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There are differences and inconsistencies to some degree in the radioactive contamination control level of personnel′s body surface availiable in many national standards, thus puzzling the users. Therefore, it is proposed to compare the applicable scope, conditions and differences between relevant national standards, and combine with similar clinical nuclear medicine standards of radiological protection content to presevent recommendations on the contamination control level that should be correctly applied in an event of nuclear and radiological emergency. Based on the discussion of similar standards, the contaminated personnel with α of 0.04-10 Bq/cm 2 and β of 0.4-100 Bq/cm 2 are advised to be treated in the institutions with higher than secondary medical insititution. Both α econtamination control levels less than 0.04 Bq/cm 2 and β levels less than 0.4 Bq/cm 2 could be achivable, if fully decontaminated.
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Hip fractures are among the most common fractures in the elderly, presenting to be a leading cause of disability and mortality. Surgical treatment is currently the main treatment method for hip fractures. The incidence of perioperative malnutrition is increased after hip fractures in the elderly due to the comorbidities, decreased basal metabolic rate, accelerated protein breakdown, weakened anabolism and surgical stress. However, malnutrition not only increases the incidence of postoperative complications, but also leads to increased mortality, indicating an important role of perioperative nursing management of nutrition for the elderly patients with hip fractures. At present, there still lacks scientific guidance and application standards on perioperative nursing management of nutrition for the elderly patients with hip fractures. Therefore, the Orthopedic Nursing Committee of Chinese Nursing Association and the Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Expert consensus on perioperative nursing management of nutrition for elderly patients with hip fractures ( version 2023) according to evidence-based medical evidences and their clinical experiences. Fourteen recommendations were made from aspects of nutrition screening, nutrition assessment, nutrition diagnosis, nutrition intervention and nutrition monitoring to provide guidance for perioperative nursing management of nutrition in elderly patients with hip fractures.
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Hip fracture is considered as the most severe osteoporotic fracture characterized by high disability and mortality in the elderly. Improved surgical techniques and multidisciplinary team play an active role in alleviating prognosis, which places higher demands on perioperative nursing. Dysfunction, complications, and secondary impact of anaesthesia and surgery add more difficulties to clinical nursing. Besides, there still lack clinical practices in perioperative nursing for elderly patients with hip fracture in China. In this context, led by the Orthopedic Nursing Committee of Chinese Nursing Association, the Expert consensus on clinical practice in perioperative nursing for elderly patients with hip fracture ( version 2023) is developed based on the evidence-based medicine. This consensus provides 11 recommendations on elderly patients with hip fracture from aspects of perioperative health education, condition monitoring and inspection, complication risk assessment and prevention, and rehabilitation, in order to provide guiding advices for clinical practice, improve the quality of nursing and ameliorate the prognosis of elderly patients with hip fracture.
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Objective:To establish the hepatic organoid of hepatitis B virus (HBV) infection on the basis of induced pluripotent stem cells (iPSC) and an inverted colloidal crystal polyethylene glycol scaffold (ICC), and to evaluate the antiviral effect of nucleoside drugs.Methods:iPSC was differentiated into hepatocyte-like cells (HLC), and inoculated into ICC to construct a hepatic organoid. The relative mRNA expressions of Nanog homeobox (NANOG), sex determining region Y-box (SOX) 2, SOX17, forkhead box protein A2 (FOXA2), alpha fetoprotein (AFP) and albumin (ALB) were detected by real time quantitative polymerase chain reaction (RT-qPCR). Confocal laser microscopy was used to photograph the three-dimension (3D) structure of organs. The expression of sodium taurocholate cotransporting polypeptide (NTCP) in HLC was analyzed by Western blot and immunofluorescence. HepG2.2.15 cells were used to extract HBV virus particles to infect hepatic organoid. The relative expression of HBV pregenome RNA (pgRNA) in cells was detected by RT-qPCR. The expressions of hepatitis B core antigen (HBcAg) and hepatitis B surface antigen (HBsAg) in cytoplasm were observed under confocal laser microscopy. A total of 0.5 μmol/L entecavir and 0.5 μmol/L lamivudine were used to treat the infected cells respectively. The relative expression of HBV pgRNA in infected and uninfected cells was detected by RT-qPCR. Independent sample t test and one-way analysis of variance were used for statistical analysis. Results:Within 21 days of iPSC differentiation, the mRNA expressions of NANOG and SOX2 in stem cells markers decreased ( F=158.90 and 8.31, respectivley; P<0.001 and P=0.002, respectively), while the mRNA expressions of SOX17 and FOXA2 in the endoderm increased first and then decreased ( F=37.23 and 82.57, respectively, both P<0.001). In the later stage of differentiation, the mRNA expressions of AFP and ALB in liver cells increased ( F=4.65 and 34.64, respectively, P=0.012 and P<0.001, respectively), and all differences were statistically significant. NTCP was highly expressed in differentiated cells detected by Western blot and fluorescence microscopy, the protein expression level was 0.803±0.099. Confocal laser microscopy confirmed that the differentiated cells expressed ALB and presented spherical structure in ICC. The expression of HBV pgRNA and the immunostaining of HBsAg and HBcAg confirmed that HBV successfully infected hepatic organoid. Three days after the application of entecavir and lamivudine, the HBV pgRNA level decreased significantly both in entecavir group (0.665±0.220) and lamivudine group (0.503±0.117) compared to the uninfected cells (3.347±0.454), and the differences were both statistically significant ( t=10.53 and 12.72, respectively, both P<0.001). Conclusions:HLC display hepatic specific genes ALB and NTCP. Hepatic organoids constructed with iPSC and ICC have human liver function and can be infected by HBV. Entecavir and lamivudine could effectively inhibit the replication of HBV in hepatic organoids.
