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Objective To explore the pharmacokinetics/pharmacodynamics(PK/PD)parameters and influencing factors in patients with augmented renal clearance(ARC)to provide the basis for the rational use of meropenem.Methods Using the method of retrospective study,the patients with increased renal clearance who used meropenem monitored the concentration from January 2018 to December 2021.The PK/PD parameters of meropenem were analyzed,and multiple linear retrospective analyses discussed the influencing factors of meropenem valley concentration.Results A total of 58 patients were included in the study,and the trough concentration was 1.35[0.23,1.86]μg·mL-1,taking 100%fT＞MIC as PK/PD target value,the compliance rate was 20.69%.The compliance rate of daily dose＜3 g·d-1 was 8.70%,and≥3 g·d-1 was 31.43%,the difference was statistically significant.With MIC of 0.5,1,2,4,and 8 μg·mL-1,PK/PD compliance rates were 62.07%,48.28%,20.69%,8.62%and 0.Respectively.Multiple linear retrospective analyses showed that dose was an independent factor affecting meropenem valley concentration.Conclusion The PK/PD compliance rate of meropenem in patients with augmented renal clearance is low,even if MIC≤0.5 μg·mL-1,the routine dose is difficult to achieve the ideal PK/PD,so the clinical should recognize ARC and perform TDM as soon as possible,and use TDM to guide the medication regimen of meropenem for ARC patients.
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【Objective】 To explore the current status of positive psychological qualities among college students who had participated in voluntary blood donation in Changsha area, so as to demonstrate that scientific blood donation can promote mental health. 【Methods】 From May to June 2022, 1 440 college students in Changsha was selected as the research subjects by stratified random sampling method. They were divided into groups based on their experience of blood donation. A questionnaire survey was conducted using the General Information Questionnaire, the Chinese College Student Positive Psychological Product Quality Scale, and the Repeated Blood Donation Behavior Survey Scale. 【Results】 There were differences in the six dimensions of positive psychological quality among different family and friends in terms of their support for blood donation, blood donation status among different family members, understanding of voluntary blood donation knowledge (P<0.05). There were differences in positive psychological qualities among different levels of blood reimbursement experiences (cognitive dimension, moderation dimension, transcendence dimension), different blood donation times (moderation dimension, interpersonal dimension), different blood donation volumes (moderation dimension, fairness dimension), different comprehensive blood donation experiences (moderation dimension, transcendence dimension, interpersonal dimension, emotional dimension) and reasons for blood donation (cognitive dimension, moderation dimension, interpresonal dimension, emotional dimension, fairness dimension)(P<0.05). The positive psychological quality of college students was positively correlated with their intention to repeat blood donation behavior (P<0.01), and the difference was statistically significant. 【Conclusion】 The positive psychological quality of college students with blood donation experience in Changsha surpassed those without blood donation experience, and their positive psychological quality was positively correlated to their intention to repeated blood donation. Therefore, it is recommended to encourage voluntary blood donation among college students.
