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1.
Clinical Medicine of China ; (12): 47-52, 2022.
Article in Chinese | WPRIM | ID: wpr-932143

ABSTRACT

Objective:To study the relationship between serum osteopontin and osteopontin and type 2 diabetes mellitus (T2DM) complicated with coronary heart disease, and to evaluate the correlation between the levels of serum osteopontin and osteopontin with the severity of coronary artery lesions in T2DM patients.Methods:A total of 100 T2DM patients who were suspected to have stable coronary heart disease and underwent coronary angiography from November 2019 to December 2020 were selected from the Affiliated Hospital of Chengde Medical College, according to coronary angiography results, 60 patients with confirmed coronary heart disease were classified as the case group and 40 patients with non-coronary heart disease were classified as the control group for retrospective analysis. The clinical data and biochemical indicators of all patients were recorded, and Gensini score was calculated. The concentration of osteopontin and osteopontin in serum was quantitatively determined by double-antibody enzyme linked immunosorbent assay method. Independent sample t-test was used to compare the mean of normal distribution measurement data between the two groups. The non normal distribution data are represented by M ( Q1, Q3), and Mann Whitney U test is used for comparison between groups. Composition comparison between count data groups χ 2 inspection. Spearman correlation analysis was used to analyze the correlation between serum osteopontin and osteopontin and Gensini score in patients with T2DM. Results:Univariate analysis showed that serum osteopontin and osteopontin were (13.076(8.433, 23.552) μg/L) and (0.437(0.300, 0.630) μg/L) significantly higher in the case group than in the control group (6.367(4.605, 9.048) μg/L) and (0.299(0.196, 0.399) μg/L) respectively, with statistically significant differences ( Z=5.12, 3.28, all P<0.001). Multi-factor logistic regression analysis showed that osteoprotegerin ( OR=2.887, 95% CI:1.850-8.515, P=0.024) and osteopontin ( OR=13.109, 95%CI: 2.557-67.204, P=0.002) were associated with T2DM combined with coronary heart disease, and the risk of T2DM combined with coronary heart disease increased with higher levels of osteoprotegerin and osteopontin. Spearman correlation analysis showed that serum osteopontin and osteoprotegerin were positively correlated with Gensini score in T2DM patients ( r=0.591, 0.467; all P<0.05). Conclusion:Serum osteopontin and osteoprotegerin are associated with T2DM combined with coronary heart disease, and high serum osteopontin and osteoprotegerin are risk factors for T2DM combined with coronary heart disease; serum osteopontin and osteoprotegerin are positively correlated with the degree of coronary artery disease in T2DM patients.

2.
Chinese Journal of Anesthesiology ; (12): 1311-1315, 2021.
Article in Chinese | WPRIM | ID: wpr-933245

ABSTRACT

Objective:To evaluate the effect of permissive high stroke volume variability (SVV) on postoperative delirium (POD) in elderly patients undergoing laparoscopic hepatectomy.Methods:A total of 100 elderly patients of either sex, with body mass index of 18.5-24.9 kg/m 2, aged 65-80 yr, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with Child-Pugh grade A or B, scheduled for elective laparoscopic hepatectomy, were divided into 2 groups ( n=50 each) using a random number table method: permissive high SVV group (group S) and control group (group C). Group S was given goal-directed fluid infusion with a target of high SVV (13%-20%), and fluid replacement was performed according to the intraoperative CVP in group C. Oxygen extraction ratio was calculated on admission to the operating room (T 0), at skin incision (T 1), at the beginning of liver resection (T 2), completion of liver resection (T 3) and at the end of operation (T 4). Intraoperative blood loss, volume of fluid infused and urine volume were recorded.Lactic acid concentrations were measured at T 0 and T 4.Regional cerebral oxygen saturation (rSO 2) was continuously recorded, and the maximum percentage of decrease in rSO 2 from baseline (rSO 2max%) was calculated.Peripheral venous blood samples were collected at 1 day before operation, at the end of operation, and at 1 and 3 days after operation to determine the concentrations of serum S100β and neuron-specific enolase.POD was evaluated at 1, 3 and 7 days after operation, and the hospitalization time was recorded. Results:Compared with group C, the intraoperative blood loss was significantly decreased, the volume of fluid infused and urine volume were increased, the lactic acid concentration at T 4, rSO 2max%, oxygen extraction ratio at T 2-4, serum S100β and neuron-specific enolase concentrations and incidence of POD at 1 and 3 days after operation were decreased, and the hospitalization time was shortened in group S ( P<0.05). Conclusion:Permissive high SVV can decrease the development of POD in elderly patients undergoing laparoscopic hepatectomy, which is related to reduction of cerebral oxygen metabolism.