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Objective:To investigate the effects of antibiotic treatment and antibiotics combined with surgery treatment on the prognosis of patients with infective endocarditis (IE).Methods:The clinical data and prognosis of all patients diagnosed as IE discharged from Shanghai Jiao Tong University Affiliated Sixth People′s Hospital from June 2011 to May 2021 were collected. There were 240 IE patients, divided into antibiotic treatment group and the antibiotics combined with surgery group according to the treatment methods. The clinical characteristics and prognosis of the IE patients were compared between the two groups, so as to investigate the timing of surgery for IE patients and to analyze the effects of the two treatment methods on the prognosis of IE patients.Statistical analysis methods including Wilcoxon rank sum test, chi-square test, Kaplan-Meier survival analysis and Cox regression analysis were used when appropriate.Results:Of the 240 patients with IE, 63 cases were only treated with antibiotics and 177 cases were treated with antibiotics combined with surgery. After propensity score matching (PSM), one-year mortality rate of the IE patients in the antibiotics combined with surgery group was 11.1%(4/36), which was significantly lower than that in the antibiotic treatment group (33.3%(12/36), χ2=5.14, P=0.023). The median values of left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD) and left ventricular fractional shortening (LVFS) in the antibiotics combined with surgery group were 59%, 47 mm and 31%, respectively, which were significantly lower than those before surgery (63%, 54 mm and 34%, respectively, Z=6.19, 9.36 and 6.11, respectively, all P<0.001). The most common surgical indication was moderate to severe heart failure, and there was no significant difference between the early operation group and the late operation group (both P>0.050). The one-year cumulative survival rate of antibiotics combined with surgery group was 94.9%, which was significantly higher than that in the antibiotic treatment group (83.2%, χ2=7.38, P=0.007). Heart failure and Pitt bacteremia scores≥4 were the independent risk factors for one-year all-cause death of the IE patients (hazard ratio ( HR)=5.668 and 19.392, respectively, both P<0.050). Hospital days and antibiotics combined with surgery were independent related factors for reducing the risks of one-year all-cause death ( HR=0.931 and 0.299, respectively, both P<0.050). Pitt bacteremia scores≥4 had the greatest impact on one-year prognosis of the IE patients. Conclusions:Surgery could significantly improve cardiac function and one-year prognosis of the IE patients. IE patients with heart failure and Pitt bacteremia score≥4 should be actively treated.
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Objective:To explore the effect and mechanism of dendritic cell derived exosomes (Dexs) loading ubiquitinated (Ub) hepatitis D antigen (HDAg) on activating specific cytotoxic T lymphocytes (CTL).Methods:Ub-S-HDAg-Dexs were co-cultured with dendritic cells (DC) which were from the femora of C57BL/6 mice for 48 h, then flow cytometry was used to detect the maturity of DC (CD86, CD80 and major histocompatibility complex (MHC) Ⅱ). The spleen-derived T lymphocytes from C57BL/6 mice were added in vitro to activate DC and co-cultivated for 72 h. The T cells were divided into Ub-S-HDAg-Dexs group (add 50 μg/mL Ub-S-HDAg-Dexs), Blank-Dexs group (add 50 μg/mL DC derived exosomes without plasmid transfection), Con-Dexs group (add 50 μg/mL DC derived exosomes transfected by cantrol plasmid), PBS group (add 50 μL/mL phosphate buffered saline), and Ub-S-HDAg-Dexs+ AG490 group (add 50 μg/mL Ub-S-HDAg-Dexs, DC and T lymphocytes stimulated by exosomes, and 50 μmol/L AG490 was also added to the cell mix). Flow cytometry was used to detect CD8 + T cells secreting interferon-gamma, non-radioactive lactate dehydrogenase release test to detect the killing activity of specific CTL. Real-time quantitative polymerase chain reaction (PCR) and Western blotting were used to detect the mRNA and protein expressions of JAK kinase (JAK) 2, GATA-binding protein 3 (GATA3), T-bet, signal transduction and activator of transcription (STAT) 1 and STAT4. Independent sample t test were used for statistical analysis. Results:The positive rates of the surface molecules CD80, CD86, MHCⅡof DC stimulated by Ub-S-HDAg-Dexs were 83.850%±0.219%、68.910%±0.134%、84.320%±0.445%, respectively.In the Ub-S-HDAg-Dexs group, the rate of CD8 + T cells secreting interferon-gamma was 6.420%±0.028%, which was higher than those of other groups, including PBS group, Blank-Dexs group, Con-Dexs group and Ub-S-HDAg-Dexs+ AG490 group ( t=90.78, 30.32, 63.06 and 85.42, respectively, all P<0.001). The cytotoxicity of T cells in the Ub-S-HDAg-Dexs group was 82.4%±3.9%, which was higher than those of other groups ( t=17.28, 9.74, 3.95 and 15.89, respectively, all P<0.050). The relative mRNA expressions of JAK2, T-bet, STAT1, STAT4 in Ub-S-HDAg-Dexs group were higher than those in other groups, including Con-Dexs group ( t=10.74, 32.34, 13.00 and 16.28, respectively, all P<0.001), Blank-Dexs group ( t=15.05, 21.51, 6.46 and 13.12, respectively, all P<0.050), PBS group ( t=21.83, 41.42, 7.30 and 17.50, respectively, all P<0.050), Ub-S-HDAg-Dexs+ AG490 group ( t=35.75, 20.69, 17.02 and 17.07, respectively, all P<0.001), and the differences were all statistically significant. The protein expressions of T-bet, STAT1, STAT4 in Ub-S-HDAg-Dexs group increased compared with those in PBS group ( t=346.70, 57.54 and 55.81, respectively, all P<0.001), with statistical significance. In the presence of AG490, the protein expressions of T-bet, STAT1 and STAT4 decreased compared with those in Ub-S-HDAg-Dexs group, and the differences were statistically significant ( t=355.40, 52.79 and 126.10, respectively, all P<0.001). Conclusions:Ubiquitinated HDAg transported by exosomes could effectively promote DC maturation, induce T lymphocyte differentiation, and generate specific CTL responses, which provides a new idea for the treatment of hepatitis D.
