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Objective:To assess the clinical efficacy of transabdominal preperitoneal(TAPP)repair aided by the L-shaped laparoscopic retractor in the treatment of giant inguinal hernia in the elderly.Methods:A total of 180 elderly patients with giant inguinal hernias from 2020 to 2021 were randomly divided into an observation group and a control group with 90 in each group.The observation group underwent TAPP surgery with the L-shaped laparoscopic hook-assisted exposure, and the control group underwent conventional laparoscopic TAPP surgery.Results:Operative time[(56.8±8.3)min vs.(62.5±6.9)min, t=3.509, P=0.001], intraoperative bleeding[(18.0±5.3)ml vs.(22.2±5.59)ml, t=3.698, P<0.001], time to first postoperative flatus[(17.8±1.6)h vs.(18.7±1.4)h, t=3.043, P=0.003], postoperative 2d VAS pain score[(1.3 ± 0.3)points vs.(1.6 ± 0.3)points, t=3.509, P=0.001], length of hospital stay[(2.7±0.5)d vs.(4.1±0.6)d, t=3.746, P<0.001]and incidence of complications(3.3% vs.18.9%, χ2=4.406, P=0.036)in the observation group were significantly lower than in the control group.There was no significant difference in the recurrence rate between the two groups during month 6-9 follow-up( P>0.05). After treatment, the levels of tumor necrosis factor, C-reactive protein and interleukin-6 in the observation group were more favorable than in the control Group(all P<0.05). Conclusions:L-shaped laparoscopic hook-assisted exposure in TAPP for the treatment of giant inguinal hernias in the elderly has the advantages of easy maneuver, increased exposure of the anterior bladder, shortened operative time, reduced surgical trauma, and early postoperative recovery.It is also safe and should be recommended in clinical practice.
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Objective@#To explore the risk factors of occupational exposure of intern nurses in an infectious disease hospital, and put forward prevention and control strategies.@*Methods@#A retrospective analysis was made of 82 reported cases of occupational exposure of intern nurses in a tertiary infectious disease hospital from 2013 to 2017. The occupational exposure rate, pathogens, occurrence sites and exposure links of the intern nurses were analyzed.@*Results@#The overall occupational exposure rate of internship nurses in 2013-2017 was 6.20% (82/1322) .The pathogens were mainly HBV, 52 cases, accounting for 63.4%. The site of occurrence was mainly finger, 75 cases, accounting for 91.5%. In the occurrence of the process, 35 cases were taken, accounting for 42.7%; 20 cases of arteriovenous puncture, accounting for 24.4%; 17 cases of separation needles and finishing materials, accounting for 20.7%.@*Conclusion@#The incidence of blood-borne occupation of intern nurses is higher, which needs special attention in infectious disease hospitals. To prevent blood-borne occupational exposure of intern nurses, occupational safety education should be strengthened, clinical operation should be standardized and humanized management should be provided.
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Objective@#To investigate the cause of occupational exposure among 136 nurses in a tertiary infectious disease hospital, and puts forward the prevention strategy.@*Methods@#A total of 136 nurses exposed to occupational exposure between 2014 and 2016 were included in the study. Analysis was conducted from the years of work of nurses, exposure routes, and the pathogens.@*Results@#The nurses suffer from the highest risk of occupational exposures (73.91%) .Nurses working for less than 5 years and interns are most likely to suffer occupational exposure (45.59% and 35.29% respectively) . Occupational exposure was mainly caused by needle injuries, in which infusion was the main route of occupational exposure (36.76%) . The improper treatment of needle pulling after infusion is the main link of needle puncture (36.76%) . Occupational exposure pathogens were mainly HBV (63.24%) .@*Conclusion@#Nursing staff is the high-risk group of occupational exposure. Irregular operation, lack of awareness of protection, improper disposal after the needle withdrawal and poor safety assessment of the operating environment are the main causes of occupational exposure. It is suggested to strengthen the training of occupational safety and protection, enhance clinical nurses occupational safety protection consciousness, standardize medical operation, so as to prevent the occurrence of occupational exposure.
