Objective To investigate the preventive effect of continuous quality improvement(CQI) on malnutrition,inflammation,peritoneal dialysis adequacy and cardiovascular events in elderly patients undergoing peritoneal dialysis.Methods A single-center prospective self-controlled study was performed.32 stable elderly patients to undergo continuous ambulatory peritoneal dialysis (CAPD) were included.The continuous quality improvement program was conducted by using the 4-step problem-solving framework called the PDCA cycle (plan,do,check and act).The dialysis adequacy,nutritional status,inflammation and cardiovascular events were analyzed before and after PDCA.Results Compared with before PDCA,the proportion of patients with Kt/V≥1.7 and urea kinetics (Kt/V) level were increased after PDCA [71.8％ vs.93.75％,(1.97±0.36) vs.(2.08±0.33),both P＜ 0.05].Serum levels of albumin (ALB),prealbumin (PAB) and serum carbon dioxide combining power (CO2 CP) were increased after PDCA (all P＜0.05).The proportion of patients with ALB≥40 g/L was increased after PDCA as compared with before PDCA (9.4％ vs.31.3％,P＜0.05).The nutritional variables including mid-arm circumference (MAC),triceps skinfold thickness (TSF),mid arm muscle circumference (MAMC),and lean body mass (LBM),lean body mass percentage (LBM％),normalized protein equivalent of total nitrogen appearance (nPNA),handgrip strength were improved after PDCA (P＜ 0.05).High sensitivity C-reactive protein (hs-CRP) level and the proportion of patients with hs-CRP＞3 mg/L were decreased after PDCA as compared with before PDCA [(8.65±6.22) mg/L vs.(5.37±4.33) mg/L,53.1％ vs.25％,both P＜0.05].The incidence of peritoneal dialysis related peritonitis was reduced obviously from 1 case every 25.4 months to 1 case every 78.1 months after PDCA (P ＜ 0.05).The hospitalization rate due to cardiovascular events was decreased after PDCA as compared with before PDCA (25％ vs.3.13％,P＜0.05).Conclusions CQI may significantly improve the malnutrition,inflammation and dialysis adequacy,and reduce the hospitalization rate due to cardiovascular events in elderly patients undergoing peritoneal dialysis.

Objective To explore whether the degree of 99Tcm-methoxyisobutylisonitrile (MIBI) uptake in non-small cell lung cancer (NSCLC) could be correlated with the treatment response to three-dimensional conformal radiotherapy.Methods A total of 102 patients with NSCLC were studied with 99Tcm-MIBI SPECT before radiotherapy.The patients were classified by a follow-up CT as responders (complete or partial remission) and non-responders (stable or progressive disease).After intravenous administration of 740 MBq 99Tcm-MIBI, SPECT imaging at 10-30 min (early) and 2-3 h (delayed) were performed.Region of interest (ROI) was placed over the tumors and contralateral normal lung tissue.The uptake ratio of tumor to contralateral normal lung (T/N) was obtained from both early (ER) and delayed (DR) SPECT images.The retention index (RI) was measured as:RI = (DR - ER)/ER×100%.Statistical analysis was performed by two independent-sample t-test and Mann-Whitney U test using software SPSS 13.0.Results 99Tcm-MIBI uptake was significantly higher in responders than in non-responders:2.36 ±0.17 vs 1.82 ±0.14 (ER) and 2.48 ± 0.20 vs 1.94 ± 0.16 (DR), respectively (t = - 13.1,- 12.7, both P＜ 0.05).The median RI in the responders group was also significantly higher than that in the non-responders group (6.60% vs 5.13%, z = - 6.83, P ＜ 0.05).Conclusion ER, DR and RI of 99Tcm-MIBI SPECT might be useful to estimate the treatment response to three-dimensional conformal radiotherapy in patients with NSCLC.

