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Objective:To explore the influencing factors of psychological stress in patients with coronary heart disease, and the effect path of joint decision-making between doctors and patients on psychological stress and to provide reference for the formulation of management plan for physical and mental health of patients with coronary heart disease.Methods:From July 2017 to April 2022, 715 retired patients with coronary heart disease hospitalized in General Hospital of the People′s Liberation Army and Air Force Hospital in Western Military Theater of the People′s Liberation Army were investigated adopted cross-sectional survey method by simple random sampling using general information questionnaire, Stress Response Questionnaire, Shared Decision-making Questionnaire between Doctors and Patients, Uncertainty in Illness Scale and Simple Coping Style Questionnaire. By using structural equation modeling, the direct and indirect influence paths of shared decision-making between doctors and patients on psychological stress were analyzed.Results:The scores of psychological stress, shared decision-making, uncertainty in illness, positive coping style and negative coping style were 49.81 ± 11.06, 79.24 ± 8.68, 76.40 ± 12.56, 21.67 ± 5.51 and 8.90 ± 3.12. Correlation analysis showed that the scores of psychological stress were positively correlated with the scores of uncertainty in illness and negative coping style ( r=0.661, 0.591, both P<0.01), and negatively correlated with the scores of shared decision-making between doctors and patients and positive coping style ( r=-0.623, -0.451, both P<0.01). Path analysis showed that shared decision-making between doctors and patients had a direct effect on psychological stress, accounting for 23.81% of the total effect; the uncertainty in illness, positive coping style and negative coping style played a part of intermediary role between the joint decision-making between doctors and patients and psychological stress, accounting for 32.35%, 8.40% and 17.93% of the total effect respectively; the uncertainty in illness and negative coping style had a chain mediating effect between them, accounting for 17.51% of the total effect. Conclusions:It suggests that the shared decision-making between doctors and patients with coronary heart disease is not only directly related to psychological stress, but also indirectly related to psychological stress through uncertainty in illness and coping style, among which coping style may play a role of "pivot" to a certain extent.
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Objective:To strengthen the integration and sharing of medical data resources, provide high-quality and usable data for clinical researchers, and promote the medical data use in clinical research.Methods:According to the development and application goals of the medical big data platform, data from different major clinical information systems in our hospital are integrated and then cleaned, processed and analyzed, and finally aggregated into a unified platform and turned to valuable and usable data resources.Results:A medical big data platform for clinical research in our hospital has been developed. It has stored over 13.42 million patients′ clinical data of more than 50 million visits since 2004 in our hospital; an analysis-oriented common data model (CDM) for clinical research has been designed; clinical researchers can query and extract clinical data according to CDM; the standard clinical research data service mechanisms have been established.Conclusions:The medical big data platform in our hospital helps to provide usable data of good quality for high-level scientific research based on medical big data, and improve the efficiency and quality of clinical research; at the same time, it also provides a efficient way to manage and control clinical research data use while ensuring data security and regulatory compliance.
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Objective To observe the effect of platelet-rich plasma (PRP) on photoaging skin of rat.Methods F344 rats were used as model animals and skin photoaging model was established by UV irradiation.The model animals were divided into 5 groups:group A was injected with activated PRP (A-PRP);group B was injected with inactive PRP (N-PRP);group C was injected with normal saline;group D was irradiated only with UV;Four weeks after the injection,the appearance and histological characteristics of the rat's skin were evaluated.Results Compared with group C and group D,the wrinkles and skin color in group A and group B were significantly improved.Histological observation showed that the histological features of group A and group B were significantly better than that of group C and D (P＜0.01).The thickness of dermis in group A was higher than that in group B (P＜0.05).There was no significant difference between groups C and D (P＞0.05).The thickness of dermis in group E was significantly higher than that in group C (P＜0.01).Conclusions Injection of PRP can improve the appearance and histological features of photo-aged skin in rats.A-PRP is better than N-PRP.
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Objective To provide helpful experiences for the development,construction,and evaluation of RRP through constructing the evaluation system.Methods The study of literature and comprebensive analysis were employed.Results Putting forward the principle of establishing the evaluation system and finally,attempting to build an evaluation system that specifically aiming at the RRP system.Conclusions The evaluation methods should be updated.
