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1.
Article in Chinese | WPRIM | ID: wpr-912475

ABSTRACT

The rapid development of point-of-care testing (POCT) in clinical laboratories has brought challenges to the unified management in the hospital. There are many problems, such as how to ensure the ability and qualification of POCT operators, how to improve the quality management awareness of human, machines, materials, methods and environment in the process of POCT in clinical laboratories, how to help the clinical laboratories in the hospital to carry out POCT comparison, and how to strengthen the information construction of POCT in the hospital. Thus, this article reviews the practice and experience of POCT management in our hospital on POCT quality assurance and the problems existing in POCT in clinical departments, proposes suggestions and solutions to strengthen the unified management of POCT in clinical laboratories and establish POCT quality management documents and to improve quality awareness. We hope to provide references for hospital administrators, medical departments, nursing departments, quality control departments and other functional departments on the quality management of POCT in the hospital, and find helpful answers to the puzzles of clinical laboratory in POCT, so as to make joint efforts to standardize the quality management of POCT in the hospital to ensure the accuracy of testing results.

2.
Article in Chinese | WPRIM | ID: wpr-912339

ABSTRACT

Objective:To compare the short-term outcomes of segmentectomy for stage ⅠA non-small cell lung cancer by two surgical methods.Methods:A retrospective analysis was performed on 101 patients with stage ⅠA non-small cell lung cancer and undergoing segmentectomy admitted to the Department of Thoracic Surgery of The General Hospital of the Northern Theater Command from July 2016 to July 2020, including 50 patients who underwent Da Vinci robotic segmentectomy and 51 patients who underwent video-assisted thoracoscopic segmentectomy during the same period. By collecting the clinical data of the patients, the operation time, intraoperative blood loss, lymph node dissection stations, lymph node dissection number, drainage volume on the first day after the operation, total drainage volume on the third day after the operation, postoperative chest catheter insertion time, postoperative hospitalization days, and postoperative complication rate were compared and analyzed.Results:Patients in both groups successfully completed pulmonary segmental resection, and there were no cases of conversion to thoracotomy and perioperative death.Compared and analyzed the postoperative clinical results of the two groups, the intraoperative blood loss [(34.40±12.96) ml vs.(85.10±26.41)ml, P=0.000], the number of lymph node dissection stations(4.72±1.20 vs. 3.60±1.40, P=0.000) and the number of lymph node dissection(15.14±5.91 vs. 10.76±5.26, P=0.000) showed statistically significant differences, and RATS group was superior to VATS group.There were no statistically significant differences in operation time[(153.90±21.88) min vs.(155.39±25.04) min, P=0.751], drainage volume on the first day after surgery[(217.80±76.94) ml vs.(210.98±86.98) ml, P=0.678], total drainage volume three days after surgery[(612.60±169.93) ml vs.(595.10±203.90) ml, P=0.641], duration of chest drainage tube after operation[(5.36±2.33) days vs.(5.18±2.54) days, P=0.706], postoperative hospitalization days[(7.50±2.35) days vs.(7.47±2.93) days, P=0.956]and postoperative complication incidence. Conclusion:Da Vinci robot segmentectomy is a safe and effective surgical method, with less bleeding and more lymph node dissection stations and number than video-assisted thoracoscopic segmentectomy for stage ⅠA non-small cell lung cancer.

