ABSTRACT
Objective:To investigate the predictive value of procalcitonin (PCT) in the development of acute kidney injury (AKI) in patients after bee stings.Methods:A total of 105 bee stings patients admitted to Mianyang Central Hospital from May 2019 to August 2021 were enrolled and were divided into AKI group (37 cases) and non-AKI group (68 cases) according to the occurrence of AKI. Baseline demographic information [gender, age, body mass index (BMI), sting season, sting site, number of stings, underlying disease, clinical manifestations, and inflammatory factor levels] were collected and compared between the two groups. Logistic regression model was used to analyze the risk factors associated with the occurrence of AKI in bee stings patients. Pearson model was used to analyze the correlation between PCT and other indicators; the receiver operator characteristic curve (ROC curve) were drawn to analyze the predictive value of each indicator on the occurrence of AKI in bee stings patients.Results:There were significant differences in age, number of bee stings, and vomiting after admission between the two groups of patients. The levels of serum creatinine (SCr), PCT, interleukin-6 (IL-6) and hypersensitive C-reactive protein (hs-CRP) were significantly higher in the AKI group than those in the non-AKI patients [SCr (μmol/L): 122.36±32.45 vs. 76.74±28.52, PCT (μg/L): 1.42±1.05 vs. 0.34±0.21, IL-6 (ng/L): 277.52±120.25 vs. 112.14±73.34, hs-CRP (mg/L): 7.64±3.26 vs. 3.01±2.13, all P < 0.05]. Serum PCT levels were positively correlated with serum SCr, IL-6, and hs-CRP levels in patients with AKI after bee stings ( r values of 0.486, 0.393, and 0.425, respectively; P = 0.002, 0.016, and 0.009, respectively). Multivariate Logistic analysis showed that age, SCr, PCT, IL-6, and hs-CRP were independent risk factors for AKI in patients with bee stings. The ROC curve analysis showed that the area under the ROC curve (AUC) of age, SCr, PCT, IL-6 and hs-CRP for predicting AKI in patients with bee stings were 0.622 [95% confidence interval (95% CI) was 0.516 to 0.727], 0.722 (95% CI was 0.601 to 0.843), 0.869 (95% CI was 0.781 to 0.958), 0.739 (95% CI was 0.627 to 0.851) and 0.799 (95% CI was 0.700 to 0.900), respectively. The best cut-off value of PCT was 0.742 μg/L, the sensitivity was 75.70% and the specificity was 90.50%. Conclusions:The serum PCT level was significantly elevated in patients with AKI after bee stings, which is an independent risk factor for AKI after bee stings. Serum PCT level has better predictive efficacy for AKI after bee stings and can be used as a valid biomarker for clinical prediction.
ABSTRACT
Objective:To investigate clinical significance and related factors of magnetic resonance hyperintense vessel sign (HVS).Methods:The clinical data and related imaging parameters of 109 patients with acute anterior circulation occlusion cerebral infarction, who admitted to Northern Theater Command General Hospital of People′s Liberation Army from April 2017 to August 2019, were analyzed retrospectively. Brain magnetic resonance imaging (MRI) examinations including fluid attenuated inversion recovery (FLAIR), diffusion weighted imaging (DWI) and three dimensional time of flight magnetic resonance angiography (3D TOF MRA) sequences within 24 hours of onset were performed. According to the distribution range of HVS in FLAIR sequence, the patients were divided into four grades (0, 1, 2 and 3), grades 0 and 1 belonging to HVS low grade group, and grades 2 and 3 HVS high grade group. Univariate and multivariate analyses were made to explore related factors of HVS. Fifty-two patients who completed baseline CT within six hours of onset before MRI examination were performed CT-Alberta Stroke Program Early CT Score (CT-ASPECTS) and DWI-Alberta Stroke Program Early CT Score (DWI-ASPECTS).The difference between CT-ASPECTS and DWI-ASPECTS was calculated. When the difference of ASPECTS ≤1, they were categorized as ASPECTS unchanged group (AN group); when the difference of ASPECTS>1, they were categorized as ASPECTS changed group (AY group). These two groups were compared to explore whether there was any difference in HVS grade, and Spearman correlation analysis was performed to investigate the relationship between HVS grade and the difference of ASPECTS.Results:The difference of hyperlipidemia, TOAST classification (large artery atherosclerosis (LAA), other etiology (SOE) or undetermined etiology (SUE)) and Willis circle classification (types Ⅰ, Ⅱ, Ⅲ and Ⅳ) between HVS groups were remarkable (58.6% (34/58) vs 37.3% (19/51), χ2=4.959, P=0.026; 23/5/23 vs 43/1/14, P=0.004; 3/14/12/22 vs 7/29/14/8, χ2=13.124, P=0.004). Other clinical factors and the locations of vessel occlusion did not show significant difference ( P>0.05). Multivariate Logistic regression analysis indicated that LAA in TOAST classification (LAA vs SOE or SUE, OR=3.054, 95% CI1.257-7.422, P=0.014), Willis circle type Ⅰ (type Ⅰ vs type Ⅳ, OR=5.494, 95% CI1.074-28.091, P=0.041), and type Ⅱ (type Ⅱ vs type Ⅳ, OR=5.571, 95% CI1.895-16.372, P=0.002) were independent related factors to stimulate wide distribution of HVS. The grades of HVS were significantly different between the AN group and the AY group (1/15 vs18/18, χ2=9.114, P=0.002). Spearman correlation analysis showed that HVS grade was negatively correlated with the difference of ASPECTS ( r=-0.573, P<0.001). Conclusions:Both TOAST and Willis circle classifications are crucial factors affecting HVS distribution. HVS distribution range reflects the status of collateral compensatory. Recognizing HVS may help to evaluate the progress of early cerebral infarction volume.
