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Objective:To explore the effect of continuous blood purification (CBP) on the immunity and endothelial cell function of patients with sepsis.Methods:A prospective study was conducted. The patients aged ≥18 years old and meeting the diagnostic criteria of sepsis admitted to the department of critical care medicine of Binzhou Medical University Hospital from March 2019 to October 2020 were selected as the research subjects, and the patients were divided into standard treatment group and CBP treatment group according to random number table method. Both groups were given standard treatment including initial fluid resuscitation, infection source control and antibiotics according to the 2016 international guidelines for the management of sepsis and septic shock. CBP treatment group was additionally given continuous veno-venous hemofiltration (CVVH) at a dose of 25-30 mL·kg -1·h -1 and blood flow rate of 150-200 mL/min for more than 20 hours a day for 3 days. The clinical data of patients including blood lactic acid (Lac), procalcitonin (PCT), lymphocyte count (LYM), acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, sequential organ failure assessment (SOFA) score were recorded before treatment and 1 day and 3 days after treatment. At the same time, the venous blood was collected, and the immune function related indexes [interleukins (IL-4, IL-7), programmed death receptor-1 (PD-1), programmed death ligand-1 (PD-L1), interferon-γ (IFN-γ)] and endothelial cell injury related markers [soluble thrombomodulin (sTM), angiopoietin-2 (Ang-2), von Willebrand factor (vWF), heparan sulfate (HS), syndecan-1 (SDC-1)] levels in serum were determined by enzyme-linked immunosorbent assay (ELISA). The length of intensive care unit (ICU) stay of patients in the two groups was recorded, and the outcomes of patients in the two groups were followed up for 28 days. Results:Finally, 20 patients were enrolled in the standard treatment group, and 19 patients were enrolled in the CBP treatment group. There were no significant differences in gender, age and infection site between the two groups. The length of ICU stay in the standard treatment group was (10±5) days, and 5 patients died and 15 patients survived after 28 days. The length of ICU stay in the CBP treatment group was (9±4) days, and 8 patients died and 11 patients survived after 28 days. There were no significant differences in the length of ICU stay and number of patients who died within 28 days between the two groups (both P > 0.05). There were no significant differences in the Lac, PCT, LYM, APACHEⅡ score, SOFA score and immune function and endothelial cell injury related indexes before treatment and 1 day after treatment between the two groups. After 3 days of treatment, the Lac, PCT, APACHEⅡ score and SOFA score of the CBP treatment group were significantly lower than those before treatment, and pro-inflammatory and anti-inflammatory cytokines such as IFN-γ and IL-4, apoptosis-related indicators such as PD-1 and IL-7, and endothelial injury related factors such as sTM, SDC-1 and HS were significantly improved compared with the pre-treatment, the improvement degree of the above indicators was more obvious than that of the standard treatment group, and LYM was significantly higher than that of the standard treatment group (×10 9/L: 1.3±0.3 vs. 0.9±0.4, P < 0.05), IL-4, IFN-γ, IFN-γ/IL-4 ratio, IL-7, PD-1, sTM, SDC-1, HS, and Ang-2 were significantly lower than those of the standard treatment group [IL-4 (ng/L): 2.8 (1.5, 3.2) vs. 3.3 (2.7, 5.2), IFN-γ (ng/L): 6.3 (5.4, 106.5) vs. 217.9 (71.4, 517.1), IFN-γ/IL-4 ratio: 3.7 (1.8, 70.3) vs. 59.1 (18.3, 124.9), IL-7 (ng/L): 4.6 (3.2, 5.1) vs. 6.3 (5.2, 8.0), PD-1 (μg/L): 0.04 (0.03, 0.06) vs. 0.08 (0.05, 0.12), sTM (μg/L): 4.9 (4.3, 7.4) vs. 8.7 (6.0, 10.8), SDC-1 (μg/L): 0.6 (0.3, 1.1) vs. 0.9 (0.8, 2.5), HS (ng/L): 434.8 (256.2, 805.0) vs. 887.9 (620.1, 957.3), Ang-2 (ng/L): 934.0 (673.3, 1 502.1) vs. 2 233.9 (1 472.5, 3 808.4)], the differences were statistically significant (all P < 0.05). Conclusion:CBP treatment can eliminate the patient's immunosuppressive state, reduce a variety of endothelial injury markers and the degradation of glycocalyx, but cannot decrease the 28-day death risk or shorten the length of ICU stay.
