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Background At present, the practice of pulmonary rehabilitation for pneumoconiosis in China is in a primary stage. The basis for formulating an individualized comprehensive pulmonary rehabilitation plan is still insufficient, which is one of the factors limiting the development of community-level rehabilitation work. Objective To formulate an exercise prescription based on maximum heart rate measured by cardiopulmonary exercise test (CPET), conduct an individualized comprehensive pulmonary rehabilitation program with the exercise prescription for patients with stable pneumoconiosis, and evaluate its role in improving exercise endurance and quality of life, thus provide a basis for the application and promotion of pulmonary rehabilitation. Methods A total of 68 patients were recruited from the Occupational Disease Prevention Hospital of Jinneng Holding Coal Industry Group Co., Ltd. from April to August 2022 , and were divided into an intervention group and a control group by random number table method, with 34 cases in each group. All the pneumoconiosis patients participated in a baseline test. The control group was given routine drug treatment, while the intervention group received multidisciplinary comprehensive pulmonary rehabilitation treatment on the basis of routine drug treatment, including health education, breathing training, exercise training, nutrition guidance, psychological intervention, and sleep management, whose exercise intensity was determined according to the maximum heart rate provided by CPET. The rehabilitation training lasted for 24 weeks. Patients were evaluated at registration and the end of study respectively. CPET was used to measure peak oxygen uptake per kilogram (pVO2/kg), anaerobic threshold (AT), carbon dioxide equivalent of ventilation (EqCO2), maximum metabolic equivalent (METs), and maximum work (Wmax). The modified British Medical Research Council Dyspnea Questionnaire (mMRC), Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Pittsburgh Sleep Quality Index (PSQI), Chronic Obstructive Pulmonary Disease Assessment Test (CAT), and Short Form of Health Survey (SF-36) were used to evaluate the potential effect of the comprehensive pulmonary rehabilitation program. Results Among the included 68 patients, 63 patients were having complete data, then 31 cases were assigned in the control group and 32 cases in the interventional group. Before the intervention, there was no significant difference in pVO2/kg, AT, EqCO2, METs, or Wmax between the two groups (P>0.05). At the end of the trail, the indicators like pVO2/kg [(19.81±2.38) mL·(min·kg)−1], AT [(14.48±2.33) mL·(min·kg)−1], METs (5.64±0.69), and Wmax [(85.25±14) W] of patients in the intervention group were all higher than those [(13.90±2.37) mL·(min·kg)−1, (11.70±1.94) mL·(min kg)−1, (3.97±0.70), and (61.77±14.72) W, respectively] in the control group (P<0.001); there was no significant difference in EqCO2 between the two groups (P=0.083). Before the trial, there was no significant difference in mMRC, SAS, SDS, PSQI, or CAT scores between the two groups (P>0.05). At the end of the trail, the mMRC score (1.16±0.57), SAS score (27.93±2.12), SDS score (26.48±1.44), PSQI score (1.08±0.88), and CAT score (4.34±3.28) of patients in the intervention group were lower than those [(2.03±0.83), (35.87±6.91), (34.23±6.65), (5.37±3.03), and (13.87±7.53), respectively] in the control group (P<0.001). The SF-36 scores of bodily pain (94.13±10.72), general health (87.50±5.68), vitality (95.31±5.53), mental health (99.88±0.71), and health changes (74.22±4.42) in the intervention group were higher than those [(71.87±32.72), (65.81±15.55), (74.52±16.45), (86.97±16.56), and (29.84±13.50), respectively] in the control group (P<0.001), and no significant difference was found in social functioning and role emotional scores (P>0.05). Conclusion Comprehensive pulmonary rehabilitation can increase the oxygen intake and exercise endurance of pneumoconiosis patients, ameliorate dyspnea symptoms, elevate psychological state and sleep quality, and improve the quality of life.
