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OBJECTIVE@#To test the reliability and validity of the Chinese version of adverse childhood experiences international questionnaire (ACE-IQ) in Chinese parents of preschool children.@*METHODS@#The parents of preschool children in 6 kindergartens in Tongzhou District of Beijing were selected by stratified random cluster sampling, and the Chinese version of ACE-IQ after translation and adaptation was used for survey online. The collected data were randomly divided into two parts. One part of the data (n=602) was used for exploratory factor analysis (EFA), to screen items and evaluate structural validity, and then form the final Chinese version of ACE-IQ. The other part of the data (n=700) was used for confirmatory factor analysis (CFA), criterion validity analysis and reliability analysis. At the same time, experts investigation method was used to evaluate the content validity of the final Chinese version of ACE-IQ.@*RESULTS@#After deleting four items of collective violence, the Chinese version of ACE-IQ with twenty-five items indicated good structural, criterion and content validity. Analysis results showed that the Chinese version of ACE-IQ presented a seven-factor model dimension, namely emotional neglect, physical neglect, family dysfunction, family violence, emotional and physical abuse, sexual abuse and violence outside the home, and the total score of the binary version of ACE-IQ Chinese version was positively correlated with the total score of childhood trauma questionaire-28 item short form (CTQ-SF, r=0.354, P < 0.001) and the center for epidemiological studies depression scale (CES-D, r=0.313, P < 0.001) respectively. Results from five experts showed that the item-level content validity index (I-CVI) of 25 items was between 0.80 and 1.00, and the average of all I-CVIs on the scale (S-CVI/Ave) of the scale was 0.984. At the same time, the internal consistency (Cronbach's α coefficient) of the whole scale was 0.818, and the split-half reliability (Spearman-Brown coefficient) was 0.621, which demonstrated good reliability.@*CONCLUSION@#This study has formed a Chinese version of ACE-IQ with 25 items and 7 dimensions, which has good reliability and validity among the parents of preschool children in China. It can be used as an evaluation instrument for measuring the minimum threshold of the adverse childhood experiences in the parents of preschool children in the cultural background of China.
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Humans , Child, Preschool , Adverse Childhood Experiences , Reproducibility of Results , Parents/psychology , Surveys and Questionnaires , China , Psychometrics/methodsABSTRACT
Hemodynamic instability is one of the main causes of death in critically ill children.Real-time and dynamic monitoring of hemodynamic changes is an important part of the work in intensive care units and operating rooms.For the past 50 years, invasive pulmonary catheter thermal dilution has been recognized as the "gold standard" for hemodynamic monitoring, but its clinical use has declined in recent years due to its patient injury, complications, and difficulty in operation.Therefore, hemodynamic monitoring techniques that are minimally or completely noninvasive, simple to perform, and highly correlated in accuracy with invasive methods are receiving increasing attention from pediatric clinicians.This review summarized the measuring principle and application status of various monitoring technologies, in order to provide evidence for the selection of appropriate monitoring methods in clinical practice.
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Objective:To understand the medical experience of patients with early lung cancer in pre-hospitalization, find out the problems and shortcomings in the service process, and provide the basis for improving the quality of medical service under the pre-hospitalization mode.Methods:Through phenomenological research method, 21 pre-hospitalized patients with early lung cancer from September to October 2020 in the First Hospital Affiliated to Guangzhou Medical University were selected by purpose sampling method for semi-structured interviews, and the research data were analyzed by Colaizzi seven-step method.Results:There were four themes in the medical experience of early lung cancer pre-hospitalized patients: the turnover rate of beds was fast, the length of stay and cost of stay were reduced, the inclusion criteria of pre-hospitalization lacked the humanization, admission and examination procedures needed to be optimized and insufficient doctor-patient communication during pre-hospitalization.Conclusions:The implementation of pre-hospitalization mode can make patients′ medical treatment more convenient and efficient, and reduce hospitalization expenses. However, there are still some shortcomings in the management of pre-hospitalization of early lung cancer patients. The pre-hospitalization process should be further standardized, and the communication and management of pre-hospitalization patients during waiting period for out-of-hospital examination should be strengthened.
