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1.
Article in Chinese | WPRIM | ID: wpr-909503

ABSTRACT

Alzheimer's disease (AD) is one of the major diseases that harmful to healthy elderly, and mild cognitive impairment (MCI) is the early clinical stage of AD. There is a lag in the clinical diagnosis of both diseases. An objective and reliable auxiliary diagnostic method is urgently needed to provide early diagnosis and differential indicators for AD and MCI, to predict the probability of individuals suffering from AD and MCI transforming into AD, and to reduce the overall incidence of AD and reduce the huge medical and economic burden for the country and society. Event-related potential is widely used in AD and MCI, and the resolution at the millisecond level can truly reflect the time course of cognitive processing and the degree of impairment of cognitive function in patients. In this study, we investigated the differences in the amplitude and latency of ERP components in healthy elderly, MCI and AD patients, and the correlation between ERP components and cognitive impairment. Early N170 and P200 showed high sensitivity and specificity in differentiating MCI from healthy elderly or MCI from AD. The late perception-related ERPs also showed high sensitivity and specificity in differentiating healthy elderly from MCI/AD. The differences in ERPs between MCI and AD may be related to the etiology, the degree of disease progression and the site of brain damage. The specific brain mechanism still need to be further explored and will be the focus of future research. With the progress of the research, the relationship between the specific ERP manifestations and the mechanism of brain injury as well as the impairment of cognitive function will be more clear. It is believed that the application of ERP in clinical will bring more benefits to AD and its early clinical MCI.

2.
Chinese Critical Care Medicine ; (12): 1129-1132, 2021.
Article in Chinese | WPRIM | ID: wpr-909466

ABSTRACT

Objective:To share the practice of medical care and rescue in the 2017-2019 Amne Machin extreme cross-country challenge.Methods:At the invitation of the Organizing Committee of Amne Machin extreme cross-country challenge of Maqin County of Qinghai Province. More than 150 medical personnel were sent to make the rescue plan and implement the medical security for three consecutive years. The support was divided into leading command group, expert consulting group, on-site medical support group, rear medical support group, and medical material support group. The on-site medical support group was equipped with the ambulance, corresponding emergency medical equipments and medicines to provide medical support at eight medical stations from the starting point to the endpoint and along the route between each station.Results:There were no cardiac arrest and sudden death cases during the three competitions. A total of 56 patients (5 cases of combined injuries) were received, including 21 cases of mild altitude reaction, 8 cases of abrasions, 13 cases of muscle spasm and strain, 11 cases of hypoglycemia, and 3 cases of abdominal pain. All the injured were treated and observed in time. Each patient achieved a complete remission.Conclusions:To achieve the success of medical security of the highest average altitude cross-country race certified by International Trail Running Association (ITRA), we must formulate a scientific and perfect medical security work plan in the first place: pre competition physical examination, especially the application of sports cardiopulmonary function test, screen out athletes who may have medical accidents; during the competition, focus on monitoring and tracking the players who may have problems; each support point is closely connected with the support vehicle; do a good job of first aid training for all kinds of personnel, so that medical accidents can be found, aided, and transferred at the first time. The medical care and rescue of Amne Machin extreme cross-country challenge have played a good role in the security of the international plateau sports events, which provides a reference for the security of similar events.

3.
Article in Chinese | WPRIM | ID: wpr-908799

ABSTRACT

Objective:To analyze the registration status of acute pancreatitis-related clinical studies registered on the Chinese Clinical Trial Registry (ChiCTR) and USA ClinicalTrials.gov database.Methods:The ChiCTR and ClinicalTrials.gov database were searched to collect, sort and analyze the clinical studies related to acute pancreatitis registered from the establishment of the database to December 31, 2020. The clinical trials were manually grouped, and the features of clinical researches were compared based on different registered data (2007-2014 vs 2015-2020) and different financial sources (self-support, enterprise support or public support). Results:A total of 157 registered clinical studies related to acute pancreatitis have been included (ChiCTR n=99; ClinicalTrial.gov n=58). The top three areas with the greatest number of registered clinical studies were Sichuan (28.0%), Shanghai (14.6%) and Jiangsu (12.1%), totally accounting for 54.7%. There were 91 interventional studies, 41 observational studies and 25 other type studies. Masking was performed in 34 studies (21.6%). Randomized parallel controlling was performed in 84 studies (53.5%). 30 trials (19.1%) were at Ⅳ phase, and 7 trials (4.4%) were at Ⅱ or Ⅲ phase. 2007-2014 group tended to use randomized parallel controlled design (68.3% vs 45.4%, P=0.005) and randomization grouping (76.7% vs 47.4%, P=0.001). 2015-2020 group tended to use relatively large sample (72.6% vs 47.4%, P=0.002)and data management committee (53.6% vs 25.0%, P=0.001). The differences between the two groups were statistically significant. Of 92 trials from ChiCTR database, 48 were self-supported, 5 was supported by enterprise, and 38 was supported by the public. The percentage of self-support and public support was 86.9%. Conclusions:The number of acute pancreatitis-related clinical studies registered on ChiCTR was generally on the increase. Most registered studies were funded by public finances or by the researchers' institutions self. There was a lack of phaseⅡ or phase Ⅲ.

