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Objective:To assess the implications of hormone therapy on confirmation of clinical diagnosis and prognosis of adult hemophagocytic syndrome (HPS) in the emergency department setting.Methods:The eligible 34 patients admitted with suspected HPS in the Emergency Department of Peking University People's Hospital from September 2019 to August 2021 were respectively collected. The patients were divided into the death group and survival group according to the prognosis and divided into early hormone therapy group and standard hormone therapy group according to the timing of hormone application. Patients in the early hormone therapy group were divided into the routine 4 criteria group and non-routine 4 criteria group according to the conditions of meeting the four HLH-2004 diagnostic criteria. Medical records of the following were collected and statistically analyzed: complete blood count, blood biochemical index, coagulation function, serum ferritin, NK cell activity, sCD25 level, peripheral blood smear, bone marrow biopsy, abdominal ultrasound scan, and abdominal CT on admission, and recheck the clinical indicators such as blood count, blood biochemical index and blood coagulation dunction 5-7 days later.Results:①Patients from the death group were older, with higher APACHEⅡ scores and SOFA scores, higher total bilirubin, and lower serum albumin. ② Univariate Logistic analysis showed age ( OR=1.098, CI: 1.019-1.183, P=0.014), APACHE Ⅱ score ( OR=1.144, CI: 1.017-1.285, P=0.024), SOFA score ( OR=1.441, CI: 1.079-1.925, P=0.013) were associated with the risk of death. Multivariate Logistic analysis showed that age ( OR=1.099, CI: 1.014-1.190, P=0.021) was associated with the risk of death. There was no significant correlation between early hormone therapy and clinical prognosis. Kaplan-Meier survival curves showed that there was no difference in the 60-day survival rate between the early hormone therapy group and the standard hormone therapy group. ③ The level of triglyceride still increased after early hormone therapy, and the number of indexes meeting the diagnostic criteria of HLH-2004 increased significantly. All patients met the criteria of Hscore>169, and 3 patients did not meet at least 5 diagnostic criteria of HLH-2004, accounting for 16.7% of the total cases of early hormone therapy. ④ Starting hormone therapy when the four HLH-2004 diagnostic criteria were met could reduce the length of hospital stay. Prothrombin time and activited partial thomboplastin time were closer to normal levels in patients 5-7 days after treatment. Early hormone therapy had no significant effect on treatment response and in-hospital death risk. There were no significant differences in APACHE Ⅱ score, SOFA score, confirmation of diagnosis, treatment response, clinical prognosis, and related clinical indicators after hormone therapy between the routine 4 criteria and non-routine 4 criteria groups. Conclusions:Initiation of early hormone therapy has no significant effect on the confirmation of clinical diagnosis, treatment response, in-hospital mortality, and 60-day survival rate of patients with HPS, and can quickly correct coagulation dysfunction and effectively reduce the length of hospital stay. An earlier start of hormonal therapy (meeting the four HLH-2004 diagnostic criteria) may be considered by the emergency physician when a patient is highly suspected of HPS diagnosis
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Objective:To explore the value of neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) combined with bedside index for severity in acute pancreatitis (BISAP) score in predicting severe acute pancreatitis (SAP) in patients with hypertriglyceridemia pancreatitis (HTGP).Methods:Patients who met the diagnostic criteria of HTGP were retrospectively collected in the Emergency Department of Peking University People's Hospital from January to December in 2019. Patients were assigned to two groups according to the severity of acute pancreatitis: the mild acute pancreatitis group and severe acute pancreatitis (SAP) group. Blood samples were taken within 24 h after the onset of HTGP for analysis. White blood cell count, neutrophil count, lymphocyte count, and other laboratory indicators were detected. BISAP score was performed, and NLR and PLR were calculated in all patients within 24 h of the onset of HTGP. Comparison of various indicators was performed in the two groups. The risk factors of SAP patients with HTGP were analyzed by Logistic regression. The correlation of risk factors was analyzed by correlation. The receiver operating characteristic (ROC) curve was drawn, and the optimal thresholds of NLR and PLR were calculated respectively. The BISAP score, NLR combined with BISAP score (BN score), PLR combined with BISAP score (BP score), and NLR, PLR combined with BISAP score (BNP score) were compared respectively to predict SAP in patients with HTGP.Results:A total of 82 patients were collected. There were significant differences in the proportion of patients with fever, NLR, PLR, lactate dehydrogenase, urea nitrogen, Ranson score, acute physiology and chronic health evaluationⅡ(APACHEⅡ) score and BISAP score between the two groups (all P<0.05). Logistic regression analysis showed that NLR ( OR=1.859, 95% CI: 1.385-2.497, P<0.001), PLR ( OR=1.074, 95% CI: 1.036-1.112, P<0.001) and BISAP score ( OR=2.880, 95% CI: 1.578-5.258, P=0.001) were risk factors for severe HTGP. Correlation analysis confirmed that NLR and PLR were positively correlated with BISAP, APACHE Ⅱand Ranson score. The AUC of BISAP score, BN score, BP score and BNP score for predicting SAP in HTGP were 0.865 (95% CI: 0.787-0.943), 0.925 (95% CI: 0.869-0.981),0.930 (95% CI: 0.885-0.987), and 0.936 (95% CI: 0.874-0.986). Conclusions:NLR and PLR combined with BISAP score has a higher sensitivity to predict the severity of HTGP, which can predict severe pancreatitis within 24 h of the onset of HTGP, so that providing better guidance for treatment.
