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ObjectiveTo explore the effects of modified Gualou Zhishitang combined with piperacillin sodium and tazobactam sodium on the immune function and serum levels of inflammatory cytokines in the patients with stroke-associated pneumonia （SAP， syndrome of phlegm-heat accumulation in lung）. MethodEighty SAP patients with the syndrome of phlegm-heat accumulation in lung were randomized into a control group （40 cases） and a study group （40 cases）. The SAP patients in the control group were treated with piperacillin sodium and tazobtam sodium， while those in the study group were treated with modified Gualou Zhishitang on the basis of the treatment in the control group for 2 consecutive weeks. The clinical therapeutic effects， immune function indexes， inflammation indexes， and lung function of SAP patients in the two groups before and after treatment were determined and compared. ResultAfter treatment， the scores of lesion， pulmonary rales， cough， fever， phlegm color， and constipation in both groups decreased （P<0.05）. After treatment， the ratio of forced expiratory volume in the first second to forced expiratory volume （FEV1/FVC） and forced expiratory volume in the first second as percentage of predicted value（FEV1%） in both groups improved （P<0.05）， and the study group outperformed the control group （P<0.05）. The treatment decreased the neutrophil to lymphocyte ratio （NLR） in the two groups （P<0.05）， and the study group had lower NLR than the control group after treatment （P<0.05）. The serum levels of procalcitonin （PCT） and hypersensitive C-reactive protein （hs-CRP） in both groups declined after treatment （P<0.05）， and the declines were more significant in the study group than in the control group （P<0.05）. After treatment， the study group was better than the control group （P<0.05）. The treatment in both groups elevated the levels of CD3+， CD4+， and CD4+/CD8+ in the peripheral blood and lowered the level of CD8+ （P<0.05）， and the changes were more significant in the study group than in the control group （P<0.05）. The total response rate of the study group was 95.00% （38/40）， which was higher than that （80.00%， 32/40） of the control group （χ2=4.114，P<0.05）. There was no significant difference in the incidence of adverse reactions between the two groups. ConclusionModified Gualhou Zhishitang combined with piperacillin sodium and tazobactam sodium demonstrates a significant therapeutic effect on the SAP patients with the syndrome of phlegm-heat accumulation in lung. This therapy can mitigate the clinical symptoms， improve the lung function， lower the serum levels of inflammatory cytokines， and improve the immune capacity， with high safety.
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Sepsis is a life-threatening organ dysfunction caused by infection that lead to dysregulation of the host response. Sepsis and septic shock with a high mortality threaten human health at present, which are important medical and health problems. Early diagnosis and treatment decision-making for sepsis and septic shock still need to be improved. Exosomes are extracellular vesicles with a diameter of 30-150 nm formed by the fusion of multi-vesicle bodies and cell membranes. Exosomes can effectively transport a variety of bioactive substances such as proteins, lipids, RNA, DNA, and participate in the regulation of inflammatory response, immune response, infection and other pathophysiological processes. In recent years, exosomes have become one of the important methods for the diagnosis and treatment of systemic inflammatory diseases. This article will focus on the basic and clinical research of sepsis, and focus on the research progress of exosomes in the diagnosis and targeted therapy of sepsis.
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Humans , Shock, Septic/therapy , Exosomes/metabolism , Sepsis/therapy , Extracellular Vesicles/metabolism , RNA/metabolismABSTRACT
Objective:To investigate the significant effects of enhanced whole-body computed tomography (EWBCT) and non-enhanced whole-body computed tomography (N-EWBCT) on the missed diagnosis rate, renal function and prognosis of patients with severe trauma.Methods:Clinical data of trauma patients admitted from January 1, 2017 to December 31, 2020 were collected from the trauma database of the Trauma Center of the Second Affiliated Hospital of Soochow University. All patients included in this study were divided into the EWBCT group and N-EWBCT group according to whether they underwent enhanced whole-body computed tomography examination. The differences in baseline data, missed diagnosis rate, renal function and prognosis of the two groups of patients were compared.Results:A total of 459 patients were included in this study, including 184 patients in the EWBCT group and 275 patients in the N-EWBCT group. The missed diagnosis rate of the N-EWBCT group was significantly higher than that of the EWBCT group (18% vs. 5%, P < 0.01). The risk ratio of acute kidney injury (AKI) in the EWBCT group and N-EWBCT group was 9% and 7%, respectively, and there was no statistical difference between the two groups ( P >0.05). The mortality rate of patients in the N-EWBCT group was higher than that in the EWBCT group (23% vs. 12%, P=0.002). Conclusions:Compared with N-EWBCT, EWBCT does not significantly increase the risk of renal damage in patients with severe trauma. For patients with severe trauma, early EWBCT can reduce the missed diagnosis rate and improve the clinical prognosis.
