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Objective:To establish a nomogram prediction model for the prognosis of patients with septic cardiomyopathy (SCM) based on afterload-corrected cardiac performance (ACP), in order to identify septic patients with poor outcomes and treatment.Methods:The data of patients admitted to the department of critical medicine of the Second Affiliated Hospital of Guangzhou Medical University from June 2016 to June 2019 were analyzed. All patients were monitored by pulse indication continuous cardiac output (PiCCO) monitor more than 24 hours and diagnosed as SCM with ACP less than 80%. The predictors of 30-day death risk of SCM patients were screened by univariate Cox regression analysis. Multivariate Cox regression analysis was used to establish the prediction model for 30-day death risk of SCM patients, which was displayed by the nomogram. Finally, the discrimination and calibration of the model were analyzed by receiver operator characteristic curve (ROC curve) and consistency index (C-index).Results:A total of 102 patients with SCM were included and the 30-day mortality was 60.8% (62 cases). Among 102 patients with SCM, 57 patients (55.9%) had mild impairment of cardiac function (60%≤ACP < 80%), and the 30-day mortality was 43.9% (25/57); 39 patients (38.2%) had moderate impairment of cardiac function (40%≤ACP < 60%), and the 30-day mortality was 79.5% (31/39); 6 patients (5.9%) had severe impairment of cardiac function (ACP < 40%), and the 30-day mortality was 100% (6/6). There was significantly difference in mortality among the three groups (χ 2 = 24.156, P < 0.001). The potential risk factors for 30-day death of SCM patients screened by univariate Cox regression analysis were included in multivariate Cox regression analysis. The results showed that the independent risk factors for 30-day death of SCM patients were acute physiology and chronic health evaluation Ⅱ [APACHEⅡ, risk ratio ( HR) = 1.031, 95% confidence interval (95% CI) was 1.002-1.061, P = 0.039], vasoactive inotropic score (VIS, HR = 1.003, 95% CI was 1.001-1.005, P = 0.012), continuous renal replacement therapy (CRRT; HR = 2.106, 95% CI was 1.089-4.072, P = 0.027), and ACP ( HR = 0.952, 95% CI was 0.928-0.977, P < 0.001). The nomogram model was established based on the above independent risk factors and age, and the area under the curve (AUC) was 0.865 (95% CI was 0.795-0.935), P < 0.001; C-index was 0.797 (95% CI was 0.747-0.847), P > 0.05. Conclusions:The nomogram model based on age, APACHEⅡ score, VIS score, CRRT and ACP has a certain clinical reference significance for the prediction of 30-day mortality of SCM patients. The discrimination and calibration are good, however, further verification is needed.
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Objective To observe the clinical efficacy of Jiajian Yijing Decoction on improving clinical symptoms and pregnancy rate of patients with diminished ovarian reserve(DOR)and kidney deficiency and hepat-ic depression syndrome. Methods Patients with DOR and kidney deficiency and hepatic depression syndrome were randomly divided into traditional Chinese medicine group(n = 33)and western medicine group(n = 34). Patients in TCM group were treated with Jiajian Yijing Decoction and those in western medicine group with artificial periodic therapy(Progynova 2 mg/d+Dydrogesterone 20 mg/d).All cases were treated with 3 menstrual cycles.The improvement of clinical symptoms of DOR and kidney deficiency and hepatic depression syndrome and pregnancy rate were observed. Results The improvement of clinical symptoms of DOR and kidney deficiency and hepatic depression syndrome after treatment in TCM group was more obvious than that in western medicine group(P<0.05 or P < 0.01). The pregnancy rate after treatment in TCM group was higher than that in western medicine group, but it had no statistic difference(P>0.05).Conclusions Jiajian Yijing Decoction can obviously improve the clin-ical symptoms of patients with DOR and kidney deficiency and hepatic depression syndrome and increase the preg-nancy rate in infertile patients.It is worthy of clinical popularization.
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Objective To evaluate the safety, feasibility and other potential advantages of laparoendoscopic single-site surgery (LESS) compared to conventional laparoscopic surgery (CLS) for tubal pregnancy. Methods We manually searched Pubmed, the Cochrane Library, web of science, CNKI and China Biology Medicine for the relevant references about comparison of single-port laparoscopic salpingectomy with multi-port laparoscopic salpingectomy in the treatment of tubal pregnancy. The quality of the studies was evaluated, then meta-analysis was conducted using RevMan 5.3 software. Result Eventually, 2 RCTS and 14 retrospective studies including a total of 1541 cases were identi昀ed. The results of the meta-analysis for LESS versus CLS were as follows: a longer operative time [WMD=8.54, 95%CI (2.43, 14.64), P = 0.006], no significant differences in terms of total complications [OR= 0.68, 95%CI (0.27,1.71), P = 0.410]/operative blood loss [WMD = -0.01, 95%CI (-2.51,2.48), P = 0.990]/gastrointestinal function recovery time [WMD = -0.45, 95%CI (-1.72,0.82), P = 0.490], but shorter hospital stay [WMD=-0.40, 95% (-0.75, -0.06), P = 0.020], less postoperative analgesic treatment [OR= 0.38, 95%CI (0.22,0.67), P = 0.000]. Conclusions LESS for surgical treatment of tubal pregnancy is safe and feasible with shorter hospitalstay, less postoperative pain. LESS may therefore be a feasible alternative of CLS in the surgical approach of tubal pregnancy.
