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Objective:To investigate the relationship between intramuscular adipose tissue index (IATI) calculated from computed tomography images at transverse process of the first lumbar and all-cause mortality in maintenance dialysis patients, and to provide a reference for improving the prognosis in these patients.Methods:It was a multicenter retrospective cohort study. The clinical data of patients who received maintenance hemodialysis or peritoneal dialysis treatment from January 1, 2017 to December 31, 2019 in 4 grade Ⅲ hospitals including Zhongda Hospital Affiliated to Southeast University, Taizhou People's Hospital Affiliated to Nanjing Medical University, Affiliated Hospital of Yangzhou University, and the Third Affiliated Hospital of Soochow University were retrospectively collected. IATI was calculated by low attenuation muscle (LAM) density/skeletal muscle density. The receiver-operating characteristic curve was used to determine the optimal cut-off value of IATI, and the patients were divided into high IATI group and low IATI group according to the optimal cut-off value. The differences of baseline clinical data and measurement parameters of the first lumbar level between the two groups were compared. The follow-up ended on December 23, 2022. The endpoint event was defined as all-cause mortality within 3 years. Kaplan-Meier survival curve and log-rank test were used to analyze the survival rates and the differences between the two groups. Multivariate Cox regression analysis models were used to analyze the association between IATI and the risk of all-cause mortality in maintenance dialysis patients. Multivariate logistic regression analysis model was used to analyze the influencing factors of high IATI.Results:A total of 478 patients were eligibly recruited in this study, with age of (53.55±13.19) years old and 319 (66.7%) males, including 365 (76.4%) hemodialysis patients and 113 (23.6%) peritoneal dialysis patients. There were 376 (78.7%) patients in low IATI (<0.42) group and 102 (21.3%) patients in high IATI (≥0.42) group. The proportion of age ≥ 60 years old ( χ2=24.746, P<0.001), proportion of diabetes mellitus ( χ2=5.570, P=0.018), fasting blood glucose ( t=-2.145, P=0.032), LAM density ( t=-3.735, P<0.001), LAM index ( t=-7.072, P<0.001), and LAM area/skeletal muscle area ratio ( Z=-9.630, P<0.001) in high IATI group were all higher than those in low IATI group, while proportion of males ( χ2=11.116, P<0.001), serum albumin ( Z=2.708, P=0.007) and skeletal muscle density ( t=12.380, P<0.001) were lower than those in low IATI group. Kaplan-Meier survival analysis showed that the 3-years overall survival rate of low IATI group was significantly higher than that in high IATI group (Log-rank χ2=19.188, P<0.001). Multivariate Cox regression analysis showed that IATI<0.42 [<0.42/≥0.42, HR(95% CI): 0.50 (0.31-0.83), P=0.007] was an independent protective factor of all-cause mortality, and age ≥60 years old [ HR (95% CI): 2.61 (1.60-4.23), P<0.001], diabetes mellitus [ HR (95% CI): 1.71 (1.06-2.78), P=0.029] and high blood neutrophil/lymphocyte ratio [ HR (95% CI): 1.04 (1.00-1.07), P=0.049] were the independent risk factors of all-cause mortality in maintenance dialysis patients. Stepwise Cox regression analysis showed that IATI<0.42 was still an independent protective factor of all-cause mortality in maintenance dialysis patients [<0.42/≥0.42, HR (95% CI): 0.45 (0.27-0.76), P=0.003]. Multivariate logistic regression analysis showed that low skeletal muscle density [ OR (95% CI): 0.84 (0.81-0.88), P<0.001] and high serum triglyceride [ OR (95% CI): 1.39 (1.07-1.82), P=0.015] were the independent influencing factors of IATI≥0.42. Conclusion:IATI<0.42 of the first lumbar level is an independent protective factor of all-cause mortality in maintenance dialysis patients. Localized myosteatosis within high-quality skeletal muscle may reduce the risk of all-cause mortality in these patients.
