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OBJECTIVES@#With the increasing detection rate of lung nodules, the qualitative problem of lung nodules has become one of the key clinical issues. This study aims to evaluate the value of combining dynamic contrast-enhanced (DCE) MRI based on time-resolved imaging with interleaved stochastic trajectories-volume interpolated breath hold examination (TWIST-VIBE) with T1 weighted free-breathing star-volumetric interpolated breath hold examination (T1WI star-VIBE) in identifying benign and malignant lung nodules.@*METHODS@#We retrospectively analyzed 79 adults with undetermined lung nodules before the operation. All nodules of patients included were classified into malignant nodules (n=58) and benign nodules (n=26) based on final diagnosis. The unenhanced T1WI-VIBE, the contrast-enhanced T1WI star-VIBE, and the DCE curve based on TWIST-VIBE were performed. The corresponding qualitative [wash-in time, wash-out time, time to peak (TTP), arrival time (AT), positive enhancement integral (PEI)] and quantitative parameters [volume transfer constant (Ktrans), interstitium-to-plasma rate constant (Kep), and fractional extracellular space volume (Ve)] were evaluated. Besides, the diagnostic efficacy (sensitivity and specificity) of enhanced CT and MRI were compared.@*RESULTS@#There were significant differences in unenhanced T1WI-VIBE hypo-intensity, and type of A, B, C DCE curve type between benign and malignant lung nodules (all P<0.001). Pulmonary malignant nodules had a shorter wash-out time than benign nodules (P=0.001), and the differences of the remaining parameters were not statistically significant (all P>0.05). After T1WI star-VIBE contrast-enhanced MRI, the image quality was further improved. Compared with enhanced CT scan, the sensitivity (82.76% vs 80.50%) and the specificity (69.23% vs 57.10%) based on MRI were higher than that of CT (both P<0.001).@*CONCLUSIONS@#T1WI star-VIBE and dynamic contrast-enhanced MRI based on TWIST-VIBE were helpful to improve the image resolution and provide more information for clinical differentiation between benign and malignant lung nodules.
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Adult , Humans , Retrospective Studies , Magnetic Resonance Imaging , Plasma , Tomography, X-Ray Computed , LungABSTRACT
Melatonin receptor 1B (MT2, encoded by the MTNR1B gene), a high-affinity receptor for melatonin, is associated with glucose homeostasis including glucose uptake and transport. The rs10830963 variant in the MTNR1B gene is linked to glucose metabolism disorders including gestational diabetes mellitus (GDM); however, the relationship between MT2-mediated melatonin signaling and a high birth weight of GDM infants from maternal glucose abnormality remains poorly understood. This article aims to investigate the relationship between rs10830963 variants and GDM development, as well as the effects of MT2 receptor on glucose uptake and transport in trophoblasts. TaqMan-MGB (minor groove binder) probe quantitative real-time polymerase chain reaction (qPCR) assays were used for rs10930963 genotyping. MT2 expression in the placenta of GDM and normal pregnant women was detected by immunofluorescence, western blot, and qPCR. The relationship between MT2 and glucose transporters (GLUTs) or peroxisome proliferator-activated receptor γ (PPARγ) was established by western blot, and glucose consumption of trophoblasts was measured by a glucose assay kit. The results showed that the genotype and allele frequencies of rs10830963 were significantly different between GDM and normal pregnant women (P<0.05). The fasting, 1-h and 2-h plasma glucose levels of G-allele carriers were significantly higher than those of C-allele carriers (P<0.05). Besides, the protein and messenger RNA (mRNA) expression of MT2 in the placenta of GDM was significantly higher than that of normal pregnant women (P<0.05). Melatonin could stimulate glucose uptake and GLUT4 and PPARγ protein expression in trophoblasts, which could be attenuated by MT2 receptor knockdown. In conclusion, the rs10830963 variant was associated with an increased risk of GDM. The MT2 receptor is essential for melatonin to raise glucose uptake and transport, which may be mediated by PPARγ.
