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By reviewing the development context of medical social work in Shanghai, this paper summarized the practical experience in the development process of medical social work in Shanghai, and provided summary and suggestions for the long-term healthy development of medical social work from four aspects that basic path, key guarantee, important boost, and social image. It is suggested to carry out interdisciplinary cooperation and deepen patient service to build harmonious doctor-patient relationships, pay attention to talent training and improve institutional mechanisms to promote the stability of talent team, develop continuing education and meet different needs to upgrade modern service levels, emphasize brand building and carry out cooperation and co-construction to continuously expand social influence.
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Objective:To explore the effect of changes in BMI (ΔBMI) on left ventricular function in early breast cancer patients undergoing anthracycline chemotherapy.Methods:The clinical data of 170 breast cancer patients treated in the Lianyungang Oriental Hospital from January 2018 to October 2021 were retrospectively analyzed. The clinicopathological data and cardiac color doppler ultrasound examination results of the patients were collected. Single-factor and multiple-factor were used to analyze the risk factors of cardiotoxicity in patients after chemotherapy. ΔBMI was calculated and the receiver operating characteristic (ROC) curve was drawn; the cut-off value of the ΔBMI was measured to obtain the diagnostic accuracy.Results:Compared with before chemotherapy, the mean values of BMI, left ventricular end-diastolic volume (EDV), left ventricular end-systolic volume (ESV), left ventricular end-diastolic diameter (LVD), and left ventricular end-systolic diameter (LVS) were increased after chemotherapy, while left ventricular ejection fraction (LVEF) value was decreased. Before and after chemotherapy, the differences between BMI [(22.30±1.88) kg/m 2 vs. (23.59±2.32) kg/m 2] and LVEF [(63.69±4.69)% vs. (59.08±4.28)%] were statistically significant ( t = 3.40 and 4.98, all P < 0.05). The range of ΔBMI was 0-41.3%, and the range of the change of LVEF (ΔLVEF) was 0-15.9%. There was a significant correlation between ΔLVEF and ΔBMI ( r = 0.709, P < 0.001). The incidence of cardiotoxicity was 21.2% (36/170). Logistic regression analysis showed that BMI( OR = 1.639, 95% CI 1.263-2.127, P = 0.000) and ΔBMI ( OR = 1.147, 95% CI 1.071-1.228, P = 0.000) were independent risk factors for cardiotoxicity in early breast cancer patients undergoing anthracycline chemotherapy. According to the cardiotoxicity, the area under the ROC curve of ΔBMI and BMI was 0.757 and 0.687, respectively. When the ΔBMI value was 4.28%, the maximum Youden index was 0.399, the sensitivity was 0.750, and the specificity was 0.649. Conclusion:For breast cancer patients treated with anthracycline chemotherapy, ΔBMI can be used as an effective indicator for predicting cardiotoxicity; when ΔBMI exceeds 4.28%, the risk of cardiotoxicity is high.
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Objective:To investigate the clinical value of zoledronic acid in improving the prognosis of osteoporotic hip fracture and preventing its sequential contralateral hip fracture.Methods:A retrospective study of 206 patients diagnosed with hip fragile fractures in China Medical University Affiliated Shengjing Hospital and treated with anti-osteoporotic drugs after surgery was conducted. The prognosis of patients with hip fracture using survival rate analysis and the risk factors of acute febrile complications with multivariate analysis after zoledronic acid treatment were evaluated. Furthermore, chi-square test and multivariate analysis was used to explore whether zoledronic acid decreases the occurrence of the contralateral sequential fracture.Results:The 3-year survival rate of patients with overall hip fracture was higher in zoledronic acid treatment group compared with control group( P=0.026), with the incidence of fever at 53.3%. The age [ OR=0.786, P=0.027, the area under receiver operating characteristic (ROC) curve was 0.724] and cardiopulmonary complications ( OR=0.043, P=0.025, the area under ROC curve was 0.628) were significantly correlated with the occurrence of acute febrile response. The incidence of sequential contralateral fractures in zoledronic acid treatment group was significantly lower than that in control group ( χ2=4.356, P=0.037). The application of zoledronic acid ( OR=0.160, P=0.007, the area under ROC curve is 0.586) and the type of femoral neck fracture ( OR=0.196, P=0.001, the area under ROC curve is 0.607) were statistically associated with the occurrence of sequential fractures. Conclusion:Zoledronic acid treatment improves the outcome of patients with osteoporotic hip fracture and reduces the incidence of sequential hip fractures, especially femoral neck fracture. Senile age and cardiopulmonary complications might be associated with lower risk of acute febrile reactions after zoledronic acid treatment.
