Guizhou Medical University Research Articles

Modification and accuracy of the STOP-Bang questionnaire for screening obstructive sleep apnea in adults

Objective:To assess the accuracy of the STOP-Bang questionnaire（SBQ） about screening for obstructive sleep apnea（OSA） in adults, and to establish appropriate cutoffs for body mass index（BMI）, neck circumference（NC）, age, and SBQ score for this population in combination with the body size characteristics of the study subjects, and to evaluate the accuracy of the SBQ for combined screening with waist to height ratio（WHtR）. Methods:The data were collected from October, 2019 to November, 2020 at the Affiliated Hospital of Guizhou Medical University, and 218 patients with suspicious OSA were included in this study, all of them completed the SBQ and underwent overnight PSG. SBQ screening and PSG were tested in a blinded concurrent manner. Using the PSG results as the gold standard, the subjects were divided into a diseased group with moderate to severe OSA and a non-diseased group based on apnea hypopnea index. According to SBQ screening results, the subjects were divided into a positive group with moderate severe OSA and negative group. And calculated in the form of four-fold table, the optimal cutoffs were determined by adjusting age, BMI, NC, and SBQ score cutoffs, and calculating the sensitivity, specificity, positive predictive value（PPV）, negative predictive value（NPV）, Youden index, and area under the receiver operating characteristic curve（ROC）. And the modified version of SBQ was combined with WHtR for joint diagnosis to evaluate the accuracy of combined screening. Results:With all 218 patients completing the experiment, 159（72.94%） patients were in the moderate-severe group. The original SBQ had a sensitivity of 93.71%, specificity of 47.46%, PPV of 82.80%, NPV of 73.70%, Youden index of 0.41, and area under the ROC curve（AUC） of 0.71 for predicting moderate to severe OSA. When adjusting the BMI cutoff to 30 kg/m², NC cutoff to 40 cm, and age cutoff to 50 years, the modified SBQ had a sensitivity of 95.60%, specificity of 47.46%, PPV of 83.10%, NPV of 80.00%, Youden index of 0.43, and AUC of 0.72 for predicting moderate to severe OSA. When the modified SBQ score was 4 or more as the cutoff value, the highest Youden index and AUC were 0.54, 0.77 respectively. When the modified SBQ≥3 points were combined with WHtR>0.55, the highest Youden index and AUC were 0.58, 0.79 respectively. Conclusion:SBQ is effective in screening for moderate to severe OSA and better screening accuracy can be achieved by using a modified version of the SBQ（BMI>30 kg/m², NC>40 cm, age>50 years）. The maximum diagnostic accuracy can be achieved when the modified SBQ total score was 4 or more as the cutoff. Those with the modified SBQ total score=3 and WHtR>0.55 can be classified as high risk for moderate to severe OSA, and the modified version of SBQ can be a screening tool to identify moderate to severe OSA.

Endoscopic management of biliary ascariasis: A case report

BACKGROUNDBiliary ascariasis is rare but remains the most common parasitic infection in remote areas and in people with poor medical conditions. Here, we reported a case of biliary ascariasis in order to raise awareness of possible parasitic infections. CASE SUMMARYA 68-year-old female was admitted to the emergency room of the Affiliated Hospital of Guizhou Medical University on 28 September 2017, with chief complaint of pain in the right upper abdomen. Ultrasonography of the abdomen showed that the upper segment of the common bile duct was slightly dilated with parallel tubular structures, indicative of biliary ascariasis. Endoscopic retrograde cholangiopancreatography was performed under general anesthesia on 29 September 2017, and an adult Ascaris lumbricoides worm was observed. After the worm was removed from the bile duct, the patient’s pain immediately subsided. The patient was successfully cured, without any complications. CONCLUSIONThis report emphasizes the need for physicians to consider biliary ascariasis as a possible cause when treating cases of biliary colic.

Clinical effect of adding hMG to the follicular phase long protocol for standard group with normal ovarian reserve function

