ABSTRACT
Objective:To evaluate neutrophil/lymphocyte ratio(NLR) and the model for end-stage liver disease-sodium(MELD-Na)score in predicting short-term prognosis of patients with HBV-related acute-on-chronic liver failure(HBV-ACLF).Methods:A total of 234 consecutive HBV-ACLF patients(194 males and 40 females, aged 23-85 years)admitted to Hangzhou Xixi Hospital from January 2019 to December 2021 were enrolled. According to the 12-week clinical outcomes, patients were divided into good prognosis group( n=141)and poor prognosis group( n=93). Univariate and multivariate Logistic regression were performed to identify independent risk factors for poor prognosis of HBV-ACLF patients. Receiver operating characteristics(ROC)curve was applied to evaluate the accuracy of risk factors in predicting short-term prognosis of HBV-ACLF patients. Results:The age [(48.7±11.9) vs. (52.5±9.9) years old, t=-2.59, P=0.011], proportion of males [78.0%(110/141) vs. 90.3%(84/93), χ2=5.99, P=0.014], total bilirubin[202.9(141.2, 287.6) vs. 320.0(224.4, 400.0) μmol/L, Z=-5.14, P<0.001], creatinine [71.0(59.0, 78.0) vs. 81.0(64.0, 111.0)μmol/L, Z=-3.98, P<0.001], international normalized ratio[1.66(1.52, 1.86) vs. 1.91(1.66, 2.27), Z=-5.46, P<0.001], leukocyte count[5.16(3.99, 6.95)×10 9/L vs. 6.57(4.83, 8.30)×10 9/L, Z=-4.14, P=0.001], NLR[2.77(2.02, 3.55) vs. 5.48(3.44, 8.53), Z=-8.48, P<0.001], MELD score[22.0(20.0, 24.0) vs. 26.0(24.0, 29.0), Z=-9.22, P<0.001], MELD-Na score[22.8(20.0, 25.6) vs. 29.0(25.0, 36.0), Z=-9.16, P<0.001], liver cirrhosis[77.3%(109/141) vs. 88.2%(82/93), χ2=4.41, P=0.036], hepatorenal syndrome[4/141(2.8%) vs. 12/93(12.9%), χ2=8.91, P=0.003] and the proportion of artificial liver treatment[21/141(14.9%) vs. 24/93(25.8%), χ2=4.30, P=0.038] were significantly elevated in poor prognosis group compared with survival group. Logistic regression analysis showed that NLR( OR=3.76, 95 %CI: 2.10-6.74, P<0.001)and MELD-Na score( OR=2.24, 95 %CI: 1.17-4.29, P=0.015) were independent risk factors for poor short-term prognosis of HBV-ACLF patients. The area under the ROC curve(AUC)of NLR, and MELD-Na for the short-term prognosis of HBV-ACLF patients was 0.792 and 0.822, respectively. The AUC of the combination of NLR with MELD-Na was 0.858, which was significantly higher than that of NLR( Z=-3.04, P=0.001) or MELD-Na score( Z=-2.16, P=0.031)alone. Based on the cut-off value of the combined model, patients were classified into high combined model score (≥0.04) group and low combined model score (<0.04) group, the survival rate of the high group was significantly higher than that of the low group( χ2=67.47, P<0.001). Conclusions:NLR and MELD-Na score are independent risk factors of the short-term prognosis of HBV-ACLF patients. The combination of NLR and MELD-Na score will be beneficial to predict the short-term prognosis of HBV-ACLF patients.
