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Radiotherapy is an important treatment for abdominal and pelvic tumors, but it has a high incidence of the adverse reaction radiation enteritis. Abdominal and pelvic radiotherapy can induce apoptosis of intestinal crypt cells, destroy the intestinal barrier and change the composition of gut microbiota. Dysbiosis of gut microbiota can aggravate radiation enteritis. Fecal flora transplantation, as well as the use of probiotics, prebiotics and antibiotics can regulate gut microbiota, which is an effective method to prevent and treat radiation enteritis.
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Objective:Analysis of subtype distribution characteristics of human papillomavirus (HPV) infection, pathological findings of HPV-positive patients operated colposcopy and cervical histopathological examination in Changsha from 2020 to 2022.Methods:Retrospective analysis of HPV infection status of 60 354 patients was treated in the First Affiliated Hospital of Hunan University of Chinese Medicine from Jan. 2020 to Oct. 2022. They were divided into<25 years old group (3 250 cases), 25-34 years old group (19 406 cases), 35-44 years old group (17 297 cases), 45-54 years old group (13 104 cases), 55-64 years old group (4 793 cases) and≥65 years old group (2 504 cases). Cervical exfoliated cells were collected from women and specimen of lesion site were collected from men. HPV genotyping detection used polymerase chain reaction (PCR) and flow fluorescence hybridization, which could detect 27 HPV genotypes. Analyze the distribution of HPV subtypes in patients of different age groups and different treatment departments. Analyze the relationship between the infection of HPV subtypes and the outcome of 224 patients with HPV positive who also underwent colposcopy and cervical histopathology. Pearson correlation test was used for correlation analysis, and two-tailed P<0.05 was statistically significant; Pearson chi-square test or continuous correction chi-square test was used to compare the rates between groups, and two-tailed P<0.05 was statistically significant; Chi-square split test was used to compare multiple sample rates. The standard test was corrected according to the number of groups and then compared. The difference was statistically significant when the two-tailed P value was less than the corrected standard test. Results:The overall positive rate of HPV was 16.4% (9 909/60 354). Among all HPV positive patients, affection of single type HPV accounted for 75.5% (7 479/9 909) and affection of multi-type HPV accounted for 24.5% (2 430/9 909). The top six HPV types with infection rates from high to low were: HPV52 22.8% (2 256/9 909), HPV58 11.1% (1 097/9 909), HPV53 10.5% (1 045/9 909), HPV16 9.0% (890/9 909), HPV61 7.8% (774/9 909) and HPV6 7.6% (750/9 909). The difference of overall infection rate between different age groups was statistically significant (χ 2=536.90, P<0.001). The HPV infection rate was the highest in the<25 years old group, 30.1% (978/3 250), and it is higher than the age groups of 25-34 years old, 15.6% (3 035/19 406), group of 35-44 years old, 14.2% (2 464/17 297), group of 45-54 years old, 16.1% (2 115/13 104), group of 55-64 years old, 19.1% (915/4 793) and group of≥65 years old, 16.1% (402/2 504), with statistical significance( P<0.001 respectively). The most common types of HPV infection were type 6, 16.7% (378/2 266) and type 11, 10.5% (239/2 266) in dermatology clinics. The positive rate of HPV16 accounted for 12/17 in cervical intraepithelial neoplasia (CIN) 3 and cervical cancer cases, it was significantly higher than that in the inflammatory cases, 25.0% (35/140) and CIN1 cases, 23.0% (11/48), the statistical values were χ 2=15.02, P<0.001 and χ 2=12.48, P<0.001, respectively, all of which were statistically significant. Conclusions:HPV infection rate is highest in young people under 25 years old. Low-risk HPV6 and 11 are the main types of skin and venereal diseases. Among the total cases, high-risk HPV52, 58 and 53 are the most common types of infection with women in Changsha. However, high-grade cervical intraepithelial neoplasia and cervical cancer are more closely related to HPV16 infection.