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J Objective To investigate the efficacy of butorphanol intravenous analgesia combined with transversus abdominal plane block in postoperative analgesia after cesarean section.Methods A total of 120 cases of cesarean section performed in Jinjiang Hospital from August 2021 to January 2022 were selected for the study.The cases were divided into three groups,according to the different methods of maternal postopera-tive analgesia,the group A was treated with intravenous analgesia(100 mL normal saline containing 3 μg/kg butorphanol+25 mg dolasetron,2 mL/h,continuous analgesia for 48 h);the group B received intravenous analgesia(100 mL normal saline containing 3 pg/kg butorphanol+25 mg dolasetron,2 mL/h,continuous an-algesia for 48 h)combined with transverse abdominal plane block(0.5％ropivacaine given bilaterally on each side).2 μg/kg butorphanol+25 mg dolasetron,2 mL/h,continuous analgesia for 48 h)combined with trans-versus abdominis plane block(10 mL of 0.5％ropivacaine was given bilaterally),and intravenous analgesia in the group C(100 mL of saline containing 2 pg/kg butorphanol+25 mg dolasetron,2 mL/h,continuous anal-gesia for 48 h)combined with transversus abdominis plane block(0.5％ropivacaine 10 mL was given bilater-ally),and the three groups were compared in terms of the VAS scores of postoperative analgesia at 4,8,12,24 and 48 h,the occurrence of the incidence of adverse reactions,such as dizziness,drowsiness,nausea,and vomi-ting,and the satisfaction with the analgesia.satisfaction of analgesia.Results Comparison of analgesic effect between groups,the VAS of group B and group C were significantly lower than those of group A at 4,8 and 12 h after surgery(P＜0.05),but there was no significant difference between group B and group C in pain scores(P＞0.05),and postoperative 24,48 h pain scores of the three groups are not statistically different(P＞0.05).In terms of the incidence of adverse reactions such as dizziness,drowsiness,nausea and vomiting,there was no significant difference in the incidence of adverse reactions between the group A and the group B,and they were all higher than that of the group C.Satisfaction with analgesia at 4,8,12,24,48 h after surgery:group C＞group B＞group A.Conclusion The multi-mode analgesia program of butorphanol intravenous an-algesia combined with transversal abdominis plane block can be safely and effectively used for postoperative analgesia after cesarean section,and appropriate reduction of butorphanol dosage when combined can alleviate the adverse reactions brought by opioids,thus improving the satisfaction of patients with postoperative analge-sia.
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Objective:To analyze the level of self-management and its influencing factors in patients with systemic lupus erythematosus (SLE).Methods:A cross-sectional study. From January to December 2021, patients with SLE in the Department of Rheumatology and Immunology in the First Affiliated Hospital of Henan University of Traditional Chinese Medicine were selected as the study objects by convenience sampling method. A total of 135 questionnaires were distributed in this study, 135 were recovered, and 128 were valid. The general data of the patients were collected, and the self-management level, self-efficacy, family care and meaning in life of the patients were evaluated with the chronic disease self-management behavior scale, general self-efficacy scale (GSES), family adaption partnership growth affection resolve index (APGAR) and the meaning in life questionnaire (MLQ). Multiple linear regression analysis was applied to explore the factors affecting the self-management of SLE patients.Results:The total score of chronic disease self-management behavior scale in the 128 SLE patients was (28.77±6.58) points. Pearson correlation analysis showed strong correlation between self-efficacy, sense of life meaning and self-management ( r=0.748, 0.717, both P<0.001), there was a moderate correlation between family care and self-management ( r=0.560, P<0.001). Multiple linear regression analysis showed that educational level ( β′=0.457), disease activity ( β′=-0.211), self-efficacy ( β′=-0.372), family care ( β′=-0.510), meaning in life ( β′=-0.386) were influencing factors of self-management level in patients with SLE (all P<0.05). Conclusions:The self-management level of SLE patients needs to be improved. Disease activity, self-efficacy, meaning in life and other factors can affect the patients′ self-management level.
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As the major means of outpatient payment for basic medical insurance (the insurance for short) relies on fee-for-service, it tends to encourage unreasonable growth of medical expenses. Based on the principal-agent theory, this paper analyzed the principal-agent relationship between the insurance handling agencies and the hospitals designated by the insurance, and constructed a benefit game model of outpatient payment methods and the supporting supervision game model. This practice aims to explore the optimal and balanced benefit of the insurance payment methods and supporting supervision mechanism, and provide decision support for promoting the reform of medical insurance outpatient payment in China. The analysis results of the benefit game model of payment methods showed that a system mixing the post-payment and pre-payment could optimize and maximize the total benefits and interests of all the stakeholders within the system. Specifically, the practice recommended was a mixed payment integrating ambulatory-payment-classification, fee-for-service and global-budget-payment. The analysis of the supporting regulatory game model found that the factors that must be considered to ensure the expected utility of the above mixed payment mode as follows: the gap between the unreasonable income obtained by the hospital by out-of-control charging and the reward obtained by under-control charging, the size of the penalty after the unreasonable income of the hospital was discovered, the size of the regulatory cost and the loss of benefits of the government and the insured group. It is suggested to adopt the mixed payment method mainly based on the ambulatory-payment-classification supported by fee-for-service and global-budget. At the same time, medical insurance agencies can improve their supervision mechanism from such aspects as perfecting penalties, reducing supervision costs, leveraging government administrative power and advocating public supervision.
