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Sepsis is a life-threatening organ dysfunction caused by the host disordered response to infections.As one of the most important innate immune cells in the body,macrophages can maintain the immune homeostasis by recruiting other immune cells,clearing pathogens,presenting antigens,and play important regulatory roles in infectious diseases such as sepsis by releasing inflammatory factors.As a critical neurotransmitter,dopamine not only participates in the neurological processes such as learning and cognition,but also regulates the immune processes,including regulating the activation,proliferation and functional changes of immune cells such as neutrophils,lymphocytes,monocytes and macrophages.Current studies demonstrate that during the infection and inflammation process of sepsis,the phagocytosis,polarization,and release of inflammatory factors of macrophages are regulated by dopamine.This review summarized the recent research progress on the regulatory functions and the underlying mechanisms of dopamine on macrophages in sepsis.
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@#Objective To explore the key points and difficulties of intraoperative frozen section diagnosis of pulmonary diseases. Methods The intraoperative frozen section and postoperative paraffin section results of pulmonary nodule patients in Beijing Chaoyang Hospital, Capital Medical University from January 2021 to January 2022 were collected. The main causes of misdiagnosis in frozen section diagnosis were analyzed, and the main points of diagnosis and differential diagnosis were summarized. Results According to the inclusion criteria, a total of 1 263 frozen section diagnosis results of 1 178 patients were included in the study, including 475 males and 703 females, with an average age of 58.7 (23-86) years. In 1 263 frozen section diagnosis results, the correct diagnosis rate was 95.65%, and the misdiagnosis rate was 4.35%. There were 55 misdiagnoses, including 18 (3.44%) invasive adenocarcinoma, 17 (5.82%) adenocarcinoma in situ, 7 (35.00%) mucinous adenocarcinoma, 4 (2.09%) minimally invasive adenocarcinoma, 3 (100.00%) IgG4 related diseases, 2 (66.67%) mucinous adenocarcinoma in situ, 1 (16.67%) atypical adenomatous hyperplasia, 1 (14.29%) sclerosing pulmonary cell tumor, 1 (33.33%) bronchiolar adenoma, and 1 (100.00%) papillary adenoma. Conclusion Intraoperative frozen section diagnosis still has its limitations. Clinicians need to make a comprehensive judgment based on imaging examination and clinical experience.
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Objective:To investigate the current situation of medical social worker supervision in Shanghai, for reference to promote the high-quality development of medical social work.Methods:From June to July 2022, a questionnaire survey was conducted on the in-service medical social workers in all medical institutions with medical social work departments or posts in Shanghai. The questionnaire mainly included demographic information, current status of supervision implementation, and effectiveness of supervision. The data were analyzed descriptively with t test for comparison between groups and the Pearson test was for correlation analysis. Results:A total of 99 medical social workers were included in this study, 65 had received supervision, and medical institutions where 58 people located had established the supervision system. The average scores of actual and expected supervisory support received by medical social workers were 3.71 and 4.20 respectively, and the mean burnout level score was 32.91. The effect of establishing a supervision institutions on burnout was statistically significant ( P<0.05) and actual access to supervision support was negatively associated with burnout ( P<0.05). Conclusions:The overall situation of medical social work supervision in Shanghai was positive, but the demand for supervision was not fully satisfied; Supervision had a positive impact on reducing the burnout level. It is suggested that medical social work should further strengthen the cultivation of supervisory talents, promote the construction of supervisory systems, and improve the quality of supervision.
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Noonan syndrome(NS)is an inherited disease involving multiple systems.The main clinical manifestations include distinctive facial features, short stature, heart defects, developmental delay and chest deformity.Short stature, reported in up to 70% of NS patients, is one of the main reasons NS patients seek medical treatment.The pathogenesis is associated with the up-regulation of RAS-mitogen activated protein kinase(RAS-MAPK)signal pathway.Further study is needed for some further specific mechanisms.Recombinant human growth hormone(rhGH)therapy has been approved for NS patients with short stature and has achieved a good therapeutic effect.However, the knowledge of drug dosage, influencing factors, long-term efficacy and risk of rhGH treatment is still insufficient.This paper reviews the pathogenesis and treatment of short stature in NS, providing help for the treatment and management of the disease.
