Objective To investigate the effect of Smecta on II pressure ulcers in elderly patients.Methods Fifty-two elderly patients with skin pressure ulcers hospitalized in our hospital during February 2011 and September 2012 were randomly divided into experimental group(n=26),in which Smecta was applied on the pressure ulcers,and control group(n=26),in which ulcers powders were applied on the ulcers.The two groups were compared concerning the curative effects.Results The curative effect in the experimental group was significantly better than that of the control group(P<0.05)and the time for ulcers healing in the former group was significantly shorter than that of the control(P<0.05).Conclusions Smecta is more effective in the treatment of pressure ulcers in elderly patients with II pressure ulcers.It is simple in clinical use and cheap in cost,which should be encouraged for wider use.

OBJECTIVE: To investigate the tumor regression and local immune function in nasopharyngeal carcinoma patients treated with p53 gene therapy. METHOD: The two-step immunohistochemical was done to detect the expression of tumor-infiltrating lymphocytes (TIL) T-cell receptor-CD3, CD4, CD8 and B cell receptor-CD20 in the primary tumor tissue of nasopharyngeal carcinoma. Nasal endoscopy with MRI or CT was used for evaluation of tumor size. RESULT: The expression of CD3, CD4, CD8 was significantly increased after p53 gene treatment (P < 0.05). There was no significant change in expression of CD20 after p53 gene treatment (P > 0.05). In conventional treatment group, CD3, CD4, CD8 and CD20 (P > 0.05) did not show any significant difference. In gene therapy group at 3 months after treatment, 20 patients had achieved CR, 10 PR, 1 SD, 1 PD. In conventional treatment group, 11 patients had achieved CR, 12 PR,5 SD,3 PD. The response rate between treatment group and control group (CR+PR) was different (P < 0.05). CD3 and CD4 expression was correlated with tumor regression rate (P < 0.05, P < 0.01), and CD8 expression was correlated with the CR rate (P < 0.05). CONCLUSION T cells are the most proliferative cell of TII. in NPC patients after p53 gene therapy The local cellular immune status is positively correlated with tumor regression rate.
Adult ; Aged ; CD4-Positive T-Lymphocytes ; immunology ; Carcinoma ; Female ; Genes, p53 ; Genetic Therapy ; Humans ; Lymphocyte Count ; Lymphocytes, Tumor-Infiltrating ; immunology ; Male ; Middle Aged ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; immunology ; pathology ; therapy

OBJECTIVE: To investigate the value of narrow-band imaging (NBI) laryngoscope for the diagnosis and therapy of the laryngopharyngeal reflux disease (LPRD). METHOD: Analyzed the NBI laryngoscope characteristic findings of the throats of 46 LPRD patients which confirmed the diagnosis according to the reflux symptom index (RSI) and reflux finding score (RFS) both positive and the proton pump inhibitor therapy effective. RESULT: The NBI laryngoscope findings as follows: erythema and edema between the arytenoid cartilages (71.7%), the epiglottis congestion (67.4%), pharyngeal isolation/integration erythema (65.2%), pharyngeal pebbles--like changes (65.2%), hypertrophy of the posterior commissure (52.2%), vocal cord erythema and edema (47.8%), vocal nodules or vocal polyps with erythema, or edema (39.1%), arytenoid cartilages edema and erythema (21.7%), ventricular edema, erythema and laryngeal ventricle disappeared (17.4%), granuloma (6.5%), ulcers (4.3%), false vocal cord ditch (4.3%). CONCLUSION LPRD has characteristic findings. NBI laryngoscope is easy to operate and has a high value on the diagnosis and the treatment of the LPRD.
Adolescent ; Adult ; Aged ; Child ; Female ; Humans ; Laryngopharyngeal Reflux ; diagnosis ; surgery ; Laryngoscopes ; Laryngoscopy ; Male ; Middle Aged ; Narrow Band Imaging ; Treatment Outcome ; Young Adult