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Objective To observe the clinical effect of oral use and acupoint application of Chinese herbal medicine with the actions of strengthening spleen and regulating stomach, lowering rebellious Qi to stop vomiting in treating pregnant pernicious vomiting. Methods One hundred and twenty-two spleen-stomach deficiency pregnant pernicious vomiting cases were randomly divided into observation group ( N=63) and control group (N=59). At the end of the trial, 2 cases of the control group dropped out, and the total case number was 57 in the control group. Both groups were treated with intravenous infusion, dietary care, daily life and emotional nursing, and oral use of Chinese herbal medicine with the actions of strengthening spleen and regulating stomach, lowering rebellious Qi to stop vomiting. Additionally, the observation group was given acupoint application of herbs for strengthening spleen and regulating stomach, lowering rebellious Qi to stop vomiting. The treatment was performed once a day, 4 days constituted one treatment course, and the treatment lasted two continuous courses. The improvement of vomiting, therapeutic effect and the safety were compared between the two groups after treatment. Results ( 1) The total effective rate was 96.8%in the observation group and was 71.9%in the control group, the difference being significant (P<0.01). (2) The time for stopping vomiting in the observation group was significantly less than that in control group (P<0.01). (3) During the treatment, no obvious adverse reaction was found in the two groups. Conclusion Acupoint application of herbs for strengthening spleen and regulating stomach, lowering rebellious Qi to stop vomiting has obvious synergistic effect on the clinical efficiency of spleen-stomach deficiency pregnant pernicious vomiting treated by oral use of herbal medicine, intravenous infusion, dietary care, and daily life and emotional nursing.
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Objective To investigate the difference of CCAAT/enhancer-binding protein α (C/EBP-α) gene induced apoptosis between hepatocytes and hepatic stellate cells (HSC) in mice with liver fibrosis.Methods Sixty BALB/c mice were evenly divided into normal group,model group,treatment group,blank control group and negative control group,12 mice in each group.Except the mice of normal control group,the mice of other groups were treated with intraperitoneal injection of CCl4 to establish liver fibrosis mice model.Mice of treatment group,blank control group and negative control group were administrated with C/EBP-α carried adenovirus (Ad-C/EBP-α),phosphate buffered solution and empty vector of adenovirus (Ad-EGFP) respectively through tail vein for the first week.The expression of C/EBP-α and α-smooth muscle actin (α-SMA) was detected by immunohistochemistry method.Sinusoidal endothelial structure of peri-portal regions and far from portal regions was observed by transmission electron microscope (TEM).Terminal dexynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) was applied to detect apoptosis of cells in liver tissue.The degree of liver fibrosis in mice was determined with sirius red staining and hydroxyproline content measurement.Single factor variance analysis was performed for comparison among multiple groups,and t test was used for comparison between two groups.Results C/EBP-α was expressed in nucleus of hepatocyte in normal control group mice.The expression decreased in model group,blank control group and negative control group.However,the expression of C/EBP-α of treatment group increased,and mainly expressed in cells located in perisinusoidal and perivascular.Hepatic sinusoids was distorted,blood vessel wall thickened.Hepatocyte degeneration and lots of lipid droplets was found in model group,blank control group and negative control group.The thicken degree of endothelial layer of blood vessel of treatment group was lower than that of model group.The percentage of sirius red positive cells of normal group,model group,treatment group,blank control group and negative control group was (0.10±0.03)％,(5.81±0.32)％,(2.32±0.45)％,(6.34± 0.81)％ and (6.10± 0.92)％,respectively; content of hydroxyproline was (0.07±0.00) μg/mg,(0.69 ± 0.10) μg/mg,(0.19±0.06) μg/mg,(0.56±0.03) μg/mg and (0.64±0.08) μg/mg,respectively; the percentage of α-SMA positive cells was (0.50 ±0.03)％,(5.30 ± 0.52)％,(2.15 ± 0.29)％,(5.53 ± 0.43) ％ and (5.42 ± 0.25) ％,respectively; the number of TUNEL positive cells was (0.25 ± 0.08),(0.15±0.02),(7.10±1.53),(0.13±0.03) and (0.18±0.07),respectively.The differences between the groups were statistically significant (F=113.74,148.29,292.43 and 140.25,all P＜0.05).The difference between normal group and model group,between model group and treatment group,between treatment group and blank control group,between treatment group and negative control group were statistically significant (tarirus positive cell =-52.54,-16.20,-10.60 and-7.99,thydroxyproline content =-168.00,11.53,11.07 and 12.54,ta SMA pusitive cells-24.77,-13.82,15.94 and 18.37,tTUNEL positive cells =3.26,-11.91,-11.95 and-11.88,all P＜ 0.05),there was no statistically significant difference between model group and blank control group,between model group and negative control group (both P＞0.05).TUNEL positive cells mainly located in perisinusoidal and perivascular of liver in mice,which was consistent with the distribution of α-SMA-positive cells.Conclusion C/EBP-α could effectively relieve CCl4 induced liver fibrosis in mice mainly through inducing HSC apoptosis,however no apoptosis effect on hepatocytes.
