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Postoperative pulmonary complications (PPCs) most commonly occur after thoracic surgery. Not only prolonged hospital stay and increased financial expenses but also morbidity and even mortality may be troublesome for those with PPCs. Herein, we aimed to conduct a comprehensive systematic review and meta-analysis of available data to examine the effectiveness of incentive spirometry (IS) to reduce PPCs and shorten hospital stay. This systematic review and meta-analysis included 5 randomized controlled trials (RCT) and 3 retrospective cohort study (10,322 patients in total) in PubMed, Embase and Cochrane Library until September 31, 2021. We assessed the clinical efficacy of IS using length of hospital stay, PPCs, postoperative pneumonia, and postoperative atelectasis with meta-analysis, meta-regression and trial sequential analysis (TSA). With this meta-analysis, the length of hospital stay in patients undergoing IS was significantly shorter (1.8 days) than that in patients not receiving IS (MD = -1.80, 95% CI = -2.95 to -0.65). Patients undergoing IS also had reduced risk of PPCs (32%) and postoperative pneumonia (17.9%) with statistical significance than patients not undergoing IS (PPC: OR = 0.68, 95% CI = 0.51-0.90) (Pneumonia: OR = 0.821, 95% CI = 0.677-0.995).In meta-regression, the benefits of undergoing IS in patients with preoperative predicted FEV

Objective Patients with chronic hepatitis C virus (HCV) infection are at high risk of developing hepatocellular carcinoma (HCC). Previous studies suggested that menopause may increase the risk of HCC. We investigated the association between bilateral oophorectomy (BO) and the risk of HCC in women with HCV infection. Study design We used data from the National Health Insurance Research Database of Taiwan and conducted a matched cohort study. Main outcome measures The main outcome was HCC. We used a competing risk model to adjust for potential confounding factors. Results From 1997–2013, we identified 2176 patients with BO and 8704 controls. A total of 107 HCC cases (4.9 %, 107/2176) were identified in the BO group compared with 465 HCC cases (5.3 %, 465/8704) in the control group. The incidence rates were 506.3 and 538.9 cases per 100,000 person-years among the HCV-infected patients with and without BO, respectively. The competing risk model showed that BO did not increase the risk of developing HCC. Furthermore, a sub-analysis of only women under 50 years of age similarly showed that BO did not increase the risk of developing HCC after adjusting for additional covariates. The log-rank test revealed that whether or not the patients had received HRT, patients with BO did not have an increased risk of developing HCC (non-BO vs BO with HRT, p = 0.10; non-BO vs BO without HRT, p = 0.09). The use of HRT after BO did not influence the risk of developing HCC. Conclusions This study examined a large dataset with a long follow-up period to test the relationship between BO and the risk of HCC in HCV-infected women. Our findings suggest that BO did not increase the risk of HCC, regardless of HRT usage, in these women.

Background An abnormal sternocleidomastoid muscle in congenital muscular torticollis can be classified into one of the four types via sonography. However, this categorization lacks quantitative measurements. The purpose of the study was to determine quantitative measurements of the sonograms via image analysis. Methods Infants younger than 12 months of age suspected of having congenital muscular torticollis were included. Intraclass correlation coefficient estimates for interobserver reliability and a simple regression analysis for criterion validity were calculated. Spearman correlation analysis was then performed. The analyzed parameters included cervical passive range of motion for lateral flexion and rotation, area, brightness, max/min Feret's diameters, and muscular width/thickness. Results Of the 29 (4.0 ± 2.6 months) screened infants, 13 (1.9 ± 1.7 months) were included. Nine were male, and 4 were female. Seven infants with mass were ultrasonographically classified into type I, and the other six infants were classified into type II. The affected/unaffected side ratios of cervical passive range of motion for lateral flexion and rotation were 0.92 ± 0.13 and 0.88 ± 0.16, respectively. The parameters measured on the sonograms were reliable, and the max/min Feret's diameters were valid measurements. The affected/unaffected side ratio of cervical passive range of motion for rotation significantly correlated with the affected/unaffected side ratios of the sternocleidomastoid muscle sonogram on area (r = −0.62, p = 0.03) and min Feret's diameter (r = −0.69, p = 0.01). Conclusions The area and min Feret's diameter were efficacious parameters for image analysis on sternocleidomastoid sonograms, and the min Feret's diameter would be more suitable than thickness for measuring the thickening SCM in transverse view. A healthy control group, more data and follow-up would be needed to confirm the changes on the SCM sonograms for clinical decision.

Previous studies on field monitoring data indicate that vertical earth pressure would be overestimated by the Terzaghi theory for a deeply buried shield tunnel, which is widely adopted in tunnel design. A kinematic mechanical model was proposed to evaluate its influence on vertical earth pressure and implementation into the finite element program in this paper. To investigate the vertical earth pressure, a numerical study using the commercial software of PLAXIS was conducted on the vertical earth pressure distribution on a single shield tunnel, considering different tunnel diameters and burial depths in sandy and clay layers, such as Shanghai soil strata. Based on finite element model results, the existing problems such as soil displacement around tunnel, earth pressure distribution, collapsed soil mass width and sliding friction in the Terzaghi loosening earth pressure formula for a sand layer were discussed. Then, a feasible calculation method for vertical earth pressure on the tunnel lining was proposed. Through comparisons between calculated results and field measurements, the improved formulas were verified, providing a reference for future designs of deep underground structures in Shanghai Soil Layers.

