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Clinical expertise, patient preference, and the best evidence are the three elements of evidence-based medicine. Based on high-level and high-quality evidence, qualitative and quantitative analysis of the prescribing decisions of physicians is beneficial to improving clinical efficacy. A mature methodological system is available for the retrieval, analysis, summary, evaluation, and recommendation of the evidence, but there are still few studies on physicians' prescribing decisions. How to analyze the trend of physicians' prescribing decisions based on the priority ranking in addition and subtraction of prescriptions? Analytic hierarchy process(AHP) is a method for decision making, which arranges the elements of the decision problem into overall goal, criteria, and operational sub-criteria, and uses the matrix eigenvector method to solve the problem. This study aims to analyze the priority of physicians' prescribing decisions for diabetes mellitus with deficiency of both Qi and Yin based on AHP. To be specific, a database of diabetes mellitus cases with deficiency of both Qi and Yin was established and AHP was used to yield the priority ranking of Chinese patent medicine prescriptions in specific clinical scenarios. In the selected cases of diabetes mellitus with deficiency of both Qi and Yin, Xiaoke Pills was the best prescription for the treatment of type 2 diabetes mellitus(deficiency of both Qi and Yin)(normalized=0.388), followed by Liuwei Dihuang Pills(normalized=0.269), Qishen Capsules(normalized=0.230), and Shengmai Injection(normalized=0.113). According to the analysis the available data, for type 2 diabetes mellitus(deficiency of both Qi and Yin), Xiaoke Pills was the most effective prescription in specific scenarios. When the physicians' prescribing decisions are consistent with the evidence, quantitative analysis of physicians' cognition will boost the evidence-based medical decision-making. However, the research results are also affected by the quality of literature, evidence level and priority, which are thus have some limitations. It is recommended that further small data research based on individual cases be carried out to lay a evidence-based basis for the clinical decision-making of type 2 diabetes mellitus.
Subject(s)
Humans , Analytic Hierarchy Process , China , Diabetes Mellitus, Type 2/drug therapy , Drug Prescriptions , Medicine, Chinese Traditional , Nonprescription Drugs/therapeutic use , Qi , Syndrome , Yin Deficiency/drug therapyABSTRACT
OBJECTIVE@#To compare the femoral and tibial tunnel positions of anterior cruciate ligament reconstruction using the modified transtibial (MTT) technique and anteromedial (AM) portal technique.@*METHODS@#Between January 2017 and September 2020, 78 patients with anterior cruciate ligament rupture underwent single-bundle reconstruction with the modified transtibial technique in 39 cases (group MTT) and through anteromedial approach in 39 cases (group AM). There were 25 males and 14 females in group MTT, with an average age of (37.0±2.3) years old; 27 males and 12 females in group AM, with an average age of (37.5±2.2) years old. CT scan of the affected knee was conducted one week after the surgery to measure and compare the femoral tunnels positioning (Fx, Fy), tibial tunnels positioning in the frontal plane(Tx1), tibial tunnels positioning in the sagittal plane (Ty1), and tibial tunnels positioning in the axial plane (Tx2, Ty2) in patients undergoing anterior cruciate ligament reconstruction through Mimics software.@*RESULTS@#Three-dimensional CT reconstruction after the surgery showed that the average Fx and Fy were(25.2±2.1)% and (34.9±3.0)% respectively and the Tx1 and Ty1 were (45.5±3.3)% and (44.7± 3.0)% respectively, while the Tx2 and Ty2 were (47.0±3.0)% and (39.9±4.2)% respectively in group MTT. In group AM, the average Fx and Fy were (26.0±2.0)% and (36.1±3.9)% respectively and the Tx1 and Ty1 were (46.5±3.1)% and (45.6± 3.1)% respectively, while the Tx2 and Ty2 were (47.4±2.5)% and (39.6±3.9)% respectively. There were no statistically significant differences in the femoral and tibial tunnels between the two groups (@*CONCLUSION@#Both the MTT and AM technique can achieve good anatomical positioning of the femoral and tibial tunnels, without significant differences in the positioning of the bone tunnels.
