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Objective@#To analyze the hotspots, frontiers, and future research trends related to puberty development among children and adolescents from 2013 to 2022, and to provide a reference for subsequent research related to puberty development.@*Methods@#Data related to puberty development from 2013 to 2022 were retrieved from the Web of Science core collection with the search formula "puberty timing (title) OR puberty development (title) OR pubertal timing (title) OR pubertal development (title) OR puberty timing (abstract) OR puberty development (abstract) OR pubertal timing (abstract) OR pubertal development (abstract)". The CiteSpace was used for visual analysis.@*Results@#A total of 6 684 publications were obtained and an upward trend could be seen in the number of publications in the field of puberty development in the last 10 years. Researchers with a high number of publications were Juul Anders, Brix Nis, and Ernst Andreas, in addition, the United States had the highest number of publications ( 2 125 ) and the highest betweenness centrality (0.23) in this field. In the last decade, research hotspots had focused on the timing of pubertal initiation, biological mechanisms of pubertal development, and sex differences in pubertal development. Research on environmental endocrine disruptors and the mechanisms of pubertal development were at the forefront of research and future research trends.@*Conclusion@#Scholars can refer to the research hotspots and research trends in this field and focus on the issues related to environmental endocrine disruptors and pubertal development mechanisms.
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Objective:To explore the value of the age, atrial fibrillation, dysphagia, sex, stroke severity (A2DS2) score, the prestroke independence, sex, age, National Institutes of Health stroke scale (ISAN) score, acute ischemic stroke-associated pneumonia score (AIS-APS), and intracerebral hemorrhage associated pneumonia score without hematoma volume included (ICH-APS-A) in predicting risk of stroke-associated pneumonia (SAP).Methods:From January to June 2019, 304 patients with acute stroke who were hospitalized in the Lianyungang Hospital Affiliated to Xuzhou Medical University were analyzed retrospectively. There were 164 patients with acute ischemic stroke (AIS), including 82 patients with SAP. And there were 140 patients with intracerebral hemorrhage (ICH), including 70 patients with SAP. They were divided into SAP group (152 cases) and non-SAP group (152 cases) depending on whether they had SAP. The area under the receiver operating characteristic curve (AUC) was used to compare the predictive value of the four scores.Results:When predicting risk of SAP in patients with the stroke, the A2DS2 score had the largest AUC compared to the ISAN score, AIS-APS score, and ICH-APS-A score. When predicting risk of SAP in patients with AIS, the AUC (0.875, 95% CI 0.815 to 0.922) of the A2DS2 score was greater than the AIS-APS score and the ISAN score. When predicting risk of SAP in patients with ICH, the AUC (0.950, 95% CI 0.900 to 0.980) of the A2DS2 score was greater than the ICH-APS-A score and the ISAN score. When predicting risk of SAP in patients with AIS and ICH: 0.911 (95% CI 0.873 to 0.94) vs. 0.882 (95% CI 0.840 to 0.916), Z = 2.319, P = 0.020, the A2DS2 score was significantly better than the ISAN score ( P<0.05). When predicting risk of SAP in patients with AIS, the A2DS2 score, ISAN score, and AIS-APS score all have good predictive value ( P>0.05). When predicting SAP in patients with ICH, the A2DS2 score, ISAN score, and ICH-APS-A score all have good predictive value ( P>0.05). Conclusions:When predicting risk of SAP in patients, the A2DS2 score is a reliable prediction tool, with good predictive value.
