Objective To study the diagnostic value of coronary disease with 16-slice spiral CT.Methods 35 patients with coronary heart disease(CHD) were divided into two groups according to the risk rate of CHD:group 1 with acute coronary artery syndrome(ACS)(including acute myocardial infarction,AMI;unstable angina,UA);group 2 with stable angina(SA).They were studied by 16-slice spiral CT(retrospectively ECG-gating,0.5 s ratation),the images were reconstructed by survey methods to display the coronary artery atherosclerosis plaques,then to evaluate the nature of plaques by detecting CT value of plaque(using the standard of the CT value of the coronary artery atherosclerosis plaque of Schroeder)and to analyze the degree of the stenosis of coronary artery caused by the different type of plaque.Results There were 19 soft plaqes,11 middle plaques and 7 calcification plaques in ACS group;3 soft plaqes,3 middle plaques and 11 calcification plaques in SA group.There was a positive relation between soft plaqes and middle plaques with the risk rate of CHD,especially soft plaque(P

Objective To investigate the treatment of intractable bile duct stones. Methods Of the total 149 cases of biliary stones, some are multiple bile duct stones,large stones,stones obstructed in the duodenal ampulla or residuary stones after T-tube surgery, others are associated with small papilla or papilla with neighoring diverticulum. All the stones were extracted with several endoscopic methods, such as choledochoscopy during or after operation, mechanical lithotripsy after EST(endoscopic sphincterotomy), biliary mother-baby endoscopy, ENBD(endoscopic nasobiliary drainage) or biliary-duodenum internal drainage. Results In general, extrahepatic bile duct stones were effectively removed in 94. 6% cases. In 19 out of 20 cases, stones were completely removed with choledochoscopy during operation; In 35 out of 40 cases stones were fully extracted through T-tube endoscopy, and in 72 of 76 cases stones were thoroughly removed with mechanical lithotripsy after EST. Conclusion The intractable bile duct stones can be effectively managed with combined endoscopic therapy, which is attributed to the high success rate in removing biliary stones and should be popularized in this field.

Objective To investigate the clinical significance of measuring resting energy expenditure (REE) for guiding an accurate nutritional support in elderly bedridden patients with nasal feeding.Methods The REE of 32 elderly bedridden patients with nasal feeding was assessed by using the Cosmed K4b2 portable telemetric gas analysis system.The waist-hip ratio, serum levels of albumin, transferrin, prealbumin and retinol-binding protein were determined to assess comprehensive nutrition status.The energy intakes were calculated, and the correlation of REE and the difference between the energy intakes and consumption with nutritional index were analyzed.Results The resting energy expendture was lower in the patients with waist-hip ratio≥0.95 than in patients with waist-hip ratio ＜0.95 (t=3.622, P＜0.01).The waist-hip ratio was reduced and serum albumin and transferrin levels were decreased along with the increase of REE in elderly patients (r=-0.55,-0.36 and-0.593, respectively, P=0.001, 0.043, ＜0.001).The difference between the energy intake and expenditure was higher in patients with waist-hip ratio≥0.95 than those with waist-hip ratio＜0.95 (t =5.643, P＜ 0.001).Serum albumin, prealbumin, transferrin and retinol-binding protein levels were increased along with the increase of the difference between the energy intake and expenditure, which showed the positive correlations (r=0.525, 0.409, 0.624, 0.414, respectively,P=0.002, 0.02, ＜0.001, 0.019).Conclusions Precise determination of REE and energy intake guided by REE are the important guarantees for the reasonable nutrition support in the elderly.

Objective To explore the event-related potentials (ERPs) P300 is changeable or not before and after treatment. Methods 99 cases of patients with first onset of depression diagnosed by DSM-Ⅳ as case group,and 100 cases matched with patients as control group were collected. P300 of two groups were obtained before and after treatment for 6 weeks,12 weeks,24 weeks. T test was used to analysis the difference of indicators of P300 among groups; repeated measure analysis of variance was used to analysis the longitudinal changes. Results shorter latency of N2-P3 ( (P ＜ 0.01 ); and lower amplitude of N2, P3, N2-P3 (P ＜ 0. 05 ), higher amplitude of P2-tency and a upward one in N2-P3 latency in the four periods; a upward trend could also be found in P3, N2-P3 amplitude, but there were no statistical differences(P ＞ 0. 05 ). The results of paired-samples t test: P3, N2-P3 amplitude in case group were higher after treatment for 6 weeks than before, the difference was significant (P ＜ 0.01 ); no significant results were found in P300 latency or amplitude between the 62 cases of depression after treatment for 24 weeks and the 65 normal controls selected (P ＞ 0. 05 ). Conclusion P300 latencies and amplitudes tend to be partly recovered after the acute treatment in patients with depression, but after the long-term therapy not clear.

