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Objective:To explore the correlation between self-efficacy and discharge readiness in patients with enterostomy.Methods:It was a cross-sectional study. Using the self-efficacy Scale and the Readiness for Discharge Scale as research tools, the patients who underwent enterostomy in the Department of General Surgery of Peking Union Medical College Hospital from December 2018 to December 2019 were conveniently selected for questionnaire survey. Statistical descriptive variables such as mean values, median values and frequency were used to investigate the current situation of self-efficacy and discharge readiness of patients with enterostomy. Pearson correlation analysis (or Spearman correlation analysis) was used to explore the correlation between self-efficacy and discharge readiness in these patients.Results:The total self-efficacy score of the 121 patients with enterostomy was (75.81±21.16) points, and the total discharge readiness score was (138.11±34.60) points. The total score of self-efficacy in the patients with enterostomy was positively correlated with the total score of readiness for hospital discharge ( r=0.379, P<0.01). No correlation was found between the self-condition dimension and the confidence and efficacy of sexual life ( r=0.125, P>0.05) and the confidence and efficacy of sexual life satisfaction ( r=0.062, P>0.05). The disease knowledge dimension was positively correlated with the following variables, self-efficacy score ( r=0.311, P<0.01), stoma care efficacy ( r=0.358, P<0.01), self-social efficacy ( r=0.227, P<0.05), diet choice efficacy ( r=0.221, P<0.05) and stoma self-care confidence efficacy ( r=0.249, P<0.01). The post-discharge coping ability dimension was positively correlated with the total score of self-efficacy ( r=0.428, P<0.01). Anticipatory social support dimension was positively correlated with self-efficacy ( r=0.218, P<0.05), self-social efficacy ( r=0.226, P<0.01), vitality confidence ( r=0.202, P<0.05) and stoma self-care confidence ( r=0.198, P<0.05). Conclusion:The self-efficacy level of patients with enterostomy can positively predict the level of readiness for discharge.
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Fluid resuscitation is an essential intervention in critically ill patients, and its ultimate goal is to restore tissue perfusion. Critical illnesses are often accompanied by glycocalyx degradation caused by inflammatory reactions, hypoperfusion, shock, and so forth, leading to disturbed microcirculatory perfusion and organ dysfunction. Therefore, maintaining or even restoring the glycocalyx integrity may be of high priority in the therapeutic strategy. Like drugs, however, different resuscitation fluids may have beneficial or harmful effects on the integrity of the glycocalyx. The purpose of this article is to review the effects of different resuscitation fluids on the glycocalyx. Many animal studies have shown that normal saline might be associated with glycocalyx degradation, but clinical studies have not confirmed this finding. Hydroxyethyl starch (HES), rather than other synthetic colloids, may restore the glycocalyx. However, the use of HES also leads to serious adverse events such as acute kidney injury and bleeding tendencies. Some studies have suggested that albumin may restore the glycocalyx, whereas others have suggested that balanced crystalloids might aggravate glycocalyx degradation. Notably, most studies did not correct the effects of the infusion rate or fluid volume; therefore, the results of using balanced crystalloids remain unclear. Moreover, mainly animal studies have suggested that plasma may protect and restore glycocalyx integrity, and this still requires confirmation by high-quality clinical studies.
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Animais , Humanos , Coloides , Soluções Cristaloides/uso terapêutico , Hidratação , Glicocálix , Derivados de Hidroxietil Amido , Soluções Isotônicas , Microcirculação , RessuscitaçãoRESUMO
Objective To investigate the epidemiology,clinical features,etiology and treatment of Kaposi sarcoma after kidney transplantation through the diagnosis and treatment of a patient with Kaposi sarcoma after kidney transplantation.Methods The clinical data of a 61-year-old man with Kaposi sarcoma who had kidney transplantation in 2015 were retrospectively analyzed,and the relevant leteratures at home and abroad were reviewed.The patient was an elderly male who underwent renal allograft transplantation for end-stage uremia,and the operation was successful.Preoperative detection of antibodies such as EB virus were negative.Besides,the donor donated organs after the death of the citizen (donation after cardiac death).The man developed dark brown plaques on the outside of his right lower leg and had a roundish-purple tumor on his left ear at the end of 3 months after kidney transplantation,gradually increasing without any other special discomfort.After admission,relevant examinations showed that the function of the transplanted kidney was stable and no other related lesions were found.HIV confirmatory test was negative and the pathology was consistent with Kaposi sarcoma.Therefore,the diagnosis was Kaposi sarcoma and kidney transplantation status.Results Then,the treatment was modified.The cyclosporine +mycophenolate mofetil + prednisone triple immunosuppressive regimen was discontinued and the immunosuppressive drug was changed to sirolimus at a concentration of about 5.69 ng/mL.After treatment for half a year,the Kaposi sarcoma disappeared gradually.Furthermore,the graft function was still stable and up to now,no recurrence of Kaposi sarcoma has been observed.Conclusion Though characteristics of skin lesion are helpful,confirmed diagnosis relies on pathology.And sirolimus may be effective in the treatment of Kaposi sarcoma after kidney transplantation.
