RESUMEN
Objective To explore the prognostic factor and its predictive value of patients with Wilson disease-related acute-on-chronic liver failure(WD-ACLF).Methods The clinical data of 70 patients diagnosed as WD-ACLF admitted to the Department of Encephalopathy of the First Affiliated Hospital of Anhui University of Chinese Medicine from January 1,2017 to January 1,2022 were retrospectively collected.According to the 12-week prognosis,patients were divided into survival group(n=36)and death group(n=34).The data of the two groups were analyzed by univariate and multivariate logistic analysis to screen the prognostic risk factors and evaluate their predictive value.The model coefficient is omnibus tested,and the model-fitting degree is evaluated by the Hosmer-Lemeshow test.ROC curve was used to analyze the prognostic value for WD-ACLF between the new model and chronic liver failure-sequential organ failure assessment(CLIF-SOFA)score,model for end-stage liver disease(MELD)score and Child-Turcotte-Pugh(CTP)score.Results A total of 70 WD-ACLF patients were enrolled in present study,including 36 cases in survival group[22 males and 14 females with median age of 30.0(17.3,40.0)]and 34 cases in death group[25 males and 9 females with median age of 34.0(28.8,41.0)].Univariate analysis showed that the course of disease,prothrombin time(PT),activated partial thromboplastin time(APTT)were shorter in survival group than that in death group,the white blood cells(WBC),international normalized ratio(INR),aspartate transaminase(AST),total bilirubin(TBIL),blood urea nitrogen(BUN),creatinine(Cre)and ceruloplasmin(CER)levels and the proportion of infection,ascites,and upper gastrointestinal bleeding were lower in survival group than those in death group,however,the proportion of infection,ascites and upper digestive bleeding in the survival group were lower than those in the death group.Meanwhile,the red blood cells(RBC),hemoglobin(Hb),Na+ and total cholesterol(TC)level in the survival group were higher than those in the death group(P<0.05 or P<0.01).The results of multivariate logistic regression analysis showed that disease course(OR=1.176,95%CI 1.043-1.325),INR(OR=7.635,95%CI 1.767-32.980),TBIL(OR=1.012,95%CI 1.003-1.021),and upper gastrointestinal bleeding(OR=11.654,95%CI 1.029-131.980)were independent risk factors affecting the prognosis of WD-ACLF(P<0.05).Based on the results of logistic regression analysis,a joint model for predicting the prognosis of WD-ACLF was established.The AUC of the model for evaluating the prognosis of WD-ACLF was 0.941,which was greater than the CLIF-SOFA score(AUC=0.802),MELD score(AUC=0.897),and CTP score(AUC=0.722).Conclusions The course of disease,TBIL,INR,and upper gastrointestinal bleeding are risk factors that affect the prognosis of WD-ACLF.The prognosis model established based on this can more accurately predict the prognosis of WD-ACLF patients,and its predictive value is superior to CLIF-SOFA score,MELD score,and CTP score.
RESUMEN
Objective:To explore the application of BOPPPS combined with TBL teaching method in orthopaedic practice teaching.Methods:A total of 101 students majoring in Clinical Medicine who practiced in the Department of Orthopaedics of our hospital from Jan 2020 to Sep 2022 were selected.They were randomly divided into two groups.The control group(n=51)adopted the traditional teaching method and the experimental group(n=50)adopted BOPPPS combined with TBL teaching method.The scores of theory and skill operation,the evaluation and satisfaction of teaching methods between the two groups were compared.Results:The scores of theory and skill operation in the test group were significantly higher than those in the control group(P＜0.01).The experimental group was more effective in improving the ability of autonomous learning,the ability of asking questions,the ability of communication,the ability of analyzing problems,the ability of teamwork,the ability of expression,the ability of clinical thinking,and the ability of problem-solving than those in the control group(P＜0.05).The students'satisfaction with the teaching method of the experimental group was also higher than that of the control group(P＜0.05).Conclusion:The combination of BOPPPS and TBL teaching methods in orthopaedic practice teaching can improve the teaching effectiveness and the satisfaction of students.