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Objective To investigate the occurrence situation and related influencing factors of obesity among children aged 6-17 years old in Chengde City.Methods The random sampling method was adopted to extract 16 811 children from 10 primary and middle schools in urban and rural areas of this city.The physical examinations were carried out.The incidence rates of over weight and obesity in different ages,sexes and areas were calculated.The risk factors for childhood obesity were preliminarily screened through questionnaire.And the Logistic regression analysis was conducted for further analyzing the risk factors for childhood obesity.Results Among 16 811 sampled children,the overweight rate was 13.09％ and the obesity rate was 12.1％.The overweight rate and obesity rate in boys were higher than those in girls;which had no statistically significant difference between urban and rural areas(P＞0.05);the incidence rates of overweight and obesity in adolescence were higher than those in preadolescence.The multivariate Logistic regression analysis showed that parental overweight,like to drink sugary drinks and watching television for long time might be the risk factors for childhood obesity.Conclusion The overweight rate and obesity rate among children aged 6-17 years old in this city are higher.Reasonable diet,correct life style and increasing exercise can partially reduce the incidence of children obesity.
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Objective To study the expression of forkhead box 2(FOXC2)and delta-like liGand 4 (DLL4)in invasive ductal carcinoma(IDC)of breast and the clinical siGnificance. Methods The expression of FOXC2 and DLL4 in l22 cases of IDC(Grade Ⅰ33,Grade Ⅱ40,GradeⅢ 49)were observed by tissue chip and immunohistochemistry. The relationship of the expression with clinicopatholoGical characteristics and between FOXC2 and DLL4 were statistically analyzed. PCR experiment was performed in normal breast tissue,ductal carcinoma in situ(DCIS)IDC Grade Ⅰ,Grade Ⅱ and Grade Ⅲ(l0 cases respectively). Results The positive rate of FOXC2 and DLL4 in IDC was 77. 87% and 74. 59% respectively. A hiGher expression was observed in GradeⅢ than in GradeⅠand Ⅱ( P<0. 05 ). The expression of FOXC2 was related to the neGative expression of ER. The expression of DLL4 was related to the tumour size,clinical staGe and lymph node metastasis( P<0. 05). The RCR of FOXC2 and DLL4 were Gradually increased in normal breast tissue,DCIS,IDC GradeⅠ, Grade Ⅱ and Grade Ⅲ(P<0. 05). Moreover the expression of FOXC2 was related to the expression of DLL4(r=0. 233,P=0. 0l0). Conclusion FOXC2 and DLL4 miGht toGether have influence on the proGression and outcome of breast carcinoma,and could be important markers of proGnosis. DLL4 miGht be reGulated by variety of factors includinG FOXC2 at the same time.
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This paper is to introduce our experiences in treating 2 batches of 13 burn victims transferred from remote areas on postburn days 3 and 4. Methods Thirteen burn victims of 2 mass casualties were transferred to our burns institute from remote areas on postburn days 3 and 4 on June 27, 2001 and June 2, 2002, respectively. There were 4 males and 9 females, age ranged from 20 to 43 years, with a mean age of 31.1±6.2 years. The mean total burn area was 74.3%±24.7% TBSA (range, 25% to 97%). Among them, 10 patients suffered from serious burn with mean total burn area involving 86.0%±11.5% TBSA (range, 60% to 97%), and mean full-thickness burn of 63.9%±26.3% TBSA. Four patients also manifested signs of severe inhalation injury, and 6 patients with moderate inhalation injury. In three patients with mean total burn area covering 35.5%±10.0% TBSA (range, 25% to 45%), with mean full-thickness burn of 15.3%±5.0%, were al having moderate inhalation injuries. Among these 13 patients, 3 were having high body temperature (39℃), while 3 manifested hypothermia. The heart rate was 140-160/min, and respiratory rate 26 to 32/min in 6 patients. Abdominal distension or loss of bowel sound were found in 4 patients. Low white cell and platelet count were found in some patients. In 13 cases, liver function, renal function, myocardiac enzyme, and coagulation function were abnormal. Results Among 13 burn victims, one patient died of myocarditis on postburn day 29, and another one died of hepatic failure (history of chronic hepatitis B) on postburn day 45 with only 2% TBSA of burn wound remained open. Conclusion Burns victims occurred in mass casualties who were transferred from remote areas to our Burns Institute were all in critical condition, usually with multiple complications, demanding most meticulous care. Our strategies in this regard consisted of dispatch of experienced surgeons and nurses to the referring hospitals and the airport to receive the patients to offer appropriate care to them during the journey,organization of the medical staff so that each of them was ordained specific function, thus conditions of the patients were evaluated immediately and appropriate treatment started expeditiously for those lethal complications on arrival. Timely and exact comprehensive treatments were prerequisite to save the patients’ life. Adequate metabolic support should be emphasized, and coagulant of anticoagulant treatment should be carried out when indicated.
