Clinical Outcome and Risk Factors of Treatment Failure of Peritoneal Dialysis Associated Peritonitis Caused by Klebsiella Pneumoniae:A Multicenter Study / 中国医学科学院学报

Objective To investigate the treatment outcomes,prognosis,and risk factors of treatment failure of peritoneal dialysis associated peritonitis (PDAP) caused by Klebsiella pneumoniae,and thus provide clinical evidence for the prevention and treatment of this disease. Methods The clinical data of PDAP patients at four peritoneal dialysis centers from January 1,2014 to December 31,2019 were collected retrospectively.The treatment outcomes and prognosis were compared between the patients with PDAP caused by Klebsiella.pneumoniae and that caused by Escherichia coli.Kaplan-Meier method was employed to establish the survival curve of technical failure,and multivariate Logistic regression to analyze the risk factors of the treatment failure of PADP caused by Klebsiella pneumoniae. Results In the 4 peritoneal dialysis centers,1034 cases of PDAP occurred in 586 patients from 2014 to 2019,including 21 cases caused by Klebsiella pneumoniae and 98 cases caused by Escherichia coli.The incidence of Klebsiella pneumoniae caused PDAP was 0.0048 times per patient per year on average,ranging from 0.0024 to 0.0124 times per patient per year during 2014-2019.According to the Kaplan-Meier survival curve,the technical failure rate of Klebsiella pneumoniae caused PDAP was higher than that of Escherichia coli caused PDAP (P=0.022).The multivariate Logistic regression model showed that long-term dialysis was an independent risk factor for the treatment failure of Klebsiella pneumoniae caused PDAP (OR=1.082,95%CI=1.011-1.158,P=0.023).Klebsiella pneumoniae was highly sensitive to amikacin,meropenem,imipenem,piperacillin,and cefotetan,and it was highly resistant to ampicillin (81.82%),cefazolin (53.33%),tetracycline (50.00%),cefotaxime (43.75%),and chloramphenicol (42.86%). Conclusion The PDAP caused by Klebsiella pneumoniae had worse prognosis than that caused by Escherichia coli,and long-term dialysis was an independent risk factor for the treatment failure of Klebsiella pneumoniae caused PDAP.

Development and validation of a prediction model for treatment failure in peritoneal dialysis-associated peritonitis patients: a multicenter study / 南方医科大学学报

OBJECTIVE@#To develop and validate a risk prediction model of treatment failure in patients with peritoneal dialysis-associated peritonitis (PDAP).@*METHODS@#We retrospectively analyzed the data of patients undergoing peritoneal dialysis (PD) in 3 dialysis centers in Jilin Province who developed PDAP between January 1, 2013 and December 31, 2019. The data collected from the Second Hospital of Jilin University and Second Division of First Hospital of Jilin University) were used as the training dataset and those from Jilin Central Hospital as the validation dataset. We developed a nomogram for predicting treatment failure using a logistic regression model with backward elimination. The performance of the nomogram was assessed by analyzing the C-statistic and the calibration plots. We also plotted decision curves to evaluate the clinical efficacy of the nomogram.@*RESULTS@#A total of 977 episodes of PDAP were included in the analysis (625 episodes in the training dataset and 352 episodes in the validation dataset). During follow-up, 78 treatment failures occurred in the training dataset and 35 in the validation dataset. A multivariable logistic regression prediction model was established, and the predictors in the final nomogram model included serum albumin, peritoneal dialysate white cell count on day 5, PD duration, and type of causative organisms. The nomogram showed a good performance in predicting treatment failure, with a C-statistic of 0.827 (95% CI: 0.784-0.871) in the training dataset and of 0.825 (95% CI: 0.743-0.908) in the validation dataset. The nomogram also performed well in calibration in both the training and validation datasets.@*CONCLUSION@#The established nomogram has a good accuracy in estimating the risk of treatment failure in PDAP patients.

