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ObjectiveTo explore the effects of modified Danggui Beimu Kushen pills on tumor growth and T-cell subsets in H22 hepatocellular carcinoma-bearing mice and to provide an experimental basis for the treatment of hepatocellular carcinoma with modified Danggui Beimu Kushen pills combined with immune checkpoint antibodies. MethodA H22 hepatocellular carcinoma-bearing mouse model was established. The modeled mice were randomized into model， cisplatin， low- （4 g·kg-1·d-1）， medium- （8 g·kg-1·d-1）， and high-dose （16 g·kg-1·d-1） modified Danggui Beimu Kushen pills groups. After continuous administration for 14 days， the mice were sacrificed on day 15. The tumor volume was measured on days 0， 4， 8， 12， 15 of drug administration. Tumors were weighed and thymus index and spleen index were calculated. Spleen lymphocytes were co-cultured with H22 hepatoma cells， and the tumor cell-killing rate was detected by the cell counting kit-8 （CCK-8）. Real-time polymerase chain reaction was carried to determine the mRNA levels of programmed cell death protein-1 （PD-1） and lymphocyte activation gene-3 （LAG-3） in spleen and tumor tissues. The number of CD4+ and CD8+ T cells and the expression of PD-1 and LAG-3 were detected by immunohistochemistry （IHC）. ResultOn day 8 of drug administration， tumor volumes in all treatment groups decreased compared with that in the model group. On day 15， both tumor volume and tumor weight were significantly lower in the treatment groups than in the model group （P<0.01）， with the cisplatin group showing the most pronounced reduction. Compared with the model and cisplatin groups， medium- and high-dose modified Danggui Beimu Kushen pills increased the thymus index （P<0.01）. Compared with the model group， all treatment groups showed increased spleen index （P<0.05， P<0.01）， with the cisplatin group showing the most significant increase. Compared with the model and cisplatin groups， all the groups of modified Danggui Beimu Kushen pills demonstrated increased number of CD4+ and CD8+ T cells and tumor cell-killing rate in the spleen and tumor tissues （P<0.01） and down-regulated mRNA and protein levels of LAG-3 （P<0.05， P<0.01）. The high-dose group of modified Danggui Beimu Kushen pills had lower mRNA level of PD-1 in the tumor tissue than the model and cisplatin groups （P<0.01）. ConclusionModified Danggui Beimu Kushen pills may promote the proliferation and tumor microenvironment infiltration of CD4+ and CD8+ T cells in H22 tumor-bearing mice by down-regulating LAG-3 expression， thereby improving T-cell immune activity and inhibiting tumor growth. This study provides an experimental basis for the combination of modified Danggui Beimu Kushen pills and immune checkpoint antibodies in the treatment of hepatocellular carcinoma.
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BackgroundThe existing tools in China for assessing psychiatric nurses' knowledge， attitude and practice towards the use of protective restraint do not sufficiently consider the specialty in psychiatric practice， and the scale items are somewhat cumbersome to use， which together restrict their further promotion and application. Accordingly， there is an urgent need for developing a more scientific assessment tool. ObjectiveTo construct a scale for assessing psychiatric nurses' knowledge， attitude and practice towards the use of protective restraint and to verify its reliability and validity， so as to provide a generic tool for the assessment. MethodsBased on the theoretical framework of the knowledge-attitude-practice model， the preliminary scale was formed through systematic literature review， qualitative interview and Delphi method. From July to December 2021， a stratified sampling was utilized to select 729 psychiatric nurses from tertiary， secondary and primary （including unclassified medical institutions and grassroots hospitals） psychiatric hospitals in Guangdong Province. The formal scale was developed through item analysis， exploratory factor analysis and confirmatory factor analysis. The validity of the scale was evaluated by content validity and structure validity， and the reliability was verified by procedures including Cronbach's α coefficient， test-retest reliability， and split-half reliability. ResultsA total of 12 items of three dimensions （knowledge， attitude， practice） were included in the scale for assessing psychiatric nurses' knowledge， attitude and practice towards the use of protective restraint. The scale-level content validity index （S-CVI） was 0.941， and the item-level content validity index （I-CVI） ranged from 0.812 to 1.000. Exploratory factor analysis extracted three common factors， and the cumulative variance contribution rate was 62.948%. The confirmatory factor yielded adequate fit. Cronbach's α coefficient was found to be 0.887 for the scale， 0.819 for knowledge dimension， 0.842 for attitude dimension， and 0.831 for practice dimension. The split-half reliability and test-retest reliability for the scale were 0.712 and 0.922， respectively. ConclusionThe scale shows satisfactory reliability and validity， which can be used to assess psychiatric nurses' knowledge， attitude and practice towards the use of protective restraint. ［Funded by Guangdong Clinical Teaching Base Teaching Reform Research Project （number， 2021JD119）］
