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Objective:To investigate the clinical and pathological characteristics and prognosis of children with lupus nephritis(LN)and thrombotic microangiopathy (TMA).Methods:In this retrospective case-control study, clinical and pathological data of LN children confirmed by renal biopsy from January 2008 to January 2023 in Xuzhou Children′s Hospital, Xuzhou Medical University were analyzed.There were 46 LN children complicated with TMA (LN-TMA group). With matched age, sex and pathology, 92 LN children (1∶2) without TMA were selected as the control group (LN group). The Kaplan-Meier method was used to evaluate the overall and renal survival rates of children with LN, and the Cox regression model was used to analyze the risk factors for the progression to end-stage renal disease (ESRD).Results:TMA was moderately associated with serum creatinine, serum C3, anti-C1q antibody (a-C1q), estimated glomerular filtration rate (eGFR), endocapillary proliferation, fibrinoid necrosis, and renal C1q deposition (all r>0.5). Serum a-C1q≥20 U/mL ( HR=8.724, 95% CI: 0.976-16.114, P=0.026) and eGFR≤60 mL/(min·1.73 m 2) ( HR=12.213, 95% CI: 1.147-25.048, P=0.038) were independent risk factors for TMA in children with LN.Glomerular sclerosis ( HR=7.228, 95% CI: 0.186-22.358, P=0.016), TMA ( HR=11.387, 95% CI: 3.426-42.554, P=0.009) and eGFR≤60 mL/(min·1.73 m 2) ( HR=3.116, 95% CI: 0.592-10.064, P=0.030) were independent risk factors for developing ESRD in LN children.The 5-year and 10-year renal survival rates in the LN-TMA group were lower than those in the LN group (97.44% vs.98.28%, 80.90% vs.87.27%, χ2=4.918, P=0.027). Conclusions:Children with LN-TMA present with severe symptoms and poor prognosis.TMA is an independent risk factor for progression to ESRD in children with LN, and the mechanism may be related to complement activation.
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BACKGROUND:Pressing massage applied to myofascial trigger points(MTrPs)has shown clear effect in relieving pain.However,further research is needed to investigate the effects of different levels of pressure applied during the massage. OBJECTIVE:To investigate the different strength of pressing on MTrPs in rats with chronic pain. METHODS:Sixty SPF-rated male Sprague-Dawley rats were randomly divided into a blank group of 10 rats not involved in MTrPs modeling and 50 rats involved in modeling.The MTrPs model was established in the left medial thigh muscle of rats by blunt strikes combined with centrifugal exercise and 40 rats that met the evaluation criteria after modeling were randomly divided into model group,light press group,medium press group and heavy press group,with 10 rats in each group.The rats in the blank group and the model group were not intervened,while the rats in the light press group,the medium press group and the heavy press group were intervened with a homemade press stimulator with light force(0.3 kg),medium force(0.5 kg)and heavy force(0.7 kg)to MTrPs.The intervention time was 7.5 minutes per session,with one session every other day,totaling seven sessions.Electromyogram,soft tissue tension and mechanical pain threshold were detected by electrophysiological instruments,soft tissue tension tester,and pressure painmeter,respectively.After the intervention,in the blank group,muscle tissue was taken from the inside of the left thigh,while in the other groups,MTrPs tissue was taken.The pathological morphology was observed by hematoxylin-eosin staining,while enzyme-linked immunosorbent assay(ELISA)was used to detect the levels of cyclooxygenase-2,prostaglandin E2 and bradykinin. RESULTS AND CONCLUSION:Compared with the blank group,the model group had lower mechanical pain thresholds,higher soft tissue tone,higher amplitude frequency of spontaneous electrical activity,significant pathomorphological changes,and increased levels of cyclooxygenase-2,prostaglandin E2 and bradykinin(P<0.05).Compared with the model group,the medium press group and the heavy press group showed increased mechanical pain thresholds,decreased soft tissue tension,decreased spontaneous potential frequency amplitude,and decreased levels of cyclooxygenase-2,prostaglandin E2 and bradykinin(P<0.05),and significant recovery on pathomorphological changes.No significant changes in the above indicators were observed in the light press group(P>0.05).Compared with the medium press group,the heavy press group showed better improvement in the above indicators(P<0.05).To conclude,moderate to heavy pressing is often required to alleviate MTrPs pain.
