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OBJECTIVE@#To observe the effects of the Xingnao Kaiqiao (regaining consciousness and opening orifices) acupuncture on hemorrhagic transformation and limb motor function after intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in stroke patients.@*METHODS@#A total of 130 stroke patients after rt-PA thrombolytic were divided into an acupuncture group (58 cases, 1 case dropped off) and a non-acupuncture group (72 cases, 7 cases dropped off) according to whether they received acupuncture treatment. Propensity score matching (PSM) was used to match each group, with 38 patients in each group. The patients in the non-acupuncture group received rt-PA thrombolytic therapy and western medical basic treatment. In addition to the basic treatment, the patients in the acupuncture group received Xingnao Kaiqiao acupuncture at Shuigou (GV 26), bilateral Neiguan (PC 6), and ipsilateral Sanyinjiao (SP 6), Chize (LU 5), once a day for 14 days. The incidence of hemorrhagic transformation within 30 days after onset was compared between the two groups. The Fugl-Meyer assessment (FMA) score and activities of daily living (ADL) score were observed at baseline and 30 days, 6 months, 1 year after onset in the two groups. The disability rate at 6 months and 1 year after onset was recorded, and safety was evaluated in both groups.@*RESULTS@#The incidence of hemorrhagic transformation in the acupuncture group was 5.3% (2/38), which was lower than 21.1% (8/38) in the non-acupuncture group (P<0.05). At 30 days, 6 month, and 1 year after onset, the FMA and ADL scores of both groups were higher than those at baseline (P<0.01), and the scores in the acupuncture group were higher than those in the non-acupuncture group (P<0.01). The disability rate in the acupuncture group at 1 year after onset was 10.5% (4/38), which was lower than 28.9% (11/38) in the non-acupuncture group (P<0.05). There was no significant difference in the incidence of adverse events between the two groups (P>0.05).@*CONCLUSION@#The Xingnao Kaiqiao acupuncture method could reduce the incidence of hemorrhagic transformation in stroke patients after intravenous thrombolysis with rt-PA, improve their motor function and daily living ability, and reduce the long-term disability rate.
Subject(s)
Humans , Tissue Plasminogen Activator/adverse effects , Activities of Daily Living , Prospective Studies , Stroke , Acupuncture Therapy , Thrombolytic Therapy/adverse effectsABSTRACT
Objective:To explore the independent risk factors of portal vein thrombosis (PVT) in liver cirrhosis, and to establish and evaluate a risk prediction model for PVT in patients with cirrhosis.Methods:A total of 295 cases of cirrhosis hospitalized in Renmin Hospital of Wuhan University from December 2019 to October 2021 were divided into a modeling set ( n=207) and an internal validation set ( n=88) by the random number table. In addition, patients with cirrhosis hospitalized in Yichang Central People's Hospital, Wuhan Puren Hospital, No.2 People's Hospital of Fuyang City and People's Hospital of China Three Gorges University during the same period were collected as an external validation set ( n=92). The modeling set was divided into PVT group ( n=56) and non-PVT group ( n=151). Univariate analysis was used to preliminarily screen the related indicators of PVT, and then multivariate logistic regression analysis with forward stepwise regression was used to determine independent risk factors for PVT. A nomogram prediction model was constructed based on the independent risk factors obtained. The internal and external validation set were used to verify the predictive ability of the model. Distinction degree was used to evaluate the ability of the model to distinguish patients with or without PVT. Hosmer-Lemeshow goodness-of-fit test was used to evaluate the consistency between predicted risk and the actual risk of the model. Results:Univariate analysis showed that smoking, history of splenectomy, trans-jugular intrahepatic portosystemic shunt (TIPS), gastrointestinal bleeding and endoscopic variceal treatment, and levels of hemoglobin, alanine aminotransferase, aspartate aminotransferase and D-dimer were significantly different between the PVT group and the non-PVT group ( P<0.05). Multivariate logistic regression analysis found that smoking ( P=0.020, OR=31.21, 95% CI: 1.71-569.40), levels of D-dimer ( P=0.003, OR=1.12, 95% CI: 1.04-1.20) and hemoglobin ( P=0.039, OR=0.99, 95% CI: 0.97-1.00), history of TIPS ( P=0.011, OR=18.04, 95% CI: 1.92-169.90) and endoscopic variceal treatment ( P=0.001, OR=3.21, 95% CI: 1.59-6.50) were independent risk factors for PVT in patients with liver cirrhosis. Receiver operator characteristic (ROC) curve analysis showed that the area under the ROC curve (AUC) for the internal validation set was 0.802 (95% CI: 0.709-0.895) ( P<0.001), and the AUC for the external validation set was 0.811 (95% CI: 0.722-0.900) ( P<0.001). Both AUC were larger than 0.75. The calibration curve of Hosmer-Lemeshow goodness-of-fit test showed that the P values of both internal validation set ( χ2=3.602, P=0.891) and the external validation set ( χ2=11.025, P=0.200) were larger than 0.05. Conclusion:Smoking, history of TIPS or endoscopic variceal treatment, levels of D-dimer and hemoglobin are independent risk factors for PVT in patients with liver cirrhosis. The prediction nomogram model based on the above factors has strong predictive ability.
