RESUMO
Objective:To report the sampling study design and radiography protocol of a large-sample investigation on skeletal maturation of 3 to 18-year-old children in China.Methods:Multi-stage stratified random sampling was employed in this study. Two provinces, municipalities, or autonomous regions were randomly selected from each of the seven regions of China, including Northeast China, Northwest China, North China, Central China, East China, Southwest China, and South China. Then one rural and one urban investigation site were randomly selected from each province, municipality, or autonomous region. In total 28 sites were included. Among those sites, four residential districts were randomly selected from each urban site, and four townships from each rural site. For each residential district or township, 1-4 kindergartens, primary schools, and middle schools were chosen. Random cluster sampling was used to extract 3-<6-year-old children in kindergartens, and 6-18-year-old children in primary schools and middle schools. The investigation on skeletal maturation was sampled proportionate to the sampling of the whole study. The estimated simple size was 780 for each site, and 21 840 for all 28 sites in total. There were six groups of 3-<6-year-old children classified at 0.5-year intervals, and 12 groups of 6-18-year-old children classified at 1-year intervals. Posteroanterior position radiography of the left hand and wrist was achieved for all subjects.Results:The study was performed from August 26, 2019 to October 16, 2021. In total, 20 444 children received posteroanterior position radiography of the left hand and wrist, including 10 196 males and 10 248 females, 9 711 urban and 10 733 rural, respectively. The 3-<6-year-old group included 1 611 (male 819, female 792) subjects, and the 6 to 18-year-old group included 18 833 (male 9 377, female 9 456) subjects.Conclusion:This nationwide investigation on skeletal maturation of 3 to 18-year-old children in seven regions of China was successfully preformed. The results of this study can provide an important reference for establishing the current evaluation criteria of bone age in Chinese children and adolescents.
RESUMO
Background: Endoscopic submucosal dissection has become the preferred treatment for early gastric cancer without lymph node metastasis (LNM). The risk of LNM is different among different pathological types of early gastric cancer. Aims: To investigate the risk factors of LNM in patients with early gastric cancer. Methods: The clinicopathological features of 1 093 early gastric cancer patients underwent radical gastrectomy and diagnosed by pathology from January 2005 to December 2019 at Nanjing Drum Tower Hospital and Nanjing Gaochun People's Hospital were retrospectively analyzed. Risk factors of LNM in patients with early gastric cancer were analyzed by univariate analysis and logistic regression model analysis. Results: A total of 1 093 patients with early gastric cancer were enrolled, and positive LNM was found in 154 patients (14.1%). Univariate analysis showed that gender, age, tumor size, tumor location, gross classification, depth of tumor invasion, vascular and nerve invasion, differentiation type, ulcers were related with LNM (P<0.05). Multivariate analysis showed that age (OR=1.654, 95% CI: 1.102-2.480, P=0.015), tumor location (OR=1.617, 95% CI: 1.227-2.131, P=0.001), differentiation type (OR=1.664, 95% CI: 1.205-2.298, P=0.002), depth of invasion (OR=1.569, 95% CI: 1.212-2.030, P=0.001), vascular invasion (OR=10.514, 95% CI: 6.353-17.401, P=0.000) were the independent risk factors of LNM in early gastric cancer. Conclusions: Age, tumor location, differentiation type, depth of invasion, and vascular invasion are the independent risk factors of LNM in early gastric cancer, especially vascular invasion. For patients with vascular invasion, if there are no contraindications, surgical intervention is recommended.
