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OBJECTIVE@#To compare the therapeutic effect of Tongdu Tiaoqi acupuncture (acupuncture for unblocking governor vessel and regulating qi ) combined with warming acupuncture, Tongdu Tiaoqi acupuncture, abdominal moxibustion and oral tamsulosin hydrochloride sustained release capsule on postoperative urinary retention.@*METHODS@#A total of 120 patients with postoperative urinary retention were randomized into an acupuncture-moxibustion group, an acupuncture group, a moxibustion group and a medication group, 30 cases in each group. Tongdu Tiaoqi acupuncture combined with warming acupuncture were applied in the acupuncture-moxibustion group. Tongdu Tiaoqi acupuncture was applied at Baihui (GV 20), Shuigou (CV 26) etc. in the acupuncture group. Moxibustion was applied at Qihai (CV 6), Guanyuan (CV 4), Shuidao (ST 28) and Sanyinjiao (SP 6) in the moxibustion group. Tamsulosin hydrochloride sustained release capsule was given orally in the medication group. The treatment was once a day, and 5-day treatment was required in each group. Before and after treatment, the residual urine volume of bladder, the visual analogue scale (VAS) score and the time of first urethral catheter removal were observed, and the clinical efficacy was compared in the 4 groups.@*RESULTS@#After treatment, the residual urine volume of bladder was decreased compared before treatment in the 4 groups (P<0.05), and that in the acupuncture-moxibustion group was less than the other 3 groups (P<0.05). After treatment, the VAS scores were decreased compared before treatment in the acupuncture-moxibustion group, the acupuncture group and the moxibustion group (P<0.05), and those in the 3 groups were lower than the medication group (P<0.05). The time of first urethral catheter removal in the acupuncture-moxibustion group was earlier than the other 3 groups (P<0.05). The total effective rate was 93.3% (28/30) in the acupuncture-moxibustion group, which was superior to 63.3% (19/30) in the acupuncture group, 60.0% (18/30) in the moxibustion group and 66.7% (20/30) in the medication group (P<0.05).@*CONCLUSION@#The therapeutic effect of Tongdu Tiaoqi acupuncture combined with warming acupuncture on postoperative urinary retention is superior to simple acupuncture, abdominal moxibustion and tamsulosin hydrochloride sustained release capsule.
Subject(s)
Acupuncture Points , Acupuncture Therapy , Humans , Moxibustion , Treatment Outcome , Urinary Retention/therapyABSTRACT
Mandibular defects caused by injuries, tumors, and infections are common and can severely affect mandibular function and the patient's appearance. However, mandible reconstruction with a mandibular bionic structure remains challenging. Inspired by the process of intramembranous ossification in mandibular development, a hierarchical vascularized engineered bone consisting of angiogenesis and osteogenesis modules has been produced. Moreover, the hierarchical vascular network and bone structure generated by these hierarchical vascularized engineered bone modules match the particular anatomical structure of the mandible. The ultra-tough polyion complex has been used as the basic scaffold for hierarchical vascularized engineered bone for ensuring better reconstruction of mandible function. According to the results of in vivo experiments, the bone regenerated using hierarchical vascularized engineered bone is similar to the natural mandibular bone in terms of morphology and genomics. The sonic hedgehog signaling pathway is specifically activated in hierarchical vascularized engineered bone, indicating that the new bone in hierarchical vascularized engineered bone underwent a process of intramembranous ossification identical to that of mandible development. Thus, hierarchical vascularized engineered bone has a high potential for clinical application in mandibular defect reconstruction. Moreover, the concept based on developmental processes and bionic structures provides an effective strategy for tissue regeneration.