3.
Chinese Journal of Anesthesiology ; (12): 1206-1211, 2021.
Article in Chinese | WPRIM | ID: wpr-911343

ABSTRACT

Objective:To establish the risk prediction models for postoperative delirium (POD) in elderly patients undergoing non-cardiac surgery and to evaluate the predictive efficacy.Methods:A total of 685 patients of both sexes, aged 65-90 yr, of American Society of Anesthesiologists (ASA) physical status Ⅰ-Ⅳ, who underwent non-cardiac elective surgery requiring tracheal intubation during general anesthesia in general surgery, orthopedics, urology, hepatobiliary and pancreatic surgery in our hospital from January 2020 to December 2020, were selected.Patients were assigned to the training set and validation set at a ratio of 7∶3 using a simple random sampling method.The clinical data of patients in the perioperative period were collected, and the patients were followed up within 1-7 days after operation (or before discharge), and the occurrence of POD was recorded.Univariate and multivariate logistic regression analysis was used to identify the independent risk factors for POD.The risk prediction model for POD was established based on the results of multivariate logistic regression analysis of the training set, a nomogram and receiver operating characteristic (ROC) curve were drawn, and the area under the curve (AUC) was calculated.The validation set was used to verify the prediction model and assess the efficacy of the risk prediction model for POD.Results:A total of 653 patients were enrolled in this study, 139 patients developed POD, and the incidence was 21.3%.The results of multivariate logistic regression analysis showed that advanced age, high ASA physical status classification, low preoperative Mini-Mental State Examination score, complication with diabetes mellitus, low years of education, high preoperative Pittsburgh Sleep Quality Index scale score, long anesthesia time and high numerical rating scale score after operation were independent risk factors for POD in elderly patients undergoing non-cardiac surgery.The risk prediction model for POD was established based on the independent risk factors mentioned above.The AUC of the training set was 0.981, the Youden index was 0.881, the sensitivity was 95.95%, and the specificity was 92.92%; the AUC of the validation set was 0.939, the Youden index was 0.795, the sensitivity was 94.44%, and the specificity was 85.09%.Conclusion:The risk prediction model for POD established based on age, ASA physical status classification, history of diabetes melittus, years of education, preoperative Mini-Mental State Examination score, preoperative Pittsburgh sleep quality index scale score, anesthesia time and postoperative numerical rating scale score has good predictive efficacy in elderly patients undergoing non-cardiac surgery.

4.
Article in Chinese | WPRIM | ID: wpr-911284

ABSTRACT

Objective:To evaluate the efficacy of remimazolam for induction and maintenance of general anesthesia in patients undergoing abdominal surgery.Methods:A total of 100 patients of both sexes, aged 18-64 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing elective abdominal surgery with general anesthesia requiring tracheal intubation, were enrolled in this study and divided into 2 groups ( n=50 each) using a random number table method: remimazolam group (group R) and propofol group (group P). Anesthesia was induced by intravenously infusing propofol 1.0-2.5 mg/kg in group P and remimazolam 0.15-0.35 mg/kg in group R. Sufentanil 0.4-0.5 μg/kg and rocuronium 0.6 mg/kg were intravenously injected in group R and group P. Anesthesia was maintained by intravenously injecting remimazolam 0.3-1.0 mg·kg -1·h -1 in group R and propofol 4-12 mg·kg -1·h -1 in group P. Remifentanil 8-15 μg·kg -1·h -1 was intravenously injected in group R and group P. Narcrotrend index (NI) was maintained at 37-64 (D 0-D 2). The success of sedation, time for loss of consciousness, time of disappearance of eyelash reflex, time when NI dropped to D 0, incidence of tidal volume, respiratory rate and apnea after the patients lost consciousness, duration of stay in post-anesthesia care unit, the fluctuation range of mean arterial pressure at 1, 3 and 5 min of induction, and the development of intraoperative and postoperative adverse events. Results:The success rate of sedation in group R and group P was 100%.Compared with group P, time for loss of consciousness, time of disappearance of eyelash reflex and time when NI dropped to D 0 were significantly prolonged, tidal volume and respiratory rate were increased, the incidence of apnea after the patients lost consciousness was decreased, awakening time was shortened, the incidence of intraoperative sinus bradycardia, injection pain and dream was decreased, fluctuation range of blood pressure at 1, 3 and 5 min of induction was decreased in group R ( P<0.05). Conclusion:Remimazolam can be safely and effectively used for induction and maintenance of general anesthesia in patients undergoing abdominal surgery, and its induction dose is 0.15-0.35 mg/kg, and maintenance dose is 0.3-1.0 mg·kg -1·h -1.

