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Objective To explore the effects of target value management for quality control indexes in chest pain center on the efficiency and effectiveness of in-hospital treatment for STEMI patients.Methods The database of Chest Pain Center in General Hospital of Guangzhou Military Command was retrospectively analyzed.STEMI patients who visited our hospital from March 2011 to March 2018 were selected as the research subjects.During the review period,the target values of quality control indexes were adjusted 4 times.Before and after the 4 adjustment,the efficiency indexes of in-hospital treatment STEMI patients were compared,including the first medical contact to the first electrocardiogram (FMC2ECG) time,catheter lab activation time and Door-to-Balloon (D2B) time.Length of hospital stay,in-hospital mortality and hospitalization cost were compared as well.Results A total of 332 STEMI patients were included in the study.As the quality control target values became stricter,the median and the average value of FMC2ECG time,catheter lab activation time and D2B time showed a downward trend.Among these data,the D2B time decreased from 95 (74,134.5) min to 50 (44.5,71) min,and its differences were of the most significance.However,there is no significant difference in the hospitalization cost,length of hospital stay and in-hospital mortality of STEMI patients.Conclusions The target value management of quality control indexes can improve the in-hospital treatment efficiency for STEMI patients,but the improvements of treatment efficiency and effectiveness cannot be immediately revealed.It takes a certain amount of time and needs enough cases to reach a significant difference.
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Objective To explore impact of BMI on the clinical efficacy of treatment of type 2 diabetes mellitus after the laparoscopic gastric bypass. Methods Twenty patients were randomly selected from type 2 diabetes mellitus patients with BMI of 25 ~28 kg/m2 after laparoscopic gastric bypass surgery in our hospital from 2010 to 2013,20 patients from type 2 diabetes mellitus patients with BMI of 28~35 kg/m2 and 20 patients from type 2 diabetes mellitus patients with BMI≥35 kg/m2 . Accordingly,the total of 60 patients were divided into low BMI group,middle BMI group and high BMI group. The difference of the rate of blood glucose control and other indicators between three groups were compared and analyzed. Results The rate of blood glucose control in low BMI group was 75%,middle BMI group was 85%, and high BMI group was 90%. There was no statistical difference of the rate of blood glucose control between three groups at 12 months after laparoscopic gastric bypass surgery. The blood glucose and weight obviously improved in all patients,and fasting insulin and postprandial ser-um insulin decreased at 12 months after laparoscopic gastric bypass surgery. Conclusion All the patient of type 2 diabetes mellitus with dif-ferent BMI in three group can acquire satisfying clinical therapeutic effect after the laparoscopic gastric bypass.
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ObjectiveTo investigate the temporal features of renal injury in rats with severe heat stroke (SHS) and their relationship with inflammatory response.Methods Fifty-six male Wistar rats were randomly divided into normal control group and SHS for 0, 2, 6, 24, 48, 72 hours group (SHS-0, 2, 6, 24, 48, 72 h groups), with 8 rats in each group. Rats were placed in an artificial climate chamber [temperature (39.5±0.2)℃, humidity (60±5)%] to induce SHS model, and the criterion for successful model reproduction was the onset of lowering peak systolic blood pressure (SBP). Then the rats were transferred to room temperature (23.0±0.2)℃ after successful reproduction of the model. The rats of normal control group were kept in room temperature of (23.0±0.2)℃. Heart blood and renal tissue samples were harvested, and the levels of serum creatinine (SCr) and blood urea nitrogen (BUN) were determined by automatic biochemistry analyzer. The levels of myeloperoxidase (MPO), tumor necrosis factor-α(TNF-α) and interleukin-6 (IL-6) in renal tissue specimens were determined by enzyme linked immunosorbent assay (ELISA). The changes in histopathology in kidney were observed with light microscopy, and Paller scores were used to assess the degree of renal injury.Results Compared with normal control group, the levels of SCr and BUN in serum, and MPO, TNF-α and IL-6 in the renal tissue homogenate were significantly increased in SHS-6 h group [SCr (μmol/L): 174.0±27.0 vs.68.0±11.3, BUN (mmol/L): 12.6±2.3 vs. 4.3±1.2, MPO: (203.0±38.0)% vs. (100.0±1.4)%, TNF-α: (121.0±16.0)% vs. (100.0±1.4)%, IL-6: (118.0±19.0)% vs. (100.0±1.3)%, allP< 0.05], and they peaked