Objective:To explore the risk factors of respiratory failure within 48 hours of admission in patients with sepsis associated acute kidney injury(SA-AKI)and establish a predictive model and verify it.Methods:A retrospective selection was made of 702 patients with SA-AKI admitted to Dongyang People's Hospital from June 2012 to October 2024, and they were randomly divided into the training set (492 cases) and the validation set (210 cases) in a ratio of 7∶3. The risk factors of respiratory failure within 48 h of admission in patients with SA-AKI were analyzed in the training set to establish a nomogram. The discriminative ability of the model was evaluated by using the receiver operating characteristic (ROC) curve, and the clinical effectiveness of the predictive model was evaluated by using decision curve analysis (DCA). Meanwhile, validation was conducted in the validation set. The Sequential Organ Failure Assessment (SOFA) and National Early Warning Score (NEWS) models were established, and the Delong test was applied to compare them with this prediction model.Results:The results of Logistic regression analysis showed that lactic acid, D-dimer, pro-B-type natriuretic peptide precursor, albumin, globulin, percutaneous blood oxygen saturation and pulmonary infection were independent risk factors for respiratory failure within 48 h of admission in patients with SA-AKI ( P<0.05). The results of ROC curve analysis indicated that the area under the curve (AUC) of this model for predicting respiratory failure within 48 h of admission in SA-AKI patients in the training set was 0.818 (95% CI 0.777 - 0.860), and that in the validation set was 0.795 (95% CI 0.723 - 0.860). The calibration curves showed that the P values were 0.973 and 0.864 respectively. The DCA curve was applied to evaluate the clinical effectiveness. The model curves were above the two extreme curves in both the training set and the validation set suggested that the model had good significance in discrimination, calibration and clinical effectiveness. The AUC of the SOFA model was 0.583 in the training set and 0.628 in the validation set. The AUC of the NEWS model was 0.601 in the training set and 0.618 in the validation set. The Delong test suggests that in both the training set and the validation set, compared with the SOFA and NEWS models, this prediction model had advantages in discrimination ability ( P<0.01). Conclusions:The nomogram model based on lactic acid, D-dimer, B-type brain natriuretic peptide precursor, albumin, globulin, percutaneous blood oxygen saturation and pulmonary infection can effectively predict the risk of respiratory failure within 48 h after admission in patients with SA-AKI.
Objective: Chronic Pelvic Pain (CPP) is a very common disease. Studies have found that some female patients with CPP have a myofascial trigger point for pain, which has classified as myofascial pelvic pain (MFPP). This study intends to compare the changes of pelvic floor electrophysiology and imaging between female patients with MFPP and normal women by measuring pelvic floor muscle potential, tension and two-dimensional and three-dimensional ultrasound, and then to explore the characteristics and significance of the changes.Methods: A total of 49 MFPP patients were randomly selected as the study group and 41 healthy women were randomly selected as the control group. Vaginal muscle potential was detected by pelvic floor muscle potential tester. The electronic tensioner was used to measure the muscle tension and the pelvic floor muscle contraction force of 5o and 10o, respectively. The parameters of the two groups were detected by transperineal 2D ultrasound and transvaginal 3D ultrasound respectively.Results: 1. The resting muscle potential and maximum muscle potential of the study group were higher than those of the control group. 2. The static tension, dynamic tension and contractile force of pelvic floor muscle in the study group were higher than those in the control group when the tensioner was opened for 5o. 3. In resting state, BND, BSD and anterior-to-posterior diameter of genital tract hiatus in the study group were smaller than those in the control group. The anal Angle in Valsalva state was greater in study group than in control group. 4. At rest, the hiatus area, anterior-posterior diameter, transverse diameter and defect score of the levator anal muscle in the study group were smaller than those in the control group.Conclusion: MFPP presents a state of continuous spasm and loss of coordination of pelvic floor muscle fascia.
Objective:To study the feasibility of preserving the subvalvular structure during mitral valve replacement and whether it is more conducive to the recovery of cardiac function.Methods:The clinical data of 205 patients who underwent mitral valve replacement due to mitral insufficiency in Enshi Central Hospital from January 2017 to December 2020 were analyzed retrospectively. According to whether the subvalvular structure of mitral valve was preserved during operation, they were divided into three groups: group A was to preserve all the subvalvular structures of anterior and posterior mitral valve, group B retained all or part of the subvalvular structure of the posterior valve, in group C, all anterior and posterior subvalvular structures were removed. The operation time, cardiopulmonary bypass time and aortic occlusion time of patients in each group were counted. Postoperative ventilator use time, ICU stay time and incidence of complications; mitral flow velocities (MVE), left ventricular end diastolic dimension (LVED), left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) were rechecked by echocardiography at 1 week, 3 months and 6 months after operation.Results:There were no significant differences in operation time, cardiopulmonary bypass time, aortic occlusion time, ventilator use time and ICU stay time among the three groups before surgery ( P>0.05). There were no death cases in perioperative period, and all patients were cured and discharged from hospital. The results of cardiac color ultrasound showed that MVE, LVED, LVEF and LVFS were improved compared with those before operation. Postoperative ultrasound results showed no significant difference in MVE at 1 week, 3 months and 6 months ( P>0.05). At 1 week after surgery, LVED in group A was lower than that in group B and C: (44.90 ± 5.59) mm vs. (46.13 ± 6.15) mm, (48.33 ± 5.59) mm. The difference was statistically significant ( P<0.05). Three months after operation, LVED and LVFS in group A were higher than those in group B and group C: (43.37 ± 5.61) mm vs. (44.69 ± 5.45) mm and (53.42 ± 5.35) mm, (33.92 ± 3.34)% vs. (31.67 ± 3.20)% and (30.37 ± 6.96)%, respectively. The differences were statistically significant ( P<0.05). At 6 months after operation, LVED in group A was lower than that in group B and group C: (41.86 ± 3.27) mm vs. (47.85 ± 6.93) mm and (53.42 ± 8.17) mm. LVFS was higher than that in group B and group C: (33.42 ± 2.64) % vs. (32.18 ± 5.98) % and (32.28 ± 2.58) %, and the differences were statistically significant ( P<0.05). Conclusions:Preserving the whole subvalvular structure of mitral valve will not lead to prosthetic valve dysfunction and increase surgical complications. After operation, it showed better reduction of left ventricular end diastolic diameter and better left ventricular shortening rate, which was more conducive to the recovery of cardiac function.
