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Objective To observe the CALR mutation in patients with Ph negative chronic myeloproliferative neoplasms(MPNs) and its clinical significance. Methods From January 2012 to January 2015,the clinical data of ninety-seven patients with chronic myeloproliferative neoplasms was retrospectively analyzed and followed up to analyze different types of MPNs, including the clinical characteristics and gene mutation of polycythemia vera(PV),essential thrombocythemia(ET)and primary myelofibrosis (PMF).The hematological parameters and prognosis of patients with different mutation types were compared ( Cox regression model). Results Among the patients,the incidence of JAK2 mutation was the highest,64. 95% (63/97), followed by CALR mutation ( 19. 59% ( 19/97 ) ) and triple negative ( 10. 31% ( 10/97 ) ) . The incidence of MPL mutation was 5. 15% (5/97),which was the lowest and CALR mutations in ET and PMF were 28. 57%(10/35) and 28. 13% (9/32),respectively. The difference was not statistically significant (χ2 =1. 616,P>0. 05);the CALR gene mutation was not detected in PV patients. Compared with the JAK2 mutation, the hemoglobin,leukocyte and neutrophils in the patients with CALR mutation were lower (P<0. 05),PLT levels were lower in CALR-mutant ET patients ( P<0. 017) ,whereas platelet levels in CALR-mutant PMF patients were higher (P<0. 017). The incidence of disease progression in JAK2 and CALR mutation was 47. 62% (30/63)and 31. 58% (6/19) (χ2=1. 525,P>0. 05). The risk of disease progression in patients with CALR mutation was significantly lower than that of JAK2 mutation ( HR=0. 46,95%CI 0. 26-0. 98,P<0. 05) . Conclusion The clinical characteristics of MPNs patients with different gene mutations are different. The prognosis of MPNs patients with CALR mutation is better than that of JAK2 mutation.
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BACKGROUND: Previous studies have proved platelet-rich fibrin (PRF) with osteoinduction ability, and the centrifugal speed and time to prepare rabbit advanced PRF (A-PRF) with the most similar structure to that of human PRF have been determined.OBJECTIVE: To observe the histological changes during A-PRF-induced osteogenesis.METHODS: Thirty Japanese white rabbits were randomly divided into A-PRF and blank control groups (n=15 per group).The full-thickness defect models were established on the rabbit parietal bone, followed by implanted with A-PRF or nothing, respectively. The model rabbits were killed immediately, at 2, 4, 8 and 12 weeks after modeling, to grossly observe the bone formation, and the histological changes in the defect region were observed through hematoxylin-eosin staining, Masson staining and immunohistochemistry.RESULTS AND CONCLUSION: Unhealed defects were observed in the blank control group. Gross and histological observations showed that the speed, amount and maturity of bone formation in the A-PRF group were significantly better than those in the blank control group immediately, 4, 8 and 12 weeks after modeling (P < 0.05). Our findings suggest that the rabbit skull bone defect is successfully established. A-PRF can induce osteogenesis, and more mature newly born bones appear with time. Additionally, osteoclasts can act with osteoblasts synergically under the A-PRF induction to promote the bone formation.
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Objective To study the effect of computerized pressure hemostat on lower limb deep vein thrombosis in high-risk elderly patients.Methods From September to December 2013,36 orthopedic hospitalized patients who received operations were divided into the hemostat group and the non-hemostat group with 18 patients in each group.D-dimer changes and lower limb deep vein thrombosis were observed in both groups.Results D-dimer was significantly increased in both groups compared with that before operation,but the extent of elevation in the non-hemostat group was lower than that in the hemostat group.D-dimer and cases of lower limb deep vein thrombosis in the hemostat group was higher than those in the non-hemostat group after operation,which showed significant difference.Conclusions The use of computerized pressure hemostat will increase the risk of lower limb deep vein thrombosis in elderly patients,so the technical operation procedures should be strictly enforced accompany with safely use of computerized pressure hemostat.
