Liaocheng People Research Articles

Efficacy of Human Umbilical Cord Blood-Mononuclear Cell Transplantation for MSA Treatment and Its Effects on Changes in T-Cell Subsets in Peripheral Blood and Inflammatory Factors.

Objective This study is aimed at examining the efficacy of human umbilical cord blood-mononuclear cell (hUCB-MNCs) transplantation through lateral atlanto-occipital space puncture in multiple system atrophy (MSA) treatment and investigating changes in T-cell subsets in peripheral blood and inflammatory factors in patients before and after treatment. Methods A total of 20 patients with MSA who underwent hUCB-MNC transplantation through lateral atlanto-occipital space puncture in the Liaocheng People's Hospital were enrolled. Patients were followed up at 0, 1, 3, and 6 months after treatment, and the Unified Multiple System Atrophy Rating Scale (UMSARS) scores, TNF-α in the peripheral blood, IL-6, percentage of CD4, and CD4/CD8 ratio were evaluated and compared for each follow-up point; any adverse effects were recorded. Results UMSARS Part I scores were 20.55 ± 3.80, 19.20 ± 3.78, and 19.40 ± 4.11, 1, 3, and 6 months, respectively, after treatment and were significantly lower as compared to that before treatment (23.50 ± 4.72; P < 0.05). Similarly, UMSARS Part II scores 1, 3, and 6 months after treatment were 25.50 ± 5.01, 24.05 ± 5.01, and 24.25 ± 5.05, respectively, significantly lower as compared to that before treatment (30.15 ± 5.63; P < 0.05). The IL-6 values in the peripheral blood 1, 3, and 6 months after treatment were 5.25 ± 2.70 pg/m, 2.96 ± 1.75 pg/m, and 3.31 ± 1.62 pg/m, respectively, which were significantly lower (P < 0.05) than that before treatment (8.22 ± 4.69) pg/m. The TNF-α levels at 3 and 6 months after treatment were 13.08 ± 6.13 pg/m and 12.24 ± 4.76 pg/m, respectively, which were significantly lower than that before treatment (22.99 ± 13.30; P < 0.01). The CD4/CD8 ratios in the peripheral blood 1, 3, and 6 months after treatment were 1.09 ± 0.25, 1.30 ± 0.24, and 1.43 ± 0.22, respectively, which were significantly different than that before treatment (0.81 ± 0.24, P < 0.01). Similarly, the CD4 percentages 1, 3, and 6 months after treatment were 34.09 ± 1.79, 36.05 ± 1.50, and 36.47 ± 1.47, respectively, which were significantly different than that before treatment (0.81 ± 0.24; P < 0.01). Conclusion hUCB-MNC transplantation through lateral atlanto-occipital space puncture could significantly improve the symptoms and signs in patients with MSA and delay the disease progression. Thus, hUCB-MNCs may modulate immune activity and reduce the inflammatory response.

Epidemiological profile of 338 traumatic spinal cord injury cases in Shandong province, China.

Hospital-based retrospective review. To describe the epidemiological characteristics of traumatic spinal cord injury (TSCI) in Liaocheng, China. Liaocheng People's Hospital. Medical records of 338 persons with TSCI admitted to Liaocheng People's Hospital from 2013 to 2017 were reviewed. The detailed information included gender, age, marital status, occupation, time, etiology, level of injury, ASIA grade, spinal stenosis, concomitant injury, treatment, length of stay. Over this period, the mean age (SD) of persons with TSCI was 50.1 (14.1) years, and the male/female ratio was 3.1:1. 96.4% of all were married. The leading cause was fall, followed by motor vehicle accident (MVA). The most common level of injury was the cervical cord. ASIA grade D and A injuries were the most common, accounting for 48.5 and 29.3% respectively. Among the concomitant injuries, spinal fractures were the most common. Within 24 h, 91.1% of individuals with TSCI arrived hospital, 63.3% of all accepted surgery. The results showed that fall and MVA were the two main causes, so we should focused on preventing fall and reducing MVA. Cervical spinal stenosis can increase the risk of TSCI, so education should be provided to this population to raise their risk awareness. In addition, timely treatment was critical for TSCI, but the data showed that rescue process was not standard, so it was necessary for medical staff to popularize professional knowledge.

Retrospective study of perioperative cardiac arrest from a Chinese tertiary hospital.

Studies on perioperative cardiac arrest in Chinese hospitals have rarely been retrieved from international journals. This survey evaluated the incidence, causes, and outcomes of perioperative cardiac arrests in a Chinese tertiary general hospital between July 2013 and December 2020. The incidence of cardiac arrest within 24 hours of anesthesia administration was retrospectively identified using an anesthesia database in Liaocheng People's Hospital. During the study period, there were 118,152 anesthetics. Data collected included patient characteristics, surgical procedures (elective or emergency), American Society of Anesthesiologists (ASA) physical status score, type of surgery, anesthesia technique, and outcome. Cardiac arrests were grouped into one of 3 groups: totally anesthesia-related, partially anesthesia-related, or anesthesia-unrelated. In total, 41 cardiac arrests (3.5:10,000) and 26 deaths (2.2:10,000) were found. Major risk factors for cardiac arrest were children under 1 year, adults between 19 and 65 years, and the elderly (>80 years) (P < .001), male patients (P = .02), emergency surgery (P < .001), and ASA grade V patients without anesthesia (P = .009). There were 19 anesthesia-related cardiac arrests (1.6:10,000) – 2 were totally related, and 17 were partially related to anesthesia. There were 9 anesthesia-related deaths (0.8:10,000), all of which were partially related to anesthesia. Perioperative cardiac arrests were correlated with age, gender, ASA grade and surgical procedures. The 2 most important patient factors leading to cardiac arrest were hemorrhagic shock from trauma and septic shock, respectively.

