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ObjectiveTo explore the immediate and short-term effects of pressure biofeedback therapy combined with Flexi-bar exercise in the sitting position on chronic non-specific low back pain (CNSLBP). MethodsFrom June to September, 2022, 27 CNSLBP students in Xuzhou Medical University and other universities around were randomly divided into pressure biofeedback unit (PBU) group (n = 9), Flexi-bar group (n = 9) and combined group (n = 9). On the basis of routine rehabilitation guidance, the PBU group accepted pressure biofeedback therapy, the Flexi-bar group accepted active vibration therapy, and the combined group accepted pressure biofeedback therapy and active vibration therapy, for three weeks. They were measured core stability with Stabilizer, lumbar joint repositioning error (LJRE) with iHandy, and bilateral transverse abdominis thickness and multifidus muscle cross-sectional area with ultrasonography; and assessed with Visual Analogue Scale for pain (VAS), Oswestry Disability Index (ODI) before and after treatment; and the core stability were measured immediately after the first treatment. ResultsThe indexes of core stability improved after the first treatment (|t| > 3.000, P < 0.05) in all groups, and improved the most in the combined group (F > 10.909, P < 0.001). All the indexes improved after three weeks of treatment (|t| > 2.604, P < 0.05), except for LJRE in PBU group; and they were the best in the combined group (|F| > 4.061, P < 0.05), except LJRE was not significantly different from the Flexi-bar group (P > 0.05). ConclusionPressure biofeedback therapy combined with Flexi-bar exercise in the sitting position can more effectively improve core stability and core muscles, proprioception, and pain for patients with CNSLBP.
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Objective:To investigate the risk factors for textbook outcomes (TO) of intra-hepatic cholangiocarcinoma (ICC) after hepatectomy.Methods:The retrospective cohort study was conducted. The clinicopathological data of 155 ICC patients who underwent hepatectomy in the First Affiliated Hospital of Sun Yat-sen University from September 2014 to August 2019 were collected. There were 90 males and 65 females, aged 60(range, 26?82)years. Observation indicators: (1) treatment situations; (2) TO situations; (3) analysis of risk factors for postoperative TO. Follow-up was conducted using outpatient examination and telephone interview to detect postoperative sur-vival of patients up to October 2020. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the independent samples t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test, Yates' calibration chi-square test or Fisher exact probability. The Kaplan-Meier method was used to calculate survival rates and draw survival curves. The Log-rank test was used for survival analysis. The univariate analysis was conducted using the corresponding statistical methods based on data type. The Logistic regression model was used for multivariate analysis. The receiver operating characteristic (ROC) curve was used for evaluating the diagnostic value of indicators (the optimal cut-off value). Results:(1) Treatment situations. Of the 155 patients, 46 cases underwent minor hepatectomy and 109 cases underwent major hepatectomy. Twenty-one of the 155 patients underwent combined bile duct reconstruction. Ninety-five of the 155 patients underwent lymph node dissection, including 41 cases with positive lymph node by postoperative histopathological examinations. The operation time and volume of intraoperative blood loss of the 155 patients were 250.0(range, 95.0?720.0)minutes and 300.0(range, 50.0?15 000.0)mL, respectively. The optimal cut-off values of the operation time and volume of intraoperative blood loss for TO calculated by ROC curve were 247.5 minutes and 325.0 mL, respectively. Of the 155 patients, 44 cases received intraoperative blood transfusion and 10 cases received postoperative blood transfusion (5 cases with intraoperative and postoperative blood transfusion). Seventy-four of the 155 patients had postoperative complications, including 39 cases with mild complications and 35 cases with serious complications. The total duration of hospital stay of the 155 patients was 19 (range, 8?77)days. (2) TO situations. Of the 155 patients, 150 cases achieved R 0 resection, 120 cases had no major postoperative complications, 106 cases had no perioperative blood transfusion, 79 cases had no prolonged duration of hospital stay, 152 cases had no death within postoperative 30 days and 150 cases had no readmission within 30 days after discharge. Of the 155 patients, 56 cases achieved postoperative TO, while 99 patients did not achieve TO. (3) Analysis of risk factors for postoperative TO. Results of univariate analysis showed that preoperative biliary drainage, preoperative Child-Pugh grading of liver function, preoperative asymp-tomatic leukocytosis, preoperative total bilirubin, preoperative alkaline phosphatase, preoperative CA19-9, preoperative CA125, operation time, volume of intraoperative blood loss, tumor diameter, pathological T staging and pathological N staging were related factors for preoperative TO of ICC patients undergoing hepatectomy ( χ2=4.31, 4.31, 4.38, 4.80, Z=?4.15, χ2=10.74, 15.44, 16.59, 27.53, 6.53, 6.77, 9.26, P<0.05). Bile duct reconstruction was also a related factor for postoperative TO of ICC patients ( P<0.05). Results of multivariate analysis showed that preoperative biliary drainage, preoperative asymptomatic leukocytosis, preoperative CA19-9 >35 U/mL, preoperative CA125 >35 U/mL and volume of intraoperative blood loss >325.0 mL were independent risk factors for postoperative TO of ICC patients undergoing hepatectomy ( odds ratio=74.77, 11.73, 2.40,4.86, 6.42, 95% confidence intervals as 1.80?113.39, 1.19?115.54, 1.04?5.53, 1.78?13.26, 2.41?17.11, P<0.05). Conclusions:Preoperative biliary drainage, preoperative asymptomatic leukocytosis, preoperative CA19-9 >35 U/mL, preoperative CA125 >35 U/mL and volume of intraoperative blood loss >325.0 mL are independent risk factors for postoperative TO of ICC patients undergoing hepatectomy.