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Objective:To understand the genome sequence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and spike protein variations during different epidemic periods in Wuxi City.Methods:Nucleic acid was extracted from the nasopharyngeal swab samples of six local cases of coronavirus disease 2019 (COVID-19) (from January to February, 2020) and 13 imported cases of COVID-19 (from March to September, 2021) in Wuxi City, and the whole genome was amplified to construct the sequencing library. The second-generation sequencer was used for sequencing. The CLC Genomics Workbench (21 version) software was used to analyze the offline data with NC_045512.2 as the reference strain, and MEGA 7.0 software was used to construct the phylogenetic tree.Identification of type was conducted by Nextstrain typing method and phylogenetic assignment of named global outbreak lineages (Pangolin) typing method.Results:There were five subtypes in Nextstrain and seven subtypes in Pangolin of the nineteen patients with COVID-19. Compared with NC_045512.2, the median nucleotide mutation sites were 29 (range 0 to 42) and amino acid mutation sites were 20 (range 0 to 34). The six local and 13 imported cases had no common nucleotide mutation sites and were in different evolutionary branches. The sequences of the six local cases were highly homologous with the reference strain sequences (NC_045512.2) at the early stage of the pandemic, and the evolutionary distance was close to that of the reference strain. The 13 imported cases were obviously divided into three evolutionary branches (Alpha, Beta, Delta variant).The four Beta variants shared eight amino acid mutation sites in spike protein, and the two Alpha variants shared eight amino acid mutation sites in spike protein, and the seven Delta variants shared five amino acid mutation sites in spike protein.Conclusions:New mutations of SARS-CoV-2 are constantly emerging during the epidemic. The increase of the nucleotide sites number may result in the change of spike protein amino acid. Therefore, the whole-genome sequencing analysis plays an important role in the accurate tracing of epidemic origin and adjustment of prevention and control measures.
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BACKGROUND@#Polycystic ovary syndrome (PCOS) is the primary cause of anovulatory infertility, bringing serious harm to women's physical and mental health. Acupuncture may be an effective treatment for PCOS. However, systematic reviews (SRs) on the efficacy and safety of acupuncture for PCOS have reported inconsistent results, and the quality of these studies has not been adequately assessed.@*OBJECTIVE@#To summarize and evaluate the current evidence on the efficacy and safety of acupuncture for PCOS, as well as to assess the quality and risks of bias of the available SRs.@*SEARCH STRATEGY@#Nine electronic databases (Cochrane Library, MEDLINE, Embase, PsycINFO, CINAHL, Chinese National Knowledge Infrastructure, Wanfang Data, Chongqing VIP Chinese Science and Technology Periodical Database, and China Biology Medicine disc) were searched from their establishment to July 27, 2022. Based on the principle of combining subject words with text words, the search strategy was constructed around search terms for "acupuncture," "polycystic ovary syndrome," and "systematic review."@*INCLUSION CRITERIA@#SRs of randomized controlled trials that explored the efficacy and (or) safety of acupuncture for treating patients with PCOS were included.@*DATA EXTRACTION AND ANALYSIS@#Two authors independently extracted study data according to a predesigned form. Tools for evaluating the methodological quality, risk of bias, reporting quality, and confidence in study outcomes, including A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2), Risk of Bias in Systematic Reviews (ROBIS), Preferred Reporting Items for Systematic Reviews and Meta-analyses for Acupuncture (PRISMA-A), and the Grading of Recommendations Assessment, Development and Evaluation (GRADE), were used to score the included SRs.@*RESULTS@#A total of 885 studies were retrieved, and 11 eligible SRs were finally included in this review. The methodological quality of 2 SRs (18.18%) was low, while the other 9 SRs (81.82%) were scored as extremely low. Four SRs (36.36%) were considered to be of low risk of bias. As for reporting quality, the reporting completeness of 9 SRs (81.82%) was more than 70%. Concerning the confidence in study results, 2 study results were considered to have a high quality of evidence (3.13%), 14 (21.88%) a "moderate" quality, 28 (43.75%) a "low" quality, and 20 (31.24%) considered a "very low" quality. Descriptive analyses suggested that combining acupuncture with other medicines can effectively improve the clinical pregnancy rate (CPR) and ovulation rate, and reduce luteinizing hormone/follicle-stimulating hormone ratio, homeostasis model assessment of insulin resistance, and body mass index (BMI). When compared with medicine alone, acupuncture alone also can improve CPR. Further, when compared with no intervention, acupuncture had a better effect in promoting the recovery of menstrual cycle and reducing BMI. Acupuncture was reported to cause no adverse events or some adverse events without serious harm.@*CONCLUSION@#The efficacy and safety of acupuncture for PCOS remains uncertain due to the limitations and inconsistencies of current evidence. More high-quality studies are needed to support the use of acupuncture in PCOS.
