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Objective:To survey the knowledge, attitudes, and practice about chronic obstructive pulmonary disease (COPD) among general practitioners in Sichuan province.Methods:From October to November 2020, a questionnaire survey on knowledge, attitudes and practice (KAP) among 104 general practitioners who participated in the training of the comprehensive prevention and control of COPD organized by Sichuan Provincial Health Commission. The content of the questionnaire included the basic information and the KAP status of COPD. The descriptive analysis, Mann-Whitney U test, and Kruskal-Wallis H were used for statistical analysis. Results:A total of 104 questionnaires were distributed and 102 were returned with a response rate of 98.1%. General practitioners with different ages, professional titles, visits of COPD patients each month, and whether or not to refer COPD patients to higher-level hospitals were not significantly different in the scores of knowledge( U=1 276.00, H=0.78, U=1 074.00, U=589.00), attitude( U=1 141.50, H=1.75, U=1 090.00, U=585.00), and practice( U=1 221.00, H=0.31, U=1 163.00, U=499.50) (all P>0.05). In knowledge part the highest correctness rate was "quitting smoking is the most powerful interventions affecting the natural disease course of COPD" (100.0%, 102/102); the lowest was that"the main objective examination for judging the airflow limitation of COPD patients is the lung function test"(5.9%, 6/102). In the part of the attitude, the highest positive rate was "educating patients to quit smoking and avoid exposure to second-hand smoke" (65.7%,67/102); the lowest positive rate was "provide exercise guidance to patients "(43.1%, 44/102) and " be responsible for long-term treatment follow-up" (43.1%, 44/102). In the part of practice, the highest behavioral rate was "when receiving patients with COPD, actively pay attention to the treatment of comorbid diseases" (95.1%, 97/102); the lowest behavioral rate was "when patients with COPD were seen at the clinic, and the patients were advised of the best time to use the inhaler" (65.7%, 67/102). Conclusions:The study indicates that the relevant departments need to increase the intensity of knowledge training for general practitioners in Sichuan province. General practitioners should continuously improve their education, prevention, and treatment ability and implement the primary responsibilities for COPD management.
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Objective To investigate the short- and mid-term outcomes of after off-pump coronary artery bypass grafting (OPCABG) in patients with severe elevation of preoperative serum creatinine levels (SEPSC). Methods The perioperative data of SEPSC patients undergoing OPCABG were investigated based on the perioperative CABG database from Feb. 2012 to Jul. 2016. The patients were also followed up for the perioperative complication, short and medium-term survival were estimated. Results The mean age of the patients was 65.4(45-85) years. The in-hospital mortality was 4.4% and the CRRT rate was 19.6%(9 case). Survival analyses revealed a survival ratio of 100% at one year, 97.6% at two years. Short-Form Mini Nutritional Assessment was used to show that 13(28.3%) patients had malnutrition. Conclusions SEPSC patients can be candidates for OPCABG procedure. The mortality in hospital and 2-year survival rate of SEPSC patients after OPCABG procedure are both considered within an acceptable range. OPCABG may be performed in these patients with a satisfactory survival rate with the development of surgical instruments and medical treatment.
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Objective To analyze risk factors of continuous renal replacement therapy (CRRT) in patients with severe serum creatinine levels elevation undergoing off-pump coronary artery bypass grafting (OPCABG).Methods The perioperative data of 45 patients with severe elevation of preoperative serum creatinine levels undergoing OPCABG were investigated based on the perioperative CABG database from Feb, 2012 to Jul, 2016.The postoperative treatment rates of CRRT were recorded and the risk factors were identified by multivariate logistic regressions.Results There were 9 patients (20%) who suffered from CRRT after OPCABG in all 45 recruitment patients.Compared with non-CRRT patients, there were higher levels of serum creatinine (Cr) and blood urea nitrogen (BUN) before surgery, a lower volume of urine during surgery, a higher level of serum creatinine at postoperative 12 hour and 24 hour, longer ICU staying time and higher in-hospital mortality after surgery in patients with CRRT (P＜0.05 or P＜0.01).Multivariate logistic regression analysis demonstrated that preoperative level of serum creatinine (OR=1.05, 95% CI 1.05-1.10, P=0.046) was the independent risk factor of postoperative CRRT in patients with severe serum creatinine levels elevation undergoing OPCABG.At the value of postoperative 12 hour serum creatinine up to 166 μmol/L, the incidence of postoperative CRRT in patients increased 5% by postoperative 12 hour serum creatinine increasing 1 μmol/L(OR=1.05, 95% CI 1.01-1.08, P=0.013).However at the value of postoperative 12 hour serum creatinine above 350 μmol/L, ceiling effect was apparent.Conclusion This study shows that 20% patients with preoperative severe serum creatinine level elevation are suffered from CRRT after OPCABG procedure and preoperative level of serum creatinine is predominant factor of postoperative CRRT.
