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This study investigated the Australian healthcare system, TCM policies, and the current situation of TCM practitioners, TCM education and TCM academic groups in Australia. Based on analysis of TCM services data released by Australian Government Department of Health and Aged Care, Australian Bureau of Statistics and Australian Health Practitioner Regulation Agency, this article summarized the recent development of TCM in Australia and drew inspiration. Australia has established a relatively sound management mechanism for TCM, in which the overall development of TCM practitioners is good, and the activities of TCM education institutions and academic groups are promoting the localization of TCM in Australia. In order to further promote the overseas development of TCM, it is necessary to gradually form a standardized system for international education of TCM and apply it in other countries. The construction of Sino-foreign TCM hospitals should be explored to enhance the influence of TCM. To keep up with the time, it is necessary to take more communication effort on "Generation Z".
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Background Air quality health index (AQHI) is derived from exposure-response coefficients calculated from air pollution and morbidity/mortality time series, which helps to understand the overall short-term health impacts of air pollution. Objective To study the effects of common air pollutants on respiratory diseases in Urumqi and to develop an AQHI for the risk of respiratory diseases in the city. Methods The daily outpatient volume data of respiratory diseases from The First Affiliated Hospital of Xinjiang Medical University, meteorological data (daily mean temperature and daily mean relative humidity), and air pollutants [fine particulate matter (PM2.5), inhalable particulate matter (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon dioxide (CO), and ozone (O3)] in Urumqi City, Xinjiang, China were collected from January 1, 2017 to December 31, 2021. A distributed lag nonlinear model based on quasi-Poisson distribution was constructed by time-stratified case crossover design. Adopting zero concentration of air pollutants as reference, the exposure-response coefficient (β value) was used to quantify the impact of included air pollutants on the risk of seeking medical treatment for respiratory diseases, and the AQHI was established. The association of between AQHI and the incidence of respiratory diseases and between air quality index (AQI) and the incidence of respiratory diseases was compared to evaluate the prediction effect of AQHI. Results Each 10 µg·m−3 increase in PM10, SO2, NO2, and O3 concentrations presented the highest excess risk of seeking outpatient services at 3 d cumulative lag (Lag03) and 2d cumulative lag (Lag02), with increased risks of morbidity of 0.687% (95%CI: 0.101%, 1.276%), 17.609% (95%CI: 3.253%, 33.961%), 13.344% (95%CI: 8.619%, 18.275%), and 4.921% (95%CI: 1.401%, 8.502%), respectively. There was no statistically significant PM2.5 or CO lag effect. An AQHI was constructed based on a model containing PM10, SO2, NO2, and O3, and the results showed that the excess risk of respiratory disease consultation for the whole population, different genders, ages, or seasons for each inter-quartile range increase in the AQHI was higher than the corresponding value of AQI. Conclusion PM10, SO2, NO2, and O3 impact the number of outpatient visits for respiratory diseases in Urumqi, and the constructed AQHI for the risk of respiratory diseases in Urumqi outperforms the AQI in predicting the effect of air pollution on respiratory health.
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Objective To investigate the family aggregation of human hookworm infections in Sichuan Province and to identify its influencing factors, so as to provide insights into management of hookworm infections. Methods Three to four counties (districts) were sampled from basins, hilly regions and mountainous regions around the basins in Sichuan Province from 2017 to 2022 as fixed survey sites, and 17 to 30 counties (districts) were selected as mobile survey sites. At least 1 000 permanent residents at ages of 3 years and older were sampled from each survey site, and hookworm eggs were detected in human stool samples using the Kato-Katz technique. Subjects with 2 and more family members and at least 2 individuals diagnosed with hookworm infections in the county (district) where they lived were selected, and the familial aggregation of hookworm infections was analyzed using the test of goodness of fit for binomial distribution. In addition, the knowledge and practice of hookworm disease control were investigated among residents in Hejiang County and Wutongqiao District, Leshan City, Sichuan Province in 2021 and 2022, and the difference in the knowledge and practice of hookworm disease control was compared between members with and without familial aggregation of hookworm infections. Results A total of 66 812 residents from 25 196 households were sampled from main endemic areas of hookworm diseases in Sichuan Province from 2017 to 2022 for detection of hookworm infections, and 4 403 infections were identified (6.59% prevalence). The distribution of human hookworm infections in Sichuan Province did not fit the binomial distribution, and showed family aggregations (χ2 = 2 116.759, P < 0.001). Family aggregation of human hookworm infections was found in endemic areas with 1% and higher prevalence of human hookworm infections (χ2 = 136.006 to 428.738, all P values < 0.001), and family aggregation of human hookworm infections was identified in different years (χ2 = 87.615 to 471.838, all P values < 0.001) and in different terrains of endemic areas (χ2 = 8.423 to 1 144.176, all P values < 0.001). The members with hookworm infections had median eggs per gram of 180 (interquartile range, 780) in aggregated families and 72 (102) in non-aggregated families (Z = −2.686, P < 0.05). The proportion of members in families with aggregation of hookworm infections who knew the preventive measures of hookworm disease was significantly lower than in non-aggregated families (24.49% vs. 51.72%; χ2 = 10.262, P < 0.05), and the proportion of members in families with aggregation of hookworm infections who often worked barefoot on the ground was significantly higher than in non-aggregated families (30.61% vs. 13.25%; χ2 = 6.289, P < 0.05). Conclusions There is a familial aggregation of human hookworm infections in Sichuan Province, and awareness of preventive measures for hookworm disease and frequent working barefoot on the ground are associated with familial aggregation of hookworm infections.
