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Background:In the clinical setting, the effect of intra-abdominal hypertension on the human body is dependent on time, but its role is not yet clear.Objective:To investigate the effect of the duration of intra-abdominal hypertension (IAH) on the prognosis of critically ill patients.Methods:This prospective cohort study enrolled 256 IAH patients who were admitted to the Surgical ICU of 10 Grade A hospitals in Fujian Province from January 2018 to December 2020. The duration of IAH (DIAH) was obtained after monitoring IAP, and ICU length of stay, duration of mechanical ventilation, duration of continuous renal replacement therapy (CRRT) and average daily energy intake from enteral nutrition during ICU stay were observed and recorded. The correlation was analyzed by Spearman rank correlation. The patients were divided into the survival group and the death group according to their survival state at 60 days after enrollment. Thereafter, clinical characteristics between the two groups were compared. Multivariable logistic regression was used to study and validate the relationship between DIAH and 60-day mortality. The receiver operating characteristics (ROC) curve was established to evaluate the predictive abilities of DIAH on the mortality risk.Results:In critically ill patients, DIAH was positively correlated with duration of mechanical ventilation ( r=0.679, P<0.001), duration of CRRT ( r=0.541, P<0.001) and ICU length of stay ( r=0.794, P<0.001), respectively. In addition, there was a negative correlation between DIAH and average daily energy intake from enteral nutrition ( r=-0.669, P<0.001). After multivariable adjustment, DIAH was an independent risk factor for 60-day mortality in critically patients with IAH ( OR=1.05, 95% CI: 1.01-1.12; P = 0.012), and exhibited a linearity change trend relationship with mortality risk. The ROC curve analysis of DIAH showed that the area under ROC curve (AUC) was 0.825 (95% CI: 0.763~0.886, P<0.01). When the cut-off value was 16.5 days, the sensitivity was 78.4% and the specificity was 75.4%. Conclusions:DIAH is an important risk factor for prognosis in critically ill patients. Early identification and rapid intervention for the etiology of IAH should be performed to shorten DIAH.
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ObjectiveTo investigate the association between CD4+/CD8+ ratio in peripheral blood and patient prognosis after hepatectomy for liver cancer. MethodsThe clinical data of 150 patients who received partial hepatectomy for liver cancer in the 180 Hospital of PLA from October 2008 to November 2011 were analyzed retrospectively. CD4+/CD8+ ratio in peripheral venous blood was measured before surgery, and the patients were divided into low-CD4+/CD8+ group (CD4+/CD8+ ratio ≤1, 52 patients) and high-CD4+/CD8+ group (CD4+/CD8+ ratio ＞1, 98 patients). Clinical indices were compared between the two groups, and outpatient follow-up and telephone follow-up were applied to record survival rate and tumor recurrence. The chi-square test was applied for comparison between the two groups, and Kaplan-Meier method (log-rank test) was applied for survival analysis. Univariate and multivariate logistic regression analyses were performed for clinical factors to determine the related risk factors for recurrence after hepatectomy for liver cancer. ResultsThe low-CD4+/CD8+ group had significantly lower 1-, 3-, and 5-year survival rates than the high-CD4+/CD8+ group (χ2=36.473, 41983, and 55.214, respectively; all P＜0.001), and the 5-year survival rate differed significantly between the two groups (χ2=81.471; P＜005); the low-CD4+/CD8+ group had significantly higher 1-, 3-, and 5-year tumor recurrence rates than the high-CD4+/CD8+ group (χ2=44.041, 68.234, and 55.157, respectively; all P＜0.05). Univariate analysis showed that CD4+/CD8+ ratio, tumor diameter, existence of satellite lesions, hepatitis B virus infection, depth of tumor invasion, microvascular invasion, lymph node metastasis, and degree of tumor differentiation were high risk factors for recurrence after resection of liver cancer. Multivariate analysis showed that CD4+/CD8+ ratio, tumor diameter, degree of tumor differentiation, lymph node metastasis, and microvascular invasion were independent risk factors for recurrence after resection of liver cancer. ConclusionThe patients with a CD4+/CD8+ ratio of ≤1 before resection of liver cancer have poor prognosis and high recurrence rates, and CD4+/CD8+ ratio has a certain predictive value for prognosis after resection of liver cancer.