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Objective:To assess the effect of intra-aortic balloon pump (IABP) on in-hospital mortality in patients with cardiac arrest undergoing extracorporeal cardiopulmonary resuscitation (ECPR).Methods:A retrospective study was performed on 696 patients with intra-hospital cardiac arrest undergoing ECPR from Samsung Medical Center in Korea between January 2004 and December 2013. According to whether IABP was used, the patients were divided into ECPR group and ECPR+IABP group. Cox regression and propensity score matching (PSM) were used to examine the correlation between IABP usage and in-hospital mortality, and standardized mean difference ( SMD) was used to check the degree of PSM. Survival analysis of in-hospital mortality was performed by the Kaplan-Meier method, and further analyzed by the Log-Rank test. Using the propensity score as weights, multiple regression model and inverse probability weighting (IPW) model were used for sensitivity analysis. In-hospital mortality, extracorporeal membrane oxygenation (ECMO) withdrawal success rate and neurological function prognosis were compared between the two groups. Results:A total of 199 patients with cardiac arrest undergoing ECPR were included, including 120 males and 79 females, and the average age was (60.0±16.8) years. Thirty-one patients (15.6%) were treated with ECPR and IABP, and 168 patients (84.4%) only received ECPR. The total hospitalized mortality was 68.8% (137/199). The 1 : 1 nearest neighbor matching algorithm was performed with the 0.2 caliper value. The following variables were selected to generate propensity scores, including age, gender, race, marital status, insurance, admission type, service unit, heart rate, mean arterial pressure, respiratory rate, pulse oxygen saturation, white blood cell count. After the propensity score matching, 24 pairs of patients were successfully matched, with the average age of (63.0±12.8) years, including 31 males and 17 females. The in-hospital mortality was 72.6% (122/168) and 48.4% (15/31) in the ECPR group and the ECPR+IABP group [hazard ratio ( HR) = 0.48, 95% confidence interval (95% CI) was 0.28-0.82, P = 0.007]. Multiple regression model, adjusted propensity score, PSM and IPW model showed that the in-hospital mortality in the ECPR+IABP group was significantly lower compared with the ECPR group ( HR = 0.44, 0.50, 0.16 and 0.49, respectively, 95% CI were 0.24-0.79, 0.28-0.91, 0.06-0.39 and 0.31-0.77, all P < 0.05). The combined application of IABP could improve the ECMO withdrawal success rate [odds ratio ( OR) = 8.95, 95% CI was 2.72-29.38, P < 0.001] and neurological prognosis ( OR = 4.06, 95% CI was 1.33-12.40, P = 0.014) in adult cardiac arrest patients. Conclusion:In patients with cardiac arrest using ECPR, the combination of IABP was independently associated with lower in-hospital mortality, higher ECMO withdrawal success rate and better neurological prognosis.
