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OBJECTIVE@#To explore the risk factors of acute respiratory distress syndrome (ARDS) in patients with sepsis and to construct a risk nomogram model.@*METHODS@#The clinical data of 234 sepsis patients admitted to the intensive care unit (ICU) of Tianjin Hospital from January 2019 to May 2022 were retrospectively analyzed. The patients were divided into non-ARDS group (156 cases) and ARDS group (78 cases) according to the presence or absence of ARDS. The gender, age, hypertension, diabetes, coronary heart disease, smoking history, history of alcoholism, temperature, respiratory rate (RR), mean arterial pressure (MAP), pulmonary infection, white blood cell count (WBC), hemoglobin (Hb), platelet count (PLT), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), D-dimer, oxygenation index (PaO2/FiO2), lactic acid (Lac), procalcitonin (PCT), brain natriuretic peptide (BNP), albumin (ALB), blood urea nitrogen (BUN), serum creatinine (SCr), acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA) were compared between the two groups. Univariate and multivariate Logistic regression were used to analyze the risk factors of sepsis related ARDS. Based on the screened independent risk factors, a nomogram prediction model was constructed, and Bootstrap method was used for internal verification. The receiver operator characteristic curve (ROC curve) was drawn, and the area under the ROC curve (AUC) was calculated to verify the prediction and accuracy of the model.@*RESULTS@#There were no significant differences in gender, age, hypertension, diabetes, coronary heart disease, smoking history, alcoholism history, temperature, WBC, Hb, PLT, PT, APTT, FIB, PCT, BNP and SCr between the two groups. There were significant differences in RR, MAP, pulmonary infection, D-dimer, PaO2/FiO2, Lac, ALB, BUN, APACHE II score and SOFA score (all P < 0.05). Multivariate Logistic regression analysis showed that increased RR, low MAP, pulmonary infection, high Lac and high APACHE II score were independent risk factors for sepsis related ARDS [RR: odds ratio (OR) = 1.167, 95% confidence interval (95%CI) was 1.019-1.336; MAP: OR = 0.962, 95%CI was 0.932-0.994; pulmonary infection: OR = 0.428, 95%CI was 0.189-0.966; Lac: OR = 1.684, 95%CI was 1.036-2.735; APACHE II score: OR = 1.577, 95%CI was 1.202-2.067; all P < 0.05]. Based on the above independent risk factors, a risk nomograph model was established to predict sepsis related ARDS (accuracy was 81.62%, sensitivity was 66.67%, specificity was 89.10%). The predicted values were basically consistent with the measured values, and the AUC was 0.866 (95%CI was 0.819-0.914).@*CONCLUSIONS@#Increased RR, low MAP, pulmonary infection, high Lac and high APACHE II score are independent risk factors for sepsis related ARDS. Establishment of a risk nomograph model based on these factors may guide to predict the risk of ARDS in sepsis patients.
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Humans , Retrospective Studies , Alcoholism , Prognosis , Respiratory Distress Syndrome, Newborn , Pneumonia , Sepsis , Intensive Care Units , Procalcitonin , Fibrinogen , ROC CurveABSTRACT
Duchenne muscular dystrophy (DMD) is a serious and progressive hereditary muscle disease. The DMD gene mutation on the X chromosome causes the loss of dystrophin, causing progressive muscle weakness and muscular atrophy. Most patients die for heart and lung failure. Current gene therapy methods are mainly aimed at restoring the expression of dystrophin, including read-through therapy, exon skipping therapy, vector-mediated gene replacement therapy and gene editing therapy. This article reviews the mechanisms of these different treatments and important advances in clinical research, and analyzes the challenges and application prospects of these treatments.
