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Objective To analyse the prognosis and risk factors of lung cancer with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in Tongchuan City, and to provide a theoretical basis for improving the prognosis of patients with lung cancer complicated with AECOPD. Methods A total of 280 patients with lung cancer combined with AECOPD admitted to Tongchuan People's Hospital from January 2021 to August 2022 were selected and divided into survival group and death group according to whether the patients survived during hospitalization. Serum carcinoembryonic antigen (CEA), cytokeratin 19 fragment (CYFRA 21-1) and other tumor markers were compared between the two groups. Lung function was measured by lung function instruments, and the levels of forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC and other lung function indicators were compared between the two groups. The patients' clinical data were collected from the medical record system, and univariate analysis and logistic regression were used to analyze the independent risk factors affecting the prognosis of patients with lung cancer complicated with AECOP. Results The values of FEV1, FVC and FEV1/FVC in the death group were significantly lower than those in the survival group (P<0.05). Serum CEA and CYFRA 21-1 levels in the death group were significantly higher than those in the survival group (P<0.05). Multiple logistic regression analysis showed that albumin level <35 g/L (OR=2.728), TNM stage III to IV (OR=2.416), multidrug-resistant bacterial infection (OR=2.982), and GOLD grade III to IV (OR=3.417) were independent risk factors for death in patients with lung cancer complicated with AECOPD in Tongchuan City (P<0.05). Conclusion Patients with lung cancer complicated with AECOPD in Tongchuan City have a high risk of death during hospitalization, especially patients with TNM stage III to IV and GOLD grade III to IV. Multi-drug resistant bacteria infection should be actively controlled to improve the albumin level of patients, which is conducive to the prognosis of patients.
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BackgroundGenetic factors contribute to individual differences in the severity of coronavirus disease 2019 (COVID-19). A portion of genetic predisposition can be captured using polygenic risk scores (PRS). Relatively little is known about the associations between PRS and COVID-19 severity or post-acute COVID-19 in community-dwelling individuals. MethodsParticipants in this study were 983 World Trade Center responders infected for the first time with SARS-CoV-2 (mean age at infection=56.06, standard deviation [SD]=7.37, 918 (93.4%) male, 813 (82.7%) European ancestry). Seventy-five (7.6%) responders were in the severe COVID-19 category, that included hospitalization and other adverse outcomes; 306 (31.1%) reported at least one post-acute COVID-19 symptom at the 4-week follow-up. Analyses were adjusted for population stratification and demographic covariates. FindingsIn responders with European ancestry, the asthma PRS was associated with severe COVID-19 category (odds ratio [OR]=1.61, 95% confidence interval: 1.17-2.21) and more severe COVID-19 symptomatology ({beta}=.09, p=.01), independently of respiratory disease diagnosis. The allergic disease PRS similarly associated with severe COVID-19 category (OR=1.97, [1.26-3.07]). The PRS for COVID-19 hospitalization was associated with the risk of severe COVID-19 category (OR=1.35, [1.01-1.82]), but this association was smaller than for the asthma PRS. PRS for coronary artery disease and type II diabetes were not associated with COVID-19 severity. InterpretationTaken together, the results indicate that recently developed polygenic biomarkers for asthma, allergic disease, and COVID-19 hospitalization capture some of the individual differences in severity and clinical course of COVID-19 illness in a community population. FundingNational Institute for Occupational Safety and Health, CDC.