Objective:To analyze the interaction of tissue delta-like ligand 3 (DLL3) expression and xeroderma pigmentosum gene G (XPG) gene polymorphism on the sensitivity of advanced lung squamous cell carcinoma to platinum-based chemotherapy.Methods:One hundred and forty patients with advanced squamous lung cancer admitted to Yuechi County People′s Hospital from March 2019 to December 2021 were selected and all were given carboplatin and paclitaxel for injection (albumin-bound) in a fully informed manner, with one cycle every 3 weeks for a total of 4 cycles of treatment. The patients were divided into sensitive group (46 cases) and non-sensitive group (94 cases) according to their sensitivity to chemotherapy. Baseline information, tissue DLL3 expression and XPG gene polymorphism were compared between the two groups, and tissue DLL3 expression in patients with different XPG genotypes was compared. Multi-factor Logistic regression analysis was used to analyzed the factors associated with the sensitivity to chemotherapy, and interaction coefficient γ was used to analyze tissue DLL3 expression and XPG.Results:The tissue DLL3 expression score of the sensitive group was lower than that in the non-sensitive group: (3.28 ± 0.93) scores vs. (7.59 ± 1.22) scores, there was statistical difference ( P<0.01). The patients with CC genotype in the sensitive group were more than those in the non-sensitive group, and the patients with CT and TT genotypes were less than those in the non-sensitive group ( P<0.05). Tissue DLL3 expression score in patients with CC, CT, TT genotype were (3.51 ± 0.93), (6.76 ± 1.08), (10.09 ± 1.12) scores, there was statistical difference ( P<0.05); and tissue DLL3 expression score was CC
尽管近年来胶质母细胞瘤的辅助治疗取得了一系列进展，但仍未能有效延长患者的远期生存时间，并使许多患者失去了再次手术的机会。随着当前新技术新方法的出现，在尽可能保证患者生命质量的前提下，通过手术最大程度切除病变以控制肿瘤进展是提高患者远期生存率的有效方法，结合临床实际，通过示例说明胶质母细胞瘤治疗的根本及基石在于手术切除。
Objective:To analyze the incidence and prognosis of epilepsy in frontotemporal lobe glioma.Methods:The clinical data of 208 patients with frontotemporal lobe gliomas in Sanbo Brain Hospital Capital Medical University from 2019 to 2021 were analyzed retrospectively. According to the 2016 World Health Organization (WHO) classification of tumors of the central nervous system, the incidence of epilepsy, Modified Rankin Scale (MRS) score, and Engel Outcome Scale of patients with different grades of tumors were calculated.Results:Among all the patients with frontotemporal lobe gliomas, there was more males than females, and it was more common in the 40 -59 age group. The incidence of epilepsy associated with WHO grade Ⅰand Ⅱ glioma was 100.0% (33/33) and 60.9% (14/23), respectively, while that of WHO grade Ⅳ glioma was 19.0%(19/100). The average follow-up time was (22 ± 9) months. During the follow-up period, the incidence of WHO grade Ⅰ, Ⅱ and Ⅲ glioma-related epilepsy decreased significantly. There was no significant difference in the incidence of glioma-related epilepsy between the total and subtotal resection groups ( P>0.05). There was no statistical correlation between the side of tumor occurrence and the occurrence of epilepsy ( P>0.05), also between the gene phenotype and the occurrence of epilepsy ( P>0.05). There was no significant difference in the Engel Outcome Scale among different grades of gliomas ( P>0.05). The prognosis of patients with Engel Outcome Scale Class 1 was significantly better than that of other grades. Conclusions:The incidence of glioma-related epilepsy is negatively correlated with tumor grade. Age and sex are risk factors for glioma-related epilepsy. The incidence of postoperative epilepsy in patients with low grade glioma is significantly lower than that in patients with high grade glioma, and the prognosis is better. However, there is no significant difference in the Engel Outcome Scale among different grades of gliomas.
