Objective To investigate the therapeutic effects of bone marrow mesenchymal stem cells (BMSCs) for radiation-induced lung injury (RILI) and the underlying mechanism. Methods Forty-five healthy adult male C57BL/6 mice were randomly divided into control, model, and BMSCs groups. The model and BMSCs groups received a single irradiation dose of 20 Gy to the chest, while the control group did not receive X-ray irradiation. For the BMSCs group, an injection of 1 × 10⁶ BMSCs cells was administered via the tail vein within 6 h after irradiation. In the 5th week, the lung tissue was taken to observe pathological changes with HE staining; examine the expression of the inflammatory factors interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) with immunohistochemical staining; observe the polarization of macrophages with immunofluorescence staining; and measure the expression of the epithelial-mesenchymal transition markers E-cadherin, N-cadherin, and vimentin proteins by Western blot. Results After radiation, the model group developed pulmonary vasodilation and congestion with septal thickening and inflammatory cell infiltration, and these changes were markedly reduced in the BMSCs group. The model group showed significantly down-regulated expression of IL-6 and TNF-α compared with significantly increased levels in the model group (P < 0.01, P < 0.05). Treatment with BMSCs significantly increased the polarization of lung macrophages towards the M2 type, while significantly decreasing the abnormally increased N-cadherin and vimentin levels in RILI mice (P < 0.05, P < 0.01). Conclusion BMSCs have therapeutic effects for RILI mice, which may be through promoting macrophage polarization from M1 to M2.

Objective:To establish a disease risk prediction model for the newborn screening system of inherited metabolic diseases by artificial intelligence technology.Methods:This was a retrospectively study. Newborn screening data ( n=5 907 547) from February 2010 to May 2019 from 31 hospitals in China and verified data ( n=3 028) from 34 hospitals of the same period were collected to establish the artificial intelligence model for the prediction of inherited metabolic diseases in neonates. The validity of the artificial intelligence disease risk prediction model was verified by 360 814 newborns ' screening data from January 2018 to September 2018 through a single-blind experiment. The effectiveness of the artificial intelligence disease risk prediction model was verified by comparing the detection rate of clinically confirmed cases, the positive rate of initial screening and the positive predictive value between the clinicians and the artificial intelligence prediction model of inherited metabolic diseases. Results:A total of 3 665 697 newborns ' screening data were collected including 3 019 cases ' positive data to establish the 16 artificial intelligence models for 32 inherited metabolic diseases. The single-blind experiment ( n=360 814) showed that 45 clinically diagnosed infants were detected by both artificial intelligence model and clinicians. A total of 2 684 cases were positive in tandem mass spectrometry screening and 1 694 cases were with high risk in artificial intelligence prediction model of inherited metabolic diseases, with the positive rates of tandem 0.74% (2 684/360 814)and 0.46% (1 694/360 814), respectively. Compared to clinicians, the positive rate of newborns was reduced by 36.89% (990/2 684) after the application of the artificial intelligence model, and the positive predictive values of clinicians and artificial intelligence prediction model of inherited metabolic diseases were 1.68% (45/2 684) and 2.66% (45/1 694) respectively. Conclusion:An accurate, fast, and the lower false positive rate auxiliary diagnosis system for neonatal inherited metabolic diseases by artificial intelligence technology has been established, which may have an important clinical value.

