ABSTRACT
Background:In the clinical setting, the effect of intra-abdominal hypertension on the human body is dependent on time, but its role is not yet clear.Objective:To investigate the effect of the duration of intra-abdominal hypertension (IAH) on the prognosis of critically ill patients.Methods:This prospective cohort study enrolled 256 IAH patients who were admitted to the Surgical ICU of 10 Grade A hospitals in Fujian Province from January 2018 to December 2020. The duration of IAH (DIAH) was obtained after monitoring IAP, and ICU length of stay, duration of mechanical ventilation, duration of continuous renal replacement therapy (CRRT) and average daily energy intake from enteral nutrition during ICU stay were observed and recorded. The correlation was analyzed by Spearman rank correlation. The patients were divided into the survival group and the death group according to their survival state at 60 days after enrollment. Thereafter, clinical characteristics between the two groups were compared. Multivariable logistic regression was used to study and validate the relationship between DIAH and 60-day mortality. The receiver operating characteristics (ROC) curve was established to evaluate the predictive abilities of DIAH on the mortality risk.Results:In critically ill patients, DIAH was positively correlated with duration of mechanical ventilation ( r=0.679, P<0.001), duration of CRRT ( r=0.541, P<0.001) and ICU length of stay ( r=0.794, P<0.001), respectively. In addition, there was a negative correlation between DIAH and average daily energy intake from enteral nutrition ( r=-0.669, P<0.001). After multivariable adjustment, DIAH was an independent risk factor for 60-day mortality in critically patients with IAH ( OR=1.05, 95% CI: 1.01-1.12; P = 0.012), and exhibited a linearity change trend relationship with mortality risk. The ROC curve analysis of DIAH showed that the area under ROC curve (AUC) was 0.825 (95% CI: 0.763~0.886, P<0.01). When the cut-off value was 16.5 days, the sensitivity was 78.4% and the specificity was 75.4%. Conclusions:DIAH is an important risk factor for prognosis in critically ill patients. Early identification and rapid intervention for the etiology of IAH should be performed to shorten DIAH.
ABSTRACT
Objective To investigate the clinical effect of Shenfu injection in the treatment of patients with post - cardiac arrest syndrome(PCAS),to analyze the patients' blood C - reactive protein (CRP) and early mean arterial pressure. Methods From September 2013 to September 2016,80 patients with PCAS in the No. 98 Hospital of PLA were randomly divided into study group and control group according to the digital table,with 40 cases in each group. The study group was treated by Shenfu injection,the control group was treated by saline. The changes of CRP,mean arterial pressure and GCS score at 4h,12h,1d,2d and 3d after resuscitation and the 90d survival rate were observed. Results At 4h,12h,1d,2d and 3d after resuscitation,the peripheral blood CRP levels in the study group were (22. 01 ±2. 16)mg/ L,(34. 68 ± 4. 95)mg/ L,(62. 51 ± 3. 68)mg/ L,(98. 65 ± 6. 57)mg/ L,(100. 67 ± 10. 03)mg/ L, respectively,which in the control group were (25. 16 ± 3. 54)mg/ L,(41. 52 ± 5. 31)mg/ L,(75. 09 ± 4. 58)mg/ L, (120. 48 ± 10. 61)mg/ L,(128. 26 ± 9. 64)mg/ L,respectively,there were statistically significant differences between the two groups(t = 4. 804,5. 959,13. 542,11. 063,12. 543,all P < 0. 01). At 4h,12h,1d,2d and 3d after resuscita-tion,the mean arterial pressure in the study group were (78. 03 ± 8. 65)mmHg,(88. 34 ± 10. 20)mmHg,(97. 05 ± 9. 57)mmHg,(105. 29 ± 10. 45)mmHg,(112. 14 ± 9. 46) mmHg,respectively,which were higher than those in the control group [(68. 21 ± 8. 03)mmHg,(74. 01 ± 10. 59) mmHg,(83. 09 ± 11. 25) mmHg,(98. 25 ± 9. 17) mmHg, (104. 68 ± 3. 14)mmHg](t = 5. 262,6. 164,5. 978,3. 203,4. 733,all P < 0. 01). At 4h,12h,1d,2d and 3d after resuscitation,the GCS scores of the study group were (5. 21 ± 1. 12) points, (5. 78 ± 2. 05) points, (6. 85 ± 1. 68)points,(7. 91 ± 2. 57)points,(9. 98 ± 2. 07) points,respectively,which were higher than those of the control group [(4. 01 ± 2. 14) points, (4. 22 ± 3. 75) points, (4. 39 ± 3. 89) points, (4. 41 ± 2. 86) points, (5. 06 ± 4. 14)points](t = 3. 142,2. 309,3. 672,5. 757,6. 723,all P < 0. 05). The survival rate of the study group was 50％(20 / 40) at 90d after resuscitation,which was higher than that of the control group [23％ (9 / 40)](χ2 = 6. 545,P =0. 011). Conclusion Shenfu injection has protective effect on the function of patients with CRP after surgery,and can improve the prognosis of patients,it is worthy of clinical use.