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Objective To study the effect of nursing intervention on the catheter prolapse of the powerpPICC (high pressure injection type PICC catheter). Methods A total of 140 patients with powerpPICC were divided into observation group and control group by the catheter inserting time, with 70 cases in each group. The observation group received conventional nursing care, and the control group the targeted care measures based on analysis of catheter prolapse in the observation group. Result The rate of catheter prolapse in the observation group was significantly higher than that of the control group (P<0.05). Conclusions The prolapse of powerpPICC is related to catheter material, exposed length, fixed method, patient's compliance, catheter caring method. The care measures based on the different causes can decrease the rate of catheter prolapse and extend its duration.
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Objective To investigate the impacts of c.388A ＞ G polymorphism of the solute carrier organic anion transporter 1B1 (SLCO1B1) gene on lipid-lowering and anti-atherosclerosis effects of atorvastatin in Chinese patients with ischemic stroke.Methods The patients with ischemic stroke whose baseline low-density lipoprotein cholesterol (LDL-C) ＞ 1.8 mmol/L were enrolled prospectively.They received atorvastatin (20 mg/d) for 12 months.The lipid and bilateral carotid intima-media thickness (CIMT) were measured respectively before and after treatment.The CIMT differences between SLCO1B1 c.388A＞G genotype groups were compared.Results A total of 71 patients with ischemic stroke were enrolled,including 5 AA genotype,31 AG genotype,and 35 GG genotype.The A allele frequency was 28.9％ and the G allele frequency was 71.1％.After treatment,the total cholesterol (TC),triglyceride (TG),and LDL-C in all patients were significantly lower than those before treatment,and high-density lipoprotein cholesterol (HDL-C) was significantly increase (all P＜0.001),but CIMT did not have significant change (P=0.475).The proportion of patients whose LDL-C ＜ 1.8 mmol/L or LDL-C decreased ≥50％ in the GG genotype group was significantly higher than the AG + AA genotypes group (74.29％ vs.44.44％;x2 =6.540,P =0.011).Conclusions SLCO1B1 gene c.388A ＞ G polymorphism could influence the lipidlowering effect of atorvastatin,lipid-lowering effect in the GG genotype group was better than that in the AG+ AA genotype group.SLCO1B1 gene c.388A ＞ G polymorphism did not have effect on the antiatherosclerosis effect of atorvastatin,but it might be associated with too short follow-up time.
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Objective To evaluate the correlation between occupational exposure and work intensity of health care workers(HCWs)in an infectious diseases hospital for 5 consecutive years,and provide reference for occupational precaution.Methods Occupational exposures cases reported between January 2010 and December 2014 were ana-lyzed retrospectively,occupation types,exposure routes,and exposure sources were analyzed.Results A total of 228 cases of occupational exposure were reported,nurses and doctors were the major exposure population(75.44%and 19.30% respectively);occupational exposure mainly occurred during the infusion process(52.19%);hepatitis B was the main exposure source (71 .05%),followed by human immunodeficiency virus (10.09%).The Pearson correlation coefficient between the occupational exposure rate of doctors and the ratio of doctors to patients was-0.849 (P <0.05),and for nurses,the correlation coefficient was -0.823 (P <0.05 ).Conclusion Nurses are high risk population of occupational exposures,occupational exposure is most likely to occur during transfusion process,occupational exposure of doctors and nurses has a strong correlation with the work intensity.