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Objective: To understand the characteristics of bacterial meningitis after pediatric neurosurgical procedures. Methods: This was a retrospective observational study. From January 2016 to December 2022, 64 children diagnosed with post-neurosurgical bacterial meningitis based on positive cerebrospinal fluid (CSF) culture in Department of Neurosurgery of Shanghai Children's Medical Center were selected as the study population. The clinical characteristics, onset time, routine biochemical indexes of cerebrospinal fluid before anti infection treatment, bacteriology characteristics and sensitivity to antibiotics of bacteria cultured from cerebrospinal fluid were analyzed. Based on the CSF culture results, the patients were divided into the Gram-positive bacteria infection group and the Gram-negative bacteria infection group. The clinical characteristics of the two groups were compared using t-tests or Wilcoxon rank-sum tests, and chi-square tests. Results: There were 64 children,42 boys and 22 girls, with onset age of 0.83 (0.50, 1.75) years. Seventy cases of post-neurosurgical bacterial meningitis occurred in the 64 children, of which 15 cases (21%) in spring, 23 cases (33%) in summer, 19 cases (27%) in autumn, and 13 cases (19%) in winter. The time of onset was 3.5 (1.0, 10.0) months after surgery; 15 cases (21%) occurred within the first month after the surgery, and 55 cases (79%) occurred after the first month. There were 38 cases (59%) showing obvious abnormal clinical manifestations, fever 36 cases (56%), vomiting 11 cases (17%). Forty-eight cases (69%) were caused by Gram-positive bacteria, with Staphylococcus epidermidis 24 cases; 22 cases (31%) were caused by Gram-negative bacteria, with Acinetobacter baumannii the prominent pathogen 7 cases. The Gram-positive bacterial infection was more common in summer than the Gram-negative bacterial infection (20 cases (42%) vs. 3 cases (14%), χ2=5.37, P=0.020), while the Gram-negative bacterial infection was more in autumn and within the first month after surgery than the Gram-positive bacterial infection (11 cases (50%) vs. 8 cases (17%), 15 cases (67%) vs. 5 cases (33%), χ2=8.48, 9.02; P=0.004, 0.003). Gram-positive bacteria resistant to vancomycin and Acinetobacter baumannii resistant to polymyxin were not found. However, Acinetobacter baumannii showed only 45% (10/22) susceptibility to carbapenem antibiotics. Conclusions: The clinical presentation of post-neurosurgical bacterial meningitis in children is atypical. Gram-positive bacteria are the main pathogens causing post-neurosurgical bacterial meningitis; Gram-negative bacterial meningitis are more likely to occur in autumn and within the first month after surgery. Acinetobacter baumannii has a high resistance rate to carbapenem antibiotics, which should be taken seriously.
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Masculino , Feminino , Humanos , Criança , China/epidemiologia , Antibacterianos/farmacologia , Meningites Bacterianas/diagnóstico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Bactérias Gram-Positivas , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Carbapenêmicos , Estudos Retrospectivos , Testes de Sensibilidade Microbiana , Farmacorresistência BacterianaRESUMO
The parallel chart records a HIV-positive patient,who initially declined treatment due to psychological reasons,however,with the support and care provided by both the medical team and his family members,he eventually accepted treatment actively and successfully reintegrated into society. The case indicates that healthcare professionals should not only treat the physical conditions of patients,but also give them the warm humanistic concern and care.
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Tanshinones are one of the main effective components of Salvia miltiorrhiza, which play important roles in the treatment of cardiovascular diseases. Microbial heterogony production of tanshinones can provide a large number of raw materials for the production of traditional Chinese medicine(TCM) preparations containing S. miltiorrhiza, reduce the extraction cost, and relieve the pressure of clinical medication. The biosynthetic pathway of tanshinones contains multiple P450 enzymes, and the catalytic element with high efficiency is the basis of microbial production of tanshinones. In this study, the protein modification of CYP76AK1, a key P450-C20 hydroxylase in tanshinone pathway, was researched. The protein modeling methods SWISS-MODEL, Robetta, and AlphaFold2 were used, and the protein model was analyzed to obtain the reliable protein structure. The semi-rational design of mutant protein was carried out by molecular docking and homologous alignment. The key amino acid sites affecting the oxidation activity of CYP76AK1 were identified by molecular docking. The function of the obtained mutations was studied with yeast expression system, and the CYP76AK1 mutations with continuous oxidation function to 11-hydroxysugiol were obtained. Four key amino acid sites that affected the oxidation acti-vity were analyzed, and the reliability of three protein modeling methods was analyzed according to the mutation results. The effective protein modification sites of CYP76AK1 were reported for the first time in this study, which provides a catalytic element for different oxidation activities at C20 site for the study of the synthetic biology of tanshinones and lays a foundation for the analysis of the conti-nuous oxidation mechanism of P450-C20 modification.
