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Objective:To study the incidences of vitamin K 1 and K 2 deficiency (VKD) in umbilical cord blood (UBC) of neonates and the dynamic changes and influencing factors of serum vitamin K 1 levels after preventive vitamin K 1 supplementation. Methods:From January 2021 to June 2022, neonates born in the Obstetrics Department of our hospital were prospectively enrolled and the levels of vitamin K 1 and K 2 in UBC and serum vitamin K 1 levels at 14 d and 28 d after vitamin K 1 supplementation were measured. The neonates were assigned into hospitalization group and healthy group and further assigned into early-preterm, late-preterm and full-term groups based on gestational age (GA). The incidences of VKD of different GA were studied. Dynamic changes of vitamin K 1 levels were calculated. Multivariate logistic regression was used to analyze the influencing factors of vitamin K 1 levels in hospitalization group at 28 d. Results:A total of 100 neonates were included. 80 neonates were hospitalized, including 25 early-preterm, 25 late-preterm and 30 full-term. 20 were healthy full-term neonates. No significant differences existed in the incidences of VKD of different GA ( P>0.05), however, the overall incidences were high (82.0% and 84.0%, respectively). After preventive vitamin K 1 supplementation, the levels of vitamin K 1 in full-term and preterm groups at 14 d were higher than at birth and 28 d. The levels of vitamin K 1 in hospitalized full-term neonates at 14 d and 28 d were higher than hospitalized preterm neonates. The levels of vitamin K 1 at 28 d in healthy group was significantly higher than hospitalization group ( P<0.05). Multivariate logistic regression analysis showed that maternal complications during pregnancy ( OR=5.889, 95% CI 1.621-21.399, P=0.007) and neonatal antibiotic use ( OR=5.615, 95% CI 1.833-17.221, P=0.003) were risk factors and formula feeding ( OR=0.389, 95% CI 0.193-0.786, P=0.008) was a protective factor for VKD. Conclusions:VKD is common in neonates. The serum vitamin K 1 level increases significantly after preventive vitamin K 1 supplementation. The vitamin K 1 levels of hospitalized full-term neonates at 14 d and 28 d are higher than hospitalized preterm neonates. The levels of vitamin K 1 at 28 d in hospitalized neonates are influenced by feeding methods, maternal complications during pregnancy and neonatal antibiotic use.
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Objective To explore the efficacy and safety of polyethylene glycol recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF) in preventing chemotherapy-induced neutropenia in locally advanced non small cell lung cancer (NSCLC) patients at nutritional risk. Methods A total of 337 locally advanced NSCLC patients at nutritional risk were selected. They were randomly divided into three groups: 112 cases in the non-prophylactic drug group (control group), 112 cases in the prophylactic use of rhG-CSF treatment group (rhG-CSF group), and 113 cases in the prophylactic use of PEG-rhG-CSF treatment group (PEG-rhG-CSF group). The incidence and duration of neutropenia after chemotherapy and the ratio of CD4+/CD8+T cells in peripheral blood were observed. Results The incidences of neutropenia in the control group, rhG-CSF group, and PEG-rhG-CSF group were 67.97%, 41.57%, and 38.98% (P < 0.05), respectively. The incidences of grade Ⅲ-Ⅳ neutropenia in the three groups were 22.39%, 14.25%, and 11.14% (P < 0.05); moreover, the incidence of febrile neutropenia in the three groups was 3.55%, 1.84%, and 1.21% (P < 0.05); in addition, the ratios of CD4+/CD8+T cells in peripheral blood were 1.27±0.44, 1.41±0.52, and 1.49±0.42 (P < 0.05). The duration of grade Ⅲ-Ⅳ neutropenia and the time required for the neutrophil value to reach 2.0×109/L from the lowest value in the PEG-rhG-CSF group were lower than those in the control and rhG-CSF groups (P < 0.05). Conclusion The PEG-rhG-CSF preventive treatment used in the course of chemoradiotherapy in locally advanced NSCLC patients at nutritional risk can reduce the incidence of neutropenia and improve immunologic function. PEG-rhG-CSF preventive treatment is worthy of clinical recommendation.
