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Objective:To investigate the implementation status of sepsis hour-1 bundle strategy for patients with septic shock in emergency department.Methods:A total of 116 septic shock patients admitted to the emergency department from January 2020 to December 2020 were included in this prospective study, and the implementation of sepsis bundles and the clinical outcomes of patients were recorded.Results:Among 116 patients, 20 cases (17.2%) had lactic acid monitored within 1 h, 20 cases (17.2%) had blood culture before antibiotics, 82 cases (70.1%) received broad-spectrum antibiotics, 16 cases (13.8%) received fluid resuscitation ≥30 ml/kg, and 57 cases (49.1%) received vasoactive drugs during resuscitation. Finally, the sepsis hour-1 bundle strategy was fully implemented only in 13 cases (11.2%). Compared with the group with incomplete implementation of sepsis hour-1 bundle strategy, the volume of fluid recovery in the group with full implementation was significantly increased [33.7 (30.0,37.5) vs. 8.9(7.3,10.8) ml/kg, Z=-4.78, P<0.001], mean artery blood pressure significantly increased [70.0 (70.0,76.7) vs. 67.7 (61.7,76.7)mmHg(1 mmHg=0.133 kPa) , Z=-2.00, P<0.001], and lactic acid significantly decreased [3.0 (2.0,3.2) vs. 4.4 (3.7,7.2) mmol/L, Z=-2.76, P=0.006]. However, there were no significant differences in ICU mortality, in-hospital mortality and 28-day mortality between the two groups ( P>0.05). Conclusions:Septic shock patients in emergency department have poor compliance with the implementation of sepsis hour-1 bundle strategy, and relevant management training should be strengthened.
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Objective To investigate the changes and clinical significance of neck-shaft angle in the treatment of proximal humerus fractures with locking plate.Methods A retrospective case-control study was done on 214 cases of proximal humerus fractures treated with locking plate in our hospital from January 2008 to June 2016.According to the presence of medial bone defects,the cases were divided into medial bone defect group (85 cases) and non-medial bone defect group (129 cases).In medial bone defect group,there were 35 males and 50 females,with an average age of 63.3 years old.In this group,the cases of Neer three-part fractures and Neer four-part fractures were 47 and 38,respectively.In non-medial bone defect group,there were 51 males and 78 females,with an average age of 65.9 years old.In this group,the cases of Neer three-part fractures and Neer four-part fractures were 57 and 72,respectively.The preoperative humeral neck-shaft angle of contralateral humerus,and the humeral neck-shaft angle with its changes on the second postoperative day as well as 1,3,6 and 12 months after surgery were evaluated by the X-ray film.The Constant scores of the shoulder function were also assessed.Results The follow-up time for the patients ranged from 12 to 42 months (mean 24.2 months).In medial bone defect group,the preoperative neck-shaft angle of contralateral humerus,as well as neck-shaft angles of fractured side at five follow-up visits were (133.4±4.0) °,(134.7 ±11.5) °,(120.8±4.0) °,(118.5 ±3.5) °,(117.9 ±10.4) °and (114.7 ±4.4)°,respectively.While in the other group,the corresponding parameters were (134.0±2.4)°,(133.8± 17.1)°,(135.6± 2.9)°,(132.7± 2.8) °,(131.5 ± 13.5) °,(135.2 ± 2.8) °,respectively.There were significant differences between the two groups of the neck-shaft angle at 1,3,6 and 12 months (P ＜ 0.05).In the medial bone defect group,there were no significant differences between neck-shaft angle of contralateral humerus and the second postoperative day (P ＞0.05),but both of them are significantly greater than others(P ＜0.05).In the other group,except for the neck-shaft angles of postoperative 1 month and 6 months (P ＜ 0.05),there was no statistically significant difference between the angles in different time points(P ＞ 0.05).The mean Constant scores of medial bone defect group and no medial bone defect group were (69.3 ± 14.6) and (75.2 ± 12.6),respectively.Conclusions After the recovery of neck shaft angle,there is still a need of attention to the losses of neck shaft angle after surgery.Neck-shaft angle could be a reference for the treatment strategy of proximal humerus fractures with locking plate,which could guide the anatomical reduction as well as be used to evaluate the effects after surgery.It could also be a reference for function exercise.Moreover,the losses of neck shaft angle will be influenced by supporting from internal side,which could have effects on the function recovery after surgery.
