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Objective@#: The spontaneous intracerebral hemorrhage (ICH) remains a significant cause of mortality and morbidity throughout the world. The purpose of this retrospective study is to develop multiple models for predicting ICH outcomes using machine learning (ML). @*Methods@#: Between January 2014 and October 2021, we included ICH patients identified by computed tomography or magnetic resonance imaging and treated with surgery. At the 6-month check-up, outcomes were assessed using the modified Rankin Scale. In this study, four ML models, including Support Vector Machine (SVM), Decision Tree C5.0, Artificial Neural Network, Logistic Regression were used to build ICH prediction models. In order to evaluate the reliability and the ML models, we calculated the area under the receiver operating characteristic curve (AUC), specificity, sensitivity, accuracy, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR). @*Results@#: We identified 71 patients who had favorable outcomes and 156 who had unfavorable outcomes. The results showed that the SVM model achieved the best comprehensive prediction efficiency. For the SVM model, the AUC, accuracy, specificity, sensitivity, PLR, NLR, and DOR were 0.91, 0.92, 0.92, 0.93, 11.63, 0.076, and 153.03, respectively. For the SVM model, we found the importance value of time to operating room (TOR) was higher significantly than other variables. @*Conclusion@#: The analysis of clinical reliability showed that the SVM model achieved the best comprehensive prediction efficiency and the importance value of TOR was higher significantly than other variables.
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Objective:To explore the intervention effect of moderate intensity aerobic exercise on body composition and glycolipid metabolism in obese adults.Methods:This was a self-controlled study, which enrolled 280 obese adults who received weight loss treatment in the Health Management Institute of the Chinese PLA General Hospital from November 2017 to March 2018 and performed a 12-week precise aerobic exercise intervention (40%-60% of heart reserved rate) based on an independently developed aerobic exercise intervention system for chronic diseases. The following requirements also need to be met as effective exercise time of ≥40 minutes every time, total exercise time of ≤100 minutes per day, effective exercise time of ≥200 minutes per week, exercise frequency of ≥4 times per week, and an interval of ≤48 hours between two exercises. During the research, 77 subjects were excluded due to illness, sports injuries, work reasons, etc., and 203 subjects were included in the analysis. These patients were divided into three groups based on weekly exercise duration, including 97 cases in short-term group (weekly exercise time <300 minutes), 63 cases in medium-term group (weekly exercise time of 300-400 minutes), and 43 cases in long-term group (weekly exercise time >400 minutes). Paired t-tests were used to compare the differences in indicators before and after intervention, and covariance analysis was used to compare the differences in indicators among three groups. The intervention effect of moderate intensity aerobic exercise on the body composition and glucose and lipid metabolism in obese adults was analyzed. Results:The resting heart rate, body weight, body mass index, body fat rate, body fat mass, muscle mass, visceral fat area, subcutaneous fat area, fasting insulin, insulin resistance index, total cholesterol, triglycerides, and low-density lipoprotein cholesterol were all decreased significantly in the 203 patients after the intervention [(66.67±9.38) vs (71.48±10.13)/min, (86.02±13.13) vs (90.16±13.93) kg, (30.33±3.08) vs (31.80±3.27) kg/m 2, 35.64%±7.19% vs 37.87%±7.21%, (30.78±8.14) vs (34.30±8.73) kg, (52±10.30) vs (52.74±10.61) kg, (100.82±38.63) vs (119.53±43.08) cm 2, (270.14±74.19) vs (305.24±77.12) cm 2, (12.33±6.92) vs (17.86±14.23) mmol/L, 3.08±2.22 vs 4.52±4.09, (4.42±0.78) vs (4.62±0.89) mmol/L, (1.46±0.82) vs (1.71±1.11) mmol/L, (2.93±0.70) vs (3.08±0.80) mmol/L] (all P<0.05). The reduction degree of indicators including body weight, body mass rate, body fat rate, and body fat mass were all significantly higher in long-term group when compared with those in medium-term and short-term group [(5.56±0.62) vs (3.97±0.51) vs (3.63±0.41) kg, (1.98±0.21) vs (1.39±0.17) vs (1.31±0.14) kg/m 2, 3.38%±0.40% vs 2.27%± 0.33% vs 1.69%±0.27%, (4.90±0.53) vs (3.54±0.43) vs (2.89±0.35) kg]. Besides, patients in long-term group had significantly higher reduction degree of fasting insulin and higher rising degree of high-density lipoprotein cholesterol [(7.38±0.94) vs (4.54±0.62) mmol/L, (0.07±0.02) vs (0.01±0.02) mmol/L] and higher reduction degree of visceral fat area [(28.45±4.53) vs (12.55±3.67) cm 2] than medium-term group (all P<0.05). Conclusions:Moderate intensity aerobic exercise can be an effective intervention for the body composition and glycolipid metabolism in obese adults. If the weekly exercise time is greater than 400 minutes, the potential benefits of improvement may be more evident.
