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Periarticular fracture of the shoulder is a common type of fractures in the elderly. Postoperative adverse events such as internal fixation failure, humeral head ischemic necrosis and upper limb dysfunction occur frequently, which seriously endangers the exercise and health of the elderly. Compared with the fracture with normal bone mass, the osteoporotic periarticular fracture of the shoulder is complicated with slow healing and poor rehabilitation, so the clinical management becomes more difficult. At present, there is no targeted guideline or consensus for this type of fracture in China. In such context, experts from Youth Osteoporosis Group of Chinese Orthopedic Association, Orthopedic Expert Committee of Geriatrics Branch of Chinese Association of Gerontology and Geriatrics, Osteoporosis Group of Youth Committee of Chinese Association of Orthopedic Surgeons and Osteoporosis Committee of Shanghai Association of Chinese Integrative Medicine developed the Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly ( version 2023). Nine recommendations were put forward from the aspects of diagnosis, treatment strategies and rehabilitation of osteoporotic periarticular fracture of the shoulder, hoping to promote the standardized, systematic and personalized diagnosis and treatment concept and improve functional outcomes and quality of life in elderly patients with osteoporotic periarticular fracture of the shoulder.
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Objective:To analyze the risk factors related to the prognosis of patients with sepsis in intensive care unit (ICU), construct a nomogram model, and verify its predictive efficacy.Methods:A retrospective cohort study was conducted using data from Medical Information Mart for Intensive Care-Ⅳ 0.4 [MIMIC-Ⅳ (version 2.0)]. The information of 6 500 patients with sepsis who meet the diagnostic criteria of Sepsis-3 were collected, including demography characteristics, complications, laboratory indicators within 24 hours after ICU admission, and final outcome. Using a simple random sampling method, the patients were divided into a training set and a validation set at a ratio of 7∶3. The restricted cubic spline (RCS) was used to explore whether there was a linear relationship between each variable and the prognosis, and the nonlinear variables were truncated into categorical variables. All variables were screened by LASSO regression and included in multivariate Cox regression analysis to analyze the death risk factors in ICU patients with sepsis, and construct a nomograph. The consistency index, calibration curve and receiver operator characteristic curve (ROC curve) were used to evaluate the prediction efficiency of nomogram model. The decision curve analysis (DCA) was used to validate the clinical value of the model and its impact on actual decision-making.Results:Among 6 500 patients with sepsis, 4 551 were in the training set and 1 949 were in the validation set. The 28-day, 90-day and 1-year mortality in the training set were 27.73% (1?262/4?551), 34.76% (1?582/4?551), and 42.98% (1?956/4?551), respectively, those in the validation set were 27.24% (531/1?949), 33.91% (661/1?949), and 42.23% (823/1?949), respectively. Both in training set and the validation set, compared with the final survival patients, the death patients were older, and had higher sequential organ failure assessment (SOFA) score and simplified acute physiology scoreⅡ (SAPSⅡ), more comorbidities, less urine output, and more use of vasoactive drugs, kidney replacement therapy, and mechanical ventilation. By RCS analysis, the variables with potential nonlinear correlation with the prognosis risk of septic patients were transformed into categorical variable. The variables screened by LASSO regression were enrolled in the multivariate Cox regression model. The results showed that age [hazard ratio ( HR) = 1.021, 95% confidence interval (95% CI) was 1.018-1.024], SOFA score ( HR = 1.020, 95% CI was 1.000-1.040), SAPSⅡ score > 44 ( HR = 1.480, 95% CI was 1.340-1.634), mean arterial pressure (MAP) ≤ 75 mmHg (1 mmHg ≈ 