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Objective:To observe the image characteristics of optical coherence tomography (OCT) in patients with primary vitreoretinal lymphoma (PVRL).Methods:A retrospective clinical study. Thirty-two eyes of 19 patients diagnosed with PVRL by vitreous pathology in the Department of Ophthalmology, Beijing Tongren Hospital from September 2016 to October 2019 were included in this study. There were 7 males and 12 females. The median age was 56 years. The mean time from symptom onset to final diagnosis was 6.1±3.8 months. The first diagnosis was uveitis in 12 cases (63.1%, 12/19), retinal vein occlusion in 2 cases (10.5%, 2/19), central retinal artery occlusion in 1 case (5.3%, 1/19), and suspected PVRL of camouflage syndrome in 4 cases (21.1%, 4/19). Routine ophthalmic examination and frequency-domain OCT examination were performed in all the patients, and typical images were stored for analysis. According to the examination results, PVRL OCT signs were divided into vitreous cells, inner retinal infiltration, outer retinal infiltration, retinal pigment epithelial (RPE) infiltration, sub-RPE infiltration, and subretinal fluid.Results:Vitreous cells were found in all eyes (100.0%, 32/32). RPE infiltrated were observed in 19 eyes (59.4%, 19/32), RPE infiltration in 16 eyes (50.0%, 16/32), outer retinal infiltration in 8 eyes (25.0%, 8/32), inner retinal infiltration in 16 eyes (50.0%, 16/32), and subretinal fluid in 4 eyes (12.5%, 4/32).Conclusions:PVRL OCT signs can involve vitreous and retinal anatomical levels, including vitreous cells, inner retinal infiltration, outer retinal infiltration, RPE infiltration, sub-RPE infiltration and subretinal fluid. The same patient can show multiple signs at the same time.
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The human gut is populated by a complex community of microbiota that coexists with the host to maintain homeostasis.Macrogenomic and metabonomics analysis shows that the imbalance in gut microbiota composition and diversity, some bacterial components, metabolites and the signaling pathways mediated by them are involved in the occurrence and development of a variety of diseases, especially in the elderly.Intestinal microorganisms are one of the important factors affecting age-related diseases and can provide insights on treatment strategies for the elderly.This review focuses on the composition of the intestinal microbiota, interaction between the microbiota and the host, features of the gut microbiota in common geriatric diseases and pathogenic mechanisms.
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Myocardial infarction refers to severe coronary artery stenosis, which leads to continuous and complete occlusion of coronary artery and myocardial necrosis. Coronary artery stenosis (>50%) or occlusion can be seen in 90% of patients undergoing coronary angiography, but 10% of patients have no obvious stenosis, that is, non obstructive myocardial infarction (MINOCA). The incidence rate of MINOCA was about 6%, showing an upward trend year by year, with an average age of 55 years, of which 40% of women. Its etiology is complex, the onset is urgent, and the clinical manifestations are complex and changeable. The incidence of major adverse cardiovascular events (MACE) is very high, and the mortality rate within one year is as high as 3.5%. There is no unified diagnosis and treatment plan at present. In this paper, the etiology, diagnosis and treatment of MINOCA were reviewed.