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Objective:To observe any effect of long-distance application of Oral Reading for Language with Aphasia (ORLA) training on patients with post-stroke aphasia.Methods:A total of 42 stroke survivors with aphasia were randomly divided into an inpatient group, and two online groups, each of 14. All three groups had their routine rehabilitation treatment supplemented with ordinary multimodal language therapy and ORLA. The inpatient group completed the routine in the rehabilitation treatment room, while the online groups completed it at home using Tencent video conferencing software. The conventional multimodal language therapy was conducted once daily, 5 days a week for 4 weeks. For the inpatient group and online group 2 the daily session lasted 30 minutes, while for the online 1 groups the daily length was doubled. The ORLA therapy was also conducted once daily, 5 days a week for 4 weeks, for the inpatient group and online group 2 the daily session lasted 1h, while for the online 1 groups the daily length was 30min.The speech function, reading ability and life quality of the three groups were evaluated before and after the intervention using the Western Aphasia Battery, the Chinese Standard Aphasia Examination Scale and the Chinese version of the Stroke Aphasia Quality of Life Scale.Results:After treatment, the average aphasia quotient (AQ), reading, naming and quality of life scores in all three groups had improved significantly compared with those before treatment. And related language ability scores (such as retelling, fluency, information volume, listening comprehension, etc.) had also improved significantly in all three groups. However, the average AQ, reading, and oral fluency scores of the inpatient group and online group 2 were significantly higher than those of online group 1. Significant improvement was also observed in the reading aloud and life quality of all three groups, but the average improvement in reading aloud was significantly greater in the inpatient group and in online group 2 compared to online group 1. The average life quality of the online groups was significantly superior to that of the inpatient group.Conclusion:Medium- and high-intensity ORLA synchronous remote speech rehabilitation can significantly improve the speech ability, reading ability and life quality of aphasic stroke survivors.
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Objective:To observe the characteristics of macular telangiectasia (MacTel) in multi-color and multi-mode fundus images.Methods:An abservational case series study was conducted.Sixteen eyes of 12 patients diagnosed with MacTel by fluorescein fundus angiography (FFA) from January to November 2019 in Shandong Eye Hospital were analyzed.There were 8 cases (8 eyes) with MacTel type Ⅰ, among which 4 cases were male and 4 cases were female, with an average age of (62.3±12.5) years.The other 4 cases (8 eyes) had MacTel type Ⅱ, all of which were female, with an average age of (58.7±10.5) years.Best corrected visual acuity, slit lamp microscopy, color fundus photography, multicolor scanning laser imaging, FFA, optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) were carried out in all the patients.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Shandong Eye Institute (No.2019S003).Results:In color fundus images of MacTel type Ⅰ eyes, annular macular exudation with macular edema occurred in 6 eyes, macular edema without hard exudates in 1 eye, and hard macular exudates without macular edema in 1 eye.However, the transparency of retina in temporal fovea in MacTel type Ⅱ eyes decreased, showing a gray color.In multi-color fundus images of MacTel type Ⅰ eyes, punctate granular yellow macular exudation and yellow-green macular edema were observed, which were clearer than those in color fundus images.Punctate exudation was seen in both the blue and green reflectance images, which was clearest in green reflectance image, followed by blue reflectance image and then the infrared reflectance image.In OCT images of MacTel type Ⅰ eyes, cystoid edema of inner retina or uneven reflection signal of outer plexiform retina were observed.Loss of inner and outer retinal structures and cavities were observable in MacTel type Ⅱ eyes, and outer retinal atrophy appeared in 2 eyes.In OCTA images, the destruction of superficial and deep capillary plexus in macular area were observed in both MacTel typeⅠand type Ⅱ eyes, and the destruction of deep capillary plexus was more obvious.In addition, more obviously increased vascular space, decreased vessel density, and increased foveal avascular zone were found in MacTel type Ⅱ eyes.In early stage of FFA, delayed capillary filling near fovea was seen in MacTel typeⅠeyes, and dilated temporal vessels in fovea, some of which showed tumor-like dilation, and the limited tumor-like dilation was enhanced in the later stage.Different degrees of dilated parafoveal blood vessels in the early stage, and the capillary in the temporal side of the macula showing diffuse strong fluorescence in the late stage of FFA was observed in MacTel type Ⅱ eyes.Conclusions:Multi-color scanning laser imaging can be used to observe the morphological characteristics of MacTel, and the imaging features of different types of MacTel are significantly different.