0.133 kPa; HR = 1.120, 95% CI was 1.026-1.222), respiratory rate (RR; HR = 1.044, 95% CI was 1.034-1.055), cerebrovascular disease ( HR = 1.620, 95% CI was 1.443-1.818), malignant tumor ( HR = 1.604, 95% CI was 1.447-1.778), severe liver disease ( HR = 1.330, 95% CI was 1.157-1.530), use of vasoactive drugs within 24 hours ( HR = 1.213, 95% CI was 1.101-1.336), arterial partial pressure of oxygen (PaO 2; HR = 0.999, 95% CI was 0.998-1.000), blood lactic acid (Lac; HR = 1.066, 95% CI was 1.053-1.079), blood urea nitrogen (BUN) > 8.9 mmol/L ( HR = 1.257, 95% CI was 1.144-1.381), total bilirubin (TBil; HR = 1.023, 95% CI was 1.015-1.031), and prothrombin time (PT) > 14.5 s ( HR = 1.232, 95% CI was 1.127-1.347) were associated with the death of ICU patients with sepsis (all P < 0.05). Based on the above factors, a nomogram model was constructed, and the model validation results showed that the consistency index was 0.730. The calibration curve showed a good consistency between the predicted results of the nomogram model and observed results in the training and validation sets. ROC curve analysis showed that the area under the ROC curve (AUC) predicted by the nomogram model in the training set and the validation set for 28-day, 90-day and 1-year death risk was 0.771 (95% CI was 0.756-0.786) and 0.761 (95% CI was 0.738-0.784), 0.777 (95% CI was 0.763-0.791) and 0.765 (95% CI was 0.744-0.787), 0.677 (95% CI was 0.648-0.707) and 0.685 (95% CI was 0.641-0.728), respectively. DCA analysis showed that the nomogram model had significant net benefits in predicting 28-day, 90-day, and 1-year death risk, verifying the clinical value of the model and its good impact on actual decision-making. Conclusions:The death risk factors related to ICU patients with sepsis include age, SOFA score, SAPSⅡ score > 44, MAP ≤ 75 mmHg, RR, cerebrovascular disease, malignant tumors, severe liver disease, use of vasoactive drugs within 24 hours, PaO 2, Lac, BUN, TBil, PT > 14.5 s. The nomogram model constructed based on this can predict the death risk of ICU patients with sepsis.
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Refractory ascites is one of the common complications of portal hypertension in decompensated liver cirrhosis and is characterized by extremely poor prognosis and high mortality rate. Transjugular intrahepatic portosystemic shunt (TIPS) is recommended by several international and national guidelines as one of the treatment methods after failure of large volume paracentesis combined protein infusion therapy. TIPS can effectively control the recurrence of ascites, but it can increase the risk of hepatic encephalopathy, and there are still controversies over whether it can prolong survival time. With a deeper understanding of TIPS, the maturity of surgical techniques, and the update of stent materials, it is urgent to reevaluate the position of TIPS in the treatment of refractory ascites due to portal hypertension. This article reviews the current status and advances in TIPS for the treatment of refractory ascites due to portal hypertension.
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OBJECTIVE@#To explore the predictive value of serum sodium variability within 72 hours, lactic acid (Lac), sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation II (APACHE II) in predicting the 28-day prognosis of sepsis patients.@*METHODS@#The clinical data of patients with sepsis admitted to the department of intensive care unit (ICU) of the Affiliated Qingdao Municipal Hospital of Qingdao University from December 2020 to December 2021 were retrospectively analyzed, including age, gender, previous medical history, temperature, heart rate, respiratory rate, systolic pressure, diastolic pressure, white blood cell count (WBC), hemoglobin (Hb), platelet count (PLT), C-reactive protein (CRP), pH value, arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), Lac, prothrombin time (PT), activated partial thromboplastin time (APTT), serum creatinine (SCr), total bilirubin (TBil), albumin (Alb), SOFA, APACHE II score, and 28-day prognosis. Multivariate Logistic regression was used to analyze the risk factors of death in sepsis patients. Receiver operator characteristic curve (ROC curve) was used to analyze the predictive value of serum sodium variability within 72 hours, Lac, SOFA, APACHE II alone and in combination on the prognosis of patients with sepsis.