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Objective:To investigate the preventive effect of airflow shock on micro-smoke in patients with mechanical ventilation through oral tracheal intubation.Methods:Using simple random sampling method, 76 patients who underwent mechanical ventilation through oral tracheal intubation in Tianjin First Central Hospital from March 2019 to August 2019 were selected as subjects. They were divided into two groups by the random number table method with 38 cases in each group. The observation group was treated with airflow shock method and intermittent glottic suction. The control group was treated with intermittent glottic suction. The total amount of retentate on the 24 h capsule and the suction tube on the capsule were compared. The incidence of catheter blockage, bacterial culture of the upper respiratory tract and lower respiratory tract secretion, ventilator-associated pneumonia (VAP) incidence rate, and changes in vital signs of patients before and after operation.Results:The incidence of VAP, the total amount of retentate on the 24 h capsule, the incidence of catheter blockage was 2.9% (1/34), (19.37 ± 5.52) ml, 17.6% (3/34) in the observation group, and 20.0% (7/35), (14.98 ± 3.77) ml, 25.7% (12/35) in the control group, the difference between the two groups was statistically significant ( χ2 values were 4.896, 7.239, t value was 5.315, P<0.05 or 0.01). The positive rate of pathogens in the sac retentate culture was 54.6% (113/207), 149 pathogens, the positive rate of lower respiratory tract secretion pathogen was 12.6% (26/207), and 37 pathogens. The pathogens of the two groups were similar. Gram-negative bacilli mainly, the main dominant bacteria were Acinetobacter baumannii, Pseudomonas aeruginosa and Stenotrophomonas maltophilia, and there was no significant difference in the ratio of the main pathogens in the sac retentate and lower respiratory tract secretions between the two groups ( P>0.05). There was no significant difference in heart rate, systolic blood pressure, diastolic blood pressure and respiratory changes between the two groups before and after operation ( P>0.05). Conclusions:The airflow impact method combined with the suction under the glottal can effectively remove the airbag wrinkles and the retentate accumulated on the capsule, which can reduce the incidence of suction tube obstruction on the capsule, prevent the occurrence of micro aspiration and reduce the incidence of VAP.
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Objective@#To explore the effect of DMAIC(Define, Measure, Analyze, Improve, Control) in reducing catheter-related urinary tract infection.@*Methods@#A retrospective case control method was used to select 578 patients admitted and treated in comprehensive ICU of Tianjin First Central Hospital from January to December 2018 with catheters as research objects.The 283 patients from January to June 2018 were the control group, and 295 patients from July to December 2018 were the observation group.Routine methods were used in the control group, and DMAIC method with 6 sigma management was used in the observation group. The correct rate of implementation of each measure, the utilization rate of urinary catheter and the infection rate between the two groups were compared.@*Results@#Implementation rate of early extubation assessment, urine collection accuracy, urine tube fixed correctly, urine tube cleaning time, urine collection bags location accuracy were 60.42%(171/283), 69.61%(197/283), 79.86%(226/283), 89.40%(253/283), 92.58%(262/283)in the control group, 80.34%(237/295), 90.85%(268/295), 94.92%(280/295), 96.27%(284/295), 97.97%(289/295) in the observation group, the differences were statistically significant (χ2= 9.411-41.415, P < 0.01). The rate of urinary catheter usage was 75.31%(3 856/5 120) in the observation group and 82.60%(4 098/4 961) in the control group, the differences was statistically significant (χ2=80.475, P < 0.01). The rate of catheter associated urinary tract infection was 0.26‰ (1/3 856) in the observation group and 1.95 ‰ (8/4 098) in the control group, the differences was statistically significant (χ2=5.832, P< 0.05).@*Conclusions@#DMAIC can improve the accuracy of nursing measures, optimize the catheter care process, and reduce catheter-related urinary tract infections.
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Objective@#To investigate the influence of condylar fractures on the growth of condylars after conservative treatments by three-dimensional measurement.@*Methods@#Twenty three children with unilateral condylar fracture followed-up for at least 1 year in Shanghai Ninth People's Hospital were included from June 2016 to March 2017. CT scans were performed for each patient. Three-dimensional virtual skulls were reconstructed and measuring points were defined with Simplant 11.04 software. The depth of glenoid fossa, height of articular eminence, width, height and depth of condylar, deviation of pogonion were measured. Statistical analyses were conducted to assess difference between the bifid group and the normal group.@*Results@#No difference was observed in the vertical position of crest of the articular eminence between two groups (P=0.110). The vertical position of roof of the glenoid fossa in bifid side was significantly superior than the one in normal side (P=0.010). Bifid side had a shorter (P=0.002) and wider(P=0.002) condylar than normal side did. No difference was observed in the depth of condylar between two groups (P=0.071). The average deviation of pogonion was (0.69±1.75) mm (P=0.072) from sagittal plan.@*Conclusions@#This short-termed study indicates that children's growth potential of condylar is under average after conservative treatments. Because the bone hyperosteogeny of glenoid fossa compensates the hypotrophy of condylar, no deviation of pogonion is detected.