Association Between Gamma-Glutamyl Transferase, Total Bilirubin and Systemic Lupus Erythematosus in Chinese Women.

BackgroundSystemic lupus erythematosus (SLE) affects many organs and systems of the human organism, at present, its specific pathogenesis is not completely clear, but inflammation is considered to be an important factor involved in the pathogenesis and progression of SLE. Gamma-glutamyl transpeptidase (GGT) and total bilirubin (TBIL) have different effects on inflammation: GGT has pro-inflammatory effects, on the contrary, TBIL has anti-inflammatory effects. Study has found that GGT and TBIL play opposite roles in metabolic diseases. However, the roles of them in SLE are unknown. Meanwhile, the relationship between GGT and SLE also remains unexplored.MethodWe recruited 341 SLE patients and 332 healthy individuals in Liaocheng People’s Hospital from August 2018 to May 2019. We diagnosed SLE using 2019 revised American College of Rheumatology (ACR) SLE criteria, and modeled the study outcomes using logistic regression to explore the respective relationship between GGT, TBIL and SLE. We also analyzed the interaction of GGT and TBIL in the progression of SLE.ResultsWe found that the levels of CRP, IL-6 and TNF-α in the aggravated group were significantly higher than those in the unaggravated group, the levels of C3 and C4 in the aggravated group were significantly lower than those in the unaggravated group. According to Spearman correlation analysis, GGT is proportional to CRP (rs=0.417) and IL-6 (rs=0.412), inversely proportional to C3 (rs=-0.177) and C4 (rs=0.-132). TBIL was inversely proportional to CRP (rs=-0.328) and TNF(rs=-0.360), and positively proportional to C3 (rs=0.174) and C4 (rs=0.172). In the fully adjusted model, compared to the lowest quartile, the highest quartile of GGT exhibited a positive association with the risk of SLE aggravation (OR=2.99, 95% CI: 1.42–6.31, P<0.001). At the same time, compared to the highest quartile, the quartile lowest of TBIL exhibited a positive association with the risk of SLE aggravation (OR=2.66, 95% CI: 1.27–5.59, P<0.001) in the fully adjusted model. Through interaction analysis, we found that women with high GGT levels had an increased risk of SLE aggravation when they had a low level of TBIL (OR=3.68, 95% CI: 1.51–9.01, for women with Q1 TBIL and Q4 GGT compared to women with Q2-Q4 TBIL and Q1-Q3 GGT, P for interaction <0.001), the combined AUC value (AUCCOMBINED=0.711) of high GGT level and TBIL were higher than their respective values (AUCGGT=0.612, AUCTBIL=0.614).ConclusionWe found that the effects of GGT and TBIL in the progression of SLE are opposite. High GGT level might be a risk factor for SLE aggravation, as GGT levels increased, so did the risk of SLE aggravation. At the same time, we found that low TBIL level might be a risk factor for SLE aggravation. Moreover, high GGT level and low TBIL level had a subadditive effect on the increased risk of SLE aggravation.

Potential Effectiveness of Piperacillin/Tazobactam in Treating Pediatric Patients Infected with IMP-Type Carbapenemase-Producing Enterobacteriaceae

Background: The resistance rate of carbapenem-resistant Enterobacteriaceae (CRE) is increasing yearly but rarely reported in children. Objectives: This retrospective study analyzed the characteristics of isolated CRE strains in pediatric patients, intending to explore reasonable antimicrobial treatment options. Methods: Some CRE isolates were collected from infected pediatric patients in Liaocheng People’s Hospital from January 2014 to December 2019. The strain identification and antimicrobial susceptibility testing were conducted using Vitek mass spectrometry and the Vitek 2 system, respectively. The carbapenemase genotypes of blaKPC, blaIMP, blaVIM, blaNDM-1, and blaOXA-48 were each detected by polymerase chain reaction and sequencing. The molecular homology analysis of strains was conducted via Pulse-field Gel Electrophoresis (PFGE). The clinical data of CRE-infected pediatric patients were collected from the hospital’s medical data information system. Results: Twenty CRE strains were isolated from 1945 infected pediatric patients with Enterobacteriaceae. All CRE strains showed multiple resistance to commonly used antimicrobials. Twelve strains of imipenemase (IMP)-4 and seven strains of IMP-8 carbapenemase were confirmed. Besides, PFGE revealed that two strains of Escherichia coli and three of Klebsiella pneumoniae had indistinguishable patterns. Sixteen patients were cured, including 10 patients using piperacillin/tazobactam. Conclusions: This study found the major sources of resistance were IMP carbapenemases. Piperacillin/tazobactam is potentially effective for the treatment of CRE infection, despite insensitivity in vitro.