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Objective:To evaluate the application effect of virtual reality in labor pain management by Meta analysis.Methods:The randomized controlled trials on the impact of virtual reality on labor pain was searched by PubMed (Medline), Web of Science, The Cochrane Library, Embase, CINAHL, China National Knowledge Infrastructure (CNKI), Wanfang database, Chinese biomedical database, and VIP database from their inception until July 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bais of included studies. Meta-analysis was performed using the Comprehensive Meta-Analysis (CMA) software Version 3.Results:Totally, 658 pregnant women were identified in the search, which were narrowed down to 8 studies. The results of Meta-analysis showed that the virtual reality group decreased the labor pain compared with the normal nursing group ( MD=-1.13, 95% CI-1.59 to -0.67, P<0.01), especially during the active phase of labor ( MD=-1.20, 95% CI-1.96 to -0.45, P<0.01). Besides, compared with the normal nursing group, the virtual reality group had a shorter first stage duration of labor ( MD=-0.93, 95% CI-1.51 to -0.34, P<0.01) and a lower level of anxiety ( SMD=-1.54, 95% CI-2.22 to -0.85, P<0.01). However, there was no significant difference between two groups in the pain scores during the latent phase of labor ( MD=-0.41, 95% CI-1.30 to 0.47, P>0.05) and the second stage duration of labor ( MD=-0.37, 95% CI-3.27 to 2.53, P>0.05). Conclusions:The findings of this Meta-analysis showed that the virtual reality significantly reduced the labor pain, shorted the first stage labor duration and lowered anxiety level. However, due to the limited quantity and quality of the included studies, its conclusions need to be verified by more large sample multicenter randomized controlled trials with rigorous design in the future.
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Objective:To summarize the nursing care experience of intrauterine infection complicated with septic shock in middle pregnancy for a patient with recurrent spontaneous abortion and postpartum hemorrhage during anti shock treatment.Methods:On June 2020, one patient with recurrent spontaneous abortion was admitted to our hospital with intrauterine infection in the second trimester of pregnancy. Close observation of disease changes, formulate personalized emergency plan, respond quickly when the condition changes, cooperate closely and actively rescue, observation and nursing of postoperative hemorrhage, anti-infective therapy timely, psychological nursing and health education. After active rescue and careful nursing, the patient recovered and discharged 8 days after abortion.Results:After active treatment and careful nursing, the patient recovered well and recovered 8 days after operation.Conclusion:For patients with intrauterine infection, especially patients with recurrent spontaneous abortion, close observation , timely initiation of emergency plans, termination of pregnancy effective anti-infection treatment, and psychological nursing and health guidance are essential to ensure the life safety of patients and promote reproductive health.
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A cross-sectional study was conducted on 1 052 patients with coronary heart disease (CHD) who visited 10 community health service centers in Chaoyang and Haidian districts of Beijing from March 2019 to September 2019. Basic information, medical history, cardiovascular risk factors, β-blocker use, height, weight, blood pressure level and resting heart rate were collected by face-to-face interview;biochemical tests and on-site physical examination were performed;and the influencing factors of heart rate control were analyzed by logistic regression. There were 563 males (53.5%) and 489 females(46.5%),with a mean age of (66.7±9.5) years. The rate of β-blockers use was 43.6% (459/1 052). The average resting heart rate was (70±8)/min, and only 14.5% (153/ 1 052) patients had the heart rate under control. The resting heart rate control rate in patients with β-blockers use was 17.9% (82/459), higher than that of those without β-blockers use [12.0% (71/593), χ 2=7.23, P=0.007]. Moderate leisure activities were beneficial to the control of resting heart rate ( OR=2.14, 95% CI: 1.26-3.62). The study shows that β-blockers use and resting heart rate control in CHD patients in Beijing community health institutions were both at low levels, and the resting heart rate was not well controlled even in patients taking beta-blockers.
