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Objective:Analysis of influencing factors of enteral nutrition interruption in critically ill patients in general surgery department and its impact on prognosis.Methods:A total of 91 cases of critically ill patients in general surgery department were selected who were admitted to the general surgery of General Hospital of Eastern Theater Command of the Chinese People′s Liberation Army in Nanjing from June 2021 to March 2022 by convenient sampling method, demographic and enteral nutrition interruption data were collected,and patients were divided into enteral nutrition interruption group and enteral nutrition uninterrupted group to investigate the analysis of the factors of affecting enteral nutrition interruption and its impact on prognosis by Logistic regression analysis.Results:There were 59 cases in the enteral nutrition interruption group and 32 cases in the enteral nutrition uninterrupted group. There were statistically significant differences in gender, analgesic and sedatives, Gastro-kinetic agent and feeding intolerance between both groups ( χ2 values were 4.51-9.97, all P<0.05). Logistic regression analysis results showed that gender ( OR=4.566, 95%CI 1.332-15.657, P<0.05), analgesic and sedatives ( OR=3.437, 95%CI 1.112-10.621, P<0.05), and feeding intolerance ( OR=4.116, 95%CI 1.257-13.479, P<0.05) were the factors of enteral nutrition interruption. There were statistically significant differences between the two groups in the number of days of enteral nutrition up to goal in 3 days, 3-7 days and 7 days, albumin,length of stay in intensive care unit, total length of stay and hospitalization expenses between both groups ( Z values were -2.80 - -0.73, all P<0.05). Conclusions:Female, analgesic and sedatives and feeding intolerance are the risk factors of enteral nutrition interruption in critically ill patients in general surgery department, and enteral nutrition interruption has an adverse impact on the prognosis.Medical staff should avoid excessive use of analgesic and sedatives, and do well in feeding tolerance management to reduce the occurrence of enteral nutrition interruption.
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Objective:To investigate the proportion of patients with clinical remission and sustained remission in Chinses patients with rheumatoid arthritis (RA).Methods:We retrospectively reviewed the medical records of RA patients in our center from January 1, 2011 to December 31, 2016. Disease activity scores and remission status at each visit were assessed by the disease activity score in 28 joints (DAS28), the simplified disease activity index (SDAI), the clinical disease activity index (CDAI), and the American Ccollege of Rheumatology/European league Against Rheumatism (ACR/EULAR) Boolean criteria. Patients were considered in sustained remission if they maintained remission during consecutive visits for 6 months. Kaplan-Meier method was applied to plot cumulative possibility of achieving remission and calculate the median time to first clinical remission. Cox multivariate regression analysis was used to analyze the relative factors of sustained remission.Results:A total of 648 patients were included in the present study. During the median follow-up of 24 months, around 70% of patients reached clinical remission at least once (DAS28: 78.7%, SDAI: 70.8%, CDAI: 68.4%, Boolean criteria: 68.7%). Specifically, the cumulative probability of achieving remission at 3-, 6- and 12- month was 10.6%-24.4%, 25.3%-43.5% and 51.8%-65.2% respectively, depending on instruments applied. The median time to first remission was 7.2 (DAS28), 10.1(SDAI), 11.7(CDAI), 11.4(Boolean criteria) months. Regarding the sustained remission, nearly half of patients experienced SR defined by DAS28(52.2%), CDAI(46.6%), SDAI(45.1%), and Boolean definitions (43.7%) respectively. Among those patients in sustained remission, the median time of persistence remission during study period was 16.0 months (DAS28-ESR), 15.4 months (CDAI), 14.9 months (SDAI) and 15.0 months (Boolean criteria). Among patients achieving sustained remission, the percentage was 18.7% and 81.3% for DMARD monotherapy and combination therapy, respectively. Additionally, 22.3% of patients received low-dose glucocorticoids treatment concomitantly and over half of them successfully tapered or discontinued the glucocorticoids during the period of sustained remission.Conclusion:In daily practice, clinical remission is a realistic target in the setting of treat-to-target strategy, and over half of patients achieveclinical remission in the first year of follow-up. Among those patients who achieve clinical remission, around half of them reach sustained remission over the subsequent follow-up period. The median time of persistent remission in patients achieving remission is about 15 months.
