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Objective:To summarize the clinical data of anti-factor H antibody-associated atypical hemolytic uremic syndrome (aHUS) in children, and analyze the risk factors for disease recurrence and poor prognosis.Methods:A prospective cohort study was conducted on 52 children with anti-factor H antibody-associated aHUS in Beijing Children′s Hospital, Capital Medical University from November 2011 to November 2021.Patient information about the genetic background, clinical and renal pathological characteristics, treatment, and prognosis were collected.Then, the disease recurrence and prognosis were analyzed using the survival curve and Cox regression model. Results:In 52 children, there were 33 males and 19 females.The average age of onset for aHUS was 2.4-12.8 years, and 92.3%(48/52) of the children developed symptoms at the age of 4-12 years.The copy numbers of complement factor-H-related 1 (CFHR1) and complement factor-H-related 3 (CFHR3) genes were calculated in 42 children.Among the 42 cases, 18 cases (42.9%) had CFHR1 homozygous deletion, and 83.3% (15/18) of them also had CFHR3 homozygous deletion.All the patients were given plasma therapy.Besides, 76.9% (40/52) of the children were treated with immunosuppressive therapy (steroid and/or immunosuppressant) at the first onset of the disease.About 86.5%(45/52 cases) of the patients received immunosuppressive therapy in the course of disease, and the immunosuppressive treatment lasted for 6-20 months in total.The median follow-up time was 58 (28, 91) months.Among 52 patients, only 12 patients (23.1%) suffered disease recurrence.The relapse-free survival rate in children with CFHR1 homozygous deletion was significantly lower than that in children with non-homozygous deletion ( χ2=4.700, P=0.030). The relapse-free survival rate in children with CFHR1 and CFHR3 homozygous deletions was also significantly lower than that in other children ( χ2=4.181, P=0.041). At the end of the follow-up, 73.1%(38/52) of the children had normal renal function and no persistent proteinuria or hypertension.23.1%(12/52 cases) of the children had persistent proteinuria and/or hypertension.One child had Stage 3-4 chronic kidney disease, and 1 child was dialysis dependent. Conclusions:Anti-factor H antibody-associated aHUS is prone to occur in children aged between 4-12 years old, who respond well to plasma therapy and immunosuppressive therapy.Children with anti-factor H antibody-associated aHUS and CFHR1 and CFHR3 homozygous deletions have a high recurrence rate.Treatment with immunosuppressive therapy and assessment of the copy number of CFHR1 and CFHR3 genes in the early stage of the disease are important for preventing disease recurrence and improving prognosis.
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OBJECTIVES@#To investigate the physical growth and dietary characteristics of children with attention deficit hyperactivity disorder (ADHD), and to analyze their relationship with core symptoms of ADHD.@*METHODS@#A total of 268 children who were newly diagnosed with ADHD in Children's Hospital of Nanjing Medical University from June to December 2020 were included in the ADHD group, and 102 healthy children who underwent physical examination during the same period were selected as the control group. Physical evaluations and dietary surveys were conducted for both groups. ADHD diagnosis and scoring were performed according to the Diagnostic and Statistical Manual of Mental Disorders (5th edition). Factor analysis, Spearman correlation analysis, and mediation analysis were used to study the relationship between core symptoms of ADHD, dietary patterns, and physical growth.@*RESULTS@#The rate of overweight/obesity in the ADHD group was significantly higher than that in the control group (35.8% vs 21.6%, P<0.05). Three dietary patterns were extracted from the food frequency questionnaire: vegetarian dietary pattern, traditional dietary pattern, and snack/fast food pattern. The factor score for the snack/fast food pattern in the ADHD group was higher than that in the control group (P<0.05). There was a significant positive correlation between ADHD symptom scores, snack/fast food pattern factor scores, and body fat percentage (P<0.05). The mediation analysis showed that the snack/fast food pattern played a partial mediating role in the relationship between ADHD symptom scores and body fat percentage, with a mediation proportion of 26.66%.@*CONCLUSIONS@#The rate of overweight/obesity in children with ADHD is higher than that in non-ADHD children. Core symptoms of ADHD are related to dietary patterns and physical growth, with the snack/fast food pattern playing a partial mediating role in the relationship between core symptoms of ADHD and physical growth.
