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Aggarwal D, Roy-Chowdhury M, Xiang N, Peacock SJ. Applications to medical and surgical specialist training in the UK National Health Service, 2021-2022: a cross-sectional observational study to characterise the diversity of successful applicants. BMJ Open 2023; 13:e069846. [PMID: 37076164 PMCID: PMC10186087 DOI: 10.1136/bmjopen-2022-069846] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVES To compare success of applicants to specialty training posts in the UK by gender, ethnicity and disability status. DESIGN Cross-sectional observational study. SETTING National Health Service, UK. PARTICIPANTS All specialty training post applications to Health Education England, UK, during the 2021-2022 recruitment cycle. INTERVENTION Nil. PRIMARY AND SECONDARY OUTCOME MEASURES Comparison of success at application to specialty training posts by gender, ethnicity, country of qualification (UK vs non-UK) and disability. The influence of ethnicity on success was investigated using a logistic regression model, where country of qualification was included as a covariate. RESULTS 12 419/37 971 (32.7%) of applicants to specialty training posts were successful, representing 58 specialties. The difference in percentage of successful females (6480/17 523, 37.0%) and males (5625/19 340, 29.1%) was 7.9% (95% CI 6.93% to 8.86%), in favour of females. Segregation of applications to specialties by gender was observed; surgical specialties had the highest proportion of male applicants, while obstetrics and gynaecology had the highest proportion of female applicants. The proportion of successful recruits to specialties largely reflected the number of applications. 11/15 minority ethnic groups (excluding 'not stated') had significantly lower adjusted ORs for success compared with white-British applicants. 'Mixed white and black African' (OR 0.52, 95% CI 0.44 to 0.61, p≤0.001) were the least successful minority group in our study, while non-UK graduates had an adjusted ORs for success of 0.43 (95% CI 0.41 to 0.46, p≤0.001) compared with UK graduates. The difference in percentage of success by disabled applicants (179/464, 38.6%) and non-disabled applicants (11 940/36 418, 32.8%) was 5.79% (95% CI 1.23% to 10.4%), in favour of disabled applicants. No disabled applicants were accepted to 21/58 (36.2%) of specialties. CONCLUSIONS Despite greater success by female applicants overall, there is an attraction issue to specialties by gender. Further, most ethnic minority groups are less successful at application when compared with white-British applicants. This requires continuous monitoring and evaluation of the reasons behind observed differences. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Dinesh Aggarwal
- Department of Medicine, University of Cambridge, Cambridge, UK
- Wellcome Sanger Institute, Hinxton, UK
| | | | - Nicola Xiang
- Imperial College Healthcare NHS Trust, London, UK
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Aggarwal D, Roy-Chowdhury M, Xiang N, Peacock SJ. Equity in recruitment to Combined Infection Training, 2021: Diversity & Inclusion considerations. J Infect 2022; 85:436-480. [PMID: 35803385 DOI: 10.1016/j.jinf.2022.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Dinesh Aggarwal
- Department of Medicine, University of Cambridge, Hills Rd, Cambridge CB2 0QQ, United Kingdom; Cambridge University Hospital NHS Foundation Trust, Hills Rd, Cambridge CB2 0QQ, United Kingdom; Wellcome Sanger Institute, Hinxton, Saffron Walden CB10 1RQ, United Kingdom.
| | | | - Nicola Xiang
- St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed St, London W2 1NY, United Kingdom
| | - Sharon J Peacock
- Department of Medicine, University of Cambridge, Hills Rd, Cambridge CB2 0QQ, United Kingdom; Cambridge University Hospital NHS Foundation Trust, Hills Rd, Cambridge CB2 0QQ, United Kingdom
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Xiang N, Hao X, Chuang G, Wang L, Zhou Z, Wang G, Kun Q, Li X. POS0102 GLOBAL CHARACTERIZATION OF SALIVARY GLANDS IMMUNE MICROENVIRONMENT IN PRIMARY SJÖGREN’S SYNDROME BY SINGLE-CELL SEQUENCING. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundPrimary Sjögren’s syndrome (pSS) is a heterogeneous, chronic, complex systemic autoimmune disease. The hallmark symptom of the disease is exocrinopathy, chiefly salivary and lachrymal glands, which often results in dryness of the mouth and eyes. As of today, although a lot of genetic and epigenetic studies have reveal the complexity of pSS to a certain extent, but the knowledge of existing pSS disease heterogeneity is still limited and the immune mechanisms of salivary glands (SG) injury have been challenging to clarify.ObjectivesSingle-cell RNA sequencing (scRNA-seq) is a powerful tool capable of defining cell types and states on the basis of their individual transcriptome in a given sample from health and disease. To characterize the salivary glands immune microenvironment of patients with pSS, we performed droplet-based single cell mRNA sequencing (scRNA-seq) (10X Genomics) to provide a deeper insight into the cellular and molecular characteristics of salivary glands from pSS patients.Methods11 patients and 5 non-pSS controls were recruited from the The First Affiliated