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Community-acquired pneumonia (CAP) is the third leading cause of death worldwide and one of the most commonly infectious diseases. Its epidemiological characteristics vary with host and immune status, and corresponding pathogen spectrums migrate over time and space distribution. Meanwhile, with the outbreak of COVID-19, some unconventional treatment strategies are on the rise. This article reviewed the epidemiological characteristics, pathogen spectrum and treatment direction of CAP in China over the years, and aimed to provide guidance for the diagnosis and treatment of CAP in clinical practice.
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Humans , COVID-19 , Pneumonia/diagnosis , Community-Acquired Infections/drug therapy , Causality , Risk FactorsABSTRACT
Background@#The influencing factors of diabetic kidney disease (DKD) in Chinese patients with type 2 diabetes mellitus (T2DM) were explored to develop and validate a DKD diagnostic tool based on nomogram approach for patients with T2DM. @*Methods@#A total of 2,163 in-hospital patients with diabetes diagnosed from March 2015 to March 2017 were enrolled. Specified logistic regression models were used to screen the factors and establish four different diagnostic tools based on nomogram according to the final included variables. Discrimination and calibration were used to assess the performance of screening tools. @*Results@#Among the 2,163 participants with diabetes (1,227 men and 949 women), 313 patients (194 men and 120 women) were diagnosed with DKD. Four different screening equations (full model, laboratory-based model 1 [LBM1], laboratory-based model 2 [LBM2], and simplified model) showed good discriminations and calibrations. The C-indexes were 0.8450 (95% confidence interval [CI], 0.8202 to 0.8690) for full model, 0.8149 (95% CI, 0.7892 to 0.8405) for LBM1, 0.8171 (95% CI, 0.7912 to 0.8430) for LBM2, and 0.8083 (95% CI, 0.7824 to 0.8342) for simplified model. According to Hosmer-Lemeshow goodness-of-fit test, good agreement between the predicted and observed DKD events in patients with diabetes was observed for full model (χ2=3.2756, P=0.9159), LBM1 (χ2=7.749, P=0.4584), LBM2 (χ2=10.023, P=0.2634), and simplified model (χ2=12.294, P=0.1387). @*Conclusion@#LBM1, LBM2, and simplified model exhibited excellent predictive performance and availability and could be recommended for screening DKD cases among Chinese patients with diabetes.
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Background@#The influencing factors of diabetic kidney disease (DKD) in Chinese patients with type 2 diabetes mellitus (T2DM) were explored to develop and validate a DKD diagnostic tool based on nomogram approach for patients with T2DM. @*Methods@#A total of 2,163 in-hospital patients with diabetes diagnosed from March 2015 to March 2017 were enrolled. Specified logistic regression models were used to screen the factors and establish four different diagnostic tools based on nomogram according to the final included variables. Discrimination and calibration were used to assess the performance of screening tools. @*Results@#Among the 2,163 participants with diabetes (1,227 men and 949 women), 313 patients (194 men and 120 women) were diagnosed with DKD. Four different screening equations (full model, laboratory-based model 1 [LBM1], laboratory-based model 2 [LBM2], and simplified model) showed good discriminations and calibrations. The C-indexes were 0.8450 (95% confidence interval [CI], 0.8202 to 0.8690) for full model, 0.8149 (95% CI, 0.7892 to 0.8405) for LBM1, 0.8171 (95% CI, 0.7912 to 0.8430) for LBM2, and 0.8083 (95% CI, 0.7824 to 0.8342) for simplified model. According to Hosmer-Lemeshow goodness-of-fit test, good agreement between the predicted and observed DKD events in patients with diabetes was observed for full model (χ2=3.2756, P=0.9159), LBM1 (χ2=7.749, P=0.4584), LBM2 (χ2=10.023, P=0.2634), and simplified model (χ2=12.294, P=0.1387). @*Conclusion@#LBM1, LBM2, and simplified model exhibited excellent predictive performance and availability and could be recommended for screening DKD cases among Chinese patients with diabetes.
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Teaching evaluation is an important part of the whole teaching process. In view of the shortcomings of the traditional final assessment, formative assessment has received wide attention from the education community with its characteristics of diverse assessing subjects, diverse assessment contents and diverse assessment tools. This paper introduces formative assessment into flipped classroom, and tries to construct formative assessment index system, which may provide the theoretical basis for the implementation of formative assessment in flipped classroom.