Objective: To investigate the impact of adding human menopausal gonadotropin (hMG) for in vitro fertilization-embryo transfer pregnancy outcomes in a standard population of non-advanced age with normal ovarian reserve function using a long follicular phase protocol. Methods: Clinical data of 489 patients with normal ovarian reserve function, who were admitted from January 2018 to January 2020 in the Affiliated Hospital of Guizhou Medical University and underwent in vitro fertilization for the first time with the long follicular phase protocol in fresh cycles, were retrospectively analyzed. The patients were divided into three groups according to whether or not to add urine-derived hMG and the timing of addition: non-addition group (group A), medium-term hMG group (group B1), whole course hMG group (group B2); the laboratory parameters of each group were observed, and the effect of ovulation induction drugs and pregnancy outcomes were compared. Results: The ages of B1 and B2 groups were significantly higher than that of group A (P=0.019 and P=0.011). The basal FSH level of group B2 was significantly higher than those of group A and group B1 (P<0.01 and P=0.006), and the basal FSH/LH ratio of group B2 was significantly higher than that of group B1 (P=0.009). Antral follicle counts of group A and group B1 were significantly higher than that of group B2 (P=0.007 and P=0.017). The superior embryo rate of group B2 [(47±27)%] was significantly higher than that of group A (P=0.017). The embryo implantation rate of group B1 was significantly lower than those of group A and group B2 (P=0.043 and P<0.01). The clinical pregnancy rate of group B2 [76.7% (155/202)] was significantly higher than those of group A (P=0.039) and group B1 (P<0.01). The live-birth rate of group B2 [67.3% (136/202)] was significantly higher than those of group A (P=0.017) and group B1 (P=0.001). Conclusions: For non-advanced aged patients with normal ovarian reserve function, the long protocol of follicular phase is suitable for those with relatively low ovarian reserve function. Adding hMG in the whole course of ovulation induction after gonadotropin-releasing hormone agonist reduction could improve the pregnancy outcomes by improving the quality of embryos.

Effects of prognostic nutrition index on side effects and prognosis of radiotherapy and chemotherapy after radical gastrectomy.

e16002 Background: To investigate the impact of preoperative prognostic nutritional index (PNI) on the severity of radiotherapy and chemotherapy toxicity and survival prognosis in patients with gastric cancer through retrospective analysis and research in order to guide clinical nutritional support treatment for patients with gastric cancer. Methods: Through a retrospective cohort study，we analyzed the data of 191 patients with gastric cancer in the Department of Gastrointestinal Surgery of the Affiliated Hospital of Guizhou Medical University and Guizhou Cancer Hospital from January 2008 to December 2018. According to the cut-off value, the patients were divided into high PNI group (PNI≥47.7) and low PNI group (PNI &lt; 47.7). We Compared the incidences of severe radiotherapy and chemotherapy toxicities and overall survival in high PNI group and low PNI group. and make Analysis of prognostic factors. Results: The low PNI group was more prone to severe radiochemotherapy hematological side effects than the high PNI group, and the postoperative survival time was shorter. Multivariate analysis showed that: TNM stage (P = 0.000) and PNI (P = 0.001) were Independent risk factors in predicting overall survival rate. Conclusions: The preoperative prognostic nutrition index is a useful factor for predicting the incidence of radiotherapy and chemotherapy toxicities in patients after gastric cancer surgery.It is one of the important factors affecting the prognosis of gastric cancer and helps to guide the nutritional support treatment of gastric cancer patients.

A preliminary study identifies early postoperative lung volume changes in patients with non-small cell lung cancer following video-assisted thoracic surgery using CT volumetry.

The present study aimed to investigate the changes in early postoperative lung volume in patients with non-small cell lung cancer (NSCLC) following video-assisted thoracic surgery (VATS) and to analyze the effects of the clinical characteristics on the lung volume of the patients. Therefore, 38 patients with NSCLC, who planned to undergo VATS at the Department of Thoracic Surgery, The Affiliated Hospital of Guizhou Medical University in June 2019, were enrolled into the present study. The clinical and computed tomography (CT) scan data from the patients was prospectively collected within 1 week preoperatively, and at 1, 3 and 6 months following surgery, then subsequently analyzed. A total of 34 patients successfully completed follow-up and were included in the datasets. The results showed that the volume of the right lung was larger compared with that in the left one, at each observational time point. The whole, right and left lung held the same trendline of volume changes, which was sharply decreased during the first postoperative month, increased quickly over the next 3 months, and slowly increased from months 3 to 6. There were 7 patients, whose whole lung volume was increased at 6 months following surgery compared with that preoperatively. In addition, significant differences were observed between males and females in the whole, right and left lung volume. However, the differences on the postoperative net expansion volume of the whole lung were not significant among sex, age, body mass index (BMI), smoking status and surgical side subgroups. The early changes of the postoperative lung volume were not linear, since the lung volume was significantly reduced during the first postoperative month, quickly increased in the next 3 months, and slowly increased from months 3 to 6. Sex, age, BMI, smoking status and surgical sides was not found to affect the postoperative volume and net expansion of the whole lung following VATS lobectomy.

