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Objective:To explore the value of serum procalcitonin (PCT) and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score on predicting prognosis of elderly patients with sepsis.Methods:A retrospective cohort study, patients with sepsis who admitted to the department of emergency and the department of geriatric medicine of Peking University Third Hospital from March 2020 to June 2021 were enrolled. Patients' demographics, routine laboratory examinations, APACHE Ⅱ score that within 24 hours of admission were obtained from their electronic medical records. The prognosis during the hospitalization and one year after discharge were collected, retrospectively. Univariate and multivariate analysis of prognostic factors were performed. And Kaplan-Meier survival curves were used to examine overall survival.Results:A total of 116 elderly patients met inclusion criteria, 55 were alive and 61 were died. On univariate analysis, clinical variables such as lactic acid [Lac, hazard ratio ( HR) = 1.16, 95% confidence interval (95% CI) was 1.07-1.26, P < 0.001], PCT ( HR = 1.02, 95% CI was 1.01-1.04, P < 0.001), alanine aminotransferase (ALT, HR = 1.00, 95% CI was 1.00-1.00, P = 0.143), aspartate aminotransferase (AST, HR = 1.00, 95% CI was 1.00-1.01, P = 0.014), lactate dehydrogenase (LDH, HR = 1.00, 95% CI was 1.00-1.00, P < 0.001), hydroxybutyrate dehydrogenase (HBDH, HR = 1.00, 95% CI was 1.00-1.00, P = 0.001), creatine kinase (CK, HR = 1.00, 95% CI was 1.00-1.00, P = 0.002), MB isoenzyme of creatine kinase (CK-MB, HR = 1.01, 95% CI was 1.01-1.02, P < 0.001), Na ( HR = 1.02, 95% CI was 0.99-1.05, P = 0.183), blood urea nitrogen (BUN, HR = 1.02, 95% CI was 0.99-1.05, P = 0.139), fibrinogen (FIB, HR = 0.85, 95% CI was 0.71-1.02, P = 0.078), neutrophil ratio (NEU%, HR = 0.99, 95% CI was 0.97-1.00, P = 0.114), platelet count (PLT, HR = 1.00, 95% CI was 0.99-1.00, P = 0.108) and total bile acid (TBA, HR = 1.01, 95% CI was 1.00-1.02, P = 0.096) shown to be associated with poor prognosis. On multivariable analysis, level of PCT was an important factor influencing the outcome of sepsis ( HR = 1.03, 95% CI was 1.01-1.05, P = 0.002). Kaplan-Meier survival curve showed that there was no significant difference with respect to the overall survival between the two groups, with patients of PCT ≤ 0.25 μg/L and PCT > 0.25 μg/L ( P = 0.220). It also showed that the overall survival rate in patients with high APACHE Ⅱ score (> 27 points) was significantly lower than that in patients with low APACHE Ⅱ score (≤ 27 points, P = 0.015). Conclusion:Serum PCT level is valuable prognostic factors of elderly patients with sepsis, and higher APACHE Ⅱ score (> 27 points) indicates a poor prognosis.
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Objective:To explore the relationship between lower respiratory tract microflora and type of anti-tuberculosis immune response, clinical characteristics in patients with pulmonary tuberculosis (PT).Methods:The clinical data of 80 patients with PT and 80 patients with non-PT from January 2018 to March 2020 in the Second Hospital of Zhejiang Medical School of Changxing District were retrospectively analyzed. All patients were treated with bronchoalveolar lavage, the bronchoalveolar lavage fluid counts of Haemophilus, Neisser coccus, Streptococcus and Veillonella were detected by germiculture, and the bronchoalveolar lavage fluid expression levels of T-bet mRNA (Th1 immune response) and GATA-3 mRNA (Th2 immune response) was detected by real-time polymerase chain reaction. The clinical symptoms of PT were recorded. The correlation was analyzed by Pearson correlation analysis.Results:There were no statistical differences in bronchoalveolar lavage fluid Neisser coccus, Veillonella and Haemophilus between patients with PT and patients with non-PT ( P>0.05); the bronchoalveolar lavage fluid Streptococcus in patients with PT was significantly lower than that in patients with non-PT (630 ± 120 vs. 1 000 ± 330), and there was statistical difference ( P<0.05). There was no statistical difference in expression level of T-bet mRNA between patients with PT and patients with non-PT ( P>0.05); the expression level of GATA-3 mRNA in patients with PT was significantly lower that in patients with non-PT: (5.883 ± 1.864) ×10 4 vs. (3.997 ± 1.186) ×10 6, and there was statistical difference ( P<0.05). Pearson correlation analysis result showed that fever was positively correlated with bronchoalveolar lavage fluid Neisser coccus and Veillonella ( r = 0.402 and 0.566, P<0.01 or <0.05); proportion of tuberculosis foci to lung area was positively correlated with T-bet and GATA-3 mRNA ( r = 0.024 and 0.442, P<0.05), the body weight loss was positively correlated with T-bet mRNA ( r = 0.112, P<0.05); GATA-3 mRNA was positively correlated with bronchoalveolar lavage fluid Neisser coccus ( r =0.332, P<0.05), T-bet mRNA was positively correlated with bronchoalveolar lavage fluid Haemophilus ( r = 0.162, P<0.05). Conclusions:There is a significant correlation between the Th1/Th2 immune response type and the bronchoalveolar lavage fluid Haemophilus and Neisser coccus in patients with PT, and the fever symptoms is also significantly related to Neisser coccus and Veillonella. There is a certain correlation between weight loss and the quantitative results of proportion of tuberculosis foci to lung area and the type of immune response.