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Objective To investigate the clinical effect of locking plate fixation in treatment of proximal humeral fractures in the elderly.Methods This retrospective case control study enrolled 96 patients with closed proximal humeral fractures admitted from October 2013 and October 2015.There were 52 males and 44 females,with age of (68.2 ± 1.4) years (range,62-74 years).According to the Neer classification of proximal humeral fractures,two-part fractures were noted in 27 patients,three-part fractures in 57,and four-part fractures in 12.According to the surgical methods,the patients were assigned to locking plate fixation (observation group) and anatomic plate fixation (control group),with 48 cases each.Operation time,intraoperative blood loss,hospitalization time,fracture healing time,varus angle of the humeral head,visual analogue score (VAS),Neer shoulder score for shoulder function and related complications were observed.Results All patients were followed up for 13-24 months (mean,18.5 months).Better results were observed in observation group than control group in aspects of operation time [(51.2 ± 14.8) minutes vs.(73.2 ±27.3)minutes],intraoperative bleeding[(158.3 ±32.9)ml vs.(270.9 ± 34.8) ml],hospitalization time [(8.2 ± 2.9) days vs.(13.1 ± 2.2) days],fracture healing time [(93.7 ±18.4)days vs.(122.9±18.9)days],varus angle of the humeral head [(2.2±1.8)° vs.(4.2± 1.3) °],VAS [(2.0 ± 0.7) points vs.(5.1 ± 1.2) points],excellence rate of Neer score (98％ vs.90％) and postoperative complication incidence (10％ vs.21％) (P ＜ 0.05).Conclusion Compared with the anatomical plate,locking plate fixation has advantages of shorter operation time,less intraoperative bleeding,earlier bone healing,better shoulder movement and less postoperative complications in treatment of proximal humeral fractures.
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Objective To investigate the incidence of gluteal muscle contracture(GMC) of students in 18 primary and secondary schools in Rongchang county .Methods We used health screening tests to investigate students′health condition about gait and knee squat ,snapping levy ,obber levy ,hip muscles ,the hip joint activities .Results Among the 15 000 students in 18 primary and second‐ary schools in Rongchang county ,25 case(1 .67‰)were diagnosed with GMC ,70% of them had received muscular injection and 40% of them were Left‐behind children .Conclusion The incidence rate of GMC in Rongchang county is appropriate to other parts of our country ,the disease should be strengthened to prevent and treat .
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Objective:To investigate the relationship between dopamine D1 receptor ( DRD1 ) gene polymorphisms and clozapine efficacy in male schizophrenic patients. Methods:Totally 46 male schizophrenic patients were treated by clozapine for 6-8 weeks. The clinical response was determined by the Positive and Negative Symptom Scale (PANSS). DRD1 gene rs265981, rs5326, rs4532, rs1799914, rs686 and rs4867798 polymorphisms were detected by the gene sequencing, while plasma clozapine levels were monitored during the treatment. Results:The total clinical efficacy of clozapine response group and the non-response group was compared, the distribution of rs265981 genotype TT, TC and CC and allele T and C had statistically significant differences (P=0. 025;P=0. 005), and the distribution of rs686 genotype CC, CT and TC and allele C and T had statistically significant differences ( P=0. 044;P=0. 010). The negative symptom of the response group was compared with that of the non-response group, the distribution of rs4532 gen-otype GG, GA and AA and allele G and A had statistically significant differences (P=0. 034; P=0. 013). Conclusion: The poly-morphisms of DRD1 gene rs265981 and rs686 may have influence on the clinical efficacy of clozapine, and rs4532 may have influence on the negative symptom.