3.
Clinical Medicine of China ; (12): 488-495, 2021.
Article in Chinese | WPRIM | ID: wpr-909783

ABSTRACT

Objective:To investigate the correlation between gamma-glutamyl transferase/high-density lipoprotein cholesterol ratio (GHR), neutrophil/lymphocyte ratio (NLR) and coronary heart disease (CHD), and evaluated its pathogenic risk and predictive value for CHD.Methods:A total of 694 patients admitted to our hospital from December 2017 to December 2018 for suspected CHD and coronary angiography were selected. According to the results of coronary angiography,the patients were divided into CHD group ( n=527) and non-CHD group ( n=167). The clinical data of all patients were recorded. Gamma-glutamyl transferase (GGT), high-density lipoprotein cholesterol (HDL-C) and other biochemical indicators were recorded. Neutrophils, lymphocyte count and other hematological indicators were recorded. GHR, NLR and Gensini scores of the patients were calculated. Clinical data and GHR, NLR and other indicators were compared between the two groups. Receiver operating characteristic curve (ROC) was used to evaluate the predictive value of GHR, NLR in CHD, and to determine the optimal cut-off value; Logstic regression analysis was used to investigate the risk factors of CHD.Spearman correlation analysis was used to analyze the correlation between serum OPN, OPG and Gensini score in patients with CHD. Results:The GHR and NLR were 32.59(21.05, 48.24) and 3.53(2.18, 8.46) significantly higher in the CHD group than in the non-CHD group 16.56(10.07, 25.21) and 2.20(1.45, 3.28) respectively, with statistically significant differences ( Z=11.094, 9.055, P<0.05). ROC curve analysis showed that the AUC of NLR and MLR in diagnosing CHD was 0.785 and 0.732( P<0.05). When the critical values of GHR and NLR respectively were 19.805 and 2.678, respectively, the diagnostic efficiency of CHD was the highest, and the sensitivity and specificity were 79.30%, 62.90% and 63.80%, 68.30%, and the AUC of GGT in diagnosing CHD was 0.628. When the critical value was 19.500, the sensitivity and specificity were 80.50% and 39.50%, respectively,the AUC of GHR was greater than that of GGT ( Z=12.973, P<0.05). Multivariate Logistic regression analysis showed that Smoking ( OR=2.887, 95% CI:1.850-4.505, P<0.05), hypertension ( OR=2.009, 95% CI: 1.311-3.080, P<0.05), fasting plasma glucose ( OR=1.109, 95% CI:1.034-1.189, P<0.05), age ≥60 years ( OR=1.567, 95% CI:1.179-2.415, P<0.05), NLR ≥2.687 ( OR=3.152, 95% CI:2.066-4.808, P<0.05) and GHR ≥19.805 ( OR=4.768, 95% CI:3.131-7.262, P<0.05) was an independent risk factor for CHD. After gradually adjustment for risk factors such as smoking, hypertensive, fasting plasma glucose, age ≥60 years and NLR ≥2.687, GHR ≥19.805 was still an independent risk factor for coronary heart disease(OR and 95% CI were 4.620 (3.049-7.000), 4.768 (3.131-7.262), 6.567 (4.408-9.810), 4.768 (3.131-7.262), 4.768 (3.131-7.262), respectively; all P<0.001). Spearman correlation analysis showed that GHR and NLR were positively correlated with Gensini score ( r=0.312, 0.394; all P<0.05). Conclusion:GHR and NLR were positively correlated with the severity of coronary artery disease, which is of significance in the diagnosis of coronary heart disease. NLR ≥2.687 and GHR ≥19.805 were independent risk factors for CHD. GHR was superior to GGT and HDL-C alone in the diagnosis of CHD,and has certain clinical application value

