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Objective:To investigate the diagnostic accuracy of serological indicators and evaluate the diagnostic value of a new established combined serological model on identifying the minimal hepatic encephalopathy (MHE) in patients with compensated cirrhosis.Methods:This prospective multicenter study enrolled 263 compensated cirrhotic patients from 23 hospitals in 15 provinces, autonomous regions and municipalities of China between October 2021 and August 2022. Clinical data and laboratory test results were collected, and the model for end-stage liver disease (MELD) score was calculated. Ammonia level was corrected to the upper limit of normal (AMM-ULN) by the baseline blood ammonia measurements/upper limit of the normal reference value. MHE was diagnosed by combined abnormal number connection test-A and abnormal digit symbol test as suggested by Guidelines on the management of hepatic encephalopathy in cirrhosis. The patients were randomly divided (7∶3) into training set ( n=185) and validation set ( n=78) based on caret package of R language. Logistic regression was used to establish a combined model of MHE diagnosis. The diagnostic performance was evaluated by the area under the curve (AUC) of receiver operating characteristic curve, Hosmer-Lemeshow test and calibration curve. The internal verification was carried out by the Bootstrap method ( n=200). AUC comparisons were achieved using the Delong test. Results:In the training set, prevalence of MHE was 37.8% (70/185). There were statistically significant differences in AMM-ULN, albumin, platelet, alkaline phosphatase, international normalized ratio, MELD score and education between non-MHE group and MHE group (all P<0.05). Multivariate Logistic regression analysis showed that AMM-ULN [odds ratio ( OR)=1.78, 95% confidence interval ( CI) 1.05-3.14, P=0.038] and MELD score ( OR=1.11, 95% CI 1.04-1.20, P=0.002) were independent risk factors for MHE, and the AUC for predicting MHE were 0.663, 0.625, respectively. Compared with the use of blood AMM-ULN and MELD score alone, the AUC of the combined model of AMM-ULN, MELD score and education exhibited better predictive performance in determining the presence of MHE was 0.755, the specificity and sensitivity was 85.2% and 55.7%, respectively. Hosmer-Lemeshow test and calibration curve showed that the model had good calibration ( P=0.733). The AUC for internal validation of the combined model for diagnosing MHE was 0.752. In the validation set, the AUC of the combined model for diagnosing MHE was 0.794, and Hosmer-Lemeshow test showed good calibration ( P=0.841). Conclusion:Use of the combined model including AMM-ULN, MELD score and education could improve the predictive efficiency of MHE among patients with compensated cirrhosis.
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Objective To investigate the expression of serum procalcitonin in patients with sepsis and its influence on prognosis.Methods From December 2014 to December 2016,119 cases of sepsis patients were enrolled in the hospital.According to the severity of the disease,49 cases in the early sepsis group,37 cases in the severe sepsis group and 33 cases in the septic shock group.According to the prognosis of 28 d after admis-sion,the patients were divided into the survival group(95 cases)and the death group(24 cases).Serum procal-citonin was measured by double antibody sandwich enzyme-linked immunosorbent assay.The changes of WBC count,C reactive protein and APACHE Ⅱ score,serum procalcitonin level,serum procalcitonin level and sur-vival group and death group were compared.Results Septic shock of white blood cell count,C reaction protein and APACHEⅡ were higher than those of early sepsis group and severe sepsis group(P<0.05);severe sep-sis group cell counts,C reactive protein and APACHE Ⅱ were higher than those of early sepsis group(P<0. 05).The septic shock group of serum procalcitonin levels higher than the early sepsis group,severe sepsis group(t=33.136,21.863,P<0.05);severe sepsis group serum procalcitonin levels higher than the early sep-sis group(t=16.876,P<0.05).The level of serum procalcitonin in the death group was higher than that in the survival group(P<0.05).Conclusion The level of serum procalcitonin in patients with sepsis is obvious-ly higher.With the severity of the disease,the serum procalcitonin level is higher,and can be used as an indica-tor of prognosis evaluation.
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Objective To analyze the efficacy of a second dose of measles-mumps-rubella (MMR) vaccine in children aged 6 to 7 years in Xicheng District, Beijing, China in 2016.Methods Serum samples were collected in duplicate from 41 children aged 6 to 7 years before and one month after immunization with a second dose of MMR vaccine.ELISA was performed to detect IgG antibodies against measles, rubella and mumps in serum samples.Results The positive rates of antibodies against measles, rubella and mumps in the 41 children before immunization with a second dose of MMR vaccine were 95.12%, 90.24% and 92.68% and the antibody titers were (825.88±499.91), (53.83±32.48) and (697.83±535.82) IU/ml, respectively.The positive rates of the three antibodies were 100%, 97.56% and 100% after revaccination with MMR vaccine and the antibody titers were (1 102.98±356.77), (95.08±26.88) and (3 383.85±1 903.06) IU/ml.Titers of antibodies against measles, rubella and mumps increased significantly following revaccination (P0.05).Conclusion The second dose immunization of MMR vaccine achieves a high successful rate in children in Xicheng District of Beijing.It would be an effective immunization strategy to protect children from measles, rubella and mumps.