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Objective:To analyze the hospitalization costs of delivery for postpartum women with different delivery methods, ages and comorbidities or complications, for references for medical institutions and medical insurance management departments to develop payment and compensation standards for inpatient delivery.Methods:The first page of medical records of hospitalized delivery women admitted to 8 large tertiary hospitals in Beijing from January 2018 to December 2021 were selected. Descriptive analysis was made on the mode of delivery, age, hospitalization expenses and cost structure of puerpera, as well as the hospitalization expenses of puerpera with different complications or complications. Wilcoxon rank sum test, Kruskal-Wallis H test, and Chi-squared test were used to statistically compare the level and structure differences between groups. Results:A total of 23 320 pregnant women were included, with an average age of 32.3 years. There were 13 605 cases of natural delivery and 9 715 cases of caesarean section. The median cesarean section rate in the right age group (<35 years old) and the elderly group (35-50 years old) were 36.73% and 56.58%, respectively, and the median hospital expenses were 5 865 yuan and 7 042 yuan, respectively. The median hospital expenses for natural delivery and caesarean section were 4 452 yuan and 10 033 yuan, respectively. The highest proportion of hospitalization expenses for natural delivery and cesarean section were treatment expenses (23.45%) and medicine expenses (29.19%), respectively. The median of hospitalization cost for women with≥2 comorbidities or complications (6 736 yuan) was higher than that for women with 1 comorbidities or complications (5 794 yuan).Conclusions:The hospitalization cost of cesarean section was significantly higher than that of natural delivery and the rate of cesarean section and the cost of delivery in women aged 35 and above were higher than those under 35 years old. The structure of hospitalization cost was different in different delivery modes, and the complications or complications had a greater impact on the average hospitalization expenses.
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Objective:To explore the effectiveness of self-assisted couple communication program(SACCP)onprenatal depression and marital quality in pregnant women.Methods:Totally 90 pregnant women receiving ante-natal checkup in Air Force Medical Center with the Edinburgh Postnatal Depression Scale(EPDS)scores of ≥10 were voluntarily recruited and randomly allocated in routine caring and SACCP groups.Thirty-nine pregnant women in SACCP group and 37 pregnant women in routine caring group ultimately completed the study.In addition to rou-tine caring,the SACCP group completed a 10-week self-assisted family communication program once a week.The EPDS and Olson Marital Quality Questionnaires(ENRICH)were used as outcomes,and covariance and independ-ent t-teat were adopted to evaluate intervention effectiveness.Statistical analysis was conducted using the full analy-sis set and the per protocol set respectively.Results:Totally 76(84.4％)pregnant women received allocation and end-point revaluation.Covariance analysis revealed that EPDS adjusted means were higher in the SACCP group than in the routine caring group(P＜0.05)in both sets.T-test showed that marital satisfaction and couple communica-tion scores were higher in the SACCP group than in the routine caring group(Ps＜0.01)in the full analysis set.Conclusion:The self-assisted couple communication program(SACCP)could effectively alleviate clinical symptoms of prenatal depression of pregnant women and improve marital quality.
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Objective@#To obtain chimeric antigen receptor macrophages ( CAR-M) targeting HER2 stably transfected．@*Methods @#CAR lentivirus vector targeting HER2 was constructed and infected with human monocytic leukemia cell line (THP-1) ．CAR THP-1 cells with green fluorescent labeling were selected by sorting flow cytometry and continued to be cultured in vitro．The CAR THP-1 cells targeting HER2 were co-cultured with the endometrial cancer cell line Ishikawa with negative and positive HER2 expression，and their targeted phagocytosis of CAR-M to HER2 positive tumor cells was detected by imaging flow cytometry ，and the targeted phagocytosis efficiency of CAR-M to HER2 positive tumor cells was detected by flow cytometry. @*Results @#CAR lentivirus infection with THP- 1 cells was less efficient ; After co-culture with cancer cells，flow cytometry and imaging flow cytometry showed that CAR THP-1 cells had enhanced phagocytosis of HER2 positive Ishikawa cells compared with the empty body group (P＜0. 01) ．@*Conclusion @#In this experiment，CAR THP-1 cell line targeting HER2 was established by constructing CAR lentivirus vector and transfecting THP-1 cells ，and it was proved that CAR THP-1 could phagocytize HER2 positive Ishikawa cells through specific targeting.