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To construct a simple and two-way interactive doctor-patient communication mode, in order to provide guidance tools for doctor-patient communication, improve the effectiveness of doctor-patient communication for cancer patients, optimize medical experience, reduce doctor-patient disputes, and provide new perspectives and ideas for the study of doctor-patient communication. Literature review and qualitative research were used to construct the index framework of ESER doctor-patient communication model, and Delphi method was used to revise and improve the index content, and evaluate its reliability and validity. The results showed that after two rounds of expert letter consultation, the final ESER doctor-patient communication mode was established, including 4 primary-level indicators, 8 second-level indicators and 40 third-level indicators. The positive coefficient of experts was 100% in both rounds. The authority coefficient of experts was 0.85 in the first round and 0.91 in the second round, indicated a high degree of overall authority. Coefficient of variation (CV) were less than 0.25, and the Kendall’s W coefficient for significant χ2 test, P values were less than 0.05, which was statistically significant. It can be considered that the coordination degree of experts was high; Cronbach’s α coefficients in the first and second rounds of importance evaluation were 0.952 and 0.971, respectively, which indicated that the index framework had good reliability and validity. Based on the needs of cancer patients for doctor-patient communication, build a two-way interactive ESER doctor-patient communication mode, integrate medicine and humanities, which can be used as a guiding tool for medical staff to communicate with cancer patients, so as to enable doctors and patients to achieve mutual trust, cooperation and win-win results.
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Objective:To analyze factors related to clinic attendance for contracted residents in a community health service center in Shanghai.Methods:It was a cross-sectional study. Through the 'Cloud Management of the Community' APP and the 'Service Fee of Contracted Residents' APP, the basic information, contracted time, hospital visits, number of visits, and medical insurance expenses of the contracted residents in Shanggang Community Health Service Center in 2021 were collected, the visiting rate to the contracted community health center and the contracted medical combination hospitals were analyzed.Results:In 2021, the contracting rate of all residents in the community was 49.96% (51 478/103 033). The contracting rate of the key population was 84.59% (43 545/51 478),among whom 66.28% (34 118/51 478) were over 60 years, 49.93% (25 702/51 478) had been contracted for more than 3 years, and 37.43% (19 270/51 478) had hypertension and/or diabetes. The number of contracted general practitioners was 4.89 times of contracted TCM doctors (1 345.17/274.81). Among all contracted residents 78.75% (40 540/51 478) had at least one visit annually, and 65.00% (33 463/51 478) had at least one visit to community health service center and the average number of visits was 17.63(5.00, 24.00)annually. The rate of visit to contracted the community health service center was (46.97±38.37) %, and 41.78% (16 937/40 540) had≥60% visit to contracted community center; the average visiting rate to the combination hospitals was (70.59±34.57) %, and 55.75% (22 602/40 540) had consultation rate≥80%. These residents were older in age, had longer contract time, higher proportion of hypertension and diabetes, and higher medical expenses, compared to those with less visits to contracted community health center and combination hospitals ( P<0.01). Meanwhile, 11 736 residents (35.07%) only visited to the contracted community health service center. Conclusion:The contracted residents are mainly the elderly and the sick ones in the community, but the use of contracted service is inadequate. Improving the visiting rate to community health center is a challenge for make a full use of the contracted health facilities.
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Objective To analyze the epidemiological characteristics of an outbreak of carbapenem resistant Klebsiella pneumoniae(CRKP)hospital infection in the neonatal intensive care unit(NICU),and to explore possible causes of the outbreak.Methods Case analysis,epidemiological studies and environmental detection methods were used to investigate the detection of CRKP in the NICU of a hospital from March 11,2022 to May 3,2022,and the causes and corresponding prevention and control measures were analyzed.Results This CRKP outbreak in the NICU occurred in two phases.The first phase was from March 11,2022,to March 30,2022,during which 3 people contracted CRKP hospital infections.The second phase was from April 13,2022,to May 3,2022,during which 4 people contracted CRKP hospital infections.The source of the hospital infection outbreak was patient No.1.All 13 CRKP cases showed sensitivity only to amikacin and tigecycline,with intermediate sensitivity to levofloxacin,and high resistance to other antibiotics.All 13 CRKP cases carried resistant genes for metalloenzymes.After the outbreak,the ward environment was sampled three times,with 35 samples taken in total,and 14 of them tested positive for CRKP.After strict environmental cleaning,disinfection,and multiple control measures,no new hospital infection cases similar to this outbreak were detected after May 13,2022.Conclusion The outbreak of NICU hospital infections may be due to the contamination of the ward environment,medical equipment,and inadequate hand hygiene of medical staff,leading to its spread.Therefore,strict cleaning and disinfection of the environmental surfaces,strengthening hand hygiene of medical staff,and implementing multiple measures can effectively control hospital infections of CRKP.
