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Objective:To investigate the relationship between renin-angiotensin system (RAS) and bone mineral density in children with glucocorticoids-induced osteoporosis (GIOP) .Methods:From Apr. 2020 to May. 2021, 53 children with GIOP were recruited in the Children’s Hospital of Taiyuan Maternal and Child Health Hospital and included in the observation group, and 47 children who received glucocorticoid therapy but did not suffer from GIOP were included in the control group. The levels of serum RAS components and bone mineral density of the two groups of pediatric patients were detected and compared, and the risk clinical indicators affecting bone mineral density and GIOP were analyzed.Results:There were no significant differences between the observation group and the control group in terms of gender, age, BMI, disease type, type of glucocorticoid use, use of anti-osteoporosis (OP) drugs, expression levels of Angiotensin converting enzyme 2 (ACE2) or angiotensin II (Ang Ⅱ) (all P>0.05) . The bone density value of the observation group was lower than those of the control group, and the levels of angiotensin converting enzyme (ACE) (1.19±0.23) , angiotensin receptor 1 (AT1R) (1.24±0.24) , angiotensin receptor 2 (AT2R) (1.14±0.17) , and Mas receptor (MasR) (1.11±0.28) were significantly higher than those of the control group (1.00±0.23, 1.00±0.25, 1.00±0.21, 1.00±0.20) , and the differences were statistically significant (all P<0.05) . Pearson analysis showed that bone mineral density was negatively correlated with the levels of ACE ( r=-0.34, P=0.013) , AT1R ( r=-0.41, P=0.002) and AT2R ( r=-0.34, P=0.014) , and stepwise regression model showed that ACE ( t=-2.21, P=0.032) and AT1R ( t=-2.92, P=0.005) were the main factors affecting bone mineral density. Logistic regression model analysis showed that bone mineral density ( OR=0.85, P<0.001) , Ang Ⅱ ( OR=0.53, P=0.041) and AT2R ( OR=2.00, P=0.024) were independent clinical risk factors affecting GIOP (all P<0.05) . Conclusion:RAS components ACE and AT1R are independent risk factors affecting bone mineral density in children with GIOP, and are significantly correlated with bone mineral density in children.
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Objective:To investigate the effects of different lymph node dissection methods in radical resection of intrahepatic cholangiocarcinoma (ICC) on the number of harvested lymph nodes and prognosis of patients.Methods:The retrospective cohort study was conducted. The clinicopathological data of 57 patients with ICC who underwent radical resection in the Second Affiliated Hospital of Nanchang University from January 2011 to January 2016 were collected. There were 25 males and 32 females, aged from 45 to 72 years, with an average age of 59 years. Of the 57 patients, 36 undergoing en bloc fusion lymph node dissection and 21 undergoing conventional lymph node dissection were allocated into observation group and control group, respectively. Observation indicators: (1) intraoperative situations; (2) results of postoperative pathological examination; (3) postoperative complications; (4) follow-up. Follow-up using outpatient examination or telephone interview was performed once every six months after hospital discharge to detect survival of patients up to January 2019. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was done using the t test. Measurement data with skewed distribution were described as M (range), and comparison between groups was analyzed by the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact propability. Comparison of ordinal data between groups was analyzed using the Mann-Whitney U test. The survival curve and rate were drawn and calculated using the Kaplan-Meier method, and survival of patients was analyzed by the Log-rank test. Results:(1) Intraoperative situations: operation time, volume of intraoperative blood loss, hepatic portal occlusion time, cases with <3 segments of hepatectomy and ≥3 segments of hepatectomy for the observation group were (218±53)minutes, (266±24)mL, (21±9)minutes, 5, 31, respectively, versus (207±45)minutes, (270±23)mL, (19±8)minutes, 2, 19 for the control group, showing no significant difference in the above indicators between the two groups ( t=-0.530, 0.774, 0.590, χ2=0.004, P>0.05). (2) Results of postoperative pathological examination: the number of harvested lymph nodes and percentage of positive lymph nodes of the observation group were 11±3 and 16.58%(66/398), respectively, versus 5±2 and 6.80%(7/103) of the control group, showing significant differences in the above indicators between the two groups ( t=-9.454, 2.148, P<0.05). (3) Postoperative complications: cases with Clavien-Dindo grade Ⅰ-Ⅱ complications or Clavien-Dindo grade Ⅲ-Ⅳ complications, cases with bile leakage, cases with postoperative hemorrhage, cases with incision infection, cases with gastroparesis were respectively 35, 1, 6, 1, 8, 0 in the observation group and 19, 2, 3, 1, 1, 2 in the control group. There was no significant difference in the cases with complications of Clavien-Dindo classification, cases with bile leakage, cases with incision infection between the two groups ( χ2=0.236, 0.000, 1.870, P>0.05) and no significant difference in the cases with postoperative hemorrhage, cases with gastroparesis between the two groups ( P>0.05). (4) Follow-up: 57 patients were followed up for 5-42 months, with a median time of 36 months. The survival time and postoperative 3-year survival rate were respectively 36 months (range, 8-42 months) and 66.7% of the observation group, versus 23 months (range, 5-39 months) and 38.1% of the control group, showing significant differences in the above indicators between the two groups ( Z=-2.253, χ2=5.317, P<0.05). Conclusion:For radical resection of ICC, the en bloc fusion lymph node dissection is beneficial to increase the number of harvested lymph nodes and improve survival rate of patients.