Efficacy analysis of different pulmonary surfactants in premature infants with respiratory distress syndrome

To explore high-risk factors of respiratory distress syndrome (RDS) and to compare the clinical efficacy of calf pulmonary surfactant (PS) combined with budesonide suspension and poractant alfa injection in the treatment of RDS in premature infants. A retrospective analysis was conducted. Preterm infants who were born in the obstetrics department of Liaocheng People's Hospital and admitted to the neonatal intensive care unit (NICU) within 24 hours from July 2016 to July 2020 were enrolled. The clinical data of these patients including perinatal conditions, clinical features, therapeutic regimens of PS and outcomes were collected and analyzed. According to the diagnostic criteria of neonatal respiratory distress syndrome (NRDS), premature infants were divided into NRDS group and non-NRDS group. First, the clinical data of the two groups were compared to analyze the related factors of NRDS. Then the related factors of NRDS were confirmed by Logistic regression analysis. In addition, according to the trapeutic regimens of PS, the children were divided into calf PS combined with budesonide suspension group and poractant alfa injection group, and the efficacy of the two PS was compared. (1) A total of 1 690 preterm infants were included, including 297 preterm infants were diagnosed with NRDS which accounted for 17.6% of live preterm infants. There were significant differences in gender, gestational age (GA), birth parity, birth weight (BW), asphyxia of newborn, caesarean section, premature rupture of membrane, placental abruption, gestational diabetes and father's smoking addiction (maternal exposure to smoke during pregnancy) between NRDS group and non-NRDS group (male: 71.0% vs. 59.0%; GA: < 28 weeks was 4.1% vs. 0.1%, 28 weeks ≤ GA < 34 weeks was 70.0% vs. 29.9%, 34 weeks ≤ GA < 37 weeks was 25.9% vs.70.0%; birth parity: 2 (1, 3) vs. 2 (1, 3); BW: < 1 000 g was 4.1% vs. 0.4%, 1 000 g ≤ BW < 1 500 g was 31.3% vs. 6.5%, 1 500 g ≤ BW < 2 500 g was 51.5% vs. 58.9%, 2 500 g ≤ BW < 4 000 g was 12.8% vs. 33.1%, BW ≥ 4 000 g was 0.3% vs. 1.1%; asphyxia of newborn: 50.8% vs. 14.6%; caesarean section: 71.7% vs. 65.0%; premature rupture of membrane: 66.7% vs. 42.2%; premature rupture of fetal membranes: 11.4% vs. 5.2%; gestational diabetes: 12.1% vs. 7.0%; father's smoking addiction: 80.8% vs. 71.5%, all P < 0.05), but there was no significant difference in prenatal use of dexamethasone (DEX) between NRDS group and non-NRDS group (80.1% vs. 84.1%, P > 0.05). Binary multivariate Logistic regression analysis showed that GA, gender, cesarean section, premature rupture of membranes, gestational diabetes, father's smoking addiction and neonatal asphyxia were the risk factors of RDS [odds ratio (OR) and 95% confidence interval (95%CI) were 0.621 (0.557-0.693), 2.043 (1.478-2.825), 1.365 (1.036-1.797), 0.697 (0.506-0.961), 3.223 (1.906-5.449), 1.836 (1.261-2.673), 3.596 (2.622-4.933), all P < 0.05]. (2) A total of 160 patients diagnosed with grade III/IV NRDS were included to analyze the efficacy of PS. Among them, 42 cases were treated with calf PS combined with budesonide suspension, and 118 cases were treated with poractant alfa injection. Compared with the poractant alfa injection group, the total oxygen consumption time of the calf PS group was shorter [days: 9.0 (5.0, 19.0) vs. 13.0 (6.0, 26.0)], the hospitalization expenses were lower [ten thousand Yuan: 3.46 (2.88, 5.18) vs. 4.58 (3.08, 6.06)], and the incidence of bronchopulmonary dysplasia (BPD) was lower (11.9% vs. 28.8%), with statistically significant differences (all P < 0.05). In addition to GA, gender, cesarean section, premature rupture of membranes, gestational diabetes, and neonatal asphyxia, the father's smoking addiction (maternal smoke exposure during pregnancy) is an important risk factor of RDS in premature infants. The efficacy of prenatal use of DEX for prevention of RDS in preterm infants is affected by many factors, such as prenatal smoke exposure, timing of use, multiple fetuses, etc. Calf PS combined with budesonide suspension is better than poractant alfa injection in reducing the incidence of BPD.

Which is preferred for initial treatment of papillary thyroid cancer, total thyroidectomy or lobotomy?

PurposesThe incidence of thyroid cancer has increased annually, and has a heavy psychological and economic burden on society and individuals. Based thyroid cancer data from patients treated in Liaocheng People's Hospital from 2015 to 2018, with Chinese national and regional characteristics, in this study, we addressed the controversy of which initial thyroid surgical mode, lobectomy or total thyroidectomy, is most effective.MethodsClinical and pathological data from 2108 patients with thyroid cancer, who were initially diagnosed and treated surgically, were collected from the Department of Thyroid Surgery. Among them, there were 1001 cases who underwent open operation with total thyroidectomy + central lymph node dissection; meanwhile, 1107 cases were treated with neck lateral lymph node dissection at the same time.ResultsThe overall metastasis rate of all patients was 57.23%. Even the lymph node metastasis of papillary thyroid microcarcinoma (PTMC) was as high as 48.97%. When the mass rose above 2 cm, the proportion of metastasis increased to 77.22%. When the tumor was complicated with bilateral and multiple high‐risk factors, the proportion of metastasis was 65.27% and 72.21%, respectively. When the tumor breaks through the capsule, the metastasis rate was 67.08%. With the increase of tumor diameter, the metastasis of cervical lymph nodes ranged from 22.54% to 73.33%, which showed positive correlation. 49.32% of patients had lymph node metastasis in the lateral cervical region. When the diameter of the tumor reached T1c level, the metastasis of the cervical lymph nodes was 56.91%, and the number of metastatic cases above T1c level accounted for 69.96% of the total metastatic cases.ConclusionThe degree of malignancy of thyroid cancer depends on tumor genome evolution. Rates of neck lymph node metastasis are high, particularly among patients with risk factors for poor prognosis. It is recommended that initial treatment should comprise at least total thyroidectomy + central lymph node dissection in China, to avoid the risks associated with secondary surgery and effects on patient quality of life. When the tumor diameter exceeds 1 cm, the risk of cervical lymph node metastasis is high, and we recommended lateral lymph node dissection.

