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Objective:To investigate the application value of ROX index in evaluating the effect of high-flow nasal cannula oxygen therapy (HFNC) on patients diagnosed with respiratory failure, and to find a simpler and more effective method to observe the efficacy of HFNC.Methods:A retrospective cohort study was conducted. Patients who were admitted to department of critical care medicine of the Tianjin Third Central Hospital from April 2020 to August 2022, diagnosed with type Ⅰ respiratory failure, and treated with HFNC after failure of conventional oxygen therapy were enrolled. Oxygenation index (PaO 2/FiO 2), fraction of inspired oxygen (FiO 2), gas flow rate at the initial time of admission, and pulse oxygen saturation (SpO 2), FiO 2 and respiratory rate (RR) at 2, 4, 6, 8, 10 and 12 hours of HFNC were collected, and ROX index was calculated. The patients with symptoms and PaO 2/FiO 2 improved after HFNC treatment and without higher respiratory support lately were defined as HFNC success, while other patients with symptoms worsening and needing follow-up non-invasive positive pressure ventilation (NIPPV) or invasive positive pressure ventilation (IPPV) were defined as HFNC failure. The tendency of changes in the ROX index at each time point was observed. Receiver operator characteristic curve (ROC curve) was plotted to obtain the optimum cut-off value of ROX index for predicting HFNC outcome and the optimal monitoring time point for HFNC. Results:A total of 142 patients were eventually enrolled, among whom 96 patients (67.61%) were in treated with HFNC successfully, while 46 patients (32.39%) were recorded as HFNC failure (39 patients and 7 patients received NIPPV or IPPV, respectively), with an overall intubation rate of 4.93% (7/142). Compared with the HFNC success group, the HFNC failure group had lower PaO 2/FiO 2 [mmHg (1 mmHg ≈ 0.133 kPa): 208.8±37.3 vs. 235.7±48.3, P < 0.01] and higher initial gas flow rate (L/min: 46.4±3.9 vs. 42.3±4.9, P < 0.01). However, there was no significant difference in gender, age, primary diagnosis, severity of disease, hemoglobin (Hb), C-reactive protein (CRP), and brain natriuretic peptide (BNP) between the two groups. In the HFNC failure group, there were 12 patients (26.09%) received progressive oxygen therapy within 12 hours of HFNC, of which 3 patients (6.52%) occurred within 6 hours, while the other 9 patients (19.57%) occurred after 6 hours. The initial ROX index was not statistically significant between the two groups. Both groups showed a continuous increasing ROX index with longer treatment duration of HFNC, and the ROX index at all of the time points of the HFNC failure group was significantly lower than that of the HFNC success group with statistically significant difference (2 hours: 9.39±2.85 vs. 10.91±3.51, 4 hours: 8.62±2.29 vs. 11.40±3.18, 6 hours: 7.62±1.65 vs. 11.85±3.45, 8 hours: 7.79±1.59 vs. 11.62±3.10, 10 hours: 7.97±1.62 vs. 12.44±2.75, 12 hours: 8.84±2.51 vs. 12.45±3.03, all P < 0.05). The ROC curve analysis showed that the areas under the ROC curve (AUC) of ROX index assessing the effect of HFNC at the time of treating 6, 8 and 10 hours were better than 2, 4 and 12 hours (0.890, 0.903, 0.930 vs. 0.585, 0.738 and 0.829), indicating that the ROX index could determine the efficacy at the early stage of HFNC (within 6 hours). When the optimum cut-off value of ROX index was 8.78, the sensitivity was 90.6%, and the specificity was 76.5%. Conclusion:The ROX index at 6 hours of HFNC has a certain predictive value for the efficacy of HFNC with an optimum cut-off value of 8.78, which can provide clinical health care personnel a method for observing the efficacy of HFNC, and guide the correct selection of oxygen therapy modality at an early stage and timely adjustment of oxygen therapy strategy.
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Vascular access devices are regarded as double-edged swords since being used as lifesaving accesses widely as well as causing vessel catheter associated infections and other complications.In severe cases, it may even endanger life. This paper expounded the importance and necessity of vessel catheter associated infections prevention and control from several aspects such as national policy promotion, medical insurance payment innovation and clinical management demand, analyzed the key links of vessel catheter associated infections prevention and control and the research status quo here and abroad based on the life cycle of the catheter, and pondered the future directions considering the current difficulties and blind spots.
