ObjectiveTo discuss the clinical efficacy of low dose heparins and low molecular weight heparins (LMWHs) in the treatment of severe traumatic disseminated intravascular coagulation (DIC).MethodsA total of 77 trauma patients (APACHE Ⅱ score for 5-10) with secondary DIC in ICU were included and randomly assigned to three groups,ie,Group A (26 patients,subcutaneously injected with LMWHs at doses of 75-150 U · kg-1 · d-1,with the average incipient dose of 4 000 U/d),Group B (25 patients,subcutaneously injected with heparins at doses of 100-250 U · kg-1 · d-1,with the average incipient dose of 5000 U/d and control group (26 patients,supplemented with simple blood coagulation factor).The injection volume was adjusted according to the level of antithrombin Ⅲ ( ATⅢ ) in each group.Within 28 days in ICU,the three groups were compared in aspects of deaths,hospital day,bleeding rate,thrombin time (TT),prothrombin time (PT),activation part thrombin time ( APTT),fibrinogen (Fg),antithrombin Ⅲ ( AT Ⅲ ) and D-dimer.Results ( 1 ) The differences of mortality were both insignificant in the control group comparel with Group A and Group B respectively at day 28 ( P ＜ 0.05 ).(2) The ICU stay of three groups showed significant differences ( P ＜ 0.01 ),with longer stay of Groups A and B than control group ( P ＜ 0.01 ) and longer stay of Group A than Group B ( P ＜ 0.05 ).( 3 ) Except for AT Ⅲ ( P ＜ 0.01 ),other blood coagulation indices showed no significant difference among three groups.(4) The differences of bleeding rate were not significant between Group A and control group (P ＞ 0.05),but significant between Group B and control group (p ＜ 0.05 ).(5) Related factor analysis indicated significant relationship between AT Ⅲ level and bleeding rate (P ＜0.01 ).ConclusionsLow dose heparins and LMWHs are beneficial to controlling traumatic DIC,but the heparin therapy adjusted by the level of AT Ⅲ with marked correlation bleeding rate shows lower bleeding rate as compared with LMWHs.

Objective To identify the differentially expressed genes in cardinal ligament between patients with pelvic organ prolapse ( POP) and postmenopausal women without POP by Human Genome Expression Chip and explore the potential molecular mechanism involved in POP.Methods From January to May,2007,cardinal ligament samples were obtained from 3 postmenopausal patients with POP-Q stage Ⅲ and 3 postmenopausal patients underwent hysterectomy due to other benign gynecologic diseases without POP in Peking Union Medical College Hospital.HE and Masson's trichrome staining was used to verify tissue origin and inspect histological changes.Those differentially expressed genes in cardinal ligaments were identified by Human Genome Chip and further interrogated with Gene Ontology (GO) and Pathway Analysis.Those remarkable expressed genes were confirmed by qRT-PCR.Results Alterations of ligament architecture in POP patients included disarrangement and collapse of smooth muscle bundles and collagen fibers.A total of 179 differentially expressed genes were screened between POP and non-POP cardinal ligament tissue,including 20 functional unknown genes.A total of 107 genes were upregulated in POP group,while 72 genes downregulated.Those differentially genes were revealed associated with multiple functional proteins and metabolic pathways by biological analysis.Among these,Wnt signaling pathway exhibited the most remarkable changes.Real-time quantitative PCR showed the genes of COL1Al,DKK1,SFRP1,FZD5,WNT16b in POP group (2.98 ±1.40,3.03 ±0.48,8.13 ±4.42,5.19 ±3.50,12.40± 3.88) were upregulated significantly compared with non-POP group (1.09 ±0.08,1/20 ±0.18,0.41 ± 0.51,0.87 ±0.24,1.40 ±0.47; P < 0.05 ).Conclusions The pathophysiology of POP is complex and associated with multiple functional proteins and metabolic pathways.Among these,the antagonist DKK1,SFRP1 in Wnt signaling pathway may contribute to a neurodegenerative role in POP development.

