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OBJECTIVE: To investigate the clinical features,treatment methods and prognosis of acute thallium poisoning.METHODS: The clinical data of 2 cases of acute thallium poisoning were analyzed retrospectively to observe its clinical features,therapeutic effect of blood purification and sodium dimercaptosulfonate,and prognosis.RESULTS: The typical triads of clinical features of the two cases of acute thallium poisoning were gastroenteritis,polyneuropathy and alopecia.Before treatment,the blood thallium level was 200.6 and 712.7 μg/L and the urine thallium level was 5 206.4 and 11050.2 μg/24 h respectively.After the combined treatment using blood purification and sodium dimercaptosulfonate,the blood thallium decreased to 31.6 and 14.6 μg/L and the urine thallium decreased to 175.2 and 265.3 μg/24 h.The two patients had a good prognosis.The result of re-examination showed that blood thallium was 7.9 and 0.6 μg/L and the urine thallium was 31.5 and 5.5 μg/24 h respectively in 2 and 5 months later.CONCLUSION: The combined treatment using blood purification and sodium dimercaptosulfonate is effective for acute thallium poisoning therapy.
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Objective To observe the clinical effect of high fat and low carbohydrate enteral nutrition (EN) for treatment of patients with chronic obstructive pulmonary disease (COPD) under mechanical ventilation (MV). Methods Fifty-six COPD patients with MV admitted to the Department of Intensive Care Unit of Traditional Chinese Medicine Hospital of Zhuji from May 2014 to July 2017 were enrolled, and they were randomly divided into an experimental group administered with high fat and low carbohydrate EN (28 cases) and a control group administered with high carbohydrate and low fat EN (28 cases ), the therapeutic course being two weeks in both groups. After two weeks of treatment, the pH value, arterial partial pressure of carbon dioxide (PaCO2), arterial partial pressure of oxygen (PaO2), every minute ventilation volume (VE), oxygen consumption volume (VO2), carbon dioxide production volume (VCO2), total peripheral blood lymphocyte count (TLC), immunoglobulins (IgA, IgG, IgM), MV time, weaning success rate and survival rate were detected and compared between the two groups. Results Two weeks after nutritional support treatment, PaCO2, PaO2, VCO2, VO2, VE, TLC were all significantly improved in experimental group compared with those in control group [PaCO2(mmHg, 1 mmHg = 0.133 kPa): 48.37±10.22 vs. 55.34±9.87, PaO2(mmHg): 73.45±14.68 vs. 67.43±7.38, VCO2(mL): 264±22 vs. 287±30, VO2(mL): 316±35 vs. 344±22, VE (L/min): 10.0±1.6 vs. 11.6±1.9, TLC (×109/L): 1.62±0.73 vs. 1.21±0.21, all P < 0.05], MV time was significantly shorter in experiment group than that in control group (days: 6.89±1.15 vs. 8.78±1.29), weaning success rate and survival rate were significantly higher in experiment group than those in control group [weaning success rate: 67.9% (19/28) vs. 42.9% (12/28), survival rate:89.3% (25/28) vs. 78.6% (22/28), both P < 0.05]. Conclusion High fat and low carbohydrate EN can improve the ventilation and immune indexes in COPD patients with MV, shorten the MV time and increase the weaning success rate and survival rate.
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Objective To observe the incidence of malnutrition, the therapeutic effect of nutritional support and the prognosis of patients with chronic obstructive pulmonary disease (COPD) under mechanical ventilation (MV) in patients with different traditional Chinese medicine (TCM) syndrome types and discuss the relationships between these indicators and the differentiation of cold-heat/deficiency-excess syndrome. Methods One hundred and three patients with COPD and MV admitted to Zhuji Hospital of TCM from September 2015 and July 2017 were enrolled, according to the different TCM syndromes, they were divided into an excess-heat syndrome group 42 cases and an asthenia-cold syndrome group 61 cases, and the differences in nutrition indexes and prognosis between the two groups were compared. Results The acute physiology and chronic health evaluationⅡ (APACHE Ⅱ) score, nutritional risk screening 2002 (NRS2002) score and the incidence of malnutrition in excess-heat syndrome group were significantly lower than those in the asthenia-cold syndrome group, while the body mass index (BMI) in excess-heat syndrome group was obviously higher than that in the asthenia cold syndrome group [APACHE Ⅱ score: 20.1±5.4 vs. 22.0±3.4,NRS2002 score: 5.2±0.6 vs. 6.2±0.8, incidence of malnutrition: 61.9% (26/42) vs. 80.3% (49/61), BMI (kg/m2): 22.6±3.8 vs. 19.9±4.8, all P < 0.05]. The levels of albumin (Alb), prealbumin (PA) and transferrin (TF) of the excess-heat syndrome group were higher than those in the asthenia-cold syndrome group, and the differences between the two groups were statistically significant on the 7th day under MV [Alb (g/L): 36.14±2.97 vs. 34.40±3.37, PA (mg/L): 237.67±28.01 vs. 185.34±30.86, TF (g/L): 2.13±0.38 vs. 1.95±0.12, all P < 0.05]. In the excess-heat syndrome group, the percentage of weaning from MV was higher than that of the asthenia-cold syndrome group [85.7% (36/42) vs. 65.6% (40/61)], the 28-day mortality [14.3% (6/42) vs. 31.1% (19/61)] and ICU stay time (days: 9.21±2.96 vs. 11.13±3.96) were lower than those of the asthenia cold syndrome group (all P < 0.05). Conclusion The analysis of TCM differentiation of cold-heat/deficiency-excess syndrome has a certain reference value to realize the changing rules in nutritional status and prognosis of patients with COPD under mechanical ventilation.