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<p><b>OBJECTIVE</b>To explore the effects of recombinant human growth hormone (rhGH) when applied postoperatively on the metabolism of branch chain amino acid in severely burned patients.</p><p><b>METHODS</b>Fifty burn patients, aged 12 - 50 years and inflicted by more than 30% TBSA with 10% or more of III degree burn and admitted from the January of 1999 to the January of 2001 were enrolled in the study. The patients were randomly divided into rhGH treating (rhGH group) and control groups. Escharectomy was performed within 3 postburn day (PBDs). rhGH (0.3 IU/kg) was injected percutaneously every evening for ten days since the 1st postoperative day (POD). The changes of the plasma levels of GH and branch chain amino acid and the urine level of 3-methyl histidine (3-MH) were observed in the morning in the patients from the two groups.</p><p><b>RESULTS</b>The plasma GH level before operation decreased obviously in two groups of patients when comparing with normal value (P < 0.05). The plasma GH level in rhGH group was evidently higher than that in control group since the 3rd POD (P < 0.05). There was significant increase of the output amount of urine 3-MH in all patients, but which was obviously higher in control group than that in rhGH group (P < 0.05). The plasma levels of branch chain amino acid in burn patients before and one day after operation were lower than normal levels. The plasma levels of valine, isoleucine and leucine increased to peak values at POD 3 in rhGH group and at POD 7 in control group and decreased thereafter. The plasma branch chain amino acid level in rhGH group was evidently lower than that in control group since POD 7 (P < 0.05). The plasma GH level in rhGH group was negatively and significantly correlated with the urine output amount of 3-MH (P < 0.01).</p><p><b>CONCLUSION</b>Postoperative application of rhGH in major burn patients might be beneficial to the protein synthesis from amino acids by skeletal muscles and to the decrease of muscle protein degrading rate.</p>
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Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Amino Acids , Metabolism , Urine , Burns , Blood , Metabolism , Urine , Human Growth Hormone , Blood , Pharmacology , Muscle, Skeletal , Metabolism , Recombinant Proteins , Blood , PharmacologyABSTRACT
<p><b>OBJECTIVES</b>To observe the effect of recombinant human growth hormone on metabolism in severely burned patients.</p><p><b>METHODS</b>From January 1999 to January 2001, 50 patients, aged 12 to 50 years, with over 30% total body surface area (TBSA) and 10% full-thickness burns, were randomized in a double-blind study. In the control group normal saline was used as a placebo (control group), while 0.3 IU/kg(-1) /d(-1) recombinant human growth hormone was given from postoperative day 1 to day 10 in the rhGH group. The excised burn wounds were closed with microautograft and allograft skin. Blood samples were collected at 6:00 am for assaying of growth hormone, blood glucose, blood insulin, anti-insulin antibody, glucagon, cortisol, serum amino acid profile, transferring, proalbumin, total protein, dielectric, and resting energy expenditure (REE) was also measured.</p><p><b>RESULTS</b>The concentration of blood GH in both groups was lower (t = 2.806, P < 0.05) than that of physiological values before surgery. However, the concentration of GH on POD 3 in the rhGH group was significantly higher than that of normal values, but a higher level was observed on POD 7 in the rhGH group than that of the control group (t = 3.142, P < 0.05). Although the concentration of anti-insulin antibody was slightly increased, there was no significant difference between the two groups. The concentration of glucagons tended to decrease with an increase in the concentration of blood glucose, and it was marked in the rhGH group. There was no significant difference between the two groups. The concentration of cortisol was higher than normal values, but no significant difference was observed between the two groups. With the administration of rhGH, the plasma concentration of amino acids was lower than that of the control group (t = 2.714, P < 0.05), and the urinary output of 3-MH in the rhGH group was lower than that of the control group (t = 2.207, P < 0.05).</p><p><b>CONCLUSIONS</b>Administration of rhGH in patients with major burn after surgery could improve their metabolic status, namely, increased lipolysis energy, accelerated protein synthesis, accelerated gluconeogenesis, reduced muscle proteolytic rate, and reduced REE expenditure. There is no effect on stress hormone. rhGH exerts a beneficial effect on metabolism in severely burned patients, but hyperglycemia is apt to occur, and water, Na(+), Cl(-) retention are suggested.</p>