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Objective:To carry out experiential and service-learning social practice activities among nursing undergraduates, and evaluate the effects.Methods:From September to December 2020, 21 junior college students were recruited from School of Nursing of Fudan University. They carried out 3 social practice services of rehabilitation training for autistic children under the guidance of professional rehabilitation teachers from the social practice base for special children. The effects of social practice were evaluated by summative evaluation, questionnaire survey and focus group interview at the end of the activity.Results:The nursing students provided a total of 66 times of volunteer services for autistic children and other special children, with a total length of 132 hours within a month. The final evaluation score of nursing students was (92.10 ± 2.10) points, 9 (42.9%) nursing students had a very satisfied sense of achievement, and 20 (95.3%) nursing students had a high overall satisfaction with social practice activities. There were two themes of practice harvest and practice reflection, of which practice harvest included three sub-themes of changing disease cognition, enhancing learning initiative and enhancing humanistic care concept, and practice reflection included three sub-themes of carrying out personalized rehabilitation training, improving practical service quality and establishing effective service evaluation system.Conclusions:It is necessary to change education and teaching concept, strengthen practice base construction, innovate practice teaching mode, and combine theoretical knowledge, professional skills with social service, so as to promote students′ all-round development of morality, intelligence, physique, aesthetics and labor.
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Objective:To investigate the correlations between albumin globulin ratio (AGR) , platelet lymphocyte ratio (PLR) , neutrophil lymphocyte ratio (NLR) and efficacy of chemotherapy for patients with metastatic colorectal cancer (mCRC) .Methods:The clinical data of 107 mCRC patients who were treated at the First Hospital of Shanxi Medical University for chemotherapy from January 2016 to September 2020 were selected, and the values of AGR, NLR and PLR before chemotherapy and after 3 cycles of chemotherapy were collected for retrospective analysis. After 3 cycles, patients were divided into three groups according to efficacy evaluation: partial response (PR) group, stable disease (SD) group and progressive disease (PD) group. The changes of AGR, PLR and NLR values before and after chemotherapy, and the relationships between the degrees of changes and the therapeutic effects were analyzed.Results:There were 18 cases in the PR group, 53 cases in the SD group and 36 cases in the PD group. There were no significant differences in age, sex, distant metastasis site, cancer site, T stage and N stage among the three groups ( F=0.33, P=0.721; χ2=2.94, P=0.230; χ2=2.34, P=0.674; χ2=0.80, P=0.669; χ2=5.68, P=0.224; χ2=2.06, P=0.375) . The AGR, PLR and NLR values before chemotherapy in the PR group were 1.57±0.19, 180.05±102.77 and 5.19 (4.50, 5.83) , and they were 1.45±0.23, 115.81±55.79 and 1.83 (1.06, 2.84) after chemotherapy, with statistically significant differences ( t=2.32, P=0.033; t=2.84, P=0.011; Z=-2.94, P=0.003) . In the SD group, AGR, PLR and NLR values before chemotherapy were 1.66 (1.40, 1.77) , 158.18 (103.81, 236.26) , 2.41 (1.75, 4.07) , and they were 1.35 (1.15, 1.60) , 123.85 (94.86, 176.44) , 1.49 (1.27, 2.33) after chemotherapy, with statistically significant differences ( Z=-4.51, P<0.001; Z=-3.31, P=0.001; Z=-3.90, P<0.001) . The AGR, PLR and NLR values in the PD group before chemotherapy were 1.60 (1.48, 1.87) , 122.07 (77.14, 175.72) , 2.37 (1.28, 4.20) , and they were 1.26 (1.08, 1.40) , 176.39 (139.89, 280.64) and 4.71 (3.71, 6.96) after chemotherapy, with statistically significant differences ( Z=-4.49, P<0.001; Z=-3.42, P=0.001; Z=-4.18, P<0.001) . The differences in AGR ( OR=3.66, 95% CI: 1.29-10.39, P=0.015) , PLR ( OR=0.99, 95% CI: 0.99-1.00, P<0.001) and NLR ( OR=0.59, 95% CI: 0.49-0.70, P<0.001) before and after chemotherapy were related to clinical efficacy. The greater the difference of AGR, the worse the short-term efficacy. The greater the difference of PLR and NLR, the better the short-term efficacy. The correlation between the changes in AGR, PLR and NLR before and after treatment and the clinical efficacy was sorted in descending order Δ NLR>Δ PLR>Δ AGR ( r=-0.68, P<0.001; r=-0.51, P<0.001; r=0.25, P=0.009) . Conclusion:The changes in the levels of AGR, NLR and PLR before and after chemotherapy are correlated with the short-term efficacy of mCRC, and it has certain significance for monitoring the curative effects of patients and further optimizing the treatment plan.