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OBJECTIVE: To establish an ultra-high performance liquid chromatography-tandem mass spectrometry(HPLC-MS) method for simultaneous detection of 12 kinds of rodenticides such as tetramine, warfarin and rodenticide in suspected poisoning patients' residual food, vomit, gastric lavage, serum and urine. METHODS: The residual food, vomit, gastric lavage, serum and urine of patients with suspected rodenticide poisoning were collected. The food, vomit, gastric lavage and urine samples were added with ammonium acetate at a concentration of 2 mol/L, and than were repeatedly extracted twice by ethyl acetate. The serum sample was extracted by adding acetonitrile. After the sample was dried by nitrogen, it was dissolved in methanol ∶ammonium acetate(60 ∶40, V/V), and the supernatant was centrifuged and separated by a C18 column, and quantified by a standard curve method. Samples were detected by HPLC-MS. RESULTS: The linearity of the 12 kinds of rodenticides in the quantitative range of residual food, vomit, gastric lavage, serum and urine in patients with suspected rodenticide poisoning was good, and the correlation coefficient was 0.992 3-0.999 9. The detection limit of food, vomit or gastric lavage was 0.03-0.14 μg/kg, and that in serum and urine were 0.10-0.30 and 0.02-0.04 μg/L, respectively. The standard recovery rate was 84.4%-114.0%, and the within-run and between-run relative standard deviations were 2.7%-6.2% and 2.4%-9.5%, respectively.CONCLUSION: The method has advantages of simple operation, high efficiency and good accuracy. This method is suitable for emergency treatment of poisoning events caused by rodent drugs or poisoning.
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Objective To explore the distribution ofchoroidal thickness and its influence factors in university students.Methods A cross-sectional study.A total of 896 eyes of 896 college students were included in the study.Among them,there were 350 males (350 eyes) and 546 females (546 eyes).All the eyes were right eyes.The average age was 19.18 ± 1.36 years old.According to the spherical equivalent refraction (SER),the eyes were divided into non-myopia group,low myopia group,moderate myopia group and high myopia group,which were 59,251,356 and 230 eyes,respectively.The subfoveal ChT (SFCT) was measured using a swept-frequency source optical coherence tomography scanner.According to the ETDRS,the choroid within 6 mm of the fovea was divided into three concentric circles centered on the fovea of the macula,which were the central area with a diameter of 1 mm,the inner ring area of 1-3 mm and the outer ring area of 3-6 mm.The outer ring area of 3-6 mm has a total of 9 zones.The inner ring and outer ring 4 regions were superior,inferior,nasal and temporal,respectively.The distribution characteristics of ChT in different regions,genders and diopter groups were observed.Bivariate correlation analysis were used to analyze the correlation of ChT and SER,axial length (AL).Results The average SFCT of 896 eyes was 221.28± 67.35 μm.The mean SFCT of males and females were 227.20 ± 69.38 and 217.50± 65.80 μm,respectively.The difference of SFCT between different genders was statistically significant (t=2.075,P=0.038).Compared with the central region ChT,there was no significant difference in ChT between the outer ring and the outer region (t=0.086,P=0.932).The difference of ChT in other regions was statistically significant (t=-21.973,-5.818,36.328,-3.065,-18.017,-10.595,57.007;P＜0.001,＜0.001,＜0.001,＜0.002,＜0.001,＜0.001,＜0.001).In the horizontal direction,ChT gradually thickens from nasal to temporal (F=2 251.558,P＜0.001);in the vertical direction,ChT gradually decreases from superior to the central,but have a little increased from central to inner inferior,then decreased to outer inferior again (F=45.425,P＜0.05).Correlation analysis showed that SFCT was negatively correlated with AL (r=0.478,P＜0.01) and a negative correlation with axial length (r=-0.395,P＜0.01),and positively correlated with SER (r=0.478,P＜0.01).SFCT decreased by 12.29 μm for every in myopic refractive error of 1 D,or by 20.14 μm for every increase in AL of 1 mm.Conclusions ChT is changed by different location.The horizontal direction is gradually thickened from nasal to temporal.The vertical direction is thicker than the center.The inferior inner ring area is thicker than the outer ring area.Gender,SER and AL are the influencing factors of SFCT.