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Objective:To explore the pathogenesis of gallbladder cholesteryl polyps (GCP) and gallbladder cholesterol calculus (GCC) by studying the different changes of mucin (MUC) expression and reverse cholesterol transporter (RCT) in gallbladder mucosa epithelium.Methods:The data of 10 GCP patients (GCP group), 10 GCC patients (GCC group) and 5 patients with normal gallbladder resection (control group) were retrospectively analyzed, who underwent cholecystectomy in the Department of General Surgery, Xuanwu Hospital, Capital Medical University from January to December 2021. Among the 10 patients in the GCP group, there were 5 males and 5 females, aged (43.40±9.59) years old. Among the 10 patients in the GCC group, 5 males and 5 female, aged (45.00±8.13) years old. Among the 5 patients in the control group, there were 3 males and 2 females, aged (43.80±6.01) years old. Immunohistochemical analysis was used to investigate the expression differences of various subtypes of MUC and RCT [ATP binding cassette transporter G1 (ABCG1) and B group type I scavenger receptor (SR-BI)] among each group.Results:Compared with the control group, the expression of MUC1 (3.40±0.70 vs. 0), MUC5AC (1.50±0.53 vs. 0), MUC6 (4.70±0.48 vs. 0), and ABCG1 (3.50±0.53 vs. 1.60±0.55) in the gallbladder mucosa of the GCP group increased, while the expression score of SR-BI decreased (1.70±0.48 vs. 3.40±0.55), with statistical significance (all P<0.001). Compared with the control group, the expression of MUC1 (4.80±0.42 vs. 0), MUC5AC (4.70±0.48 vs. 0), MUC6 (3.30±0.67 vs. 0), and ABCG1 (3.40±0.52 vs. 1.60±0.55) in the gallbladder mucosa of the GCC group increased, while the expression score of SR-BI decreased (0 vs. 3.40±0.55), with statistically significant differences (all P<0.001). Conclusion:The different expression levels of MUC1, MUC5AC, MUC6, and RCT proteins lead to the differential formation of GCP and GCC on the basis of the co-pathogenesis in high cholesterol in bile.
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Objective:To study the association of non-alcoholic fatty liver disease(NAFLD) and advanced liver fibrosis with osteoporosis in patients with type 2 diabetes mellitus(T2DM).Methods:Data was collected from 391 in-patients with type 2 diabetes mellitus(T2DM) from September 2019 to September 2020 at the Department of Endocrinology and Geriatric Medicine, Affiliated Huai′an First Hospital of Nanjing Medical University in this cross-sectional study. Participants were divided into T2DM with coexistent NAFLD(TCN) and with no NAFLD(TON) group via liver B-mode ultrasound.Also, the patients were divided into low and middle-high risk group via fibrosis index based on 4 factors index(FIB-4). Participant characteristics, laboratory results, and dual energy x-ray absorptiometry were obtained and analyzed. Multivariable logistic regression models were used to evaluate the association of NAFLD and advanced liver fibrosis with osteoporosis in T2DM. Interaction and stratified analyses were conducted according to age, sex, body mass index(BMI) and duration of diabetes(DD).Results:There was no significant difference in risk of osteoporosis and bone mineral density(BMD) loss between TCN and TON group(all P>0.05). After adjusting for age, sex, BMI, and DD, total hip BMD( β=-0.044, 95% CI -0.087--0.001, P=0.046) and lumbar L 1-L 4BMD( β=-0.044, 95% CI -0.087--0.002, P=0.044) were significantly reduced, and the risk of osteoporosis was significantly increased( OR=2.428, 95% CI 1.124-5.244, P=0.024) in FIB-4 middle-high risk group compared with low risk group. The subgroup analysis showed that overweight patients with T2DM had a significantly increased risk of osteoporosis( OR=4.240, 95% CI 1.637-10.987, interaction P=0.018) in FIB-4 middle-high risk group compared with low risk group. Conclusion:There was no significant difference in risk of osteoporosis and BMD loss between TCN and TON group. However, among T2DM patients who were overweight, NAFLD-related progressive liver fibrosis emerged as an independent risk factor for both BMD decline and the development of osteoporosis.