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Objective To observe the feasibility and safety of dexmedetomidine used in motor evoked potentials(MEP)monitoring in patients undergoing neurosurgery.Methods Thirty ASA Ⅰ orⅡ patients,male 1 5 cases,female 1 5 cases,aged 20-60 years,weighing 40-80 kg undergoing neuro-surgery receiving MEP monitoring were randomly divided into 2 groups (n =1 5 each):control group (group C)and dexmedetomidine group (group D).In group D,dexmedetomidine 0.5 μg/kg was in-fused over 10 minutes before anesthesia induction,and then was infused at a rate of 0.5 μg·kg-1 · h-1 toward the end of operation.Group C received the equal volume of normal saline.HR,MAP and BIS were recorded at admission to the operating room (T0 ),skin incision (T1 ),when the muscle re-laxants were stopped (T2 )and 50 minutes later (T3 ).The current intensity and the time when first MEP was induced after muscle relaxant was stopped,the amplitudes and latencies of MEP on thenar muscle at T3 ,the total consumption of anesthetics,and development of adverse effects were also re-corded.Results Compared with T0 ,HR in group C at T1 ,T3 and MAP in group C at T1-T3 was in-creased,HR in group D was decreased at T2-T3 (P <0.05).Compared with group C,HR and MAP were decreased at T1-T3 in group D(P <0.05).The amount of propofol consumed and the current in-tensity inducing MEP were lower in group D than in group C (P <0.05).The amplitude of MEP at T3 was higher in group D than in group C (P <0.05).Compared with group C,the incidences of hy-pertension and tachycardia were decreased in group D,and the incidence of bradycardia was increased (P <0.05).Conclusion Dexmedetomidine used in MEP monitoring in patients undergoing neurosur-gery can meet the operation requirements,maintain hemodynamic stability,reduce the incidences of adverse reactions,and improve monitoring quality of MEP.It is a safe and feasible anesthesia method.
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Objective To study the value of serum procalcitonin(PCT) to the early diagnosis of sepsis .Methods From June 2014 to June 2015 ,a total of 686 cases were enrolled in this retrospective study .PCT tests were assayed within 2 days of bacterial culture .Results In this study ,56 cases ,67cases ,and 567cases were classified into the positive blood culture group ,positive body fluid culture group ,and negative all culture group ,respectively .Median PCT values were 4 .26 2 .78 ,0 .46 ng/mL ,respectively .Me-dian PCT values in the gram-positive bacterial culture group and gram-negative bacterial culture group ,respectively ,were 2 .35 and 4 .56 ng/mL .Median PCT values in the positive hydrothorax culture group ,positive ascites culture group ,and positive bile culture group ,respectively ,were 1 .91 ,5 .23 ,3 .64 ng/mL .In all ,Median PCT values of 47 cases of sepsis and 16 cases of severe sepsis were 5 .32 and 10 .25 ng/mL ,respectively .Conclusion PCT level is correlated with the severity of sepsis ,pathogenic bacteria type ,and the site of infection ,and can be used in the early diagnosis of sepsis .
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Objective_To investigate the effect of estrogen(E2) on different age rat groups of Parkinson’s disease (PD) models induced by Rotenone and its mechanism.Methods_24-month-old SD rats(high age group)and 12-week-age SD rats( low age group ) were divided into control group ( saline ) , Rotenone treatment group ( Rotenone 2 mg/kg), Estrogen treatment group(Rotenone 2 mg/kg and E2 1 mg/kg)and Tamoxifen treatment group(Rote-none 2 mg/kg, E2 1 mg/kg and Tamoxifen 1 mg/kg).Behavior tests were carried out to observe the change of movement function, Immunohistochemistry and Western blot were used to assess the changes of TH and LC-3. HPLC-ECD was used to detect possible changes of monoamine neurotransmitters in striatum.Results_1) Rotenone reduced significantly old age rat’s rotarod latencies and prolonged the climbing pole time(P high age rats(P<0.05), E2 partly restored TH positive cell loss, Tamoxifen reduced this effect of E2, so did the ex-pression of TH protein.3)Rotenone increased the expression of LC-3(P<0.05), E2 did not affect the expression of LC-3, so did Tamoxifen.4)Rotenone significantly decreased the level of DA and its metabolite DOPAC(P<0.05), elevated the level of 5-HT especially in old rats(P<0.05).E2 downregulated the influence, and Tamoxifen reduced the effect of E2.5)Rotenone increased the number of autophagosomes, but E2 increased the proportion of autolyso-somes/autophagosomes.Conclusions_Old age rat PD model was more reliable.Estrogen promoted autophagy ma-ture, and had obvious therapeutic effect on rat PD model induced by rotenone.