Hospital of USTC. The non-pSS were subjects who had experienced subjective symptoms of dryness, but no not meet any of the classification criteria of pSS. The clinical characteristics and laboratory findings of enrolled patients were also collected. After resection, salivary glands tissue samples were obtained after labial gland biopsy, rapidly digested to a single-cell suspension and subjected to scRNA-seq using the 10X platform. After rigorous quality control (QC) definition, low-quality cells were filtered. Following gene expression normalization for read depth and mitochondrial read count, we applied principle component analysis on genes variably expressed across all 72,853 cell.ResultsA total of 72,853 cells were obtained from all salivary glands samples. Our results revealed 12 major unique cell populations of salivary glands cell, including T cells, B cells, plasma cells, epithelial cells, myoepithelial cells, endothelial cells, myofibroblast, pericytes, melanocytes, fibroblast, myeloid cells and a cluster of unknown cells. As expected, lymphocytes (T and B cell populations) were significant increase in the salivary glands of patients with pSS. For further subsets analysis, we identify 41 subsets, including novel subpopulations in cell types hitherto considered to be homogeneous, as well as transcription factors underlying their heterogeneity. Strikingly, we found that differentially expressed genes (DEGs) that myoepithelial cells uniquely downregulated in pSS patients were involved in regeneration, stem cell population maintenance, cell division, and epithelial cell proliferation. This indicated an impaired stem cell property and regeneration capacity of myoepithelial cells in the SG of pSS patients which may result in the reduction of normal epithelial cells differentiation and proliferation. Our results identified three distinct endothelial subtypes according to the differentially expressed cell markers. ACKR1+ endothelial cells were expanded in the SG of pSS patients which may enhance Leukocyte transendothelial migration. A clear interferon response was observed in most celltypes. We also found a significantly expand PD-1hiCXCR5–CD4+T peripheral helper (Tph), GZMK+CD8+ T cells and a patient-specific fibroblasts in pSS patients. Cellular interaction analysis of SG revealed a strong interaction between epithelial cells and immune cells from pSS patients through CD74-MIF, MIF-TNFRSF14 and HLA-C-FAM3C receptor/ ligand pairs. Chemokine receptors CXCR4 were broadly expressed in SG immune cells implying a potentially central role in cell trafficking.ConclusionThis resource provides deeper insights into pSS salivary glands immune microenvironment that will be helpful in understanding of the disease heterogeneity and advancing pSS therapy.Disclosure of InterestsNone declared
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Zhu W, Zeng XJ, Xiang N, Zeng N, Liu ZH, Fang XQ, Jia FC, Yang J, Wanyee YY, Fang CH. [Application of augmented reality and mixed reality navigation technology in laparoscopic limited right hepatectomy]. Zhonghua Wai Ke Za Zhi 2022; 60:249-256. [PMID: 35078301 DOI: 10.3760/cma.j.cn112139-20210918-00447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the application effect of augmented reality and mixed reality navigation technology in three-dimensional(3D) laparoscopic narrow right hepatectomy(LRH). Methods: A retrospective analysis was performed on the clinical data of 5 patients with hepatic malignancy admitted to the First Department of Hepatobiliary Surgery,Zhujiang Hospital,Southern Medical University from September 2020 to June 2021,all of whom were males,aged from 42 to 74 years.Preoperative evaluation was performed using the self-developed 3D abdominal medical image visualization system; if all the 5 patients were to receive right hemihepatectomy,the remnant liver volume would be insufficient,so LRH were planned.During the operation,the independently developed 3D laparoscopic augmented reality and mixed reality surgical navigation system was used to perform real-time multi-modal image fusion and interaction between the preoperative 3D model and 3D laparoscopic scene.Meanwhile,intraoperative ultrasound assisted indocyanine green fluorescence was used to determine the surgical path.In this way,the LRH under the guidance of augmented reality and mixed reality navigation was completed.The predicted liver resection volume was evaluated before surgery,actual resected liver volume,surgical indicators and postoperative complications were analyzed. Results: All the 5 patients completed LRH under the guidance of augmented reality and mixed reality navigation technology,with no conversion to laparotomy.The median operative time was 300 minutes(range:270 to 360 minutes),no intraoperative blood transfusion was performed,and the median postoperative hospital stay was 8 days(range:7 to 9 days).There were no perioperative deaths,or postoperative complications such as liver failure,bleeding,or biliary fistula. Conclusion: For patients who need to undergo LRH,the use of augmented and mixed reality navigation technology can safely and effectively guide the implementation of surgery,retain more functional liver volume,improve surgical safety,and reduce postoperative complications.