Subject(s)
Pregnancy , Humans , Female , Polycystic Ovary Syndrome/etiology , Acupuncture Therapy/adverse effects , Infertility, Female/etiology , ChinaABSTRACT
Objective:To analyze the changes of gray matter volume and resting-state functional connectivity in children with attention deficit hyperactivity disorder (ADHD) comorbid with oppositional defiant disorder (ODD).Methods:A total of 22 ADHD comorbid with ODD children (ADHD-ODD group, n=22) were selected from a public-assess resting-state fMRI ADHD cohort, namely, ADHD-200.Meanwhile, 22 age- and sex- matched ADHD children without ODD (ADHD group, n=22) and 22 healthy children(control group, n=22) were also included.T1-weighted MRI and resting-state fMRI scans were performed on all of the participants.The voxel-based morphometric (VBM) method was used to compare the volume of gray matter in three groups.The gray matter with aberrant volume was set as the region of interest(ROI) for mapping the functional connectivity of the whole brain.For comparison of gray matter volumes, one-way ANOVA and two-sample t-test analysis were applied, while two-sample t-test analysis was used for comparison of functional connectivity. Results:Compared with the control group, ADHD-ODD group showed decreased gray matter volume in the left cerebellum anterior lobe (MNI coordinate: x, y, z=-19.5, -42, -18) and right cerebellum anterior lobe (MNI coordinate: x, y, z=19.5, -39, -21). The left cerebellum anterior lobe showed increased functional connectivity with left superior frontal gyrus, left middle frontal gyrus (MNI coordinate: x, y, z=-24, 19, 43), right superior frontal gyrus, right middle frontal gyrus (MNI coordinate: x, y, z=30, 9, 45) and bilateral precuneus, posterior cingulate gyrus(MNI coordinate: x, y, z=-6, -35, 24). Compared with the ADHD group, ADHD-ODD group showed decreased gray matter volume in the right cerebellum anterior lobe (MNI coordinate: x, y, z=19.5, -37.5, -22.5). The right cerebellum anterior lobe showed increased functional connectivity with bilateral superior frontal gyrus, bilateral middle frontal gyrus, bilateral medial frontal gyrus, anterior cingulate gyrus and posterior cingulate gyrus(MNI coordinate: x, y, z=18, -12, 42), bilateral cuneus, bilateral lingual gyrus(MNI coordinate: x, y, z=9, -87, 27).Conclusion:ADHD comorbid with ODD children show decreased cerebellum volume and excessive functional connectivity with several brain regions of the cerebral hemispheres, which may be one of the neuropathological bases of cognitive, emotional, and behavioral disorders.
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Objective:To evaluate the efficacy and safety of endoscopic ultrasound (EUS)-guided coil embolization combined with endoscopic cyanoacrylate injection for gastric fundal varices with large spontaneous shunt.Methods:Data of 24 patients with gastric fundal varices with large spontaneous shunt (the smallest diameter was 5-15 mm) treated by EUS-guided coil embolization combined with endoscopic cyanoacrylate injection in Renmin Hospital of Wuhan University from December 2016 to December 2020 were retrospectively analyzed. The short-term efficacy (the rates of technical success, five-day rebleeding and six-week mortality) and long-term efficacy (the rates of one-year rebleeding, one-year mortality and three-year mortality) and safety (ectopic embolism) were evaluated.Results:The technical success rate was 91.7% (22/24), and the five-day rebleeding rate was 0 (0/22). Computed tomography angiography of portal vein reexamined 2 days after the treatment showed embolism of splenic vein in 1 patient (4.5%). The median follow-up time was 14.9 months (ranging 1.0-48.6 months) and 2 patients were lost during follow-up. The six-week mortality was 0 (0/20), and the one-year rebleeding rate was 35.0% (7/20). Among 12 patients who underwent endoscopy in the follow-up, 5 had aggravation of esophageal varices, and 5 had aggravation of portal hypertension gastropathy. The one-year and three-year mortalities were 5.0% (1/20) and 20.0% (4/20), respectively, neither of which was related to such events as bleeding or ectopic embolism.Conclusion:EUS-guided coil embolization combined with endoscopic cyanoacrylate injection for gastric fundal varices with large spontaneous shunt is effective and safe in short term, with a low rate of ectopic embolism. Long-term efficacy and safety need to be further confirmed.
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Objective:To investigate the efficacy and safety of different endoscopic treatment strategies for grade Ⅰ-Ⅲ internal hemorrhoids.Methods:Clinical data of 107 internal hemorrhoid patients who received endoscopic sclerotherapy or band ligation in Renmin Hospital of Wuhan University from December 2018 to December 2020 were retrospectively studied. Postoperative adverse events, efficacy, and satisfaction were followed up.Results:Among the 107 patients, there were 45 patients (42.06%) with grade Ⅰ, 55 (52.34%) with grade Ⅱ, and 6 (5.60%) with grade Ⅲ. At the same time, 94.39% (101/107) patients underwent other gastrointestinal endoscopic treatment. The postoperative follow-up time ranged from 3 to 25 months, with a median of 5 months. A total of 84 patients underwent routine endoscopic injection sclerotherapy, and 8 had adverse events after the surgery. The overall effective rate was 97.61% (82/84), and satisfaction rate was 95.24% (80/84). Nine underwent endoscopic foam sclerotherapy, and no postoperative adverse events were observed. The overall effective rate and the satisfaction rate were both 100.00% (9/9). Among the 11 patients undergoing endoscopic band ligation, 2 had adverse events after the surgery. The overall effective rate was 81.82% (9/11), and the satisfaction rate was 72.73% (8/11). Three patients underwent sclerotherapy combined with ligation, and 2 had postoperative adverse events. The overall effective rate was 100.00% (3/3), and the satisfaction rate was 66.67% (2/3). Sclerotherapy was generally superior to ligation in operation cost. Further subgroup analysis for grade Ⅰ-Ⅱ patients showed that for grade Ⅰ patients, sclerotherapy was better than band ligation in the incidence of postoperative pain ( P<0.05), and for grade Ⅱ patients, no statistically significant differences were observed in adverse events, effective rate and satisfaction rate ( P>0.05). Conclusion:Both endoscopic injection sclerotherapy and band ligation for internal hemorrhoids are safe and effective, and may not increase the risk of adverse events when simultaneously completed with other gastrointestinal endoscopic treatment.