5.
Article in Chinese | WPRIM | ID: wpr-911184

ABSTRACT

Objective:To investigate the value of α-synuclein (α-syn) concentration in cerebrospinal fluid (CSF) in predicting postoperative delirium (POD).Methods:One thousand patients underwent elective surgery with combined epidural-spinal anesthesia in our hospital from January 2018 to September 2020 were selected.The epidural puncture was performed at L 3, 4 interspace, and 2 ml of CSF was collected after the needle reaching the subarachnoid space.The concentrations of α-syn, β-amyloid (Aβ)40, Aβ42, total tau protein (T-tau), and phosphorylated tau protein (P-tau) in CSF were determined by enzyme-linked immunosorbent assay.The concentrations of α-syn in CSF and occurrence of POD in patients of different ages were recorded.Patients were divided into POD group and non-POD group according to whether POD occurred, and frequency matching (1∶1) was performed based on five matching variables of age, ASA physical status, education level, duration of operation, and intraoperative blood loss. Results:Eight hundred and forty-one patients were finally included in the study, and the incidence of POD was 15.0%. There were 126 cases in POD group and 126 cases in non-POD group after matching. The concentrations of α-syn in CSF and incidence of POD were gradually increased with age ( P<0.05). Compared with non-POD group, the concentrations of α-syn, T-tau and P-tau in CSF were significantly increased, the concentrations of Aβ40 and Aβ42 were decreased, Aβ40/P-tau, Aβ42/P-tau, Aβ42/Aβ40 and P-tau/T-tau were decreased in POD group ( P<0.05). After confounding factors were corrected by logistic regression analysis, increased concentrations of α-syn, p-tau, and T-tau in CSF were risk factors for POD ( P<0.05). Increased concentrations of Aβ40 and Aβ42 in CSF and increased Aβ40/P-tau and Aβ42/P-tau were protective factors for POD ( P<0.05). Multiple linear regression analysis showed that the concentration of α-syn in CSF was negatively correlated with Aβ40 and Aβ42 concentrations and positively correlated with P-tau and T-tau concentrations ( P<0.05). The area under the receiver operating characteristic curve of concentrations of α-syn in CSF predicting POD was 0.895, Youden index was 0.664, sensitivity was 80.00%, and specificity was 86.36% ( P<0.001). Conclusion:The concentration of α-syn in CSF is related to the occurrence of POD, and it provides higher accuracy in predicting POD.

6.
Chinese Journal of Orthopaedics ; (12): 1607-1613, 2021.
Article in Chinese | WPRIM | ID: wpr-910754

ABSTRACT

Objective:To investigate the effect of lateral tibial periosteum distraction on diabetic foot and vasculitis foot.Methods:A retrospective analysis of 13 patients (16 feet) who received lateral tibial periosteal distraction between June 2019 and May 2020 were included in the study. 9 males and 4 females; aged 39-77 years (average 66 years); left foot 7 cases, right foot 9 cases. 5 cases were patients with diabetic foot, 1 case was diabetic foot with arteriosclerosis obliterans, 2 cases were thromboembolic vasculitis, and 5 cases were arteriosclerosis obliterans. The tibial periosteum was dissected and a distraction device was placed. In the 3 patients with foot ulcers, tibial periosteum distraction devices were placed on the severer side. The periosteal distraction began on the third day after surgery, about 0.75 mm/d, the adjustment was done usually in two weeks. Two weeks later, the stretch plate was removed surgically. The followings were evaluated: visual analogue scale (VAS) pain score, foot peripheral oxygen saturation, foot capillary filling test, lower extremity arterial CT angiography (CTA), etc.Results:All 13 patients were followed up for 2-12 weeks, with an average of 3.85 weeks. VAS pain score: the average pain score of 13 patients with preoperative foot pain was 5.31±1.84 (range, 2-9) points, and 2 weeks after surgery, the average value was 2.46±1.39 (range, 1-6) points with statistical significance ( t=6.124, P<0.001) ; peripheral foot oxygen saturation: the average preoperative blood oxygen saturation of 12 patients was 87.83%±14.83% (range, 50%-98%), 1 patient was not detected before surgery, and 2 weeks after operation, the average blood oxygen saturation was 92.33%±7.91% (range, 75%-99%). There was no significant difference between them ( t=1.124, P=0.285). The foot skin temperature of 10 patients was 35.68±0.85 ℃ (range, 34.00-36.60 ℃) before surgery and 36.23±0.46 ℃ (range, 35.50-36.90 ℃) after surgery, and the difference was statistically significant ( t=3.197, P=0.008) . Capillary filling test: 2 weeks after operation, the capillary filling response was significantly improved. All 13 patients had improved CTA of both lower extremity arteries before operation, and 11 patients had CTA taken back after two weeks of operation. Compared with preoperative CTA, new vascular network was found in the operation limb. In addition to 1 patient with thromboangiitis obliterans (mainly suffering from foot pain, no wound symptoms), 2 of 12 patients with heart failure, renal failure and other basic diseases did not heal, and the wounds of the other 10 patients had improved significantly 1 month later. Conclusion:Lateral tibia periosteum distraction can be used to treat chronic ischemic diseases of lower extremities with satisfactory postoperative results.