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Objective To investigate the characteristics and failure risk factors of sequential high-flow nasal cannula oxygen therapy (HFNC) after weaning from invasive ventilation. Methods The patients who received sequential HFNC after weaning from invasive ventilation admitted to surgical intensive care unit (ICU) of Peking University People's Hospital from June 1st 2016 to May 31st 2018 were retrospectively analyzed. Clinical variables, respiratory therapy parameters, respiratory variables, cardiac variables and outcomes were reviewed and analyzed. Treatment characteristics of HFNC after weaning was analyzed. Patients were divided into HFNC success group and HFNC failure group according to the failure of HFNC, and the differences between the two groups were compared. The independent risk factors of HFNC treatment failure were analyzed by Logistic regression analysis. The value of predictive treatment failure of risk factors and regression models were analyzed by receiver operating characteristic (ROC) curve. Results A total of 99 patients were included, 61 men, and the median age was 67.0 (57.0, 76.0) years old. The medianinitial HFNC flow was 50 (50, 60) L/min, and inspired oxygen concentration (FiO2) was 0.50 (0.40, 0.60). Eighteen patients experienced HFNC failure (18.2%). Compared with the HFNC success group, the sequential organ failure assessment (SOFA) score in the HFNC failure group was higher [4 (3, 5) vs. 2 (1, 3), P < 0.01], B type natriuretic peptide (BNP) before HFNC therapy were significant higher [ng/L: 647.2 (399.2, 1 331.3) vs. 127.2 (55.2, 369.5), P < 0.01], and respiratory frequency (RR) and heart rate (HR) were significant faster, mean arterial pressure (MAP) was significant higher, oxygen index (PaO2/FiO2) was significant lower after 30 minutes HFNC treatment [RR (times/min): 26 (22, 28) vs. 19 (17, 21), HR (bpm): 105 (97, 107) vs. 85 (77, 90), MAP (mmHg, 1 mmHg = 0.133 kPa): 104.3 (101.7, 110.7) vs. 92.3 (88.3, 97.7), PaO2/FiO2 (mmHg): 207.3 (185.8, 402.8) vs. 320.2 (226.2, 361.5), all P < 0.05]. It was shown by multiple Logistic regression analysis that the SOFA score [odds ratio (OR) = 2.818, P = 0.022, β = 1.036], BNP before HFNC treatment (OR = 1.002, P = 0.033, β = 0.002) and HR after HFNC treatment 30 minutes (OR = 1.140, P = 0.032, β = 0.131) were independent risk factors for HFNC treatment failure. It was shown by ROC curve that the area under the ROC curve (AUC) for the prediction of HFNC failure was 0.840, 0.859, 0.860 and 0.962 for SOFA, BNP before HFNC treatment, HR after HFNC treatment 30 minutes, and regression model, all had good forecast values (all P < 0.01). Conclusions HFNC is one of the commonly used oxygen therapy methods in the ICU, but not all patients who are treated as a sequential therapy after invasive mechanical ventilation weaning can benefit from it. SOFA score, BNP before HFNC treatment and HR after 30 minutes HFNC treatment were independent risk factors of HFNC failure. Each independent risk factor and regression model can predict the success of HFNC treatment.
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In recent years, more and more people have recognized the importance of patients' family in the intensive care unit (ICU) in medical care, and advocated the use of patient- and family-centered care (PFCC) in the ICU. This article explains the content (family presence, family support, communication with family members, consultations and ICU team members, environmental issues) and significance of PFCC in the ICU, and provides guidance for the practice of PFCC in China.
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Objective:To provide basis for the rational use of valproic acid(VPA) in the patients with epilepsy through the analy-sis on the therapeutic monitoring data. Methods:The VPA plasma concentration and the other related information of 233 cases were analyzed retrospectively. Results:The total daily dose of VPA increased with age (P<0.05) in children group. Compared with that in adults group (19-50 years old),the target rate of VPA concentration was significantly higher in children group(4-14 years old) (P<0.001). VPA had similar antiepileptic effect in children and adults. Oral solution was the main dosage form for children and con-ventional tablets for adults. Children had higher target rate of VPA concentration than adults (P<0.05). Compared with the group with VPA alone,VPA combined with enzyme inducers such as carbamazepine,phenobarbital and phentoin significantly decreased the target rate of VPA concentration(P<0.001). Moreover,VPA combined with phenobarbital significantly decreased the total daily dose of VPA (P<0.05). Conclusion:With great inter-individual variance,VPA plasma concentration is associated with efficacy and side effects. Monitoring of VPA plasma concentration is useful to the individualized treatment of VPA.
