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Objective:To retrospectively analyze the pregnancy outcomes of patients with adenomyosis requiring fertility in a single center under real world condition.Methods:From June 2015 to May 2020, 231 cases of pregnancy complicated with adenomyosis diagnosed by ultrasound with fertility requirements were treated in the Women′s and Children′s Hospital Affiliated to Qingdao University with complete clinical data. And they were divided into three groups according to the treatment of adenomyosis before pregnancy: expectation group, drug group and operation group. The relevant data before pregnancy of the three groups were analyzed, and the pregnancy outcomes of the patients were summarized. According to whether the early pregnancy was treated with medication, the patients who were naturally conceived without symptoms of threatened abortion were divided into observation group and fetus protection group, and the pregnancy outcomes of the two groups were compared.Results:(1) Compared with the expectation group, the ages of patients in the drug group and the operation group were larger [(31.5±1.8) vs (34.1±3.7) vs (36.9±3.6) years old], and the difference was statistically significant ( P<0.05). Only 9 patients (11.5%, 9/78) had clinical symptoms in the expectation group, while the patients in the drug group and the operation group had a higher proportion of dysmenorrhea and increased menstrual volume. The uterine volume of the drug group and the operation group were larger than that of the expectation group [(151±46) vs (166±27) vs (97±18) cm 3], the difference was statistically significant ( P<0.05). 78.6% (33/42) of the operation group were focal adenomyosis. The proportion of natural pregnancy in the expectation group was 97.4% (76/78), and in vitro fertilization and embryo transfer was mainly used in the drug group and the operation group. (2) The abortion rates of the three groups were 48.7% (26/111), 4/17, 67.5% (27/78) respectively. Compared with the drug group and the operation group, the preterm birth rate was lower [55.9% (33/111) vs 11/17 vs 12.5% (5/78)] and the natural delivery rate was higher [44.1% (26/111) vs 4/17 vs 67.5% (27/78)] in the expectation group. (3) There were 89 cases of spontaneous pregnancy without threatened abortion symptoms, including 31 cases in the observation group and 58 cases in the fetus protection group. Compared with the observation group, the abortion rate of patients in the fetus protection group was lower [41.9% (13/31) vs 34.5% (20/58)], and the difference was statistically significant ( P<0.05). Conclusions:Patients with adenomyosis who have fertility requirements should be comprehensively evaluated and individualized treatment plans should be given. Pregnancy patients with adenomyosis have a high rate of miscarriage, and they should be included in the management of high-risk pregnant women. Active fetal protection treatment during early pregnancy might improve pregnancy outcomes.
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Objective@#To investigate the efficacy of enticavir and lamivudine in preventing rituximab-associated hepatitis B virus(HBV) reactivation in patients with B-cell non-Hodgkin lymphoma complicated with resolved hepatitis B during chemotherapy.@*Methods@#This retrospective study included 216 B-cell non-Hodgkin lymphoma patients with complete data from January 2012 to January 2018 treated in 3 hospitals.Of 78 patients with resolved hepatitis B, they were divided into lamivudine prophylactic group(17 cases), entecavir prophylactic group(11 cases) and control group(50 cases). The changes of HBVM, HBV DNA and liver function before or after rituximab combination chemotherapy were analyzed.The incidence of HBV reactivation, liver function injury and chemotherapy delay were compared.@*Results@#Compared to the other 71 patients, 7 cases experienced HBV reactivation in 78 patients with resolved hepatitis B. There were no statistically significant differences between the two groups in patient demographics, pathological pattern, chemotherapy regimen.Six patients in the control group developed HBV reactivation(12%) and 1 patient in lamivudine prophylactic group(5.88%), none had HBV reactivation in enticavir prophylactic group.There was statistically significant difference among three groups(Fisher P=0.016). A total of 7 cases experienced HBV reactivation in 78 patients with resolved hepatitis B respectively, 2 cases in the first chemotherapy period, 2 cases in the third chemotherapy period, 1 case in the fifth chemotherapy period, the last one occurred after the completion of chemotherapy.Four patients had HBsAg reverse seroconversion, occurred in the 1, 3, 5 cycles during and after the completion of chemotherapy.Twenty patients (40.0%) experienced liver function parameters abnormal in the control group, 4 cases(23.5%) in lamivudine prophylaxis group, 2 cases (18.2%) in enticavir prophylaxis group during chemotherapy.@*Conclusion@#Antiviral prophylaxic therapy can potentially prevent rituximab associated HBV reactivation in patients with resolved hepatitis B. Entecavir can more reduce the risk of rituximab associated HBV reactivation than lamivudine.
