Background: Twenty-four-hour urinary free cortisol (UFC) measurement is the initial diagnostic test for Cushing’s syndrome (CS). We compared UFC determination by both direct and extraction immunoassays using Abbott Architect, Siemens Atellica Solution, and Beckman DxI800 with liquid chromatography-tandem mass spectrometry (LC-MS/MS). In addition, we evaluated the value of 24-hr UFC measured by six methods for diagnosing CS. Methods: Residual 24-hr urine samples of 94 CS and 246 non-CS patients were collected.A laboratory-developed LC-MS/MS method was used as reference. UFC was measured by direct assays (D) using Abbott, Siemens, and Beckman platforms and by extraction assays (E) using Siemens and Beckman platforms. Method was compared using Passing–Bablok regression and Bland–Altman plot analyses. Cut-off values for the six assays and corresponding sensitivities and specificities were calculated by ROC analysis. Results: Abbott-D, Beckman-E, Siemens-E, and Siemens-D showed strong correlations with LC-MS/MS (Spearman coefficient r = 0.965, 0.922, 0.922, and 0.897, respectively), while Beckman-D showed weaker correlation (r = 0.755). All immunoassays showed proportionally positive bias. The areas under the curve were 0.975 for Abbott-D, 0.972 for LCMS/MS, 0.966 for Siemens-E, 0.948 for Siemens-D, 0.955 for Beckman-E, and 0.877 for Beckman-D. The cut-off values varied significantly (154.8–1,321.5 nmol/24 hrs). Assay sensitivity and specificity ranged from 76.1% to 93.2% and from 93.0% to 97.1%, respectively. Conclusions Commercially available immunoassays for measuring UFC show different levels of analytical consistency compared to LC-MS/MS. Abbott-D, Siemens-E, and Beckman-E have high diagnostic accuracy for CS.

Objective To investigate the knowledge and behavioral status of foot care among patients with type 2 diabetes in Xinjiekou Community in Beijing and analyze its influencing factors. Methods A convenient sampling method was used to select 278 diabetes patients from Xinjiekou Community in Beijing for questionnaire surveys, which included general information, foot care knowledge, and behaviors of the patients. Results The average score of foot care knowledge among the 278 patients was (71.65±14.59), indicating a moderate level overall. The average score of foot care behavior was (48.83±8.83), indicating a poor level overall. Multivariate stepwise regression analysis showed that gender, duration of diabetes, and whether the patients had received foot care education or not were independent influencing factors for both the foot care knowledge score and the foot care behavior score among community diabetes patients (P < 0.05). Pearson correlation analysis showed that a positive correlation between foot care knowledge and foot care behavior among community diabetes patients was observed(r=0.593, P < 0.001). Conclusion The level of foocare knowledge among diabetes patients in this community in Beijing is moderate, while the status of foot care behaviors is not optimistic. Community healthcare professionals should strengthen health education on foot care, improve patients' knowledge of foot care and compliance with foot care behaviors, and pay attention to male patients and those with a shorter duration of diabetes to reduce the occurrence of diabetic foot.

Humans ; Dexmedetomidine/therapeutic use* ; Hypnotics and Sedatives ; Cognitive Dysfunction/drug therapy*

OBJECTIVE: To explore the genetic basis for fetus with bilateral lateral ventriculomegaly. METHODS: Fetus umbilical cord blood and peripheral blood samples of its parents were collected. The fetus was subjected to chromosomal karyotyping, whilst the fetus and its parents were subjected to array comparative genomic hybridization (aCGH). The candidate copy number variation (CNV) were verified by qPCR, Application goldeneye DNA identification system was used to confirm the parental relationship. RESULTS: The fetus was found to have a normal karyotype. aCGH analysis indicated that it has carried a 1.16 Mb deletion at 17p13.3, which partially overlapped with the critical region of Miller-Dieker syndrome (MDS), in addition with a 1.33 Mb deletion at 17p12 region, which is associated with hereditary stress-susceptible peripheral neuropathy (HNPP). Its mother was also found to harbor the 1.33 Mb deletion at 17p12. qPCR analysis confirmed that the expression levels of genes from the 17p13.3 and 17p12 regions were about the half of that in the normal control, as well as the maternal peripheral blood sample. Parental relationship was confirmed between the fetus and its parents. Following genetic counseling, the parents has chosen to continue with the pregnancy. CONCLUSION The fetus was diagnosed with Miller-Dieker syndrome due to the de novo deletion at 17p13.3. Ventriculomegaly may be an important indicator for prenatal ultrasonography in fetuses with MDS.
Pregnancy ; Female ; Humans ; Classical Lissencephalies and Subcortical Band Heterotopias ; Comparative Genomic Hybridization ; DNA Copy Number Variations ; Fetus ; Hydrocephalus ; Prenatal Diagnosis ; Chromosome Deletion

