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The awake prone position plays an important role in the treatment of hypoxemia and the improvement of respiratory distress symptoms in non-intubated patients. It is widely used in clinical practice because of its simple operation, safety, and economy. To enable clinical medical staff to scientifically and normatively implement prone position for awake patients without intubation, the committees of consensus formulation, guided by evidence-based methodology and Delphi method, conducted literature search, literature quality evaluation and evidence synthesis around seven topics, including indications and contraindications, evaluation, implementation, monitoring and safety management, termination time, complication prevention and health education of awake prone position. After two rounds of expert letter consultation, Expert consensus on implementation strategy of awake prone positioning for non-intubated patients in China (2023) was formulated, and provide guidance for clinical medical staff.
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Humans , Consensus , Prone Position , Wakefulness , China , DyspneaABSTRACT
Objective:To investigate the relationship between metabolic syndrome (MetS) and clinicopathological characteristics of patients with gastric cancer.Methods:The clinicopathological data of 245 patients with gastric cancer diagnosed by pathology in Xinzhou People's Hospital of Shanxi Province from January 2015 to December 2018 were retrospectively analyzed, and 462 non-tumor patients who underwent routine physical examination at Xinzhou People's Hospital of Shanxi Province during the same period were selected as control group. The occurrence of MetS and the correlation of MetS with clinicopathological characteristics and overall survival of patients with gastric cancer were analyzed.Results:The incidence rate of MetS in 245 patients with gastric cancer was 21.6% (53/245) and 13.6% (63/462) in the control group, and the difference between the two was statistically significant ( χ2 = 7.464, P = 0.008). Among patients with gastric cancer, the incidence of postoperative lung infection in the MetS group and non-MetS group was 17.0% (9/245) and 3.1% (6/462), respectively, and the difference was statistically significant ( χ2 = 13.874, P = 0.001); there was no significant difference in the tumor site and the incidence of incision infection, abdominal cavity infection, anastomotic leakage, gastric emptying disorder, and overall survival between the two groups (all P > 0.05). In patients with gastric cancer, MetS was associated with poor histological differentiation and late TNM stage ( χ2 = 4.242, P = 0.040; χ2 = 5.547, P = 0.027). Conclusions:The incidence of MetS in patients with gastric cancer is higher than that in the general population, and MetS-related abnormalities are more common in patients with low differentiated, undifferentiated and advanced gastric cancer. MetS may play a role in the occurrence and development of gastric cancer.
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Objective:To investigate the relationship between abdominal visceral adipose tissue (VAT) and cardiometabolic risk (CMR) through quantitative computed tomography (QCT).Methods:The present study included 76226 participants. Abdominal fat areas were measured using the QCT Pro Model 4 system. Cardiometabolic indices were collected, including systolic and diastolic blood pressures, fasting plasma glucose, total cholesterol, triglyceride, and low-density and high-density lipoprotein cholesterols CMR score was the sum of abnormal blood pressure, fasting glucose, triglyceride, and high-density lipoprotein cholesterol. Restricted cubic spline and ordered logistic regression models were applied.Results:The mean age was 50±13 years and the percentage of men was 58.8%. The level of VAT area was higher in men than in women (191.7±77.1 cm 2 vs 116.4±56.2 cm 2, P<0.0001 for all). After adjustment for age, the cardiometabolic indices except high-density lipoprotein cholesterol increased with increasing VAT area. When VAT area was 300 cm 2, age-adjusted odds ratios and 95% confidence intervals of a CMR score ≥ 1 were 14.61 (13.31, 16.04) for men and 5.46 (4.06, 7.36) for women, and the age-adjusted probability of a CMR score ≥ 3 was 31.7% for men and 31.3% for women. Conclusions:QCT-derived VAT is closely related to CMR. The findings suggest that measurement of visceral fat is recommended for the management of abdominal obesity in subjects who agree to undergo lung cancer screening via low-dose CT without additional radiation exposure.
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OBJECTIVE：To establ ish artificial neural netw orks（ANN）model to predict the interferon in the treatment of chronic hepatitis B （CHB），and to provide evidence for selecting suitable CHB therapy plan in clinic. METHODS ：The clinical data of 92 CHB patients treated by interferon ，from Guangzhou Eighth People ’s Hospital were retrospectively analyzed from Jul. 2011 to Dec. 2019. The basic information ，biochemical indexes ，blood routine indexes and virological markers of patients were collected. According to the effect of interferon ，the patients were divided into response group （73 cases）and non-response group （19 cases）. Minitab 18.0 software was used for multivariate Logistic regression analysis to screen the factors influencing the efficacy of interferon. Neurosolutions 5.0 software was used to randomly select 30％ of patients with CHB （27 cases）as the test group to establish and verify the ANN model. RESULTS ：The mean platelet volume ，platelet distribution width ，direct bilirubin ， hepatitis B e antigen and hepatitis B virus DNA more than 4×107 IU/mL had significant effect on interferon response （P＜0.05）. The accuracy ，specificity and area under characteristic curve of ANN test group were significantly higher than those of Logistic regression（P＜0.05）. CONCLUSIONS ：ANN model is accurate in predicting the efficacy of interferon in the treatment of CHB.