RESUMEN
Objective:To study cerebral oxygen metabolism and cerebral blood flow in etomidate and sevoflurane anesthesia effects of perfusion and postoperative delusions.Methods:A prospective study was used. The 96 elderly patients who underwent elective spinal surgery in Guang′anmen Hospital, China Academy of Chinese Medical Sciences from March 2020 to May 2021 were selected as the study subjects. All patients were divided into sevoflurane group and etomidide group by random numbers table, each with 48 cases. The sevoflurane group was treated with sevoflurane inhalation for analgesia, with etomidate intravenous-controlled analgesia in the etomidate group. The recovery time of spontaneous respiratory, wake time, awake extubation time, numerical rating score (NRS; 1, 3, 6, 12, 24 and 48 h), incidence of postoperative delusion, internal jugular vein oxygen saturation (SjvO 2) were recorded. Arteriovenous oxygen content (AVDO 2) and cerebral oxygen intake rate (CERO 2) were calculated. The peak cerebral artery constriction rate (Vs-MCA), diastolic velocity (Vd-MCA) and mean flow rate (Vm-MCA) pre-induction of anesthesia (T 0), loss of consciousness (T 1), after fentanyl injection (T 3), endotracheal intubation (T 4), 30 min (T 5), 60 min (T 6) and postoperative (T 7) were recorded. Results:There were no significant differences in the recovery time of spontaneous breathing, wake time and awake extubation time between the two groups ( P>0.05). The resting NRS in sevoflurane group at 1, 3, 6, 12, 24 and 48 h after operation were (1.27 ± 0.12), (2.13 ± 0.22), (3.26 ± 0.23), (3.29 ± 0.22), (2.52 ± 0.11) and (2.02 ± 0.11) points, respectively. Etomidate group was (1.27 ± 0.13), (2.02 ± 0.21), (2.13 ± 0.13), (2.11 ± 0.26), (2.08 ± 0.17) and (1.02 ± 0.17) points, respectively. The results of repeated measurement ANOVA showed that there was significant difference in NRS between the two groups ( P<0.05). There were significant differences in postoperative resting NRS between the two groups at different time points ( P<0.05). The incidence of postoperative delusion in etomidate group was lower than that in sevoflurane group: 4.17% (2/48) vs. 16.67% (8/48), and the difference was statistically significant ( P<0.05). Postoperative SjvO 2 in sevoflurane group and etomidate group was higher than that before surgery: (69.96 ± 4.17)% vs. (58.26 ± 4.16)%, (61.22 ± 4.19)% vs. (58.25 ± 4.17)%. In addition, both AVDO 2 and CERO 2 were lower than those before operation: (60.23 ± 5.22)% vs. (64.22 ± 4.17)%, (50.23 ± 6.19)% vs. (64.23 ± 4.19)%, (37.22 ± 6.23)% vs. (40.23 ± 5.16)%, (31.26 ± 5.17)% vs. (40.27 ± 4.18)% ( P<0.05), postoperative SjvO 2 in etomidate group was higher than that in sevoflurane group, and AVDO 2 and CERO 2 were lower than that in sevoflurane group. The difference was statistically significant ( P<0.05). The results of repeated measurement ANOVA showed that there were statistically significant differences in cerebral blood perfusion indexes of Vs-MCA, Vd-MCA and Vm-MCA between the two groups ( P<0.05). There were statistically significant differences in Vs-MCA, Vd-MCA and Vm-MCA between two groups at different time points ( P<0.05). There were significant differences in Vs-MCA, Vd-MCA and Vm-MCA between the two groups at different time points ( P<0.05). Conclusions:Compared with sevoflurane, etomidate can reduce the postoperative delusion rate, improve cerebral oxygen metabolism and reduce cerebral blood flow perfusion.
RESUMEN
Objective To explore the clinical characteristics and treatment scheme of patients with spinal infection caused by Prevotella intermedia(P.intermedia).Methods Clinical diagnosis and treatment processes of a patient with spinal infection caused by P.intermedia admitted to the spinal surgery department of a hospital were summa-rized,and relevant literature was retrieved from database for reviewing.Results The patient,a 50 year old male,was admitted to the hospital due to"lumbago pain complicated with pain in double lower extremities for 2 months".The lesion tissue was taken for metagenomic next-generation sequencing(mNGS)detection,which detected P.in-termedia,and the patient was diagnosed with P.intermedia spondylitis.After treatments with open lesion clea-rance,tube rinsing+autologous bone transplantation fusion internal fixation,intravenous drip of ceftriaxone sodium and metronidazole,as well as metronidazole rinsing,infection was under control.A total of 16 available papers were retrieved,together with this case,a total of 17 patients were included,with 7 males and 10 females.The main risk factors were diabetes and history of corticosteroid use(35.3％).The most common invasion sites were lumbar ver-tebra(n=12)and thoracic vertebra(n=6).13 cases were positive for pathogen culture,3 cases were positive for molecular detection,and 1 case was positive for staining microscopy.17 patients received anti-anaerobic bacteria treatment,with 14 cases receiving combined surgical treatment.One case died,with a mortality of 5.9％;5 cases had partial neurological impairment,with a disability rate of 29.4％.The survival rate of patients who received treatment of anti-anaerobic bacteria combined with surgery was 92.8％,3 patients only with anti-anaerobic bacteria treatment but without surgery were all cured.Conclusion P.intermedia is an opportunistic pathogeanic bacteria which often causes infection in immunocomprised individuals and is prone to be misdiagnosed.It is recommended to perform mNGS detection to identify the pathogen as early as possible and seize the opportunity for treatment to reduce mortality.