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Background@#Different views have been proposed on the radiofrequency treatment modes and parameters of radiofrequency thermocoagulation of the spinal dorsal root ganglion for the treatment of postherpetic neuralgia (PHN). It is urgent to identify a more effective therapy for patients with PHN. @*Methods@#Patients who underwent radiofrequency thermocoagulation therapy for PHN were retrospectively reviewed and were divided into a radiofrequency thermocoagulation (CRF) and double neddles radiofrequency thermocoagulation (DCRF).The pain scores (numerical rating scale, NRS) were evaluated at the following time points: before the operation, 1 day, 3 months, 6 months, 1 year, and 2 years after operation. The incidence of complications and the degree of pain relief were evaluated. The in vitro ovalbumin experiment was used to indicate the effects of radiofrequency thermocoagulation. @*Results@#Compared with the preoperative NRS scores, the postoperative NRS scores decreased significantly; the NRS scores of the DCRF group was lower than that of the CRF group at all time points from 6 months to 2 years following the operation. The total effective rate of the DCRF group was significantly higher than that of the CRF group at 2 years following the operation. The incidence of numbness in the DCRF group was higher than that noted in the CRF group. The ovalbumin experiments in vitro indicated that the effects of radiofrequency thermocoagulation were optimal when the distance between the two needles was 5 mm. @*Conclusions@#DCRF with a 5 mm spacing exhibits a longer duration and higher effective rate in the treatment of PHN and is worth promoting.
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Objective:To observe the changes of regional saturation of cerebral oxygenation (rScO 2) and blood neuron specific enolase (NSE) in patients after cardiopulmonary resuscitation (CPR), and to explore its value in evaluating the prognosis of patients' neurological function. Methods:From January 2012 to December 2020, 97 patients with return of spontaneous circulation (ROSC) after cardiac arrest (CA) treated in the intensive care unit (ICU) of the Second Affiliated Hospital of Soochow University were selected. According to the prognosis, the patients were divided into two groups: good neurological function group [Glasgow-Pittsburgh Cerebral Performance Categories (CPC) 1-2, 20 cases] and neurological dysfunction group (CPC classification 3-5, 77 cases). The clinical data of gender, age, the number of patients with defibrillable rhythm, time of ROSC, the number of CA patients outside the hospital, acute physiology and chronic health evaluationⅡ(APACHEⅡ), Glasgow coma scale (GCS), global non-response scale (FOUR), body temperature, mean arterial pressure (MAP), blood lactic acid (Lac) and GCS at discharge, as well as the length of ICU stay, rScO 2 and blood NSE were collected. The differences of rScO 2 and NSE between the two groups were compared; and the receiver operator characteristic curve (ROC curve) was drawn to evaluate the value of rScO 2 and NSE alone or in combination in predicting the prognosis of patients with ROSC after CA. Results:The rScO 2 of good neurological function group was significantly higher than that of neurological dysfunction group at 1, 3, 6, 12, 24 and 48 hours (all P < 0.05). At 24 hours after admission, the rScO 2 on the left and right sides of good neurological function group was significantly higher than that in neurological dysfunction group [left: 0.65 (0.59, 0.76) vs. 0.55 (0.44, 0.67), right: 0.62 (0.61, 0.73) vs. 0.50 (0.30, 0.69), both P < 0.05], and NSE was significantly lower than that in the neurological dysfunction group [ng/L: 21.42 (15.38, 29.69) vs. 45.82 (24.05, 291.26), P < 0.05]. ROC curve analysis showed that both rScO 2 and NSE alone and combined detection had a certain value in predicting the prognosis of neurological function in patients with ROSC after CA, and the area under the ROC curve (AUC) detected by the combination was the largest, which was higher than the AUC predicted by rScO 2 or NSE (0.904 vs. 0.884, 0.792). When the cut-off value of combination was 0.83, the sensitivity and specificity were 75.7% and 100% respectively. Conclusion:Monitoring rScO 2 and NSE can predict the prognosis of neurological function after CPR, especially the combined evaluation of the two indexes, which can greatly improve the accuracy of diagnosis.
