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Objective:To investigate the risk factors of pleural effusion after spinal separation surgery for patients with spinal metastatic tumors.Methods:A total of 427 patients with spinal metastatic tumors from January 2014 to January 2022 in the Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively analyzed. There were 252 males and 175 females, with an average age of 59±12 years (range, 15-87 years). All patients underwent separation surgery. Based on the chest CT within 1 month after surgery, the volume of pleural effusion was measured individually by reconstruction software. Pleural effusion was defined as small volume (0-500 ml), moderate volume (500-1 000 ml), and large volume (above 1 000 ml). Baseline data and perioperative clinical outcomes were compared between the groups, and indicators with statistically significant differences were included in a binary logistic regression analysis to determine the independent risk factors for the development of pleural effusion after isolation of spinal metastatic cancer. Receiver operating characteristic (ROC) curves were conducted to calculate the area under the curve (AUC) for each independent risk factor.Results:All patients successfully completed the operation. Among the 427 patients, there were 35 cases of large pleural effusion, 42 cases of moderate pleural effusion, and 350 cases of small pleural effusion. There were significant differences in tumor size (χ 2=9.485, P=0.013), intraoperative blood loss ( Z=-2.503, P=0.011), blood transfusion ( Z=-2.983, P=0.003), preoperative total protein ( Z=2.681, P=0.007), preoperative albumin ( Z=1.720, P= 0.085), postoperative hemoglobin ( t=2.950, P=0.008), postoperative total protein ( Z=4.192, P<0.001), and postoperative albumin ( t=2.268, P=0.032) in the large pleural effusion group versus the small and moderate pleural effusion group. Logistic regression analysis showed that decreased preoperative albumin ( OR=0.89, P=0.045) and metastases located in the thoracic spine ( OR=4.01, P=0.039) were independent risk factors for the occurrence of large pleural effusion after separation surgery. The ROC curve showed that the AUC and 95% CI for preoperative albumin, lesion location, and the combined model were 0.637 (0.54, 0.74), 0.421 (0.36, 0.48), and 0.883 (0.81, 0.92). The combined predictive model showed good predictive value. Conclusion:The volume of pleural effusion can be measured individually and quantitatively based on chest CT. Decreased preoperative albumin and metastases located in the thoracic spine are independent risk factors for the occurrence of large pleural effusion after separation surgery. The combined prediction of the two factors has better predictive efficacy.
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Objective:To study the application of systemic meta-competence and its difficulties in the clinical practice of initial family therapy by qualitative research, with the aim of providing an empirical basis for developing local family therapists' clinical practice competence in systemic thinking.Methods:A purposive sample of 4 senior and 4 novice family therapists were gained, and a total of 12 hours of initial interviews were recorded.The materials were coded by thematic analysis with reference to the theoretical models of National Institute for Health and Care Excellence(NICE) and the American Association for Marriage and Family Therapy (AAMFT), and one-on-one interviews (totally 4 hours)were conducted with the therapists based on the coding results.Results:The application of systemic meta-competence in the initial family therapy was mainly manifested in four superordinate themes: adapting a non-pathological perspective, maintaining a relational orientation, focusing on interpersonal interactions and applying systemic intervention strategies, under which a total of 16 subordinate themes were included.The application difficulties of therapists with different qualification had both commonalities and differences.Conclusion:The systemic meta-competency is a key competence in the practice of family therapy.The application of systemic meta-competence in initial interview will benefit the therapeutic relationship, family information collections and formulation of therapy goals, and the application difficulties may reflect the culturally practical needs of professional trainings and supervisions.