Subject(s)
Female , Humans , Pregnancy , Blood Glucose/metabolism , Diabetes, Gestational/metabolism , Glucose/metabolism , Melatonin/metabolism , Polymorphism, Genetic , PPAR gamma , Receptor, Melatonin, MT2/geneticsABSTRACT
Objective:To explore the effects of application of the patient participation decision aid in patients undergoing cardiac valve replacement.Methods:A total of 38 patients hospitalized for cardiac valve replacement from June to November, 2020 in the First Affiliated Hospital of Nanjing Medical University, were enrolled as the control group, and 38 patients admitted from January to May, 2020, were recruited as the experimental group by convenient sampling method. The control group was given routine nursing intervention, while the experimental group was carried out patient participation decision aid assistant program on the basis of routine nursing. The effects of intervention were assessed by Decision Conflict Sale (DCS), Preparation for Decision Making (PrepDM) and Risk Perception Questionnaire for patients with chronic diseases at admission and one day before operation.Results:There was no significant difference in the scores of DCS, PrepDM and Risk Perception Questionnaire for patients with chronic diseases at admission between the two groups( P>0.05). At one day before operation, the information& values scores dimension, support and valid decision dimension scores, decision uncertainty dimension scores and total scores of DCS were (12.37 ± 4.11) , (12.50 ± 4.65) , (3.74 ± 1.17), (28.61 ± 7.07) points in the experimental group, lower than those in the control group (15.11 ± 3.62) , (17.84 ± 4.25), (4.37 ± 1.30), (37.32 ± 6.57) points, the differences were statistically significant between the two groups( t values were 2.22-5.56, all P<0.05). At one day before operation, the score of PrepDM was (73.58 ± 5.32) points in the experimental group, higher than that in the control group (67.82 ± 4.89) points, the difference was statistically significant ( t=4.92, P<0.05). At one day before operation, the scores of economic risk dimension, physical and medical risk dimension, psychosocial risk dimension scores and total scores of Risk Perception Questionnaire for patients with chronic diseases were (11.45 ± 3.94), (12.39 ± 3.64), (7.21 ± 4.09), (31.05 ± 6.11) points in the experimental group, lower than those in the control group (13.50 ± 3.73), (15.82 ± 5.18), (9.32 ± 3.59), (38.63 ± 7.27) points, the differences were statistically significant ( t values were 2.33-4.92, all P<0.05). Conclusions:Patient participation decision aid program can effectively decrease decision conflict, promote preparation for decision making and alleviate risk perception of patients undergoing cardiac valve replacement.
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The main clinical phenotypes, imaging features and genetic test results of a child with Joubert syndrome treated in Shenzhen Children′s Hospital in July 2020 were analyzed retrospectively, and the literature on Joubert syndrome was summarized.The main manifestations of the protester during infancy were respiratory abnormalities and developmental retardation.The brain magnetic resonance imaging (MRI) showed a " molar sign" , which was consistent with the diagnosis of Joubert syndrome.Genetic testing suggested that the protestor carried complex heterozygous variations of KIAA0586 gene.Two variants were not reported previously, one of which was synonymous mutation.The child is the first case of Joubert syndrome caused by KIAA0586 gene in China.Joubert syndrome is a rare congenital brain development malformation characterized by high clinical heterogeneity and MRI molar signs.It may involve multiple systems.Early identification and intervention can improve outcomes.