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Objective The present study aimed to establish a bone mineral density (BMD) reference database in China and to investigate the prevalence of osteoporosis in Chinese adults aged 50 years and older using dual energy X-ray absorptiometry (DXA). Method A total of 75321 examineers over 25 years old who underwent health checkups in 7 health check centers between 2008 and 2018 were included. All centers used a GE Lunar-DXA system to measure BMD of the lumbar spine (L1-L4), femoral neck, and total femur. The same European Spine Phantom (ESP) was used for scanning 10 times at every center, a regression equation was generated, and BMD data were cross-calibrated in each center. Peak BMD and standard deviation (SD) were identified according to 5-year age groups, and T scores were calculated based on the peak BMD and SD. Osteoporosis was defined according to the World Health Organization criteria. The prevalence of osteoporosis was standardized based on 2010 national census data for the Chinese population. Result The mean BMD values decreased with age, were highest in North China, followed by Northeast China, East China, and Southwest China, respectively, and increased with body mass index. Males aged 20-30 years and females aged 35-40 years had peak BMD values. Peak BMD values of the lumbar spine, femoral neck, and total femur were 1.09 g/cm2, 0.97 g/cm2, and 0.97 g/cm2 in males, and 1.11 g/cm2, 0.84 g/cm2, and 0.88 g/cm2 in females, respectively. Among all scanned sites, the prevalence of osteoporosis was highest in the femoral neck in males (4.58％) and in the lumbar spine in females (23.38％). The age-standardized prevalence of osteoporosis at any site was 6.46％ in males and 29.13％ in females aged 50 years and older. Based on the 2010 national census data, 10879115 males and 49286542 females currently have osteoporosis. Conclusion Mean BMD values varied according to geographic region, body mass index, age group, and sex in Chinese adults. The age-standardized prevalence of osteoporosis was 6.46％ in males and 29.13％ in females aged 50 years and older.
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Objective To explore the methylation status of Rap1 GTPase activating protein (Rap1GAP) promoter in colon cancer, and to provide the oretical basis and research direction for the early diagnosis, targeted therapy, anti-multidrug resistance of colon cancer and so on. Methods The paraffin embedded specimens of 33 patients with colonic adenocarcinoma diagnosed by pathology were analyzed from Department of Pathology of Xinzhou City People′s Hospital from January 2010 to September 2014, including 19 males and 14 females, and aged 41-72 years old. The paraffin embedded specimens of 16 patients with colonic adenoma were enrolled, including 9 males and 7 females, and aged 34-58 years old. 13 normal tissues from the tumor distal margin (from the tumor > 15 cm) were selected. Quantitative methylation specific PCR (q-MSP) was applied to detect methylation level of Rap1GAP gene promoter. The methylation level differences of Rap1GAP gene promoter region among 3 groups or between different clinicopathologic factor subgroups were compared. Results The methylation rates [median (interquartile range)] of Rap1GAP promoter were 65.43 % (50.35 %), 21.37 % (8.39 %) and 17.43 % (15.71 %) in colonic adenocarcinoma group, colonic adenoma group and adjacent normal tissue group, respectively. The methylation rate of colonic adenocarcinoma group was significantly higher than that of colon adenoma group or that of adjacent normal tissue group (P60yearsold:36.26%(62.62%)and26.23%(76.42 %);well-differentiated vs. moderately/poorly-differentiated: 21.98 % (40.32 %) vs. 42.74 % (74.20 %); TNM Ⅰ-Ⅱ vsⅢ-Ⅳ: 25.31 % (48.27 %) vs. 36.26 % (75.55 %); all P> 0.05]. Conclusion The methylation status of RAP1GAP promoter maybe associate with genesis and development of colon cancer, which might be used as a target for early diagnose of colon cancer.