7.
Article in Chinese | WPRIM | ID: wpr-910570

ABSTRACT

Objective:To investigate the changes of liver volume and liver function in patients with extensive hepatic vein occluded Budd-Chiari syndrome (BCS) treated with transjugular intrahepatic portosystem shunt (TIPS).Methods:The clinical data of 29 BCS patients from Affiliated Hospital of Xuzhou Medical University during March 2016 to June 2019 were retrospectively collected and analyzed. The BCS was caused by extensive hepatic vein occlusion and patients were treated with TIPS. Pre- and postoperative abdominal CT/MRI images were collected and analyzed, and hepatic volume was measured with 3D-reconstruction. The liver volume and liver function during before and post the surgery were also collected and analyzed with preoperative value.Results:Patients including 8 males and 21 females, aged (33.3±6.3) years, were enrolled in this study. TIPS was successfully performed in all patients, with a technical success rate 100%. No serious complications related to TIPS occurred. Patients were followed up for 12-33 months (median, 16 months). Compared with preoperative [(2 124.6±420.9) cm 3] , the hepatic volume of time points after operation [1 week: (1 926.3±372.3) cm 3; 3 months: (1 480.6±183.1) cm 3; 6 months: (1 461.9±153.0) cm 3; 12 months: (1 469.3±148.5) cm 3] were all significantly reduced, and the differences were statistically significant ( P<0.05). Compared with preoperative values, the hepatic function indexes at each time point after operation were significantly improved ( P<0.05). The complete remission rate of ascites was 96.4% (27/28), 100.0% (28/28) and 100.0% (28/28) at 3, 6 and 12 months, respectively. Conclusion:The extensive hepatic vein occlusive BCS patients were benefit from TIPS therapy. Six months after operation, the hepatic volume and the hepatic function returned to normal level.

8.
Article in Chinese | WPRIM | ID: wpr-910453

ABSTRACT

Objective:To explore the feasibility of the clinical implementation of intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) plans with 6MV photon on two Elekta Linacs (Versa HD and Synergy) after beam matching.Methods:The images of 12 patients with nasopharyngeal carcinoma, central lung cancer and prostate cancer were randomly selected, and the IMRT and VMAT plans were designed. Two different dose tools of ionization chamber and three-dimensional detector ArcCheck were used to verify the individualized radiation treatment of 6MV photon beams on two Linacs and compare the differences.Results:The deviations between the doses of two Linacs (Versa HD and Synergy) measured by the ion chamber and treatment planning system were (0.32±1.32)% and (0.54±1.29)%. The differences of all plans were within the range of ±3%, and the deviations of the point dose between two Linacs were within the range of ±2% with no statistical significance (both P>0.05). The γ analysis of verification using ArcCheck showed that the passing rates of all plans under the 2mm/3% and 3mm/3% with 10% threshold conditions were over 95%, respectively. The average differences between two Linacs were 0.19%(2mm/3%) and 0.09%(3mm/3%). Conclusions:The results of performing IMRT/VMAT plans on two Linacs meet the clinical requirements and the differences between two Linacs are small. Hence, the same plans can be implemented interchangeably on different Linacs.

9.
Article in Chinese | WPRIM | ID: wpr-910038

ABSTRACT

Objective:To compare short-term clinical efficacy between femoral neck system (FNS) and cannulated compression screws (CCS) in the treatment of femoral neck fractures in young adults.Methods:Retrospectively analyzed were the data of 94 patients with femoral neck fracture who had been admitted to Department of Orthopedics and Traumatology, The First Affiliated Hospital to University of Science and Technology of China, Department of Orthopaedics, The First Affiliated Hospital to Anhui Medical University and Department of Orthopaedics, The Second Affiliated Hospital to Anhui Medical University from October 2019 to October 2020. They were divided into 2 groups according to their modes of internal fixation: a FNS group ( n=47) and a CCS group ( n=47). In the FNS group there were 30 males and 17 females with a mean age of (47.8±9.8) years; in the CCS group there were 26 males and 21 females with a mean age of (43.7±13.1) years. The 2 groups were compared in terms of operation time, incision length, intraoperative blood loss, fracture healing time, weight-bearing time, Harris hip score and complications. Results:There was no significant difference in preoperative general data or follow-up duration between the 2 groups, showing comparability between groups ( P>0.05). In the FNS group, operation time [(47.7±9.4) min] was significantly shorter than that in the CCS group [(66.1±3.8) min], postoperative partial and full weight-bearing time [2.0 (2.0, 3.0) weeks, (6.4±2.1) weeks] significantly earlier than that in the CCS group [8.0 (3.0, 9.0), (10.1±3.4) weeks], fracture healing time [3.0(3.0, 4.0) months] significantly shorter than that in the CCS group [3.0(3.0, 4.0) months], Harris hip score at the last follow-up [95.0 (93.0, 95.0) points] significantly higher than that in the CCS group [90.0 (88.0, 95.0) points], incidence of lateral thigh irritation [0% (0/47)] significantly lower than that in the CCS group [31.9% (15/47)], and neck shortening length (4.3±3.9 mm) significantly shorter than that in the CCS group (6.9±4.5 mm) (all P<0.05). There was no significant difference in the rate of avascular necrosis of the femoral head or rate of internal fixation failure between the 2 groups ( P>0.05). Conclusion:In the treatment of femoral neck fractures in young adults, compared with CCS fixation, FNS fixation can shorten operation time and fracture healing time, allow patients to ambulate early after surgery, which is beneficial to maintenance of femoral neck length and to functional recovery of the hip.