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Objective To explore the effect of sequential and comprehensive preventative measures on the development of premature infants' intelligence.Methods A cohort of 120 premature infants was randomly divided into an observation group and a control group,each of 60.Both groups were given routine premature infant care,but the observation group was additionally provided with sequential and comprehensive preventive intervention.It included neonatal screening,inpatient-outpatient link-up,and their parents' watching CDs explaining early childhood education and health education.All of the infants were followed up from birth to 3 years old.Their adaptive capacity,fine motor skills,language acquisition,gross motor skills and social communication were evaluated at 12,24 and 36 months old using a child intelligence developmental scale for neurological development.Development intelligence quotients (DQs) were calculated and compared.Results After 12 months,significant inter-group differences were observed in adaptability and fine motor control.At 24 and 36 months old there were also significant differences in language skills.At one,two and 3 years old the average DQ of the observation group was significantly higher than that of the control group.Significant within-group differences in average DQ were observed in both groups between 1 and 2 years old,but not between 2 and 3.Conclusion Intervention within two years after birth is critical for premature infants.Timely,sequential,integrated,preventive intervention can promote the development of intelligence and better life quality for premature infants.
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ObjectiveTo explore the characteristics and correlation of intelligence development and socioemotional development in 1~3 years old children with expressive language disorder,and provide a basis for early intervention.Methods125 cases with expressive language disorder(language disorder group) and 126 normal children (normal group) are evaluated in two parts (intelligence and social mood) with 0~6 years old neuropsychological development diagnosis scale and Chinese version of urban infant-toddler social and emotional assessment.Results (1)The scores in language disorder group were lower than normal group in the area of free movements (81.60±10.40 vs 89.62±7.94),adaptability (81.48±10.95 vs 91.25±8.89),language (67.46±7.20 vs 89.13±8.24),social behavior (76.61±9.73 vs 90.12±8.13) and total developmental quotient (80.17±6.39 vs 91.15±6.05) (P<0.05).(2) There were significant differences between language disorder group and normal group in the area of externalizing behavior(56.28±10.15 vs 53.57±7.91),deregulation (56.45±10.61 vs 51.11±9.32) and capabilities(46.79±9.08 vs 51.25±7.47) (P<0.05).The boys' scores in internalizing behavior were lower than the girls' (49.19±10.76 vs 54.71±9.90) (P<0.05).(3) The scores of gross motor had positive correlation with externalizing behavior (r=0.220,P<0.05).The scores of language had negative correlation with externalizing behavior and deregulation(r=-0.650,P<0.05;r=-0.470,P<0.05).The scores of social behavior had negative correlation with externalizing behavior (r=-0.208,P<0.05).There was also a negative correlation between total development and deregulation (r=-0.184,P<0.05).(4) Multiple stepwise linear regression results showed that the externalizing behavior domain and mothers' education could predict 44.1% of variances in the language area.ConclusionThe children with expressive language disorder not only show backward in level of language development,but also in the development of other areas,and also bad social behavior and emotional problems.Individualized parenting interventions should be adopted to promote these children's intelligent development in an all-round way.