Subject(s)
Adult , Female , Humans , Male , Anterior Cruciate Ligament/surgery , Anterior Cruciate Ligament Injuries/surgery , Anterior Cruciate Ligament Reconstruction , Femur/surgery , Knee Joint/surgery , Software , Tibia/surgery , Tomography, X-Ray ComputedABSTRACT
Objective · To investigate the micro/ nano structure of human vaginal wall acellular matrix, and provide parameters for bionic vagina.Methods · A total of 35 vaginal specimens were obtained from 35 postmenopausal patients who underwent cystocele repair and/or rectocele repair.Cells in specimens were entirely removed, and the extracellular matrix was maintained. Then the acellular matrix was observed by general observation,H-E staining, Masson staining, scanning electron microscope and Micro-CT. The external and internal structure properties were measured and analyzed.Results · All cells in 35 vaginal specimens were totally removed. The vaginal wall acellular matrix was a double-layer fibrous reticular structure composed of interlaced collagen fibers, which were further arranged into bundles. Pores were distributed among fiber bundles. Epithelial side structure of vaginal wall acellular matrix was dense and subepithelial tissue was loose. There was no significant difference in fiber diameter [(82.4±9.3) nm vs (87.5±10.2)nm, P=0.432] and fiber bundle thickness [(67.6±9.3) μm vs (65.3±5.2) μm, P=0.634] between the dense and loose layers. Fiber bundle separation [(180.1±24.5) μm vs (118.2±23.0) μm, P=0.003] and total porosity [(77.1±4.2)% vs (66.6±2.8)%, P=0.002] were higher in loose layer. There was no significant difference in the micro/nano structure parameters of the acellular matrix between the anterior vaginal wall and the posterior vaginal wall.Conclusion · There was no significant difference in the fiber diameter and the fiber bundle thickness between the dense layer and the loose layer of vaginal wall acellular matrix, but the porosity of the dense layer fiber bundle was smaller than that of the loose layer.
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Objective · To investigate the micro/ nano structure of human vaginal wall acellular matrix, and provide parameters for bionic vagina.Methods · A total of 35 vaginal specimens were obtained from 35 postmenopausal patients who underwent cystocele repair and/or rectocele repair.Cells in specimens were entirely removed, and the extracellular matrix was maintained. Then the acellular matrix was observed by general observation,H-E staining, Masson staining, scanning electron microscope and Micro-CT. The external and internal structure properties were measured and analyzed.Results · All cells in 35 vaginal specimens were totally removed. The vaginal wall acellular matrix was a double-layer fibrous reticular structure composed of interlaced collagen fibers, which were further arranged into bundles. Pores were distributed among fiber bundles. Epithelial side structure of vaginal wall acellular matrix was dense and subepithelial tissue was loose. There was no significant difference in fiber diameter [(82.4±9.3) nm vs (87.5±10.2)nm, P=0.432] and fiber bundle thickness [(67.6±9.3) μm vs (65.3±5.2) μm, P=0.634] between the dense and loose layers. Fiber bundle separation [(180.1±24.5) μm vs (118.2±23.0) μm, P=0.003] and total porosity [(77.1±4.2)% vs (66.6±2.8)%, P=0.002] were higher in loose layer. There was no significant difference in the micro/nano structure parameters of the acellular matrix between the anterior vaginal wall and the posterior vaginal wall.Conclusion · There was no significant difference in the fiber diameter and the fiber bundle thickness between the dense layer and the loose layer of vaginal wall acellular matrix, but the porosity of the dense layer fiber bundle was smaller than that of the loose layer.
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BACKGROUND:We explore the transfection effects of different lentiviruses on bone marrow mesenchymal stem cells (BMSCs) from the same source in order to screen out appropriate cell transfection tools.OBJECTIVE:To explore the difference in the transfection efficiency of three different lentiviruses carrying green fluorescent protein (GFP) to transfect the rabbit BMSCs.METHODS:Bone marrow samples were extracted from the ilium of 2-week-old Japan white rabbits,and then the BMSCs were separated,purified and extended using density gradient centrifugation.Cell surface markers were identified using flow cytometry.pTomo-GFP lentivirus,Ad-GFP lentivirus and lenti-GFP lentivirus were used to transfect the BMSCs,and the transfection efficiency was tested using flow cytometry.The cell viability was detected using cell counting kit-8 before and after transfection.RESULTS AND CONCLUSION:As the positive rates of CD44,CD34 and CD45 were 75.64％,6.14％ and 9.48％,respectively,the cultured cells were identified as BMSCs by the flow cytometry.The expression levels of GFP after transfection by pTomo-GFP,Ad-GFP and ienti-GFP were 2.64％,16.72％ and 45.24％,respectively.The cell growth curve showed that pTomo-GFP lentivirus,Ad-GFP and ienti-GFP lentivirus showed certain effects on cell growth,pTomo-GFP and Ad-GFP had an effect on cell growth at incubation period and logarithmic growth phase at 1-8 days after transfection,which may cause some interference to the viability of early cells,ienti-GFP had little effect on cell growth in the short term,but there was a change in cell growth at day 12 after lenti-GFP transfection,and a long-term effect of lenti-GFP on cell viability was considered.Therefore,lenti-GFP lentivirus could highly transfect the BMSCs and could not impact the normal growth of BMSCs,indicating that lenti-GFP lentivirus is suitable for BMSCs tracing and gene transfection.