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Objective To investigate the changes and clinical significance of neck-shaft angle in the treatment of proximal humerus fractures with locking plate.Methods A retrospective case-control study was done on 214 cases of proximal humerus fractures treated with locking plate in our hospital from January 2008 to June 2016.According to the presence of medial bone defects,the cases were divided into medial bone defect group (85 cases) and non-medial bone defect group (129 cases).In medial bone defect group,there were 35 males and 50 females,with an average age of 63.3 years old.In this group,the cases of Neer three-part fractures and Neer four-part fractures were 47 and 38,respectively.In non-medial bone defect group,there were 51 males and 78 females,with an average age of 65.9 years old.In this group,the cases of Neer three-part fractures and Neer four-part fractures were 57 and 72,respectively.The preoperative humeral neck-shaft angle of contralateral humerus,and the humeral neck-shaft angle with its changes on the second postoperative day as well as 1,3,6 and 12 months after surgery were evaluated by the X-ray film.The Constant scores of the shoulder function were also assessed.Results The follow-up time for the patients ranged from 12 to 42 months (mean 24.2 months).In medial bone defect group,the preoperative neck-shaft angle of contralateral humerus,as well as neck-shaft angles of fractured side at five follow-up visits were (133.4±4.0) °,(134.7 ±11.5) °,(120.8±4.0) °,(118.5 ±3.5) °,(117.9 ±10.4) °and (114.7 ±4.4)°,respectively.While in the other group,the corresponding parameters were (134.0±2.4)°,(133.8± 17.1)°,(135.6± 2.9)°,(132.7± 2.8) °,(131.5 ± 13.5) °,(135.2 ± 2.8) °,respectively.There were significant differences between the two groups of the neck-shaft angle at 1,3,6 and 12 months (P ＜ 0.05).In the medial bone defect group,there were no significant differences between neck-shaft angle of contralateral humerus and the second postoperative day (P ＞0.05),but both of them are significantly greater than others(P ＜0.05).In the other group,except for the neck-shaft angles of postoperative 1 month and 6 months (P ＜ 0.05),there was no statistically significant difference between the angles in different time points(P ＞ 0.05).The mean Constant scores of medial bone defect group and no medial bone defect group were (69.3 ± 14.6) and (75.2 ± 12.6),respectively.Conclusions After the recovery of neck shaft angle,there is still a need of attention to the losses of neck shaft angle after surgery.Neck-shaft angle could be a reference for the treatment strategy of proximal humerus fractures with locking plate,which could guide the anatomical reduction as well as be used to evaluate the effects after surgery.It could also be a reference for function exercise.Moreover,the losses of neck shaft angle will be influenced by supporting from internal side,which could have effects on the function recovery after surgery.
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Objective To observe the effect of Shenxian Yiganling Tablets ( SYT) , a Chinese herbal recipe with the actions of tonifying kidney and removing toxicity, combined with HBsAg gene-modified dendritic cells (DC/HBsAg) on immune response and hepatocyte damage of hepatitis B virus (HBV) transgenic mice. Methods HBV transgenic mice ( Tg mice) were immunized with injection of DC/HBsAg ( 100 μg every three weeks) through caudal vein, and then were given intragastric administration of SYT in the dosage of 12.8, 23.5, and 47.0 mg/d for four weeks. HBV Tg mice splenic T cell cytokines of interleukin 2 ( IL-2) and interferon gamma ( IFN-γ) levels as well as serum alanine aminotransferase ( ALT) and aspartate aminotransferase ( AST) conents were detected by enzyme-linked immunosorbent assay ( ELISA) . Lactate dehydrogenase ( LDH) release assay was used to detect the in-vitro cytotoxic activity of splenic HBsAg specific T lymphocytes. Serum HBsAg level of HBV Tg mice was detected by ELISA after immunization. Results Compared with DC/HBsAg administration alone, DC/HBsAg combined with SYT could significantly increase HBV Tg mice splenic T cells cytokines IL-2 and IFN-γ levels ( P<0.05 or P<0.01) , increase the cytotoxic activity of HBsAg-specific T lymphocytes ( P<0.05 or P<0.01), increase the inhibition rate of HBsAg expression (P<0.05 or P<0.01), and reduce hepatocyte damage. Conclusion SYT could enhance the immune response of Tg mice to DC/HBsAg immunization, and relieve the hepatic damage, which enable the HBV clearance process out of hepatic damage in the case of anti-HBV activity of IFN-γbeing unaffected.
