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Radical resection is the only measurement to cure patients of hepatobiliary and pancreatic tumors. The comprehensive application of endoscopy, interventional therapy, radiotherapy and systemic therapy can not only significantly improve the early diagnosis rate of the disease, and successfully transform some borderline resectable tumors into radical resectable states, but also reduce the recurrence rate of tumors after surgery, thus prolonging the survival time of patients. In recent years, the continuous emergence of new systemic therapeutic drugs has brought new opportunities for patients with hepatobiliary and pancreatic malignancies, but the number of doctors participating in diagnosis and treatment has also increased accordingly. Therefore, the contradiction between the division system based on treatment methods and the orderly and standardized treatment is becoming more and more prominent. According to the latest progress of hepatobiliary and pancreatic cancer research at home and abroad, and combined with our clinical experience, we proposed a long-term management concept based on hepatobiliary and pancreatic comprehensive multi-technical team. Based on this concept, we have carried out new thought and practice on the diagnosis and treatment of patients with hepatobiliary and pancreatic malignant tumors.
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Objective:To evaluate and summarize the best evidence of energy and protein intake targets and calculation in adult critically ill patients, and to provide evidence-based basis for critical nutrition management.Methods:Evidence related to energy and protein intake targets and calculation of adult critically ill patients, including guideline, expert consensus, systematic review and evidence summary, were systematically searched in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Cochrane Library, UpToDate, BMJ Best Practice, Joanna Briggs Institute (JBI), Web of Science, SinoMed, Medive, China National Knowledge Infrastructure, Wanfang database, VIP database, Guidelines International Network (GIN), National Institute for Health and Care Excellence (NICE), National Guideline Clearinghouse (NGC), Registered Nurses Association of Ontario (RNAO), and Society of Critical Care Medicine (SCCM) from January 2012 to June 2022. Two researchers independently evaluated the quality of the included literatures using the JBI Evidence-based Health Care Center evaluation tool and the Appraisal of Clinical Practice Guidelines for Research and Evaluation Ⅱ (AGREE Ⅱ), extracted and summarized the best evidence for the nutritional intake goal and calculation of adult critically ill patients, and described the evidence.Results:A total of 18 literatures were included, including 5 clinical guidelines, 8 expert consensus, 3 systematic reviews and 2 evidence summaries. After literature quality evaluation, 18 articles were all enrolled. The evidence was summarized from the four aspects, including energy target calculation method, dose body weight, energy and protein intake target, and calculation method, 24 pieces of the best evidence were finally formed.Conclusions:The best evidence of energy and protein intake targets and calculation for critically ill patients was summarized based on evidence-based. Clinical medical staff can choose indirect calorimetry to calculate energy goals when equipment is available. Patient's height, body weight should be recorded accurately, dose body weight can be determined by body mass index (BMI). Meanwhile, blood urea nitrogen (BUN) loss, fat-free body weight, simple formulas and other methods should be used to continuously evaluate and adjust protein intake targets, to achieve the purpose of optimizing intensive nutrition support.
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Objective:To analyze the expression of targeting protein for Xklp2 (TPX2) in kidney renal clear cell carcinoma (KIRC) and its clinical significance.Methods:The postoperative tissue samples of 54 patients with KIRC admitted to the Department of Urology, the First Affiliated Hospital of Bengbu Medical College from July 2017 to June 2019 were collected. Immunohistochemistry was used to detect the protein expression of TPX2 in renal carcinoma and paracancerous tissues. The difference of TPX2 mRNA expression between KIRC tissues and normal tissues was analyzed by using the TIMER database, which verified the immunohistochemical results. The UALCAN database and the Kaplan-Meier plotter database were used to analyze the relationship between TPX2 mRNA expression and clinical stage, molecular subtypes, lymph node metastasis, and prognosis of patients with KIRC. The protein interaction network was constructed by STRING database to obtain TPX2-related proteins, and the genes corresponding to the related proteins were enriched for the KEGG pathway. The relationship between TPX2 expression and immune cell infiltration and the immune checkpoint was studied by using the TIMER database.Results:Immunohistochemical results showed that the positive expression rate of TPX2 protein was 48.15% (26/54) in cancer tissues, which was higher than that in paracancerous tissues (20.37%, 11/54) ( χ2=9.25, P=0.002). The results of bioinformatics analysis showed that TPX2 mRNA expression was significantly up-regulated in KIRC [cancer tissue: 1.89 (1.49, 2.42), normal tissue: 0.35 (0.24, 0.57), U=2 297.00, P<0.001]. The expression of TPX2 mRNA was related to the clinical stage ( χ2=34.36, P<0.001), molecular subtypes ( χ2=30.15, P<0.001), and lymph node metastasis status ( χ2=27.21, P<0.001) of KIRC patients. The 5-year survival rate (53.80%) in patients with high TPX2 expression was lower than that in patients with low TPX2 expression (74.40%, χ2=18.87, P<0.001). STRING database protein interaction network construction obtained 20 TPX2-related proteins, and the genes corresponding to the related proteins were enriched in the cell cycle. The expression of TPX2 was positively correlated with B cells ( r=0.30, P<0.001), CD8 + T cells ( r=0.23, P<0.001), CD4 + T cells ( r=0.18, P<0.001), macrophages ( r=0.20, P<0.001), neutrophils ( r=0.31, P<0.001), dendritic cells ( r=0.39, P<0.001) infiltration and most of its biomarkers (all P<0.05). It was positively correlated with immune checkpoint PD-1 ( r=0.31, P<0.001) and CTLA-4 ( r=0.27, P<0.001), but not correlated with PD-L1 ( r=0.07, P=0.146) . Conclusion:TPX2 is highly expressed in KIRC and is closely associated with poor prognosis. It is expected to be a new therapeutic target for KIRC.
