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OBJECTIVE@#To assess the outcomes after acupoint application in patients with pharyngeal pain in a real-world settings, and analyze the characteristics of effective population and prescription characteristics of acupoint application.@*METHODS@#Based on CHUNBO platform, patients with pharyngeal pain who were candidates for acupoint application on the basis of physician-evaluation, were enrolled in a nationwide, prospective, 69-week multicenter observational study from August 2020 to February 2022. Propensity score matching (PSM) was used to match the confounding factors and the association rules were used to analyze the characteristics of effective population and prescription characteristics of acupoint application. Outcome assessments included the disappearance rate of pharyngeal pain (within 3, 7, and 14 days), disappearance time of pharyngeal pain, as well as adverse events.@*RESULTS@#Of 7,699 enrolled participants, 6,693 (86.9%) received acupoint application and 1,450 (21.7%) with non-acupoint application. After PSM, there were 1,004 patients each in the application group (AG) and non-application group (NAG). The disappearance rate of pharyngeal pain in the AG at 3, 7, and 14 days were all higher than those in the NAG (P<0.05). The disappearance time of pharyngeal pain in the AG were shorter than that in the NAG (logrank P<0.001, hazard ratio=1.51, 95% confidence interval: 1.41-1.63). The median age of effective cases was 4 years, mainly 3-6 years old (40.21%). The disappearance rate of pharyngeal pain in the application group with tonsil diseases was 2.19 times higher than that in the NAG (P<0.05). The commonly used acupoints for the effective cases were Tiantu (RN 22), Shenque (RN 8) and Dazhui (DU 14). The commonly used herbs for the effective cases were Natrii sulfas, Radix et Rhizoma Rhei, and Herba Ephedrae. Among them, Natrii sulfas was applied to RN 8 most frequently (support 84.39%). A total of 1,324 (17.2%) patients experienced AEs, and mainly occurred in the AG, with significant difference in the incidence of AEs between goups (P<0.05). All AEs reported were the first grade, and the average regression days of AEs was 2.8 days.@*CONCLUSIONS@#Acupoint application in patients with pharyngeal pain resulted in improved effective rate and shortened duration, especially children aged 3-6 years old, and those with tonsil diseases. Acupoint of RN 22, RN 8 and DU 14, Natrii sulfas, Radix et Rhizoma Rhei, and Herba Ephedrae were the most commonly used herbs in the treatment of pharyngeal pain.
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Child , Humans , Child, Preschool , Acupuncture Points , Medicine, Chinese Traditional/methods , Prospective Studies , PainABSTRACT
Objective: To compare the prognostic value of 3 diagnostic criteria of bronchopulmonary dysplasia (BPD) in preterm infants with gestational age<32 weeks. Methods: The retrospective cohort study was conducted to collect the clinical data of 285 preterm infants with BPD admitted to the Department of Neonatology, Children's Hospital Affiliated to Zhengzhou University from January 2019 to September 2021, who were followed up regularly after discharge. The primary composite adverse outcome was defined as death or severe respiratory morbidity from 36 weeks of corrected gestational age to 18 months of corrected age, and the secondary composite adverse outcome was defined as death or neurodevelopmental impairment. According to the primary or secondary composite adverse outcomes, the preterm infants were divided into the adverse prognosis group and the non-adverse prognosis group. The 2001 National Institute of Child Health and Human Development (NICHD) criteria, 2018 NICHD criteria, and 2019 Neonatal Research Network (NRN) criteria were used to diagnose and grade BPD in preterm infants. Chi-square test, Logistic regression analysis, receiver operating characteristic (ROC) curve and Delong test were used to analyze the prognostic value of the 3 diagnostic criteria. Results: The 285 preterm infants had a gestational age of 29.4 (28.1, 30.6) weeks and birth weight of 1 230 (1 000, 1 465) g, including 167 males (58.6%). Among 285 premature infants who completed follow-up, the primary composite adverse outcome occurred in 124 preterm infants (43.5%), and the secondary composite adverse outcome occurred in 40 preterm infants (14.0%). Multivariate Logistic regression analysis showed that severe BPD according to the 2001 NICHD criteria, gradeⅡand Ⅲ BPD according to the 2018 NICHD criteria and grade 2 and 3 BPD according to the 2019 NRN criteria were all risk factors for primary composite adverse outcomes (all P<0.05). ROC curve showed that the area under the curve (AUC) of the 2018 NICHD criteria and 2019 NRN criteria were both higher than that of the 2001 NICHD criteria (0.70 and 0.70 vs. 0.61, Z=4.49 and 3.35, both P<0.001), but there was no significant difference between the 2018 NICHD and 2019 NRN criteria (Z=0.38, P=0.702). Multivariate Logistic regression analysis showed that the secondary composite adverse outcomes were all associated with grade Ⅲ BPD according to the 2018 NICHD criteria and grade 3 BPD according to the 2019 NRN criteria (both P<0.05). ROC curve showed that the AUC of the 2018 NICHD criteria and 2019 NRN criteria were both higher than that of the 2001 NICHD criteria (0.71 and 0.71 vs. 0.58, Z=2.93 and 3.67, both P<0.001), but there was no statistically significant difference between the 2018 NICHD and 2019 NRN criteria (Z=0.02, P=0.984). Conclusion: The 2018 NICHD and 2019 NRN criteria demonstrate good and comparable predictive value for the primary and secondary composite adverse outcomes in preterm infants with BPD, surpassing the predictive efficacy of the 2001 NICHD criteria.