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Humans , Child , Attention Deficit Disorder with Hyperactivity/epidemiology , Cross-Sectional Studies , Overweight , Pediatric Obesity , DietABSTRACT
Pertussis is an acute, highly infectious respiratory disease caused by Bordetella pertussis, and is one of the leading causes of infant disease and death worldwide. The pertussis vaccine has been used in the expanded program on immunization globally since 1974 and the vaccination coverage remains high. In recent years, the pertussis incidence rate increased, even pertussis outbreaks occurred, in more and more countries or areas after years with low incidence level. The disease burden of pertussis has been seriously underestimated, and the prevention and control of pertussis is facing many challenges. This article reviews the epidemic status of pertussis worldwide, the factors affecting the reemergence of pertussis, and the challenges in the prevention and control to provide a reference for prevention and control of pertussis.
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Infant , Humans , Whooping Cough/prevention & control , Vaccination , Pertussis Vaccine/therapeutic use , Bordetella pertussis , Disease OutbreaksABSTRACT
OBJECTIVES@#To compare the effects of cell lysis method and magnetic beads method in forensic DNA identification and to explore these two methods in forensic DNA identification.@*METHODS@#The genome DNA of THP-1 cells in different quantities was extracted by the cell lysis method and magnetic beads method, and the DNA content was quantified by real-time quantitative PCR. The cell lysis method and magnetic beads method were used to type the STR of human blood with different dilution ratios.@*RESULTS@#When the numbers of THP-1 cell were 100, 400 and 800, the DNA content extracted by cell lysis method were (1.219±0.334), (5.081±0.335), (9.332±0.318) ng, respectively; and the DNA content extracted by magnetic beads method were (1.020±0.281), (3.634±0.482), (7.896±0.759) ng, respectively. When the numbers of THP-1 cells were 400 and 800, the DNA content extracted by the cell lysis method was higher than that by the magnetic beads method. The sensitivity of cell lysis method and magnetic beads method was similar in STR typing of human blood at different dilution ratios. Complete STR typing could be obtained at 100, 300 and 500-fold dilutions of blood samples, but could not be detected at 700-fold dilution. STR typing of undiluted human blood could not be detected by cell lysis method.@*CONCLUSIONS@#The cell lysis method is easy to operate and can retain template DNA to the maximum extend. It is expected to be suitable for trace blood evidence tests.
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Humans , Forensic Medicine , DNA/genetics , Real-Time Polymerase Chain Reaction , Magnetic Phenomena , DNA Fingerprinting/methods , Microsatellite RepeatsABSTRACT
Wearable technology, which can continuously and remotely monitor physiological and behavioral parameters by incorporated into clothing or worn as an accessory, introduces a new era for ubiquitous health care. With big data technology, wearable data can be analyzed to help long-term cardiovascular care. This review summarizes the recent developments of wearable technology related to cardiovascular care, highlighting the most common wearable devices and their accuracy. We also examined the application of these devices in cardiovascular healthcare, such as the early detection of arrhythmias, measuring blood pressure, and detecting prevalent diabetes. We provide an overview of the challenges that hinder the widespread application of wearable devices, such as inadequate device accuracy, data redundancy, concerns associated with data security, and lack of meaningful criteria, and offer potential solutions. Finally, the future research direction for cardiovascular care using wearable devices is discussed.
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Big Data , Delivery of Health Care , Wearable Electronic Devices , Technology , Blood PressureABSTRACT
【Objective】 To investigate the frequency of P1PK and GLOB blood group in Chinese Lahu population and their genetic status, so as to provide data support for the safety of blood transfusion and give advice and transfusion guidance for pregnant women. 【Methods】 Unrelated individuals of Chinese Lahu population were randomly selected for serological identification of P1PK and P blood group and gene sequencing analysis. The frequency of P1PK and GLOB blood group were analyzed. 【Results】 Six cases of anti-PP 1Pk(formerly known as anti-Tja) negative blood type were identified as the rare P1-PK-P- blood type (formerly known as Tja- blood type or p blood type, hereinafter referred to as p blood group) from 300 Lahu population, with phenotypic frequency of p blood group in P1PK and GLOB blood group system in Lahu population at 2.0%(6/300). 【Conclusion】 The phenotypic frequency of blood group p in Lahu population was significantly higher than that in Europe (5.8 persons per million) and Hong Kong, China (1 person per million),indicating significant ethnic specificity and regional ethnic differences.