@*RESULTS@#A total of 135 patients with sepsis were included, 73 survived and 62 died at 28 days, with 28-day mortality of 45.93%. (1) Compared with the survival group, SOFA, APACHE II, Lac and serum sodium variability within 72 hours in the death group were significantly higher [SOFA: 10.00 (8.00, 12.00) vs. 6.00 (5.00, 8.00), APACHE II: 18.00 (16.00, 21.25) vs. 13.00 (11.00, 15.00), Lac (mmol/L): 3.55 (2.90, 4.60) vs. 2.00 (1.30, 2.80), serum sodium variability within 72 hours: 3.4% (2.6%, 4.2%) vs. 1.4% (1.1%, 2.5%)], the differences were statistically significant (all P < 0.01). (2) Multivariate Logistic regression showed that SOFA, APACHE II, Lac, serum sodium variability within 72 hours were independent risk factors of prognosis in patients with sepsis [SOFA: odds ratio (OR) = 1.479, 95% confidence interval (95%CI) was 1.114-1.963, P = 0.007; APACHE II: OR = 1.163, 95%CI was 1.009-1.340, P = 0.037; Lac: OR = 1.387, 95%CI was 1.014-1.896, P = 0.040; serum sodium variability within 72 hours: OR = 1.634, 95%CI was 1.102-2.423, P = 0.015]. (3) ROC curve analysis showed that SOFA, APACHE II, Lac and serum sodium variability within 72 hours had certain predictive value for the prognosis of sepsis patients [SOFA: the area under the ROC curve (AUC) = 0.858, 95%CI was 0.795-0.920, P = 0.000; APACHE II: AUC = 0.845, 95%CI was 0.776-0.913, P = 0.000; Lac: AUC = 0.840, 95%CI was 0.770-0.909, P = 0.000; serum sodium variability within 72 hours: AUC = 0.842, 95%CI was 0.774-0.910, P = 0.000]. The combined predictive value of the four indicators (AUC = 0.917, 95%CI was 0.870-0.965, P = 0.000) was higher than that of any single indicator, and has higher specificity (79.5%) and sensitivity (93.5%), indicating that the combined index has higher predictive value for the prognosis of sepsis patients than any single index.@*CONCLUSIONS@#SOFA, APACHE II, Lac, serum sodium variability within 72 hours are independent risk factors for 28-day death in patients with sepsis. The combination of SOFA score, APACHE II score, Lac and serum sodium variability within 72 hours has higher predictive value for prognosis than single index.
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Humans , Lactic Acid , Prognosis , Retrospective Studies , Sepsis , SodiumABSTRACT
Lipid nanoemulsions are promising nanodrug delivery carriers that can improve the efficacy and safety of paclitaxel(PTX).However,no intravenous lipid emulsion of PTX has been approved for clinical treatment,and systemic safety profiles have not yet been reported.Here we outline the development of a PTX-loaded tumor-targeting intravenous lipid emulsion(PTX Emul)and describe its characteristics,colloidal stability,and systemic safety profiles in terms of acute toxicity,long-term toxicity,and tox-icokinetics.We also compare PTX Emul with conventional PTX injection.Results showed that PTX Emul exhibited an ideal average particle size(approximately 160 nm)with narrow size distribution and robust colloidal stability under different conditions.Hypersensitivity reaction and hemolysis tests revealed that PTX Emul did not induce hypersensitivity reactions and had no hemolytic potential.In addition,where the alleviated systemic toxicity of PTX Emul may be attributed to the altered toxicokinetic characteristics in beagle dogs,including the decreased AUC and increased plasma clearance and volume of distribution,PTX Emul alleviated acute and long-term toxicity as evidenced by the enhanced the median lethal dose and approximate lethal dose,moderate body weight change,decreased bone marrow suppression and organ toxicity compared with those under PTX injection at the same dose.A fundamental understanding of the systemic safety profiles,high tumor-targeting efficiency,and superior antitumor activity in vivo of PTX Emul can provide powerful evidence of its therapeutic potential as a future treatment for breast cancer.