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Objective:To evaluate the diagnostic capabilities of PCR-flow Fluorescence Hybridization technology in prenatal genetic diagnosis of thalassemia.Methods:8 005 cases of prenatal genetic diagnosis of thalassemia in Guangdong Women and Children Hospital from September 2017 to December 2020 were retrospectively analyzed. All samples were diagnosed by traditional genetic methods include multiple Gap-PCR, PCR-RDB, MLPA and Sanger sequencing. Meanwhile, PCR-flow Fluorescence Hybridization technology was used as a verification platform for detecting common mutation sites of thalassemia. The results were analyzed to evaluate the diagnostic capabilities of PCR-flow Fluorescence Hybridization technology compared with traditional methods in prenatal genetic diagnosis of thalassemia.Results:By traditional methods, 1 939 cases (24.22%, 1 939/8 005) were normal and 6 066 cases (75.78%, 6 066/8 005) were diagnosed as thalassemia, including 4 513 cases of α-thalassemia, 1 475 cases of β-thalassemia, and 78 cases of αβ-thalassemia. By PCR-flow Fluorescence Hybridization technology, 7 845 samples were successfully diagnosed after initial interpretation by software. Compared with traditional methods, all the sensitivity, specificity and accuracy were 100%. The other 160 samples which failed in the initial interpretation can be successfully interpreted after review or manual interpretation.Conclusion:There were no differences between the two methods on the detecting of common mutation sites of thalassemia.
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Objective:To explore the effects of different approaches for second-trimester multifetal pregnancy reduction on pregnancy outcome in women with dichorionic triamniotic (DCTA) triplet.Methods:A retrospective study was performed on 51 women with DCTA triplet pregnancies who were referred to Guangdong Women and Children Hospital for second-trimester multifetal pregnancy reduction from January 2014 to January 2020. All participants were divided into either preventive group ( n=39) or treatment group ( n=12) according to the indication for multifetal pregnancy reduction, and they were further allocated to three subgroups based on different reduction methods, which were reduction to dichorionic twin by radiofrequency ablation (RFA) (RFA subgroup), reduction to monochorionic singleton (KCl-singleton subgroup) or monochorionic twin (KCl-twin subgroup) by cardiac injection of potassium chloride. Pregnancy loss rate, neonatal birth weight, gestational age at delivery, incidence of intrauterine death, and neonatal death were compared and analyzed between different groups using t-test, analysis of variance, Chi-square test, Fisher's exact test and Bonferroni correction. Results:(1) The mean gestational week at operation in the treatment group was significantly later than that in the preventive group [(18.5±3.1) vs (15.0±2.3) weeks, t=-4.209, P<0.001]. In the preventive group, the mean gestational week at operation in the RFA subgroup was later than the KCl-singleton and KCl-twin subgroup[(17.2±1.6) vs (13.8±1.5) and (12.7±1.0) weeks, t=6.630 and 3.875, respectively, both P<0.05]. (2) The postoperative pregnancy loss rate in the preventive group was decreased compared with the treatment group [10.3%(4/39) vs 5/12, Fisher's exact test, P<0.05], and the live birth ratio was increased [ 85.7%(48/56) vs 10/18, χ2=5.640, P=0.018]. No live birth infants with birth weight <1 500 g was reported in the KCl-singleton subgroup in preventive group, and the statistical significance was observed in the intra-group differences ( P<0.05) rather than the pairwise comparison differences in the preventive group. For the proportion of live births, there was a statistically significant difference in the intra-group comparison in the treatment group, which was higher in the RFA subgroup than that in the KCl-twin subgroup (6/6 vs 1/6, P=0.045). No significant difference was revealed among pregnancy loss rate, gestational weeks at delivery, the mean birth weight, premature delivery <32 gestational weeks, and full-term birth rate among three different approaches within the two groups. (3) No monochorionic twin complications or perinatal death occurred in any RFA or KCl-singleton subgroups in the two groups. In the KCl-twin subgroups including five cases with ten fetuses, including three live birth, four miscarriage, three intrauterine death occured, while no neonatal death was reported. One case with selective fetal uterine growth restriction in the preventive group delivered two live births, and one case with twin-to-twin transfusion syndrome in the treatment group had intrauterine death in one fetus and one survival neonate. Conclusions:The pregnancy outcome of multifetal pregnancy reduction to dichorionic diamniotic twins by RFA or reduction to singleton by cardiac injection of potassium chloride are comparative in women with DCTA triplet, regardless of whether it is a preventive or therapeutic reduction.