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Objective To evaluate the of the decision process to perform staged or synchronous bilateral percutaneous nephrolithotripsy (PCNL) in the treatment of bilateral upper urinary tract calculi. Methods Patients with an indication for bilateral PCNL were enrolled in the study from Jan. 2008 to Dec. 2008. The decision to perform staged or synchronous bilateral PCNL was based on the initial side operative time, the changes of hemoglobin level and systolic arterial pressure, the results of blood gas analysis and the patient′s tolerance at the end of initial side operation. The patients were divided into two groups, patients who underwent synchronous bilateral PCNL were in group one. Patients where the PCNL procedure was stopped after the initial side and subsequently underwent staged bilateral PCNL three to six weeks later were placed in group two. The success and complication rates of two groups were compared and analyzed. Results Of 60 planned simultaneous bilateral PCNLs, nine were stopped after the initial side, due to prolonged operative time in four cases, a hemoglobin level ＜100 g/L or the decrease of more than 30 g/L in three cases, a systolic arterial pressure lower than 90 mm Hg or the decrease more than 30 mm Hg in two cases, an arterial blood pH lower than 7.35 or the arterial oxygen saturation lower than 95% in two cases or the patients were intolerant to the surgery in three cases. Between the two groups, the differences of patient gender, age, BMI, preoperative hemoglobin level, the total hemoglobin decrease, the side initiated operation, stone number and second side stone burden were insignificant. However, there were significant differences in the first operative side stone burden, total stone burden, the first operative side operative time and total operative time. The stone-clearance rate was 87.3% in group one and 88.9% in group two. There was no difference in complication rate of two groups. Conclusions Prolonged operative time, large blood loss during the first operation side and patient intolerance are the main causes of staged bilateral PCNL.
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Objective To investigate the possible role of plasma leptin and total cholesterol in the pathophysiology of attempted suicide in depressive episode patients. Methods The subjects were 25 depressive episode patients who had recently attempted suicide and 30 depressive episode patients without suicide attempt. The Hamilton Depression Rating Scale-24 items ( HAMD24 ), Beck Helpless Rating Scale (BHS) and Self-rating Idea of Suicide Scale (SIOSS) were used to evaluate the severity of symptoms. In addition, 32 individuals who took part in health examination were selected as health control group. Body height and weight were measured to get body mass index (BMI) of all objects, and plasma leptin and total cholesterol were measured by venous blood before taking pill. Results (1)HAMD score , BHS score and SIOSS score in patients with attempted suicide were higher than patients without suicide (P ＜ 0.01 ). (2) The total cholesterol and plasma leptin in patients with attempted suicide ( (3.3 ±0.9)mmol/L, (6.1 ±3.7)μg/L)were lower than that in patients without suicide( (3.6± 1.2)mmol/L, (9.4 ± 4.4)μg/L; P ＜ 0.05 ～ 0. 0l ), while total cholesterol and leptin in patients without suicide attempt ( (3.6 ± 1.2 ) mmol/L, ( 9.4 ± 4.4 ) μg/L) were lower than that in normal controls ( ( 4.8 ± 0.9 )mmol/L, ( 13.4 ± 6.7 ) μg/L; P ＜ 0.05 ～ 0.01 ). (3) Plasma leptin and total cholesterol of all patients were positively correlated with BMI(P＜0.01 ). Moreover, plasma leptin and total cholesterol in patients with attempted suicide and patients without attempted suicide were inversely positively correlated with HAMD score , BHS score and SIOSS score. Plasma leptin was significantly positively correlated with total cholesterol in patients with attempted suicide and patients without suicide, but there was no significant difference in normal controls(P＞ 0. 05). Conclusion The results suggest that decreased plasma leptin is related to the pathophysiology of attempted suicide in depressive episode patients.
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Lidamycin (LDM) is a potent antitumor antibiotic. Previous studies have shown that LDM could inhibit proliferation and migration in endothelial cells. In the present report, the effect of LDM on angiogenesis of zebrafish embryo was studied. The results showed that treatment of zebrafish embryos with LDM resulted in significant inhibition of angiogenesis. Morphological observation, quantitative endogenous alkaline phosphatase (EAP) assay, alkaline phosphatase staining, and transgenic zebrafish assay were performed to evaluate vascular development defects in zebrafish. The results indicated that after the zebrafish embryos were exposed to LDM, angiogenesis defects of zebrafish embryos were observed, including pericardial edema, reduced numbers of circulating red blood cells, suppression of zebrafish vessel growth, and absences of SIV (subintestinal vein). The expression of VEGF was detected by RT-PCR assay, quantitative reverse transcriptase real-time PCR (qRT-PCR) assay and Western blotting analysis. The results revealed that LDM could inhibit the expression of VEGF protein, while the expression of mRNA was not significantly affected. The study suggests that LDM could inhibit the zebrafish embryo angiogenesis by down-regulation ofVEGF expression.
