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Cervical cancer is still a common gynecolgical tumor in China. Radical surgery is often the first choice for the treatment of early stage cervical cancer (FIGO stage ⅠB-ⅡA), and postoperative pathological examination often has adverse prognostic factors affecting the survival. According to the NCCN guidelines, patients with cervical cancer who meet Sedlis criteria and have intermediate-risk factors (lymphatic vascular space involvement, tumor size or deep interstitial infiltration) are recommended to receive concurrent chemotherapy with postoperative pelvic external irradiation ± cisplatin. However, the diagnostic criteria, indications and methods of adjuvant therapy for patients with intermediate risk factors after early cervical cancer surgery are still controversial. In this article, research progress on the definition of intermediate risk factors for early cervical cancer after radical hysterectomy and adjuvant treatment was mainly reviewed.
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Objective:To evaluate the effectiveness of multi-disciplinary treatment (MDT) for reducing carbapenem-resistant Enterobacteriaceae (CRE) infections in intensive care unit(ICU).Methods:Patients admitted in the emergency ICU (EICU) and neurosurgical ICU (NICU) of the First People’s Hospital of Lianyungang during January 2018 to December 2019 were enrolled in the study, which was analyzed by historical control study. For patients admitted in 2018, the conventional method was adopted for prevention and control of drug-resistant bacteria (control group, n=1, 076), and for patients admitted in 2019, the MDT was adopted for the prevention and control of CRE (intervention group, n=1, 237). Chi-square test was used to compare the incidence rate of CRE infection, CRE detection rate, rate of rational antibiotic use and compliance with implementation of prevention and control measures between two groups. Results:Compared to control group, the incidence rate of CRE infection in EICU and NICU decreased from 3.45% (14/406) and 3.58% (24/670) to 1.65% (9/547) and 2.32% (16/690) in intervention group, respectively; while the detection rate of CRE decreased from 66.21% (96/145) and 57.72% (86/149) to 41.11% (51/124) and 33.06% (40/121), the pathogens were mainly carbapenem-resistant Klebsiella pneumoniae (CRKP). The rational medication rate of carbapenem antibiotics was significantly increased from 65.00%(78/120) in 2018 to 92.73%(319/344) in 2019 ( χ2=55.382, P<0.05). In addition, the single room isolation rate, the rate of specialized nursing care, the cleaning and disinfection quality of bench surface and the special use rate of articles were also significantly improved( χ2=21.646, 18.116, 39.869 and 19.713, P<0.01). Conclusion:The establishment of multi-department collaborative management based on MDT can effectively improve the prevention and control effect of CRE in ICU and significantly reduce the prevalence of CRE infection.
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Objective To investigate the effect of comprehensive intervention measures on submission of microbiological specimens before therapeutic use of antimicrobial agents.Methods August 2014 to August 2015 was as preintervention group,comprehensive intervention measures were started to carry out from September 2015,Septem ber 2015 to September 2016 was as post-intervention group.Microbiology specimen submission rates before therapeutic antimicrobial use,positive rate of blood culture,and rate of antimicrobial use in all departments and key departments were compared between pre-intervention group and post-intervention group.Results The submission rates of microbiological specimens before general,restricted,and special therapeutic antimicrobial use increased from 42.21％,45.19％,and 74.71％ of pre-intervention respectively to 53.54％,55.68％,and 89.70％ of postintervrntion respectively,showing significant difference (all P＜0.01);after intervention,except gastrointestinal surgery and trauma department of orthopedics,the other departments all met the requirements of the microbiological specimen submission rates set by the hospital;but submission rates of microbiological specimens from department of gastrointestinal surgery and trauma department of orthopedics increased from 5.46％ and 11.67％ before intervention to 11.66％ and 29.45％ respectively after intervention,difference was statistically significant (both P＜0.001).The missing report rate of healthcare-associated infection(HAI) dropped from 13.56％ before intervention to 10.98％ (P＜ 0.05),and the use rate of antimicrobial agents decreased from 57.36％ to 54.47％ (P＜0.001).Conclusion Comprehensive intervention measures can effectively improve the submission rates of microbiological specimens before therapeutic use of antimicrobial agents,reduce missing report rates of HAI and utilization rate of antimicrobial agents,and achieve certain clinical effectiveness.