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Objective To investigate the early remission rate of rheumatoid arthritis (RA) and identify the potential predictive factors in Chinese population. Methods For this study, medical records of RA patients during January 1, 2009 to December 31, 2016 were retrospectively reviewed. Disease activity scores at visits were measured by (disease activity score uses 28 joint counts (DAS28)-erythrocyte sedimentation rate (ESR) and remission status was determined subsequently. Early remission was defined as the time interval between first visit and clinical remission for less than 6 months. Logistic regression analysis was applied to identify predictive factors for early remission. Results Seven hundred and seventy nine patients in total were included into the present study. Overall, 317 (40.7％) patients achieved early remission and the median time to early remission was 2.8 (1.8, 1.4) months. Comparison of characteristics between RA patients with and without early remission, male gender (26.5％ vs 16.5％, x2=11.631, P=0.001), treatment-na?ve (64.7％ vs 53.5％, x2=9.692, P=0.002), early RA (50.4％ vs 40.9％, x2=7.656, P=0.01), as well as initial use of hydroxy-chloroquine (44.8％ vs 34.0％, x2=9.293, P=0.003) was significantly higher in patients with early remission. Conversely early remission was less frequent in patients with late onset [(49±16) vs (47±16), t=2.925, P=0.003], long disease duration [24(6, 96) vs 14 (4,72), Z=3.126, P=0.003] high level of all baseline individual com-ponents of disease activity [(TJC, SJC, PGA, EGA, ESR, C-reactive protein (CRP)] and DAS28-ESR [(4.33± 1.21) vs (4.92 ±1.38), t=6.118, P<0.01], as well as initial treated with glucocorti-coids (44.6％ vs 36.0％, x2=5.780, P<0.05). No significant differences were observed in terms of serological features, initial used of MTX, LEF, SSZ, as well as DAMRDs combination. Further logistic regression analyses identified that male [OR=1.70, 95％CI (1.16, 2.47)], treatment-na?ve [OR=1.64, 95％CI (1.20, 2.24)], and treatment with hydroxy-chloroquine initially [OR=1.87, 95％CI(1.37, 2.56)] as independent factors associated with early remission. In contrast, late disease onset [OR=0.99, 95％CI(0.98, 1.00)], high baseline DAS28-ESR [OR=0.70, 95％CI(0.62, 0.79)] were independently associated with decreased possibility of early remission ( P<0.05). Conclusion Early remission is uncommon in clinical practice. Male, treatment-na?ve, and initial hydroxychloroquine treatment increases the probability of early remission, while advanced age, higher baseline DAS28-ESR decreases the chance of early remission.
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Objective To analyze the image characteristics of chest schwannoma in coincidence 18FFDG SPECT studies,and to evaluate its prospective diagnostic function on chest schwannoma.Methods Four cases confirmed as schwannoma by surgery and pathology were enrolled in this retrospective study.Enhanced CT and coincidence 18F-FDG SPECT studies were performed before surgery.Imaging characteristics for the diagnosis of chest schwannoma were summarized.Results Tumors were totally removed by surgery.The histological diagnosis of schwannoma was confirmed by pathological,HE and immunohistological staining examination (positivity for the S-100 protein and vimentin),including 1 case of malignant schwannoma and 3 cases of benign.Four cases all showed high uptake of 18F-FDG.The uptake in malignant schwannoma was much higher than that in benign schwannoma.Benign schwannomas were noninvasive masses and mainly showed compression symptoms,with obvious lobulation and distinct borders.Malignant schwannoma was invasive masses.Conclusions 18 F-FDG coincidence SPECT is of limited value as a prospective diagnostic imaging technique for the identification of benign schwannoma from malignant schwannoma.But it could play an important role in the staging,restaging,and post-therapy follow-up of schwannoma.
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Objective To evaluate the diagnostic value of dobutamine?stressed cardiac morphing ( CM) MPI ( CMMPI) for coronary artery disease ( CAD) in middle?aged patients. Methods A total of 97 middle?aged patients (52 males, 45 females, age 40-65 (52.98±7.74) years) from March 2011 to Febru?ary 2015 with chest distress, cardiopalmus and chest pain symptoms ( suspected CAD) were retrospectively studied. Informed consents were signed by patients before examination. All patients underwent one?day dobu?tamine?stressed/rest CMMPI and CAG within one month. The diagnostic value of CMMPI was assessed and compared with CAG. Results CMMPI revealed 42 abnormal cases and 9 normal cases in 51 cases with cor?onary artery stenosis by CAG. CMMPI found 11 abnormal cases and 35 normal cases in 46 cases with normal coronary artery by CAG. In comparison with CAG, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of CMMPI were 82.35%(42/51), 76.09%(35/46), 79.38%(77/97), 79.25%(42/53)and 79.55%(35/44) respectively. The side effect was slight and transient with an inci?dence of 82.47%(80/97). Conclusion The dobutamine?stressed CMMPI has an important value for the diagnosis of CAD and the assessment of myocardial damage in middle?aged patients.