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Objective To explore the application value of traditional Chinese medicine (TCM) symptom score in the evaluation of the prognosis of patients with acute exacerbation of chronic cardiac insufficiency and establish a mortality probability model to assess the patients' consistency between the risk of death and actual death. Methods A retrospective observational study was conducted. Three hundred and twenty patients with acute exacerbation of chronic cardiac insufficiency admitted to Zhuji Hospital of TCM from January 2015 to June 2017 were divided into survival and death groups according to 28-day prognosis. The TCM symptom score and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score were recorded on admission, then Spearman correlation analysis was used to determine the correlation between the two types of evaluating score; the differences in APACHE Ⅱ score and TCM symptom score between the two groups of patients were compared; the receiver operating characteristic curve (ROC) was drawn, and the area under ROC curve (AUC) was calculated to evaluate the values of APACHE Ⅱ score and TCM symptom score in predicting the prognosis of patients. Whether the patients being dead or not and the TCM symptom score were used to carry out the logistic regression analysis and establish the regression model, then the relationship between the risk of death and actual death was verified. Results A total of 320 patients were enrolled, of whom 279 survived and 41 died.① The APACHE Ⅱ score and TCM symptom score in the dead group were significantly higher than those in survival group [APACHE Ⅱ score: 30.0 (22.5, 33.5) vs. 14.0 (8.0, 21.0); TCM symptom score: 28 (25, 33) vs. 15 (10, 20); both P < 0.01]. ② The APACHE Ⅱ score of patients with acute exacerbation of chronic cardiac insufficiency was positively correlated with their TCM symptom score obviously (r = 0.814, P < 0.01). ③ The AUC for predicting the prognosis of patients with acute exacerbation of chronic cardiac insufficiency by APACHE Ⅱ score and TCM symptom score were 0.816 and 0.920 respectively, when the best critical value of APACHE Ⅱ score was 21, the sensitivity of predicting death in the patients was 82.9%, and specificity was 74.1%, and the 95% confidence interval (95%CI) was 0.739-0.893;when the best critical value of TCM symptom score was 25, the sensitivity of predicting death in patients was 82.7%, specificity was 91.0% and 95%CI was 0.876-0.964. ④ Whether the patient being dead or not and TCM symptom score were brought into logistic regression analysis to obtain the death risk model: ln [R/(1-R)] = -8.131+0.283×TCM symptom score, after the TCM symptom score was substituted into the death risk model, the result revealed that the death risk was consistent with the actual death situation, that is with the rising of TCM symptom score, the death risk rate increases, and the actual fatality rate also increases gradually. Conclusions The application of TCM symptom score is helpful to realize the degree of disease severity and early judgement of prognosis in patients with chronic cardiac insufficiency.