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Objective:To study the clinical characteristics of congenital tuberculosis (CTB).Methods:From June 2016 to February 2021, the clinical data of infants with CTB admitted to the neonatal department of our hospital were retrospectively analyzed, including their clinical characteristics, diagnosis, treatment and prognosis.Results:A total of 7 infants with CTB were enrolled into the study. 4 mothers had in vitro fertilization embryo transfer (IVF-ET) due to tubal obstruction and 2 mothers who were diagnosed of tubal tuberculosis. The 7 infants included 1 male and 6 female, 6 preterm and 1 full-term. The median age of onset was 18 d (7~30 d).All of the 7 infants had fever, 6 had shortness of breath and poor response, 5 had apnea, 3 were coughing, 1 showed pale skin colour, 1 had bilateral rales in the lung, 6 had hepatomegaly, 3 splenomegaly and 1 lymphadenopathy. Chest X-ray showed patchy exudation in 3 infants, miliary pattern of opacification in 2 infants, patchy opacification in 1 infant, bilateral increased lung markings in 1 infant. The positive rate of acid-fast bacilli (AFB) was 50% in all sputum samples. Specimens from glottic and subglottic area showed higher positive rate than oropharyngeal specimen. PCR MTB-DNA tests of sputum samples were positive in all 7 cases. 1 infant received invasive respiratory support for 1 d and died after discharge. 2 infants improved significantly after initial treatment, received 1~2 months of anti-TB therapy outside the hospital and died of severe respiratory failure. Of the 4 infants survived, 1 was cured and 3 significantly improved.Conclusions:Mothers with tubal tuberculosis receiving IVF-ET may cause high risk of CTB. Sputum AFB test and sputum PCR MTB-DNA test are preferred diagnostic tests. Genetic test of drug-resistant TB may guide clinical drug use. Glottic or deeper throat specimens can increase the positive rate.
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Objective:To investigate the distribution of clustered regularly interspaced short palindromic repeats (CRISPR) in group B Streptococcus (GBS) in the genital tract of women during the third trimester and in infants with invasive infection and its relationship with multilocus sequence typing (MLST) and drug-resistance genes. Methods:This study retrospectively collected 84 GBS strains isolated from pregnant women with GBS colonization and infants with invasive GBS infection who were admitted to Children's Hospital Affiliated to Shanxi Medical University from January 2017 to January 2022. CRISPR, MLST, and drug-resistance phenotype and genes were detected and analyzed using χ 2 test or Fisher exact probability method. MEGA11 was used to construct a dendrogram. Results:There were ten sequence typing in the 84 GBS strains and ST10 was the dominant one (46.4%). GBS was sensitive to penicillin, and its resistance rates to erythromycin (75.0%) and clindamycin (73.8%) were high. Among the 17 invasive GBS strains, ST10 had 100% resistance to erythromycin, clindamycin, and levofloxacin. CRISPR1 gene was amplified in 62 strains (73.8%). CRISPR1-positive strains had a significantly higher proportion of ST10 [56.5%(35/62) vs 18.2%(4/22), χ 2=9.56, P=0.002] and ermB, gyrA, parC [54.8%(34/62) vs 22.7%(5/22), 67.7%(42/62) vs 36.4%(8/22), 71.0%(44/62) vs 36.4%(8/22); χ 2=6.73, 6.64, and 8.25, all P<0.05], and a lower proportion of ermA [6.5%(4/62) vs 31.8%(7/22), χ 2=7.09, P=0.008] than CRISPR1-negative strains. Conclusions:ST10 is the main GBS genotype among the colonized microbiota the genital tract of pregnant women and in infants with invasive GBS infection, which is also a dominant type in CRISPR1-positive strains. GBS is sensitive to penicillin and CRISPR1 gene is linked to the spread of some drug-resistance genes.
