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Objective:To explore the influencing factors of severe pneumonia in children with respiratory syncytial virus (RSV) infection.Methods:A retrospective case-control study was used to collect 210 children with RSV infected pneumonia admitted to Hebei Children′s Hospital from October 2017 to October 2020. Among them, 70 children with severe pneumonia were included in the severe pneumonia group, and 140 children with common pneumonia were included in the common pneumonia group; the baseline data and relevant laboratory indicators of the two groups were compared; Logistic regression was used to analyze the influencing factors of severe pneumonia in children infected with RSV.Results:The proportions of wheezing, congenital heart disease, respiratory failure, heart failure and pleural effusion of children in severe pneumonia group were higher than those in common pneumonia group, and the forced vital capacity (FVC) and forced expiratory volume in the first second (FEV 1) were lower than those in common pneumonia group (all P<0.05); the levels of C-reactive protein (CRP), CD8 + cells, RSV load and Beclin-1 in severe pneumonia group were higher than those in common pneumonia group, and the levels of CD4 + cells and 1, 25-dihydroxyvitamin D [1, 25-(OH) 2D] were lower than those in common pneumonia group (all P<0.05). After treatment, the levels of CRP, CD8 + cells and Beclin-1 in children with severe pneumonia were lower than those before treatment, and the levels of CD4 + cells and 1, 25-(OH) 2D were higher than those before treatment (all P<0.05). Multiple regression model analysis was established. The results showed that congenital heart disease, high CRP level, high CD8 + cells, high RSV load and high Beclin-1 level were risk factors for severe pneumonia in children with RSV infected pneumonia (all OR>1, P<0.05), and high CD4 + cells and 1, 25-(OH) 2D level were protective factors (all OR<1, P<0.05). Conclusions:Severe pneumonia in children with RSV infected pneumonia may be affected by congenital heart disease, CRP, CD4 + cells, CD8 + cells, 1, 25-(OH) 2D, RSV load and Beclin-1.
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Objective:To analyze the application effect of cluster management measures in improving the quality of emergency medical treatment.Methods:By analyzing the problems existing in the work of emergency department, the cluster management scheme was formulated and the intervention measures were implemented from the aspects of intelligent information system, patient management system and medical service process. The accuracy and efficiency of emergency triage, the satisfaction of patients and medical staff, the incidence of medical complaints and disputes and the rate of sudden death were compared before and after cluster management.Results:Before and after the implementation of cluster management, the accuracy of triage classification was 95.0% and 98.7% respectively, and the triage time was (68.3±12.8) s and (50.5±7.2) s respectively( P<0.001). The satisfaction of patients, doctors and nurses increased, the number of complaints decreased from 15 to 5 in half a year, and the number of sudden death decreased from 39 to 23 with a significant difference( P<0.05). Conclusions:The application of cluster management measures in emergency management can improve the medical quality, the satisfaction of medical staff and patients, and ensure the safety of patients.
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Objective:Based on the clinical indicators of severe community-acquired pneumonia in emergency department, the early warning indicators of critical condition were constructed.Methods:The general information, vital signs before entering ICU, laboratory indexes and the survival rate in 30 days of 118 patients with community-acquired pneumonia were retrospectively collected in the emergency care unit of Peking Union Medical College Hospital from January to December 2018. The indexes of death patients (24 cases) and alive patients (98 cases) underwent comparative analysis, using ROC curve to predict the clinical outcome and reliable parameters of emergency patients with community-acquired pneumonia. The best cutoff value was determined according to Youden index and then undergoing multiple factors Logistic stepwise regression analysis. Then early warning model of critical degree was finally built.Results:Eleven indicators were used to predict the criticality of patients with acute community-acquired pneumonia, including AVPU (alert, voice, pain, unresponsive) score, Glasgow Coma Scale(GCS), heart rate, pulse oxygen saturation (SpO 2), fraction of inspiration O 2, oxygenation index,potential of hydrogen, blood potassium (K +), bilirubin, urea nitrogen, and C reactive protein, the optimal cutoff values were 2 points, 8 points, 91 times per minute, 0.94, 41%, 81.20%, 7.38, 4.0 mmol/L, 10.90 μmol/L, 2.23 mmol/L, and 41.5 mg/L. Multiple Logistic stepwise regression showed that the independent factors for predicting death were GCS score, SpO 2 and urea nitrogen, and the predictive ability of the early-warning model was 83.7%. Conclusions:GCS score, SpO 2 and urea nitrogen are effective early warning indicators for the severity of severe community-acquired pneumonia in emergency department, which are conducive to the rapid and efficient early identification and treatment of critically ill patients. Therefore, they are worthy of promotion and application in clinical practice.