OBJECTIVE: To explore the genetic etiology of two patients with developmental delay and intellectual disability. METHODS: Two children who were respectively admitted to Henan Provincial People's Hospital on August 29, 2021 and August 5, 2019 were selected as the study subjects. Clinical data were collected, and array comparative genomic hybridization (aCGH) was carried out on the children and their parents for the detection of chromosomal microduplication/microdeletions. RESULTS: Patient 1 was a 2-year-and-10-month female and patient 2 was a 3-year-old female. Both children had featured developmental delay, intellectual disability, and abnormal findings on cranial MRI. aCGH revealed that patient 1 has harbored arr[hg19] 6q14.2q15(84621837_90815662)×1, a 6.19 Mb deletion at 6q14.2q15, which encompassed ZNF292, the pathogenic gene for Autosomal dominant intellectual developmental disorder 64. Patient 2 has harbored arr[hg19] 22q13.31q13.33(46294326_51178264)×1, a 4.88 Mb deletion at 22q13.31q13.33 encompassing the SHANK3 gene, haploinsufficiency of which can lead to Phelan-McDermid syndrome. Both deletions were classified as pathogenic CNVs based on the guidelines of American College of Medical Genetics and Genomics (ACMG) and were not found in their parents. CONCLUSION The 6q14.2q15 deletion and 22q13-31q13.33 deletion probably underlay the developmental delay and intellectual disability in the two children, respectively. Haploinsufficiency of the ZNF292 gene may account for the key clinical features of the 6q14.2q15 deletion.
Humans ; Child ; Female ; Child, Preschool ; Intellectual Disability/genetics* ; Comparative Genomic Hybridization ; Chromosome Disorders/genetics* ; Chromosome Deletion ; Magnetic Resonance Imaging ; Chromosomes, Human, Pair 22 ; Developmental Disabilities/genetics* ; Carrier Proteins/genetics* ; Nerve Tissue Proteins/genetics*

Purpose: The role of vacuolar protein sorting 34 (Vps34), an indispensable protein required for cell vesicular trafficking, in the biological behavior of hepatocellular carcinoma (HCC) has yet to be studied. Materials and Methods: In the present study, the expression of Vps34 in HCC and the effect of Vps34 on HCC cell invasion was detected both in vivo and in vitro. Furthermore, by modulating the RILP and Rab11, which regulate juxtanuclear lysosome aggregation and recycling endosome respectively, the underlying mechanism was investigated. Results: Vps34 was significantly decreased in HCC and negatively correlated with the HCC invasiveness both in vivo and in vitro. Moreover, Vps34 could promote lysosomal juxtanuclear accumulation, reduce the invasive ability of HCC cells via the Rab7-RILP pathway. In addition, the deficiency of Vps34 in HCC cells affected the endosome-lysosome system, resulting in enhanced Rab11 mediated endocytic recycling of cell surface receptor and increased invasion of HCC cells. Conclusion Our study reveals that Vps34 acts as an invasion suppressor in HCC cells, and more importantly, the endosome-lysosome trafficking regulated by Vps34 has the potential to become a target pathway in HCC treatment.