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Objective:To investigate the correlation between the level of thyrotropin receptor antibody(TRAb) and bone turnover markers(BTMs) in the patients with newly-diagnosed Graves′ disease(GD).Methods:The clinical data of GD patients who were newly-diagnosed in the First Affiliated Hospital of Zhengzhou University from October 2016 to June 2021 were collected, including free triiodothyronine(FT 3), free thyroxine(FT 4), thyroid stimulating hormone, thyroid related antibodies, N-terminal procollagen of type I collagen(PINP), N-terminal osteocalcin(N-MID), β-cross-linked C-telopeptide of type I(β-CTX), blood lipid and renal function, etc. Results:There were 618 GD patients with an average age of(43.7±13.2) years(male∶female=1∶1.99). The PINP and β-CTX level in male GD patients were significantly higher than those in female(all P<0.05). Spearman correlation analysis showed that PINP, N-MID and β-CTX were positively correlated with FT 3, FT 4, TRAb, serum calcium and serum phosphorus; and negatively correlated with body mass index and low density lipoprotein cholesterol(all P<0.05). Linear regression analysis showed that TRAb was positively correlated with lg-PINP, lg-N-MID and sqrt-β-CTX in the univariate model of total GD patients( β were 0.006, 0.005, and 0.006, respectively; all P<0.001); positive correlation remained after adjusting for thyroid function(all β=0.004, all P<0.001); and for multiple confounding factors(model 3 and 4, all P<0.05). Results of univariate and adjusted thyroid function models with GD in different genders were consistent with the total patients(all P<0.05). Conclusion:TRAb is a risk factor for accelerated bone turnover in GD patients which is independent of thyroid function.
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The treatment of hepatocellular carcinoma (HCC) has always been a hot spot of medical research worldwide. At present, surgical resection is the main therapy for HCC, supplemen-ted by interventional therapy, chemotherapy, radiotherapy, etc. Although the overall survival of HCC has been significantly improved in recent years, the overall effect is still unsatisfactory. New systemic therapeutic drugs are constantly emerging and applied to clinical practice, which bring new opportunities and challenges for the treatment of HCC. However, too many diagnosis and treatment topics bring obvious contradiction between the division system and the orderly and standardized HCC treatment. In the future, how to realize unified and standardized homogeneous diagnosis and treatment is the key problem to be solved urgently. The authors summarize the current status of diagnosis and treatment of HCC and propose the long-term management concept for HCC according to their own clinical experience and the current advances of the diagnosis and treatment at home and abroad, and carry out new practice and investigation on the patients with HCC by constructing a hepatobiliary multi-technical team.
