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Objective:To observe the application effect of self-made anti-pressure sore cotton cover on the prevention of facial pressure injury in patients with non-invasive ventilation, and to explore the effective method of preventing facial pressure injury.Methods:A prospective study was conducted. Patients with mild to moderate respiratory failure and non-invasive ventilation admitted to the department of intensive care medicine of Harisen International Peace Hospital Affiliated to Hebei Medical University from March 2020 to August 2021 were enrolled, and they were divided into gauze pad group, foam dressing group and self-made anti-pressure ulcer cotton cover group by random number table method. Before wearing the ventilator mask, the gauze pad group and the foam auxiliary dressing group should fold or cut out the auxiliary dressing with the corresponding size and suitable for the patient's facial contour. In the self-made anti-pressure sore cotton cover group, the ventilator cotton cover could be worn only by selecting the cotton cover suitable for the patient's face shape, aligning the vent to the mouth and nose, and tying the fixed belt behind the ear. The incidence of facial pressure sore, the time required to connect man-machine interface (from the preparation of auxiliary dressing for pressure sores to the connection of ventilator) and the cost of dressing were compared among the three groups.Results:A total of 150 patients with non-invasive ventilation were enrolled, with 50 patients in each group. Compared with the gauze pad group and the foam dressing group, the incidence of facial pressure sore in the self-made anti-pressure sore cotton cover group was significantly reduced [6.0% (3/50) vs. 44.0% (22/50), 12.0% (6/50), both P < 0.05], and the time required to connect the man-machine interface was significantly shortened (minutes: 5.0±1.5 vs. 10.0±1.5, 8.0±2.0, both P < 0.05), dressing cost was significantly reduced (yuan: 30±10 vs. 150±20, 118±29, both P < 0.05). Conclusion:Compared with the gauze pad and the foam dressing, the incidence of facial pressure sore in non-invasive ventilation patients with self-made anti-pressure sore cotton cover is lower, the time required to connect man-machine interface is shorter, and the cost of pressure sore prevention dressing is less, which is suitable for the prevention of facial pressure injury in non-invasive ventilation patients.
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Objective:To investigate the role of signal lymphocyte activating molecule family member 5 (SLAMF5) in liver transplantation rejection in SD rats.Methods:Forty-five male SD rats without special pathogens, weight 260-300 g, aged 10-12 weeks were included. Among them, forty male SD rats (20 donors and 20 recipients respectively) were established with reference to the " two cuff" method. 15 liver transplantation model rats were randomly divided into 1 week (LT-1W) group, 2 weeks (LT-2W) group and 3 weeks (LT-3W) group, with 5 rats in each group, and 5 normal rats were taken as the normal control group. The expressions of SLAMF5, CD4 and CD8 were detected by polymerase chain reaction (PCR), Western blot and immunohistochemistry. The correlations between SLAMF5 expression in the lymphocyte infiltration area and the rejection activity index was analyzed.Results:The levels of alanine aminotransferase, aspartate aminotransferase and total bilirubin were significantly higher in LT-1W group, LT-2W group and LT-3W group than those in the normal control group (all P<0.05). PCR results showed that the relative expression of SLAMF5 mRNA were (5.44±1.11), (4.69±1.12), (2.18±0.68) respectively, which were increased in LT-1W group, LT-2W group and LT-3W group than those in normal control group (1.01±0.23), and the differences were statistically significant (all P<0.05). Immunohistochemical staining showed that SLAMF5 and CD4, CD8 positive T cells were mainly distributed in the portal area, hepatic lobule area and around the proliferative bile duct, and there was a certain overlap. Correlation analysis showed that there was a positive correlation between the expression of SLAMF5 in the lymphocyte infiltration area and the rejection activity index ( r=0.519, P=0.048). Conclusion:The expression of SLAMF5 is increased after liver transplantation in SD rats, and there is a correlation between SLAMF5 expression and liver transplantation rejection in rats.