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Objective:To analyze the risk factors of lower extremities deep vein thrombosis after thoracoscopic surgery in elderly patients with lung cancer, establish a nomogram prediction model and conduct internal verification.Methods:A total of 183 elderly patients with lung cancer who underwent thoracoscopic radical resection in Nanchong Central Hospital from February 2018 to February 2022 were selected as the study subjects. According to the presence or absence of deep venous thrombosis of the lower extremities within one month after operation, the patients were divided into lower extremities deep venous thrombosis group ( n=61) and non-deep lower extremities venous thrombosis group ( n=122) . Univariate and multivariate analyses of deep venous thrombosis of lower extremities after thoracoscopic surgery for lung cancer in the elderly were performed, and a nomogram prediction model was constructed according to the multivariate analysis results, and the model was verified. Results:There were statistically significant differences in smoking history ( χ2=13.40, P<0.001) , preoperative chemotherapy ( χ2=8.79, P=0.003) , surgical method ( χ2=7.97, P=0.005) , operation time ( t=7.23, P<0.001) , postoperative bed rest time ( t=10.40, P<0.001) , combined with diabetes ( χ2=6.37, P=0.012) , combined with hyperlipidemia ( χ2=9.58, P=0.002) , preoperative D-dimer ( t=13.08, P<0.001) , preoperative fibrinogen ( t=5.84, P<0.001) and preoperative platelet count ( t=7.01, P<0.001) between the lower extremity deep venous thrombosis group and the non-lower extremity deep venous thrombosis group. The results of multivariate logistic regression analysis showed that preoperative chemotherapy ( OR=2.45, 95% CI: 1.05-5.71, P=0.038) , surgical method ( OR=2.55, 95% CI: 1.14-5.73, P=0.023) , postoperative bed rest time ( OR=1.50, 95% CI: 1.24-1.81, P<0.001) , combined with diabetes ( OR=3.60, 95% CI: 1.05-12.33, P=0.042) , and preoperative D-dimer ( OR=1.01, 95% CI: 1.01-1.01, P<0.001) were all independent risk factors for lower extremity deep vein thrombosis in elderly patients with lung cancer after thoracoscopic surgery. The C-index of nomogram for predicting lower extremity deep vein thrombosis-related factors was 0.86 (95% CI: 0.81-0.93) . The calibration curve showed that the model had a good correlation in predicting lower extremities deep venous thrombosis. Conclusion:Preoperative chemotherapy, surgical method, postoperative bed rest time, combined with diabetes, and postoperative D-dimer level are influence factors for lower extremity deep vein thrombosis in elderly patients with lung cancer after thoracoscopic surgery. The nomogram prediction model established in this study has high accuracy and discrimination for the prediction of lower extremity deep vein thrombosis in elderly patients with lung cancer after thoracoscopic surgery.
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Objective:To study the efficacy of different surgical methods in treatment of hilar cholangiocarcinoma (HCCA), and to analyze the factors affecting long-term prognosis of HCCA patients after surgical treatment.Methods:The clinical data of 105 patients who underwent surgical treatment for HCCA at the First Affiliated Hospital of Soochow University from April 2010 to October 2021 were retrospectively analysed. There were 58 males and 47 females, with age (64.2±10.6) years old. Data analysed included surgical treatments, postoperative pathological data, perioperative complications and survival on follow-up. The Kaplan Meier survival curve was plotted, and the log-rank test and Cox proportional hazard model were performed to analyze the key factors affecting long-term prognosis.Results:Of 105 patients, 4 (3.8%) patients died during the perioperative period, and 58 patients (55.2%) developed complications with included 32 (30.5%) patients with pleural effusion and 12 (11.4%) patients with biliary leakage. The follow-up data was available in 85 patients with the overall median survival time of 19 months, and the 1-, 3-, 5-year cumulative survival rates of 58.1%, 27.0% and 24.8% respectively. The 1-, 3-, and 5-year cumulative survival rates for the R 0 resection patients ( n=59) were 69.4%, 36.2%, 27.4%, respectively, which were significantly better than 49.4%, 12.3%, 0% for the R 1/2 resection patients ( n=20), and 0% for the palliative drainage patients ( n=6) (all P<0.05). Univariate analysis and Cox multivariate analysis showed that age ≥70 years ( HR=2.158, 95% CI: 1.175-3.965), preoperative CA19-9 level ≥1 015 U/ml ( HR=1.981, 95% CI: 1.009-3.894), resection margin ( HR=2.587, 95% CI: 1.371-4.881), and lymph node metastasis ( HR=2.308, 95% CI: 1.167-4.567) were independent risk factors for long-term prognosis of HCCA patients (all P<0.05). Conclusions:R 0 resection was an effective way to prolong survival of patients with HCCA. Age, preoperative CA19-9 level, resection margin and lymph node metastasis were related to long-term survival of HCCA patients.