Objective To investigate the effect of human umbilical cord mesenchymal stem cells (hUC-MSCs) on autophagy and the secretion of chemokine receptor CXCR4 induced by low-dose immunosuppressive durgs.Methods Flow cytometry was used to detect the changes of hUC-MSCs surface markers after treatment with low-dose tacrolimus and rapamycin.The effect of treatment with tacrolimus and rapamycin on proliferation of hUC-MSCs was analyzed with WST-1 assay.Regular RT-PCR was applied to analyze the mRNAs expression of ligands such as LC3B,Atg5 and Beclin1 in hUC-MSCs.Western blotting was carried out to detect the expression of LC3B,Atg5,Beclin1 and p-ULK1 in hUC-MSCs after treatment with tacrolimus and rapamycin.The secretion of chemokine receptor CXCR4 in hUC-MSCs was analyzed under the state of autophay by flow cytometry.Results Flow cytometry analysis confirmed low-dose immunosuppressive drugs tacrolimus and rapamycin did not cause changes in hUC-MSCs phenotypes significantly.Low-dose tacrolimus had no cytotoxic effect on hUC-MSCs,while,rapamycin could inhibit the proliferation of hUC-MSCs after 24 h or 48 h,with survival rate being 73.66％ and 68.81％ (P＜0.05) of controls,respectively.Moreover,both tacrolimus and rapamycin could inhibit PI3K/AKt/mTOR signaling pathway to activate hUC-MSCs autophagy,and the related proteins of LC3B,Atg5 and Beclin1 increased significantly and induced the up-regulation of CXCR4 secretion.Conclusion Our results here demonstrated that low-dose tacrolimus and rapamycin induce autophagy in hUC-MSCs and promote the secretion of CXCR4.

AlM: To silent hypoxia inducible factor-1α ( HlF-1α) gene in malignant melanoma of the choroid cell by small interference RNA ( siRNA ) and investigate its effect on the expression of matrix metalloproteinase-2 ( MMP-2 ) in the choroid cell line human uveal melanoma cell (OCM-1) in hypoxia environment.METHODS:OCM-1 cells cultured on culture flask were divided into normal group and hypoxia group. Hypoxia group were divided into five groups: simple hypoxic group, and interference group, and negative control group, and positive control group, and liposome group. Normal group cells were cultured on DMEM culture flask with 10% FBS, 100U/mL penicillin, 100μg/mL streptomycin as well as high concentration of glucose. The cells were maintained at 37℃ in a humidified 5% CO2 incubator. Cells in good condition were selected for experiment. For hypoxia group, chemical hypoxia inducer CoCl2 was added into nutrient medium at the concentration of 100μmol/L to simulate hypoxia microenvironment. We designed and synthesised siRNA ( siRNA + negative control+positive control ) , the target sequences of the HlF-1α to transfect hypoxic malignant melanoma of the choroid cell. SiRNA including HlF-1α siRNA, β-actin siRNA and negative control group synthesized in vitro transfected hypoxic OCM - 1 cell through Lipofectamine2000. The expression of HlF-1α, MMP-2 gene and the protein were detected by RT-PCR and Western blot. RESULTS: Compared with the normal group, the expression of HlF-1α mRNA was not obviously changed (P>0. 05), but the expression of HlF-1α protein and MMP- 2 mRNA protein was significantly higher ( P<0. 05) . Compared with the other hypoxia groups,β-actin mRNA expression of positive control group decreased ( P< 0. 05 ) , which proved successful transfection. The expression of HlF-1α mRNA and the expression of its protein and both MMP-2 mRNA and its protein was significantly lower ( P < 0. 05 ). The negative control group, liposome control group had no significant difference in the detection of factors (P>0. 05).CONCLUSlON: Hypoxia status may upregulate the HlF-1α in OCM-1 cells by increasing the expression of protein. Hypoxia can also inactivate MMP-2, resulting in upregulation of MMP-2 RNA and the expression of its protein. The expression of HlF-1α and MMP-2 mRNA can be down-upregulated by transfecting OCM-1 with HlF-1α siRNA.

