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Sepsis is a serious complication of infection, and its further development may lead to multi-organ dysfunction syndrome. Sepsis cardiomyopathy is a common complication of sepsis and has been directly linked to high mortality. Although the pathogenesis of septic cardiomyopathy is not fully understood, in-depth study of the pathogenesis of septic cardiomyopathy and the identification of its potential therapeutic targets may reduce mortality in patients with sepsis. Ferroptosis is an iron-dependent mode of cell death that has been shown to be involved in the pathophysiological mechanisms of many diseases. Some related studies have reported that ferroptosis may be a potential mechanism of septic cardiomyopathy. This review provides new insights into the mechanisms of mitochondrial dysfunction, lipid peroxidation, xc-system, glutathione peroxidase 4 (GPX4), iron metabolism and the role of ferroptosiswith septic cardiomyopathy for further research and treatment of septic cardiomyopathy.
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Objective:To identify the risk factors for massive blood loss in pediatric patients with congenital scoliosis undergoing posterior hemivertebra resection.Methods:The clinical data of pediatric patients with congenital scoliosis who underwent posterior hemivertebra resection in our hospital from May 2017 to July 2019 were collected.The children were divided into group A (massive blood loss, blood loss/blood volume ≥30%) and group B (non-massive blood loss, blood loss/blood volume <30%) according to intraoperative blood loss.Logistic regression analysis was used to stratify the risk factors.Results:A total of 108 pediatric patients were enrolled in the study including 29 cases in group A and 79 cases in group B, respectively.There were significant differences in the preoperative Cobb angle, body mass index, the number of fused levels, the number of screws and operative time between the two groups ( P<0.05). Logistic regression analysis showed that the preoperative Cobb angle, operative time, the number of fused levels and body mass index were the risk factors for intraoperative massive blood loss ( P<0.05). Conclusion:Lower BMI, larger Cobb angle, increased operative time and more fused levels are the risk factors for massive blood loss in pediatric patients with congenital scoliosis undergoing posterior hemivertebra resection.
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Objective:To assess the impact of caudal regional anesthesia on complications after hypospadias repair with tubularised incised plate urethroplasty (TIP).Methods:A total of 125 cases with hypospadias undergoing TIP surgery from June 2017 to June 2019 at Beijing Children′s Hospital, Capital Medical University, were reviewed, aged 12-75 months, American Society of Anesthesiologists Ⅰ orⅡ grade.Totally, 86 cases had distal and 39 cases suffered from proximal hypospadias.Caudal anesthetics were used in 42 cases (caudal anesthesia group) and general anesthetics were used in 83 cases (general anesthesia group). All cases were repaired by TIP procedure.The children with urethral fistula and urethral stricture were followed up for 6 months, and multivariate statistical analyses were performed.Results:There were 11 cases of urethral fistula after hypospadias surgery, with 8 cases (9.64%)in the general anesthesia group and 3 cases (7.14%) in the caudal anesthesia group.There were no significant differences between the 2 groups ( χ2=0.223, P=0.636), and 12 cases of urethral stricture, with 8 cases(9.64%) in the general anesthesia group and 4 cases(9.52%) in the caudal anesthesia group.There were no significant differences between the 2 groups ( χ2=0.001, P=0.984). Based on multivariable Logistic regression, urethral fistula was associated with proximal hypospadias ( OR=0.036, 95% CI: 0.003-0.511, P=0.014), and the width of glans( OR=0.469, 95% CI: 0.220-0.998, P=0.049). Urethral stricture was correlated with proximal hypospadias( OR=0.004, 95% CI: 0.000-0.146, P=0.002), the width of urethral plate( OR=0.004, 95% CI: 0.000-0.422, P=0.020), and the duration of catheter( OR=72.976, 95% CI: 1.802-2 594.790, P=0.023). Conclusion:Caudal regional anesthesia appears to have no impacts on urethral fistula and stricture after hypospadias repair.