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Objective:To explore the expression of miR-6883-5p in the serum of bladder cancer patients and its effect on the migration and proliferation ability of bladder cancer cells.Methods:The real-time fluorescent quantitative polymerase chain reaction (qRT-PCR) method was used to detect the expression level of miR-6883-5p in the serum of 39 patients with bladder cancer and 39 healthy subjects, as well as the expression level of miR-6883-5p in normal bladder mucosal epithelial cells and bladder cancer cells. The bladder cancer cells with the lowest expression of miR-6883-5p were transfected with miR-6883-5p mimics or negative control (NC), namely miR-6883-5p group and NC group. Transwell migration experiment and cell counting kit-8 (CCK-8) colorimetric method were used to detect the migration and proliferation ability of cells transfected with miR-6883-5p. Bioinformatics software and dual luciferase reporter gene were used to predict and test the target genes of miR-6883-5p. qRT-PCR and Western blot were used to detect the expression levels of target genes in cells transfected with miR-6883-5p.Results:The expression level of miR-6883-5p in the serum of bladder cancer patients was significantly lower than that of healthy persons ( P<0.01). The expression level of miR-6883-5p in bladder cancer cells was significantly lower than that in normal bladder mucosal epithelial cells (all P<0.05), and the lowest expression of miR-6883-5p was in 5637 cells ( P<0.01). After transfection with miR-6883-5p, the migration and proliferation of cells in miR-6883-5p group were significantly lower than those in NC group (all P<0.05). Phosphatidyl alcohol proteoglycan-6 (GPC6) was the target gene of miR-6883-5p. After transfection with miR-6883-5p, the expression levels of GPC6 mRNA and protein in miR-6883-5p group significantly decreased ( P<0.01). Conclusions:miR-6883-5p is significantly low expressed in the serum of bladder cancer patients, and miR-6883-5p is related to the occurrence and development of bladder cancer; overexpression of miR-6883-5p can inhibit the migration and proliferation of bladder cancer cells; miR-6883-5p can inhibit the occurrence and development of bladder cancer by down-regulating the expression of GPC6.
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Objective:To evaluate the efficacy and safety of continuous infusion of low-dose intravenous (Ⅳ) heparin during perioperative period of simultaneous pancreas-kidney (SPK) transplantation for donation after citizen death (DCD) donor to prevent pancreatic thrombosis post-transplantation.Methods:From January 2015 to August 2019, 46 DCD donors undergoing SPK were divided into retrospective cohort groups 1 ( n=27) and 2 ( n=19). Group 1 received aspirin enteric-coated tablets only at Day 1 post-SPK. In Group 2, 5-7 days of continuous infusion of heparin 260 IU per hour at Day 1 post-SPK was followed by a daily intake of aspirin enteric-coated tablets of 100 mg. Incidence of thrombus, recovery of graft function and adverse reactions of anticoagulant therapy were observed. Results:Thrombosis occurred in (5.3%, 1/19 vs 14.8%, 4/27) in heparin and non-heparin groups. Thrombosis and graft loss were significantly lower in heparin group than those in non-heparin group ( P<0.05). Conclusions:Continuous infusion of low-dose heparin vein is effective and safe in preventing thrombosis after SPK transplantation.
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Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection, and has a high morbidity and mortality worldwide. The characteristic of sepsis is the inflammatory reaction. Cytokines produced by the severe inflammatory reaction can activate neutrophils and cause excessive production of reactive oxygen species (ROS), thus damage cells and tissue, and further develop into organ dysfunction and failure. Ferroptosis is an iron-dependent form of nonapoptotic cell death discovered recently. Its main mechanism is the intracellular lipid peroxidation induced by iron and the low expression of antioxidant systems [glutathione (GSH) and glutathione peroxidase 4 (GPX4)]. Recently, many studies have shown that Kelch-like ech-associated protein 1/nuclear factor E2-related factor 2/antioxidant response element (Keap1/Nrf2/ARE) signal pathway can improve oxidative stress and alleviate ferroptosis in sepsis. This article reviews the molecular mechanism and research of Nrf2 inhibiting ferroptosis in sepsis, in order to innovate prevention and treatments for the intervention of sepsis.
