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【Objective】 To conduct the laboratory quality assessment between 12 blood stations in Hebei province, analyze the results and explore the accuracy and comparability of testing, so as to improve the level of testing ability and quality management. 【Methods】 With reference to the external quality assessment rules of National Center for Clinical Laboratories and combined with the instructions of quality assessment samples, daily testing process of the laboratories were assessed. The quality indicators include blood cell count (WBC, RBC, Hb, HCT, MCV, MCH, MCHC and PLT), biochemical items (TP) and coagulation parameters (FIB and FⅧ). 【Results】 There are still problems in laboratories in terms of personnel operation, instrument maintenance and the impact of different reagent batches, especially in biochemical items and coagulation parameters. The pass rate of biochemical items was the lowest, only 72.75%, and that of blood cell count was the highest, reaching 98.75%. 【Conclusion】 With the progress of the project, the quality monitoring level of daily blood sampling tests in the quality control laboratory of each blood station has been improved. However, it is still necessary for each laboratory to improve the testing ability and quality management to a higher level in Hebei.
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Objective:To explore the values of ultrasound, pathology combined with inflammatory indicators in predicting high nodal burden (HNB) in patients with early breast cancer and to construct a nomogram to provide reference for individualized diagnosis and treatment.Methods:The ultrasonographic, pathological features and preoperative inflammatory indicators of 378 female patients diagnosed with early breast cancer confirmed by pathology in the South Hospital of the Sixth People′s Hospital Affiliated to Shanghai Jiaotong University from January 2014 to July 2022 were retrospectively analyzed. They were randomly divided into training set ( n=302) and test set ( n=76) in a ratio of 8∶2, and the baseline data of the two groups were compared. The optimal cutoff values of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and lymphocyte to monocyte ratio (LMR) were obtained by ROC curve. In the training set, with axillary high lymph node load (≥3 metastatic lymph nodes) as the dependent variable, independent influencing factors of HNB were identified by univariate and multivariate Logistic regression analyses, and the nomogram was established. The test set data were used to verify the model. The discrimination, calibration and clinical applicability of the model were assessed by the area under the ROC curve (AUC), C-index, the calibration curve, Brier score and the decision curve analysis, respectively. Results:There were no significant differences in all variables between the training set and the test set (all P>0.05). ROC curve analysis results showed that AUCs of NLR, PLR and LMR were 0.578, 0.547 and 0.516, respectively, and the optimal cut-off values were 2.184, 150 and 3.042, respectively. Univariate Logistic regression analysis showed that age, pathological type, histological grade, Ki-67, lymphovascular invasion, NLR, PLR, ultrasonic characteristics (maximum diameter of primary tumor, shape, long/short diameter of lymph node, cortical thickness, cortical and medullary boundary, lymph node hilum, lymph node blood flow pattern) were correlated with HNB of early breast cancer (all P<0.05). Multivariate Logistic regression analysis showed that ultrasonic characteristics (maximum diameter of primary tumor >2 cm, effacement of lymph node hilum, non-lymphatic portal blood flow), lymphovascular invasion, Ki-67>14% and NLR>2.184 were independent risk factors for HNB in early breast cancer ( OR=7.258, 8.784, 6.120, 8.031, 3.394 and 3.767, respectively; all P<0.05) and were used to construct the nomogram model. The AUC of the training set was 0.914 (95% CI=0.878-0.949), C-index was 0.914; The AUC of the test set was 0.871 (95% CI=0.769-0.973), C-index was 0.871, indicating good discrimination. Calibration curve and Brier score were 0.090, indicating high calibration degree of the model. The clinical decision curve indicated good clinical benefit. Conclusions:The nomogram based on ultrasonic characteristics (maximum diameter of primary tumor, lymph node hilum, lymph node blood flow pattern), lymphovascular invasion, Ki-67 and NLR can effectively predict the risk of HNB in patients with early breast cancer, and provide a reference for precision diagnosis and treatment to avoid excessive or insufficient treatment.