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Objective @#To analyze the incidence characteristics and trends in pulmonary tuberculosis in the Hotan prefecture , before and after the epidemic , and to provide a reference basis for the formulation and evaluation of tuberculosis prevention and control measures in the Hotan prefecture . @*Methods @#The Hotan prefecture ’s pulmonary tuberculosis incidence data was collected between 2015 and 2021 . Joinpoint regression (JPR) model and Interrupted Time Series (ITS) model were established to explore the incidence trend of pulmonary tuberculosis , as well as the impact of COVID-19 prevention and control measures in Xinjiang on the incidence trend in Hotan , respectively. Furthermore , an analysis of variations in incidence among different age and gender subgroups was carried out. @*Results@#The results of the JPR model showed that from 2015 to 2021 , the reported incidence rate of pulmonary tuberculosis in the Hotan prefecture initially increased and then decreased , with a turning point appearing in December 2018 . The incidence rate in males was slightly higher than that in females , and the turning point and incidence trend were consistent with the overall trend . Among all age subgroups , those ≥60 age group had the highest incidence rate , with the trend also showing an initial increase followed by a decrease . A turning point in the incidence rate for the under 18 age group appeared in June 2021 , yet the trend was not statistically significant (P > 0. 05) .The turning points in the 19 - 59 age group and in those aged ≥60 were consistent with the overall trend . The results of the ITS model showed that the incidence rate of pulmonary tuberculosis in the Hotan prefecture significantly decreased since January 2020 , dropping from 319. 28 per 100 000 in 2019 to 155 . 88 per 100 000 in 2021 , a decrease of 51 . 16% year-on-year , with a monthly average reduction of 0. 049 per 100 000 .@*Conclusion @# In 2018 ,Xinjiang province integrated tuberculosis screening into the universal health checkup for the entire population ,which led to the identification of numerous cases of tuberculosis . In the Hotan prefecture , the reported incidence of pulmonary tuberculosis peaked in December 2018 and then started to decline . Under the impact of COVID-19 isolation measures in Xinjiang , the reported incidence rate showed a notable decrease starting in January 2020 . Reiterating preventive measures and remaining watchful for the possible appearance of latent tuberculosis patients is crucial as the pandemic fades .