RESUMEN
Objective To evaluate the value of miniprobe endoscopic ultrasound(EUS)in guiding endoscopic treatment of small-diameter(maximum diameter less than 1 cm)and low-grade(G1 grade)rectum neuroendocrine neoplasm(R-NEN),and to provide evidence and clues for its clinical application and further research.Methods The clinical data of 85 cases of low-grade(G1 grade)R-NEN with a maximum diameter of less than 1 cm who underwent endoscopic treatment in our center from January 2014 to December 2020 were retrospectively analyzed.The patients were divided into the EUS group(37 cases)and control group(48 cases)according to whether EUS was performed before endoscopic treatment.The positive rate of incision margin,the incidence of complications,the recurrence rate,the hospital stay,the cost of hospitalization and endoscopic therapy were compared between the two groups.Results The positive rate of incision margin in the EUS group was significantly lower than that in control group(P<0.05).There was no significant difference in the incidence of complications,tumor recurrence rate,hospital stay or hospital costs between the two groups(P>0.05).There was statistically significant difference in the endoscopic therapy between the two groups(P<0.05).Conclusion Evaluating the lesion depth of small-diameter and low-grade(G1 grade)R-NEN before surgery by miniprobe EUS and selecting endoscopic surgery according to its results of can significantly reduce the residual risk of resection margin tumors.
RESUMEN
Objective:To explore the expression of long non-coding RNA(lncRNA)ZIM2-AS1 in hepatocellular carcinoma(HCC)and its clinical significance as well as diagnostic value using the data obtained from the Cancer Genome Atlas(TCGA).Meth-ods:The transcriptome sequencing(RNA-seq)data and clinical information of 374 HCC tissues and 50 paired paracancerous tissues were gathered from the TCGA database,then the expression trends of ZIM2-AS1 in HCC and its correlation with clinicopathological features,prognosis,immune cell infiltration,as well as diagnostic value was inspected by bioinformatics analysis using relevant R packages.The expression of ZIM2-AS1 in human normal liver cell line and HCC cell lines was examined by qRT-PCR.Results:The ex-pression of ZIM2-AS1 was highly expressed in HCC tissues(P<0.001),and its expression level was significantly correlated with age,gender,N stage,histologic grade and AFP level(P all<0.05).The overall survival(OS)and disease specific survival(DSS)of patients with high ZIM2-AS1 expression were significantly shorter than those of patients with low expression(P<0.05),and ZIM2-AS1 was an in-dependent risk factor affecting OS.Immune cell infiltration analysis showed that ZIM2-AS1 was closely related to the infiltration of Th2 cells,CD56brightNK cells,follicular helper T cells(Tfh),neutrophils and plasmacytoid dendritic cells(pDC)(|Spearman's r|>0.1,P<0.05)in HCC.ROC curve analysis revealed that the expression level of ZIM2-AS1 possesse potential diagnostic value in HCC,N0 stage,histologic grade G1 and G2,OS and DSS(AUC all>0.50).qRT-PCR results showed that the expression level of ZIM2-AS1 in HCC cell lines was significantly higher than that in human normal liver cells(P all<0.05).Conclusion:The elevated expression of lncRNA ZIM2-AS1 is an independent risk factor for poor prognosis of HCC patient and has potential application value as a biomarker for HCC diagnosis,prognosis as well as tumor immune microenvironment assessment.
