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ObjectiveTo investigate the clinical efficacy of Huangqi injection combined with Buzhong Yiqi acupuncture in the treatment of chronic fatigue syndrome (CFS) with Qi deficiency and its effects on TCM syndromes, fatigue symptoms, serum superoxide dismutase (SOD), malondialdehyde (MDA), and oxidized low-density lipoprotein (ox-LDL) levels. MethodA total of 200 patients with CFS of Qi deficiency were randomly divided into a control group (100 cases) and an observation group (100 cases). The control group was treated with vitamin B compounds, and the observation group was treated with Huangqi injection combined with Buzhong Yiqi acupuncture for two weeks. The scores of TCM syndromes, fatigue symptoms, levels of serum SOD, MDA, and ox-LDL and the incidence of adverse reactions were observed and compared before and after treatment in two groups. ResultAfter treatment, the total effective rate of the control group was 54.34% (50/92), while that of the observation group was 88.54% (85/96). The total effective rate of the observation group was higher than that of the control group (χ2=27.13,P<0.05). Compared with those in the two groups before treatment, scores of fatigue self-assessment scale (FSAS), physical fatigue and mental fatigue, and sleep/rest response scores of fatigue in the two groups after treatment were significantly decreased (P<0.05). After treatment, scores of FSAS, physical fatigue and mental fatigue, and sleep/rest response scores of fatigue in the observation group were significantly decreased compared with those in the control group (P<0.05). Compared with those in the two groups before treatment, TCM syndrome scores in the two groups after treatment were significantly decreased (P<0.05). After treatment, TCM syndrome scores in the observation group were significantly decreased compared with those in the control group (P<0.05). Compared with those in the two groups before treatment, MDA levels in the two groups were significantly decreased (P<0.05), ox-LDL levels in the observation group were significantly decreased (P<0.05), and SOD levels were significantly increased (P<0.05). After treatment, compared with those in the control group, the serum MDA and ox-LDL levels in the observation group were significantly decreased (P<0.05), and the serum SOD was significantly increased (P<0.05). No serious adverse events or adverse reactions occurred during this clinical trial. ConclusionHuangqi injection combined with Buzhong Yiqi acupuncture has a good clinical curative effect in the treatment of CFS with Qi deficiency, which can effectively improve the fatigue symptoms of patients, increase the level of SOD, and reduce the level of serum MDA and ox-LDL. It is related to the production of antioxidants, inhibiting the production of lipid peroxides, and improving the body's ability to resist oxidative stress.
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Objective:To explore the clinical feasibility of finger-pressing therapy based on the theory of treating impotence alone with Yang Ming to reduce incidence of ICU acquired weakness (ICU-AW) in critically ill children and provide a feasible nursing plan for ICU acquired asthenia in critically ill children.Methods:A quasi-experimental study was conducted. A total of 73 critically ill children were admitted to the PICU of Kunming Children′s Hospital from January 1 to April 30, 2021. According to the random number table, the subjects were divided into the observation group (37 cases) and the control group (36 cases). Children in the control group received routine PICU nursing. The children in the observation group were treated with PICU routine nursing and finger-pressing therapy based on the theory of treating impotence alone with Yang Ming. The two groups were compared in terms of limb muscle strength score (MRC-Score), incidence of ICU-AW, basic activities of life (Barthel Index, BI), limb muscle thickness.Results:After intervention, the MRC-Score of the observation group was 50 (46, 52) points, which was higher than 46 (40, 48) points of the control group, and the difference between the two groups was statistically significant ( Z=-3.70, P<0.05). The incidence of ICU-AW in the observation group was 32.43% (12/37), and the incidence of ICU-AW in the control group was 72.22% (26/36). The difference between the two groups was statistically significant ( χ2=11.58, P<0.05). The BI score of the observation group was 63 (50, 70), which was higher than 44 (40,60) of the control group, and the difference between the two groups was statistically significant ( Z=-3.94, P<0.05). The reduction degree of quadriceps femoris thickness in the observation group at D3-D1 was (-0.381 ± 0.131) cm, which was lower than (-0.762 ± 0.182) cm in the control group, and the difference between the two groups was statistically significant ( t=10.29, P<0.05). Conclusions:The application of finger-pressing therapy guided by theory of treating impotence alone with Yang Ming in the early rehabilitation of critically ill children can enhance muscle strength, prevent muscle atrophy and reduce the incidence of ICU-AW in critically ill children.