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Infant , Male , Child , Infant, Newborn , Humans , Infant, Premature , Bronchopulmonary Dysplasia/complications , Prognosis , Retrospective Studies , Gestational AgeABSTRACT
OBJECTIVE To investigate the effects of esketamine for multimodal analgesia on opioid consumption and gastric motility in mechanically ventilated non-surgical intensive care unit （ICU） patients. METHODS Forty cases of mechanically ventilated non-surgical patients in the ICU of our hospital from February 1st， 2023 to July 31st， 2023 were selected and randomly divided into control group and esketamine （S-K） group using grouping method with opaque envelopes， with 20 cases in each group. Control group was given sufentanil， and S-K group was infused with Esketamine hydrochloride injection at a constant rate of 0.2 mg/（kg·h）+ sufentanil. The treatment period length， analgesic compliance rate， sedation level， analgesic and sedative consumption， and gastric motility indexes were compared between the two groups. RESULTS There was no statistically significant difference in the treatment period length， analgesic compliance rate， sedation level， or the consumption of propofol and midazolam between the two groups （P＞0.05）. The consumption of sufentanil in the S-K group was significantly less than control group （P＜ 0.05）. Compared with 1 h after randomization， the antral contraction frequency， antral contraction amplitude and antral motility index of patients in the S-K group were significantly higher at 72 h after randomization and were significantly higher than control group （P＜0.05）. CONCLUSIONS Esketamine may reduce opioid consumption and improve gastric motility in mechanically ventilated non-surgical ICU patients while ensuring a level of analgesic sedation.
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AIM:To investigate the clinical efficacy of minimally invasive foldable capsular buckle(FCB)scleral buckling in treating rhegmatogenous retinal detachment(RRD).METHOD: This retrospective study enrolled 11 patients(11 eyes)with RRD treated with minimally invasive FCB scleral buckling at the Hainan Traditional Chinese Medicine Hospital from May to July 2023. The surgeries were performed without subconjunctival anesthesia, extraocular muscle pulling, intraocular positioning, retinal cryotherapy or drainage of subretinal fluid, or FCB suture fixation. Furthermore, the best corrected visual acuity(BCVA), intraocular pressure and complications were observed.RESULTS: Minimally invasive FCB scleral buckling was performed on 11 eyes, with successful retinal reattachment in 10 eyes(91%), and the remaining 1 eye(9%)had postoperative retinal re-detachment and underwent vitrectomy with silicone oil filling for multiple retinal tears. One-time successful surgery was in 4 eyes(40%), gas injection in vitreous body after the surgery was performed in 1 eye(10%), FCB position adjustment after the surgery was performed in 3 eyes(30%), gas injection in vitreous body and FCB position adjustment after the surgery were performed in 2 eyes(20%); and FCB was removed 4-12 wk after the surgery in 5 eyes(50%), without retinal redetachment. The average BCVA(LogMAR)of the 10 eyes improved from 1.30±1.10 before surgery to 0.37±0.39 at 4 wk after surgery(P&#x003C;0.01); the average preoperative intraocular pressure was 11.51±3.37 mmHg and 13.72±2.57 mmHg at 4wk after surgery(P&#x003E;0.05). No serious complications occurred.CONCLUSION:Minimally invasive FCB scleral buckling effectively treats RRD with minimal injury, simple operation, time-saving, and fewer complications.