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Objective:To analyze the body composition of breast cancer patients and the changes with age; to compare the incidence of obesity in breast cancer patients with different diagnostic criteria; To understand the relationship between body mass index (BMI) and body composition; to investigate the incidence of sarcopenia and its relationship with obesity in breast cancer patients.Methods:The bioelectrical impedance technique was used to analyze the body composition of 1 187 female breast cancer patients before surgery.Results:There was a statistically significant difference between different age groups of breast cancer patients with various body composition indicators ( F values were 3.767-32.627, P < 0.01), and the incidence of obesity and sarcopenia was different in different age groups ( χ2 value was 20.819, P < 0.01). The obesity detection rate of different diagnostic methods was different. The obesity rate diagnosed by body fat percentage (PBF) was the highest. 28.14% (334/1 187) of breast cancer patients were diagnosed as "invisible obesity", which refers to normal or low BMI but excessive PBF. BMI was positively correlated with all body composition indicators ( r values were 0.137-0.954, P < 0.01), and moderately correlated with PBF and skeletal muscle mass ( r values were 0.761, 0.534, P < 0.01). The incidence of sarcopenia in breast cancer patients was 8.26% (98/1 187). 8.78% (64/1 187) of the patients with normal BMI were diagnosed as Sarcopenia. Among patients with excess PBF and excess visceral fat area, 6.70% (47/1 187) and 5.98% (15/1 187) were diagnosed with sarcopenia, respectively. Conclusion:The incidence of PBF obesity in breast cancer patients is high, and some patients have sarcopenia, which is not good for prognosis. Bioelectrical impedance technology can accurately assess the body composition of patients, and can find "invisible obesity" and sarcopenia that cannot be diagnosed by BMI, which is worthy of further promotion and application in clinical practice.
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Objective:To explore the effect of dynamic multi-dimensional management model based on informatization on improving the home self-care of lymphedema patients.Methods:A total of 80 patients who received lymphedema combined detumescence treatment from January 2018 to June 2018 were selected as the control group.From July 2018 to December 2018, 80 patients were treated as the intervention group, and the whole process was managed on the basis of the control group using the dynamic multidimensional management mode based on informatization. Patients' compliance and quality of life were compared between the two groups.Results:The intervention group patients' compliance was better than control group, correctly measure the circumference of limbs, the law of life that occupy the home was good, correct manual lymph drainage direction, bandages, functional exercise, 18 standards compliance, respectively, 95.0%(76/80), 87.5%(70/80), 97.5%(78/80), 95.0%(76/80), 100.0%(80/80), 87.5%(70/80), better than that of control group were 77.5%(62/80), 75.0%(60/80), 80.0%(64/80), 70.0%(56/80), 75.0%(60/80), 50.0%(40/80), difference was statistically significant ( χ2 values were 4.103-26.182, P<0.05 or 0.01). After a course of treatment and 3 months of home-based self-care, the scores of role function, physical function, emotional function and social function of the quality of life in the intervention group were (75.44 ± 2.78), (80.11 ± 3.01), (78.25 ± 2.78), (79.93 ± 5.43), which were better than those of the control group (66.25 ± 2.58), (75.88 ± 3.57), (65.16 ± 2.47), (62.78 ± 4.01), with statistically significant differences ( t values were 8.09, 31.50, P<0.01). Conclusions:The dynamic multi-dimensional management model based on informationization and doctor-patient participation can improve the compliance and quality of life of patients participating in home-based self-care and better meet the needs of home-based nursing.
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Objective:To investigate the level and change of compliance of functional exercise in patients with breast cancer in one year after operation.Methods:The compliance of limb functional exercise in 90 patients with breast cancer at 3, 6 and 12 months after operation was measured by the compliance scale of functional exercise after operation of breast cancer. Taking time as independent variable( x), functional exercise compliance and index of each dimension as dependent variable( y), regression curve estimation equation was used to draw compliance curve. Results:The functional compliance index of patients at 3, 6, 12 months after surgery was 67.31±14.21, 62.93±12.53, 56.62±14.75, there was significant difference( F value was 31.13, P<0.01). The physical exercise compliance index of patients at 3, 6, 12 months after surgery was 63.06±17.69, 58.03±14.86, 50.83±16.75, there was significant difference ( F value was 30.82, P<0.01). The active recommendation index of patients at 3, 6, 12 months after surgery was 58.56±19.75, 48.56±17.94, 42.94±18.69, there was significant difference( F value was 4.99, P<0.05). The post-consideration index of patients at 3, 6, 12 months after surgery was 81.95±12.70, 83.30±13.25, 78.10±16.55, there was significant difference ( F value was 38.26, P<0.01). The compliance curve of the functional exercise compliance score was y=50.22-1.08 x-0.69 x2 ( R2 value was 0.091, F value was 13.426, P<0.01); the body exercise compliance curve formula was y=23.73-0.64 x-0.39 x2 ( R2 value was 0.086, F value was 12.522, P<0.01); the actively seeking the recommendation compliance curve formula was y=11.67-2.652 x+0.35 x2 ( R2 value was 0.106, F value was 15.911, P<0.01); the postoperative cautionary compliance curve formula was y=14.82+2.22 x-0.65 x2 ( R2 value was 0.023, F value was 3.188, P<0.05). The functional compliance of breast cancer patients during the first year after operation was moderate, and then showed a downward trend. Among them, physical exercise compliance and active seeking compliance showed a low level, and a downward trend. But the postoperative attention complied with a high level. And a trend of a small increase after 6 months after surgery. Conclusions:According to the compliance curve, the overall compliance of postoperative functional exercise in breast cancer patients is poor, and the compliance has a general downward trend with time. This may be related to the low attention of patients, family members and health care workers after discharge or the patient′s own "forgotten curve".Therefore, after discharge, the nurse needs to repeatedly strengthen the patient′s memory, and follow up and supervise the patient according to the key points of the patient′s functional exercise and the reasons for the decline of compliance.