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Objective:To evaluate the effect of nalbuphine combined with propofol for esophageal dilation with gastroscope in the pediatric patients.Methods:A total of 150 pediatric patients with esophageal stenosis, aged 6 months-2 yr, weighing 6-15 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective painless balloon dilation with gastroscope under general anesthesia, were randomized into 3 groups ( n=50 each) according to the random number table method: nalbuphine 0.1 mg/kg plus propofol group (N 1P group), nalbuphine 0.2 mg/kg plus propofol group (N 2P group), and fentanyl plus propofol group (FP group). Nalbuphine 0.1 and 0.2 mg/kg and fentanyl 1 μg/kg were intravenously injected in N 1P, N 2P and FP groups, respectively, and 2 min later propofol 1.5-2.0 mg/kg was intravenously injected for sedation until the eyelash reflex disappeared in the three groups.Propofol 1.0 mg/kg was added when body movement occurred during surgery.The amount of propofol consumed during surgery, occurrence of body movement and respiratory depression, occurrence of adverse reactions such as postoperative nausea and vomiting, and laryngospasm, emergence time, Face Legs Activity Cry Consolability (FLACC) pain scale score and surgeons′ satisfaction were recorded. Results:Compared with group N 1P, the consumption of propofol, body movement classification ratio and FLACC score were significantly decreased, and the emergence time was shortened in group N 2P ( P<0.05), and no significant change was found in the parameters mentioned above in group FP ( P>0.05). There was no significant difference in the incidence of perioperative adverse reactions and degree of surgeons′ satisfaction among the three groups ( P>0.05). Conclusion:Nalbuphine combined with propofol can provide satisfactory anesthetic efficacy with fewer adverse reactions when used for esophageal dilation with gastroscope in the pediatric patients.
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Objective:To evaluate the efficacy of ultrasound-guided bilateral erector spinae plane (ESP) block for pediatric patients undergoing Nuss procedure with general anesthesia.Methods:Thirty-two American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 4-15 yr, undergoing Nuss procedure with general anesthesia, were divided into ESP block plus general anesthesia group (group EG, n=16) and general anesthesia group (group G, n=16) using a random number table method.Bilateral ESP blocks were performed after anesthesia induction in group EG.Intravenous analgesia was performed postoperatively in both groups.Face Legs Activity Cry Consolability (FLACC) scores both at rest and during coughing were recorded on admission to postanesthesia care unit (PACU) and at 1, 6, 12, 24 and 48 h after operation.When FLACC score at rest >4, ibuprofen 5.0-7.5 mg/kg was taken orally according to the requirements of pediatric patients and their parents.The intraoperative amount of propofol and remifentanil used and postoperative requirement for fentanyl and ibuprofen were recorded.The development of postoperative hypoxia (SpO 2 <90%), nausea and vomiting, and urinary retention was recorded.The development of puncture site infection, hematoma and subcutaneous emphysema was recorded.The tracheal extubation time, duration in PACU and length of postoperative hospital stay were also recorded. Results:Compared with group G, FLACC scores at rest within 12 h after operation and during coughing within 6 h after operation were significantly decreased, the intraoperative consumption of remifentanil was reduced, the postoperative requirement for fentanyl and ibuprofen was decreased, the incidence of hypoxemia was decreased, the tracheal extubation time and duration in PACU were shortened ( P<0.05), and no significant change was found in the consumption of propofol, incidence of nausea and vomiting, or length of postoperative hospital stay in group EG ( P>0.05). Conclusion:Ultrasound-guided bilateral ESP block can reduce the consumption of opioids in the perioperative period and enhance the analgesic efficacy with a higher safety, which is helpful in promoting short-term outcomes for pediatric patients undergoing Nuss procedure with general anesthesia.
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Objective:To explore the clinical value of mean platelet volume/platelet count ratio(MPV/PLT)in predicting short-term prognosis of elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods:A total of 226 elderly patients with AECOPD admitted to our hospital from January 2017 to January 2019 were retrospectively enrolled as research subjects.All cases were divided into the survival group(n=175)and the death group(n=51), based on prognosis 28-day after admission.General data and laboratory test results were compared between the two groups.The relevant factors for death were analyzed by the Logistic regression equation.The receiver operating characteristic(ROC)curve was used to evaluate the prognostic value of MPV/PLT, and the Kaplan-Meier survival curve was drawn according to the cut-off.Methods:Compared with the survival group, Acute Physiology and Chronic Health Status Evaluation(APACHEⅡ)score, levels of procalcitonin(PCT), high-sensitivity C-reactive protein(hs-CRP), creatinine, neutrophil count(NEU), lymphocyte count(LYM)and MPV were elevated, and levels of albumin and PLT decreased in the death group( P<0.05). Hospital stay lengths and costs were higher in the death group than in the survival group( P<0.05). The level of MPV/PLT was higher in the death group than in the survival group(0.065±0.016 vs.0.054±0.013, t=5.036, P<0.01). Multivariate Logistic regression showed that MPV/PLT was an independent risk factor for recent death( OR=2.331, 95% CI: 1.772-8.224, P<0.01). ROC curve analysis showed that the area under the curve(AUC)of MPV/PLT was 0.829, the sensitivity was 83.41%, the specificity was 82.80%, and the cut-off was 0.061.Optimal cut-off value analysis showed that APACHEⅡ score, PCT and hs-CRP levels and mortality were higher in patients with MPV/PLT≥0.061 than in patients with MPV/PLT<0.061( P<0.05). The Kaplan Meier survival curve showed that the cumulative survival rate was lower in those with MPV/PLT≥0.061 than in those with MPV/PLT<0.061( Log- rank=6.323, P<0.05). Conclusions:The increase of MPV/PLT may be an independent risk factor for recent death in elderly patients with AECOPD and has good clinical value in predicting poor prognosis.
