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Objective:To explore the related prognostic factors in patients with aortic dissection (AD) after surgery or interventional therapy, and to construct a multi-factor Cox regression analysis nomogram prediction model.Methods:The clinical data of patients diagnosed with AD in the emergency department of Affiliated Hospital of Jining Medical University of Shandong Province from January 2019 to December 2021 were collected to analyze retrospectively. The survival time was followed up, the survival curve was drawn by Kaplan-Meier method, the difference of survival rate among different Stanford types was tested by Log-Rank test, and Cox regression univariate and multivariate survival analysis was used to screen the prognostic factors. According to the results of multivariate analysis, the death risk nomogram model after AD was established, the differentiation of the model was evaluated by C-index, the accuracy of the model was evaluated by calibration curve, and the clinical benefit of the model was evaluated by decision curve analysis (DCA).Results:A total of 256 patients with AD were included, the mortality rate was 4.45% (37/256), and the overall survival rates at 3 months, 6 months and 12 months after operation were 90.23%, 87.50% and 85.55%, respectively. There was no significant difference in postoperative survival rate among AD patients with different Stanford types (χ 2=2.30, P=0.13). Cox multivariate regression analysis showed that history of hypertension ( HR=3.791, 95% CI 1.150-12.501, P=0.029), number of branch vessels involved ( HR=1.210, 95% CI 1.029-1.422, P=0.021), preoperative left ventricular ejection fraction (LVEF) ( HR=0.936, 95% CI 0.880-0.996, P=0.038) and perioperative complications ( HR=4.024, 95% CI 1.839-8.807, P<0.001) were independent prognostic factors in patients with AD. Furthermore, the predictive nomogram model of 3-month, 6-month and 12-month survival rate in patients with AD was constructed, and the C-index was 0.778. The calibration curve indicated that the accuracy of the model was good, and the clinical benefit of the DCA model was good. Conclusions:Hypertension history, the number of branch vessels involved, preoperative LVEF and perioperative complications are independent risk factors of postoperative death in patients with AD. The nomogram prediction model based on the above factors can be used to evaluate the postoperative survival of patients with AD.
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Objective To analyze clinical characteristics of patients with neuropsychiatric systemic lupus erythematosus (NPSLE) and to explore the risk factors affecting the occurrence of NPSLE. Methods A total of 63 NPSLE patients and 61 non-NPSLE patients were enrolled. The clinical manifestations and laboratory examination data of the two groups were collected, and the disease characteristics of NPSLE were summarized to analyze the risk factors affecting the occurrence of NPSLE by multivariate Logistic regression. Results The most common clinical manifestations of NPSLE patients were headache (39.7%), affective disorder (33.3%) and cognitive impairment (30.2%), with cranial magnetic resonance abnormalities (63.5%) and a high cerebrospinal fluid protein positive rate (52.4%). Compared with non-NPSLE patients, there were significantly increased levels of Raynaud's phenomenon, renal involvement, anti-RNP antibody, anti-ribosomal P protein, hypocomplementemia, lymphocyte-to-monocyte ratio (LMR) and neutrophil-to-lymphocyte ratio (NLR) in NPSLE patients. Multivariate Logistic regression analysis showed that renal involvement, Raynaud's phenomenon, positive anti-ribosomal P protein antibody, and elevated LMR and NLR were independent risk factors for NPSLE. Conclusion Headache is the most common symptom in patients with NPSLE, and abnormal cranial MRI and cerebrospinal fluid examination are more common. SLE patients who present with renal involvement, Raynaud's phenomenon, positive anti-ribosomal P protein antibodies, and elevated levels of LMR and NLR are more susceptible to developing NPSLE.
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Humanos , Vasculitis por Lupus del Sistema Nervioso Central , Factores de Riesgo , Cefalea , Anticuerpos Antinucleares , Disfunción CognitivaRESUMEN
Objective:To construct a case management index for acute myocardial infarction based on multidisciplinary collaboration, and to provide guidance for the case management of patients with acute myocardial infarction.Methods:From October 2021 to April 2022, a research group with clinical experience was established to initially formulate an index system for acute myocardial infarction case management based on multidisciplinary collaboration after a literature review. After 2 rounds of Delphi expert correspondence, the items of the case management index system were revised according to the opinions of the expert correspondence.Results:Twenty-two experts were interviewed in the first round, and the effective recovery rate of the questionnaire was 95.45%(21/22); in the second round, 21 experts were interviewed, the effective recovery rate of the questionnaire was 100.00%(21/21). The first and the second round of the expert authority coefficient was 0.896 and 0.912, respectively, the coefficient of variation of each item was 0-0.17, Kendall′s coefficient of concordance was 0.20 ( P<0.01), the average importance value of indexes were 4.43-5.00, and the rate of full marks was 38.1%-100.0%. Finally, an acute myocardial infarction case management index system based on multidisciplinary collaboration was established, including 3 primary indexes and 51 secondary indexes. Conclusions:The case management index constructed in this study is scientific and reliable, closely integrated with clinical practice, and has strong clinical practical value.