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Objective:To investigate the application effect of virtual simulation combined with flipped classroom in experimental teaching of the nursing care of falls in the elderly.Methods:The 497 nursing undergraduates in the class of 2019 in Chongqing Medical University were selected as subjects and were then divided into control group (two classes with 251 students) and intervention group (two classes with 246 students). The students in the control group received traditional experimental teaching, and those in the intervention group received blended experimental teaching with virtual simulation combined with flipped classroom. At the end of the course, the use of virtual simulation platform was analyzed for the students in the intervention group, and a questionnaire survey and theoretical examination were used to compare the effect of experimental teaching between the two groups. SPSS 27.0 was used for the t-test and the chi-square test. Results:The frequency of use of the virtual simulation platform was (2.65±1.38) times per person in the intervention group, with an online learning time of 54.12-147.32 minutes. The questionnaire survey showed that compared with the control group, the intervention group had significantly higher scores of the achievement of teaching objectives and teaching satisfaction ( P<0.05). Compared with the control group after teaching, the intervention group had significantly higher scores of teaching promotion in terms of stimulating learning interest, cultivating self-learning ability, developing clinical thinking ability, improving innovation, and enhancing health education ability ( P<0.05). The intervention group had a significantly higher theoretical examination score than the control group [(79.38±5.09) vs. (77.88±4.97), P<0.05]. Conclusions:In the blended experimental teaching of the nursing care of falls in the elderly, virtual simulation combined with flipped classroom can help students master related knowledge and skills and cultivate their self-learning ability, clinical thinking ability, innovation ability, and health education ability.
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Objective To systematically evaluate the risk factors associated with the occurrence of nosocomial infections(NI)in patients undergoing extracorporeal membrane oxygenation(ECMO)support.Methods A computerized systematic search was performed aross the Chinese databases including CNKI,Wanfang Database,China Biomedical Literature Database(CBMdisc),and Weipu,as well as the English databases such as PubMed,EMBase,Web of Science,and the Cochrane Library for case-control or cohort studies on the risk factors of hospital-acquired infections in patients undergoing ECMO support from the time of database construction to February 2023.The relevant literatures were screened by two researchers independently.Meta-analysis was performed using RevMan 5.4 software.Results A total of 20 papers,including 2 746 patients and 16 risk factors,were included.Meta-analysis results showed that older age[>50 years:odds ratio(OR)= 2.87,95％ confidence interval(95％ CI)was 1.24-6.63,P = 0.01;>65 years:OR = 1.66,95％ CI was 1.22-2.26,P = 0.001],combined hypertension(OR = 1.48,95％ CI was 1.01-2.15,P = 0.04),combined diabetes mellitus(OR = 1.40,95％ CI was 1.02-1.94,P = 0.04),sequential organ failure assessment(SOFA)was higher(OR = 1.06,95％ CI was 1.02-1.10,P = 0.000 7),the installation of ECMO in the intensive care unit(ICU,OR=1.48,95％ Ciwas 1.11-1.99,P=0.008),ECMO course(OR=1.27,95％ Ciwas 1.05-1.54,P = 0.01),ventilator-assistance for >48 hours(OR = 4.91,95％ CI was 2.40-10.05,P<0.000 1),and tracheotomy(OR = 9.56,95％ CI was 3.60-25.35,P<0.000 01)were identified as ECMO risk factors for hospital-acquired infections in patients.Conclusion Older age,combined hypertension,diabetes mellitus,higher SOFA,ECMO installation site in ICU,ECMO course,ventilator assistance>48 hours,tracheotomy are the risk factors for the occurrence of hospital-acquired infections in patients with ECMO,healthcare professionals should promptly identify the risk factors related to hospital-acquired infections,and take active and effective measures against controllable risk factors,including early intervention to prevent the occurrence of NI in ECMO patients.