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With the development of medical technology, the fixation method of the oral duct is constantly updated, and the selection of a relatively safe, effective, simple and fast fixation method of the oral duct has been widely concerned. However, the use of traditional 3M I-shaped tape fixation needs to be cut, which wastes time and easily leads to the outward displacement of the tracheal tube, and is easy to be soaked by oral secretions, resulting in facial skin damage. Therefore, the medical staffs of the department of critical care medicine of Hengshui People's Hospital designed a self-made tracheal catheter fixing band (composed of the main structure, the fixed band, the internal adjusting structure and the internal structure of the fixed block), and obtained the national utility model patent (ZL 2018 2 0508681.6). The inner side of the fixing band is fixed with a spongy body, which can absorb the secretions around the mouth to avoid the moist condition around the mouth and cheek skin. Meanwhile, the endotracheal catheter is fixed with the help of the card slot, hinge and other structures, which can fully ensure the fixation effect. A total of 80 patients undergoing airway intubation were admitted to the department of critical care medicine of our hospital from October 2020 to September 2021. They were divided into observation group and control group according to intubation time (single number and double number), with 40 patients in each group. The observation group was fixed with self-made tracheal catheter fixation band. Through evidence-based practice path, relevant literatures at home and abroad were searched for clinical practice basis, and the practice plan was formulated and implemented. The control group was fixed with 3M tape + inch tape according to the traditional method. The fixation of tracheal tube and the degree of facial skin injury were compared between the two groups. All patients were included in the final analysis without shedding cases. Severe catheter displacement occurred in 3 patients (7.5%) in the control group, and no severe catheter displacement occurred in the observation group. The incidence of facial skin injury in the observation group was significantly lower than that in the control group [25.0% (10/40) vs. 55.0% (22/40), P < 0.05]. Moreover, the fixation time of the observation group was significantly shorter than that of the control group (minute: 12.11±1.69 vs 17.59±1.27, P < 0.05). The application of self-made tracheal catheter fixation band can shorten the fixation time of tracheal catheter and reduce the incidence of unplanned endotracheal extubation (UEE) and facial skin injury, which is worthy of clinical promotion and application.
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【Objective】 To analyze the efficacy of ABO-matched platelet transfusions and ABO-mismatched platelet transfusions in patients with hematonosis and to explore the effect of circulating immune complexes (CIC) on the efficacy. 【Methods】 A total of 1 510 platelet transfusions involving 757 patients in our hospital from January 2013 to June 2018 were retrospectively analyzed. The patients were divided into ABO-matched group and ABO-mismatched group. The 12-hour percent platelet recovery (PPR) was used to evaluate the effect of platelet transfusion between the groups. TEG was used to evaluate the efficacy of the transfusions, and CIC value was measured before and after platelet transfusion. The effect of A-B/CIC (or AB-O/CIC) on platelet function was tested. 【Results】 1)The results showed that platelet transfusion was effective(PPR>30%) in both ABO-matched group[PPR=(66.5±52.8)%] and ABO-mismatched group[PPR=(47.7%±51.6)%], and there was no increase in the report of hemolytic transfusion reaction of ABO-mismatched group. The efficacy of ABO-matched platelet transfusions was significantly better than that of ABO-mismatched group(P 0.05. 2) In the experiment of simulating platelet transfusion in patients, no difference in MA value of TEG was noticed between ABO-mismatched groups and ABO-matched groups (all P>0.05). 3) There was no difference in CIC value before and after platelet transfusions (P>0.05) in the ABO-matched group, while CIC value decreased significantly in all ABO-mismatched groups (all P < 0.05). 4) The MA values (mm)of AB, A and O blood group platelets mixed with A-B/CIC and AB-O/CIC were 36.1 vs 31.1, 37.8 vs 35.0 and 43.1 vs 45.7, with the MA value (mm) in control group at 49.2 vs 49.5, respectively. 【Conclusion】 Platelet transfusion was effective in both ABO-matched group and ABO-mismatched group, and the efficacy of ABO-matched group was significantly better compared with the ABO-mismatched group. There was no increase in the safety risk of ABO-mismatched platelet transfusion with major mismatches/minor matches. CIC can inhibit the function of platelets and combine more with ABO-matched platelets than with ABO-mismatched platelets, therefore, CCI is an important influencing factor on the efficacy of platelet transfusions.
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V set and Ig domain containing 4 (VSIG4), a co-inhibitory molecule expressed by macrophages, is a B7 family-related protein. It can serve as the second signal of T cell activation and regulate the function of T cells. It has been found that VSIG4 is essential in maintaining immune tolerance. Moreover, VSIG4 can also act as a complement receptor, playing a role in recognizing pathogens, regulating the complement alternative pathway and inhibiting inflammatory response. This review summarized the expression of VSIG4 and its role in the immune system.