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Objective:To investigate the risk factors affecting the prognosis of patients with extremely severe burns.Methods:Totally 46 patients with extremely severe burn in the dust explosion of aluminum powder in Kunshan, Jiangsu province on August 2, 2014 were included in this study. The patients were divided into the survival group and death group according to the prognosis of the patients. The patients' age, sex, burn degree, white blood cell, and lactic acid at admission, lactic acid at 48 h, creatinine, albumin, urine volume, blood calcium, acute physiology and chronic health score system II (APACHE II) and SOFA scores, and 90 d mortality were collected. COX regression analysis was used to analyze the possible relationship between the indicators of the two groups and the prognosis.Results:There were no significant differences in white blood cell at admission, creatinine, albumin, urine volume, SOFA score, and APACHE II score in the survival group compared with those in the death group (all P>0.05) and burn degree, the levels of lactic acid at admission, lactic acid at 48 h and blood calcium were significantly different (all P<0.05). Multivariate regression analysis showed that age, albumin and lactic acid at 48 h were independent predictors of death in patients with severe burn ( P<0.05), and these are independent outcome predictors of patients with severe burns ( P<0.05). Conclusions:Age, albumin level and lactic acid at 48 h are independent risk factors affecting the prognosis of patients with severe burns.
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Objective To compare the clinical efficacy of laparoscopiceft and open left lateral lobe hepatectomy for living donor liver transplantation in children.Methods The retrospective cohort study was conducted.The clinical data of 65 cases (14 males and 51 females) receiving laparoscopic living donor liver resection from October 2016 to October 2018 were analyzed.At the same time,the same number of male and female donors who underwent open left lateral lobe hepatectomy performed by the same group during the same period were randomly selected as the control group.The occurrence of complications and long-term follow-up of physical and mental health were compared between the two groups.Follow-up using outpatient examination and telephone interview was performed to detect postoperative recovery and complications up to November 2018.Results Intraoperative conditions:In the laparoscopic operation group,one donor was converted to open operation due to the confluence of the middle hepatic vein branches bleeding during the operation,and the rest donors successfully completed the laparoscopic left lateral lobe hepatectomy.The operation time of laparoscopic group was (216.0 ± 36.5) min,the amount of bleeding during operation was (56.0 ± 44.3) mL,and the warm ischemia time of donor liver was (6.4 ± 3.8) min.All 65 donors in open operation group successfully completed the operation.The operation time was (167.0 ± 19.7)min,the amount of bleeding was (138.0 ± 59.4) mL,and the time of warm ischemia of donor liver was (1.4 ± 0.5) min.There were significant differences in the above indexes between the two groups (P＜0.05).Postoperative complications:The incidence of incision fat liquefaction was 3.54％ and 2.51％ respectively in laparoscopic group and open group.The time to first anal exhaust after operation of laparoscopic and open groups was (52.3 ± 4.9) h vs.(62.6 ± 4.1) h,P ＜ 0.05.The average length of hospitalization in laparoscopic and open groups was (4.2 ± 0.4) days vs.(5.0 ± 0.6)days,P ＞ 0.05.Conclusions Laparoscopic left lateral lobe living donor liver resection can achieve the same safety as traditional open surgery,and can reduce the physical and mental injury of donors.It is a reasonable choice for living donor liver transplantation.
