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Objective:To explore the effectiveness of Acute Care of the Elderly(ACE)model and its existing problems in the clinical practice for older adults with acute clinical conditions.Methods:Using the random number table method, a random number sequence was generated, and the patients admitted to the Department of Geriatrics of Shenzhen Nanshan Hospital due to acute diseases From January 2019 to September 2021 were enrolled in the ACE model intervention group(160 cases)and the control group(77 cases)in a 2: 1 ratio.The inclusion criteria were based on disease severity, frailty assessment, and activity of daily living(ADL)assessment.The intervention time was 1-3 weeks.Outcomes of the patients include ADL, hospitalization days, hospitalization expenses, drug proportion, human resource investments, adverse events, 30-day readmission rate, and 1-year mortality.Results:There were no significant difference in baseline indicators such as frailty index and ADL score between the two groups at admission.The ADL score(Barthel index)of the ACE group was significantly improved compared with the control group at discharge(81.71±14.23 vs.70.9±23.89, P<0.001)and at 30 days after discharge(85.84±15.25 vs.68.29±30.91, P<0.001). The hospital cost[(12 735.81±6 541.41)￥ vs.(16 391.54±12 962.34)￥, P=0.002], drug proportion(21.34% vs.28.93 %, P=0.036)and 30-day readmission rate(13.1% vs.23.4%, P=0.037)of the ACE group were significantly lower compared to the control group.The human resource input(32.97±6.72 vs.25.03±5.31, P=0.008)and patient satisfaction(98.23% vs.90.66%, P=0.031)in the ACE group were significantly higher than those of the control group.(4)The incidence of adverse events during hospitalization was significantly lower in the ACE group than in the control group in terms of aspiration(0.63% vs.20.8%, P<0.001), falls(0 vs.10.4%, P<0.001), incontinence dermatitis(0 vs.3.9%, P=0.033), and 1-year mortality(6.3% vs.24.7%, P<0.001). There was no significant difference in the average length of stay(8.98±4.25 vs.10.03±5.32, P=0.101), pressure sores(13.01±4.77 vs.13.27±4.89, P=0.364), DVT risk score(8.53±2.79 vs.8.89±2.76, P=0.340)and medical staff satisfaction(73% vs.80%, P=0.240)between the two groups. Conclusions:The ACE model helps to reduce the disability rate of elderly patients with frailty, adverse events during hospitalization, save drug costs, and improve patient satisfaction.It is worth promoting in geriatric practice, but its localization management details and processes still face many challenges.
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Objective:To investigate the expression profile change of long non-coding RNA (IncRNA) and mRNA in plasma samples before and after drug resistance of gefitinib for non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR)-sensitive gene mutation treated, and to screen out RNA molecule related to gefitinib-resistance.Methods:A total of 12 NSCLC patients with EGFR-sensitive gene mutation treated by gefitinib from Xianyang Center Hospital of Shaanxi Province and Yongchuan Hospital of Chongqing Medical University from March 2015 to April 2019 were selected. Plasma samples before and after drug resistance were collected, and 6 samples in sensitive stage and 6 samples in drug-resistant stage were taken. Gene microarray was used to screen the differentially expressed lncRNA and mRNA; the biological pathway and the function of the differentially expressed mRNA were obtained by using the gene ontology (GO) function annotation analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis.Results:The microarray detection results showed that the expression profiles of lncRNA and mRNA in the plasma of NSCLC patients were different before and after gefitinib-resistance. Fold change≥2 and P < 0.05 were taken as the differential gene screening standard, finally 38 differentially expressed lncRNAs and 53 differentially expressed mRNAs were found. Compared with the sensitive stage, 18 lncRNAs were differentially up-regulated and 20 lncRNAs were down-regulated in the drug-resistant stage; the largest up-regulation lncRNA was RP1-102K2.6 (fold change was 47.31), and the largest down-regulation lncRNA was RP11-149I2.4 (fold change was 24.34). In mRNA expression microarray, compared with sensitive stage, the expressions of 29 mRNAs were up-regulated and 24 mRNAs were down-regulated in the drug-resistant stage, the largest up-regulation mRNA was CUL2 (fold change was 58.49), the largest down-regulation mRNA was CHEK2 (fold change was 23.29). GO functional analysis showed that the differentially expressed mRNA in the plasma of patients with gefitinib-resistance were enriched in the apoptosis and protein binding regulation process. KEGG analysis showed that the differentially expressed mRNA mainly targeted cancer pathway, NSCLC pathway and other pathways. Conclusion:For NSCLC patients with EGFR gene sensitive mutation, there are multiple differentially expressed lncRNAs and mRNAs in plasma before and after drug resistance, and the differential expression may play an important role in the mechanism of gefitinib resistance.