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Objective To investigate the risk factors for anastomotic leakage (AL) after laparoscopic intersphincteric resection (Lap-ISR) for patients with low-lying rectal cancer.Methods This retrospective study was conducted in the Characteristic Medical Center of PLA Rocket Force from Jun 2011 to Nov 2018.151 patients undergoing Lap-ISR were enrolled for this study.Results All patients in this series had a defunctioning ileostomy.The overall leakage rate was 17.2％ (26/151),including peri-operative AL (n =20) and delayed AL (n =6).In accordance with the grading system of the International Study Group of Rectal Cancer,there were 24 patients (15.9％) with AL Grade B (requiring active therapeutic intervention) and two patients (1.3％) with AL Grade C (requiring re-laparotomy).Univariate analysis showed that BMI (≥ 25 kg/m2),tumor annularity (≥ 3/4) and operation time (≥ 240 min) were associated with AL (P ＜ 0.05).Multivariate analysis showed that operation time (≥ 240 min,OR =7.390,95％ CI:2.483-21.988,P =0.000),tumor annularity (≥ 3/4,OR =6.233,95％ CI:1.932-20.107,P=0.002) and higher BMI (≥ 25 kg/m2,OR=3.523,95％ CI:1.275-9.738,P=0.015)were independently predictive of AL Conclusion Tumor annularity,operation time and higher BMI are independently associated with symptomatic AL after Lap-ISR.
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Objective:To explore the relationship between body mass index (BMI) and clinicopathological features and prognosis of gallbladder cancer.Methods:The clinical and follow-up data of three hundred and eighty-six patients of gallbladder carcinoma were retrospectively, who were treated from January 2008 to December 2013 in the Department of Hepatobiliary Surgery, Eastern Hepatobiliary Hospital, Second Military Medical University. According to the guidelines for prevention and control of overweight and obesity in Chinese adults, the patients were divided into three groups: normal weight group(BMI<23.5 kg/m 2, 239 cases, accounting for 61.9%), overweight group (23.5 kg/m 2≤BMI<27.5 kg/m 2, 127 cases, accounting for 32.9%) and obesity group(BMI≥27.5 kg/m 2, 20 cases, accounting for 5.18%). The clinicopathological factors(gender, age, diabetes mellitus, hypertension, gallbladder related diseases, jaundice, tumor location, TMN, postoperative days, tissue differentiation, liver invasion, intraoperative blood transfusion, complications) of the three groups were compared, and the relationship between BMI and 5-year survival rate was analyzed. Measurement data with normal distribution were indicated as mean±standard deviation( Mean± SD), measurement data with skewed distribution were represented as M( P25, P75). Nonparametric rank sum test was used for measurement data. Categorical variables were compared by the chi-square test or Fisher probability method. The survival curve was drawn by the Kaplan-Meier method. The univariate analysis and multivariate analysis of prognosis were respectively done using the Log-rank test and COX regression model. Results:The median survival time of 386 patients with gallbladder cancer was 12.1 months. The overall survival rates of 1, 3 and 5 years were 51.8%, 25.2% and 16.8%, respectively. Univariate survival analysis showed that age, jaundice, accidental gallbladder cancer, tumor location, TMN, surgical method, tissue differentiation, liver invasion, intraoperative blood transfusion, and complications affected the 5-year survival rate ( χ2=12.24, 30.87, 37.01, 7.92, 104.23, 118.76, 12.05, 49.12, 6.85, 12.24, P<0.05). BMI was related to hypertension, but it had no significant effect on the 5-year survival rate. However, with the increase of BMI, the 5-year survival rate increased (16.3% vs 16.7% vs 23.3%, P=0.774). Multivariate survival analysis showed that surgical method( OR=1.441, 95% CI: 1.219-1.705), liver invasion( OR=1.625, 95% CI: 1.264-2.091), M stage( OR=1.664, 95% CI: 1.070-2.587), and N stage( OR=1.511, 95% CI: 1.218-1.875) were independent risk factors for prognosis in this group of patients ( P<0.05), and BMI was not an independent risk factor ( P=0.901). Conclusions:BMI has no significant effect on the prognosis of patients with gallbladder cancer. Obese patients with gallbladder cancer do not need to wait for weight loss before surgery.
