Objective To analyze the mediating effect of mental resilience on the relationship between work stress and sleep quality in psychiatrists. Methods A total of 221 front-line psychiatrists from four mental health centers in Shannxi Province were selected as the study subjects using convenience sampling method. The questionnaires of Scale for Occupational Stressors on Clinician，Chinese Version of Connor-Davidson Resilience Scale and Pittsburgh Sleep Quality Index Scale were used to investigate the work stress，mental resilience and sleep quality of the psychiatrists. We conducted Bootstrap mediation test to analyze the mediating effect of mental resilience using SPSS PROCESS V3.5 macro program. Results The total score of work stress of psychiatrists was 97.0±17.5，and the medium（P25，P75）of mental resilience and sleep quality scores were 84.0（75.5， 94.0）and 6.0（5.0，9.0）respectively. The detection rate of sleep disorders among psychiatrists was 33.9%（75/221）. The total score of work stress of psychiatrists was negatively correlated with the total score of mental resilience ［rank correlation coefficient（rS ）=−0.34，P<0.01］，and was positively correlated with the total score of sleep quality（rS =0.48，P<0.01）. The total score of mental resilience was negatively correlated with that of sleep quality （rS = − 0.39，P<0.01）. The work stress of psychiatrists had a positive predictive effect on sleep quality［standardized regression coefficient（β）=0.41.P<0.01］，and a negative predictive effect on mental resilience（β）=−0.38，P<0.01）. Mental resilience had a negative predictive effect on sleep quality（β）=−0.24，P<0.01. Mental resilience played a partial mediating role between work stress and sleep quality，and the mediating effect accounted for 22.0% of the total effect. Conclusion Both work stress and mental resilience of psychiatrists can directly affect their sleep quality，and the mental resilience has a partial mediating role in the effect of work stress on sleep quality.

OBJECTIVETo analyze the prognostic factors in patients after surgical resection of a huge primary liver cancer (HPLC).

METHODSClinical and follow-up data of 69 cases of huge HPLC treated in our hospital from July 2001 to July 2008 were retrospectively analyzed. Sixteen clinicopathologic factors possibly influencing the survival were selected, and multivariate analysis of these parameters was performed using the Cox proportional hazards model.

RESULTSThe cumulative 1-, 3-, 5-year survival rates of 58 patients were 58.2%, 31.4% and 12.3%, respectively. Univariate analysis showed that radical resection, intrahepatic metastasis, vascular invasion and degree of hepatic cirrhosis significantly affect the postoperative survival. The Cox multivariate analysis indicated that radical resection, intrahepatic metastasis and degree of hepatic cirrhosis are independent prognostic factors.

CONCLUSIONSSurgical resection is a major and active treatment for huge HPLC. The therapeutic efficacy depends on intrahepatic metastasis, degree of hepatic cirrhosis and radical resection. Aggressive treatment and prevention on postoperative intrahepatic recurrence and metastasis is an important strategy to improve the survival of patients with huge HPLC.

Adult ; Aged ; Carcinoma, Hepatocellular ; pathology ; surgery ; Female ; Follow-Up Studies ; Hepatectomy ; methods ; Humans ; Liver Cirrhosis ; pathology ; Liver Neoplasms ; pathology ; surgery ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Survival Rate ; Tumor Burden ; Young Adult

Objective: To investigate the long-term outcome of anterior decompression and bone graft fusion for cervical spondylotic myelopathy(CSM) and factors affecting the outcome. Methods: Two hundred and forty-five patients with CSM were treated with anterior cervical decompression and auto iliac bone graft fusion, of whom 31 had a second operation between 4 months and 2 years after operation. Follow-up studies were carried out within 5 to 15 years after operation, averaging 6.8 years. Results: Function evaluation: excellent in 118 cases (48.16%), good in 71 (28.98%), passable in 35 (14.29%) and poor in 21 (8.57%). According to the 40 points score method, there was an average of 8 point increase in all cases, of which 101 were between 36 to 40 points, 54 between 31 to 35 points. Conclusion: The long-term outcome of surgical treatment for CSM is definite. Significant factors affecting the outcome include timing of operation, degree of pathology and technique of surgery.