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On September 15, 2020, a patient came in to Peking Union Medical College Hospital after suffering from chest pain, rash and lymphadenopathy for more than 2 years, and expericing general pain for 8 months. He also lost 15 kilograms of weight in the past half a year. For chest pain, cough, and expectoration symptons, cephalosporins and symptomatic treatments were empirically used and the symptoms were relieved. However, drug-induced rash occurred. After anti-allergic treatments, the rash was relieved but the swelling of cervical lymph nodes was not relieved. Diagnostic antituberculosis therapy was employed after biopsy result showed multifocal granulomatous inflammation. The therapy reduced the lymph nodes, but the condition repeated, and the whole body pain appeared. Further examinations showed that lung cancer in the right upper lobe was accompanied by obstructive pneumonia and whole body metastasis to multiple sites. The patient had no history of immunosuppression, and the γ interferon antibody was strongly positive, adult-onset immunodeficiency syndrome was considered. In order to confirm the diagnosis, bone and tissue biopsy were necessary, but the patient failed to cooperate. The histopathological examination results of the right cervical lymph node and the left iliac bone biopsy were weakly acid fast staining positive, Nocardia infection was suspected. The clinical symptoms improved after using sulfanilamide and imipenem empirical treatments against Nocardia. The content of cyanobacteria marneffei, which was detected by metagenomic next generation sequencing, was low. More laboratory pathogenic examinations were actively confirmed for this rare pathogen. The antifungal treatment (amphotericin B plus itraconazole) was used after successfully cultivating the cyanobacteria marneffei pathogen. After two months, the body nodules and masses disappeared and the skin wounds healed. It is of great significance to the diagnosis and treatment of patients to obtain qualified samples, maintain timely communication between the laboratory and the clinic, and construct reasonable interpretations of the results of metagenomic next generation sequencing technology.
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Objective:To analyze clinical characteristics of neurosyphilis patients with abnormal mental behaviors as the initial symptom, and to provide a reference for clinical classification of, as well as outcome prediction and efficacy monitoring in neurosyphilis.Methods:Clinical data were collected from 67 HIV-negative neurosyphilis patients with abnormal mental behaviors as the initial symptom in the Second Affiliated Hospital of Soochow University from November 2012 to November 2019, and retrospectively analyzed. Statistical analysis was carried out by using t test. Results:Among the 67 patients, 52 (77.6%) were males, and 15 (22.4%) were females; there were 63 (94.0%) middle-aged and elderly patients and 4 (6.0%) adolescent patients; 38 (56.7%) patients were diagnosed with progressive general paresis, 21 (31.3%) with meningovascular neurosyphilis, 1 (1.5%) with meningeal neurosyphilis, 3 (4.5%) with tabes dorsalis, and 4 (6.0%) with mixed-type neurosyphilis. As laboratory examination showed, 67 patients all presented with positive serum rapid plasma reagin (RPR) test, serum Treponema pallidum particle agglutination (TPPA) test, and cerebrospinal fluid TPPA test, 55 (82.1%) had positive cerebrospinal fluid RPR test, 47 (70.1%) had elevated cerebrospinal fluid protein levels of > 0.45 g/L, 50 (74.6%) had increased white blood cell counts of > 8 ×10 6/L in cerebrospinal fluids, and 28 (41.8%) had elevated IgG levels in cerebrospinal fluids. Magnetic resonance imaging of the brain revealed multiple ischemic foci in 21 (31.3%) cases, multiple leukodystrophy in 17 (25.4%) , cerebral atrophy in 15 (22.4%) , infarction in 8 (11.9%) , and encephalitis-like changes in 2 (3.0%) . Of the 67 patients, 48 were treated with penicillin in aqueous solutions, 15 with ceftriaxone, and 4 with doxycycline. Six months later, the follow-up showed that 46 (68.7%) patients responded to the treatment, and the early course of disease was significantly shorter in the highly responsive group than in the poorly responsive group ( P < 0.05) . Conclusion:The middle-aged and elderly males were predominant in the neurosyphilis patients with abnormal mental behaviors as the initial symptom, magnetic resonance imaging is helpful for clinical classification and prognosis prediction of neurosyphilis, and early and standardized antisyphilitic treatment can markedly improve the prognosis of patients.
