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Objective:To evaluate the effects of recombinant human thrombopoietin (rhTPO) on platelet count (PLT) and liver function in acute liver failure (ALF) rats by observing the dynamic changes of PLT, thrombopoietin (TPO) and liver function during ALF.Methods:Twenty-four male Sprague-Dawley (SD) rats were divided into model group, TPO group and interleukin-11 (IL-11) group using a random number table method, with eight rats in each group. All rats were intraperitoneally injected with D-galactosamine (D-GalN, 1?500 mg/kg, dosed within 72 hours) to induce the ALF model. After modeling, rats in TPO group was received subcutaneous injection of 15 μg/kg of rhTPO for 5 days, and rats in IL-11 group was received subcutaneous injection of 0.45 mg/kg of IL-11 for 5 days. Venous blood samples were collected before and at 1, 3, 5, 7 and 12 days after molding for whole blood cell detection. The level of TPO in serum was detected by enzyme-linked immunosorbent assay (ELISA). Liver function indexes including serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil) and albumin (ALB) were measured before and at 1, 3 and 5 days after modeling. The rats were sacrificed 12 days after the modeling, and the pathological changes of liver tissue were observed by hematoxylin-eosin (HE) staining.Results:Two rats in each group died within 24-48 hours after modeling. HE staining showed that all three groups of ALF rats showed large flake necrosis of hepatocytes, disorder of hepatic lobular structure, mesh scaffold collapse, hepatic sinus congestion and hemorrhage, and flake infiltration of inflammatory cells on day 12 after modeling. The levels of serum ALT, AST and TBil of rats in each group were significantly increased 1 day after modeling and then decreased. The level of ALB decreased significantly on the first day after modeling and then increased, but there was no significant difference in the trend of liver function indexes among the three groups. PLT in the three groups decreased rapidly on day 1 after modeling, and then recovered gradually with the improvement of liver function. The PLT of the TPO group rose to the peak value 7 days after molding and was significantly higher than that of the model group [PLT (×10 9/L): 1?673.3±347.5 vs. 855.3±447.0, P < 0.05], while there was no significant difference between the IL-11 group and the model group [PLT (×10 9/L): 1?350.3±386.6 vs. 855.3±447.0, P > 0.05]. The level of serum TPO of the three groups increased significantly on day 1 after modeling, then decreased, and dropped to the lowest value on day 5, but there was no significant difference in the trend of serum TPO level among the three groups. Conclusions:PLT in ALF rats decreased rapidly in the early stage and recovered gradually with the improvement of liver function, and the serum TPO level increased first and then decreased. Injection of rhTPO can significantly increase PLT in ALF rats, but has no significant effect on liver function and survival rate.
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Objective To investigate the efficacy and safety of tenofovir alafenamide fumarate(TAF)in the treatment of patients with decompensated hepatitis B cirrhosis.Methods We retrospective analyzed 41 patients with decompensated hepatitis B cirrhosis receiving TAF antiviral therapy for 24 weeks at Wuwei Tumor Hospital in Gansu province from June 2022 to June 2023.Primary endpoint was proportion of patients achieving virologic response(HBV DNA<20 IU/mL).Other endpoints included changes in ALT,AST,TBIL,Child-Pugh score(CTP),and MELD score from baseline to week 24.In terms of safety,changes in Scr,eGFR and adverse events from baseline to week 24 were observed.Results Of 41 patients,73.2%were male(n = 30),with mean age of 53.49 years.24 weeks after treatment with TAF,HBV DNA was undetectable in 90.2%of the patients.The median levels of ALT,AST and total bilirubin(TBIL)were 50.70 U/L,48.70 U/L and 26.40 μmol/L respectively at base-line,and reduced significantly to 31.50 U/L,37.8 U/L and 23.8 μmol/L(P<0.05)respectively after 24-week therapy with TAF.CTP score was improved in 58.6%of the patients(n = 24),and so was MELD score in 63.4%of the patients(n = 26)at week 24.The median serum creatinine and eGFR were 58.5 μmol/L and 106.15 mL/(min·1.73 m2)respectively at baseline,and creatinine and eGFR were stable during treatment.No drug-related adverse events or severe adverse events occurred during treatment,neither did creatinine and eGFR liver transplan-tation,HCC or death.Conclusions Our clinical studies demonstrated better effectiveness and safety of TAF for decompensated CHB patients.