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Objective:To investigate the relationship between anemia and renal function prognosis in IgA nephropathy (IgAN) patients.Methods:Patients diagnosed with IgAN by renal biopsy in Shenzhen Second People′s Hospital (The First Affiliated Hospital of Shenzhen University) from January 1, 2010 to December 31, 2018 were retrospectively analyzed. Patients who lacked baseline estimated glomerular filtration rate (eGFR), or patients with the baseline eGFR<15 ml·min -1·(1.73 m 2) -1, or patients who lacked baseline hemoglobin data were excluded. Clinical data, laboratory data, pathological data and follow-up data of renal function were collected. Patients were divided into anemic group (hemoglobin level<120 g/L in males and<110 g/L in females) and non-anemic group. A generalized additive mixed model (GAMM) was used to analyze the relationship between anemia at baseline and decreased renal function (eGFR) in follow-up. Results:A total of 821 IgAN patients were enrolled in this study, including 666 non-anemia patients and 155 anemia patients. There were 397 males (48.36%), aged (34.91±9.46) years. The median baseline eGFR was 72.00(15.00, 167.46) ml·min -1·(1.73 m 2) -1, and the median baseline urinary protein quantification was 1.00(0.01, 15.82) g/24 h. The median follow-up time was 176(0, 3 770) days. A total of 2 352 repeated measurements were performed of which 1 268 (53.91%) repeated measurements were from males. Compared with those in non-anemia group, patients in anemia group had lower levels of baseline eGFR, body mass index (BMI) and serum albumin, higher proportion of females, and higher pathologic manifestations of glomerular segmental sclerosis (S1), tubulointerstitial atrophy/fibrosis (T1 and T2), and crescent (C1 and C2) (all P<0.05). Using the single-factor GAMM, the eGFR decreased by 4.778 ml·min -1·(1.73 m 2) -1 (95% CI 2.727-6.830, P<0.001) more per year in the anemia group than that in the non-anemia group. After adjusting for age, gender, BMI, blood uric acid, mean arterial pressure, serum albumin, blood cholesterol, 24 h urinary protein, glomerular mesangial cell proliferation (M), capillary cell proliferation (E), glomerular segmental sclerosis (S), tubulointerstitial atrophy/fibrosis (T), and crescent formation (C), each additional year of time, eGFR decreased by 6.817 ml·min -1·(1.73 m 2) -1 (95% CI 4.245-9.388, P<0.001) more in the anemia group than that in the non-anemia group. Conclusions:Anemia is correlated with renal function decline in IgAN patiens. IgAN patients with anemia have accelerated deterioration of progress. Early intervention of anemia might delay renal function progression.
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Objective:To investigate the relationship between hemoglobin levels and renal prognosis in patients with IgA nephropathy (IgAN).Methods:The clinical data and pathological examination results of IgAN patients diagnosed by renal biopsy at the Second People's Hospital of Shenzhen from February 25, 2010 to September 9, 2020 were retrospectively collected and analyzed. The patients were divided into anemic group and non-anemic group according to the anemia diagnostic criteria (The hemoglobin levels were<120 g/L and<110 g/L in males and females respectively at sea level area). Endpoint event was defined as a decrease in estimated glomerular filtration rate (eGFR) of>50% from baseline and/or progression to stage 5 chronic kidney disease [eGFR<15 ml·min -1·(1.73 m 2) -1]. Cox regression analysis was used to analyze the factors affecting the poor renal prognosis. The relationship between hemoglobin and renal function prognosis was analyzed by smoothing curve fitting and threshold effect. Kaplan-Meier survival curve was used to compare and analyze the difference of renal survival rate between the anemic and non-anemic IgAN patients. Results:A total of 1 263 IgAN patients were included in this study, 255(20.19%) patients were in the anemia group and 1 008 (79.81%) patients were in the non-anemia group. The anemia group had lower body mass index, baseline eGFR, serum albumin, and triglyceride than those in the non-anemia group (all P<0.05). The proportion of females, 24 h urinary protein content, and the proportion of renal tubule atrophy/interstitial fibrosis, segmental sclerosis and crescents in the anemia group were higher than those in the non-anemia group (all P<0.05). Multivariate Cox regression analysis showed that low hemoglobin was an independent influencing factor for renal endpoint event ( HR=0.25, 95% CI 0.07-0.90, P=0.022). Smoothing curve fitting analysis and threshold effect analysis showed that a curving relationship was detected between hemoglobin and relative risk of renal endpoint event. As hemoglobin increased, there was a protective effect on renal function when hemoglobin level was lower than 147 g/L ( β=0.96, 95% CI 0.94-0.99, P=0.008). Kaplan-Meier survival curve analysis suggested that patients with anemia had a lower cumulative renal survival rate than that of patients without anemia (Log-rank test χ2=10.106, P=0.002). Conclusions:Low hemoglobin is an independent influencing factor for poor prognosis of renal function in IgAN patients. Cumulative renal survival rate is lower in IgAN patients with anemia than that of patients without anemia.