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Objective:At present, emergency acute heart failure unit has been gradually carried out in China. This study is to analyze the impact of acute heart failure unit on the mortality and readmission rate of acute heart failure (AHF) within 6 months after discharge.Methods:Patients with AHF admitted to Emergency Department and Department of Cardiology, Peking University People's Hospital between December 2019 and December 2020, were prospectively collected. Patients with complicated malignant tumor, stage 4-5 chronic kidney disease, automatic discharge, and incomplete medical history were excluded. The baseline data, past medical history, admission condition, and auxiliary examination were collected. After discharge, the information of oral drugs, hospital readmission and death were collected through outpatient medical records in clinical data center or telephone consultation. Patients were divided into the emergency acute heart failure unit treatment group (emergency AHFU group), emergency routine treatment group (outside AHFU group) and cardiology treatment group according to the different treatment locations. SPSS 25.0 software was used for comparison between groups, and a P<0.05 was considered as statistically significant. ResuIts:A total of 238 patients with AHF were enrolled, 28 patients died in hospital, and 210 patients were followed up. Four cases were excluded from malignant tumor during follow-up, and 6 cases were lost to follow-up. There were 40 cases in the emergency AHFU group, 67 cases in the outside AHFU group, and 93 cases in the cardiology treatment group. According to the prognosis, the patients were divided into the poor prognosis group ( n=83) and good prognosis group ( n=145). The age, sex, vital signs and cardiac function of patients in the emergency AHFU group were basically the same as those in the outside AHFU group at admission, and the proportion of patients in the emergency AHFU group using non-invasive positive pressure ventilation was higher (52.5% vs. 32.8%, P<0.05). The utilization rate of angiotensin converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor enkephalinase inhibitors, β-blockers, diuretics and other oral drugs was higher in the emergency AHFU group after discharge, and patients also had more regular follow-up (95% vs. 79.1%, P<0.05). The 6-month readmission rate (15.0% vs. 40.3%, P<0.05) and the 6-month readmission and mortality composite results of patients in the emergency AHFU group (17.5% vs. 43.3%, P<0.05) were significantly lower than those in the outside AHFU group. COX regression analysis showed that the readmission rate of patients in the emergency AHFU group was lower than that in the outside AHFU group ( OR=2.882, 95% CI:1.267~6.611, P=0.12). Compared with the cardiology treatment group, the AHFU group had higher systolic blood pressure, faster heart rate, NT-probNP level, higher proportion of NYHA grade Ⅳ and Killip grade Ⅲ cardiac function (all P<0.05). The proportion of non-invasive mechanical ventilation in the AHFU group was significantly higher than that in the cardiology treatment group (52.5% vs. 30.1%, P<0.05). After discharge, there were no significant differences between angiotensin converting enzyme inhibitor/angiotensin receptor blocker/angiotensin receptor enkephalinase inhibitors and β-blockers. There were also no significant differences in readmission and mortality rate 6 months after discharge. Binary logistics regression analysis found that the independent risk factors of AHF were routine emergency treatment, age, female sex, coronary heart disease, and BUN peak. Conclusions:The emergency acute heart failure unit is an independent protective factor for acute heart failure and reduced readmission rates within 6 months and readmission and mortality composite outcomes. Older age, female sex, coronary heart disease and elevated BUN peak are independent risk factors affecting the prognosis of AHF, which should be identified and preventive measures should be taken early.
