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Type 2 diabetes mellitus (T2DM) therapy is facing the challenges of long-term medication and gradual destruction of pancreatic islet β-cells. Therefore, it is timely to develop oral prolonged action formulations to improve compliance, while restoring β-cells survival and function. Herein, we designed a simple nanoparticle with enhanced oral absorption and pancreas accumulation property, which combined apical sodium-dependent bile acid transporter-mediated intestinal uptake and lymphatic transportation. In this system, taurocholic acid (TCA) modified poly(lactic-co-glycolic acid) (PLGA) was employed to achieve pancreas location, hydroxychloroquine (HCQ) was loaded to execute therapeutic efficacy, and 1,2-dilauroyl-sn-glycero-3-phosphocholine (DLPC) was introduced as stabilizer together with synergist (PLGA-TCA/DLPC/HCQ). In vitro and in vivo results have proven that PLGA-TCA/DLPC/HCQ reversed the pancreatic islets damage and dysfunction, thus impeding hyperglycemia progression and restoring systemic glucose homeostasis via only once administration every day. In terms of mechanism PLGA-TCA/DLPC/HCQ ameliorated oxidative stress, remodeled the inflammatory pancreas microenvironment, and activated PI3K/AKT signaling pathway without obvious toxicity. This strategy not only provides an oral delivery platform for increasing absorption and pancreas targetability but also opens a new avenue for thorough T2DM treatment.
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Objective:To analyze the use and satisfaction of smart healthcare in public hospitals in Hangzhou from the perspective of patient experience.Methods:From August to September 2020, 501 patients from 2 class A tertiary hospitals and 5 community health centers in Hangzhou were randomly selected for questionnaire survey. The survey included their usage and satisfaction of smart healthcare. Based on SERVQUAL theory, the patient satisfaction scale included 5 dimensions of tangibility, reliability, reactivity, assurance, and empathy. The factors affecting patient satisfaction were analyzed by single factor and multi factor analysis.Results:The average score of patient satisfaction was 3.94±0.56. The satisfaction with tangibility(4.25±0.64), assurance(4.07±0.71)and reactivity(4.02±0.73)was higher, while the scoring of empathy(3.84±0.77)and reliability(3.52±0.70)were lower than the average score. The results of multiple linear regression analysis showed that patients′ educational level, occupational type and UTAUT score had a certain impact on satisfaction( P<0.05). Conclusions:The overall satisfaction of patients with smart healthcare in Hangzhou is high. In the future, we should pay more attention to big data security and personal privacy protection, upgrade the smart medical system, improve the hospital Internet platform, empower smart healthcare service system through digital technology, and promote the comprehensive digital transformation of health.
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Objective:To analyze the implementation of evidence-based nursing indicators for deep open wound pain management and its difficulties.Methods:From May to October 2018 at Department of Traumatology and Orthopaedics, Nanfang Hospital, 2 nurses were selected by objective sampling and 20 patients with deep open wound by convenient sampling. According to the 13 best practices in nursing guidelines for pain management, we formulated a no-pain dressing change program for deep open wounds on the basis of the research evidence in wound care and pain management. After the program was implemented, its effect on pain relief was evaluated. Practical Application of Clinical Evidence System (PACES) and software GRiP were used to evaluate the whole implementation process. IBM SPSS 21.0 was used to analyze the pain scores before and after implementation.Results:The results of PACES showed that the implementation rate of best practices by the 2 nurses increased significantly during the project period and remained at a reasonable level one month after the project. The patients＇ pain scores before dressing were 3.2±2.3 and 3.5±1.2 at the baseline evaluation and the follow-up evaluation 1, respectively; the pain scores during dressing at the base evaluation and the subsequent evaluation 1 were 5.4±2.3 and 4.2±2.4. The effect of implementation of evidence-based nursing indicators for deep open wound pain management on pain relief was significant ( P<0.05). Conclusions:This project improved the implementation rate of the best pain management practices in dressing change for deep open wounds, but the implementation encountered difficulties in interdisciplinary cooperation and organizational structure. This study may provide a reference for other evidence-based nursing projects aiming at transforming evidence-based nursing guidelines into clinical practice.
