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Objective:To investigate the correlation between cognitive impairment and blood glucose, serum neuron specific enolase (NSE) and brain-derived neurotrophic factor (BDNF) levels after ischemic small-artery stroke.Methods:A total of 160 patients with ischemic small-artery stroke who received treatment in Jincheng People's Hospital from January 2018 to December 2019 were included in this study. They were divided into an observation group (with cognitive impairment, n = 68) and a control group (without cognitive impairment, n = 92) according to whether they had cognitive impairment. General data, blood glucose, NSE and BDNF levels were compared between the two groups. Multivariate logistic regression analysis was used to analyze the correlation between cognitive impairment and each factor after ischemic small-artery stroke. Results:There were no significant differences in gender, age, course of disease, body mass index, history of hypertension, hyperlipidemia, history of type 2 diabetes mellitus, history of smoking, and history of drinking between the two groups (all P > 0.05). The National Institute Health of Stroke Scale (NIHSS) score in the observation group was significantly higher than that in the control group [(18.86 ± 4.08) points vs. (14.27 ± 2.66) points, t = 6.664, P < 0.05], and the Mini-Mental State Examination (MMSE) score in the observation group was significantly lower than that in the control group [(21.45 ± 3.03) points vs. (24.28 ± 3.32) points, t = 4.452, P < 0.05]. There were no significant differences in glycosylated hemoglobin, fasting blood glucose, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglyceride (TG) and total cholesterol levels between the two groups (all P > 0.05). There were significant differences in oxidized low-density lipoprotein (ox-LDL), NSE and BDNF levels between the two groups. The ox-LDL [(44.8 ± 7.6) mmol/L] and NSE [(26.5 ± 9.5) ng/mL] levels in the observation group were significantly higher than those in the control group [(35.9 ± 4.7) mmol/L, (11.6 ± 6.9) ng/mL, t = 7.04, 8.973, both P < 0.05]. BDNF level in the observation group was significantly lower than that in the control group [(5.1 ± 1.8) ng/mL vs. (6.3 ± 2.4) ng/mL, t = 2.828, P < 0.05]. Multivariate logistic regression analysis showed that ox-LDL and NSE levels and NIHSS score were independent risk factors of cognitive impairment after ischemic small-artery stroke (all P < 0.05), and BDNF level and MMSE score were independent protective factors (all P < 0.05). Conclusion:Cognitive impairment was correlated with NIHSS score, MMSE score, ox-LDL, NSE and BDNF levels in patients with ischemic small-artery stroke. ox-LDL and NSE levels as well as NIHSS score were independent risk factors and BDNF level and MMSE score were independent protective factors of ischemic small-artery stroke.
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Since the outbreak of COVID-19, the epidemic has been spreading rapidly. As an important base to combat the epidemic, the hospital infection prevention and control work is facing great challenges. In particular, as one of the first COVID-19 designated hospitals in a province and a large general hospital at the same time, how to prevent and control nosocomial infection among patients and medical staff during the epidemic period of COVID-19 is of paramount importance. Our strategies start with the three key elements of infectious disease management, namely, "controlling the source of infection, cutting off the route of transmission, and protecting the susceptible population." The in-patients in pre-examination and triage, fever clinic, isolation ward and common ward were inspected from fever screening, pre-examination and triage, personal protection, in-patient management, emergency treatment, accompanying care management, and environmental disinfection. A series of interventions were carried out to effectively cut off the transmission of COVID-19 in hospitals. After effective screening and rational pre-examination and triage for outpatients, emergency patients and inpatients, medical personnel received a series of training, scientific protection, and accompanying personnel were effectively managed and controlled, there was not a single case of nosocomial infection during the epidemic of COVID-19. This series of intervention strategies provides some reference for other medical institutions to carry out effective prevention and control of the epidemic.
