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ObjectiveTo investigate the effect of factors correlated with trauma emergency care system on the length of ICU stay and figure out independent risk factors of prolonged ICU stay. Methods A total of 1 361 trauma patients admitted to the ICU of five tertiary hospitals in Zhejiang province in 2009 were retrospectively studied.Demographic data,time of ICU stay and variables related to trauma care were collected.Logistic regression was performed to determine the independent risk factors of prolonged ICU stay ( ≥ 15 days). ResultsOverall,192 trauma patients ( 14.1％ ) had a prolonged ICU stay ( ≥15 days).Single factor analysis indicated that ISS≥ 16 points,GCS≤7 points,blunt trauma,prehospital emergency care,length of emergency department stay ≥4 hours,mechanical ventilation and central venous pressure monitoring were associated with the prolonged ICU stay.Multivariate analysis showed that pre-hospital emergency care was a protective factor for the prolonged ICU stay( ≥ 15 days) and that mechanical ventilation,length of emergency room stay≥4 hours and ISS≥ 16 points were the independent risk factors for the prolonged ICU stay ( ≥ 15 days).Conclusions Pre-hospital emergency care and ICU care show significant influence on the length of ICU stay.Furthermore,shortened length of emergency department stay is also contributive to reduced length of ICU stay.
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ObjectiveTo explore the relationship between sleep quality and glucose level,diabetic complications in elderly type 2 diabetes mellitus.Methods A total of 130 hospitalized elderly type 2 diabetes in our hospital were included in the study. Questionnaires and other related clinical data were collected within one week after admission.Patients were divided into two groups:poor-sleeper group and good-sleeper group according to Pittsburgh Sleep Quality Index(PSQI).ResultsSixty percent (78/130) of these patients were poor sleepers. The following parameters differed in the two groups:the duration of diabetes [ (7.9 ± 1.8 ) years vs ( 7.2 ± 1.5 ) years,t =2.318 ],systolic blood pressure [ ( 148 ± 30 ) mm Hg ( 1 mm Hg =0.133 kPa) vs ( 138 ± 23 ) mm Hg,t =2.037 ],fasting plasma glucose (FPG) [ ( 10.7 ± 2.2) mmol/Lvs ( 9.8±1.9)mmol/L,t =2.410],hemoglobin A1c (HbA1c) [(8.6 ±2.2)％ vs (7.8±2.1 ) ％,t =2.068],high-sensitive C-reactive protein (hs-CRP) [ (5.27 ± 2.34) mg/L vs (4.44 ± 1.76)mg/L,t =2.179 ],ratio of diabetic complications ( 61％ vs 32％,x2 ＝ 4.257 ),percentage of depression ( 20％ vs 8％,x2 =3.722 ),score of life quality [ ( 98 ± 19 ) scores vs ( 89 ± 13 ) scores,t ＝ 2.980 ],and proportion of patients treated with insulin (32％ vs 12％,x2 =4.489). All the above parameters were significantly higher in poor-sleeper group than the good-sleeper group (all P value＜ 0.05 ). Multiple correlation analysis showed that the factors affecting sleep quality were FPG,HbA1c,duration of diabetes,diabetic complications,depression,life quality and insulin application (r =0.213,0.257,0.223,0.335,0.422,0.3451,0.231,respectively ; all P value ＜ 0.05 ).By multivariate logistic regression analysis,the followings were found:FPG (β =1.29,P ＜ 0.05 ) and PSQI (β =1.07,P ＜ 0.05 ) were found to be correlated with HbA1c.With increasing of PSQI,FPG,HbA1c,diabetic complications and life quality were changed significantly( all P value ＜ 0.05 ).The indcpcndcnt risk factors of diabetic complications were duration of diabetes ( OR ＝ 1.32,95％ CI 1.01-2.01 ),HbA1c ( OR =2.01,95％ CI 1.63-2.67 ),hs-CRP( OR =1.12,95％ CI 1.08-1.21 ) and PSQI ( OR =1.71,95％ CI 1.58-2.02).ConclusionsElderly type 2 diabetes mellitus are usually poor sleepers. Sleep quality probably affects blood glucoseregulation, and is closely correlated with the occurrence of complications.In addition,poor sleep quality results in poor life quality.