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Objective:To investigate the characteristics and management of the emergency patients with orthopaedic trauma during COVID-19 epidemic.Methods:A retrospective analysis was performed of the 32 emergency inpatients at Department of Orthopedics, Nanfang Hospital from January 20 to February 26, 2020. They were 23 males and 9 females, aged from 4 to 66 years (mean, 35 years). The causes for their injury included traffic accident in 14 cases, sharp cutting (e.g. by a kitchen knife) in 6 cases, heavy object crushing in one, machine crushing in one, fall in 2, and machine twisting in one. High energy injury occurred in 13 cases and low-energy injury in 9 cases. The injury involved the upper limb in 7 cases and the lower limb in 15 cases. Grade Ⅱ protection was adopted during the diagnosis and treatment for the one emergency patient who had not undergone nucleic acid screening for 2019-nCoV while grade Ⅰ protection for the other 21 patients. 2019-nCoV infection was recorded in the patients and medical staff as well. The measures and experience were reviewed in the management of orthopaedic emergencies during the COVID-19 epidemic.Results:During the diagnosis and treatment of 22 emergency patients with orthopaedic trauma, none of the medical staff or patients was infected with COVID-19. As the one emergency patient was treated as a suspected case and protected by grade Ⅱ measures, COVID-19 infection was ruled out after surgery.Conclusions:During the COVID-19 epidemic, front-line medical staff dealing with traumatic emergencies faced a higher risk of infection. The emergency orthopaedic traumas were mainly caused by a traffic accident or a machine, and those in the elderly patients by a sharp cutting or a fall. The incidence of COVID-19 infection could be reduced by COVID-19 screening before admission, appropriate anesthesia and surgical methods, protection of perioperative medical staff, postoperative wards care and psychological counseling.
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Objective To observe the effect of sevoflurane preconditioning on serum GDF-15,TNF-α, cTnI expression during perioperative period in patients in congenital heart diseases(CHD)with pulmonary artery hypertension(PAH),and to investigate the mechanism of myocardial protection. Methods Forty adult patients of CHD with PAH who received open-heart surgery under extracorporeal circulation were randomly divided into two groups(n=20):sevoflurane preconditioning group(Group S)and the control group(Group C). In the group S, 1MAC sevoflurane was inhaled for 20 min from beginning of operation ,and followed with oxygen elution for 10 min,in twice;only inhaling pure oxygen in the Group C. The artery blood samples were collected for measurements of serum GDF-15,TNF-α,cTnI immediately before anesthesia induction(T0),at 2 h(T1),12 h(T2),24 h (T3)after aorta declamping and 7 d(T4)after operation. The restoration of spontaneous heart beat ,reperfusion arrhythmia scores,preoperative and postoperative pulmonary artery systolic pressure were recorded. Results Com-pared with preoperative pumonary artery systolic pressure(PASP),it became low in the two groups at 7 days after operation(P<0.05);compared with the group C,the rate of restoration of spontaneous heart beat was promoted, and reperfusion arrhythmia scores were decreased in the group S(P<0.05);compared with the group C,GDF-15 were increased,TNF-α,cTnI were decreased in the group S at T1～3(P < 0.05);Compared with T0,GDF-15, TNF-α,cTnI were increased in the two groups at T1～3,GDF-15 in the two groups were decreased at T4(P <0.05). Conclusion Sevoflurane preconditioning may reduce inflammatory reaction during perioperative period in patients of CHD with PAH by promoting the expression of GDF-15,inhibiting the expression of TNF-α and then improve myocardial ischemia-reperfusion injury.
