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Enteral nutrition plays an irreplaceable role in the nutritional treatment of critically ill patients. In order to help clinical medical staff to manage the common complications during the implementations of enteral nutrition for critically ill patients, the consensus writing team carried out literature retrieval, literature quality evaluation, evidence synthesis. Several topics such as diarrhea, aspiration, high gastric residual volume, abdominal distension, etc. were assessed by evidence-based methodology and Delphi method. After two rounds of expert investigations, Expert consensus on prevention and management of enteral nutrition therapy complications for critically ill patients in China (2021 edition) developed, and provided guidance for clinical medical staff.
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Objective:To establish a program for the prevention and management of parastomal hernia in patients with ostomy.Methods:Based on literature analysis and clinical needs, combined with the individual and family self-management theory (IFSMT), a preliminary plan for prevention and management of parastomal hernia was developed with the framework of case management model. Sixteen experts were selected for two rounds of Delphi expert consultations to analyze and screen indicators at all levels to calculate the expert′s positive coefficient, authority coefficient and coordination coefficient to analyze the credibility of expert consultation results.Results:The effective recovery rates of the two rounds of expert letter inquiries were 88.89% and 100.00%, the authoritative coefficients were 0.825 and 0.844, and the two rounds of Kendall′s W values were 0.221 and 0.269, which were statistically significant( P<0.01). The concentration of indicators is high. Finally, a programe for parastomal hernia prevention and management based on the self-management theory of individual and family consisting of 6 first-level indicators,16 second-level indicators and 42 third-level indicators was obtained. Conclusion:The programe for prevention and management of parastomal hernia based on individual and family self-management theory has high reliability and scientificity, and can provide a basis for the study of parastomal hernia prevention and management.
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With the steady progress of the rule of law for Internet in China, " Internet+medicine" is drawing greater attention and legislative demand. The enactment of E-commerce Law in early 2019 has provided rich legal connotations of " Internet+" commerce scenario, clarifying its legal subject scope and legal service scope.The authors analyzed the legal system of medical E-commerce, and the legal obligations of medical E-commerce. From the following four aspects of legitimate business conduct, consumer rights protection, platform responsibility and intellectual property protection, the authors held that the current legal regulation of medical E-commerce is plagued by major setbacks as follows.These setbacks include incomplete legislation, low legal ranking, ambiguous subject definition and legal guidance, as well as lack of behavior regulation and unclear legal obligations.In this regard, the state is recommended to advocate the enactment of the Pharmaceutical E-commerce Law, speed up the revision of a series of laws and regulations, and improve the supporting service policies as a whole, so as to strengthen the rule of law regulation of future pharmaceutical E-commerce.
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Objective To explore the effect of comprehensive nursing intervention on the rehabilitation of patients with schizophrenia,and to provide reference for clinical nursing.Methods Sixty-seven long-term hospitalized patients with schizophrenia received 6 months comprehensive nursing intervention.The instruments of the nurse observation scale for inpatient evaluation(NOSIE),insight and treatment attitude questionnaire (ITAQ),scale of social function in psychosis inpatients (SSPI) were administered both at the start and the end of intervention.Result After 6 months of treatment,the scores on mental disorder,recovery of social ability and treatment compliance and recovery or selfconcicousness increased as compared with pre-intervention (all P＜0.001).Conclusion The comprehensive nursing intervention can improve the mental symptoms and social function,alleviate their depression and promote mental rehabilitation of the patients with schizophrenia.
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Objective:To investigate the effect of silver diamine fluoride(SDF)on the bonding strength between dentine and glass ion-omer cement(GIC).Methods:1 2 extracted sound molars were prepared into dintine samples and distributed into sound dentine group and demineralized dentine group.According to the treatment methods,the samples in each group were respectively divided into 3 sub-groups:A(control group),B[coated with 38% Ag(NH3 )F2 ]and C(SDF treatment with additional lighting-curing)(n =20).Then a hand-mixed conventional glass ionomer cement Fuji IX was placed on the dentine surface.After 24 h,micro tensile bond strength test and scanning electron microscope (SEM)analysis were conducted.Results:The bonding strength of demineralized dentine was higher than that of sound dentine(P <0.01 ).SDF with additional lighting-curing treated dentine showed a higer bonding strength value than only SDF treated dentin(P <0.01 ).Conclusion:SDF may improve the bonding between dentine and GIC.
