Objective:To investigate the effect of peer support education on family function of breast cancer patients with breast reconstruction.Methods:Totally 146 patients who received surgical treatment in the department of plastic surgery for breast cancer from June 2017 to June 2019 were randomly divided into the experimental group and the control group by the method of random number table, 73 cases each. The control group received routine education. Patients in the observation group received regular education and peer support education. The intervention time was from admission to 6 months after discharge, and the control group received routine nursing care. Quality of life questionnaire was used to evaluate the quality of life of the patients at six months after operation, family care index questionnaire was used to evaluate the family function of the patients, and comprehend social support scale was used to evaluate the level of social support, then various indicators of the two groups of patients were compared.Results:6 months after operation, the scores of quality of life function and symptom dimension of the intervention group were 6.43±1.54. 5.83±1.47, while control group were 6.02±1.59; 6.39±1.63. There were statistically significant differences between the two groups ( t values were 4.30, 5.01, P < 0.05); family care scores of the two groups were compared, the intervention group was 8.78±2.04. The control group was 8.43±2.05. There were statistically significant differences between the two groups ( t value was 2.02, P < 0.05); the comprehension support score of the two groups was compared, and that of the intervention group was 62.24±14.81. The control group was 55.74±13.58. There were statistically significant differences between the two groups ( t value was 4.26, P < 0.05). Conclusion:Peer support education can improve the quality of life and family care of breast cancer patients with breast reconstruction.

Objective: To examine the impact of metabolic syndrome (MS) on the clinicopathological characteristics and prognosis of patients with colorectal cancer (CRC). Methods: The clinical data of 650 patients with CRC admitted in Shanxi Provincial Cancer Hospital between January 2010 and December 2011 were retrospectively analyzed. Among 650 patients there were 190 cases complicated with MS (MS group) and 460 cases without MS (non-MS group), the clinicopathological features and prognosis were compared between two groups. Results: The serum insulin and insulin-like growth factor-1 (IGF-1) levels in MS group were significantly higher than those in non-MS group [(9.2±4.7) vs.(6.8±4.7)μIU/L, t=8.88, P<0.01 and (200.2±44.1) vs.(136.7±63.2)mg/L,t=12.63, P<0.01]. The proportions of stage T₃ and T₄ cancer, extra-regional lymph node metastasis (ELN), and TNM stage Ⅲ and Ⅳ patients in MS group were significantly higher than those in non-MS group [(83.2% (158/190) vs. 72.6% (334/460), χ²=8.19, P=0.04; 9.5% (18/190) vs. 4.8%(22/460),χ²=8.61, P=0.04; 56.3% (107/190) vs. 45.2%(208/460), χ²=8.22, P=0.04, respectively]. The 5-year disease-free survival (DFS) in MS group was significantly lower than that in non-MS group [57.9%(99/171)vs. 66.1%(279/422), P<0.01]. Multivariate analysis indicated that MS(HR=1.623, 95%CI:1.511-1.963, P=0.03), IGF(HR=1.382, 95%CI:1.031-1.765, P=0.02) and, ELN(HR=4.270, 95%CI:2.177-7.463, P<0.01)were independent factors affecting the prognosis of CRC patients. Conclusion Metabolic syndrome is one of the risk factors affecting the prognosis of CRC patients.

Objective To study the incidence of moderate and severe preoperative anxiety and its related risk factors in patients undergoing elective general anesthesia.Methods A total of 562 pa-tients undergoing selective anesthesia 225 males and 337 females,aged 18-85 years,ASA physical status Ⅰ-Ⅲ,were selected in the affiliated hospital of Xuzhou medical university.State-trait anxiety inventory (STAI)was used to assess the degree of preoperative anxiety and the patients were divided into mild anxiety group (SAI ≤ 37,n=294)and moderate and severe anxiety group (SAI > 37,n=268)according to SAI score.The factors related to preoperative anxiety such as age,gender,edu-cational background,marital status,history of previous surgery,presence of pain,preoperative diag-nosis of tumor and presence or absence of hypertension were collected.Results The incidence of moderate and severe preoperative anxiety in our study was 268 (47.7%).Logistic regression analysis showed that female (OR=1.846,95%C I 1.298-2.624),single (OR=2.208,95%C I 1.218-4.004) might be the risk factors of preoperative anxiety.Conclusion Females and single individuals may be independent risk factors for preoperative anxiety.

