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Objective:To investigate the implementation status of sepsis hour-1 bundle strategy for patients with septic shock in emergency department.Methods:A total of 116 septic shock patients admitted to the emergency department from January 2020 to December 2020 were included in this prospective study, and the implementation of sepsis bundles and the clinical outcomes of patients were recorded.Results:Among 116 patients, 20 cases (17.2%) had lactic acid monitored within 1 h, 20 cases (17.2%) had blood culture before antibiotics, 82 cases (70.1%) received broad-spectrum antibiotics, 16 cases (13.8%) received fluid resuscitation ≥30 ml/kg, and 57 cases (49.1%) received vasoactive drugs during resuscitation. Finally, the sepsis hour-1 bundle strategy was fully implemented only in 13 cases (11.2%). Compared with the group with incomplete implementation of sepsis hour-1 bundle strategy, the volume of fluid recovery in the group with full implementation was significantly increased [33.7 (30.0,37.5) vs. 8.9(7.3,10.8) ml/kg, Z=-4.78, P<0.001], mean artery blood pressure significantly increased [70.0 (70.0,76.7) vs. 67.7 (61.7,76.7)mmHg(1 mmHg=0.133 kPa) , Z=-2.00, P<0.001], and lactic acid significantly decreased [3.0 (2.0,3.2) vs. 4.4 (3.7,7.2) mmol/L, Z=-2.76, P=0.006]. However, there were no significant differences in ICU mortality, in-hospital mortality and 28-day mortality between the two groups ( P>0.05). Conclusions:Septic shock patients in emergency department have poor compliance with the implementation of sepsis hour-1 bundle strategy, and relevant management training should be strengthened.
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Objective:To observe the emulsification of silicone oil in eyes with rhegmatogenous retinal detachment (RRD) after silicone oil filling surgery, and to preliminarily analyze the possible clinical factors related to it.Methods:A cross-sectional clinical study. From January 2019 to April 2022, 50 eyes of 50 patients with RRD who underwent pans plana vitrectomy (PPV) combined with silicone oil filling surgery in Eye and ENT Hospital of Fudan University were included in the study. Among them, there were 25 males with 25 eyes and 25 females with 25 eyes; the age was 54.86±11.79 years old. The retina was in place 3 months after surgery. Before silicone oil removal surgery, intraocular pressure >21 mm Hg (1 mm Hg=0.133 kPa) or treated with≥1 anti-glaucoma drug (high intraocular pressure) in 20 eyes; intraocular pressure ≤21 mm Hg and no anti-glaucoma drug treatment in 30 eyes (normal intraocular pressure). During follow-up after surgery, silicone oil emulsification was found and those who met the indications for silicone oil removal were subjected to silicone oil removal surgery. The first 2 ml of lavage fluid was collected immediately after removal of the silicone oil, and the particle diameter and number of emulsified silicone oil were measured using a Multisizer ? 3 particle/cell counter and particle size analyzer. The measuring range was 0.4-12.0 μm, and the diameter is accordingly divided into 0.4-<1.0, 1.0-<3.0, 3.0-<5.0, 5.0-<7.0, 7.0-12.0 μm. Each sample was measured 3 times and the average value was taken. Spearman correlation analysis and multiple linear regression analysis were used to analyze the correlation between the number of emulsified silicone oil particles and clinical factors. Results:The number of emulsified silicone oil particles was (1.74±2.94)×10 7/ml (0.96×10 7-14.11×10 7/ml), of which the diameter of 0.4-<1.0 μm emulsified silicone oil particle was (1.25±2.41)×10 7/ml, accounted for (64.26±12.70)% [(1.25±2.41)×10 7/(1.74±2.94)×10 7]. The results of correlation analysis showed that there was no correlation between the total particle number of emulsified silicone oil and various clinical factors ( P>0.05). The number of emulsified silicone oil particles with a diameter of 7.0-12.0 μm was negatively correlated with age ( r=-0.298, P=0.036), and positively correlated with axial length ( r=0.325, P=0.021). There was no correlation between the previous ocular trauma, choroidal detachment and different lens states and the number of emulsified silicone oil particles ( P>0.05). Multiple linear regression analysis showed that eye axis ( β=1 570.868, P=0.023) and age ( β=-316.128, P=0.039) were the risk predictors of silicone oil emulsification into large diameter particles (7-<12 μm). The number of emulsified silicone oil particles with a diameter of 7-12 μm in the patients with high intraocular pressure was significantly higher than that in the patients with normal intraocular pressure, and the difference was statistically significant ( U=195.00, P=0.037). Conclusions:Most of the emulsified silicone oil particles in the eyes of RRD patients after silicone oil filling surgery are small-diameter particles; the silicone oil emulsification is more serious in young patients and patients with long ocular axis, and young patients are more prone to high intraocular pressure.