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Sorafenib, as the first-line treatment drug for advanced hepatocellular carcinoma (HCC), can effectively improve the prognosis of patients with HCC, but sorafenib resistance has become a major obstacle to the therapeutic outcome of HCC. Recent studies have shown that non-coding RNA plays a key role in sorafenib resistance in HCC. This article summarizes that non-coding RNA regulates the sensitivity of HCC to sorafenib by inducing the autophagy of hepatoma cells, promoting the proliferation of liver cancer stem cells, promoting the EMT process of hepatoma cells, inhibiting the apoptosis of hepatoma cells, and regulating the microenvironment of liver cancer tissue. It is pointed out that the molecular mechanism of non-coding RNA in regulating sorafenib resistance in HCC has potential clinical significance in overcoming sorafenib resistance in HCC.
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Objective:Analyzed the funding data of the National Natural Science Foundation of China in the field of preventive medicine from 2009 to 2019 in Nanjing Medical University, to provide scientific basis for scientific research management and decision-making.Methods:Descriptive statistics was used to reveal the status of application and funding in the field of preventive medicine, the distribution and development trends of each secondary code, the research hotspots and key themes in this field.Results:From 2009 to 2019, Nanjing Medical University submitted 566 applications in total and 230 projects were funded with a total funding of 144.03 million in the field of preventive medicine. The top five codes in the funded projects were H2610, H2607, H2603, H2611 and H2601.The funding of H2610 was mainly concentrated in four major areas including cancer, cardiovascular and cerebrovascular diseases, diabetes and hematological system diseases.H2607 funded a large amount of projects for Non-coding RNA and related pathways in recent years. Funding in the H2603 were mainly focused on tumors, glucose metabolism disorders and vitamin A requirements. The funding rate in the H2605 was 9.26%, which was significantly lower than other secondary disciplines in preventive medicine.Conclusions:The National Natural Science Foundation of Preventive Medicine in the Nanjing Medical University has a good development trend, but it also faced challenges. In the future, evidence-based scientific management will be adopted to promote the development of preventive medicine according to the characteristics of different secondary disciplines.
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Objective@#To investigate the effect of pediatric early warning score(PEWS) on the evaluation of severity of emergency children admitted to pediatric intensive care unit(PICU).@*Methods@#A total of 1 069 cases hospitalized through emergency room into PICU in Guiyang Children′s Hospital, from January to December in 2017 were analyzed, and the PEWS was recorded for the first time in emergency room and PICU, while receiver operating curve was used to analyze the efficacy of PEWS to diagnose the children, who were at risk of clinical deterioration and required transfer to the PICU, which included the sensitivity, specificity, Youden index.The diagnostic value of PEWS in asse-ssing the severity of disease in critically ill children was explored.@*Results@#The 1 069 severe cases of PICU ranged from 1 month to 13 years and 8 months, and PEWS score was (4.6±0.8) scores in the emergency room, and (5.1±0.5) scores in the PICU, so there were significant differences of the PEWS score between the death group [(8.0±0.5) scores] and the survival group [(4.8±0.8) scores] in the emergency room and PICU(all P<0.05). The PEWS score of the respiratory, nervous, circulatory and digestive system groups in PICU was (5.8±0.5) scores, while other systemic diseases (blood, kidney, poisoning, and so on) PEWS score was(4.2±0.5) scores; which showed significant differences between 2 groups(t=4.60, P<0.05). In PICU, the score of PEWS was greater than or equal to 4.7, which was the demarcation point to distinguish the critical condition and predict the death risk of the patient.@*Conclusions@#PEWS is of great significance for assessing the children sent to PICU.Patients with mainly respiratory, circulatory, neurological, and digestive system diseases have higher PEWS scores.The PEWS score of other system diseases is significantly reduced.It is suggested that PEWS is not able to reflect the disease of such a system and needs to be taken seriously.
