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Objective:To explore the clinical characteristics, treatment regimens and prognostic influencing factors of patients with multiple myeloma (MM) involving central nervous system (CNS).Methods:The clinical data of 18 MM patients involving CNS in Second Affiliated Hospital of Naval Medical University from January 2014 to June 2020 were retrospectively analyzed. Their clinical characteristics, treatment and prognosis were also analyzed. Kaplan-Meier method was used to make survival analysis and log-rank was performed; Cox proportional risk model was used to make univariate and multivariate analysis.Results:The cohort of 18 patients included 12 males and 6 females; the median age of patients involving CNS was 54 years (38-71 years). The median time from diagnosis to the involvement of CNS was 22 months (0-126 months).Among 18 patients, 1 case was primary MM involving CNS, and 17 cases were secondary MM involving CNS. All patients had Durie-Salmon (DS) stage Ⅲ; 10 cases had international staging system (ISS) stage Ⅲ, 6 cases had ISS stage Ⅱ, and 2 cases had ISS stage Ⅰ. Involvement sites of CNS included 7 cases of involving the dura mater alone and 4 cases of involving the pia mater alone, 2 cases of involving brain parenchyma and 5 cases of involving both meninges and brain parenchyma. The most common neurological symptoms were headache and cranial nerve palsy, and 9 patients had multiple neurological symptoms. All patients received systemic therapy, 16 patients received an intrathecal injection and/or radiotherapy; and the overall effective rate was 66.7%, including 3 achieving strict complete remission (sCR), 1 achieving complete remission (CR), 3 achieving very good partial remission (VGPR), 5 achieving partial remission (PR). The median overall survival (OS) was 32.7 months. Counting from the point of CNS involvement, the median progression-free survival (PFS) and OS time was 7.5 months, 12.2 months, respectively. The median PFS of MM patients in the dura-involved alone group was longer than that in the non-dura-involved alone group (15.1 months vs. 5.9 months, P = 0.009); the median OS of MM patients in the dura-involved alone group was longer than that in the non-dura-involved alone group (16.9 months vs. 10.7 months, P = 0.175). Multivariate Cox analysis showed that dura mater involvement alone was an independent factor affecting PFS in MM patients with CNS involvement ( HR = 0.191,95% CI 0.038-0.952, P = 0.043). Conclusions:MM involving CNS is rarely found and has a very poor prognosis. Different sites of CNS involvement could affect the prognosis of patients. There is a lack of effective treatment regimens.
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OBJECTIVES@#To construct a quantitative index system with the integrated medical and nursing care assessment for the elderly service needs, this system can assess the cost of medical and care services accurately and objectively, so as to provide scientific basis for the allocation of old-age service resources in China.@*METHODS@#Based on the survival needs of the Existence, Relation and Growth theory, an index system is constructed through literature analysis, group discussion, and expert correspondence. Analytic hierarchy process was used to determine the weights of indicators at all levels. The 3-grades service items corresponding to each index were quantified through the measurement of working hours, and the medical and nursing care needs of 624 disabled/demented elderly people over 60 years old in Changsha were investigated to evaluate their reliability and validity.@*RESULTS@#The authoritative coefficients of the 2 rounds of expert correspondence were 88.5% and 88.6%, respectively, and the opinion coordination coefficients were 0.159 and 0.167, respectively. The final quantitative evaluation index system included 4 first-level indicators, 17 second-level indicators, and 105 third-level indicators. The service time of doctor ranged from 6.01 to 22.64 min, the service time of nurses ranged from 0.77 to 24.79 min, and the service time of caregiver ranged from 0.12 to 51.88 min. The Cronbach's αcoefficient was 0.73, the split-half reliability was 0.74, the content validity was 0.93, and the calibration validity was 0.781.@*CONCLUSIONS@#The quantitative evaluation index system of medical and nursing service need for the elderly can be used to accurately evaluate the medical and nursing service need.