ABSTRACT
Objective:To analyze the clinicopathological features of de novo early colorectal cancer and to evaluate the efficacy of endoscopic treatment.Methods:Patients with de novo early colorectal cancer who underwent endoscopic resection in Beijing Friendship Hospital, Capital Medical University from June 2020 to May 2022 were enrolled. The baseline data, endoscopic manifestations, treatment methods, postoperative pathological results and prognosis of the patients were collected retrospectively.Results:A total of 33 patients with de novo early colorectal cancer were enrolled with the age of 62.67 ± 8.62 years, and the male to female ratio was 7.25∶1. The long diameter of lesions was 0.96 ± 0.36 cm. The lesion morphology was mainly superficial phenotype (type 0-Ⅱ), accounting for 72.7% (24/33). Endoscopic submucosal dissection (ESD) was performed in 29 cases and endoscopic mucosal resection (EMR) was performed in 4 cases. Postoperative pathology showed that 11 cases (33.3%) were well differentiated tubular adenocarcinoma, of which the superficial submucosal layer was invaded in 2 cases. Twenty cases (60.6%) were moderately differentiated tubular adenocarcinoma, of which the superficial submucosa layer was invaded in 5 cases and the deep submucosa layer in 15 cases. Two cases (6.1%) were moderately-poorly differentiated tubular adenocarcinoma, where the deep submucosa layer was invaded in both. There was significant correlation between the depth of invasion and the degree of differentiation ( P<0.001), and moderately and moderately-poorly differentiated lesions were more likely to invade the deep submucosa layer. The en bloc resection rate was 100.0% (33/33), the complete resection rate was 97.0% (32/33), and the curative resection rate was 42.4% (14/33). Among the 19 patients who did not achieve curative resection, 13 patients received supplementary surgical treatment. No tumor residue or lymph node metastasis was found in the postoperative pathology. All patients were followed up for 3-25 months, and no signs of local recurrence or metastasis were found. Conclusion:Most de novo early colorectal cancers are superficial phenotype under endoscopy. The pathology is mainly moderately differentiated tubular adenocarcinoma. Endoscopic resection of de novo early colorectal cancer shows encouraging short-term efficacy.
ABSTRACT
Objective To evaluate the clinical application value of SpyGlass DS cholangioscopy in diagnosis and therapy of patients with biliary tract diseases. Methods Seven patients with biliary tract diseases were examined and treated with SpyGlass DS system. Three patients with large choledocholithiasis underwent laser lithotripsy under SpyGlass DS system, and then the broken stones were removed by ERCP. Four patients with indeterminate bile duct stricture underwent SpyGlass DS examination and SpyGlass DS-guided biopsies if necessary.Results SpyGlass DS cholangioscopy was successfully performed in all patients with a mean procedure time of 12. 6 min. Complete stone clearance was achieved in 3 patients with large biliary stones. Of the 4 patients with indeterminate biliary stricture, 2 underwent SpyGlass DS-guided biopsies and were diagnosed as malignant biliary tumor; the other 2 patients were diagnosed as inflammatory bile duct stenosis after visualizing the target lesions without biopsy. Two patients developed hyperamylasemia after the procedure, and recovered spontaneously. Conclusion SpyGlass DS cholangioscopy can provide accurate diagnosis in indeterminate biliary strictures and facilitate therapy in patients with challenging biliary stones.
ABSTRACT
OBJECTIVE:To evaluate the effects and safety of Bencycloquidium bromide nasal spray in the treatment of acute rhinitis after a cold. METHODS:A multicenter,dose parallel controlled,randomized,double-blind,placebo-controlled clinical tri-al was conducted. Two hundred and thirty-eight patients with acute rhinitis after a cold were selected and divided into group A(24 cases),B(24 cases),C(24 cases),D(24 cases),E(23 cases),F(24 cases),G(23 cases),H(24 cases),I(24 cases),J (24 cases). Group A-C were given Bencycloquidium bromide nasal spray 22.5μg,45μg,90μg,respectively,bid,spraying it once for each nostril. Group D-F were given Bencycloquidium bromide nasal spray 22.5 μg,45 μg,90 μg,respectively,tid,spraying it once for each nostril. Group G-I were given Bencycloquidium bromide nasal spray 22.5 μg,45 μg,90 μg,respectively,qid,spray-ing it once for each nostril. Group J was given placebo. All groups were treated for(4±1)d. Rhinorrhea score and continuous rhi-norrhea duration were compared among 10 groups,and the safety was evaluated. RESULTS:The rhinorrhea score and continuous rhinorrhea duration of 10 groups were improved significantly,with statistical significance (P0.05). There was no statistical significance in the incidence of ADR among 10 groups(P>0.05). CONCLUSIONS:Bencycloquidium bromide nasal spray with 90 μg,qid times significantly improves rhinorrhea score and continuous rhinorrhea duration with good safety.