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Objectives: Licoflavone A (LA) is a natural flavonoid compound derived from the root of Glycyrrhiza. This study investigated the antitumor effect and underlying molecular mechanisms of LA against gastric cancer (GC) in vitro and in vivo. Materials and Methods: A CCK8 assay was used to measure the antiproliferative activity of LA in human GC SGC-7901, MKN-45, MGC-803 cells, and human GES-1 cells. Target prediction and protein-protein interaction (PPI) analysis were used to identify the potential molecular targets of LA. The binding pattern of LA to VEGFR-2 was analyzed by molecular docking and molecular dynamic (MD). The affinity of LA for VEGFR-2 was determined by microscale thermophoresis (MST). The protein tyrosine kinase activity of VEGFR-2 in the presence of LA was determined by an enzyme activity test. The effect of LA on the proliferation of VEGF-stimulated MKN-45 cells was measured with CCK8 assays, clone formation assays, and 3D microsphere models. Hoechst 33342 staining, FCM, MMP, and WB assays were used to investigate the ability of LA to block cell cycle and promote apoptosis of VEGF-stimulated MKN-45 cells. Transwell matrix assays were used to measure migration and invasion, and WB assays were used to measure EMT. Results: LA inhibited the proliferation of SGC-7901, MKN-45, and MGC-803 cells and VEGF-stimulated MKN-45 cells. VEGFR-2 was identified as the target of LA. LA could also block cell cycle, induce apoptosis, and inhibit migration, invasion, and EMT of VEGF-stimulated MKN-45 cells. Functional analyses further revealed that the cytotoxic effect of LA on VEGF-stimulated MKN-45 cells potentially involved the PI3K/AKT and MEK/ERK signaling pathways. Conclusions: This study demonstrates that LA has anti-GC potency in vitro and in vivo. LA affects the proliferation, cycle, apoptosis, migration, invasion, and EMT by targeting VEGFR-2 and blocks the PI3K/AKT and MEK/ERK signaling pathways in VEGF-stimulated MKN-45 cells.
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Objective:To investigate the application value of the PDCA cycle in increasing the rate of timely completion of a rapid frozen-section pathological report.Methods:The basic data of 1 926 rapid frozen section pathological reports not managed by the PDCA cycle in the Department of Pathology, Zhoushan Hospital, during January to August 2019 were collected. The number of pathological reports completed within 30 minutes and the rate of timely completion of pathological reports were calculated and compared with those calculated based on 1 051 pathological reports managed by the PDCA cycle during September to December 2019.Results:After management by the PDCA cycle, the rate of timely completion of frozen-section pathological reports was significantly increased from (84.51 ± 3.61)% to (91.87 ± 1.37)% ( t = 3.86, P < 0.05). Conclusion:Application of the PDCA cycle to pathology management can help monitor the completion of pathological reports on frozen sections. This facilitates determination of reasonable intervention measures and thereby increases the rate of timely completion of pathological reports on frozen sections.
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To construct a simple and two-way interactive doctor-patient communication mode, in order to provide guidance tools for doctor-patient communication, improve the effectiveness of doctor-patient communication for cancer patients, optimize medical experience, reduce doctor-patient disputes, and provide new perspectives and ideas for the study of doctor-patient communication. Literature review and qualitative research were used to construct the index framework of ESER doctor-patient communication model, and Delphi method was used to revise and improve the index content, and evaluate its reliability and validity. The results showed that after two rounds of expert letter consultation, the final ESER doctor-patient communication mode was established, including 4 primary-level indicators, 8 second-level indicators and 40 third-level indicators. The positive coefficient of experts was 100% in both rounds. The authority coefficient of experts was 0.85 in the first round and 0.91 in the second round, indicated a high degree of overall authority. Coefficient of variation (CV) were less than 0.25, and the Kendall’s W coefficient for significant χ2 test, P values were less than 0.05, which was statistically significant. It can be considered that the coordination degree of experts was high; Cronbach’s α coefficients in the first and second rounds of importance evaluation were 0.952 and 0.971, respectively, which indicated that the index framework had good reliability and validity. Based on the needs of cancer patients for doctor-patient communication, build a two-way interactive ESER doctor-patient communication mode, integrate medicine and humanities, which can be used as a guiding tool for medical staff to communicate with cancer patients, so as to enable doctors and patients to achieve mutual trust, cooperation and win-win results.