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ObjectiveTo explore the effect of home visit based on empowerment education on psychotic symptoms， self-management ability and well-being of schizophrenia patients in home rehabilitation. MethodsA total of 87 cases of schizophrenia patients who met the diagnostic criteria of International Classification of Diseases， tenth edition （ICD-10） and were recovering at home in Caiba town， Yibin city from January to July 2021 were selected by random sampling method as research subjects. They were divided into experimental group （n=43） and control group （n=44） according to the random number table method. The two groups received routine family visits， and the experimental group received family visits based on empowerment education. The intervention cycle of the two groups was 6 months. Before and after the intervention， the severity of psychotic symptoms， self-management ability and well-being of the patients in the two groups were assessed with the Brief Psychiatric Rating Scale （BPRS）， the Schizophrenia Self-Management Instrument Scale （SSMIS） and the Index of Well-Being Scale （IWB）. ResultsAfter intervention， the intra group comparison showed that the BPRS score in the experimental group was lower than that before the intervention （t=4.550， P<0.01）， the SSMIS scores in both groups were higher than those before intervention （t=-17.107， -6.367， P<0.01）， and the IWB score in the experimental group was higher than that before intervention （t=-9.239， P<0.01）. The comparison between groups showed that the BPRS score of the experimental group was lower than that of the control group， and the SSMIS and IWB scores were higher than those of the control group （t=-3.899， 10.564， 9.690， P<0.01）. ConclusionThe implementation of family visit based on empowerment education may help to improve the psychotic symptoms of home rehabilitation schizophrenia， and improve their self-management ability and well-being.
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OBJECTIVE To conduc t qualitative and quantitative analysis for the chemical compounds in 3 species of wild Veratrum（V. nigrum ，V. maackii ，V. dahuricum ）from Inner Mongolia. METHODS HPLC-Q-Exactive-MS/MS technology was used to identify the chemical components of V. nigrum ，V. maackii and V. dahuricum by consulting SciFinder ，ChemSpider database and related literatures and comparing with the reference substance. The contents of polydatin ，oxyresveratrol and resveratrol in 3 species of wild Veratrum were determined by HPLC. RESULTS A total of 31 compounds were identified ，including 13 stilbenes， 11 flavonoids，4 organic acids ，2 glycosides，1 brasilin. Most of the compounds were shared by 2 or 3 species of wild Veratrum， only 2 flavonoids kaempferol and luteolin were owned by V. dahuricum . The total contents of polydatin ，oxyresveratrol and resveratrol in 3 species of wild Veratrum were in the range of 6.618-11.292 mg/g，and the total contents of them in V. nigrum were the highest ，followed by V. maackii and V. dahuricum . The contents of polydatin and resveratrol in V. maackii were the highest ，and the content of oxyresveratrol in V. nigrum was highest. CONCLUSIONS Most of the components of 3 species of wild Veratrum are similar，only kaempferol and luteolin are unique to V. dahuricum . The contents of polydatin ，oxyresveratrol and resveratrol are significantly different among 3 species of wild Veratrum.
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Objective:To investigate the application value and treatment opportunity of single balloon enteroscopy in children with Peutz-Jeghers syndrome(PJS).Methods:A retrospective analysis was conducted on 33 children diagnosed with PJS in Hunan Children′s Hospital from January 2011 to September 2021.The patient′s age, gender, family history, clinical symptoms, enteroscopy examination and treatment, number of polyps, intraoperative and pos-toperative complications, surgical treatment, recurrence of surgery, and follow-up data were analyzed, and the chi- square test was used for statistical analysis. Results:A total of 33 PJS children aged (9.00±3.13) years, including 21 males and 12 females, were included.All of them received at least once single balloon enteroscopy test.The main manifestations of the children were black spots (33 cases) and multiple polyps in the digestive tract (31 cases). In all the 33 cases, black spots were distributed on lips.Some black spots were also found at the end of fingers (3 cases), at the end of foot toes(2 cases), and at the end of finger toes (6 cases). During the operation, 391 polyps were removed, most of which were jejunum polyps (37.08%, 145/391 polyps). Eleven children with PJS has intussusception, of which intestinal intussusception accounted for 90.91% (10/11 cases). Ten cases (30.30%, 10/33 cases) received surgical treatment, and 72.73% (8/11 cases) underwent surgery for acute refractory intussusception.One case had intestinal perforation and 2 cases were bleeding during the operation, and the 3 cases recovered completely after hemostatic clip sealing and surgical treatment.The incidence of hollow ileum polyps and giant polyps in children aged >8 years was higher than that in children aged ≤8 years[92.55% (149/161 polyps) vs.7.45%(12/161 polyps), 96.20%(76/79 polyps) vs.3.80% (3/79 polyps)]. The differences were statistically significant ( χ2=9.854, 8.711, all P<0.05). There was no significant difference in the incidence of intussusception among different age groups ( P>0.05). Among the 33 children with PJS, 57.58% (19/33 cases) had recurrence 1-3 years after operation, and no cases of cancer have been followed up so far. Conclusions:Intestinal polyps are common in children with PJS, and the application of single-balloon enteroscopy in children with PJS is reliable and safe.Children over 8 years old are more vulnerable to empty ileum polyps and giant polyps.Therefore, it is advised that children aged above 8 years with PJS should undergo at least once enteroscopy.