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Objective:To investigate the current status of endoscopic treatment for gastroesophageal varices in portal hypertension in China, and to provide supporting data and reference for the development of endoscopic treatment.Methods:In this study, initiated by the Liver Health Consortium in China (CHESS), a questionnaire was designed and distributed online to investigate the basic condition of endoscopic treatment for gastroesophageal varices in portal hypertension in 2022 in China. Questions included annual number and indication of endoscopic procedures, adherence to guideline for preventing esophagogastric variceal bleeding (EGVB), management and timing of emergent EGVB, management of gastric and isolated varices, and improvement of endoscopic treatment. Proportions of hospitals concerning therapeutic choices to all participant hospitals were calculated. Guideline adherence between secondary and tertiary hospitals were compared by using Chi-square test.Results:A total of 836 hospitals from 31 provinces (anotomous regions and municipalities) participated in the survey. According to the survey, the control of acute EGVB (49.3%, 412/836) and the prevention of recurrent bleeding (38.3%, 320/836) were major indications of endoscopic treatment. For primary [non-selective β-blocker (NSBB) or endoscopic therapies] and secondary prophylaxis (NSBB and endoscopic therapies) of EGVB, adherence to domestic guideline was 72.5% (606/836) and 39.2% (328/836), respectively. There were significant differences in the adherence between secondary and tertiary hospitals in primary prophylaxis of EGVB [71.0% (495/697) VS 79.9% (111/139), χ2=4.11, P=0.033] and secondary prophylaxis of EGVB [41.6% (290/697) VS 27.3% (38/139), χ2=9.31, P=0.002]. A total of 78.2% (654/836) hospitals preferred endoscopic therapies treating acute EGVB, and endoscopic therapy was more likely to be the first choice for treating acute EGVB in tertiary hospitals (82.6%, 576/697) than secondary hospitals [56.1% (78/139), χ2=46.33, P<0.001]. The optimal timing was usually within 12 hours (48.5%, 317/654) and 12-24 hours (36.9%, 241/654) after the bleeding. Regarding the management of gastroesophageal varices type 2 and isolated gastric varices type 1, most hospitals used cyanoacrylate injection in combination with sclerotherapy [48.2% (403/836) and 29.9% (250/836), respectively], but substantial proportions of hospitals preferred clip-assisted therapies [12.4% (104/836) and 26.4% (221/836), respectively]. Improving the skills of endoscopic doctors (84.2%, 704/836), and enhancing the precision of pre-procedure evaluation and quality of multidisciplinary team (78.9%, 660/836) were considered urgent needs in the development of endoscopic treatment. Conclusion:A variety of endoscopic treatments for gastroesophageal varices in portal hypertension are implemented nationwide. Participant hospitals are active to perform emergent endoscopy for acute EGVB, but are inadequate in following recommendations regarding primary and secondary prophylaxis of EGVB. Moreover, the selection of endoscopic procedures for gastric varices differs greatly among hospitals.
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Crohn’s disease is a chronic intestinal inflammatory disorder of unknown etiology. Although the pharmacotherapies for Crohn’s disease are constantly updating, nutritional support and adjuvant therapies have recently gained more attention. Due to advancements in clinical nutrition, various clinical nutritional therapies are used to treat Crohn’s disease. Doctors treating inflammatory bowel disease can now offer several diets with more flexibility than ever. The Crohn’s disease exclusion diet is a widely used diet for patients with active Crohn’s disease. The Crohn’s disease exclusion diet requires both exclusion and inclusion. Periodic exclusion of harmful foods and inclusion of wholesome foods gradually improves a patient’s nutritional status. This article reviews the Crohn’s disease exclusion diet, including its structure, mechanisms, research findings, and clinical applications.