RESUMEN
Objective To quickly analyze and identify the chemical constituents in Zhuangxi-6 powders by HPLC-Q-Exactive-MS.Methods The separation was performed on Shim-pack GIST C18 column(150 mm×4.6 mm,5 μm)with the mobile phase of methanol-0.1%formic acid aqueous solution(gradient elution).The flow rate was 0.35 mL/min,column temperature was 35℃,and the volume of sample injection was 10 μL.Electrospray ionization was applied for scanning under positive and negative ion modes with the scanning range of m/z 110-1 200.Results Combining mass spectrometry data and literature information,a total of 65 components were identified in Zhuangxi-6 powders,including 16 alkaloids,11 flavonoids,14 organic acids,6 chromones,7 sesquiterpenoids,4 fatty acids,3 amino acids,2 tannins,1 phenolic acids,and 1 phenylpropanoid.Conclusion HPLC-Q-Exactive-MS method can quickly identify the chemical components of Zhuangxi-6 powders,laying a foundation for the further research on the pharmacodynamics substances of Zhuangxi-6 powders.
RESUMEN
Purpose To establish a nomogram based on conventional ultrasound combined with contrast-enhanced ultrasound(CEUS)for predicting the probability of cervical central lymph node metastasis(CLNM)in clinical lymph node-negative(CN0)papillary thyroid carcinoma(PTC)patients.Materials and Methods A retrospective study was performed on 359 patients with single CN0 PTC,all of whom underwent thyroid surgery and prophylactic central compartment neck dissection in the First Affiliated Hospital of Shihezi University from September 2015 to March 2022.According to the postoperative pathological results,there were 116 cases with CLNM(+)and other 243 cases with CLNM(-).The indicators of gender,age,conventional ultrasound and CEUS were recorded,and multivariate stepwise Logistic regression was performed to screen out risk predictors to construct prediction models for CLNM in CN0 PTC.The receiver operating characteristic curves of prediction models were drawn,and the area under the curve(AUC)was further compared.The preferable prediction model was selected to establish the risk probability nomogram,and the prediction performance and clinical applicability of the nomogram model were assessed.Results Multivariate analysis showed that gender,age,the maximum diameter of nodule,capsule invasion and enhancement pattern on CEUS were risk factors for CLNM in CN0 PTC(all P<0.05).The AUC of prediction model 1 including the above five indicators was 0.753,and the AUC of prediction model 2 excluding CEUS indicator was 0.704.There were statistically significant difference in AUCs between the two models(Z=2.473,P=0.013).Prediction model 1 was selected to construct a risk probability nomogram for predicting CLNM in CN0 PTC.The nomogram had a C-index of 0.753 and showed well consistency on the calibration curve.Clinical decision curve analysis indicated that the nomogram could achieve ideal net benefit when the threshold probability was between 10.7%to 81.5%.Conclusion Gender,age,the maximum diameter of nodule,capsule invasion and enhancement pattern on CEUS may be the risk predictors for CLNM in CN0 PTC.The nomogram model based on the above indicators can predict the probability of CLNM effectively,and the CEUS indicators can substantially improve the prediction performance of the model.
RESUMEN
Objective:To identify the risk factors for 1-year death after surgery in elderly patients with hip fractures and evaluate the accuracy of the prediction model based on LASSO-logistic regression analysis.Methods:A case-control study was conducted on elderly patients (age ≥65 yr) who underwent surgical treatment for hip fractures in the Second Affiliated Hospital of Wenzhou Medical University from January to December 2019. Patients were divided into death group and survival group according to their survival status at 1-year after surgery. General data and preoperative laboratory indicators were obtained. The variables were selected by utilizing LASSO regression and incorporated into multivariate logistic regression analysis to identify the risk factors for 1-year death after surgery in elderly patients with hip fractures. Then a prediction model was established based on the results and evaluated.Results:There were 63 patients in death group and 564 in survival group. The results of LASSO regression and multivariate logistic regression analysis showed that age, preoperative cognitive dysfunction, Chalson comorbidity index ≥3 points and preoperative serum prealbumin level were the independent risk factors for 1-year death after surgery in elderly patients with hip fractures ( P<0.05). The area under the receiver operating characteristic curve of the prediction model was 0.788 (95% confidence interval [0.731-0.846]), with the sensitivity and specificity of 76.2% and 68.6% respectively. The average absolute error of the calibration curve was 0.007. The results of Hosmer-Lemeshow goodness-of-fit test showed that there was no significant difference between the predicted value and actual observed value ( χ2=5.065, P=0.751). Decision curve analysis showed that patients had a high net benefit rate when the threshold probability range was 0-0.7. Conclusions:Age, preoperative cognitive dysfunction, Chalson comorbidity index ≥3 points and preoperative serum prealbumin level are the independent risk factors for 1-year death after surgery in elderly patients with hip fractures, and the prediction model developed based on LASSO-logistic regression has high accuracy.
