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Objective:To investigate clinical efficacy of tunneled subcutaneous pedicle flaps in the repair of ipsilateral nasal alar defects.Methods:A total of 20 patients with nasal alar defects after excision of basal cell carcinoma, which were repaired with ipsilateral tunneled subcutaneous pedicle flaps, were retrospectively collected from January 2018 to January 2020. There were 11 male patients and 9 female patients, with an average age of 60.6 years (range, 48 - 76 years) . According to clinical manifestations, the basal cell carcinoma lesions could be classified into 3 types: nodular-ulcerative type (13 cases) , superficial type (4 cases) and pigmented type (3 cases) , and the skin lesions varied from 0.4 cm × 0.5 cm to 0.9 cm × 1.1 cm in size. All the patients received extended surgical resection of basal cell carcinoma, and nasal alar defects were repaired with tunneled subcutaneous pedicle flaps, with the size of flaps ranging from 0.7 cm × 0.8 cm to 1.2 cm × 1.4 cm.Results:All flaps survived successfully, the nasal alar defects were completely repaired, and all wounds healed primarily. During the postoperative follow-up of 6 - 24 months, neither recurrence of tumors nor obvious scar hyperplasia occurred on the nasal ala, and nasal morphology and appearance were favorable.Conclusion:The tunneled subcutaneous pedicle flap can be used for the repair of ipsilateral nasal alar defects following excision of tumors or other lesions, resulting in favorable therapeutic outcomes and aesthetic appearance.
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Objective:To detective the cut-off values of amino acid levels in premature infants in Sichuan.Methods:Data of newborns screening for inherited metabolic diseases (IMD) by tandem mass spectrometry in Sichuan Province from January 2018 to December 2019 were retrospectively analyzed.They were divided into premature infant group ( n=2 264, 1 312 males and 952 females) and full-term infant group ( n=53 275, 28 269 males and 25 006 females). The cut-off values of amino acids in dry blood spots were expressed as percentage ( P0.5 - P99.5), and rank sum test was used for comparison between preterm and full-term infants. Results:(1) The distribution of 11 amino acids [alanine (ALA), arginine (ARG), citrulline (CIT), glycine(GLY), leucine (LEU), methionine (MET), ornithine (ORN), phenylalanine (PHE), proline (PRO), tyrosine (TYR) and valine (VAL)] in premature infants were abnormal.(2) The cut-off values of amino acids in premature infants were as follows: ALA: 135.20-552.33 μmol/L, ARG: 1.34-47.04 μmol/L, CIT: 5.66-32.02 μmol/L, GLY: 181.48-909.93 μmol/L, LEU : 71.10-283.29 μmol/L, MET: 4.21-34.51 μmol/L, ORN: 40.58-293.76 μmol/L, PHE: 23.60-106.30 μmol/L, PRO: 77.76-358.24 μmol/L, TYR: 27.52-352.91 μmol/L, VAL: 53.74-228.37 μmol/L.(3) The cut-off values of amino acid in full-term infants were as follows: ALA: 135.20-552.33 μmol/L, ARG: 1.30-42.73 μmol/L, CIT: 5.92-30.35 μmol/L, GLY: 208.17-980.09 μmol/L, LEU: 72.91-287.49 μmol/L, MET: 4.27-33.90 μmol/L, ORN: 48.40-305.59 μmol/L, PHE: 27.63-92.27 μmol/L, PRO: 97.38-372.75 μmol/L, TYR: 40.19-276.54 μmol/L, VAL: 65.75-237.92 μmol/L.(4) Except for PHE ( Z=-0.58, P>0.05), the other indicators were significantly different between 2 groups [ALA ( Z=-15.32, P<0.05), ARG ( Z=-5.62, P<0.05), CIT ( Z=-5.86, P<0.05), GLY ( Z=-14.52, P<0.05), LEU ( Z=-5.62, P<0.05), MET ( Z=-5.22, P<0.05), ORN ( Z=-13.01, P<0.05), PRO ( Z=-22.09, P<0.05), TRY ( Z=-2.09, P<0.05), VAL ( Z=-17.82, P<0.05)]. Conclusions:The establishment of the cut-off values of amino acids in premature infants in Sichuan provides a theoretical basis for laboratory diagnosis of IMD screening, which enhances the accuracy of diagnosis and avoids excessive medical treatment.