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Objective: To investigate the effect of chemotherapy combined with sodium cantharidinate vitamin B6 injection in the patients with non-small cell lung cancer (NSCLC) and its effect on the patients' quality of life, and to clarify its mechanism. Methods: A total of 110 NSCLC patients were divided into chemotherapy group and combined group according to the different treatment methods adopted by the patients. A total of 55 patients were treated with chemotherapy alone (chemotherapy group) and 55 patients treated with chemotherapy combined with sodium cantharidate vitamin B6 injection (combined group). The total effective rate of the patients in two groups were compared; EORTC QLO-C43 scale was used to evaluate the quality of life of the patients in two groups before and after treatment; the serum levels of vascular endothelial growth factor (VEGF), tumor necrosis factor-alpha (TNF-a), and interleukin-12 (IL-12) of the patients in two groups before and after treatment were detected by double-antibody sandwich enzyme-linked immunoassay method. Results: After treatment, the total effective rate of the patients in combined group was higher than that in chemotherapy group, but the difference was not statistically significant (χ2 = 0.806, P= 0.369). Before treatment, there were no significant differences in the scores of functional scale, overall health status, symptom subscale and lung cancer specific subscale of the patients between combined group and chemotherapy group (P>0. 05). After treatment, the scores of functional scale and overall health status of the patients in combined group were significantly higher than those in chemotherapy group (P0. 05). After treatment, the serum level of VEGF of the patients in combined group was significantly lower than that in chemotherapy group (χ2= 3. 608, P<0. 05), and the serum levels of TNF-a and IL-12 were significantly higher than those in chemotherapy group (t= 3.426, P<0.05; t= 2.849, P < 0. 05). Conclusion: The effect of chemotherapy combined with sodium cantharidate vitamin B6 injection in the treatment of the NSCLC patients is good, and it can significantly improve the quality of life of the patients; its mechanism may be related to decreasing the serum VEGF level and increasing the serum TNF-α and IL-12 levels.
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Objective To investigate the effectiveness of training at morning shift meeting in improving healthcare-associated infection(HAI) prevention and control among health care workers(HCWs) in newly established hospital departments.Methods On July 11-22, 2016, HAI management full-time personnel performed training for HCWs about HAI prevention and control at morning shift meeting of 8 newly established clinical departments and 1 laboratory, the questionnaire survey was conducted before, immediately after, and 3 months after training, training effectiveness was evaluated.Results A total of 239 HCWs were required to receive training, including 85 doctors (35.6％), 150 nurses (62.8％), and 4 technicians (1.7％).The knowledge of HAI prevention and control that most HCWs wanted to know was occupational exposure and occupational precaution(85.6％);most HCWs wanted to obtain knowledge of HAI through training in their respective department by HAI management full-time personnel(87.1％).Total awareness rates of HAI knowledge before, immediately after, and 3 months after training were 45.1％, 96.7％, and 83.9％ respectively, difference was significant(P<0.001);comparison among groups showed that HCWs'' awareness in influencing factors of HAI, hand hygiene opportunity, isolation measures, and medical waste classification 3 months after training was significantly lower than immediately after training(all P<0.001);the average scores of HAI prevention and control knowledge among HCWs immediately after and 3 months after training were both higher than before training(P<0.001);average score of HAI prevention and control knowledge among HCWs 3 months after training was lower than that of immediately after training(P<0.001).Conclusion The training at morning shift meeting of clinical departments can improve the awareness of HAI prevention and control knowledge among HCWs.