Increased Levels of Serum Neuregulin 1 Associated with Cognitive Impairment in Vascular Dementia.

Objective Neuregulin 1 (NRG 1) is a member of the epidermal growth factor (EGF) family and is believed to play an important role in neuroplasticity. However, the relationship between NRG 1 and vascular dementia (VaD) is poorly understood. The purpose of this study is to explore the correlation between neuregulin 1 and VaD. Patients and Methods. From October 2018 to September 2020, 93 VaD patients and 79 control populations who attended Liaocheng People's Hospital were included in the study. Baseline characteristics including age, gender, years of education, HDL, LDL, FBG, SBP, and DBP are collected. At the same time, peripheral blood was collected, and the concentration of serum NRG 1 was detected by enzyme-linked immunosorbent assay (ELISA). All research subjects received professional cognitive function assessment. Results A total of 93 VaD patients and 79 controls were enrolled. There was no significant difference in age, gender, years of education, HDL, LDL, FBG, SBP, and DBP between the two groups (p > 0.05). However, compared with the control group, VaD patients have lower MoCA and higher serum NRG 1 levels, and the difference is statistically significant (p < 0.001). The correlation analysis of MoCA and baseline characteristics showed that the MoCA score in VaD was significantly negatively correlated with serum NRG 1 (r = −0.374, p = 0.036). The results of multivariate regression showed that the MoCA score of VaD patients was only associated with NRG 1 (β = 0.258, p = 0.012). Conclusions The concentration of serum NRG 1 in VaD patients is significantly increased, which may be an independent risk factor for cognitive impairment in VaD patients.

Total thyroidectomy is superior for initial treatment of thyroid cancer.

PurposeThe incidence of thyroid cancer has increased annually, and has a heavy psychological and economic burden on the society and individuals. Based on thyroid cancer data from patients treated in Liaocheng People's Hospital in 2017, with Chinese national and regional characteristics, in this study we addressed the controversy of which initial thyroid surgical mode, lobectomy, or total thyroidectomy is the most effective.Patients and methodsClinical and pathological data from 552 patients with thyroid cancer, who were initially diagnosed and treated surgically, were collected from the Department of Thyroid Surgery. Among them, 40 patients underwent endoscopic surgery, with resection, including lobectomy + central lymph node dissection of the affected lobe, while 512 cases underwent total thyroidectomy + central lymph node dissection.ResultsThe metastasis rate for all patients was 59.42%, with lymph node metastasis of papillary thyroid microcarcinoma of 46.92%; however, for patients with tumors >2 cm, the proportion developing metastasis was increased to 77.53%.ConclusionIn thyroid cancer, rates of neck lymph node metastasis are high, particularly among patients with risk factors for poor prognosis. Our data suggest that initial treatment should comprise at least total thyroidectomy + central lymph node dissection in China, at least in tumors larger than 1 cm, to avoid the risks associated with secondary surgery and effects on patient quality of life.

Application Effects of Whole Course High-Quality Nursing on Patients with Liver Cancer during Radiotherapy

To explore the application effects of whole course high-quality nursing on patients with liver cancer during radiotherapy. One hundred and five patients with liver cancer who received radiotherapy in Liaocheng People's Hospital, Liaocheng, China from March 2010 to February 2012 were selected and divided into a control group (42 cases with routine nursing) and an experimental group (63 cases with whole course high-quality nursing). The two groups of patients were observed and compared in terms of clinical data and the Activity of Daily Living (ADL) score before and after nursing (1 course of treatment/6 week). The Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) were used to evaluate and compare the patients' anxiety and depression before and after nursing. Adverse reactions during radiotherapy and nursing satisfactory of patients were observed and compared between the two groups. After nursing, the ADL score and the nursing satisfaction in the experimental group was significantly higher than that in the control group (P<0.05). The SDS and SAS scores in the 2 groups before nursing were significantly higher than those after nursing (P<0.05). The total incidence of adverse reactions in the control group was significantly higher than that in the experimental group (P<0.05). Whole course high-quality nursing can improve the negative emotions, quality of life and nursing satisfaction, and reduce adverse reactions of patients with liver cancer during radiotherapy.

