OBJECTIVE: To study the effect of basic fibroblast growth factor (bFGF) and hyaluronic acid gel (HAG) combined with freeze-dried bone allograft in repairing segmental bone defect and to explore their mechanism. METHODS: The 15 mm segmental bone/periosteum defects were created on bilateral radius in 50 New Zealand rabbits and were treated with four different kinds of implants on 25 radius respectively (group A: bFGF and HAG combined with freeze-dried bone; group B: bFGF combined with freeze-dried bone; group C: HAG combined with freeze-dried bone; group D: simple freeze-dried bone as a control). The repair of defect was observed radiologically and histologically and were analyzed by radionuclide bone imaging and measurement of calcium contents at different periods. RESULTS: The new bone formation, bone metabolic activity and calcium contents of defects were higher in group A than in group B (P lt; 0.05), and were higher in group B than in groups C and D (P lt; 0.05). There were no significant difference between groups C and D. The bone defects healed in the 8th week in group A, in the 10th week in group B, but did not healed in the 10th week in groups C and D. CONCLUSION: As an osteogenetic factor, bFGF promotes the new bone formation; as a slow-release carrier, HAG enhances the effectiveness of bFGF. The combination of bFGF, HAG and freeze-dried bone allograft can repair the segmental bone defect more effectively.
Objective To evaluate the efficacy of light cured composite resin and glass ionomer cement for wedge shaped defect filling. Methods PubMed, The Cochrane Library (Issue 3, 2016), EMbase, CNKI, CBM, VIP and WanFang Data were searched from inception to April 5th 2016, to collect randomized controlled trials (RCTs) of light cured composite resin versus glass ionomer cement for wedge shaped defect filling. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.2 software. Results A total of 12 studies, involving 3 744 cases of teeth were included. Meta-analysis results showed that there was no significant difference in the two groups on the shedding rate after 2 years (OR=1.19, 95%CI 0.70 to 2.02,P=0.53). But the wear rate of the light cured composite resin group was significantly lower than that of the glass ionomer cement group (Peto OR=0.31, 95%CI 0.22 to 0.44,P<0.000 01). The light cured composite resin group had higher rate of micro leakage or secondary caries rate (OR=1.83, 95%CI 1.11 to 3.01,P=0.02) and incidence of endodontic or periapical lesions (Peto OR=2.84, 95%CI 1.82 to 4.45,P<0.000 01) than the glass ionomer cement group. Conclusion Glass ionomer cement for filling wedge-shaped defects of 2 years after the wear degree is higher than the light cured composite resin, but the occurrence probability of micro leakage or secondary caries and stimulation to pulp are lower than the light cured composite resin. Because of the limitations of the quality of the included studies, the above conclusion still needs to be verified by more high-quality studies.
ObjectiveTo analyze the predictive value of ensemble classification algorithm of random forest for delirium risk in ICU patients with cardiothoracic surgery. MethodsA total of 360 patients hospitalized in cardiothoracic ICU of our hospital from June 2019 to December 2020 were retrospectively analyzed. There were 193 males and 167 females, aged 18-80 (56.45±9.33) years. The patients were divided into a delirium group and a control group according to whether delirium occurred during hospitalization or not. The clinical data of the two groups were compared, and the related factors affecting the occurrence of delirium in cardiothoracic ICU patients were predicted by the multivariate logistic regression analysis and the ensemble classification algorithm of random forest respectively, and the difference of the prediction efficiency between the two groups was compared.ResultsOf the included patients, 19 patients fell out, 165 patients developed ICU delirium and were enrolled into the delirium group, with an incidence of 48.39% in ICU, and the remaining 176 patients without ICU delirium were enrolled into the control group. There was no statistical significance in gender, educational level, or other general data between the two groups (P>0.05). But compared with the control group, the patients of the delirium group were older, length of hospital stay was longer, and acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, proportion of mechanical assisted ventilation, physical constraints, sedative drug use in the delirium group were higher (P<0.05). Multivariate logistic regression analysis showed that age (OR=1.162), length of hospital stay (OR=1.238), APACHEⅡ score (OR=1.057), mechanical ventilation (OR=1.329), physical constraints (OR=1.345) and sedative drug use (OR=1.630) were independent risk factors for delirium of cardiothoracic ICU patients. The variables in the random forest model for sorting, on top of important predictor variable were: age, length of hospital stay, APACHEⅡ score, mechanical ventilation, physical constraints and sedative drug use. The diagnostic efficiency of ensemble classification algorithm of random forest was obviously higher than that of multivariate logistic regression analysis. The area under receiver operating characteristic curve of ensemble classification algorithm of random forest was 0.87, and the one of multivariate logistic regression analysis model was 0.79.ConclusionThe ensemble classification algorithm of random forest is more effective in predicting the occurrence of delirium in cardiothoracic ICU patients, which can be popularized and applied in clinical practice and contribute to early identification and strengthening nursing of high-risk patients.
