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Objective:To determine the level of epilepsy knowledge of caregivers for children with epilepsy and analyze its influencing factors, and investigate caregivers' educational needs and their acceptance for remote education, in order to provide reference for clinical telenursing education.Methods:From March to September 2022, 221 caregivers of epileptic children in the outpatient department and ward of neurology department of Xuzhou Children's Hospital were recruited by convenient sampling method for cross-sectional investigation. The status of caregivers' knowledge and educational needs were investigated by the general information questionnaire, epilepsy knowledge questionnaire, epilepsy knowledge needs questionnaire and telenursing acceptance questionnaire, and the influencing factors of knowledge level were analyzed by multiple linear regression.Results:The average score of epilepsy knowledge of caregivers was (15.68 ± 6.43) points. The course of disease, taking medicine on time, education background and monthly income of caregivers were the influencing factors of caregivers' knowledge level, and the difference was statistically significant ( P <0.05). 94.12% (208/221)- 96.38% (213/221) of the caregivers had high educational needs, and they had the highest demand for safety guidance during seizures. Caregivers' acceptance of remote education was moderate, ranging from 34.39% (76/221) to 71.95% (159/221). Conclusions:Caregivers' epilepsy knowledge needs to be improved. Medical institutions should formulate education plans according to the different characteristics of caregivers. Caregivers have a high demand for nursing knowledge, and medical staff should increase health education. Before giving health education based on remote nursing platform, we should fully understand the attitude of caregivers to the platform, so that they can master disease knowledge, strengthen their disease management ability, and improve the quality of life of children.
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OBJECTIVE To investigate the effects of polyphyllin Ⅵ（PPⅥ） on the proliferation and apoptosis of glioma cells and potential mechanism. METHODS Using human glioma LN229 cells as objects， MTT assay was used to detect the survival rate after treated with different concentrations of PPⅥ [0 （control group）， 1， 2， 4， 8， 16， 32， 64 μmol/L] for different time （24， 48， 72 h）. The clone formation experiments were adopted to detect the number of cell clones and clone formation rate after being treated with different concentrations of PPⅥ [0 （control group）， 2， 4， 8 μmol/L] for 14 days. The flow cytometry and Western blot assay were used to detect the apoptotic rate of cells， the expressions of apoptosis-related protein [B cell lymphoma-2 （Bcl-2）， Bcl-2 associated X protein （Bax）， cleaved caspase-3]， and the expressions of related proteins of Fas/Fas ligand （FasL） death receptor pathway and protein kinase B （Akt）/glycogen synthesis kinase-3β （GSK-3β） pathway after being treated with different concentrations of PPⅥ [0（control group）， 4， 8 μmol/L] for 24 h. RESULTS Compared with the control group， the survival rate of cells， the number of clones and clone formation rate， the protein expression of Bcl-2， and the phosphorylation levels of Akt and GSK-3β protein were decreased significantly in different concentration groups of PPⅥ （P＜0.05 or P＜0.01）. The apoptotic rate， the protein expressions of Bax， cleaved caspase-3， Fas， FasL and cleaved caspase-8 were increased significantly （P＜0.05 or P＜ 0.01）. CONCLUSIONS PPⅥ can inhibit the proliferation and induce the apoptosis of human glioma LN229 cells， which may be related to the activation of the Fas/FasL death receptor pathway and the inhibition of the Akt/GSK-3β pathway.
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Strengthening medical ethics education for medical students is the need for the healthy development of human medical health, the cultivation of medical students’ professional ethics and the integration of medical ethics spirit and medical ethics practice. Through in-depth discussion of the new mode of the integration of medical ethics education and medical ethics practice, stimulating the new impetus of the integration of medical students’ self-cultivation into practice, and the new ways to cultivate the growth of medical students in the new era, this paper put forward specific measures to create an education suitable for each student’s development by selecting the medical ethics education team, learning ethics and humanistic education, taking medical students as the center, and creating a suitable learning environment for students, with a view to cultivating medical students to grow into guardians who can cope with the challenges of public health emergencies.