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ObjectiveTo investigate the efficacy of Bushen Shengxue prescription and Yiqi Yangxue prescription in the treatment of chronic aplastic anemia and the effect on T cell subsets and the expression of T-box expressed in T cells (T-bet) and GATA binding protein 3 (GATA3). MethodA total of 585 patients with chronic aplastic anemia who were treated in 19 hospitals in China from May 2018 to June 2021 were enrolled. With the prospective, double-blind and randomized control methods, the patients were randomized into three groups: kidney deficiency group, Qi and blood deficiency group, and control group. The three groups were respectively treated with Bushen Shengxue prescription granule, Yiqi Yangxue prescription granule, and Placebo (half the dose of Bushen Shengxue formula granules). In addition, all of them were given oral cyclosporin and androgen. The treatment lasted 6 months, with 3 months as a course. The blood routine indexes, T cell subsets, and fusion genes T-bet and GATA3 before and after treatment were analyzed, and the safety indexes were monitored. ResultDuring the observation, a total of 75 cases dropped out and 18 were rejected. Finally, 161 cases in the kidney deficiency group, 164 in the Qi and blood deficiency group, and 167 in the control group were included. After 6 months of treatment, the total effective rate was 98.8% (159/161) in the kidney deficiency group, which was higher than the 79.9% (131/164) in the Qi and blood deficiency group (χ2=30.135, P<0.01) and the 61.7% (103/167) in the control group (χ2=70.126, P<0.01). The total effective rate was higher in the Qi and blood deficiency group than in the control group (χ2=13.232, P<0.01). After treatment, the hemoglobin (HGB) content increased significantly in three groups (P<0.05) as compared with that before treatment, particularly the kidney deficiency group (P<0.01). After treatment, the white blood cell (WBC) count and platelet (PLT) count in the kidney deficiency group and the control group increased compared with those in the Qi and blood deficiency group (P<0.01). There was no specific difference in neutrophils (ANC) after treatment among the three groups. At the same time point, the level of T helper type 1 (Th1) cells, Th1/Th2 ratio (P<0.05), level of CD4+, and CD4+/CD8+ ratio (P<0.05) were significantly low in the kidney deficiency group among three groups. There was no significant difference in CD19-, HLA/DR+, and CD25+ between the kidney deficiency group and the other two groups, but the T-bet of the kidney deficiency group and the control group was lower than that of the Qi and blood deficiency group (P<0.05). ConclusionBushen Shengxue prescription exerts therapeutic effect on the aplastic anemia by improving the immunoregulatory mechanism, inhibiting the activity of immune system, modulating T cell subsets, suppressing Th1 and CD4+, and promoting bone marrow hematopoiesis. Moreover, it is safe with little side effects, which is worthy of further promotion.
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Common mental health problems from the perspective of prevention among medical stu-dents were discussed in this activity which was learning from the concept and method of PBL. Participants had to find the solutions themselves by small-group discussion so as to improve their mental health. Results showed that most participants confirmed the innovation, interest and intellectuality of this activity. Moreover, students could not only learn knowledge related to mental health, but also improve their friendship as well as communication skills which were beneficial to medical students' mental health.
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Objective:To explore relationship amongpersonality,family interpersonal dynamics and college students'adaption.Methods:Adaption to college was assessed with the Symptom Checklist 90 (SCL-90)in internet when 1850 freshman selected conveniently from a university in Shanghai (Students with single factor score of SCL-90 equal or greater than 2.5 belonged to the positive group,while the other students with single factor score of SCL-90 all less than 2.5 belonged to the negative group).At the same time,they were evaluated with the Cattell's 16 Personality Factor(16PF)to evaluate their characteristics and Multi-Interpersonal Dynamics Questionnaire for Un-dergraduates (MIDQ-U)for undergraduate students to assess family interpersonal dynamics.Results:The scores of anxiety of 16PFwere higherin the positive groupwith 50 students than in the negative group[(7.2 ±1.4)vs.(4.6 ± 1.9),P <0.001 ],while the scores of extroversion,serenity and alertness of 16PF were lower in the positive groupthan inthe negativegroup.In the SCL-90 positive group,the MIDQ-Uscores of indifference and submissivenesswere higher[(17.3 ±6.0)vs.(14.9 ±4.2),(11.5 ±3.2)vs.(10.3 ±3.1);P <0.001]and the scores of indepen-dencewere lower than that in the positive group[(18.7 ±3.0)vs.(19.8 ±3.4),P =0.02].Path graphanalysiss-howed that anxiety and extroversionpartly predicted freshmen's adaption directly(β=0.57 --0.01 )and partly worked through indifference(β=0.031 --0.004),while decisivenesscompletely functioned through indifference with the coefficient of 0.008.Anxiety had part mediating effect between indifference and freshmen's adaption(β=0.008).In the other three factors,anxietyplayedcompletemediatingrole.Conclusion:Personalities and family inter-personal dynamics may affect each other,then mutually predictstudents'adaption to college.