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OBJECTIVE@#To explore the cause of inconsistency between the results of trisomy 7 by expanded non-invasive prenatal testing (NIPT-PLUS) and trisomy 18 by prenatal diagnosis.@*METHODS@#A pregnant woman who received genetic counseling at Jiaozuo Maternal and Child Health Care Hospital on July 5, 2020 was selected as the study subject. NIPT-PLUS, systematic ultrasound and interventional prenatal testing were carried out. The middle segment and root of umbilical cord, center and edge of the maternal and fatal surface of the placenta were sampled for the validation by copy number variation sequencing (CNV-seq).@*RESULTS@#The result of NIPT-PLUS indicated that the fetus has trisomy 7. Systematic ultrasound has shown multiple malformations including atrioventricular septal defect, horseshoe kidney, and rocker-bottom feet. However, QF-PCR, chromosomal karyotyping analysis, and CNV-seq of amniotic fluid samples all showed that the fetus was trisomy 18. Validation using multiple placental samples confirmed that the middle segment of the umbilical cord contains trisomy 18, the center of the placenta contained trisomy 7, and other placental sites were mosaicism for trisomy 7 and trisomy 18. Notably, the ratio of trisomy 18 became lower further away from the umbilical cord.@*CONCLUSION@#The false positive results of trisomy 7 and false negative trisomy 18 by NIPT-PLUS was probably due to the existence of placental mosaicism. Strict prenatal diagnosis is required needed aneuploidy is detected by NIPT-PLUS to exclude the influence of placental mosaicisms.
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Child , Pregnancy , Female , Humans , Trisomy/genetics , Trisomy 18 Syndrome/genetics , Placenta , DNA Copy Number Variations , Prenatal Diagnosis/methods , Chromosome Disorders/genetics , AneuploidyABSTRACT
AIM: To revise the referral criteria for the SPOT Vision Screener in children under 6 years old and assessed its accuracy based on the American Association for Pediatric Ophthalmology and Strabismus(AAPOS)uniform guidelines for instrument-based pediatric vision screen validation 2021.METHODS: Children who visited the Maternal and Child Health Center of Yuhuatai District in Nanjing city from January 2022 to April 2023 were included in the study and underwent SPOT refractive screening, cycloplegic retinoscopy, and other examinations. Abnormal children were defined according to AAPOS guidelines with amblyopia risk factors(ARFs)and visually significant refractive error(VSRE). Receiver operating characteristic(ROC)curve was used to calculate the optimal referral criteria and compared with manufacturer criteria, Wu's criteria, and Peterseim's criteria.RESULTS: A total of 959 children were examined, with 342 in the <4-year-old group and 617 in the ≥4-year-old group. The optimal referral criteria for the <4-year-old group were myopia ≤-2.75 D, hyperopia ≥+2.25 D, astigmatism ≤-2.75 D, and anisometropia ≥1.00 D. For the ≥4-year-old group, the criteria were myopia ≤-1.75 D, hyperopia ≥+2.00 D, astigmatism ≤-2.25 D, and anisometropia ≥1.00 D. The Youden index was 0.38 and 0.52, respectively, which were higher than other criteria.CONCLUSION: The use of new referral criteria for refractive screening in children under 6 years old demonstrates higher accuracy compared to previous criteria. It provides valuable guidance for pediatric eye care and vision health in children.
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Thyroid-associated ophthalmopathy(TAO)is an autoimmune disease associated with thyroid dysfunction that can significantly impact quality of life, result in visual impairment and facial disfigurement. Traditional treatments are often unsatisfactory. Studies have shown that teprotumumab, a human monoclonal antibody that can inhibit insulin-like growth factor 1 receptor(IGF-1R), has become an emerging targeted drug for TAO. Although the drug has proven to be effective and relatively safe in the treatment of TAO, adverse reactions are worthy of attention of ophthalmologists with the continuous promotion of clinical application, including hearing impairment, hyperglycemia, diarrhea, muscle spasms, infusion reactions, cognitive decline, thyroid suppression, alopecia, nausea and fatigue. Teprotumumab was generally well tolerated, with most adverse events being mild or moderate in severity. This paper aims to review the adverse reactions and precautions of teprotumumab in the treatment of TAO.