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Objective To study the effect of systemic group music therapy (SGMT) on social living function and life quality in patients with schizophrenia. Methods By systematic sampling, 160 patients were divided into intervention group (80 patients) and control group (80 patients).Patients in the intervention group were treated by SGMT, and the control group was treated by general care.Comparison was made before intervention and 18 months after intervention on the following:scores of social living function as determined by the Activity of Daily Living Scale (ADL), Social Disability Screening Schedule (SDSS), and Social Maladjustment (SOC) scale.The WHO quality of Life-BREF scale was used to analyze score changes of patients′ life quality. Results ADL, SDSS and SOC scores of the patients in intervention group were significantly lower than those in control group (P values all 0.05).In comparison of the life quality scores, physical health, mental health and social relationship scores were higher in intervention group than those in control group(P values all < 0.05).There was no significant difference between two groups in environment scores(P>0.05). Conclusion Implementation of SGMT intervention can efficiently improve patients′ social living function and quality of life.
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Objective@#To investigate the influence of the degrees of intravesical prostatic protrusion (IPP) on the recovery of urinary continence after radical prostatectomy.@*METHODS@#We retrospectively analyzed the clinical data on 212 patients diagnosed with prostate cancer by biopsy and treated by laparoscopic radical prostatectomy by the same surgeon. Based on the degrees of IPP measured by MRI, we divided the patients into an IPP ≤ 10 mm group (n = 146) and an IPP > 10 mm group (n = 66) and determined the factors influencing the recovery of urinary continence by univariate and multivariate logistic regression analyses.@*RESULTS@#At 1, 3, 6 and 12 months after surgery, the urinary continence rates of the patients were 32.5%, 50.5%, 82.1% and 91%, respectively. Univariate analysis indicated that the factors influencing the recovery of urinary continence included IPP, body mass index (BMI), bladder neck preservation (BNP), neurovascular bundle preservation (NVBP) and clinical tumor (T) stage at 3 months (P 10 mm (P 10 mm and BMI ≥ 25 kg/m2 are independent factors influencing the long-term recovery of urinary continence after radical prostatectomy.
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OBJECTIVE: To investigate the relationship between urinary synaptopodin levels and clinical pathology in patients with diabetic nephropathy, in order to provide new biomarkers for diabetic nephropathy. METHODS: Seventy-five patients with diabetic nephropathy confirmed by renal biopsy were enrolled in this study. Those patientsin was in the First Affiliated Hospital of Zhengzhou University and the Second Hospital of Lanzhou University from September 2016 to December 2017. The level of urinary synaptopodin was measured and the relationship between urinary synaptopodin and clinical and pathological changes was analyzed. RESULTS: The levels of urinary synaptopodin/β-Actin in patients with nodular diabetic nephropathy and diffuse sclerosing diabetic nephropathy were significantly higher than those in the early diabetic nephropathy group(P<0.05). Correlation analysis indicated urinary synaptopodin/β-Actin had a positive correlation with 24-hour urine protein(r=0.408, P=0.014), urinary albumin(r=0.0.341, P=0.043) and serum creatinine(r=0.386, P=0.021) CONCLUSION: The level of urinary synaptopodin in patients with diabetic nephropathy is significantly increased and is associated with clinical and pathological conditions, which may become a potential new biomarker for diabetic nephropathy.
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Objective To investigate the treatment experience of rectal cancer patients with excessively extended surgery after neoadjuvant chemoradiotherapy.Methods Seven cases of rectal cancer patients admitted to our hospital from 2014 to 2016 with excessively extended surgical intervention (6 to 13 months) after neoadjuvant chemoradiotherapy were included in the present study.All of the patients were treated with radical surgery,and the operation effect and postoperative complications were observed.Results Three patients underwent anterior resection of the rectum (Dixon),including 2 cases of anastomotic leakage;3 cases occurred intestinal rupture during operation,1 of them complicated with postoperative pelvic abscess;there were 4 cases complicated with incision infection or liquefaction.No presacral venous plexus hemorrhage occurred.Conclusion Excessively extended surgery after neoadjuvant chemoradiotherapy increases the difficulty of operations and the occurrence of postoperative complications in patients with rectal cancer.
