Objective To understand the cognition and acceptance of community hemodialysis centers among hemodialysis patients in Yangzhou, and to provide theoretical basis for the development of community hemodialysis centers. Methods A cluster random sampling method was used to select 400 maintenance hemodialysis patients treated in various areas of Yangzhou in April 2021 for a questionnaire survey to analyze the influencing factors of patients’ medical treatment behavior. Results A total of 390 valid questionnaires were recovered, with an effective recovery rate of 97.50%. Among the patients, 40.51% were very concerned about the construction of hemodialysis centers in the community, 56.67% understood the relevant policies, and 56.92% of the patients were willing to choose the community for dialysis treatment. The results of logistic regression analysis showed that the main factors affecting whether patients choose community for hemodialysis treatment include the patients’ residence [Jiangdu vs. Guangling: odds ratio (OR)=7.183, 95% confidence interval (CI) (2.010, 25.674), P=0.002; Gaoyou vs. Guangling: OR=22.512, 95%CI (7.201, 70.373), P<0.001; Yizheng vs. Guangling: OR=25.137, 95%CI (7.636, 82.744), P<0.001; Baoying vs. Guangling: OR=23.784, 95%CI (7.795, 72.569), P<0.001], degree of concern [some concern vs. very concerned: OR=0.267, 95 %CI (0.137, 0.521), P<0.001; not very concerned vs. very concerned: OR=0.062, 95%CI (0.023, 0.168), P<0.001; not concerned vs. very concerned: OR=0.101, 95% CI (0.023, 0.439), P=0.002], awareness [somewhat know vs. know very well: OR=0.025, 95%CI (0.002, 0.318), P=0.004; don’t know very well vs. know very well: OR=0.035, 95%CI (0.003, 0.439), P=0.009; don’t know vs. know very well: OR=0.006, 95%CI (0.000, 0.084), P<0.001]. Conclusions Hemodialysis patients in Yangzhou have a low level of awareness and acceptance of community-based hemodialysis centers. The patients’ residence, degree of attention and awareness of community-based hemodialysis center directly affect whether they choose the community for treatment. The relevant departments and medical institutions can start from the factors that affect patients’ choice of medical treatment, further strengthen the publicity of community dialysis, optimize the allocation of medical resources, and improve the capacity of community health services.
ObjectiveThe aim of this meta-analysis and systematic review is to assess the effectiveness of microRNAs as a diagnostic tool for individuals with epilepsy. MethodsA systematic search of PubMed, EMBASE, the Cochrane Library, and Web of Science databases was performed to collect literature on miRNA diagnosis of epilepsy up to January 1, 2024. Two researchers independently screened and extracted the literature and resolved discrepancies by negotiation. The QUADAS-2 evaluation tool was used to assess the quality of the included studies. Statistical analysis was performed using Review Manager 5.4, Meta-Disc 1.4, and Stata 17.0. Results A total of 17 papers were included, including 942 patients with epilepsy and 932 healthy controls. miRNA in the diagnosis of epilepsy had a combined sensitivity of 0.76 [95%CI (0.71, 0.79)], combined specificity of 0.78 [95%CI (0.74, 0.82)], and area under the SROC curve of 0.84 [95%CI (0.80, 0.87)]. Subgroup analysis showed that miRNA had higher diagnostic value for temporal lobe epilepsy, especially medial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS). ConclusionThe study suggests that miRNA may be a promising tool for the diagnosis of epilepsy, especially temporal lobe epilepsy, but more high-quality studies are needed to support it.
目的 对尿液特征组分与糖尿病早期肾损害的关系进行了初步探索。 方法 对2011年12月－2012年5月间28例2型糖尿病组、33例2型糖尿病肾病组及26例健康对照组尿液中尿蛋白含量和几种常见非蛋白氮物质，包括肌酸、尿囊素、肌酐、尿酸和假尿嘧啶核苷的浓度进行测定，采用多种归一化方法对数据进行对比分析，并通过t检验减少高效液相色谱测定的变量信息，保留P＜0.05的检出峰进行主成分分析，获得分类结果。 结果 采用体积归一化方法，发现健康对照组尿液中肌酸、尿囊素和尿酸的含量与2型糖尿病组和糖尿病肾病组相比，差异均有统计学意义（P＜0.05），2型糖尿病组尿液中尿蛋白的浓度与糖尿病肾病组相比，差异有统计学意义（P＜0.05）。 结论 通过肌酸、尿囊素、尿酸和尿蛋白的联合测定为肾脏损伤程度的监测及疗效观察提供依据，为2型糖尿病患者肾功能损坏的早期预防与诊断进行初步判断提供了新的方法。
Total anomalous pulmonary venous connection (TAPVC) is a relatively rare but complex congenital heart disease characterized by the anomalous drainage of the pulmonary veins. Rather than connecting to the left atrium, the pulmonary veins drain either directly or indirectly into the systemic venous circulation or the right atrium via abnormal pathways. While there is broad consensus on the diagnostic criteria for TAPVC, significant debate persists regarding the optimal timing of surgical intervention, preferred surgical techniques, and postoperative management including re-intervention strategies. This article formulates a Chinese consensus based on evidence-based data from the literature and opinions from domestic experts, with the goal of further standardizing the surgical treatment of TAPVC in China.