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Objective To understand the occurrence of healthcare-associated infection (HAI),distribution of pathogens,and drug resistance in a general hospital in 2014-2016,provide basis for prevention and control of HAI.Methods Clinical data of hospitalized patients from January 2014 to December 2016 were collected by prospective and retrospective investigation,distribution and drug resistance of pathogens causing HAI were statistically analyzed.Results From 2014 to 2016,4 750 patients had 5 352 cases of HAI,incidence and case incidence of HAI were 2.19％ and 2.46％ respectively.Incidences of HAI in three years were 2.47％,2.07％,and 2.05％ respectively,showing a decreased tendency,difference was statistically significant (x2 =36.217,P＜0.01).Incidences of HAI were high in intensive care unit,department of neurosurgery,as well as department of burn and plastic surgery,the common HAI sites were respiratory tract,urinary tract,and surgical sites.The main pathogens causing HAI were gram-negative bacteria (76.10％).Resistance rates of Escherichia coli to cephalosporins and fluoroquinolones were relatively higher (＞60％);resistance rates of Klebsiella pneumoniae to carbapenems were relatively higher;resistance rates of Pseudomonas aeruginosa to carbapenems showed a increased tendency year by year (x2 =15.175,P =0.001);antimicrobial resistance rates of Acinetobacter baumannii were all＞50 ％.Methicillin-resistant Staphy lococcus aureus (SA) accounted for about 60％ of SA,methicillin-resistant coagulase negative Staphylococcus(CNS) accounted for more than 80％ of CNS,vancomycin-and linezolid-resistant Staphylococcus spp.were not found.Conclusion The common pathogens causing HAI in this hospital are higher.Scientific monitoring on HAI and regular analysis of clinical data are of great significance for guiding rational use of antimicrobial agents,controlling multidrug-resistant organisms,and reducing the occurrence of HAI.
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Objective To observe the effect of Delta-like ligand 4 (Dll-4) on the pathological structure of retina in early diabetic rats (DM) and its relationship with vascular endothelial growth receptor-2 (VEGFR-2).Methods A total of 70 male Sprague-Dawley rats were randomly divided into normal group and DM group,with 10 and 60 rats in each group,respectively.The rats of DM group was induced by intraperitoneal injection of streptozotocin to established DM model.The rats with blood glucose recovery and death were excluded,and the final 60 rats were included in the statistics.Rats in the normal group were injected with an equal volume of citric acid-sodium citrate buffer.Rats in the DM group were divided into DM 1 month (DM lm) group,DM 2 months (DM 2m) group,DM 3 months (DM 3m) group and DM 3m + Anti group,DM 3m + phosphate buffer solution (PBS) group by random number table method,and 10 rats in each group.In the DM 3m+Anti group,4 μl ofantiDll-4 polyclonal antibody was injected into the vitreous cavity,and the antibody concentration was 0.25 mg/ml.The DM 3m+PBS group was intravitreally injected with an equal volume of PBS.Five days after the injection,the rats were sacrificed.Rats in the DM 3m group and the normal group were not treated,and were sacrificed 3 months after the model was established.The structure and microvascular changes of the retina were observed by hematoxylin-eosin staining,and the total thickness of the retina was measured.The expression of Dll-4 and VEGFR-2 in the retina was detected by immunohistochemistry and fluorescence quantitative polymerase chain reaction (PCR).One-way analysis of variance was used to compare the expression of Dll-4 and VEGFR-2 in the retina of each group.The least significant difference t test was used to compare the two groups.Results Light microscopy showed that the retinal ganglion cells layer in the DM 3m group were obviously edematous,the inner and outer nuclear layers were thinner,the number of cells was reduced,the arrangement was disordered,the edema of outer plexiform layer was obvious,and the microvessels were abnormally dilated.In the DM 3m+Anti group,the edema of outer plexiform layer was lessened than that of the DM 3m group,and the other layers were not significantly different from the DM 3m group.Compared with the normal group,the total retinal thickness of the DM 3m group,the DM 3m+Anti group and the DM 3m+PBS group increased (t=5.596,3.290,4.286;P=0.000,0.008,0.002).Immunohistochemical staining showed that a small amount of Dl14 was positively expressed in the retinal ganglion cell layer of the normal group;a small amount of VEGFR-2 was positively expressed in the ganglion cell layer and the inner and outer nuclear layers.The positive expression of Dll-4 and VEGFR-2 in retinal vascular endothelial cells of DM 3m group increased significantly.The expression of Dll-4 was significantly decreased in the retinal layers and vascular endothelial cells ofDM 3m+Anti group,while the expression of VEGFR-2 was significantly increased.There was no significant difference between the positive expression of Dll4 and VEGFR-2 in the DM 3m+PBS group and the DM 3m group.The results of real-time PCR showed that the relative expression of Dll-4 and VEGFR-2 mRNA in the DM 3m group was significantly higher than that in the normal group (t=6.705,20.871;P＜0.05).Compared with DM 3m group,the relative expression of Dll-4 mRNA in DM 3m+Anti group decreased,and the relative expression of VEGFR-2 mRNA increased (t=2.681,3.639;P＜0.05).The relative expressions of Dll-4 and VEGFR-2 mRNA in the DM 3m+PBS group and DM 3m group were not statistically significant (t=0.513,0.657;P＜0.05).Conclusions The expression of Dll-4 in retinal vascular endothelial cells is gradually increased during the early retinopathy of DM rats.The expression of Dll-4 is inhibited,the expression of VEGFR-2 is up-regulated,and the plexus edema is alleviated.
