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1.
Article in Chinese | WPRIM | ID: wpr-876080

ABSTRACT

@#Objective    To explore the possibility that GREM1, a bone morphogenetic protein (BMP) antagonist, is a mechanical explanation for BMP signal suppression in congenital heart disease associated pulmonary arterial hypertension (CHD/PAH) patients. Methods    Systemic-to-pulmonary shunt induced PAH was surgically established in rats. At the postoperative 12th week, right heart catheterization and echocardiography evaluation were performed to evaluate hemodynamic indexes and morphology of right heart system. Right heart hypotrophy index and pulmonary vascular remodeling were evaluated. Changes of BMP signal pathway related proteins and GREM1 in lungs and plasma GREM1 concentration were detected. The effect of GREM1 on the proliferation and apoptosis of pulmonary arterial endothelial cells (PAECs) was also explored. Results    The hypertensive status was successfully reproduced in rats with systemic-to-pulmonary shunt model. BMP signal pathway was suppressed but GREM1 was up-regulated with no change in hypoxia inducible factor-1 in lungs exposed to systemic-to-pulmonary shunt, while this trend was reversed by systemic-to-pulmonary shunt correction (P<0.05). Immunohistochemical staining demonstrated enhanced staining of GREM1 in remodeled pulmonary arteries. In vitro experiments found that BMP signal was down-regulated but GREM1 expression and secretion were up-regulated in proliferative PAECs (P<0.05). Furthermore, BMP2 significantly inhibited PAECs proliferation and promoted PAECs apoptosis (P<0.05), which could be antagonized by GREM1. In addition, plasma level of GREM1 in rats with systemic-to-pulmonary shunt was also increased and positively correlated with pulmonary hemodynamic indexes. Conclusion    Systemic-to-pulmonary shunt induces the up-regulation of GREM1 in lungs, which promotes pulmonary vascular remodeling via antagonizing BMP cascade. These results present a new mechanical explanation for BMP pathway suppression in lungs of CHD/PAH patients.

2.
Article in Chinese | WPRIM | ID: wpr-885691

ABSTRACT

As an anti-inflammatory factor, Interleukin 35 (IL-35) is composed of p35 subunit and EBI3 subunit. IL-35 plays an important role in many diseases, but many mechanisms are not clear. In recent years, it has been found that IL-35 plays an important immunomodulatory role in autoimmune diseases, such as rheumatoid arthritis, inflammatory bowel disease, psoriasis, idiopathic inflammatory myopathy, systemic lupus erythematosus, multiple sclerosis, type I diabetes, pemphigus and primary biliary cirrhosis, etc. This review summarizes the research progress of the mechanism of IL-35 in the above autoimmune diseases.

3.
Chinese Critical Care Medicine ; (12): 113-116, 2021.
Article in Chinese | WPRIM | ID: wpr-883832

ABSTRACT

Causal inference research is a causal test designed to assess the impact of exposures on outcomes.Both experimental and observational studies can be used to examine causal associations between exposure factors and outcomes. Experimental studies are sometimes limited by factors such as ethics or experimental conditions. Observational studies account for a large proportion in clinical studies, but the effectiveness and research value of observational studies will be affected if the design of observational studies is not rigorous and the confounding factors are not well controlled.The Guidelines for controlling confounding factors and reporting results in causal inference studie formulated by a special group of 47 editors from 35 journals from all over the world provide good guidance to researchers. This article interprets the guidelines and hopes to provide help for clinical researchers.