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Objective To study the postpartum pelvic floor rehabilitation on the improvement of pelvic floor electrical physiological indexes and the prevention of female pelvic floor dysfunction in China. Methods A multicenter prospective randomized controlled study was carried out. From October 2011, postpartum women in five provinces were randomly assigned into treatment group and control group. The women in treatment group received electrical stimulation and biofeedback treatment. The women in control group performed pelvic floor muscle exercise at home. When 6 months and 12 months after delivery, comparing two groups of patients with pelvic floor electrical physiological indexes and pelvic organ prolapse quantitation measurements (POP-Q), to evaluate the effect of postpartum pelvic floor rehabilitation on the prevention of pelvic floor dysfunction. Pelvic floor impact questionnaire short form (PFIQ-7) and pelvic organ prolapse/incontinence sexual questionnaire-12 (PISQ-12) were used to evaluate the influence on quality of life and sexual life. Results Until June 2013, 324 women were participated, 124 in control group, 200 in treatment group. According to the baseline results, there was statistical significance in the results of pelvic floor electrical physiological indexes between the treatment and control groups in postpartum 6 months and 12 months; the proportion above level Ⅲ of type Ⅰ and type Ⅱ muscle fibers strength in the treatment group, it was from 41.5% (83/200) and 40.5% (81/200) to 76.3% (145/190) and 79.5% (151/190) in postpartum 6 weeks and postpartum 6 months, increased to 80.6%(58/72) and 80.6%(58/72) in postpartum 12 months, improved significantly comparing with the control group (P0.05). There was no significant difference in the questionnaires in quality of life and quality of sexual life (P>0.05). Conclusion Neuromuscular electrical stimulation and biofeedback therapy in the early postpartum period could obviously improve pelvic floor electrical physiological indexes, and is beneficial to prevent the pelvic floor dysfunction.
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Objective To develop a scale to measure three representative real relationships of undergraduates (parent-child relationship,collegemate relationship and teacher-student relationship) and test its validity and reliability(multi-interpersonal dynamics questionnaire for undergraduates,MIDQ-U).Methods A total of 1 310 students were conveniently sampled as respondents to analyze validity and reliability indexes.Result Three relationships share four factors for interpersonal dynamic characteristics:closeness,indifference,independence and submissiveness.The revised MIDQ-U composed of 26 items to separately measure characteristics of three relationships both separately and together.The factor loading of items in parent-child relationship scale were 0.41-0.73 and 50.71% of the variances could be explained,while eollegemate relationship 0.41-0.72 and 51.81% explained,teacher-student relationship 0.42-0.76 and 49.58% explained.The model in 4 factors(x2/df =2.59,CFI =0.85) fitted the data with well construct validity.The Cronbach α coefficients were 0.847 in parent-child relationship scale,0.865 in collegemate relationship scale and 0.836 in teacher-student relationship scale.The test-retest reliabilities were 0.867,0.786 and 0.746.Conclusions The MIDQ-U has satisfactory validity aud reliability.It can be used to measure one of the three relationships separately,and also as an evaluation tool to compare and correlate multiple interpersonal dynamics.
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Objective To explore the association between family function and self-esteem in college students.Methods Totally 2560 college students were sampled.They were assessed with the self-compiled questionnaire on family information,Rosenberg' s self-esteem scale (SES) and family assessment device (FAD).Results The students from only-child family (30.32±4.19) scored higher on SES than students with siblings (29.54±3.97).The students with experience of grandparents raising (29.84±4.19) scored lower on SES than students raised by parents (30.29±4.13).Students from harmonious family and with monthly incoming above 10000 Yuan scored higher on SES than other groups.All the differences were statistically significant (P<0.01,P<0.05).There was significant correlation between SES and all of the dimensions of FAD (r=-0.260-0.379,P=0.000).Multiple regression showed that such dimensions of FAD as role,communication,behavior control,problem solving and general functioning,as well as social economic status of the family played important role on self-esteem of the students(β=0.039-0.169,P<0.01 orP<0.05).Conclusion Family factors have significant impact on self-esteem of the college students,especially family role and communication which are important positive predictors on self-esteem of college students.
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Objective To study the influence of serum containing Fuzheng Toudu Qudu Recipe, a Chinese formula with the actions of supporting healthy qi to expel and remove toxicity, on serum levels of interleukin 2 (IL-2) and soluble interleukin 2 receptor (sIL-2R) at different stages of CD34+derived dendritic cells (DC) of patients with minimal residual disease of myelogenous leukemia ( MRD-L) , and to explore the biological mechanism of Fuzheng Toudu Qudu Recipe in promoting CD34+ to transform into DC in MRD-L patients. Methods Bone marrow mononuclear cells ( BMMC) were separated from the bone marrow of acute myeloid leukemia patients at complete remission stage by using Ficoll centrifugation. CD34+ cells were isolated by using immuno-magnetic mircobeads method, and then were cultured with various concentrations of Chinese medicine medicated serum and cytokines in vitro for the induction of DC. The morphologic characteristics of DC were observed with the inverted phase contrast microscope, and the expression levels of DC surface molecules such as CD83, CD80, CD86, CD1a and HLA-DR were detected by using flow cytometry. On culturing day 0, 6 and 9, serum levels of IL-2 and sIL-2R of each group were measured by enzyme-linked immunosorbent assay ( ELISA). Results ( 1) Chinese medicine medicated serum combined with cytokines was effective on promoting CD34+ to differentiate into DC with typical morphology, and inducing DC to have high expression of CD80, CD83, CD86 and HLA-DR, which differed from those in fetal calf serum (FCS) group and blank rabbit serum group (P0.05) . At the same time point, combination groups had lower IL-2 content than the blank rabbit serum group (P<0.05 or P<0.01). Conclusion Fuzheng Toudu Qudu Recipe is effective on increasing serum content of IL-2 and reducing sIL-2R content, and the changes of cytokine contents are more obvious along with the maturity of DC, which indicates that the recipe plays positive effect in the process of promoting CD34+cells to differentiate into DC.