Objective:To investigate the prognostic value of gastroepiploic lymph node (GLN) metastasis in transverse colon cancer.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 371 patients with transverse colon cancer who were admitted to Fujian Medical University Union Hospital from November 2010 to November 2017 were collected. There were 202 males and 169 females, aged from 21 to 92 years, with a median age of 58 years. Patients were performed complete mesocolic excision combined with GLN dissection by one group of surgeons. Of the 371 patients with transverse colon cancer, 15 cases had positive GLN metastasis (GLN+), and 356 cases had negative GLN metastasis (GLN-). Observation indicators: (1) the propensity score matching conditions and comparison of baseline data between GLN- patients and GLN+patients with transverse colon cancer after propensity score matching; (2) follow-up and survival of GLN- patients and GLN+patients with transverse colon cancer; (3) influencing factors for prognosis of patients with transverse colon cancer. Patients were followed up by outpatient examination or telephone interview to detect tumor metastasis and survival. Follow-up was conducted once every 3 months within postoperative 2 years, once every 6 months within postoperative 2-5 years and once a year thereafter up to January 2020. The propensity score matching was conducted by 1∶4 matching using the nearest neighbor method. Measurement data with skewed distribution were described as M (range), and comparison between groups was analyzed using the rank sum test. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. The Kaplan-Meier method was used to calculate survival rates and draw survival curves, and Log-rank test was used for survival analysis. Univariate and multivariate analyses were performed using the COX proportional hazard regression model. The variables with P<0.10 in the univariate analysis were included for multivariate analysis. Results:(1) The propensity score matching conditions and comparison of baseline data between GLN- patients and GLN+ patients with transverse colon cancer after propensity score matching: 55 of 371 patients had successful matching, including 44 GLN- patients and 11 GLN+ patients. Before propensity score matching, the age, cases in stage 0 or stage 1 of M staging, preoperative carcinoembryonic antigen were 60 years(range, 24-92 years), 328, 22, 4.1 μg/L(range, 0.2-343.7 μg/L) for GLN- patients, respectively, versus 67 years(range, 21-79 years), 11, 4, 5.0 μg/L(range, 0.7-952.4 μg/L) for GLN+ patients, showing significant differences in the above indicators between the two groups ( Z=-1.440, χ2=9.031, Z=-2.086, P<0.05). After propensity score matching, the above indicators were 58 years(range, 45-67 years), 40, 4, 4.0 μg/L(range, 2.0-10.0 μg/L) for GLN- patients, respectively, versus 67 years(range, 59-71 years), 9, 2, 5.0 μg/L(range, 8.0-19.0 μg/L) for GLN+ patients, showing no significant difference between the two groups ( Z=-1.580, χ2=0.105, Z=-0.821, P>0.05). (2) Follow-up and survival of GLN- patients and GLN+ patients with transverse colon cancer: GLN- patients and GLN+ patients with transverse colon cancer were followed-up for 12-92 months and 1-70 months, with a median time of 53 months and 30 months respectively. Three cases of GLN- patients and 2 cases of GLN+patients had postoperative liver metastasis, respectively, showing no significant difference between the two groups ( χ2 =0.344, P>0.05). One case of GLN- patients and 3 cases of GLN+ patients had heterochronous lung metastasis, respectively, showing a significant difference between the two groups ( χ2 =4.870, P<0.05). The 5-year disease progression-free survival rates were 82.3% and 33.9% for GLN- patients and GLN+ patients, respectively, showing a significant difference between the two groups ( χ2 =13.366, P<0.05). (3) Influencing factors for prognosis of patients with transverse colon cancer: results of univariate analysis showed that pT staging, pN staging, M staging and GLN metastasis were related factors for prognosis of patients with transverse colon cancer ( hazard ratio=1.599, 5.107, 4.511, 6.273, 95% confidence interval as 0.467-5.471, 1.867-13.971, 1.385-14.694, 2.052-19.176, P<0.05). Results of multivariate analysis showed that pN staging, M staging and GLN metastasis were independent influencing factors for prognosis of patients with transverse colon cancer ( hazard ratio=6.399, 6.163, 4.024, 95% confidence interval as 2.028-20.189, 1.666-22.800, 1.177-13.752, P<0.05). Conclusion:For the patients with transverse colon cancer, GLN metastasis is associated with high postoperative heterochronous lung metastasis rate and poor prognosis. GLN metastasis is an independent prognostic factor for patients with transverse colon cancer.