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Objective To explore the application value of traditional Chinese medicine (TCM) symptom score in the evaluation of the prognosis of patients with acute exacerbation of chronic cardiac insufficiency and establish a mortality probability model to assess the patients' consistency between the risk of death and actual death. Methods A retrospective observational study was conducted. Three hundred and twenty patients with acute exacerbation of chronic cardiac insufficiency admitted to Zhuji Hospital of TCM from January 2015 to June 2017 were divided into survival and death groups according to 28-day prognosis. The TCM symptom score and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score were recorded on admission, then Spearman correlation analysis was used to determine the correlation between the two types of evaluating score; the differences in APACHE Ⅱ score and TCM symptom score between the two groups of patients were compared; the receiver operating characteristic curve (ROC) was drawn, and the area under ROC curve (AUC) was calculated to evaluate the values of APACHE Ⅱ score and TCM symptom score in predicting the prognosis of patients. Whether the patients being dead or not and the TCM symptom score were used to carry out the logistic regression analysis and establish the regression model, then the relationship between the risk of death and actual death was verified. Results A total of 320 patients were enrolled, of whom 279 survived and 41 died.① The APACHE Ⅱ score and TCM symptom score in the dead group were significantly higher than those in survival group [APACHE Ⅱ score: 30.0 (22.5, 33.5) vs. 14.0 (8.0, 21.0); TCM symptom score: 28 (25, 33) vs. 15 (10, 20); both P < 0.01]. ② The APACHE Ⅱ score of patients with acute exacerbation of chronic cardiac insufficiency was positively correlated with their TCM symptom score obviously (r = 0.814, P < 0.01). ③ The AUC for predicting the prognosis of patients with acute exacerbation of chronic cardiac insufficiency by APACHE Ⅱ score and TCM symptom score were 0.816 and 0.920 respectively, when the best critical value of APACHE Ⅱ score was 21, the sensitivity of predicting death in the patients was 82.9%, and specificity was 74.1%, and the 95% confidence interval (95%CI) was 0.739-0.893;when the best critical value of TCM symptom score was 25, the sensitivity of predicting death in patients was 82.7%, specificity was 91.0% and 95%CI was 0.876-0.964. ④ Whether the patient being dead or not and TCM symptom score were brought into logistic regression analysis to obtain the death risk model: ln [R/(1-R)] = -8.131+0.283×TCM symptom score, after the TCM symptom score was substituted into the death risk model, the result revealed that the death risk was consistent with the actual death situation, that is with the rising of TCM symptom score, the death risk rate increases, and the actual fatality rate also increases gradually. Conclusions The application of TCM symptom score is helpful to realize the degree of disease severity and early judgement of prognosis in patients with chronic cardiac insufficiency.
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ObjectiveTo estimate the value of serum soluble scavenger receptor CD163 (sCD163) to the prognosis of patients with stroke associated pneumonia (SAP).Methods A prospective study was conducted. The clinically suspected SAP patients admitted to Department of Intensive Care Unit (ICU) and Emergency ICU (EICU) in Zhejiang Province Zhuji City Chinese Medicine Hospital from February 2014 to January 2015 were all enrolled. According to clinical pneumonia severity index (PSI), they were divided into SAP group and non SAP group according to the presence or absence of SAP, the patients of SAP group were subdivided into mild SAP group (PSI grade Ⅰ-Ⅲgrade) and severe SAP groups (PSI grade Ⅳ-Ⅴ grade) and according to the 28-day prognosis, the patients were subdivided into hospitalized death group and survival group. The clinical data were collected, including gender, age, history of stroke presence or absence, present stroke pattern, National Institutes of Health Stroke Scale score (NIHSS) on the day of stroke suspect diagnosis, Glasgow coma scale (GCS) score, acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score, clinical pulmonary infection score (CPIS), PSI score, body temperature, result of chest X-ray film, oxygenation index (PaO2/FiO2), result of sputum culture, serum levels of white blood cell (WBC) and C-reactive protein (CRP) in a period of 7 days after the suspected diagnosis, PCT, sCDl63 levels on days 1, 3, 5, 7 days, length of stay in ICU, the total time of hospitalization and 28-day survival situation, etc. The ability of each index to evaluate the prognosis of SAP was analyzed by the receiver operating characteristic curve (ROC curve). The risk factors influencing the prognosis of SAP patients were analyzed by multivariate logistic regression analysis.Results ① Seventy-eight patients were finally enrolled in the study, 44 patients were diagnosed as SAP, 34 were non SAP. In 44 patients with SAP, there were 28 cases of severe SAP and 16 cases of mild SAP. On the first day of the suspected diagnosis, the NIHSS score [13 (7, 22) vs. 8 (4, 17), the CPIS score [6 (4, 9) vs. 4 (3, 5), sCD163 [mg/L: 0.80 (0.59, 1.32) vs. 0.33 (0.22, 0.46)], CRP [mg/L: 84.2 (50.8, 114.9) vs. 51.4 (26.2, 79.9)] and 28-day mortality [38.6% (17/44) vs. 11.8% (4/34)] in SAP group were significantly higher than those in non SAP group (allP 0.05). ② The levels of sCD163 reached the peak value on the third day after the suspected diagnosis among SAP group and non SAP group, mild SAP group and severe SAP group, survival group and death group and then began to fall; the levels of sCD163, WBC, CRP, PCT within 7 days in SAP, severe SAP and death groups were higher than those in non SAP, mild SAP and survival groups (allP < 0.05). ③ROC curve analysis indicated: sCDl63 showed a better capacity for evaluating the 28-day prognosis of SAP [ROC curve (AUC) =0.673, 95% confidence interval (95%CI) = 0.515-0.807, sensitivity and specificity were 41.2% and 96.3% respectively and the cut-off was 2.65 mg/L]. However, the levels of other inflammatory indexes and scores on the first day after the suspected diagnosis had no value for early prognosis of SAP. The multiple logistic regression analysis showed that the level of sCD163 on the first day after the suspected diagnosis was the independent risk factor of death in hospital of SAP patients [dominance ratio (OR = 1.27, 95%CI = 1.06-1.52,P < 0.05]. Age (OR = 1.04, 95%CI = 1.01-1.06,P = 0.015), NIHSS score (OR = 2.86, 95%CI = 1.64-4.92,P = 0.010), CPIS score (OR = 1.52,95%CI = 1.28-1.90,P < 0.001) and APACHEⅡ score (OR = 2.06, 95%CI = 1.53-3.07,P < 0.001) were also the risk factors of influencing the death of patients with SAP.Conclusions Early sCD163 level is an independent risk factor in predicting the 28-day mortality of patients with SAP, and it has a certain value for the prognosis of SAP.