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Objective To analyze the current status and influencing factors of occupational health literacy(OHL) among workers in automobile manufacturing industry in Beijing City. Methods A total of 1 639 frontline workers from 15 automobile manufacturing enterprises in Beijing City were selected using stratified cluster sampling method. The National Occupational Health Literacy Monitoring for Key Groups Questionnaire was used to investigate the OHL of the workers. Results The overall awareness of OHL was 60.5% in these 1 639 automobile manufacturing workers. The awareness of OHL in the four dimensions, from high to low, were basic knowledge of occupational health protection, info of healthy working style and behaviors, legal knowledge of occupational health and basic skills of occupational health protection (82.1% vs 73.2% vs 57.5% vs 43.3%, P<0.01). The multivariate logistic regression analysis results showed that gender, marriage status, education level, personal monthly income and enterprise scale were influencing factors of OHL of automobile manufacturing workers (all P<0.05). Conclusion The OHL awareness among workers of automobile manufacturing industry in Beijing City, especially the basic skills of occupational health protection and the legal knowledge of occupational health, needs to be improved. It is essential to focus on promotion and intervention of occupational health in female workers, those with low education levels, low-income levels, and workers in small- and medium-sized enterprises.
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Objective:To provide a basis for later training, by investigating the status quo and influencing factors of the health education competency of nursing staff in secondary and above traditional Chinese medicine hospitals in Anhui Province.Methods:This study was a cross-sectional study. Convenience sampling method was adopted, and 3 482 nursing staff in 13 secondary and 24 tertiary traditional Chinese medicine hospitals in Anhui Province from July to September, 2020 were investigated by a general survey form and a Self-evaluation Scale for Health Education Competency of Nursing Staff in Traditional Chinese Medicine Hospitals, Self-Efficacy Scale and Organizational Support Scale through electronic questionnaires. A total of 3 482 questionnaires were issued, 3 147 questionnaires were effectively returned, and the effective response rate was 90.38%.Results:The total score of health education competency of 3 147 nursing staff in hospitals of traditional Chinese medicine in Anhui Province was (345.80 ± 50.08) points, and the standard score was (77.70 ± 11.25) points. The lower item scores were "knowledge of Yin and Yang and Five Elements""knowledge of Qi, Blood and Body Fluid""effectively convey information to patients through digital media"; the scores of self-efficacy, organizational support, instrumental support and emotional support were (29.28 ± 5.96), (47.56 ± 11.15), (10.25 ± 1.47), (37.31 ± 9.68) points, respectively. Multiple linear regression showed that initial academic qualifications, school health education learning experience, hospital health education training experience, health education work plan, self-efficacy, and organizational support were the main influencing factors of health education competence of nurses in traditional Chinese medicine hospitals (adjusted R2=0.194, F=85.10, P<0.01). Conclusions:The health education competency of nurses in secondary and above Anhui Provincial hospital of traditional Chinese medicine is still at a medium level and needs to be improved. At the same time, managers should also focus on improving their sense of self-efficacy and organizational support to better serve patients.