RESUMEN
Objectives:Analyze the clinical characteristics of patients with primary antiphospholipid syndrome (PAPS) progressing to systemic lupus erythematosus (SLE).Explore the risk factors for the progression from PAPS to SLE.Methods:The clinical data of 262 patients with PAPS enrolled in Peking Union Medical College Hospital from February 2005 to September 2021 were evaluated. Assessments included demographic data, clinical manifestations, laboratory tests (serum levels of complement, anti-nuclear antibodies, anti-double-stranded DNA antibodies), treatment, and outcomes. Kaplan-Meier analysis was used to calculate the prevalence of SLE in patients with PAPS. Univariate Cox regression analysis was employed to identify the risk factors for PAPS progressing to SLE.Results:Among 262 patients with PAPS, 249 had PAPS (PAPS group) and 13 progressed to SLE (5.0%) (PAPS-SLE group). Univariate Cox regression analysis indicated that cardiac valve disease ( HR=6.360), positive anti-double-stranded DNA antibodies ( HR=7.203), low level of complement C3 ( HR=25.715), and low level of complement C4 ( HR=10.466) were risk factors for the progression of PAPS to SLE, whereas arterial thrombotic events ( HR=0.109) were protective factors ( P<0.05 for all). Kaplan-Meier analysis showed that the prevalence of SLE in patients suffering from PAPS with a disease course>10 years was 9%-15%. Hydroxychloroquine treatment had no effect on the occurrence of SLE in patients with PAPS ( HR=0.753, 95% CI 0.231-2.450, P=0.638). Patients with≥2 risk factors had a significantly higher prevalence of SLE compared with those with no or one risk factor (13-year cumulative prevalence of SLE 48.7% vs. 0 vs. 6.2%, P<0.001 for both). Conclusions:PAPS may progress to SLE in some patients. Early onset, cardiac-valve disease, positive anti-dsDNA antibody, and low levels of complement are risk factors for the progression of PAPS to SLE (especially in patients with≥2 risk factors). Whether application of hydroxychloroquine can delay this transition has yet to be demonstrated.
RESUMEN
AIM To analyze the component composition of Xeriga-4 Powder,and to determine the contents of phellodendrine,chlorogenic acid,gardenoside,berberine,rutin and curcumin.METHODS The high performance liquid chromatography-Q-exactive orbitrap mass spectrometry(HPLC-Q-Exactive-MS)qualitative analysis was performed on a 35℃thermostatic Agilent ZORBAX SB-Aq column(4.6 mm×150 mm,5 μm),with the mobile phase comprising of methanol-0.1%formic acid flowing at 0.35 mL/min in a gradient elution manner,and electron spray ionization source was adopted in positive and negative ion scanning.High performance liquid chromatography tandem mass spectrometry(HPLC-MS/MS)quantitative analysis was performed on a 35℃thermostatic Shim-pack GIST-HP C18 column(2.1 mm×100 mm,3 μm),with the mobile phase comprising of methanol-0.1%formic acid flowing at 0.25 mL/min in a gradient elution manner,and electron spray ionization source was adopted in positive and negative ion scanning with multiple reaction monitoring mode.RESULTS Total 65 constituents were identified,containing 19 alkaloids,13 organic acids,13 flavonoids,7 curcumins,6 iridoids,4 fatty acids,2 aldehydes,and 1 amino acid.Six constituents showed good linear relationships within their own ranges(r≥0.999 1),whose average recoveries were 96.44%-102.37%with the RSDs of 2.05%-3.74%.CONCLUSION This study can provide a reference for the quality control for Xieriga-4 Powder.
RESUMEN
AIM To identify the chemical components of Longmu Qingxin Mixture by UPLC-Q-TOF-MS and study its material basis for the treatment of attention deficit hyperactivity disorder.METHODS The sample was detected by mass spectrometry in positive and negative ion mode on a Waters CORTECS? UPLC? T3 chromatographic column.The data were analyzed with Peakview 1.2 software and matched with the Natural Products HR-MS/MS Spectral Library 1.0 database,and the components were identified in combination with literature reports.The material basis of Longmu Qingxin Mixture for the treatment of attention deficit hyperactivity disorder was analysed according to the identified components.RESULTS Forty chemical components were identified,including 11 flavonoids,6 monoterpene glycosides,4 triterpene saponins,3 phenolic acids,6 alkaloids etc.,which mainly derived from Radix Astragali,Radix Paeoniae Alba,Radix Scutellariae,licorice root,Ramulus Uncariae cum,etc.,baicalein,formononetin,astragaloside Ⅳ and rhynchophylline may be the material basis for the therapeutic effect of Longmu Qingxin Mixture.CONCLUSION UPLC-Q-TOF-MS can quickly identify the chemical components of Longmu Qingxin Mixture.Flavonoids,triterpene saponins and alkaloids may be the material basis for Longmu Qingxin Mixture for the treatment of attention deficit hyperactivity disorder,which can provide the basis for its material basis research,quality standard establishment and pharmacological study of the dismantled formula.