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Objective:To investigate the incidence and risk factors of acute kidney injury in patients admitted to the resuscitation room of the Emergency Department.Methods:Patients were enrolled from the resuscitation room of our hospital from September to December 2018 by a retrospective cohort study. Patients were divided into AKI group and non-AKI group according to whether AKI occurred within seven days after admission. Demographic characteristics, APACHEⅡ score, whether to use nephrotoxic drugs,24-hour fluid volume, and patients survival time were collected. Multivariate regression analysis was used to explore the risk factors for AKI. Cox regression was used to study the effect of the occurrence of AKI on survival and to analyze the influence of AKI severity on the death risk of patients in the resuscitation room.Results:Among 238 critical patients who were finally included, 108 patients developed AKI(45.4%), 83 patients were in AKI stage 1 (34.9%), and 25 patients were in AKI stage 2-3 ( 10.5%).APACHEⅡ score>13( OR=1.11, 95% CI (1.08-1.16), P <0.01), vasoactive drugs ( OR=2.20, c95% CI (1.08-4.49), P=0.03), diabetes mellitus ( OR=2.33, 95% CI (1.23-4.42), P=0.01), and fluid load> 3 L( OR=3.10, 95% CI (1.17-8.25). P=0.02) were independent risk factors for AKI. After adjustment for APACHEⅡ score and age by multivariate COX regression, AKI remained an independent risk factor for death in emergency patients, and the severity of AKI significantly increased the risk of death in these patients(AKI 1: HR=1.45, 95% CI (1.08-2.03), P =0.04; AKI 2~3: HR=3.15, 95% CI (1.49-4.81), P=0.03). Conclusions:AKI occurred commonly in the resuscitation room of the emergency department. APACHE Ⅱ score>13, vasoactive drugs, diabetes, and fluid load>3 L were independent risk factors for AKI. The risk of death increased with the aggravation of AKI severity.
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Objective To explore the risk stratification of pulse oxygen saturation (SpO2) in patients with emergency hypoxemia patients, and to provide evidence for the identification of critical illness. Methods Self-designed clinical data registration form for patients with emergency hypoxemia , and prospective collection of 344 hypoxemia patients in the emergency department of Peking Union Medical College Hospital from March to April in 2018, including baseline data (name, gender, age, ID number, date, registration time), hospitalization method, past history, patient complaint and diagnosis, triage level, SpO2, whether to enter the rescue room, etc. Results All of 344 emergency hypoxemia patients, there were 163 cases (21.2% ) of ambulances, and 107 cases (31.1% ) of patients requiring immediate rescue. There were 54 cases (25.7%) and 53 cases (39.6%) in need of immediate rescue in day shift (8:00-20:00) and night shift (20:00-8:00 next day), with 9:00-10:00, 14:00-15:00, 20:00-24:00 in the majority. There was a statistical difference in the way of hospitalization, triage, and SpO(2 25.780, t=4.722, all P<0.05). SpO2 risk stratification was 0.905 in patients without pulmonary disease, and SpO2 risk stratification in patients with lung disease was 0.765. Conclusions Patients with hypoxemia account for a certain proportion in the emergency department and are in critical condition. The degree of critical condition of patients can be evaluated based on whether they have lung diseases, and the risk stratification of patients can be accurately determined with the help of SpO2, so as to further guide the hierarchical treatment measures for patients with emergency hypoxemia and rationally optimize the χ2=29.537, allocation of emergency resources.