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Objective:To explore the clinical efficacy of CT-guided 125I radioactive seed implantation in the treatment of bone metastases. Methods:The data of 43 patients with bone metastases treated by seed implantation from June 2016 to July 2018 in the 3201 Hospital was retrospectively analyzed. The 52 lesions of 43 patients with bone metastases were treated with 125I radioactive seed implantation. The patients were followed up, and the efficacy was evaluated based on pain relief, quality of life improvement, and whole body bone imaging. Results:The number of pain relief patients in 43 patients with bone metastases at 1, 3, 7, 30, 60, 90, and 180 d after 125I radioactive seed implantation were 19, 32, 39, 36, 36, 34, and 31 cases; the pain relief rates were 44.19%, 74.28%, 90.70%, 83.72%, 79.07%, and 72.09%, respectively. The pain relief rate was highest at 7 d after seed implantation, and the pain degree after seed implantation was significantly lower than that before seed implantation, the difference was statistically significant (Z = -5.216, P < 0.05). The difference in quality of life between patients before and after 125I radioactive seed implantation was statistically significant (Z = -4.308, P < 0.05). The re-examination in 3 to 6 months after treatment showed that the metabolism of 45 bone metastases lesions was reduced and shrunk, and the efficiency rate was 86.54% (45/52). Conclusion:125I radioactive seed implantation has good curative effect in the treatment of patients with bone metastases, which can effectively relieve pain, improve local control rate, and improve patients' quality of life.
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Bedside ultrasound plays an important role in the evaluation of critically ill patients. In order to standardize the application of bedside ultrasound, Chinese Research Hospital Association of Critical Care Medicine and Nursing Research Group of Chinese Research Hospital Association of Critical Care Medicine organized the experts in related fields in China to analyze, discuss and summarize the following contents: ① bedside ultrasound assessment of lungs; ② bedside ultrasound -guided nutrition tube placement; ③ bedside ultrasound assessment of gastric residual volume; ④ bedside ultrasound -guided endovascular catheterization. Finally, the Evidence-based nursing expert consensus on adult bedside ultrasound was formulated.
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Objective@#This project aimed to explore the effectiveness of estimating individual treatment effect on real data, among the heterogeneous population, with Causal Forests (CF) method, to find out the characteristics of heterogeneous population.@*Methods@#We designed and conducted four computer simulation schemes to verify the effect of estimating on individual treatment, using the CF under four different environments of the treatment effects. Real data was then analyzed for the catheterization on right heart.@*Results@#Results from the simulation process showed that the values on individual treatment effect that were estimated by causal forests were consistent with the population effect as well as in line with the expected distribution under the setting of four different effect values. Results of real data analysis showed that values of individual treatment effect among most patients appeared positive, so the use of RHC could cause an increase of the '180-day mortality rate’ in the sampled population. Patients with lower predicted probability of 2-mo survival and albumin were more likely to have a lower risk of death after using the RHC.@*Conclusion@#CF method could be effectively used to estimate the individual treatment effect and helping the individuals to make decision on the receipt of treatment.
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Objective To evaluate the effects on catheter related blood stream infection by different dressing frequency of peripherally inserted central catheter(PICC)with neonates. Methods A systematic review of randomized controlled trials (RCTs) from databases, Data were searched about the transparent dressing replacement frequency for neonatal PICC catheterization. The meta-analysis was performed by using RevMan 5.2 software. Results Nine RCTs were included in a total of 1 730 patients. Meta analysis showed that there was no significant difference in the incidence of PICC puncture dressing, catheter-related infections (including puncture port infection, catheter-related blood flow infection, catheter bacterial colonization) at every 3, 5, and 7 days (P> 0.05). Conclusion the dressing of PICC catheter are replaced will not increase the incidence of catheter-related infections within 7 days, throughout the more appropriate frequency of dressing replacement is once every 7 days.