ABSTRACT
Objective To investigate the diagnostic significance of bone marrow smear combined with bone marrow biopsy in pancytopenia.Methods The clinical data of 94 pancytopenia patients who were detected by bone marrow smear and bone marrow biopsy synchronously were retrospectively analyzed.Results In 94 pancytopenia patients,leukemia was in 29 cases (30.85％),myelodysplastic syndrome (MDS)was in 20 cases (21.28％),aplastic anemia (AA) was in 18 cases (19.15％),multiple myeloma (MM) was in 4 cases (4.26％),primary myelofibrosis (MF) was in 2 cases (2.13％),metastatic cancer was in 3 cases (3.19％),lymphoma in bone marrow infiltration was in 3 cases (3.19％),megaloblastic anemia (MA) was in 10 cases (10.64％),and iron deficiency anemia (IDA) was in 5 cases (5.32％).In 29 leukemia patients,acute myeloid leukemia-M2 (AML-M2) was in 5 cases,acute myeloid leukemia-M3 (AML-M3) was in 9 cases,acute myeloid leukemia-M5 (AML-M55) was in 6 cases,acute myeloid leukemia-M4 (AML-M4) was in 2 cases,acute lymphoblastic leukemia (ALL) was in 3 cases,chronic lymphocytic leukemia (CLL) was in 3 cases,and hairy cell leukemia was in 1 case.The diagnostic accuracy of bone marrow smear was 88.30％ (83/94),the diagnostic accuracy of bone marrow biopsy was 92.55％ (87/94),and the diagnostic accuracy of bone marrow smear combined with bone marrow biopsy was 98.94％ (93/94).The diagnostic accuracy of bone marrow biopsy was higher than that of bone marrow smear,but there was no statistical difference (x2 =0.89,P ＞ 0.05).The diagnostic accuracy of bone marrow smear combined with bone marrow biopsy was higher than that of bone marrow smear,and there was statistical difference (x2 =8.70,P ＜ 0.01).There was no statistical difference in the misdiagnosis rate between bone marrow smear and bone marrow biopsy:11.70％ (11/94) vs.7.45％(7/94),x2 =0.89,P ＞ 0.05.Conclusions The bone marrow smear combined with the bone marrow biopsy can improve the diagnostic accuracy of the blood system diseases,especially in pancytopenia,and has a very important diagnostic significance.It should be included in routine testing project.
ABSTRACT
Objective To evaluate the clinical effect of the chest orthosis on patients with multiple rib or(and) sternal fracture in early period of closed chest trauma.Methods Patients with multiple fractured of ribs or (and) sternal fracture were divided into control group (n =16)treated with the traditional fixation methods ( thoracic girdle added with folding towels) and experimental group ( n =30 ) treated with chest orthosis between January 2009 and December 2011.Correlated parameters of these patients in the two groups,including pain,indexes of blood gas analysis,pulmonary complications and hospitalization time were evaluated.Results There were significant differences on visual analogue scale(VAS) [ (4.45 ±2.23) vs (8.15 ±2.02),t =2.921,P ＜0.01 ],blood gas analysis including PaO2 [ 88.16 ± 9.12) mm Hg vs (77.22 ± 6.24 ) mm Hg,t =2.413,P ＜0.05] andPaCO2[ (40.91 ±3.40)mm Hg vs (46.06 ±5.40)mm Hg,t =2.335,P＜0.05] between experimental group and control group.The incidence rate of pulmonary complications in experimental group was significantly lower than that in control group [ 17％ ( 5/30 ) vs 44％ ( 7/16 ),x2 =23.478,P ＜ 0.05 ].And hospitalization time in experimental group was significantly shorter compared with control group[ (7.26 ± 4.17) d vs ( 14.26 ±3.53)d,t =2.430,P ＜0.05].Conclusion The chest orthosis in early treatment of chest trauma can reduce the pain and improve the condition of patients,and it is a simple,effective and cheap method with significant clinical effect.
