Progress on nutritional assessment and nutritional support for liver transplant recipients / 器官移植

Patients with end-stage liver disease after liver transplantation constantly suffer from malnutrition due to primary diseases and transplantation-related factors. Malnutrition will worsen clinical condition of the patients, increase the incidence of complication, length of hospital stay and medical expense after transplantation, and lower the survival rate. Sufficient nutritional support at all stages of liver transplantation is of significance. Accurate assessment of nutritional status and timely intervention are prerequisites for perioperative nutritional treatment in liver transplantation. In this article, the latest nutritional risk screening indexes and evaluation tools, nutritional support methods and other perioperative nutritional intervention measures for liver transplantation were reviewed, aiming to deepen the understanding and cognition of perioperative nutritional therapy for liver transplantation and provide reference for improving nutritional status and clinical prognosis of liver transplant recipients.

Action research of creative expression therapy for older adults with mild cognitive impairment / 中华护理杂志

Objective To establish the standard paths of creative expression cognitive intervention program for Chinese older adults with mild cognitive impairment(MCI).Methods Thirty MCI older adults received creative expression cognitive program twice per week for six weeks.The action research process was implemented through plan,action,observation and reflection to constantly modify and improve the paths.The Montreal cognitive assessment scale(MoCA),daily living activity scale(ADL),self-made creative story-telling therapy activity observation table and feedback form were used to evaluate the effects of program.Results The standard paths of the creative expression cognitive intervention program for Chinese older adults with MCI were established through the action research method.There were no significant differences in MoCA and ADL before and after intervention(P＞0.05).The attending intention,attention,expression ability,communication skills,participant levels,enjoyment had been significantly improved through this program (P＜0.05).Patients believed that the creative storytelling was able to stimulate their creativity and expression ability,help them attain more social support and trust,thus they would be more willing to involve and cooperate in developing group activities.Conclusion The creative expression cognitive intervention activity is an effective and feasible non-pharmacological treatment for Chinese older adults with MCI.It provides an economical,convenient,easy to implement,and higher participatory nursing suitable technology for elderly service industry.

Effects of health education using therapeutic lifestyle changes method in a population with dyslipidemia / 中华健康管理学杂志

Objective This study evaluated the effects of health education promoting therapeutic lifestyle changes in a population with dyslipidemia. Methods Patients with dyslipidemia were randomly assigned to one of four groups: the current group (CG) received conventional health guidance, the educational course (EC) group attended six lectures as part of an educational course, the phone call (PC) group received twice-monthly follow-up by telephone,and the comprehensive group(EC+PC)attended both the educational course and received follow-up telephone calls. Total cholesterol (TC), total triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein (HDL-C), and the knowledge, attitude, and behavior (KAP) score for blood lipids were compared within each group and among groups. Results A total of 214 patients were enrolled and completed the study: 62 patients in CG,49 patients in EC,56 patients in PC,and 47 patients in EC+PC.There were significant differences in the EC,PC,and EC+PC groups after the 24-week intervention. For example, pre- and post-intervention values for each group were as follows:EC group:(5.74±0.69)mmol/L and(5.14±0.87)mmol/L for TC,35.22±1.67 and 42.96±5.72 for KAP;PC group:(5.63±0.58)mmol/L and(5.22±1.07)mmol/L for TC, 34.54.±0.97and 39.41±5.03 for KAP;EC+PC group:(5.60±0.48)mmol/L and(4.00±0.79)mmol/L for TC,35.44±1.80 and 45.05±3.19 for KAP, respectively (P<0.05). The CG group showed no significant differences before and after treatment:(5.66±0.54)vs.(5.32±1.28)mmol/L for TC,34.37±0.65 vs.35.28±4.02 for KAP(P>0.05).In a comparison among the four groups,the EC and PC groups showed greater improvements than the CG group.Moreover, the EC+PC group showed statistically significant differences in the results compared with the other three groups (P< 0.05). Conclusion An educational course combined with telephone follow-up calls was more effective than a single intervention in improving blood lipids and enhancing the health awareness of patients with dyslipidemia.This combined health education model not only improves the effectiveness of treatment to some degree,but also plays a role in its supervision and management.Furthermore,it may also assist in the implementation of continuous nursing services in medical institutions.