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Objective:To compare the spermatogenes response of human chorionic gonadotropin(HCG)combined with human menopausal gonadotropin(HMG)in patients with idiopathic hypogonadotropic hypogonadism(IHH)and congenital combined pituitary hormone deficiency(CCPHD), and to explore related factors.Methods:Clinical data of 90 IHH patients and 61 CCPHD patients from January, 2014 to November, 2018 were retrospectively analyzed. Spermatogenesis was compared between the two groups receiving combined gonadotropin therapy. The patients were then divided into two subgroups: spermatogenesis subgroup and nonspermatogenesis subgroup. Related factors of spermatogenesis after the combined gonadotropin therapy were investigated.Results:After the combined treatment of HCG/HMG for 3, 6, and 9 months, the patients with CCPHD revealed lower testicular sizes than those with IHH( P=0.004, 0.021 and 0.032, respectively). Compared with IHH patients, CCPHD patients had larger testicular volume increments( P<0.001), higher spermatogenesis rates( P=0.048), and shorter initial time for sperm appearance( P<0.001)after 24-month treatment. Multivariate logistic regression analysis showed that lower total cholesterol(TC)(IHH group: OR=5.508, 95% CI 1.110-27.326, P=0.037; CCPHD group: OR=4.068, 95% CI 1.077-15.371, P=0.039)was an independent risk factor of poorer spermatogenesis in patients with IHH and CCPHD. Conclusions:The patients with CCPHD demonstrate a better response to combined gonadotropin treatment than those with IHH. Lower TC is an independent risk factor for poor spermatogenesis of combined HCG/HMG therapy in patients with IHH or CCPHD.
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Objective:To study the correlation between systemic immune inflammation index (SII) and prognosis of patients with hilar cholangiocarcinoma after surgical treatment.Methods:The clinical data of 181 patients with hilar cholangiocarcinoma treated by surgery at the First Affiliated Hospital of Zhengzhou University from January 2012 to December 2016 were retrospectively analyzed. There were 119 men and 62 women, with an average age of 62.4 years. SII was calculated using preoperative routine blood tests. Receiver operating characteristic (ROC) curve was used to obtain the optimal cutoff value of SII. The Kaplan-Meier method was used to draw survival curves and survival rates were compared by log-rank test. The Cox proportional risk model was used to analyze single and multiple factors.Results:The SII area under the ROC curve in predicting postoperative survival was 0.749(95% CI: 0.641-0.858), the optimal threshold was 412.6. Using this threshold, patients were divided into the low SII group (SII≤412.6, n=80) and the high SII group (SII>412.6, n=101). The 1, 3, and 5-year cumulative survival rates of patients in the low SII group were 87.5%, 57.5%, and 26.3%, which were significantly better than those of the high SII group of 71.3%, 39.6%, and 9.9% respectively ( P<0.05). Multivariate analysis showed that SII>412.6 ( HR=2.887, 95% CI: 2.256-7.903, P<0.05) was an independent risk factor for overall survival of patients with hilar cholangiocarcinoma. Conclusion:Preoperative SII had predictive values for postoperative survival of patients with hilar cholangiocarcinoma, SII>412.6 was an independent risk factor for postoperative survival.
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ObjectiveTo screen out the mRNAs involved in the resistance of hepatoma cells to anlotinib using ceRNA microarray. MethodsHigh-dose shock combined with low-dose induction was used to culture hepatoma cells resistant to anlotinib, and CCK8 assay was used to verify the difference in the proliferation of drug-resistant hepatoma cells treated by anlotinib. The ceRNA microarray was used to screen out the differentially expressed genes between drug-resistant hepatoma cells and normal hepatoma cells, and real-time PCR was used to verify the differentially expressed genes detected by some microarrays. the independent samples t-test was used for comparison of continuous data between two groups, and the Kaplan-Meier method was used to analyze the overall survival of hepatoma cells samples, and the log-rank test was used to compare survival rates. Fisher’s exact test was used for chip screening. ResultsThere was a significant difference in gene expression between drug-resistant hepatoma cells and normal hepatoma cells, and 10 genes with the greatest difference were screened out for analysis by reducing the range. There were 4 genes associated with drug resistance and tumor growth, i.e., BIRC2, BIRC7, ABCC2, and MAPK8. There were significant reductions in the expression levels of BIRC2, ABCC2, and MAPK8 (P=0001 4, 0001 2, and 0.011 8), and there was a significant increase in the expression of BIRC7 (P＜0.001). The results of real-time PCR were consistent with those of microarray (t=10.74,32.65,18.34, and 2.80; P=0.000 4, 0.000 1, 0.000 1, and 0.044 8). The high expression of BIRC7 and the low expression of MAPK8 were associated with the significant reduction in survival time (P=0.022 0 and 0.005 6). ConclusionBIRC2, BIRC7, ABCC2, and MAPK8 are differentially expressed between anlotinib-resistant hepatoma cells and normal hepatoma cells and may be involved in the resistance of hepatoma cells to anlotinib.