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Objective:To investigate clinical features and prognosis of purulent meningitis in premature infants versus full-term infants and to better understand purulent meningitis and improve the diagnosis and treatment of purulent meningitis in infants. Methods:The clinical data of 54 infants with purulent meningitis who received treatment in Shanxi Children's Hospital, China between January 2017 and December 2019 were included in this study. The included infants were divided into preterm group (gestational age < 37 weeks, n = 11) and full-term group (gestational age 37-42 weeks, n = 43) according to different gestational ages. Clinical features and cerebrospinal fluid biochemical indexes (white blood cell count, protein concentration, glucose level) as well as total effective rate were compared between the preterm and full-term groups. Results:The main clinical features of neonatal purulent meningitis were fever, bradykinesia, low amount of milk intake, convulsion, lethargy, irritability, increased intracranial pressure, hypotonia or hypertonia. Hypotonia was the prominent manifestation in the preterm group, while fever, convulsion and bradykinesia were the prominent manifestations in the full-term group. White blood cell count and cerebrospinal fluid glucose level in the preterm group were significantly higher than those in the full-term group ( t = 2.215, 2.023, both P < 0.05), but cerebrospinal fluid protein level in the preterm group was significantly higher than that in the full-term group ( t = 2.437, P < 0.05). There was no significant difference in total effective rate between preterm and full-term groups [90.91% (10/11) vs. 90.70% (39/43), χ2 = 0.001, P > 0.05]. Conclusion:The clinical features of neonatal purulent meningitis are not specific, and the clinical features of premature infants with purulent meningitis are not typical. It is necessary to carefully observe the clinical manifestations of premature infants with purulent meningitis and detect the biochemical indexes of cerebrospinal fluid to strive for early diagnosis and treatment.
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Objective:To explore the feasibility and safety of minimally invasive surfactant therapy(MIST) in the treatment of neonatal respiratory distress syndrome(RDS).Methods:A total of 93 preterm infants with gestational age of 32-36 weeks admitted from April 2017 to April 2019 were eligible to receive exogenous pulmonary surfactant(PS) with diagnosis as RDS.According to the random digital table method, they were randomly divided into two groups: MIST group( n=48) and intubation-surfactant-extubation(INSURE) treatment group( n=45). During nasal continuous positive airway pressure(NCPAP) ventilation, PS with thin catheter and trachea intubation were chosen, the curative effects of the two groups were compared. Results:All infants received PS successfully, the heart rate, breath rate and fraction of inspiratory oxygen(FiO 2) after treatment of the two groups were significantly lower than those before treatment, and the differences were statistically significant ( t=7.739, 6.497, 7.450, 3.992, 3.787, 4.343, all P<0.05). However, there were no statistically significant differences in heart rate, breath rate and FiO 2 between the two groups whenever before or after administration(all P>0.05). There were also no statistically significant differences in the rate of mechanical ventilation within 72 hours after birth, the time of mechanical ventilation and NCPAP, the time of oxygen inhaling and hospital stays, and the rate of pneumothorax between the two groups(all P>0.05). The incidence of drug reflux in the MIST group [20.8%(10/48)] was higher than that in the INSURE group [8.3%(4/45)](χ 2=3.876, P<0.05), but the incidences of bradycardia, transcutaneous oxygen saturation decreased(<85%) and the secondary administration had no statistically significant difference between the two groups( P>0.05). Conclusion:MIST is effective in the treatment of RDS in moderately preterm infants, but it presents not too much benefits of effectiveness and complications, as well as the disadvantage of drug reflux, thus whether it is better choice for surfanctant procedure needs more studies.
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Objective This experiment will use from yu liquid Elimination hemorrhoids decoction in the treatment of inflammatory external piles,and to evaluate the clinical curative effect analysis.MethodsThe experiment selected the June 2016-December 2016 in our hospital 120 cases of patients with inflammatory external piles as the research object,were randomly divided into control group and observation group,60 cases in each group.Among them,the control group were treated by hemorrhoid better treatment.observation group to adopt the yu fumigation sitz bath liquid Elimination hemorrhoids soup treatment.Recorded before and after treatment in patients with symptoms of 3 days, 7 days, 14 days, including bleeding, anal discomfort, lower rectal mucosa, emergence, defecate unwell, etc., and score four grade three points method.Then compared two groups of patients was improved and the recurrence rate,further to explore the treatment effectiveness.ResultsTwo groups after treatment in patients with the disease were eased,and the observation group has better effect to improve patients,in particular,involves the bleeding,anal discomfort,lower rectal mucosa,hernia,defecate unwell wait for a problem,and group therapy 3 days, 7 days, 14 days total score, respectively (10.2±4.0), (8.6±3.5), (5.3±3.1) and control group corresponding to(11.3±4.2), (9.9±3.5), (6.4±3.2) and significant difference comparing the two groups, with statistical significance(P<0.05).But in comprehensive treatment efficiency,small difference between the two groups,no statistically significant.ConclusionUsing the quasi yu liquid elimination hemorrhoids decoction in the treatment of inflammatory external piles have good improvement effect, eliminate edema, quick effect, medical expenses low salient features, and avoid the operation of psychological pressure and economic pressure, is worthy of popularization and application in the process of clinical treatment.