Objective:To investigate the changes of Toll-like receptor 4(TLR4) level in peripheral blood of endometriosis (EMT) patients with infertility and its relationship with clinicopathological types and pregnancy outcomes.Methods:A total of 150 patients with EMT complicated with infertility (study group) admitted to Huangzhou District People′s Hospital of Huanggang City from May 2019 to March 2021 and 50 healthy married women (control group) who participated in physical examination during the same period were selected as the research objects. Reverse transcription polymerase chain reaction (RT-PCR) was used to determine the level of TLR4 in peripheral blood of the two groups, and different pathological types of EMT were compared. The receiver operating characteristic (ROC) curve was used to evaluate the predictive efficacy of TLR4 expression for postoperative pregnancy in EMT patients with infertility. At the same time, the relationship between changes in TLR4 level in peripheral blood and pregnancy outcomes was analyzed according to the TLR4 cut-off value.Results:The expression of TLR4 mRNA in peripheral blood in the study group was higher than that in the control group: 98.65 ± 10.63 vs. 1.27 ± 0.20, there was statistical difference ( t = 64.66, P<0.01). After treatment, the expression of TLR4 mRNA in peripheral blood of patients with simple peritoneal type, internal cystic type and adenomyosis type EMT complicated were decreased :81.13 ± 8.89 vs. 64.31 ± 6.44, 103.58 ± 10.01 vs. 85.40 ± 8.78, 118.69 ± 12.76 vs. 96.38 ± 9.96, There were statistical differences ( P<0.05); No matter before or after treatment, the expression of TLR4 mRNA in peripheral blood of patients with adenomyosis was higher than that of patients with internal cystic type and simple peritoneal type, while the expression of TLR4 mRNA in peripheral blood of patients with internal cystic type was higher than that of simple peritoneal type, and there were statistical differences ( P<0.05). The results of ROC curve analysis showed that when the area under the curve (AUC) was 0.787(95% CI 0.701 - 0.863, P<0.05) and the best cut-off value was 41.75, the sensitivity, specificity and accuracy of TLR4 mRNA expression in peripheral blood to predict postoperative pregnancy in EMT patients with infertility were 80.12%, 81.57% and 80.30%, respectively. Using the peripheral blood TLR4 mRNA expression of 41.75 as the cut-off value, 143 patients with EMT and infertility with complete follow-up data were divided into high expression group (58 cases, TLR4 mRNA≥41.75) and low expression group (85 cases, TLR4 mRNA < 41.75). The postoperative intrauterine pregnancy rate and total pregnancy rate in the high expression group were lower than those in the low expression group: 44.83% (26/58) vs. 70.59% (60/85), 58.62% (34/58) vs. 81.18% (69/85), and there were statistical differences ( χ2 = 9.54, 8.71, P<0.05). Conclusions:There is abnormal expression of TLR4 in peripheral blood of EMT patients with infertility, and its high expression is closely related to adverse clinicopathological features and pregnancy outcomes. Effective intervention of treatment and postoperative recovery according to the expression level of TLR4 mRNA can further improve the natural pregnancy rate of such patients.
Objective:To investigate the effects of different radiotherapy regimens on the short-term and long-term prognosis of patients with limited-stage small cell lung cancer (SCLC).Methods:Sixty patients with limited-stage SCLC in the Third People′s Hospital of Yangquan City from September 2017 to September 2019 were selected. The patients who received concurrent radiotherapy and chemotherapy were in group A and the patients who received sequential radiotherapy and chemotherapy were in group B, 30 cases in each group. The short-term efficacy and adverse reactions of the two groups were compared, and the levels of neuron-specific enolase (NSE), gastrin release precursor (ProGRP), carcinoembryonic antigen (CEA), vascular endothelial growth factor (VEGF), endostatin (ES), circulating endothelial cells (CEC) were compared between the two groups. The survival status of the two groups were followed-up.Results:After treatment, the disease control rate in group A was higher than that in the group B : 80.00%(24/30) vs. 53.33%(16/30), the difference was statistically significant ( χ2 = 4.80, P<0.05). The levels of serum NSE, ProGRP and CEA in the group A after treatment were lower than those in the group B: (19.42 ± 3.31) pg/L vs. (24.58 ± 4.42) pg/L, (95.45 ± 10.33) ng/L vs. (115.54 ± 15.66) ng/L, (8.25 ± 1.02) μg/L vs. (10.33 ± 1.15) μg/L, the differences were statistically significant ( P<0.05). The levels of VEGF and CEC in the group A were lower than those in the group B after treatment and ES was higher than that in the group B: (356.62 ± 56.63) ng/L vs. (442.21 ± 55.38) ng/L, (65.56 ± 5.41) × 10 6/L vs. (99.28 ± 7.24) ×10 6/L, (52.65 ± 6.44) μmol/L vs. (31.85 ± 5.49) μmol/L, the differences were statistically significant ( P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups ( P>0.05). The survival rate in the group A was higher than that in the group B at 1 year after treatment: 82.14%(23/28) vs. 56.00%(14/25), the difference was statistically significant ( χ2 = 4.28, P = 0.038). Conclusions:Compared with sequential radiotherapy and chemotherapy, concurrent radiotherapy and chemotherapy is effective in treating limited-stage SCLC, which can adjust the level of tumor markers and angiogenesis indicators, and improve the treatment effect and survival rate.
