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Objective To analyze the situation and study trend of large-scale nurses'health cohort studies based on Web of Science,to help design clinical guidelines and scientific research for nursing staff in China.Methods Articles of large nurses'health cohort studies published from 1993 to 2023 were retrieved from Web of Science(WOS)Core Collection.Citespace and Bibilometrix were used to perform the bibliometric analysis.Results 2882 studies were included in this study.Total volume of papers was enlarging by year.Clustering results showed that the main keywords could be divided into 3 categories:risks of women's health,risks of cardiovascular disease and reproducibility.Results of keywords burst showed that lifestyle,cardiovascular disease,women reproductive health and mental health were the highlights of studies in recent 5 years.Conclusion Research on large-scale nurse health cohorts holds significant scientific significance.It is recommended to establish a nationwide large-scale nurse health cohort as soon as possible.In the study,appropriate exposure factors should be selected,with reproductive health,mental health,and psychiatric disorders being the primary outcome measures,and chronic physical illnesses being the secondary outcome measures.By systematically describing the factors influencing the physical and mental health of nurses in China,we can better safeguard their well-being and promote the development of the nursing discipline.
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Objective: To observe the efficacy and adverse reactions of a combination therapy regimen based on bortezomib and glucocorticoids in recurrent/refractory immune thrombocytopenic purpura (iTTP) . Methods: Six patients with recurrent/refractory TTP were included and treated with a glucocorticoid and two courses of bortezomib-based regimen. The clinical remission status of patients, changes in ADAMTS13 activity/ADAMTS13 inhibitor, and the occurrence of treatment-related adverse reactions were observed. Results: Of the 6 patients, 2 were males and 4 were females, with a median age of 21.5 (18-68) years. Refractory TTP was found in 1 case and recurrent TTP in 5 cases. Glucocorticoids were administered with reference to prednisone at 1 mg·kg(-1)·d(-1), and gradually reduced in dosage after achieving clinical remission. Bortezomib is subcutaneously administered at 1.3 mg/m(2) on days 1, 4, 8, and 11 with a 28-day treatment course consisting of 2 courses. Six patients achieved clinical remission after receiving bortezomib as the main treatment. ADMATS13 activity returned to normal in all patients with TTP after treatment, and the ADAMTS13 inhibitor turned negative. Thrombocytopenia is the most common adverse reaction after treatment, with other adverse reactions, including peripheral neuritis and abdominal pain, but ultimately all patients returned to normal. In a median follow-up of 26 (9-41) months, 5 patients maintained sustained remission, and 1 patient relapsed after 16 months of bortezomib treatment. Conclusion: Combination therapy of bortezomib and glucocorticoids has a satisfactory therapeutic effect and controllable adverse reactions for recurrent/refractory iTTP.
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Male , Female , Humans , Young Adult , Adult , Middle Aged , Aged , Bortezomib/therapeutic use , Glucocorticoids/therapeutic use , Rituximab/therapeutic use , Purpura, Thrombotic Thrombocytopenic/drug therapy , Purpura, Thrombocytopenic, Idiopathic/drug therapy , ADAMTS13 Protein/therapeutic useABSTRACT
Compared with traditional prosthodontic methods, digital prosthodontic technology greatly simplifies the treatment process of patients and improves the accuracy of prosthesis. The fully digital workflow is becoming an important direction of the development of fixed prosthodontics. It can not only effectively improve the efficiency, accuracy and predictability of prosthodontics, but also help the cooperation between multiple disciplines to ensure the systematic treatment. This article systematically discusses the concept process, key technology, material progress and application of completely digital prosthodontic process, as well as the remaining problems, in order to provide reference for its clinical application.