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Objective:To explore the early prediction value of neutrophil to lymphocyte ratio (NLR) combined with platelet to lymphocyte ratio (PLR) for severe acute pancreatitis (SAP).Methods:A total of 216 patients were collected in the Emergency Department of Peking University People's Hospital who met the diagnostic criteria of acute pancreatitis (AP) from January to December in 2019. Patients were assigned to 3 groups according to the severity of AP: the mild acute pancreatitis group (MAP, n=86), moderately severe acute pancreatitis group (MSAP, n=40), and severe acute pancreatitis group (SAP, n=90). The peripheral blood was taken immediately. White blood cell count (WBC), neutrophil count (NEUT), lymphocyte count (LYM), hemoglobin (HGB), platelet count (PLT), total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low density lipoprotein (LDL), serum creatinine (CR), and glucose (GLU) were detected. At the same time, CT imaging and other examinations were completed. NLR and PLR were calculated and compared among the three groups. The correlation between NLR, PLR, APACHE II score and Ranson score were compared. The receiver operating characteristic (ROC) curve was drawn to calculate the optimal thresholds of NLR and PLR. NLR-PLR was calculated according to the optimal thresholds of NLR and PLR, and the ROC curve was drawn to study the predictive value of NLR-PLR for SAP. Results:NLR [ OR=1.071, 95% CI (1.025, 1.120), P=0.002] and PLR [ OR=1.003, 95% CI (1.000, 1.244), P=0.044] were risk factors for SAP. NLR was positively correlated with Ranson score ( r=0.0342). NLR was positively correlated with APACHE II score ( r=0.0210). PLR was positively correlated with Ranson score ( r=0.0218, P=0.002). There was no correlation between PLR and APACHE II score ( P=0.157). The areas under the ROC curve (AUC) of NLR and PLR were 0.894 and 0.728. The optimal threshold, sensitivity and specificity of NLR were 6.105, 92.9% and 76.1%, and the optimal threshold, sensitivity and specificity of PLR were 154.358, 78.2% and 73.2%. The AUC of NLR-PLR (0.864) was the largest. Conclusions:NLR and PLR have predictive value for SAP patients within 48 h of the onset of AP. NLR-PLR combined detection have early predictive value for SAP within 48 h of onset.
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Objective:At present, the postgraduate education of emergency medicine in China mainly relies on the internal medicine system and lacks specialty pertinence. The purpose of this study is to establish a compulsory curriculum system for professional postgraduates of emergency medicine.Methods:Modified Delphi method was used to subscribe questionnaires to experts, and the contents were mainly about medical education management and research of emergency in the affiliated teaching hospitals of Peking University. Microsoft Excel 2016 was used for double entry of questionnaire contents, and SPSS 22.0 software was used for statistics.Results:The panel was consisted of 14 experts in total and two rounds of Delphi questionnaires were completed. The response rate of the two rounds were both 100%. The authority coefficient of experts was > 0.9 and the average score of each evaluation index was 4.07-5.00 points. The coefficient of variation of each index was 0-0.22 and the Kendall coefficient of concordance was 0.07-0.10.Conclusion:As a result, a comprehensive emergency professional postgraduate curriculum system has been established.
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Objective:To investigate the prognostic value of platelet volume indices (PVIs), neutrophil/lymphocyte ratio (NLR) and the combination of these parameters for the neurological function of acute ischemic stroke (AIS) patients after intravenous thrombolysis.Methods:From January 2016 to January 2019, the data of 147 AIS patients with intravenous thrombolysis in the Emergency Department of Peking University People's Hospital who met the diagnostic criteria of AIS were retrospectively analyzed. The patients were divided into two groups according to modified rank in scale (MRS) score: MRS≤2 and MRS≥3. The general information, past medical history and laboratory examination results of each group were compared. Logistic regression analysis was used to analyze the risk factors of poor prognosis of neurological function in AIS patients with thrombolysis.Results:NLR ( OR=1.045, 95% CI: 1.032-2.350, P=0.032), mean platelet volume (MPV) ( OR=4.212, 95% CI:1.074-16.513, P=0.039), MPV×NLR/PLT ( OR=5.711, 95% CI: 1.342-24.298, P=0.018), platelet distribution width (PDW) ( OR=1.015, 95% CI: 1.001-2.372, P=0.032), and NIHSS score ( OR=1.266, 95% CI: 1.111-1.443, P<0.01) were related with poor prognosis neurological function of AIS patients with intravenous thrombolysis. Conclusions:MPV, NLR, MPV×NLR/PLT PDW and NIHSS scores are the risk factors for poor prognosis of neurological function in AIS patients with thrombolysis. MPV×NLR/PLT can predict the neurological severity of AIS after 3 months.