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Objective@#To evaluate the efficacy and side effects of priming regimen with pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF) in the treatment of initial treatment elderly patients with acute myeloid leukemia (AML).@*Methods@#Thirty-five elderly patients with early-stage AML (non-M3) who received pre-excitation chemotherapy in Yancheng Third People's Hospital from February 2015 to January 2019 were retrospectively analyzed. According to the different granulocyte colony-stimulating factor (G-CSF) in the chemotherapy regimen, 15 cases were in PEG-rhG-CSF group, 6 mg PEG-rhG-CSF was used alone on day 0 by subcutaneous injection; 20 cases were in recombinant human granulocyte colony-stimulating factor (rhG-CSF) group, 200 μg/m2 rhG-CSF was used per day from day 0 to day 13 by subcutaneous injection, rhG-CSF was suspended or continued according to the number of white blood cells. In addition, both groups were given priming regimen with cytarabine and arubicin, or cytarabine and harringtonine. The efficacy and adverse reactions of the two groups were compared.@*Results@#In the PEG-rhG-CSF group, there were 5 cases of complete remission, 6 cases of partial remission, 4 cases of non-remission, and 11 cases were effective. In the rhG-CSF group, there were 8 cases of complete remission, 7 cases of partial remission, 5 cases of non-remission, and 15 cases were effective. There was no significant difference in the efficacy between the two groups (χ 2= 0.012, P= 0.911). In terms of adverse reactions, the incidence of infectious fever, bone pain, duration of neutropenia, and duration of thrombocytopenia were not statistically significant (all P > 0.05).@*Conclusions@#In the pre-excitation chemotherapy for AML, the clinical efficacy and adverse effects of PEG-rhG-CSF are similar to rhG-CSF. However, the use of PEG-rhG-CSF can simplify the operation and reduce the pain and risk of local infection during chemotherapy.
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<p><b>Background</b>Research on the changes to knee structures in asymptomatic amateur ice hockey players (AAIHPs) has been limited. We aimed to assess the performance of the knees in AAIHPs using 3.0-T magnetic resonance imaging (MRI).</p><p><b>Methods</b>A total of 71 asymptomatic knees (32 AAIHPs and 39 age- and sex-matched controls) were imaged using a 3.0-T MRI scanner at the Affiliated Zhongshan Hospital of Dalian University in April 2017. Two experienced musculoskeletal radiologists were blinded to assess all MRI findings, including bursae around the knee, bone marrow edema (BME), meniscal signal changes, and articular cartilage and ligament damage. Any disagreements were resolved by a third professor of musculoskeletal radiology. Categorical variables were compared using the Chi-square test and continuous variables using the Student's t-test or Mann-Whitney U-test.</p><p><b>Results</b>The most common finding was fluid-filled bursae surrounding the knee. In the AAIHP group, which totaled 32 knees and 416 bursae, 155 (37%) fluid-filled bursae were present. In the control group, there were a total of 39 knees and 507 bursae, and 91 (18%) fluid-filled bursae were present. There was a significant difference in the number of fluid-filled bursae between the two groups (P < 0.05). However, in AAIHPs, the prevalence of meniscal signal changes (16 knees, 50%) was higher than in the control group (2 knees, 5%; P < 0.001). Importantly, 15 of the 19 were grade II signals. Other changes were only found in AAIHPs. Articular cartilage lesions were detected in 47% of their knees, predominantly at the patellofemoral joint, and BME was found in 34% of their knees.</p><p><b>Conclusion</b>The MRI findings of knees in AAIHPs mainly manifested as self-protection reaction, and proper ice hockey exercise could be advocated.</p>
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Adolescent , Adult , Child , Female , Humans , Male , Young Adult , Case-Control Studies , Knee Joint , Diagnostic Imaging , Magnetic Resonance Imaging , Methods , Meniscus , Diagnostic ImagingABSTRACT
Objective The aim of the study was to evaluate the hearing performance of a new transcutaneous bone conduction hearing aid.Methods One hundred and nine patients with conductive or mix hearing loss and eleven patients with single sided sensorineural hearing loss from four tertiary referral centers were tested under unaided and aided conditions with the sound processors on testbands.Free field test was performed to obtain the hearing thresholds and speech recognition thresholds in quiet.Adverse events were also documented by a self-reported questionnaire.Results ①Conductive or mixed hearing loss patients:for aged≥6 yrs subgroup,the bone conduction PTA average of aided sides was 18.55±8.99 dB HL.For aged<6 yrs subgroup, the bone conduction ABR hearing threshold average was 18.33±8.36 dB HL.②Statistically significant improvements in free field hearing thresholds were seen when compared aided hearing with unaided outcomes.The average PTA (pure tone average in free field) was measured at 32.21±10.00, 37.33±14.15, and 34.38±10.76 dB HL respectively in conductive or mixed hearing loss aged≥6 yrs subgroup;aged<6 yrs subgroup and SSD subgroup.③In aided situations;speech recognition thresholds in quiet were significantly better compared to unaided situation in patients aged≥6yrs.④None of patients presented adverse events related to the devices.Conclusion The Sophono bone conduction hearing aid has satisfactory hearing performance and can be considered an alternative device for patients with conductive or mix hearing loss or with SSD.