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OBJECTIVE: To evaluate the distribution and characteristics of peripheral nerve abnormalities in chronic inflammatory demyelinating polyneuropathy (CIDP) using magnetic resonance neurography (MRN) and to examine the diagnostic efficiency.MATERIALS AND METHODS: Thirty-one CIDP patients and 21 controls underwent MR scans. Three-dimensional sampling perfections with application-optimized contrasts using different flip-angle evolutions and T1-/T2- weighted turbo spin-echo sequences were performed for neurography of the brachial and lumbosacral (LS) plexus and cauda equina, respectively. Clinical data and scores of the inflammatory Rasch-built overall disability scale (I-RODS) in CIDP were obtained.RESULTS: The bilateral extracranial vagus (n = 11), trigeminal (n = 12), and intercostal nerves (n = 10) were hypertrophic. Plexus hypertrophies were observed in the brachial plexus of 19 patients (61.3%) and in the LS plexus of 25 patients (80.6%). Patterns of hypertrophy included uniform hypertrophy (17 [54.8%] brachial plexuses and 21 [67.7%] LS plexuses), and multifocal fusiform hypertrophy (2 [6.5%] brachial plexuses and 4 [12.9%] LS plexuses) was present. Enlarged and/or contrast-enhanced cauda equina was found in 3 (9.7%) and 13 (41.9%) patients, respectively. Diameters of the brachial and LS nerve roots were significantly larger in CIDP than in controls (p < 0.001). The largest AUC was obtained for the L5 nerve. There were no significant differences in the course duration, I-RODS score, or diameter between patients with and without hypertrophy.CONCLUSION: MRN is useful for the assessment of distribution and characteristics of the peripheral nerves in CIDP. Compared to other regions, LS plexus neurography is more sensitive for CIDP.
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Objective@#To explore the effect of case management on postoperative affected limb lymphedema in breast cancer patients.@*Methods@#This study is a non-concurrent control trial. A total of 157 cases of breast cancer patients who met the inclusion/exclusion criteria were selected from the Sun yet-sen University Cancer Center from June 2016 to July 2017 and from June 2016 to July 2017 by the convenient sampling method. Among them, 80 patients from June to July 2016 were listed as the control group, and 77 patients from June to July 2017 were listed as the intervention group. The control group implemented the routine nursing mode of breast cancer. The intervention group implemented case management on the basis of routine nursing. Lymphedema of the affected limb were compared between the two groups before intervention, 3 months after surgery, 6 months after surgery and 1 year after surgery.@*Results@#The incidence of postoperative lymphedema (OR=2.467, 95%CI1.177-5.169, P<0.05) of the affected limb was lower in the intervention group than in the control group. The incidence of lymphedema in the limbs of the two groups was not statistically different 3 months after operation (χ2=0.617, P>0.05). There was a statistically significant difference between the two groups 6 months after operation (χ2=5.835, P<0.05) and 1 year after operation (P=0.003). The incidence of lymphedema in the affected limbs in the experimental group was lower than that in the control group. There was an increased incidence of lymphedema in the control group, the incidence of side pain, but an incidence of lymphedema in the intervention group was in a downward trend.@*Conclusion@#Case management mode can effectively prevent and improve the occurrence of postoperative lymphedema in patients with breast cancer.