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Objective To investigate the effect of labor induction of full-term pregnancy use of oxytocin,and the incidence of adverse reactions of mode of delivery of cervical dilatation balloon with pubeisheng.Methods The clinical data of full-term pregnant women who were delivered in our hospital from October 2014 to November 2015 were retrospectively analyzed,According to the induction of labor is divided into the way of pubeisheng group and cervical dilation balloon group.The differences of delivery mode,oxytocin utilization,maternal and neonatal outcomes and adverse reactions were observed between the two groups.Results Cervical dilatation balloon group vaginal delivery rate was 90.38％,higher than that of pubeisheng group(P<0.05); oxytocin use rate of 11.54％,lower than that of pubeisheng group(P<0.05); Cervical dilatation balloon group first,second and third labor time is shorter pubeisheng group(P<0.001); The cervical dilation balloon group bleeding more than pubeisheng group(P<0.001),two groups of infection,urinary retention complication rate had no significant difference.Two groups of neonatal aspiration pneumonia incidence rate had no significant difference after the birth of 1min Apgar score difference,and cervical dilatation balloon group after the birth of 5min Apgar was higher than that of pubeisheng group(P<0.05).Conclusion The application of cervical dilation balloon in the induction of labor in term pregnancy is better,which can significantly improve the rate of vaginal delivery,reduce the use rate of oxytocin and shorten the labor process,and has the value of clinical application.
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Objective To evaluate Parecoxi on postoperative analgesia for the elderly patients undering colorectomy.Methods 82 patients were randomly divided into group of 44 patients undergoing open surgery and 38 patients receiving laparoscopic colorectomy.22 patients in open surgery using Parecoxib sodium combined with PCA analgesic way were named as observation group,while the other 22 patients using placebo combined with PCA analgesic way named as control group.19 laparoscopic surgery patients using Parecoxib sodium analgesia were named as observation group,while the other 19 patients using Tramadol analgesia named as control group.Results In the absence of any differences of VAS pain score,in the open surgery group,the average dosage of Fentanyl in observation group was (0.45 ± 0.23) mg vs.(0.78 ± 0.16) mg in observation group (P ＜ 0.05).Parecoxib reduced the dosage of Fentanyl of PCA in the open surgery group.In laparoscopic group,at the time of postoperative 6,12,24,48,72 h,in the observation group patients resting pain scores were 5.01 ±0.36,4.44 ±0.37,4.02 ±0.46,3.35 ±0.52,2.54 ±0.23 respectively,while in the control group patients resting pain scores were 5.86 ± 0.45,5.03 ± 0.64,4.89 ± 0.75,3.94 ± 0.73,2.56 ± 0.41 respectively,(P ＜ 0.01).The postoperative gastrointestinal function recovery time was (3.1 ±0.7) d in observation group vs.(5.9 ±0.4) d in the control group (P ＜0.01).The incidence of postoperative nausea and vomiting,were lower in observation group,(P ＜ 0.01).Conclusion Parecoxib can be used for postoperative analgesia in elderly patients with colorectal cancer,reducing the dosage of opioids,and protecting the patient's immune function.
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Objective To analyze the risk factors of the patients with gestational diabetes mellitus(GDM),to explore the effect of GDMon pregnancy outcome,and provide reference for early clinical prevention and intervention. Methods Randomly selected 220 GDMpatients who were treated from January 2014 to January 2016 as the observa-tion group,and collected 236 cases of non -diabetic pregnant women in our hospital during the same period as control group.Retrospectively analyzed the risk factors of GDM and the effect of GDM on pregnant women and neonates by questionnaires and clinical data.Results Single factor analysis and Logistic regression analysis showed that the age, history of diabetes,body mass index(BMI)before pregnancy,BMI before 1 week of childbirth and weight of oral glucose tolerance test(OGTT)were the risk factors of GDM(OR =2.988,5.684,4.255,3.765,3.051;P =0.003, 0.000,0.000,0.024,0.021 ).The incidences of phydramnion,postpartum hemorrhage,pregnancy period hyperten-sion,premature rupture,premature birth,cesarean section and ketoacidosis in the observation group were higher than the control group,and the differences were statistically significant (χ2 =5.539,11.338,14.103,4.527,8.160, 4.719;P =0.019,0.001,0.000,0.033,0.004,0.030).The incidence of newborn malformation,asphyxia,fetal distress and macrosomia in observation group were higher than the control group,and the differences were statistically significant(χ2 =4.929,5.539,4.163,5.950;P =0.026,0.019,0.041,0.015).Conclusion The age,history of diabetes,BMI before pregnancy,BMI before 1 week of childbirth and weight of OGTT were the risk factors of GDM, which should pay close attention to these people and take corresponding treatment measures,so as to improve the adverse outcome of maternal and infant in clinic.