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Humans , Aged , Middle Aged , Reproducibility of Results , Surveys and Questionnaires , Delphi Technique , Nursing Care , ChinaABSTRACT
OBJECTIVES@#This work aimed to investigate the molecular mechanism of cyclic tensile stress (CTS) stimulating autophagy in human periodontal ligament cells (hPDLCs).@*METHODS@#hPDLCs were isolated and cultured from normal periodontal tissues. hPDLCs were loaded with tensile stress by force four-point bending extender to simulate the autophagy of hPDLCs induced by orthodontic force du-ring orthodontic tooth movement. XMU-MP-1 was used to inhibit the Hippo signaling pathway to explore the role of the Hippo-YAP signaling pathway in activating hPDLC autophagy by tensile stress. The expression levels of autophagy-related genes (Beclin-1, LC3, and p62) in hPDLCs were detected by real-time quantitative polymerase chain reaction. Western blot was used to detect the expression levels of autophagy-related proteins (Beclin-1, LC3-Ⅱ/LC3-Ⅰ, and p62) and Hippo-YAP pathway proteins (active-YAP and p-YAP) in hPDLCs. Immunofluorescence was used to locate autophagy-related proteins (LC3-Ⅱand p62) and Hippo-YAP pathway proteins (active-YAP) of hPDLCs.@*RESULTS@#CTS-activated autophagy in hPDLCs and expression of autophagy-related proteins initially increased and then decreased; it began to increase at 30 min, peaked at 3 h, and decreased (P<0.05). CTS increased the expression of active-YAP protein and decreased the expression of p-YAP protein (P<0.05). When XMU-MP-1 inhibited the Hippo-YAP signaling pathway (P<0.05), active-YAP protein was promoted to enter the nucleus and autophagy expression was enhanced (P<0.05).@*CONCLUSIONS@#The Hippo-YAP signaling pathway is involved in the regulation of autophagy activation in hPDLCs under CTS.
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Humans , Hippo Signaling Pathway , Periodontal Ligament/metabolism , Beclin-1/metabolism , Cells, Cultured , AutophagyABSTRACT
Digital polymerase chain reaction (dPCR) is an absolute quantitative technique that has been rapidly developed in recent years. This technique assigns the reaction system containing DNA template to a large number of independent reaction units for PCR, and calculates the DNA copy number according to the Poisson distribution and statistical positive signals. In contrast to conventional qPCR, dPCR does not depend on amplification curves, is not affected by amplification efficiency, thus has high accuracy and repeatability, and can achieve the absolute quantification. This article reviews the development history of dPCR and its application in molecular diagnosis, tumor liquid biopsy and prenatal diagnosis of infectious diseases, and looks forward to the application prospect of this technology.
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Objective@#To investigate the awareness and identify the influencing factors of sexual knowledge among primary and middle school students in Butuo County, Sichuan Province, so as to provide insights into sex education.@*Methods@#Six primary and middle schools were randomly sampled from 40 primary and middle schools in Butuo County using the cluster sampling method on March and April, 2021, and a class was randomly sampled from each of grades 4 to 6 of primary schools and grades 1 to 3 of junior high schools, with all students from the class as study subjects. Students' demographic features and awareness of sexual knowledge were investigated using self-designed questionnaires, and the factors affecting the awareness of sexual knowledge were identified among primary and middle school students using multivariable linear regression analysis.@*Results@#A total of 980 questionnaires were allocated, and 957 valid questionnaires were recovered, with an effective recovery rate of 97.65%. The respondents included 458 boys ( 47.86% ) and 499 girls ( 52.14% ), and included 908 students with Yi Ethnicity. The respondents included 802 primary school students ( 83.80% ) and 155 junior high school students ( 16.20% ). The awareness of sexual knowledge was 21.94% among the primary and middle school students, and their sexual knowledge was predominantly derived from parents ( 338 students, 35.32% ) and teachers ( 335 students, 35.01% ). The awareness of sexual knowledge was significantly lower in boys than in girls ( 17.69% vs. 25.86%; χ2=8.344, P=0.004 ), and the awareness of sexual knowledge appeared a tendency towards a rise with age ( χ2trend = 63.908, P<0.001 ). Low awareness of sexual knowledge was seen in students with fathers going out for labor ( 19.54% ), mothers going out for labor (11.24%) and living in the countryside ( 14.32% ) ( χ2=7.790, 9.224 and 34.144, all P<0.01 ). Multivariable linear regression analysis showed that students living in the countryside, students’ mothers going out for labor, ages of 12 to 14 years and ages of over 14 years were factors affecting the score of sexual knowledge ( β'=-0.072, 0.341, 0.645 and 0.843, all P<0.05 ).@*Conclusions@#The awareness of sexual knowledge is low among primary and middle school students in Butuo County. Health education of sexual knowledge should be emphasized on male students, those living in the countryside and students with mothers going out for labor.