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Objective To study the clinical value of brain natriuretic peptide (BNP) and soluble urokinase plasminogen activator receptor (suPAR) in the diagnosis and prognosis of bloodstream infection.Methods Totally 165 patients suspected of bloodstream infection admitted in intensive care unit (ICU) of the Second Hospital Affiliated to Suzhou University were enrolled in this study.According to the diagnosis standard of bloodstream inflection,patients were divided into the bloodstream infection group and non-bloodstream infection group.According to the prognosis of the patients,the bloodstream infection group was further divided into the survival group and the death group.Serum levels of suPAR,BNP,CRP,PCT,and chronic health evaluation Ⅱ acute physiology score (APACHE Ⅱ),and mortality of the patients were analyzed,and the possible relation of the above indexes between the two groups were compared.Based on the receiver operating characteristic curve (ROC) and the area under the curve (AUC),the early diagnostic value of suPAR,BNP,CRP,PCT,and APACHE Ⅱ score in the bloodstream infection patients was determined.Results Serum levels of suPAR,BNP,CRP,PCT and APACHE Ⅱ score in the bloodstream infection group were higher than those in the non-bloodstream infection group (P＜0.05);Serum levels of suPAR,BNP,CRP,PCT and APACHE Ⅱ score in the death group were higher than those in the survival group (P＜0.05).There was a positive correlation between serum suPAR,BNP,PCT and APHCHE Ⅱ] score in patients of bloodstream infection(r=0.503,0.548,0.781,all P＜0.05).The levels of suPAR,BNP,PCT and APACHE Ⅱ in the patients of blood stream infection were related to significant the prognosis (P＜0.05).And these indexes can provide good evaluation on the prognosis of the patients.Conclusion Detection of serum suPAR,BNP can evaluate the severity of bloodstream infection and preliminarily determine the prognosis of patients with bloodstream infection.Therefore,the method is worth applying in the clinical field.
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Objective To observe the effect of early bundle therapy on prognosis of patients with sepsis/septic shock and analyze the risk factors for death.Methods A retrospective cohort study was conducted to select patients with sepsis/septic shock at the Second Soochow University Hospital betweenJanuary 1,2016,and December 31,2016.Data pertaining to demographic variables,compliance rate of bundle therapy,and incidence of organ failure were collected.Patients were categorized into the nonsurvivor or survivor groups based on 28-day mortality.Logistic regression analysis was used to identify risk factors for 28-day mortality.Results Totally 118 sepsis/septic shock patients were included in the analysis;28-day mortality was 32.2％.Compared to the survivor group,patients in the non-survivor group were more likely to have chronic heart dysfunction and cerebrovascular disease,lower lactate clearance,lower 6-h compliance rate of bundle therapy and higher incidence of failure of one or ＞2 organs.Age,leukocyte,blood urea nitrogen,creatinine,brain natriuretic peptide,sequential organ failure score and acute physiological and chronic health scores Ⅱ on admission,and lactate after bundle therapy were higher than that of the survivor group.Logistical regression analysis showed that age ≥ 75 years [odds ratio (OR)1.012],6-h lactate clearance ＜30％ (OR=1.122),chronic heart failure (OR=1.741),failure of ＞2 organs (OR=1.769),and 6-h compliance rate of bundle therapy (OR=1.958) were independent risk factors for 28-day mortality.Conclusions Patients with sepsis/septic shock need early diagnosis and resuscitation to improve the compliance rate of bundle therapy and reduce the mortality.