Clinical Characteristics and Treatment Outcome of Pseudomonas Peritoneal Dialysis-associated Peritonitis / 中国医学科学院学报

Objective To explore the clinical characteristics and treatment of Pseudomonas peritoneal dialysis-associated peritonitis(PsP). Methods The data of patients receiving peritoneal dialysis in four tertiary hospitals in Jilin province from 2015 to 2019 were retrospectively analyzed.According to the etiological classification,the patients with peritoneal dialysis-associated peritonitis(PDAP)were classified into PsP group and non-PsP group.The incidence of PsP was calculated,and the clinical characteristics and treatment outcomes of the two groups were compared.Kaplan-Meier method was used to draw the survival curve,and Cox regression was performed to analyze the risk factors affecting the technical failure of PsP.The treatment options of Pseudomonas aeruginosa-caused PDAP and the drug sensitivity of PsP were summarized. Results A total of 1530 peritoneal dialysis patients with complete data were included in this study,among which 439 patients had 664 times of PDAP.The incidence of PsP was 0.007 episodes/patient-year.PsP group had higher proportion of refractory peritonitis(41.38% vs.19.69%,P=0.005),lower cure rate(55.17% vs.80.79%, P=0.001),and higher extubation rate(24.14% vs.7.09%,P=0.003)than non-PsP group.The technical survival rate of PsP group was lower than that of non-PsP group(P<0.001).Multivariate Cox regression analysis showed that Pseudomonas aeruginosa was an independent risk factor for technical failure in patients with PsP(HR=9.020,95%CI=1.141-71.279,P=0.037).Pseudomonas was highly sensitive to amikacin,meropenem,and piperacillin-tazobactam while highly resistant to compound sulfamethoxazole,cefazolin,and ampicillin. Conclusion The treatment outcome of PsP is worse than that of non-PsP,and Pseudomonas aeruginosa is an independent risk factor for technical failure of PsP.

Effectiveness of chloral hydrate sedation in pediatric patients who receive cone beam computed tomography examinations / 中国实用护理杂志

Objective To discuss the success rate and image quality in pediatric patients who used chloral hydrate before their cone beam computed tomography exam. Methods 1752 patients aged 1 to 6 were selected for this retrospective study. They were divided into sedated group (219 cases) and non-sedated group (1 533 cases). The success rate and image quality were compared between two groups. Results The sedated group had a higher success rate to non-sedated group: 99.5%(218/219) vs. 90.4% (1 386/1 533). The motion artifact in sedated group was lower than non-sedated group with I degree: 4.8% (15/314) vs. 20.1%(327/1 630) and II degree: 0.3%(1/314) vs. 12.2%(199/1 630). Conclusion Giving chloral hydrate to pediatric patients before their CBCT exam would improve both success rate and image quality, and reduce unnecessary radiation expose.

Analysis on efficacy and safety of total neoadjuvant therapy in patients with locally advanced rectal cancer with high risk factors / 中华胃肠外科杂志

