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Objective@#To investigate the effect of the socket-shield technique (SST) concurrent with immediate implant placement and provisionalization (IIPP) in the aesthetic restoration of anterior teeth.@*Methods@#A case of maxillary anterior tooth stumps with a thin labial bone wall was treated with SST for preservation of labial soft and hard tissue fullness, combined with an immediate implant placement and immediate provisional crown for restoring the shape of the tooth and gingival molding@*Results@#Immediate implant placement and provisionalization restored the morphology and function of the affected tooth in the shortest possible time. The patient's labial soft and hard tissue contours in the affected tooth area were well preserved in the 18-month follow-up after the application of the SST, which presented a better aesthetic result. The literature review indicates that the indications for SST are unrestorable maxillary anterior teeth, whose dental, periodontal and periapical tissues are healthy and intact. In the esthetic zone, root shielding is effective in maintaining the soft and hard tissue contour on the labial side of the implant. However, there is no consensus on the technical details of SST, such as the ideal coronal height and thickness of the shield, and the management of the gap between the shield and the implant. Thus, more clinical studies and histologic evidence are needed to provide a reference for clinical decision-making. In addition, digital technology can improve the accuracy of implant placement and shield preparation.@*Conclusion@#The correct application of SST combined with IIPP in the esthetic zone can ensure esthetic results. However, more high-quality evidence-based medical evidence is needed for its long-term efficacy, and indications should be strictly controlled during clinical application.
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Objective:To evaluate the dose calculation accuracy of cone-beam CT (CBCT) image by actual measurement method.Methods:CBCT images of 60 patients in the Second Affiliated Hospital of Soochow University from September, 2021 to May, 2022 were retrospectively analyzed. CBCT images of full-fan and half-fan scanning of the head, half-fan scanning of the chest and pelvis were obtained by the Varian OBI system. Hounsfield unit - electron density (HU-ED) curves corresponding to the scanning conditions were established with CIRS electron density phantom. The radiotherapy plans were designed on the CBCT images, and the dose calculation results of the detection point were compared with the ionization chamber measurement results to analyze the dose error. Then, three-dimensional dose verification system was adopted to detect the accuracy of the CBCT image radiotherapy plans implementation process in 60 patients, and the accuracy of dose calculation was verified according to the D 99%, D mean, D 1% of target volume, D mean and D 1% of organs at risk (OAR), and the γ pass rate. Results:In point dose detection in phantom, the dose calculation errors of CBCT images in the above four scanning patterns were -1.06%±0.87%、-1.67%±0.86%, 0.91%±0.73%, -1.54%±0.90%, respectively. In dosimetric verification based on patients' CBCT image treatment plan, the mean difference of D mean, D 99%, and D 1% of planning target volume (PTV) in all scanning modes were not higher than 2%, and the D mean and D 1% differences of other OAR were not higher than 3%, except for the lens of patients in the head. The average γ values of target volume and OAR were less than 0.5 under the criteria of 3%/2 mm. Conclusions:Under the condition of correctly establishing HU-ED curves, intensity-modulated radiation therapy (IMRT) / volumetric-modulated arc therapy (VMAT) planning based on CBCT images can be employed to estimate and monitor the actual dose to target volume and OAR in adaptive radiotherapy. Full-fan scanning patterns can further improve the accuracy of dose calculation for the head of patients.
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Although the use of postmastectomy radiation therapy (PMRT) has been proven to bring survival benefit to breast cancer patients, the use of chest wall tissue equivalent filler (bolus) remains controversial. In recent years, a large number of studies have shown that the use of bolus in PMRT does not significantly improve the local control rate, while it can significantly increase the acute skin toxicity, and even leads to more frequent and longer treatment interruption. Existing retrospective studies have indicated that for breast cancer patients undergoing mastectomy and systemic therapy, if there is no skin invasion, it is recommended not to routinely use bolus during radiotherapy. However, higher-level clinical studies are needed for further confirmation.
