Evaluation of the efficacy and safety of endoscopic band ligation in the treatment of bleeding from mild to moderate gastric varices type 1

BACKGROUND According to practice guidelines,endoscopic band ligation(EBL)and endoscopic tissue adhesive injection(TAI)are recommended for treating bleeding from esophagogastric varices.However,EBL and TAI are known to cause serious complications,such as hemorrhage from dislodged ligature rings caused by EBL and hemorrhage from operation-related ulcers resulting from TAI.However,the optimal therapy for mild to moderate type 1 gastric variceal hemorrhage(GOV1)has not been determined.Therefore,the aim of this study was to discover an individualized treatment for mild to moderate GOV1.AIM To compare the efficacy,safety and costs of EBL and TAI for the treatment of mild and moderate GOV1.METHODS A clinical analysis of the data retrieved from patients with mild or moderate GOV1 gastric varices who were treated under endoscopy was also conducted.Patients were allocated to an EBL group or an endoscopic TAI group.The differences in the incidence of varicose relief,operative time,operation success rate,mortality rate within 6 wk,rebleeding rate,6-wk operation-related ulcer healing rate,complication rate and average operation cost were compared between the two groups of patients.RESULTS The total effective rate of the two treatments was similar,but the efficacy of EBL(66.7%)was markedly better than that of TAI(39.2%)(P<0.05).The operation success rate in both groups was 100%,and the 6-wk mortality rate in both groups was 0%.The average operative time(26 min)in the EBL group was significantly shorter than that in the TAI group(46 min)(P<0.01).The rate of delayed postoperative rebleeding in the EBL group was significantly lower than that in the TAI group(11.8%vs 45.1%)(P<0.01).At 6 wk after the operation,the healing rate of operation-related ulcers in the EBL group was 80.4%,which was significantly greater than that in the TAI group(35.3%)(P<0.01).The incidence of postoperative complications in the two groups was similar.The average cost and other related economic factors were greater for the EBL than for the TAI(P<0.01).CONCLUSION For mild to moderate GOV1,patients with EBL had a greater one-time varix eradication rate,a greater 6-wk operation-related ulcer healing rate,a lower delayed rebleeding rate and a lower cost than patients with TAI.

Skin Disinfection with 2% Chlorine Gluconate-Adine in Autologous Peripheral Hematopoietic Stem Cell Transplantation Patients

Background: Autologous peripheral blood hematopoietic stem cell transplantation is widely used in the treatment of malignant lymphoma. Patients are prone to infection during the transplantation immune deficiency period. There has been a lot of clinical research into how to better manage this period of vulnerability. Objective: This study aims to investigate the efficacy of 2% chlorhexidine gluconate (CHG) for skin disinfection in patients undergoing autologous hematopoietic stem cell transplantation (HSCT) and observe any adverse reactions. Methods: A total of 106 patients receiving autologous hematopoietic stem cell transplantation from November 2019 to December 2020 in our district were selected as the control group. From January 2021 to January 2022, 106 patients with autologous hematopoietic stem cells were included in the experimental group. The control group used the immersion bath method. The experimental group was treated with an improved scrub bath method (including 3M 2% chlorhexidine gluconate medical sanitary wipes to wipe the whole skin once). Results: The bacteria-carrying rate of the improved method (37.74%) was significantly better than that of the traditional soaking method (72.64%), and the difference was statistically significant (P Conclusion: The improved bath/wipe method has a significant positive effect on skin disinfection for patients undergoing HSCT.

A Cross-Sectional Study on Appetite, Nutritional Status and Nutritional Support of Hospitalized Patients