RESUMO
Objective To investigate the assessment and treatment strategy of patients with renal cell carcinoma.Methods The clinical data of 43 patients with renal cell carcinoma and bone metastases admitted to the First Affiliated Hospital of Nanjing Medical University from January 2006 to December 2018 were retrospectively analyzed.The follow-up time was 6 years,with an average age of 55.4 years (21-87 years).There were 29 males,14 females,22 cases of limb bone metastasis,12 cases of spinal metastasis,9 cases of multiple bone metastasis,21 cases of Fuhrman grade 1 and 2,19 cases of T1,and 20 cases of N0.All patients were confirmed by postoperative pathological examination or imaging data suggesting that bone metastasis are from renal cell carcinoma.Forty-three patients underwent primary renal surgery,and molecular targeted therapy was used after the operation.The treatment process was smooth,no obvious discomfort,and postoperative pathology showed clear cell carcinoma.22 patients with limb bones metastasis and 12 patients with spinal metastasis included in the study all met the indications for secondary surgery after the disease assessment.After communicating with the patient,13 patients with limbs metastasis and 6 patients with spinal metastasis received local treatment,including complete resection of the extremities and spinal fixation,the remaining 15 patients and 9 patients with multiple bone metastasis were treated conservatively.There were 19 patients in the local treatment group,13 patients with limbs bone metastasis,6 patients with spinal bone metastasis,the average age was 54.9 years,the average diameter of the primary tumor was 4.7 cm.There were 24 patients in the conservative treatment group,9 patients with limbs metastasis,6 patients with spinal metastases and 9 cases with multiple bone metastasis,with an average age of 56 years and a primary tumor diameter of 5.6 cm.Limb metastatic lesions were evaluated according to the patient's general condition,bone pain,fracture risk,and bone metastasis.Spinal lesions were evaluated according to Tokuhashi score,Harrington score,Tomita score,vertebral stability assessment,and molecular targeted therapy.Aminokinase inhibitors,conservative treatment with local radiotherapy and bisphosphonate treatment.Results During the follow-up period,the 1-year overall survival rate of the local treatment group was 100.0％,the 2-year overall survival rate was 89.4％,and the 5-year overall survival rate was 73.7％.The 1-year overall survival rate of the conservative treatment group was 87.5％,and the 2-year overall survival rate was 62.5％.The 5-year overall survival rate was 16.7％.The 2-year and 5-year survival rates of the local treatment group were statistically different (P =0.044,P =0.000) compared with the conservative treatment group.For patients with limb bone metastasis,the 5-year survival rate was significantly higher in patients receiving topical treatment than in the conservative treatment group (P =0.011).For spinal metastasis,spinal pain in the local treatment group was alleviated to varying degrees.No spinal instability and spasticity were observed after follow-up.In the spine patients who received conservative treatment,3 patients developed paraplegia,which was statistically different from local treatment (P =0.046).Another 9 patients with multiple bone metastases did not undergo local surgery,and all died after multiple organ failure.Conclusions At the same time of molecular targeted therapy,according to the evaluation results,selective treatment of bone metastases with secondary surgical indications,including complete resection of the extremities and spinal fixation,can significantly improve the survival and quality of life of those patients.
RESUMO
Objective@#To investigate the assessment and treatment strategy of patients with renal cell carcinoma.@*Methods@#The clinical data of 43 patients with renal cell carcinoma and bone metastases admitted to the First Affiliated Hospital of Nanjing Medical University from January 2006 to December 2018 were retrospectively analyzed. The follow-up time was 6 years, with an average age of 55.4 years (21-87 years). There were 29 males, 14 females, 22 cases of limb bone metastasis, 12 cases of spinal metastasis, 9 cases of multiple bone metastasis, 21 cases of Fuhrman grade 1 and 2, 19 cases of T1, and 20 cases of N0. All patients were confirmed by postoperative pathological examination or imaging data suggesting that bone metastasis are from renal cell carcinoma. Forty-three patients underwent primary renal surgery, and molecular targeted therapy was used after the operation. The treatment process was smooth, no obvious discomfort, and postoperative pathology showed clear cell carcinoma.22 patients with limb bones metastasis and 12 patients with spinal metastasis included in the study all met the indications for secondary surgery after the disease assessment. After communicating with the patient, 13 patients with limbs metastasis and 6 patients with spinal metastasis received local treatment, including complete resection of the extremities and spinal fixation, the remaining 15 patients and 9 patients with multiple bone metastasis were treated conservatively. There were 19 patients in the local treatment group, 13 patients with limbs bone metastasis, 6 patients with spinal bone metastasis, the average age was 54.9 years, the average diameter of the primary tumor was 4.7 cm. There were 24 patients in the conservative treatment group, 9 patients with limbs metastasis, 6 patients with spinal metastases and 9 cases with multiple bone metastasis, with an average age of 56 years and a primary tumor diameter of 5.6 cm. Limb metastatic lesions were evaluated according to the patient's general condition, bone pain, fracture risk, and bone metastasis. Spinal lesions were evaluated according to Tokuhashi score, Harrington score, Tomita score, vertebral stability assessment, and molecular targeted therapy. Aminokinase inhibitors, conservative treatment with local radiotherapy and bisphosphonate treatment.@*Results@#During the follow-up period, the 1-year overall survival rate of the local treatment group was 100.0%, the 2-year overall survival rate was 89.4%, and the 5-year overall survival rate was 73.7%. The 1-year overall survival rate of the conservative treatment group was 87.5%, and the 2-year overall survival rate was 62.5%. The 5-year overall survival rate was 16.7%. The 2-year and 5-year survival rates of the local treatment group were statistically different (P=0.044, P=0.000) compared with the conservative treatment group. For patients with limb bone metastasis, the 5-year survival rate was significantly higher in patients receiving topical treatment than in the conservative treatment group (P=0.011). For spinal metastasis, spinal pain in the local treatment group was alleviated to varying degrees. No spinal instability and spasticity were observed after follow-up. In the spine patients who received conservative treatment, 3 patients developed paraplegia, which was statistically different from local treatment (P=0.046). Another 9 patients with multiple bone metastases did not undergo local surgery, and all died after multiple organ failure.@*Conclusions@#At the same time of molecular targeted therapy, according to the evaluation results, selective treatment of bone metastases with secondary surgical indications, including complete resection of the extremities and spinal fixation, can significantly improve the survival and quality of life of those patients.
