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Purpose@#Oligometastatic non–small cell lung cancer (NSCLC) patients have been increasingly regarded as a distinct group that could benefit from local treatment to achieve a better clinical outcome. However, current definitions of oligometastasis are solely numerical, which are imprecise because of ignoring the biological heterogeneity caused by genomic characteristics. Our study aimed to profile the molecular alterations of oligometastatic NSCLC and elucidate its potential difference from polymetastasis. @*Materials and Methods@#We performed next-generation sequencing to analyze tumors and paired peripheral blood from 77 oligometastatic and 21 polymetastatic NSCLC patients to reveal their genomic characteristics and assess the genetic heterogeneity. @*Results@#We found ERBB2, ALK, MLL4, PIK3CB, and TOP2A were mutated at a significantly lower frequency in oligometastasis compared with polymetastasis. EGFR and KEAP1 alterations were mutually exclusive in oligometastatic group. More importantly, oligometastasis has a unique significant enrichment of apoptosis signaling pathway. In contrast to polymetastasis, a highly enriched COSMIC signature 4 and a special mutational process, COSMIC signature 14, were observed in the oligometastatic cohort. According to OncoKB database, 74.03% of oligometastatic NSCLC patients harbored at least one actionable alteration. The median tumor mutation burden of oligometastasis was 5.00 mutations/Mb, which was significantly associated with smoking, DNA damage repair genes, TP53 mutation, SMARCA4 mutation, LRP1B mutation, ABL1 mutation. @*Conclusion@#Our results shall help redefine oligometastasis beyond simple lesion enumeration that will ultimately improve the selection of patients with real oligometastatic state and optimize personalized cancer therapy for oligometastatic NSCLC.
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Objective: To observe the effects of acupoint sticking therapy of different dosages and durations on the subjective and objective sleep indicators in insomnia patients.Methods: Ninety-six patients with insomnia due to liver-Qi stagnation and spleen deficiency were divided into a high-dosage 7 d group (25 cases), a high-dosage 14 d group (22 cases), a low-dosage 7 d group (21 cases), and a low-dosage 14 d group (28 cases) using the random numbers generated in a stratified and stage-by-stage manner in combination with the visiting sequence. The four groups all received the same acupuncture treatment, but acupoint sticking therapy varied in dosage and duration. Before and after treatment, the actigraphic readings (total time in bed, total sleep time, sleep efficiency, number of wake bouts, length of wakes after asleep, and sleep latency), Pittsburgh sleep quality index (PSQI) score, and symptoms score of traditional Chinese medicine (TCM) were observed. A correlation analysis was conducted among the subjective and objective indicators. Results: The PSQI score was positively correlated with the total time in bed and total sleep time (P<0.05). After treatment, the sleep latency, PSQI scores, and TCM symptoms scores changed significantly in the four groups (P<0.05). The total sleep time and sleep efficiency gained improvements after treatment in the high-dosage 14 d and low-dosage 14 d groups (P<0.05). The high-dosage acupoint sticking groups had longer total sleep time compared with the low-dosage groups of the same treatment duration (P<0.05). After treatment, the length of wakes after asleep, PSQI scores, and TCM symptoms scores were better in the 14 d groups than in the 7 d groups of the same acupoint sticking dosage (P<0.05). Conclusion: Given the same acupuncture treatment, acupoint sticking therapy of different treatment durations produces different effects on the length of wakes after asleep, PSQI score, and TCM symptoms score in insomnia patients, and the 14-day acupoint sticking treatment is superior to the 7-day treatment.
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Anticipatory grief is the grief that an individual feels about the imminent loss, which can cause adverse effects on the patient ,s family, such as psychology, physiology, and behavior. In order to fully understand the research progress of anticipated grief in the patient ,s family, this article starts with expectations. The concept of anticipatory grief, measurement tools, influencing factors, intervention programs, and study population are reviewed in order to provide references for the domestic research on anticipatory grief of patients , families.
