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Objective:To investigate the significant effects of enhanced whole-body computed tomography (EWBCT) and non-enhanced whole-body computed tomography (N-EWBCT) on the missed diagnosis rate, renal function and prognosis of patients with severe trauma.Methods:Clinical data of trauma patients admitted from January 1, 2017 to December 31, 2020 were collected from the trauma database of the Trauma Center of the Second Affiliated Hospital of Soochow University. All patients included in this study were divided into the EWBCT group and N-EWBCT group according to whether they underwent enhanced whole-body computed tomography examination. The differences in baseline data, missed diagnosis rate, renal function and prognosis of the two groups of patients were compared.Results:A total of 459 patients were included in this study, including 184 patients in the EWBCT group and 275 patients in the N-EWBCT group. The missed diagnosis rate of the N-EWBCT group was significantly higher than that of the EWBCT group (18% vs. 5%, P < 0.01). The risk ratio of acute kidney injury (AKI) in the EWBCT group and N-EWBCT group was 9% and 7%, respectively, and there was no statistical difference between the two groups ( P >0.05). The mortality rate of patients in the N-EWBCT group was higher than that in the EWBCT group (23% vs. 12%, P=0.002). Conclusions:Compared with N-EWBCT, EWBCT does not significantly increase the risk of renal damage in patients with severe trauma. For patients with severe trauma, early EWBCT can reduce the missed diagnosis rate and improve the clinical prognosis.
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Objective:To observe the changes of regional saturation of cerebral oxygenation (rScO 2) and blood neuron specific enolase (NSE) in patients after cardiopulmonary resuscitation (CPR), and to explore its value in evaluating the prognosis of patients' neurological function. Methods:From January 2012 to December 2020, 97 patients with return of spontaneous circulation (ROSC) after cardiac arrest (CA) treated in the intensive care unit (ICU) of the Second Affiliated Hospital of Soochow University were selected. According to the prognosis, the patients were divided into two groups: good neurological function group [Glasgow-Pittsburgh Cerebral Performance Categories (CPC) 1-2, 20 cases] and neurological dysfunction group (CPC classification 3-5, 77 cases). The clinical data of gender, age, the number of patients with defibrillable rhythm, time of ROSC, the number of CA patients outside the hospital, acute physiology and chronic health evaluationⅡ(APACHEⅡ), Glasgow coma scale (GCS), global non-response scale (FOUR), body temperature, mean arterial pressure (MAP), blood lactic acid (Lac) and GCS at discharge, as well as the length of ICU stay, rScO 2 and blood NSE were collected. The differences of rScO 2 and NSE between the two groups were compared; and the receiver operator characteristic curve (ROC curve) was drawn to evaluate the value of rScO 2 and NSE alone or in combination in predicting the prognosis of patients with ROSC after CA. Results:The rScO 2 of good neurological function group was significantly higher than that of neurological dysfunction group at 1, 3, 6, 12, 24 and 48 hours (all P < 0.05). At 24 hours after admission, the rScO 2 on the left and right sides of good neurological function group was significantly higher than that in neurological dysfunction group [left: 0.65 (0.59, 0.76) vs. 0.55 (0.44, 0.67), right: 0.62 (0.61, 0.73) vs. 0.50 (0.30, 0.69), both P < 0.05], and NSE was significantly lower than that in the neurological dysfunction group [ng/L: 21.42 (15.38, 29.69) vs. 45.82 (24.05, 291.26), P < 0.05]. ROC curve analysis showed that both rScO 2 and NSE alone and combined detection had a certain value in predicting the prognosis of neurological function in patients with ROSC after CA, and the area under the ROC curve (AUC) detected by the combination was the largest, which was higher than the AUC predicted by rScO 2 or NSE (0.904 vs. 0.884, 0.792). When the cut-off value of combination was 0.83, the sensitivity and specificity were 75.7% and 100% respectively. Conclusion:Monitoring rScO 2 and NSE can predict the prognosis of neurological function after CPR, especially the combined evaluation of the two indexes, which can greatly improve the accuracy of diagnosis.