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ObjectiveTo sort out the historical evolution, prescription evolution and modern clinical application of Huagaisan. MethodHuagaisan and its synonym Huagaitang are used as keywords to search the databases of Traditional Chinese Medicine Think Tank, Chinese Medical Dictionary, Airusheng Chinese Medical Database and China National Knowledge Infrastructure(CNKI). According to the inclusion and exclusion criteria, we obtained the information of ancient books and modern clinical research literature related to Huagaisan, and systematically reviewed and analyzed the historical origin, prescription composition, preparation method, dosage, efficacy, medicinal material origin, processing method and modern clinical application of Huagaisan. ResultA total of 198 pieces of ancient book information were included, involving 93 ancient Chinese medicine books. Huagaisan was composed of fried Perillae Fructus, red Poria, fried Mori Cortex, Citri Eoxcarpium Rubrum, stir-fried Armeniacae Semen Amarum, Ephedrae Herba and fried Glycyrrhizae Radix et Rhizoma, which had the efficacy of promoting the lungs and relieving epidemiological symptoms, expelling phlegm and relieving cough, and treating cough with wind-cold bundled epidemiological symptoms and stagnation of phlegm and Qi. The preparation method was suggested as boiling powder, crushing the seven herbs into coarse particles, the dosage of each drug was fried Perillae Fructus of 1.27 g, red Poria of 1.27 g, fried Mori Cortex of 1.27 g, Citri Eoxcarpium Rubrum of 1.27 g, stir-fried Armeniacae Semen Amarum of 1.27 g, Ephedrae Herba of 1.27 g and fried Glycyrrhizae Radix et Rhizoma of 0.64 g, taking 8.26 g when decocting, adding 300 mL of water, decocting to 210 mL, removing the dregs, and taking it warmly after meals. Twenty-one clinical research papers were included to analyze the modern clinical application of Huagaisan, which was mainly used in the treatment of respiratory diseases such as pneumonia, asthma, bronchitis and so on. ConclusionThis paper has verified and summarized the key information of the famous classical formula Huagaisan, which can provide a detailed reference basis for the development and clinical application of its compound preparation.
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Antiplatelet drugs are the cornerstone of long-term treatment and secondary prevention for ischemic stroke/transient ischemic attack (TIA) recommended by guidelines, aimed at reducing the risk of recurrent stroke and other cardiovascular events. However, some patients with ischemic stroke/TIA may still experience ischemic events during antiplatelet therapy, known as high on-treatment platelet reactivity (HTPR), which typically occurs in patients taking aspirin or clopidogrel. This article elaborates the incidence, risk factors, and commonly used evaluation methods of HTPR in patients with ischemic stroke/TIA, and elucidates the clinical significance of HTPR in patients with ischemic stroke/TIA, and investigates the antiplatelet treatment protocol of patients with HTPR.
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A total of 225 patients with colorectal cancer (CRC) admitted to the General Hospital of Shaoxing Second Hospital Medical community from May 5, 2020 to May 28, 2022 were enrolled (CRC group), and 101 healthy subjects underwent colorectal examination were selected as the control group. The tissue biopsy samples of all subjects were obtained by colonoscopy, and subjected to Sanger sequencing to determine the polymorphism sites of the syndecan-2 (SDC2) gene. The association between SDC single nucleotide polymorphism (SNP) and colorectal cancer in CRC patients was analyzed with logistic regression. The logistic regression analysis showed that the gene polymorphism of SDC2 rs2515127 was associated with colorectal cancer ( OR=1.643, 95% CI: 1.025-2.337, P=0.012). The frequency of GG, AG and AA the in genotypes of SDC2 rs2515127 was 60.7% (102/168), 30.4% (51/168) and 8.9% (15/168), respectively. The results showed that the gene polymorphism of SDC2 rs2515127 was associated with colorectal cancer, and the frequencies of GG and AG genotypes were higher in the genotypes of SDC2 rs2515127.
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Human herpesvirus 6 encephalitis (HHV-6) is relatively rare in children with normal immune function, and its secondary autoimmune encephalitis is even more rarely reported. A previously healthy 1-year-old boy who presented with fever, convulsions and partial status epilepticus was reported. He was diagnosed with severe HHV-6 encephalitis by next generation sequencing of cerebrospinal fluid pathogens. After aggressive antiviral treatment, the symptoms improved, but his condition recurred again with frequent involuntary movements and was finally diagnosed with secondary anti-N-methyl-D-aspartate receptor encephalitis. After treatment with gamma globulin, high-dose cortico-steroids and rituximab, his condition got stable but was left with encephalomalacia, developmental delay and intractable epilepsy in the long term.