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Objective:To establish a method of serum detection by Raman spectroscopy for the diagnosis of gastric cancer.Methods:Between April and November 2019, 110 patients with gastric cancer [73 males, 37 females, age (57.4±10.3) years] and 74 patients with colorectal cancer [48 males and 26 females, aged (58.3±12.2) years] were collected at the First Affiliated Hospital of Army Military Medical University, along with 100 healthy subjects [59 males and 41 females, aged (55.6±10.61) years] during the same period. Fasting venous blood serum samples were collected from the subjects. A Raman spectrometer XploRA PLUS was used in this experiment, with an excitation light source of 532 nm, a field of view of 100 times, and a spectrum range of 200-2 000 cm -1, etc. The serum samples were detected by nondestructive and non-contact rapid detection, and the Raman spectra of serum samples were collected. Using the Raman spectrum acquisition and processing supporting software LabSpec6 to smooth, baseline, and normalize the obtained Raman spectrum. Multivariate statistical analysis software SIMCA14.1 were applied to import and analyze the obtained Raman spectrum data by principal component analysis (PCA), orthogonal partial least squares discriminant analysis (OPLS-DA), and other methods for statistical analysis. An operating characteristic curve (ROC) was constructed to evaluate the model analysis effect between serum samples of healthy people and those with gastric cancer. Serum samples from the colorectal cancer group were used to verify the reliability of the model. Results:Six Raman peaks with good repeatability were detected in serum samples in health and gastric cancer group, and peaks were located at 1 001.17, 1 154.63, 1 337.89, 1 446.85, 1 515.33, and 1 658.34 cm -1, respectively. Raman intensities at six Raman peaks were significantly different between healthy and gastric cancer groups. At the displacement of 1 001.17, 1 154.63, and 1 515.33 cm -1, the Raman intensity in the healthy group was higher than that in the gastric cancer group. At 1 337.89, 1 446.85, and 1 658.34 cm -1 displacement, the Raman intensity of the gastric cancer group was higher than that of the healthy group. An OPLS-DA model was constructed to analyze the serum samples of the healthy group and the gastric cancer group. In the model, R 2 is the fitting power, and Q 2 is the predictive ability. The closer the values of R 2 and Q 2 are to 1, the better the performance of the model, and the obtained model's R 2X(cum)=0.809, R 2Y(cum)=0.819, Q 2(cum)=0.758. ROC characteristic curve was drawn based on the OPLS-DA model. The area under the curve (AUC) of the gastric cancer group was 0.998. Six peaks with good repeatability were detected in the serum Raman spectra of gastric cancer stage Ⅰ, Ⅱ, Ⅲ, and Ⅳ, which were located at the displacement of 1 001.85, 1 155.07, 1 338.36, 1 445.75, 1 515.92, and 1 657.68 cm -1, respectively, and at the displacement of 1 155.07 and 1 515.92 cm -1. The Raman intensity of gastric cancer stage Ⅳwas significantly higher than that of gastric cancer stages Ⅰ, Ⅱ, and Ⅲ. Conclusions:According to the model reliability verification, the healthy group, gastric cancer group and colorectal cancer group can also be effectively separated based on OPLS-DA results; it showed a good performance in separating the healthy group from the gastric cancer group. It is possible to detect serum samples from healthy people and gastric cancer patients unlabeled by combining Raman spectroscopy and the OPLS-DA method in multivariate statistics.
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Objective:To investigate the effects of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in treatment of high-risk multiple myeloma (MM) patients and its influencing factors of the prognosis.Methods:The clinical data of 44 high-risk MM patients treated with allo-HSCT in Changzheng Hospital Affiliated of Naval Military Medical University from April 2003 to March 2017 were retrospectively analyzed. The overall response rate (ORR), relapse rate, non-relapse-related death (NRM) rate, graft-versus-host disease (GVHD) incidence of patients were also analyzed. Kaplan-Meier was used to analyze the overall survival (OS) rate and progression-free survival (PFS) rate after transplantation. Cox proportional hazard model was used to make regression analysis of the factors affecting the prognosis.Results:Among 44 patients, 38 cases could be evaluated for efficacy after transplantation. The median follow-up time was 111 months (0-216) months, 22 cases survived, 22 cases died, 21 cases relapsed. Before transplantation, complete remission (CR) rate was 29.5%(13/44), very good partial remission(VGPR) rate was 45.5%(20/44), partial remission (PR) rate was 22.7% (10/44), stable disease (SD) rate was 2.3% (1/44); After transplantation, CR rate was 71.7%(27/38), VGPR rate was 13.2% (5/38), PR rate was 13.2% (5/38), the progression of the disease (PD) rate 2.6% (1/38). The 5-year OS rate and PFS rate was 51.8% and 47.8%, the 10-year OS rate and PFS rate was 51.3% and 43.1%, respectively; the 5-year and 10-year cumulative disease relapse rate was 38.6% and 45.4%, the 5-year cumulative NRM rate was 25.0%. Acute GVHD rate was 38.6% (17/44) and grade 3-4 acute GVHD rate was 6.8% (3/44); chronic GVHD rate was 27.3% (12/44). Cox univariate and multivariate analysis showed that the use of bortezomib before transplantation ( HR = 3.461, 95% CI 1.211-9.880, P = 0.020) and post-transplant infection ( HR = 0.283, 95% CI 0.098-0.819, P = 0.020) were independent factors affecting OS after transplantation. Conclusions:Allo-HSCT can overcome the high-risk factors of MM and is worth to try for high-risk MM patients. The use of bortezomib before transplantation and post-transplant infection can be important factors affecting OS after transplantation.