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Objective To investigate the teaching effect of the PCMC-type (problem-originated clinical medical curriculum) pathology experiment course and clinical pathological conference (CPC) by using microscope digital system.Methods 384 undergraduates of second grade in clinical medicine major and imaging diagnosis major were chosen for the teaching reform project,all of whom were divided into experimental group (192) and control group (192),randomly,and they were taught by PCMC pathological experiment teaching and the traditional pathological experiment teaching separately.After the curriculum,statistic analysis of test score was used to analyze the teaching effect.SPSS 13.0 software diagram method was used to perform Levene variance analysis and t test to the achievement of two groups of students and the students' ability of self evaluation was investigated through questionnaire.Results The average score of the students in the experimental group (86.16 ± 3.28) in the theory exam was significantly higher than that of control group (75.63 ± 2.24) (P=0.000).And the average score of the students in the experimental group in experiment (27.10 ± 0.61) was significantly higher than that in control group (19.87 ± 0.25) (P=0.000).The questionnaire showed that compared with control group,the comprehensive ability of the students in the experimental group was obviously enhanced.Conclusion The PCMC pathology teaching is beneficial to improving the students' ability of linking theory with practice and enhancing their ability to analyze and solve problems,and obviously stimulate their interest in learning.It is worth promoting.
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Objective To discuss the influence hand hygiene intervention on general ICU acquired methicillin-resistant staphylococcus aureus (MRSA) infection and its improvement. Methods Hand Hygiene Cognition Questionnaire that passed the reliability and validity test was used to compare the change of cognition on hand hygiene of medical staff. According to the results of the questionnaire, the intervention was carried out by continuous intensive training. The compliance with hand hygiene of medical staff was observed by monitoring equipment in the ward. Implementation status and effect of hand hygiene of medical staff on duty were examined randomly each month. At the same time MRSA infection rate of patients in comprehensive ICU was monitored in the same period. The relationship between hand hygiene compliance and MRSA infection rate was analyzed. Results The score of medical staff of cognition of hand hygiene was (41.70±3.67) points before the intervention, while the score was (44.10±3.55) points after the intervention. The difference had statistical significance (t=24.37, P<0.01). The correct rate of hand washing, positive rate of bacterial culture in hand, hand hygiene compliance and infection rate of MRSA of patients in comprehensive ICU were 68.75%, 14.58%, 66.90%, 12.90% respectively before the intervention. The correct rate of hand washing, positive rate of bacterial culture in hand, hand hygiene compliance and infection rate of MRSA of patients in comprehensive ICU were 88.54%, 3.12%, 74.14%, 3.10% respectively after the intervention. The difference had statistical significance (χ2=7.809-24.520, P<0.01). Conclusions Questionnaires with high credibility reviews could better identify issues in hand hygiene compliance, and sustained, reinforcing intervention measures could improve the compliance of hand hygiene; Good hand hygiene practice of medical and nursing staff contributes to controlling MRSA infection rates in general ICU.