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Objective To investigate the clinical characteristics and predictors of mortality in patients with candidemia in intensive care unit (ICU). Methods The patients with candidemia admitted to ICU of Peking University People's Hospital from January 2010 to December 2017 were enrolled. The general clinical data, indicators related to Candidia infection and prognosis were collected, and the clinical characteristics, infection characteristics and prognosis of patients with candidiasis were analyzed. Patients were divided into death group and survival group according to hospital survival status. The differences of each index were compared between two groups. The independent risk factors of mortality in patients with candidemia were analyzed by multivariate Logistic regression analysis. Results A total of 95 patients (55 males) with candidemia were included, with an average age of (69.3±16.5) years, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) was 24.7±3.6, sequential organ failure assessment (SOFA) was 6.6±2.7. Candida albicans accounted for the largest proportion of Candida infections (n = 56, 58.9%). Thirty-two (33.7%) patients received inadequate antifungal therapy and 38 (40.0%) patients received inadequate source control. Fifty-five (57.9%) patients were died in hospital. Compared with the survival group, patients in the death group was older (years: 72.5±14.6 vs. 64.9±18.0, P < 0.05), had higher APACHEⅡ and SOFA scores (26.6±2.2 vs. 22.1±3.6, 7.9±2.0 vs. 4.7±2.4, both P ﹤ 0.01), higher rate of glucocorticoid treatment (18.2% vs. 10.0%, P < 0.05), and higher proportion of Candida albicans and Candida glabrata (69.1% vs. 45.0%, 10.9% vs. 7.5%, both P < 0.05), the rate of multi-site Candida infection also significantly increased (47.3% vs. 17.5%, P < 0.05). Intra-abdominal infection was the primary infection site and more common in death group (49.1% vs. 35.0%, P < 0.05). The rates of sepsis (87.3% vs. 62.5%), inadequate antifungal therapy (49.1% vs. 10.0%), inadequate source control (60.0% vs. 12.5%) in death group were all higher than those in survival group (all P < 0.01). It was shown by multivariate Logistic regression analysis that APACHE Ⅱ[odds ratio (OR) = 1.605, P = 0.002, β = 0.473], SOFA (OR = 1.501, P = 0.029, β = 0.406), inadequate antifungal therapy (OR = 12.084, P = 0.006, β = 2.492) and inadequate source control (OR = 7.332, P = 0.024, β = 1.992) were independent risk factors for mortality in ICU patients with candidemia. Conclusions Candidemia patients were severe and had poor prognosis. APACHE Ⅱ, SOFA, inadequate antifungal therapy and inadequate source control were independent risk factors of mortality.
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Sepsis has relatively high morbidity and mortality in patients at intensive care unit (ICU). With the study of sepsis having continued to develop in recent years, the defects existing in this research have unceasingly exposed. Because the lack of design process of international standardized clinical randomized controlled trials (RCT) for septic patients, the situation of incomplete data record exists in these clinical studies, that may further affect the interpretation of the research results, therefore it is in urgent need to have an international standardized RCT design process for septic patients.
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The majority of patients have experienced pain or discomfort associated with surgery or mechanical ventilation in intensive care unit (ICU), and the use of analgesic drugs can relieve patients' anxiety, improve sleep, promote the disease recovery, reduce the use of sedative drug dosage and the occurrence of delirium. Because of less adverse reactions of the non opioid analgesic drugs, in recent years gradually the doctors in ICU have paid attention to them. In this study, the related literatures have been reviewed to realize the present situation of applying non opioid analgesic drugs in ICU. It was found that nowadays the application of commonly used non opioid drugs in ICU (including ketamine, non-steroidal anti-inflammatory drugs, tramadol, lidocaine, tramadol and gabapentin) can all decrease the use of sedative drugs and opioids, reduce the incidence of adverse reactions, and gradually they will obtain more and more attention.