10.
Chinese Journal of Trauma ; (12): 825-832, 2021.
Article in Chinese | WPRIM | ID: wpr-909945

ABSTRACT

Objectives:To investigate the nursing effect of perioperative enhanced recovery after surgery(ERAS)management model in elderly patients with hip fracture.Methods:A retrospective case-control study was conducted to analyze the clinical data of 94 elderly patients with hip fracture admitted to Second Affiliated Hospital of Soochow University from July 2017 to June 2018,including 24 males and 70 females aged 76-98 years[(83.7±5.4)years]. There were 54 patients with intertrochanteric fracture and 40 patients with femoral neck fracture. Surgical method was proximal femoral nail antirotation(PFNA)fixation or artificial hip arthroplasty. A total of 44 patients were managed by ERAS(enhanced recovery group)and 50 patients by traditional nursing(traditional rehabilitation group). The off-bed time was compared between the two groups from aspects of different fracture sites,bone mineral density and causes of injury. The visual analogue scale(VAS)was tested preoperatively and at postoperative days 1,3 and 7. The complications were recorded at postoperative 1 month. The activity of daily living(ADL)score was assessed preoperatively and at postoperative 1 week,1 month and 3 months. The Harris hip score was assessed at postoperative 1 week,1 month,3 months and at the last follow-up. The length of hospital stay and death at postoperative 3 months and at the last follow-up were recorded.Results:All patients were followed up for 12-24 months[(17.7±6.2)months]. In enhanced recovery group,the off-bed time of patients with different fracture sites(femoral neck,femoral intertrochanter),bone mineral density(>-2.5 SD,≤-2.5 SD)and causes of injury(falls,traffic accidents and others)were markedly shortened as compared with traditional rehabilitation group( P<0.01). There was no significant difference in VAS between the two groups before operation( P>0.05). However,the VAS in enhanced recovery group was(3.4±0.9)points,(2.7±0.5)points,(1.7±0.6)points at postoperative days 1,3 and 7,significantly lower than that in traditional rehabilitation group[(4.3±1.1)points,(3.5±0.5)points,(2.7±0.9)points]( P<0.01). One month after operation,the incidence of pulmonary infection was 0% in enhanced recovery group and 28%(14/50)in traditional rehabilitation group( P<0.01). While there showed no significant differences in incidences of cardiovascular system,nervous system,urinary tract infection,lower limb deep vein thrombosis,impaired liver and kidney function,anemia,electrolyte disorder or hypoalbuminemia between the two groups( P>0.05). There was no significant difference in preoperative ADL score between the two groups( P>0.05). The ADL score in enhanced recovery group was(37.0±6.6)points,(70.1±8.4)points,(86.2±9.3)points at postoperative 1 week,1 month and 3 months,significantly higher than that in traditional rehabilitation group[(26.5±10.4)points,(50.1±11.4)points,(70.7±9.0)points]( P<0.01). The Harris hip score in enhanced recovery group was(80.9±8.6)points at postoperative 1 month,significantly higher than that in traditional rehabilitation group[(71.1±9.2)points]( P<0.01). There were no significant differences in Harris hip score between the two groups at postoperative 1 week,3 months and at the last follow-up( P>0.05). The length of hospital stay was(4.7±2.4)days in enhanced recovery group,significantly shorter than(7.8±3.9)days in traditional rehabilitation group( P<0.01). The enhanced recovery group showed no death within 3 months after operation and 2 deaths[5%(2/44)]at the last follow-up,while the traditional rehabilitation group revealed 4 deaths[8%(4/50)]within 3 months after operation. There was no significant difference in the mortality between the two groups until the last follow-up( P>0.05). Conclusion:For elderly patients with hip fracture,perioperative ERAS management model can effectively shorten periods in bed,relieve postoperative pain,reduce incidence of postoperative pulmonary infection,accelerate recovery of hip function,improve quality of life,shorten length of hospitalization and promote early recovery.