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Objective:To investigate the risk factors affecting the prognosis of patients with extremely severe burns.Methods:Totally 46 patients with extremely severe burn in the dust explosion of aluminum powder in Kunshan, Jiangsu province on August 2, 2014 were included in this study. The patients were divided into the survival group and death group according to the prognosis of the patients. The patients' age, sex, burn degree, white blood cell, and lactic acid at admission, lactic acid at 48 h, creatinine, albumin, urine volume, blood calcium, acute physiology and chronic health score system II (APACHE II) and SOFA scores, and 90 d mortality were collected. COX regression analysis was used to analyze the possible relationship between the indicators of the two groups and the prognosis.Results:There were no significant differences in white blood cell at admission, creatinine, albumin, urine volume, SOFA score, and APACHE II score in the survival group compared with those in the death group (all P>0.05) and burn degree, the levels of lactic acid at admission, lactic acid at 48 h and blood calcium were significantly different (all P<0.05). Multivariate regression analysis showed that age, albumin and lactic acid at 48 h were independent predictors of death in patients with severe burn ( P<0.05), and these are independent outcome predictors of patients with severe burns ( P<0.05). Conclusions:Age, albumin level and lactic acid at 48 h are independent risk factors affecting the prognosis of patients with severe burns.
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Objective To study the clinical value of brain natriuretic peptide (BNP) and soluble urokinase plasminogen activator receptor (suPAR) in the diagnosis and prognosis of bloodstream infection.Methods Totally 165 patients suspected of bloodstream infection admitted in intensive care unit (ICU) of the Second Hospital Affiliated to Suzhou University were enrolled in this study.According to the diagnosis standard of bloodstream inflection,patients were divided into the bloodstream infection group and non-bloodstream infection group.According to the prognosis of the patients,the bloodstream infection group was further divided into the survival group and the death group.Serum levels of suPAR,BNP,CRP,PCT,and chronic health evaluation Ⅱ acute physiology score (APACHE Ⅱ),and mortality of the patients were analyzed,and the possible relation of the above indexes between the two groups were compared.Based on the receiver operating characteristic curve (ROC) and the area under the curve (AUC),the early diagnostic value of suPAR,BNP,CRP,PCT,and APACHE Ⅱ score in the bloodstream infection patients was determined.Results Serum levels of suPAR,BNP,CRP,PCT and APACHE Ⅱ score in the bloodstream infection group were higher than those in the non-bloodstream infection group (P＜0.05);Serum levels of suPAR,BNP,CRP,PCT and APACHE Ⅱ score in the death group were higher than those in the survival group (P＜0.05).There was a positive correlation between serum suPAR,BNP,PCT and APHCHE Ⅱ] score in patients of bloodstream infection(r=0.503,0.548,0.781,all P＜0.05).The levels of suPAR,BNP,PCT and APACHE Ⅱ in the patients of blood stream infection were related to significant the prognosis (P＜0.05).And these indexes can provide good evaluation on the prognosis of the patients.Conclusion Detection of serum suPAR,BNP can evaluate the severity of bloodstream infection and preliminarily determine the prognosis of patients with bloodstream infection.Therefore,the method is worth applying in the clinical field.