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Objective:To investigate the correlation between serum CXCL12 and the outcomes after intravenous thrombolytic therapy in patients with acute ischemic stroke.Methods:Consecutve patients with acute ischemic stroke treated with intravenous thrombolytic therapy in the Department of Neurology, the First Affiliated Hospital of Soochow University from January 1, 2020 to August 31, 2021 were enrolled retrospectively. Serum CXCL12 was measured by enzyme-linked immunosorbent assay within 24 h of onset. No improvement in early neurological function was defined as the National Institutes of Health Stroke Scale (NIHSS) 24 h after thrombolysis decreased by <4 compared with the baseline. The clinical outcome was evaluated by the modified Rankin Scale at 90 d after onset, and >2 were defined as a poor outcome. Multivariate logistic regression analysis was used to evaluate the correlation between serum CXCL12 and the outcome after intravenous thrombolysis, and the predictive value of serum CXCL12 for no improvement of early neurological function and poor short-term outcome was analyzed by the receiver operating characteristic (ROC) curve. Results:A total of 66 patients were enrolled, and the serum CXCL12 was 15.72±6.52 g/L. Twenty-seven patients (40.9%) had poor outcomes, and 34 (51.5%) had no improvement in early neurological function. Multivariate logistic regression analysis showed that higher serum CXCL12 was an independent predictor of poor outcome (odds ratio [ OR] 1.245, 95% confidence interval [ CI] 1.093-1.419; P=0.001) and no improvement in early neurological function ( OR 1.250, 95% CI 1.100-1.420; P=0.001). ROC curve analysis showed that the area under the curve of serum CXCL12 for predicting poor outcome was 0.793 (95% CI 0.679-0.908), the best cut-off value was 15.38 μg/L, and the corresponding sensitivity and specificity were 81.5% and 76.9%, respectively. The area under the curve of serum CXCL12 for predicting no improvement of early neurological function was 0.849 (95% CI 0.748-0.951), and the best cut-off value was 15.68 μg/L, and the corresponding sensitivity and specificity were 76.5% and 87.5%, respectively. Conclusion:Serum CXCL12 had a better predictive value for the outcomes of patients with acute ischemic stroke after intravenous thrombolytic therapy.
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Objective:To investigate the factors that affect the therapeutic effects of endoscopic radiofrequency ablation (Stretta procedure) on gastroesophageal reflux disease (GERD).Methods:Seventy patients with gastroesophageal reflux disease who received endoscopic radiofrequency ablation (Stretta procedure) treatment in Jinhua Hospital of Traditional Chinese Medicine from January 2016 to January 2019 were included in this study. They were divided into good prognosis group ( n = 57) and poor prognosis group ( n = 13) according to prognostic effects. The clinical data of all patients were collected, including gender, age, body mass index (BMI), course of disease, complications (hypertension, coronary heart disease, diabetes), smoking, drinking, Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) scores. Unconditional stepwise logistic regression was performed to analyze the factors that affect the therapeutic effects of Stretta procedure on GERD. Results:Univariate analysis results revealed that the proportion of patients aged ≥ 60 years with BMI ≥ 25 kg/m 2, alcohol abuse, HAMD score ≥ 8, HAMD score ≥ 7 was significantly higher in the poor prognosis group than in the good prognosis group ( χ2 = 9.574, 10.821, 22.575, 8.653, 10.586, 4.070, 8.653, all P < 0.05). Logistic regression analysis confirmed that female gender, age ≥ 60 years, BMI ≥ 25 kg/m 2, course of disease ≥ 5 years, alcohol abuse, HAMD score ≥ 8 and HAMA score ≥ 7 were the risk factors for poor prognosis of gastroesophageal reflux disease ( χ2 = 11.174, 6.023, 8.698, 5.972, 5.821, 7.485, 5.443, all P < 0.05). Consistency analysis revealed that gender, age, BMI, course of disease, alcohol abuse, HAMD score and HAMA score could be used to predict the therapeutic effects of endoscopic radiofrequency ablation (Stretta procedure) on GERD. Combined application of gender, age, BMI, course of disease, alcohol abuse, HAMD score and HAMA score exhibited higher consistency than a single application, 0.827 > 0.577, 0.533, 0.795, 0.547, 0.606, 0.434 and 0.547. Conclusion:There are many factors that affect the therapeutic effects of endoscopic radiofrequency ablation (Stretta procedure) on GERD, including gender, age, BMI, course of disease, alcohol abuse, HAMD score and HAMA score. This is of certain reference value for clinical treatment of GERD, and combined application of these influential factors has a high accuracy in the prediction of the therapeutic effects of Stretta procedure on GERD.