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Oxirredutases , Vias Biossintéticas , Simulação de Acoplamento Molecular , Reprodutibilidade dos Testes , Salvia miltiorrhiza/química , Aminoácidos/metabolismo , Raízes de Plantas/genéticaRESUMO
Infectious diseases are still the most important diseases in infants and young children.Due to young age and imperfect immune function, infectious diseases in children are characterized by "urgent" , "serious" and "complex pathogens" , which often lead to serious complications.Rapid and accurate diagnosis is particularly important for children.However, the existing pathogen detection methods are inefficiency, subject to experimental conditions and person, and impopularized in hospitals.The pathogen detection method based on loop mediated isothermal amplification presents high specificity, low-cost and simple operation and is suitable for promotion in primary medical units, which has great application value in the detection of pathogens of children.In addition, the combination of loop mediated isothermal with paper-based micro-gene chip, intelligent automation and digital system will make progress to clinical etiological diagnosis.
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Objective:To explore the value of detecting pneumocystis carini(PC)rapidly in immunocompromised patients by loop mediated isothermal amplification(LAMP).Methods:Respiratory tract specimens of immunocompromised children suspected of pneumocystis carinii pneumonia(PCP) at Shanghai Children′s Medical Center, School of Medicine, Shanghai Jiao Tong University were collected from May 2020 to May 2021.PCR and LAMP methods were used to detect PC.Firstly, LAMP primers of PC were synthetized according to the conserved region of PC gene, and the LAMP reaction system and reaction conditions were optimized to evaluate the sensitivity and specificity.Then, the results of pathogens were compared with those of PCR detection.Results:The established LAMP detection technology for PC had high specificity and super sensitivity.The detection results could be obtained within 1 hour.In 12 clinical samples, 10 cases were positive and 2 cases were negative, the coincidence rate of LAMP and PCR technique was 100%.Conclusion:LAMP can detect PC more rapidly and sensitively than PCR, and it can provide a good support for clinical rapid diagnosis of PCP.
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Objective:To explore the value of detecting pneumocystis carini(PC)rapidly in immunocompromised patients by loop mediated isothermal amplification(LAMP).Methods:Respiratory tract specimens of immunocompromised children suspected of pneumocystis carinii pneumonia(PCP) at Shanghai Children′s Medical Center, School of Medicine, Shanghai Jiao Tong University were collected from May 2020 to May 2021.PCR and LAMP methods were used to detect PC.Firstly, LAMP primers of PC were synthetized according to the conserved region of PC gene, and the LAMP reaction system and reaction conditions were optimized to evaluate the sensitivity and specificity.Then, the results of pathogens were compared with those of PCR detection.Results:The established LAMP detection technology for PC had high specificity and super sensitivity.The detection results could be obtained within 1 hour.In 12 clinical samples, 10 cases were positive and 2 cases were negative, the coincidence rate of LAMP and PCR technique was 100%.Conclusion:LAMP can detect PC more rapidly and sensitively than PCR, and it can provide a good support for clinical rapid diagnosis of PCP.