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@#Objective Patients with obstructive sleep apnea (OSA) can present with excessive daytime sleepiness (EDS),insomnia,and other symptom subtypes. It remains unclear whether proteomics differs in patients with OSA with EDS and insomnia. Therefore,we examined the serum proteomics of patients with OSA with different clinical subtypes,in order to identify potential biomarkers for the classification of clinical subtypes of OSA,and provide insights into the molecular biological mechanisms underlying different subtypes of the disease. Methods We included six patients with OSA (three with EDS and three with insomnia) at the Second Affiliated Hospital of Air Force Medical University. All the patients underwent overnight polysomnography (PSG) and sleep scale evaluation,followed by blood sample collection on the next morning after PSG. Differentially expressed proteins were selected by label-free quantification,and bioinformatics analysis was performed. Results We identified a subset of 34 proteins that were differentially expressed between OSA with EDS and with insomnia. Compared with the OSA with insomnia group,the OSA with EDS group showed 20 up-regulated and 14 down-regulated serum proteins. The bioinformatics analysis revealed that the main functions of these proteins focused on DNA damage,reactive oxygen species elimination,immune regulation,and inflammatory response,and they were mainly involved in intracellular transport,secretion,and vesicle transport and other biological processes. The differentially expressed proteins were mainly localized in the cytoplasm,which might be secretory proteins. The APRT-AK1 interaction pathway might play an important role in different clinical subtypes of OSA. Conclusion We determined 34 differentially expressed proteins between OSA with EDS and OSA with insomnia,such as significantly up-regulated DDI2 and PRDX6 in the serum of patients with OSA with EDS,which can identify different clinical subtypes of OSA. In addition,the APRT-AK1 interaction pathway might play an important role in different subtypes of OSA.
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【Objective】 To investigate the role of LIF/LIFR/STAT3 pathway in endometrial receptivity in rats with polycystic ovary syndrome (PCOS). 【Methods】 Forty 21-day-old SD female rats were divided into normal (control) group, model group, sham-operation group, and LIF group with 10 rats in each. The rat model of PCOS was constructed by subcutaneous injection of prasterone sodium sulfate at the back of the neck. The serum levels of testosterone (T), glucose and insulin in each group were detected. The morphological changes of the uterus in each group were observed by HE staining, and the morphological changes of endometrium were measured. Immunohistochemistry, Western blotting, and Real-time fluorescence quantitative PCR(qRT-PCR) were used to determine the protein expression and mRNA expression of LIF and STAT3 in rat endometrium. 【Results】 Compared with control group, the levels of integrin avb3, serum T, insulin and glucose in PCOS rats were significantly increased (P=0.000, P=0.000, P=0.001). Supplementation of exogenous LIF could significantly reduce the levels of integrin avb3, serum T, glucose and insulin in PCOS rats (P=0.000, P=0.002, P=0.003, P=0.007). HE results showed that exogenous LIF could reduce uterine cavity and glandular morphology in PCOS rats and increase the equivalent diameter (P=0.000, P=0.000) and area (P=0.000, P=0.000) of uterine glands and glandular cavity, the ratio of glandular interstitial area (P=0.000), and the average endometrial thickness (P=0.006), with statistically significant differences. Immunohistochemistry, Western blotting, and qRT-PCR results showed that the expression levels of LIF and p-STAT3 protein and mRNA in model group were significantly decreased compared with control group. Compared with model group, the protein and mRNA expressions of LIF and p-STAT3 in LIF group were significantly increased (P<0.05). 【Conclusion】 Exogenous LIF supplementation can improve endometrial receptivity in PCOS rats, and its mechanism is related to the LIF/LIFR/STAT3 pathway.
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ObjectiveTo analyze the epidemiological characteristics of varicella in Minhang District, Shanghai from 2013 to 2022, and to evaluate the impact of adjusting the varicella vaccination program to a two-dose regimen and its inclusion in the Shanghai immunization program on the incidence of varicella. MethodsData on reported varicella cases from 2013 to 2022 in Minhang District were collected. Interrupted time series analysis and segmented regression models were used to analyze the changes in varicella incidence before and after the adjustment of varicella immunization strategies. ResultsFrom 2013 to 2022, the average annual incidence of varicella was 76.58/100 000, with the highest incidence in 2017 (119.21/100 000) and the lowest in 2022 (27.02/100 000). The varicella incidence exhibited seasonal patterns with peaks occurring from March to June and October to January of the following year. Prior to the adjustment of varicella immunization strategies (2013‒2017), the varicella incidence showed an upward trend (z=2.20, P=0.03), while after the adjustment (2018‒2022), a adownward trend was observed (2018‒2022) (z=-2.25, P=0.02). Interrupted time series analysis showed that following the adjustment of varicella immunization strategies, an immediate change of -33.91/100 000 (t=-4.35, P<0.001) in varicella incidence was observed, and the incidence slope was -17.59/100 000 with a decline of 28.61/100 000 (t=-12.16, P<0.001) compared to before inclusion. ConclusionThe incidence of varicella in Minhang District, Shanghai from 2013 to 2022 exhibits distinct seasonal patterns. After adjusting the varicella vaccination program to a two-dose regimen and incorporating it into the immunization program, the second dose of varicella vaccine administration substantially increases. As a result, the rising trend of varicella incidence is effectively controlled, and the incidence level decreases significantly, showing a sustained downward trend.