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Background Diagnosis of pneumoconiosis by radiologist reading chest X-ray images is affected by many factors and is prone to misdiagnosis/missed diagnosis. With the rapid development of artificial intelligence in the field of medical imaging, whether artificial intelligence can be used to read images of pneumoconiosis deserves consideration. Objective Three deep learning models for identifying presence of pneumoconiosis were constructed based on deep convolutional neural network. An optimal model was selected by comparing diagnostic efficiency of the three models. Methods Digital radiography (DR) chest images were collected between June 2017 and December 2020 from 7 hospitals and standard radiograph quality control protocol was also followed. The DR chest images with positive results were classified into the positive group, while those without pneumoconiosis were classified into the negative group. The collected chest radiographs were labeled by experts who had passed the assessment of reading radiographs,and the experts were constantly assessed for consistency in the labeling process based on an expectation-maximization algorithm. The labeled data were cleaned, archived, and preprocessed, and then were grouped into a training set and a verification set. Three deep convolutional neural network models TMNet, ResNet-50, and ResNeXt-50 were constructed and trained by ten-fold cross-validation method to obtain an optimal model. Five hundred cases of DR chest radiographs that were not included in the training set and the validation set were collected, and identified by five senior experts as the gold standard, named the test set. The accuracy rate, sensitivity, specificity, area under curve (AUC), and other indexes of the three models were derived after testing, and the efficiency of the three models was evaluated and compared. Results A total of 24867 DR chest radiographs of the training set and the validation set were collected in this study, including 6978 images in the positive group and 17889 images in the negative group. There were 312 cases of pulmonary abnormalities such as pneumothorax and pulmonary tuberculosis. A total of nine experts labeled the chest radiographs, the labeling consistency rate of pneumoconiosis (non-staging) was above 88%, and the labeling consistency rate of pneumoconiosis staging ranged from 84.68% to 93.66%. The diagnostic accuracy, sensitivity, specificity, and AUC of TMNet were 95.20%, 99.66%, 88.61%, and 0.987, respectively. The indicators of ResNeXt were 87.00%, 89.93%, 82.67%, and 0.911, respectively. Those of ResNet were 84.00%, 85.91%, 81.19%, and 0.912, respectively. All these indexes of TMNet were higher than those of ResNeXt-50 and ResNet-50 models. The AUC differences between TMNet and the other two models were both statistically significant (P<0.001). Conclusion All the three convolutional neural network models can effectively diagnose the presence of pneumoconiosis, among which TMNet provides the best efficiency.
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Objective To investigate the clinical effect of placement of distal tibiofibular screw which is parallel to tibial in treating ankle fracture with tibiofibular syndesmosis separation.Methods Data of 59 cases with ankle fracture combined with tibiofibular syndesmosis separation from May 2014 to December 2015 were retrospectively analyzed.According to the direction of distal tibiofibular syndesmosis screw,59 cases were divided into two groups.There were 27 cases (18 males and 9 females) in Group A (parallel nailing group),with an average age of 42.00± 11.35 years.According to Lauge-Hansen classification,6 cases were supination extension-rotation Ⅲ and 9 were supination extension-rotation Ⅳ°,3 pronation extension-rotation Ⅲ and 7 pronation extension-rotation Ⅳ,2 pronation abduction ⅢL In group B (traditional nailing group),there were 32 cases (20 males and 12 females),with an average age of 44.00±13.34 years.According to Lauge-Hansen classification,5 cases were supination extension-rotation Ⅲ° and 12 supination extension-rotation Ⅳ°,4 pronation extension-rotation Ⅲ° and 8 pronation extension-rotation Ⅳ°,3 pronation abduction Ⅲ°.Two groups were compared of the flexion and extension angle of ankle joint after operation and function of ankle joint according to Baird-Jackson score.Results All the patients were followed up for 18 months.The fracture healing time of parallel nailing group was 2.5 to 5 months with an average of 3.4 months.While the fracture healing time of traditional nailing group was 2.5 to 6 months with the average of 3.8 months.The excellent rate of planting nail for group A was 100％ (24 cases for excellent and 3 for good),and for group B was 53.13％ (5 cases for excellent and 12 for good).There was significant difference between two groups (x2=16.97,P=0.0001).The excellent rate of group A was better than that in group B.6 weeks after operation,the flexion and extension angle of ankle joint