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Objective@#By analyzing the examination results of physical examination of workers exposed to DMF among 32 factories in some areas of a province, to investigate the working years of dimethylformamide (DMF) poisoning and the impact on the health status of exposed workers, and to explore the targeted intervention strategies.@*Methods@#From February to May 2018, 2, 457 workers exposed to DMF in some areas of Jiangsu Province were selected as survey targets. Cross-sectional survey was conducted to investigate the health status of workers exposed to health, And the health surveillance data, detection data of occupational disease risk factors in the workplace were collected and analyzed, respectively.@*Results@#The positive rate of abnormal liver function and B-ultrasound of males exposed to DMF was significantly higher than that of females. The abnormal rates of liver function, blood pressure and B-ultrasound in workers aged between 60 and 69 were higher in contrast to those in any other age groups. And the differences was statistically significant. In particular, the highest rate of abnormal blood pressure was found in workers exposed 21-30 years (39.2%) , the highest rate of abnormal liver function was found in workers exposed 11-20 years (44.3%) , and the highest rate of abnormal B-ultrasound was found in workers exposed 0-10 years (60.4%) .@*Conclusion@#Long-term exposure to dimethylformamide can affect workers’ liver function and blood pressure. Specifically, with the increase of contact age, the degree of chronic damage to liver, cardiovascular and other organs also increases.
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Objective To study the effects of hemodialysis (HD) combined with hemoperfusion (HP) on sleep quality in maintenance hemodialysis (MHD) patients. Methods Sixty MHD patients admitted to Department of Blood Purification of Wuhan General Hospital of PLA from January to December 2016, 30 cases were treated with HD, and the other 30 cases were treated by HD+HP, the course of treatment was 12 weeks in both groups. The changes of serum β2-microglobulin (β2-MG) and parathyroid hormone (iPTH) were observed before treatment and 12 weeks after treatment; the sleep quality of all patients in the two groups were evaluated by Pittsburgh Sleep Quality Index (PSQI) Scale, and the correlations between the sleep quality of MHD patients andβ2-MG level, iPTH level were analyzed by Pearson linear correlation analysis. Results All the 60 patients completed the treatment. The serum β2-MG, iPTH levels and PSQI score after treatment were decreased obviously in HD+HP group compared with those before treatment, and the degrees of decrease in HD+HP group were more significant than those in the HD group [β2-MG (mg/L): 12.34±2.12 vs. 20.27±3.15, iPTH (ng/L): 224.54±100.28 vs. 398.42±155.37, PSQI score:8.56±0.86 vs. 12.45±0.88, all P < 0.05]. Pearson linear correlation analysis showed that the PSQI score was significantly positively correlated with serum β2-MG, iPTH level (r respectively was 0.416 and 0.462, both P < 0.01). Conclusion HD+HP therapy can significantly improve the sleep quality of MHD patients, and the mechanism may be related to the elimination of serum iPTH and β2-MG from the body of MHD patients.