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@#To explore the main influencing factors of acute ischemic stroke complicated with depression in elderly patients，and to establish an individualized prediction of depression risk histogram model. Methods A total of 330 elderly patients with acute ischemic disease admitted to our hospital from March 2018 to March 2021 were selected as the model group，and 120 patients with depression treated from June 2018 to December 2020 were selected as the validation group. Clinical data of the two groups were collated. Univariate and Logistic multivariate regression models were used to explore the influencing factors of depression in AIS patients. And R software is used to verify the individualized prediction risk histogram model. Results There were significant differences in age，diabetes mellitus，hypertension，chronic kidney disease，serum creatinine，EGFR，BNP，hs-CRP and cardiac function Ⅳ grade between the two groups （P<0.05），and was determined to be related to depression in AIS patients. R software was used to establish a histogram model for predicting the risk of depression in AIS patients. According to the histogram score，the score of cardiac function Ⅳ was 40.30 points，and the score of associated diabetes was 24.00 points. With the increase of age，the decrease of EGFR and the increase of hs-CRP，the corresponding score of the histogram model increased，and the risk of complicated depression also increased. The practicability and feasibility of the model were verified （internal and external）. The C-index value of the model was 0.857 and 0.823 in the model group and the validation group，respectively. When ROC curve was used to analyze the predictive risk efficiency of this model for patients with depression in the model group and the validation group，the AUC of the model group was 0.841，while the AUC of the validation group was 0.817.Conclusion This study showed that the patient’s age，diabetes mellitus，cardiac function grade Ⅳ，EGFR and hs-CRP were independent influencing factors for depression. The individualized predictive histogram model based on this model has good resolution and accuracy，and can be widely used in the prediction of other clinical diseases.
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Colorectal cancer is one of the most common malignant tumors. Myeloperoxidase (MPO), as an oxidase in neutrophils lysosomes, plays an important role in activating carcinogenic gene intermediates and enhancing exogenous carcinogenesis. It can stimulate oxidative stress reaction in vivo by producing hypochlorite, reactive oxygen species and other oxidants, and induce gene instability factors such as DNA damage, mutation, mismatch repair and so on, which leads to the occurrence and development of colorectal cancer. MPO single nucleotide polymorphism (SNP) is related to the genetic susceptibility of cancer. Mpors 2333227-463G>A can reduce the risk of colorectal cancer. Therefore, the research on MPO, MPO-463G>A will provide new ideas and strong evidence for early detection, prevention, disease assessment and targeted treatment of colorectal cancer.
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Objective To investigate the influence of combined drug therapy by intratracheal infusion on clinical prognosis of premature infants with severe respiratory distress syndrome (RDS). Methods One hundred and twenty-eight premature infants with severe RDS were chosen in the period from August 2015 to December 2017 in central hospital of Hebei Handan and randomly divided into 2 groups including control group (64 children) treated with pulmonary surfactant (PS) by intratracheal infusion and experimental group (64 children) treated with PS and budesonide by intratracheal infusion. The invasive ventilation time, withdrawal time, total hospitalization time, the levels of blood oxygen index before and after treatment and the complications incidence of two groups were compared. Results The invasive ventilation time, withdrawal time and total hospitalization time in experimental group were significantly shorter than those in control group:(3.50 ± 0.72) d vs.(4.84 ± 0.98) d, (29.52 ± 3.97) d vs. (35.21 ± 5.10) d, (45.26 ± 6.27) d vs. (53.85 ± 8.04) d, and there were significant differences (P<0.05). The levels of blood oxygen index after treatment of experimental group were significantly better than those of control group (P < 0.05). The incidence of total bronchopulmonary dysplasia(BPD), retinopathy, necrotizing enterocolitis, pulmonary hemorrhage, sepsis, intracranial hemorrhage and ventilator-associated pneumonia (VAP) in two groups had not significant differences (P>0.05). But the moderate to severe BPD in experimental group was significantly lower than that in control group: 15.63％(10/64) vs. 45.31％(29/64), P < 0.05. Conclusions Combinated drug therapy by intratracheal infusion in the treatment of premature infants with severe RDS can efficiently promote disease recovery process, improve the lung function and be helpful to prevent the moderate and severe degree BPD.