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Objective:To study whether the "combination of medical care and pension" service model can effectively control the development of chronic disease in the elderly and reduce the direct economic burden caused by the disease.Methods:A total of 180 elderly participants who received the "combination of medical care and pension" service model for chronic disease management in Chongqing, China were investigated and analyzed statistically. Epidata 2.0 was used for data entry, SPSS 20.0 was used for data analysis, and paired sample t test was used for comparison between groups. Results:After 12 months of chronic disease management, hospitalization events and expenses of the elderly were reduced, among which the number of hospitalization was reduced by 0.24 timed on average, the length of hospitalization was reduced by 10.41 days on average, and the hospitalization expenses were reduced by 11 144 yuan on average. The direct economic burden due to chronic diseases was reduced by approximately 8 844.5 yuan, accounting for 33.8% of the average cost of hospitalization for the elderly without the application of the model.Conclusion:The chronic disease of the elderly is well controlled by chronic disease management through the "combination of medical care and pension" service model.
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Objective:To explore the clinical effect and nursing experience of papaverine intramuscular injection after finger replantation with self-designed hip intramuscular injection positioning device.Methods:Totally 216 cases of patients treated with palavering for anti-vasospasm after of severed fingers from January 2018 to December 2019 were randomly divided into control group (108 cases) and observation group (108 cases) by random number table method. The control group received intramuscular injection of buttock muscle according to the conventional method, and the observation group used the auxiliary intramuscular injection with self-designed glutei muscle positioning device. The incidence of postoperative hip indurations and ecchymosed, survival rate of and buttock were analyzed Pain scores were compared.Results:Totally 76 cases (70.37%) and 62 cases (48.15%) in the control group, 12 cases (11.11%) and 6 cases (5.56%) in the observation group. The difference between the two groups was statistically significant ( χ2 values were 78.545, 67.307, P<0.01). 78 cases (72.22%) survived in the control group and 96 cases (88.89%) survived in the observation group ( χ2 value was 11.416, P<0.01). After papaverine intramuscular injection, there was no significant difference in hip pain score between the two groups on the first and second day ( P>0.05), but there was significant difference between the two groups on the third to seventh day ( t values were 17.17 to 45.97, P<0.05). Conclusion:Palavering intramuscular injection can reduce the incidence of hip indurations and ecchymosed, relieve buttock pain and improve the survival rate of amputated finger, which is worthy of clinical application.
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Objective:To explore the effect of self-designed fixed support in the postoperative nursing of abdominal flap repair.Methods:From January 2016 to December 2019, 47 patients with hand tissue defects undergoing abdominal skin flap repair in Shajing People′s Hospital, Guangzhou Medical University were divided into control group (23 cases) and observation group (24 cases) by random digits table method. The control group was treated with traditional methods, and the observation group was treated with self-designed fixed support. The wound healing of abdominal flap, the wound tearing after flap operation, pedicle ulcer after flap operation and the patients' nursing satisfaction were compared between the two groups.Results:There were 7 cases of primary healing and 16 cases of secondary healing in the control group, 18 cases of primary healing and 6 cases of secondary healing in the observation group. The difference between the two groups was statistically significant ( χ2 value was 9.368, P<0.01). The incidence rate of the wound tearing after flap operation was 26.1% (6/23) in the control group and 0 (0/24) in the observation group. The difference between the two groups was statistically significant ( χ2 value was 7.177, P<0.05). The incidence rate of pedicle ulcer after flap operation was 69.6% (16/23) in the control group and 33.3% (6/23) in the observation group. The difference between the two groups was statistically significant ( χ2 value was 6.170, P<0.05). The patients' nursing satisfaction was (76.8±8.4)points in the control group and (90.4±6.5) points in the observation group.The difference between the two groups was statistically significant (t value was -4.640, P<0.01). Conclusions:The use of fixed support after the operation of abdominal flap is helpful to the wound healing, reduce the occurrence of wound tear and pedicle ulcer, and improve the satisfaction of nursing, which is worth popularizing.