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Bone Regeneration , Bone Transplantation/methods , Hedgehog Proteins , Humans , Mandible/surgery , OsteogenesisABSTRACT
In the 42 nd and 44 th workshops of CSPEN-nutritional risk-undernutrition-support-outcome-cost effectiveness ratio (NUSOC) multi-center database collaboration group, Jens Kondrup and Henrik Rasmussen described again the application of NRS 2002, the evidence-based basis of NRS 2002 development and the methodology for prospective validation of clinical effectiveness. There is no gold standard for validation. They both considered that malnutrition could be identified as a score of 3 or more for impaired nutritional status in NRS 2002. Although NRS 2002 is simple and easy to be applied, it is not comprehensive enough for malnutrition diagnosis. ASPEN and ESPEN on-line published the Global Leadership (nutritional) Initiative on Malnutrition(GLIM)diagnosis criteria in September 2018. With the gradual implementation of medicare payment based on diagnosis related groups(DRG)in China, the nutritional risk and the malnutrition diagnosis with Chinese version of ICD-10 (2016) code should be recorded in the first page of the medical records. In this terminology interpretations, the terms of nutritional risk screening(NRS 2002.01.016)and malnutrition diagnosis (GLIM-phenotypic criteria 01.028, etiologic criteria 01.029) published in Parenteral and Enteral Nutrition Terminology 2019 are discussed based on the reports given by Kondrup and Rasmussen in Beijing and Zhengzhou.
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Objective:To investigate the risk factors for early complications after laparoscopy-assisted gastrectomy in patients with gastric cancer.Methods:The retrospective case-control study was conducted. The clinicopathological data of 196 patients who underwent laparos-copy-assisted radical gastrectomy at Peking Union Medical College Hospital from March 2016 to March 2019 were collected. There were 144 males and 52 females, aged (61±10)years. Observation indicators: (1) early complications after laparoscopy-assisted radical gastrectomy and treatment; (2) analysis of risk factors for early complications after laparoscopy-assisted radical gastrectomy.Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M( P25,P75). Count data were represented as absolute numbers. Univariate analysis was conducted using the t test, Mann-Whitney U test or chi-square test. Multivariate analysis was conducted using the Logistic regressional model. Results:(1) Early complications after laparoscopy-assisted radical gastrectomy and treatment: 51 of 196 patients had early postoperative complications, including 7 cases of grade Ⅰ according to Clavien-Dindo classi-fication system, 32 cases of grade Ⅱ, 9 cases of grade Ⅲa, 3 cases of grade Ⅲb. There was no grade Ⅳ or Ⅴ complication. There were 25 cases with abdominal complications, 7 cases with thoracic complications, 3 cases with internal/catheter related complications and 16 cases with other unclassified complications. All patients with complications were improved after symptomatic and supportive treatments. (2) Analysis of risk factors for early complications after laparoscopy-assisted radical gastrectomy: results of univariate analysis showed that the lymphocyte count, neutrophil-to-lymphocyte ratio, radiotherapy, operation time, volume of intraoperative blood loss, T stage, lymph node metastasis were related factors for early complications after laparoscopy-assisted radical gastrectomy in patients with gastric cancer ( Z=?2.048, χ2=6.385, 4.168, 8.068, 6.336, 12.497, 7.522, P<0.05). Results of multivariate analysis showed that the neutrophil/lymphocyte ratio ≥1.96, operation time ≥222 minutes, and lymph node metastasis were independent risk factors for early complica-tions after laparoscopy-assisted radical gastrectomy in patients with gastric cancer ( odds ratio=2.279, 2.245, 2.226, 95% confidence interval as 1.149-4.519, 1.116-4.517, 1.125-4.402, P<0.05). Conclusions:The abdominal complications are the most common early complications after laparoscopy-assisted radical gastrectomy. The neutrophil-to-lymphocyte ratio ≥1.96, operation time ≥222 minutes, and lymph node metastasis are independent risk factors for early complications after laparoscopy-assisted radical gastrectomy in patients with gastric cancer.
