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Objective:To investigate the correlation between malnutrition and early neurological deterioration (END) after intravenous thrombolysis in patients with acute ischemic stroke.Methods:Patients with ischemic stroke received intravenous thrombolysis in the Department of Neurology, Nanjing Jiangbei People's Hospital from January 2018 to December 2021 were retrospectively enrolled. Nutritional status was assessed by geriatric nutritional risk index (GNRI) and prognostic nutritional index (PNI). END was defined as an increase of ≥4 in the National Institutes of Health Stroke Scale score within 24 h after intravenous thrombolysis compared with the baseline value. The demographic and baseline clinical data of the patients in the END group and the non-END group were compared. Multivariate logistic regression analysis was used to determine the independent correlation between malnutrition and END. Results:A total of 256 patients were enrolled, including 156 males (60.9%), aged 65.6±12.0 years. According to GNRI and PNI, there were 122 (46.7%) and 62 (24.2%) patients with malnutrition respectively. END occurred in 37 patients (14.5%) during hospitalization. Multivariate logistic regression analysis showed that after adjusting for other confounding factors, there was a significant independent correlation between malnutrition and END after intravenous thrombolysis in patients with acute ischemic stroke (severe malnutrition as assessed by GNRI compared to normal nutritional status: odds ratio 5.736, 95% confidence interval 1.033-31.866, P=0.046; severe malnutrition as assessed by PNI compared to normal nutritional status: odds ratio 4.928, 95% confidence interval 1.589-15.282, P=0.006). Conclusion:Malnutrition is very common in patients with acute ischemic stroke and has a significant correlation with END after intravenous thrombolysis.
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Objective:To investigate the relationship between plasma Dickkopf-1 and early neurological deterioration (END) and outcome in patients with acute ischemic stroke.Methods:From January 2020 to December 2020, consecutive patients with first-ever ischemic stroke form the Department of Neurology, Nanjing Jiangbei Hospital were included. All patients were hospitalized within 24 h after onset. END was defined as the National Institutes of Health Stroke Scale (NIHSS) score within 7 d after admission increased by ≥2 or motor function score increased by ≥1 compared with the baseline. Poor outcome was defined as the modified Rankin Scale score >2 at 90 d after onset. Multivariate logistic regression analysis was used to determine the independent correlation between plasma Dickkopf-1 and END and outcome. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of plasma Dickkopf-1 for END and poor outcome. Results:A total of 176 patients were enrolled, including 92 males (52.3%), aged 66.7±9.6 years. The median Dickkopf-1 was 4.30 μg/L, 52 patients (29.5%) developed END, and 81 (46.0%) had poor outcome. Multivariate logistic regression analysis showed that the higher Dickkopf-1 was an independent predictor of END (odds ratio [ OR] 1.696, 95% confidence interval [ CI] 1.223-2.351; P=0.002) and poor outcome ( OR 1.566, 95% CI 1.156-2.121; P=0.004). ROC curve analysis showed that plasma Dickkopf-1 had good predictive value for END, and its area under the curve was 0.717 (95% CI 0.634-0.801); the optimal cut-off value was 4.40 μg/L, and the corresponding predictive sensitivity and specificity were 71.2% and 60.5%, respectively. Dickkopf-1 also had good predictive value for poor outcome, and its area under the curve was 0.701 (95% CI 0.624-0.778); the optimal cut-off value was 4.25 μg/L, and the corresponding predictive sensitivity and specificity were 65.4% and 61.1%, respectively. Conclusion:Plasma Dickkopf-1 has good predictive value for END and poor outcome in patients with acute ischemic stroke.