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Objective To understand the status of depression and anxiety in patients with chronic hepatitis B in Tianjin, and to analyze its influencing factors, so as to provide references for scientific psychological intervention and health education. Methods Chronic hepatitis B cases whose addresses were Tianjin were randomly selected from the report of infectious disease surveillance system from January 2018 to December 2019 as the study subjects. A certain number of healthy people living in Tianjin were selected as the control. A unified mental health questionnaire survey was conducted by telephone follow-up or face-to-face survey. The distribution characteristics of depression and anxiety were described, and influencing factors of depression and anxiety were analyzed by univariate and multivariate logistic regression analysis. Results A total of 825 cases of chronic hepatitis B and 376 cases of healthy people were investigated. The crude SDS and SAS were (35.47±9.34) and (32.33±8.26), respectively, which were higher than those of healthy people ( P <0.05). The rates of depression and anxiety in chronic hepatitis B patients were 25.45% and 20.61%, respectively, which were significantly higher than those in healthy people (15.96% and 11.70%, respectively) (P < 0.001). The analysis of depression influencing factors showed that the OR of high average monthly income was 0.791 ( 95% CI：0.655～0.955 ), the OR of not knowing correct preventive measures was 1.509 (95% CI：1.084～2.102 ), and the OR of feeling discriminated was 1.650 ( 95% CI：1.166～2.335 ). The multifactor analysis of anxiety influencing factors showed that the OR of not knowing correct preventive measures was 1.490 ( 95% CI:1.049～2.117)), while the OR of feeling discriminated was 1.854 ( 95% CI: 1.289～2.666). Conclusion The levels of depression and anxiety of chronic hepatitis B patients were higher than that of general healthy people. Not knowing correct preventive measures and feeling discriminated in daily life were risk factors while high income was a protective factor.
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Objective@#To describe the epidemiological characteristics of a cluster of COVID-19 cases reported in Baodi district of Tianjin as of 18 February, 2020, which might be associated with the exposure in a local department store, and provide suggestions for prevention and control strategy development.@* Methods@#The basic characteristics, time and area distributions, clinical manifestations, epidemiological history and transmission mode of the COVID-19 cases associated with the department store exposure were analyzed.@* Results@#A total of 40 COVID-19 cases were associated with the department store exposure, accounting for 75.47% of the total confirmed cases (53 cases) reported in Baodi district. The cases were mainly at the age of 60 years or older (35.00%) and farmers (40.00%). The main clinical manifestations included fever (95.00%), cough (35.00%), and diarrhea (15.00%). The proportion of confirmed severe cases was 32.50%. The incidence curve showed that the incidence peak occurred on 31 January, 2020. Among the 40 cases, 6(15.00%) were department store employees, 19(47.50%) were customers and 15(37.50%) were close contacts (secondary cases). The first case occurred on 21 January, 2020, this case was a department store employee who had a purchasing history at whole sale markets in other provinces and cities before the onset, and 3 employees were still on duty after symptom onsets. The median of the incubation period of customer cases was 6 days, and the median of the interval between onset and medical treatment of customer cases was 7 days.@* Conclusion@#This was a cluster epidemic of COVID-19, which might be associated with the exposure in the department store. By now, the current prevention and control measures have achieved satisfied effects.