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Objective@#To explore the impact of maternal anxiety during pregnancy on social emotional development of toddlers aged 1-3 year old, so as to provide references for scientific early parenting and early intervention for toddlers with social emotional difficulties.@*Methods@#From September 2022 to March 2023, a total of 815 toddlers aged 1-3 who underwent physical examinations and their mothers at Nantong Maternal and Child Health Hospital were enrolled. The Chinese Infant Toddler Social and Emotional Assessment (CITSEA) was used to evaluate the social emotional ability among toddlers. Maternal anxiety evaluated using the Self rating Anxiety Scale (SAS) during prenatal visit was collected.@*Results@#The average scores on the externalizing, internalizing, dysregulation and competence domains of the CITSEA were (49.40±9.48,47.42±9.60,48.67± 10.15 , 50.07± 10.20), respectively. Among boys, the score of externalizing domain (50.89±9.45) was higher than that of girls (48.76± 9.50 ), while the score of competence domain (49.22±10.30) was lower than that of girls (51.17±9.84), and the differences were statistically significant( t =2.10, -3.03, P <0.05). The detection rates of abnormalities in the externalizing, internalizing, dysregulation, and competence domains were 7.36%, 7.12%, 7.61%, and 7.24%, respectively. Among them, boys (8.43%,6.32%, 7.96 %,7.49%) and girls (6.19%, 7.99 %,7.22%,6.96%) showed no statistical differences ( χ 2=1.50, 0.85, 0.16, 0.09, P >0.05). There were significant differences in externalizing domain scores(47.77±9.52,49.56±8.95,52.51±9.77) and competence domain scores(51.70±10.38,49.65±10.05,46.68±10.03) among toddlers of different maternal anxiety(normal, mild, moderate to severe) ( F =7.05,7.10, P <0.01). There were significant differences in the abnormal detection rate of externalizing domain (4.81%,7.54%,11.17%) and competence domain(4.81%,6.96%,11.73%)( χ 2=6.60,7.98, P <0.05).@*Conclusion@#Maternal anxiety during pregnancy has a negative impact on the social emotional development among toddlers. In order to improve social emotional development of toddlers, multidimensional social support and education during pregnancy should be carried out.
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Objective:To evaluate the radiation shielding performance for a novel self-shielded ZAP-X radiotherapy system used for intra-cranial and neck treatments. The present evaluation was performed according to the relevant Chinese national standards and the clinical placement of the radiotherapy system in an unshielded treatment room.Methods:The radiation source of the ZAP-X was a 3 MV linear accelerator. A total of 33 detection sites were selected surrounding the self-shielded system at 1.3, 2.3 and 3.3 m away from the periphery of the equipment. The maximum ambient dose equivalent rate in each irradiation condition was measured accordingly. A commonly used clinical treatment plan was selected to simulate the treatment process. During the delivery of this treatment plan, the cumulative doses of these 33 sites were measured, separately. The applicable current radiation protection standard for radiotherapy in China was chosen to evaluate the radiation shielding performance of the system.Results:According to the measurement result of the ambient dose equivalent rates along the aforementioned perimeter lines, a suggestion was put forward to redefine the existing 1 m controlled area by determining the distance at which the instantaneous dose rate of 10 μSv/h will not be exceeded. This is to meet the requirements of the Chinese standard GBZ 121-2020.Conclusions:According to the existing Chinese national radiation protection standards, the self-shielded radiotherapy system in the unshielded treatment room has the clinical applicability in China. But for such a novel self-shielded system, the corresponding performance testing and radiation protection standards shall be formulated.