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Objective:To compare the efficacy of three approaches of parallel-style bilateral metal stenting in the management of unresectable malignant hilar biliary obstruction.Methods:Data of 118 patients with unresectable malignant hilar biliary obstruction (Bismuth type Ⅱ-Ⅳ) treated by endoscopic bilateral metal stenting in Oriental Hepatobiliary Surgery Hospital from January 2012 to February 2019 were retrospectively studied. According to the method of stent placement, patients were divided into three groups, both stents crossing the main duodenal papilla (long long-stent by stent, LL-SBS) group (53 cases), one stent crossing the papilla (long short-SBS, LS-SBS) group (53 cases) and no stent crossing the papilla (short short-SBS, SS-SBS) group (12 cases). The main outcomes, clinical success rate, stent patency, success rate of re-intervention of both intrahepatic systems and overall survival, were compared among the three groups.Results:There were no significant differences in clinical success rate [96.2% (51/53), 98.1% (52/53), and 91.7% (11/12)], median stent patency [9.2 (8.0-10.3) months, 11.6 (6.8-16.4) months, and 8.1 (3.7-12.5) months] or overall survival time [6.7 (4.6-8.8) months, 7.6 (5.7-9.4) months, and 7.1 (0.7-13.6) months] among the three groups (all P>0.05). The success rate of endoscopic re-intervention of both intrahepatic systems was 12/13, 0/10, and 1/5 in LL-SBS, LS-SBS and SS-SBS groups, respectively ( P<0.001). Conclusion:Parallel-style bilateral metal stenting is an effective endoscopic modality in the treatment of malignant hilar biliary obstruction, and LL-SBS may improve the success rate of endoscopic re-intervention to both intrahepatic systems.
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Objective:To investigate the feasibility and efficacy of endoscopic placement of transpapillary parallel-style bilateral metal stents for malignant hilar biliary stricture.Methods:A total of 55 patients with malignant hilar biliary stricture (Bismuth Ⅱ-Ⅳ) were treated with an improved endoscopic drainage technique (endoscopic transpapillary parallel-style bilateral metal stenting) from January 2012 to December 2018 in Shanghai Oriental Hepatobiliary Surgery Hospital. The technical success rate, clinical success rate, incidence of complications, success rate of endoscopic re-intervention, stent patency and overall survival were analyzed.Results:The technical success rate of endoscopic placement of bilateral metal stents was 96.4% (53/55), the clinical success rate was 96.2% (51/53), and the early complication incidence was 13.2% (7/53). The median stent patency was 9.2 months (95% CI: 8.0-10.3 months), the success rate of endoscopic re-intervention of bilateral biliary systems was 92.3% (12/13), and the median overall survival was 6.7 months (95% CI: 4.7-8.8 months). Conclusion:This modified technique of bilateral metal stent placement is safe and effective for malignant hilar biliary stricture that is unsuitable for surgery.
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Objective:To compare the efficacy of bilateral and unilateral metallic stenting in the treatment of unresectable malignant hilar biliary obstruction.Methods:From January 2012 to December 2018, a total of 300 patients with malignant hilar biliary obstruction (Bismuth type Ⅱ-Ⅳ) were treated with endoscopic metallic stenting in Oriental Hepatobiliary Surgery Hospital. Ninety-four patients with bilateral metallic stenting (bilateral metallic stent group) and 94 patients with unilateral metallic stenting (unilateral metallic stent group) were matched and analyzed by propensity score matching. The clinical success rate, the total number of interventions, the stent patency and overall survival time were compared between the two groups.Results:The clinical success rate in the bilateral metallic stent group was significantly higher than that of the unilateral metallic stent group [98.9% (93/94) VS 78.7% (74/94), χ2=19.352, P<0.001], and the mean number of intervention in the bilateral metallic stent group was significantly less than that of the unilateral metallic stent group (1.2±0.5 times VS 1.7±0.9 times, t=-4.345, P<0.001). The stent patency time in the bilateral metallic stent group was significantly longer than that of the other group [10.0 (8.0, 12.1) months VS 5.7 (5.2, 6.3) months, χ2=19.789, P<0.001]. The median survival time of patients in the bilateral group was numerically longer than that in the unilateral group, but did not reach statistical significance [7.6 (6.3, 8.9) months VS 4.6 (3.7, 5.7) months, χ2=3.628, P=0.057]. Conclusion:Endoscopic bilateral metallic stenting is superior to unilateral metallic stenting in the clinical management of malignant hilar biliary obstruction unsuitable for surgery.