4.
Article in Chinese | WPRIM | ID: wpr-906182

ABSTRACT

Objective:To identify the chemical constituents of Platycladi Cacumen<italic> </italic>before and after being carbonized. Method:Chemical constituents in 3 batches of Platycladi Cacumen and its carbonized products<italic> </italic>were identified and compared by ultra performance liquid chromatography-quadrupole-time of flight-mass spectrometry (UHPLC-QTOF-MS/MS). Chromatographic separation was performed on an ACQUITY UPLC BEH C<sub>18</sub> column (2.1 mm×100 mm, 1.7 μm) with 0.1% formic acid aqueous solution (A)- acetonitrile (B) as mobile phase for gradient elution (0-3.5 min, 5%-15%B; 3.5-6 min, 15%-30%B; 6-6.5 min, 30%B; 6.5-12 min, 30%-70%B; 12-12.5 min, 70%B; 12.5-18 min, 70%-100%B; 18-22 min, 100%B). The flow rate was 0.4 mL·min<sup>-1</sup> and the injection volume was 5 μL. Mass spectrometry was performed by an electrospray ionization, and the primary and secondary mass spectrometry data were collected with the full scan mode of positive and negative ions, the peaks containing MS/MS data were identified by self-established secondary mass spectrometry database and corresponding fragmentation law matching method. Result:A total of 77 and 76 substances with the same change trend were identified under positive and negative ion modes. After being<italic> </italic>carbonized, the disappeared components of Platycladi Cacumen were mainly amino acids, ketone aldehydes and other volatile components. Among newly produced components, there were 6 kinds of flavonoid aglycones (rhamnetin, 6,7,3'-trihydroxyflavone, 3,6,3'-trihydroxyflavone, 4'-hydroxy-2'-methyl-3,4,5-trimethoxychalcone, herbacetin and 3',5'-dimethoxy-3,5,7,4'-tetrahydroxyflavone), 3 kinds of coumarins (7-hydroxycoumarin, 7,8-dihydroxycoumarin and 8-acetyl-7-hydroxycoum-arin) and 3 kinds of benzoic acids (3-methylcatechol, pyrocatechol and chromone-3-carboxylic acid). There were a total of 40 flavonoids (quercitrin, quercetin, kaempferol, etc.) among these identified chemical constituents. Conclusion:There are significant quantitative and qualitative changes in the chemical compositions of Platycladi Cacumen after being carbonized. The flavonoids, the identified main active ingredients, can provide data reference for further study on the material basis of efficacy changes of Platycladi Cacumen<italic> </italic>before and after being carbonized.

5.
Article in Chinese | WPRIM | ID: wpr-885975

ABSTRACT

Objective: To investigate the mechanisms of electroacupuncture (EA) at Zusanli (ST 36), Liangmen (ST 21) and Sanyinjiao (SP 6) in intervening diabetic gastroparesis (DGP) based on calcium-activated chloride channel. Methods: Forty Sprague-Dawley rats were randomly divided into four groups, including a normal control group (group A), a model group (group B), an EA group (group C) and a metoclopramide group (group D), with 10 rats in each group. A single intraperitoneal injection of 2% streptozotocin (STZ) combined with 8-week high-glucose high-fat diet was used to establish a DGP rat model. After intervention, gastrointestinal propulsive rate was observed; the expression level of transmembrane protein 16A (TMEM16A) was examined by immunohistochemistry; the Ca2+ concentration in interstitial cells of Cajal (ICCs) was detected by immunofluorescence; and whole-cell patch-clamp technique was applied to detect the current intensity of calcium-activated chloride channel (ICaCC) in ICCs in gastric antrum. Results: After modeling, the blood glucose levels in group B, group C and group D were significantly increased compared with group A (all P<0.01); after intervention, compared with group B, the blood glucose levels in group C and group D were significantly decreased (P<0.05, P<0.01); the intra-group comparison of blood glucose level between after modeling and after intervention found significant difference only in group C (P<0.01). The gastrointestinal propulsive rates in group B, group C and group D were significantly different from that in group A (P<0.01 or P<0.05); the gastrointestinal propulsive rates were markedly higher in group C and group D than in group B (P<0.01, P<0.01). The expressions of TMEM16A in group B and group C were decreased compared with group A (P<0.01, P<0.05); the expressions of TMEM16A in group C and group D were increased compared with group B (P<0.01, P<0.05). The fluorescence intensity of Ca2+ was significantly lower in group B than in group A (P<0.01); the fluorescence intensity of Ca2+ was significantly higher in group C and group D than in group B (P<0.01, P<0.05). ICaCC in ICCs in group B was significantly decreased compared with group A; ICaCC in group C and group D were increased compared with group B. Conclusion: EA at Zusanli (ST 36), Liangmen (ST 21) and Sanyinjiao (SP 6) can significantly improve gastrointestinal motility in DGP rats by up-regulating the ICaCC in ICCs.