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Objective:To probe the therapeutic effects of Butylphthalide Injection in the elderly patients with acute cerebral infarction (ACI) and its influence in cerebral hemodynamics and cerebral vascular reserve (CVR),and to clarify the pharmacological action mechanism of butylphthalide in treatment of ACI.Methods:A total of 100 cases of elderly patients with ACI were selected as the subjects and divided into observation group and control group according to the serial number on admission.Fifty cases were included in each group.The patients in control group were treated with the conventional treatment, while the patients in observation group were treated with Butylphthalide Injection on the basis of the conventional treatment.The National Institute of Health Stroke Scale (NIHSS) score, the brain hemodynamics indexes of the peak velocity (Vp), the mean velocity (Vm) and the differences of the velocity (DVp, DVm) as well as pulsatility index (PI), CVR of bilateral middle cerebral artery (MCA)of the patients in two groups were observed and compared.The therapeutic effects of the patients in two groups were evaluated and compared.Results:The NIHSS score of the patients in observation group after treatment was significantly lower than that in control group (t=15.420, P<0.05).The therapeutic effects and the clinical efficiency of the patients in observation group were significantly better than those in control group (U=2.225, χ2=5.005, P<0.05).The Vp and Vm of the patients in observation group after treatment were significantly higher than those in control group(t=10.819,t=7.259, P<0.05)and the DVp and DVm were significantly lower than those in control group (t=16.438,t=19.055, P<0.05).The CVR of the patients in observation group after treatment was significantly higher than that in control group(t=6.884, P<0.05)and the PI was significantly lower than that in control group (t=4.979, P<0.05).Conclusion:Butylphthalide Injection can effectively correct the abnormality of brain hemodynamics in the ACI patients, enhance the ability of body in maintaining the stability of cerebral vascular perfusion, improve the neurological symptoms in the patients with ACI, and improve the therapeutic effects.
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Objective To investigate the effect of clinical pathway on inpatients for rehabilitation. Methods The hospital expense, the ex-pense for medicine and length of stay in hospital were compared in patients with cerebral hemorrhage, cerebral infarction, spinal cord injury and spastic cerebral palsy before (January 1st, 2012 to April 30th, 2013) and after (May 1st, 2013 to December 31st, 2015) clinical pathway implementation, 50 inpatients for each disease, totally 200 patients. Results The length of stay in hospital reduced after of clinical pathway implementation, in all the diseases (t>5.226, P0.05). Conclusion The implementation of rehabilitation clinical pathway can reduce the length of stay in hospital for the patients rehabilitation in hospital, without increasing their cost.
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Objective To evaluate the effect of training for therapists based on Kirkpatrick's Four-level Model. Methods Totally 39 ther-apists who completed 2014 Beijing Clinical Shortage of Manpower Training Programs (Therapist) were investigated with Kirkpatrick's Four-level Model, named reaction, learning, behavior and results. Results For reaction level, the total satisfaction was high, but different with the degree of education, especially in the items of Participate in Training, Type of Cases, Organizing on Practice Training, Organizing Case Discussions and Get A Lot of Benefits from the Training (F>4.59, P9.53, P4.44, P<0.001). For results level, eleven therapists passed the rehabilitation therapist test, two therapists participated in some researches, and one published an article. Conclusion The thera-pists satisfied in the training, that may improve the ability of therapists to contribute to their organization.
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Objective To investigate the effect of urinary kallidinogenase on serum concentrations of hydrogen sulfide (H2S),neuron-specific enolase (NSE),and S100β in patients with cerebral infarction (CI).Methods From June 2011 to June 2014,80 patients with CI were chosen as study objectives.All patients were divided into two groups:40 patients in study group (urinary kallidinogenase group),and 40 patients in control group.The death rate,the rate of complication and National Institute of Health Stroke Scale (NIHSS) were compared between two groups.The concentrations of H2S,NSE,and S100βwas compared between two groups.Results In study group,the death rate was 5.00％ (2/40),the rate of complication was 22.50％ (9/40);in control group,the death rate was 12.50％ (5/40),the rate of complication was 15.00％ (6/40);and no significant significance was found between two groups (P ＞ 0.05).The NIHSS was (11.2 ± 3.2) in the study group,and (15.7 ± 2.7) in the control group,with statistically significant difference between two groups (P ＜ 0.05).After treatment,the concentrations of H2 S,NSE,and S100β of two groups were decreased significantly (P ＜0.05).At 1w,2w,and 3w,the concentrations of H2S,NSE and S100βhad statistically significant difference between two groups (P ＜ 0.05).Conclusions Urinary kallidinogenase has a cerebral protective effect,which can decrease the concentration of H2S,and increase the concentrations of NSE and S100βin CI patients.