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Objective:To explore the risk factors affecting central lymph node metastasis in cN0 isthmus papillary thyroid carcinoma and the significance and feasibility of preventive dissection, so as to provide reference for clinical treatment.Methods:The clinical data of 108 patients with cN0 stage isthmus papillary thyroid cancer who underwent surgery in the General Surgery Department of Lianyungang Oriental Hospital from January 2014 to December 2021 were retrospectively analyzed. There were 32 males and 76 females, with an age range of 24 to 70 years, with a mean age of (46.0±12.7) years. Statistical analysis was performed using the SPSS 22.0 statistical software. Chi-square test and logistic regression were used to analyze the relationship between central lymph node metastasis and patients Relationship between clinical case factors.Explore the feasibility of preventive cleaning.Results:The positive rate of lymph node metastasis in central region of isthmic papillary thyroid carcinoma was 37.9% (41/108). Univariate analysis showed that central lymph node metastasis was associated with tumor diameter ( χ2=5.36, P=0.021), capsular infiltration ( χ2=7.69, P=0.006), and elevated thyroglobulin ( χ2=7.73, P=0.005). Multivariate analysis showed that capsular infiltration ( HR=2.75, P=0.037) and tumor diameter ( HR=4.454, P=0.004) were independent risk factors for central lymph node metastasis. The ROC curve of tumor diameter to predict central lymph node metastasis was drawn, and the AUC value of the area under the curve was calculated to be 0.720. When the diameter was 0.695 cm, the Youden index was 0.326, the sensitivity was 0.878, and the specificity was 0.448. 6 cases (5.56%) had temporary recurrent laryngeal nerve palsy, 13 cases (12.04%) had temporary hypoparathyroidism, no permanent complications occurred. Conclusions:cN0 stage PTCI has the risk of early occult lymph node metastasis. Prophylactic CLND can clarify the stage of the tumor, assess the risk, and guide the follow-up treatment of patients. CLND should be routinely performed for patients with tumor diameter >0.695 cm and capsular invasion.
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Bladder has many important functions as a urine storage and voiding organ. Bladder injury caused by various pathological factors may need bladder reconstruction. Currently the standard procedure for bladder reconstruction is gastrointestinal replacement. However, due to the significant difference in their structure and function, intestinal segment replacement may lead to complications such as hematuria, dysuria, calculi and tumor. With the recent advance in tissue engineering and regenerative medicine, new techniques have emerged for the repair of bladder defects. This paper reviews the recent progress in three aspects of urinary bladder tissue engineering, i.e., seeding cells, scaffolds and growth factors.
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Humanos , Péptidos y Proteínas de Señalización Intercelular , Medicina Regenerativa , Ingeniería de Tejidos , Andamios del Tejido , Vejiga UrinariaRESUMEN
Objective To investigate the effects of moderate-to-vigorous intensity physical activity (MVPA) in early pregnancy on the onset of gestational diabetes mellitus (GDM) in Sichuan Province. Methods A case-control study was performed on 1 508 gravidas at 8-14 gestational weeks in Sichuan Provincial Hospital for Women and Children from February to July, 2017. Baseline information during early pregnancy was collected through questionnaires. Information on time and intensity of physical activity were collected through pregnancy physical activity questionnaire. The time spent in MVPA was calculated and was categorized as active ( ≥ 3.5 h/week) or inactive MVPA (<3.5 h/week). Based on self-reported pre-pregnancy weights collected by questionnaire as well as the measured heights, body mass index (BMI) before pregnancy was calculated. After a 75 g oral glucose tolerance test (OGTT) at 24-28 gestational weeks, all subjects were divided into GDM (n=561) or non-GDM group (n=947), according to the GDM diagnostic criteria of the Guidelines for the Diagnosis and Treatment of Pregnancy Diabetes in China (2014). Mann-Whitney U test and Chi-square test were used for statistical analysis. Multivariate unconditional logistic regression model was used to analyze the association between the time of MVPA in early pregnancy and GDM incidence. ResuLts The median time spent in MVPA [M(P25-P75)] in early pregnancy was 3.00 (0.50-3.12) h/week, and 345 gravidas (22.9%) were classified as active in MVPA. After the control of confounding factors such as age, gravidity and parity history, and pre-pregnancy BMI, the multivariate unconditional logistic regression analysis showed that compared with the inactive group, the risk of GDM of active MVPA gravidas was reduced by 26.1% (OR=0.739, 95%CI: 0.553-0.989, P=0.042). Among primigravidas and primiparae, the risk of GDM in active MVPA gravidas was decreased by 47.6% and 44.3% than the inactive ones, respectively (primigravidas: OR=0.524, 95%CI: 0.297-0.925, P=0.026; primiparae: OR=0.557, 95%CI: 0.357-0.868, P=0.010). ConcLusions Insufficient physical activity in early pregnancy is common in gravidas in Sichuan, China. The risk of GDM could be reduced if the frequency of MVPA during early pregnancy is no less than 3.5 h/week, especially in primigravidas and primiparae.