Objective:To investigate the status of anticipatory grief among primary caregivers of families with advanced Alzheimer′s disease (AD) and analyze the influencing factors.Methods:A total of 160 primary caregivers in the families of AD patients in the middle and late stage who were treated in Shaoxing Seventh People′s hospital from August 2018 to September 2019 were selected as research subjects to investigate caregivers′ gender, age, education level, relationship with patients, reasons for taking care of patients, and the patients′ time of illness, combined diseases, and self-care ability. Anticipatory Grief Scale was used to compare the anticipatory grief level (AGL) of caregivers with different characteristics, and Pearson correlation analysis was used to analyze the correlation between the anticipatory grief and burden of caregivers, with a further exploration of the factors affecting caregivers′ anticipatory grief.Results:The anticipatory grief score of primary caregivers of families with AD patients in the middle and late stage was (83.88±17.21). Single factor analysis showed the following facts: the AGL of female caregivers was higher than that of males ( t =12.337, P<0.05); the AGL of spouses was higher than that of children and other family members ( F=10.940); the AGL showed in caretaking based on willingness was lower than that based on responsibility and obligation, and the reason was because other people were available ( F=4.501); the AGL of caregivers of patients with 5-10 years of illness was higher than that of those with 2-4 years of illness ( F=6.014); the AGL of caregivers of patients with more than 3 kinds of other diseases was higher than that of those with less than 1 and 2 kinds of other diseases; the AGL of caregivers of patients with no self-care ability was higher than that of those of patients who lost partial or most self-care ability ( F=5.712). The burden score of primary caregivers of patients in the middle and late stages of AD was (50.19±12.61). Pearson correlation analysis indicated that the anticipatory grief of caregivers was positively correlated with their burden of care ( r=0.581, P<0.001), and multiple regression analysis showed that the caregivers′ gender and relationship with patients, patients′ time of illness, and capacity of self-care, and the caregivers′ burden are the main factors influencing the anticipatory grief of caregivers in families of patients in the middle and late stages of AD (all P<0.05). Conclusion:There exists serious anticipatory grief among primary caregivers in families of patients in the middle and late stages of AD. The main influencing factors include caregivers′ gender, burden of care, relationship with patients, patients′ time of illness, and self-care capacity. Health management should be enhanced to improve the quality of life of the primary caregivers of patients in the middle and late stages of AD.

Objective To investigate the prevalence of complication and related risk factors in Uygur patients with type 2 diabetes mellitus (T2DM).Methods Total 1 507 Uygur patients aged above 20 with T2DM were recruited in the First Affiliated Hospital of Xinjiang Medical University from January 2010 to October 2015.Clinical characteristics,biochemical parameters and related complications were analyzed in different age groups of patients.Multivariate logistic regression was performed to determine associated factors for diabetic complications.Results Among 1 507 cases,there were 61.3％ male patients (n=924),37.4％ (n=564) with diabetes duration ≥5 years,12.5％ (n=189) with HbA1c＞10％,31.5％ (n=475) with hypertension,28.8％ (n=434) with smoking history and 37.4％ (n=564) patients without antidiabetic drug treatment.The average body mass index (BMI) of patients was (27.4±5.2)kg/m2 with a obesity rate of 43.0％ (648/1 507),and 65.0％ (980/1 507) had physical exercise＜150 min/week.The prevalence of diabetic complication was 70.6％(1 064/1 507),in which 28.7％,19.2％ and 22.7％ cases had 1,2 and 3 or more complications,respectively.The proportion of patients with coronary heart disease,stroke/transient ischemic attack and large artery atherosclerosis was 32.4％,10.4％ and 35.8％,respectively.The proportion of patients with diabetic retinopathy,nephropathy and neuropathy were 23.4％,6.5％ and 35.8％,respectively.Patients aged ≥60 years had highest prevalence of large artery atherosclerosis (38.2％,163/427) and diabetic retinopathy (27.2％,116/427);patients in age group 50-59 years had highest prevalence of diabetic neuropathy (40.3％,207/514).Multivariate logistic regression analysis showed that HbA1c＞10％ (OR=2.74,95％CI:1.40-5.34),obesity (OR=1.54,95％CI:1.07-2.21),systolic pressure≥140 mmHg (1 mmHg=0.133 kPa) (OR=1.42,95％CI:1.01-1.99),diastolic pressure≥90 mmHg (OR=0.37,95％CI:0.21-0.67),smoking (OR=1.53,95％CI:1.09-2.15) and physical aetivity＜150 min/week (OR=1.42,95％CI:1.07-1.89) were the risk factors of diabetic complications.Conclusion Uygur patients with type 2 diabetes in Xinjiang show a relatively high prevalence of complications.Poor glycemic control,obesity,hypertension,smoking and physical inactivity may contribute to development of complications,while well-controlled blood glucose and hypertension and quitting smoking and increasing physical activity may reduce diabetic complications.