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Objective To investigate the relationship between uridine diphosphate glucuronosyltransferases (UGT) 1A6 rs2070959 polymorphism and serum concentration of valproic acid (VPA) in patients with epilepsy.Methods We selected 200 cases of epilepsy patients treated in our hospital from June 2014-January 2017.All the patients were treated with VPA monotherapy ＞ 3months.When the VPA of patients reached steady state,we detected the VPA blood level.The genotypes and allele frequencies of UGT1A6 rs2070959 in 200 epilepsy patients were determined.The average standard deviation of 1-fold VPA was used as high VPA group and vice versa as low VPA group.The genotype and allele frequencies of UGT1A6 rs2070959 were compared between the two groups,and the influencing factors of VPA concentration in epileptic patients were analyzed.Results The frequencies of A genotype,AG genotype and GG genotype were 77.01％,18.39％ and 4.60％ in the high VPA group,67.26％,19.47％ and 13.27％ in the low VPA group,with no significant difference between the two groups (P ＞ 0.05);the allele G frequency in the high VPA group was significantly lower than that in the low VPA group (13.79％).The age and weight of the high VPA group were significantly higher than those of the low VPA group (P ＜ 0.05),and the gender composition of the high VPA group was not significantly different from that of the low VPA group (P ＞0.05).Logistic regression analysis showed that age and weight gain were positively correlated with VPA concentration (P ＜ 0.05),allele G expression was negatively correlated with VPA concentration (P ＜0.05).Conclusions Allele G expression at UGT1 A6 rs2070959 is associated with decreased VPA concentration in epileptic patients,which may require a higher dose of VPA.
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Objective To study the effect of exosomes ( EXs) released from high expression of miR-132-3p mesenchymal stem cells (MSCs) on hypoxia/reoxygenation (H/R) injured endothelial cell function. Methods MSCs extracted from bone marrow of C57BL/6 mice were cultured primarily. MSCmiR-132-3p was obtained from MSCs infected with lentivirus loaded with miR-132-3p vector. At the same time,MSCNC was obtained by infecting MSCs with control lentivirus loaded with scramble sequence. EXs released from MSCNCand MSCmiR-132-3pwas isolated,and MSC-EXs and MSC-EXsmiR-132-3pwere obtained respectively. The obtained EXs and H/R damaged mouse brain microvascular endothelial cells (bend3) were co-cultured. According to culture conditions,the cells were divided into normal culture group (normal cell culture),H/R group (making a H/R model),MSC-EXs group (MSC-EXs co-culture),MSC-EXsmiR-132-3p group (MSC-EXsmiR-132-3pco-culture), and MSC-EXsmiR-132-3p+ LY294002 group ( before the cells and MSC-EXsmiR-132-3pwere co-cultured,treated by adding phosphatidyl alcohol 3 kinase [ PI3K] signaling pathway blocker LY294002 [20 μmol/L]). Quantitative real-time quantitative polymerase chain reaction was used to detect the expression of miR-132-3p in MSCs,MSC-EXs,and bend3 cells. Angiogenesis kit was used to detect angiogenic ability of bend3 cells,and 3-(4,5-dimethylthiazole-2)-2,5-diphenyltetrazolium bromide (MTT) assay was used to detect the proliferative capacity of bend3 cells. Scratch test was used to detect the migration ability of bend3 cells. hochest33258 staining showed cell apoptosis. Western blot was used to detect the phosphorylation level of protein kinase B ( Akt) . Results Compared with the H/R group, the MSC-EXs treatment group significantly improved the angiogenesis,proliferation,migration abilities, and Akt phosphorylation level of bend 3 cell damage induced by H/R (The H/R group were 3 ± 1,0. 275 ± 0. 020,147 ± 8 μm,and 0. 89 ± 0. 12,respectively;the MSC-EXs treatment group were 8 ± 3,0. 358 ± 0. 030,218 ± 10 μm, and 1. 37 ± 0. 25 μm,respectively;all P<0. 01). Apoptosis was significantly reduced (47 ± 2% vs. 63 ± 2%,all P<0. 01). Compared with the MSC-EXs treatment group,the angiogenesis,proliferation,migration abilities,and Akt phosphorylation level of bend 3 cells in the MSC-EXsmiR-132-3ptreatment group were increased (14 ±3,0. 444 ± 0.050,357±10μm,and1.67±0.23,respectively,all P<0.01).Apoptosis was significantly reduced (34±1%,all P<0. 01) . Compared with the MSC-EXsmiR-132-3ptreatment group, cell proliferation, migration, angiogenesis abilities,and Akt phosphorylation level in the MSC-EXsmiR-132-3p+LY294002 group were significantly reduced (5 ± 2,0. 304 ± 0. 050,175 ± 8 μm and 0. 95 ± 0. 11,respectively,all P<0. 01). Conclusion MSC-EXs with high expression of miR-132-3p may improve many physiological functions of H/R-induced damaged cerebrovascular endothelial cells by activating PI3K/Akt signaling pathway.
