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Objective:To improve the ability of identification and differential diagnosis of severe systemic lupus erythematosus (SLE).Methods:A severe SLE patient with lupus myocarditis, neuropsychiatric lupus, thrombotic microangiopathy (TMA) and other multiple system involvement was reported and discussed.Results:A young female patient developed albuminuria 5 months ago, edema of both lower limbs 3 months ago, change of consciousness 1 month ago and two convulsions attack 2 days ago. She experienced life threatening manifestations such as neuropsychiatric lupus, myocardial involvement of lupus, and TMA. During the course, her condition was generally improved after glucocorticoid pulse therapy and plasma exchange.Conclusion:Various complicated clinical manifestations related to SLE need to be recognized earlier and intervened as soon as possible.
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Objective:To observe the impact of application of ward rounds checklist on the post competency of residents in the standardized residency training of critical care medicine.Methods:From April 2016 to January 2017, different batches of residents who were admitted to the Department of Critical Care Medicine for standardized residency training were randomized into the experimental group and the control group. Both groups were taught by experienced ICU senior attending physicians one-to-one. The control group routinely conducted rounds and handovers. The experimental group implemented a ward rounds checklist system during rounds and handovers. The training time for each group was 2 months. According to the characteristics of ICU combined with the requirements of post competency, a questionnaire was formulated. SPSS 17.0 was used for t test and chi-square test. Results:The resident physicians in the experimental group gave more satisfactory evaluations in terms of the actual patient care ability, medical knowledge mastery, clinical work under the system, learning and improvement from work, professional literacy, and communication skills to reflect the post competency, and had relatively higher degree of satisfaction with the teaching training, all with statistical significance ( P<0.05). Conclusion:It's helpful to improve the post competency and teaching satisfaction of ICU residents by implementing the ward rounds checklist system during the rotation of resident physicians in the standardized residency training of critical care medicine.
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Objective:To explore the effect of group visits on health condition among follow-up patients with chronic heart failure.Methods:Totally 126 outpatient follow-up patients with heart failure were divided into intervention group and control group by random number table from 2018 to 2019. The intervention group consisted of 63 cases and control group consisted of 59 cases. The intervention lasted 6 months. The intervention group received group visits, while the control group received routine outpatient follow-up. Medication adherence, quality of life and heart failure related indicators were evaluated at baseline and after 6 months of intervention.Results:At 6 months after intervention, the scores of medication adherence, total quality of life, body, emotion and others dimensions of the intervention group were (5.79±1.38), (30.11±8.22), (12.65±5.53), (5.24±4.57) and (12.22±4.76) points. These scores of the control group were (5.31±1.09), (37.26±9.02), (15.87±5.21), (7.03±5.14), (14.36±5.54) points. The differences between the two groups were statistically significant ( t values were -4.581-2.161, P<0.05 or 0.01). The BNP and proportion of New York Heart Association (NYHA) I the intervention group were (180.87±174.92) ng/L and 84.1% (53/63). These indicators of the control group were (351.02±268.13) ng/L and 67.8% (40/59). The differences between the two groups were statistically significant ( t value was -4.177, χ2 value was 4.484, P<0.01 or 0.05). Conclusions:Group visits program is an effective management mode to provide intensive patient education and foster peer support, improving medication adherence and quality of life of follow-up patients with heart failure.