6.
Chinese Journal of Geriatrics ; (12): 637-640, 2021.
Article in Chinese | WPRIM | ID: wpr-884925

ABSTRACT

Objective:To investigate the effects of Dexmedetomidine for supplemental anesthesia on perioperative hemodynamics and postoperative sedation and analgesia in elderly patients receiving radical gastric cancer surgery under general anesthesia.Methods:From January 2019 to April 2020, 63 patients admitted to our hospital for radical gastric cancer surgery were included as observation objects.They all underwent general anesthesia and were divided into the Dexmedetomidine group(odd-numbered group)and the normal saline group(even-numbered group)according to the parity of serial numbers the subjects were assigned to.Changes in perioperative hemodynamic index values and the amounts of anesthetic drugs used in the two groups were monitored and recorded, and postoperative sedation and analgesia effects were evaluated by using the Ramsay sedation scale and the visual analog scale(VAS).Results:The mean artery pressure(MAP)and heart rate(HR)were lower in the Dexmedetomidine group than in the normal saline group before anesthesia induction(T1), immediately after intubation(T3)and immediately after extubation(T5)( P<0.05). The Ramsay scores were higher and the VAS scores were lower in the Dexmedetomidine group than in the normal saline group at 1 h and 4 h after surgery( P<0.05). The doses of intraoperative propofol and remifentanil were lower in the Dexmedetomidine group than in the normal saline group[(1121.5±198.5)mg vs.(1395.6±332.7)mg, (3.1±0.9)mg vs.(5.5±1.2)mg, P<0.05]. Conclusions:The use of Dexmedetomidine for supplemental anesthesia can effectively maintain the stability of the patient's intraoperative hemodynamics and enhance the sedative and analgesic effects while reducing the amount of anesthetic drugs in patients receiving radical gastric cancer surgery under general anesthesia.

7.
Article in Chinese | WPRIM | ID: wpr-883974

ABSTRACT

Objective:To explore the mediation effect of personality between negative life events and risky mentation of university students.Methods:A cross sectional investigation was conducted among 8 379 freshmen with the adolescent self-rating life events check list (ASLEC), the prodromal questionnaire(PQ-16) and the Eysenck personality questionnaire (EPQ). The data were analyzed by SPSS 23.0 and AMOS 24.0.Results:The total score of negative life events scale((31.16±0.58) vs (15.19±0.15)), the scores of neuroticism((58.20±0.36) vs (41.59±0.13)) and psychoticism((53.07±0.29) vs (47.71±0.08)) in the risk psychological state group were significantly higher ( t=26.611, 42.270, 17.286, all P<0.01), and the score of introversion-extroversion factor was significantly lower((49.83±0.42) vs (55.88±0.13), t=-13.634, P<0.01) than those in the risk-free psychological state group. There was a positive correlation between the scores of risk psychological state and negative life events( r=0.290, 0.334, both P<0.01), and the scores of risk psychological state and negative life events were positively correlated with the scores of personality neuroticism and psychoticism ( r=0.139-0.469, all P<0.01) in both risk psychological state and risk-free psychological state group.The risk psychological state score of college students was negatively correlated with the inside and outside personality score( r=-0.070, P<0.01), and the score of negative life events was not correlated with introversion-extroversion personality score in the risk psychological state group, while the score of risk psychological state, negative life events and introversion-extroversion personality score were negatively correlated in the risk-free psychological state group ( r=-0.177, -0.080, P<0.01). The personality of college students played a complete mediating role between negative life events and risk psychological state in the risk psychological state group, while the personality of college students in the risk-free psychological state group played a partial mediating role between negative life events and risk psychological state, accounted for 71.43% of the total effect. Conclusion:Negative life events not only directly lead to the risky mentation of college students, but also affect the risky mentation of college students by the mediation effect of introverted and extroverted tendency and unstable emotion.

8.
Article in Chinese | WPRIM | ID: wpr-883523

ABSTRACT

Objective:To explore the clinical features of acute pancreatitis in pregnancy (APIP) and the risk factors for fetal death.Methods:The clinical data of 90 patients with APIP in the Affiliated Hospital of Southwest Medical University were retrospectively analyzed from January 2013 to June 2020. Based on the severity, the patients were classified into MAP groups ( n=41), MSAP groups ( n=33), SAP group ( n=16). According to the presence of fetal deaths, the patients were divided into fetal death group ( n=13) and fetal survival group ( n=77). The clinical characteristics and indicators of patients in each group were compared. Binary logistic regression analysis was performed on the variables with differences between groups to explore independent risk factors for fetal death. The receiver operating characteristic curves of laboratory indicators were drawn to evaluate their diagnostic efficacy. Results:Hyperlipidemia was the main cause in 90 APIP cases (42/90, 46.7%). The levels of LDH, CRP, blood glucose, D2 polymer, albumin and ApoA1, the 1-min and 5-min Apgar scores of neonates were statistically significant among MAP group, MSAP group and SAP group (all P<0.05). There were no maternal deaths in 90 cases and 13 fetal deaths (14.4%). Fetal mortality increased with the severity of APIP. APIP combined with hypertension ( OR=14.742, 95% CI 1.157-187.890, P=0.038), ketoacidosis ( OR=19.587, 95% CI 1.789-214.469, P=0.015) and CRP level ( OR=1.013, 95% CI 1.001-1.025, P=0.031) were risk factors for fetal death. ApoA1 level ( OR=0.118, 95% CI 0.021-0.664, P=0.015) was a protective factor for fetal death. The sensitivity and specificity of ApoA1 for predicting fetal death were 84.6% and 79.2%, the sensitivity and specificity of CRP for predicting fetal death were 76.9% and 84.4%, and the sensitivity and specificity of the combination of the two indicators for predicting fetal death were 100% and 67.5%. Conclusions:The severity of APIP was closely related to fetal death. Hypertension, ketoacidosis and blood level CRP were independent risk factors for fetal death, which should be paid special attention.