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Objective To evaluate the effect of endoscopic management of foreign bodies in the upper digestive tract. Methods Clinical data and endoscopic treatment methods of 41 patients were retrospectively analyzed from October 2014 to May 2016. Patients with incomplete medical records were excluded. Results Foreign bodies in the upper digestive tract occurred high frequency in elderly. 53.6% of the foreign bodies were located in the esophagus. Date stones was the main type of foreign bodies (56.1%). 41 cases with foreign bodies in digestive tract were successfully extracted, while 1 case occurred perforation. Conclusion Endoscopic management of gastrointestinal foreign bodies is safe and effective.
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Objective:To investigate the effects of early postoperative enteral nutrition on recovery of patients with gastric cancer.Methods:Sixty-five cases of patients with gastric cancer were randomized into early enteral nutrition (EEN) group and enteral nutrition (EN) group.Serum total protein (TB),albumin(ALB),Prealbumin,white blood cell count (WBC),C-reactive protein (CRP),immunoglobulin,peripheral T-lymphocyte subsets,gastrointestinal recovery time,hospital stay and cost were recorded.The nutritional and cellular immunity parameters of the EEN group on 7th day after operation were higher than those of the EN group.Inflammatory response of the EEN group on 3th day after operation was lower than EN group.EEN group showed better immunological response and clinical recovery than the EN group (P ＜ 0.05).Conclusion:Early enteral nutrition in postoperative gastric cancer patients can improve early postoperative nutritional status and immune function,alleviate inflammatory response,promote the recovery of intestinal function and shorten hospital stay.
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Narrative medicine has brought new ideas to medical humanities education, and its con-notation is suitable to Undergraduate Medical Education Standards-Clinical Medicine (Trial). By analyz-ing the proposal and development of narrative medicine, its foundation and core, its programs and methods, as well as its forms and values, the author deepened the understanding of narrative medicine. And through the following four pathways including strengthening the renewal of ideas and concepts on medical humanities quality education, promoting the diversification of teaching ways and methods of medical humanities educa-tion, enhancing the effect of early exposure to clinical medical students, opening the path of integration narrative medicine and evidence-based medicine, the author analyzed narrative medical enlightenment on medical humanities quality education in China.
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@#Based on International Classification of Functioning, Disability and Healthy (ICF), this paper discussed the education of exercise rehabilitation in the terms of the goal, knowledge system and practice system. It suggested that the framework of ICF could be used to develop course system. The professional undergraduate education of exercise rehabilitation should include knowledge of rehabilitation medicine, sports science, and skills in modern rehabilitation.
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The emergence of small molecular tyrosine kinase inhibitors opened the era of targeted therapy of gastrointestinal stromal tumor(GIST). Survival and life of quality of patients from advanced stage are significantly improved by using targeted therapy. However, with prolonged treatment, drug resistance is becoming more and more common and directly affects the survival of patients. The current clinical management in failure of multi-line targeted therapies will be discussed in this article.
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Humans , Antineoplastic Combined Chemotherapy Protocols , Gastrointestinal Neoplasms , Gastrointestinal Stromal Tumors , Imatinib Mesylate , Indoles , PyrrolesABSTRACT
Based on International Classification of Functioning, Disability and Healthy (ICF), this paper discussed the education of ex-ercise rehabilitation in the terms of the goal, knowledge system and practice system. It suggested that the framework of ICF could be used to develop course system. The professional undergraduate education of exercise rehabilitation should include knowledge of rehabilitation medicine, sports science, and skills in modern rehabilitation.