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Objective: To explore the utility of stool-based DNA test of methylated SDC2 (mSDC2) for colorectal cancer (CRC) screening in residents of Shipai Town, Dongguan City. Methods: This was a cross-sectional study. Using a cluster sampling method, residents of 18 villages in Shipai Town, Dongguan City were screened for CRC from May 2021 to February 2022. In this study, mSDC2 testing was employed as a preliminary screening method. Colonoscopy examination was recommended for individuals identified as high-risk based on the positive mSDC2 tests. The final screening results, including the rate of positive mSDC2 tests, the rate of colonoscopy compliance, the rate of lesions detection, and the cost-effectiveness of screening, were analyzed to explore the benefits of this screening strategy. Results: A total of 10 708 residents were enrolled and completed mSDC2 testing, giving a participation rate of 54.99% (10 708/19 474) and a pass rate of 97.87% (10 708/10 941). These individuals included 4 713 men (44.01%) and 5 995 women (55.99%) with a mean age of (54.52±9.64) years. The participants were allocated to four age groups (40-49, 50-59, 60-69, and 70-74 years), comprising 35.21%(3770/10 708), 36.25% (3882/10 708), 18.84% (2017/10 708), and 9.70% (1039/10 708) of all participants, respectively. mSDC2 testing was positive in 821/10 708 (7.67%) participants, 521 of whom underwent colonoscopy, resulting in a compliance rate of 63.46% (521/821). After eliminating of 8 individuals without pathology results, data from 513 individuals were finally analyzed. Colonoscopy detection rate differed significantly between age groups (χ2=23.155, P<0.001),ranging from a low of 60.74% in the 40-49 year age group to a high of 86.11% in the 70-74 year age group. Colonoscopies resulted in the diagnosis of 25 (4.87%) CRCs, 192 (37.43%) advanced adenomas, 67 (13.06%) early adenomas, 15 (2.92%) serrated polyps, and 86 (16.76%) non- adenomatous polyps. The 25 CRCs were Stage 0 in 14 (56.0%) individuals, stage I in 4 (16.0%), and Stage II in 7(28.0%). Thus, 18 of the detected CRCs were at an early stage. The early detection rate of CRCs and advanced adenomas was 96.77% (210/217). The rate of mSDC2 testing for all intestinal lesions was 75.05% (385/513). In particular, the financial benefit of this screening was 32.64 million yuan, and the benefit-cost ratio was 6.0. Conclusion: Screening for CRCs using stool-based mSDC2 testing combined with colonoscopy has a high lesion detection rate and a high cost-effectiveness ratio. This is a CRC screening strategy that deserves to be promoted in China.
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Male , Humans , Female , Adult , Middle Aged , Cross-Sectional Studies , Early Detection of Cancer/methods , Colorectal Neoplasms/pathology , Colonoscopy/methods , Mass Screening/methods , Adenoma/diagnosis , DNA , Syndecan-2/geneticsABSTRACT
Objective To investigate the content of thorium (Th) in surface water in Sichuan Province, China, and to evaluate Th-associated health risk via water intake for residents. Methods Twenty-three monitoring sections were set in main surface water bodies in Sichuan Province. From 2016 to 2021, the Th radioactivity level in the water bodies was measured during dry and normal-water seasons. The health risk of residents was evaluated by calculating radioactive Th intake from the surface water bodies combined with the use of a health risk assessment model. Results The Th radioactivity level of the surface water bodies in Sichuan Province was 0.02-0.67 μ./L. There was no significant difference in the Th radioactivity level of different years or different surface water bodies (P > 0.05). A significant difference was observed in the Th radioactivity level of different water seasons (P < 0.05). The total mean annual committed effective doses of Th in all age groups caused by drinking water and water immersion ranged from 3.14 × 10−8 to 8.75 × 10−7 Sv, all lower than the World Health Organization (WHO)-recommended reference level of 0.1 mSv. The overall carcinogenic risks for residents in all age groups ranged from 3.93 × 10−10 to 1.09 × 10−8, all below the most rigorous control limits issued by WHO and International Commission on Radiological Protection. Conclusion The Th-associated health risk via direct water intake and water immersion in main surface water bodies of Sichuan Province is at an acceptable level. Th in main surface water bodies of Sichuan Province is safe for all age groups.
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AIM: To investigate the effect of phacoemulsification with steep meridian transparent corneal incision on visual function, corneal astigmatism and tear film changes.METHODS: A total of 106 cataract patients(106 eyes)who underwent phacoemulsification in our hospital from January 2019 to December 2020 were selected as research objects, and they were divided into observation group and control group according to the operation mode: with 51 patients in the observation group who were treated with steep meridian transparent corneal incision, and 55 patients in the control group who were treated with transnasal transparent corneal incision. The changes of visual function, corneal astigmatism and tear film between the two groups were compared before operation and at 1wk, 1 and 3mo after operation.RESULTS: There was no statistical difference between the operation of two groups(all P&#x003E;0.05). The visual acuity was significantly improved at 1wk, 1 and 3mo after operation, and it was better in the observation group than that in the control group. Mean defect(MD)of visual field was significantly lower, and it was significantly lower in the control group(all P&#x003C;0.05); The corneal astigmatism AKP(+0)of the two groups was significantly lower at 3mo after operation, and the observation group was significantly lower than the control group(P&#x003C;0.05). There was no statistical difference in corneal astigmatism AKP(+45)(P&#x003E;0.05); Schirmer Ⅰ test(SⅠt)value increased first and then decreased, and the valley value was at 1wk after operation; Tear film break-up time(BUT)decreased first and then increased, and the valley value was at 1wk after operation. SⅠt in the observation group was lower than that in the control group at each time point(all P&#x003C;0.05), while BUT in the observation group was higher than that in the control group at each time point(all P&#x003C;0.05).CONCLUSION: Steep meridian transparent corneal incision phacoemulsification surgery is beneficial to improve the postoperative visual function of patients, reduce postoperative corneal astigmatism, reduce the damage to the patient's tear film function, and promote its recovery.