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Objective To observe the clinical effect of the Placenta Polypeptides injection combined with paclitaxel plus paraplatin(TC)chemotherapy in the treatment of advanced ovarian cancer.Methods Eighty patients with advanced ovarian cancer receiving tumor cytoreductive surgery were divided into the treatment group and control group,40 cases in each group.The control group accepted single TC chemotherapy,while on this basis the treatment group was added with the Placenta Polypeptides injection.The short-term effect,KPS scores and occurrence of chemotherapeutic toxic reactions were observed in both groups.Results The short-term effective rates in the treatment group and control group were 90.00％ and 87.50 ％ respectively,the difference was not statistically significant (P＞0.05);the living quality KPS score in the treatment group was significantly better than that in the control group,the difference indicated statistical significance(P＜0.05).The occurrence rates of adverse reactions,including leukopenia,nausea and vomiting,liver function damage,heart toxicity,muscle and joint pain were significantly lower than those in the control group (P＜0.05).Conclusion The Placenta Polypeptides injection combined with TC chemotherapeutic regimen in the treatment of advanced ovarian cancer could improve the quality of life of the patients,reduce the toxic and adverse reactions of chemotherapeutic drugs.
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Objective To compare the various partial Fourier reconstruction algorithms in MRI image processing and their advantages and disadvantages for improving algorithm .Methods Based on the conjugate symmetry in k‐space data in the partial Fourier reconstruction algorithm theory ,the 1 .5T medical magnetic resonance equipment was utilized ,the k‐space data were collect‐ed ,in reconstruction ,only 55% -80% of full data were utilized to simulate the partial collection pattern and reconstruct the images by using the several algorithms of zero filling ,conjugate synthesis ,Homodyne detection and POCS .Results The results presented that the ringing artifact was most obvious in the conjugate filling pattern and the POCS algorithm had the best effect for eliminating the ringing artifact .Conclusion The POCS algorithm repeatedly uses the weighted iteration with low frequency phase positions , which eliminates artifact ,meanwhile causes the lose of high frequency image details ,moreover the time consuming is longer ;the Ho‐modyne algorithm can keep a good balance between maintaining the image details and diminishing ringing .If the Sinc function serves as a weighting function for conducting phase unwrapping ,the image quality may be further improved .
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BACKGROUND:To reduce the amount of bleeding and the amount of hemoglobin after total knee replacement has been a key project in the clinical research in the division of bone and joint. Currently, ice therapy has been widely used in the clinic for tissue sweling and pain due to various physical and chemical factors. OBJECTIVE:To investigate the risk factors of postoperative hemoglobin after total knee replacement and discuss the effects of ice intervention. METHODS: 240 patients with osteoarthritis based on the random draw principles were equaly divided into the treatment group and the control group. The general information, disease status, diagnosis and treatment and prognosis of the two groups were investigated. Al patients were actively subjected to artificial total knee replacement. On the basis of the treatment in the control group, the treatment group received ice intervention at 2 hours after replacement for 7 consecutive days. RESULTS AND CONCLUSION:The postoperative hemoglobin decrease occurred in 34 patients, with the incidence of 14.2% among 240 patients at 7 days after replacement. Multivariate logistic regression analysis results showed that age, no ice treatment, body mass index were the main risk factors for hemoglobin decrease after total knee replacement (P 0.05). Results verify that clinical application of total knee replacement facilitated the knee recovery in patients with osteoarthritis, but hemoglobin decrease and bleeding existed. Active ice intervention can reduce the risk and relieve postoperative pain.
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Objective Systemic analysis the effect of the application of continuity nursing in community diabetes.Methods Retrieve documents from the PubMed,Cochrane Library,EMBASE,Science Direct,CBM,WANFANG Data and CNKI.Dating from the dates of establishment to May,2014.Randomized controlled trials (RCTs) on continuity of patient care for patients with diabetes were included.Two reviewers independently screened the literature according to the inclusion and exclusion criteria,extracted the data and assessed the quality of the included studies,and then meta-analysis was performed by RevMan 5.1 software.Results 5 RCTs (156 cases with diabetes) were involved into this Meta-analysis.The experimental group was superior to the control group in FBG,2h PBG,HbA1c and the level of treatment compliance,with statistically significant differences,P＜0.05.The descriptive analysis showed that the differences in the score of diabetes knowledge and the quality of life were statistically significant,P＜0.05,because the data could not be converted.Conclusions The continuity nursing can improve the compliance and the quality of life of community diabetes,ameliorate certain biochemical indicators.Study of large sample and RCTs should be take because of the existence of some restraining factors.