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Objective To analyze the clinical characteristics of urinary tract infection after kidney transplantation and to analyze the distribution of pathogenic virulence factors.Methods From January 2014 to June 2016,a total of 255 cases were subjected to DCD renal transplantation in our center,and 45 cases of urinary tract infection occurred after operation.Among them,urinary tract E.coli infection occurred in 32 cases.The virulence factors gene aer,hly,irp2 and iucD in the 32 strains of E.coli isolated from urine were tested using PCR and multiple PCR.Results Thirty-two cases (71.1％) of urinary tract infection after renal transplantation was caused by E.coli,and divided into 9 cases of nosocomial infection group,and 23 cases of community-acquired group.The positive rate for aer,hly,irp2 and iucD in Nosocomial infection group was 66.7％,33.3％,88.9％ and 77.8％,and that in community-acquired group was 30.4％,8.70％,39.1％ and 34.7％,respectively.There were statistically significant differences among four kinds of virulence factors between two groups (P＜0.05).The positive rate of virulence factors was significantly higher in nosocomial infection group than in community-acquired groups.The total resistance rate was 84.38％,and there was significarit difference in multi-drug resistance rate between two groups (P＜0.01).Conclusion E.coli is the main pathogenic bacteria of urinary tract infection after renal transplantation,especially nosocomial infections.The detection rate of virulence factor is high,and the multiple drug resistance is outstanding,so the attention should be paid clinically.
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The paper summarized the literature in recent 5 years about the researches on the metabolic syndrome (MS) in traditional Chinese medicine. The paper discussed the etiology and pathogenesis, summarized the clinical research and experiment of traditional Chinese medicine for MS.
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Objective To explore the relationship between the types of female breast density and age and breast cancer .Methods By accepting the digital mammography X -ray examination for 5 006 women cases and according to the ACR BI -RADS standard in the fourth edition ,the breast density assessment was quantified . We analysed the relationship between the breast density and age and breast cancer .Results In 5 006 cases,the average female age was between 44.22 ±8.09 years old,median age was 43 years old.The components of the breast density were fat type , small amount type , large amount type and compact type each count were 256 (5.11%),726(14.51%),3 719(74.29%),305(6.09%)respectively.By dividing into different age -group to analyze the breast density,there was significant statistical differences of the breast density among age -groups(P<0.001).Among them the breast cancer were 184 cases.Age was between 51.26 ±10.15 years old.Breast cancer in each breast density were fat type 10.16%(26/256),small amount type 9.09%(66/726),large a-mount type 2.45%(91/3719)and compact type 0.33%(1/305).There were statistical differences among age -groups and breast densities and breast (P<0.001).Conclusion Age plays a very important effects on the fe-male breast density .The lower breast density is a high risk factor to breast cancer occurrence .
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ObjectiveTo explore the methods for prevention and treatment of endotoxemia and multiple organ failure in patients with severe hepatitis. MethodsA total of 61 patients with severe hepatitis and toxic enteroparalysis were randomly assigned to three groups. The first group was treated with plasmapheresis, the second group with plasmapheresis and colon dialysis, and the third group with plasmapheresis, colon dialysis, and oral probiotics. Analyses were performed on the clinical symptoms and physical signs, hepatic function, endotoxin level, and clinical outcome in each group. Comparison of continuous data between groups was performed by analysis of variance, and further pairwise comparison by SNK test; comparison of categorical data between two groups was performed by chi-square test. ResultsThe liver function improved in all groups after treatment. The endotoxin level was significantly lower in the third group than in the other two groups (P＜005). The symptom improvement rates in the three groups were 35.3%, 64.7%, and 81.5%, respectively; the recurrence rates were 833%, 727%, and 364%, respectively; the clinical remission rates were 5.9%, 17.6%, and 48.1%, respectively, and the third group had a significantly higher rate than the first group (χ2=8.59, P＜0.05). ConclusionA combination of plasmapheresis, colon dialysis, and oral probiotics can effectively improve the prognosis of patients with severe hepatitis and toxic enteroparalysis, and can help prevent and treat multiple organ failure in such patients.