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"The Expert Group on Tumor Ablation Therapy of Chinese Medical Doctor Association, The Tumor Ablation Committee of Chinese College of Interventionalists, The Society of Tumor Ablation Therapy of Chinese Anti-Cancer Association and The Ablation Expert Committee of the Chinese Society of Clinical Oncology" have organized multidisciplinary experts to formulate the consensus for thermal ablation of pulmonary subsolid nodules or ground-glass nodule (GGN). The expert consensus reviews current literatures and provides clinical practices for thermal ablation of GGN. The main contents include: (1) clinical evaluation of GGN, (2) procedures, indications, contraindications, outcomes evaluation and related complications of thermal ablation for GGN and (3) future development directions. .
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Nanocrystals self-stabilized Pickering emulsion(NSSPE) is a new kind of emulsion where only nanocrystals of poorly soluble drugs are used as stabilizers. Our previous study showed that NSSPE with Ligusticum chuanxiong oil as the main oil phase can significantly promote oral absorption of puerarin. The present study aimed to explore its absorption mechanism in oral administration. The in vitro dissolution test was carried out to study the effect of NSSPE on release of puerarin. The effects and mechanism of NSSPE on uptake and transport of puerarin across Caco-2 cell were investigated. The results showed that the drug release rate of NSSPE was similar to that of nanocrystals, with their cumulative dissolution of puerarin not affected by pH of releasing mediums, both significantly higher than that of crude material. The uptake of puerarin in NSSPE was concentration-dependent and significantly higher than that of solution or surfactant stabilized emulsion. Genistein and indomethacin, inhibitors of lipid rafts/caveolin, could significantly reduce the uptake of puerarin in NSSPE. Compared with solution, NSSPE and surfactants stabilized emulsion obviously increased transport rate K_a and apparent permeability coefficient P_(app) of puerarin in AP → BL direction, but there was no significant difference in BL → AP direction. It could be inferred that there were both passive and active transport mechanisms, as well as lipid raft/caveolin mediated endocytosis for absorption of NSSPE. The promoted oral absorption of puerarin in NSSPE was mainly related to the existing nanocrystal form which could promote dissolution, puerarin as well as Ligusticum chuanxiong oil which could promote drug transmembrane transport and inhibit drug efflux. It is the unique structure and composition of the compound NSSPE that promoted the oral absorption of puerarin.
Subject(s)
Caco-2 Cells , Drugs, Chinese Herbal , Emulsions , Humans , Isoflavones , NanoparticlesABSTRACT
Objective To investigate the levels of serum N-acetyl-β-D-glucosidase (NAG),neutrophil gelatin-related lipid transporter protein (NGAL) and urinary kidney injury molecule-1 (KIM-1)in children with sepsis and their correlation with the condition.Methods Fifty-eight children with sepsis were selected as the observation group from January 2018 to May 2019 in Guangzhou Red Cross HoSpital,and sequential organ failure assessment (SOFA) score was conducted.According to the score results,all the patients were divided into three groups:mild,moderate and severe group.Meanwhile,58 healthy children were selected as the control group,and the serum NAG,NGAL levels and urinary KIM-1 level in the two groups were detected respectively,and the differences in various indicators among the mild,moderate and severe groups were compared.Pearson correlation analysis was used to explore the correlation between serum NAG,NGAL levels and urinary KIM-1 level and SOFA scores respectively.Results The levels of serum NAG,NGAL and urinary KIM-1 in the observation group were all significantly higher than the control group:(30.53 ± 7.18) U/L vs.(12.36 ± 3.46) U/L,(78.72 ± 12.97)μg/L vs.(30.62 ± 3.24) μg/L,(60.59 ± 10.73) ng/L vs.(22.54 ± 4.25) ng/L,and there were statistical differences (P＜0.05).Serum NAG,NGAL levels and urinary KIM-1 level in the moderate group and the severe group were all higher than the mild group:(31.81 ± 1.41) and (34.24 ± 1.70) U/L vs.(28.11 ± 2.36)U/L,(85.94 ± 5.45) and (94.17 ± 3.91) μg/L vs.(67.45 ± 7.58) μg/L,(67.03 ± 4.63) and (72.17 ± 3.98) ng/Lvs.(51.49 ± 7.08) ng/L,while the levels of serum NAG,NGAL and urinary KIM-1 in the severe group were all higher than those in the moderate group (P＜0.05).Pearson correlation analysis showed that the levels of serum NAG,NGAL and urinary KIM-1 levels in sepsis children were positively correlated with SOFA score (r =0.836,0.935,0.892;P＜0.01).Conclusions The levels of serum NAG,NGAL and urinary KIM-1 in children with sepsis increased significantly,and were related to the severity of the disease,which provides some reference value for the judgment of the sepsis condition.