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Objective: To report the clinical manifestations and laboratory features of five patients with congenital thrombotic thrombocytopenic purpura (cTTP) and explore its standardized clinical diagnosis and treatment along with a review of literature. Methods: Clinical data of patients, such as age of onset, disease manifestation, personal history, family history, and misdiagnosed disease, were collected. Treatment outcomes, therapeutic effects of plasma infusion, and organ function evaluation were observed. The relationship among the clinical manifestations, treatment outcomes, and ADAMTS13 gene mutation of patients with cTTP was analyzed. Additionally, detection of ADAMTS13 activity and analysis of ADAMTS13 gene mutation were explored. Results: The age of onset of cTTP was either in childhood or adulthood except in one case, which was at the age of 1. The primary manifestations were obvious thrombocytopenia, anemia, and different degrees of nervous system involvement. Most of the patients were initially suspected of having immune thrombocytopenia. Acute cTTP was induced by pregnancy and infection in two and one case, respectively. ADAMTS13 gene mutation was detected in all cases, and there was an inherent relationship between the mutation site, clinical manifestations, and degree of organ injury. Therapeutic or prophylactic plasma transfusion was effective for treating cTTP. Conclusions: The clinical manifestations of cTTP vary among individuals, resulting in frequent misdiagnosis that delays treatment. ADAMTS13 activity detection in plasma and ADAMTS13 gene mutation analysis are important bases to diagnose cTTP. Prophylactic plasma transfusion is vital to prevent the onset of the disease.
Subject(s)
Female , Pregnancy , Humans , Adult , Blood Component Transfusion , Plasma , Purpura, Thrombotic Thrombocytopenic/therapy , Mutation , Purpura, Thrombocytopenic, Idiopathic , ADAMTS13 Protein/therapeutic useABSTRACT
Objective:To investigate the risk factors and their early warning effectiveness for the occurrence of early neurological deterioration (END) in patients with moderate traumatic brain injury (modTBI).Methods:A retrospective cohort study was conducted to analyze the clinical data of 265 patients with modTBI admitted to the Second Affiliated Hospital of Fuyang Normal University from January 2018 to April 2023. There were 165 males and 100 females, with age range of 20-91 years [(59.5±14.4)years]. The patients were divided into END group ( n=46) (17.4%) and non-END group ( n=219) (82.6%) according to whether the Glasgow Coma Score (GCS) decreased by 2 points or more within 72 hours after injury. Data of the two groups were recorded, including gender, age, basic diseases (hypertension and diabetes), cause of injury (traffic injuries, falls, etc), vomiting before admission, admission GCS, first CT scan time, epilepsy, brain contusion, subarachnoid hemorrhage, types of intracranial hematoma (epidural, subdural, and intracerebral hematoma), types of fracture (skull base fracture and skull fracture), laboratory indicators [platelet count (PLT), blood potassium level, serum total calcium concentration, thrombin time (TT), prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), level of fibrinogen (FIB), and level of D-dimer. Correlations between above-mentioned indicators and occurrence of END among modTBI patients were assessed and the independent risk factors were revealed by univariate and multivariate binary Logistic regression analysis. Receiver operating characteristic (ROC) curve and area under curve (AUC) were used to evaluate the early-warning effectiveness of each risk factor for END. Results:Univariate analysis showed that admission GCS, first CT scan time, epidural hematoma, subdural hematoma, intracerebral hematoma, serum potassium level, FIB and D-dimer were statistically correlated with occurrence of END among modTBI patients ( P<0.05 or 0.01). Multivariate binary Logistic regression analysis showed that admission GCS≤10 points ( OR=0.53, 95% CI 0.34, 0.84, P<0.01), first CT scan time≤2.0 hours ( OR=0.58, 95% CI 0.37, 0.92, P<0.05), epidural hematoma ( OR=0.26, 95% CI 0.10, 0.69, P<0.05), intracerebral hematoma ( OR=0.14, 95% CI 0.04, 0.44, P<0.01), level of FIB≤2.3 g/L ( OR=0.34, 95% CI 0.18, 0.64, P<0.01), level of D-dimer>10.4 mg/L ( OR=1.04, 95% CI 1.02, 1.07, P<0.01) were independent risk factors for END among modTBI patients. ROC curve analysis showed that the first CT scan time had relatively higher early warning value (AUC=0.79, 95% CI 0.74, 0.84), level of D-dimer (AUC=0.75, 95% CI 0.70, 0.80) and level of FIB (AUC=0.70, 95% CI 0.65, 0.76) had moderate early warning value, which was higher than that of admission GCS (AUC=0.62, 95% CI 0.56, 0.68), intracerebral hematoma (AUC=0.62, 95% CI 0.56, 0.68) and epidural hematoma (AUC=0.60, 95% CI 0.54, 0.66). The combination of the risk factors revealed superior early warning efficiency for END (AUC=0.90, 95% CI 0.85, 0.93). Conclusions:Admission GCS≤10 points, first CT scan time≤2.0 hours, epidural hematoma, intracerebral hematoma, level of FIB≤2.3 g/L and level of D-dimer>10.4 mg/L are independent risk factors for END among modTBI patients. The early warning value of the first CT scan is the highest, followed by D-dimer and FIB, and the early warning effectiveness of admission GCS, intracerebral hematoma and epidural hematoma is ordinary.The combination of the above risk factors has better early warning efficiency for occurrence of END among modTBI patients.
