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The co-existence of multiple chronic diseases has been increasing in the elderly population, it has become a major challenge globally, and identifying comorbidities patterns can help provide clues for disease prevention and treatment, as well as improving prognosis. This article reviews the identification methods, influencing factors and management strategies of chronic disease comorbidities, to provide a reference for the research and management of comorbidity.
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Objective:To observe the effect of noninvasive positive pressure ventilation (NIPPV) and high-flow nasal cannula oxygen therapy (HFNC) on the prognosis of patients with coronavirus disease 2019 (COVID-19) accompanied with acute respiratory distress syndrome (ARDS).Methods:A retrospective study was conducted in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology when authors worked as medical team members for treating COVID-19. COVID-19 patients with pulse oxygen saturation/fraction of inspiration oxygen (SpO 2/FiO 2, S/F) ratio < 235, managed by medical teams [using S/F ratio instead of oxygenation index (PaO 2/FiO 2) to diagnose ARDS] from February to April 2020 were included. The patients were divided into NIPPV group and HFNC group according to their oxygen therapy modes. Clinical data of patients were collected, including general characteristics, respiratory rate (RR), fraction of FiO 2, SpO 2, heart rate (HR), mean arterial pressure (MAP), S/F ratio in the first 72 hours, lymphocyte count (LYM), percentage of lymphocyte (LYM%) and white blood cell count (WBC) at admission and discharge or death, the duration of dyspnea before NIPPV and HFNC, and the length from onset to admission. The differences of intubation rate, all-cause mortality, S/F ratio and RR were analyzed, and single factor analysis and generalized estimation equation (GEE) were used to analyze the risk factors affecting S/F ratio. Results:Among the 41 patients, the proportion of males was high (68.3%, 28 cases), the median age was 68 (58-74) years old, 28 cases had complications (68.3%), and 34 cases had multiple organ dysfunction syndrome (MODS, 82.9%). Compared with HFNC group, the proportion of complications in NIPPV group was higher [87.5% (21/24) vs. 41.2% (7/17), P < 0.05], and the value of LYM% was lower [5.3% (3.4%-7.8%) vs. 10.0% (3.9%-19.7%), P < 0.05], the need of blood purification was also significantly lower [0% (0/24) vs. 29.4% (5/17), P < 0.05]. The S/F ratio of NIPPV group gradually increased after 2 hours treatment and RR gradually decreased with over time, S/F ratio decreased and RR increased in HFNC group compared with baseline, but there was no significant difference in S/F ratio between the two groups at each time point. RR in NIPPV group was significantly higher than that in HFNC group after 2 hours treatment [time/min: 30 (27-33) vs. 24 (21-27), P < 0.05]. There was no significant difference in rate need intubation and hospital mortality between NIPPV group and HFNC group [66.7% (16/24) vs. 70.6% (12/17), 58.3% (14/24) vs. 52.9% (9/17), both P > 0.05]. Analysis of the factors affecting the S/Fratio in the course of oxygen therapy showed that the oxygen therapy mode and the course of illness at admission were the factors affecting the S/F ratio of patients [ β values were -15.827, 1.202, 95% confidence interval (95% CI) were -29.102 to -2.552 and 0.247-2.156, P values were 0.019 and 0.014, respectively]. Conclusion:Compared with HFNC, NIPPV doesn't significantly reduce the intubation rate and mortality of patients with COVID-19 accompanied with ARDS, but it significantly increases the S/F ratio of those patients.