Effects of FRNK on activation and migration of hepatic stellate cells

Objective: To investigate the effect of focal adhesion kinase related non kinase (FRNK) on the activation and migration of hepatic stellate cells (HSCs). Methods: Human liver tissue was divided into healthy control group and fibrosis group from March 2019 to September 2019 in Affiliated Hospital of Guizhou Medical University. C57BL/6 mice were divided into wild type (WT) and FRNK gene knockout type (FRNK-/-) groups. The liver fibrosis model was established with carbon tetrachloride (CCl4). After that, FRNK gene overexpression (Ad-FRNK) was constructed with adenovirus vector. HE and Masson staining were used to evaluate the pathological changes and fiber deposition of liver tissue. Western blot was used to detect the expression of PY397-FAK and α-SMA protein. Mouse primary HSCs were extracted, and the effect of FRNK on HSCs migration was detected by wound healing, activation of Rac and Rho was detected by Western blot. Results: The expression of PY397-FAK protein in human liver tissue with hepatic fibrosis was significantly higher than that in healthy control group (0.88±0.09 vs. 0.73±0.09). FRNK was significantly lower than that in control group(0.68±0.09 vs. 0.79±0.11). After animal model was set up, the degree of liver fibrosis in FRNK-/-mice (153±13)% was more serious than that in WT (100%) group. The expression of PY397-FAK and α-SMA protein was significantly elevated (2.50±0.23 vs. 0.75±0.09, 1.46±0.20 vs. 0.92±0.10). After FRNK gene was re-expressed (100%), the degree of liver fibrosis was mainly reversed [(74±6)%], and the expression of PY397-FAK and α-SMA was accordingly decreased(0.68±0.11 vs. 1.12±0.19,0.68±0.10 vs. 0.85±0.06). In vitro, FRNK inhibited the migration of HSCs [WT∶FRNK-/-∶Ad-FRNK,(339±49)%∶(580±53)%∶(259±33)%] and the activation of Rac and Rho proteins (Rac: 0.54±0.07 vs. 0.91±0.10 vs. 0.77±0.12,Rho:0.45±0.05 vs. 0.64±0.06 vs. 0.53±0.07), all P<0.01. Conclusions: FRNK can inhibit the activation and migration of HSCs which contributed to liver fibrosis. The potential mechanism is related to down regulation of PY397-FAK and inhibition of Rac and Rho activation.

The Effect of the Prognostic Nutritional Index on the Toxic Side Effects of Radiochemotherapy and Prognosis After Radical Surgery for Gastric Cancer.

ObjectiveA retrospective analysis was conducted to investigate the effect of the preoperative prognostic nutritional index (PNI) on the severity of toxic side effects of radiochemotherapy and the survival prognosis of patients with gastric cancer to guide the clinical nutritional support for patients with gastric cancer.MethodsData of 191 patients with gastric cancer in the Department of Gastrointestinal Surgery of Guizhou Cancer Hospital and the Affiliated Hospital of Guizhou Medical University between January 2008 and December 2018 were analyzed retrospectively. Patients were allocated to the high PNI group (with PNI ≥47.7) and the low PNI group (with PNI <47.7) according to the PNI cutoff value, and the incidence of severe toxic side effects of radiochemotherapy and the overall survival time were compared between the high PNI group and low PNI group. In addition, prognostic factor analysis was performed.ResultsThe severe hematologic side effects of radiochemotherapy and shorter postoperative survival time were more likely to occur in the low PNI group than in the high PNI group. The multifactor analysis showed that TNM stage (p = 0.000) and PNI (p = 0.001) were the independent risk factors for the overall postoperative survival time in patients with gastric cancer.ConclusionPreoperative PNI might predict the severity of hematologic toxic side effects of adjuvant chemotherapy/radiochemotherapy in patients with gastric cancer after surgery. Patients in the low PNI group were more likely to have severe hematologic toxic side effects, and therefore a low PNI might be one of the important factors affecting the prognosis of gastric cancer.

A case-control study on the relationship between the ratio of neutrophils to lymphocytes in malignant tumors and ventilator-associated pneumonia

To explore the relationship between ventilator-associated pneumonia (VAP) and neutrophil/lymphocyte ratio (NLR) before mechanical ventilation in patients with malignant tumors. A retrospective nested case-control study was conducted. Patients with malignant tumor treated by mechanical ventilation admitted to the Third Affiliated Hospital of Guizhou Medical University from February 2015 to February 2020 were enrolled. The patients with VAP were selected as the case group, and the matched non-VAP cases were selected according to 1:2 as the control group. The clinical data were collected, and the differences of each index between the two groups were compared. The influencing factors of VAP in patients with malignant tumor were analyzed by multivariate Logistic regression. During the study period, 1 271 patients with malignant tumors were treated with mechanical ventilation, of which 241 cases had VAP, and the incidence of VAP was 18.96%. There were 232 VAP patients in the case group matched 464 non-VAP patients in the control group. The clinical data of age, gender, hospitalization diagnosis, primary tumor, regional lymph node and distant metastasis (TNM) stage, acute physiology and chronic health evaluation II (APACHE II), complications, duration of mechanical ventilation, hemoglobin (Hb) and serum albumin (Alb) levels were balanced and comparable between the two groups, and the cluster nursing measures were consistent. Compared with the control group, although there was no significant difference in neutrophil count (NEU) and lymphocyte count (LYM) in the case group [NEU (×109/L): 3.81±1.07 vs. 3.64±1.05, LYM (×109/L): 2.06±0.59 vs. 2.15±0.62, both P > 0.05], NLR was significantly increased (2.07±1.05 vs. 1.89±0.96, P < 0.05), and the hospital stay was significantly longer (days: 24.84±3.81 vs. 13.19±3.98, P < 0.01). NLR, gender, age, APACHE II score, TNM stage, Hb, serum Alb and duration of mechanical ventilation were included in multivariate Logistic regression analysis. The results showed that patients with elevated NLR had higher risk of VAP [odds ratio (OR) = 1.187, 95% confidence interval (95%CI) was 1.015-1.387, P = 0.032]. In patients with VAP, NLR was negatively correlated with the time of mechanical ventilation before VAP (r = -0.327, P = 0.000), and positively correlated with the time of treatment with antibiotics after VAP (r = 0.559, P = 0.000). Elevated NLR in patients with malignant tumors who were on mechanical ventilation can significantly increase the risk of VAP and increase the difficulty of treatment.