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Objective To investigate the accuracy of the new trauma scoring method:Glasgow coma score (GCS),age and systolic pressure score (GAP),in diagnosing patients' traumatic condition and predicting fatality rate in department of emergency.Methods The chnical data of 27 706 traumatic patients in department of emergency were collected.The observation was categorized into three kinds:death within 24 h after reaching department of emergency (24 h death);death from 24 h after reaching department of emergency to 7 d (death after 24 h);survival.On the basis of the trauma mechanism,GCS,age and systolic pressure score (MGAP),the GAP method was used for judging traumatic condition and predicting fatality rate of traumatic patients in department of emergency.The accuracy of GAP in predicting fatality rate was compared with revised trauma score (RTS),trauma and injury severity score (TRISS) and MGAP.The C-statistics method was used to calculate the accuracy in predicted the fatality rate.Results The C values (0.936 and 0.961) of GAP in predicting fatality rate after 24 h and in 24 h were higher than RTS (0.917 and 0.958) and MGAP (0.920 and 0.950),but slightly lower than TRISS (0.950 and 0.970).The traumatic condition in GAP was defined in this way:severity 3-10 scores,moderation 11-18 scores,and slightness 19-24 scores.Conclusions The GAP is simple,practical and accurate in diagnosing patients' traumatic condition and predicting their fatality rate.It is helpful in physicians' decision of a proper treatment plan.
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10.3969/j.issn.1008-9691.2013.03.012
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In order to express PebC1 in Pichia pastoris, the pebC1 sequence was amplified from genome Botrytis cinerea BC-4-2-2-1 by PCR and subcloned into the Pichua pastoris expression vector pPIC9K to generate pPIC9K-pebC1. The recombinant plasmid was linearized by Bgl II and transformed into Pichia pastoris GS115 by electroporation. Recombinant Pichia pastoris GS115/pPIC9K-pebC1 was screened by MD and G418-YPD plates and further confirmed by PCR. The protein expression was induced by methanol and analyzed by SDS-PAGE. SDS-PAGE analysis showed a special band about 39 kDa and western blotting indicated a good antigenicity of the expressed protein. Bioassay results showed that the recombinant protein PebC1 can induce resistance to gray mould disease of cucumber and Arabidopsi thaliana.
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Botrytis , Chemistry , Fungal Proteins , Genetics , Pharmacology , Pichia , Genetics , Metabolism , Plant Diseases , Recombinant Proteins , Genetics , PharmacologyABSTRACT
Objective To evaluate the value of contrast-enhanced ultrasonography(CEUS)in the diagnosis of hepatic artery complications after liver transplantation.Methods Thirty-seven patients suspected of hepatic artery complications were examined by CEUS.Contrast agent was SonoVue and low mechanical index harmonic CEUS was performed.Results CEUS helped significantly improve flow visualization in hepatic artery(100%).After contrast agent injection,mean contrast material arrival time was(16.1±5.5)s in hepatic artery and(19.3±4.6)s in portal vein.The diagnostic accuracy of hepatic artery thrombosis(HAT)was improved from 86%(30/35)to 100%(35/35)with CEUS.In the HAT group,contrast material arrival time in portal vein was(13.6±4.6)s,shorter to that in group without HAT(P＜0.05).Hepatic artery pseudo-aneurysm was also showed in 2 patients with CEUS after liver transplantation.Conclusions CEUS is a useful technique in improving hepatic artery visualization,which contribute to diagnose hepatic artery complications after liver transplantation.
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We have used continuous epidural anaethesia for 308 cases of orthopoedis operation of poliomyelitic sequel since 1983 to 1987. The satisfactory rate of anesthesia effect is 92%. However, as the disease caused by a special change of pathology, we have also found some ineffective cases. The causes of defect are multiple. The questions met during Anesthesia in our case series were discussed.