was 25.00°±6.33° in group A and 17.00°±4.46° in group B with significant difference between two groups (t=5.82,P=0.0002).12 weeks after operation,the flexion and extension angle of ankle joint was 31.00°±7.75° in group A and 19.00°±5.58° in group B,with significant difference between two groups (t=7.54,P=0.0008).The flexion and extension angle of group A was better than that in group B for early postoperative period.6 months after operation,according to BairdJackson score,the excellent rate of ankle function of group A was 44.44％ (2 cases for excellent and 10 for good),and group B was 12.50％ (4 cases for good),with significant difference between two groups (x2=7.56,P=0.007).12 months after operation,the excellent rate of group A was 77.78％ (6 cases for excellent and 15 for good),group B was 34.38％ (2 cases for excellent and 9 for good),with significant difference between two groups (x2=11.11,P=0.001).18 months after operation,the excellent rate of ankle function of group A was 88.89％ (17 cases for excellent and 7 for good),and group B was 78.13％ (10 cases for excellent and 15 for good),with no significant differences (x2=0.56,P=0.23).One year after operation,the ankle function of group A was better than that in group B,while 18 months after operation,there was no statistical differences between the two groups.The data of 18 months after operation were further studied,using the method of stratified analysis,and the rate of excellent of group A was 59.26％ (16/27),while group B was 34.38％ (11/32),with significant difference between two groups (x2=3.65,P=0.049).The ankle function of group A was better than that of group B 18 months after operation.Conclusion Compared with the traditional method,this kind of method could accurately locate the distal tibiofibular syndesmosis screw.About early and mid-term postoperative period,it is superior to the traditional method for ankle function.
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ObjectiveTo investigate the influence of fluid balance and model of renal replacement therapy (RRT) on renal function and prognosis of patients suffering from septic acute kidney injury (AKI).Methods A retrospective cohort analysis of 117 septic AKI patients who had undergone RRT between January 2009 and December 2014 was performed in the Second Affiliated Hospital of Nanjing Medical University. The patients were divided into positive fluid balance group (n = 52) and negative fluid balance group (n = 65) according to the total amount of fluid calculated from the difference between fluid administered and fluid lost during the first 1 week of RRT. The incidence of renal recovery and death of the patients by 60 days as the endpoint events were taken to judge the prognosis of two groups. RRT strategies included continuous renal replacement therapy (CRRT) and intermittent renal replacement therapy (IRRT). Multiple factors including estimated glomerular filtration rate (eGFR), sequential organ failure assessment (SOFA) score, RRT model, the accumulation of fluid before initiation of RRT, and negative fluid balance during RRT were analyzed for outcome predictors by Cox proportional hazards model.Results There were no differences between two groups regarding clinical characteristics. The percentage of receiving CRRT in the negative fluid balance group was slightly higher than that of the positive fluid balance group (52.31% vs. 36.54%,χ2 = 2.899,P = 0.089). With Kaplan-Meier survival curves, it was shown that the patients of negative fluid balance group had a higher rate of recovery of renal function (χ2 = 4.803,P = 0.028) and significantly lower mortality rate (χ2 = 9.505, P = 0.002). The rate of recovery of renal function by 60 days was higher in the negative fluid balance group than that in the positive fluid balance group (47.69% vs. 28.85%,χ2 = 3.991,P = 0.046), while the mortality rate was significantly lowered in the negative fluid balance group compared with that of the positive fluid balance group (40.00% vs. 67.31%,χ2 = 4.378,P = 0.036). Cox multivariate regression was used for excluding confounding factors. After adjusting for the clinically relevant variables, RRT negative fluid balance was significantly associated with recovery of renal function [hazard ratios (HR) = 2.440, 95% confidence intervals (95%CI) = 1.089-5.464,P = 0.030] and mortality (HR = 0.443, 95%CI = 0.238-0.822,P = 0.010]. Higher eGFR before RRT and CRRT were independent favorable factors for recovery of renal function (HR= 1.014, 95%CI = 1.003-1.026,P = 0.012;HR = 3.138, 95%CI = 1.765-7.461,P = 0.002), and higher SOFA score was associated with a significantly higher risk of death (HR = 1.115, 95%CI = 1.057-1.177, P< 0.001).ConclusionsOnce the patients with septic AKI showed the signs of fluid overload, timely RRT and effective removal of excessive liquid may reverse the adverse prognosis. RRT with negative fluid balance is beneficial for the recovery of renal function, and reduce the mortality in patients with septic AKI, and CRRT model is a good choice.