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Objective To investigate the strategy of cardiopulmonary resuscitation (CPR) after lung protective mechanical ventilation in critical children and follow-up study of the survivals 90 d after discharge.Methods Four hundred and eighty-nine cases of respiratory cardiac arrest which occurred for various reasons from January 2011 to June 2016 were analyzed in Pediatric Intensive Care Unit (PICU) in Guiyang Children's Hospital,in which mechanical ventilation was performed after CPR in 251 cases,death,or giving up treatment within 24 h in 83 cases,children surviving ＞ 24 h in 168 cases,118 cases were assigned into small tidal volume ventilation group,and 50 cases into conventional tidal volume ventilation group,and according to the tidal volume to adjust positive end expiratory pressure ventilation (PEEP),and the oxygen partial pressure [pa (O2)] and the oxygen index (OI),the change of the indexes of blood gas analysis,lactic acid clearance,and oxygenation were also observed.To observe the complications of mechanical ventilation,the situation of withdrawing machine as well as the outcome of the children.Follow-up was conducted for 90 d,including continuous respiratory symptoms,lung imaging examination after discharge and lung function,nervous system examination.Results (1) After mechanical ventilation treatment of 48 hours,compared with the levels of fractional inspired oxygen (FiO2) (0.42 ± 0.15 vs.0.43 ± 0.22),pa (O2) (8.25 ± 0.22 vs.8.27 ± 0.68),OI (5.33 ± 2.01 vs.6.59 ± 1.99) and lactic acid clearance(61.05 ± 1.87 vs.60.93 ± 2.71) between the routine tidal volume ventilation group and the lower tidal volume ventilation group,showing that the difference had no statistical significance (t =1.645,1.165,2.302,2.037,all P ＞ 0.05).(2) In small tidal volume group,the incidence of ventilator associated lung injury was significantly lower than that in the conventional tidal volume group,and the difference was statistically significant (x2 =5.873,P ＜ 0.05).(3) Comparing 2 groups of different tidal volume ventilation,the mortality of critical ill children had no statistically significant difference (x2 =1.063,P ＞ 0.05).(4) One hundred and twenty-seven cases of children survived and were discharged,and compared with their discharge,the follow-up of 62 cases after discharge for 30 d,90 d showed that all the children's lung function improved,tidal volume,inspiratory and expiratory time ratio(I/E),volume ratio of peak(VP/VE),time ratio of peak(TP/TE) and breathing rate(RR) were also improved,and there was significant difference (F =43.225,6.108,68.821,78.237,20.361,all P ＜ 0.05).(5) Neurological examination and children's brain function classification rating scale showed that some children had nerve dysfunction.Conclusions Small tidal volume ventilation in reducing the occurrence of ventilator associated lung injury is superior to the conventional tidal volume ventilation.To improve case fatality rate of the children with cardiac arrest resuscitation and oxygenation is not better than the conventional tidal volume group.Dynamic monitoring is helpful to adjust breathing mechanics indexes and parameters and ventilator.Through the follow-up most of the discharged children recovered well,but a few had recurrent respiratory infection and neurological sequelae.