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Objective To understand the health-related quality of life (HRQOL) of migrant workers with pneumoconiosis who received basic medical treatment in Hunan Province. Methods A total of 613 migrant workers with pneumoconiosis who received basic medical treatment and assistance in Hunan Province was selected as the study subjects using stratified random sampling method. The European Quality of Life-5 Dimensions (EQ-5D) questionnaire was used to assess their HRQOL. Results The abnormality of the five dimensions of the EQ-5D health description system, from high to low, were as follows： daily activities, mobility, pain/discomfort, anxiety/depression, and self-care, with the abnormal rates of 50.9%, 46.8%, 41.1%, 21.0%, and 14.5%, respectively. The visual analogue scale (VAS) score of EQ-5D was (63.5±18.6) points. Patients with stage Ⅲ pneumoconiosis had high abnormality in mobility, daily activities, and pain/discomfort compared with those with stage Ⅰ and Ⅱ disease (all P<0.02). Patients in stage Ⅱ and Ⅲ of pneumoconiosis had higher incidence of anxiety/depression compared with those with stage I disease (all P<0.02). Patients with complications in addition to pneumoconiosis had higher abnormality in mobility, self-care, and pain/discomfort compared to those with simple pneumoconiosis or those eligible for lung lavage treatment (all P<0.02). Patients with simple pneumoconiosis had a higher incidence of anxiety/depression compared with those eligible for lung lavage treatment (P<0.02). Patients with stage Ⅲ pneumoconiosis had lower average VAS scores compared with stage Ⅰ and Ⅱ patients (all P<0.02). Patients with simple pneumoconiosis or those with complications had lower average VAS scores compared with those eligible for lung lavage treatment (all P<0.05). Conclusion The HRQOL of pneumoconiosis patients among migrant workers needs improvement, especially for patients with stage Ⅲ disease and those with complications. This study indicates the need of optimizing policies, raising the hospitalization expense limit for critically ill patients with stage Ⅲ pneumoconiosis or with complications, and improving their HRQOL.
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Objective To establish a surveillance and early warning index system for schistosomiasis transmission risk along the middle and lower reaches of the Yangtze River basin, so as to provide insights into creation of a sensitive and highly efficient surveillance and early warning system for schistosomiasis. Methods National and international publications, documents, laws and regulations pertaining to schistosomiasis control were retrieved with keywords including schistosomiasis, surveillance, early warning and control interventions from 2008 to 2022, and a thematic panel discussion was held to preliminarily construct surveillance and early warning index system for schistosomiasis transmission risk along the middle and lower reaches of the Yangtze River basin. The index system was then comprehensively scored and screened using the Delphi method, and the weight of each index was determined using analytic hierarchy process and the modified proportional allocation method. In addition, the credibility of the Delphi method was evaluated using positive coefficient, authority coefficient, degree of concentration and degree of coordination of experts. Results Following two rounds of expert consultation, a surveillance and early warning index system for schistosomiasis transmission risk in endemic areas along the middle and lower reaches of the Yangtze River basin was preliminarily constructed, including 3 primary indicators, 9 secondary indicators and 41 tertiary indicators. The normalized weights of primary indicators epidemics, natural and social factors and comprehensive control were 0.639 8, 0.145 6 and 0.214 6, respectively, and among all secondary indicators, snail status (0.321 3) and schistosomiasis prevalence (0.318 5) had the highest combined weights, while social factors had the lowest combined weight (0.030 4). Of all tertiary indicators, human egg-positive rate (0.041 9), number of acute schistosomiasis cases (0.041 5), number of stool-positive bovine and sheep (0.041 1), and prevalence of Schistosoma japonicum in free-ranging livestock (0.041 1) had the highest combined weights. During two rounds of consultation, the positive coefficient of experts was both 100%, and the authority coefficient was both 0.9 and greater, while the coordination coefficients were 0.338 to 0.441 and 0.426 to 0.565 (χ2 = 22.875 to 216.524, both P values < 0.05). Conclusions The established surveillance and early warning index system for schistosomiasis transmission risk along the middle and lower reaches of the Yangtze River basin is of great scientific values and authority, which may provide insights into construction of the sensitive and highly efficient surveillance and early warning system for schistosomiasis in the context of low prevalence and low intensity of infection in China.
