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Objective:To investigate the factors associated with delay in anticoagulant therapy in patients with cerebral venous sinus thrombosis (CVST) and its effect on outcome.Methods:Patients with CVST admitted to Changhai Hospital, Naval Medical University from January 2010 to August 2021 were retrospectively enrolled. Patients were divided into early anticoagulation group and late anticoagulation group by the median time interval from first symptom to initiation of anticoagulation. The modified Rankin Scale was used for outcome assessment at 90 d after onset. 0-2 scores were defined as good outcome and 3-6 were defined as poor outcome. Demographic and clinical data were compared for the early versus late anticoagulation group and for the good versus poor outcome groups. Multivariable logistic regression was used to identify independent influencing factors of delay in anticoagulation and the correlation of delay in anticoagulation with poor outcome. Results:A total of 131 patients were included, their age was 40.07±15.11 years old, and 68 (51.91%) were male. Of these, 65 patients (49.62%) were in the early anticoagulation group and 14 (10.69%) were in the poor outcome group. Compared with the late anticoagulation group, the early anticoagulation group had a significantly higher proportion of patients with seizures and brain parenchymal damage as well as higher D-dimer levels on admission, while the proportion of patients with visual impairment/papilloedema was significantly lower (all P<0.05). Compared with the good outcome group, the poor outcome group had significantly higher proportions of patients with seizures, dyskinesia, impaired consciousness, low Glasgow Coma Scale score, and brain parenchymal damage as well as higher D-dimer, total cholesterol and low density lipoprotein cholesterol levels, sites of thrombus involvement were more common in the superior sagittal and straight sinuses, and significantly lower proportions of patients with headache and lower albumin levels on admission (all P<0.05). Multivariate logistic regression analysis showed that visual impairment/papilloedema (odds ratio [ OR] 0.119, 95% confidence interval [ CI] 0.030-0.473; P=0.002) and brain parenchymal damage ( OR 1.341, 95% CI 1.042-1.727; P=0.023) were independently associated with a delay in anticoagulation treatment, and a delay in anticoagulation treatment ( OR 6.102, 95% CI 1.185-30.504; P=0.030) and D-dimer level on admission ( OR 1.299, 95% CI 1.141-1.480; P<0.001) were the independent predictors of poor outcome in patients with CVST. Conclusions:Visual impairment/papilloedema and absence of brain parenchymal damage on cranial imaging are the independent risk factors for delay in anticoagulation in patients with CVST. The delay in anticoagulation is strongly associated with the poor outcome in patients with CVST.
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Objective To explore the effect of the clinical case oriented management model on nurses comprehensive ability, psychological and critical mind. Methods In 2014 on the implementation ofroutine clinical case management modelas the control group, collected 97 cases of clinical cases. In 2015 on the implementation ofthe clinical case oriented management modelas the observation group, collected 110 cases of clinical cases. Compared two methods of management to improve the nurse management theoretical knowledge, clinical practice ability and deal with the size of the case skills help. When/after clinical special case found the influence for nurses, including psychology, work in the nursing work will, enthusiasm, independent ability to deal with related cases and the nurse critical thinking ability, etc. Results The proportion of the nurses thought that it was helpful to improve the management of theoretical knowledge, clinical practice ability and deal with the size of the case skills and the case analysis of satisfaction were 98.79%(244/247), 99.19%(245/247), 98.79%(244/247), 99.60%(246/247) in the observation group, and 88.57%(217/245), 87.35%(214/245), 87.76%(215/245), 90.61%(222/245) in the control group. The differences were statistically significant (χ2=21.390-27.571, P < 0.01). The proportion of the nurse considered that special case on the psychological effects of nursing