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Objective:To investigate the changes of disease constitution in general practice outpatients before and after COVID-19 pandemic.Methods:Rank-sum ratio (RSR)method and Pareto method were used to comprehensively analyze the disease composition of patients in general practice outpatients in Huacao Community Health Service Center of Shanghai from January 2019 to December 2021.Results:The number of visits to general practice clinic decreased from 2019 to 2021. The top five diseases in RSR were circulatory system, endocrine, nutrition and metabolism, respiratory system, digestive system, and nervous system(RSR=1.000,0.917,0.896,0.813 and 0.750), all of which were classified as Class A factors, with a cumulative composition ratio of 80.45%. Taking the above 5 categories as the main diseases, and consistency analysis was performed for the annual changes. The coefficient of concordance of the top five diseases was poor, and not statistically significant ( WR=0.956, χ 2=11.47, P>0.01), suggesting that the disease spectrum was changed. The visits of patients with respiratory diseases dropped from the 2nd place to the 3rd after COVID-19 pandemic, with an average annual change rate of-14.31%, the lowest among all diseases. Among the top five diseases, nervous system disease had the highest annual change rate (7.68%). Among the factors affecting health status and contact with health care institutions, eye and appendage diseases ranked the first with the annual change rate of 12.97% and 10.35%,respectively. Conclusions:After the outbreak of COVID-19 pandemic, the disease spectrum in general practice clinics has changed. Measures must be taken in time to meet the needs for medical care.
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Sarcopenia is a common and insidious complication in patients with liver cirrhosis and is closely associated with the prognosis of patients with liver cirrhosis. Transjugular intrahepatic portosystemic shunt (TIPS) is an important method for the treatment of portal hypertension-related complications. More and more studies have shown that sarcopenia is associated with the prognosis of cirrhotic portal hypertension after TIPS. This article reviews the research on sarcopenia and its association with TIPS in China and globally, in order to explore the association between them and guide clinical treatment.
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Objective:To investigate the clinical characteristics and prognosis of cytomegalovirus (CMV) reactivation in patients with liver failure.Methods:A total of 75 patients diagnosed with liver failure and tested for serum CMV DNA between January 2016 and June 2019 in Huashan Hospital, Fudan University were retrospectively analyzed. According to the CMV DNA test results, the patients were divided into CMV DNA positive group and CMV DNA negative group. The classification of liver failure, the use of glucocorticoids, the proportions of T lymphocyte subsets of the two groups were compared and the prognosis was evaluated. Mann-Whitney U test and chi-square test were used to analyze the data. Results:Of the 75 patients with liver failure, 17 were CMV DNA positive and 58 were CMV DNA negative. Among the 17 CMV DNA positive patients, nine were acute (subacute) liver failure, and 13 were treated with glucocorticoids, which were all significantly higher than those in the CMV negative group (20.7%(12/58) and 20.7%(12/58), respectively). The differences were both statistically significant ( χ2=6.70 and 18.40, respectively, both P<0.05). The proportions of CD3 + T lymphocytes and CD8 + T lymphocytes in the CMV DNA positive group were both higher than those in the CMV DNA negative group, and the proportions of CD4 + T lymphocytes, the ratio of CD4 + /CD8 + T lymphocytes and the proportion of B lymphocytes were all lower than those in the CMV DNA negative group. The differences were all statistically significant ( U=274.50, 165.50, 273.00, 185.00 and 189.00, respectively, all P<0.05). Acute (subacute) liver failure (odds ratio ( OR)=4.3, 95% confidence interval ( CI) 1.3-12.6) and glucocorticoid use ( OR=12.5, 95% CI 3.4-38.3) were risk factors for CMV reactivation in patients with liver failure. The disease improvement rate in the CMV DNA negative group was 56.9% (33/58), and five out of 17 patients improved in the CMV DNA positive group, with a statistically significant difference ( χ2=1.99, P=0.04). Conclusions:The use of glucocorticoids increases the risk of CMV reactivation in patients with liver failure, and CMV reactivation in patients with liver failure presents immune disorders which seriously affect their prognosis. Therefore, it is important to pay attention to CMV DNA monitoring in patients with liver failure using glucocorticoids.