ABSTRACT
Objective To evaluate the opening level and optimal time window of the blood-brain barrier induced by adenosine A2 receptor agonist ( Lexiscan) via dynamic enhanced MRI. Methods Twen-ty New Zealand white rabbits were divided into experiment group ( group A, n=10) and control group ( group B, n=10) . Rabbits in group A were injected with Lexiscan and rabbits in group B were injected with physiological salt via ear vein, then the coronary scanning was performed. Contrast enhanced MRI was performed at different time points ( 5, 10, 15, 20 min, and then every 10 min, until 2 h) following the in-fusion of Gd-diethylene triamine pentaacetic acid (DTPA). The signal intensity (SI) of region of interest ( ROI) was measured and the percent enhancement of SI was calculated. Evens blue staining results in brain tissues were observed. Pair t test was used to analyze the data. Results The percent enhancement of SI in group A significantly increased to (40. 93±3.70)％ at 5 min, reached the maximum of (43.03±3.62)％ at 30 min, slowly decreased until 50 min, and got to a stable level at almost 80 min. At each time point, the per-cent enhancement of SI in group A was significantly higher than that in group B ( t values:6.88-20.28, all P<0. 05) . The staining was evident in group A. Conclusions Lexiscan can open blood-brain barrier tem-porarily and reversibly, and the optimal opening time window is 10-50 min post-injection.
ABSTRACT
Objective To explore the better strategy of cardiopulmonary resuscitation (CPR) and electric defibrillation skills training and assessment on nurses in order to improve the first-aid level of nursing staff.Methods 1 258 nurses of a hospital were trained and assessed in batches.Core group and instruc -tor team were established,multimedia lecture,situation simulation training ahd network self-learning were available.Paperless examinations were conducted.Results of the examinations were analyzed by SPSS19.0,and the comparison between the two groups of independent samples were analyzed by Mann-Whitney U test.Results All the 1 258 nurses were qualified,for the median score was 88.0 and the quartile spacing was 7.5.The step-scores of step1-3,13,14,22,23 were high,while the step-scores of step5,7-17,16-21,24,25 were low.Compared with nurses without professional-titles,nurses with professional-titles got better results in total score,step 8-12 and step17-21,and the differences were statistically significant(P＜0.05).Conclusions It is necessary to pay attention to the training and assessment of CPR and electric defibrillation skills on nurses.Advanced and effective training methods need to be used to carry on regular training and assessment.For the weak links and low-grade nursing staff,intensive training needs to be conducted to improve the entire skill level of nurses.
ABSTRACT
Objective To explore better management of cardiopulmonary resuscitation(CPR)skill train-ing and assessment and to improve CPR skills of non-clinical medical staff. Methods We developed standard CPR process and produced operating video ,and CPR models were used to train and assess 385 non-clinical medi-cal staff then the results were analyzed. Results All the 385 non-clinical medical staff were qualified. The medi-an score was 86.0,and quartile spacing 9.5. Scoring rate and full mark rate were the lowest in assessing for breath-ing and pulse before and after rescue ,followed by chest compressions/rescue breathing and quality of CPR. Age had significant positive correlation with the score of step 12(assessing for breathing and pulse after rescue),(r=0.1,P < 0.05). Gender and different professional titles had no significant effect on the results of the assessment. Conclusions Non-clinical medical staff need to pay more attention to CPR skill. Sound system ,advanced and ef-fective training methods,repeated training and regular assessment are conducive to the improvement of CPR skill of young non-clinical medical staff.