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Objective:To evaluate the effectiveness and feasibility of health management based on cloud platform for population with high-risk of coronary heart disease (CHD).Methods:In this study, self-control method was used to study the high-risk group of CHD in two community outpatient clinics in Jinshui District, Zhengzhou through cloud platform. One year later, the clinical indicators, the degree of mastering CHD prevention knowledge andthe medicine compliance of the group were evaluated. Finally, the feasibility and acceptance of cloud platform management were evaluated through questionnaire survey.Results:A total of 272 people were enrolled intothe group. After one year of cloud platform management, the blood lipid, uric acid, homocysteine and fasting blood glucose in the group weresignificantly improved (all P<0.05), but the glycosylated hemoglobin was not significantly reduced [(6.4±1.2)% vs.(6.3±1.1)%, P>0.05]. The degree of mastering CHD prevention knowledgewas significantly improved, and the medicine compliance was not significantly improved [(5.0±1.6) vs. (5.0±1.5), P>0.05]. Questionnaire survey showed that 228 (83.8%) of the patients had a high acceptance of cloud platform management, and 208 (76.5%) of the group wanted to continue to use cloud platform for health management. Conclusions:Health management based on cloud platform can improve the clinical index control of the high-risk population of CHD, and help the high-risk population to master the relevant knowledge of CHD prevention. Some functions of cloud platform need to be further improved.
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Objective@#To investigate clinical outcomes of modified reattachment of superior peroneal retinaculum (SPR) for patients with recurrent peroneal tendon dislocation.@*Methods@#A total of 24 cases with recurrent peroneal tendon dislocation from December 2012 to June 2017 were treated with modified reattachment of SPR. There were 20 males and 4 females. The average age was 24.9±9.3 years (14-48 years). The average BMI was 23.18±3.50 kg/m2 (15.8-32.2 kg/m2). A 4-5 cm incision was made along the lateral margin of the fibula and curved distally around the fibular tip in line with the peroneal excursion. The superior peroneal retinaculum, peroneus longus and peroneus brevis were exposed. The periosteum and SPR were stripped from the fibula. The false pouch was formed. Two suture anchors were inserted into the postero-lateral ridge of the lateral malleolus without damaging the cartilaginous ridge, after which the SPR was reattached to the lateral malleolus with the anchored suture. The inner layer of the false pouch was incised, while the outer layer (periosteum) was sutured with the SPR in a pants-over-vest style. The following items, including American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS), rate of return to previous sports level, time to return to sports activity, complication, and patients satisfaction were evaluated preoperatively and at the final follow-up.@*Results@#The average operation duration was 36.1±8.8 min (20-51 min). The blood loss was 1-10 ml, average 4.1±2.7 ml. The follow-up was carried out in 22 cases for mean 33.9±15.7 months (13-61 months). AOFAS score was improved from 77.8±7.8 points to 95.5±4.3 points significantly (t=-11.89, P<0.001). VAS score was reduced from 4.2±2.4 to 0.3±0.8 significantly (t=7.69, P<0.001). Mean duration return to sports activity was 5.0±1.9 months (3-10 months). A total of 20 patients (91%) returned to their previous sports level. Only one patient (5%) was found with limitation of range of motion, while two patients (9%) reported pain at the scar site without recurrence. The satisfaction rate was 91%.@*Conclusion@#Clinical outcomes of modified reattachment of SPR for patients with recurrent peroneal tendon dislocation was safe and effective.