11.
Article in Chinese | WPRIM | ID: wpr-908399

ABSTRACT

Objective:To analyze the influence of Corona Virus Disease 2019(COVID-19) epidemic on inpatient disease spectrum, treatment methods and outcomes in pediatric intensive care unit(PICU)in non-epidemic areas.Methods:The clinical data of children admitted to PICU at Shengjing Hospital of China Medical University from February 1, 2019 to May 30, 2019(group Ⅰ)and from February 1, 2020 to May 30, 2020(group Ⅱ)were collected retrospectively.We analyzed the spectrum changes of infectious and non-infectious diseases, visiting time, as well as compared the diseases of various systems and accidental injuries, and the use of important treatment methods, all-cause mortality.Results:There were 339 cases in group Ⅰ and 208 cases in group Ⅱ.The total number of patients in group Ⅱ decreased by 38.6% compared with group Ⅰ.There was no significant difference in pediatric multiple organ dysfunction score (P-MODS)( P=0.894)between two groups within 24 hours after admission, but pediatric logistic organ dysfunction score (PELOD)-2 in group Ⅱ[1(0, 3)] was higher than that in group Ⅰ[1(0, 2)] within 24 hours after admission, with statistical difference( P=0.012). The length of hospital stay in group Ⅱ was longer than that in group Ⅰ, but there was no statistical difference.The length of hospital stay in shock group, accidental injury and poisoning group were 6(5.25, 8.25)days and 9(6, 16)days, respectively, with statistical differences( P=0.048, P=0.001). Compared with group Ⅰ, the number and ratio of infectious diseases(pneumonia, aseptic encephalitis and sepsis)in group Ⅱ decreased significantly[176(52.1%)to 93(44.5%), P=0.095]. Neuromuscular diseases: aseptic encephalitis decreased from 13.2% to 7.2%; non-traumatic intracranial hemorrhage increased from 0.9% to 3.8%, with statistical difference( P=0.028, P=0.017). Compared with group Ⅰ, the number of invasive interventional therapy cases in group Ⅱ decreased significantly, among which non-invasive ventilator, plasma exchange and fiberoptic bronchoscope decreased by at least 50%, but there was no significant difference between two groups.The average time from onset to visit was 7(4, 12)days in group Ⅰ and 3(1, 6)days in group Ⅱ, with statistical difference( P=0.002). There were 16 hospital deaths in group Ⅰ, with a mortality rate of 4.7%, and 7 hospital deaths in group Ⅱ, with a mortality rate of 3.4%.There was no significant difference in the total mortality and the mortality of the main diseases causing death. Conclusion:The epidemic situation of Corona Virus Disease 2019 led to characteristic changes in disease spectrum of children admitted to PICU, and infectious diseases were obviously reduced.Non-infectious diseases such as trauma and poisoning were still the main causes of critically ill children.During the epidemic period, there was no obvious change in treatment, PICU admission time and all-cause mortality rate of critically ill children in non-epidemic areas, thus it could be seen that the epidemic did not have adverse effects on treatment, referral, and prognosis of critically ill children.

12.
Article in Chinese | WPRIM | ID: wpr-908381

ABSTRACT

Traumatic brain injury(TBI) is one of leading causes of death and disability in children.Targeted temperature management(TTM) may reduce unfavorable outcomes of TBI patients, and many studies have made much effort for developing a norm in managing temperature in TBI patients.TTM, including therapeutic hypothermia, has been recognized as one of candidate methods of neuroprotective treatment.However, the efficacy of hypothermia for patients with severe TBI is not clear.In this article, we will review studies on the potential effects of hypothermia, discuss the possible pathophysiology of neuroprotection with therapeutic hypothermia in PICU, and explore the role of TTM in pediatric severe TBI.

13.
Article in Chinese | WPRIM | ID: wpr-908348

ABSTRACT

Objective:To explore the clinical characteristics and early diagnosis of cerebral infarction in critically ill children.Methods:The clinical data of the children who were diagnosed with cerebral infarction in PICU at Shengjing Hospital of China Medical University from January 2013 to September 2019 were analyzed retrospectively.Results:There were 27 children in this study, including 15 males and 12 females.The age of onset ranged from 1 month to 13 years old, with age of 3.0(0.7, 8.0) years old.Among 27 cases, there were ten cases of infection(37.0%), six cases of trauma(22.2%), three cases of congenital heart disease (11.1%), two cases of cerebrovascular disease (7.4%), one case of diabetic ketoacidosis(3.7%) and two cases of autoimmune factors(7.4%). The cause was unknown in three cases(11.1%). The main clinical manifestations were convulsion in 11 cases(40.7%), status convulsion in five cases(18.6%), limb dysfunction in four cases(14.8%), disturbance of consciousness in fvie cases(18.5%) and facial paralysis in four cases(14.8%). Among 27 cases, mechanical ventilation was performed in 12 cases (44.4%). The levels of D-dimer in all children were increased in varying degrees.After improvement and discharge, two children developed secondary epileptic sequelae.Head CT examination was performed in 20 cases, of which 11 cases showed definite cerebral infarction, eight cases of temporal lobe lesions and three cases of basal ganglia lesions.MRI+ MRA examination of the head in 27 cases showed that there were cerebral infarction and the infarct area large.Conclusion:The high incidence age of cerebral infarction in critically ill children is infantile.The most common diseases are infection, trauma, congenital heart disease, and the first clinical manifestations are convulsion and coma.Imaging examination showed that a high proportion of children had large area infarction, and the diagnostic effect of MRI is better than that of CT.D-dimer may be helpful for early clinical diagnosis.

