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ObjectiveWe conducted a two-sample Mendelian randomization （MR） study to assess the causal relationship between circulating isoleucine， leucine and valine levels and the risk of peripheral atherosclerosis. MethodsBased on the large-scale genome-wide association study （GWAS） database， single nucleotide polymorphisms （SNPs） closely related to the circulating levels of isoleucine， leucine and valine were identified as instrumental variables （IVs）. Two-sample MR analysis applying the inverse variance weighted （IVW） method and the weighted median estimator （WME） method were performed to estimate the causal relationship between the risk of peripheral atherosclerosis and the exposure with more than three SNPs that were available as IVs. The pleiotropy was evaluated by using the MR-Egger regression and MR-PRESSO method， and the leave-one-out method was used in sensitivity analysis. ResultsFour， one and one SNPs were identified as IVs for circulating isoleucine， leucine and valine levels， respectively. For isoleucine， the IVW model demonstrated there was no evidence of heterogeneity among the IVs （P=0.715）， and there was a significant causal relationship between the increase of circulating isoleucine level and a higher risk of peripheral atherosclerosis risk. Per every 1 elevated standard deviation （SD） of circulating isoleucine level resulted in increasing 31% of peripheral atherosclerosis risk （OR=1.31， 95%CI： 1.07‒1.61）. Similarly， the OR（95%CI） was 1.33 （1.04‒1.71） in the WME model. The MR-Egger regression and MR-PRESSO analysis indicated no evidence of pleiotropy in IVs （all P>0.05）. The result of the leave-one-out sensitivity analysis was stable. The Wald ratio model displayed that the causal relationship between circulating leucine and valine levels and the risk of peripheral atherosclerosis was not statistically significant. The OR （95%CI） for leucine and valine was 1.13 （0.78‒1.63） and 1.11 （0.82‒1.50）， respectively. ConclusionThere is a significant causal relationship between the increase of circulating isoleucine level and a higher peripheral atherosclerosis risk. The causal relationships between circulating leucine and valine levels and the risk of peripheral atherosclerosis need to be further confirmed in future studies.
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:To establish and verify a risk prediction nomogram for ipsilateral axillary lymph node metastasis in breast cancer stage T1 （mass ≤ 2 cm）. :The clinicopathological data of 907 patients with T1 breast cancer who underwent surgical treatment from January 2010 to June 2015 were collected，including 573 cases from the Second Affiliated Hospital of Zhejiang University School of Medicine （modeling group） and 334 cases from Zhejiang University Lishui Hospital （verification group）. The risk factors of ipsilateral axillary lymph node metastasis were analyzed by univariate and multivariate logistic regression. The influencing factors were used to establish a nomogram for predicting ipsilateral axillary lymph nodes metastasis in T1 breast cancer. The model calibration，predictive ability and clinical benefit in the modeling group and the verification group were analyzed by C index，receiver operating characteristic curve，calibration curve and decision curve analysis （DCA） curve，respectively. :Univariate analysis showed that lymph node metastasis was related with primary tumor size，vascular tumor thrombus，Ki-67，histopathological grade，and molecular type （ vascular tumor thrombus，Ki-67 positive，estrogen receptor （ER） positive，and histopathological grade 2-3 were independent risk factors of axillary lymph node metastasis （<0.05 or <0.01）. Based on the independent risk factors，a nomogram prediction model was established. The C indexes of the model group and the validation group were 0.739 （95%:0.693-0.785） and 0.736 （95%:0.678-0.793），respectively. The calibration curve and DCA curve of the modeling group and the verification group indicated that the model was consistent and had good clinical benefit. :Primary tumor size，histopathological grade，vascular tumor thrombus，Ki-67，and ER status are predictors of ipsilateral axillary lymph node metastasis in T1 breast cancer. The established prediction nomogram can effectively predict the risk of ipsilateral axillary lymph node metastasis in T1 breast cancer，which can be used as a reference for individualized axillary management.