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AbstractsIn light of the novel coronaviruss (COVID-19s) threat to public health worldwide, we sought to elucidate COVID-19s impacts on the mental health of children and adolescents in China. Through online self-report questionnaires, we aimed to discover the psychological effects of the pandemic and its associated risk factors for developing mental health symptoms in young people. We disseminated a mental health survey through online social media, WeChat, and QQ in the five Chinese provinces with the most confirmed cases of COVID-19 during the late stage of the country-wide lockdown. We used a self-made questionnaire that queried children and adolescents aged 6 to 18 on demographic information, psychological status, and other lifestyle and COVID-related variables. A total of 17,740 children and adolescents with valid survey data participated in the study. 10,022 (56.5%), 11,611 (65.5%), 10,697 (60.3%), 6,868 (38.7%), and 6,225 (35.1%) participants presented, respectively, more depressive, anxious, compulsive, inattentive, and sleep-related problems compared to before the outbreak of COVID-19. High school students reported a greater change in depression and anxiety than did middle school and primary school students. Despite the fact that very few children (0.1%) or their family members (0.1%) contracted the virus in this study, the psychological impact of the pandemic was clearly profound. Fathers anxiety appeared to have the strongest influence on a childrens psychological symptoms, explaining about 33% of variation in the childs overall symptoms. Other factors only explained less than 2% of the variance in symptoms once parents anxiety was accounted for. The spread of COVID-19 significantly influenced the psychological state of children and adolescents. It is clear that children and adolescents, particularly older adolescents, need mental health support during the pandemic. The risk factors we uncovered suggest that reducing fathers anxiety is particularly critical to addressing young peoples mental health disorders in this time.
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Objective:To evaluate the efficacy of combination of dexmedetomidine and compound lidocaine cream for the prevention and treatment of the stress responses during recovery from general anesthesia in the patients undergoing transnasal transphenoidal pituitary adenoma resection.Methods:A total of 90 patients, aged 18-64 yr, with body mass index of 18-25 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing elective pituitary tumor resection by transsphenoidal approach with general anesthesia, were divided into 3 groups ( n=30 each) by the random number table method: combination of dexmedetomidine and compound lidocaine cream group (D-L group), dexmedetomidine group (D group) and compound lidocaine cream group (L group). Compound lidocaine cream 2 g was applied to the anterior 1/3 of the tracheal tube and surface of the cuff in D-L and L groups, and paraffin oil was applied to the surface of the tracheal tube in group D. In D-L and D groups, dexmedetomidine 0.5 μg/kg was intravenously infused for 10 min at 30 min before the end of surgery, while the equal volume of normal saline was given in group L. Heart rate and mean arterial pressure were continuously monitored during peritracheal extubation, and the occurrence of responses to extubation was recorded.The optic nerve sheath diameter (ONSD) was measured by ultrasound after entering the operating room(t 0), after anesthesia induction(t 1), and at 5 min after extubation (t 2). The bucking and agitation scores were recorded during recovery from anesthesia. Results:Compared with group D and group L, the incidence of bucking and responses to extubation was significantly decreased in group D-L (27%, 37%, 6%; 23%, 27%, 3%, respectively, P<0.05). Compared with group L, the incidence of agitation was significantly decreased in D-L and D groups (37%, 10%, 13%, respectively, P<0.05). No severe bucking and agitation occurred in group D-L.There was no significant difference in ONSD at each time point among three groups ( P>0.05). Conclusion:Combination of dexmedetomidine and compound lidocaine cream performs better than either alone and can prevent and treat stress responses during recovery from general anesthesia in the patients undergoing transnasal transsphenoidal pituitary adenoma resection.