4.
Article in Chinese | WPRIM | ID: wpr-802717

ABSTRACT

Objective@#To study the therapeutic effect of laparoscopic ureteral end-to-side anastomosis at pelvic level for duplicate ureteral malformation.@*Methods@#Clinical data of 10 children with unilateral ureteral duplication, who received laparoscopic ureteral end-to-side anastomosis at pelvic level at Department of Urology, Affiliated Children′s Hospital of Nanjing Medical University from September 2016 to November 2017 were reviewed.There were 6 boys and 4 girls with an average age of 13.9 months(1 month and 21 days to 3 years and 9 months). Ultrasonography, intravenous pyelography and magnetic resonance urography were performed before surgery.There were 6 cases of duplication with hydronephrosis in the upper moiety. The rest 4 cases were complicated with ureteroceles.Presentations included urinary dripping and symptoms caused by urinary tract infections.Urine test, ultrasonography, intravenous pyelography were performed during the 3-16 months follow-ups for all the patients after surgery.@*Results@#The laparoscopic ureteral end-to-side anastomosis was performed successfully in all patients at the pelvic level, the average ope-rating time was 98 minutes (60-125 minutes) and mean hospital stay was 7.3 days(7-8 days). All the presentations disappeared after surgery.All the patients were followed up for 3 to 6 months with relieved hydronephrosis.Postoperative examination of intravenous pyelography in 10 cases showed that there was no anastomotic obstruction.@*Conclusions@#The laparoscopic ureteral end-to-side anastomosis can be used for duplicate ureter, and it is a safe and effective method for the treatment of ureteral duplication.

5.
Article in Chinese | WPRIM | ID: wpr-754482

ABSTRACT

Objective: To summarize the diagnosis and prognosis of adrenocortical carcinoma in children. Methods: Medical records of 10 pediatric patients with adrenocortical cancer treated in Children's Hospital of Nanjing Medical University from September 2010 to March 2018 were retrospectively reviewed, and their clinical manifestation, laboratory, auxiliary, and pathological examination results, and prognosis were analyzed. Results: The average age of all patients (5 male and 5 female pediatric patients) was (53.3+48.4) months. Clinical mani-festations included abdominal mass, hypertension, cortisol level, and peripheral precocious puberty. Laboratory tests showed that lactate dehydrogenase, neuroenolase, and cortisol levels were high in some patients, and sex hormones were abnormal. Auxiliary examination using the abdominal computed tomography enhancement showed irregular an adrenal gland, uneven density, necrosis, mass calcification, and some infiltration into the surrounding tissue. Pathological examination suggests tumor cell pleomorphism, more frequent pathological division, high mitotic index, abundant interstitial sinusoid, necrosis, tumor infiltration, vascular invasion, and Weiss score of≥3 points. Lactate acid dehydrogenase and cortisol levels; Weiss score; and tumor size, staging, and resection rate were not statistically different among prognostic factors. Conclusions: For pediatric patients with adrenal masses, the survival rate should be improved by combining the clinical manifestation, laboratory examination, and auxiliary examination for the early diagnosis of adrenocortical carcinoma and to select the appropriate treatment. Combined with pathological results, adrenocortical carcinoma can be well differentiated from other adrenal masses.

6.
Article in Chinese | WPRIM | ID: wpr-752376

ABSTRACT

Objective To study the therapeutic effect of laparoscopic ureteral end-to-side anastomosis at pelvic level for duplicate ureteral malformation.Methods Clinical data of 10 children with unilateral ureteral duplication,who received laparoscopic ureteral end-to-side anastomosis at pelvic level at Department of Urology,Affiliated Children's Hospital of Nanjing Medical University from September 2016 to November 2017 were reviewed.There were 6 boys and 4 girls with an average age of 13.9 months(1 month and 21 days to 3 years and 9 months).Ultrasonography,intravenous pyelography and magnetic resonance urography were performed before surgery.There were 6 cases of duplication with hydronephrosis in the upper moiety.The rest 4 cases were complicated with ureteroceles.Presentations included urinary dripping and symptoms caused by urinary tract infections.Urine test,ultrasonography,intravenous pyelography were performed during the 3-16 months follow-ups for all the patients after surgery.Results The laparoscopic ureteral end-to-side anastomosis was performed successfully in all patients at the pelvic level,the average operating time was 98 minutes (60-125 minutes) and mean hospital stay was 7.3 days(7-8 days).All the presentations disappeared after surgery.All the patients were followed up for 3 to 6 months with relieved hydronephrosis.Postoperative examination of intravenous pyelography in 10 cases showed that there was no anastomotic obstruction.Conclusions The laparoscopic ureteral end-to-side anastomosis can be used for duplicate ureter,and it is a safe and effective method for the treatment of ureteral duplication.