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ObjectiveTo investigate the late detection of HIV/AIDS cases in the elderly in Jilin Province and analyze its influencing factors， to provide theoretical basis for improving their life quality. MethodsThe first CD4 values of HIV/AIDS patients aged 50 years and above living in Jilin Province were used to estimate late detection， and the influencing factors of late detection in elderly cases were analyzed. ResultsThe average CD4 cell count of newly reported HIV/AIDS cases aged 50 and above in Jilin Province from 1996 to 2021 was （230.55±191.97）， the low value group accounted for the largest proportion （50.8%）， and the late detection rate was 59.3% （1397/2325）. The late detection cases were mainly from sexual transmission （46.8% for same-sex and 48.2% for heterosexual contact）. From the perspective of sample sources， most of the late detection patients were diagnosed while testing for other illnesses， followed by testing and consulting. In terms of contact history， the late detection of cases of men who have sex with men was higher. The binary logistic regression analysis showed that gender， marriage， sample source and report year were the factors affecting the late detection of AIDS. The late detection rate of males was higher， and cases of married couples were more likely to be late detection. With the increase of report year， the late detection rate decreased， and testing and counseling could effectively reduce the late detection rate of AIDS. ConclusionThe CD4 cell count in the first detection of HIV/AIDS in the elderly in Jilin Province is low， and the late detection rate of male cases is high. In recent years， the expansion of voluntary counseling and testing in Jilin Province has effectively reduced the late detection rate of HIV/AIDS. At the same time， sex education should be strengthened for the elderly， healthy marital relationships should be advocated and more attention should be paid to the mental health of the elderly.
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Objective:To explore the effect of follow-up care based on the knowledge attitude belief practice theory on postoperative care quality and readmission rate for children with critical congenital heart disease (CCHD).Methods:From June 2018 to October 2020, 76 children with CCHD admitted to this hospital were selected and divided into 38 cases in the control group and 38 cases in the study group according to the random number table method. The control group was given routine follow-up care after discharge, and the study group was given follow-up care based on the knowledge attitude belief practice theory besides the routine follow-up care for the control group after discharge. The readmission rates during the follow-up period were compared between the two groups, and the quality of care and self-efficacy (GSES) of caregivers were compared between the two groups at discharge, 6 months after discharge.Results:During the follow-up period, the readmission rate of the study group was 2.63% (1/38) lower than that of the control group 18.42% (7/38) ( P<0.05); 6 months after discharge, the study group had higher scores of care quality in postoperative feeding, surgical incision care, medication after discharge, prevention of complications, and critical illness recognition than those of the control group [(10.56±1.12) vs (9.78±1.03), (10.92±1.05) vs (9.96±0.98), (10.62±1.32) vs (9.35±1.02), (10.95±1.03) vs (9.97±0.99), (11.05±0.80) vs (9.23±0.75), (10.56±1.35) vs (8.95±0.99)] (all P<0.05); 6 months after discharge, the caregiver′s GSES score of the study group was higher than that of the control group ( P<0.05). Conclusion:Follow-up care based on the knowledge attitude belief practice theory can improve the quality of postoperative care for children with CCHD, reduce the readmission rate, and improve the self-efficacy of caregivers.
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Objective:To systematically evaluate the efficacy and safety of precision thoracic radiotherapy (TRT) in the limited-stage small cell lung cancer (LS-SCLC) patients by network meta-analysis.Methods:Randomized controlled trials (RCTs) of TRT regimes in the LS-SCLC were electronically searched from PubMed, Web of Science, The Cochrane Library, CNKI and Wanfang Data from inception to September 1 st, 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Statistical analysis was performed by Stata 17 and R 4.1.1 software. Results:A total of 6 RCTs involving 1730 patients with six radiation regimens including hyperfractionated radiotherapy (HFRT): HFRT 45(45 Gy/30 F) and HFRT 60(60 Gy/40 F); conventional fractionated radiotherapy (CFRT): CFRT 70(70 Gy/35 F) and CFRT 66(66 Gy/33 F); moderately hypofractionated radiotherapy (MHFRT): MHFRT 65(65 Gy/26 F) and MHFRT 42(42 Gy/15 F) were included. The network meta-analysis showed that: in terms of improving progression-free survival and overall survival, there was no statistically significant difference among the six radiotherapy regimens. The probabilistic ranking results were: MHFRT 65> HFRT 60>CFRT 66>CFRT 70>MHFRT 42>HFRT 45, and HFRT 60>MHFRT 65>CFRT 66>CFRT 70>HFRT 45>MHFRT 42, respectively. The HFRT 60 regimen was superior to other regimens in reducing the incidence of grade ≥3 pneumonia, and there was no difference between the regimens in causing grade ≥3 radiation esophagitis, and the results of ranking probability were: HFRT 60> MHFRT 42>CFRT 66>CFRT 70>HFRT 45>MHFRT 65, and HFRT 60>CFRT 70>CFRT 66>HFRT 45>MHFRT 42>MHFRT 65, respectively. Conclusions:HFRT 60 radiotherapy regimen may be more effective and safer in the treatment of LS-SCLC patients as a priority choice for LS-SCLC TRT. Limited by the number and quality of included studies, the above conclusions need to be verified by more high-quality studies.