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Objective To study correlation between serum 25 (OH) d level and metabolic indexes in elderly patients with diabetes mellitus. Methods In this prospective study, 315 elderly patients with diabetes who were diagnosed and treated in our hospital from January 2018 to June 2020 were selected as the research objects, and 100 healthy volunteers in the same period were selected as the control group. The blood lipid, fasting blood glucose (FPG), fasting insulin (fins), glycosylated hemoglobin (HbA1c) and insulin resistance (HOMA) of the two groups were analyzed- The levels of FPG, fins, GHbA1c, HOMA-IR and homa-is in patients with 25 (OH) D deficiency of different severity were compared, and the correlation between serum 25 (OH) d level and metabolic indexes was studied. Results The serum 25 (OH) d level of the observation group was significantly lower than that of the control group (t = 6.080, P = 0.000); the FPG (t = 14.708, P = 0.000), GHbA1c (t = 7.165, P = 0.000), HOMA-IR (t = 8.880, P = 0.000) of the observation group were significantly higher than those of the control group, homa-is (t = 120.847, P = 0.000), fins (t = 120.847, P = 0.000)= The levels of FPG (F = 12.334, P = 0.000), fins (F = 11.897, P = 0.000), GHbA1c (F = 10.090, P = 0.000), HOMA-IR (F = 11.232, P = 0.000) and homa-is (F = 9.009, P = 0.000) were not significantly different between the two groups (P < 0.05) FPG, GHbA1c, HOMA-IR of patients from high to low were deficiency group, deficiency group and sufficiency group, fins, homa-is levels from high to low were sufficiency group, deficiency group and deficiency group; through correlation analysis, serum 25 (OH) d levels of patients were negatively correlated with FPG, GHbA1c, HOMA-IR, and positively correlated with fins, homa-is. Conclusion The level of serum 25 (OH) d in elderly patients with diabetes is significantly correlated with metabolic indexes, which can become one of the important evaluation indexes of treatment effect in the future.
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BackgroundThe mortality of COVID-19 differs between countries and regions. By now, reports on COVID-19 are largely focused on first-generation cases. This study aimed to clarify the clinical characteristics of imported and second-generation cases. MethodsThis retrospective, multicenter cohort study included 134 confirmed COVID-19 cases from 9 cities outside Wuhan. Epidemiological, clinical and outcome data were extracted from medical records and were compared between severe and non-severe cases. We further profiled the dynamic laboratory findings of some patients. Results34.3% of the 134 patients were severe cases, and 11.2% had complications. As of March 7, 2020, 91.8% patients were discharged and one patient (0.7%) died. The median age was 46 years. The median interval from symptom onset to hospital admission was 4.5 (IQR 3-7) days. The median lymphocyte count was 1.1x109/L. Age, lymphocyte count, CRP, ESR, DBIL, LDH, HBDH showed difference between severe and no-severe cases (all P<0.05). Baseline lymphocyte count was higher in the survived patients than in the non-survivor case, and it increased as the condition improved, but declined sharply when death occurred. The IL-6 level displayed a downtrend in survivors, but rose very high in the death case. Pulmonary fibrosis was found on later chest CT images in 51.5% of the pneumonia cases. ConclusionImported and second-generation cases outside Wuhan had a better prognosis than initial cases in Wuhan. Lymphocyte count and IL-6 level could be used for evaluating prognosis. Pulmonary fibrosis as the sequelae of COVID-19 should be taken into account. SummaryImported and second-generation cases manifested less complications, lower fatality, and higher discharge rate than initial cases, which may be related to the shorter interval from symptom onset to hospital admission, younger age, and higher lymphocyte count of the imported and second-generation patients. Lymphocyte count and IL-6 level could be used as indicators for evaluating prognosis. Pulmonary fibrosis was found in later chest CT images in more than half of the pneumonia cases and should be taken into account.