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Objective:To summarize and analyze the clinical and genetic characteristics of Chinese patients with adrenomyeloneuropathy (AMN).Methods:Clinical data were collected and analyzed retrospectively on AMN patients who were diagnosed by genetic testing in Shanghai Sixth People′s Hospital, Shanghai Jiao Tong University School of Medicine from May 2008 to August 2022. Clinical characteristics of AMN patients with different types of gene mutations were compared. Loe score was used to evaluate the severity of white matter demyelinating, and the serum levels of very long-chain fatty acids (VLCFA) in patients with or without white matter demyelinating were compared. The motor function of the AMN patients was assessed using the Expanded Disability Status Scale (EDSS), and the association between EDSS scores and the course of disease was analyzed.Results:A total of 23 male patients with onset age of (29.52±9.91) years were included in this study. The first symptom of all patients was abnormal lower extremities, of which 17 patients showed stiffness and weakness in their lower limbs (73.9%, 17/23), and 6 patients showed numbness and pain in both lower limbs (26.1%, 6/23). The occurrence of symptoms was not related to the type of gene mutation. White matter demyelination occurred in 33.3% (7/21) of patients over a disease duration of (7.67±4.46) years. There was no statistically significant difference in serum VLCFA level between the white-matter demyelination group and the non-demyelination group. The EDSS score was positively correlated with the disease duration ( r=0.57, P=0.006). Sixteen ABCD1 gene mutations were found in this study, among which c.5_19delinsTCTCCAGG (p.P2Lfs *12) was reported for the first time. Four probands belonging to different families carried the c.1415_1416del (p.Q472Rfs *83) variant. Conclusions:Lower limb movement disorders and sensory dysfunction are the prominent clinical manifestations in AMN patients, with deterioration of motor function associated with the course of disease. AMN may be converted to cerebral type and VLCFA concentration is not associated with the phenotypic changes. The c.1415_1416del (p.Q472Rfs *83) mutation is a hot spot mutation of the disease.
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Objective:To investigate the clinical efficacy and prognostic factors of 125I seeds implantation in the treatment of patients with advanced lung cancer after radiotherapy and chemotherapy. Methods:From January 2017 to December 2019, 44 patients (39 males, 5 females, age 41-84 years) with advanced lung cancer after radiotherapy and chemotherapy who received 125I seeds implantation in Hebei General Hospital were retrospectively analyzed. All patients were followed up for ≥12 months, and the clinical efficacies were observed. χ2 test was used to analyze the difference of effective rates between groups. The cut-off value of postoperative dose delivered to 90% gross tumor volume ( D90) was obtained by ROC curve analysis. Kaplan-Meier method was used to calculate the survival rate and log-rank test was used for univariate analysis. Cox proportional hazards model was used for multivariate analysis to find the influencing factors for clinical efficacy. Results:The total effective rate was 72.73%(32/44) after 6 months treatment. The cut-off value of D90 was 120 Gy with the AUC of 0.771. The short-term effective rate of D90≥120 Gy group was better than that of D90<120 Gy group (18/19 vs 56.00%(14/25); χ2=8.17, P=0.004). The 1-year survival rate was 77.27%(34/44). Univariate analysis showed that age ( χ2=3.99, P=0.046), preoperative Hb ( χ2=10.60, P=0.001), tumor maximum diameter ( χ2=11.50, P=0.001) and postoperative D90( χ2=5.81, P=0.016) could affect the survival of patients. Multivariate analysis showed that preoperative Hb (hazard ratio ( HR)=0.023, 95% CI: 0.001-0.882, P=0.043) and tumor maximum diameter ( HR=40.889, 95% CI: 1.458-1 146.586, P=0.029) were prognostic factors. Conclusions:125I seeds implantation shows a good effect in the treatment of lung cancer patients after the progress of radiotherapy and chemotherapy. The short-term effect of patients with D90≥120 Gy is better than that of patients with D90<120 Gy. Preoperative Hb and tumor maximum diameter are prognostic factors of survival after implantation.
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ObjectiveTo evaluate the therapeutic effect of Guizhi Gegentang on cervical vertigo and its impact on hemodynamics and vascular endothelial function. MethodA total of 144 patients with cervical vertigo treated from April 2019 to June 2022 were included in the study and randomly divided into a control group and an observation group， with 72 patients in each group. During the study， three patients dropped out from the observation group and two patients from the control group. The control group received conventional treatment （oral betahistine mesylate tablets）， while the observation group received conventional treatment combined with Guizhi Gegentang. The clinical efficacy， changes in the frequency and duration of dizziness attacks per month before and after treatment， changes in symptoms and functional evaluation scores of cervical vertigo assessed by the European Scale for Cervical Vertigo （ESCV）， changes in the average blood flow velocity of the left vertebral artery， right vertebral artery， and basilar artery， changes in indicators such as endothelin-1 （ET-1）， neuropeptide Y （NPY）， calcitonin gene-related peptide （CGRP）， changes in the Neck Disability Index （NDI） score， changes in the Functional Assessment of Cancer Therapy-General （FACT-G） score， and adverse reactions were observed and compared between the two groups. ResultThe total effective rate in the observation group was 95.65% （66/69）， significantly higher than 84.29% （59/70） in the control group （χ2=4.957， P<0.05）. Before treatment， there were no significant differences in the frequency and duration of dizziness attacks per month， ESCV scores， average blood flow velocity of the left vertebral artery， right vertebral artery， and basilar artery， levels of ET-1， NPY， CGRP， NDI score， and FACT-G score between the two groups. After treatment， compared with the baseline within each group， there were improvements in the frequency and duration of dizziness attacks per month， ESCV scores， average blood flow velocity of the left vertebral artery， right vertebral artery， and basilar artery， levels of ET-1， NPY， CGRP， NDI score， and FACT-G score in both groups （P<0.05， P<0.01）. Compared with the control group， the observation group showed better improvements in the frequency and duration of dizziness attacks per month， ESCV score， average blood flow velocity of the left vertebral artery， right vertebral artery， and basilar artery， levels of ET-1， NPY， CGRP， NDI score， and FACT-G score （P<0.05， P<0.01）. During the study period， one case of nausea occurred in the control group， and one case of dizziness occurred in the observation group. There was no statistically significant difference in the incidence of adverse reactions between the two groups. ConclusionGuizhi Gegentang can improve the therapeutic effect of cervical vertigo， effectively improve patients' hemodynamics and vascular endothelial function， and enhance their quality of life with few adverse reactions. It is worth applying in clinical practice.