Objective:To explore the clinical effect of Intensive Care Unit (ICU) catheter whole life cycle management system.Methods:An ICU catheter whole life cycle management system was constructed and applied in clinical practice. This study collected data on catheter management and hospital infection of patients in ICU of Zhejiang Hospital before the application of the catheter whole life cycle management system from April to December 2019 and after the application of the catheter whole life cycle management system from April to December 2020. The accuracy of catheter recording, the compliance rate of daily catheter nursing quality, and the incidence of major catheter-associated infections were compared before and after the application of the ICU catheter whole life cycle management system. The time-consuming of catheter information recording under the two methods of applying the ICU catheter whole life cycle management system and computer manual input was analyzed, and the nurses' experience of using the ICU catheter whole life cycle management system was investigated through semi-structured interviews.Results:After the application of the ICU catheter whole life cycle management system, the accuracy rate of catheter recording increased from 89.96% (22 491/25 001) to 96.09% (30 897/32 155) , and the difference was statistically significant ( P<0.05) . The compliance rate of daily catheter nursing quality increased from 89.81% (22 453/25 001) to 95.94% (30 849/32 155) , and the difference was statistically significant ( P<0.05) . There was no significant difference in the incidence of major catheter-associated infections before and after system application ( P>0.05) . In addition, the time-consuming of catheter recording by nurses using the ICU catheter whole life cycle management system was less than that of manual input by computer, and the difference was statistically significant [ (0.98±0.28) min vs. (1.78±0.50) min, P<0.05] . The semi-structured interview results showed that nurses had a good experience in using the ICU catheter whole life cycle management system. Conclusions:The ICU catheter whole life cycle management system provides nurses with a systematic, convenient and standardized catheter management method. The system has a good user experience, can improve the accuracy of nurse catheter recording and the catheter nursing quality, and shorten catheter recording time. However, further studies are needed to confirm whether it helps to reduce the incidence of major catheter-associated infections.

Objective:To systematically evaluate the application effect of high flow nasal cannula (HFNC) in patients with chronic obstructive pulmonary disease (COPD) .Methods:Cochrane Library, PubMed, Ovid, CNKI, Wanfang database and other Chinese and English databases were searched for randomized controlled trials or cohort studies on the effect of HFNC in COPD patients. The retrieval time limit was from the establishment of the databases to September 30, 2021. Two researchers independently screened the literature, evaluated quality of the literature and extracted data. RevMan 5.0 software was used to conduct a meta-analysis on the literature that met the inclusion criteria.Results:A total of 8 literatures were included, including 4 English literatures and 4 Chinese literatures, with a sample size of 575 cases. Meta-analysis results showed that there were no statistically significant statistical differences between the HFNC group and the non-invasive mechanical ventilation group patients in the 24-hour heart rate [ WMD=-2.65, 95% CI (-7.17-1.86) , P=0.25], 24-hour mean arterial pressure [ WMD=0.45, 95% CI (-3.10-4.00) , P=0.80], 24-hour arterial partial pressure of oxygen [ WMD=-0.08, 95% CI (-0.89-0.74) , P=0.85], 24-hours arterial blood carbon dioxide partial pressure [ WMD=-0.96, 95% CI (-2.29-0.36) , P=0.15], 24-hour oxygenation index [ WMD=0.87, 95% CI (-4.85-6.58) , P=0.77], length of stay in ICU [ WMD=-0.83, 95% CI (-1.79-0.14) , P=0.09], tracheal intubation rate [ RR=0.98, 95% CI (0.58-1.64) , P=0.93], incidence of aspiration [ RR=0.30, 95% CI (0.08-1.18) , P=0.08]and 28-day mortality rate [ RR=1.12, 95% CI (0.61-2.03) , P=0.72] ( P>0.05) . Compared with non-invasive mechanical ventilation, HFNC could reduce the 24-hour respiratory rate in COPD patients [ WMD=-0.78, 95% CI (-1.48--0.08) , P=0.03], the incidence of nasal and facial pressure injury [ RR=0.14, 95% CI (0.05-0.39) , P=0.000 1] and improved 24-hour arterial blood pH [ WMD=0.03, 95% CI (0.01-0.04) , P<0.01]. Conclusions:Compared with non-invasive mechanical ventilation, HFNC can reduce the 24-hours respiratory rate, the incidence of nasal and facial pressure injury and improve the 24-hours arterial blood pH in COPD patients. However, more high-quality, multicenter randomized controlled trials are needed to verify the results of this study in the future.