Aims The present study aimed to investigate the role and underlying mechanisms of CD166 in cancer stem cell-like (CSCs) phenotype of the radioresistant nasopharyngeal carcinoma cell CNE-2R. Main methods Established CD166-shRNA- CNE-2R cell line by lentivirus-mediated silencing CD166. Then, CSC-related genes mRNAs and proteins, and EGFR/ERK1/2 signaling pathway were detected using RT-PCR and western blot. Sphere formation assay was performed to evaluate the sphere formation capacity in CD166-shRNA- CNE-2R cells. The tumorigenesis ability in vivo was examined in nude mice mode. Key findings Downregulation of CD166 inhibited the expression of the CSC-related genes, pEGFR and pERK in vitro and vivo. The capacity to form spheres and tumorigenesis was significantly decreased in CD166-shRNA cells. Furthermore, EGF-stimulated CD166-shRNA cells exhibited an increase in CSC-like traits by activating EGFR/ERK1/2 signaling. Significance CD166 induced CSCs formation by activating the EGFR/ERK1/2 signaling pathway in nasopharyngeal carcinoma, which may serve as a critical molecular target for NPC therapeutic strategies.

Based on the characteristics of the shield tunnel structure and marine environment, this paper discusses the durability factors affecting the joint components of shield tunnel. Based on engineering practices this study draws the conclusions as follows: the tidal water pressure causes the increase and decrease of the compression displacement of the rubber gasket, and reduces its fatigue lifetime; the impermeability of the rubber gasket is antagonistic to its lifetime in the condition of high water pressure, and its lifetime should coordinate with the service life of shield tunnel when the gasket meets the requirements of waterproof performance; the migration rate of chloride increases under high water pressure in erosion environment, which reduces chloride migration time to the surface of shield tunnel segment. Finally, the tree diagram of durability influencing factors of joint components under high water pressure in erosion environment is established, which will provide references for the waterproof design and the evaluation system of durability of joint components.

We aimed to identify predictors for the changes of various developmental outcomes in preschool children with cerebral palsy (CP). Participants were 78 children (49 boys, 29 girls) with CP (mean age: 3 years, 8 months; SD: 1 year, 7 months; range: 1 year to 5 years, 6 months). We examined eight potential predictors: age, sex, CP subtype, Gross Motor Function Classification System (GMFCS) level, selective motor control, Modified Ashworth Scale, and the spinal alignment (SA) and range of motion subscales of the Spinal Alignment and Range of Motion Measure (SAROMM). Developmental outcomes for cognition, language, self-help, and social and motor functions were measured at baseline and a 6-month follow-up with the Comprehensive Developmental Inventory for Infants and Toddlers. Regression model showed GMFCS level was a negative predictor for change of language (adjusted r(2)=0.30, p

Background In this study, we attempted to identify differences in the outcomes of patients with severe trauma who were directly transported to our hospital, and those who were stabilised initially at other hospitals in south-central Taiwan. Methods We performed a prospective observational study to review the records of 231 patients with major trauma (Injury Severity Scores (ISS) >15) who visited our hospital's emergency department from January 2010 to December 2010. Among these patients, 75 were referred from other hospitals. Logistic regression was performed to assess the effects of transfer on mortality. Results Patients in the transfer group had a shorter interval between trauma and admission to the first hospital (25.3 min vs. 28.1 min), and the average interval between the two hospital arrivals was 138.3 min. Transfer from another hospital was not significantly correlated with mortality in this study (odds ratio: 1.124, 95% confidence interval: 0.276–4.578). Conclusion In trauma patients with ISS > 15, there is no difference in mortality between those transferred from another hospital after initial stabilisation and those who visited our emergency department directly.

Background Reviewing the literature on central neurocytoma revealed that functional outcomes traditionally have been assessed by KPS. However, KPS is not sufficiently sensitive to assess functional outcomes compared with the Barthel Index and the Functional Independence Measure (the FIM™ instrument). Discussion of other functional assessments and various aspects of central neurocytomas has never been documented clearly. Methods Nine case series of primary central neurocytomas received total or STR at our hospital. The clinical features, neuroradiologic findings, histopathologic features, and functional outcomes were listed and analyzed. Moreover, the functional outcomes were assessed using KPS, Barthel Index, and FIM™ instrument. The follow-up period ranged from 8 to 33 months after surgery. Results Patients with increased GFAP positivity or MIB-1 index greater than 3% did not have the worst scores in functional assessments. The functional outcomes of the cases presented here, including KPS, Barthel Index, and FIM™ instrument, were listed in Table 4. Most patients achieved good functional outcomes. The average KPS, Barthel Index, and FIM™ instrument were 86.25 ± 14.08 (range, 60-100), 86.88 ± 17.31 (range, 50-100), and 111 ± 17.02 (range, 78-126), respectively. Conclusion Most of the patients in this investigation achieved good ability to independently perform daily activity. Whether the high score of functional outcome was correlated with benign tumor course or 5-year survival rate remains uncertain. We recommend regular follow-up for detecting tumor growth or recurrence, although central neurocytomas are always benign.