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Objective:To analyze the correlation between nutritional status and acute toxicity induced by concurrent chemoradiotherapy in patients with rectal cancer.Methods:A total of 115 patients with rectal cancer who underwent concurrent chemoradiotherapy in Zhejiang Cancer Hospital from March 2018 to August 2019 were prospectively selected. Nutritional risk was assessed by NRS 2002 and PG-SGA nutritional screening tools before, during and after radiotherapy. The acute toxicity was assessed by RTOG and CTCAE 3.0 scoring criteria. The correlation between nutritional status and the acute toxicity of chemoradiotherapy was analyzed by Spearman′ s correlation analysis. Results:The nutritional risk of the cohort was gradually increased from the beginning of chemoradiotherapy to the fourth week of chemoradiotherapy, and then decreased gradually. Spearman′ s correlation analysis showed that NRS 2002 and PG-SGA scores were positively correlated with acute hematological toxicity ( r=0.26, P<0.05; r=0.31, P<0.01), upper gastrointestinal toxicity ( r=0.51, P<0.01; r=0.63, P<0.01), proctitis ( r=0.23, P<0.05; r=0.45, P<0.01) and fatigue ( r=0.47, P<0.01; r=0.64, P<0.01) in patients with rectal cancer undergoing chemoradiotherapy. The correlation coefficients between PG-SGA and various toxicities were higher than those of NRS 2002. Stratified analysis showed that patients with stage Ⅱ-Ⅲ B, age<65 years and postoperative adjuvant chemoradiotherapy, nutritional status was significantly associated with the severity of toxicity (all P<0.05). Conclusions:Patients with rectal cancer has a high risk of malnutrition during concurrent chemoradiotherapy. The higher the risk of malnutrition, the greater the acute toxicity of chemoradiotherapy. Therefore, dynamic nutrition assessment and nutritional support should be strengthened for rectal cancer patients during chemoradiotherapy.
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Objective To establish an extended nursing service model for intravenous treatment in outpatient,so that patients with venous catheters nearby can receive catheter maintenance,which can reduce the medical cost and the incidence of complications during the maintenance of the catheters.Methods A three-level network of catheter maintenance was established in the area to evaluate the rate of return maintenance and the incidence of complications [catheter-related infection,medical adhesive-related skin injuries (MARSI) and catheter blockage] during catheterization.Results The rate of patient return maintenance as statistically signif-icant between the first half of 2015 and the second half of 2016 (60.0％ vs.29.7％,P=0.000).Compared with the first half of 2015,the incidence of catheter-related infections decreased in the second half of 2016 from 8.6％ to 3.3％,the incidence of MARSI decreased from 29.7％ to 10.1％,and the incidence of catheter blockage decreased from 8.5％ to 0.6％.(All P =0.000).Conclusion The comprehensive extended service mode for outpatient with venous catheters can reduce the incidence of complications during catheter maintenance,which can reduce the workload of outpatient intravenous treatment and also provide patients the convenience of catheter maintenance,and is worthy of clinical promotion.
