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Objective:To investigate the effect of T-lymphocyte and subpopulation counts on the prognosis of severe acute pancreatitis (SAP) patients.Methods:The clinical data of 90 patients with SAP diagnosed at the Shanghai General Hospital between January 2019 and June 2022 were retrospectively analyzed, and the patients were divided into good prognosis and poor prognosis group according to whether they were diagnosed for 28 d. The general information of the patients was recorded, including blood-related immunological indicators within 24 h of diagnosis, including leukocytes, neutrophils, lymphocytes, monocytes, CD 3+ , CD 4+ , CD 8+ T-lymphocyte count and CD 4+ /CD 8+ T-lymphocyte ratio, IgG4 level; blood inflammation index procalcitonin, albumin level and APACHEⅡ score at admission; survival and complication status of patients at 28 d of diagnosis. Non-parametric Mann-Whitney U test was used to analyze the correlation between each index and the prognosis of the patients. The subject operating characteristic curve (ROC) of patients was plotted, and area under curve (AUC) was calculated to assess the value of CD 3+ and CD 4+ T-lymphocytes in predicting the prognosis of SAP. Results:The majority of SAP patients were male (65.6%). The main cause of SAP was gallstone (56.7%), followed by hyperlipidemia (35.6%). At 28 days after diagnosis, 85(94.4%) patients survived, and 39 of them were cured and included in the good prognosis group. Forty-six cases were complicated with infection, multiple organ dysfunction syndrome (MODS) and local pancreatic complications, and 5 cases (5.56%) died; and a total of 51 cases were included in the poor prognosis group. Compared with the good prognosis group, the number of CD 3+ T-lymphocytes [366(268, 498) cells /μl vs 709(578, 999) cells /μl], CD 4+ T-lymphocytes [209(120, 298) cells /μl vs 486(303, 548) cells /μl] and albumin level (33.9 g/L vs 35.9 g/L) within 24 hours in the poor prognosis group were significantly lower, while the level of procalcitonin (1.02 ng/ml vs 0.43 ng/ml) and APACHEⅡ score [7(4, 10) vs 5(3, 8)] were significantly increased, and all the differences were statistically significant (all P value <0.05). ROC curve analysis showed that the AUC values for CD 3+ and CD 4+ T-lymphocyte counts within 24 hours for predicting poor prognosis of SAP were 0.857 (95% CI 0.696-1.000) and 0.867 (95% CI 0.708-1.000), respectively. The cut-off values were 524 cells /μl and 301 cells /μl, the sensitivity were both 85.7%, and the specificity were 78.6% and 85.7%, respectively. Conclusions:The significant decrease of peripheral blood CD 3+ and CD 4+ T-lymphocyte count within 24 h of SAP diagnosis has a certain predictive value for the prognosis of patients with SAP.
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Objective:To observe the changes of pulmonary function and its influential factors in residents of a rural community and investigate the prevention and control measures.Methods:A survey was made in residents from a rural community in Qingdao who received public health services from September 2017 to December 2019. The demographic data, behavioral and medical history information were collected. Forced vital capacity and forced expiratory volume in one second were measured. The factors that affect lung function were analyzed using univariate analysis and multivariate analysis.Results:This survey involved 5184 residents consisting of 2199 (42.4%) males and 2985 (57.6%) females. 1322 (25.5%) residents had pulmonary dysfunction. Univariate analysis showed that residents aged ≥ 60 years had a higher risk for developing pulmonary dysfunction than residents aged < 60 years (26.1% vs. 14.3%, χ2 = 19.34, P < 0.001), and male residents had a higher risk for developing pulmonary dysfunction than female residents (32.9% vs. 20.0%, χ2 = 110.74, P < 0.001). With the increase in body mass, the incidence of pulmonary dysfunction gradually decreased. The proportion of residents with pulmonary dysfunction with low body mass was higher than that in residents with normal body mass and high body mass (43.4% vs. 27.8% or 22.8%, χ2 = 8.86, 17.63, P = 0.003, < 0.001). The proportion of residents with pulmonary dysfunction was higher in those with a history of chronic bronchitis, bronchial asthma, or obstructive pulmonary disease than in those without such a history (68.3% vs. 23.2%) χ2 = 263.33, P < 0.001). The proportion of residents with pulmonary dysfunction was significantly higher in smokers, whether or not had quit smoking than in non-smokers (35.1%, 36.3% vs. 22.8%, χ2 = 48.83, 86.46, both P < 0.001). The proportion of residents with the normal pulmonary function was not related to the exposure history of dust and chemical poisons and the family history of respiratory diseases ( χ2 = 0.38, 2.29, P = 0.535, 0.130). Multivariate analysis showed that age ≥ 60 years, male sex, low body mass, smoking, and a history of respiratory system diseases were the independent risk factors for pulmonary dysfunction. Among smokers, the number of cigarettes smoked was higher in smokers with pulmonary dysfunction than those with normal pulmonary function ( t = -2.39, P = 0.009). Conclusion:There are many risk factors for pulmonary dysfunction. Primary medical service institutes should carry out pulmonary function testing and formulate targeted prevention strategies, which help realize early detection and treatment of chronic obstructive pulmonary disease.