Objective:To explore the effect of total hip arthroplasty via modified direct anterior approach on hip function, balance function and gait parameters in patients undergoing primary total hip arthroplasty.Methods:Eighty-nine patients who underwent total hip arthroplasty for the first time in Anqing First People′s Hospital of Anhui Medical University from January 2020 to December 2021 were selected as the study subjects by prospective study, and they were divided into the observation group (modified direct anterior approach total hip arthroplasty, 45 cases) and the control group [direct anterior approach (DAA) total hip arthroplasty, 44 cases] according to the random number table method. Perioperative indexes of the two groups were observed and complications were counted, and hip function, balance function, gait parameters and follow-up imaging data were compared between the two groups at 1 year after postoperative follow-up.Results:After treatment, the anal exhaust time, hospital stay, blood loss, ambulation time and postoperative feeding time in observation group were shorter or less than those in control group:(9.15 ± 1.33) h vs. (10.89 ± 1.53) h, (5.07 ± 2.21) d vs. (7.04 ± 2.23) d, (53.48 ± 12.43) ml vs. (64.44 ± 12.53) ml, (4.07 ± 0.21) d vs. (6.15 ± 1.24) d, (0.47 ± 0.13) d vs. (0.75 ± 0.24) d, P<0.05. At 3, 6 and 12 months after treatment, the hip function scores in the two groups were risen compared with those before treatment ( P<0.05), and the above hip function scores in observation group were higher compared to control group: (65.47 ± 8.38) points vs. (57.91 ± 2.83) points, (76.12 ± 5.31) points vs. (72.25 ± 2.44) points, (85.27 ± 4.45) points vs. (83.24 ± 4.55) points, P<0.05. The balance function scores of the two groups at 3, 6 and 12 months after treatment were enhanced compared with those before treatment ( P<0.05), and the balance function scores in observation group were higher than those in control group: (35.26 ± 1.22) points vs. (29.51 ± 1.49) points, (39.42 ± 4.36) points vs. (37.57 ± 2.21) points, (45.57 ± 2.01) points vs. (43.36 ± 2.18) points, P<0.05. The stride distance and stride length in the observation group were higher compared to the control group: (0.78 ± 0.12) m vs. (0.71 ± 0.19) m, (0.46 ± 0.04) m vs. (0.32 ± 0.08) m, while the stride frequency and gait asymmetry index were lower than those in the control group: (89.74 ± 8.05) steps/min vs. (98.68 ± 9.04) steps/min, 0.10 ± 0.02 vs. 0.16 ± 0.05, P<0.05. After treatment, the incidence rate of complications in the observation group was lower than that in the control group: 2.44%(1/41) vs. 19.51%(8/41), P<0.05. At 1-month follow-up after surgery, there were no statistical differences in acetabular cup anteversion angle, abduction angle, femoral stem peripheral zona pellucida score, and lower limb lebgth between the two groups ( P>0.05). Conclusions:Modified direct anterior approach total hip arthroplasty can promote postoperative recovery, improve hip function, enhance balance function, reduce risk of complications, and improve gait parameters.
Objective:To investigate the risk factors of post-stroke depression (PSD) in patients with first acute stroke 6 months after onset.Methods:Three hundred and sixty-seven patients with acute stroke who were treated for the first time in the Affiliated Hospital of Xuzhou Medical University were selected retrospectively. After onset for 6 months, the patients were followed up and divided into PSD group and non-PSD group. The clinical data, blood index, imaging data, degree of nerve damage and the patient's stigma level were compared between the two groups.Results:Totally 182 and 185 cases were included in the PSD and non-PSD groups, respectively. The incidence of PSD at 6 months post-stroke was 49.6% (182/367). The results of univariate analysis showed that diseased region, drinking history, monthly income, standard of culture, serum cortisol, total cholesterol (TC), high sensitivity C-reactive protein (hs-CRP), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), Stigma Scale for Chronic Illness-8 Chronic Disease Stigma Scale-8(SSCI-8) scores, National Institute of Health Stroke Scale (NIHSS) scores and subtype of stroke were risk factors for PSD ( P<0.05). Binary Logistic regression analysis showed that diseased region at frontal lobe ( OR = 3.245, P = 0.011), basal ganglia region ( OR = 2.820, P = 0.007), cerebellar hemisphere ( OR = 4.594, P = 0.010) and serum cortisol ( OR = 1.174, P<0.001), hs-CRP ( OR = 1.057, P<0.001), SSCI-8 scores ( OR = 1.674, P<0.001), NIHSS scores ( OR = 1.283, P<0.001) were independent risk factors for PSD. Conclusions:PSD is a common complication in patients with stroke. Diseased region (at frontal lobe, basal ganglia region, cerebellar hemispheres), hs-CRP, serum cortisol, level of morbidity stigma and degree of neurological impairment are development risk factors for the PSD at 6 months of acute stroke.