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Objective To investigate default mode networks (DMN) in healthy rhesus monkey brain.Methods Under anesthesia,two healthy rhesus macaques underwent resting state fMRI at a 7.0T MR scanner.The functional images were firstly normalized to the standard rhesus monkey template 112SM-RL-T1,and the GIFT software was aplied to conduct group-level independent component analysis on all preprocessed functional images.Results The functional connectivity maps of the resting-state networks of rhesus macaques were obtained using this method.DMN bilaterally included posterior cingulate cortex,anterior cingulate cortex,medial parietal cortex,retrosplenial cortex,arcuate sulcus,ventral intraparietal area,temporoparietal area,superior temporal sulcus dorsal bank and a portion of visual cortex.Conclusion With the help of cutting-edge 7.0T fMRI technology,It was demonstrated that DMN of rhesus macaque brain highly resembled the ones in human,which could support the notion that non-primates are useful models for neuropharmacological and neurocognitive studies.
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Objective: To observe the clinical effect of umbilical paste and salt-separated moxibustion on the adverse reactions of digestive tract in the patients with non-hodgkin's lymphoma(NHL). Methods: Totally 60 patients with NHL were divided into two groups according to the order of admission. The control group was treated with the conventional nursing, and the observation group was treated with umbilical paste and salt-separated moxibustion. The preventive effect on constipation, nausea, vomiting and loss of appe-tite were compared between the groups. Results: The incidence of constipation, nausea, vomiting and anorexia on the 3nd and 5th day after the chemotherapy was significantly lower than that in the control group(P<0. 05). Conclusion: The preventive effects of umbili-cal paste combined with umbilical and salt-separated moxibustion on the gastrointestinal adverse reactions after chemotherapy for non-Hodgkin's lymphoma are better than those of the routine nursing, and the method is simple and easy to implement and popularize.
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Objective To explore the value of using the characteristic P wave of the intracavitary electrocardiogram (ECG) in positioning the tips of the peripherally inserted central catheters (PICC).Methods Totally 201 patients with PICC from December 1,2015 to February 29,2016 were enrolled in this study.The characteristic P wave of the intracavitary ECG was applied to locate the PICC tips.The pre-determined depth of catheter insertion (Y),highest P wave (L),and actual insertion depth (Z) were recorded.Chest radiography was performed after a successful insertion of PICC.The optimal depth (H) was recorded.Then we observed the sensitivity of P wave in positioning PICC tips,the operative time of positioning PICC tip with intracavitary ECG,and the difference in the predicted depth and the actual depth of PICC insertion.Results The sensitivity of the intracavitary ECG in positioning PICC tips was 100％.The operation time of the intracavitary ECG in guiding PICC tip was significantly shorter than the that of ultrasonic diagnosis of ectopic PICC [(3.4 ± 2.4) min vs.(5.6 ± 3.4) min] (P =0.006 9).The actual depth of ECG-guided positioning was significantly more accurate than the predicted depth [(0.4 ± 0.1) cm vs.(3.9 ± 0.8) cm] (P =0.007 2).L minused Z averaged (4.3 ± 1.6) cm.Conclusion Positioning PICC tips with ECG is simple,accurate,and easy to learn,and it is worth to be widely used in clinical settings.
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Objective To evaluate the safety and effect of one-way barbs line (absorbable sutures v - locTM180) in primary suturing of laparoscopic choledocholithotomy. Methods From July 2014 to June 2015, clinical data of 86 cases performed primary suturing in laparoscopic choledocholithotomy by the same performer were retrospectively analyzed. The patients were divided into three groups, One-way barbs line continuous full-thickness suture group (A group), ordinary absorption line continuous full-thickness suture group (B group) and ordinary absorption line discontinuous full-thickness suture group (C group). The bile duct suture needed time, intraoperative blood loss, postoperative eating time, postoperative hospital stay and postoperative bile fistula were compared. Results All the 86 cases underwent successful operation without T tube, and none of them received alternative open operation. Compared with group B and C, time needed for bile duct suturing in A group have statistical significance. There was no significant difference in the intraoperative blood loss, postoperative eating time, postoperative hospital stay between the three groups (P > 0.05). The incidence of postoperative bile fistula in A group were none. The incidence of postoperative bile fistula in B group was 1 case, the incidence of postoperative bile fistula in C group was 2 cases.Conclusions The method of one-way barbs line continuous full-thickness suture were simple and secure in primary suturing of laparoscopic choledocholithotomy.