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Objective@#To investigate the effect of phacoemulsification combined with capsular tension ring implantation in patients with ultra-high myopia and cataract.@*Methods@#A randomized-controlled study was performed.The clinical data of 48 eyes of 48 patients with ultra-high myopia and cataract were collected at Shanghai Jiaotong University Affiliated Sixth People's Hospital South Campus from October 2016 to December 2018.The patients were randomly divided into a control group and a clinical trial group using a random number table method, with 24 eyes in each group.The eyes in the control group underwent phacoemulsification, and capsular tension ring implantation was performed during the surgery in the trial group.The patients were followed up for 3 months.Best corrected visual acuity (BCVA), intraocular pressure, corneal endothelial cell count, intraocular lens (IOL) decentration, and subjective visual quality were observed and compared preoperatively and 1 week, 1 month and 3 months postoperatively, and the postoperative inclination angle of the IOL and surgical complications were compared between the two groups.Written informed consent was obtained from each patient prior to entering the study cohort.This study conformed to the tenets of the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of the Shanghai Jiaotong University Affiliated Sixth People's Hospital South Campus (No.2016-KY-05).@*Results@#The operation procedure was successfully completed, and the IOL was implanted into capsular bag in all the eyes.The postoperative BCVA was higher than that before surgery in both groups, with significant differences between them (all at P<0.05). There were no significant differences in intraocular pressure and the corneal endothelial cell count between the two groups (F=0.122, P=0.729; F=0.006, P=0.939). The level of IOL horizontal decentration, vertical decentration, or total decentration were not significantly different between the two groups at 1 month and 3 months after operation (all at P>0.05). At 1 month after operation, the horizontal and total inclination angles of the IOL in the trial group were statistically significantly lower than those in the control group (P<0.05). At 3 months after operation, the vertical and total inclination angles of the IOL were significantly lower than those in the control group (both at P<0.05). The total inclination in the trail group was significantly lower than that of the control group (P<0.05). The subjective visual quality scores of the patients in the trial group at 1 week, 1 month, and 3 months after operation were 2.85±0.24, 3.30±0.36, and 3.43±0.42, respectively, and those in the control group were 2.34±0.23, 2.65±0.44, and 2.57±0.39, respectively, both significantly improved over the preoperative 1.31±0.22 and 1.19±0.17 (all at P<0.01).@*Conclusions@#The use of a bag tension ring in phacoemulsification for ultra-high myopia with cataract is safe and effective, and can result in good visual quality.
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Efficient mucosal delivery remains a major challenge for the reason of the respiratory tract mucus act as a formidable barrier to nanocarriers by trapping and clearing foreign particulates. The surface property of nanoparticles determines their retention and penetration ability within the respiratory tract mucus. However, the interaction between nanoparticles and mucus, and how these interactions impact distribution has not been extensively investigated. In this study, polymeric nanoparticles loaded with a baicalein-phospholipid complex were modified with two kinds of polymers, mucoadhesive and mucus-penetrative polymer. Systematic investigations on the physicochemical property, mucus penetration, transepithelial transport, and tissue distribution were performed to evaluate the interaction of nanoparticles with the respiratory tract. Both nanoparticles had a similar particle size and good biocompatibility, exhibited a sustained-release profile, but showed a considerable difference in zeta potential. Interestingly, mucus-penetrative nanoparticles exhibited a higher diffusion rate in mucus, deeper penetration across the mucus layer, enhanced cellular uptake, increased drug distribution in airways, and superior local distribution and bioavailability as compared to mucoadhesive nanoparticles. These results indicate the potential of mucus-penetrative nanoparticles in design of a rational delivery system to improve the efficiency of inhaled therapy by promoting mucus penetration and increasing local distribution and bioavailability.
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TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.