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Objective:To confirm the efficacy and safety of Tiankui antihypertension tablets combined with chemical drugs in the treatment of patients with hypertension whose blood pressure can 't reach the standard after the treatment only with chemical drugs. Methods:Randomized, double-blind, placebo control and multicenter clinical trials were performed on 240 subjects (160 in the ex-periment group and 80 in the control group) in 6 clinical trial centers. Tiankui antihypertension tablets and the placebo were respec-tively given with 4 tablets per time and 3 times a day. The efficacy and safety were observed. Results:For the blood pressure control, the significant efficiency of the experimental group was 63. 23%, while that of the control group was 31. 65%. The significant efficien-cy and effective rate of the traditional Chinese medicine (TCM) syndrome of the experimental group was 48. 39% and 20. 25%, re-spectively, while that of the control group was 20. 25% and 36. 71%, respectively. All of the studied clinical indicators showed signifi-cant differences between the two groups (P<0. 05). No severe adverse reaction was shown in the two groups. Conclusion:Tiankui an-tihypertension tablets combined with chemical drugs exhibits better curative effect and safety in the treatment of hypertension patients whose blood pressure can’ t reach the standard after the treatment only with chemical drugs.
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<p><b>OBJECTIVE</b>To study the effect of platelet derived growth factor-B and its receptor expression on the proliferation of renal cell carcinoma ACHN cells in vitro and in vivo.</p><p><b>METHODS</b>PDGF-B gene was transfected into human renal carcinoma cell line ACHN cells, and the proliferation capability of ACHN cells transfected with or without PDGF-B was assessed by MTT assay. The effect of PDGF-B on the expression of p-PDGFR-β in endothelial cells and vascular smooth muscle cells (VSMC) was detected by Western blot. ACHN cells transfected with PDGF-B were injected into mice (untransfected ACHN as control) to induce tumor formation. Immunohistochemical staining was used to detect the expression of Ki-67 in tumor cells and the tumor volume was measured to compare the tumor growth in the two groups.</p><p><b>RESULTS</b>The PDGF-B expression of ACHN cells in transfected group was significantly increased than that in the untransfected group. MTT assay showed that the proliferation capability of ACHN cells in the transfected and untransfected groups had no significant differences at different time points (P>0.05). The expression of p-PDGFR-β in VSMC was significantly increased when cultured with PDGF-B overexpression culture medium. The mean tumor size of the PDGF-B group and control group was (0.305±0.108) cm(3) and (0.577±0.218) cm(3), respectively (P=0.007). Ki-67-positive tumor cells were (41.00±5.34)/HPF in the PDGF-B-transfected group and (55.80±2.95)/HPF in the untransfected group (P=0.001).</p><p><b>CONCLUSION</b>PDGF-B overexpression may up-regulate p-PDGFR-β expression of VSMC in renal cell carcinoma, and inhibit the tumor cell proliferation and tumor growth through paracrine signaling.</p>
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Animals , Humans , Mice , Carcinoma, Renal Cell , Metabolism , Pathology , Cell Line, Tumor , Cell Proliferation , Kidney Neoplasms , Metabolism , Pathology , Proto-Oncogene Proteins c-sis , Receptor, Platelet-Derived Growth Factor beta , Genetics , MetabolismABSTRACT
Objective To explore prognostic factors of renal cell carcinoma and investigate the association of neutrophil-to-lymphocyte ratio (NLR) with the prognosis of renal cell carcinoma (RCC) in patients who received nephrectomy treatment.Methods We retrospectively reviewed the records of 1325 patients with renal cell carcinoma who underwent nephrectomy between January,2008 and December,2012.We retrospectively analyzed the clinicopathologic characteristics of patients.The optimal cutoff value for NLR was determined using receiver operating characteristic curve (ROC) analysis.We defined them as high NLR group when NLR ≥ 2.7 and low NLR group when NLR ＜ 2.7.Overall survival (OS) and recurrence free survival (RFS) were estimated using the Kaplan-Meier method and compared using the logrank test.Multivariate models were used to analyze the association of NLR with clinicopathologic outcomes.Results By the end of the study, 1220 cases were followed up.The follow-up rate was 92.1％.Mean follow-up was 40 months (range 2 months to 87 months).The three-year and five-year overall survival rate were 91.3％ and 86.9％, respectively.Meanwhile the three-year and five-year recurrence free survival rate were 88.2％ and 85.8％ ,respectively.2.7 was selected as the optimal cutoff value to differentiate between low NLR and high NLR.A NLR ≥2.7 was significantly associated with worse 5-year overall survival and worse 5-year recurrence free survival than a NLR ＜2.7,91.4％ vs 87.3％ ,89.6％ vs 71.9％ (P ＜0.05).Age ＞65, presentation mode with symptom, higher tumor stage, higher Fuhrman grade,histologic subtype,neutrophil count ≥ 4.5, lymphocyte count ＜ 1.7, NLR ≥ 2.7 significantly correlated with poor OS on univariate analysis.Multivariate analysis revealed that higher tumor stage, preoperative NLR ≥ 2.7 at diagnosis were poor independent prognostic factors for OS of renal cell carcinoma.Conclusion High NLR was independent poor predictor of renal cell carcinoma.