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Objective:To study the feasibility of a new composite mineralized collagen membrane in alveolar ridge preservation.Methods:The third mandibular premolars on both sides were extracted from 12 dogs,the 24 alveolar sockets were randomly assigned into A,B and C groups(n =8).The distal alveolar sockets of group A was immediately implanted with the new composite mineralized collagen membrane and bone graft material,those of group B with bone graft material,group C was the blank control.The healing of sockets was evaluated by gross observation,morphological measurements,X-ray microscope and photographs of spiral CT.Results:The horizontal width of the alveolar process of group A was bigger than that of group B (P ＜ 0.05),that of group B was bigger than that of group C (P ＜ 0.05).The region of extraction interest in spiral CT value was higher in group A than that in group B and C (P ＜ 0.05).The extraction sockets were generated new bone and the degree of reconstruction measurements was higher in group A than that in group B and C (P ＜ 0.05).Conclusion:The new composite mineralized collagen membrane can induce the regeneration of new bone,and preserve the alveolar.
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Objective Our retrospective study was aimed to analyze the clinical value of serum CEA and CA19-9 in patients with chole-lithiasis.Methods The clinical data of 98 patients with cholelithiasis and 44 patients with inguinal hernia received treatment in our hospital from February 2011 to February 2015 were retrospectively analyzed.The expressive levels of CEA and CA19-9 of the patients were detected and compared.The important roles of CEA and CA19-9 in the patients with cholelithiasis were analyzed.Results The levels of CEA,CA19-9 and inflammatory factors in normal group and control group had no statistical differences (P>0.05).The levels of CEA,CA19-9 and inflam-matory factors in rising group were higher than those in control group (P0.05),but the levels of CEA,CA19-9,inflammatory factors in rising group were obvi-ously decreased( P<0.05) .Conclusion The levels of CEA and CA19-9 in patients with cholelithiasis had correlation with inflammation of biliary tract,which will increased by severe choleithiasis.
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OBJECTIVE: To understand the general awareness of the residents around a newly built nuclear power,to evaluate the safety and the attitude on the construction of nuclear power. METHODS: By the stratified random sampling method,1 029 general publics and 260 representatives were selected for investigation. The participants were from 30 km range around the nuclear power plant,each 5 km was assigned as 1 layer and there were total 6 layers. RESULTS: 74. 9%( 965 /1 289) interviewees were not aware of nuclear power,3. 1%( 40 /1 289) interviewees were well or very-well understand nuclear power. The awareness score of the general publics was lower than that of the representatives( 1. 0 vs3. 0,P < 0. 01); male,younger people,higher educational level,higher family income,religious people and living close to the nuclear power plant had higher awareness( P < 0. 05). A total of 28. 4%( 366 /1 289) interviewees considered the nuclear power was very safe or safe. The evaluation of nuclear power safety of the general publics was inferior to the representatives( P < 0. 05). The representatives,older people and those living far away from the nuclear power have better evaluation on the nuclear power safety than the general publics( P < 0. 05). Only 13. 0%( 167 /1 289) interviewees supported building the nuclear power in their residence construction; male,people with family members working in nuclear power plant,people with high degree of awareness on nuclear power,considered highly safety of the nuclear power had higher support for the local nuclear power construction( P < 0. 05). The interviewees who mostly believe about nuclear energy sources were experts,government officials,plant management and domestic media. CONCLUSION: Residents around the nuclear power plant had low awareness of the knowledge about nuclear power. Therefore,it is necessary to enhance the awareness of residents on nuclear power and the trust on the government.
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Objective To explore the correlation of Connexion43(Cx43),E-cadherin(E-cad)in breast infiltrating ductal carcinoma tis-sue. Methods The expressions of Cx43 and E-cad proteins were detected in 89 cases breast infiltrating ductal carcinoma tissue,48 cases partition groups. by immunohistochemistry Elivision method. Results The expressions of Cx43 and E-cad has a better consistency in the tumor area,the border area and far cancer area of breast infiltrating ductal carcinoma. For both the negative expression in tumor area same time,the rate of lymph node metastasis was highest. Conclusion Cx43 and E-cad in breast invasive ductal carcinoma has a certain synergy in the process of the occurrence and development,which related to its metastasis occurred.