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Recently, patients co-infected by two SARS-CoV-2 lineages have been sporadically reported. Concerns are raised because previous studies have demonstrated co-infection may contribute to the recombination of RNA viruses and cause severe clinic symptoms. In this study, we have estimated the compositional lineage(s), tendentiousness, and frequency of co-infection events in population from a large-scale genomic analysis for SARS-CoV-2 patients. SARS-CoV-2 lineage(s) infected in each sample have been recognized from the assignment of within-host site variations into lineage-defined feature variations by introducing a hypergeometric distribution method. Of all the 29,993 samples, 53 (~0.18%) co-infection events have been identified. Apart from 52 co-infections with two SARS-CoV-2 lineages, one sample with co-infections of three SARS-CoV-2 lineages was firstly identified. As expected, the co-infection events mainly happened in the regions where have co-existed more than two dominant SARS-CoV-2 lineages. However, co-infection of two sub-lineages in Delta lineage were detected as well. Our results provide a useful reference framework for the high throughput detecting of SARS-CoV-2 co-infection events in the Next Generation Sequencing (NGS) data. Although low in average rate, the co-infection events showed an increasing tendency with the increased diversity of SARS-CoV-2. And considering the large base of SARS-CoV-2 infections globally, co-infected patients would be a nonnegligible population. Thus, more clinical research is urgently needed on these patients.
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OBJECTIVE：To improve the level of pharmaceutical care，enhance the professional value and social status of pharmacists by clarifying the development process of pharmaceutical care and summarizing the value of pharmacists in pharmaceutical care. METHODS：The development process of pharmaceutical care at home and abroad（service objects，service contents and service methods）was summarized；the current situation of pharmaceutical care in China was analyzed；the value of pharmaceutical care were defined in respects of rational drug use，humanistic value and medical resources. The development of pharmaceutical care in the future was prospected. RESULTS & CONCLUSIONS：The development of pharmaceutical care can be divided into three stages：“drug supply as the center”“promoting rational drug use as the center”and“patients as the center”，and the service objects，service contents and service methods in different stages are expanding and diversifying. Compared with developed countries，the overall level of pharmaceutical care in China lags behind，and there are differences in level of pharmaceutical care modes in hospitals at different levels. Pharmacists ensure the safety，effectiveness and economy of drug use through pharmaceutical care，and promote rational drug use；the compliance，quality of life and satisfaction of patients have been improved through pharmaceutical care；pharmacists participate in medical quality management to save medical and health resources through pharmaceutical care. Pharmaceutical care，as an important part of the medical and health system，plays an important and irreplaceable role in the medical process，which is suggested that the relevant government departments should fully understand the value of pharmaceutical care and further strengthen their support for pharmaceutical care；pharmaceutical staff should improve their self-cultivation and cooperate with other disciplines to achieve the sustainable development of hospital pharmacy in different regions and medical institutions.
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Objective:To investigate the clinical efficacy and safety of modified Shaoyao Gancao decoction in the treatment of hyperprolactinemia caused by amisulpride. Methods:Ninety patients with hyperprolactinemia caused by amisulpride who received treatment in Kangci Hospital from June 2018 to October 2019 were included in this study. They were randomly divided into the placebo control, control and observation groups ( n = 30/group). The placebo control group was treated with the decoction with the taste and color (without drug ingredients) similar to that of modified Shaoyao Gancao decoction. The control group was treated with Shaoyao Gancao decoction. The observation group was treated with modified Shaoyao Gancao decoction. All patients were treated for 8 weeks. Clinical efficacy, serum prolactin level and Positive and Negative Syndrome Scale score before and after treatment, Treatment Emergent Symptom Scale score after treatment, glucose and lipid metabolism, liver and kidney function before and after treatment were compared among the three groups. Results:The effective rate in the placebo control, control and observation groups was 90.0% (27/30), 96.7% (29/30) and 100.0% (30/30), respectively, and the difference among the three groups was statistically significant (χ 2 = 7.027, P < 0.05). After treatment, serum prolactin level in the observation group [(48.2 ± 15.7) μg/L] was significantly lower than that in the control group [(52.5 ± 13.7) μg/L] and placebo control group [(57.7 ± 16.9) μg/L, t = 7.134, 7.034, both P < 0.05]. After treatment, Positive and Negative Syndrome Scale score in the observation group [(51.02 ± 3.98) points] was significantly lower than that in the control group [(54.07 ± 4.19) points] and placebo control group [(58.13 ± 4.24) points, t = 5.813, 6.317, both P < 0.05]. After treatment, Treatment Emergent Symptom Scale score in the observation group [(5.2 ± 1.3) points] was significantly higher than that in the control group [(4.9 ± 1.4) points] and placebo control group [(4.4 ± 1.2) points, t = 7.011, 7.231, both P < 0.05]. After treatment, blood glucose, low-density lipoprotein cholesterol, triglyceride, total cholesterol, alanine aminotransferase, aspartate aminotransferase levels in the observation group were significantly lower than those in the placebo control and control groups (all P < 0.05). Serum level of high-density lipoprotein cholesterol in the observation group was significantly higher than that in the placebo control and control groups (both P < 0.05). Conclusion:Modified Shaoyao Gancao decoction is highly effective in the treatment of hyperprolactinemia caused by amisulpride. It can reduce serum prolactin level and has good safety.