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Objective: To investigate the effects of ticagrelor on cardiorespiratory fitness in patients with coronary heart disease after percutaneous coronary intervention (PCI). Methods: A total of 1 073 patients, who were diagnosed as coronary heart disease and underwent cardiopulmonary exercise testing (CPET) within 1 year after PCI, were enrolled from September 2017 to September 2019 in Peking University Third Hospital, including 309 patients in ticagrelor group and 764 patients in clopidogrel group. Clinical information, blood test results, echocardiographic parameters, cardiorespiratory fitness related parameters (including peak oxygen uptake (VO(2)), anaerobic threshold VO(2), peak oxygen pulse (VO(2)/HR) and carbon dioxide ventilation equivalent (VE/VCO(2)) slope), coronary lesions and intervention information were obtained. Cardiopulmonary fitness related indexes were compared between the two groups, and the correlation between ticagrelor use and cardiopulmonary fitness related indexes was analyzed by multivariate logistic regression. Patients who underwent CPET within 1 month after PCI were included in the subgroup analysis. Results: In ticagrelor group, the age was (60.3±10.3) years, and 253(81.9%) cases were male. The age of clopidogrel group was (60.6±10.0) years, and there were 608(79.6%) males. No significant differences were observed in peak VO(2), anaerobic threshold VO(2), and peak VO(2)/HR between the two groups (all P>0.05), but the VE/VCO(2) slope was significantly higher in the ticagrelor group than in the clopidogrel group (30.075 (27.207, 33.603) vs. 28.853 (25.970, 32.336), P<0.001). Logistic regression analysis suggested that the peak VO(2), anaerobic threshold VO(2) and peak VO(2)/HR were not significantly correlated with the ticagrelor use (all P>0.05), while the VE/VCO(2) slope was independently correlated with ticagrelor use (OR=1.098, 95%CI 1.032-1.168, P=0.003). Subgroup analysis of patients who underwent CPET within 1 month after PCI also indicated that no significant difference were observed in peak VO(2), anaerobic threshold VO(2), peak VO(2)/HR and VE/VCO(2) slope between the two groups (all P>0.05). Logistic regression analysis suggested that the peak VO(2), anaerobic threshold VO(2) and peak VO(2)/HR were not significantly correlated with ticagrelor use (all P>0.05), while the VE/VCO(2) slope was significantly correlated with ticagrelor use (OR=1.132, 95%CI 1.030-1.244, P=0.010). Conclusion: Among coronary heart disease patients after PCI, treatment with clopidogrel does not result in significant decrease in exercise endurance as compared with patients treated with ticagrelor.
Subject(s)
Aged , Cardiorespiratory Fitness , Exercise Test , Female , Heart Failure , Humans , Male , Middle Aged , Oxygen Consumption , Percutaneous Coronary Intervention , TicagrelorABSTRACT
Objective:To investigate the characteristics and clinical significance of lymph node metastasis of peripheral non-small cell lung cancer(NSCLC) with diameter ≤ 2 cm; to explore the possibility of regional mediastinal lymphadenectomy.Methods:Collect all patients’ data with peripheral NSCLC ≤2 cm from January 2017 to August 2018 in our hospital, there was no previous history of other malignant tumors. All patients underwent lobectomy, segmentectomy, or wedge resection, and mediastinal lymphadenectomy , and comprehensive analysis was performed based on pathological findings and clinical features.Results:Among the peripheral NSCLC with a diameter of ≤ 2 cm, metastatic degree and rate of mediastinal lymph nodes were low(0.67% and 1.87%, respectively). The lymph nodes metastatic rate of pGGO, mGGO and solid nodule were 0, 1.18% and 4.92%, respectively. The 11th group of lymph node metastasis was positively correlated with the solid components of lymph nodules( P=0.024). While lymph node metastasis had no significant correlation between gender, age, smoking history, size, location, and tumor type. The metastasis of the 11th group of lymph nodes was positively correlated with the 2nd, 3rd, 4th and 6th lymph nodes( P=0.014, Kappa value 8.406). Conclusion:For the operation of pGGO patients, mediastinal lymphadenectomy was not necessary, or maybe N1 lymph nodes sampling was enough. For the operation of mGGO or solid nodules, the surgeon can determine the lymphadenectomy scope according to the 11th-group lymph nodes frozen pathology result. If positive, the extent of lymph node dissection should be appropriately expanded; If negative, the lymph node dissection can be skipped, so as to reduce the complications.