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Objective:To discuss the risk factors, treatment process and prevention strategy of the cases of acute pulmonary embolism after cerebral hemorrhage, so as to improve the attention and level of the disease.Methods:The data of a patient with cerebral hemorrhage and acute pulmonary embolism treated in Lianyungang First People's Hospital were analyzed retrospectively, and the literature related to intracerebral hemorrhage complicated with acute pulmonary embolism was reviewed.Results:One week after intracerebral hemorrhage, the patient was diagnosed with acute pulmonary embolism and given anticoagulant treatment with low molecular weight heparin. The condition was alleviated without aggravating intracerebral hemorrhage. Lying in bed after intracerebral hemorrhage, limb braking, use of dehydration, diuresis, hemostasis and other drugs were the high-risk factors of pulmonary embolism.Venous thromboembolism can be prevented clinically by physical methods and drugs.Conclusions:Venous thromboembolism is easy to occur after intracerebral hemorrhage. Clinically, the incidence can be reduced by pneumatic therapy or anticoagulant drugs. In treatment, it is necessary to weigh the risk of death of pulmonary embolism and rebleeding. After comprehensive evaluation, we can formulate an individualized treatment plan. It may be safe and effective to use low molecular weight heparin to treat pulmonary embolism after the intracerebral hemorrhage hematoma is stable.
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Objective:To explore the application of speckle tracking imaging (STI) stratification strain technique in the assessment of circumferential myocardial function and the myocardial protection of ATP-postconditioning (ATP-PostC) in a rabbit model of acute myocardial infarction.Methods:A total of 40 rabbits were randomly divided into 2 groups: pure ischemia reperfusion group (IR group)and ATP-PostC group. STI images were recorded before and 45 min after occlusion of coronary artery, post low-dose dobutamine stress echocardiography, 60 and 120 min after reperfusion, respectively. The following parameters were obtained: left ventricular ejection fraction(LVEF), heart rate (HR), endocardial circumferential systolic strain (CSsys-endo), mid-myocardial circumferential systolic strain (CSsys-mid) and epicardial circumferential systolic strain (CSsys-epi) at left ventricular short-axis level. At different time points after occlusion and reperfusion, 5 experimental rabbits were killed in each group for pathological examination.Results:①Forty-five min after coronary artery occlusion in both groups, the values of LVEF and HR were decreased( P<0.05), and the absolute values of CSsys-endo, CSsys-mid and CSsys-epi were significantly reduced( P<0.01). After LDDSE, the absolute values of CSsys-endo, CSsys-mid and CSsys-epi were increased, which were different from those after blockade( P<0.05). ②After reperfusion, the circumferential strains were not significantly different from those after blockade in IR group ( P>0.05). After blockade, the absolute values of circumferential strains were increased significantly in the ATP-PostC group compared with IR group( P<0.05). In the ATP-PostC group, the absolute values of CSsys-endo at different time points after reperfusion increased significantly compared with that after blockade ( P<0.05). The absolute values of CSsys-endo and CSsys-mid 120 min after reperfusion continued to increase significantly compared with those 60 min after reperfusion( P<0.05). ③Pathological examination: After 60 min of blockade, there was no significant difference in myocardial infarction area between the IR group and the ATP-PostC group( P>0.05). The percentage of infarct areas at each time point of reperfusion in the ATP-PostC group was decreased compared with that after blockade( P<0.05). Compared with the IR group, the percentage of infarct area in the ATP-PostC group was smaller after 120 minutes of reperfusion and the difference was statistically significant ( P<0.05). Conclusions:The applications of STI stratification strain technique and LDDSE can assess left ventricular circumferential strains at each of myocardial layers before and after reperfusion in rabbit myocardial ischemia ATP-PostC model, identify and evaluate the function of viable myocardium, and exhibit the significant protective effects of ATP-PostC on myocardial reperfusion injury.
