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Objective:To construct an early predictive model for the death of patients after extracorporeal membrane oxygenation (ECMO) based on the baseline information of patients and laboratory indicators.Methods:The clinical data of 139 patients who underwent ECMO in Affiliated Jinhua Hospital, Zhejiang University School of Medicine from January 2015 to December 2021 were collected, including age, gender, primary disease, ECMO model, other clinical characteristics, and laboratory indicators 2 hours after establishment of ECMO. The patients were divided into training cohort ( n = 111) and validation cohort ( n = 28) according to a ratio of 4∶1. The least absolute shrinkage and selection operator (Lasso) regression and multivariate Logistic regression were used to select predictive factors, and a nomogram was used to establish the predictive model. The calibration and discrimination of the model were assessed using the receiver operator characteristic curve (ROC curve), the calibration curve and Kaplan-Meier analysis. Results:Four predictive variables including anion gap (AG), lactic acid (Lac), arterial partial pressure of oxygen (PaO 2), and serum amylase (AMY) 2 hours after ECMO were selected from 34 laboratory indicators by Lasso regression. These variables and three other clinically important factors [primary diseases, ECMO model, and acute kidney injury (AKI)] were analyzed using multivariate Logistic regression (forward: LR method), Finally, four strong predictive factors (Lac-2 h, PaO 2-2 h, AMY-2 h, and primary diseases) for mortality were used to construct a nomogram [the area under ROC curve (AUC) was 0.85, 95% confidence interval (95% CI) was 0.78-0.92]. The optimal cut-off value of the ROC curve was 0.398 based on the maximum principle of the Youden index, corresponding to 80.2% accuracy, 89.1% sensitivity, and 68.1% specificity. The validation cohort with an in-hospital mortality of 64.3% was used to verify the performance of the model by ROC curve and Kaplan-Meier analysis. According to the optimal cut-off value of the ROC curve (0.398), the validation cohort was divided into low- and high-risk groups. Based on this model, the survival probability of the low-risk group was significantly higher than that of the high-risk group ( P = 0.018), indicating this model had good discriminative ability in the validation cohort. Based on this model, the AUC of the validation cohort was 0.76, 95% CI was 0.58-0.94, and the accuracy rate was 71.43%, which indicated this model showed good calibration consistency. Conclusions:The predictive model incorporating Lac-2 h, PaO 2-2 h, AMY-2 h, and primary diseases may be significant for predicting the in-hospital mortality of patients undergoing ECMO.
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Objective To investigate the effect of volume resuscitation with normal saline (NS) at 37 ℃ on the coagulation function and microcirculation of neonates with septic shock. Methods Children with septic shock admitted to neonatal intensive care unit (NICU) of the First Affiliated Hospital of Gannan Medical University were enrolled. Twenty-four newborns with septic shock were divided into two groups by random number table method (12 in each group), and were resuscitated with 10 mL/kg at 25 ℃ NS and 37 ℃ NS respectively on the basis of routine treatment. FactorⅡ,Ⅴ,Ⅶ,Ⅷ,Ⅸ,Ⅹ, and prothrombin time (PT), thrombin Time (TT), fibrinogen (FIB), activated partial thromboplastin time (APTT), D-Dimer (DD), lactic acid (Lac) were detected before treatment and 6 hours and 12 hours after treatment. Results The levels of coagulation factors Ⅱ,Ⅴ,Ⅶ,Ⅷ,Ⅸ,Ⅹ were not significantly changed before and after treatment in the two groups, and there was no significant difference between the two groups. After treatment, PT and APTT in both groups were gradually shortened, DD and Lac were gradually decreased, FIB were gradually increased, while TT had no significant change. Among them, PT, APTT, DD and Lac at 6 hours after treatment in 37 ℃NS group were significantly lower than those before treatment [PT (s): 14.07±1.02 vs. 17.08±1.54, APTT (s):54.83±12.39 vs. 69.17±16.36, DD (mg/L): 2.40±0.63 vs. 4.18±0.88, Lac (mmol/L): 2.84±0.82 vs. 5.98±1.17, all P < 0.05]; DD and Lac at 6 hours after treatment in 25 ℃ NS group were significantly lower than those before treatment [DD (mg/L): 3.13±0.84 vs. 4.16±1.04, Lac (mmol/L): 4.83±0.64 vs. 5.69±0.74, both P < 0.05], and PT at 12 hours after treatment was significantly shorter than that before treatment (s: 14.63±1.14 vs. 16.48±1.61, P < 0.01); FIB in both 25 ℃ NS group and 37 ℃ NS group at 12 hours after treatment were significantly higher than those before treatment (g/L: 2.83±0.83 vs. 1.58±0.43, 2.87±0.87 vs. 1.47±0.41, both P < 0.01), but TT had no significant change. The comparison between groups showed that PT, DD and Lac in the 37 ℃ NS group were significantly lower than those in the 25 ℃ NS group at 6 hours after treatment [PT (s): 14.07±1.02 vs. 15.69±1.21, DD (mg/L): 2.40±0.63 vs. 3.13±0.84, Lac (mmol/L): 2.84±0.82 vs. 4.83±0.64, all P < 0.05]; at 12 hours after treatment, PT, APTT and DD in the 37 ℃NS group were significantly lower than those in the 25 ℃ NS group [PT (s): 13.26±0.91 vs. 14.63±1.14, APTT (s):37.08±10.43 vs. 54.75±14.96, DD (mg/L): 1.20±0.59 vs. 2.06±0.69, all P < 0.01], and FIB was significantly higher than that in the 25 ℃ NS group (g/L: 2.87±0.87 vs. 2.83±0.83, P < 0.05). Conclusion Volume resuscitation at 37 ℃ can improve the coagulation function and microcirculation of newborns with septic shock.
