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Objective To investigate the influence of the establishment of Chest Pain Center (CPC) on the reperfusion treatment and prognosis of patients with acute ST segment elevated myocardial infarction (STEMI).Methods One hundred and eighteen patients with acute STEMI admitted into the Department of Emergency in Weifang People's Hospital from March to May 2016 before the establishment of the CPC were assigned as a control group,and 112 patients with STEMI admitted from September to November 2016 after the establishment of CPC were assigned as a study group.The first electrocardiograph (ECG) of all emergency patients was finished by nurses in the control group,after the cardiology physicians of Emergency Department having examined the patients,those with definite diagnosis of acute STEMI were sent into a resuscitation room immediately,and a loading dose of aspirin 300 mg and ticagrel 180 mg were given orally to each of the patients.The patients who accepted the primary percutaneous coronary intervention (PPCI) were transferred into a catheterization room as soon as possible;the patients who could not accept the PPCI,after the exclusion of contraindications of thrombolysis,were transferred into the emergency intensive care unit (EICU) to receive the intravenous thrombolytic treatment.For the study group,a uniform training was implemented,including the ECG interpretation,the diagnosis and treatment processes of chest pain for all of the medical staff,and establishment of a CPC database.The patients who were diagnosed as acute STEMI entered into the green channel of chest pain.For the patients who accepted the PPCI,the catheterization room was started immediately.The patients who could not accept the PPCI received the intravenous thrombolysis treatment:intravenous drip of urokinase 1 500 kU dissolved in 100 mL physiological saline was finished in 30 minutes.After treatment,the differences in the time from symptom onset to first medical contact (SO-to-FMC),the finished time of the first ECG after admission,the time of visiting doctor to reperfusion treatment[beginning of thrombolysis or ballon dilatation (DTRT)] including the door-to-needle (D2N) time or the doorto-balloon (D2B) time,the incidence of heart failure during hospitalization,the left ventricular ejection fraction (LVEF) measured with color Doppler ultrasound on the 7th day after admission and the in-hospital mortality were compared between the two groups of patients.Results There was no statistically significant difference between the study and control groups in the SO-to-FMC time (minutes:140.3 ± 108.4 vs.139.4 ± 112.7,P ＞ 0.05).The finished time of the first ECG after admission in the study group was significantly shorter than that of the control group (minutes:7.7 ± 1.3 vs.8.9 ± 1.7,P ＜ 0.05),the door to reperfusion time in the study group was also significantly shorter than that of the control group [D2B (minutes):72 ± 13 vs.83 ± 17,D2N (minutes):27 ± 9 vs.33 ± 12,both P ＜ 0.01].The incidence of heart failure during hospitalization of the study group was significantly lower than that of the control group [40.2％ (45/112) vs.53.4％ (63/11 8)].The left ventricular ejection fraction (LVEF) measured at one week after admission in study group was significantly higher than that of the control group (0.54 ± 0.05 vs.0.53 ± 0.04,P ＜ 0.01).The in-hospital mortality of the study group was lower than that of the control group [9.8％ (11/112) vs.14.4％ (17/118)],but there was no statistically significant difference between the two groups (P ＞ 0.05).Conclusion The application of the CPC run mode can further elevate the therapeutic level of reperfusion therapy,shorten the total ischemic time and improve the prognosis of patients with STEMI.
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Objective:To investigate levels of autophagy in T cells and B cell of patients with systemic lupus erythematosus ( SLE) and its clinical significance.Methods: 68 SLE patients without treatment within 4 weeks were enrolled in this study.We accessed the levels of autophagy in T cells and B cells of 23 healthy controls and 68 patients before and after treatment by flow cytometry,and analyzed their correlations with serum levels of C3 and anti-dsDNA antibodies,SLEDAI score,et al.Results: Before treatment,a significantly increased levels of LC3-Ⅱ was observed in SLE patients than healthy controls, the active group ( SLEDAI score≥10) was significantly higher than the stable group(SLEDAI score0.05 ) . Conclusion:Levels of autophagy in T and B lymphocytes of SLE patients are abnormal compared to healthy controls,and these changes are associated with disease activity.Also,these changes are expected to be the indicators of disease activity and potential therapeutic targets in SLE.
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[ ABSTRACT] AIM:To investigate the effects of pathological products, urinary proteins and advanced glycosyla-tion end products ( AGE) produced in the progression of chronic kidney disease ( CKD) , on the structure and function of lysosomes in renal tubular epithelial cells ( TECs ) , and try to find a novel approach for preventing or delaying CKD. METHODS:The renal specimens of the untreated patients with minimal change nephrotic syndrome (MCNS), diabetic nephropathy (DN) or normal kidney were collected.The expression of lysosomal-associated membrane protein 1 (LAMP1) and cathepsin B ( CB) was studied in TECs by indirect immunofluorescent staining.Human renal tubular epithelial cell line HK-2 was incubated with 8 g/L urinary proteins or 100 mg/L AGE.The expression of LAMP1 and CB was investigated by indirect immunofluorescence and the activity of CB and cathepsin L ( CL) was measured by biochemical and enzymatic as-says.The degradation of DQ-ovalbumin was also determined.RESULTS: The lysosomal membrane permeabilization oc-curred in the TECs of MCNS and DN patients.After treatment with urinary proteins or AGE-BSA, the lysosomal membrane permeabilization of the HK-2 cells was increased.The activity of CB and CL and degradation of DQ-ovalbumin were de-creased as compared with normal control group.CONCLUSION:The digestive function of lysosome was decreased and ly-sosomal membrane permeabilization occurred in the TECs exposed to urinary proteins and AGE, which might be a key factor to induce the tubulointerstitial fibrosis.