7.
Article in Chinese | WPRIM | ID: wpr-744737

ABSTRACT

Objective To explore the impact of WeChat-assisted follow-up on self-administer medication capability of stroke survivors.Methods Seventy patients were recruited from a tertiary hospital and randomly divided into intervention group (n=35) and control group (n=35).Patients in intervention group were given WeChat-assisted follow-up including health education program and behavior guidance,and patients in control group received regular discharge care.The effects of WeChat-assisted follow-up and regular care on self-administer medication ability,cognitive and behavior level were assessed.Results After three months' follow-up,the scores of self-administer medication capability (38 (32,42)),experience (25 (20,28) and the integral level (87 (71,92)) in intervention group were significantly higher than those in control group (capability 25(16,38),experience 21 (8.75,27),total score 68 (38,87)) (Z=-2.511,-2.033,-2.209,P<0.05).The self-administer medication experience,cognitive,capability and total scores increased significantly in intervention group after intervention(Z=-4.525,-4.610,-3.806,-4.718,all P< 0.01),while only the cognitive level increased slightly in control group (18 (10,24) vs 13 (11,18),Z =-1.794,P=0.073).Conclusions Follow-up intervention based on WeChat platform can improve the stroke patients' self-administration medication capability,however,the long-term effects on cognitive level and further reform need to be strengthened.

8.
Article in Chinese | WPRIM | ID: wpr-733335

ABSTRACT

Objective To analyze the prognostic factors of adrenal tumor in children under 12 years of age. Methods A total of 90 children with 97 adrenal tumors admitted from June 2006 to August 2017 were selected in Children's Hospital of Nanjing Medical University.The age distribution,tumor type,biochemistry and tumor indicators, treatment,stage classification and prognosis were analyzed.Results There were 46 males and 44 females in 90 cases. Ages ranged from 4 days to 11 years and 1 month,with an average of (38.1 ± 31.3)months.The main clinical mani-festations were abdominal mass,fever and abdominal pain.Eighty cases (82.5%)underwent surgery,while 17 cases (17. 5%)did not.Open resection was performed in 48 cases,open partial resection in 11 cases,laparoscopic surgery in 10 cases,and just biopsy in 11 cases.The pathological examination showed 43 cases with neuroblastoma,13 cases with ganglioneuroblastoma,8 cases with ganglioneuroma,5 cases with adrenocortical carcinoma,3 cases with teratoma,1 case with pheochromocytoma,1 case with malignant rhabdoid tumor.Statistical analysis revealed that neuron-specific eno-lase(NSE)value of neuroblastoma and lactate dehydrogenase(LDH)value of cortical cancer increased significantly. The age was correlated with tumor stage,and patients had older age on stage Ⅳ.Complete resection in surgery was correlated with the stage of the tumor,as tumor in lower tumor stage seemed easier to be completely removed.Fifty-three cases (58.9%)were followed up for 2 months up to 11 years and 4 months.Forty-four cases survived and 9 ca-ses died.Higher tumor stage predicated worse prognosis.Conclusions Adrenal gland tumors need early diagnosis and active treatment.Earlier onset of age,complete surgical resection with patients have better prognosis.Complete resection of the disease was a key factor in the prognosis.