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Objective To provide insight into the clinical manifestation,histopathology characteristics,diagnostic and therapeutic methods of primary histiocytic sarcoma (HS) of central nervous system.Methods The clinical,auxiliary examination and pathological data of one patient with intracranial primary histiocytic sarcoma were presented,and relevant literature were reviewed.Results A 55-year-old female had an 2-month history of hypomnesia and unsteady gait.MRI scans showed multiple mass lesions in brain.Biopsies of the brain lesion showed the tumor cells had polymorphism,and abundant cytoplasm was eosinophilic or clear,with large,pleomorphic nuclei.Immunohistochemically,the tumor cells stained positively with CD45,CD68,CD163,Ki67 and Vimentin,but negatively with pan-cytokeratin,epithelial membrane antigen,CD3,CD20,CD79 a,estrogen receptor,progesterone receptor,Melan-A and glial fibrillary acidic protein.Though she had received radiotherapy,the disease progressed and her consciousness deteriorated within 2 months.Conclusions HS should be considered if multiple or single intracranial unexplained lumps are found and the earliest pathological biopsy is required for early diagnosis.There are no effective therapeutic methods for HS and the prognosis is very poor.
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Objective To explore the predictive value of cholinesterase (ChE) in the prognosis of gerontal patients with systemic inflammatory response syndrome. Methods The clinical data of 124 elderly patients with systemic inflammatory response syndrome collected from September 2009 through September 2010 were retrospectively analyzed. All patients were divided into death group and survival group according to the outcome of patients. The cholinesterase ( ChE), albumin, D-Dime, lactic acid and C-reactive protein (CRP) were detected, and the APACHE Ⅱ and GCS scores were documented in the first 24 hours in the ICU. Results There were no significant differences in age, gender, APACHE Ⅱ score and GCS score of patients between death group and survival group ( all P ＞ 0. 05 ), but there were significant differences in lactic acid, D-Dime, albumin, CRP and ChE between two groups ( theP values were 0.011,0.011, 0. 007,0. 008, 0. 000, respectively) . The results of multiple factors regression analysis showed that age, gender,lactic acid, D-Dime, albumin, CRP, APACHE Ⅱ score, and GCS score were not the independent risk factors of prognosis of gerontal patients with SIRS ( the P = 0. 401, 0. 165, 0. 446, 0. 841,0. 615, 0. 120,0. 502, 0. 184, respectively) except ChE ( P = 0. 000) . The receiver operating characteristic curve (ROC) of ChE in the gerontal patients with SIRS showed the area under curve (AUC) = 0.797, SE =0.04, P=0. 000, and the ChE = 103.00 U/L could be a diagnosis point with sensitivity = 0.793, 1-specificity = 0. 258. The correlation analysis showed that the APACHE Ⅱ score, CRP, and albumin were poorly correlated with ChE ( Kendall coefficients were 0. 061, 0. 231, and -0. 090, and theP = 0. 161,0. 000, and 0. 069, respectively ) . Conclusions ChE maybe played a important role in the gerontal patients with SIRS, and could be a predictive index for the prognosis of gerontal patients with systemic inflammatory response syndrome.
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Objective To study the impact of TCM staging treatment on serum alkaline phosphatase of Rabbit radius fractures delayed union. Metheods Left radial bone defect 1 cm were created in 75 New Zealand rabbits and they were divided into 5 group: The first, the second and the third therapeutic group, model group, and delayed union group. The second therapeutic group received herb medicine two days after the operation, the first and the third therapy group received herb medicine four weeks after the operation, the model group and delayed union group received saline solution two days after the operation, and the delayed union group received local bone marrow transplantation(2ml)four weeks after the operation. Results were observed by ALP and X-ray at 4 weeks and 8 weeks after the operation. Results ALP in the second therapy group was increased significantly[(155.54±23.33)U/L]than other groups at 4 weeks after the operation(P＜0.01). ALP in the second therapy group was increased significantly than the delayed union group(P＜0.01)and the model group(P＜0.05) at 8weeks after the operation[(62.44±27.67)U/L]; ALP in the first and the third therapy group[(74.79±2.068)U/L] were significantly lower than the model group(P＜0.05), and lower than the second therapy group(P＞0.05)at 8 weeks after the operation. X-ray endoscopic scoring in the model group increased significantly than other groups(P＜0.01)4 weeks after the operation, X-ray endoscopic scoring in the second therapy group increased significantly than the first therapy group, the third therapy group and the delayed union group(P＜0.01), but no significant difference than the model group(P＞0.05)at 8 weeks after the operation. Conclusion The treatment of traditional Chinese medicine by stages can promote fracture healing.
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Hepatitis B is a kind of common infectious diseases,often shows no symptoms in the early phase.But the disease can be diagnosed by the modem techniques in advance.So with the modem scientific technology for diagnosis,we can treat the disease atavery early time with TCM to improve the therapeutic effects.
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The article tries to discuss the usage of "modthod of strengthening qi" in treating minimal residual leukemia(MRL). We believe that the mechanisms for MRI are qi weakness and pathogenic factors staying in yinfen. By using the method of strengthening qi, we hope to achieve the effects of regulating yin and yang, qi and blood, and physiological functions of visceras and meridians, and enhance body immunity. Thus, we can prevent and treat MRL and resist tumor indirectly.