Aetiological Diagnosis of the U-EPS-S Test in Patients with Chronic Prostatitis-Like Symptoms

Background: Prostate examination is considered to be most important in the diagnosis and differential diagnosis of patients with chronic prostatitis-like symptoms, and little attention has been given to other genital organ examinations for these patients. We speculate that this may be an important factor affecting the treatment effect of chronic prostatitis. Methods: We randomly selected 200 patients with chronic prostatitis-like symptoms from the clinic services of hospitals in China for this study and used a urine-prostate-semen test (U-EPS-S test) to collect urine, prostatic secretion and semen specimens. The specimens were inoculated into a suitable medium culture for bacteriological/fungal localization detection, and the number and distribution of colonies in each isolation culture were observed. The gene assay by PCR was used to further identify the Chlamydia and the species of Neisseria and Candida. Findings: All of these patients had an infection of the internal genital organs, and the infection rate was 100%. Of these, prostatic secretion-positive isolation cultures were obtained in 66 cases (33%), semen-positive isolation cultures were obtained in 34 cases (17%), and prostatic secretion- and semen-positive isolation cultures were obtained in 100 cases (50%). In these patients, gram-positive microbes were the most common pathogens, accounting for 91.1%. Positive isolation cultures of more than two kinds of microbes occurred in 107 cases, and multiple microbial infections (MMIs) accounted for 53.5%. Positive isolation cultures of semen and both prostatic secretions and semen occurred in 134 cases, and multi-organ infections (MOIs) accounted for 67%. Interpretations: In patients with chronic prostatitis symptoms, there was a high incidence of MMI and MOI caused by resistant strains of different microbial species, and gram-positive microbes were the most common causative agents. Neglecting semen sample collection and posttherapy pathogen redetection are important factors leading to missed diagnosis and misdiagnosis of patients and thus treatment failure. Funding: This study was supported by the Science and Technology Department of Guizhou Province of China (SY[2001]3045) and Health Department of Guizhou Province of China (gzwkj2009-1-028) and State Key Laboratory for Infectious Diseases Prevention and Control, National Institute for Communicable Disease Control and Prevention, National Institute for Viral Disease Control and Prevention, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention (2011SKLID302). Declaration of Interest: We declare no competing interests. Ethical Approval: This protocol was evaluated and approved by the ethics committee of Guizhou Medical University.

Effects of meteorological factors on daily outpatient visits for skin diseases: a time series study in a Chinese population

Effects of meteorological factors on daily outpatient visits for skin diseases: a time series study in a Chinese population

Analysis of prognostic risk factors of bloodstream infection in intensive care unit patients