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Objective:To investigate the correlation between circadian blood pressure pattern and heart rate variability and stroke severity and outcome in patients with acute ischemic stroke (AIS).Methods:Patients with first-ever AIS admitted to the Affiliated Qingdao Central Hospital of Qingdao University from January 2015 to January 2021 were retrospectively included. Ambulatory blood pressure monitoring (ABPM) and ambulatory electrocardiogram (AECG) were performed after admission. The severity of stroke was assessed according to the National Institutes of Health Stroke Scale. ≤8 were defined as minor stroke, and >8 were defined as moderate to severe stroke. The modified Rankin Scale was used to evaluate the clinical outcome at 3 months after onset. ≤ 2 were defined as good outcomes, and >2 were defined as poor outcomes. Multivariate logistic regression analysis was used to determine the independent influencing factors of stroke severity and outcome. Results:A total of 516 patients with AIS were enrolled, including 328 male (63.57%), aged 59.62±6.67 years old. Among them, 266 patients (51.55%) were in the minor stroke group and 250 (48.45%) were in the moderate to severe stroke group. There were 463 patients (89.73%) were in the good outcome group and 53 (10.27%) were in the poor outcome group. Multivariate logistic regression analysis showed that hypertension (odds ratio [ OR] 5.021, 95% confidence interval [ CI] 2.635-10.923; P<0.001), atrial fibrillation ( OR 3.896, 95% CI 2.574-8.521; P<0.001), circadian blood pressure pattern (non-dipper type: OR 2.436, 95% CI 1.031-4.749, P<0.001; reverse dipper type: OR 2.654, 95% CI 1.642-5.268, P<0.001), SDNN ( OR 0.298, 95% CI 0.114-0.730; P=0.002), SDANN ( OR 0.325, 95% CI 0.200-0.679; P=0.009), rMSSD ( OR 0.437, 95% CI 0.255-0.876; P=0.016) and pNN50 ( OR 0.369, 95% CI 0.291-0.767; P=0.013) were the independent influencing factors of stroke severity. Hypertension ( OR 4.857, 95% CI 1.957-8.552; P<0.001), baseline NIHSS score ( OR 2.189, 95% CI 1.597-3.315; P<0.001), stroke severity ( OR 3.853, 95% CI 2.316-5.958; P<0.001), circadian blood pressure pattern (non-dipper type: OR 2.997, 95% CI 1.128-5.430, P<0.001; reverse dipper type: OR 3.703, 95% CI 1.478-5.902; P<0.001), SDNN ( OR0.369, 95% CI 0.215-0.779; P=0.015), SDANN ( OR 0.372, 95% CI 0.198-0.862; P=0.018), rMSSD ( OR 0.455, 95% CI 0.314-0.896; P=0.026) and pNN50 ( OR 0.448, 95% CI 0.307-0.825; P=0.021) were the independent influencing factors of poor outcomes. Conclusion:The non-dipper and reverse dipper circadian blood pressure patterns and lower heart rate variability are independently associated with stroke severity and poor outcomes in patients with AIS.
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Objective:To investigate the effect of high glucose on the release of interleukin (IL)-1β and IL-18 in placental trophoblast by activating NLRP3 inflammasome.Methods:Gestational diabetes mellitus(GDM) placentas and control placentas were collected and the expression levels of NLRP3 and Caspase-1 were determined. Human placental trophoblast HTR-8/SVneo were cultured and divided into control group(5.5 mmol/L glucose), high glucose group(25 mmol/L glucose), DMSO+ high glucose group, and Ac-YVAD-cmk(NLRP3 inflammasome inhibitor)+ high glucose group. The expression levels of NLRP3 and Caspase-1 in cells as well as the contents of IL-1β and IL-18 in the medium were determined.Results:The expression levels of NLRP3 and Caspase-1 in GDM placenta were higher than those in control placenta( P<0.05) and positively correlated with homeostasis model assessment of insulin resistant index(HOMA-IR) and fasting insulin. The expression levels of NLRP3 and Caspase-1 in HTR-8/SVneo cells and the secretion levels of IL-1β and IL-18 in high glucose group were higher than those in control group( P<0.05). Ac-YVAD-cmk significantly suppressed high glucose-stimulated IL-1β and IL-18 secretion( P<0.05). Conclusion:High glucose promotes the release of IL-1β and IL-18 from placental trophoblast via activating NLRP3 inflammasome.
