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The existing regulations and systems of the Swedish Medical Products Agency (MPA) have clear provisions on the definition, classification and listed on the market procecure of pharmaceutical products, and the supervision strictly follows the EU standards. Traditional Chinese Medicine (TCM) products belong to the category of Swedish Herbal Medicine Products (HMP) or Traditional Herbal Medicine Products (THMP) and are under the supervision of Swedish Pharmaceutical Products Administration (MPA). This paper analyzes the classification, relevant regulations and registration procecures of TCM products in Sweden. It is suggests that TCM enterprises should fully understand the EU regulations and guidance regulations before listed on the market of TCM products. They should also clarify the product category, and provide sufficient and accurate evidence. In the application process, they should pay attention to strengthening communication with the drug administration units of Sweden.
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Objective:To explore the efficacy and safety of in-class transition from proteasome inhibitor bortezomib to ixazomib in the treatment of newly-treated patients with multiple myeloma (MM).Methods:The clinical data of 63 newly-treated MM patients in Shenzhen Second People's Hospital from January 2018 to December 2020 were retrospectively analyzed. They were divided into transition group (23 cases) and bortezomib group (40 cases). Both groups were treated with bortezomib-containing regimen as the first-line treatment regimen. In case of intolerable adverse reactions, patients in the transition group were treated with ixazomib instead of bortezomib, while the patients in the bortezomib group did not undergo drug transition. The curative effect and progression-free survival (PFS) were compared between the two groups.Results:In the transition group, the overall response rate (ORR) before in-class transition was 95.7% (22/23), the rate of ≥ very good partial remission (VGPR) was 52.2% (12/23); the ORR after transition was 95.7% (22/23), and the rate of ≥ VGPR was 82.6% (19/23). In the bortezomib group, ORR was 90.0% (36/40), and the rate of ≥ VGPR was 72.5% (29/40). There was no significant difference in ORR and the rate of ≥VGPR between the two groups ( χ2 = 0.64, P=0.424; χ2 = 0.82, P = 0.364). The median number of cycles of PI therapy in the transition group was 9, and the median PFS time was not reached. The median number of cycles of PI therapy in the bortezomib group was 7.5, and the median PFS time was 30.0 months (95% CI 19.1-40.9 months), there was no significant difference in PFS between the two groups ( P = 0.275). In the bortezomib group, 12 patients discontinued bortezomib due to adverse reactions, the median PFS time was 20.0 months (95% CI 12.6-27.4 months), and the PFS of patients who discontinued PI in the transition group and the bortezomib group was compared, the difference was statistically significant ( P = 0.043). In the transition group, 21 patients (21/23, 91.3%) developed peripheral neuropathy, and the incidence of ≥grade 3 adverse reactions was 13.0% (3/23); in the bortezomib group, 22 patients (22/40, 55.0%) developed peripheral neuropathy, and the incidence of ≥grade 3 adverse reactions was 12.5% (5/40). Conclusions:For newly-treated MM patients, the transition from bortezomib to ixazomib can improve the depth of remission and reduce the recurrence caused by the discontinuation of PI.
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Background Diabetes is a major threat to public health across the world. Studies have shown that exposure to p,p'-dichlorodiphenyldichloroethylene (p,p'-DDE) is closely related to the occurrence of type 2 diabetes mellitus. However, the relevant molecular mechanism is not clear. Objective To investigate the effects of p,p'-DDE on H19 differentially methylated region (DMR) methylation and insulin secretion of rat insulinoma cells (INS-1 cells). Methods INS-1 cells were cultured with different concentrations (0, 3.125, 6.25, 12.5, 25, 50, and 75 µmol·L−1) of p,p'-DDE for 24 h, and the viability of INS-1 cells was detected by CCK-8 method. INS-1 cells were exposed to 0, 12.5, 25, and 50 µmol·L−1 p,p'-DDE for 24 h in subsequent experiments. The methylation levels of 24 CpG sites in H19 DMR were analyzed by bisulfite genomic sequencing. The expression levels of insulin-like growth factor 2 (IGF2) mRNA were detected by real-time quantitative PCR. The expression levels of IGF2 and insulin-like growth factor-1 receptor (IGF1R) proteins were detected by Western blotting. The insulin secretion function of INS-1 cells was determined by glucose-stimulatedinsulin secretion test (5 and 25 mmol·L−1 glucose, respectively). Results Compared with the control group, the viability of INS-1 cells increased significantly after treatment with 12.5 µmol·L−1 p,p'-DDE; however, it was significantly inhibited after treatment with 50 or 75 µmol·L−1 p,p'-DDE (P<0.01); therefore, 50 µmol·L−1 was chosen as the maximum concentration of exposure for subsequent experiments. The 25 µmol·L−1 p,p'-DDE treatment decreased the methylation levels of CpG18 and CpG22-CpG24 sites in H19 DMR, and the 50 µmol·L−1 p,p'-DDE treatment decreased the methylation levels of CpG10-CpG24 sites (P<0.05 or P<0.05). Multiple concentrations (12.5, 25, and 50 µmol·L−1) of p,p'-DDE down-regulated the mRNA and protein relative expression levels of IGF2 and the protein relative expression levels of IGF1R. The transcription level of IGF2 decreased to 67.8%, 68.6%, and 62.5% of the control group, the protein level of IGF2 decreased to 73.3%, 79.5%, and 80.9% of the control group, and the protein level of IGF1R decreased to 54.8%, 25.6%, and 12.9% of the control group, respectively (P<0.01). In the high glucose context, p,p'-DDE at selected concentrations inhibited the insulin secretion levels to 85.0%, 58.6%, and 49.5% of the control group, respectively (P<0.01). Conclusion p,p'-DDE could down-regulate methylation level of H19 DMR, interfere the IGF2/IGF1R signaling pathway, and inhibit insulin secretion of islet cells.