ABSTRACT
Objective To explore better management of cardiopulmonary resuscitation(CPR)skill train-ing and assessment and to improve CPR skills of non-clinical medical staff. Methods We developed standard CPR process and produced operating video ,and CPR models were used to train and assess 385 non-clinical medi-cal staff then the results were analyzed. Results All the 385 non-clinical medical staff were qualified. The medi-an score was 86.0,and quartile spacing 9.5. Scoring rate and full mark rate were the lowest in assessing for breath-ing and pulse before and after rescue ,followed by chest compressions/rescue breathing and quality of CPR. Age had significant positive correlation with the score of step 12(assessing for breathing and pulse after rescue),(r=0.1,P < 0.05). Gender and different professional titles had no significant effect on the results of the assessment. Conclusions Non-clinical medical staff need to pay more attention to CPR skill. Sound system ,advanced and ef-fective training methods,repeated training and regular assessment are conducive to the improvement of CPR skill of young non-clinical medical staff.
ABSTRACT
Objective To summarize and analyze the shielding,retention and reentry works of blood donors,and to investigate the feasibility of retention and reentry strategy.Methods The samples of ELISA single reagent reactive/NAT non-reactive and ELISA non-reactive/ NAT reactive were negative by confirmatory tests.Then the blood was weeded out and the donation qualification was reserved.The donors of shielding more than 6 months could propose the reentry application at any blood station in the province,and were allowed to return to the ranks after qualified by routine detection and re-detection by Jiangsu Provincial Blood Center.The unqualified rates were compared between the donors of again blood donation after retention and reentry with the common donors by χ2 test.Results From October 2014 to June 2016,1 615 cases were ELISA single reagent reactive/NAT non-reactive,among which 67 cases were confirmed as positive,42 cases were undetermined and 1 506 cases were negative;831 cases were ELISA non-reactive/ NAT reactive,in which 809 cases were positive by confirmation and 22 cases were negative.A total of 1 528 donors were confirmed as negative and their donation qualifications were reserved,89 donors conducted blood donation again and 79 were qualified in blood detection.The unqualified rate was 11.24%,compared with that of common donors,the difference was statistically significant(P<0.001).Meanwhile,596 donors applied for reentry,among them 218 persons were weeded out by the reentry blood station.In remaining 378 samples sent to Jiangsu Provincial Blood Center,359 samples were qualified and confirmed to the reentry condition.Among them,332 donors conducted blood donation and all were qualified by blood detection.Conclusion The reentry strategy in Jiangsu Province is reasonable and feasible,but the donors retention strategy needs to be further optimized and perfected.
ABSTRACT
Objective To explore the role of bright vessel sign (BVS) on raw three dimensional arterial spin labeling (3D ASL) image in evaluating occlusion of intracranial artery. Methods One hundred and twenty-two patients who were highly suspected of acute cerebral infarction were enrolled and analyzed. All patients were performed magnetic resonance scan with diffusion weighted image (DWI), 3D ASL and magnetic resonance angiography (MRA) sequences within 24 hours after admission. The presence or absence of restricted lesion on DWI, BVS and occlusion of intracrainal artery on MRA was reviewed. The sensitivity, specificity, positive predictive value, negative predictive value of BVS and consistency of BVS and MRA in assessing occlusion of intracranial artery were assessed. Results The sensitivity, specificity, positive predictive value and negative predictive value of BVS in assessing occlusion of intracranial artery were 83%, 99%, 95% and 96%, respectively.And the presence or absence of BVS on ASL was highly consistent with MRA in assessing occlusion of intracranial artery (κ=0.86, P<0.01). Conclusion BVS has a good sensitivity and high specificity in identifying occlusion of intracranial artery, and it is highly consistent with MRA.
ABSTRACT
Objective:To investigate the correlation of the relative cerebral blood flow (rCBF) of three dimensional arterial spin labeling (3D ASL) with vascular endothelial growth factor (VEGF) expression and microvessel density (MVD) in glioma. Methods:Fifty-three glio-ma patients confirmed by pathology were subjected to conventional, enhanced MR and 3D ASL imaging before operation to deter-mine VEGF expression and MVD levels in each patient. The correlations of rCBF with VEGF expression and MVD in glioma were evaluat-ed, respectively. Results:rCBF was noted to be positively correlated to VEGF expression and MVD in glioma. The rs were 0.728 (VEGF) and 0.620 (MVD), respectively (P<0.05). Conclusion:The positive correlation of rCBF with VEGF expression and MVD in glioma implied that 3D ASL is beneficial for evaluating microvessel angiogenesis in glioma prior to surgery. This finding is significant for developing clin-ical treatment plans and for assessing patient prognoses.
