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OBJECTIVE To investigate the effects of the peroxisome proliferator-activated receptors δ （PPARδ） agonist GW501516 on the injury of pulmonary artery endothelial cells （PAECs） induced by hypoxia and its mechanism. METHODS The cytotoxic effects of GW501516 were observed by detecting the relative survival rate of PAECs； the protein expression of PPARδ was determined by Western blot assay. The cellular model of PAECs injury was established under hypoxic conditions； using antioxidant N-acetylcysteine （NAC） as positive control， the effects of GW501516 on cell injury and reactive oxygen species （ROS） production were investigated by detecting cell apoptotic rate， cell viability， lactate dehydrogenase （LDH） activity and ROS levels. Using nuclear factor erythroid 2-related factor 2（Nrf2） activator dimethyl fumarate （DMF） as positive control， PAECs were incubated with GW501516 and/or Nrf2 inhibitor ML385 under hypoxic conditions； the mechanism of GW501516 on PAECs injury induced by hypoxia was investigated by detecting cell injury （cell apoptosis， cell viability， LDH activity）， the levels of superoxide dismutase （SOD）， glutathione peroxidase （GPx）， catalase （CAT）， malondialdehyde （MDA） and ROS， the expressions of Nrf2， heme oxygenase-1 （HO-1） and cleaved-caspase-3 （C-caspase-3） protein. RESULTS The results demonstrated that hypoxia inhibited the protein expression of PPARδ （P＜0.05）， while GW501516 promoted the protein expression of PPARδ in hypoxia- exposed PAECs without obvious cytotoxic effects. GW501516 inhibited the apoptosis of PAECs， improved cell viability， and reduced LDH activity and ROS levels. GW501516 could up-regulate the protein expression of HO-1 in PAECs and the levels of SOD， GPx and CAT， while down-regulated the levels of MDA and ROS by activating the Nrf2 pathway （P＜0.05）； but Nrf2 inhibitor ML385 could reverse the above effects of GW501516 （P＜0.05）. GW501516 exerted similar effects to Nrf2 activator DMF in down-regulating the expression of C-caspase-3 and inhibiting the injury of PAECs under conditions of hypoxia （P＜0.05）. Moreover， Nrf2 inhibitor ML385 reversed the 163.com inhibition effects of GW501516 on PAECs injury （P＜0.05）. CONCLUSIONS GW501516 can relieve the hypoxia-induced injury of PAECs via the inhibition of oxidative stress， the mechanism of which may be associated with activating Nrf2.
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【Objective】 To explore the rational management of contralateral patent processus vaginalis (CPPV) in laparoscopic high ligation of processus vaginalis. 【Methods】 A total of 300 children with unilateral oblique inguinal hernia/hydrocele who received laparoscopic high ligation of processus vaginalis in Baoding Children’s Hospital during Jun.2018 and Jun.2022 were selected and divided into two groups by random number table method, with 150 in either group. In the control group, 53 cases of CPPV were found intraoperatively, which were treated simultaneously. In the study group, 58 cases of CPPV were detected, among which 11 met the indications of high ligation and received simultaneous surgical treatment. The incidence of recurrence was compared between the two groups. 【Results】 After 1 year of follow-up, the recurrence rate was 8.62% in the study group and 1.88% in the control group (P>0.05). The detection rate of CPPV was 23.02% in children with unilateral inguinal hernia, significantly lower than that in children with unilateral hydrocele (49.07%, P<0.001). The detection rate of CPPV was 42.71% in children with left patent processus vaginalis and 32.95% in children with right patent processus vaginalis (P=0.19). The detection rate of CPPV was 62.93% in the age group of 1-2 years, significantly higher than that in other age groups (P<0.001). 【Conclusion】 The incidence of CPPV conversion into oblique inguinal hernia or hydrocele is low. Only children who meet the indications can be treated at the same time during surgery.
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Objective@#To describe the prevalence and association of sleep quality and anxiety-depression co-morbid symptoms among nursing students, in order to provide a reference basis for promoting the development of nursing students mental health.@*Methods@#Using a prospective study design, baseline survey was conducted in January 2019 among a random cluster sample of 1 716 individuals in three medical universities in Hefei, Anhui Province, and a follow-up survey was conducted in October 2019, with a valid number of 1 573 individuals after matching with the baseline survey. The Pittsburgh Sleep Quality Index (PSQI) was used to assess nursing students sleep quality, and the Depression Anxiety Stress Scale (DASS-21) to assess the anxiety-depression comorbid symptoms.@*Results@#The detection rates of anxiety-depression co-morbidities among nursing students at baseline and follow-up survey were 16.9% and 18.2%, respectively, and the detection rates of poor sleep quality among nursing students at baseline and follow-up survey were 10.1% and 10.3%, respectively. The results of the binary Logistic regression model showed that baseline PSQI score were positively associated with the risk of anxiety-depression co-morbid symptoms among nursing students at baseline ( OR=1.49, 95%CI =1.40-1.59) and after nine months of follow-up ( OR=1.22, 95%CI =1.16-1.28). Furthermore, the influence of baseline sleep quality on the risk of anxiety-depression co-morbid symptoms were mainly concentrated in the five dimensions of sleep time, sleep efficiency, sleep disorders, hypnotic drugs and daytime dysfunction, and such effects of sleep time, sleep disorders and daytime dysfunction still existed in the follow-up investigation.@*Conclusion@#Poor sleep quality of nursing students can increase the risk of anxiety-depression co-morbidities. Improving sleep quality of nursing students has a positive effect on improving their mental health.