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Objective To investigate if women with subclinical hypothyroidism (SCH), positive thyroid gland peroxidase antibody(TPOAb) in early pregnancy accepted treatment or not had effect on perinatal outcomes. Methods 15 000 pregnant women who delivered in Women and Infants Hospital of Zhengzhou from January 1, 2013 to June 30, 2014 were recruited retrospectively. Among them, 2 042 women had SCH in early pregnancy. The diagnostic standard of SCH was serum free thyroxine (FT4) between 12.91-22.35 pmol/L and TSH level between 5.22-10.00 mU/L. TPOAb level ≥34 U/L was defined as positive result. The 2 042 patients with SCH were divided into the treated group (1 236 cases) and the untreated group (806 cases), according to whether or not women accepted the levothyroxine treatment. Meanwhile, the 2 042 patients with SCH were divided into the TPOAb (+) treated group (1 021 cases), the TPOAb (+) untreated group (201 cases), the TPOAb (-) treated group (215 cases) and the TPOAb (-) untreated group (605 cases), according to the TPOAb result and acceptance the levothyroxine treatment. 2 000 pregnant women with normal thyroid function who delivered in the same period were selected as the control group. Perinatal outcomes were analyzed. Results (1) The incidence of SCH in early pregnancy was 13.61%(2 042/15 000). 60.53%(1 236/2 042) accepted levothyroxine treatment and 39.47%(806/2 042) did not. (2) The incidence of abortion (5.71%, 46/806), premature delivery (6.20%, 50/806), gestational hypertension disease (13.90%, 112/806), gestational diabetes mellitus (GDM;6.58%, 53/806), fetal growth restriction (FGR;12.28%, 99/806)and low birth weight infants (10.17%, 82/806)in the untreated group were higher than those in the treated group [3.96%(49/1 236), 4.21%(52/1 236), 10.76%(133/1 236), 4.13%(51/ 1 236), 8.90%(110/1 236), 7.52%(93/1 236), respectively] and the control group [3.60% (72/2 000), 4.00%(80/2 000) , 10.70%(214/2 000) , 3.80%(76/2 000), 9.60%(192/2 000), 7.50%(150/2 000), respectively]. The differences were statistically significant (P0.05). (3)The incidences of abortion (11.44%, 23/201), premature delivery (12.44%, 25/201), gestational hypertension disease (22.89%, 46/201), GDM (8.46%, 17/201), FGR (19.90%, 40/201) and low birth weight infants (16.42%, 33/201) in the TPOAb (+) untreated group were higher than those in TPOAb (+) treated group [4.02% (41/1 021), 4.21% (43/1 021), 10.77% (110/1 021), 4.11% (42/1 021), 8.72% (89/1 021), 7.35%(75/1 021), respectively] and the control group, with statistically significant differences (P0.05). (4)There were no statistically significant difference (P> 0.05) in the incidence of abortion (3.72%, 8/215), premature delivery (4.19%, 9/215), gestational hypertension disease (10.70%, 23/215), GDM (4.19%, 9/215), FGR (9.77%, 21/215) or low birth weight infants (8.37%, 18/215) among the TPOAb (-) treated group, the TPOAb (-) untreated group [3.80% (23/605), 4.13%(25/605), 10.91%(66/605), 5.95%(36/605), 9.75%(59/605), 8.10%(49/605), respectively] and the control group. Conclusions (1) The incidence of abortion, premature delivery, gestational hypertension disease, GDM, FGR and low birth weight infants could be increased in women with SCH in early pregnancy.(2) Thyroxine treatment could reduce the incidence of pregnancy complications in women with SCH in early pregnancy. Objective To investigate if women with subclinical hypothyroidism (SCH), positive thyroid gland peroxidase antibody(TPOAb) in early pregnancy accepted treatment or not had effect on perinatal outcomes. Methods 15 000 pregnant women who delivered in Women and Infants Hospital of Zhengzhou from January 1, 2013 to June 30, 2014 were recruited retrospectively. Among them, 2 042 women had SCH in early pregnancy. The diagnostic standard of SCH was serum free thyroxine (FT4) between 12.91-22.35 pmol/L and TSH level between 5.22-10.00 mU/L. TPOAb level ≥34 U/L was defined as positive result. The 2 042 patients with SCH were divided into the treated group (1 236 cases) and the untreated group (806 cases), according to whether or not women accepted the levothyroxine treatment. Meanwhile, the 2 042 patients with SCH were divided into the TPOAb (+) treated group (1 021 cases), the TPOAb (+) untreated group (201 cases), the TPOAb (-) treated group (215 cases) and the TPOAb (-) untreated group (605 cases), according to the TPOAb result and acceptance the levothyroxine treatment. 