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Objective To investigate cartilage oligomeric matrix protein( COMP) gene mutation in a three-generation pedigree with two cases of pseudoachondroplasia, and to definitize genotype-phenotype correlation. Methods The clinical data and peripheral blood were collected from the patients with pseudoachondroplasia and their family members. All the 19 exons and their flanking sequences of COMP gene in two patients and three unaffected family numbers and 50 unrelated individuals were analyzed by PCR amplification and direct sequencing. Results The proband, a 6-year-old girl presented with typical clinical features of pseudoachondroplasia, including disproportionate short limb dwarfism, staggering gait, double genu varus deformity, and wider clinical and imaging long bone metaphysis. The 33-year-old father showed a similar manifestation including disproportionate short limb dwarfism and double genu varus deformity, and was performed correcting operation on lower limbs for double genu varus at the age of 10 years. DNA sequencing analysis of the COMP gene revealed a del mutation ( c. 1417 1419delGAC)in exon 13 in two patients with pseudoachondroplasia, but not in the other unaffected members from the pedrgree and 50 control subjects. Conclusion A del mutation c. 1417 1419delGAC of COMP gene may contribute to the disease in the pedigree.
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<p><b>OBJECTIVE</b>To analyze CYP21A2 gene mutation in two families with 21-hydroxylase deficiency (21-OHD) and to explore the correlation between genotype and clinical phenotype.</p><p><b>METHODS</b>Two patients with 21-OHD and their families were investigated. CYP21A2 gene mutation was analyzed by PCR and direct sequencing.</p><p><b>RESULTS</b>The probands from family 1 and 2 have been respectively diagnosed with simple virilizing and non-classical 21-OHD. Both showed increased baseline serum 17hydroxyprogesterone, testosterone and adrenocorticotropic hormone (ACTH), but had no evidence of salt loss. Computer tomography revealed bilateral adrenal hyperplasia in both patients. After 1 year treatment, both had conceived successfully. DNA sequencing revealed that the proband of family 1 had compound heterozygous mutations for IVS2 13 A>G and Ile172Asn. Her father was heterozygous for Ile172Asn, whilst her mother and brother were heterozygous for IVS213A/C>G. In family 2, the proband was heterozygous for Arg341Trp and Gln318X. Her father, sister and nephew were heterozygous for Arg341Trp, whilst her mother was heterozygous for Gln318X. her brother and niece were non-affected. Carriers of single heterozygous mutations in both families had no clinical sign.</p><p><b>CONCLUSION</b>In both families, the disease has been caused by compound heterozygous mutations, for which there has been a good genotype-phenotype agreement. Screening of CYP21A2 gene can facilitate both diagnosis and genetic counseling.</p>
Subject(s)
Adult , Child , Female , Humans , Male , Young Adult , Adrenal Hyperplasia, Congenital , Blood , Genetics , Adrenocorticotropic Hormone , Blood , Base Sequence , Genotype , Molecular Sequence Data , Mutation, Missense , Pedigree , Phenotype , Steroid 21-Hydroxylase , Genetics , Metabolism , Testosterone , BloodABSTRACT
[Summary] The characteristics ot clinical data and relevant inspection (quantitative sensory and electrophysiological studies) in 5 patients hospitalized with acute painful neuropathy following rapid glycaemic control with insulin from 2010 to 2012 in our hospital were analyzed.The results showed that 5 patients were all males,aged 31-49 years,with lower body mass index,and diagnosed as latent autoimmune diabetes of adults (LADA) or type 2 diabetes.Glycaemic control was poor before application of insulin.When insulin was used,the hyperglycemia was rapidly corrected in a short time,with recurrent episodes of hypoglycemia during insulin treatment.The painful neuropathic symptoms appeared within 2-4 weeks after application of insulin,and were relieved partially or completely after 2-6 months.Neuropathic symptoms manifested as tingling and tenderness,with worsening during night and after insulin injection.The neuropathic symptoms were not significantly alleviated after application of neurotrophic drugs such as methycobal,protogen,and prostaglandin.These patients often suffered from severe anxiety.Nerve electromyogram examination showed slowed or normal motor conduction velocity of tibial and fibular nerves,and normal feeling threshold.
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The clinical and genetic data were retrospectively analyzed in a pedigree with pseudohypoparathyroidism type Ⅰ a.Clinically typical Albright hereditary osteodystrophy (AHO),hypocalcemia,hyperphosphatemia,and PTH- and TSH-resistance were manifested in the proband,but not in his brother and parents.The proband's symptom of epilepsy was alleviated by treatment with calcium and vitamin D,which was of no avail in regard to AHO.After GNAS1 genes were sequenced and compared with the GenBank data among the family members,a deletion of c.1107_1108 ( p.Glu370ArgfsX11 ) in exon l3 of GNAS1 gene leading to a frameshift mutation was found in the proband and his mother.It suggested that the GNAS1 gene mutation might be related to the pathogenesis of the disease.
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Objective To discuss the influence of personalized comprehensive nursing intervention on complications after coronary stent implantation in patients with acute cardiac infarction,and provide an effective and feasible method for prevention and reduction of these complications.Methods 118 patients with acute cardiac infarction after coronary stent implantation were divided into the intervention group (51 cases)and the control group (67 cases),the puncture site complications,CRP level were compared,and the mastering of health knowledge were compared between two groups through questionnaires and telephone return visit as well.Results The incidence rate of puncture site complications in the intervention group was lower than that of the control group.Significant differences were seen in reasonable diet,medicine knowledge,emotional adjustment and preventive measures between two groups.CRP levels were compared between two groups and the result showed no statistical difference.Conclusions Through strengthening the personalized comprehensive nursing intervention,nurses can significantly reduce the rate of complications after coronary stent implantation and facilitate the recovery of patients.