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Objective To investigate the effect of phacoemulsification combined with capsular tension ring implantation in patients with ultra-high myopia and cataract.Methods A randomized-controlled study was performed.The clinical data of 48 eyes of 48 patients with ultra-high myopia and cataract were collected at Shanghai Jiaotong University Affiliated Sixth People's Hospital South Campus from October 2016 to December 2018.The patients were randomly divided into a control group and a clinical trial group using a random number table method,with 24.eyes in each group.The eyes in the control group underwent phacoemulsification,and capsular tension ring implantation was performed during the surgery in the trial group.The patients were followed up for 3 months.Best corrected visual acuity (BCVA),intraocular pressure,corneal endothelial cell count,intraocular lens (IOL) decentration,and subjective visual quality were observed and compared preoperatively and 1 week,1 month and 3 months postoperatively,and the postoperative inclination angle of the IOL and surgical complications were compared between the two groups.Written informed consent was obtained from each patient prior to entering the study cohort.This study conformed to the tenets of the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of the Shanghai Jiaotong University Affiliated Sixth People's Hospital South Campus (No.2016-KY-05).Results The operation procedure was successfully completed,and the IOL was implanted into capsular bag in all the eyes.The postoperative BCVA was higher than that before surgery in both groups,with significant differences between them (all at P＜0.05).There were no significant differences in intraocular pressure and the corneal endothelial cell count between the two groups (F=0.122,P=0.729;F=0.006,P=0.939).The level of IOL horizontal decentration,vertical decentration,or total decentration were not significantly different between the two groups at 1 month and 3 months after operation (all at P＞0.05).At 1 month after operation,the horizontal and total inclination angles of the IOL in the trial group were statistically significantly lower than those in the control group (P＜0.05).At 3 months after operation,the vertical and total inclination angles of the IOL were significantly lower than those in the control group (both at P＜0.05).The total inclination in the trail group was significantly lower than that of the control group (P＜0.05).The subjective visual quality scores of the patients in the trial group at 1 week,1 month,and 3 months after operation were 2.85 t 0.24,3.30± 0.36,and 3.43 ± 0.42,respectively,and those in the control group were 2.34±0.23,2.65 ±0.44,and 2.57 ± 0.39,respectively,both significantly improved over the preoperative 1.31 ± 0.22 and 1.19±0.17 (all at P＜0.01).Conclusions The use of a bag tension ring in phacoemulsification for ultra-high myopia with cataract is safe and effective,and can result in good visual quality.
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Organ shortage is one of the important factors restricting the development of human organ transplantation. The identification and referral of potential donors determine the total scale of organ donation. Whether potential donors can be identified and referred is the most important reason for the difference of organ donation rates in different regions. This paper interprets the chapter of the identification and referral of potential donors in the Guide to the Quality and Safety of Organs for Transplantation (6th edition) issued by European Union in order to provide reference for the staff of organ procurement organization and related medical personnel in China and improve the organ donation rate in China.
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Objective To evaluate the effectiveness of salvage liver transplantation ( SLT) versus repeat hepatectomy (RH) in post-hepatectomy recurrent hepatocellular carcinoma. Methods Data from 1 January 1990 to 31 July 2018 were retrieved from the Cochrane library, PubMed, EMbase, Wan Fang Data, CBM, CNKI, VIP and other databases. The collected publications were all on case-control studies comparing SLT with RH for post-hepatectomy recurrent hepatocellular carcinoma. The literatures’ quality and the data of each study were evaluated and analyzed using RevMan. Relative risk (RR) and 95% confidence interval (CI) were used. Results Five articles which included 525 patients were enrolled. There were no signifi-cant differences between SLT and RH on the 1-, 3-and 5-year overall survival (P＞0. 05 for all). Howev-er, for the 1-year (RR=2. 86, 95% CI: 1. 37～5. 97, P＜0. 05), 3-year (RR=2. 57, 95% CI: 0. 99～6. 70, P=0. 05), and 5-year disease-free survivals (RR=4. 79, 95% CI: 1. 88～12. 25, P＜0. 05), PLT was significantly better than RH. Conclusion The effectiveness of SLT was superior to RH in the treatment of post-heptectomy recurrent hepatocellular carcinoma. However, considering the similar overall survival rates, RH is still an important treatment option for post-hepatectomy recurrent hepatocellular carcinoma because of liver donor shortage.
