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Extracorporeal membrane oxygenation (ECMO), as an effecitive life support technique, is widely used in patients with respiratory and/or cardiac failure. Infection, with a prevalence of approximately 21% in adult patients with ECMO, is one of the most common complications and has a significant impact on mortality. Early identification of infections, and accurate prevention and anti-infective therapies for ECMO patients can improve their survival, but there is a lack of standardized protocols for recognition, diagnosis, management, prevention and treatment of the infections. By analyzing a series of literatures on healthcare-associated infections in patients with ECMO, the epidemiology, pathogens, risk factors, diagnosis, prevention and treatment were summarized to provide a theoretical background for the early identification, diagnosis and patient management of nosocomial infections.
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Objective:To analyze the clinical characteristics of ischemic colitis(IC) and further improve the diagnosis and treatment of the disease.Methods:The clinical manifestations, risk factors, colonoscopy and abdominal CT examination results of 35 patients with IC confirmed from January 2014 to December 2018 in the Second Hospital of Jilin University were retrospectively analyzed, and their clinical characteristics were summarized.Results:The sudden manifestation of abdominal pain and blood in 31 cases of the 35 patients were the main manifestations.Ten patients who underwent abdominal CT scan showed a thickened bowel wall with a thickness of (7.92±1.41)mm.The CT value of the thickened bowel wall decreased significantly to (21.20±2.27)Hu.In 35 cases of colonoscopy, 42.86%, 31.42%, 20.00%, 2.86% and 2.86% were involved in the descending colon, sigmoid colon, transverse colon, ascending colon and whole colon, respectively.The left colon was the main part, with clusters and bands Mucosa-like erythema, ecchymosis, erosion, and even ulcers.No rectum was involved in 35 patients.Conclusion:The typical manifestation of IC is sudden abdominal pain and bloody stool.Abdominal CT in emergency department has obvious suggestive value for early diagnosis of this disease.Colonoscopy is the main diagnostic method for this disease.
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Objective To explore the method and performance of using multiple indices to diagnose sepsis and to predict the prognosis of severe ill patients.Methods Critically ill patients at first admission to intensive care unit (ICU) of Changzheng Hospital, Second Military Medical University, from January 2014 to September 2015 were enrolled if the following conditions were satisfied: ① patients were 18-75 years old;② the length of ICU stay was more than 24 hours; ③ All records of the patients were available. Data of the patients was collected by searching the electronic medical record system. Logistic regression model was formulated to create the new combined predictive indicator and the receiver operating characteristic (ROC) curve for the new predictive indicator was built. The area under the ROC curve (AUC) for both the new indicator and original ones were compared. The optimal cut-off point was obtained where the Youden index reached the maximum value. Diagnostic parameters such as sensitivity, specificity and predictive accuracy were also calculated for comparison. Finally, individual values were substituted into the equation to test the performance in predicting clinical outcomes.Results A total of 362 patients (218 males and 144 females) were enrolled in our study and 66 patients died. The average age was (48.3±19.3) years old. ① For the predictive model only containing categorical covariants [including procalcitonin (PCT), lipopolysaccharide (LPS), infection, white blood cells count (WBC) and fever], increased PCT, increased WBC and fever were demonstrated to be independent risk factors for sepsis in the logistic equation. The AUC for the new combined predictive indicator was higher than that of any other indictor, including PCT, LPS, infection, WBC and fever (0.930 vs. 0.661, 0.503, 0.570, 0.837, 0.800). The optimal cut-off value for the new combined predictive indicator was 0.518. Using the new indicator to diagnose sepsis, the sensitivity, specificity and diagnostic accuracy rate were 78.00%, 93.36% and 87.47%, respectively. One patient was randomly selected, and the clinical data was substituted into the probability equation for prediction. The calculated value was 0.015, which was less than the cut-off value (0.518), indicating that the prognosis was non-sepsis at an accuracy of 87.47%. ② For the predictive model only containing continuous covariants, the logistic model which combined acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and sequential organ failure assessment (SOFA) score to predict in-hospital death events, both APACHE Ⅱ score and SOFA score were independent risk factors for death. The AUC for the new predictive indicator was higher than that of APACHE Ⅱ score and SOFA score (0.834 vs. 0.812, 0.813). The optimal cut-off value for the new combined predictive indicator in predicting in-hospital death events was 0.236, and the corresponding sensitivity, specificity and diagnostic accuracy for the combined predictive indicator were 73.12%, 76.51% and 75.70%, respectively. One patient was randomly selected, and the APACHE Ⅱscore and SOFA score was substituted into the probability equation for prediction. The calculated value was 0.570, which was higher than the cut-off value (0.236), indicating that the death prognosis at an accuracy of 75.70%.Conclusion The combined predictive indicator, which is formulated by logistic regression models, is superior toany single indicator in predicting sepsis or in-hospital death events.
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Objective To evaluate the safety and reliability of laparoscopic in treatment of gastric gastric stromal tumor (GST).Methods 48 GST patients were selected for laparoscopic operation who had no distant metastases,adjacent organ invasion and non-cardia and pylorus infiltration confirmed by preoperative examination.The postoperative treatment,follow-up and the effect was observed.Results 48 patients included 22 males and 26 females,and mean age was 56 years old.The tumor diameter was 0.6-10.0 cm,in which 36 cases had tumor size ≥ 2 cm.12 cases of tumor occurred in gastric antrum,12 cases in gastric fundus,16 cases in anterior wall of gastric body,8 cases in posterior wall of gastric body.The mean operative time was 85 min,the mean operation blood loss was 65 ml,the postoperative average start eating time was 3 d,and the mean postoperative in-patient time was 7 d.All patients were followed up for 12-36 months.There were no local recurrence and distant metastasis and tumor-related deaths.Conclusions For the GST patients who have no distant metastases,adjacent organ invasion and non-cardia and pylorus infiltration,laparoscopic operation is safe and effective,which is not only applied to less than 2 cm diameter GST,but also to larger diameter tumor.