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Objective To explore the management mode of regional clinical blood ,as well as the role of Regional Medical Center in the blood management ,and have a comprehensive understanding of Daxing district clinical blood using present situation .Methods Organized Daxing district clinical blood using quality control center experts to do a research of 18 medical institutions in the blood management status of clinical blood demand within the jurisdiction ,and analyzed the statistics related to clinical use of blood in vari‐ous medical institutions from January to December in 2014 ,according to Beijing Wei Yi [2008]189 words in medical institutions of Beijing City ,the department of transfusion(blood bank) in the relevant provisions of the basic standard.Results Through the sur‐vey ,only regional medical center established the department of transfusion in 18 medical institutions ,other medical institutions have set up blood bank .Practitioners of department of transfusion (blood bank) in the number full‐time staff ,with post qualification num‐ber and degree of structure ,difference between regional medical center and other kind hospitals was significant (P0 .05) .Three grade hospitals in biological safety and continuous im‐provement of quality ,could be carried out in accordance with the PDCA cycle ,and have obvious advantages compared with the other one or two grade hospitals .Conclusion Fifteen medical institutions do not have the clinical blood transfusion compatibility testing conditions .To ensure the safety of blood for clinical use ,blood need to be tested by the department of transfusion regional medical center .
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Objective:To evaluate the prognostic significance of standard pelvic lymphadenectomy on the disease-free survival (DFS) rate of bladder cancer patients undergoing radical cystectomy (RC) and to discuss the influencing factors of lymph node positivity and the relationship between positive lymph nodes and lymphadenectasis. Methods:This prospective analysis includes 120 cases of bladder cancer treated with pelvic lymphadenectomy and RC in Tianjin Medical University Cancer Institute and Hospital between 2008 and 2013. The cases were divided into two groups, namely, the standard pelvic lymphadenectomy group (Group A) and the nonstandard pelvic lymphadenectomy group (Group B). The relationships among positive lymph nodes, lymphadenectasis, tumor stage, and patho-logical grade were retrospectively analyzed. Results:The 1-, 3-, and 5-year overall survival rates of 120 patients were 84%, 69.9%, and 57.9%, respectively. Group A was significantly correlated with a better 3-year overall survival rate than Group B, i.e., 78.4%vs. 46.2%(P<0.05). Lymphadenectasis influenced the DFS rate of bladder cancer patients after RC with pelvic lymphadenectomy, i.e., 50.0%vs. 86.4%(χ2=9.303, P<0.05). Meanwhile, lymphadenectasis was positively correlated with lymph node positivity (P<0.001). Tumor stage, histological subtype (urothelial carcinoma and non-urothelial carcinoma), and age were the prognostic factors for bladder cancer (P<0.05). Conclusion:Intraoperative lymphadenectasis is the influencing factor of lymph node positivity. This study determined that standard pel-vic lymphadenectomy and lymphadenectasis may influence the DFS rate after RC and are the independent risk factors for the prognosis of bladder cancer. Creating evidence-based guidelines of standardized lymphadenectomy for further improvement of the surgical quali-ty and survival of bladder cancer patients is essential.
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Objective:To analyze the impact of endophytic extent of renal tumor on the perioperative outcomes after partial ne-phrectomy and evaluate the long-term therapeutic effect of early renal cancer. Methods:A retrospective review was performed for 157 patients who underwent partial nephrectomy of T1N0M0 kidney cancer in Tianjin Medical University Cancer Institute and Hospital be-tween January 2011 and December 2013. The patients were classified into two groups according to the distance of the tumor margin to the collective system or renal sinus fat:group A,0.05). The warm ischemia time and operation time were significantly longer in group A than in group B (P=0.001;P=0.033). Postoperative complications occurred in 10 patients. No local tu-mor recurrence or metastasis was observed in the patients during a median follow-up of 18 months. Conclusion:The distance between the tumor margin and the collective system reflects the complexity of partial nephrectomy, which is associated with the warm ischemia time and operation time. Partial nephrectomy is safe and effective. This procedure has low complications and good survival.
