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Objective:Exploring the risk factors of recurrent laryngeal nerve injury in thyroid surgery.Methods:The hundred and sixteen patients undergoing secondary thyroid surgery from January 2016 to January 2019 were selected in the general surgery department of the First Affiliated Hospital of Harbin Medical University. The patients were divided into an injury group ( n=20) and a control group ( n=296) according to whether the recurrent laryngeal nerve injury occurred after the secondary operation. SPSS 23.0 was used to perform univariate analysis and multivariate regression analysis. Results:The total injury rate of recurrent laryngeal nerve in secondary thyroid surgery was 6.33% (20/316). In the univariate analysis, the size of the thyroid, the first operation, the interval between two operations, the tumor aggressiveness, the secondary operation, and whether nerve monitoringa were statistically significant in the injury group and the control group( χ2=1.495, 1.503, 1.628, 1.299, 1.938, 1.262, P<0.05). Logistic regression analysis showed that the size of the thyroid gland ( OR=4.962, P=0.001), the first operation ( OR=12.296, P=0.002), the interval between two operations ( OR=3.590, P=0.025) and the secondary operation ( OR=2.319, P=0.002) were an independent risk factors for recurrent laryngeal nerve injury in secondary thyroid surgery. Conclusions:Secondary thyroid surgery is more likely to cause recurrent laryngeal nerve damage. For the thyroid disease with a high risk of recurrence, total thyroidectomy should be selected for the first surgery to to avoid the risk of complications caused by secondary surgery; For some complicated secondary surgery patients, the use of recurrent laryngeal nerve monitoring technology during operation can minimize the recurrent laryngeal nerve injury and improve the patient′s postoperative quality of life.
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Objective To propose on and improve direct settlements by medical insurance offices and hospital systems in their processing of medical treatment in allopatry (MTA), by analyzing such data as the homepages of medical records of such inpatients at a tertiary cancer hospital with their medical expenses settled directly. Methods Data of 6 379 MTA inpatients with direct settlements of in-hospital fees from April 2017 to March 2018 were included in this study. Such data were used to identify the change trend of their case counts and their regional distribution, and analyzed with hierarchical clustering to calculate the settlement counts of various provinces. Results Analyses found that the total cases of such patients remained stable at the hospital, yet the cases of direct settlement rose from five to 1 263, and the proportion of direct settlement among all MTA inpatients rose month by month from 0.14% to 29.26%. Most of MTA inpatients come from Hebei, Shandong, Inner Mongolia and Shanxi provinces in turn, yet the direct settlement counts and hospitalization case trends appear different. Clustering results indicate Hebei as the type-1 province with the highest proportion of direct settlement inpatients, accounting for 30. 41% ;Shandong, Inner Mongolia and Shanxi as the type-2 provinces, accounting for 15. 05% , 13. 45% and 11.00% respectively; Liaoning, Henan and Heilongjiang as the type-3 provinces, accounting for 6.79% , 4.81% and 4.42% respectively; while the rest provinces as the type-4, accounting for less than 3%. Conclusions Regional distribution varies distinctively among such inpatients, and the number of these inpatients keeps rising stably. In such circumstances, hospitals are recommended to enhance their management in strengthening medical insurance audit systems, speeding up settlement, and building regional medical alliances.
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Objective To investigate the impact of applying patient-centered care concept on easing the negative moods among the parents of the neonates hospitalized in NICU.Methods The parents of neonates (76 people) hospitalized in NICU from March to May in 2012 were selected as the control group,they conducted normal nursing.The parents of neonates hospitalized in NICU during June and August in 2012 were named as the observation group (81 people).In addition to the normal nursing,they were given nursing intervention according to patient-centered care concept.The anxiety and depression moods of the two groups was analyzed.Results Before the patient-centered care concept intervention,there was no statistical difference of SAS,SDS scores for both groups.For the observation group,the SAS,SDS scores after intervention were significantly lower than those before the intervention.While for the control group,there was no statistical difference of SAS,SDS scores.After intervention,the SAS、SDS scores of the observation group were significantly lower than those of the control group,and the difference was statistically significant.Conclusions The negative moods of the parents of hospitalized neonates can be eased significantly by applying patient-centered care concept intervention.