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Objective:To investigate the relationship between prolonged PR interval and carotid atherosclerosis(CAS)in middle-aged and elderly patients with type 2 diabetes mellitus(T2DM).Methods:A total of 537 middle-aged and elderly inpatients with T2DM in the Southern Branch of the Sixth People′s Hospital of Shanghai Jiaotong University from January 2019 to January 2021 were selected as the research objects. Color Doppler ultrasound was used to detect bilateral carotid artery intima-media thickness(CIMT). The subjects were divided into carotid atherosclerosis group(CAS group, n=352)and non-carotid atherosclerosis group(NCAS group, n=185). The difference in the PR interval of ECG between the two groups was compared. Pearson or Spearman rank correlation analysis was used for evaluating the correlation of PR interval and CAS lesions with various clinical index. The relationship between PR interval and CAS lesions was adopted by multivariate logistic regression analysis. Results:The average PR interval of middle-aged and elderly patients with T2DM was(164.57±23.02)ms. The average PR interval in CAS group was significantly higher than that in NCAS group [(169.76±24.28) vs (154.70±16.42)ms, P<0.01]. The results of multifactorial logistic regression analysis showed that age, low density lipoprotein-cholesterol, serum osteocalcin, and PR interval were independent factors influencing the development of CAS lesions in middle-aged and elderly patients with T2DM( OR=1.079, 1.936, 0.879, 1.039, respectively, P<0.05 or P<0.01)where each 1 ms increase in PR interval was associated with a 3.9% increase in the risk of CAS in middle-aged and elderly patients with T2DM( OR=1.039, 95% CI 1.006-1.073, P=0.020). Multivariate logistic regression analysis showed that middle-aged and elderly type 2 diabetic patients with PR interval≥158 ms were 4.072 times more likely to have CAS lesions than those with PR interval<158 ms( OR=4.072, 95% CI 1.417-11.702, P<0.01). Conclusion:The PR interval of electrocardiogram is correlated with CAS lesions in middle-aged and elderly patients with T2DM. Middle-aged and elderly type 2 diabetic patients with significantly prolonged PR interval should be reminded to screen for CAS lesions early.
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Objective:To validate the role of color Doppler ultrasound in an animal model to detect early heterotopic ossification (HO) after brain-traumatic/burn/tenotomy.Methods:Forty-four rats were randomly divided into two groups. Rats in experimental group ( n=22) were operated to build brain-traumatic/burn/tenotomy model and others in control group ( n=22) underwent only skin incision injury. Color Doppler ultrasound, X-ray film examination at 2, 3, 4, 6, 8 and 10 weeks post-injury were performed to follow up the progression of HO in both groups respectively. Histology was used to confirm bone formation. Results:In the experimental group, disorder structure with a hypoechoiccore in treated Achilles tendon was visualized using color Doppler ultrasound in the 2nd week. Additional tiny hyperechoic foci were observed in the 3rd week, which increased in the fourth week and fused into a mineralized island in the sixth week. No obvious abnormality was found in control group at the aforementioned time point. X-ray could detect heterotopic bone tissue in the sixth week in the experimental group but not in the control group. X-ray and HE stainning had confirmed bone formation in the tenth week in the experimental group.Conclusions:Color Doppler ultrasound can detect early HO and continuously follow up the progression of HO.
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The clinical practice teaching reform of pediatrics based on TBL combined with medical simulation teaching model was carried out. TBL teaching plan writing under the model of medical simulation teaching was researched. The principles, requirements, contents and procedures of compiling teaching plans were formed. Emphasis should be placed on medical simulation teaching, team cooperation, humanistic quality education and humanistic skills training. The purposes of the reform were to achieve standardized operation skills, improve clinical ability, ensure medical safety, and improve the quality of medical purposes, but still the reform need further improvement in the teaching practice.
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Objective To investigate the effects of negative pressure wound therapy (NPWT) on the expression of EDA+ FN in granulation tissues of human diabetic foot wounds.Methods Forty patients with diabetic foot wounds fitting the inclusion criteria,admitted from Jan.2014 to Jun.2016,were randomly and equally apportioned to receive either NPWT or conventional gauze therapy (control) for 14 days.Granulated tissue biopsies were collected before (0 day) and after (14 day) treatment in both groups.All biopsies were subdivided into two parts.One part was preserved in 4％ paraformaldehyde for immunocytochemical staining of EDA+FN,and the other part was stored at-80 ℃ for Western blotting and PCR analysis of EDA+FN.Results The immunohistochemical analysis revealed that the mean area density of EDA+ FN increased in both NPWT group and control group at day 14 relative to day 0,but the change value of mean area density was higher in NPWT group than in control group (P＜0.01).Western blotting showed that the relative protein levels of EDA+FN increased in both NPWT group and control group at day 14 relative to day 0,but the change value of relative protein levels of EDA+FN was higher in NPWT group than in control group (P＜0.01).The real time PCR analysis demonstrated that the relative mRNA levels of EDA+ FN increased in both NPWT group and control group at day 14 relative to day 0,but the change value of relative mRNA levels of EDA+ FN was higher in NPWT group than in control group (P＜0.01).The results demonstrated the higher protein and mRNA levels of EDA+FN in NPWT group than that in control group.Conclusion NPWT obviously enhances EDA+FN expression in granulation tissue of diabetic foot wound,as a result promotes wound healing.