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Hepatolithiasis is a common biliary tract disease in China and other Asian countries.It has insidious onset,recurrent disease,and may lead to biliary cirrhosis or even cancer in the late stage without inter-vention.At present,surgery is considered to be the best choice for treatment.In the 21st century of minimally inva-sive surgery,traditional procedures such as partial hepatectomy,choledochotomy,cholangioenterostomy and liver transplantation can be performed with the assistance of laparoscopy and da Vinci robots,and emerging endoscopic techniques such as endoscopic retrograde cholangiopancreatography(ERCP)and percutaneous transhepatic cho-ledochoscopic lithotripsy(PTCSL)have also been developed,bringing better treatment for patients with hepatoli-thiasis.As treatment options are becoming more varied,there are also some clinical problems that need to be addressed.In this article,we would like to briefly review the current surgical treatment modalities in order to provide a theoretical basis for optimizing the treatment modalities.
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The number of dental schools increased from 55 in 2000 to 66 in 2019 in the United States. The number of public, private, and private-state-related dental schools were 40, 22 and 4, respectively. A majority of them were located in most developed areas, such as western, eastern, and southern regions of the country. In the same period, the number of freshman enrollees rose from 4 234 to 6 231 while the average of enrollees kept under 100. On the basis of learning relevant experiences of the United States, it might be necessary for China to expand the overall scale of stomatology education in order to address the shortage of dentists, take measures to increase the number of stomatology schools and improve their distribution, and control the number of enrollees per school to enhance the quality of education.
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Objectives:To explore the cardiac magnetic resonance(CMR)features of early ventricular aneurysm formation in patients with acute anterior myocardial infarction. Methods:One hundred and eight patients with acute anterior myocardial infarction who underwent primary percutaneous coronary intervention and completed CMR scans within two weeks were retrospectively analyzed and divided into non-ventricular aneurysm group(n=72)and ventricular aneurysm group(n=36)according to the absence or presence of early ventricular aneurysm after primary percutaneous coronary intervention.The obtained CMR images were imported into CVI42 software for image analysis,and a logistic regression analysis model was established to evaluate CMR features useful for the diagnosis of early ventricular aneurysm formation. Results:Aging and larger area of late gadolinium enhancement(LGE)and worse left ventricular systolic function and lower myocardial strain were features of patients in the ventricular aneurysm group as compared to the non-ventricular aneurysm group.LGE area(OR=1.32,95%CI:1.071-1.628,P=0.009),apical angle(OR=1.24,95%CI:1.041-1.475,P=0.016),septal mitral annular plane systolic excursion(septal MAPSE,OR=0.36,95%CI:0.169-0.757,P=0.007)and global longitudinal strain(GLS,OR=0.53,95%CI:0.154-0.953,P=0.046)were associated with early ventricular aneurysm formation.ROC curves were analyzed for the above four CMR parameters,and the AUC were 0.922,0.921,0.905,and 0.814,respectively.The optimal cutoff values were 28.5%,90°,8.245 mm,and 10.155%,respectively. Conclusions:Estimation of LGE area,apical angle,septal MAPSE and GLS using CMR technique can help diagnose early ventricular aneurysm in patients with acute anterior myocardial infarction.