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A lot of important information were hidden in mass LIS data.Data mining technology can find useful data from multiple dimensions,providing information support for clinical diagnosis and treatment.This paper described the newly gained features of the laboratory medicine in the era of big data and analyzed the potential application of data mining in laboratory medicine.
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Objective To explore the methods of training for therapists. Methods The students participated in 2014 Beijing Clinical Shortage of Manpower Training Programs (Therapist) by Beijing Quality Control and Improvement Center of Medical Rehabilitation accept-ed theoretical and operating training and tests. They were interviewed for the situation of training program. Results 39 students had complet-ed the training with the average age of (28.41±6.05) years. The average scores of theory test was (76.23±5.70), and it was (87.18±8.00) of operation. The score of theory test was more than that before the training (P<0.01). From interview, a total of 59 recommendations were ob-tained, which focused on the quality of training of training provider and the support from sending institutes. Conclusion Beijing Clinical Shortage of Manpower Training Programs (Therapist) has improved the academic and operative level of therapists.
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@#Objective To explore the methods of training for therapists. Methods The students participated in 2014 Beijing Clinical Shortage of Manpower Training Programs (Therapist) by Beijing Quality Control and Improvement Center of Medical Rehabilitation accepted theoretical and operating training and tests. They were interviewed for the situation of training program. Results 39 students had completed the training with the average age of (28.41±6.05) years. The average scores of theory test was (76.23±5.70), and it was (87.18±8.00) of operation. The score of theory test was more than that before the training (P<0.01). From interview, a total of 59 recommendations were obtained, which focused on the quality of training of training provider and the support from sending institutes. Conclusion Beijing Clinical Shortage of Manpower Training Programs (Therapist) has improved the academic and operative level of therapists.
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Objective: To evaluate the intervention effect of clinical pharmacists in hypertension chronic disease management. Methods:All the patients with hypertensive chronic diseases from Ziyang community, Xingan Street, Beilun district were involved in the study. Combined with community doctors, clinical pharmacists provided pharmaceutical care for the patients, such as regular face-to-face medication guide, telephone communication, home follow-up, special lectures on health and so on. The cognitive level, blood pressure control level and medication compliance were statistically analyzed and compared before and after the pharmacy intervention. Results:After the intervention of clinical pharmacists, the level of hypertension cognition and the level of antihypertensive drug under-standingof the patients was improved significantly (P<0. 05 or 0. 01), the level of blood pressure control and medication compliance of the patients were improved significantly (P<0. 01), and unscheduled outpatient rate, emergency rate, hospitalization rate and fre-quency were decreased (P<0. 05 or 0. 01). Conclusion: Pharmacy intervention carried out by clinical pharmacists for the patients with hypertension chronic diseases can provide reasonable medication security and improve the quality of life, and the pharmacy inter-vention mode for the hypertension chronic disease management is worthy of promotion.
