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@#Objective: This study aimed to evaluate the effects of implementation of a neurological sub-specialized nursing module in critically ill neurological patients. Methods: We selected 22 neurological nurses from our hospital in Nanchang, China as study subjects. The outcome of 100 neurological patients were documented and evaluated. The period from December 2017 to March 2018 was the preimplementation period, in which the conventional nursing was implemented in 50 patients. The time from April 2018 to July 2018 was the post-implementation period, in which the sub-specialized nursing module was implemented with another 50 patients. We conducted assessment and evaluation consisting of doctor satisfaction, nursing complications (aspiration, diarrhea, pressure sores, and ventilatorassociated pneumonia), and the comprehensive ability of nurses in the pre- and post-implementation periods. Results: The total comprehensive ability score of the nurses after implementing the nursing module was higher than that before the implementation (P < 0.05). The satisfaction rate of doctors after implementation (95.45%) was also higher (68.18%) (P < 0.05), and the incidences of nursing complications (aspiration, diarrhea, pressure sores, and ventilator-associated pneumonia) among patients were lower after implementing the nursing module (P < 0.05). Conclusion: The implementation of a sub-specialized nursing module in the care of patients with critically ill neurological diseases can improve the comprehensive ability of nurses and the satisfaction rate of doctors as well as reducing the incidence of nursing-related complications.
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A boy, aged 2 years and 4 months, had a sudden onset of blepharoptosis of the right eyelid, accompanied by the mouth deviated to the right side, drinking cough, nystagmus, and developmental regression. Cranial MRI showed softening lesions formed after infarction of the right dorsolateral medulla oblongata, while head CT angiography showed no imaging of the proximal part of the V4 segment of the right vertebral artery. The child was diagnosed with dorsolateral medulla oblongata syndrome and was treated with gamma globulin to regulate immune function, with mannitol to reduce neuronal edema, with low-molecular-weight heparin sodium to improve local hypercoagulation of occluded blood vessels, with hyperbaric oxygen to improve local ischemia and hypoxia and promote the recovery of brain function, and with neuromuscular electrical stimulation to promote the recovery of neuromuscular function. Before discharge, only mild right ataxia and Horner syndrome remained. This article reports the first case of infantile dorsolateral medulla oblongata syndrome and provides experience for the diagnosis and treatment of the disease.
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Child, Preschool , Humans , Male , Blepharoptosis/etiology , Dysarthria/etiology , Lateral Medullary Syndrome/diagnosis , Magnetic Resonance Imaging , Medulla Oblongata/diagnostic imagingABSTRACT
Objective To explore value of high-frequency ultrasound-guided minimally invasive fixation treatment for metacarpus and phalange fractures.Methods Totally 26 patients of acute metacarpus and phalange fractures were selected and randomly divided into experimental group and control group (each n =13).The patients in experimental group underwent ultrasound-guided closed reduction,while in control group underwent C-arm X-ray fluoroscopy-guided reduction.Then the patients in two groups were followed up,and the curative effect of both methods were observed.Results The successful rate of closed reduction was 76.92％ (10/13) in experimental group,while was 84.62％ (11/13) in control group (x2=0,P=1.00).C-arm fluoroscopy was performed (0.62±1.19) times in experimental group,and (3.46±0.78) times in control group (t=-7.21,P＜0.01).The average healing time of fracture was (5.45±0.64) weeks in experimental group and (5.71±0.78) weeks in control group.The excellent and good rate of total active motion (TAM) was 84.62％ (11/13) in experimental group and 92.31％ (12/13) in control group,respectively.The average grip strength was (32.22±2.44) kg in experimental group,and (34.11±2.74) kg in control group (all P＞0.05).Conclusion High frequency ultrasound-guided minimally invasive fixation is reliable in treatment of metacarpal and phalangeal fractures,which can significantly reduce X-ray radiation.