Objective@#To evaluate the safety and preliminary efficacy of total neoadjuvant therapy (TNT) in patients with locally advanced rectal cancer (LARC) with high risk factors.@*Methods@#Data of 101 patients who were diagnosed with stage II-III rectal cancer with high risk factors and received TNT between March 2015 and January 2018 at West China Hospital of Sichuan University were analyzed retrospectively. Inclusion criteria: (1) patients were diagnosed with stage II-III rectal cancer by high-resolution MRI combined with CT and endorectal ultrasound; (2) at least one high risk factor: cT4a, cT4b, cN2, EMVI+, CRM+ and lateral lymph node+; (3) distance from tumor to anal verge was within 15 cm; (4) Eastern Collaborative Oncology Group (ECOG) performance status score was 0-1; bone marrow function, liver function and kidney function were suitable for chemoradiotherapy; (5) patients were treated with TNT strategy; (6) the follow-up data and postoperative pathological data were complete. Patients with previous rectal cancer surgery (except prophylactic colostomy), pelvic radiotherapy, and systemic chemotherapy, those with distant metastases, those without neoadjuvant radiotherapy, those receiving less than 4 cycles of neoadjuvant chemotherapy were excluded. The regimen of TNT: 3 cycles of induction CAPOX (oxaliplatin plus capecitabine) were followed by pelvic radiotherapy and concurrent CAPOX, then 3 cycles of consolidation CAPOX were delivered after radiotherapy. Total mesorectal resection (TME) or watch-and-wait strategy was selected according to the therapeutic effect and patients' wishes. Short-term efficacy, including tumor regression grade (TRG), pathological complete response (pCR), clinical complete response (cCR), postoperative complications within 30 days of surgery, and adverse events (AE) to radiotherapy and chemotherapy (measured using CTCAE 4.0) was analyzed.@*Results@#The 101 patients included 68 males (67.3%) and 33 females (32.7%) with a median age of 54 years. The proportion of patients with cT4a, cT4b, cN2 and enlarged lateral lymph node was 13.9%, 29.7%, 56.4% and 43.6%, respectively. The mean cycle of neoadjuvant chemotherapy was 6.0±1.3. Seventy-five patients (74.3%) received at least 6 cycles of neoadjuvant chemotherapy and 100 (99.0%) completed radiotherapy. The mean cycle of induction and consolidation chemotherapy was 2.0±0.9 and 2.8±1.0 respectively. Most common grade 3 AE was leucopenia (n=13, 12.9%) and thrombocytopenia (n=7, 6.9%). Grade 3 diarrhea and radiation dermatitis were observed in 5 cases (5.0%) respectively. Grade 3 anemia and rectal pain were observed in 4 cases (4.0%) respectively. And rectal mucositis was observed in 2 cases (2.0%). Most of the AE was observed during concurrent chemoradiotherapy. No grade 4 or higher AE was observed. After TNT, 32 patients (31.7%) achieved pCR or cCR, and 62 patients (60.4%) achieved partial response (PR). Only 2 patients (2.0%) developed distant metastasis after chemoradiotherapy, while the other patients did not show disease progression. Seven patients (6.9%) with cCR refused surgery and selected watch-and-wait, while 7 patients without cCR still refused surgery. The other 87 patients (86.1%) underwent TME successfully. The mean interval from the completion of chemoradiotherapy to surgery was (20.1±8.5) weeks. The R0 resection rate was 97.7% (85/87).The morbidity of surgical complication was 16.1% (14/87), including pelvic infection or abscess in 6 cases (6.9%), anastomotic leakage in 3 (3.4%), hemorrhage in 2 (2.3%), and gastrointestinal dysfunction in 3 (3.4%). Pathological findings revealed that 24 cases (27.6%) had TRG 0, 20 (23.0%) had TRG 1, 30 (34.5%) TRG 2, and 13 (14.9%) TRG 3.@*Conclusion@#TNT is safe and has good short-term efficacy for locally advanced rectal cancer patients with high risk factors.

First line nucleos(t)ide analog monotherapy is more cost-effective than combination strategies in hepatitis B e antigen-positive chronic hepatitis B patients in China / 中华医学杂志(英文版)

Background@#Nucleos(t)ide analog (NA) in combination with peginterferon (PegIFN) therapy in patients with hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB) shows better effectiveness than NA monotherapy in hepatitis B surface antigen loss, termed "functional cure," based on previous published studies. However, it is not known which strategy is more cost-effective on functional cure. The aim of this study was to analyze the cost-effectiveness of first-line monotherapies and combination strategies in HBeAg-positive CHB patients in China from a social perspective.@*Methods@#A Markov model was developed with functional cure and other five states including CHB, compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and death to assess the cost-effectiveness of seven representative treatment strategies. Entecavir (ETV) monotherapy and tenofovir disoproxil fumarate (TDF) monotherapy served as comparators, respectively.@*Results@#In the two base-case analysis, compared with ETV, ETV generated the highest costs with $44,210 and the highest quality-adjusted life-years (QALYs) with 16.78 years. Compared with TDF, treating CHB patients with ETV and NA - PegIFN strategies increased costs by $7639 and $6129, respectively, gaining incremental QALYs by 2.20 years and 1.66 years, respectively. The incremental cost-effectiveness ratios were $3472/QALY and $3692/QALY, respectively, which were less than one-time gross domestic product per capita. One-way sensitivity analysis and probabilistic sensitivity analyses showed the robustness of the results.@*Conclusion@#Among seven treatment strategies, first-line NA monotherapy may be more cost-effective than combination strategies in HBeAg-positive CHB patients in China.