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Objective@#To understand the prevalence, diagnosis and treatment of chronic critical illness (CCI) in China.@*Methods@#The clinical data of 472 adult patients admitted to ICU in 53 hospitals, including basic information, disease-related data, nutrition program, etc., were collected on May 10, 2019, by means of multi-center cross-sectional study. If surgical intervention was needed or the occurrence of the disease was directly related to the surgery, ICU patients were regarded as surgical ICU cases (n=211). In this study, the diagnostic criteria for CCI were: (1) admission to ICU >14 days;(2) combined with persistent organ dysfunction. The prevalence,distribution and treatment of CCI and surgery-related CCI were recorded and analyzed. The Mann-Whitney U test, chi-square test or Fisher exact test were used for comparative analysis.@*Results@#Among the 472 ICU patients from 53 hospitals, 326 were male (69.1%) and 146 were female (30.9%). The prevalence of CCI was 30.7% (145/472). Among 211 surgery-related ICU patients, 57 developed CCI with a prevalence of 27.0%. As compared to non-CCI patients, higher APACHE II score [median (IQR) 13.5 (10.0, 18.3) vs. 11.0 (7.0, 16.0), U=2970.000, P=0.007], higher Charlson comorbidity index [median (IQR) 4.0 (2.0, 7.0) vs. 3.0 (1.0, 5.0), U= 3570.000, P=0.036] and higher ratio of breath dysfunction [68.4% (39/57) vs. 48.1% (74/154), χ2=6.939, P=0.008] and renal dysfunction [42.1% (24/57) vs. 18.2% (28/154), χ2=12.821, P<0.001] were found in surgery-related CCI patients. While SOFA score, Glasgow coma score and other visceral function were not significantly different between surgery-related CCI and non-CCI patients (all P>0.05). NUTRIC score showed that surgery-related CCI patients had higher nutritional risk [43.9% (25/57) vs. 26.6%(41/154), U=5.750, P=0.016] and higher ratio of mechanical ventilation [66.7% (38/57) vs. 52.3% (79/154), χ2=3.977, P=0.046] than non-CCI patients. On the survey day, the daily caloric requirements of 50.2% (106/211) of surgery-related ICU patients were calculated according to the standard adult caloric intake index (104.6 to 125.5 kJ·kg-1·d-1, 1 kJ=0.239 kcal), and the daily caloric requirements of 46.4% (98/211) of patients were calculated by physicians according to the severity of the patient′s condition. 60.2% (127/211) of nutritional support therapy was enteral nutrition (including a combination of enteral and parenteral nutrition), while the remaining patients received parenteral nutrition (24.6%, 52/211), simple glucose infusion (9.0%, 19/211), or oral diet (6.2%, 13/211). The target calorie of CCI group was 104.6 (87.9, 125.5) kJ·kg-1·d-1, and the actual calorie intake accounted for 0.98 (0.80, 1.00) of the target calory. In the non-CCI group, the target calorie was 104.6 (87.9, 125.5) kJ·kg-1·d-1, and the actual calorie consumed accounted for 0.91 (0.66, 1.00) of the target calorie. There was no statistically significant difference between two groups (P=0.248, P=0.150).@*Conclusion@#The prevalence of CCI and surgery-related CCI in ICU is high, along with severe complications, respiratory and renal dysfunction and mechanical ventilation. Surgical patients admitted to ICU are at high nutritional risk, and active and correct nutritional support is essential for such patients.
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Objective To explore the knowledge and training needs of cardiopulmonary resuscitation (CPR) among a health checkup population, and to provide evidence for promoting cardiopulmonary resuscitation knowledge and skills at physical examination centers. Methods Using physical examination numbers, the random number table method was used to randomly select 1 000 people from a health checkup population, information collected including their basic information, cognitive status of cardiopulmonary resuscitation, and attitudes and behaviors toward cardiopulmonary resuscitation. The statistical analysis was performed using χ2test, a one-way ANOVA, and multivariate logistic regression analysis. Results Questionnaires was acquired from 997 consenting adult subjects. From which, 26% had received CPR training, and they demonstrated a low ratio of cognitive knowledge, scoring only 9.94 ± 6.36 (from a possible score of 30). Additionally, 92.1% had a willingness to learn CPR skills, and the CPR performance score was 23.12±3.27 (the highest score was 28). Unmarried people younger than 25 years old, professional and technical personnel, and military men had higher CPR scores than other groups. The CPR learning efficiency of military men, undergraduates, and people younger than 25 years old was higher than other groups. Older people had a lower willingness to learn cardiopulmonary knowledge and the better the feel-good status, the lower the willingness to learn CPR skills, of which OR values were 0.787 and 0.657, respectively (P<0.05). The rate of people learning CPR skills for relatives was higher than for strangers (P<0.05), and 83.8% were willing to receive medical training. Conclusion The health checkup population had a low cognitive level of CPR knowledge, and the willingness to learn CPR was high. To address this, free CPR training should be conducted at medical examination institutions.