Skeletal maturity can reflect an individual's developmental status and predict their future growth potential, provide clinicians with valuable diagnostic information. In recent years, significant progress has been made in imaging techniques for assessing skeletal maturity. This article aims to review the application status and research progress of X-ray, MRI and ultrasound in assessing skeletal maturity in adolescents and children, with a view of providing clinical reference.

OBJECTIVETo investigate the distribution of rubidium (Rb), cesium (Cs), beryllium (Be), strontium (Sr), and barium (Ba) in blood and urine in general Chinese population.

METHODSA total of 18 120 subjects aged 6~60 years were enrolled from 24 regions in 8 provinces in Eastern, Central, and Western China from 2009 to 2010 based on the method of cluster random sampling. Questionnaire survey was conducted to collect the data on living environment and health status. Blood and urine samples were collected from these subjects, and the levels of Rb, Cs, Be, Sr, and Ba in these samples were determined by inductively coupled plasma mass spectrometry. The distribution of these elements in blood and urine in male or female subjects living in different regions was analyzed statistically.

RESULTSIn the general Chinese population, the concentration of Be in the whole blood was below the detection limit (0.06 μg/L); the geometric mean (GM) of Ba in the whole blood was below the detection limit (0.45 μg/L), with the 95th percentile (P95)of 1.37 μg/L; the GMs (95% CI)of Rb, Cs, and Sr in the whole blood were 2 374(2 357~2 392) μg/L, 2.01 (1.98~2.05) μg/L, and 23.5 (23.3~23.7) μg/L, respectively; in males and females, the GMs (95%CI)of blood Rb, Cs, and Sr were 2 506 (2 478~2 533) μg/L and 2 248 (2 227~2 270) μg/L, 1.88 (1.83~1.94) μg/L and 2.16 (2.11~2.20) μg/L, and 23.4 (23.1~23.7) μg/L and 23.6 (23.3~23.9) μg/L, respectively(P<0.01, P>0.05, and P>0.05). In the general Chinese population, the GM of urine Be was below the detection limit (0.06 μg/L), while the GMs (95%CI)of urine Rb, Cs, Sr, and Ba were 854 (836~873) μg/L, 3.65 (3.56~3.74) μg/L, 39.5 (38.4~40.6) μg/L, and 1.10 (1.07~1.12) μg/L, respectively; in males and females, the GMs (95%CI)of urine Rb, Cs, Sr, and Ba were 876 (849~904) μg/L and 832 (807~858) μg/L, 3.83 (3.70~3.96) μg/L and 3.47 (3.35~3.60) μg/L, 42.5 (40.9~44.2) μg/L and 36.6 (35.1~38.0) μg/L, and 1.15 (1.12~1.19) μg/L and 1.04 (1.01~1.07) μg/L, respectively (all P< 0.01). Correlation analyses showed that there were weak correlations between blood Rb and urine Rb (r=0.197)and between blood Sr and urine Sr (r=0.180), but a good correlation between blood Cs and urine Cs (r=0.487).

CONCLUSIONThe levels of Rb, Cs, Be, Sr, and Ba in the general Chinese population are similar to those reported in other countries, and there is a significant difference in the concentration of each element among the populations living in different regions, as well as significant differences in blood Rb, urine Rb, urine Cs, urine Sr, and urine Ba between males and females.

