ABSTRACT
Objective:To compare the clinical features between chronic active Epstein-Barr virus infection(CAEBV) and infectious mononucleosis(IM)in adult patients.Methods:Clinical data from 56 adult IM patients and 14 adult CAEBV patients admitted in the First Affiliated Hospital of Nanjing Medical University during January 2011 to December 2019 were enrolled. Clinical manifestations, laboratory indicators, treatment and outcomes were compared between two groups. Chi-square test and Mann-whitney U test were used to analyze data. Results:The average age of CAEBV patients was higher than that of IM patients [36.0(23.8, 50.5)years vs. 19.0(17.3, 22.8) years; U=90.0, P<0.05]. The symptoms of sore throat, throat congestion, tonsilla enlargement and lymphadenopathy in IM group were more common than those in CAEBV group( χ2=14.088, 16.875, 31.855 and 10.938, all P<0.01). However, the incidence of pulmonary infection, sleepiness/dysphoria and splenomegaly in CAEBV group were significantly higher than those in IM group( χ2=17.217, 5.809 and 6.254, P<0.05 or <0.01). The white blood cell counts, hemoglobin levels, platelet counts, alanine aminotransferase(ALT) and albumin in CAEBV group were significantly lower than those in IM group( U=47.0, 49.5, 158.5, 173.0 and 263.5, all P<0.01). The levels of neutrophil ratio, C-reactive protein, serum ferritin and EBV DNA load in CAEBV group were significantly higher than those in IM group( U=145.0, 140.0, 128.5 and 115.0, P<0.05 or <0.01). The proportions of CD3 + T cell counts and CD8 + T cell counts in CAEBV group were significantly lower compared to those in IM group( U=42.0 and 24.5, P<0.01); the proportions of CD4 + T cell counts, the CD4 + T/CD8 + T cell counts ratio and B lymphocytes in CAEBV group were significantly higher compared to those in IM group( U=29.0, 23.5 and 34.5, P<0.01). Fifty-six IM patients were all cured and discharged from hospital. In CAEBV group, 8 cases died, 3 cases were improved and 3 cases lost follow-up. Conclusions:Patients with IM represent a favorable prognosis, while the prognosis of CAEBV is relatively poor and complication with HLH may occur. For older patients with EBV infection complicated with pulmonary infection, lethargy/irritability, attention should be paid to monitor blood routine, liver function, serum EBV DNA load and peripheral blood lymphocyte subsets.
ABSTRACT
Objective:To systematically evaluate the efficacy and safety of enteral nutrition via percutaneous endoscopic gastrostomy (PEG) and nasogastric feeding (NGF) in stroke patients.Methods:Databases including PubMed, EMbase, Cochrane Library, Wangfang database (Wangfang data), CNKI and CBM were searched for relevant literature about enteral nutrition via percutaneous gastrostomy in stroke patients. Literature screening, data extraction and quality evaluation of the included study were performed by two independent investigators. RevMan5.3 was used for data analysis.Results:A total of 12 publications were included, of which 7 were randomized controlled trials (RCTs) and 5 were non-RCTs. There were no significant differences in BMI, hemoglobin, serum albumin and mortality. In terms of safety, PEG resulted in effective decreases in the incidence of pneumonia (RR=0.31, 95% CI: 0.18-0.53, P<0.01), hypoproteinemia (RR=0.34, 95% CI: 0.17-0.68, P=0.003) and fluid and electrolyte disorder (RR=0.24, 95% CI: 0.06-0.92, P=0.04) compared with NGF while there was no significant difference in the incidence of abdominal distension, diarrhea and gastrointestinal bleeding .Conclusion:Compared with NGF, enteral nutrition with PEG can effectively reduce the incidence of pneumonia and the risk of infections in stroke patients and can also reduce the incidence of hypoproteinemia and fluid and electrolyte disorder, leading to improved patient outcomes.
ABSTRACT
Objective:To systematically review the barriers encountered by nursing staff in the implementation of early activities in adult ICU units.Methods:A systematic search was conducted on CNKI, Wanfang Database, VIP Database, China Biomedical Database, PumMed, Web of Science, Cochrane Library and EMBASE for the research on the obstacles of early activity nursing implementation in adult ICU from the establishment of the database to July 2020, and the final integrated analysis of the included literature was carried out.Results:A total of 26 articles were included, and 59 obstacles in 5 categories were integrated, including 6 kinds of technical level, 13 kinds of organizational culture level, 7 kinds of personnel level, 4 kinds of structural level, and 29 kinds of 6 sub categories of patients level. The most frequent obstacles were unstable condition of patients, sedation or continuous deep sedation, low staffing level, disturbance of consciousness of patients, insufficient equipment related to early activities, and low willingness or compliance of patients to participate.Conclusion:The nursing staff are facing with many obstacles in guiding and assisting ICU adult patients to carry out early activities. It is necessary to formulate modified policies aiming at changeable factors in order to promote the application of early activities in adult ICU units.