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Objective:To evaluate the efficacy and safety of lactulose combined with polyethylene glycol for bowel preparation before colonoscopy in patients of different risks.Methods:A total of 208 patients undergoing colonoscopy were enrolled, including 108 high-risk and 100 low-risk patients. The high-risk patients were divided into group A (54 taking lactulose + polyethylene glycol) and group B (54 taking polyethylene glycol), and the low-risk patients were divided into group C (49 taking lactulose + polyethylene glycol) and group D (51 taking polyethylene glycol). The Boston bowel preparation score, cecal intubation time, withdrawal time, the detection rate of colonic polyps and adenoma, and the incidence of adverse reactions were observed.Results:Among the high-risk patients, the Boston bowel preparation score and adenoma detection rate in group A [(6.35±1.15) scores, 46.3%] were significantly higher than those in group B [(5.76±0.89) scores, 22.2%, both P<0.05], and the first defecation interval in group A was significantly shorter than that in group B [(1.20±0.85) h VS (3.29 ± 2.93) h, P<0.05]. There was no significant difference in adequate bowel preparation rate, polyp detection rate, frequency of defecation or incidence of adverse reactions between group A and B. In the low-risk patients, the first defecation interval in group C was significantly shorter than that in group D [(1.65 ± 1.35) h VS (3.42 ± 2.64) h, P<0.05], and the incidence of adverse reactions was significantly lower than that in group D (44.9% VS 64.7%, P<0.05). There was no significant difference in adequate bowel preparation rate, Boston bowel preparation score, adenoma detection rate, polyp detection rate or frequency of defecation between group C and D. Conclusion:For the high-risk patients, the effect of lactulose combined with polyethylene glycol for bowel cleansing is better than that of traditional polyethylene glycol in the improvement of the Boston bowel preparation score, adenoma detection rate, and the first defecation interval. For low-risk patients, lactulose combined with polyethylene glycol regimen has few advantages over traditional polyethylene glycol regimen.
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BACKGROUND@#High-frequency irreversible electroporation (H-FIRE) is a novel, next-generation nanoknife technology with the advantage of relieving irreversible electroporation (IRE)-induced muscle contractions. However, the difference between IRE and H-FIRE with distinct ablation parameters was not clearly defined. This study aimed to compare the efficacy of the two treatments in vivo.@*METHODS@#Ten Bama miniature swine were divided into two group: five in the 1-day group and five in the 7-day group. The efficacy of IRE and H-FIRE ablation was compared by volume transfer constant (Krans), rate constant (Kep) and extravascular extracellular volume fraction (Ve) value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), size of the ablation zone, and histologic analysis. Each animal underwent the IRE and H-FIRE. Temperatures of the electrodes were measured during ablation. DCE-MRI images were obtained 1, 4, and 7 days after ablation in the 7-day group. All animals in the two groups were euthanized 1 day or 7 days after ablation, and subsequently, IRE and H-FIRE treated liver tissues were collected for histological examination. Student's t test or Mann-Whitney U test was applied for comparing any two groups. One-way analysis of variance (ANOVA) test and Welch's ANOVA test followed by Holm-Sidak's multiple comparisons test, one-way ANOVA with repeated measures followed by Bonferroni test, or Kruskal-Wallis H test followed by Dunn's multiple comparison test was used for multiple group comparisons and post hoc analyses. Pearson correlation coefficient test was conducted to analyze the relationship between two variables.@*RESULTS@#Higher Ve was seen in IRE zone than in H-FIRE zone (0.14 ± 0.02 vs. 0.08 ± 0.05, t = 2.408, P = 0.043) on day 4, but no significant difference was seen in Ktrans or Kep between IRE and H-FIRE zones at all time points (all P > 0.05). For IRE zone, the greatest Ktrans was seen on day 7, which was significantly higher than that on day 1 (P = 0.033). The ablation zone size of H-FIRE was significantly larger than IRE 1 day (4.74 ± 0.88 cm2vs. 3.20 ± 0.77 cm2, t = 3.241, P = 0.009) and 4 days (2.22 ± 0.83 cm2vs. 1.30 ± 0.50 cm2, t = 2.343, P = 0.041) after treatment. Apoptotic index (0.05 ± 0.02 vs. 0.73 ± 0.06 vs. 0.68 ± 0.07, F = 241.300, P 0.05). Electrode temperature variations were not significantly different between the two zones (18.00 ± 3.77°C vs. 16.20 ± 7.45°C, t = 0.682, P = 0.504). The Ktrans value (r = 0.940, P = 0.017) and the Kep value (r = 0.895, P = 0.040) of the H-FIRE zone were positively correlated with the number of hepatocytes in the ablation zone.@*CONCLUSIONS@#H-FIRE showed a comparable ablation effect to IRE. DCE-MRI has the potential to monitor the changes of H-FIRE ablation zone.