Effectiveness of chloral hydrate sedation in pediatric patients who receive cone beam computed tomography examinations / 中国实用护理杂志

Objective@#To discuss the success rate and image quality in pediatric patients who used chloral hydrate before their cone beam computed tomography exam.@*Methods@#1752 patients aged 1 to 6 were selected for this retrospective study. They were divided into sedated group (219 cases) and non-sedated group (1 533 cases). The success rate and image quality were compared between two groups.@*Results@#The sedated group had a higher success rate to non-sedated group: 99.5%(218/219) vs. 90.4% (1 386/1 533). The motion artifact in sedated group was lower than non- sedated group with I degree: 4.8% (15/314) vs. 20.1%(327/1 630) and II degree: 0.3%(1/314) vs. 12.2%(199/1 630).@*Conclusion@#Giving chloral hydrate to pediatric patients before their CBCT exam would improve both success rate and image quality, and reduce unnecessary radiation expose.

First line nucleos(t)ide analog monotherapy is more cost-effective than combination strategies in hepatitis B e antigen-positive chronic hepatitis B patients in China / 中华医学杂志(英文版)

BACKGROUND@#Nucleos(t)ide analog (NA) in combination with peginterferon (PegIFN) therapy in patients with hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB) shows better effectiveness than NA monotherapy in hepatitis B surface antigen loss, termed "functional cure," based on previous published studies. However, it is not known which strategy is more cost-effective on functional cure. The aim of this study was to analyze the cost-effectiveness of first-line monotherapies and combination strategies in HBeAg-positive CHB patients in China from a social perspective.@*METHODS@#A Markov model was developed with functional cure and other five states including CHB, compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and death to assess the cost-effectiveness of seven representative treatment strategies. Entecavir (ETV) monotherapy and tenofovir disoproxil fumarate (TDF) monotherapy served as comparators, respectively.@*RESULTS@#In the two base-case analysis, compared with ETV, ETV generated the highest costs with $44,210 and the highest quality-adjusted life-years (QALYs) with 16.78 years. Compared with TDF, treating CHB patients with ETV and NA - PegIFN strategies increased costs by $7639 and $6129, respectively, gaining incremental QALYs by 2.20 years and 1.66 years, respectively. The incremental cost-effectiveness ratios were $3472/QALY and $3692/QALY, respectively, which were less than one-time gross domestic product per capita. One-way sensitivity analysis and probabilistic sensitivity analyses showed the robustness of the results.@*CONCLUSION@#Among seven treatment strategies, first-line NA monotherapy may be more cost-effective than combination strategies in HBeAg-positive CHB patients in China.

Grading method of inhomogeneity of contrast-enhanced ultrasound for rectal tumors based on gray level co-occurrence matrix / 生物医学工程学杂志

Transrectal contrast-enhanced ultrasound (CEUS) is an important examination for rectal tumors. The inhomogeneity of the CEUS images has important clinical significance. However, there is no objective method to evaluate this index. In this study, a method based on gray-level co-occurrence matrix (GLCM) is proposed to extract texture features of images and grade these images according the inhomogeneity. Specific processes include compressing the gray level of the image, calculating the texture statistics of gray level co-occurrence matrix, combining feature selection and principal component analysis (PCA) for dimensionality reduction, and training and validating quadratic discriminant analysis (QDA). After ten cross-validation, the overall accuracy rate of machine classification was 87.01%, and the accuracy of each level was as follows: Grade Ⅰ 52.94%, Grade Ⅱ 96.48% and Grade Ⅲ 92.35% respectively. The proposed method has high accuracy in judging grade Ⅱ and Ⅲ images, which can help to identify the grade of inhomogeneity of contrast-enhanced ultrasound images of rectal tumors, and may be used to assist clinical doctors in judging the grade of inhomogeneity of contrast-enhanced ultrasound of rectal tumors.

