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Objective To investigate the value of early lactate levels in predicting the progressionof acute kidney injury (AKI) in patients with extremely severe burns.Methods A retrospective casecontrol study was conducted to analyze 30 severe burn patients with early AKI who met the AKIhierarchical diagnostic criteria JP3 (RIFLE) and occurred within 72 hours after injury in the aluminiumdust explosion accident in Kunshan City,Jiangsu Province on August 2,2014.There were 20 males and10 females,aged 20-50 years [(37.1 ± 7.4) years].The total area of burn was 75％-100％ of total bodysurface area (TBSA) [(95.5 ± 4.3) ％ TBSA].Acute Physiological and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) score ranged from 7 to 20 points [(13.0 ± 2.7)points].According to the progression ofrenal injury within one week after injury,the patients were divided into aggravation group and non-aggravation group,with 15 patients in each group.Laboratory examinations upon admission such as whiteblood cell (WBC),platelet,and plasma albumin,medical treatments during the first week after burninjury and 30-day mortality were compared between the two groups.The blood lactic acid,urea nitrogen,creatinine concentration and crinetime kinase in 72 hours after injury were compared between the twogroups.The receiver operative characteristic (ROC) curve of early blood lactic acid,blood urea nitrogen,creatinine concentration and crinetime kinase in patients with early AKI after injury was drawn to evaluateits predictive effect on early AKI aggravation in patients with severe burn.Results The plasma albuminconcentration of patients in the aggravation group was higher than that in the non-aggravation group onadmission to ICU (P ＜ 0.05).There were no significant differences in concentrations of WBC andplatelet upon admission and application of nephrotoxic antibiotics during the first week after burn injurybetween the two groups (P ＞ 0.05).In the aggravation group,the blood lactate concentration at 24 and48 hours after injury did not change significantly compared with the first detection after injury (P ＞0.05),but the concentration at 72 hours after injury was significantly lower than the first detection (P ＜0.05).In the non-aggravation group,the blood lactate concentrations at 24 hours,48 hours,72 hoursafter injury were not significantly different compared with the first detection (P ＞ 0.05).The first bloodlactate concentration in the aggravation group was significantly higher than that in the non-aggravationgroup (P ＜ 0.05),but there were no significant differences in the concentrations between the early AKIaggravation group and the non-aggravation group at 24 hours,48 hours and 72 hours after injury (P ＞0.05).The blood urea nitrogen concentration of patients in the early AKI aggravation group was higherthan that in non-aggravation group on admission (P ＜ 0.05),and no differences were observed in serumncreatine and creatine kinase concentrations between these two groups (P ＞ 0.05).The serumn creatineand creatine kinase concentrations of patients in the aggravation group were higher than those in non-aggravation group 24,48,and 72 hours after burn injury (P ＜0.05),and no difference was observed increatine kinase concentration between these two groups (P ＞ 0.05).The total area under ROC curve offirst blood lactic acid,blood urea nitrogen,creatinine and crinetine kinase in early AKI patients were0.872 (95％CI0.703-1.000,P＜0.05),0.722 (95％CI0.477-0.967,P＞0.05),0.411 (95％CI0.143-0.679,P＞0.05) and 0.656 (95％CI0.400-0.911,P＞0.05).The optimum threshold for thefirst blood lactate concentration after injury was 3.5 mmol/L.The sensitivity and specificity for predictingearly AKI exacerbation were 100％ and 72.7％,respectively.The 30-day mortality rate in the aggravationgroup was significantly higher than that in the non-aggravation group (P ＜ 0.05).Conclusion The firstblood lactate concentration in patients with severe burn is an early predictor of AKI aggravation,and itsearly predictive value is better than that of routine indicators such as serum creatinine blood urea nitrogenand crinetine kinase.