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Objective:To investigate the relationship between neutrophil to lymphocyte ratio (NLR) and the severity of acute ischemic stroke (AIS) and the prognosis of patients undergoing intravenous thrombolysis (IVT).Methods:From January 2016 to January 2019, 147 AIS patients with intravenous thrombolysis in the Emergency Department of Peking University People's Hospital who met the diagnostic criteria of AIS were studied retrospectively. According to the NLR value, 147 patients were divided into the NLR 2 or less group ( n=37) or less, 2 < NLR < 3 group ( n=31), and the NLR≥3 group ( n=79). General data, medical history, laboratory examination results, NIHSS score and mRS score of patients in each group were compared. Logistic regression analysis was used to analyze the relationship between NLR and severity of acute ischemic stroke patients and clinical prognosis with thrombolysis. Results:NLR was associated with AIS stroke severity ( OR=2.044, 95% CI: 1.011-8.566, P=0.006). NLR was associated with poor prognosis of AIS neurological function with thrombolysis ( OR=3.744, 95% CI: 0.997-4.713, P=0.003). However, NLR was not associated with AIS death after thrombolysis ( OR=0.591, 95% CI: 0.750-1.933, P=0.442). Conclusions:NLR was associated with the severity of stroke in AIS patients and the prognosis of poor neurological function with thrombolysis.
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Objective:To investigate the clinical characteristics, risk stratification, thrombolytic effects and prognosis of 110 patients with acute pulmonary embolism (PE) treated with thrombolysis.Methods:The clinical data of 110 patients with PE admitted to Beijing University People's Hospital from May 2009 to March 2019 were retrospective analyzed. The clinical data including general information, symptoms and signs, blood pressure, artery blood gas, coaglulation, and radiography were collected. Inclusion criteria: high-risk and intermediate high-risk group. Exclusion criteria: intermediate low-risk and low-risk group. According to the prognosis and risk stratification, the patients were divided into survival group and non-survival group, high-risk group and intermediate high-risk group. The indicators above were compared between with χ 2 test, t test or nonparametric test where appropriate. Results:Of the 110 patients with PE, 49 patients were male and 61 female with an average age of 65±16 years old; and 12 patients were in the high-risk group and 98 in the intermediate high-risk group. The respiratory rate of the high-risk group was higher, and blood pressure, PO 2, SaO 2 before thrombolysis were more lower than the intermediate high-risk group ( P<0.05). One hundred and nine patients were treated with systemic recombinant tissue plasminogen activator (rtPA), 70 patients with 50 mg, and 39 patients with 100 mg. One patient, who was contraindicated to systemic thrombolysis (with active vagina bleeding), was treated with interventional local thrombolysis; another 5 patients treated with interventional local thrombolysis because the clinical symptom were not improved markedly. One hundred and two patients survived and 8 patients died, among which, 3 patients were in the high-risk group and 5 in the intermediate high-risk group. The age, heart rate, respiration rate of the non-survival group were higher than those in the survival group, and the PO 2 before thrombolysis, PCO 2 after thrombolysis were lower ( P<0.05). Bleeding complication were occurred in 22 patients: 18 patients with minor bleeding, such as bleeding gums, skin ecchymosis, and 4 patients with moderate-severe bleeding, such as cerebral hemorrhage, abdominal bleeding, gastrointestinal bleeding, and vagina bleeding. Thirteen of 70 patients in the 50 mg group and 9 of 39 patients in the 100 mg group occurred bleeding complication. The bleeding complication of the low dose group was lower than that of the standard dose group ( P<0.05). Conclusions:Thrombolysis is first-line therapy to high-risk PE. Thrombolysis is safe and effective in the intermediate high-risk group with a lower incidence rate of bleeding complication.
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Objective To investigate the clinical features,diagnosis,treatment and prognosis of 59 patients with thrombotic thrombocytopenic purpura (TTP),therefore to improve the ability of diagnosis and treatment.Methods The clinical data of 59 patients with TTP admitted to Peking University People's Hospital from January 2004 to October 2018 were retrospectively analyzed.All the patients were clinically diagnosed,fulfilled the triad syndrome,or quinary syndrome.Laboratory data included complete blood count,blood biochemistry,immtmology,hemolysis;some patients tested the activity of ADAMTS13.The differences between groups were compared according to the prognosis.Results Among the 59 patients with TTP,21 were male and 38 were female,with an average age of 46.8 years.Fifty-five patients had the triad syndrome and 46 patients had the quinary syndrome.The platelet count and hemoglobin decreased,the percentage of erythrocyte fragmented increased,and the value or the activity of ADAMTS13 was decreased significantly.PLASMIC scores of 57 patients were between 6 and 7.All 59 patients were treated with glucocorticoid,41 patients received plasma exchange (PEX),and 28 patients survived;18 patients did not received PEX,and only 6 patients survived.There was a significant difference of the survival between the two groups (P＜0.05).Six patients were treated with rituximab and four patients survived.Conclusion The PLASMIC score can predict the activity of ADAMTS 13 well.PEX can significantly improve the survival rate of patients with TTP.