ObjectiveTo investigate the in vitro effect of pseudolaric acid B (PAB) on apoptosis of protoscolece cells and its regulatory effects on angiogenesis and cell apoptosis in the the lesion-host microenvironment tissue in vivo, as well as its possible mechanisms, in order to provide a basis for the clinical development of new alternative drugs for Echinococcus multilocularis. MethodsIn vitro experiments: the protoscoleces, vesicles, germinal cells, human foreskin fibroblasts (HFFs) and normal human liver cells were treated with different concentrations of PAB (0, 2.5, 5, 10, 20, 40, 80, 160 and 320 μmol/L) for 7, 5, 5, 5 and 5 days, then evaluated the survival rate of the protoscoleces, the release level of phosphoglucose isomerase (PGI) from the vesicles, the viability of the germinal cells, as well as the viability of HFFs and normal human liver cells. The protoscoleces and vesicles were fixed with 2.5% glutaraldehyde and used for scanning electron microscopy and transmission electron microscopy observation. Animal experiments: the protoscoleces were isolated from the abdominal lesions of the protected gerbils, and then infected 18 C57BL/6J mice by intraperitoneal injection to establish models, dividing into 3 groups with 6 mice in each group. The model group was given 0.3 mL of PBS by gavage daily, the albendazole (ABZ) group was given 0.3 mL ABZ (100 mg/kg) daily by gavage, the PAB group was given 0.3 mL of PAB (40 mg/kg) by gavage daily. After continuous gavage for 6 weeks, the lesion host microenvironment tissue was taken and ELISA was used to detect the expression levels of vascular endothelial growth factor (VEGF), endothelial nitric oxide synthase (eNOS) and cysteinyl aspartate specific proteinase3 (caspase3), the expression levels of nitric oxide (NO) was detected using a biochemical detection kit, Western blot was used to detect the expression levels of BCL2-associated X protein (Bax), B-cell lymphoma-2 (Bcl2), caspase3, cleaved-caspase3, VEGF, vascular endothelial growth factor receptor 2 (VEGFR2), phosphatidylinositol 3 kinase (PI3K), phosphorylated PI3K (p-PI3K), protein kinase B (AKT) and phosphorylated AKI (p-AKT) protein. ResultsIn vitro experiments: the protoscoleces of Echinococcus multilocularis were cultured with different concentrations of PAB for 7 days in vitro, the protoscoleces of 40, 80, 160 and 320 μmol/L group all died after 6, 4, 2 and 1 day, respectively; PAB exhibited a certain time and concentration dependence on the protoscoleces of Echinococcus multilocularis. After PAB treatment, the release of PGI in culture supernatant of Echinococcus multilocularis gradually increased with the increase of PAB concentration [concentration for 50% of maximal effect value was (24.40±1.42) μmol/L], the vitality of germinal cells was significantly inhibited [half maximal inhibitory concentration value was (15.94±2.55) μmol/L]. PAB had no significant toxicity to mammalian cells. When 20 μmol/L PAB intervention in the protoscoleces for 3 days, the expression levels of Bax and caspase3 proteins were upregulated, while the expression level of Bcl2 protein was downregulated. Animal experiments: compared with the model group, the wet weight of lesions in the PAB and ABZ groups decreased (P<0.01), and the inhibition rates of lesion growth in the PAB and ABZ groups were 91.03% and 74.44%, respectively. The expression of proliferation and angiogenesis indicators (Ki67, CD34, VEGF, VEGFR2, eNOS, NO) were downregulated in the lesion host microenvironment tissues of mice in the ABZ and PAB groups (P<0.05), while the expression of apoptosis related proteins (caspase3, cleaved-caspase3 and Bax) were upregulated and the expression of PI3K/AKT signaling pathway related proteins (p-PI3K and p-AKT) were downregulated (P<0.05). ConclusionPAB has a strong in vitro and in vivo effect against Echinococcus multilocularis, and its mechanism may be related to the inhibition of PI3K/AKT signaling pathway, leading to increased apoptosis and decreased angiogenesis.