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Objective To explore the value of Color Doppler Flow Imaging in diagnosis of superfi-cial substantial tumors.Methods Retrospective analysis of 742 cases of superficial substantial masses ( all confirmed by operation and pathology) of Patients'ultrasonography , and summarized its features of benign and malignant, and made a comparison.Results Of the 742 patients, ultrasound detection rate of 100%, including 12 cases of malignant lesions, ultrasound diagnosis of 12 malignant cases, the accuracy rate of 100%;730 cases of benign lesions, ultrasound diagnosis of 711 cases of benign, qualitative accuracy rate 97.4%.Conclusions Color Doppler Flow Imaging has an important value in the diagnosis of benign and malignant of superficial substantial tumors.
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BACKGROUND:Compared with bone marrow and autologous peripheral blood stem cells, umbilical cord mesenchymal stem cells are characterized as more primitive, more powerful amplification and lower immunogenicity, no ethical problems, which are more important to the elderly patients with diabetes mel itus. OBJECTIVE:To evaluate the efficacy and safety of umbilical cord mesenchymal stem cells transplantation in the treatment of the elderly patients with diabetic lower limb vascular disease. METHODS:Fifty-six elderly patients with diabetic lower limb vascular disease were randomly divided into observation group and control group. The control group was treated with conventional therapy, while the observation group was treated with umbilical cord mesenchymal stem cells transplantation. RESULTS AND CONCLUSION:Observation group showed a higher efficiency than the control group, with significant difference (P<0.05). After treatment, foot skin temperature, transcutaneous oxygen pressure, and ankle brachial index were al improved in both two groups, and the ankle brachial index showed a better value in the observation group (P<0.05). There were no significant adverse reactions in the two groups. Umbilical cord mesenchymal stem cells transplantation is a simple, safe and effective therapy for the elderly patients with diabetic lower limb vascular disease, with better short-term curative effect.
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Objective To visualize the pelvic floor structures by translabial three‐dimensional(3D) ultrasonography performed during labor and immediately after delivery, and to observe the morphological changes of levator hiatus in intrapartum women. Methods Totally 62 nulliparous women with singleton pregnancy and cephalic presentation in labor ward underwent intrapartum translabial 3D ultrasound examination before cervical dilatation, at 10 cm dilatation and immediately after delivery. Volume datasets were obtained at rest, biometric measurements and observation of the morphological changes of levator hiatus in different stages were determined in the axial plane. Comparative analyses of parameters in three stages were carried out. Results Translabial 3D ultrasound demonstrated the pelvic floor structures of intrapartum women well. All biometric measurements of the hiatus before cervical dilatation were the smallest and became the largest at 10 cm dilatation, showed statistically significant differences. The measurements after delivery got smaller immediately but still significantly larger than those before cervical dilatation ( P <0 0.01). Conclusions Translabial 3D ultrasound examination of the pelvic floor during labor and within the first 2h after delivery is feasible. It seems to be an effective tool to visualize pelvic floor structures in intrapartum women. Hiatal enlargement may be a common consequence of vaginal childbirth.