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Objective:To investigate the pathogens and drug resistance of bacterial enteritis in children, analyze the clinical characteristics of bacterial enteritis in children, and provide basis for clinical diagnosis and treatment.Methods:The fecal culture strain and drug sensitivity of patients with bacterial enteritis admitted to our hospital from January 2016 to December 2020 were analyzed and summarized, and the clinical characteristics of patients who were infected by Salmonella and Escherichia coli were compared.Results:There were a total of 173 patients, aged from 21 days to 15 years, with a median age of 2.00(1.10, 3.54)years.Bacterial enteritis was most likely to occur in summer and autumn, and the incidence rate was 40.5% and 29.5%, respectively.One hundreds and seventy-three strains of bacteria were cultured in feces, including 148 strains of Salmonella(85.5%), 18 strains of Escherichia coli(10.4%), five strains of Staphylococcus aureus and two strains of Shigella.One hundreds and one of 141 patients who were infected with Salmonella were detected for leukocytes of in feces(71.6%), and four of 16 patients with Escherichia coli were detected for leukocytes(25.0%). The difference was significant( χ2=14.1, P<0.001). Eighty-eight of 113 patients(77.9%) who were infected by Salmonella with increased CRP(CRP>8 mg/L)and the proportion in Escherichia coli infection cases was 6/13(46.2%). There was significant difference( χ2=4.63, P=0.03). The drug sensitivity of Salmonella and Escherichia coli was summarized.There was no carbapenem resistant strain cultured; The sensitivity to piperacillin/tazobactam and cefoperazone/sulbactam was higher than 85%; The sensitivity to cefepime, ceftazidimeand ceftriaxone was higher than 75%; The sensitivity to ampicillin was lower than 30%, and the sensitivity to quinolones was between 20%-40%. Conclusion:Children aged 1-3 years are prone to bacterial enteritis in summer and autumn.The most common pathogens causing bacterial enteritis are Salmonella and Escherichia coli.White blood cells are more easily detected in feces of patients with Salmonella infection, and the increase rate of C-reactive protein in peripheral blood is higher.Patients with bacterial enteritis are recommended to use the third-generation cephalosporins and aforementioned antibiotics and piperacillin/tazobactam for empirical treatment.The sensitivity to quinolones is reduced, and may not be suitable for clinical application.
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Objective:To study the clinical characteristics of neonatal community-acquired Novel Coronavirus (COVID-19) Omicron variant infection.Methods:From March 30 to May 15, 2022, the epidemiological characteristics, clinical manifestations and outcomes of neonatal cases of community-acquired COVID-19 Omicron variant infection admitted to the isolation ward of our hospital were analyzed.Results:A total of 7 neonates infected with community-acquired COVID-19 Omicron variant were treated, including 3 males and 4 females. All of them were term infants with clear epidemiological exposure history. The infection was originated from caregivers of close contact (parents or babysitters). The main clinical symptoms was upper respiratory tract infection, including fever (6 cases), nasal congestion (6 cases), cough (5 cases), runny nose (2 cases), poor appetite (2 cases) and diarrhea (1 case). On admission, no abnormalities were found in blood routine examination and C-reactive protein (CRP). All but one case had normal serum amyloid A (SAA). No obvious abnormalities were found on chest X-ray. All patients were isolated in single-patient rooms after admission. They received standard symptomatic treatment and regular nucleic acid tests. The first negative nucleic acid results came on median 17 d(8~26 d) after the onset of the disease. The patients were discharged after two consecutive (24 h apart) nucleic acid tests with CT value ≥35 and continued health-monitor at home. On discharge, 5 patients had nasal congestion and 2 of them had cough. During the follow-up 4~6 weeks after discharge, all patients gradually recovered without positive nucleic acid results.Conclusions:All 7 neonates with community-acquired COVID-19 Omicron variant infection have epidemiological exposure history. The main clinical symptoms are long-lasting upper respiratory tract infections. It takes a relatively long time for the nucleic acid to turn negative, however, the overall short-term prognosis is good.