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Objective To investigate the effects of agonist of angiotensin-(1-7)(AVE0991) on endothelial function and atherogenesis in apolipoprotein E knockout (ApoE-/-) mice.Methods Eight-week-old ApoE-/-male mice and C57BL/6J male mice were randomly divided into 3 groups:a normal diet control group(ND,n=10),a high-fat diet group(HFD,n=10),and a high-fat diet with AVE0991 0.58 μmol · kg-1 · d-1 group(HFD+ AVE0991,n=10).After 12 weeks of treatment,serum levels of lipids and parameters of endothelial function were measured.Atherosclerotic lesions in aorta roots were detected by Oil Red O staining.CD31 levels in the arterial intima were analyzed by immunohistochemistry.Results AVE0991 had no effects on blood lipids (P ＞ 0.05)but lowered serum levels of nitric oxide in high-fat diet mice(76.8±34.4 μmol/L vs.116.8±33.9 μmol/L,P＜0.05).Also,AVE0991 had no effects on the activity of serum nitric oxide synthase(19.5±5.7 U/ml vs.17.9±3.3 U/ml,P＞0.05)but decreased the activity of serum induced nitric oxide synthase(9.0 ±2.3 U/ml vs.12.7 ± 3.2 U/ml,P ＜0.05) and increased the ratio of phosphorylated endothelial nitric oxide synthase to induced nitric oxide synthase in the vessel wall in high-fat diet mice(0.8±0.2％ vs.0.6 ± 0.2％,P ＜ 0.05).AVE0991 decreased serum levels of C-reactive protein,tumor necrosis factor-α and interleukin-6 (P ＜ 0.05),and decreased the area percentage of atherosclerotic lesions in aorta roots (15.6 ± 3.3 ％ vs.45.4 ± 9.8 ％,P ＜ 0.05) and increased the integrated optical density of CD31 in the arterial intima in high-fat diet mice(54.1±11.0％ vs.28.7±10.6％,P＜0.05)Conclusions AVE0991 can attenuate atherogenesis in ApoE-/-mice fed a high-fat diet,possibly via reducing inflammatory response,regulating the activity of nitric oxide synthases and improving endothelial functions.
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Objective To investigate the effect of polyphosphazene(PAGP) microspheres controled release of growth factors on the adhesion and proliferation of bone marrow mesenchymal stem cells (BMSCs).Methods Two kinds of functional poly(alanine ethyl ester-co-glycine ethyl ester) phosphazene microspheres with different ratios of side-substituent groups were synthesized using the emulsion technique.The rate of degradation/hydrolysis of the polymers was carefully tuned to suit the desired application for controlled release.The enzyme-linked immune sorbent assay was utilized to investigate the characterization of the temporal controlled release strategy of microspheres loaded with transforming growth factor-beta 1(TGF-β1) and insulin-like growth factor-l(IGF-1) respectively.The cell adhesion and proliferation stimulated by different growth factors were evaluated by acridine orange staining.Resuits The morphological difference between two PAGP microspheres was identified according to SEM images.The average diameter of two microspheres was 54.22 ± 19.19 μm and 34.11 ± 18.82 μm respectively.The release assay showed that two kinds of microspheres had different release characteristics,with earlier outburst of TGF-β1 and IGF-1 for them to cooperate and later sustained release of TGF-β1 to stimulate the differentiation of stem cells.The result of the acridine orange staining demonstrated that PAGP microspheres supported cell adhesion and growth without obvious cytotoxicity.Meanwhile,the growth factors release strategy significantly improved the proliferation of BMSCs.Conclusion The two polyphosphazene microspheres have a great release-control effect and their controlled release system will have a promising prospect in the future tissue engineering field.
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<p><b>OBJECTIVE</b>To detect potential mutation of the WAS gene in a Chinese family affected with Wiskott-Aldrich syndrome.</p><p><b>METHODS</b>Peripheral blood samples were collected from the proband and his family members. All exons and flanking regions of the WAS gene were subjected to PCR amplification - Sanger sequencing as well as restriction endonuclease analysis. Plasma level of B-cell activating factor (BAFF) was also determined for all family members.</p><p><b>RESULTS</b>A hemizygous mutation (c.257G>A) of the WAS gene was identified in all patients from the family, for which the patient's mother was heterozygous. The same mutation was not found among healthy members of the family. Compared with unaffected members, all patients had a higher level of BAFF.</p><p><b>CONCLUSION</b>The c.257G>A mutation of the WAS gene probably underlies the Wiskott-Aldrich syndrome in this family.</p>