ABSTRACT
Objective:To discuss the influence of mindfulness-based stress reduction plus micro-class education on the complications and knowledge mastery rate in surgical patients with diabetes mellitus.Methods:A total of 105 patients, diagnosed as diabetes mellitus complicated with appendicitis in the Affiliated Hospital of Chengde Medical College were selected from January 2019 to January 2020. They were hospitalized for laparoscopic appendectomy and were randomly divided into the control group ( n = 52) and the study group ( n = 53) in accordance with the random number table. The patients in the control group were given routine nursing care, and the patients in the study group were given mindfulness decompression therapy combined with micro-classroom education. The blood glucose control and psychological emotion of the two groups before and after operation, and the postoperative complications and the mastery rate of disease knowledge of the two groups were compared. Results:There was no significant difference in blood glucose indexes between the two groups at baseline ( P>0.05); FBG, HbA1c and other indicators in the two groups were improved during operation and 24h after operation, but FBG (7.38±0.54) mmol/L, HbA1c (6.39±0.21)% and FBG (6.90±0.52) mmol/L and HbA1c (6.10±0.39)% in the study group were lower than those in the control group [(8.16±1.21) mmol/L, (7.53±1.05)%, (7.60±0.57) mmol/L, (6.50±0.41)%], the difference was statistically significant ( t value was 6.789-13.264, P < 0.05); there was no significant difference in SAS and SDS scores between the two groups at baseline ( P > 0.05), until discharge, the SAS and SDS scores of the treatment group were 35.81±5.49 and 42.08±4.91 respectively, which were significantly lower than those of the control group (42.21±5.53, 6.51±4.72) respectively, compared with the corresponding scale scores of the control group, the difference between the two groups after treatment was statistically significant ( t value was 5.386, 4.265, P < 0.05). Compared with 17.31% (9/52) of the control group, the incidence of complications in the study group decreased to 5.66% (3/53), there was significant difference ( χ2 value was 6.789, P < 0.05). The qualified rate of disease knowledge mastery in the study group (98.11%,52/53) was significantly higher than that in the control group (86.53%, 45/52), and the difference was significant ( χ2 value was 5.062, P < 0.05). Conclusion:The mindfulness-based stress reduction plus micro-class education can effectively control the laparoscopic appendectomy patients blood glucose, stabilize the mental emotions, increase the illness knowledge mastery degree, keep in good mood, reduce the postoperative complications and promote the fast recovery.
ABSTRACT
Objective To investigate the epidemiological and clinical features of patients with hepatic echinococcosis in Nanjing City. Methods Epidemiological data, clinical manifestations, laboratory and image examination results, diagnosis and treatment of twenty patients with hepatic echinococcosis from January 2009 to December 2016 at the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. Results A total of 20 hospitalized cases were investigated, of which 7 cases were males and 13 cases were females, the median age was 48 years (17 - 76 years). One case came from Tibet which was the epidemic area of hepatic echinococcosis;the other 19 cases were local hepatic echinococcosis patients including 3 cases that had raised dogs for many years and 2 cases engaged in processing and selling livestock products. Among the 20 cases, 14 cases had no remarkable symptoms and not sought medical advice until imaging examination showed focal liver lesions during a routine check-up, 2 cases saw a doctor due to hepatic cyst, 1 case due to progressive enlarged hepatic hemangioma, the remaining 3 cases due to abdominal discomfort or pain. In addition, 7 cases were diagnosed definitely in 7 to 14 days, 4 cases in 15 to 30 days, 5 cases in > 30 to 60 days, 1 case in 3 months, 1 case in 7 years and 1 case in 9 years. Thirteen patients had partial hepatectomy; the other 7 patients received endocystectomy. All patients had a good prognosis during the follow-up period. Conclusions Most of the local hepatic echinococcosis cases have no definite epidemiological data and no significant manifestations, leading to misdiagnosis and missed diagnosis. Clinical medical staff should strengthen their understanding of imaging characteristics especially the sonographic features of hepatic echinococcosis.
