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OBJECTIVE@#To establish a new emergency dynamic score (EDS) method based on modified early warning score (MEWS) combined with clinical symptoms, rapidly available examination results and bedside examination data in the emergency department, and to observe its applicability and feasibility in the clinical application of emergency department.@*METHODS@#A total of 500 patients admitted to the department of emergency of Xing'an County People's Hospital from July 2021 to April 2022 were selected as research objects. After admission, EDS and MEWS scores were performed first, and then acute physiology and chronic health evaluation II (APACHE II) was performed retrospectively, and the prognosis of patients was followed up. The difference of short-term mortality in patients with different score segments of EDS, MEWS and APACHE II were compared. Receiver operator characteristic curve (ROC curve) was drawn to evaluate the prognostic value of various scoring methods in critically ill patients.@*RESULTS@#The mortality of patients in different score groups of each scoring method increased with the increase of the score value [The mortality of 0-1, 2-3, 4-5, 6-7 and ≥ 8 of MEWS were 1.9% (3/159), 2.9% (6/208), 12.4% (11/89), 29.0% (9/31) and 61.5% (8/13), respectively. The mortality of EDS stage 1 weighted MEWS score 0-3, 4-6, 7-9, 10-12 and ≥ 13 were 0 (0/49), 3.2% (8/247), 6.6% (10/152), 31.9% (15/47) and 80.0% (4/5), respectively. The mortality of EDS stage 2 clinical symptom score 0-4, 5-9, 10-14, 15-19, ≥ 20 were 0 (0/13), 0.4% (1/235), 3.6% (6/165), 26.2% (17/65), 59.1% (13/22), respectively. The mortality of EDS stage 3 rapid test data score 0-6, 7-12, 13-18, 19-24 and ≥ 25 were 0 (0/16), 0.6% (1/159), 4.6% (6/131), 13.7% (7/51) and 65.0% (13/20), respectively. The mortality of patients with APACHE II score 0-6, 7-12, 13-18, 19-24 and ≥ 25 were 1.9% (1/53), 0.4% (1/277), 4.6% (5/108), 34.2% (13/38) and 70.8% (17/24), respectively, all P < 0.01]. When the MEWS score was more than 4, the specificity was 87.0%, the sensitivity was 67.6%, and the maximum Youden index was 0.546, which was the best cut-off point. When the weighted MEWS score of EDS in the first stage was greater than 7, the specificity of predicting the prognosis of patients was 76.2%, the sensitivity was 70.3%, and the maximum Youden index was 0.465, which was the best cut-off point. When clinical symptom score of EDS in the second stage was more than 14, the specificity and sensitivity of predicting the prognosis of patients were 87.7% and 81.1%, respectively, and the maximum Youden index was 0.688, which was the best cut-off point. When the third stage rapid test of EDS reached 15 points, the specificity of predicting the prognosis of patients was 70.9%, and the sensitivity was 96.3%, and the maximum Youden index was 0.672, which was the best cut-off point. When APACHE II score was higher than 16, the specificity was 87.9%, the sensitivity was 86.5%, and the maximum Youden index was 0.743, which was the best cut-off point. ROC curve analysis showed that: EDS score in the stage 1, 2 and 3, MEWS score and APACHE II score can predict the short-term mortality risk of critically ill patients. The area under the ROC curve (AUC) and 95% confidence interval (95%CI) were 0.815 (0.726-0.905), 0.913 (0.867-0.959), 0.911 (0.860-0.962), 0.844 (0.755-0.933) and 0.910 (0.833-0.987), all P < 0.01. In terms of the differential ability to predict the risk of death in the short-term, the AUC in the second and third stages of EDS were highly close to APACHE II score (0.913, 0.911 vs. 0.910), and significantly higher than MEWS score (0.913, 0.911 vs. 0.844, both P < 0.05).@*CONCLUSIONS@#EDS method can dynamically evaluate emergency patients in stages, and has the characteristics of fast, simple, easy to obtain test and inspection data, which can facilitate emergency doctors to evaluate emergency patients objectively and quickly. It has strong ability to predict the prognosis of emergency patients, and is worth popularizing in emergency departments of primary hospitals.
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Humans , Research Design , Critical Illness , Retrospective Studies , Hospitals , Emergency Service, HospitalABSTRACT
【Objective】 To evaluate the efficacy and safety of percutaneous nephrolithotomy in Galdakao-modified supine Valdivia (GMSV) position and prone position in the treatment of renal calculi. 【Methods】 PubMed, Embase and Cochrane Library databases were searched systematically to identify all eligible studies. Literature collected were screened and data were extracted by three authors independently. RevMan5.4 software was used for Meta-analysis. 【Results】 A total of 9 articles were enrolled, including 7 randomized controlled studies and 2 case-control studies, with a total of 1 690 patients. The results of Meta-analysis showed that compared with the prone position group, the GMSV group had shorter hospital stay (WMD:-9.04, 95%CI:-16.85--1.22, P=0.02), shorter intraoperative radiation exposure (WMD:-1.23, 95%CI:-1.98--0.48, P=0.001), lower rate of complications (RR:0.72, 95%CI:0.59-0.88, P=0.001), but there were no significant differences in operation time, primary stone clearance rate, postoperative hemoglobin loss, blood transfusion rate, fever rate and non-tubulization rate. 【Conclusion】 Compared with percutaneous nephrolithotomy in prone position, percutaneous nephrolithotomy in GMSV position has the comparable stone clearance rate, but has significant advantages in hospital stay, intraoperative radiation time, and overall complications. It is safe for the treatment of renal stones and upper ureteral stones.