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Objective:To improve awareness about infratentorial dural arteriovenous fistula (DAVF).Methods:Three cases of DAVF in the First Affiliated Hospital of Soochow University from September 2017 to September 2019 were retrospectively analyzed in terms of clinical features, cerebrospinal fluid (CSF) analysis, brain imaging and treatment, and followed up through telephone call.Results:Case 1: A 43-year-old woman, in chronic but acute aggravated course, presented with weakness of both lower limbs and urination and defecation dysfunction. Brain magnetic resonance imaging (MRI) revealed abnormal signal in medulla. CSF analysis demonstrated aquaporin-4 antibodies positive. Misdiagnosed as neuromyelitis optica spectrum disorders, the treatment was poor. Then digital subtraction angiography (DSA) showed DAVF at the left infratentorial area, and endovascular treatment was operated. Relapse was not observed in two-year follow up. Case 2: A 57-year-old woman, in chronic progressive course, mainly manifested as memory loss, but progressed with dysphagia, fever, coma. Treatment as “central nervous infection” was poor. Then DSA showed DAVF at the bilateral transverse-sigmoid sinus area, and endovascular treatment was operated with embolized partial fistulas. The patient died from lung infection within two months. Case 3: A 52-year-old man, in subacute course, was treated in the Gastroenterology Department with clinical manifestion of stubborn nausea and vomiting. Brain MRI revealed abnormal signal in medulla, with prominent vessel flow voids nearby. Then DSA showed DAVF at the craniocervical junction, and endovascular treatment was operated. Relapse was not observed in six-month follow up.Conclusions:DAVF has a variety of clinical manifestations, and infratentorial DAVF can manifest as acute neurological dysfunction involving the brain stem, cerebellum, spinal cord, which may be easily misdiagnosed. When brain MRI showed intracranial abnormal signal, the possibility of DAVF should be considered. DSA remains the gold standard to diagnose DAVF. Endovascular embolization is the main treatment of infratentorial DAVF at present. Prognosis depends on clinical presentation and fistula classification.
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Tyrosine kinase inhibitor (TKI) have been proved to be effective in the treatment of advanced non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) sensitive mutation, which is superior to chemotherapy. However, there are still some patients with sensitive mutations have primary drug resistance. It may be related to the coexistence of susceptible and resistant mutations of EGFR gene, downstream mutations of EGFR pathway, MET amplification and BIM deletion polymorphism. We present 2 cases of primary drug resistance and analyze the reasons. .
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Humans , Male , Middle Aged , Carcinoma, Non-Small-Cell Lung , Diagnostic Imaging , Drug Therapy , Genetics , Disease Progression , Drug Resistance, Neoplasm , Genetics , ErbB Receptors , Genetics , Fatal Outcome , Lung Neoplasms , Diagnostic Imaging , Drug Therapy , Genetics , Mutation , Protein Kinase Inhibitors , Therapeutic Uses , Treatment OutcomeABSTRACT
Objective To observe the relationship between clinical medication and the prognosis in elderly community-acquired pneumonia (CAP).Methods A prospective randomized controlled single-blind study in Tianjin Hospital Internal Medicine.A total of 160 elderly patients with CAP were selected from January 2011 and January 2015.According to the computer,patients were randomly divided into treatment group and control group,80 cases in each group.Treatment group adopted routine treatment and moderate amount of glucocorticoids in combination with a low-dose of diuretic,and the control group only received routine treatment.In two groups of patients,we observed the initial treatment effect,change in pulse oxygen saturation,the rate of invasive test,the incidence of adverse reactions,mortality rate,total hospital stay,etc.Results Compared with control group,the initial treatment was better,the improvement rate in SPO2 was increased,and the rate of invasive test was decreased in treatment group 72 hours after treatment (x2 =6.234,3.906 and 7.059,respectively,P=0.013,0.048 and 0.008).After the overall prognosis and outcome analysis,compared with control group,the percentage of patients transferred to the intensive care unit,the mortality rate was decreased (x2=4.783 and 4.737,P=0.029 and 0.030),hospitalization cost was declined,and the total hospital stay was shorted (x2 =-72.087 and-5.127,both P＜0.0001).There was no statistically significant difference in the incidence of adverse reactions such as electrolyte disorder and mental disorder(both P＞0.05).Conclusions Corticosteroids in combination with a low-dose of diuretic for the auxiliary treatment of elderly CAP can reduce the mortality rate,decrease the rate of invasive test,and shorten the duration of hospitalization,with no obvious increase of adverse events,and it help to improve the prognosis of CAP patients.