Construction of nano-silver coating on pure titanium surface and its antibacterial effect on Staphylococcus aureus / 中国组织工程研究

BACKGROUND:Nano-silver is a new antibacterial material developed based on nano-technology. It is characterized as stable physical and chemical properties, and good electrical, optical, and catalytic performance, but its antibacterial response to Staphylococcus aureus is controversial. OBJECTIVE:To explore the preparation methods of nano-silver coating on pure titanium surface and to explore its antibacterial effect on Staphylococcus aureus. METHODS:(1) Preparation of nano-silver coating on the surface of pure titanium: Hydroxyapatite and silver powder as research objects were fully mixed at a ratio of 20:1. The mixture was ball-milled to ensure the formation of nanosized particles. The mixture of hydroxyapatite and silver powder was put into a stirrer for continuous stirring to ensure the uniform distribution. The mixture was then placed in an ethanol solution followed by insertion of a titanium plate (anode) and a stainless steel plate (cathode). The precipitated powder was obtained on the titanium surface at a voltage of 20 V, and the pure titanium surface with nano-silver coating was prepared after heat treatment in a tube resistance furnace. (2) Observation of antibacterial properties: A minimal inhibitory concentration test was used to determine the antibacterial concentration of the nano-silver coating on the pure titanium surface when shaken with Staphylococcus aureus. A scanning electron microscope was used to observe the structure of Staphylococcus aureus on the pure titanium surface with nano-silver coatings of different mass concentrations. RESULTS AND CONCLUSION:Nano-silver/hydroxyapatite composite coating and hydroxyapatite coating were relatively uniform. The nano-silver/hydroxyapatite composite coating was white in color but slightly yellowish. The hydroxyapatite coating was white in color. The coating surface was rough and bonded firmly. No peeling of the coating was observed under gross observation. The antibacterial ability of the nano-silver group at 37℃ static culture and at 37℃ shaking culture was significantly higher than that of the hydroxy-apatite group (P<0.05). The absorbance value of Staphylococcus aureus at 600 nm in the nano-silver group was lower than that of hydroxyapatite group at 7, 10, 30 hours after intervention (P<0.05). The layer cells on the nano-silver coating become lighter in color compared with those on the hydroxyapatite coating and there were cells that ruptured and died. The number of Staphylococcus aureus on the nano-silver coating was reduced, and a large number of vacuoles were found. These findings indicate that the 20:1 mixture of hydroxyapatite and silver at micron level can be used to prepare nano-silver coating through ball milling, water bath, ultrasound and heat treatment. The prepared coating can exert excellent antibacterial effects on Staphylococcus aureus.

Progress of multi-cellular tumor spheroids culture technique for treatment of bladder cancer / 肿瘤研究与临床

Cell culture is an important tool for biological research.To better understand the pathogenesis and therapeutic methods of the tumors,the three-dimensional cell culture is applied by more and more researchers to create a culture environment that closes to the tumor microoenvironment.Thanks to the advances in the tissue engineering technology,many kinds of models of the three-dimensional cell culture achieve wide accessibility.Compared with the traditional two-dimensional cell culture,the three-dimensional cell culture is better in simulating physiological features of the human histology and cells,including cell proliferation and differentiation,the interaction of cell to cell and cell to matrix.This paper reviews the progress of multi-cellular tumor spheroids (MCTS) culture technique of the three-dimensional cell culture for treatment of bladder cancer.

Transfection of CTGF siRNA inhibits transdifferentiation in human lens epithelium cell line B3 in vitro / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the expression of connective tissue growth factor (CTGF) and α-SMA in human lens epithelium cell (HLEC) line B3 after transfection by liposome-coated siRNA targeting CTGF.METHODS: HLECs were transfected with small interfering RNA (siRNA) targeting CTGF,labeled with 5`-fluorescein isothiocyanate (5`-FITC) and coated with lipofectamine.The transfection ratio was evaluated via fluorescence intensity.Cell counting kit-8 (CCK-8) assay was performed to assess cytoviability of both non-transfected and transfected HLECs.Quantitative RT-PCR,cell immunochemistry and Western blot analysis were conducted to detect the expression changes of CTGF and α-SMA after transfection.RESULTS: A highly effective transfection ratio was observed in siRNA co-transfected with lipofectamine.The transfection ratio reached 95% at 24h.The proliferation of HLECs was inhibited by siRNA after 72h transfection.The expression of CTGF and α-SMA significantly decreased in HLECs after transfected by CTGF siRNA for 24h.This effect was not found in negative control siRNA.CONCLUSIONS: SiRNA targeting CTGF decreased CTGF and α-SMA expression in HLECs,which is a potential therapeutic strategy for posterior capsular opacification.