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Objective To investigate the curative effect of Sandplay therapy on attention deficit hyperactivity disorder (ADHD)preschool children co - morbid sleep disorder. Methods According to the random number generated by EXCEL software's RAND function,a total of 62 ADHD children co - morbid sleep disorder were randomly divi-ded into experimental group(n = 31)and control group (n = 31). The control group was treated with family behavior therapy and the experimental group was treated with sandplay therapy based on the family behavior therapy. With the Achenbach Child Behavior Check List (CBCL),Conners Parent Symptom Questionnaire (PSQ),Conner Concise Questionnaire (Conners Abbreviated Symptom Questionnaire,ASQ)and Children′s Sleep Habit Questionnaire(CSHQ),the overall curative effect was evaluated before and after treatment by their scores. Results The results of independent - samples t test showed that the scores of PSQ′s all factors,ASQ′s and CBCL′s total score,CSHQ′s total score and all factors had no significant difference between the two groups before the intervention (t conduct problem = - 0. 847,t learning problems =0. 504,t psychosomatic disorder = - 1. 008,t hyperactivity/ impulsion = - 0. 331,t anxiety = 0. 690,t hyperactivity index = 0. 757,t CBCL′s total score =- 0. 532,t ASQ′s total score = 0. 514,t CSHQ′s total score = 1. 132,t sleep impedance = - 0. 767,t sleep latency = - 0. 634,t sleep duration = 0. 150, tsleep anxiety = 0. 149,t sleep wake = 0. 417,t sleep disorder = 0. 709,t sleep apnea = 0. 950,t daytime sleepiness = 1. 530,all P > 0. 05). The scores of PSQ′s all factors,ASQ′s and CBCL′s total score,sleep impedance,sleep latency,sleep duration,sleep wake, daytime sleepiness and CSHQ′s total score all had significant differences between the two groups after the intervention(t conduct problem = - 3. 982,t learning problems = - 2. 258,t psychosomatic disorder = - 2. 470,t hyperactivity/ impulsion = - 4. 377,t anxiety =- 2. 684,t hyperactivity index = - 4. 249,t CBCL′s total score = - 3. 982,t ASQ′s total score = - 5. 576,t sleep impedance = - 3. 712,t sleep latency =- 2. 947,t sleep duration = - 2. 332,t sleep wake = - 6. 031,t daytime sleepiness = - 6. 256,t CSHQ′s total score = - 6. 706,all P < 0. 05). The results of analysis of variance of repeated measurement showed that PSQ behaviour problem,psychosomatic disor-der,hyperactivity and hyperactivity index scores of the main effects of intervention had significant difference (F conduct problem = 4. 966,F psychosomatic disorder = 5. 176,F hyperactivity/ impulsion = 4. 949,F hyperactivity index = 4. 926,all P < 0. 05);the main intervention effects of ASQ and CBCL′s total score had statistical difference (F CBCL = 4. 398,F ASQ = 4. 814,all P < 0. 05);the main intervention effects of sleep impedance,sleep duration,sleep wake and CSHQ′s total score had statistical difference (F sleep impedance = 5. 697,F sleep duration = 4. 467,F sleep wake = 6. 610,F CSHQ′s total score = 6. 016,all P <0. 05). There were significant differences in the characteristics of the initial sand table and the final sand table in the experimental group [traumatic subject:(4. 48 ± 1. 55)cases vs. (1. 23 ± 0. 81)cases,t = 8. 247;curing subject:(1. 77 ± 1. 09)cases vs. (4. 55 ± 1. 46)cases,t = 11. 274,all P < 0. 05]. Conclusion Sandplay therapy can effectively improve the core symptoms of preschool ADHD children co - morbid sleep disorders,which can be used as an early in-tervention.
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Objectivc To observe the short-term changes of anterior corneal biometry after discontinuation of orthokeratology in patients with 2-year wearing.Methods Retrospective study.Sixty myopic patients aged from 8-14 years old during October 2012 and October 2014 were wearing orthokeratology for 2 years in Tianjin Medical University Eye Hospital.According to the degree of myopia,they are divided into three groups(SE≤-2.00 D for group A,-2.00 D ＜ SE ≤-4.00 D for group B and -4.00 D ＜ SE ≤-6.00 D for group C).The recovery of anterior corneal curvature,including flat K(FK),steep K(SK),average K (AVEK),changes of axial length and central corneal thickness (CCT) at 1 week,2 weeks,1 month after discontinuation of orthokeratology were observed.Results There was no statistical differences in FK,SK,AVEK before and 2 weeks after wearing orthokeratology in group A (all P ＞ 0.05).While in group B,there was no significant difference in FK,SK,AVEK before and 1 month after wearing orthokeratology;There were statistically differences in FK,SK,AVEK at 1 month after discontinuation in group C compared with the baseline (all P ＜0.05).As for CCT,there was no statistical differences among group A,B,C after discontinuation of orthokeratology for 2 weeks (all P ＞ 0.05).There were statistical differences in the axial length between 1 week and 2 weeks after discontinuation of orthokeratology in group B and C (all P ＜ 0.05);There were statistical differences in the axial length between 1 month and 2 weeks after discontinuation of orthokeratology in three groups (all P ＜ 0.05);Compared with the state before wearing orthokeratology,the increase of axial length in group A,B,C were (0.43 ± 0.36) mm,(0.35 ± 0.21)mm and (0.36 ± 0.29) ram,respectively.Conclusion The time course of returning to the original corneal parameter varies among different degree of myopia,and the axial length has no significant growth after short-term discontinuation.
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Objective To explore the relationship among psychological resilience, self-efficacy and core competence in psychiatric nurses. Methods Totally 237 psychiatric nurses in a psychiatric hospital in Shandong province were recruited and assessed with general information questionnaire, Connor-Davidson Resilience Scale, General Self-Efficacy Scale and Competency Inventory for Registered Nurse. Results The total core competence of psychiatric nurses was (2.59 ± 0.66) points, at a moderate level. Psychological resilience were positively corrected with self- efficacy (r=0.454,P=0.000) and core competence (r=0.647, P=0.000), self-efficacy were positively corrected with core competence (r=0.487, P=0.000). Psychological resilience partially mediate the relationship between self- efficacy and core competence, It′s mediating effect was 44.8%. Conclusions Psychological resilience plays an important role to core competence in psychiatric nurses.Nursing managers should carry out related training, improve the psychological resilience and self-efficacy of psychiatric nurses, and comprehensively improve the level of core competencies.