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Objective:To investigate the effect of septic shock rapid response team (SSRRT) on the compliance and prognosis of hour-1 bundle therapy strategy in emergency department patients with septic shock.Methods:This study was conducted on emergency patients with septic shock who were admitted to Huai’an First Hospital Affiliated to Nanjing Medical University from January 2020 to December 2021. The inclusion criteria were emergency patients with septic shock who met the international guideline for surviving sepsis campaigns (Sepsis 3.0). Exclusion criteria: age<18 years, pregnant patients, patients transferred from another hospital who had received fluid resuscitation and/or vasoactive drugs, patients requiring emergency surgery, patients with emergency detention time<1 h, patients who refused to place central venous catheterization or had contraindications for catheterization, and patients who refused to give informed consent. SSRRT was established in January 2021. According to the establishment of SSRRT, patients were divided into the pre-SSRRT intervention group and the post-SSRRT intervention group. The general clinical data of the enrolled patients were collected, including vital signs, lactate, fluid resuscitation volume, maximum vasoactive drug pumping rate at the diagnosis of septic shock, implementation of hour-1 bundle therapy strategies, and ICU and 28-day mortality. Statistical software SPSS 25.0 was used. Pearson chi-squared test was used to compare categorical variables between groups, and Mann-Whitney U test was used to compare continuous variables between groups.Results:A total of 289 emergency patients met the inclusion criteria, 115 patients were excluded, and 174 patients were eventually included, including 83 patients in the pre-SSRRT group and 91 patients in the post-SSRRT group. Compared with the pre-SSRRT group, the proportion of lactate monitoring (54.2% vs. 100.0%, P<0.001), blood culture (27.7% vs. 93.4%, P<0.001), antibiotics (57.8% vs. 97.8%, P<0.001), fluid resuscitation volume ≥ 30 mL/kg (4.8% vs. 34.1%, P<0.001), and mean arterial pressure ≥ 65 mmHg (49.4% vs. 68.1%, P<0.001) were significantly increased. There was no significant difference in ICU mortality (50.6% vs. 37.4%, P=0.079) or 28-day mortality (53.0% vs. 38.5%, P=0.054) between the two groups. Conclusions:SSRRT can significantly improve the compliance of hour-1 bundle therapy strategy implementation in patients with emergency septic shock, and has a trend of decreasing mortality.
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Objective:To investigate the efficacy of triamcinolone acetonide injection behind the eyeball in the treatment of Purtscher disease and its effects on vision, inflammatory factors, nitric oxide (NO) and endothelin-1 (ET-1) of aqueous fluid.Methods:A total of 64 patients with Purtscher disease admitted to First People′s Hospital of Lanzhou City from January 2016 to January 2020 were selected and divided into two groups by random number table, with 32 cases in each group. The control group was given conventional treatment, and the observation group was injected with triamcinolone acetonide behind the eyeball on this basis. The total effective rate after 6 weeks of treatment, the best corrected visual acuity and hemodynamic indicators peak flow velocity (V max), end-diastolic flow velocity (V min), resistance index (RI) of ophthalmic artery and central retinal artery during systole, aqueous humor inflammatory factors tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-2, IL-6, NO, ET-1, and adverse reactions after 3 and 6 weeks of treatment were compared between the two groups. Results:After 6 weeks of treatment, the total effective rate in the observation group was higher than that in the control group: 96.9% (31/32) vs. 75.0% (24/32), and the difference was statistically significant ( χ2 = 4.655, P<0.05). After 3, 6 weeks of treatment, the best corrected visual acuity in the observation group was higher than that in the control group: 0.44 ± 0.13 vs. 0.35 ± 0.12, 0.88 ± 0.16 vs. 0.62 ± 0.15, and the difference was statistically significant ( P<0.05). After 3, 6 weeks of treatment, the V max and V min of the ophthalmic artery and central retinal artery in the observation group were higher than those in the control group: after 3 weeks of treatment: (29.42 ± 0.93) cm/s vs. (28.65 ± 0.90) cm/s, (8.04 ± 1.08) cm/s vs. (6.95 ± 1.12) cm/s, (8.42 ± 1.21) cm/s vs. (8.39 ± 1.19) cm/s, (4.05 ± 0.61) cm/s vs.(3.58 ± 0.57) cm/s; after 6 weeks of treatment: (31.72 ± 1.03) cm/s vs. (29.58 ± 0.95) cm/s, (9.81 ± 1.06) cm/s vs. (7.78 ± 1.15) cm/s, (12.01 ± 1.23) cm/s vs. (10.82 ± 1.07) cm/s, (4.65 ± 0.47) cm/s vs. (4.02 ± 0.36) cm/s; the RI of the ophthalmic artery and central retinal artery in the observation group were lower than those in the control group: after 3 weeks of treatment: 0.76 ± 0.06 vs. 0.80 ± 0.05, 0.70 ± 0.03 vs. 0.76 ± 0.04; after 6 weeks of treatment: 0.71 ± 0.05 vs.0.75 ± 0.04, 0.68 ± 0.04 vs.0.72 ± 0.03, and the differences were statistically significant ( P<0.05). After 3 and 6 weeks of treatment, the levels of TNF-α, IL-1β, IL-2, IL-6 of aqueous fluid in the observation group werelower than those in the control group: after 3 weeks of treatment: (2.61 ± 0.38) μg/L vs.