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Objective:To explore the feasibility of using vascular graft interposition for lowering the complications of portal vein during pediatric liver transplantation.Methods:From June 1, 2013 to May 31, 2018, clinical data were collected for 297 children undergoing liver transplantation, including basic demographics, general preoperative status, preoperative tests, imaging findings, graft related profiles, surgical procedures and postoperative follow-ups, etc. Then the authors analyzed the effect of using interposition vessels upon lowering postoperative complications of portal vein reconstruction.Results:With a median age of 12 months, there were 153 boys (51.5%) and 144 girls (48.5%). The primary disease was mostly biliary atresia ( n=222, 74.7%). The median diameter of portal vein was 5 mm. There were 19 cases (6.4%) using vascular interposition. Among 20 cases of portal vein complications, there were portal vein stenosis ( n=17, 5.7%) and portal vein thrombosis ( n=3, 1.0%). After univariate analysis, binary Logistic regression analysis revealed that diameter of recipient's portal vein was an independent risk factor for the occurrence of portal vein complications after liver transplantation. Statistical analysis of children with portal vein diameter <4 mm ( n=90) was carried on and the results showed that there was no inter-group statistical difference ( χ2=3.061, P=0.080)on the occurrence of portal vein complications. Conclusions:Diameter of portal vein is an important factor affecting the strategic choice of portal vein reconstruction during pediatric liver transplantation and an independent risk factor for portal vein complications after liver transplantation. When the diameter of portal vein is ≤4 mm, using interposition vascular anastomosis shows no significant difference with other conventional modes.
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Objective:To review our experience in the use of "Full right-Full left" split liver transplantation in adult-to adult or adult-to adult-size child.Methods:The clinical data of liver donors to 4 recipients of full right-full left split liver transplantation performed at Beijing Friendship Hospital of Capital Medical University from January to December 2019 were reviewed. The surgical methods of split liver transplantation, cold ischemia time, operation time, intraoperative blood transfusion, and postoperative complications and prognosis were analyzed.Results:The 4 recipients of complete right hepatic-left hepatic split liver transplantation included 3 adults and 1 heavy child (45 kg). Their ages ranged from 14 to 48 years, and body weight ranged from 45 to 61 kg. The end-stage liver disease model score were 21, 12, 41, and 30 points. The ratios of graft mass to recipient's body mass ranged from 0.85% to 1.35%. The cold ischemia time was 457-650 min, and the operation time was 460-575 min. Early liver function recovered smoothly in all the 4 patients after transplantation, and no small liver syndrome occurred. Patients were followed up to 6 months after operation. One patient developed anastomotic biliary leak, which was cured by endoscopic retrograde cholangiopancreatographic treatment. Another patient developed biliary stricture presenting with repeated biliary tract infection despite percutaneous transhepatic puncture biliary drainage. A third patient died six months from lung infection.Conclusion:In properly selected patients, using full right-full left hemiliver by split liver transplantation increased organ utilization and provided patients with increased treatment opportunities.
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The chemotherapy combined with photothermal therapy has been a favorable approach for the treatment of breast cancer. In present study, nanoparticles with the characteristics of photothermal/matrix metalloproteinase-2 (MMP-2) dual-responsive, tumor targeting, and size-variability were designed for enhancing the antitumor efficacy and achieving "on-demand" drug release markedly. Based on the thermal sensitivity of gelatin, we designed a size-variable gelatin nanoparticle (GNP) to encapsulate indocyanine green (ICG) and doxorubicin (DOX). Under an 808 nm laser irradiation, GNP-DOX/ICG responded photothermally and swelled in size from 71.58 ± 4.28 to 160.80 ± 9.51 nm, which was beneficial for particle retention in the tumor sites and release of the loaded therapeutics. Additionally, GNP-DOX/ICG showed a size reduction of the particles to 33.24 ± 4.11 nm and further improved drug release with the degradation of overexpressed MMP-2 in tumor. In the subsequently performed
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Objective:To inhibit the Itch gene expression of T-lymphocytes and investigate the immune activity of T lymphocytes using ultrasound-targeted microbubble destruction (UTMD).Methods:T lymphocytes were separated by magnetic bead, and to establish an Itch gene targeted short hairpin RNA (shRNA) plasmid. There were three groups in this study: ①experimental group, Itch-shRNA plasmid-SonoVue microbubbles combined with ultrasound irradiation; ②control group, negative control shRNA plasmid-SonoVue microbubbles combined with ultrasound irradiation; ③blank group, untreated. Forty-eight hours after UTMD transfection, transfection efficiency was detected and analyzed by fluorescence microscopy and flow cytometry, the expression of Itch protein was measured with Western blotting.Seventy-two hours after UTMD transfection, the secretion of interleukin 2 (IL-2) and interferon γ (IFN-γ) in the cell supernatant were measured by enzyme-linked immunosorbent assay (ELISA). One-way ANOVA was used to compare the differences between groups, and LSD- t test was used to compare the differences between groups. Results:The UTMD mediated shRNA transfection rate was 52.3%, and the relative expression levels of Itch protein in the experimental group, control group and blank group were 0.301±0.080, 0.773±0.101 and 0.719±0.090, respectively, and the difference was statistically significant( F=24.441, P<0.01). The Itch gene expression can be effectively suppressed in the experimental group. Seventy-two hours after transfection, the concentrations of IL-2 in the experimental group, control group and blank group were (417.3±37.1)ng/L, (158.7±17.3)ng/L and (147.0±10.2)ng/L, respectively, and the difference was statistically significant( F=118.701, P<0.001) and the concentrations of IFN-γ were (168.3±12.1)ng/L, (74.3±3.7)ng/L and (74.6±7.1)ng/L, respectively, and the difference was statistically significant ( F=126.833, P<0.001). The expression levels of IL-2 and IFN-γ in the experimental group were significantly higher than those in the control group and the blank group. Conclusions:UTMD mediated shRNA transfection can significantly decrease the expression of Itch and promote immune activity of T lymphocyte.