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ObjectiveTo understand the premature mortality of the most common cancers in the residents in Putuo District， Shanghai for the goal to decrease the probability of premature cancer mortality. MethodsLife table was used to calculate crude and age-standardized incidence rate， mortality， and the probability of premature mortality caused by cancers among Putuo residents from 2004 to 2016. The annual percent change was used to describe the change of these indexes. ResultsFrom 2004 to 2016， the crude incidence rate increased from 383.51/105 to 573.94/105 （APC=3.52%， P<0.01） while the age-standardized incidence rate changed from 223.20/105 to 241.38/105 （APC=3.52%， P<0.01）. The crude mortality rate changed from 229.99/105 to 269.94/105 （APC=1.64%， P<0.01） while the age-standardized mortality rate changed from 122.48/105 to 87.49/105 （APC=-2.04%， P<0.01）. The probability of premature mortality changed form 7.14% to 5.53% （AAPC=-2.29%， P<0.01）. The probability of premature mortality for male changed from 8.73% to 7.10% （AAPC=-1.74%， P=0.01） while the female from 5.54% to 3.88% （AAPC=-2.88%， P=0.08）. Trachea， bronchus and lung cancers were the top cancers causing premature mortality both for male and female. The probability of premature mortality showed a downward trend for both male liver cancer （APC=-3.83%， P=0.01） and female stomach cancer （APC=-4.17%， P<0.01）. The other types cancers did not show the significant changes （P>0.05）. Male nasopharyngeal carcinoma and female cervical carcinoma ranked top ten cancers causing probability of premature mortality but not the top ten cancers according to the crude mortality rate. ConclusionThe premature death caused by cancers shows a downward trend in general， but not in the female and most common cancers. The burden to reduce the premature mortality is still heavy. More efforts should focus on those cancers that are preventable and detectable by screening in order to decrease the premature cancer mortality.
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OBJECTIVES@#The mechanism for traditional Chinese medicine in treating of recurrent spontaneous abortion is not clear. This study aims to explore the mechanism of baotaiyin in the treatment of recurrent abortion by regulating the immune inflammatory axis of interleukin (IL)-23/helper T cell (Th)17.@*METHODS@#Spontaneous abortion model mice were randomly divided into a model group, 3 dose (low, medium, and high) groups of baotaiyin, with 10 mice in each group. After 14 days of medication, the levels of IL-17, IL-23, IL-10, and TGF-β in serum were detected with enzyme-linked immunosorbent assay. The proportion of Th17 and regulatory T cells (Treg) cells in spleen lymphocytes was tested with flow cytometry. The expressions of (retinoid-related orphan receptor γt, ROR-γt) and forkhead box P3 (FOXP3) mRNA in decidua tissues was detected with RT-PCR. Embryo absorption rate was counted.@*RESULTS@#Compared with the model group, the absorption rate of embryo and Th17/Treg cell ratio in baotaiyin medium- and high-dose groups were decreased significantly (all P<0.05); the levels of IL-17 and IL-23 in serum were decreased (both P<0.05), while the levels of TGF-β and IL-10 in baotaiyin medium- and high-dose groups were increased (P<0.05, P<0.01, respectively); the expression of ROR-γt mRNA was decreased and the expression of FOXP3 mRNA was increased (all P<0.01) in decidua tissues of baotaiyin medium- and high-dose groups.@*CONCLUSIONS@#Baotaiyin inhibits the positive feedback cycle of IL-23/Th17 immune inflammatory axis, which regulates Th17/Treg cell balance, mediates the maternal and fetal immune tolerance, and prevents the recurrent abortion.