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Objective To investigate the association between different number of inferomedial screws (0-3 screws) and their efficacy in locking plate of proximal humerus fractures.Methods Data of 90 patients who had undergone locking plate for proximal humerus fracture between January 2007 and December 2012 were retrospectively analyzed.They were divided into four groups according to the number of inferomedial screws.In the NS (no-screw support) group,36 patients did not have inferomedial screws for mechanical support of the inferomedial region of the proximal humerus; in the OS (one-screw support) group,23 patients had the reconstruction by insertion of only one inferomedial screw; there were 19 patients in the TS (two-screw support) group and 12 in the ThS (three-screw support) group.There were no significant differences among 4 groups in sex,fracture type and age.The Constant scores of the shoulder function,changes in humeral head height at the latest follow-up,incidence of complications and time for fracture healing among the 4 groups were collected.Results The follow-ups for the patients ranged from 12 to 56 months (mean,21.4 months).At the latest follow-up,the ThS,TS,OS and NS groups had a mean Constant score of 76.7 (SD,11.6),74.1 (SD,7.4),66.8 (SD,10.7),65.8 (SD,10.2),respectively; the mean change in humeral head height were 1.4 (SD,1.0) mm,2.9 (SD,1.2) mm,5.3(SD,3.2) mm and 6.7(SD,3.3) mm,respectively.There were no significant differences between the ThS and TS groups in Constant score,and Constant scores in ThS and TS groups were significantly higher than those in OS and NS groups.However,the loss in humeral head height in the ThS group was significantly less than those in the TS,OS and NS groups,and the loss in humeral head height in TS group was significantly less than those in the OS and NS groups.There were no significant differences among 4 groups in time for fracture healing and incidence of complications.Conclusion Locking plate in general do not appear to be a panacea for proximal humerus fractures especially in cases of medial comminution or bone defects because of the malreduction of the medial cortical bone.However,medial support with two or three inferomedial screws being meticulously placed in the inferomedial region may enhance the mechanical stability of medial column support and allow for better maintenance of reduction.
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Objective To observe the clinical efficacy of Kuijiening Paste acupoint application on ulcerative colitis (UC) patients of spleen-kidney Yang deficiency type, and its effect on serum levels of IFN-γand IL-4. Methods Sixty UC patients were divided into treatment group, control group and combined treatment group, 20 cases in each group, and were given Kuijiening Paste acupoint application plus placebo, oral sulfasalazine plus comfort paste and Kuijiening Paste acupoint application plus sulfasalazine respectively for 60 days. The clinical efficacy, mucosal lesions efficacy, mucosal pathology efficacy, changes of serum IFN-γand IL-4 were observed after treatment. Results There was no significant difference in clinical efficacy, mucosal lesions efficacy and mucosal pathology efficacy among the three groups (P>0.05). After treatment, IFN-γlevels of the three groups significantly reduced, and IL-4 levels significantly increased (P<0.01). The difference between the treatment group and the control group was significant (P<0.05). The difference between the combined treatment group and the control group was significant (P<0.01). Conclusion Kuijiening Paste acupoint application combined with sulfasalazine can regulate the level of immune cytokine in UC patients of spleen-kidney Yang deficiency type, and receive good clinical efficacy.