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Objective:To evaluate the detection of copy number variation (CNV) by chromosome microarray analysis (CMA) in fetuses with congenital anomalies of the kidney and urinary tract (CAKUT).Methods:A total of 1 929 fetuses who were ultrasonically found with CAKUT and underwent CMA from Guangdong Women and Children's Hospital and Health Institute were enrolled in this retrospective study from January 2016 to July 2020. These fetuses were divided into isolated CAKUT group ( n=1 567), CAKUT with soft markers group ( n=269), and CAKUT with other structural anomalies group ( n=93) for comparing the detection rate of pathogenic CNV using Chi-square test or Fisher exact test. Results:(1)The detection rate of all and pathogenic CNVs were 6.5%(125/1 929) and 4.8%(93/1 929), respectively. The total detection rate of CNV, clinically significant CNV and large chromosome structural variations in the CAKUT with other structural anomalies group were higher than those of the CAKUT with soft markers group and isolated CAKUT groups[31.2%(29/93), 11.5%(31/269) vs 4.2%(65/1 567), χ2=119.002; 18.3%(17/93), 9.0%(24/269) vs 3.6%(56/1 567), χ2=49.677; 9.7%(9/93), 2.2%(6/269) vs 0.3%(4/1 567), χ2=42.727; all P<0.001]. CAKUT with other structural anomalies group had a higher detection rate of pathogenic CNV (18.3%, 17/93) than the CAKUT with soft markers group (8.6%, 23/269) and the isolated CAKUT group [3.4%(53/1 567)] ( χ2=51.932, P<0.001). (2) The detection rate of pathogenic CNV was the highest in fetuses with enhanced renal echo (14.7%, 23/156), followed by renal enlargement (8.2%, 5/61), renal dysplasia (5.0%,13/261), polycystic renal dysplasia (5.0%, 13/261), and hydronephrosis (4.8%, 20/413). Fetuses with polycystic renal dysplasia, renal agenesis, fused kidney and hydronephrosis in the CAKUT with other structural anomalies group had a higher detection rate of pathogenic CNV than those in the isolated CAKUT group [3/9 vs 3.5%(8/230), 2/17 vs 1.3%(3/237), 1/8 vs 0.0%(0/59) and 3/18 vs 3.4%(12/344), all P<0.017]. The CAKUT with other structural anomalies group had a higher detection rate of pathogenic CNV than CAKUT with soft markers group in fetuses with enhanced renal echo [4/8 vs 12.8%(5/39), P<0.017]. (3) The top three microdeletion/microduplication syndrome were 17q12 microdeletion syndrome (36.6%, 34/93), 22q11.2 microdeletion syndrome (23.7%, 22/93), and 16p11.2 microdeletion syndrome (7.5%, 7/93) among those with pathogenic CNV. Conclusions:The risk of CNV in fetuses with isolated CAKUT, CAKUT with soft markers, and CAKUT with additional structural anomalies increased progressively. CMA might be a better choice in fetuses with hydronephrosis, enhanced renal echo, renal enlargement, renal hypoplasia, and multicystic renal dysplasia to improve the detection rate of CNV.
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Frailty is a common physiological dysfunction syndrome in the elderly. Aging requires active prevention and treatment of the aging problem. Based on the background of aging problem, this paper introduces the classic and personalized methods for identifying senile frailty and analyzes their applicability. This paper discusses the evolution of the intervention center of senile frailty from the horizontal expansion of the intervention object and the vertical extension of the intervention path, discusses the significance of the comprehensive care model based on the comprehensive assessment of the elderly and the multidisciplinary cooperation in the frailty management, and expounds the bottleneck problems in the frailty management of the elderly.