Subject(s)
Animals , Contrast Media , Electroporation , Follow-Up Studies , Liver/surgery , Magnetic Resonance Imaging , SwineABSTRACT
Objective:To investigate the optimal emergency endoscopy timing in patients with esophagogastric variceal bleeding (EGVB).Methods:The clinical data of patients with EGVB emergency endoscopy in Renmin Hospital of Wuhan University from December 2018 to November 2020 were collected and analyzed. According to the time interval from admission to the start of emergency endoscopy, they were divided into emergency endoscopy group (<6 h, n=115) and early endoscopy group (6-24 h, n=57). The baseline data, clinical efficacy and postoperative situation of the two groups were compared, and the risk factors of 6-week mortality of EGVB emergency endoscopy were analyzed by univariate and multivariate analysis. Results:In terms of baseline characteristics, there were no significant differences in age, gender, causes, shock index, model for end-stage liver disease (MELD) score, charlson complication index (CCI) score, portal hypertension related complications between the two groups ( P<0.05). However, the albumin (ALB) in emergency endoscopy group was significantly lower than that in early endoscopy group ( P<0.001). There were significant differences in Child Pugh grading and Child Pugh score between the two groups ( P=0.002, P=0.001). In terms of endoscopic efficacy, the detection rate of bleeding site in emergency endoscopy group was significantly higher than that in early endoscopy group (90.4% and 73.7%, P<0.05). There was no significant difference in operation duration, immediate hemostasis success rate, 5-day rebleeding rate, rescue treatment demand and 6-week mortality between the two groups ( P>0.05). There was no significant difference in bleeding related death between the two groups ( P>0.05). In addition, there was no significant difference in blood product consumption, intensive care unit (ICU) stay and total hospital stay between the two groups ( P>0.05). Multivariate analysis showed that Child Pugh grade C ( P=0.018), MELD score ( P=0.005) and CCI score ( P=0.001) were independent risk factors for 6-week death outcome of EGVB patients, while emergency endoscopic intervention time was not related to 6-week death outcome ( P=0.5). Conclusions:The efficacy of early endoscopic intervention is no worse than that of emergency endoscopic intervention, except for the identification of bleeding site. Child-Pugh grade C, MELD score, and CCI score are the independent risk factors for 6-week mortality, while the timing of emergency endoscopy is not associate with 6-week mortality in EGVB patients.
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In the present study, the composition and content of pulmonary surfactant (PS) were analyzed to explore the hypoxia adaptation mechanism in plateau zokors (Myospalax baileyi) and plateau pikas (Ochotona curzoniae). 36 plateau zokors and plateau pikas were trapped alive at the Laji Mountain in Guide County, Qinghai Province (at the altitude of about 3 600 m), and 36 Sprague-Dawley (SD) rats were purchased from the experimental animal center of Lanzhou University (at the altitude of about 1 500 m). All animals were lavaged after laboratory anesthesia, the blood in lung tissues was fully washed out and the lung tissues were then taken out to obtain the bronchoalveolar lavage fluid by bronchoalveolar lavage. The composition and content of phospholipids in the PS of three different kinds of animals were analyzed by using high performance liquid chromatography; the protein composition, content and types in the PS were analyzed by G-250 Coomassie brilliant blue method, polyacrylamide gel electrophoresis (PAGE) and mass spectrometry; the dissolved oxygen in the PS solutions were determined by using dissolved oxygen electrode. The results showed that the total contents of phospholipids in the PS were successively increased among plateau zokors, plateau pikas and SD rats (P 0.05). The relative content of PSe had no significant differences between plateau zokors and plateau pikas (P > 0.05), but both were significantly higher than that of SD rats (P < 0.01). The serum albumin (SA) was identified in the PS of three kinds of animals, including homologous tetramer protein containing heme, which is composed of hemoglobin β subunit, in plateau zokors and plateau pikas. Immunoglobulin (Ig) heavy chain was found in PS of plateau zokors and SD rats. The content of Ig heavy chain in plateau zokor was significantly higher than that in SD rats (P < 0.01), and the content of protein containing heme was significantly higher than that in plateau pikas (P < 0.05). The amount of dissolved oxygen was successively decreased in the PS among plateau zokors, plateau pikas and SD rats (P < 0.01), but it was significantly higher than that in saline (P < 0.01). These results suggest that the total content of proteins in the PS of plateau zokors and plateau pikas was significantly higher, while the total content of phospholipids was significantly decreased. There were high content of homologous tetramer protein containing heme in the PS of plateau zokors and plateau pikas. The relative content of DPPC, the main component of phospholipids, was significantly increased in plateau zokors. The changes of PS component and content improve the adaptability of the two plateau animals in hypoxia environment.