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Objective:To evaluate the dosimetric characteristics of Zap-X system and CyberKnife (CK) G4 system of stereotactic radiosurgery (SRS) for single brain metastasis.Methods:Twelve patients with single brain metastasis had been treated with CK were selected retrospectively. The prescribed dose of planning target volume (PTV) was 18-24 Gy for 1-3 fractions. The PTV was ranged from 0.44 to 11.52 cm 3. The 12 patients were re-planned in the Zap-X planning system using the same prescription dose and organs at risk constraints, and the prescription dose of PTV was normalized to 70% for both Zap-X and CK. The planning parameters and dosimetric parameters of PTV and organs at risk were compared and evaluated between two plans. All data were read at MIM Maestro. A paired Wilcoxon' signed-rank test was adopted for statistical analysis. A P value of less than 0.05 was considered as statistical significance. Results:For the target coverage, CK was significantly higher than Zap-X (99.14±0.57% vs. 97.55±1.34%, P<0.01), but Zap-X showed a higher conformity index (0.81±0.05 vs. 0.77±0.07, P<0.05), a lower Paddick gradient index (2.98±0.24 vs. 3.15±0.38), and a higher gradient score index (GSI) than CK. The total monitor unit (MU) of Zap-X was significantly lower than that of CK (11 627.63 ±5 039.53 vs. 23 522.16 ±4 542.12, P<0.01) and the treatment time was shorter than that of CK [(25.08 ±6.52) vs. (38.08 ±4.74) min, P<0.01]. Zap-X had lower dose volumes than CK for the dose of brain ( P<0.05). Zap-X had a lower D mean and D max of brainstem (both P<0.05), but a higher value of eyes and lens. For optic nerves and optic chiasm, there were no significant differences between two groups. In addition, for the protection of skin (V 22.5 Gy), Zap-X seemed better than CK [(4.15±4.48) vs. (4.37±4.50) cm 3, P<0.05]. Conclusions:For SRS treating single brain metastasis, Zap-X could provide a high quality plan equivalent to or even better than CK, especially reducing the treatment time. With continuous improvement and upgrading of Zap-X system, it may become a new SRS platform for the treatment of brain metastasis.
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Objective:To compare the dosimetric characteristics of beams between Zap-X and G4 CyberKnife and provide reference for clinical application of Zap-X.Methods:PTW three-dimensional water tank and dosimetry diode ionization chamber were used to measure the two orthogonal off-axis ratio and field size at isocenter of 7 different collimators (5 mm, 7.5 mm, 10 mm, 12.5 mm, 15 mm, 20 mm and 25 mm) of Zap-X and CyberKnife at the water depth of maximum dose, 50 mm, 100 mm, and 200 mm. The penumbra, flatness, symmetry and field size under each parameter condition were analyzed by using PTW supporting software PTW MEPHYSTO (version 5.1). Data analysis and graph were performed using Origin 2021 software.Results:With the same collimator, the dose plateau area of Zap-X was wider than that of G4 CyberKnife, and the dose fall-off at the field edge of Zap-X system was faster. With the increase of the collimator, the penumbra of Zap-X and CyberKnife tended to become larger, and the flatness tended to become smaller, the penumbra and flatness of Zap-X were significantly smaller than those of CyberKnife. Both of them had excellent symmetry (<1%), and the symmetry results of CyberKnife (<0.39%) were better than that of Zap-X (0.99%). The accuracy of Zap-X collimator size at isocenter was better than that of CyberKnife.Conclusion:Compared with G4 CyberKnife, Zap-X system has smaller penumbra, better flatness and higher accuracy of collimator size, which is suitable for stereotactic radiosurgery.
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Objective@#To understand sensory characteristics and its correlation with behavioral problems among children with autism spectrum disorder (ASD), so as to provide reference basis for early diagnosis and comprehensive intervention of ASD children.@*Methods@#Using cross sectional survey, 193 ASD children trained by Nantong rehabilitation institutions were recruited from September 2021 to February 2022. All children were investigated with the Short Sensory Profile (SSP) and Parent Symptom Questionnaire (PSQ).@*Results@#Among the 193 ASD children, 106 (54.9%) children had abnormal sensory characteristics, including 45 (23.3%) with possible abnormalities and 61 (31.6%) with obvious abnormalities. The abnormal rate of auditory filtering was the highest in the seven dimensions, reaching 85.0%, followed by low strength/weakness, motor sensitivity, taste/smell sensitivity, low response/seeking sensation, vision/hearing sensitivity and tactile sensitivity. The total incidence of sensory abnormalities was 93.3%. There were significant differences in six dimensions of PSQ scale scores of ASD children with different degrees of sensory abnormalities, including conduct problems, learning problems, psychosomatic disorders, impulsive hyperactivity, anxiety and hyperactivity index ( H =38.89, 38.90, 19.53, 46.34, 34.54, 54.90, P <0.01). With the aggravation of sensory abnormalities in children with ASD, the scores of all dimensions of the PSQ scale increased significantly. The total score of SSP was negatively correlated with the six dimensions of conduct problems, learning problems, psychosomatic disorders, impulsive hyperactivity, anxiety and hyperactivity index in PSQ ( r =-0.53, -0.50, -0.32, -0.55, -0.43, -0.61, P <0.01).@*Conclusion@#ASD children generally have sensory abnormalities, which coincide with severity of behavioral problems. There is a positive correlation between sensory abnormalities and behavioral problems in ASD children. More attention should be paid to the abnormal sensory characteristics of children with ASD in the future diagnosis and treatment process.