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Child, Preschool , Humans , Male , B-Cell Activating Factor , Blood , Heterozygote , Mutation , Wiskott-Aldrich Syndrome , Genetics , Wiskott-Aldrich Syndrome Protein , GeneticsABSTRACT
Objective To study the general shape of anterior cruciate ligament (ACL) insertion in rabbits and establish an animal model of ACL reconstruction using oval tunnels.Methods Eighteen mature white New Zealand rabbits were used in this study.Eight of them were used for anatomy study and the other 10 were for building an animal model.After removal of the medial femoral condyle and other soft tissues around ACL,the morphology of the ACL insertion was examined and the diameter of ACL insertions was measured using a caliper.An oval-tunnel dilator (1.6 mm×2.5 mm) was designed to make an oval-tunnel in the right knee of the rabbits while a round tunnel was drilled using a 2 mm diameter Kirschner wire in the left knee of the rabbits.Their hamstring tendon grafts were harvested as grafts for both sides and the compatibility between the bone tunnel and graft was examined for both groups.Right after the surgery,the knees of both sides were given the three-dimensional CT scan.Results The shape of ACL insertion of rabbits was oval.In the femur side,the average major and minor diameter of the ACL insertion was 5.28 ± 0.83 mm and 2.61 ± 0.33 mm respectively.In the tibial side,the major and the minor diameter of the ACL insertion was 5.33 ± 0.40 mm and 2.68 ±0.11 mm.The bone tunnel was compatible with the graft in both groups.In the oval tunnel ACL reconstruction group,the cross sectional area of the femoral bone tunnel was 3.18 ± 0.09 mm2 and the cross sectional area of the tibial bone tunnel was 3.26 ± 0.15 mm2.In the round tunnel ACL reconstruction group,the corresponding measurements were 3.13 ± 0.10 mm2 and 3.11 ± 0.11 mm2 respectively.There was no significant difference between the two groups.Conclusion The shape of ACL insertion in rabbits is oval.Using the self-made oval tunnel dilator we have successfully built an oval tunnel ACL reconstruction animal model with a good compatibility between the bone tunnel and graft.This lays the foundation for further research in the future.
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Objective To investigate the correlation between coronary lesions with serum cystatin C (Cys C)and vascular endothelial function(RHI)in the patients with coronary heart disease(CHD).Methods A total of 318 patients receiving coronary angiography(CAG)were selected as the research subjects and divided into the control group(65 cases)and CHD group;then the CHD group was divided into the single-vessel lesion group(77cases),double-vessel lesions group(70c ases),multiple-vessel lesions group(106 cases)according to CAG and the number of disease vessels;the CHD group was re-divided into the low score group(67 cases),middle score group(107 cases)and high score group(79 cases)according to the Gensini score of coronary artery lesions.The vascular endothelial function was evaluated by using peripheral arterial tension (PAT)measurement technique.The reactive hypere-mia index(RHI)was calculated;serum Cys C level was determined by immunoturbidimetry.Results The serum Cys C level was in-creased and RHI level was reduced as the number of lesion vessels increasing,the inter-group comparison showed the statistical difference (P 0.05);the serum Cys C level was increased as the Gensini score increasing,the difference between the groups had statistical significance (P <0.05);the vascular RHI value was reduced as the coronary Gensini score increasing(P <0.05);moreover the Cys C level was positively correlated with the Gensini score (r=0.375,P <0.01);RHI was negatively correlated with corornary Gensi-ni score (r=-0.587,P <0.01 );the serum Cys C was negatively correlated with RHI(r =-0.350,P <0.01 ).Conclusion The vascular endothelial dysfunction and serum Cysc C level increase are associated with coronary lesions in CAD patients,moreover Cys C is negatively correlated with vascular RHI,serum Cys increase may be a predictive index for vascular endothelial function damage in CHD patients.