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In order to investigate the distribution of Yersinia enterocolitica in Citellus dauricus plague focuses in Inner Mongolia,three different ecological environ/ments were chosen as the sampling area.Feces,tongue roots throat swabs,and intestinal contents of rodent,livestock,and poultry were separately collected,and different Y.enterocolitica strains were isolated,and identified.PCR analysis was conducted to detect the toxicity genes of Y.enterocolitica.Statiscal analysis was performed by chisquare test.Of the 3 260 samples,65 Y.enterocolitica strains were isolated and the overall detection rate was 1.99％.To include O ∶ 3/3,O ∶ 5/1A,O ∶ 4/4 serum biological type,the pathogenic strain of serotype O ∶ 3 and biological typt 3 carryinq toxicity genes ail,ystA,VirF yadA and rfbc was isolated from pigs in Citellus dauricus plague focuses,Inner Mongolia are the major carrier of pathogenic Y.enterocolitica distributed in three different ecological environment,and distributed mainly in agricultural area.
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Objective To investigate the distribution of the prevalence of albuminuria in elderly population of a community in Tianjin and analyze the situation of their early renal injury and its clinical and environmental risk factors.Methods The morning spot urine sample and the clinical data from 2 050 old population (aged ≥ 60 years)who took part in healthy examination were collected.The concentration of urine albumin and creatinine were tested,and the albumin/creatinine ratio(ACR)was calculated.We analyzed the prevalence of albuminuria,and used logistic regression to analyze the odd ratio(OR) of risk factors.Results In the 2 050 participants,the prevalence was 1162 cases (56.69％) for hypertension,264 cases (12.86％) for diabetes and 568 cases (27.71％) for albuminuria.The prevalence of ACR ＞ 30 mg/g was lower in men than in women (21.61％ vs.32.55％,P＜0.001).The OR for increased ACR was 1.45 in 70-79y subjects as compared with 60-69y subjects,and the OR was 1.89 in ＞80y old people.The OR of increased ACR was 2.03 in ＞80y old people after adjusting gender.Body mass index and waist circumference were not the risk factors of increased ACR after adjusting confounding factors.There was an association between the prevalence of albuminuria and triglycerides(OR=1.19),hypertension(OR=1.68),diabetes(OR=1.95).ACR value was increased along with increased number of cigarettes,however,there was also no association between smoking and albuminuria(P＞ 0.05).Physical activity could reduce the risk of albuminuria,the OR of ACR＞30 mg/g in those undertaking a activity once daily was 0.52 (P =0.027) Conclusions There is a high prevalence of albuminuria in elderly population(higher in female than in male) in a community of Tianjin.Hypertension and diabetes have the greatest influence on ACR.Additionally,the physical activity once daily can reduce the risk of albuminuria.
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Objective To investigate the situation of urine albumin measurement of clinical laboratory in Tianjin.Methods Control materials from patient mixed urine samples were made to validate precision in the clinical laboratories in Tianjin.Reference Material ERM-DA470K was prepared as the first external quality assessment ( EQA) sample, and the bias between laboratories was calculated.Then we give some advice about the methods of routine maintenance, calibration, standardized operation, internal quality assessment and so on to the laboratories which were not qualified in the first EQA.Then the second EQA was carried out and CV and bias were culculated.Results 52 clinical laboratories has 12 series of instruments and 17 series of reagents.The precision research showed that most laboratories ( 93.55%) had good precision for urine albumin measurement, while CV of inter-laboratory was great:the range of low level of control sample was 8.91 -43.95 mg/L, 34.46% for CV; and the high level was 36.32 -281 mg/L, 28.51% for CV.Only 36.5% laboratories were qualified in the first EQA. The qualified rate for nephelometry and turbidimetry was higher (55.6%, 42.9%).The qualified rate of trueness verification was 58.6%in the second EQA, and the CV between laboratories was significantly decreased, Inter-laboratory CV of the five samples were:19.83%, 13.57%, 13.41%, 13.08%, 11.37%. The qudified rate for nephelomety and turbidimetry was 71.4% and 56.3%.Conclusions There are a mide variety of measurement systems of urine albumin in Tianjin, and the CV between these systems is great.Clinical laboratory should strengthen the laboratory standardization operation and upgrade calibration testing to improve the testing consistency.