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Affiliation(s)
- W Zhu
- First Department of Hepatobiliary Surgery,Zhujiang Hospital,Southern Medical University;Guangdong provincial clinical and engineering center of digital medicine,Guangzhou 510282,China
| | - X J Zeng
- First Department of Hepatobiliary Surgery,Zhujiang Hospital,Southern Medical University;Guangdong provincial clinical and engineering center of digital medicine,Guangzhou 510282,China
| | - N Xiang
- First Department of Hepatobiliary Surgery,Zhujiang Hospital,Southern Medical University;Guangdong provincial clinical and engineering center of digital medicine,Guangzhou 510282,China
| | - N Zeng
- First Department of Hepatobiliary Surgery,Zhujiang Hospital,Southern Medical University;Guangdong provincial clinical and engineering center of digital medicine,Guangzhou 510282,China
| | - Z H Liu
- First Department of Hepatobiliary Surgery,Zhujiang Hospital,Southern Medical University;Guangdong provincial clinical and engineering center of digital medicine,Guangzhou 510282,China
| | - X Q Fang
- First Department of Hepatobiliary Surgery,Zhujiang Hospital,Southern Medical University;Guangdong provincial clinical and engineering center of digital medicine,Guangzhou 510282,China
| | - F C Jia
- Shenzhen Institutes of Advanced Technology,Chinese Academy of Sciences,Shenzhen 518055,China
| | - J Yang
- First Department of Hepatobiliary Surgery,Zhujiang Hospital,Southern Medical University;Guangdong provincial clinical and engineering center of digital medicine,Guangzhou 510282,China
| | - Y Y Wanyee
- Faculty of Medicine,the Chinese University of Hong Kong, Hong Kong 999077, China
| | - C H Fang
- First Department of Hepatobiliary Surgery,Zhujiang Hospital,Southern Medical University;Guangdong provincial clinical and engineering center of digital medicine,Guangzhou 510282,China
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Fang CH, Zhang P, Luo HL, Zhu W, Zeng SL, Hu HY, Xiang N, Yang J, Zeng N, Fan YF, Jia FC, Liu LX. [Application of augmented-reality surgical navigation technology combined with ICG molecular fluorescence imaging in laparoscopic hepatectomy]. Zhonghua Wai Ke Za Zhi 2019; 57:578-584. [PMID: 31422626 DOI: 10.3760/cma.j.issn.0529-5815.2019.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objective: To study the application value of augmented-reality (AR) surgical navigation technology combined with indocyanine green (ICG) molecular fluorescence imaging in three-dimensional (3D) laparoscopic hepatectomy. Methods: The clinical data of forty-eight patients who had undergone 3D laparoscopic hepatectomy for hepatocellular carcinoma at First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University from January 2018 to April 2019 were retrospectively analyzed.The patients were divided into two groups: the group of 3D laparoscopic hepatectomy navigated by augment reality technology combined with ICG molecular fluorescence imaging (Group A) , and group of conventional 3D laparoscopic hepatectomy (Group B) . Patients in Group A (n=23) underwent 3D laparoscopic hepatectomy using augmented-reality technology combined with ICG molecular fluorescence imaging. In this group, the self-developed three-dimensional laparoscopic augmented-reality surgical navigation system (No. 2018SR840555) was operated to project the preoperative three-dimensional model to the surgical field, and the use of this system in combination with ICG molecular fluorescence imaging navigated laparoscopic hepatectomy. No surgical navigation technology was applied in Group B (n=25) . All patients signed the informed consent, which were in accordance with the requirements of medical ethics (Ethics No.: 2018-GDYK-003) . The preoperative data, surgical indicators and postoperative complications between the two groups were compared and analyzed. Results: The median amount of intraoperative blood loss of Group A was 250 (200) ml (M (Q(R)) ) , which was significantly lower than that of Group B (300 (150) ml) (Z=-2.307, P=0.021) .The transfusion rate of Group A was 13.0% (3/23) , which was significantly lower than that of Group B (40.0%, 10/25) (χ(2)=4.408, P=0.036) .The median postoperative hospitalization time of Group A was 8 (2) d, which was significantly shorter than that of Group B (11 (6.5) d) (Z=-2.694, P=0.007) . There were no serious complications and perioperative death in both groups.The incidence of postoperative complications in Group A was 17.4% (4/23) , which was not significantly different from that in group B (28%, 7/25) (χ(2)=0.763, P=0.382) . Conclusion: Augmented-reality surgical navigation technology combined with ICG molecular fluorescence imaging has better effect in 3D laparoscopic hepatectomy.