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Objective To investigate the current situation of community nurses′practice environment and work engagement, and to analyze the impact of practice environment on work engagement. Methods Totally 380 community nurses in 26 community health service institutions were investigated with Practice Environment Scale of the Nursing Work Index (PES-NWI) and Utrecht Work Engagement Scale (UWES). Results The effective questionnaires rate was 88.95%(338/380). The total of PES-NWI was 50-120 (90.542±12.095) scores, the different dimension from high to low were medical cooperation,nursing managers' ability and leadership style, high quality nursing service basis, nurses in hospital affairs, staffing and resource adequacy:(3.213 ±0.510), (3.048 ±0.404), (3.015 ±0.419), (2.739 ±0.494), (2.693 ±0.549) scores. The total of UWES was 17-88 (52.189±19.610) scores,the different dimension from high to low were activity, focus, dedication:(3.556±1.380), (3.493±1.389), (3.346±1.475) scores.Nurse practice environment ofnurses in hospital affairs and high quality nursing service basis had significant prediction effect on community nurses′work engagement, P<0.01. Conclusions It exists closely correlation between professional practice environment and work engagement. Community hospital managers should reasonable allocation of personnel and materials, provide equal participations in hospital affairs platform, meet the needs of nurses in different levels of education and learning, and perfecting the community nurses performance appraisal, in order to enhance community nurses' work engagement degree.
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Objective: To investigate the incidence of coutrast media iodixanol-induced delayed adverse reaction with the risk factors in general clinical practice. Methods: A total of 20,185 patients with contrast iodixanol were recruited from 95 medical centers in China. The risk factors for adverse drug reaction as hypertension, asthma, previous contrast reaction were assessed;the administrative processes as route, injection manner, lfow rate of injection, prior heating of iodixanol were monitored and the demographic information was documented. The immediate adverse reaction within 1 hour of media administration and the delayed adverse reaction from 1 hour to 7 days after administration were recorded. The risk factors for iodixanol-induced delayed adverse reaction were studied by singlevariate and multivariate logistic regression analysis. Results: The overall iodixanol-induced adverse reaction rate was 1.52%, of which the immediate reaction was 0.58%and delayed reaction was 0.97%. The major delayed reaction was mild and it mostly happened in skin (0.68%) including rash, pruritus and urticaria. Multivariate logistic regression analysis revealed that male gender (OR=0.71, P=0.036), age (OR=0.82, P=0.001), route of administration (OR=0.21, P<0.001), prior heating of iodixanol (OR=1.44, P=0.036), lfow rate of injection (OR=1.28, P=0.001) and previous contrast reaction (OR=16.04, P<0.001) were the independent risk factors for delayed adverse reactions.
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Acidic environment of organelles of eukaryotic cells plays an important role in endocytosis, the secretion of lysoso-mal enzymes and other physiological activities.V-ATPase (vacuolar ATPases) and CLC (chloride channel) family are widely distribu-ted and present in virtually all eukaryotic cells in intracellular membranes and in the plasma membrane.They are responsible for the a-cidification of the vesicular interior.In this paper, the distribution, structure, mechanism of action and physiological and pathological significance of V-ATPase and CLC protein are discussed.
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Objective To investigate the effects of Xuebijing injection on T-lymphocyte subgroups and clinical efficacy in treatment of patients with severe pneumonia.Methods 60 patients with severe pneumonia were selected into the study.The patients were randomly divided into Xuebijing group (n =30) and control group (n =30).Patients in the control group were given routine therapy.The Xuebijing group received the treatment of routine therapy combined with Xuebijing injection.The changes of T lymphocyte subgroups and clinical efficacy were compared between the two groups.Results The levels of CD3,CD4,CD4/CD8 after treatment in Xuebijing group and control group were significantly higher than those of before treatment (t =4.95,4.89,4.96,3.13,3.11,3.09,all P ＜ 0.05),those in the Xuebijing group were significantly higher than control group (t =3.89,3.56,3.78,all P ＜ 0.05).The total effective rate in the Xuebijing group was 93.3％,which was significantly higher than 76.6％ in the control group (x2 =4.55,P ＜ 0.05).Conclusion Xuebijing injection combined with routine western medicine is quite effective in treatment severe pneumonia.Xuebijing can improve the immune function of patients.
