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Objective:To analyze the difference and reliability of blood 17-hydroxyprogesterone (17-OHP), an indirect screening index for congenital adrenal hyperplasia (CAH), between preterm and full-term infants.Methods:In this retrospective cross-sectional study, a total of 210 285 newborns who underwent CAH screening at the Neonatal Screening Center of Shanghai Children′s Hospital from January 2019 to December 2022 were collected, including 14 312 premature infants and 195 973 full-term infants.The concentration of 17-OHP in dried blood spots on filter paper was determined by an automatic fluorescence analyzer.The distribution of 17-OHP levels in preterm and full-term infants and its statistical index were analyzed.The Kolmogorov-Smirnov test was used for normal distribution.The skewed distribution data was converted into approximately normal distribution using Box-Cox.Outliers were eliminated by the interquartile range method.The cumulative frequency distribution map was drawn by R language programming.The 99.5 th percentile value was used as the screening threshold and compared with the reference value given by the manufacturer or laboratory and with the reference change value (RCV). Results:According to the threshold provided by the laboratory, 26.76‰ of premature infants were tested positive in preliminary screening, and 4 were confirmed with an incidence of 1∶3 578, while 0.79‰ of full-term infants were tested positive in preliminary screening, and 11 were confirmed with an incidence of 1∶17 816.The thresholds for CAH screening established indirectly were 20.35 nmol/L in preterm infants and 10.78 nmol/L in full-term infants.The relative deviations between the indirect CAH screening thresholds and the manufacturer′s or laboratory′s CAH screening thresholds were higher than the RCV, respectively.According to the indirect CAH screening thresholds, the negative and positive coincidence rates of 65 samples in 13 batches from the Centers for Disease Control and Prevention interlaboratory quality assessment program in the United States reached 100%.A retrospective analysis of 210 285 neonates showed that 17-OHP concentration was higher than the screening threshold in all CAH-positive neonates.The application of this screening threshold reduced the false positive rate of preterm infants by 59.79%.Conclusions:It is feasible to establish the CAH screening thresholds for premature and full-term infants by an indirect method, which can improve the efficiency of screening and provide better diagnostic basis for clinical practice.
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Objective:To observe the clinical efficacy of pressing-kneading manipulation combined with herb-insulated moxibustion at Shuidao(ST28)for postpartum urinary retention after labor analgesia and its effect on bladder urination function. Methods:A total of 154 patients with postpartum urinary retention after labor analgesia were randomly divided into a Western medication group and a herb-insulated moxibustion group,with 77 cases in each group.In the Western medication group,neostigmine sulfate was injected into Zusanli(ST36).In the herb-insulated moxibustion group,after pressing-kneading manipulation at Shuidao(ST28),herb-insulated moxibustion was applied to Shuidao(ST28)with self-made Tong Quan San.Both groups were treated once,and the clinical efficacy was evaluated 5 h after treatment.The first urination time,first urination volume,average urinary flow rate,bladder residual urine volume,hospitalization days,and costs were recorded. Results:The total effective rate and markedly effective rate of the herb-insulated moxibustion group were higher than those of the Western medication group(P<0.05),the time to the first urination and residual urine volume in the bladder of the herb-insulated moxibustion group were shorter or smaller than those of the Western medication group(P<0.01),the first urination volume and average urine flow rate of the herb-insulated moxibustion group were larger than those of the Western medication group(P<0.01).There were no significant differences in the hospitalization days and costs between the two groups(P>0.05). Conclusion:Pressing-kneading manipulation combined with herb-insulated moxibustion at Shuidao(ST28)can effectively treat postpartum urinary retention after labor analgesia and improve bladder urination function.