Adult ; Aged ; Bone Plates ; Bone Transplantation ; Female ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Spinal Canal ; surgery ; Spinal Fusion ; Spinal Stenosis ; surgery ; Spondylolisthesis ; surgery

OBJECTIVETo explore the clinical application of the expanded cross-leg flap for repairing instep soft tissue defects with bone exposure.

METHODSThe expanded cross-leg flap was used to repair instep defects in 10 patients. After flap transferring the donor site was closed directly without skin grafting.

RESULTSSatisfactory results were achieved in all the cases. The flaps survived well. The donor site had less scar and kept good appearance.

CONCLUSIONSThe expanded cross-leg flap is a better choice for repairing the soft tissue defects of the instep. It is simple and easy with less trauma to the donor site. After the operation, both the recipient and the donor areas had good appearance.

Adult ; Aged ; Female ; Foot Injuries ; surgery ; Humans ; Male ; Middle Aged ; Skin Transplantation ; methods ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; Tissue Expansion ; Young Adult

OBJECTIVETo investigate the effect of chemokine stromal cell-derived factor-1 (SDF-1) and its receptor CXCR4 on liver metastasis of human colon cancer.

METHODSExpression of CXCR4 in different colon cancer cell lines and SDF-1 in different tissues were detected by using Western-blot technique. Effect of SDF-1 and anti-CXCR4 monoclonal antibody (McAb) on proliferation and migration of HT-29 cells were measured using MTT methods. Model mimicking liver metastasis of human colon cancer was established by injecting HT-29 cells intrasplenically into BALB/C nude mice. Mice were randomly divided into AMD3100 treated group and control group. Liver metastatic rate and tumor foci were measured 7 weeks after.

RESULTSHT-29 cells expressed higher level of CXCR4 protein, and liver tissue expressed higher level of SDF-1 protein. Compared with the control, SDF-1 could significantly induced the proliferation and migration of the HT-29 cells, and anti-CXCR4 McAb could inhibited both functions of SDF-1. The liver metastasis rate in the control group was 100%, and it was 40% in the AMD3100 treating group (P < 0.05). The mean liver metastasis number also significantly decreased by AMD3100 (7.8 +/- 2.6 vs 22.4 +/- 8.6, P < 0.05).

CONCLUSIONSSDF-1/CXCR4 biological axis play an important role in liver metastasis of human colon cancer. Arrest of CXCR4 can inhibit liver metastasis of colon cancer through blocking cell proliferation and migration induced by SDF-1.

Animals ; Cell Line, Tumor ; Cell Movement ; Cell Proliferation ; Chemokine CXCL12 ; metabolism ; physiology ; Colonic Neoplasms ; metabolism ; pathology ; HT29 Cells ; Humans ; Liver Neoplasms, Experimental ; secondary ; Mice ; Mice, Inbred BALB C ; Mice, Nude ; Receptors, CXCR4 ; metabolism ; physiology ; Xenograft Model Antitumor Assays

Objective To explore the impact of chronic complications of type 2 diabetic mellitus (T2DM)on quality of life(QOL)among T2DM outpatients in urban China.Methods A cross.Sectional study was carried Out in 1524 T2DM outpatients recruited from 15 hospitals in 4 major cities of China.Questionnaire interviews were used to collect data on general characters and complications of T2DM.SF-36 questionnaire(version 1)was used and self-completed by patients under the help from interviewers for those having difficulties in reading.T test,one-way ANOVA and generalized linear model were used to explore the association between complications of T2DM and quality of life.Results Complication Was a significant predictor leading to poorer SF-36 subscale scores(decreased by 4.68-16.06 scores)and two summary scores (PCS,MCS).The scores of role-physical subscale(decreased by 22.45％)and role-emotionsl subscale(decreased by 16.28％)decreased much more than the other subscales in patients with complication.Overall,QOI Was reduced by 11.02％in patients with complication.The QoL had a gradual decrease with the increasing number of complications.The average scores descended from 2.82 to 10.33 in the eight subscales with the increase of one complication.Conclusion Having complication or multiple complications seemed to be predietors of poor QOL among T2DM outpatients.