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The new business forms are the new patterns of the job market extended by the use of mobile internet, big data, cloud computing, and other information technologies in the context of a new round of information technology development. In recent years, under the catalysis of the new employment model, a large number of new business employees have emerged such as food delivery riders, couriers, and online car-hailing drivers, whose employment forms are flexible and don’t fully conform to the establishment of labor relations with the employers, and whose problem of overtime work is common. The employment characteristics of new business forms of "focusing on performance and ignoring responsibility" make workers at great risks of occupational injuries and occupational health problems such as work-related musculoskeletal disorders, mental disorders, and overwork. However, the current research on occupational safety and health of workers in new business forms is insufficient, and the experience of institutional practice and supervision is also limited. Therefore, based on relevant research progress at home and abroad, this paper discussed the health injuries of workers in new business forms, summarized associated influencing factors from four aspects: employment form, employment affiliation, long working hours exposure, and institutional guarantee, and then proposed countermeasures to strengthen occupational safety and health protection of workers. For the current problems in the employment of new business forms, the government, enterprises, and workers need to work together to improve the legal and regulatory system for employment of new business forms, and standardize occupational safety and health management, thus effectively protect the occupational safety and health rights and interests of workers in new business forms.
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Objective:To investigate the effect of external dissection and internal ligation (MMH) in the treatment of grade Ⅲ to Ⅳ mixed hemorrhoids with anorectal resting hypertension and its prognostic risk factors.Methods:The clinical data of 48 patients with grade Ⅲ-Ⅳ mixed hemorrhoids complicated with rectal and anal resting hypertension treated by MMH in Nanjing Jiangbei people′s Hospital Affiliated to Nantong University from February 2018 to February 2020 were analyzed retrospectively (observation group), including 24 males and 24 females; The age ranged from 22 to 55 (41.87±7.52) years. Another 48 patients with grade Ⅲ-Ⅳ mixed hemorrhoids complicated with anorectal resting hypertension treated by PPH were selected as the control group, including 20 males and 28 females; The average age was (42.68±7.14) years. The clinical effective rates , pain score at 6, 24 and 72 h after operation, postoperative complications were compared between the two groups. Multiple logistic regression was used to analyze the related risk factors affecting the prognosis.Results:There was no significant difference in VAS score between the two groups at 6 h after operation ( t=0.25, P=0.807); the VAS score of the observation group at 24 h and 72 h after operation was lower than that of the control group ( t=7.044, P<0.001; t=5.307, P<0.001); the total effective rate of the observation group was higher than that of the control group (93.75% vs 77.08%, χ2=5.35, P=0.021); the total incidence of postoperative anal edema, defecation difficulty, bloody stool, anal pain and fecal incontinence in the observation group was lower than that in the control group, the difference was statistically significant (12.50% vs 33.33%, χ2=5.879, P=0.015). Age, course of disease, grading of internal hemorrhoids and treatment methods were related to the prognosis of patients ( P<0.05); logistic regression analysis showed that age (> 45 years), course of disease (>10 years), grade of internal hemorrhoids (grade Ⅳ) and treatment (PPH) were independent risk factors for prognosis of patients ( P<0.05). Conclusions:MMH has less complications, less postoperative pain and satisfactory curative effect in the treatment of Ⅲ to Ⅳ mixed hemorrhoids and anorectal resting hypertension. The older the patients, the longer the course of disease, the higher the degree of internal hemorrhoids and the choice of treatment methods were the risk factors for the prognosis. Early diagnosis and reasonable treatment are helpful to improve the prognosis of patients.