9.
Journal of Clinical Hepatology ; (12): 1164-1168., 2021.
Article in Chinese | WPRIM | ID: wpr-876664

ABSTRACT

ObjectiveTo investigate the clinical and prognostic features of hypertriglyceridemic pancreatitis (HTGP) during pregnancy. MethodsA total of 77 patients with acute pancreatitis in pregnancy who were admitted to The Affiliated Hospital of Southwest Medical University from January 2013 to June 2020 were enrolled as subjects, and according to the presence or absence of HTGP, they were divided into HTGP group with 38 patients and non-HTGP group with 39 patients. The two groups were compared in terms of the clinical features including age, pregnancy, laboratory markers, complication, and prognostic indices. The independent samples t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups, and the Mann-Whitney U test was used for comparison of ranked data between two groups. According to the trimester of pregnancy, the patients were divided into early pregnancy group with 4 patients, middle pregnancy group with 14 patients, and late pregnancy with 59 patients, and blood lipid levels were compared between groups; the Kruskal-Wallis H test was used for comparison between two groups or within each group. ResultsCompared with the non-HTGP group, the HTGP group had significantly higher mean age (t=-3.000, P=0.004) and proportion of patients with diabetes (χ2=8.867, P=0.003). Compared with the non-HTGP group, the HTGP group had a significantly higher proportion of patients with disease onset in the third trimester (P<0.001) and a significantly lower serum level of sodium (Z=-6.328, P<0.001). Compared with the non-HTGP group, the HTGP group had significantly higher incidence rates of acute peripancreatic fluid collection (76.3% vs 33.3%, χ2=14.342, P<0.001) and systemic inflammatory response syndrome (81.6% vs 410%, χ2=13.310, P<0.001). There were significant differences between the two groups in the length of hospital stay, the rate of admission to the intensive care unit, and hospital costs (Z=-2.077, χ2=11.537, Z=-3.525, all P<0.05). The levels of total cholesterol and triglyceride in the third trimester were significantly higher than those in middle pregnancy (both P<0.05). ConclusionCompared with the non-HTGP group, the HTGP group has a higher proportion of patients with disease onset in the third trimester of pregnancy, a higher risk of complications, a longer length of hospital stay, and higher hospital costs.

10.
Article in Chinese | WPRIM | ID: wpr-876478

ABSTRACT

Objective To identify the etiology of the first local dengue infection outbreak in Hubei Province in 2019, and to determine the serotype and genotype of the virus and trace its source. Methods Serum samples were collected from dengue fever cases in the acute phase. The IgM and IgG antibodies were detected by enzyme-linked immunosorbent assay (ELISA),and the serotype was determined by fluorescence quantitative PCR. C6/36 cells were used to isolate virus and obtain virus E gene and complete genome sequence for systematic evolution analysis to trace the possible source of infection. Results The pathogen of the outbreak was identified as dengue serotype I infection,and five virus strains were isolated. Sequence analysis showed that the virus belonged to genotype I of dengue I, and had the highest homology with the strain isolated in Guangzhou, 2019. Conclusion The first local dengue infection outbreak in Hubei Province in 2019 was caused by genotype I of the type I dengue virus.

11.
Gut and Liver ; : 153-167, 2021.
Article in English | WPRIM | ID: wpr-874592

ABSTRACT

Peroral endoscopic myotomy (POEM) has emerged as a rescue treatment for recurrent or persistent achalasia after failed initial management. Therefore, we aimed to investigate the efficacy and safety of POEM in achalasia patients with failed previous intervention. We searched the MEDLINE, Embase, Cochrane, and PubMed databases using the queries “achalasia,” “peroral endoscopic myotomy,” and related terms in March 2019. Data on technical and clinical success, adverse events, Eckardt score and lower esophageal sphincter (LES) pressure were collected.The pooled event rates, mean differences (MDs) and risk ratios (RR) were calculated. A total of 15 studies with 2,276 achalasia patients were included. Overall, the pooled technical success, clinical success and adverse events rate of rescue POEM were 98.0% (95% confidence interval [CI], 96.6% to 98.8%), 90.8% (95% CI, 88.8% to 92.4%) and 10.3% (95% CI, 6.6% to 15.8%), respectively. Seven studies compared the clinical outcomes of POEM between previous failed treatment and the treatment naïve patients. The RR for technical success, clinical success, and adverse events were 1.00 (95% CI, 0.98 to 1.01), 0.98 (95% CI, 0.92 to 1.04), and 1.17 (95% CI, 0.78 to 1.76), respectively. Overall, there was significant reduction in the pre- and post-Eckardt score (MD, 5.77; p<0.001) and LES pressure (MD, 18.3 mm Hg; p<0.001) for achalasia patients with failed previous intervention after POEM. POEM appears to be a safe, effective and feasible treatment for individuals who have undergone previous failed intervention. It has similar outcomes in previously treated and treatment-naïve achalasia patients.