ABSTRACT
Objective To investigate the histological injury as well as the risk factors for the course of HBeAg-negative chronic hep-atitis B virus( HBV)-infected patients with persistently normal alanine aminotransferase ( ALT) levels ( PNAL) . Methods Ninty four patients of HBeAg-negative chronic HBV-infected with PNAL were performed liver puncturing. The ALT, HBV markers, and liver histo-logical changes were detected. The gender, age, family history, HBV-DNA and HBsAg levels were compared between different patients with liver inflammation and fibrosis. And the Logistic model was used during the analysis of independent risk factor. Results Among 94 cases, patients with inflammatory necrosis classification≥G2 accounted for 74. 5%, fibrosis grading≥S2 accounted for 27. 7%. Patients in the group of inflammatory necrosis classification≥G2 was older than the group of < G2, and the ALT level of≥G2 group was higher, as well as a higher HBV-DNA. What is more,Patients in the group of inflammatory necrosis classification ≥G2 were mainly male, and were associated with a family history of hepatitis B. Patients in the group of fibrosis stage ≥S2 was older than < S2 group, and the ALT level of fibrosis stage ≥S2 group was higher. And those patients were often associated with a family history of hepatitis B, but there was no significant difference among the HBV-DNA level and gender constitution. HBV-DNA and family history were the independent risk fac-tors of liver inflammation necrosis≥G2, and family history was the only independent risk factor of fibrosis stage≥S2. Conclusion The patients of HBeAg-negative chronic HBV-infected with PNAL, regardless of the ALT and HBV-DNA, must have a liver biopsy. The pa-tients with high level of HBV-DNA and with a family history of hepatitis B should be performed liver puncturing accordingly.
ABSTRACT
Objective To observe the changes of endothelin-1 (ET-1) and prostaglandin E2 (PGE2) in exhaled breath condensate (EBC) and serum of patients with acute respiratory distress syndrome (ARDS) after treated by Qingfeitang and investigate its clinical value. Methods 52 ARDS patients receiving mechanical ventilation at intensive care unit (ICU) were divided into the Qingfeitang treatment group and the control group, with 26 cases in each group. The EBC were collected by Ecoscreen condenser within 24 h after diagnosis of ARDS and on the 5th day of medication, and the venous blood were collected at the same time. The levels of ET-1 and PGE2 in the EBC and serum of different period were measured by EIA. Results (1) After treatment, The levels of ET-1 in EBC and serum of the Qingfeitang treatment group were significantly lower than those of the control group. (2) After treatment, the levels of PGE2 in serum of the Qingfeitang treatment group were significantly lower than that of the control group. (3) The oxygenation index difference before and after treatment of Qingfeitang in the treatment group was higher than in the control group. (4) The duration of mechanical ventilation of the Qingfeitang treatment group was significantly less than that of the control group. Conclusions Qingfeitang could be an effective method for alleviating acute respiratory distress syndrome.
ABSTRACT
Nowadays,patients more and more realize protecting their personal rights in hospitals.Clinic probation teaching of obstetrics and gynecology is facing the difficulty of teaching cases selecting caused by uncooperation of the patients.Establishing good relationship with the patients,improving teaching method and teaching in different ways will be helpful to accomplish the clinic probation teaching.
ABSTRACT
We arranged for experienced doctors to carry out the programme of short-term strengthening training in obstetrics,gynecology and pediatrics to trainees before the end of their clinical practice,aiming at assisting trainees to systematize and categorize skill and knowledge that they had gained confusedly and disorderly during obstetrics,gynecology and pediatrics practice.It demonstrated that such programme was beneficial to their comprehensive examination of graduation and future clinical practice.
ABSTRACT
Objective To compare the postoperative complications rate of total mesorectal excision(TME) performed by laparoscopic and conventional laparotomy method in treatment of rectal cancer.Methods The clinical data of patients with rectal cancer treated by laparoscopic surgery(n=42) or traditional laparotomy(n=50) were retrospectively analysed to analysis of the cause and occurrence rate of complications.(Results) The laparoscopic group had an advantage over the conventional laparotomy group in bowel movement recovery,earlier mobility and short hospital stay time.There was no difference in intraoperative injury,(anastomotic) leakage,sexual function preservation,long-term urinary dysfunction,and local recurrence or(incision) metastasis rates.Conclusions Laparoscopic TME treatment of rectal cancer had the same therapeutic effect as the conventional laparotomy procedure did,and has a better subjective outcome.