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Objective To evaluate the correlation between quantitative parameters of contrastenhanced ultrasound(CEUS) and microvessel density (MVD) of rabbit atherosclerotic plaques.Methods Twenty-six male New Zealand rabbits were damaged abdominal aortic by balloon expanded,fed with high fat 12 weeks later.Thirty two plaques were detected using conventional ultrasound examination.The maximum area,luminal area stenosis rate and the maximum thickness of each plaque were recorded.CEUS was performed on 32 plaques and enhancement images were offline analyzed quantitatively by ACQ software and the parameters such as arrival time(AT),time to peak(TTP),basic intensity(BI),and peak intensity(PI) were acquired.Enhanced intensity (EI) was calculated according to the formula:EI =PI- BI.Then the experimentalrabbitswerekilledforpathologicalexaminationandCD34monoclonalantibody immunohistochemical detection.MVD was counted under the microscope.The correlation between the parameters of CEUS and MVD was analyzed.Based on pathological findings,the plaques were divided into vulnerable plaques and stable plaques.ResultsEI and MVD of vulnerable plaques group were significantly higher than that of stable plaques group [EI:(26.36 ± 1.44) dB vs (23.90 ± 2.92)dB,t =- 3.243,P =0.001 ；MVD:(5.23 ± 1.16)/mm2 vs (2.47 ± 1.12)/mm2,Z =- 4.378,P ＜0.001].The maximum area,luminal area stenosis rate,the maximum thickness and PI,AT,TTP had no significant difference between two groups( P ＞0.05).The value of EI showed significant positive correlation with MVD ( r =0.676,P ＜0.001).ConclusionsEI can accurately evaluate the angiogenesis of rabbit atherosclerotic plaques,which can be regarded as a useful index to distinguish between vulnerable and stable plaques.
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@# Objective To explore the effect of electrical acupuncture on the cytokines in adjuvant arthritis rats. Methods 60 rats were divided into 5 groups randomly, each with 12 rats. The blank control group and the model group were only bundled; while the Zusanli group, the Guanyuan group, and the Weizhong group were electroacupunctured each single point after bundled, once per 2 d. 32 d later, the swelling of voix pedis was measured and the level of interleukin (IL)-1, IL-2, IL-10, tumor necrosis factor (TNF)-α in plasma was determined in each group. Results After being modeled, the voix pedis of rats were swelling (P<0.05), while the swelling of voix pedis in the Zusanli, Guanyuan and Weizhong groups significantly reduced (P<0.05). The plasma IL-1, IL-2 and TNF-α was significantly higher in the model group than in the blank group (P<0.01), and reduced in Zusanli, Guanyuan and Weizhong groups (P<0.05). Compared with Zusanli and Guanyuan groups, there was a significant difference in the Weizhong group (P<0.01). The plasma IL-10 was significantly lower in the model group than in the blank control group (P<0.05), and increased in the Zusanli, Guanyuan and Weizhong groups (P<0.05). Compared with Zusanli and Guanyuan groups, there was a significant difference in the Weizhong group (P<0.01). The swelling of voix pedis was positively correlated with the level of IL-1, IL-2, and TNF-α (r=0.881~0.912, P<0.01). There was positive correlation among the IL-1, IL-2, and TNF-α (P<0.01). IL-10 was negatively correlated with the swelling, IL-1, IL-2, and TNF-α (r=-0.293~-0.519, P<0.05). Conclusion Electroacupuncture can significantly reduce the swelling of voix pedis in adjuvant arthritis rats, and it may be related with improving immune function by increasing the level of IL-10 and decreasing the level of IL-1, IL-2 and TNF-α in plasma.