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Mice , Animals , Female , Humans , Pregnancy , Interleukin-23 , Interleukin-17/genetics , Interleukin-10 , Abortion, Habitual , Transforming Growth Factor beta/geneticsABSTRACT
Objective@#To classify the characteristics of circadian type among clinical nurses and examine their relationships with presenteeism and work-related flow. @*Methods@#Using a cross-sectional design, 568 nurses were recruited through convenience sampling in January 2021 from three hospitals in Shandong Province, China. The data were collected using self-report measures, including the 11-item Circadian Type Inventory, Stanford Presenteeism Scale-6, and Work-Related Flow Inventory. Latent class analysis was performed to identify any clustering of circadian types. One-way analysis was performed to compare the differences between presenteeism and work-related flow in different circadian types. @*Results@#Four latent classes were identified, including high response class (14.4%), high flexible class (20.1%), high languid class (51.1%), and low response class (14.4%). Regarding presenteeism, the high languid class had higher scores than others. Regarding work-related flow, the scores of high flexible class were higher than those of high languid class, while the differences in all three dimensions were statistically significant. @*Conclusion@#Although the shift work mode is not expected to change, nursing managers could use circadian type as a predictive index to select and employ individuals for shift work to enhance work performance and provide sufficient support to staff who are intolerant to shift work.
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Objective:To construct the core competence evaluation indicators for clinical teaching nurses,provide quantifiable indicators for the core competency of clinical teaching nurses.Methods:Using literature review, survey of nursing students, interview of clinical teaching nurses, and two-round Delphi expert consultation for 18 clinical teaching nurses, the core competence evaluation indicators was constructed.Results:The response rates for two rounds of expert consultation were 18/18 and 16/18, authority coefficients were 0.83 and 0.85, and coordination coefficients at all levels ranged from 0.096-0.503( P<0.05). The core competence evaluation indicators for clinical teaching nurses consisted of 7 first-class indicators, 25 second-class indicators and 43 third-class indicators. Conclusions:The enthusiasm, authority, concentration degree and coordination degree of experts are comparatively high. It can provide references for standardized evaluation, training and management of clinical teaching nurses.
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Objective:To analyze the autistic severity and developmental level of children with autism spectrum disorder (ASD) of different gender and age.Methods:From March 2018 to February 2019, a total of 286 ASD children aged 18-96 months were enrolled.Severity of ASD was evaluated by the autism behavior checklist (ABC) and the childhood autism rating scale (CARS), while the Griffiths mental development scales-Chinese (GDS-C) was used to evaluate the children's mental development.According to gender and age, ASD severity and developmental levels of different subgroups were analyzed.SPSS 23.0 statistical software was used to analyze the data.According to the non-normal distrbution of variables, Mann-Whitney U test was used for comparison between the two groups, and Kruskal-Wallis H test was used for comparison between multiple groups and Spearman correlation analysis was used to analyze the correlation between two variables. Results:No gender difference was found in the total scores of ABC (52(40, 62), 57(36, 67), Z=0.661, P=0.509) and CARS (31(28, 35), 33(27, 36), Z=0.672, P=0.502) between the ASD boys and ASD girls.No gender difference was found in the total scores of ABC (43(33, 53), 52(34, 58), Z=0.717, P=0.473) and CARS (29(26, 32), 27(26, 30), Z=0.212, P=0.832) between the ASD boys and ASD girls when the general quotient of the GDS-C were all greater than or equal to 70 points.Also, no gender difference was found in the total ABC (55(44, 67), 59(40, 67), Z=0.067, P=0.947) and CARS (32(30, 35), 34(30, 36), Z=0.657, P=0.511) between the ASD boys and ASD girls when the general quotient of the GDS-C were all less than 70 points.The eye-hand coordination (64(52, 77), 60(43, 72), Z=2.138, P=0.033), performance (68(51, 86), 59(43, 68), Z=3.270, P=0.001), and practical reasoning (68(55, 91), 51(33, 58), Z=2.686, P=0.007) quotients of the ASD boys were significantly higher than those of the ASD girls.Compared with boys, a markedly higher proportion of developmental delay (35(80%), 124(51%), χ 2=12.083, P=0.001) was recorded for girls in relation to the performance subscale.There were significant differences in the total scores of ABC and CARS, the locomotor and eye-hand coordination quotients in GDS-C among ASD children of different ages(all P<0.05). The older the first diagnosis age, the lower the scores.The age of initial diagnosis was negatively correlated with the total scores of ABC ( r=-0.259), CARS ( r=-0.268), general quotient of GDS-C ( r=-0.127), locomotor ( r=-0.275), eye-hand coordination ( r=-0.213), performance ( r=-0.160) and practical reasoning ( r=-0.307) (all P<0.05), while positively correlated with hearing and language development quotient ( r=0.143) ( P<0.05). Conclusion:No significant gender difference was found on the severity of ASD in children aged 18 to 96 months, but the developmental level of some areas in boys was better than that of girls with ASD.ASD severity and developmental level vary depending on the age at which their ASD was diagnosed.The age of initial diagnosis is related to the severity and developmental level of ASD.