14.
Article in Chinese | WPRIM | ID: wpr-907972

ABSTRACT

Anaphylaxis is a hypersensitivity reaction that is rapid in onset, multi-system involved and can be fatal.Adrenaline is the first-line treatment of anaphylaxis.Adrenaline autoinjector is an important device in emergent situation.In European Academy of Allergy and Clinical Immunology anaphylaxis guideline updated in 2021, adrenaline autoinjector is systemically described and recommended.The following interpretation is focused on adrenaline autoinjector, including advantages, indications for prescription, pharmacokinetic data, dose and long-term management, aimed to enhance understanding of this device and standardize future application.

15.
Article in Chinese | WPRIM | ID: wpr-907952

ABSTRACT

The World Health Organization published guidelines on physical activity, sedentary behavior, and sleep for children under 5 years old in 2019 and then published guidelines on physical activity and sedentary behavior for children and adolescents aged 5-17 years in 2020 for the purpose of improving the physical activity level of people around the world.The physical activity guidelines for children under the age of 5 and the physical activity recommendations for children aged 5-17 in the 2020 guidelines are interpreted, summarized the suggestions on children in physical activity, and provided help for pediatricians with suggestions on physical activity in children.

16.
Article in Chinese | WPRIM | ID: wpr-907875

ABSTRACT

Objective:To investigate the physical activity level and sedentary time of school-age children with bronchial asthma (asthma).Methods:Asthmatic children aged 6 to 17 years old who used Chinese Children′s Asthma Action Plan on smartphones from March to May 2021 were included in the study.International Physical Activity Questionnaire (IPAQ) was employed to assess exercise level, and Health Behavior in School-Aged Children (HBSC) was employed to evaluate sedentary behavior.The Childhood Asthma Control Test (C-ACT), and the Asthma Control Test (ACT) were employed to assess asthma control status.Clinical information was collected, including age, gender, body mass index (BMI), respiratory symptoms after exercise and adherence to medication.Results:A total of 265 valid questionnaires were collected, with a median age of 9.4 (7.5, 11.6) years old.The rate of ACT/C-ACT score ≥ 20 was 74.0% (196 cases). There were 52 cases with high, 110 cases with medium and 103 cases with low activity levels.There was no significant correlation between activity level and gender, BMI, regular drug use or educational level of parents ( P>0.05). The number of children with sedentary time ≥2 hours was 204 on weekdays and 233 on weekends, respectively, and the number on weekends was significantly higher (87.9% vs.77.0%, χ2=10.967, P=0.001). There were 160 cases (60.4%) with respiratory symptoms after exercise, with the most common symptoms including cough(72 cases), wheezing(53 cases), dyspnea(43 cases), chest pain(16 cases) and chest tightness(15 cases). Despite the symptoms, 79.6%(211 cases)of all children had the subjective intention to participate in physical activities.The incidence of post-exercise symptoms in children with ACT/C-ACT scores ≥20 was significantly lower than that in children with ACT/C-ACT≤19 (37.8% vs.72.5%, χ2=10.967, P<0.001). Conclusions:Most school-age children with bronchial asthma had low to moderate levels of physical activity, and the sedentary time is long.Children with poorly controlled asthma are more likely to develop respiratory symptoms after exercise.Standardized and individualized exercise prescriptions should be further formulated to guide children with asthma to carry out reaso-nable physical exercise.