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Objective:To comprehensively understand the basic construction of intensive care unit (ICU) in the secondary and tertiary hospitals in Xinjiang Uygur Autonomous Region, and to provide a theoretical basis for the development direction of critical care medicine and the rational allocation of medical resources in our region.Methods:On the March 14th, 2020, a cross-sectional survey of 147 ICU in 122 hospitals in Xinjiang Uygur Autonomous Region was conducted using an online questionnaire. The survey included 6 modules: the basic conditions of the hospital, ICU profile, ICU human resources status, equipment allocation, technology development, and ICU quality control.Results:Among the 147 ICUs, there were 69 ICUs in tertiary hospital and 78 ICUs in secondary hospital. 75.51% (111/147) were comprehensive ICU and 24.49% (36/147) were specialized ICU. The total number of ICU beds was 1 818, accounted about 2.43% (1 818/74 912) of the total number of hospital beds. In ICU terms of human resourse, physicians/beds ratio was 0.54∶1, and nurses/beds ratio was 1.55∶1. Physicians/beds ratio in the secondary hospitals was 0.52∶1, and nurses/beds was 1.45∶1; physicians/beds ratio in the tertiary hospital was 0.56∶1, and nurses/beds ratio was 1.79∶1. The ICU management model was mainly closed management (82.99%, 122/147), and the proportion of closed management in tertiary hospitals was 88.41% (61/69), which was higher than that in secondary hospitals (78.21%, 61/78). In aspect of ICU equipment, the invasive ventilator/bed ratio, enteral nutrition infusion pump/bed ratio, and blood purifier/bed ratio in the tertiary hospitals were significantly higher than those in the secondary hospitals [0.70 (0.46, 1.00) vs. 0.45 (0.33, 0.67), 0.18 (0.00, 0.56) vs. 0.00 (0.00, 0.13), 0.08 (0.00, 0.13) vs. 0.00 (0.00, 0.10), respectively, all P < 0.01]. In the tertiary hospital, the chest sputum excretion device, blood gas analyzer, blood purification instrument, transport ventilator, fiber bronchoscope, enteral nutrition infusion pump, bedside ultrasound machine, continuous hemodynamics and oxygen metabolism monitor, electroencephalogram bispectral index monitor, bedside electroencephalography machine and extracorporeal membrane oxygenation (ECMO) were also superior to the secondary hospitals. ICU technologies, such as deep venipuncture, jejunal nutrition tube placement, percutaneous tracheotomy, invasive blood pressure monitoring, invasive hemodynamic monitoring, bedside ultrasound examination, continuous blood purification, fiber bronchoscopy, high frequency ventilation, intra-aortic balloon counterpulsation (IABP), and ECMO had also performed better than secondary hospitals. In the management of ICU medical quality control, in tertiary hospitals, the proportions of single or isolated room for patients with drug-resistant bacteria, 1-hour bundle and hemodynamic monitoring for patients with septic shock, routine prone position ventilation and lung recruitment for patients with acute respiratory distress syndrome (ARDS), common analgesic, and use of personal digital assistant (PDA) for pre-operation scan code by nurses and electronic medical record for routine rounds were significantly higher than those in secondary hospitals (91.30% vs. 85.90%, 68.12% vs. 48.72%, 85.51% vs. 70.51%, 28.99% vs. 12.82%, 85.51% vs. 61.54%, 76.81% vs. 61.54%, 71.01% vs. 29.49, 49.28% vs. 28.21%, respectively), and the differences were statistically significant (all P < 0.05). 89.74% (70/78) ICU in secondary hospitals and 89.86% (62/69) of tertiary hospitals used acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) to evaluate the severity of critically ill patients; in terms of sequential organ failure assessment (SOFA), the difference between the secondary hospitals and the tertiary hospitals was not statistically significant (51.28% vs. 62.32%, χ2 = 1.814, P = 0.178). Conclusions:Although the ICU construction of the tertiary hospitals in Xinjiang Uygur Autonomous Region is more complete than secondary hospitals, there is a big gap between the requirements of the national guidelines and the developed regions in the east. The ICU's investment in human resource, equipment and supporting facilities allocation, promotion of suitable technology, and medical quality control management should be increased to promote the development of critical care medicine in Xinjiang Uygur Autonomous Region.