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Affiliation(s)
- C H Fang
- First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University; Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou 510282, China
| | - P Zhang
- First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University; Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou 510282, China
| | - H L Luo
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - W Zhu
- First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University; Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou 510282, China
| | - S L Zeng
- First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University; Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou 510282, China
| | - H Y Hu
- First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University; Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou 510282, China
| | - N Xiang
- First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University; Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou 510282, China
| | - J Yang
- First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University; Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou 510282, China
| | - N Zeng
- First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University; Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou 510282, China
| | - Y F Fan
- First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University; Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou 510282, China
| | - F C Jia
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - L X Liu
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of University of Science and Technology of China, Hefei 230001, China
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Tang X, Liu H, Chen L, Wang Q, Luo B, Xiang N, He Y, Zhu W, Zhang J. Semi-automatic volume measurement for orbital fat and total extraocular muscles based on Cube FSE-flex sequence in patients with thyroid-associated ophthalmopathy. Clin Radiol 2018; 73:759.e11-759.e17. [DOI: 10.1016/j.crad.2018.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 02/13/2018] [Indexed: 10/16/2022]
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Zeng N, Fang CH, Fan YF, Yang J, Xiang N, Zhu W, Liu J, Cai W, Mo ZK. [The construction of three-dimensional visualization platform and its application in diagnosis and treatment for hilar cholangiocarcinoma]. Zhonghua Wai Ke Za Zhi 2017; 54:680-5. [PMID: 27587211 DOI: 10.3760/cma.j.issn.0529-5815.2016.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To explore the construction and clinical efficacy of three-dimensional(3D) visualization platform about diagnosis and treatment of hilar cholangiocarcinoma. METHODS From January 2009 to December 2015, a total of 32 patients with hilarcholangiocarcinoma treated in Zhujiang Hospital of Southern Medical University were analyzed.There were 20 male and 12 female patients aged from 40 to 85 years. Bismuth-Corlette 3D visualization type: 2 cases with type Ⅰ, 5 cases with type Ⅱ, 10 cases with type Ⅲa, 11 cases with type Ⅲb, 4 cases with type Ⅳ.Among 32 cases, there were 5 cases who were established liver 3D printing models to guide intraoperative real-time navigation.The clinical effect of this platform was evaluated by the operation time, intraoperative blood loss, laboratory test and postoperative complications.The 3D visualization platform consists of the preoperative surgical planning with the aid of virtual 3D reconstruction technology and intraoperative real-time navigation with 3D printing models. RESULTS The liver 3D models for all patients were constructed successfully, they could clearly show intrahepatic pipeline, size and location of tumors, relationship between tumor and intrahepatic pipeline.The 3D printing models could accomplish real-time intraoperative navigation surgery with strong stereoscopic sense.According to Bismuth classification 3D visualization type, 2 patients with type Ⅰ received local excision of tumor and choledochojejunostomy; 5 patients with type Ⅱ received resection of segment Ⅰ, Ⅳb and partial Ⅴ combined with choledochojejunostomy; 10 patients with type Ⅲa received right semi-hepatectomy combined with resection of segment Ⅰ and choledochojejunostomy; 11 cases with type Ⅲb received left semi-hepatectomy combined with resection of segment Ⅰ and choledochojejunostomy; 4 cases with type Ⅳ received resection of segment Ⅳb and Ⅴ combined with choledochojejunostomy.The operation time was 270-660 minutes; the mean intraoperative blood loss was 588 ml; the mean postoperative hospital stay was 25 days.The bilirubin level three day after operation was 233 μmol/L.There was 1 case presented biliary fistula and cured by conservative treatment; there was no incision infection, no liver failure and no perioperative deaths occurred. CONCLUSION The 3D visualization is valuable for optimizing the operation scheme preoperatively and navigating surgery accurately intraoperatively in real-time which may improve the precision of the operation and achieve better the recovery.