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Objective:To study the long-term clinical effect of transvaginal mesh (TVM) and pelvic floor reconstruction with native tissue repair (NTR) in the treatment of advanced pelvic organ prolapse (POP).Methods:Totally 207 patients with advanced POP who were treated in Hunan Provincial Maternal and Child Health Care Hospital from Jan. 2016 to Sep. 2019 were enrolled. The patient′s pelvic organ prolapse quantification were all at degree Ⅲ or above, and they all complained for different degree of symptoms. They were divided into two groups according to the different surgical methods, TVM group and NTR group. In TVM group, the mesh was implanted through the vagina for pelvic floor reconstruction, while in NTR group, the traditional transvaginal hysterectomy combined with uterosacral ligament suspension and anterior and posterior wall repair, as well as perineal body repair were performed. The median follow-up time was 60 months, during the follow up time, 164 cases (79.2%, 164/207) had completed follow-up, including 76 cases in TVM group and 88 cases in NTR group. The perioperative data and complication rates of the two groups were compared, and the subjective and objective outcomes of the two groups at 1, 3 and 5 years were observed, respectively. The objective efficacy was evaluated by three composite criteria, namely: (1) the distance from the farthest end of the prolapse of the anterior and posterior wall of the vagina to the hymen is ≤0 cm, and the descending distance of the top is ≤1/2 of the total length of the vagina; (2) determine the disappearance of relevant POP symptoms according to “Do you often see or feel vaginal mass prolapse？”; (3) no further operation or pessary treatment was performed due to prolapse. If the above three criteria were met at the same time, the operation is successful; otherwise, it was recurrence. The subjective efficacy was evaluated by the pelvic floor distress inventory-short form 20 (PFDI-20) and pelvic floor impact questionnaire-short form 7 (PFIQ-7).Results:The median follow-up time of the two groups was 60 months (range: 41-82 months). Five years after the operation, the subjective and objective cure rates of TVM group were 89.5% (68/76) and 94.7% (72/76), respectively. The subjective and objective cure rates in NTR group were 80.7% (71/88) and 85.2% (75/88), respectively. There were significant differences in the subjective and objective cure rates between the two groups ( χ2=9.869, P=0.002; χ2=3.969, P=0.046). The recurrence rate of TVM group was 5.3% (4/76), and that of NTR group was 14.8% (13/88). There was a significant difference between the two groups ( P=0.046). The postoperative PFDI-20 and PFIQ-7 scores of the two groups were significantly lower than those before surgery, and there were significant differences of the two groups before and after surgery (all P<0.05). Postoperative mesh exposure in TVM group was 1.3% (1/76). Conclusions:The long-term outcomes between the two groups show that the subjective and objective outcomes of pelvic floor reconstruction in TVM group are significantly higher than those in NTR group, and the recurrence rate is significantly lower than that in NTR group. TVM has certain advantages in the treatment of advanced POP.
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Bone defects caused by different causes such as trauma, severe bone infection and other factors are common in clinic and difficult to treat. Usually, bone substitutes are required for repair. Current bone grafting materials used clinically include autologous bones, allogeneic bones, xenografts, and synthetic materials, etc. Other than autologous bones, the major hurdles of rest bone grafts have various degrees of poor biological activity and lack of active ingredients to provide osteogenic impetus. Bone marrow contains various components such as stem cells and bioactive factors, which are contributive to osteogenesis. In response, the technique of bone marrow enrichment, based on the efficient utilization of components within bone marrow, has been risen, aiming to extract osteogenic cells and factors from bone marrow of patients and incorporate them into 3D scaffolds for fabricating bone grafts with high osteoinductivity. However, the scientific guidance and application specification are lacked with regard to the clinical scope, approach, safety and effectiveness. In this context, under the organization of Chinese Orthopedic Association, the Expert consensus for the clinical application of autologous bone marrow enrichment technique for bone repair ( version 2023) is formulated based on the evidence-based medicine. The consensus covers the topics of the characteristics, range of application, safety and application notes of the technique of autologous bone marrow enrichment and proposes corresponding recommendations, hoping to provide better guidance for clinical practice of the technique.
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OBJECTIVE To reveal the role of the basal forebrain(BF)GABAergic neurons in the regulation of isoflurane anesthesia and to elucidate the underlying neural pathways.METHODS The activity of BF GABAer-gic neurons was monitored during isoflurane anesthesia using a genetically encoded calcium indicator in Vgat-Cre mice of both sexes.The activity of BF GABAer-gic neurons was manipulated by chemogenetic and opto-genetic approaches.Sensitivity,induction time and emer-gence time of isoflurane anesthesia were estimated by righting reflex.The electroencephalogram(EEG)power and burst-suppression were monitored by EEG recording.The effects of activation of GABAergic BF-thalamic reticu-lar nucleus(TRN)pathway on isoflurane anesthesia were investigated with optogenetics.RESULTS The activity of BF GABAergic neurons was generally inhibited during isoflurane anesthesia,obviously decreased during the induction of anesthesia and gradually restored during the emergence from anesthesia.Activation of BF GABAergic neurons with chemogenetics and optogenetics promoted behavioral emergence from isoflurane anesthesia,with decreased sensitivity to isoflurane,delayed induction and accelerated emergence from isoflurane anesthesia.Optogenetic activation of BF GABAergic neurons prom-oted cortical activity during isoflurane anesthesia,with decreased EEG delta power and burst suppression ratio during 0.8%and 1.4%isoflurane anesthesia,respectively.Similar to the effects of activating BF GABAergic cell bod-ies,photostimulation of BF GABAergic terminals in the TRN also strongly promoted cortical activation and behav-ioral emergence from isoflurane anesthesia.CONCLU-SION The GABAergic neurons in the BF is a key neural substrate for general anesthesia regulation that facilitates behavioral and cortical emergence from general anesthe-sia via the BF-TRN pathway.