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Objective@#To investigate the impact of immediate cessation of antiviral therapy on postpartum liver function and the factors influencing postpartum abnormality in mothers with chronic hepatitis B virus infection.@*Methods@#A retrospective cohort study was conducted. One hundred eighty-eight pregnant women with HBV DNA level > 2×106 IU/ml were enrolled from June 2014 to June 2018. Demographic information and clinical data of liver function and HBV DNA load during gravidity, intrapartum and postpartum period were collected. According to the antiviral treatment recommendations during pregnancy, the women were divided into three groups, namely, tenofovir (TDF), telbivudine (LdT) and control group. Liver function abnormalities among the three groups were compared within 6 months after delivery, and the factors influencing abnormal liver function were analyzed by unconditional logistic regression.@*Results@#Of the 188 cases, 72 cases were in the TDF group, 80 cases in the LdT group, and 36 cases in the control group. Pregnant women in the TDF and LdT groups received oral TDF (300 mg/d) and LdT (600 mg/d) from 28 ± 4 weeks of gestation till delivery. Among the 188 patients, 30 (16.0%) had abnormal postpartum liver function abnormality. The incidence of postpartum liver function abnormality [alanine aminotransferase (ALT) > 2 × upper limit of normal (ULN)] in the TDF, LdT, and control groups was 19.4%, 12.5%, and 16.7%, respectively. The postpartum peak levels of ALT (median, range) in the three groups were 34.5 (12.0-946.0) U/L, 37.5 (12.0-733.8) U/L, and 39.0 (7.0-513.0) U/L, respectively. There was no significant difference between the two indexes among the three groups (P > 0.05). There was no statistically significant difference in the degree of postpartum liver function abnormalities between the three groups (P = 0.944). Most of the liver function abnormalities were mild to moderate (2 × ULN≤ALT < 10 × ULN), and usually resolved spontaneously or by treatment. Univariate and multivariate analysis showed that baseline ALT level during pregnancy was an independent factor associated with postpartum liver function abnormality (OR = 1.031, CI 95%: 1.005-1.058; χ2 = 5.340, P = 0.021), whereas age, antiviral therapy, HBeAg-positivity, baseline HBV DNA levels, gravidity, parity, preterm delivery and delivery mode were not significantly associated with postpartum liver function abnormality.@*Conclusion@#Cessation of antiviral therapy after delivery did not significantly increase the risk of postpartum liver function abnormality in pregnant women with chronic HBV infection. The ALT level during pregnancy is a factor influencing postpartum liver function abnormality.
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Objective To study the protective effect of polyene phosphatidylcholine on hepatic injury induced by oxaliplatin and 5?fluorouracil. Methods A subcutaneous tumor model was established by transplanting colocarcinoma HCT116 cells into 30 nude mice,which were random?ized into three groups. The polyene phosphatidylcholine group was injected with polyene phosphatidylcholine(85 mg · kg-1 · d-1)and 5?fluorouracil (20 mg·kg-1·d-1)for 7 days,and then injected with oxaliplatin(6 mg·kg-1·d-1)for 1 day. The hepatic injury group was injected with 5?fluoroura?cil(20 mg·kg-1·d-1)for 7 days and oxaliplatin(6 mg·kg-1·d-1)for 1 day. The tumor?bearing blank group was injected with normal saline. Hepat?ic injury was observed with ultrathin pathological sections. Liver homogenates were prepared to detect superoxide dismutase(SOD)and catalase (CAT)activity. Results In the hepatic injury group,pathological sections revealed dissolved cellular cytoplasm,mitochondrial membrane dam?age,cell membrane edema,and fuzzy,sinusoidal cell expansion . There were no obvious hepatic injuries observed in the polyene phosphatidylcho?line group. The expression of SOD and CAT were lower in the hepatic injury and polyene phosphatidylcholine groups compared to the tumor?bear?ing blank group(P<0.05). The expression of SOD and CAT were higher in the polyene phosphatidylcholine group compared to the hepatic injury group(P<0.05). Conclusion Polyene phosphatidylcholine has a protective effect on hepatic injury induced by oxaliplatin and 5?fluorouracil, which may be related to its effect on membrane repair and inhibition of oxidative stress.