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Objective:To investigate the diagnostic value of ultrasonography in Poland′s syndrome.Methods:From February 2016 to December 2020, the ultrasonographic images of 15 patients with Poland′s syndrome diagnosed by Provincial Hospital Affiliated to Shandong First Medical University were retrospectively analyzed, and the ultrasonographic features were summarized.Results:High-frequency ultrasound could clearly show the anatomical structures of each layer of the chest wall of the patients with Poland′s syndrome. The sonogram of Poland′s syndrome mainly showed the absence of all or part of the pectoralis major on the affected side, some of which were combined with the absence of pectoralis minor. The difference between the thickness of the affected chest wall and the healthy side was statistically significant ( P<0.01). Among the 15 cases of Poland′s syndrome, 11 cases had brachydactyly or syndactyly. Ultrasound showed that the bifurcation position of the common palmar digital artery of the middle finger was lower than that of the healthy side. Conclusions:The ultrasonography is an effective imaging method for diagnosis of Poland′s syndrome.
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【Objective】 To understand the situation of free blood use of blood donors in Changsha to explore the correlation between free blood use of donors and repeated blood donation behaviors, so as to provide a theoretical basis for the recruitment of voluntary blood donations. 【Methods】 A total of 260 voluntary blood donors were selected by random sampling and divided into reimbursed group(n=97) and unreimbursed group(n=163), based on the results of a questionnaire, inquiring their using of free blood. 【Results】 The reimbursed group differed from the unreimbursed group in all dimensions, including behavioral attitude dimension(Z=3.250, P<0.05), subjective behavioral norm dimension(Z=4.576, P<0.05), and perceptual behavioral control dimension(Z=7.255, P<0.05) and the total score of the scale(Z=8.625, P<0.05), and the differences were statistically significant. 【Conclusion】 The intention to donate again was stronger in donors who experienced free blood use than those didn’t. Such donors are suitable candidates for blood donor recruitment. It is recommended to develop a suitable recruitment strategy for this population and further guarantee the clinical use of blood.
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Objective:To evaluate the risk factors related to the mid-term outcomes of hip preserving surgery for early stages osteonecrosis of the femoral head (ONFH) basing on China-Japan Friendship Hospital (CJFH) classification system.Methods:From June 2012 to September 2016, there were consecutive 325 patients (432 hips) were enrolled and divided into different preserving surgery groups, namely core decompression (CD) group 141 hips and "lightbulb" operation (LB) group 291 hips, respectively. Harris hip score (HHS) was used to evaluate the clinical outcomes. The progression of ONFH was observed by radiography. Clinical failure was defined as worsen of HHS and/or radiographic evaluation. Clinical endpoint events were marked as significant hip pain (HHS<70), and/or collapse of the femoral head requiring further interventions. Potential risk factors, including sex, age, etiology, the duration from symptom onset to treatment, preoperative CJFH type, ARCO stage and HHS, were analyzed using univariate risk analysis and Cox regression multivariate risk model.Results:The rate of hip failure was 47.5% (67/141) in CD group, including type C+M 13.0% (3/23), L1 38.1% (24/63), L2 82.4% (14/17) and L3 68.4% (26/38), respectively. There was significant difference in age (χ 2=3.887, P=0.049), type of CJFH (χ 2=40.943, P=0.000) in CD group. The Cox regression analysis revealed that age≥40 ( HR=2.325, 95% CI 1.398, 3.866, P=0.000), pre-HHS 70-80 ( HR=2.163, 95% CI 1.140, 4.105, P=0.018) and <70 ( HR=2.597, 95% CI 1.173, 5.749, P=0.019), type L2 ( HR=35.052, 95% CI 7.721, 159.133, P=0.000) and L3 ( HR=13.242, 95% CI 3.104, 56.491, P=0.000) were associated with failure of core decompression. The rate of hip failure was 36.4%(106/291) in LB group, including type C+M 33.3% (1/3), L1 31.3% (41/131), L2 84.6% (22/26) and L3 32.1% (42/131), respectively. There were significant differences in age (χ 2=8.437, P=0.004), pre-HHS (χ 2=19.737, P=0.000) and type of CJFH (χ 2=29.265, P=0.000) in LB group. The Cox regression analysis showed that poor pre-HHS ( HR=5.102, 95% CI 2.339, 11.129, P=0.000), type L2 ( HR=32.761, 95% CI 6.165, 43.507, P=0.000) were associated with failure of "lightbulb" preserving surgery. Conclusion:The results of hip preserving surgery for ONFH are associated with age, preoperative HHS and CJFH typing. The prognosis depends on the severity of symptoms, the residual of weight-bearing joint surface and lateral pillar of the femoral head.