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Primary biliary cholangitis (PBC) is a chronic progressive cholestatic liver disease often observed in the middle-aged and elderly women and it can eventually lead to liver cirrhosis or liver failure. Osteoporosis is one of the common complications in PBC patients and is characterized by decreased bone mass and increased susceptibility to fractures. Osteoporosis and fractures caused by osteoporosis seriously affect the quality of life of PBC patients, and with the improvement of PBC treatment strategies and the increase in life expectancy, early diagnosis, prevention, and treatment of PBC with osteoporosis is of particular importance. This article briefly summarizes the epidemiology, pathogenesis, and diagnosis and treatment of patients with PBC and osteoporosis and proposes current challenges and future research directions.
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Primary biliary cholangitis (PBC) is a chronic progressive cholestatic liver disease often observed in the middle-aged and elderly women and it can eventually lead to liver cirrhosis or liver failure. Osteoporosis is one of the common complications in PBC patients and is characterized by decreased bone mass and increased susceptibility to fractures. Osteoporosis and fractures caused by osteoporosis seriously affect the quality of life of PBC patients, and with the improvement of PBC treatment strategies and the increase in life expectancy, early diagnosis, prevention, and treatment of PBC with osteoporosis is of particular importance. This article briefly summarizes the epidemiology, pathogenesis, and diagnosis and treatment of patients with PBC and osteoporosis and proposes current challenges and future research directions.
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Objective:The clinical efficacy, safety and quality of life in female patients with stress urinary incontinence (SUI)treated by midurethral sling were studied by multicenter retrospective study.Methods:From January 2018 to December 2018, 531 female patients with severe stress urinary incontinence from seven domestic urinary center were included in this study, including 78 cases from General Hospital of Central Theater Command, 122 cases from Shanghai Jiao tong University School of Medicine Affiliated Ren Ji Hospital, 67 cases from Shanghai Jiaotong University Affiliated First People’s Hospital, 68 cases from People’s Hospital of Jiangsu Province, 71 cases from The First Affiliated Hospital of Xi’an Jiaotong University, 65 cases from Zhejiang Provincial People’s hospital, 60 cases from Xiamen University First Affiliated Hospital. Among the 531 patients, 214 cases received TVT sling with an average age of (58.14±10.16) years. 181 cases were in postmenopausal(84.6%). The number of births ≥2 times was 89 (41.6%) cases. The score of ICI-Q-SF was 16.00±1.73. There were 166 cases of moderate incontinence (77.6%) and 48 cases of severe incontinence (22.4%). There were 317 patients in the TOT/TVT-O group with an average age of (58.33±10.25) years. 247 cases were in postmenopausal(77.9%). The number of births ≥2 times was 120 (37.8%) cases. The score of ICI-Q-SF was 15.79±1.75. There were 256 cases of moderate incontinence (80.8%) and 61 cases of severe incontinence (19.2%). There was no statistically significant difference in general data parameters between the two groups ( P>0.05). 1, 6, 12 months after the operation, the two groups of patients incontinence questionnaire Summary(ICI-Q-SF), common complications and Patient Global Impression of Improvement(PGI-I), satisfaction evaluation follow-up. ICI-Q-SF score improved > by 50% (cure + significant improvement) and 1-hour pad test <10 g (qualitative index) were used as the evaluation index of surgical success. Result:Both of the two surgical methods have high successive rate. There was no significant difference between 94.9% (203/214) of the TVT group and 93.7% (297/317) of the TOT/ TVT-O group ( P>0.05). Postoperative improvement of urinary incontinence (cure rate) [88.3% (189/214)]in the TVT group was slightly higher than that in the TOT/ TVT-O group [77.0% (244/317)] ( P<0.05). There was no change in the recurrence rate of urinary incontinence in the follow-up 6 and 12 months after the operation. There was no statistically significant difference between 4.4% (9/203) in the TVT group and 5.4% (16/297) in the TOT/TVT-O group ( P>0.05). The subjective cure rate 12 months after the operation was 96.3% (206/214) in the TVT group and 95.9% (304/317) in the TOT/TVT-O group ( P>0.05). 10 patients occurred bladder perforation occurred in the TVT group, and no bladder perforation occurred in the TOT/TVT-O group ( P<0.001). The incidence of pain and discomfort in the TVT group was significantly lower at 1.9% than that in the TOT/TVT-O group at 6.9% ( P<0.01). There was no statistically significant difference between the two groups in the incidence of complications such as dysuria/urinary retention, frequent urination/urgency incontinence. Both of them exposed sling ( P>0.05). Conclusion:Both TVT and TOT/TVT-O sling can effectively treat female stress urinary incontinence, and both can improve the sexual satisfaction of patients after the surgery, with fewer complications and other advantages. The selection of specific surgical methods in clinical practice can be individualized according to the patient's physical conditions, clinical needs and the operation methods familiar to doctors.
