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Objective:To evaluate the value of preoperative peripheral blood neutrophil-lymphocyte ratio (NLR) and blood platelet-lymphocyte ratio (PLR) and immune indexes in the evaluation of the prognosis of cervical cancer patients.Methods:The clinical data of 283 patients with cervical cancer who underwent radical surgery in Shanxi Province Cancer Hospital from May 2017 to September 2018 were retrospectively analyzed, and 100 healthy people who underwent physical examination during the same period were collected as the healthy control group. Test results of blood cells and immune cells expressions of all subjects were collected. Peripheral blood NLR and PLR of cervical cancer patients, people in the healthy control group and cervical cancer patients with different pathological characteristics were compared. Kaplan-Meier method was used to make survival analysis and Cox regression risk model was used to analyze the factors influencing the prognosis of patients with cervical cancer.Results:The preoperative peripheral blood NLR and PLR in patients with cervical cancer was higher than that of the healthy control group (NLR: 2.53±1.35 vs. 2.00±1.21, t = 5.35, P < 0.001; PLR: 163±57 vs.144±38, t = 4.71, P = 0.006). Pathological results showed that there were no statistically significant differences in NLR and PLR in peripheral blood of cervical cancer patients with different pathological types, tumor diameter, vascular invasion, and nerve invasion (all P > 0.05), while there were statistically significant differences in NLR and PLR in peripheral blood of cervical cancer patients with different clinical staging and muscle wall invasion (all P < 0.05). When the proportions of the expression levels of preoperative CD3 positive cells, CD4 positive cells, CD8 positive cells, CD19 positive cells, CD56 positive cells, and CD127 positive cells were 60%-85%, 30%-40%, < 25%, 8%-15%, 15%-25% and < 5%, respectively, the overall survival of cervical cancer patients was the best. Univariate analysis showed that pathological type, clinical staging, vascular invasion, preoperative NLR, preoperative PLR,CD3 positive cells, CD4 positive cells, CD8 positive cells, CD19 positive cells, CD56 positive cells and CD127 positive cells were influencing factors of the overall survival of cervical cancer patients (all P < 0.05). Multivariate analysis showed that clinical staging, vascular invasion, preoperative NLR, preoperative PLR, and preoperative CD4 positive cells were independent influencing factors for the overall survival of cervical cancer patients (all P < 0.05). Conclusions:Preoperative high NLR and PLR in peripheral blood have a certain impact on the clinicopathological characteristics and poor prognosis of cervical cancer patients. When the immune cells in peripheral blood are in dynamic balance, the prognosis of cervical cancer patients is the best.
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Objective:To investigate the efficacy of dexmedetomidine combined with transversus abdominis plane block in laparoscopic radical resection of colorectal cancer and its effect on serum CXCL8 level.Methods:A total of 72 patients who planned to undergo laparoscopic radical resection of colorectal cancer in Changzhou Hospital of Traditional Chinese Medicine from March 2017 to March 2021 were selected as the research subjects, and they were divided into transversus abdominis plane block anesthesia group (group A) and dexmedetomidine combined with transversus abdominis plane block anesthesia group (group B) by random number table method with 36 cases in each group. The operation time, intraoperative blood loss, fluid supplementation, visual analogue score (VAS) and Ramsay sedation score at different times after operation, and serum CXCL8 level after operation were compared between the two groups of patients. The adverse reactions of the two groups of patients were compared.Results:There was no significant difference in operation time and fluid supplementation between the two groups (both P > 0.05). The VAS scores of patients in group B at 4, 8 and 24 hours after operation were lower than those in group A [(2.8±0.6) points vs. (4.2±1.2) points, (2.1±1.0) points vs. (3.4±1.1) points, (1.8±0.4) points vs. (2.5±0.7) points, all P < 0.05], and the Ramsay sedation scores of patients in group B at 4, 8 and 24 hours after operation were higher than those in group A [(4.3±1.2) points vs. (2.7±0.7) points, (3.5±1.1) points vs. (2.2±1.0) points, (2.4±0.9) points vs. (1.6±0.6) points, all P<0.05]. Serum CXCL8 levels of patients in group B at 2, 24 and 48 hours after operation were lower than those in group A [(78±16) ng/ml vs. (87±19) ng/ml, (68±14) ng/ml vs. (75±15) ng/ml, (52±10) ng/ml vs. (61±13) ng/ml, all P<0.05]. The incidence rates of adverse reactions in group A and group B were 8.3% (3/36) and 13.9% (5/36), and the difference was not statistically significant ( P > 0.05). Conclusions:Dexmedetomidine infusion during laparoscopic radical resection of colorectal cancer under general anesthesia combined with transversus abdominis plane block can help reduce postoperative pain, increase sedative effect, and reduce serum CXCL8 level.