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Objective:To evaluate the role of high frequency ultrasonography in diagnosis of closed volar plate injury of proximal interphalangeal joint.Methods:From May 2015 to may 2021, 41 patients with acute closed volar plate injury confirmed by Department of Hand and Foot Surgery of the Provincial Hospital Affiliated to Shandong First Medical University were examined by high frequency ultrasonography. The sonographic features were analyzed and classified.Results:High frequency ultrasonography could not only clearly show the thickness, shape and echo of volar plate, but also the degree of injury and avulsion fracture of volar plate, according to which the closed volar plate injury could be divided into three types: A, B and C. Type A(13 cases): Avulsion fracture of the middle phalangeal base was found with volar plate rupture, the sonogram showed that the continuity of the volar plate attachment of the middle phalangeal base was interrupted, and avulsion fracture was found at the distal end of the volar plate. Type B(11 cases): Complete rupture of the volar plate attachment of the middle phalangeal base was found without avulsion fracture, the sonogram showed that the continuity of the volar plate attachment of the middle phalangeal base was interrupted, and the end of the volar plate contracted and thickened. Type C(17 cases): Tear of the volar plate was found, the sonogram showed enlarging volar plates, heterogeneous internal echo, and liquid dark area was visible in some cases. The average thickness of the three types of closed volar plate injury of the proximal interphalangeal joint measured by ultrasound was (0.33±0.05)cm, and the average thickness of the volar plate at the same position of the corresponding finger on the opposite side was (0.22±0.03)cm. There was significant difference between the two groups ( t=7.864, P=0.006). Conclusions:High frequency ultrasonography is the preferred imaging examination method for the diagnosis of closed volar plate injury in proximal interphalangeal joint, which has an important guiding significance for the selection of clinical treatment.
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Since its founding 100 years ago, the Communist Party of China (CPC) has attached great importance to the occupational health of workers, and closely linked the safeguard of occupational safety and health of workers with the missions of leading the people to stand up, get rich, and become strong. Based on this, the achievements of occupational health work made under the leadership of the CPC since the new democratic revolution, socialist revolution and construction, the new period of reform and opening up and socialist modernization, and socialism with Chinese characteristics for a new era were summarized, so as to provide reference for understanding the legacy of China's occupational health undertaking, and innovating to create the future.
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Objective To investigate the expression of LncRNA DLEU1 in ESCC tissues, and its effect on the proliferation and migration of ESCC cells. Methods We collected 58 cases of ESCC tissues and corresponding para-cancerous tissues. RT-qPCR was used to detect the relative expression levels of DLEU1 in ESCC tissues and cells. Log-rank test was used to analyze the relation between the expression of DLEU1 and clinicopathological features. Kaplan-Meier analysis was used to investigate the correlation between the expression of DLEU1 and the survival of ESCC patients. Multivariate Cox regression model was used to evaluate the effect of DLEU1 on the prognosis of ESCC patients. Effects of DLEU1 on the proliferation and migration of Eca9706 cells were evaluated by CCK-8 and wound healing assays, respectively. Results DLEU1 was highly expressed in ESCC tissues (P < 0.01) and significantly correlated with tumor size, TNM stage and lymph node metastasis (all P < 0.05). High expression of DLEU1 was negatively correlated with poor prognosis of ESCC patients (P < 0.01), and DLEU1 was also an independent prognostic risk factor (P < 0.05). Moreover, knockdown of DLEU1 significantly inhibited the proliferation and migration of Eca9706 cells, compared with the control group (P < 0.01). Conclusion DLEU1 is highly expressed in ESCC tissues. The expression of DLEU1 is an independent risk factor for the prognosis of ESCC patients and promotes ESCC cell proliferation and migration.