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@#Abstract: Objective To investigate the prevalence and genetic characterization of Blastocystis in primary and middle school students in Baisha Li Autonomous County, Hainan Province, in order to understand the infection status of Blastocystis and its subtype distribution characteristics in this area. Methods From March to November 2021, fecal samples were collected from two primary and middle schools in Baisha Li Autonomous County. Nested PCR targeting the SSU rDNA was employed in this study, sequence analysis were performed to determine the prevalence and subtype. A neighbor-joining tree was built using Mega 7. Meanwhile, the risk factors of the Blastocystis infection among different grades and genders were evaluated. Results The infection rate of Blastocystis was 4.1% (13/314), there was no statistical difference in infection rates among genders and grades (P>0.05). Sequence analysis revealed that three Blastocystis subtypes were identified, namely ST3 (n=7), ST7 (n=4) and ST1 (n=2), all of which have zoonotic potential. Conclusions This is the first report of the identification of Blastocystis in humans in Hainan at the subtype level, and provide the basic data for the prevention and control of Blastocystis in this area. The zoonotic subtypes identified in this area indicated more studies should be taken in humans and various animals, to better evaluate the transmission of Blastocystis and provide scientific support for the prevention and control of Blastocystis.
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Objective:To study the clinical features of intrahepatic biliary cystadenoma (BCA), with the aim to improve its treatment results.Methods:The clinical data and follow-up results of 86 patients with BCA treated at our department from March 2010 to January 2021 were retrospectively analyzed. Of 86 patients, there were 15 males and 71 females, with age of (48.4±13.1) years old. According to the surgical procedures carried out, 44 patients were divided into the minimally invasive group and 42 into the open group. Clinical data including imaging data, blood biochemistry, and tumor markers were collected. The follow-up data of these patients was collected in outpatient clinics or by telephone review.Results:Of 86 patients, 19(22.1%) patients had a monocystic lesion while 67(77.9%) patients had a multicystic lesion, 64 patients (74.4%) had intracapsular segregation, and 12(14.0%) patients had solid structures. Eighty-six patients with BCA were misdiagnosed as hepatic cysts in 9 patients (10.4%), hepatic echinococcosis in 2 patients (2.3%), biliary hamartoma in 1 patient (1.2%), and hepatic hemangioma in 1 patient (1.2%) before surgery. The tumor size [(6.5±3.2) vs. (9.0±4.0) cm], operative time [115(88, 185) vs. 195(160, 254) min], intraoperative blood loss [50(20, 162) vs. 300(200, 600) ml], and postoperative hospital stay [4(3, 6) vs. 8(7, 10) d] were significantly lower in the minimally invasive group than the open group. The differences were statistically significant ( P<0.05). In the 73 patients with complete follow-up, (median follow-up 63.5 months), 4 patients had developed tumor recurrence. Conclusion:Intrahepatic bile duct cystadenoma lacks specific clinical manifestations, and has a high rate of misdiagnosis and mistreatment. Early radical hepatectomy improved clinical outcomes.
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Mineralocorticoid receptor antagonists not only are used as a diuretics to treat essential hypertension, but also protect the heart and kidney by inhibiting inflammation and fibrosis. Since the discovery of spironolactone, the first generation of mineralocorticoid receptor antagonist, two types of non-steroid mineralocorticoid receptor antagonists (finerenone and esaxerenone) approved for clinical use have been developed, which have the advantages of high affinity, high selectivity and balanced distribution in heart and kidney, and can be used in clinic as a cardiorenal protective drug. In this paper, the development history of mineralocorticoid receptor antagonists was reviewed, and the pathophysiological mechanism of inflammation and fibrosis caused by mineralocorticoid receptors and the similarities and differences of different generations of mineralocorticoid receptor antagonists were analyzed. In particular, the phase III clinical research evidence of finerenone and esaxerenone was discussed. This paper also reviews the research progress of cardiorenal protection of non-steroid mineralocorticoid receptor antagonists in patients with chronic kidney disease.