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<p><b>OBJECTIVE</b>To elucidate the epidemic condition and molecular subtyping of ciprofloxacin and cefotaxime co-resistant Salmonella Indiana (S. Indiana) isolated from retail chicken carcasses in six provinces of China.</p><p><b>METHODS</b>A total of 2 647 Salmonella strains isolated from retail chicken carcasses collected from six provinces of China were subjected to antimicrobial susceptibility testing. All Salmonella isolates co-resistant to ciprofloxacin and cefotaxime were further characterized by serotyping, extended-spectrum beta-lactamases (ESBLs) producing strains screening and pulsed field gel electrophoresis (PFGE) typing.</p><p><b>RESULTS</b>Among 2 629 Salmonella isolates tested, 227 (8.52%) isolates were co-resistant to ciprofloxacin and ceftazidime/cefotaxime (Beijing: 11.67% (99/874), Jilin: 8.20% (60/726), Guangdong: 1.39% (7/502), Jiangsu: 15.61% (42/260), Shaanxi: 8.56% (16/186), Inner Mongolia: 0 (0/81)), and 224 of them were identified as S. Indiana. 213 (95.10%) isolates of S. Indiana were ESBLs producing strains. All ciprofloxacin and cefotaxime co-resistant S. Indiana isolates developed a multi-drug resistant profile and 17.86% (40/224) of them were resistant to all antibiotics tested except carbapenems, and 50.89% (114/224) of them resistant to 9 antibiotics, additionally, 25.45% (57/224) of them showed multi-drug resistance to 8 antibiotics. All ciprofloxacin and cefotaxime co-resistant S. Indiana isolates were divided into 32 PFGE clusters and 150 PFGE patterns. Strains of S. Indiana from same or different sampling site and time seemed to either share the same PFGE patterns or be differential to each other in different regions.</p><p><b>CONCLUSION</b>The results indicated that chicken carcasses collected from parts of China were heavily contaminated by ciprofloxacin and cefotaxime co-resistant S. Indiana and could serve as an important reservoir of ciprofloxacin and cefotaxime co-resistant Salmonella. Molecular subtyping results indicated that cross contamination or common pollution source might be in these strains.</p>
Subject(s)
Animals , Anti-Bacterial Agents , Pharmacology , Cefotaxime , Pharmacology , Chickens , Microbiology , China , Ciprofloxacin , Pharmacology , Drug Resistance, Multiple, Bacterial , Electrophoresis, Gel, Pulsed-Field , Food Contamination , Food Microbiology , Meat , Microbiology , Salmonella , Classification , Serotyping , beta-LactamasesABSTRACT
OBJECTIVE:To establish a method for content determination of rosmarinic acid and total polysaccharide in Hysso-pus. offcinalis. METHODS:HPLC was conducted to determine the content of rosmarinic acid in H. offcinalis. The column was Shim-pack VP-ODS with mobile phase of acetonitrile-0.5% formic(17:83,V/V) at flow rate of 1.0 ml/min,detection wavelength was 330 nm,column temperature was 30 ℃,and the injection volume was 10 μl. UV-visible spectrophotometry was conducted to determine the content of total polysaccharide,detection wavelength was 620 nm. RESULTS:The linear range was 10.86-54.30 μg/ml (r=0.999 8)for rosmarinic acid and 1.996-15.97 μg/ml for total polysaccharide(r=0.999 6);RSDs of precision,stability and re-producibility tests were lower than 1.0% and 2.0%,respectively;recoveries were 98.20%-101.79%(RSD=1.68%,n=6) and 96.62%-101.68%(RSD=1.88%,n=6). CONCLUSIONS:The method is simple and reproducible,and can be used for the con-tents determination of rosmarinic acid and total polysaccharide in H. offcinalis.