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ObjectiveTo explore the clinical application of preoperative biliary drainage in the treatment of patients with malignant obstructive jaundice (MOJ) with acute cholangitis (AC). MethodsA retrospective study was performed on the clinical data of 74 patients with MOJ and AC who were treated with preoperative biliary drainage in our hospital from January 2010 to December 2014. In those patients, 29 patients treated with percutaneous transhepatic biliary drainage (PTCD) were assigned to PTCD group, and 35 patients treated with endoscopic retrograde biliary drainage (ERBD) were assigned to ERBD group. The levels of total bilirubin (TBil), direct bilirubin (DBil), and alanine aminotransferase (ALT) before and after treatment, total hospitalization cost, average duration of hospitalization, and postoperative complications were compared between the two groups. The advantages and disadvantages were compared between the two preoperative biliary drainage approaches. Between-group comparison of continuous data was made by t test, and between-group comparison of categorical data was made by χ2 test. ResultsIn both groups, the levels of TBil, DBil, and ALT were significantly reduced after treatment (all P＜0.05). The ERBD group had significantly larger decreases in the levels of the three biochemical indices than the PTCD group (all P＜0.05). The ERBD group had significantly shorter average duration of hospitalization and significantly lower total hospitalization cost than the PTCD group (t=3.172, P＜0.05; t=2.562, P＜0.05). The incidence of acute pancreatitis in the ERBD group was significantly higher than that in the PTCD group (14.28% vs 3.45%, P＜0.05); however, the incidence rates of biliary tract bleeding, biliary tract infection, and resection or puncture site infection were significantly lower in the ERBD group than in the PTCD group (all P＜0.05). ConclusionPreoperative biliary drainage can substantially control AC symptoms and improve liver function. Compared with PTCD, ERBD achieves shorter duration of hospitalization, lower total hospitalization cost, and lower incidence rates of complications after treatment, which can be taken as the first choice for the treatment of MOJ with AC.
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ObjectiveTo explore the clinical application of preoperative biliary drainage in the treatment of patients with malignant obstructive jaundice (MOJ) with acute cholangitis (AC). MethodsA retrospective study was performed on the clinical data of 74 patients with MOJ and AC who were treated with preoperative biliary drainage in our hospital from January 2010 to December 2014. In those patients, 29 patients treated with percutaneous transhepatic biliary drainage (PTCD) were assigned to PTCD group, and 35 patients treated with endoscopic retrograde biliary drainage (ERBD) were assigned to ERBD group. The levels of total bilirubin (TBil), direct bilirubin (DBil), and alanine aminotransferase (ALT) before and after treatment, total hospitalization cost, average duration of hospitalization, and postoperative complications were compared between the two groups. The advantages and disadvantages were compared between the two preoperative biliary drainage approaches. Between-group comparison of continuous data was made by t test, and between-group comparison of categorical data was made by χ2 test. ResultsIn both groups, the levels of TBil, DBil, and ALT were significantly reduced after treatment (all P＜0.05). The ERBD group had significantly larger decreases in the levels of the three biochemical indices than the PTCD group (all P＜0.05). The ERBD group had significantly shorter average duration of hospitalization and significantly lower total hospitalization cost than the PTCD group (t=3.172, P＜0.05; t=2.562, P＜0.05). The incidence of acute pancreatitis in the ERBD group was significantly higher than that in the PTCD group (14.28% vs 3.45%, P＜0.05); however, the incidence rates of biliary tract bleeding, biliary tract infection, and resection or puncture site infection were significantly lower in the ERBD group than in the PTCD group (all P＜0.05). ConclusionPreoperative biliary drainage can substantially control AC symptoms and improve liver function. Compared with PTCD, ERBD achieves shorter duration of hospitalization, lower total hospitalization cost, and lower incidence rates of complications after treatment, which can be taken as the first choice for the treatment of MOJ with AC.
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This study was aimed to optimize the extraction process of hyperoside from leaves ofAcanthopanax senticosusby compounding-enzyme method and orthogonal experiment. The hyperoside compound was regarded as standard and determined by HPLC. Based on the experiments of 4 factors including the enzyme amount, temperature, extraction time and PH values, the extraction process of hyperoside was determined by the orthogonal experiments and variance analysis. The results of single-factor experiments showed that different enzymes showed different effects on the enhance yield of hyperoside. The effects of different factors showed that the order of PH, neutral protease, temperature, time, pectinase, xylanase and cellulose was from strong to weak. Through orthogonal analysis, the optimum conditions were 2% pectinase, 2% xylanase, 0.5% neutral protease, and 0.5% cellulose, under the temperature of 30°C, extraction time of 10 min, and pH = 4.5. Under these conditions, the extraction rate was 1.84%. The yield was increased 107% compared with traditional process. It was concluded that the use of compounding enzyme can increase the yield of hyperoside, which possessed a lot of economic benefits.
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Objective To investigate the incidence and related risk factors of post-traumatic stress disorders (PTSD) after acci-dents in the Pearl River Delta .Methods Inpatients after accidents from April 2009 to February 2010 in seven hospitals of the Pearl River Delta cities ,such as Guangzhou ,Shenzhen and Zhuhai ,were surveyed with PTSD Checklist-Civilian Version (PCL-C) and self-made questionnaire .Results In a total of 554 post traumatic patients ,a prevalence of 28 .5% of PTSD symptoms were found in this region with 7 .8% (marks≥50) of severe degree and 20 .8% (marks :38-49) of mild to moderate degree .In the severe PTSD symptoms group ,the top three items were getting nervous and upset once faced similar situation ,difficulty sleeping or easy to be a-wake ,and the trauma experience caused recurring disturbing memory ,ideas or image .Multivariate analysis showed that female ,una-ble self-care ,incapable of working ,lack help from friends ,multiple injury ,and injury time longer were all associated with the PTSD symptom incidence .Conclusion The prevalence of PTSD symptoms is relatively high in injured patients after accidents in the Pearl River Delta .Early identification and intervention of PTSD symptoms in post-traumatic patients are important for the prevention of PTSD .