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Objective:To establish a risk model of placenta accreta spectrum(PAS) based on the clinical risk factors and ultrasound signs of patients with placenta accreta, and identify severe placenta accreta prenatal.Methods:A retrospective analysis was performed on 121 PAS patients admitted to Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University from January 2018 to June 2022 who were clinically classified or pathologically diagnosed during delivery. The two groups were divided into light and severe groups according to the implantation type. The clinical risk factors and ultrasound signs between the two groups were compared. A risk model of PAS was established based on the clinical risk factors and ultrasound signs to predict the perinatal complications.Results:A total of 130 cases of PAS were clinically diagnosed or pathologically diagnosed with placenta, 9 cases with incomplete clinical data or irregular ultrasound images were excluded, and the remaining 121 cases were included in the study. Among the 121 patients, 64 cases were placental accreta, 39 cases were placental increta, and 18 cases were placenta percreta. The placental accreta was defined as mild group, and the combination of placental increta and placenta percreta were referred to as severe group. There were no significant differences in placenta previa, and the number of uterine cavity operations (all P>0.05). There were significant differences in the number of cesarean section, myometrium thinning, placental lacunae, abnormal vascularization at the utero-bladder junction, bridging vessels at the utero-bladder junction, placental protuberance and cervical involvement (all P<0.05). Binary logistic regression analysis showed that placental lacunae, abnormal vasculization of the utero-bladder interface and the number of cesarean sections were independent risk factors for severe PAS. Based on this, a risk model was established and the ROC curve of each independent risk factor and risk model was plotted respectively. The AUC of the risk model was 0.826, which had better diagnostic efficacy than other independent risk factors. Conclusions:In the prenatal ultrasound classification diagnosis of high-risk patients with PAS, the placental lacunae, abnormal vascularization of utero-bladder interface and the number of cesarean section are combined to establish the risk model of PAS, which has a good diagnostic efficacy for severe placenta accreta.
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Objective:To establish a nomogram to evaluate the adequacy of bowel preparation before colonoscopy and to guide clinical decision-making.Methods:A total of 1 023 valid questionnaires from subjects who underwent diagnosis and treatment of colonoscopy at the digestive endoscopy center, Xiangya Hospital, Central South University from September 2020 to March 2021 were finally returned. The contents of the questionnaire mainly included the clinical characteristics, defecation habits, the number of defecation and the time of the last defecation after taking the medicine and the self-assessment results of bowel preparation before colonoscopy. Subjects' bowel preparation was graded with the Boston bowel preparation scale (BBPS) by a designated endoscopist in a single blinded method. Multivariate analyse was used to explore the influencing factors for bowel preparation adequacy, and a nomogram was drawn accordingly.Results:Based on BBPS scores, bowel preparation of 674 subjects were adequate and 349 were inadequate. Multivariate analyse identified the number of defecation per week ( OR=1.649,95% CI:1.233-2.204, P=0.001), the number of defecation after medication ( OR=3.963, 95% CI: 1.851-8.485, P<0.001), the time of the last defecation after medication ( OR=5.151, 95% CI: 1.152-23.037, P=0.032), and self-assessment of bowel preparation before examination ( OR=8.284, 95% CI: 2.042-33.601, P=0.003) were influencing factors for the adequacy of bowel preparation for colonoscopy. The area under the receiver operating characteristic curve of assessment of colonoscopic bowel preparation adequacy with nomogram visualization according to influencing factors was 0.913, optimal cutoff value was 0.824, the sensitivity was 0.746, and the specificity was 0.971 under the internal validation cohort. Conclusion:The nomogram based on the number of defecation per week, the number of defecation after medication, the time of the last defecation after medication, and self-assessment of bowel preparation before examination could evaluate the adequacy of bowel preparation before colonoscopy, which is worthy of application.
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Objective:To explore the role of self-directed learning theory combined with target teaching method in the teaching of new obstetric nurses.Methods:A total of 36 new nurses who were newly recruited in the Department of Obstetrics of Xuanwu Hospital, Capital Medical University from June 2018 to June 2019 were selected as the control group, and another 32 newly recruited nurses from July 2029 to July 2020 were selected as the observation group. The control group adopted the traditional teaching mode, while the observation group adopted self-directed learning theory combined with target teaching method. The scores of theoretical knowledge and practical skills, the scores of self-rating scale for self-directed learning (SRSSDL), the core competence of obstetric nurses before and after teaching and the satisfaction with the teaching mode were compared between the two groups. SPSS 20.0 was performed for t test, rank sum test and chi-square test. Results:After teaching, the scores of theoretical knowledge [(92.57±5.36) vs. (85.13±6.17)] and practical skills [(90.58±6.65) vs. (84.22±5.94)] in the observation group were both higher than those in the control group ( P<0.05). After teaching, the scores of all dimensions and total scores of SRSSDL scale and the scores of each item of core competence of obstetric nurses of the two groups were higher than those before teaching ( P<0.05), and the above scores in the observation group were higher than those in the control group ( P<0.05). The satisfaction of the observation group [93.75%(30/32)] with the teaching mode was higher than that of the control group [61.11%(22/36)] ( P<0.05). Conclusion:The combination of self-directed learning theory and target teaching method in the teaching of new obstetric nurses can consolidate theoretical knowledge, and improve the level of practical skills, self-directed learning ability and the core ability of obstetric nurses, with high satisfaction.
