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Objective:To analyze the clinical features of severe or critical 2019 novel coronavirus pneumonia (NCP) patients.Methods:Clinical data of 58 patients with severe or critical NCP in Wuhan Union Hospital, Tongji Medical College of Huazhong University of Science and Technology from January 29 to February 26, 2020 were collected. The general information, clinical symptoms, results of blood test and chest computed tomography (CT) imagings, treatments and outcomes of patients were analyzed retrospectively.Results:Among the 58 patients, 36 patients (62.1%) were severe and 22 (37.9%) were critical, 28 (48.3%) were male and 30 (51.7%) female, with an average age of (62.12±12.95) years. Twenty-eight patients (48.2%) had previous underlying diseases, including 21 patients (36.2%) with hypertension, 11 patients (19.0%) with diabetes mellitus, 6 patietns (10.3%) with coronary heart disease, 2 patients (3.4%) with chronic renal failure, and 1 patient (1.7%) with malignant tumor. The symptoms included fever (54 cases, 93.1%), dyspnea (48 cases, 82.8%), cough (46 cases, 79.3%), muscle soreness (32 cases, 55.2%), sore throat (15 cases, 25.9%), and diarrhea (6 cases, 10.3%). Decreased or increased white blood cell count was found in 7 patients (12.1%) and 6 patietns (10.3%). Decreased percent of lymphocyte, increased percent of neutrophil, and decreased hemoglobin level were found in 35 patients (60.3%), 27 patients (46.6%), and 24 patients (41.4%), respectively. Elevated CRP, PCT and D-dimmer level were demonstrated in 38 patients (65.5%), 36 patients (62.1%), and 45 patients (77.5%). Increased level of ALT, AST, LDH and decreased serum albumin were found in 32 patients (55.2%), 25 patients (43.1%), 39 patietns (67.2%) and 43 patietns (74.1%), respectively. The main features of CT imaging were diffuse lesion in both lungs, which were mainly manifested as multiple patchy shadows and ground-glass shadows, bilateral and peripheral distribution, consolidation and interlobular septal thickening. Twenty-nine patients (50.0%) were treated with antibiotics, and 14 patients (24.1%) with systemic glucocorticoid. In addition to supportive and antivirus treatment, oxygen therapy methods including nasal catheter (9 cases, 15.5%), oxygen mask (33 cases, 56.9%), high-flow nasal catheter (8 cases, 13.3%) and invasive mechanical ventilation were adopted. Twenty-one patients (36.2%) were discharged from the hospital, 27 patients (46.6%) in remission were still in the isolation wards, 3 patients (5.2%) were transferred to the ICU for further treatment, and 7 patients (12.1%) died.Conclusions:Severe and critical NCP are at higher risk in the elderly and those having underlying diseases. Severe/critical NCP patients often show extrapulmonary abnormity as well as lung dysfunction. Comprehensive treatment as early as possible is the key to improve the prognosis and reduce the mortality.