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Objective To observe the clinical curative effect of cinobufacini injection in the treatment of primary bronchopulmonary carcinoma.Methods 120 patients with primary bronchopulmonary carcinoma were randomly divided into the control group and treatment group,60 cases in each group.Patients of the control group were treated with the general,symptomatic and dialectical therapy.Patients of the treatment group were given general,symptomatic,dialectical treatment and cinobufacini injection.The curative effect was determined by the standard efficacy of tumor,the survival quality of the patients was judged by the Karnofsky score.The adverse reactions,median survival time and the survival rate were compared between the two groups.Results The effective rate of the control group was 40.0％,that of the treatment group was 56.7％,the difference was statistically significant (x2 =4.034,P ＜ 0.05).By the Karnofsky score,27 patients of the control group were stable,39 patients of the treatment group were stable,the difference was statistically significant(x2 =12.265,P ＜0.05).Median survival time of the control group was (168 ± 16) d,that of the treatment group was (178 ± 20)d,the difference was statistically significant(x2 =12.265,P ＜ 0.05).One year survival rates of the control group and the treatment group were 5.0％,10.0％,the difference was statistically significant.There was no statistically significant difference between two groups in adverse reactions (P ＞ 0.05).Conclusion Cinobufacini injection can improve the quality of life and prolong survival of patients with primary bronchopulmonary carcinoma.It is effective and safe in clinical application.
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[Objective] To explore the clinical effect of Buyang Huangwu Decoction and Guipi Decoction together on BTS. [Method] Select 48 cases of BTS in accordance of diagnosis standard, divide them into treatment group 48 cases(take revised Buyang Huangwu Decoction and Guipi Decoction ) and control one 20(routine western medicine), judge their cure effect after 2~4 courses. [Result] The cure rate and total effective rate were respectively 60.42%and 87.50% for treament group, for control one, they were respectively 30.00% and 65.00%; with χ2 test, their differences were respectively of marked statistical meaning and statistical meaning. [Conclusion] Buyang Huangwu Decoction and Guipi Decoction together had definite cure effect on BTS.
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Objective To establish the quality standard of Zhilou Lotion. Methods TLC was adopted to identify Radix et Rhizoma Rhei and Cortex Phellodendri. HPLC was adopted to determine the content of chlorogenic acid in Zhilou Lotion. The chromatography column was Agilent Ecilipse XDB-C18 (4.6 mm× 250 mm, 5 μm), the mobile phase was acetonitrile-0.4% phosphoric acid solution (10∶90), the flow rate was 0.80 mL/min, the temperature of column was room temperature, and the detection wavelength was 327 nm. Results The method for identification had good specificity and repeatability. There was no interference in blank control. Chlorogenic acid had good linearity in the range of 2.442-122.1 μg (r=1.000 0). The average recovery rate was 100.30% and RSD was 1.05% (n=9). Conclusion The qualitative and quantitative method is simple, specific, accurate and reliable, and can be used for quality control of Zhilou Lotion.
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<p><b>BACKGROUND</b>A recent genome-wide association study in Caucasians revealed that three loci (rs174547 in fatty acid desaturase 1 (FADS1), rs2338104 near mevalonate kinase/methylmalonic aciduria, cobalamin deficiency, cblB type (MVK/MMAB) and rs10468017 near hepatic lipase (LIPC)) influence the plasma concentrations of high-density lipoprotein-cholesterol (HDL-C) and triglycerides (TG). However, there are few reports on the associations between these polymorphisms and plasma lipid concentrations in Chinese individuals. This study aimed to evaluate the associations between these three polymorphisms with HDL-C and TG concentrations, as well as coronary heart disease (CHD) susceptibility in Chinese individuals.</p><p><b>METHODS</b>We conducted a population-based case-control study in Chinese individuals to evaluate the associations between these three polymorphisms and HDL-C and TG concentrations, and also evaluated their associations with susceptibility to CHD. Genotypes were determined using polymerase chain reaction-restriction fragment length polymorphism assays and TaqMan genotyping assays.