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Objective:To investigate the diagnostic value of fluorescence quantitative method and G6PD/6PGD ratio method in glucose-6-phosphate dehydrogenase (G6PD) deficiency and the type of gene mutation.Methods:A total of 1 201 patients (711 males and 490 females) with suspected G6PD deficiency in Shanghai Children′s Hospital were collected from June 2018 to March 2021. Fluorescence quantification method, G6PD/6PGD ratio method and multicolor melting curve were used to detects enzyme activity, ratio and gene mutation type. Comparison of each index and evaluation of its diagnostic efficiency were performed.Results:Among 1 201 suspicious samples, 163 cases (135 males and 28 females) were finally diagnosed. 156 cases were diagnosed by fluorescence quantitative method with a detection rate of 95.71%, and 140 cases were diagnosed by G6PD/6PGD ratio method with a detection rate of 85.89%. enzymatic activity of G6PD and ratio of G6PD/6PGD in male were significantly lower than female, and the differences were statistically significant ( U=642.5, 734.5, P<0.001). 112 cases received G6PD gene mutation detection and 92 cases were diagnosed, 74 were hemizygous mutations, 1 were homozygous mutations, 15 were heterozygous mutations, and 2 were compound heterozygous mutations. Among 15 cases of heterozygous mutations, 11 cases were diagnosed by fluorescence quantitative method, the diagnosed rate was 73.33%, 4 cases were diagnosed by G6PD/6PGD ratio method, and the diagnosed rate was 26.67%. A total of 7 mutation sites were detected and the proportions were c.1388G>A (32.22%), c.1376G>T (30.00%), c.871G>A (13.33%), c.1024C>T (11.11%). c.95A>G (7.78%), c.487G>A (4.44%), c.392G>T (1.11%). The enzymatic activities of c.1376G>T and c.1024C>T, c.487G>A were statistically significant ( P<0.001,0.015); the G6PD/6PGD ratios of c.1024C>T and c.1388G>A, c.1376G>T were statistically significant ( P=0.017,0.002,0.011,0.013). Fluorescence quantitative method had sensitivity of 100%, specificity of 95.65%, and the area under the curve (AUC) is 0.972. The sensitivity of the G6PD/6PGD ratio method was 100%, the specificity was 94.57%, and the AUC was 0.979. The sensitivity of fluorescence quantitative method combined with G6PD/6PGD ratio was 96.7%, the specificity was 100%, and the AUC was 0.992. Conclusions:Compared with fluorescence quantification, the G6PD/6PGD ratio method might not be able to diagnose female heterozygotes effectively; The panel of G6PD fluorescence quantification and G6PD/6PGD ratio was helpful to reduce the missed diagnosis. Combined with gene mutation analysis, it could improve the diagnosis rate of G6PD deficiency in the children.
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Objective To analyze the risk factors and pathogen drug resistance of senile stroke-associated pneumonia (SAP), and to provide references for early clinical intervention. Methods A total of 859 elderly patients with cerebral stroke admitted to our hospital from June 2018 to June 2020 were selected and divided into the study group (SAP, n=375) and the control group (no SAP, n=484) according to the occurrence of stroke associated pneumonia. Clinical data of age, gender, and other complications of the two groups were analyzed. The sputum culture and drug sensitivity test of senile SAP patients were analyzed. Results A total of 313 pathogens were detected in 375 SAP patients, including 211 strains of gram-negative bacteria (67.41%), mainly consisting of 92 Acinetobacter baumannii (29.39%), 54 Pseudomonas aeruginosa (17.25%), and 42 Klebsiella pneumoniae (13.42%), and 73 strains (23.32%) of gram-positive bacteria, mainly 62 strains of Staphylococcus aureus (19.81%). In addition, there were 29 strains of fungi (9.27%). Pseudomonas aeruginosa was highly sensitive to piperacillin/tazobactam and ceftazidime. Acinetobacter baumannii and Klebsiella pneumoniae were highly sensitive to imipenem, meropenem, and cefoperazone sodium and sulbactam sodium. Staphylococcus aureus and Enterococcus were highly sensitive to teicolanin, linezolid and vancomycin. The proportion of patients aged ≥80 years old, mechanical ventilation, bed rest and use of prophylactic antibiotics in the experimental group was significantly higher than that in the control group (P<0.05). Logistic regression analysis showed that age ≥80 years, mechanical ventilation, hypoproteinemia and use of prophylactic antibiotics were independent risk factors for SAP (P<0.05). Conclusion The main pathogens of stroke-associated pneumonia in the elderly are Pseudomonas aeruginosa, Staphylococcus aureus and Acinetobacter baumannii. It is necessary to rationally choose antibiotics according to the results of drug sensitivity. The risk factors are patients' age ≥ 80 years old, mechanical ventilation, and bed rest. Clinicians should attach great importance to the prevention of stroke-related pneumonia in the elderly.