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Objective:To investigate the molecular classification of endometrial carcinoma (EC) and atypical endometrial hyperplasia (AEH) treated with fertility-sparing therapy, and to analyze its relationship with clinicopathological factors and treatment efficacy.Methods:A total of 46 EC and AEH patients who received fertility-sparing therapy and molecular classification tested by next generation sequencing in Peking University People's Hospital from June 2020 to December 2021, were retrospectively collected. The relationships between molecular classification and clinicopathological factors and treatment outcomes were analyzed.Results:(1) Of the 46 patients, including 40 EC and 6 AEH patients, 32 cases (71%, 32/45) had complete response (CR) after treatment, with median CR time of 8 months, 6 cases (13%, 6/45) had partial response, and 8 cases (25%, 8/32) had recurrence. (2) The cases were distributed as no specific molecular profile (NSMP) 34 cases (74%, 34/46) subtype mainly, high microsatellite instability (MSI-H) 7 cases (15%, 7/46), POLE ultra-mutated 3 cases (7%, 3/46), and copy number high (CNH) 2 cases (4%, 2/46). Patients with CNH had the hightest serum cancer antigen 125 (CA 125) level [(34.3±35.2) kU/L]. MSI-H subtype had more family history of tumors (6/7), more with loss of mismatch repair (MMR) protein expression by immunohistochemical (7/7), and higher nuclear antigen associated with cell proliferation (Ki-67) expression level (3/3). (3) Patients in MSI-H subgroup had the lowest CR rate at 6 months (0/6; P=0.019), and survival analysis showed that they were less likely to achieve CR than those with NSMP subtype ( P=0.022). Subgroup analysis of patients with NSMP showed that age ≥30 years related with longer treatment time to CR ( P=0.010). In addition, CR was obtained after treatment in 2/3 POLE ultra-mutated cases and 2/2 CNH, respectively. Conclusions:Molecular classification relates with the treatment response in patients with EC and AEH treated with fertility-sparing therapy. Patients with MSI-H subtype have poor treatment efficacy, and patients with NSMP need to be further studied and predict treatment benefit. However, there are few cases in POLE ultra-mutated and CNH subtypes, which need further clinical research.
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Objective@#To identify the latent classes of various health risk behaviors among medical students and further analyze the correlation between different classes and depression.@*Methods@#Using the method of convenient sampling, 2 014 medical students were selected from Anhui Medical University in October 2018. Self-designed online questionnaire were used to collect demographic data, health risk behavior (including smoking, drinking, suicide, sleep disorders, mobile phone dependence and lack of exercise) and depressive symptoms. Latent Class Analysis was used to cluster individuals. Logistic regression was provided to further analyze the association between health risk behaviors and depressive symptoms for the groups.@*Results@#The health hazard behaviors of medical students could be divided into three separate classes: substance dependence group (8.4%), mobile phone dependence group (22.4%) and low-risk group (69.2%). The distribution of health risk behaviors of medical students with different gender, major, grade, only child，father s educational level，monthly living expenses, academic achievement and number of friends were statistically significant (χ 2=99.37,19.07,12.05,6.64,14.28,19.35,20.61,26.39,P<0.05). The results of Logistic regression analysis showed that after adjusting for gender, major, grade, only child, father s educational level，monthly living expenses, academic achievement and number of friends, the mobile phone dependence group was positively correlated with depressive symptoms (β=1.75, P<0.01).@*Conclusion@#Different ratent classes of health risk behaviors have different correlation with depressive symptoms in groups.It is suggested that school health workers should make individualized intervention plan for different types of health hazard behavior of medical students in the future educational activities, carry out stratified intervention, alleviate the symptoms of depression and promote the mental health of medical students.