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Objective@#To investigate the clinical characteristics, coagulation function and associated prognostic factors of acute aortic dissection.@*Methods@#The clinical data of 119 patients with acute aortic dissection (AAD) admitted to Beijing University People's Hospital from November 2008 to January 2016 were analyzed. All the participants were confirmed by computed tomography angiography, and the onset time was less than 14 days. Data of blood routine test, coagulation function at the first admission were collected, and surgical intervention and prognosis were recorded. All the patients, according to the prognosis, or whether disseminated intravascular coagulation (DIC) occurred, were divided into two groups, and the differences between the two groups were compared. Logistic regression analysis was applied to analyze independent risk factors related to in-hospital death in AAD patients.@*Results@#In 119 patients with AAD, the average age was (52.9±14.2) years, with a male/female ratio of 5.3:1. Pain was the most common clinical manifestation in patients with AAD, accounting for more than 90.0%. The nature of pain was mostly expansible and/or transitive pain. Dominant DIC occurred in 13 cases (10.9%), and 7 patients died (53.8%). There were significant differences between the DIC group and non-DIC group in neutrophil/lymphocyte ratio (NLR), platelet count, fibrinogen, D-dimer, FDP, PT, APTT and mortality rate (P<0.05). All the 16 patients in the death group were type A AAD, among which, 7 patients (43.8%) developed with DIC. There were significant differences between the death group and survival group in NLR, platelet count, fibrinogen, D-dimer, FDP, PT, APTT, DIC proportion and surgical operation rate (P<0.05).Logistic regression analysis showed that NLR and platelet count were independent risk factors of in-hospital death (P<0.05).@*Conclusions@#D-dimer has a high diagnostic and prognosis value for AAD. The mortality increased with the activation and depletion of platelet. Once DIC occurs, the prognosis is extremely poor. NLR and platelet count are independent risk factors for in-hospital death in patients with AAD.
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Objective To investigate the clinical characteristics and prognosis of patients with acute aortic dissection (AAD) and hypertension,and explore other related prognostic factors in AAD.Methods The present study enrolled consecutive patients diagnosed with AAD who were admitted to Peking University People's Hospital between January 2000 to December 2015.Patients diagnosed with AAD by CT angiography,aortography or magnetic resonance imaging within 14 days of onset were included.Patients with infectious diseases,haematological diseases,malignancies,autoimmune diseases and patients without clearly clinical diagnosis or incomplete data were excluded.The patients were initially divided into two groups based on their history of hypertension,and their clinical characteristics were compared and analyzed.We further divided AAD patients into survival group and death group according to their in-patient outcomes,and factors related to their prognoses were analyzed.Logistic regression analysis was applied to analyze the independent risk factors related to hospital death in AAD patients with P＜0.05 as the significant value.Results The hypertensive group contained 237/346 cases included (68.45％),patients in this group were generally older than their non-hypertensive counterparts,accompanied by increased prevalence of comorbidities (coronary heart diseases or diabetes) and a statistical significant elevated admission blood pressures (systolic and diastolic,P＜0.05).No significant difference were found between the groups in terms of white blood cell and platelet count,D-dimer,neutrophil to lymphocyte ratio(NLR),fibrinogen,serum creatinine and serum lipid profiles (P＞0.05).Hypertensive patients were less likely to receive surgical treatment compared with those without hypertension(P＜0.05),with increased risk of in-hospital mortality (P＞0.05).Further logistic regression analysis revealed the presence of hypertension did not independently predict in-hospital mortality of AAD patients.Factors such as age,Stanford classification of the AAD,NLR and platelet counts were found to have independent predictive values for in-hospital mortality (P＜0.05).Conclusion AAD patients with hypertension are generally older,have more comorbidities such as coronary heart diseases and diabetes.The presence of hypertension itself is not directly associated with in-hospital mortality in AAD patients,while the Stanford classification,age,NLR and platelet counts are independent risk predictors.
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Objective To investigate the clinical characteristics,coagulation function and associated prognostic factors of acute aortic dissection.Methods The clinical data of 119 patients with acute aortic dissection (AAD) admitted to Beijing University People's Hospital from November 2008 to January 2016 were analyzed.All the participants were confirmed by computed tomography angiography,and the onset time was less than 14 days.Data of blood routine test,coagulation function at the first admission were collected,and surgical intervention and prognosis were recorded.All the patients,according to the prognosis,or whether disseminated intravascular coagulation (DIC) occurred,were divided into two groups,and the differences between the two groups were compared.Logistic regression analysis was applied to analyze independent risk factors related to in-hospital death in AAD patients.Results In 119 patients with AAD,the average age was (52.9±14.2) years,with a male/female ratio of 5.3:1.Pain was the most common clinical manifestation in patients with AAD,accounting for more than 90.0％.The nature of pain was mostly expansible and/or transitive pain.Dominant DIC occurred in 13 cases (10.9％),and 7 patients died (53.8％).There were significant differences between the DIC group and non-DIC group in neutrophil/lymphocyte ratio (NLR),platelet count,fibrinogen,D-dimer,FDP,PT,APTT and mortality rate (P＜0.05).All the 16 patients in the death group were type AAAD,among which,7 patients (43.8％) developed with DIC.There were significant differences between the death group and survival group in NLR,platelet count,fibrinogen,D-dimer,FDP,PT,APTT,DIC proportion and surgical operation rate (P＜0.05).Logistic regression analysis showed that NLR and platelet count were independent risk factors of in-hospital death (P＜0.05).Conclusions D-dimer has a high diagnostic and prognosis value for AAD.The mortality increased with the activation and depletion of platelet.Once DIC occurs,the prognosis is extremely poor.NLR and platelet count are independent risk factors for in-hospital death in patients with AAD.