(4.75 ± 0.41) μg/L, (3.45 ± 0.28) μg/L vs.(6.28 ± 1.05) μg/L, (6.28 ± 0.34) μg/L vs. (9.45 ± 1.14)μg/L, (9.82 ± 1.66) ng/L vs. (12.45 ± 2.31) ng/L; after 6 weeks of treatment: (0.98 ± 0.23) μg/L vs. (1.44 ± 0.27) μg/L, (1.11 ± 0.36) μg/L vs. (1.69 ± 0.38) μg/L, (3.68 ± 1.02) μg/L vs. (5.73 ± 1.15) μg/L, (4.11 ± 1.19) ng/L vs. (7.38 ± 1.06) ng/L, and the differences were statistically significant ( P<0.05). After 3, 6 weeks of treatment, the levels of NO in the observation group washigher than that in the control group: (56.49 ± 9.17) μmol/L vs. (50.22 ± 8.68) μmol/L, (60.18 ± 8.27) μmol/L vs. (53.24 ± 7.96) μmol/L; the levels of ET-1 waslower than that in the control group: (60.77 ± 9.61) ng/L vs. (65.02 ± 10.85) ng/L, (56.59 ± 7.22) ng/L vs. (61.18 ± 6.76) ng/L, and the differences were statistically significant ( P<0.05). The incidence of adverse reactions in the two groups had no statistical significance ( P>0.05). Conclusions:The injection of triamcinolone acetonide behind the eyeball to treat Purtscher disease can improve ocular hemodynamics, inhibit inflammation, improve vascular endothelial function and improve visual acuity. It has significant curative effect and certain safety.
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During the Huai′an Emergency Alliance meeting in January 2020, 143 emergency physicians from 21 level Ⅱ general hospitals in the region who attended the meeting, participated in a questionnaire survey on the knowledge of hour-1 bundle therapy for septic shock. The average score of the correct answer was (5.4±2.9), that for senior ( n=39), intermediate ( n=50) and primary ( n=54) physicians was (6.4±3.3), (6.0±3.2) and (3.4±1.9), respectively ( P<0.01); the rate of failure (≤5) for them was 28% (11/39), 40% (20/50) and 56% (30/54) ( P=0.03), respectively. The hour-1 bundle was summarized into four measures. For the measure of "blood culture", 95% of all levels emergency physicians answered correctly. In answering question of "liquid resuscitation and vasoactive drugs" the accurate rate was 15% (6/39), 24% (12/50) and 7% (4/54) for senior, intermediate and primary physicians; while in answering questions about other measures the overall correct rates were all around 50%. The correct rate for "time of implementing the bundle" in intermediate, senior and primary physicians was 60% (30/60), 59% (23/39) and 44% (24/54); for "monitoring lactate timing" in intermediate, senior and primary physicians was 64% (32/50), 80% (31/39) and 65% (35/54); for the target value of "MAP" was 68% (34/50), 62% (24/39) and 50%(27/54); for the "use time of vascular active drug" was 50% (25/50), 46% (18/39) and 17% (9/54), respectively. The survey suggested that the knowledge of hour-1 bundle therapy for septic shock among emergency physicians in Huai′an secondary general hospitals are insufficient, and relevant training should be strengthened.
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Objective@#To investigate the correlation between β-fibrinogen (FGB) gene -455G/A polymorphism and plasma fibrinogen (Fg) level and lacunar infarction (LI).@*Methods@#From June 2018 to August 2019, consecutive subjects without cerebrovascular disease and dementia admitted to the Department of Neurology, the People's Hospital of Liaoning Province were enrolled prospectively. According to whether there was LI or white matter hyperintensities (WMHs) in brain MRI, the patients were divided into LI group, LI+ WMHs group and control group. Polymerase chain reaction and gene sequencing technology were used to detect FGB -455G/A polymorphism. The turbidimetry was used to measure plasma Fg level. Multivariate logistic regression analysis was used to determine the independent risk factors for LI and LI+ WMHs.@*Results@#A total of 202 subjects were included, including 48 in the LI group, 58 in the LI+ WMHs group, and 96 in the control group. The proportions of patients with hypertension, dyslipidemia, and hyperhomocysteinemia and plasma Fg levels in the LI and LI+ WMHs groups were significantly higher than those in the control group (all P<0.05). There was no statistical difference in FGB -455G/A genotype and allele frequency between the three groups. The plasma Fg level of AG+ AA genotype was significantly higher than that of GG genotype (P<0.001), and there was no significant difference in demography and other vascular risk factors. Regardless of the genotype, the plasma Fg level was highest in the LI+ WMHs group, followed by the LI group and the control group, and the differences between each pair were statistically significant (P<0.05). Multivariate logistic regression analysis showed that hypertension (odds ratio [OR] 2.289, 95% confidence interval [CI] 1.015-5.166, P=0.046; OR 2.457, 95% CI 1.021-5.913, P=0.045), dyslipidemia (OR 2.681, 95% CI 1.217-5.905, P=0.014; OR 3.061, 95% CI 1.296-7.233, P=0.011) and plasma Fg levels (OR 5.038, 95% CI 2.328-10.902, P<0.001; OR 20.198, 95% CI 8.143-50.097, P<0.001) were all the independent risk factors for LI and LI+ WMHs.@*Conclusions@#The increased plasma Fg level, dyslipidemia, and hypertension were the independent risk factors for LI and LI+ WMHs. Although FGB -455G/A polymorphism could affect plasma Fg level, it had no significant correlation with LI and LI+ WMHs.