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Objective:To explore the application experience of autologous fat transplantation in improving the facial contour of young cosmetic patients.Methods:From October 2017 to October 2020, the plastic surgery department of Beijing Tsinghua Changgung Hospital admitted 10 young cosmetic patients with poor facial contours, including 1 male and 9 females, aged 18-35 years, with an average of 28 years. Autologous subcutaneous fat was harvested by liposuction and static purification and then injected into the areas with poor facial contour with an amount of 10%-30% over.Results:The facial contour of 10 young cosmetic patients was well improved, and there were no postoperative complications such as facial asymmetry, local uneven skin, skin infection and necrosis or fat embolism. 8 cases were filled once and 2 cases were filled twice. The patients were followed up for 6-24 months and the postoperative effect was good. The excellent and good rate evaluated by patients, plastic surgeon and the third party doctor was more than 80%.Conclusions:The use of autologous fat to improve the facial contour of young cosmetic patients is easy to operate with less trauma and good effect, which is worthy of promotion.
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Objective:To explore the reliability and validity of the International Classification of Functioning, Disability and Health′s 17-item Rehabilitation Set (ICF-RS-17) when used to evaluate multidisciplinary inpatients.Methods:A total of 359 inpatients in the departments of rehabilitation, orthopedics, neurology, and neurosurgery of three hospitals in Jiangsu province were assessed with the ICF-RS-17 at admission and at discharge, and the internal consistency of the tool was calculated. Inter-rater and intra-rater reliability were quantified using interclass correlation coefficients (ICCs). Structural validity was analyzed using factor analysis.Results:The tool′s Cronbach′s α was 0.945. The overall inter-rater ICC was 0.946 with the ICCs of all of the items except b280 sensation of pain within the range from 0.630 to 0.948. The overall intra-rater ICCs ranged from 0.471 to 0.947. The factor analysis found three factors with eigenvalues greater than 1, accounting for 74% of the variation, without double-loaded items. The three influential factors were exercise ability, sleep perception communication ability and self-care ability.Conclusion:The ICF-RS-17 has good internal consistency, inter-rater and intra-rater reliability and structural validity in the evaluation of multidisciplinary inpatients.
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Food wastes are rich in nutrients and can be used for producing useful chemicals through biotransformation. Some oleaginous microorganisms can use food wastes to produce lipids and high value-added metabolites such as polyunsaturated fatty acids, squalene, and carotenoids. This not only reduces the production cost, but also improves the economic value of the products, thus has large potential for commercial production. This review summarized the advances in food waste treatment, with a focus on the lipid production by oleaginous microorganisms using food wastes. Moreover, challenges and future directions were prospected with the aim to provide a useful reference for related researchers.
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Biofuels , Biotransformation , Food , Lipids , Refuse DisposalABSTRACT
Objective:To analyze the serology and molecular typing of Listeriamonocytogenes isolated from patients in Henan, and to explore the epidemic situation of listeriosis, construct the molecular traceability database of patient isolates, so as to provide laboratory basis for listeriosis traceability. Methods:From January 2015 to July 2020, 71 positive Listeriamonocytogenes cases were monitored in 16 sentinel hospitals in Henan. Eighty samples of positive cases were collected for detection, and 71 positive strains were obtained for molecular typing. According to the Entry-exit Inspection and Quarantine Industry Standard of China (SN/T 2521-2010) and the instructions for the use of diagnostic serum of Listeriamonocytogenes, 80 strains of Listeriamonocytogenes were serotyped, and PFGE cluster analysis was performed according to the User Manual of National Foodborne Disease Molecular Traceability Network. Results:A total of 71 positive listeriosis cases were detected, of which 38 cases were perinatal cases and 33 cases were non-perinatal cases. Among the 80 positive cases of listeriosis, 58.75% (47/80) were from perinatal cases, 20.00% (16/80) were from non-perinatal cases with underlying diseases, the proportion of>1 month-≤5 years old,>5-≤60 years old and >60 years old was 7.50% (6/80), 12.50% (10/80) and 1.25% (1/80), respectively, in non-perinatal age group. There were 5 types of specimens, 73.75% (59/80) were blood, 15.00% (12/80) were cerebrospinal fluid, and 3.75% (3/80) were stool, intrauterine swab and sputum. 