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AIM: To evaluate the application of single-pass four-throw releasable suture drainage tube ligation technique in Ahmed glaucoma valve(AGV)implantation.METHODS: A total of 78 patients(78 eyes)with refractory glaucoma who underwent AGV implantation in the People's Hospital of Leshan from May 2020 to January 2022 were retrospectively analyzed. According to the treatment, the patients were divided into the modified AGV implantation group, with 43 patients(43 eyes)treated by modified AGV implantation, ligating the drainage tube with single-pass four-throw releasable suture, and the traditional AGV implantation group, with 35 patients(35 eyes)treated by traditional AGV implantation. Followed-up for 6mo, the intraocular pressure(IOP), success rate and complications were observed at 1d, 1 and 2wk and 1 and 6mo after operation.RESULTS: Postoperative IOP at all follow-up visits was significantly lower than that before surgery in both groups(all P<0.05). There was no significant difference in IOP between groups at all follow-up visits(all P>0.05). The incidence of shallow anterior chamber was 5% in the modified AGV implantation group and 23% in the traditional AGV implantation group at 1wk after surgery(P<0.05). At 6mo after operation, the overall success rate was 98% in modified AGV implantation group and 89% in the traditional AGV implantation group(P>0.05).CONCLUSION:During AGV implantation, ligation of drainage tube with single-pass four-throw releasable suture can effectively reduce IOP and reduce the incidence of shallow anterior chamber in early postoperative stage. Furthermore, the technique is safe and efficacious.
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ObjectiveTo establish a rat model of diabetic wound by feeding on a high-fat and high-sugar diet combined with intraperitoneal injection of streptozotocin （STZ） and surgical preparation of full-thickness skin defects， observe the effect of cinnamaldehyde on the wound healing of diabetes rats， and explore the therapeutic mechanism of cinnamaldehyde in improving wound healing of diabetes rats based on the PTEN-induced putative kinase （PINK1）/Parkin pathway-mediated mitochondrial autophagy. MethodForty-eight male SD rats were randomly divided into blank group （n=12） and diabetes group （n=36）. The diabetes group was further randomly divided into model group， cinnamaldehyde group， and Beifuxin group， with 12 rats in each group. The blank group and the model group received routine disinfection with physiological saline after creating the wounds， while the cinnamaldehyde group received topical application of polyethylene glycol 400 （PEG 400） gel containing 4 μmol·L-1 cinnamaldehyde， and the Beifuxin group received topical application of Beifuxin gel. Dressings were changed once daily. The wound healing rate of each group was observed. On the 7th and 14th days after intervention， the wound tissues of the rats were collected. Hematoxylin and eosin （HE） staining was performed to observe the pathological changes in the local tissues. Immunohistochemistry （IHC） was used to detect the expression of interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， vascular endothelial growth factor （VEGF）， and collagen fibers. Immunofluorescence （IF） and Real-time polymerase chain reaction （Real-time PCR） were used to detect the protein， and mRNA expression of PINK1， Parkin， microtubule-associated protein 1 light chain 3 Ⅱ （LC3 Ⅱ）. ResultAfter intraperitoneal injection of STZ， compared with the blank group， the random blood glucose values of rats in the diabetic group increased significantly （P<0.01）， all higher than 16.7 mmol·L-1， and persistently hyperglycemic for some time after modeling. Compared with the blank group， the model group showed poor growth and healing of granulation tissue in the wounds， and the wound healing rate decreased （P<0.01）. On the 7th day after intervention， the blank group had squamous epithelial coverage on the wounds. Compared with the blank group， the model group only had a small amount of scab at the wound edges， with a large number of infiltrating inflammatory cells in the wounds. The protein expression levels of IL-6 and TNF-α in the tissues increased （P<0.01）， and the protein and mRNA levels of PINK1， Parkin， and LC3Ⅱ decreased （P<0.01）. On the 14th day after the intervention， the granulation tissue in the wounds of the blank group was mature and well-healed. Compared with the blank group， the model group still had infiltrating inflammatory cells and red blood cell exudation. The protein expression levels of VEGF and collagen fibers in the tissues decreased （P<0.01）， and the protein and mRNA expression levels of PINK1， Parkin， and LC3Ⅱ increased （P<0.01）. Compared with the model group， the cinnamaldehyde group and the Beifuxin group showed better wound healing， with increased wound healing rates （P<0.01）. On the 7th day after intervention， the protein expression levels of IL-6 and TNF-α in the tissues decreased （P<0.01）， and the protein and mRNA expression levels of PINK1， Parkin， and LC3Ⅱ increased （P<0.01）. On the 14th day after intervention， the protein expression levels of VEGF and collagen fibers in the tissues increased （P<0.01）， and the protein and mRNA expression levels of PINK1， Parkin， and LC3Ⅱ decreased （P<0.01）. ConclusionCinnamaldehyde can promote the wound healing of diabetes rats by increasing the wound healing rate， reducing the levels of inflammatory factors IL-6 and TNF-α， and increasing the levels of VEGF and collagen fibers. Its mechanism may be related to the regulation of the PINK1/Parkin signaling pathway， activation of mitochondrial autophagy， inhibition of inflammatory responses， and promotion of angiogenesis and collagen synthesis， thereby promoting the wound healing of diabetes rats.