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Objective@#To assess the effectiveness and safety of rituximab in Chinese children with autoimmune diseases of the nervous system.@*Method@#An ambispective cohort study enrolled patients with refractory and(or) relapse autoimmune diseases of nervous system from June 2010 to June 2016 in Peking University First Hospital.These patients failed to respond to steroids and(or)intravenous immunoglobulin (IVIG) were treated with rituximab and seen for follow-up visits once every 3 months.The effectiveness was assessed by modified Rankin scale (mRs) and the annualized relapse rate.B cell was repeatedly counted after the treatment.Side effects attributed to rituximab were recorded.Paired rank test and chi-square test were used to compare the mRs score and the recurrence rate (time/year) before and after the treatment.@*Result@#A total of 38 patients (15 males and 23 females) with mean age of (6±4) years were treated with rituximab.Among those patients, 4 cases were in multiple sclerosis, 5 in neuromyelitis optica, 6 in opsoclonus myoclonus syndrome, 9 in myasthenia gravis, and 14 in autoimmune encephalitis and other nervous system autoimmune diseases.The course of the disease before rituximab treatment was from two months to 7.25 years, with the average of (21±19) months.The patients had been followed up for 2-52 months. The mRs score and recurrence rate of 38 patients before receiving rituximab was 3 points (3, 4) and 2.56 (1.80, 4.75) times per year, respectively, while patients after receiving rituximab were mRs score of 0 (0, 2) and had a recurrence rate of 0 (0, 0.17) per year.There was statistical difference before and after treatment (Z=-4.51 and -4.71, P<0.01). Rituximab had a definite benefit in 23 patients, probable benefit in 2 patients, possible benefit in 3 patients, no benefit in one patient, and the disease worsened in 2 patients.Therefore the total effective rate was 74%, except for 6 undetermined cases because of the short follow-up time, and one patient withdrew from the study due to allergic reaction.During the follow-up, only one patient with severe allergy gave up the rituximab treatment. And only one patient was found severe infection with Pneumocystis carinii pneumonia.@*Conclusion@#Rituximab is an effective and safe treatment strategy for patients with refractory and relapse autoimmune diseases of CNS, especially in neuromyelitis optica and myasthenia gravis.The adverse events including infection and allergy during infusion are not common.
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Objective To identify the risk factors for severe acute lower respiratory infections (ALRI) in children and to provide scientific basis for prevention and treatment of ALRI. Methods Several databases including Pubmed, Databases-Medline (Ovid), Embase, CINAHL and Global Health Library, CNKI, VIP and Wanfang Date were searched (1990.1-2014.12) for references. All selected studies were about risk factors of ALRI in children. The screening and quality evalua? tion of the literature data was conducted independently by two reviewers according to the inclusion and exclusion criteria. Stata 11.0 software was used for Meta-analysis. Results Meta-analysis of 27 included literature showed that seven risk fac?tors were significantly associated with severe ALRI:low birth weight, lack of exclusive breastfeeding, crowded household, ex?posure to indoor air pollution, malnutrition, living in a house with smokers or smoking in pregnant and HIV-exposed unin?fected condition. Conclusion The above seven risk factors play the important role in the development of ALRI in children. Furthermore, it emphasizes the need for further studies investigating other potential risk factors to decrease the possibility of childhood ALRI.
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Objective To investigate the prevalence of year-round respiratory viral infection in children with lower respiratory tract infection (LRTI), and the relationship between respiratory viral infection and allergen sensitization in exacerbating asthma. Methods A total of 231 hospitalized children with acute LRTI were investigated from May 2013 to April 2014. The 5 most common respiratory viruses were isolated from nasopharyngeal aspirate using multiplex reverse transcription-polymerase chain reaction, including respiratory syncytial virus (RSV), adenovirus (AV), parainfluenza virus (PIV), influenza virus (IFV) and rhinovirus (RV). Atopic sensitization was defined if more than 1 serum specific immunoglobulin E level measured using immunofluorescence experiment was over 0.35 IU/mL. Results RSV was the most common pathogen of bronchiolitis in hospitalized children through the year. RV or IFV infections were more prevalent in asthma exacerbations compared to other LRTIs. AV was more likely to cause pneumonia. RV and IFV were associated with asthma exacerbations in children with atopic sensitization, but not in nonatopic children. Conclusion RV and IFV are associated with hospitalization for asthma exacerbation in children with atopic sensitization.