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Affiliation(s)
- N Zeng
- First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
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Fang CH, Liang HB, Chi CW, Tao HS, Fang C, Zhu W, Mo ZK, Yang J, Xiang N, Zeng N, Tian J. [Application of indocyanine green-fluorescent imaging technique in planning resection line and real-time surgical navigation in small hepatocellular carcinoma]. Zhonghua Wai Ke Za Zhi 2017; 54:444-450. [PMID: 27938579 DOI: 10.3760/cma.j.issn.0529-5815.2016.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the value of near-infrared technology guided by indolecyanine green(ICG) in planning resection line and real-time surgical navigation in small liver cancer. Methods: From March to September 2015, 11 patients with hepatic tumors received hepatectomy were treated in First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University.There were 5 male and 6 female patients with average age of (55±10)years (range 39-70 years). Among whom, there were 9 cases with hepatocellular carcinoma and 2 cases with colorectal cancer. A near-infrared light camera system was used to detect the liver surfaces before resection, and to plan resection line and surgical specimens. A student's t test was used to compare continuous parametric variables. Results: The ICG-fluorescent imaging and histological examination had been used in the 15 lesions of the 11 patients. Among the 15 lesions, 7 lesions were detected by visual inspections, palpation and ICG-fluorescent imaging, 6 lesions were identified only by ICG-fluorescent imaging, 2 lesions were detected only by ICG-fluorescent imaging after resection.Results of pathologic examination indicated that the total fluorescent type include 5 well differentiated hepatocellular carcinoma and 2 cirrhotic nodule; the partial fluorescent type include 3 moderately differentiated hepatocellular carcinomas and 1 well differentiated hepatocellular carcinomas; the rim fluorescent type included 2 liver metastatic carcinoma and 2 poorly differentiated hepatocellular carcinomas. The average diameter of the tumor size measured by CT was (1.7±0.2)cm, while the average diameter measured by ICG-fluorescent imaging was (1.7±0.3)cm(t=-0.188, P>0.05). Conclusion: Near-infrared technology guided by ICG has important value in planning resection line and real-time surgical navigation in small liver cancer.
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Affiliation(s)
- C H Fang
- First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
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Zhu X, Lan L, Xiang N, Liu W, Zhao Q, Li H. Thermodynamic studies on the adsorption of Cu2+, Ni2+ and Cd2+ on to amine-modified bentonite. B CHEM SOC ETHIOPIA 2017. [DOI: 10.4314/bcse.v30i3.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Li HX, Xiang N, Hu WK, Jiao XL. Relation between therapy options for Graves' disease and the course of Graves' ophthalmopathy: a systematic review and meta-analysis. J Endocrinol Invest 2016; 39:1225-1233. [PMID: 27220843 DOI: 10.1007/s40618-016-0484-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 05/07/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The relation between therapy options for Graves' disease (GD) and the course of Graves' ophthalmopathy (GO) are still controversial. Our aim was to compare the occurrence of development or worsening of GO in patients who were treated with antithyroid drugs (ATDs) or radioactive iodine (RAI) or thyroidectomy (TX). METHODS We conducted a comprehensive search of the Embase and PubMed database. Odds ratio (OR) was used as a measure of the effect of therapy options for GD on the risk of development or worsening of GO. The analysis was further stratified by factors that could affect the treatment effects. RESULTS Nine trials involving 1773 patients were included. RAI therapy showed a significant effect on the risk of development or worsening GO compared with ATD (OR 2.25; 95 % CI 1.61-3.14; P < 0.00001). Glucocorticoid prophylaxis was effective in preventing GO development or worsening (0.40; 0.23-0.68; P = 0.002); especially for patients with preexisting GO (0.41; 0.23-0.73; P = 0.002). At 3 months, showed GO to be improved in 17 TX and 21 total thyroid ablation (TTA) patients, with no significant difference between the two groups; between 6 and 12 months, TTA did show significant beneficial effect on the improvement of GO (6.02; 2.80-12.96; P < 0.00001); GO was found to be inactive in a significantly higher percentage of patients in the TTA (2.17; 1.04-4.52; P = 0.04). CONCLUSION Radioiodine therapy is a significant risk factor for development or worsening of GO in GD. But GO progression can be prevented by prophylactic glucocorticoids in patients with preexisting GO. Compared with TX alone, TTA induces an earlier and steadier GO improvement in patients with mild to moderate-severe and active GO. Whether this is sufficient to offer TTA to patients needs further investigation.
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Affiliation(s)
- H X Li
- Tianjin Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, 300020, China
| | - N Xiang
- Department of Ophthalmology, Tong Ji Hospital, Tong Ji Medical College, Huazhong University of Science and Technology, No. 1095. Jiefang Rd, Hankou District, Wuhan, 430030, China.