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Objective To evaluate the efficacy of adjustable oral appliance (OA) on ventilation of patients with obstructive sleep apnea hypopnea syndrome (OSAHS).Methods Databases were searched from Junuary 1990 to July 2014 for randomized controlled trials on the use of adjustable OA for the promotion of ventilation in OSAHS.Meta analysis was performed with RevMan5.2 software,and descriptive analysis of the data that could not be converted and merged was performed.Results Totally 6 RCTs involved,including 1 109 patients,which involved 4 random parallel controlled trials and 2 random crossover controlled trials.Meta-analysis showed that adjustable OA were associated with a decreased apnea-hypopnea index(AHI) [fixed effect model,WMD=-2.38,95％CI (-3.59--1.17),P＜0.01] and an improvement in minimum arterial oxygen saturation (SaO2)[randomized effect model,WMD=3.09,95％CI(1.16-5.02),P＜0.01] of OSAHS patients.The descriptive analysis showed that the difference in the sleep score was not statistically significant because the data could not be converted.Conclusions Compared to fixed oral appliance,adjustable oral appliance produced greater effect in reduction of AHI and the improvement in minimum SaO2,but the sleep score is not improved significantly,the large sample and multi-center randomized controlled test needs to be designed for the verification of comprehensive effect of adjustable oral appliance.
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Objective To explore the effects of silencing Livin gene by RNA interference mediated by lentiviral vector on colorectal cancer HT-29 cell xenograft growth and sensitivity to radiotherapy in nude mice.Methods BALB/c nude mice models were established by subcutaneously inoculating differently treated HT-29 cells into nude mice and the tumor growth situation of tumors was observed by measuring the volume of tumors and the weight of the nude mice at different time points after cell seeding.Livin expression was detected by RT-PCR and immunohistochemistry,respetively.Apoptosis rate was detected by TUNEL.Normal saline,lentivirus carring unrelated sequences,lentivirus caning Livin shRNA were injected intratumorally.All the nude mice were given 10 Gy of 6 MV X-ray irradiation.The changes of mice weight and the tumor volume were measured at different time points and the weight and tumor growth curves were drawn.Results The inhibition rate of tumor volume was(50.04 ± 0.07)％ and the tumor weight of the RNA interfering group was significantly less than that in experimental group compared to the blank and negative groups(F=4.85,P＜0.05),and the inhibition rate of tumor weight was(50.27 ±0.17)％.Relative Livin mRNA expression level in the RNA interfering experimental group was(17.75 ±0.08)％,and was significantly lower than that of the blank group(67.60 ± 0.05)％ and the negative group(68.54 ± 0.03)％(F=89.97,P＜0.01).Livin protein expression level in the RNA inferring group was also significantly lower[(36.00 ± 3.40)％ versus(85.00 ± 3.15)％,(80.33 ± 3.08)％,F=107.32,P＜0.01].The apoptosis rate in the RNA interfering experimental group was significantly higher than that in the blank and the negative groups[(23.67 ± 2.25)％ versus(5.00 ± 1.50)％,(8.33 ± 1.82)％,F=56.94,P＜0.01].Combined with radiotherapy,the tumor volume at different groups had significant difference(F=10.70,P＜0.01),and RNA interfering group was significantly less than negative group and blank group(F=7.01-9.32,P＜0.01).Conclusions Silencing of Livin gene expression by lentiviral vector-mediated RNA interference could inhibit the growth of colorectal HT-29 cell xenograft and increase the sensitivity of the transplanted tumors to radiotherapy.
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Phased array transducers are very attractive because the beam generated by the arrays can be electronically focused and steered. The present work characterizes far-field 2D properties of phased array system by functions that are deduced from rectangle source, rectangle line array and phased array based on point source. Results are presented for the distribution of ultrasound intensity on plane xoz and on x-axis by simulation using numerical calculation. It is shown that the shape of response of rectangle line array is modulated by the single array element. It is also demonstrated that the delay time of phased array is the key to steer the beam, sacrificing the value of main lobe and increasing the number of side lobes.