Value of N-terminal pro-brain natriuretic peptide in evaluating early septic cardiac dysfunction in neonates

To investigate the significance of N-terminal pro-brain natriuretic peptide (NT-proBNP) in the early assessment of neonatal cardiac dysfunction in sepsis. The children diagnosed with neonatal sepsis and common infection neonates admitted to the department of pediatric neonatal intensive care unit (NICU) of Liaocheng People's Hospital from January 2016 to January 2019 were enrolled. Data of clinical sign, laboratory results, bedside echocardiography and survival data were collected, and the differences of clinical indexes were compared among sepsis patients with and without cardiac dysfunction and common infection. The risk factors of sepsis with cardiac dysfunction were analyzed by multivariate Logistic regression, and the early prediction value of NT-proBNP for neonatal septic cardiac dysfunction was evaluated by the receiver operating characteristic (ROC) curve. There were 112 neonates with sepsis (49 with cardiac dysfunction and 63 without cardiac dysfunction) and 67 children with common infection included in the analysis. The onset time of neonates in septic cardiac dysfunction group was significantly earlier than that of septic non-cardiac dysfunction group and common infection group [hours: 52.9 (0, 180.3) vs. 53.9 (0, 183.6), 81.0 (45.6, 202.4), both P < 0.05]. Compared with the general infection group, albumin (ALB), white blood cell count (WBC), left ventricular ejection fraction (LVEF) in septic cardiac dysfunction group significantly decreased, NT-proBNP, hypersensitive C-reactive protein (hs-CRP)/ALB, pulmonary artery systolic pressure (PASP) significantly increased, while right ventricular (RV) and Tei index significantly increased [ALB (g/L): 24.1±3.8 vs. 27.8±3.6, WBC (×109/L): 12.7 (3.7, 18.9) vs. 15.4 (9.9, 23.2), LVEF: 0.626±0.123 vs. 0.700±0.021, NT-proBNP (ng/L): 20 230.6 (15 890.0, 35 000.0) vs. 7 324.5 (2 426.5, 13 890.0), hs-CRP/ALB: 0.33 (0.29, 0.81) vs. 0.06 (0.00, 0.21), PASP (mmHg, 1 mmHg = 0.133 kPa): 52.25±14.12 vs. 41.07±27.73, RV (mm): 10.74±2.42 vs. 8.55±1.41, Tei index: 0.52±0.03 vs. 0.30±0.04, all P < 0.05]. NT-proBNP and Tei index in septic cardiac dysfunction group were significantly higher than those in septic non-cardiac dysfunction group [NT-proBNP (ng/L): 20 230.6 (15 890.0, 35 000.0) vs. 13 057.6 (8 946.0, 35 000.0), Tei index: 0.52±0.03 vs. 0.39±0.02, both P < 0.05], and LVEF was significantly lower than that in septic non-cardiac dysfunction group (0.626±0.123 vs. 0.671±0.086, P < 0.05). Multivariate Logistic regression analysis showed that NT-proBNP, Tei index and hs-CRP/ALB were independent risk factors for cardiac dysfunction in sepsis neonates [odds ratio (OR) and 95% confidence interval (95%CI) were 8.73 (1.54-5.67), 1.97 (1.26-2.87), 1.87 (1.03-3.40) respectively, all P < 0.05]. ROC curve analysis showed that NT-proBNP, Tei index and hs-CRP/ALB had good predictive value for the occurrence of cardiac dysfunction in septic neonates, the area under ROC curve (AUC) was 0.81 (95%CI was 0.84-0.91), 0.78 (95%CI was 0.65-0.79) and 0.77 (95%CI was 0.61-0.77), respectively. The sensitivity and specificity of NT-proBNP were 80.0% and 79.0% respectively with 12 291.5 ng/L as the cut-off value, the sensitivity and specificity of Tei index were 74.0% and 77.0% respectively with 0.45 as the cut-off value, and the sensitivity and specificity of hs-CRP/ALB were 76.0% and 76.3% respectively with 0.10 as the cut-off value. NT-proBNP can be used as a diagnostic marker of early cardiac dysfunction, and for rapid diagnosis of neonatal cardiac dysfunction in sepsis. The application may guide clinicians to use drugs better to improve cardiac function and treatment effect.

With High-Risk Factors, Total Thyroidectomy is Preferred for Thyroid Cancer.

IntroductionBased on thyroid cancer data from patients treated in Liaocheng People’s Hospital in 2017, with Chinese national and regional characteristics, in this study we addressed the controversy of which initial thyroid surgical mode, lobectomy or total thyroidectomy, is most effective.Patients and MethodsClinical and pathological data from 552 patients with thyroid cancer, who were initially diagnosed and treated surgically, were collected from the Department of Thyroid Surgery. Among them, 40 patients underwent endoscopic surgery, with resection including lobectomy + central lymph node dissection of the affected lobe, while 512 cases underwent total thyroidectomy + central lymph node dissection.ResultsThe metastasis rate for all patients was 59.42%. Further, among patients with bilateral or multiple tumors or capsule invasion, the proportions who developed metastatic disease were 63.54% and 71.19% and 67.46%, respectively. Meanwhile, the incidence of contralateral accidental malignancy was 7.25% after postoperative paraffin pathology.DiscussionRates of neck lymph node metastasis are high, particularly among patients with risk factors for poor prognosis. It is recommended that, among patients with risk factors, initial treatment should comprise at least total thyroidectomy + central lymph node dissection in China, to avoid the risks associated with secondary surgery and effects on patient quality of life.