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Anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) is usually a multisystem disorder,and pulmonary renal syndrome is a common presentation.Patients with AAV are less likely to experience relapse when they progress to end-stage renal disease (ESRD).We report a rare case of diffuse alveolar hemorrhage (DAH) in relapsing AAV after eight years of haemodialysis.A 58-year-old woman was admitted to our hospital with the chief complaints of dyspnea and hemoptysis accompanied by anemia,fever,fatigue,and weight loss.She had elevated anti-myeloperoxidase (MPO) titer.The computer tomoghraphy showed diffuse alveolar hemorrhage.After the recurrent episode of AAV was diagnosed,she underwent the following therapy:Plasmapheresis was initiated within 24 h after admission,3 000 mL of plasma was removed per session,and the anticoagulation of citrate was applied during plasmapheresis.Five plasmapheresis treatments were performed,and after three apheresis sessions,the pulmonary hemorrhage ceased.Other treatments included a methylprednisolone bolus,tapered to oral prednisone and cyclophosphamide.Regular hemodialysis was scheduled.These treatments resulted in resolution of the inflammatory symptoms,DAH improved.Her anti-MPO level decreased.The patient was discharged in good condition.AAV with DAH is usually acute at the onset and is generally a condition with high morbidity and substantial mortality.Therefore,prompt diagnosis and aggressive treatment are needed to improve survival.
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Objective To provide reference for the cold chain of stored RBCs on the sea by evaluating both blood containers containing phase-changed materials and the quality of stored RBCs during transportation.Methods In order to simulate blood supply on the sea,we transported the stored RBCs on land(100 min),on the sea(45 h)and stored them on the sea for another 7 days.The free hemoglobin(Hb), lactate dehydrogenase(LDH), and concentrations of K +and Na+were measured.Results The temperature of the blood container containing phase-changed materials rose from 4.1℃to 9.5℃.The contents of free Hb,K+and LDH were increased to(0.083 ±0.032)g/L,(15.097 ±1.791)mmol/L, and(106.00 ±17.83)U/L,respectively.During blood storage,the contents of the above three indices were increased to (0.111 ±0.035)g/L,(27.238 ±3.509)mmol/L and(227.00 ±111.94)U/L, while Na +decreased to(113.63 ± 4.012)mmol/L.Conclusion The temperature of the blood container containing phase-changed materials can be maintained at a constant temperature under more complicated environmental conditions,and the quality of the stored RBCs can be ensured.RBCs stored on the sea for more than 7 days are damaged more seriously than those stored on land.
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The plague occurs due to the long-term persistence of Yersinia pestis in natural environment.During the period of plague epidemic and quiescence,there are still some unknown scientific questions,such as where Yersinia pestis preserved,which mode preserved,and which mechanism caused plague epidemic.Thus,the researches on the preservation and viability of Yersinia pestis in every ecological element of plague natural foci will contribute to find the pattern for the occurrence and spread of plague.
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OBJECTIVE: To observe the effect of crotonaldehyde exposure on lung injury in male rats,and to explore the mechanism of toxic action. METHODS: Specific pathogen free healthy adult male Wistar rats were randomly divided into 4groups with 10 rats in each group: a control group and low-,medium- and high-dose groups. Rats were treated with 0. 00,2. 11,4. 22,8. 44 mg / kg body weigh crotonaldehyde by intra-gastric administration,once per day for 25 consecutive days.After the last treatment,rats were secrificed and the lung was isolated. Lung organ coefficients were calculated and the pathologic changes in lung tissues were observed. The levels of interferon( IFN)-γ,interleukin( IL)-1 β,IL-4,IL-6 and tumor necrosis factor( TNF)-α in lung tissue were determined by enzyme-linked immunosorbent assay. RESULTS: The lung tissue in both the medium- and high-dose group showed early inflammatory pathological changes with alveolar structure damage,interval widened and inflammatory cell infiltration,congestion,bronchiolar epithelial hyperplasia,visible red blood cells and inflammatory cells infiltration. The changes in the high-dose group were more severe than that in the medium-dose group. The lung organ coefficient and the levels of IFN-γ,IL-1 β,IL-4,IL-6,TNF-α in lung tissue were increased in dose-effect relations( P < 0. 01). CONCLUSION: Crotonaldehyde can increase the level of inflammatory factors in the lung tissues of rats,causing inflammatory injury of lung tissue.