Objective:To investigate the level of functional fitness of elderly hypertensive patients in the community and to analyze its influencing factors.Methods:A cross-sectional survey was used from November 2021 to September 2022, questionnaire survey and Senior Functional Fitness Test (SFT) were conducted on 189 elderly hypertensive patients in the community by convenience sampling method, multiple linear regression was used to analyze the influencing factors of SFT in elderly hypertensive patients in the community.Results:Totally 189 cases of community-aged hypertensive patients completed the investigation, 88 cases were male and 101 were female. The total SFT score of community-aged hypertensive patients was (58.61 ± 16.07). Single factor analysis showed that there were significant differences in SFT scores among patients with different gender, age and education ( t=-2.57, F=6.24, 7.54, all P<0.05). Multifactorial analysis revealed that age ( t=-5.55), gender ( t=2.63), and literacy ( t=5.69) were influential factors in the total SFT scores of community-dwelling elderly hypertensive patients (all P<0.05). Conclusions:Age, gender, and literacy level are the main factors affecting the total SFT scores of elderly hypertensive patients in the community, and community caregivers should pay close attention to the above elderly hypertensive population.

Pancreatic cancer(PC)is one of the deadliest malignant tumors worldwide,known as the'king of cancers'due to its insidious onset,high malignancy,and high mortality rate.PC is highly malignant and pro-gresses rapidly,but its onset is insidious with atypical early symptoms,making it difficult to detect early lesions through conventional imaging studies.It is usually only discovered when symptoms like jaundice,abdominal and back pain occur.Surgical resection is currently the only curative option for PC.However,due to the difficulty in early diagnosis,the majority of patients are already in the middle to late stages at the time of diagnosis,missing the opportunity for surgery.Studies have confirmed that the progression of pancreatic cancer is relatively slow,with the initial tumor cells requiring at least 15 years to gain metastatic ability.Therefore,timely detection of pancreatic cancer through tumor markers could significantly improve the survival rate of patients.The most widely used and diagnostically valuable tumor marker in clinical practice is Carbohydrate antigen 199(CA199).However,due to about 3%～7%of pancreatic cancer patients being Lewis antigen-negative blood types and not expressing CA19-9,its sensitivity is only 79%～81%,which does not provide good efficacy for the diagnosis of pancreatic cancer.Pan-creatic juice,as a fluid near the tumor,has attracted much attention as a good source of tumor-related biomarkers.Many studies have confirmed the accuracy of using proteins,DNA,and exosomes in pancreatic juice for the diag-nosis of pancreatic cancer,showing great prospects for pancreatic juice as a source of tumor markers for the diagnosis of pancreatic cancer.Therefore,this thesis reviews the efficacy of pancreatic juice as a specimen for the diagnosis of pancreatic cancer.

ABSTRACT:Objective To assess the effectiveness of the disease management model of stepped-nursing intervention in the metabolic control in patients with type 2 diabetes (DM2). Methods 114 patients with DM2 were randomized in experimental group and control group.The experimental group applied stepped-nursing model while the control group applied conventional nursing.Blood glucose,glycated hemoglobin A1c,body mass index (BMI),waist -hip ratio (WHR),blood pressure,lipids and control criteria were observed.Results BMI,glycated hemoglobin A1c,fasting blood sugar(FBS),triglycerides,systolic blood pressure (SBP)levels and diabetic knowledge score decreased significantly in the stepped-nursing group(P <0.05).The decrease levels in postprandial blood sugar(PBS),diastolic blood pressure (DBP),total cholesterol (TC),LDL cholesterol and WHR reduced,which showed no significant difference(P >0.05). The levels of HDL cholesterol were slightly improved,which showed no significant difference(P >0.05).Conclusion Stepped-nursing model is useful in overall treatment of patients with type 2 diabetes,it improves the condition of glycated hemoglobin A1c,SBP levels FBS and triglycerides and increases the command of diabetic knowledge.

ABSTRACT:Objective To assess the effectiveness of the disease management model of stepped-nursing intervention in the metabolic control in patients with type 2 diabetes (DM2). Methods 114 patients with DM2 were randomized in experimental group and control group.The experimental group applied stepped-nursing model while the control group applied conventional nursing.Blood glucose,glycated hemoglobin A1c,body mass index (BMI),waist -hip ratio (WHR),blood pressure,lipids and control criteria were observed.Results BMI,glycated hemoglobin A1c,fasting blood sugar(FBS),triglycerides,systolic blood pressure (SBP)levels and diabetic knowledge score decreased significantly in the stepped-nursing group(P <0.05).The decrease levels in postprandial blood sugar(PBS),diastolic blood pressure (DBP),total cholesterol (TC),LDL cholesterol and WHR reduced,which showed no significant difference(P >0.05). The levels of HDL cholesterol were slightly improved,which showed no significant difference(P >0.05).Conclusion Stepped-nursing model is useful in overall treatment of patients with type 2 diabetes,it improves the condition of glycated hemoglobin A1c,SBP levels FBS and triglycerides and increases the command of diabetic knowledge.