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Objective To analyze the effect of different environments risks on the prognosis of patients with chronic obstructive pulmonary disease (COPD). Methods A total of 231 patients diagnosed with COPD who visited Mianyang Hospital of Traditional Chinese Medicine from April 2018 to January 2021 were selected as the study subjects and divided into two groups according to whether the residence was changed after discharge, that is, Mianyang Environmental Living Suzhou Environmental Living Group. The follow-up time was 2019 December to September 2021. The contents include relative humidity, temperature, PM2.5, PM10, air quality index, exposure to household smoking environment, and open windows for ventilation. The regional environment was mainly measured three times, namely October to February (expressed as cold period), June to August (expressed as warm period), March to May and September to October (expressed as suitable period). The family environment was followed up every 2 months by means of questionnaires and interviews, and detailed records were recorded. After the follow-up, the COPD Assessment Test (CAT) and Modified Dyspnea Rating Score (mMRC) were analyzed. Concentration-response curves were used to analyze the influence of living environment exposure on the prognosis of COPD patients. The generalized additive model with semi-Poisson distribution as the connection function was used to study the influence of univariate and multifactor environmental factors on COPD. Results The air quality index of Mianyang was higher than that of Suzhou during the cold period, while that of Mianyang was lower than that of Suzhou during the suitable period. Meanwhile, the average relative humidity of Suzhou was higher than that of Mianyang during the warm period. The comparison of CAT and mMRC scores of COPD patients in the two regions in different quarters showed that the CAT and mMRC scores of COPD patients in Mianyang City were lower than those in Suzhou City during the cold period, and the difference between groups was statistically significant (P2.5 (warm period), PM10 (warm period) and NO2 (suitable period) increased by 10μg/m3, 8μg/m3, 12μg/m3 and CO (suitable period) increased by 0.3mg/m3 respectively caused COPD function The scores of indicators CAT and mMRC increased. After adjusting for other pollutants, PM2.5, CO were still related to the prognosis of COPD. Concentration-response curve results showed that the risk of increasing CAT score decreased with increasing daily windowing time; conversely, the risk of increasing CAT score was increasing with increasing environmental exposure to smoking. Conclusion Pollutant exposure and living environment factors have a significant impact on the prognosis of COPD, and improving the environment is of great significance for the recovery of COPD pulmonary function.
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OBJECTIVE To explore the pharmaceutical service model in multidisciplinary diagnosis and treatment （MDT） of rare diseases in children. METHODS Clinical pharmacists of West China Second University Hospital （hereinafter referred to as “our hospital”） participated in the process of MDT of children’s rare diseases. Clinical pharmacists took part in the entire diagnosis and treatment process of children and established the MDT pharmaceutical service model of children’s rare diseases by formulating drug treatment plans based on evidence-based practice， improving the accessibility of drugs， pharmaceutical monitoring and drug treatment management. RESULTS From January 2021 to April 2022， clinical pharmacists of our hospital had participated in a total of 39 cases of rare diseases MDT in children， including 21 hospitalized children with rare diseases and 18 outpatient com children with rare diseases， involving a total of 23 rare diseases. Clinical pharmacists completed 45 pharmaceutical zhanglingli@scu.edu.cn rounds and 26 pharmaceutical consultations for rare diseases inpatients， 25 outpatients’ MDT and 5 pharmaceutical outpatient service for outpatients with rare diseases， 38 medication educations for inpatients and outpatients with rare diseases and 25 follow-up services for out-of-hospital patients. There were 24 cases （61.54%） of off-label drug use， involving 13 rare diseases and 16 therapeutic drugs， among which off-label drug use registration of 11 drugs had been completed or was in progress. The temporary purchase evaluations of 3 drugs had been completed； 268 cases of medical insurance drug and high-value drug prescription had been reviewed. CONCLUSIONS Our hospital have primarily established a loop pharmaceutical service model of MDT for children with rare diseases， which covers inpatients and outpatients. The model improves the availability and standardization of clinical application of therapeutic drugs， and diagnosis and treatment level for children with rare diseases in our hospital.
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Emerging SARS-CoV-2 variants have made COVID-19 convalescents susceptible to re-infection and have raised concern about the efficacy of inactivated vaccination in neutralization against emerging variants and antigen-specific B cell response. To this end, a study on a long-term cohort of 208 participants who have recovered from COVID-19 was conducted, and the participants were followed up at 3.3 (Visit 1), 9.2 (Visit 2), and 18.5 (Visit 3) months after SARS-CoV-2 infection. They were classified into three groups (no-vaccination (n = 54), one-dose (n = 62), and two-dose (n = 92) groups) on the basis of the administration of inactivated vaccination. The neutralizing antibody (NAb) titers against the wild-type virus continued to decrease in the no-vaccination group, but they rose significantly in the one-dose and two-dose groups, with the highest NAb titers being observed in the two-dose group at Visit 3. The NAb titers against the Delta variant for the no-vaccination, one-dose, and two-dose groups decreased by 3.3, 1.9, and 2.3 folds relative to the wild-type virus, respectively, and those against the Omicron variant decreased by 7.0, 4.0, and 3.8 folds, respectively. Similarly, the responses of SARS-CoV-2 RBD-specific B cells and memory B cells were boosted by the second vaccine dose. Results showed that the convalescents benefited from the administration of the inactivated vaccine (one or two doses), which enhanced neutralization against highly mutated SARS-CoV-2 variants and memory B cell responses. Two doses of inactivated vaccine among COVID-19 convalescents are therefore recommended for the prevention of the COVID-19 pandemic, and vaccination guidelines and policies need to be updated.