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Objective:To compare the clinical efficacy of arthroscopy-assisted and open reduction and internal fixation in the treatment of Schatzker type I-III tibial plateau fractures.Methods:The data of patients with Schatzker type I-III tibial plateau fractures who were treated from August 2017 to July 2019 were retrospectively analyzed. According to the treatment, the patients were divided into the arthroscopic-assisted minimally invasive reduction and internal fixation group (arthroscopy group) and the conventional open reduction and internal fixation group (incision group). In the arthroscopy group, there were 30 patients, 19 males and 11 females were included; the age was 45.13±7.12 years old (range, 29-60 years). Among them, 13 cases were Schatzker type I fractures, 14 cases were Schatzker type II fractures, and 3 cases were Schatzker type III fractures. In the incision group, there were 30 patients, 17 males and 13 females were included; the age was 43.53±7.79 years old (range, 31-58 years). Among them, 11 cases were Schatzker type I fractures, 15 cases were Schatzker type II fractures, and 4 cases were Schatzker type III fractures. The operation time, intraoperative blood loss, postoperative ambulation time, postoperative complete weight-bearing time and postoperative complications were recorded. The degree of knee joint swelling, knee flexion and extension range of motion and the American knee society knee score (AKS score) were compared between the arthroscopy group and the incision group.Results:Both groups were followed up. The follow-up time of the arthroscopy group were 10-18 months, with an average of 14 months; the follow-up time in the incision group were 12-18 months, with an average of 15 months. In the arthroscopy group, the operation time (87.60±9.20 min vs. 94.33±10.65 min), intraoperative blood loss (57.16±9.63 ml vs. 71.93±11.15 ml), postoperative ambulation time (5.13±1.28 d vs. 6.17±1.53 d) and postoperative complete weight-bearing time (12.83±1.68 weeks vs. 14.23±1.77 weeks) were superior to the incision group, and the differences were statistically significant ( t=2.62, 5.49, 2.83, 3.94; all P<0.05). The healing time was 13.33±1.37 weeks in the arthroscopy group and 14.86±1.63 weeks in the incision group, and the difference was statistically significant ( t=3.94, P<0.001). At 1 year after surgery, the range of flexion and extension of knee joint in the arthroscopy group was 116.77°±12.46°, which was better than that in the incision group, which was 109.13°±9.89°, and the difference was statistically significant ( t=2.63, P=0.011). The AKS score in the arthroscopy group was 164.57±11.16 points, and the score in the incision group was 149.53±14.77 points, and the difference was statistically significant ( t=4.45, P<0.001). There were no malunion or compartment syndrome in the arthroscopy group and the incision group. The total incidence of complications in the arthroscopy group was 13% (4/30), including 2 cases of poor wound healing, 2 of poor knee range of motion after operation. The total incidence of complications in the incision group was 23% (7/30), including 4 cases of poor wound healing, 1 of wound infection, 2 of poor knee range of motion after operation. And the difference between the two groups in complication incidence was not statistically significant (χ 2=1.00, P=0.317). Conclusion:Arthroscopic-assisted reduction and internal fixation in the treatment of Schatzker I-III tibial plateau fractures has the advantages of less trauma, less bleeding, early mobility, fewer complications, and better knee joint function, and there are no obvious arthroscopic-related complications, which is a safe and reliable treatment method.
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Objective:To evaluate the clinical significance of molecular detection testing multiple pathogens in children with viral central nervous system infections.Methods:We retrospectively included 176 children who were suspected with central nervous system infection at Shanghai Children′s Medical Center from January 2017 to May 2021.Film Array Meningitis/Encephalitis Panel(FA-M/E) was used to test cerebrospinal fluid samples of these children.The results were analyzed compared with clinical symptoms and cerebrospinal fluid indices.Results:There were 34 samples with positive FA-M/E virus detection(19.32%, 34/176). Among the 34 samples, enterovirus was the most common pathogen(27 cases, 79.41%). In different combinations, the sensitivity and positive predictive value were all less than 90%.The median time for antiviral drugs used in FA-M/E virus-positive and negative children was 4.5(0, 8.5)d and 2.6(0, 2.0)d, respectively.The difference was statistically significant( P<0.05). Conclusion:Molecular tests of multiple pathogens can quickly and sensitively detect pathogens.It can improve the efficacy of clinical diagnosis of viral central nervous system infection.