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Objective:To develop a quality assessment scale of ICU transitional care based on patient-reported outcomes and test its performance.Methods:According to the guidelines of patient-reported outcomes development process, the item pool was established combining with analysis of relevant literatures and patients′ experience and needs in ICU transitional period based on the grounded theory about ICU transitional care. Cognitive test of patients and Delphi expert correspondence were utilized to amend the initial scale before pretest. One hundred and seventy-seven patients who had been transferred from ICU to general ward from March to August 2019 in Tianjin Third Central Hospital were recruited by convenience sampling method for project analysis.Results:The active coefficient and authority degree of expert were above 0.90 and 0.785 respectively for the two rounds of expert enquiry. The final scale consisted of 28 items, from which 4 principal factors, which were preparation for self-care, communication and coordination, psychological support and health belief, respectively, were extracted by exploratory factor analysis, explaining 78.307% of total variance. The content validity index of each item was 0.769-1.000, and the scale-level content validity was 0.896. The Cronbach α coefficients of the 4 factors and the scale were 0.844, 0.793, 0.897, 0.681 and 0.807, respectively.Conclusions:The patient-reported outcomes scale measuring ICU transitional care quality has good reliability and validity and can be used as an auxiliary tool measuring ICU transitional care quality in clinic.
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Objective:To explore the application effect of optimizing diet management in patients with hyperphosphatemia.Methods:Seventy-seven patients who underwent regular hemodialysis in the blood purification department of the First Affiliated Hospital of Guangxi Medical University from September 2018 to June 2019 were selected. Patients were randomly divided into control group (39 cases) and intervention group (38 cases) by the method of random number table. The control group received routine nursing, while the intervention group received optimized dietary management intervention. The blood phosphorus, blood calcium, hemoglobin, albumin, dietary phosphorus related knowledge level and phosphorus control diet compliance of the two groups before and after the intervention were compared respectively.Results:After 3 months of intervention, the scores of knowledge about food phosphorus, compliance of phosphorus control diet and total score of the intervention group were (22.00±3.92), (34.82±4.69) and (56.82±7.48) points, which were higher than (18.46±3.57), (30.54±3.52) and (49.00±6.13) points of the control group, the difference was statistically significant ( tvalues were 4.146, 4.536 and 5.022, P<0.05). After 6 months of intervention, the scores of knowledge about food phosphorus, compliance of phosphorus control diet and total score of the intervention group were (25.74±3.36), (41.63±5.27) and (67.37±7.67) points, which were higher than (20.97±3.81), (32.36±4.38) and (53.33±6.80) points of the control group, the difference was statistically significant ( tvalues were 5.815, 8.403 and 8.504, P<0.05). After 3 months of intervention, the blood phosphorus level in the intervention group was 1.81 (1.67, 2.10) mmol/L, which was lower than 2.13 (1.87, 2.32) mmol/L in the control group, the difference was statistically significant ( Zvalue was-3.237, P<0.05). After 6 months of intervention, the blood phosphorus level in the intervention group was 1.75 (1.63, 1.91) mmol/L, which was lower than that in the control group 1.90 (1.83, 2.13) mmol/L, and the difference was statistically significant ( Zvalue was-3.343, P<0.01). Conclusion:Optimizing dietary management can improve patients' knowledge level of food phosphorus and dietary compliance of phosphorus control, effectively reduce blood phosphorus level, and have no obvious effect on nutritional status.