ObjectiveTo investigate the role of myeloid-derived suppressor cell (MDSC) in bleomycin (BLM)-induced pulmonary fibrosis and the possible mechanism of bone marrow mesenchymal stem cell (MSC) in therapy of BLM-induced pulmonary fibrosis.MethodsBone marrow mesenchymal stem cells (MSC) were harvested from 6-week old male BALB/c mice. One hundred and four female BALB/c mice were randomly divided into 3 groups. Mice in control (n=32) and BLM group were instilled with normal saline (NS) or BLM via trachea and NS were injected via tail vein on the 1st, 2nd and 3rd day after NS administration. Mice in MSC group (n=40) were instilled with BLM via trachea and MSC (total cell number=1.5×106) were injected via tail vein. On the 1st, 3rd, 5th, 8th, 11th, 14th, 18th, 21st, 25th and 32nd day after BLM administration, the percentage of Gr-1+CD11b+ cells in peripheral blood mononuclear cell (PBMC) was detected by flow cytometry. Eight mice from each group were killed on the 3rd, 8th, 18th and 32nd day after BLM administration, the percentage of Gr-1+CD11b+ cells in the lung tissue was detected by flow cytometry. Meanwhile, the lung tissue specimens were stained with Masson. The sry gene of Y chromosome was detected by polymerase chain reaction (PCR).ResultsCompared with BLM group, MSC transplantation significantly reduced pulmonary inflammation in MSC group [(1.32±0.25) vs. (2.53±0.56); and (1.06±0.42) vs. (2.27±0.82), respectively, P<0.01)]. Likewise, MSC transplantation significantly reduced pulmonary fibrosis and deposition of collagen as compared with BLM group [(1.02±0.44) vs. (1.81±0.74), and (1.51±0.73) vs. (2.72±0.54), respectively, P<0.05)]. The percentage of Gr-1+CD11b+ cells in the BLM group was significantly increased as compared with control group. Compared with BLM group, MSC transplantation significantly reduced Gr-1+CD11b+ cells in MSC group (P<0.05). The sry gene (201 bp) was detected in the lungs of female mice within 96 hours after MSC administration.ConclusionsMDSC participates in the procedure of BLM-induced pulmonary fibrosis. Syngeneic MSC inhibits the generation of MDSC and further suppresses BLM-induced pulmonary fibrosis.
Objective To evaluate and summarize the relevant evidence of oxygenation strategies with tracheal intubation after extubation for adult in intensive care unit (ICU), and to provide evidence-based practice for the development of scientific and effective strategies tracheal intubation after extubation for ICU adult patients. Methods Evidence-based databases, related guideline websites, association websites and original databases were searched by computer for literature about oxygenation strategies with tracheal intubation after extubation for ICU adults patients was extracted. The retrieval time was from the establishment of the databases to May 2023. Two researchers trained in evidence-based practice evaluated the quality of the included literature and extracted evidence from the literature that met the quality evaluation criteria. Results A total of 18 articles were included, including 7 guidelines, 4 clinical decisions, 2 expert consensus, 4 systematic reviews and 1 randomized controlled trial. A total of 22 pieces of best evidence were formed, including 7 aspects of basic principles, evaluation, selection, parameter setting, withdrawal, effect evaluation and precautions. ConclusionThe medical staff should select the best evidence based on the actual clinical situation and the patient’s own needs, and adjust the oxygenation strategies to reduce the rate of tracheal intubation and improve the prognosis of patients.