2 000 pregnant women with normal thyroid function who delivered in the same period were selected as the control group. Perinatal outcomes were analyzed. Results (1) The incidence of SCH in early pregnancy was 13.61%(2 042/15 000). 60.53%(1 236/2 042) accepted levothyroxine treatment and 39.47%(806/2 042) did not. (2) The incidence of abortion (5.71%, 46/806), premature delivery (6.20%, 50/806), gestational hypertension disease (13.90%, 112/806), gestational diabetes mellitus (GDM;6.58%, 53/806), fetal growth restriction (FGR;12.28%, 99/806)and low birth weight infants (10.17%, 82/806)in the untreated group were higher than those in the treated group [3.96%(49/1 236), 4.21%(52/1 236), 10.76%(133/1 236), 4.13%(51/ 1 236), 8.90%(110/1 236), 7.52%(93/1 236), respectively] and the control group [3.60% (72/2 000), 4.00%(80/2 000) , 10.70%(214/2 000) , 3.80%(76/2 000), 9.60%(192/2 000), 7.50%(150/2 000), respectively]. The differences were statistically significant (P0.05). (3)The incidences of abortion (11.44%, 23/201), premature delivery (12.44%, 25/201), gestational hypertension disease (22.89%, 46/201), GDM (8.46%, 17/201), FGR (19.90%, 40/201) and low birth weight infants (16.42%, 33/201) in the TPOAb (+) untreated group were higher than those in TPOAb (+) treated group [4.02% (41/1 021), 4.21% (43/1 021), 10.77% (110/1 021), 4.11% (42/1 021), 8.72% (89/1 021), 7.35%(75/1 021), respectively] and the control group, with statistically significant differences (P0.05). (4)There were no statistically significant difference (P> 0.05) in the incidence of abortion (3.72%, 8/215), premature delivery (4.19%, 9/215), gestational hypertension disease (10.70%, 23/215), GDM (4.19%, 9/215), FGR (9.77%, 21/215) or low birth weight infants (8.37%, 18/215) among the TPOAb (-) treated group, the TPOAb (-) untreated group [3.80% (23/605), 4.13%(25/605), 10.91%(66/605), 5.95%(36/605), 9.75%(59/605), 8.10%(49/605), respectively] and the control group. Conclusions (1) The incidence of abortion, premature delivery, gestational hypertension disease, GDM, FGR and low birth weight infants could be increased in women with SCH in early pregnancy.(2) Thyroxine treatment could reduce the incidence of pregnancy complications in women with SCH in early pregnancy.
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Objective To investigate the clinical characteristics and risk factors of neonatal hyperbilirubinemia.Methods The clinical data of 826 cases with neonatal hyperbilirubinemia were retrospectively analyzed.The jaundice appeared time,clinical characteristics were monitored,and the causes of jaundice appeared were analyzed.Results The jaundice cases at ≤ 1 day,＞ 1 ～ 7 days,more than ＞ 7 days were 71 cases,471 cases,284 cases,accounted for 8.60％,57.02％,34.38％ ;The top three risk factors of jaundice constitute were breast milk jaundice,perinatal factors,infectious factors,the cases were 215 cases,206 cases,200 cases,the proportions were 26.03 ％,24.94％,24.21％ ;The proportion jaundice of newborn caused by ABO hemolytic was 9.44％ ;There were 220 cases of 812 cases had neonatal jaundice,including 170 cases of full-term of breast milk jaundice,the proportion was 27.15％,50 cases of preterm infants of breast milk jaundice,accounted for 26.88％,there was no significant difference(P ＞ 0.05) ;78 cases was full-term breast milk jaundice,the proportion was 22.94％,120 cases of cesarean section appeared breast milk jaundice,accounting for 36.81％,the difference was statistically significant(P ＜ 0.05).Conclusion The degree of neonatal jaundice is affected by many factors,which related with individual differences,geographical,economic and cultural level,race,gender,feeding methods,genetic and so on,the strict observation and identification of neonatal jaundice and the establishment of supervision system and the protection for active and effective measures,taking active and effective treatment have very good effect to reduce hyperbilirubinemia complication as well as a good effect on the prevention and treatment of neonatal hyperbilirubinemia.