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Objective To evaluate the application of clinical cases related problem-based-learning (PBL) method in critical care medical standardized resident training program. Methods 84 residents were randomly divided into experimental group (n=42) and control group (n=42) by lottery way. The experimental group received PBL process during clinical case analysis while the control group learned completely through traditional teaching method . The residents' clinical competence were assessed by multiple scale mixed method including question bank examination (QBE), case-based discussion (CBD), direct observation of procedural skills (DOPS), simulation etc, and Likert-type scale questionnaire was used to evaluate the feedback of training residents. SPSS 17.0 was used to do line t test to the data of both groups. Results Finally 84 residents finished the study. There were no difference in the general conditions in two groups. The PBL group achieved higher examination score during QBE [(80.26 ±8.89) vs. (86.10 ±9.32)], CBD [(84.83±5.43) vs. (75.36±6.06)], DOPS [(88.81±6.68) vs. (82.70±6.98)], simulation [(79.86±10.09) vs.(72.71±9.30)]. Except two groups residents all gave high scores in enhancing cross connection in clinical knowledge [(4.786±0.470) vs. (4.571±0.859), P=0.16], and the questionnaire results showed that the resi-dents of PBL group gave higher points in exciting autonomous learning, improving clin-ical analysis ability, accelerating clinical thinking establish, developing independent thinking habits, improving the clinical communication skills and teamwork ability (P<0.05). Conclusion The clinical cases related PBL method can improve the training effects during critical care medical standardized resident training program. It can be used broadly after adapting modification in critical care medical education.
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Objective To examine the effects of IL-10 on cardiac fibroblasts ( CFBs) proliferation and phenotype transformation to myofibroblasts (MyoFbs) induced by transforming growth factor-β1 (TGF-β1);and to investigate the regulating pathways .Methods Cardiac fibroblasts were isolated from cardiac ventricles of neonatal SD rats . The passage 2~4 were used and divided into the following groups for treatment:1) control group, 2) IL-10 reac-tion group, 3) TGF-β1 reaction group, and 4) IL-10 plus TGF-β1 reaction group (TGF-β1 treatment followed with IL-10 pretreatment ) .Cells proliferation was assessed by MTT assay and immunocytochemistry staining for prolifera-ting cell nuclear antigen (PCNA);the phenotype transformation into MyoFbs was assessed by immunocytochemistry of α-smooth muscle actin (α-SMA);extracellular signal related kinase ( ERK1/2) and P38 kinase pathways were assessed by western-blot.Results TGF-β1 (10 μg/L) treatment boosted the proliferation and the expression ofα-SMA significantly (P<0.01), while IL-10 (10, 50 or 100 μg/L) plus TGF-β1 co-treatment induced lower cell proliferation and expression of α-SMA than treating with TGF-β1 alone ( P<0.05 ) , with the inhibitory effect of IL-10 being concentration dependent .TGF-β1 could significantly stimulate the ERK 1/2 and P38 kinase phospho-rylation ( P<0.01 ) , however IL-10 (100 μg/L) plus TGF-β1 co-treatment failed to down-regulated the phospho-rylation of ERK1/2 and P38 kinase compared with TGF-β1 alone ( ERK1/2:P<0.05;P38:P<0.01 ) .Conclu-sions IL-10 can attenuate TGF-β1-induced CFBs proliferation and phenotype transformation to MyoFbs .The in-hibitory effects may explained by a mechanism of inhibiting the activation of ERK 1/2 and P38 kinase .