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BACKGROUND: Osteonecrosis of the femoral head is a refractory disease in department of orthopedics. Especially with steroid-induced osteonecrosis, incidence rate is high, and it is easy to collapse. Increasing knowledge of hormone necrosis will help early identification and intervention, and choose reasonable treatment measures to improve prognosis. OBJECTIVE: To investigate the clinical effects and influencing factors in the treatment of different kinds of steroid-induced osteonecrosis of the femoral head of CJFH type L1 patients through femoral head and neck junction decompression by fenestration and bone grafting. METHODS: Clinical data of 82 patients (106 hips) with CJFH type L1 steroid-induced osteonecrosis of the femoral head, who underwent femoral head and neck junction decompression by fenestration in China-Japan Friendship Hospital, were analyzed. The clinical effect evaluation consisted of two parts: Harris hip score system, the observation of bilateral hip joint and frog position film. Clinical endpoint events were marked by poor Harris hip score < 70, progressive collapse of the femoral head with/without obvious clinical manifestation. Univariate and multivariate analyses were used to analyze the influence of gender, age, etiology, preoperative ARCO stage, onset time and preoperative Harris score on prognosis. RESULTS AND CONCLUSION: (1) All patients were followed up, and the mean duration was 3-51 months. (2) Based on Harris hip score of the last follow-up, the results were excellent in 4 hips, good in 33 hips, fair in 50 hips, and poor in 19 hips. The excellent and good rate was 34.9% (37/106). Harris hip score was higher in the final follow-up (83.1±14.3) than that before surgery (64.4±9.8) (P < 0.05). (3) Imaging results demonstrated that there were 15 hips with progressive collapse of the femoral head, and 6 hips without obvious clinical symptoms. (4) The 26 hips were classified as clinical failed. Univariate and multivariate analyses showed that preoperative Harris hip score < 70 was the independent risk factor for prognosis of osteonecrosis of the femoral head (P < 0.05). There was no significant difference among different types of steroid-induced osteonecrosis of the femoral head. (5) The method through femoral head and neck junction decompression by fenestration and bone grafting has a good effectiveness in patients with type L1 steroid-induced osteonecrosis of the femoral head in short and medium terms, but preoperative Harris hip score < 70 is a risk factor affecting the prognosis of hip preservation.
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Objective To evaluate the accuracy and diagnostic value of bronchoalveolar lavage fluid galactomannan test (BALF-GM) combined with serum GM test on invasive pulmonary aspergillosis (IPA). Methods 190 cases of BALF-GM and 4 787 cases of serum GM specimens suspected of fungal infection in patients admitted to Affiliated Hospital of Jining Medical University from January 2016 to June 2018 were enrolled and analyzed. All patients were classified into clinically confirmed IPA, clinically diagnosed IPA, suspected IPA and excluded IPA according to the classification standard of Expert consensus on diagnosis and treatment of pulmonary mycosis. The coincidence rate of BALF and serum GM test results with clinical diagnosis was analyzed. Receiver operating characteristic (ROC) curve was performed, and the diagnostic value of BALF and serum GM test alone or in combination for IPA was evaluated. Subgroup analysis was performed in patients with normal or abnormal immune function, and the sensitivity and specificity of BALF and serum GM test were compared separately or jointly. Results The positive rate of BALF-GM was 46.8% (89/190), and 10.4% (497/4 787) on serum GM. Among them, 156 patients were both tested on BALF and serum GM. There were 44 cases with both positive in BALF and serum GM, the coincidence rate of clinical definite was 93.2% (41/44). There were 34 cases with positive BALF-GM and negative GM test in serum, and the coincidence rate of clinical definite was 64.7% (22/34). There were 56 cases positive in serum GM and negative in BALF-GM, and the coincidence rate of clinical definite was 48.2% (27/56). BALF and serum GM tests were both negative in 22 cases, and the coincidence rate of exclusion diagnosis was 90.9% (20/22). ROC curve analysis showed that the diagnostic value of BALF-GM test combined with serum GM test for IPA was better than that of BALF-GM test or serum GM test alone [area under ROC curve (AUC): 0.992 vs. 0.983, 0.976]. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 95.3%, 87.0%, 93.2% and 90.9%, respectively. Subgroup analysis showed that among 89 patients with positive BALF-GM test, 85 cases (95.5%) had normal immune function and 4 cases (4.5%) had unknown condition. Among 497 patients with positive serum GM test, 12 cases (2.4%) had normal immune function, 372 cases (74.9%) had abnormal immune function and 113 cases (22.7%) were uncertain. It was shown by ROC curve analysis that the sensitivity of positive BALF-GM test in diagnosis of IPA in patients with normal immune function was higher than that of positive serum GM test (95.6% vs. 88.9%), while the sensitivity of positive serum GM test in patients with abnormal immune function was higher than that of positive BALF-GM test (91.8% vs. 89.9%). Conclusion The results of BALF and serum GM tests are in good agreement with clinical diagnosis, and the combined detection of BALF and serum GM is more valuable for IPA diagnosis than single detection, especially for patients with unknown immune function.