RESUMO
Objective This study was designed to determine the mechanisms of carbapenem and fosfomycin resistance in an Escherichia coli strain isolated from bloodstream infection in Huashan Hospital,Shanghai in 2010 and the mode of transmission of resistance genes.Methods The Escherichia coli isolate was characterized by antibiotic susceptibility testing,multilocus sequence typing (MLST),molecular identification of resistance genes,plasmid typing and the resistant genetic environment analysis.Results It was found that the isolate was resistant to carbapenem,fosfomycin and produced extended-spectrum β-1actamases.MLST genotyping showed it belonged to ST46.The carbapenem-resistant gene blaKPC-2 and fosfomycin resistant genefosA3 co-located on the same conjugative plasmid (～ 70 kb).The β-lactamases gene blaTEM and blaCTX-M located on another conjugative plasmid (～ 150 kb).PCR mapping showed that blaKPC-2 gene located in the structure Tn1721-blaKPC-2-Tn3 andfosA3 gene located between two IS26 elements.Conclusions This Escherichia coli strain isolated from bloodstream infection carried multiple antibiotic resistant genes,including blaKPC-2,fosA3,blaTEM,and blaCTX-M.More attention should be paid to the mechanisms of antibiotic resistance and transmission of resistance genes in Escherichia coli isolates for better control of hospital infections.
RESUMO
Objective There were few studies of prediction on type 2 diabetic patients with acute pulmonary thromboembo?lism.To evaluate the performance of the Padua score, revised Geneva score and Wells PE score in the prediction value of diagnosis of type 2 diabetes mellitus with acute pulmonary thromboembolism( APTE) . Methods 151cases with suspected APTE of type 2 diabe?tes were collected from January 2013 to December 2015 by a retrospective case analysis mode. Among 151 pations,80 cases had diag?nosed with pulmonary thromboembolism.The receiver operating characteristic (ROC) curve was used to evaluate the probability of type 2 diabetic patients with APTE predicted by the Padua, the revised Geneva and the Wells PE score. We calculated the Youden Index for the cut?off point. Results The area under curve( AUC) of the ROC curve in the Padua score, revised Geneva score and Wells PE score for APTE was 0.804±0.035、0.635±0.045 and 0.705±0.043. The area under the ROC curve of the Padua score was the highest and there was a significant difference compared with the revised Geneva( P0.016 7) . The comparison of revised Geneva score and Wells PE for the predication value was no statistically significant difference ( P>0.016 7) . The cut?off of Padua score was 3 points and Youden Index was 0.51. The cut?off of Revised Geneva was 3 points and Youden In?dex was 0.24. The cut?off of Wells PE score was 1 points and Youden Index was 0.39. Conclusion Padua score, revised Geneva score and Wells PE score in predicting diabetes patients have some ex?tent clinical value terms, which Padua score has higher predictive value than the Revised Geneva.The predictive value of Padua score and Wells PE score was equivalent.However, the predictive value of Padua score is limited.
RESUMO
This study was aimed to explore the suppression of nitric oxide (NO) production in RAW264.7 cells by total lactones fraction from Andrographis paniculata. The inflammatory model in vitro was established by stimulating the RAW264.7 cells with lipopolysaccharide (LPS). The NO production and inhibitory rate were determined by Griess assay. Cytotoxicity was evaluated by MTT method. The results showed that total lactones fraction ofA. paniculata suppressed NO production in a concentration-dependent manner in the concentration range from 5 to 50μmol·L-1 and their IC50 values were 8.58μmol·L-1, 11.52μmol·L-1 and 8.94μmol·L-1, respectively. In this condition, major constituents were andrographolide (5-60μmol·L-1), dehydroandrographolide (5-100μmol·L-1) and neoandrographolide (5-100μmol·L-1) inhibited NO production in a dose-dependent manner with an IC50 values of 17.54μmol·L-1, 49.54μmol·L-1 and 41.80μmol·L-1, respectively. It was concluded that the NO inhibitory activity of total lactones fromA. paniculata was better than three active ingredients, which may be able to provide a theoretical foundation and scientific basis for the preparation and clinical application of total lactones fraction fromA. paniculata.