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Objective:To systematically evaluate the risk factors of implantable venous access port-related bloodstream infections and provide basis for prevention of catheter-related bloodstream infection in tumor patients.Methods:The Cochrane Library, PubMed, EMBASE, Web of science, CNKI, Wanfang database, VIP database, CBM, Chinese and English Clinical trials Registry (ChiCTR) were searched to collect the literature on risk factors for implantable venous access port-related bloodstream infections in tumor patients from the establishment of the database to April 2022. Two evaluators independently screened and extracted the obtained literature according to the inclusion and exclusion criteria, and used the Newcastle-Ottawa Scale for quality evaluation. Meta-analysis was conducted by RevMan 5.3 software and Stata SE/MP(14.0 version).Results:A total of 13 studies were included, including 23 related risk factors. Among them, prolonged use of catheters, palliative treatment, hematological tumors, neutropenia, hospitalized patients, and chemotherapy were risk factors for implantable venous access port-related bloodstream infections in tumor patients, with statistically significant differences ( OR values ranging from 0.26 to 8.77, all P<0.05). Conclusions:The long time of catheter use, palliative treatment, hematological tumor, neutropenia and chemotherapy were the risk factors of implantable venous access port-related bloodstream infection in patients with tumor, Medical personnel should make a good assessment and strengthen health education to minimize the chances of infection and effectively reduce the incidence of infection related to the infusion port.
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OBJECTIVE@#To evaluate the clinical efficacy and adverse reactions of peginterferon-α2b for treatment of chronic myeloproliferative neoplasms (MPN).@*METHODS@#We retrospectively analyzed the data of 107 patients with MPN, including 95 with essential thrombocythemia (ET) and 12 with polycythemia vera (PV), who all received peginterferon-α2b treatment for at least 12 months. The clnical and follow-up data of the patients were analyzed to evaluate the efficacy and adverse reactions of the treatment.@*RESULTS@#After receiving peginterferon- α2b treatment, both ET and PV patients achieved high hematological remission rates, and the total remission rates did not differ significantly between the two groups (86% vs 78%, P>0.05). In the overall patients, the spleen index decreased by 13.5% (95%CI: 8.5%-18.5%) after the treatment. The patients with hematological remission showed a significantly greater reduction of the total symptom score than those without hematological remission (P < 0.01). The median percentage of JAK2V617F allele load of PV patients decreased from 67.23% (49.6%-84.86%) at baseline to 19.7% (0.57%-74.6%) after the treatment, and that of JAK2V617F-positive ET patients decreased from 48.97% (0.45%-74.24%) at baseline to 22.1% (0.33%-65.42%) after the treatment. Mild adverse reactions (grade 1-2) were observed in both ET and PV groups without significant differences between them. The overall incidence of thrombotic events during the treatment was 2.8% in these patients, and no serious adverse reactions were observed.@*CONCLUSION@#For patients with chronic myelodysplasia, peginterferon-α2b treatment can achieve a high peripheral blood cell remission rate and maintain a long-term stable state with good effect in relieving symptoms such as splenomegaly. Peginterferon- α2b treatment caused only mild adverse reactions, which can be tolerated by most of the patients.
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Humans , Retrospective Studies , Neoplasms , Alleles , Plastic Surgery Procedures , SpleenABSTRACT
Objective To investigate the clinical characteristics of patients with chronic myeloid leukemia (CML) in chronic phase with deletion and non-deletion of the argininosuccinate synthesis gene (ASS gene) on the derivative chromosome 9. Methods The clinical data of patients with CML initially treated with imatinib and BCR/ABL1/ASS1 3-color fusion probe to detect ASS gene deletion were analyzed. The patients were divided into deletion group (n=27) and non-deletion group (n=92). Clinical characteristics, treatment effects, and prognosis were analyzed. Results The average age of 119 patients was 37.22±12.72 years old. The sokal score differed between the deletion and non-deletion groups (χ2=4.304, P=0.038). No statistically significant difference in other general characteristics was found (P > 0.05). The 3-month CCyR rate, 6-month CCyR rate, and BCR-ABLIS≤ 1% rate in the deletion group were lower than those in the non-deletion group (P < 0.05). The median follow-up of 119 patients was 35.0 (3.0-60.0) months. The PFS in the deletion group was lower than that in the non-deletion group (χ2=4.293, P=0.038). Overall survival was not significantly different between the two groups (χ2=0.008, P=0.931). Conclusion The deletion of the ASS gene in patients with chronic CML is related to the poor efficacy of imatinib treatment, poor prognosis, and high risk of disease progression.
