Objective To explore the feasibility and safety of MCCE in gastrointestinal examination of elderly patients with malignant tumors.Methods Clinical data of 127 patients who underwent MCCE examination from April 2019 to September 2022 were retrospectively analyzed.According to age,the patients were divided into the elderly group(age≥65 year-old,n = 88)and the middle-aged group(40≤age<65 year-old,n = 39),and the clinical data of patients with malignant tumors were screened from the two groups for analysis and comparison.Results 131 patients received MCCE examination,and 4 elderly patients were excluded from this study due to swallowing failure,so 88 elderly patients were actually included in the study.In the elderly group,45.4%had serious cardiovascular diseases(40/88),27.3%had malignant tumors(24/88),8.0%had serious respiratory diseases(7/88),6.8%had anesthesia problems(6/88),and 9.1%had neurological diseases(8/88).Among the 24 elderly patients with malignant tumors,25.0%had severe cardiovascular disease,25.0%had poor general status,20.8%had brain metastases,and 12.5%had severe respiratory dysfunction.The positive diagnosis rate of gastric P2 lesions in the elderly group(52/88,59.1%)was significantly higher than that in the middle-aged group(13/39,33.3%)(P = 0.013).There was significant difference in positive rate of ulcer diagnosis between the two groups(29.5%and 10.2%)(P = 0.032).In patients with malignant tumors,the positive rate of ulcer diagnosis between the two groups(45.8%and 11.1%)was statistically significant(P = 0.038).The cleanliness and visualization scores of proximal stomach in the middle-aged group were higher than those in the elderly group,and the differences were statistically significant(P<0.05).Conclusion MCCE is generally effective and safe in elderly patients,especially those with malignant tumors,without missing any significant gastric lesions.

Objective:To discuss the feasibility of offering specialized courses of critical care medicine in undergraduate clinical medicine education, so as to alleviate the shortage of critical care medicine staffs and lay a foundation for improving the success rate for the treatment of critical cases.Methods:The undergraduates majoring in clinical medicine from 2008 to 2011 in Guizhou Medical University (the former Guiyang Medical College) were enrolled. After they had been enrolled in the undergraduate education for 3 years and were ready for Grade four, which meant basic medicine teaching had been completed and clinical medicine teaching was about to start, they were introduced and preached to each discipline, including critical care medicine. The undergraduates were free to choose professional direction of clinical training in Grade four. Students majoring in clinical medicine from 2012 to 2014 were free to choose their major direction when they entered the school.Results:From September 2011 to July 2019, the university had cultivated 246 undergraduates majoring in clinical critical care medicine from 2008 to 2014, and the critical care medicine professional team of affiliated hospital had undertaken 540 teaching hours. By July 2019, all students had graduated on time, with an employment rate of 100%. Forty students took postgraduate programs in our school and other schools, accounting for 16.3%.Conclusions:Professional education of critical care medicine in the undergraduate course of clinical medicine can mobilize students' interest in learning and subjective initiative, which is conducive to career selection. During the clinical training, the students can identify and timely cure critical care cases in the early stage, and partly alleviate the current shortage of critical care medical staffs.

We employed a multiplex polymerase chain reaction (PCR) coupled with capillary electrophoresis (mPCR-CE) targeting six Clostridium difficile genes, including tpi, tcdA, tcdB, cdtA, cdtB, and a deletion in tcdC for simultaneous detection and characterization of toxigenic C. difficile directly from fecal specimens. The mPCR-CE had a limit of detection of 10 colony-forming units per reaction with no cross-reactions with other related bacterial genes. Clinical validation was performed on 354 consecutively collected stool specimens from patients with suspected C. difficile infection and 45 isolates. The results were compared with a reference standard combined with BD MAX Cdiff, real-time cell analysis assay (RTCA), and mPCR-CE. The toxigenic C. difficile species were detected in 36 isolates and 45 stool specimens by the mPCR-CE, which provided a positive rate of 20.3% (81/399). The mPCR-CE had a specificity of 97.2% and a sensitivity of 96.0%, which was higher than RTCA (x = 5.67, P = 0.017) but lower than BD MAX Cdiff (P = 0.245). Among the 45 strains, 44 (97.8%) were determined as nonribotype 027 by the mPCR-CE, which was fully agreed with PCR ribotyping. Even though ribotypes 017 (n = 8, 17.8%), 001 (n = 6, 13.3%), and 012 (n = 7, 15.6%) were predominant in this region, ribotype 027 was an important genotype monitored routinely. The mPCR-CE provided an alternative diagnosis tool for the simultaneous detection of toxigenic C. difficile in stool and potentially differentiated between RT027 and non-RT027.
Clostridium Infections ; diagnosis ; Clostridium difficile ; genetics ; Electrophoresis, Capillary ; Feces ; microbiology ; Genes, Bacterial ; Humans ; Polymerase Chain Reaction ; Ribotyping ; Sensitivity and Specificity