work, engaged in the willingness and enthusiasm were the main factor were 15.79%(39/247), 13.77%(34/247), 11.34%(28/247) in the observation group, and 31.84%(78/245), 31.02%(76/245), 30.61%(75/245) in the control group. The differences were statistically significant (χ2=17.475, 21.097, 27.611, P < 0.01). After special case, the percentage of nurses to independently handle the case, help others, loss rates were 97.57%(241/247), 2.02% (5/247), 0.40% (1/247) in the observation group, and 85.71% (210/245), 12.24% (30/245), 2.04% (5/245) in the control group. The proportion of nurses to independently handle the case in the observation group was higher than that in the control group, but the ratio of nurses to help others, loss rates in the observation group were lower than those in the control group, the differences were statistically significant (χ2=22.647, P<0.01).Critical thinking score, the observation group of nurses in the search for truth, open mind, analytical ability, system organization, judging thinking self-confidence, curiosity, cognitive maturity, such as total score were respectively (43.24±4.01), (43.03±4.12), (47.66±4.23), (44.21± 3.92), (44.00 ± 4.97), (52.13 ± 4.44), (48.23 ± 4.85), (319 ± 14.57) points. The control group nurses were respectively (39.00±3.56), (38.90±3.28), (43.65±2.47), (40.55±1.99), (39.00±3.40), (47.87±4.01), (41.89± 5.11), (292.23 ± 6.02) points. The differences were statistically significant(t =12.15-24.19, P < 0.01). Conclusions The clinical case oriented management model can improve nurses comprehensive ability, reduce the adverse impact of the special case for nurses, improve the clinical nurses' critical thinking ability, to ensure patient safety.
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Objective To explore the effect of head nurses′tutoring and commenting on nursing ward round. Methods The nursing ward rounds performed during August 2013 to July 2014 were assigned as the control group and those nursing ward rounds during August 2014 to August 2015 as observation group: in the former group routine nursing ward rounds were done once a week and in the latter the rounds were performed by head nurses′tutoring and commenting once every week. The two groups were compared in terms of examination performances of nursing ward rounds, doctors′ and nurses′ satisfaction degree, nurses′ and student nurses′evaluation on the ward rounds and their critical thinking ability. Results The examination performances and the satisfaction degree in the observation group were significantly higher than those of the control group (P<0.05). The nurses in the observation group thought the head nurse′s commenting at ward rounds could be more effective than those from the control group in their improvement of theoretical knowledge and clinical ability (P<0.05). In terms of critical thinking by California Critical Thinking Disposition Inventory-Chinese Version), the total score and the scores on its dimensions in the observation group were significantly higher than those of the control group. Conclusion The nursing ward rounds by head nurses′tutoring and commenting can help the nurses to strengthen their ability in nursing ward rounds and improve their theory and clinical practice so that the nursing quality is improved.
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<p><b>OBJECTIVE</b>To study the methylation changes in promoter CpG islands induced by low-dose X-ray radiation (LDR).</p><p><b>METHODS</b>Twenty male BALB/c mice were randomly divided into control and fractionated radiation group exposed to 6 MV X-ray for 10 days (0.05 Gy/day). All the mice were sacrificed 2 h after the last radiation on day 10, and blood samples were collected for detecting DNA methylation changes using Roche-NimbleGen mouse DNA methylation 3×720K Promoter Plus CpG Island Array. MeDIP-qPCR was used to further validate the methylation status of specific genes.</p><p><b>RESULTS</b>A total of 811 genes were found to show specific hypermethylation in fractional radiation group as compared with the control group, involving almost all the main biological processes by GO analysis. Eight candidate genes (Rad23b, Tdg, Ccnd1, Ddit3, Llgl1, Rasl11a, Tbx2, and Slc6a15) were confirmed to be hypermethylated in LDR samples by MeDIP-qPCR, consistent with the results of the methylation chip study.</p><p><b>CONCLUSION</b>LDR induces promoter hypermethylation on specific genes, which may contribute to radiation-induced pathogenesis.</p>