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Objective:To explore the nursing effect of clinical nursing pathway in emergency care of severe pneumonia and its effect on lung function.Methods:A total of 90 patients with severe pneumonia in Lianyungang First People ′s Hospital of Jiangsu Province from June 2017 to July 2019 were selected as subjects. The randomized patients were divided into control group ( n=45 cases) and observation group ( n=45 cases). The control group received routine nursing. The observation group was combined with the clinical nursing pathway on the basis of the control group. Both groups were treated for 1 month. The symptom improvement time, lung function level and nursing satisfaction were compared. Results:The improvement time of wheezing (3.45 ± 1.06) d, the improvement time of antipyretic fever (3.48 ± 1.08) d, and the improvement time of lung rales (4.31 ± 0.49) d in the observation group were shorter than those in the control group [(7.01 ± 1.42) d, (4.56 ± 1.32) d, (6.62 ± 0.79) d] ( t value was 9.642, 7.375, 6.189, P <0.05); maximum voluntary minute ventilation (MVV) of the observation group in 1 month after nursing , Vital capacity (VC) and 1s forced expiratory volume (FEV1) levels were higher than before nursing ( P <0.05); MVV (71.42 ± 18.75) L, VC (72.41 ± 17.74)% and FEV1 were observed in the observation group 1 month after nursing (67.36 ± 18.48) L, all higher than (62.38 ± 16.69) L, (60.18 ± 15.69)% and (59.15 ± 17.13) L of the control group ( t value was 6.393, 5.544, 7.491, P <0.05); observation group after-care, nursing method, content, form of nursing, nursing service attitude, and nursing effect satisfaction were 97.78% (44/45), 95.56% (43/45), 97.78% (44/45), 93.33% (42/45 ), 95.56% (43/45), which were higher than 80.00% (36/45), 90.48% (38/45), 82.22% (37/45), 77.78% (35/45), 80.00% of the control group (36/45), with statistically significance ( χ2 value was 5.412-9.581, P <0.05). Conclusions:The clinical nursing pathway is effective for emergency nursing of patients with severe pneumonia. It can shorten the time of symptom disappearance, improve the lung function level and satisfaction of nursing, and it is worthy of popularization and application.
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Logistic regression is a kind of multiple regression method to analyze the relationship between a binary outcome or categorical outcome and multiple influencing factors, including multiple logistic regression, conditional logistic regression, polytomous logistic regression, ordinal logistic regression and adjacent categorical logistic regression. This paper illustrates the basic principle, independent variable selection and assignment, applied condition, model evaluation and diagnosis for multiple logistic regression model. Moreover, the principle and application for polytomous logistic regression and ordinal logistic regression models were also introduced. By providing SAS codes and detailed explanations of the result for an example of obesity, readers could be able to better understand logistic regression model, and apply this method correctly to their research and daily work, so as to improve their capacity of the data analysis.
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Interrupted time series (ITS) is a statistical method for the quasi-experimental design specific to the outcome of time series, in which the effectiveness of an intervening measure is evaluated by examining change in slope and immediate change in level. The key feature of ITS is that the secular trend of time series prior to the intervention can be effectively controlled so as to accurately estimate the intervention effect. The design principle and statistical method for ITS were illustrated by an example of evaluating halving policy for the expert registration fee in the general hospital of a city. The segmented linear regression was used to fit the above time series data and the results were explained in detail. Meanwhile, the study design and model fitting along with explanations of the results with respect to the effects of two types of successive interventions and on different time-points of an intervention were illustrated as well in this paper. The existed upward or downward trend should be taken into account in order to accurately estimate the intervention effect as it exists in most of the public health surveillance data. Two parameters, known as change in slope and immediate change in level, were employed to evaluate the effect of the intervention. The ITS analysis can be widely applied to the program evaluation as it could enrich methods of the evaluation compared to the traditional model of the program evaluation.
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Phosphatidylinositol 3 kinase/serine/threonine kinase B (PI3K/Akt) signaling pathway plays a key role in regulating immune response and inflammatory factor release in vitro and in vivo by regulating the activation of downstream signaling molecules, and is closely related to the occurrence and development of sepsis. Innate immune cells play important roles in maintaining the stability of the environment and regulating the immune response during sepsis. This review summarized the PI3K/Akt signaling pathway and its regulation in the sepsis of different types of immune cells in the inflammatory response, apoptosis and other aspects to provide clues and pathways for the prevention and treatment of sepsis.