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Objective:To analyze the clinical features and mutation of myeloid differentiation factor 88 (MYD88) L265P in patients with diffuse large B-cell lymphoma (DLBCL) of central nervous system (CNS).Methods:The clinicopathological materials of 45 cases of DLBCL of CNS were retrospectively collected in Xuanwu Hospital, Capital Medical University from September 2014 to February 2017. The clinicopathological data were retrospectively analyzed, combined with immunohistochemistry, EB virus in situ hybridization, imaging and medical history. The mutation of MYD88 L265P gene was detected by pyrosequencing and its clinical significance was analyzed. Results:The age of the patients ranged from 42 to 82 years [(57.6±8.8) years], including 24 males and 21 females. Totally 93.3% (42/45) of the patients had supratentorial tumours, which were single or multiple. The cerebral hemisphere (31/45, 68.9%) was the most common involved site, and 21 cases (21/45, 46.7%) had multiple lesions. Histologically, DLBCL in the CNS showed diffuse infiltration of tumor tissue, some of which grew around blood vessels in a "sleeve" arrangement. CD 20 and CD 79a were diffusely and strongly positive. Thirty-nine cases (39/45, 86.7%) were non-germinal center B cell (non-GCB) subtype and 6 cases (6/45, 13.3%) were germinal center B cell (GCB) subtype. MYD88 L265P mutation was found in 64.4% (29/45) patients. There was statistically significant difference between non-GCB type (71.8%, 28/39) and GCB type DLBCL (1/6, P=0.017). Compared with the operation/biopsy group without chemotherapy, operation+chemotherapy, biopsy+chemotherapy, operation/biopsy+chemotherapy+stem cell transplantation can improve the survival and prognosis ( HR=0.05, 95% CI 0.01-0.33 , P=0.002; HR=0.04, 95% CI 0.01-0.36 , P=0.004; HR=0.01, 95% CI 0.00-0.17 , P=0.001; respectively). Conclusions:DLBCL of the CNS is aggressive tumor with poor prognosis, the clinical manifestations are complex and diverse, and the diagnosis is challenging. MYD88 L265P is a common and specific gene mutation in primary CNS lymphoma(PCNSL), which is of great significance in the diagnosis and treatment of lymphoma. The MYD88 L265P mutation was more frequently detected in non-GCB than GCB subtype. Chemotherapy can improve the survival rate of PCNSL patients. If chemotherapy achieves complete remission and autologous hematopoietic stem cell transplantation is performed, there may be a chance of long-term survival.
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Overall progress of the Healthy China initiative highlights the importance of medical humanities in the connotation construction of health services, hence making standardized construction and effective governance of medical social workers a focus of the current healthcare reform. This study summarized the practices of medical social workers engaged in the cabin hospital in Wuchang district, Wuhan city, Hubei province during the outbreak of COVID-19. Their efforts aimed at reducing the stress faced by front-line medical workers, and assisting the patients to achieve body-mind balance for better treatment outcomes." Online+ offline" and" in-cabin+ out-of-cabin" service teams were organized to assist these medical staff, provide social support, and integrate resources. The study analyzed the problems and challenges in the process of practice, and provided a reference for further improving the management of public health emergency services.
