Effects of integrated management on surgical outcomes and mental health of patients following endoscopic submucosal dissection

BACKGROUND Endoscopic submucosal dissection(ESD)is a less invasive local treatment for diseases throughout the gastrointestinal tract.AIM To develop an integrated management protocol and analyze its effects on surgical outcomes and mental health of patients after ESD.METHODS The study population consisted of patients undergoing ESD before implementation of integrated management and those undergoing ESD by the same pool of surgeons after implementation of integrated management.RESULTS The management group exhibited shortened fasting time and length of hospital stay compared to the control group(P<0.05).The management group exhibited a higher incidence rate of postoperative complications than the control group(3 cases vs 11 cases;P=0.043).The management group exhibited a lower uncertainty score for disease knowledge compared to the control group 12 h after surgery(P<0.05).The management group gave more scores on the domains of patient familiarity to the responsible nurses,professional skills of responsible nurses,and general evaluation compared to the control group.The management group had a higher total score of patient satisfaction towards the responsible nurses in term of health care than the control group(P<0.01).The management group exhibited lower Self-Rating Anxiety Scale and Self-Rating Depression Scale scores compared to the control group 12 h after surgery(P<0.01).CONCLUSION The study demonstrates that integrated management could improve surgical outcomes and mental health of patients undergoing ESD.

Pygopus 2 promotes kidney cancer OS-RC-2 cells proliferation and invasion in vitro and in vivo

Objective:Human Pygopus 2(Pygo2)was recently discovered to be a component of the Wnt signaling pathway required for b-catenin/Tcf-mediated transcription.But the role of Pygo2 in malignant cell proliferation and invasion has not yet been determined.Methods:Lentivirus-mediated small interfering RNA(siRNA)and vector-based overexpression were used to study the function of Pygo2 in OS-RC-2 cells.The resulted cells were subject to Western blotting assay,MTT assay,colony formation and cell invasion assays.Furthermore,renal cell carcinoma(RCC)models were established in BALB/c nude mice inoculated with OS-RC-2 cells.Immunohistochemistry(IHC)staining of matrix metalloproteinase-7(MMP-7),matrix metalloproteinase-9(MMP-9)and vascular endothelial growth factor(VEGF)was performed in tumor tissue.Results:Pygo2 gene was successful knocked down and overexpressed in RCC OS-RC-2 cells by using an shRNA and overexpressing vector,respectively.Overexpression of Pygo2 effectively promoted cell proliferation,colony formation and invasion in vitro.Knockdown of Pygo2 obviously inhibited xenograft tumor growth in nude mice.In addition,overexpression of Pygo2 increased the levels of MMP-7,MMP-9 and VEGF in the xenograft tumors.Conclusion:Pygo2 has a role in promoting cell proliferation,invasion and metastasis,and may regulate angiogenesis via the Wnt/b-catenin signaling pathway.

Simple cholangitis induces extremely and recurrently elevated serum carbohydrate antigen 19-9 level

To the Editor: The carbohydrate antigen 19-9 (CA19-9) is a tumor maker which is usually used in biliary and pancreatic malignancies [1]. However, the specificity of CA19-9 can be reduced by biliary inflammation and other benign diseases [2].

Application of River Network Hydrodynamic Model in Determining Water Distribution Scale of Haishu Plain

The water distribution network is an important part of the plain water environment improvement system. To make efficient use of the regional water diversion source, scientifically distribute the water diversion flow and improve the water environment carrying capacity of Haishu Plain, the river network hydrodynamic model is used in this paper to simulate the water intake location, reasonable water quantity and influence range of water transfer in Haishu Plain. The simulation results have high accuracy, which can provide a scientific basis for the scale, water transfer mechanism and project layout of water transfer construction in Haishu Plain and show a strong reference value for the study of water diversion and distribution scheme of coastal plain river network.

Efficacy observation on pediatric tuina plus Chinese medicine for exogenous fever in children

Objective: To observe the clinical effects of pediatric tuina plus Chinese medicine for exogenous fever in children. Methods: A total of 150 children withexogenous fever were randomly divided based on the random digital table into a control group (75 cases) and a treatment group (75 cases). The control group was treated with oral Xiao'er Chaigui Tuire Keli (<1 year old, 0.5 bag/time;1-3 years old, 1 bag/time;4-6 years old, 1.5 bags/time), 4 times/day. The treatment group was treated with pediatric tuina plus the intervention of the control group. The amount and usage of Chinese medicine were the same as those of the control group;tuina was conducted 1 time/day. The clinical effects and adverse reactions were observed after 3 d of treatment in both groups. The recurrence was observed within 7 d after the end of treatment. Results: The total effective rate was 92.0% in the treatment group and 81.3% in the control group. The difference between the two groups was statistically significant (P<0.05). There were no obvious adverse reactions in the two groups after treatment. The recurrence rate was 1.5% in the treatment group and 13.1% in the control group. The difference in the recurrence rate between the two groups was statistically significant (P<0.05). Conclusion: Pediatric tuina plus Chinese medicine is effective in treating children with exogenous fever.