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Objective To discuss the safety and efficacy of simultaneous bilateral percutaneous nephrolithotomy (SBPCNL) for bilateral renal or upper ureteral calculi. Methods Forty-eight cases (26 males, 22 females, 24-57 years )who underwent SBPCNL with pneumatic and ultrasonic power for bilateral renal or upper ureteral calculi were retrospectively reviewed. Clinical data including opera-tion time, blood loss, transfusion rates, length of hospital stay, stone free rate and complications were analyzed. Results The percutaneous renal access was successfully established under ultrasonic guid-ance in all patients. The average operation time was(105±18) rain(range 80-190 min). The average drop in hemoglobin was 21 g/L (range 5-54 g/L), with 5 patients requiring blood transfusion. In 43 patients, a single stage was performed on both sides, while 5 required the second stage PCNL on one side. A single tract was adopted on both sides in 44 patients, while 4 cases of the patients required two tracts on one side. No one required two tracts on both sides or more than one stage on both sides. The stone-clearance rate was 87.5 %. The average hospital stay was 6.5 d. There was no severe complica-tion occurred. Conclusion SBPCNL might be safe and effective for bilateral renal or upper ureteral calculi for selected patients.
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Objective To explore the safety of the elderly donors in living related donor kidney transplantation. Methods Forty-five elderly donors (51 - 78 years,study group) who underwent ne-phrectomy for living related donor kidney transplantation from April 1993 to December 2007 were retrospectively investigated. Clinical data including serum creatinine (SCr), glomerular filtration rate (GFR) in pre-and post-operation, operation complications and hospital stay time were analyzed and compared with the control group(62 cases, the donors age were younger than 50 years). Results The operations of all living donors were successful. The SCr and GFR in pre-operation were (82.16 ± 10.86)μmol/L, (85. 82±6.26)ml/min(study group)and (78. 66±10. 41)μmol/L, (88. 74±9. 44) ml/min (control group) respectively. There were no significant differences in SCr and GFR between the groups at different time points (P>0. 05). The average hospitalization time was 9 days in study group and 8 days in control group. There were no severe perioperative complications and no renal function failure was found in long-term following-up in study group. Conclusions Age is not the absolute contraindication of donor for living related donor kidney transplantation. The preoperative evaluation and careful operation can ensure the safety of elderly donors.
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Objective To report the experiertce of management of complicated renal stones by percu taneous nephrolithotripsy (PCNL) with pneumatic and ultrasonic power by ultrasound guidance. MethodsThree hundred and eighty two cases(218 males,164 females,4 74 years) who underwent PCNL by u sing the third generation Swiss LithoClast Master for kidney stones from 2004 to 2007 were retrospectivelyreviewed. Clinical data including operation time,stone free rate and complications were analyzed. ResultsPhaseⅠlithotripsy was performed in 397 sides and delayed phaseⅡlithotripsy in 8 sides. Twenty three casesunderwent simultaneous bilateral PCNL. The operation time ranged from 70 to 190 min,average time was(93±11)min. Nine cases needed blood transfusion. Severe complications did not occur during operations.Stone free rate was 91.8% (372/405). Residual stone fragment was found in 33 cases after delayed phase Ⅱlithotripsy and 14 cases received adjuvant extracorporeal shock wave lithotripsy. One hundred and forty sixcases were followed up for 3 to 24 months and showed no recurrence. Conclusion PCNL with pneumaticand ultrasonic power could be an efficient treatment for complicated kidney stones.