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【Objective】 To investigate the effect and mechanism of inhibiting Yes-associated protein1 (YAP1) expression by verteporfin on proliferation, migration and invasion of human umbilical vein endothelial cells (HUVECs) exposed to hypoxia environment and the possible mechanisms that further affect placental angiogenesis in preeclampsia. 【Methods】 MTT method was used to detect the cell viability of HUVECs at different concentrations (0, 4, 8, 12 and 16 μg/mL) after 12 h and 24 h treatment with verteporfin under hypoxia and calculate the IC50 value to select the subsequent experimental drug concentration. Flow cytometry was made to analyze verteporfin’s effect on HUVEC apoptosis in hypoxic environment. The wound healing assay and Transwell invasion assay were used to determine the effect of verteporfin on HUVEC cell migration and invasion abilities under hypoxic environment. Angiogenesis test was used to detect the effect of verteporfin on the angiogenesis of HUVECs under hypoxic environment. The effects of verteporfin on the expression levels of YAP1 and TEAD1 in Hippo signaling pathway under normoxia and hypoxia were determined by Western blotting. 【Results】 Under hypoxic environment, verteporfin could inhibit the proliferation of HUVECs by calculating the IC50 value, the subsequent experimental group selected 16 μg/mL verteporfin to treat cells. Flow cytometry showed that verteporfin induced the apoptosis rate of HUVECs under hypoxia (P<0.01). The results of wound healing, Transwell invasion and the angiogenesis experiments confirmed that compared with the control group, verteporfin could inhibit the migration, invasion and angiogenesis of HUVECs in hypoxic environment (P<0.05). Western blotting assay indicated that under normoxia and hypoxia, the expressions of YAP1 and TEAD1 were reduced (P<0.01). 【Conclusion】 In hypoxic environment, verteporfin inhibits the proliferation of HUVECs by inhibiting the expressions of YAP1 and TEAD1, and reduces the migration, invasion and angiogenesis of HUVECs. It is confirmed that the Hippo-YAP1 signaling pathway may affect the placental angiogenesis of preeclampsia and participate in the occurrence of preeclampsia by regulating the proliferation and invasion of vascular endothelial cells.
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Curriculum for undergraduate medical education in the United Kingdom consists of two parts, namely pre-clinical and clinical courses. Medical undergraduate students are encouraged to study for a second degree and individualized education is emphasized. Various methods are employed in teaching highly integrated courses, mainly according to human organs and systems or physiological functions. Drawing lessons from relevant experiences of the United Kingdom, China should further strengthen the formulation and supervision of standards and guidelines for undergraduate medical education, and actively promote the reform of teaching models in order to facilitate the connection and integration between basic medical education and clinical practice. It's also suggested that priorities be given to the cultivation of compound medical talents and individualized education for medical students. Finally, educational system should be further improved in order to enhance the effects of clinical practice.
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Objective:To investigate the prevalence and risk factors of depression in patients with acute ST-segment elevation myocardial infarction(STEMI) after percutaneous coronary intervention(PCI).Methods:From January 2019 to December 2019, 205 patients with STEMI who underwent PCI were selected randomly in Department of Cardiology of Heilongjiang Provincial Hospital.And 200 health examined people from our hospital at the same time were selected as health control group.The Zung self-rating depression scale(SDS) was used to score the depression in STEMI patients one week after PCI.The social demographic data were investigated, including age, gender, education status, place of residence, medical payments, monthly income, marital status, smoking history, drinking history, diabetic history, cardiovascular and cerebrovascular diseases history.The clinical indicators were measured, including height, weight, waist circumference(WC), hip circumference(HC), body mass index(BMI), waist-hip rate(WHR), fasting plasma glucose(FPG), fasting serum insulin(FINS), homeostasis model assessment-insulin resistance index(HOMA-IR), serum total cholesterol(TC), total triglyceride(TG), low density lipoprotein-C(LDL-C), high density lipoprotein-C, (HDL-C), systolic blood pressure(SBP) and diastolic blood pressure(DBP).Results:The prevalence of depression in the STEMI group was obviously higher than that in the control group(17.07% vs.9.50%, χ 2=5.025, P=0.025). There was statistically significant difference in the severity of depression between the two groups(χ 2=8.360, P=0.039). Multivariate Logistic regression analysis showed that the risk factors for depression in order of OR values were FPG, gender(female), age(65 or old), BMI, monthly income(<5 000 RMB), HOMA-IR, self-paying for medical services ( OR=1.894, 1.812, 1.545, 1.428, 1.335, 1.285, 1.202). Conclusion:The prevalence of depression in STEMI patients after PCI is increased.The risk factors for depression include female, old age, obesity, low income, insulin resistance and self-paying for medical services.