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Objective:To investigate the effects of dexmedetomidine on monocyte pyroptosis in peripheral blood of patients with cardiac valve replacement.Methods:Forty-four American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes, aged 45-64 yr, with body mass index of 18-25 kg/m 2, of New York Heart Association Ⅱ or Ⅲ, scheduled for elective cardiac valve replacement, were divided into 2 groups ( n=22 each) using a random number table method: dexmedetomidine group (group Dex) and normal saline group (group NS). In group Dex, dexmedetomidine was intravenously infused in a dose of 0.5 μg/kg over 10 min starting from the end of anesthesia induction, followed by a continuous infusion at 0.5 μg·kg -1·h -1 until the end of operation, while the equal volume of normal saline was given instead of dexmedetomidine in group NS.Before skin incision (T 1), at 30 min after the beginning of cardiopulmonary bypass (CPB) (T 2), immediately after the end of CPB (T 3) and at 24 h after CPB (T 4), the blood samples of internal jugular vein were collected for determination of the concentrations of plasma interleukin-18 (IL-18) and IL-1β (by enzyme-linked immunosorbent assay), and the expression of NOD-like receptor family, pyrin domain containing 3 (NLRP3), caspase-1 and gasdermin-D (GSDMD) in monocytes (by Western blot). The intraoperative consumption of propofol, sufentanil and norepinephrine, time of postoperative mechanical ventilation and time of intensive care unit stay were recorded. Results:The levels of plasma IL-18 and IL-1β and expression of NLRP3, caspase-1 and GSDMD in monocytes were significantly higher at T 2-4 than at T 1 in two groups ( P<0.05). Compared with group NS, the levels of plasma IL-18 and IL-1β were significantly decreased and the expression of NLRP3, caspase-1 and GSDMD was down-regulated at T 2-4, postoperative mechanical ventilation time was shortened ( P<0.05), and no significant change was found in the consumption of propofol, sufentanil and norepinephrine and time of intensive care unit stay in group Dex ( P>0.05). Conclusion:The mechanism by which dexmedetomidine reduces inflammatory responses may be related to inhibiting the NLRP3/caspase-1 pathway and reducing monocyte pyroptosis in the patients undergoing cardiac valve replacement.
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Objective:To investigate the influence of metformin on serum thyrotropin (TSH) levels in type 2 diabetes patients with euthyroidism.Methods:A retrospective case-control study was conducted to analyze the clinical data of 180 patients with type 2 diabetes who were newly diagnosed with normal thyroid function or first treated with metformin from June 2014 to June 2018 in the endocrine metabolism Department of Beijing Anzhen Hospital Affiliated to Capital Medical University.The patients were divided into metformin group and non metformin group according to the different treatment plan, 90 cases in each group.According to the baseline TSH level, the metformin group was divided into 36 cases of high TSH (baseline TSH>2.50 mU/L-≤4.91 mU/L) and 54 cases of low TSH (baseline TSH ≥ 0.49 mU/L-≤ 2.50 mU/L). The high TSH group was further grouped and analyzed according to the level of thyroid peroxidase antibody (TPOAb). Treatment for 12 months.The changes of TSH, FT3 and FT4 were observed at baseline and 12 months after treatment.Results:There was no significant difference in serum TSH and thyroid hormone between metformin group and non metformin group at baseline and 12 months after treatment (all P>0.05). However, in metformin group subjects only with high-normal basal TSH level, significant decrease in TSH levels after 12-month therapy was observed ((2.31±1.48) mU/L vs.(3.19±0.62) mU/L, t=3.291, P=0.002). Further grouping analysis showed that, regardless of TPOAb positive / negative, the TSH level in the high TSH subgroup decreased significantly after treatment compared with that before treatment ( TPOAb(+ ): (1.92±1.27) mU/L vs.(3.34±0.56) mU/L, t=3.235, P=0.005) ( TPOAb(-): ( 2.36±1.50) mU/L vs.(3.16±0.63) mU/L, t=2.507, P=0.016). Conclusion:Metformin treatment reduced TSH levels in type 2 diabetic patients with normal and high baseline TSH, and TPOAb levels had no effect on this effect.