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Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Amino Acids , Blood , Burns , Blood , Drug Therapy , General Surgery , Growth Hormone , Therapeutic Uses , Human Growth Hormone , Genetics , Therapeutic Uses , Insulin , Blood , Recombinant Proteins , Therapeutic Uses , Sodium Chloride , BloodABSTRACT
<p><b>OBJECTIVES</b>To observe the changes in proteolytic rate and the influence of escharectomy and skin-grafting during shock stage on the proteolytic rate of skeletal muscle in severely scalded rats, and to investigate necessity of escharectomy during shock stage.</p><p><b>METHODS</b>Wistar rats afflicted with 30%TBSA (total body surface area) full-thickness burn on the back were randomly divided into 3 groups: burn injury group (group B), escharectomy during shock stage group (group S), and escharectomy after shock stage group (group N). Escharectomy and skin-grafting was performed on the postburn day 1 (PBD1) and PBD4 in group S and N. The extensor digitorium longus (EDL) muscle was collected using a technique without injury to the muscle, and the proteolytic rate of the EDL was determined by the in-vitro muscle incubation system with sufficient oxygen supply and amino acid automatic analyzer.</p><p><b>RESULTS</b>The total proteolytic rate (TPR) in rat EDL muscles increased significantly (t > 2.988, P < 0.01) on PBD1, but no prominent changes were observed at other time points. There were no statistically significant changes in TPR between group S and group N, but the myofibrillar proteolytic rate (MPR) in rat EDL muscles increased markedly at each time point after scald (t > 2.988, P < 0.01). The MPR in group S decreased significantly as compared with that in group N on PBD2, 4, 5 (t = 2.311, P < 0.05; t = 3.054, 3.319, P < 0.01), and the mean values were 3.17, 2.33, 1.75 nmol/wet weight in g/3 h, respectively. No significant changes were observed between group N and S.</p><p><b>CONCLUSION</b>The high protein catabolism of skeletal muscle can be alleviated by escharectomy and skin-grafting during shock stage, and it is beneficial to organics.</p>
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Animals , Male , Rats , Burns , Metabolism , General Surgery , Disease Models, Animal , Muscle, Skeletal , Metabolism , Peptide Hydrolases , Metabolism , Rats, Wistar , Shock, Surgical , Skin TransplantationABSTRACT
Objective To investigate the influence of different stimulating factors on protein metabolism of rat skeletal muscle. Methods Three kinds of animal models were used in this study as follows: burn injury group (group B, n =40), endotoxin challenge group (group E, n =40), and burn injury followed by endotoxin challenge group (group B+E, n =40). The proteolytic rate of extensor digitorium longus (EDL) muscle was determined by amino acid auto analyzer after incubation in a muscle incubation system. Results The proteolytic rate of EDL muscle of rats was increased markedly in those three groups, especially the myofibrillar proteolytic rate. The protein breakdown of muscle in group E was higher than that of group B, and it was even much higher in group B+E. Conclusions As compared among burn injury, endotoxin challenge and burn injury followed by endotoxin challenge, the change in muscle proteolytic rate is correlated to seriousness of the injuries
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Objective To investigate the mechanism of changes in skeletal muscle proteolytic rate after escharectomy during early stage of severe burn in rats. Methods One hundred and fifty six Wistar rats were subjected to 30% total body surface area (TBSA) full thickness burn on the back, and they were randomly divided into normal control group (group C), burn injury group (group B), escharectomy during early stage (1 PBD) group (group S)and escharectomy after early stage (4 PBD) group (group N). The extensor digitorium longus (EDL) muscle was collected from each rats using a technique that injury to the muscle was avoided, and the