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Objective:To study the effect of sodium-glucose cotransporter 2 inhibitor (SGLT2i) on serum Chemerin, blood lipid levels and insulin dosage in patients with type 2 diabetes and coronary heart disease.Methods:The clinical data of 96 patients with type 2 diabetes mellitus and coronary heart disease admitted in Xianyang Central Hospital from June 2019 to June 2020 were retrospectively analyzed. According to different treatment methods, they were divided into control group and observation group, with 48 cases in each group. The control group was treated with insulin combined with metformin, and the observation group was treated with insulin combined with SGLT2i (this study mainly used dagglitazone). The blood glucose, serum Chemerin, blood lipid level and insulin dosage of the two groups were observed before and after treatment. The incidence of cardiovascular adverse events and adverse reactions were compared between the two groups.Results:After treatment, the levels of fasting blood glucose (FBG), 2 h PG (plasma glucose), glycosylated hemoglobin (HbA 1c), and Chemerin in the two groups were better than those before treatment ( P<0.05). The decrease in the levels of FBG, 2 h PG, HbA 1c and insulin dosage in the observation group were greater than those in the control group ( P<0.05). However, there was no difference in the decline of Chemerin levels between the two groups ( P>0.05). After treatment, the levels of total cholesterol (TC), triglycerides (TG) and low density lipoprotein cholesterol (LDL-C) in the two groups were lower than before treatment, and the levels of high density lipoprotein cholesterol (HDL-C) were higher than before treatment (all P<0.05). The decrease of TG in the observation group was greater than that in the control group, the decrease of TC and LDL-C was samller than that in the control group, and the increase of HDL-C was greater than that in the control group (all P<0.05). The incidence of cardiovascular adverse events in the observation group was 4.17%(2/48), which was lower than that in the control group [16.67%(8/48), P<0.05]. Conclusions:SGLT2i has a significant therapeutic effect on patients with type 2 diabetes complicated with coronary heart disease. It can better control blood glucose and lipid levels and reduce insulin dosage, which is worthy of clinical application.
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Objective:To explore the the predictive value of ultrasound signs of the involvement of the cervix in the clinical grade diagnosis of placenta accreta spectrum(PAS) with placenta previa and adverse pregnancy outcomes.Methods:A retrospective analysis was performed on PAS patients with placenta previa diagnosed during delivery or by cesarean section in Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University from January 2018 to March 2021. According to the signs of cervical involvement on prenatal ultrasound, the patients were divided into cervical involvement group and cervical non-involvement group. Logistic analysis was performed on clinical data between the two groups. The clinical data, hysterectomy rate, intraoperative blood loss and clinical diagnosis were compared between the two groups.Results:There were 1 455 patients with PAS diagnosed by clinical diagnosis or placental pathology, of which 170 were with placenta previa, 24 with incomplete clinical data or non-standard ultrasound images, and the remaining 146 patients were included. In the cervical involvement group, all of 6 cases had placenta percreta. Of the 140 cases in the unaffected cervical group, 89 cases (63.6%) had placental accreta, 48 cases (34.3%) had placental increta, and 3 cases (2.1%) had placenta percreta. There were no significant differences of the age and uterine operation history between the two groups. There was significant difference in the number of cesarean sections between the two groups ( P<0.05). There were significant differences in intraoperative blood loss, hysterectomy rate and placenta accreta grade diagnosis between the two groups(χ 2/ Z=4.203, 11.165, 95.248, all P<0.05). Conclusions:The ultrasonographic signs of cervical involvement have a good predictive value for the pregnancy outcome of PAS.