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Objective To evaluate the cognitive function and its correlative factors in centenarians.Methods Forty-nine subjects in Zhongxiang city were included in this mass screening.Questionnaire was utilized to collect basic data,including age,gender,ability of daily life,depression,life habits,body mass index,and history of chronic diseases on all the subjects.And the mini-mental state examination(MMSE)was adopted to evaluate cognitive function of old people.T test and chi-square test were used to compare the difference in effectiveness of multiple different factors on cognitive function,while binary logistic regression analysis was used to assess the effects of multiple different factors on cognitive function.Results The mean score of the ability of different dimensions of cognitive function was (7.10 ± 2.71) in direction,(1.94 ±± 0.80) in memory,(0.61 ± 1.07) in attention and computation,(1.92 ± 0.86) in recall,and (4.73 ± 2.14) in speech,respectively,with total score of cognitive function of(16.30±6.02) in forty-nine centenarians.Normal cognitive function was found in 25 cases,and decreased cognitive function was found in 24 cases.Single factor logistic analysis indicated that body mass index(t=-3.399,P=0.001)and self-rating depression scale(t=-5.731,P＜0.001) were lower in patients with normal cognitive function than in patients with declined cognitive function.And smoking patients were associated with higher rates of normal cognitive function than the non-smoking patients(87.5％ vs.43.9％,x2 =5.091,P=0.028),and patients with normal hearing were associated with higher rate of normal cognitive function than patients with hearing loss(70.3 ％ vs.27.3 ％,x2 =9.01,P=0.030).Multivariate logistic analysis indicated that depression index(β=-14.40,P=0.001) and body mass index(β=-0.424,P=0.015) were independent effective factors for cognitive function.Conclusions Improvement of the condition of depression and controlling the body mass index are hopeful for recovering or postponing their cognitive impairment in centenarians.
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Objective To explore the clinical efficacy and safety of microsurgery in hand retrograde skin avulsion.Methods 56 patients with hand retrograde skin avulsion were selected and randomly divided into study group(28 cases)and control group(28 cases).The study group was taken treatment of microsurgery,the control group was taken treatment of free return FLAP treatment plant.The treatment effect of the two groups was compared. Results The total effective rate of the study group was 96.4%,which was significantly higher than 78.6% of the control group(χ2 =4.082,P =0.043).The average survival skin rate of the study group was (95.62 ±4.23)%, which was significantly higher than (73.20 ±6.48)% of the control group(t =15.331,P =0.000).The skin index in the study group was significantly better than the control group (χ2 =4.909,P =0.027).Conclusion Hand retrograde skin avulsion in patients using microsurgical treatment method can maximize recovery skin vitality and improve the appearance and function of the hand of patients,and improve the therapeutic effect.
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Objective Explore the risk factors and prevention of HAP after surgical excision of Esophageal carcinoma in elderly Patients.Methods Two hundred and eight elderly patients with HAP after Surgical excision of Esophageal carcinoma from 2009 to 2012 were analyzed.Logistic regression analysis was used to find the related risk factors.Results The incidence of HAP was 25.9％.In several factors Logistic regression analysis,smoking,low lung function,postoperative non-epidural analgesia,injure of recurrent laryngeal nerve and fistula of anastomotic were the risk factors.Conclusions The preoperative evaluation,Intensive monitoring during the postoperative period and reducing the complication after operation can decrease the incidence of HAP.
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The basic principles of dishonesty disciplinary mechanism are called into play tO probe into such issues as the necessity and key points of building such a mechanism in China's hospitals.The paper focused on ascertaining government leadership,designating key regulators of hospital dishonesty,formulating the regulations for hospital dishonesty recognition and accountability,penalty system for hospital dishonesty,information disclosure system for hospital dishonesty behavior.In addition,it covered such aspects as the incentives and education measures for hospital credit,and building supportive measures for hospitals dishonesty disciplinary mechanism.
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Presentation of the importance to resolve medical treatment disputes via mediation,holding that mediation enjoys a promising perspective in this regard.At present,unsatisfactory use of mediation in resolving medical treatment disputes in China finds its root in the system itself.Reconstruction of the existing mechanism for disputes mediation and resolution is inevitable in caUing this mechanism into an active play.Mediation organizations and private institutions in the society should be mobilized to play a greater role in resolving disputes,in an effort to make mediation agreements binding,normalize mediation behavior.This way a new mechanism joining "private,administrative and judiciary" mediation with standardized behavior will be built.