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OBJECTIVE@#To investigate the effects of SINC, a secreted protein of Chlamydia psittaci, on autophagy of host cells and the role of MAPK/ERK signaling pathway in mediating SINC-induced autophagy.@*METHODS@#RAW 264.7 cells treated with recombinant SINC were examined for changes in expression levels of LC3-II, Beclin-1, phosphorylated and total ERK1/2 using Western blotting. The expression level of LC3 in the treated cells was detected using immunofluorescence analysis, and the formation of autophagosomes and autolysosomes was observed with transmission electron microscopy (TEM). The effect of pretreatment with U0126 (a specific ERK inhibitor) on the expression levels of LC3-II and Beclin-1 in RAW 264.7 cells exposed to different concentrations of SINC was examined using Western blotting, and LC3 puncta in the cells was detected with immunofluorescence analysis.@*RESULTS@#The expression levels of LC3-II and Beclin-1 were the highest in RAW 264.7 cells treated with 2 μg/mL SINC for 12h. Immunofluorescence analysis showed exposure to SINC significantly increased the number of cells containing LC3 puncta, where the presence of autophagosomes and autolysosomes was detected. Exposure to 2 μg/mL SINC for 15 min resulted in the most significant increase of the ratios of p-ERK1/2/ERK1/2 in RAW 264.7 cells. Pretreatment of the cells with U0126 prior to SINC exposure significantly decreased the ratio of p-ERK1/2/ERK1/2, lowered the expression levels of LC3-II and Beclin-1, and decreased LC3 aggregation in the cells.@*CONCLUSIONS@#SINC exposure can induce autophagy in RAW 264.7 cells by activating the MAPK/ERK signaling pathway.
Subject(s)
MAP Kinase Signaling System , Chlamydophila psittaci , Beclin-1 , Signal Transduction , AutophagyABSTRACT
Cerebral small vessel disease (CSVD) is a senile brain lesion caused by the abnormal structure and function of arterioles, venules and capillaries in the aging brain. The etiology of CSVD is complex, and disease is often asymptomatic in its early stages. However, as CSVD develops, brain disorders may occur, such as stroke, cognitive dysfunction, dyskinesia and mood disorders, and heart, kidney, eye and systemic disorders. As the population continues to age, the burden of CSVD is increasing. Moreover, there is an urgent need for better screening methods and diagnostic markers for CSVD, in addition to preventive and asymptomatic- and mild-stage treatments. Integrative medicine (IM), which combines the holistic concepts and syndrome differentiations of Chinese medicine with modern medical perspectives, has unique advantages for the prevention and treatment of CSVD. In this review, we summarize the biological markers, ultrasound and imaging features, disease-related genes and risk factors relevant to CSVD diagnosis and screening. Furthermore, we discuss IM-based CSVD prevention and treatment strategies to stimulate further research in this field.
Subject(s)
Humans , Integrative Medicine , Brain/pathology , Cerebral Small Vessel Diseases/pathology , Stroke/complications , Cognitive Dysfunction/complications , Magnetic Resonance ImagingABSTRACT
OBJECTIVE To provide reference for safe use of risperidone in clinic. METHODS Data mining and analysis of risperidone-related adverse drug event （ADE） reports from the first quarter of 2017 to the third quarter of 2021 in the United States FAERS database were carried out using reported odds ratio and composite criteria methods from Medicines and Healthcare Products Regulatory Agency. RESULTS There were 101 181 ADE reports with risperidone as the primary suspect drug，involving a total of 33 179 patients. Among those reports，the male-to-female ratio was about 6.21 to 1； most of them were ＜18 years old （15.01%）； ADE was mainly reported by consumers （69.74%） and mainly reported by the United States （79.72%）； oral dosage form was the most used，accounting for 83.71%. A total of 409 ADE signals were obtained，including male breast development， pseudogynecomastia，abnormal increase in body mass，hyperprolactinemia and Wellens syndrome，etc. Twenty-six systems and organs were involved，mainly including reproductive system and breast diseases，various injuries，poisoning and operational complications， mental diseases，metabolic and nutritional diseases，and various nervous system diseases，etc. CONCLUSIONS The common ADE signals of risperidone and the system involved are consistent with the instructions，but we should also be alert to the ADE not recorded in the instruction，such as Wellens syndrome，fibroproliferative endocarditis，cavernous degeneration of portal vein，rabbit syndrome，etc.