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Objective To evaluate the appropriateness of hospitalization days at a tertiary hospital in 2014 by means of the Appropriateness Evaluation Protocol ( AEP ) , and to analyze the causes of inappropriate stays. Methods Medical records of inpatients admitted at a tertiary hospital in 2014 were randomly selected. AEP( US version) was used to evaluate the appropriateness of every hospitalization day, while the causes of inappropriate hospitalization day were also analyzed. Results A total of 1 641 days of stay from 148 medical records were reviewed, and 129 days of stay (7. 9%) were seen as inappropriate. Two major factors for inappropriate stays were waiting for surgery and waiting for test, roughly 89. 1% of the inappropriate hospitalization days. The proportion of inappropriate hospital stays reduced to 4. 8% after adjustment of two-day weekend. Inappropriate hospital stays mostly appeared during the second day to the eighth day after admission(93. 8%). Logistic analysis results showed that with concomitant symptoms, preoperative waiting days > 5 days, high level surgery, non-emergency admission were significantly associated with appropriateness of hospital stays (P<0. 05). Conclusions The rate of inappropriate stays will be reduced and the quality of medical services will be improved if comprehensive measures could be carried out according to the causes of inappropriate stays.
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Objective To investigate the relationship between plasma homocysteine on admission and the outcome at discharge of acute ischemic stroke.Methods A non-concurrent cohort study was performed and a total of 1 3 1 9 patients with acute is-chemic stroke were continuously included in this study.According to tertile range of plasma homocysteine,patients were di-vided into three group.Logistic regression analysis was used to assess the independent association between plasma homocys-teine on admission and poor outcome at discharge of acute ischemic stroke.Results The difference of plasma homocysteine on admission between the poor outcome and those with good outcome had statistical significance (P<0.000 1).Without the adj ustment of multiple factors,when comparing to the first group,the second and third tertile seemed to have a tendency of increasing the risk of poor outcome at discharge,the OR (95%CI)was 2.111 (1.297~3.437,P<0.05),2.113 (1.361~3.279,P<0.05).After adjustment for multivariate,the second and third tertile also seemed to have a tendency of increasing the risk of poor outcome at discharge,the OR (95%CI)was 1.876 (1.160~3.036,P<0.05),2.396 (1.414~4.062,P<0.05).Conclusion The current study indicated that higher plasma homocysteine level was an independent risk factor for poor outcome at discharge in ischemic stroke patients.It would increase the risk of the outcome at discharge in patients with acute ischemic stroke,and suggests that there is a dose-response relationship between plasma homocysteine level on admis-sion and the poor outcome at discharge.
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Objective To study of zoledronic acid in the treatment of multiple myeloma bone dis-ease clinical effect and detection of serum macrophage inflammatory protein (MIP)changes of primary mye-loma (mm)in patients with serum macrophage inflammatory protein levels and multiple myeloma bone dis-ease curative effect.Methods 48 cases of multiple myeloma bone disease patients were treated with VTD regimen chemotherapy were randomly and equally divided into two groups,one group (group A)chemother-apy intermission applied zoledronic acid 4 mg per month 1 time,treatment 2 course of treatment,observa-tion of curative effect and adverse reaction,another group (B group)declined to azole phosphonic acid treatment.Results Group of pain Solution of 16 cases were markedly effective,effective in 4 cases,4 ca-ses were ineffective,efficiency 83.3%.B group bone pain relieved markedly effective in 12 cases,effective in 4 cases,8 cases were ineffective,have efficiency 66.7%.A compared to the B,the curative effect was obvious (P <0.05).By enzyme linked immunosorbent assay for the detection of the patients with a,levels of peripheral serum MIP-1a and MIP-1 beta B two groups before and after treatment.Conclusions zole-dronic acid in the treatment of multiple myeloma bone disease effectively,can significantly improve the qual-ity of life in patients with MM patients serum MIP-1a and MIP-1 beta level and multiple myeloma tumor bone disease curative effect is negative correlation,used for evaluating the effect The reference index.