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Objective:To investigate the value of the novel SpyGlass peroral choledochoscopy for the diagnosis of indeterminate biliary strictures.Methods:Data of 66 patients with biliary strictures assessed by the second generation SpyGlass were collected in the retrospective study from January 2018 to January 2019. The imaging characteristics and type of biliary strictures were observed. The sensitivity, specificity, positive predictive value and negative predictive value of SpyGlass were evaluated with the results of pathology and long-term follow-up results as the golden standard.Results:A total of 20 benign biliary stricture and 46 malignant biliary stricture were confirmed by pathology, other imaging examinations and long-term follow-up results. The sensitivity, specificity, positive predictive value and negative predictive value of SpyGlass were 100.0% (46/46), 90.0% (18/20), 95.8% (46/48) and 100.0% (18/18), respectively. Vessels of irregular morphology or brittle texture was the most common manifestation of malignant strictures under SpyGlass observation.Conclusion:The novel SpyGlass system can evaluate imaging features of most benign and malignant biliary strictures with high sensitivity.
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Objective:To evaluate the efficacy of endoscopic photodynamic therapy (PDT) combined with biliary stenting on treatment of patients with extrahepatic cholangiocarcinoma or ampullary carcinoma.Methods:Data of 60 patients with extrahepatic cholangiocarcinoma or ampullary carcinoma were collected in Eastern Hepatobiliary Hospital from September 2013 to December 2016, and patients were divided into stent group (n=36, undergone endoscopic biliary stenting only) and PDT group (n=24, undergone endoscopic PDT combined with biliary stenting). The clinical success rate, adverse events incidence, stent patency time and overall survival time were analyzed.Results:No significant differences were found on baseline data between the stent group and PDT group (all P>0.05). No significant difference was found between the two groups in clinical success rate [94.4% (34/36) VS 95.8% (23/24), χ2=0.060, P=1.000], and early adverse events incidence [41.7% (15/36) VS 62.5% (15/24), χ2=2.50, P=0.187]. The Karnofsky performance score of the first, third and sixth month after operation in the PDT group were significantly higher than those in the stent group (all P<0.001). The median patency time of stent was 102.0 d (95% CI: 73.9-130.1 d) in the stent group, and 119.0 d (95% CI: 96.8-141.2 d) in the PDT group ( P=0. 634). However, the median overall survival time was longer in the PDT group (327.0 d, 95% CI: 215.9-438.1 d) than that in the stent group (162.0 d, 95% CI: 125.0-199.0 d, P=0.006). Cox regression analysis showed that PDT was associated with a longer survival ( P=0.012), while distal cholangiocarcinoma ( P=0.016) and higher TNM staging ( P=0.001) were associated with a shorter survival. Conclusion:PDT with biliary stenting results in a longer survival and a better quality of life than the stenting therapy alone in patients with extrahepatic cholangiocarcinoma or ampullary carcinoma. PDT, location of lesions and TNM staging are independent prognostic factors for the survival of patients.