To explore the prognostic risk factors of bloodstream infection (BSI) in intensive care unit (ICU) patients, furthermore, to provide a reliable evidence for early warning and treatment for the critical patients with BSI. A retrospective study was performed. The clinical data of patients with blood culture-positive admitted to ICU of the Affiliated Hospital of Guizhou Medical University from January 1 to September 30, 2019 were analyzed. The data including gender, age, proportion of basic diseases, acute physiology and chronic health evaluation II (APACHE II), the duration of mechanical ventilation after being diagnosed with BSI, length of stay in ICU, aggressive operation and blood product infusion after BSI, proportion of using continuous renal replacement therapy (CRRT) and continuous vasoactive agents for more than 72 hours after being diagnosed with BSI, and site of central venous catheterization were recorded. Meantime, the worst laboratory values within 72 hours after being diagnosed with BSI, information about pathogenic microorganism categories and distributions were collected and analyzed. The patients were divided into survival and death groups based on the the 28-day prognosis, and the differences of clinical data between the two groups were compared. Logistic regression analysis was used to select the independent prognostic risk factors of BSI. One hundred and fifty-four patients with positive results of BSI were enrolled, and the 156 strains of bacteria were detected, including 75 Gram positive (G+) bacteria strains, 70 Gram negative (G-) bacteria strains and 11 fungi strains among those BSI patients. The top five pathogenic microorganisms were Coagulase negative staphylococcus (35.9%), Klebsiella pneumonia (12.8%), Acinetobacter baumannii (9.0%), Enterococci (9.0%), and Escherichia coli (8.3%). There were 45 strains (60.0%) of multidrug-resistant strains in G+ bacteria and 40 strains of multidrug-resistant strains (57.1%) in G- bacterial strains, but in fungi there was only 1 strain (9.1%). There were 81 cases in survival group and 73 cases in death group according to 28-day prognosis. We found that there were no significant differences between the comparators in age, lenth of stay in ICU, duration for mechanical ventilation after being diagnosed with BSI, percentage of BSI with chronic obstructive pulmonary disease (COPD), hypertension, cardiovascular disease or chronic kidney dysfunction (all P > 0.05). In death group, the proportion of male was obviously lower than that of survival group [58.9% (43/73) vs. 75.3% (61/81), P < 0.05] and APACHE II score was significantly higher than that in survival group (27.1±7.0 vs. 19.5±6.7, P < 0.05). The mean arterial pressure (MAP) of death group on first 3 days of BSI was significantly lower than that of survival group [mmHg (1 mmHg = 0.133 kPa): 72.8±13.6 vs. 79.7±12.9, P < 0.05), in the death group, the proportion of patients complicated with diabetes, cancer [28.8% (29/73) vs. 12.3% (10/81), 19.2% (14/73) vs. 7.4% (6/81)], post-BSI CRRT and blood transfusion [39.7% (29/73) vs. 16.0% (13/81), 64.4% (47/73) vs. 46.9% (38/81)], and continuous use of asoactie drugs for ≥ 72 hours [37.0% (27/73) vs. 12.3% (10/81)] were significantly higher than those in the survival group (all P < 0.05). In death group, platelet count (PLT) was significantly decreased than that of survival group [×109/L: 124.93±98.21 vs. 181.15±116.39,P < 0.05], aspartate aminotransferase (AST) level was significantly higher than that of survival group [U/L: 75.40 (38.50, 140.95) vs. 56.20 (29.20, 85.70), P < 0.05], the rest of the laboratory indexes had no statistically significant differences between the two groups (all P > 0.05). The results of Logistic regression analysis showed that the APACHE II score [odds ratio (OR) = 1.279, 95% confidence interval (95%CI) was 1.158 to 1.412, P < 0.001], CRRT after BSI (OR = 3.522, 95%CI was 1.013 to 12.245, P = 0.048) were independent risk factors affecting the prognosis of patients with BSI, and MAP is a protective factor for prognosis (OR = 0.961, 95%CI was 0.927 to 0.996, P = 0.031). In our ICU, G+ bacteria are still dominant in bloodstream infection, G- bacteria take the second place. Besides, APACHE II score and CRRT after being diagnosed with BSI are the independent prognostic risk factors.

Earlier cranioplasty following posttraumatic craniectomy is associated with better neurological outcomes at one-year follow-up: a two-centre retrospective cohort study

Purpose Cranioplasty (CP) after decompressive craniectomy (DC) is routinely performed for reconstructive purposes and improves rehabilitation. However, the optimal timing of CP remains controversial. This study aimed to assess differences in clinical outcomes following different timings of CP in patients with traumatic brain injury. Materials and methods Patients with traumatic brain injury who underwent CP after DC in Zhongnan Hospital of Wuhan University from 1 January 2010 to 1 May 2017, and in Affiliated Hospital of Guizhou Medical University from 1 January 2015, to 1 May 2017, were retrospectively reviewed. According to the timing of CP, patients were divided into an ‘early group’ (3–6 months) and a ‘late group’ (6–12 months). The clinical characteristics of patients and postoperative complications occurred within 1-year follow-up were analysed. The neurological function was assessed with Barthel Index (BI). Results A total of 100 patients (58 cases in early group and 42 cases in late group) were included. The median interval between DC and CP was 135 days and 225 days in the early and late CP groups, respectively. The overall complication rate after CP was 16%, and no significant difference in complication rate was observed between the early and late CP groups (17.2% vs.14.3%, p = 0.69). The neurological function was improved in early CP group (pre-CP 85.77 ± 11.61 vs. post-CP 95.34 ± 9.02, p < 0.001, but not in late CP group (pre-CP 82.74 ± 22.82 vs. post-CP 88.93 ± 22.86, p = 0.22). In addition, a significantly higher proportion of patients in the early CP group showed neurological functional improvement in comparison with the late CP group (early vs. late: 74.1% vs. 57.1%, p = 0.04). Multivariate analysis further demonstrated that the timing of CP is an independent predictor for neurological outcomes (OR = 0.32, 95% CI 0.13–0.82, p = 0.02). Conclusion Early CP (3–6 months) following posttraumatic DC was associated with better neurological outcomes than late CP (>6 months).

