ABSTRACT
Objective:To analyze the clinical characteristics and risk stratification of 182 patients with acute pulmonary embolism (APE), and to investigate the correlation of neutrophil (N)/lymphocyte (L) ratio (NLR) and risk stratification/prognosis.Methods:The clinical data of 182 APE patients admitted to Peking University People’s Hospital from January 2015 to March 2021 were retrospectively collected, including age, sex, symptoms and signs, blood pressure, blood gas analysis, blood routine parameters, cardiac biomarkers, coagulation parameters, and right ventricular imaging parameters. The patients were divided into groups according to the risk stratification at admission and prognosis in hospital. χ2 test, t test or nonparametric test were used to analyze the differences in clinical characteristics, blood routine parameters, blood gas analysis, coagulation parameters and other parameters between the groups. Multivariate logistic regression analysis was used to study the independent risk factors for the prognosis of APE. Results:Among the 182 patients, 79 were male and 103 were female, 23 were in the high-risk group, 51 were in the intermediate-high-risk group, 46 were in the intermediate-low risk group, and 62 were in the low-risk group. There were 27 deaths and 155 survivors. The respiratory rate of the high/intermediate-high-risk group was significantly higher than that of the low/intermediate-low-risk group. Compared with the other three groups, pH, oxygen partial pressure (PO 2) and blood oxygen saturation (SO 2) in the high-risk group were significantly lower ( both P<0.05). There were statistically significant differences in WBC, N, and NLR levels between the high/intermediate-high-risk group and low/intermediate-low-risk group ( both P<0.05). However there were no significant differences in PLT, PLT/MPV, PLT/PDW, and coagulation related parameters PT, FIB, APTT and D-D between groups (all P > 0.05). MPV and PDW were only significantly different between the low-risk group, intermediate-low-risk group and high-risk group ( both P<0.05). Multivariate logistic regression analysis showed that NLR ( OR=1.179,95% CI:1.029-1.410, P=0.039) and PH ( OR=1.156,95% CI:1.031-1.522, P=0.041) were independent predictors of in-hospital mortality. The ROC curve was used to analyze the predictive value of NLR for in-hospital mortality. When the cutoff value of NLR was 8.38, the AUC of NLR was 0.824 (95% CI: 0.829-0.913), the corresponding sensitivity was 0.831, and the specificity was 0.887. Conclusions:NLR is correlated with risk stratification and prognosis of APE, and is an independent risk factor for poor prognosis.
ABSTRACT
【Objective】 To explore the clinical characteristics and risk factors of renal function deterioration in children with renal dysplasia and chronic kidney disease (CKD), so as to provide a basis for the diagnosis, treatment, and management. 【Methods】 The clinical data of children with renal dysplasia complicated with CKD treated in the Children’s Hospital of Chongqing Medical University during 2012 and 2022 were retrospectively analyzed, including the gender, age of diagnosis, growth index, concomitant malformation and complications. According to the diagnostic criteria and staging standard of KDIGO2020 guidelines, patients with disease deteriorated to CKD stage 4-5 were enrolled into the regression group. Factors affecting the deterioration of renal function were determined with Cox regression analysis. 【Results】 A total of 122 children were involved, including 66 (54.1%) with CKD stag 4-5. There were more boys than girls. Bilateral and unilateral renal dysplasia occurred in 88 (72.13%) and 34 (27.87%) cases, respectively, and 64 (52.46%) cases were complicated with other urinary diseases. There were significant differences in weight, height and body mass index (BMI) among patients with CKD stage 1-5 (P<0.01). The age of onset of CKD <10 years, BMI lower than the 3rd percentile of the same sex and age, bilateral renal dysplasia, and one or more complications of congenital renal and urinary tract abnormalities (CAKUT) were the risk factors of deterioration of renal function (P<0.05). 【Conclusion】 Renal dysplasia complicated with CKD are more common in boys, with high incidence of bilateral renal dysplasia. Bilateral renal dysplasia, age of onset of CKD <10 years, BMI lower than 3% and complications are important influencing factors of renal dysplasia in children with CKD.