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Objective To investigate the effect of space glucose control (SGC) on the quality of blood glucose management in ICU patients with stress hyperglycemia.Methods A prospective,cross-controlled,quasi-trial was conducted to observe patients with ICU-induced stress hyperglycemia between January 2018 and January 2019.Patients with conventional blood glucose management served as the control group,and SGC blood glucose management was used as the intervention group.The enrolled patients were interchanged between the two groups every 24 h,and the end point was 96 h.The differences in blood glucose management quality indicators between the two groups were compared,including the average blood glucose level,the highest and lowest blood glucose level,the average blood glucose monitoring interval,and the accumulated insulin dosage.SPSS 23.0 was used to analyze the data.The paired t test was used for the normal distributed data.Otherwise,two nonparametric correlation sample tests was used.A P＜0.05 was considered statistically significant.Results A total of 41 patients enrolled in this study during the study period.The average blood glucose value in the intervention group was significantly lower than that in the control group [(8.60 ±l.42)mmol/L vs (10.02 ±1.49)mmol/L,P＜0.01].The frequency of hyperglycemia was lower than that of the control group (16.59 ±8.56 vs 18.73 ±7.91,P=0.023).The frequency of blood glucose value in the target blood glucose range was significantly higher than that of the control group (53.07±19.11 vs 29.44±19.60,P＜ 0.01).However,the frequency of hypoglycemia,the frequency of blood glucose monitoring and the accumulated insulin dosage in the intervention group were higher than those in the control group [1 (0,5) vs 0 (0,2),P＜ 0 01;1 36 ±0 23 vs 1 89 ±0 28,P＜ 0.01;and (139.61 ±77.06)U vs (107.49 ±64.41)U,P＜0.01].Conclusions SGC can optimize the control of blood glucose in the target blood glucose range,but it can easily lead to mild hypoglycemia,and to a certain extent increases the workload of medical staff.
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Objective@#To investigate the effect of space glucose control (SGC) on the quality of blood glucose management in ICU patients with stress hyperglycemia.@*Methods@#A prospective, cross-controlled, quasi-trial was conducted to observe patients with ICU-induced stress hyperglycemia between January 2018 and January 2019. Patients with conventional blood glucose management served as the control group, and SGC blood glucose management was used as the intervention group. The enrolled patients were interchanged between the two groups every 24 h, and the end point was 96 h. The differences in blood glucose management quality indicators between the two groups were compared, including the average blood glucose level, the highest and lowest blood glucose level, the average blood glucose monitoring interval, and the accumulated insulin dosage. SPSS 23.0 was used to analyze the data. The paired t test was used for the normal distributed data. Otherwise, two nonparametric correlation sample tests was used. A P<0.05 was considered statistically significant.@*Results@#A total of 41 patients enrolled in this study during the study period. The average blood glucose value in the intervention group was significantly lower than that in the control group [(8.60 ±1.42)mmol/L vs (10.02 ±1.49)mmol/L, P< 0.01]. The frequency of hyperglycemia was lower than that of the control group (16.59 ±8.56 vs 18.73 ±7.91, P=0.023). The frequency of blood glucose value in the target blood glucose range was significantly higher than that of the control group (53.07±19.11 vs 29.44±19.60, P< 0.01). However, the frequency of hypoglycemia, the frequency of blood glucose monitoring and the accumulated insulin dosage in the intervention group were higher than those in the control group [1 (0, 5) vs 0 (0, 2), P< 0 01; 1 36 ±0 23 vs 1 89 ±0 28, P< 0.01; and (139.61 ±77.06)U vs (107.49 ±64.41)U, P<0.01].@*Conclusions@#SGC can optimize the control of blood glucose in the target blood glucose range, but it can easily lead to mild hypoglycemia, and to a certain extent increases the workload of medical staff.