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Objective:To evaluate the discrimination, reliability and validity of the evaluation system of clinical nurse training based on post competency in hospitals of traditional Chinese and Western medicine.Methods:From August 2018 to January 2019, 271 clinical nurses from a three-A hospital were selected by convenient sampling method. The competency of clinical nurses was assessed on the spot by case tracking method. The discrimination, reliability and validity of the evaluation system were tested by item analysis, Cronbach's α coefficient and confirmatory factor analysis.Results:The evaluation system had good discrimination, reliability and validity. Among the four scales of the evaluation system, there were significant differences in the high score and the low score of all items ( P < 0.05). The Cronbach's α coefficient of each dimension of the four scales was 0.769-0.898. Four structural equation model diagrams were established, the AVE (average variance extracted) of each dimension was 0.51-0.74, factor load was 0.53-0.93, C.R. (composite reliability) was 0.79-0.91, and the discrimination validity was up to the standard. Conclusion:This system provides a reference for the establishment of scientific, objective, measurable and homogeneous clinical nurse training evaluation tools.
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Objective:To explore the inconsistent and consistent classifications for lesions ≤2 cm by contrast-enhanced ultrasound(CEUS) Liver Imaging Reporting and Data System(LI-RADS) v2017 and contrast-enhanced computed tomography/contrast-enhanced magnetic resonance imaging(CECT/MRI) LI-RADS v2018.Methods:The focal liver lesions ≤2 cm underwent CEUS and CECT/MRI within 1 month were enrolled in this retrospective study.Each nodule was categorized according to the CEUS LI-RADS v2017 and CECT/MRI LI-RADS v2018. Intermodality agreement between the CEUS LI-RADS and CECT/MRI LI-RADS for each lesion was assessed with Cohen′s Kappa. Lesions with inconsistent classification for CEUS LI-RADS and CECT/MRI were analyzed.Results:A total of 145 lesions with a size of (1.65±0.33)cm in 145 patients were included. The numbers of lesions in LR-3, 4, 5 and M were 16, 23, 90 and 16 on CEUS LI-RADS, 25, 31, 87 and 2 on CECT/MRI, respectively. And 73.1% lesions were classified as LR-5 or M on CEUS, while 61.4% lesions were classified as LR-5 or M on CECT/MRI ( P=0.033). The incidences of HCC in LR-3, 4 and 5 were 37.5%, 52.2% and 97.8% on CEUS LI-RADS, 56.0%, 64.5% and 96.6% on CECT/MRI LI-RADS respectively. Among the 145 lesions, 56 lesions had inconsistent classifications of CEUS and CECT/MRI LI-RADS. Twenty-eight lesions in CECT/MRI LR-3 and 4 were escalated to LR-4 and 5 by CEUS and 82.1% of them were found to be HCC. Fourteen lesions on CEUS LR-3 and 4 were escalated to LR-4 and 5 by CECT/MRI and 85.7% of them were found to be HCC. Conclusions:The LR-5 of the CEUS and CECT/EOB-MRI LI-RADS has a comparable incidence of HCC. However, the inter-modality agreement of the LI-RADS category between CEUS and CECT/EOB-MRI is poor. The proportion of lesions in CEUS LR-5 and M is much higher than that in CECT/MRI LR-5 and M, while the proportion of lesions in CECT/MRI LR-3 and 4 is high than that in CEUS LR-3 and 4.