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Objective:To explore the influence of maternal attachment and alexithymia on risk of non-suicidal self-injury in adolescents.Methods:Fifty-seven outpatients and inpatients from Anhui Mental Health Center with non-suicidal self-injury (NSSI) and their mothers were involved as the case group, and fifty-three age-, gender-, and education-matched adolescents and their mothers as the normal controls.They were assessed with the experience in close relationship inventory(ECR), the 20-item Toronto alexithymia scale (TAS-20) and the adolescents self-harm scale.SPSS 22.0 software was used for correlation analysis and Logistic regression analysis.Results:There were significant differences in attachment avoidance ((3.7±0.6), (3.0±0.6)), attachment anxiety ((4.0±0.7), (3.1±0.9)), difficulty identifying feelings ((2.9±0.7), (2.3±0.7)), difficulty describing feelings((3.0±0.6), (2.4±0.5)) and alexithymia ((57.2±8.3), (49.5±9.5))between the two mother groups ( t=6.53, 5.79, 4.01, 5.50, 4.56, all P<0.05). NSSI of adolescents was positively correlated with the scores of attachment anxiety, attachment avoidance, alexithymia, difficulty identifying feelings, difficulty describing feelings( r=0.487, 0.532, 0.401, 0.360, 0.468, all P<0.05). Logistic regression analysis showed that unsafe maternal attachment( B=2.57, OR=3.07, 95% CI=1.01-169.54, P=0.024)and the higher alexithymia level( B=1.95, OR=2.14, 95% CI=1.29-3.58, P=0.003)could lead to higher risk of NSSI in adolescents. Conclusion:Unsafe maternal attachment and the higher alexithymia level may be the risk factors for adolescents with NSSI.
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Objective@#To clarify the relationship between the hemoglobin level and renal tubular atrophy/interstitial fibrosis (T) in the Oxford stage of renal pathology in IgA nephropathy (IgAN) patients.@*Methods@#Patients diagnosed with IgAN by renal biopsy from January 1st 2010 to December 31st 2015 in Shenzhen Second People's Hospital with complete laboratory and imaging data were retrospectively analyzed. Patients were divided into anemic group and non-anemic group. The relationship between hemoglobin level and renal tubular atrophy/interstitial fibrosis was determined by logistic regression analysis. The possible curve relationship between hemoglobin and renal tubular atrophy/interstitial fibrosis was analyzed by smooth curve fitting analysis. The diagnostic value of hemoglobin for renal tubular atrophy/interstitial fibrosis was analyzed by the receiver operating curve (ROC).@*Results@#A total of 630 patients with IgAN were included in this study, 130 patients in the anemia group (20.63%) and 500 patients in the non-anemia group (79.37%). There was no statistically significant difference in age between the two groups, but the difference of the gender was statistically significant (male 35.38% vs 53.80%, χ2=10.740, P<0.001). Compared with the non-anemia group, the anemia group had a higher proportion of tubular atrophy/interstitial fibrosis (χ2=62.586, P<0.001), higher 24 h urinary protein quantification (Z=-6.082, P<0.001), and lower eGFR (t=7.126, P<0.001). Multivariate logistic regression analysis showed that increasing hemoglobin level was an independent protective factor for reducing the risk of renal tubular atrophy/interstitial fibrosis (OR=0.973, 95%CI 0.958-0.987, P<0.001). Smooth curve fitting analysis showed that there was a linear negative correlation between hemoglobin and tubular atrophy/interstitial fibrosis. The ROC curve suggested that the best threshold of hemoglobin was 120.5 g/L when renal tubular atrophy/interstitial fibrosis occurred. That was, when hemoglobin was above 120.5 g/L, the severity level of renal tubular atrophy interstitial fibrosis might be reduced.@*Conclusion@#The incidence of renal tubular atrophy/interstitial fibrosis is higher in IgAN patients with anemia, and hemoglobin>120.5 g/L may reduce the risk of tubular atrophy/interstitial fibrosis.