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Female , Humans , Axilla , Breast Neoplasms , Lymph Nodes , Lymphatic Metastasis , Nomograms , Retrospective StudiesABSTRACT
Objective@#To explore the effect of family need-based health education mode on family members under stress caused by transferring their children out of pediatric intensive care unit(PICU).@*Methods@#A total of 40 family members of children transferred from PICU of Shengjing Hospital of China Medical University from July to December 2017 were selected as the control group, and 40 family members of children transferred from April to September 2018 were selected as the observation group. In the control group, daily routine health education mode were implemented by nurses on the relatives, while in the observation group, nurses provide the family members of children with corresponding graphic and text materials of health education according to the 2 copies of Critical Care Family Needs Inventory completed by their relatives within 24 hours and 72-96 hours of admission, and implement the daily health education combined with the Flipped Classroom method. The level of uncertainty in illness, stress in transfer and the satisfaction for family-centered nursing were compared between the groups.@*Results@#In the observation group, the total score of the family members′ level of uncertainty in illness and stress in transfer were (80.05 ± 3.96) and (39.65 ± 2.41) points respectively, which were lower than those in the control group (99.70 ± 3.78) and (67.15 ± 2.38) points, and all the differences were statistically significant (t=-22.60, -50.21, P<0.01). The satisfaction for family-centered nursing in the observation group was higher than the control group, and the difference was statistically significant (P < 0.05).@*Conclusions@#The implementation of health education mode based on family needs is beneficial to reduce the level of uncertainty in illness of the family members of critically ill children transferred out of PICU, relieve the stress in transfer, and thus improving the family-centered high-quality nursing services in PICU.
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Drug retention enema is a common therapy for various illnesses. However, it is impossible to keep the drug in the colon for a long time, due to the limitation of the current equipment, and it is unable to achieve the purpose of retention enema. A retention enema device was designed by the department of intensive care unit (ICU) of Dongfeng Hospital Affiliated to Hubei University of Medicine. The retention enema device adds a spindle shaped inflatable air bag on the basis of the traditional enema device, which not only fix on the anus, but also prevent the leakage of enema fluid. It can achieve retention enema, play the enema drug effect fully, and significantly reduce the nursing workload, in addition, the silica gel material of the retention enema device ensures the comfort of the patients, the decompression air bag also avoids the damage of the high pressure of the spindle fixed air bag for the patients, which is worthy of clinical use.
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Drug retention enema is a common therapy for various illnesses. However, it is impossible to keep the drug in the colon for a long time, due to the limitation of the current equipment, and it is unable to achieve the purpose of retention enema. A retention enema device was designed by the department of intensive care unit (ICU) of Dongfeng Hospital Affiliated to Hubei University of Medicine. The retention enema device adds a spindle shaped inflatable air bag on the basis of the traditional enema device, which not only fix on the anus, but also prevent the leakage of enema fluid. It can achieve retention enema, play the enema drug effect fully, and significantly reduce the nursing workload, in addition, the silica gel material of the retention enema device ensures the comfort of the patients, the decompression air bag also avoids the damage of the high pressure of the spindle fixed air bag for the patients, which is worthy of clinical use.
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Di-(2-ethylhexyl) phthalate (DEHP) is an ubiquitous environmental contaminant because of its extensive use in plastics and its persistence. As an environmental endocrine disruptor, it is suspected to interfere with neurodevelopment in people. However, evidence of the effects of maternal DEHP exposure on cerebellar development in offspring is scarce. The objective of this study was to investigate maternal exposure to DEHP and its effect on apoptosis of cerebellar granule cells (CGCs) and related mechanisms. Pregnant Wistar rats were administrated DEHP (0, 30, 300 and 750 mg/kg/d) by gavage from gestational day (GD) 0 to postnatal day (PN) 21. Primary CGCs were also exposed to mono-(2-ethylhexyl) phthalate (MEHP), the main metabolite of DEHP, for 24 h with concentrations of 0, 25, 100 and 250 µM. The CGCs of male offspring from 300 and 750 mg/kg/d DEHP exposure groups showed significantly increased apoptosis. In addition, the PI3K/AKT signaling pathway was inhibited in the male offspring of the 300 and 750 mg/kg/d DEHP exposure groups. However, effects on female pups were not obvious. Apoptosis was also elevated and the PI3K/AKT signaling pathway was inhibited after primary CGCs were exposed to MEHP. Furthermore, apoptosis was reduced after treatment with the PI3K/AKT signaling pathway activator, insulin-like growth factor (IGF) 1, and increased after treatment with LY294002, an inhibitor of the PI3K/AKT signaling pathway. These results suggested that maternal DEHP exposure induced apoptosis in the CGCs of male pups via the PI3K/AKT signaling pathway, and the apoptosis could be rescued by IGF1 and aggravated by LY294002.