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ObjectiveTo compare the clinical efficacies of acupuncture plus TDP lamp versus acupuncture plus moxibustion in treating rheumatoid arthritis.MethodOne hundred and fifty patients were randomly allocated to treatmentand control groups, 75 cases each. The treatment group received acupuncture plus moxibustion and the control group, acupuncture plus TDP radiation.Both groups were treated for two courses. The VAS scores and the clinical sign grades and scores were compared between the two groups before and after treatment.ResultThe VAS score and the clinical sign score improved in both groups after treatment compared with before (P<0.05). The total efficacy rate was 93.3% in the treatment group and 78.7% in the control group; there was a statistically significant difference between the two groups (P<0.05). The effect was better in the treatment group than in the control group.ConclusionAcupuncture plus moxibustion is more effective than acupuncture plus TDP lamp in treating rheumatoid arthritis.
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<p><b>OBJECTIVE</b>To evaluate the impact of the biomarkers and the clinicopathological characteristics on the prognosis of malignant melanoma (MM).</p><p><b>METHODS</b>The clinical data of 127 MM cases were retrospective analyzed. The surgical specimens of MM were analyzed with immunohistochemistry for detecting HMB45, S-100 and vimentin expressions, and univariate and multivariate regression analysis was performed to analyze their correlation to the prognosis of the patients.</p><p><b>RESULTS</b>Among the 127 MM cases, the positivity rates of HMB45, S-100 and vimentin were 89.8%, 92.1% and 78.0%, respectively. Univariate analysis showed that the patients' age, ulcer, Clark classification, postoperative tumor margin, AJCC, treatment outcomes, and S-100 were significantly correlated to the prognosis, and multivariate analysis indicated that age, Clark classification, S-100, tumor margin and outcomes were the independent predictive factors for the prognosis of MM.</p><p><b>CONCLUSION</b>S-100, age, Clark classification, S-100, tumor margin and treatment outcomes were the independent prognostic factors for MM, and HMB45 and vimentin have no predictive value in the prognosis of MM.</p>
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Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Biomarcadores de Tumor , Metabolismo , Melanoma , Diagnóstico , Mortalidad , Patología , Antígenos Específicos del Melanoma , Metabolismo , Análisis Multivariante , Pronóstico , Estudios Retrospectivos , Proteínas S100 , Metabolismo , Neoplasias Cutáneas , Diagnóstico , Patología , Tasa de Supervivencia , Vimentina , MetabolismoRESUMEN
The paper reviewed the research cooperation on public health between China and US in 30 years since the establishment of Sino-US diplomatic relation, based on the project database of Peking University, and made out the comments on the benefits, shortages and expectation in future cooperation.
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Objective: To observe the effect of acupuncture plus LONG's manual manipulations on the functional improvement of the patients with lumbar intervertebral disc protrusion. Methods: 60 cases of the patients were randomly divided into a observation group and a control group, 30 cases in each group. The observation group was treated with acupuncture plus LONG's manual manipulations, and the control group was treated with single acupuncture. The functions of the lumber vertebrae were processed in accordance with the assessment system of Japanese Orthopedic Association (JOA), and the therapeutic effects were assessed by Visual Analog Scale (VAS). Results: After the treatments, the differences in JOA and improvement indexes were statistically significant (P＜0.05) between the two groups. VAS was decreased much remarkably in the observation group (P＜0.01) than before the treatments and decreased remarkably in the control group (P＜0.05) than before the treatments. There was a remarkable difference in VAS between the two groups after the treatments (P＜0.05).Conclusion: Acupuncture plus LONG's manual manipulations are better than single acupuncture in improving the functions of the patients with lumbar intervertebral disc protrusion.
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Based on the findings of the past five decades, the seasonal regularity of respiratory disease was summed leading to respiratory tract diseases were summed up.