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@#Objective To investigate the knowledge, attitude and behavior related to stroke and rehabilitation in the stroke patients and their relatives. Methods Questionnaires were performed in 60 stroke patients and 100 relatives. Results 71.7% patients knew "what is stroke". 40% knew "hypertension is the most risk factors of stroke". 45% patients and 41% relatives knew that the risk factors for stroke were hypertension, diabetes, hyperlipidemia, smoking and drinking. 35% patients and 29% relatives learned that the prevention of stroke should start being young. 50% patients did not understand post-stroke rehabilitation. Patients learned some to limit their smoking, alcohol, salt intake and alter their personality. More than 80% relatives wished to help the patients abstain smoking, limit fat and salt. 55% patients agreed to control the blood pressure. About 40% patients or their families did not know it was necessary to monitor the blood pressure and lipid, 70% relatives would help the patient exercise. Less than 50% patients began to treat their hypertension, heart disease and diabetes. 40% accepted low-fat diet and regular exercise. 35% measured their blood pressure and lipid regularly, or go to the hospital for the medical examination. Conclusion At present, the knowledge, attitude and behavior related to stroke and rehabilitation in stroke patients and their relatives need to be improved.
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BACKGROUND: There is an intimate temporal and spatial relationship between growth of primitive cardiac cells, septum transversum mesenchyme and liver development. The signal from primitive cardiac cells and septum transversum mesenchyme induces the ventral foregut endoderm cells specialize toward hepatocytes. While the septum transversum mesenchyme provides a suitable environment for forming the liver bud and promoting the growth and differentiation. However, the molecular mechanism of this induction is not yet delineated.OBJECTIVE: Using alpha-fetal protein (AFP), c-Met and cytokeratin (CK) 19 as markers of hepatic stem cells, the growth of early human embryo of 3-5 weeks and morphologic characteristic of hepatic stem cells were observed to demonstrate the characteristic and factors that affected the proliferation and differentiation of hepatic stem cell, which provided experimental evidence for basic research and clinical application of hepatic stem cells.DESIGN: An opening experiment was designed.SETTING: Department of Anatomy, Weifang Medical College.MATERIALS: The experiment was carried out at the Scientific Research Center of Chengdu Medical College between September 2004 and January 2005. Twenty cases fresh human embryos aged less than 2 months were collected with signed agreements of the pregnant women suffering from pregnancy termination with mifepristone. The samples were fixed with 40 g/L polymerisatum in 20 minutes and embedded routinely in paraffin, and then 5 μm thick series sections were continuously made. After hematoxylin-eosin staining, the embryonicage was determined under the microscope according to the length of embryos, the number of somites and the development of organs, which was referring to the Jirasek's staging standard of human embryo.METHODS: The immunohistochemical staining was conducted with SABC method on one of every ten sections, which were incubated overnight at 4 ℃ with polyclonal antibodies against hepatocyte growth factor (HGF),c-Met, insulin-like growth factor (IGF-Ⅰ), IGF-Ⅰ receptor (IGF-IR), transforming growth factor (TGFβ1), TGFβR1, TGFβR2 or monoclonal antibodies against proliferating cell nuclear antigen (PCNA), AFP and CK19.The following day, the sections were incubated for 2 hours at room temperature with biotinylated anti-mouse or anti-rabbit IgG and SABC liquid respectively, and then diaminobenzidine (DAB) was used to color them. The negative control was conducted with the phosphate buffer, then the sections were observed and photographed under light microscope.MAIN OUTCOME MEASUERS: ①the morphologic characteristic of human hepatic stem cells and immunohistochemical staining of markers②the expression of HGF, IGF-Ⅰ, TGFβ1 and their receptors on human embryonic livers of 3-5 weeks, primitive cardiac cells and septum transversum mesenchyme.RESULTS: ①The morphologic characteristic of human hepatic stem cells and immunohistochemical staining of markers: The hepatic bud formed at the end of 3rd week and migrated into the septum transversum mesenchyme to form the hepatic cords at the 4th week. The cells structuring the hepatic cords displayed the typical characteristic of immature cells. At the 5th week, the number of cells within the hepatic cords, the size of cell body,the cytoplasmic acidophilia all increased, whereas the basophilia of nuclei decreased. However the cellular forms were still homogeneous and displayed the typical characteristic of immature cells. The cells of hepatic cords were negative for PCNA response during 3rd-4th week but began to express positive at the 5th week, mainly in the nucleus and minority cellular cytoplasm showed weak positive. Most hepatic cells during 3rd-5th weeks were positive for AFP, c-Met and negative for CK19. The immunologic reaction depositors of AFP positive cells were located in the nuclei, cytoplasm and membrane of the hepatocytes, and c-Met presented mainly in the nuclei and the positive signal was weak in the cytoplasm. ②Expressions of HGF, IGF-Ⅰ, TGFβ1 and their receptors in the embryonic human liver, primitive heart and septum transversum mesenchyme: At the 4th week,the c-Met expressed only in all hepatocytes, whereas the other growth factors and their receptors were undetectable. At the 5th week, all the growth factors, except HGF, were expressed in the hepatocytes. The immunologic reaction depositors of TGFβ1, TGFβ1R1 and TGFβ1R2 were located in the cytoplasm and cell membrane. The positive response of IGF-Ⅰ and IGF-IR were present at nuclei, cytoplasm and cell membrane. At the 3rd-5th week, myocardial cells surrounding liver bud or hepatic cord and the septum transversum mesenchyme were positive for HGF, TGFβ1 and IGF-Ⅰ,with the signals were aggregated mainly in cytoplasm and minority nucei.CONCLUSION: ①It was at the end of 3rd week that part of endoderm cells in foregut ventral were specialized to hepatic stem cells. ②The undifferentiated hepatic stem cells could be drawn to develop to the liver stem cells with bi-directional differentiation potentials by using specific markers for studying human embryonic liver stem cells. According to the corresponding relation of embryonic age between human and rats, the time studying the rat hepatic stem cells could be calculated. ③HGF, IGF-Ⅰ,TGFβ1 and their receptors promoted the early development of human embryonic liver.