Objective To investigate the characteristics of target motion in esophageal cancer during normal breathing with four-dimensional computed tomography(4DCT). Methods Twenty patients with primary esophageal cancer received respiratory gated 4DCT to obtain the target motion during normal breathing and delineate the gross tumor volume (GTV). The center coordinate and volume of each GTV were measured and recorded to calculate the displacement of the GTV center and the change in volume in different respiratory phases. Results The displacement of the GTV center in each esophageal segment in superior-inferior direction (0.521±0.319 cm) was significantly greater than that in right-left direction (0.169± 0.083 cm) and that in anterior-posterior direction (0.167±0.095 cm)(all P<0.05). The maximum displacement of the GTV center in each direction was significantly different in different esophageal segments(all P<0.05).The displacement of the GTV center in each direction was not entirely consistent in different respiratory phases. The displacement of the GTV center in each direction in T50phase was greatest when T0phase was the reference phase. The volume of GTV had no significant changes at the end of the expiratory phase and the inspiratory phase (P=0.313). Conclusions The displacement of GTV center in each esophageal segment in superior-inferior direction is significantly greater than that in right-left direction and that in anterior-posterior direction and the displacement of GTV center in each direction is significantly different in different esophageal segments. Therefore, all the factors should be considered to develop a reasonable target for precise radiotherapy. For esophageal cancer in cervical and upper chest esophageal segment,it is reasonable to delineate ITV based on the fusion image of the images at the end of inspiratory phase and expiratory phase. The deformation of target volume of the esophageal cancer in the cervical and upper chest esophageal segment is not significant in the respiratory cycle.

Objective To investigate the effects of transient receptor potential cation channel 6 (TRPC6) on the expression of nephrin, desmin and caspase 9 and on the apoptosis of podocytes in a mouse model of podocyte injury induced by TGF-β1.Methods Conditionally immortalized mouse podocytes were cultured in vitro and divided into four groups: control, TGF-β1 treatment, TGF-β1+PGPU6/GFP/Neo-TRPC6-mus-581 (TRPC6 knockdown) and TGF-β1+PGPU6/GFP/Neo-NC (negative control).Real-time RT-PCR and Western blot analysis were performed to detect the expression of nephrin, desmin and caspase 9 at mRNA and protein levels, respectively.Flow cytometry was used to analyze the apoptotic rate of podocytes.DAPI fluorescent staining was used to observe the morphological changes of apoptotic podocytes.Results Green fluorescent protein (GFP)-expressing podocytes at 48 hours after transfection were significantly more than those at 24 hours after transfection.The level of TRPC6 in mouse podocytes transfected with PGPU6/GFP/Neo-TRPC6-mus-581 was significantly decreased as compared with that of the control group (P<0.05).No significant difference in the expression of TRPC6 was observed between the negative control group and the control group.Compared with the control group, the TGF-β1 treatment group showed increased expression of desmin and caspase 9 at both mRNA and protein levels (P<0.01), but decreased expression of nephrin at mRNA and protein levels at 48 hours after TGF-β1 intervention (P<0.05).The up-regulated desmin and caspase 9 and the down-regulated nephrin induced by TGF-β1 could be inhibited by the means of TRPC6 knockdown.The apoptosis rate of podocytes in TGF-β1 treatment group was (14.0±2.1)%, while that in TRPC6 knockdown was (10.90±0.56)% (P<0.05).The apoptosis rate of podocytes in negative control group was higher than that in TGF-β1 treatment group (P>0.05).More apoptotic cells with typical morphological features of apoptosis were observed after exposure to TGF-β1 for 48 hours.Conclusion TGF-β1 could induce the apoptosis of podocytes, inhibit the expression of nephrin and enhance the expression of caspase 9 and desmin, the possible mechanisms of which may be related to TRPC6 signal pathway.These changes in TGF-β1-treated podocytes could be alleviated by inhibiting the expression of TRPC6, which might have a protective effect on podocyte injury.