ABSTRACT
Objective To investigate the influence of low-dose,long-term arsenite exposure on keratinocyte (HaCat) cell apoptosis and the expression of Bcl-2 and Bax proteins.Methods HaCat cells were exposed to different concentrations of NaAsO2[0(control group),0.05,0.10 μmol/L] for 15 weeks.A total of 10 000 cells in each group were measured to detect the level of apoptosis by flow cytometry.The protein expressions of Bcl-2 and Bax were determined by Western blotting method.Results The cell apoptosis rate was significantly different between groups (F =17.19,P ＜ 0.05).Compared with that of the control [(1.42 ± 0.13)％],the apoptosis rates of the 0.05 and 0.10 μmol/L groups [(1.23 ± 0.08)％ and (1.04 ± 0.06)％] decreased significantly (all P ＜ 0.05); the 0.10 μmol/L group was significantly lower than that of the 0.05 μmol/L group(P ＜ 0.05).The protein expressions of Bcl-2 and Bax were significantly different between groups (F=107.38,346.45,all P＜ 0.05).The protein expression of Bcl-2 of the 0.05 and 0.10 μmol/L groups were (143.89 ± 7.74)％ and (199.96 ± 12.18)％,respectively,which were significantly higher than that of the control group[(100.00 ± 1.45)％,all P ＜ 0.05] ; the 0.10 μmol/L group was significantly higher than that of the 0.05 μmol/L group (P ＜ 0.05).The protein expression of Bax of the 0.05 and 0.10 μmol/L groups were (70.78 ± 1.53)％ and (54.80 ± 1.34)％,respectively,which were markedly lower than that of the control group[(100.00 ± 3.09)％,all P ＜ 0.05]; the 0.10 μmoL/L group was significantly lower than that of the 0.05 μmol/L group(P ＜ 0.05).Conclusion Decreased level of apoptosis induced by low level and long-term arsenic exposure may be associated with increased expression of Bcl-2 protein and decreased expression of Bax protein.
ABSTRACT
Objective To explore the distribution on-511C/T,-31T/C single nucleotide polymorphism of IL-1β gene among Uygur population in Xinjiang,and to analyze the correlation between IL-1β gene polymorphism and depressive disorders.Methods A total of 100 patients with depressive disorders and 120 control subjects were selected.Polymerase chain reaction and restriction fragment length polymorphism (RFLP-PCR),enzyme digestion and sequence reaction were used to detect the common-511C/T,-31T/C polymorphism of the IL-1β gene.The relationship between the polymorphism in the IL-1β gene and the severity of depressive disorders was analyzed.Results The frequencies of CC,CT,TT in-511 were 19.0％,58.0％ and 23.0％ in patient group,while those were 19.2％,55.0％,25.8％ in the control group,which did not show statistically significant differences (x2=0.266,P=0.875).The frequencies of CC,CT,TT in-31 were 24.0％,58.0％ and 18.0％ in the patient group,while those were 24.2％,58.3％,17.5％ in the control group,which did not show statistically significant differences (x2=0.0093,P=0.995).The frequencies of CC,CT,TT genotypes of the IL-1β gene polymorphism (-511 C/T,-31 T/C) were not statistically different between depressive patients and healthy controls.Conclusion The findings suggest no significant association between-511C/T,-31T/C polymorphism and depressive disorders in Uygur population of Xinjiang.
ABSTRACT
Objective To investigate the action of interlukin-2(IL-2),interlukin-6(IL-6) and its soluble receptors (sIL-2R,sIL-6R) in the first episode of depression in the patients of Uyghur nationality and the differences in IL-2,IL-6 and sIL-2R,sIL-6R levels between the responsive depressed patients and the refractory depressed patients treated with venlafaxine.Methods A case-control study design was conducted.57 first-episode patients with depression (patient group) and 55 healthy people matched with gender and age (control group) were recruited in the study.An intervention with sustained-releasing venlafaxine tablets at fixed dose of 150 mg/d was performed in the patient group.The severity of the illness was evaluated by using the Hamilton's depression scale (HAMD-17) before and after the therapy.And by calculating the reduction rate of HAMD-17 (≥ 50％ or ＜50％),the patients were divided into the responsive or refractory groups.The serum levels of IL-2,IL-6,sIL-2R and sIL-6R in patients and controls were tested by ELISA,and a re-test was done with the patients after treatment.Results There were statistical significant differences of the levels of serum IL-2,IL-6 and sIL-2R,sIL-6R between the patients and the control group (P ＜ 0.01).After treatment,the levels of serum IL-2,IL-6,sIL-2R and sIL-6R in responsive patients were significantly decreased when compared with those before the treatment(P＜ 0.01).The four indexes of refractory patients didn' t alter after venlafaxine treatment (P ＞ 0.05).There were positive correlations between HAMD,serum IL-2 (r =0.677 ; P =0.000) and IL-6 (r =0.197 ; P =0.033) before treatment in all patients.Conclusion Serum IL-2 and IL-6 may play a role in the onset of the depression.The efficacy of venlafaxine is negatively correlated with the levels of serum IL-2 and IL-6.Regulating the imbalanced inflammatory cytokines and the immune system may be one of the mechanisms of drug therapy of depression.