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Objective To explore the effect of health education and comprehensive nursing intervention on quality of patients with lung cancer.Methods One hundred lung cancer patients who were treated with chemotherapy from February 2010 to February 2013 in our hospital were selected and assigned to the intervention group (n=50) and the control group (n=50).The participants in the control group received conventional anti-cancer drug and routine primary care,however those of the intervention group additionally obtained health education and comprehensive nursing intervention.The Zung Anxiety Scale (SAS),Depression Rating Scale (SDS) and the core quality of life questionnaire (QLQ-C30) were used to evaluate the quality of life of the patients.Paired samples t test and ANOVA were used for data analysis.Results Differences of age,gender,disease duration,SAS,SDS score and EORTC QLQ-C30 score were not statistically significant between the two groups (all P＞0.05).After the intervention,SAS and SDS scores of the control subjects were 58.8±7.6 and 49.5±10.1 respectively,and SAS and SDS scores of the intervention group were 46.5±7.8 and 37.4±9.2 respectively (t velues were 5.347 and 6.215,respectively; both P＜0.05).Quality of life scores in the intervention group were as followed:general condition 57.2± 18.3,physical fitness 63.0±25.9,mutual affection 67.3±23.3,cognitive score 75.4±28.2,social role 67.7±24.8 and function scores 58.5±22.3.Quality of life scores in the control group were as followed:general condition 47.3±23.0,physical fitness 54.9±26.6,mutual affection 60.4±19.1,cognitive score 66.2±25.8,social role 54.1±26.2 and function scores 49.4±21.5 (t values were 5.725,6.144,5.021,5.702,7.137 and 6.357,respectively; all P＜ 0.05).Conclusion Health education and comprehensive nursing intervention for lung cancer patients may reduce their anxiety and depression symptoms and improve the quality of life.
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Objective To investigate the change in blood lymphocyte levels and lymphocyte percentage in critical patients,including those with non-infectious systemic inflammatory response syndrome (SIRS),sepsis and severe sepsis.Methods Clinical data of 423 patients admitted to intensive care unit (ICU) of Department of Emergency of Peking University Third Hospital from January 2011 to September 2013 were retrospectively analyzed.Among these patients,there were 54 with non-infectious SIRS,177 with sepsis and 192 with severe sepsis.150 of them died,and 273 survived.The white blood count (WBC),neutrophil (N),lymphocyte count,lymphocyte percentage,lactic acid,serum high-sensitivity C-reactive protein (hs-CRP) and procalcitonin (PCT) were determined at admission,and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) was estimated.The patients were divided into different groups according to diagnosis and prognosis to compare the value of the indexes,and the correlation between lymphocyte count and other markers were analyzed by Spearman relative analysis.Results The older the patients,the more severe the disease.In the non-infective SIRS,sepsis and severe sepsis groups,APACHE Ⅱ scores (7.78 ± 3.72,13.85 ± 7.22,24.00 ± 9.79),time of stay in hospital [days:6.0 (1.0,9.0),12.0 (8.0,22.0),19.5 (7.0,29.0)],the mortality rate (0,10.2％,52.6％),WBC (× 109/L:7.59 ± 3.27,8.94 ± 3.95,10.32 ± 5.50),N (0.685 ± 0.132,0.778 ± 0.135,0.831 ±0.086),hs-CRP [mg/L:4.60 (2.80,7.52),23.58 (13.49,49.22),59.77 (19.36,110.62)] andPCT [μg/L:0.05 (0.05,0.05),0.09 (0.05,0.61),0.63 (0.10,5.25)] showed gradually increasing tendency (all P=0.000).Serum lymphocyte count levels [× 109/L:1.53 (0.89,1.88),0.90 (0.65,1.42) and 0.80 (0.50,1.12)],lymphocyte percentage (0.225 ± 0.122,0.138 ± 0.097,0.106 ± 0.070) showed gradually decreasing tendency (P＜0.05 or P＜0.01).There was significant difference in blood lactic acid among three groups [blood lactic acid were 2.40 (1.30,5.10),1.10 (0.80,2.00) and 1.40 (1.00,2.50) mmol/L in the non-infective SIRS,sepsis and severe sepsis groups respectively,P=0.000].Age (years old:76.71 ± 12.21 vs.73.21 ± 14.49),APACHE Ⅱ score (24.69 ± 9.58 vs.13.91 ± 8.41),time of stay in hospital [days:12.0 (4.0,28.0) vs.11.0 (8.0,22.0)],WBC (× 109/L:10.29 ± 5.82 vs.8.89 ± 3.98),N (0.809 ± 0.130 vs.0.776 ± 0.120),lactic acid [mmol/L:1.80 (1.10,2.90) vs.1.30 (0.90,2.49)],hs-CRP [mg/L:50.94 (19.21,97.13) vs.21.71 (6.39,54.40)] and PCT [μg/L:0.74 (0.13,5.83) vs.0.08 (0.05,0.59)] levels in the death group were higher than those in the survival group (P＜0.05 or P＜0.01),serum lymphocyte count levels [× 109/L:0.90 (0.50,1.29) vs.1.05 (0.70,1.54)],lymphocyte percentage (0.123 ± 0.098 vs.0.143 ± 0.097) level in the death group were obviously lower than those in the survival group (P＜0.01 and P＜0.05).Serum lymphocyte count levels were negative correlated with N (r=-0.597,P=0.000),hs-CRP (r=-0.298,P=0.000),PCT (r=-0.304,P=0.000),APACHE Ⅱ (r=-0.124,P=0.000),and positively correlated with lymphocyte percentage (r=0.691,P=0.000),and non correlations was found with WBC (r=0.082,P=0.091) and lactic acid (r=0.073,P=0.132).Conclusion The serum lymphocyte levels in the critically ill patients are related with the severity of sepsis,and monitoring the change in lymphocyte may be an indicator for evaluating the illness and effect of treatment.