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Objective To explore the association between acute ischemic stroke and albumin to creatinine ratio (ACR).Methods A case-control study.During January to December in 2013, 127 acute ischemic stroke patients as case group and 150 controls who were similar with case group in age and gender were recruited in Tianjin Union Medicine Center . According to diabetes , hypertension , cardiovascular diseases and patients without these three diseases , case group was divided into A1, B1, C1 and D1 subgroups, control group was divided into A2, B2, C2 and D2 subgroups in the same way.The first morning urine from participants were collected .Urinary albumin concentration was tested by nephelometry , urinary creatinine was examined by using enzymic method , ACR were calculated(≥30 mg/g as the cutoff value). Then difference of ACR between case and control group was compared , the cutoff value of albuminuria for ischemic stroke patients was analyzed by ROC , and the risk factor of ischemic stroke were analyzed by logistic regression analysis.Results The prevalence of albuminuria in ischemic stroke patients was 38.58%(49).According to analysis of covariance, after adjustment for age, gender, cardiac-disease, diabetes, hypertension, lnACR in case group was significantly higher than control group (3.18 mg/g vs 2.78 mg/g, t=2.13 P=0.03), especially D1 was significantly higher than D2 subgroup (3.01 mg/g vs 2.51 mg/g,t=5.56,P=0.009) .If 19.82 mg/g from ROC analysis was used as the cut-off value, the sensitivity and specificity are 68.5% and 61.7%.The odds ratio ( OR ) of ACR >19.82 mg/g was about 2-fold when compared with ACR<19.82 mg/g adjusted for stroke risk factors , and the OR value is 2.43 in comparison of patients without diabetes , hypertension and cardiovascular diseases .Conclusions Urinary albumin excretion is the independent risk factor of ischemic stroke .The increased urinary albumin has important clinical significance to predict the risk of ischemic stroke for the patients without diabetes , hypertension and cardiovascular diseases.
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Objective To analyze the expression of glial fibrillary acidic protein(GFAP) in hippocampal of rats with hypoxic-ischemic brain damage(HIBD) after injection of bone marrow stromal cells(BMSCs) supernatant into the lateral ventricle of the neonate rats,assess the ability of learning and memory,and explore the mechanism.Methods 7-day-old SD rats were randomly divided into sham operation group,model group,cells and supernatant group,with 20 rats in each group.The HIBD model was established via the ligation of left carotid arteries followed by 2-hour hypoxia.One week later,rats in control group were injected with 0.01 mol/L PBS 2 μl via the left ventricle.Meanwhile,the cell and the supernatant groups were injected with BMSCs and supernatant harvested from BMSC culture,respectively,via the same route.In the sham operation group,the left carotid arteries were separated but not ligated,and no hypoxia treatment was imposed on this group.They also received 0.01 mol/L PBS injection 2 μl per weak post surgery.8 weeks later,Morris water maze test was performed to assess the learning and memory,and the expression of GFAP in the dentate gyrus of rats was measured by immunohistochemistry.Results Morris water maze showed that the searching time of the probe trail(T1:(15.40±2.80) s) and reversal probe trail (T2:(16.45± 1.16) s) of the model group was shorter than that of the sham operation group (T1:(19.96±2.57) s,T2:(2:25.32±2.54)s,P＜0.05),while the searching time of the cell group(T1:(17.54± 1.80)s,T2:(18.99± 1.47) s) and supernatant group (T1:(17.40±2.37) s,T2:(17.96± 1.09) s) was prolonged compared with that of the model group (P＜0.05).No significant difference between the cell group and the supernatant group (P＞0.05).The integral optical density (IOD) value of GFAP positive cells was higher in the model group than that in the sham operation group(15.26±1.49 vs 12.82±2.56,P＜0.05),while the IOD of cell group(18.13±1.97) and that of the supernatant group(17.38± 1.64) were higher than that of the model group (P＜0.05).However,there was no significant difference between the cell group and the supernatant group (9＞0.05).Conclusion BMSC supernatant injected through lateral ventricle can improve the HIBD rats' abilities of learning and memory.The mechanism might be that MSCs secrete some cytokines to promote central nervous system repair.