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Objective To investigate the clinical characteristics and associated prognostic factors of the acute aortic syndrome. Methods The clinical data of 391 patients with acute aortic syndrome (AAS) admitted to Beijing University People's Hospital from January 2000 to December 2015 were analyzed. Results In 391 patients with AAS, the average age was (52.7 ±13.3) with a male/female ratio of 4.3:1, and 73.4％ patients had hypertension. The most common clinical manifestation of patients with AAS was pain accounting for more than 90.0％, and the nature of pain was expansible and/or transitive pain. The level of D-dimer was elevated in 91.1％ of patients with AAS (ELISA), and significantly higher in type A patients than type B patients. Ultrasound/echocardiography was used to diagnose AAS with a sensitivity of 88.4％, of which the sensitivity of type A patients was 99.1％; the mortality of type A patients was significantly higher than type B patients (34.3％ vs. 0.9％, P <0.01). The mortality was declined obviously (11.7％ vs. 28.0％, P <0.01) when patients were treated with stent. Compared with the in-hospital surviving group, the in-hospital mortality group had decreased platelet counts and FIB, higher level of D-dimer, FDP and NLR (neutrophil to lymphocyte ratio). Conclusions Transitive and(or) expansible pains were the characteristic clinical manifestations of acute aortic syndrome,which usually happened suddenly or tearing;D - dimer and ultrasound were valueble and simple methods in AAS patients; Compared with In-hospital surviving group,the In-hospital mortality group had decreased platelet counts and FIB,higher level of D-dimer, FDP and NLR.The mortality of type A was significantly higher than type B,operation can lower the mortality of AAS patients obviously.
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Objective To explore the risk factors of contrast-induced nephropathy (CIN) in patients with acute ST-segment elevation myocardial infarction(STEMI)treated with emergent percutaneous coronary intervention(PCI).Methods The clinical data of patients with STEMI treated by emergent PCI from January 2014 to February 2017 in Peking University People's Hospital was reviewed.Exclusion criteria included contrast agent allergy,previous renal diseases,chronic renal failure,heart failure,tumor,acute infection,only one renal function test available during hospitalization and lacking essential medical records.Data of demographics,past medical history,general conditions at admission,laboratory findings,etc,were collected.Patients were divided into CIN group and non-CIN group.The univariate comparison analysis and Logistic regression analysis were performed to obtain the risk factors of CIN.Results A total of 236 patients were enrolled.The incidence of CIN was 10.2％ (24/236).Univariable analysis demonstrated that the risk factors of CIN were age,diabetes mellitus,Killip grade ≥ 3 stage,serum uric acid (SUA) level at admission,blood glucose level at admission.Binary logistic regression analysis showed that SUA ≥ 350 μ mol/L at admission,blood glucos ≥ 11 mmol/L at admission,age ≥ 75 years were independent risk factors for CIN.Conclusion SUA ≥ 350 μ mol/L at admission,blood sugar ≥ 1 1 mmol/L at admission,age ≥ 75 years were independent risk factors of CIN in patients with STEMI treated with emergent PCI.