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Objective To investigate the clinical application value of the levels of heparin-binding protein (HBP) in cerebrospinal fluid (CSF) for intracranial infectious diseases. Methods A case-control study was conducted. 150 patients after craniotomy(73 in the postoperative bacterial intracranial infection group, 77 in the postoperative non-infection group) admitted to the Department of Neurology of the People's Hospital of Liaoning Province from December 2016 to May 2018 were collected. At the same time, 46 patients without operation (14 in the non-bacterial intracranial infection group, 32 patients without intracranial infection were selected as control group whose white blood cell count (WBC) values in CSF were all below 10 × 106/L) in the same period were also collected. According to the diagnostic criteria for severe intracranial infection, the patients with bacterial intracranial infection were divided into 26 cases of mild intracranial infection group and 47 cases of severe intracranial infection group. According to the Glasgow Outcome Scale (GOS) score at the time of discharge, the patients were divided into 30 cases of good prognosis group (GOS score 4-5 points) and 43 cases of poor prognosis group (GOS score 1-3 points). The concentrations of HBP in CSF were tested with latex immunoturbidimetry, and the concentrations of procalcitonin(PCT) in cerebrospinal fluid and serum were tested with electrochemiluminescence, and cerebrospinal fluid routine were tested with instrument method, and the concentrations of total protein(TP) in cerebrospinal fluid were tested with turbidimetry. The differences of the laboratory test indicators in each group were statistically analyzed, and the levels of HBP in CSF of patients with different degrees of intracranial infection and different prognosis were compared. Comparison of two independent samples was performed using the Mann-Whitney U test. Results The HBP levels in cerebrospinal fluid were 187.00 (73.00, 635.00) ng/ml, 10.00 (3.50, 32.00) ng/ml, 1.50 (0, 4.00) ng/ml, 3.00 (1.00, 4.00) ng/ml in post-craniotomy bacterial intracranial infection group, uninfected group after craniotomy, non-bacterial intracranial infection group and control group respectively. The cerebrospinal fluid levels of WBC count were 1280.00 (363.00, 4327.00)×106/L, 63.00 (18.50, 300.00)×106/L, 5.00 (3.00, 14.75)×106/L, 3.00 (2.00, 5.75)×106/L. The absolute value of cerebrospinal fluid neutrophils were 1216.00 (225.50, 3895.50)×106/L, 24.00 (2.00, 209.50)×106/L, 1.00 (1.00, 3.00)×106/L, 1.00 (1.00, 1.00)×106/L. The cerebrospinal fluid levels of PCT were 0.16 (0.10, 0.32) ng/ml, 0.09 (0.07, 0.14) ng/ml, 0.07 (0.06, 0.12) ng/ml, 0.07 (0.06, 0.13) ng/ml. The serum levels of PCT were 0.36 (0.15, 1.09) ng/ml, 0.09 (0.04, 0.16) ng/ml, 0.08 (0.04, 0.13) ng/ml, 0.07 (0.03, 0.11) ng/ml. The levels of HBP, WBC, neutrophils, PCT in CSF and serum PCT in the post-craniotomy bacterial intracranial infection group were significantly higher than those in the uninfected group after craniotomy (Z=-9.246,-6.759,-6.741,-4.477,-6.202, P<0.05), non-bacterial intracranial infection group(Z=-5.840,-5.412,-5.259,-2.923,-5.104,P<0.05) and the control group (Z=-7.905,-7.919,-7.335,-4.397,-5.474, P<0.05). There were significant differences in the levels of HBP, WBC and neutrophils in CSF(Z=-3.763,-3.444,-3.041,P<0.05) and no significant differences in CSF and serum PCT (Z=- 0.869, - 1.850, P>0.05)between the uninfected group after craniotomy and the non-bacterial intracranial infection group. There were significant differences in the levels of HBP, WBC and neutrophils in CSF(Z=-4.496,-6.685,-4.842,P<0.05) and no significant differences in CSF and serum PCT(Z=-0.676,-1.303, P>0.05)between the uninfected group after craniotomy and the control group. There were no significant differences in the levels of HBP, PCT in CSF and serum PCT (Z=-0.861,-0.514,-0.273, P>0.05)and significant differences in the levels of WBC and neutrophils in CSF(Z=-2.756,-3.060, P<0.05) between the non-bacterial intracranial infection group and the control group. The levels of HBP in CSF in the severe intracranial infection group were significantly higher than those in the mild intracranial infection group(Z=-6.267, P<0.05). The levels of HBP in CSF in the poor prognosis group were significantly higher than those in the good prognosis group(Z=-7.064, P<0.05). The area under the ROC curve for the diagnosis of bacterial intracranial infection by HBP, WBC, neutrophils, TP, PCT in CSF and PCT in serum was 0.986, 0.987, 0.945, 0.945, 0.770 and 0.914, respectively. The area under the ROC curve for differential diagnosis of bacterial intracranial infection and non-bacterial intracranial infection was 0.994, 0.958, 0.961, 0.929, 0.747 and 0.936, respectively. Conclusions HBP in CSF is an ideal indicator for the diagnosis of bacterial intracranial infection. It is important to distinguish between bacterial intracranial infection and non-bacterial intracranial infection. The extent of increase is related to the severity of infection and prognosis of the disease.