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Objective:To investigate the association between breast cancer and thyroid diseases, and to provide evidence for the prevention and treatment of thyroid diseases in breast cancer patients.Methods:A total of 511 newly diagnosed breast cancer patients were recruited between March 2018 and August 2019 from Shanxi Province Cancer Hospital, and 303 age-matched newly diagnosed breast benign disease patients and 341 age-matched healthy controls were recruited during the same time-frame. Thyroid B-ultrasound and thyroid function test were performed in the three groups. By reviewing the medical records, the general and clinicopathological data of the patients were collected, and the differences in the prevalence of thyroid diseases among the three groups were compared. The changes of thyroid function in breast cancer patients before treatment, in the middle stage of chemotherapy and at the end of chemotherapy were compared.Results:Among breast cancer group, breast benign disease group and healthy control group, the differences in the prevalence rates of hypothyroidism [32.5% (166/511), 25.7% (78/303) and 21.7% (74/341)], thyroid nodules [50.7% (259/511), 43.2% (131/303) and 41.6% (142/341)] and Thyroid Imaging Reports and Data System(TI-RADS) grade 4 and above thyroid nodules [15.4% (40/259), 14.5% (19/131) and 4.9% (7/142)] were statistically significant (all P < 0.05). The abnormal rates of thyroid stimulating hormone (TSH) and free thyroxine (fT4) in breast cancer group were higher than those in breast benign disease group and healthy control group [34.1% (174/511) vs. 26.1% (79/303), 23.5% (80/341); 24.9% (127/511) vs. 8.6% (26/303), 3.2% (11/341)], and the differences were statistically significant (both P < 0.05). The levels of fT4, free three iodide thyroxine (fT3), thyroid immunoglobulin antibody (TgAb) and thyroid peroxidase antibody (TPOAb) in breast cancer patients before treatment, in the middle stage of chemotherapy and at the end of chemotherapy were statistically different (all P < 0.05). The abnormal rates of fT4, TgAb and TPOAb in the last chemotherapy cycle were lower than those before chemotherapy [11.5% (59/511) vs. 24.9% (127/511), 5.1% (26/511) vs. 17.4% (89/511), 11.9% (61/511) vs. 20.4% (104/511)] in breast cancer patients, and the differences were statistically significant (all P < 0.001). Conclusions:The breast cancer is associated with thyroid diseases. Clinicians should pay more attention to the changes of thyroid diseases and thyroid function during the treatment and in the follow-up process of breast cancer patients, so as to detect the thyroid diseases early and carry out standardized treatment.
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OBJECTIVE@#To explore the genetic basis for a child with Rothmund-Thomson syndrome (RTS).@*METHODS@#The child has featured poikeloderma, short stature, cataract, sparse hair and skeletal malformation. Peripheral blood samples of the child and her family members were collected and subjected to whole exome sequencing. Candidate variants were verified by Sanger sequencing.@*RESULTS@#The child was found to harbor compound heterozygous variants of the RECQL4 gene, namely c.1048_1049delAG and c.2886-1G>A, among which c.2886-1G>A was unreported previously. According to the ACMG guidelines, the c.1048_1049delAG was predicted to be pathogenic (PVS1+PM3_Strong+PM2), while the c.2886-1G>A was predicted to be likely pathogenic (PVS1+PM2).@*CONCLUSION@#The compound heterozygous variants of the RECQL4 gene probably underlay the pathogenesis of RTS in this patient. Above finding has enriched the mutational spectrum of the RECQL4 gene.