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Objective To explore the clinical effect of continuous venous-venous hemofiltration (CVVH) combined with hemoperfusion (HP) in treatment of patients with hypertriglyceridemia pancreatitis (HTGP). Methods The clinical data of 33 patients with moderate and severe HTGP who were treated by CVVH combined with HP were retrospectively analyzed from March 2012 to March 2017 in Wuhan general hospital of the people's liberation army. The differences of vital signs and the serum levels of triglyceride (TG), total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL), amylase (AMS), interleukin-6 (IL-6), blood calcium (Ca2+) and white blood cell count (WBC), haemoglobin (Hb), platelet count (PLT) before and 24 hours,72 hours and 1 week after therapy were compared, the changes of recovery time to target serum TG level, frequency of blood purification therapy, time for disease situation becoming stable, days staying in hospital and mortality were observed. Results The levels of LDL were not high in patients with HTGP, the levels of TG and TC were decreased significantly after using CVVH plus HP, and after treatment for 24 hours statistical differences appeared compared with those before treatment [TG (mmol/L):7.14±1.04 vs. 11.90±2.03, TC (mmol/L): 7.47±1.04 vs. 10.20±1.26], the decline persisting to 1 week after treatment;the drop rates of TG and TC were the largest after the first combined treatment, and the TG drop rate was more obvious than that of TC [(51.92±14.18)% vs. (30.09±10.01)%, P < 0.05], an average of (2.58±1.45) days and (2.38±0.98) times of combined blood purification could restore the TG to its safe level (TG < 5.65 mmol/L), the time of disease situation tending to be stable was (7.46±3.05) days and the time of staying in hospital was (20.00±2.12) days. Systemic inflammatory response syndrome (SIRS) related vital signs and inflammatory response indicators were also improved obviously after the combined therapy (all P < 0.05), after treatment for 72 hours, various vital signs and Ca2+reached to their normal reference ranges, after treatment for 24 hours IL-6 began to decline significantly compared with that before treatment (ng/L: 120.85±16.45 vs. 151.05±18.19), and AMS and WBC returned to their normal reference ranges after treatment for 1 week. Conclusion CVVH combined with HP can quickly and effectively eliminate TG in blood in patients with HTGP and in the mean time it may ameliorate and block the early progression of SIRS, resulting in good therapeutic effect on alleviating the disease development and improving its prognosis.
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Objective To observe the clinical curative effect of cinacalcet combined with activated vitamin D for treatment of patients with secondary hyperparathyroidism (SHPT) undergoing maintenance hemodialysis (MHD).Methods Eighty-six patients with SHPT undergoing MHD admitted to the Blood Purification Center of Wuhan General Hospital of Chinese People's Liberation Army from April 2014 to April 2016 were enrolled, and they were divided into an observation group and a control group by random number table, 43 cases in each group. The patients in control group were given cinacalcet whose initial dose was 25 mg/d and maximum dose should not exceed 75 mg/d, and the calcium acetate orally; on the basis of control group, the patients in observation group were additionally given activated vitamin D therapy, and both groups were treated for consecutive 12 weeks. After treatment, the clinical therapeutic effect, serum calcium, serum phosphorus, calcium phosphorus product, intact parathyroid hormone (iPTH) levels and the incidence of adverse reactions were compared between the two groups.Results The total effective rate in observation group was higher than that of the control group [90.70% (39/43) vs. 74.42% (32/43),P < 0.05]. After treatment, the difference of the serum calcium, calciumphosphorus product were higher than those before treatment in both groups [serum calcium (mmol/L): the control group was 2.24±0.25 vs. 1.99±0.26, observation group was 2.60±0.21 vs. 2.03±0.24; calcium phosphorus product (mmol2/L2): the control group was 4.05±0.34 vs. 3.79±0.35, observation group was 4.25±0.37 vs. 3.86±0.36, allP < 0.05], serum phosphorus, iPTH were lower than those before treatment in both groups [phosphorus (mmol/L): the control group was 1.69±0.14 vs. 2.09±0.12, observation group was 1.15±0.18 vs. 2.03±0.16; iPTH (ng/L): the control group was 297.36±59.73 vs. 499.54±69.32, observation group was 198.53±57.32 vs. 492.92±67.54, allP < 0.05], the degrees of changes in observation group were more significant than those in control group [serum calcium (mmol/L): 2.60±0.21 vs. 2.24±0.25, serum phosphorus (mmol/L): 1.15±0.18 vs. 1.69±0.14, calcium phosphorus product (mmol2/L2): 4.25±0.37 vs. 4.05±0.34, iPTH (ng/L): 198.53±57.32 vs. 297.36±59.73, allP < 0.05]; and the incidence of adverse reactions was significantly lower in observation group than that of the control group [4.65% (2/43) vs. 20.93% (9/43),P < 0.05].Conclusion Cinacalcet combined with activated vitaminD for treatment of SHPT patients undergoing maintenance hemodialysis shows obvious curative effect, reduces the whole segment of iPTH, and simultaneously has less adverse reactions.