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The incidence of gastrointestinal stromal tumor(GIST) is 1-2 per 100 000. Micro GIST with a size less than 1 cm are found in 3%-35% elderly population. These small-size GIST are usually located in the middle or upper stomach, with gain-function KIT or PDGFRA mutation. In this review, the clinicopathological features and management of these small-size GISTs are discussed.
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Humans , Gastrointestinal Neoplasms , Pathology , Gastrointestinal Stromal Tumors , Mutation , Proto-Oncogene Proteins c-kit , Receptor, Platelet-Derived Growth Factor alphaABSTRACT
<p><b>OBJECTIVE</b>To investigate the feasibility and short-term efficacy of laparoscopic resection of primary local gastric and intestinal gastrointestinal stromal tumors(GIST).</p><p><b>METHODS</b>Clinicopathological data of 26 patients with GIST, 20 located at the stomach and 6 at the intestine, undergoing laparoscopic complete resection from October 2010 to April 2013 were retrospectively analyzed.</p><p><b>RESULTS</b>Hand-assisted laparoscopic surgery was performed in 3 patients with gastric GIST, while the other 23 underwent regular laparoscopic surgery. All the procedures were performed successfully without conversion to open operation. According to tumor location and growth types, gastric local resection was performed in 18 cases, distal gastrectomy in 2 cases and intestinal segmental resection in all 6 cases of intestinal GIST. The mean diameter of tumor was (4.5±1.6) cm. The mean operational time was(96.2±28.2) min, with a mean blood loss of (49.6±38.6) ml. Postoperative bowel function recovery time was (2.3±0.7) d and the length of postoperative hospital stay was (6.8±1.9) d. Bleeding from gastrointestinal tract developed in 1 patient after resection of intestinal GIST. Postoperative pathology indicated very low risk of GIST in 1(3.8%), low risk in 13(50.0%), intermediate in 9(34.6%) and high risk in 3(11.5%) patients, respectively. After a follow-up ranging form 3 to 32 months, no recurrence or death was found.</p><p><b>CONCLUSION</b>Laparoscopic surgery of primary local GISTs from stomach or intestine is safe and feasible in selected patients, with less invasiveness, rapid recovery, and favorable short-term outcomes.</p>
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Humans , Gastrectomy , Gastrointestinal Stromal Tumors , General Surgery , Hand-Assisted Laparoscopy , Intestinal Neoplasms , General Surgery , Laparoscopy , Length of Stay , Neoplasm Recurrence, Local , Operative Time , Retrospective Studies , Stomach Neoplasms , General Surgery , Treatment OutcomeABSTRACT
Objective To investigate association of IL-10 gene promoter polymorphisms with first episode schizophrenic and efficacy of risperidone.Methods 513 schizophrenic patients with first episode(patient group) and 627 health controls(control group)participated in this study.Genotyping for IL-10 gene label single nucleotide polymorphism(SNP) sites-592A/C (rs1800872),-1082A/G (rs1800896),-819T/C (rs1800871) were performed by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP)genotyping technology.513 patients were administered orally risperidone for 8 weeks.Clinical efficacy were evaluated with PANSS.Results The frequences of rs1800896 genotypes (332:166:15,453:161:13 ; x2 =7.55,df=2,P=0.02) and alleles(830:196,1067:187; x2 =7.09,df=1,P=0.008,OR=1.35,95％ CI=1.08 ～ 1.68) showed significant differences between patient group and control group,however only allele differences showed statistical significance after Bonferroni correction (P=0.024).The frequencies of rs1800872and rs1800871 genotypes and alleles had no significant differences between patient group and control group(P＞0.05).There were no significant differences of haplotype frequences between patient group and control group (P＞ 0.05).There were no significant differences of genotypes (134:209:38,61:59:12;x2 =5.16,df=2,P=0.08;244:129:8,88:37:7;x2 =4.57,df=2,P=0.10; 188:158:35,54:64:14;x2=2.80,df=2,P=0.25) and alleles (477:285,181:83;x2 =3.03,df=1,P=0.08;617:145,213:51 ;x2 =0.01,df=1,P=0.92;534:228,172:92;x2 =2.22,df=1,P=0.14) frequences of rs1800872,rs1800896,rs 1800871 between effective group (381 cases) and invalid group (132 cases) of Risperidone efficacy (P＞ 0.05),while ATC haplotype frequences had significant difference between two groups(x2 =7.501,P=0.006,OR (95％ CI) =2.420(1.262-4.640)).Conclusion IL-10 gene rs1800896 polymorphism may be associated with susceptibility to schizophrenia.The clinical curative effect of risperidone in the treatment of schizophrenia is associated with ATC haplotype,ATC haplotype may be good predictors to the overall curative effect of risperidone.