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Objective To investigate the biodistribution and gamma imaging of 99Tcm-arginine-glutamate-threonine (RET) in nude mice bearing lung cancer xenografts and to explore its feasibility for human lung cancer imaging.Methods RET was labeled directly with 99Tcm.The binding efficiency of 99Tcm-RET with human NSCLC H1299 cells was measured.99Tcm-RET was injected via the tail vein in nude mice bearing H1299 xenografts.The mice(n=32) were sacrificed at different time points:15 min,30 min,1 h,2 h,4 h,8 h,24 h,and 48 h.Organs of interest were excised,weighted and counted by a gamma counter.The organ uptake was calculated as ％ID/g.The gamma imaging was performed on 3 mice at 0.5,1,2,4,4.5,5,6 h after intravenous injection of 4.81 MBq 99Tcm-RET.Results The radiolabeling yield of 99Tcm-RET was (93.15±2.02)％,and the binding efficiency of 99Tcm-RET with H1299 cells was (3.56±0.37)％.At 4 h after injection,the uptake of tumor,liver and spleen was (4.96±1.05) ％ID/g,(15.89±1.84) ％ID/g and (10.83±1.66) ％ID/g and the T/NT was 5.70±0.21 for the heart and 12.40±0.11 for the blood.The tumor in nude mice could be best visualized at 4.5-6.0 h.Conclusion 99Tcm-RET might have potential to serve as a lung cancer imaging agent.
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Objective To assess the clinical value of dobutamine 201Tl stress-redistribution/nitroglycerin augmented ~(99m)Tc-metho~(99m)Tc-xyisobutylisonitrile (MIBI) gated myocardial perfusion imaging (MPI) in patients with coronary artery disease (CAD). Methods A total of 132 patients with suspected CAD underwent dobutamine 201Tl stress-redistribution/nitroglycerin augmented MIBI gated MPI and coronary arteriography (CAG) within two weeks after MPI. Percutaneous coronary interventions (PCI) were performed in 23 patients with myocardial infraction. The regional wall movement was assessed with echocardiography before and within three months after PCI. Results Taking stenosis ≥50% as standard of CAD, the sensitivity, specificity and accuracy of dual-isotopic SPECT imaging in diagnosing CAD was 93.41%, 87.80% and 91.67%, respectively. The sensitivity, specificity and accuracy in diagnosing left anterior descending artery (LAD) stenosis was 93.85%, 91.04% and 92.42%, for left circumflex artery (LCX) was 86.79%, 89.87% and 88.64%, while for right coronary artery (RCA) was 81.25%, 82.14% and 81.82%, respectively. Of all 207 myocardium segments in 23 patients with myocardial infarction, radioactivity defect was found in 113 segments on the redistributed ~(201)Tl images, and radiofilling was found in 52 (52/113) segments on the nitroglycerin augmented ~(99m)Tc-MIBI images, whereas 61 segments had no radiofilling. Taking regional wall movement improvement as the criterion of viable myocardium, the sensitivity, specificity and accuracy of identifying viable myocardium with nitroglycerin augmented ~(99m)Tc-MIBI imaging was 87.23%, 83.33% and 84.96%. Conclusion Dobutamine ~(201)Tl stress-redistribution/nitroglycerin augmented ~(99m)Tc-MIBI gated MPI is able to effectively detect CAD and viable myocardium and helpful in diagnosis and treatment of CAD.
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Objective To investigate the characteristics of fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of association fiber tracts in patients with amnestic mild cognitive impairment (aMCI), and to assess the application value of diffusion tensor imaging (DTI) in differential diagnosis of aMCI and AD. Methods DTI were performed in 20 patients of aMCI (aMCI group), 20 patients of AD (AD group) and 20 normal control subjects (control group). FA and ADC values were calculated in the regions of interest (ROI) in inferior fronto-occipital fasciculus (IFOF), genu and splenium of corpus callosum, superior longitudinal fasciclesⅡ (SLFⅡ) and cingulated bundles. Results There was significant difference of FA values in inferior fronto-occipital fasciculus and cingulate bundles between aMCI group compared with control group (P<0.05), as well as of FA values in cingulate bundles between aMCI group and AD group (P<0.05). Conclusion Abnormal FA values in inferior fronto-occipital fasciculus and cingulate bundles suggest that DTI can be used as a diagnosis index of aMCI. Furthermore, it is helpful in the differential diagnosis of aMCI and AD.