12.
Journal of Clinical Hepatology ; (12): 660-665, 2021.
Article in Chinese | WPRIM | ID: wpr-873815

ABSTRACT

ObjectiveTo investigate the value of neutrophil-lymphocyte ratio (NLR) combined with apolipoprotein A-I (ApoA-I) level in predicting the severity of acute pancreatitis (AP). MethodsA retrospective analysis was performed for 460 patients with AP who were admitted to The Affiliated Hospital of Southwest Medical University from January 2015 to December 2019, among whom 250 had mild acute pancreatitis (MAP), 166 had moderate-severe acute pancreatitis, and 44 had severe acute pancreatitis (SAP). Related clinical data were collected, including basic information, laboratory markers (neutrophil count, lymphocyte count, serum triglyceride, serum total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, ApoA-I, and apolipoprotein B), and scores (Ranson, BISAP, and MCTSI). A one-way analysis of variance or the Kruskal-Wallis H test was used for comparison of continuous data between multiple groups; a logistic regression analysis was performed for the variables with statistical significance in univariate analysis; a Spearman correlation analysis was performed to investigate the correlation between data. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficiency of indices, and MedCalc software was used to investigate whether there was a significant difference in diagnostic efficiency. ResultsThere were significant differences in NLR and ApoA-I level between the groups with different severities of AP (χ2= 64.124, F=40.277, P<0.001). On admission, NLR was positively correlated with Atlanta grading, Ranson score, MCTSI score, and BISAP score (r=0.370, 0.129, 0.260, and 0.122, all P<0.05), and ApoA-I level was negatively correlated with Atlanta grading, Ranson score, MCTSI score, and BISAP score (r=-0.358, -0.220, -0.297, and -0.251, all P<0.05). NLR was an independent risk factor for non-MAP (odds ratio [OR]=1.104, 95% confidence interval [CI]: 1.070-1.140, P<0.001), while ApoA-I was an independent protective factor against non-MAP (OR=0.138, 95% CI: 0.070-0.264, P<0.001); NLR was an independent risk factor for SAP (OR=1.163, 95% CI: 1.107-1.222, P<0.001), while ApoA-I was an independent protective factor against SAP (OR=0013, 95% CI: 0.003-0.056, P<0.001). NLR had an area under the ROC curve (AUC) of 0.700 (95% CI: 0.656-0.742, P<0.001) in predicting non-MAP; ApoA-I had an AUC of 0.684 (95% CI: 0.640-0.726, P<0.001) in predicting non-MAP; NLR combined with ApoA-I had an AUC of 0.748 (95%CI: 0.706-0.787, P<0.001) in predicting non-MAP. NLR combined with ApoA-I had a better value than NLR or ApoA-I alone in predicting non-MAP (Z=3.439 and 2.462, both P<0.05). NLR had an AUC of 0.752 (95% CI: 0.710-0.791, P<0.001) in predicting SAP; ApoA-I had an AUC of 0.797 (95% CI: 0.757-0.833, P<0.001) in predicting SAP; NLR combined with ApoA-I had an AUC of 0.857 (95% CI: 0.822-0.888, P<0.001) in predicting SAP. NLR combined with ApoA-I had a better value than NLR or ApoA-I alone in predicting SAP (Z=3.171 and 2.630, both P<0.05). ConclusionNLR combined with ApoA-I can be used as a good indicator for predicting the severity of AP in the early stage after admission.

13.
Journal of Clinical Hepatology ; (12): 654-659, 2021.
Article in Chinese | WPRIM | ID: wpr-873814

ABSTRACT

ObjectiveTo investigate the potential association between early-stage inflammatory response and late-stage infectious pancreatic necrosis (IPN) in patients with acute pancreatitis (AP). MethodsA retrospective analysis was performed for the clinical data of 219 patients with moderate-severe acute pancreatitis (MSAP) and 53 patients with severe acute pancreatitis (SAP) who were admitted to The Affiliated Hospital of Southwest Medical University from June 2019 to June 2020, and according to the presence or absence of systemic inflammatory response syndrome (SIRS) at the initial stage of the disease, they were divided into SIRS group with 160 patients and non-SRIS group with 112 patients. Baseline data, serological markers, complications, and mortality rate were included for analysis. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups; the chi-square test was used for comparison of categorical data between multiple groups, and the Bonferroni method was used for further comparison between two groups. A logistic regression analysis was used to screen out valuable variables; the receiver operating characteristic (ROC) curve was used to compare the diagnostic value of variables, and the Z-test was used for pairwise comparison of area under the ROC curve (AUC). ResultsCompared with the non-SIRS group, the SIRS group had significantly higher white blood cell count (WBC), C-reactive protein (CRP), and procalcitonin (all P<0.05) and a significantly higher proportion of patients with acute peripancreatic necrosis (ANC), IPN, pancreatic necrosis (PN), organ dysfunction, multiple organ dysfunction syndrome (MODS), SAP, critically-ill acute pancreatitis (CAP), death, BISAP score >2, CTSI score >2,or RANSON score >2 (all P<0.05). The univariate analysis showed that SIRS duration, obesity, CRP, WBC, blood urea nitrogen, PN, ANC, SAP, MODS, RANSON score, BISAP score, and CTSI score were risk factors for IPN in patients with AP (all P<005), and the multivariate analysis showed that SIRS duration (odds ratio [OR]=1.307, 95% confidence interval [CI]: 1.081-1580, P=0006) and ANC (OR=42.247, 95% CI: 10.829-164.818, P<0.001) were risk factors for IPN; when ANC was excluded, SIRS duration (OR=1.430, 95% CI: 1.207-1.694, P<0.001) and PN (OR=5.296, 95% CI: 1.845-15.203, P=0.002) were risk factors for IPN. The ROC curve showed that SIRS duration (AUC=0.772, Youden index=0.521), RANSON score (AUC=0701, Youden index=0.319), BISAP score (AUC=0.741, Youden index=0.377), and CTSI score (AUC=0.765, Youden Index=0.414) had a certain value in predicting IPN, and there was no significant difference in AUC between any two indices. The long-duration SIRS group(>4 d) had a significantly higher proportion of patients with PN, ANC, IPN, SAP, or CAP than the non-SIRS group(0 d), the transient SIRS group(1~2 d), and the persistent SIRS group(3~4 d) (all P<0.05), and the persistent SIRS group had a significantly higher proportion of patients with SAP than the non-SIRS group (P<0.05). ConclusionAP patients with SIRS in the early stage are likely to develop organ failure and local complications, and there is a significant increase in the risk of IPN when SIRS duration is >4.5 days.