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Objective To explore clinical value of detection of carcinoembryonic antigen(CEA) ,cytokeratin 19 fragment(CY-FRA21-1) and neuron specific enolization enzyme(NSE) in pleural effusion and serum during the differential diagnosis and patho-logical classification of lung cancer .Methods 180 patients with pleural effusion were divided into two groups ,one including 55 be-nign pleural effusion cases(benign pleural effusion group) and the other including 125 lung cancer cases(lung cancer group) .CEA , NSE and CYFRA21-1 in pleural effusion and serum of two groups were measured ,respectively ,and the measure results between two groups were conducted .Results CEA ,NSE and CYFRA21-1 levels in lung cancer group were significantly higher than those in benign pleural effusion group(P<0 .05) .CEA levels in pleural effusion and serum in lung adenocarcinoma group were significantly higher than those in benign pleural effusion group ,lung squamous carcinoma group and small cell lung cancer group(P<0 .05) .CY-FRA21-1 levels in pleural effusion and serum in lung squamous carcinoma group were significantly higher than those in benign pleu-ral effusion group ,lung adenocarcinoma group and small cell lung cancer group(P<0 .01) .NSE levels in pleural effusion and serum in small cell lung cancer group were significantly higher than those in benign pleural effusion group ,lung adenocarcinoma group and lung squamous carcinoma group(P< 0 .01) .The positive detection rate of CEA in lung adenocarcinoma group was significantly higher than that in lung squamous carcinoma group and small cell lung cancer group(P<0 .05) .The positive detection rate of CY-FRA21-1 in lung squamous carcinoma group was significantly higher than that in lung adenocarcinoma group and small cell lung cancer group(P<0 .05) .The positive detection rate of NSE in small cell lung cancer group was significantly higher than that in lung squamous carcinoma group and lung adenocarcinoma group(P<0 .01) .Conclusion CEA ,CYFRA21-1 and NSE in pleural effusion and serum are specific tumor markers of lung adenocarcinoma ,lung squamous carcinoma and small cell lung cancer ,respectively , which may have a certain clinical significance for the differential diagnosis and pathological classification of lung cancer .
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Objective To establish a high-performance induction culture system for Raw264.7 cells to differentiate into osteoclasts(OC)invitro by improving the cell culture program.Methods The Raw264.7 cells were cultured withα-MEM medium containing 50 μg · L-1 M-CSF, 100 μg · L-1 RANKL, and 1 × 10-8 mol · L-1 1α,25-(OH)2 D3 in 5% CO2 for 12 d at 37℃. The cells were digested transiently every time before the medium was changed after every three days. The morphologic changes of the Raw264.7 cells were observed by inverted microscope.The maturation and phagotrophic function of OC were identified by HE,TRAP,FITC-phalloidin staining and immunofluorescence.Results The cells remained to grow in single layers all the time in most areas of the well during the whole induction by the improved culture program. The observation results of inverted microscope and HE staining showed that the growth area of the polykaryotic OC reached to 70% of the well on day 1 2. FITC-phalloidin staining showed that in the maturation of the OC, the cluster-shaped podosomes in the pseudopodia gradually transformed into rings,which finally fused to form a large belt surrounding the periphery of the cytoplasm. The calcitionin receptor (CTR) expressed by OC was markedly enhanced compared with the precursor cells by immunofluroescence staining,and a large number of red granules appeared in the cytoplasm of OC with TRAP staining on day 1 2. These results comfirmed that the obtained OC were maturated and owned phagotrophic function. Conclusion A high-performance induction culture system for Raw264. 7 cells to differentiate into OC in vitro induced by combination of 50μg · L-1 M-CSF, 100 μg · L-1 RANKL,and 1 × 10-8 mol·L-1 1α,25-(OH)2 D3 is established by improving the cell culture program.
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An increasing body of evidence shows that the lipid droplet, a neutral lipid storage organelle, plays a role in lipid metabolism and energy homeostasis through its interaction with mitochondria. However, the cellular functions and molecular mechanisms of the interaction remain ambiguous. Here we present data from transmission electron microscopy, fluorescence imaging, and reconstitution assays, demonstrating that lipid droplets physically contact mitochondria in vivo and in vitro. Using a bimolecular fluorescence complementation assay in Saccharomyces cerevisiae, we generated an interactomic map of protein-protein contacts of lipid droplets with mitochondria and peroxisomes. The lipid droplet proteins Erg6 and Pet10 were found to be involved in 75% of the interactions detected. Interestingly, interactions between 3 pairs of lipid metabolic enzymes were detected. Collectively, these data demonstrate that lipid droplets make physical contacts with mitochondria and peroxisomes, and reveal specific molecular interactions that suggest active participation of lipid droplets in lipid metabolism in yeast.