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Objective:To establish a method for the determination of 4-methyl-N-(4-(pyridin-3-yl) pyrimidin-2-yl) benzene-1,3-diamine as an impurity in the preparation of imatinib mesylate. Methods: An LC-MS/MS method was used with ESI ion source con-trolled by a positive-ion mode. The MRM mode was performed with 278. 1/106. 1 as the scanning and ion-pair. Acetonitrile solution containing ammonium formate and formic acid was used with gradient elution. Results:The linear range was 1. 572~47. 160 ng/ml(r=0. 999 7). The detection limit was 0. 002 1ng and the limit of quantitation was 0. 006 8ng. The average recovery was 100. 9% with RSD of 2. 88. The results of specificity, solution stability, repeatability and durability all met the specification. Conclusion:The meth-od is sensitive, accurate and special in the determination of 4-methyl-N-(4-(pyridin-3-yl) pyrimidin-2-yl) benzene-1,3-diamine in imatinib mesylate.
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Objective:To evaluate the tolerance and safety of Zhengbiguanjie tablets in healthy volunteers to provide the safe dose range for phase II clinical trial. Methods:Totally 36 healthy volunteers were randomly divided into five single dose groups at different doses ranging from 400 mg to 3200 mg per day and two multiple dose groups with 1600 mg and 2400 mg for continuous 7 days. The tol-erance and safety of the tablets were observed. Results: All vital signs were normal in all the volunteers in both single and multiple dose tests. Although some indicators turned into abnormal after the administration, it was not significant for clinical judgment. Neither drug combination nor serious adverse reactions were shown during the trial. However, two mild adverse events occurred and disap-peared later without any treatment. Conclusion:All the volunteers have good tolerance to Zhengbiguanjie tablets. The study proved the safety of Zhengbiguanjie tablets at single and multiple dose.
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Objective:To investigate the effect of Operation Maps application on relieving anxiety of patients of the nurses of operation room preoperative visits. Methods:39 cases of operation were randomly divided into the application of operation maps 19 cases and routine visit group 20 cases, regular visiting group received routine preoperative interview content, and on the basis of content, the original application mapping group are visited by nurses carrying atlas album, and according to the related content the nurses explain to patients in the album when they introduce the patients the operating room environment surgery, surgical notes, position, etc. At the same time, the self rating anxiety scale measurement measures the anxiety of patients when they are admitted and after into operation room, and blood pressure, heart rate, pain intensity, the first time getting out of bed, exhaust time, clearing time, and they compare the difference. Results:The anxiety values of the original application mapping group mapping group, systolic blood pressure, heart rate are lower than regular visits group(t=2.28, t=4.756, t=10.28;P<0.05). Intensity of pain after operation in the two groups , get out of bed the first time, exhaust time showed no significant differences(t=3.04, t=3.06, t=2.56;P<0.01). Conclusion:Application of operation atlas of systematic, standardized preoperative visit is an important psychological guidance, and it can reduce the anxiety level of patients and effectively improve the quality of medical operation period.
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Objective To investigate the distribution of pathogens in adult patients with community-acquired pneumonia (CAP) in Tangshan area. Methods The clinical data of 530 hospitalized patients with CAP were retrospectively collected in department of respiratory medicine from 6 hospitals in Tangshan area from October 2011 to September 2012. The sputum samples were isolated and cultured. Results A total of 195 strains were isolated from 530 patients with CAP. The most common types of pathogens included Klebsiella pneumoniae (64 strains,12.08%), Streptococcus pneumoniae (24 strains, 4.53%) and Bauman Acinetobacter (19 strain, 3.58%). The detective rates of Klebsiella pneumoniae and Pseudomonas aeruginosa were significantly higher in patients with basic diseases than those of patients without basic diseases (P0.05). Conclusion The gram-negative bacterial pathogens were the majority isolated from patients with CAP in Tangshan area. And Klebsiella pneumoniae was the primary bacteria. Patients with serious illness, above 60 years old, without antibiotic treatment before hospitalization, with basic diseases and above PORTⅢlevels should be given treatment of anti-gram-negative bacteria.