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Objective To analyze the correlation between pressure ulcer during operation and operation time under lateral operation position.Methods 89 operation patients all adopted lateral position.Pressure ulcer during operation was observed and operation time was registered.Results The operations went on smoothly.Operation time lasted 1 to 8 hours.There were 42 operations exceeded 4 hours and pressure ulcer during operation was observed in 15 patients.Positive rate was 35.7％.There were 47 operations lasted less than 4 hours and pressure ulcer during operation was observed in 6 patients.Positive rate was 12.8％.Statistical differences were significant between the two groups.Conclusions For those operation patients with lateral position whose operation time would be longer,especially more than 4 hours,nursing intervention measures should be adopted to prevent pressure ulcer during operation.
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Objective To study the effect of nursing intervention on preoperative anxiety of patients with gynecological carcinoma.Methods 60 patients with gynecological carcinoma in our hospital who were to receive operations were randomly distributed into the control group and the intervention group with 30 in each group.The control group was given routine nursing,while the intervention group received nursing intervention based upon routine nursing.Indexes such as preoperative anxiety,sleeping quality and satisfaction degree to nursing care were evaluated within them.Results Through targeted nursing intervention preoperative anxiety of patients in the intervention group alleviated,their confidence enhanced and satisfaction degree to nursing care improved compared to those of the control group.Conclusions Targeted nursing intervention can reduce preoperative anxiety of patients with gynecological carcinoma and increase satisfaction degree to nursing care.
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Objective To explore the effects of insulation measures on blood coagulation during laparotomy in the aged patients. Methods Sixty patients were randomly divided into the experimental group and the control group with 30 cases in each group from September 2007 to August 2008. The experimental group received a series of insulation measures based on general perioperative nursing care, which was given to the control group. Patients' temperature, platelet count (PLT), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TV),fibrinogen (Fbg) were measured and these preand postoperative values together with blood loss during operation were compared between two groups. Results No significant change was seen in perioperative body temperature in the experimental group, the incidence rate of hypothermia was lower, the change in coagulation index was better than that of the control group. Conclusions These results suggested that mild hypothermia could influence aged patients' blood coagulation function and increase blood loss during laparotomy. Active insulation measures can maintain the stability of patients" temperature.
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Objective To know the influence of heat preservation intervention on temperature among aged patients who had accepted abdomen surgery. Methods Divided 40 aged patients into the heat preservation group and the routine temperature group, there were 20 cases in the each group. Heat preservation intervention were used in the heat preservation group, while the routine nursing cares were used in the routine temperature group. Compared the incidence rate of shivering and the changing of temperature during the course of operation between the two groups. Results There was no significant difference in the heat preservation group about changing of temperature during the course of operation, while the difference in the routine group was significant. The incidence rate in the shivering in routine group was significant higher than that of in the beat preservation group. Conclusions It is necessary for aged patents about heat preservation during the operation, which can avoid low body temperature and promote satisfactory prognosis.
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Objective To explore influence of perioperative protection from hypothermia on surgical site infection (SSI) in patients undergoing gastroenteritic operation. Methods A retrospective study was carried out in 1536 patients undergoing gastroenteritic operation in general surgery department of our hos-pital.Patients (764 cases) admitted before July 2006 were set as the control group,while those after July 2006(772 cases) were set as the observation group. The observation group received a series of measures for protection from hypothermia besides of routine perioperative nursing.The control group only adopted routine perioperative nursing.The SSI rate was compared between the two groups. Results The SSI rate of the observation group was lower than that of the control group(P < 0.01 ). Conclusions Incidence of periop-erative hypothermia in patients undergoing gastroenteritic operation can increase the SSI rate.Appropriate measures for protection from hypothermia can prevent the incidence of hypothermia as well as SSI.
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Objective To investigate the effect of insulation during surgery on the prognosis of hy-potherrnic trauma patients. Methods Trauma patients (80 cases) with injury severity score (ISS) of 16～40 and anal temperature < 36℃,were selected and randomly divided into the insulation group and the control group with 40 cases in each group.Both operations went along under room temperature. The in-sulation group keep anal temperature ≥ 36 ℃,while the control group received no insulation interven-tion.The palinesthesia time,time length of hospital stay,infection of wound and fatality were observed in the two groups. Results The palinesthesia time and time length of hospital stay dramatically shortened,the infection rate of Wound and fatality reduced in the insulation group compared with that of the control group (P<0.05). Conclusions Insulation during surgery can significantly shorten the palinesthesia time and time length of hospital stay,reduce the infection rate of wound and fatality.