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The interleukin (IL) -23/IL-17 axis is the main pathway in the pathogenesis of plaque-type psoriasis vulgaris, and IL-17A plays a key role in the relevant immune pathways. IL-17A mediates overlapping inflammatory pathways in atherosclerosis and psoriasis, promotes inflammation, coagulation and thrombosis, and plays an important role in the occurrence and development of cardiovascular comorbidities in patients with psoriasis. Inhibiting the inflammatory effect of IL-17A can reduce the incidence and mortality of cardiovascular comorbidities in patients with severe psoriasis. This review summarizes recent research progress in IL-17A-mediated systemic inflammation and cardiovascular comorbidities in patients with psoriasis, and provides a reference for prevention and reduction of cardiovascular comorbidities in patients with psoriasis in clinical practice.
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Diabetic peripheral neuropathy is a common complication of diabetes， and its pathogenesis is complex. Its high morbidity can result in disability， teratogenesis， and death in diabetic patients. At present， the pathogenesis of diabetic peripheral neuropathy has not been clearly elucidated， which may be related to oxidative stress， inflammatory response， microcirculation dysfunction， metabolic abnormalities， etc. Recent studies have found that apoptosis plays an important role in the pathogenesis of diabetic peripheral neuropathy. The three pathways， i.e.， mitochondrial pathway， death receptor pathway， and endoplasmic reticulum pathway， jointly regulate the cell apoptosis in the body. Traditional Chinese medicine， with definite efficacies in the treatment of diabetic peripheral neuropathy， is advantageous in overall regulation and multi-target and multi-pathway treatment. As reported， the active ingredients in Chinese medicine and Chinese medicinal compounds can alleviate diabetic peripheral neuropathy by regulating apoptosis signaling pathways. Furthermore， apoptosis pathways are expected to be potential targets for new drugs against diabetic peripheral neuropathy following oxidative stress. Therefore， this paper， taking apoptosis as the entry point， reviewed the research progress on TCM intervention in diabetic peripheral neuropathy in recent years to provide references for the clinical prevention and treatment of diabetic peripheral neuropathy and the development of new drugs.
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According to the polarity of different components in Sanpian Decoction, two fingerprints were established. Then the substance benchmark freeze-dried powder of 15 batches of Sanpian Decoction was prepared, followed by the determination of the fingerprints, index component content, and dry extract rates, the identification of attribution of characteristic peaks, and the calculation of similarities between these fingerprints and the reference(R), the content and transfer rate ranges of ferulic acid, sinapine thiocyanate, liquiritin, and glycyrrhizic acid, and the dry extract rate range. The results showed that the similarities of 15 batches of the substance benchmark fingerprints with R were all greater than 0.900.Further summarization of the characteristic peaks revealed that there were a total of 20 characteristic peaks in fingerprint 1, among which, eight were from Sinapis Semen, four from Paeoniae Radix Alba, six from Chuanxiong Rhizoma, and two from Glycyrrhizae Radix et Rhizoma. A total of 16 characteristic peaks were observed in fingerprint 2, including one from Sinapis Semen, three from Paeoniae Radix Alba, eight from Chuanxiong Rhizoma, and four from Glycyrrhizae Radix et Rhizoma. The average dry extract rate of 15 batches of substance benchmarks was 18.25%, with a dry extract rate range of 16.28%-20.76%. The index component content and transfer rate ranges were listed as follows: 0.15%-0.18% and 38.81%-58.05% for ferulic acid; 0.26%-0.42% and 36.51%-51.02% for sinapine thiocyanate; 0.09%-0.15% and 48.80%-76.61% for liquiritin; 0.13%-0.24% and 23.45%-35.61% for glycyrrhizic acid. The fingerprint, dry extract rate, and index component content determination was combined for analyzing the quality value transfer of substance benchmarks in the classic prescription Sanpian Decoction.The established quality evaluation method for the substance benchmarks was stable and feasible, which has provided a basis for the quality control of Sanpian Decoction and the follow-up development of related preparations.