BACKGROUND: It is unclear whether autophagy mediates the long-term exercise adaptation of the skeletal muscle induced by high-intensity interval training (HIIT) . OBJECTIVE: To identify the influence of HIIT on skeletal muscle autophagy of middle-aged rats over time, and to understand the potential regulatory effects of autophagy on maintaining the muscle mass and improving aerobic capacity by HIIT. METHODS: Rats were randomly divided into quiet, moderate training group (50-minute running at the intensity of 60% VO2 max) and HIIT group (6 times of 3-minute running at 80% VO2 maxand 3-minute active recovery at 50% VO2 maxwith a 7-minute warm-up and a 7-minute cool-down at 60% VO2 max). All rats were tested for VO2 max, exhaustive running time and distance at baseline and after 4, 8 and 12 weeks of exercise, respectively. The soleus muscle were collected and weighted, and then the expression levels of autophagy-related protein Beclin 1, LC3 and P62 were detected by western blot assay. RESULTS AND CONCLUSION: The soleus muscle mass in the quiet group decreased at the 12thweek (P < 0.01), while the moderate training and HIIT groups improved this decline (P < 0.05). The HIIT group dramatically improved the VO2 maxfrom the 4thweek when compared with the pre-experiment and the quiet group, until the 12thweek. The expression levels of Beclin1 and LC3II in the quiet group declined at the 12thweek (P < 0.05, P < 0.001), but the expression level of LC3II and ratio of LC3II/LC3I raised from the 4thand 8thweeks till the 12thweek compared with the pre-experiment and the quiet group, and the expression level of LC3II and ratio of LC3II/LC3I point time significantly raised in the moderate training group at the 12thweek (P < 0.001, P < 0.01). In the quiet group, the content of P62 significantly increased at the 4th and 8thweeks (P < 0.05), and decreased at the 12thweek (P < 0.001), but the content of P62 remained at the low level in the moderate exercise and HIIT groups. These results imply that an equivalent or better effects on improving basic autophagy level, skeletal muscle mass and aerobic capacity of the middle aged rats,by HIIT versus moderate training,providing the theory and empirical data that highlight the role of HIIT in health promotion.

Objective To investigate the related risk factors of cerebral microbleeds (CMBs) and their relations with leukoaraiosis and lacunar infarction in patients with cerebrovascular disease.Methods One hundred and sixty-four patients with cerebrovascular disease,admitted to our hospital from January 2015 and January 2017 were chosen;susceptibility weighted imaging (SWI) was performed,and the distribution and number of CMBs were recorded by Microbleed Anatomical Rating Scale (MARS).The demographic data,personal history,previous medical history,biochemical indices and imageological examination results of the patients were collected and multivariate Logistic regression analysis was carried out on the basis of these data.Spearman dependence analysis was used to analyze the relations of CMBs with leukoaraiosis and lacunar infarction.Results Age (OR=1.071,P=0.024,95％ CI:1.009-1.137),hypertension (OR=3.875,P=0.012,95％CI:1.347-11.148),leukoaraiosis(OR=2.080,P=0.005,95％ CI:1.245-3.475),lacunar infarction (OR=2.326,P=0.003,95％ CI:1.336-4.050) were independently associated with CMBs.And number of CMBs had positive correlation with severity of leukoaraiosis and number of lacunar cerebral infarcts (r=0.564,P=0.000;r=0.762,P=0.000).Conclusion Age,hypertension,leukoaraiosis,and lacunar infarction are the independent risk factors of CMBs;the severity of CMBs is positively correlated with severity of leukoaraiosis and lacunar infarction.

STUDY DESIGN: Retrospective, case control evaluation of 86 patients who underwent microendoscopic discectomy (MED) and percutaneous transforaminal endoscopic discectomy (PTED) for the treatment of lumbar disc herniation (LDH). PURPOSE: To evaluate the safety and the outcomes of MED and PTED for the treatment of LDH. OVERVIEW OF LITERATURE: MED and PTED are minimally invasive surgical techniques for lower back pain. Studies to date have shown that MED and PTED are safe and effective treatment modalities for LDH. METHODS: A retrospective study was performed in patients with LDH treated with MED (n=50) and transforaminal endoscopic discectomy (PTED; n=36) in our hospital. All patients were followed-up with self-evaluation questionnaires, Oswestry disability index (ODI), medical outcomes study 36-item short form health survey and MacNab criteria. All the patients in both groups were followed up to 12 months after the operation. RESULTS: ODI questionnaire responses were not statistically different between the MED and PTED groups (53.00 vs. 48.72) before treatment. Average scores and minimal disability after 5 days to 12 months of follow-up were 4.96 in the MED group and 3.61 in the PTED group. According to MacNab criteria, 92.0% of the MED group and 94.4% of the PTED group had excellent or good results with no significant difference. CONCLUSIONS: There was no significant difference between MED and PTED outcomes. Further large-scale, randomized studies with long-term follow-up are needed.
Case-Control Studies ; Diagnostic Self Evaluation ; Diskectomy* ; Follow-Up Studies ; Health Surveys ; Humans ; Intervertebral Disc Degeneration ; Low Back Pain ; Retrospective Studies* ; Surgical Procedures, Minimally Invasive