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Objective:To have a better understanding of congenital leukemia by summarizing its clinical features and prognosis.Methods:This study retrospectively recruited 10 neonates with congenital leukemia treated in Beijing Children's Hospital, Capital Medical University from January 2006 to December 2018. Clinical data including clinical manifestations, laboratory examinations, treatment and follow-up were described.Results:The 10 patients consisted of six boys and four girls. In all cases, symptoms presented within 11 d after birth. The admission complaints were jaundice ( n=4), polypnea ( n=3), fever ( n=2) and rash ( n=2). Physical examinations of the 10 patients showed eight with splenomegaly, seven with hepatomegaly and seven with petechia/skin rash. All patients had significantly increased white blood cell count (from 45.8×10 9/L to 553.0×10 9/L), complicated by different degrees of anemia and thrombocytopenia. By bone marrow biopsy, two cases were diagnosed as acute lymphoblastic leukemia and the other eight cases as acute myeloid leukemia. All cases refused chemotherapy on the preliminary diagnosis. Three cases lost follow-up and six died within two months after discharge requested by their parents. One baby had spontaneous remission, but relapsed two years later. Complete remission was achieved after strict management and no relapse was reported until ten years old. Conclusions:Congenital leukemia is a severe condition with high mortality. Some cases may achieve spontaneous remission, but long-term follow-up is needed.
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Objective@#To summarize the clinical features of 7 rare cases of hemolytic disease of newborn (HDN), and to improve the understanding of rare HDN.@*Methods@#Data of clinical information, laboratory findings, treatments and outcomes were collected and analyzed for four cases with HDN due to anti-M, two cases due to anti-Kidd, and one case due to anti-Duffy. All of them were admitted to the Department of Neonatology, Beijing Children's Hospital Affiliated to Capital Medial University from July 2007 to June 2017.@*Results@#Among the four MN hemolytic babies, two were males and two were females. Jaundice was found in three cases. Two cases had hyperbilirubinemia, one of them had severe hyperbilirubinemia. All the four cases developed anemia, including severe anemia in three cases. Two cases of Kidd hemolytic disease and 1 case of Duffy hemolytic disease had jaundice and anemia, but did not reach the level of severe hyperbilirubinemia and severe anemia. MN hemolytic disease babies got negative results in direct antiglobulin test, whereas the Kidd and Duffy hemolytic disease babies had positive findings in direct antiglobulin test. None of the babies had blood transfusion, and they were discharged from the hospital.@*Conclusions@#Without maternal and fetal blood group incompatibility (ABO or Rh blood-group system), for early onset of jaundice, severe jaundice or anemia, antiglobulin test to mother and child earlier should be administered, and MN, Kidd, Duffy and other rare hemolytic disease of the newborn should be pay attention to.
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Objective To investigate the prevalence and specific manifestations of enduring psychological distress in patients with breast cancer after operation. Methods Totally 263 patients of the newly diagnosed breast cancer treated with the operation from August 2014 to August 2015 were collected by convenience sampling. Distress Thermometer (DT) and Problem List recommended by national Comprehensive Cancer Network was used to assess the persistent psychological distresses in the 6th, 15th, 20th, 25th, 30th months after the disease diagnosis,while a self-designed questionnaire was for the demographic data. Results The results of the DT screening showed that 16％(42/263) patients had persistent psychological problems;the incidences of five stages of significant psychological distress (DT≥4) was 43％(113/263), 34％(89/263), 31％(81/263), 28％ (73/263) and 25％ (65/263), respectively. The main manifestations of persistent psychological distress were:fatigue 59 cases (22.4％) , sleep disorders 51 cases (19.4％), nervous 48 cases (18.2％), anxiety 24 cases (9.1％), fear of appearance 23 cases (8.7％) and the difference in persistent psychological distress scores between different demographic characteristics (age, educational level, marital status, economic situation, operation method, disease stage) were statistically significant (t=-2.295-2.966, P<0.05). Conclusion The incidences of persistent psychological distress in patients with breast cancer is higher and the manifestation is different,which should be paid attention to by medical workers.
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Objective To enhance the utilization rate of large medical equipment in medical university.Methods The running and utilization rates of 36 pieces of large medical equipment were statistically analyzed during the past 5 years in the Scientific Experiment Center of some university,and the histogram was established for the effective machine hours to explore the utilization of large medical equipment.Results The statistical analysis and histogram showed that the utilization rate in the past 5 years was low and idleness occurred in some equipment sometimes.Conclusion Some measures are proposed to enhance the utilization rate of large medical equipment from the aspects of equipment maintenance and calibration,propaganda,new function development,personnel and etc.