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Objective:To explore the data of patients with inoperable stage Ⅲ non-small cell lung cancer (NSCLC) after radiotherapy from the Surveillance, Epidemiology, and End Results (SEER) database, and to evaluate the effect of age on prognosis.Methods:The data of patients with inoperable stage Ⅲ A and Ⅲ B NSCLC according to the 7th edition of the American Joint Committee on Cancer (AJCC) staging standard who had been treated with radiotherapy from 2010 to 2016 were collected in the SEER database. A total of 17 117 cases were included in the analysis. According to the maximally selected test, the best cut-off value of age was 72 years old. According to the best cut-off value of age, patients were divided into the young group (< 72 years old, 11 008 cases) and the elderly group (≥ 72 years old, 6 109 cases). The basic clinical characteristics were compared between the two groups. Kaplan-Meier method was used to analyze the overall survival (OS) and log-rank test was performed. The multivariate Cox proportional hazards regression model was used to analyze the influencing factors for OS. The cumulative incidence function (CIF) was used to calculate the lung cancer-specific death rate and death rate from other causes in the different age groups, and the difference between the two groups was compared by Fine-Gray competing risk model, and the influencing factors of lung cancer-specific death were analyzed. Results:The proportion of squamous cell carcinoma in the elderly group was higher than that in the young group [51.1% (3 123/6 109) vs. 46.8% (5 154/11 008), P < 0.01], and the proportion of stage Ⅲ A was also higher than that in the young group [67.4% (4 120/6 109) vs. 60.1% (6 615/11 008), P < 0.01]; the proportion of patients receiving chemotherapy in the elderly group was lower than that in the young group [69.2% (4 226/6 109) vs. 88.6% (9 748/11 008), P < 0.01]. The 2-year and 5-year OS rates of the young group were 39.2% and 18.0%, and the elderly group were 32.4% and 12.5% (both P < 0.01). The multivariate Cox regression analysis showed that age, gender, race, year of diagnosis, pathological type, T stage, N stage, reason for non-operation and chemotherapy were independent influencing factors for patients' OS after radiotherapy, and among them, HR of age (≥ 72 years old vs. < 72 years old) was 1.13 (95% CI 1.09-1.18) ( P <0.01). The 2-year and 5-year cumulative incidence rate of lung cancer-specific death in the elderly group were 60.3% and 75.7%, which were higher than the corresponding values of 55.9% and 74.0% in the young group, and the difference of cumulative incidence rate of lung cancer-specific death between the two groups was statistically significant ( P < 0.01). The 2-year and 5-year cumulative incidence rate of death from other causes in the elderly group were 7.3% and 11.8%, which were higher than the corresponding values of 4.9% and 8.0% in the young group, and the difference of death from other causes between the two groups was statistically significant ( P < 0.01). The competing risk model analysis showed that age, gender, race, year of diagnosis, pathological type, T stage, N stage, and with or without chemotherapy were independent influencing factors for lung cancer-specific death in patients with inoperable stage Ⅲ NSCLC after radiotherapy, and among them, HR of age (≥ 72 years old vs. < 72 years old) was 1.07 (95% CI 1.02-1.12) ( P =0.002). Conclusions:Age is an independent prognostic factor for patients with inoperable stage Ⅲ NSCLC after radiotherapy. The prognosis of elderly patients is poor, and they have high risks of lung cancer-specific death and death from other causes.
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Objective:To analyze the correlation between serum uric acid and clinical features of patients with novel coronavirus pneumonia(COVID-19).Methods:A total of 200 patients with COVID-19 admitted to Wuhan Lei Shen Shan hospital from January 20, 2020 to April 10, 2020 were included in this retrospective cohort study. The patients were divided into the hyperuricemia group and the non-hyperuricemia group. The data of patients were collected through electronic medical record system. SPSS 19.0 and Graphpad Prism 8.0 statistical software were used to compare clinical features, laboratory results, survival time, and prognosis of patients between hyperuricemia and non-hyperuricemia groups.Results:Compared with the non-hyperuricemia group, the hyperuricemia group showed a higher BMI and mortality( P<0.05)as well as higher white blood cell count, lymphocytes, serum creatinine, creatine kinase, cystatin C, myoglobin, interleukin(IL)-6 levels( P<0.05). Serum uric acid level was positively correlated with lymphocytes, hemoglobin, albumin, creatinine, creatine kinase, cystatin C, D-dimer levels while negatively correlated with IL-2 receptor and IL-8. The patients with hyperuricemia had significantly shorter survival time and worse prognosis than those without hyperuricemia( P=0.04). Conclusion:COVID-19 patients with hyperuricemia show higher mortality and worse prognosis compared with the patients with non-hyperuricemia.
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Objective:To evaluate the clinical effect of surgical treatment of scapular body complicated fractures with reverse Judet operation approach.Methods:A retrospective review was made on 36 patients with scapular body complicated fractures from Jan. 2013 to Jan. 2019. All the fractures were type Ⅳ according to Miller ME classification. There were 29 males and 7 females, at mean age of 46 years(ranged from 20 to 63 years). High energy traffic injury occurred in 13 patients, high fall injury in 8 patients, heavy pound in 3 patients.CT scan and 3D reconstruction were performed before operation, to expose the scapula with reverse Judet approach and do the internal fixation operation with reconstruction plate. Instructed the patients in functional exercises and clinic effects. All patients were followed up after operation. Twenty patients with scapular body complicated fractures from Jan. 2013 to Jan. 2019 treated by classic Judet approach operation were control analysised, compared the operation time, blood less, Incision healing and the shoulder function score after 1 year postoperation.Results:One-stage incision healing were achieved in all 36 patients, no infection and necrosis occurred in the muscle and skin flaps, all patients were followed up for 1 to 6 years(mean 3.8 years). According to Hardegger evaluation standard, 28 cases were excellent, 8 cases were good, the excellent and good rate was 100%. Opteration time and blood loss were less than those in classic Judet group, the differences were significant( P<0.001). Conclusion:For the surgical treatment of complicated fractures, reverse Judet approach that muscle flap and skin flap separated is feasible, the operation is simple, which can obviously shorten the operation time and blood loss, sufficient exposure is good for the reduction and stable fixation of fractures in the operation, early functional exercise can be proformed after operation, reverse Judet approach is a safe and efficient choice for the surgical treatment of scapular body complicated fractures.