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Objective:To clarify the relationship between the hemoglobin level and renal tubular atrophy/interstitial fibrosis (T) in the Oxford stage of renal pathology in IgA nephropathy (IgAN) patients.Methods:Patients diagnosed with IgAN by renal biopsy from January 1 st 2010 to December 31 st 2015 in Shenzhen Second People's Hospital with complete laboratory and imaging data were retrospectively analyzed. Patients were divided into anemic group and non-anemic group. The relationship between hemoglobin level and renal tubular atrophy/interstitial fibrosis was determined by logistic regression analysis. The possible curve relationship between hemoglobin and renal tubular atrophy/interstitial fibrosis was analyzed by smooth curve fitting analysis. The diagnostic value of hemoglobin for renal tubular atrophy/interstitial fibrosis was analyzed by the receiver operating curve (ROC). Results:A total of 630 patients with IgAN were included in this study, 130 patients in the anemia group (20.63%) and 500 patients in the non-anemia group (79.37%). There was no statistically significant difference in age between the two groups, but the difference of the gender was statistically significant (male 35.38% vs 53.80%, χ2=10.740, P<0.001). Compared with the non-anemia group, the anemia group had a higher proportion of tubular atrophy/interstitial fibrosis ( χ2=62.586, P<0.001), higher 24 h urinary protein quantification ( Z=-6.082, P<0.001), and lower eGFR ( t=7.126, P<0.001). Multivariate logistic regression analysis showed that increasing hemoglobin level was an independent protective factor for reducing the risk of renal tubular atrophy/interstitial fibrosis ( OR=0.973, 95% CI 0.958-0.987, P<0.001). Smooth curve fitting analysis showed that there was a linear negative correlation between hemoglobin and tubular atrophy/interstitial fibrosis. The ROC curve suggested that the best threshold of hemoglobin was 120.5 g/L when renal tubular atrophy/interstitial fibrosis occurred. That was, when hemoglobin was above 120.5 g/L, the severity level of renal tubular atrophy interstitial fibrosis might be reduced. Conclusion:The incidence of renal tubular atrophy/interstitial fibrosis is higher in IgAN patients with anemia, and hemoglobin>120.5 g/L may reduce the risk of tubular atrophy/interstitial fibrosis.
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Objective To explore the effect of nursing mode based on 6-hour resuscitation goal theory on various functions and quality of life of patients with sepsis. Methods One hundred and forty-two septic patients admitted to the Second Affiliated Hospital of Wenzhou Medical University from April 2016 to July 2018 were enrolled. A total of 71 patients selected to use traditional nursing intervention strategy were assigned in the routine nursing group;in the 6-hour resuscitation target theory group, 71 patients were given nursing care based on 6-hour resuscitation target theory on the basis of traditional routine nursing. The differences in oxygenation function indexes [central venous blood oxygen saturation (ScvO2), arterial partial pressure of oxygen (PaO2) and oxygenation index (PaO2/FiO2)], circulatory function indexes [central venous pressure (CVP), mean arterial pressure (MAP) and heart rate (HR)], renal function indexes [urine volume and serum creatinine (SCr)] before and after intervention for 6 hours were compared between the two groups of patients; at the same time, the survival rate, treatment status and life quality improvement of the two groups after 1 month of intervention were recorded. Results After 6 hours of intervention, CVP, MAP, ScvO2, PaO2, PaO2/FiO2, urine volume and quality of life scores of patients in the 6-hour resuscitation target theory group and the routine nursing group were all increased compared with those before intervention, while the HR and SCr levels were lower than those before the intervention, moreover, the changes above indexes in the 6-hour resuscitation target theory group were more significant than those in the routine nursing group [CVP (cmH2O, 1 cmH2O = 0.098 kPa): 11.89±2.94 vs. 7.33±2.37, MAP (mmHg, 1 mmHg = 0.133 kPa): 84.11±6.13 vs. 66.15±5.27, HR (bpm):89.05±6.00 vs. 102.41±5.86, ScvO2: 0.78±0.03 vs. 0.66±0.04, PaO2 (mmHg): 154.71±20.75 vs. 106.54±24.66, PaO2/FiO2 (mmHg): 364.13±38.47 vs. 331.21±33.26, urine volume (mL/h): 71.13±10.22 vs. 37.42±13.41, SCr (μmol/L): 113.10±14.35 vs. 125.12±13.87, role function scores: 87.82±4.52 vs. 71.28±4.92, cognitive function scores: 89.23±4.63 vs. 71.75±5.34, body function scores: 90.24±4.43 vs. 72.74±5.03, emotional function scores:88.92±5.71 vs. 73.42±3.48, social function scores: 94.31±2.71 vs. 75.21±4.83, all P < 0.05]. One month after intervention, the survival rate in the 6-hour resuscitation target theory group was higher than that in the routine nursing group [69.01% (49/71) vs. 42.25% (30/71), P < 0.05], compared with routine nursing group, stay time in intensive care unit (ICU) and mechanical ventilation time in the 6-hour resuscitation target theory group were significantly shortened [stay time in ICU (days): 7.34±3.31 vs. 9.42±3.60, mechanical ventilation time (days): 3.52±0.84 vs. 5.83±0.85, both P < 0.05]. Conclusion The application of nursing intervention based on 6-hour resuscitation target theory for patients with sepsis has very significant effects on promoting the patients' oxygenation, renal and circulatory functions, and improving their survival rate and quality of life.