Objective To evaluate the effect of maternal and child health care training at the primary levelin Chongqing, and to detect and solve the existing problems so as to provide evidence for the further training andmonitoring. Methods The rural maternal and children health staff of Rongchang County, Chongqing were trained. A test and, in-depth interviews and field observation wereused to evaluate the training process and results. Results Seventynine members of the Clinical Skill Group (CS) and 73 members of Health Education Group (HE) have taken the test. The median score of CS before training was 11 while it was 23 after training (Plt;0.01); the median score of HE was 18 before training while it was 25 after training (Plt;0.01). The scores change of thetest before and after training showed that the training had a good result. Conclusion Primary level health staff members had poor knowledge of maternal and children health care. This training enhanced their knowledge of maternal and child health care improved their skill. Organizers should ensure that the training contents are rich,novel, and varied. Maternal and child health staff should be willing to join the training.
ObjectiveTo investigate the effectiveness of sagittal top compression reduction technique in the treatment of thoracolumbar vertebral fractures. Methods A retrospective analysis was conducted on the clinical data of 59 patients with thoracolumbar vertebral fractures who met the selection criteria and were admitted between November 2018 and January 2022. Among them, 34 patients were treated with sagittal top compression reduction technique (top pressure group), and 25 patients were treated with traditional reduction technique (traditional group). There was no significant difference in baseline data between the two groups (P>0.05), including gender, age, fracture segment, cause of injury, AO classification of thoracolumbar vertebral fractures, thoracolumbar injury classification and severity (TLICS) score, American Spinal Injury Association (ASIA) grading, surgical approach, preoperative vertebral body index, height ratio of the anterior margin of injured vertebra, injured vertebra angle, segmental kyphosis angle, visual analogue scale (VAS) score, and Oswestry disability index (ODI). The operation time, intraoperative blood loss, and incidence of complications between the two groups were recorded and compared. After operation, VAS score and ODI were used to evaluate effectiveness, and X-ray and CT examinations were performed to measure imaging indicators such as vertebral body index, height ratio of the anterior margin of injured vertebra, injured vertebra angle, and segmental kyphosis angle. ResultsThere was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05). No complication such as dural sac, nerve root, or vascular injury was found during operation, and all incisions healed by first intention. Patients in both groups were followed up 6-48 months, with an average of 20.6 months. No loosening, breakage, or failure of internal fixation occurred during follow-up. The imaging indicators, VAS score, and ODI of the two groups significantly improved at 1 week and last follow-up when compared to preoperative ones (P<0.05). At last follow-up, the VAS score and ODI further significantly improved when compared to 1 week after operation (P<0.05). At 1 week after operation and last follow-up, the vertebral body index, segmental kyphosis angle, injured vertebra angle, and ODI in the top pressure group were significantly better than those in the traditional group (P<0.05). There was no significant difference in VAS score and height ratio of the anterior margin of injured vertebra between the two groups at 1 week after operation (P>0.05), but the two indicators in the top pressure group were significantly better than those in the traditional group at last follow-up (P<0.05). Conclusion The treatment of thoracolumbar vertebral fractures with sagittal top compression reduction technique can significantly improve the quality of vertebral reduction, and is superior to traditional reduction techniques in relieving pain and improving spinal function.