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Paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired hematopoietic stem cell disease. Gastrointestinal involvement is rarely seen in PNH. This study aims to analyze the clinical features in PNH patients complicated with ischemic bowel disease. Clinical date of 6 patients were collected at Peking Union Medical College Hospital from January 2010 to December 2020. The clinical manifestations, laboratory tests,imaging, endoscopic,and histopathological features and treatment were analyzed.Five in 6 patients were men, with a median age of 31 years old at onset. Most of disease course were recurrent episodes of chronic disease, with abdominal pain (5/6) and gastrointestinal bleeding (5/6). Laboratory examinations showed pancytopenia, reticulocytosis, elevated serum lactate dehydrogenase, high D-dimer and C-reactive protein levels in all patients. Multiple segments of small intestine were the most commonly involved and colon was also affected. Abdominal CT scan showed thickening and roughness or exudation of the intestinal wall (6/6), increased mesenteric density or “comb sign”(4/6), and cholestasis or gallbladder stones (5/6). Endoscopic manifestations included irregular shallow ulcers in the annular cavity (5/6), swelling mucosa with well-defined margins (6/6). Pathological biopsy revealed chronic inflammation of mucosa. The efficacy of steroids combined with anticoagulant therapy was better than that of steroids alone. Ischemic bowel disease in PNH patients is different from typical ischemic enteritis. Young patients, involvement of intestine with multiple segments are common characteristics. The anticoagulant is an essential agent for these patients.
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To determine the physicians′compliance of hour-1 bundle for sepsis. A management system of hour-1 bundle for sepsis was established. The clinical data of 286 sepsis patients were collected, who were classified into 3 months before the bundle (control group), 9 months during process (observation group) and 3 months after bundle (study group). The compliance of hour-1 bundle implementation was compared in three groups. The results showed that with the application and implementation of the management system, the compliance of hour-1 bundle for sepsis in the control group, observation group and study group was 58.3%(28/48), 69.1%(105/152) and 88.4%(76/86) respectively (χ 2=7.053, P=0.029). The 28 day mortality in sepsis patients was 41.7%(20/48), 34.9%(53/152) and 23.3%(20/86) respectively (χ 2=5.576, P=0.062).The management system of hour-1 bundle for sepsis can effectively improve the physicians′ compliance.
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Objective:To investigate the clinical manifestations, characteristics of chest high-resolution computed tomography (HRCT), and prognosis of connective tissue disease (CTD) complicated with interstitial lung disease (ILD) in children.Methods:The clinical data of 53 children with CTD-ILD who were admitted to the Department of Rheumatology and Immunology, Affiliated Xi′an Children′s Hospital of Xi′an Jiaotong University from October 2013 to October 2019 were retrospectively analyzed, including clinical manifestations, blood gas analysis, chest HRCT and prognosis.Results:As for these 53 children with CTD-ILD, the ratio of male to female was 1.0∶1.4, the average age was (7.50±3.34) years, and the course of disease was 2.00 (0.85, 7.50) months.Among them, there were 25 cases (47.2%) of juvenile idiopathic arthritis (JIA), 15 cases (28.3%) of systemic lupus erythematosus (SLE), 11 cases of polymyositis / dermatomyositis (PM/DM) (20.7%), 1 case of overlap syndrome (OS) (1.9%), and 1 case of allergic granulomatosis with polyangiitis (AGPA) (1.9%). Although cough (39.6%) was the most common symptom of respiratory system in these children with CTD-ILD and fever(66.0%) was the most common symptom in the systemic features.Blood gas analysis appeared abnormal in 17 cases, including 10 cases of hypoxemia (18.9%) and 7 cases of type Ⅰ respiratory failure (13.2%). HRCT chest showed ground glass shadow, strip shadow, subpleural spot shadow, grid shadow, pleural thickening, consolidation shadow, nodular shadow and cystic low-density shadow, with the proportion of 52.8%, 26.4%, 22.6%, 18.9%, 11.3%, 7.5%, 1.9% and 1.9%, respectively; nonspecific interstitial pneumonia (NSIP)(39.6%) was the most common type of imaging classification.After the combined treatment with glucocorticoids, immunosuppressive agents and biological agents, HRCT chest showed remarkably improvement in 36 cases (67.9%), while no change in 8 cases (15.1%). A total of 75.0%(33 cases) of 44 cases were infected in the course of combined treatment.In addition, 9 cases (17.0%) died from acute respiratory distress syndrome (ARDS), among which 4 cases exacerbated to rapid progressive luge disease and 5 cases aggravated secondary ARDS due to infection.Conclusions:Only a small number of children with CTD-ILD have respiratory symptoms and signs.HRCT chest contributes to the early diagnosis of CTD-ILD, and its imaging manifestations are diverse.Blood gas analysis and HRCT chest play an important role in the disease evaluation and treatment planning.Moreover, it is the direction for further research to develop effective methods to prevent and control secondary infection so as to improve the survival rate and reduce the mortality rate during the active treatment of primary diseases.