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Objective:To explore the application and clinical significance of the cancer genome atlas (TCGA) molecular classification in endometrial cancer (EC).Methods:Sixty-six EC patients collected from December 2018 to March 2021 from Peking University People′s Hospital were categorized into four subgroups based on TCGA molecular classification tested by next generation sequencing. The correlation among four molecular subgroups and the clinical-pathological features including prognosis were analyzed.Results:(1) Clinical and pathological features: median age at diagnosis was 56 years (range: 24-78 years). The cases were distributed as follows: 3 (5%) cases DNA polymerase epsilon (POLE) ultra-mutated, 11 (17%) cases high microsatellite instability (MSI-H) including 2 Lynch syndrome, 42 (64%) cases low copy-number (CN-L) and 10 (15%) cases high copy-number (CN-H). There were significant differences among four subtypes in the combination of other tumors, tumor family history, surgical method, International Federation of Gynecology and Obstetrics (FIGO, 2009) stage, depth of muscle invasion and lymph vascular space invasion (all P<0.05). The proportions of patients in CN-H subgroup with advanced FIGO stage (stage Ⅲ-Ⅳ), deep muscle invasion and positive lymph-vascular space invasion were significantly increased. There were no significant differences in age, menopausal status, body mass index, metabolic syndrome-related complications, preoperative serum CA 125 and human epididymis protein 4 levels, tumor size, pathological grade (only endometrioid cancer), and lymph node metastasis among the 4 TCGA molecular types (all P>0.05). (2) Immuno-related molecular analysis: among 66 EC patients, 27 patients underwent immunohistochemical analysis of programmed cell death 1 ligand 1 (PD-L1) protein, and 28 patients underwent tumor mutation burden (TMB) detection. POLE and MSI-H subgroups contained TMB than those in CN-L and CN-H ( P<0.05).(3) Prognosis: the median follow-up time was 10 months (range: 0-28 months). The progression-free survival rate of TCGA molecular types were 100% (POLE ultra-mutated), 100% (MSI-H), 98% (CN-L), and 80% (CN-H) respectively and had significant differences ( P=0.034). The overall survival were 100% (POLE ultra-mutated), 100% (MSI-H), 98% (CN-L), and 90% (CN-H) respectively, but there were not statistically significant difference ( P=0.361). POLE ultra-mutated and MSI-H subgroups had the best survival, while CN-H had the worst. Conclusion:TCGA molecular classification has feasibility and clinical value in clinical application of EC, which is helpful to identify the prognosis of patients.
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Objective:To explore the method and experience of augmentation mammoplasty with autologous fat transplantation assisted by external expander.Methods:From January 2013 to December 2020, 352 female patients (698 breasts, 346 bilateral and 6 unilateral), aged from 18 to 55 years, with an average age of 41.5 years, were admitted to the Department of Cosmetic Surgery, Beijing Jingmei Medical Cosmetology Clinic. From 1-28 days before surgery, autologous fat transplantation was performed after wearing the dilator, and postoperative wearing of the dilator lasted from 1 to 24 months, with an average of 3.5 months.Results:The volume of fat transplantation per breast ranged from 150 ml to 460 ml, with an average of 320 ml. No obvious postoperative complications such as fat liquefaction, infection, intramammary induration and fat embolism were observed, and the postoperative appearance was lasting. The postoperative follow-up was conducted from 6 months to 7 years, and patient postoperative satisfaction rate reached 84.9% and doctors＇ satisfaction after surgery reached 82.1%.Conclusions:Augmentation mammoplasty with autologous fat transplantation assisted by external expander can effectively improve the appearance of breast morphology and contour defects and increase the survival rate of fat transplantation, which is worthy of clinical application.
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Objective:To investigate the safety and effectiveness of cytoreductive nephrectomy and tumor thrombectomy in patients with metastatic renal cancer with renal vein or inferior vena cava tumor thrombus.Methods:From February 2015 to May 2019, 56 cases of metastatic renal cell carcinoma with venous tumor thrombus were analyzed retrospectively, including 44 male (78.6%) and 12 female (21.4%)cases, and the average age was (59.2±10.7)(22-82). The clinical presentations covered local symptoms in 26 cases (46.4%), systemic symptoms in 8 cases (14.3%), both local symptoms and systemic symptoms in 12 cases (21.4%), and asymptomatic in 10 cases (17.9%). Among them, renal tumors were located in 35 cases (62.5%) on the right and 21 cases (37.5%) on the left. The average tumor diameter was (10.1±3.8)(1.5-21.1) cm. Forty-five cases (80.4%) scored 2 points and 11 cases (19.6%) scored 3 points by the American Society of anesthesiologists(ASA). Preoperative hemoglobin was (118.2±23.1)(72-178) g/L, and albumin was (37.9±5.6)(23-50) g/L, total protein was (67.7±6.7)(43-81) g/L, serum creatinine was (111.3±119.6)(32-958) μmol/L. There were 16 cases of Mayo 0 (28.6%), 14 cases of Mayo Ⅰ(25.0%), 17 cases of Mayo Ⅱ(30.4%), 4 cases of Mayo Ⅲ(7.1%), and 5 cases of Mayo Ⅳ(8.9%). Fourteen cases (25.0%) were in the stage of cN 0 and 42 cases (75.0%) in the stage of cN 1. Five cases (8.9%) had simple bone metastasis, 16 cases (28.6%) had simple lung metastasis, 2 cases (3.6%) had simple adrenal metastasis, 6 cases (10.7%) had simple liver metastasis, and 27 cases (48.2%) had 2 or more multiple system metastasis. According to the location of the organ system, 91 metastatic lesions were found in 56 patients. Among them, 37 cases (40.7%) had lung metastasis, 18 cases (19.8%) had liver metastasis, 21 cases (23.1%) had bone metastasis and 15 cases (16.5%) had adrenal metastasis. All 56 patients belonged to IMDC prognosis score model medium risk group. The surgical treatment of Mayo grade 0 tumor thrombus was the same as that of routine radical nephrectomy. The tumor thrombus of Mayo grade Ⅰ was removed after IVC was partially blocked by Satinsky′s forceps. The Mayo Ⅱ tumor thrombus was removed, after blocking the distal vena cava, the contralateral renal vein and the proximal vena cava. Mayo grade Ⅲ tumor thrombus needed pringer's method to block the first porta hepatis. For grade Ⅳ tumor thrombus the diaphragm could be cut directly, or the thrombus could be removed by cardiopulmonary bypass. Laparoscopic surgery was performed in 22 cases (39.3%) and open surgery in 30 cases (53.6%). Six cases (10.7%) underwent IVC wall resection because of tumor invasion. 