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Objective:To assess the impact of not inflated lung tissue (NILT) volume on the prognosis of patients with moderate-to-severe acute respiratory distress syndrome (ARDS).Methods:The clinical data of 131 patients with moderate-to-severe ARDS admitted to the intensive care unit (ICU) of Tianjin Third Central Hospital from March 2016 to June 2019 were collected. The basic data of patients, including gender, age, body mass index (BMI), causes of ARDS, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score and oxygenation index (PaO 2/FiO 2), were collected. The CT imaging data of patients on the 1st and 7th day in the ICU were collected. According to the CT value, they were divided into hyperventilated areas (-1 000 to -900 HU), normal ventilation areas (-899 to -500 HU), poorly ventilated areas (-499 to -100 HU), and atelectasis area (-99 to 100 HU). The total lung volume and the percentage of NILT to the total lung volume (NILT%) were calculate. At the same time, duration of mechanical ventilation, length of ICU stay, total length of hospital stay were collected. According to the 28-day follow-up, they were divided into survival group and death group. Multivariate Logistic regression analysis was used to determine the risk factors for 28-day death in ARDS patients. The receiver operating characteristic (ROC) curve was drawn, the area under ROC curve (AUC) and 95% confidence interval (95% CI) were calculated to determine the accuracy of NILT% in predicting the 28-day prognosis of ARDS patients, and the NILT% threshold was used for subgroup analysis of patients. Results:Among the 131 patients with moderate-to-severe ARDS, patients were excluded for more than 48 hours after ARDS diagnosis, repeated admission to ICU due to ARDS, the ICU duration less than 7 days, death within 72 hours of admission, chronic interstitial lung disease or congestive heart failure, no chest CT examination within 7 days of admission to ICU, and no specimen collection within 2 hours of admission to ICU. Finally, a total of 53 patients were enrolled in the analysis. Of the 53 patients, 31 patients survived and 22 patients died. The 28-day mortality was 41.5%. Compared with the survival group, patients in the death group were older (years old: 65.32±11.29 vs. 55.77±14.23), and had a higher SOFA score (11.68±3.82 vs. 8.39±2.23) with significant differences (both P < 0.05), while there were no significant differences in gender, BMI, ARDS cause, APACHE Ⅱ score and PaO 2/FiO 2 between the two groups. There was no significant difference in CT value, total lung volume and NILT% between the two groups at 1st day after admission to ICU; NILT% on day 7 after admission to ICU in the death group was significantly higher than that in the survival group [(28.95±8.40)% vs. (20.35±5.91)%, P < 0.01], but there was no significant difference in CT value and total lung volume between the two groups. Multivariate Logistic regression analysis showed that the 28-day prognosis of ARDS was related to age, SOFA score and NILT% independently [age: odds ratio ( OR) = 0.892, 95% CI was 0.808-0.984, P = 0.023; SOFA score: OR = 0.574, 95% CI was 0.387-0.852, P = 0.006; NILT%: OR = 0.841, 95% CI was 0.730-0.968, P = 0.016]. ROC curve analysis showed that 7-day NILT% could predict the 28-day prognosis of patients with moderate-to-severe ARDS, and AUC was 0.810 (95% CI was 0.678-0.952, P < 0.01). The NILT% threshold was 15.50%, sensitivity was 95.5%, specificity was 80.6%, positive predictive value was 85.7%, and negative predictive value was 74.6%. According to the 7-day NILT% threshold, a subgroup analysis of patients was performed, and 7-day NILT% > 15.50% was defined as a high-risk clinical prognosis, and ≤ 15.50% was a low-risk. Compared with low-risk patients ( n = 7), the duration of mechanical ventilation, the length of ICU stay and total length of hospital stay in high-risk patients ( n = 46) were significantly prolonged [duration of mechanical ventilation (days): 9.37±6.14 vs. 4.43±1.72, length of ICU stay (days): 12.11±5.85 vs. 7.57±1.13, total length of hospital stay (days): 18.39±5.87 vs. 11.29±2.22, all P < 0.05]. Conclusion:The 7-day NILT% > 15.50% of patients with moderate-to-severe ARDS after ICU admission is related to poor prognosis.
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Objective:To compare enhancement patterns of combined hepatocellular-cholangiocarcinoma (CHC) in CEUS and CECT/MRI and to explore the role of imaging, the discordance of imaging findings and tumor markers, differences in tumor markers in the diagnosis of CHC.Methods:Thirty-five CHCs from July 2011 to August 2019 in Third Central Hospital of Tianjin confirmed by pathological diagnosis were retrospectively reviewed. The enhancement patterns of CHCs on CEUS and CECT/MRI were compared. A combination of the discordance of CEUS and CECT/MRI, the discordance of elevated tumor markers and imaging findings and the discordance of tumor markers was applied to diagnose CHC.Results:About 62.9% and 37.1% lesions showed the HCC and ICC enhancement patterns on CEUS, while 48.6%, 31.4% and 20% lesions showed the HCC, ICC and CHC enhancement patterns, on CECT/MRI, respectively. For 12 lesions with a diameter≤3.0 cm, all of which presented HCC enhancement patterns on CEUS, and 91.7% lesions showed HCC enhancement pattern and 9.3% lesions showed ICC enhancement pattern on CECT/MRI, respectively. For 23 lesions with a size >3.0 cm, 43.5% and 56.5% of which showed the HCC and ICC enhancement patterns on CEUS, respectively. And 26.1%, 43.5% and 30.4% of the lesions showed the HCC, ICC and CHC enhancement patterns on CECT/MRI, respectively. If the discordance of CEUS and CECT/MRI, the discordance of image features and tumor markers, or simultaneous elevation of AFP and CA19-9, were used as diagnostic information, 78.6% of the lesions met at least one of the three criteria.Conclusions:CHCs show different enhancement patterns on CEUS and CECT/MRI. With the increase of size of tumors, the enhancement patterns of CHCs have changed from HCC-like to ICC-like or CHC-like. Combination of the discordance of CEUS and CECT/MRI, the discordance of imaging findings and tumor markers and differences in tumor markers can improve the detection rate of CHCs.