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Objective:To investigate the damage effect of different concentrations of N-methyl-D-aspartic acid (NMDA) to retinal ganglion cells (RGCs) in mice and explore the expression of long noncoding RNA (lncRNA) Tsix in the retina of mice with excitotoxicity as well as the protective effect of lncRNA Tsix on retina and RGCs.Methods:A total of 105 C57B6/J mice at 7-8 weeks of age were selected and randomly divided into the normal control group, 2 mmol/L NMDA group, 10 mmol/L NMDA group, 20 mmol/L NMDA group and 40 mmol/L NMDA group using a random number table method, with 21 mice in each group.In the normal control group, the mice were intravitreally injected with 1 μl of sodium chloride solution in the right eye, and mice were given intravitreal injection of 1 μl of different doses of NMDA according to grouping.At one week after the injection, the thickness of each retinal layer, the number of ganglion cell layer (GCL) cells and the number of RGCs were analysed and compared among different groups through optical coherence tomography (OCT), hematoxylin-eosin staining, retinal whole mount staining and immunofluorescence staining.RNAscope in situ hybridization was used to verify the expression of lncRNA Tsix in the GCL of different groups.The quantitative real-time PCR was used to detect the transcript levels of Tsix in different groups.This study was approved by an Ethics Committee of Tianjin Medical University (No.SYXK2018-0004), and the use of experimental animals was in accordance with the regulations of Tianjin Medical University and ARVO statement. Results:The OCT results showed that the total retinal thickness of mice in the 2, 10, 20 and 40 mmol/L NMDA groups were (255.00±6.63), (252.40±6.41), (248.67±6.20) and (229.11±10.37)μm, respectively, which were thinner than (269.60±20.01)μm in the normal control group, and the differences were statistically significant (all at P<0.05). Hematoxylin-eosin staining showed that the cells in the GCL of the normal control group were uniform and compact, and arranged in a single layer with large and round nuclei.In the NMDA groups, the cells were uneven in volume with vacuoles and nuclear pyknosis.The cell density in the GCL was decreased significantly with the increasing NMDA doses in NMDA groups in comparison with the normal control group, and the differences were statistically significant (all at P<0.05). In the 20 mmol/L NMDA group, the cell density in the GCL was reduced to half of the normal control group.The results of retinal whole mount staining showed that the density of β3-tubulin-positive RGCs was decreased significantly as the dose of NMDA increased in NMDA groups, and the differences were statistically significant compared with the normal control group (all at P<0.05). The number of RGCs in the 10 mmol/L NMDA group was reduced to half of that in the normal control group.RNAscope results showed that lncRNA Tsix was mainly expressed in the cytoplasm of the GCL cells.The proportion of lncRNA Tsix-positive cells was significantly reduced with the increase of the NMDA dose ( F=13.670, P<0.01). The quantitative real-time PCR results verified that the trend of Tsix expression was consistent with the RNAscope result. Conclusions:NMDA exerts a dose-dependent damage to the layer thickness of mouse retina and RGCs.The expression of lncRNA Tsix in mouse retina is mainly enriched in the cytoplasm of the cells in the GCL, and the transcript level of Tsix is reduced with the increase of NMDA concentration and have a protective effect on RGCs.
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Objective:To study the methylation level of retinal gene promoter region in a rat model of type 1 diabetes (T1D) and investigate the correlation between DNA methylation level and retinal damage caused by T1D.Methods:Twenty male SD rats aged 8-10 weeks were randomly divided into a control group and a T1D group using a random number table.T1D model was established via a rat tail vein injection of streptozotocin (STZ). The same volume of sodium citrate buffer was injected in the same way in the control group.Body mass of the rats was monitored before and after the injection of STZ.Blood glucose concentration of the rats was detected three days and five weeks following the injection.Methylated DNA immunoprecipitation-chip (MeDIP-chip) technology was employed to analyze the DNA methylation in the CpG islands of retinal gene promoter regions of the rats.Methylation data were compared between the two groups and subjected to Gene Ontology (GO) and pathway enrichment analyses.This study protocol was evaluated and approved by the Institutional Animal Care and Use Committee of Tianjin Medical University, and the use and care of the animals were in accordance with the Guide for the Care and Use of Laboratory Animals of the National Institutes of Health.Results:Compared to the normal control group, typical deregulated metabolic syndromes were found in the T1D group.including hyperphagia, polydipsia, polyuria, and loss of body weight.According to the results of MeDIP-chip analysis, 1 478 differentially methylated gene loci were detected in the T1D group compared to the normal control group, of which 689 were hypermethylated and 789 hypomethylated.Of these differentially methylated loci 768, 365 and 345 were located in high, intermediate, and low CpG-density promoters, respectively.GO analysis showed that the differentially methylated genes were involved in some molecular functions such as protein binding.The pathway analysis revealed that the hypermethylated genes in the rats of the T1D group were associated with mitogen-activated protein kinase (MAPK) and calcium signaling pathways; whereas the hypomethylated genes were associated with MAPK, Notch, and glutamatergic synapse signaling pathways.Conclusions:Methylation level of the majority of genes was altered in T1D rats.A differential methylation in the retinal gene promoter regions provides a preliminary theoretical basis for elucidating the molecular mechanism underpinning diabetic retinopathy and searching for novel therapeutic targets.