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<p><b>OBJECTIVE</b>To evaluate the application of different variable number tandem repeats (VNTR) locus in genotyping of Mycobacterium tuberculosis (M.tuberculosis) strains isolated from eight provinces in China, and to find the suitable locus-set of VNTR for epidemical strains in China.</p><p><b>METHODS</b>All 140 M.tuberculosis strains were randomly selected from 2800 M.tuberculosis strains isolated from eight provinces in China, 27 VNTR loci were used for typing all isolates. Discriminatory power (Hunter-Gaston Index, HGI) of every locus and different locus-set were analyzed by BioNumerics software. Meanwhile, Spoligotyping was used to identify Beijing family and non-Beijing family. Then the HGI of different locus-sets in two families was also evaluated.</p><p><b>RESULTS</b>All 140 isolates were clustered into Beijing kindred (112 strains, 80%) and non-Beijing kindred (28 strains, 20%) by Spoligotyping. The discriminatory power of Spoligotyping in 140 isolates was 0.4589. Every locus showed different polymorphism and HGI were from 0 to 0.809. The number of VNTR loci with HGI higher than 0.5 in all strains, Beijing family and non-Beijing family was 8, 7 and 14 respectively. 27 loci were combined into four groups which included 8, 12, 15 and 24 VNTR loci respectively. Four locus-sets showed different polymorphism, HGI of eight-locus, 12-locus, 15-locus, and 24-locus set in 140 strains was 0.9991, 0.9882, 0.9980 and 0.9986, and their discriminatory power were calculated in Beijing kindred (HGI: 0.9987, 0.9318, 0.9969 and 0.9975) and non-Beijing kindred (HGI: 1, 0.9894, 1 and 1).</p><p><b>CONCLUSION</b>Different VNTR locus and locus-set showed different discriminatory power in the selected M.tuberculosis strains isolated from China. Eight-locus set can be used in molecular epidemiological study of M.tuberculosis in China after standardization.</p>
Subject(s)
Bacterial Typing Techniques , DNA, Bacterial , Genetics , Mycobacterium tuberculosis , Classification , Genetics , Tandem Repeat SequencesABSTRACT
<p><b>OBJECTIVE</b>To investigate class I integrons and integrated gene cassettes in metalloenzyme-producing Pseudomonas aeruginosa.</p><p><b>METHODS</b>A total of 68 isolated clinical strains of Pseudomonas aeruginosa were subjected to PCR analysis with primers specific for bla(IMP-1) and bla(VIM). The positive strains then underwent examination for class I integrons and integrated gene cassettes with PCR with primers specific to class I integrase ((IntI)1) and integrated gene cassettes, followed by sequence analysis for some of the positive strains.</p><p><b>RESULTS</b>Only 1 isolated strain showed positive results for both bla(IMP-1) and bla IntI1 detection. Fifty-five strains were positive for bla(VIM), including 26 positive for bla (IntI)1. Of the 26 bla (IntI)1-positive strains, only 18 contained integrated gene cassettes, which were classified into 5 types according to agarose gel electrophoresis.</p><p><b>CONCLUSION</b>It is the first time to identify IMP-1-producing Pseudomonas aeruginosa carring bla(Int)1 in West China. The class I integrons were widespread in these Pseudomonas aeruginosa and 69.2% of them carry the gene cassettes. These findings provide useful insights into the clinical spread of these drug-resistant genes.</p>
Subject(s)
Humans , Bacterial Proteins , Genetics , Metabolism , DNA, Bacterial , Genetics , Drug Resistance, Bacterial , Genetics , Electrophoresis, Agar Gel , Integrons , Genetics , Polymerase Chain Reaction , Pseudomonas Infections , Microbiology , Pseudomonas aeruginosa , Genetics , Species Specificity , beta-Lactamases , Genetics , MetabolismABSTRACT
To determine whether addition of vitamin C (Vit C) to single-unit plasma could influence the efficacy of inactivating viruses and could maintain the activity of plasma proteins by methylene blue (MB)-light treatment. Vesicular stomatitis virus (VSV) Indiana strain was used as the indicating virus. Human plasma containing VSV was added with different concentrations of Vit C and final concentration 1 micromol/L MB and irradiated by fluorescence at an intensity of 40,000 lx, samples were collected at different times for detection. Cytopathic effect was used to test the effect of virus inactivation. A segment of the nucleic acid encoding capsid protein of VSV was amplified with RT-PCR. Some methods, such as the Clauss method, the one-stage method, microimmunoelectrophoresis, were used to investigate the changes of plasma components. The results showed that when the VSV plasma was added with 240 micromol/L Vit C and treated by MB-light irradiation for 60 min, the titer of VSV decreased by more than 8 lg TICD50/ml. Meanwhile, target segment amplification of VSV was also negative. The recovery rates of fibrinogen and coagulation factor VIII (FVIII: C) were 83.55% and 81.67% respectively, which had significant difference comparing with the routine MB-fluorescent light treatment. Most of plasma proteins were not affected significantly. No change in immunogenicity of these proteins was observed by using microimmunoelectrophoresis. It is concluded that virus inactivation is not influenced and plasma proteins are effectively protected by Vit C. Vit C can be used as a protector and is beneficial to improving the quality of plasma subjected to MB- photodynamic treatment.