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Benchmarking , Chromatography, High Pressure Liquid , Drugs, Chinese Herbal , Glycyrrhizic Acid/analysis , Paeonia , Quality Control , ThiocyanatesABSTRACT
Taste is an important factor affecting the medicinal properties of oral preparations and patient compliance with medication, and also an important evaluation index for oral preparation design and clinical application. How to characterize the taste objectively, accurately, simply, and efficiently is a bottleneck problem that restricts the taste design, development, and utilization of oral preparations. At present, the commonly used taste assessment methods for oral preparations are traditional human taste panel, electronic tongue, animal preference test, in vitro release study, and electrophysiological test. The traditional human taste panel is the first choice for taste evaluation, but it is limited by poor subjectivity and reproducibility. Therefore, despite some limitations, the other four taste assessment methods have been applied in the pharmaceutical industry as auxiliary methods. This study reviewed the detection principles, applicability, advantages, and disadvantages of the above methods to provide references for the taste correction research and taste assessment of oral preparations, improve patient compliance and the competitiveness of oral preparation products in the industry, and promote the development of oral preparation technologies.
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Administration, Oral , Animals , Electronic Nose , Humans , Pharmaceutical Preparations , Reproducibility of Results , TasteABSTRACT
Silicotic nodules and pulmonary fibrosis are histopathological appearance in silicosis patients after long-term inhalation of crystalline silica particles, and are difficult to reverse and recover. Research on the pathogenesis and treatment strategies of silicosis has significantly lagged behind medical progress and clinical needs, resulting in the disease remaining a thorny clinical problem. Traditional Chinese medicine extracts or compound preparations have become a hot issue in exploring silicosis treatment strategies in recent years. This paper described the main pathological processes of pulmonary fibrosis caused by silicosis, followed by introducing its main pathogenesis mechanisms, including transforming growth factor-β1 (TGF-β1)/Smad signaling pathway, oxidative stress reaction, apoptosis, and autophagy. In addition, it briefly described the research progress, targets, and intervention effects of selected traditional Chinese medicine extracts, which provides a scientific basis for the theoretical and clinical research of traditional Chinese medicine extracts in inhibiting pulmonary fibrosis. To change the clinical status quo of silicosis fibrosis which is difficult to control and reverse, the paper proposed that we can further explore the pathogenesis and progression mechanisms of silicosis and drug treatment strategy, and focus on the transformation of basic research into clinical practice.
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Objective:To explore clinical characteristics, diagnosis and treatment of pulmonary tuberculosis (TB) after lung transplantation (LTx).Methods:Between March 2017 and December 2021, 17 TB infections were diagnosed in 424 LTx recipients at China-Japan Friendship Hospital.Clinical data were retrospectively reviewed and clinical features, treatments, therapeutic efficacies and outcomes examined.Results:The incidence of TB was 4%(17/424). There were 14 males and 3 females, with a median age of 57 years.Bilateral LTx was performed (n=12). Eight probably donor derived infection, six de novo exposure and infection and 3 reactivation of latent tuberculosis infection (LTBI) of recipients were determined.Most infections (16/17) were diagnosed within the first year post-LTx and 11 infections within the first month.All 17 cases were TB DNA positive and one positive for rifampin-resistant gene.Four cases were positive for TB DNA and acid-fast bacilli test and 6 cases positive for TB DNA and culture.Nodular or cavity (10/13) was the most common finding on chest tomography and the lesions were located predominantly in superior lobe.Therapeutic regimen without rifamycin (n=14) and rifabutin or rifapentine replacing rifampin (n=2) were employed.Treatment was successful (n=10) and clinically effective (n=2). Only one TB infection related death was recorded.Conclusions:LTBI or donor derived infection is common.Therapeutic regimen without rifamycin shows some potential clinical feasibility.