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Objective:To explore the application of lecture-based learning (LBL) combined with problem-based learning (PBL) in the teaching of pathophysiology case analysis.Methods:The subjects were 62 preventive medicine majors of Grade 2015 and 68 stomatology majors of Grade 2015, and the course content was case analysis. PBL teaching was implemented in the preventive medicine major group and LBL+PBL teaching was implemented in the stomatology major group. Both groups received 6 class hours, among which the LBL+PBL teaching hours were allocated 2 class hours for LBL and 4 class hours for PBL. In addition, the questionnaire was used to evaluate the teaching effects between the two groups, and the descriptive analysis was used to evaluate relevant data lines.Results:Eleven students (17.742%) from the preventive medicine major group chose PBL teaching, while 38 students (92.647%) in the stomatology major group held a very positive attitude towards LBL+PBL teaching. It can be seen that the recognition degree of LBL+PBL teaching in the stomatology major group was higher than that of PBL teaching in the preventive medicine major group.Conclusion:Since students have received LBL teaching mode for a long time, it is difficult to accept and adapt to PBL teaching in terms of thinking and teamwork. Therefore, in the course of pathophysiology case analysis, LBL+PBL teaching shows a good effect, which is worthy of further exploration.
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Objective:To investigate the current situation of kinesiophobia in patients with knee osteoarthritis and its influencing factors, in order to provide basis for clinical intervention.Methods:Totally 230 patients with knee osteoarthritis were selected from 2 tertiary hospital in Ji′nan by convenience sampling method, the self-designed general data questionnaire, Tampa Scale for Kinesiophobia, Numerical Rating Scale, Self-efficacy for Managing Chronic Disease, Hospital Anxiety and Depression Scale were used as research tools. Logistic regression analysis was used to analyze the influencing factors.Results:A total of 219 valid questionnaires were collected. Kinesiophobia occurred in 166 patients, with an incidence of 75.80% (166/219). Logistic regression analysis showed that gender, education level, chronic complications, pain and self-efficacy were the main influencing factors of kinesiophobia in patients with knee osteoarthritis ( P<0.05). Conclusion:The incidence of kinesiophobia in patients with knee osteoarthritis is relatively high, and medical staff should pay attention to the evaluation of kinesiophobia symptoms in this population, early identify the high-risk factors, provide timely health education, implement the appropriate intervention measures to reduce the occurrence of kinesiophobia.
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Objective:To study the application of the best evidence of dysphagia recognition in acute stroke patients.Methods:The study was performed guided by JBI evidence-based continuous quality improvement pattern, including evidence acquisition, baseline audit, evidence implementation and re-audit. Data were collected by using field observation, questionnaire survey and review of nursing records. 80 patients and 18 nurses were recruited in the study. Barriers to evidence implementation and available solutions were analyzed. Before and after the application of evidence, the compliance of audit criterion, screening rate of swallowing disorder, screening accuracy, screening record rate and knowledge of nurses were compared.Results:Before and after the implementation of evidence, the compliance of all audit criterion was 0-33.3% and 95.0%-100.0%, and had a significant difference ( P<0.05). The dysphagia recognition knowledge score was improved from 40-80(60.56±10.69) to 60-100 (82.78±10.18) and had a significant difference ( t value was -6.39, P<0.05). The screening rate for dysphagia increased from 7.5% to 95.0%, with statistically significant difference ( χ2 value was 119.10, P<0.05). The screening accuracy was 100%, and the screening record rate was 97.4%, only 4 of the 24 patients at risk of dysphagia developed pulmonary infection. Conclusion:The application of the best evidence of dysphagia recognition in acute stroke patients can improve the nurses′ ability of dysphagia screening and improve nursing practice in dysphagia management.
