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Objective:To explore the risk factors of early infection patients after heart transplantation(HT)and provide references for preventing and treating early infection.Methods:From April 2018 to May 2021, clinical data were retrospectively reviewed for 95 HT recipients treated at Zhengzhou Seventh People's Hospital.They were divided into two groups of infected(n=34)and uninfected(n=61). Gender, age, disease type, preoperative IABP implantation, postoperative intra-aortic balloon pump(IABP)implantation, postoperative extracorporeal membrane oxygenation(ECMO)implantation, preoperative mechanical ventilation, preoperative leukocyte, preoperative lymphocyte, preoperative serum C-reactive protein(CRP), operative approach, APACHEⅡscore, NYHA grade, hemoglobin, cardiopulmonary bypass time, donor heart cold ischemia time, postoperative thoracic drainage tube indwelling time, postoperative gastric tube indwelling time, postoperative urinary tube indwelling time, postoperative acute rejection, postoperative ventilator assisted treatment time and postoperative ICU time.The risk factors of early infection were analyzed by univariate and multivariate Logistic regression analysis.Results:There were 34 cases of early infection after HT and 8 cases died.In infection group, preoperative hemoglobin(female <110 g/L or male <120 g/L), ECMO post-operation, 24-48 h post-operation, APACHE post-operation(>6), postoperative intrathoracic drainage tube indwelling time(≥7 d), postoperative gastric tube indwelling time(≥4 d), postoperative urinary tube indwelling time(≥5 d), postoperative acute rejection(positive), postoperative ventilator assisted treatment time(≥2 d)and postoperative ICU time(≥10 d)were 18 cases(52.94%), 8(23.53%), 30(88.24%), 22(64.71%), 18(52.94%), 20(58.82%), 4(11.76%), 21(61.76%)and 19(55.88%); uninfected group: 16 cases(26.23%), 3(4.92%), 32(52.46%), 24(39.34%), 15(24.59%), 31(34.43%), 1(1.64%), 21(34.43%)and 4(6.56%). Significant inter-group differences existed( χ2=6.778, 5.68, 12.326, 5.623, 7.740, 5.297, 4.489, 6.615, 28.947, P<0.05). Multivariate Logistic regression analysis indicated that 24-48h post-operation, APACHEⅡ score >6(β=1.024, Wald χ2=7.653, OR=2.141, OR95% CI=1.323~4.215), ECMO post-operation(β=1.783, Wald χ2=6.186, OR=5.949, OR95% CI =1.459~24.25), postoperative intrathoracic drainage tube indwelling time ≥7 d(β=0.712, Wald χ2=5.745, OR=1.054, OR95% CI=1.183~6.753), postoperative gastric tube indwelling time(β=0.832, Wald χ2=6.756, OR=1.132, OR95% CI=1.416~8.406), postoperative ventilator assisted treatment time(β=0.745, Wald χ2=6.563, OR=1.212, OR95% CI=1.289~7.346)and postoperative ICU time=1.28(β=1.325, Wald χ2=9.752, OR=2.435, OR95% CI=1.426~6.354)were independent risk factor for early infection after HT( P<0.05). Conclusions:Early infection after HT remains higher.It is significantly correlated with 24-48 h post-operation APACHE II score, ECMO post-operation, postoperative intrathoracic drainage tube indwelling time, postoperative gastric tube indwelling time, postoperative ventilator assisted treatment time and postoperative ICU time.Targeted interventions should be adopted for lowering the incidence of early infection after HT.
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【Objective】 To investigate the effects of 80 kVp combined with multi-model adaptive statistical iterative reconstruction algorithm （ASiR-V） on the image quality of CT angiography （CTA） of iliac artery in kidney transplantation candidates before operation. 【Methods】 Totally 50 kidney transplantation candidates underwent “one-stop” scanning combined CTA for coronary and iliac arteries were recruited consecutively. After the scanning， images were reconstructed with different ASiR-V levels on the iliac artery from 50% to 100% at a 10% interval， and 6 groups of images were obtained. We evaluated and compared all image qualities， DLP and CTDI in the patients’ examination were recorded， and the effective dose （ED） was calculated. 【Results】 All of the image quality objective scores of different ASiR-V levels on the iliac artery were above 3 points （3.32±0.24）， and the average CT value was （344.30±74.53）HU. The ED received by the patient throughout the examination was （2.71±0.42)mSv. The image noise decreased while SNR and CNR increased monotonically as the ASiR-V levels increased， among which 80% ASiR-V image quality score was the highest with 3.41±0.26. 【Conclusion】 For patients who need to have both coronary and iliac arteries evaluated before kidney transplantation operation， low tube voltage （80 kVp） combined with 80% ASiR-V can obtain high-quality iliac artery images under the premise of reducing the ED dose， which can provide practical basis for further reducing the dose in personalized scanning scheme for such patients. It has good feasibility and clinical application value.