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Purpose To evaluate the clinical and pathological features of extramammary Paget’ s disease ( EMPD) and to investigate the related prognostic factors. Methods The clinical and pathological data of 30 patients with EMPD were reviewed retrospectively. The HE slides in the file were rechecked. Immunohistochemical stains were performed on archival paraffin-embedded sections with En-Vision method in 20 cases. Follow-up data were recorded. The relationship between the clinicopathological parameters and prognosis was statistically analyzed. Results Among the 30 patients, there were 26 males and 4 females, aged from 53 to 88 years with median age 70. Macroscopically, typical presentations of EMPD were eczematoid lesions. Microscopically, Paget’s cells were distributed sin-gly or in groups ( as glandular or nests patterns) within the epidermis. Immunohistochemical stains showed that Paget’ s cells were pos-itive for CK7, and negative for CK5/6 and p63. Follow-up data were available in 23 cases, 8 cases recurred resection, among them, 6 patients had positive resected margin and 4 died. The recurrent rate and mortality between the groups of dermal invasion and no der-mal invasion (P0. 05). Conclusions CK7 is a sensitive and specific marker of Paget’s cells. Dermal invasion, lymphatic metastasis and positive resected margin are poor prognostic factors in EMPD.
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<p><b>OBJECTIVE</b>To observe the status of iron deposition in patient with β thalassemia major, and to formulate appropriate treatment strategies.</p><p><b>METHOD</b>The data of status of transfusion and chelation in 135 patients aged from 6 years and 4 months to 17 years and 11 months with β thalassemia major were collected and analyzed. Serum ferritin levels were determined and cardiac and hepatic iron deposition was determined using MRI T2(*) technology.</p><p><b>RESULT</b>Of the 135 cases studied, 66 were male, and 69 were female, their average age was 12.1 years. Serum ferritin (SF) was determined for 111 cases, it varied from 1 086.8 µg/L to 15 011.5 µg/L. Among them, 16 cases had SF level <2 000 µg/L (14.5%) , in 41 cases SF were between 2 000 and 4 000 µg/L (36.0%) ;in 54 cases SF >4 000 µg/L (48.7%) . Liver MRI T2(*) results showed that in only 8 cases (5.9%) iron content in the liver was in normal range, 19 cases (14.9%) showed mild liver iron deposition;34 (25.2%) moderate and 74 (54.8%, the youngest one was only 6 years and 4 months of age) had severe iron deposition respectively. Cardiac MRI T2(*) showed that in 89 cases (65.9%) iron content in the heart was in normal range;19 cases (14.1%) had mild cardiac iron deposition and 27 (20.0%) presented severe iron deposition (the youngest one was only 9 years and 3 months of age) . SF level was obviously related to liver and cardiac iron deposition (MRI T2(*)) r and P value were -0.284, 0.003 and -0.374, 0.000 respectively. In 108 cases regular transfusion and chelation were delayed due to financial problem. The late and insufficient dosage administered and irregular chelation caused the higher SF level and the severe iron deposition.</p><p><b>CONCLUSION</b>The survival status of β thalassemia major in China is worrisome. Majority of them had not received regular transfusion and chelation. Liver and cardiac iron deposition occur early and had a high incidence.</p>