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Objective To observe the clinical efficacy of electroacupuncture at Zusanli (ST36) and Diji (SP8) in easing pain after Caesarean section (C-section) and the safety of the treatment. Method Sixty patients going to receive lower-uterine-segment C-section were enrolled and randomized into two groups. The control group was intervened by patient-controlled intravenous analgesia (PCIA) with Sufentanil after the surgery, while the treatment group was intervened by 30-minute electroacupuncture (EA) after the surgery. The contents of blood β-endorphin (β-EP), 5-hydroxytryptamine (5-HT) and prostaglandin E2 (PGE2) were evaluated at several time points: prior to EA (T1), 2 h after the surgery (T2), 12 h after the surgery (T3), 24 h after the surgery (T4) and 48 h after the surgery (T5). Visual Analogue Scale (VAS) was adopted to measure pain intensity at T2, T3, T4 and T5. The therapeutic efficacy, safety level and adverse reactions were recorded at each time point. Result The VAS score was significantly lower in the treatment group than in the control group at T2, T3 and T4 (P0.05). Regarding the efficacy evaluation, the excellent rate was 86.7% in the treatment group 2 h after the surgery, significantly higher than 60.0% in the control group (P<0.05). The security level in the treatment group was markedly higher than that in the control group (P< 0.05). Conclusion EA can provide a safe and effective post-operation analgesia for C-section, and the possible mechanism is that EA at Zusanli and Diji increases the secretion of β-EP and inhibits the release of inflammatory mediators 5-HT and PGE2.
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Objective To investigate the relationship between subclinical hypothyroidism (SCH) and diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM).Methods A total of 792 patients of T2DM were enrolled in the study.There were 448 males and 344 females,with an average age of (54.13 ± 13.06)years.The average duration of diabetes was (8.03 4±6.70) years.The patients were grouped according to the degree of DR and thyroid function.Among them,483 patients (61.0％) were no DR,240 patients (30.3％) were mild DR,69 patients (8.7％) were severe DR.725 patients (91.5％) were normal thyroid function,67 patients (8.5％) were SCH.The prevalence of SCH among no DR group,mild DR group and severe DR group was compared.And the prevalence of DR between normal thyroid function group and SCH group was compared.Logistic regression analysis was used to estimate the association between SCH and DR.Results No significant differences among the three groups (no DR group,mild DR group,severe DR group) were found in the prevalence of SCH (x2=1.823,P=0.402).There were no significant differences in the incidences of DR between normal thyroid function group and SCH group (x2=1.618,P=0.239).Logistic regression analysis demonstrated that SCH was not significant associated with DR [mild DR:odds ratio (OR)=1.361,95％ confidence interval (CI)=0.773-2.399,P=0.286;severe DR:OR=1.326,95％CI=0.520-3.384,P=0.555;DR:OR=1.353,95％ CI=0.798-2.294,P=0.261).Conclusion SCH is not significant associated with DR in patients with T2DM.
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Objective To investigate the epidemiology characteristics of crawfish related rhabdomyolysis (RM) in Nanjing, 2016.Methods Outpatient and inpatient electronic medical system of 21 hospitals in Nanjing during 2016 were retrospectively searched, and all the patients diagnosed with RM were selected. The patients with none crayfish-related RM was excluded. The epidemiology characteristics were depicted. The geographic information system (GIS) was used to collect, manage and analyze the spatial data, to visualize it, to analyze the spatial distribution features of the disease, and to explore the cause of disease prediction. GeoDa 1.8 software was used to analyze the global and local spatial auto-correlation.Results A total of 1183 patients with crawfish related RM were initially screened, excluding 59 patients with RM caused by trauma, severe exercise, heat stroke, myositis, poisoning, drugs, and genetic diseases, and 1124 patients were enrolled. The proportion of men was 36.48% (410/1124) with an incidence of 12.54/100 thousands; while of women was 63.52% (714/1124) with an incidence of 21.86/100 thousands. The median age at onset was 34 (28, 43) years. From July to August, the incidence of crawfish related RM was the highest, accounting for 96.53% of the total number of cases. The top four incidence areas were Pukou (41.54/100 thousands), Jianye (25.94/100 thousands), Qixia (25.73/100 thousands), Gulou (25.04/100 thousands), all of which were adjacent to the Yangtze River. Global spatial autocorrelation analysis showed: MoranI = 0.427,Z = 2.646,P = 0.003, suggesting that the crawfish related RM had positive spatial autocorrelation. The results showed that the spatial structure of crawfish related RM existed in Nanjing in 2016. Local spatial autocorrelation analysis showed that the high-high concentration areas were Pukou, Jianye and Liuhe. The incidences of above three areas which were the Nanjing section of the lower reaches of the Yangtze River flowed through the region and surrounding areas were higher than the overall incidence of Nanjing.Conclusion The prevalence of crawfish related RM in Nanjing during 2016 had an obvious region-concentrated character and global spatial autocorrelation with the high prevalent regions mainly concentrated in the urban areas adjacent to the Yangtze River.