Application of language intervention to alleviate the discomfort of patients during the colonoscopy process / 中国实用护理杂志

Objective To investigate the effect of the language intervention to reduce patients′discomfort during a colonoscopy examination. Methods A total of 72 subjects who accepted a colonoscopy process in the Digestive Endoscopy Department of the Dalian Central Hospital from September 2014 to December 2015 were divided by random number table method into two groups, 38 for the control group and 34 for the observation group. The control group adopted routine nursing care, while the observation group adopted the language intervention besides the routine nursing care, in accordance with the implementation steps of language intervention for patients who accepted the colonoscopy examination, which means the four stages , the four positions and the four methods. The first stage: the enteroscope entered the anus and arrived the rectum , applied the deep breathing with anal movement method . The second stage: from the rectum to the sigmoid colon, used the induce distraction method. The third stage: stimulated the patients′ excitement at the junctional area of descending colon and transverse colon (the spleen area). The fourth stage: at the junctional area of transverse and ascending colon (the liver ares), used the continuous excitation method. In each stage, individualized language intervention and psychological nursing were given to every patient in the observation group. The cooperating effect of the two groups were evaluated. Results The frequency of pain, the pain scores,the frequency of pressing and the average insertion time of the control group respectively were (8.68 ± 0.83) times,(45.08 ± 6.66) points, (5.73±0.75) times,(372.26±31.77) s, while the observation group were (4.53±0.38) times,(17.07± 3.01) times,(2.05±0.38) times,(268.61±14.51) s, less than the control group ,the t value respectively were 3.81,27.17,3.51,4.66, and the difference was significant (P<0.01 or 0.05). Conclusions Using the language intervention nursing method can significantly relieve the patients′ nervous and anxiety during the procedure, ease the pain and discomfort, shorten the insertion time, improve the subjects′ experience during the colonoscopy examination, make the patients more coordinate with the examination and complete it successfully.

Application of ISO9001 Quality Management System combined with level 3 general hospital evalua-tion standard in nursing management / 中国实用护理杂志

Objective To observe the application effect of ISO9001 Quality Management System combined with level 3 general hospital evaluation standard (2011 version) in nursing management. Methods ISO9001 Quality Management System combined with nursing part of level 3 general hospital evaluation standard applied in nursing management; and data of nursing goals were collected before and after the implementation of nursing management system from 2011 to 2014. Results Nursing management system got more perfect, safety of blood transfusion, adverse event reports and so on were included. Both nursing quality target completion and satisfaction rate of hospitalized patients on nursing work increased year by year from 2011 to 2014. Satisfaction rate of doctors and nurses with high quality nursing service were both above 96%. Conclusions Nursing management system can promote can promote quality of nursing care, and provide comprehensive development guarantee to the whole hospital quality system, and offer reference for other hospital′s nursing management.

Triptolide inhibites Th17 cell differentiation via regulating cyclooxygenase-2/ prostaglandin E2 axis in synovial fibroblasts from rheumatoid arthritis / 中国中药杂志

Triptolide (TPT), an active compound extracted from Chinese herb Tripterygium wilfordii , has been used in therapy of rheumatoid arthritis (RA). In this study, after synovial fibroblasts from rheumatoid arthritis (RASFs) were treated with TPT, we investigated its effect on the differentiation of Th17 cells. Firstly, the mRNA level of cyclooxygenase (COX) wad detected by qRT-PCR and the protein level of prostaglandin E2 (PGE2) was tested by ELISA in RASFs treated with different concentrations (0, 10, 50, 100 nmol L-1 ) of TPT. Then after TPT pre-treated RASFs and RA CD4 + T cells wer e co-cultured for 3 days in the presence or absence of PGE2, IL-17 and IFN-gamma production in CD4 T cell subsets were detected by flow cytometry. The results showed TPT decreased the mRNA experssion of COX2 and the secretion of PGE2 in RASFs in a dose-dependent manner(P <0. 05). We further found that differentiation of Thl7 cells was downregulated in a dose-dependent manner, and exogenous PGE2 could reverse the inhibition of Th17 cell differentiation(P <0. 05). Taken together, our results demonstrated that TPT inhibited the mRNA level of COX2 and the secretion of PGE2 in RASFs, which partly led to impaired Th17 cell differentiation in vitro.