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Female , Humans , Male , Apoptosis , Diethylhexyl Phthalate , Maternal Exposure , Plastics , Rats, WistarABSTRACT
Objective: To explore influence of urokinase on expression of soluble CD40 ligand (sCD40L) in patients with acute coronary syndrome (ACS).Methods: A total of 94 ACS patients diagnosed and treated in our hospital from Aug 2013 to Aug 2015 were selected.According to random number table, they were randomly and equally divided into routine treatment group and urokinase group (received small dose urokinase intravenous drip based on routine treatment group).Levels of sCD40L and cardiac troponin T (cTnT) before and after treatment, therapeutic effect and incidence rate of major adverse cardiovascular events (MACE) were measured and compared between two groups.Results: Compared with before treatment, there were significant reductions in levels of sCD40L and cTnT in both groups after treatment, P<0.01 all;compared with routine treatment group after treatment, there were significant reductions in levels of sCD40L [(2.92±0.36) ng/ml vs.(2.58±0.18) ng/ml] and cTnT [(0.10±0.02) μg/L vs.(0.04±0.01) μg/L] in urokinase group, P=0.013, 0.001 successively.Compared with routine treatment group, there was significant rise in total effective rate (76.6% vs.95.7%),and significant reduction in incidence rate of MACE (34.0% vs.4.3%) within six months in urokinase group (P<0.01 both).Conclusion: Urokinase can significantly inhibit expression of sCD40L and reduce release of cTnT, and improve therapeutic effect, and prevent major adverse cardiovascular events in patients with acute coronary syndrome.
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Objective Postoperative cognitive dysfunction (POCD) is a common complication of cardiac surgery, which seriously affects the prognosis of the patient.This study aimed to explore the risk factors for early POCD in patients undergoing cardiac valve surgery and the correlation between early POCD and the serum S100B protein level.Methods Eighty patients underwent mitral valve replacement surgery in combination with tricuspid plasty.At 1 day before and 5 days after surgery, we assessed the cognitive function of the patients and divided them into a POCD and a non-POCD group.We obtained such data as the age, sex, education, New EuroSCORE Ⅱ, and preoperative NYHA cardiac function grades and left ventricle ejection fraction (LVEF) of the patients, collected the venous blood to determine serum S100B protein concentration by ELISA, and analyzed the independent risk factors of early POCD using single-factor and binary logistic regression analyses.Results POCD was found in 20 (25%) of the patients, , Logistic regression analysis showed the independent risk factors for early POCD to be hyperglycemia (OR=6.038, 95% CI: 1.202-30.337), operation time (OR=6.423, 95% CI: 1.276-32.332), and aspartate aminotransferase (AST, 2 times higher than normal) (OR=12.878, 95% CI: 2.289-72.445).The serum S100B protein concentrations in the POCD group were (1.9±0.3) μg/L and (1.7±0.4) μg/L at 48 and 72 hours after cardiopulmonary bypass, significantly lower than (2.4±0.4) μg/L and (2.1±0.3) μg/L at 30 minutes and 24 hours (P<0.05), and so was it in the non-POCD group at 72 than at 48 hours postoperatively ([1.4±0.4]) vs [1.5±0.4] μg/L, P<0.05).Conclusion Long operation time, perioperative hyperglycemia and high AST are independent predictors and the serum S100B protein level is a significant marker of early POCD.