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Objective:To explore the change characteristics of amino acid levels in neonates, so as to provide theoretical basis for accurate clinical interpretation.Methods:By preliminary screening and diagnosis from 32 855 newborns, 32 843 samples were collected using tandem mass spectrometry to inherited metabolic disease (IMD) scree-ning in Sichuan Province from January to December 2018.Afterwards, according to gestational age (1 363 premature infants, 31 468 full-term infants and 12 overdue infants), blood collection time (3-7 days old, 3 095 cases, 8-28 days old, 1 637 cases, and more than 28 days old, 248 cases) and season (7 737 cases in the first quarter, 11 428 cases in the second quarter, 5 482 cases in the third quarter, and 8 196 cases in the fourth quarter), neonates were divided into different study groups.The difference of amino acid level in each group was compared, and the correlation between various influencing factors and metabolic index was analyzed.Results:(1) The distribution of 11 amino acids [alanine(ALA), arginine(ARG), citrulline(CIT), glycine(GLY), leucine+ isoleucine+ hydroxyproline (LEU+ ILE+ PRO-OH), methionine(MET), ornithine(ORN), phenylalanine(PHE), proline(PRO), tyrosine(TYR), and valine(VAL)] in neonates showed non-normally distribution.(2)The distribution of 11 amino acids in different gestational age were tested by nonparametric test, except for PHE( H=0.61, P>0.05)and TYR( H=2.02, P>0.05), and other indicators were significantly different [ALA( H=187.11, P<0.05), ARG( H=23.60, P<0.05), CIT( H=22.90, P<0.05), GLY( H=85.18, P<0.05), LEU( H=56.42, P<0.05), MET( H=18.74, P<0.05), ORN( H=129.27, P<0.05), PRO( H=344.40, P<0.05), and VAL( H=272.92, P<0.05)]. (3) The distribution of 11 amino acids in different blood collection time were significantly different [ALA( H=65.19, P<0.05), ARG( H=404.48, P<0.05), CIT( H=502.13, P<0.05), GLY( H=1 719.44, P<0.05), LEU( H=396.41, P<0.05), MET( H=199.39, P<0.05), ORN( H=31.26, P<0.05), PHE( H=325.49, P<0.05), PRO( H=70.09, P<0.05), TYR( H=159.29, P<0.05), and VAL( H=102.52, P<0.05)]. (4) The distribution of 11 amino acids in different birth seasons were significantly different [ALA( H=401.37, P<0.05), ARG( H=3 229.03, P<0.05), CIT( H=65.45, P<0.05), GLY( H=597.82, P<0.05), LEU( H=1 120.42, P<0.05), MET( H=10 515.18, P<0.05), ORN( H=1 275.23, P<0.05), PHE( H=2 260.17, P<0.05), PRO( H=319.57, P<0.05), TYR( H=884.37, P<0.05), and VAL( H=1 824.49, P<0.05)]. Conclusion:According to different gestational age, season and blood collection time, the metabolism of amino acids in neonates was different.When using tandem mass spectrometry for detection, appropriate interpretation criteria should be selected based on different conditions.