</p><p><b>RESULTS</b>We found significant differences in TG and HDL-C concentrations among the TT, TC and CC genotypes of FADS1 rs174547 (P=0.017 and 0.003, respectively, multiple linear regression). The CC variant of rs174547 was significantly associated with hyperlipidemia compared with the TT variant (adjusted odds ratio (OR)=1.71, 95% confidence intervals (CI): 1.16-2.54). The FADS1 rs174547 CC variant was also associated with significantly increased CHD risk compared with the TT and TC variant (adjusted OR=1.53, 95%CI: 1.01-2.31), and the effect was more evident among nonsmokers and females. The polymorphisms rs2338104 and rs10468017 did not significantly influence HDL-C or TG concentrations in this Chinese population.</p><p><b>CONCLUSION</b>rs174547 in FADS1 may contribute to the susceptibility of CHD by altering HDL-C and TG levels in Chinese individuals.</p>
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Aged , Female , Humans , Male , Middle Aged , Asian People , Genetics , Case-Control Studies , Cholesterol, HDL , Blood , Coronary Disease , Blood , Epidemiology , Genetics , Fatty Acid Desaturases , Genetics , Polymorphism, Single Nucleotide , Genetics , Triglycerides , BloodABSTRACT
<p><b>OBJECTIVE</b>To assess the safety and effects of 40 mg atorvastatin on serum lipids, inflammatory markers and clinical events in ACS patients post PCI.</p><p><b>METHODS</b>A total of 92 patients with ACS post successful PCI were randomly divided into atorvastatin 10 mg/d (group A) and atorvastatin 40 mg/d (group B) on top of the standard medical therapy. Blood were taken at baseline, 4, 12 and 24 weeks for serum alanine aminotransferase (ALT), lipids, high-sensitive C-reactive protein (hs-CRP) and matrix metalloprotease-9 (MMP-9) measurements. The major adverse cardiac events (MACE) were also observed.</p><p><b>RESULTS</b>There was no significant difference in medication withdrawn (2 vs. 3 cases) due to increased ALT (3 times higher than normal) and incidence of MACE (5 vs. 7 cases) between the groups. TC and LDL were significantly reduced in both groups 4 weeks and thereafter post medication compared to pre-treatment (P < 0.05) and the reduction was more significant in group B than that in group A at 24 weeks post medication (P < 0.05) while TG and HDL remained unchanged. hs-CRP was significantly reduced at 12 and 24 weeks in both groups compared to baseline and the reduction was more significant in group B than that in group A at 24 weeks. MMP-9 was significantly reduced in both groups 4 weeks and thereafter post medication compared to pre-treatment (P < 0.05) and the reduction was more significant in group B than that in group A at 12 weeks post medication (P < 0.05).</p><p><b>CONCLUSION</b>Both atorvastatin doses significantly reduced TC, LDL, hs-CRP and MMP-9 in ACS patients post PCI and the reduction was more significant in high dose atorvastatin group at 24 weeks while the MACE and drug withdraw rates were similar between the groups.</p>
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Humans , Acute Coronary Syndrome , Blood , Drug Therapy , Alanine Transaminase , Blood , Angioplasty, Balloon, Coronary , Atorvastatin , C-Reactive Protein , Metabolism , Heptanoic Acids , Therapeutic Uses , Hypolipidemic Agents , Therapeutic Uses , Matrix Metalloproteinase 9 , Blood , Prospective Studies , Pyrroles , Therapeutic UsesABSTRACT
<p><b>OBJECTIVES</b>To obtain prokaryotic expressed IA-2 recombinant protein and to identify its immunological activity.</p><p><b>METHODS</b>The complimentary DNA (cDNA) coding for the intracytoplasmic part of IA-2 (IA-2ic) was amplified from human fetal brain RNA, and was subcloned into the PinPoint Xa-1 T vector to construct recombinant expression plasmid, and was then expressed in E. coli JM109 cells as a fusion protein with a biotinylated peptide sequence at the aminoterminus. The biotinylated fusion protein was then purified by affinity chromatography and was subsequently dialyzed. Finally, its immunogenicity was evaluated by enzyme linked immunosorbent assay (ELISA).</p><p><b>RESULTS</b>The purified IA-2ic fusion protein resolved on sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) as a single Coomassie brilliant blue stained band with a molecular weight of 59 kDa and its immunogenicity was confirmed by ELISA.</p><p><b>CONCLUSIONS</b>E. coli expressed IA-2ic fusion protein has immunological activity. It can be used for detection of IA-2 autoantibodies (IA-2A) and for further studies on type 1 diabetes in future.</p>