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Pancreatic ductal adenocarcinoma (PDAC) has poor prognosis due to limited therapeutic options. This study examines the roles of genome-wide association study identified PDAC-associated genes as therapeutic targets. We have identified HNF4G gene whose silencing most effectively repressed PDAC cell invasiveness. HNF4G overexpression is induced by the deficiency of transcriptional factor and tumor suppressor SMAD4. Increased HNF4G are correlated with SMAD4 deficiency in PDAC tumor samples and associated with metastasis and poor survival time in xenograft animal model and in patients with PDAC (log-rank P = 0.036; HR = 1.60, 95% CI = 1.03-2.47). We have found that Metformin suppresses HNF4G activity via AMPK-mediated phosphorylation-coupled ubiquitination degradation and inhibits in vitro invasion and in vivo metastasis of PDAC cells with SMAD4 deficiency. Furthermore, Metformin treatment significantly improve clinical outcomes and survival in patients with SMAD4-deficient PDAC (log-rank P = 0.022; HR = 0.31, 95% CI = 0.14-0.68) but not in patients with SMAD4-normal PDAC. Pathway analysis shows that HNF4G may act in PDAC through the cell-cell junction pathway. These results indicate that SMAD4 deficiency-induced overexpression of HNF4G plays a critical oncogenic role in PDAC progression and metastasis but may form a druggable target for Metformin treatment.
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Environmental complexity leads to differences in the spatial distribution of heavy metal pollution in soil and rice. Such spatial differences will seriously affect the safety of planted rice and can impact regional management and control. How to scientifically reveal these spatial differences is an urgent problem. In this study, the spatial mismatch relationship between Cd pollution in soil and rice grains (brown rice) was first explored by the interpolation method. To further reveal the causes of these, the specific recognition rules of the spatial relationship of Cd pollution were extracted based on a decision tree model, and the results were mapped. The results revealed a spatial mismatch in Cd pollution between the soil and rice grains in the study area, and the main results are as follows: (i) slight soil pollution and safe rice accounted for 68.88% of the area; (ii) slight soil pollution and serious rice pollution accounted for 13.39% of the area and (iii) safe soil and serious rice pollution accounted for 11.63% of the area. In addition, 11 recognition rules of Cd spatial pollution relationship between soil and rice were proposed, and the main environmental factors were determined: SOM (soil organic matter), Dis-residence (distance from residential area), soil pH and LAI (leaf area index). The average accuracy of rule recognition was 75.90%. The study reveals the spatial mismatch of heavy metal pollution in soil and crops, providing decision-making references for the spatial accurate identification and targeted prevention of heavy metal pollution spaces.
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Oryza , Poluentes do Solo/análise , Cádmio/análise , Árvores de Decisões , Monitoramento Ambiental , Poluição Ambiental/análise , SoloRESUMO
BACKGROUND: Neuromodulation is recommended for patients with refractory tuberous sclerosis related epilepsy (TRE) who are unable to localize epileptogenic nodules after comprehensive preoperative evaluation or for patients and families who do not agree to resection. CASE DESCRIPTION: We report a patient with refractory TRE who received deep brain stimulation of anterior thalamic nucleus (ANT-DBS) and achieved a satisfactory response. To our knowledge, this is the first case of TRE being treated with ANT-DBS. A 22-year-old male was admitted to the hospital for refractory TRE seeking surgical treatment. Seizures were mainly manifested by deep temporal and frontal lobe epilepsy and suspected to originate in the limbic system. Magnetic resonance imaging revealed extensive potentially epileptogenic nodules in the brain lacking significant nodules. Scalp electroencephalogram showed a comprehensive, bilateral synchronous low-voltage rapid rhythm, unable to localize seizure origin. We performed bilateral ANT-DBS according to the preoperative evaluation, and the frequency and intensity of seizures were significantly reduced after the 15-month follow-up (P <0.05, Student's t-test). Our case extends the therapeutic indications of ANT-DBS to a certain extent, providing a neuromodulation alternative to vagus nerve stimulation for patients with TRE who are unsuitable candidates or refuse resection.