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Humans , Fibrosis , Heart Failure , Mineralocorticoid Receptor Antagonists/therapeutic use , Mineralocorticoids/therapeutic use , Renal Insufficiency, Chronic/drug therapy , Clinical Trials, Phase III as TopicABSTRACT
Objective To investigate the application value of transjugular liver biopsy (TJLB) in the diagnosis and treatment of complicated and severe liver diseases. Methods A retrospective analysis was performed for the clinical data of 31 patients who underwent TJLB in The Fifth Medical Center of Chinese PLA General Hospital, including indication for puncture, success rate, and final diagnosis. Results Among the 31 patients, there were 15 male patients and 16 female patients. Percutaneous liver biopsy was unsuitable for 8 patients with liver failure and disturbances of blood coagulation, 13 with liver cirrhosis and ascites, and 10 with liver cirrhosis and thrombocytopenia (< 50×10 9 /L), which were the indications for TJLB. The success rate of TJLB puncture was 100%, with 2-4 passes for puncture. No serious adverse event was observed. Of all 31 patients, 26 (83.87%) had a definite diagnosis at discharge, among whom there were 5 patients with idiopathic portal hypertension, 9 patients with drug-induced liver failure or liver cirrhosis, 5 patients with autoimmune liver disease, and 7 patients with liver cirrhosis or liver failure due to other causes, and 5 patients had unknown etiology. In addition, 3 patients underwent biopsy to confirm the diagnosis and decision of whether liver transplantation should be performed. Conclusion TJLB plays an important role in the diagnosis and treatment of complicated and severe liver diseases and still has certain limitations, and therefore, suitable patients should be selected in clinical practice.
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Objective:To analyze the clinical characteristics and transthyretin ( TTR) gene mutation of a family with familial vitreous amyloidosis (FVA). Methods:A pedigree investigation was performed.The clinical data of 20 family members of a Han family with FVA treated in the Affiliated Hospital of Guizhou Medical University from May 2005 to March 2019 were collected, including demographic data and ophthalmic examination results.Nine eyes of five patients underwent vitrectomy successively, and vitreous samples collected during operation were sent for pathological examination by Congo red staining.The best corrected visual acuity (BCVA) and intraocular pressure (IOP) were measured, and the anterior segment as well as fundus was observed under the slit lamp microscope at 1 week and 6 months after surgery.Peripheral venous blood (4 ml) was collected from 20 members in this family and DNA was extracted.The next-generation sequencing technology was used for gene detection of proband, and Sanger sequencing was performed in 20 family members including the proband.The pathogenicity of the mutation sites was analyzed according to ACMG guidelines.This study adhered to the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of Affiliated Hospital of Guizhou Medical University (No.2019-296). Written informed consent was obtained from each subject.Results:The preoperative BCVA of the nine eyes (5 patients) remained 0.1 to 0.2 in 6 eyes, and counting fingers to 50 cm in 3 eyes, and the mean value of preoperative IOP was (15.18±1.32) mmHg (1 mmHg=0.133 kPa). Cotton-wool like opacity in the vitreous and white pedal disc punctate granule on the posterior lens capsule were seen in the 9 eyes under the slit lamp microscope.Vitreous specimens of patients were Congo red stain positive.The BCVA remained 0.8 in 8 eyes and 0.6 in 1 eye at 1 week after vitrectomy, and remained 0.8 in 6 eyes, 0.6 in 2 eyes and light perception in 1 eye at 6 months after surgery.Mean values of postoperative IOP were (15.32±2.11) mmHg and (16.13±1.25) mmHg at 1 week and 6 months after surgery, respectively.Secondary glaucoma occurred in 8 eyes at 3 to 14 years postoperatively.Mean BCVA of the 13 phenotypic normal family members (26 eyes) remained 0.8 to 1.0, and the mean value of IOP was (15.52±1.15) mmHg, and abnormalities were not found in anterior segment or fundus.Additionally, two members (4 eyes) failed to take examinations.Genetic testing revealed heterozygous mutation in p. Gly103Arg of TTR gene in 15 family members.According to ACMG guidelines, the variation score was PS1+ PM2+ PP3, and it was likely pathogenic. Conclusions:The secondary glaucoma is of relatively high incidence in patients with FVA after vitrectomy.The heterozygous mutation of TTR gene (p.Gly103Arg) might be the variation site of the family with vitreous amyloidosis.