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The number of IPFI has increased in recent years because of the increasing of immunocompromised hosts due to abuse of antibiotics,glucocorticoids,immunosuppressants and all kinds of invasive operations,organ transplants.The mortality of IPFI remains highly because it's difficult to early diagnosis.Histopathologic biopsy remains as the gold standard for IPFI diagnosis although limited by materials.Imaging manifestations are nonspecific but have important suggestive values to some kinds of fungus.Direct examination is quickly but it's difficult to distinguish strain.Fungal culture can guide the treatment but its positive rate is low and the distinguish for contamination,infection and colonization is hard.Serological test has high sensitivity and specificity,but it cannot distinguish strain and it can yield false positives and false negative.Molecular biology is one of rapid developing methods,but its application is limited due to lack of standardized procedures and standards to assess its results,furthermore it can yield false positives.The proper diagnosis for IPFI relies on the comprehensive assessment combing with advantages and disadvantages of various methods.
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Objective To investigate the clinical value of the peripheral blood monocyte human leukocyte antigen-DR (mHLA-DR) for assessment of degree of severity and the diagnosis of acute pancreatitis (AP). Methods A case-control study was conducted. Eighty-six AP patients admitted to Shandong Liaocheng People's Hospital from June 2014 to May 2015 were enrolled. Patients were classified into four groups [mild (n = 33), moderate (n = 25), severe (n = 16), critical (n = 12)] according to the disease classification. Eighty healthy persons subjected to physical examination center of our hospital at the same time were served as controls. Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores in patients were estimated. Flow cytometry was used to measure the expression of the peripheral blood mHLA-DR, and the Pearson method was used to analyze the relationship between the level of mHLA-DR and the APACHE Ⅱ score. The receiver-operating characteristic curve (ROC) was plotted, and then the clinical value of the peripheral blood mHLA-DR was analyzed for the diagnostic value in AP patients. Results The expression of the mHLA-DR in patients with AP was significantly lower than that of healthy control group [(63.7±18.6)% vs. (86.4±8.3)%, t = 5.319, P < 0.001]. The expression levels of the mHLA-DR in mild group, moderate group, severe group, and critical group were (79.6±6.5)%, (66.4±9.4)%, (49.9±8.1)%, (32.5±12.0)%, respectively, and the APACHE Ⅱ score were 4.67±1.99, 5.88±2.05, 9.06±2.62, 12.33±3.96, respectively. Pair wise comparisons were statistically significant (all P < 0.05). The HLA-DR expression level in the peripheral blood of patients with AP was negatively correlated with the APACHE Ⅱ score (r = -0.695, P < 0.001). The area under the ROC curve (AUC) of mHLA-DR expression in peripheral blood for AP was 0.894 [95% confidence interval (95%CI) = 0.847-0.941, P < 0.001], and the cut-off point was 84.40%, with the sensitivity of 75.0%, the specificity of 90.7%, and the accuracy rate of 83.1%. The AUC of mHLA-DR expression for mild AP was 0.938 (95%CI = 0.889-0.987, P < 0.001), and the cut-off point was 72.70%, with the sensitivity of 87.9%, the specificity of 88.7%, and the accuracy rate of 88.4%. The AUC of mHLA-DR expression for severe and critical AP was 0.943 (95%CI = 0.881-1.005, P < 0.001), and the cut-off point was 57.85%, with the sensitivity of 84.0%, the specificity of 96.4%, and the accuracy rate of 90.6%. Conclusions The expression levels of the peripheral blood mHLA-DR in AP patients can reflect the degree of disease, and contribute to the diagnosis of AP. The value of mHLA-DR may be used as a new biological indicator in the diagnosis and assessment for the severity of AP.
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Objective To investigate the early diagnostic value of traditional scoring systems in critical acute pancreatitis.Methods From Jan 2007 to Ju12013,consecutive 184 patients with AP who were admitted to the surgical intensive care unit of the Institute of General Surgery,Nanjing Generai Hospital of Najing Militery Region within 72 h from the onset of the disease were studied.Patients were assigned to four groups,including mild,moderate,severe and critical AP according to the determinant based classification and the receiver operating characteristics(ROC) curve was used to predict the presence of critical AP,and Z test and logistic regression was applied to determine the diagnostic value of traditional scoring systems.Results The area under ROC (AUC) of Sofa,BISAP and CTSI score for early diagnosis of critical AP was 0.896,0.877 and 0.862;the best cut off value was 4.5,9.5 and 2.5.Moreover,the AUC of APACHE Ⅱ and Ranson score was 0.807 and 0.707,and the best cut off value was 8.5 and 3.5,respectively.Z test showed early diagnosis rate of Sofa,BISAP,CTSI score was significantly higher than that in Ranson score,and the difference between the two groups was statistically significant (P ＜ 0.05);though they were higher than APACHE Ⅱ score,the difference between the two groups was not statistically significant (P ＞ O.05).Logistic regression showed that high APACHE Ⅱ,Sofa,BISAP and CTSI score were independent risk factors for the development of critical AP (P ＜ 0.05).Conclusions Sofa,CTSI and BISAP score may be clinically important for early diagnosis of critical AP.