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Objective:To investigate the efficacy of liposomal doxorubicin intensive preconditioning regimen and allogeneic hematopoietic stem cell transplantation (allo-HSCT) in treatment of leukemia.Methods:The data of 20 patients with intensive preconditioning regimen allo-HSCT who were admitted to Shenzhen Second People's Hospital from January 2016 to June 2017 were retrospectively analyzed. The transplantation effect, occurrence of complications and prognosis of patients were analyzed.Results:The median time of granulocyte engraftment was 17 d (13-23 d); the median time of platelet engraftment was 22.5 d (minimum 13 d, maximum >90 d). The acute graft-versus-host disease (GVHD) and chronic GVHD occurred in 2 cases and 1 case, respectively. Eight cases occurred hemorrhagic cystitis, 15 cases occurred Epstein-Barr viremia, 8 cases occurred cytomegaloviremia, 1 case occurred sepsis, 1 case occurred acute liver injury, and 2 cases occurred fungal pneumonia. The median follow-up time was 31.7 months (0.8-53.8 months). One patient died of intracranial infection on the 25th day after transplantation; 3 patients relapsed during the follow-up period, and 2 of them died; the other 16 patients carried 100% donor genes during the follow-up period.Conclusions:The liposomal doxorubicin intensive preconditioning regimen and allo-HSCT have a good effect on leukemia. Increasing the intensity of pretreatment does not increase the treatment-related adverse reactions. The incidence rates of Epstein-Barr viremia and cytomegaloviremia are high, but they are improved after active treatment.
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Objective:To investigate the effectiveness and advantage of visual laryngoscope in the treatment of patients with sudden cardiac arrest who need spontaneous respiration tracheal intubation.Methods:Totally 60 patients who suffered from cardiac arrest and needed spontaneous respiration tracheal intubation were enrolled from June 2020 to February 2021 in the Affilicated Hospital of Chifeng University. Theywere randomlydivided into two groups-traditional laryngoscope (TL) group and visual laryngoscope (VL) group, with30 patients in each group. Then the success rate of glottis exposure, the operative time, success rate and complication rate of tracheal intubation were compared between the two groups. Subgroup assessment between the junior emergency resident doctor (A group) and the senior emergency resident doctor (B group) was conducted.Results:According to Cormack Lehan grades, the success rate of glottis exposure in VL group was higher than that in TL group ( P>0.05), and the success rate of Grade I in VL group was significant higer than that in TL group: 56.70%(17/30) vs. 30.00%(9/30), P<0.05. The trial times of successful intubation cases and the operative time of successful intubation cases were significantly less than those in TL group (1.30 vs 1.67, P = 0.049) and (56.37 s vs 67.12 s, P<0.05). In the subgroup, the one-time success rate of tracheal intubation in A-TL group was significantly lower than that in B-TL group (4/15 vs. 11/15, P<0.05), while the one-time success rate of tracheal intubation in A-VL group was 60.00%, which is lower than that in B-VL group ( P>0.05). The operative time consumed for successful intubation in A-TL group was significantly longer than that in B-TL group: 78.00 s vs. 55.57 s, P<0.05, while the operative time in A-VL group was a little longer than that in B-VL group ( P>0.05). Conclusions:Visual laryngoscope used in spontaneous respiration tracheal intubation can not only increase the success rate of glottis exposure, decrease trial times and shorten operative time of intubation, but also improve the success rate and decrease the complication rate of emergency tracheal intubation.
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Objective:To investigate the incidence and clinical characteristics of cranial imaging abnormalities in children with systemic lupus erythematosus (SLE) at the initial diagnosis.Methods:The clinical data of 74 children with SLE admitted to the Department of Rheumatology in Children′s Hospital Affiliated to Xi′an Jiaotong University for the initial diagnosis from January 2012 to May 2019 were subject to retrospective analysis.They were divided into the cranial imaging abnormality group and the cranial imaging non-abnormality group according to the imaging.A description and statistical analysis were carried out for both groups with respect to the course before initial diagnosis, gender, rash, arthralgia, hair loss, pulmonary lesions, white blood cells (WBC), hemoglobin (Hb), platelets (PLT), erythrocyte sedimentation rate (ESR), serum ferritin (FER), serum complement values (C 3 and C 4), anticardiolipin antibody (ACA), alanine aminotransferase (ALT), aspartate transaminase (AST), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and total cholesterol (TC). Results:Seventy-four children with SLE underwent a cranial imaging exa-mination at the initial diagnosis, including 52 cases for magnetic resonance imaging (MRI) and 22 cases for CT.There were 36 abnormal cases (48.6%), including 27 cases (51.9%) in MRI and 9 cases (40.9%) in CT.Among 36 cases of abnormal cranial imaging in children with SLE, MRI abnormalities were mainly demyelinating lesions and sulcus widening (brain atrophy), while CT abnormalities were mainly sulcus widening (brain atrophy). There were 21 cases presenting with neurological symptoms, including 17 cases of headache, 11 cases of dizziness, 3 cases of convulsions, and 1 case of coma.There were no significant differences between both groups in the course before initial diagnosis, gender, rash, arthralgia and hair loss.Among the 36 cases of SLE with cranial imaging abnormalities, 20 cases presented with interstitial pulmonary lesions, of which 4 cases presented with pulmonary hemorrhage; Among 38 cases of SLE without cranial imaging abnormality, 8 cases presented with interstitial pulmonary lesions, which indicated that there were statistical differences between both groups; within terms of the laboratory test items, there were significant differences in PLT between both groups, and there was no significant difference in WBC, Hb, ESR, FER, C 3, C 4, ACA, ALT, AST, TG, HDL, LDL and TC. Conclusions:The cranial imaging abnormalities in children with SLE, especially the earlier occurrence in MRI, may occur before the manifestation of clinical symptoms of the nervous system.They were also associated with other important organ damages, such as abnormal blood system and lung lesions.Early detection may contribute to the short-term prognosis.