Clinical Charactistics of Ph-Negative MPN Patients with Coexistence of JAK2V617F, Calr and MPL Mutation

Background and purpose: JAK2, CALR and MPL gene mutations are the driver genes leading to the pathogenesis of ph-negative myeloproliferative meoplasm (MPN). However, it's still unkonwn about the effect of double gene mutations coexisting in ph-negative MPN patients. In this study, we analyzed the clinical significance of the three driver gene mutations when they coexisted in patients with MPN. Methods: Collected bone marrow or peripheral blood samples of 221 patients with suspected MPN who were in the Affiliated Hospital of Guizhou Medical University between May 2017 and April 2020; qPCR detection for JAK2V617F mutation and sanger sequencing detection for CALR gene exon 9 and MPL Exon 10 mutation. Searched Pubmed database related to the coexistence of the three driver gene mutations and extracted information; Fisher exact test to analyze the differences in clinical characteristics between double mutation carriers and single mutation carriers. Shapiro-Wilk statistical analysis of the differences in clinical characteristics of ET patients with different types of double mutations. Results: 1 ET and 1 PMF patient carried both JAK2V617F and CALR gene mutations were found in our center, accounting for 0.9% of ph-negative MPN. The CALR carried by PMF patients was a newly discovered mutation type, c.1126_1127insTTTGC, R376Lfs*56. Through database search, we collected 26 literatures involving MPN case reports with double-driver gene mutations. By fitting analysis with the clinical information of positive patients in our center, a total of 74 MPN patients were collected, of which the number of ET patients was the largest(57/74, accounting for 77.03%). The most common coexisting mutant type was JAK2V617F plus CALR (63/74, 85.14%). The age of onset of MPN patients with double-driver gene mutations was significantly higher than that of single-mutation carriers, and the proportion of patients over 70 years of age was higher (p&amp;lt;0.05), and double mutation carriers had higher platelet count levels(Plt) (p&amp;lt;0.05). The proportion of patients with splenomegalia was lower (p&amp;lt;0.05). The clinical characteristics of ET patients were similar to MPN patients, but no difference in the incidence of splenomegalia (p&amp;gt;0.05). Among PMF patients, the Plt and the proportion of patients with megasplenomegaly in double mutation carriers were similar to those in MPN patients, but the hemoglobin(Hb) was higher (p&amp;lt;0.05). In addition, we also compared the clinical characteristics of ET patients with different gene mutation types. The results showed that the Hb of patients with JAK2V617F and CALR mutations were higher than those of ET patients with JAK2V617F and MPL mutations (p&amp;lt;0.05), but the Plt level is low (p&amp;lt;0.05). Although there were no significant differences in age, gender, IPSET-thrombosis and IPSET (IWG-MRT) scores and WBC between the two groups, the proportion of female ET patients with JAKV617F with MPL mutation was significantly higher than that of JAK2V617F with CALR mutation group (p&amp;lt;0.05). And the proportion of patients with WBC exceeding 11×109/L was also higher (p&amp;lt;0.05). In addition, only one PV patient carried JAK2V617F and CALR, and achieved partial or complete remission after treatment with standard treatment regimens (hydroxyurea or interferon-α). Conclusion: JAK2V617F, CALR and MPL gene mutations are not mutually exclusive in MPN patients, but a certain number of double mutation carriers are ignored. Compared with patients with single-gene mutations, patients with double-gene mutations are older and have higher platelet counts, and should be treated differently in later treatment. At the same time, there are also differences between ET patients with different mutation combinations. These results suggest that it is very necessary for MPN patients to check for three driver gene mutations at the same time, and this type of patients may become a new subtype of MPN. Disclosures No relevant conflicts of interest to declare.