Bone mineral density change in patients with hyperthyroidism after 131I therapy: a Meta-analysis / 中华核医学与分子影像杂志

Objective To review the influence of 131I therapy on bone mineral density (BMD) in patients with hyperthyroidism.Methods Published articles of prospective randomized controlled study,clinical controlled study or case-control study on BMD change in patients with hyperthyroidism after 131I therapy were selected from PubMed,the Excerpta Media Database (Embase),Cochrane library,Chinese Journal Full-text Database,Wanfang Database,Vip Database and Chinese Biomedical Literature Database.Data from the date of database establishment to October 2015 were all reviewed.The languages were restricted to English and Chinese.Meta-analysis was performed with RevMan 5.3.Results Thirteen trials with a total of 668 hyperthyroidism patients were included.The meta-analysis showed that BMD of the lumbar spine,hip joint,femoral neck and osteocalcin were significantly improved after 131I therapy.The weighted mean difference (WMD) for BMD of the lumbar spine was 0.07 (95％ CI:0.04-0.11),P=0.O00 2;that of the hip joint and the femoral neck was 0.13(95％ CI:0.09-0.16) and 0.05(95％ CI:0.03-0.06),respectively(both P＜0.01).The standardized mean difference (SMD) of osteocalcin was-1.20(95％ CI:-1.43--0.97) with P＜0.01.Furthermore,the improvements were time dependent within the 2 years' follow-up.Conclusions 131I therapy improves the BMD and osteocalcin in patients with hyperthyroidism in a time dependent manner within 2 years' follow-up.

Effect of low concentrations of p,p′- dichlorodipheny ltrichloroethane on proliferation and apoptosis of coIorectal adenocarcinoma SW620 cells / 中国药理学与毒理学杂志

OBJECTIVE To investigate the effect and mechanism of low concentrations of p,p′-dichlorodiphenyltrichloroethane (p,p′-DDT) on colorectal adenocarcinoma SW620 cell proliferation and apoptosis. METHODS SW620 cells were exposed to low concentrations of p, p′-DDT ranging from 1×10-12 to 1×10-6 mol.L-1 for 48 and 96 h. MTT assay was employed to examine the effect of p,p′-DDT on SW620 cell viability. Different cell stages of cycle and apoptosis rate were determined by flow cytometry after SW620 cells were exposed to 1×10-10 , 1×10-9 and 1×10-8 mol.L-1 for 96 h. Western blotting was used to determine the protein expression of Wnt/ β-catenin signaling components 〔β-catenin, phospho-β-catenin and phospho-glycogen synthase kinase ( GSK) 3β〕, their downstream target proteins ( c-Myc and cyclin D1)and apoptosis related proteins (Bcl-2, Bax, procaspase 8 and procaspase 3). RESULTS The viability of colorectal adenocarcinoma SW620 cells was significantly increased after exposure to low concentrations of p,p′-DDT ranging from 1×10-12 to 1×10-7 mol.L-1 for 96 h. p,p′-DDT 1×10-10 , 1×10-9 and 1×10-8 mol.L-1 exposure led to a decreased percentage of SW620 cells in G1 stage(P<0.01) along with an increased percentage of cells in S stage(P<0.01). Meanwhile, the apoptosis rate was signifi-cantly decreased compared with control group ( P < 0. 01). Exposure to p, p′-DDT from 1 × 10-10 to 1×10-8 mol.L-1 induced upregulation of phospho-GSK3β ( Ser9), β-catenin, c-Myc and cyclin D1 in SW620 cells( P <0.01). Moreover, apoptosis related proteins Bcl-2, procaspase 8 and procaspase 3 were unregulated(P<0.01), and Bax level and caspase 3 activity were decreased in p,p′-DDT-stimulated cells(P < 0.01). CONCLUSION Low concentrations of p, p′-DDT exposure activates Wnt/ β-catenin signaling and affects apoptosis-related proteins, which may be involved in p,p′-DDT-induced cell prolifer-ation as well as suppression of cell apoptosis in SW620 cells.