RESUMEN
AIM To study the chemical constituents from the twigs of Aglaia perviridis Hiern and their total antioxidant and neuroprotective activities.METHODS The 95%ethanol extract from the twigs of A.perviridis were isolated and purified by silica gel,ODS and semi-preparative HPLC,then the structures of obtained compounds were identified by physicochemical properties and spectral data.The antioxidant and neuroprotective activities were evaluated by T-AOC kit and MTT assay,respectively.RESULTS Twenty-one compounds were isolated and identified as 3-epicotillol(1),syringic acid(2),palmitic acid(3),di-N-pentyl phthalate(4),ethyl-4-hydroxyphenylacetate(5),7-hydroxy-6-methoxycoumarin(6),1-octanol(7),p-hydroxyphenylacetic acid(8),(+)-syringaresinol-4-O-β-D-glucopyranoside(9),(+)-episyring-4-O-β-D-glucopyranoside(10),methy-4-hydroxyphenylacetate(11),koaburaside(12),byzantionoside B(13),quercetin 3-O-α-L-rhamnopyranoside(14),(2R,3R)-(+)-glucodistylin(15),(2S,3S)-(-)-glucodistylin(16),(+)-lyoniresinol-3α-O-β-D-glucopyranoside(17),(+)-isolariciresinol-9'-O-β-D-glucopyranosidede(18),(-)-lyoniresinol-3α-O-β-D-glucopyranoside(19),phlorizin(20),β-sitosterol(21).The total antioxidant capacity of compounds2,9-10,14-20 was 10.300-38.367 U/(mmol·L-1).The neuroprotective effects of compounds 2,10 and 17 were concentration-dependent,and the optimal concentrations of compounds 9 and 15 were 50,100 μmol/L,respectively.CONCLUSION Compounds 1-20 are isolated from this plant for the first time.Compounds 2,9-10,14-20 have strong total antioxidant activities.Compounds 2,9-10,15,17 have neuroprotective activities.
RESUMEN
Objective @#To explore the risk factors for intracardiac thrombosis in dilated cardiomyopathy (DCM) pa- tients and to construct , validate , and evaluate a nomogram prediction model based on these factors .@*Methods @#88 patients diagnosed with DCM and complicated with intracardiac thrombus , and 544 patients without intracardiac thrombus were included . The participants were randomly divided into training and validation sets at a ratio of 7 ∶ 3 . U sing both univariate and multivariate Logistic regression analyses , independent risk factors for intracardiac thrombosis in DCM patients were identified . A nomogram prediction model was constructed using R software . The model ’s validity and performance were assessed using the receiver operating characteristic (ROC) curve , the Hos- mer-Lemeshow goodness-of-fit test , calibration curve , and decision curve . @*Results @#The binary Logistic regression analysis showed that age , atrial fibrillation , left ventricular end-diastolic diameter ( LVEDD) , brain natriuretic peptide ( BNP) , and β-blockers were independently associated with intracardiac thrombosis in DCM patients . Based on these five factors , a nomogram was constructed and validated . The area under the ROC curve for the training set was 0. 823 (95% CI: 0. 760 ~ 0. 887) and 0 . 803 (95% CI: 0 . 705 ~ 0 . 901) for the validation set , in- dicating a good discriminative ability. The Hosmer-Lemeshow test results for the calibration curve were ( χ2 = 6. 679 , P = 0. 572) for the training set and ( χ2 = 2 . 588 , P = 0. 958) for the validation set , indicating a good fit between predicted and ob served outcomes . The decision curve showed a high net clinical benefit in the threshold range of 0. 05 ~ 0. 92 . @*Conclusion @#Based on age , atrial fibrillation , LVEDD , BNP , and β-blockers , the nomo- gram prediction model exhibits good discriminative and calibration abilities , and high clinical benefit. It can effec- tively guide clinicians in early intervention of risk factors , reducing the risk of intracardiac thrombosis in DCM pa- tients .