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Objective To investigate the expression of signal-induced proliferation-associated gene 1 (SIPA1), Ezrin and E-cadherin (E-cad), and their relationship with clinical patterns in epithelial ovarian carcinoma.Methods Immunohistochemistry was used to detect the expression of SIPA1, Ezrin and E-cad in normal ovarian tissue, benign epithelial ovarian tumor, borderline epithelial ovarian tumor and epithelial ovarian carcinoma,respectively. Results The positive rate of SIPA1 expression was 44.2 % (23/52), 64.5 %(20/31), 93.3 % (28/30) and 100.0 % (15/15) in epithelial ovarian carcinoma, borderline epithelial ovarian tumor, benign epithelial ovarian tumor, and normal ovarian tissue, respectively, and there was a statistical difference (χ2 = 29.159, P= 0.000). The corresponding rates were 57.7 % (30/52), 61.3 % (19/31), 90.0 %(27/30) and 93.3 % (14/15) for the positive rate of Ezrin expression (χ2= 14.555, P= 0.002), as well as for 23.1 % (12/52), 58.1 % (18/31), 86.7 % (26/30) and 0 (0/15) for the positive rate of E-cad expression, respectively (χ2= 45.731, P= 0.000). In patients with epithelial ovarian carcinoma, the expression of SIPA1 was correlated with tumor differentiation (χ2=3.895, P=0.048), but not with histological type and clinical stage (all P>0.05). The expression of Ezrin was not correlated with histological type, tumor differentiation and clinical stage (all P>0.05). There was a positive correlation between expression of E-cad and SIPA1, Ezrin in epithelial ovarian carcinoma, respectively (r= 0.339, P= 0.014; r= 0.284, P= 0.041), but no correlation between the expression of SIPA1 and Ezrin (r= 0.214, P= 0.128). Conclusions SIPA1, Ezrin and E-cad play important roles in the occurrence and development of epithelial ovarian carcinoma. They cooperate in the progression and their combined detection can better evaluate the prognosis of epithelial ovarian carcinoma.
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Objective To investigate the effects of icariin (ICA) on partial vasoactive substances in monocrotaline (MCT)-induced pulmonary arterial hypertension (PAH) rat model.Methods Sixty male SD rats were randomly divided into five groups:normal control group,model control group,ICA low-,middle-and high-dose (20,40,80 mg · kg-1 · d-1) group,12 rats in each group.Except for normal control group,the rats were injected with MCT (50 mg · kg-1 · d-1) to establish PAH model.After 1 week MCT-injection,ICA was given by intragastric administration for 3 weeks according to different groups.Mean pulmonary artery pressure (mPAP) was recorded through catheter connected with Power Lab system.Except for normal control group,the right ventricular hypertrophy index (RVHI) was calculated using formula:right ventricle weight/the weight of left ventricle with septum× 100％.The morphology of lung artery was assessed by HE staining.Concentration of angiotensin Ⅱ (Ang Ⅱ),endothelin (ET),prostaglandine F2α(PGF2α),thromboxane A2(TXA2) and prostacyclin (PGI2) in serum was measured by ELISA kit assay.The protein levels of angiotensin converting enzyme (ACE),cyclooxygenase-2 (COX-2) and thromboxane A2 synthetase (TXAS) were analyzed by Western blotting,expression of ACE,COX-2 and TXAS mRNA was measured by real time RT-PCR.Results Compared with the normal control group,mPAP [(48.5±5.2) mmHg] and RVHI (33.3±3.8)％in model control group were significantly increased (P ＜ 0.05),the morphology revealed there was obvious artery remodeling at distal artery,the contents of Ang Ⅱ,PGFA2,TXA2 in serum were elevated,and ACE,COX-2 and TXAS gene expression was up-regulated in rats treated with MCT.ICA (40,80 mg · kg-1 · d-1) treatment significantly attenuated mPAP,RVHI and pulmonary artery remodeling (P ＜ 0.05),and decreased the contents of serum Ang Ⅱ,ET,PGF2β,TXA2,and PGI2,and inhibited the gene expression of ACE,COX-2 and TXAS.Conclusion ICA decreases the contents of AngⅡ,ET,PGI2,PGF2α and TXA2 in the serum of MCT-induced PAH rats,which may be one of the mechanisms underlying ICA inhibiting PAH.
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Objective To investigate the expression of Rap1 GTPase-activating protein 1 (Rap1GAP),matrix metalloproteinase 2 (MMP-2) and matrix metalloproteinase 9 (MMP-9),and their relation with clinical patterns in colorectal carcinoma.Methods Immunohistochemistry was used to detect the expression of Rap1GAP,MMP-2 and MMP-9 in colorectal carcinoma,villous adenoma,tubular adenoma and normal colorectal tissue,and their relationship with clinicopathological parameters was analyzed.Results The positive rate of Rap1GAP expression was 30.4 ％ (14/46),77.8 ％ (14/18),69.6 ％ (16/23) and 95.2 ％ (20/21) in colorectal carcinoma,villous adenoma,tubular adenoma,and normal colorectal tissue,respectively (x2 =30.659,P=0.000).The figures were 71.7 ％ (33/46),55.6 ％ (10/18),52.2 ％ (12/16) and 9.5 ％ (2/21) for the positive rate of MMP-2 expression (x2 =22.459,P =0.000),as well as for 76.1％ (35/46),61.1％ (11/18),56.5 ％ (13/23) and 14.3 ％ (3/21) for the positive rate of MMP-9 expression,respectively (x2 =22.643,P =0.000).In patients with colorectal carcinoma,the expression of Rap1GAP was correlated with tumor differentiation (x2 =5.275,P =0.022),but not sex,age,or lymphatic metastasis (all P ＞ 0.05).The expression of MMP-2 and MMP-9 were correlated with lymphatic metastasis (x2 =6.661,P =0.010;x2 =8.475,P =0.040),but not sex,age or tumor differentiation(all P ＞ 0.05).There was a negative correlation between expression of Rap1GAP and MMP-2,MMP-9 in colorectal carcinoma,respectively (r =-0.424,P =0.003;r =-0.294,P =0.048),but no correlation between the expression of MMP-2 and MMP-9 (r =0.101,P =0.505).Conclusions Rap1GAP,MMP-2 and MMP-9 play important roles in the malignant biological behavior of colorectal carcinoma,and the expression of Rap1GAP is negatively correlated with MMP-2 and MMP-9.The interactions among the three affect the occurrence and development of colorectal carcinoma.