OBJECTIVE: To investigate the clinical value that surgical treatment with comprehensive treatment in treating early stage nasopharyngeal carcinoma. METHOD: Based on the case selection criteria, patients with early nasopharyngeal carcinoma were divided into surgery group and the conventional group according to patients' wishes. Surgery group were treated with surgery plus Radiochemotherapy as a comprehensive treatment while conventional group were treated with Radiochemotherapy. Outcome indices: (1) 5-year survival rate and 5-year disease-free survival rate; (2) Radiation dose to the nasopharynx; (3) Incidence of xerostomia. RESULT: (1) The overall 5-year follow-up rate was 97.12%; 1 patient was lost to follow-up in surgical group, the 5-year follow-up rate was 96.77%; 2 patients were lost in conventional Group with 5-year rate of 97.26%. (2) The 5-year survival rate of 104 patients was 83.65% (87/104). (3) The 5-year survival rate and 5-year tumor-free survival rate were 96.77% (30/31) and 93.55% (29/31) in surgical group, 78.08% (57/73) and 73.97% (54/73) in conventional group. There were significant differences between the two groups (P < 0.05). (4) The radiation dose to the nasopharynx in surgery group and conventional group were (63.90 +/- 5.56) Gy and (71.48 +/- 4.18)Gy, respectively; the dose in surgical group was significantly less than the conventional group, there were statistical significance between the two groups. (5) The incidence of xerostomia was significantly less in surgical group (22.58%) than conventional group (65.75%), the difference was statistically significant. CONCLUSION The surgery combined with concurrent chemoradiotherapy is a effective comprehensive therapeutic interchange program for early stage nasopharyngeal carcinoma. These program can increase the long-term survival rate, but also reduce the radiation dose to the nasopharynx and the occurrence of radiation complications. A further aspect is worth consideration.
Aged ; Carcinoma ; Chemoradiotherapy ; Combined Modality Therapy ; methods ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Incidence ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; mortality ; pathology ; surgery ; therapy ; Nasopharynx ; radiation effects ; Neoplasm Staging ; Prospective Studies ; Radiotherapy Dosage ; Survival Rate ; Xerostomia ; epidemiology ; etiology

Objective To investigate the effects of enteral nutritional emulsions on glucose and lipid metabolism in elderly patients with diabetes. Methods This randomized controlled trail recruited 80 elderly diabetic patients whose MNA-SF scores were between 0-11 with dysphagia or inability for oral feeding and who were randomized into a TPF-DM group ,a TPF-D group ,a TPF-T group ,and a TPF group.Glycolipid metabolism indexes and nutritional indexes were measured before intervention and at 1 m ,2 m and 3 m after intervention. Results Compared with baseline levels , FBG and HbA1c declined in the TPF-DM group[(5.70 ± 0.69)mmol/L vs .(7.90 ± 1.71)mmol/L and (6.39 ± 1.11)% vs .(7.92 ± 1.50)%,all P＜0.05]and the TPF-D group[(5.72 ± 1.12)mmol/L vs . (7.63 ± 1.73 )mmol/L and (6.86 ± 0.97 )% vs .(7.81 ± 1.04 )%,all P＜ 0.05 ]after 3 months of treatment ,but no significant difference was found between these two groups. The TPF-DM ,TPF-D , TPF-T groups showed significantly narrower fluctuation ranges of 24 h blood glucose levels after 3 months[(2.20 ± 0.88)mmol/L vs .(4.43 ± 2.07)mmol/L ,(2.94 ± 1.16)mmol/L vs .(4.22 ± 1.60) mmol/L ,(3.21 ± 1.64)mmol/L vs .(4.36 ± 1.88)mmol/L ,all P ＜ 0.05).Serum albumin levels increased in all four groups ,compared with baseline levels (all P＜0.05) ,but there was no significant difference between the groups(all P＞0.05). Furthermore ,the serum HDLC level increased in all four groups than baseline (all P＜ 0.05). Conclusions Enteral nutritional emulsions containing slow release starch and fructose ,dietary fibers and proper ω6 and ω3 ratio can stabilize blood sugar ,regulate blood lipids ,and improve nutritional status.

Objective:To explore the application value of humanistic literacy and clinical practice ability training in postgraduate courses of geriatrics.Methods:Postgraduates in Zhejiang University School of Medicine were taken as research objects. The teaching curriculum combining humanistic literacy and clinical practice ability training was set as the course of experimental group, and the teacher-led teaching course was set as the course of control group. The questionnaire survey was conducted to the evaluate the teaching effect among the postgraduates from three aspects: classroom situation, knowledge application and ability training. SPSS 17.0 was used for t-test. Results:The teaching of combining humanistic literacy and clinical practice ability training in classroom atmosphere, participation, teacher-student communication, helping memory, knowledge comprehension, knowledge application, collaboration ability, expression ability, organizational ability, knowledge acquisition ability, and autonomous learning ability scores of the experimental group were (3.96±0.20), (3.92±0.28), (3.75±0.44), (3.92±0.28), (3.96±0.20), (3.96±0.20), (3.83±0.38), (3.92±0.28), (3.79±0.41), (3.88±0.34), and (3.83±0.38), which were better than those of the control group, especially in classroom atmosphere, participation, knowledge application, expression ability, and autonomous learning ability.Conclusion:The combination of humanistic literacy and clinical practice ability training can significantly improve the classroom atmosphere of geriatric postgraduate courses, enhance students' medical humanistic literacy, familiarize students with the core skills of geriatrics, and improve students' ability to express and learn independently.