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Circular RNA (circRNA), as a competitive endogenous RNA (ceRNA), plays an importantrole in the regulation of cell differentiation. The purpose of this study was to identify and analyze porcinecircular RNA insulin-like growth factor 1 receptor (circIGF1R), explore its expression patterns, construct a ceRNA regulatory network related to circIGF1R, and explore the regulation of its ectopicexpression on adipogenic differentiation of mouse mesenchymal stem cells (C3H10T1 / 2) effect. Forwardand reverse PCR, Sanger sequencing, RNase R enzyme digestion tests, and qRT-PCR were used toverify that circIGF1R is a circRNA formed by the second exon of insulin-like growth factor 1 receptor(IGF1R). It was expressed in all tissues of pigs, and its expression level increased with age in adiposetissues. miRDB, TargetScan and miRWalk online software were used to predict circIGF1R target genes. RNAhybrid software was used for binding site prediction. DAVID bioinformatics functional analysissoftware was used to perform GO and KEGG enrichment analysis on candidate target genes. Cytoscapesoftware was used to construct the ceRNA network diagram. Based on the gene expression correlation andpredicted target relationship, the GO and KEGG enrichment analysis was drawn and the ceRNA networkwas constructed; the dual luciferase reporter gene test was used, and we found that circIGF1R andFABP4 can bind to ssc (Sus scrofa chromosome) -miR-133a-5p. The circIGF1R overexpression vectorwas successfully constructed and expressed in C3H10T1/ 2 cells. It was found that after overexpression ofcircIGF1R, the expression of key adipogenic regulatory factors CEBPa, CEBPß, FABP4 and PPAR? increased significantly(P<0. 01), and the number of lipid droplets increased significantly. The results ofthis study show that circIGF1R exists in pig adipose tissues, and may positively regulate the adipogenicdifferentiation of C3H10T1/ 2 cells through the ceRNA mechanism, which lays a theoretical foundation forfurther research on circIGF1R regulating the adipogenic differentiation of pig precursor intramuscularadipocytes.
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A high-precision human metabolic measurement system is designed. The system uses STM32F103 as the main control chip to acquire oxygen, carbon dioxide and flow signals to calculate four quantitative indicators: oxygen consumption(VO2), carbon dioxide production(VCO2), respiratory entropy(RQ) and resting energy metabolism(REE), and finally uses an upper computer to display the calculation results.In this paper, the signal acquisition circuit design was carried out for the oxygen sensor, carbon dioxide sensor and flow sensor, and the validity of the device was verified with the American machine MGCDiagnositcs using Bland-Altman analysis method, and the results showed that the four parameters of VO2,VCO2, RQ and REE of both devices fell in the agreement interval of more than 95%. The device thus provides accurate metabolic measurements and offers an effective tool for the field of general health and clinical nutrition support in China.
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Humanos , Calorimetria Indireta , Dióxido de Carbono/metabolismo , Metabolismo Energético , Oxigênio , Consumo de OxigênioRESUMO
Objective: To explore the effect of perioperative chemotherapy on the prognosis of gastric cancer patients under real-world condition. Methods: A retrospective cohort study was carried out. Real world data of gastric cancer patients receiving perioperative chemotherapy and surgery + adjuvant chemotherapy in 33 domestic hospitals from January 1, 2014 to January 31, 2016 were collected. Inclusion criteria: (1) gastric adenocarcinoma was confirmed by histopathology, and clinical stage was cT2-4aN0-3M0 (AJCC 8th edition); (2) D2 radical gastric cancer surgery was performed; (3) at least one cycle of neoadjuvant chemotherapy (NAC) was completed; (4) at least 4 cycles of adjuvant chemotherapy (AC) [SOX (S-1+oxaliplatin) or CapeOX (capecitabine + oxaliplatin)] were completed. Exclusion criteria: (1) complicated with other malignant tumors; (2) radiotherapy received; (3) patients with incomplete data. The enrolled patients who received neoadjuvant chemotherapy and adjuvant chemotherapy were included in the perioperative chemotherapy group, and those who received only postoperative adjuvant chemotherapy were included in the surgery + adjuvant chemotherapy group. Propensity score matching (PSM) method was used to control selection bias. The primary outcome were overall survival (OS) and progression-free survival (PFS) after PSM. OS was defined as the time from the first neoadjuvant chemotherapy (operation + adjuvant chemotherapy group: from the date of operation) to the last effective follow-up or death. PFS was defined as the time from the first neoadjuvant chemotherapy (operation + adjuvant chemotherapy group: from the date of operation) to the first imaging diagnosis of tumor progression or death. The Kaplan-Meier method was used to estimate the survival rate, and the Cox proportional hazards model was used to evaluate the independent effect of perioperative chemo therapy on OS and PFS. Results: 2 045 cases were