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Objective To investigate the expression and significance of Periostin,VEGF and MMP-9 in breast invasive ductal carcinoma.Methods Immunohistochemistry was employed to detect the expression of Periostin,VEGF and MMP-9 in breast invasive ductal carcinoma and normal breast tissue.Results In breast invasive ductal carcinoma and normal breast tissue,the positive rates of Periostin were 63.8 ％ (37/58) and 0 (x2 =24.272,P =0.000).The figures were 69 ％ (40/58) and 8 ％ (2/25) for the positive rates of VEGF (x2 =25.977,P =0.000),respectively,as well as 70.69 ％ (41/58) and 16.0 ％ (4/25) for the positive rates of MMP-9 (x2 =21.050,P =0.000),respectively.There were significant differences among the groups (P ＜ 0.05).In breast invasive ductal carcinoma,the expression of Periostin was correlated with clinical stage (x2 =4.835,P =0.028),whereas not correlated with age (x2 =1.155,P=0.282),histological grade (x2 =0.05,P =0.972),lymphatic metastasis (x2 =1.660,P =0.198).The expression of VEGF was correlated with clinical stage (x2 =4.230,P =0.040),lymphatic metastasis (x2 =9.667,P =0.002),whereas not correlated with age (x2 =0.506,P =0.477),histological grade (x2 =0.532,P =0.767).The expression of MMP-9 was correlated with clinical stage (x2 =8.456,P =0.004),lymphatic metastasis (x2 =5.494,P =0.019),whereas not correlated with age (x2 =0.153,P =0.695),histological grade (x2 =0.224,P =0.894).The expression of Periostin,VEGF and MMP-9 were positively correlated with each other in breast invasive ductal carcinoma (r =0.348,P =0.001; r =0.303,P =0.021; r =0.469,P =0.000).Conclusion Periostin,VEGF and MMP-9 are correlated closely with the occurrence and development of breast invasive ductal carcinoma,which might be valuable in evaluating the invasiveness,metastasis and prognosis.
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Objective To investigate the clinicopathological significance of periostin and MMP-2 in colorectal carcinoma.Methods Immunohistochemistry was used to detect the expression of periostin and MMP-2 in colorectal carcinoma,tubular adenoma,villous adenoma and normal colorectal tissue.The correlations between the expression of periostin and MMP-2 with clinicopathologic parameters were analyzed.Results In colorectal carcinoma,tubular adenoma,villous adenoma and normal colorectal tissue,the positive rates of periostin were 83.7 ％ (41/49),40.0 ％ (6/15),32.1％ (9/28),0 (0/15),respectively,while the positive rates of MMP-2 were 71.4 ％ (35/49),60.0 ％ (9/15),64.3 ％ (18/28),0(0/15),respectively.There were significant differences among the groups (x2 =41.252,P =0.000; x2 =24.811,P =0.000).The expression of periostin in colorectal carcinoma tissue were not correlated with sex (x2 =0.002,P =0.961),age (x2 =2.267,P =0.132),tumor sites (x2 =1.506,P =0.220),differentiation status (x2 =0.875,P =0.350) and lymphatic metastasis (x2 =3.315,P =0.069).The expression of MMP-2 in colorectal carcinoma were correlated with lymphatic metastasis (x2 =5.800,P =0.016),whereas not correlated with sex (x2 =0.562,P =0.453),age (x2 =0.138,P =0.711),tumor sites (x2 =0.408,P =0.532),differentiation degree (x2 =1.335,P =0.248).The expression of periostin and MMP-2 were positively correlated in colorectal carcinoma (r =0.332,P =0.020).Conclusion Periostin and MMP-2 are correlated closely with the development and progression of colorectal carcinoma.It might be helpful for evaluating the biological properties and prognosis of colorectal carcinoma,and it would be more accurate to use a combined analysis of the two indicators.