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Objective:To evaluate the influence of goal-directed volume management based on cardiac output index (CI), intrathoracic blood volume index (ITBVI) and extravascular lung water index (EVLWI) in patients undergoing off-pump coronary artery bypass surgery.Methods:Forty patients (ASA 2 to 3 grade) undergoing off-pump coronary artery bypass surgery in Lanzhou University Second Hospital from January 2017 to December 2018 were selected. The patients were divided into 2 groups by random digits table method with 20 cases in each group: study group (goal-directed fluid therapy treatment with CI, ITBVI and EVLWI) and control group (conventional fluid therapy). The control group was given central venous pressure (CVP) monitoring rehydration, and the study group was given PiCCO hemodynamic monitoring indicators. The CVP, CI, ITBVI and EVLWI for fluid management were measured. Accurate assessment of volume status of patients was done. The study group received goal-directed fluid therapy based on CVP, CI, ITBVI and EVLWI, with the goal of CI in the 3.0 to 5.0 L/(min·m 2) range, ITBVI in the 800 to 1 000 ml/m 2 range and EVLWI in the 3.0 to 7.0 ml/kg range. The heart rate, mean arterial pressure (MAP), urine volume, central venous oxygen saturation (ScvO 2), lactic acid and renal function were monitored. The ventilator withdrawal time, hospitalization in ICU, length of stay, incidence of acute pulmonary edema, incidence of acute renal failure, mortality of 30 d after surgery were recorded and compared between the two groups. Results:Tissue perfusion and urine volume of the study group was significantly improved compared with that of control group ( P<0.05). ScvO 2 of the study group was higher than that of the routine group ( P<0.05). The concentration of lactic acid of the study group was lower than that of the routine group ( P<0.05). The incidences of acute pulmonary edema, acute renal insufficiency and mortality of the study group were lower than those of the routine group (5.0% vs. 15.0%, 5.0% vs. 10.0% and 5.0% vs. 15.0%), and there were statistical differences ( P<0.05). The length of stay and hospitalization in ICU were both lower than those in the control group ( P<0.01). Conclusions:Goal-directed fluid therapy based on CI, ITBVI and EVLWI can effectively optimize the cardiac preload of patients undergoing off-pump coronary artery bypass surgery, improve cardiac output, ensure microcirculation perfusion, maintain the balance of oxygen supply and demand, and reduce the incidence of complications and mortality.
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Objective:To investigate the clinical characteristics and treatment of the abdominal cocoon.Mehods:The clinical data of 28 patients with abdominal cocoon from Jan 2004 to Dec 2018 were analyzed retrospectively.Results:Intestinal obstruction was the main clinical manifestations (25 cases), recurrent chronic ileus(17 cases) and abdominal mass (7 cases). Preoperative imaging examination showed varying degrees of intestinal obstruction. CT or MRI scan displayed that small intestinal loops were disorganized , clustered and encased in a thickened capsule. All the cases underwent operations, showing that small bowel were encapsulated in a dense gray-white fibrous membrane. Adhesiolysis and fibrous membrane excision were done with segmental enterectomy when it was necessary. Early postoperative intestinal obstruction occured in 6 cases, all were cured by conservative treatment.Conclusions:The combination of clinical symptoms and CT or MRI may facilitate in preoperative diagnosis. Abdominal cocoon is putative diagnosis when recurrent intestinal obstruction with abdominal mass. Surgery is the therapy of choice.
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Objective A retrospective analysis was conducted on standardized laparoscopic left lateral sectionectomy in liver resection (LLLR) using the "Two Step Two Endo-GIA" procedure.The aim of the study was to improve safety and efficacy of the operation.Methods All patients who underwent LLLR in Department of General Surgery,the First Affiliated Hospital of Soochow University from May 2014 to July 2018 were included in the study.All patients were divided into laparoscopic group (n=56) and open group (n=44).The operative plan followed the standardized procedure used in our department.Results Of 56 patients,there were 28 males and 28 females.No hepatic hilar occlusion was required and no case was converted to laparotomy.The average age was (55.7± 13.0),tumor diameter (6.3±3.7) cm,liver dissection time (30.0± 10.9) min,intraoperative blood loss (142.3±22.8) ml,and postoperative length of hospital stay (6.1±2.4) d.The average follow-up was (36.6± 10.1) months.One patient developed mild bile leakage and recovered after drainage.The other patients had no serious postoperative complications.The laparoscopic group was superior to the open group in operation time (90.0±17.0 vs.129.3±38.8) min,fasting time (1.5±1.0 vs.2.1±1.1) d,TBil (13.0±2.6 vs.19.0±3.1) μmol/L and ALT (80.0±19.3 vs.200.0±32.1) U/L.Conclusion A standardized LLLR has the advantages of short operation time,good reproducibility and short learning curve.It can be used as a standard procedure at all hospital levels.