Objective To discuss the resection extent of primary surgery for papillary thyroid carcinoma （PTC） based on the analysis of the remaining thyroid gland residue and lymph nodes metastasis. Methods The clinical data of 163 patients with PTC received reoperation from January 2009 to September 2011 in our hospital were analyzed retrospectively. Results There were 24 males and 139 females in these patients. The age was 10-75 years old with （38.22±14.57） years old. Among 131 patients received residual thyroid thyroidectomy，88 patients were below 45 years old，and the cancer residual rate was 60.23% （53/88）；the others were over 45 years old，and the cancer residual rate was 76.74% （33/43），which was no significant difference （P?=?0.062）.The lymph nodes metastasis rate was 77.14% （81/105） in the patients below 45 years old and 81.13%?（43/53） in the patients over 45 years old among 158 patients received cervical lymph nodes dissection，which was no significant difference （P?=?0.958）.The cancer residual rate was 74.36%?（58/78），53.66%?（22/41），50.00%?（6/12），and 0 （0/32） in the patients with the tissue less than one lobe resection，lateral lobe （isthmus） resection，lateral lobe plus opposite side subtotal resection，total or subtotal resection，respectively. The total cancer residual rate was 65.65% （86/131） and the bilateral cancer residual rate was 52.76%?（86/163） after reoperation.79.75%?（130/163） of the patients didn’t received lymph nodes dissection in the primary surgery. The lymph nodes metastasis rate was 71.21%?（94/132） and 80.58% （83/103） in the reoperation patients received central region lymph nodes dissection and cervical lateral lymph nodes dissection, respectively. Conclusions Multifocus is an obvious character of PTC. Patients over 45 years old have more opportunities of tumor residual than that of the youngers （below 45 years old），but the result was no statistic value. For the most patients with PTC，a smaller resection extent suggests a larger risk for cancer residual，and total thyroidectomy or subtotal thyroidectomy leads to the least possibility for the risk. Cervical lymph node is a major type for its metastasis. Proper lymph nodes dissection is an essential way to reduce recurrence and reoperation. The Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer （2009） could be a best choice for therapy of PTC. And it is proposed to take central region lymph nodes dissection during primary surgery.
ObjectiveTo explore a new strategy for constructing three-dimensional dermoid tissue in vitro by using cell sheets technology.MethodsRabbit bone marrow mesenchymal stem cells (rBMSCs) were isolated from bone marrow of New Zealand white rabbits and cultured by whole bone marrow adherent method. Human dermal fibroblasts (HDFs) were cultured and passaged in vitro. The 2nd generation rBMSCs and the 3rd generation HDFs were cultured in a culture dish for 2 weeks with cell sheets conditioned medium respectively to obtain a monolayer cell sheets. Human umbilical vein endothelial cells (HUVECs) were inoculated on rBMSCs sheet to construct pre-vascularized cell sheet. During the culture period, the morphological changes of the cell sheet were observed under an inverted phase contrast microscope. At 1, 3, 7, and 14 days, HE staining and CD31 immunofluorescence staining were performed to observe the cell distribution and microvascular network formation. The rBMSCs sheet was used as control. The pre-vascularized cell sheet (experimental group) and rBMSCs sheet (control group) cultured for 7 days were placed in the middle of two HDFs sheets, respectively, to prepare three-dimensional dermoid tissues. After 24 hours of culture, CD31 immunofluorescence staining and collagen type Ⅰ and collagen type Ⅲ immunohistochemical stainings were performed to evaluate cell distribution and collagen expression.ResultsHDFs and rBMSCs sheets were successfully prepared after 2 weeks of cell culture. After inoculation of HUVECs on rBMSCs sheet for 3 days, HUVECs could be seen to rearrange on rBMSCs sheet and forming vacuoles. The reticular structure was visible at 7 days and more obvious at 14 days. The formation of vacuoles between the cell sheets was observed by HE staining, and the vacuoles became more and more obvious, the thickness of the membranes increased significantly with time. CD31 immunofluorescence staining showed the microvascular lumen formation. However, only the thickness of rBMSCs sheet increasing was observed, with no changes in cell morphology or cavitation structure. The three-dimensional dermoid tissue observation showed that the endothelial cells in the experimental group were positive expressions, and the rBMSCs, HDFs, and HUVECs cells were arranged neatly. The endothelial cells were negative expressions and randomly arranged in the control group. The collagen type Ⅰ and collagen type Ⅲ were positive expression in the experimental group and the control group. But compared with control group, experimental group presented a " honeycomb” network connection, where the matrix was distributed regularly, and cells were arranged tightly. The difference in the expression of collagen type Ⅰ and collagen type Ⅲ between the experimental group and the control group was not significant (P>0.05).ConclusionThree-dimensional dermoid tissue is successfully constructed by using cell sheet technology. The cell matrix distribution of the pre-vascularized cell sheet constructed by HUVECs and rBMSCs sheet is relatively regular, which has the potential to form tissue engineered dermis.
Objective To summarize the relationship between IgG4 and IgG4 related thyroid diseases. Methods Domestic and international publications involving the pathological features of IgG4-related thyroid diseases and relationship with IgG4 were retrieved and reviewed. Results IgG4-related disease was a newly recognized class of chronic and systemic lymphocytes disease， which may be solitary or involving multiple body organs， as well as thyroid. The expression of IgG4 was found in leisons of Hashimoto thyroiditis， Riedel thyroiditis， and papillary thyroid carcinoma. Conclusions IgG4-related thyroid disease is a new concept of thyroiditis. The knowledge of this new disease will provide appropriate treatment for patients with thyroiditis.