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Objective:To evaluate the effectiveness and safety of morpholinidazole in senile suppurative appendicitis during the perioperative period.Methods:A randomized, double-blind, controlled study was used to prospectively analyze 65 senile suppurative appendicitis patients admitted to our hospital from Dec 2017 to Dec 2018. There were 32 cases in the ornidazole group and 33 cases in the morpholinidazole group. The clinical cure rate, the incidence of serious complications, the incidence of wound infection, and the clearance rate of anaerobic bacteria were evaluated 5 days after the administration in the two groups of patients.Results:After treatment, the CRP, PCT, and WBC of the morpholinidazole group were significantly lower than those of the ornidazole group ( P<0.05). The anaerobic clearance rate and the incidence of serious complications were not statistically different in between the 2 groups ( P>0.05). The complications of intraperitoneal infection in the morpholinidazole group were lower than those of the ornidazole group ( P=0.048), The clinical cure rate was also significantly higher than the ornidazole group ( P=0.041). Conclusions:The use of morpholinidazole in elderly patients with suppurative appendicitis during the perioperative period is effective and safe.
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Objective:To evaluate the effect of epidural labor analgesia on hyperalgesia in the early postpartum period.Methods:Ninety nulliparas of primigravid, of American Society of Anesthesiologists physical statusⅠor Ⅱ, aged 20-35 yr, who were at full term with a singleton fetus, at 38-41 weeks of gestation, were assigned to labor analgesia group (group LA, n=38) and labor group (group L, n=52) according to whether the patient requested epidural labor analgesia or not.Epidural labor analgesia was performed when the cervical dilatation was 3-4 cm in LA group.The mechanical pain threshold was measured on admission to the delivery room and at days 1, 2 and 3 after delivery.Visual analog scale scores were assessed and recorded when cervical dilatation was 3 cm (T 1), at complete cervical dilatation (T 2), and at 12, 24 and 48 h after delivery (T 3-5). The duration of the first and second stage of labor and amount of intrauterine bleeding 2 h after delivery were recorded.Apger scores at 1, 5 and 10 min after birth were recorded. Results:Fifty-one cases completed surgery in group L and 37 cases in group LA.Compared with group L, the mechanical pain threshold was significantly increased, and visual analog scale score at T 2-4 was decreased, the first and second stages of labor were prolonged( P<0.05), and no statistically significant change was found in intrauterine bleeding volume or Apgar score at 2 h after delivery in group LA( P >0.05). Conclusion:Epidural labor analgesia can reduce hyperalgesia in the early postpartum period.
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Objective: To explore and analyze the differences of clinicopathological features and prognosis and influencing factors in young breast cancer patients in different age groups. Methods: A total of 277 female breast cancer patients with invasive ductal carcinoma under 40 years old who were diagnosed and treated by operation at the International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine from Jan. 2010 to Dec. 2018 were retrospectively analyzed. The patients were divided into two groups by the age of 35 years old, i.e. aged ≤ 35 group and aged >35 and ≤ 40 group. The differences of clinicopathological features were compared between the two groups, including histological classification of cells, tumor size, lymph node metastasis, estrogen receptor (ER) expression, progesterone receptor (PR) expression, human epidermal growth factor receptor-2 (HER2) expression, the expression of Ki-67, the degree of intravascular invasion, pathological stage and molecular subtype. The prognostic differences and influencing factors of the two groups were analyzed. Results: There were no significant differences in histological classification of cells, tumor size, lymph node metastasis, ER expression, PR expression, HER2 expression, the expression of Ki-67, the degree of intravascular invasion, pathological stage and molecular subtype between the two groups. The 3-year disease-free survival (DFS) of the patients in the aged ≤ 35 and >35 and ≤ 40 group were 89.66% and 95.03%, respectively, and there was no significant difference. There was no statistically significant difference in the 3-year DFS among the four molecular subtypes between the two groups. Cox proportional hazards model showed that intravascular invasion and lymph node metastasis were the independent risk factors of DFS. Conclusion: >35 and ≤ 40 year-old breast cancer patients and ≤ 35 year-old breast cancer patients have similar clinicopathological features and prognosis, so the same treatment strategy should be given.