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Objective:To investigate the differences of umbilical vein diameter(D), time average peak velocity(TAmax) and blood flow between congenital heart disease and normal fetus.Methods:The umbilical vein diameter and time average peak velocity of 69 fetuses with congenital heart disease (disease group) from 22 to 27 weeks were prospectively studied in Maternal-Fetal Medical Center in Fetal Heart Disease of Beijing Anzhen Hospital from May 2021 to September 2021. Q 1 (umbilical venous blood flow) was calculated according to the formular [Q=0.5TAmax·π·(D/2) 2)], and Q 2 (Q 2=Q 1/weight) was calculated according to the fetal weight. At the same time, 111 normal fetuses with matched gestational age were selected as control group. The differences of fetal umbilical vein D, TAmax, Q 1 and Q 2 between the two groups were analyzed. Results:The inner diameter of umbilical vein D, TAmax, Q 1 and Q 2 in the congenital heart disease group were lower than those in the control group(all P<0.05). In the control group, the inner diameter of umbilical vein D, TAmax and Q 1 increased with the increase of gestational age and showed a positive linear correlation( r=0.608, 0.320, 0.626; all P≤0.001), while there was no obvious linear correlation between Q 2 and gestational age( r=0.189, P=0.047). Conclusions:The decrease of umbilical vein D, TAmax, Q 1 and Q 2 in the fetus with congenital heart disease indicates the decrease of effective blood flow in placenta-fetus circulation, which indirectly reflects the decrease of placental function in the fetus with congenital heart disease.
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@#AIM: To examine the clinicopathological characteristics of adult orbital xanthogranulomatous disease(AOXGD).<p> METHODS: From January 2015 to January 2021, the researchers collected postoperative pathological diagnoses cases of AOXGD from Xi'an People's Hospital(Xi'an Fourth Hospital), retrospectively analyzed clinical pathological data, and reviewed related literature. <p>RESULTS: A total of five AOXGD cases were collected, including three cases of adult-onset xanthogranuloma(AOX), one case of necrobiotic xanthogranuloma(NBX), and one case of Erdheim-Chester disease(ECD). The five patients were composed of middle-aged and elderly patients with local orbital lesions were treated. Microscopic examination revealed that the orbital skin and subcutaneous tissue had foam-like non-Langerhans histiocytes that exhibited diffused or nested infiltration. Immunohistochemistry revealed that the cells were positive for CD68, CD163, FXⅢa, lysozyme, negative for S100, CD1a, Langerin, HMB-45, MDM2. One ECD patient had orbital lesions as the first symptom and exhibited a combination of retroperitoneal lesions, right atrium pseudotumor, and long bones, heart, kidney lesions. The diagnosis of AOXGD depends on clinical manifestations and pathological features. The treatment was based on subtypes and clinical manifestations to select corresponding strategies, which mainly include the administration of glucocorticoids, immunosuppressants, and surgical treatment. <p>CONCLUSION: AOXGD is relatively rare in clinical practice. AOXGD can manifest as a local orbital disease or an orbital disease combined with a systemic disease. In the clinical and pathological work of ophthalmology, the understanding and identification of this group of diseases should be strengthened, and correct diagnosis and standard treatment should be promoted.
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Objective@#This cross-sectional study explores the serial multiple mediation of the correlation between internet addiction and depression by social support and sleep quality of college students during the COVID-19 epidemic. @*Methods@#We enrolled 2,688 students from a certain university in Wuhu, China. Questionnaire measures of internet addiction, social support, sleep quality, depression and background characteristics were obtained. @*Results@#The prevalence of depression, among 2,688 college students (median age [IQR]=20.49 [20.0, 21.0] years) was 30.6%. 32.4% of the students had the tendency of internet addiction, among which the proportion of mild, moderate and severe were 29.8%, 2.5% and 0.1%, respectively. In our normal internet users and internet addiction group, the incidence of depression was 22.6% and 47.2%, respectively. The findings indicated that internet addiction was directly related to college students’ depression and indirectly predicted students’ depression via the mediator of social support and sleep quality. The mediation effect of social support and sleep quality on the pathway from internet addiction to depression was 41.97% (direct effect: standardized estimate=0.177; total indirect effect: standardized estimate= 0.128). The proposed model fit the data well. @*Conclusion@#Social support and sleep quality may continuously mediate the link between internet addiction and depression. Therefore, the stronger the degree of internet addiction, the lower the individual’s sense of social support and the worse the quality of sleep, which will ultimately the higher the degree of depression. We recommend strengthening monitoring of internet use during the COVID-19 epidemic, increasing social support and improving sleep quality, so as to reduce the risk of depression for college students.