Objective: To understand the appetite and nutritional status of hospitalized patients in a tertiary A general hospital in Guangzhou, Guangdong Province. Methods: A cross-sectional survey of appetite and nutritional status assessment on inpatients in 44 wards of the hospital was conducted. Taking all “conscious patients hospitalized for more than 48 hours” in the hospital on November 25, 2020 as the survey subjects, the patients’ appetite, dietary intake, nutrition and nutritional support in the past week were investigated. Results: A total of 890 cases were investigated, among which 25 cases (2.81%) with missing data were excluded, and thus 865 investigated cases were considered effective. The incidence of nutritional risk was 28.67%, malnutrition 13.29%, external tube feeding nutrition 3.24%, parenteral nutrition 7.05%, and oral nutritional supplement 10.40%. The average score of appetite assessment was (6.99 ± 2.43) points. Among them, cases with appetite assessment scores < 5 points accounted for 15.84%, and 52 patient cases utilized appetite-improving drugs. Among the 137 patients with appetite scores < 5, only 7 patients utilized appetite-improving drugs. The patients’ dietary self-evaluation scores were averagely (4.08 ± 1.16) points, and the daily intake compliance rate of patients was 85.78%. Appetite assessment score was correlated with dietary intake score (r = 0.548) and daily intake compliance rate (r = 0.263) (p < 0.01). The differences in body weight, BMI, grip strength, albumin, and hemoglobin concentration of patients with different appetite states were statistically different (p < 0.01). Appetite was an influencing factor of weight change (β = −0.079, p = 0.023). The difference between the appetite assessment scores and the daily intake compliance rates of patients with different nutritional support methods was statistically significant (p < 0.05);the individualized diet group had the highest appetite assessment score (8.57 ± 1.70), while the parenteral nutrition group had the lowest appetite assessment score (4.90 ± 2.99);the individualized diet group had the highest daily intake rate of 100%, followed by the parenteral nutrition group with 96.72%, and the regular diet group had the lowest rate of 84.02%. Conclusion: The appetite of hospitalized patients is closely related to nutritional status, and therefore, attention should be paid to the appetite status and nutritional status of hospitalized patients. Inpatients with different nutritional support methods should be given individualized appetite and nutritional interventions.

Offspring of rats with cerebral hypoxia-ischemia manifest cognitive dysfunction in learning and memory abilities

Neonatal hypoxic-ischemic encephalopathy is a serious neurological disease,often resulting in long-term neurodevelopmental disorders among surviving children.However,whether these neurodevelopmental issues can be passed to offspring remains unclear.The right common carotid artery of 7-day-old parental-generation rats was subjected to permanent ligation using a vessel electrocoagulator.Neonatal hypoxic-ischemic rat models were established by subjecting the rats to 8%O2–92%N2 for 2 hours.The results showed that 24 hours after hypoxia and ischemia,pathological damage,cerebral atrophy,liquefaction,and impairment were found,and Zea-Longa scores were significantly increased.The parental-generation rats were propagated at 3 months old,and offspring were obtained.No changes in the overall brain structures of these offspring rats were identified by magnetic resonance imaging.However,the escape latency was longer and the number of platform crossings was reduced among these offspring compared with normal rats.These results indicated that the offspring of hypoxic-ischemic encephalopathy model rats displayed cognitive impairments in learning and memory.This study was approved by the Animal Care&Welfare Committee of Kunming Medical University,China in 2018(approval No.kmmu2019072).

Antireflux surgery vs medical treatment for gastroesophageal reflux disease: A meta-analysis

AIM: To compare the effect of antireflux surgery with medicine in treating gastroesophageal reflux disease(GERD) patients using meta- analysis.METHODS: MEDLINE, Embase and the Cochrane Library were searched. We only included randomized controlled trials(RCTs) comparing the effect of surgical intervention with medical therapy for GERD. Statistical analyses were performed using Rev Man 5.2 and STATA 12.0 software. Rev Man 5.2 was used to assess the risk of bias and calculate the pooled effect size, while Stata 12.0 was used to evaluate publication bias and for sensitivity analysis. We evaluated the primary outcomes with GERD-/health-related quality of life in short(one to three years) and long(three to twelve years) periods of follow-up. Secondary outcomes evaluated were De Meester scores and the percentage of time that p H < 4 to evaluate the degree of acid exposure.RESULTS: This meta-analysis included 7 studies with 1972 patients. It showed a positive effect of antireflux surgery compared with medical treatment in terms of health-related quality of life [standardized mean difference(SMD) = 0.18; 95%CI: 0.01 to 0.34] and GERD-related quality of life(SMD = 0.35; 95%CI: 0.11 to 0.59). We also conducted the subgroup analyses based on follow-up periods and found that surgery remained more effective than medicine over the short to medium follow-up time, but the advantage of antireflux surgery probably not maintained for long time. GERD-related quality of life in the surgical group was significantly higher than medical group for the < 3 years follow-up(SMD = 0.45; 95%CI: 0.23 to 0.66); the difference was not statistically significant when the follow-up time was ≥ 3 years(SMD = 0.30; 95%CI:-0.10 to 0.69). Meta-analysis showed a statistically significant difference between thesurgical group and medical group in the percentage of time that p H < 4(SMD = 0.38; 95%CI: 0.14 to 0.61). Meta-analysis indicated a positive effect of antireflux surgery compared with medical treatment concerning De Meester scores(SMD = 0.32; 95%CI: 0.00 to 0.65).CONCLUSION: Although both were effective, in some respects surgical intervention was more effective than medical therapy to treat GERD when follow-up time was up to three years.