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Objective:To summarize the etiological mechanism, echocardiographic and clinical features of fetal cardiomyopathies (FCMs).Methods:According to the data of echocardiography in Maternal-Fetal Medicine Center in Fetal Heart Disease of Beijing Anzhen Hospital during 2015 January to 2020 December, 70 cases with FCMs were retrospectively reviewed, and the clinical, ultrasonic, pathological and clinical outcome data were collected. Whole exome sequencing and whole genome sequencing were used to identify the genetic changes.Results:Primary FCMs were diagnosed in 55 cases (78.6%, 55/70), including 39 fetuses with non-compaction of the ventricular myocardium (NVM), 10 with dilated cardiomyopathy (DCM), 5 with hypertrophic cardiomyopathy (HCM), and 1 with restricted cardiomyopathy (RCM). Secondary FCMs were diagnosed in 15 cases (21.4%, 15/70), including 7 fetuses with maternal anti-Ro/La antibodies (presenting with DCM), 4 with twin-twin transfusion syndrome (2 with DCM and 2 with HCM), 2 with fetal anemia (presenting with DCM), 1 with maternal diabetes (presenting with HCM) and 1 with chorioangioma of the placenta (presenting with DCM). In all cases, 9 cases were born, 3 cases died in perinatal period, and 58 pregnancies were terminated due to ineffective treatment or the decisions of pregnant women. Thirty cases with primary FCMs were performed with genetic tests, and 13 of them were identified with positive genetic changes related to FCMs, including 12 cases with NVM and 1 with HCM.Conclusions:Primary FCMs are more common than secondary FCMs in fetal period. The genetic disorders have a high proportion in fetal NVM. Fetal DCM and HCM have a large spectrum of intrinsic and extrinsic causes.
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Objective:To investigate the differences of umbilical vein diameter(D), time average peak velocity(TAmax) and blood flow between congenital heart disease and normal fetus.Methods:The umbilical vein diameter and time average peak velocity of 69 fetuses with congenital heart disease (disease group) from 22 to 27 weeks were prospectively studied in Maternal-Fetal Medical Center in Fetal Heart Disease of Beijing Anzhen Hospital from May 2021 to September 2021. Q 1 (umbilical venous blood flow) was calculated according to the formular [Q=0.5TAmax·π·(D/2) 2)], and Q 2 (Q 2=Q 1/weight) was calculated according to the fetal weight. At the same time, 111 normal fetuses with matched gestational age were selected as control group. The differences of fetal umbilical vein D, TAmax, Q 1 and Q 2 between the two groups were analyzed. Results:The inner diameter of umbilical vein D, TAmax, Q 1 and Q 2 in the congenital heart disease group were lower than those in the control group(all P<0.05). In the control group, the inner diameter of umbilical vein D, TAmax and Q 1 increased with the increase of gestational age and showed a positive linear correlation( r=0.608, 0.320, 0.626; all P≤0.001), while there was no obvious linear correlation between Q 2 and gestational age( r=0.189, P=0.047). Conclusions:The decrease of umbilical vein D, TAmax, Q 1 and Q 2 in the fetus with congenital heart disease indicates the decrease of effective blood flow in placenta-fetus circulation, which indirectly reflects the decrease of placental function in the fetus with congenital heart disease.
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Objective:To investigate the microbiota distribution and drug resistance in gravidas with suspected infection to provide a reference for the treatment of maternal infectious diseases.Methods:This retrospective study analyzed the distribution and in vitro antimicrobial susceptibility of microorganisms isolated from obstetric patients in Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University (Beijing Maternal and Child Health Care Hospital) from January 1, 2016. to December 31, 2019. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS) was used to identify pathogenic microorganisms. The susceptibility of isolated pathogenic bacteria to common antimicrobial agents was detected using bioMerieux VITEK-2 (France). Descriptive statistical methods was used. Results:A total of 4 086 strains were isolated from 3 781 samples of 3 225 gravidas and 44.17% (1 670) of the strains were from secretion specimens, including 767 cervical, 423 vulvovaginal, 318 perineum wound and 117 uterine secretion specimens. The most common bacterium was Escherichia coli (1 728, 42.29%), followed by Saccharomyces (901, 22.05%), Streptococcus (429, 10.50%), Enterococcus (377, 9.23%), and Staphylococcus (300, 7.34%). The proportion of Enterococcus among all the positive bacteria increased during the study period with its ranking rising from the 5th in 2016 to the 3rd in 2019, while the ranking of the proportion of Staphylococcus fell from the 4th in 2016 to the 5th in 2019. More than 90% of Escherichia coli were sensitive to carbapenems, piperacillin/tazobactam, amikacin, nitrofurantoin and ceftazidime, but only 35% or less to ampicillin and cefazolin. More than 98% of Candida strains were sensitive to amphotericin, but less than 56% to itraconazole. From 2016 to 2019, the sensitivity of Escherichia coli to cefuroxime sodium and ceftriaxone remained around 65%. The sensitive rate of Candida albicans to voriconazole and fluconazole gradually decreased from about 90% to 56%. The most common Enterococcus was Enterococcus faecalis and its susceptibility to vancomycin, ampicillin, penicillin, linezolid, nitrofurantoin and levofloxacin were all over 90%. Conclusions:Escherichia coli is the most common pathogenic microorganism in gravidas with suspected clinical infection and its susceptibility to cefuroxime sodium and ceftriaxone is stable. Candida albicans shows a gradually decreased susceptibility to voriconazole and fluconazole, which needs close attention. The proportion of Enterococcus in all pathogenic bacteria increases significantly over time, while that of Staphylococcus decreases.