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Objective To investigate the roles of cerebral metabolic rate for oxygen (CMRO2) monitoring in the evaluation of cerebral function after cardiopulmonary resuscitation (CPR) through transcranial doppler (TCD) and SjvO2. Methods In this prospective/retrospective analysis, we included 46 cases admitted to the general intensive care unit (GICU) of the Second Affiliated Hospital of Soochow University from January 2012 to December 2014. Upon admission, TCD and SjvO2 were performed,and the patients' characteristics were recorded. Based on the CPC score upon GICU discharge, the patients were divided into two groups with satisfactory cerebral function and poor cerebral function, respectively. Then the clinical symptoms, cerebral blood flow (CBF), a-vDO2, SjvO2 and CMRO2 were analyzed, followed by investigating their correlation with the prognosis of cerebral function. The measurement data that were normally distributed were presented by mean ± standard deviation. Student's t test was utilized for the inter-group comparison. Correlation analysis was performed. ROC was plotted, followed by evaluating roles of each index in the specificity and sensitivity of nervous prognosis. Results No statistical differences were noted in the gender, age, initial monitoring indicators, ICU duration and initial GCS between the two groups (P>0.05). The CA-ROSC time and APACHE II score in the satisfactory cerebral function group were significantly shorter than those of the poor cerebral function group (P<0.05). The SjvO2 in the satisfactory cerebral function group was significantly lower than that of the poor function group (67.33±10.30 vs. 76.89±13.08, t=-3.579, P<0.05). The Vs and Vd as revealed by TCD in the satisfactory function group were higher than those of the poor function group, together with the CBF. Significant decrease was noted in the PI and RI in the satisfactory function group compared with that of the poor function group (P<0.05). Besides, the CMRO2 and a-vDO2 in the satisfactory function group showed significant increase compared with those of the poor function group (P<0.05). ROC indicated that CMRO2, CBF, a-vDO2 and SjvO2 could be utilized for the evaluation of cerebral function, among which CMRO2 showed the highest accuracy for the cerebral function prognosis. Conclusions CMRO2, CBF, a-vDO2 and SjvO2 were associated with cerebral function prognosis. CMRO2 was the most appropriate parameter to evaluate the oxygen metabolism in brain tissues, which could evaluate the prognosis of cerebral function.
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To calculate resting energy expenditure (REE) in patients receiving invasive mechanical ventilation and compare different predictive equations with indirect calorimetry(IC).A total of 60 patients in intensive care unit(ICU) were enrolled. Measure calculating daily REE in the first week included IC, Harris-Benedict formula, Penn State formula and Swinamer formula. Daily REE did not exhibit significant difference in the first week of mechanical ventilation by IC (all P>0.05).All patients' REE values by IC were higher than those by Harris-Benedict formula (all P<0.01). By Penn State formula, REE in day l, 2, and 5 were comparable (all P>0.05) with those by IC, whereas the consistency between the two methods was poor. Similarly, daily REE by Swinamer formula calculation in the first week did not show significant difference (all P>0.05), with acceptable consistency as IC. Resting energy expenditure in patients receiving invasive mechanical ventilation dose not significantly change during the first week. Swinamer formula is more accurate than other equations when IC is considered as the standard method.
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Objective To investigate and analyze the death situation of children aged under 5 year old in a class 3A hospital during 2007-2015 to provide a basis for formulating corresponding interventional measures to reduce the disease mortality of children.Methods The medical records of children death in this hospital during 2007 2015 were retrospectively analyzed.Results The mortality rate of children under 5 years old in this hospital during 2007-2015 showed a decreasing trend year by year.There was the statistically significant difference in the mortality rates among different years,between male and female (3.58 ％vs.2.10％) and between rural family registers and non-rural family registers(P＜0.05);the neonatal mortality rate was highest (50.45 ％);the top 5 places of death causes were premature delivery or low birth weight newborns,respiratory system diseases,nervous system diseases,congenital diseases and accidents.Conclusion The key for reducing the children mortality rate is to strengthen the perinatal health care,strengthen prenatal examinations and pregnant examinations,prevent the occurrence of respiratory system disease,pay attention to the influence of various factors on children health and prevention and treatment of accidents.