14.
Journal of Clinical Hepatology ; (12): 142-146, 2021.
Article in Chinese | WPRIM | ID: wpr-862559

ABSTRACT

ObjectiveTo investigate the clinical features of elderly patients with acute pancreatitis (AP) aged ≥80 years. MethodsA retrospective analysis was performed for 3642 patients with pancreatitis who were admitted to Department of Gastroenterology in The Affiliated Hospital of Southwest Medical University from January 2013 to December 2019, and according to age, they were divided into young group (aged <65 years) with 2955 patients, middle-aged group (aged 65-79 years) with 558 patients, and elderly group (aged ≥80 years) with 129 patients. Related clinical data were collected and analyzed, including sex, age, etiology, predisposing factors, past medical history, disease severity, complication, and clinical outcome. The independent samples one-way ANOVA-test was used for comparison of normally distributed continuous data between groups and the least significant difference t-test was used for comparison within each group; the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups; the Kruskal-Wallis H test was used for comparison of ordinal categorical variables. ResultsIn the young group, there were 1721 male patients and 1234 female patients; in the middle-aged group, there were 214 male patients and 334 female patients; in the elderly group, there were 48 male patients and 81 female patients; the middle-aged group and the elderly group had a significantly higher proportion of female patients than the young group (62.8% vs 61.6% vs 41.8%, P<0.05). High-fat diet was the main predisposing factor for all three groups, and compared with the young group, the elderly group had a significantly lower proportion of patients with AP induced by alcohol or high-fat diet+alcohol (P<0.05). The elderly group had a significantly higher proportion of patients with the etiology of biliary diseases than the middle-aged group and the young group (798% vs 69.2% vs 41.4%, χ2=204.127, P<0.05), as well as a significantly lower proportion of patients with the etiology of hyperlipidemia, alcohol, or biliary diseases+hyperlipidemia (all P<0.05). Among the 129 patients in the elderly group, 83 (64.3%) had mild AP, 23 (17.8%) had moderate-severe AP, and 23 (17.8%) had severe AP; there was a significant difference in the constituent ratio of disease severity between the elderly group and the middle-aged/young groups (H=1972.5, P<005). The elderly group and the middle-aged group had a significantly lower proportion of patients with recurrence than the young group (both P<0.05). There were no significant differences in local complications between the three groups (all P>0.05), and as for systemic complications, compared with the young group, the elderly group had a significantly higher proportion of patients with pneumonia (3.9% vs 2.2%, P<0.05), acute kidney injury (AKI) (6.2% vs 2.5%, P<0.05), or multiple organ dysfunction syndrome (MODS) (7.8% vs 4.0%, P<0.05). Compared with the middle-aged group and the young group, the elderly group had a significantly lower proportion of cured patients (67.4% vs 76.3% vs 820%, P<0.05) and a significantly higher proportion of patients with improvement (23.3% vs 147%/12.7%, P<0.05). The elderly group and the middle-aged group had a significantly higher proportion of patients withdrawn from treatment than the young group (8.5%/5.9% vs 3.4%, P<0.05). There was 1 death in the elderly group (0.8%), 9 deaths in the middle-aged group (1.6%), and 16 deaths in the young group (0.5%), and there was no significant difference between the three groups (P>0.05). There were no significant differences in length of hospital stay and hospital costs between the three groups (P>0.05). ConclusionAP patients aged ≥80 years are mainly female and are often caused by biliary factors, and they are likely to develop the complications such as pneumonia, AKI, and MODS.

15.
Article in Chinese | WPRIM | ID: wpr-879372

ABSTRACT

OBJECTIVE@#A3 intertrochanteric fracture is an extremely unstable fracture, which is often treated with intramedullary nail, but the implant failure is common due to the posterior medial fragment cannot be reconstructed. A new medial sustainable nail (MSN-Ⅱ) which can reconstruct the femoral medial support by sustainable screw was introduced in this study. The mechanical effect was verified by biomechanical experiment.@*METHODS@#The loss medial support model of intertrochanteric fracture (A3) was made by artificial Sawbones model, fixed with MSN-Ⅱ and PFNA-Ⅱ, underwent axial loading and axial failure tests. The axial stiffness, yield load, displacement of head-neck fragment and torsional angle of fracture site of these nails were recorded and compared for biomechanical differences. The effect of early reconstruction of medial support with MSN-Ⅱ was determined.@*RESULTS@#The axial stiffness, yield load, the displacement of head and neck fragment when the axial load was 1 800 N and torsional angle of the fracture site after the axial failure test of MSN-Ⅱ were (222.76 ±62.46) N /mm, (4 241.71 ±847.42) N, (11.51 ±0.62) mm, (1.71 ±0.10)° respectively, while the PFNA -Ⅱ was (184.58±40.59) N /mm, (3 058.76±379.63) N, (16.15±1.36) mm, (2.52±0.26)°respectively. The difference between the two groups was statistically significant.@*CONCLUSION@#The axial stiffness of MSN-Ⅱ is better than that of PFNA-Ⅱ. The MSN-Ⅱ can bear more loads when fixed A3.3 intertrochanteric fracture and has greater axial and rotational stability. It is an effective means to reconstruct the medial support of A3 intertrochanteric fracture.