ABSTRACT
Objective:To investigate the effects of hepatitis C virus (HCV) NS3/4A protein on proliferation, apoptosis and division of human hepatocarcinoma SMMC-7721 cells.Methods:The recombinant plasmid pLV-Green-NS3/4A and pLV-puro-NS3/4A were produced by homologous recombination method, and then the cells were divided into pLV-Green-NS3/4A or pLV-puro-NS3/4A transfection group and their corresponding control group (transfected with empty vector). The expression of recombinant protein was detected by immunofluorescence staining and Western blotting. Methyl thiazol tetrazolium (MTT) method was used to detect cell proliferation, DAPI staining was used to detect cell apoptosis, and immunofluorescence was used to analyze cell devision.Results:The growth state of SMMC-7721 cells in the pLV-Green-NS3/4A transfection group was worse than that in the corresponding empty vector control group. Compared with the corresponding empty vector control group, the proliferation activity of SMMC-7721 cells in the pLV-Green-NS3/4A transfection group on the 3rd and 4th day was inhibited (both P < 0.05). The apoptosis rates of cells in the pLV-Green-NS3/4A transfection group and the corresponding empty vector control group were (20.3±3.5)% and (5.3±1.5)%, and the difference was statistically significant ( t = -8.57, P < 0.001). Compared with the corresponding empty vector control group, the cells in the pLV-puro-NS3/4A transfection group had more multipolar spindles, and the multipolar division rates of the two groups were (2.33±0.58)% and (6.01±0.99)%, and the difference was statistically significant ( t = -5.50, P = 0.005). Conclusions:HCV NS3/4A can inhibit the proliferation, promote the apoptosis and multipolar division of human hepatocarcinoma SMMC-7721 cells.
ABSTRACT
Objective To evaluate the observation period and association between the initial visit data including initial APD measured by ultrasonography (USG) and outcome of unilateral hydronephrosis caused by ureteropelvic junction obstruction (UPJO) in children.Methods One hundred and ninety-three children with UPJO,who underwent the USG at the initial visit time.There were 155 boys and 38.166 cases in left side and other 27 cases in right side.All cases were divided by initial visit time and initial APD respectively.There were 109 infancy(≤ 12 months),36 toddler(12-36 months),19 preschooler(36-60 months),29 school-age children(＞ 60 months)and 11 cases in normal group (APD ＜ 0.5 cm),47 in mild (0.5 cm≤APD ＜ 1.0 cm),54 in moderate(1.0 cm≤ APD≤ 1.5 cm),81 in sever(APD ＞ 1.5 cm).All the patients were follow up for at least 24 months and divided into two groups depended on whether the patients received the surgery.Results Areas under the receiver operating characteristic plots were 0.924 (95％ CI 0.870-0.977,P ＜ 0.01);sensitivity,specificity,positive predictive value,and negative predictive value were 87.2％,88.9％,87.5％,and 95.5％,respectively,for the cut of APD is ≥ 1.85 cm.Infancy and initial APD ＞ 1.5 cm was the risk factors predicting operation with the hazard ratio of 2.991 (95％ CI 1.328-6.734,P =0.008) and 16.593 (95％ CI 5.893-46.719,P ＜ 0.01),respectively.Operation rate at one year of UPJO,for initial APD ＞ 1.5 cm,initial APD ≤ 1.5 cm,infancy and after infancy,were 43.20％(35/81),2.67％ (3/112),30.27％ (33/109),5.95％ (5/84),respectively.Conclusions Initial USG is an efficient diagnostic tool to detect pathologic hydronephrosis.Initial APD predicts the clinical outcome of UPJO in pediatrics accurately.Further investigation is recommended when initial APD ＞ 1.5 cm.Close observation is needed during the one year after initial visit to detect the deterioration of UPJO,especially in infancy.