Aim To confirm the inhibitory effect of chronic intermittent hypobaric hypoxia ( CIHH) on my-ocardial apoptosis induced by metabolism syndrome ( MS) , and to investigate its mechanism. Methods A rat model of MS induced by fructose was used. The blood pressure and the plasma content of glucose, tri-glyceride, cholesterol, and insulin after 12 h fasting were detected. HE stain were used to detect the cardi-ac structure. The TUNEL staining and activity of caspase-3 were used to detect the apoptosis of myocar-dium. The protein expression of Bcl-2 and Bax was detected by Western blot . Results Compared with the control rats, the blood pressure and the plasma content of glucose, triglyceride, cholesterol, and insu-lin were all increased in rats with MS. In rats with MS, the impairment of cardiac structure and the increase of apoptosis were also observed. The protein expression of Bcl-2 was significantly down-regulated, and that of Bax was significantly up-regulated in MS rats. The ratio of Bcl-2/Bax was also significantly decreased. Interest-ingly, CIHH could ameliorate all of the above issues. There was no significant difference between control group and CIHH group. Conclusion CIHH may im-prove the increased apoptosis in rats with MS via inhib-iting the mitochondrial pathway of apoptosis. This stud-y might provide new targets for therapy and the preven-tion of MS patients.

BACKGROUNDAspirin is widely used in the secondary prevention of coronary artery diseases, including myocardial infarction, stroke, and vascular related deaths. However, the antiplatelet effect of aspirin appears to be variable and aspirin resistance (AR) is currently still controversial for Chinese patients. The aim of this study was to describe the prevalence of AR, and identify possible risk factors associated with a lack of response to aspirin treatments in patients with unstable coronary artery disease.

METHODSPlatelet function tests with arachidonic acid (ARA) and urinary 11-dehydro-thromboxane B2 (11-DH-TXB2) concentrations were performed in 262 patients with unstable coronary artery disease who had not been taking aspirin before admission. ARA induced platelet aggregation and 11-DH-TXB2 were detected to evaluate the functional and biochemical responses to aspirin before and on days 1, 4, and 10 after aspirin administration. Six-month follow-up was completed in patients who developed AR to evaluate the effect of aspirin in a long-term treatment. GP1Bα (C1018T), Pl (A1/A2), P2Y1 (A1622G), TBXA2R (T924C) were also detected to evaluate the influence of genetic variant on aspirin responsiveness.

RESULTSA total of 8.8% of patients were indentified as AR at the first day after aspirin treatment. The level of urine 11-DH-TXB2 in the AR group was higher compared to non-AR group (P < 0.05). There was no relationship between ARA induced platelet aggregation and urinary 11-DH-TXB2 levels (r = 0.038, P = 0.412). The results of DNA sequencing showed that TBXA2R-924TT homozygotes had a significantly high rate of AR. Logistic regression demonstrated that diabetes was an independent risk factor of AR.

CONCLUSIONSIn the beginning period of administration, aspirin was not a sufficient factor that inhibits platelet aggregation. TBXA2R-924T allele was involved in AR. Diabetes was an independent risk factor of AR.

Aged ; Aged, 80 and over ; Arachidonic Acid ; pharmacology ; Aspirin ; therapeutic use ; Coronary Artery Disease ; drug therapy ; genetics ; Diabetes Mellitus, Type 2 ; Female ; Genotype ; Humans ; Male ; Membrane Glycoproteins ; genetics ; Middle Aged ; Platelet Aggregation ; drug effects ; Platelet Aggregation Inhibitors ; therapeutic use ; Platelet Function Tests ; Platelet Glycoprotein GPIb-IX Complex ; Polymerase Chain Reaction ; Polymorphism, Genetic ; genetics ; Receptors, Purinergic P2Y1 ; genetics ; Receptors, Thromboxane A2, Prostaglandin H2 ; genetics ; Thromboxane B2 ; analogs & derivatives ; urine

BACKGROUNDIt is a surgical dilemma when patients present with both severe heart disease and neoplasms. The best surgical treatment remains controversial. This study aimed to analyze the early and long-term results of simultaneous surgical treatment of severe heart disease and neoplasms.