Characteristics of natural changes in CD4+lymphocyte counts among untreated HIV-infected patients in central districts of Shanghai / 上海预防医学

Objective Objective To explore the characteristics and determinants of natural chan-ges in CD4+lymphocyte counts among HIV -infected patients without previous antiviral therapy in two dis-tricts of Shanghai . [ Methods] A retrospective study was conducted on HIV -infected patients reported from 1987 through May 2013 in two districts of Shanghai , who had received at least twice CD 4+lymphocyte counting tests before antiretroviral treatment ( ART) .The characteristics of natural changes in CD 4+lympho-cyte count and the determinants of significant decrease in count were described . [ Results] A total of 365 patients were included in the study .The monthly rate of CD 4+lymphocyte count changes between the first and the last counting tests had a median of -4.4 (IQR:-11.1~0.2).Among them 263(72.1%) showed remarkable decrease in CD 4+lymphocyte counts and 143 ( 39 .2%) presented a significant decrease (≥30%).Multiple logistic regression analysis indicated that the age , the first CD4+lymphocyte counts and the interval between the first and the last counting tests were significantly associated with the significant de -crease of CD4+lymphocyte counts among HIV-infected patients. [Conclusion] Natural changes of CD4+lymphocyte counts were gentle as a whole among untreated patients infected with HIV in central districts of Shanghai and rapid decrease in CD 4+lymphocyte counts among some HIV -infected patients was associated with many factors .It is held that CD 4+lymphocyte count and its changing rate should be regularly monitored so as to estimate the progress of the disease and perform targeted behavior intervention and clinic intervention .

Retrospective analysis of ultrasound imaging characteristics of 58 patients with Meckel's diverticulum disease / 生物医学工程学杂志

To evaluate the ultrasound imaging characteristics and diagnostic criteria for acute abdominal Meckel's di- verticulum disease (MD), we retrospectively analyzed the ultrasonic characteristics, clinical data of 58 cases of pathologically proved MD from January 2009 to May 2012. We found that among all the 58 patients, 21 patients were diagnosed with the preoperative clinical diagnosis of MD. Fourteen cases of MD inflammation with acute appendicitis were evaluated by pathological examinations after the surgery. We also found 4 cases of MD with perforation, 15 cases of MD with intussusceptions, 14 cases MD with intestinal obstruction, 5 cases of MD secondary to intestinal obstructionor intestinal necrosis, and 5 cases of MD without any obvious complications. Emergency ultrasound examinations revealed 8 cases of simple MD, 1 case of MD with intussusceptions, 9 cases of MD with acute appendicitis, 12 cases of MD with intestinal obstruction, 2 cases of MD with intussusceptions and intestinal obstruction, 1 case of MD with omphalocele and 1 case of MD with abdominal abscess. The emergency sonographic findings suggested that MD was relatively fixed bowel or thick-walled cystic mass, with one end connected to small intestine, and the other end connected to the blind side, at the periumbilicus region or at the lower right abdomen. A conclusion could be drawn that MD is difficult to be detected by ultrasound (detection rate was about 15. 5%), and MD with complications such as intussusceptions, intestinal obstruction, acute appendicitis can usually be more easily detected (detection rates were 24.1%, 24.1% and 15.5%, respectively). Sonography is a simple, effective way to make diagnosis and differential diagnosis of MD with different acute abdomen symptoms from other disease.