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Objective To explore family functioning and related factors in anxiety disorder(AD)adoles cents.Methods 84 adolescent patients with AD and 124 controls without mental disorder matched by gender,age,and residential township were assessed with Family Adaptability and Cohesion Scale(FACES-Ⅱ),Family Assessment Device.Chinese version(FAD-CV)and demographic questionnaires.Results There were statistical differences between case and control groups in family economic conditions(P<0.05).There was lower family cohesion in AD group(64.82±9.63)than that in the control group(69.72±8.91);the scores of communication,emotional involvement and behavioral control were higher in AD group((2.34±0.45),(2.52±0.44),(2.46±0.32))than that in controls((2.12±0.34),(2.36±0.42),(2.24±0.24)),all P<0.05.Logistic regression analysis showed that better family economic condition(OR=0.784;95%CI:1.459-3.396)and higher cohesion of family(OR=0.969;95%CI:0.942~0.998)were protective factors for AD,while over-strict behavioral control (OR=2.181;95%CI:0.993~2.441)was a risk factor for AD.Conclusion There are different family functioning characters between AD and controls,and the intimacy relationship and suitable behavior control in family may improve the mental health of adolescents.
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Dioxin,as a kind of strong carcinogenic substance,a kind of environment hormone with tremendous harm,can get into human body through food chain and accumulate in fat of animals and persons,forming serious threat to human health. Dioxin has been included in the list of monitoring objects in food part of the global environment monitoring program as a new environmental pollutant by World Health Organization. In this paper,the toxicity,the source of dioxin and its impact on human health and prevention and control measures are introduced.
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OBJECTIVE To know the bacterial distribution in the blood of septicemia patients and the characteristics of drug resistance.METHODS To train the blood in BD BACTEC 9050 full-automatic blood training system and to analyze it in the FOUTUNE IMS bacterial identification and hypersusceptibility analysis system of Fuxing Company.RESULTS The Gram-negative bacilli were in superiority with 64.9% of the total isolated bacteria.Then were the Gram-positive cocci,and Staphylococcus were the main.The Enterococcus and fungi were with a certain proportion.The drugs to which had relatively low resistance for the Gram-positive bacilli and the Gram-positive cocci were the carbapenems,the enzyme inhibitors and vancomycin.CONCLUSIONS The Gram-negative bacilli get priority in the blood bacteria in patients with septicemia during the last two years,the enterococci and fungi have a certain proportion.And the pathogenic bacteria have higher resistance clinically to antibacterial drugs.
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Objective:To study effect of tripterygium glycosides(TG)on T-lymphocyte subsets in rats with idiopathic thrombocytopenic purpura(ITP),and further to discuss the possible mechanism of TG in treating ITP.Methods:ITP animal model was established by intraperitoneal injection of exogenous anti-platelet–serum(APS).Sixty model rats were randomly divided into five groups:normal group,saline group,the high and low dosage of TG groups,prednisone group.Every rat was giving liquid medicine by intragastric administration one time per day for ten days 36 hours after the first intraperitoneal injection of exogenous APS.The changes of peripheral hemogram,the amount of megakaryocyte of bone marrow and T-lymphocyte subsets were observed.Results:In high dosage of TG group,the number of platelet count increased obviously,the number of megakaryocyte in bone marrow,CD8+and CD4+decreased,and CD4+/CD8+increased.Conclusion:High dosage of TG had obviously therapeutic effect on IPT rat,such as increasing platelet count obviously,reducing number of megakaryocyte in bone marrow obviously and ameliorating T-lymphocyte subsets.The mechanism may be related to regulating the cell immune function.