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Objective To explore the value of cardiac troponin-I (cTnI), B-type natriuretic peptide (BNP) and blood lactic acid (Lac) on evaluation of severity and prognosis in patients with septic myocardial dysfunction (SMD). Methods According to retrospective analysis of clinical data,161 cases with sepsis were divided in to SMD group and non-SMD group. And the SMD group was further divided in to death group and survival group. Blood cTnI, BNP and Lac value in each group were detected respectively. The ROC curve was used to evaluate the forecast value of cTnI, BNP and Lac on prognosis for patients. Results The value of cTnI, BNP and Lac in SMD group were significantly higher than those in non-SMD group(P<0.05);The value of cTnI, BNP and Lac in death group among the SMD patients were significantly higher than those in survival group(P<0.05);cTnI, BNP and Lac contribute to predict the 28 day mortality rate of SMD. Conclusions Blood cTnI, BNP and Lac contributes to the assessment of the severity and the prognosis of septic patients with myocardial dysfunction.
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To explore the current status of job burnout among 1210 staffs at local community health stations and analyze its influencing factors with multiple logistic regression analysis.The regression model of high emotional exhaustion had statistical significance (SE =0.070,P =0.000).The possibility of high emotional exhaustion was negatively correlated with the satisfaction of organizational commitment,rules and regulations,cooperation between colleagues,satisfaction of job nature and family supports.And it had a positive correlation with supports from family and colleagues and satisfaction of welfare.The regression model of high depersonlization had statistical significance (SE =0.072,P =0.000).The possibility of high depersonlization had a negative correlation with organizational commitment,cooperation between colleagues,satisfaction of job nature and smooth communications with leaders and family.And it was positively correlated with compensation,promotion,satisfaction of welfare and smooth inter-colleague communications.The regression model of highly reduced personal accomplishment had statistical significance (SE =0.061,P =0.000).The possibility of highly reduced personal accomplishment had a negative correlation with satisfaction of superiors,job category and communication,age,smooth communications with leaders and family.And it was positively correlated with satisfaction of compensation.
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Site surveys were conducted with a self-designed questionnaire for 4102 urban residents regarding their awareness and utilization rate of service projects and satisfaction (total satisfaction,medical environment,service attitude,content of communication and diagnostic & therapeutic modalities).The influencing factors of satisfaction were analyzed by multiple linear regression analysis.The factors of improving total satisfaction were as follows:①When content of communication,diagnostic & therapeutic modalities,service attitude and medical environment improved 10％,total satisfaction rose by 2.44％,2.50％,2.47％ and 0.98％ respectively; ② Utilization rate rose by 2.33％,1.60％ and 0.85％ respectively if they accepted home care services,rehabilitation services and chronic disease management services ; ③Total satisfaction rose by 0.94％ if they became aware of family planning and reproductive health services.And the factors of reducing total satisfaction were as follows:①total satisfaction declined by 1.68％ if their children accepted preventive vaccination services.②total satisfaction declined by 1.13％ if the respondents maintained their health records.
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To observe the pathological changes of vascular aging in spontaneously hypertensive rats (SHRs), and the effects of extracts from Panax ginseng, Panax notoginseng (Burk.) and Ligusticum chuanxiong on vascular aging.