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Objective To observe the effect of sevoflurane preconditioning on serum GDF-15,TNF-α, cTnI expression during perioperative period in patients in congenital heart diseases(CHD)with pulmonary artery hypertension(PAH),and to investigate the mechanism of myocardial protection. Methods Forty adult patients of CHD with PAH who received open-heart surgery under extracorporeal circulation were randomly divided into two groups(n=20):sevoflurane preconditioning group(Group S)and the control group(Group C). In the group S, 1MAC sevoflurane was inhaled for 20 min from beginning of operation ,and followed with oxygen elution for 10 min,in twice;only inhaling pure oxygen in the Group C. The artery blood samples were collected for measurements of serum GDF-15,TNF-α,cTnI immediately before anesthesia induction(T0),at 2 h(T1),12 h(T2),24 h (T3)after aorta declamping and 7 d(T4)after operation. The restoration of spontaneous heart beat ,reperfusion arrhythmia scores,preoperative and postoperative pulmonary artery systolic pressure were recorded. Results Com-pared with preoperative pumonary artery systolic pressure(PASP),it became low in the two groups at 7 days after operation(P<0.05);compared with the group C,the rate of restoration of spontaneous heart beat was promoted, and reperfusion arrhythmia scores were decreased in the group S(P<0.05);compared with the group C,GDF-15 were increased,TNF-α,cTnI were decreased in the group S at T1～3(P < 0.05);Compared with T0,GDF-15, TNF-α,cTnI were increased in the two groups at T1～3,GDF-15 in the two groups were decreased at T4(P <0.05). Conclusion Sevoflurane preconditioning may reduce inflammatory reaction during perioperative period in patients of CHD with PAH by promoting the expression of GDF-15,inhibiting the expression of TNF-α and then improve myocardial ischemia-reperfusion injury.
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Objective Transesophageal Doppler monitoring ( TDM) has been widely applied to fluid therapy in some major op-erations but rarely used in aortic valve replacement.The purpose of this study was to assess the value of TDM in fluid therapy, vasoactive drugs use, and left ventricular function in patients undergoing aorta valve replacement after cardiopulmonary bypass. Methods This study included 40 patients undergoing aotic valve replacement after cardiopulmonary bypass in Anhui Provincial Hospital from March 2014 to June 2015, which were randomly assigned to a TDM and a control group of equal number.TDM was used for the guidance of fluid infu-sion and vasoactive drug administration for the patients in the former group, while central venous pressure, mean arterial pressure, and heart rate were employed for those in the latter.The fluid volume infused, urine volume, blood loss, hemodynamics, arterial blood lac-tate, and outcomes were compared between the two groups. Results Compared with the control, the TDM group showed significantly increases in the colloidal fluid volume ([303 ±60] vs [373 ±65]mL, P<0.05), crystal fluid volume ([533 ±87] vs [596 ±83]mL, P<0.05), and urine volume ([274 ±95] vs [338 ±84]mL, P<0.05), but remarkable decreases in the red blood cell count, blood plasma vol-ume, postoperative extubation time, doses of dopamine and dobu-tamine, and length of hospital stay (all P<0.05).The hemodynamics were more stable and arterial blood lactate was lower in the TDM group than in the control (P<0.05). Conclusio n Transesophageal Doppler monitoring can timely and exactly manifest the hemodynamic changes and left ventricular function of the patient undergoing aotic valve replacement and provide precise guidance for fluid therapy and vasoactive drug administration.
