLUSIONS Compensation method is perceived to be a significant influence on physician productivity, particularly among group practice leaders. The changing context of medical practice represents another powerful "macro" lever on physician behavior.
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Affiliation(s)
- J Tufano
- University of Washington, Department of Health Services, 1959 NE Pacific St. Room H660, Seattle, WA 98195-7660, USA
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Yao QS, Peng XP, Liang SY, Wang HB, Zhu JZ, Xu XH. [Brainstem changes in death from head injury]. Fa Yi Xue Za Zhi 1999; 15:129-30, 189. [PMID: 12536440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
The cortex and brainstem changes in death from head injury were observed. There were hemorrhage, edema and neuron necrosis in brain injury group, and also in disputed group of brainstem injury.
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Affiliation(s)
- Q S Yao
- Institute of Forensic Sciences of GuangZhou, GuangZhou 510060, P. R. China
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Abstract
Medical groups are challenged to adopt a systematic, evidence-based approach to selecting a physician compensation method that supports the group's overall financial and organizational strategies, including managed care contracting strategies; is consistent with the philosophies, beliefs, and attitudes of the group's membership as they pertain to individual productivity; and can be supported by the organization's information technology, decision support, and management infrastructures. This article explains how research in physician profiling, benchmarking, general compensation theory, and physician productivity provides evidence that can serve as the foundation for a pragmatic approach to evaluating physician compensation method alternatives. It also presents a unique production-based compensation model for illustrative purposes.
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Affiliation(s)
- J T Tufano
- Department of Health Services, University of Washington, Seattle, USA
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Abstract
A simple method to create a chromosome-specific DNA library of rice, including microdissection, amplification, characterization and cloning, is described. Rice chromosome 4 from a metaphase cell has been isolated and amplified by the Linker Adapter PCR (LA-PCR). The PCR products were labeled as probes with DIG-11-dUTP using the random priming method. Southern blot analysis with rice genomic DNA and specific RFLP markers demonstrated that the PCR products were derived from rice chromosome 4. A large library comprising over 100,000 recombinant plasmid microclones from rice chromosome 4 was constructed. Colony hybridization showed that 58% of the clones contained single or low-copy sequences and 42% contained repetitive sequences. The size of inserts generated by PCR ranged from 140bp to 500bp. This method will facilitate cloning of the specific chromosome DNA markers and important genes of rice.
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Affiliation(s)
- Y W Mao
- Biology Department, Nankai University, Tianjin, China
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Conrad DA, Maynard C, Cheadle A, Ramsey S, Marcus-Smith M, Kirz H, Madden CA, Martin D, Perrin EB, Wickizer T, Zierler B, Ross A, Noren J, Liang SY. Primary care physician compensation method in medical groups: does it influence the use and cost of health services for enrollees in managed care organizations? JAMA 1998; 279:853-8. [PMID: 9516000 DOI: 10.1001/jama.279.11.853] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Growth of at-risk managed care contracts between health plans and medical groups has been well documented, but less is known about the nature of financial incentives within those medical groups or their effects on health care utilization. OBJECTIVE To test whether utilization and cost of health services per enrollee were influenced independently by the compensation method of the enrollee's primary care physician. DESIGN Survey of medical groups contracting with selected managed care health plans, linked to 1994 plan enrollment and utilization data for adult enrollees. SETTING Medical groups, major managed care health plans, and their patients/enrollees in the state of Washington. STUDY PARTICIPANTS Sixty medical groups in Washington, 865 primary care physicians (internal medicine, pediatrics, family practice, or general practice) from those groups and affiliated with 1 or more of 4 managed care health plans, and 200 931 adult plan enrollees. INTERVENTION The effect of method of primary care physician's compensation on the utilization and cost of health services was analyzed by weighted least squares and random effects regression. MAIN OUTCOME MEASURES Total visits, hospital days, and per member per year estimated costs. RESULTS Compensation method was not significantly (P>.30) related to utilization and cost in any multivariate analyses. Patient age (P<.001), female gender (P<.001), and plan benefit level (P<.001) were significantly positively related to visits, hospital days, and per member per year costs. The primary care physician's age was significantly negatively related (P<.001) to all 3 dependent measures. CONCLUSIONS Compensation method was not significantly related to use and cost of health services per person. Enrollee, physician, and health plan benefit factors were the prime determinants of utilization and cost of health services.
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Affiliation(s)
- D A Conrad
- Department of Health Services, University of Washington, Seattle 98195-7660, USA.
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Zhu BJ, Bi L, Liang SY, Pang L, Wang SL, Liu JF, Jiang AP, Li CJ, Ye ZJ, Yang H. Effect of acupuncture on left ventricular function, microcirculation, blood rheology and cyclicnucleotides in patients with acute myocardial infarction. J TRADIT CHIN MED 1989; 9:63-8. [PMID: 2548039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Chen KY, Liang SY, Feng XE. The effect of acupuncture using reinforcing and reducing methods on nail microcirculation and local skin temperature. J TRADIT CHIN MED 1984; 4:279-81. [PMID: 6570500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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