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Objective:To evaluate the application value of transcranial Doppler in the detection of intracranial artery stenosis in patients with cerebral infarction.Methods:120 patients with cerebral infarction who received treatment in Zhuji Hospital of Traditional Chinese Medicine from December 2018 to December 2020 were included in this study. The patients underwent CT angiography and transcranial Doppler examination. The results of CT angiography and transcranial Doppler examination for screening intracranial artery stenosis at different locations were evaluated. Taking CT angiography results as the gold standard, the efficacy of transcranial Doppler examination for screening intracranial artery stenosis at different locations was determined. The consistency of transcranial Doppler examination versus CT angiography in screening intracranial necrosis at different locations was evaluated. Results:The sensitivity of transcranial Doppler examination in the detection of intracranial artery stenosis at bilateral middle cerebral arteries, anterior cerebral artery, posterior cerebral artery, basilar artery, bilateral vertebral arteries, and internal carotid artery (Siphon segment) was 89.47%, 91.18%, 85.00%, 90.62%, 81.82%, 96.55%, respectively. The specificity of transcranial Doppler examination in the detection of intracranial necrosis at bilateral middle cerebral arteries, anterior cerebral artery, posterior cerebral artery, basilar artery, bilateral vertebral arteries, and internal carotid artery (Siphon segment) was 87.30%, 95.35%, 91.25%, 94.32%, 96.33%, and 87.88%, respectively. The Kappa value for judging the consistency between transcranial Doppler examination and CT angiography in the detection of intracranial artery stenosis at bilateral middle cerebral arteries, anterior cerebral artery, posterior cerebral artery, basilar artery, bilateral vertebral arteries, and internal carotid artery (Siphon segment) was 0.766, 0.858, 0.758, 0.833, 0.800, and 0.852, respectively.Conclusion:Transcranial Doppler examination has high sensitivity and specificity in the detection of intracranial artery stenosis at different locations. Its screening results are highly consistent with those from CT angiography. Transcranial Doppler examination is of high clinical application value.
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Objective:To construct an evaluation index system for the risk factors of peripheral venous indwelling catheter failure in adults.Methods:Through literature review, focus group interview method and Delphi method, an evaluation index system for risk factors of peripheral venous indwelling catheter failure in adults was established.Results:The recovery rate of the two round were both 100%; the authority coefficient was 0.939, the coordination coefficient was 0.452 and 0.315 respectively ( χ2=607.88, 502.45, P<0.05). Finally an evaluation index system for adult peripheral venous indwelling needle catheter failure risk factors including puncture factors, patient factors, indwelling needle placement factors, indwelling needle maitenance and withdrawal factors and 54 second-level indicators were formed. Conclusions:The construction of adult peripheral venous indwelling needle catheter failure risk factor assessment system is reasonable and comprehensive in content, which provides reference for clinical nurses to evaluate and prevent the failure of adult peripheral venous catheter failure.