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Alzheimer's disease (AD) is characterized byβ-amyloid (Aβ) deposition and tauprotein hyperphosphorylation, whereas its pathogenesis has not been fully known so far. The metabolism of Aβand tau protein is critically affected by autophagy. In the early phase of AD, Aβand tau protein can induce themselves to be eliminated via mTOR-dependent and independent autophagy pathways. In addition, transcription factors EB and apolipoprotein E4 also regulate autophagy and thus participate in the metabolism of Aβand tau protein, affecting AD progression. This review summarized the roles of autophagy in the metabolism of Aβand tau protein and the autophagy regulators closely related to AD in the recent studies.
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OBJECTIVE@#To evaluate the accuracy and diagnostic value of bronchoalveolar lavage fluid galactomannan test (BALF-GM) combined with serum GM test on invasive pulmonary aspergillosis (IPA).@*METHODS@#190 cases of BALF-GM and 4 787 cases of serum GM specimens suspected of fungal infection in patients admitted to Affiliated Hospital of Jining Medical University from January 2016 to June 2018 were enrolled and analyzed. All patients were classified into clinically confirmed IPA, clinically diagnosed IPA, suspected IPA and excluded IPA according to the classification standard of Expert consensus on diagnosis and treatment of pulmonary mycosis. The coincidence rate of BALF and serum GM test results with clinical diagnosis was analyzed. Receiver operating characteristic (ROC) curve was performed, and the diagnostic value of BALF and serum GM test alone or in combination for IPA was evaluated. Subgroup analysis was performed in patients with normal or abnormal immune function, and the sensitivity and specificity of BALF and serum GM test were compared separately or jointly.@*RESULTS@#The positive rate of BALF-GM was 46.8% (89/190), and 10.4% (497/4 787) on serum GM. Among them, 156 patients were both tested on BALF and serum GM. There were 44 cases with both positive in BALF and serum GM, the coincidence rate of clinical definite was 93.2% (41/44). There were 34 cases with positive BALF-GM and negative GM test in serum, and the coincidence rate of clinical definite was 64.7% (22/34). There were 56 cases positive in serum GM and negative in BALF-GM, and the coincidence rate of clinical definite was 48.2% (27/56). BALF and serum GM tests were both negative in 22 cases, and the coincidence rate of exclusion diagnosis was 90.9% (20/22). ROC curve analysis showed that the diagnostic value of BALF-GM test combined with serum GM test for IPA was better than that of BALF-GM test or serum GM test alone [area under ROC curve (AUC): 0.992 vs. 0.983, 0.976]. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 95.3%, 87.0%, 93.2% and 90.9%, respectively. Subgroup analysis showed that among 89 patients with positive BALF-GM test, 85 cases (95.5%) had normal immune function and 4 cases (4.5%) had unknown condition. Among 497 patients with positive serum GM test, 12 cases (2.4%) had normal immune function, 372 cases (74.9%) had abnormal immune function and 113 cases (22.7%) were uncertain. It was shown by ROC curve analysis that the sensitivity of positive BALF-GM test in diagnosis of IPA in patients with normal immune function was higher than that of positive serum GM test (95.6% vs. 88.9%), while the sensitivity of positive serum GM test in patients with abnormal immune function was higher than that of positive BALF-GM test (91.8% vs. 89.9%).@*CONCLUSIONS@#The results of BALF and serum GM tests are in good agreement with clinical diagnosis, and the combined detection of BALF and serum GM is more valuable for IPA diagnosis than single detection, especially for patients with unknown immune function.