included, including 1 293 cases in the surgery+adjuvant chemotherapy group and 752 cases in the perioperative chemotherapy group. After PSM, 492 pairs were included in the analysis. There were no statistically significant differences in gender, age, body mass index, tumor stage before treatment, and tumor location between the two groups (all P>0.05). Compared with the surgery + adjuvant chemotherapy group, patients in the perioperative chemotherapy group had higher proportion of total gastrectomy (χ(2)=40.526, P<0.001), smaller maximum tumor diameter (t=3.969, P<0.001), less number of metastatic lymph nodes (t=1.343, P<0.001), lower ratio of vessel invasion (χ(2)=11.897, P=0.001) and nerve invasion (χ(2)=12.338, P<0.001). In the perioperative chemotherapy group and surgery + adjuvant chemotherapy group, 24 cases (4.9%) and 17 cases (3.4%) developed postoperative complications, respectively, and no significant difference was found between two groups (χ(2)=0.815, P=0.367). The median OS of the perioperative chemotherapy group was longer than that of the surgery + adjuvant chemotherapy group (65 months vs. 45 months, HR: 0.74, 95% CI: 0.62-0.89, P=0.001); the median PFS of the perioperative chemotherapy group was also longer than that of the surgery+adjuvant chemotherapy group (56 months vs. 36 months, HR=0.72, 95% CI:0.61-0.85, P<0.001). The forest plot results of subgroup analysis showed that both men and women could benefit from perioperative chemotherapy (all P<0.05); patients over 45 years of age (P<0.05) and with normal body mass (P<0.01) could benefit significantly; patients with cTNM stage II and III presented a trend of benefit or could benefit significantly (P<0.05); patients with signet ring cell carcinoma benefited little (P>0.05); tumors in the gastric body and gastric antrum benefited more significantly (P<0.05). Conclusion: Perioperative chemotherapy can improve the prognosis of gastric cancer patients.
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Feminino , Humanos , Masculino , Quimioterapia Adjuvante , Gastrectomia , Terapia Neoadjuvante , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/cirurgiaRESUMO
Objective:To explore the effect of dialysis pipeline nursing group mode combined with predictive nursing measures on hemodialysis efficacy of diabetic nephropathy patients with maintenance hemodialysis (MHD).Methods:A total of 96 patients with MHD of diabetic nephropathy admitted to No. 904 Hospital of Joint Logistics Support Force of Chinese People's Liberation Army from January 2015 to December 2019 were selected as the research objects and divided into control group and observation group, 48 cases in each group. Patients in the control group were treated with routine dialysis pipeline and other hemodialysis nursing interventions, while patients in the observation group were treated with predictive nursing measures on this basis. The biochemical indexes, psychological state, compliance, incidence of nosocomial infection and complications and nursing satisfaction of the two groups before and after intervention were compared.Results:After the nursing intervention, the blood urea nitrogen (BUN), creatinine (Cr), and β2 microglobulin (β2-MG) of the two groups of patients were lower than those before the intervention, and the BUN of the observation group after the intervention, Cr and β2-MG were (12.04±1.98) mmol/L, (451.62±82.49) μmol/L, (13.53±2.31) mg/L, respectively, which were lower than those of the control group (15.82±2.31) mmol/L, (591.35±99.21) μmol/L, (18.83±2.92) mg/L, the difference was statistically significant ( t value was 8.608, 7.503, 9.862, P<0.05). After the intervention, the scores of the treatment compliance subscales of the observation group were 29.06±3.58, 23.42±2.99, 20.11±3.01, 14.76±2.94, which were higher than those of the control group (31.91±3.97, 21.53±3.21, 17.03±2.74, 12.36±3.04), the difference was statistically significant ( t value was 2.985-3.932, P<0.05). After the intervention, the SAS and SDS scores of the two groups were lower than those before the intervention, and the SAS and SDS scores of the observation group after intervention were 39.12±4.82 and 36.43±6.03, which were lower than those of the control group 48.25±5.14, 46.75±5.36, the difference was statistically significant ( t value was 8.997, 8.862, P<0.05). The incidence of nosocomial infections and complications in the observation group were 2.08% (1/48) and 4.17% (2/48), which were significantly lower than those in the control group, 14.58% (7/48) and 18.75% (9/48), The difference was statistically significant ( χ2 value was 4.91, 5.26, P<0.05). The nursing satisfaction degree of the observation group was 95.83% (46/48), which was higher than 72.92% (35/48) of the control group, and the difference was statistically significant ( χ2 value was 9.56, P<0.05). Conclusions:The dialysis pipeline combined with predictive nursing can improve the psychological state of patients, reduce the incidence of hospital infection and complications, prolong the service life of vascular access, improve the quality of life of hemodialysis patients, improve the relationship between nurses and patients, and create a harmonious atmosphere, which is worthy of clinical promotion and application.