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@#AIM: To investigate the effect of triamcinolone acetonide(TA), artesunate(ART), and luteolin(LU)on the prevention and treatment of traumatic proliferative vitreoretinopathy(TPVR). <p>METHODS: Forty-eight cyanotic blue rabbits were selected to prepare TPVR animal models by making a penetrating eye injury and intravitreal injection of 0.3mL platelet-rich plasma, and were randomly divided into four groups(<i>n</i>=12), in which the vitreous cavity of the control group was injected with 0.1mL saline; The vitreous cavity of the TA group was injected with 0.1mL(1mg/mL)triamcinolone acetonide; The vitreous cavity of the ART group was injected with 0.1mL(20μg/mL)artesunate; 0.1mL(10μg/mL)luteolin was injected into the vitreous cavity of the LU group. The vitreous and retinal proliferation were observed by fundus photography and ocular ultrasound at 1, 2, 3 and 4wk postoperatively. The expression levels of α-SMA and VIM protein in the vitreous fluid of each group of rabbit eyes were detected by Western Blot at 28d postoperatively, and the retinal tissue structure of each group was observed by retinal HE staining. <p>RESULTS: At 28d postoperatively, the TPVR grading of rabbit eyes in the TA, ART and LU groups were significantly lower than that in the control group(<i>P</i><0.05), and the TPVR grading of rabbit eyes in the TA group was significantly lower than that in the ART and LU groups(<i>P</i><0.05). The expression levels of α-SMA and VIM proteins in the vitreous fluid of the rabbit eyes in the TA, ART and LU groups were significantly lower than those in the control group at 28d after surgery(<i>P</i><0.01). The results of HE staining showed that the arrangement of retinal layers in rabbit eyesin the control group were disordered, severely distorted or locally broken, the structure of each layer were unclear, the anterior membrane was obviously thickened, and the retina was obviously detached; The arrangement of retinal layersin rabbit eyes in the LU group were slightly distorted, inflammatory exudation was visible in front of the retina, and the retina was superficially detached; The structure of retina in rabbit eyes in the ART group were clear, with mild edema and superficial detachment; The structure of retinal layers in rabbit eyes in the TA group were clear, the arrangement was still neat, the retinal folds were locally visible, and there was no retinal detachment.<p>CONCLUSION: Intravitreal injection of triamcinolone acetonide, artesunate and luteolin were all effective in preventing and treating traumatic TPVR, among which triamcinolone acetonide has the most obvious effect.
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【Objective】 To analyze the changes of fibrinogen (Fg) and Ⅷ factor levels of cryoprecipitated coagulation factors prepared by different methods and post-preparation quick-freezing time. 【Methods】 The fresh frozen plasma (FFP), prepared from 400mL whole blood, was randomly divided into 6 groups(group A1, A2, A3, B1, B2, B3) with 20 eliquots each, to prepare cryoprecipitate coagulation factors. Group A1, B1 were prepared by automatic cryoprecipitation preparation instrument. group A2, B2 applied the instrument after centrifugation and group A3, B3 were prepared manually. The quick-freezing time after preparation in group A1-A3 and B1-B3 were different(within 1 hour vs. more than 1 hour after preparation). The automated coagulation analyzer was used to measure Fg and Ⅷ factor levels in six groups, and further statistical analysis was carried out. 【Results】 The Fg content (mg) of six groups were 245.29±27.44 in group A1, 227.13±18.68 in group A2, 221.11±20.95 in group A3, 182.12±9.15 in group B1, 163.68±15.50 in group B2, and 155.61±19.28 in group B3, respectively. The Ⅷ factor levels(IU) were of six groups were 115.86±27.99 in group A1, 93.79±36.29 in group A2, 91.92±34.75 in group A3, 83.04±18.82 in group B1, 66.33±19.57 in group B2, and 69.34±13.26 in group B3, respectively. There were no significant differences in gender or age between group As and groups Bs. The levels of Fg and Ⅷ factors in group A1 were significantly higher than those in group A2 and group A3 (P<0.05). In addition, the levels of Fg and Ⅷ factors in group B1 were also obviously higher than those in group B2 and group B3 (P<0.05). Further, the levels of Fg and Ⅷ factors in group As were significantly higher than those in group Bs (P<0.05). 【Conclusion】 The automatic cryoprecipitation preparation instrument plus quick-freezing within 1 hour after preparation contribute to a higher efficiency and better quality than others.