Subject(s)
Animals , Rats , Altitude , Hypoxia , Lagomorpha , Pulmonary Surfactants , Rats, Sprague-DawleyABSTRACT
OBJECTIVE@#To evaluate the clinical efficacy of acupuncture at different timings in acute stage for limb dysfunction in patients with cerebral infarction.@*METHODS@#A total of 101 patients with cerebral infarction limb dysfunction were divided into an early exposure group (@*RESULTS@#Compared before treatment, the mRS grade at 30 and 60 days after onset in the early exposure group was improved (@*CONCLUSION@#The timing of acupuncture is an independent factor affecting the disability status and limb motor dysfunction in patients with cerebral infarction, and the effect of early intervention may be better than late intervention.
Subject(s)
Humans , Acupuncture Points , Acupuncture Therapy , Cerebral Infarction/therapy , Pilot Projects , Prospective Studies , Stroke , Treatment OutcomeABSTRACT
OBJECTIVE：To provi de reference for the construction of shared TCM pharmacy information platform based on county medical alliance. METHODS ：By literature research ，the construction and development of TCM pharmacy in primary medical and health institutions were analyzed ，and the feasibility ，advantages and limitations of shared TCM pharmacy based on county medical alliance were also analyzed. The construction process and method of shared TCM pharmacy information platform based on county medical alliance introduced from aspects of overall architecture ，business model and main functions. RESULTS & CONCLUSIONS：The policies for the revitalization and development of medical alliance and TCM ，the needs for the improvement of grass-roots TCM service ability ，and the application of modern information technology provide the feasibility for the construction of shared TCM pharmacy based on county medical alliance. The construction of shared TCM pharmacy based on county medical alliance can broaden TCM list in the primary medical institutions ，integrates and diverts human resources ，save costs ，and provides homogeneous and standardized pharmaceutical care. However ，it is generally affected by non information technology factors such as county regional environment ，policy support ，logistics distribution speed ，cost benefit sharing. T he shared TCM pharmacy information platform based on county medical alliance is mainly based on the TCM alliance led by county-level TCM hospital ，and constructs business model from three aspects ：business processing ，business management and business sharing on the basis of the health information platform of TCM department. Its main functions include the whole flow management of TCM decoction pieces ， TCM dispensing ，decocting，distribution，pharmaceutical care ，quality control ，convenient service and interface management and so on. The application of shared TCM pharmacy information platform based on county medical alliance helps the opening of the business cooperation and information sharing channel of shared TCM pharmacy based on county medical alliance expands the service scope of TCM ，and enhances the TCM service ability in primary medical institutions.
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OBJECTIVE@#To investigate the clinical efficacy and prognosis of double-hit multiple myeloma patients with deletion P53 treated with regimen based on bortezomib.@*METHODS@#The ethnical data from 186 newly diagnosed MM patients hospitalized in the Department of Hematology of Harrison International Peace hospital from January 2012 to January 2019 were analyzed retrospectively. The fluorescent in situ hybridization (FISH) and G-binding staining were used to detect cytogenetic abnormalities (P53 deletion, lq21 amplification and IgH rearranagement) for analyses of complete remission (CR), overall response rate (ORR), progression-free survival (PFS) and overall survival (OS) of patients treated with bortezomib for 4 circles.@*RESULTS@#In 186 patients, simple P53 deletion was 14 cases, 1q21 amplification and P53 deletion were found in 11 cases (A group), t (14;16) and P53 deletion in 7 cases (B group), t (4;14) and P53 deletion in 9 cases (C group). The complete remission rate (CR%) of above-mentioned three groups was 27.27%, 28.57% and 33.33% respectively, and the ORR of the three groups was 54.54%, 57.14% and 55.56%, respectively, there was no statistically significant difference between the three groups (P＞0.05). The patients with 1q21 amplification and P53 deletion had shorter OS and PFS time (P=0.041, P=0.046). The double-hit patients with 1q21 amplification showed shorter OS time, compared with the patients with P53 deletion (P=0.027). The double-hit patients with t(14;16) and t(4;14) showed shorter OS time (P=0.871, P=0.276) and PFS time (P=0.955, P=0.379) than those of the patients with P53 deletion.@*CONCLUSION@#P53 deletion and 1q21 amplification are an adverse prognostic factor of early recurrence and short lifetime in patients with newly diagnosed double-hit MM.
Subject(s)
Humans , Bortezomib , Chromosome Aberrations , In Situ Hybridization, Fluorescence , Multiple Myeloma , Prognosis , Retrospective Studies , Treatment Outcome , Tumor Suppressor Protein p53ABSTRACT
OBJECTIVE@#To study therapeutic efficacy and side effects of single decitabine for DNMT3A myelodysplastic syndrome (MDS) patients.@*METHODS@#The clinical characteristics, efficacy and side effects of 59 myelodysplastic syndrome patients received the decitabine therapy in our center from January 2015 to December 2018 were retrospectively analyzed. Based on gene mutations, these patients were divided into 2 groups: DNMT3A MDS patients (n=27) and DNMT3A MDS patients (n=32). All patients in two groups were treated with decitabine for 4 circles. The efficacy and side effects in the two groups were compared.@*RESULTS@#The median age of patients in DNMT3A MDS group was 56.2 (37-81) which was no statistic difference from DNMT3A MDS group. And there was no statistical difference including age, white blood cells, hemoglobin and platelet count between the two groups (P＞0.05). The ORR and complete response (CR) rate of DNMT3A group were 70.37% and 40.74%, the ORR and CR rate of DNMT3A group were 40.63% and 21.88% respectively. Significant differences were observed in ORR rate (P=0.035) between two groups. However, significant differences did not found in CR rate (P=0.159) between two groups, The similar adverse reaction was observed in DNMT3A and DNMT3A MDS patients. Among the 59 patients, 21 patients showed TP53+ mutation. DNMT3A/TP53 MDS patients (n=13) had similar ORR and CR compared with the DNMT3A/TP53 MDS patients (n=8) (P＞0.05). The overall survival (OS) in DNMT3A MDS group and DNMT3A MDS group were 29.1±13.4 months and 27.8±14.4 months, respectively, no significant differences between two groups were observed (P=0.475).@*CONCLUSION@#Decitabine treatment is an effective and safe for DNMT3A MDS patients, but not shows better survival advantage.