ObjectiveTo investigate the clinical efficacy, side effects, influence on viral nucleic acid conversion and prognosis of glucocorticoid used in patients with coronavirus disease 2019.MethodsEighty-seven patients with severe and critical coronavirus disease 2019 were included to observe respiratory symptoms, blood oxygen saturation, pulmonary imaging absorption, weaning status, complicated bacterial infection and double infection, and prognosis after glucocorticoid use. Whether glucocorticoid use affects the patient's viral nucleic acid was analyzed.ResultsOf the 87 patients included, 55 were severe, 32 were critical, and 38 died, which included 30 critical patients. Seventy-seven patients accepted short-term glucocorticoid, and 10 patients accepted long-term glucocorticoid due to diffuse lung lesions and poor absorption. Eleven patients had bacterial infection and 4 cases had double infection. In 10 patients with long-term use of glucocorticoids, the lung lesions relieved, no double infection was found, but 1 patient maintained nucleic acid positive even after 5 weeks’ treatment.ConclusionsThe use of appropriate glucocorticoids is beneficial to the improvement of disease status and disease absorption in patients with coronavirus disease 2019. Long-term oral administration of glucocorticoids in patients with diffuse lung lesions may be beneficial to disease absorption.
Objective The current study aimed to compare the differences in clinical characteristics and prognosis of elderly patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection between patients who were vaccinated and those not and to explore the clinical significance of vaccination for the elderly.Methods A total of 92 elderly patients (≥60 years old) with SARS-CoV-2 infection who were admitted to Chengdu Public Health Clinical Center from December 10, 2020, to May 2, 2022, were included, and they were grouped according to whether vaccinated. The differences in clinical manifestations, laboratory examinations, imaging, treatment, prognosis, hospitalization time, and nucleic acid conversion time between the two groups were compared in this study. Results A total of 92 elderly patients were included, with a male-to-female ratio of 1.3:1, and a median age of 66 (62, 71) years old. There were 79 patients in the vaccinated group and 13 in the unvaccinated group. The positive rate of total SARS-CoV-2 antibody in 92 patients was 91.3%, and those of IgG and IgM of SARS-CoV-2 antibody were 89.1% and 37%, respectively. The positive rates of total SARS-CoV-2 antibody and IgG of SARS-CoV-2 antibody in the vaccinated group were higher than those in the unvaccinated group (97.5% vs. 53.8%, 96.2% vs. 46.2%) (P<0.01), and COI values of total antibody, IgM and IgG were higher than those of unvaccinated group (P<0.01). The proportions of the initial symptoms of sputum, ground-glass opacity or patchy opacity involving both lungs in chest CT in the unvaccinated group were higher than those in the vaccinated group (P<0.05). The white blood cell counts and platelet counts in the vaccinated group were higher than those in the unvaccinated group, whereas the prothrombin time and D-dimer were lower than those in the unvaccinated group (P<0.05). COI values of total antibody in the 3-doses group were higher than those in the 2-doses group, and the white blood cell counts in the 3-doses group were higher than those in the 2-doses group (all P<0.05). During hospitalization, asymptomatic infection (58.2%) and general type (53.8%) was the most common in the vaccinated and unvaccinated group, respectively. Patients in the unvaccinated group were more likely to progress to severe status than the vaccinated group during hospitalization (15.4% vs. 0%, P=0.019). The unvaccinated group received more treatments of intravenous immune globulin, non-invasive and invasive mechanical ventilation, plasma after immunization of vaccine and convalescent plasma of SARS-CoV-2 infected patients than those of the vaccinated group (P<0.05). Patients in the unvaccinated group developed a higher proportion of respiratory failure, secondary infection, acute respiratory distress syndrome, and heart failure than in the vaccinated group (P< 0.05). The median lengths of hospitalization and nucleic acid conversion in the unvaccinated group were 22 (7, 32) days and 13 (2, 20) days, which were longer than those in the vaccinated group [8 (7, 12) days, 2 (2, 7) days] (all P<0.05). Conclusions Vaccination of SARS-CoV-2 can improve the positive rate of total SARS-CoV-2 antibody and IgG of SARS-CoV-2 antibody in elderly patients with SARS-CoV-2 infection, milder disease status, and can shorten the time of hospitalization and nucleic acid conversion. These results suggest that the COVID-19 vaccine can reduce the disease and improve the prognosis in the elderly.