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Objective To investigate the risk factors for pulmonary complications in patients with aneurysmal subarachnoid hemorrhage (aSAH) and the impact on outcome.Methods Patients with aSAH admitted to the First People's Hospital of Tianmen from January 2016 to December 2017 were enrolled retrospectively.The demographic and baseline data of the patients were collected.Pulmonary complications mainly included pulmonary infection,acute lung injury,and neurogenic pulmonary edema.Clinical outcomes were assessed after 6 months using the modified Rankin scale,0-3 was defined as good outcome and ＞3 was defined as poor outcome.Multivariate logistic regression analysis was used to determine independent risk factors for pulmonary complications and poor outcome.Results A total of 230 patients with aSAH were enrolled,with an average age of 57 years,135 males and 95 females.One hundred and twenty patients (52.2％) complicated with pulmonary complications,113 of them complicated with hospital-acquired pneumonia,5 complicated with acute lung injury,and 2 complicated with neurogenic pulmonary edema.One hundred and seventy-two patients (74.8％) had good outcomes and 58 had poor outcomes.Multivariate logistic regression analysis showed that Hunt-Hess grade 3-5 (odds ratio [OR] 1.500,95％ confidence interval[CI] 1.043-2.159;P=0.029),Fisher grade 3-4 (OR 1.366,95％ CI 1.031-1.089;P=0.022),and tracheotomy or mechanical ventilation (OR 1.662,95％ CI 1.002-2.757;P =0.049) were the independent risk factors for pulmonary complications;Hunt-Hess grade 3-5 (OR 1.840,95％ CI 1.590-2.129;P ＜0.001),Fisher grade 3-4 (OR 3.522,95％ CI 3.056-4.058;P＜0.001),ventricular casting (OR 2.130,95％ CI 1.258-3.609;P=0.005),and pulmonary complications (OR 1.531,95％ CI 1.186-1.975;P=0.001) were the independent risk factors for poor outcome.Conclusions Higher Hunt-Hess and Fisher grades and tracheotomy or mechanical ventilation were associated with the increased risk of pulmonary complications in patients with aSAH.The occurrence of pulmonary complications had adverse effects on the clinical outcomes of patients.
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Objective To investigate the antimicrobial resistance profile of the Streptococcus pneumoniae strains isolated from respiratory tract of children in Zhongshan Boai Hospital, Guangdong Province for better management of such infections. Methods The sputum samples were collected from respiratory tract of children in pediatric outpatient and inpatient from May 2013 to August 2017. S. pneumoniae strains were isolated and identified and their susceptibility to antimicrobial agentswas determined. Results The prevalence of S. pneumoniae was 10.6％ (2 963/28 006) in the sputum samples. S. pneumoniae was mainly isolated from children under 6 years old, and relatively higher in winter and spring. About 43.0％ of the S. pneumoniae isolates was associated with mixed infection, especially Moraxella catarrhalis and Haemophilus influenzae. About 6.0％ of the S. pneumoniae isolates were non-susceptible to penicillin, 59.3％ non-susceptible to ceftriaxone, and more than 95％ non-susceptible to erythromycin, clindamycin or tetracycline. However, more than 95％ of the isolates were susceptible to chloramphenicol or ofloxacin. No S. pneumoniae isolate was found resistant to rifampin, linezolid or vancomycin. Conclusions The respiratory tract infection caused by S. pneumoniae of children is increasing year by year, which is associated with age, season, and higher rate of mixed infection. These data showed that penicillin non-susceptible S. pneumoniae is highly prevalent in Zhongshan. More than 95％ of the S. pneumoniae isolates from children are resistant to erythromycin, clindamycin or tetracycline. S. pneumoniae isolates should be closely monitored for the emergence of multidrug resistant strains. Appropriate control measures must be taken according to the results of susceptibility testing.
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Current status and problems of experimental teaching for medical postgraduate were an-alyzed. Based on experimental teaching in Center of Experimental Teaching for Postgraduates in Medicine at Xi'an Jiaotong University , application of flipped classroom to experimental teaching for postgraduates were discussed in details. Application of flipped classroom to experimental teaching of Cellular and Molec-ular Biology for postgraduates in medicine was introduced. After advantages and disadvantages of flipped classroom were analyzed, countermeasures were proposed. Combining flipped classroom with traditional teaching method is considered to be helpful to the utilization of flipped classroo, and the enhancement of in-novative thinking of postgraduates.