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Objective To establish an appropriate cut-off value of high sensitivity cardiac troponin T (hs-cTnT) and optimal combination measurement in the early diagnosis of acute myocardial infarction (AMI).Methods This research is a prospective study.342 patients admitted to emergency department with chest pain,43 patients with renal failure,40 patients with pneumonia and 18 premature with patent ductus arteriosus were involved from June 2012 to June 2013 in Peking University Third Hospital.The plasma hs-TnT,NT-proBNP,cardiac troponin Ⅰ (cTnI),CK-MB and copeptin were measured.The distribution of hs-cTnT among associated diseases was analyzed,the diagnostic performance of hs-cTnT and the role of combination hs-cTnT with NT-proBNP,CK-MB and copeptin were evaluated by receiver operating characteristic (ROC) curve.The statistical method was used to calculate the Sensitivity,specificity,negative predictive value and positive predictive value of hs-cTnT in the diagnosis of AMI.Results As compared to patients with STEMI(median 0.52 μg/L,range 0.037-7.610 μg/L),hs-cTnT was lower in the patients with Non-STEMI(median 0.127 5 μg/L,range 0.021-4.260 μg/L).However,the levels of hs-TnT in other diseases were also increased increased in varyng degrees (Chi-square =76.432,P ＜ 0.05)The areas under the curve (AUC) for hs-cTnT and cTnI in the diagnosis of AMI were 0.862 (95％ CI:0.729-0.928) and 0.748 (95％ CI0.666-0.818) respectively (Z =2.713,P ＜ 0.05).Taking 0.014μg/L and 0.035 μg/L as cut-off value of hs-TNT,the sensitivities were 100％ vs 95.1％,the specificities were 44.4％ vs 65.7％.The combination of hs-cTnT,NT-proBNP,CK-MB resulted in a increase in AUC (0.915,95％ CI:0.838-0.964) (Z =2.147,P ＜ 0.05) and the combination of hs-cTnT and copeptin resulted in a increase in AUC 0.921 (95％ CI:0.820-0.975) (Z =2.589,P ＜ 0.05).Conclusion With the cut-off value of 0.035 μg/L for diagnosis of AMI was appropriate,and the combination measurement can improve the accuracy of early diagnosis of AMI.
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Objective To develop and evaluate the reliability and validity of evaluation criterion for continuing health education in very low birth weight premature infants.Methods The literature review,theoretical analysis,qualitative research and Delphi technique were conducted to identify the evaluation criterion for continuing health education.The reliability and validity of evaluation criterion was tested in 112 parents of very low birth weight premature infants.Results The evaluation criterion which was based on the frame of KABP Model and Nursing Outcomes Classification as well as Nursing Interventions Classification consisted of 3 projects with 29 specific items.The content validity index for the scale was 0.950.Three common factors were extracted by the principal components extraction analysis and the cumulative contribution rate was 49.70％,73.25％ and 46.90％ respectively.The Cronbach' s alpha coefficient was 0.934,the retest reliability was 0.865 and the ICC was 0.940 for the total scale.Conclusion The evaluation criterion for continuing health education in very low birth weight premnature infants has good reliability and validity and can be used as a measurement tool for health education effect of continuing health education.The design of the scale provides basis for making transitional care model as well.
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Objective To investigate the efficacy and safety of warfarin anticoagulation in Chinese elderly patients based on vitamin K epoxide reductase complex 1 (VKORC1) and cytochrome P450 2C9 (CYP2C9) genetic polymorphisms.Methods Clinical data of 41 elderly patients with initial anticoagulation therapy in our emergency department and respiratory department were collected.Patients were divided into observation group (n=20,patients treated with warfarin based on genetic polymorphisms) and control group (n =21,patients treated based on clinical experience).The international normalized ratio (INR),the time of INR stabilized within target range (2.0-3.0) and the incidence of bleeding episodes in 6-month follow up were compared between groups.Results INR within target range at day 3,4,5 and 7 were 0.0％,42.1％,52.6％,68.4％ in observation group and 0.0％,10.0％,25.0％,35.0％ in control group,respectively.There were significant differences in INR within target range at day 4,7 between the two groups (both P＜0.05),while no significant difference was found in INR within target range at day 5 (P＞0.05).The time of INR stabilized within target range was shorter in observation group than in control group [(9.5±2.4) d vs.(12.3± 4.8) d,P＜0.05].Bleeding complication occurred in 3 patients in observation group and 5 patients in control group,and there was no significant difference between the two groups.Conclusions Warfarin therapy based on VKORC1 and CYP2C9 gene polymorphisms may shorten the time of first INR reaching the target value and INR within target range in elderly patients.However,the risk of bleeding complications should be alerted.