Objective:To investigate the effect of pretreatment with butorphanol on perineal discomfort caused by intravenous injection of dexamethasone sodium phosphate.Methods:Using the method of prospective study, ninety patients undergoing elective gynecological surgery in Dalian Women And Children′s Medical Group from June to December 2021 were randomly divided into three groups: butorphanol 0.5 mg pretreatment group (group B1), butorphanol 1.0 mg pretreatment group (group B2) and normal saline control group (group C), with 30 cases in each group. Patients in groups B1 and B2 were given butorphanol 0.5 mg and 1.0 mg intravenously, respectively, prior to induction of anesthesia, while those in group C were given 0.9% sodium chloride injection. 3 minutes later, all patients in the three groups were given dexamethasone sodium phosphate injection 10 mg, and the incidence, grade and adverse reactions of their perineal discomfort symptoms were recorded.Results:The incidence of perineal discomfort and moderate perineal discomfort of patients in group B1 and group B2 was lower than that in group C: 20.00%(6/30)and 10.00%(3/30)vs. 60.00%(18/30), 3.33%(1/30)and 3.33(1/30)vs. 30.00%(10/30), with a statistically significant differences ( P<0.05). The incidence of adverse reactions such as dizziness was increased in the group B2:26.67%(8/30)and 10.00%(3/30)vs. 40.00%(12/30), with a statistically significant difference ( χ2 = 7.13, P = 0.028). Conclusions:Butorphanol 0.5 mg and 1.0 mg pretreatments are touted as effective in inhibiting perineal discomfort caused by intravenous injection of dexamethasone sodium phosphate. However, the butorphanol 0.5 mg pretreatment group have fewer adverse reactions.
Objective:To study the relationship between fasting glucose (FPG) and gene polymorphisms of adiponectin (ADIPOQ), interleukin 6 (IL-6) and tumor necrosis factor-alpha (TNF-α) in early pregnancy and insulin resistance in patients with gestational diabetes mellitus (GDM).Methods:Sixty patients diagnosed with GDM within 24 -28 weeks from January 2022 to August 2022 in the Affiliated Hospital of Jining Medical University were selected as the GDM group, and another 60 healthy pregnant women were taken as the normal control group. The fasting insulin (FINS), FPG levels and the homeostatic model assessment insulin resistance index (HOMA-IR) and other clinical data were detected at 8 -12 weeks of pregnancy. Meanwhile, polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to detect the polymorphisms of ADIPOQ gene at S0100622 locus, IL-6 gene at S01006318 locus, TNF- α gene at S01009718. Receiver operating characteristics(ROC) curve was used to evaluate the diagnostic performance of FPG combined with polymorphisms of ADIPOQ, IL6 and TNF-α in predicting GDM in early pregnancy.Results:The body mass index (BMI), early pregnancy FPG, mid pregnancy FPG, 75 g oral glucose tolerance test (OGTT) 1 h blood glucose, OGTT 2 h blood glucose, glycosylated hemoglobin (HbA 1c), FINS and HOMA-IR in the GDM group were higher than those in the normal control group: (27.1 ± 2.6) kg/m 2 vs. (25.6 ± 2.5) kg/m 2, (4.7 ± 1.3) mmol/L vs. (4.1 ± 1.5) mmol/L, (5.5 ± 1.3) mmol/L vs. (4.2 ± 1.2) mmol/L, (6.3 ± 1.5) mmol/L vs. (5.5 ± 1.7) mmol/L, (6.0 ± 1.5) mmol/L vs. (5.2 ± 1.4) mmol/L, (5.8 ± 0.7)% vs. (5.2 ± 0.6)%, (6.4 ± 1.1) mU/L vs. (5.2 ± 1.2) mU/L, 1.5 ± 0.6 vs. 1.0 ± 0.7, there were statistical differences ( P<0.05). According to the risk assessment of genotype, the high-risk rate in the GDM group was 88.33% (53/60), while the normal control group was 56.67% (34/60), there was statistical difference ( χ2 = 17.67, P<0.05). In GDM group, the HOMA-IR with ADIPOQ gene S0100622 locus TG genotype was higher than that with TT genotype: 6.58 ± 0.89 vs. 4.98 ± 0.58; the HOMA-IR with IL-6 gene S01006318 locus CG genotype was higher than CC and GG genotype: 8.13 ± 1.31 vs. 6.53 ± 0.81, 4.85 ± 0.54, the HOMA-IR with TNF-αgene S01009718 locus AG genotype was higher than GG genotype: 6.31 ± 1.04 vs. 5.16 ± 0.82, there were statistical differences ( P<0.05). Logistic regression analysis showed that age>35 years, previous diabetes history, BMI, TG genotype at S0100622 locus of ADIPOQ gene, CG genotype at S01006318 locus of IL-6 gene, AG genotype at S01009718 locus TNF- α gene were risk factors for the onset of GDM ( P<0.05). The results of ROC curve analysis showed that the area under the curve (AUC) of FPG for predicting GDM onset was 0.737, with a specificity of 83.50%; FPG combined with ADIPOQ, IL-6, TNF- α genetic risk assessment predicted with AUC of 0.921 and a specificity of 86.80%. Conclusions:ADIPOQ gene TG genotype at S0100622 locus, IL-6 gene CG genotype at S01006318 locus, TNF- α gene AG genotype at the S01009718 locus has a certain correlation with the onset of GDM, which can predict the onset of GDM and is associated with perioperative insulin resistance in patients. Early FPG testing combined with genetic screening has practical clinical guiding significance in reducing adverse pregnancy outcomes for mothers and infants.