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Objective:To explore the relationship between the polymorphisms in gene FGFR1, FGF10, FGFI8 and the nonsyndromic cleft lip with or without cleft palate (NS CLP) in Chinese population. Methods: Genomic DNA was isolated from peripheral lymphocytes of 75 patients with NS CLP and their parents and 75 unimpaired healthy children. The polymorphisms in FGFRI gene rs13317, p. E467K, p. M3691 and p. S393S, FGF10 gene rs1448037 and FGFI8 gene rs4043716 were detected by applying three-dimensional (3-D) polyacrylamide gel microarray technology. The data were performed using statis-tical analysis : the genotype frequenc+ y and allele frequency between patients with NSCL/P and control subjects were performed. Haplotype relative risk (HRR) , family based association test (FBAT) , and transmission disequilibrium test (TDT) in nuclear family were performed. Results: There were no poly-morphism in FGFR1 gene p. E467K, p. M369I and p. $393S site, the corresponding base was all G. The polymorphisms of rs13317 and rs1448037 were detected and their genotype frequency and allele frequen-cy showed no significant difference between 75 patients with NSCL/P and 75 normal children. TDT, HRR and FBAT were also no significant differences. The genotype frequency of gene FGF18 rs4043716 showed significant difference, but allele frequency were no significant difference. TDT, HRR and FBAT were also no significant difference. Conclusion: Our studies suggest an association between gene FGF18 rs4043716 and the NS CLP in Chinese population, and no association among gene FGFR1 rs13317, p. FA67K, p. M3691, p. S393S and gene FGF10 rs1448037.
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The preventive theory of traditional Chinese medicine means treating before occurrence or transference of diseases, which guides the modern health work. This paper analyses some health problem of citizens, proposes the solution and suggestion. Treating before occurrence or transference of diseases should not only be a medical ideal and the true approach is to strengthen system health education to citizens, especially all the students in school.
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BACKGROUND: The attack of temporal epilepsy is associated with the loss and death of hippocampal neurons, in which the specific pattern and mechanism of the loss of hippocampal neurons are still unclear, and it is hard to make sure the inevitable association of the epileptic discharge with activation of cysteine-containing ASPartate-specific protease (caspase 3)and neuronal apoptosis, of hippocampal neurons.OBJECTIVE: To observe the neuronal apoptosis and caspase 3 gene expression of in vitro cultured rat hippocampal neurons of epilepsy models.DESIGN: An open experiment.SETTINGS: Department of Neurosurgery, Changhai Hospital, the Second Military Medical University of Chinese PLA; Department of Neurosurgery,Changzheng Hospital, the University.MATERIALS: The experiments were carried out in the Neurosurgery Laboratory of the Second Military Medical University of Chinese PLA from June 2002 to June 2003. Ten male or female SD rats with 24 hours after birth were used. The Caspase 3 flow detection kit was purchased from American BD Company, and polymerase chain reaction (PCR) primers were synthetized by Shanghai Haojia Company.METHODS: ① The SD rats within 24 hours after birth were killed by cutting down the head to remove the brain, then bilateral hippocampi were taken out, and hippocanpal neuron models of epileptic discharge were established. The discharge of the models was recorded with whole cell patch clamp technique. The neurons cultured for 8 days and treated with Mg-free medium were taken as epileptic discharge model group, and those cultured for 8 days but not treated with Mg-free medium were taken as the blank control group, and the changes of potentials were recorded. ② The fulllength cDNA of caspase 3 was cloned with reverse transcription-polymerase chain reaction (RT-PCR), and then it was labeled. The expression of caspase 3 gene and neuronal apoptosis were detected with in situ hybridization and flow cytometry.MAIN OUTCOME MEASURES: ① Results of cDNA cloning of caspase 3; ② Results of Caspase 3 in situ hybridization; ③ Results of apoptosis.RESULTS: ① The products amplified by RT-PCR showed DNA segment lanes of about 800 bp after treated with 12 g/L agarose gel electrophoresis (Figure 1), which was concordant with the predicted value. The detection of DNA sequence showed that the length of the obtained cloning open-reading frame was 843 bp. ② The hybridization showed that in the blank control group, the positively stained hippocampal neurons were less than 10%, the neurites were well-stacked, and formed extensive synaptic association; In the epileptic discharge model group, the positively stained neurons were obviously increased at 3 hours after the Mg-free treatment, and there were many strongly and positively stained neurons at 12 hours, all these neurons kept the neurites, which became little. ③ The flow cytometry showed that at 6 hours after the Mg-free treatment, the apoptotic cells began to increase obviously, the numbers of apoptotic cells in certain times were not the same.CONCLUSION: Epileptic discharge can trigger the caspase 3 gene expression, by which neuronal apoptosis is induced.