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Objective To evaluate the clinical effect of Decitabine as the basis of the chemotherapy regimen on the treatment of elderly patients with acute myeloid leukemia( AML)?Methods The clinical data of elderly patients with AML admitted to the Third People ’ s Hospital of Yancheng from January 2013 to November 2015 were retrospective analyzed?The patients were divided into Decitabine group ( cases ) and the traditional group(19 cases) according to whether or not useed Decitabine,then evaluated the efficacy?Results The overall response rate( ORR) was 70?0% in 10 patients received decitabine,47?4% in 9 patents of the traditional group, and the difference was significant( P=0?03)?At the same time,the median survival time of the two groups was 44?87 months and 13?40 months respectively,the difference was statistically significant between the two groups (P=0?04)?There was no significant difference in the incidence of adverse reactions between the two groups ( granulocyte reduction, PLT reduction, fatigue, cardiovascular events, and respiratory tract infections ) ( P>0?05)?Conclusion The effect of Decitabine as the basis of the chemotherapy regimen on the treatment of AML is better,can prolong the survival time.
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Objective To examine the association between uric acid (UA)levels of patients with acute ischemic stroke at ad-mission and discharged outcome.Methods The acute ischemic stroke patients of Xinganmeng People’s Hospital in Inner Mongolia,from June 1,2009 to May 31,2012 were continuity included in the present study,the included analysis sample size were 3 440 cases.Poor discharged outcome was defined as the occurrence of disability or death.With reference to the Modi-fied Rankin's Scale (MRs)Stroke Scale,Scores were recorded in the questionnaires,score of 3 or more (MRs≥3)was de-fined as disability.The patients were all grouped by P20,P60,P90 of UA,binary logistic regression were used in studying of risk factors,calculated the odds ratios (Odds ratio,OR)and 95% confidence interval (95% Confident interval,95%CI).All tests were two-sided test and a significance level of 0.05.Results A total of 359 people occurred poor outcomes in the stud-y,accounting for 10.44%.Univariate logistic regression analysis of poor outcome occurred showed that relative to the lowest group(P20,UA≤222.6 mmol/L),the second and third group (UA:222.7 ~ 310.9 mmol/L and 311.0~419.7 mmol/L) OR (95% CI)were:0.70(0.53~0.91)(P <0.05)and 0.66(0.49~0.88)(P <0.05).After adjusted age,body tempera-ture,high blood pressure,hyperglycemia,history of stroke,high triglycerides,high LDL-C and smoking,relative to the low-est level group,the second and third group occurred poor outcoming OR (95% CI)were:0.70(0.53~0.93)(P <0.05)and 0.66(0.48~0.90)(P <0.05).Conclusion Higher levels of uric acid levels in patients with acute ischemic stroke may inde-pendently related with occurred poor discharged outcome.
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Obgective To explore the antimicrobial resistance genotypes and molecular epidemic features of Klebsiella pneumoniae (K.pneumoniae) producing extended spectrum 3-lactamases (ESBLs) in the Pediatric Intensive Care Unit (PICU) of Guiyang Children' s Hospital.Methods Disc diffusion technique (Kirby-Bauer method) and automatic microbiology analysis system were employed to determine the antimicrobial resistance,and Double-disk Diffusion was adopted in the phenotype confirmatory test of ESBLs,and PCR was used to determine the antimicrobial resistance genotypes.Results Among 44 straits of non-repetitive-K.pneumoniae,isolated from the children during hospitalization since April to December of 2013,29 straits (65.9％) were detected.The findings of sensitivity tests showed that 29 strains of ESBLs-producing K.pneumoniae presented a higher rate of sensitivity to carbapenems,cephamycin and quinolones,100％ resistance to penicillin and cephalosporins of the first and the second generations.Fifteen non-ESBLs-producing K.pneumoniae presented 100％ resistance to penicillin.The rate of resistance to 9 kinds of antibiotics (Ampicillin/Sulbactam,Cefazolin,Cefuroxime,Cefamandole,Cefiriaxone,Ceftazidime,Cefepime,Gentamicin,Aztreonam) in ESBLs-producing K.pneumoniae strains(79.3％,100.0％,100.0％,100.0％,100.0％,79.3％,65.5％,41.4％,79.3％) was significantly higher than that of non-ESBLs-producing K.pneumoniae trains (13.3％,6.7％,20.0％,20.0％,0,0,0,6.7％,0) (x2 =17.54,35.51,28.00,28.00,44.00,24.93,17.30,4.18,24.93,all P ＜ 0.05).In 29 strains of ESBLs-producing K.pneumoniae,3 genotypes were detected respectively:93.1％ of SHV (27/29 strains),51.7 ％ of TEM (15/29 strains) and 37.9 ％ of CTX-M (11/29 strains).Five forms of genotype distribution were presented:14 (43.8％) strains carrying single ESBLs gene,5 (17.2％) strains carrying 2 types,19 (31.0％) strains carrying 3 types,and 1 strain had not been genotyped.Conclusions ESBLs-producing K.pneumoniae had been epidemic in PICU of Guiyang Children's Hospital,with multiple antimicrobial resistances and diversification of antimicrobial resistance genotypes.