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Animales , Ratas , Línea Celular , Prueba de Complementación Genética , Metabolismo de los Lípidos , Lípidos , Microscopía Electrónica de Transmisión , Microscopía Fluorescente , Mitocondrias , Metabolismo , Células Musculares , Metabolismo , Músculo Esquelético , Biología Celular , Metabolismo , Proteínas Oncogénicas , Genética , Metabolismo , Peroxisomas , Metabolismo , Plásmidos , Unión Proteica , Mapeo de Interacción de Proteínas , Métodos , Proteínas Recombinantes de Fusión , Genética , Metabolismo , Saccharomyces cerevisiae , Factores de Transcripción , Genética , Metabolismo , Transformación GenéticaRESUMEN
@#Objective To investigate the effect of long-term cardiac rehabilitation on risk factors with doctor supervision after percutaneous coronary intervention(PCI). Methods One hundred and twelve patients after PCI were divided into the cardiac rehabilitation group(56 cases) and the control group (56 cases). All of the patients were given medication and health education, meanwhile the cardiac rehabilitation group received 4～6 weeks hospitalized cardiac rehabilitation program and one year ambulatory cardiac rehabilitation with doctor supervision. Risk factors were assessed six mouths and twelve mouths after the treatment. Results The risk factors except diastolic blood pressure and body weight index improved more significantly in the cardiac rehabilitation group than in the control group. Clinical event in the cardiac rehabilitation group is lower than in the control group. Conclusion Long-term cardiac rehabilitation with doctor supervision is safe, efficiency and good compliance to improve risk factors of coronary heart disease after PCI except diastolic blood pressure and weight management.
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@# Objective To identify the incidence and risk factors associated with urinary tract infection in spinal cord injured patients who accepted sterile intermittent catheterization. Methods 243 patients with spinal cord injury were analysed retrospectively. Results The overall incidence of urinary tract infection was 0.93 episodes per 100 person-days. The risk factors associated with urinary tract infection were age older than 40, frequent exposure to antibiotics, cervical injury, score of functional independence measure less than 71 and bladder dysfunction. The independence risk factors were cervical injury, score of functional independence measure less than 71 and bladder dysfunction. Conclusion High level spinal cord injured patients with lower function and bladder dysfunction are higher risk for urinary tract infection.
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Purpose: In order to explore the clinical mechanism of Neiguan (PC 6) in the treatment of acute seizure of migraine and the relationship between Neiguan (PC 6) and cerebral blood flow. Methods: Clinically, 30 cases of the patients with acute seizure of migraine (ascending phase) were selected, in TCD abnormality, and divided randomly into the treatment group and control group, 15 cases in each group. In acute seizure of migraine, Neiguan (PC 6)was punctured with electric stimulation on the healthy side of the patients in the treatment group and Xuehai (SP 10) was punctured with electric stimulation on the healthy side of the patients in the control group. TCD was determined in the patients 30 min before and after the treatment. Results and conclusion: After transdermal electric stimulation on Neiguan (PC 6),the velocity of intracranial blood flow was obviously slowed down, indicating that transdermal electric stimulation on Neiguan (PC 6) can effectively relieve the spasm of intracranial blood vessels and also shows its relative specificity.
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Objective To observe the therapeutic effect of reformed subhibernation therapy on status epilepticus in patients with severe viral encephalitis.Methods 96 children with severe viral encephalitis complicated by status epilepticus were randomly divied into control group and experimental group.Control group: routine treatment was given that includes anticonvulsivus,ice compress and conventional therapy.The anticonvulsivus was applied in five drugs: the same doses of wintermin and phenergan mixed up,10% chlorpromazine hydrochloride,luminal,valii,the drugs were delivered when convulsion occurred otherwise not.Experimental group: in addition to routine treatment reformed subhibernation therapy was given.The anticonvulsivus drug's was delivered in return each 4-6 h according to the drugs half life.And anticonvulsivus drugs were applied for 2 d then gotten off.The clinical manifestation,auxiliary examination and therapeutic efficacy of patients in two groups were observed.Results All of 96 cases were analyzed.The lotal effective rate in experimental group is higher than that in control group(?2=5.872,P
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@#目的了解目前康复医学进修人员的状况,为各医院选派进修人员提供依据。方法对我院1994—2001年687名康复医学进修人员的进修专业、职称等资料进行分析。结果进修人员呈逐年上升趋势,多分布在物理治疗科、作业治疗科等康复治疗科室,以初级职称为主。结论医院应对选派人员的进修专业统筹考虑,并注意人才梯队建设。