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Objective To evaluate the effect of bundles of care on the prevention of postoperative delirium among elderly patients with hip fractures.Methods A prospective randomized case control study was conducted on 80 patients (≥65 years old) with hip fractures from March 2017 to June 2017.The patients were divided into experimental group (n =43) and control group (n =37) according to the random number table method.The experimental group received bundles of care,while the control group received routine nursing.The patients in both groups were all surgically treated,and the confusion assessment method (CAM) was applied to diagnose delirium after surgery.Gender,age,fracture type,duration from injury to operation,internal fixation type,operation time,total amount of bleeding,visual analogue scale (VAS),incidence of delirium,complications,and adverse events were compared between the two groups.Results Among the 80 patients,there were 11 males and 69 females,aged averagely 79.3 years (range,65-95 years).No significant differences were found between experiment group and control group in terms of gender (male:6 cases vs.5 cases,females:37 cases vs.32 cases),age [(79.8 ± 7.8) years vs.(78.7 ± 8.9) years],cause of injury (traffic injuries:7 cases vs.4 cases;falling injuries:36 cases vs.33 cases),duration from injury to operation [(66.1 ±14.3)hours vs.(63.4 ±14.9) hours],fracture type (femoral neck:13 cases vs.10 cases;intertrochanteric:26 cases vs.24 cases;subtrochanteric:4 cases vs.3 cases),internal fixation type (artificial total hip:5 cases vs.5 cases;artificial femoral head:8 cases vs.5 cases;PFNA:29 cases vs.27 cases),operation time [(55.5 ± 16.8) minutes vs.(51.6 ± 17.0) minutes],total blood loss [(114.4 ± 73.9) ml vs.(108.1 ±72.0) ml] (P ＞ 0.05).After bundles of care intervention,the postoperative VAS [(2.2 ± 0.8) points vs.(4.3 ± 1.2) points],postoperative delirium incidence (9％ vs.32％),incidence of complications and adverse events (2％ vs.19％) in experimental group were significantly lower than those in control group (P ＜ 0.05).Conclusion Bundles of care can relieve the pain and effectively reduce the incidences of postoperative delirium,complications,and adverse events in elderly patients with hip fracture.
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Objective To observe and analyze the difference of CYP2C19 gene polymorphism and serum valproic acid concentration in the patients with epilepsy to provide reference for clinical individualized medica-tion .Methods A total of 148 patients with epilepsy in the hospital from January 2015 to December 2016 were selected and their CYP2C19 genotypes were detected by adopting the real-time fluorescence polymerase chain reaction ,meanwhile the cases were given the valproic acid treatment .Then the correlation between CYP2C19 gene polymorphism and serum valproic acid concentration was analyzed .Results There was great individual differences in serum valproic acid concentration difference among CYP2C19 genotypes ,in which the alleles and genotypes distribution frequency had no statistically significant difference among 148 cases of epilepsy ( P>0 .05);Serum valproic acid concentrations at 2 ,4 ,8 h after medication in the patients with AA genotype at CYP2C192 locus were significantly higher than those in the patients with GG genotype at CYP2C192 lo-cus ,the difference was statistically significant (P<0 .05);Serum valproic acid concentrations at 8 h after medi-cation in the patients with AA genotype at CYP2C193 was significantly higher than that in the patients with GG genotype at CYP2C193 locus ,the difference was statistically significant (P<0 .05);Serum valproic acid concentration had no statistically significant difference among other genotypes (P> 0 .05) .Conclusion The CYP2C19 gene in the patients with epilepsy has polymorphism ,moreover which is correlated with the patient′s blood concentration of vaproic acid .Therefore ,treating the patients with epilepsy by using valproic acid can detect the CYP2C19 genotyping in the patients in order to guide their individualized treatment .