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Objective To investigate the genotype of carbapenem-resistant Acinetobacter baumannii(CRAB) acquired from intensive care units (ICUs) environment in Shanghai hospitals and to evaluate the gene homology of CRAB isolated from patients and environment in ICUs in Shanghai hospital.Methods Sixty-one CRAB isolated from ICUs environment in Shanghai hospitals and 14 strains isolated from ICUs patients in S hospital were typed by REP-PCR based DiversiLab system.Results There were 7 types of the CRAB isolated from ICUs environment in Shanghai hospitals.Type G1 was the dominant type,accounting for 75.4％ of all CRAB,mainly in 13 hospitals in Shanghai.The percentage of the 7 types CRAB strains were 75.4％,13.1％,3.3％,1.6％,1.6％,3.3％ and 1.6％,respectively.Except for 1 strain of type G6 isolated in D hospital,type G1 CRAB was identified in every hospital which was isolated CRAB.There were 25 strains isolated from patients and environment in S hospital ICUs,which were divided into 4 types.Type G1 was the dominant type mainly distributed in SICU and CICU,including 9 from patients and 8 from environment.The distribution diagram of environmental and patients' strains indicated that the patients in adjacent bed isolated G1 CRAB in SICU and a patient in CICU and its surrounding environment both isolated G1 CRAB.Conclusion Type G1 is the dominant type in ICUs environment in Shanghai hospitals.There are inter-hospital transmission of CRAB in ICUs environment and highly homology of CRAB isolated from patients and environment in ICUs in Shanghai hospitals.Active surveillance of infection and colonization by CRAB,together with implementation of enhanced control strategies should be taken to eradicate CRAB in ICU environment.
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Objective To further elucidate the CT characteristics and diagnostic approaches to non-acquired immune deficiency syndrome patients with pulmonary cryptococcosis. Methods The histories of forty-two pulmonary cryptococcosis (PC) patients diagnosed in Zhongshan Hospital from 2003 -2008 were collected and analyzed for demography data, underlying conditions, clinical symptoms, chest CT and diagnostic studies. Results None of the 42 PC patients had avian or its feces contacting history, and 71.4% (30/42) of them were immunocompetent. The most frequent CT lesions were multiple nodules (67. 9% ) with peripheral predominance (67. 9% ), and cavitations (50%) often presented within them. Masses/consolidation (31.4%) and patching lesions (2. 9% ) could exist occassionally. Positive detection rates of non-aggressive examinations including sputum, bronchoalveolar lavage fluid and bronchofibroscope aspiration were 4. 3%, 8. 3% and 6. 3% respectively, while those of aggressive approaches including transbrunchial lung biopsy (TBLB), thin needle aspiration biopsy (TNAB) and pneumonectomy by surgery were 64. 7%, 64. 3% and 100% respectively. Non-aggressive serum cryptococcus antigen test was performed in 14 patients who had been diagnosed by histopathology or pathogen culture, and all of them were positive. Conclusion Our study suggests that PC is common in immunocompetent population. Avian or its feces contacting is not so important as used opinion to PC differential diagnosis. CT characteristics of PC are diversiform and always change very slowly. Besides the most frequent multiple nodules with subpleural predominance, pulmonary lesions can present as masses, consolidation or patchings. Aggressive techniques such as TBLB and TNAB are benefit to clinical diagnosis of PC, and non-aggressive serum cryptococcus antigen test may be promising for its early diagnosis as well as clinical course follow-up and therapeutic effect evaluation.
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Objective To establish a method for the determination of hesperidin content in Qiansheng Baizhusan Jiawei Granule (QBJG). Methods The content of hesperidin was determined by HPLC. Results Hesperidin showed a good linearity in the range of 0. 22-1.1ug(r = 0. 9998). The average recovery was 103. 0 % and RSD was 3. 12 %. Conclusion The methods are accurate and can be used for the quality control of QBJG.
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Objective:To observe the expression of GATA-3in asthmatic mice lungs and to explore the feasibility of in-terleukin(IL-12)blockading GATA-3expression in treatment of bronchial asthma.Methods:C57BL/6mice were randomly divided into3groups:control group(group A),asthmatic model group(group B)and IL-12injection group(group C).Asth-matic models were established in group B and C.Normal saline(0.1ml)and IL-12(1?g)were injected in group B and C re-spectively on the1,3,7,9,25,26,27and28d.Six mice from each group were obtained for analyses of bronchoalveolar lavage fluid(BALF)on d31.The airway pathology changes and the expression of GATA-3were observed by hematoxylin/eosin(H-E)and immunohistochemistry respectively.Results:There was no symptom in group A,and the symptoms of group B were more severe than those of group C.Eosinophil(EOS)was not seen in the BALF of group A,while EOS in group B and group C were(20.0?4.0)%and(0.2?0.1)%respectively.In the same microscopic visual field,there was no inflam-mation cell in group A and a large number of inflammation cells in group B,but inflammation cells in group C were signifi-cantly decreased.Immunohistochemistry showed that the expression of GATA-3in group B was strong and no GATA expres-sion was found in group A and group C.Conclusion:The expression of GATA-3in asthmatic mice is high;IL-12can inhibit asthmatic airway and lungs inflammtion,whose mechanism may be the blockade of GATA-3expression in asthmatic models.[