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Objective To evaluate the efficacy of computed tomography ( CT ) image?guided 125 I radioactive seed implantation for locally recurrent rectal cancer ( LRRC ) , and to analyze the relationship between the dosimetry and prognosis. Methods A retrospective analysis was performed on the clinical data of 36 patients with LRRC who received CT image?guided 125 I seed implantation in our hospital from 2003 to 2011. Dosimetric verification was performed using CT scan immediately after 125 I seed implantation. The D90 , D100 , V100 , and V150 values were evaluated. In all the patients, the median activity of seeds was 0?7 mCi (0?4?0?8 mCi) and the median number of implanted seeds was 74(33?137). The local control (LC) and overall survival ( OS ) rates were calculated using the Kaplan?Meier method. The log?rank test and Cox regression model were used for the univariate and multivariate analyses, respectively. Results The median OS time was 16?2 months ( 95% CI= 13?5?18?9 months ) . The median LC time was 10?0 months (95% CI=6?2?13?8 months). The D90 and V100 values were (118.6±25?1) Gy and (90.0±0?3)%, respectively. The univariate analysis suggested that D90 was correlated with the LC time ( P=0?048) and V100 was correlated with the OS time ( P=0?035) . The multivariate analysis showed that a V100 value higher than 90% was a prognostic factor of OS (P=0?044). Conclusions In the treatment of LRRC using CT image?guided 125 I radioactive seed implantation, a D90 value larger than 140 Gy and a V100 value higher than 90% in the postoperative verification plan help improve the LC and OS rates. The D90 and V100 values in the postoperative verification plan may predict treatment outcomes in patients.
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Objective To investigate cleanliness of hospital environmental object surfaces and hands of health care workers(HCWs).Methods The adenosine triphosphate (ATP)bioluminescence assay was used to detect object surfaces and hands of HCWs in a hospital,on-the-spot intervention was conducted.Results The qualified rates of hospital environmental object surfaces and ventilator-relevant object surfaces were 58.14% (200/344)and 69.88%(116/166)respectively,the qualified rate of ventilator tracheal intubation site was low (29.17%);the qualified rate of telephone surfaces was the lowest (27.27%).The qualified rates of ventilator-relevant object surfaces used con-tinuously for ≥48h and <48 h were 56.70%(55/97)and 88.41 %(61/69)respectively,there was significant differ-ence between the two(χ2 =19.26,P <0.01).The qualified rates of HCWs’hands before and after intervention were 34.18% and 85.58% respectively,relative light unit (RLU)values were (1 033.46±106.20)and (80.46±10.68) respectively,the qualified rates and RLU before and after intervention were both significantly different (both P <0.01).Conclusion Contamination of object surfaces and hands’of HCWs in hospital dynamic environment is seri-ous,ATP bioluminescence detection and on-the-spot intervention is helpful for improving cleanliness of hospital en-vironment object surfaces and HCWs’compliance to hand hygiene.
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Objective:To investigate the psychological changes of leukemia children and their parents during treatment and rehabilitation,and provide the basis for medical staff giving humanistic care to them.Methods:20 leukemia children and their parents were interviewed and accepted one to one individualized intervention after ana-lyzing the information and posing problems.Results:Leukemia children need long-term treatment, and chemo-therapeutic drugs has obvious side effect, which make parents and children painful and easily cause negative emo-tion and psychological problems.Timely psychological intervention and humanistic care are good for disease recov-ery.Conclusion:According to children′s psychological characteristics in different treatment stages and parents′psy-chological needs conclusion was made that humanistic care on leukemia children should include:to make the pa-tient comfortable first, meet the psychological demands of children in different ages, improve medical technology, carry out painless therapy, enhance communication skills between doctors and patients, give the necessary social support, and improve the children′s quality of life.
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Objective To investigate the effect of cetuximab (C225) on the radiosensitivity of colorectal cancer cells CL187 and underlying mechanism.Methods Cell survival was detected by colony forming assay.The levels of apoptosis and cell cycle distribution were determined by flow cytometer.The mitotic ratio was measured by Wright' s-Giemsa mixed coloring method.The protein levels of Bax and Bcl2 were detected by Western blot.Results The sensitizing enhancement ratio of C225 was approximately 1.4.C225 treatment and 125I seed radiation induced G1 cell cycle arrest individually.C225 increased the radiation-induced apoptosis (t =6.6,P ＜ 0.05) and cellular Bax/Bcl-2 ratio (t =9.4,P ＜ 0.05),but did not increase radiation-induced G1 arrest.In addition,there was no difference in mitotic index among different groups.Conclusions C225 sensitizes CL187 to 125I seed irradiation,which might be related with increase of radiation-induced apoptosis.