Rapid identification of chronic kidney disease in electronic health record database using computable phenotype combining a common data model

To the Editor:Chronic kidney disease(CKD)is a global burden of the public health.The global prevalence of CKD exceeded 10%while the awareness was around 10%.[1]In the era of big data,improving the identification of CKD using informatic tools is important.Computable phenotype is proven as an efficient tool to facilitate the process of patient identification using electronic health record(EHR)data.

Analysis and Evaluation of Housing Price Factors Using Mathematical Modeling

In recent years,the real estate industry has achieved significant progress,driving the development of related sectors and playing a crucial role in economic growth.However,rapid real estate market expansion has led to challenges,particularly concerning housing prices,which have drawn widespread societal attention.This article explores the theories of housing prices,analyzes factors influencing them,and conducts an empirical investigation of the impact of representative factors on ordinary residential prices.Using regression analysis and the entropy weight method,a mathematical model was developed to examine how various factors affect housing prices.

Therapeutic observation of Tui-pushing Wujing plus Chinese patent medicine for infantile diarrhea due to spleen deficiency

Objective:To observe the therapeutic efficacy of pediatric tuina plus Chinese patent medicine for preschool kids with diarrhea due to spleen deficiency.Methods:Ninety-two eligible kids were divided into a tuina plus Chinese patent medicine and a Chinese patent medicine group by the random number table,with 46 cases in each group.The Chinese patent medicine group was intervened by oral administration of Qi Wei Bai Zhu San(Seven-ingredient Atractylodes Macrocepholo Powder);the tuina plus Chinese patent medicine group was additionally given pediatric tuina therapy once a day,20 min each time.Efficacy and safety were evaluated after 7-day treatment in both groups,and a 14-day follow-up was conducted.Results:After treatment,the symptom scores all changed significantly in the two groups(all P<0.05).After intervention,the symptom scores in the tuina plus Chinese patent medicine group were significantly different from those in the Chinese patent medicine group(all P<0.05).The total effective rate was 78.3%in the Chinese patent medicine group,versus 89.1%in the tuina plus Chinese patent medicine group,and the between-group difference was statistically significant(P<0.05).Three cases got a relapse in the Chinese patent medicine group,versus one case in the tuina plus Chinese patent medicine group,and the between-group difference was statistically insignificant(P>0.05).The two groups each had one case of vomiting,which were treated properly and turned better.No other adverse reactions occurred.Conclusion:Tuina plus Chinese patent medicine and Chinese patent medicine alone both are effective for diarrhea due to spleen deficiency in kids,but the combined therapy can produce more significant efficacy.

A Risk Prediction Model for In-hospital Mortality in Patients with Suspected Myocarditis

Background：Myocarditis is an inflammatory disease of the myocardium that may lead to cardiac death in some patients.However,little is known about the predictors of in-hospital mortality in patients with suspected myocarditis.Thus,the aim of this study was to identify the independent risk factors for in-hospital mortality in patients with suspected myocarditis by establishing a risk prediction model.Methods：A retrospective study was performed to analyze the clinical medical records of 403 consecutive patients with suspected myocarditis who were admitted to Ningbo First Hospital between January 2003 and December 2013.A total of 238 males （59%） and 165 females （41%） were enrolled in this study.We divided the above patients into two subgroups （survival and nonsurvival）,according to their clinical in-hospital outcomes.To maximize the effectiveness of the prediction model,we first identified the potential risk factors for in-hospital mortality among patients with suspected myocarditis,based on data pertaining to previously established risk factors and basic patient characteristics.We subsequently established a regression model for predicting in-hospital mortality using univariate and multivariate logistic regression analyses.Finally,we identified the independent risk factors for in-hospital mortality using our risk prediction model.Results：The following prediction model for in-hospital mortality in patients with suspected myocarditis,including creatinine clearance rate （Ccr）,age,ventricular tachycardia （VT）,New York Heart Association （NYHA） classification,gender and cardiac troponin T （cTnT）,was established in the study：P =ea/（1 ＋ ea） （where e is the exponential function,P is the probability of in-hospital death,and a =-7.34 ＋ 2.99× [Ccr 〈60 ml/min =1,Ccr ≥60 ml/min =0] ＋ 2.01 × [age ≥50 years =1,age 〈50 years =0] ＋ 1.93 × [VT =1,no VT =0] ＋ 1.39 × [NYHA ≥3 =1,NYHA 〈3 =0] ＋ 1.25 × [male =1,female =0] ＋ 1.13 × [cTnT ≥50 μg/L 1,cTnT 〈50 μg/L =0]）.The area under the receiver operating characteristic curve was 0.96 （standard error =0.015,95% confidence interval [CI]：0.93-0.99）.The model demonstrated that a Ccr 〈60 ml/min （odds ratio [OR] =19.94,95% CI：5.66-70.26）,an age ≥50 years （OR =7.43,95% CI：2.18-25.34）,VT （OR =6.89,95% CI：1.86-25.44）,a NYHA classification ≥3 （OR =4.03,95% CI：1.13-14.32）,male gender （OR =3.48,95% CI：0.99-12.20）,and a cTnT level ≥50 μg/L （OR =3.10,95% CI：0.91-10.62） were the independent risk factors for in-hospital mortality.Conclusions：A Ccr 〈60 ml/min,an age ≥50 years,VT,an NYHA classification ≥3,male gender,and a cTnT level ≥50 μg/L were the independent risk factors resulting from the prediction model for in-hospital mortality in patients with suspected myocarditis.In addition,sufficient life support during the early stage of the disease might improve the prognoses of patients with suspected myocarditis with multiple risk factors for in-hospital mortality.