Quantitative study of iron metabolism-related genes expression in rat / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To investigate the multiple iron metabolism-related genes expression, its regulation by iron and the expression correlation among the genes in rat tissues.</p><p><b>METHODS</b>Two groups (n=30) of Sprague-Dawley female weanling rats were fed with a control diet and an iron deficient diet respectively for 4 weeks. All rats were then sacrificed, and blood and tissue samples were collected. The routine blood examination was performed with a veterinary automatic blood cell analyzer. Elemental iron levels in liver, spleen and serum were determined by atomic absorption spectrophotometry. The mRNA expression of genes was detected by real-time fluorescence quantitative PCR.</p><p><b>RESULTS</b>After 4 weeks, the hemoglobin (Hb) level and red blood cell (RBC) count were significantly lower in the iron deficient group compared with those in the control group. The iron levels in liver, spleen and serum in the iron deficient group were significantly lower than those in the control group. In reference to small intestine, the relative expression of each iron-related gene varied in the different tissues. Under the iron deficiency, the expression of these genes changed in a tissue-specific manner. The expression of most of the genes significantly correlated in intestine, spleen and lung, but few correlated in liver, heart and kidney.</p><p><b>CONCLUSION</b>Findings from our study provides new understandings about the relative expression, regulation by iron and correlation among the mRNA expressions of transferrin receptors 1 and 2, divalent metal transporter 1, ferritin, iron regulation proteins 1 and 2, hereditary hemochromatosis protein, hepcidin, ferroportin 1 and hephaestin in intestine, liver, spleen, kidney, heart, and lung of rat.</p>

Research in perioperative nursing methods in patients with OSAHS and type 2 diabetes mellitus / 中国实用护理杂志

Objective To study the perioperative nursing methods in patients with OSAHS and type 2 diabetes mellitus.Methods From March 2009 to December 2010,a total of 46 patients with OSAHS and type 2 diabetes mellitus were randomly divided into the control group and the experimental group with 23 cases in each group.Conventional care was given to the control group,while the experimental group received systematic,phased and individualized nursing.The sleep quality before and after the operation was compared.The oropharynx wound healing and possible complications,pain were observed after operation.Results In the control group,there was one patient with bleeding during operation,one patient happened blood lost after operation and 2 patients had postoperative infection.The hyperglycemia was found in 3 patients and hypoglycemia occurred in 2 patients.But in the experimental group,all of the patients did not suffer complication.The scores of sleep quality on the day before surgery were significantly higher than those scores on admission,and the scores on discharge from hospital were significantly lower than those scores on admission.There were statistical differences.The scores of the experimental group were significantly improved compared to those of the control group.The score of pain was the highest at the day of surgery,and then gradually decreased.The score of pain of the experimental group was significantly lower than that of the control group,and the difference was statistically significant.Conclusions This comprehensive nursing method during operation period for patients with OSAHS and type 2 diabetes mellitus not only can reduce risk of postoperative complication,but also can improve operation efficacy,quality of nursing and life quality of patients as well as can speed recovery.It approved that this standardized,systematic nursing method during the whole period is practical and effective in OSAHS and type 2 diabetes mellitus treatment and care.

Implanting dual-chamber pacemaker through right thoracotomy to establish a canine tachycardia-mediated cardiomyopathy model / 第二军医大学学报

Objective To create a canine model of premature ventricular contraction-induced tachycardia-mediated cardiomyopathy, and to explore the effect of frequent premature ventricular contraction on the function of the left ventricular function. Methods Sixteen mongrel dogs were randomly divided into sham operation group and paced group. Animals in the paced group underwent the implantation of a dual-chamber pacemaker through right thoracotomy, and the pacemaker was connected to two epicardial right ventricular leads, with one creviced in the cardiac apex and the other one in the outflow tract of the right ventricle, with an atrioventricular delay adjusted to ensure the presence of coupled pacing to simulate ventricular bigeminy. Dogs in the control group were not connected to the leads. Echocardiographic measurements were obtained before and 4 weeks after operation. Results One dog in the paced group died of infection after 4 weeks. In the paced group (n = 7), LV end-diastolic diameter (LV-EDD) increased from (2. 86 ± 0. 10) cm before operation to (3. 35 ± 0. 27) cm after operation (P< 0. 05) and LV end-systolic diameter (LV-ESD) increased from (2. 07 ± 0. 20) cm before operation to (2. 72 ± 0. 21) cm after operation (P<0. 05). In addition, the left ventricular ejection fraction (LVEF) decreased from (67. 57 ± 4. 49)% before operation to (43. 66 ± 3. 88) % after operation (P<0. 05). No significant changes in LV dimensions or function were noted before and after operation in the control group. Conclusion It is feasible to simulate ventricular bigeminy with coupled pacing in canines. Premature ventricular contraction-induced cardiomyopathy can lead to increased LV dimensions and decreased LV.