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@#ObjectiveTo observe the therapeutic efficacy of early acupoint stimulation and physical therapy on patients with cerebral infarction.Methods100 cases of cerebral infarction were divided randomly into the treatment group A (n=50), treatment group B (n=50) and other 50 cases were selected as the control group. The treatment group A received physical therapy, the treatment group B received acupoint stimulation and physical therapy, the control group only received routine therapy. Fugl-Meyer assessment (FMA) and Barthel index (BI) were used to assess physical function and activities of daily living (ADL) at pre-therapy and 3 months post-therapy respectively.ResultsThe scores of FMA and BI in three groups were similar at pre-therapy stage (P>0.05). The treatment groups showed much higher scores of FMA and BI than those in the control group after 3 months' follow-up (P<0.05), so were the scores in treatment group B compared with the scores in treatment group A.ConclusionEarly rehabilitation is much more effective, the therapeutic efficacy of acupoint stimulation and physical therapy is better than single physical therapy.
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To study the morphological characteristics of hepatic stem cells and the expression of HGF, IGF-I, TGFbeta1 and their receptors in human embryonic livers at 3-5 weeks of gestation. The SABC immunohistochemical method with HE counterstaining was employed. We found that the hepatic bud formed at the end of the 3rd week. At the 4th week, the cells of hepatic bud migrated into the septum transversum mesenchyme and formed the hepatic cords. The hepatic cells at 3-4 weeks displayed the typical characteristics of immature cells: small size, a round or ovoid nucleus with dark color, scant cytoplasm with slight blue and a high ratio of nuclei/cytoplasm. They were positive for alpha-Fetoprotein (AFP), c-Met and negative for cytokertin 19 (CK19), and proliferating cell nuclear antigen (PCNA). At the 5th week, compared to those at the 4th week, the number of cells within the hepatic cords increased. But the cells at the 5th week were homogeneous and displayed the typical characteristic of immature cells. Those cells began to express PCNA at the 5th week. The hepatic cells at the 5th week were positive for insulin-like growth factor I (IGF-I), transforming growth factor beta1 (TGFbeta1) and their receptors, and were negative for hepatocyte growth factor (HGF), while HGF were positive in the cardiac cells and septum transversum mesenchyme. The results indicated that the cells of hepatic bud and cords were the hepatic stem cells. The difference of morphology and proteins expression at 3-5 weeks of gestation inferred that those stem cells belong to different developmental stage. AFP and c-Met were the markers of hepatic stem cells at the early stage of human embryo. HGF, IGF-I, TGFbeta1 and their receptors may involve in regulating the development of early embryonic human liver.
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Humanos , Embrião de Mamíferos , Idade Gestacional , Fator de Crescimento de Hepatócito , Genética , Fator de Crescimento Insulin-Like I , Genética , Fígado , Biologia Celular , Metabolismo , Proteínas Proto-Oncogênicas c-met , Genética , Receptor IGF Tipo 1 , Genética , Células-Tronco , Biologia Celular , Fator de Crescimento Transformador beta , Genética , Fator de Crescimento Transformador beta1RESUMO
Purpose To study the proteins expression of genes related to apoptosis of retinal cells in development of human fetus． Methods Fifty cases of retinas of human fetus aged from 12 to 38 weeks were collected and paraffin embedded sections were made． Immunohistochemical method was used． Results Fas protein was expressed by cells of ganglion cell layer, inner and outer nuclear later, which were just formed on 16th week． It was not expressed until 38th week, Fas(+) staining appeared in layers of retina． Fas-L(+) staining was detected in cells of layers of retina on 26th week and the positive staining located in ganglion cell layer on 32th week． Neuronal fiber layer was Fas-L positive． Bax positive staining was detected on 8th week． Bax positive nucleus were observed mainly in GCL and ONL on 16th week． It was in INL on 24th week and in Müller cells inner terminates on 26th week． After this time, all cells of retina were bax immune negative staining． Bcl-2(+) staining appeared in differentiating neuroblastic layer on 16th week． Beginning on 24th week, bcl-2 (+) staining was observed in glial cells of GCL and inner terminates of Müller cell． Conclusion Apoptosis of developing retinal cell may be Fas/Fas-L independent and bax may be involved in apoptosis of the cells．
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Objective To study the distribution of insulin-like Growth Factors (IGFs) in liver、 spleen、kidney、thymus and supraadrenal glands of fetus from 16 to 24 weeks.Method Using ABC immunohistochemistry. Results IGF-I positive cells were found in these organs during this period of fetal life, but the differences of number and reaction intensity of IGF-I positive cells appeared in different organs and individuals.Conclusion These organs tissues can express IGF-I during fetal development and play paracrine and/or autocrine role in cellular proliferation and differentiation of these fetal tissue.