Objective:To investigate the related factors of cerebral collateral circulation in patients with acute cerebral infarction (ACI).Methods:A retrospective study was conducted on 4 483 inpatients with ACI admitted to the Renqiu Kangji Xintu Hospital from January 2014 to November 2018 were selected as the research subjects. According to transcranial Doppler (TCD) and CT angiography(CTA) examination results, they were divided into the group with collateral circulation (154 cases) and the group without collateral circulation (4 329 cases) according to the presence of collateral circulation. The related factors affecting the formation of cerebral collateral circulation in the two groups were statistically analyzed. According to the Modified Rankin Scale (mRS) score, 0 - 1 score was defined as good discharge outcome, and mRS ≥ 3 scores was defined as bad discharge outcome. The relationship between collateral circulation opening and poor discharge outcome was analyzed.Results:Compared with the group without collateral circulation, age: 67.00 (61.00, 73.00) years vs. 65.00 (57.00, 72.00) years, history of stroke: 52.59% (81/154) vs. 32.08% (1 389/4 329), carotid artery stenosis: 85.71% (132/154) vs. 20.23%(876/4 329), homocysteine (Hcy): 16.85 (13.00, 28.03) μmol/L vs. 15.00 (11.00, 21.00) μmol/L, significantly promoted the formation of collateral circulation, and the differences were statistically significant ( P<0.05). After adjusting for confounding factors, age ( OR = 0.97, 95% CI 0.95 - 0.99), stroke history ( OR = 1.60, 95% CI 1.11 - 2.32), carotid artery stenosis ( OR = 23.63, 95% CI 14.64 -38.11) and Hcy ( OR = 1.01, 95% CI 1.00 -1.02) were independent factors promoting the formation of cerebral collateral circulation in ACI patients ( P<0.05), carotid artery stenosis was a significant promoting factor, OR value was 23.63. Receiver operating characteristic (ROC) curve analysis showed that the model predicted the area under the curve value of cerebral collateral circulation opening reached 0.869. Among 4 483 ACI patients, 798 cases (17.80%) had poor discharge outcome, including 18 cases (11.68%) with collateral circulation and 780 cases (18.01%) without collateral circulation, suggesting that the incidence of adverse discharge outcome was lower in the group with collateral circulation ( P<0.05), OR = 0.60, 95% CI 0.36 - 0.99, suggesting that the formation of cerebral collateral circulation was a factor promoting the good prognosis of ACI patients. Conclusions:Age, history of stroke, carotid artery stenosis and Hcy are correlated with the formation of cerebral collateral circulation in ACI patients. Existing model can effectively predict the formation of cerebral collateral circulation in ACI patients, and the formation of cerebral collateral circulation is closely related to the discharge outcome of ACI patients.
Objective:To investigate the CT angiography (CTA) characteristics and etiological screening of ischemic stroke (IS) in young adults.Methods:A total of 61 young IS patients (17-35 years old) admitted to Huzhou Nanxun District Traditional Chinese Medicine Hospital and Lishui Central Hospital from January 2019 to December 2021 were selected as the observation group, and the characteristics of brain CTA were observed. One hundred and thirty-six cases of young medical examiners of the same age were selected as the control group. The general clinical data of the two groups of subjects were recorded. Univariate analysis and multivariate Logistic regression were used to analyze the related factors affecting the incidence of patients in the observation group.Results:The results of CTA examination of 61 patients showed that the infarcts of the patients were usually located in the basal ganglia in 50.82%(31/61), and in the lobe of the brain in 39.34%(24/61), and the lesions were mostly multiple in 60.66%(37/61). Most of the diseased vessels were anterior circulation arteries in 67.21% (41/61), internal carotid artery disease was more common in 47.54%(29/61), and vertebrobasilar artery disease was more common in posterior circulation in 29.51%(18/61). The results of multivariate Logistic analysis showed that hypertension, diabetes, family history of stroke, smoking, alcoholism, dyslipidemia and serum homocysteine >6 μmol/L were independent influencing factors of the incidence of young IS patients ( P<0.05). Conclusions:In young IS patients, infarcts in the basal ganglia and cerebral lobes are common, with multiple lesions, internal carotid artery lesions and vertebrobasilar artery lesions are more common. The incidence of this disease is multi-factorial, and the incidence is higher in young people with hypertension, diabetes, family history of stroke, smoking, alcoholism, dyslipidemia and hyperhomocysteinemia.
Objective:To study the efficacy and success rate of dental pulp revascularization surgery for young permanent teeth with dental pulp necrosis.Method:A total of 100 young patients with dental pulp necrosis of permanent teeth admitted to Xixi Hospital of Hangzhou from March 2019 to March 2023 were selected prospectively, they were divided into the control group and the study group according to the principles of balance and randomization, with 50 cases in each group. The control group and the research group received apical induction shaping surgery and pulp revascularization surgery, respectively. The treatment success rate, root canal wall thickness, crown root ratio, and dental pulp vitality and development of the affected teeth before and after 6 months of treatment were compared between the two groups.Results:The success rate in the study group was higher than that in the control group : 94.00%(47/50) vs. 80.00%(40/50), there was statistical difference ( χ2 = 4.33, P<0.05). After 6 months of treatment, the thickness of the root canal wall in the study group was greater than that in the control group, the affected tooth crown root ratio was lower than that in the control group: (2.43 ± 0.42) mm vs. (2.25 ± 0.39) mm, 0.71 ± 0.09 vs. 0.78 ± 0.11, there were statistical differences ( P<0.05). The proportion of active dental pulp and secondary dental pulp development in the study group during the last follow-up were higher than those in the control group: 92.00%(46/50) vs. 76.00%(38/50), 94.00%(47/50) vs. 80.00%(40/50), there were statistical differences ( P<0.05). Conclusions:The use of dental pulp revascularization surgery in young permanent teeth with dental pulp necrosis can prolong the root of the affected tooth, thicken the root canal ratio, and improve the success rate of treatment by increasing dental pulp vitality and promoting root development.