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Objective To investigate the effects of mild hypothermia on post-resuscitation neurological outcome after ventricular fibrillation (VF) in rabbits.Methods Forty-five adult New Zealand rabbits were induced VF by direct current of electricity.The rabbits were randomly(random number) divided into following groups:normothermic resuscitation group (NR),mild hypothermia prearrest group (HP),mild hypothermia resuscitation 30 min group (HRe30),mild hypothermia resuscitation 90 min group (HRe90),normothermic sham group (NS),and hypothermia sham group (HS).The rabbits of NR group were observed for 600 min in room temperature after restoration of spontaneous circulation (ROSC).The mild hypothermia was induced by surface cooling,and maintained for 600 min after the aimed low temperature reached.The arterial blood samples were collected for determining neuron-specific enolase (NSE) and thioredoxin (Trx) and the mean arterial pressure (MAP),left ventricular end-diastolic pressure (LVEDP) and left ventricular pressure raise and fall rate (±dp/dtmax) were observed at 15 min before CA,and 30 min,60 min,120 min,360 min and 600 min after ROSC.After the animals were sacrificed at 600 min after ROSC,the whole brain of animals was harvested and observed under light microscope to calculate the apoptotic index of the hippocampal CA1 neurons by using TUNEL method.One-way ANOVA was used to determine the statistical significance between two groups,a two-tailed value of P＜0.05 was considered statistically significant.Results (1) Hemodynamically compared with normal temperature groups,HR was lower in hypothermia groups.Compared with NR,HRe30,and HRe90 group,LVEDP was higher in HP group at 30 min after ROSC(3.4±0.8 vs.4.6±1.0,4.1±0.5,4.3±0.2,F=9.85,P=0.019).In Hp group,the level of +dp/dtmax was higher than that in NR,HRe30 and HRe90 groups at 30 min and 120 min after ROSC.In HP group,the level of-dp/dtmax was higher than that of NR group at 30 min,60 min,120 min,360 min and 600 min after ROSC.(2) Serologically compared with HP,HRe30 and HRe90 group,NSE levels were higher in NR group at 60 min,120 min and 360 min after ROSC.Compared with NR,HRe30,and HRe90 group,Trx levels in NR group were lower at 60 min,120 min,360 min and 600 min after ROSC.Compared with HP group,Trx levels in HRe30 and HRe90 groups were higher at 60 min,120 min,360 min and 600 min after ROSC.(3) Pathologically compared with NR group,histopathological changes in hippocampus CA1 area were milder found in HP,HRe30 and HRe90 groups.AI (％) was lower in HP,HRe30 and HRe90 groups than that in NR group[(62.25±10.43)％ vs.(20.61±5.02)％,(25.08±3.92)％,(30.33±7.15)％,P=0.001].Concusions This study shows that hypothermia should be initiated as soon as possible,and especially early intra-arrest cooling appears to be significantly better than post-ROSC cooling and normothermia.
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Objective@#To investigate the clinical manifestations and genetic features of a child with Bainbridge-Ropers syndrome caused by ASXL3 gene variation and review the literature.@*Methods@#Clinical data and genetic features were collected and analyzed from a child with Bainbridge-Ropers syndrome who was diagnosed in Bao'an Maternity and Child Health Hospital in November 2016. "ASXL3" and "Bainbridge-Ropers" were used as key words to search at China National Knowledge Infrastructure, Wangfang Data Knowledge Service Platform, PubMed and Human Gene Mutation Database up to June 2017.@*Results@#A 29/12 years old girl was presented with psychomotor retardation, feeding difficulty, hypotonia and specific craniofacial phenotype. She showed severe growth retardation (height: 84 cm, body weight: 8.0 kg (both were less than 3rd percentile rank of the children at the same age) and head circumference: 46 cm(=3rd percentile rank)), without obvious abnormalities in laboratory tests and neuroimaging tests. A de novo heterozygous nonsense variation: c.3349C>T(p.R1117*) in ASXL3 gene was identified by the whole exome sequencing, and the novel variation was classified into pathologic variant based on Standards and guidelines for the interpretation of sequence variants from ACMG. According to literature retrieval, no Chinese cases with ASXL3 variation had been reported. Totally 28 cases including the present girl harboring ASXL3 variations with detailed clinical information were reported. Thirty-one variations in ASXL3 gene were involved, including 1 missense variation and 30 loss of function variations, which were all de novo variations.@*Conclusions@#The clinical features of Bainbridge-Ropers syndrome include severe psychomotor retardation, feeding difficulties, hypotonia and specific facial features. The heterozygous nonsense variation in ASXL3 gene is the cause of the patient. All the pathogenic variations in ASXL3 gene are de novo and loss of function variations.