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Objective To investigate the gender differences of coronary heart disease secondary prevention status in patients post percutaneous coronary intervention (PCI). Methods Patients diagnosed with coronary heart disease from 31 tertiary hospitals were enrolled for a baseline survey. Medical history and laboratory tests were taken. Analysis was done for outpatient or inpatient with the history of at least one PCI treatment. Status of smoking cessation, weight management, blood pressure < 140/90 mm Hg, low-density lipoprotein cholesterol (LDL-C) < 100 mg/dL (2.6 mmol/L), and use of antiplatlet drugs, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARB) and statins were collected and compared. Results Women (n=1151) accounted for 25.4% of all PCI patients (n=4532). Proportion of female with history of smoking was signiifcantly lower than male, but the proportion of quitting was similar between female and male, 53%(n=98) vs. 53.7%(n=1344), P=0.849. The average body mass index, mean waist circumference and proportion of overweight were higher in man than women, P=0.000. However, the proportion of abdominal obesity in women is higher than men, 75.2%vs. 52.8%, P=0.000. More female were comorbid with hypertension, hyperlipidemia and diabetes than male and the differences were signiifcant, P=0.000. Control rate of blood pressure, LDL-C and fasting glucose were lower in women than in man, the differences were 66.2% vs 73.4% for blood pressure, 47.8%vs. 57.0%for LDL-C and 57.5%vs. 62.7%for fasting glucose, P=0.000. There was no signiifcant difference in medication usage between different genders. Conclusions In patients post pecutaneous coronary intervention, female patients had more risk factors than male while risk factor control rate was lower comparing with male. Medication usage for coronary heart disease secondary prevention was similar between different genders.
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Objective To test the hypothesis that IL-10 may promoting left ventricular remodeling and cardiac function by modulating extracellular matrix after acute myocardial infarction. Methods Male adult rats were randomly divided into three groups: control group (n=6) , MI/AAV2 group (n=16) and MI/AAV2-IL-10 group (n=16). Establishing animal modol of experimental myocardial infarction and recombinant adeno-associated virus type 2 (AAV)/IL-10 (AAV2-rhIL-10) and AAV2 were injected around the ischemic zone. Echocardiography parameters, hemodynamic parameters, left ventricular mass index (LVMI) , collagen volume fraction (CVF) , perivascu-lar circumferential area (PVCA) , collagen type Ⅰ & Ⅲ volume fraction and mRNA levels of collagen type Ⅰ & Ⅲ , matrix metalloproteinases-2 ( MMP-2 ) and tissue inhibitor of metalloproteinase-1 ( TIMP-1) were compared among the three groups. Results Improved cardiac function was observed in MI/AAV2-IL-10 group shown by echocardiography and hemodynamic examination. Four weeks after myocardial infarction, thickness of different parts of LV was not different in MI/AAV2-IL-10 group and MI/AAV2 group. Nevertheless CVF, PVCA and collagen type Ⅰ volume fraction was significantly descending in remote zone of MI/AAV2-IL-10 group compared with that of MI/ AAV2 group. The mRNA expression of collagen type I and MMP-2 was lower in MI/AAV2-IL-10 group than that in MI/AAV2 group. Conclusion Recombinant IL-10 expression mediated by AAV2-rhIL-10 transfection of rats' myocardium promotes LV remodeling and cardiac function after acute myocardial infarction. The promotion was partially achieved by inhibition myocardium collagen deposition.
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Objective To evaluate the correlating clinical factors of coronary artery calcification score(CACS).Methods 141 patients suspected of coronary artery disease were included.They underwent multi-slice row computed tomography,pulse wave velocity ( PWV ),UCG and blood biochemistry within a period of 3 months.The subjects were divided into three groups according to CAC score:A(CACS =0-10),B ( CACS = 11-400),C ( CACS > 400).Results CACS was significantly associated with age,history of hypertension and diabetes mellitus.It was also associated with the presence of mitral annular calcification and aortic valve calcification,low ankel brachial pressure index(ABI) and high mean artery pressure(MAP) as well as high values of brachial ankel PWV (baPWV) and Upstroke time (UT).Muhifactorial logistic regression analysis showed that the presence of aortic valve calcification and mitral annular calcification,the history of diabetes mellitus and high value of UT were independently correlated with severe coronary artery calcification.Conclusions Aortic valve calcification,mitral annular calcification,history of diabetes mellitus,high value of UT were independently correlated with severe coronary artery calcification.Measurement of PWV and UCG should be performed before muhi-slicerow computed tomography,because the assessment of coronary artery lumen narrowing with multi-slice row computed tomography can not be carried out accurately in the presence of severe coronary artery calcification.