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Objective:To investigate the effects of dexmedetomidine on perioperative coagulation function and inflammatory factors in patients with malignant ovarian tumors.Methods:A total of 60 patients undergoing cytoreductive surgery for malignant ovarian tumors from September 2019 to May 2020 in the Second Hospital of Shanxi Medical University were selected and divided into the dexmedetomidine group and the control group according to the random number table method, 30 cases in each group. Patients in the dexmedetomidine group were pumped with dexmedetomidine 0.5 μg/kg 10 min before induction of anesthesia, and then the intravenous pump was maintained at a rate of 0.2-0.6 μg·kg -1·h -1 until 30 min before the completion of the operation pump injection. The control group was pumped with 0.9% NaCl solution of the same volume at the same time. Before induction of anesthesia (T 0), 2 h after administration (T 1), and 3 h after operation (T 2), the patients' venous blood was collected to detect platelet count (Plt), prothrombin time (PT), activated partial thrombin time (APTT), plasma fibrinogen (FIB), D-dimer; and levels of serum inflammatory factors interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α) were also detected. The operation time, intraoperative fluid infusion, amount of anesthetics, and total intraoperative blood loss were compared between the two groups. Results:Plt at T 1 and T 2 time were (154±28)×10 9/L, (138±27)×10 9/L of the dexmedetomidine group and (133±44)×10 9/L, (114±50)×10 9/L of the control group, which were lower than those of both groups at T 0 time [(182±46)×10 9/L, (184±55)×10 9/L], and the differences were statistically significant ( F values were 11.975, 16.058, all P < 0.05); and Plt at T 1 and T 2 time of the control group were lower than those of the dexmedetomidine group (all P < 0.05). FIB level at T 1 and T 2 time [(3.2±0.9) g/L, (3.3±0.9) g/L of the dexmedetomidine group; (3.7±0.6) g/L, (4.6±0.9) g/L of the control group] and D-dimer level at T 1 and T 2 time [(0.77±0.25) mg/L, (0.81±0.51) mg/L of the dexmedetomidine group; (0.96±0.31) mg/L, (1.15±0.56) mg/L of the control group] were higher than those of both groups at T 0 time [FIB: (3.0met) g/L, (2.8 met) g/L; D-dimer: (0.65rt T) mg/L, (0.63 rt T) mg/L], and the differences were statistically significant (F values were 5.234, 46.121, 4.358, 11.091, all P < 0.05); FIB and D-dimer levels at T 1 and T 2 time of the control group were higher than those of the dexmedetomidine group (all P < 0.05). PT and APTT at T 2 time of the dexmedetomidine group were (12.7±0.5) s and (33.8±3.7) s, respectively, and the control group were (12.3±0.8) s, (31.8±2.4)s, respectively, which were shorter than those of both groups at T 0 time [PT: (13.0±0.3) s, (13.0±0.3) s; APTT: (35.7±2.0) s, (35.7±2.6) s], and the differences were statistically significant (all P < 0.05), and PT and APTT levels at T 2 time of the control group were shorter than those of the dexmedetomidine group (all P < 0.05). IL-6 level at T 1 and T 2 time [(73.3±2.8) pg/L, (84.7±3.8) pg/L of the dexmedetomidine group; (81.5±3.6) pg/L, (89.8±3.2) pg/L of the control group] and TNF-α level at T 1 and T 2 time [(27.4±4.4) ng/L, (32.9±3.7) ng/L of the dexmedetomidine group; (32.7±2.5) ng/L, (39.8±4.0) ng/L of the control group] were higher than those of both groups at T 0 time [IL-6: (65.9±2.9) pg/L, (65.0±1.8) pg/L; TNF-α: (15.4±3.1) ng/L, (16.6±2.6) ng/L)], and the differences were statistically significant ( F values were 264.650, 553.019, 162.447, and 438.225, respectively, all P < 0.05), and IL-6 and TNF-α levels at T 1 and T 2 time of the control group were higher than those of the dexmedetomidine group (all P < 0.05). There were no statistically significant differences in operation time, intraoperative fluid infusion, and intraoperative total blood loss between the two groups (all P > 0.05), but the intraoperative use of propofol and remifentanil of the control group was more than that of the dexmedetomidine group (all P < 0.05). Conclusion:Dexmedetomidine under general anesthesia for malignant ovarian patients undergoing surgery can effectively improve the perioperative coagulation function and reduce the level of inflammatory factors, thereby reducing the risk of postoperative thrombotic events.