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Objective@#To analyze the gene mutations in the patients with myelodysplastic syndromes (MDS).@*Methods@#Forty-seven patients with MDS newly diagnosed in Xiyuan Hospital, China Academy of Chinese Medical Sciences from January 2016 to July 2017 were enrolled. NGS 127-gene panel was used to detect the gene mutations, and the relationship between the gene mutations and the clinicopathological features was also analyzed.@*Results@#Thirty-one (66.0 %) cases had gene mutations in 47 patients with MDS, and 23 gene mutations were detected with clinical significances. There were 7 mutant genes with a mutation frequency over 5 % in the population, including U2AF1 (23.4 %), SF3B1 (12.8 %), ASXL1 (10.6 %), TET2 (8.5 %), BCOR (8.5 %), TP53 (8.5 %) and DNMT3A (6.4 %) in turn. Among 31 patients with gene mutations, 16 (51.6 %) patients had ≥ 2 synergistic mutations, and 12 cases had synergistic mutations in different genetic functional groups, which was higher than that in same genetic functional groups (4 cases). There was a tendency of coexistence in IDH2-KRAS, IDH2-SRSF2, IDH2-STAG2, KRAS-SRSF2, KRAS-STAG2, RUNX1-PHF6, EZH2-ASXL1, EZH2-ZRSR2, and NPM1-NRAS (all P < 0.05). The variant allele frequency (VAF) of signaling pathway related genes including JAK2, KRAS, NRAS, SH2B3 was low in general and in a sub-clone status. JAK2 gene mutation was observed in 1 case with MDS-U. SH2B3 gene mutation was observed in a patient with very poor prognosis of karyotype. SETPB1 and EZH1 gene mutations were observed in two patients with high-risk revised international prognostic scoring system (IPSS-R).@*Conclusions@#The common mutated genes include U2AF1, SF3B1, ASXL1 and TET2. The genes in different genetic functional groups tend to synergistic mutations. Gene mutations can be used to predict the prognosis of diseases and become the target in the treatment of MDS.
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Objective To study the spiral CT performance of tertiary silicosis by three-dimension thin-slice reconstruction.Methods Sixty patients with tertiary silicosis were selected in the research.All of the patients were given thin slice scan,and the images of patients with tertiary silicosis were reconstructed by workstation,the spiral CT performance was analyzed.Results In all patients,the pulmonary large shadow mainly distributed in the upper middle lung field,accounted for 93.33％ (56/60).Big shadow internal signs for calcification,containing air bronchogram,empty.Big shadow around with signs of more complex,with 40 patients with adjacent pleural thickening phenomenon,accounted for 66.67％ (40/60).15 cases complicated with tuberculous,accounted for 25.00％ (15/60) of the total number of patients.3 cases with lung cancer,accounted for 5.00％ (3/60) of the total number of patients.Conclusion The spiral CT performance of tertiary silicosis by three-dimension thin-slice reconstruction is diversified,which included pulmonary large shadows with symmetric distribution,pleural thickening,bullae of lung in subintima,lymph gland swelling and calcification in mediastinum and hilus pulmonis.It can provide reference for the diagnosis of tertiary silicosis.
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Objective To determine the median effective dose (ED50) of oxycodone inhibiting responses to laryngeal mask airway (LMA) insertion when combined with propofol in the adult female patients.Methods Female patients,aged 18-60 yr,with body mass index of 18-24 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective gynecologic surgery,were included.ED50 of oxycodone was determined by up-and-down sequential technique.Anesthesia was induced by target-controlled infusion of propofol at target plasma concentration of 3.0 μg/ml.Oxycodone was injected at the initial dose of 0.11 mg/kg after the target effect-site and plasma concentrations were balanced.LMA was inserted at 5 min following injection.When the response to LMA insertion was positive,the concentration of oxycodone was increased/decreased in the next patient.The difference between the two successive doses was 0.02 mg/kg.LMA insertion response was defined as occurrence of swallowing,biting on the LMA and bucking and/or body movement during insertion.Probit analysis was used to calculate the ED50 and 95％ confidence interval of oxycodone inhibiting responses to LMA insertion when combined with propofol.Results The ED50 (95％ confidence interval) of oxycodone inhibiting responses to LMA insertion was 0.095 (0.080-0.108) mg/kg when combined with propofol.Conclusion The ED50 of oxycodone inhibiting responses to LMA insertion is 0.095 mg/kg when combined with propofol in the adult female patients.