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Objective To investigate the clinical effect and immunologic function of Moxifloxacin combined with small dose of hormone in the treatment of Ventilator pneumonia in elder.Methods 64 cases of Ventilator pneumonia in our hospital were collected and randomly divided into experiment group and control group, 32 cases each.Two groups were given conventional treatment, the control group received Methylprednisolone Sodium Succinate 1 mg/kg qd, the experiment group was given Methylprednisolone Sodium Succinate 1 mg/kg qd, and Moxifloxacin Hydrochloride and Sodium Chloride Injection 400 mg qd.Two groups of patients were continuous treated for 10 days.After treatment,T lymphocyte subsets, NK cells, white blood cell count, C reactive protein, clinical symptoms disappeared time, mechanical ventilation time, ICU length of stay and mortality rate were compared. Results After treatment, the total effective rate in the experiment group 75% was higher than the control group 50%( P <0.05 ).The levels CD3 +, CD4 +, CD4 +/CD8 +and NK cell in two groups increased(P<0.05), levels of CD8 +decreased(P<0.05),levels of WBC, CPR and PCT decreased in the two groups(P<0.05), and compared with the control group, the levels CD3 +, CD4 +, CD4 +/CD8 +and NK cell in the experiment group were higher(P<0.05), levels of CD8 + were lower(P<0.05),levels of WBC,CPR and PCT were lower(P <0.05), the rales disappeared time, cough disappeared time, fever disappeared time were significantly shorter than the control group(P <0.05), the duration of mechanical ventilation and the length of hospital stay were significantly shorter(P<0.05).Conclusion Moxifloxacin combined with small dose of hormone in the treatment of Ventilator pneumonia in elder was significantly effective, and it can relieve inflammation, prevention of infection control, enhance immune function.
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Objective To find out the factors affecting the outcome of severe acute respiratory distress syndrome (ARDS) patients treated with extracorporeal membrane oxygenation (ECMO).Methods From November 2008 to September 2010,patients with severe acute respiratory distress syndrome (ARDS) required extracorporeal membrane oxygenation (ECMO) after failure of conventional therapy were retrospectively studied.Patients treated by veno-arterial ECMO,treated by mechanical ventilation for more than l0 days were excluded.All patients were divided into survival group and non-survival group,according to the 28 day survival situation after ECMO treatment.We compared the clinical data of the two groups when transferred to Intensive Care Unit (ICU),before and after ECMO treatment.We used Independent-samples t test and Chi-square tests to find out the factors affecting the results of ECMO treatment in the patients with severe ARDS.Results A total of twenty-five patients were enrolled in the study,of whom 15 patients survived,10 patients died.The results showed that the average age of the survival group is lower than that of non-survival group (49.8 ± 10.5) vs.(59.9 ± 11.5),P =0.044,and the proportion of patients with severe ARDS caused by Influenza A (H1 N1) in the survival group was higher than that of the non-survival group (x2 =4.453,P =0.048).In addition,the duration of mechanical ventilation before ECMO treatment in the survival group was shorter than that in the non-survival group (57.8 ± 8.7) hours vs.(68.3 ±13.7) hours,P =0.013.Conclusions The age,pre-ECMO ventilation duration and the cause of ARDS are the important factors influencing the efficacy of ECMO treatment in the patients with severe ARDS.
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Objective To study the relationship between the fbxl 20 gene、E-cadherin gene and the clinocopathologic features ,respectively , and the correlation about the fbxl 20 and the set gene .Methods The mRNA expression level of fbxl 20 and E-cadherin gene in 50 pairs of human colorectal adenocarcinoma tissues and matched normal tissues were detected by RT -PCR.Results The mRNA expression level of fbxl 20 gene in tumor tissues were significantly increased than that in normal tissues (0.479 ±0.141 vs.0.296 ±0.121,P=0.001),while the E-cadherin were decreased (0.440 ±0.026 vs.0.741 ±0.059,P=0.000).There was no found on the correlation between the mRNA expression level of fbxl 20 and the E-cadherin gene in the 50 tumor tissues(r=-0.165,P=0.251).However,the E-cadherin expressed level was negatively correlated with the fbxl 20 expressed level in the lower differentiation degree、in the high differentiation degree and the Duke′s D tumor tissues(r=-0.600,P=0.008;r=-0.784,P=0.017;r=-0.643,P=0.032).Conclusions The decreased mRNA expression level of E -cadherin in tumor tissues are largely due to the increased fbxl 20 gene expressed level ,which is related with the high mobility and invasion ability of the advanced tumor .