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Multi-walled carbon nanotubes-tungsten oxide (MWCNTs-WOx) nanocomposites were fabricated on glassy carbon electrode (GCE) through a simple electrodeposition method,in which WOx were fabricated on MWCNTs. The morphology and constitution were characterized by field emission scanning electron microscopy(SEM) and X-ray photoelectron spectroscopy(XPS). Electrochemical characterization of modified electrode was done by electrochemical impedance spectroscopy (EIS). The cyclic voltammogram (CV)method was adopted to investigate the electrochemical behavior of dopamine (DA) on MWCNTs-WOx-modified glassy carbon electrode, and a new detection method for DA was developed by differential pulse voltammetry (DPV). The results showed that MWCNTs-WOx nanocomposites had obvious electrocatalytic effect on DA in phosphate buffer solution (pH=6.5). Under the optimized experimental conditions, the DA peak current demonstrated a good linear relationship with concentration in the range of 0.05-1.00 mmol/L, and the detection limit was 17 μmol/L(S/N=3). Effects of different experimental parameters on the response current of the modified electrode were investigated,and it was found that the prepared electrochemical sensor displayed good reproducibility,high selectivity and strong anti-interference ability. UA did not interfere with the detection of DA. A new electrochemical method for the quantitative determination of DA was established and successfully applied to the determination of dopamine hydrochloride injection samples.
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<p><b>BACKGROUND</b>It is important to choose an appropriate antiepileptic drug (AED) to manage partial epilepsy. Traditional AEDs, such as carbamazepine (CBZ) and valproate (VPA), have been proven to have good therapeutic effects. However, in recent years, a variety of new AEDs have increasingly been used as first-line treatments for partial epilepsy. As the studies regarding the effectiveness of new drugs and comparisons between new AEDs and traditional AEDs are few, it is determined that these are areas in need of further research. Accordingly, this study investigated the long-term effectiveness of six AEDs used as monotherapy in patients with partial epilepsy.</p><p><b>METHODS</b>This is a retrospective, long-term observational study. Patients with partial epilepsy who received monotherapy with one of six AEDs, namely, CBZ, VPA, topiramate (TPM), oxcarbazepine (OXC), lamotrigine (LTG), or levetiracetam (LEV), were identified and followed up from May 2007 to October 2014, and time to first seizure after treatment, 12-month remission rate, retention rate, reasons for treatment discontinuation, and adverse effects were evaluated.</p><p><b>RESULTS</b>A total of 789 patients were enrolled. The median time of follow-up was 56.95 months. CBZ exhibited the best time to first seizure, with a median time to first seizure of 36.06 months (95% confidential interval: 30.64-44.07). CBZ exhibited the highest 12-month remission rate (85.55%), which was significantly higher than those of TPM (69.38%, P = 0.006), LTG (70.79%, P = 0.001), LEV (72.54%, P = 0.005), and VPA (73.33%, P = 0.002). CBZ, OXC, and LEV had the best retention rate, followed by LTG, TPM, and VPA. Overall, adverse effects occurred in 45.87% of patients, and the most common adverse effects were memory problems (8.09%), rashes (7.76%), abnormal hepatic function (6.24%), and drowsiness (6.24%).</p><p><b>CONCLUSION</b>This study demonstrated that CBZ, OXC, and LEV are relatively effective in managing focal epilepsy as measured by time to first seizure, 12-month remission rate, and retention rate.</p>
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Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Anticonvulsants , Therapeutic Uses , Carbamazepine , Therapeutic Uses , China , Epilepsies, Partial , Drug Therapy , Fructose , Therapeutic Uses , Piracetam , Therapeutic Uses , Retrospective Studies , Treatment Outcome , Triazines , Therapeutic Uses , Valproic Acid , Therapeutic UsesABSTRACT