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Objective:To explore the value of FilmArray meningitis/encephalitis(ME)Panel in etiological diagnosis of infection in central nervous system(CNS) in Chinese children.Methods:Cerebrospinal fluid(CSF)obtained through lumbar puncture was collected from 145 patients with suspected CNS infection at Shanghai Children′s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine from March 2019 to November 2019.All specimens were cultured simultaneously, which were detected by FilmArray ME Panel, and the results of cerebrospinal fluid culture and FilmArray ME Panel were compared.Results:Among 145 patients with suspected CNS infection, three samples were found to be positive after cerebrospinal fluid culture, and the positive rate was 2.1%(3/145). For the FilmArray ME Panel, 30 specimens were found to be positive, with a positive rate of 20.7%(30/145), and the difference of positive rate between the two methods was statistically significant( χ2=24.927, P<0.05). Among the samples FilmArray ME Panel tested positive with pathogen, 26 specimens were positive with virus making up 17.9%(26/145)and enterovirus(15.2%)was the primary pathogen.In addition, of the 142 specimens cerebrospinal fluid culture negative, 28 samples were tested positive by the FilmArray ME Panel, accounting for 19.7%(28/142). Conclusion:FilmArray ME Panel has the characteristics with high positive rate and could be time-saving.Meanwhile, FilmArray ME Panel has significant advantage in the detection of virus and improves the positive detection rate of virus.
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Objective:To explore the morphological characteristics, treatment strategies and clinical results of complex hyperextension tibial plateau fractures.Methods:From October 2017 to January 2019, data of 27 patients with complex hyperextension tibial plateau fractures were retrospectively analyzed. There were 19 males and 8 females with an average age of 43.4 years (range, 23-68 years). According to Schatzker classification of tibial plateau fractures: there are 8 cases of type IV, 5 of type V, and 14 of type VI; according to the three-column theory classification: there are 8 cases of two-column fracture and 19 cases of three-column fracture. Bicondylar fractures were treated with medial Tomofix locking plate and anterolateral L-shaped locking plate through medial and anterolateral approach; tibialmedial condylar fractures was treated with T-shaped plate and posteromedial locking plate through extended medial approach. Patients with anterior tibial fractures were treated with horizontal strip plate through modified anterior median approach. Combined soft tissue or bone injury was repaired. The fracture healing and reduction were evaluated by X-ray and CT scan. The reduction of tibial plateau fracture was evaluated by Rasmussen radiology standard, and the knee joint function was evaluated 12 months after the operation by the score of American hospital for special surgery (HSS).Results:All the 27 surgeries were performedsuccessfully. The operation time was 130-350 minutes, with an average time of 165 minutes. Twenty-seven cases were followed up for 12-24 months, with an average period of 15.8 months. All fractures were healed. The average clinical healing time was 13.5 weeks (range, 10-18 weeks). Twelve months after operation, Rasmussen's radiology score was 13-18, with an average of 16.7 points, among them there were 19 excellent and 8 good. Twelve months after the operation, the score of HSS knee joint was 82-98, with an average score of 93.2 points, and there were 22 cases excellent, 4 cases good and 1 case fair. The excellent and good rate was 96.2% (26/27).Conclusion:Complex hyperextension tibial plateau fractures often combined with tibial bicondylar, medial tibial condyle or anterior tibial fractures. According to the morphological characteristics of complex hyperextension tibial plateau fractures, using appropriate surgical approach and internal fixation, repairing ligament soft tissue structure and reconstructing knee joint stability can achieve satisfactory results.