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Objective To evaluate the effects of cardiac resynchronization therapy with pacemaker (CRT- P) and cardiac resynchronization therapy with defibrillator (CRT -D) on the outcomes of patients with heart failure.Methods MEDLINE,Cochrane Controlled Trials Register,EMBASE and Chinese Wan Fang,CNKI database were searched to collect data from randomized controlled trials and cohort trials of CRT - P versus CRT - D for the treatment of heart failure from January 1,1990 through September 30,2011.Meta - analysis of data including all causes leading to mortality and mortality of sudden cardiac arrest and heart failure was carried out by using the RevMan 5.0 package.Results A total of 3 404 patients were collected from seven studies.Pooled analysis demonstrated CRT - D significantly reduced mortalities of all causes in comparison with CRT - P [ odds ratio (OR) =0.61,95％ confidence interval (CI) =0.47 ～0.79,P =0.0001 ].Sub - group analysis showed that an increased benefit was seen after extended follow -up period ( after 1 year,OR =0.56,95 ％ CI =0.41 ～ 0.77,P =0.0004),but not after relatively short follow - up period ( within one year,OR =0.76,95 ％ CI =0.54 ～ 1.06,P =0.11 ).Mortalities of sudden cardiac arrest ( OR =0.20,95％ CI =0.07 ～ 0.59,P =0.003) and heart failure ( OR =0.72,95％ CI =0.54 ～ 0.96,P =0.02) of patients treated with CRT - D were lower than those of patients treated with CRT- P.Conclusions This study suggests that CRT - D is superior over CRT - P in respect of better outcome of patients with heart failure.
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Objective To assess the change of left ventricular wall motion at ventricular pacing(VP)by using global circumferential strain (GCS) and segmental circumferential strain of speckle tracking imaging(STI). Methods Seven adult pigs were sedated,followed by median sternotomy and opening of the pericardium. Temporary pacing leads were placed on the right ventricular (RV) epicardium and LV epicardium for RV or LV pacing. A LV short axis view at the mid-level LV was acquired at sinus and VP rhythm. Analysis of circumferential strain by STI was performed offline. The onset of QRS wave was used to characterize the beginning of the cardiac cycle, and the ratio of beginning systolic time, end systolic time and total systolic time to cardiac cycle dyssynchrony was analyzed at sinus and VP rhythm. Results Compared with sinus rhythm,in VP rhythm all of the ratio of the beginning systolic time,end systolic time and total systolic time to cardiac cycle were increased (all P ＜0.05), and the construction of six segments were dyssynchrony,even segmental paradoxical movement. At VP ≥130 beats/min,both LV global and LV segments sometimes showed irregular motion while the EKG remained normal, which included: ( 1 ) multiple construction and diastole in one heart cycle; (2) A large variability of construction amplitude in several consecutive cardiac cycles. Conclusions VP can lead to several kinds of disturbance of left ventricular wall motion, including delay and lengthening of LV systole, dyssynchrony, and irregularity of systole and diastole.
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The effectiveness of rhIL-11 on thrombocytopenia induced by carboplatin in rhesus monkeys was investigated. Thrombocytopenia was induced in monkeys by i.v. administration of carboplatin at a dose of 15 mg/kg(-1)/d(-1) for three consecutive days. rhIL-11 (50 or 100 micro g/kg(-1)/d(-1)) or Neumega (100 micro g/kg(-1)/d(-1)) were administered s.c. for 14 days beginning one day following the final dose of carboplatin. The results showed that rhIL-11 significantly improved mean platelet nadirs and shortened the mean duration of platelet counts less than 50% of pre-treatment values. Administration of rhIL-11 also resulted in moderate increase of the reticulated platelet, leukocyte and reticulocyte counts in peripheral blood and megakaryocytic and erythroid progenitors in bone marrow. rhIL-11 did not enhance ADP-induced platelet aggregation. These results indicate that rhIL-11 has a potent thrombopoietic effect in vivo and could be an important agent to reduce the severity and duration of thrombocytopenia following chemotherapy.
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Objective To investigate the effect of variation of cesarean sections during labour and their indications on the total cesarean section rate. Methods A total of 458 cases of cesarean section was selected from January to June of 1990,1996,2002. They were divided as indication group and no indication group. The change of the indication and cesarean section rate was compared. Results The ratio of cesarean section during labour in total cesarean sections rised. The ratio was 22.0%, 20.8% and 39.4% in 1990, 1996 and 2002 respectively. The proportion of no indication surgery in 2002(63.37%) showed significant growth as compared with that of 1990 (33.84) and 1996 (32.58). Of all cases of cesarean section having indications, the rate of trial produce failure increased in 2002 (25.81%) while it was 11.45% and 16.67% in 1990 and 1996 respectively. The rate of fetal distress decreased from 25.19% (1990), 21.67% (1996) to 12.90% (2002). Conclusion Ascen ding of cesarean section rates during labour was an important factor that increased cesarean section rate in recent years. To decrease the total rates of cesarean section, many important measures should be done such as paying more attention to social factors, reinforcing propaganda and maternal health care , encouraging spontaneous vaginal delivery, emphasizing company during labour and analgesia or pain free delivery, laying stress on the management and monitoring during first stage of labour as well as psychological care.