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With in-depth studies on the etiology and pathogenesis, pathological viscera and bowels, and rule of disease progression of primary liver cancer in recent years, some clinical and experimental results have been achieved for the treatment of primary liver cancer with traditional Chinese medicine, such as treatment based on syndrome differentiation and disease differentiation, compound prescriptions and monomers of Chinese herbs, oral administration of drugs/acupuncture and moxibustion/external application, and prevention before disease onset and prevention of recurrence, which reflects the rich methodological connotations of traditional Chinese medicine and lays a foundation for constructing a new diagnostic and therapeutic mode for liver cancer based on integrated traditional Chinese and Western medicine therapy.
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Objective:To survey the awareness of common primary care clinical guidelines among primary care providers in Qingdao city.Methods:A questionnaire survey on the awareness of common clinical guidelines in primary care was conducted in August 2020 among 659 providers (293 males and 366 females) from 81 primary medical institutions in Qingdao city. The contents of the questionnaire included the general information of primary physicians, the frequency of using the guidelines, the level of understanding of the guidelines, the effect of guidelines in clinical work, the attitudes towards promoting the guidelines, and the interest in learning the guidelines and the way of learning.Results:A total of 659 valid questionnaires were recovered with a recovery rate of 100.0%. The results showed that 14.7% (97/659) practitioners applied the guidelines in most cases, and 31.6% (208/659) frequently used. There were significant differences in use frequency among providers with different practice types, professional titles, education background, practice locations and institutions ( P<0.01). Among participants, 15.2% (100/659) did not know about primary care guidelines, 63.3% (417/659) knew but did not learned guidelines, 21.5% (142/659) knew and studied guidelines carefully. The top five of the learned guidelines (114, 80.3%) were bronchial asthma (113, 79.6%), type 2 diabetes (108, 76.1%), chronic obstructive pulmonary disease (101, 71.1%), and chronic cor pulmonale (83, 58.5%). Most participants who learnt the guidelines viewed the guidelines as quite helpful or very helpful, the score of usefulness for professional knowledge was the highest (4.44±0.60). Most of participants (94.2%, 621/659) thought it was necessary to develop primary care guidelines; and the major factors affecting the promotion were lack of training (79.8%, 526/659), difficulties in access (46.7%, 308/659) and ignorance or neglect (23.2%, 153/659).Most practitioners (93.8%, 618/659) were interested in learning primary care clinical guidelines, and the expected ways of training were online teaching (70.0%, 420/618), training courses(58.3%, 360/618) and special lectures (55.2%, 341/618). Conclusion:The current situation of learning clinical guidelines among primary care providers in Qingdao is not satisfactory, but they are willing to learn the guidelines for improving clinical practice. We should strengthen the training and promotion of primary care guidelines among primary care providers in the future.
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Objective To investigate the effects of zoledronic acid on bone mineral density (BMD) and serum markers of bone metabolism in elderly patients with osteoporosis.Methods The 90 elderly patients with osteoporosis who treated in our hospital were selected from January 2014 to June 2016,they were divided into control group and treatment group randomly,45 cases in each.The control group were treated with Caltrate D tablets,600 mg each time,once a day,alendronate,70 mg each time,once a week.The treatment group were treated with Caltrate D tablets,600 mg each time,once a day,zoledronic acid 5 mg with 100 ml 0.9％ sodium chloride solution in intravenous infusion,infusion time ＞ 15 min,once a year.Compared the clinical efficacy,bone mineral density and serum related markers of bone metabolism between the 2 groups.Results The total effective rate of the treatment group was 95.56％ [markedly effective in 29 cases (64.44％) and effective in 14 cases (31.11％) respectively],which was significantly higher than that of the control group (80.00％) (P ＜ 0.05).Before the treatment,the bone density of patients in 2 groups were similar (P ＞ 0.05).After treatment,the bone mineral density of the lumbar spine,femoral neck and femoral trochanter in the treatment group was higher than that in the control group (P ＜ 0.05).Before treatment,serum bone metabolism markers of 2 groups were similar (P ＞ 0.05).After treatment,the levels of bone alkaline phosphatase (BALP),tartrate-resistant acid phosphatase-5b (TRACP-Sb) and collagen type Ⅰ C-terminal peptide (CTX-Ⅰ) in the two groups decreased significantly,while the levels of osteocalcin (BGP) increased.Serum markers of bone metabolism level in treatment group were better than those in the control group (P ＜ 0.05).Conclusions Zoledronic acid can significantly improve the bone mineral density of elderly patients with osteoporosis and improve the level of serum related markers of bone metabolism,the clinical efficacy is good,and it is worthy of clinical application.