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Objective To investigate the effects of ulinastatin on the number of peripheral blood lymphocyte and the percentage of its subsets in patients with severe sepsis. Methods The scores of APECHE II and SOFA, the number of lymphocyte and the percentage of different subsets in these sepsis patients at different treatment time were measured. Results After treatment, the scores of APECHE II and SOFA of severe sepsis patients were decreased, the number of lymphocyte elevated and the percentages of different subset were corrected. Sepsis caused by Gram- positive pathogens had stronger suppression of peripheral blood lymphocyte and subsets compared with Gram - negative pathogens. Conclusion Patients with severe sepsis had less peripheral blood lymphocyte and abnormal subsets. Ulinastatin could help to correct such abnormality.
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Objective To test the hypothesis that IL-10 may promoting left ventricular remodeling and cardiac function by modulating extracellular matrix after acute myocardial infarction. Methods Male adult rats were randomly divided into three groups:control group (n=6),MI/AAV2 group (n=16) and MI/AAV2-IL-10 group (n=16). Establishing animal modol of experimental myocardial infarction and recombinant adeno-associated virus type 2 (AAV)/IL-10 (AAV2-rhIL-10) and AAV2 were injected around the ischemic zone. Echocardiography parameters,hemodynamic parameters,left ventricular mass index (LVMI),collagen volume fraction (CVF),perivascular circumferential area (PVCA),collagen type Ⅰ&Ⅲ volume fraction and mRNA levels of collagen type Ⅰ&Ⅲ,matrix metalloproteinases-2 (MMP-2) and tissue inhibitor of metalloproteinase-1 (TIMP-1) were compared among the three groups. Results Improved cardiac function was observed in MI/AAV2-IL-10 group shown by echocardiography and hemodynamic examination. Four weeks after myocardial infarction,thickness of different parts of LV was not different in MI/AAV2-IL-10 group and MI/AAV2 group. Nevertheless CVF,PVCA and collagen type Ⅰ volume fraction was significantly descending in remote zone of MI/AAV2-IL-10 group compared with that of MI/AAV2 group. The mRNA expression of collagen type I and MMP-2 was lower in MI/AAV2-IL-10 group than that in MI/AAV2 group. Conclusion Recombinant IL-10 expression mediated by AAV2-rhIL-10 transfection of rats' myocardium promotes LV remodeling and cardiac function after acute myocardial infarction. The promotion was partially achieved by inhibition myocardium collagen deposition.
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Objective To study the effects of estradiol-17β (17β-E2) on the synthesis of GnRH and GH in submandibular gland of rat. Method Immunohistochemical ABC method was used to observe the localization of GnRH and GH in submandibular gland of rat.Results The synthsis of GnRH was promoted and the synthesis of GH was inhibited by 17β-E2 in rat's submandibular gland. Conclusion The 17β-E2 may play an important regulative role in the synthesis of GnRH and GH.
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Objective In order to explore the mechanizms of thymosin action on hypothalamus. Methods RT-PCR and in situ hybridization histochemistry (ISHH)were used. Results The expression of prothymosin ?1-mRNA was detected in preoptic area of hy- pothalamus by using RT-PCR technique. The results of ISHH showed that prothymosin ?1-mRNA was expressed in the preoptic mag- nocellular nucleus, suprachiasmatic nuclei and paraventricular nuclei of hypothalamus. In addition, the positive signal of prothymosin ?1- mRNA was also observed both in the microglicyte near the third ventricle and in medium to small sized pyramidal cells in cerebral cor- tex. Conclusion Prothymosin ?1 is produced in preoptic area of the hypothalamus by means of paracrine, which indicates that prothy- mosin ?1 participates in the regulation of hypothalamic function.
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Objective To study the effect of in utero exposure of TCDD on synthesis of EGF and EGFR in submandibular gland of rat offspring. Methods SD rats were treated with TCDD 5??g/kg on Day 15 of gestation, the expression of EGF and EGFR in submandibular gland of rat offspring were analyzed by immunohistochemistry method. Results On PND32 and PND49, the expression of EGF and EGFR in TCDD experiment group were more than that of control group, the difference was statistically significant.Conclusion In utero exposure of TCDD can promote the synthesis of EGF and EGFR in submandibular gland of rat offspring from prepuberty stage through puberty stage. [