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Objective:To investigate the risk factors for ischemic stroke in patients with spontaneous extracranial vertebral artery dissection.Methods:From November 2013 to December 2019, patients with spontaneous extracranial vertebral artery dissection admitted to the Department of Neurology, Baotou Central Hospital were enrolled retrospectively. According to whether they had ischemic stroke or not, they were divided into ischemic stroke group and non-ischemic stroke group. The independent risk factors for ischemic stroke in patients with spontaneous extracranial vertebral artery dissection were identified by binary logistic regression analysis. Results:A total of 39 patients were enrolled, 25 were female (64.1%), 14 were males (35.9%), their age was 51.51±14.98 years old, 16 of them (41.0%) had ischemic stroke. The proportion of patients with double-lumen sign, intimal flap sign of occluded lumen (37% vs. 4%; P=0.013) and specific initial symptoms (56% vs. 9%; P=0.003) of the ischemic stroke group were significantly higher than those of the non-ischemic stroke group. Multivariate logistic regression analysis showed that double-lumen sign and intimal flap sign of occluded lumen (odds ratio 47.951, 95% confidence interval 26.284-87.478; P<0.001), and specific initial symptoms (odds ratio 19.232, 95% confidence interval 10.695-34.587; P<0.001) were independently associated with ischemic stroke in patients with spontaneous extracranial vertebral artery dissection. Conclusions:Double-lumen sign, intimal flap sign of occluded lumen and specific clinical symptoms are the independent risk factors for ischemic stroke in patients with spontaneous extracranial vertebral artery dissection.
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Respiratory diseases are serious complications of premature infants, especially respiratory distress syndrome , and also the main cause of early death.antenatal corticosteroids can significantly reduce respiratory complications in preterm infants before 34 weeks of gestation, but there is no consensus on the application of Antenatal corticosteroids in late preterm infants and term infants.The review summarizes the recent studies on the use of antenatal corticosteroids in the outcome of late preterm and term infants, especially in the respiratory system, in order to guide clinical treatment.
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OBJECTIVE@#To observe the clinical effect of plasma exchange and tocilizumab in treatment of patients with severe coronavirus disease 2019 (COVID-19).@*METHODS@#Six patients with severe COVID-19 admitted in First Affiliated Hospital of Bengbu Medical College from January 25 to February 25, 2020. Three patients were treated with plasma exchange and three patients were treated with tocilizumab. The effect on excessive inflammatory reaction of plasma exchange and tocilizumab was observed.@*RESULTS@#The C-reactive protein (CRP) and IL-6 levels were significantly decreased and the lymphocyte and prothrombin time were improved in 3 patients after treatment with plasma exchange; while inflammation level was not significantly decreased, and lymphocyte and prothrombin time did not improve in 3 patients treated with tocilizumab.@*CONCLUSIONS@#For severe COVID-19 patients with strong inflammatory reaction, plasma exchange may be preferred.
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Antibodies, Monoclonal, Humanized , Betacoronavirus , Coronavirus Infections , Blood , Allergy and Immunology , Therapeutics , Cytokine Release Syndrome , Therapeutics , Humans , Pandemics , Plasma Exchange , Reference Standards , Pneumonia, Viral , Blood , Allergy and Immunology , Therapeutics , Prothrombin Time , Treatment OutcomeABSTRACT
Purpose@#Enhanced recovery after surgery (ERAS) is an evidence-based perioperative measure to improve outcomes. Although the benefits of ERAS are well proven for other surgeries, little is known about its effect on off-pump coronary artery bypass graft (OPCABG) surgery. Thus, this study aimed to explore the effect of an ERAS protocol in patients who underwent OPCABG surgery. @*Methods@#This quasi-experimental study included 94 participants (traditional care group = 47 vs ERAS group = 47). An ERAS protocol was established by a multidisciplinary team. Knowledge of coronary artery disease, fasting time, water deprivation time, extubation time of the tracheal tube and pericardial and mediastinal drainage tube, off-bed activity participation rate, length of hospital stay, hours of intensive care unit (ICU) stay, expenses in ICU, incidence rates of ICU delirium and postoperative nausea and vomiting, and the 6-Minute Walk Test on postoperative day 7 were recorded and calculated between the groups. @*Results@#Demographics, lifestyle, and disease severity showed no significant difference between the two groups (p > .05). The ERAS group patients had improved understanding of coronary artery disease (t = −3.89, p < .01), shorter fasting time (t = 7.98, p < .01), shorter water deprivation time (t = 9.29, p < .01), increased off-bed activity participation (t = 17.67, p < .01), and the improved 6-Minute Walk Test on postoperative day 7 (t = −3.23, p < .01). @*Conclusions@#The ERAS protocol is safe and effective for patients undergoing OPCABG surgery.