| | - W K Hu
- Department of Ophthalmology, Tong Ji Hospital, Tong Ji Medical College, Huazhong University of Science and Technology, No. 1095. Jiefang Rd, Hankou District, Wuhan, 430030, China
| | - X L Jiao
- Tianjin Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, 300020, China
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Xiang N, Liu R, Zhang SJ, Hu WK, Zhan XY, Luo B, Ai T. [A comparative study of lacrimal magnetic resonance hydrography and lacrimal endoscopy examination in the diagnosis and treatment of lacrimal duct obstructive diseases]. Zhonghua Yan Ke Za Zhi 2016; 52:117-22. [PMID: 26906707 DOI: 10.3760/cma.j.issn.0412-4081.2016.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To evaluate the diagnostic value and treatment guidance of lacrimal magnetic resonance hydrography (LMRH) and lacrimal endoscopy examination in lacrimal duct obstruction. METHODS A retrospective analysis of clinical and imaging data of 59 patients with epiphora who had LMRH examination in Tongji Hospital during June 2013 and January 2014. Multiplanar reconstruction (MPR) and maximum intensity projection (MIP) were used to process the three dimensions T2-weighted images (T2WI). The size of lacrimal sac, lacrimal mucosal lesions and the obstructed plane of nasolacrimal duct were observed. The lacrimal irrigation results were used as gold standard. The sensitivity, specificity, accuracy of LMRH in diagnosis of lacrimal duct obstructive diseases and the consistency between the two methods were analyzed. In addition, 22 cases had lacrimal endoscopy examination in less than half month after MRD. The results of lacrimal endoscopy were compared with LMRH images. The treatment method was made according to the results of LMRH and lacrimal endoscopy. RESULTS According to the results of lacrimal irrigation, among 78 eyes of 59 patients, 2 eyes were diagnosed as lacrimal canalicular obstruction (2.6%, 2/78), 8 eyes were diagnosed as nasolacrimal duct stenosis (10.3%, 8/78), 24 eyes were diagnosed as nasolacrimal duct obstruction (30.8%, 24/78), 44 eyes were diagnosed as nasolacrimal duct obstruction accompanied with chronic dacryocystitis (56.4%, 44/78). The other 40 eyes were negative controls. LMRH had a high degree of consistency with lacrimal irrigation in diagnosis of lacrimal duct obstructive diseases. The value of Kappa was 0.963 (P= 0.026). The sensitivity of MRD in diagnosis of lacrimal duct obstructive diseases was 97.4%, the specificity was 100%, the accuracy was 98.3%, the positive predictive value was 100% and the negative predictive value was 95.2% . According to 40 eyes of the control group, the mean value of the maximum cross-sectional area of the lacrimal sac was: (10.9 ± 0.4) mm(2). Twenty-two eyes underwent lacrimal endoscopy examination and the endoscopic findings were consistent with LMRH diagnosis. The lesions in the lacrimal duct displayed more clearly and intuitively than the LMRH, while LMRH had its unique advantages in showing the size of lacrimal sac, the mucosal thickness of lacrimal duct, large foreign bodies and lesions around the lacrimal duct. According to the results of LMRH and lacrimal endoscopy, 2 eyes of canalicular obstruction, 8 eyes of nasolacrimal duct stenosis, 20 eyes of nasolacrimal duct obstruction underwent lacrimal probing and stent implantation. Four eyes of nasolacrimal duct obstruction had drug treatment under lacrimal endoscopy. Thirty-eight eyes of chronic dacryocystitis underwent endonasal dacryocystorhinostomy. The other 6 eyes of chronic dacryocystitis underwent stent removal combined with endonasal dacryocystorhinostomy. CONCLUSIONS LMRH is a noninvasive and reliable method to examine the lacrimal duct obstruction. It can better display the size of lacrimal sac, lacrimal mucosal thickness and surrounding soft tissues of lacrimal duct. It is also a good complementary method of lacrimal endoscopy and has guiding significance for individualized treatment in patients with lacrimal duct obstruction.
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Affiliation(s)
- N Xiang
- Department of Ophthalmology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Xiang N, James M, Walters S, Bamford A, Foster C. Improved serum cholesterol in paediatric patients switched from suppressive lopinavir-based therapy to boosted darunavir or atazanavir: an 18-month retrospective study. HIV Med 2015; 15:635-6. [PMID: 25334035 DOI: 10.1111/hiv.12180] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- N Xiang
- Department of Paediatric Infectious Diseases, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
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Liang W, Feng L, Xu C, Xiang N, Zhang Y, Shu Y, Wang H, Luo H, Yu H, Liang X, Li D, Lee CK, Feng Z, Hou Y, Wang Y, Chen Z, Yang W. Response to the first wave of pandemic (H1N1) 2009: experiences and lessons learnt from China. Public Health 2012; 126:427-36. [PMID: 22516790 PMCID: PMC7111655 DOI: 10.1016/j.puhe.2012.02.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 09/26/2011] [Accepted: 02/08/2012] [Indexed: 01/19/2023]
Abstract
More than 2 years after the start of pandemic H1N1, the world is fortunate that the impact, to date, has been moderate. An evaluation of the global response to the first wave of the pandemic is still ongoing. The results of an analysis of the situation in China is presented in order to gain a better understanding of the episode; to summarize the experiences in preparedness, control and mitigation of the pandemic; and to identify issues for further consideration and investigation in order to improve the response to possible next waves of the pandemic. China's response shows how a huge challenge can be transformed into an opportunity, and may offer some valuable lessons to face another wave of the pandemic or other potential public health emergencies in the future, not only for China but also for the international community.