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Animals , Male , Mice , CpG Islands , Radiation Effects , DNA Methylation , Dose-Response Relationship, Radiation , Genome , Mice, Inbred BALB C , X-RaysABSTRACT
Objective The invasion and metastasis of colon cancer often leads to treatment failure and mortality in patients . Our research is to investigate the influence of FoxM 1 to malignant human colon cancer line . Methods In two human colon cancer lines, the protein and mRNA expression levels of FoxM 1 were analyzed with the application of RT-PCR and Western blot , from which high-expressed HT-29 and low-expressed HCT-116 were determined.The expression of FoxM1 was down-regulated by RNA interfering in HT-29 and up-regulated by constructing overexpression transgenic line in HCT-116.The proliferation of the above cells was assayed by healing method;while the metastasis and invasion ability were examined by Transwell chamber assay . Results Two colon cancer lines were selected with high-expression or low-expression of FoxM1 separately named HT-29 and HCT-116.Application of PEX-2-FoxM1 raised after HCT-116 cells express FoxM1, cell scratches in HCT-116 experimetal group ([70.92 ±1.48]%) compared with HCT-116 control group([16.92 ±4.05]%)and HCT-116 blank control group([16.66 ±2.63]%) will markedly enhance its capabil-ity of healing (P<0.05), Transwell Chambers in membrane cells in HCT-116 experimetal group (186.0 ±6.8) compared with HCT-116 control group(42.0 ±2.0) and HCT-116 blank control grou (37.0 ± 2.2)was increased (P<0.05).On the other hand, the applied pG-PH-shFoxM1 can reduce FoxM1 expression in HT-29 cell, cell scrat-ches healing ability in HT-29 experimetal group ( [ 10 .37 ± 3.86]%) compared with HT-29 control group([34.63 ±2.35]%)and HT-29 blank control group([67.36 ±2.61]%) decreased significantly (P<0.05), Transwell Chambers in membrane cells in HT-29 experimetal group (53.0 ±1.8)compared with HT-29 control group(95.0 ±2.2)and HT-29 blank control grou(118.0 ±4.0) was also reduced (P<0.05). Conclusion The expression of FoxM1 is in close relation to the invasion and metastasis of CRC .The fact that the siRNA interfering FoxM1 could effectively inhibit the proliferation, metastasis and invasion, suggesting FoxM1 could po-tentially be a new molecular target for inhibiting the proliferation of human colon cancer line .
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Objective To study the whole genome DNA methylation changes induced by low dose radiation (LDR) in mouse,and mRNA expression profiles of DNMT1 and MBD2 in peripheral blood mononuclear cell (PBMC) and tissues.Methods Thirty male BALB/c mice were randomly divided into 3 groups:control,single exposure (0.5 Gy),and fractionated exposure of 6 MV X-rays for 10 d (0.05 Gy/d × 10 d).Control mice were sham-treated.To determine the immediate (early) effect of irradiation,15 mice (5/group) were sacrificed 2 h after the last irradiation.The other 15 mice were sacrificed 1 month after the last irradiation (delayed effect).Before sacrifice,blood was sampled immediately.Kidney,liver,spleen,brain and lung tissues were collected.A global DNA methylation quantification Kit and highperformance liquid chromatography (HPLC) were used to investigate the methylation level in blood DNA.The expressions of DNMT1 and MBD2 were determined by RT-PCR.Results For the early effects of irradiation,as compared with controls,fractionated exposure to X-ray irradiation led to the significant depression of global DNA methylation level in blood (t =10.19 and 8.93,P ＜ 0.05).DNMT1 and MBD2 mRNA were down-regulated in PBMC,kidney and liver (t =5.06,3.01,3.97,12.25,3.50 and 3.73,P ＜0.05),and MBD2 was also down-regulated in spleen (t =3.03,P ＜ 0.05).However,no changes were observed in single exposed group.As for the delayed effects,the methylation levels of blood were not changed in the single or fractionated exposed groups,and only MBD2 mRNA was down-regulated in PBMC and brain of fractionated exposed group (t =3.52 and 2.85,P ＜ 0.05).Conclusions Fractionated LDR exposure can induce genome DNA hypomethylation,which is tissue-specific,and may be related with down-regulation of DNMT1 and MBD2.