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Objective To summarize the clinical characteristics of hepatic lymphoepithelioma-like carcinoma,and to explore the diagnosis and treatment strategies of hepatic lymphoepithelioma-like carcinoma.Methods A retrospectively analysis on 13 patients with liver lymphoepithelioma-like carcinoma in Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,between March 2005 and May 2019 were carried out.Results 8 cases were male,5 were female,median age was 45years (27 to 68 y).There were 8 cases of intrahepatic cholangiocytic lymphoepithelioma-like carcinoma,4cases of hepatocytic lymphoepithelioma-like carcinoma,and 1 case of mixed hepatocytic and cholangiocytic lymphoepithelioma-like carcinoma.All patients received partial hepatectomy and postoperative comprehensive treatment.The patients were followed from 6 months to 7 years.Only one patient died,and the other patients were all in a tumor-free state.Conclusion Primary hepatic lymphoepithelioma-like carcinoma is a rare liver cancer.It is confirmed mainly by pathological examination and immunohistochemistry.With surgery as the main treatment,prognosis is usually fair.
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Objective To investigate the clinical characteristics and prognostic factors in elderly patients with acute myeloid leukemia(AML).Methods Clinical data of 232 patients with acute myelocytic leukemia(AML,except for acute promyelocytic leukemia) admitted in our hospital from January 2012 to December 2015 were retrospectively analyzed.Factors affecting complete remission (CR) were analyzed by using x2 test,and Kaplan-Meier survival analysis was conducted.Univariate and multivariate analysis of prognostic factors were performed by using Log-Rank test and Cox regression model respectively.Results Of 232 patients,195 patients received induction chemotherapy,among whom 8 patients died in early phase,efficacy could not be evaluated in 25 cases,with 162 patients for final statistical study.The CR rate was 37.0％ (60/162) after the first therapy course,and overall CR rate was 54.9％ (89/162).Thirty-seven patients received palliative treatment,among whom 6 patients died in early phase and none achieved CR.Therefore,the 162 patients receiving an induction chemotherapy,whose efficacy can be evaluated,could be clinically analyzed.They were in 60-69 years old (x2 =4.102,P =0.043),with ECOG score≤ 2 (x2 =9.917,P =0.002),NPM1 +FLT3-ITD-(x2 =6.423,P =0.038),favorable karyotypes(x2 =6.033,P =0.049),and related to a higher CR rate.The median overall survival(OS) was 205 days in the 232 patients.Univariate analysis results demonstrated that age(x2 =8.700,P =0.003),white blood cell (WBC) count ≥ 100 × 109/L (x2=4.249,P=0.039),karyotypes(x2=4.807,P=0.028),palliative treatment(x2 =191.221,P=0.000) were influencing factors for the prognosis.Multivariable analysis showed that age(HR =0.464,95％CI:0.245-0.877,P =0.018),karyotypes(HR =3.618,95％CI:1.491-6.728,P =0.003) and whether or not to receive induction chemotherapy (HR =0.076,95 ％ CI:0.030-0.194,P =0.000) were independent influencing factors for OS in elderly patients with AML.Conclusions The prognosis of elderly patients with AML is affected by multiple factors.Age,karyotypes and whether or not to receive induction chemotherapy are independent influencing factors for OS in elderly patients with AML.
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A total of 187 patients with polycystic ovary syndrome (PCOS) in our hospital from January 2016 to December 2018 were enrolled, and 190 healthy people served as control group. The levels of homeostasis model assessment of insulin resistance index ( HOMA-IR), β-cell function index ( HOMA-β), total cholesterol ( TC), triglyceride (TG), low density lipoprotein-cholesterol ( LDL-C), high density lipoprotein-cholesterol ( HDL-C), body fat content ( BF), and miR-93 were compared between the two groups. The results showed that HOMA-IR, HOMA-β, TG, TC, LDL-C, BF, and miR-93 in PCOS group were significantly higher while HDL-C was significantly lower than those in control group (all P＜0.05). HOMA-IR, HOMA-β, TG, TC, and LDL-C levels in patients with Fat≥35% of PCOS group were significantly higher compared with those in patients with BF＜35% ( P＜0.05) while HDL-C was significantly lower (P＜0.05). There were no significant differences in TC and miR-93 between patients with BF≥35% and Fat＜35% in PCOS group (P＞0.05). HOMA-IR and HOMA-β were positively correlated with BF level (r=0.427 and 0.224, P＜0.05), while miR-93 was not correlated with BF level (P＞0.05).