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Objective@#To explore the risk stratification of pulse oxygen saturation (SpO2) in patients with emergency hypoxemia patients, and to provide evidence for the identification of critical illness.@*Methods@#Self-designed clinical data registration form for patients with emergency hypoxemia, and prospective collection of 344 hypoxemia patients in the emergency department of Peking Union Medical College Hospital from March to April in 2018, including baseline data (name, gender, age, ID number, date, registration time), hospitalization method, past history, patient complaint and diagnosis, triage level, SpO2, whether to enter the rescue room, etc.@*Results@#All of 344 emergency hypoxemia patients, there were 163 cases (21.2%) of ambulances, and 107 cases (31.1%) of patients requiring immediate rescue. There were 54 cases (25.7%) and 53 cases (39.6%) in need of immediate rescue in day shift (8:00-20:00) and night shift (20:00-8:00 next day), with 9:00-10:00, 14:00-15:00, 20:00-24:00 in the majority. There was a statistical difference in the way of hospitalization, triage, and SpO2 (χ2=29.537, 25.780, t=4.722, all P<0.05) . SpO2 risk stratification was 0.905 in patients without pulmonary disease, and SpO2 risk stratification in patients with lung disease was 0.765.@*Conclusions@#Patients with hypoxemia account for a certain proportion in the emergency department and are in critical condition. The degree of critical condition of patients can be evaluated based on whether they have lung diseases, and the risk stratification of patients can be accurately determined with the help of SpO2, so as to further guide the hierarchical treatment measures for patients with emergency hypoxemia and rationally optimize the allocation of emergency resources.
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Objective To investigate the characteristics of serum lipid levels in centenarians in Hainan province.Methods A total of 899 centenarians were enrolled.Fasting venous blood samples were collected,and serum levels of total cholesterol (TC),triglyceride (TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol (HDL-C),apolipoprotein A-1 (Apo A1),apolipoprotein B(Apo B) and lipoprotein (a) [Lp (a)] were determined.Characteristics of serum lipid levels in centenarians with different age and gender were analyzed.Results The ratio of male to female in this study was 1 ∶ 4,101 years of age comprised the largest proportion(20.4 ％,183 cases),and the highest age was 109 years old for men and 116 years old for women.People aged 102 years had the highest levels of TC,TG,LDL-C and Apo B,and also had the lowest levels of HDL-C and Apo A1.Serum levels of TC and LDL-C reached the peak at the age of 102 years and showed downward trends year by year.Serum levels of TC,TG,LDL-C,Apo A1 and Apo B were lower in males than in females(P＜0.01),and HDL-C had no significant difference between males and females(P ＞0.05).The detection rates for abnormal serum lipid levels were higher in females than in males(P＜0.01).Serum Lp(a) level was higher in females than in males.Conclusions Serum lipid levels show a peak expression at a certain age in centenarians of Hainan,and the types and ratio of abnormal blood lipids are higher in female centenarians than in male centenarians.
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Objective We investigate the possible effect of inflammative indicator C reactive protein(CRP) ,interleukin‐6(IL‐6) and procalcitonin(PCT) on the outcome of HBV infection .Methods The clinical data and peripheral serum of 48 patients with HBV related hepatocellular carcinoma and 48 patients with decompensated cirrhosis were collected ,HBV copy numbers ,PCT ,IL‐6 , CRP ,ALT ,AST ,prothrombin time(PT ) and other indicators were tested for comparison and correlative analysis .Results HBV copy numbers ,PCT ,CRP ,lymphocytes and mononuclear cells showed no significant difference between primary hepatocellular car‐cinoma and decompensated cirrhosis group;however ,IL‐6 level was significantly higher in decompensated liver cirrhosis than in hep‐atocellular carcinoma ,as opposed to the absolute number of neutrophils .Conclusion IL‐6 increase may be related to final outcome of HBV infection ,dynamic monitoring IL‐6 is helpful to evaluate the prognosis of HBV infection .