Objective:To systematically evaluate the application effect of high flow nasal cannula (HFNC) in patients with chronic obstructive pulmonary disease (COPD) .Methods:Cochrane Library, PubMed, Ovid, CNKI, Wanfang database and other Chinese and English databases were searched for randomized controlled trials or cohort studies on the effect of HFNC in COPD patients. The retrieval time limit was from the establishment of the databases to September 30, 2021. Two researchers independently screened the literature, evaluated quality of the literature and extracted data. RevMan 5.0 software was used to conduct a meta-analysis on the literature that met the inclusion criteria.Results:A total of 8 literatures were included, including 4 English literatures and 4 Chinese literatures, with a sample size of 575 cases. Meta-analysis results showed that there were no statistically significant statistical differences between the HFNC group and the non-invasive mechanical ventilation group patients in the 24-hour heart rate [ WMD=-2.65, 95% CI (-7.17-1.86) , P=0.25], 24-hour mean arterial pressure [ WMD=0.45, 95% CI (-3.10-4.00) , P=0.80], 24-hour arterial partial pressure of oxygen [ WMD=-0.08, 95% CI (-0.89-0.74) , P=0.85], 24-hours arterial blood carbon dioxide partial pressure [ WMD=-0.96, 95% CI (-2.29-0.36) , P=0.15], 24-hour oxygenation index [ WMD=0.87, 95% CI (-4.85-6.58) , P=0.77], length of stay in ICU [ WMD=-0.83, 95% CI (-1.79-0.14) , P=0.09], tracheal intubation rate [ RR=0.98, 95% CI (0.58-1.64) , P=0.93], incidence of aspiration [ RR=0.30, 95% CI (0.08-1.18) , P=0.08]and 28-day mortality rate [ RR=1.12, 95% CI (0.61-2.03) , P=0.72] ( P>0.05) . Compared with non-invasive mechanical ventilation, HFNC could reduce the 24-hour respiratory rate in COPD patients [ WMD=-0.78, 95% CI (-1.48--0.08) , P=0.03], the incidence of nasal and facial pressure injury [ RR=0.14, 95% CI (0.05-0.39) , P=0.000 1] and improved 24-hour arterial blood pH [ WMD=0.03, 95% CI (0.01-0.04) , P<0.01]. Conclusions:Compared with non-invasive mechanical ventilation, HFNC can reduce the 24-hours respiratory rate, the incidence of nasal and facial pressure injury and improve the 24-hours arterial blood pH in COPD patients. However, more high-quality, multicenter randomized controlled trials are needed to verify the results of this study in the future.

Objective To observe the relation of phase angle (PA) measured by bioelectrical impedance method with nutritional status of patients with primary liver cancer, and to explore its influence on clinical outcomes. Methods We collected 120 inpatients with primary liver cancer for nutritional risk screening, patient-generated subjective nutrition assessment(PG-SGA), anthropometry, biochemical examination and body composition analysis. According to the phase angle, the patients were divided into low PA group and normal PA group. The correlation between PA and nutrition-related indicators was analyzed. The survival and complications of the two groups were compared after 1-year follow-up. Results There were 56.7% (68/120) of primary liver cancer patients with lower PA. TP, ALB, CHE, HB, AMC, GS, BCM, FFM and ASMI in low PA group were lower while ECW/TBW was higher than those in normal PA group (all P < 0.05). The correlation analysis showed that PA was negatively correlated with ECW/TBW (P < 0.05), but positively correlated with TP, ALB, CHE, HB, AMC, GS, BCM, FFM and ASMI (all P < 0.05). Low PA was significantly associated with nutritional risk, deterioration of liver function, progress of liver cancer staging and severe malnutrition (all P < 0.05). During the follow-up period, the mortality of the low PA group was higher than that of the normal PA group (P < 0.05). The risk of death in the low PA group increased by 2.738 times (OR=3.738, 95%CI: 1.465-9.535). Conclusion Phase angle is an economic and effective index to reflect the nutritional status of patients with primary liver cancer, and closely related to the risk of death. Phase angle measurement is helpful for assessing nutritional status and predicting clinical outcome of patients with primary liver cancer.