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Objective:To observe the efficacy of conbercept in the treatment of different types of diabetic macular edema (DME).Methods:A retrospective clinical study. From March 2019 to March 2021, 136 eyes of 136 patients with DME diagnosed in Department of Ophthalmology of Xi'an No.3 Hospital were included in the study. Among them, there were 65 males and 71 females; the average age was 56.65±8.65 years. All patients underwent best corrected visual acuity (BCVA), optical coherence tomography (OCT) examination, and glycosylated hemoglobin level (HbA1c) examination. Early Treatment Diabetic Retinopathy Study visual acuity chart was used for BCVA examination, which was converted into the logarithmic minimum angle of resolution (logMAR) visual acuity during statistics. An OCT instrument was used to measure the central retinal thickness (CRT) of the macula. According to the characteristics of OCT, DME was divided into diffuse retinal thickening (DRT) type, cystoid macular edema (CME) type, serous retinal detachment (SRD) type, mixed type, and grouped accordingly, respectively, about 30, 38, 33, 35 eyes. There was no significant difference in age ( F=1.189), sex ratio ( χ2=1.331), and HbA1c level ( F=3.164) of the four groups of patients ( P>0.05). All eyes were treated with intravitreal injection of 10 mg/ml conbercept 0.05 ml (including conbercept 0.5 mg) once a month for 3 consecutive times, and then treated as needed after evaluation. BCVA and OCT examinations were performed 1, 3, and 6 months after treatment with the same equipment and methods as before treatment. The changes of BCVA and CRT before and after treatment were compared and observed. For measurement data subject to normal distribution, one-way analysis of variance was performed for comparison between groups; χ2 test was performed for comparison of count data. Results:Before treatment, the logMAR BCVA of the eyes in the DRT group, CME group, SRD group, and mixed group were 0.68±0.11, 0.69±0.15, 0.71±0.12, 0.73±0.14, and CRT was 631.4±50.7, 640.6±55.7, 652.3±63.4, 660.4±61.8 μm. Compared with before treatment, 1, 3, 6 months after treatment, DRT group (BCVA: t=8.139, 11.552, 11.672; CRT: t=16.163, 21.653, 25.855), CME group (BCVA: t=8.923, 9.995, 13.842; CRT: t=16.163, 21.653, 25.855), SRD type group (BCVA: t=5.171, 7.315, 6.051; CRT: t=9.099, 13.731, 21.306), mixed type group (BCVA: t=5.072, 6.939, 7.142; CRT: t=6.920, 15.352, 17.538) The BCVA of the affected eyes was significantly increased, and the CRT was significantly decreased, and the difference was statistically significant ( P<0.05). At 6 months after treatment, the differences in logMAR BCVA and CRT of the 4 groups of eyes were statistically significant ( χ2=58.478, 64.228; P<0.05). The average number of injections in the eyes of the DRT group, CME group, SRD group, and mixed group were 3.37±1.35, 3.68±1.38, 4.18±1.40, 4.13±1.50 times, respectively. Compared with the average number of injections in the eye, the difference was statistically significant ( χ2=9.139, P=0.028). Conclusions:Conbercept can effectively reduce CRT and increase BCVA in eyes with different types of DME. Compared with SRD type and mixed type, DRT and CME type eye are more effective in improving vision, CRT reduction degree is greater, and the number of injections is less.
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Objective:To investigate the characteristics of gastrointestinal (GI) symptom spectrum in patients with Parkinson′s disease (PD), and to help the early identification of gastrointestinal symptoms and management of PD.Methods:One hundred PD patients in the Department of Neurology, Peking Union Medical College Hospital from January 2017 to August 2017 were enrolled in this study. They were assessed by face-to-face GI dysfunction questionnaire, including eight common symptoms involved in oropharynx, upper and lower digestive tract. The Spearman correlation analysis was performed.Results:The age of PD patients was (61.9±10.5) years, the ratio of male to female was 53∶47 and the disease duration was 4.0 (2.0, 6.0) years. There were 42 cases of Hoehn-Yahr (H-Y) stage 1, 30 cases of H-Y stage 2 and 28 cases of H-Y stage 3 and above (24 cases of H-Y stage 3, three cases of H-Y stage 4 and one case of H-Y stage 5). Totally 58% (58/100) of PD patients had one or more GI symptoms. Constipation (42%, 42/100), dysdefecation (38%, 38/100) and salivation (28%, 28/100) were the top three of most common GI symptoms. Lower GI symptoms were the most common (57%, 57/100), followed by oropharyngeal symptoms (33%, 33/100), and upper GI symptoms (27%, 27/100). GI symptoms could appear in H-Y stage 1 patients, 26.1% (11/42) of which had 1-2 kinds of GI symptoms and over 20% of which had more than three kinds of GI symptoms. A total of 39.3% (11/28) of PD patients with H-Y stage ≥3 had more than three kinds of GI symptoms. The Gastroparesis Cardinal Symptom Index (GCSI) score in patients with upper GI symptoms was 3.0 (2.0,6.5). The constipation symptom score in patients with constipation and dysdefecation was 19.0 (12.0,27.3). As for the clinical type of constipation, 66.7% (38/57) of them were mixed, 21.0% (12/57) were slow transit and 12.3% (7/57) were dysdefecation. In 38.6% (22/57) of the constipated patients, constipation symptoms occurred earlier than PD motor symptoms. Correlation analysis showed that H-Y stage was positively correlated with the course of PD, the number of GI symptoms, salivation, constipation, dysdefecation and constipation symptom scores.Conclusions:Constipation, dysdefecation and salivation were the most common GI symptoms in PD patients. PD patients had at least one GI symptom in the early stage (H-Y stage 1). Lower GI symptoms were more common than oropharyngeal symptoms and upper GI symptoms. With the development of PD, the number of GI symptoms, salivation, constipation and dysdefecation were aggravated, which were important for early symptomatic identification and disease management.