80 strains of Listeriamonocytogenes were classified into three serotypes, Type 1/2b, Type 1/2a and Type 4b accounted for 61.25% (49/80), 35.00% (28/80) and 3.75% (3/80) respectively. The 71 strains of Listeriamonocytogenes were digested by AscⅠ, and 58 bands were obtained. Each band type included 1-4 strains, and the similarity was 60.8%-100%. GX6A16HA0005, GX6A16HA0011, GX6A16HA0030, GX6A16HA0023, GX6A16HA0029 and GX6A16HA0054 were dominant bands, including 4, 4, 4, 3, 2 and 2 strains respectively. Four strains of GX6A16HA0005 from 2016, 2018 and 2020 were isolated. One strain from 2016 and one strain from 2018 were from Puyang City. Four strains of GX6A16HA0011 were isolated from samples of 2016, 2018 and 2020, including two strains of 2020 from Luoyang City. Four strains of GX6A16HA0030 were isolated from 2018 samples from Luoyang City, Shangqiu City and Zhengzhou City, respectively. Three strains of GX6A16HA0023 were isolated from 2017 and 2018 samples, of which one strain from 2017 and one strain from 2018 were from Luoyang City. Two strains of GX6A16HA0029 were isolated from 2018 samples, from Kaifeng City and Puyang City respectively. Two strains of GX6A16HA0054 were isolated from 2020 from Pingdingshan City and Anyang City, respectively. The PFGE patterns of 4 strains with different serotypes were the same. Conclusion:Listeriosis cases in Henan are mainly found in patients during the perinatal period, and in elderly, new-born, and low immunity population. The infection type is mainly invasive infection; the serotypes of epidemic strains are 1/2a, 1/2b and 4b, and the results of PFGE typing of strains are diverse. There is a consistent phenomenon of cross-year or different regions in the same year, different time zones in the same year and the same region; phenotyping and genotyping or different genotyping techniques should be combined in the traceability analysis.
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Objective:To assess the β-amyloid (Aβ) deposition of voxel-based PET imaging in Alzheimer′s disease (AD) and its relationships with blood biomarkers (Aβ).Methods:From January 2015 to December 2018, a total of 23 AD patients (9 males, 14 females, age (68.5±9.0) years; duration: (40.9±23.3) months; 8 mild patients, 15 moderate or severe patients) who underwent Aβ PET and with positive imaging results in Daping Hospital, Army Medical University were retrospectively enrolled. The information of Mini-Mental State Examination (MMSE) and Clinical Dementia Rating (CDR) were collected. Blood level of Aβ42, Aβ40 were measured. Differences of those metrics including Aβ42/Aβ40 between mild and moderate or severe patients were compared. For all 11C-Pittsburgh compound B (PIB) PET images, voxel-based one-sample independent t test analyses were performed. Voxel-based two-sample independent t test analyses were also performed between mild and moderate or severe patients. The voxel-based Pearson correlation analyses were run to assess the associations between blood metrics and Aβ deposition of 11C-PIB PET. Results:Comparing with mild patients, moderate or severe patients had lower MMSE (9.67±4.37 vs 17.13±2.80; t=4.349, P<0.001) and longer duration ((48.8±23.8) vs (26.0±13.5) months; t=-2.489, P<0.05). On voxel-wise analysis, amyloid PET illustrated brain Aβ deposition in bilateral frontal, right temporal, right occipital and posterior cingulate regions ( t values: 0.44-0.67, all P<0.001). Within AD, Aβ42/Aβ40 ( r values: from -0.62 to -0.41, 0.41-0.66, all P<0.05) were associated with amyloid PET, but not associated with Aβ42 ( r values: from -0.33 to 0, all P>0.05) or Aβ40 ( r values: from -0.41 to 0, all P>0.05). Conclusions:Based on voxel-wise analysis, 11C-PIB PET has comparable value for brain Aβ deposition. Aβ42/Aβ40 has the potential to predict brain Aβ deposition.