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<p><b>OBJECTIVE</b>To determine the origin and pathogenicity of a chromosomal aberration for a fetus and analyze the possible mechanism.</p><p><b>METHODS</b>The karotypes of the fetus and its parents were analyzed with routine G-banding. Their genomic DNA was also analyzed with array comparative genomic hybridization (aCGH).</p><p><b>RESULTS</b>No karyotypic abnormality was detected at cytogenetic level for the fetus and its parents. aCGH has identified a de novo 2.04 Mb deletion at 6q27 in the fetus. The region involves candidate genes responsible for structural brain abnormalities. The area flanking the chromosomal breakpoint contains a 2410 bp sequence rich in palindromes which can form stable secondary structures.</p><p><b>CONCLUSION</b>The de novo 6q27 deletion is pathogenic. The 6q27 deletion may be responsible for the structural brain abnormalities in the fetus. The palindrome sequence flanking the chromosomal breakpoint may be involved the formation of the 6q27 deletion.</p>
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Adult , Female , Humans , Pregnancy , Chromosome Deletion , Chromosomes, Human, Pair 6 , Comparative Genomic Hybridization , Genetic Testing , Prenatal DiagnosisABSTRACT
<p><b>OBJECTIVE</b>To determine the origin of chromosomal aberration in a boy with mental retardation and multiple congenital malformations.</p><p><b>METHODS</b>The karotypes of the proband and his parents were analyzed with conventional G-banding. Their genomic DNA was analyzed with array comparative genomic hybridization (aCGH).</p><p><b>RESULTS</b>No karyotypic abnormality was detected in the proband and his parents. aCGH has identified a de novo 405 kb deletion at 9q34.3 in the proband, which encompassed the EHMT1 gene and part of CACNA1B gene.</p><p><b>CONCLUSION</b>The de novo 9q34.3 deletion probably underlies the mental retardation and development delay in the boy. EHMT1 may be one of the key genes responsible for 9q34.3 microdeletion syndrome.</p>
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Child , Humans , Male , Chromosome Banding , Chromosome Deletion , Chromosomes, Human, Pair 9 , Genetics , Comparative Genomic Hybridization , Craniofacial Abnormalities , Genetics , Heart Defects, Congenital , Genetics , Histone-Lysine N-Methyltransferase , Genetics , Intellectual Disability , Genetics , KaryotypingABSTRACT
<p><b>OBJECTIVE</b>To screen potential mutations of PRRT2 gene in a Chinese family affected with paroxysmal kinesigenic dyskinesia (PKD).</p><p><b>METHODS</b>Polymerase chain reaction, DNA sequencing and restriction endonuclaese analysis were used to analyze all members of the family.</p><p><b>RESULTS</b>A heterozygous mutation c.649dupC was identified in the PRRT2 gene in all patients, while no similar mutation was found in healthy members from the family.</p><p><b>CONCLUSION</b>The c.649dupC mutation of the PRRT2 gene probably underlies the PKD in this family. Prenatal diagnosis can reduce the risk for further birth of affected children for this family.</p>
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Adult , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Young Adult , Asian People , Genetics , Base Sequence , China , DNA Mutational Analysis , Dystonia , Genetics , Frameshift Mutation , Membrane Proteins , Genetics , Molecular Sequence Data , Nerve Tissue Proteins , GeneticsABSTRACT
Objective To study the gene mutation of a Chinese family with Alport syndrome and to perform preimplantation genetic diagnosis before embryo implantation.Methods Next generation sequence analysis was done for checking COL4A3,COL4A4 and COL4A5 genes in the Alport syndrome family members.Array comparative genomic hybridization(CGH) was used to detect the embryos.Results A mutation c.2605G ＞ A was found and identified in COL4A5 gene of all of the Alport syndrome patients in the family,but COL4A3 and COL4A3 genes were normal in all of the detected people.After searching for the mutation database,the mutation c.2605G ＞ A of COL4A5 gene was related to the X-linked dominant Alport syndrome.Three embryos were detected by using the preimplantation genetic diagnosis.Among these embryos,there were two male and one female.One of the male embryos was chromosomal aneuploidy,which was 45,XY,-16 and the other was normal.This normal embryo was implanted,and after 20 weeks the prenatal amniocentesis diagnosis approved that the fetus was normal.Conclusions The mutation of COL4A5 gene (c.2605 G ＞ A) is the cause of Alport syndrome in this family,which indicates that next generation sequence analysis proves to be an accurate and rapid method to detect Alport syndrome disease.Meanwhile array CGH can be used to reduce birth rates as a useful preimplantation genetic diagnosis method.