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Objective To observe the effect of early bundle therapy on prognosis of patients with sepsis/septic shock and analyze the risk factors for death.Methods A retrospective cohort study was conducted to select patients with sepsis/septic shock at the Second Soochow University Hospital betweenJanuary 1,2016,and December 31,2016.Data pertaining to demographic variables,compliance rate of bundle therapy,and incidence of organ failure were collected.Patients were categorized into the nonsurvivor or survivor groups based on 28-day mortality.Logistic regression analysis was used to identify risk factors for 28-day mortality.Results Totally 118 sepsis/septic shock patients were included in the analysis;28-day mortality was 32.2％.Compared to the survivor group,patients in the non-survivor group were more likely to have chronic heart dysfunction and cerebrovascular disease,lower lactate clearance,lower 6-h compliance rate of bundle therapy and higher incidence of failure of one or ＞2 organs.Age,leukocyte,blood urea nitrogen,creatinine,brain natriuretic peptide,sequential organ failure score and acute physiological and chronic health scores Ⅱ on admission,and lactate after bundle therapy were higher than that of the survivor group.Logistical regression analysis showed that age ≥ 75 years [odds ratio (OR)1.012],6-h lactate clearance ＜30％ (OR=1.122),chronic heart failure (OR=1.741),failure of ＞2 organs (OR=1.769),and 6-h compliance rate of bundle therapy (OR=1.958) were independent risk factors for 28-day mortality.Conclusions Patients with sepsis/septic shock need early diagnosis and resuscitation to improve the compliance rate of bundle therapy and reduce the mortality.
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The morbidity and mortality of tumors of digestive system is much higher in recent years .Realizing diagnosis of early phase tumors can improve the surgical resection rate and prolong survival time of patients .Compared with traditional diagnosis methods, multiphoton microscopy has got an obvious improvement in the penetration depth .Furthermore, phototoxicity and photo-bleaching has been largely reduced .Combining with the second harmonic microscopy , the change of collagen fibers can be observed in the organization.MPM can achieve early diagnosis of cancer at the cellular level .Therefore, multiphoton microscopy , with the imaging characteristics of unique high resolution , real-time, nondestructive , deeply spectral resolution , is of great potential in the diagnosis of early stage tumors of digestive system .Based on the latest research results , this review summarizes the latest progress of multiphoton microscopy diagnosing early phase of gastrointestinal tumor .
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Objective To summarize the clinical experience of fat granule injection for auto-trans-plantation in the treatment of concave temporal area. Methods The fat granule was extracted with injec-tor and injected into temporal area after washing and purging, but it might be necessany for patient to be injected extra 20 % fat autograft due to his absorptive effect. Results Satisfactory results were obtained in all patients. Transplantation was carried out one time in 139 cases, two times in 9 cases, and three times in 4 cases. 6 - 28 ml fat granule was injected in one site at each time. Conclusion Fat granule injec-tion for auto-transplantation is a safe and ideal method to treat concave temporal area.
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Objective To study the effect of plant Coleus forskohlii active elements Isoforskolin(ISOF)and CT-E(analogs mixture of Isoforskolin)on human neutrophill(PMN)in vitro in order to uncover the mechanism of their properties of mitigating acute lung injury(ALI).Method The effects of ISOF and CF-E on PMN aggregation induced by N-formyl-methiony-leucyl-phenylalanine(fMLP)was performed by using a 4-channel platelet aggregometer.Cytometry Was applied to analyze the effect of tested samples on adhension between PMN and endothelial cells(ECV-304)activated by using lipopolysaccharides(LPS).Expression of LPS-induced PMN adhension molecules was determined with flow cytometry.Radioimmunoassay Was applied to detect the level of TNT-α liberated bv PMN and intracellular cyclic adenosine monophosphate(cAMP)level of PMN.Results It was found that ISOF(25,50,100 μmnol/L)and CF-E(1.25,2.5,5 mg/ml)inhibitted PMN aggregation induced by fMLP,PMN adhemion to ECV-304 indeed by LPS,expression of PMN adhesion molecules,and TNF-α level released by PMN.ISOF and CF-E also increased intracellular cAMP level of PMN.Condusions ISOF and CF-E inhibit PMN aggregation,adhension and adhension molecules,and TNF-α released by PMN,while they increase intracellular cAniP level of PMN.It suggests that their specific alleviating the ALI by the mechanism of the modulation of PMN function.