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Objective:To investigate the efficacy and safety of dexmedetomidine and dexamethasone in inhibiting opioid-induced cough (OIC) during general anesthesia induction in patients with gynecological tumors.Methods:A total of 180 patients who were scheduled for elective gynecological tumor surgery under general anesthesia in Shanxi Provincial Cancer Hospital from March to November 2019 were selected. They were randomly divided into blank control group, dexmedetomidine group and dexamethasone group according to the random number table method, each group had 60 cases. Firstly, all patients had a 10-minute rest (T 0) after they entered the operate room. Treatment before general anesthesia induction:dexmedetomidine group was pumped dexmedetomidine 0.5 μg/kg (diluted to 10 ml with 0.9% NaCl injection) using an electronic infusion pump; dexamethasone group was injected intravenously dexamethasone 10 mg; blank control group was pumped with 10 ml 0.9% NaCl injection. The pumping was finished within 5 minutes, and the end time of pumping was denoted as T 1. Induction of general anesthesia was performed 5 minutes after the end of pumping: firstly, sufentanil was given intravenously at 0.3 μg/kg, and the injection was finished within 5 seconds (T 2). Two minutes after sufentanil injection (T 3), cis-atracurium 0.3 mg/kg and propofol medium/long-chain injection 2 mg/kg were sequentially injected. Then preoxygenation, endotracheal intubation and mechanical ventilation were implemented in turn. One minute after intubation was recorded as T 4. The incidence and severity of cough in patients within T 2-T 3 of each group were recorded, as well as the incidence of tachycardia, bradycardia, hypertension, hypotension, respiratory depression and myotonia during T 1-T 4. Results:The incidence of OIC in the dexmedetomidine group (10.0%, 6/60) and dexamethasone group (8.3%, 5/60) was lower than that in the blank control group (33.3%, 20/60), and the difference among the three groups was statistically significant ( χ2 = 16.445, P < 0.01), while there was no significant difference in the incidence of OIC between the dexmedetomidine group and the dexamethasone group ( P > 0.05). The incidence of sinus bradycardia in the dexmedetomidine group (16.3%, 10/60) was higher than that in the blank control group (0, 0/60) and dexamethasone group (8.4%, 1/60), and the difference was statistically significant ( P < 0.05). Respiratory depression and myotonia did not occur in the three groups. Conclusions:Pretreatment with dexmedetomidine or intravenous dexamethasone before anesthesia induction can effectively reduce the incidence of OIC in patients with gynecological tumors, and there is no significant difference between the effects of the two drugs. The incidence of sinus bradycardia increases significantly after dexmedetomidine infusion.
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Objective:To study the effect of intravenous injection with butorphanol at different time points on stress response, recovery time after drug withdrawal, emergence agitation and postoperative pain in lung cancer patients undergoing thoracoscopic lobectomy.Methods:A total of 90 lung cancer patients who underwent elective thoracoscopic lobectomy from September 2019 to May 2020 in the Second Hospital of Shanxi Medical University were selected and randomly divided into three groups according to random number table, 30 cases in each group. Group A was set as a preemptive analgesia group, and 20 μg/kg butorphanol was injected intravenously at 15 min before anesthesia induction; group B was injected with 20 μg/kg butorphanol at 30 min before the end of operation; and the blank control group (group C) was given with the same volume of 0.9% NaCl injection at the same time points. The following data including blood glucose, cortisol, heart rate and mean arterial pressure (MAP), recovery time after skin suture and drug withdrawal, emergence agitation score and incidence rate of restlessness, postoperative pain visual analogue scale (VAS) were observed.Results:The level of blood glucose [(5.25±0.32), (5.17±0.58) mmol/L] and cortisol [(253.63±48.29), (222.17±35.73) ng/ml] in group A were lower than those in group B [(5.85±0.53), (5.52±0.48) mmol/L; (302.83±48.63), (274.87±47.93) ng/ml] and group C [(6.07±0.70), (5.68±0.52) mmol/L; (319.97±32.05), (295.57±46.83) ng/ml] immediately after skin suture and 6 h after the operation (all P < 0.05). There were no significant differences in MAP and heart rate at intubation among the three groups (all P > 0.05). The levels of MAP and heart rate in group A at intubation were higher than those before anesthesia induction (all P < 0.05); there were no statistical differences of the levels of MAP and heart rate at 30 min after one-lung ventilation and at extubation compared with those before anesthesia induction (all P > 0.05). In group B and group C, heart rate and MAP at intubation, 30 min after one-lung ventilation and extubation were higher than those before anesthesia induction (all P < 0.05). Among them, the recovery time after drug withdrawal in group B [(16.53±3.64) min] was longer than that in group A [(13.83±3.24) min] and group C [(12.47±3.35) min] (all P < 0.05), while there was no significant difference between group A and group C ( P > 0.05). In addition, in terms of emergence agitation score and agitation incidence, group A [(3.20±0.41) scores, 0 (0/30)] was lower than group B [(3.73±0.74) scores, 7% (2/30)] and group C [(4.00±0.79) scores, 10% (3/30)] (all P < 0.05). The pain VAS in group A [(3.10±0.61) scores, (3.27±0.52) scores] at 3 h and 12 h after operation were lower than those in group B [(3.53±0.86) scores, (3.70±0.53) scores] and group C [(4.00±0.83) scores, (4.10±0.71) scores] at the same time points (all P < 0.05). However, there was no significant difference in pain VAS among the three groups at 24 h and 48 h after operation (all P > 0.05). Conclusions:For lung cancer patients who underwent thoracoscopic lobectomy, preemptive analgesia with butorphanol not only can reduce the stress response and increase the stability of hemodynamics, but also can effectively reduce the incidence of postoperative pain and restlessness without prolonging the recovery time after stopping drug.