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Affiliation(s)
- W. Liang
- Ministry of Health, People’s Republic of China, Beijing, China
| | - L. Feng
- Chinese Centre for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, PR China
| | - C. Xu
- Chinese Centre for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, PR China
| | - N. Xiang
- Chinese Centre for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, PR China
| | - Y. Zhang
- Chinese Centre for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, PR China
| | - Y. Shu
- Chinese Centre for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, PR China
| | - H. Wang
- Chinese Centre for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, PR China
| | - H. Luo
- Chinese Centre for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, PR China
| | - H. Yu
- Chinese Centre for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, PR China
| | - X. Liang
- Chinese Centre for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, PR China
| | - D. Li
- Chinese Centre for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, PR China
| | - C.-K. Lee
- World Health Organization Beijing Office, Beijing, China
| | - Z. Feng
- Chinese Centre for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, PR China
| | - Y. Hou
- Chinese Centre for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, PR China
| | - Y. Wang
- Chinese Centre for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, PR China
| | - Z. Chen
- Ministry of Health, People’s Republic of China, Beijing, China
| | - W. Yang
- Chinese Centre for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, PR China
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Abstract
We report on the experimental evidence of four wave mixing (FWM) between the two polarization components of a vector soliton formed in a passively mode-locked fiber laser. Extra spectral sidebands with out-of-phase intensity variation between the polarization resolved soliton spectra was firstly observed, which was identified to be caused by the energy exchange between the two soliton polarization components. Other features of the FWM spectral sidebands and the soliton internal FWM were also experimentally investigated and numerically confirmed.
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Affiliation(s)
- H Zhang
- School of Electrical and Electronic Engineering, Nanyang Technological University, Singapore
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15
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Abstract
We report on the soliton trapping in a fiber ring laser modelocked with a SESAM. It was observed that solitons along the two orthogonal polarization directions of the cavity with fairly large difference in central frequency and energy could be coupled together to form a group velocity locked vector soliton. In particular, due to that each of the coupled solitons forms its own soliton sidebands, two sets of soliton sidebands could be observed on the vector soliton spectrum. Numerical simulations have well confirmed the experimental observations.
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Affiliation(s)
- L M Zhao
- School of Electrical and Electronic Engineering, Nanyang Technological University, Singapore 639798.
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16
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Okhotnikov OG, Gomes L, Xiang N, Jouhti T, Grudinin AB. Mode-locked ytterbium fiber laser tunable in the 980-1070-nm spectral range. Opt Lett 2003; 28:1522-1524. [PMID: 12956366 DOI: 10.1364/ol.28.001522] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Spectral tuning of a mode-locked Yb-doped fiber laser over a 90-nm range is reported. Using semiconductor saturable absorber mirrors in a fiber laser cavity incorporating a grating-pair dispersive delay line, we obtain reliable self-starting mode locking over the whole tuning range. The wide tuning range is achieved by optimization of reflection characteristics and bandgap energy of the multiple-quantum-well semiconductor saturable absorber and by proper engineering of the laser cavity.
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Affiliation(s)
- O G Okhotnikov
- Optoelectronics Research Centre, Tampere University of Technology, P.O. Box 692, FIN-33101, Tampere, Finland.
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17
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Xiang N, Li J, Liu F. [A case of refractory hypertension complicated with thoracic and pericardial effusion by peritoneal dialysis]. Hunan Yi Ke Da Xue Xue Bao 2002; 24:Inside back cover. [PMID: 12080702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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18
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Guina M, Xiang N, Vainionpää A, Okhotnikov OG, Sajavaara T, Keinonen J. Self-starting stretched-pulse fiber laser mode locked and stabilized with slow and fast semiconductor saturable absorbers. Opt Lett 2001; 26:1809-1811. [PMID: 18059706 DOI: 10.1364/ol.26.001809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A self-starting stretched-pulse mode-locked erbium-doped fiber laser that uses fast and slow semiconductor saturable absorbers is described. By using two absorbers, we obtained reliable operation at a fundamental repetition rate with 250 pJ of pulse energy without multiple-pulse breakup. External chirp compensation was used to compress the highly chirped pulses to durations of 135 fs.
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Abstract
Determination of sound decay times in coupled spaces often demands considerable effort. Based on Schroeder's backward integration of room impulse responses, it is often difficult to distinguish different portions of multirate sound energy decay functions. A model-based parameter estimation method, using Bayesian probabilistic inference, proves to be a powerful tool for evaluating decay times. A decay model due to one of the authors [N. Xiang, J. Acoust. Soc. Am. 98, 2112-2121 (1995)] is extended to multirate decay functions. Following a summary of Bayesian model-based parameter estimation, the present paper discusses estimates in terms of both synthesized and measured decay functions. No careful estimation of initial values is required, in contrast to gradient-based approaches. The resulting robust algorithmic estimation of more than one decay time, from experimentally measured decay functions, is clearly superior to the existing nonlinear regression approach.
