ABSTRACT
Objective To investigate the predictive value of the baseline ,week 1 and week 2 model for end‐stage liver disease (MELD) scores ,MELD‐Na scores and MELDNa scores for 3‐month mortality in hepatitis B virus (HBV) related acute‐on‐chronic liver failure (ACLF) patients .Methods Fifty‐three eligible HBV‐related ACLF patients who received initial treatment in People′s Hospital of Deyang City , Sichuan Province from January 2014 to January 2015 were enrolled in this retrospective clinical follow‐up study .Patients were divided into death group and survival group according to the prognosis after 3 months of treatment .Biochemical data and complications were collected .t test was used to compare the means between two groups and χ2 test was used to compare categorical data .Accuracy of scoring models in predicting mortality within 3 months was performed by area under receiver operating characteristic curve (AUC) .Results Of the fifty‐three patients ,twenty‐one HBV‐related ACLF patients died in 3‐month , while thirty‐two patients survived .The AUC of MELD scores ,MELD‐Na scores and MELDNa scores at the baseline in predicting 3‐month mortality were 0 .548 (95% CI:0 .406 -0 .685 , P= 0 .555) ,0 .502 (95% CI:0 .362-0 .643 ,P=0 .978) and 0 .523 (95% CI:0 .381-0 .662 ,P=0 .778) ,respectively .The AUC increased gradually at the first and the second week .At the second week ,the AUC of MELD scores ,MELD‐Na scores and MELDNa scores were 0 .881 (95% CI:0 .762 -0 .953 ,P<0 .01) ,0 .878 (95% CI:0 .759-0 .951 ,P<0 .01) and 0 .897 (95% CI:0 .783 -0 .963 ,P<0 .01) ,respectively .The AUC of the second week was higher than those of the baseline and the first week (both P<0 .05) .The sensitivity ,specificity ,positive predictive value (PPV) ,and accuracy at the second week were best when the cut off was 26 for MELD ,29 for MELD‐Na and 29 for MELDNa , and were higher than the corresponding values of the baseline and the first week .Conclusions The predictive values of MELD scores ,MELD‐Na scores and MELDNa scores at the second week are superior to the baseline and the first week for 3‐month mortality in HBV‐related ACLF patients ,while the predictive values at the baseline could be poor .
ABSTRACT
Objective To observe the effect of 6% hydroxyethylstarch (130/0.4) on hemorheology in patients with acute myocardial infarction (AMI) complicated by shock before and after early fluid resuscitation. Methods 72 AMI patients complicated by shock were randomly divided into two groups , namely groupⅠwith 6%hydroxyethylstarch (130/0.4) for early liquid resuscitation and group Ⅱwith balanced salt (1.86% sodium lactate solution and compound sodium chloride solution for a ratio of 1∶2 ) for liquid recovery; and another 36 subjects was assigned to normal control group (groupⅢ). The hemorheological indices were detected after admission and 2 to 3 hours after fluid resuscitation in groupsⅠandⅡ. Results After fluid resuscitation , high-and low-shear viscosity , red cell aggregation index, hematocrit, fibrinogen, and platelet aggregation rate decreased in groupⅠand groupⅡ, with significant statistical differences (P < 0.05 and P < 0.01). Conclusions 6% hydroxyethylstarch (130/0.4) can effectively improve abnormal hemorheology in patients with AMI complicated by shock.
ABSTRACT
Gas gangrene is an emergency condition, which usually develops after injuries or surgery. This study was designed to investigate clinical characteristics, appropriate therapy, and effective control of nosocomial cross-infection of gas gangrene in Wenchuan earthquake victims. Data on diagnosis, treatment, and prevention of confirmed, suspected, or highly suspected gas gangrene were collected. Sixty-seven (2.41%) cases of suspected gas gangrene were found, in which 32 cases were highly suspected of gas gangrene and 5 cases were confirmed by culture of Clostridium perfringens. Thereof, injury sites were mainly located on the limbs, and typical indications, including crepitation, severe localized pain, swelling, wound discoloration, dark red or black necrotic muscle, foul smell as well as different degrees of systemic toxic performance were common among them. After hospitalization, all patients were isolated and had surgery quickly to remove dead, damaged or infected tissue. The wounds were also exposed for drainage and washed or padded with 3% liquid hydrogen peroxide for disinfection before all diagnostic test results were available. Additionally, high doses of antibiotics (mainly penicillin) were given for the prevention of infection, and supportive therapy was applied for corresponding symptoms control. Among those cases, no fatality was reported. In summary, in post-disaster emergency relief, the diagnosis of gas gangrene should be primarily based on clinical manifestations; while patient isolation, wound debridement and disinfection, as well as antibiotics treatment, is the main measures for proper treatment and control of nosocomial infection for gas gangrene.