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@#To study the clinical effects of beprost sodium tablets combined with Epley manual reduction in treatment of benign paroxysmal positional vertigo（BPPV）. Methods A total of 338 patients with posterior semicircular canal BPPV who were treated in the neurogy clinic of our hospital from January 2019 to December 2020 were enrolled in the study，who were randomly divided into the observation group，who were treated in Epley manual reduction combined with oral beprost sodium tablets，118 cases；control group 1，who were treated with only Epley manual reduction，114 cases and control group 2，who were treated with Epley manual reduction combined with oral betahistine mesilate tablets，106 cases. The clinical efficacy，vestibular symptom index（VSI），dizziness handicap inventory（DHI） and relapse rate were observed and compared between the three groups. Results The total effective rate in the observation group was 91.53%，which was significantly higher than that（73.68） in control group1 and（86.79%） in control group2，the difference was statistically significant（P<0.05）. One week and one month After manual reduction，the vestibular symptom index（VSI） scores and the dizziness handicap inventory（DHI） scores in three group were significantly lower than pretreatment，moreover，the decrease degree in the observation group was more significant than the other two control groups，the difference was statistically significant（P<0.05）. Within 3 months after treatment，the relapse rate in the observation group（18.64%）was lower than that in control group1（34.21%） and in control group2（27.36%），the difference was statistically significant（P<0.05）. Conclusion The clinical effects of beprost sodium tablets combined with Epley manual reduction in treatment of posterior semicircular canal BPPV are superior to those by simple Epley manual reduction and by Epley manual reduction combined with betahistine mesilate.
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@#To discuss the clinical characteristics and the imaging characteristics of hemichorea associated with non-ketotic hyperglycemia. Methods Six cases of hospitalized patients in our hospital with Non-ketotic Hyperglycemia Hemichorea were collected，summary analysis the clinical characteristics，the imaging characteristics. Results All the Six patients were acute onset，previous diabetes or hyperglycemia was found，the symptoms were as follows Hemichorea. Patients all showed platy or striatal heperdensity in the contralateral basal ganglia on head CT，and show ganglia hyperintensity on T-1-weighted MR imaging，hypointensity on T-2WI，the boundary was clear，the lesions often disappeared after treatment. Conclusion Hemichorea associated with non-ketotic hyperglycemia is mainly related to hyperglycemia and has characteristic CT and MRI features.
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Objective:To explore the application effect of SBAR (situation, background, assessment and recommendation) standard communication mode in the training of morning shift handover ability of nursing interns in gynecology and obstetrics, so as to provide reference for improving the ability of morning shift handover of nursing interns.Methods:This study included in 30 nursing interns in Xuanwu Hospital in 2018 who were selected as the observation group, and 31 nursing interns in 2017 who were selected as the control group. The control group was trained in the traditional way of teaching, while the observation group was trained with SBAR standard communication mode on the basis of traditional teaching. After one month's teaching, the evaluation standard of nursing morning shift handover formulated by our hospital was used as the evaluation index to observe the effectiveness of SBAR mode in improving the morning shift handover ability of nursing interns in obstetrics and gynecology. The scores of morning shift handover of the nursing interns in two groups were compared by independent sample t test. Results:The total average score of nursing interns in the observation group was higher than that of the control group, with statistical significance ( P<0.05). Among them, the scores of shift handover environment, complete content, reasonable process and reasonable time control were higher and the difference was statistically significant ( P<0.05), but there was no significant difference in the scores of emphasis, specialty characteristics and language fluency ( P>0.05). The total average score of bedside handover ability in the observation group was significantly higher than that in the control group, with significant difference ( P<0.05). The scores of shift handover environment, complete content, outlining key points, reflecting specialty characteristics, reasonable process, material preparation and humanistic care were higher than those of the control group, with statistical significance ( P<0.05). Conclusion:SBAR mode can improve the bedside and collective shift handover ability of obstetrics and gynecology nursing interns, and nursing managers can use SBAR mode to cultivate nursing interns' ability of morning shift handover.