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Objective:To investigate the synergistic killer effect of natural killer cells(NK cells) combined with tamoxifen(TAM) on breast cancer cells(BCC)through the experiment in vitro,and to explore its mechanism.Methods:Three kinds of BCC with different receptor expression levels were selected for the experiment.Blank control group, different concentrations of TAM groups and different time groups were set up.MTT assay was used to detect the inhibitory rates of proliferation of cells,and the final experiment concentration of 5 μmol·L-1 was determined.The cells were divided into natural-release group,largest-release group,TAM group,NK cells group, and combined-experimental group(BCC+NK cells+TAM),and the synergistic killer effect of NK cells combined with TAM in different effector-target ratios were detected with Calcein-AM release assay.In ELISA assay the cells were divided into blank control group (NK cells),NK cells+TAM group, NK cells+BCC group and combined-experimental group,and the levels of IFN-γ and TNF-α in the NK cells in various groups were measured.In flow cytometry detection the cells were divided into blank control group (NK cells),NK cells+TAM group,NK cells+ BCC group, and combined-experimental group,and the expression levels of NKp46,CD158a,CD158b,CD158b2,and CD158e were determined;while the cells were divided into blank control group (BCC),BCC+TAM group,BCC + NK cells group, and combined-experimental group,and the expression levels of the MICA,ULBP1 and ULBP2 were detected.Results: The MTT assay results showed that the inhibitory rates of proliferation of 3 kinds of BCC had obvious time-and concentration-dependence (P<0.05).The Calcein-AM release assay results showed that the killing-rates of BCC in TAM groups were increased with the increase effector-target ratios of compared with NK cells group;and the killing-rate in combined experimental group was obviously higher than those in NK cells and TAM groups(P<0.05).The ELISA assay results showed that the levels of TNF-α and IFN-γ of NK cells in various experimental groups with BCC or not were increased compared with blank control group(P<0.05 or P<0.01);the levels were significantly increased when combined with TAM (P<0.05).The flow cytometry results showed that the NKp46 expression levels in various experimental groups were elevated compared with blank control group(P<0.05);the expression levels of CD158a, CD158b,CD158b2, and CD158e were significantly decreased(P<0.05);the expression levels MICA,ULBP1, and ULBP2 in BCC were significantly increased (P<0.05).Conclusion:The NK cells combined with TAM has the synergistic killer effect on the BCC in vitro.The synergetic mechanism may be as follows: TAM could increase the secretion of TNF-α and IFN-γ of NK cells to enhance their cytotoxicity;TAM also could up-regulate the expression levels of activating receptors and activating ligands,and down-regulate the expression levels of inhibitory receptors to increase the killing ability of NK cells.
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Objective To explore the risk factors for acute kidney injury (AKI) in patients with acute heart failure (AHF).Methods A total of 254 patients with AHF admitted in the emergency department of Peking University People's Hospital from January 2015 to September 2016 were enrolled for retrospective study.Exclusion criteria included:age ＜ 18 years old,end stage renal disease or long-term dialysis,length of hospital stay ＜ 2 days,only one renal function test available during hospitalization,patients discharged by themselves and lacking essential medical records.Data of demographics,past medical history,general conditions at admission,accessory examinations and treatments,etc,were collected.Patients were divided into AKI group and non-AKI group according to Kidney Disease:Improving Global Outcomes (KDIGO) criteria.Univariate comparison analyses were performed to evaluate the differences between the two groups.Results Of 254 eligible patients,there were 78 (30.7％) in AKI group and 176 (69.3％) in non-AKI group.The mortality rates of AKI group and non-AKI group were 34.6％ and 11.9％ (P ＜ 0.05),respectively.Compared with the non-AKI group,baseline serum creatinine,C-reactive protein,the peak level of B-type natriuretic peptide,the proportion of proteinuria,cardiac function grade Ⅳ,the daily dose of intravenous furosemide dose ≥ 80 mg,the use of nesiritide,cardiac inotropic agents and renal replacement therapy in the AKI group were significantly higher;the estimated glomerular filtration rate was significantly lower (P ＜ 0.05).Conclusions The incidence of AKI in patients with AHF was high and the prognosis of patients with AHF developing to AKI was poor.The baseline serum creatinine,estimated glomerular filtration rate,proteinuria,C-reactive protein,cardiac function grade Ⅳ,the peak level of B-type natriuretic peptide,the daily dose of intravenous furosemide dose ≥ 80 mg,the use of nesiritide,cardiac inotropic agents and renal replacement therapy were the significant risk factors of AKI in patients with AHF.
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Objective To explore the risk factors for acute kidney injury (AKI) in patients with acute heart failure (AHF).Methods A total of 254 patients with AHF admitted in the emergency department of Peking University People's Hospital from January 2015 to September 2016 were enrolled for retrospective study.Exclusion criteria included:age ＜ 18 years old,end stage renal disease or long-term dialysis,length of hospital stay ＜ 2 days,only one renal function test available during hospitalization,patients discharged by themselves and lacking essential medical records.Data of demographics,past medical history,general conditions at admission,accessory examinations and treatments,etc,were collected.Patients were divided into AKI group and non-AKI group according to Kidney Disease:Improving Global Outcomes (KDIGO) criteria.Univariate comparison analyses were performed to evaluate the differences between the two groups.Results Of 254 eligible patients,there were 78 (30.7％) in AKI group and 176 (69.3％) in non-AKI group.The mortality rates of AKI group and non-AKI group were 34.6％ and 11.9％ (P ＜ 0.05),respectively.Compared with the non-AKI group,baseline serum creatinine,C-reactive protein,the peak level of B-type natriuretic peptide,the proportion of proteinuria,cardiac function grade Ⅳ,the daily dose of intravenous furosemide dose ≥ 80 mg,the use of nesiritide,cardiac inotropic agents and renal replacement therapy in the AKI group were significantly higher;the estimated glomerular filtration rate was significantly lower (P ＜ 0.05).Conclusions The incidence of AKI in patients with AHF was high and the prognosis of patients with AHF developing to AKI was poor.The baseline serum creatinine,estimated glomerular filtration rate,proteinuria,C-reactive protein,cardiac function grade Ⅳ,the peak level of B-type natriuretic peptide,the daily dose of intravenous furosemide dose ≥ 80 mg,the use of nesiritide,cardiac inotropic agents and renal replacement therapy were the significant risk factors of AKI in patients with AHF.