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ObjectiveTo explore the clinical effect of kidney-tonifying and blood-generating method and qi-promoting and blood-nourishing method combined with western medicine on the treatment of aplastic anemia and the characteristics of blood routine recovery， and to explore a new phased treatment model for aplastic anemia. MethodThis study was based on a prospective， multicenter， double-blind， and randomized controlled clinical trial. Patients with aplastic anemia from 19 centers were analyzed and divided into a kidney-tonifying and blood-generating group and a Qi-promoting and blood-nourishing group， which were treated with traditional Chinese medicine （TCM） combined with western medicine. The clinical effect and the changes in blood routine in each group during treatment were evaluated. ResultDuring the observation period， 375 cases of aplastic anemia were included in two groups， and TCM syndrome differentiation conformed these cases as Qi-deficiency type and both Qi and blood-deficiency type. These cases were randomly divided into two groups， including 184 in the kidney-tonifying and blood-generating group and 191 in the Qi-promoting and blood-nourishing group， being treated by kidney-tonifying and blood-generating granules and Qi-promoting and blood-nourishing granules， respectively， and combined oral androgen and ciclosporin soft capsules. The treatment lasted for six months and was divided into three stages. Visits were conducted from the beginning of the treatment to the end of the first， fourth， and sixth months. The curative effect was evaluated six months later. The total effective rate of the kidney-tonifying and blood-generating group was 86.4% （159/184）， which was significantly better than that of the Qi-promoting and blood-nourishing group ［68.6% （131/191）， P<0.01）］. The results of the percentage quartile of blood cell growth in each stage of the 2 groups were analyzed. The hemoglobin concentration and platelet count of the patients in the kidney-invigorating blood group continued to increase after treatment, and significantly increased in the second and third stages compared with the first stage (P<0.05). The increase of reticulocyte count was most significant in the first stage of treatment (P<0.05). The reticulocyte count in supplementing Qi and nourishing blood group increased significantly in the first and second stages of treatment (P<0.05). The other observation indicators increased at each stage, but there was no statistical difference in the growth rate. The effects of the two groups were compared by stages. In the second stage of treatment, the increase of hemoglobin concentration in the kidney-invigorating blood group was better than that in the supplementing Qi-nourishing blood group (P<0.05). The increase of platelet count and red blood cell count in supplementing Qi and nourishing blood group was greater (P<0.05). In the third stage of treatment, the increase of hemoglobin concentration in the bushen Shengxue group was more significant (P<0.05). ConclusionThe overall effective rate of the kidney-tonifying and blood-generating method in the treatment of aplastic anemia is better than that of the Qi-promoting and blood-nourishing method， with significant effects and safety. This study has proposed a three-stage early treatment mode for aplastic anemia. The first and third stages (0-1, 5-6 months) were mainly treated by invigorating kidney and generating blood. In the second stage of treatment (2-4 months), invigorating kidney and generating blood combined with invigorating Qi and nourishing blood were adopted. It may be closer to the actual clinical treatment response and objective rule changes of aplastic anemia.
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ObjectiveTo investigate the predictive indicators of early efficacy of Bushen Shengxue prescription combined with western medicine in the treatment of aplastic anemia， and provide prognosis indicators for the treatment of aplastic anemia （AA） with kidney-tonifying therapy in traditional Chinese medicine （TCM） combined with western medicine. MethodA total of 126 patients treated by Bushen Shengxue prescription combined with western medicine in 19 hospitals including Xiyuan Hospital of the China Academy of Chinese Medical Sciences from September 2018 to March 2021 were selected for a retrospective study. The therapy was proven to be effective after six months of treatment. According to the efficacy after 4 months of treatment， the patients were assigned into a 4-month effective group and a 4-month ineffective group. The age， sex， disease severity （including severe aplastic anemia and non-severe aplastic anemia）， course of disease， degree of bone marrow nucleated cell proliferation， baseline hemogram levels ［including white blood cell count （WBC）， absolute neutrophil count （ANC）， hemoglobin （HGB）， platelets （PLT）， and reticulocytes （RET）］， T lymphocytes subsets， and the expression levels of T-box transcription factor （T-bet） and GATA-binding protein-3 （GATA-3） were compared between the two groups before treatment. ResultThe proportions of patients within the age ranges of ［20， 40） and ［60， 80） were higher in the 4-month effective group （P<0.05）. The sex， disease severity， course of disease， and comorbidities had no significant differences between the two groups. The 4-month effective group had higher baseline levels of HGB， WBC， ANC， and PLT than the 4-month ineffective group （P<0.05）， and there was no significant difference in the RET level between the two groups before treatment. Binary Logistic regression analysis showed that the PLT level before treatment was an independent factor affecting the onset time， while other indicators did not affect the onset time. The receiver operating characteristic （ROC） curve was established to analyze the value of PLT level before treatment for predicting the onset time， and the area under the curve was 0.691. With the critical value of 40.5×109/L， the sensitivity and specificity of the prediction that the therapy will take effect within 4 months were 0.569 and 0.893， respectively. The two groups of patients were graded according to age ｛（14， 20）， ［20， 40）， ［40， 60）， and ［60， 80）｝ and PLT level before treatment （PLT<40×109/L， PLT≥40×109/L）. The proportion of the patients with PLT≥40×109/L before treatment in the 4-month effective group was significantly higher than that in the 4-month ineffective group （P<0.05）. The degree of bone marrow nucleated cell proliferation before treatment had no significant difference between the two groups. The level of total T lymphocytes in the 4-month effective patients was lower than that in the 4-month ineffective patients before treatment （P<0.05）. The levels of Th1 cells， Th2 cells， CD4+ T cells， and CD8+ T cells showed no significant differences between the two groups before treatment. The T-bet expression level in the 4-month effective group was higher than that in the 4-month ineffective group before treatment （P<0.05）， while the expression level of GATA-3 showed no significant difference between the two groups before treatment. ConclusionBushen Shengxue prescription combined with western medicine will achieve faster effect for the patients within the age ranges of ［20， 40） or ［40， 60）， with higher levels of HGB， WBC， ANC， and PLT （especially those with PLT≥40×109/L）， lower level of total T lymphocytes， or higher T-bet expression level before treatment.