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Objective To establish two models of long-term chronic allograft rejection (CR)following orthotopic small bowel transplantation and compare the two models induced by cyclosporine A (CsA) or tacrolimus (Tac).Methods F344 and Lewis rats severed as donors and recipients,respectively.Transplantation was performed by anastomosing the graft superior mesenteric artery to the recipient infrarenal aorta and the graft portal vein to the recipient infrarenal inferior vena cava in an end-to side fashion.The recipients intestine was replaced with the graft by performing end-to-end small bowel anastomosis.In the study I,the rat was given intramuscularly CsA (5 mg · kg-1 · day-1) from postoperative day (POD) 0 to 13; In the study Ⅱ,the rat was given intramuscularly FK 506 at a dose of 0.3,0.5 and 1.0 mg· kg-1 · day-1 on POD 0-13,20,27,respectively.The body weight gain,survival rate and histology were observed.Results In the study I,there were significant changes of the CR histologically,including villous architecture,interstitial fibrosis,leukocyte infiltration,and obliterative arteriopathy.There was no significant difference in features of CR between POD 60 and POD 90,however,the serious villous blunting was not found; In the study II,the rats received Tac at dose of 0.3 and 0.5 mg·kg-1 ·day-1 and survived up to POD 126.The recipients received Tac at dose of 1.0 mg·kg-1 · day-1 and survived more than POD 180 and the body weight gain was the same as the isogenic groups.The histopathological analysis revealed distinctive features of CR including villous blunting.The characteristics of CR induced by CsA or Tac in the rat model of orthotopic small bowel transplantation could be demonstrated,however,the Tac-induced model was more closer to clinical small bowel transplantation pathology of CR.Conclusion Using the protocol of CsA or Tac,we developed a rat CR model of orthotopic small bowel transplantation,however,the Tac-induced recipients survived longer and had more classic characteristics of CR than CsA.
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BACKGROUND: Adipose-derived stem cells (ADSCs), a kind of adult stem cells, possess plasticity and can be induced into myocardial cells under certain conditions. Autologous ADSCs transplanted into the infarct area can differentiate into myocardial cells and vascular endothelial cells to construct new vessels and thereby improve cardiac pump function. OBJECTIVE: To study the factors that influence ADSCs differentiation and transplantation and the current clinical and laboratory research progress of ADSCs transplantation for treatment of cardiomyopathy.METHODS: A computer-based retrieval was performed in Medline (between January 1990 and April 2010), PubMed database, the China Biological Medicine Database (CBM) (between January 1990 and April 2010), and China National Knowledge Infrastructure (CNKI) with the keywords adipose-derived stem cells, myocardial cells, cell differentiation, cell transplantation, cardiomyopathy treatment.RESULTS AND CONCLUSION: A total of 30 articles, consisting of 6 reviews and 24 randomized controlled trials, were obtained. At present, there have been uniform methods of ADSCs isolation and culture, and ADSCs can be effectively proliferated in vitro, but there have been no direct methods to identify these stem cells. ADSCs differentiation can be induced both in vitro and in vivo, besides, with a characteristic of early differentiation. ADSCs transplantation is a more conductive therapy for myocardial disease compared with bone marrow stem cells (BMSCs) transplantation. Different ADSCs transplantation methods should be carried out in different types of cardiomyopathy. Stem cell labeling technique can help to dynamically monitor implanted in vivo. Transplantion of autologous ADSCs is a new way to treating cardiomyopathy. However, for successes in clinical practice, the method to inhibit tumor cells-promoting characteristics is needed to ensure long-term safety of the patients receiving ADSCs transplantation.
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Identification and characterization of Niemann-Pick C1 Like 1 (NPC1L1) has established NPC1L1 as an essential protein in the intestinal cholesterol absorption process,and NPC1L1 is the molecular target of ezetimibe, which is a cholesterol absorption inhibitor. The expression of the gene and protein of NPC1L1 may be regulated by some nuclear receptors. Lack of NPC1L1 auses a nearly complete protection from the development of atherosclerosis in apoE-/- mice c, which provides new target for the treatment for atherosclerosis and cardiovascular disease.
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Enteral resuscitation is a new concept, but the treatment supplied has been already well known. Enteral resuscitation has been used widely for critical patients, which is benefit for their recovery. It is a safe and effective method for critical patients which could result in the amelioration of the hormonal stress response to promote the intestine function and improve outcome, and it is good in cost-effectiveness. Complications are minimal.
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Objective To isolate and identify human anti-oxidized low density lipoprotein (LDL) autoantibodies.Methods Oxidized LDL (Ox-LDL) autoantibodies were isolated from eight healthy subjects by affinity chromatography with using an Ox-LDL cross-linked Sepharose 4B column.Results Three elution peaks of Ox-LDL autoantibodies were washed out from the Ox-LDL column by NaHCO3,acetate and KCNS buffer in turn and collected respectively.Ox-LDL autoantibodies were isolated from all the selected healthy subjects.All the three elution peaks had good reactivity with Ox-LDL.Among them,the elution peaks by KCNS buffer had high protein level and strong reactivity with Ox-LDL.The types of these antibodies included IgG and IgM, and IgG was the main type.Conclusion The isolated Ox-LDL autoantibodies had strong reactivity with Ox-LDL.