4.
Article in Chinese | WPRIM | ID: wpr-883261

ABSTRACT

Objective:To investigate the influence of bundled ligation of the pancreatic stump on postoperative pancreatic fistula (POPF) of distal pancreatectomy (DP).Methods:The retrospective case-control study was conducted. The clinical data of 60 patients with diseases in pancreatic body and tail who underwent DP in the Affiliated Hospital of Inner Mongolia Medical University from January 2011 to August 2018 were collected. There were 24 males and 36 females, aged from 19 to 68 years, with a median age of 45 years. Of the 60 patients, 36 cases undergoing dissection of pancreas with Endo-GIA stapler were allocated into non-bundled group, and 24 cases undergoing bundled ligation of the pancreatic stump with No.10 or No.7 suture at the site over 1 cm of the resection site before dissection of pancreas were allocated into bundled group. Observation indicators: (1) postoperative situations; (2) analysis of risk factors for POPF of DP. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test or ANOVA test. Measurement data with skewed distribution were represented as M (range).Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test. Univariate analysis was conducted using the chi-square test and multivariate analysis was conducted using the Logistic regression model. Results:(1) Postoperative situations: the amylase concentration, cases with biochemical fistula, cases with grade B pancreatic fistula, cases with complications, time to extubation, duration of postoperative hospital stay, total hospital expenses were (2 629±592)U/L, 14, 5, 7, (11.9±0.7)days, (13.6±0.7)days, (49 430±1 626)yuan in non-bundled group and (683±312)U/L, 3, 1, 2, (9.7±0.6)days, (11.3±0.5)days, (44 767±1 163)yuan in bundled group, respectively. There were significant differences in the amylase concentration, cases with biochemical fistula, time to extubation, duration of hospital stay, total hospital expenses between the two groups ( t=2.528, χ2=1.512, t=2.341, 2.311, 2.111, P<0.05), and there was no significant difference in the cases with grade B pancreatic fistula or cases with complications between the two groups ( χ2=1.512, 1.394, P>0.05). (2) Analysis of risk factors for POPF of DP. Results of univariate analysis showed that tumor diameter and bundled ligation of the pancreatic stump were related factors of patients undergoing pancreatic fistula after DP ( χ2=4.462, 5.061, P<0.05). Results of multivariate analysis showed that bundled ligation of the pancreatic stump was an independent influencing factor of patients undergoing pancreatic fistula after DP ( odds ratio=0.187, 95% confidence interval as 0.037-0.954, P<0.05). Conclusions:Bundled ligation of the pancreatic stump was an independent influencing factor of patients undergoing pancreatic fistula after DP. Bundled ligation of the pancreatic stump can effectively reduce the incidence of POPF, especially biochemical fistula, the time to extubation, duration of postoperative hospital stay and total hospital expenses, and promote patient recovery after DP.

5.
Article in English | WPRIM | ID: wpr-880566

ABSTRACT

OBJECTIVE@#To explore the effectiveness of Danhong Injection () on improving microcirculatory injury after percutaneous coronary intervention (PCI) in patients with coronary heart disease (CHD).@*METHODS@#A randomized controlled trial was conducted and 90 patients were enrolled. A random sequence was generated using statistical analysis software. Patients with microcirculatory injuries after PCI were randomly divided into 3 groups for treatment (30 subjects in each group): Danhong Injection group: after PCI, Danghong Injections were given with intravenous administration with 40 mL twice a day for a week; statins intensive group: after PCI, atorvastatin calcium tablets were given oral medication with 80 mg once, and then atorvastatin 40 mg daily for 1 week; the control group: after PCI, atorvastatin calcium tablets were given oral medication with 10-20 mg daily for 1 week. The index of microcirculation resistance (IMR) was used to assess microcirculatory injury during PCI. The IMR of the target vessel was reexamined after 1 week of drug treatment.@*RESULTS@#After one week's drug treatment, IMR was significantly decreased in both statins intensive group and Danhong Injection group compared with the control group (P<0.01), but no difference was found between statins intensive group and Danhong injection group (14.03 ± 2.54 vs. 16.03 ± 5.72 U, P=0.080).@*CONCLUSIONS@#The efficacy of Danhong Injection is non-inferior to statin. Early use of Danhong Injection after PCI can effectively improve coronary microcirculation injury after PCI.