32 cases (57.1%) underwent ipsilateral adrenalectomy because of tumor invasion or adrenal metastasis, and 23 cases (41.1%) underwent ipsilateral lymphadenectomy. In this study, there were 11 cases of solitary metastasis, 8 cases of which were operated on and 3 cases of which were not operated on. Forty-three patients were treated with sunitinib after palliative nephrectomy, 9 patients were treated with pazopanib, 3 patients were treated with acitinib, and 1 patient was treated with sorafenib. Results:The operations were successfully completed in 56 patients. Four cases (7.1%) changed from laparoscopic surgery to open surgery. The operation time was (326.8±114.9)(108-589) min. Intraoperative hemorrhage was (1 435.2±1 513.4)(20-6 000) ml, intraoperative red blood cells transfusion was (1 456.7±832.8)(400-3 600) ml in 30 cases, and intraoperative plasma transfusion was (700.0±473.6)(200-1 800) ml in 15 cases. The postoperative hospital stay was (10.6±4.6)(5-26) days. The serum creatinine one week after operation was (109.5±98.7) (47-772) μmol/L. There were 46 cases (82.1%) of renal clear cell carcinoma, 7 cases (12.5%) of papillary renal cell carcinoma and 3 cases (5.4%) of unclassified renal cell carcinoma. One case was WHO/ISUP 2016 nuclear grade 1 (1.8%), 20 cases(36.4%) was grade 2, 18 cases(32.7%)was grade 3, and 16 cases(29.1%)was grade 4. Early postoperative complications occurred in 22 cases (39.3%). Among them, 1 case of Clavien gradeⅠ was wound infection. There were 16 cases with Clavien gradeⅡ, including 5 cases who received blood transfusion due to anemia, 3 cases with chylous fistula, 4 cases with postoperative pulmonary infection, 2 cases with postoperative lower extremity venous thrombosis, 1 case with atrial fibrillation and 1 case with epididymitis. Clavien gradeⅢ a was found in 1 case with pneumothorax. Clavien gradeⅣ was found in 2 cases, including 1 case of acute cerebral infarction and 1 case of renal insufficiency.There were 2 cases with Clavien gradeⅤ with perioperative death. Among the 56 patients, 5 lost the follow-up, 2 died during the perioperative period, and the other 49 patients were followed up for 1-39 months, with a median follow-up of 14 months. The mean survival time was (25.6±2.5) months, and the median survival time was 25 months.Conclusions:It was relatively safe and effective to perform cytoreductive nephrectomy and tumor thrombectomy in patients with metastatic renal cancer with tumor thrombus. For the patients with clinical symptoms, IMDC prognosis score model medium risk group, and strong desire for surgery, the combination of cytoreductive nephrectomy with tumor thrombectomy and postoperative targeted medical therapy was recommended.
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Objective To evaluate the effect of dexmedetomidine on postoperative pain in rats with preoperative sleep deprivation. Methods Fifty healthy adult male Sprague-Dawley rats, aged 12 - 14 weeks, weighing 200-300 g, were divided into 5 groups ( n = 10 each) using a random number table:control group (group C), sleep deprivation group (group SD), incisional pain group (group IP), sleep deprivation plus incisional pain group ( group SD + IP) and sleep deprivation plus incisional pain plus dexmedetomidine group (group SD+IP+DEX). Sleep deprivation was induced by the flower pot technique, and then the incisional pain model was carried out on first day after completion of sleep deprivation. Dexme-detomidine 50 μg∕kg was intraperitoneally injected for 3 consecutive days before establishing the model of in-cisional pain in group SD+IP+DEX, and the equal volume of normal saline was given in the other groups. The mechanical paw withdrawal threshold ( MWT) and thermal paw withdrawal threshold ( TWT) were measured before operation or at 1 day before sleep deprivation and after operation or at 12, 24 and 72 h af-ter sleep deprivation. Blood samples were collected and spinal cord tissues were removed after the end of be-havior test for determination of serum corticosterone concentrations (by enzyme-linked immunosorbent assay and content of 5-hydroxytryptamine (5-HT) in spinal dorsal horns (by high-performance liquid chromatogra-phy). Results Compared with group C, the MWT and TWT were significantly decreased, and the serum corticosterone concentrations and content of 5-HT in spinal dorsal horns were increased in the other 4 groups(P<0. 05). Compared with group IP, the MWT and TWT were significantly decreased, and the serum cor-ticosterone concentrations and content of 5-HT in spinal dorsal horns were increased in group SD+IP, and the MWT and TWT were significantly increased (P<0. 05), and no significant change was found in the ser-um corticosterone concentrations or content of 5-HT in spinal dorsal horns in group SD + IP + DEX ( P >0. 05). Compared with group SD+IP, the MWT and TWT were significantly increased, and the serum cor-ticosterone concentrations and content of 5-HT in spinal dorsal horns were decreased in group SD+IP+DEX (P<0. 05). Conclusion Dexmedetomidine can reduce postoperative pain in rats with preoperative sleep deprivation, and the mechanism may be related to inhibiting stress responses and levels of 5-HT in spinal dorsal horns.