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Objective:To investigate the relationship between advanced glycation end products (AGEs) in the lens and type 2 diabetes mellitus.Methods:226 subjects were recruited between August 14 to September 14, 2018 from the Endocrinology Department of Central South University Xiangya Hospital, the Third Hospital of Changsha City, and the Fourth Hospital of Changsha City. The OGTT test, combined with clinical indicators, were used as the gold standard. Subjects were screened for type 2 diabetes using both the lens AGE fluorescence assay and the gold standard. Drawing the receiver operating characteristic (ROC) curve, we calculated the area under the curve (AUC) and its 95% CI and calculated the AGE for the diagnosis of type 2 diabetes. Sensitivity, specificity, Youden index, Kappa value, and its 95% CI, and the optimal cut-off value were determined according to the Youden index. Taking diabetes as the outcome indicator and AGE as the binary indicator, three logistic regression models were constructed. Stratified by age and sub-center, the differences between fasting blood glucose and 2 h postprandial blood glucose were compared between the AGE-negative and AGE-positive groups to determine the relationship between AGE and diabetes. Results:The area under the ROC curve was 0.86(95% CI: 0.81-0.91). According to the Youden index, the optimal cut-off point for AGE was 0.24. At this time, the sensitivity was 82.86(95% CI: 77.81-87.91), the specificity was 77.06(95% CI: 71.43-82.7), the Youden index was 59.92(95% CI: 53.36-66.49), the Kappa value was 79.62(95% CI: 74.22-85.02). Except for the 20-39-year-old group, the fasting blood glucose and 2 h postprandial blood glucose of the AGE-positive group in different age groups, different sub-centers, and the general population were higher than those of the AGE-negative group (all P<0.05). After adjusting for the confounding effects of age, gender, and sub-center (model 3), the relative risk of diabetes in the AGE-positive group was 11.75 times higher than the AGE-negative group (95% CI: 5.61-24.60), all with P<0.001. Conclusion:There was a high correlation between AGE in the lens and the risk of type 2 diabetes. When the cut-off point of AGE is 0.24, it had high sensitivity and specificity and could be used as a practical tool for early screening of type 2 diabetes.
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Objective:To compare the outcomes of watch&wait (W&W) strategy in patients with locally advanced rectal cancer who achieved complete clinical response (cCR) after neoadjuvant therapy, with those who obtained pathological complete response (pCR) after total mesorectal excision (TME).Methods:This is a retrospective cohort analysis study. Patients histologically proven with locally advanced rectal adenocarcinoma (stage Ⅱ-Ⅲ) who had received neoadjuvant chemotherapy were eligible between January 2014 and December 2019. In whom we included patients who had cCR offered management with W&W strategy after completing neoadjuvant therapy and follow-up ≥1 year (W&W group), and patients who did not have cCR but pCR after TME (pCR group). The primary endpoints were 3-year and 5-year overall survival (OS), colostomy-free survival (CFS), disease-free survival (DFS), non-local regrowth disease-free survival (NR-DFS), and organ preservation rate. Kaplan-Meier analysis was used for survival analysis and log-rank test was performed. For comparative analysis, we also derived one-to-one paired cohorts of W&W versus pCR using propensity-score matching (PSM).Results:A total of 118 patients were enrolled, 49 of whom had cCR and managed by W&W, 69 had pCR, with a median follow-up period of 49.5 months (12.1-79.9 months). No difference was observed in the 3-year OS (97.1% vs. 96.7%) and 5-year OS (93.8% vs. 90.9%, P=0.696) between the W&W and pCR groups. Patients managed by W&W had significantly better 3-year and 5-year CFS (89.1% vs. 43.5%, P<0.001), better 3-year DFS (83.6% vs. 97.0%) and 5-year DFS (83.6% vs. 91.2%, P=0.047) compared with those achieving pCR. The 3-year NR-DFS (95.9% vs. 97.0%) and 5-year NR-DFS (92.8% vs. 97.0%, P=0.407) did not significantly differ between the W&W and pCR groups. Local regeneration occurred in six cases, and 87.7% of patients had successful rectum preservation in the W&W group. In the PSM analysis (34 patients in each group), absolutely better CFS (90.1% vs. 26.5%, P<0.001) was noted in the W&W group. A median interval of 17.5 weeks was observed for achieving cCR, while only 23.9% of patients achieved cCR within 5 to 12 weeks from radiation completion. Patients with short-course sequential chemoradiotherapy achieved cCR significantly later when compared with those with long-course concurrent chemoradiotherapy (19.0 vs. 9.8 weeks, P<0.001). Conclusions:The oncological outcomes of W&W strategy in patients with locally advanced rectal cancer are safe and effective, significantly improving the quality of life. Longer interval for cCR evaluation may improve rectal organ preservation rate.