Background Chloropropanol esters (MCPDE) have attracted much attention in recent years as a kind of new contaminant found in various refined oils. The pollution of 3-monochloropropane-1,2-diol esters (3-MCPDE) is the most prominent. 3-MCPDE is hydrolyzed in organisms to 3-monochloropropane-1,2-diol which has been shown to have reproductive toxicity, nephrotoxicity, and potential carcinogenicity. Infant formula powders can be polluted by 3-MCPDE when refined edible oils are added during production. Objective To assess the risk of exposure to 3-MCPDE related to the consumption of infant formula powders for children aged 0-3 years in Shanghai market using the food consumption data and the data of 3-MCPDE contamination in these foods. Methods Gas chromatography-mass spectrometry was used to determine 3-MCPDE in 133 samples of infant formula powders in Shanghai. Using a multistage stratified random sampling method, a total of 807 infants and toddlers aged 0-3 years were randomly selected from each district/rural/town in Shanghai, including 208 children aged 0-6 months, 276 children aged 6-12 months, and 323 children aged 12-36 months. The food consumption data was investigated using food frequency questionnaire (FFQ) distributed by combining telephone inquiries and face-to-face interviews among guardians. Population's probability distributions of 3-MCPDE exposure were assessed by @Risk 7.5 software and Monte Carlo simulation algorithm. According to the dietary intake assessment model and the tolerable daily intake (TDI) of 3-MCPDE of 2.00 μg·(kg·d)⁻¹ proposed by the European Food Safety Authority (ESFA), a risk assessment of exposure to 3-MCPDE was conducted for infants and toddlers aged 0 to 3 years old in Shanghai who consumed 3-MCPDE via infant formula powders. Results The average concentration of 3-MCPDE in 133 samples of infant formula powders was 0.115 mg·kg⁻¹ with a positive rate of 100.00%. Among different types of formula powders, infant formula powders for infants of 0-6 months had the highest concentrations of 3-MCPDE and fat [0.136 mg·kg⁻¹ and 25.2 g (per 100 g sample) in average respectively]. There was a positive correlation between fat concentration and 3-MCPDE concentration in the samples (r=0.438, P<0.05). The average consumption of infant formula powders of 807 infants aged 0-3 years was 88.3 g·d⁻¹. Among all investigated age groups, the average consumption of infant formula powders by infants aged 0-6, 6-12, and 12-36 months was 87.7, 98.3, and 80.1 g·d⁻¹ respectively. The dietary exposure to 3-MCPDE from infant formula powders of infants aged 0-3 years averaged 0.83 μg·(kg·d)⁻¹ for general intake level or valued 1.44 μg·(kg·d)⁻¹ using the 95 percentile for high intake level. Exposure decreased with increasing age and was highest in infants 0-6 months of age, whose general and high intake levels were 1.41 and 2.34 μg·(kg·d)⁻¹, respectively. The risk population defined with the exposure higher than the TDI proposed by EFSA were proportioned to be 13.90% and 0.50% in infants aged 0-6 months and 6-12 months respectively, indicating a risk that cannot be ignored, and no risk in infants aged 12-36 months. Conclusion Among the investigated infants aged 0-3 years in Shanghai, those aged 0-6 months are at a high risk of exposure to 3-MCPDE. In view of the sensitivity of infants to pollutant exposure, the risk of exposure to 3-MCPDE should be highly concerned.