HPDA/Zn as a CREB Inhibitor for Ultrasound imaging and Stabilization of Atherosclerosis Plaque+

Thrombosis,secondary to rupture of unstable plaque,is a fatal risk factor for myocardial infarction and ischemic stroke.At present,more novel methods are needed for the diagnosis and treatment of vulnerable plaque.Here,we report a hollow polydopamine/Zn(HPDA/Zn)ultrasound contrast agent.Through western-blot,Elisa,and other experiments,we found that in addition to having a good contrast-enhancement capability in ultrasound imaging in vitro and in vivo,HPDA/Zn also has the effect of reducing the expres-sion of CREB.CREB protein and its downstream-regulated proteins and factors are closely related to the stability of plaque.HPDA/Zn has the effect of reducing the expression of CREB protein,which leads to the decrease of expression of MMP-9,the regulatory pro-tein downstream of the CREB protein.In addition,it also reduces the secretion of inflammatory factors hs-CRP and IL-17A.Thus,HPDA/Zn can stabilize plaque by inhibiting CREB and reducing plaque vulnerable markers and inflammatory factors.In a word,HPDA/Zn is a kind of ultrasound contrast agent,which can stabilize plaques by inhibiting CREB protein.

A multi-center randomized controlled trial to evaluate efficacy and safety of early conversion to a low-dose calcineurin inhibitor combined with sirolimus in renal transplant patients

Although the triple immunosuppressive regimen based on calcineurin inhibitors(CNIs)has greatly improved the short-term prognosis of renal transplantation,the longterm prognosis of renal transplantation has not significantly improved.CNIs associated nephrotoxicity is a major risk factor affecting the graft survival.[1]It is feasible to improve the long-term prognosis by reducing the dose of CNIs or removing the CNIs.Studies have demonstrated that the combination of sirolimus(SRL)with low-dose CNIs can both reduce CNI-related nephrotoxicity and improve graft function without increasing the risk of acute rejection(AR),which helps to improve long-term graft survival.[2]However,the validation of mammalian target of rapamycin inhibitor as an immunosuppression regimen and the timing of its application in renal transplantation is still needed.The aim of this study was to investigate the effects of early conversion to low-dose CNIs and SRL on the long-term prognosis of renal transplantation.

A randomized controlled trial to evaluate efficacy and safety of early conversion to a low-dose calcineurin inhibitor combined with sirolimus in renal transplant patients

Background:The calcineurin inhibitor(CNI)-based immune maintenance regimen that is commonly used after renal transplantation has greatly improved early graft survival after transplantation;however,the long-term prognosis of grafts has not been significantly improved.The nephrotoxicity of CNI drugs is one of the main risk factors for the poor long-term prognosis of grafts.Sirolimus(SRL)has been employed as an immunosuppressant in clinical practice for over 20 years and has been found to have no nephrotoxic effects on grafts.Presently,the regimen and timing of SRL application after renal transplantation vary,and clinical data are scarce.Multicenter prospective randomized controlled studies are particularly rare.This study aims to investigate the effects of early conversion to a low-dose CNI combined with SRL on the long-term prognosis of renal transplantation.Methods:Patients who receive four weeks of a standard regimen with CNI+mycophenolic acid(MPA)+glucocorticoid after renal transplantation in multiple transplant centers across China will be included in this study.At week 5,after the operation,patients in the experimental group will receive an additional administration of SRL,a reduction in the CNI drug doses,withdrawal of MPA medication,and maintenance of glucocorticoids.In addition,patients in the control group will receive the maintained standard of care.The patients’vital signs,routine blood tests,routine urine tests,blood biochemistry,serum creatinine,BK virus(BKV)/cytomegalovirus(CMV),and trough concentrations of CNI drugs and SRL at the baseline and weeks 12,24,36,48,72,and 104 after conversion will be recorded.Patient survival,graft survival,and estimated glomerular filtration rate will be calculated,and concomitant medications and adverse events will also be recorded.Conclusion:The study data will be utilized to evaluate the efficacy and safety of early conversion to low-dose CNIs combined with SRL in renal transplant patients.