Adolescent ; Adult ; Barium ; blood ; urine ; Beryllium ; blood ; urine ; Cesium ; blood ; urine ; Child ; China ; Female ; Humans ; Limit of Detection ; Male ; Middle Aged ; Rubidium ; blood ; urine ; Strontium ; blood ; urine ; Young Adult

Objective:To investigate the demand and influencing factors of home care social support services for the elderly with dementia in urban areas, and provide a decision-making basis for improving home care social support services for the elderly with dementia.Methods:This was a cross-sectional study. From March 2021 to March 2022, 386 family caregivers of elderly people with dementia were randomly selected from tertiary hospitals in four central urban areas of Wuhan by stratified sampling method. A questionnaire was used to investigate the current situation and attributes of the demand for home care social support services for the elderly with dementia in urban areas. The importance of the demand for home care social support services for the elderly with dementia in urban areas was calculated by the Better-Worse coefficient method and sensitivity formula method. The optimal scale regression model was used to analyze the influencing factors and influencing forces of independent variables on service demand.Results:The score of social support service demand for home care was (88.6 ± 29.71) points. The Better coefficient of demand for all social support services was greater than the absolute value of the Worse coefficient. One requirement (pressure ulcer prevention and treatment guidance) was a one-dimensional attribute, and the remaining 29 items were charm attributes. The top 6 items in importance ranking were 2 items of informational support (pressure ulcer prevention and treatment guidance; telephone counselling guidance for family caregivers), 1 items of instrumental support (financial assistance for family caregivers) and 3 items of social companionship support(cultural recreation/physical activity activities, door-to-door accompaniment, accompany the elderly to social activities). Optimal scale regression model test: all four models of social support service demand were statistically significant ( F values were 2.75-4.23, all P <0.01). The gender, education level, number of children of the elderly with dementia, age,education level, self rated physical condition of family caregivers, the average monthly income of families, and the relationship between family caregivers and the elderly with dementia were the influencing factors of self-esteem support (all P<0.05). The educational level, marital status, type of dementia of the elderly with dementia, educational level, self rated physical condition of family caregivers, the average monthly income of the family, and the relationship between family caregivers and the elderly with dementia were the influencing factors of informational support (all P <0.05). The educational level and type of dementia of the elderly with dementia, the educational level, self rated physical condition of family caregivers, and the average monthly income of families were the influencing factors of social companionship support (all P <0.05). The type of dementia of the elderly with dementia, the self rated physical condition of family caregivers, the average monthly income of families, and the relationship between family caregivers and elderly relatives were the influencing factors of instrumental support (all P <0.05). Five times for caregiver human resources, 3 times for family economic resources and 3 times for the elderly with dementia, and 1 time for relatives resource factors were the top 3 times of independent variable influence force entered the ranking. Conclusions:The demand for social support services for home care of the elderly with dementia is low, with the characteristics of expectant tendency and centralized demand. The provision of home-based care social support services should give priority to meeting the needs of "pressure ulcer prevention and treatment guidance", and provide financial assistance, counseling and guidance, social companionship and other services as much as possible. Caregiver human resources are the key factors affecting home care social support services, family economic resources and the elderly with dementia are important factors, it is recommended to fully tap the potential of relatives resources and community resources.