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Objective To quantify the left ventricular flow field characteristics of different phases of cardiac cycle in patients with different degrees of coronary artery stenosis by using vector flow mapping ( VFM ),and explore the value of quantitative parameters of VFM in diagnosis of degrees of coronary artery stenosis in patients with coronary heart disease. Methods Eighty-four patients with coronary artery stenosis showed by coronary angiography served as case group. According to the results of coronary angiography,all the patients of case group were divided into 3 groups:mild stenosis group,moderate stenosis group and severe stenosis group. Forty-five healthy adult volunteers were selected as control group. The quantitative parameters,including average energy loss ( EL-base,EL-mid,EL-apex ) and circulation ( vortex area,circulation),were measured in the different periods of VFM mode. The difference of parameters were evaluated between case group and control group during different periods. E/e′was derived via dual-Doppler imaging technology and correlation was analyzed between aEL, circulation, E/e′( L ) and E/e′( S ), separately. ROC curve was used to analyze aEL in severe stenosis group,and to evaluate the diagnostic efficacy of aEL in different cardiac cycles. Results ①Compared with the control group,aEL in global and regional segment of left ventricle in the severe stenosis group were significantly increased during isovolumetric relaxation period,reduced filling period,atrial systolic phase and isovolumic contraction period ( all P ＜ 0.05 ). And the aEL in global and regional segment of left ventricular in the moderate stenosis group were significantly increased during reduced filling period, atrial systolic phase and isovolumic contraction period ( all P ＜0.05). And the aEL in middle segment of left ventricular in the mild stenosis group was significantly increased during reduced filling period ( P ＜0.05). ②Compared with the control group, the vortex area and circulation intensity in left ventricular of the severe stenosis grrculation intensity and E/e′( L) or E/e′( S) during reduced filling period and atrial systolic phase . Conclusions VFM can effectively evaluate the flow field characteristics of left ventricle in patients with oup were significantly increased during isovolumetric relaxation period,reduced filling period,atrial systolic phase and isovolumic contraction period( P ＜0.05). ③ In case group,there were positive correlations between aEL withE/e′(L) orE/e′(S) at global and regional segment of rapid filling phase and atrial systolic phase . And there were positive correlations between the vortex area orcoronary heart disease . The quantitative parameters of VFM can reflect the extent of coronary artery stenosis in some extent.
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Objective To explore the ef fi cacy and safety of long-term use of low dose glucocorticoids in acute respiratory distress syndrome (ARDS). Methods Fifty ARDS patients were randomly divided into two groups. The control group(25 patients)received non-invasive or invasive mechanical ventilation,antibiotics and support treatments. The glucocorticoids group(25 patients)received the same treatments plus long-term use of low dose glucocorticoids. Results The mortality in glucocorticoids group(32％(8/25))was much lower than that in the control group(60％(15/25))(P < 0.05). The ventilator-free days and organ failure-free days within 28d in glucocorticoids group were significantly higher than those in the control group (P < 0.05). The oxygenation index and the serum IL-8 levels in glucocorticoids group at 14d and 28d were higher than those in the control group(P<0.05). Compared to the control group ,long-term use of low dose glucocorticoids in ARDS did not increase fasting blood-glucose at 7d,gastrointestinal bleeding and hospital infections within 28d. Conclusions Long-term use of low dose glucocorticoids in ARDS could reduce the serum IL-8 levels and improve the prognosis.
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Objective To explore the ef fi cacy and safety of long-term use of low dose glucocorticoids in acute respiratory distress syndrome (ARDS). Methods Fifty ARDS patients were randomly divided into two groups. The control group(25 patients)received non-invasive or invasive mechanical ventilation,antibiotics and support treatments. The glucocorticoids group(25 patients)received the same treatments plus long-term use of low dose glucocorticoids. Results The mortality in glucocorticoids group(32％(8/25))was much lower than that in the control group(60％(15/25))(P < 0.05). The ventilator-free days and organ failure-free days within 28d in glucocorticoids group were significantly higher than those in the control group (P < 0.05). The oxygenation index and the serum IL-8 levels in glucocorticoids group at 14d and 28d were higher than those in the control group(P<0.05). Compared to the control group ,long-term use of low dose glucocorticoids in ARDS did not increase fasting blood-glucose at 7d,gastrointestinal bleeding and hospital infections within 28d. Conclusions Long-term use of low dose glucocorticoids in ARDS could reduce the serum IL-8 levels and improve the prognosis.