Objective:To investigate the effects of laparoscopic total extraperitoneal hernia repair (TEP) on respiratory function and motilin (MOL) in elderly patients with inguinal hernia.Methods:One hundred and twenty elderly patients with inguinal hernia admitted in Chongqing Fengdu People′s Hospital from January 2020 to December 2021 were divided into two groups according to the method of operation, 60 patients who performed laparoscopic preperitoneal hernia repair (TAPP) was enrolled in control group, and 60 patients who performed TEP was enrolled in the study group. The operation index, visual analogue scale (VAS) scores at different time, respiratory function index and gastrin (GAS), MOL levels and postoperative complications were compared between the two groups.Results:Compared with the control group, the operation time in the study group was longer, the recovery time was shorter and the VAS scores were lower on the 1st, 3rd and 7th day after operation: (66.36 ± 10.05) min vs. (53.69 ± 8.59) min, (4.09 ± 0.59) d vs. (5.15 ± 1.06) d, (4.49 ± 1.26) scores vs. (5.46 ± 1.48) scores, (3.65 ± 0.58) scores vs. (4.52 ± 0.95) scores, (2.42 ± 0.41) scores vs. (3.54 ± 0.48) scores, there were statistical differences ( P<0.05). The levels of end-expiratory carbon dioxide pressure (P ETCO 2) and airway pressure (Paw) in the study group at 10, 30 and 90 min postoperatively were higher than those in the control group: (40.66 ± 4.52)mmHg(1 mmHg = 0.133 kPa) vs. (37.48 ± 5.26) mmHg, (19.88 ± 1.63) cmH 2O (1 cmH 2O = 0.098 kPa) vs. (16.59 ± 2.15) cmH 2O; (44.65 ± 4.18) mmHg vs. (41.58 ± 4.58) mmHg, (20.49 ± 1.65) cmH 2O vs. (16.95 ± 2.84) cmH 2O; (50.16 ± 3.54) mmHg vs. (45.59 ± 4.65)mmHg, (21.69 ± 1.78) cmH 2O vs. (17.49 ± 2.15) cmH 2O, there were statistical differences ( P<0.05). The levels of MOL and GAS in the study group at 3 d postoperatively were higher than those in the control group: (396.54 ± 13.58) ng/L vs. (332.52 ± 16.95) ng/L, (118.95 ± 8.95) ng/L vs. (102.58 ± 10.65) ng/L, there were statistical differences ( P<0.05). There was no significant difference in the incidence of complications between the two groups ( P>0.05). Conclusions:Both TEP and TAPP have certain therapeutic effects on the inguinal hernia, but TEP has shorter postoperative recovery time, less pain, less impact on gastrointestinal function, but it will have a certain impact on respiratory function.
Objective:To study the correlation between serum uric acid (SUA) and vascular calcification in middle-aged and elderly men.Methods:Using the Yiduyun electronic medical record retrieval system, a cross-sectional study was conducted on the clinical data of 2 786 male patients aged ≥40 years who underwent lung CT examinations in Dalian Central Hospital, Dalian University of Technology from January 2010 to October 2022. According to the degree of pulmonary CT vascular calcification, they were divided into vascular calcification group (1 296 cases)and non vascular calcification group (1 490 cases). The clinical data were collected and the correlation between SUA and vascular calcification were analyzed.Results:The levels os SUA in the vascular calcification group was higher than that in the non vascular calcification group: 311.50(270.25, 359.00) μmol/L vs. 284.00(251.00, 318.00) μmol/L, there was statistical difference ( F = 14.16, P<0.01). The constituent ratio of hyperuricemia in vascular calcification group was higher than that in non vascular calcification group : 25.62%(332/1 296) vs. 11.68%(174/1 490), there was statistical difference ( χ2 = 20.15, P<0.01). Spearman correlation analysis found a positive correlation between SUA level and vascular calcification in middle-aged and elderly men ( r = 0.489, P<0.01). Binary Logistic regression analysis results showed that SUA, body mass index (BMI), diastolic blood pressure(DBP), fasting plasma glucose(FPG) were positively correlated with vascular calcification ( P<0.01); after adjusting the influence of BMI, DBP and FPG on male vascular calcification, SUA was still a risk factor for vascular calcification. Conclusions:In the middle-aged and elderly male population, with the increase of blood uric acid, vascular calcification increase, and the elevated blood uric acid level is an independent risk factor for vascular calcification.