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Objective:To compare the contracting status for combination medical service( "1+1+1" contract)between elderly residents in Shanghai urban and suburban communities and its influencing factors.Methods:Total 574 outpatients aged over 60 were selected with stratified sampling and convenient sampling method from 3 urban community health service centers and 3 suburban community health service centers in Shanghai. A questionnaire survey was conducted from July to September 2017, the survey included the general information, health status, health concern, purpose of this visit, satisfaction with the center, frequency of visit, choice of first contact, willingness of referral, understanding "1+1+1" contract and preferential policies, contract signing status and reasons.Results:Total 574 questionnaires were distributed and 564 valid questionnaires were retrieved with an effective rate of 98.25%. Of the 292 participants in urban areas, 167 (57.2%) had signed the contract; of the 272 participants in the suburbs, 133 (48.9%) had signed the contract. Univariate analysis showed that self-evaluated health status, visits to the community health service center, satisfaction with the center, concerning health knowledge, long-term medication, the choice of community health center as first contact, the willingness of referral, knowing the "1+1+1" contract policy were associated with the contract-signing in urban residents (χ 2=13.05, 8.51, 13.89, 10.76, 6.26, 12.98, 24.73, 76.77, respectively; all P<0.05); while age, self-evaluated health status, the purpose of this visit, medical examination, type of chronic disease, long-term medication, the choice of community health service center as first contact, the willingness of referral, knowing the "1+1+1" contract policy were associated with the contrct-signing in suburban residents (χ 2=9.56, 14.26, 13.83, 18.30, 18.65, 11.96, 5.99, 5.46 83.44, respectively all P<0.05). Multivariate analysis showed that self-rated health status and awareness of "1+1+1" contract were independent influencing factors for contract-signing in urban residents ( P<0.05); while the awareness of "1+1+1" contract, the purpose of this visit and the frequency of physical examination were influencing factors for contract-signing in suburban residents ( P<0.05). Conclusion:The "1+1+1" signing rate in urban residents is higher than that in suburban residents due to more self health-concerns and higher awareness of the "1+1+1" contracts. It is suggested that the government attach importance to construction of the "1+1+1" contract system for suburb community health service institutions.
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OBJECTIVE：To systematically evaluate the efficacy an d s afety of apatinib combined with transcatheter arterial chemoembolization（TACE）in the treatment of moderate and advanced liver cancer ，and to provide evidence-based reference for rational drug use in the clinic. METHODS ：Retrieved from Cochrane Library ，Embase，PubMed，Web of Science ，SinoMed， CNKI，Wanfang，VIP database ，RCTs about apatinib combined with TACE （trial group ）versus TACE （control group ）in the treatment of moderate and advanced liver cancer were collected from inception to Sep. 2019. After screening the literature and extracting the data ，the quality of included literatures was evaluated by using bias risk assessment tool recommended by the Cochrane system evaluator manual 5.1.0 and the modified Jadad scale. Meta-analysis was carried out by using Stata 12.0 software. RESULTS：Totally 16 RCTs were included ，involving 1 043 patients. Results of Meta-analysis showed that objective response rate [OR ＝3.10，95％CI（2.38，4.03），P＜0.001]，disease control rate [OR ＝3.56，95％CI（2.62，4.83），P＜0.001] and survival rate [OR ＝2.40，95％ CI（1.86，3.10），P＜0.001]，the incidence of diarrhea [OR ＝2.27，95％ CI（1.21，4.24），P＝0.011]， hypertension [OR ＝6.97，95％ CI（1.21，40.15），P＝0.030]， proteinuria [OR ＝12.44，95％CI（2.51，61.71），P＝0.002] and com hand foot syndrome [OR ＝32.50，95％CI（12.03，87.77），P＝ 0.001] of trial group were significantly higher than those of control group. The serum level of VEGF [SMD ＝－ 3.64， 95％CI（－5.06，－2.22），P＜0.001]，MMP-9 [SMD＝－3.21，95％CI（－4.31，－2.10），P＜0.001]，AFP [SMD ＝－3.54， 95％CI（－7.03，－0.06），P＝0.046] after treatment ，the incidence of myelosuppression [OR ＝0.61，95％CI（0.39，0.97），P＝ 0.035]，fever [OR ＝0.63，95％CI（0.42，0.95），P＝0.027]，nausea and vomiting [OR ＝0.70，95％CI（0.51，0.97），P＝0.030] in trial group were significantly lower than those of control group. There was no statistical significance in the incidence of abdominal pain [OR ＝0.87，95％CI（0.54，1.39），P＝0.547] and skin itching [OR ＝1.63，95％CI（0.36，7.50），P＝0.530] between 2 groups. CONCLUSIONS：Apatinib combined with TACE can significantly improve clinical efficacy ，prolong survival time ，reduce tumor recurrence and metastasis. It can reduce the occurrence of related ADR as diarrhea after TACE ，but increase the occurrence of apatinib-related ADR as myelosuppression.