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OBJECTIVE：To study the imp rovement effects of β-boswellic acid on hippocampal neurons cells injury of rats induced by oxygen-glucose deprivation. METHODS ：The hippocampal neurons cell of rats were divided into normal control group ， model group and β-boswellic acid low-concentration ，medium-concentration and high-concentration groups （1，10，100 μmol/L）. Except for normal control group ，other groups were cultured with relevant medium and given oxygen glucose deprivation to induce oxygen-glucose deprivation induced injury model. MTT assay was adopted to detect cell viability. Chemical colorimetry was used to detect LDH activity in cell culture supernatant. Hoechst-PI staining was used to detect the morphology change of cells. Flow cytometry was used to detect early apoptosis rate of cells. The expression of apoptosis-related protein （Bcl-2，Bax and cleaved caspase-3） were detected by Western blot. RESULTS ：Compared with model group ，the survival rate of cells and protein expression of Bcl- 2 were increased significantly in β-boswellic acid medium-concentration and high-concentration groups （P＜ 0.01），while LDH activity ，early apoptosis rate ，protein expression of cleaved caspase- 3 and Bax were all decreased significantly （P＜0.05 or P＜0.01）. The densely stained nuclei and fragmentation decreased significantly. CONCLUSIONS ：β-boswellic acid can relieve oxygen-glucose deprivation induced injury of hippocampal neurons cells ，the mechanism of which may be associated with down-regulating the protein expression of cleaved caspase- 3 and Bax and up-regulating the protein expression of Bcl- 2.
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Objective@#To investigate the drug resistance pattern and drug resistance genotypes of Salmonella. spp isolated from fecal specimens and anal swabs of diarrhea cases in Anhui Province.@*Methods@#The 149 strains of Salmonella.spp isolated from feces and anal swabs of diarrhea cases in Anhui Province from April to October 2017 were selected. The serotypes of Salmonella.spp were identified by slide agglutination. The susceptibility of all strains to 14 antibiotics were determined by micro-broth dilution method. Sixty of the cephalosporin-resistant antibiotics were selected. The β-lactamase encoding genes blaTEM, blaSHV, blaOXA-1, blaOXA-2, blaPER, blaCMY, blaCTX-M, and colistin resistance genes mcr-1 and mcr-2 were performed using the multi-PCR method.@*Results@#Of the 149 diarrhea cases, the median (P25, P75) of the age was 5.0 (1.1, 38.5). The 92 of them were male and 54.4% were children. Of the 149 strains of Salmonella.spp, 105 strains had different degrees of resistance to 13 antibiotics other than imipenem. The resistance rate of ampicillin was 55.0% (82/149), which was the highest. 53.0% strains (79 strains) were multidrug resistant, main of which were Salmonella typhimurium and Salmonella enteritidis. A total of 53 resistance patterns were detected, and 10 strains were resistant to ampicillin-ampicillin/sulbactam-tetracycline-chloramphenicol-cefazolin-trimethoprim/sulfamethoxazole, which was the most common resistance pattern. Among the 60 cephalosporin resistant strains, 45 strains carried blaTEM-1, 6 of which also carried blaCTX-M-14 and 3 of which also carried blaCTX-M-65. All the 32 strains carried only blaTEM-1 show resistance to ampicillin and 31 of them show resistance to cefazolin. There were 2 strains showing negative results of gene detection. mcr-1 was detected in a multidrug resistant strain.@*Conclusion@#The resistance of Salmonella.spp to ampicillin shows a serious situation in this region, and there were a number of multidrug resistant strains. The blaTEM-1 was the major drug resistance gene detected in this research. Detection of the mcr-1 suggests the emergence of surveillance to colistin resistance of Salmonella.spp in this area.
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Objective@#To analyze the molecular characteristics of Listeria monocytogenes strains from ready-to eat food in China.@*Methods@#A total of 239 Listeria monocytogenes strains isolated from ready-to-eat food in 2017, all strains underwent whole-genome sequencing (WGS) , and comparisons uncovered population structure derived from lineages, clonal complex, serogroups, antimicrobial susceptibility and virulence, which were inferred in silico from the WGS data. Core genome multilocus sequence typing was used to subtype isolates.@*Results@#All strains were categorized into three different lineages, lineage Ⅱ was the predominant types in food, and IIa was the main serogroups. CC8, CC101 and CC87 were the first three prevalent CCs among 23 detected CCs, accounting for 49.4%. Only 4.6% (11 isolates) of tested strains harbored antibiotic resistance genes, which were mostly trimethoprim genes (7 isolates, 2.9%). All strains were positive for LIPI-1, and only a part of strains harbored LIPI-3 and LIPI-4, accounting for 13.8% (33 isolates) and 14.2% (34 isolates), respectively. ST619 carried both LIPI-3 and LIPI-4. 51.5% (123 isolates) of strains carried SSI-1, and all CC121 strains harbored SSI-2. Different lineages, serogroups and CCs can be separated obviously through cgMLST analysis, and 24 sublineages were highly concordant with CCs.@*Conclusion@#Ⅱa was the main serogroups in ready-to-eat food isolates in China; CC8, CC101 and CC87 were the prevalent CCs, and CC87 isolates was hypervirulent isolates, cgMLST method can be adopted for prospective foodborne disease surveillance and outbreaks detection.