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Objective To explore the methods of the nutritional support of children with severe sepsis.Methods The biochemical index,nutrition index,blood gas,blood routine and 24 hours urinary urea nitrogen of 198 children with severe sepsis were detected after hospitalization.Enteral nutrition,parenteral nutrition,or enteral and parenteral nutrition at the same time were selected for every children according to patients status.Children with parenteral nutrition were divided into glutamine (Gln) group and non-Gln group.Nutrition and metabolism indexes of survival and dead children were detected,including blood glucose,C-reactive protein,hemoglobin (Hb),pH,blood sodium,blood potassium,alanine transaminase,blood urea nitrogen,creatinine,blood lacticacid,lactate clearance rate,blood triglycerides,blood total cholesterol,serum pre-albumin (PA),retinal-binding protein (RBP),serum albumin (ALB) and 24 hours urinary urea nitrogen.The intake of calories were compared between survival and dead children before nutrition support (0 d),3 d and 7 d after nutrition support.Immunoglobulins of Gln group and non-Gln group were compared.Results The nutrition indexes of the survival group were higher than those of dead group [PA (130.0 ± 30.0) mg/L vs (50.8 ±20.5) mg/L,RBP(22.3 ±10.3) mg/L vs (15.7 ±6.7) mg/L,ALB(35.3 ±8.1) g/L vs (28.7 ±6.2) g/L,Hb(113.2 ±27.7) g/L vs (95.3 ±10.6) g/L,IgA(0.40 ±0.03) g/L vs (0.40 ±0.03) g/L,IgM(0.52 ±0.18) g/L vs (0.49 ±0.03) g/L] (P ＜0.05).The intake calories of survival group in 3 d and 7 d after nutrition support were (50.32 ±2.76) kcal/(kg·d) and (65.70 ±3.25) kcal/(kg·d),which were significantly higher than those of dead group [(32.54 ± 1.72) kcal/(kg·d) and (46.12 ± 1.08) kcal/(kg·d)).Among the survival children with parenteral nutrition,the levels of immunoglobulin in Gln group were higher than non-Gln group [IgG(4.93 ± 2.1) g/L vs (4.01 ± 1.03) g/L,IgA (0.31 ± 0.07) g/L vs (0.19 ±0.03) g/L,IgM(0.52 ±0.08) g/L vs (0.32 ±0.10) g/L] (P ＜0.05).Negative nitrogen balance was better in Gln group as(-2.5 ± 1.4) g/d than non-Gln group as (-5.3 ± 1.3) g/d(P ＜0.05).Conclusion Children with severe sepsis manifeste significantly increased metabolic rate and energy consumption,the protein decomposition utilization is greater than the synthetic with negative nitrogen balance.Children with more severe sepsis have lower metabolic indexes,nutrition indexes,and immunoglobulin.It is necessary for children with severe sepsis to use glutamine while having parenteral nutrition.