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ObjectiveTo observe the clinical efficacy and safety of treating mediate-risk pure ground glass pulmonary nodules （pGGNs） based on the state theory. MethodsA prospective clinical randomized controlled trial was used. Totally 141 cases of mediate-risk pGGNs were divided into treatment group （92 cases） and control group （49 cases） according to the random table method. The treatment group was given the basic Sanjie Formula （基础散结方） orally with modification according to the identification of traditional Chinese medicine （TCM） state， 1 dose per day， 3 months as a course of treatment.Three months after the treatment patients were checked by CT. Patients who were clinically judged as cure， moderate to low risk， and turned to surgical resection do not carry out a second course of treatment，and the rest of the patients continued to complete the second courses. Patients in the control group did not receive any treatment and were only followed up periodically. Patients in both groups received a CT review 3 months and 6 months after enrolled. Comprehensive curative effect was evaluated according to the reduction rate of the area of pulmonary nodules shown in chest CT， to further explore the clinical effective difference for patients at different TCM state； the risk of malignancy index （Mayo score） was calculated by Mayo model at enrollment and 3 months and 6 months after enrolled. Adverse events were monitored continuously during the study. ResultsDuring the follow-up， 8 cases in the treatment group and 7 cases in the control group were lost. A total of 126 cases completed the whole process， including 84 cases in the treatment group and 42 cases in the control group. The total effective rates at 3 months and 6 months of the treatment group were 46.15% （30/65） and 45.71% （32/70） in the treatment group， while the total effective rates at 3 months and 6 months in the control group were 12.5% （4/32） and 10.00% （4/40）. Compared with the control group， the comprehensive curative effect of 3 months and 6 months of enrollment in treatment group was significantly better than that in corresponding control group （P＜0.01）. The pulmonary nodule area and Mayo score in the treatment group decreased after 3 and 6 months of enrollment （P＜0.01）. In contrast， there was no statistically significant difference in nodule area between pre- and post-enrollment time points in the control group （P＞0.05）， and probability of Mayo risk increased in the control group after 6 months of enrollment compared to pre-enrollment （P＜0.05）. Among the 84 patients in the treatment group， there were 15 cases of qi deficiency state， 7 cases of yin deficiency state， 5 cases of yang deficiency state， 20 cases of qi depression state， 32 cases of damp-heat state， and 5 cases of harmonious state； the difference in the distribution of the total clinical effective rate of the patients with different TCM states after treatment was statistically significant （P＜0.05）， and the total effective rate of two-by-two comparison of qi depression state was higher （13/20，65.00%） than that of the total effective rate of damp-heat state （8/32，25.00%， P＜0.00833）. There were no significant changes in blood routine， urine routine， liver function and kidney function in both groups， and no adverse events occurred. ConclusionTreating mediate-risk pGGNs based on the state theory can effectively reduce the area of pulmonary nodules and inhibit the growth of malignant risk of pulmonary nodules.
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Objective:To investigate the relationship between the expression patterns of SMG family members and aortic dissection by comparing the expression levels of SMGs in aortic wall of patients with Stanford type A aortic dissection(AD) and normal controls.Methods:The aortic wall samples were collected from 31 normal controls and 65 patients with Stanford type A aortic dissection. The mRNA levels of SMGs in the aortic wall were quantified by RT-PCR, and the correlations between SMGs and aortic diameters of patients with aortic dissection were analyzed.Results:The results of RT-PCR showed that compared with normal aortic wall, the mRNA levels of SMG3(0.642±0.529 vs. 1.126±0.858, P=0.023), SMG6(0.737±0.652 vs. 1.877±1.902, P=0.005), and SMG7(0.624±0.449 vs. 1.339±0.866, P=0.00067) were obviously increased in aortic wall of patients with aortic dissection, while comparable mRNA levels of SMG1, SMG2, SMG4, SMG5, SMG8 and SMG9 were detected between these two groups. In addition, there was no significant correlation between the expression levels of SMG3, SMG6, SMG7 and aortic diameters. Conclusion:The expression levels of SMG3, SMG6 and SMG7mRNA were significantly increased in patients with aortic dissection, suggesting that they may promote the occurrence of aortic dissection, and targeting SMG family members expected to a novel strategy for the prevention and treatment of aortic dissection.