Subject(s)
Biomechanical Phenomena , Bone Nails , Bone Screws , Femur , Fracture Fixation, Intramedullary , Hip Fractures/surgery , Humans
16.
Article in Chinese | WPRIM | ID: wpr-878862

ABSTRACT

In order to effectively solve the over-processing problem of Platycladi Cacumen Carbonisata, which was commonly used as a hemostatic drug in clinical application, we used the quantitative analysis method of multi-components by single marker(QAMS) in this study, with quercetin as internal reference to simultaneously determine the content of six flavonoids which can be used to control the internal quality of Platycladi Cacumen Carbonisata. Based on the comparison of QAMS and external standard method(ESM) results, the limit standards of contents were established as follows: isoquercitroside ≥0.002 0%, quercitroside ≥0.050%, quercetin ≥0.030%, kaempferol and amentoflavone both ≥0.010%, hinokiflavone ≥0.050%. Based on the color detection of Platycladi Cacumen and Platycladi Cacumen Carbonisata with different processing degrees, the law of influence of different processing degrees on the color of Platycladi Cacumen Carbonisata was found. A new external quality standard of Platycladi Cacumen Carbonisata was established by fitting curve of color recognition for the external quality control, based on which the standard ranges of ΔL~*, Δb~* and ΔE were-50.00--44.00, 6.00-11.00 and 45.00-50.00 respectively. Effective combination of established internal and external quality control standards by this study can be used to evaluate the processing degree and quality of Platycladi Cacumen Carbonisata more comprehensively and objectively, which can guarantee its clinical efficacy. At the same time, this study also provides reference and basis for further improving the quality control standard of Platycladi Cacumen Carbonisata.


Subject(s)
Chromatography, High Pressure Liquid , Drugs, Chinese Herbal , Flavonoids , Hemostatics , Quality Control
17.
Chinese Medical Journal ; (24): 2919-2927, 2020.
Article in English | WPRIM | ID: wpr-877929

ABSTRACT

BACKGROUND@#Albuvirtide is a once-weekly injectable human immunodeficiency virus (HIV)-1 fusion inhibitor. We present interim data for a phase 3 trial assessing the safety and efficacy of albuvirtide plus lopinavir-ritonavir in HIV-1-infected adults already treated with antiretroviral drugs.@*METHODS@#We carried out a 48-week, randomized, controlled, open-label non-inferiority trial at 12 sites in China. Adults on the World Health Organization (WHO)-recommended first-line treatment for >6 months with a plasma viral load >1000 copies/mL were enrolled and randomly assigned (1:1) to receive albuvirtide (once weekly) plus ritonavir-boosted lopinavir (ABT group) or the WHO-recommended second-line treatment (NRTI group). The primary endpoint was the proportion of patients with a plasma viral load below 50 copies/mL at 48 weeks. Non-inferiority was prespecified with a margin of 12%.@*RESULTS@#At the time of analysis, week 24 data were available for 83 and 92 patients, and week 48 data were available for 46 and 50 patients in the albuvirtide and NRTI groups, respectively. At 48 weeks, 80.4% of patients in the ABT group and 66.0% of those in the NRTI group had HIV-1 RNA levels below 50 copies/mL, meeting the criteria for non-inferiority. For the per-protocol population, the superiority of albuvirtide over NRTI was demonstrated. The frequency of grade 3 to 4 adverse events was similar in the two groups; the most common adverse events were diarrhea, upper respiratory tract infections, and grade 3 to 4 increases in triglyceride concentration. Renal function was significantly more impaired at 12 weeks in the patients of the NRTI group who received tenofovir disoproxil fumarate than in those of the ABT group.@*CONCLUSIONS@#The TALENT study is the first phase 3 trial of an injectable long-acting HIV drug. This interim analysis indicates that once-weekly albuvirtide in combination with ritonavir-boosted lopinavir is well tolerated and non-inferior to the WHO-recommended second-line regimen in patients with first-line treatment failure.@*TRIAL REGISTRATION@#ClinicalTrials.gov Identifier: NCT02369965; https://www.clinicaltrials.gov.Chinese Clinical Trial Registry No. ChiCTR-TRC-14004276; http://www.chictr.org.cn/enindex.aspx.


Subject(s)
Adult , Anti-HIV Agents/adverse effects , Antiretroviral Therapy, Highly Active , China , Drug Therapy, Combination , HIV Infections/drug therapy , HIV-1 , Humans , Maleimides , Peptides , Ritonavir/therapeutic use , Treatment Outcome , Viral Load
18.
Chinese Medical Journal ; (24): 2682-2687, 2020.
Article in English | WPRIM | ID: wpr-877826