This study investigated the association between serum 25(OH)D 3 levels and cardiovascular risk-related indicators. 4 727 participants aged 20 and above from the National Health and Nutrition Examination Survey 2015-2018 database were enrolled. Body mass index, hypersensitive C-reactive protein, high density lipoprotein cholesterol, systolic blood pressure, waist-height ratio, and total cholesterol were selected as the research indicators. Weighted multiple linear regression models, subgroup analyses, smooth curve fitting, and saturation threshold effect analyses were employed to explore the relationship between serum 25(OH)D 3 and these indicators. The results showed that after full adjustment for covariates, every 1 nmol/L increase in serum 25(OH)D 3, the changes in β (95% CI) values for body mass index(BMI), hypersensitive C-reactive protein(hs-CRP), systolic blood pressure(SBP), waist-height ratio(WHtR), high density lipoprotein cholesterol(HDL-C), and total cholesterol(TC) were -0.05 (-0.06, -0.04) kg/m 2, -0.01 (-0.02, -0.01) mg/L, -0.02 (-0.04, -0.01) mmHg, -0.000 7 (-0.000 8, -0.000 6), 0.10 (0.08, 0.11) mg/dl, and 0.08 (0.04, 0.12) mg/dl, respectively. Female participants were more sensitive to changes in serum 25(OH)D 3, while participants aged 60 and above were relatively less sensitive. The relationship between serum 25(OH)D 3 and these indicators partially exhibited nonlinear patterns across different gender and age subgroups. The saturation threshold effect analysis revealed 8 meaningful inflection points. In summary, vitamin D has a close association with cardiovascular risk-related indicators.

This study investigated the association between serum 25(OH)D 3 levels and cardiovascular risk-related indicators. 4 727 participants aged 20 and above from the National Health and Nutrition Examination Survey 2015-2018 database were enrolled. Body mass index, hypersensitive C-reactive protein, high density lipoprotein cholesterol, systolic blood pressure, waist-height ratio, and total cholesterol were selected as the research indicators. Weighted multiple linear regression models, subgroup analyses, smooth curve fitting, and saturation threshold effect analyses were employed to explore the relationship between serum 25(OH)D 3 and these indicators. The results showed that after full adjustment for covariates, every 1 nmol/L increase in serum 25(OH)D 3, the changes in β (95% CI) values for body mass index(BMI), hypersensitive C-reactive protein(hs-CRP), systolic blood pressure(SBP), waist-height ratio(WHtR), high density lipoprotein cholesterol(HDL-C), and total cholesterol(TC) were -0.05 (-0.06, -0.04) kg/m 2, -0.01 (-0.02, -0.01) mg/L, -0.02 (-0.04, -0.01) mmHg, -0.000 7 (-0.000 8, -0.000 6), 0.10 (0.08, 0.11) mg/dl, and 0.08 (0.04, 0.12) mg/dl, respectively. Female participants were more sensitive to changes in serum 25(OH)D 3, while participants aged 60 and above were relatively less sensitive. The relationship between serum 25(OH)D 3 and these indicators partially exhibited nonlinear patterns across different gender and age subgroups. The saturation threshold effect analysis revealed 8 meaningful inflection points. In summary, vitamin D has a close association with cardiovascular risk-related indicators.

Objective:To understand the current status of fear of falling in patients receiving maintenance hemodialysis and analyze the influencing factors.Methods:The convenient sampling method was used to select maintenance hemodialysis patients admitted to BenQ Hospital Affiliated to Nanjing Medical University from August to October 2022 as the research objects. A survey was conducted on patients using the general information questionnaire, modified falls efficacy scale (MFES), fatigue, resistance, ambulation, illness, loss of weight (FRAIL), and Braden Mobility Subscale.Results:A total of 219 questionnaires were sent out, and 219 were effectively collected, with an effective recovery rate of 100.00%. Among 219 patients with maintenance hemodialysis, 96 had fear of falling, and the incidence of fear of falling was 43.84%. Binary logistic regression analysis showed that age, type of kidney disease, fall history, and score of FRAIL were the influencing factors of fear of falling in patients with maintenance hemodialysis ( P< 0.05) . Conclusions:The incidence of fear of falling in patients with maintenance hemodialysis is relatively high. Age, diabetic nephropathy, history of falls, and frailty are the risk factors for fear of falling in patients with maintenance hemodialysis. Medical staff can develop targeted intervention measures for maintenance hemodialysis patients based on risk factors to reduce their fear of falling.