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Object To establish and apply an evaluation method based on DEA in NSFC project performance evaluation. Methods Based on the analysis of NSFC projects in Peking University People's Hospital,this paper determined the evaluation index system of NSFC projects.The outputoriented DEA was selected and applied in the performance evaluation.Results We figures out the DEA ratio of every NSFC project with the established method in the program of DEAP Version 2.1.Conclusion The method based on DEA can reflect the performance of NSFC projects,and the evaluation results can provide project managers and the management department of NSFC with evidences and references to make polices for project management.
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Objective To evaluate the abstinence rate and relapse rate of smoker with ACS after discharged from hospital, to evaluate the effect of simple smoking cessation interventions.Methods 150 smokers with ACS were collected and was divided into simple intervention group ( n = 87) and control group (n = 63) , respectively, followed up for 6 months.2 months, 6 months abstinence rate, relapse rate were compared between two groups, logistic regression model was used to analyzed the relevant factors for relapse.Results The smoking rate in patients with ACS was 31.14% , 6-month continuous abstinence rate and 6-month relapse rate was 64.6% , 36.4% , respectively.6-month continuous abstinence rate and relapse rate between simple quit-smoking intervention group and control group showed no difference.Nicotine dependence score more than 4 points can be used as predictor of relapse.Conclusions The smoking rate and the abstinence rate of smoker with ACS is higher than the general population, simple quit-smoking intervention do not increase the success rate of quit-smoking, indicated the need to strengthen the intervention in patients with ACS and smoking.
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Objective To investigate blood level of triglyceride(TG)in community residents of urban and rural Beijing.Methods A total of 10 054 community residents were recruited by cluster samphng for investigation using questionnaire,as well as physical examinations and fasting plasma TG determination for diagnosing hypertriglyceridemia,during June to August,2007.Results Median of plasma level of TG of the participants was 1.17 mmol/L,ranging(0.81-1.78)mmoVL Totally,1234 people were diagnosed as borderline hypertriglyceridemia and 15 12 as hypertriglycefidemia.with prevalence of 12.27%and 15.04%,respectively.There was no significant difference in plasma level ofTG between men andwomen[1.16(0.80-1.84)mmol/L vs.1.18(0.81-1.75)mmol/L,P:0.187].Age-adjusted prevalence of borderline hypertriglyceridemia and hypertriglyeeridemia was higher in men than those in women(11.60% vs.10.90%and 20.32% vs.10.88%,respectively),and the same results were obrained in those less than 50 years old,however,reveraw outcomes were got in those more than 50 years old.Plasma level of TG,as well as prevalence of hypertriglyceridemia,were higher in those living in urban areas than those in rural areas[1.31(0.89-1.95)mmol/L vs.1.05(0.73-1.58)mmol/L].Awareness,proportion of people with hyperglycefidemia under treatment and proportion of those with TG under coutrol were 13.95%.35.92%and 38.51%,respectively.Standardized prevalence of borderline hyperglycefidemia and hyperglycefidemia were higher in those with coronary heart disease than those without it(24.79% vs.11.22%and 25.31% vs.15.35%,respectively).Conclusions Awareness,proportion of treatment and proportion of those under control for hyperglyceridemia were all lower in community residents of Beijing.Education and monitoring on hyperglyeeridemia should especially be strengthened for urban residents,women aged more than 50 years,and these with coronary heart disease.
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Objective To investigate the factors associated with awareness of dyslipidemia among residents in Beijing.Methods Cross-sectional data of 3 373 patients with dyslipidemia from CCEIP were analyzed.The patients were seleted from 10 054 residents from Daxing,Chaoyang,Haidian,and Xicheng Districts of Beijing during June-August,2007.The socioeconomic status and awareness of dyslipidemia were surveyed by questionnaires.The risk factors for cardiovascular diseases(CVDs),such as hypertension,obesity and diabetes,were assessed by physical examination and fasting blood analysis.Results (1)Awareness of dyslipidemia was improved with the increase of patients' age (P