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Objective:To evaluate the efficacy of compound chamomile and lidocaine hydrochloride gel in prevention of complications related to laryngeal mask airway (LMA) insertion.Methods:Ninety American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 18-60 yr, undergoing elective surgery with ventilation using LMA under general anesthesia, were divided into 3 groups ( n=30 each) using a random number table method: paraffin oil group (group A), compound lidocaine cream group (group B), and compound chamomile and lidocaine hydrochloride gel group (group C). The paraffin oil, compound lidocaine cream, and compound chamomile and lidocaine hydrochloride gel were evenly applied on the front, shoulder and back of the LMA before inserting the LMA in A, B and C groups, respectively.The severity of sore throat, oropharyngeal mucositis score, hoarseness score and occurrence in each time period (0-1 h, >1-6 h, >6-24 h, > 24-48 h) were recorded at 1, 6, 24 and 48 h after removal of the laryngeal mask.The stress responses during removal of the LMA and occurrence of drug-related adverse reactions within 48 h after removal of LMA were recorded. Results:Twenty-nine cases in group A, 28 cases in group B and 27 cases in group C completed the trial.Compared with group A, the severity of sore throat at each time point after removal of the LMA and incidence of sore throat in each time period were significantly decreased, the oropharyngeal mucositis score at 6, 24 and 48 h after removal of the LMA and the incidence of oropharyngeal mucositis in the time period >1-48 h were decreased, and the incidence of drug-related adverse reactions was increased in group C ( P<0.05). Compared with group B, the severity of sore throat at 6 h after removal of the LMA and incidence of sore throat > 1-48 h after removal of the LMA were significantly decreased, the oropharyngeal mucositis score at 6, 24 and 48 h after removal of the LMA and incidence of oropharyngeal mucositis in the time period >1-48 h after LMA removal were reduced, and the incidence of drug-related adverse reactions was decreased in group C ( P<0.05). There was no significant difference in the hoarseness score and incidence of hoarseness after removal of the LMA and incidence of stress responses during removal of the LMA among the three groups ( P>0.05). Conclusions:Compound chamomile and lidocaine hydrochloride gel has a certain efficacy in preventing complications related to LMA placement.
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Objective:To investigate the value of paraffin-embedded section of cell block in the diagnosis of lung adenocarcinoma in bloody pleural effusion.Methods:The data of 60 patients with lung adenocarcinoma diagnosed by bloody pleural effusion and confirmed by pathological biopsy in the First Affiliated Hospital of Xi'an Jiaotong University from June 2018 to June 2019 were retrospectively analyzed. Cell smears and paraffin-embedded sections of cell blocks using removed red blood cells sedim entation method were used to make cytological examination in bloody pleural effusion. The expressions of carcinoembryonic antigen (CEA), cytokeratin 7 (CK7), NapsinA, thyroid transcription factor 1 (TTF-1), cytokeratin 5/6 (CK5/6), calretinin, P63 and P40 in the specimens were detected by using immunohistochemistry. The results of histopathological examination were used as the gold standard, and the diagnostic values of cell block paraffin-embedded sections and cell smears for lung adenocarcinoma in bloody pleural effusion were evaluated and compared.Results:The cell block sections had a clear background, clear and easy to distinguish cell morphology, and can be made into permanent specimens. The bloody pleural effusion cell smears results of 60 cases of lung adenocarcinoma showed that 21 cases were diagnosed as atypical cells, 39 cases were diagnosed as adenocarcinoma, and the coincidence rate with the diagnosis of adenocarcinoma by histopathological examination results was 65% (39/60); the immunohistochemistry results of cell block paraffin-embedded sections of bloody pleural effusion showed that CK7, NapsinA, TTF-1 and CEA were positive, and P40, P63, CK5/6 and calretinin were negative, all 60 cases were diagnosed as adenocarcinoma according to the results, and the coincidence rate with the diagnosis of adenocarcinoma by histopathological examination results was 100% (60/60), which was significantly higher than that of cytological smears ( χ2 = 23.088, P < 0.01). Conclusions:The technique of paraffin-embedded section of cell block using removed red blood cells sedim entation method has a high diagnostic rate for lung adenocarcinoma in bloody pleural effusion, and it has a high coincidence rate with histopathological diagnosis. It can improve the accuracy of diagnosis of lung adenocarcinoma in bloody pleural effusion, and it also has a good reference value for cytological typing.