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Objective To explore the value of abdominal aorta strain reserve(SR) of rabbits during the period of early atherosclerosis using velocity vector imaging(VVI) techniques combined with nitroglycerin (NTG) vasodilation experiment.Methods Fifty-two male New Zealand White rabbits were used in this experiment.Group A(n=12) was the normal control group.Forty rabbits were made into atherosclerosis models.The SR of abdominal aortas of all rabbits were analyzed in short axis views using VVI and NTG vasodilation experiment at the forth week and the eighth week after feeding.The period of atherosclerosis into endothelial injury stage(group B) and intima thickening stage(group C) were divided.Results There were eighteen rabbits at the endothelial injury stage in group B and thirteen at the intima thickening stage in group C.Compared with control group,arterial SR values of group B and group C were significantly decreased in turn [4.13±1.21＞2.31±0.89＞1.22±0.77,Z=-2.978,P=0.003;Z=1.959,P=0.001],IMT of group C was significantly higher than that of group A(Z=-3.108,P=0.002),strain of group C was significantly lower than that of group A(Z=-2.415,P=0.016),the strain and IMT had no significant difference among three groups except group A and group C (P>0.05).A cut-off value was 3.67 of SR for diagnosing the endothelial injury aretary had a sensitivity of 70% and spectificity of 92.3% respectively obtained by the area under the ROC curve.The agreement of this diagnosis was very good.Conclusions The variable of the SR could stand for the variable of the vascular elasticity during the period of the early atherosclerosis.VVI and NTG vasodilation experiment could quantitatively assess SR of abdominal aortas of rabbits.
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Objective To explore the value of biomechanics parameter of rabbit abdominal aortic atheroma using velocity vector imaging(VVI).Methods Ten of 45 male New Zealand rabbits were chosen as normal control group randomly,the rest experimental rabbits were made atheromatous plaque model.The rabbits were examined by two-dimensional ultrasound and VVI respectively.The intima-media thickness(IMT) or thickness of plaques of abdominal aorta 1 cm from right renal artery branch were recorded.Maximum tangential velocity,strain and strain rate of IMT or plaques were measured using VVI.Then the rabbits were killed for pathological and immuno-histochemical examination.Results Based on pathology,the rabbites were divided into 4 groups:control group(group A,n=10),group of pathological endometrial thickening(group B,n=9),group of thick fibrous cap atheromatous plaques (group C,n=15) and group of thin fibrous cap atheromatous plaques (group D,n=11).The difference of plaques thickness and biochemical indicators had no statistically significant between group B and C(P>0.05),both bigger than group A and B (P0.46×10-2 cm/s,Smax>0.37%,SRmax>1.415×10-2 s-1 to find the vulnerable plaques,the sensitivity were 75.0%,84.4%,84.4% respectively,specificity were 70.8%,91.7%,83.3% respectively.Conclusions VVI can identify plaque biomechanics parameter of different progression periods,which is expected to be a reliable method to find vulnerable plaques earlier in clinic.
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OBJECTIVE To seek for an effective,rapid,economic,safety and practical cleaning method,so as to ensure the high quality of sterilization in hospital supply center.METHODS Six hundred moderately contaminated recyclable instruments were divided into three groups randomly,conventional group,experimental group A and experimental group B(two hundred sorts each).The instruments in experimental group A were put into warmed water(40 ℃) for ten minutes first,and that in experimental group B were put into multi-enzyme solution for five minutes first,and then all the instruments in three groups were put into automatic sprinkling cleaning machine to accomplish the cleaning process automatically.After cleaning process,cleaning degree of the instruments and remained blood residues were compared in three groups.RESULTS The cleaning quality in the groups A and B was significantly higher than that of the conventional group,both P