9.
Article in Chinese | WPRIM | ID: wpr-807156

ABSTRACT

Objective@#To explore the application of penile base staggered flap in the operation of severe hypospadias with penoscrotal transposition.@*Methods@#Twenty-three cases with severe hypospadias with penoscrotal transposition were corrected by urethroplasty and staggered flap plasty in our department from May 2013 to June 2016. After urethroplasty, the skin at the junction of the penile base and scrotum was transversely cut by 1.5-2.0 cm, and then sutured with Z-plasty to reconstruct the angle of the penis and scrotum.@*Results@#After the operation, infection and cracking at the suture of the staggered flap occurred in one child and was cured after dressing change and symptomatic treatment. Two cases suffered from urine leakage at the suture of the staggered flap. One of the cases realized self-healing and the other received a repair operation for urinary fistula. Three children suffered coronary sulcus fistula and was cured by urethroplasty. All the patients were followed up from 10 to 30 months with normal penis scrotal position and satisfactory appearance.@*Conclusions@#The application of penile base staggered flap can be used for severe hypospadias in one stage with penoscrotal transposition surgery. It is a simple and satisfactory method for the treatment of hypospadias with penoscrotal transposition.

10.
Article in Chinese | WPRIM | ID: wpr-665807

ABSTRACT

Objective To explore the diagnosis,treatment options and outcomes of patients with ureteropelvic junction obstruction(UPJO)and ureterovesical junction obstruction(UVJO). Methods Clinical records of 12 children with UPJO and UVJO who received treatment in Children′s Hospital of Nanjing Medical University from April 2008 to December 2015 were reviewed. Presentations included prenatal hydronephrosis and symptoms caused by urinary tract in-fections. Ultrasonography,intravenous pyelography,magnetic resonance imaging and renography were performed before surgery. Results Four patients underwent nephrostomy,followed by pyeloplasty and eventually,ureteroneocystostomy. Five patients underwent heterochronic pyeloplasty plus ureteroneocystostomy. Two patients received pyeloplasty only. And another patient underwent heterochronic nephrostomy plus ureteroneocystostomy. The 12 patients received a 2. 0 months to 2. 5 years′ follow - up. Recurrent urinary tract infection and abdominal pain were relieved after the treatment. Ultrasonography showed hydronephrosis reduced obviously after the surgery. Conclusions UVJO patients with unparallel hydronephrosis should be considered with the coexistence of UPJO. Retrograde pyelography(RPG)is recommended for the diagnosis. And the treatment includes both pyeloplasty and ureteroneocystostomy. The patients diagnosed with UPJO should be first managed with pyeloplasty or nephrostomy instead of RPG. Subsequently anterograde pyelography can be performed to decide if the patients need additional ureteroneocystostomy.

11.
Chinese Pharmacological Bulletin ; (12): 641-646, 2017.
Article in Chinese | WPRIM | ID: wpr-615941

ABSTRACT

Aim To examine the effect of zacopride,a specific inward rectifier potassium channel(IK1)agonist,on L-thyroxine(T4)-induced ventricular remodeling and the underlying mechanism.Methods SD rats were randomly divided as control,L-thyroxine(L-thy,1 mg·kg-1·d-1,ig,10 d)model,L-thy +zacopride(5,15,50 μg·kg-1,respectively,ip),L-thy+zacopride(15 μg·kg-1)+chloroquine(7.5 μg·kg-1,ip)and L-thy+captopril(100 mg·kg-1·d-1,drinking water)groups.Echocardiography and cardiac hypertrophic indexes were measured to confirm the establishment of the ventricular remodeling model.The changes of IK1 and L-calcium current(ICa-L)were detected by whole cell patch clamp technique.The confocal microscopy and fluorescent indicator Fluo-4 were applied to examine the intracellular Ca2+ concentration([Ca2+]i)of isolated adult rat ventricular myocytes.Results L-thyroxine induced left ventricular hypertrophy with increased ratio of heart weight(HW)to body weight(HW·BW-1),ratio of left ventrical weight(LVW)to body weight(LVW·BW-1),left ventricular dimension in diastole(LVIDd),left ventricular dimension in systole(LVIDs),interventricular septum thickness(IVS)and decreased ejection fraction(EF),fractional shortening(FS)(P<0.01).Patch clamp data suggested IK1 was downregulated,while ICa-L was upregulated(P<0.01).In isolated adult cardiomyocytes,L-thyroxine increased the cell area and [Ca2+]i(P<0.01).Zacopride treatment obviously alleviated cardiac remodeling,improved cardiac function,reversed the changes of IK1 and ICa-L,and significantly attenuated intracellular calcium overload(P<0.01).The optimum dose of zacopride in vivo was 15 μg·kg-1 at which the effect was compared favourably with captopril,a classical anti-remodeling agent.Low-dose IK1 atagonist chloroquine could reverse the effect of zacopride(P<0.01).Conclusion Via activating IK1,zacopride could significantly decrease Ca2+ influx and intracellular calcium overload thereby inhibiting L-thyroxine-induced cardiac ventricular remodeling.