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Currently the detection of albumin excretion rate is widely used to screen early renal injury.In recent years,there are many researches about the prevalence of albuminuria in the general population around the world,showing the high prevalence of albuminuria in the general population,and indicating that the increased albumin in urine is significantly correlated with obesity,abnormal lipid metabolism,abnormal glucose metabolism,hypertension and life habits.Meanwhile,numerous studies find that albuminuria is an independent risk factor for the progression and risk evaluation of cardiovascular disease and all-cause mortality,it can be a useful predictor of cardiovascular mortality and all-cause mortality in the general population.
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Objective To evaluate the auxiliary diagnostic ability and applicability of ~(18)F-FDG PET/CT and the LungCare soft-ware of dual source CT in solitary pulmonary nodule(SPN). Methods 28 patients with SPN proved by pathologically were examined by ~(18)F-FDG PET/CT and LungCare software of dual source CT. ~(18)F-FDG PET/CT and LungCare software of dual source CT data were analysed comparatively in terms of the diagnostic accuracy in distinguishing malignant and benign. All data were analyzed for significance by using the χ~2-test,the value of P<0.05 was accepted as significance. Results There were 15 malignant and 9 benign nodules. In evaluating SPN,the diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 80.0% ,88.8% ,83.3%,92.3% and 72.7% with ~(18)F-FDG PET/aT respectively,and 93.3% ,77.7% ,87.5%,87.5% and 87.5% with LungCare software, respectively. To evaluate SPN,LungCare software and ~(18)F-FDO PET/CT was not significant difference in accuracy(P>0.05) ,while there were significant differences in sensitivity , specificity , positive and negative predictive value (P< 0.05). The sensitivity and negative predictive values with~(18)F-FDG PET/aT were much better than that with LungCare software, but the specificity and positive predictive values were less than that with LungCare software. Conclusion ~(18)F-FDG PET/CT has certain auxiliary function in distinguishing benign SPN from malignant SPN,it combining with LungCare software , the accuracy of diagnosis can be improved.
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Objective To investigate the feasibility of the adaptive cardio sequence prospective ECG-gated dual-source CT coronary angiography (CTCA).Methods Thirty one patients underwent prospective ECG-gated dual-source CTCA. The patients were divided into two groups: group A, heart rate ≤ 75 times / minutes, 70% of R-R interval was chose; group B, heart rate> 75 times / minutes, 40% of R-R interval was chose. Two experienced radiologists assessed the image quality of 15 segments of coronary arteries in a double blinded fashion in a four score scale. Student t test was used to compare the image quality between two groups. CT dose index(CTDIvol) and effective dose(ED) were also calculated for both groups. Results 437 segments of coronary arteries in 31 patients were included this analysis, 408 segments (93.4%) had assessable image quality, while 29 segments (6.6%) had non assessable image quality. Of 226 segments in group A, 12 segments (5.3%) had non assessable image quality; however, 17 segments (8.1%) of 211 segments in group B had non assessable image quality. The average score of image quality was 3.57±0.64 in 31 patients. There was no statistical difference for mean image quality of group A (3.65±0.39) and group B (3.41±0.43)( t=1.62,P=0.12 ) . There was a statistical difference for mean image quality for segment 10 on a per segment basis ( t = 3.8 ,P＜0.05). CTDIvol and ED were (18.88±5.04) mGy and (4.31±1.05) mSv, respectively.Conclusion Adaptive cardio sequence prospective ECG-gated dual source CT can acquire assessable image quality of coronary artery with lower radiation dose to the patients, which has the potential to be a routine CTCA technique.
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Objective To evaluate the auxiliary diagnostic ability and applicability of the Lung Care software of dualsource CT in the study of solitary pulmonary nodule(SPN). Methods 40 cases with SPN proved by pathologically were examined by dual-source CT. R-MPR and VOI of Lung Care software three-dimension rebuilding image were obtained to analyze imaging features of SPN and compared with routine chest CT. 20 cases had regular visits during 12 months which were divided into three stages to measure the growing speed or doubling time. Results There were 28 cases of malignant nodules and 12 cases of benign nodules in 40 cases of SPN. The accuracy for malignancy of routine chest CT and LungCare software three-dimension rebuilding are 53.57% ,82.14% respectively. The accuracy for benign nodules is 41.67%,83.33% respectively. Both are significant difference (P
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Objective:To study the effects of celioscope carbon dioxide pneumoperitoneum on the growth of cervical carcinoma cell line in vitro. Methods:Cervical carcinoma cells CASKI were cultured in vitro,and then treated with 14mmHg,100% carbon dioxide for 2h. The proliferation,cell cycle and expressions of CDK4 and Cyclin D1 were examined by MTT, FCM and immunocytochemistry respectively. Results:After the treatment of carbon dioxide, the proliferation of cervical carcinoma cells CASKI was significantly increased at the 3th day, the proportion of proliferative phase in the cell cycle was significantly increased, and the expressions of CDK4 and Cyclin D1 were also significantly increased. Conclusion:carbon dioxide may promote the proliferation of cervical carcinoma cell line.