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Child , Female , Humans , Family , Mutation , RecQ Helicases/genetics , Rothmund-Thomson Syndrome/genetics , Exome SequencingABSTRACT
Objective:To explore the clinicopathological characteristics and factors influencing the survival of young breast cancer patients with diagnostic age below 35 years, and to provide the basis for the prevention and treatment of young breast cancer patients.Methods:Epidemiological and clinicopathological data of young female patients with newly diagnosed breast cancer from Shanxi Province Cancer Hospital between January 2015 and December 2016 were retrospectively analyzed. The data included age at diagnosis, reproductive history, history of abortion, menopausal status, and immunohistochemical results. Univariate and multivariate analysis were performed by using Cox regression model.Results:A total of 118 young breast cancer patients were collected, and the median age was 31 years old. Among them, the vast majority of 118 young breast cancer patients were invasive cancer (113 cases, accounting for 95.8%); there were 65 cases (55.1%) with tumor diameter ≤ 20 mm, 61 cases (51.7%) at N 0 stage, and 112 cases (94.9%) at M 0 stage. The positive rates of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2) were 73.7% (87/118), 69.5% (82/118) and 28.8% (34/118), respectively. Luminal B breast cancer was the predominant molecular subtype, accounting for 55.1% (65/118). By the end of follow-up (median follow-up period of 60 months), the overall survival rate of young breast cancer patients was 78.8%. Multivariate analysis showed that TNM staging was an independent factor affecting overall survival in young breast cancer patients ( HR = 7.858, 95% CI 2.924-21.120, P < 0.001). Conclusions:Young breast cancer patients have unique clinicopathological features and TNM staging is an independent factor affecting the prognosis. Individualized treatment helps to improve the quality of life and prolong the survival time of patients.
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Promoting balanced distribution of medical resources and realizing high-quality sharing of basic medical services between urban and rural areas are an important part of common prosperity. Huzhou urban medical alliance was a new urban and rural of medical alliance mode based on level 4 vertical integration, which played an important role in the whole evolution process of the medical alliance. This medical alliance had not only broken through the " integration of counties" but also explored the " integration of cities" . It was a bridge connecting counties and cities, which was of great significance in narrowing the gap between urban and rural medical health services. The construction of urban medical alliance took digital transformation and systematic integration as two breakthroughs to comprehensively promote the upgrade of energy efficiency and benefit stacking of health governance. In 2021, the grass-roots medical utilization rate and county-level medical utilization rate were 72.7% and 90.6%. In 2020, the average hospitalization cost(8 726.7 yuan)and the average outpatient and emergency expenses(239.6 yuan)of public hospitals were 25.0% and 8.6% lower than the average level of Zhejiang Province, respectively. Although Huzhou city had broken through the restrictions of administrative divisions and actively promoted the construction of the medical alliance, and achieved phased results, there were still structural defects and institutional difficulties. In order to solve these problems, the author proposed to promote the improvement of governance structure and optimization of governance system through " three governance" and " three characteristics" , and then promote the high-quality development of urban medical alliances.
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To report the process of diagnosis and treatment of 1 case with SRY gene mutation of 46, XY complete gonadal dysplasia, and to discuss the clinical characteristics, diagnosis and treatment of the disease.Due to clitoral enlargement for 8 months, a 9 years old girl was admitted to the Children′s Hospital Affiliated to Zhejiang University School of Medicine.Previously, she had early breast development, and suffered from high gonadotropin expression when she was 6 years and 4 months old.Physical examination: breast B3 stage, female vulva, clitoris hypertrophy, normal urethra, normal vaginal opening, slightly thick hymen ring, the development of pubic hair was 2 stages, and Prader score level 1.Laboratory data showed elevated levels of estradiol, testosterone, and human chorionic gonadotrophin.Genetic examination revealed that the chromosome karyotype was 46, XY and SRY gene detection was positive.Therefore, the patient was diagnosed with 46, XY complete gonadal dysplasia.Bilateral gonadectomy was performed, and the posto-perative pathological diagnosis was bilateral gonadoblastoma with left dysgerminoma.The tumor did not recur after che-motherapy.The etiology of early breast development needs to be carefully identified.Patients with sexual characteristics dysplasia need to accept the chromosome karyotype analysis and gene detection, and surgical exploration should be performed when necessary for a correct diagnosis as soon as possible.