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Objective@#To investigate the clinical characteristics and prognostic factors in elderly patients with acute myeloid leukemia(AML).@*Methods@#Clinical data of 232 patients with acute myelocytic leukemia(AML, except for acute promyelocytic leukemia) admitted in our hospital from January 2012 to December 2015 were retrospectively analyzed.Factors affecting complete remission(CR) were analyzed by using χ2 test, and Kaplan-Meier survival analysis was conducted.Univariate and multivariate analysis of prognostic factors were performed by using Log-Rank test and Cox regression model respectively.@*Results@#Of 232 patients, 195 patients received induction chemotherapy, among whom 8 patients died in early phase, efficacy could not be evaluated in 25 cases, with 162 patients for final statistical study.The CR rate was 37.0%(60/162) after the first therapy course, and overall CR rate was 54.9%(89/162). Thirty-seven patients received palliative treatment, among whom 6 patients died in early phase and none achieved CR.Therefore, the 162 patients receiving an induction chemotherapy, whose efficacy can be evaluated, could be clinically analyzed.They were in 60-69 years old(χ2=4.102, P=0.043), with ECOG score≤2(χ2=9.917, P=0.002), NPM1+ FLT3-ITD-(χ2=6.423, P=0.038), favorable karyotypes(χ2=6.033, P=0.049), and related to a higher CR rate.The median overall survival(OS) was 205 days in the 232 patients.Univariate analysis results demonstrated that age(χ2=8.700, P=0.003), white blood cell(WBC) count≥100×109/L(χ2=4.249, P=0.039), karyotypes(χ2=4.807, P=0.028), palliative treatment(χ2=191.221, P=0.000) were influencing factors for the prognosis.Multivariable analysis showed that age(HR=0.464, 95%CI: 0.245-0.877, P=0.018), karyotypes(HR=3.618, 95%CI: 1.491-6.728, P=0.003) and whether or not to receive induction chemotherapy(HR=0.076, 95%CI: 0.030-0.194, P=0.000) were independent influencing factors for OS in elderly patients with AML.@*Conclusions@#The prognosis of elderly patients with AML is affected by multiple factors.Age, karyotypes and whether or not to receive induction chemotherapy are independent influencing factors for OS in elderly patients with AML.
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In the United Kingdom,undergraduate education of geriatric medicine focuses on helping students understand or describe relevant contents,with only a few ability requirements.At most medical schools,the teaching of geriatric medicine is integrated with other clinical curriculums,such as mental health and internal medicine.The pedagogy of geriatric medicine that consists of formal and informal ones,tends to become varied and has some innovations in terms of simulation education,interdisciplinary education,and student-centered education.Based on the relevant experience in the UK,it is suggested that China should study and formulate the teaching requirements of geriatrics for undergraduate clinical medicine specialty in order to standardize and promote related work.Medical colleges and universities can better integrate geriatric knowledge into the existing curriculum system,constantly innovate geriatric teaching methods,actively use simulation teaching,student-centered education and other ways to improve the teaching effect.
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Objective@#To explore the clinical and laboratory characteristics and therapeutic effect of acute promyelocytic leukemia (APL) with t(2;17;15).@*Methods@#The G-banding technique was used for karyotypic analysis in a female patient with APL who was admitted to the First Affiliated Hospital of Zhengzhou University in December 2018. PML-RARα fusion gene was quickly detected by fluorescence in situ hybridization (FISH). The real-time quantitative polymerase chain reaction (RT-PCR) was used to detection 43 kinds of fusion gene, and the gene mutations were detected by next generation sequencing (NGS). The induction therapy was given with oral retinoic acid+ intravenous infusion of arsenic trioxide, followed by 3 courses of retinoic acid+ arsenic trioxide consolidation therapy.@*Results@#The G-banding karyotypic analysis demonstrated 46, XX, t(2;17;15) (q31;q21;q22)[8]/46, XX[2]. FISH results indicated that 62.0% of analyzed cells were positive for the PML-RARα fusion gene. RT-PCR further revealed the positive PML-RARα fusion gene transcript. NGS detection of gene mutations showed no obvious abnormalities. After 39 days of induction therapy with retinoic acid and arsenic trioxide, the patient achieved complete remission (CR). The karyotype was 46XX[20], and PML-RARα/ABL was 0/100. Then, the patient was treated with 3 courses of consolidation therapy, and the results remained in CR.@*Conclusions@#APL with complex t(2;17;15) (q31;q21;q22) is rare, and the morphological characteristics are not typical, but it is still associated with the formation of PML-RARα fusion gene. Retinoic acid+ arsenic trioxide has a good therapeutic effect, and the long-term efficacy still needs follow-up.