OBJECTIVE: To summarize and analyze the postoperative short-term complications of laparoscope-assisted transanal total mesorectal excision (taTME) for rectal cancer patients after neoadjuvant therapy. METHODS: A prospectively established database on taTME patients at Peking University Cancer Hospital was screened with the following conditions: data retrieval from June 2016 to August 2018, pathologically confirmed adenocarcinoma, receiving preoperative neoadjuvant chemoradiotherapy or chemotherapy. The transabdominal procedure and the transanal procedure were performed simultaneously in the taTME operation. Occurrence of complications during perioperative period (within postoperative 3 months) in these patients, especially anastomosis-related complications and their management were analyzed. The relevant complications were recorded according to the Clavien-Dindo (CD) grading criteria. The severity of anastomotic leakage and anastomotic stenosis was evaluated according to criteria developed by the International Rectal Cancer Research Group. RESULTS: A total of 29 patients were enrolled in this study. In the 29 patients, 25 (86.2%) were male and 4 (13.8%) were female, the median age was 60 (range, 30 to 72) years, the median body mass index was 25.8 (range, 19.8 to 36.4) kg/m, the median distance from the tumor to anal verge was 4 (range, 2 to 8) cm. All the patients completed laparoscope-assisted taTME operations successfully without conversion to laparotomy, intra-operative severe complication or death. The median operation time was 300 (range, 198 to 405) minutes, and the median intra-operative blood loss was 100 (range, 50 to 200) ml. All the TME specimens were complete according to the Nagtegaal standard. All the patients underwent prophylactic ileostomy. Hartmann procedure was performed in one case due to poor blood supply in the proximal bowel without the possibility of anastomosis. Anal sphincter preservation rate was 96.6% (28/29). The median postoperative exhaust time was 2 (range, 1 to 10) days, and the median postoperative hospital stay was 9 (range, 7 to 24) days. Fifteen patients (51.7%) had postoperative complications, among which serious complication (CD grade IIIb and above) accounted for 6.9% (2/29). No perioperative death was observed. Five patients (17.2%) presented anastomosis-related complications, including 2 cases of grade C anastomotic leakage due to anastomotic rupture, who underwent abdominal perineal resection 1 month after operation; 2 cases of grade B anastomotic leakage, who improved after conservative treatment; 1 case of grade A anastomotic stenosis, who improved with anal expansion 1 month after operation. The incidence of postoperative infection was 24.1% (7/29), including 6 cases of pelvic infection and 1 case of trocar site infection, all of which were CD grade II. One case had incomplete intestinal obstruction (CD grade II); 1 case had gastroplegia; 1 case had abdominal trocar hernia. All the patients were followed up for a median of 12.0 (range, 3.9 to 29.9) months. Seven cases did not undergo ileal stoma closure. The anal sphincter preservation rate was 75.9% (22/29). CONCLUSION Pelvic infection and anastomosis-related complications are common after laparoscope-assisted taTME surgery for rectal cancer patients following neoadjuvant chemoradiotherapy, which require active management and appropriate treatment.
Adult ; Aged ; Anal Canal ; Female ; Humans ; Laparoscopes ; Male ; Middle Aged ; Neoadjuvant Therapy ; Postoperative Complications ; Rectal Neoplasms ; therapy

OBJECTIVETo explore the applicable value of transanal total mesorectal excision (taTME) in male low rectal cancer patients with narrow pelvis-"difficult pelvis", which remains difficult for both open and laparoscopic sphincter-saving operations.