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Objective To evaluate the value of bacteria culture and antimicrobial susceptibility test of bronchoalveolar lavage fluid(BALF) in diagnosis and treatment of refractory pneumonia in children.Methods Three hundred and sixty-eight patients who failed to a 2 weeks,routine antibiotic therapy,hospitalized in Department of Respiration,Tianjin Children's Hospital from Aug.2010 to Dec.2011,were diagnosed as refractory pneumonia.They were examined with fiberoptic bronchoscopy,BALF was collected,and bacteria culture and antimicrobial susceptibility test in BALF were performed.Results One hundred and ninety-five stains of bacteria were identified from BALF of 181 cases.There were 10 (5.1％) gram-positive stains (7 Streptococcus pneumonia and 3 Staphylococcus aureus),48 stains (24.6％) were gram-negative bacterial,and the predominant were Pseudomonas aeruginosa (23 stains,11.8 ％),followed by Serratia marcescens and Stenotrophomonas maltophilia (6 stains respectively,3.1％).There were 1 Staphylococcus aureus with positive beta-lactamases and 1 Pseudomonas fluorescens with positive AmpC enzyme.There were 1 fungi (0.5％)and 136 parasitic bacteria stains(69.7％).Gram-positive stains were universally resistant to Erythromycin,Penicillin,Cefuroxime,and susceptible to Chloramphenicol,Levofloxacin,Vancomycin.Gram-negative stains were universally resistant to Ampicillin,Cefazolin,Cefuroxime,Cefotaxime,and susceptible to Amikacin,Cefepime,Cefoperazone sulbactam,Meropenem,Imipenem,Levofloxacin,Ceftazidime,Piperacillin.There were mixed infection in most children and the predominant pathogen was Mycoplasma pneumoniae.Conclusions Bacteria culture of BALF is relatively reliable and instructively recommended for the treatment of refractory pneumonia in children,meanwhile,it can help choose the antibiotics reasonably.
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Objective To investigate the distribution, clinical diagnosis and treatment methods of the extrapulmo-nary complications in children with mycoplasma pneumoniae (MP). Methods The clinical data of 1 100 patients confirmed the diagnosis of mycoplasma pneumonia and with the positive serum MP-IgM test were collected in this study. The distribu-tion and clinical characteristics and MP-DNA detection rates were compared between 417 patients with extrapulmonary com-plications and 683 cases without complications. The occurrence of various complications in a four-year period was analyzed. Clinical data were compared between fiberoptic bronchoscopy lavage group and non-surgical group. Results The MP-DNA detection rate and the length of hospital stay were higher in patients with pulmonary complications than those of patients without complications. The most common types of extrapulmonary complications were liver damage, skin rashes and gastrointestinal reactions , but less severe. Encephalitis, nephritis and myocarditis were rare complications, but severe and occult. The fatal hemophagocytic lymphohistiocytosis (HLH) was also visible in patients. Bronchoscopy lavage was conducive to the recovery of the disease. Conclusion MP pneumonia showed high incidence and risks of extrapulmonary complica-tions, which required careful clinical observation and inspection, the dynamic monitoring laboratory markers and comprehen-sive treatment as well.
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<p><b>OBJECTIVE</b>To study the significance and safety of flexible bronchoscopy and balloon dilatation in the diagnosis and treatment of respiratory diseases in children.</p><p><b>METHODS</b>A total of 438 children (236 males and 202 females) with respiratory diseases who were aged from 17 days to 15 years, were examined and/or treated by bronchoscopy (including bronchoscopic intervention) under local anesthesia.</p><p><b>RESULTS</b>Of the 438 children, 311 were diagnosed with pulmonary infection, 68 with atelectasis, 36 with recurrent cough and asthma, 6 with hemoptysis of unknown origin, 6 with bronchial foreign body, 5 with congenital bronchopulmonary dysplasia, 2 with bronchiectasis, 1 with ciliary dyskinesia syndrome, 1 with lung tumor, and 2 with congenital immunodeficiency disease. After bronchoscopic examination, local flushing or bronchoalveolar lavage, and foreign body extraction, marked response was seen in 379 cases and response was seen in 46 cases. High-pressure balloon dilatation under bronchoscopy was performed in 5 cases with inflammatory stricture and achieved satisfying clinical effect. No severe complications were found in bronchoscopy.</p><p><b>CONCLUSIONS</b>Bronchoscopy and balloon dilatation under local anesthesia is safe and effective for the diagnosis and treatment of respiratory diseases in children.</p>
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Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Anesthesia, Local , Bronchoscopy , Methods , Dilatation , Methods , Respiratory Tract Diseases , Diagnosis , TherapeuticsABSTRACT
Objective To explore the relationship between plasm level of vascular endothelial growth factor (VEGF) and children Anaphylactoid purpura(AP).Methods The concentrations of VEGF in serum were detected with enzyme-linked immunosorhent assay in twenty four children with AP,twenty four children with APN in acute phase and twenty four healthy children.Results The concentrations of VEGF in patients with APN in acute phase,AP and normal control was (244.56±51.12)μg/L,(155.71±50.48)μg/L and (54.91±40.07)μg/L,respectively.Plasma levels of VEGF in children with APN and AP were significantly higher than those in normal control,statistically significant difference was observed (F=95.789,P=0.000＜0.01).Conclusion The concentrations of VEGF in serum increases markedly in acute phase of AP,those in APN is higher than in AP.It indicated that VEGF involved in the occurrence and development of AP vaseulitis,and may reflect the extent of pathogenetic condition.