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Objective To explore the clinical value of combined detection of serum beta human chorionic gonadotropin (β-hCG),estradiol (E2),progesterone (P) and antiphospholipid antibodies (ACA) in predicting the outcomes of early threatened abortion.Methods 80 pregnant women were chosen from six to eight weeks singleton pregnancies,50 cases of threatened abortion and 30 cases of normal pregnancy.The serum levels of β-HCG,estradiol,progesterone and ACA-IgG,ACA-IgM and ACA-IgA were detected.The threatened abortion patients were given intramuscular progesterone 20 mg/day/time for 1 week,then,the pregnancy outcomes were analyzed and the serum levels of β-HCG,estradiol and progesterone were explored.Results The serum β-HCG,estradiol and progesterone of the threatened abortion group [(5 140.77 ± 2 365.47) IU/L,(680.28 ± 306.06) pg/mL,(15.59 ± 3.65) pg/L]were lower than those of the normal pregnant women [(14 520.4 ± 11 016.24) IU/L,(1 142.81 ± 670.57) pg/mL,(27.6 ± 4.78) pg/L] (t =3.224,P =0.003 ; t =2.43,P =0.022 ; t =7.72,P =0.001).According to pregnancy outcome,patients with threatened miscarriages were divided into the two groups,including 45 patients with continuing pregnancies and 5 patients with inevitable miscarriages.The serum levels of β-HCG,estradiol and progesterone in ongoing pregnancies group [(10 829.42 ± 6 926.28) IU/L,(832.9 ± 397.91) pg/mL,(25.62 ± 4.51) pg/L] were higher than those in inevitable miscarriages [(6 310.14 ± 2 593.19) IU/L,(487.14 ± 275.47) pg/mL,(13.6 ±4.84) pg/L] (P ＜ 0.05) ;The serum levels of ACA-IgG,ACA-IgM and ACA-IgA in 80 cases tested,only 2 cases who appeared in the threatened abortion group were detected with the positive of serum ACA-IgG,accounted for 4％ (2/50) (x2 =68.05,P =0.000),occurred spontaneous abortion in the end.Conclusion Combined detection of serum ACA,β-HCG,estradiol and progesterone may be helpful for prognosis of threatened abortion.However,the clinical predictive value of ACA needs further study in the early threatened abortion.
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Objective:To study the effects of artesunate on K562, K562 /ADM cell apoptosis and NF-κB p65 expression in hu-man leukemia. Methods: The effect of artesunate with different concentrations on K562 and K562 /ADM cell apoptosis at various times was studied by a flow cytometer. The effect of artesunate with 15 μmol·L-1 on NF-κB P65 expression in K562 was explored u-sing a Western blot method. Results:Artesunate showed little effect on K562 cell apoptosis, while exhibited notable effect on K562 /ADM cell apoptosis. K562 /ADM cells were more sensitive than K562 to artesunate at the concentration of 7. 5 μmol·L-1 and 15μmol·L-1(P<0. 01), and after 4-hour treatment with 15 μmol·L-1 artesunate, K562 /ADM cell apoptosis was much higher than K562(P<0. 01). Artesunate could reduce leukemia cell p65 expression at the concentration of 15 μmol·L-1. Conclusion:Artesu-nate can induce the apoptosis of leukemia cells by down-regulating the expression of p65.
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Because of the changed metabolic behaviors of cancer cells, tumor cells uptake a corresponding larger amount of glucose in physiological condition when compared with normal cells. And they were prone to metabolize glucose for generating energy in anaerobic glycolysis ways in order to grow quickly. Anaerobic glycolysis consumes more glucose than aerobic way when the same amount of energy is obtained, which also results in large demand of glucose in tumor cells. This review briefly describes therapy methods related to characteristic mentioned above, and summarizes the research progress of drugs, diagnostic reagents and carriers conjugated with glucose, glucose derivatives or other kinds of sugars for cancer targeting. Furthermore, typically relative research reports from 2012 till now were listed and analyzed.