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Objective:To explore the status and characteristic of psychology for primipara and gravida with second child so as to improve psychological status of them and take them keep positive mentality in whole gestation.Methods: 176 gravidas randomly were selected in this study, and a self-designed questionnaire of psychology was applied to evaluate and compare the psychological status and self-care capacity between primipara and gravida with second child by using method of questionnaire survey. The primipara and gravida with second child were implemented hierarchical management depended on their differently psychological problem, and personalized intervening measurement was adopted to enhance their self-care capacity.Results: The psychological enduring capacity, self-care capacity and the ability of deal with problem about interpersonal relationship of gravidas with second child were obviously better than that of primiparas, while the neglect degree for antenatal care of them was higher than that of primiparas.Conclusion: The whole society should pay attention to the process for gestation of pregnant woman, and give them higher social support so as to promote the maternal and child health and effectively decrease the occurrence rate of delivery risk.
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Objective To investigate the prevalence of healthcare-associated infection (HAI)in a hospital in 2013-2015,and provide reference for the improvement of HAI management.Methods Prevalence rates of HAI among patients in the First Affiliated Hospital of Zhengzhou University in 2013 -2015 were investigated with cross-sec-tional survey method,prevalence rates of HAI and constituent ratios of HAI sites in patients of different genders and different age groups were analyzed.Results In 2013 -2015,29 605 patients should be investigated,29 581 (99.92%)were actually investigated.Prevalence rates of HAI in 2013-2015 were 2.83%,2.14%,and 1 .73%,re-spectively,difference was significant(χ2 =27.521 ,P 30 age group increased with age.The top three sites for prevalence of HAI were lower respiratory tract (45.67%),upper respiratory tract (9.92%),and urinary tract (8.52%).Conclusion The prevalence rates of HAI decreased year by year in 2013-2015,which suggests that HAI prevention and control measures are effectively implemented.
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Objective To investigate the status and risk factors of surgical site infection (SSI)in hospitals in Chi-na,so as to provide theoretical basis for the prevention and treatment of SSI.Methods Four types of surgeries (colorectal surgery,abdominal hysterectomy,femoral neck repair surgery,and vascular surgery)in 29 hospitals were monitored prospectively,risk factors for SSI were analyzed.Results A total of 6 309 surgical procedures were investigated,incidence of SSI was 1 .60%.Incidences of SSI in patients receiving colorectal surgery,abdominal hys-terectomy,femoral neck repair surgery,and vascular surgery were 4.47%(74/1 655 ),1 .03%(22/2 139),0.21 %(5/2 372),and 0.00% (0/143 )respectively.The incidences of SSI were different among different regions (χ2 =114.213,P <0.05).The most common SSI was superficial incisional infection,the next was deep incisional infec-tion.The major pathogens causing SSI were Escherichia coli ,Enterococcus spp .,coagulase negative staphylococ-cus ,Staphylococcus aureus ,and Klebsiella pneumoniae .The independent risk factors for SSI were male patients, long duration of surgery,and high NNIS score.Conclusion The risk of SSI is varied with different types of surger-ies.Male,long duration of surgery,and high NNIS score can increase the risk of postoperative SSI.
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Molecular mechanisms underlying the effects of Fyn on cell morphology, pseudopodium movement, and cell migration were investigated. The Fyn gene was subcloned into pEGFP-N1 to produce pEGFP-N1-Fyn. Chinese hamster ovary (CHO) cells were transfected with pEGFP-N1-Fyn. The expression of Fyn mRNA and proteins was monitored by reverse transcription-PCR and Western blotting. Additionally, transfected cells were stained with 4',6-diamidino-2-phenylindole and a series of time-lapse images was taken. Sequences of the recombinant plasmids pMD18-T-Fyn and pEGFP-N1-Fyn were confirmed by sequence identification using National Center for Biotechnology Information in USA, and Fyn expression was detected by RT-PCR and Western blotting. The morphology of CHO cells transfected with the recombinant vector was significantly altered. Fyn expression induced filopodia and lamellipodia formation. Based on these results, we concluded that overexpression of mouse Fyn induces the formation of filopodia and lamellipodia in CHO cells, and promotes cell movement.