Subject(s)
Humans , Azacitidine , Decitabine , Myelodysplastic Syndromes , Retrospective Studies , Treatment OutcomeABSTRACT
OBJECTIVE@#To investigate the expression characteristics and clinical value of OTC4 gene in patients with myelodysplastic syndrome (MDS).@*METHODS@#Sixty-five patients with MDS were selected from June 2017 to April 2018, and 39 healthy subjects were selected as control group. Mononuclear cells were isolated from bone marrow collected by aseptic puncture. The OTC4 gene level of MDS patients was detected by RT-PCR, and the OTC4 protein of MDS patients was detected by Western blot. The survival curve of MDS patients was drawn by Kaplan-Meier. Cox multivariate analysis was used to analyze the independent prognostic factors.@*RESULTS@#The relative expression level of OTC4 gene in MDS patients was significantly higher than that in the control group (P＜0.05). Western blot showed that the expression level of OTC4 protein in MDS patients was higher than that in the control group (P＜0.05). OTC4 gene expression level closely related with the leukocyte count, and the level of hemoglobin, and lactate dehydrogenase and platelet count in MDS patients (P＜0.05). CR rate of MDS patients with low OTC4 gene expression was 54.8%, which was higher than that of high OTC4 gene expression group (P＜0.05), while HI, SD and PD rates of MDS patients with low OTC4 gene expression were 9.7%, 12.9% and 6.5% respectively, which were lower than those of high OTC4 gene expression group (P＜0.05). Kaplan-Meier survival analysis showed that OS and DFS in patients with low OTC4 gene expression were superior to those with high OTC4 gene expression (P＜0.05). Multivariate Cox regression analysis showed that leukocyte count and OTC4 gene were independent influencing factors for OS (P＜0.05), platelet level and OTC4 gene expression were independent influencing factors for DFS (P＜0.05).@*CONCLUSION@#OTC4 gene closely relates with the severity of MDS. The patients with lower expression of OTC4 gene have better prognosis, the detection of OTC4 gene has higher clinical value for evaluating the prognosis of MDS patients.
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Objective:To compare the different follow-up methods on compliance and prognosis of non-selective beta blockers (NSBBs) for out-patients with secondary prevention of esophagogastric variceal bleeding (EGVB).Methods:A total of 72 patients with portal hypertension and esophageal gastric varices (EGV), who were admitted to the department of gastroenterology, Renmin Hospital of Wuhan University from July 2018 to April 2019 were randomly included in the traditional outpatient follow-up group (group A, 24), remote platform follow-up group (group B, 23) and combined follow-up group (group C, 25) according to the random number table. The patient′s medication compliance, heart rate response, condition change and treatment were recorded. NSBBs medication compliance, influencing factors and prognosis of patients in different groups were analyzed.Results:Forty (40/72, 55.6%) patients had good compliance with NSBBs, among which 34 (34/40, 85.0%) achieved heart rate response. The medication compliance of the group B (15/23, 65.2%) and the group C (17/25, 68.0%) was higher than that of the group A (8/24, 33.3%; χ2=4.778, P=0.029; χ2=5.889, P=0.015, respectively). There was no significant difference in the medication compliance between the group B and the group C ( χ2=0.042, P=0.838). In the group A, the subgroup of good compliance had higher proportion of local patients than that of poor compliance subgroup [7/8 VS 37.5% (6/16), P=0.033]. Patients with good drug compliance had higher proportion of gastroscopy review than that of poor compliance patients [75.0% (30/40) VS 21.9% (7/32), χ2=20.085, P<0.001] and less patients with EGVB [5.0% (2/40) VS 21.9% (7/32), P=0.073]. Conclusion:Patients with portal hypertension and EGV have poor compliance with NSBBs. Remote platform follow-up is a better way to improve compliance of drug prevention. Patients with good NSBBs compliance have a higher compliance of gastroscopy review. The risk assessment of variceal bleeding and endoscopic sequential therapy based on the results of gastroscopy review are expected to reduce the risk of EGVB.