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Objective To evaluate the efficacy and adverse reactions of CT-guided 125I radioactive seed implantation in treatment of locally recurrent rectal cancer (LRRC).Methods Thirty patients with LRRC who refused operation or were unable to endure pelvic radiotherapy received 125I seed implantation under CT guidance.Three-dimensional treatment planning system was used to calculate the number,activity,and dose of the seeds needed.The activity of seeds ranged from 14.8 to 29.6 MBq with a median of 25.9 MBq,the seed numbers ranged from 33 to 137 with a median of 74.5,the prescription doses ranged from120-160 Gy,and the actual verification dose D90 ranged from 75.91 to 159.32 Gy with a median of 119.77 Gy.Dosimetric verification by CT scanning was conducted immediately after the treatment.Follow-up was conducted for 15.2 months(4.2-35.0 months).Results The follow-up rate was 93.3％.The pain relief rate was 95.2％.The overall response rate was 50.0％,including a complete response rate of 13.3％ and a partial response rate of 36.7％.The 1-and 2-year local control rates were 30.0％ and 8.0％ respectively.The median local control survival time was 7.8 month.The 1-and 2-year survival rates were 66.5％ and 32.9％ respectively.The median overall survival time was 21.5 months.Complications,mainly adverse effects of skin and urinary system (frequent urination,urgent urination,and dysuria) occurred in 6 patients with a rate of 20.0％.Conclusions Minimally invasive and with satisfying efficacy and tolerable complications,CT-guided 125I radioactive seed implantation is a favorable option for treatment of LRRC,especially for the patients who have undergone previous pelvic radiation.
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Objective To investigate the inhibition effect of continuous low dose rate radiation by 125Ⅰ radioactive seeds on Hep-2 cells and the corresponding mechanisms.Methods Hep-2 cells were divided into three groups,control group,single dose radiation group with high dose rate form X-rays (SDR) and continuous low dose rate radiation by 125Ⅰ seeds group (125Ⅰ-CLDR).After exposure to SDR and 125Ⅰ-CLDR,colony formation assay was used to determine the radiosensitivity and RBE,trypan blue exclusion assay was used to determine cell proliferation,and flow cytometry was used to detect cell apoptosis and cell cycle arrest.Results The radiosensitivity of Hep-2 cells to 125Ⅰ-CLDR was higher than that to SDR.The RBE of 125Ⅰ-CLDR versus SDR was approximately 1.61.The α/β ratio of 125Ⅰ-CLDR group was higher than that of SDR group.Both SDR and 125Ⅰ-CLDR inhibited cell proliferation (t =30.9,40.7,P＜0.05),in which 125Ⅰ-CLDR was stronger than SDR (t =9.8,P＜0.05).In addition,the incidences of apoptosis and G2/M arrest induced by125Ⅰ-CLDR were also stronger than those induced by SDR (t =5.8,19.8,P ＜ 0.05).Conclusions 125Ⅰ-CLDR generates more serious inhibition effects than SDR on reducing cellular DNA repair capacity,inducing cell apoptosis and G2/M arrest and inhibiting proliferation of Hep-2 cells.
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Objective To investigate the effect of C225 on DNA repair and molecular pathways in CL187 colorectal cancer cells after irradiated by 125Ⅰ radioactive seeds.Methods In the experiment involved were four groups:control group,100 nmol/L C225 treatment group,125Ⅰ radioactive seeds continuous low-dose rate irradiation group and C225 combined with 125Ⅰ radioactive seeds continuous lowdose rate irradiation group.Cells were collected at 48 h after 4 Gy irradiation,and γH2AX foci/cell and γH2AX foci positive cells were counted with immunofluorescence.At the same time,DNA repair proteins were detected by Western blot.Cells were lyzed immediately after 4 Gy irradiation,and changs in EGFR downstream signaling molecules were detected by Western blot.Results Compared with 125Ⅰ seeds irradiated cells,cells treated with C225 and 125Ⅰ seeds irradiation showed more γH2AX foci per cell (t =8.0,P =0.05),and more γH2AX foci positive cells (t =6.8,P ＜ 0.05) and less expression of Ku70 (t =6.6,P ＜ 0.05) and DNA-PKcs (t =5.6,P ＜ 0.05).Combined with 125Ⅰ-CLDR irradiation,C225 reduced cellular EGFR level(t =4.9,P ＜0.05) and inhibited the activation of Akt(t =5.5,P ＜0.05).Conclusions In the condition of 125Ⅰ seeds irradiation,C225 reduced the expression of Ku70 and DNA-PKcs,inhibited the activation of Akt and attenuated the DNA damage repair capacity in CL187 colorectal cancer cells.