Coronavirus disease 2019 (COVID-19) is a grade B infectious disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). In pace with the spreading of the disease, biosafety risk of the biological specimen preservation in biobanks has been significantly increased and biosafety protection during biological specimen preservation become increasingly important. According to the related national rules and the corresponding guidelines of Chinese Medical Association, this paper introduced the etiology about SARS-CoV-2, epidemiology about COVID-19, and the biosafety protection principles of individuals and biological specimen storage places in the process of personal protection, protection of collection, transport, handling, preservation, detection, post-detection disposal and emergencies of biological specimen. Emphasized to carry out a strict biosafety-risk assessment on biological specimen basing on virus load information, infectivity, and sample type (possible contact transmission, aerosol transmission, and fecal oral transmission).
Betacoronavirus ; isolation & purification ; Containment of Biohazards ; standards ; Coronavirus Infections ; epidemiology ; prevention & control ; transmission ; Humans ; Pandemics ; prevention & control ; Pneumonia, Viral ; epidemiology ; prevention & control ; transmission ; Prevalence ; Risk Assessment ; Specimen Handling ; standards

OBJECTIVES: Tubulointerstitial diseases is one of the common causes of renal dysfunction. Some rare pathological types are easy to be misdiagnosed and missedly diagnosed because of their low prevalence and relatively insufficient understanding, which affects the treatment and prognosis of patients. This study aims to explore clinical manifestations and pathological characteristics of several rare tubulointerstitial diseases, and therefore to improve their diagnosis and treatment. METHODS: A total of 9 363 patients diagnosed by renal biopsy in the Department of Nephrology, Second Xiangya Hospital, Central South University from November 2011 to September 2021 were selected. Six cases of light chain cast nephropathy (LCCN), 2 cases of light chain proximal tubulopathy (LCPT), 1 case of LCCN with LCPT, 4 cases of genetic tubulointerstitial disease, and 6 cases of non-genetic related tubulointerstitial lesion were screened out, and their clinical manifestations and renal biopsy pathological results were collected, compared, and analyzed. RESULTS: Patients with LCCN presented with mild to moderate anemia, microscopic hematuria, and mild to moderate proteinuria. Compared with patients with LCPT, proteinuria and anemia were more prominent in patients with LCCN. Five patients with LCCN and 2 patients with LCPT had elevated serum free kappa light chain. Five patients with LCCN presented clinically with acute kidney injury (AKI). Two patients with LCPT and 1 patient with LCCN and LCPT showed CKD combined with AKI, and 1 LCPT patient presented with typical Fanconi syndrome (FS). Five patients with LCCN, 2 patients with LCPT, and 1 patient with LCCN and LCPT were diagnosed with multiple myeloma. Five patients with LCCN had kappa light chain restriction in tubules on immunofluorescence and a "fractured" protein casts with pale periodic acid-Schiff (PAS) staining on light microscopy. Immunohistochemical staining of 2 LCPT patients showed strongly positive kappa light chain staining in the proximal tubular epithelial cells. And monoclonal light chain crystals in crystalline LCPT and abnormal lysosomes and different morphological inclusion bodies in noncrystalline LCPT were observed under the electron microscope. Six patients with LCCN were mainly treated by chemotherapy. Renal function was deteriorated in 1 patient, was stable in 4 patients, and was improved in 1 patient. Two patients with LCPT improved their renal function after chemotherapy. Four patients with genetic tubulointerstitial disease were clinically presented as CKD, mostly mild proteinuria, with or without microscopic hematuria, and also presented with hyperuricemia, urine glucose under normal blood glucose, anemia, polycystic kidneys. Only 1 case had a clear family history, and the diagnosis was mainly based on renal pathological characteristics and genetic testing. Compared with patients with non-genetic related tubulointerstitial lesion, patients with genetic tubulointerstitial disease had an earlier age of onset, higher blood uric acid, lower Hb and estiated glomemlar fitration (eGFR), and less edema and hypertension. Renal pathology of genetic tubulointerstitial disease presented tubular atrophy and interstitial fibrosis, abnormal tubular dilation, glomerular capsuledilation, and glomerular capillary loop shrinkage. Glomerular dysplasia and varying degrees of glomerular sclerosis were observed. Genetic tubulointerstitial disease patients were mainly treated with enteral dialysis, hypouricemic and hypoglycemic treatment. Two genetic tubulointerstitial disease patients had significantly deteriorated renal function, and 2 patients had stable renal function. CONCLUSIONS Patients with AKI or FS, who present serum immunofixation electrophoresis and/or serum free kappa light chain abnormalities, should be alert to LCCN or LCPT. Renal biopsy is a critical detection for diagnosis of LCCN and LCPT. Chemotherapy and stem cell transplantation could delay progression of renal function in patients with LCCN and LCPT. If the non-atrophic area of the renal interstitium presents glomerular capsule dilatation, glomerular capillary loop shrinkage, and abnormal tubular dilatation under the light microscopy, genetic tubulointerstitial disease might be considered, which should be traced to family history and can be diagnosed by genetic testing.
Humans ; Hematuria ; Immunoglobulin Light Chains/analysis* ; Multiple Myeloma ; Proteinuria ; Nephritis, Interstitial ; Acute Kidney Injury ; Anemia ; Renal Insufficiency, Chronic