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The construction of multiple campuses of one public hospital is an effective way to enlarge supply of high-quality medical resources. On the basis of sorting out the key and difficult problems faced in " multiple campuses" , People′s Hospital of Zhengzhou took " integrated management, homogeneous service, joint logistics support, and high quality development" as the main goal. It followed the guidelines of " Party committee taking overall charge, headquarters taking charge of building, campuses taking charge of routine operations, and orchestrated logistics support" . The hospital took the tactics of " collaborative oriented homogenization management" and " demand oriented and differentiated hospital positioning and discipline layout" . The practice and effect of the hospital included building multiple campuses in terms of management system, medical quality system, outstanding service system, personnel management system, cost management system, cultural construction system, and information management system. By such measures, the hospital has scientifically determined its orientation and discipline layout of every campus, hence offering references for the establishment and management model of " multiple campuses" at public hospitals at large.
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Objective:To investigate the prognostic value of proprotein convertase subtilisin/kexin type 9 (PCSK9) and blood lipid indexes in patients with sepsis.Methods:Patients with sepsis or septic shock who were ≥ 18 years old and met the Sepsis-3.0 diagnostic criteria admitted to the department of critical care medicine of Binzhou Medical University Hospital from January to October 2021 were enrolled. Healthy adults at the same period were selected as healthy control group. Baseline characteristics, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and sequential organ failure assessment (SOFA) score were recorded. Venous blood samples were collected within 24 hours after diagnosis, and serum PCSK9 was determined by enzyme-linked immunosorbent assay (ELISA) at 1, 3 days and 5 days. Meanwhile, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglyceride (TG) and lipoprotein A were detected. The differences of each index between sepsis group (28-day death group and survival group) and healthy control group were compared. Meanwhile, the indexes of patients with different severity and 28-day prognosis in sepsis group were compared. Receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of PCSK9 and blood lipid for the prognosis of sepsis. Multivariate Logistic regression was used to analyze the influencing factors for the prognosis of sepsis, and the Kaplan-Meier survival curve at 28th day was drawn.Results:There were 50 patients in sepsis group (including 19 patients with sepsis, 31 patients with septic shock) and 27 patients in healthy control group. In the sepsis group, 19 patients died and 31 patients survived within 28 days. The serum PCSK9 in the sepsis group was significantly higher than that in the healthy control group [μg/L: 223.09 (198.47, 250.82) vs. 188.00 (165.27, 214.90), P < 0.01], and HDL-C, LDL-C, TC and lipoprotein A were significantly lower than those in the healthy control group [HDL-C (mmol/L): 0.82±0.35 vs. 1.45±0.24, LDL-C (mmol/L): 1.53 (1.14, 2.47) vs. 2.89 (2.55, 3.19), TC (mmol/L): 2.03 (1.39, 2.84) vs. 4.24 (3.90, 4.71), lipoprotein A (g/L): 8.80 (5.66, 17.56) vs. 27.03 (14.79, 27.03), all P < 0.01]. PCSK9 in the sepsis death group was higher than that in the survival group [μg/L: 249.58 (214.90, 315.77) vs. 207.01 (181.50, 244.95), P < 0.01], and the HDL-C, LDL-C and TC were lower than those in the survival group [HDL-C (mmol/L): 0.64±0.35 vs. 0.93±0.30, LDL-C (mmol/L): 1.32±0.64 vs. 2.08±0.94, TC (mmol/L): 1.39 (1.01, 2.23) vs. 2.69 (1.72, 3.81), all P < 0.01]. With the progression of the disease, the PCSK9 in the sepsis death group and the survival group was significantly lower than that within 1 day of diagnosis (all P < 0.05). ROC curve analysis showed that PCSK9 had higher predictive value of 28-day death than HDL-C, LDL-C, TC [area under ROC curve (AUC) and 95% confidence interval (95% CI): 0.748 (0.611-0.885) vs. 0.710 (0.552-0.868), 0.721 (0.575-0.867), 0.702 (0.550-0.854)]. Multivariate Logistic regression analysis showed that PCSK9 was an independent risk factor affecting the 28-day prognosis of sepsis (β value was 1.014, P = 0.020). Kaplan-Meier survival curve analysis showed that when PCSK9 ≥ 208.97 μg/L, with the increase of PCSK9, the 28-day survival rate of sepsis patients decreased significantly. Conclusions:PCSK9, HDL-C, LDL-C and TC can all predict the 28-day prognosis of patients with sepsis. The prognostic value of PCSK9 is the highest. PCSK9 is an independent risk factor affecting the prognosis of sepsis. In the early stage of the disease, PCSK9 may have a good predictive value for the prognosis of sepsis. When PCSK9 ≥ 208.97 μg/L, the 28-day survival rate decreased significantly.