ABSTRACT
Objective To study the relationship between bronchial asthma and smoking status in Chinese people.Methods Asthma epidemiological survey and stratified-cluster-random method survey were performed in residents over 14 years in 8 provinces (cities) of China from February 2010 to August 2012.Asthma was diagnosed based upon case history,clinical signs and lung function test.Smoking status was investigated by questionnaire.Results Sampling population was 180 099 and 164 215 were valid.A total of 2 034 subjects were diagnosed as asthma including 79 692 men and 84 523 women.The overall prevalence rate of asthma was 1.24% (2 034/164 215).Smokers were 23.8% (39 137/164 215) in the whole population.Smokers were 34.5% (702/2 034) in asthmatic patients,compared with 23.7% (38 435/ 162 181) in no-asthmatic population.The incidence of asthma was 1.79% and 1.06% in smokers and nonsmokers respectively (P <0.001),suggesting that OR of smoking was 1.70 (95% CI 1.55-1.86,P < 0.001).According to asthma control test (ACT) score,the level of asthma control in non smoking group was higher than that in smoking group(43.2% vs 35.3%).The times of hospitalization due to acute exacerbations (0.51 vs 0.41 events/person/year),total hospitalization rate (27.35 % vs 20.12%),annual emergency room visits (0.80 vs 0.60 events/person/year) and emergency room visit rate (31.77% vs 24.47%) were all much higher in smoking asthmatic patients than those in non smoking asthmatic patients,indicating that the level of asthma control in smoking patients was significantly worse than in non smoking patients.Conclusions The smoking rate in Chinese people over 14 years is still high.The prevalence rate of asthma in smokers is significantly higher than that of non-smokers.The level of asthma control in smokers is significantly worse than that in non smokers.
ABSTRACT
Important/potential value of macrolides has been proved in the management of chronic respiratory diseases by increasing basic and clinical trials.Through three face-to-face discussions,10 experts examined important data and drafted this consensus related to macrolides:(1) mechanism of nonantiinfective effects;(2) clinical use in chronic respiratory diseases;(3) cautions of long-term use.The mechanism out of non-antiinfective effects includes anti-inflammatory effect,modifying airway secretion,immune-regulation related to antibacterial effect,corticoid saving effect and anti-viral effect.The efficacy of long-term use of low-dose macrolides is definitely confirmed in diffuse panbronchiolitis,chronic rhinosinusitis.It is considerably used in bronchiectasia,cystic fibrosis,severe asthma and chronic obstructive pulmonary disease.Further studies should be conducted in cryptogenic organizing pneumonia and respiratory viral infection.It should be paid attention to its possible adverse effects (including drug interactions,cardiac toxicity,ototoxicity and disturbance of intestinal flora) and drug resistance in long-term use.A Chinese consensus for non-antiinfective effects and clinical use of macrolides is developed for the first time,which aims to expand their rational use and the further research.
ABSTRACT
Objective To study the desired therapeutic effect of vaginoplasty using sigmoid colon or peritoneum for entire vaginal atre-sia.Methods From May 2015 to October 2015,8 patients with complete vaginal atresia in our hospital performed vaginoplasty using sigmoid colon or peritoneum successfully.The operation methods,prognosis and therapeutic effect and quality of sexual life of two groups were com-pared and analyzed to investigate a perfect operative method and ideal nursing.Results Laparoscopic vaginoplasty using the peritoneum compared with that using sigmoid colon has advantages of shorter time of operation,less bleeding,less trauma and quicker recovery.However, artificial vagina using sigmoid colon was much more similar to a natural vagina in morphological and physiological characteristics,merely ac-companied by excessive mucus discharge during the postoperative period.At lower risk of vaginal adhesion and stenosis,laparoscopically as-sisted vaginoplasty using sigmoid colon graft also puts high technical requirements.Two patients normally developed uterus menstruate regular-ly.Four patients without uterus and 2 patients with rudimentary uterus experienced good sexual intercourse after vaginoplasty.Conclusion Patients with complete colpatresia who have normal womb should creat a patent and functional vagina until adolescence to restore its physio-logical and reproductive function.Anatomical reconstructive treatment of vaginal agenesis for patients with absent or hypoplastic uterus can be postponed till the late teens or in the adult.Both laparoscopic sigmoid vaginoplasty and peritoneal vaginoplasty achieve a minimal-invasive, cosmetic,natural lubricous, smooth artificial vagina for patient’ s sex life satisfactory.