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Objective:To investigate the clinical efficacy of laparoscopic adrenalectomy and traditional open adrenalectomy for adrenal tumors in children.Methods:In Department of Pediatric Surgery, Fujian Provincial Maternity and Children′s Hospital from June 2008 to June 2016, the clinical data of 31 pediatric adrenal tumors was retrospectively analyzed.According to different surgical methods, they were divided into traditional open adrenalectomy group and laparoscopic adrenalectomy group.Bleeding loss, operation duration, incision length, abdominal drainage time, postoperative hospital stay, postoperative complications and recurrence were compared between the 2 groups.Results:There was no significant difference in age, sex, weight, and tumor size between the 2 groups (all P>0.05). The intraoperative bleeding loss was (18.06±4.86) mL for open adrenalectomy group and (15.20±4.48) mL for laparoscopic adrenalectomy group, and there existed no significant difference in the amount of bleeding between the 2 groups( T=-1.702, P>0.05). The operation duration was (137.44±19.32) min for open adrenalectomy group versus (134.80±6.21) min for laparoscopic adrenalectomy group, and there was no significant difference in operation duration between the 2 groups ( T=-0.504, P>0.05). The length of incision was (7.94±1.34) cm for open adrenalectomy group versus (3.44±0.21) cm for laparoscopic adrenalectomy group, the length of incision in laparoscopic group was shorter than that in open adrenalectomy group.There was significant difference in the length of incision between the 2 groups ( T=-12.843, P<0.001). The hospitalization time was (9.63±2.55) d for open adrenalectomy group versus (7.20±1.37) d for laparoscopic adrenalectomy group, the hospitalization time in laparoscopic group was shorter than those in open adrenalectomy group.The difference of operation time between the 2 groups was statistically significant ( T=-3.261, P=0.003). The average indwelling time of abdominal drainage tube was(5.94±1.53) d for open adrenalectomy group versus (4.80±1.74) d for laparoscopic adrenalectomy group, with no significant difference in postoperative abdominal drainage time between the 2 groups( T=-1.938, P>0.05). There was 1 case of retroperitoneal hematoma in laparoscopic adrenalectomy group and 2 cases of complications in open adrenalectomy group.There was no significant difference in the incidence of complications between the 2 groups ( P=1.000). There were 3 cases of distant metastasis and 1 case of recurrence in laparoscopic group, and 2 cases of distant metastasis and 1 case of recurrence in open adrenalectomy group.There was no significant difference in recurrence between the 2 groups ( P=1.000). Conclusions:Compared with open adrenalectomy surgery, laparoscopic adrenalectomy in children has various advantages, including beautiful incision, less trauma and fast recovery.However, it is necessary to select the appropriate cases.
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Airway humidification is an important treatment for tracheotomy patients. At present, the commonly used methods of humidification are atomization inhalation, intra-tracheal drip, etc., but most of them have the disadvantages of interrupted humidification, inadequate humidification, repeated exposure of airway, increased nursing workload, etc. An improved disposable atomizer was designed by the emergency department of Jiaxing First Hospital in Zhejiang Province, which solved the above problems and obtained the National Utility Model Patent of China (ZL 2014 2 0406688.9). In the traditional atomizer, a make-up pipeline is added to run through the liquid container. The replenishing pipe is connected with an external infusion device. At the end of the pipeline inside the liquid container, a buoy with a guide rod is designed to continuously add liquid and automatically control the make-up speed. The device is driven by oxygen to perform airway humidification. The design can keep sufficient airway humidification, avoid frequent addition of humidification fluid, achieve the effect of increasing humidification, reducing the occurrence of complications, increasing the comfort of patients, and reducing the workload of nursing, and has a certain clinical value.
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In daily medical work, most of the critically ill patients who cannot move by themselves are pulled and lifted by manpower, often relying on the cooperation of many doctors and nurses, which not only increases the risk of transfer and patients' discomfort, but also causes certain skeletal and muscle damage to the porters. The emergency department of the First Hospital of Jiaxing City, Zhejiang Province designed a kind of patient transfer device, and obtained the National Utility Model Patent (ZL 2018 2 0579844.X). The transfer device is composed of upper frame, lower frame and base. The upper frame and the lower frame are rectangular and in a horizontal position. The upper frame can slide laterally through the circular tubes which are fixed on the lower frame. The lower part of the base is provided with four universal foot brake wheels. During the usage, the booster frame facilitates the transfer of patients by the rolling and two sliding tracks of the circular tube, which can make patients move smoothly and comfortably, and reduce the working intensity of the transporter. This device has good practical value.
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In daily medical work, most of the critically ill patients who cannot move by themselves are pulled and lifted by manpower, often relying on the cooperation of many doctors and nurses, which not only increases the risk of transfer and patients' discomfort, but also causes certain skeletal and muscle damage to the porters. The emergency department of the First Hospital of Jiaxing City, Zhejiang Province designed a kind of patient transfer device, and obtained the National Utility Model Patent (ZL 2018 2 0579844.X). The transfer device is composed of upper frame, lower frame and base. The upper frame and the lower frame are rectangular and in a horizontal position. The upper frame can slide laterally through the circular tubes which are fixed on the lower frame. The lower part of the base is provided with four universal foot brake wheels. During the usage, the booster frame facilitates the transfer of patients by the rolling and two sliding tracks of the circular tube, which can make patients move smoothly and comfortably, and reduce the working intensity of the transporter. This device has good practical value.