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Hypoxemia is a common complication of pneumonia, asthma, and bronchopulmonary dysplasia in children.Rapid identification of hypoxemia is of great significance for the disposal and management of critical children.Pulse oximetry is recognized by the World Health Organization as the best way to monitor hypoxemia in children, and it can monitor pulse oxygen saturation noninvasively and continuously.Based on the related literature at home and abroad, combined with the clinical needs of pediatrics, the " Expert consensus on clinical application of pulse oximetry in children" is formulated to improve the understanding of pediatricians and nurses on the application in pediatric clinical practice, principle, operation techniques, and limitations of pulse oximetry.
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Objective:To explore the effects of type 2 diabetes mellitus (T2DM) on the levels of serum magnesium in patients with community-acquired pneumonia (CAP) and the effects of abnormal serum magnesium on the prognosis in T2DM patients with CAP.Methods:The study was a retrospective single-center study conducted in adult patients hospitalized with CAP at the First Hospital of Qinhuangdao between January 2015 and December 2018. These patients were divided into two groups according to the diagnosis of T2DM (control group and T2DM group). The reference range for serum magnesium is from 0.75 to 1.25 mmol/L. The primary endpoint was in-hospital mortality.Results:The prevalences of hypomagnesemia and hypermagnesemia were numerically higher in T2DM group than in control group (hypomagnesemia: 14.6% vs 12.0%, hypermagnesemia: 1.4% vs 0.7%), but there was no statistical difference ( P>0.05). In patients with T2DM, the in-hospital mortalities in patients with normal serum magnesium and hypomagnesemia were 5.9% and 12.7%, respectively; In multivariate logistic regression analysis, the in-hospital mortality of patients with hypomagnesemia was 5.629(95% CI 2.012-15.750, P=0.001)times as much as that of patients with normal serum magnesium. Conclusions:Abnormal serum magnesium was common in T2DM inpatients with CAP and hypomagnesemia was the most common. Hypomagnesemia was closely related to in-hospital mortality in T2DM patients with CAP. The assessment of serum magnesium levels on admission may be helpful in predicting the prognosis of T2DM patients with CAP.
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Objective:To explore the impact of social support on cognitive function and depression in patients with mild cognitive impairment (MCI).Methods:From March to September 2018, 5 765 subjects over 60 years old from 52 villages in Yanlou Town, Yanggu County were selected and they were screened by mini-mental state examination (MMSE) and activities of daily living(ADL). Finally 4 750 valid questionnaires were recovered.According to the " Diagnostic and Statistical Manual of Mental Disorders" 4th Edition (DSM-Ⅳ), 733 patients with MCI (patient group) and 3 662 patients with normal cognitive function (healthy control group) were diagnosed.The social support rating scale (SSRS) and geriatric depression scale-15 (GDS-15) were used to evaluate the patients.SPSS 26.0 software was used for independent sample t-test, chi-square test, Pearson correlation analysis and linear regression analysis. Results:The total score of social support (48.55±9.72), objective social support (16.49±4.00), subjective social support (24.28±4.75) and social support utilization (7.78±2.85) in patients group were significantly lower than those in the healthy control group (total score of social support (50.94±7.66), objective social support (17.23±3.42), subjective social support (25.59±3.61) and social support utilization (8.13±2.71)). The differences were statistically significant ( t=-6.291, -4.363, -8.245, -3.068, all P<0.05) .All the dimensions of social support(total score, objective support, subjective support, support utilization) were positively correlated with cognitive function ( r=0.084, 0.062, 0.128, 0.011, all P<0.05), and negatively correlated with depression score ( r=-0.240, -0.195, -0.200, -0.169, all P<0.01). Subjective social support, objective social support and social support utilization could positively predict MMSE score of MCI patients( β=0.190, 0.007, 0.029, all P<0.05), while could negatively predict the GDS-15 score of MCI patients( β=-0.145, -0.098, -0.105, all P<0.05). Conclusion:Good social support is a protective factor for cognitive function and depression in MCI patients.