proteolytic rate of EDL was determined after in vitro muscle incubation with sufficient oxygen supply with amino acid automatic analyzer. Transcriptional expression of ubiquitin was assessed by Northern Blot. Results The myofibrillar proteolytic rate (MPR) was markedly increased at each time points after scald, and the MPR in group S was significantly decreased compared with group N. The expression of ubiquitin mRNA markedly increased in the three groups compared with group C, and was decreased in Group S. There was a significant positive correlation between MPR and expression of ubiquitin mRNA. Conclusion Escharectomy during early stage can alleviate protein catabolism in skeletal muscle, and may be related to decreased activity of ubiquitin proteasome pathway
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Objevtive To study the effect of ubiquitin proteasome pathway inhibition on NF ?B activity and I?B?expression as well as TNF ? secretion in the liver in burned rats with sepsis. Methods Rats were subjected to 30% full thickness scald injury, followed by intraperitoneal injection of lipopolysaccharide (LPS), was used for this experiment to mimic early sepsis after burn. Sixty Wistar rats were randomly divided into normal control group, burn sepsis group, burn sepsis with proteasome inhibitor N Acetyl leucinyl leucinyl norleucinal (ALLN) treatment group, and burn sepsis with NF ?B inhibitor Pyrrolidine Dithiocarbamate (PDTC) treatment group with 6 rats in each group. The following parameters were measured with the method indicated in parentheses: NF ?B activity (electrophoretic mobility shift assay, EMSA), I?B ? expression (Western blotting), and TNF ? (Enzyme linked immunoadsordent assay, ELISA). Results These showed that NF ?B activity was markedly activated and reached its peak 1h after challenge ( P
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To study the regularity of ubiquitin and ubiquitinated protein expression in rat skeletal muscle after burn injury, the molecular mechanism of skeletal muscle protein catabolism was investigated. Wistar rats were inflicted on a 30% full thickness burn. They were grouped according to the time of sacrifice :2, 6, 12 and 24 hours after burn, each group included normal control. The extensor digitorium logus (EDL) muscle was taken to assay the proteolytic rate and the expression of ubiquitin and ubiquitinated protein during postburn period. It was found that proteolytic rate of EDL muscle was markedly enhanced, especially in myofibrillar proteolytic rate, by 185% and 153% at 12h and 24h after burn injury, respectively. The contents of free ubiquitin and ubiquitinated protein in rat EDL muscle were significantly increased after burn injury, especially at 12 and 24 hour. The contents of free ubiquitin and ubiquitinated protein increased 33% and 186% at 12h postburn, increased 30% and 163% at 24h,respectively. The high protein catabolism of skeletal muscle during postburn stage is in close relation to high expression of free ubiquitin and ubiquitinated protein.
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To observe the changes in proteolytic rate of different kinds of skeletal muscle and the content of serum glucocorticoid in rats after burn injury,to compare the response of different types of skeletal muscle to burn injury,and to preliminarily investigate the factors modulating skeletal muscle proteolysis after burn injury, Wistar rats were inflicted 30%TBSA(total body surface area) full-thickness burn. The rats were randomly divided into 4 groups as the following: 2h, 6h, 12h and 24h after burn injury, each time point was matched with a sham control group. In-vitro muscle incubation system with sufficient oxygen supply as well as amino acid automatic analyzer were used for the assessment of the proteolytic rate of extensor digitorium longus(EDL) and soleus(SOL)muscles. The level of serum glucocorticoid was determined with radio-immuno assay. The result indicated that total proteolytic rate and myofibrillar proteolytic rate in EDL muscle increased strikingly at each time point after burn injury, and the rise of myofibrillar proteolytic rate was even greater in magnitude. No statistically significant difference in total and myofibrillar proteolytic rate occurred in SOL muscle during postburn period. Serum glucocorticoid notably increased in each observation time point compared with that of normal control( P