ABSTRACT
With the development of endoscopic techniques in recent years,therapeutic endoscopic retrograde cholangiopancreatography has replaced surgery as the first approach to the extraction of common bile duct stones.Endoscopic sphincterotomy and endoscopic papillary bal-loon dilation have become established endoscopic techniques for stone removal.However,it remains a challenge for endoscopists to remove large common bile duct stones.Emerging endoscopic modalities,such as endoscopic papillary large balloon dilation and cholangioscopy-guided laser or electrohydraulic lithotripsy,have been shown to be safe and effective for management of large common bile duct stones.This paper reviews recent advances in the endoscopic management of large common bile duct stones.
ABSTRACT
<p><b>BACKGROUND</b>Little is known about asthma control and perception of asthma among asthmatic patients in China. This study marked the first survey conducted on a national scale that aimed at obtaining baseline information on asthma control and patients' perception of asthma and providing a point of reference for future studies.</p><p><b>METHODS</b>This face-to-face, questionnaire-based survey was conducted from April 2007 to March 2008 with 3 069 asthmatic patients from the respiratory outpatient clinics of 36 general hospitals located in 10 geographically dispersed cities.</p><p><b>RESULTS</b>Consistent with the Global Initiative for Asthma (GINA) guidelines, 28.7% and 45.0% of our patients achieved control and partial control, respectively. Of the patients in the study, only 21.8% had used a peak flow meter (PFM), and 6.6% of these patients used it daily. Inhaled corticosteroids (ICS) plus a long-acting β2 agonist (LABA) and ICS were the two most common medication regimens and were used in 45.6% and 30.4% of patients, respectively. Asthma had a significant effect on the patients' life and work. A considerable number of hospitalizations, emergency department visits, and sick days were observed.</p><p><b>CONCLUSION</b>Despite improvements in asthma control and ICS and PFM compliance compared with past literature, the current level of asthma control countrywide continues to fall short of the goals set in the GINA.</p>
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Adrenal Cortex Hormones , Therapeutic Uses , Adrenergic beta-Agonists , Therapeutic Uses , Anti-Asthmatic Agents , Therapeutic Uses , Asthma , Drug Therapy , Epidemiology , China , Epidemiology , Data Collection , Surveys and QuestionnairesABSTRACT
Objective To investigate outpatients' cognition towards common cold and their habituated medication so as to provide evidence for future public healthcare education.Methods Patients who attended hospital for diagnosis and treatment of common cold at least within past three months were asked to fill a questionnaire independently so as to learn their cognition towards common cold and medication habit.Results Among the patients underwent survey,52.2 % had incorrect knowledge about common cold; 2.99% didn't know about the hazards of common cold; 34.80% couldn't distinguish common cold from influenza; 30.07% considered common cold couldn't get relief without treatment; 68.24% didn't know about the proper effects of influenza vaccination; 6.4% often took oral medicine even intravenous injection when they caught a common cold; 59.77% often took medication from drugstore without prescription by doctor,and a few asked doctors to prescribe medicine on their request; 9.42% didn't know about the side effects of drug for cold treatment; and 9.72% didn't know about the active ingredients of drug for cold treatment.There were significant differences in the common cold cognition among population of different ages and education background.The older or the higher education status patients had a better cognition ( P <0.0 ).Conclusion There exist a certain degree of wrong cognition towards common cold among patients of different literacy degree and different age. Public health education on common cold need to be further strengthened.