12.
Chinese Journal of Urology ; (12): 122-126, 2016.
Article in Chinese | WPRIM | ID: wpr-488027

ABSTRACT

Objective To retrospectively analyze the efficacy of Onlay-tube-onlay urethroplasty used for one-stage repairing of severe hypospadias.Methods From May 2012 to October 2014, a total of 32 patients with severe hypospadias who underwent primary HR at Nanjing Medical University Affiliated Children Hospital were enrolled.Urethral opening was located in the penis and scrotum, and onlay-tube-onlay urethroplasty was performed in the patients who had severe penile curvature even after skin degloving. The average age was 2.8 years (7 months-13 years and 7 months), postoperative follow-up was 2 years and 1month on average ( 6 months -2 years and 11 months ), and clinical data including appearance, complications and uroflowmetry were documented.Results All of 32 surgeries were completed by one experienced pediatric urologist, and the urethral defect length was measured after penile curvature completely corrected.The postoperative complications included two cases of urinary fistula ( 6.25%) and 3 cases of urethral stricture (9.37%).Two cases of fistula were cured by one operation.Stricture of urethral external orifice was relieved after urethral dilation in 1 case, and another 2 cases underwent another operation.The straightening and appearance of penis were satisfactory and meatus was located at normal anatomical position postoperatively.Uroflow was shaped into bell or high platform.Conclusions Onlay-tube-onlay urethroplasty is a combination of Onlay and Duckeet surgery, with low complication rates.Fully stripping and preserving urethral plate decrease the occurrence of complications, especially stricture. Urethral plate transecting permitted penile straightening completely.Onlay-tube-onlay can be a good option for the patients with severe hypospadias.

13.
National Journal of Andrology ; (12): 916-918, 2004.
Article in Chinese | WPRIM | ID: wpr-267781

ABSTRACT

<p><b>OBJECTIVE</b>To compare the success rate, postoperative complications and cosmetic appearance of the perinatal flap (Mathieu) and the tubularized incised-plate (Snodgrass) urethroplasty in distal hypospadias repair.</p><p><b>METHODS</b>Between March 2001 and April 2004, Snodgrass-type repair was done in 36 patients and Mathieu-type repair in 43 patients with primary hypospadias either with or without minimal chordee.</p><p><b>RESULTS</b>The mean duration of surgery was significantly shorter for the Snodgrass procedure than for the Mathieu repair. With 3-10 months follow-up, the total numbers of complications of Snodgrass repair and Mathieu repair were 8 (22.2%) and 16 (37.2%) (P > 0.05), the fistula formation rates 8.3% and 25.6%, the meatal stricture formation rates 5.6% and 2.3%, and the wound dehiscence rates 8.3% and 2.3%, respectively. Flap necrosis was seen in 3 cases in the Mathieu group. Cosmetic appearance was highly satisfactory in the Snodgrass group.</p><p><b>CONCLUSION</b>The fistula and flap necrosis rates were lower and the surgery more convenient with the Snodgrass urethroplasty, which also had a better cosmetic outcome. The Snodgrass technique is recommended as a primary treatment to substitute Mathieu repair for distal hypospadias with or without minimal chordee.</p>


Subject(s)
Child , Child, Preschool , Follow-Up Studies , Humans , Hypospadias , General Surgery , Male , Penis , Surgical Flaps , Urethra , Urologic Surgical Procedures, Male , Methods
14.
Article in Chinese | WPRIM | ID: wpr-516826

ABSTRACT

The biochemical and other lab indices of blood in 35 cases of nephrosis syndrome (NS) treated with Huangqi Xianlingpi Decoction plus Hirudo (HQXL) were observed. The results that HQXL was capable of decreasing urine protein, increasing plasma protein, lowering blood lipids (P

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