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Objective:To investigate the therapeutic effects of antibiotic articular cement spacer on shoulder joint infection in the elderly patients during stage-one operation.Methods:The data of 3 patients were analyzed retrospectively who had been treated at Department of Orthopaedics, The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University for shoulder infection from May 2018 to December 2019. They were one man and 2 women with an average age of 65.3 years (from 64 to 67 years). One case of infection followed shoulder puncture, another proximal humeral fracture and another shoulder prosthesis replacement. All the 3 patients underwent radical debridement and implantation of antibiotic shoulder cement spacer in stage-one operation but no stage-two operation. The therapeutic effects were evaluated by American Shoulder and Elbow Surgeons (ASES) scoring, Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) scoring, Visual Analog Scale (VAS), and range of shoulder motion.Results:The 3 patients were followed up for 18 to 28 months (mean, 22.7 months). There was no recurrence of infection and the spacers were in good position. The microorganisms detected were Bifidobacterium brevis in one case and methicillin-resistant Staphylococcus aureus in 2 cases. At the final follow-up, the ASES scores averaged 54.4 (from 46.3 to 60.0), Quick-DASH scores 45.1 (from 40.8 to 50.0), VAS scores 2.3 (from 2 to 3), ranges of elevation 65.7 °, ranges of abduction 43.8° and ranges of external rotation 21.7°.Conclusion:For the elderly patients with shoulder infection, implantation of antibiotic shoulder cement spacer after radical debridement can well control infection, relieve pain and improve shoulder functions, sparing them secondary operation.
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Objective:To clarify the effect of ubiquitination hepatitis B virus core antigen (Ub-HBcAg) on dendritic cells (DC) autophagy, and to explore the mechanism of autophagy in enhancing DC antigen presentation and inducing hepatitis B virus-specific cytotoxic T lymphocyte (CTL) responses.Methods:Ub-HBcAg lentiviral vector (LV-Ub-HBcAg), lentiviral vector-hepatitis B virus core antigen (LV-HBcAg) and no-load plasmid LV (LV) were constructed and packaged. DC2.4 cells were divided into LV-Ub-HBcAg group, LV-HBcAg group and LV group. The blank control group (NC group) was also set. The protein expression of autophagy-related protein P62, microtubule associated protein 1 light chain 3 beta (LC3B), autophagy related 5(ATG5) and Beclin-1 were detected by Western blotting. The expressions of co-stimulatory molecules such as CD86, CD80 and major histocompatibility complex (MHC)-Ⅱ were detected by flow cytometry. Cell counting kit-8 (CCK-8) method was used to detect T lymphocytes proliferation. The non-radioactive lactic acid dehydrogenase (LDH) release method was applied to detect the killing ability of CTL. Statistical analysis was conducted by independent sample t test. Results:The relative protein expressions of LC3B-Ⅱ/LC3B-Ⅰ, Beclin-1 and ATG5 in NC group were 0.445±0.076, 0.522±0.026 and 0.761±0.038, respectively, which were all lower than those in LV-Ub-HBcAg group (0.926±0.021, 0.919±0.016 and 1.451±0.028, respectively). The relative protein expression of P62 in the NC group was higher than that in LV-Ub-HBcAg group ((1.875±0.016) vs (0.647±0.121)). The differences were all statistically significant ( t=6.102, 9.842, 17.490 and 10.590, respectively, all P<0.01). The expressions of CD86 (75.51%), CD80 (83.35%), MHC-Ⅱ (66.66%) in the LV-Ub-HBcAg group were high, and those in the NC group were 8.03%, 7.49%, 0.04%, respectively. The specific CTL killing rate ((65.310±2.091)%) of the LV-Ub-HBcAg group was significantly higher than both NC group ((14.400±0.497)%) and LV-HBcAg group ((54.870±1.443)%), and the differences were both statistically significant ( t=23.690 and 4.111, respectively, both P<0.05). Conclusion:Ub-HBcAg promotes the DC autophagy, up-regulates the expressions of costimulatory molecules on cell surface of DC to induce the maturation and activation, and then stimulates T lymphocyte to induce a stronger specific CTL response under the effort of ubiquitination.