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Objective:To compare the pregnancy outcome and neonates prognosis in the late pregnant women with or without group B streptococcus (GBS) infection, and the women with or without standard treatment for GBS, so as to provide scientific evidence for improving the maternal and infant prognosis.Methods:From July 2018 to June 2019, women in the late stage of pregnancy who came to Tongzhou Maternal & Child Health Hospital of Beijing for prenatal examination were selected in our study. Questionnaire survey and GBS sampling test were conducted. They were divided into two groups based on the result of GBS positive or negative, and women with GBS infection were further divided two groups whether they accepted standard treatment for GBS or not. All of them were followed up to observe and record the situation of pregnancy outcome and neonates prognosis.Results:1 127 women completed the GBS test and follow-up in this study with an average age of (26.5±4.8)years old and a mean gestation of (36.6±0.9)weeks. Of them, 142 women were tested for GBS positive, and the rate of GBS infection was 12.6%. 104 women (73.2%) accepted the standard treatment for GBS. The incidence of puerperium infection (4.9% vs 0.9%, P=0.001), neonatal infection (2.1% vs 0.1%, P=0.003), neonatal asphyxia (2.8% vs 0.5%, P=0.017), amniotic fluid pollution (4.2% vs 1.1%, P=0.013) in the GBS positive group were significantly higher than those of the GBS negative group. Furthermore, the incidence of puerperium infection (13.2% vs 1.9%, P=0.021) and amniotic fluid pollution (15.8% vs 0, P<0.001) in the group with out GBS standard treatment were significantly higher than the group with GBS standard treatment. Conclusions:GBS infection in the late stage of pregnancy can significantly increase the incidence of infection, and the outcome for pregnant women and infant may be worse if they do not accept standard treatment. Therefore, GBS screening for pregnant women in the late stage of pregnancy and early effective treatment are very essential to improve the maternal and infant prognosis.
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Objective:To analyze the clinical characteristics and treatment of Stevens-Johnson syndrome.Methods:The clinical data of 30 children with Stevens-Johnson syndrome admitted to our hospital in recent 3 years(January 2016-June 2019) were retrospectively analyzed.Results:Among the 30 cases, 18 cases were male and 12 cases were female, the ratio of male to female was 3: 2.The average age of onset was (7.57±2.48)years, with the oldest age 13years and the youngest age was 2years.The 30 patients met the diagnostic criteria for Stevens-Johnson syndrome.Among the suspected allergen, there were 15 cases of antibiotics, accounting for 50%.There were 8 cases of antiepileptic drugs(4 cases of phenobarbital, 2 cases of carbamazepine and 2 cases of valproic acid), accounting for 26.7%.Five cases of NSAIDS (4 cases of ibuprofen and 2 cases of aspirin), accounted for 16.7%.Two cases had no specific sensitizing drugs, accounted for 6%.All 30 patients had oral mucosa and conjunctiva involvement, corneal ulcer complicated in 1 case.Vulva and genital were involved in 10 cases.All 30 cases received implosive therapy with methylprednisolone sodium succinate + intravenous gamma globulin, among which 3 cases were treated with plasma exchange due to obvious impairment of organ function.Four cases developed toxic epidermal necrolysis, three of which were treated with cyclosporine.One patient had neurological sequelae, manifested as consciousness disorder and limb movement disorder, and recovered after 2 months of rehabilitation treatment.Conclusion:For children with Stevens-Johnson syndrome, most of the children with abnormal liver function.The antiepileptic drugs and antibacterial drugs are the most susceptible drugs.After early identification, early use of high-dose glucocorticoid plus intravenous gamma globulin shock treatment, the prognosis of most patients is good.When the effect is not good, other immune inhibitors such as ciclosporin, biological agents and blood purification, etc.can also be used.
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Objective:To detect the expressions of chemokine receptor 6 (CCR6), CC chemokine ligand 20 (CCL20) E-cadherin and vimentin in tissues of colorectal cancer and their paired liver metastases, and to investigate the possible mechanism of CCR6 in liver metastasis of colorectal cancer.Methods:A total of 62 cases (54 cases of colon cancer and 8 cases of rectal cancer) of primary colorectal adenocarcinoma resection with wax lumps were selected from the First Hospital of Shanxi Medical University and Shanxi Oncology Hospital from 2009 to 2017 with complete data, including 20 samples of colorectal cancer resection with liver metastasis during the same period. The expressions of CCR6, CCL20, E-cadherin and vimentin in colorectal cancer and liver metastases tissues were detected by immunohistochemistry, and the relationships between the expressions of CCR6, E-cadherin and vimentin and the clinicopathological features of patients were analyzed. Logistic multivariate regression was used to analyze the relationship between liver metastasis and clinicopathological features, CCR6, E-cadherin and vimentin. Spearman correlation was used to analyze the correlations between CCR6 and E-cadherin and vimentin.Results:The positive expression rate of CCR6 in colorectal cancer tissues was 66.1% (41/62), 85.0% (17/20) in colorectal cancer with liver metastasis and 70.0% (14/20) in liver metastasis tissues. The positive expression rate of CCL20 in colorectal cancer tissues was 83.9% (52/62), 90.0% (18/20) in colorectal cancer with liver metastasis and 90.0% (18/20) in liver metastasis tissues. The positive expression rate of E-cadherin in colorectal cancer tissues was 67.7% (42/62), 50.0% (10/20) in colorectal cancer with liver metastasis and 65.0% (13/20) in liver metastasis tissues. The positive expression rate of vimentin in colorectal cancer tissues was 79.0% (49/62), 85.0% (17/20) in colorectal cancer with liver metastasis and 90.0% (18/20) in liver metastasis tissues. The expression of CCR6 was closely related to lymph node metastasis ( χ2=11.142, P=0.001), liver metastasis ( χ2=4.694, P=0.030) and TNM stage ( χ2=21.785, P<0.001). E-cadherin was closely related to lymph node metastasis ( χ2=4.694, P=0.030), liver metastasis ( χ2=4.253, P=0.039) and TNM stage ( χ2=7.867, P=0.005). Vimentin was closely related to lymph node metastasis ( χ2=7.293, P=0.007) and TNM stage ( χ2=5.712, P=0.017). CCR6, E-cadherin and vimentin were independent of gender, age, tumor site, tumor size and differentiation degree of colorectal cancer patients (all P>0.05). Logistic regression analysis showed that the expressions of CCR6 ( OR=6.812, 95% CI: 1.206-38.474, P=0.030) and E-cadherin ( OR=0.256, 95% CI: 0.069-0.945, P=0.041) were independent factors affecting the liver metastasis of colorectal cancer. Spearman correlation analysis showed that CCR6 was associated with E-cadherin expression ( r=0.454, P=0.044) and vimentin expression ( r=0.509, P=0.022) in 20 iver metastasis tissues of colorectal cancer. Conclusion:CCR6 may promote colorectal cancer progress and liver metastasis by part of epithelial-mesenchymal transition.