Subject(s)
Humans , Ascorbic Acid , Pharmacology , Blood Proteins , Metabolism , Light , Methylene Blue , Pharmacology , Plasma , Virology , Vesicular stomatitis Indiana virus , Virus InactivationABSTRACT
<p><b>BACKGROUND</b>There is a growing interest in studying the relationship between intrinsic resistance and biofilms resistance to drugs. However, the relationship still remains unclear in the macroscopic bacterial growth. Our study is to illuminate the change of bacterial drug resistance of gyrA mutant and active efflux pump during the development of Pseudomonas aeruginosa (P. aeruginosa) biofilms.</p><p><b>METHODS</b>The strains of type II topoisomerase gene mutant (gyrA mutant) and multidrug resistance (MDR) efflux pump were clinical isolates and detected by polymerase chain reaction (PCR). The process of bacterial biofilms development was observed by scanning electron microscope. Triparental mating experiments were performed to transfer report gene of green fluorescent protein (GFP) into P. aeruginosa biofilms strains and followed by analysis of bacterial survival rate between intrinsic resistance and biofilms resistance.</p><p><b>RESULTS</b>The fluorescent strains with pGFPuv could develop mature biofilms on Teflon surface. Before a period of 72 hours, the survival rate of biofilms bacteria and intrinsic resistance strains in ciprofloxacin solution was significantly different (P < 0.05). The survival number of intrinsic resistance strains (gyrA mutation and active efflux pump) was illustriously higher than biofilm strain in the initial stage of biofilms development. After 72 hours incubation, there was no clearly difference between mutants and biofilms strains in the survival rate (P > 0.05). The carbonyl cyanide m-chlorophenylhydrazone and azithromycin could significantly reduce the drug resistance of biofilm strains and efflux pump strains.</p><p><b>CONCLUSIONS</b>In the development of P. aeruginosa biofilms, the strains of gyrA mutation and MDR efflux could be conferred with new level of drug resistance. When co-cultured mutated strains with biofilm strains, biofilms may play a major role in bacterial resistance. But after 72 hours incubation (a mature biofilms had been developed), there was no clearly difference between the number of mutant strains and biofilm strains.</p>
Subject(s)
Biofilms , Carbonyl Cyanide m-Chlorophenyl Hydrazone , Pharmacology , Ciprofloxacin , Pharmacology , DNA Gyrase , Genetics , Drug Resistance, Bacterial , Mutation , Pseudomonas aeruginosa , GeneticsABSTRACT
<p><b>OBJECTIVE</b>To study the antiviral effect and mechanisms of the liquid extract from Ceratostigma willmattianum against herpes simplex virus type 1 (HSV-1) in vitro.</p><p><b>METHOD</b>C. willmattianum in various concentration was applied to different steps of HSV-1 replication cycle. 50% Tissue culture infective dose (TCID50), cytopathic effect (CPE), MTT staining method, dot blotting and Northern blotting analysis were used to estimate index of antiviral activity.</p><p><b>RESULT</b>50% Toxic concentration (TC50) was 1077 mg x L(-1), IC50 29.46 mg x L(-1) and therapeutic index (TI) 36.56 in C. willmattianum. TC50 330 mg x L(-1), 50% Inhibiting concentration (IC50) 9.12 mg x L(-1) and TI 36.18 in ACV by MTT staining method. The liquid extract from C. willmattianum had remarkable effect on inhibiting HSV-1 in vitro. Ceratostigma could interfere absorption of HSV-1 to Vero cells to prevent HSV-1 infectivity, inhibit HSV-1 gD DNA replication and HSV-1 gD mRNA expression.</p><p><b>CONCLUSION</b>C. willmattianum possesses strong anti-HSV-1 activity in vitro. The antiviral mechanisms are related to inhibiting virus absorption, HSV-1 gD gene replication and HSV-1 gD gene transcription.</p>