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The signal transduction pathway of VEGF combing with vascular endothelial growth factor receptor (VEGFR) is not only key pathway to regulate angiogenesis, but also the focus of basic research and important target of clinical treatment. Salvia miltiorrhiza extract and its main compound salvianolic acid B also have two-way regulative effect on VEGF/VEGFR signal pathway in different diseases. Tanshinone Ⅰ , tanshinone Ⅱ A and cryptotanshinone could inhibit the angiogenesis throughthis pathway, and sodium tanshinone ⅡA sulfonate could promote the angiogenesis through this pathway.
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Objective:To explore the efficacy of nimodipine combined with ganglioside in the treatment of cerebral hemorrhage and its effect on the expression of serum resistin and oxidized low-density lipoprotein (ox-LDL).Methods:According to the random number table method, 100 patients with cerebral hemorrhage admitted in Central Hospital of Zibo from February 2018 to February 2020 were divided into the single treatment group and the combined treatment group, with 50 cases in each group. In addition to conventional treatment, the single treatment group was additionally treated with nimodipine, and the combined group was additionally treated with nimodipine combined with ganglioside. After 2 weeks of intervention, the efficacy of the two groups was evaluated, and the National Institutes of Health Stroke Scale (NIHSS) scores, Ability of Daily Living (ADL) scores, serum inflammatory factors, resistin and ox-LDL levels were evaluated and recorded between the two groups before and after treatment.Results:The total effective rate of treatment in the combined treatment group was higher than that in the single treatment group: 90.0%(45/50) vs. 74.0%(37/50), and the difference was statistically difference ( P<0.05). After 2 weeks′ treatment, the scores of NIHSS was decreased and the scores of ADL was increased in two groups, and the scores of NIHSS in combined treatment group was lower than that in the single treatment group: (9.41 ± 1.27) scores vs. (12.10 ± 1.65) scores; the scores of ADL in the combined treatment group was higher than that in the single treatment group: (67.82 ± 9.04) scores vs. (59.10 ± 8.75) scores, and the differences were statistically differences ( P<0.05). After 2 weeks′ treatment, the levels of serum high-sensitivity C-reactive protein (hs-CRP), interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), resistin and ox-LDL in the two groups were decreased, and the levels of above index in the combined treatment group were lower than those in the single treatment group: (4.81 ± 1.03) mg/L vs. (6.10 ± 1.73) mg/L, (40.96 ± 9.21) μg/L vs. (56.74 ± 8.93) μg/L, (33.20 ± 7.96) μg/L vs. (44.76 ± 8.43) μg/L, (0.29 ± 0.09) μg/L vs. (0.45 ± 0.13) μg/L, (336.25 ± 69.74) mg/L vs. (372.18 ± 68.52) mg/L, and the differences were statistically differences ( P<0.05). There was no significant difference in adverse reactions between the two groups ( P<0.05). Conclusions:Nimodipine combined with ganglioside has a clear efficacy in the treatment of cerebral hemorrhage. It can effectively inhibit inflammation indicators, reduce serum resistin and ox-LDL levels, promote the recovery of nerve defects, and improve their living ability.
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Esophageal squamous cell carcinoma (ESCC) accounts for more than 90% of the confirmed cases of esophageal cancer in Asia, and the degree of malignancy is high. There is a growing number of research on ESCC immunotherapy, particularly programmed death-1 (PD-1) and programmed death-ligand 1 (PD-L1). Among them, the most studied PD-1/PD-L1 inhibitors in ESCC are nivolumab, pembrolizumab, camrelizumab, toripalimab, tislelizumab, atozolizumab, SHR-1316 and durvalumab. Some of the clinical trials of these drugs are still in progress, and some have initially shown good results.