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Núcleos Anteriores do Tálamo/cirurgia , Estimulação Encefálica Profunda/métodos , Epilepsia Resistente a Medicamentos/etiologia , Epilepsia Resistente a Medicamentos/cirurgia , Procedimentos Neurocirúrgicos/métodos , Esclerose Tuberosa/complicações , Esclerose Tuberosa/cirurgia , Eletrodos Implantados , Eletroencefalografia , Humanos , Imageamento por Ressonância Magnética , Masculino , Exame Neurológico , Convulsões/etiologia , Convulsões/cirurgia , Resultado do Tratamento , Adulto JovemRESUMO
Objective:To assess the efficacy and safety of different antithrombotic strategies in patients following transcatheter aortic valve replacement(TAVR).Methods:A computerized search was performed to identify all relevant publications from PubMed, EMbase, CNKI and Wangfang databases.Non-randomized controlled trials of oral anticoagulant(OAC) vs. antiplatelet therapy(APT)and vitamin K antagonists(VKAs) vs. non-vitamin K antagonist oral anticoagulants(NOACs)after TAVR were collected, and the effects on postoperative bleeding, cerebrovascular events and all-cause mortality were analyzed.A meta-analysis was performed using RevMan 5.2 software provided by the Cochrane Collaboration. Results:A total of 9 studies were included.Compared with APT, the incidence of bleeding events caused by OAC increased(20.3% vs. 26.3%, OR=1.20, 95% CI: 1.04-1.39, P=0.01), while the incidence of cardiovascular events and all-cause mortality had no statistical difference.In the OAC group, all-cause mortality was lower in the VKAs group than in the NOACs group(9.8% vs. OR=0.73, 95% CI: 0.55-0.97, P=0.03). However, there was no statistical significance in cardiovascular and bleeding events( P>0.05). Conclusions:Compared with patients receiving APT, the incidence of bleeding events is higher in patients taking OAC.In patients taking OAC, VKAs can significantly decrease the mortality compared with NOACs.
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Prostate cancer is one of the life threatening disorders for human being, which has a high incidence over the world. At present, treatments include surgery, radiation therapy, cryosurgery, chemotherapy and hormonal therapy etc. Also, dietary modifications may decrease incidence of developing prostate cancer. This article summarizes current treat-ments, which may be helpful to prevent life threatening disease.
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Objective To compare the transurenthral resection to radical cystectomy on muscle invasive bladder cancer, and to explore the factors affecting the prognosis. Methods Data of 74 patients with muscle invasive bladder can?cer were retrospectively analyzed. There were 38 cases underwent radical cystectomy (group A), and were treated with intra?venous chemotherapy after operation. There were 36 cases underwent transurenthral resection (group B), and were treated with intravenous and urinary bladder irrigation chemotherapy. All patients were followed up 61 (5-91) months. Data were compared between two groups including duration of surgery, intraoperative blood loss, the cumulative length of hospital stay, cancer recurrence rate and 5-year survival rate . The factors may affecting the prognosis in patients were collected and ana?lyzed by the Log-rank univariate and Cox multivariate analyzed. Results The values of operation time, intraoperative blood loss and the cumulative length of hospital stay were significantly lower in group B than those of group A ( P0.05). Results of the Log-rank univariate analysis showed that the tumor size≥5 cm and T3 stage were the important factors of 5-year relapse-free survival rate and 5-year overall survival rate. Results of the Cox multivariate analysis showed that the tumor size≥5 cm (RR=3.687, 95%CI:1.913-7.105, P<0.001) was the important factor of recurrence in patients after operation. T3 stage (RR=3.325, 95%CI:1.437-7.695, P=0.005) and tumor size≥5 cm (RR=5.017, 95%CI:2.440-10.317, P=0.002) were the risk fac?tors of the 5-year overall survival rate. Conclusion The transurenthral resection with intravenous and urinary bladder irri?gation chemotherapy deserves recommendation for the treatment of muscle invasive bladder cancer. Tumor size ≥5 cm and T3 stage are the important factors for the prognosis.