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BACKGROUND:Studies addressing coronary heart disease are largely dependent on the establishment of myocardial infarction animal models. It is very important that exploring a safe method with easy operation, less damage, long time survival and high survival rate for myocardial infarction animal model OBJECTIVE:To compare the pros and cons of two kinds of thoracotomy anterior descending coronary artery ligation to do myocardial infarction animal model. METHODS: Thirty healthy male New Zealand white rabbits were randomly divided into three groups: control, median sternotomy incision, and left sternal incision. The anterior descending coronary artery was ligated after thoracotomy. The operation time, amount of intraoperative bleeding, postoperative food intake, and recovery time of eating were monitored during the surgery and within 24 hours after the surgery. And myocardial enzyme indexes were also monitored within 24 hours after the surgery. Rabbits were detected with ultrasonic echocardiogram at 4 weeks. RESULTS AND CONCLUSION:Different levels of ST segment elevation appeared in median sternotomy and left sternal incision groups by echocardiogram. The success rate of modeling was 70% in median sternotomy incision group, and 80% in left sternal incision group. Within 24 hours post-surgery, the myocardial enzyme indexes in the two groups were significantly increased compared with before surgery (P < 0.05). At 4 weeks, the left ventricular ejection fraction and the left ventricular shortening fraction were significantly decreased when compared to before surgery (P< 0.05). The operation time was shorter, the amount of bleeding was less, the time of eating recovery was less and the amount of eating was much in median sternotomy group than in left sternal incision, with significant differences between he two groups (P < 0.05). The median sternotomy incision for the ligation of anterior descending coronary artery is better than the left sternal incision to establish myocardial infarction models.
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BACKGROUND: Mesenchymal stem cells in Wharton's Jelly of the human umbilical cord can induce differentiation into islet-like cells.OBJECTIVE: To verify the possibility of human umbilical cord derived mesenchymal stem cells co-cultured with rat pancreatic cells differentiate into islet-like cells, and to observe the effects of transplantation of islet-like cells on blood glucose of diabetic rats.METHODS: Mesenchymal stem cells in Wharton's Jelly of the human umbilical cord was separated, induced, passaged, and co-cultured with pancreatic cells to induce differentiation into islet-like clusters. Rats were divided into the normal control, model and experimental groups. Rats in the model group were prepared for diabetic models, and those in the experimental group were transplanted islet-like cells after model preparation. RESULTS AND CONCLUSION: There were cells crawled out of cultured Wharton's Jelly of the human umbilical cord, and morphology of adhered cells turned into fusiform shape at 7 days. The isolated cells are characterized by expressing specific surface markers of mesenchymal stem cells, such as CD44, CD29, CD105, but not expressing CD34, CD45 or CD14. The cells were strongly stained by PDX-1 and human insulin at 7 and 10 days. Compared with the simple culture group, the expression of human insulin and concentration of C-peptide were obviously increased; PDX-1 and human insulin mRNA expressions were highly expressed at 7 and 10 days after induction. Compared with the model group, the streptozotocin test of rats in the experimental group was obvious decreased (P < 0.01), but extremely higher than that of the normal control group at 1 week after transplantation (P < 0.01). Brdu positive nuclei and insulin positive kytoplasms could be seen in the experimental group at 8 weeks after transplantation. The results demonstrated that, umbilical cord derived mesenchymal stem cells existed in Wharton's Jelly. The co-cultured cells promote mesenchymal stem cells differentiating into islet-like cells, which can dramatically decrease blood glucose in diabetic rats.
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ObjectiveTo investigate the risk factors of metabolic syndrome ( MS ) in obese subjects.Methods A seven-year follow-up study was conducted in 413 simple obese subjects and 196 subjects with normal body weight who were recruited from community residents during physical examination in 2000.There was a 7 years follow-up.Anthropometrics,blood pressure,lipid profile,fasting blood glucose,and 2 h blood glucose after glucose loading were measured.Endothelium-dependent dilatation (EDD) test was also performed.Results Among 553 of 609 subjects who were followed up in 2007,there were 381 simple obese subjects ( simple obese group) and 172 normal weight subjects( normal weight group).Seven-year cumulative incidence of MS was 35.17％ in simple obese group and 8.14％ in normal weight group.In simple obese group,subjects with MS showed greater or higher levels of waist circumference( WC ),waist-hip ratio ( WHR ),triglyceride ( TG ),fasting plasma glucose ( FPG ),fasting insulin (FINS),and homeostasis model assessment for insulin resistance index (HOMA-IR) (all P＜0.05 ),and also decreased EDD( P＜0.05 ) as compared with those without MS.WC,WHR,and FINS were higher( all P＜0.05 ) and EDD was lower( P＜0.05 ) in subjects with MS of normal weight group than those without MS.Logistic analysis showed that the male gender,WC,WHR,FPG,HOMA-IR,and EDD were major risk factors of MS.Conclusion Central obesity,insulin resistance,and endothelial dysfunction are important independent risk factors for development of MS.