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Objective To investigate the awareness of AIDS knowledge among medical staffs and their preventive behaviors among hospitals of traditional Chinese Medicine in Liangshan and to analyze the influential factors so as to provide the scientific basis for the staffs' training as well as for the prevention and control about AIDS. Methods Medical staffs from 7 hospitals of traditional Chinese medicine in Liangshan were surveyed using self-designed questionnaires,among which 276 were valid. Results The total score of the medical staffs' knowledge on AIDS was 34.14 ±6.92 points. Those with the highest score accounted for 16.73%, others with intermediate score accounted for 56.13%and still others with the low score accounted for 27.14%. The total score of the medical staffs' preventive behaviors on AIDS was 35.20 ±9.48 points, with the highest score being 12.64%, the intermediate score being 30.86%and the low score being 56.51%. The major factors to influence the medial staffs' knowledge about AIDS related to his/her educational level, specialty, education background of education, trainings on AIDS and contacts with HIV/AIDS patients and so on (<0.05) . The hospital's level, the specialty, whether or not being trained with AIDS knowledge concerned the level of occupational protection ( <0.05), whereas their ages, titles of a technical post, working years of working were irrelevant. Conclusion The overall level of these medical staffs’knowledge and preventive behaviors has not been satisfactory. Therefore, the various training programs will be necessary to improve the technical level of the medical staffs.
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Objective To investigate the use of free transplantation of peroneal artery perforator-based propeller to the repair of the front feet skin defect.Methods Thirteen cases with front foot skin defect patients repaired through transplation of propeller flap of the peroneal artery from January 2009 to September 2012.The wound range was 5 cm ×4 cm-11 cm × 14 cm.The propeller flap of the peroneal artery designed according to the position of the propeller of the peroneal artery in a leg.The wound of the leg were repaired through suture directly or transplantation of skin.Results All 13 cases of free propeller flap were survived,the wound healing goodly.One case with the postoperatie blood vessels were removed by the surgical exploration.The time of follow-up between 3 and 17 months(mean 9.4 months).The quality of free flap was good.The function of walk of the foot repaired were not significantly affect.The patients were satisfactory to the results.The wound of the leg healed well ; The leg had no obvious muscle cicatricial adhesion.According to the foot disease treatment effect evaluation standard (JOA) evaluation,the result for 77-100 points,an average of 85.5 points.Conclusion Using propeller flap of the peroneal artery to repair the skin defect of front feet with a little injury,the skin texture more close to the repaired area,it is a reasonable approach.
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Objective To discuss the impact of a immunosuppressive protocol using tacrolimus combined with mycophenolate without steroid on glycometabolism after liver tansplantation (LT).Methods 295 adult liver transplant recipients were under investigation and divided into two groups,to receive immunosuppression therapy using tacrolimus and mycophenolate with (n =142) or without steroid (n =153).The fasting blood-glucose level,rate of hyperglycemia,infection and metabolic complications were followed up at 1st,2nd,4th,8th,12th,16th,20th and 24th week after LT.Results There were no significant differences between two groups in gender,age.body weight and FBG level before LT.In both groups,the FBG levels were significantly elevated immediately and reached the peak at 1st week after LT,then gradually decreased over time post-LT.The FBG level and rate of hypcrglycemia were significantly lower in steroid-free group than in steroid group in each observation time point with the differences being significant (P＜0.05) at 4th week post-LT.The overall rate of hyperglycemia was 52.9％ in steroid free group and 76.8％ in steroid group with the difference being significant between the two groups (P＜0.05) and a risk ratio of 2.94 (steroid-free group versus steroid group).The rate of acute rejection was slightly higher in steroid-free group (8.50 ％ ) than in steroid group (7.75％ ) (P ＞ 0.05 ).Also the incidence of intention badness,infection and hypercholesterinemia was significantly lower in steroid group than in steroid-free group.Conclusion The immunosuppressive protocol without steroids is safe and effective of reducing the risk of hyperglycemia and metabolic complications after LT.