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Objective To investigate the relationships between serum procalcitonin (PCT) level and APACHE Ⅱ score as well the prognosis of septic patients.Methods Ninety patients with sepsis were collected from emergency and critical care department of Third Hospital,Peking University,Beijing.Within 24 hours after admission,the serum PCT,hypersensitive C-reactive protein (hs-CRP),leucocyte count (WBC) and lactic acid were examined,and APACHE Ⅱ score were calculated.According to APACHE Ⅱscore,the septic patients were divided into three groups of high,median and low scores.Based on the 28 -day outcomes of patients,the patients were divided into survival group and death group.The differences in PCT,APACHE score,WBC and lactic acid between the survival group and the death group were detected.Results The serum levels of PCT were significantly higher ( P ＜ 0.01 ) in patients with high APACHE Ⅱ score ( ＞ 20) than that in patients with median score (10-20) and low score ( ＜ 10 ).There was significant correlation between PCT level and APACHE Ⅱscore ( r =0.58,P ＜0.01 ).Conclusions There is a good correlation between serum PCT level and APACHE Ⅱ score.The serum PCT and APACHE Ⅱ can be used for predicting the outcomes of septic patients.
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Objective To analyze the psychological characteristics of stroke patients and the effects of psychological interventions on their functional rehabilitation.Methods A total of 180 stroke patients with hemiplegia were randomly assigned to the control group ( n =90) or the treatment group ( n =90 ).Those of the control group received conventional drug therapy and rehabilitation programme,and those of the treatment group were additionally given psychological intervention.Symptom checklist (SCL-90) and the WHO QOL-100 checklist were used to assess the effect of psychological intervention on mental health of the participants.Results Before the treatment,the difference of SCL-90 results was not statistically significant between the two groups ( P ＞ 0.05 ).At 3 months,SCL-90 results of the treatment group was lower in comparisou with the baseline level ( 120.3 ± 21.2 vs 133.1 ± 34.1 ) and the control group ( P ＜ 0.05 ).However,there was no statistical significance in the control group before and after the treatment ( P ＞ 0.05 ).SCL-90 and the WHO QOL-100 checklist results in the treatment group were significantly different before and after the treatment ( P ＜ 0.05 ).The SCL-90 showed no significant difference in the control group before and after the treatment (P ＞ 0.05 ).Conclusion Timely and appropriate psychological intervention could improve the functioning,reduce disability and improve the quality of life of stroke patients.
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A sensitive method was developed for the determination of pacific ciguatoxin (P-CTX1) residue in fishes by high performance liquid chromatography coupled with electrospray tandem mass spectrometry ( HPLC-MS/MS). Homogenized samples of fish was extracted with acetone,degreased by freezing under -20℃ and filtered with filter paper. Then the supernatant was cleaned up with PSA column. Identification was achieved by electrospray ionization (ESI) in positive mode using multiple reaction monitoring. The calibration curve of P-CTX1 showed good linearity in the range of 0.5 -20μg/L with correlation coefficient of 0.9998. The limit of quantitation (LOQ) was 0. 1 mg/L( S/N = 10). The recoveries of P-CTX1 were between 82. 3% and 87. 2% (n =7) at spiked levels of 1.0 -20.0 ng/kg. The relative standard derivations( RSD) of the method were less than 7.8%.
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OBJECTIVE To study the characteristic of pathogenic bacteria isolated from patients in the emergency department and to investigate the relativity of experience and targeted antibiotic treatment.METHODS The pathogenic bacteria and drug sensitivity results of all samples in 2005 were analyzed and the relativity of experience and targeted antibiotic treatment was summarized.RESULTS Totally 1061 specimens were acquired from 463 patients including sputum,venous blood,middle urine,purulent fluid on wound surface and 312 strains pathogenic bacteria were isolated.52.09% of them were Gram-positive bacteria,28.29% were Gram-negative bacteria and 19.16% were fungi.Of all pathogenic bacteria,there were 44 strains of drug-resistant bacteria.The relativity of experience and targeted antibiotic treatment was 89.67%.CONCLUSIONS The patients admitted to the emergency department are in severe and complicated conditions,with multiple system diseases.The pathogenic bacteria of emergency department are different from the bacteria of other units.Antibiotic treatment by experience should combined with bacteria monitoring and drug sensitivity.Infection caused by fungi should be paid great attention.