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Objective To study the expression of insulin-like growth factor I(IGF-I)and insulin like growth factor binding protein -3(IGFBP-3)in the colorectal cancer and the relations between them. Methods A case-control study was conducted.We selected 113 patients with a pathologically conformed diagnostic colorectal cancer as the colorectal cancer(CRC)group, 37 patients with colorectal benign diseases as benign control(N-CRC)group, and other 76 healthy subjects as normal control(NC)group. CRC was divided into lymphatic metastasis(M-CRC)subgroup and no lymphatic metastasis(NM-CRC) subgroup and was also categorized by TNM staging.Concentrations of serum IGF-I and IGFBP-3 were measured by chemiluminescence method.SNK test and one-way ANOVA were used for comparison between the two groups and among multi-groups, respectively.Results A slightly decreasing trend of the concentrations of serum IGF-I was observed following the sequences of the NC, N-CRC and CRC groups. Moreover,the concentrations of serum IGF-I in T4 were significantly lower than that in(T1+T2)and T3 (F=6.279,P=0.003).The concentration of serum IGFBP-3 in the CRC group(3.13 ±1.57)μg/ml was significantly lower than that both in the N-CRC(3.42 ±1.32)μg/ml(F=3.04,P=0.09)and the Normal group(4.62 ±1.10)μg/ml(F=10.88,P=0.001).The concentration of serum IGFBP-3 in the M-CRC was higher than that in NM-CRC(F=4.44,P<0.05).The ratio of IGF-I/IGFBP-3 in the CRC group (48.85 ±29.14)was remarkably higher than that both in the N-CRC group(42.38 ±12.58)(F=5.05, P=0.02)and the Normal group(42.46 ±16.24)(F=5.68,P=0.02).The value of diagnosis is general. The area under the ROC curve(AUC)of IGF-I was 0.63(95% CI 0.56 -0.70), the sensitivity and specificity of IGF-I were 85.8%and 40.7%respectively when the critical value was 102.5 μg/ml.The area under the ROC curve(AUC)of IGFBP-3 was 0.72(95%CI 0.64-0.78),the sensitivity and specificity of IGFBP-3 were 78.8%and 62.8%respectively when the critical value was 3.32 μg/ml.Conclusions The concentrations of IGF-I and IGFBP-3 were low expressed in serum of patients with colorectal cancer. Meanwhile,they are correlated with the lymphatic metastasis and TNM staging.
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Objective To evaluate the effects of intra-aortic balloon counterpulsation (IABP) on mortality of patients with acute myocardial infarction (AMI) treated with percutaneous coronary intervention (PCI).Methods Randomized controlled trials (RCTs) of IABP compared with non-IABP control in AMI patients, from January 1970 to May 2015, were searched from MEDLINE, Embase and Web of Science.The data were analyzed with software RevMan 5.0.Results Five RCTs involving 1 450 AMI patients, including 722 treated with IABP (IABP group) and 728 without IABP (non-IABP group), were included for analysis.Compared with non-IABP group, IABP did not significantly decrease the hospital mortality or 30-day mortality (OR=0.92, 95%CI: 0.69-1.25,P=0.61).According to the timing of IABP before or after PCI, it was further divided into IABP-before-PCI subgroup and IABP-after-PCI subgroup.Compared with non-IABP group, the 30-day mortality was not decreased in IABP-before-PCI subgroup or in IABP-after-PCI subgroup (OR=0.64, 95%CI: 0.23-1.78,P=0.39;OR=1.25, 95%CI: 0.42-3.77,P=0.69, respectively).According to complicating with cardiogenic shock (CS) or not, patients were divided to AMI with CS subgroup and AMI with no-CS subgroup;the hospital or 30-day mortality were not significantly decreased in both subgroups (OR=0.96, 95%CI: 0.70-1.32,P=0.80;OR=0.68, 95%CI: 0.28-1.70,P=0.27, respectively).Conclusion IABP does not decrease the 30-day mortality of AMI patients treated with PCI.
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Objective To provide reference and ideas for information service in hospital library by analyzing the influencing factors for its service satisfaction.Methods The satisfaction of hospitalized patients for information service was investigated.The characteristics of patients,their requirements for information service and the influencing factors for their satisfaction were analyzed by logistic regression analysis.Their satisfaction for information service was assessed according to the IPA method and analyzed using the SPSS19.0.P0.05).The importance of information service and the satisfaction of patients for information service were rather high.IPA analysis showed that the patients considered high the importance of library-provided personal bibliography and departments-provided health pamphlets with a low satisfaction,which should thus be solved.Conclusion The satisfaction of patients for information service is good.However,the importance of library-provided personal bibliography and departments-provided health pamphlets is high and the satisfaction for them is low.It is thus necessary for librarians to improve their service and encourage more medical staff to participate in information service for patients.
