Objective: To explore and analyze the effect of comprehensive nursing care in endoscopic treatment of esophageal and gastric varicose bleeding. Methods: A retrospective analysis of 60 cases of patients with esophageal and gastric varicose hemorrhage admitted to the hospital was conducted. The patients were randomly divided into 30 cases of control group and 30 cases of observation group. Routine nursing and comprehensive nursing were adopted respectively to evaluate different nursing effects. Results: Intraoperative and postoperative heart rate of the observation group (91.0 ± 4.0) times/min, (89.2 ± 4.2) times/min, which were lower than (98.0 ± 4.2) times/min, (94.7 ± 4.5) times/min of the control group. There was statistically significant difference (t values were 6.610, 4.894, P < 0.05). The bleeding prevention effectiveness rate of the observation group (93.33%, 28/30) was higher than the control group (73.33%, 22/30), The difference was statistically significant (χ² value was 4.32, P < 0.05). The total nursing satisfaction rate (100.00%, 30/30) in the observation group was higher than that in the control group (86.70%, 26/30), the difference was statistically significant (χ² value was 4.29, P< 0.05). Quality of life, disease cognition, compliance behavior, proper rest, self-protection, General Quality of life Inventory (GQOLI) score in the observation group were (33.5 ± 3.5), (21.5 ± 3.7), (32.5 ± 2.8), (21.5 ± 3.3), (22.0±4.2), (130.2 ± 17.4) points, which were higher than those in the control group (28.2 ± 3.2), (17.5 ± 2.5), (28.5 ± 3.0), (17.2 ± 3.0), (18.0 ± 3.0), and (110.2 ± 15.2) points. The differences were statistically significant (t values were 4.245-6.121, P<0.05). Conclusions Endoscopic treatment of esophageal and gastric varicose bleeding patients combined with comprehensive nursing intervention, can effectively prevent the occurrence of rebleeding, improve the quality of life of patients. The application effect is significant.

Objective: To evaluate the left ventricular systolic synchrony and investigate the early diagnostic value of left ventricular systolic dyssynchrony on cardiotoxicity caused by anthracyclines in patients with diffuse large B-cell lymphoma (DLBCL). Methods: Thirty-two patients (22 males, 10 females, age: 22-73(54.4±14.2) years) from June 2016 to January 2019 with confirmed DLBCL and normal gated myocardial perfusion imaging (GMPI) before anthracyclines chemotherapy were enrolled prospectively. GMPI was performed after 6 cycles or more of chemotherapy. Changes of myocardial markers, electrocardiogram (ECG) indicators, left ventricular function indicators including left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), peak filling rate (PFR), summed motion score (SMS) and summed thickening score (STS) as well as left ventricular systolic synchrony indicators including phase bandwidth (BW), phase standard deviation (SD) and entropy before and after anthracyclines chemotherapy were analyzed. Paired t test, Wilcoxon signed rank test and χ² test were used for data analysis. Results: Compared with pre-chemotherapy, the left ventricular systolic synchrony indicators were significantly higher than those before chemotherapy (BW: (42.81±11.37)° vs (29.28±8.68)°; SD: (11.65±4.64)° vs (8.79±3.14)°; entropy: (39.84±5.51)% vs (36.19±5.94)%; t values: -9.132 to -3.173, all P<0.05). There were no significant differences in other indicators (t values: -1.161 to 1.750, z values: -1.633 to -0.096, all P>0.05). Of 32 patients, 13 patients (40.62%) had left ventricular systolic dyssynchrony, and the rate of chemotherapy-induced left ventricular systolic dyssynchrony was significantly higher than that of left ventricular dysfunction (15.62%, 5/32; χ²=4.947, P=0.025). All 5 patients with left ventricular dysfunction caused by chemotherapy had left ventricular systolic dyssynchrony. The LVEF of the chemotherapy-induced left ventricular systolic dyssynchrony group was significantly lower than that of the left ventricular systolic synchronization group ((54.54±9.25)% vs (66.79±7.65)%; t=4.087, P<0.01). Conclusion Left ventricular systolic dyssynchrony can be appeared in DLBCL patients after chemotherapy and is significantly earlier than left ventricular dysfunction, which can be an early indicator of cardiotoxicity caused by anthracycline chemotherapy.