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Postoperative ileus (POI) is a common abdominal postoperative complication of surgery as well as obstetrics and gynecology. There is a lack of an effective method of modern medicine due to its complex pathophysiological mechanism and the postoperative physiological disorder of patient. Acupuncture has remarkable regulatory effects on gastrointestinal function. Some clinical studies indicated that acupuncture was an effective method to treat POI, which could reduce the duration of POI and the treatment costs of patients in hospital. However, the mechanism and law of acupuncture on treating POI is still unclear. Some clinical studies indicated that the regulatory effect of acupuncture on the gastrointestinal motility was associated with its regulation of the autonomic nerve system and immune system. Based on its effect on regulating autonomic nerve system and immune system, acupuncture would be a potential and safe treatment for POI.
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<p><b>OBJECTIVE</b>To study whether the dose of controlling antihypertensive drug is reduced by transcutaneous electrical acupoint stimulation (TEAS) and the anesthetics, as well as the control of blood pressure (BP) and heart rate (HR) in endoscopic endonasal surgery with general anesthesia.</p><p><b>METHODS</b>Sixty patients for selective endoscopic endonasal surgery with general anesthetics and controlling antihypertension involved were selected and randomized into a TEAS group, a sham-TEAS group, 30 cases in each one. The electric pads were attached to bilateral Hegu (LI 4), Zusanli (ST 36), Sanyinjiao (SP 6) and Quchi (LI 11), stimulated with Hans-200 apparatus, 3 to 5 mA, 2 Hz/100 Hz in the TEAS group based on the patients' response to comfort. No electric stimulation was applied to the sham-TEAS group. The general anesthesia started after 30 min intervention and lasted till the end of surgery. The BP and HR were observed and recorded at the end of monitoring in operation room, 10 min after tranquilization (T0), 30 min after intervention (Tj, after induction~of general anestiesa (T2), 30 min after surgery start (T3), 60 min after surgery start (T4) and 30 min after extubation (T5). The doses of vecuronium bromide, propofol and nitroglycerin were recorded statistically in surgery, as well as the operative bleeding volume, the operative time, the resuscitation time and the visual analogue scale (VAS) score after resuscitation.</p><p><b>RESULTS</b>Compared with that at T0, the mean arterial pressure (MAP) at T2, T3, T4 and T5 in the TEAS group and at T3 and T4 in the sham-TEAS group was all reduced, indicating the significant difference (all P < 0.01). MAP at T2 and T5 in the TEAS group was lower than that in the sham-TEAS group (both P < 0.01). Compared, with that at T5, except at T2 in the TEAS group (P<0. 05), HR was not different significantly at the rest time points (all P > 0.05). HR was different at T2 to Ts in the sham-TEAS group statistically (all P < 0.01). The doses of vecuronium bromide, propofol and nitroglycerin, the operative bleeding volume, the operative time, the resuscitation time and VAS after resuscitation were not different significantly between the two groups (all P > 0.05).</p><p><b>CONCLUSION</b>The general anesthesia with TEAS and anesthetics involved for controlling antihypertension contributes to the control of BP and HR in the patients in endoscopic endonasal surgery. The impacts are not obvious on the doses of antihypertensive drug, the general anesthetics, the operative bleeding volume, the time of resuscitation and the postoperative analgesia.</p>
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Adult , Female , Humans , Male , Middle Aged , Young Adult , Acupuncture Analgesia , Acupuncture Points , Anesthetics, General , Blood Pressure , Electric Stimulation , Endoscopy , Heart Rate , Nose Diseases , General SurgeryABSTRACT
Objective To evaluate the predictive value of plasma atrial natriuretic peptide (ANP) level on prognostic of patients with systemic inflammatory response syndrome by dynamic monitoring ANP levels.Methods Ninety-eight patients admitted to the intensive care unite were classified into survival group(n =78) and death group (n =20).The level of plasma ANP,procalcitonin,C-reactive protein and lactic acid were measured.Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score were recorded.Results The plasma ANP level of patients in the death group was 0.40 (0.26) μg/L,significantly higher than that in the survival group(0.22(0.12) μg/L,P =0.000).Along with treatment scheme,the plasma ANP level decreased in survival group,and there were significant difference among three times (0.22 (0.12) μg/L,0.17 (0.09) μg/L,0.13 (0.11) μg/L,P =0.000).But there was no difference in ANP level of patients in death group along with the disease developing (0.38 (0.30) μg/L,0.39 (0.23) μg/L,0.39 (0.22) μg/L,P =0.99).ICU hospitalized time in survive group associated with APACHE Ⅱ score,ANP and PCT(r =0.735,0.628,0.487 respectively,P =0.000,0.001,0.021).Conclusion ANP is proved to be a good clinical index in prognostic evaluation of patients with sepsis.