RESUMEN
Objective @#To compare the ultrasound signs of symptomatic joint lesions in rheumatoid arthritis (RA) and gouty arthritis ( GA) , musculoskeletal ultrasound ( MSUS) was utilized. @*Methods @#A retrospective analysis was performed for 85 hospitalized patients with RA and 55 hospitalized patients with GA in the same period , and the differences in general data , diseased joints and ultrasound signs between the two groups were compared. @*Results@#The gender, age and diseased joints of the two groups were statistically significant (all P < 0. 05) . The detection rate of knee joint lesions was the highest; the RA group had high sensitivity , high specificity of meniscal injury , and high diagnostic efficiency of bone erosion , while the diagnostic performance of the three combined ultrasound signs of punctate strong echo , double track sign and tophi in the GA group was higher than that of any individual diagnosis , and the sensitivity and specificity were also higher. The course of disease in the RA group was positively correlated with bone erosion (P < 0. 05) , and the course in the GA group was positively correlated with tophi (P < 0. 05) .@*Conclusion @#The ultrasound signs of RA and GA are different , and MSUS has good value in the diagnosis and differential diagnosis of the two.
RESUMEN
End stage heart failure(ESHF) is the terminal stage of heart failure in patients with heart failure, or refractory heart failure. heart transplantation(HT) and mechanical circulatory assistance represented by ventricular assist device(VAD) are the main treatments for circulatory support in patients with ESHF. However, the serious shortage of donors has restricted the extensive development of HT. VAD technology, represented by left ventricular assist device(LVAD), has developed rapidly, and the 2-year survival rate after surgery has approached of HT. Although LVAD support can directly alleviate symptoms of left heart failure, it only partially relieves symptoms of right heart failure, resulting in high readmission rates.Therefore, more precise monitoring and regulation of right heart function in LVAD recipients is key to improving long-term prognosis. This article aims to provide an overview of strategies for the regulation of right heart function in patients after LVAD implantation.
RESUMEN
Objective:To analyze the resilience level and influencing factors of tertiary public general hospitals in Hunan province under the background of major emergencies, so as to provide reference for the construction of resilient hospital and improvement of emergency response ability.Methods:Fifty tertiary public general hospitals in Hunan province that participated in the performance evaluation of national tertiary public hospitals were selected as research samples. The data was sourced from the performance evaluation management platform of public hospitals from 2019 to 2021. The DEA-Malmquist model was used to analyze the static and dynamic efficiency, hospital resilience index model was constructed based on the efficiency indicators, the entropy weight TOPSIS method was used for comprehensive evaluation, and the influencing factors of hospital resilience were analyzed by one-way ANOVA and logistic stepwise regression method.Results:From 2019 to 2021, the average technical efficiency values of tertiary public general hospitals in Hunan province were 0.861, 0.749 and 0.810. The total factor productivity in 2020 decreased by 12.3% compared with that in 2019, the total factor productivity in 2021 increased by 8.3% compared with 2020, and the total factor productivity in 2021 decreased by 5.7% compared with that in 2019. In the context of major emergencies, the hospital resilience index of tertiary public general hospitals in Hunan province was 0.557, and the hospital resilience index of super-scale hospitals and hospitals under the National Health Commission was relatively high, with indexes of 0.647 and 0.715, respectively. The logistic stepwise regression model included three indicators: the number of medical staff with senior professional titles, the proportion of minimally invasive surgery and the average length of stay, and the OR values were 1.005, 1.261 and 0.406, respectively. Conclusions:The efficiency of tertiary public general hospitals in Hunan province needs to be improved, and the resilience level of hospitals under the background of major emergencies is not enough. The hospital resilience index is a useful attempt to evaluate the resilience of hospitals, and can be used as a policy management tool for continuous improvement of health emergency. It is suggested that the tertiary public general hospitals in Hunan province should promote the construction of resilient hospitals from the aspects of emergency talent reserve, research and application of key core technologies, and optimization of operational efficiency management concepts and mechanisms.
RESUMEN
Heart failure combined with pulmonary infection is characterized by heart-lung qi deficiency， spleen-kidney yang deficiency， and deficiency of both qi and yin as the the root of disease； lung heat， phlegm heat， and blood stasis as the manifestation of disease. Thus， clearing， dispersing， supplementing， and transforming as the main treatment methods were proposed. “Clearing” refers to the method of clearing heat to release the exterior， clearing heat from the ying level to relieve heat， and clearing heat and cooling blood， based on the degree of differentiation of pathogenic heat and stagnation of qi and blood； “dispersing” mainly refers to the method of diffusing the lung and dredging the bowels； “supplementing” refers to the method of relieving fever with sweet-warm medicinals， nourishing yin and tonifying qi， and warming yang and transforming qi； “transforming” refers to the method of resolving phlegm and dampness， invigorating blood and dissolving stasis according to different pathological factors.