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Objective To understand the current status of healthcare-associated infections (HAI) among inpatients in medical institutions of Wuhan, and to provide a scientific basis for improving the management of healthcare-associated infections. Methods A combined method of bedside investigation and case review of the patients’ medical records were used to investigate all hospitalized patients in 31 hospitals. Results A total of 42 429 inpatients were investigated, of whom 938 had HAI (2.21%), and 7 561 had community-associated infection (CAI, 17.82%). The top three departments with the highest prevalence rate of HAI were ICU (17.95%), hematology (8.49%), and neurosurgery (6.57%), while the top three departments with the highest prevalence rate of CAI were burns (75.00%), pediatric non-neonatal group (70.26%) and respiratory department (67.53%). Both healthcare-associated infections and community infections were mainly in the lower respiratory tract, which accounted for 47.33% and 53.00%, respectively. The main pathogens of both HAI and CAI were Gram-negative bacteria, which accounted for 65.03% and 57.73%, respectively. The use rate of antimicrobial drugs was 31.74%, and the detection rate of pathogenic bacteria before antimicrobial treatment was 55.77%. The three departments with the highest rates of the use of antibacterial drugs were the pediatric non-neonatal group (78.20%), the department of burns (75.00%) and the department of urology (73.24%). Conclusion ICU, hematology department, and neurosurgery department were high-risk departments for healthcare-associated infections. Pediatrics, burns, and urology departments were the departments with high use of antibacterial drugs. The pathogenic bacterial detection rate has declined, which needs to be strengthened.
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Red blood cell distribution width is an index reflecting the size heterogeneity of circulating red blood cells, which is usually used for diagnosis and treatment of blood system diseases.In recent years, more and more evidences show that the increase of red blood cell distribution width level is closely related to the occurrence, development and prognosis of cardiovascular diseases.We focused on the relationship between red blood cell distribution width and atrial fibrillation (AF) and its possible mechanism, in order to provide some reference value for the clinical treatment of AF.
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Objective:To investigate the cognitive status of the elderly in rural areas and explore the characteristics and influencing factors of subjective cognitive decline (SCD).Methods:A baseline survey was conducted among 5 765 rural elderly people aged 60 years old or above from March to September 2018.Subjective cognitive decline questionnaire(SCD-Q9), mini-mental state examination(MMSE), verbal fluency test (VFT), Chinese auditory verbal learning test (CAVLT), digital span test(DST)and activities of daily living(ADL)were used in the survey.The result of the survey indicated that there were 2 654 subjects with SCD (SCD group) and 1 008 subjects with normal cognitive function (NC group). Social support rating scale (SSRS) and short version of geriatric depression scale-15(GDS-15) were used to evaluate their psychosocial status.Descriptive analysis and Logistic regression analysis were conducted by SPSS 26.0 software.Results:(1) Compared with NC group, the SCD group had the following characteristics: delayed recognition rate(8.25 ±2.51), (12.38 ±2.53), reverse digit span (2.63±1.37), (3.69±1.45), social support (69.81±8.71), (64.40±9.44), GDS-15 (2.27±2.63), (1.31±2.17), and the differences were statistically significant (all P<0.05). However, there were no significant differences in the following characteristics: MMSE score (21.62±5.73), (21.47±5.84), speech fluency (27.80±7.35), (28.25±7.56), ADL score (20.70±1.35), (20.77±1.30), all P>0.05.(2) There were no significant differences in diet structure, blood glucose, blood lipid, cerebrovascular disease, diabetes, epilepsy and coronary heart disease between SCD group and NC group (all P>0.05). (3)SCD was mainly affected by age( β=0.06, OR=2.29, 95% CI=1.09-4.85), depression( β=-0.01, OR=2.96, 95% CI=0.68-4.94), hypertension( β=-0.17, OR=1.89, 95% CI=1.11-2.15), and low level of social support( β=2.07, OR=1.49, 95% CI=1.32-2.12) (all P<0.05). Conclusion:The scores of delayed recognition and reverse digit span in patients with SCD are lower than those with normal cognitive function.The other objective cognitive functions are basically normal.Old age, low social support level, depression, low education level and hypertension are the risk factors of SCD.