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Objective To investigate the imaging features and preoperative staging value of ultrasonic endoscopy and gastrointestinal ultrasonic contrast in the gastric carcinoma examination.Methods One hundred and sixty eight patients with gastric carcinoma verified by operation and pathology in our hospital from October 2010 to October 2015 werecollected.Then their imageological data including ultrasonic endoscopy and gastrointestinal ultrasonic contrast examinations were retrospectively analyzed and compared with the postoperative pathological results.Results The accuracy rate of preoperative T staging in ultrasonic endoscopy was significantly higher than that of gastrointestinal ultrasonic contrast,the difference had statistical significance(P＜0.05);the accuracy rate of preoperative N/M staging in gastrointestinal ultrasonic contrast was s1gnificantly higher than that in ultrasonic endoscopy,the difference had statistical significance(P＜0.05).Conclusion Ultrsonic endoscopy and gastrointestinal ultrasonic contrast have different advantages and values in preoperative staging:ultrasonic endoscopy has higher accuracy rate in the diagnosis of primary gastric carcinoma;gastrointestinal ultrasonic contrast is better in diagnosing metastasis of gastric carcinoma,moreover which shows the consistency with postoperative pathological staging.
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Objective To analyze the clinical characteristics of suspected acute aortic dissection with ST-segment elevation detected by inferior leads in order to avoid the misdiagnosis of acute aortic dissection facilitating an appropriate treatment strategy carried out in time.Methods A total of 14 patients with suspected acute aortic dissection with ST-segment elevation detected by inferior leads were enrolled.Their clinical presentation,ECG features,imaging findings,laboratory testing,coronary angiography results, treatment and outcome were retrospectively analyzed.Results Clinical characteristics of suspected acute aortic dissection with ST-segment elevation detected by inferior leads suggested that hypertension as a single risk factor accounted for 79%.The patients with normal blood pressure or high blood pressure in emergency visits accounted for 86%.The amplitude of ST elevation in lead Ⅲ was greater than that in lead Ⅱ,and lead Ⅲ accompanied with ST elevation in lead V1 or V4R accounted for 86%.Significantly elevated D-dimer >2 000 ng/mL was found in those patients.Coronary angiography showed that the opening of coronary artery not seen,normal coronary arteries or a simple right coronary artery proximal lesion.Transesophageal echocardiography and computed tomography angiography were used to identify the diagnosis with 100%accuracy.The mortality rate of this group was 50%.Conclusions Patients with acute aortic dissection evidenced by ST-segment elevation detected by inferior leads are in critical setting of high mortality. Emergency surgical treatment can significantly improve the survival rate of patients.
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Objective:To study the inhibitory effect of γδT cells on the proliferation of ovarian cancer SKOV3 cells,and to clarify its possible mechanism of inducing apoptosis. Methods:The human ovarian cancer SKOV3 cells cultured in vitro were used as control group,and theγδT and SKOV3 cells were co-cultured for 72 h as γδT cells treatment group.Laser scanning confocal microscope was used to obeserve the morphological changes of nucleus SKOV3 cells,and the inhibitory rate of proliferation of SKOV3 cells in two groups were detected by MTT method;Transwell Chambers was used to detect the cell migration ability,then the apoptotic rates of SKOV3 cells were tested by flow cytometry (FCM).Results:The apoptotic morphology of nucleus of SKOV3 cells in γδT cells treatment group were found under microscope,such as nuclear shrinkage.The MTT resultes displayed that the inhibitory rate of proliferation of SKOV3 cells in γδT cells treatment group was higher than that in control group (P <0.05).The Transwell Chambers results showed that the number of transmembrane cells in γδT cells treatment group was lower than that in control group,and the migration rate was decreased compared with control group (P <0.05).The FCM results showed that the apoptotic rate of SKOV3 cells in γδT cells treatment group was higher than that in control group (P < 0.05 ).Conclusion:γδT cells can inhibit the proliferation and the migration abilities of ovarian cancer SKOV3 cells,and promote the apoptosis.