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Objective:To investigate the predictive value of anticardiolipin antibody (ACA) and D-dimer (D-D) combined with risk assessment profile for thromboembolism (RAPT) for deep vein thrombosis (DVT) in elderly postoperative patients with intertrochanteric fracture of femur (IFF).Methods:The clinical data of 123 elderly patients with IFF in Suzhou Hospital Affiliated to Anhui Medical University from January 2019 to March 2022 were retrospectively analyzed. All patients underwent closed reduction intramedullary nail fixation. The patients were divided into DVT group (27 cases) and non-DVT group (96 cases) according to the presence or absence of DVT 7 d after surgery. Before surgery and 3, 5 d after operation, the ACA was detected by enzyme-linked immunosorbent assay, the D-D was detected by automatic coagulation analyzer, and RAPT was performed. The correlation among ACA, D-D and RAPT was analyzed by Spearman method. Multivariate Logistic regression was used to analyze the independent risk factors of DVT in elderly postoperative patients with IFF. Receiver operating characteristic (ROC) curve was used to analyze the efficacy of ACA, D-D and RAPT in predicting DVT in elderly postoperative patients with IFF. The incidences of postoperative DVT in patients with different ACA, D-D and RAPT patients were compared.Results:There were no statistical difference in ACA, D-D and RAPT before operation between the two groups ( P>0.05); the ACA, D-D and RAPT 3 and 5 d after operation in DVT group were significantly higher than those in the non-DVT group, 3 d after operation: (12.44 ± 3.25) × 10 3 RU/L vs. (8.67 ± 2.81) × 10 3 RU/L, (7.29 ± 1.49) mg/L vs. (4.70 ± 1.23) mg/L and (9.79 ± 1.15) scores vs. (9.21 ± 1.32) scores; 5 d after operation: (10.28 ± 2.16) × 10 3 RU/L vs. (6.45 ± 2.04) × 10 3 RU/L, (5.49 ± 1.26) mg/L vs. (3.63 ± 1.05) mg/L and (9.57 ± 1.08) scores vs. (9.12 ± 0.70) scores, and there were statistical differences ( P<0.01 or <0.05). Since ACA, D-D and RAPT in the two groups all reached their peak 3 d after operation, this time point was selected for analysis. Three days after operation, Pearson correlation analysis result showed that ACA and D-D were positively correlated with RAPT ( r = 0.635 and 0.630, P<0.01), and ACA was positively correlated with D-D ( r = 0.657, P<0.01). ROC curve analysis result showed that the area under the curve (AUC) of ACA and D-D combined RAPT 3 d after operation in predicting DVT in elderly postoperative patients with IFF was greater than that predicted by the 3 indexes alone (0.982 vs. 0.894, 0.870 and 0.868), the optimal cut-off values were 11.48 × 10 3 RU/L, 6.75 mg/L and 9 scores. According to the optimal cut-off value of ROC curve analysis at 3 d after operation, the patients were divided into ACA low expression (≤11.48 × 10 3 RU/L, 92 cases) and ACA high expression (>11.48 × 10 3 RU/L, 31 cases), D-D low expression (≤6.75 mg/L, 99 cases) and D-D high expression (>6.75 mg/L, 24 cases), low RAPT (≤9 scores, 93 cases) and high RAPT (>9 scores, 30 cases). The incidences of postoperative DVT in patients with ACA high expression, D-D high expression and high RAPT were significantly higher than those in patients with ACA low expression, D-D low expression and low RAPT: 43.39% (15/31) vs. 13.04% (12/92), 54.17% (13/24) vs. 14.14% (14/99) and 53.33% (16/30) vs. 11.83% (11/93), and there were statistical differences ( χ2 = 16.91, 18.06 and 22.81; P<0.01). After controlling for diabetes and other factors, multivariate Logistic regression analysis result showed that ACA, D-D and RAPT 3 d after operation were independent risk factors for DVT in elderly postoperative patients with IFF ( OR = 2.156, 2.276 and 6.106; 95% CI 1.356 to 3.429, 1.240 to 4.177 and 1.564 to 23.840; P<0.01). Conclusions:The ACA, D-D combined with RAPT can improve the predictive value of DVT in elderly postoperative patients with IFF, which has important reference significance for taking timely and effective intervention measures in early clinical stage.
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Objective:To explore the current status and influencing factors of medical narrative competence among nurses in Luzhou, offering theoretical insights for improving nurses′ narrative competence.Methods:This study was a cross-sectional survey. From July 2021 to January 2022, using convenience sampling method, 267 nurses from Zhongshan Area of Affiliated Hospital of Southwest Medical University, Kangjian Area of Affiliated Hospital of Southwest Medical University and the Traditional Chinese Medicine Hospital Affiliated to Southwest Medical University were investigated by the general information questionnaire, Narrative Competence Scale, Nurses′ Perceived Professional Benefits Questionnaire And Perceived Social Support Scale.Results:The total scores of narrative competence of the 267 nurses was (142.25 ± 19.03), nurses′ perceived professional benefits was (137.16 ± 15.89) and perceived social support was (65.86 ± 10.38). The results of multiple linear regression showed that nurses′ perceived professional benefits and perceived social support were the important factors affecting their narrative ability ( t = 5.09 and 5.95, both P<0.05), which could account for 35.7% of the total variation of narrative competence. Conclusions:Nurses have narrative competence at low level in Luzhou. Managers should pay more attention to nurses who have poor level of perceived professional benefits and perceived social support, so as to keep the nurses′ mental health and improve nurses′ narrative competence by taking corresponding measures.