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Objective To observe the effect ofXuebijing injection on vascular endothelial function and inflammatory factor in the patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 100 patients with AECOPD were randomly divided into the study and control groups, 50 patients in each group. The control group were given the conventional therapy. The study group were given the Xuebijing injection on the basis of the control group. Both The changes of lung function, vascular endothelial function and inflammatory factor were observed.Results The expression of FVC (3.23 ± 0.83 Lvs. 2.79 ± 0.71 L,t=1.786), PEF (5.36 ± 0.51 L/svs. 4.79 ± 0.46 L/s,t=1.904), FEV1/FVC (59.21 ± 4.38vs. 54.94 ± 4.29,t=1.882), NO (3.84 ± 0.81 ng/mlvs.2.97 ± 0.62 ng/ml,t=1.869) increased significantly in the study group than those in the control group after treatenmt (P<0.05). The VEGF (0.14 ± 0.04 ng/ml vs.0.17 ± 0.05 ng/ml, t=2.097), TNF-a (0.11 ± 0.03 ng/ml vs.0.14 ± 0.02 ng/ml,t=1.903), IL-13 (107.27 ± 44.37 ng/mlvs. 136.54 ± 48.32 ng/ml,t=2.005) in the study group decreased significantly than those in the control group (P<0.05). ConclusionsXuebijing injection could significantly decrease inflammatory factor,and obviously improve vascular endothelial function and lung function,the clinical curative effect is distinct.
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Objective To explore the significance of 18 F-fluorodeoxyglucose positronemission tomography/ computed tomography (18F-FDG PET/CT) scanning for childhood neuroblastoma clinical staging.Methods From December 2014 to December 2015,59 patients confirmed as NB in Beijing Children's Hospital,Capital Medical University,and finding or clinical features were selected by histopathology.Those patients underwent 18 F-FDG PET/CT,bone scan,cranial magnetic resonance image (MRI),bone marrow puncture (two sites) and biopsy,regional CT,ultrasound,serum tumor markers like lactic dehydrogenase and neuronspecific enolase.In comparison of 18F-FDG PET/CT image findings with other detective methods,the differences were analyzed between the primary sites and metastasis were analyzed.Results (1) General features:Out of 59 children with NB,31 were males,28 were females.Primary lesions were as follows:14 cases located in the postmediastinum,44 cases in the retroperitoneum (1 case in retroperitoneum + postmediastinum),1 case in left neck.International Neuroblastoma Staging System Ⅰ to Ⅳ:O,1,9 and 49 cases,respectively.(2)18F-FDG PET-CT manifestations:The maximum of standardized uptake value (SUVmax):before-treatment group was (2.34 ± 1.06) which was larger than the post-surgery group value of (1.08 ± 0.50),and the difference was significant(F =5.699,P =0.000);bone marrow metastasis ranged from 1.5 to 2.9,regional lymphatic metastasis ranged from 1.0 to 2.1.(3)18F-FDG PET-CT imaging compared with other detection:in bone metastases,the whole body bone scan finding were normal in 3 cases,while PET/CT showed disseminated bone and bone marrow involvement and bone scanning showed 2 cases had metastases,combined with 18 F-FDG PET/CT,which were considered as postoperative inflammatory reaction or residual tumor tissues invade adjacent intervertebral foramen.Bone cytology was positive in 30 cases,while PET/CT showed 34 patients with bone marrow metastasis,and 1 case was suspicious.In central metastasis,1 case of PET/CT showed epidural metastasis,while cranial MRI was negative;Cranial MRI showed 9 cases had skull metastasis,1 case had orbital metastasis,1 case had meningeal metastases;while 18F-FDG PET/CT showed no abnormality.All children had no parenchymal metastasis.Corresponding tumor markers as LDH was related to the maximum value of primary tumor focal SUVmax (rs =0.581,P ＜ 0.01).Conclusions 18 F-FDG PET/CT can fully display the distribution of primary sites and metastases,and can be served as medical imaging evidence for both the diagnosis and staging of neuroblastoma.But as for cranial bone and central metastasis,it has high false negative rate.Clinical practice should be combined with cranial MRI to improve relevance ratio.