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Objective To compare the diagnostic efficacies of contrast-enhanced ultrasonography (CEUS) and gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) in the diagnosis of liver nodules ≤2.0 cm in patients with cirrhosis,and to explore the clinical values of combining the arterial phase of CEUS and hepatobiliary phase of EOB-MRI in the diagnosis of early hepatocellular carcinoma (HCC).Methods One hundred and thirteen nodules with diameters lower than 2.0 cm in 98 patients from February to December 2016 in Tianjin Third Central Hospital were included in this retrospective study.The enhancement patterns of nodules in CEUS and EOB-MRI were analyzed.The reference standard was pathological diagnosis or substantial lesion growth at a follow-up of at least 6 months.The efficiencies of CEUS and EOB-MRI in the diagnosis of liver lesions with a diameter lower than 2.0 cm were compared.A new diagnostic strategy,which combines the arterial phase of CEUS and hepatobiliary phase of EOB-MRI was presented to diagnose the early HCC in this study.Results The area under the ROC curve of CEUS and EOB-MRI were 0.858 and 0.814 (P ＞ 0.05),the sensitivity were 79.1％,81.4％,specificity were 92.6 ％,81.5 ％ and diagnostic accuracy were 82.3 ％ and 81.4 ％,respectively.By combination of CEUS and EOB-MRI,the area under the ROC curve was 0.831,without difference from CEUS,EOB-MRI (0.831 vs 0.858,0.814;all P ＞0.05);its sensitivity was 66.3 ％,specificity was 100％ and diagnostic accuracy was 74.3％.The area under the ROC curve of the new diagnostic strategy,combining the arterial phase of CEUS and hepatobiliary phase of EOB-MRI was 0.934,which was larger than that of CEUS,EOB-MRI and the combination of CEUS and EOB-MRI(0.934 vs 0.858,0.814,0.831;all P ＜0.05).The sensitivity,specificity and diagnostic accuracy of new strategy were 94.2％,92.6％ and 93.8％,respectively.Conclusions The new diagnostic strategy based on the arterial phase of CEUS and hepatobiliary phase of EOB-MRI improves the sensitivity and accuracy in detecting small lesions,which can be used as a complementary diagnostic enhancement pattern for lesions with an atypical enhancement pattern in CEUS or EOB-MRI.
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Objective@#To compare the diagnostic efficacies of contrast-enhanced ultrasonography (CEUS) and gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) in the diagnosis of liver nodules ≤2.0 cm in patients with cirrhosis, and to explore the clinical values of combining the arterial phase of CEUS and hepatobiliary phase of EOB-MRI in the diagnosis of early hepatocellular carcinoma (HCC).@*Methods@#One hundred and thirteen nodules with diameters lower than 2.0 cm in 98 patients from February to December 2016 in Tianjin Third Central Hospital were included in this retrospective study. The enhancement patterns of nodules in CEUS and EOB-MRI were analyzed. The reference standard was pathological diagnosis or substantial lesion growth at a follow-up of at least 6 months. The efficiencies of CEUS and EOB-MRI in the diagnosis of liver lesions with a diameter lower than 2.0 cm were compared. A new diagnostic strategy, which combines the arterial phase of CEUS and hepatobiliary phase of EOB-MRI was presented to diagnose the early HCC in this study.@*Results@#The area under the ROC curve of CEUS and EOB-MRI were 0.858 and 0.814(P>0.05), the sensitivity were 79.1%, 81.4%, specificity were 92.6%, 81.5% and diagnostic accuracy were 82.3% and 81.4%, respectively. By combination of CEUS and EOB-MRI, the area under the ROC curve was 0.831, without difference from CEUS, EOB-MRI (0.831 vs 0.858, 0.814; all P>0.05); its sensitivity was 66.3%, specificity was 100% and diagnostic accuracy was 74.3%. The area under the ROC curve of the new diagnostic strategy, combining the arterial phase of CEUS and hepatobiliary phase of EOB-MRI was 0.934, which was larger than that of CEUS, EOB-MRI and the combination of CEUS and EOB-MRI(0.934 vs 0.858, 0.814, 0.831; all P<0.05). The sensitivity, specificity and diagnostic accuracy of new strategy were 94.2%, 92.6% and 93.8%, respectively.@*Conclusions@#The new diagnostic strategy based on the arterial phase of CEUS and hepatobiliary phase of EOB-MRI improves the sensitivity and accuracy in detecting small lesions, which can be used as a complementary diagnostic enhancement pattern for lesions with an atypical enhancement pattern in CEUS or EOB-MRI.