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Objective To investigate the efficiency and safety of agkistrodon hemocoagulase on coagulation function in pa?tients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB). Methods In this prospective,randomized controlled trial,80 eligible patients accepted valve replacement were assigned to control group (n=20) and agkistrodon hemoco?agulase groups (H1, H2, H3) according to the different timing of administration. Twenty patients were given treatment 20 minutes before anesthesia induction (H1 group), 20 patients were given treatment 20 minutes after CBP (H2 group) and 20 patients were given treatment after CBP (H3 group). Coagulation parameters including prothrombin time (PT), activated partial thromboplas?tin time (APTT), thrombin time (TT), fibrinogen (Fib) and platelet (PLT) were detected 20 minutes before surgery (T0), immedi?ately after surgery (T1) and 24 hours after surgery(T2). Data of 24-h postoperative drainage of mediastinal and pericardial, dura?tion of mechanical ventilation, stay time of intensive care unit (ICU), the actual days of hospitalization and hospital costs were recorded. The clinical parameters were also recorded including blood transfusion after surgery, secondary thoracotomy, aller?gies, liver and kidney dysfunction, deep vein thrombosis and neuropsychiatric symptoms. Results Compared with control group, values of PT, APTT and TT at T1 and T2 were significantly lower in H1, H2 and H3 groups (P<0.05). Compared with T0, values of PT, APTT and TT at T1 and T2 were significantly higher in all groups of patients (P<0.05). Values of PT and TT at T1 and T2 were significantly decreased in H3 group than those of H1 group (P<0.05). The pericardial and mediastinal drainage, the duration of ventilation support within 24-h after surgery were significantly lower in H1, H2 and H3 groups than those of control group (P<0.05). There was no significant difference in the incidence of adverse events between groups. Conclusion Agkis?trodon hemocoagulase is safe and effective in patients undergoing cardiac valve replacement with cardiopulmonary bypass.
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Objective To explore the effect of glial cells on cerebral neuron damage induced by amyloid beta protein (Aβ) in Alzheimer′s disease rat .Methods 20 male Wistar rats were randomly divided into the control group and the model group ,10 cases in each group The gel state Aβ(10μg) was injected into the rat′s bilateral hippocampus in the model group ,while the control group was injected with normal saline ;the Morris water maze test was performed to assess the rat′s learning and memory ability ;the thio‐nine stain was used for observing the morphology and quantity of cerebral cortex neurons ;the enzyme linked immunosorbent assay (ELISA) was adopted to detect the serum tumor necrosis factor alpha (TNF‐α) and interleukin 1 beta(IL‐1β) levels ;the immuno‐histochemical was used to detect the expression of glial cell and glial fibrillary acidic protein (GFAP) .Results The various indexes in the model group were significantly lower than those in the control group(P<0 .05);the quantity of cerebral cortex neurons in the model group was significantly decreased compared with that in the control group (P<0 .01);the ELISA results showed that the lev‐els of TNF‐αand IL‐1βin the model group were significantly higher than those in the control group(P<0 .05);the immunohisto‐chemistry showed that the number of GFAP positive cells in the hippocampus in the model group was significantly more than that in the control group(P<0 .05) .Conclusion Aβmight activate the glial cells and promote the release of inflammatory cytokines ,which causes the damage of rat cerebral neurons and leads to decrease the rat′s learning and memory ability .
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Objective To find out the distribution of the subunit of Gs proteins (GNAS1) T393C polymorphism genetic in congestive heart failure patients and to investigate the effects of genetic polymorphisms on the therapeutic efficacy of carvedlol. Methods Genotype of 65 patients with congestive heart failure (heart function was ranked Ⅱ~Ⅳ level by NYHA) underwent PCR-RFLP for GNAS1 polymorphism genetic analysis, and then were treated with carvedlol. The initial dosage of carvedlol was 12.5 mg once daily in patients , and increased by 6.25 mg every 1 ~ 2 weeks for 12 months to a maximum dosage within 50 mg/d. Degree of LVEF changes and heart function improvement was adopted as measuring index , effect of Gs proteins α subunit T393C genetic polymorphism on carvedlol response in congestive heart failure patients was analyzed. Results After carvedlol treatment for 12 months , NYHA class distribution and LVEF in congestive heart failure patients improved significantly (P < 0.05). After carvedlol treatment for 6 months and 12 months mutation symptoms patients′ heart function improved significantly (P < 0.05) and LVEF increased significantly (P < 0.01). Conclusions GNAS1 T393C genetic polymorphism can influence the therapeutic efficacy of carvedlol in chronic congestive heart failure patients. 393 homozygous mutant and mutated symptoms patients′ heart improved more obviously and their LVEF improved more significantly.