ABSTRACT
Objective To investigate the cognition of the common cold and current situation of the treatment among physicians from various levels of hospitals in Chinese mainland,so as to provide evidence for future continuing medical education and rational medication.Methods A questionnaire designed for this survey was used to learn about the general information,cognitive degree of the common cold and prescription habits of physician who prescribed for cold within last three months,from various levels hospitals.Results A total of 1001 physicians were interviewed.Among them,749 physicians chose right options that the cold was the common cold and the influenza with 79.84% in resident physicians and 56.76% in chief physicians.A total of 745 physicians chose options that the course of common cold will be lasting 4 to 7 days; 895 physicians chose options that old people are the most susceptible for complication; 669 physicians thought the common cold was the most common infection in winter; 841 physicians used clinical methods to diagnose the common cold; 736 physicians thought although the cold was a kind of self-limited disease and symptomatic treatment could alleviate symptoms and improve life quality,patients should see doctor in time if it turns to severer; and 745 physicians held the opinion that treatment of the common cold should focus on relieving symptoms first. In addition, 61.60% physicians had made prescription based on clinical symptoms; 505(54.24% ) of them thought compound drugs were priority in treating the common cold.However,there were still 43 physicians prescribed antibiotics for common cold.Conclusions There is misunderstanding and discrepancy in cognition towards common cold and treatment among physicians from various levels of hospticals in mainland China.Physicians should standardize diagnosis and treatment for the common cold according to the domestic and foreign guidelines.
ABSTRACT
Objective To know the influence of out-hospital nursing with no gap on the level of HbAlc for patients with diabetes.Methods Divided 80 patients with diabetes into the intervention group and control group randomly,there were 40 cases in the each group.Out-hospital nursing cares with no gap were used in the intervention group,while the routine nursing cares were used in the control group.Fellowed up 1 year.Compared the FPG,2 hPG and HbAlc between the two groups at the time points of the 3rd,6th,9th and 12th month when out of hospital.Results All the indexes which had monitored were better in the intervention group than those of in control group.Conclusions Out-hospital nursing with no gap can remain the indexes in the normal level,and then promote their quality of life,which should be developed in clinical field.
ABSTRACT
Objective To assess the clinical significance of three different noninvasive airway inflammatory indices in induced sputum and exhaled breath condensate ( EBC ) from persistent asthmatic patients.Methods Moderate and severe asthmatic patients were prescribed inhaled corticosteroids combined with long-acting β2 agonists for a month.The symptom scores and percentage of predicted value of forced expiratory volume in one second ( FEV1 ) ( FEV1% pred) were measured while the concentrations of H2O2,NO3-/NO2-,and cysteinyl-leukotriene E4(LTE4) in induced sputum and EBC were detected before and after therapy.Results A total of twenty-five subjects with moderate and severe asthma were enrolled.By combined therapy for one month the asthma aymptoms relieved and FEV1% pred improved significantly (P<0.01).The concentrations of H2O2,NO3-/NO2- arid LTE4in induced sputum and EBC declined significantly(P<0.01) although the concentrations were still higher than those at normal baseline.More marked reduction of H2O2 and NO3-/NO2- compared to LTE4was observed.It was revealed that the concentrations of H2O2 and NO3-/NO2- but not of LTE4in EBC were negatively correlated with FEV1% pred (P <0.01) and positively with symptom scores.Such correlations were also found in H2O2 in induced sputum with FEV1 % pred and symptom scores as well as NO3-/NO2- in induced sputum with FEV1 % pred.The improvement of FEV1 % pred after treatment was positively correlated with the reduction of H2O2 and NO3-/NO2- both in induced sputum and EBC.Correlation analysis also demonstrated three inflammatory indices were equivalent in induced sputum and EBC( correlation coefficient of H2O2,NO3-/NO2- and LTE4,0.759,0.826 and 0.653,respectively.P < 0.01 ).Conclusions (1) Combined therapy with inhaled corticosteroid plus long-acting β2 agonist significantly improves the clinical symptoms and lung function of patients with moderate and severe asthma companied with marked suppression of airway inflammation.(2) Both of EBC and induced sputum sampling are valuable noninvasive procedures for detecting asthma airway inflammation,however,EBC technique is superior in safety and reproducibility.(3) H2O2 and NO3-/NO2- seem to be more sensitive indices in diagnosis and monitoring asthma compared to LTE4.