Efficacy and safety of vitamin D3 in patients with diabetic nephropathy: a meta-analysis of randomized controlled trials / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Several studies found that vitamin D3 might alter glucose metabolism, protect kidney from injury and even proposed the mechanisms. But results from previous studies have been conflicting. The aim of this study was to evaluate the efficacy and safety of vitamin D3 in patients with diabetic nephropathy. The underlying mechanism of vitamin D3 decreasing proteinuria is also discussed.</p><p><b>METHODS</b>We conducted a search of English and Chinese articles using database of Pubmed, Embase, Sinomed, CNKI, Wanfang and clinical trial register centers, for randomized controlled trials of vitamin D3 in diabetic nephropathy patients. Two reviewers performed independently. Meta-analysis was used when studies were homogeneous enough.</p><p><b>RESULTS</b>Twenty studies, including 1 497 patients with diabetic nephropathy, were involved in this systemic review. Vitamin D3-treated patients with diabetic nephropathy had a statistically significant reduction in 24-hour proteinuria (weighted mean difference -0.44, 95% CI -0.54 to -0.34, Z = 8.80, P < 0.000 01) and urine albumin/creatine ratio (standardized mean difference -0.29, 95% CI -0.48 to -0.10, Z = 2.96, P = 0.003). But vitamin D3 supplementation did not significantly reduce blood pressure and hemoglobin A1c compared with control group. The potential mechanisms about the renal protection of vitamin D3, including the inhibition of rennin-angiotensin system, the protection of kidney from inflammation, fibrosis and the structure change of kidney are discussed. In addition, vitamin D3 did not significantly increase the incidence of adverse effects, including total adverse effects, gastrointestinal adverse effects and fluctuation of blood pressure.</p><p><b>CONCLUSIONS</b>Vitamin D3 can ameliorate proteinuria and protect kidney from injury in patients with diabetic nephropathy. This renoprotective effect is independent of blood pressure and glucose reduction. And it does not increase any adverse effects than control, even in combination therapy with angiotensin converting enzyme inhibitors/angiotensin receptor blockers. But due to the limited randomized controlled trials of high quality, more clinical researches should be taken in the future.</p>

A multi-center, randomized, double-blind and controlled study of BP180NC16a enzyme-linked immu-nosorbent assay (BP180NC16a-ELISA) in the diagnosis of bullous pemphigoid / 中华皮肤科杂志

Objective To evaluate the sensitivity and specificity of BP180NC16a-ELISA in the diagnosis of bullous pemphigoid (BP). Methods A multi-center, randomized, double-blind, parallel-controlled study was conducted. Sera were collected from 106 patients with clinically confirmed active BP and 106 control subjects including patients with non-BP bullous diseases, scleroderma, psoriasis or systemic lupus erythematosus,late pregnant women and healthy blood donors. BP180NC16a-ELISA was performed on these sera. The IgG antibody levels measured by ELISA kit were compared with those measured by indirect immunofluorescence (IIF) test. Results Of the 106 BP sera, 81 were positive for BP180NC16a-ELISA with a sensitivity of 76.4%,83 for ⅡF test with a sensitivity of 78.3%. Among the 106 control serum samples, 95 were negative for BP180NC16A-ELISA with a specificity of 89.6%, and 102 for ⅡF test with a specificity of 96.2%. There was no significant difference between the two tests in dignostic sensitivity and specificity for BP (both P ＞ 0.05).Conclusion BP180NC16A-ELISA may serve as an adjuvant tool for the diagnosis of BP.

Evaluation of desmoglein 1 enzyme-linked immunosorbent assay in the detection of serum antibodies in patients with pemphigus foliaceus / 中华皮肤科杂志

Objective To evaluate the performance of desmoglein (Dsg)1 enzyme-linked immunosorbent assay (ELISA) in the detection of serum antibodies in patients with pemphigus foliaceus (PF). Methods Sera were obtained from 80 patients with PF and 132 human controls including 33 patients with bullous pemphigoid, 3 patients with linear IgA bullous dermatosis, 2 patients with acquired bullous epidermolysis, 20 patients with systemic lupus erythematosus (SLE), etc, and subjected to a random and blind test by Dsg1 ELISA and indirect immunofluorescence (IIF) on monkey oesophagus. Results The Dsg1 ELISA was positive in 75 (93.8%) patients with PF and 5 (3.8%) human controls (including 1 case of bullous pemphigoid, 1 case of SLE, 1 case of dermatomyositis, 1 case of eczema and 1 normal human control with indeterminate value), and IIF was positive in 71 (88.8%) patients with PF, but in none of the controls. The sensitivity and specificity was 93.8% (95% CI: 0.85 - 0.98) and 96.2% (95% CI: 0.91 - 0.99) respectively for Dsg1 ELISA in the serodiagnosis of PF, 88.8% (95% CI: 0.82 - 0.96) and 100% (95% CI: 0.96 - 1.00) respectively for IIF. There was no statistical difference in the sensitivities (P= 0.289) or specificities (P= 1.000) between the two test methods.Conclusions Dsg1 ELISA is a simple, sensitive and specific serological detection method, and can serve as an adjunct in the diagnosis of PF.