Objective: To explore the relationship between liver controlled attenuation parameters (CAP) and body fat mass and its distribution. Methods: From May to December 2018, 978 adult patients visited at the fatty liver center of the Third People's Hospital of Changzhou were treated. The patient's liver controlled attenuation parameters were measured by transient elastography and the body fat mass and its distribution were measured by bioelectrical impedance technology. Pearson’s correlation coefficient was adopted to describe the correlation between liver CAP value and body mass index (BMI), body fat mass index (BFMI), trunk fat mass index (TFMI), limbs fat mass index (LFMI) and visceral fat area (VFA). Receiver operating characteristic curve (ROC) and area under the curve (AUC) were used to evaluate BMI, BFMI, TFMI, LFMI and VFA to differentiate the cut-off points and efficacy of CAP for diagnosing grading of fatty liver changes in S0-1 and S2-3. Results: In 653 cases of male, S0 ~ S3 accounted for 4.90%, 3.37%, 22.36% and 69.37%, respectively, and in 325 cases of females, S0 ~ S3 accounted for 7.38%, 6.46%, 13.23% and 72.92%, respectively. Female patients had more visceral, trunk and limbs fat than male (P < 0.01). Body mass, body fat mass, body fat percentage, BMI, BFMI, TFMI, LFMI, and VFA were increased in male and female patients with increasing liver fat grade (P < 0.01). CAP values ​​of male and female patients were positively correlated with BMI, BFMI, TFMI, LFMI and VFA. Percentage of body fat mass increased with increasing liver fat grade (male: F = 13.42, P < 0.001; female: F = 3.22, P = 0.023); while limb fat mass percentage did not increase with liver fat grade (Male: F = 1.13, P = 0.34; female: F = 1.05, P = 0.37). Hepatic steatosis grading (S0 ~ 1 or S2 ~ 3) diagnosed with CAP were distinguished through BMI, BFMI, TFMI, LFMI and VFA. AUC was 0.80 ~ 0.82 in males (P < 0.01), and 0.75 ~ 0.78 in females (P < 0.01). Conclusion The liver CAP value is positively correlated with the body's limbs, trunk and visceral fat, and has a strong correlation with trunk and visceral fat. BMI, BFMI, TFMI, LFMI and VFA up to some extent can identify the CAP diagnosis of grading of fatty liver changes in S0-1 and S2-3.

Objective: To evaluate the value and safety of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients. Methods: The clinical data of 377 elderly patients with therapeutic ERCP from January 2010 to September 2017 in Changzhou First People′s Hospital of Jiangsu Province were retrospectively analyzed. Among them, there were 34 patients (observation group) aged ≥ 90 years and 343 patients (control group) aged 75 to 89 years old. The results of ERCP examination, treatment of bile duct stones and related complications were compared between 2 groups. Results: There was no statistical difference in the success rate of ERCP between 2 groups (P>0.05). There were no statistical difference in detection rates of bile duct stones, cholangiocarcinoma and benign biliary stricture between 2 groups (P<0.05); however, the detection rates of duodenal papillary carcinoma and nipple diverticulum in observation group were significantly higher than those in control group: 11.8% (4/34) vs. 2.0% (7/343) and 38.2% (13/34) vs. 18.7% (64/343), and there were statistical differences (χ² = 10.326 and 7.294, P<0.01). There were 21 patients with bile duct stones in observation group, including 14 patients with multiple stones; there were 241 patients with bile duct stones in control group, including 188 patients with multiple stones. The maximum stone diameter, rate of in-line stent drainage and rate of extracorporeal lithotripsy in multiple stones patients of observation group were significantly higher than those in multiple stones patients of control group: (1.5 ± 0.3) cm vs. (1.2 ± 0.4) cm、9.5% (2/21) vs. 1.7% (4/241), 4.8% (1/21) vs. 0.4% (1/241), and there were statistical differences (P<0.05). There was no statistical difference in incidence of ERCP complications between observation group and control group: 14.7% (5/34) vs. 6.7% (23/343), P>0.05; but the incidence of cardiac accidents in observation group was significantly higher than that in control group: 5.9% (2/34) vs. 1.2% (4/343), and there was statistical difference (χ² = 4.393, P<0.05). There was no statistical difference in the length of hospital stay between observation group and control group: (11.5 ± 5.0) d vs. (13.2 ± 5.8), P>0.05. Conclusions Therapeutic ERCP is an important treatment for elderly patients with biliary and pancreatic diseases. For patients over 90 years old, ERCP is safe and reliable, but it is necessary to actively pay attention to comorbidities, especially cardiac function.

Diabetes, obesity, and metabolic diseases are globally prevalent, and induction and increase of endogenous energy consumption, especially activation of brown adipose tissue (BAT), is a new therapeutic target. Non-invasive imaging techniques, including radionuclide imaging, MRI, ultrasound imaging, and optical imaging, have attracted wide attention in BAT monitoring and have good application prospects. This article reviews the progress and application of these imaging techniques in BAT monitoring.