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Objective To observe the curative effect of esophageal cancer with three-dimensional conformal radiotherapy and acute adverse reaction. Methods 28 cases with esophageal cancer were received three-dimensional conformal radiotherapy from August,2008 to August,2009. The conformal radiotherapy was performed in the way of 200cGy/fraction,5 fractions/week,total dose of 60-64Gy,30-32fraction. In addition,the curative effect and acute adverse reaction were evaluated along the radiotherapy. Results The number of complete relief(CR) cases was 10, part relief(PR) was 15 ,no change was 3 ,and the overall relief(CR + PR) rate was 89.3%. The local control rate and the survival rate in the first year were 75.0% and 60.7%, and second year were 71.4% and 46.4%. The cases of 0 level acute radioactive pneumonia was 14,1 level was 8,2 level was 5,3 level was 1. The cases of 0 level acute radioactive esophagitis was 5, 1 level was 14,2 level was 7,3 level was 2. Conclusion Three-dimensional conformal radiotherapy was a very safe and effective way to treat esophageal cancer. Whether the therapy could improve the long-term survival rate was remained to be observed.
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Objective To explore the diagnosis value of morphology changes of pleomorphic megakaryocytes in the bone marrow (BM) smears and BM sections in chronic MPD(CML-CP, ET,PV and PMF). Methods BM aspiration was taken in 182 patients of MPD aspiration and biopsy examination was performed synchronously to obtain the BM smears and BM sections samples. The BM smears were subjected to Wright/Giemsa stain and immunohistochemistry stain, while the BM sections were subjected to Haematoxylin-Giemsa-Fuchsin stain. The morphology of pleomorphic megakaryocytes was classified into five groups, which were Ⅰ type ( inclusion type), Ⅱtype ( hypolobulated muclei type), Ⅲ type ( giant hyperlobulated nuclei type), IV type (micro pyknotic type), and V type(extrusion type). The size of megakaryocytes clusters was recorded as no clusters(0) , predominantly small clusters of fewer than 6 cells (1) or predominantly large clusters of at least 6 cells (2) . The detection rates of various types of pleomorphic megakaryocytes and megakaryocytes clusters were both analyzed in the BM smears and BM sections. Results In CML-CP group, the detection rates were (3. 73±3. 84)% , (14.19 ±7. 62)% ,(5.99 ±4.67)%, (34. 37 ±10.79)%, (9.45 ±6. 87)%, (32. 28 ±7. 67)% and 3.13 ±2. 30)% ,(12.61 ± 9.28)%,(4.94±4.27)%,(35.26±9.63)%,(9.47 ±5.89)%,(34.58 ±6.81)% for I tⅠype,Ⅱ type,Ⅲ type, Ⅳtype and Ⅴ type pleomorphic megakaryocyte in BM smears and BM sections. There were no significantly differences between the BM smears and BM sections(t value were 0.524,0.510,0.645, 0.239,0.011,0. 869,all P>0.05). In ET group, the detection rate of I type [ (6.17 ±2. 89)% ] in BM smears was significantly higher than that in BM sections [ 2.42 ± 1. 28) % ] (t = 7. 183, P < 0. 01) , while the detection rate of V type [ (6. 28 ± 3. 34) % ] in BM smears was significantly lower than that in BM sections [ (10. 18± 4.03) % ] (t = 3.940, P < 0.01). Besides these, the detection rates of other types were not significantly different between the BM smears and BM sections(t value were 0.079,0. 122,1.643, 1. 638,all P>0. 05). In PV group, the detection rate of V type in BM smears [ (6. 55 ±4. 11)% ] was significantly lower than that in BM sections [ (10. 30±3. 34) % ] (t = 2. 351, P < 0.05 ). However, the detection rates of the other types were not significantly different between the BM smears and BM sections (t value were 1. 635,0. 301,0. 132,0. 704,0. 681 ,all P' >0. 05). In PMF group, the detection rate of IV type in BM smears [(13.05 ±5.24)%] was significantly lower than that in BM sections [(29.14± 8. 72) % ] (t = 5. 245, P < 0. 01). And the detection rate of normal type in BM smears [ ( 33. 58 ± 14.39)% ] was significantly higher than that in BM sections [(23. 01±7.96)%] (t =2. 132,P<0. 05). Besides these, the detection rates of the other types were not significantly different between BM smears and BM sections( t value were 0. 787,0.646,2.062,0. 869, P > 0. 05 ) . In CML-CP and PV groups, the detection rates of size of clusters were not significantly different between the BM smears and BM sections (x~2 = 2. 772, P > 0. 05 ). In ET group, the detection rate of small clusters (1) in BM smears was obviously higher than that in BM sections, however, the detection rate of larger clusters (2) in BM smears was obviously lower than that in BM sections (x~2 = 13. 748, P < 0.01). In PMF group, the detection rate of no clusters(0) in BM smears was obviously higher than that in BM sections, however, the detection rate of large clusters(2) in BM smears was obviously lowers than that in BM sections (x~2 =18.741 ,P<0. 01). Conclusions Both BM smears and BM sections can be applied to observe pleomorphic megakaryocytes. The morphology changes of pleomorphic megakaryocytes have certain reference values for identification of MPD subtypes and differential diagnosis.