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Objective:To explore anti-seizure medication (ASM) treatment patterns, seizures, maternal and fetal outcomes and offspring outcomes of pregnant women with epilepsy (PWWE) who withdraw ASM in the first trimester of pregnancy.Methods:A retrospective analysis was performed on the PWWE database registered in West China Hospital, Sichuan University from January 2009 to October 2022. Patients who withdrew ASM therapy in the first trimester and those who maintained ASM therapy throughout pregnancy were included. Withdrawal in the first trimester was defined as discontinuation of ASM between 0 and 3 months of pregnancy. Sixty-five PWWE (withdrawal group) who withdraw ASM in the first trimester were included, and 130 PWWE (maintained-therapy group) who took ASM throughout pregnancy in West China Hospital during the same period were matched 1∶2. Demographic characteristics, ASM, seizures, maternal and fetal outcomes within 1 year were compared between the 2 groups. In the subgroup analysis, the withdrawal group was divided into a full withdrawal group ( n=53) and a resumption group ( n=12) according to whether the ASM was resumed in the second and third trimesters of pregnancy, and the 2 groups were stratified and compared. Results:In the withdrawal group, the proportion of patients with bachelor degree below [72.3% (47/65) vs 54.6% (71/130), χ 2=5.68, P=0.017], family income less than 5 000 yuan per capita [44.6% (29/65) vs 18.5% (24/130), χ 2=14.98, P<0.001], a family history of epilepsy [12.3% (8/65) vs 3.1% (4/130), χ 2=4.90, P=0.027], and a second pregnancy [43.1% (28/65) vs 26.2% (34/130), χ 2=5.72, P=0.017] was higher than in the maintained-therapy group. The proportion of patients who received multiple ASM was lower in the withdrawal group than in the maintained-therapy group [16.9% (11/65) vs 38.5% (50/130), χ 2=9.35, P=0.002]. In the withdrawal group, the rate of seizures with tonic-clonic seizures during pregnancy [50.8% (33/65) vs 31.5% (41/130), χ 2=6.81, P=0.009] and seizure exacerbation during pregnancy [32.3% (21/65) vs 9.2% (12/130), χ 2=16.41, P<0.001] was higher. The preterm birth rate in the withdrawal group was lower than that in the maintained-therapy group [4.6% (3/65) vs 19.2% (25/130), χ 2=101.70, P<0.001]. The rate of seizure exacerbation during pregnancy was higher in the resumption group than in the full withdrawal group [7/12 vs 26.4% (14/53), χ 2=3.22, P=0.073]. Conclusions:PWWE with a family history of epilepsy and a second pregnancy were more likely to withdraw ASM during pregnancy. After withdrawal, the seizures during pregnancy were significantly worse, but the preterm birth rate of offspring was relatively reduced.
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Objective:To explore the association between the preoperative nocturnal blood pressure pattern and postoperative complications in elderly patients undergoing laparoscopic gastrointestinal surgery.Methods:A prospective observational cohort study was conducted in 131 elderly patients undergoing elective laparoscopic gastrointestinal surgery under general anesthesia between September 2018 and September 2021.All subjects underwent 24 h ambulatory blood pressure monitoring 1 day before surgery and, based on the nocturnal blood pressure pattern, patients were divided into two groups.Those with the nocturnal blood pressure reduction rate ≥0% entered the nocturnal blood pressure reduction group(Group D, n=80), and those with the reduction rate <0% entered the nocturnal blood pressure increase group(Group R, n=51). Differences in postoperative complication rates between the two groups were compared, and multivariate Logistic regression was used to analyze the influencing factors of postoperative complications.Results:(1)Compared with Group D, the prevalence of diabetes and left ventricular mass index were significantly increased and the mean nighttime SBP and DBP were significantly increased in Group R( P<0.05); (2)Compared with Group D, the incidence of acute kidney injury and acute heart failure in Group R was significantly higher( P<0.05), with the relative risk( RR)values at 2.941(95% CI: 1.344-6.435)and 3.660(95% CI: 0.991-13.512), respectively; (3)Multivariate Logistic regression analysis showed that elevated blood pressure at night was an independent risk factor for acute kidney injury after surgery( OR=3.700, 95% CI: 1.286-10.648, P=0.015); (4)Kaplan-Meier curves for acute kidney injury and acute heart failure showed that the cumulative incidence of events in Group R was significantly higher than that in Group D(Log rank test: P<0.05). Conclusions:For elderly patients undergoing selective laparoscopic gastrointestinal surgery, preoperative nocturnal blood pressure patterns were associated with postoperative complications.Elevated preoperative nocturnal blood pressure increases the incidence of postoperative acute kidney injury and heart failure, and elevated nocturnal blood pressure is an independent risk factor for acute kidney injury.