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This study designed a studio English classroom which was based on foreign nursing jobs related language.It included high-frequency words,foreign nurse-patient dialogue,and European and American nursing video which was foreign patients’ nursing procedures oriented.The studio classroom was characterized as interactive internet platform.It provided a complete system for input and output in English language,and motivated students to learn nursing English.Therefore,it improved students’ professional verbal competencies.
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Objective To study the efficacy of repetitive transcranial magneticstimulation(rTMS) of the right prefrontal cortex combined paroxetine for patients with obsessive-compulsive disorder ( OCD) under doubleblind , sham-controlled conditions. Methods Patients were randomly assigned to 2 sessions of real ( n = 32) or sham ( n = 31) rTMS and both group received Paroxetine treatment. rTMS treatments lasted 20 minutes,and the frequency was 10 Hz and the intensity was 100% of motor threshold for real rTMS. Psychopathology was assessed by HAMA.Y-BOCS before the treatment,immediately after the experimental treatment,and 1,2,4,6 weeks after the experimental treatment by an independent reviewer. Results In combined therapy group,9(32. 14% ) recovered, 10(35.71% ) remitted,5( 17. 86% ) improved,4( 14. 29% ) remained unresponsive. In contrast,there were 4(16.36%) recovery,5(21.82%) remission, 10(38.18% ) improvement,6(23.64% ) unresponse in drug therapy group. The outcome of ITT showed all the patients in the two groups significant improvement (the scores of YBOCS( F=56.258, P=0.000) ;the scores of HAMA( F=41.675, P=0.000) after the treatment,but the effectiveness in the combined therapy group was better than that in the drug therapy group (the scores of Y-BOCS, F= 13.652, P=0.028;the scores of HAMA, F= 11.632, P=0.031). Conclusions Repetitive transcranial rTMS of the right prefrontal cortex combined paroxetine is more effective than paroxetine only in treatment of refractory OCD.
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@# Objective To observe the effect and safety of the aversion therapy with furazolidone on patients with alcohol dependence.Methods 90 patients with alcohol dependence were randomly divided into the aversion therapy group and the control group with 45 cases in each group. The cases of the aversion therapy group were treated by aversion therapy with furazolidone and those of the control group were treated with routine therapy. The changes of the blood pressure, pulse and respiratory rate before and after drinking were observed and the rate of successful abstinence in one year was investigated.Results The effect of the aversion therapy group treated with furazolidone was significantly better than that of the control group ( P<0.05). The aversion therapy was safe.Conclusion The aversion therapy with furazolidone is more effective and safe.
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Artificial ureter has been studied for nearly 60 years, however it is still in experimental stage. So far there are no commercially available products for clinical use except autologous intestines loop even though many progresses have been made. Each approach for making artificial ureter has its own inherent advantages, disadvantages and limitations. But some approaches have shown great potential to be used as ureteral substitutes. Preventing the conduit from salt depositing and ensuring a watertight anastomoses with native tissues are the key factors in designing and manufacturing the prosthetic ureter. Along with scientific and technical improvement, artificial ureter will be successfully used in clinical therapeuticsin in the very near future.
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Objective To study the clinical and X-ray findings in mamma virilis devolopment.Methods Clinical and X-ray findings in 11 patients with primary mamma virilis development were presented and analysed retrospectvely.Results X-ray findings were divided into 3 groups:1)mass(n=4):round or oval mass with high density and well-defined border;2)patch(n=4):patch like uneven mass with high density and ill-defined border;3)nodule(n=3):irregular uneven nodules.Conclusion Clinical and X-ray findings of mamma virilis development have some characteristic features,it can be differentiated from mamary cancer and pseudogynecomastia.