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OBJECTIVE:To promote clinical rational drug use (RDU). METHODS:2000 prescriptions before intervention (from Jan. to Apr. in 2003) and another 2000 after intervention (from Jan. to Apr. in 2006) were randomly selected for a statistical analysis in accordance with the international RDU indicators of WHO/INRUD. RESULTS:Regarding the prescription indicators,the average number of drugs per prescription was 3.88 kinds before intervention versus 1.97 after intervention; the proportion of patients treated with antibiotics was 38.40% before intervention versus 24.05% after intervention; the proportion of injections was 21.75% before intervention versus 12.75% after intervention. In terms of patient care indicators,the average consultation time was 9.5 minutes and the average dispensing time was 23 seconds,and the percentage of drugs with integral labeling was as high as 100%. CONCLUSION:Most of the RDU indictors in our hospital were satisfactory; however,the average cost per prescription was still on the high side,which calls for further intervention.
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OBJECTIVE:To analyze the cost of three schemes in treatment of unstable angina pectoris METHODS:88 patients with unstable angina pectoris were divided into three groups:group Ⅰ was given isosorbide,asprin,nifedipine and nitroglycerin;group Ⅱ was given isosorbide,asprin,nifedipine,nitroglycerin and red sage injection and group Ⅲ was given isosorbide,asprin,nifedipine,nitroglycerin and puerarin;then using pharmacoeconomic method,cost-effectiveness analysis was carried out RESULTS:The efficacy in the group Ⅱ and group Ⅲ was higher than that in group Ⅰ(P0 05),and the E/C(effectiveness/cost) of the three groups were 15 98,18 02 and 33 40 respectively Compared with group Ⅰ,?C/?E of group Ⅱ and Ⅲ were 24 66,83 90 respectively;Compared with group Ⅱ,?C/?E of group Ⅲ was 643 60 CONCLUSION:The scheme for group Ⅱ is the best one
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OBJECTIVE:To explore ways of promoting the rational use of antibacterials.METHODS:To analyze and e-valuate the effect of whole-ranged pharmaceutical care on promoting rational use of antibacterials.RESULTS:The whole-ranged pharmaceutical care was the efficient way to ensure the rational drug use of antibacterials.CONCLUSION:The whole-ranged pharmaceutical care should be carried out in hospital pharmacy so as to promote the rational use of antibacterials and to make the utmost use of the limited resource of Antibacterials.
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Objective: To investigate the prevalence of overweight and obesity and relation of body mass index (BMI) to body fat percentage and waist circumference in Chinese healthy adults. Methods: 1005 healthy adults were divided into five groups by BMI,which was made by WHO's recent classification of BMI for Asian adults. Anthropometric measurements (waist and hip circumference , skinfold thickness and ratio of waist and hip circumference) and bioelectrical impedance analysis (BIA) were done in subjects. Results: The prevalence of overweight and obesity classⅠin males were significantly higher than in females. The prevalence of obesity classⅡwas lower both in males and in females. Females had higher percent body fat than males measured by BIA and by skinfold thickness measurements. BMI was significantly correlated with waist circumference in all age groups. Waist circumference was more than 80 cm in overweight females, and more than 90 cm in obesity classⅠin males. Conclusion: The age of overweight and obesity in males was younger than in females. The body fat in females was higher than in males. BMI cut off points for obesity diagnosis are over estimated much more than BIA and skinfold thickness measurements for percent body fat in adults. It should be noted that age, sex and physical activity need to be considered besides BMI when obesity is diagnosed.