Objective To evaluate the performance of diluted thrombin time (dTT) assay for detecting Dabigatran levels and observe whether this assay may meet the requirements of clinical laboratory.Methods According to EP15-A2,EP6-A,EP7-A and C-24 documents of the Clinical and Laboratory Standards Institute (CLSI),the precision,trueness,analytical measurement range,carryover rate and anti-biological interference of dTT assay were evaluated and the stability of specimen for dTT assay was observed.Results Both the within-day and between-day coefficient of variation (CV) of dTT assay for detecting Dabigatran levels were consistent with manufacturer's stated CV.Compared with target values of Dabigatran,the relative bias of 3 levels of proficiency test materials from College of American Pathologists (CAP) were less than 10％.The results meet linear verification when Dabigatran concentration was between 30.92 and 249.13 ng/mL.The carryover rate was-0.84％.There was no interference for Dabigatran levels by dTT assay for detecting Dabigatran when Hb≤3 g/L,triglyceride≤873 mg/dL,heparin≤2.2 IU/mL and FDP≤29 mg/L.The results of stability showed that plasma specimens for dTT could not be stored at room temperature more than 4 hours,at 4 ℃ more than 4 days,at-20 ℃ exceed 1 month,while at-80℃ the plasma specimens could be stored at least 6 months for dTT assay.Conclusion The precision,trueness,analytical measurement range,carryover rate,anti-biological interference of dTT assay may meet the requirement of clinical laboratory.The stability of the specimen can fulfill the clinical requirements.

OBJECTIVETo study the pathology characteristics and management of Hangman's fracture combined with intervertebral disc injury.

METHODSTwenty-one patients suffered from this special injury were converged in this study. All patients underwent anterior C(2 - 3) discectomy and fusion, 18 cases were fixed by anterior cervical plate. The type of fractures, radiology characteristics, and clinical outcomes were investigated.

RESULTSNo graft displacement or absorption, infection and neurologic deterioration occurred. All fresh dislocation of axis and C(2 - 3) angulation were corrected. Fusion of C(2 - 3) intervertebral space and pedicle fracture were acquired in all of the patients. After a mean follow-up of 31 months, ranging from 8 to 48 months, nearly all of the complains disappeared after operation.

CONCLUSIONSHangman's fracture is not restricted at pedicle of the axis. Fracture combined with intervertebral disc injury is a special type of Hangman's fracture. Anterior discectomy and fusion of C(2 - 3) intervertebral disc is an effective operation method in accord with the pathophysiology of this special injury.

Adult ; Axis, Cervical Vertebra ; Bone Transplantation ; methods ; Cervical Vertebrae ; injuries ; surgery ; Diskectomy ; methods ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc ; injuries ; surgery ; Male ; Middle Aged ; Spinal Fractures ; complications ; diagnosis ; surgery ; Spinal Fusion ; methods ; Traction ; Treatment Outcome

OBJECTIVETo observe the results and its related factors of surgical treatment of cervical spondylotic myelopathy (CSM).

METHODSTotally 365 CSM patients were reviewed. All patients were treated with anterior cervical decompression and fusion with autogenous iliac bone or titanium mesh cages with local bone graft. Anterior locking plates were used for fixation. Five patients received revision surgery 3 to 6 months after the initial operation.

RESULTSClinical function was excellent in 175 patients (47.94%), good in 129 patients (35.34%), fair in 44 patients (12.05%), and poor in 17 patients (4.66%).

CONCLUSIONAnterior cervical decompresion of CSM has good clinical efficacy. The timing of operation, disease severity, and surgical technique are the important factors affecting the outcome of treatment.

Adult ; Aged ; Bone Plates ; Cervical Vertebrae ; surgery ; Decompression, Surgical ; Female ; Follow-Up Studies ; Humans ; Ilium ; transplantation ; Male ; Middle Aged ; Recovery of Function ; Spinal Fusion ; Spinal Osteophytosis ; complications ; surgery ; Transplantation, Autologous ; Treatment Outcome

OBJECTIVETo investigate the diagnostic and therapeutic approach of solitary necrotic nodule of the liver (SNNL).

METHODSFifteen cases were diagnosed as SNNL from June 1999 to December 2005. The clinical characteristics, imaging findings, diagnosis and treatment were analyzed with related literature retrospectively.

RESULTSThe patients manifested abdominal pain and discomfort in 7 cases (46.7%), fever in 1 case (6.7%), debilitation in 1 case (6.7%). Lesions were screened as hypoechogenic patterns in B ultrasound, and CT scan confirmed that the lesion appeared slightly hypodense compared with the normal liver parenchyma without detectable enhanced graphic phases. No significant enhancement was on dynamic magnetic resonance imaging study. All of the nodules demonstrated hypointense and isointense signal relative to parenchyma of liver on both T1 and T2-weighted images. Histologically, the lesion composed mainly of coagulative necrosis with a homogeneous periphery, and the central zone had a rough patchy appearance with cellular debris. The coagulative necrosis was surrounded by a thin boundary of collagen fibers with scanty mononuclear, lymphocyte, plasmocyte inflammatory cells and elastic fibers. Preoperative laboratory examinations showed hepatic function slightly abnormal in 3 patients, and AFP level was normal in all patients. Diagnosis of SNNL was established in 4 cases (26.7%) preoperatively. All patients underwent liver resection with no recurrence within 3 months to 6 years follow-up.

CONCLUSIONSPreoperative diagnosis of SNNL can be established via comprehensive analysis of clinical characteristics and imaging findings. Liver resection is the optimal therapeutic approach.

Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Liver ; pathology ; surgery ; Liver Neoplasms ; diagnosis ; surgery ; Male ; Middle Aged ; Necrosis ; Retrospective Studies

OBJECTIVE: To explore the acupoint selection rules of acupuncture for Alzheimer's disease (AD) in modern clinical practice by complex network technology. METHODS: The relevant articles of clinical trials were retrieved from CNKI published before December 2017. Using Microsoft Excel 2010, the database was established. Using Gephi 0.8.2 software, the complex network mode was built and its topological structure was analyzed. RESULTS: Finally, 81 articles were eligible and 114 acupoint prescriptions were extracted. The constructed complex network of acupoint prescriptions for AD was characteristics as small world effect and scale-free property, the crucial acupoints included Baihui (GV 20), Sishencong (EX-HN 1), Fengchi (GB 20), Yintang (GV 29), Shenmen (HT 7), Shenting (GV 24), Zusanli (ST 36), Fenglong (ST 40) and Taichong (LR 3). In acupoint combination, Baihui (GV 20), Neiguan (PC 6), Shenmen (HT 7) and Sanyinjiao (SP 6) were the most common, and the combination of the distal and nearby points was predominant. Using k-core for acupoint optimization, 29 core acupoints were screened and they were mostly located on the governor vessel and the head and neck, with the highest use frequency. 82.76% of acupoints were specific acupoints and the influential points were dominant. Using community structure partition, these acupoints were classified into two groups, i.e. deficiency syndrome and excess syndrome. CONCLUSION The selection of local acupoints is the first choice in acupuncture treatment for AD. The combination of distal and nearby points is the most common and the special points are the core. In clinical practice, the great consideration is provided on mind regulation, integration of disease and symptoms, the mutual treatment of the primary and the secondary as well as the deficiency and the excess.
Acupuncture Points ; Alzheimer Disease ; therapy ; Databases, Factual ; Humans ; Publications

Purpose: Systemic inflammatory response is a critical factor that promotes the initiation and metastasis of malignancies including pancreatic cancer (PC). This study was designed to determine and compare the prognostic value of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and fibrinogen-to-albumin ratio (FAR) in resectable PC and locally advanced or metastatic PC. Materials and Methods: Three hundred fifty-three patients with resectable PC and 807 patients with locally advan-ced or metastatic PC were recruited in this study. These patients were classified into a training set (n=758) and a validation set (n=402). Kaplan-Meier survival plots and Cox proportional hazards regression models were used to analyze prognosis. Results: Overall survival (OS) was significantly better for patients with resectable PC with low preoperative PLR (p=0.048) and MLR (p=0.027). Low FAR, MLR, NLR (p < 0.001), and PLR (p=0.003) were significantly associated with decreased risk of death for locally advanced or metastatic PC patients. FAR (hazard ratio [HR], 1.522; 95% confidential interval [CI], 1.261 to 1.837; p < 0.001) and MLR (HR, 1.248; 95% CI, 1.017 to 1.532; p=0.034) were independent prognostic factors for locally advanced or metastatic PC. Conclusion The prognostic roles of FAR, MLR, NLR, and PLR in resectable PC and locally advanced or metastatic PC were different. FAR showed the most prognostic power in locally advanced or metastatic PC. Low FAR was positively correlated with OS in locally advanced or metastatic PC, which could be used to predict the prognosis.

Esophageal squamous cell carcinoma(ESCC)is a major histological subtype of esopha-geal cancer with a poor prognosis.Although several serum metabolomic investigations have been reported,ESCC tumor-associated metabolic alterations and predictive biomarkers in sera have not been defined.Here,we enrolled 34 treatment-naive patients with ESCC and collected their pre-and post-esophagectomy sera together with the sera from 34 healthy volunteers for a metabo-lomic survey.Our comprehensive analysis identified ESCC tumor-associated metabolic alterations as represented by a panel of 12 serum metabolites.Notably,postoperative abrosia and parenteral nutrition substantially perturbed the serum metabolome.Furthermore,we performed an examina-tion using sera from carcinogen-induced mice at the dysplasia and ESCC stages and identified three ESCC tumor-associated metabolites conserved between mice and humans.Notably,among these metabolites,the level of pipecolic acid was observed to be progressively increased in mouse sera from dysplasia to cancerization,and it could be used to accurately discriminate between mice at the dysplasia stage and healthy control mice.Furthermore,this metabolite is essential for ESCC cells to restrain oxidative stress-induced DNA damage and cell proliferation arrest.Together,this study revealed a panel of 12 ESCC tumor-associated serum metabolites with potential for monitor-ing therapeutic efficacy and disease relapse,presented evidence for refining parenteral nutrition composition,and highlighted serum pipecolic acid as an attractive biomarker for predicting ESCC tumorigenesis.