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Purpose@#Enhanced recovery after surgery (ERAS) is an evidence-based perioperative measure to improve outcomes. Although the benefits of ERAS are well proven for other surgeries, little is known about its effect on off-pump coronary artery bypass graft (OPCABG) surgery. Thus, this study aimed to explore the effect of an ERAS protocol in patients who underwent OPCABG surgery. @*Methods@#This quasi-experimental study included 94 participants (traditional care group = 47 vs ERAS group = 47). An ERAS protocol was established by a multidisciplinary team. Knowledge of coronary artery disease, fasting time, water deprivation time, extubation time of the tracheal tube and pericardial and mediastinal drainage tube, off-bed activity participation rate, length of hospital stay, hours of intensive care unit (ICU) stay, expenses in ICU, incidence rates of ICU delirium and postoperative nausea and vomiting, and the 6-Minute Walk Test on postoperative day 7 were recorded and calculated between the groups. @*Results@#Demographics, lifestyle, and disease severity showed no significant difference between the two groups (p > .05). The ERAS group patients had improved understanding of coronary artery disease (t = −3.89, p < .01), shorter fasting time (t = 7.98, p < .01), shorter water deprivation time (t = 9.29, p < .01), increased off-bed activity participation (t = 17.67, p < .01), and the improved 6-Minute Walk Test on postoperative day 7 (t = −3.23, p < .01). @*Conclusions@#The ERAS protocol is safe and effective for patients undergoing OPCABG surgery.
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Ventilator-associated pneumonia(VAP) is more likely to occur in patients with mechanical ventilation due to the decrease of oral self-purification ability, weakening of mucosal defense ability and translocation of oropharyngeal colonies. Oral care can reduce plaque and mucosal inflammation, improve oral function, promote oral health and effectively prevent VAP. This article reviewed the current situation of oral care for mechanical ventilation patients at home and abroad. Based on the best evidence, the evaluation of oral function, the choice of oral care solution and appliances were summarized. We suggested further improving the training system and unifying the evaluation, inspection standard and operation procedure, so as to develop the optimum oral care scheme.
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Objective@#To investigate the characteristics of body composition (BC) in gout patients and its clinical significance.@*Methods@#Consecutive gout patients were recruited between August 2017 and December 2018. Demographic information, clinical characteristics and comorbidities were collected. BC was assessed by bioelectric impedance analysis including body fat percentage (BF%), trunk and limb BF%, appendicular skeletal muscle index. Overfat was defined by BF% ≥25% for male and ≥35% for female. The association between BC and serum uric acid (sUA) was evaluated by multiple linear regression.@*Results@#A total of 362 gout patients were recruited with median age 38 (30, 52) years, 96.1% (348/362) were male. Mean sUA was (551±133) μmol/L. The mean BF% was (25.8±6.4)% with 53.6%(194/362) patients overfat. Male gout patients with overfat showed more affected joints [4(2, 6) vs. 2(2, 5)], higher sUA [(576±126)μmol/L vs. (523±134) μmol/L], higher prevalence of dyslipidemia [70.1%(131/187) vs. 54.0%(87/161)], metabolic syndrome [60.8%(118/187) vs. 28.0%(47/161)], fatty liver [58.2%(113/187) vs. 35.1%(59/161)] and hypertension [44.4%(83/187) vs. 25.5%(41/161)] than male patients with normal fat (all P<0.05). Their BF%, trunk BF% and limb BF% were positively correlated with the numbers of affected joints, sUA, metabolic syndrome, fatty liver, and hypertension, respectively (r=0.154-0.435, all P<0.05). Multivariable linear regression suggested that BF% (β=4.29, P=0.020) and trunk BF% (β=9.11, P=0.007), but not limb BF%, were positively correlated with sUA.@*Conclusion@#Overfat is very common in gout patients. The proportion of trunk fat in male patients is positively correlated with sUA. When assessing obesity in gout patients clinically, body composition analysis should be performed simultaneously.