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To evaluate the cardiac function of cecal ligation and puncture (CLP) induced sepsis rats with high-resolution ultrasound. Methods According to the method of random number table, 48 adult male Sprague-Dawley (SD) rats were randomly divided into normal control group and sepsis 6, 12, 24, 30, 48 hours groups, with 8 rats in each group. The sepsis model was produced by CLP, and the rats in the normal control group were only anesthetized and resuscitated. The general situation after modeling in each group was observed, and the left ventricular function was assessed by high-resolution echocardiography at all the time points. The abdominal aorta blood of rats was collected, and the serum levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and MB isoenzyme of creatine kinase (CK-MB) were determined by enzyme-linked immunosorbent assay (ELISA). The myocardial tissue was harvested, and the pathological changes in myocardial tissue were observed by hematoxylin-eosin (HE) staining. Results The rats challenged to CLP displayed symptoms of sepsis, such as depression, ruffled fur, decreased diet and activity, and the symptoms became more obvious with the extension of time. High-resolution echocardiography could clearly show the structure of left ventricle in each group and obtain satisfactory M-mode echocardiography of left ventricle. The heart rate (HR) of rats in all sepsis groups was elevated with the increase in model time as measured by high-resolution ultrasound, and it was significantly higher than that in the normal control group at 12, 24, 30 hours (bpm: 359.66±23.33, 361.35±12.85, 392.67±11.33 vs. 306.24±29.79, all P < 0.05). Stroke volume (SV) and cardiac output (CO) in sepsis rats were decreased with the increase in model time, while left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) were increased first and then decreased, and SV and LVEF in sepsis 48 hours group were significantly lower than those in the normal control group [SV (μL): 78.43±17.52 vs. 122.61±15.88, LVEF: 0.763±0.018 vs. 0.902±0.011, both P < 0.05]. Left ventricular weight (LVW) in all sepsis groups was increased to different degrees as compared with that in the normal control group, as well as the left ventricular anterior and posterior wall thickness increased in diastole and systole. Compared with the normal control group, the left ventricular posterior wall thickness was increased significantly at the end of diastolic and systolic period in the sepsis 12 hours group, and the left ventricular anterior wall thickness was also increased significantly at the end of diastolic period in the sepsis 48 hours group. The serum levels of TNF-α, IL-1β and CK-MB in sepsis rats were increased first and then decreased with the extension of model making time. The above parameters in the sepsis 48 hours group were still significantly higher than those in the normal control group [TNF-α (ng/L): 61.59±3.99 vs. 16.87±4.89, IL-1β (ng/L):255.03±13.23 vs. 119.59±10.43, CK-MB (μg/L): 1.27±0.15 vs. 0.52±0.15, all P < 0.05]. HE staining showed that the myocardial striations of the rats in the normal control group were clear and complete, with normal morphology and orderly arrangement of cardiac cells. However in the sepsis groups, myocardial cells were swollen, ruptured and necrotic, and inflammatory cells were infiltrated, with myocardial fibers ruptured and necrosis dissolved, and the above pathological manifestations gradually increased with the extension of the model making time. Conclusion High-resolution ultrasound can evaluate the cardiac function of CLP induced sepsis rat model more comprehensive, and the consequence of evaluation index is consistent with the expression level of myocardial enzyme and histopathologic manifestations.
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Objective@#To evaluate the cardiac function of cecal ligation and puncture (CLP) induced sepsis rats with high-resolution ultrasound.@*Methods@#According to the method of random number table, 48 adult male Sprague-Dawley (SD) rats were randomly divided into normal control group and sepsis 6, 12, 24, 30, 48 hours groups, with 8 rats in each group. The sepsis model was produced by CLP, and the rats in the normal control group were only anesthetized and resuscitated. The general situation after modeling in each group was observed, and the left ventricular function was assessed by high-resolution echocardiography at all the time points. The abdominal aorta blood of rats was collected, and the serum levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and MB isoenzyme of creatine kinase (CK-MB) were determined by enzyme-linked immunosorbent assay (ELISA). The myocardial tissue was harvested, and the pathological changes in myocardial tissue were observed by hematoxylin-eosin (HE) staining.@*Results@#The rats challenged to CLP displayed symptoms of sepsis, such as depression, ruffled fur, decreased diet and activity, and the symptoms became more obvious with the extension of time. High-resolution echocardiography could clearly show the structure of left ventricle in each group and obtain satisfactory M-mode echocardiography of left ventricle. The heart rate (HR) of rats in all sepsis groups was elevated with the increase in model time as measured by high-resolution ultrasound, and it was significantly higher than that in the normal control group at 12, 24, 30 hours (bpm: 359.66±23.33, 361.35±12.85, 392.67±11.33 vs. 306.24±29.79, all P < 0.05). Stroke volume (SV) and cardiac output (CO) in sepsis rats were decreased with the increase in model time, while left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) were increased first and then decreased, and SV and LVEF in sepsis 48 hours group were significantly lower than those in the normal control group [SV (μL): 78.43±17.52 vs. 122.61±15.88, LVEF: 0.763±0.018 vs. 0.902±0.011, both P < 0.05]. Left ventricular weight (LVW) in all sepsis groups was increased to different degrees as compared with that in the normal control group, as well as the left ventricular anterior and posterior wall thickness increased in diastole and systole. Compared with the normal control group, the left ventricular posterior wall thickness was increased significantly at the end of diastolic and systolic period in the sepsis 12 hours group, and the left ventricular anterior wall thickness was also increased significantly at the end of diastolic period in the sepsis 48 hours group. The serum levels of TNF-α, IL-1β and CK-MB in sepsis rats were increased first and then decreased with the extension of model making time. The above parameters in the sepsis 48 hours group were still significantly higher than those in the normal control group [TNF-α (ng/L): 61.59±3.99 vs. 16.87±4.89, IL-1β (ng/L): 255.03±13.23 vs. 119.59±10.43, CK-MB (μg/L): 1.27±0.15 vs. 0.52±0.15, all P < 0.05]. HE staining showed that the myocardial striations of the rats in the normal control group were clear and complete, with normal morphology and orderly arrangement of cardiac cells. However in the sepsis groups, myocardial cells were swollen, ruptured and necrotic, and inflammatory cells were infiltrated, with myocardial fibers ruptured and necrosis dissolved, and the above pathological manifestations gradually increased with the extension of the model making time.@*Conclusion@#High-resolution ultrasound can evaluate the cardiac function of CLP induced sepsis rat model more comprehensive, and the consequence of evaluation index is consistent with the expression level of myocardial enzyme and histopathologic manifestations.