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【Objective】 To understand the distribution and gene frequency of main red blood cell blood groups in Lahu ethnic minority and analyze the genetic characteristics of Lahu people. 【Methods】 1) ABO forward and reverse typing had been performed by microplate method; 2) Rh, MN, H, P1Pk and Mur antigen were tested by the tube method. If the ABO forward and reverse typing were incompatible, the tube method was used for confirmation. 【Results】 The distribution characteristics of blood group and gene frequency in Lahu ethnic minority were as follows: B>O>A>AB for ABO, with genotype frequency as p 11.1%, q 27.5% and r 61.4%; the frequency of Rh genotype was CDe 83.3%, cDE 12.0%, cDe 2.42%, CDE 2.32%, CdE 0%, Cde 0%, cdE 0% and cde 0%; M > MN>N for MN blood group, with genotype frequency as M 75.26% and N 24.74%; P1
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Objective: To explore the effect of perioperative chemotherapy on the prognosis of gastric cancer patients under real-world condition. Methods: A retrospective cohort study was carried out. Real world data of gastric cancer patients receiving perioperative chemotherapy and surgery + adjuvant chemotherapy in 33 domestic hospitals from January 1, 2014 to January 31, 2016 were collected. Inclusion criteria: (1) gastric adenocarcinoma was confirmed by histopathology, and clinical stage was cT2-4aN0-3M0 (AJCC 8th edition); (2) D2 radical gastric cancer surgery was performed; (3) at least one cycle of neoadjuvant chemotherapy (NAC) was completed; (4) at least 4 cycles of adjuvant chemotherapy (AC) [SOX (S-1+oxaliplatin) or CapeOX (capecitabine + oxaliplatin)] were completed. Exclusion criteria: (1) complicated with other malignant tumors; (2) radiotherapy received; (3) patients with incomplete data. The enrolled patients who received neoadjuvant chemotherapy and adjuvant chemotherapy were included in the perioperative chemotherapy group, and those who received only postoperative adjuvant chemotherapy were included in the surgery + adjuvant chemotherapy group. Propensity score matching (PSM) method was used to control selection bias. The primary outcome were overall survival (OS) and progression-free survival (PFS) after PSM. OS was defined as the time from the first neoadjuvant chemotherapy (operation + adjuvant chemotherapy group: from the date of operation) to the last effective follow-up or death. PFS was defined as the time from the first neoadjuvant chemotherapy (operation + adjuvant chemotherapy group: from the date of operation) to the first imaging diagnosis of tumor progression or death. The Kaplan-Meier method was used to estimate the survival rate, and the Cox proportional hazards model was used to evaluate the independent effect of perioperative chemo therapy on OS and PFS. Results: 2 045 cases were included, including 1 293 cases in the surgery+adjuvant chemotherapy group and 752 cases in the perioperative chemotherapy group. After PSM, 492 pairs were included in the analysis. There were no statistically significant differences in gender, age, body mass index, tumor stage before treatment, and tumor location between the two groups (all P>0.05). Compared with the surgery + adjuvant chemotherapy group, patients in the perioperative chemotherapy group had higher proportion of total gastrectomy (χ(2)=40.526, P<0.001), smaller maximum tumor diameter (t=3.969, P<0.001), less number of metastatic lymph nodes (t=1.343, P<0.001), lower ratio of vessel invasion (χ(2)=11.897, P=0.001) and nerve invasion (χ(2)=12.338, P<0.001). In the perioperative chemotherapy group and surgery + adjuvant chemotherapy group, 24 cases (4.9%) and 17 cases (3.4%) developed postoperative complications, respectively, and no significant difference was found between two groups (χ(2)=0.815, P=0.367). The median OS of the perioperative chemotherapy group was longer than that of the surgery + adjuvant chemotherapy group (65 months vs. 45 months, HR: 0.74, 95% CI: 0.62-0.89, P=0.001); the median PFS of the perioperative chemotherapy group was also longer than that of the surgery+adjuvant chemotherapy group (56 months vs. 36 months, HR=0.72, 95% CI:0.61-0.85, P<0.001). The forest plot results of subgroup analysis showed that both men and women could benefit from perioperative chemotherapy (all P<0.05); patients over 45 years of age (P<0.05) and with normal body mass (P<0.01) could benefit significantly; patients with cTNM stage II and III presented a trend of benefit or could benefit significantly (P<0.05); patients with signet ring cell carcinoma benefited little (P>0.05); tumors in the gastric body and gastric antrum benefited more significantly (P<0.05). Conclusion: Perioperative chemotherapy can improve the prognosis of gastric cancer patients.