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OBJECTIVE@#To investigate the incidence rate and risk factors for metabolic bone disease of prematurity (MBDP) in very low birth weight/extremely low birth weight (VLBW/ELBW) infants.@*METHODS@#The medical data of 61 786 neonates from multiple centers of China between September 1, 2013 and August 31, 2016 were retrospectively investigated, including 504 VLBW/ELBW preterm infants who met the inclusion criteria. Among the 504 infants, 108 infants diagnosed with MBDP were enrolled as the MBDP group and the remaining 396 infants were enrolled as the non-MBDP group. The two groups were compared in terms of general information of mothers and preterm infants, major diseases during hospitalization, nutritional support strategies, and other treatment conditions. The multivariate logistic regression analysis was used to investigate the risk factors for MBDP.@*RESULTS@#The incidence rate of MBDP was 19.4% (88/452) in VLBW preterm infants and 38.5% (20/52) in ELBW preterm infants. The incidence rate of MBDP was 21.7% in preterm infants with a gestational age of < 32 weeks and 45.5% in those with a gestational age of < 28 weeks. The univariate analysis showed that compared with the non-MBDP group, the MBDP group had significantly lower gestational age and birth weight, a significantly longer length of hospital stay, and a significantly higher incidence rate of extrauterine growth retardation (@*CONCLUSIONS@#A lower gestational age, hypocalcemia, extrauterine growth retardation at discharge, and neonatal sepsis may be associated an increased risk of MBDP in VLBW/ELBW preterm infants. It is necessary to strengthen perinatal healthcare, avoid premature delivery, improve the awareness of the prevention and treatment of MBDP among neonatal pediatricians, and adopt positive and reasonable nutrition strategies and comprehensive management measures for preterm infants.
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Female , Humans , Infant , Infant, Newborn , Pregnancy , Birth Weight , Bone Diseases, Metabolic/etiology , China/epidemiology , Infant, Extremely Low Birth Weight , Infant, Premature , Infant, Very Low Birth Weight , Retrospective Studies , Risk FactorsABSTRACT
BACKGROUND@#Acute type A aortic dissection (ATAAD) and acute type A intramural hematoma (ATAIMH) are life-threatening diseases with high mortality. To better understand their clinical features in the Chinese population, we analyzed the data from the first Registry of Aortic Dissection in China (Sino-RAD) to promote the understanding and management of the diseases.@*METHODS@#All patients with ATAAD and ATAIMH enrolled in Sino-RAD from January 1, 2012 to December 31, 2016 were involved. The data of patients' selection, history, symptoms, management, outcomes, and postoperation complications were analyzed in the study. The continuous variables were compared using the Student's t test for normal distributions and the Mann-Whitney U test for non-normal distributions. Categorical variables were compared using the Chi-square test or Fisher exact test.@*RESULTS@#A total of 1582 patients with ATAAD and 130 patients with ATAIMH were included. The mean age of all patients was 48.4 years. Patients with ATAAD were significantly younger than patients with ATAIMH (48.9 years vs. 55.6 years, P < 0.001). For the total cohort, males were dominant, but the male ratio of patients with ATAAD was significantly higher compared to those with ATAIMH (P = 0.01). The time range from the onset of symptom to hospitalization was 2.0 days. More patients of ATAIMH had hypertension than that of ATAAD (82.3% vs. 67.6%, P < 0.05). Chest and back pain were the most common clinical symptoms. Computerized tomography (CT) was the most common initial diagnostic imaging modality. 84.7% received surgical treatment and in-hospital mortality was 5.3%. Patients with ATAAD mainly received surgical treatment (89.6%), while most patients with ATAIMH received medical treatment (39.2%) or endovascular repair (35.4%).@*CONCLUSIONS@#Our study suggests that doctors should comprehensively use clinical examination and genetic background screening for patients with ATAAD and ATAIMH and further shorten the time range from symptoms onset to intervention, achieving early diagnosis and treatment, thereby reducing the mortality rate of patients with aortic dissection in China. We should standardize the procedures of aortic dissection treatment and improve people's understanding. Meanwhile, the curing and transferring efficiency should also be improved.