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Objective To observe the effect of ganglioside GM3 on the proliferation and cell cycle of multiple myeloma (MM) cell line U266. Methods The experimental groups were treated with 20, 40, 80, 160μmol/L GM3, while the control group was not given GM3. The growth inhibition effect of GM3 on U266 cells after 48 hours were measured by using methyl thiazolyl tetrazolium (MTT) method. The cell cycle was tested by flow cytometry with PI labeling. Results The results indicated that the GM3 displayed anti-proliferative effects on U266 cells in a dose-dependent manner. The cell inhibition rates were (13±4) %, (26± 4) %, (47 ±6) %, (55 ±10) % in different dose of GM3 (20, 40, 80, 160 μmol/L), respectively. There was a difference between the experimental group and the control group (F= 93.063, P< 0.05). At the same time, the cell cycle analysis results showed that the U266 cell ratio in S phase was increased from (22.6 ±3.7) % to (71.5±3.8) %(P<0.01) and in G2/M phase was decreased from (42.6±2.5) %to (0.8±0.6) %(P<0.05) while in G0/G1 phase was not significantly changed. Conclusion GM3 can inhibit the proliferation of MM cell line U266 by blocking them in the S phase.
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The teaching of geriatrics requires the combination of basic medicine,clinical medicine,nursing,rehabilitation medicine and pharmacy,and the intersection of medical science and humanities.In order to meet the problems of coping with much disease coexistance in geriatrics,poor efficacy,long course of disease,slow recovery and adverse drug reactions,the article puts forward the combination of blackboard and multimedia,the combination of teacher teaching and student lectures,the combination of PBL and CBL,and the combination of theoretical knowledge and clinical practice.It also puts forward carrying out reforms from such measures as the classroom teaching,teaching rounds,case discussion,literature reading,academic research,humanistic influence,going to community pension center for social practice and so on,to improve the quality of gerontology teaching.
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Objective To investigate the postoperative complication and nursing experience of hand-assisted laparoscopic J-type ileal pouch-anal anastomosis (IPAA) in familial adenomatous polyposis (FAP). Methods A total of 36 patients with FAP who had undergone hand-assisted laparoscopic J-type ileal pouch- anal anastomosis (IPAA) were analyzed retrospectively. Results The postoperative complication included ileal pouch bleeding in 2 cases, urinary retention in 3 female patients, external hemorrhoids swelling in 3 cases, and anastomotic fistula in 2 cases. Six cases had ileum pouch inflammation during the postoperative follow- up. All the complications were relieved after conservative medical therapy. Conclusions IPAA operation puts forward high technical requirements with more postoperative complications. Therefore, it is important to strengthen nursing of the patients, reduce postoperative complication and increase quality of life of FAP.
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Objective To describe the monitoring and control of pan-drug resistant Acinetobacter baumannii (XDRABA) colonization and infection in a medical intensive care unit (ICU),and to summarize the effective measures of surveillance of nosocomial infection and control.Methods Nonsurgical patients admitted to medical ICU of Peking University People's Hospital from September 2009 to April 2013 with length of ICU stay over 48 hours were surveyed.Number of cases of colonization and infection of XDRABA per month was recorded,and the clinical features of patients with XDRABA colonization and infection were observed.The control of XDRABA colonization and infection was divided into three stages:① Outbreak stage,from September 2009 to August 2010,the infection control measures included stringent hand hygiene and surface disinfection,use of disposable ventilator tubes and improvement in antibiotics use.② Environmental control stage,from September 2010 to April 2012,the infection control measures consisted of on-the-spot investigation,isolation of patients with XDRABA colonization and infection,tubes terminal environment disinfection.③ Microbial screening stage,from May 2012 to April 2013,throat,nose and axillary swabs were obtained when the patients admitted.Results From 2009 September to 2013 April there was a total of 193 patients colonized or infected with XDRABA,and 64 patients died (mortality rate was 33.2％),and 133 (68.9％) patients were on mechanical ventilation.Patients with XDRABA colonization and infection had severer illness [acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score 20.3 ±6.7],longer ICU stay [(34.6 ± 13.8) days].In outbreak stage,number of cases with XDRABA colonization and infection was 5-9 per month.In environmental control stage,case number of XDRABA colonization and infection was 3-6 per month.In microbial screening stage,case number of XDRABA colonization and infection,which were already present,was 2-4 per month,and they were mainly admitted from emergency department (59.5％).The number of cases of ICU acquired XDRABA colonization and infection decreased from 2-3 to 0-1 per month.Conclusion To control the colonization and infection of XDRABA,monitoring of microorganism,hand hygiene,isolation of patients with XDRABA colonization and infection,and stringent environment disinfection were very necessary.