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To apply the concept of evidence-based nursing in the practice of inhalation therapy for patients with chronic obstructive pulmonary disease (COPD) complicated respiratory failure, introduce the application method of self-made anti-carbon dioxide retention atomizer, and to observe the application effect. Methods Patients with COPD combine respiratory failure admitted to the respiratory department of Harrison International Peace Hospital Affiliated to Hebei Medical University from May 2018 to April 2019 were enrolled. All patients received atomization inhalation therapy in addition to anti-infection and spasmolysis. By using self-made carbon dioxide retention atomizer time node, 40 patients in the prospective study using home-made carbon dioxide retention atomizer inhalation therapy from November 2018 to April 2019 were enrolled as observation group. Through evidence-based nursing strategy, the related literature at home and abroad was retrieved, to find the clinical evidence, formulation and implementation of care plan. Forty patients who received inhalation therapy with normal mask atomizer from May to October in 2018 were enrolled as the control group in the retrospective analysis. The peripheral arterial blood gas analysis indexes [pH value, arterial oxygen partial pressure (PaO2), arterial carbon dioxide partial pressure (PaCO2)], the disappearance of pulmonary asthma at 5 minutes before atomization inhalation and 20 minutes after atomization inhalation, and the patient's cooperation in treatment were compared between the two groups. Results All patients were included in the final analysis. There was no significant difference in blood gas analysis indexes between the two groups. After 20 minutes of atomization inhalation, the pH value, PaO2 and PaCO2 of the two groups were improved, and the improvement was more obvious in the observation group [pH value: 7.32±0.35 vs. 7.25±1.25, PaO2 (mmHg, 1 mmHg = 0.133 kPa) :61.50±1.55 vs. 59.50±1.05, PaCO2 (mmHg) : 43.25±1.65 vs. 49.05±1.75, all P < 0.05]. The lung asthma in the two groups was significantly improved with 20 minutes of atomization inhalation as compared with that before atomization, and the improvement of lung asthma in the observation group was significantly better than that in the control group (asthma score: 0.91±0.29 vs. 1.65±0.35, P < 0.05). The good coordination rate of the observation group was significantly higher than that of the control group [90% (36/40) vs. 70% (28/40), χ2 = 3.828, P = 0.048]. Conclusion Compared with the inhalation treatment with ordinary mask nebulizer, inhalation treatment with self-made anti-carbon dioxide retention atomizer for COPD patients with respiratory failure can reduce carbon dioxide retention, significantly improve respiratory failure symptoms and improve compliance.
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Objective To apply the concept of evidence-based nursing to the practice of non-invasive ventilation,and to introduce the method of using self-made pressure-resistant cap cotton cover and its application effect.Methods Fifty patients on non-invasive ventilation admitted to intensive care unit (ICU) of Harrison International Peace Hospital Affiliated to Hebei Medical University from September 2017 to April 2018 were enrolled as observation group.By retrieved the relevant literature at home and abroad to look for clinical evidence,the concept of evidence-based nursing care program was formulated and implemented,and self-made pressure-resistant cap cotton cover was used to prevent facial pressure sores in patients on non-invasive ventilation.Forty non-invasive ventilation patients admitted from January to August in 2017 were enrolled as the historical control group,and conventional nursing was conducted by using traditional hydrocolloid dressings to prevent pressure ulcers.The incidence of facial pressure ulcers,ocular complications,dressing replacement time and cost were compared between the two groups.Results All patients were enrolled in the final analysis.The incidence of pressure ulcers in the observation group was significantly lower than that in the control group [4.0％ (2/50) vs.22.5％ (9/40),P ＜ 0.05],and the incidences of ocular complications such as eyelid swelling [2.0％ (1/50) vs.5.0％ (2/40)],conjunctival congestion [2.0％ (1/50) vs.5.0％ (2/40)] and irritant keratitis [0％ (0/50) vs.7.5％ (3/40)] were also significantly lower than those in the control group (P ＜ 0.05).Because the pressure-resistant cap cotton cover made by ourselves was easy to be replaced at any time,the interval time of dressing change in the observation group was significantly shorter than that in the control group (minutes:1.5 ± 0.5 vs.2.0 ± 0.5,P ＜ 0.05).In addition it could be cleaned,used alternately,and the cost was low,so the dressing cost in the observation group was significantly lower than that in the control group (Yuan:30±10 vs.123±20,P ＜ 0.01).Conclusion The application of self-made pressure-resistant cap cotton cover could obviously reduce the occurrence of complications such as facial pressure sores in patients on non-invasive ventilation.