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Objective:To assess the clinical use of dezocine injection. Methods:The application of dezocine injection in the in-patients during December 2015 and November 2016 in a hospital was statistically analyzed and evaluated from indications, dosage, treatment course and combined drug use, etc. Results:A total of 12847 patients with the age range of 0-97 and the average age of (49 ± 15. 6) years old were treated with dezocine injection. The top three departments using dezocine injection were orthopaedics (12. 70％), hand surgery (10. 30％) and liver surgery (9. 39％). Totally 132 patients were with overdose(1. 03％), and mainly in cardiac surgery. The medication course of 1042 patients was more than one week(8. 11％), which was too long, while most of the pa-tients were with tumor. Conclusion:The clinical use of dezocine injection in the hospital is basically reasonable. However, clinicians still need more training to minimize the risks involved in the process of clinical medicine application.
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Objective: To investigate the effects of different extracts of Smilax china L on the activity of ovarian cancer cells. Methods:Solvent extraction method was used to extract the active ingredients of Smilax china L. , and CCK-8 assay method was ap-plied to detect the influence of different Smilax china L. extracts (0, 50, 100, 150 and 200μg·ml-1 ) on the survival rate of ovarian cancer cells including low invasiveness A2780 cells and high invasiveness HO-8910PM cells. At the same time, the status of the two kinds of ovarian cancer cells at different time points (24, 48 and 72 h) was observed. Results:The IC50 of N-butanol extracts (SCR-B) on HO-8910 and A2780 ovarian cancer cells was 47. 5 μg· ml-1 and 69. 2 μg· ml-1 , respectively, and that of ethyl acetate ex-tracts (SCR-E) on A2780 and HO-8910 cells was 147. 9 μg· ml-1 and 166. 0 μg· ml-1, respectively. Smilax china L. extracts had the inhibition against both A278 and HO-8910PM ovarian cells in a dose-and time-dependent manner. Conclusion:The inhibitory activity of SCR-B against ovarian cancer cells is stronger than that of SCR-E, and SCR-B has stronger inhibition against A2780 cells than against HO-8910 cells. SCR-B has better inhibition against ovarian cancer cells.
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Objective:To introduce the application and practice of information technology in the pharmacy management of our hos-pital in order to provide reference for fine hospital management. Methods: The difficulties and application experience of information technology in the practice of hospital storeroom, pharmacy and medication management were summarized and analyzed. Results: The introduction of information and automation technology was beneficial to the improvement of work efficiency, prevention of medication er-rors, reduction of the incidence of clinical irrational drug use and improvement of patient treatment service quality. Conclusion:Imple-menting information-based pharmacy management is not only a new idea and method in hospital pharmacy development, but also the in-evitable tendency of the times.
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Objective To explore the postoperative observation and nursing of double intervention therapy in patients with hepatocellular carcinoma accompanying hypersplensim.Methods The nursing of 30 patients with hepatocellular carcinoma accompanying hypersplensim who received hepatic arterial embolization combined with partial splenic embolization was retrospectively analyzed.Adverse events and nursing experience were summarized.Results All patients had varying degree of fever,abdominal pain,nausea,vomiting and other side effects.The tumor size was reduced and white blood cells and platelets increased to varying degrees.Hypersplenism was relieved after treatment,and serious complications didn't occur.All 30 cases were discharged.Conclusions In double interventional therapy for hepatocellular carcinoma accompanying hypersplenism,nurses must closely observe the disease and take measures to treat the postoperative side effects and serious complications,and promote the rehabilitation of patients.