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Objective To investigate the methods of early identification and early intervention for newborn with life-threatening congenital heart disease.Methods Between January 2010 and December 2010,223 neonates with serious congenital cardiac malformations were hospitalized in PICU of Fuwai Hospi-tal.Results The most type of cardiac lesions was complete transposition of the great arteries,accounting for 59%(131 cases),and the second was total anomalous pulmonary venous connection,17%(39 cases).For the primary clinical symptoms,the most common were any cyanosis,dyspnea and cardiac murmur,accounting for 91 %(204 cases),56%(125 cases)and 53%(1 18 cases),respectively.Fifty-nine cases developed into critical conditions such as severe hypoxia,metabolic acidosis and heart failure and were sent to PICU for emergency rescue.Early intervention included maintaining ductus arteriosus open,correcting internal environ-ment disturbances,treatment of heart failure,and surgical treatment as soon as possible.Four cases died before operation and 10 cases were abandoned to continue care,which all died within 12 days after discharge.In 209 cases who received operation,9 cases died.The total operation mortality was 4.3%.Within 3 to 63 month following-up,the late death was in 2 cases,2 cases received two-stage corrective operation,and three for reop-eration.The others all were in normal cardiac function and growth.Conclusion Most of neonatal life-threat-ening congenital cardiac malformations were ductus dependent such as transposition of the great arteries and total anomalous pulmonary venous connection,which the baby needs immediate diagnosis and management for survival.Early recognition,appropriate preoperative management and operation as soon as possible are the key to rescue.
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ObjectiveTo analyze the clinical manifestation of hemolytic disease of the newborn (HDN) due to anti-M and Rhesus system.MethodsClinical information was collected and analyzed for three cases with HDN due to anti-M and 64 with Rhesus hemolytic disease, who were admitted to Department of Neonatology, Beijing Children's Hospital Affiliated to Capital Medical University from February 2011 to January 2015, as well as another 28 cases of HDN due to anti-M with complete information retrieved from literature in Wanfang and China National Knowledge lnfrastructure (CNKI) Database from 1992 to 2014.Chi-square test was performed for statistical analysis.ResultsTwo out of the 64 Rh hemolytic babies gave up therapy due to kernicterus and another two out of the 31 MN hemolytic babies, obtained from literature, died 24 h after birth because of anemia or edema, while the rest survived. Although more babies were the first child of the family in HDN due to anti-M than those of Rh hemolytic disease [26%(8/31) vs 9%(6/64),χ2=4.487, P=0.034], but lower incidence of jaundice [81%(25/31) vs 98%(63/64),χ2=9.686,P=0.002], less proportion of presentation of jaundice within 24 h after birth [29% (9/31) vs 64%(41/64),χ2=10.279,P=0.001] and lower positive rate of direct antiglobulin test [39%(12/31) vs 100%(64/64), Fisher exact test,P=0.000] were shown in HDN due to anti-M. No significant difference was found in the incidences of hyperbilirubinemia [58%(18/31) vs 66%(42/64),χ2=0.513], severe hyperbilirubinemia [23%(7/31) vs 36%(23/64),χ2=1.724], anemia [81%(25/31) vs 89%(57/64),χ2=1.253] and severe anemia [29%(9/31) vs 34%(22/64),χ2=0.271] between HDN due to anti-M and Rh hemolytic babies (allP>0.05).ConclusionsHDN due to anti-M and Rhesus hemolytic disease can cause severe pathological jaundice and/or anemia in newborns. Indirect antiglobulin test should be offered when direct antiglobulin test is negative which is helpful in the diagnosis of HDN due to anti-M.
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Objective To explore the effects of different extracts of modified Siwu Siteng Decoction (TFT-Ⅰ, TFT-Ⅱ) on rat models with hyperuricemia. Methods Rat model with hyperuricemia was induced by hypoxanthine and oxonic acid potassium salt. Seventy rats were randomly divided into 7 groups:normal group, model group, allopurinol group, TFT-Ⅰ high and low dose groups, TFT-Ⅱhigh and low dose groups. Each dose group was given lavage with related medicine, and blank group and model group were given lavage with distilled water for one week, respectively. Uric acid in serum (SUA) was measured through fully automatic biochemical analyzer, and xanthine oxidase (XOD) activity in serum and liver tissue was measured through colorimetric method. Results Compared with model group, TFT-Ⅰ and TFT-Ⅱ high dose groups significantly reduced the level of SUA, serum and liver XOD activity (P0.05). Conclusion Alcohol soluble ingredients of astragalus membranaceus and Siwu decoction in modified Siwu Siteng Decoction can effectively reduce the level of blood uric acid.