Leukocyte Telomere Length: A Potential Biomarker for the Prognosis of Coronary Artery Disease

Background: Coronary artery disease(CAD) is a worldwide disease with high morbidity and mortality. There are many risk factors to predict the prognosis of CAD. We aimed to demonstrate the difference of leukocyte telomere length (LTL) between different types of CAD and illustrate the predictive value of LTL on the prognosis in patients with CAD. Methods: 366 patients hospitalized for coronary angiography were divided into three groups according to the CAD criteria and clinical manifestation: 98 stable angina pectoris (SAP), 144 unstable angina pectoris (UAP) and 124 acute myocardial infarction (AMI). Patients with a normal coronary artery diagnosed by coronary computed tomography angiography were chosen as the normal control (NC) group. LTL was measured using quantitative real-time polymerase chain reaction (qRT-PCR). All patients were followed-up for 6 months to analysis major adverse cardiac events (MACEs). Findings: CAD patients had significantly shortened LTL comparing with NC group (p < 0.05). LTL in AMI patients were significantly shorter compared with the SAP and UAP group (p < 0.05). Area under the curve values of LTL for predicting MACEs was 0.769 (p < 0.001). Cox proportional hazards regression analysis revealed shorter LTL was an independent predictor of MACEs. Kaplan-Meier analysis suggested that a trend toward poorer event free survival rate was observed in shorter LTL group (p < 0.001). Interpretations: LTL was independently correlated with short-term MACEs and can be used for risk stratification of CAD patients. Funding Statement: Supported by Traditional Chinese Medicine Science and Technology Development Plan Project of Shandong Province (No. 2019-0891). Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: The study was approved by the Medical Ethics Committee of Liaocheng People's Hospital. All procedures were in accordance with principles of Helsinki Declaration. Informed consent was obtained from all subjects.

Determinants affecting the prognosis of decompressive craniectomy for traumatic brain injury.

Objective:This research was designed to investigate the prognostic determinants of patients with traumatic brain injury (TBI) undergoing decompressive craniectomy (DC).Methods:The present study was a retrospective single center research including a total of 112 patients undergoing DC for TBI in Liaocheng People’s Hospital between January 2017 and December 2018. The results were measured by Extended Glasgow Outcome Sale (GOSE). The prognostic determinants were identified by univariate and binary logistic regression analysis between the deaths and survivors or favorable and unfavorable outcomes.Results:At the six-month follow-up, the mortality was 45.5% including 37 (33.0%) patients died within 30 days. The independent prognostic factors of 30-day mortality were age (p=0.033), D-dimer level at admission (p=0.032) and postoperative hypernatremia (p=0.014). Seventy five patients survived more than 30 days after DC, among which 27 (36.0%) patients had unfavorable prognosis (GOSE 1-4) and 48 (64.0%) patients presented favorable prognosis (GOSE 5-8). After 30 days from DC, the occurrence of post-traumatic hydrocephalus(PTH) (p= 0.008) was associated with unfavorable prognosis.Conclusions:Although DC is an effective treatment for TBI patients, the mortality and morbidity risk remain high. A combination of age, D-dimer level at admission and postoperative hypernatremia may be a good prognostic factor for 30-day mortality. Developing an accurate therapy strategy to prevent and control PTH may be beneficial to the 6-month prognosis for TBI patients undergoing DC.

Comparison of the clinical application values of PCT, hs-CRP and SAA detection in the early diagnosis of sepsis.

Objectives:To investigate the clinical application values of procalcitonin (PCT), high-sensitivity C-reactive protein (hs-CRP) and serum amyloid A (SAA) in the early diagnosis of sepsis.Methods:In this retrospective analysis, 36 patients admitted to Liaocheng People’s Hospital were selected from May 2018 to July 2019. According to infectious disease diagnostic criteria, 17 patients were confirmed to have sepsis (observation group), and 19 patients were determined to be nonseptic (control group). The levels of PCT, CRP and SAA of patients were detected on admission, and the clinical application values of PCT, CRP and SAA for sepsis were compared.Results:Seventeen patients were included in the observation group, including 9 males and 8 females, with an average age of 52.18 ± 9.49 years; 19 patients were included in the control group, including 12 males and 7 females, with an average age of 51.53 ± 8.50 years. On admission, there were significant differences in white blood cell (WBC) count (t = 5.134), neutrophil count (t = 3.143), lymphocyte count (t = 2.510), PCT (t = 9.250), hs-CRP (t = 2.947) and SAA (t = 11.360) between the observation group and the control group, and the differences were statistically significant. For the comparison of clinical application values: the sensitivity of PCT, hs-CRP and SAA was 78.95%, 52.17% and 50.00%, respectively; the specificity of PCT, hs-CRP and SAA was 88.24%, 61.54% and 37.50%, respectively; the area under the ROC curve (AUC) of PCT, hs-CRP and SAA was 0.920, 0.684 and 0.870, respectively; the logistic regression coefficient of PCT, hs-CRP and SAA was -0.577, -0.028 and -0.009, respectively; and the 95% confidence interval (CI) of PCT, hs-CRP and SAA was 0.779-0.985, 0.508-0.828 and 0.716-0.958, respectively.Conclusion:Compared with hs-CRP and SAA, PCT had a higher clinical application value for sepsis, and PCT could be used as a reliable index for the early diagnosis of sepsis.