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Objective:To analyze the common disease spectrum and medication of field medical team in our hospital in summer, and to provide medical and medicinal material supply for field medical team.Methods:The data of all cases of field medical team members during the training period were collected. The types and composition ratio of diseases were analyzed, the drug consumption was counted, and the drug use indicators were calculated including daily drug dose (DDDs), daily drug dose cost (DDDC), drug utilization rate (DUR) and drug ranking ratio (R).Results:During the 12 days of the field training in summer, 77 field medical team members had 91 medical visits and 117 cases of diseases, including 44 males and 33 females, with an average age of 39.7 years. There were 52 cases of respiratory diseases, 21 cases of digestive diseases, 18 cases of mosquito bites and skin diseases, 15 cases of trauma and skeletal muscle system diseases, 5 cases of ophthalmic diseases, 2 cases of neurological diseases, 2 cases of gynecological diseases, 1 case of oral diseases and 1 case of heat stroke. The top five drugs of DDDs and DUR were respiratory drugs, sensory organ drugs, dermatological drugs, antibiotic drugs, digestive system drugs and musculoskeletal system drugs.Conclusions:The disease composition and drug demand of field training in summer have certain characteristics. It is of great guiding significance to know the characteristics of disease incidence and drug consumption of field training for the medical support ability and training tasks for field medical teams in field training in summer.
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Objective:To study the clinical characteristics and risk factors of intrauterine Ureaplasma urealyticum (UU) infection in very low birth weight preterm infants.Methods:From March 2019 to February 2022, very low birth weight preterm infants with gestational age 28~32 weeks admitted to our hospital were enrolled in this single-center retrospective study. According to the UU test results of respiratory tract samples obtained within 24 h after admission, the infants were assigned into the UU group (UU-PCR positive) and the non-UU group (UU-PCR negative). SPSS 26.0 statistical software was used to compare the clinical characteristics, laboratory indices, and complications between the two groups. Risk factors of UU infection were calculated.Results:A total of 327 preterm infants were included: 45 in the UU group and 282 in the non-UU group. No significant differences existed in gender, gestational age, birth weight and delivery pattern between the two groups ( P>0.05). Compared with the non-UU group, the UU group had significantly higher incidences of premature rupture of membranes (PROM) and chorioamnionitis, elevated white blood cell and platelet counts, procalcitonin and C-reactive protein levels, total duration of oxygen use and ventilation, bronchopulmonary dysplasia, necrotizing enterocolitis and metabolic osteopathy ( P<0.05). Multivariate logistic regression analysis showed that PROM ( OR=5.444, 95% CI 2.749-10.781, P<0.001) and chorioamnionitis ( OR=2.161, 95% CI 1.048-4.454, P=0.037) were independent risk factors for UU infection. Conclusions:PROM and chorioamnionitis are risk factors for UU infection in very low birth weight preterm infants. For high-risk premature infants, the UU test should be completed as soon as possible after birth.
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Objective To describe and analyze the disease burden and its changing trend of liver cancer caused by nonalcoholic steatohepatitis (NASH) in China from 1990 to 2019, and to provide reference for reducing the morbidity and mortality of liver cancer in China. Methods Based on data from the Global Burden of Disease (GBD2019) study, different gender and age groups were selected. The morbidity, mortality, and disability adjusted life year (DALY) rate were used to analyze the disease burden of liver cancer caused by NASH in China from 1990 to 2019. The time trend was analyzed by using the Joinpoint regression model, and the annual percent of change (APC) and annual average percentage change (AAPC) of morbidity, mortality and DALY rate were calculated. Results Compared with 1990, the incidence rate, mortality rate and DALY rate of liver cancer caused by NASH in 2019 decreased by 4.05%, 12% and 25.79%, respectively. Age-standardized morbidity, standardized mortality and standardized DALY rates decreased by 49.50%, 54.72% and 58.45%, respectively. In 2019, the incidence rate, mortality data and DALY rate of liver cancer caused by NASH increased with age, and the highest mortality rate was among people over 85 years old. The average annual change percentage (AAPC) of age-standardized incidence rate, standardized mortality rate and standardized DALY rate of liver cancer caused by NASH from 1990 to 2019 were -2.65% [95% CI(-3.09%,-2.21 %),P<0.001], -2.86%[95% CI(-3.34%,-2.38 %),P<0.001], and -2.91%[95% CI(-3.23%,-2.58%),P<0.001],respectively. The AAPC of all indexes in males was higher than that in females. Conclusion From 1990 to 2019, the disease burden of liver cancer caused by NASH in China showed an overall downward trend. The AAPC of all indexes in males is higher than that in females, and the elderly population is a high-risk group.