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Objective To investigate the clinical diagnostic value of circulating tumor cells (CTCs)and circulating cell-free DNA (cfDNA) in peripheral blood samples in breast cancer. Methods From July 2017 to April 2018, 47 patients with BMC (7 in stage Ⅱ, 19 in stage Ⅲ and 21 in stage Ⅳ), 24 patients with benign breast diseases and 28 healthy people were selected. After collecting peripheral blood samples, serum and blood cells were separated. The size-based high-throughput microfluidic chip was used to capture CTCs. The real-time fluorescent quantitative PCR based on Alu sequence was used to detect the length of cfDNA(247 bp, 115 bp)in the serum, and the ratio of amplified products of long and short fragments was used as the index of DNA integrity. The Mann-Whitney U test or Kruskal-Wallis H test was used to compare the differences between the groups and analyze the relationship between CTCs and cfDNA and clinical parameters of breast cancer. The ROC curve was drawn and the area under the curve (AUC) was used to evaluate the feasibility of blood cell CTCs and plasma cfDNA detection as diagnostic criteria. Results The CTCs and cfDNA of 47 BMC patients were analyzed. The CTCs and cfDNA integrity index (Alu 247/115) of BMC patients were significantly higher than those of physical examination patients[(13.98± 12.36)cells / ml vs (1.14 ± 1.35) cells / ml; 0.7687 ± 0.3868 vs 0.5094 ± 0.2456], and the difference was statistically significant(the U value was 126.5,359.0;P<0.001), the area under ROC curve of CTCs was 0.885 (95％CI: 0.805-0.965), cut-off value was 7.68/ml, sensitivity was 80.4％, specificity was 96.4％. The area under ROC curve of Alu 247/115 was 0.727(95％CI: 0.608-0.847), cut-off value was 0.431, sensitivity was 71.7％, specificity was 71.4％. The AUC of CTCs and Alu 247/115 was 0.919 (95％CI 0.854-0.984), which was higher than the single test of each indicator. Conclusions CTCs and cfDNA may be the potential biological indicators for breast cancer diagnosis. The combined detection of CTCs and cfDNA maybe improve the diagnosis rate of breast cancer patients.
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Objective: to observe the effects of Huanglian ointment promote wound healing and angiogenesis by the AKT/VEGF/eNos pathway in full-thickness skin defect mice. Methods: 7.5 mm diameter full-thickness skin excision modelwas made in the back of the 45 male C57 BL/6 J mice respectively. That were subsequently randomly placed into 3 groupswith Random number table method; i.e., vehicle, Huanglian ointment groups and the control group. In the Huanglianointment group, topical Huanglian ointment was applied to the wound, in the vehicle group were treated with vehicleointment, and in the control group were treated with nothing. Changes in the size of their wounds was monitored by takingpictures with a digital camera on days 0, 3, 7, 10, and 14 after wound creation. The mice were sacrificed on the 3, 7, and14 days after wound creation, and the tissue samples of the wounds were obtained for m RNA level of b FGF and PDGF、CD-31 cells and expression of AKT、VEGF-A、eNos were measured too. Results: Comparison of the sizes of the woundsamong the groups showed that there was no significant difference on the 0, 3 and 7 days, the most significant decreaseswere found in experimental Huanglian ointment group on the day10 (Huanglian ointment versus vehicle: (76±7) ％ VS (48±9) ％, huanglian ointment versus control: (76±7) ％ VS (46±7) ％, P＜0.01), and day14: (Huanglian ointment versus vehicle: (93±5) ％ VS (68 ±11) ％, huanglian ointment versus control: (93 ±5) ％ VS (64±9) ％, P＜0.01) . The percentage of CD-31 cells on the Huanglian ointment group were significantly higher than that of the vehicle and control groups on the 3、7 days, (Huanglian ointment versus vehicle: day3: (16.3±3.2) ％ VS (12.5±4.6) ％, P＜0.05;day7: (33.6±5.0) ％ VS (19.2±4.0) ％, P＜0.01; (Huanglian ointment versus control: day3: (16.3±3.2) ％ VS (8.4±2.4) ％, P＜0.05;day7: (33.6±5.0) ％ VS (17.8±6.0) ％, P＜ 0.01. The m RAN of b FGF on the Huanglian ointment group were significantly higher than the vehicleand control groups on the 3 and 7 days, (day3: Huanglian ointment versus vehicle: (1.75±0.22) VS (0.96±0.13), day7: (2.98±0.35) VS (1.53±0.24), P＜0.01) ); (day3: Huanglian ointment versus control (1.75±0.22) VS (0.78±0.24), and day7: (2.98 ± 0.35) VS (1.64 ± 0.31), P＜0.01) . But on 14 day, the vehicle and control groups were significantly higher thanHuanglian ointment group, Huanglian ointment versus vehicle (1.43±0.42) VS (1.88±0.38), Huanglian