RESUMO
Objective To observe clinical efficacy and safety on the treatment of moderate-severe cancer pain by Fluvoxamine combined with Oxycodone. Methods 120 cancer patients with moderate pain and 120 cases with severe pain were selected, randomly divided into experimental group and control group. The control group were given oxycodone alone , and experimental group given fluvoxamine combined with oxycodone , till the pain relieved, then the degree of pain relief, oxycodone dosage, life quality and side effects were evaluated. Results The degree of pain relief in experimental group were much better than control group (P < 0.05). Oxycodone consumption were lower in experimental group than control group , and the difference was no significant difference in controlling moderate pain (P = 0.065), while statistically significant in controlling severe pain (P = 0.035). The general status, daily activity, mood, and sleep affected by cancer pain were released after treatment, especially in experimental group (P < 0.05). The most common side effects were approximative, and the incidence of constipation, nausea/vomiting, lethargy were lower in experimental group than control group (P =0.026). Conclusion Fluvoxamine combined with Oxycodone can effectively control moderate-severe cancer pain, and reduce the oxycodone dosage and some side effects, and therefore, improve the quality of life.
RESUMO
<p><b>BACKGROUND</b>The performance of computed tomography X-ray absorptiometry (CTXA) against the dual energy X-ray absorptiometry (DXA) as standard has not been studied in Chinese population. The aim of this study was to evaluate the precision of this measurement and validate the value of quantitative computed tomography (QCT) by comparing CTXA results with DXA results in an elderly Chinese population.</p><p><b>METHODS</b>One hundred and three females of 46 to 76 years old and 49 males of 52 to 76 years old were recruited from the Prospective Urban Rural Epidemiology study. All subjects underwent hip scans by both QCT and DXA on the same day. For precision determination, 30 subjects had duplicate DXA hip scans. The hip QCT data of a subset of 27 subjects were separately analyzed by two observers and reanalyzed by one observer at a different time. The inter- and intra-observer variations of CTXA measurement were assessed, and the difference and correlation between CTXA and DXA results were analyzed.</p><p><b>RESULTS</b>The inter- and intra-observer variations of CTXA were 0.070 and 0.024 g/cm(2) in the femoral neck (FN), and 0.030 and 0.012 g/cm(2) in the total hip (TH), which were comparable to the DXA inter-scan variations (0.013 g/cm(2) for FN and 0.014 g/cm(2) for TH). The results of CTXA bone mineral density (BMD) were highly correlated with those of DXA (R(2) = 0.810 for FN and R(2) = 0.878 for TH). The BMD values of CTXA in FN and TH were lower than those of DXA by 21.0% and 17.8% (P < 0.05), respectively. However, after appropriate transformation, the difference was eliminated and a comparable T score could be obtained.</p><p><b>CONCLUSIONS</b>CTXA shows good agreement with DXA for the measurement of BMD in the proximal femur, which makes QCT suitable for the quantification of bone mineral content in the hip and helpful for the diagnosis of osteoporosis.</p>
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Absorciometria de Fóton , Métodos , Densidade Óssea , Fisiologia , Osteoporose , Diagnóstico , Diagnóstico por Imagem , Tomografia Computadorizada por Raios XRESUMO
Objective To reduce the turnaround time for laboratory diagnosis of bacteremia, the feasibility of rapid identification and susceptibility testing using samples taken directly from positive blood culture bottles was evaluated. Methods The growth of microorganisms in blood culture bottles was screened by the BACTEC 9000 blood culture system. 65 positive blood culture bottles containing gram-negative bacteria were adopted to test. Culture fluid was injected into BD SST vacutainer and centrifuged to pellet blood cells. After collecting required McFarland units, they were cultured on Phoenix 100 NMIC/ID-4(identification-gram-negative bacteria and susceptibility testing) cards using 0.25 McF and 0.5 McF methods respectively. They were also evaluated by the standard method, involving subculture tests from positive blood culture bottles. Results 63 of 65 gram-negative bacteria (96. 9% ) were correctly identified with 0. 25 McF method. 59 of 65 gram-negative bacteria(90.8% ) were correctly identified with 0.5 McF method. For antimicrobial susceptibility testing, the 0.25 McF direct method had an agreement rate more than 94% , the 0.5 McF method was more than 85.7% and direct blood sample KB method was more than 93.8% compared to the standard method. But the overall minor error rate in susceptibility testing of direct blood sample KB method is higher than other methods. Conclusion Applying 0. 25 McF and 0. 5 McF rapid identification and susceptibility test was practical. During to possessing more prominent advantages, laboratory put the 0. 25 McF direct method into practice had a timely, remarkable significance.