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Objective:To investigate the application value of sound touch quantification (STQ) in screening high risk group of non-alcoholic steatohepatitis(NASH).Methods:From February 2019 to January 2020, 98 patients with non-alcoholic fatty liver disease(NAFLD) and 36 healthy volunteers were included in this study. NAFLD patients were divided into NASH high risk group and NASH low risk group. The liver Young′s modulus were measured by STQ and compared among the three groups. The ROC curve was used to analyze the effectiveness of STQ in screening NASH high risk population. When the maximum value of Jordan index was selected, the best boundary threshold was selected to analyze its sensitivity, specificity and accuracy. Liver biopsy was performed in 15 patients with abnormal liver function as validation group.Results:There were significant differences in the mean values of Young′s modulus among high risk group, low risk group and control group ( F=33.068, P<0.01). The Young′s modulus of NASH high risk group was significantly higher than those in NASH low risk group and control group ( P<0.05). The Young′s modulus between NASH Low risk group and control group was not significantly different( P=0.443). The best screening threshold was 6.46 kPa, the sensitivity was 89.2%, the specificity was 85.2%, and the accuracy was 88.6%. In the verification group, when the Young′s modulus≥6.46 kPa, the accuracy was 73.3%, the sensitivity was 75.0%, and the specificity was 66.7%. Conclusions:As a screening index, STQ elastic imaging technology has certain value in screening NASH high risk group.
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Objective:To analyze the inter-observer consistency of Smart 3D super microvascular imaging (Smart-3D SMI) in evaluating the blood flow of breast lesions.Methods:Prospective study on Smart-3D SMI images of 225 cases of continuous breast lesions in Peking Union Medical College Hospital from January to December 2018. Two sonographers conducted qualitative evaluation of vascular architecture(VA) under Smart-3D SMI, and took the mean value of three measurements evaluations of vascular index(VI). Weighted Kappa was used to test the consistency of the vascular architecture, and Bland-Altman scatter plot was used to calculate the 95% consistency limit of the measured data for the VI value. Spearman correlation coefficient was used to analyze whether the absolute difference of VI between observers was correlated with the mean value of VI.Results:The Weighted Kappa coefficient of Smart-3D SMI for the evaluation of VA by two sonographers was 0.839 (95% CI was 0.795-0.881, P<0.001), showing strong inter-observer consistency. Bland-Altman plot analysis of VI value showed that the value of 95.11% was within the clinically acceptable range and had good consistency, and there was a correlation between the difference of VI value between observers and the value of VI mean ( r s=0.639, P<0.001). Conclusions:There is a good inter-observer consistency in evaluating the blood vascular architecture and quantitatively measuring the blood flow abundance by Smart-3D SMI.
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Objectives:To explore the related factors that influence the postpartum loss to follow-up of women with gestational diabetes mellitus and the corresponding countermeasures to improve management of postpartum loss to follow-up in order to improve its rate.Methods:A total of 212 patients were selected from women diagnosed with gestational diabetes before delivery in Women′s Hospital School of Medicine Zhejiang University between December, 2018 and March, 2019. These patients were reminded by hospital education and telephone call-back and followed up by questionnaire at 12 weeks after delivery. The rates of follow up and the rate of postpartum blood glucose screening after delivery were calculated. The demographic and social data, clinical data during pregnancy and delivery, and postpartum blood glucose screening were compared between the follow-up group and the group of loss to follow up. The group of loss to follow up was contacted by telephone to inquiry the reason of loss.Results:Totally 159 out of 212 cases completed postpartum follow-up with the rate of 75.00% (159/212) and the loss rate was 25.00% (53/212). 52 cases underwent postpartum blood glucose screening with the rate of 24.53% (52/212), 22.64% (48/212) in the follow-up group and 1.89% (4/212) in the group of loss to follow up. Permanent residence, occupation, monthly family income, medical payment method, obstetric complications, family history, management doctor's own quality, attendance of pregnancy specialist from outpatient service, acceptance of complication propaganda and education, attitude to postpartum follow-up, etc are the influencing factors, the difference was statistically significant ( χ2 value was 4.392-65.328, P<0.01 or 0.05). Conclusion:Women with gestational diabetes mellitus have a high rate of postpartum loss to follow up. Medical personnel should improve their professional quality and strengthen the multidisciplinary and joint management model, establishing a standardized and targeted postpartum follow-up procedure and strengthening the focus of postpartum follow-up education to improve the quality and efficiency of postpartum follow-up management.