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Inherent complexity of plant metabolites necessitates the use of multi-dimensional information to accomplish comprehensive profiling and confirmative identification. A dimension-enhanced strategy, by offline two-dimensional liquid chromatography/ion mobility-quadrupole time-of-flight mass spec-trometry (2D-LC/IM-QTOF-MS) enabling four-dimensional separations (2D-LC, IM, and MS), is proposed. In combination with in-house database-driven automated peak annotation, this strategy was utilized to characterize ginsenosides simultaneously from white ginseng (WG) and red ginseng (RG). An offline 2D-LC system configuring an Xbridge Amide column and an HSS T3 column showed orthogonality 0.76 in the resolution of ginsenosides. Ginsenoside analysis was performed by data-independent high-definition MSE (HDMSE) in the negative ESI mode on a Vion TM IMS-QTOF hybrid high-resolution mass spectrometer, which could better resolve ginsenosides than MSE and directly give the CCS information. An in-house ginsenoside database recording 504 known ginsenosides and 58 reference compounds, was estab-lished to assist the identification of ginsenosides. Streamlined workflows, by applying UNIFI TM to auto-matedly annotate the HDMSE data, were proposed. We could separate and characterize 323 ginsenosides (including 286 from WG and 306 from RG), and 125 thereof may have not been isolated from the Panax genus. The established 2D-LC/IM-QTOF-HDMSE approach could also act as a magnifier to probe differ-entiated components between WG and RG. Compared with conventional approaches, this dimension-enhanced strategy could better resolve coeluting herbal components and more efficiently, more reli-ably identify the multicomponents, which, we believe, offers more possibilities for the systematic exposure and confirmative identification of plant metabolites.
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Objective:To observe the effect of autologous fat filling combined with botulinum toxin A injection for facial rejuvenation.Methods:From October 2018 to September 2019, 14 patients treated with autologous fat filling and botulinum toxin A injection were analyzed retrospectively. The fat granule was harvested by liposuction from waist abdomen or lateral thigh under intravenous anesthesia and local infiltration anesthesia. After purified, the fat was filled into the forehead, temps, eyebrow, glabella, zygomatic, cheek, nasolabial fold, marionette lines and chin in 14 patients with multiple-layer, multiple-tunnel, multiple-point and low-amount injection with even speed slowly. Botulinum toxin A was injected at the same time, 10~20 u in forehead wrinkles; 8-12 u in glabellar wrinkles; 6-12 u in Crow's feet; 1-4 u in marionette lines and 4 u in depressor muscle.Results:After 3-12 months follow-up, 14 cases achieved the expected effect by injecting once and 1 cases achieved satisfactory results after reoperation. The proportion of all parts of the face was more harmonious, the local depression was corrected, the facial wrinkles were reduced, and the skin texture and color were improved. No serious complications occurred.Conclusions:Autogenous fat filling combined with botulinum toxin A injection can enhance the facial rejuvenation, which is worth spreading in clinical practice.
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Objective@#To analyze the genotype diversity and phylogenetic characterization of norovirus(NoV) in patients with diarrhea from Anhui province.@*Methods@#NoV positive fecal specimens from sentinel hospitals were collected from January, 2016 to December, 2017. The samples were detected by Real-time fluorescent quantitative PCR. Positive samples were of randomly selected and amplified by RT-PCR and the products were sequenced. Phylogenetic tree was constructed by the Neighbor-Joining method based on partial VP1 gene regions of NoV to perform phylogenetic analysis.@*Results@#A total of 263 NoV positive samples were genotyped, of which 239 belonged to genogroup II, 24 belonged to genogroup I. Fifty-five positive samples were successfully sequenced. There were 6 NoV GII genotypes, which included GII.2, 3, 4/Sydney_2012, 13, 17 and 21, while NV GII.17 and GII.4 were the dominant genotypes from 2016 to 2017. The predominant genotype was GII.4/Sydney 2012 (47.27%, 26/55), followed by GII.17 (23.64%, 13/55) and GII.2 (14.55%, 8/55). Phylogenetic tree showed that 26 strains belonged to genotype GII.4/Sydney 2012, NoV. The nucleotide homology among the 26 VP1 genes was 97.8% to 100%. Analysis of the partial VP1 genes of 26 strains showed that it shared the highest homology of 98.9% with the strain of GII.4Sydney2012 (GenBank ID: KU720515). However, the prevailing genotype in the Anhui province has shifted on two separate occasions, the GII.17 strain was dominant in 2016, and the GII.4/Sydney 2012 strain was dominant in 2017.@*Conclusions@#NoV GII was the major pathogen causing sporadic diarrhea in Anhui province during from 2016 to 2017, the genotypes are widely distributed, and shifted into the two predominant strains.