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Langerhans cell histiocytosis(LCH)and Langerhans cell sarcoma(LCS)are characterized by clone proliferation of Langerhans-type cells, which may occur concurrently or sequentially with T-cell acute lymphoblastic leukemia (T-ALL) and other Lymphoid neoplasms. A 15-year old female patient diagnosed with T-ALL developed LCH involving multiple systems during maintenance chemotherapy of T-AL. After treated with chemotherapy with improved result, the patient showed progression of the illness and refractory to the second-line treatment. We found c.G35A (p.G12D)mutation in the KRAS gene and used the targeted drug Trametinib for treatment. The treatment proved effective, leading to partial remission within a week. Three months after Trametinib treatment, the patient developed new lymphadenopathy. Biopsy revealed the existence of LCS. The disease progressed quickly, and the patient died 7 days after diagnosis of LCS. The case of patients with T-ALL then developing LCH and LCS sequentially is extraordinarily rare. The causes of the case is unclear and may be related to cell transdifferentiation, clonal evolution, and chemotherapy. Targeted drugs can contain this disease for a short time.
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In order to construct a recombinant replication deficient human type 5 adenovirus (Ad5) expressing a foot-and-mouth disease virus (FMDV) capsid protein, specific primers for P12A and 3B3C genes of FMDV-OZK93 were synthesized. The P12A and 3B3C genes were then amplified and connected by fusion PCR, and a recombinant shuttle plasmid pDC316-mCMV-EGFP-P12A3B3C expressing the FMDV-OZK93 capsid protein precursor P12A and 3B3C protease were obtained by inserting the P12A3B3C gene into the pDC316-mCMV-EGFP plasmid. The recombinant adenovirus rAdv-P12A3B3C-OZK93 was subsequently packaged, characterized and amplified using AdMaxTM adenovirus packaging system, and the expression was verified by infecting human embryonic kidney cell HEK-293. The humoral and cellular immunity levels of well-expressed and purified recombinant adenovirus immunized mice were evaluated. The results showed that rAdv-P12A3B3C-OZK93 could be stably passaged and the maximum virus titer reached 1×109.1 TCID50/mL. Western blotting and indirect immunofluorescence showed that rAdv-P12A3B3C-OZK93 expressed the FMDV-specific proteins P12A and VP1 in HEK-293 cells. In addition, the PK cell infection experiment confirmed that rAdv-P12A3B3C-OZK93 could infect porcine cells, which is essential for vaccination in pigs. Comparing with the inactivated vaccine group, the recombinant adenovirus could induce higher FMDV-specific IgG antibodies, γ-IFN and IL-10. This indicates that the recombinant adenovirus has good immunity for animal, which is very important for the subsequent development of foot-and-mouth disease vaccine.