ABSTRACT
Objective To study the vascular anatomy of duplex kidney and to provide a scientific basis for surgical resection of the renal segment.Methods From February 2012 to April 2018,the clinical data of 84 children with renal duplex kidney disease admitted to our hospital,were reviewed and analyzed.Among them,75 cases (89.3％) were unilateral and 9 cases (10.7％) were bilateral.According to the preoperative CT + CTA and the duplicated renal morphology,size,location,and anatomical relationship of the kidney segment,combined with the branches and passage of the renal artery which supplies the upper moiety,it described the blood supply of the upper renal moiety.At the same time,it analyzed various types of embryological related factors and gender differences and summarized the tips for laparoscopic surgery.Results Of the 93 duplex kidneys,69 (74.2％) were supplied with 1 artery,and 25 (26.9％) were supplied with 2 or more arteries.Based on the shape and orifice of artery,they were divided into 3 types.The most common type was that the renal artery separated into two or more arteries near the renal parenchyma.The upper and lower renal poles were respectively supplied,which could be summarized as early branching,a total of 71 sides (76.3 ％).The second type was the arteries from abdominal aorta or its branches,directly flowing into the upper renal pole,which was classified into the sub-renal artery,a total of 18 sides (19.4％).The others (4 sides,3.3％) were less common,and most of them were a combination of the above-mentioned two types,and one of them whose upper pole was supplied by branches of adrenal artery.Based on the classification of vascular variability,no significant difference was found between males and fenmals,or left and right sides.Conclusions The upper renal moiety are mainly supplied by one branch of renal artery,and the most common type of this artery is prehilar branch,without gender difference.The determination of vascular variability before surgery can avoid bleeding during surgery and avoid accidental injury of normal blood vessels.
ABSTRACT
Teaching method of grouping and numbering the experimental animals refers to management of laboratory animals by marking them with numbers. In an experimental group, the same marked experimental animal is performed surgery operation by each group member. As a whole, each group member gets the same score according to the evaluation of operation performance of that group and the score is recorded as usual performance score. This method is simple and easy to implement. It is the optimizing of traditional basic operative surgery teaching methods which is conducted not only to improve medical students' sense of responsibility and animal protection awareness, to make full use of teaching resources and reduce waste, to cultivate medical students' team cooperation awareness, but also to deepen medical students' knowledge about surgical complications and improve the quality of teaching.
ABSTRACT
Objective To summarize the diagnosis and treatment of urethral injury in children ,and to discuss the effective treat-ment method .Methods The retrospective analysis was performed on the data of 73 cases of children urethral injury in this hospital during recent 10 years .Results 66 cases were male ,7 cases were female ,aged 1-15 years old(average 7 years old) .In the male ca-ses ,there were 8 cases of anterior urethral injury ,10 cases of bulbous urethral injury ,44 cases of posterior urethral injuries and 4 cases of bladder neck injury ;in the female cases ,there were 6 cases of urethral injury and 1 case of bladder neck injury .The once cure rate of urethral realignment was 78 .6% ,which of stageⅠ urethral anastomosis was 80% and which of stage Ⅱurethral repair was 69 .6% .Conclusion Different operation modes have their advantages and disadvantages .The corresponding treatment scheme should be formulated according to the comprehensive assessment of the patient′s general condition and damage types .
ABSTRACT
We made the third party medical disputes mediation organization dispose medical disputes more quickly and effectively by analyzing its theoretical knowledge,running mode,economic framework,administrative agency and personnel disposition,which provided institutional insurance for the establishment of harmonious relationship between doctors and patients in our country.
ABSTRACT
Objective To compare the prescrotal orchiopexy and traditional inguinal orchiopexy in the clinical treatment of children with low cryptorchidism.Methods Seventy-two patients(78 testes)who underwent orchiopexy in our hospital during March 2006 to May 2011 were retrospectively analyzed.And the undescended testis could be manipulated beyond the external inguinal ring under anaesthesia.Matching conditions were age differences among 3 months,same preoperative testicular positioning,same surgeon and same side.Using the paired study of 1 to 1,all the patients were divided into 2 groups: prescrotal orchiopexy(group A)and the traditional inguinal orchiopexy(group B),each group included 36 patients(39testes).Mean age was 5.4 years(group A)and 5.5 years(group B).The time of operation and restore standing,success rate and complications,including hernia,hydrocele,testicular atrophy and ascent were compared between the 2 groups.Results All the patients were successfully operated.The average surgical time for the prescrotal and inguinal groups were 33 and 41 min(P =0.0022),and average time of standing was 1.2 and 5.4 d(P =0.0003).All the patients had no wound infection.Followup ranged from 3 to 65 months.No hernia,hydrocele,testicular atrophy and ascent were identified in either group.The ratios of successful surgery were 100％ in the two groups.Conclusions The prescrotal orchiopexy is simple,safe,and effective in the cases that testis could be pushed down through the external inguinal ring.Compared with traditional inguinal approach,the advantages of prescrotal approach are shorter operative time,fewer traumas,less pain,faster recovery and cosmetic results.