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Objective:To evaluate the safety and efficacy of LVIS stent-assisted coil embolization in the acute phase of ruptured intracranial aneurysms.Methods:The clinical data of 55 patients with ruptured intracranial aneurysm treated with LVIS stent-assisted coil embolization admitted to Zhongshan Hospital of Xiamen University from January 2016 to December 2018 were analyzed retrospectively. The general data, the characteristics of aneurysms and the occurrence of perioperative complications of the patients were collected. The clinical prognosis of the patients at discharge and 6 months of follow-up was recorded. The Glasgow prognosis score (GOS) was graded as good (5), average (3-4), and poor (1-2), and the cerebral angiography results were recorded immediately after embolization and 6-month follow-up. The aneurysm occlusion was assessed by Raymond grade, Raymond Ⅰ was complete obliteration, Ⅱ was residual neck and Ⅲ was residual aneurysm.Results:All 55 patients received LVIS stent-assisted coil embolization within 72 hours of ruptured intracranial aneurysms, and all stents were released successfully, including 16 males (29.1%) and 39 females (70.9%). The median age was 53 (24-80) years old. Anterior circulation aneurysms were found in 49 patients (89.1%) and posterior circulation aneurysms in 6 patients (10.9%). According to Hunt-Hess classification, there were 43 patients with grade Ⅰ-Ⅱ (78.2%), 7 patients with grade Ⅲ (12.7%) and 5 patients with grade Ⅳ-Ⅴ (9.1%). The first digital subtraction angiography (DSA) examination of 55 patients after embolization showed that 41 patients had complete obliteration of aneurysms and 14 had residual neck; and the smaller the aneurysm was, the higher the rate of complete obliteration after embolization was. The proportion of small aneurysms (maximum diameter ≤ 7 mm) in the complete obliteration group was significantly higher than that in the neck residual group (100.0% vs. 64.3%, P < 0.01). Among the 55 patients, there was 1 patient suffered from in-stent thrombosis during embolization, 1 patient suffered from distal vascular thrombosis induced by plaque shedding during embolization, 1 patient suffered from vasospasm during embolization, and 1 patient suffered from postoperative distal cerebral hemorrhage after embolization. In 2 dead patients, 1 died of cardiogenic disease and 1 died of respiratory failure caused by severe pneumonia. At discharge, the prognosis was good in 40 patients, average in 10 patients, and poor in 5 patients; and the higher the Hunt-Hess grade at admission, the worse the prognosis. The proportion of patients with Hunt-Hess grade Ⅰ-Ⅱ at admission in the good prognosis group was significantly higher than that in the general prognosis group and the poor prognosis group (90.0% vs. 50.0%, 40.0%, P < 0.01). Of the 55 patients, 39 completed clinical prognosis and cerebral angiography 6 months after embolization for follow-up. All patients had GOS no less than 3, including 32 patients with complete obliteration of aneurysm, 4 with residual neck and 3 with residual aneurysm. The smaller the aneurysm, the higher the rate of complete obliteration at 6-month follow-up was. The proportion of small aneurysm in the complete obliteration group was significantly higher than that in the residual neck group and the residual aneurysm group (100.0% vs. 75.0%, 33.3%, P < 0.01). There was no rebleeding or ischemic complication at 6-month follow-up. Conclusions:LVIS stent assisted coil embolization is safe, effective and feasible in the acute stage of ruptured intracranial aneurysms. Standardizing antiplatelet therapy and dense packing of aneurysms during embolization are the key to reduce bleeding and ischemic complications.
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Extracorporeal membrane oxygenation (ECMO) hit a great milestone in critical care medicine since it has brought more hope for the diagnosis and treatments of critically ill patients. However, benefits to patients are alongside with nursing challenges as the technique develops. This paper discusses the challenges and dilemma concerning critical care of patients with ECMO, proposing to improve the quality of critical care management of ECMO patient by standardized nursing process of ECMO patients, specialized nursing training and in-depth regional cooperation.
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Objective To assess the influence of case management based on 5E mode on water-salt control in the patients with peritoneal dialysis.Methods One hundred eligible cases of peritoneal dialysis were randomly divided into two groups,50 cases in each group.The control group received regular nursing care,while on this basis the experimental group applied the case management based on 5E mode for conducting the nursing intervention.The various indicators were evaluated at 3 time points (the first stage of the baseline data ceollection),second stage (4-month intervention) and third stage (3-month follow up).Results There was no statistically significant difference in the first stage between the two groups;in the second and third stage the body weight,systolic blood pressure,diastolic blood pressure,water and salt intake amount in the experimental group were lower than those in the control group,compliance was superior to thas of the control group(P＜0.05);the descent speed of urine volume and PD ultrafiltration amount in the experimental group was slowed down compared with the control group(P＜0.05);the patient's daily sleeping time was improved(P＜0.05).Conclusion The case management based on 5E mode used in the water-sak control of the patients with peritoneal dialysis is effective and feasible.