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Objective To investigate the distribution characteristics of pathogenic bacteria among different seasons and ages in children lower respiratory tract infection.Methods To retrospectively analyze the results of bacterial culture in pediatric outpatients and inpatients with lower respiratory tract infections in our hospital from September 2014 to August 2015.The pathogenic bacterial detection situation of lower respiratory tract infection among different age groups and different were statistically analyzed.Results A total of 2 809 pathogenic bacterial strains were isolated from 4 629 lower respiratory tract specimens,and detection rate was 60.7%.The pathogenic bacteria distribution was different among different age groups.Haemophilus influenzae (33.3%) ranked the first place in the lower respiratory infection among children aged from 19 d to 7 year old.The detection rates of Haemophilus parainfluenzae,Moraxella catarrhalis and staphylococcus aureus had obvious seasonality,while Streptococcus pneumoniae had no obvious seasonality.Conclusion Pathogenic bacteria causing lower respiratory tract infections in children are different from those in adults,which are affected by age and seasonal change.
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Objective To determine the clinical value of laparoscopic right hepatectomy (LRH) carried out following a standardized technique.Methods The medical records of 15 patients who underwent LRH at the First Affiliated Hospital of Soochow University were retrospectively reviewed.The perioperative indicators which included the operation duration,blood loss,tumor diameter,hospitalization duration and postoperative complications were analyzed.Results There was no conversion to open surgery.The operation duration was (251.1 ± 73.3) min.The resected tumor diameter was (8.5 ± 4.2) cm,the blood loss was (550.8 ± 343.6) ml,and the hospitalization duration was (10.2 ± 3.7) days.There was one patient who developed postoperative bile leakage.There was no other complication and there was no perioperative death.Conclusions The standardized technique of LRH was easy and effective.This technique shortened the operation duration and improved patient safety.
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New characteristics and changes of laboratory security were summarized,and then current status and problems of awareness of laboratory security of medical postgraduate under the new situation were analyzed in detail.Based on laboratory security education in Center of Experimental Teaching for Postgraduates in Medicine at Xi'an Jiaotong University,strategies to enhance their awareness and capacity of laboratory security were proposed.Compilation of textbooks on laboratory security,development of curriculum content,training of laboratory security practice,and establishment of evaluation system and laboratory access regulation,will be helpful to maximize safety of postgraduates and to guarantee security of laboratory.
ABSTRACT
Trichloroethylene (TCE) is a ubiquitous environmental contaminant. Occupational TCE exposure has been associated with severe, generalized contact hypersensitivity (CHS) skin disorder. The development of CHS depends on innate and adaptive immune functions. Transforming growth factor-ß activated kinase-1 (TAK1) controls the survival of dendritic cells (DCs) that affect the immune system homeostasis. We aimed to investigate the role of TAK1 activity in DC on TCE-induced CHS response. Control mice and DC-specific TAK1 deletion mice were treated with 80% (v/v) TCE using local lymph node assay (LLNA) to establish a TCE-induced CHS model. The draining lymph nodes (DLNs) were excised and the lymphocytes were measure for proliferation by BrdU-ELISA, T-cell phenotype analysis by flow cytometry and signaling pathway activation by western blot. The ears were harvested for histopathological analysis. Control mice in the 80% TCE group displayed an inflammatory response in the ears, increased lymphocyte proliferation, elevated regulatory T-cell and activated T-cell percentages, and more IFN-γ producing CD8(+) T cells in DLNs. In contrast to control mice, DC-specific TAK1 deletion mice in the 80% TCE group showed an abolished CHS response and this was associated with defective T-cell expansion, activation and IFN-γ production. This effect may occur through Jnk and NF-κB signaling pathways. Overall, this study demonstrates a pivotal role of TAK1 in DCs in controlling TCE-induced CHS response and suggests that targeting TAK1 function in DCs may be a viable approach to preventing and treating TCE-related occupational health hazards.