6.
Article in English | WPRIM | ID: wpr-880507

ABSTRACT

OBJECTIVE@#To assess the trends in characteristics, treatments, and outcomes of acute myocardial infarction (AMI) patients in tertiary Chinese medicine (CM) hospitals in China between 2006 and 2013.@*METHODS@#This retrospective study was based on two nationwide epidemiological surveys of AMI in tertiary CM hospitals during 2 years (2006 and 2013). Patients admitted to the hospital for AMI were enrolled. Hospital records were used as the data source. Case data were derived regarding baseline characteristics, treatments, and outcomes of patients to assess changes from 2006 to 2013. Logistic regression was used to analyze the relationship between prognosis, general influencing factors of disease, and various treatment measures.@*RESULTS@#Totally 26 tertiary CM hospitals in 2006 and 29 tertiary CM hospitals in 2013 (18 were repetitive) were surveyed. A total of 2,311 patients with AMI were enrolled (1,094 cases in 2006 and 1,217 cases in 2013). From 2006 to 2013, the mean age did not significantly change, but the proportion of patients younger than 65 years increased. The prevalence of risk factors such as hypertension, diabetes, and hyperlipidemia also increased. Significant increases were observed in primary percutaneous coronary intervention [20.48% (2006) vs. 24.90% (2013)] and revascularization [36.11% (2006) vs. 52.42% (2013)]. In-hospital mortality decreased from 11.15% in 2006 to 10.60% in 2013. A mortality logistic regression analysis identified reperfusion therapy [odds ratio (OR), 0.222; 95% confidence interval (CI), 0.106-0.464], Chinese patent medicines (OR, 0.394; 95% CI, 0.213-0.727), and CM decoctions (OR, 0.196; 95% CI, 0.109-0.353) as protective factors.@*CONCLUSION@#Reperfusion and revascularization capabilities of tertiary CM hospitals have improved significantly, but in-hospital mortality has not significantly decreased. Efforts are needed to improve medical awareness of AMI and expand the use of CM to reduce in-hospital mortality in China.

7.
Article in Chinese | WPRIM | ID: wpr-873547

ABSTRACT

@#Objective    To investigate the prognosis and risk factors of mild to moderate or moderate atrioventricular valve regurgitation (AVVR) after Fontan operation. Methods    A total of 34 patients with mild to moderate or moderate AVVR who accepted Fontan operation and atrioventricular valve (AVV) repair between 2004 and 2018 in our center were selected as an AVV repair group. The patients in the same period were matched as a control group by the ratio of 1 : 1-2. Finally 99 patients were included into this study, including 64 males and 35 females, with an average age of 63.4±36.3 months and weight of 17.3±6.7 kg. Grades of AVVR decreased more than 1 was defined as significant improvement. Endpoints of the study were death, Fontan takedown, AVV replacement. Risk factors including Fontan procedures, AVV repair procedures, cardiac anatomy were analyzed. Results    Patients were followed up for 1.5 (0.3-4.0) years. Overall mortality was 15.2%. Most (82.4%) of AVV repair group accepted single AVV repair procedure while partial annuloplasty was the most common (52.9%). With the extension of follow-up, the degree of AVVR in the whole group showed a gradually increasing trend (r=0.352, P=0.000). Mild to moderate AVVR improved spontaneously after Fontan operation, while moderate AVVR did not. AVV repair could improve the degree of AVVR after moderate regurgitation, without increasing the surgical mortality, and regurgitation significantly decreased in 8.8% patients. AVV repair was not effective for mild to moderate AVVR and would increase surgical mortality. Conclusion    AVV function shows a gradual downward trend after Fontan operation. AVV repair is effective for moderate AVVR, does not increase mortality, but the degree of improvement is limited. AVV repair is not effective for mild to moderate AVVR and increases surgical mortality.

8.
Article in Chinese | WPRIM | ID: wpr-781335

ABSTRACT

Identifying the ideal implantation site is important for the long-term stability and effectiveness of follow-up restorations. Implant surgical guide and navigation are used to determine the implantation site in clinic and improve the precision of implantation. However, due to difficulties in digital methods, such as multiple procedures, high cost, and actual accuracy of more than 1 mm, many physicians still prefer to operate with free hand. In preoperative, intraoperative, and postoperative procedures, time-saving and practical methods for implant site evaluation are lacking. In many cases, oral physicians found that the position deviates only by cone beam CT, which was costly to modify the position. In this article, we presented a precise implantation insertion technology that is guided by a measurable technique throughout the implantation application for all implant systems. This method was guided by a dynamic control measuring ruler, which functions together with the measuring and intraoperative locating rulers. The 3D space of the operative area was measured by a measuring ruler prior to operation, and the implant plan and quantitative guidance design were conducted according to the measured and cone beam CT data. The whole implantation process was guided by the dynamic control measuring ruler, and measuring verification results were also considered. This method can realize the quantification of the entire preoperative space analysis, intraoperative precise implantation guidance, and postoperative site measurement and evaluation. This practical technique also helps to adjust the position, improve the implantation accuracy and is suitable in generalizing dental implantation.