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Enteral nutrition (EN) therapy is one of the most important treatments of Crohn's disease (CD),especially in European countries,EN is considered as the first-line of treatment for pediatric CD.EN can improve the poor nutrition condition,induction and maintenance remission,the risk of this treatment is very low.But in our country the application of EN is still limited,deepening the understanding and obtained clinical guidelines are very important.
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Objective@#To study the relationship between morphological characteristics, grading, diagnosis and prognosis in phyllodes tumors (PT) of the breast.@*Methods@#A retrospective study was carried out on 83 PTs diagnosed between 1999 and 2003 that were classified semi-quantitatively according to the WHO recommendation. Follow-up data was available for some cases, and Cox regression analysis was used to evaluate factors affecting metastasis and recurrence.@*Results@#All cases were classified into the benign (57.8%), borderline (28.9%) and malignant (13.3%). The overall recurrence rate for the 72 cases with follow-up data was 20.8% (15/72), and was 17.5% (7/40) in benign, 22.7% (5/22) in borderline and 3/10 in malignant PT, respectively, with no significant difference (P>0.05). The median interval between the initial diagnosis and the first recurrence was 24 months. Lung or bone metastases occurred in 1/22 borderline and 3/10 malignant PT patients 5 years post-surgery. The mitotic count and the degree of stromal cell atypia were significantly correlated with recurrence (P=0.001 and P=0.006). Multivariate analysis showed that severe stromal cell atypia was an independent predictor of recurrence-free survival in PT [HR=6.40 (95% CI=1.378 to 29.732), P=0.018].@*Conclusions@#Each parameter in the histological grading of PT may have different prognostic value, and markedly increased mitotic count and were predictive of relapse.
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Objective To analyze the comparation of national early warning score (NEWS), rapid emergency medicine score (REMS) and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score in predicting prognosis of critically ill patients in emergency department (ED). Methods A retrospective study was conducted. Critically ill patients, aged > 16 years, hospitalized > 24 hours, and admitted to the ED of Nanhua Hospital Affiliated to South China University from January 2016 to June 2017 were enrolled. NEWS, REMS and APACHE Ⅱ score were calculated based on the worst value of each index within 24 hours after emergency admission. The primary endpoint was 28-day mortality. The relationship between the three scoring systems and the prognosis of patients was analyzed. The predictive value of three scoring systems for the prognosis of critically ill patients in ED was analyzed by receiver operating characteristic curve (ROC). Results A total of 119 emergency severe patients were enrolled in the study, and the 28-day mortality was 21.0%. The scores of NEWS, REMS and APACHE Ⅱ in the death group were significantly higher than those in the survival group (NEWS score: 9.40±3.19 vs. 5.72±2.35, REMS score: 12.64±4.46 vs. 7.97±3.28, APACHE Ⅱscore: 26.64±6.92 vs. 16.19±5.48, all P < 0.01). With the increase of NEWS, REMS and APACHE Ⅱ score, the 28-day mortality of patients gradually increased [28-day mortality of NEWS < 5, 5-6, ≥ 7 was 3.03% (1/34), 13.33% (4/34), 64.25% (20/51); 28-day mortality of REMS < 12, 12-16, ≥ 17 was 10.99% (10/91), 50.00% (11/22), 66.67% (4/6); 28-day mortality of APACHE Ⅱ < 15, 15-24, ≥ 25 was 2.33% (1/43), 15.09% (8/59), 69.57% (16/23), respectively, all P < 0.01]. The ROC curve analysis showed that the areas under the ROC curve (AUC)of NEWS, REMS and APACHE Ⅱ score for predicting the prognosis of emergency critically ill patients were 0.830 [95% confidence interval (95%CI) = 0.737-0.923], 0.782 (95%CI = 0.671-0.892) and 0.878 (95%CI = 0.800-0.956), respectively (all P = 0.000), and the accuracy of prediction was 57.4%, 48.6%, 65.4%, respectively. Conclusions The scores of NEWS, REMS and APACHE Ⅱ were useful in predicting prognosis of critically ill patients, with the highest accuracy of APACHE Ⅱ forecast, followed by NEWS, and the lowest of REMS. After comprehensive consideration of cost-effectiveness, NEWS is more reliable in ED.
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Malignancies threaten human health seriously.Recently studies show that intercellular signal transduction influences the biological characteristics of tumor cells.It has closely relationship with tumor growth and metastasis.Insulin-like growth factor ( IGFs ) signal transduction system is a potential mitogen that distributed in the body′s tissues, organs and blood.Researches show that the abnormal expression of IGFs exists in many tissues, such as breast cancer, colorectal cancer, gastric carcinoma, lung carcinoma, pancreatic cancer and so on, which may play an important role in occurrence and metastasis as a novel tumor marker.