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Objective@#To evaluate the efficacy and safety of three-dimensional electroanatomical mapping system for catheter ablation of paroxysmal supraventricular tachycardiain (PSVT) children.@*Methods@#Clinical data from 187 children with paroxysmal supraventricular tachycardia undergoing radiofrequency catheter ablation in our department between January 2012 and April 2016 were analyzed. Among the patients, 91 cases were treated with traditional two-dimensional X-ray radiofrequency ablation, 96 cases were treated with radiofrequency ablation guided by three-dimensional electroanatomical mapping system. Postoperative electrocardiogram and echocardiography follow-up was performed at 1, 3, 6, 12, and 24 months. The success rate, recurrence rate, complication rate, operation time and amount of X-ray exposure were compared between the two groups. Kaplan-Meier survival curve was used to analyze the PSVT-free survival rate of the patients between the 2 groups.@*Results@#The mean follow-up time was (739±92) days. The success rate (95.8%(92/96) vs. 94.5%(86/91), P=0.912), recurrence rate (5.4%(5/92) vs. 4.7%(4/86), P=0.807), complication rate (4.2%(4/96) vs. 5.5%(5/91), P=0.379), operation time ((73±31)min vs. (79±36)min, P=0.124) were similar between the two groups. However, X-ray exposure time ((8.1±2.9)min vs. (21.3±8.4)min, P=0.026), amount of X-ray ((23±11)mGy vs. (58±23)mGy, P=0.013) were significantly lower in the three-dimensional electroanatomical mapping system group than in the traditional two-dimensional X-ray radio frequency ablation group. PSVT-free survival rate was similar between the two groups (χ2=0.060, P=0.807) .@*Conclusion@#Three-dimensional electroanatomical mapping system is safe and effective for radiofrequency ablation of paroxysmal supraventricular tachycardia in children, and can significantly reduce the amount of radiation as compared to the traditional two-dimensional X-ray radiofrequency ablation.
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OX40 (CD134) is a costimulatory molecule on the surface of T cells. It binds to OX40L (CD252) that is expressed on the surface of antigen presenting cells (APC) and participates in the transmission of the second signal of T cell activation, indicating that it is of great importance to the proliferation, differentiation, survival and migration of T cells. In theory, blocking the OX40/OX40L costimulatory pathway can suppress immune response and induce immune tolerance. In this review, we reviewed the research progress in OX40/OX40L-induced transplantation tolerance.
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Objective To assess the influence of metabolic syndrome(MS)on the success rate of catheter ablation for the treatment of atrial fibrillation (AF)in the elderly. Methods A retrospective study included a total of 221 aged patients with AF who underwent AF ablation for the first time. The patients were divided into two groups :an MS group(n＝72)and a control group(without MS)(n＝149) . The MS group had a mean age of (67.1 ± 5.2) years ;the control group had a mean age of (68.3 ± 5.7) years. Forty-six patients in the MS group and 105 patients in the control group experienced paroxysmal atrial fibrillation. Prognoses in two groups were compared at the end of the follow-up. Results At the end of the follow-up ,the success rates of the procedure in the MS group and the control group were 37.5%(n ＝ 27)and 51.7%(n ＝ 77) ,respectively (χ2＝ 3.917 ,P ＝ 0.049) .Recurrence happened in 19 patients of the MS group and 28 patients of the control group ,and they underwent a repeat ablation. The overall success rates after the last ablation in the two groups were 51.4%(n＝37)and 65.8%(n＝98) ,respectively (χ2＝4.224 ,P＝0.034).In the multivariable model adjusted for risk factors ,MS(HR＝1.42 ,95% CI :1.11-1.64 ,P＝0.033)and left atrial diameter(HR＝ 1.83 ,95% CI :1.27-3.19 , P ＝ 0.017 ) were independent predictors for recurrence. Conclusions MS can affect the success rate of catheter ablation for AF in elderly patients and the effect remains even after the procedures are repeated