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Objective To investigate the relationship between Trp64Arg mutation in the β3-adrenergic receptor (β3-AR) gene and the incidence of hypertension in obese subjects. Methods A seven-year follow-up study was conducted in 377 simple obese subjects who had Trp64Arg mutation in the β3-AR gene and some clinical metabolic parameters, such as body mass index, waist circumference, waist-hip ratio, blood pressure, lipid profile, fasting blood glucose, fasting insulin and insulin resistance index (HOMA-IR) were measured in the year of 2000 and 2007. Results The results of follow-up indicated that the incidence of hypertension in Trp64Arg heterozygote subjects were higher than that in Trp64Trp homozygote subjects (52.7% ,69/131 vs 37.0% ,91/246,P < 0.01), the difference was only seen in male (59.5%, 50/84 vs 45.1%, 64/142, P < 0.05). The incidence of hypertension in both Trp64Trp homozygote and Trp64Arg heterozygote subjects were higher in obese male than those in obese female (P < 0.01 or <0.05). After seven years, the blood pressure increased (9.7 ± 4.3)/(5.4 ± 4.0) mm Hg(1 mm Hg = 0.133 kPa) in Trp64Trp homozygote,and (12.8 ± 5.2)/ (7.9 ± 4.7) mm Hg in Trp64Trp heterozygote subjects. Compared with that in Trp64Trp homozygote subjects, lipid profile, fasting insulin and HOMA-IR was increased significantly in Trp64Trp heterezygote subjects (P < 0.05). Logistic analysis showed that β3-AR gene mutation, male, central obesity and insulin resistance were associated with the incidence of hypertension in obese subjects. Conclusion The β3-AR gene Trp64Arg mutation is the independent risk factor in the incidence of hypertension in male.
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Objective To study the best titer of recombinant adeno-associated virus serotype 2 (rAAV2) delivered to myocardium by targeted ultrasound microbubbles. Methods Twenty one adult SD rats were divided into seven groups. SonoVue attached with different titer [1.5 × 109~ 3.0 × 1011 vg/ml (virus genome/ml)] of rAAV2-EGFP was infused into the tail vein of rats, following ultrasound mediated microbubbles destruction,as experiment groups. Normal saline was infused into the tail vein of rats as the control group (without rAAV2). Rats were killed after 14 days and hearts were harvested. GFP protein expression which showed rAAV2 transfer was observed under fluorescence microscope in frozen section and integrate optical density(IOD) was measured by Image Pro Plus software. Results When the titer of rAAV2 was 1.5 × 1011 vg/ml infused into the tail vein of rats there was much more GFP expression in myocardium than lower titers (P <0.01). Conclusions The best titer of rAAV2 delivered to myocardium by targeted ultrasound microbubbles is 1.5 × 1011 vg/ml in the tail vein infusion of rats.
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Objective To study the changes of left ventricular(LV) function before and after rAAV2-GFP targeted to myocardium by the ultrasound mediated microbubbles. Methods Twenty rats were divided into 2 groups. Ten rats underwent ultrasound mediated microbubbles destruction without rAAV2-GFP as control. Another ten rats underwent ultrasound mediated microbubbles destruction containing rAAV2-GFP as experimental group. The mean value of LV rotation of rats was obtained in apical and base plane using speckle tracking imaging(STI) software. LV torsion(LVtor) was defined as apical rotation relative to the base. LV function including circumferential strain,circumferential strain rate of systolic and early diastolic and late diastolic, torsion, time to peak, ejection fraction, fractional shortening, end-diastolic volume, end-systolic volume of LV,heart rate and so on were also measured before and after 14 days. Other rats were killed after 14 days and hearts were harvested. GFP protein expression which showed rAAV2 transfer was observed under fluorescence microscope in frozen section. Results There was no significant difference of LV function of rats before and after rAAV2-GFP myocardium transfection by the ultrasound mediated microhubbles. Conclusions LV myocardial function has no significant difference before and after delivering rAAV2 to the heart in vivo by ultrasound-mediated microbubbles destruction.