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OBJECTIVE@#To systematically review the therapeutic effect of acupuncture-moxibustion therapies on post-stroke constipation based on the network Meta-analysis.@*METHODS@#The randomized controlled trials of acupuncture and moxibustion for post-stroke constipation were retrieved from the databases, starting from the time of establishment through to June, 2019, i.e. the PubMed, EMbase, Cochrane Library, Web of Science, SinoMed, CNKI, Wanfang and VIP. The literature was selected according to inclusion and exclusion criteria, the quality of literature was evaluated by bias risk assessment tool of Cochrane Review Manual 5.3 and the data was statistically analyzed by softwares of Stata 13.1 and R Language.@*RESULTS@#A total of 28 trails were included, involving 9 intervention methods. The therapeutic effect was arranged from high to the low according to the surface under cumulative ranking area (SUCRA), i.e. acupuncture combined with medication (0.86), warm needling (0.83), electroacupuncture combined with medication (0.68), electroacupuncture (0.68), moxibustion (0.50), auricular point sticking (0.44), acupuncture (0.31), Chinese herbal medicine (0.12) and western medication (0.04).@*CONCLUSION@#Acupuncture- moxibustion therapies have superiority on treating post-stroke constipation, acupuncture combined with medication has the most optimum therapeutic effect and the therapeutic effect of acupuncture-moxibustion combined with medication is superior to the single treatment of medication.
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The transcription factor nuclear factor kappa B (NF-B) is activated in hepatocytes in the pathogenesis of hepatic steatosis. However, the action mechanism of NF-B remains to be established in the hepatic steatosis. In this study, the subunit of NF-B was found to promote the hepatic steatosis through regulation of histone deacetylase 1 (HDAC1) in hepatocytes. The activity was supported by the phenotypes of knockout (-KO) mice and knockout (-KO) mice. Hepatic steatosis was reduced in the -KO mice, but not in the -KO mice. The reduction was a result of inhibition of HDAC1 activity in the -KO cells. Knockdown of gene led to suppression of hepatocyte steatosis in HepG2 cells. A decrease in sterol-regulatory element binding protein 1c (SREBP1c) protein was observed in the liver of -KO mice and in cell with knockdown. The decrease was associated with an increase in succinylation of SREBP1c protein. The study suggests that stabilizes HDAC1 to support the SREBP1c activity in hepatic steatosis in the pathophysiological condition. Interruption of this novel pathway in the -KO, but not the -KO mice, may account for the difference in hepatic phenotypes in the two lines of transgenic mice.
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OBJECTIVE@#To study the gene distribution characteristics of neonatal thalassemia in Dongguan, China and the changing trend of the gene distribution characteristics of neonates with thalassemia in Dongguan in 2014-2018.@*METHODS@#A retrospective analysis was performed for the data on neonatal thalassemia screening from the Dongguan Neonatal Disease Screening System between January 2014 and December 2018. A total of 616 718 neonates were enrolled who were born in Dongguan.@*RESULTS@#Among the 616 718 neonates, 52 308 were positive for primary screening, 10 366 were recalled, 8 576 underwent genetic diagnosis, and 6 432 were confirmed with thalassemia by genetic diagnosis. The carrying rates of thalassemia genes in 2014-2018 were 5.81%, 5.47%, 5.96%, 6.91%, and 7.90% respectively, and showed an upward trend (P<0.001). The positive rates of neonatal thalassemia screening in 2014-2018 were 9.12%, 8.34%, 7.54%, 8.13%, and 9.32% respectively (P<0.001). The positive rates of genetic diagnosis of neonatal thalassemia in 2014-2018 were 0.89%, 1.11%, 1.24%, 0.90%, and 1.09% respectively (P<0.001). In 2014-2018, 5 098 cases of α-thalassemia were detected, accounting for 79.26% of all cases, and 1 230 cases of β-thalassemia were detected, accounting for 19.12% of all cases. The detection rate of α-thalassemia was significantly higher than that of β-thalassemia in each year (P<0.001). In 2014-2018, static α-thalassemia, mild α-thalassemia, and mild β-thalassemia were the main types observed in neonates.@*CONCLUSIONS@#Most of the neonates with thalassemia have α-thalassemia in Dongguan, with static α-thalassemia and mild α-thalassemia as the main types. The carrying rate of thalassemia genes keeps increasing in neonates in Dongguan, and the prevention and treatment of thalassemia is still challenging.