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Objective The staffs of biosafety level 3 laboratories (BSL-3) face with the stress of handling highly pathogenic microbs and special laboratory environment.The job stress may result in accidents in the laboratory as negative factor for the risk control.The research may provide support for the control of risk in biosafety laboratories.Methods In order to assess the job stress in the staff in BSL-3 laboratory, we modified “the Chinese simple job stress questionnaire”based on the theory of the JDC mode and ERI mode, and an investigation was carried out.The present study included the staffs (87 employees) from six BSL-3 laboratories located in five provinces ( Shanghai, Zhejiang, Jiangsu, Fujian and Wuhan) .Results Analysis of the data indicates that variables of age, working years, job duties, manipulating of animals, type of microorganisms and transmission route have a significant influence on the level of job stress in BSL-3 laboratory.Conclusion The BSL-3 laboratory staff in higher stress level have the characteristicses:20-39 years old, short work years, regular staff, operating on air-borne microbiology, manipulating of animals and operating on one more microbiology.
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The immune effect of CD4~+CD28~-T cells on Graves'ophthalmopathy(GO)was investigated.The expressions of interferon-γ(IFN-γ),interleukin-2(IL-2),and IL-4 in CD4~+ CD28~-T ceils were assayed by flow cytometry in GO patients,Graves'disease(GD)patients without ophthalmopathy,and healthy control subjects.The results showed that the percentage of CD4~+CD28~-T cells significantly increased in GO patients(P<0.05),with increased IFN-γ expression(P<0.05)and decreased IL-2 expression(P<0.05).These changes were closely correlated with clinical activity score(P<0.05).There were no significant differences in IL-4 expression among three groups.The resuh suggests that CIM~+ CD28~- T cells which hishly secrete IFN-γare related to the pathological lesion of GO.
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AIM: To investigate the effect of nitric oxid e (NO) and taurin on hemorrhagic shock /reperfusion injury. METHODS: Twenty-four rabbit s were divided randomly into 3 groups ( n= 8): control group and shock group and taurine group. The model of hemorrhagic shock/reperfusion was used. The activities of ni tric oxide synthase (NOS),superoxide dismutase(SOD),lactate dehydrogenase (LDH)and the contents of malondialdehyde(MDA),nitric oxide pvoducts( NO - 2/NO - 3) in plasma were observed before shock and shock 1.5 h,reper fusion 1 h ,2 h and reperfusion 3 h. RESULTS: ①During shock/reperfusion, the ac tivities of NOS,LDH and the contents of MDA,NO - 2/NO - 3 were significan tly highe r, but the activity of SOD was significantly lower in plasma of shock group than that of before shock and shock 1.5 h. ②At 3 h reperfusion, the activity of NOS and the contents of MDA, NO - 2/NO - 3 were significantly higher,bu t the act ivity of SOD was significantly lower in the lung and heart of shock group than t hat of control group. ③ Taurine(40 mg?kg -1 ,iv) attenuated all the c hanges above mentioned at total time points of reperfusion. ④ A close correlation was shown between MDA content and NO - 2/NO - 3 content in plasma, lung and i n heart. CONCLUSION: These results suggeste that NO may be involved in oxida nt-mediated shock/reperfusion, antagonistic effect of taurine on hemorrhagic shock/reperfusi on injury may be relate d to decreasing the generation of NO and anti-lipoperoxidation.
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AIM:To investigate whether Smad pathway participates the process of extracellular signal regulated kinase (ERK) induced the proliferation of vascular smooth muscle cells (VSMCs). METHODS: Human umbilical artery smooth muscle cells (hUASMCs) were divided into four groups: control group, PDGF (platelet derived growth factor) group, ERK blocking agent group and PDGF+ERK blocking agent group. MTT assay was used to detect the proliferation of hUASMCs (A value). Immunohistochemical technique was used to detect the expression of PCNA, phosphorylated ERK (p-ERK) and phosphorylated Smad2/3 (p-Smad2/3) protein in hUASMCs. The expression of Smad2/3 mRNA in hUASMCs was detected by RT-PCR. RESULTS: The proliferation of hUASMCs and the expression of PCNA, p-ERK and p-Smad2/3 proteins in hUASMCs in PDGF group were increased obviously than those in other groups (P