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Objective:To observe the expression of IL-12 family subunit genes by real-time quantitative PCR in mice C6 glioma cells,construct the basis of the brain glioma research on IL-12 family in the future.Methods:Mice C6 glioma RNA was abstracted and reversed transcription cDNA.The mice C6 glioma cells mRNA expression influence of IL-12 family subunit genes was compared and analyzed by real-time quantitative PCR.Results: In mice C6 glioma cells, high expression abundances in IL-23a, IL-12a, midlde expression abundances in EBI3, IL-27, low expression abundance in IL-12b.Conclusion: IL-12 families are closely related to the occurrence and development of glioma,IL-12,IL-23 are regarded as the most potential anti-glioma cytokines among them,research de-velopments will bring a new way of brain glioma immune therapy.
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Objective The purpose of this study was to assess the imaging features of newly diagnosed high-grade glioma and the effect of relevant factors such as postoperative radiotherapy and chemotherapy on progression-free sur-vival (PFS) time. Methods A total of 54 patients with recurrent high-grade glioma confirmed by pathology or progressive malignant glioma proved by clinical follow-up were included in this retrospective study from 4 clinical centers. The prog-nostic factors selected included MR image features at initial diagnosis (including the maximum diameter of tumor, peritu-moral edema, degree of enhancement, degree of necrosis and presence of cystic or satellite), postoperative radiotherapy and chemotherapy. Kaplan-Meier method and Cox’s proportion-hazards model were used to analyse the factors influenc-ing the progression free survival (PFS) time. Results The univariate Kaplan-Meier analysis revealed that the degree of peritumoral edema (PTE, P=0.001), degree of necrosis (P<0.001) , degree of enhancement (P<0.001), postoperative radio-therapy (P=0.008) and chemotherapy(P=0.035) were significant factors for PFS. Cox multivariate analysis also showed that the degree of PTE(P=0.019),degree of necrosis (P<0.001) were all significantly correlated with PFS. The less edema or necrosis was associated with the longer PFS. In addition, postoperative radiotherapy (P=0.035) and chemotherapy (P=0.049) were also significantly correlated with PFS. The normative chemotherapy and radiotherapy were associated with longer PFS. Conclusions The PTE and necrosis on preoperative MR images can be used to predict the PFS of glioma af-ter total resection. Adjuvant normative chemotherapy and radiotherapy should be recommend for supratentorial high-grade glioma including those even with MRI confirmed total resection.
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Objective To explore the influence of peritumoral edema (PTE) on the tendency of recurrent location and morphological character after total resection using MRI. Methods MRI data was collected from 43 patients with recur-rent brain glioma after total resection from four clinical centers and then the influence of of PTE on recurrence patterns af-ter total resection was retrospectively analyzed based on the T2 weighted image. Results The PTE had a significant influ-ence on the recurrent patterns of brain gliomas after total resection. When PTE was mild, the shapes of recurrent gliomas tended to be focal (6/8) and the recurrent locations tended to be local (5/8). When PTE was severe, the shapes of the recur- rent gliomas tended to be spread(30/35 and the recurrent locations tended to be distant (25/35), followed by marginal (7/35), In addition, the morphological patterns and locations of recurrent gliomas were significantly different among different PTE types (all P<0.001). When PTE was ring shape, the shapes of recurrent gliomas tended to be focal (7/9) and the recur-rent locations tended to be local (6/9), followed by marginal (2/9) and distant (1/9). When PTE was irregular shape, most of recurrent locations tended to be distant (25/34), followed by marginal (7/34) but rarely local (2/34). Conclusions The de-grees and the types of brain glioma PTE can significantly influence the locations and morphological patterns of recurrent gliomas after total resection.
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Objective To study the effect of applying food composition table and foodstuff substitution method on nutritional status in patients with diabetic nephropathy and undergoing peritoneal dialysis.Methods Forty patients with diabetic nephropathy,treated with peritoneal dialysis for over three months was included in this study.Under the guidance of the food composition table and foodstuff substitution method for six months,nutritional status was compared before and after treatment. Results There was a significant difference in HGS,triceps skin foId thickness(TSF),mid-arm circumference(MAC),midarm muscle circumference(MAMC),Hb,albumin(Alb),serum crcatinine after 6 mortths of intervention compared with those before intervention. Conclusions Food composition table and foodstuff substitution method can obviously impwve the nutritional status for patients with diabetic nephwpathy undergoing peritoneal dialysis and increase the patients'diet compliance as well.