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Objective:To investigate the correlation between antiplatelet agents and the risk of ruptured intracranial aneurysm.Methods:Patients with intracranial aneurysm admitted to the Department of Neurology, East Hospital Area of Qingdao Municipal Hospital from June to December 2018 were selected retrospectively. The baseline data of patients and the characteristics of intracranial aneurysms were collected. The independent correlation between antiplatelet agents and the risk of ruptured intracranial aneurysm was identified by the univariable analysis and multivariate logistic regression analysis. Results:A total of 90 patients with intracranial aneurysm were included in the study. There were 31 males (34.44%) and 59 females (65.56%). The median diameter of the aneurysm was 4 mm. Forty-six patients taking antiplatelet agents before being diagnosed with intracranial aneurysm, of which 36 taking aspirin, 3 taking clopidogrel, and 7 taking aspirin+ clopidogrel. There were 31 patients (34.44%) with ruptured aneurysm and 59 (65.56%) with unruptured aneurysm. There were statistical differences in the proportion of patients with age <60 years ( P<0.05), diabetes ( P<0.1), ischemic heart disease ( P<0.05), history of previous stroke or transient ischemic attack ( P<0.01), internal carotid artery aneurysm ( P<0.01), anterior communicating artery aneurysm ( P<0.05), posterior communicating artery aneurysm ( P<0.01) and taking antiplatelet agents before diagnosis ( P<0.1) between the ruptured group and the unruptured group. Multivariate logistic regression analysis showed that age <60 years (odds ratio[ OR] 4.116, 95% confidence interval [ CI] 1.337-12.673; P=0.014), anterior communicating artery aneurysm ( OR 5.015, 95% CI 1.155-22.559; P=0.032) and posterior communicating artery aneurysm ( OR 68.796, 95% CI 6.762-699.951; P<0.001) were the independent risk factors for ruptured intracranial aneurysm, and taking antiplatelet agents was an independent protective factor for ruptured intracranial aneurysm ( OR 0.320, 95% CI 0.104-0.992; P=0.048). Conclusions:Taking antiplatelet agents, especially aspirin, does not increase the risk of ruptured intracranial aneurysm, but may be a protective factor of ruptured intracranial aneurysm. Unruptured aneurysms are not contraindications for antiplatelet therapy in patients with clear indications.
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Objective:To investigate the risk factors for ischemic stroke in patients with spontaneous extracranial vertebral artery dissection.Methods:From November 2013 to December 2019, patients with spontaneous extracranial vertebral artery dissection admitted to the Department of Neurology, Baotou Central Hospital were enrolled retrospectively. According to whether they had ischemic stroke or not, they were divided into ischemic stroke group and non-ischemic stroke group. The independent risk factors for ischemic stroke in patients with spontaneous extracranial vertebral artery dissection were identified by binary logistic regression analysis. Results:A total of 39 patients were enrolled, 25 were female (64.1%), 14 were males (35.9%), their age was 51.51±14.98 years old, 16 of them (41.0%) had ischemic stroke. The proportion of patients with double-lumen sign, intimal flap sign of occluded lumen (37% vs. 4%; P=0.013) and specific initial symptoms (56% vs. 9%; P=0.003) of the ischemic stroke group were significantly higher than those of the non-ischemic stroke group. Multivariate logistic regression analysis showed that double-lumen sign and intimal flap sign of occluded lumen (odds ratio 47.951, 95% confidence interval 26.284-87.478; P<0.001), and specific initial symptoms (odds ratio 19.232, 95% confidence interval 10.695-34.587; P<0.001) were independently associated with ischemic stroke in patients with spontaneous extracranial vertebral artery dissection. Conclusions:Double-lumen sign, intimal flap sign of occluded lumen and specific clinical symptoms are the independent risk factors for ischemic stroke in patients with spontaneous extracranial vertebral artery dissection.