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Objective To observe the metabolism characters of plasma glucagon-like peptide 1 (GLP-1) in surgical critical ill patients.Methods Totally 64 selective surgical patients were prospectively enrolled and randomly divided into two groups:enteral nutrition (EN) group (50％ glucose 100 ml orally administered or through nasogastric tube on the next day after operation) and parenteral nutrition (PN) group (50％ glucose 100 ml intravenously infused on the next day after operation).Blood glucose and plasma GLP-1 were determined before operation,after operation,and 0 min,30 min,90 min,and 180 min after the 50％ glucose was used.Then,the EN group was divided into stress hyperglycemia (SH) subgroup and non-stress hyperglycemia (non-SH) subgroup.In both subgroups,plasma tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were detected before operation,after operation,and the next day after operation.Blood glucose,plasma insulin,C-peptide,and GLP-1 were measured before operation,after operation,and 0 min,30 min,90 min,and 180 min after 50％ glucose was used.Results The plasma GLP-1 level (pmol/L) of EN group increased significantly after 50％ glucose was used,and reached the peak at the time of 30 min.In contrast,it did not change in PN group,and were significantly lower than EN group at the time of 30 min [(5.69 ± 2.92) pmol/L vs (33.52 ± 12.32) pmol/L,P ＜0.01] and 90 min [(5.71 ±2.14) pmol/L vs (15.92 ±6.63) pmol/L,P =0.00].Plasma insulin level in SH subgroup were significantly higher than in non-SH group after operation [(18.17±6.18) mU/Lvs (12.10±3.60) mU/L,P=0.01] and30 min [(56.02±14.78) mU/Lvs (43.39±15.60) mU/L,P=0.03] and 90min [(114.58±25.11) mU/Lvs (90.45±25.91) mU/L,P=0.03] after 50％ glucose was used.Plasma C-peptide level in SH subgroup was also significantly higher at the time of 30min [(6.86 ±1.15) μg/L vs (4.76 ± 1.06) μg/L,P=0.04] and 90 min[(12.17 ± 1.96) μg/L vs (9.81 ± 2.35) μg/L,P =0.03] after 50％ glucose was used when compared with non-SH subgroup.Plasma GLP-1 level in SH subgroup was significantly lower than in non-SH group at the time of 30 min [28.76 ± 9.61) pmol/L vs (37.36 ± 10.51) pmol/L,P =0.03] and 90 min [(13.49±4.26) pmol/Lvs (17.33±5.57) pmoL/L,P=0.04] after 50％ glucose was used.Conclusions Early post-operative PN increases plasma GLP-1 level and reduces the SH incidence.In SH patients,endogenous insulin expression increases while plasma GLP-1 level decreases.Post-surgery inflammatory reaction may result in low plasma GLP-1 level and high blood glucose level.
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Polystyrene microspheres (PS) were successfully prepared by suspension polymerization processes. Chloroacetylated polystyrene has been prepared by Friedel-Crafts acetylation of PS with chloroacetyl chloride. In this report, carcinogenic compound (chloromethylether etc.) was avoided. The effects of solvent, catalyst, acylating agent and reaction time were studied. Novel adsorption resins were obtained by synthesis of chloroacetylated polystyrene with amine. The influences of solvent, amine reagent and reaction time on ion exchange capacity were investigated. Under the optimized reaction condition, the ion exchange capacity of the prepared resins was 4.1587 mmol/g. The maximum amount of adsorbed bilirubin was 30.85 mg/g, the adsorption percentage was 80%.