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Objective: To compare clinical efficacy of interventional treatment with graft vessel and native coronary artery for patients with late saphenous vein grafts disease(SVGD) after coronary artery bypass grafting (CABG). Methods: A total of 1 608 patients underwent CABG in Tianjin Chest from March 2014 to December 2017 were screened. During the follow-up period, 165 hospitalized patients with recurrence of angina pectoris within one year after CABG, who had at least one narrow vein graft(≥50%) confirmed by the coronary angiography were enrolled. According to the results of angiography and surgeon's clinical experiences, the patients received interventional treatment to vein grafts(grafts group, n=53) or native coronary vessels(native group, n=112). The operation success rate, mortality and incidence of serious complications after interventional treatment in two groups at the time of hospitalization were compared.And the incidence of major adverse cardiovascular events(MACE) in two groups at one year after discharge were also compared. Kaplan-Meier survival curve was used to compare the cumulative event-free survival rates. The risk factors for the MACE in the patients with late SVGD and treated by interventional therapy were analyzed by Cox regression analysis. Results: A total of 165 patients were included for analysis, including 98 males(59.4%). The age was (64.2±7.1) years old. The follow-up time was 12 (8, 12) months. In the grafts group, operation success rate was 90.57%(48/53), and 3 cases(5.66%) suffered from serious complications after interventional treatment, 2 cases(3.77%) died. For native group the operation success rate was 88.39%(99/112), and 7(6.25%) cases suffered from serious complications after interventional treatment, and no deaths. The operation success rate and the incidences of serious complications after interventional treatment in two groups had no statistically significant difference(both P>0.05). The mortality in hospital of native group was lower than that in grafts group(P<0.05). Within 12 months after discharge, there was no statistically significant difference in incidence of MACE of two groups (11.32%(6/53) vs. 10.71%(12/112), P>0.05). Survival analysis showed that the cumulative event-free survival rates in two groups were 73.58% (39/53) and 66.13%(74/112), and there was no statistically significant difference (P>0.05). Cox regression analysis showed acute coronary syndrome (HR=41.203, 95%CI 4.859-349.361, P<0.01), and peripheral vascular diseases (HR=2.808, 95%CI 1.067-7.393, P<0.05) were the risk factors of the MACE for the patients treated by interventional therapy with late SVGD. Conclusion: For the patients with late SVGD after CABG, the success rate of intervention with vein grafts and own coronary vessels are both high with satisfactory safety.The in-hospital mortality of interventional therapy in own coronary vessels is lower than in graft vessel. Patients with acute coronary syndrome and peripheral vascular disease have a poor prognosis.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Coronary Angiography , Coronary Artery Bypass , Coronary Artery Disease/surgery , Coronary Vessels , Saphenous Vein , Time Factors , Treatment OutcomeABSTRACT
Compartment model and statistical moment model are important theories of pharmacokinetics. However, they have obvious limitations due to the influence of drug distribution. Sometimes, the demarcation point between the distribution phase and the elimination phase of the compartment model is difficult to determine, which results in inconvenience for its application. The nature of zero order moment, AUC of statistical moment model, is blood drug concentration, but not drug amount in the body. For drugs of two-compartment or multi-compartment models, the results reflect alterations in blood drug concentration, not necessarily changes in the amount of drug in the body. In the slow and steady intravenous drip, the drug distribution in the body is basically balanced, and the alteration of blood drug concentration can reflect the alteration of drug amount in the body. Over 5 half-life, the blood drug concentration basically reaches a stable status. And the alteration of the blood drug concentration only reflects the drug elimination. For first-order kinetic drugs, the elimination rate constant (K) can be calculated by linear regression according to the elimination rule (lnC=lnC0-Kt). And then, the half-life (t1/2), the amount of drug in the body, the apparent distribution volume (Vd), and the clearance rate (CL) can be calculated successively. During slow and constant velocity intravenous dripping, drug amount is proportional to blood drug concentration in the body. And there is an exponential relationship between the blood drug concentration and time [Ct=C0+(Css-C0) (1-e-Kt)]. The first-order exponential regression is performed between Ct and t to calculate elimination threshold concentration (C0), steady blood drug concentration (Css) and K. Then, t1/2, steady drug amount (Ass), Vd and CL are calculated. The distributed equilibrium model avoids the interference of drug distribution, and is closer to reality.
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Objective@#To investigate the epidemiological characteristics and causes of an outbreak of respiratory infection in schools.@*Methods@#Epidemiological investigation was carried out on respiratory infection cases in schools. Pharyngeal swab samples of children were collected for respiratory tract virus nucleic acid detection, and hexon genes were amplified. Positive PCR result were sequenced.@*Results@#All cases were in school, involving 2 classes, 12 cases in class 2 (3) and 13 cases in class 3 (4), all on the west side of the 2nd and 3rd floors of teaching building 2. From September 3 to September 12, a total of 25 cases were involved, with the onset peak on the 10th and 11th. The clinical features were fever, cough, sore throat and aching limbs, etc. The onset was aggregated, the course of the disease was about 5 d, the prognosis was good, and there were no deaths. There are 13 males and 12 females. The males to females ratio is 1.08∶1. The age distribution is 7-9 years, with an average of 8.6 years. The result of fluorescence quantitative PCR were negative for influenza A/B virus and positive for adenovirus. The products of positive samples after PCR amplification were sequenced as AdV-3 and AdV-4.@*Conclusions@#The combined result of epidemiological investigation and laboratory tests demonstrated that this epidemic of school respiratory tract infection is an upper respiratory tract infection caused by adenovirus B3 and E4 mixed infection.