不同肾功能的糖尿病合并慢性肾脏病患者血糖管理指标估算模型的构建与验证

目的构建并验证适合不同肾功能的糖尿病合并慢性肾脏病(CKD)患者的血糖管理指标(GMI)估算模型。方法本研究为回顾性研究。选择2018年8月至2022年10月于南方医科大学南方医院内分泌科住院期间佩戴持续葡萄糖监测设备的163例糖尿病合并CKD患者作为研究对象。收集糖化血红蛋白(HbA1c)、血白蛋白(ALB)、血红蛋白(Hb)、GMI等资料。根据估算的肾小球滤过率(eGFR)水平,将患者分为G1~3a期[eGFR≥45 ml·min^(-1)·(1.73 m^(2))^(-1),101例]和G3b~5期[eGFR<45 ml·min^(-1)·(1.73 m^(2))^(-1),62例]两组。采用Pearson相关性分析法分析HbA1c和GMI的相关性。在G1~3a期和G3b~5期两组患者中,通过简单随机抽样,将研究对象按6∶4的比例划分为训练集和验证集,利用患者的实验室生化指标数据,分别构建与验证G1~3a期和G3b~5期两组患者的GMI估算模型。在训练集中,将各生化指标进行单因素线性回归分析,将具有临床意义和统计学意义(P<0.05)的变量纳入多因素逐步回归分析,作为GMI估算模型的自变量。在验证集中,使用构建的模型估算GMI,用配对t检验及Bland-Altman分析评估估算GMI和实测GMI的一致性。结果G1~3a期糖尿病合并CKD患者HbA1c和GMI之间呈正相关(r=0.547,P<0.001),而G3b~5期患者HbA1c和GMI之间不存在相关性(r=0.197,P=0.125)。在G1~3a期患者中构建的GMI估算模型为:GMI(%)=0.245×HbA1c(%)-0.043×ALB(g/L)+6.380;验证集GMI估算值为7.04%±0.76%,实测值为6.81%±0.81%,两者差异无统计学意义(P=0.059)。在G3b~5期患者中构建的GMI估算模型为:GMI(%)=0.108×HbA1c(%)-0.03×ALB(g/L)+贫血(不合并贫血,+0;合并贫血,-0.840)+7.549;验证集GMI估算值为6.55%±0.32%,实测值为6.82%±0.89%,两者差异无统计学意义(P=0.165);Bland-Altman分析结果提示,在G1~3a和G3b~5期患者中,分别有8.33%(3/36)和4.35%(1/23)的点在95%一致性界限之外。结论HbA1c评估G3b~5期糖尿病合并慢性肾脏病患者血糖控制情况的准确性较弱。使用适合不同肾功能的糖尿病合并慢性肾脏病患者GMI的估算模型,可较为合理地估算GMI值。

Mineralization and osteoblast behavior of multilayered films on TiO_2 nanotube surfaces assembled by the layer-by-layer technique

In this paper,the multilayer films of poly-L-lysine（PLL） and DNA were created on TiO2 nanotube surfaces using the layer-by-layer（LBL） self-assembly technique.Chemical compositions of the assembled multilayered films were investigated by X-ray photoelectron spectroscopy.Biological properties of the multilayered films were evaluated by the biomimetic mineralization and osteoblast cell culture experiments.The results indicated that PLL and DNA were successfully assembled onto TiO2 nanotube surfaces by electrostatic attraction.Moreover,the samples of assembled PLL or/and DNA had better bioactivity in inducing HA formation and promoting osteoblast cells adhesion,proliferation and early differentiation.