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Animaux , Humains , Souris , Adenoviridae/génétique , Adénovirus humains/génétique , Anticorps antiviraux , Capside/métabolisme , Protéines de capside , Fièvre aphteuse/prévention et contrôle , Virus de la fièvre aphteuse/génétique , Cellules HEK293 , Protéines recombinantes/génétique , Sérogroupe , Suidae , Protéines virales , Vaccins antiviraux/génétiqueRésumé
Objective:To analyze the perioperative clinical characteristics of patients with oral cancer underwent radical resection and flap reconstrution and the nursing managements.Methods:From January 2020 to December 2020, 658 patients with oral cancer underwent radical resection and flap reconstrution in the Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University were retrospectively analyzed. All patients were divided into the elderly group (≥60 years) and the younger group (< 60 years), including 279 cases in the elderly group and 379 cases in the younger group. The perioperative clinical data of the patients were collected, and the perioperative general situation, postoperative complications and influencing factors of complications were analyzed.Results:There were differences between the two groups in the aspects of sex ( χ2 = 12.38, P<0.001), preoperative BMI ( t = 2.43, P = 0.015), smoking history ( χ2 = 18.34, P<0.001), preoperative anesthesia grade ( χ2 = 25.61, P = 0.001), preoperative coexisting disease ( χ2 = 46.97, P<0.001), whether oral floor or tongue cancer ( χ2 = 16.68, P<0.001), whether free flap ( χ2 = 6.81, P = 0.003), operation time ( t = 2.19, P = 0.029), preoperative test index hemoglobin ( t = 4.96, P<0.001), albumin ( t = 5.44, P<0.001), D-dimer( Z = -13.52, P<0.001), calcium levels ( t = 4.07, P<0.001) and postoperative complications ( χ2 = 14.55, P<0.001). Multivariate analysis of postoperative complications showed that the age ( OR = 1.021, 95% CI = 1.005-1.037, P = 0.011), preoperative D-dimer ( OR = 1.219, 95% CI = 1.026-1.447, P = 0.024) and the preoperative coexisting disease ( OR = 1.642, 95% CI = 1.108-2.432, P = 0.013) were the risk factors for the postoperative complications. Multivariate analysis of discharge with tube showed that the age ( OR = 1.017, 95% CI = 1.003-1.031, P = 0.017), preoperative BMI ( OR = 0.917, 95% CI = 0.873-0.963, P = 0.001), whether oral floor or tongue cancer ( OR = 2.135, 95% CI = 1.475-3.091, P<0.001), and operation time ( OR = 1.220, 95% CI = 1.120-1.328, P<0.001) were the related factors for the discharge with tube. Conclusion:In view of the above risk factors, it is beneficial for the physical and mental recovery of patients to pay attention to preoperative evaluation, make adequate preoperative preparation, postoperative nursing and observation, improve swallowing function training, prepare for discharge, pay attention to continuous nursing, and establish a tertiary hospital-community-family rehabilitation system.
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Objective:To learn about the iodine nutritional status and thyroid function of pregnant women in the areas of oral lipiodol pills in Xinjiang Uygur Autonomous Region (Xinjiang).Methods:In October 2019, using the probability proportionate to size sampling (PPS sampling) method, Aksu Prefecture (Aksu) of Xinjiang was divided into 5 sampling areas according to the directions of east, west, south, north and middle. One county was selected from each area, one township was selected from each county according to the directions of east, west, south, north and middle, and 20 pregnant women were selected from each township. The general demographic data of pregnant women were collected by questionnaires, and 24-hour urine samples, household salt samples and drinking water samples were collected for iodine detection, and serum samples were collected for thyroid function index detection.Results:A total of 555 pregnant women were investigated, including 121, 234 and 200 women in the early, middle and late pregnancy, with an average age of 26 years. Among them, the median of urinary iodine of women in early, middle and late pregnancy was 209.53, 204.27 and 225.29 μg/L, respectively, which was all in the appropriate state. The median of salt iodine was 24.70, 26.00 and 26.20 mg/kg, respectively, and the median of water iodine was 4.85, 3.30 and 4.85 μg/L, respectively. There were no significant difference in urinary iodine, salt iodine and water iodine during different pregnancy ( H= 1.61, 4.38, 2.63, P > 0.05). The prevalence rate of subclinical hypothyroidism, subclinical hyperthyroidism and hyperthyroidism in pregnant women was 4.32% (24/555), 0.54% (3/555) and 0.36% (2/555), respectively; and the highest prevalence rate was in the middle pregnancy, which was 7.26% (17/234), 1.28% (3/234) and 0.85% (2/234), respectively. The positive rate of autospecific antibody in pregnant women with normal thyroid function was 13.15% (73/555). The positive rate of thyroid peroxidase antibody (TPOAb) and thyroglobulin (TgAb) was 11.35% (63/555), 8.11% (45/555), respectively. After excluding the pregnant women with positive thyroid autospecific antibody, the range ( P2.5- P97.5) of thyroid stimulating hormone (TSH) in different pregnancy were close to or slightly higher than the recommended reference value in the "Guideline on Diagnosis and Management of Thyroid Diseases During Pregnancy and Postpartum (2nd ed)". Except that the P2.5 value of free thyroxine (FT 4) in early pregnancy was lower than the reference value, the FT 4 range in other pregnancy showed the same trend as that of TSH. The results of Spearman correlation analysis showed that free triiodothyronine (FT 3) and FT 4, TPOAb and TgAb, TgAb and FT 4 were positively correlated ( r= 0.497, 0.504, 0.216, P < 0.05), and TSH and FT 3 was negatively correlated ( r = - 0.194, P < 0.05) in the early pregnancy; FT 3 and FT 4, TPOAb and TgAb were positively correlated in the middle and late pregnancy ( r = 0.188, 0.527, 0.177, 0.623, P < 0.05); TSH was negatively correlated with FT 3 in the late pregnancy ( r = - 0.165, P < 0.05); there was no correlation between urinary iodine and thyroid function indexes ( P > 0.05). Conclusions:The water iodine in the outer environment of the oral lipiodol pills area Aksu in Xinjiang is low, and the iodine nutrition level of pregnant women is appropriate. Except that the P2.5 value of FT 4 in the early pregnancy is lower than the reference value, the TSH range close to or of women during each pregnancy and the FT 4 range of women in the middle and late pregnancy are slightly higher than the reference value, which still need continuous monitoring.