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BACKGROUND:The effect of dimethyl sulfoxide cryoprotectants has been got a lot of verification in the low-temperature medical applications. But there is no literature addressing microdialysis detection of dimethyl sulfoxide cryoprotectants. OBJECTIVE:To investigate the microdialysis relative recovery of different concentrations of dimethyl sulfoxide cryoprotectants used for limb reattachment. METHODS:In vitro linear probe relative recovery of different concentrations of dimethyl sulfoxide (2%, 5%, 8%) was detected by retrodialysis gain and loss method. The correction in vivo experiment was done to estimate dimethyl sulfoxide relative recovery in rabbit amputated limbs. RESULTS AND CONCLUSION:The relative recoveries of different concentrations of dimethyl sulfoxide (2%, 5%, 8%) were (49.49±3.56)%, (46.30±1.48)%, (52.66±2.54)%using retrodialysis gain method and (50.99±6.89)%, (43.86±1.35)%, (50.67±0.75)%using retrodialysis loss method. The average recoveries were (49.48±3.18)%and (48.51±4.03)%, respectively. There was no difference in the relative recovery of dimethyl sulfoxide detected using two methods. The change of dimethyl sulfoxide concentration could not influence the retrodialysis gain and loss method calibration results. The recovery was (15.45±4.8)%in vivo. These findings indicate that the microdialysis technology is suitable for dimethyl sulfoxide sampling in vivo that has no obvious influence on the relative recovery.
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Objective To investigate the change of AQP1 and AQP2 before and after the release of obstruction and explore the relationship between reabsorption dysfunction of renal tubule and the change of AQPs. Methods The model of unilateral ureter obstruction (UUO) was established by surgery. Western blot and immunohistochemistry were used to study the expression of AQPs before and after obstruction. Results In UUO model, both AQPs began to down-regulate one day after obstruction, the expression of both AQPs became lower one day after the release of obstruction. And they started to up-regulate 7 day after the release of obstruction. AQP2 became normal since 14 days after the release of obstruction, and AQP1 became normal since 21 days after the release of obstruction. Conclusion The expression of AQP1 and AQP2 were descended in hydronephrosis. The dysfunction of renal tubule and the osmotic-dependent polyuria after the release of obstruction in UUO were caused by the down - regulation of AQPs.
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OBJECTIVE@#A rapid and selective method has been developed for the determination of propofol in blood by gas chromatography-mass spectrometry (GC-MS).@*METHODS@#The blood was extrasted with the solution of internal standard, the extracted residue was analyzed by gas chromatography-mass spectrometry using selected-ion monitoring mode.@*RESULTS@#The linear range was 0.1-10 microg/mL. The coefficient(R2) was 0.993 1. The detection limit was 0.05 microg/mL.@*CONCLUSION@#The method is simple and rapid, offering superior sensitivity and selectivity for propofol. The method can be used successfully during clinical and forensic toxicology.
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Humanos , Anestésicos Intravenosos/sangue , Cromatografia Gasosa-Espectrometria de Massas/métodos , Propofol/sangue , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
It is a common way for estimating of time of death in forensic science by the extent of gastric emptying, but this method may be less accurate in sometimes. Here, we report 5 cases with significant delayed gastric emptying and made discussion about it.
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Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morte , Ingestão de Alimentos , Alimentos , Medicina Legal/métodos , Esvaziamento Gástrico , Motilidade Gastrointestinal/fisiologia , Fatores de TempoRESUMO
<p><b>BACKGROUND</b>Recent studies have indicated that chronic stress may give rise to brain damage, which is related to the genesis of depression. The purpose of this study is to investigate the effects of extract of Ginkgo biloba (EGb) and venlafaxine on depression.</p><p><b>METHODS</b>Rats were treated with chronic and comprehensive stress to create a depression model. Immunohistochemistry was used to detect the expression of brain-derived neurotrophic factor (BDNF) in the hippocampal CA3 neurons of rats treated with different drugs. Behavioral changes of these rats were also examined.</p><p><b>RESULTS</b>The expression of BDNF in the hippocampal CA3 neurons of the depression model decreased with a reduction in exploring behavior and a significant increase in fecal production. The expression of neuron nitric-oxide synthase (nNOS) protein also increased in the rats compared to normal controls. The rats treated with EGb and venlafaxine showed an increase in expression of BDNF and exploring behavior compared to untreated rats, but a decrease in nNOS and fecal production.</p><p><b>CONCLUSIONS</b>Rats sustain damage to the brain after being subjected to chronic and comprehensive stress. Our research has indicated that combined EGb with venlafaxine enhances the protection of neurons and decreases damage to the brain, while relieving the side effects of synthetic antidepressants.</p>