17.
Article in Chinese | WPRIM | ID: wpr-907853

ABSTRACT

Objective:To know the exercise status of asthmatic in school-age, and to identify possible influen-cing factors.Methods:School-age children with a firm diagnosis of asthma were continuously included in Asthma Clinic of Allergy Department, Children′s Hospital Affiliated to Capital Medical University from January 2016 to January 2017.Patients who complain any symptoms during or after exercise with or without exercise limitation were assigned to the abnormal exercise group (ANE), and children who stated no symptoms and exercise limitation were defined as normal exercise group (NE), correspondingly.These data include age, gender, length of recurrent wheezing history, duration of treatment with inhaled corticosteroids (ICS), asthma control status, body mass index (BMI), pulmonary function parameters by spirometry and plethysmography that were collected and analyzed.Results:A total of 194 cases were included: 135 cases (69.6%) were well controlled, 39 cases (20.1%) were partially controlled, and 20 cases (10.3%) were uncontrolled.Totally, 95 cases (49.0%) were distributed in ANE group, while 99 cases (51.0%) were in NE group.Meanwhile, 111 patients (57.2%) had normal BMI, 32 patients (16.5%) were overweight, and 51 patients (26.3%) were obese.In the Logistic regression model of all cases, the worse asthma control level (partially controlled OR=4.77, 95% CI: 2.07-11.00, P<0.001, uncontrolled OR=10.02, 95% CI: 2.70-37.22, P=0.001) and higher BMI ( OR=1.15, 95% CI: 1.06-1.25, P=0.001) were closely associated with the significantly increased risk of exercise abnormality.Among the patients with normal BMI, ANE group had more cases with hyperinflation than normal exercise group (43.8% vs.19.0%, P=0.005). Conclusions:The results suggested that poor asthma control status and overweight/obesity are risk factors for exercise limitation, and excessive lung inflation may also affect exercise in children with asthma.

18.
Article in Chinese | WPRIM | ID: wpr-907239

ABSTRACT

Maintaining normal physical activity level is one of the goals of asthma treatment in children with asthma.In order to better understand the relationship between asthma and exercise, it is necessary to summarize the related studies on exercise in children with asthma.This paper overviews the related researches on the benefits of exercise to patients with asthma, the current situation of exercise in children with asthma, exercise-induced bronchoconstriction, and the formulation of exercise prescription in children with asthma, so that clinicians can have a deeper understanding of exercise-related content in children with asthma, in order to better guide children with asthma in exercise.

19.
Journal of Leukemia & Lymphoma ; (12): 419-425, 2021.
Article in Chinese | WPRIM | ID: wpr-907195

ABSTRACT

Objective:To systematically evaluate the effects of body mass index (BMI) on the prognosis of patients with diffuse large B-cell lymphoma (DLBCL).Methods:The databases (PubMed, Medline,Web of Science) were searched to identify clinical literatures about the relationship between BMI and the prognosis of DLBCL according to the inclusion and exclusion criteria. RevMan 5.3 software was used to analyze hazard ratio ( HR) and 95% confidence interval (95% CI) of overall survival (OS) and progression-free survival (PFS); the quality of included literatures, publication bias risk and heterogeneity were also evaluated. Results:There were 12 articles included in our research. Meta-analysis result showed that compared with normal weight patients (BMI 18.5-24.9 kg/m 2), the overweight patients (BMI 25.0-29.9 kg/m 2) had longer OS and PFS time, while the differences were not statistically significant (OS: HR=0.93, 95% CI 0.78-1.11, P=0.42; PFS: HR=0.89, 95% CI 0.67-1.20, P=0.45). The under-weight (BMI < 18.5 kg/m 2) (OS: HR=1.97, 95% CI 1.41-2.74, P < 0.01; PFS: HR=1.89, 95% CI 1.19-3.03, P < 0.01) and the obesity (BMI≥30.0 kg/m 2) patients both had shorter OS and PFS time, but the latter had no statistically significant difference (OS: HR=1.15, 95% CI 0.88-1.51, P=0.31; PFS: HR=1.32, 95% CI 0.90-1.94, P=0.15). No publication bias was observed in the symmetric funnel plot analysis. Conclusion:The increased BMI within a certain range is a protective factor for the prognosis of DLBCL patients.

20.
Journal of Leukemia & Lymphoma ; (12): 321-324, 2021.
Article in Chinese | WPRIM | ID: wpr-907176

ABSTRACT

Chronic lymphocytic leukemia (CLL) is a kind of B-cell chronic lymphoproliferative disease. At present, the common clinical treatment regimens (such as FCR, BR, ibrutinib, etc.) have showed good therapeutic effects, but recurrence and progression still occur in some patients. In order to further improve the efficacy, the new combination therapies for CLL are continuously emerging. This article summarizes the treatment progress of CLL in combination with the related reports at the 62nd American Society of Hematology Annual Meeting.

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