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Objective To compare the characteristics of pulmonary function between stable chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap syndrome (ACO) in the elderly males. Methods Three hundred and eighteen elderly male patients with stable COPD were followed up between January 2014 and December 2017. A11 patients underwent pulmonary function tests and bronchial dilation test (BDT) in the stable condition. According to the occurrence of ACO, the patients were divided into ACO group (54 cases) and non-ACO group (264 cases). The indexes of pulmonary function before and after BDT (T0 and T1) in two groups were statistically compared. Results Among 318 elderly male patients with stable COPD, ACO patients accounted for 17.0％(54/318). Compared with non-ACO group, at T0 ACO group had significantly lower values in forced vital capacity (FVC) pred [(83.5 ± 15.4)％vs. (93.9 ± 5.6)％], in forced expiratory volume in 1 second (FEV1) pred [(61.1 ± 13.6)％vs. (74.5 ± 12.0)％], in forced expiratory volume in 3 seconds (FEV3) pred [(70.5 ± 13.4)％ vs. (81.8 ± 12.9)％] and in forced expiratory flow rat (FEF25％-75％) pred [(26.7 ± 8.5)％vs.(36.7 ± 10.2)％](P<0.05), but at T1 there were no significant differences in FVC pred, FEV1 pred, FEV3 pred and FEF25％-75％ pred between the two groups(all P>0.05). And ACO group also had significantly higher values in residual volume pred [(138.9 ± 25.7)％vs. (117.5 ± 26.6)％] and in residual volume/total lung capacity [(55.8 ± 9.7)％ vs. (45.1 ± 8.9)％] (P<0.05). Conclusions ACO is common in the elderly male patients with stable COPD, and ACO patients have lower time vital capacity as compared with non-ACO patients. But after bronchodilation test, the two groups have similar ventilation function, and the small airway function in ACO patients improves more significantly .
الملخص
Objective The blending instructional teaching mode was used in the obstetrical resi-dent standardization training course and the effect was evaluated. Methods 36 resident physicians who attended obstetrical resident standardization training were chosen as blending instructional teaching group and traditional teaching group, 18 physicians per group. The physicians of blending instructional teaching group received blending instructional teaching mode, which included the obstetrical MOOC and Flipped Class, while the traditional teaching group only took part in the clinical management ruled by the hospital. Staging examination was performed according to the resident physician culture curriculum. Descriptive statistics, t test and chi-square test were performed by SPSS 21.0 lines. Results The average score of theory examination [(93.21±5.40) vs. (81.32±7.10)], practical skill [(89.75±4.70) vs. (68.96±8.20)] and clinical intellectual [(88.64±9.30) vs. (75.88±9.70)] in the blending instructional teaching group was significantly higher than that in the traditional teaching group (P<0.05). The physicians' satisfaction rate of manipulative ability in the blending instructional teaching group was significantly higher than that in the traditional teaching group (72.22% vs. 16.76%), which had statistical significance ( χ2=16.74, P=0.003); The physi- cians' satisfaction rate for the tutor in the blending instructional teaching group was significantly higher than that in the traditional teaching group (83.30% vs. 11.11%), which had statistical significance ( χ2=21.67, P=0.000). Conclusion The blending instructional teaching mode adapts to the development trend of teaching , and improves the effect of obstetrical resident standardization training course.