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This paper introduced the present situation and the existing problems of palliative care and hospice care system in Russia.The coverage of palliative is narrow,regional development is not balanced,the medical professionals in palliative care is lack,the professional skills should be improved urgently,the training system of palliative care is not perfect and the quality of training is not high,the medical professionals have high work pressure,the brain drain is serious,the social cognition is not enough,the volunteer service system is underdeveloped,and the acquisition rate of mental and narcotic drugs is low.On the basis of the above,this paper introduced the development strategy of Russian palliative care,and discussed the enlightenment to our country.For example,government departments should attach importance to the introduction of legal norms of palliative care,perfect the service system of palliative care,establish the supporting facilities,reasonably plan palliative care system,implement the integration of service management and scientific research,and bring the guarantee palliative care fund into the national budget.
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Objective To evaluate the efficacy of dexmedetomidine mixed with sufentanil for patient-controlled intravenous analgesia (PCIA) in the patients undergoing transcatheter hepatic arterial chemoembolization (TACE).Methods One hundred and twenty patients of both sexes,aged 40-65 yr,weighing 45-80 kg,of American Society of Anesthesiologists physical status Ⅰ-Ⅲ,scheduled for elective TACE under monitored anesthesia care,were divided into 2 groups (n =60 each) using a random number table:sufentanil group (S group) and dexmedetomidine mixed with sufentanil group (DS group).At 15 min prior to surgery,0.1 μg/kg sufentanil and 5 mg tropisetron were intravenously injected in both groups.In addition,dexmedetomidine 0.6 μg/kg was intravenously infused for 15 min in DS group,while the equal volume of normal saline was given instead in S group.PCIA solution contained sufentanil 2 μg/kg and tropisetron 5 mg in 100 ml of normal saline in S group.PCIA solution contained sufentanil 2 μg/kg,dexmedetomidine 2.μg/kg and tropisetron 5 ng in 100 ml of normal saline in DS group.The PCIA pump was programmed to deliver a 0.5 ml bolus dose with a lockout interval of 15 min and background infusion of 2 ml/h.Observer's Assessment of Alertness/Sedation Scale scores and scores for patient's satisfaction with analgesia were recorded at 30 min and 2,6,12,24 and 48 h after surgery.The pressing times of PCIA,total consumption of sufentanil and requirenent for morphine as rescue analgesics were recorded.The development of requirement for antiemetics,nausea and vomiting,bradycardia,respiratory depression and agitation was also recorded during analgesia.Results Compared with S group,the pressing times of PCIA,total consumption of sufentanil and requirement for morphine were significantly reduced,scores for satisfaction with analgesia were increased,and Observer's Assessment of Alertness/Sedation Scale scores were decreased (P＜0.05),and no significant change was found in the incidence of nausea and vomiting,additional requirement for antiemetics,bradycardia,respiratory depression or agitation in DS group (P＞0.05).Conclusion Dexmedetomidine mixed with sufentanil produces better efficacy than sufentanil alone when used for PCIA in the patients undergoing TACE.
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Objective To evaluate the optimum ratio of medicine dosage for dexmedetomidine mixed with sufentanil used for patient?controlled intravenous analgesia ( PCIA) after Nuss procedure in pedi?atric patients with pectus excavatum. Methods Sixty pediatric patients diagnosed with pectus excavatum, aged 5-12 yr, weighing 18-50 kg, of ASA physical statusⅠorⅡ, scheduled for elective Nuss procedure under general anesthesia, were randomly divided into 3 equal groups using a random number table:different ratios of medicine dosage while dexmedetomidine was added to sufentanil groups ( SD1-3 groups) . Postopera?tive analgesia was as follows: group SD1 received sufentanil 1 μg∕kg + dexmedetomidine 2 μg∕kg; group SD2 received sufentanil 1 μg∕kg + dexmedetomidine 3 μg∕kg; group SD3 received sufentanil 1 μg∕kg +dexmedetomidine 4 μg∕kg. A mixture of tropisetron 0?1 mg∕kg and dexamethasone 0?1 mg∕kg ( in 100 ml of normal saline) was added in each group. The PCA pump was programmed to deliver 0?5 ml with a lockout interval of 15 min and background infusion at 2 ml∕h. The PCA pump was connected immediately after the end of operation, and sufentanil with a dosage of 0?1μg∕kg was used as a rescue analgesic within 48 h post?operatively. The VAS score was maintained below 4. The requirement for rescue analgesics was recorded. The Ramsay sedation scores was recorded at 4, 8, 12, 24 and 48 h postoperatively, and the occurrence of adverse reactions such as nausea and vomiting, bradycardia, over?sedation, respiratory depression, agitation and shivering was recorded within 48 h after surgery. Results No pediatric patients developed nausea and vomiting, respiratory depression, bradycardia, over?sedation, and shivering. No pediatric patients required rescue analgesics in SD2 and SD3 groups. Compared with group SD1 , the requirement for rescue analgesics and incidence of agitation were significantly decreased, and Ramsay sedation scores were increased at 4 and 8 h after operation in SD2 and SD3 groups. Ramsay sedation scores were significantly higher at 4 h after oper?ation in SD3 group than in SD2 group. Conclusion Dexmedetomidine 3 μg∕kg mixed with sufentanil 1μg∕kg is the optimum ratio of medicine dosage when used for PCIA after Nuss procedure in pediatric patients with pectus excavatum.