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Objective to explore the effect of non nutritive sucking combined with maternal voice stimulation on feeding process in premature infants. Methods A total of 129 premature infants admitted to the neonatal department of a tertiary hospital from July 2016 to July 2017 were randomly selected. According to the random number table method, there were 3 groups: NNS group, control group (routine nursing group), and NNS+MSS group, each with 43 cases. Non-nutritive sucking was given in the NNS group, general routine treatment and nursing in the control group, and non-nutritive sucking combined with mother's voice stimulation in the NNS+MSS group. The duration of feeding, initial feeding and hospitalization were observed in 3 groups. Results NNS+MSS group feeding transition time, the first feeding duration, hospitalization days three points respectively (8.60 ± 1.24)d, (8.16 ± 1.74)min, (13.26 ± 1.84)d, and NNS group respectively (12.09 ± 2.10) d, (4.72±1.45) min, (14.70±1.79) d, the control group, respectively (17.70±2.30) d (2.28 ± 1.39) min (19.81± 4.17) d. The differences between the three groups were statistically significant (F=242.085, 159.313, 63.856, all P<0.05). Conclusions Non nutritive sucking combined with mother sound stimulation can promote early feeding from nasal feeding to complete transoral feeding as soon as possible, reduce intermediate conversion time, accelerate feeding process and shorten hospitalization time.
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Objective To explore the main risk factors of hospital infection in children with hypospadias after operation and to formulate targeted nursing measures so as to provide accurate nursing strategies for effective prevention and control of hospital infection after operation. Methods Totally 383 children who underwent hypospadias surgery in the hospital from January 2016 to December 2017 were selected as the research objects. The clinical data of all cases were reviewed and sorted out. The hospital infection rate, infection site and main risk factors of hospital infection after operation were analyzed to formulate prevention strategies. Results 71 of 383 children suffered from hospital infection, and the incidence rate of hospital infection was 18.5% .The distribution of infection sites was: respiratory tract infection in 30 cases, accounting for 42.25% ;Urinary tract infection was found in 25 cases (35.21% ). Incision infection was found in 14 cases (19.72%).Gastrointestinal infection occurred in 2 cases (2.82%). Logistic multivariate analysis showed that age, length of hospital stay after operation were closely related to hospital infection. Conclusions The major risk factors for postoperative nosocomial infection in children with hypospadias are age and postoperative hospital stay.Nursing measures: The hospital stay of children after operation can be shortened as much as possible by reminding and standardizing the routine maintenance of urinary catheter and strengthening the cooperation between doctors and nurses through charts. Strict implementation of visiting and accompanying system, good environmental control, strengthening hand hygiene, standardization of preoperative skin preparation and other nursing measures are adopted to protect children to the greatest extent.
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BACKGROUND@#Small cell lung cancer (SCLC) is characterized by poor differentiation, high malignancy and rapid growth fast, short double time, early and extensive metastatic malignancy. In clinical, chemotherapy is the main treatment method, while resistance to multiple chemotherapy drugs in six to nine months has been a major clinical challenge in SCLC treatment. Therefore, It has important clinical value to building SCLC aninimal model which is similar to patients with SCLC. Animal model of xenotransplantation (PDX) from the patients with small cell lung cancer can well retain the characteristics of primary tumor and is an ideal preclinical animal model. The study is aimed to establish SCLC PDX animal model and induce the chemoresistance model to help to study the mechanism of chemoresistance and individual treatment.@*METHODS@#Fresh surgical excision or puncture specimens from SCLC patients were transplanted into B-NSGTM mice subcutaneous tissues with severe immunodeficiency in one hour after operation the B-NSGTM mice subcutaneous in 1 hour, and inject chemotherapy drugs intraperitoneally after its tumor growed to 400 mm³ with EP which is cisplatin 8 mg/kg eight days and etoposide 5 mg/kg every two days until 8 cycles. Measure the tumor volum and mice weights regularly, then re-engrafted the largest tumor and continue chemotherapy.@*RESULTS@#Nine cases were conducted for B-NSG mice modeling. Three of nine cases could be engrafted to new B-NSG mice at least two generation. The SCLC PDX animal models have been established successfully. After adopting chemotherapy drugs, the chemoresistance PDX models have been established. High homogeneity was found between xenograft tumor and patient's tumor in histopathology, immunohistochemical phenotype (Syn, CD56, Ki67).@*CONCLUSIONS@#The SCLC PDX animal model and the chemoresistance PDX animal model have been successfully constructed, the success rate is 33%, which provides a platform for the clinical research, seeking for biological markers and choosing individual treatment methods of SCLC.