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Objective To observe the effects of insulin caliper for blood glucose control on glycemic central tendency, fluctuation and incidence of hypoglycemia, etc., in emergent and critical patients to evaluate its application value.Methods A prospective single-blinded randomized parallel controlled intervention study was conducted. One hundred patients with severe hyperglycemia requiring treatment with insulin infusion admitted to emergency department and intensive care unit (ICU) of the First Hospital of Jiaxing from November 2015 to November 2017 were enrolled, and they were divided into the caliper group (used patented product insulin calipers for blood glucose control to adjust insulin dose for blood glucose control) and the conventional group (used paper-based insulin dose modification scheme to adjust insulin dose for blood glucose control) on average by random number table, 50 in each group. The gender, age, acute physiology and chronic health evaluation Ⅱ(APACHEⅡ), sequential organ failure assessment (SOFA), the principal diseases, main factors affecting blood glucose (hepatic and renal insufficiency, hypoglycemic drugs, glucocorticoids, mechanical ventilation, enteral nutrition, parenteral nutrition, intravenous glucose use, etc.), blood glucose levels at each time node (once every 2 hours after insulin use and once every 4 hours after 16-72 hours), glycemic coefficient of variance (CV), glycemic lability index (GLUGLI) and mean amplitude of glycemic excursion (GLUMAGE), insulin dose, incidence of hypoglycemia, proportion of achieving the glucose control target at each time point, the length of ICU stay and hospitalization cost per patient were recorded and compared between the two groups.Results After excluding those with incomplete data and withdraw in the midway, 92 patients were enrolled in the analysis finally,47 in caliper group and 45 in conventional group. There were no significant differences in the incidence of the gender, age, APACHEⅡ, SOFA, presence of infection at admission, previous diabetes history, glycosylated hemoglobin level, blood glucose at admission, proportion of patients after surgery, major diseases at admission and major factors affecting blood glucose between the two groups. A total of 1379 blood glucose measurements were obtained in the caliper group and 1332 blood glucose measurements were obtained in the conventional group. The glycemic measurements in caliper group were significantly lower than that in conventional group at each time point from 6-72 hours. Compared with conventional group, GLUGLI and GLUMAGE were significantly decreased in the caliper group [GLUGLI: 12.96 (8.73, 19.58) vs. 23.27 (13.07, 44.61), GLUMAGE (mmol/L): 0.66±0.22 vs. 0.87±0.28, bothP< 0.01]; there was a tendency towards decreasing incidence of hypoglycemia in the caliper group [8.51％ (4/47) vs. 15.56％ (7/45)], but no statistical difference was found (P > 0.05); the proportion of achieving the glucose control target was significantly increased in the caliper group [41.99％ (579/1379) vs. 27.18％ (362/1332),P < 0.01]. There were no significant differences in glycemic CV, insulin dose, proportion of hypoglycemic measurements in total measurements, and the length of ICU stay, the length of hospital stay, incidence of nosocomial infection, patient prognosis and cost between the two groups.Conclusion For emergent and critical patients, insulin caliper for blood glucose control presents favorable application value for achieving glucose control target, reducing glycemic fluctuation, and lowering the incidence of hypoglycemia.Clinical trial registration China clinical trial registration center, ChiCTR1800015024
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Objective To develop a washing tube for minimally invasive treatment of sinus cavity pressure ulcer, and to observe its clinical effect. Methods Using transparent non-toxic PU plastic to make sinus cavity flushing and drainage tube, and with rounded hemispherical blunt head for the entry of the sinus, the perforated tube in the sinus cavity was designed with perforated holes (3 rows, 5 for each row); the end of the tube is blocked with heparin cap. The invented sinus cavity flushing tube was used for clinical observation and its use effect was observed. When used, the sinus cavity flushing drainage tube must be placed in the deepest antrum. The wounds were covered with PU sponge. By the active aspiration drainage of the negative pressure with sterile isotonic flushing fluid, bacteria, liquefied necrotic tissue, purulent secretion, internal and external toxins produced by bacteria, and the harmful material such as exudate of inflammatory medium in the sinus cavity was thoroughly removed. Results When treating sinus cavity and mixed pressure ulcer, minimally invasive treatment using the developed sinus cavity flushing drainage tube for irrigation and negative pressure drainage can significantly reduce patients' iatrogenic trauma, observably reduce the pain of the patients, shorten the treatment cycle, improve the cure rate of sinus pressure ulcers, and achieve good clinical effect. The sinus cavity flushing drainage tube has no damage to soft tissue, with simple operation and easy tolerance of patients. It is low price and using disposable materials, which can avoid cross-infection; It can be used to treat oxygen negative pressure in sinus cavity, and it has therapeutic effect on the sinus cavity pressure sore infected by anaerobic bacteria. It can be made into different specifications, different models, and widely used in different professional fields. Conclusion The sinus cavity flushing drainage tube combined with negative pressure treatment is a new technique of mild and undamaged cleansing wound, which makes up for the deficiency of flap surgery, and it is a very ideal method for minimally invasive treatment for sinus and cavity pressure ulcers.