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OBJECTIVE：To systematically evaluate therapeutic efficacy and safety of Breviscapine injection combined with routine treatment of acute exacerbation of chronic obstructive pulmonary disease （AECOPD），and to provide evidence-based reference for clinical drug use. METHODS ：Retrieved from Cochrane Library ，PubMed，Embase，CBMdisc，CNKI，VIP and Wanfang database ，randomized controlled trials （RCTs）about Breviscapine injection combined with routine treatment （trial group ） versus routine treatment （control group ）in the treatment of AECOPD were collected. After literature screening and data extraction ， the qualities of literatures were evaluated with modified Jadad scale ；Meta-analysis was performed by using Rev Man 5.2 statistical software. RESULTS ：A total of 19 RCTs were included ，involving 1 930 patients. Results of Meta-analysis showed that total response rate [OR ＝2.80，95％ CI （1.96，4.01），P＜0.000 01]，FEV1[MD＝0.65，95％ CI（0.57，0.72），P＜0.000 01]， FEV1％[MD＝5.33，95％CI（0.31，10.35），P＝0.04]，FVC[MD＝0.69，95％CI（0.23，1.16），P＝0.004]， FEV1/FVC [MD ＝ 4.83，95％CI（0.98，8.67），P＝0.01]，PEF [M D＝0.95，95％CI （0.57，1.33），P＜0.001]，PaO2 [MD＝4.70，95％CI（2.02， No.81402991） + 7.37），P＜0.001]，CD3 level [MD ＝5.11，95％ CI（3.04， 7.18），P＜0.001] and CD 4+ level [MD ＝2.62，95％CI（1.78， qq.com 3.47），P＜0.001] of trial group were significantly higher than those of control group ；PaCO2 [MD＝－3.33，95％CI（－5.02， －1.65），P＜0.001]，CD8+ level [MD ＝－2.55，95％CI（－4.28，－0.82），P＜0.004]，cough relief time [MD ＝－1.93，95％CI （－2.24，－1.63），P＜0.001]，sputum remission time [MD ＝－2.19，95％CI（－2.48，－1.89），P＜0.001]，wheezing remission time [MD ＝－1.59，95％CI（－1.86，－1.32），P＜0.001] and hospital stay [MD ＝－1.73，95％CI（－2.06，－1.39），P＜0.001] of trial groups were significantly lower or shorter than those of control group ；there was no statistical significance in CD 4+/CD8+ between 2 groups [MD ＝－0.11，95％CI（－0.23，0.01），P＝0.06]. In terms of safety ，3 studies reported the occurrence of ADR ， and no serious ADR occurred. CONCLUSIONS ：Breviscapine injection can improve clinical efficacy and lung function ，enhance immunity in patients with AECOPD with good safety.
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Objective@#To evaluate the prognostic value of serum free light chain ratio (rFLC) and difference (dFLC) in patients with multiple myeloma (MM) .@*Methods@#Clinical data of 479 cases of newly diagnosed MM patients with FLC test records referred to our hospital from January 2012 to March 2016 were collected. rFLC preferred cut-off values were selected as≤14.828,14.828-364.597, ≥364.597 according to the literatures. The dFLC was divided into ≤112.85,112.85-2891.83, ≥2891.83 mg/L three groups. The rFLC and dFLC values among the death, the non-death, the progress and the non-progress groups were compared by t test. The correlation analysis showed that the rFLC and dFLC values were related to the death or progression of the disease. Logistic regression was used to analyze the correlation between each factor and death or progression. Univariate survival analysis (PFS) and total survival (OS) were performed using Kaplan-Meier. Single-variable and multivariate prognostic analysis were performed using Cox model.@*Results@#The cutoff values of rFLC less than 14.828 or dFLC less than or equal to 112.85 mg/L impacted most significant on OS and PFS of the patients (P<0.05) . Different rFLC cut-off values between two groups showed that when rFLC=14.828, OS was significantly better than the other two groups (NR vs 61 & 47 months, P=0.019) ; different dFLC cut-off values between two groups disclosed that PFS and OS were statistically significant when dFLC less than or equal to 112.85 mg/L compared with the other two groups (P<0.05) . The 4-year PFS/OS rates in the initial dFLC≤112.85 mg/L and rFLC≤14.828 groups was significantly higher than of the other two groups.@*Conclusion@#Different cutoff levels of rFLC and dFLC might have obviously effects on the prognoses of patients with newly diagnosed MM. The difference of survival prognosis would be more pronounced when rFLC≤14.828 or dFLC≤112.85 mg/L with lower risk of death and lower risk ratio, which might be ideal cutoff value for determining the prognosis of these patients.
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Objective@#Practice of setting up campus clinics in school,to explore adolescent outpatient service mode to better meet the diversified demands of teenagers,and to promote more effective implementation of adolescent health care.@*Methods@#Campus-based adolescent outpatient clinics were established in 2 universities in Chongqing,a questionnaire survey was conducted among 136 students who participated in the consultation, campus-based outpatient services and adolescents’ satisfaction towards the services were analyzed. Hospital adolescent outpatient services were compared before and after the establishment of campus adolescent clinic.@*Results@#Most of adolescent outpatient clinic in hospitals offered disease-based treatment instead of consultation. The overall satisfaction rate was 94.85%, and the satisfaction towards service ability, communication skills, outpatient time arrangement, and privacy protection was 96.32%, 96.32%, 88.97% and 94.12%, respectively. After the establishment of campus adolescent outpatient clinics, adolescent outpatient services in hospital increased dramatically including consultation.@*Conclusion@#It is necessary to offer adolescent outpatient services in schools, which are more helpful for the diversified demands of teenagers.