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<p><b>OBJECTIVE</b>To investigate the expression patterns of ZEB2 and C-myc in epithelial ovarian cancer (EOC) and the associations between their expressions and the pathological features of EOC.</p><p><b>METHODS</b>The expressions of ZEB2 and C-myc proteins were detected immunohistochemically in 191 cervical cancer tissues and 13 normal ovarian tissues. The relationship between ZEB2 and C-myc protein expressions and the clinicopathological features of EOC was evaluated.</p><p><b>RESULTS</b>ZEB2 positive expression ratea in EOC tissues and normal ovarian tissues were 49.2% (94/191) and 30.8% (4/13), respectively (P=0.007), and C-myc positive expression rates in the two tissues were 53.9% (103/191) and 15.4% (2/13), respectively (P=0.001). A high expression of ZEB2 was positively correlated with the pathological type of the tumor (P=0.003), FIGO stage (P=0.028), T stage (P=0.002), and N stage (P=0.04), and a high expression of C-myc was positively correlated with FIGO stage (P=0.035), histological grade (P=0.039), and T stage (P=0.002). C-myc and ZEB2 expressions were positively correlated in EOC (P<0.001), and their co-expression in EOC was significantly correlated with T stage (R=0.358, P<0.001) and FIGO stage (P=0.008).</p><p><b>CONCLUSION</b>ZEB2 and C-myc can promote the progression, invasion and metastasis of EOC, and their combined detection may assist in early diagnosis of EOC.</p>
Subject(s)
Female , Humans , Disease Progression , Homeodomain Proteins , Genetics , Metabolism , Neoplasms, Glandular and Epithelial , Genetics , Metabolism , Ovarian Neoplasms , Genetics , Metabolism , Prognosis , Proto-Oncogene Proteins c-myc , Genetics , Metabolism , Repressor Proteins , Genetics , Metabolism , Zinc Finger E-box Binding Homeobox 2ABSTRACT
Objective To investigate the diagnosis and treatment of renal neoplasm with calcification .Methods Retrospectively summarized the clinical data of the 2 patients with calcific renal neoplasm admitted in our hospital from the May to July in 2014, then analyzed and discussed the clinical manifestations , diagnosis and treatment com-bined with the literatures .Results The two cases were both suspected of renal malignant tumor preoperatively .The case 1 was a 32-year-old male , laparoscopic partial resection of the left kidney was performed , and the postoperative pathology was clear cell carcinoma (Fuhrman levelⅠ).The case 2 was a 18-year-old male, partial resection of the right kidney was performed because of the tumor size , and the postoperative pathology was adult nephroblastoma . Conclusions The calcific renal neoplasm is a rare disease , the property determination depends on postoperative pa-thology, and as to the choice of surgical method , the patients'age, the tumor size and the tumor location should be taken into consideration , and intraoperative frozen should be performed when necessary .
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Objective: To explore the changes of protein expression and activity of calcium/calmodulin-dependent protein kinase-II (CaMK-II) in myocardium nucleus and sarcoplasmic reticulum in experimental rabbits with heart failure (HF). Methods: A total of 16 rabbits were divided into 2 groups: Sham group and HF group, the HF model was established by volume overload plus pressure overload.n=8 in each group and all animals were treated for 7 weeks. Left ventricular structure, hemodynamic parameters and protein expression and activity of CaMK-II in myocardium nucleus and sarcoplasmic reticulum were examined and compared between 2 groups. Results: Compared with Sham group, HF group presented increased left ventricular mass index (LVMI) (1.32 ± 0.06) g/kg vs (3.61 ± 0.09) g/kg, LVEDP (-1.50 ± 0.50) mmHg vs (23.00 ± 2.37) mmHg, allP Conclusion: Increased protein expression and activity of CaMK-II in myocardium nucleus and sarcoplasmic reticulum might be one of the mechanisms for HF occurrence in experimental rabbits.
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Objective To observe the influence of emergency PCI in different time windows to cardiac scar and cardiac function after myocardial infarction. Methods One hundred and twenty-seven patients with acute myocardial infarction, who were treated in different time windows by emergency PCI, were enrolled into this study. The cases were divided into two groups according to the time when they took PCI after onset;group 3 hPCI included 66 patients had PCI at 3 h after onset and group 6 hPCI included 61 patients had PCI at 6 h. At 4th, 8th and 12th weeks, the fragmented QRS (fQRS) were observed by twelve synchronization cardiogram; ventricle wall movement strain rate were determined by cardiac speckle tracking imaging;left ventricular ejection fraction (LVEF)were measured by cardiac ultrasound to evaluate cardiac events and cardiac function after myocardial infarction. Results At 4th,8th and 12th weeks,the fQRS positive leads were significantly more in 6 hPCI group than 3 hPCI group ( P ＜ 0. 05 respectively ) . The ventricle wall movements strain rate and LVEF improved significantly in 3 hPCI group compared with 6 hPCI group (P ＜ 0. 05 ). Conclusions The earlier emergency PCI treatment was applied and the earlier the"criminal"blood vessels were opened ,the more ischemic myocardial cells were restored. Combination use of fQRS、 STI and LVEF examination could improve the diagnosis of cardiac scar formation and direct protective therapy.
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This article reviewed many different opinions on teeth-marked tongue, and made a discuss on the differentiation of symptoms and signs based on clinical practice. We consider that the teeth-marked tongue indicates the diseases that are caused by pathogenic dampness, while the correlation between such diseases and spleen deficiency still needs study.
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0.05).The effective rate on relieving traditional Chinese medical syndrome was 95.0% in the treatment group and 73.3% in the control group,the difference being significant(P0.05).After treatment,the parameters of 24-h dynamic blood pressure were improved in both groups(P