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@#（正）食管癌位于我国恶性肿瘤发病率第 5 位及死亡率第 4 位，每年大约有 10 万新增病例，占全球50% 以上。食管癌病因复杂，发病隐匿，目前公认的治疗方案是以手术为主、放化疗为辅的综合治疗。而传统开胸手术治疗创伤大，并发症多，恢复时间长，预后较差。经过多年的不断探索与发展以及腔镜技术的日益成熟，以三野清扫为目的的胸腹腔镜联合食管癌切除已成为一种趋势，其在切除范围、淋巴结清扫程度、切口疼痛程度、快速康复以及预后等方面较传统术式有明显优势，同时并发症发生率并未增加[1]。本视频旨在展示胸腹腔镜食管癌切除术的手术入路、操作要点及术后情况。
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Objective:To analyze results of microbiological culture of lesion exudates and drug sensitivity test in patients with pemphigus, and to optimize the management protocol of pemphigus.Methods:Inpatients with pemphigus were collected from Department of Dermatology and Venereology, the First Affiliated Hospital of Anhui Medical University from January to December in 2008, and the results of microbiological culture of skin lesion exudates and drug sensitivity test were retrospectively analyzed.Results:A total of 176 patients were collected, and skin lesion exudate culture yielded 25 kinds of bacteria and 11 kinds of fungi in 156 (88.64%) patients. Of the 156 patients, 1 kind of pathogen was yielded in 104 (66.67%), and 2 or more kinds of pathogens were yielded in 52 (33.33%). Gram-positive cocci were detected in 134 (76.14%) cases, including Staphylococcus aureus in 80, Staphylococcus hemolyticus in 21, and Staphylococcus epidermidis in 16; Gram-negative bacilli were detected in 66 (37.50%) cases; fungi were detected in 24 (13.64%) cases. In addition, 89 (93.68%) of 95 relapsed patients showed positive culture results, 67 (82.72%) of 81 patients with newly developed pemphigus had positive culture results, and the positive rate significantly differed between the two groups ( χ2 = 5.22, P <0.05). Drug sensitivity test for Staphylococcus aureus isolates showed that 71 (97.26%) of 73 were sensitive to vancomycin, 69 (97.18%) of 71 to linezolid, and 61 (87.14%) of 70 to rifampin. Conclusion:Cutaneous infection, especially Gram-positive cocci infection, is very common in patients with pemphigus, and Staphylococcus aureus clinical isolates were highly sensitive to vancomycin, linezolid and rifampicin.
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Objective: To explore the clinical value of MRI and CTA in the preoperative assessment of tumors in the foramen magnum region. Methods: Clinical and imaging data of 32 patients with foramen magnum region tumors confirmed by surgical pathology were retrospectively analyzed. Tumor location, extent and the relationship of the tumor and surrounding important structures were assessed and compared with surgical findings. Results: Among 32 patients with foramen magnum region tumors, there were 29 cases of benign tumors, including 4 cases of angioblastomas, 3 cases of ependymoma, 2 cases of hairy cell astrocytoma, 13 cases of meningioma, 5 cases of schwannoma, 1 case of lipoma and 1 case of epidermoid cyst; there were 3 cases of malignant tumor, including 1 case of chondromatoid chordoma, 1 case of melanoma and 1 case of metastasis. Nine tumors located in intramedullary, 23 in extramedullary, including ventral in 5 cases, ventrolateral in 7 cases, dorsal in 11 cases. The diagnostic accuracy of MRI was 93.75% (30/32), and the evaluation of tumor scope was consistent with that of surgery. The coincidence rate of CTA in evaluation on supplying artery with intraoperative findings was 100%. Conclusion: MRI and CTA play an important role in evaluating the location and extension of tumors in the foramen magnum region, as well as the relationship with adjacent tissue and vessels, which is useful for determining the surgical approach, the extent of tumor resection and management of the surrounding vessels in clinical routine.