ABSTRACT

BACKGROUND@#The reverse obliquity inter-trochanteric fracture is a distinct fracture pattern that is mechanically different from most inter-trochanteric fractures and the optional treatment of it is still controversial. The purpose of this study was to compare differences in the efficacy of a novel nail (medial support nail [MSN-II]) and proximal femoral nail anti-rotation (PFNA-II) in the treatment of reverse obliquity inter-trochanteric fractures (Arbeitsgemeinschaft fur Osteosynthesfrogen/Orthopedic Trauma Association [AO/OTA] 31-A3.1) using finite-element analysis.@*METHODS@#Modeling software was used to establish a three-dimensional model of MSN-II and PFNA-II and an A3.1 inter-trochanteric fracture model. Abaqus software was used to implement different force loads to compare finite-element biomechanical parameters such as the maximum stress in implant and the displacement of fracture site.@*RESULTS@#The femoral stress, implant stress and fracture site displacement of MSN-II was less than that of PFNA-II. The results indicated that the maximal femoral stress was 581 MPa for PFNA-II and 443 MPa for the MSN-II. The maximum stress values in the PFNA-II and MSN-II models were 291 and 241 MPa, respectively. The maximal displacements of the fracture site were 1.47 and 1.16 mm in the PFNA-II and MSN-II models, respectively.@*CONCLUSION@#Compared with PFNA-II for inter-trochanteric fracture (AO/OTA 31-A3.1), MSN-II which was designed with a triangular stability structure can provide better biomechanical stability. The MSN-II may be a feasible option for the treatment of reverse obliquity inter-trochanteric fracture.


Subject(s)
Bone Nails , Femur , Finite Element Analysis , Fracture Fixation, Intramedullary , Hip Fractures/surgery , Humans , Treatment Outcome
19.
Article in Chinese | WPRIM | ID: wpr-865966

ABSTRACT

Objective:To investigate the demand and practical utility of simulation operations specialists (SOS) in simulation teaching modules during the standardized residency training.Methods:Based on the feedback for stimulated courses of standardized residency training, subjective evaluation of all residents, teachers and SOS who participated in simulation courses in 2017-2018 academic year were investigated and studied via the mobile phone online investigation. At the same time, the design data of teaching concept map of relevant curriculum were also included. The SPSS 13.0 was used to conduct the t test and chi-square test. Results:At present, only 26.3% of the preset functions were used in the medical simulation courses based on high-tech medical simulator. Tutors commanded less than 30% functions, while SOS participated in the whole process of the course preparation and commanded 63.6% of the course operations, which was higher than the requirement of teaching concept map (45.5%). Among them, ECG monitoring regulation, venous management and special effects makeup were in greatest needs and were items with the biggest gap between ideality and reality. Resident physicians required SOS to replace the tutors to operate teaching facilities, so as to reduce interruption (37.0%), implications (31.3%) during courses, and improvement of experience sense during the course (32.3%). Furthermore, specialists with clinical background needed more assistance from SOS than those without clinical background ( tQ3=3.204, tQ4=2.573, tQ5=2.660; P<0.05). Differences were found between the actual work content of SOS and their job requirement ( χ2=12.632, P<0.01). Conclusion:SOS plays a significant role in the simulation course of standardized residency training, especially in the course of clinical professional physicians. Auxiliary functions of simulated courses, such as teaching aids management, special effects makeup, course designing, qualified SP and others are the main necessities for SOS at present. Participation of tutors and SOS together is essential to ensure a good development and performance of medical simulation courses for standardized residency training.

20.
Article in Chinese | WPRIM | ID: wpr-865681

ABSTRACT

Objective:To explore the tumor microenvironment (TME) module associated with pancreatic ductal adenocarcinoma (PDAC) and identify prognostic biomarkers and potential immunotherapeutic targets.Methods:The genetic expression profile data were collected and selected from a dataset of 142 PDAC patients in The Cancer Genome Altas (TCGA) database and 2 microarray datasets (GSE2150, GSE62452) of 168 PDAC patients in Gene Expression Omnibus (GEO) database, and the cell type enrichment analysis of PDAC gene expression data was analyzed by xCell network tool. According to the median cell enrichment score, 142 patients from TCGA were divided into high score group and low score group, and the cell types with prognostic value were determined by univariate survival analysis and validated by GEO datasets. According to the cell type, the differential expression gene analysis and univariate survival analysis were performed to determine the prognosis related differential expression genes (DEGs), and the prognostic DEGs were analyzed by function enrichment analysis and protein-protein interaction (PPI) network analysis. At the same time, GEO dataset was used to verify the prognosis related DEGs of TCGA datasets. Finally, TISIDB database was searched for the common DEGs of TCGA and GEO database, and its correlation with immune system was analyzed.Results:Cell type enrichment analysis showed that Th1 cell and keratinocyte had the same prognostic value in both TCGA and GEO dataset; the overall survival rate of patients with high score was lower than that of those with low score, and the differences were statistically significant (all P values <0.05). 216 prognosis related DEGs were identified, and the results of functional enrichment showed that 9 of the 21 biological process items were closely related to the immune process, and 4 of the 5 KEGG (Kyoto Encyclopedia Of Genes and Genomes) pathways were closely related to the immune process. Through PPI network analysis, CCR7, CD 27, CD 5, CXCL13, ZAP70, MS4A1 and CCL19 were proved to be possibly closely associated with central genes. Through the validation of GEO datasets, there were 15 DEGs with similar prognostic value in GEO and TCGA datasets, which was searched in TISIDB dataset, and the result showed that GIMAP7 was closely related with the immune process of PDAC. Conclusions:A group of 216 TME genes and 7 central genes related to the prognosis of PDAC were identified, and 5 potential targets for immunotherapy of PDAC were provided, including CCR7, CCL19, CD 27, CXCL13 and GIMAP7.

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