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Objective:To construct a preoperative rehabilitation program for gastric cancer patients, aiming to provide scientific and reasonable preoperative guidance for gastric cancer patients.Methods:On the basis of literature research and expert group meeting, the first draft of the preoperative rehabilitation program for gastric cancer patients was constructed. From October 2021 to January 2022, the Delphi method was used to conduct 2 rounds of expert letter inquiries to 16 experts in related fields from 11 hospitals in Jiangsu Province, and the entries were revised according to the experts′ inquiries.Results:In the two rounds of expert correspondence, the positive coefficients of experts were 88.89% and 100.00%, and the authority coefficients of experts were both 0.88. The coordination coefficients of the items in the two rounds of inquiry were 0.279 and 0.290, respectively. The final program consisted of 3 first-level entries, 11 second-level entries and 32 third-level entries.Conclusions:The scheme constructed in this study is scientific, reliable and applicable, and is worth being promoted further in clinical practice.
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Objective:To discuss the effect of Hashimoto’s thyroiditis (HT) on papillary thyroid carcinoma (РТС) .Methods:The clinical features and pathological characteristics of 682 patients who underwent surgical treatment for the first time from Sep. 1st,2019 to May. 1st, 2021 in Department of Thyroid, Breast and Hernia Surgery, and confirmed by postoperative pathology as papillary thyroid carcinoma were retrospectively analyzed. There were 189 male patients, and 493 female patients, 529 patients < 55 years old and 153 patients ≥55 years old. 476 patients were classified as PTC group and 206 patients as PTC combined with HT group. Chi square test was used to compare the difference between two groups in gender, age, thyroglobulin antibody, thyroid stimulating hormone, thyroid peroxidase antibodies, thyroid peroxidase, number of lesions, metastasis lymph node in central region, thyroid stimulating hormone receptor antibody, carcinoembryonic antigen, whether microcarcinoma, vascular invasion, glandular outside violation, capsule and lateral transfer analysis, ultrasonic calcification, etc. At the same time, all patients were divided into the group without central lymph node metastasis (345 cases) and the group with central lymph node metastasis (337 cases) . The χ 2 test was used to compare the differences between the two groups in terms of sex, age, number of lesions, microcarcinoma, vascular invasion, extradular invasion, capsular invasion, lateral cervical lymph node metastasis, ultrasonic calcification and so on, so as to analyze the differences in clinical characteristics between the two groups. Results:There were 206 cases (30.21%) in PTC combined with HT group and 476 cases (69.79%) in PTC without HT group. There were significant differences in gender (12/194 vs 177/299) ( P=0.000) , age (175/31 vs 354/122) ( P=0.002) , TgAb (115/91 vs 455/21) ( P=0.000) ,TSH (13/175/18 vs 33/429/14) ( P=0.004) , TPOAb (90/116 vs 422/54) ( P=0.000) , number of lesions (114/92 vs 325/151) ( P=0.001) and lymph node metastasis in central area (87/119 vs 250/226) ( P=0.014) between the two groups ( P < 0.05) , but there were no significant differences in TRAb (196/10 vs 461/15) ( P=0.171) , CEA (205/1 vs 469/7) ( P=0.478) , microcarcinoma (136/70 vs 309/167) ( P=0.781) , vascular invasion (4/202 vs 16/460) ( P=0.446) , extraglandular invasion (52/154 vs 108/368) ( P=0.470) , capsule invasion (149/57 vs 358/118) ( P=0.429) , lateral neck lymph node metastasis (31/175 vs 72/404) ( P=0.979) or ultrasonic calcification (157/49 vs 392/84) ( P=0.063) . Compared with PTC group, PTC combined with HT group had the characteristics of more women, younger age, high TgAb, high TSH, high TPOAb, multiple lesions and high proportion of non central lymph node metastasis. There were 345 cases (50.59%) without central lymph node metastasis and 337 cases (49.41%) with central lymph node metastasis. Gender (71/274 vs 118/219) ( P=0.000) , age (246/99 vs 283/54) ( P=0.000) , exadular invasion (66/279 vs 94/243) ( P=0.007) , number of lesions (240/105 vs 199/138) ( P=0.004) , microcarcinoma (259/86 vs 186/151) ( P=0.000) , calcification on ultrasound (250/95 vs 299/38) ( P=0.000) , and HT (119/226 vs 87/250) ) ( P=0.014) had statistical significance ( P<0.05) but had no statistical significance in capsule invasion (250/95 vs 257/80) ( P=0.256) or vascular invasion (10/335 vs 10/327) ( P=0.958) . In addition, patients in the group with central lymph node metastasis were more male, younger, with multiple lesions, exadenocarcinoma, less microcarcinoma, and calcification on ultrasound without hashimoto. Univariate analysis showed that gender, age, number of lesions, extraglandular invasion, calcification, microcarcinoma and Hashimoto had significant effects on lymph node metastasis in the central region; Multivariate analysis showed that the presence of microcarcinoma, ultrasonic calcification, Hashimoto and the number of lesions were independent risk factors for central lymph node metastasis. Conclusion:HT may promote the occurrence of PTC, but at the same time inhibit its development, so that PC patients with HT have a better prognosis.