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Objective:To explore the perioperative management strategy for the elderly with hip fractures during the epidemic of corona virus disease 2019 (COVID-19) and evaluate its clinical effect.Methods:A retrospective case series study was conducted on 33 elderly patients with hip fractures admitted to Chongqing General Hospital, University of Chinese Academy of Sciences, from January 20 to February 29, 2020, including 14 males and 19 females, aged 65-92 years [(76.5±6.3)years]. There were 20 patients with intertrochanteric fractures and 14 with femoral neck fractures. In total, 15 patients were combined with hypertension and 9 with diabetes. A total of 19 patients were treated with open reduction and internal fixation and 14 with total hip/semi-hip replacement. The time from injury to admission was 2-14 hours. The temperature measurement, routine blood test and chest CT examination were performed to exclude COVID-19 in all patients, which showed 12 patients with pulmonary infection. The medical staff received different levels of protection: first level protection for those in the special ward, secondary level protection for the emergency isolation ward and tertiary level protection for those collecting the throat swab samples. The time from admission to operation, intensive care unit (ICU) stay time, hospitalization time, visual analogue score (VAS), perioperative complications as well as infection of patients and medical staff were observed and recorded.Results:The time from admission to operation was (3.18±0.19)days for all patients, with (2.24±0.28)days for 21 patients with no obvious pulmonary abnormality and (4.83±0.39)days for 12 with pulmonary infection. The hospitalization time was (10.97±0.31)days in all patients, with (9.71±0.27)days for 21 patients with no obvious pulmonary abnormality and (12.51±0.78)days for 12 with pulmonary infection. After operation, 12 patients were treated in ICU for 1-3 days, and the rest 21 patients were treated in general wards. The pain of all patients was effectively controlled. The time for exercise was (4.0±1.4)days after operation in all patients, among which 19 treated with fracture reduction and internal fixation started at (4.3±1.3)days after operation and 14 treated with total hip/semi-hip replacement started at (3.6±1.3)days after operation. VAS was (4.55±0.29)points at 12 hours before operation, (5.62±1.12)points at 6 hours, (3.54±0.39)points at 24 hours, and (2.42±0.11)points at 72 hours after operation ( P<0.05). Chest CT showed that the pulmonary inflammation was significantly improved one day before discharge. There was no indication of nucleic acid detection, with no urinary tract infection, pressure sore, deep vein thrombosis or other complications were found. No infection of patients or medical staff occurred. Conclusion:During pandemic of COVID-19, early surgical treatment for the elderly with hip fractures can be done in the general wards, based on strictly following the principle of infection prevention and control and carefully evaluating the perioperative risks, which can avoid the probability of infection of patients and medical staff without prolonging the hospitalization time or increasing the incidence of complications.
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Objective:The serum levels of pepsinogen (PG) and gastrin 17 (G17) in patients with primary gastric cancer were determined, and the correlation between them and the degree of tumor malignancy was analyzed to provide a reliable basis for clinical diagnosis and treatment.Methods:The study group included 155 patients with primary gastric cancer treated in Peking University (PKU) Care Luzhong Hospital from January 2019 to January 2020, and with the same period to the hospital physical examination of 100 cases of healthy volunteers as control group. Peripheral venous blood samples were taken from all subjects for detection, and serum PG Ⅰ, PG Ⅱ, G17 level were compared and analyzed, and PG Ⅰ/PG Ⅱ (PGR) was calculated. The indexes of gastric cancer patients in different stages and tumor node metastasis (TNM) stages were analyzed, and the receiver operating characteristic (ROC) curve was drawn to analyze the efficacy of the above indicators in the diagnosis of gastric cancer.Results:The levels of PG Ⅰ and PGR in the study group were significantly lower than those in the control group ( P<0.05), and the serum level of G17 was significantly higher than that of the control group, while the difference of PG Ⅱ level was not statistically significant ( P>0.05). Based on the progress of tumor focus, serum PG Ⅰ and PGR in patients with advanced gastric cancer were significantly lower than those in patients with early gastric cancer ( P<0.05), while serum G17 level were higher in patients with early gastric cancer ( P<0.05). Based on TNM stage, serum PG Ⅰ level decreased significantly with the increase of tumor stage ( P<0.05), while serum G17 level increased significantly ( P<0.05). The ROC curve showed that the combined detection of serum PG Ⅰ, PG Ⅱ, PGR and G17 was superior to single index in the diagnosis of gastric cancer. The area under curve (AUC) of combined detection was the highest, with sensitivity and specificity of 83.87% and 76.77%, respectively. Conclusions:The expression levels of serum PG Ⅰ, PGR and G17 are correlated with the degree of malignancy of primary gastric cancer. Moreover, combined detection and diagnosis of primary gastric cancer has good efficacy and important clinical value.
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BACKGROUND AND PURPOSE: There is conflicting evidence in the literature on the association between benzodiazepines (BDZs) and the risk of dementia. This meta-analysis aimed to determine the relationship between the long-term usage of BDZs and the risk of dementia. METHODS: The PubMed and Embase databases were systematically searched for relevant publications up to September 2017. The literature search focused on observational studies that analyzed the relationship between the long-term use of BDZs and the risk of dementia. Pooled rate ratios (RRs) with 95% confidence interval (CI) were assessed using a random-effects model. The robustness of the results was checked by performing subgroup and sensitivity analyses. RESULTS: Ten studies were included: six case–control and four cohort studies. The pooled RR for developing dementia was 1.51 (95% CI=1.17–1.95, p=0.002) in patients taking BDZ. The risk of dementia was higher in patients taking BDZs with a longer half-life (RR=1.16, 95% CI=0.95–1.41, p=0.150) and for a longer time (RR=1.21, 95% CI=1.04–1.40, p=0.016). CONCLUSIONS: This meta-analysis that pooled ten studies has shown that BDZ significantly increases the risk of dementia in the elderly population. The risk is higher in patients taking BDZ with a longer half-life (>20 hours) and for a longer duration (>3 years).