METHODSClinical data of male low rectal cancer patients diagnosed by pathology undergoing taTME between June 2016 and January 2018 at Peking University Cancer Hospital were collected. A retrospective cohort study was performed. Patients were selected according to the following criteria: (1) low rectal cancer, the distance between inferior margin of tumor and anal verge ≤5 cm; (2) the distance between two sciatic tubercles <5 cm; (3) body mass index (BMI) >25 kg/m; (4) tumor horizontal diameter ≤4 cm. Operation time, intraoperative blood loss, postoperative hospital stay, postoperative complications and anal function were analyzed.

RESULTSA total of 20 patients were included in this study. All the patients received preoperative neoadjuvant chemoradiation and hybrid transabdominal and transanal surgery. The median BMI was 27.7(26.2-36.4) kg/m; the median distance between two sciatic tubercles was 92.5 (78-100) mm; the median distance between the inferior margin of tumor to the anal verge was 4 (2-5) cm; the median operation time was 302 (215-402) min; the median intraoperative blood loss was 100 (50-200) ml; the median postoperative hospital stay was 9 (5-15) d. Postoperative complications occurred in 5 patients (25%), including 3 pelvic infection, 1 intestinal obstruction, 1 anastomotic leakage receiving sigmoid colostomy. There was no perioperative death. Sphincter-preservation rate was 100%. Nineteen patients received anal manometry 1 month after operation with normal resting pressure (41.5±8.6) mmHg and squeeze pressure (121.0±11.6) mmHg. All the patients were followed up to March 2018, and the median follow-up time was 4.5 months. Only 1 patient had supraclavicular lymph node metastasis and no local recurrence was found.

CONCLUSIONSThe safety of transanal total mesorectal excision for male patients with low rectal cancer and difficult pelvis is acceptable. TaTME is helpful to preserve the anal sphincter.

Adult ; Anal Canal ; surgery ; Humans ; Laparoscopy ; Male ; Neoplasm Recurrence, Local ; Pelvis ; surgery ; Postoperative Complications ; Rectal Neoplasms ; surgery ; Retrospective Studies ; Treatment Outcome ; Universities

Objective To evaluate the feasibility of PerkinElmer Genetic Screening Processor(GSP) in the application of newborn screening for congenital hypothyroidism (CH) and congenital adrenal hyperplasia (CAH) by detecting thyroid-stimulating hormone (TSH) and 17-OH-progesterone(17-OHP).Methods The dried-blood spots specimens from Centers for Disease Control and Prevention(CDC) and the quality control in the reagent kit were detected and the accuracy,precision and linearity were calculated.A total of 1 012 samples of TSH(60 of positive and 952 negative samples) and 991 samples of 17-0HP(34 positive and 957 negative samples)were detected.The initial cut-off value was determined by ROC curve determined.The consistency between the results from GSP and clinical diagnosis was analyzed.Results The average of within-run coefficient of variation(CV) of TSH and 17-OHP were 6.69％ to 12.6％ and 7.52％ to 9.29％,and the average of between-run CV were 6.91％ to 10.96％ and 6.86％ to 12.36％,respectively.The average of bias of TSH and 170HP were-14.28％ to-0.74％ and-0.45％ to 12.54％.The linearity of GSP detection was fine.The initial cut-off values were 23.43 U/mL(TSH) and 21.42 ng/mL(17-OHP).The sensitivity of GSP detection was 100％ and the specificity of TSH and 17-OHP were 98.11％ and 99.58 ％ respectively.The results of GSP detection showed good consistency with clinical diagnosis.Conclusion As the first real automatic fluorescence immunoassay analyzer,GSP could be used in routine clinical diagnosis for CH and CAH.