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Objective To analyze the risk factors of mucous plug caused byMycoplasma pneumoniae pneumonia (MPP) in children and guide clinical therapy to decrease the incidence of sequela caused by airway inlfammatory obstruc-tion.Methods We conducted a retrospective study of the clinical data of 116 children with MPP who received ifber broncho-scope from January 2012 to January 2014 admitted to the respiratory department of the Children's Hospital of Hebei provience. Based on the airway mucosal lesions seen through the bronchoscope, the subjects were divided into the mucous plug group (n=67) and the control group (n=49). Gender, age of onset, febrile course, pleural effusion, white blood cell counts, neutrophil ratio, C reactive protein (CRP), serum lactate dehydrogenase level (LDH), initial time of received macrolides and ifber bronchoscope were compared between the two groups. If the Results of single factor analysis showedP<0.05, the indicators were analyzed by the logistic regression analysis. The receiver operator characteristic (ROC) curve was drawn to evaluate the predictability of logistic regression model.Results The Results of single factor analysis showed that age of onset, febrile course, CRP, serum LDH, pleural effusion cases in the mucous plug group were higher than those in control group (P<0.05). The Results of the logis-tic regression analysis showed that older than three years (OR=7.45), febrile course more than 10 days (OR=4.01), the level of CRP and LDH higher than 40 mg/L (OR=5.41) and 350 U/L (OR=3.63) were respectively the risk factors of mucous plug caused by MPP in children. The area under the ROC curve is 0.846 (95%CI: 0.773-0.919,P=0.000).Conclusions MPP children with age older than three years, or with febrile course more than 10 days, or with the level of CRP and LDH higher than 40 mg/L and 350 U/L has the possibility of forming a mucous plug.
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Objective To establish the quality standard of Buxin Ruanmai granules. Methods TLC was used to identify Ophiopogonis, Corni Fructus, Hirudo, Ginkgo Folium and Polygoni Cuspidati Rhizoma et Radix. HPLC was used to determine the content of salidroside and loganin. Results Ophiopogonis, Corni Fructus, Hirudo, Ginkgo Folium and Polygoni Cuspidati Rhizoma et Radix could be identified by TLC. The linear range of salidroside was within 0.290 2-2.902 4 μg and the average recovery (n=6) was 99.64%(RSD=2.72%). The linear range of loganin was within 0.083 1-0.831 2 μg and the average recovery (n=6) was 100.12% (RSD=2.27%). Conclusion The method is simple, accurate and reproducible, which can effectively control the quality of Buxin Ruanmai granules.
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Objective To study the effect of immunocontraception of Spink12,the fusion protein 6?His-Spink12 was induced to express in E.coli BL21,and purified.MethodsThe total mouse epididymal RNA was extracted,and the Spink 12 protein coding exon without signal peptide sequence was amplified by RT-PCR,digested by restrictive enzyme Nde Ⅰ and EcoR Ⅰ,and then cloned into the prokaryotic expression vector pET28 (a) which contained the 6?His tag in N terminal.The recombinant plasmid pET28a-Spink12,after being confirmed by enzyme digestion and sequencing,was transformed into the competent cells of E.coli BL21.The fusion protein 6?His-Spink12 was expressed by IPTG induction and analyzed by SDS-PAGE and Western blotting.The products were purified by Ni-NTA under native condition with different imidazole gradients and characterized by Western blotting with anti-His monoclonal antibody.ResultsThe results of digestion and sequencing indicated that the recombinant prokaryotic expression vector pET28a-Spink12 was successfully constructed.After E.coli BL21 was transformed with pET28a-Spink12 and induced with IPTG,the recombinant target protein of about 9 kDa was obtained by SDS-PAGE analysis,which was coincident with the theoretical value.The fusion protein was of 23.5% of the total E.coli cell proteins.The Western blotting analysis with anti-His monoclonal antibody showed that the band was fusion protein 6?His-Spink12.After purified with Ni-NTA,a higher quality of fusion protein 6?His-Spink12 was obtained in a purity of 91.1%.ConclusionsThe fusion protein 6?His-Spink12 has been successfully expressed in E.coli BL21 and purified.It may provide a base for the study of the effect of Spink12 on immunocontraception.