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Objective:To verify the validity of the clinical dementia rating(CDR) for early screening of Alzheimer's disease in the community.Methods:One thousand two hundred and eighty-one community volunteers (580 males and 701 females) came to hospital for clinical interviews, laboratory tests and a series of psychological assessment, including CDR, brief elderly cognitive screening inventory (BECSI), quickly cognitive screening scale for elderly (QCSS-E), mini-mental state examination (MMSE) and core neurocognitive test (CNT). According to clinical interview, assessment and DSM-5 criteria, 623 normal cognition, 570 mild cognitive impairment (MCI) and 88 dementia with Alzheimer's type (DAT) were screened.Results:(1) The results of CDR-global scores (CDR-GS)in the community volunteers showed that 506 (39.5%) scored 0, 688 (53.7%) scored 0.5, 72 (5.6%) scored 1, and 15 (1.2%) scored 2 or more.(2) There were significantly differences on the BECSI score, QCSS-E score, MMSE score and CNT score among people with different CDR-GS ( P<0.01). In the total or dementia sample, CDR-sum of box score (CDR-SB) and CDR-GS were significantly correlated with BECSI score ( r=0.577-0.639), QCSS-E score ( r=-0.586--0.680), MMSE score ( r=-0.570--0.764) and CNT score ( r=-0.244--0.357)( P<0.01). (3) The accuracy (95.8%) and specificity (99.8%) of the CDR-GS screening DAT were slightly higher than those of the CDR-SB(91.1%, 92.0%), and its sensitivity (65.9%) was lower than that of CDR-SB(82.5%). The accuracy (72.6%), sensitivity (81.9%) and specificity (64.0%)of the CDR-GS were close to those of CDR-SB(72.1%, 83.3%, and 61.8% respectively) in screening MCI. Conclusion:The CDR can be used for screening of AD in community populations.CDR-GS and CDR-SB have their own advantages, and combination of both advantages can improve the screening efficiency.
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Objective:To explore the changes of biparietal diameter, head circumference and cerebrovascular hemodynamics in fetuses with hypoplastic left heart syndrome (HLHS) during middle pregnancy.Methods:The biparietal diameter, head circumference, middle cerebral artery pulsatility index (MCA-PI), umbilical artery pulsatility index (UA-PI) and MCA-PI/UA-PI (CPR) of 41 fetuses with HLHS(HLHS group) were retrospectively analyzed from January 2015 to December 2019 in Beijing Anzhen Hospital, and were compared with those of 82 normal fetuses matched for gestational age at the same period (control group).Results:The Z-scores of head circumference, MCA-PI and CPR in with HLHS group were lower than in control group(all P<0.05); Head circumference in HLHS group were weakly and positively correlated with the MCA-PI and CPR ( r=0.385, 0.416; all P<0.05). Conclusions:There are some changes in the head circumference and cerebral hemodynamics in fetuses with HLHS during mid-gestational age, and the head circumference is weakly and positively correlated with MCA-PI and CPR, which has clinical significance.
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Objective To find out whether we can get the optimality in the prognosis of acute respiratory distress syndrome (ARDS) by combing the pressure parameters in mechanical ventilation with traditional PaO2/FiO2.Methods This is a retrospective study.Patients included here were diagnosed as ARDS in the Emergency Unit (EICU) of the First Affiliated Hospital of China Medical University fiom January 2018 to December 2018.All the patients were intubated and mechanically ventilated.Patients with a short observation time (＜ 48 h) or unable to cooperate with treatment were excluded.According to the patient's 28-day survival,patients were divided into the survival and non-survival groups.Parameters in the two groups such as basic characteristics,SOFA score,non-respiratory system SOFA score (nR-SOFA),and PaO2/FiO2 were analyzed with LSD-t test or rank sum test.Simultaneously,plateau pressure,driving pressure,mean airway pressure and the ratio of these mechanical ventilation pressure parameters to the PaO2/FiO2 were also analyzed.Results A total of 147 patients were included in the study and 117 of them were analyzed.The overall 28-day mortality was 31.62％ (n=37).There were no significant differences in gender,age,body mass index,initial arterial oxygen partial pressure and carbon dioxide partial pressure between the survival group and non-survival groups (P ＞0.05).But there was a significant difference in SOFA score(6.53 ± 2.96 vs 8.65 ± 3.00) and nR-SOFA(3.44 ± 2.98 vs 5.27 ± 2.86).Among the evaluation indexes,the PPOI obtained the AUC of 0.828,with the sensitivity of 86.5％,and specificity of 71.2％.The AUC of the SOFA score was 0.707,while the AUC of the PPOI combined with the SOFA score was 0.833.Conclusion Mechanical ventilation pressure parameters can be used to predict the prognosis of patients with ARDS.PPOI may evaluate the prognosis of ARDS in a more simple,timely and real-time manner.