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@#Objective To investigate the clinical effect of Maze Ⅳ in the treatment of elderly patients with valvular heart disease and persistent atrial fibrillation (AF). Methods We retrospectively analyzed the clinical data of 78 elderly patients with cardiac valve disease combined with persistent AF in our hospital from 2017 to 2018. The patients were allocated to two groups including a trial group (n=37) and a control group (n=41). There were 21 males and 16 females aged 61 to 74 (65.2±2.5) years in the trial group. There were 23 males and 18 females aged 62 to 76 (64.8±3.3) years in the control group. The clinical effects of the two groups were compared. Results There was no statistical difference in baseline data between the two groups (P>0.05). The aortic occlusion time, extracorporeal circulation time, and operation time of the trial group were longer than those of the control group with statistical differences (P<0.05). There was no statistical difference in postoperative ventilator assistance time, complication rate, mortality, ICU retention time, perioperative drainage, red blood cell transfusion volume, or length of hospital stay between the two groups (P>0.05). At the time of discharge, postoperaive 1-month, 3-month, 6-month, and 12-month, the maintenance rates of sinus rhythm in the control group were statistically different from those of the trial group (P<0.05). Compared with the control group, left atrial diameter, left ventricular end diastolic diameter and the decrease of pulmonary artery systolic blood pressure were statistically different (P<0.05). Conclusion Maze Ⅳ is safe and effective in the treatment of elderly patients with valvular heart disease and persistent AF, which is conducive to the recovery and maintenance of sinus rhythm, and is beneficial to the remodeling of the left atrium and left ventricle and the reduction of pulmonary systolic blood pressure with improvement of life quality of the patients.
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BACKGROUND:Brain natriuretic peptide, an important serum marker for diagnosis of cardiovascular diseases, is crucial for risk factor analysis of cardiovascular diseases. OBJECTIVE: To analyze the relationship between brain natriuretic peptide and hemodynamic parameters before and after coronary artery bypass grafting. METHODS:Thirty patients with coronary heart disease undergoing coronary artery bypass grafting were selected, including 13 patients with left ventricular ejection fraction≥ 50% (normal heart function) and 17 patients with left ventricular ejection fraction RESULTS AND CONCLUSION: Preoperative and postoperative levels of plasma brain natriuretic peptides were significantly lower in the patients with left ventricular ejection fraction≥ 50% than those with left ventricular ejection fraction < 50%; while in each group, the level of brain natriuretic peptides was remarkably increased after coronary artery bypass grafting (P < 0.05 orP< 0.001). Preoperative brain natriuretic peptide levels were positively correlated with New York Heart Association classification grading, left atrial diameter and left ventricular diameter (r=0.61;r=0.34;r=0.67), but negatively correlated with echocardiographic left ventricular ejection fraction and cardiac output (r=-0.75;r=-0.70). The postoperative peak level of brain natriuretic peptides was positively correlated with New York Heart Association classification grading, echocardiographic left ventricular end diastolic diameter and pulmonary artery pressure (r=0.72;r=0.70;r=0.45). These findings indicate that the plasma level of brain natriuretic peptides before coronary artery bypass grafting shows a good correlation with left ventricular ejection fraction and left ventricular end diastolic diameter, which accurately reflect the state of cardiac function before coronary artery bypass grafting.
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Objective To study a purification prototype with a noble metal nano catalyst as the main material in order to improve the combat capability of the crew of armored vehides.Methods At natural temperature, the single way purification experiment, static and dynamic purification experiments were carried out in the 1 m3 and the 7 m3 cabins. Results In the single way purification experiment, the prototype kept the purification rate above 40%and 50%when the CO concentration was below 800 mg/m3 and the air flow rate was 1 and 2 m3/min.During static experiments, the CO purification rate was 90% at the initial concentration of 800 mg/m3 and after 3′43″and 20′.During the dynamic experiment, the average elevation rate of the gas concentration was significantly lower than that of the control experiment. Conclusion In a natural environment, the prototype can effectively purify CO gas.Key technology of CO gas purification has been made available that can be used to develop CO gas purification devices in armored vehicles.