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Objective To investigate the expression of interleukin-18(IL-18) and signal transducers and activators of transcription 5(STAT5)in retina of 4-24-week-old diabetic rats, and explore the potential molecular mechanisms involved in diabetic retinopathy (DR). Methods Retinal gene expression profile of healthy and 8-week-old diabetic rats was established with restriction fragment differential display-polymerase chained reaction (RFDD-PCR), and the differences was analyzed by bioinformatics. IL-18 and STAT5 were filtrated as the candidate genes of DR. The expression of IL-18 and STAT5 in retina of diabetic rats with the age of 4, 8, and 24 weeks was observed by semi-quantitative reverse transcriptase-polymerase chain reaction(RT-PCR). Results The result of RFDD-PCR showed:expression of IL-18 was higher in healthy retina than that in diabetic one; expression of STAT5 was not found in healthy rats but in diabetic ones. The result of RT-PCR showed:compared with the normal, high expression of IL-18 was found in 4-week diabetic retina, reduced in 8-week one, and decreased to the lowest in 24-week one. The expression of STAT5 was not observed in healthy or 4-week diabetic retina, but occurred in 8-week one, and increased in 24-week one. Conclusion The expression of IL-18 and the activation of STAT5 may relate to the occurrance of DR. The expression of IL-18 doesn′t depend on the activation of STAT5.
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Objective To investigate the protective effect of losartan on acute ischemia-reperfusion(I/R)(injury) of pancreas in rats.Methods Seventy-two Wister rats were randomly divided into 3 groups:(1)(Control group);(2)Ischemia-reperfusion group:the anterior mesenteric artery and the celiac artery were(occluded) for 15 min,30min and 60min followed by 6 hours reperfusion;(3)Losartan group:losartan(40mg/kg)were administered by gavage at 12h and 1h before arterial occlusion.The pathologic changes of pancreatic tissue were observed under light microscopy;TUNEL was used to detect apoptosic of pancreatic cells;Bcl-2 expression in the pancreatic cells of rats was analyzed by immunohistochemistry technique.(Results) Losartan treatment reversed the histological abnormalities including infiltration of inflammatory cells and atrophy of acinar cells.Compared with losartan group,pancreatic tissue of I/R group exhibited increased MDA[((20.1?1.2))nmol/g and((34.9?2.6)) vs(17.9?2.1)nmol/g and(25.2?3.3)nmol/g,P
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Objective To observe the expression of p53, bcl 2 genes, vascular endothelial cell growth factor (VEGF), basic fibroblast growth factor (bFGF), insulin like growth factor I (IGF I), and the receptors of these factors of retinal vascular endothelial cells (VECs) of 1 to 20 week diabetic rats, and the relationship between the expressions and cell cycle arrest. Methods Retinal sections of diabetic rats induced by alloxan were immunohistochemically stained and observed by light microscopy (LM) and electron microscopy (EM). Dot blotting and Western blotting were used to determine the expression of mRNA, proteins of p53 and bcl 2. Results Under LM, immunohistochemical positive expression of p53 and bcl 2 were found on the vessels of ganglion cell layer and inner nuclear layer of retinae of 8 to 20 week diabetic rats; under EM, these substances were observed depositing in VECs. The retinal VECs also expressed VEGF, bFGF, IGF I and their receptors. There was no positive expression of other cell types in these retinae, all cell types of retinae in control group, or all cells of retinae of diabetic rats with the course of disease of 1 to 6 weeks. The result of dot blotting revealed that retinal tissue of 20 week diabetic rat expressed p53 and bcl 2 mRNA, and the result of Western blotting revealed that they also expressed p53 and bcl 2 proteins. But retinal tissues of control group did not. Positive expression of bax was not found in the retinae in control group or 1 to 20 week diabetic rats. Conclusion p53, bcl 2 may introduce cell cycle arrest of VECs of retinae in 8 to 20 week diabetic rats. High glucose might stimulate the expression of VEGF, bFGF, IGF I and their receptors, and the growth factors may keep VECs surviving by self secretion.