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Objective To study the effect of potassium chloride (KCl) before CPR on successful resuscitation of rats with ventricular fibrillation (VF).Methods Sprague-Dawley (SD) rats with VF induced by alternating electricity current were randomly (ramdam runmber) divided into KCl group and normal saline (NS) group.Rats of two groups were prepared with 0.8 mL/kg of 2.5％ KCl in KCI group and equivalent volume of NS in NS group instead before CPR.The resuscitation was considered to be failure if ROSC was absent for 10 min.The comparisons of time required for ROSC,the average attempt of defibrillation,the average joule used for defibrillation,ROSC rate and 72 h survival rate were carried out between the two groups.Results The length of time required for ROSC in the KCl group (n =10) was shorter than that in NS group (n=10) [(283.89±152.44) svs.(404.38±164.27) s] (t=1.369,P =0.196).The average attempt of defibrillation in KCl group were fewer compared to the NS group [(1.50 ± 0.75) times vs.(2.66 ± 0.57) times,(t =2.701,P =0.022)],the average joule used for defibrillation in KCl group were less compared to NS group [(3.75 ± 2.86) J vs.(8.33 ± 2.88) J,(t =2.78,P =0.019)].The ROSC rate in the KCl group was higher than that in NS group (P =0.011).The 72 h survival rate in KCl group was higher than that in NS group (P =0.001).Conclusions Increasing plasma potassium level before CPR could increase the ROSC rate and survival rate in rats with VF.
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Objective To investigate whether increasing the concentration of serum potassium facilitates the cardioversion to sinus rhythm during cardiopulmonary resuscitation (CPR) in a rat ventricular fibrillation (VF) model. Methods Sprague-Dawley (SD) rats with sustained VF by electrical induction were randomized into two groups by random number table. Five minutes after onset of electrical induction, 2.5% potassium chloride solution at a dose of 0.8 mL/kg (KCl group, n = 9) or equivalent normal saline (NS group, n = 9) was given respectively via femoral vein followed by traditional CPR. The changes of electrocardiogram (ECG) and the effect of defibrillation were compared between the two groups. Results During the CPR, the number of animals with spontaneous cardioversion (2 vs. 1, P = 1.000) and successful defibrillation (7 vs. 3, P = 0.026) were both increasing in KCl group compare with those in the NS group, which required fewer defibrillation (1.60±0.79 vs. 2.70±0.58, P = 0.064), lower calculative defibrillation energy (J: 4.00±3.00 vs. 8.30±2.89, P = 0.068), more animals restore spontaneous circulation (ROSC, 9 vs. 4, P = 0.029) and shorter ROSC time (s: 265.10±134.58 vs. 421.30±162.06, P = 0.096). At the beginning of CPR, animals in two groups all presented the fine amplitude (amplitude < 0.5 mV). At CPR 3 minutes the KCl group presented significantly larger amplitude compared with NS group (mV: 0.92±0.16 vs. 0.67±0.23, P = 0.030); The amplitude decreased in the animals which did not attain cardioversion to sinus rhythm over time. The animal number of fine amplitude at CPR 7 minutes were 0 and 5, respectively, in the KCl group and the NS group. Conclusion Increasing serum potassium concentration facilitates the VF amplitude enlargement, promotes the spontaneous conversion, increases the successful rate of defibrillation and reduces the energy for defibrillation in a rat VF model.