Objective:To provide clinicians with insights about the patients with breast cancer complicated with thyroid cancer and dermatomyositis,and to improve early detection of the diseases by observing the clinical characteristics of 1 case of breast cancer complicated with thyroid cancer and dermatomyositis and reviewing the literatures about the relationships between these three kinds of diseases.Methods:The medical information of this patient,including gender,age,clinical manifestations,glucocorticoid treatment dose,type of concurrent tumor and the time point it occured and therapeutic regimen were collected and recorded.These clinical data were retrospectively analyzed.Results:The patient with dermatomyositis was diagnosed with breast cancer and thyroid cancer in succession.Oral administration of 50 mg dexamethasone per day was continued in the treatment of dermatomyositis.Then the patient received 4 cycles of pirarubicin/cyclophosphamide (AC) followed by 4 cycles of paclitaxel/Hessaitin (TH) as neoadjuvant chemotherapy for breast cancer.During the 24 weeks of chemotherapy,the breast tumor size was gradually decreased while there was no significant change in thyroid tumor size.The clinical symptoms of dermatomyositis were also improved.The blood lactic acid dehydrogenase and alpha hydroxybutyrate dehydrogenase levels were decreased,but not obviously.After 8 courses of AC-TH neoadjuvant chemotherapy followed by radical resection of thyroid cancer,there was no significant improvement in the symptoms of dermatomyositis 1 week after operation and the myocardial enzyme levels remained unchanged.Then modified radical mastectomy was performed.The myocardial enzymes were examined again 1 week after the second operation all of them were decreased to the normal levels.The clinical symptoms of dermatomyositis were also improved.Conclusion:Although the relationships between the three diseases is still controversial,the clinical data of the patient and relevant literatures collected in this paper support that breast cancer is associated with thyroid cancer and dermatomyositis is associated with breast cancer,but not thyroid cancer.

OBJECTIVETo investigate clinical efficacy and feasibility of double-plating fixation via anteriormiddle approach in treating type C3 distal femoral fractures.

METHODSFrom August 2008 to August 2011, 12 cases with type C3 distal femoral fractures were treated, including 5 open fractures and 7 closed fractures. Among them, there were 8 males, 4 females with an average of 40 years (ranged, 25 to 55 years). There were 7 in left side, 5 in right side. Nine cases were caused by car accident, 3 cases by falling down. The duration from injury to hospital was form 20 minutes to 5 days (mean 135 min). After tibia bone traction for 5 to 8 days, the operation were performed by double-plating fixation via anteriormiddle approach, and autograft of iliac bone or allograft bone grafting were given to bone defect. Knee joint function was evaluated according to Merchanetal criteria.

RESULTSThe operation time was from 110 to 160 min, with an average of 135 min, the blood loss was from 300 ml to 500 ml,with an average of 400 ml. Post-operative wound were stage I healing. All patients were followed up from 16 to 36 months (mean 24 months). No infection, reduction loss, nonunion, deep vein thrombosis occurred. Bone healing time was for 18 to 24 weeks with an average of 21 weeks. According to the Merchanetal criteria, 4 cases got excellent results, 6 good, 1 fair and 1 poor.

CONCLUSIONDouble-plating fixation via anteriormiddle approach for type C3 distal femoral fractures is an effective way, which has advantages of obvious exposure, simple manipulation, anatomical reduction, stable fixation. However,operation indications and operating instructions should be strictly followed.

Adult ; Bone Plates ; Female ; Femoral Fractures ; diagnostic imaging ; surgery ; Fracture Fixation, Internal ; instrumentation ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed ; Treatment Outcome