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Objective To evaluate the efficacy of preoperative femoral nerve block on preemptive analgesia in the elderly patients undergoing total knee arthroplasty under general anesthesia.Methods Sixty ASA physical status Ⅰ-Ⅲ patients of both sexes,aged 65-75 yr,scheduled for elective total knee arthroplasty,were randomly divided into 3 groups (n =20 each) using a random number table:control group (group Ⅰ),preoperative femoral nerve block group (group Ⅱ) and postoperative femoral nerve block group (group Ⅲ).Single-injection femoral nerve block was performed with 0.375％ ropivacaine 20 ml injected around the nerve under thc guidance of ultrasound immediately before induction of anesthesia and at the end of surgery in Ⅱ and Ⅲ groups,respectively.Patient-controlled intravenous analgesia (PCIA) with sufentanil (background infusion 2 ml/h,bolus dose 2 ml,lockout interval 15 min) was used until 2 days after surgery,and VAS score was maintained ≤ 3.When VAS score＞3,flurbiprofen axetil 50 mg was injected intravenously as rescue medication.The consumption of sufentanil per hour,requirement for rescue medication,and development of adverse reactions were recorded within 24 h after surgery.Sufentanil-sparing degree was calculated.Results Compared with group Ⅰ,the consumption of sufentanil per hour,requirement for rescue medication and the incidence of nausea and vomiting were significantly decreased within 24 h after surgery in Ⅱ and Ⅲ groups.The consumption of sufentanil per hour,requirement for rescue medication and the incidence of nausea and vomiting were significantly lower within 24 h after surgery in group Ⅱ than in group Ⅲ.The consumption of sufentanil per hour was decreased by 35％ in group Ⅱ as compared with group Ⅰ,and decreased by 18％ in group Ⅱ as compared with group Ⅲ.Conclusion Preoperative femoral nerve block can provide good preemptive analgesia in the elderly patients undergoing total knee arthroplasty under general anesthesia.
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PurposeTo investigate the accuracy of18F-FDG PET/CT in diagnosing mediastinal and hilar lymph node metastasis of lung cancer and in guiding surgery. Materials and Methods Seventy-eight pathology-proven lung cancer patients underwent 18F-FDG PET/CT scanning and surgery. Histology was used as gold standard to evaluate the diagnosis of mediastinal and hilar lymph node metastasis.18F-FDG PET/CT was also compared to chest CT.Results The pathological examination confirmed metastasis lymph nodes in 105 out of 231 excised lymph nodes in 18 patients. No lymph node metastasis was found in mediastinum in the other 60 patients with lymph node staging of pN0. Lymph node staging was pN1 in 5 patients, pN2 in 11 patients, and pN3 in 2 patients. In all 78 cases, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of18F-FDG PET/CT were 80.9%, 94.7%, 91.0%, 85.0%, 93.1%; while 61.1%, 71.7%, 69.2%, 39.2%, 86.0% on chest CT. These were statistically different (χ2=4.325,P<0.05).Conclusion PET/CT is superior to plain chest CT examination as an accurate and efficient method in evaluating lymph nodes staging of lung cancer.
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<p><b>OBJECTIVE</b>To investigate the similarity and difference in blood group serology and molecular biology of A2 and A2B phenotypes between healthy blood donors and patients.</p><p><b>METHODS</b>The A and AB phenotypes were screened with anti-A1. Exons 1 to 7 and intron 6 of the ABO gene were analyzed with polymerase chain reaction-sequence-based typing (PCR-SBT) method. The blood type was determined by referring to the Blood Group Antigen Gene Mutation Database (BGMUT).</p><p><b>RESULTS</b>Among 7111 tested individuals, 75 were assigned as A2 or A2B phenotypes. However, only 28 individuals still belonged to the A2-related allele group based on genetic analysis. Among these, A205/B101 was the most common genotype. Among those non-A2-related alleles, A102/B101 was the most common genotype. Based on serologic testing, there was an imbalance between the A2 and A2B subgroups. In both donor group and patient group, the proportion of A2B was significantly higher than that of the A2. There were statistical differences between different groups (χ² = 64.613, 33.137, 34.963, P< 0.01). At the gene level, the imbalance still existed in both the overall population and the donor group, though there was a statistical difference between the two (χ² = 17.678, 14.157, P< 0.01). The same imbalance did not exist in the patient group (with continuous correction, χ² = 2.351, P= 0.125).</p><p><b>CONCLUSION</b>The concordance rate for blood type determined by serology and genetic analysis has been low and deserves attention. For A2 and A2B phenotypes by serological screening, A102/B101 was the most common gene among non-A2-related alleles. Further study is needed to clarify this phenomenon.</p>
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Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , ABO Blood-Group System , Blood , Genetics , Asian People , Genetics , Blood Donors , Chi-Square Distribution , China , Exons , Genetics , Gene Frequency , Genotype , Introns , Genetics , Phenotype , Polymerase Chain ReactionABSTRACT