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Objective@#To explore the effect of enterostomy on analgesic pattern in advanced digestive tract cancer.@*Methods@#A retrospective cohort study was carried out, which was approved by the Ethics Committee of the Sixth Affiliated Hospital of Sun Yat-sen University (E2018026). Inclusion criteria were as follows: (1)age and gender were not limited; (2) all the gastrointestinal malignancies were confirmed histologically, and local recurrence or metastasis were confirmed by CT or MR; (3) numerical rating scale (NRS) ≥4 points, opioid analgesic drugs were required; (4) informed consents were signed by patients of their own. Exclusion criteria were as follows: (1) malignancies of early stage; (2) suspicious adverse mental states which might lead to poor administration compliance; (3) hypersensitivity or allergic reactions to opioids. Clinical data of patients with advanced gastrointestinal cancer receiving comprehensive treatment at the Medical Oncology Department of the Sixth Affiliated Hospital of Sun Yat-sen University from September 2016 to April 2017 were retrospectively collected. The patients were divided into the stoma group and the non-stoma group. The clinical findings of two groups were analyzed, including age, sex, ostomy status, pain location, presence or absence of intestinal obstruction, pain characteristics, selection of opioid analgesic agents, treatment of side effects of analgesics. Pain was assessed using brief pain inventory(BPI) table and NRS score. Strong opioids were prescribed for patients of NRS ≥4. Patients who were intolerant to opioids required opioid titration. The titration drugs included oral or IV morphine and oxycodone. After achievement of adequate pain control, long-acting opioids were administered, which included sustained-release morphine tablets, controlled release oxycodone and transdermal fentanyl. Criteria for pain relief included NRS≤3, breakthrough pain <3 times/day and duration of adequate pain control >3 days. The χ2 test and the Wilcoxon signed rank sum test (nonparametric test) were used to analyze the clinical features of patients in the stoma and non-stomach groups. In order to find the factors associated with maintenance therapy and the use of laxatives, the variables were compared as well as in multivariate analysis with multiple regression models. For all the statistical tests, a value of P<0.05 in a two-tailed test was established as the alpha significance level.@*Result@#A total of 123 patients were enrolled in this study, including 79 males (64.2%) and 44 females (35.8%) with a median age of 51 years. Fifty-two patients were in stoma group, including 30 (24.4%) of ileostomy and 22 (17.9%) of colostomy, and 71 patients were in non-stoma group. Pain of 40 (76.9%) patients in stoma group located in abdomenopelvic site while the pain of 44 (62.0%) patients in non-stoma group located in other sites. Compared with non-stoma group, cases in stoma group complained more abdominopelvic pain (73% vs. 62.0%, P<0.001).The median NRS pain score before treatment in the stoma group and the non-stoma group was 5.7 and 5.6, respectively, without statistically significant difference (P=0.741). After analgesic management, the above scores reduced to 2.1 and 2.3, respectively, without statistically significant difference as well (P=0.092). Analgesic treatment was effective in 111 cases (90.2%), including 49 cases (94.2%) in the stoma group, and 62 cases (87.3%) in the non-stoma group, and there was no statistically significant difference between the two groups (P=0.202). There was more application of fentanyl transdermal patch [34.6%(18/52) vs. 9.8%(7/71)] in the stoma group, while more application of lactulose laxative [78.9%(56/71) vs. 61.5%(32/52)](χ2=10.023, P=0.002) in the non-stoma group. Multivariate analysis revealed that ostomy (OR=0.290, 95%CI: 0.102-0.824, P=0.009) and pain site (OR=5.691, 95%CI:1.709-18.948, P=0.005) were independent factors affecting the choice of the first line opioid sustained release agent. Of the 123 patients with maintaining analgesia, 98 had available data of laxative use, of whom 46 used laxatives to prevent or treat constipation, and the proportion of laxatives in stoma group (21.2%, 11/52) was significantly lower than that in non-stoma group (49.3%, 35/71) (χ2=6.957, P=0.008). Multivariate analysis of the application of laxative use showed that age (OR=0.281, 95% CI: 0.123-0.684, P=0.010) and ostomy (OR=2.621, 95% CI: 1.033-6.687, P=0.045) were independent factors affecting the use of lactulose laxatives.@*Conclusions@#Enterostomy may affect the analgesic pattern in advanced digestive tract cancer. Patients with stoma are more likely to use fentanyl transdermal patches and younger patients with stoma do not need prophylactic use of laxatives.