ointment versuscontrol (1.43±0.42) VS (2.03±0.21), P＜ 0.05. The m RAN of PDGF on the Huanglian ointment group were significantlyhigher than the vehicle and control groups on the 3、7 days, (day3: Huanglian ointment versus vehicle (1.04±0.28) VS (0.56±0.15), Huanglian ointment versus control (1.04±0.28) VS (0.67±0.20) (P＜0.01); day7: Huanglian ointment versusvehicle (1.82±0.25) VS (1.38±0.21), Huanglian ointment versus control (1.82±0.25) VS (1.45±0.26) (P＜0.05) . On the 7 day, the protein of P-AKTS308 and P-AKTS437 in wound tissue on the Huanglian ointment group were significantlyhigher than the vehicle and control groups, (P-AKTS308: Huanglian ointment versus vehicle: (0.45±0.04) VS (0.23±0.06), Huanglian ointment versus control: (0.45 ± 0.04) VS (0.19 ± 0.08), (P＜0.05); (P-AKTS437: Huanglian ointmentversus vehicle: (0.27±0.03) VS (0.16±0.04); Huanglian ointment versus control: (0.27±0.03) VS (0.20±0.05), (P＜0.01) .the protein of VEGF-A and e NOS on the Huanglian ointment group were significantly higher than the vehicle and controlgroups too, Huanglian ointment versus vehicle: (VEGF-A: (0.18±0.02) VS (0.26±0.04), P＜0.01, e NOS: (0.12±0.05) VS (0.14±0.07, P＜0.01) ); Huanglian ointment versus control: (VEGF-A: (0.18±0.02) VS (0.13±0.06), P＜0.01, e NOS: (0.12±0.05) VS ((0.17±0.03), (P＜0.01) ) . Conclusions: Huanglian ointment promotes wound healing and enhance b FGF, PDGFand VEGF-A content by increasing the angiogenesis with the AKT/VEGF/eNos pathway.
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Objective To explore nurses' bonus assessment and distribution methods based on the information technology platform and to improve the efficiency of nursing management. Methods We build a hospital informa-tion platform in order to collect nursing work efficiency data by using existing computer information network. We distributed the bonus through the information platform according to evaluate nursing quality and performance effi-ciency. Results After the information flatform used for 2 years,the satisfaction of nurses with different professional titles and different experience showed no significant difference (P>0.05). The time of department management person-nel collecting and distributing data change from [103.75 (180.00,215.00)] min per month to [42.50 (60.00,90.00)] min per month.The difference showed statistical significance(P<0.05). Conclusion The technology platform can im-prove the satisfaction and the nursing management efficiency.
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BACKGROUND:Shengjiyuhong ointment has been reported to inhibit hypertrophic scarring. OBJECTIVE:To verify the effects of Shengjiyuhong ointment on hypertrophic scarring of in a rabbit ear model. METHODS:Each ear of thirty-six Japanese rabbits was used to make four 1-cm-diameter circular ful-thickness skin wounds with the entire perichondrium removed. Final y, 288 wounds were made and randomly divided into 6 groups:model, negative control (no drugs were administered), low-, moderate-, high-crude herbal dose drugs (Shengjiyuhong ointment was administered topical y at concentrations of 8.39%, 25.18%, and 75.54%), and positive control (recombinant bovine basic fibroblast growth factor was administered topical y). Shengjiyuhong ointment was administered twice daily til wound healing. The wounds were evaluated by the Vancouver scar scale (VSS). Scar elevation index (SEI) of scar specimens was calculated under a microscope at 40× magnification. mRNA expression levels of type I and III col agen, connective tissue growth factor, fibronectin, andα-smooth muscle actin (α-SMA) were determined by fluorescent quantitative PCR. Protein expression levels of type I and III col agen andα-SMA were detected by western blot assay.α-SMA immunoreactivity was determined by immunofluorescent staining. RESULTS AND CONCLUSION:VSS scores and SEI were significantly increased in each group at 30 days (P<0.05). VSS scores and SEI were significantly decreased in the moderate-and high-crude herbal dose drug groups and positive control groups compared with the model, negative control, and low-crude herbal dose drug groups (P<0.05 or P<0.01). mRNA expression levels of type I and III col agen, connective tissue growth factor and fibronectin, and protein expression levels of type I and III col agen andα-SMA were significantly inhibited after moderate-crude herbal dose Shengjiyuhong ointment and positive drug treatment (P<0.01). These findings suggest that Shengjiyuhong ointment can reduce hypertrophic scars by inhibiting fibroblast proliferation and col agen deposition.