ObjectiveTo determine the diversity of outer membrane protein expression of Leptospira interrogans during infection of human THP-1 monocytes,and protein antigen candidates for developing leptospiral genetically engineering vaccines.MethodsThe outer membrane proteins(OMPs) of Leptospira interrogans serogroup Icterohaemorrhagiae serovar Lai strain Lai before or after infection of human THP-1 monocyte line were extracted using Triton X-114 method.The OMPs extracts were separated by two-dimensional gel electrophoresis(2-DGE) and then detected using silver staining method.Four up-regulated and four down-regulated OMPs were selected for hydrolysis by trypsin and then identified by using liquid chromatography-tandem mass(LC-MS/MS) method.The transmembrane regions and signal peptides in the eight target OMPs were analyzed using bioinformatic software.Several real-time fluorescent quantitative RT-PCRs were performed to determine the mRNA level changes of the eight target genes of L.interrogans strain Lai before or after infection of THP-1 cells.The prokaryotic expression systems of target genes were generated and the immunoprutection of target recombinant proteins was determined using leptospire-infected guinea pigs model.ResultsAfter a 60 min infection of THP-1 cells,four OMPs( Loa22,GroEL,F0F1 ATP synthase alpha- and beta-subunits) of L interrogans strain Lai were noticeably up-regulated ( P＜0.05 ),while the other four OMPs( FlaB2,LigB,OmpA family protein and OmpA) were significantly down-regulated (P＜0.05).The results of real-time fluorescent quantitative RT-PCRs were coincident with those confirmed by the 2-DGE phus silver staining.The bioinformatic analysis indicated that among the eight OMPs,OmpA and OmpA family protein belonged transmembrane proteins,while the rest had no membrane structure.Loa22,LigB and OmpA family protein contained a signal peptide in their sequences.200 μg of the recombinant proteins rLoa22 and rGroEL presented 75.0％ immunoprotective rates in the infected guinea pigs.Conclusion An obvious change of the OMP expression map of L.interrogans strain Lai occurs during infection of host cells.The up-regulated leptospiral OM Ps during infection,especially for the GroEL and Loa22 proteins,can be used as the immunogen candidates for developing leptospiral genetically engineering vaccines.
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Objective To determine the function of toxic protein VapC in toxin/antitoxin system of Leptospira species and the cytotoxicity to host cells of the toxic protein.Methods Using genomic DNA of pathogenic L.interrogans serogroup Icterohaemorrhagiae serovar Lai strain Lai as the template,several PCRs were performed to amplify entire vapB,vapC and vapBC genes.Subsequently,the prokaryotic expression systems of vapB,vapC and vapBC genes were constructed.Expression of the target recombinant proteins rVapB and rVapC was detected by SDS-PAGE and the expressed rVapB and rVapC were extracted by NiNTA affinity chromatography.Activity of rVapB and rVapC to lyse the DNAs or RNAs from L.interrogans strain Lai and THP-1 cells were then determined.The changes of transcription and expression of vapB and vapC genes of L.interrogans strain Lai before and after infection of THP-1 cells were detected by real-time fluorescent quantitative RT-PCR and Western blot assay.The eukaryotic expression vectors of the vapB and vapC genes were generated for transfection of host cells and CCK-8 agent was used to detect the effect of leptospiral VapB and VapC proteins on activity of host cells.Results The nucleotide and putative amino acid sequences of the cloned vapB and vapC genes were completely identical with the reported corresponding genes.The constructed prokaryotic expression systems could express rVapB and rVapC,respectively.rVapC displayed RNase avtivity but did not lyse DNA.When L.interrogans strain Lai infected THP-1 cells,the transcription and expression of vapB and vapC genes were upregulated and partial VapC protein was secreted from the leptospiral cells.The mass mortality was observed in HEK293 human renal tubular epithelial ceils containing the vapC gene through transfection.Conclusion VapC protein of L.interrogans strain Lai is a RNase and is secreted during infection of host cells with obvious cytotoxicity.
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Objective To explore the value of PET-CT and CT in the assessment after radiofrequency ablation (RFA) in lung cancer.Methods Eighteen patients were randomly divided into short-term group ( 8 cases) and long-term group ( 10 cases).Patients in short-term group received PET-CT and CT examination within 10 days after RFA therapy,whereas those in long-term group got PET-CT and CT examination within 2 months after RFA therapy.The value of PET-CT and CT after RFA therapy through the result of the image was compared between two groups.Results All patients were classified as stable disease in CT,while in PET-CT assessment,33.33％ (6/18) of the patients presented complete remission and 66.67％ (12/18)presented partial remission.37.50％ (3/8) of short-term group presented complete remission,62.50％ (5/8) of short-term group presented partial remission.30.00％ (3/10) of long-term group presented complete remission,70.00％(7/l0) of long-term group presented partial remission.Conclusion PET-CT is superior to CT in the assessment of the effectiveness of RFA therapy,and there is no difference between short-term and long-term PET-CT examination,therefore early PET-CT is more with clinical significance.