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Aged , Humans , Benzodiazepines , Cohort Studies , Dementia , Half-LifeABSTRACT
Objective@#To investigate the effect of intensive insulin therapy on the immune function and prognosis of severe thoracic injuries patients with stress hyperglycemia.@*Methods@#A retrospective case control study was performed to analyze the clinical data of 60 patients with severe chest trauma and stress-induced hyperglycemia admitted to Chongqing People's Hospital from October 2016 to October 2018. There were 31 males and 26 females, aged 25-61 years [(46.1±4.0)years]. The abbreviated injury scale (AIS) range was 3-5 points. Thirty patients received routine insulin therapy (routine treatment group) and thirty patients received intensive insulin therapy (intensive treatment group). Venous blood was collected from two groups of patients before treatment, 1 day, 3 days, 5 days and 7 days after treatment respectively. Level of inflammatory cytokines [tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP)], and lymphocyte count (CD14＋, CD4＋ and CD4＋/CD8＋) were detected respectively. The incidence of nosocomial infection, length of hospital stay, mortality and incidence of hypoglycemia were compared between the two groups.@*Results@#There were no significant differences in plasma TNF-α, IL-6 and CRP levels between the two groups before treatment (P>0.05). After treatment (1-7 days), the levels of serum TNF-α, IL-6 and CRP in the intensive treatment group were lower than those of routine treatment group (P<0.05 or 0.01). Compared with these before treatment, the levels of TNF-α, IL-6 and CRP in both groups increased to varied degrees, reaching a peak on day 3, followed by a gradual decline (P<0.05 or 0.01). There were no statistically significant differences in CD14＋, CD4＋、CD4＋/CD8＋ lymphocyte counts between the two groups before treatment (P>0.05). On days 3, 5, and 7 after treatment, the counts of CD14＋ lymphocytes [3 d: (0.61±0.08)×109 vs. (0.55±0.09)×109, 5 d: (0.68±0.05)×109 vs. (0.63±0.05)×109, 7 d: (0.77±0.07)×109 vs. (0.71±0.06)×109], CD4＋ lymphocytes [3 d: (0.29±0.04)×109 vs. (0.25±0.03)×109, 5 d: (0.32±0.04)×109 vs. (0.30±0.05)×109, 7 d: (0.34±0.03)×109 vs. (0.32±0.06)×109], CD4＋/CD8＋ lymphocytes [3 d: (0.28±0.04)×109 vs. (0.26±0.06)×109, 5 d: (0.33±0.03)×109 vs. (0.31±0.06)×109, 7 d: (0.35±0.03)×109 vs. (0.32±0.06)×109] in the intensive treatment group were higher than those in the routine treatment group. Compared with before treatment, the counts of CD14+ , CD4+ , CD4+ /CD8+ lymphocytes in the two groups were raised to different degrees after treatment for 3 days, with significant differences (P<0.05 or 0.01). Compared with routine treatment group, patients in intensive treatment group had lower incidence of nosocomial infection [57%(17/30) vs. 30%(9/30)], shorter duration of mechanical ventilation [(12.8±2.4)vs. (7.4±1.2)days], and lower hospital mortality rate [27%(8/30) vs. 10%(3/30)]. There was no significant difference in the incidence of hypoglycemia between the two groups(P>0.05).@*Conclusion@#For severe chest trauma patients with stress hyperglycemia, intensive insulin therapy can effectively improve the immunity, inhibit the inflammatory reaction, reduce the complication incidence, restore ventilation function and improve survival rate.
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Objective To investigate the effect of intensive insulin therapy on the immune function and prognosis of severe thoracic injuries patients with stress hyperglycemia.Methods A retrospective case control study was performed to analyze the clinical data of 60 patients with severe chest trauma and stress-induced hyperglycemia admitted to Chongqing People's Hospital from October 2016 to October 2018.There were 31 males and 26 females,aged 25-61 years [(46.1 ± 4.0)years].The abbreviated injury scale (AIS) range was 3-5 points.Thirty patients received routine insulin therapy (routine treatment group) and thirty patients received intensive insulin therapy (intensive treatment group).Venous blood was collected from two groups of patients before treatment,1 day,3 days,5 days and 7 days after treatment respectively.Level of inflammatory cytokines [tumor necrosis factor-α (TNF-α),interleukin-6 (IL-6) and C-reactive protein (CRP)],and lymphocyte count (CD14 +,CD4 +and CD4 +/CD8 +) were detected respectively.The incidence of nosocomial infection,length of hospital stay,mortality and incidence of hypoglycemia were compared between the two groups.Results There were no significant differences in plasma TNF-α,IL-6 and CRP levels between the two groups before treatment (P ＞ 0.05).After treatment (1-7 days),the levels of serum TNF-α,IL-6 and CRP in the intensive treatment group were lower than those of routine treatment group (P ＜ 0.05 or 0.01).Compared with these before treatment,the levels of TNF-α,IL-6 and CRP in both groups increased to varied degrees,reaching a peak on day 3,followed by a gradual decline (P ＜ 0.05 or 0.01).There were no statistically significant differences in CD14 +,CD4 + 、CD4 +/CD8 + lymphocyte counts between the two groups before treatment (P ＞ 0.05).On days 3,5,and 7 after treatment,the counts of CD14+ lymphocytes [3 d:(0.61 ±0.08) × 109 vs.(0.55 ±0.09) × 109,5 d:(0.68 ±0.05) × 109 vs.(0.63±0.05) ×109,7 d:(0.77±0.07) ×109 vs.(0.71±0.06) ×109],CD4 + lymphocytes [3 d:(0.29 ±0.04) × 109 vs.(0.25 ±0.03) × 109,5 d:(0.32 ±0.04) × 109 vs.(0.30 ±0.05) × 109,7 d:(0.34±0.03) ×109 vs.(0.32±0.06) ×109],CD4 +/CD8+ lymphocytes [3 d:(0.28 ±0.04) ×109 vs.(0.26 ±0.06) × 109,5 d:(0.33 ±0.03) × 109 vs.(0.31 ±0.06) × 109,7 d:(0.35 ±0.03) × 109 vs.(0.32 ± 0.06) × 109] in the intensive treatment group were higher than those in the routine treatment group.Compared with before treatment,the counts of CD14 +,CD4 +,CD4 +/CD8 + lymphocytes in the two groups were raised to different degrees after treatment for 3 days,with significant differences (P ＜0.05 or 0.01).Compared with routine treatment group,patients in intensive treatment group had lower incidence of nosocomial infection [57％ (17/30) vs.30％ (9/30)],shorter duration of mechanical ventilation [(12.8 ± 2.4) vs.(7.4 ± 1.2) days],and lower hospital mortality rate [27％ (8/30) vs.10％ (3/30)].There was no significant difference in the incidence of hypoglycemia between the two groups(P ＞ 0.05).Conclusion For severe chest trauma patients with stress hyperglycemia,intensive insulin therapy can effectively improve the immunity,inhibit the inflammatory reaction,reduce the complication incidence,restore ventilation function and improve survival rate.