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Objective To evaluate the effects of adenovirus mediated gene transfer of TIMP 2 and PTEN on invasion of human U87 glioma cells in vitro . Methods U87 cells were transinfected with AdTIMP 2 and AdPTEN in vitro . The mRNA and protein expressions of TIMP 2 and PTEN were detected with RT PCR and Western blotting, respectively. The relative activity of MMP 2 and MMP 9 was determined by gelatin zymogram, and invasion of U87 in vitro was observed using Boyden chamber. Results Gene and protein expressions of PTEN and TIMP 2 were shown to be up regulated when U87 was transinfected with AdPTEN and AdTIMP 2. The number of invasion cells of U87 infected with AdX gal, AdPTEN, AdTIMP 2 and PTEN+TIMP 2 was 55 64 13 27, 48 26 14 75, 35 27 10 94, 27 38 12 81, and 19 16 5 45, respectively. In vitro invasion of glioma cells was significantly inhibited after infected with AdTIMP 2 and/or AdPTEN, while the inhibition effect was more remarkable in the combined group than that in single group, and it was not consistent with the change in MMPs activity. Conclusion These results imply that combined TIMP 2 and PTEN gene therapy mediated by adenorirus may be useful for anti invasion therapy of malignant glioma
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Objective To explore the effects of hyperlipidemia on serum levels of matrix metalloproteinase-9(MMP-9) and C-reactive protein(CRP) in the patients with cerebral infarction(CI).Methods Testing the serum levels of MMP-9,CRP and triglyceride(TG) in 36 CI patients [with high level TG(n=18) and with normal TG(n=18)] and 17 normal controls(NC group).The relationship among the serum levels of MMP-9,CRP and TG were analysed.Results The contents of MMP-9,CRP and TG were significantly higher in CI patients with high level TG group than those in normal level TG group and NC group(all P
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Objective To study the optimal time of MRI follow-up after transsphenoidal surgery in patients with nonfunctional pituitary macroadenoma. Methods MRI records of 50 patients before surgery,within 1 postoperative week (early stage),at 3 months (intermediate stage) and 1 year after surgery (late stage),respectively,were retrospectively analyzed.Dynamic changes in the sella turcica were observed and the degrees of tumor excision were studied before and after MRI T 1-weighted enhanced scans at different postoperative stages. Results In the early stage MRI images showed that the size of sellar contents decreased by 8%～32%,tumor disappeared in 22 cases,and suspected residual tumor was found in 28 cases.At 3 months after surgery,MRI scans revealed that sellar contents decreased by 11%～85% in size.On coronal position MRI scans,the size of sellar contents decreased more than 50% in 11 cases,30%～50% in 9 cases,less than 30% in 8 cases.Out of the 28 cases that were suspected of residual tumor in the early stage,confirmation of residual tumor in the sella turcica was made in 23 cases.MRI findings 1 year after surgery showed no change in the sella turcica in 46 cases and continuing to decrease in 4 cases. Conclusions Re-examination of MRI in intermediate stage after transsphenoidal surgery in patients with nonfunctional pituitary macroadenoma facilitates the detection of residual tumor and recurrence.