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Objective To evaluate the efficacy of sirolimus (SRL) after liver transplantation for hepatocellular carcinoma (HCC).Methods The information up to January 2018 was retrieved from Cochrane library,Pubmed,EMbase,CBM,CNKI,VIP.Collected publications were all about casecontrol study of SRL versus calcineurin inhibitors (CNIs) after liver transplantation for HCC.After evaluating the literatures' quality and extracting the data,RevMan 5.3 was used to analyze the data of each study.Results A total of 13 articles including 4181 patients were enrolled.There was no significant difference between SRL and CNIs in 3 and 5 year diseasefree survival (RR=1.13,95％CI:0.97-1.31,P=0.11;RR=1.07,95%CI:0.92-1.24,P=0.37),however,the 1-,3-and 5-year overall survival rate and 1-year disease-free survival rate in SRL were significantly higher than CNIs (RR=1.09,95％CI.:1.03-1.15,P=0.005;RR=1.08,95％CI:1.02-1.14,P =0.006;RR =1.11,95％CI:1.00-1.23,P =0.05;RR=1.14,95％CI:1.05-1.24,P =0.001).Conclusion There was no significant difference between SRL and CNIs in 3-and 5-year disease-free survival,but the 1-,3-and 5-year overall rate and 1-year disease-free survival rate in SRL was significantly higher than in CNIs.
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Objective To observe the biological characteristics of db/db mice, and to provide the basis for application of db/db mice in experimental research.Methods Spontaneous type 2 diabetes BKS.Cg-Dock7m +/+ Leprdb/JNju mice and wild type mice of the same age were used in this study.Their fasting blood glucose was determined at 8,12,16, 20 and 24 weeks of age, the body weight was recorded at 10, 12,16, 20 and 24 weeks of age, the levels of serum insulin, total cholesterol and triglyceride were measured, the organ weight and liver coefficient were determined, and the liver and pancreas were taken for pathological examination at 24 weeks of age.Results The db/db mice maintained a high level of fasting blood glucose and body weight.Levels of serum insulin, total cholesterol, and triglyceride were significantly higher than the wild type mice.Compared with wild type mice, liver weight and kidney weight were also significantly increased.Obvious pathological changes of liver and pancreas were observed in 24-week old db/db mice.Conclusions db/db mouse has obvious characteristics of type 2 diabetes, such as hyperglycemia, hyperlipidemia, and hyperinsulinemia, can maintain stable levels of high blood glucose,and is an ideal animal model for experimental study of type 2 diabetes mellitus.
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Esophageal collision tumor is an extremely rare tumor which defined as the concrescence of two distinct primary neoplasms.The pathobiological mechanism of collision tumors is yet to be understood.Clinical symptoms,endoscopic examination and imaging are all lack of specificity.Diagnosing a collision tumor prior to surgery is difficult.Careful pathological examination is crucial for accurately diagnosing the neoplasms in a collision tumor and ensuring appropriate management and a favorable prognosis.Esophageal collision tumors have been increasingly reported in recent years.With the aim of improving the knowledge level of esophageal collision tumor,the clinical and pathological features of this tumor is needed to be summarized.
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Objective To study the clinical value of combined detection of D-dimer,PT,FIB and Cyc-C in the patients with nephrotic syndrome(NS) complicating thromboembolism.Methods Sixty-five patients with clinically diagnosed NS(observation group) in the Huangshi Municipal Central Hospital from April 2013 to March 2016 were selected and divided into the non-thromboembolism group(group A,45 cases) and thromboembolism group(group B,20 cases).Contemporaneous 43 individuals undergoing physical examination served as the control group(group C).The levels of Cys-C and 24 h urine protein were tested by the electrochemical luminescence method;meanwhile PT,FIB and D-dimmer levels were detected by the nephelometry method.Their changes in the patients with NS complicating thromboembolism were observed.Results The levels of Cys-C,24 h urine protein and D-dimer in the observation group were significantly higher than those in the control group (P＜0.01).The difference of PT and FIB levels were not statistically significant(P＞0.05);the D-dimer and Cys-C levels in the observation B group was significantly higher than that in the observation A group(P＜0.05),moreover the D-dimer level was positively correlated with Cys-C.Conclusion D-dimer and Cys-C can be used as the predictive factors of thromboembolism occurrence in NS patients.