Objective:To evaluate the clinical efficacy of ultrasound-guided radiofrequency ablation therapy for patients with papillary thyroid microcarcinoma (PTMC).Methods:A retrospective analysis was conducted on the clinical data of 80 PTMC patients admitted to Zhongshan Hospital of Traditional Chinese Medicine(Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine) from January 2018 to September 2020. All cases were divided into two groups according to different treatment methods, with 40 cases in each group. The control group received PTMC radical surgery, while the observation group received ultrasound guided radiofrequency ablation. The situation of new tumors and cervical lymph node metastasis in both groups was observed through follow-up, the relative indexes of operation and safety of the two groups were compared.Results:There was no significant difference in the incidence of situation of new tumors and cervical lymph node metastasis between the two groups ( P>0.05). The operation time, intraoperative blood loss and hospital stay in the observation group were less than those in the control group: (20.23 ± 5.07) min vs. (54.51 ± 12.13) min, (1.68 ± 0.28) ml vs.(13.68 ± 2.31) ml, (1.82 ± 0.32) d vs. (5.43 ± 0.57) d, there were statistical differences ( P<0.05). The incidence of complications in the observation group was lower than that in the control group: 5.00%(2/40) vs. 25.00%(10/40), there was statistical difference ( P<0.05). Conclusions:Ultrasound guided radiofrequency ablation for the treatment of PTMC is safe and effective, minimally invasive in beauty, and can effectively reduce the incidence of complications.
Objective:To explore the clinical value of metagenomics next-generation sequencing (mNGS) in the diagnosis of urinary calculi with secondary infection.Methods:From September 2021 to May 2022, a total of 110 urinary calculi patients from the First People′s Hospital of Zhejiang Province Tonglu County were collected retrospectively, the urine sample of the patients with bacterial meningitis was measured by urine bacterial culture and mNGS respectively. Taking urine bacterial culture as the "gold standard", the sensitivity, specificity, positive predictive value, negative predictive value, and Kappa consistency of mNGS in the diagnosing of urinary calculi with secondary infection were analyzed. Results:The positive of urine bacterial culture were 35 cases and negative were 75 cases; while positive and negative were 39 cases and 71 cases in the mNGS detection. Taking urinary bacterial culture as the "gold standard", the specificity, sensitivity, positive predictive value, negative predictive value and Kappa consistency coefficient of mNGS in the diagnosis of secondary infection of urinary calculi were 89.3%, 88.6%, 79.5%, 94.4% and 0.756 respectively. Compared with urine bacterial culture, the Kappa consistency coefficients of three common pathogens detected by the mNGS of macrogenomics, included escherichia coli, klebsiella pneumoniae and enterococcus faecalis were 0.703, 0.735 and 0.769, respectively. Conclusions:mNGS can improve the detection rate of pathogens of secondary infection of urinary calculi, and has a high consistency with the detection results of urinary bacterial culture.
Objective:To investigate the change and clinical significance of macrophange inflammtory protein-1α (MIP-1α) and human cartilage glycoprotein 39 (YKL-40) levels in serum and cerebrospinal fluid of children with mycoplasma pneumonia complicated with encephalitis.Methods:A total of 108 children with mycoplasma pneumonia treated in Shishou People′s Hospital from July 2018 to May 2020 were retrospectively selected as the study objects, including 66 patients with encephalitis and 42 patients without encephalitis. Fifty-three healthy children who participated in physical examination during the same period were selected as the normal control group. The levels of MIP-1α and YKL-40 in serum and cerebrospinal fluid were detected by enzyme-linked immunosorbent assay (ELISA). Pearson test was used for correlation analysis. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of MIP-1α and YKL-40 levels in serum and cerebrospinal fluid for mycoplasma pneumonia complicated with encephalitis.Results:The serum levels of MIP-1α and YKL-40 in the encephalitis group and without encephalitis group were higher than those in the normal control group: (84.82 ± 12.85) and (63.46 ± 9.23) mg/L vs. (24.12 ± 2.45) mg/L, (53.46 ± 9.25) and (31.45 ± 7.35) ng/L vs. (23.95 ± 6.38) ng/L, and the serum levels of MIP-1α and YKL-40 in the encephalitis group were higher than those in the without encephalitis group, there were statistical differences ( P<0.05). The cerebrospinal fluid levels of MIP-1α and YKL-40 in the encephalitis group were higher than those in the without encephalitis group: (124.82 ± 20.85) mg/L vs. (113.46 ± 18.23)mg/L, (46.46 ± 10.25) ng/L vs.(22.95 ± 5.38) ng/L, there were statistical differences ( P<0.05). The results of Pearson test showed that the levels of MIP-1α and YKL-40 in serum and cerebrospinal fluid had positively correlated ( r = 0.697, 0.403, P<0.05). ROC curve analysis results showed that the area under the curve (AUC) of serum YKL-40 and MIP-1α levels in the diagnosis of children with mycoplasma pneumonia complicated with encephalitis was 0.845 and 0.885, respectively, and the AUC of combined YKL-40 and MIP-1α levels in the diagnosis of children with mycoplasma pneumonia complicated with encephalitis was 0.943, higher than the level of single index detection. Conclusions:The levels of MIP-1α and YKL-40 in serum and cerebrospinal fluid of children with mycoplasma pneumonia are increased. The combined detection of MIP-1α and YKL-40 can be used as serum markers to predict encephalitis in children with mycoplasma pneumonia.