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BACKGROUND:Now researches on psychiatric disease and molecular heredity are becoming more and more gradually because of the development of molecular genetics,but conclusions are controversial,and for the time being there are no reports about whether there are regional differences and ethnical differences in the distribution of genotype frequency of 5-hydroxytryptamine 2A receptor gene T102C.OBJECTIVE:Researches on the geographic distribution of genotype frequency of 5-hydroxytryptamine 2A receptor gene T102C of schizophrenics people.DESIGN:Sample survey and observation with schizophrenics selected as subjects.SETTING: Mental Department, Changzhou Peace Hospital.PARTICIPANTS: The experiment was completed in The No.102 Hospital of PLA from January 1999 to August 2003.Totally 177 people of Han nationality (Age: 18-45; Duration of illness: 1 month-20 years) from different provinces and autonomous regions of China in compliance with diagnostic standards of Psychiatric Disease Classification and Diagnosis Standards of China (The 3rd version) were selected as the subjects.METHODS:The blood samples from 117 schizophrenics were given test of polymerase chain reaction(PCR),and the distribution differences of genotype frequency of 5-hydroxytryptamine receptor gene of normal control population from different provinces and autonomous regions were compared. DNA were abstracted by means of phenol chloroform, amplification and cataphoresis test of polymerase chain reaction of target DNA,primer sequence of gene segment amplification of 5-hydroxytryptamine (5-HT) 2A receptor gene T102C: 5'-TCT GCT ACA AGT TCT GGC TT-3', 5 '-CTG CAG CTT TTT CTC TAG GG-3'; Reaction system of 50 μL, DNA 0.5 μg,Primer 50 pmol,TagDNA enzyme 2U were added with dNTP to the final concentration of 200 μmol/L.MAINOUTCOMEMEASURES: DNA cataphores is test of schiophrenicanddistributionofgenotypefrequencyof5-hydroxytryptamine 2A receptor gene.RESULTS: The distribution of genotype frequency of 5-hydroxytryptamine(5-HT) 2A receptor gene: A1A1, 0.07-0.03; A1A2, 0.50-0.72; A2A2,0.17-0.29. Correlation analysis of genotype frequency in different regions:A1A1, x2=4.44, P=0.617 1, P ＞ 0.05;A1A2, x2=1.14, P=0.942 2, P ＞ 0.05;A2A2, x2=0.93, P=0.985 7, P ＞ 0.05.CONCLUSION: The geographic distributions of genotype frequency of 5-hydroxytryptamine 2A receptor gene T102C of schizophrenics of the Chinese Han nationality people were comparatively even.
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Objective To assess the clinical efficacy of patient controlled intravenous analgesia (PCIA) with mixture of fentanyl and droperidol for post-prostatectomy pain. Methods 104 patients undergone prostatectomy were randomly divided into two groups. In group A, the patients received PCIA.In group B, they received routine analgesia.The pain scores of visual analogue pain scale (VAS) and control of bladder spasm were recorded at various time postoperatively, and the time of continuous infusion of bladder, the time of indwelling catheter and the mean hospitalization time were also recorded. Results Compared with those of group B,the VAS,continuous time and ratio of bladder spasm decreased markedly in group A ( P
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Objective To study the diagnosis and treatment of aldosterone producing adenoma of the adrenal gland. Methods From January 1988 to January 2000,69 cases of aldosterone producing adenoma of the adrenal gland were diagnosed and treated.The diagnosis was all confirmed on open surgery and pathological studies. Results In all the patients,serum potassium level resumed to normal range in a week postoperatively.48 patients have been followed up for 3 months to 10 years,in 45 of them the blood pressure dropped to normal.In the other 3, drugs are still needed to control blood pressure after operation. Conclusions Spironolactonum test and serum aldosterone assay were the main methods of qualitative diagnosis of aldosterone producing adenoma.The location of the growth was mainly assessed on B ultrasono graphy and CT, the diagnostic accuracy being 81.2 percent and 100 percent respectively.Operation was the effective treatment method for aldosterone producing adenoma.
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Objective To investigate the geographic distribution of 5-HT2A T102C genotypes frequency in the PLA schizophrenia patients. Methods The 5-HT2A receptor gene T102C polymorphism was analyzed for genotyping by the method of polymerase chain reaction(PCR)in 177 male PLA schizophrenia patients. Results The distribution of 5-HT2A genotypic frequencies in 177 male PLA schizophrenia patients were 0.07~0.33(? 2=4.44,P=0.617 1) for A1A1, 0.50~0.72 for A1A2 (? 2=1.14, P=0.942 2), and 0.17~0.29 for A2A2 (? 2=0.93, P=0.985 7), respectively. There was no significant correlation between 5-HT2A frequencies and different populations. Conclusion The frequencies of 5-HT2A T102C genotypes in the PLA schizophrenia patients were uniform in different populations.
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A method for determination of seleninm in foods by hydride generation -atomic absorption spectrometry was described. Food samples were digested by heating with a mixture of nitric, perchloric, and sulfuric acids. After addition of 4ml of 6mol/L HC1, the digests were heated in a boiling water bath to reduce selenate to selenite. The hydride of selenium was evolved by reduction with 1% KBH4 from a system of 2mol/L HC1-1% K3Fe(CN)6 and then atomized in a laboratory-constructed electrically heated silica absorption tube. Absolute detection limit of the method was 2ng and the linear range was from 0 to 10 ng/mlSe. Recoveries of inorganic selenium added to a variety of foods ranged from 83% to 112%. Accuracies checked with standard materials of pig liver and brassica oleraca were within the certified values. The loss and pollution of selenium during the sample pretreatment were also studied.