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OBJECTIVE： To promote rational use of proton pump inhibitors （PPIs） during perioperative period. METHODS： PDCA （Plan， Do， Check， Action） cycle management was used， the irrational use of PPIs of 300 medical records in neurosurgery department of our hospital were collected. The reasons were analyzed， management target was formulated and measures were implemented. The effects of management were evaluated through comparing the rate of irrational drug use and ratio of irrational type of PPIs in 300 medical records of neurosurgery department during perioperative period after management. RESULTS： Through collecting related data to confirm risk factors of stress ulcer， establishing rationality evaluation criteria for perioperative prophylactic use of PPIs， conducting rational drug use training among medical staff， drawing up various management systems and strengthening supervision and management， the rate of irrational use of PPIs was decreased significantly in our hospital； the number of irrational drug use cases decreased from 240 before management to 156 after management， among which the rate of prophylactic drug use without indication decreased from 37.33％ to 29.00％ （P＜0.05）； the irrational dosage rate decreased from 11.33％ to 6.33％ （P＜0.05）； the rate of irrational dosing frequency dropped from 12.67％ to 5.00％ （P＜0.01）. CONCLUSIONS： PDCA cycle management of our hospital can standardize the prophylactic use of PPIs in neurosurgery department during perioperative period and promote rational use of PPIs.
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Objective@#To investigate the prevalence and related factors of obesity and central obesity among 35-75 year-old population in Jiangsu Province. @*Methods@#During 2015-2017,83 530 eligible subjects aged 35-75 years from six study sites of Jiangsu Province were interviewed and examined. The data of demography,lifestyles,disease history,height,weight and waistline were collected. Logistic regression analysis was conducted for the influencing factors for obesity and central obesity.@*Results@#A total of 83 393 residents completed the study,with a response rate of 99.84%. The prevalence of overweight,obesity and central obesity was 43.35%（standardized rate：35.90%）,20.02%（19.48%）and 59.93%（57.03%）. The results of multivariate logistic regression analysis showed that females（OR=0.822,95%CI：0.786-0.859;OR=0.900,95%CI：0.851-0.952;OR=1.130,95%CI：1.083-1.179）,45-75 years old（OR：1.120-1.731,95%CI：1.102-1.881）,graduating from high school or above（OR：0.767-0.902,95%CI：0.721-0.943）,living in urban areas（OR：1.530-2.077,95%CI：1.284-3.007）,smoking（OR：0.724-0.855,95%CI：0.678-0.898）,drinking （OR：1.125-1.179,95%CI：1.076-1.235）,hypertension（OR：1.884-3.461,95%CI：1.821-3.613）,diabetes（OR：1.363-1.758,95%CI：1.305-1.851）, dyslipidemia（OR：1.478-1.870,95%CI：1.429-1.851）were associated with overweight,obesity and central obesity. @*Conclusion@#The standardized prevalence rates of overweight,obesity and central obesity among 35-75 year-old population in Jiangsu Province are 35.90%,19.48% and 57.03%,respectively. Gender,age,education,residence,smoking,drinking,hypertension,diabetes and dyslipidemia are related factors.