ABSTRACT
Objective To explore a rapid,simple and effective therapy for serious pneumothorax which could be used in pre-hospital and in-hospital first-aid.Methods Sixty-seven patients were randomly divided into the observation group and control group .Patients in the observation group were treated using laparoscopic trocar for rapidly closed thoracic drainage,and patients in the control group were treated by using the traditional large caliber drainage tube and the intercostal incision method of conventional closed thoracic drainage.The operation time,remaining time of drainage,length of stay,effective rate,and complications,including of postoperative pain,hemorrhage,subcutaneous emphysema and infection were observed in both groups. Results The total effective rate was 94.1%(32/34) in the observation group,which was significantly higher than that in the control group(90.9%,30/33)(x2=1.876,P＞0.05).No significant difference was found on the remaining time of drainage and length of stay between the two groups(remaining time of drainage:[4.56±1.65]d vs.[6.26±3.45]d;length of stay:(6.0±2.6)d vs.(6.7±2.2)d ,t=1.335 and 0.779,respectively,Ps＞0.05).The operation time of using laparoscopic trocar was significantly lower than that of the control group((5.00±1.28)min vs.(15.00±4.03)min,t=3.031,P＜0.05).The incision length was(0.95±0.11)cm in the observational group,which was significantly lower than that in the control group((2.41±0.52)cm ,t=2.585,P＜0.05).Postoperative pain occurred in 14.7%(5/34) of patients in the observational group,which was significantly lower than that in the control group(87.9%(29/33))(t=2.983,P＜0.05).In the observational group no hemorrhage and infection occurred,whereas in the control group the hemorrhage and infection rate was 36%(12/33) and 33%(11/33),respectively(x2=5.880 and 3.687,respectively,Ps＜0.05). Conclusion The use of laparoscopic trocar for rapidly closed thoracic drainage in the treatment of serious pneu-mothorax is simple,easy,convenient,effective and reliable,with few complications.This therapy is suitable for using in pre-hospital and in-hospital first-aid.
ABSTRACT
Objective To evaluate the clinical pathology meaning of atypical squamous cell of undetermined significance (ASCUS) in cervical cytology. Methods The clinical data of 2118 cases who underwent cervical liquid thin-prep cell test (TCT) were analyzed retrospectively, ASCUS and squamous epithelium (SIL) were diagnosed according to the classification of the data TBS cytology, the histopathological examination results were tracked. Results The incidence of ASCUS was 3.4% (72/2218), and the ratio for SIL ( 1.2%, 25/2118) was 2.9. In the cellular pathology of ASCUS, there were four aspects, atypical surface cells and atypical hollowed cells in 16 cases (22.2%), atypical atrophy of the squamous epithelial cells in 11 cases (15.3%), atypical mature or immature metaplastic cells 28 cases (38.9%), atypical cells less influence diagnosis 17 cases (23.6%). Tracking the histologic findings in 43 cases with chronic cervicitis 22 cases (51.2%), low level squamous epithelium neoplasia in 12 cases (27.9%), high levels of squamous epithelial change in 8 cases (18.6%), squamous cell carcinoma 1 case(2.3%). Conclusion ASCUS exists within the risk of squamous lesions, management should be strengthened.
ABSTRACT
Objective Investigate the frequency of loss of heterozygosity (LOH) at chromosome arm the short arm chromosome 3p14,25 in the serum DNA from ovarian cancer and its clinical application Methods Thirty eight ovarian cancer serum samples with 18 corresponding tumor tissues and 8 benign ovarian tumors were obtained,and DNA samples extracted from serum and tissue were examined for 3p14,25 LOH by using of polymerase chain reaction with four polymorphic microsatellite markers (D3S1029, D3S1228, D3S1300, D3S1481) Results Matched serum and tissue DNAs from 18 ovarian cancer patients showed significant concordance of 3p14,25 LOH ( P
ABSTRACT
Objective To analyse the prevalence, etiology, presentation, preserving ovary and progonosis of cervical cancer in women under 35 years old. Methods The clinical information of 174 patients were retrospectively analysed.Results The percentage of new cervical cancer cases from 1991 to 2001 was 1.2%, 1.2%, 4.3%, 4.2%, 4.6%, 4.5%, 7.3%, 9.0%, 10.7%, 9.4%, 10.8%, respectively( P 0.05).For patients with two or more risk factors, it was 68%, 1/7, respectively ( P