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Laiminin,which has been found 15 isoforms up to today,is a kind of noncollagen glycoprotein of extracellular matrix.However,the functions of laminin varis from each other,which mainly takes participation in the process of the cell adherence,migration,differentiation,growth,cell signaling and tissue repair in vivo.In recent years,some scholars have found that laminin plays an important role in angiogenesis.The purpose of this article is to summarize the role of laminin in angiogensis and sum up the current research progress.
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Objective To observe the effect of adding on glimepiride in treating type 2 diabetic patients who had suffered the disease for more than 10 years and were poorly controlled with insulin combined with nonsulfonylureas drugs. Methods Seventy-five type 2 diabetic patients poorly controlled with insulin combined with non-sulfonylureas drugs were randomly divided into glimepiride-added group (INS+GM, n = 39 )and continuation of insulin group ( INS, n = 35 ). HbA1c, plasma glucose, daily insulin dose, number of hypoglycemic events, body weight, plasma lipid concentration,and high-sensitive C-reactive protein (hs-CRP)were recorded at weeks 0, 12,and 24. The levels of plasma free fatty acid ( FFA), adiponectin, and tumor necrosis factor-α ( TNF-α ) were measured before and 24 weeks after the therapy. Results At 12 and 24 weeks, fasting blood glucose, 2 h postprandial blood glucose,and HbA1c were improved in INS+GM group more markedly than in INS group, and daily insulin dose and body weight were decreased in INS+GM compared with INS ( P＜0. 05 ). The number of hypoglycemic events and plasma lipid concentration did not differ between two groups ( P＜0.05 ). The levels of plasma FFA,TNF-α,hs-CRP, and HOMA-IR were lower in INS+GM than INS ( P＜0.05 ), the adiponectin was higher in INS + GM than INS ( P ＜ 0.05 ). Conclusion Adding glimepiride to insulin therapy resulted in a sustained better glycemic control with less insulin daily dose, decresed body weight, and no increase in hypoglycemic events as compared with the continuing insulin therapy group. Increased adiponectin, as well as decreased plasma FFA and TNF-α may underlie the improvement of insulin resistance with glimepiride treatment.
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Alc in trial group were significant better than those in control group ( P < 0. 05 ). The results indicate that type 2 diabetic patients with Hp infection should receive moxifloxacin-based triple therapy as first-line treatment.
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Objective To solve the caducity question of Dendrobium officinale during the tissue-culture process. Methods Added the different concentration of 0.1 and 2 mg/L AgNO3 into the PLB proliferation medium, buds proliferation medium, and rooting medium separately. The quantity of the ethylene production was to be determined and the situation of the tube seedling growth was to be observed. ResultsAgNO3 can suppress the production of the ethylene, enhance the multiplication speed of PLB and split-up efficiency the clump of bud, and obviously promote the seedling′s growth. It showed that the survival ratio of transplant could enhance as many as two times and display the merit of caducity-resistant. ConclusionAgNO3(1 mg/L) can be taken as the caducity-resistant reagent of D. officinale during the tissue-culture processing.
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Object To optimize the best extraction of the total saponins in the root of Ophiopogon japonicus (Thunb.) Ker-Gawl. (RO). Methods The extract condition of total saponins in RO was observed by orthogonal design with ophiopogonis D as index. Results The optimum extract condition of RO was established. The more effective way was to smash RO to 5-10 mesh and extract total saponins in RO with ten times amount of 80% alcohol thrice by refluxing, one hour each time. Conclusion The total saponins in RO could be fully extracted in this condition.