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Objective:To explore the value of fetal lung volume and mediastinal shift angle (MSA) based on fetal MRI in predicting the prognosis of congenital diaphragmatic hernia (CDH).Methods:Fetuses with left CDH that did fetal MRI in Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine from September 2016 to January 2022 were retrospectively collected. There were 65 patients, and their gestational age was 29 (26, 35) weeks when they were diagnosed with left CDH by MRI. Observed fetal lung volume and MSA were measured based on fetal MRI, and observed/expected lung volume (o/eFLV) based on gestational age was calculated. The clinical data were collected from birth to discharge, and patients were divided into survival group and death group in case of prognosis at discharge, with 54 cases in the survival group and 11 cases in the death group. The student′s t test was used to compare the difference of o/eFLV and MSA between the survival group and the death group, and the receiver operating characteristic (ROC) curve was used to evaluate the value of o/eFLV and MSA in predicting the prognosis of left CDH. Results:The o/eFLV of the survival group was 51.5%±18.3%, higher than that of the death group (27.8%±4.4%), and the difference was significant ( t=8.29, P<0.001). The MSA of the survival group was 33.1°±1.2°, lower than that of the death group (41.8°±2.7°), and the difference was significant ( t=-11.15, P<0.001). The area under the ROC curve (AUC) of o/eFLV to predict the fetal survival or death was 0.939 (95%CI 0.851-0.983), the cutoff value was 33.8%, the sensitivity was 100%, the specificity was 88.9%. The AUC of MSA was 0.998 (95%CI 0.941-1.000), the cutoff value was 37.2°, the sensitivity was 100%, the specificity was 98.2%. Conclusions:The o/eFLV and MSA that were measured based on fetal MRI can effectively predict the fetus′s prognosis with left CDH.
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Restricted and repetitive behaviors is the characteristic clinical manifestation of many neuropsychiatric diseases, which seriously affects the work, study and daily communication of patients, and brings huge mental and economic burden to the family and society.Its causes are complex and its manifestations are diverse.Current studies have shown that microglia is closely related to the occurrence of restricted and repetitive behaviors, and the in-depth study of microglia has become a research hotspot to explore the mechanism of restricted and repetitive behaviors.In recent years, studies have found that restricted and repetitive behaviors of various neuropsychiatric diseases (such as frontotemporal dementia, obsessive-compulsive disorder, autism spectrum disorder) are related to microglia.However, reliable evidence for the exact mechanism of microglia involved in restricted and repetitive behaviors remains lacking.This article reviews the recent research progress of microglia involved in restricted and repetitive behaviors.It is expected to provide a new theoretical basis and therapeutic targeting cell for the development and treatment of neuropsychiatric diseases related to restricted and repetitive behaviors in the future.
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Objective:To assess the association of appendicular skeletal muscle mass(ASM) to fat mass(FM) ratio in early pregnancy with the risk of gestational diabetes mellitus (GDM).Methods:A total of 468 pregnant women who visited the Nutritional Department of Peking Union Medical College Hospital or Shunyi Maternal and Child Care Service Center in 2018 and 2019 were recruited. Detailed information and clinical data were collected. The body components were measured using the bioelectrical impedance analysis (BIA) method during early pregnancy (< 14 weeks) and the ASM to FM ratio was calculated. The patients were divided into the GDM group and normal glucose tolerance (NGT) group according to the results of the oral glucose tolerance test (OGTT) performed during 24-28 weeks. Binary logistics regression was used to explore the correlation between the ASM/FM ratio and the risk of GDM. The receiver operator characteristic (ROC) curve of subjects was used to evaluate the predictive value of ASM/FM ratio for GDM and the cut-off value was reported.Results:Compared to the NGT group, the ASM and FM in early pregnancy in the GDM group were significantly higher, while the ASM/FM ratio was significantly lower. A lower ASM/FM ratio in early pregnancy was one of the risk factors of developing GDM. The cut-off value of the ASM/FM ratio was 0.809. The area under the ROC curve for predicting GDM increased from 68.1% to 72.3% when ASM/FM ratio was incorporated, with a significant difference by Delong test ( P = 0.006). Conclusion:Inadequate muscle mass would increase the risk of GDM and the ASM/FM ratio could serve as a predictor of GDM.