Subject(s)
Computer-Aided Design , Cone-Beam Computed Tomography , Dental Implantation, Endosseous , Dental Implants , Imaging, Three-Dimensional , Patient Care Planning , Surgery, Computer-Assisted
9.
Article in Chinese | WPRIM | ID: wpr-828242

ABSTRACT

OBJECTIVE@#To compare clinical effects of common Kirschner wire, anatomical plate and perforated Kirschner wire in treating olecranon fracture.@*METHODS@#From March 2014 to May 2017, clinical data of 79 patients with olecranon fracture treated with different internal fixation was retrospectively analyzed. Among them, 26 patients treated with common Kirschner wire (group A), including 19 males and 7 females aged from 23 to 51 years old with an average of (37.2±9.6) years old;11 patients were typeⅠ, and 15 patients were typeⅡ according to Mayo classification. Twenty eight patients were treated with olecroanon anatomical plate internal fixation, including 16 males and 12 females aged from 25 to 52 years old with an average of (36.6±8.9) years old;10 patientswere typeⅠ and 18 patients were typeⅡ according to Mayo classification. Twenty five patients were treated with perforated Kirschner wire, including 13 males and 12 females aged from 26 to 51 years old with an average of (38.2±9.2) years old;9 patients were typeⅠand 16 patients were typeⅡ according to Mayo classification. Operation time, intraoperatve blood loss, fracture healing time and postoperative complications among three groups were compared; VAS score at 1 week after operation was used to evaluate pain relief, Broberg-Morrey function score of elbow joint at the final follow up was applied to evaluate clinical effect.@*RESULTS@#Seventy nine patients were followed up from 13 to 23 months with an average of (18.3±4.5) months. Operation time, intraoperatve blood loss, fracture healing time in group A were (82.9±19.7) min, (113.5±32.3) ml, (4.2±0.6) months respectively;in group B were(101.2±24.5) min, (150.2±39.5) ml, (4.6±0.8) months respectively;in group C were (83.3±18.7) min, (119.3±34.3) ml, (4.1±0.5) months respectively. Operation time, intraoperatve blood loss, fracture healing time in group A and group C were better than that of group B(0.05).@*CONCLUSION@#Common Kirschner wire has more complications; anatomical plate has greater surgical trauma and long fracture healing time;while perforated Kirschner wire was not only benefit for fracture union with less trauma, but also could reducing the incidence of postoperative complications, and it is the appropriate method for patients with olecranon fracture.


Subject(s)
Adult , Bone Plates , Female , Fracture Fixation, Internal , Humans , Male , Middle Aged , Olecranon Process , Retrospective Studies , Treatment Outcome , Ulna Fractures , Young Adult
10.
Article in Chinese | WPRIM | ID: wpr-827532

ABSTRACT

The minimum amount of tooth preparation that can be fully controlled is crucial in achieving long-term, stable, and effective aesthetic restoration, which is also a major difficulty in aesthetic restoration. The tooth preparation can be imple-mented efficiently and accurately through digital technology based on the fixed-deep hole guiding technology. Prior the actual tooth preparation, the technology first designs the virtual contour, layering, and virtual occlusion of the prosthesis on the computer. Then, virtual tooth preparation is carried out by cutting back according to the virtual prosthesis. Next, the virtual drilling operation plan is designed according to the shape of the virtual tooth preparation and the contour of the abutment tooth. Finally, the tooth preparation guide plate is designed and printed in 3D. It realizes the whole process of quantitative and precise guidance of dental preparation, visualizes the restoration space, reduces the clinical operation time, and guarantees the quality of dental preparation. It also promotes the improvement of the teaching quality of digital practical exercises.


Subject(s)
Bone Plates , Esthetics, Dental , Printing, Three-Dimensional , Tooth , Tooth Preparation
11.
Article in Chinese | WPRIM | ID: wpr-871869