ObjectiveTo conduct comprehensive assessment of internal and external cadmium exposure and health risks for Shanghai residents. MethodsCadmium levels in food samples were calculated by employing two dietary exposure assessment methods， total diet study （TDS） and food frequency questionnaire （FFQ）， to estimate the daily dietary cadmium exposure of Shanghai residents. The provisional tolerable monthly intake （PTMI） of cadmium set by joint food and agriculture organization/WHO expert committee on food additives （JECFA） was applied to evaluate the health risk. Differences in dietary and urinary cadmium were compared by rank-sum test among different regions， age， gender， smoking status， and BMI groups， and the association between internal and external cadmium exposure was investigated by correlation analysis. ResultsThe mean value of urinary cadmium for 1 300 respondents was 0.542 μg·L^-1. Urinary cadmium was higher in the population in central urban and urban-rural fringe areas than in the suburban area， higher in the older age group than in the younger age group， and higher in the smoking group than in the non-smoking group （all P<0.01）. The two assessment methods showed that the mean values of daily dietary cadmium exposure for Shanghai residents were 0.306 and 0.090 μg·kg^-1， with 3.69% and 0.85% of Shanghai residents exceeding the PTMI， respectively. Correlation analyses showed that dietary exposure to cadmium based on the FFQ method was positively correlated with the urinary cadmium level when smoking status， age， gender， and BMI were adjusted. ConclusionDietary exposure to cadmium of Shanghai residents is mainly derived from vegetables， aquatic products， cereals and potatoes， and is overall at a low-risk level. Dietary exposure assessment based on FFQ and risk monitoring data can effectively estimate long-term cadmium exposure.

OBJECTIVETo investigate the treatment and prognosis for rN3 neck recurrence of nasopharyngeal carcinoma (NPC) after primary radiotherapy.

METHODSA total of 37 cases with rN3 neck recurrence after radiotherapy in NPC between October 2003 and August 2013 were retrospectively analyzed. Of them 19 cases presented with lymph node (LN) metastasis in supraclavicular fossa, 18 cases had metastasis LN > 6 cm, 10 cases received chemoradiotherapy, and 27 cases underwent neck dissection including modified radical neck dissection (MRND) for 9 cases, radical neck dissection (RND) for 18 cases. Six of 18 cases with RND underwent reconstructive surgery with pectoralis major flap, 12 cases received postoperative radiotherapy and 20 cases had postoperative adjuvant chemotherapy.

RESULTSEight patients had documented recurrence or residue, 17 patients developed distant metastases, one patient showed recurrence and distant metastasis. The 5-year overall survival rate and disease-free survival rate were 27.5% and 21.6% respectively, and the median survival time was 41 months. The survival rate in surgery group was significantly higher than that in chemoradiotherapy group, and the prognosis of patients with LN > 6 cm was better than that of patients with metastasis LN to supraclavicular fossa.

CONCLUSIONSPatients with rN3 NPC are prone to metastasis, and patients with supraclavicular fossa lymph node metastasis had poor prognosis. Surgery combined with chemoradiotherapy is an effective treatment for the patients without distant metastasis.

Antineoplastic Combined Chemotherapy Protocols ; Carcinoma ; Chemotherapy, Adjuvant ; Combined Modality Therapy ; Disease-Free Survival ; Humans ; Lymph Nodes ; Lymphatic Metastasis ; Nasopharyngeal Neoplasms ; radiotherapy ; surgery ; Neck ; Neck Dissection ; Neoplasm Recurrence, Local ; diagnosis ; Prognosis ; Retrospective Studies ; Survival Rate ; Treatment Outcome

Objective: To evaluate the diagnostic value and feasibility of narrow-band imaging in detection of recurrent nasopharyngeal carcinoma (NPC). Methods: One thousand three hundred and sixty-four NPC patients who had completed NPC treatment were enrolled. All patients were followed-up with imaging, serological examination of EB virus and nasopharyngeal endoscopy(WL and NBI mode), in which (1) both white light (WL) and NBI modes were done; (2) positive endoscopic patients were given nasopharyngeal biopsy; (3) using histologic finding as criterion standard, the sensitivity, specificity, accuracy and Yonden′s index of two modes were compared. Kappa index was used to evaluate the consistency between the two modes and pathological results respectively; (4) the positive rates of WL and NBI in patients with early recurrent (stage Ⅰ+ Ⅱ) were compared. Results: A total of 265 cases were suspected as having recurrent lesions by endoscopy in WL mode and 68 cases of them were pathologically diagnosed as having NPC; and 82 cases were suspected as having recurrent lesions by endoscopy in NBI mode and 74 cases of them were pathologically diagnosed as having NPC. The sensitivity, specificity, accuracy and Yonden′s index of WL mode were 91.89%, 0, 25.09% and -0.0811, respectively, with a kappa of -0.045; the sensitivity, specificity, accuracy and Yonden′s index of NBI mode were 100.00%, 95.94%, 97.05% and 0.9594, respectively. Conclusion NBI has higher sensitivity, specificity, early diagnosis rate and Yonden′s index than WL.