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Objective:To investigate the application effect of case-based learning (CBL) combined with flipped classroom in the teaching of experimental diagnostics in the integrated course of Diagnosis and Treatment Fundamentals. Methods:The cluster random sampling method was used to select the class of 2019 in the eight-year program and the class of 2020 in the five-year program, with the major of stomatology in Air Force Medical University. The 24 students in the observation group received CBL combined flipped classroom, and the 37 students in the control group received traditional teaching. The two groups were compared in terms of theoretical assessment score, classroom assessment score, comprehensive ability, self-learning ability, and degree of satisfaction with teaching. SPSS 22.0 was used for the t-test. Results:The observation group had a significantly higher theoretical assessment score than the control group [(74.88±3.46) vs. (71.89±4.45), P<0.05]. The observation group had significantly better scores of practical skill assessment than the control group ( P<0.05). Compared with the control group, the observation group had significantly better scores of comprehensive ability and self-learning ability ( P<0.05). The observation group had significantly better scores of satisfaction with teaching than the control group ( P<0.05). Conclusion:The application of CBL combined with flipped classroom in the teaching of experimental diagnostics in the integrated course of Diagnosis and Treatment Fundamentals can improve theoretical knowledge, practical skills, comprehensive quality, and satisfaction with teaching among students, and therefore, it holds promise for application in teaching.
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Practice teaching is an important link in the training of public health talents in colleges and universities. At present, there are still some problems in the education of public health and preventive medicine in the colleges and universities in China, such as attaching greater importance to theory than to practice and weak training of practical skills among students. In view of this situation, a public health practice teaching model of "internal-external interactions" has been constructed in Dalian Medical University with focuses on the following aspects: ①experiments in the university are optimized based on social needs; ②the practice base outside the university is expanded based on the teaching in the university; ③"internal-external interactions" are adopted to enhance practice training and improve post competence. The teaching practice shows that the implementation of the teaching model of "internal-external interactions" can help to improve practice teaching ability, promote the improvement in the training quality of public health talents, and meet the social demand for application-oriented professionals.
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Objective:To investigate the effect of rumination on learning burnout of nursing undergraduate students and the mediating role of psychological capital between rumination and learning burnout of nursing undergraduate students.Methods:A total of 296 undergraduate nursing students from three medical colleges were assessed by using ruminative responses scale, learning burnout questionnaire and psychological capital scale. SPSS 20.0 was used for t-test. Pearson correlation was to analyze the relationship among psychological capital, learning burnout and ruminative thinking. AMOS 20.0 was used to construct and analyze the mediating model of psychological capital and its mediating effect was tested by Bootstrap method. Results:The average score of rumination of nursing undergraduate students was 46.60±11.40, learning burnout score was 56.18±11.25, and psychological capital scale score was 99.93±15.27. There was a significant difference among the rumination, psychological capital, and learning burnout scores in whether there was curriculum failure ( P < 0.05). The total score of rumination was positively related to the total score of learning burnout ( r = 0.39, P < 0.01), and was negatively related to the total score of psychological capital ( r = -0.53, P < 0.01). The total score of rumination was negatively related to the total score of psychological capital ( r = -0.46, P < 0.01). The psychological capital played a partial mediating role between rumination and learning burnout. The mediating effect value was 0.216, accounting for 61.521% of the total variation. Conclusion:The rumination can both directly affect the learning burnout of nursing undergraduate students and indirectly affect the learning burnout through psychological capital. Psychological capital plays a bridge role in improving rumination related to learning burnout.
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Objective:Severe trauma events are emergent, with low incidence and unpredictable. Current guideline does not provide precise recommendations on how the trauma centers should arrange the number of beds in trauma intensive care units while making rational use of medical resources. We analyzed the trauma intensive care unit bed requirement in the branch campus of our hospital to propose a reasonable assessment.Methods:Patients with severe trauma sent to the Intensive Care Unit of Peking University People's Hospital from January 2022 to June 2022 were collected. The daily number of patients received intensive care was counted. The bed requirement of the intensive care unit covering 99% of clinical needs was calculated based on the probability distribution function.Results:From January 2022 to June 2022, 103 patients with severe trauma [74 males and 29 females, aged (51.47±16.06) years, ranging 16 to 87 years] were included in the study. Among the 103 patients, 57 were injured in traffic accidents, 26 fell from a high altitude, 12 fell, 4 were hit by heavy objects, and 4 were stabbed. TISS ranged from 16 to 50. The range of the daily bed requirement in the intensive care unit was 0–10, which was consistent with the Poisson distribution. According to the probability distribution function, nine trauma intensive care beds could meet 99.19% of clinical needs.Conclusions:In severe traumatic events, patients need to be transferred to intensive care unit as soon as possible. For our branch campus, nine trauma intensive care beds can cover more than 99% of clinical needs. It follows that, in accordance with the basic requirements of trauma center construction, hospitals with trauma centers need at least 9 beds in intensive care units. However, traumatic events cannot be predicted; thus, the bed requirement needs to be regularly evaluated.