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Objective To explore the correlation between lymphatic metastasis and central lymph node metastasis and pre-surgery levels of serum thyrotropin (TSH), thyrobolulin (TG), anti-thyrobolulin antibodies (A-TG), anti-thyroid peroxidase antibodies (A-TPO) in patients with papillary thyroid carcinoma (PTC). Methods The clinical characteristics such as sex, age, tumor diameter, and some markers of thyroid function detection in 289 simple PTC cases were retrospectively analyzed, and their roles in lymphatic metastasis and central lymph node metastasis were discussed. Results Age < 45 years old (χ2= 5.86, P =0.02),multifocal(χ2=38.95, P<0.001), serum increased A-TG level(χ2=13.31,P <0.001) or A-TPO level (χ2= 7.30, P< 0.01) leaded to higher rate of lymphatic metastasis. Different TSH levels had different impact on lymphatic metastasis (χ2= 11.81, P = 0.02). When at 1.81-2.52 mU/L, the lowest rate of lymphatic metastasis was 34.68 %. Multivariable logistic regression analysis showed that focus (OR= 3.29, 95 % CI 1.85-5.52) and serum A-TG level (OR= 2.17, 95 % CI 1.11-4.26) were risk factors, whereas TSH at 1.81-2.52 mIU/L was more safe factor in simple PTC cases with lymphatic metastasis (OR= 0.28,95 % CI 0.09-0.85). Different groups of age (χ2= 11.54, P= 0.001), focal (χ2= 38.95, P< 0.001), serum TG level (χ2=9.01, P=0.01), A-TG level (χ2=14.51, P <0.001) or A-TPO level (χ2= 6.78, P= 0.02) leaded to statistically different central lymph node metastasis ending; further analysis showed that age (OR= 0.96, 95 % CI 0.94-0.98) and focus (OR= 5.47, 95 % CI 3.09-9.69) were risk factors of central lymph node metastatic in PTC patients. Conclusion Higher pre-surgery serum A-TG level and multifocal predict lymphatic metastasis, TSH level in 1.81-2.52 mU/L indicates lower rate of lymphatic metastasis, but age<45 years old and multifocal PTC patients are apt to occur central lymph node metastasis.
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Objective To understand the status and influencing factors of thyroid disease in breast cancer patients, and to identify the high-risk people with thyroid disease. Methods Breast cancer patients were continually collected from Jan 2016 to Mar 2016 in Shanxi Cancer Hospital. Age, surgery time, the state of thyroid disease, medical record, the general condition, immunohistochemistry and pathological findings, thyroid B-mode ultrasonography were investigated respectively. All cases were divided into two groups according to whether to suffer from thyroid disease or not. The influencing factors for thyroid disease in patients with breast cancer were screened. Logistic regression was used for univariate and multivariate analysis. Results A total of 293 cases (69.3 %) suffered from thyroid disease in 423 breast cancer patients. The univariate analysis showed that prevalence rate of thyroid disease had statistical differences in age [<50 years old:49.5%(145/293) vs. 76.1%(99/130); ≥50 years old:50.5%(148/293) vs. 23.9%(31/130);χ2=24.297, P<0.001], body mass index [18.5-23.9 kg/m2:41.0%(120/293) vs. 52.3%(68/130);24.0-27.9 kg/m2:45.4%(133/293) vs. 40.8 % (53/130); ≥28.0 kg/m2: 13.7 % (40/293) vs. 6.9 % (9/130); χ2= 6.395, P=0.041], menopausal state [not: 59.7%(175/293) vs. 77.7%(101/130); yes: 40.3%(118/293) vs. 22.3%(29/130);χ2=12.443, P<0.001], estrogen receptor (ER) [ER--ER+: 44.0%(129/293) vs. 56.9%(74/130);ER++ - ER+++: 56.0 % (164/293) vs. 43.1 % (56/130); χ2 = 5.951, P= 0.015]. There were no significant differences in the times of pregnancy and production, history of abortion, progesterone receptor (PR), human epidermal growth factor receptor-2 (HER-2), triple negative breast cancer, T stage, N stage, histological grade and TNM stage (P> 0.05). Multivariate analysis showed that the risk factors were age (OR= 3.928, 95 %CI=1.819-8.482, P<0.001) and ER++-ER+++(OR= 1.696, 95 %CI= 1.094-2.628, P= 0.018). Conclusion Age≥50 and ER++-ER+++are the major influencing factors of thyroid disease for patients with breast cancer.