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Neoadjuvant chemoradiotherapy combined with total mesorectal excision is the standard treatment for stage T 3-T 4/N+ locally advanced rectal cancer (LARC). However, proctectomy is burdened with consistent postoperative morbidity, severely affecting the quality of life. "Organ preserving" methods could achieve similar oncological outcomes in highly selected patients whose tumors demonstrate (almost) clinical complete response to neoadjuvant treatment, while maintaining the quality of life and anorectal function by keeping the anus. This article aims to summarize the strategies of organ preservation after neoadjuvant treatment of LARC, salvage treatment for regrowth or recurrence, and anorectal function after organ preservation strategies.
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Objective:To summarize the etiological mechanism, echocardiographic and clinical features of fetal cardiomyopathies (FCMs).Methods:According to the data of echocardiography in Maternal-Fetal Medicine Center in Fetal Heart Disease of Beijing Anzhen Hospital during 2015 January to 2020 December, 70 cases with FCMs were retrospectively reviewed, and the clinical, ultrasonic, pathological and clinical outcome data were collected. Whole exome sequencing and whole genome sequencing were used to identify the genetic changes.Results:Primary FCMs were diagnosed in 55 cases (78.6%, 55/70), including 39 fetuses with non-compaction of the ventricular myocardium (NVM), 10 with dilated cardiomyopathy (DCM), 5 with hypertrophic cardiomyopathy (HCM), and 1 with restricted cardiomyopathy (RCM). Secondary FCMs were diagnosed in 15 cases (21.4%, 15/70), including 7 fetuses with maternal anti-Ro/La antibodies (presenting with DCM), 4 with twin-twin transfusion syndrome (2 with DCM and 2 with HCM), 2 with fetal anemia (presenting with DCM), 1 with maternal diabetes (presenting with HCM) and 1 with chorioangioma of the placenta (presenting with DCM). In all cases, 9 cases were born, 3 cases died in perinatal period, and 58 pregnancies were terminated due to ineffective treatment or the decisions of pregnant women. Thirty cases with primary FCMs were performed with genetic tests, and 13 of them were identified with positive genetic changes related to FCMs, including 12 cases with NVM and 1 with HCM.Conclusions:Primary FCMs are more common than secondary FCMs in fetal period. The genetic disorders have a high proportion in fetal NVM. Fetal DCM and HCM have a large spectrum of intrinsic and extrinsic causes.
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Objective:To investigate the prevalence of overactive bladder (OAB) in Chinese boys and risk factors, and to evaluate the psychological and behavioral status of OAB patients.Methods:Cross-sectional study.From October 2020 to July 2021, 2 800 boys aged 6-15 years from 6 primary and secondary schools in a county of Henan Province were selected by stratified random cluster sampling method.An anonymous questionnaire was used to investigate the epidemiological situation of OAB, including the basic information, lower urinary tract symptoms, Overactive Bladder Score Scale (OABSS) scores, pediatric sleep questionnaire (PSQ) and strengths and difficulties questionnaire (SDQ). In addition, the correlation between OAB and residence, body mass index (BMI), nocturnal enuresis (NE), overuse of diapers, history of urinary tract infection, abnormal stool, phimosis, redundant prepuce, and concealed penis by Chi- square test, Logistic multivariate regression analysis, and t-test. Results:A total of 2 333 valid questionnaires were collected.The overall prevalence of OAB in boys was 6.0%(141/2 333 cases). NE, history of urinary tract infection, abnormal stool, overuse of diapers, phimosis, redundant prepuce, concealed penis were risk factors for OAB in boys ( OR>1, P<0.05), while BMI was not a risk factor for OAB in boys ( OR<1, P>0.05). The emotional symptoms[ (7.64±2.03) scores vs.(6.51±2.53) scores], conduct problems [(8.14±1.62) scores vs.(7.31±1.88) scores], hyperactivity[(5.64±2.27) scores vs.(4.98±2.03) scores], peer communication problems [(7.16±1.63) scores vs.(6.59±1.60) scores], difficulty scores[(30.26±6.48) scores vs.(27.69±6.44) scores] and PSQ scores [(5.36±3.00) scores vs.(3.94±2.53) scores] in OAB group were significantly higher than those of non-OAB group ( t=-5.117, -5.005, -3.310, -4.056, -4.553, -5.006, respectively, all P<0.05). Conclusions:OAB in boys is common and affects mental health and sleep quality.Meanwhile, NE, history of urinary tract infection, abnormal stool, overuse of diapers, phimosis, redundant prepuce, or concealed penis are the risk factors for OAB in boys.