ABSTRACT
Objective:To compare the effect and safety of continuous veno-venous hemofiltration (CVVH)+double plasma molecular absorption (DPMA)+hemoperfusion (HP), CVVH+HP, and CVVH+plasma exchange (PE) in treatment of patient with severe wasp stings injury.Methods:Multicenter, historical cohort study and superiority test were used. From July 2020 to October 2022, patients with wasp sting injury and multiple organ damage admitted to the intensive care units (ICU) of five hospitals were consecutively screened and recruited into the CVVH+DPMA+HP group (intervention group). Propensity score matching was used to establish historical cohorts. Patients with severe wasp sting injury who hospitalized from January 2016 to June 2020 in each ICU were collected and matched 1∶1 with the intervention group, and divided into CVVH+HP group and CVVH+PE group according to their actual hemopurification protocols (historical control groups). The primary outcome was the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score on days 3 and 7 after initiation of treatment. Secondary outcomes included complications, length of ICU and hospital stays, and all-cause mortality. Multivariate Cox proportional risk regression was used to analyze the prognosis of patients.Results:After propensity score matching, 56 patients in intervention group and each of the two historical control groups were matched successfully. There were no significant differences in age, gender, comorbidities, biochemical test indices and critical illness scores among the groups. After treatment, APACHE Ⅱ score markedly declined in all groups, and the decrease was faster in the intervention group; treatment with DPMA [hazard ratio ( HR) = 1.04, 95% confidence interval (95% CI) was 1.02-1.08, P = 0.00], the decreased levels of body temperature ( HR = 1.02, 95% CI was 1.00-1.03, P = 0.02), serum creatine kinase (CK; HR = 0.98, 95% CI was 0.96-1.00, P = 0.05) and myoglobin (MYO; HR = 2.88, 95% CI was 1.24-6.69, P = 0.01) were independent risk factors for APACHE Ⅱ score decline to the target value (15 scores). There were no significant differences in the incidence of bleeding complications, filter or perfusion thrombosis, blood pressure reduction, catheter-related infection and anaphylaxis among the groups. Conclusion:CVVH+DPMA+HP regimen can significantly reduce the APACHE Ⅱ score of patients with severe wasp sting injury, and the efficacy is superior to CVVH+HP and CVVH+PE regimens, with safety.
ABSTRACT
Objective: To evaluate periodontal status of 380 pregnant women and its related factors. Methods: 380 healthy pregnant women aged 20 to 43 at 10-35 weeks of gestation were enrolled and received a questionnaire and a periodontal examination, in order to compare and analyse the effects of different ages, gestational weeks and educational levels on periodontal condition. Results: The prevalence of periodontal disease of the subjects was 87. 1％. In first (10-15 weeks), second (16-27 weeks) and third (28-35 weeks) trimester PD (mm) was 2. 48 ± 0. 54, 2. 60 ± 0. 54 and 2. 71 ± 0. 48 respectively (P ＜ 0. 05) ; the percentage of PD≥4 mm in 2 or more sites were 76. 5％, 84. 1％ and 93. 5％ respectively (P ＜ 0. 05) ; GI and BI did not show significant differences among of the 3 groups trimester stages (P＞ 0. 05) ; PD in maternal age (year) 20-27, 28-35 and 36-43 years was2. 39 ± 0. 51, 2. 61 ± 0. 53 and 2. 61 ± 0. 56 respectively (P ＜ 0. 05) . A significantly positive linear trend was observed between age and GI (P ＜ 0. 05) or PD (P ＜ 0. 05), but without significant correlation between age and BI. Significant correlation was found between pregnant weeks and PD (P ＜ 0. 05), but without correlation between pregnant weeks and GI (P＞ 0. 05) or BI (P＞ 0. 05) .Conclusion: The prevalence of periodontal disease during pregnancy is high. Meanwhile, the periodontal inflammation is increasing worse with the increase of gestational weeks and maternal age.
ABSTRACT
Objective: To compare the difference of maternal periodontal status and TNF-? levels in gingival cervical fluid in pregnancy with pre-term and full-term and find the relationship between periodontal infections and pre-term. Methods:The case group consisted of 28 women with pre-term and the control group consisted of 22 women giving birth in time. The clinical examination was performed before delivery. The periodontal conditions were evaluated on the basis of the following parameters: gingival index(GI), probing depths(PD), clinical attachment level(CAL) and sulcus bleeding index(SBI). Gingival crevicular fliud(GCF) samples were collected from all individuals and TNF-? levels were measured by enzyme-linked immunoabsorbent assay. Results:Clinical periodontal measures(GI, PD, CAL, SBI) in pre- term group were significantly greater than that in the control group. And pre- term group also showed higher prevalence of periodontitis. TNF-? in GCF was detected in 67.85% of pre-term group and in 27.27% of the control group. GCF volumes of case group significantly increased than that of control group. Significant negative correlations were observed between the gestational age at delivery and PD as well as GCF- volumes. Conclusion: There is a possible link between periodontal infections and pregnancy with pre-term condition.