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Background/Aims@#A strong correlation between depression and irritable bowel syndrome with diarrhea (IBS-D) has been identified. The aim of this study is to identify the correlations among depression, structural factors, gastrointestinal (GI) and extra-GI symptoms, and efficacy of neuromodulators in patients with IBS-D. @*Methods@#Patients meeting the Rome III Diagnostic Criteria for IBS-D were enrolled. The intestinal symptoms and psychological states were evaluated using IBS-specific symptom questionnaires and Hamilton Depression Rating Scale. @*Results@#In total, 410 patients with IBS-D were enrolled, 28.8% (118/410) had comorbid depression. Patients with depression did not readily experience improvement in abdominal pain/discomfort after defecation, and had a higher prevalence of passing mucus, overlapping functional dyspepsia, and extra-GI symptoms. The structural factor “mental disorders” significantly correlated with main bowel symptom score and degree of pre-defecation abdominal pain/discomfort. No structural factor significantly correlated with bowel movements or stool form. Patients who had passing mucus, overlapping functional dyspepsia and extra-GI painful symptoms have higher score of “anxiety/somatization.” Patients with sexual dysfunction have higher score of “retardation symptoms.” In total, 28.3% of patients with IBS-D were prescribed neuromodulators. Baseline scores of “anxiety/somatization” and “retardation symptoms” positively correlated with improvement of diarrhea after paroxetine, and “sleep disturbances” positively correlated with improvement of abdominal pain/discomfort and diarrhea after mirtazapine. @*Conclusions@#Comorbid depression and higher scores of structural factors might aggravate GI and extra-GI symptoms other than bowel movements and stool form. Structural factors of Hamilton Depression Rating Scale correlated with efficacy of paroxetine and mirtazapine in patients with IBS-D.
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Quality of medical records is key to hospital′s total quality management, while the establishment and improvement of real-time monitoring feedback system is of great significance to the improvement of the quality of medical records. The authors explored real-time quality control of electronic medical records through artificial intelligence data processing and machine learning. The quality control covers timeliness and completeness in writing the medical records, the consistency and logic of the content, the identification of typos and the quality control of the medical records etc. Its practice showed that the defect rate of medical records has decreased significantly and the quality control management efficiency has greatly improved.
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Objective:To observe the correlation between obstructive sleep apnea syndrome (OSAS) and central serous chorioretinopathy (CSC).Methods:From October 2016 to December 2018, 50 cases of CSC patients (CSC group) and 50 healthy people (control group) matched by age and sex who were diagnosed in the ophthalmological examination of Xi’an No.3 Hospital were included in the study. According to the course of the disease, CSC was divided into acute phase and chronic phase, with 20 and 30 cases respectively. The average age ( Z=1.125) and body mass index (BMI) ( Z=0.937) of the two groups were compared, and the difference was not statistically significant ( P>0.05); the age of patients with different courses of CSC ( Z=1.525) and gender composition ratio ( χ2=0.397) and BMI ( Z=1.781) were compared, the difference was not statistically significant ( P>0.05). The Berlin questionnaire was used to assess the OSAS risk of subjects in the CSC group and the control group; polysomnography was used to monitor the apnea-hypopnea index (AHI) and minimum blood oxygen saturation (MOS) during night sleep. OSAS diagnostic criteria: typical sleep snoring, daytime sleepiness, AHI (times/h) value ≥ 5. The severity of OSAS was classified as mild OSAS: 5≤AHI<15; moderate OSAS: 15≤AHI <30; severe OSAS: AHI≥30. Non-normally distributed measurement data were compared by rank sum test; count data were compared by χ2 test. Spearman correlation analysis was performed on the correlation between OSAS and CSC. Results:The AHI data in the CSC group and the control group were 17.46±3.18 and 15.72±4.48 times/h, respectively; the MOS were (83.48±4.68)% and (87.40±3.82)%, respectively; those diagnosed with OSAS were respectively 36 (72.00%, 36/50) and 13 (26.00%, 13/50) cases. AHI ( Z=0.312), MOS ( Z=0.145), and OSAS incidence ( χ2=21.17) were compared between the two groups of subjects, and the differences were statistically significant ( P=0.028, 0.001,<0.001). The AHI of acute and chronic CSC patients were 15.95±3.02 and 18.47±2.92 times/h; the MOS were (86.10±11.07)% and (81.73±4.58)%, respectively. There were statistically significant differences in AHI ( Z=0.134) and MOS ( Z=0.112) in patients with different course of disease ( P=0.005, 0.001). The results of Spearman correlation analysis showed that OSAS and CSC were positively correlated ( r=0.312, P=0.031). Conclusion:OSAS may be a risk factor for the onset of CSC.