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Objective To evaluate the efficacy of closed-loop infusion of propofol for surgery on the body Surface in preschool and school-age pediatric patients.Methods American Society of Anesthesiologists physical status Ⅰ pediatric patients of both sexes,undergoing elective surgery on the body surface,were included in the study.One hundred twenty-four preschool pediatric patients (aged 3-6 yr) were divided into 2 groups (n=62 each) using a random number table:closed-loop group (CPRE group) and openloop group (OPRE group).Thirty-eight school-age pediatric patients (aged 7-12 yr) were divided into 2 groups (n=19 each) using a random number table:closed-loop group (CSTU group) and open-loop group (OSTU group).The target bispectral index (BIS) value was set at 50 during maintenance of anesthesia.Propofol was delivered using closed-loop anesthesia delivery system,and the target plasma concentration of propofol was automatically regulated in CpRE and CSTU groups.Propofol was given using open-loop anesthesia delivery system,and the target plasma concentration of propofol was manually regulated in OpRE and OSTU groups.The adequate anesthesia time ratio (BIS40-60％) and global score (GS) of the delivery system were recorded during maintenance of anesthesia.The consumption of propofol,frequency of regulation and mean BIS value were recorded.The delivery system-related complications were recorded during the perioperative period.Results Compared with group OpRE,the consumption of propofol,GS and mean BIS value were significantly decreased,BIS40-60％ was increased (P＜0.05),and no significant change was found in the frequency of regulation in group CpRE (P＞0.05).Compared with group OSTU,GS was significantly decreased,BIS40-60％ was increased (P＜0.05),and no significant change was found in the consumption of propofol,mean BIS value or frequency of regulation in group CSTU (P＞0.05).Compared with group CpRE,the consumption of propofol and GS were significantly decreased,BIS40-60％ was increased (P＜0.05).and no significant change was found in the mean BIS value or frequency of regulation in group CSTU (P＞0.05).One pediatric patient in group CSTU developed airway spasm,and no severe complications were found in the other pediatric patients.Conclusion For surgery on the body surface in preschool and school-age pediatric patients,closed-loop infusion of propofol is safe and effective,the stability and precision of anesthesia is superior to that of open-loop anesthesia delivery system,and it provides better efficacy in school-age pediatric patients than in preschool pediatric patients.
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Objective To explore the effect of misoprostol combined with psychological intervention to prevent maternal postpartum hemorrhage, and to provide evidence for clinical prevention of postpartum hemorrhage.Methods 120 cases of delivery in maternal and child health care hospital of Ningxia autonomous region from March 2015-March 2017 were collected.All women were given misoprostol treatment after fetal delivery, according to whether or not to accept the individual psychological intervention were divided into intervention group and control group, 64 cases in intervention group, 56 cases in the control group.The control group received only routine symptomatic nursing,the intervention group received psychological intervention at the time of admission and postpartum psychological intervention.The maternal mental state, the third stage of labor time, the rate of postpartum hemorrhage, the amount of postpartum hemorrhage of 24 h, the degree of nursing satisfaction and complications were compared between the two groups.Results The incidence of anxiety, fear and depression in the intervention group was lower than that in the control group (P<0.05).The third stage of labor in the intervention group was shorter than that in the control group,the incidence of postpartum hemorrhage was lower than that of the control group, and the amount of postpartum hemorrhage of 24 h was less than that of the control group, and the difference was statistically significant (P<0.05).The nursing satisfaction of the intervention group was 96.88%(62/64), and the nursing satisfaction was 78.57%(44/56)in the control group, and the difference was statistically significant between the two groups (P<0.05).In the intervention group, two cases were prolonged labor, two cases were fetal distress, one case of placental abruption, in the control group three cases were prolonged labor, three cases of placental abruption, two cases of placenta previas.The incidence of complications in the intervention group was lower than that in the control group, but there was no significant difference.Conclusion Misoprostol combined with psychological intervention can significantly improve maternal adverse psychological status, reduce the incidence of postpartum hemorrhage, reduce bleeding, improve nursing satisfaction.
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Objective To study the prevalence and genotypes of rotavirus (RV) among children,< 5 years old hospitalized with viral diarrhea in Tianjin. Methods Stool specimens were collected from hospitalized diarrhea children in Tianjin children's hospital between May 2008 and April 2009. Detection of rotavirus was employed by Colloidal Gold Device. The detected positives were inoculated to MA-104 cells. The total RNA of virus was extracted after CPE which was caused by rotavirus were observed, The VP7 serotypes were determined by using RT-PCR to amplify the VP7 gene and sequencing the RT-PCR products.The clinical data for each patient were also collected. Results Among 837 specimens, the RV antigen positive rate was 26. 3% (220/837). Among all the children with rotavirus diarrhea, 90. 5% (199/220)were < 2 years old. The prevalence of rotavirus diarrhea in children peaked during Oct. 2008 through Apr.2009. Of the 208 rotavirus positive specimens, 95 were successfully identified by RT-PCR Thirty-five positive strains of RV were sequenced, and the sequencing results showed that 32 positive strains were belonged to rotavirus G1 type, 2 positive strains were belonged to rotavirus G3 type and 1 positive strain were belonged to rotavirus C9 type. Conclusion RV was the dominant etiological agent for infantile diarrhea infection in Tianjin, and the predominant serotype was G1.