Subject(s)
Animals , Female , Humans , Antineoplastic Combined Chemotherapy Protocols , Pharmacology , Cisplatin , Disease Models, Animal , Drug Resistance, Neoplasm , Etoposide , Interleukin Receptor Common gamma Subunit , Genetics , Lung Neoplasms , Drug Therapy , Metabolism , Pathology , Mice, Inbred BALB C , Mice, Inbred NOD , Mice, Knockout , Mice, SCID , Small Cell Lung Carcinoma , Drug Therapy , Metabolism , Pathology , Transplantation, Heterologous , Methods , Xenograft Model Antitumor AssaysABSTRACT
Objective To analyze the characteristics of elderly frequent clinic attenders in a Shanghai community health service center.Methods The medical records of patients over 60 year who visited Shanghai Weifang Community Health Center clinic from October 2014 to October 2017 were obtained from the hospital outpatient management system.The persistent frequent attenders were defined as whose visiting times were among the top 10％ of attendance in the three consecutive years.The general condition and disease characteristics of persistent frequent attenders were analyzed and compared with those of non-frequent attenders and transient frequent attenders.Results There were total 19 240 patients paying 1 171 thousand clinic visits in the center for three years,the persistent frequent attenders accounted for 5.3％ (1 029) of total patients and had 21.4％ of total visits (251 thousand);those figures for transient frequent attenders were 10.2％(1 965) and 23.9％ (280 thousand);for non-frequent attenders were 84.5％ (16 246) and 54.7％(640 thousand),respectively.The average annual visits of three groups were (81.4 ± 27.5),(47.5 ± 21.4) and (13.1± 11.1) times,respectively.The reasons for encounter in persistent frequent attenders were:coronary heart disease (11.2％,48 thousand),cerebral insufficiency (3.5％,15 thousand),joint pain (2.5％,11 thousand),osteoporosis (2.9％,13 thousand) and sequelae of stroke (2.1％,9 thousand).Age above 70(OR=2.163,95％CI:1.872-2.498),age above 80 (OR=2.243,95％CI 1.895-2.655),female sex (OR=1.426,95％CI:1.249-1.627) and contracting general practitioners (OR=5.665,95％CI 4.217-7.611) were associated with persistent frequent attendance (P＜0.05).Conclusion Elderly frequent attenders occupy large outpatient resources of community health center,and age,gender and contracting status could affect their attending frequency.
ABSTRACT
Objective@#to explore the effect of non nutritive sucking combined with maternal voice stimulation on feeding process in premature infants.@*Methods@#A total of 129 premature infants admitted to the neonatal department of a tertiary hospital from July 2016 to July 2017 were randomly selected. According to the random number table method, there were 3 groups: NNS group, control group (routine nursing group), and NNS+MSS group, each with 43 cases. Non-nutritive sucking was given in the NNS group, general routine treatment and nursing in the control group, and non-nutritive sucking combined with mother's voice stimulation in the NNS+MSS group. The duration of feeding, initial feeding and hospitalization were observed in 3 groups.@*Results@#NNS + MSS group feeding transition time, the first feeding duration, hospitalization days three points respectively (8.60 ± 1.24)d, (8.16±1.74)min, (13.26 ± 1.84)d, and NNS group respectively (12.09 ± 2.10) d, (4.72±1.45) min, (14.70±1.79) d, the control group, respectively (17.70±2.30) d (2.28 ± 1.39) min (19.81± 4.17) d. The differences between the three groups were statistically significant (F=242.085, 159.313, 63.856, all P<0.05).@*Conclusions@#Non nutritive sucking combined with mother sound stimulation can promote early feeding from nasal feeding to complete transoral feeding as soon as possible, reduce intermediate conversion time, accelerate feeding process and shorten hospitalization time.