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Objective To observe the effects of Qingre Paidu Capsule on NF-κB and IL-1βin acute gouty arthritis model rats induced by monosodium urate crystals (MSU);To explore its preventive and therapeutic mechanism for acute gouty arthritis. Methods Sixty SD rats were randomly divided into normal group, model group, diclofenac sodium group, and Qingre Paidu Capsule high, medium and low dose groups. Rats in different treatment groups were given corresponding medicines by gavage for 7 days. On the fifth day, after 1 hour of gastric perfusion, acute gouty arthritis rat model was established by MSU injection in ankle joint cavity. All rats were sacrificed and materials were taken 48 h after the model was established. The morphological changes in the synovial tissue of ankle joint were observed by light microscope. The expression levels of NF-κB and IL-1β in the articular leachate were monitored by ELISA. Results The expression levels of NF-κB and IL-1βin the articular leachate of Qingre Paidu Capsule each dose group and diclofenac sodium group were obviously lower than the model group (P<0.05, P<0.01). Histopathologic examination revealed that Qingre Paidu Capsule could abate tissue swelling of ankle joints, reduce inflammatory cell infiltration of synovial tissues and improve the pathologic changes of the hyperplasia of synovium and so on. Conclusion Qingre Paidu Capsule play the anti-inflammatory role by inhibiting the expressions of NF-κB and IL-1βin articular tissue of rats.
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BACKGROUND: Fresh amniotic membrane has been extensively used in treating ocular surface disease, which can inhibit fibrous tissue proliferation, inhibit neovascularization, and relieve inflammation. However, its application in treating glaucoma is rarely reported.OBJECTIVE: To explore the antiproliferative effect of fresh amniotic membrane on postoperative scar and compared with preserved amniotic membrane.METHODS: A total of 36 New Zealand white rabbits were randomly divided into 3 groups. Fresh amniotic membrane and preserved amniotic membrane combined with trabeculectomy separately underwent fresh amniotic membrane and preserved amniotic membrane transplantation. The control group was subjected to trabeculectomy alone. After 1, 2, 3, and 4 weeks, the morphology and function of filtering bleb were checked, and the platelet-derived growth factor (PDGF) of surrounding tissue was determined by immunohistochemical method.RESULTS AND CONCLUSION: Fresh amniotic membrane and preserved amniotic membrane groups displayed bulged filtering bleb with good filtering function. Pathological observation showed that fibroblasts of the filtration pathway had less, but more sparse scar tissues than control group, but inflammatory infiltration was observed in all groups. The cavity of different sizes and shapes were detected in filtration pathway of control group, which was replaced by fibrous tissue hyperplasia, with a large number of fibroblasts. Immunohistochemical results showed that the expression of PDGF was significantly less in fresh amniotic membrane and preserved amniotic membrane groups compared with the control group, and the PDGF expression was less in fresh amniotic membrane group than the preserved amniotic membrane group. Fresh and preserved amniotic membrane can improve the filtering bleb function, reduce scar formation, and maintain the patency of filtering pathway. Moreover, the effects of fresh amniotic membrane is better than preserved amniotic membrane.
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Objective:Cardiogenesis is a precise process controlled by sequential gene regulatory steps.Heart-specific transcription factors (TFs)GATA4,Nkx2.5,MEF2C and Tbx5 play critical roles in controlling heart development.But the genetic basis for the temporal expression of genes during heart development still remains unclear.Substantial studies displayed gene regulation partly attributes to histone acetylation.However,the functions of individual histone acetyltransferases (HATs)in specific developmental transcription programs are not well elucidated.p300,a histone acetyltransferase and coactivator,plays key role in many physiological processes,moreover our previous study suggests that expression of p300 is developmentally regulated during mouse cardiogenesis,but the underlying molecular mechanism remains elusive.Methods:The whole hearts from embryonic mice on embryonic days (E)10.5 and 16.5 were collected accordingly,and then total RNA was extracted.Heart-specific TFs GATA4,Nkx2.5,MEF2C and Tbx5 mRNA from mouse myocardium at differential embryonic days during cardiac development were analyzed by quantitative (Q)-PCR.The levels of histone H3 acetylation on these heart-specific TFs promoter and transcription factor binding sites of p300 to these genes were identified by chromatin immunoprecipitation assays (ChIP).Results:The present study furnishes a comparative temporal expression map of cardiac transcriptional factors,during murine heart development (E10.5 and E16.5).The mRNA levels of these genes present dynamic change.On E10.5,the expressions of GATA4 and MEF2C were remarkable lower than those on E16.5 (P