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Objective To study the risk factors of obstetrical brachial plexus palsy (OBPP).Methods Forty-six newborn infants with OBPP were recruited between January 1997 and December 2009 from Technical Appraisement Center for Medical Malpractice of Shandong province as OBPP group.In the control group,138 newborn infants delivered in the same time,same hospital and same gender were collected,with a ratio of 1:3.All the cases were analyzed retrospectively.The newborn,maternal,childbirth data and working experience of midwives were analyzed by univariate and multivariate logistic regression analysis.Results ( 1 ) External pelvimetries of the two groups were normal.All were singleton newborns by vaginal deliveries with cephalic presentation.Twenty-two newborns had left unilateral palsies,and the other 24 had right unilateral palsies.The numbers of the whole,upper and fore arm type were 17,26 and 3,respectively.The maternal age,gravidity,parity and gestational weeks were higher in OBPP group than in the control group ( P ＜ 0.05 ).( 2 ) The maternal antepartum body mass index ( BMI ) [ ( 29.5 ± 2.4 ) kg/m2 ],height of the uterus [ (34.9 ± 2.4) cm ] and abdominal circumference [ ( 105 ± 6) cm ] in OBPP group were higher than those in the control group [ ( 26.1 ± 2.5 ) kg/m2,( 33.7 ± 2.2 ) cm and ( 99 ± 5 ) cm,respectively ] ( P ＜ 0.05 ).The newborn birth weight in OBPP group [ ( 4390 ± 489 ) g ] was significantly higher than the control group [ ( 3404 ± 360 ) g] ( P ＜ 0.01 ).The working experience of midwives in OBPP group [ ( 5.2 ± 2.3 ) years ] was less than the control group [ ( 8.9 ± 5.4) years ] ( P ＜ 0.01 ).(3) There was a higher proportion of instrumental delivery ( 28.3％ vs.3.6％ ),uterine atony (28.3％ vs.6.5％ ),prolonged second stage(8.7％ vs.0.7％ ) and fetal malposition( 10.9％ vs.2.9％ ) in the OBPP group than in the control group ( P ＜ 0.05 ).(4) Univariate logistic analysis showed that the P values of maternal age,antepartum BMI,height of uterus,abdominal circumference,newborn birth weight,gravidity,second stage duration,instrumental delivery,fetal malposition,uterine atony and working experience of midwives were all less than 0.10.And the working experience of midwives was a protective factor.(5)The factors listed above were taken as variables,selected stepwise regression for multivariate logistic regression analysis.Boundary value was 0.10.It showed that the antepartum BMI ( OR =1.733 ) and newborn birth weight ( OR =1.004 ) were related to OBPP ( P ＜ 0.10 ).The significance of maternal antepartum BMI was higher than birth weight.Conclusions The maternal antepartum BMI is the most important risk factor for OBPP,and the newborn birth weight is the other risk factor.The working experience of midwives is a protective factor.
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s Objective To investigate the predictive value of maternal serum C reactive protein,IL 6 and glucose concentration for the early intrauterine infection in patients with preterm premature rupture of the membranes(PPROM).Methods Amniotic fluid(AF) was collected from patients with PPROM,IL 6,glucose concentration,anti Chlamycdia trachomatis, anti lytomegalovirus IgM and ureaplasma urealytiaum were detected and cultured.Results The most sensitive test was AF IL 6 determination(P
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Objective To investigate the role of soluble intracellular adhesion molecule-1(sICAM-1), corticotropin-releasing hormone(CRH)and interleukin-6(IL-6) in the pathogenesis of pregnancy-induced hypertension (PIH). Methods Maternal plasma sICAM-1, CRH and IL-6 level were determined in 81women at 26~37 gestational weeks among which 23 were normal pregnant women and 58 with PIH. The later were grouped into 21 women with mild, 19 with moderate, 18 with severe PIH. sICAM-1 and IL-6 were measured by ELISA and CRH by RIA. Results The levels of plasma sICAM, CRH and IL-6 were significantly elevated in women with moderate and severe PIH compared with control subjects(P