ABSTRACT
Objective:To determine the relationship between serum resistin levels and carotid intima media(IMT)thickness in patients with essential hypertension. Methods:This study consisted of 272 patients with essential hypertension. The patients were divided into three groups according to their serum resistin levels. Group 1,n=91,serum resistin level 1.233-3.701 ng/ml;Group 2,n=91,serum resistin level 3.728-8.777 ng/ml;and Group 3,n=90,serum resistin level 8.809-28.658 ng/ml. Results:The carotid IMT and maximum carotid IMT of Group 3 were the highest in three groups.(P＜0.05).As shown in multivariate analysis for factors affecting carotid IMT,serum resistin level(β=0.220,t=5.793,P=0.000)was independently associated with the carotid IMT after controlling the age,blood glucose,uric acid,low-density lipoprotein cholesterol,systolic blood pressure and diastolic blood pressure. Serum resistin level(β=0.189,t=4.733,P=0.000)was independently associated with the maximum carotid IMT after controlling the age,blood glucose,body mass index,diastolic blood pressure,diabetes mellitus,high sensitivity C reactive protein,total cholesterol and triglyceride. Conclusion:Serum resistin was independently associated with the increased carotid IMT in essential hypertension patients.
ABSTRACT
Objective To investigate the feasibility and efficacy of laparoscopic orchiopexy for inguinal palpable undescended testes. Methods Ninety patients with 103 inguinal undescended pal-pable testes were treated by laparoscopic orchiopexy performed by the same surgeon. There were 24 (26.7 %) left and 53 (58. 9%) right palpable cryptorchidism cases, plus 13 cases (14.4 % ) with bilat-eral undescended testes. The mean age of the patients was 17 months (range 8 months-6 years). The surgical procedures were described as following. First, the peritoneum was opened at the anterior sur-face of the spermatic vessels and vas deferens before the testis was pulled into the abdominal cavity so that the spermatic vessels and vas deferens were released and easily manipulated. Second, the inter-space between internal spermatic fascia (transversalic fascia) and processus vaginalis was divided so, that the testis could be pulled into the abdominal cavity. Finally, the trocar which was inserted from scrotum was placed through the outer ring. Finally, the testis was placed at position and fixed. Re-suits The mean operative time was 32.7±5.2 min. The processus vaginalis unclose was found in 93 (90.3%) cases; and contralateral process us vaginalis unclose were found in 12 (15.6%) cases of 77 unilateral undescended testes. The complication rate was 3(3.3%)cases, all in bilateral cases. All 103 testes were descended by laparoscopy. On follow-up ranging 6-12 months, all testes maintained good size and a proper position. Conclusions The laparoscopic approach may be a safe way to descend the inguinal palpable testes. Orchiopexy of palpable undescended testes can be done with advantages in the laparoscopic approach.
ABSTRACT
Objective To evaluate renal hemodynamic changes in hydronephrosis children with no image on intravenous urography by color doppler flow image(CDFI). Methods The resistance indexes(RIs)in main renal arteries(MRAs),interlobar renal arteries(IRAs)and arcuate renal arteries(ARAs)were measured in 48 children with hydronephrosis with no image on intravenous urography.The thickness and area were also measured in hydronephrotic kidneys.Resistive index ration(RIR=hydronephrotic kidneys RI/contralateral RI)was calculated. And pathological changes of kidneys were graded in these cases.Spearman's correlation test was used to compare RIR and pathological grades in these kidneys. Results In healthy and hydronephrotic kidneys,the relevant parameters were as fol1.13±0.14,1.14±0.09,respectively in MRAs,IRAs,ARAs in hydronephrotic kidneys(P＞ness,area of hydronephrotic kidneys(P＜0.05),also between RIR and thickness,araa(P＜0.05),MRAs,IRAs,ARAs and pathologic grades(P＜0.05),especially in IRP(s(r=0.795,P＜0.01).Conclusions RIR of IRA could be an ideal parameter of renal hemodynamics to evaluate renal damage in children with congenital hydronephrosis with no image on intravenous urography.