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Humans , Acetates , Chemistry , Adsorption , Amines , Chemistry , Bilirubin , Chemistry , Microspheres , Polystyrenes , Porosity , Resins, Synthetic , ChemistryABSTRACT
Objective To assay the expression chinse of ED1 positive cell in focal segmental glomemlosclerosis in rats,we investigated the relationship between the infiltration of mononuclear phagocytes and the progression of glomendar sclerosis.Methods We used 12 Wistar ratswhichwere dividedintotwo groups.1est group and coutrol group.Themodel offocal segmental glomerursclerosiswas ulade by in jecting PAN 9 mg/100g body weights.The rats ofcontrol group were injected 3ml 0.9％80diuln chloride.The proteinuria,serum creatinine,fipi&and protein of the rats were examined.The rata were killed at the 20th week.All the kidneys were kept and nlade into pathologic slEun-pie.1mmunohistochemical method was applied to detect the protein expression of FIN and the EDI positive cell in renal tissue of all the rats,and the number of Edl positive cell W88 counted.The results were analyzed by SPSS.Results The proteinuria of the mts in FSGS model group was significantly increased,the serum lipid ofthem was also increased.The pathology changes of the rat renal in model group showed that a part of giomemli appeared focal segmental sclerosis or all glomerular sclerosis,and the extracelhlar matrix accumulated.In the renal of model rats,the amount of EDI positive cells was significantly higher than that in normal rats(P<O.05).The expression of FN in the rehal of model rats was significantly higher than that in the normal rats(P<0.05).111e mount ofEDl positive cells WaS significantly positively correlated WitII the expression of FN(P=0.002).The amount of Edl positive cells W88 significantly positively correlated with the pmteinuria of the rats(P=0.014).Conclusion Theinfiltration ofEDI positivecell contributed to the progression of glomerular sclerosis.
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Objective To find the changes and effects of nitric oxide synthase activity in atherosclerotic rabbit models. Methods Thirty rabbits were divided into 3 groups at random: control group, atherogenic diet group, balloon-injury+ atherogenic diet group. Three months later underwent pharmacological triggering with Chinese Russell’s viper venom and histamine to make the plaque rupture. Lipid concentrations and the levels of nitric oxide (NO), NOS and hydroxy radical (OH) in the serum were obtained at different period, and pathologic changes were observed. Results In atherogenic diet group and balloon-injury+ atherogenic diet group, serum lipid concentrations markedly increased, but the levels of NO did not show any difference. The activity of NOS and OH levels were obviously increased after the atherogenic diet. But it reduced after pharmacological triggering and plaque rupture. Conclusion In early period of atherosclerosis, NOS activity up regulated and endothelium functions were compensated. But, When the atherosclerotic plaques were unstable, the activity of NOS descended obviously and endothelium function goes into incompensation.
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Aim To investigate the effect of iontophoresis on skin permeation of defibrase. Methods Iontophoresis was carried out in side-by-side chambers, excised rat skin membrane (RSM) or human epidermis membrane (HEM). The effects of electrode polarity, permeation medium pH and ionic strength were evaluated. Results Permeation of defibrase caused by anodal iontophoresis was more effective [the apparent permeability coefficient was (1.2±0.4)×10-4 cm·h-1] than that of cathodal iontophoresis[(4.3±1.4)×10-5 cm·h-1]. The amount of permeated defibrase caused by anodal iontophoresis in pH 7.4 medium was (25±5)×10-14 mol·cm-2, which was higher than that of in pH 6.4 permeation medium [(15±4)×10-14 mol·cm-2]. Conclusion Iontophoresis could enhance skin permeation of defibrase. Electroosmotic flow effect played an important role.
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Objective To explore the prevalence of mild cognitive impairment (MCI) among elderly veterans. Methods 2 674 veterans ( aged 60 years and over) from 26 military sanatorium in Shijiazhuang city were studied. The Mini-Mental State Examination, Global Deterioration Scale, Activity of Daily Living, Hachinski Ischemic Scale and Hamilton Depression Scale were served as screening tools. Results The prevalence of total MCI was 8 08% in elderly people. The standardized prevalence of MCI was 6 87% in male and 10 38% in female (P