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Objective To assess the significance of elevated serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in predicting 30-day mortality rate for patients in intensive care unit (ICU).Methods A retrospective study was conducted.The clinical data of 480 patients admitted to ICU in Tianjin First Center Hospital from June 2012 to October 2013 were studied.The characteristics of patients were recorded,the acute physiology and chronic health evaluation Ⅱ (APACHE I) score was calculated,and the routine blood tests,blood biochemistry,and serum NT-proBNP level within 24 hours after admission were determined.Patients were divided into non-survival and survival groups according to 30-day outcome,and the characteristics and clinical parameters were compared between two groups,and single factor analysis affecting prognosis was analyzed.All patients were divided into four groups according to four percentile method as NT-proBNP＜280 ng/L (group Q1),280 ng/L≤NT-proBNP＜ 1 200 ng/L (group Q2),1 200 ng/L≤NT-proBNP＜1 990 ng/L (group Q3),1 990 ng/L≤NT-proBNP＜4 700 ng/L (group Q4).A Cox regression analysis was used to test the independence of the predictors.A receiver operator characteristic curve (ROC curve) was plotted to compare the power of APACHE Ⅱ score and NT-proBNP in predicting the outcome.Kaplan-Meier analysis was used to assess survival rate among different NT-proBNP patients.Results By single factor analysis it was shown that age,APACHE Ⅱ score,creatinine,NT-proBNP and severe infection were those influencing the outcome.NT-proBNP 1 200-4 700 ng/L (groups Q3 and Q4) and APACHE Ⅱ score ＞20 were independent risk factors for predicting outcome [relative risk (RR) for group Q3 was 3.624,95％ credibility interval (95％CI) was 1.258-10.138; RR for group Q4 was 5.059,95％ CI was 3.202-9.993; RR for APACHE Ⅱ score ＞20 was 2.987,95％ CI was 1.345-5.823].The area under the ROC curve (AUC) for APACHE Ⅱ score and serum NT-proBNP was similar,and it was 0.831 (95％CI 0.778-0.884) and 0.876 (95％CI 0.827-0.925),respectively.The cut-off value of NT-proBNP for predicting mortality was 1 250 ng/L.Kaplan-Meier analysis showed that groups of Q2,Q3 and Q4 had lower cumulative survival rate compared with group Q1 (26.5％,25.4％,16.2％ vs.29.6％),and group Q4 showed most significant extent of lowering of survival rate (x2=122.920,P＜ 0.05).Conclusion Elevated NT-proBNP level in ICU patients signify severity of the disease,and it is an independent predictor of death of ICU patients.
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Nowadays,patients more and more realize protecting their personal rights in hospitals.Clinic probation teaching of obstetrics and gynecology is facing the difficulty of teaching cases selecting caused by uncooperation of the patients.Establishing good relationship with the patients,improving teaching method and teaching in different ways will be helpful to accomplish the clinic probation teaching.
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In order to improve the teaching effect ,we tried to use problem-based learning(PBL)in combination with traditional teaching method to teach medical students in clinical probation of Gynecology and Obstetrics. The results showed that PBL in combination with traditional teaching method was possible and effective. PBL was helpful to cultivating the clinical consciousness and comprehensive diathesis of medical students.
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Objective:With a scrutiny of the gastroscope aspects of hepatogenic ulcer (HU),this sutdy was to find out the relationship between HU and hepatocelluar damage and portal hypertension.Methods:262 cases of portal hyprtension of cirrhosis were reviewed with HU being grouped according to the clinical gravity of cirrhosis and the gravity of esophageal varies (EV).Results:①Duodenal ulcer prevails under endoscopy.Superficial ulceration accounted for 70.49% while ulceration less than 0.5cm in full diameter made up 55.74%.The figure was 62.3% with erosive gastritis.②Out of a total of 262,61(23.28%) cases of HU were found in connection with portal hypertension.The χ2 test showed that HU was related with hepatocellular grade and the gravity of EV (P＜0.05).Conclusions:The incidence of HU were higher than normal.indicating that the onset of HU responded positively to the clinical intensity of cirrhosis and the gravity of EV.
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Objective To evaluate the typical multidrug resistance in colorectal cancer chemotherapy with drugs including 5-Fu,MMC and cisplatin. Methods The expression of mdrl gene and GP170 in thirty colorectal cancer specimens were detected by reverse transcription polymerase chain reaction and immunohistochemistry.At the same time,the sensitivity of the cancer cells to six common chemotheraputic drugs were also detected by MTT colorimetric assay. Results In thirty colorectal cancer specimens,the expression of mdr_1 gene(63.3%) and GP170 (73.3%) were not different,and was concordant with the results of ADM cytotoxicity assay (P
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100 cases of gastritis verrucosa were classified into acute stage and chronic active stage according to the morpnological and histological characteristics.The CP positive rates in the above two stages were 97% and 68.7%,respectively,while that of the erosion area and the surrounding intact mucosa ' were 83.0% and 45.0%,respectively.The amount of CP was directly related to the degree of inflammatory cell infiltration and erosion.So VG was closely related to CP infection.In the chronic active stage,the detection rates of the Ig coated CP in the tissue section,serum IgA,IgG,and gastric juice IgA were all higher than those in the acute stage (P