At present, the somatic function assessment of the elderly mostly depends on the doctor's observation and the scale evaluation, and there isn't the objective and quantitative assessment criteria. In this paper, we design and construct a digital system for the geriatric somatic function assessment, which is based on digital ground, inertial unit, mobile terminal and PC terminal. The gait and balance parameters of the elderly were obtained by the Time Up and Go test and five postures test. Based on the linear regression model of gait and balance parameters, the system was used to evaluate the somatic function of the elderly. The experimental results show that the system not only can accurately distinguish elderly between fall and non-fall, but also has a high correlation between the score of the system and the score of clinical geriatric physical function scale.

In order to evaluate the ability of Parkinson's patients to walk comprehensively, a system based on MEMS to aid clinical quantification of ability in Parkinson's is established. The inertial units are respectively fixed on the back and the waist of subject to be measured. The Kalman fusion algorithm is used to extract the characteristic parameters of accelerometer and gyroscope data. SVM classifier is designed to train and test the classifier by the feature. The results show that the system possesses a high recognition rate for Parkinson's patients and normal subjects and for the classification of the walking ability of patients with Parkinson's disease. So, this system can aid doctors to give more object diagnostic conclusion.

A new type of isokinetic muscle tone testing system was designed for the Parkinson’s patients with dysmyotonia. The system consists of a mechanical device, a data acquisition unit, and a data processing and analyzing software. The mechanical device comprises an arm supporting device, a safety limiting device and a height adjusting device. Data acquisition unit, composed of a torque sensor module, a motor control module, a data communication module, and so on, is used to control the arm at constant speed and convert the sensor's analog signal into digital signal, then the signal is transmitted to the computer in real-time by USB interface. The data processing and analyzing software, developed by VC++, has finished the data processing, display, storage, generated the reports, et al. The experimental results show that this system is reliable and safe, not only can evaluate the degree of abnormal muscle tone in Parkinson’s patients, but also can be used in the rehabilitation training of patients with dysmyotonia, which has strong expansibility.

Objective To explore the effect of intensive statin on platelet activity and inflammation factors 24 h after rat myocar‐dial infarction .Methods Seventy Sprague‐Dawley rats were randomly divided into five groups (n= 14):Sham‐operated group (SHAM group);AMI group(control group) ,general group;intensive statin therapy group ;general and intensive statin therapy group;established AMI rat model by ligation of left anterior descending branch of coronary artery .The general group ,general and intensive statin therapy group was fed atorvastatin by 10 mg · kg -1 · d-1 with distilled water 2 mL by intragastric gavage daily for two weeks .The intensive statin therapy group ,general and intensive statin therapy group was fed atorvastatin by 50 mg/kg with distilled water 2 mL by intragastric gavage 12 h before surgery .Serum PAC‐1 ,CD62p ,TNF‐α,hs‐CRP was measured at the time of 24 h of postoperation .Results TNF‐α,hs‐CRP ,PAC‐1 and CD62p levels in control group were significantly higher than the SHAM group and intensive statin group 24 h after the LADS were ligated(P<0 .05);and the factors of intensive statin group were signifi‐cantly lower than that of control group(P<0 .05) .There was no significant difference between the intensive statin group and gener‐al‐intensive group in the concentration of serum TNF ,hs‐CRP and the relative expression of PAC‐1 and CD62p(P> 0 .05);and there was no significant difference between normal group and control group in all the four factors (P>0 .05) .Conclusion Intensive statin therapy before acute myocardial infarction could decrease the level of inflammation factors and inhibit platelet activity postop‐eration .

Objective To observe the efficacy of combination therapy with nimodipine and oxiracetam for type 2 diabetes melli‐tus(T2DM)patients with mild vascular cognitive impairment(mVCI) .`Methods Seventy‐two T2MD‐mVCI patients were divided into control group and observation group and each group was 36 cases .Control group was given routine treatment and nimodipine 40 mg ,3 times every day ;observation group was given oxiracetam 800 mg ,2 times every day ;the treatment course was 6 months .fast‐ing blood glucose(FBG) ,2 h postprandial hyperglycemia(2 h PBG) ,glycosylated hemoglobin A1C(HbA1C) ,C peptide level were recorded and MoCA cognitive function scale was used to evaluated patients cognitive function of each group before and after the treatment .Results Before the treatment ,both two groups with C peptide level were declined and mild cognitive impairment ,there were no statistically significant differences(P>0 .05) .After the treatment ,C peptide level ,MoCA scores and cognitive function sub‐scores of memory ,executive ,attention were significantly higher than before(P<0 .05);the observation group compared with the control group improved significantly(P< 0 .01) .Conclusion Combination therapy with nimodipine and oxiracetam could signifi‐cantly improve cognitive function in patients with T2DM‐mVCI ,its efficacy is superior to nimodipine .