Skin cancer and precancerous skin lesions:clinical analysis of 632 cases / 中华皮肤科杂志

Objective To investigate the clinical features of skin cancer.Methods Clinical data of skin cancer and precancerous skin lesions confirmed pathologically from 2005 to 2008 in Peking University First Hospital were retrospectively analyzed by using statistical methods.Results A total of 632 cases of skin cancer and precancerous skin lesions were studied.The most common skin cancer was basal cell carcinoma and squamous cell carcinoma (invasive and in situ) which accounted for 29.3%and 24.2%,respectively.The average age at onset was older than 60 years in 55.4%of the patients,between 35 and 59 years in 34.3%,younger than 35 years in 10.3%.The concordance between clinical and pathological diagnosis reached nearly 90.O%for Paget's disease,70.0% for other common skin cancer and precancerous skin lesions.Conclusions Skin cancer and precancerous skin lesions have a predilection for scalp and face.Patients aged from 35 to 59 years account for a significant proportion not only in cutaneous lymphoma but also in melanoma and epithelium-derived nonmelanoma skin cancer.

A Preliminary Study on the Antibody Secreted in Castleman's Disease Associated with Paraneoplastic Pemphigus / 中华皮肤科杂志

Objective To identify features of antibodies in the supernatants of cultured Castleman's disease cells.Methods Lymphocytes of Castleman's disease were isolated and cultured.Immunofluorescence and immunoblot assays were performed with IgG extracted from culture supernatants.The immunoglobulin heavy chaingene of cultured tumor B cells was analyzed by RT-PCR,cloning and sequencing.ResultsIg Gextracted from culture supernatant scouldattachtotheepithelialcellsurfacesofmousebladdertissues.Theantibodycouldalsoidentifytwoantigencomponents,210000and190000,ofnormalhumanepidermaltis-sues.ThesequencesimilaritywasfoundinimmunoglobulinheavychaingeneofculturedtumorBcellscom-paredwiththatof6patientswithCastleman'sdiseasepreviouslyreported.Conclusions Castleman's tumor associated with paraneoplastic pemphigus can secret autoantibody with similar features to that found in patients'sera.

Prenatal diagnosis of Hallopeau-Siemens recessive dystrophic epidermolysis bullosa / 中华皮肤科杂志

Objectives To identify the COL7A1 gene mutation in a recessive dystrophic epidermolysis bullosa (RDEB) family, and to perform prenatal diagnosis in the patient's offspring. Methods The genomic DNA, obtained from the patient and his wife, was used to screen all 118 exons of the type VII collagen gene (COL7A1) via polymerase chain reaction (PCR) followed by direct DNA sequencing of the PCR products. Fetal DNA was extracted from amniotic fluid of the patient's wife at the 15th week of gestation. PCR, direct DNA sequencing and restriction fragment length polymorphisms (RFLPs) were performed for prenatal diagnosis. Results The patient in this study was a compound heterozygote for a S48P missense mutation in exon 2 and an 11 base pair deletion (3625del11) leading to a premature termination codon (PTC) in exon 27, which are a novel combination of COL7A1 mutations in RDEB. The COL7A1 genotype of his wife was normal. In the fetus, the same deletion of 11 base pair (3625del11) was found in exon 27, but no mutation was found in exon 2. Thus, the fetus was predicted to be a clinically normal child with a carrier genotype. Seven months later, a clinically unaffected male infant was born and the prediction was confirmed. Conclusion We successfully performed the first DNA-based prenatal diagnosis in China in a family with Hallopeau-Siemens RDEB.

Expression of Desmoglein 1 and 2 in Different Epidermal Tumors / 中华皮肤科杂志

Objective To evaluate the relationship between desmosome-related proteins and epidermal tumors. Methods Using anti-desmoglein 1 and 2 monoclonal antibodies, expression of desmoglein 1 and 2 was examined by an immunohistochem ical staining method in various epidermal tumors such as squamous cell carcinoma (SCC), actinic keratosis(AK), keratoacanthoma(KA) and seborrhoeic keratosis(SK). Results Desmoglein 1 and 2 were strongly expressed in intercellular space of wh ole epidermis in normal human skin. Expression of desmoglein 1 and 2 was markedl y reduced or absent in SCC cells. Compared with normal epidermal cells, expressi on of desmoglein 1 and 2 was equal to or reduced,with complete absence of stain ing in dysplastic areas in AK cells. Extensive pericellur staining of desmoglein 1 and 2 was found in KA and SK cells, similar to that observed in normal epider mis. Conclusion Expression of desmoglein 1 and 2 is markedly reduced or absent i n human malignant epidermal cancers, reduction of these molecules may contribute to invasiveness and metastasis of epidermal carcinomas.