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Objective To investigate the effects of sevoflurane postconditioning on lung function in patients undergo-ing heart valve prosthesis implantation with cardiopulmonary bypass (CPB). Methods Thirty patients, scheduled for heart valve prosthesis implantation, were randomly divided into control group (C, n=15) and sevoflurane postconditioning group (S, n=15). Anesthesia was maintained by intermittent intravenous injection of midazolam, fentanyl and pipecuronium. In group S, 2%sevoflurane was inhaled continuously for 15 min , 2 min before aortic unclamping. Blood samples were taken at 30 min before CPB (T2), 30 min after CPB (T3), 6 h (T4), 12 h (T5) and 24 h (T6) after operation. The values of p(O2), SaO2, airway peak pressure (Ppeak) and airway plateau (Pplat) pressure during the time of mechanical ventilation were recorded. Oxygen index (OI), alveolar arterial oxygen tension difference (AaDO2), dynamic pulmonary compliance (Cdyn) and static pulmonary compli-ance (Cstat) were calculated. Results Compared with group C, the values of SaO2 and Cdyn were significantly higher in group S after 30 min of CPB. The values of OI, p(O2), Cdyn and Cstat were significantly higher in group S than those of group C after 6 h of operation. The value of AaDO2 was significantly lower 12 h and 24 h after operation than that of group C (P＜0.05). Conclusion CPB led to the lung injury. The sevoflurane postconditioning has a protective effect on lung function in pa-tients undergoing cardiac valve replacement with CPB.
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<p><b>OBJECTIVE</b>To analyze the diagnosis and treatment of autoimmune hemolytic anemia (AIHA) in liver transplant recipients.</p><p><b>METHODS</b>A retrospective analysis was conducted of 3 patients who developed AIHA following orthotopic liver transplantation. The results of hemolysis tests and examinations of hemoglobin, white blood cells, platelets, total bilirubin, and alanine aminotransferase before and after treatments were reviewed.</p><p><b>RESULTS</b>These 3 patients developed AIHA following the transplantation possibly in association with the use of immunosuppressive agents, and the condition was effectively controlled after corresponding treatments.</p><p><b>CONCLUSION</b>AIHA is a uncommon complication after liver transplantation and can be cured after a definitive diagnosis with corresponding treatments.</p>
Subject(s)
Aged , Humans , Male , Middle Aged , Anemia, Hemolytic, Autoimmune , Diagnosis , Therapeutics , Liver Transplantation , Retrospective StudiesABSTRACT
Improving the innovation quality of medical students is the key for cultivating the medical staff with international competition. The most important point for improving the innovation quality is to establish an educational model in favor of cultivation of medical students.Adjusting curriculum system,conforming experimental content and enhancing extracurricular research activity can make for the improvement of medical stndents' innovation and cultivation of scientific research quality.
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Secondary metabolites are produced during the growth and development of plants along with the adaptation of outer environment, as a rule they are the main active ingredients in medicinal plants and ensure the quality of crude drugs. Since biogenesis is quite complex, the production and accumulation of secondary metabolites are influenced by various biotic and abiotic factors either from gene or environments, the complexity may affect quality control of crude drugs and utilization of the active ingredients. The thought and approach adopted in systems biology is a powerful tool to explore biology fully, along with the development of modern molecular biology and information biology, omics integration like genomics, transcriptomics, proteomics, and metabolomics will bring new opportunities for the study of secondary metabolites of medicinal plant. It has great significance to apply this holistic and systematic method in researches on biosynthetic pathway, signal transduction, ecological environment and metabolic engineering of the formation of the secondary metabolites of medicinal plants, and in building secondary metabolite biosynthesis gene expression and regulation system model, in order to explain the origin of the active ingredients of medicinal plants, formation mechanism of the Chinese herbs, metabolic engineering effecting active ingredients of medicinal plants, and the rational exploitation and utilization of resources of medicinal plants systematically.