METHODSWe reviewed the clinical records of 15 patients who underwent simultaneous neoplastic resection and cardiac surgery between September 2006 and January 2011. There were 5 male and 10 female patients. The mean age was (59.2 ± 12.5) years and the mean left ventricular ejection fraction was (57.4 ± 11.0)%. All patients were followed up completely for a period of 12 to 51 months (mean, (33.1 ± 11.2) months).

RESULTSFifteen patients underwent simultaneous cardiac surgery and neoplastic resection. Cardiac procedures consisted of off pump coronary artery bypass grafting (n = 7), aortic valve replacement (n = 3), mitral valve replacement (n = 3), mitral valve replacement with coronary artery bypass grafting (n = 1) and left atrial myxoma resection (n = 1). Neoplastic resection consisted of lung cancer resection (n = 5), colonic cancer resection (n = 3), gallbladder resection (n = 1), colonic cancer resection with gallbladder resection (n = 1), hysterectomy (n = 2), hysterectomy with bilateral salpingo-oophorectomy (n = 2) and left ovariectomy (n = 1). Pathological examination confirmed malignant disease in 10 patients and benign disease in 5 patients. There were no perioperative myocardial infarctions, stroke, pericardial tamponade, renal failure or hospital deaths. The most frequent complications were atrial fibrillation (33.3%), pneumonia (26.7%), low cardiac output syndrome (6.7%) and delayed healing of surgical wounds (6.7%). There was 1 late death 42 months after surgery for recurrent malignant disease. At 1 and 3 years, survival rates were 100% (Kaplan-Meier method).

CONCLUSIONSSimultaneous cardiac surgery and neoplastic resection was not associated with increased early or late morbidity or mortality. Cardiopulmonary bypass does not appear to adversely affect survival in patients with malignant disease. The long-term survival was determined by tumor stage.

Adult ; Aged ; Colonic Neoplasms ; surgery ; Female ; Heart Diseases ; surgery ; Humans ; Hysterectomy ; adverse effects ; Lung Neoplasms ; surgery ; Male ; Middle Aged ; Ovariectomy ; adverse effects ; Thoracic Surgery ; statistics & numerical data ; Treatment Outcome

OBJECTIVETo investigate the association of the polymorphisms of cytochrome P450 2C9 (CYP2C9) exon 4 608T/G, 561A/C, 537A/C and 527A/C, and -65G/C with warfarin sensitivity.

METHODSA total of 102 patients under warfarin anticoagulant therapy were selected. During follow-up, warfarin dosage and associated Prothrombin Time-International Normalized Ratio (P-INR) values were recorded. Simultaneous monitoring of incidence of bleeding and thrombosis adverse effect was recommended. Genetic polymorphisms of the above mentioned loci were identified by polymerase chain reaction and DNA sequencing.

RESULTSThe average age of the 102 patients was (62.1+/-10.5) years. The body mass index (BMI) was (24.7+/-3.8) kg/m2. Mean daily warfarin requirement was from 1.250 to 5.077 mg/day when therapeutic PT-INR (1.5-2.5) was maintained. DNA sequencing showed no polymorphisms of 608T/G, 561A/C, 537A/C, 527A/C in CYP2C9 exon 4. Warfarin daily dosage in CYP2C9 exon 4 -65C carriers was 3.106+/-0.619 mg/d, while it was (2.555+/-0.708) mg/d in individuals with wild-type -65G (P=0.020). Receiver operating characteristic (ROC) analysis showed that warfarin daily dosage of more than 2.5 mg/d can be used to predict the CYP2C9 exon 4 -65GC genotype (AUC: 0.770, P=0.005, 95%CI:0.626-0.915). Logistic regression indicated that BMI was an independent factor of bleeding during anti-coagulation therapy (OR=0.794, 95%CI: 0.651-0.970, P=0.024).

CONCLUSIONThe Chinese population are, generally, warfarin-sensitive. Exon 4 of the CYP2C9 gene is highly conserved in this population. The warfarin maintenance dosage in CYP2C9 exon 4 -65CG carriers was significantly higher than those with wild-type -65GG. The clinical significance needs further investigation with more large-scale, multi-center trials.

Adult ; Alleles ; Anticoagulants ; pharmacology ; therapeutic use ; Aryl Hydrocarbon Hydroxylases ; genetics ; Cytochrome P-450 CYP2C9 ; Exons ; genetics ; Female ; Genetic Predisposition to Disease ; Genotype ; Humans ; Male ; Middle Aged ; Point Mutation ; Polymorphism, Genetic ; Thrombosis ; drug therapy ; Warfarin ; pharmacology ; therapeutic use