Purpose Medicine information and features of adverse reactions induced by non-ionic iodinated contrast agent injection for CT examination are analyzed and discussed,offering empirical evidence and reference for medication choice and patient information for clinical CT examination and targeted adverse reactions disposal.Materials and Methods General material,medicine type and name,adverse reactions occurrence time,symptoms and other information of the 20,418 patients receiving CT examination with non-ionic iodinated contrast agent at X-ray Department in Gansu Provincial Hospital from July 2013 to September 2016 were retrospectively analyzed.Results For observation objects in this group,11,679 were male and 8,739 female,aging from 3 to 93 and the average age was (52.1 ± 13.2) years.Various adverse reactions occurrence rate of non-ionic iodinated contrast agent was 0.4％ and adverse reactions occurrence rate of secondary hypertonic contrast and isotonic contrast agent was 0.47％ and 0.27％,respectively.Among the 81 adverse reactions,91.3％ were acute,among which 88.9％ occurred within 15 min after injection.8.7％ were delayed,97.6％ mild and moderate,and 2.4％ severe.Secondary hypertonic contrast and isotonic contrast agent occupied 74.0％ and 26.0％,respectively for the cause of adverse reactions.Delayed adverse reactions were mainly caused by isotonic contrast agent,representing as mild and moderate.Representation frequency of adverse reactions symptoms in turn was skin,digestive tract,central nervous system,respiratory system and circulatory system.Conclusion Adverse reactions caused by iodinated contrast agent were mainly acute and mild and moderate.The patients or their family members shall be fully notified before examinations.Severe adverse reactions caused by iodinated contrast agent developed very quickly and multi-systems would be damaged.Efficient on-site treatment is very important.Delayed reactions caused by isotonic contrast agent shall be paid more attention.

Objective To explore the epidemic characteristics,clinical features and treatment outcome of brucellosis in the Dali area of Yunnan province.Methods The clinical data of 43 cases with brucellosis from Janurany 2012 to September 2015 were retrospectively analyzed.Results Among 43 cases,there were 35 males,8 females, 37 farmers,5 veterinary,and 1 teacher.42 patients had a clear history of contact with cattle and sheep,1 case of no clear history of exposure to cattle and sheep,mainly fever,accompanied by chills,headache,joint pain,low back pain, weight loss,hepatosplenomegaly etc.Laboratory routine examination showed no specificity,SAT was detected in 30 cases,positive rate was 100.0%,blood culture in 28 cases,23 cases were positive,the positive rate was 82.1%. 41 cases of adult patients with rifampicin and tetracycline or doxycycline + levofloxacin and cefotaxime drugs combined therapy,treatment for 6 weeks,2 cases of children took rifampicin and SMZ -TMP treatment for 6 weeks, improvement rate was 100%,there was no recurrence and death cases.Conclusion Dali area is popular in brucellosis, the clinical manifestations and the infection way diversification,need the attention of the clinicians.

Objective To observe the treatment effect of acupoints massage nursing for sub-health fatigue people .Methods According to the Yin and Yang and the five elements theory of zang-fu organs and meridians, 59 patients at sub-health status were given the acupoints massage to adjust the immunity of the organism.The Sub-Health State Evaluation Questionnaire (SHSQ-25) and Fatigue Scale (FS-14) were used to assess the treatment effect .Results After meridians nursing , the scores of fatigue symptoms , cardiovascular symptoms, digestive tract symptoms , immunity and mental symptoms of the SHSQ-25 in the 59 cases at sub-health status were (19.28 ±3.75),(2.45 ±2.01),(2.77 ±2.68),(3.12 ±2.11) and (7.23 ±2.31). Compared with those scores before the intervention , there were significant differences ( t=13.34,4.98,3.57, 5.80,6.44, respectively;P<0.01), with a decreased score rate of 68.57%.The scores of physical fatigue and mental fatigue of FS-14 were (3.21 ±1.27) and (2.13 ±1.35).Compared with those scores before the intervention, there were significant differences (t=12.47, 11.20, respectively;P<0.01), with a decreased score rate of 82.67%.Conclusions It is confirmed that the meridian nursing can effectively eliminate the fatigue and improve the body ’ s resistance to disease .To the sub-health status individuals , acupoints massage is effective to prevent disease and maintain health .