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We assessed the effects of trxS gene on changes of proteinase activity, contents of different protein fractions and SDS-PAGE profiles in germinating seeds of contrasting transgenic and nontransgenic barley variety. Proteinase activity was enhanced by 70.28% in transgenic than nontransgenic barley seeds, whereas contents of albumin, globulin, hordein and glutelin in transgenic seeds were 3.68%, 23.52%, 31.37%, and 21.04%, lower than those in nontransgenic seeds. Degradation rates of hordein and glutelin in transgenic seeds were faster than those in nontransgenic seedlings as indicated by the SDS-PAGE profiles. Our data imply that the transformation of trxS gene could promote the degradation of protein, providing theoretic basis for the use of trxS gene and barley quality breeding.
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Germination , Hordeum , Genetics , Metabolism , Peptide Hydrolases , Metabolism , Plant Proteins , Metabolism , Plants, Genetically Modified , Genetics , Metabolism , Seeds , Thioredoxins , Genetics , Metabolism , Transformation, GeneticABSTRACT
We found seven tag sequence with high homology in dbEST by using human musclin gene, and got its cDNA sequence, which consists of 651bp and the open reading frame was 54-452 bp detected by RT-PCR, encoding 132 amino acid residue protein. The new gene has high homology with that of human, mouse and rat, the rate is 87.2%, 77.6% and 77.9%, respectively; the gene fragment was cloned into expression vector pGEX-4T-1, and the recombinant was transformed into E. coli BL21. Induced by IPTG, the fusion protein GST-musclin, a 38.59 kD protein was successfully expressed in E. coli BL21 and identified by Western blotting.
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Animals , Humans , Mice , Rats , Amino Acid Sequence , Base Sequence , Cloning, Molecular , DNA, Complementary , Genetics , Escherichia coli , Genetics , Metabolism , Molecular Sequence Data , Muscle Proteins , Genetics , Muscle, Skeletal , Metabolism , Open Reading Frames , Genetics , Recombinant Fusion Proteins , Genetics , Swine , Genetics , Transcription Factors , GeneticsABSTRACT
AIM: There are many active components of tonifying kidney to strengthen the bone in Kanggu Zengsheng capsule, but there are few reports about its effect in treating bone fracture. CR molybdenum target X-ray is often used in mammary gland examination and disease diagnosis. This study detected the callus density during fracture healing in rats by CR molybdenum target X-ray to explore the promoting effects of Kanggu Zengsheng capsule on fracture healing. METHODS: The experiment was performed at the Laboratory Centre of Second Hospital of Hebei Medical University from July 2005 to March 2006. Sixty Wistar rats with an equal amount of males and females, 170-200 g, aged 9-10 months were randomly divided into experimental group and control group (n =30). After the tibial fracture model was made, the rats in the experimental group were given 1 mL Kanggu Zengsheng capsule suspension, 14.00-15.75 mg for each, once daily, while the rats in the control group orally took matching normal saline (9 g/L) once daily. All animals were executed under anesthesia by batch on the 3rd, 10th, 17th, 24th, and 33rd days after the operation, separately. The diameter of callus was measured with vernier caliper. The values of callus density were calculated by image analysis system in the CR molybdenum target X-ray. RESULTS: Sixty rats were all included in the final analysis. The photo of CR molybdenum target X-ray showed clear bone lines, and bone and soft tissue were evident. During the process of fracture union, there were significant differences in callus density between the two groups (P
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This paper suggested a new method of spacial risk-trend trace (SRTT) to assess and monitor the spacial balance condition during paraplegic walking assisted by functional electrical stimulation (FES), which main component was a measurement system of upper limb support based on a standard walker. With the support data, the spacial positions of moving center of gravity could be located through the upper body mechanical model and, combining with the definition of walker rolling index, transmitted into SRTT to describe the balance conditions at different axial space. The experimental and clinical results demonstrated the new SRTT method was reliable and real-time. Its potential clinical usefulness in evaluating and monitoring FES-assisted paraplegic walking ability may provide the foundation to enact the relevant national rehabilitation criterions for effective FES usage.
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Humans , Electric Stimulation Therapy , Methods , Monitoring, Physiologic , Methods , Paraplegia , Rehabilitation , Postural Balance , Physiology , Self-Help Devices , Therapy, Computer-Assisted , Methods , Walking , PhysiologyABSTRACT
Biotechnology is one of the important areas of life science, consequently the ethical problems were caused by its researches and applications. The article analyzed the ethical problems related to the development of biotechnology and put forwards some countermeasures in order to keep it developing constantly and steady.