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Objective To explore the effect of manual lymphatic drainage on prevention of postoperative axillary web syndrome of breast cancer. Methods From June to December, 2015, 400 breast cancer patients after modified radical mastectomy were randomly divided into control group (n=200) and intervention group (n=200). The control group accepted routine functional exercise on affected upper limbs, while the intervention group accepted manual lymphatic drainage in addition. The incidence of axillary web syndrome in both groups was compared one, two and three months after operation. Results The incidence of axillary web syndrome was less in the intervention group than in the control group in all the time points after operation (χ2>6.17, P<0.05). Conclusion Manual lymphatic drainage can effectively pre-vent axillary web syndrome in patients with breast cancer after modified radical mastectomy.
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Objective To explore the effects of seven-step complex decongestion therapy (CDT) on post-operative upper limb lymphede-ma of breast cancer. Methods From August, 2015 to September, 2016, 71 patients with upper limb lymphedema after breast cancer surgery accepted CDT for 20 days, including skin care, opening of lymphatic pathway, relief of scar tissue, manual lymphatic drainage, bandage compression, air pressure wave therapy and functional exercise. The circumference of eight sites of both limbs was measured and the differ-ences were calculated before treatment, and one, five, ten, fifteen and twenty days of the treatment. Results The differences of circumfer-ence increased one to 15 days of the treatment (Z>2.03, P<0.05), and decreased 20 days of the treatment (Z=3.01, P<0.01). Conclusion CDT is effective on lymphedema after breast cancer surgery for 20 days of a course, but may worsen in the first 15 days, which may be relat-ed to acute stress response or redistribution of lymph.
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Objective To summarize the perioperative nursing of huge malignant lobulated breast tumor, so as to promote the recovery of patients. Methods A total of 11 patients with huge malignant lobulated breast tumor patients were selected, assessed the preoperative status,finished breast tumor site nursing, strengthen psychological nutritional assessment, the adjustment of the respiratory system for the operation, prevent falls. In addition to do a good job in general nursing and postoperative pain management, but should also focus on the observation of the chest wall flap, drainage tube care, to prevent bleeding and infection, etc. Results By implementing the nursing plan, 1 case of breathing difficulties preoperative patients with respiratory function improved, 1 case of refuse treatment of patients accepted surgical treatment after psychological intervention, 2 cases of postoperative patients with skin flap necrosis, local treatment, after compression bandage, 1 case of good recovery, 1 case of poor treatment effect for the wound recovered well after back surgery graft;1 case of patients with subcutaneous effusion, to adjust the drainage tube, suction fluid, after compression bandage, partial treatment, recovering well. Patients were good recovery, discharged smoothly. Conclusions By constantly sum up experience, through positive assessment of patients after preoperative mental and physical health and attaches importance to patients' skin flap, bleeding, pain, completes the drainage tube nursing and prevention of infection, can effectively promote the recovery of patients.