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Objective@#To understand the incidence and related factors of HIV-1 drug resistance among HIV/AIDS patients experiencing treatment failure in Jiangsu province, China.@*Methods@#The HIV/AIDS integrated prevention and control data information management system of China were used to collect the basic data of patients, blood specimens were collected from patients who had antiretroviral therapy (ART) failure with ≥12 months and older than 18 years in 2016 in Jiangsu, excluding cases with missing information, 713 cases were enrolled in this study. HIV-1 RNA was extracted, and then pol gene region was amplified and sequenced. The obtain sequences were submitted to Stanford University HIV Drug Resistance Database to interpret and analyse HIV-1 drug resistance and sub-types. Multivariate logistic regression model was used to explore the related factors of drug resistance.@*Results@#A total of 579 subjects were amplified successfully, male accounted for 85.66% (496 cases), and the median age was 39 years old. The main route of infection was sexual transmission (553 cases, 95.51%). A total of 331 patients with drug resistance gene mutation were detected, drug resistance mutation rate was 57.18%. Compared with patients with baseline CD4+T cell count >500 cells/μl, patients with CD4+T cell count in 201-500 cells/mm3 and ≤200 cells/μl had a higher incidence of genetic drug resistance, the odds ratio was 3.33 and 6.87, respectively. Compared with patients with treatment less than 24 months, patients treated for 25-48 months had a higher incidence of drug resistance, the odds ratio was 1.88. Compared with patients infected by CRF07_BC strains, patients infected by CRF01_AE strains were associated with higher incidence of drug resistance, the odds ratio was 2.22 and 3.32, respectively. Protease inhibitor (PI) resistance mutations, nucleoside reverse transcriptase inhibitor (NRTI) and non-nucleoside reverse transcriptase inhibitor (NNRTI) were found in 3.80%, 33.16% and 53.37% of patients, respectively. 31.95% of patients harbored NRTI and NNRTI resistance mutations simultaneously. M184V/I and K103N/Q were the highest frequency of NRTI and NNRTI resistance mutation, the prevalence of M184V/I and K103N/Q were 28.15% and 22.28%, respectively.@*Conclusion@#The status of HIV-1 drug resistance mutations are complex and diverse among patients experiencing failure of ART in Jiangsu. Patients with lower baseline CD4+T cell count, longer treatment time and HIV-1 CRF01_AE and B strains infection were associated with higher incidence of drug resistance mutation.
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Chlamydia psittaci is a causative agent of psittacosis,which can infect a wide range of hosts including birds and humans.However,information regarding C.psittaci infection in pigeons is scarce.In the present study,a total of 399 fecal samples from pigeons were collected from Jilin Province,northeastern China,between March and May 2015,and examined by nested PCR amplification of outer membrane protein A (ompA) gene.The overall Chlamydiosis prevalence was 5.01％ (21/399),with 3.19％ in Changchun City and 9.40％ in Jilin City.Furthermore,breed was the major risk factor associated with Chlamydia infection in pigeon,boiler pigeons had a prevalence of 7.49％,whereas no C.psittaci was detected in racing pigeons.Sequence analysis of the ompA gene revealed that all the identified isolates represented C.psittaci genotype B.Our results firstly indicated the presence of zoonotic C.psittaci in boiler pigeons in Jilin Province,northeastern China,and effective measures should be implemented to reduce the risk of C.psittaci transmission from pigeons to humans.