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Objective:To evaluate the effect of high-flow nasal cannula (HFNC) oxygen on the early respiratory distress in patients with acute paraquat poisoning.Methods:This prospective study included patients who were hospitalized in the Emergency Department of First Hospital of China Medical University diagnosed and were diagnosed with acute PQ poisoning from May 1, 2017 to May 1, 2018. Inclusion criteria: acute PQ poisoning patients with dyspnea, and meet the following conditions: dyspnea with RR > 25 beats/min or PCO 2 < 32 mmHg. The following information were recorded: RR, SpO 2, HR and MAP before and 15 min, 30 min, 1 h, 2 h, 4 h, 6 h, 12 h and 24 h after HFNC application, as well as and arterial blood gas before and 6 h, 24 h after HFNC application. The improvement of RR, SpO 2, HR, MAP, PCO 2, PO 2, pH and Lac were compared before and after HFNC. Mann-Whitney U rank test and Chi-square test were used and a P<0.05 was regarded as statistically significant. Results:A total of 50 patients were included in the study. After 28 days of follow-up, 26 patients survived and 24 died. There was no difference between the two groups in gender and age. There were differences in PQ oral doses, urinal PQ concentration, Lac and PaCO 2 between the two groups. HFNC significantly reduced the RR and HR of all patients at all time points, and PaCO 2 was significantly increased at 6 h after application, 36 mmHg(34, 38) mmHg vs 30 mmHg (27, 32) mmHg ( P<0.05), while MAP, SpO 2, PO 2, and pH had no significant differences. RR and HR of the survival group were significantly lower than those of the non-survival group, as well as the maximum flow rate, 35 L/min (25, 40) L/min vs 55 L/min(50, 60) L/min ( P<0.01). Conclusions:HFNC can significantly reduce the early respiratory frequency and heart rate of patients with acute PQ poisoning and improve dyspnea. Meanwhile, it can significantly reduce the patients' oxygen consumption and improve the relative or absolute hypoxic state of patients after poisoning.
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Objective:To investigate the value of artificial intelligence in screening normal or abnormal four-chamber view of the fetal heart.Methods:Selecting 3 996 pictures of normal and abnormal end systolic four chamber views and 450 video clips from the database of Beijing Key Laboratory of Fetal Heart Disease Maternal and Fetal Medicine Research in Beijing Anzhen Hospital as training set, test set and verification set to train, test and verify DGACNN model. ①Comparing DGACNN, DGACNN-ALOCC and other classification models(Densenet, Resnet50, InceptionV3, InceptionResnetV2) to detect the model with the most advanced level by recognizing 200 normal pictures and 200 abnormal pictures. ②Fetal echocardiographers were divided into three groups according to their experiences: primary, intermediate and advanced, 3 doctors in each group, and comparing the average score between each group or three groups and DGACNN by recognizing 100 normal pictures and 100 abnormal pictures.Results:①When the the false positive rate(FPR) was in the range of 20%, the recognition accuracy of DGACNN was the highest with 0.850, the recognition accuracy of other models were DGACNN-ALOCC 0.835, Densenet 0.780, Resnet50 0.700, InceptionV3 0.670, InceptionResnetV2 0.650, respectively. ②When FPR was in the range of 20%, the area under ROC curve of DGACNN was the largest with 0.881, the area under ROC curve of other models were DGACNN-ALOCC 0.864, Densenet 0.850, Resnet50 0.822, Inceptionv3 0.779, InceptionResnetV2 0.703, respectively. ③When the FPR was in the range of 20%, the average recognition accuracy of the senior fetal echocardiographer group was the highest with 0.863, followed by DGACNN 0.840, which was higher than the average recognition accuracy of the primary and intermediate groups with 0.760, 0.807; the average recognition accuracy of DGACNN was higher than the total average recognition accuracy of the primary, intermediate and advanced groups with 0.810.Conclusions:Artificial intelligence is accessible in screening four chamber view of fetal echocardiography, with high recognition accuracy.