Observation on the efficacy and complications of intravenous nutrition strategy in premature infants with birth weight < 1 500 g

To explore the safety and efficacy of intravenous nutrition strategy for preterm infants with birth weight < 1 500 g combined with literatures. The clinical data of 93 preterm infants with very low or extremely low birth weight (< 1 500 g) who were admitted to the neonatal intensive care unit (NICU) of Liaocheng People's Hospital of Shandong Province from October 2012 to December 2018 were retrospectively analyzed. On the basis of active treatment of primary disease and early enteral nutrition, all preterm infants received "all-in-one" intravenous nutrition strategy. The intravenous nutrient solution containing 6% pediatric compound amino acids, 20% fat emulsion, glucose, vitamins, NaCl, KCl, microelements and minerals was transfused uniformly in 20-24 hours. The changes in growth and biochemical indexes of preterm infants before and after intravenous nutrition intervention were observed. The occurrence of intravenous nutritional complications such as parenteral nutrition associated cholestasis (PNAC) and prognosis were recorded. The receiver operating characteristic (ROC) curve was plotted to assess the predictive power of each indicator for extra uterine growth retardation (EUGR). Ninety-three preterm infants were enrolled in the final analysis. The gestational age was (28.75±1.93) weeks and the birth weight was (1 113.28±190.48) g. All the children except 4 non-surviving preterm infants were discharged from hospital. The average hospitalization time was (51.64±15.98) days. In 89 surviving preterm infants, the maximum weight loss percentage was (4.42±3.12)%, and the time to regain birth weight was (6.36±2.60) days. In these surviving preterm infants, the daily average growth rate of weight gain was (19.53±4.64) g/kg, and the weekly average growth of body length and head circumference gain was (1.06±0.34) cm and (0.69±0.22) cm, respectively. The mean duration of intravenous nutrition was (21.56±8.54) days in 89 surviving preterm infants. The body weight, body length and head circumference of these surviving preterm infants were increased significantly at discharge compared with their admission to NICU [body weight (g): 2 191.63±186.00 vs. 1 118.71±188.78, body length (cm): 45.21±1.50 vs. 37.34±2.56, head circumference (cm): 31.04±1.27 vs. 25.96±1.80]. The level of albumin (Alb) was significantly increased (g/L: 27.52±3.77 vs. 25.70±3.88), however the blood urea nitrogen (BUN) level was significantly reduced (mmol/L: 1.65±1.39 vs. 5.11±3.20) with statistical differences (all P < 0.05). In the 89 surviving preterm infants, 79 preterm infants (88.8%) suffered from premature anemia and 48 (53.9%) achieved transfusion criteria. Forty-two preterm infants (47.2%) had glucose metabolism disorder and 38 (42.7%) had electrolyte disturbances. PNAC occurred in 9 preterm infants (10.1%). Thirty-eight preterm infants (42.7%) had EUGR in weight. ROC curve analysis showed that the combination of gestational age, birth weight and time to restore birth weight had a good predictive value for EUGR in very low or extremely low birth weight preterm infants, and the area under the ROC curve (AUC) was 0.902, the sensitivity was 86.4%, and the specificity was 86.8%. The intravenous nutrition strategy for preterm infants with birth weight < 1 500 g is effective and safe. However, intravenous nutrition can cause some complications, such as glucose metabolism disorder, electrolyte disturbances and PNAC, etc. So the process of intravenous nutrition should be closely monitored. To start EN as early as possible and shorten the duration of intravenous nutrition is an important measure for the prevention of PNAC. The combination of gestational age, birth weight and the time to regain birth weight has a good predictive value for EUGR, and intervention can be strengthened early in hospital to avoid EUGR.

Digital anatomic study on sacral lateral mass screw for sacral fracture

Objective To investigate the anatomical features of the safe zone for sacral lateral mass screw placement and find the safe trajectory, so as to provide reference for clinical application. Methods The three-dimensional computed tomography scan materials of sacrococcygeal vertebrae in 60 patients admitted to the Liaocheng People's Hospital of Shandong Province were analyzed by Mimics software to establish three-dimensional models. There were 33 males and 27 females, aged 25-78 years, with an average age of 45.7 years. After the safe zone was separated from sacral lateral mass model, a maximum cylinder was placed into the safe zone according to its anatomical feature. The cylinder was established as safe trajectory. Anatomical data were measured, including the length and diameter of screw trajectory, the distance between the entry point and the middle jaw, and adjacent upper and lower foramen, as well as the intersection angle between the screw direction and sagittal plane, between the screw direction and the adjacent upper end plate. Results The restriction factor of screw size on S1, S2 lateral mass was transverse diameter, while the restriction factor on S3, S4 was the distance between adjacent intervertebral foramen. The maximal length of screw from S1 to S4 was 30 mm, 35 mm, 30 mm, 14 mm respectively, while the maximal diameter was 12 mm, 9 mm, 5 mm, 5 mm respectively. The best entry point of S1 mass screw was lateral to the zygopophysis. The best entry point of S2-S4 mass screw was located at the midpoint of a line connecting the lateral edge of adjacent posterior sacral foramen approximately about 2 cm from median sacral crest. The leaning angles of screw was increased successively, and the sagittal plane was slightly inclined. There were significant differences between male and female groups in the leaning angle in S2 [male: (35.8±1.2)°, female: (37.9±3.7)°] and the distance between entry point and median sacral crest [male: (20.5±1.0)mm, female: (19.1±1.4)mm](P 0.05). Conclusions Cylindrical bony channel which is feasible for screw placement can be found in the lateral mass of sacrum. Individualized measurement can provide reference for application of lateral mass screw. Key words: Sacrum; Computer-aided design; Models, anatomic; Bone screws