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Objective To access the clinical effect of medical radiation protective ointment compared with trolamine cream to prevent acute radiation-induced skin injury in breast cancer patients undergoing radiotherapy after modified radical mastectomy. Methods Between February 2017 and February 2018,a total of 120 stage T1-4 N1-3 M0 eligible patients received intensity modulated radiation therapy were enrolled and matches into two groups:study group (60 cases) was administered medical radiation protective ointment from the first irradiation fraction,and control group (60 cases) received trolamine cream. When 3 grade reaction was observed,patients in control group start to administer medical radiation protective ointment until a month after radiation. Results The occurrence rate of acute breast dermal radiation reaction was 100％.Most patients in study group only underwent 1 grade radiation reaction (82％),while 2 and 3 grade radiation reaction (47％ and 13％) in control group were common ( P= 0. 000). Both pruritic degree and pain degree were higher in control group compared with study group (both P= 0. 000).In study group,the occurrence of 2 grade acute radiation-induced skin injury was obviously later than in control group with significant difference (P= 0. 000).Patients observed with 3 grade reaction relieved to certain reaction after administering medical radiation protective ointment. Conclusions Medical radiation protective ointment can effectively both alleviate and delay acute radiation-induced skin injury compared with trolamine cream. It also has therapeutic effect on 3 grade radiation reaction.
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Objective To prospectively evaluate the short-term test-retest reproducibility of intravoxel incoherent motion (IVIM) parameters for lung cancer,and to investigate its impact factors.Methods Thirty-eight lung cancer patients underwent twice free breathing IVIM scanning (0.5-1.0 h interval).Two radiologists independently analyzed IVIM images to obtain true diffusion coefficient (D),pseudo-diffusion coefficient (D*) and perfusion fraction (f).All the parameters were compared between repeated measurements and scans.Intra-and inter-observer,test-retest reproducibility was assessed with interclass correlation coefficients (ICCs).The impact of lung cancer type (peripheral and central),size (the largest diameter ≥2 cm and ＜2 cm) and location (upper,mid,and lower lung field) on short-term reproducibility were compared by using coefficient of variations (WCVs).Results There was no significant difference between repeated measurements for all parameters (all P＞ 0.05).All the parameters showed good intra-and inter-observer agreement.WCVsof D* and f (19.88％-36.83％) were higher than those of D (2.97％-4.62％).WCVs of D were higher for central lung cancer and the largest diameter ＜2 cm,and increasing from apical to lower zone.WCV of f was larger in the central lung cancer and the largest diameter ≥2 cm,while D* was greatly influenced by type,size and location of lung cancer.Conclusion The test retest reproducibility of D is good,while of D* and f are poor in lung cancer.The type,size and location of lung cancers are the impact factors of IVIM parameters.
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Objective To explore the effect of early stage of comprehensive lung rehabilitation on cervical spinal cord injury in patients with mechanical ventilation.Methods The patients with cervical spinal cord injury admitted from January to December 2015 were selected as the control group which was treated with routine nursing measures.The patients with cervical spinal cord injury admitted from January to December 2016 were selected as the treatment group,which received early stage lung rehabilitation measures.We compared two groups of patients in the using time of breathing machine,the total length of hospital stay and pulmonary infection rate.Results The duration of mechanical ventilation and hospitalization days in the control group were(13.98±11.11),(25.10±16.98)d,which were higher than those in treatment group[(7.23±4.94),(16.26±6.41)d](P<0.05).The infection rates of control group and treatment group were 76.19％and 52.38％respectively,and the difference was significant(P<0.05).Conclusion In the early stages comprehensive pulmonary rehabilitation measures for mechanical ventilation in patients with cervical spinal injury can shorten the breathing machine use time and the total hospitalization days,and reduce pulmonary infection rate.