Subject(s)
Female , Humans , Male , Chemotherapy, Adjuvant , Gastrectomy , Neoadjuvant Therapy , Neoplasm Staging , Prognosis , Retrospective Studies , Stomach Neoplasms/surgeryABSTRACT
Stroke is a destructive cerebrovascular event caused by the interruption of cerebral blood flow caused by the blockage or rupture of cerebral vessels， which is easy to cause physical disability and multiple functional injuries. The mortality rate of stroke patients in China occupies the first place in the world. How to effectively treat stroke is one of the urgent health problems to be solved. In the clinic， academician WANG Yong-yan observed that 60% of stroke patients with heat-phlegm and sthenic-Fu syndrome. Most of the patients with heat-phlegm and sthenic-Fu syndrome are characterized by stagnation of stool， bad breath and dry pharynx， and so on， After clinical practice， Xinglou Chengqi decoction （XLCQD） was established to treat stroke patients with heat-phlegm and sthenic-Fu syndrome. XLCQD is one of the representative prescriptions for removing phlegm to relax bowels， which is composed of Rhei Radix et Rhizoma， Natrii Sulfas， Trichosanthis Fructus and Arisaema Cum Bile by the ratio of 5∶5∶15∶3. At present， the research on XLCQD is mainly focused on clinical observation and pharmacological mechanism， while the basic research of its pharmacodynamic substance is relatively weak. This paper intends to sort out the chemical composition and pharmacological mechanism of XLCQD， in order to provide the basis for the chemical component identification， drug target prediction and material basis screening of this compound in the later stage. In addition， through the case analysis of XLCQD and modified XLCQD in the treatment of stroke， its rules of clinical application were summarized， in order to provide reference for the clinical application of this compound.
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ObjectiveTo investigate the clinical features of patients with hepatic myelopathy (HM) in China. MethodsThe articles on HM, published in China from January 2009 to December 2018, were collected to analyze the clinical features, laboratory examination results, diagnosis, treatment, and prognosis of HM patients. ResultsA total of 94 articles were included, with 562 patients in total, among whom there were 489 male patients and 73 female patients. Their age ranged from 17-81 years, with a mean age of 46.3±17.5 years. Hepatitis B cirrhosis was the most common etiology (64.4%), followed by alcoholic cirrhosis (10.3%) and hepatitis C cirrhosis (9.2%). The clinical manifestations of HM mainly included decline of muscle strength (89.50%), tendon hyperreflexia (76.87%), ataxia, and movement disorder (76.51%). Laboratory examination showed an increase in blood ammonia by 92.31% and a reduction in albumin by 88.96%. Imaging diagnosis mainly depended on electromyography (64.92%) and spinal cord MRI (22.82%), and abdominal color Doppler ultrasound, CT, or MRI alone has limited clinical value. After comprehensive medical treatment, no patient (0%) was cured, 106 patients (18.86%) were improved, 211 patients (37.54%) had no response, 31 patients (5.52%) worsened, 129 patients (22.95%) died, and 53 patients (9.43%) were not explained. A total of 39 patients underwent liver transplantation, with an improvement rate of 5641%. ConclusionHM is a rare complication of end-stage liver disease and is mainly observed in middle-aged men. It has the main manifestation of chronic and progressive spastic paraplegia of both lower limbs. Currently, there is no effective treatment method, and liver transplantation is feasible for some patients, with poor treatment response and poor prognosis.
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Over the past decade, traditional Chinese medicine (TCM) has widely embraced systems biology and its various data integration approaches to promote its modernization. Thus, integrative pharmacology-based traditional Chinese medicine (TCMIP) was proposed as a paradigm shift in TCM. This review focuses on the presentation of this novel concept and the main research contents, methodologies and applications of TCMIP. First, TCMIP is an interdisciplinary science that can establish qualitative and quantitative pharmacokinetics-pharmacodynamics (PK-PD) correlations through the integration of knowledge from multiple disciplines and techniques and from different PK-PD processes