CD56briCD27+CD11b+/- NK Cells Mediated Remission of Agvhd Via Immunoregulation

Background: In our previous study CD56briCD27+CD11b+/- NK cells show the potential of the remission of aGvHD, while the mechanism behind it is still unknown. Here, three hypothesis have been proposed according to further pilot experiment and literature. Method: 74 samples of patients after allo-HSCT were collected in the affiliated hospital of Guizhou medical university. Immunomonitoring with respect to the phenotype and function of CD56briCD27+CD11b+/- NK cells was performed on rested peripheral blood mononuclear cells (PBMCs) using multiparametric flow cytometry. Furthermore, the western-blot has been performed to determine the expression of HO-1 protein in sorted CD56briCD27+CD11b+/- NK cells as well. Result: (1) Our result shows a positive correlation between CD56briCD27+CD11b+/- NK cells and Th22, Tfh as well as Th1 like Tfh cells. Interestingly, a dramatic higher expression of homing marker CD62L has been observed on CD56briCD27+CD11b+/- NK cells. Thus we hypothesis that the CD56briCD27+CD11b+/- NK cells may migrate into the lymphoid tissues and regulate the differentiation of naïve T cells. (2) On the other hand, an elevated percentage of NKG2D has been found on CD56briCD27+CD11b+/- NK cells in patients with aGvHD. Meanwhile a high expression of Fas and exhaustion markers have been observed on CD4+ and CD8+ T cells. These results suggest that T cells may be eliminated by CD56briCD27+CD11b+/- NK cells. (3) Besides, our work displays that the expression of Heme Oxygenase-1 (HO-1) in CD56briCD27+CD11b+/- NK cells positively correlated with the secretion of IL-10. Compared with the patients with aGvHD, a higher expression of HO-1 and IL-10 in CD56briCD27+CD11b+/- NK cells has been found in patients without aGvHD at day 30 after allo-HSCT . Conclusion: According to these findings, the CD56briCD27+CD11b+/- NK cells may result in the remission of aGvHD via immunoregulation by regulation of T cells and secretion of IL-10. Disclosures No relevant conflicts of interest to declare.

Surgical versus conservative management of fifth metatarsal fractures in adults: A protocol of retrospective study.

Background:At present, the treatment of base fractures of the fifth metatarsal, especially the area I fractures, is still a controversial topic. The objective of our work was to assess the radiological and clinical outcomes of displaced avulsion fractures of the fifth metatarsal base after treated with conservative treatment or intramedullary screw.Methods:All of the fifth metatarsal fractures patients underwent surgery by the senior authors in our hospital from January 2017 to December 2019 were reviewed. Institutional Review Board in the Subsidiary Hospital of Guizhou Medical University approved this study. Patients with the following conditions can be included:(1)the displaced avulsion fracture of fifth metatarsal base;(2)aged 18 to 40 years;(3)a completed medical history;(4)the patients were followed up for at least 6 months.Patients with the following conditions will be excluded: follow-up less than 6 months; open fracture; pathological fracture; osteoporotic fracture; patients have the history of ankle or foot surgery. Radiographs were taken at 1, 3, 6 and 12 months in outpatient follow-up. The following outcomes were assessed in the follow-up: functional outcomes, the score of patient satisfaction, as well as the motion range, and complications. All the statistical analyses were implemented via applying the software of SPSS Version 12 (SPSS Inc, Chicago, IL).Results:We hypothesized that there was no remarkable difference between two groups in the outcomes after operation.Trial registration:This study protocol was registered in Research Registry (researchregistry6024).

Clinical analysis of septic shock caused by acute upper and lower gastrointestinal perforation

To analyze the clinical characteristics of septic shock caused by upper and lower gastrointestinal perforation. Clinical data of patients with septic shock due to gastrointestinal perforation admitted to the department of critical care medicine of the Affiliated Hospital of Guizhou Medical University from January 2018 to December 2019 were analyzed retrospectively. The general information; procalcitonin (PCT), acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores during the first 24 hours in intensive care unit (ICU); results of ascites culture during the first 72 hours in ICU; the maximum dosage and total time of norepinephrine (NE) in ICU; mechanical ventilation time, the length of ICU stay, occurrence of acute kidney injury (AKI), continuous renal replacement therapy (CRRT) and 28-day mortality were collected. The patients were divided into upper gastrointestinal tract group (stomach and duodenum) and lower gastrointestinal tract group (jejunum, ileum, appendix, colon and rectum), with a boundary of Treitz. The clinical features between the two groups were compared. There were 33 patients in the upper gastrointestinal tract group and 30 patients in the lower gastrointestinal tract group. There was no significant difference in gender and age between the two groups. The main pathogens in the ascites cultures in the upper gastrointestinal tract group were Candida albicans (45.5%), Enterococcus faecalis (18.2%) and Escherichia coli (18.2%). Escherichia coli (46.2%) and Enterococcus faecalis (30.8%) were the main pathogens in the lower gastrointestinal tract group. There were significant differences in PCT, the length of ICU stay, mechanical ventilation time, the maximum dosage and total time of NE between the upper gastrointestinal tract group and lower gastrointestinal tract group [PCT (μg/L): 17.69 (3.83, 26.62) vs. 32.82 (4.21, 100.00), the length of ICU stay (hours): 149.0 (102.5, 302.0) vs. 115.5 (30.8, 214.5), mechanical ventilation time (hours): 106.0 (41.5, 183.0) vs. 57.5 (25.0, 122.3), the maximum dosage of NE (μg×kg-1×min-1): 1.2 (0.5, 2.0) vs. 0.7 (0.5, 1.2), the total time of NE (hours): 72.0 (21.0, 145.0) vs. 26.5 (18.0, 80.5), all P < 0.05], while there was no statistically differences in APACHE II or SOFA scores [APACHE II: 30.0 (24.5, 35.0) vs. 28.0 (25.0, 33.5), SOFA: 10.67±4.14 vs. 9.50±3.33, both P > 0.05]. Compared with the lower gastrointestinal tract group, patients in the upper gastrointestinal tract group were more likely to have AKI (78.8% vs. 53.3%, P < 0.05) and require CRRT (39.4% vs. 16.7%, P < 0.05), but there was no significant difference in the 28-day mortality (39.4% vs. 43.3%, P > 0.05). The clinical characteristics of septic shock caused by upper and lower gastrointestinal perforation are not the same. Patients with septic shock caused by upper gastrointestinal perforation are more likely to suffer from fungal infection, with more severe shock, more likely to have AKI and require CRRT, and significantly longer mechanical ventilation and the length of ICU stay. While patients with septic shock caused by lower gastrointestinal perforation showed higher PCT.