Subject(s)
Humans , Male , Middle Aged , Acute Disease , Aortic Dissection/diagnosis , China , Hematoma , Registries , Retrospective Studies , Time Factors , Treatment OutcomeABSTRACT
Objective@#To investigate application and safety of pediatric interfacility-transport with extracorporeal membrane oxygenation (ECMO) in China.@*Methods@#The data of 48 patients transported inter-hospital from February 2016 to May 2018 were collected from the following 4 centers: pediatric intensive care unit (PICU) of Bayi Children′s Hospital Affiliated to the 7th Medical Center of PLA General Hospital, Pediatric Hospital of Fudan University, Henan Provincial People′s Hospital and Children′s Hospital of Zhejiang University School of Medicine. The data of patients′ characteristics, ECMO mode and wean rate, and mortality were reviewed, which was further compared with the data of 57 compatible inner-hospital ECMO cases with t test, Rank sum test or chi-square test.@*Results@#All the 48 interfacility-transports were accomplished by ambulance on land, with an average transfer distance of (435±422) km. The incidence of ECMO complications was 13% (6 case), without death. There were no significant differences in lactic acid, PaO2 or SaO2 before and after transport (4.0 (2.0, 7.5) vs. 3.0 (1.5, 6.0) mmol/L, Z=-1.579, P>0.05; 112(47, 405) vs. 166(122, 240) mmHg (1 mmHg=0.133 kPa), Z=-0.104, P>0.05; 0.97±0.02 vs. 0.96±0.03, t=1.570, P>0.05). Instead, PaCO2 and pH were significantly different ((47±8) vs. (42±5) mmHg, t=2.687, P<0.05; 7.3±0.2 vs. 7.5±0.2, t=3.379, P<0.05). The total ECMO weaned rate was 73% (35/48) and the survival rate was 67% (32/48). No significant differences in demographic characteristics, ECMO mode or duration, transport distance or duration, or complications existed between the survival group and the death group (7/25 vs. 2/14, χ2=0.615, P>0.05; 4/28 vs. 2/14, χ2=0, P>0.05; (405±404) vs. (493±465) km, t=0.525, P>0.05; (5±4) vs. (5±5) h, t=0.388, P>0.05; 166 (128, 239) vs. 187(52, 405) h, Z=-0.104, P>0.05; 3/32 vs. 3/16, χ2=0.734, P>0.05). The lowest lactate value in survival group before ECMO transport was significantly lower than that in the death group ((5±5) vs. (8±6) mmol/L, t=2.151, P<0.05). There were neither significant differences in age, ECMO mode or support pattern (9/39 vs. 15/42, χ2=0.845, P>0.05; 6/42 vs. 7/50, χ2=0.001, P>0.05; 29/19 vs. 38/19, χ2=0.441, P>0.05), nor in ECMO weaned rate, survival rate or complications between interfacility-transport group and inner-hospital group (35/48 vs. 37/57, χ2=0.775, P>0.05; 32/48 vs. 35/57, χ2=0.313, P>0.05; 20/48 vs. 22/57, χ2=0.102, P>0.05).@*Conclusion@#With appropriate transport equipment and mature teams who handle problems timely during the transport, critically ill children could be safely transported to the destination with ECMO.
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Objective: To investigate the inflammatory effect and possible mechanism of curcumin in BV-2 cells and primary microglia by amyloid beta protein fragment 1-42 (Aβ1-42) stimulation. Methods: BV-2 cells were cultured with curcumin (0.1, 1,5, 10,15, 25 and 40 μmol·L-1) for 24 h, and cell viability was measured by MTT and ATP assay. After being pretreated with curcumin (5 and 10 μmol-L-1) for 2 h, BV-2 cells or primary microglia were co-cultured with curcumin and Aβ1-421 mg · L-1for 24 h. mRNA expressions of interleukin 6 (IL-6), tumor necrosis factor-α (TNF-α) and inducible nitric oxide synthase (/A/OS) in BV-2 cells, as well as, TNF-α and iNOS in primary microglia were detected by real time qPCR. After being pretreated with curcumin (5 and 10 pmol-L-1) for 2 h, BV-2 cells were co-cultured with curcumin and Aβ1-421 mg · L-1for 24 h. Protein expressions of iNOS, autophagy protein 5 (Atg-5), ubiquitin-binding protein 62 (P62) and protein ratio of microtubule-associated protein 1 light chain3- II (LC3-II) and LC3-1 were detected by Western blotting in BV-2 cells. After being pretreated with curcumin (5 and 10 Mmol - L-1) for 24 h, BV-2 cells or primary microglia were co-cultured with curcumin and Aβ1-42mg·L-1for 4 h. Ap,-42 protein were detected by Western blotting in BV-2 cells and primary microglia. After being pretreated with curcumin (5 and 10 μmol·L-1) for 24 h, primary microglia were co-cultured with curcumin and Aβ1-421 mg·L-1for 4 h. Protein levels of Aβ1-42and ionized calcium binding adapter molecule 1 (Iba1) were detected by immunofluorescence. After being pretreated with curcumin (5 and 10 μmol·L-1) for 2 h, BV-2 cells of knocked down Atg-5 gene were co-cultured with curcumin and Aβ1-421 mg·L-1for 24 h. Protein expressions of iNOS, Atg-5, P62 and protein ratio of LC3-II and LC3- I were detected by Western blotting. Results: Results of MTT and ATP assay showed that the curcumin concentration of less 25 μmol·L-1had no cytotoxicity to BV-2 cells. Compared with Ap,-42 group, curcumin 5 and 10 μmol·L-1reduced IL-6, TNF-α and iNOS mRNA expressions in BV-2 cells, as well as, TNF-α and iNOS mRNA expressions in primary microglia (P<0.01). Results of Western blotting showed that curcumin 10 μmol·L-1reduced protein expressions of iNOS and P62 (P<0.01) and increased the protein ratio of LC3-II and LC3- I and protein expression of Atg5 (P<0.01), compared with Aβ1-42group. Curcumin 10 μmol·L-1enhanced the phagocytosis to Aβ1-42protein in BV-2 cells and primary microglia (P<0.01), compared with Aβ1-42group. Results of immunofluorescence showed that curcumin 5 and 10 μmol·L-1increased the fluorescence intensity value of Ap,.42 in primary microglia (P<0.01), but decreased the fluorescence gray value of Iba1 in primary microglia (P<0.01), compared with Aβ1-42group. However, compared with Aβ group, curcumin 10 μmol·L-1did not change the protein ratio of LC3-II and LC3-1 or protein expressions of iNOS, P62 and Atg-5 in BV-2 cells of knocked down Atg-5 gene. Conclusion: Curcumin can inhibit the inflammatory activity of microglia stimulated with Aβ1-42by enhancing the expression of Atg-5 and increasing the capability of microglia for autophagy of Aβ1-42protein.