RESUMEN
【Objective】 To elucidate the possible role of arginine and histidine in the pathogenesis of schizophrenia by exploring the serum levels of semi-essential amino acids (arginine and histidine) in patients with schizophrenia and their correlation with psychiatric symptoms. 【Methods】 We selected 72 inpatients with schizophrenia admitted to The First Affiliated Hospital of Xi’an Jiaotong University from March 2021 to October 2022 and 72 healthy volunteers enrolled in Yanta Community during the same period as the research subjects. Serum arginine and histidine levels were measured in patients with schizophrenia and healthy controls using serum liquid chromatography-mass spectrometry (LC-MS). We used the Positive and Negative Symptom Scale (PANSS) to evaluate the mental symptoms of patients with schizophrenia and analyzed the correlation of serum arginine and histidine levels with disease course, frequency of onset, and PANSS score. 【Results】 The levels of serum arginine (P<0.001) and histidine (P=0.011) in the schizophrenia group were significantly lower than those in the control group. The levels of serum arginine and histidine were significantly negatively correlated with the frequency of onset (rs=-0.410, rs=-0.262), total score of PANSS (rs=-0.298, rs=-0.256), positive factors (rs=-0.299, rs=-0.234) and cognitive impairment factors (rs=-0.251, rs=-0.296). In addition, serum arginine levels had significantly negative correlation with anxiety and depression factors (rs=-0.269, P<0.05). 【Conclusion】 The serum levels of arginine and histidine in patients with schizophrenia are significantly lower than those in healthy individuals, and are negatively correlated with overall mental symptoms, severity of positive symptoms and cognitive impairment. The severity of anxiety and depression symptoms is negatively correlated with arginine levels. The detection of serum arginine and histidine can provide reference for the diagnosis and assessment of the severity of schizophrenia in the future.
RESUMEN
Objective:To analyze the clinical characteristics of patients with inflammatory bowel disea-ses(IBD)in pre-pregnancy,pregancy and loctation.Methods:The clinical data of pregnancy compli-cated with IBD in Department of Obstetrics and Gynecology of Peking University Third Hospital and deli-very from September 2011 to June 2022 were collected.The clinical characteristics of the patients were analyzed retrospectively.According to the state of diseases during pre-pregnancy,pregnancy and lactation,the patients were divided into active and remission group,and the two groups were compared interms of pre-pregnancy counseling,nutritional status,pregnancy and delivery complications,gestational week,mode of delivery,and neonatal outcome.Results:A total of 33 pregnant women with IBD were included in this study,of which 7 delivered a second child,for a total of 40 deliveries,with 36 natural pregnan-cies(90.0％)and 4 assisted reproductions(10.0％).Among the 40 cases,21 cases(52.5％)were sustained in remission in pre-pregnancy,pregnancy and lactation,and 19 cases(47.5％)in disease ac-tivity,of which 8 cases(42.1％)were due to self-withdrawal of drugs or failure to take medicine regu-larly.Compared with the activity group,the disease remission group had a higher rate of pre-pregnancy counseling(57.1％vs.15.8％,P=0.010),and higher levels of hemoglobin[(112.67±8.53)g/L vs.(102.84±5.23)g/L,P＜0.001],serum total protein[(66.58±6.34)g/L vs.(60.83±6.25)g/L,P=0.006],serum albumin[36.4(35.1,38.3)g/L vs.34.3(31.1,35.6)g/L,P=0.006],se-rum calcium[(2.25±0.10)μmol/L vs.(2.13±0.15)μmol/L,P=0.004],but a lower incidence of gestational hypertensive disorders(0 vs.31.6％,P=0.007).In 40 deliveries,there were 27 cases of vaginal delivery(67.5％),13 cases of cesarean section(32.5％).The analysis of neonatal outcomes showed 38 full-term deliveries and 2 preterm deliveries;1 case of macrosomia,1 case of small-for-gesta-tional-age,1 case of low birth weight and 3 cases of birth defects.There were 10 newborns admitted to neonatal intensive care unit,including 4 cases of neonatal infections and 2 cases of neonatal jaundice.Conclusion:Pre-pregnancy counseling and evaluation of IBD patients are very important,and good preg-nancy outcomes can be obtained through careful management during pregnancy in the most of the pa-tients.