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Objective To investigate the efficiency of closed tracheal suction system (CTSS) using novel splash-proof ventilator circuit component on ventilator-associated pneumonia (VAP) and the colonization of multiple-drug resistant bacteria (MDR) in patients undergoing mechanical ventilation (MV) prevention.Methods A prospective single-blinded randomized parallel controlled intervention study was conducted. 330 severe patients admitted to the intensive care unit (ICU) of the First Hospital of Jiaxing from January 2014 to May 2016 were enrolled, and they were divided into open tracheal suction group, closed tracheal suction group, and splash-proof suction group on average by random number table. The patients in the three groups used conventional ventilator circuit component, conventional CTSS, and CTSS with a novel splash-proof ventilatorcircuit component for MV and sputum suction, respectively. The incidence of VAP, airway bacterial colonization rate, MDR and fungi colonization rate, duration of MV, length of ICU and hospitalization stay, and financial expenditure during hospitalization, as well as the in-hospital prognosis were recorded.Results After excluding patients who did not meet the inclusion criteria, incomplete data, backed out and so on, 318 patients were enrolled in the analysis finally. Compared with the open tracheal suction group, the total incidence of VAP was decreased in the closed tracheal suction group and splash-proof suction group [20.95% (22/105),21.90% (23/105) vs. 29.63% (32/108)], but no statistical difference was found (both P > 0.05), and the incidence of VAP infections/1000 MV days showed the same change tendency (cases: 14.56, 17.35 vs. 23.07). The rate of airway bacterial colonization and the rate of MDR colonization in the open tracheal suction group and splash-proof suction group were remarkably lower than those of closed tracheal suction group [32.41% (35/108), 28.57% (30/105) vs. 46.67% (49/105), 20.37% (22/108), 15.24% (16/105) vs. 39.05% (41/105)] with significantly statistical differences (allP 0.05). Compared with theclosed tracheal suction group, the duration of MV, the length of ICU and hospitalization stay were shortened in the open tracheal suction group and splash-proof suction group [duration of MV (days): 8.00 (4.00, 13.75), 8.00 (5.00, 13.00) vs. 9.00 (5.00, 16.00); the length of ICU stay (days): 10.00 (6.00, 16.00), 11.00 (7.00, 19.00) vs. 13.00 (7.50, 22.00); the length of hospitalization stay (days): 16.50 (9.25, 32.00), 19.00 (10.50, 32.50) vs. 21.00 (10.00, 36.00)], and financial expenditure during hospitalization was lowered [10 thousand Yuan: 4.95 (3.13, 8.62), 5.47 (3.84, 9.41) vs. 6.52 (3.99, 11.02)] without significantly statistical differences (allP > 0.05). Moreover, no significantly statistical difference was found in the in-hospital prognosis among the three groups.ConclusionsCTSS performed using novel splash-proof ventilator circuit component shared similar advantages in preventing VAP with the conventional CTSS. Meanwhile, it is superior because it prevented the colonization of MDR and high price in the conventional CTSS.Clinical Trail Registration Chinese Clinical Trial Registry, ChiCTR-IOR-16009694.
ABSTRACT
Objective To understand the status and influencing factors of thyroid disease in breast cancer patients, and to identify the high-risk people with thyroid disease. Methods Breast cancer patients were continually collected from Jan 2016 to Mar 2016 in Shanxi Cancer Hospital. Age, surgery time, the state of thyroid disease, medical record, the general condition, immunohistochemistry and pathological findings, thyroid B-mode ultrasonography were investigated respectively. All cases were divided into two groups according to whether to suffer from thyroid disease or not. The influencing factors for thyroid disease in patients with breast cancer were screened. Logistic regression was used for univariate and multivariate analysis. Results A total of 293 cases (69.3 %) suffered from thyroid disease in 423 breast cancer patients. The univariate analysis showed that prevalence rate of thyroid disease had statistical differences in age [<50 years old:49.5%(145/293) vs. 76.1%(99/130); ≥50 years old:50.5%(148/293) vs. 23.9%(31/130);χ2=24.297, P<0.001], body mass index [18.5-23.9 kg/m2:41.0%(120/293) vs. 52.3%(68/130);24.0-27.9 kg/m2:45.4%(133/293) vs. 40.8 % (53/130); ≥28.0 kg/m2: 13.7 % (40/293) vs. 6.9 % (9/130); χ2= 6.395, P=0.041], menopausal state [not: 59.7%(175/293) vs. 77.7%(101/130); yes: 40.3%(118/293) vs. 22.3%(29/130);χ2=12.443, P<0.001], estrogen receptor (ER) [ER--ER+: 44.0%(129/293) vs. 56.9%(74/130);ER++ - ER+++: 56.0 % (164/293) vs. 43.1 % (56/130); χ2 = 5.951, P= 0.015]. There were no significant differences in the times of pregnancy and production, history of abortion, progesterone receptor (PR), human epidermal growth factor receptor-2 (HER-2), triple negative breast cancer, T stage, N stage, histological grade and TNM stage (P> 0.05). Multivariate analysis showed that the risk factors were age (OR= 3.928, 95 %CI=1.819-8.482, P<0.001) and ER++-ER+++(OR= 1.696, 95 %CI= 1.094-2.628, P= 0.018). Conclusion Age≥50 and ER++-ER+++are the major influencing factors of thyroid disease for patients with breast cancer.