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Objective To explore the association between gestational weight gain (GWG) and adverse pregnancy outcomes.Methods A prospective study was conducted among 1 220 healthy singleton pregnant women in the first trimester of pregnancy,from Chengdu city,Sichuan province.Pre-gestational body mass and other basic information were collected through a set of questionnaires.Weight at the last week before delivery was measured and GWG was classified by IOM criteria (2009).Related information on pregnancy outcomes was collected after delivery,through the hospital information system.Multiple non-conditional logistic regression models were used to test the association between GWG and adverse pregnancy outcomes.Results In total,data on 1 045 pregnant women were analyzed.Compared with adequate GWG,excessive GWG was associated with the increased risks of cord entanglement and large for gestational age (OR=1.641,95％CI:1.197-2.252;OR=1.678,95％ CI:0.132-2.488),respectively.Additionally,when compared with the adequate GWG,insufficient GWG was associated with the increased risk of preterm delivery (OR=3.189,95％CI:1.604-6.341).Conclusions Both excessive and insufficient GWG appeared associated with the pregnancy outcomes.Weight monitoring should be strengthened for pregnant women to reduce related risks on adverse pregnancy outcomes.
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Objective To explore the association between gestational weight gain (GWG) and adverse pregnancy outcomes.Methods A prospective study was conducted among 1 220 healthy singleton pregnant women in the first trimester of pregnancy,from Chengdu city,Sichuan province.Pre-gestational body mass and other basic information were collected through a set of questionnaires.Weight at the last week before delivery was measured and GWG was classified by IOM criteria (2009).Related information on pregnancy outcomes was collected after delivery,through the hospital information system.Multiple non-conditional logistic regression models were used to test the association between GWG and adverse pregnancy outcomes.Results In total,data on 1 045 pregnant women were analyzed.Compared with adequate GWG,excessive GWG was associated with the increased risks of cord entanglement and large for gestational age (OR=1.641,95％CI:1.197-2.252;OR=1.678,95％ CI:0.132-2.488),respectively.Additionally,when compared with the adequate GWG,insufficient GWG was associated with the increased risk of preterm delivery (OR=3.189,95％CI:1.604-6.341).Conclusions Both excessive and insufficient GWG appeared associated with the pregnancy outcomes.Weight monitoring should be strengthened for pregnant women to reduce related risks on adverse pregnancy outcomes.
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Innovative self-efficacy is the degree of self-confidence in the individual's ability to per-form innovative activities. Although the theory of innovation self-efficacy is shorter, but as an important indicator of innovation ability measurement, it has been accepted by scholars in various countries, and innovative self-efficacy provides a new perspective for the cultivation of innovative talents. The research of innovation self-efficacy is still the initial stage. Chinese and foreign scholars have made some progress in measuring tools, antecedents, aftereffect and development, but there are still obvious differences and defi-ciencies,and the research results are not abundant.The future research will focus on the measurement tools, influencing factors and research direction of three aspects of systematic research to improve the theory of innovation self-efficacy.
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Death with dignity is now not legislation in our country .This paper mainly discussed about some barriers to the legalization of death with dignity in China , from the viewpoint of Chinese traditional ideas , the lack of death education , risk of abusing , the subject change of the informed consent right , doctor-patient communica-tion and trust lsot and so on .It is proposed that our country should perfect the medical security system , strengthen the education of death at the same time and help the citizen set up the view of science .Outside, still need to fur-ther deepen the reform of medical system in our country , the maintaining patient ’ s autonomy and right of choosing , protect the informed consent right of patients .Create the doctor-patient relationship of mutual trust .