Supporting the battle against COVID-19 in E'zhou, Hubei Province: the experience of Guizhou medical team

To suppress the rapid spread of coronavirus disease 2019 (COVID-19) in Hubei province, a medical rescue team consisting of 860 members was sent to E'zhou, one of the hard-hit cities in east Hubei. A total of 414 of the team members, whose core members were from Guizhou Medical University and its Affiliated Hospital, took over the full operation of Leishan hospital of E'zhou, a makeshift hospital built for treating COVID-19 patients. Under the instructions by the E'zhou Medical Team Front Command, the staff made quick responses to the surging number of patients with COVID-19 and rapidly formulated treatment plans based on the local conditions. The medical team efficiently carried out the operations and successfully completed the rescue mission. Herein the authors, as members of Guizhou Medical Team supporting COVID-19 containment in E'zhou, analyze and summarize the experiences of Guizhou Medical Team with the organization, implementation and logistic support of medical rescue operations, which may provide reference for future rescue missions in a similar scenario.

Discussion on the undergraduate education mode of critical care medicine majoring in clinical medicine

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. 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. 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%. 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.

Effects of interleukin-35 on the balance of helper T cell 17/regulatory T cell in peripheral blood of patients with oral lichen planus

Objective: To investigate the effects of exogenous interleukin (IL)-35 on the balance of helper T cell 17 (Th17) and regulatory T cell (Treg) in peripheral blood of patients with oral lichen planus (OLP). Methods: Totally 12 peripheral blood samples of OLP patients (OLP group, one male and 11 female, 26-68 years old; four cases of reticular OLP and eight cases of erosive OLP) were collected from patients of Department of Oral Mucosal Specialist of the Affiliated Hospital of Guizhou Medical University from October to December 2016. During the same period, thirteen normal peripheral blood samples were collected from the Physical Examination Center of the Affiliated Hospital of Guizhou Medical University (normal control group, one male and 12 female, 20-68 years old). The peripheral blood mononuclear cells (PBMC) were extracted in sterile condition and CD4+ T cells were sorted by flow cytometry (FCM). Quantitative real-time PCR (qPCR) technique was used to detect the mRNA expression levels of retinoid-related orphan nuclear γt (RORγt) and forkhead box3 (Foxp3). The CD4+ T cells were divided into experimental group and control group. The CD4+ T cells of experimental group were cultured in vitro by adding rhIL-35, and the CD4+ T cells of control group were cultured with the same volume of phosphate buffered saline (PBS). After the completion of the culture, the cells were collected. The expression levels of the same factors were detected by qPCR. Results: The expression [M(Q(25), Q(75))] of Foxp3 [0.15 (0.09, 0.30)] and RORγt mRNA [1.04 (0.45, 2.15)] in the CD4+ T cells of OLP were significantly higher than those in normal control group [0.04 (0.02, 0.06), 0.10 (0.05, 0.11)] (Z=-4.134, P<0.01; Z=-3.699, P<0.01). The ratio of ROR γt/Foxp3 mRNA in OLP group [6.22(3.67, 15.34)] was higher than that in normal control group [2.50 (1.24, 5.23)] (Z=-2.665, P=0.007). In the CD4+ T cells of OLP patients, the expression of Foxp3 mRNA in the experiment group [0.40 (0.21, 1.22)] was higher than that in the control group [0.15 (0.11, 0.26)](Z=-2.510, P=0.012), and the expression of ROR γt mRNA between two groups showed no significant difference (P>0.05). The ROR γt/Foxp3 mRNA ratio [3.44 (1.55, 8.16)] of the experiment group was lower than that in the control group [6.22 (4.43, 12.21)] (Z=-2.746, P=0.006). Conclusions: There was a Th17/Treg imbalance with predominated by Th17 cells in the peripheral blood of patients with OLP. Exogenous rhIL-35 had an immunomodulatory effect on the balance of Th17/Treg.

免费医学生的专业认同与专业满意度研究—以贵州医科大学为例

免费医学生的专业认同与专业满意度研究—以贵州医科大学为例