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Objective To analyze the impact of the comprehensive reform of public hospitals in Tianjin on the cost structure of inpatients at a tertiary general hospital.Methods Homepage data of the medical records from January 2015 to June 2018 were selected from a tertiary general hospital in Tianjin.The Beijing version of diagnosis related groupings(BJ-DRGs) was used to compare the expense structure of these inpatients before and after such a reform.Wilcoxon signed rank sum test,Z test and Pearson correlation analysis were performed for each index.Results Since the reform,the number of hospital discharges and that of DRGs had remained basically stable,while the case mixed index(CMI) weight increased slightly(from 1.0065 to 1.0386);the total hospitalization expenses,medical expenses,nursing expenses,management expenses and consumables expenses had increased.On the other hand,the expenses of medication and medical technology decreased,and the differences of these expenses were statistically significant (P ＜0.05).The time consumption index (0.87) and drug consumption index (0.80) were always lower than average,but the cost consumption index (1.38) remains above average with a slight rise.Conclusions The reform of public hospitals in Tianjin has encouraged such hospitals to improve their service procedures by adjusting such measures as pricing of medical services,and promoted their proactive management of hospitals.Hence the initial goal of "controlling costs,adjusting structure,and reducing costs" has been met.However,cost rise control still deserves major attention.
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Objective To construct the objective and quantifiable model for evaluating clinical nurses' competency in hospital of Integrated Traditional Chinese and Western Medicine. Methods From December 2016 to August 2017, preliminary formulation of evaluation indicators was constructed through semi-structured interviews, combined with literature analysis. 21 experts from five hospitals of Traditional Chinese Medicine and medical universities were selected using Delphi method for performing two rounds of consultations and weight assignment of indexes. Data was logged and processed using SPSS 16.0. Results The preliminary system of the competency model included four items of Level one and 20 items of Level two. The weight coefficients of the first level indicators were 0.2609, 0.2598, 0.2570 and 0.2224. The positive coefficients from consulations of experts were 100 . 00％ and 95 . 24％, respectively . Authority coefficient was 0.88. The coefficients of variation were 0.0923 to 0.1628 and 0.0430 to 0.1827, respectively. Conclusions This model can provide guidance for the training objective of nurses' competency and serve as an instrument for hospital managers to evaluate nurses in hospital of Integrated Traditional Chinese and Western Medicine.
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Objective@#To construct the objective and quantifiable model for evaluating clinical nurses' competency in hospital of Integrated Traditional Chinese and Western Medicine.@*Methods@#From December 2016 to August 2017, preliminary formulation of evaluation indicators was constructed through semi-structured interviews, combined with literature analysis. 21 experts from five hospitals of Traditional Chinese Medicine and medical universities were selected using Delphi method for performing two rounds of consultations and weight assignment of indexes. Data was logged and processed using SPSS 16.0.@*Results@#The preliminary system of the competency model included four items of Level one and 20 items of Level two. The weight coefficients of the first level indicators were 0.260 9, 0.259 8, 0.257 0 and 0.222 4. The positive coefficients from consulations of experts were 100.00% and 95.24%, respectively. Authority coefficient was 0.88. The coefficients of variation were 0.092 3 to 0.162 8 and 0.043 0 to 0.182 7, respectively.@*Conclusions@#This model can provide guidance for the training objective of nurses' competency and serve as an instrument for hospital managers to evaluate nurses in hospital of Integrated Traditional Chinese and Western Medicine.