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More than 40 institutions have set up the specialty of medical law in order to train inter-disciplinary talents of medical law.Many scholars undertook extensive research aiming at strengthening and developing this new specialty,but many problems still existed in its teaching and the quality of the graduates was been questioned.Through in-depth analysis of the existing research,we pointed out three problems of the current research:being subjective and lacking data support; confining to the ivory tower and lacking contact with the social; limiting to scholars and teachers and lacking retrospective thinking and critique from postgraduates.
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Objective To assess the effect of nicotinic acid on hyperphosphatemia in maintenance hemodialysis (MHD) patients.Methods Twenty-six MHD patients with stable disease condition and hyperphosphatemia that could not be successfully controlled by conventional methods were selected.All patients were treated with oral nicotinic acid for 20 weeks.The changes of serum calcium,high sensitivity Creactive protein (hs-CRP),albumin (ALB),aspartate aminotransferase (AST),alanine aminotransferase (ALT),gamma-glutmyltransferase (GGT),total bilirubin (TBIL),derect bilirubin (DBIL),high density lipoprotein cholesferol (HDL-C),low density lipoprotein cholesferol (LDL-C),triacylglycerol (TG),total cholesterol (TC),intact parathyroid hormone,hemoglobin,platelet count,etc were observed before and after treatment.Results Two patients withdrew from this study because.of pruritus and diarrhea after two weeks of oral nicotinic acid.In 24 cases,compared with that before treatment,the serum phosphate,calcium-phosphorus product was decreased [(1.49 ± 0.19) mmol/L vs.(2.13 ± 0.16) mmol/L,(4.40 ± 0.49)mmol2/L2 vs.(5.45 ± 0.36) mmol2/L2] and HDL-C was increased [(1.45 ± 0.14) mmol/L vs.(1.18 ± 0.15)mmol/L] after treatment,and there was significant difference (P ＜ 0.05).There was no significant difference in the serum calcium,iPTH,LDL-C,TG,TC,ALB,AST,ALT,GGT,TBIL,DBIL,hs-CRP,platelet count,hemoglobin between before and after treatment (P ＞ 0.05).Conclusions Nicotinic acid is effective as all adjuvant measure in control of hyperphosphatemia in patients on MHD and can increase HDL-C.It provides a new approach for the treatment of hyperphosphatemia.
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Objective To observe the efficacy and complication of laser subepithelial keratom ileusis (LASEK) combined with mitomycin C (MMC) in treatment of high myopia.Methods 118 cases ( 236 eyes) diagnosed as high myopia were treated by LASEK combined with MMC.The changes of vision,refractive regression,postoperation pain and haze were observed.Results 7-days after operation,all patients' post-operation relief.6-months after operation,the quantity of vision reached or exceeded BCVA were 228 cases ( 96.61％ ),average refraction wsa ( + 0.54 ± 0.24 ) D,the incidence of haze was 4.66％.Conclusion Is safe the LASEK combined with MMC in treatment of high myopia,effective,low incidence of haze.
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Objective To assess the level of radiation exposures of operators in three typical types of interventional fluoroscopic procedures.Methods Alderson Radiation Therapy (ART) phantom was used to stimulate the practices of diagnosis and therapy using TLDs for dose measurement.The radiation exposures of eye lens, neck, and breast were measured when the lead shielding of machine was on/off and the equivalent dose and effective dose to the eye lens were estimated.Results Radiation exposure of head was obviously reduced by 85% -90% when the lead shielding was on.The doses in different procedures were different.In cerebral angiography the dose equivalent of eye len was the highest in the three procedures.The annual effective dose for the operators was smaller in peripheral vascular interventions than that in cardiovascular interventional therapy and that in cerebral angiography.Conclusions The operators involved in intervention will receive an annual effective dose of less than 20 mSv as recommended by the ICRP under the protection conditions provided by the current study, except for eye lens.Attention should be paid to the protection of the eyes of operators.
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Objective To discuss the promoting effect of humanistic care plus psychological cage on basis of conventional nursing on rehabilitation of patients after breast cancer surgery.Methods 460 cases of breast cancer patients from January 2008 to January 2010 were randomly divided into the control group and the observation group with 230 cases in each group.The control group received routine nursing care after surgery,while for the observation group,in addition to conventional care,they received humanistie care and psychological care.The alleviation degree of psychological barrier and degree of satisfaction of the two groups were compared.Results The alleviation degree of psychological barrier was 62.2% .and was 40.4% in the control group.The patients'satisfaction rate was 95.2% in the observation group,and 71.7% in the control group.the difference Was significant.Conclusions Humanistic care and psychological care can effectively relieve mental disorders of patients,promote their early recovery,also can improve their satisfaction degree with nursing work.