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<p><b>OBJECTIVE</b>To investigate the effects of shikonin on the proliferation, expression of CXCR4 and the migratory responses to CXCL12 in colorectal carcinoma cell line SW480.</p><p><b>METHODS</b>The proliferation of SW480 cells was assessed by MTT assay. Cell surface expression of CXCR4 was determined by flow cytometry. The migratory ability was determined by Transwell.</p><p><b>RESULTS</b>Shikonin inhibited the proliferation of SW480 cells in time- and concentration-dependent manner. The expression rate of CXCR4 in SW480 cells was 99.1%. After application of shikonin 0.01 micromol/L, 0.1 micromol/L and 1.0 micromol/L for 24 h, the expression rate of CXCR4 decreased to 76.0%, 59.1% and 35.5% respectively (F=1098.041, P <0.001), and the CXCL12-induced SW480 cell migratory inhibition rate was 25.2%, 38.5% and 55.7% respectively (F=48.970, P <0.001).</p><p><b>CONCLUSION</b>Besides having inhibiting tumor cell proliferation effect, Shikonin may also play a role in anti-metastasis via down-regulating the expression of CXCR4 and reducing the CXCL12-induced migratory response in colorectal carcinoma cell.</p>
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Humans , Cell Line, Tumor , Cell Proliferation , Chemokine CXCL12 , Metabolism , Down-Regulation , Naphthoquinones , Pharmacology , Receptors, CXCR4 , MetabolismABSTRACT
<p><b>OBJECTIVE</b>To investigate the expression of B cell specific MLV integration site-1 (Bmi-1) in colorectal cancer (CRC) and its correlation to the clinicopathological features and prognosis of CRC.</p><p><b>METHODS</b>Sixty CRC, 30 adenomas and 20 normal colorectal mucosal tissues were collected to detect the expression of Bmi-1 protein using immunohistochemistry, and the results were analyzed in comparison with the clinicopathological features and survival rate of patients.</p><p><b>RESULTS</b>The positivity rate of Bmi-1 expression in CRC tissue was 51.7%. In CRC, the rate of Bmi-1 overexpression was 25.0%, significantly higher than that in the adenomas and normal colorectal mucosal tissues (6.67% and 0%, respectively, P<0.05). The overexpression of Bmi-1 protein in CRC was obviously associated with distant metastasis and the TNM stage (P<0.05), but not with gender, age, tumor size, tumor site, histological type, differentiation degree and lymph node metastasis (P>0.05). But logistic regression analysis showed that Bmi-1 protein overexpression in CRC was associated only with distant metastasis (P<0.01,OR>1); Kaplan-Meier survival analysis showed that the survival rate of the patients with high Bmi-1 expression was significantly lower than that in patients with low expression (P<0.05).</p><p><b>CONCLUSION</b>The overexpression of Bmi-1 protein was significantly correlated to the tumorigenesis, metastasis and prognosis of CRC, and may serve as an indicator for evaluating the prognosis of CRC.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Case-Control Studies , Colorectal Neoplasms , Metabolism , Pathology , Neoplasm Metastasis , Nuclear Proteins , Genetics , Metabolism , Polycomb Repressive Complex 1 , Prognosis , Proto-Oncogene Proteins , Genetics , Metabolism , Repressor Proteins , Genetics , MetabolismABSTRACT
<p><b>OBJECTIVE</b>To study the changes of TLR2 and TLR4 on peripheral blood mononuclear cells (PBMCs) and their role in the pathogenesis of chronic hepatitis B and chronic severe hepatitis B.</p><p><b>METHODS</b>The expressions of TLR2 and TLR4 on 10000 CD14+ PBMCs were determined by flow cytometry in 30 healthy controls, in 31 patients with chronic hepatitis B and in 30 patients with chronic severe hepatitis B. The level of serum tumor necrosis factor alpha (TNF alpha) was determined by ELISA. The differences of expression of TLR2 and TLR4 on PBMCs and serum TNFalpha among the three groups of study subjects were determined by Student-t test. The correlations between TLR2, TLR4 and TNF alpha were determined by linear correlation test.