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Objective: To assess the significance of DDAVP use in the diagnosis and treatment of VWD. Methods: An analysis of 15 VWD cases who referred to Hematology Division of First affiliated Hospital of Soochow University and treated with DDAVP from March 2016 to August 2018 was conducted. Efficacy and treatment response of DDAVP were monitored by observations of changes in factor Ⅷ procoagulant (FⅧ∶C) and von Willebrand Factor (VWF) related indicators before and 2 h after DDAVP injection. Results: Of 15 cases with VWD, 7 males and 8 females with a median age of 23 (6-46) years, 7 of 9 type I VWD patients achieved complete response (CR) , 1 type 2A VWD case CR, 5 type 3 VWD ones no response (NR) . The VWF multimer analysis in 5 patients combined with other plasma VWF values were in accordance with the known diagnosis. Conclusions: DDAVP was effective in most type 1 patients, and ineffective in some type 2 and almost all type 3 cases. It was helpful for diagnosis and subsequent treatment planning.
Subject(s)
Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Young Adult , Deamino Arginine Vasopressin , Hemostatics , von Willebrand Diseases , von Willebrand FactorABSTRACT
ObjectiveTo investigate the hepatitis B virus (HBV) infection rate among pregnant women in Shaanxi Province, China and the high-risk population of mother-to-infant transmission (MTIT). MethodsA survey was performed for 13 451 pregnant women in 18 hospitals in Shaanxi Province to investigate the status of HBV infection, and combined immunization was performed for the infants born to HBsAg-positive women. Univariate and multivariate logistic regression analyses were used to investigate the risk factors for MTIT. The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. ResultsThe prevalence rate of HBsAg was 7.07% among the pregnant women in Shaanxi Province, and the rate reached as high as 9.40% in southern Shaanxi. The MTIT rate of HBV was 5.21%. The univariate analysis showed that HBsAg titer, HBeAg titer, positive HBeAg, and HBV DNA load in mothers were associated with HBV infection in infants, and the multivariate analysis showed that HBV DNA load in mothers is an independent risk factor for MTIT (relative risk=1.586, 95% confidence interval: 1.020-2.465, P=0.041). Among the pregnant women with HBV infection and MTIT, 84.62% had positive HBeAg and an HBV DNA load of >106 IU/ml; among the infants with MTIT, 15.38% were the infants born to the HBeAg-negative pregnant women. For the pregnant women with positive HBeAg and HBV DNA>106 IU/ml, the relative risk of MTIT in infants was 1.210 (1.129-1.297); for the pregnant women with negative HBeAg, HBV DNA>2×103 IU/ml, and HBsAg >104 IU/ml, the relative risk of MTIT in infants was 26.062 (2.633-258024). ConclusionThere is a high HBV infection rate among pregnant women in Shaanxi Province. Pregnant women with positive HBeAg and a high HBV DNA load have a high risk of MTIT. Although the infants born to HBeAg-negative mothers have a low HBV infection rate, there is still a high risk of MTIT when the mother has an HBV DNA load of >2×103 IU/ml and an HBsAg level of >104 IU/ml.
ABSTRACT
As a traditional Chinese medicine, the root of Astragalus membranaceus var. mongholicus (AMM) or A. membranaceus (AM) has been widely used in China and other Asian countries for thousands of years. Till now, the flavonoids, phenolic acids and saponins are considered as the main active components contributing to their therapeutic effect in these plants. In order to clarify the distribution and contents of these compounds in different organs of these plants, a rapid and sensitive analytical method for simultaneous determination of 25 active compounds including seven types (i.e. dihydroflavones, iso-flavane, isoflavones, flavones, pterocarpans, phenolic acid and saponins) within 10 min was established using ultra-pressure liquid chromatography coupled with tandem mass spectrometry (UPLC-MS/MS). Then, the established method was fully validated and successfully applied to the determination of the contents of these analytes in different parts (root, rhizome, stem, leaf and flower) of AMM and AM. The results indicated that the contents of the same type of compounds in two different species plants were significantly different. Moreover, the obvious differences were also found for the distribution and con-tents of different type of compounds in five organs of the same species. The present study could provide necessary information for the rational development and utilization of AMM and AM resource.