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Objective:To clarify the pathogenicity and further explore the association between genotype and clinical phenotype of this variant, analyzing a novel variation of SPAST gene in hereditary spastic paraplegia (HSP) family from Changzhi city, Shanxi Province.Methods:A family with HSP was tracked and collected in Neurology Department of Heping Hospital Affiliated to Changzhi Medical College in October 2019. Peripheral venous blood of 2 ml was extracted from the proband and 8 other members of the family, genomic DNA was extracted from the blood samples, and the genes of spastic paraplegia were screened by next-generation sequencing (NGS). HGMD, 1000G, OMIM databases and PolyPhen2, SIFT and other software were used for bioinformatics analysis of suspected mutations. Multiplex ligation-dependent probe amplification (MLPA) was used to further screen for total deletions/duplications in patients who remained negative after targeting NGS, and Sanger sequencing was performed to verify the suspected pathogenic mutation sites in the family to determine co-isolation of the mutation sites in the family members. Finally, it is necessary to refer to the latest version of The American College of Medical Genetics and Genomics (ACMG) sequence variation interpretation guidelines to interpret the mutation sites to determine pathogenicity.Results:The HSP family consist 47 members of 4 generations and 10 patients, with onset ages ranging from 2 to 44 years. The proband′s daughter only showed positive bilateral Babbitt signs on physical examination, and the rest of the patients showed spasticity and weakness of lower limbs with varying severity on this basis. Preliminary screening by next-generation sequencing technology showed that the proband had frame-shift variation of SPAST gene c.1057_1058insCC (p.Leu354HisfsTer11) and missense variation of DCTN1 gene c.2213A>G (p.Gln738Arg). Then, Sanger sequencing was used for in-family verification, which showed SPAST gene c.1057_1058insCC (p.Leu354HisfsTer11) was detected in the affected members include father, brother, son and daughter, and not detected in the unaffected normal members, the proband′s wife, mother, sister and sister-in-law. However, the unaffected of mother detected missense variation of DCTN1 gene c.2213A>G (p.Gln738Arg), while the remaining members did not detect this variation. The results of MLPA showed that no large fragment variation was found.Conclusions:The genetic pattern of the HSP family was autosomal dominant, and the clinical characteristics were consistent with hereditary spastic paraplegia type 4 (SPG4). Co-segregation of SPAST gene c.1057_1058insCC (p.Leu354HisfsTer11) was found in the HSP family and was the pathogenicity cause of this SPG4 family, and it was a newly discovered mutation locus.
Résumé
Langerhans cell histiocytosis (LCH) is a rare myeloid tumor disease, which is characterized by CD1a + CD 207+ dendritic cell proliferation.The clinical manifestations of LCH vary greatly due to the different locations and different involved organs.Among them, neurodegenerative disease (ND) is one of the manifestations of central nervous system involvement in LCH.The pathogenesis of LCH-ND is unclear and it is mainly characterized by neurological disorders and progressive imaging changes.Due to its unclear etiologies and long progress of LCH-ND, the treatment of LCH-ND remains very challenging.Presently, the main modalities of treatment include intravenous immunoglobulin, chemotherapy and targeted therapy.Early treatment and timely intervention may be the key to halt the progression of LCH-ND, to stabilize the central nervous system function and to improve the quality of life.The pathogenesis, clinical manifestations, diagnosis, treatment and clinical evaluation of LCH-ND are briefly reviewed.