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Objective@#To investigate the pathogen spectrum distribution and drug resistance of febrile neutropenic patients with hematological diseases in Shanghai.@*Methods@#A retrospective study was conducted on the clinical isolates from the febrile neutropenic patients hospitalized in the departments of hematology in 12 general hospitals in Shanghai from January 2012 to December 2014. The drug susceptibility test was carried out by Kirby-Bauer method. WHONET 5.6 software was used to analyze pathogenic bacteria and drug susceptibility data.@*Results@#A total of 1 260 clinical isolates were collected from the febrile neutropenic patients. Gram-positive bacteria accounted for 33.3% and Gram-negative bacteria accounted for 66.7%. Klebsiella pneumoniae (12.5%) , Stenotrophomonas maltophilia (9.5%) , Escherichia coli (9.1%) , Pseudomonas aeruginosa (8.7%) , Acinetobacter baumannii (6.6%) , Staphylococcus aureus (5.6%) and Enterococcus faecium (5.0%) were ranked in the first 7 of all pathogens. In the respiratory tract secretions specimens, non-fermented strains accounted for 56.2%. Stenotrophomonas maltophilia accounted for 15.2%. Enterobacteriaceae and coagulase-negative Staphylococci accounted for 42.3% (104/246) and 32.6% (85/246) respectively in blood samples. Enterobacteriaceae and Enterococcus bacteria accounted for 39.4% (76/193) and 28.5% (55/193) respectively in pus specimens. The detection rates of methicillin resistant Staphylococcus aureus (MRSA) and methicillin resistant coagulase negative Staphylococci (MRCNS) were 54.3% and 82.5%, respectively. Staphylococcus bacterial strain was not found to be resistant to linezolid, vancomycin and teicoplanin. The detection rate of Enterococcus vancomycin-resistant strains was 8.9%. Enterococcus was not detected resistance to oxazolidinone strains. Enterobacteriaceae bacteria were highly sensitive to carbapenems. The resistance rate of Pseudomonas aeruginosa to imipenem and meropenem was 34.1% and 15.8%, respectively. Stenotrophomonas maltophilia was more sensitive to minocycline hydrochloride, levofloxacin and sulfamethoxazole. The resistance rate of Acinetobacter baumannii only to cefoperazone-sulbactam was less than 10.0%. The antibiotic resistance rate of Klebsiella pneumoniae, Stenotrophomonas maltophilia, Pseudomonas aeruginosa and Acinetobacter baumanii to most of common antibiotics was lower than that of the CHINET surveillance.@*Conclusions@#The pathogenic strain distribution in common infection sites of febrile neutropenic patients was characterized. Bacterial resistance surveillance was better than the CHINET nationwide large sample surveillance in China.
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Objective@#To explore the effect of 6 common cytogenetic abnormalities on the prognosis of multiple myeloma (MM).@*Methods@#Myeloma cells from a cohort of 532 newly-diagnosed MM patients enrolled were enriched by CD138 immunomagnetic beads, then detected 13q-, 17p-, 1q+, t (4;14), t (11;14) and t (14;16) and other common genetic abnormalities in MM by using interphase fluorescence in situ hybridization (FISH) technique to compare the influence of different genetic abnormalities on their prognoses.@*Results@#The rate of cytogenetic abnormalities was 78.20% (416/532) in 532 patients, of which 13q-accounted for 42.29% (225/532), 17p-16.35% (87/532), 1q+ 53.38% (284/532), t (4;14) 25.94% (138/532), t (11;14) 21.62% (115/532), t (14;16) 2.07% (11/532). Six kinds of cytogenetic abnormalities were analyzed, 13q- and 17p-, 1q+, t (4; 14), t (14;16) were all correlated (P <0.05). The univariate analysis indicated that 13q-, 1q+, t (4;14) and t (14;16) had a significant effect on progression-free survival (PFS), 13q-, 17p-, t (4;14) and t (14;16) had a marked influence on overall survival (OS). The multivariate analysis showed that 1q+, t (4;14) and t (14;16) were independent adverse factors of PFS, 17p-, t (4;14) and t (14;16) were independent unfavorable factors of OS. According to the independent prognosis factors number-based groups, the median PFS with 0, 1, 2, 3 independent prognosis factors of patients were 30.9, 28.4, 18.7 and 17.6 months (P =0.035) respectively, and the median OS were 54.4, 46.1, 38.0 and 21.2 months (P =0.004) respectively.@*Conclusion@#1q+, 17p-, t (4;14) and t (14;16) were independent prognostic factors affecting the survival of MM patients. 13q-is often accompanied by 17p-, 1q + and (or) t (4;14) , simply 13q- was not an independent prognostic factor; the more number of independent prognostic factors, the worse the prognosis of patients.