</p><p><b>RESULTS</b>The values of mean fluorescence intensity (MFI) of TLR2 on PBMCs of the healthy controls, patients with chronic hepatitis B and patients with chronic severe hepatitis B groups were 21.5+/-2.7, 39.0+/-4.1, and 47.7+/-21.4; TLR4 of those groups was 2.3+/-1.1, 3.7+/-2.3, and 6.9+/-4.1. The serum TNF alpha(ng/L) of the respective groups was 53.8+/-38.1, 164.3+/-89.9, and 359.8+/-140.0. There was a gradual increase of these values from the group of healthy controls to the group of patients with chronic hepatitis B and patients with chronic severe hepatitis B. No significant positive correlations between TLR2, TLR4 and serum TNFalpha were found.</p><p><b>CONCLUSION</b>TLR2 and TLR4 may have a role in the pathogenesis of chronic hepatitis B and chronic severe hepatitis B.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Case-Control Studies , Hepatitis B, Chronic , Blood , Monocytes , Metabolism , Toll-Like Receptor 2 , Metabolism , Toll-Like Receptor 4 , Metabolism , Tumor Necrosis Factor-alpha , BloodABSTRACT
<p><b>OBJECTIVES</b>To study the relationship between intra-hepatic levels of regulated on activation, normal T-cell expressed and secreted (RANTES) and the disease severity and liver inflammatory degrees in patients with chronic hepatitis B and the possible mechanism of the changes of intra-hepatic levels of RANTES.</p><p><b>METHODS</b>The expression of RANTES of the livers was studied using immunohistochemical stainings and morphometric quantitative measurements in liver specimens from 10 normal subjects and 64 patients with chronic hepatitis B with different degrees of liver inflammation and different clinical severity. The expressions of RANTES protein and mRNA in cell line HepG2, HepG2.2.15 and HepG2 treated with 10 ng/ml TNFa at different times were quantified by ELISA and one-step RT-PCR.</p><p><b>RESULTS</b>The expression of RANTES of the livers in patients was significantly higher than that in the normal controls. Hepatic RANTES levels increased significantly and the increases were parallel to the increases of the severity of the hepatitis, from mild, moderate to severe hepatitis (the positive units were 3.7+/-1.5, 15.6+/-6.9, 24.0+/-4.0, 37.9+/-11.1, respectively) and from G0 degree to G4 degrees of liver inflammation (the positive units were 3.7+/-1.5, 15.0+/-5.7, 21.6+/-5.9, 30.3+/-8.2, 40.9+/-12.3, respectively). The expressions of RANTES protein and mRNA of HepG2.2.15 were higher than that of HepG2. RANTES protein and mRNA were induced in HepG2 by TNFa.</p><p><b>CONCLUSION</b>RANTES may have an important role in the pathogenesis of chronic hepatitis B. The elevation of hepatic RANTES may be caused by hepatitis B virus and TNFa.</p>
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Case-Control Studies , Chemokine CCL5 , Metabolism , Hep G2 Cells , Hepatitis B virus , Hepatitis B, Chronic , Metabolism , Liver , Metabolism , Tumor Necrosis Factor-alphaABSTRACT
Objective To investigate the method for the treatment of haemorrhage of all ventricles.Methods 46 cases were treated by continuous extrinsic drainage through puncture of the lateral ventricle which accumulated more blood combming with substitution of CSF by meams of lumbus puncture per day.Urokinase was injected into ventricle at regular intervals.Results The symptoms were improved.Head CT were reexamined in 41 cases,which showed disappearance of hematocele in ventricle within 4～15 days.Except for 5 cases of death,other cases recovered from the disease.Conclusion The hematocele above and below the duct in ventricle can be eliminated by this method,and the mortality rate can reduced greatly and the quality of survival can improved.