To investigate the role of the extracellular signal-regulated kinase (ERK1/2) and PI3K/AKT/ mTOR signal pathway inducing bone marrow mesenchymal stem cells (BMSCs) differentiation into neural cells, mouse bone marrow-derived mesenchymal stem cell lines D1 cells were used as research object. And they were divided into control groups and salidroside (SD) groups. Different concentrations (5, 25, 50, 100 and 200 microg x mL(-1) of SD were used and SD (100 microg x mL(-1)) was used to induce at different time (0.5, 1, 3, 6, 9, 12, 24, 48 and 72 h). The immunofluorescence staining chemical technology, real-time PCR and Western blotting were used to detect the positive rates of NSE, MAP2, beta-Tubulin III, NES, GFAP and the expression levels of beta-Tubulin III, NSE, ERK1/2, AKT. The expression of ERK1/2 and NSE was detected when the ERK1/2 and PI3K/AKT/ mTOR signal pathway was blocked by PD98059 and LY294002. It indicated that the positive rates of NSE, MAP2, beta-Tubulin III, NES and GFAP were gradually enhanced with time increased. The expression level of NSE and beta-Tubulin III protein were significantly higher than those in control groups (P < 0.01). The expression of ERK1/2, AKT mRNA and protein were higher with concentration and time increased. When the ERK1/2 and PI3K/AKT/mTOR signal pathway were blocked, the expression levels of NSE, NES and beta-Tubulin III mRNA and NSE protein were inhibited significantly. It points out that SD can stimulate the ERK1/2 and PI3K/AKT/mTOR signal pathway to promote BMSCs differentiation into neural cells.
Subject(s)
Animals , Mice , Bone Marrow Cells , Cell Biology , Cell Differentiation , Cells, Cultured , Chromones , Pharmacology , Enzyme Inhibitors , Pharmacology , Flavonoids , Pharmacology , Glial Fibrillary Acidic Protein , Metabolism , Glucosides , Pharmacology , MAP Kinase Signaling System , Mesenchymal Stem Cells , Cell Biology , Microtubule-Associated Proteins , Metabolism , Mitogen-Activated Protein Kinase 1 , Genetics , Metabolism , Mitogen-Activated Protein Kinase 3 , Genetics , Metabolism , Morpholines , Pharmacology , Nestin , Metabolism , Neurons , Cell Biology , Metabolism , Phenols , Pharmacology , Phosphatidylinositol 3-Kinases , Metabolism , Phosphopyruvate Hydratase , Genetics , Metabolism , Plants, Medicinal , Chemistry , Protein Kinase Inhibitors , Pharmacology , Proto-Oncogene Proteins c-akt , Genetics , Metabolism , RNA, Messenger , Metabolism , Rhodiola , Chemistry , Signal Transduction , TOR Serine-Threonine Kinases , Metabolism , Tubulin , MetabolismABSTRACT
<p><b>OBJECTIVE</b>Duchenne muscular dystrophy (DMD) is an X-linked recessive disease caused by dystrophin gene mutations; 55%-65% of these pathogenic mutations are large deletion and duplication mutations that can be detected by multiplexed polymerase chain reaction. However, finding the remaining micro-mutations (substitutions, deletions or insertions of one or several nucleotides) cannot be achieved in this way. The aim of the present study was to detect mutations of the dystrophin gene in individuals with Duchenne muscular dystrophy (DMD) by denaturing high-performance liquid chromatography (DHPLC) and to establish a rapid and sensitive screening platform for micro-mutations leading to DMD.</p><p><b>METHODS</b>Twenty patients negative for large deletions in the dystrophin gene by multiplex PCR were selected for further screening by DHPLC and 20 normal male without DMD family history as the control cohort. Dystrophin exons and their flanking sequences were individually amplified by genomic PCR and the amplicons showing abnormal DHPLC profile were directly sequenced to identify the position and the type of the mutations.</p><p><b>RESULTS</b>After screening 68 exons covering the two deletion hotspots and 3'UTR region, four pathogenic mutations, including c.6808_6811del TTAA, c.4959_4960insA, c.8656C > T and c.8608C > T, were found in four DMD patients. Moreover, c.6808_6811del TTAA, c.4959_4960ins and c.8656C > T have not been reported previously. The first two frameshift mutations were predicted to produce premature stop codons, p.Leu2270MetfsX9 and p.Ser1654LysfsX5, respectively. The remaining two were nonsense mutations, leading to p.R2886X and p.R2870X, respectively.</p><p><b>CONCLUSION</b>Three novel and one recurrent dystrophin mutations have been identified in Chinese DMD patients. This study has demonstrated that DHPLC is an effective screening method for micro-mutation associated with DMD.</p>