ABSTRACT
Objective To evaluate the efficacy of Budesonide/formoterol to control asthma under real-life conditions.Methods A muhi-center, open label, non-interventional study was conducted.Asthma control after 12 week therapy with Budesonide/formoterol was assessed by Asthma Control Questionnaire (ACQ) and modified Asthma Control Questionnaire (ACQ5).Results A total of 360 asthma patients were recruited,including 228 adult patients and 132 child patients.After 12 weeks' therapy,all the patients' medium value of ACQ was decreased significantly from 2.03 (adults 2.20, children 1.74) at baseline to 0.60 (adults 0.78, children 0.29) (P < 0.0001), and the medium value of ACQ5 was also decreased significantly from 2.4 (adults 2.24, children 1.76) at baseline to 0.47 (adults 0.62, children 0.20) (P < 0.0001).Conclusion Budesonide/formoterol is effective in asthma treatment, by which most asthma patients obtain and maintain clineal control.
ABSTRACT
Objective To determine the diagnostic value of fractional exhaled nitric (FeNO) measurement in diagnosis of bronchial asthma. Methods The patients with unkown-cause respiratory symptoms including wheezing, cough, and breathlessness were enrolled from August to September in 2008. FeNO was measured by nitric oxide analyzer (NIOX; Aerocrine AB; Solna, Sweden). Bronchial challenge test (BCT) or bronchodilator test was defined as golden standard for asthma diagnosis. The value of FeNO was assessed and the optimal operating point of FeNO testing was determined by the means of the receiver operating characteristic (ROC) curves. Results A total of 101 patients were enrolled, in which 48 cases were diagnosed as asthma by positive yield in BCT (in 38 cases) or bronchodilator test (in 10 cases). The severity of airway hyperresponsiveness (AHR) judged by BCT was mild in 15 cases, moderate in 15 cases and severe in 8 cases. The levels of FeNO of asthma group were higher than those of non-asthma group [(68.19±43.00) pph vs (19.52±10.60) ppb, P < 0.05]. A linear correlation of FeNO with lnPD20 FEV1 was revealed in the cases with AHR. Area under ROC curve was 0.9. The optimal diagnostic cutoff point was 36.5 ppb which was capable of differentiating asthma and non-asthma with sensitivity of 92.7%, specificity of 83.3%, positive predictive value of 79.17% , negative predictive value of 94.34% and accuracy of 87.13%. Conclusion FeNO test may be helpful in the diagnosis of asthma with high sensitivity and specificity.
ABSTRACT
0.05).Conclusion:HLA-DQA1*0102 and DQA1*0104 were associated with protection from chronic HBV infection and development of LC,respectively.There was no significant association between HLA-DQA1 and development of HCC in chronic HBV infection patients.
ABSTRACT
Gastresophageal reflux disease(GERD)is a common morbidity in asthma patients.GRED is contributing factor for poor controlled asthma.GERD should be intergrated into the routine diagnostic procedure of asthma.Antireflux therapy may improve the outcomes of asthma with GERD.
ABSTRACT
Objective:To investigate the immune mechanism of 5-fluorouracil(5-Fu) and Octerotide(Oct)in the treatment of severe acute pancreatitis(SAP)and it’s kidney injury.Methods:55 male SAP rats induced by retrograde infusion of 5% sodium taurocholate into bilopancreatic duct were randomly divided into 3 groups:Normal saline group(n=17)were treatmented with normal saline infusion,Oct group(n=18):The first dose of Oct was 2?g/100g iv,then 0.2?g/(100g?h)continuous injection,5-Fu group(n=20):The dose of 5-Fu was 2mg/h?12h.Rats from each group were killed at 12h after opertation.The plasma levels of tumor necrosis factor-?(TNF-?),interleukin-1(IL-1)were assessed by ELISA method.Thromboxan B_2(TXB_2)and prostaglandinE_2(PGE_2)were assessed by radioimmunoassay method.The expression of TNF-? mRNA was detected by RT-PCR.The apoptosis rate of rat kidney tissue were detected by TUNEL method.Apoptosis rate of NRK cell treated by serum of different groups were assessed by flow cytometry methods.Results:The plasma level of TNF-?、IL-1 and TXB_2 in 5-Fu and Oct group were much lower than that in normal saline group.The expression of TNF-? mRNA of kidney tissue decreased significantly after the SAP was treated by 5-Fu or octreotide.The apoptosis rate of NRK cell disposed by normal saline group,oct group,5-Fu group and control group rat plasma were (38.67?11.4)%,(20.4?18.4)%,(10.5?11.0)% and (1.7?2.2)% respectively(P