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Objective:To evaluate the assistant role of manifestations under tracheoscopy in the diagnosis of invasive pulmonary aspergillosis (IPA) in severe patients.Methods:A retrospective study was conducted. The patients with suspected IPA admitted to intensive care unit (ICU) of Affiliated Hospital of Binzhou Medical College from January 2015 to December 2019 were enrolled. The diagnosis, clinical diagnosis and suspected diagnosis were made according to the grading criteria of Guidelines for the diagnosis and treatment of invasive fungal infection in severe patients (2007). Those who met the criteria were enrolled in the IPA group, and those who did not meet the criteria or other pathogens were enrolled in the non-IPA group. The general data of the patients were collected, and the changes of tracheal and bronchial mucosa under tracheal microscope before and after treatment were recorded, as well as the results of galactomannan (GM) test and aetiology culture of bronchoalveolar lavage fluid (BALF). The baseline, bronchoscopy and pulmonary CT manifestations and their dynamic changes were compared in each group. Results:A total of 142 patients with suspected IPA were finally enrolled. Among them, 12 were pathologically proven IPA, 77 were probable IPA, 22 were possible IPA, and 31 were undefined IPA. Of the 142 patients, 60 had typical manifestations of mucosal injury under bronchoscopy, including 7 proven IPA patients (58.3%), 52 probable IPA patients (67.5%), and 1 possible IPA patient (4.5%), but none undefined IPA patient. The patients undergoing lung CT scan were 12 proven IPA patients (100%), 73 probable IPA patients (94.8%), and 21 possible IPA patients (95.5%), respectively. Most of the Chest CT showed patchy or strip density increasing and other non-specific manifestations. There were 3 proven IPA patients (25.0%), 7 probable IPA patients (9.0%), and 0 possible IPA patient (0%) who had typical IPA CT manifestations (halo sign and cavity or crescent sign). Among the patients of proven IPA and probable IPA (89 cases), there were a total of 35 cases with endoscopic airway mucosal injury and tracheoscopy reexamination ≥ 3 times. All the 35 patients received anti-aspergillus treatment, among which 16 survived and 19 died. Among the 16 patients who survived, the microscopic appearance of mucosal injury was gradually reduced and the clinical manifestations were gradually improved. Of the 19 patients who died, 16 had deteriorated endoscopic airway mucosal injury.Conclusions:The specific manifestations of severe patients with bronchial mucosal injury are of great significance in the diagnosis of IPA. In the case of severe patients who cannot receive pathological examination or chest CT in time, dynamic observation of the changes of airway mucosal injury is a simple auxiliary method to discover the changes of patients' condition in time, evaluate the effect of antifungal therapy and the prognosis of IPA.
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Objective:To analyze the genetic characteristics of Brucella strains isolated from a human brucellosis epidemic in Baoding City of Hebei Province, and to provide scientific basis for control and prevention of brucellosis. Methods:Brucella antibody was detected in a high-risk population ( n=22) of brucellosis in Baoding City in 2018 by using rose bengal plate test and tube agglutination test. Blood samples of patients with brucellosis were collected for Brucella isolation ( n=3). Conventional methods were used to identify the bacteria strains. Multiple locus variable-number tandem repeat analysis (MLVA) and multilocus sequence typing (MLST) were used to analyze the genetic characteristics of the strains. Results:The sero-prevalence of Brucella antibodies in high-risk populations was 4.55% (1/22). Three suspected Brucella strains were isolated from blood samples of three patients (No. BDY-1, BDY-2 and BDY-3) and were identified as Brucella melitensis biovar 3. The results of MLVA showed that strain BDY-1 and strain BDY-2 were the same genotype. Strain BDY-3 added two tandem repeats at the locus of Bruce04 and Bruce16, respectively, and lost three tandem repeats at the locus of Bruce30. The genotype of panel 1 (MLVA-8) and panel 1 + panel 2A (MLVA-11) were 42 and 116, respectively, which belonged to the "East Mediterranean group". They were closely clustered with Brucella melitensis biovar 3. MLST analysis showed that all isolated strains could be classified into a ST8 type. Conclusions:The isolated strains from the epidemic are Brucella melitensis biovar 3. In the future, the prevention and control of brucellosis in Baoding City should strengthen the health education and behavior intervention of the high-risk population.
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This paper aims to study the accuracy of cardiopulmonary physiological parameters measurement under different exercise intensity in the accompanying (wearable) physiological parameter monitoring system. SensEcho, an accompanying physiological parameter monitoring system, and CORTEX METALYZER 3B, a cardiopulmonary function testing system, were used to simultaneously collect the cardiopulmonary physiological parameters of 28 healthy volunteers (17 males and 11 females) in various exercise states, such as standing, lying down and Bruce treadmill exercise. Bland-Altman analysis, correlation analysis and other methods, from the perspective of group and individual, were used to contrast and analyze the two types of equipment to measure parameters of heart rate and breathing rate. The results of group analysis showed that the heart rate and respiratory rate data box charts collected by the two devices were highly consistent. The heart rate difference was (-0.407 ± 3.380) times/min, and the respiratory rate difference was (-0.560 ± 7.047) times/min. The difference was very small. The Bland-Altman plot of the heart rate and respiratory rate in each experimental stage showed that the proportion of mean ± 2SD was 96.86% and 95.29%, respectively. The results of individual analysis showed that the correlation coefficients of the whole-process heart rate and respiratory rate data were all greater than 0.9. In conclusion, SensEcho, as an accompanying physiological parameter monitoring system, can accurately measure the human heart rate, respiration rate and other key cardiopulmonary physiological parameters under various sports conditions. It can maintain good stability under various sports conditions and meet the requirements of continuous physiological signal collection and analysis application under sports conditions.