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Hepatitis B virus (HBV)/hepatitis D virus (HDV) co-infection can accelerate the progression of liver diseases, but due to the limitations of the detection methods for HDV RNA, the epidemiology of HDV remains unclear. Further studies are needed to investigate the pathogenesis of HBV/HDV co-infection caused by HDV and related treatment methods. By reviewing the epidemiological features of HDV, HDV-specific immunity, genotype, and pathogenesis in China and other countries and summarizing HDV detection methods and treatment methods, this article shows that current detection methods for HDV infection have low sensitivity and specificity, with a lack of standardized detection methods. Exploration of new HDV detection methods will help to develop new and effective anti-HDV drugs, which has great significance in improving the outcome of HDV infection.
ABSTRACT
Hepatitis B virus (HBV)/hepatitis D virus (HDV) co-infection can accelerate the progression of liver diseases, but due to the limitations of the detection methods for HDV RNA, the epidemiology of HDV remains unclear. Further studies are needed to investigate the pathogenesis of HBV/HDV co-infection caused by HDV and related treatment methods. By reviewing the epidemiological features of HDV, HDV-specific immunity, genotype, and pathogenesis in China and other countries and summarizing HDV detection methods and treatment methods, this article shows that current detection methods for HDV infection have low sensitivity and specificity, with a lack of standardized detection methods. Exploration of new HDV detection methods will help to develop new and effective anti-HDV drugs, which has great significance in improving the outcome of HDV infection.
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Objective To investigate the application of enhanced recovery after surgery (ERAS)in the nursing of thoracolumbar fracture with nerve injury.Methods A retrospective case-control study was conducted to analyze the clinical data of 64 patients with bilateral thoracolumbar fractures with nerve injury admitted to the Chongqing General Hospital from November 2013 to November 2017.There were 52 males and 12 females,aged 26-62 years,with an average age of 43 years.The injured segments were located at T11-T12in 28 patients,T12-L1 in 15 patients,L1-L2 in 10 patients,and L2-L3 in 11 patients.According to the Frankel classification of neurological function,there were 14 patients at grade A,18 at grade B,24 at grade C and eight at grade D.All patients were treated with common pedicle screw placement under direct vision combined with dome shaped decompression through small incision.Among the patients,32 received ERAS rehabilitation nursing (ERAS group) and 32 received routine rehabilitation nursing (routine group).The incidence of complications,hospitalization time,hospitalization expense,patients' satisfaction with nursing work,visual analogue scale (VAS),Oswestry dysfunction index (ODI) and Frankel classification of neurological function at 3 months after operation were compared between the two groups.Results The patients were followed up for 8-12 months [(10.2 ±1.3) months].In the ERAS group,one patient had pulmonary infection;in the routine group one patient had wound infection,one had bedsore,and one had venous thrombosis in lower limb (P ＜ 0.01).The hospitalization time of ERAS group was significantly shorter than that of routine group [(9.3 ± 1.2)days:(15.6 ± 1.8) days] (P ＜ O.01).The hospitalization expense of ERAS group was significantly lower than that of routine group [(52 ± 13)thousand yuan (RMB) vs.(63 ± 17) thousand yuan (RMB)](P ＜ 0.05).The satisfaction rates of ERAS group and routine group were 84％ (27/32) and 56％ (18/ 32),respectively (P ＜ 0.05).At 3 months after operation,the ERAS group had significantly lower VAS [(2.6±1.2)pointsvs.(3.8±1.5)points] and ODI (11.4±2.1)pointsvs.(15.8±2.5)points]than the routine group (P ＜ 0.05 or 0.01).At 3 months after operation,according to the Frankel grading,there was one patient at grade A,five at grade B,nine at grade C,five at grade D,and 12 at grade E in the ERAS group;while there were three patients at grade A,seven at grade B,seven at grade C,nine at grade D,and six at grade E.The recovery rate of Frankel grade 1 and/or above in ERAS group was significantly higher than that in routine group [97％ (31/32) vs.91％ (29/32),P ＜0.05].Conclusion Rehabilitation nursing measures of ERAS can help reduce perioperative complications,hospitalization time and hospitalization expenses,relieve pain,promote functional recovery,and gain satisfactory feedbacks from the patients.