at 24 hours [SCr (μmol/L): 489.0±96.0 vs. 68.0±11.3, BUN (mmol/L): 19.3±5.7 vs. 4.3±1.2, MPO: (511.0±41.0)% vs. (100.0± 1.4)%, TNF-α: (399.0±47.0)% vs. (100.0±1.4)%, IL-6: (473.0±56.0)% vs. (100.0±1.3)%, allP< 0.01], then declined to the normal levels at 72 hours. Under light microscopy, tissue edema and necrosis of renal tubules were found, and leukocyte infiltration was found to be most profuse at 24 hours, then they returned to normal levels at 72 hours. Paller scores in SHS-6 h group were significantly higher than those of the normal control group (75.45±9.70 vs. 14.23±3.26,P< 0.01), and it peaked at 24 hours (186.00±14.25 vs. 14.23±3.26,P< 0.01), followed by a gradual lowering, back to normal level at 72 hours.ConclusionThe results suggest that progressive renal damage occurred in the rats with SHS within 24 hours, and it was accompanied with elevated levels of MPO, TNF-α and IL-6 in the kidney homogenate, suggesting that inhibition of neutrophil activation and the release of IL-6, TNF-α may protect the SHS associated renal injury.
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Objective To evaluate diagnostic value of Sonoclot in the diagnosis of heat stroke complicated with disseminated intravascular coagulation (DIC). Methods 43 patients with heat stroke and coagulation dysfunction were retrospectively included and divided into 2 groups according to scores by International Society of Thrombosis and Hemostasis (ISTH): DIC dominant group (22 case) and DIC non-dominant group (21case). Regular coagulation tests , routine blood test , D-dimer and Sonoclot tests were performed at admission and their clinical data were compared. Logistic regression analysis was applied to evaluate the relationships between DIC occurrence and Sonoclot parameters. ROC curves were used to evaluate diagnostic value of Sonoclot for the patients with DIC and heat stroke. Results There were no differences in age, sex, central temperature and total hospital stay between the 2 groups except ICU stay, DIC symptoms, outcome, ISTH scores and APACHEⅡscores (P <0.05). ACT and CR correlated with the occurrence of DIC (P < 0.05). The AUC of ACT and ACT combined with CR were 0.854 and 0.877 respectively. The specificity of ACT in predicting DIC was 69.2%with the sensitivity of 90.3%. When combined with CR, both the specificity and the sensitivity were increased to 80.2% and 93.5%, respectively. Conclusions Sonoclot can predict DIC quickly and is effective in the diagnosis of heat stroke patients with DIC.
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Objective To prepare mouse model with heat stress and determine its pathological changes of the lung and brain during heat stress. Methods BALB/c mouse were randomly (random number) divided into two groups, control group and heat stress group. The animals in the control group were sham- heated at a temperature of ( 25 ± 0.5) ℃ and humidity of (35 ± 5 ) %. The animals of heat stress group were placed in a prewarmed incubator maintained at (35.5 ± 0.5) ℃ and relative humidity of (60 ± 5) %. Rectal temperature (Tc) was monitored, and when Tc respectively reached 39 ℃, 40 ℃ , 41 ℃ and 42 ℃, those study animals were killed. The other animals were removed from the incubator and allowed to cool at an ambient temperature of (25 ±0. 5)℃ and humidity of (35 ±5)% , respectirvely for 12 and 24 hrs when Tc reached 41 ℃ , and for 6 hrs when Tc reached 42 ℃. The lung and brain of all the animals were isolated. Hematoxylin and eosin stain and light microscope were used to detect their pathological changes. Results All the animals displayed uniform response to the heat stress. Low degree of heat stress could induced obviously pathological changes of the lung, progressively greater damage to lung with further congestion of lung matrix, asystematic hemorrhage of alveolar space, abscission of alveolar epithelial cell and disappear of pulmonary alveolus tissue structure were detected with the rise of Tc to 42 ℃. However, absorption of congestion and hemorrhage and recovery of pulmonary alveolus tissue structure could also be seen with cooling at ambient temperature. With low degree of heat stress, the brain only showed moderate edema. Neuronal denaturation and necrosis were detected when Tc reached to 42 ℃. Interestingly, the lesions of brain further aggravated even through cooling treatment after Tc reached to 42 ℃ , but recovery could been observed after cooling treatment followed with Tc of 41 ℃. Conclusions The pathological changes of the lung and brain showed distinctive lesions to heat stress and cooling treatment, and these changes were correlated with the timing and time of cooling treatment, which provide the experimental basis to further study the mechanisms between the heatstroke and multiple organ dysfunction syndrome (MODS).