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Objective To explore and establish a method for quantitative evaluation of facial skin pores based on dermoscopy,and to evaluate the scientificity and practicability of this method.Methods Totally,30 patients with enlarged facial skin pores were enrolled from Department of Dermatology,Peking University Third Hospital between June 2017 and December 2017,and treated with 2 940 nm Er pixel laser.Photographs were taken,and dermoscopic images were collected before and after treatment.According to the standard photographs of facial pores,the improvement of enlarged facial pores was evaluated by comparing the photos before and after the treatment.A dermoscope-based pore detection system was established,and quantified indices for pore area and color difference before and after the treatment were evaluated by using this system.A pre-post self-contrast study was conducted,and statistical analysis was carried out by using paired t test for the comparison of measurement data and paired non-parametric test (Wilcoxon signed-rank test) for the comparison of ranked data.Results After the treatment,the standard photograph method for the assessment of facial pores showed score reduction by 3 grades in 1 of the 30 patients (3.3％),by 2 grades in 7(23.3％),by 1 grade in 21(70％),and no changes of grades in 1 (3.3％).Additionally,the differences between pre-and post-treatment grades were significant (Z =-4.94,P ＜ 0.01).The detection rate of skin pores by using the detection system was (70.59 ± 3)％.After the treatment,the quantified values of pore area and color difference both significantly decreased compared with those before the treatment (pore area:712.95 ± 87.45 vs.831.45 ± 88.92,t =5.70,P ＜ 0.05;color difference:23.82 ± 9.43 vs.28.92 ± 9.91,t =2.76,P ＜ 0.05).Conclusion The dermoscopy-based method for quantitative evaluation of skin pores after the treatment with 2 940 nm Er pixel laser showed highly consistent results with the standard photograph method,which can be further verified and popularized in the evaluation of enlarged skin pores.
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Objective To investigate the genetic characteristics and prognostic influencing factors of the middleˉhighˉrisk patients with multiple myeloma (MM) based on Mayo Stratification of Myeloma and RiskˉAdapted Therapy (mSMART) consensus guidelines. Methods A total of 179 hospitalized MM patients in Fujian Provincial Hospital from June 2009 to October 2017 were collected. Eventually, 49 patients were included except for the patients who were unable to perform mSMART stratification. According to the mSMART stratification criteria, the patients were divided into lowˉrisk group (24 cases) and middleˉhighˉrisk group (25 cases). The genetic characteristics of the two groups were analyzed to explore the relationship between mSMART stratification and clinical features. KaplanˉMeier method and logˉrank test were used to make survival analysis; logistic regression analysis was used to analyze the prognostic influencing factors in highˉrisk patients. Results The incidence of CSK1B gene amplification was the highest in the lowˉrisk group (41.7%, 10/24), while in the middleˉhighˉrisk group, the incidence of RB1 gene deletion was the highest (88.0%, 22/25). In the lowˉrisk group and the middleˉhighˉrisk group, there were no statistical differences in bone destruction, hypercalcemia, renal damage, anemia, β2 microglobulin abnormality, albumin abnormality, lactate dehydrogenase abnormality, and plasma cell ratio abnormality (all P> 0.05). Survival analysis showed that the median survival time of the middleˉhighˉrisk group was lower than that of the lowˉrisk group (23.19 months vs. 39.71 months, P＝ 0.043). Multivariate logistic regression analysis found that anemia and bone destruction were risk prognostic influencing factors for mSMART stratification as a middleˉhighˉrisk group (P＝ 0.044, P＝ 0.002). Conclusion mSMART stratification could indicate the poor prognosis for the patients with middleˉhighˉrisk, and the anemia and bone destruction are risk prognostic influencing factors for patients with middleˉhighˉrisk stratification.
ABSTRACT
Researches on the inhibitors of programmed death-1 (PD-1) and programmed death-1 ligand (PD-L1) enjoy considerable breakthroughs in recent years, which has brought relative changes in the therapeutic model of non-small cell lung cancer (NSCLC) at an unexpected speed. However, it seems that PD-1/PD-L1 inhibitors are less effective in patients with epidermal growth factor receptor (EGFR) mutation than those without. Previous studies have shown that the expression rate of PD-L1 on tumor cells is correlated with the therapeutic effect of PD-1/PD-L1 inhibitors. Yet, there is no complete agreement on the effect of EGFR mutation on PD-L1 expression. In this review, relevant studies will be summarized with an expectation of making some contributions to basic researches and to the clinical treatment.