This prospective study was designed to examine the combined influence of insulin resistance (IR) and inflammatory biomarker levels on type 2 diabetes mellitus (T2DM) among 1,903 Inner Mongolians. During follow-up, 205 (10.77%) participants developed T2DM, and the incidence of T2DM was higher among subjects with IR, elevated C-reactive protein (CRP), elevated sICAM-1, elevated sE-selectin, or the coexistences of IR with elevated CRP, elevated sICAM-1, elevated sE-selectin, and elevated angiotensin II (all P < 0.05) compared with patients without IR or any elevated biomarkers. In multivariate analysis, the odd ratios [OR, (95% confidence intervals)] for these conditions were 1.944 (1.405-2.691), 2.003 (1.449-2.767), 1.706 (1.232-2.362), 1.560 (1.123-2.165), 2.708 (1.809-4.054), 1.885 (1.155-3.078), 2.101 (1.340-3.295), and 2.260 (1.426-3.582), respectively. Our findings demonstrated that IR and elevated inflammatory biomarkers were associated with T2DM, and that the coexistence of IR and elevated inflammatory biomarkers increased the risk of T2DM.
Asian Continental Ancestry Group ; Biomarkers ; China ; epidemiology ; Cohort Studies ; Diabetes Mellitus, Type 2 ; blood ; epidemiology ; genetics ; Humans ; Inflammation ; metabolism ; Insulin Resistance ; genetics ; physiology ; Multivariate Analysis ; Odds Ratio ; Prospective Studies

Objective: To analyze the risk factors of delirium in intensive care unit (ICU) patients, and to investigate the predictive value of C-reactive protein (CRP), procalcitonin (PCT), lactic acid (Lac) and neuron-specific enolase (NSE) in the diagnosis of ICU delirium. Methods: The patients admitted to central ICU and respiratory medicine ICU of Changzhou First People's Hospital from August 2016 to November 2017 were enrolled. The patients were divided into two groups according to whether delirium occurred within 7 days or not, which was evaluated by using the confusion assessment method for ICU (CAM-ICU). The gender, age and blood CRP, PCT, Lac, NSE levels were compared between the two groups. Multivariate Logistic regression model was used to analyze the risk factors of ICU delirium. Receiver operating characteristic curve (ROC) was drawn to assess the predictive value of CRP, PCT, Lac and NSE in the occurrence of ICU delirium. Results: 133 patients were enrolled. Delirium occurred in 67 patients, and did not occurred in 66 patients, with a prevalence rate of 50.4%. There was no significant difference in gender or age between the two groups. Compared with non-delirium group, blood CRP, PCT and Lac levels in delirium group were significantly increased [CRP (mg/L): 110.75±77.31 vs. 51.32±36.51, PCT (μg/L): 3.95 (1.01, 23.90) vs. 0.09 (0.06, 0.36), Lac (mmol/L): 2.40 (1.70, 4.30) vs. 1.20 (0.90, 2.00), all P < 0.01], but no significant difference was found in NSE [μg/L: 12.59 (9.61, 17.69) vs. 13.39 (10.14, 19.05), P > 0.05].② It was shown by multivariate Logistic regression analysis that blood PCT and Lac were risk factors of ICU delirium [PCT: odds ratio (OR) = 1.185, 95% confidence interval (95%CI) = 1.006-1.396, P = 0.042; Lac: OR = 1.398, 95%CI = 1.011-1.934, P = 0.043].③ROC curve analysis showed that blood CRP, PCT and Lac had certain predictive value for ICU delirium, and the area under the ROC curve (AUC) of PCT was the highest (0.840 vs. 0.694 and 0.751). When the cut-off value of PCT ≥ 0.55 μg/L, the sensitivity was 72.7%, the specificity was 86.2%, positive predictive value was 84.48%, and negative predictive value was 75.68%. Blood NSE had no predictive value for ICU delirium (AUC = 0.446, P = 0.290). Conclusions Blood PCT and Lac are the risk factors of ICU delirium. PCT has predictive value for ICU delirium.