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Objective@#To study the nutritional status and energy metabolic characteristics of patients with nonalcoholic fatty liver disease (NAFLD), and to provide evidence for clinical evaluation and intervention.@*Methods@#A total of 359 NAFLD patients diagnosed on ultrasound from June 2015 to March 2017 were selected as study subjects and divided into mild, moderate to severe fatty liver disease group and 50 healthy subjects as control group. The changes of ICW, ECW, body fat, skeletal muscle, protein and visceral fat area (VFA) of patients and controls were analyzed by using body composition analyzer. The energy metabolism index was measured by the oxidation rate of resting energy expenditure(REE), respiratory quotient (RQ), and the oxidation rates of the three nutrients (CHO %, FAT %, and PRO %). According to different types of data, non-parametric tests like Kruskal-Wallis or χ2 were used for this analysis.@*Results@#Compared with the mild fatty liver group and the control group, the moderate and severe fatty liver group the BMI, waist circumference, waist-hip ratio were significantly elevated (P-value < 0.001), and their serum alanine aminotransferase, triglyceride, total cholesterol, high-density lipoprotein, low-density lipoprotein, FBS levels were significantly increased (P value < 0.05). The Body composition analysis showed that there was no significant difference in skeletal muscle content between the three groups (P = 0.067). The ICW, ECW, protein, body fat content of moderate and severe fatty liver group were significantly higher than those of mild fatty liver group and control group (P < 0.01), but there was no significant difference between the mild fatty liver group and the control group. There was significant difference in the VFA between the three groups, while VFA in the moderate and severe fatty liver group was significantly increased. Metabolic results showed that the RQ of patients with moderate-severe fatty liver and mild fatty liver were 0.72 ± 0.08 and 0.78 ± 0.06, respectively, which were lower than those of the control group (0.80 ± 0.02), P = 0.004. Resting energy expenditure (REE) was not significantly different between moderate and severe fatty liver group and mild fatty liver group (P = 0.207), but both were significantly higher than those of the control group (P < 0.001). The percentages of CHO, FAT and PRO in moderate and severe fatty liver group were 19.49% ± 9.71%, 66.23% ± 12.54% and 14.22% ± 6.11% respectively. Compared with the control group, CHO % decreased, and FAT % increased.@*Conclusion@#NAFLD patients have different extent of nutritional imbalance and energy metabolism disorders, the use of Body Composition analyzer and metabolic cart can comprehensively assess and monitor NAFLD patient’s nutrition and energy metabolism status, to provide a basis for clinical intervention.
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Objective@#To investigate the clinicopathologic features, immunophenotype, pathological diagnosis and treatment of malignant mixed tumor (MMT).@*Methods@#Clinical and pathological features including immunohistochemical phenotypes were analyzed in a case of MMT accompanied with eccrine porocarcinoma (EP) involving both hands, diagnosed definitely in January 2018 along with review of relevant literature.@*Results@#A 64-year-old man presented with multiple rash on both hands for 4 years. Three lesions of 0.5 to 2.2 cm were removed for pathological evaluation. The pathological changes on little finger of left and right hands were MMT with EP, whereas that removed from the right ring finger was EP. MMT showed infiltrative growth with vascular wall invasion and consisted of epithelial (glandular or tube differentiation) and mesenchymal components (mucinous and/or cartilage stroma). The endothelial cells showed moderate to severe cytological atypia, nuclear pleomorphism and increased mitotic activity. The glandular component had histological characteristics of syringocarcinoma with moderately atypical chondrocytes but without myoepithelium. EP was composed of basal cells with visible vacuoles in cytoplasm and the presence of tubular and squamous differentiation, along with obvious atypia. Immunohistochemically cavosurface epithelium of glandular differentiation of MMT showed positivity for CK7, EMA and CD117. Myoepithelium showed S-100, CK5/6 and p63 positivity and stromal cells were positive for S-100. Differential diagnoses included metaplastic carcinoma, malignant myoepithelioma and atypical mixed tumor of skin.@*Conclusions@#MMT with EP is extremely rare.The diagnosis of MMT depends on the morphologic features. Immunohistochemical staining is helpful for differential diagnosis. Surgical excision with safety margins is the treatment of choice. Complementary radiotherapy and/or chemotherapy is still controversial. The clinical course of MMT is deemed unpredictable and long-term follow-up is necessary.