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Objective To study the epidemiologic characteristics of trauma in the prehospital first-aid in megapolis. Methods The epidemiologic data of 10 654 traumatic patients,including treated by prehospital treatment and emergency treatment from January 2000 to January 2005,were analyzed.Results The proportion of male was 70.96%,adult patients(21～50 years old)79.23%,suburb 62.86%,downtown 37.14%.The patients whose ISS scores surpassed 16 accounted for 37.98%,which caused by traffic accident was 37.74%,by public order 24.39%,by industrial trauma 21.71%.The trauma in the limbs accounted for 67.51%,cephalic and cervical wounds accounted for 58.64%,multiple wounds 41.77%,thoracic and abdominal wounds 39.41%.Three hundred and sixty one were killed on the spot,which caused by traffic accident were 46.81%,by public order 28.81%,by industrial trauma 14.40%.Forty-two percent point six six patients died of multiple trauma,54.07% died of cephalic and cervical trauma,15.79% died of thoracic and abdominal wounds.Conclusion Suburban area gradually became the frequently-occurred areas of trauma in megapolis. The wounded were mainly young adults and had a tendency of juvenility.The majority of damaging and lethal factors were traffic accident,public order and industrial trauma.Some pertinet measures and professional first-aid models may improve the traumatic first-aid level.
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Objective To analyze the immune state and discuss the effects of immunoregulation therapy of combined use of ulinastatin and thymosin ?1 in the treatment of posttraumatic sepsis. Methods Forty-eight patients with posttraumatic sepsis admitted to ICU during Oct. 2005 to Oct. 2007 were included and randomly divided into treatment group and control group (24 each). Patients in control group received conventional SSC treatment, while those in treatment group received conventional SSC treatment plus immunoregulation therapy with a combination of ulinastatin and thymosin ?1. Peripheral blood CD14+ monocyte HLA-DR expression was detected by flow cytometry to determine the innate immunity of posttraumatic septic patients on day 1, 5, 7 and 28 (or death), and serum levels of IL-6 and IL-10 were assessed by ELISA to evaluate the nonspecific immunity at day 1 and 28 (or death). APACHE Ⅱ scores were recorded on day 1, 5, 7 and 28 (or dearth). Ten healthy volunteers were enrolled as healthy controls. Results At admission the expression of CD14+ monocyte HLA-DR was lower than 30% in 9 posttraumatic septic patients. The expression levels of CD14+ monocyte HLA-DR in the patients in treatment group were much higher than those in control group (P0.05). Before treatment, no significant difference existed in APACHE Ⅱ scores between treatment group and control group, while this score in the patients in treatment group was much lower than that in control group on day 5, 7 and 28 (P0.05). Conclusions There is immunosuppression in some posttraumatic patients with somplication of sepsis. All these patients manifest exaggerated nonspecific immunity at the early stage, and then manifest immunodepression as sepsis progresses. The immunoregulation effects of a combination of ulinastatin and thymosin may facilitate the balance of pro-inflammatory and anti-inflammatory media, thus ameliorating septic symptoms. No improvement in 28 day mortality has been seen, probably due to limited number of patients in present study.
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Objective To observe the influences of combined therapy of ulinastatin and thymosin ?1 on the immune state in the treatment of sepsis and multiple organ failure(MODS),and to evaluate the therapeutic rationality.Methods 46 patients with sepsis and 18 patients with MODS were randomly divided into two groups.The patients in control group were treated with classical SSC therapy,those in treatment group were treated with the combined ulinastatin and thymosin ?1 therapy.The contents of IL-6 and IL-10 were detected with ELISA at the beginning of and after the treatment.Results After treatment,the concentrations of IL-6 and IL-10 declined significantly in treatment group,while no apparent changes were observed in the control group.There existed a significant difference between the two groups(P