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Objective To explore the association of serum bilirubin level at the time of admission with the compos?ite outcome（disability or death）in discharged patients with acute ischemic stroke. Methods In a retrospective cohortstudy from June 1st 2009 to May 31st 2012, we continuously included 3151 patients with acute ischemic stroke and col?lected demography,lifestyle,clinical manifestations and laboratory test data. Functional outcome was measured with themodified Rankin scale (mRS) when subjects were discharged. Disability was defined as mRS≥3 and composite outcomewas defined as mRS≥3 or death. Serum bilirubin was divided into four groups according to the quartile. Multiple Coxregression analysis was used to assess the independent relation between serum bilirubin and disability death and the com?posite outcome. Results There were 407 disabled patients，the disability rate was 12.9%；and 104 patients were dead，the fatality rate was 3.3%.After adjusting for multiple factors, we found the risks of composite outcome with total bilirubin in the four quartile were higher than that in the first quartile, aHR and 95%CI were 1.335(1.047～1.702) respectively；The risks of composite outcome with indirect bilirubin in the four quartile were higher than that in the first quartile, aHR and 95%CI were 1.355(1.062～1.728) respectively; The risks of composite outcome with bilirubin direct in the third and the forth quartile were higher than that in the first quartile, aHR and 95% CI were11.403(1.089～1.807)and 1.431 (1.118～1.833) respectively.With the increase of total bilirubin，indirect bilirubin and direct bilirubin level，the compos?ite outcome of discharged patient was on the increase. Conclusions The study indicated that higher serum bilirubincould increase the risk of composite outcome in ischemic stroke patients, there was dose-response relationship ,and bili?rubin was a independent risk factor.
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BACKGROUND:It is important to prepare a mal eable putty to repair irregular bone defects because the preformed bone substitute material cannot suit to bone defects. OBJECTIVE:To prepare mal eable demineralized bone matrix/hyaluronic acid putty and to screen out the optimal composite ratio, as wel as to evaluate its cellcompatibility. METHODS:Demineralized bone matrix was prepared from the cortical bone of healthy donors. The hyaluronic acid was dissolved at concentrations of 0.75%, 1.5%, 3%, 4.5%, and the viscosity of them was measured. Then 450 mg demineralized bone matrix was compounded with 1 mL hyaluronic acid solution to prepare the demineralized bone matrix/hyaluronic acid putty, and the optimal ratio of demineralized bone matrix/hyaluronic acid was screened by the disintegrated time of the putty at 37 ℃. L-929 mouse fibroblasts were cultured in the leaching liquor of demineralized bone matrix/hyaluronic acid, and the cytotoxicity was tested by cellcount kit-8 assay at days 1, 4 and 7. RESULTS AND CONCLUSION:With the increase of hyaluronic acid concentration, the viscosity of hyaluronic acid solution was increased;the demineralized bone matrix/hyaluronic acid putty was strengthened and the disintegrated time was prolonged gradual y. When the ratio of demineralized bone matrix/hyaluronic acid was 15/1, demineralized bone matrix/hyaluronic acid was molded easily, and the disintegrated time was 8 hours in 7 ℃ PBS. The results of cytotoxicity showed that cellproliferation rates were 93.72%, 101.65%and 97.68%at days 1, 4 and 7 respectively, while the cytotoxicity was in grade 0 or 1. These findings indicate that demineralized bone matrix/hyaluronic acid putty at a compound ratio of 15:1 can be molded easily and difficult to disintegrate, with low cytotoxicity.
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Objective To explore the association between quality of sleep and quality of life among residents of Suzhou city.Methods A total of 3225 residents at the age of 18-55 years old in Suzhou city were selected through a clustered sampling method.All the participants were comprehensively evaluated on their quality of sleep by Pittsburgh Sleep Quality Index (PSQI) and on their quality of life (QOL) by SF-36 quality of life scale.Partial canonical correlation analysis was performed.Results Negative relationships were noticed between all the dimensions of sleep quality white all the QOL domains remained significant when the confounding effect of age,gender,marital status,occupation and cultural level were adjusted.The first pair of canonical correlation variances showed statistically significant differences,with 0.7978 of canonical correlation coefficient,1.7505 of eigenvalue,and 92.43％ of proportion.Data on daytime dysfunction,sleep disturbances and subjective sleep quality were inversely associated with factors as vitality,general health perceptions and mental health,respectively,after controlling for covariates.The inverse relationship between the quality of sleep and the quality of life mainly manifested the following aspects:the association between the status of daytime dysfunction,sleep disturbances,subjective quality of sleep and vitality,general health perceptions and mental health.Conclusion Quality of sleep had influenced the quality of life,overall health and mental health.Daytime dysfunction,sleep disturbances and subjective sleep quality seemed the main factors in Suzhou city.Intervention programs related to improving the sleep need to be popularized among the residents,so as to make the quality of life better.