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Objective:To discuss the effective therapeutic regimen and the thoughts of pharmaceutical care for subclinical hypothy-roidism complicated with anemia and hemorrhoids during pregnancy. Methods:During the drug treatment process, clinical pharmacist provided pharmaceutical care for the patient,and the results were summarized and analyzed. Results: Clinical pharmacist performed pharmaceutical care for the treatment process of hypothyroidism, anemia and hemorrhoids during pregnancy, and when the oral iron treatment of hemorrhoids was with poor efficacy, clinical pharmacist analyzed and discussed the reasons and put forward reasonable sug-gestions. Conclusion:Subclinical hypothyroidism complicated with anemia and hemorrhoids during pregnancy treated with iron agent and wheat cellulose particles must pay attention to the drug interactions. The administration time of levothyroxine sodium and that of i-ron preparations and wheat cellulose particles should be staggered at least 2 hours. Because hypothyroidism can cause iron malabsorp-tion, intravenous iron therapy may be considered when oral iron supplementation shows poor effect.
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Gastric cancer is a leading cause of cancer death worldwide. It is well known that Japan is the world leader in endoscopic diagnosis and treatment of early gastric cancer (EGC),thus the current status and executive standard in this area in Japan is worthy of studying. This paper reviewed numerous researches,reviews and epidemiological data, summarized the basic principles,standardized protocols,and the diagnostic algorithm and criteria and progress on endoscopic screening and diagnosis of EGC in Japan. Finally,the differences in endoscopic strategies for EGC existed between Japan and China were compared.
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This paper reports a case of Ancylostoma duodenale parasitized in the hepatic flexure of colon and the case was misdiagnosed at the beginning. The causes of misdiagnosis are analyzed and the laboratory examination methods of hookworm are summarized.
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Objective To analyze re-treatments of recurrence after the pelvic floor repair surgery.Methods The protocol and the effect of re-treatments were investigated by reviewing and analyzing the clinical data of 81 recurrent patients (grade Ⅱ and above),who had received the pelvic floor repair surgery from January 2011 to January 2016.Pelvic organ prolapse quantitation system (POP-Q) and two questionnaires about quality of life [pelvic floor distress inventory-short form 20 (PFDI-20) and pelvic floor impact questionnaire short form (PFIQ-7)] were used to evaluate objective and subjective efficacy,respectively.Results Among 81 recurrent patients who were followed up for a median of 35 months (10-69 months),78 cases (with prolapse up to grade Ⅲ or Ⅳ) were treated by surgical operation with both objective cure rate and subjective satisfaction being 100％ (78/78);3 cases (with grade Ⅱ prolapse) were treated by pelvic floor electrical stimulation biofeedback,and 1 case among the three cases had the vaginal foreign body sensation,the subjective satisfaction was 2/3.The methods of surgical operation for the 78 recurrent patients included:total pelvic floor reconstructive surgery (55 cases;3 of which involve trachelectomy),anterior pelvic reconstructive surgery (2 cases),posterior pelvic reconstructive surgery (3 cases),Y-mesh sacral colpopexy (2 cases),colpocleisis (11 cases),vaginal hysterectomy combined posterior fornix forming (3 cases),and vaginal hysterectomy combined posterior pelvic reconstructive surgery (2 cases).Conclusion The extent of recurrence,the recurrent site and complications must be carefully considered and evaluated for re-treatments of recurrence after pelvic floor repair surgery,and then an appropriately individualized re-treatment protocol could be designed for each of the patients.
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Objective To compare the clinical efficacy and postoperative liver function in patients with primary hepatic carcinoma treated by transcatheter arterial chemoembolization(TACE) or TACE combined with portal vein chemoembolization.Methods 48 patients with primary hepatic carcinoma, randomly divided into 2 groups (hepatic artery group in 25 cases and dual interventional group in 23 cases),underwent interventional treatment.The hepatic artery group underwent conventional hepatic artery interventional therapy, while the dual interventional group underwent hepatic artery and portal vein interventional treatment.The postoperative clinical efficiency, liver volume and liver function between the two groups'' patients were compared.Results To the endpoint of observation,the clinical efficacy and tumor reduction degree of dual interventional group were better than that of hepatic artery group.Compared with hepatic artery group, the postoperative ALT, AST and TBIL of dual interventional group were higher on the first and third days.On the seventh and fourteenth days, the statistical difference was not significant.The volume of non-embolization part in dual interventional group was larger than that in preoperative volume to different degrees.The most obvious change of liver volume happened in the 4th weeks after treatment.There was no treatment-related death or severe adverse reaction in two groups.Conclusion The treatment of TACE combined with portal vein chemoembolization is a safe and effective method, which may effectively inhibit the growth and reduce the volume of tumor, and result in compensatory hypertrophy of non-embolization part.