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Objective To investigate the effect of enriched environment (EE) on behavior and expression of mitogenactivated protein kinase phosphatase-1 (MKP-1) in hippocampus of depression rats induced by chronic unpredicted mild stress (CUS) and to provide clues for the molecular mechanism of treating depression.Methods Forty Sprague-Dawley rats were randomly divided into control group,CUS group,fluoxetine group and EE group,with 10 rats in each group.The rats in CUS group,fluoxetine group and EE group were given 8 weeks of CUS,and from the fifth week,the rats in EE group and fluoxetine group were given EE and fluoxetine for 4 weeks,respectively.The changes of behavioristic of the rats in the four groups were evaluated by body mass gain,open field test,and sucrose preference.The expression of MKP-1 in hippocampus was detected by Western blot.Results There was no significant difference in body mass,distance of horizontal movement,the number of upright,the times of passing through the grid and sucrose preference index among the four groups(P ＞ 0.05).After modeling,compared with the control group,the body mass gain,distance of horizontal movement,the number of up-right,the times of passing through the grid and sucrose preference index in the CUS group,fluoxetine group and EE group were decreased significantly(P ＜ 0.05);there was no significant difference in the body mass gain,distance of horizontal movement,the number of up-right,the times of passing through the grid and sucrose preference index among the CUS group,fluoxetine group and EE group(P ＞ 0.05).After intervening by fluoxetine and EE,the body mass gain,distance of horizontal movement,the number of up-right,the times of passing through the grid and sucrose preference index in the CUS group were lower than those in the control group(P ＜0.05);but there was no significant difference in the body mass gain,distance of horizontal movement,the number of up-right,the times of passing through the grid and sucrose preference index between the control group and the fluoxetine group and EE group(P ＞ 0.05).Compared with the CUS group,the body mass gain,distance of horizontal movement,the number of up-right,the times of passing through the grid and sucrose preference index in the fluoxetine group and EE group were higher(P ＜ 0.05);there was no significant difference in the body mass gain,distance of horizontal movement,the number of up-right,the times of passing through the grid and sucrose preference index between the fluoxetine group and EE group (P ＞ 0.05).The expression of MKP-1 in hippocampus of CUS group and EE group was higher than that in the control group (P ＜0.05).There was no significant difference in the expression of MKP-1 in hippocampus between the fluoxetine group and control group(P ＞ 0.05).Compared with the CUS group,the expression of MKP-1 in hippocampus in the fluoxetine group decreased (P ＜ 0.05).There was no significant difference in the expression of MKP-1 in hippocampus between the EE group and CUS group(P ＞0.05).Compared with the fluoxetine group,the expression of MKP-1 in hippocampus in the EE group was higher(P ＜ 0.05).Conclusion EE can significantly improve depressive symptoms in rats,but it has no significant effect on MKP-1 protein expression in hippocampus,and EE may not act on depression by affecting MKP-1.
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Objective To analyze and compare the differences in application of 24-hour dietary recall and dietary balance index (DBI) in dietary survey and evaluation of patients with type 2 diabetes mellitus,meanwhile investigate their nutrition status.Method This was a cross-sectional study.A total of 100 type 2 diabetes inpatients at the age of 19-59 were recruited from Shanghai Jiaotong University Affiliated Sixth People's Hospital from December 2013 to February 2014.They were surveyed and evaluated by 24-hour dietary recall and DBI respectively.Result The micronutrient intake in patients with type 2 diabetes was not sufficient.Compared with RNI,the intake of vitamin B1,B2,and calcium was less than 50％.The average of DBI lower bound score (DBI-LBS) of the 100 patients was 32.1±6.1,65％; the patients were in moderate or severe deficit of food intake.DBI higher bound score (DBI-HBS) was 4.4±2.8.No significant excess intake problem was found.Dietary quality distance was 36.4±6.9.Eighty-seven percent of them had a dietary patterns of mode B.Conclusion Dietary patterns in type 2 diabetes patients were not reasonable.Nutrition education and nutrition intervention for type 2 diabetes should be emphasized.The two methods can be used to evaluate dietary quality independently,but it would be better to evaluate the quality of the patients' diet using two dietary survey methods together.
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Objective To investigate the effects of β1-adrenergic receptor autoantibodies (β1-AA) on the proliferation of different subtypes of T lymphocytes in patients with heart failure .Methods β1-AA-positive IgG antibodies isolated from patients with heart failure were purified by using affinity chromatog -raphy.CD3 +CD4 +T and CD3 +CD8 +T lymphocytes were sorted by flow cytometry analysis .The prolifera-tion of different subtypes of T lymphocytes was tested by using CCK-8 kit.Tests for lactate dehydrogenase ( LDH) level and cell apoptosis were performed to evaluate T lymphocytes damage .Results The prolifera-tion of activated lymphocytes was inhibited by β1-AA isolated from the serum of patients with heart failure in a concentration dependent manner , but it could be blocked by β1 receptor blocker .The damage of lympho-cytes induced by β1-AA was increased.Moreover, β1-AA promoted the necrosis and apoptosis of CD 3 +CD4 +T and CD3 +CD8 +T lymphocytes and thus inhibited the proliferation of them .Conclusion β1-AA isolated from the serum of patients with heart failure inhibited the proliferation of CD 3 +CD4 +T and CD3 +CD8 +T lymphocytes through increasing the necrosis and apoptosis of them .This study suggests that β1-AA might induce immune disorders in addition to causing pathological changes in heart tissues .