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ObjectiveTo explore the effect of salmeterol/fluticasone inhalation in treatment of children with asthma.Methods120 children asthma were divided into two groups at random.Each group had 60 patients.The control group used common therapy,while the observation group received inhalation of seretided.Check the pefr of children with Mini peak flow meter.The PEFR and clinical effect after 3 months were observedin two groups.ResultsThe diverse of PEFR of two groups before surgery had no significant difference(P ＞0.05).The PEFR of observation group was higher than control group in 1,2 months after surgery (t =4.92,5.02,5.38,P ＜ 0.05).The total effective rate of observation group was obviously higher than control group (90.9％ vs 62.1％,x2 =6.83,P ＜0.05).ConclusionSalmterol/fluticasone inhalation in the treatment of children with asthma had obvious clinical effect and could relieve the symptom quickly,which was worth using widely.
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Objective To observe the expression of nuclear factor-kappa B(NF-κ3)and monocyte chemnattractant protein-1(MCP-1),and the infiltration of mononuclear macrophage CD68 in lupus nephritis (LN).The association between NF-κB,MCP-1 and MΦ with kidney pathology and clinical manifestations is explored.MethodsNF-κB,MCP-1 and MΦ in renal biopsy specimens from 49 cases of LN were detected using immunohistochemical techeniques.Forty-nine cases of renal tissues were examined for NF-κB by in situ hybridization.The relationship between NF-κB,MCP-1 and MΦ with kidney pathology and clinical manifestations were analyzed.Results ①Compared with the control group ,the expression of NF-κB,MCP-1 and MΦ in LN was significantly higher(P＜0.01).The expression of MCP-1 positively correlated with MΦinfiltration and NF-κB(P＜0.01)in glomeruli and renal tubule and renal interstitium of LN.The expression of NF-κB,MCP-1 and the infiltration of MΦ in LN Ⅳ was significandy higher than non LN Ⅳ and the control group(P＜0.01,P＜0.05).There was no significant difference between renal NF-κB positive group and negative groups in the degree of the immunohistochemical and in situ hybridization examination(P＞0.05).②The histological activity index,urine protein volume(24 h)and serum creatinine in LN were significantly higher than the control group(P＜0.01),and the expression of NF-κB in LN was correlated with histological activity index,urine protein volume(24 h)and serum creatinine(P＜0.01,P＜0.01,P＜0.05).MCP-1 and CD68 expression in LN were correlated with histological activity index and urine protein volume(24 h),but not correlated with serum creatinine(P＞0.05).Conclusion NF-κB induced MΦ by activating MCP-1 may be one cause of kidney injury of LN.NF-κB signal pathway may act as a new therapeutic target for MΦinfiltration and proliferation inhibition in kidney.
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Objective To evaluate the effect of pelvic floor muscle training in postpartum urinary incontinence. Methods A total of 355 postpartum women 6 weeks after delivery were randomly allocated to training group ( 182 cases) and control group ( 173 cases). The training group attended in one to one pelvic floor muscle training conduction. The control group received the customary information. The two groups finished the questionaire 6 months after delivery to understand the general state of health, duration of pregnancy, urinary tract symptom and urinary incontinence 6 weeks,6 months after delivery. Results Ten cases failed, 4 cases lost in the training group and 6 cases lost in the control group. Significantly fewer women in the training group were reported stress urinary incontinence compared with the control group 6 months after delivery [11.3%(19/168) vs. 21.0%(35/167)](P＜0.01). Significantly fewer frequency of nocturia in the training group was reported compared with the control group 6 months after delivery [(1.3 ± 0.3) times vs.(2.2 ± 0.4) times ] (P ＜ 0.01 ). Conclusion Pelvic floor muscle training plays a positive role in postpartum urinary incontinence.