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Affiliation(s)
- N Xiang
- National Center for Physical Acoustics and Department of Electrical Engineering, University of Mississippi, University 38677, USA.
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20
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Jia Z, Xiang N, Sun M, Zhou H. [Expression of inducible nitric oxide synthase in atherosclerotic rabbits]. Hunan Yi Ke Da Xue Xue Bao 2001; 23:349-52. [PMID: 11189390] [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
Atherosclerotic lesions contain vascular smooth cells and thus may have an increased capacity for generation of nitric oxide (NO) by inducible NO synthase (iNOS). Rabbits (n = 8) were raised for eight weeks by the atherogenic diet, then the aortic rings were captured. Contractive responsiveness to norepinephrine, changes of CGMP, expression of iNOS of aortic rings were examined in vitro. There was a substantial decrease in contractile responsiveness to norepinephrine (NE) (P < 0.05), a decrease of CGMP (P < 0.01) and an increase of expression of iNOS (P < 0.05), after L-arginine or sodium nitroprusside treatment. The contractile responsiveness to NE was attenuated (P < 0.01). The CGMP was increased ((P < 0.01). After NG-nitric arginine (L-NNA) treatment, those reaction were reversed. It implied that L-arginine/NO pathway obstructure might likely be another mechanism of atherosclerosis and atherosclerotic arteries and had an increased capacity for generation of NO by iNOS.
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Affiliation(s)
- Z Jia
- Department of Cardiology, Xiangya Hospital, Hunan Medical University, Changsha 410078
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Ba Y, Xiang N, Tan Z, Zhang Y, Tan Y. Treatment of epigastralgia by external application of huweigao at shenque point. J TRADIT CHIN MED 1999; 19:214-7. [PMID: 10921154] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
140 cases of epigastralgia were divided into two groups at random. The 100 cases in the treatment group were treated with Huweigao externally applied at Shenque (Ren 8), and the 40 cases in the control group by oral administration of Weinaian capsule. After a one-month treatment, the total symptom-relieving rate and the gastroscopy-proved effective rate were 94.0% and 52.6% respectively in the treatment group, much superior to those in the control group.
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Affiliation(s)
- Y Ba
- Affiliated Hospital, Hubei College of Traditional Chinese Medicine, Wuchang
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22
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Jia Z, Sun M, Zhou H, Xiang N. [Effect of nitric oxide and tumor necrosis factor on pericardial effusion]. Hunan Yi Ke Da Xue Xue Bao 1998; 22:183-4. [PMID: 9868070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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23
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Valden M, Keiski R, Xiang N, Pere J, Aaltonen J, Pessa M, Maunula T, Savimäki A, Lahti A, Härkönen M. Reactivity of Pd/Al2O3, Pd/La2O3–Al2O3and Pd/LaAlO3Catalysts for the Reduction of NO by CO: CO and NO Adsorption. J Catal 1996. [DOI: 10.1006/jcat.1996.0224] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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25
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Valden M, Pere J, Xiang N, Pessa M. Strong molecular interaction of carbon dioxide with Pd/LaAlO3 catalyst. Chem Phys Lett 1996. [DOI: 10.1016/0009-2614(96)00223-0] [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: 11/26/2022]
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26
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Leibsle FM, Francis SM, Davis R, Xiang N, Haq S, Bowker M. Scanning tunneling microscopy studies of formaldehyde synthesis on Cu(110). Phys Rev Lett 1994; 72:2569-2572. [PMID: 10055917 DOI: 10.1103/physrevlett.72.2569] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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27
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Zick CD, Xiang N. Assessing the correlates of desired family size in Shaanxi, China. Soc Biol 1994; 41:150-167. [PMID: 7761902 DOI: 10.1080/19485565.1994.9988870] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
This exploratory analysis of factors associated with Chinese women's fertility desires uses data on married women between the ages of 18 and 35 who live in Shaanxi Province, China. Analyses using an economic framework found that both rural and urban couples who intended to sign, or who had already signed, the one-child certificate reported wanting significantly fewer children. However, in rural areas (where 80 per cent of the provincial population lives), education level, living arrangements, participation in an arranged marriage, attitudes regarding the ideal age for marriage, and knowledge of the reasons for the government's fertility policies appear to play a relatively larger role in shaping fertility preferences.
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Affiliation(s)
- C D Zick
- Department of Family and Consumer Studies, University of Utah, Salt Lake City 84112, USA
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28
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Xiang N. Stochastic motion of charged particles in a magnetic field. Phys Rev E Stat Phys Plasmas Fluids Relat Interdiscip Topics 1993; 48:1590-1592. [PMID: 9960757 DOI: 10.1103/physreve.48.1590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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