Objective: To analyze the imaging characteristics and diagnostic value of ¹⁸F-fluorodeoxyglucose (FDG) PET/CT in muscular inflammation in dermatomyositis (DM), as well as the relationship between maximum standardized uptake value (SUV_max) and activity of muscular inflammation. Methods: From July 2013 to November 2016, 17 hospitalized DM patients (8 males, 9 females, age range: 35-78 years) who underwent ¹⁸F-FDG PET/CT were retrospectively reviewed, including 13 typical DM (TDM) and 4 amyopathic DM (ADM). Seventeen healthy volunteers (8 males, 9 females, age range: 35-78 years) in the same period were enrolled as the control group. The proximal limb muscles of whole body were divided into 7 areas, and the SUV_max of each was measured and recorded. Two-sample t test, one-way analysis of variance, Dunnett-t test and Spearman correlation analysis were used to analyze data. Results: Five TDM cases showed diffuse increased FDG uptake in global muscles; 8 TDM cases showed increased FDG uptake in local muscles, mainly in the shoulder and hip. The FDG uptake by muscles of 4 ADM patients was similar with that of controls. The SUV_max was lower and lower in the order of shoulder and back muscles, hip muscles, thoracic vertebra muscles, cervical vertebra muscles, biceps, proximal quadriceps and lumbar vertebra muscles in DM group. The muscle SUV_max of DM, TDM, ADM and the controls were 1.92±0.86, 2.14±0.85, 1.19±0.44 and 0.93±0.26, respectively (F=69.50, P<0.001). Muscle SUV_max of DM group was higher than that of controls, muscle SUV_max of TDM was higher than that of ADM, and muscle SUV_max of ADM was higher than that of controls (t values: 4.102-11.970, all P<0.05). Muscle SUV_max of 9 DM patients with interstitial lung disease (ILD) was lower than that of patients without ILD (1.73±0.09 vs 2.13±0.13; t=5.857, P<0.001). Muscle SUV_max of DM was positive correlated with serum levels of creatine kinase (CK) and creatine kinase isoenzyme composed by M and B subunits (CK-MB) (r_s values: 0.814 and 0.751, both P<0.001). Conclusion ¹⁸F-FDG PET/CT is helpful to detect muscular inflammation of DM and it can reflect the activity and severity with SUV_max, and meanwhile evaluate the condition of ILD associated with DM.

OBJECTIVETo investigate the percentage of blasts with the CD34/CD38/CD123phenotype in de novo acute myeloid leukemia (AML) patients and analyse its correlation with prognosis.

METHODSThe percentage of CD34/CD38/CD123cells in the blast population of 148 newly diagnosed patients with AML was determined by using flow cytometry and its correlation with complete response, disease-free survival and overall survival were evaluated.

RESULTSThe median percentage of CD34/CD38/CD123cells in newly diagnosed patients was 2.8% (ranged from 0.01 to 67%). The high expression of CD34/CD38/CD123in AML patients positively correlated with the NPM1 wild-type (χ=5.194,P<0.05), but did not relate with the positive FLT3-ITD mutations (χ=0.418,P>0.05). Further multivariable analysis showed that the higher expression of the CD34/CD38/CD123was associated with lower complete remission (P<0.05), worse disease-free survival(P<0.01) and shorter overall survival(P<0.01) in AML patients.

CONCLUSIONThe percentage of CD34/CD38/CD123cells at diagnosis significantly correlates with the response to treatment and survival. This prognostic marker may be used to rapidly identify the risk of treatment failure in clinical practice.

Summary: The inhibitory effect of niacinamide on tumor necrosis factor-α (TNF-α) induced annulus fibrous (AF) degradation was assessed, and the mechanism of the inhibition was investigated. Chiba's intervertebral disc (IVD) culture model was established. Forty-eight IVDs from 12 adult Japanese white rabbits were randomly divided into 4 groups (12 IVDs in each group), and various concentrations of niacinamide and TNF-α were added to the medium for intervention: negative control group, niacinamide control group (0.5 mg/mL niacinamide), degeneration group (10 ng/mL TNF-α), and treatment group (0.5 mg/mL niacinamide and 10 ng/mL TNF-α). After one week's culture, AFs were collected for glycosaminoglycan (GS) content measurement, safranin O-fast green staining, and immunohistochemical staining for typeⅠ,Ⅱ collagen and cysteine containing aspartate specific protease-3 (Caspase-3). It was found that the GS content in treatment group was increased by about 48% as compared with degeneration group (t=16.93, P<0.001), and close to that in niacinamide control group (r=0.71, P=0.667). Safranine O-fast green staining exhibited higher staining density and better histological structure of AF in the treatment group as compared with the degeneration group. Immunohistochemical staining for both Type Ⅰ and Ⅱ collagen demonstrated that lameilar structure and continuity of collagen in treatment group were better reserved than in degeneration group. Positive staining rate of Caspase-3 in AFs of negative control group, niacinamide control group, degeneration group and treatment group was 3.4%, 4.3%, 17.9% and 10.3% respectively. The positive rate in treatment group was significantly lower than in degeneration group (P<0.01). It was concluded that niacinamide could effectively alleviate TNF-α induced destruction and synthesis inhibition of matrix ingredients in AFs. The inhibition may be related with reduction of expression of Caspase-3. Thus, niacinamide is of potential for IVD degeneration clinical treatment.