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BACKGROUND: Neuroleptic agents are effective in treating Tourette syndrome (TS). Side effects such as acute myodystonia and oculogyric crisis as well as the risk of delayed dyskinesia have led to search for alternative therapy.OBJECTIVE: To explore the effects of metoclopramide in controlling the symptoms of TS and improving the intelligence and memory function without causing extrapyramidal side effects.DESIGN: Randomized controlled trial and blind method.SETTING: Neurological Department of Xiangya Hospital Affiliated to Central South University; Institute of Traditional Chinese Medicine of Hunan Province; Neurological Department of the First People's Hospital of Nanning City; Public Health College of Central South University.PARTICIPANTS: Fifty patients with TS came from Tic Specialty Clinic,Neurological Department of Xiangya Hospital, between January 2000 and June 2001. Patients and their family members agreed toaccept our medical treatment and reexamination on fixed dates. There were 38 males and 12 females aged 5-21 years with the mean age of (10.4±4.2) years. All of them were divided into metoclopramide group and haloperidol group with 25 in each group.METHODS: Metoclopramide and haloperidol were white tablets bottled without tag (100 tablets of white color medicine in each bottle). The two types of medicine in each bottle were marked Ⅰ or Ⅱ, respectively. The blind method (patients, their parents and evaluation blinded) was used to test the real biochemical nature of the medicine. Medicine was given by a specific doctor on regular days (2, 4, 8, 16 weeks) to patients on their revisit. The daily dose of metoclopramide for body weight was 0.5-2 mg/(kg· d) and haloperidol was 0.05 mg/(kg· d) and was assigned 3-4 times (principle of dose individuality). In addition, TS patients with severe tics in metoclopramide group would receive metoclopramide 10 mg by intramuscular injection twice a day, at the initial treatment for 2-4 days. ①Before and after treatment, TS severity of patients at weeks 2, 4, 8 and 16 was evaluated by YGTSS (the total score was 100 points; the higher the score, the more severe the condition and overall impairment). ② The clinical curative effect of the medicines was evaluated with YGTSS deduction rate before and after treatment. ③ Asberg side-effect rating score: The lower the score, the fewer and milder the side effects. ④ The cognition function was evaluated with WISC score before treatment and after 3 months of treatment. WISC consisted of language and performance components with 11 subtests, while memory scale category had 10 subtests (memory score lower than the standard indicated problem in memory function).MAIN OUTCOME MEASURES: ① Comparison of YGTSS in patients before and after treatment; ② comparison of efficacy in patients of the two groups; ③ comparison of intelligence quotient and memory quotient of patients before and after treatment; ④ adverse events and side effects.RESULTS: Totally 50 patients entered the final analysis. ① Comparison of Tourette' s syndrome in patients before and after treatment: YGTSS score in the two groups decreased significantly after treatment. The comparison of the differences suggested that metoclopramide had better curative effect than haloperidol. In metoclopramide group, YGTSS score was reduced steadily at weeks 2, 4, 8 and 16. In haloperidol group, YGTSS score was also reduced steadily at weeks 2, 8 and 16, but it was similar at week 2 and week 4. ② Comparison of efficacy in patients of the two groups: The total clinical curative effect rate was 92% (23/25) in both groups withoutany difference (P ＞ 0.05). ③ Comparison of intelligence quotient beforeand after treatment: In both metoclopramide group and haloperidol group itwas higher after treatment than before treatment (93.0±15.1, 87.0±14.6; 93.2±17.0, 87.3±13.6, t=3.43, 2.3, P ＜ 0.01). ④ Comparison of memory quo tient of patients before and after treatment: It was higher only in metoclo pramide group after treatment than before treatment (87.8±12.8, 75.8±15.5, t=3.30, P ＜ 0.01). ⑤ Score of Asberg side effects: It was lower in metoclo pramide group than in haloperidol group [(1.00±0.76), (3.24±1.40) points, t=7.05, P ＜ 0.01]. CONCLUSION: The results suggest that metoclopramide is effective in con trolling the symptoms of TS and improving intelligence and memory function. Metoclopramide causes mild side effects, but no extrapyramidal side effects.