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Objective To evaluate the left ventricular flow field characteristics in patients with obstructive and non-obstructive hypertrophic cardiomyopathy (HCM) using vector flow mapping (VFM),then assess the left ventricular hemodynamics.Methods 40 patients with HCM were randomly selected as case group,among which 20 patients with left ventricular outflow tract(LVOT) obstruction (group Ⅰ) and 20 patients without LVOT obstruction(group Ⅱ),40 healthy adult volunteers served as control group.The conventional parameters:left ventricular ejection fraction(LVEF),interventricular septal thickness and radial and pressure gradient of left ventricular outflow tract and VFM parameters:left ventricular peak systolic velocity (Vs),systolic flow (Fs),total negative systolic flow (SQ-) and vortex parameters were measured and compared.The correlation between LVOT pressure gradient and VFM parameters were assessed.Results There was no significant difference of LVEF in three groups.Compared with control group,interventricular septal thickness in group Ⅰ and group Ⅱ was much higher(P ＜0.05).Radius in group Ⅰ was much lower than that of group Ⅱ and pressure gradient of LVOT in group Ⅰ was significantly higher compared with group Ⅱ (P ＜0.05).Comparison of VFM parameters:①Compared with control group,SQ-of basal segments in case groups were lower (P ＜0.05),while SQ-of mid and apical segments were higher(P ＜ 0.05),Vs and Fs of all segments increased (P ＜0.05),and number of vortex,vortex diameter and vorticity of obstruction and non-obstruction groups were higher(P ＜0.05).②Compared with group Ⅱ,SQ-of basal segments decreased and SQ-of mid and apical segments increased in group Ⅰ,Vs and Fs of all segments were higher.The number of vortex,vortex diameter were higher in group Ⅰ (P ＜ 0.05).③ Correlation analysis:Fs in apex,the number of vortex relatively correlated with press gradient of LVOT(r =0.60,0.65,respectively).Conclusions VFM can effectively evaluate the flow field characteristics of left ventricle in patients with obstructive and non-obstructive HCM,and Fs in apex,number of vortex were correlated with the degree of obstruction,then further assess the left ventricular hemodynamics quantitively.
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Objective To explore the role of procalcitonin (PCT) in diagnosis and antibiotics therapy of community acquired pneumonia (CAP). Methods A total of 296 patients with CAP and 221 patients with other diseases were included. PCT levels between CAP patients and non-CAP patients, aged and non-aged CAP patients were analyzed. SPSS19.0 was used to make ROC, and the maximum Youden index to determine the optimal cutoff value, the corresponding sensitivity (SEN) and specificity (SPE). Results PCT levels in CAP patients were significantly higher than those in non-CAP (P0.05). Conclusion PCT has a high value in diagnosis and antibiotics therapy of CAP.
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Objective To assess the value of wave intensity (WI) on the discrimination of hypertension with concentric hypertrophy and non-obstructive hypertrophic cardiomyopathy(NOHCM).Methods 36 patients with hypertension with concentric hypertrophy,30 patients with NOHCM and 36 healthy volunteers were randomly selected to perform routine ultrasound examination and carotid arterial WI test.The conventional parameters,inlcuding interventricular septal thickness in diastole (IVSTd),left ventricular posterior wall thickness in diastole(LVPWd),left ventricular diameter in diastole(LVIDd) and WI parameters,including the first peak (W1),the second peak (W2),negative area (NA),the interval between the R wave of the ECG and the peak of W1 (R-1st),the interval between the peaks of W1 and W2 (1st-2nd) were archived and compared among the different groups.Results ① There were statistical significances in IVSTd among the three groups(P ＜0.01).LVPWd of hypertension group was obviously higher than that of normal and NOHCM groups (P ＜0.01),but there were no statistical significances in NOHCM and normal groups(P ＞0.05).There were no statistical significances in LVIDd among different groups(P ＞ 0.05).②Compared with the normal group,W1 in NOHCM group increased significantly,whereas W2 and R-1st was much lower (P ＜0.01);W1 and NA in hypertension group was obviously higher(P ＜0.01).W2 and R-1st in NOHCM group were much smaller than those of hypertension group (P＜0.01).③W2 in 850 mmHg · m · s-3 was an optimal cutoff value to identify NOHCM and hypertension and to yield the sensitivity of 78.9％ and specificity of 72.4％.R-1st in 98.5 ms was a cutoff point to discriminate NOHCM and hypertension and to bring the sensitivity 65.8％ and specificity 72.4％.Conclusions WI analysis can effectively distinguish the difference of NOHCM and hypertension and provide a new viewpoint for the discrimination of hypertension with concentric hypertrophy and non-obstructive hypertrophic cardiomyopathy.