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Objective To investigate the effect and underlying mechanism of single,fractioned and continuous low dose rate radiation on CL187 colorectal cancer cell line.Methods CL187 cells were exposed to 6 MV X-rays at a high dose rate of 4 Gy/min and 125Ⅰ seed at a low dose rate of 2.77 cGy/h with three groups:single dose radiation group (SDR),fractioned dose radiation group (FDR) by 2 Gy/f,and continuous low dose rate radiation group (CLDR).The radiation doses were 0,2,4 and 8 Gy.Total cell number and cell viability were determined by trypan blue.Clone forming assay was used to evaluate the cell proliferation ability.The percentage of apoptosis cells was analyzed by flow cytometry.Western blot was used to detect the protein expression levels of PHLPP2,PTEN and Bax.Results Compared with SDR and FDR groups,the total cell number and survival fraction of CLDR group decreased.The relative biological effect (RBE) for 125Ⅰ seeds compared with 6 MV X-rays was 1.41.The percentage of apoptosis cells of CLDR group was significantly increased (t =-15.08,-11.99,P ＜ 0.05).The expression level of Bax increased in CLDR group,while no obvious changes were observed on PHLPP2 and PTEN among three groups.Conclusions The expression level of PHLPP2 increaseS in SDR,FDR and CLDR group,while it seems that it was not influenced by dose rate.The expression level of Bax increased in three groups,while more colorectal CL187 cells in CLDR group may be killed due to the increase of Bax expression.
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ObjectiveTo investigate the therapeutic value of noninvasive mechanical ventilation in patients with conscious disturbance due to severe chronic obstructive pulmonary disease (COPD) with respiratory failure. MethodsForty-two patients with conscious disturbance due to COPD complicated with respiratory failure were selected in the study. GALILEO or PAPHAEL large EMT ventilator produced by Switzerland Hamilton Company was used for noninvasive mechanical ventilation with P-SIMV+PSV+PEEP mode. Meanwhile, the change of vital signs, consciousness, the degree of inspiratory muscle fatigue and blood gas indexes were observed before and after treatment. Glasgow coma scale (GCS) was applied to evaluate the consciousness, and scale for accessory muscle use was adopted to measure the degree of inspiratory muscle fatigue. ResultsAll the patients were treated successfully. Compared with admission, the pH value, the pressure of arterial carbon dioxide (PaCO2) and the arterial oxygen pressure/inhaled oxygen concentration (PaO2/FiO2)were significantly improved 2 hours, 4 hours and 24 hours after treatment. The respiration rate and heart rate were markedly decreased 24 hours after treatment, which indicated that the condition of the patients tended to be stable and the patients could endure the therapy. The average GCS was increased from 5.69-1-0.93 to 10.45±1.23 (t= 31.68, P<0.001), and the state of consciousness was improved significantly. The scale for accessory muscle use was decreased from 3.70±0. 45 to 2. 06±0. 52 (t = 31.21, P < 0. 001), and the respiratory muscle fatigue was relieved. ConclusionsNoninvasive mechanical ventilation has obvious clinical curative effect on severe infection and conscious disturbance due to severe COPD complicated with respiratory failure.
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Objective To establish the isodose curves and dose calculation models of()~(125)I seed plane implantation using the three-dimensional treatment planning system(3D-TPS). Methods The isodose cures of 1 000 cGy,3 000 cGy,6 000 cGy,9 000 cGy,12 000 cGy,15 000 cGy,and 20 000 cGy and dose calculation models of triangular,quadrilateral,hexagon,and dodecagon patterns of()~(125)I seed plane implantation were created using the 3D-TPS.The isocenter dose pattern of 0,0.5,1.0,1.5,2.0,2.5,3.0,and 4.0 cm from the plane center was calculated with 3D-CRT. Results The study showed that if doses were less than 10 Gy at 2.0 cm,2.5 cm,3.0 cm and 4.0 cm apart from the center of triangular,quadrilateral,hexagon,and dodecagon patterns and the distance was beyond 1 cm between seeds,there was a low dose region in the centeral point. Conclusions The study showed that the isodose distribution curves and dose calculation models in plane implantation were primarily established using the seed implantation 3D-TPS.