Effects of health education based on Problem-based learning in patients with non-alcoholic fatty liver disease

Objective To explore the effects of health education based on problem-based learning (PBL) in patients with non-alcoholic fatty liver disease (NAFLD) , so as to provide a basis for improving nursing quality and health education. Methods From January 2017 to January 2018, we selected NAFLD patients at Liaocheng People's Hospital of Shandong Province as subjects by convenience sampling. All of the patients were divided into control group and intervention group with the method of random number table, 100 cases in each group. Control group carried out routine health education, while intervention group adopted health education based on PBL. We compared the result of B-ultrasound and quality of life among patients between two groups 9 months after intervention. Results After intervention, the ratio of NAFLD by liver B-ultrasound of intervention group was lower than that of control group with a statistical difference (χ2=10.526, P<0.05) ; the score of quality of life of patients in observation group was higher than that in control group with a statistical difference (t=-4.949, P<0.01) . Conclusions Patient-centered health education based on PBL can effectively improve fatty liver of patients with NAFLD, patients' quality of life and nursing intervention. Key words: Fatty liver; Non-alcoholic fatty liver disease; Problem-based learning; Health education; Quality of life

Overexpression of microRNA-620 facilitates the resistance of triple negative breast cancer cells to gemcitabine treatment by targeting DCTD.

Patients with triple negative breast cancer (TNBC) have a poor survival rate following chemotherapy due to drug resistance. Notably, the molecular mechanism of drug resistance remains elusive. Between December 2011 and December 2014, 36 TNBC samples were obtained from Liaocheng People's Hospital. Three gemcitabine-resistant MDA-MB-231 cell lines (MDA-MB-231rGEM1, MDA-MB-231rGEM2 and MDA-MB-231rGEM3) were obtained by exposure of MDA-MB-231 cells to increasing concentrations of gemcitabine for >12 months. Reverse transcription-quantitative polymerase chain reaction was performed to detect the expression levels of specific genes, including microRNA (miR)-620, ATP-binding cassette sub-family B member 1 (ABCB1), ABCC10, cytidine monophosphate kinase, deoxycytidine monophosphate deaminase (DCTD), nucleoside diphosphate kinase 1 (NME1), ribonucleoside-diphosphate reductase large subunit (RRM1) and RRMB2. Western blot analysis was performed to assess the protein expression levels of DCTD. Furthermore, cell proliferation was assessed using a Cell Counting Kit-8 assay and cell apoptosis was detected using an Annexin V/Dead Cell Apoptosis kit. Interactions between miR-620 and DCTD were predicted using TargetScan and detected with the dual luciferase reporter assay. Elevation of miR-620 expression levels were detected in two of the assessed gemcitabine-resistant MDA-MB-231 cell lines compared with MDA-MB-231 cells. Gemcitabine induced significant elevation of miR-620 in MDA-MB-231 cells. An increase of DCTD at mRNA and protein expression levels in MDA-MB-231rGEM1 cells was observed compared with those in MDA-MB-231 cells. Results suggested that DCTD was directly regulated by miR-620. Inhibition of miR-620 and overexpression of DCTD reversed gemcitabine resistance in MDA-MB-231rGEM1 cells via inducing cell apoptosis and cell growth arrest. A negative correlation was identified between miR-620 and DCTD mRNA expression levels in patients with TNBC. The present results demonstrated that overexpression of miR-620 could contribute to the development of gemcitabine resistance in patients with TNBC via the direct downregulation of DCTD.

The status of the discharge readiness in patients with intracranial aneurysm undergoing interventional therapy and its influencing factors

Objective To describe the status of discharge readiness of patients with intracranial aneurysm undergoing interventional therapy and explore its influencing factors. Methods Easy sampling method was used to select 136 patients with intracranial aneurysm undergoing interventional therapy at the Department of Neurosurgery, Liaocheng People's Hospital. Clinical data questionnaire was applied to collect the clinical data of patients. Discharge readiness scale and discharge guidance quality scale were adopted to assess patients′ discharge readiness and discharge guidance quality. Pearson correlation analysis was used to analyze the correlation between discharge guidance quality and discharge readiness, while multi-linear regression analysis was used to analyze the influencing factors of discharge readiness. Results In this study, the total score of discharge readiness in patients with intracranial aneurysm undergoing interventional therapy was (157.90±26.98) points, which was at a moderate level. Pearson correlation analysis showed that the discharge guidance quality was positively correlated with the discharge readiness for patients with intracranial aneurysm (r=0.619, P<0.01). Multi-linear regression analysis showed that the education level, family average monthly income, place of residence, numbers of long-term medications required, and discharge guidance quality were factors influencing the discharge readiness of patients with intracranial aneurysm undergoing interventional therapy (β′=0.102, 0.175, 0.391, -0.226, 0.314, P<0.05). Conclusion In patients with intracranial aneurysm undergoing interventional therapy, the discharge readiness was at a moderate level, and the medical staff should make interventional strategies, taken the factors affecting the discharge readiness into consideration, and strength the discharge guidance quality to improve the patients′ discharge readiness and prognosis. Key words: Intracranial aneurysm; Discharge readiness; Discharge guidance quality; Influencing factors