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Objective@#To examine the impact of physical intelligence teaching on the function of children s sensory integration, so as to provide reference for promoting the development of sensory integration system.@*Methods@#From February to May 2023, the intervention was implemented for 12 weeks among 136 children aged 4-5 (68 in the intervention group and 68 in the control group). The intervention group received situational and game based physical intelligence teaching, the control group received sports game teaching according to the original curriculum objectives of the kindergarten. Intervention was administered 3 times a week for 40 minutes each time. The sensory integration ability of the intervention group and the control group were evaluated before and after the intervention with Chi square test and t test.@*Results@#The vestibular sensation, proprioception and tactile sensation of between boys and girls in the intervention group were significantly improved compared with before intervention (boys：44.14±11.52 vs. 53.34± 9.49 ，44.57±12.76 vs. 50.54±11.86，49.31±12.18 vs. 55.00±10.24,girls：46.00±11.01 vs. 54.58±10.06，48.79±13.17 vs. 53.64±11.97，52.67±11.67 vs. 56.91±10.42, t =-3.24，-2.49，-2.09，-5.24，-12.94，-2.56， P <0.05). There was no significant difference in vestibular sensation between boys and girls in the control group (boys：45.91±11.66 vs. 46.31± 11.20，girls：48.27±13.56 vs. 48.45 ±13.54, t =-0.87，-0.07， P >0.05), but there was a significant improvement in proprioception and tactile sensation in both boys and girls (boys：46.63±11.76 vs. 48.06±11.69，51.63±11.98 vs. 52.40±12.18，girls：50.45±12.16 vs. 51.67± 12.03 ，53.36±12.48 vs. 54.39±12.57， t =-3.36，-2.08，-4.66，-2.86， P <0.05). After the intervention, compared with the control group, the vestibular sensation of both boys and girls significantly improved ( t=2.83, 2.08, P <0.05), with exception of proprioception and tactile sensation ( t =0.88,0.67,0.97,0.88, P >0.05). In the experimental group, the number of normal boys increased from 12 to 24, while the number of dysfunctional boys decreased from 23 to 11, with a statistically significant difference ( χ 2=11.53, P <0.01). There was no statistically significant difference in sensory integration in boys of the control group before and after the experiment ( χ 2= 1.10 , P >0.05). After intervention,the number of normal girls in the experimental group increased from 15 to 27, while the number of dysfunctional girls decreased from 18 to 6, with a statistically significant difference ( χ 2=10.39, P < 0.05 ). There was no statistically significant difference in sensory integration in girls from the control group before and after the experiment ( χ 2=2.08, P > 0.05 ).@*Conclusion@#Physical intelligence teaching can effectively improve children s sensory integration ability, especially for vestibular function.
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OBJECTIVE@#To identify the problems in clinical radiotherapy planning for cervical cancer through quantitative evaluation of the radiotherapy plans to improve the quality of the plans and the radiotherapy process.@*METHODS@#We selected the clinically approved and administered radiotherapy plans for 227 cervical cancer patients undergoing external radiotherapy at Sun Yat-sen University Cancer Center from May, 2019 to January, 2022. These plans were transferred from the treatment planning system to the Plan IQTM workstation. The plan quality metrics were determined based on the guidelines of ICRU83 report, the GEC-ESTRO Working Group, and the clinical requirements of our center and were approved by a senior clinician. The problems in the radiotherapy plans were summarized and documented, and those with low scores were re-planned and the differences were analyzed.@*RESULTS@#We identified several problems in the 277 plans by quantitative evaluation. Inappropriate target volume selection (with scores < 60) in terms of GTV, PGTV (CI) and PGTV (V66 Gy) was found in 10.6%, 65.2%, and 1% of the plans, respectively; and the PGTV (CI), GTV, and PCTV (D98%, HI) had a score of 0 in 0.4%, 10.1%, 0.4%, 0.4% of the plans, respectively. The problems in the organs at risk (OARs) involved mainly the intestines (the rectum, small intestine, and colon), found in 20.7% of the plans, and in occasional cases, the rectum, small intestine, colon, kidney, and the femoral head had a score of 0. Senior planners showed significantly better performance than junior planners in PGTV (V60 Gy, D98%), PCTV (CI), and CTV (D98%) (P≤0.046) especially in terms of spinal cord and small intestine protection (P≤0.034). The bowel (the rectum, small intestine and colon) dose was significantly lower in the prone plans than supine plans (P < 0.05), and targets coverage all met clinical requirements. Twenty radiotherapy plans with low scores were selected for re-planning. The re-planned plans had significantly higher GTV (Dmin) and PTV (V45 Gy, D98%) (P < 0.05) with significantly reduced doses of the small intestines (V40 Gy vs V30 Gy), the colon (V40 Gy vs V30 Gy), and the bladder (D35%) (P < 0.05).@*CONCLUSION@#Quantitative evaluation of the radiotherapy plans can not only improve the quality of radiotherapy plan, but also facilitate risk management of the radiotherapy process.