ABSTRACT

Objective:To analyze the alterations and clinical significance of serum calcium binding protein S100A8/A9 and soluble receptor for advanced glycation end products (sRAGE) levels in patients with chronic obstructive pulmonary disease(COPD).Methods:Enzyme-linked immonosorbent assay was established to detect serum levels of S100A8/A9 and sRAGE in 203 patients with COPD[male166, female 37, aged 52-92 years, average years(69.72±9.079)] and in 41 smoking elderly non-COPD patients[male 35,female 6, aged 55-89 years, average years(68.66±8.74)], and 167 non-smoking healthy subjects as the control group[male 132, female 35, aged 57-92 years, average years(69.13±7.21)] from April 2018 to January 2019. The relationship between the S100A8/A9, sRAGE and clinical biomarkers [the percentage of fored expiratory volume in one second(FEV 1) in the predicted value, FEV 1/fored vital capacity(FVC), neutrophile granulocyte(NEU)%, pack-year] were investigated. The diagnostic value of S100A8/A9, sRAGE and their combined detection for COPD was analyzed using the subject operating characteristic curve. Results:The serum S100A8/A9 level [(2.70±1.11)μg/ml] in COPD patients was significantly higher than that in the smoking control group [(1.65±0.63) μg/ml] and the non-smoking control group[(0.99±0.48)μg/ml], t=5.807, P<0.000 1; t=18.45, P<0.000 1. The serum S100A8/A9 levels in patients with COPD[GOLD Ⅰ(2.08±1.08) μg/ml, GOLDⅡ (2.58±1.06) μg/ml, GOLD Ⅲ (2.69±1.12) μg/ml, GOLDⅣ (2.95±1.10)μg/ml] were significantly higher than the non-smoking control group(0.99±0.48)μg/ml, t=6.616, P<0.000 1; t=14.56, P<0.000 1; t=17.10, P<0.000 1; t=18.09, P<0.000 1.The serum sRAGE level [(0.29±0.25)ng/ml] in COPD patients was significantly higher than that in the smoking control group[(0.60±0.24)ng/ml] and the non-smoking control group[(0.85±0.35)ng/ml], t=7.367, P<0.000 1; t=18.14, P<0.000 1. The serum sRAGE levels in patients with COPD[GOLD Ⅰ(0.46±0.40),GOLDⅡ (0.28±0.25),GOLD Ⅲ (0.29±0.25),GOLD Ⅳ (0.25±0.19)ng/ml] were significantly lower compared with non-smoking control group[(0.85±0.35)ng/ml], t=3.459, P=0.000 5; t=10.23, P<0.000 1; t=13.95, P<0.000 1; t=11.70, P<0.000 1. Serum S100A8/A9 levels were positively correlated with smoking amount and NEU% ( r=0.458 5, P<0.000 1; r=0.228 3, P=0.001 1), negatively correlated with FEV 1/FVC, the percentage of FEV 1 in the predicted value, and sRAGE( r=-0.190 6, P=0.006 4; r=-0.186 3, P=0.007 8; r=-0.201 7, P=0.003 9). sRAGE levels were negatively correlated with NEU% ( r=-0.155 9, P=0.026 4). In the ROC curve, the area under the curve of S100A8/A9, sRAGE and combined detection were 0.922[95 %CI(0.897-0.947)], 0.926[95 %CI(0.899-0.952)]and 0.966 [95 %CI(0.950-0.983)], respectively. Conclusion:S100A8/A9 and sRAGE are closely correlated with the degree of airflow constrains and the levels of serum inflammatory mediators, which are expected to be as potential biomarkers of COPD.

12.
Chinese Journal of Dermatology ; (12): 290-292, 2020.
Article in Chinese | WPRIM | ID: wpr-870265

ABSTRACT

Objective:To analyze characteristics of and distribution of pathogenic fungi in patients with tinea capitis in the First Affiliated Hospital of Xinjiang Medical University from 2010 to 2018.Methods:Clinical data were collected from 122 tinea capitis patients with positive fungal culture results in Department of Dermatology, First Affiliated Hospital of Xinjiang Medical University from 2010 to 2018, and retrospectively analyzed. Fungal culture was carried out, and lactophenol cotton blue staining was performed for morphological identification of the fungal isolates.Results:Of the 122 patients with tinea capitis, 112 (91.8%) were children, including 70 (62.5%) males and 42 (37.5%) females, and there were 58 (51.79%) preschool children and 37 (33.04%) school-age children; 9 (7.38%) were adults, including 7 females and 2 males; 66 (54.1%) were of Uygur nationality, 46 (37.7%) of Han nationality, 5 (4.1%) of Kazakh nationality, 3 (2.46%) of Hui nationality, 1 (0.82%) of Mongolian nationality, and 1 of unknown nationality. The annual number of cases of tinea capitis was more than 20 from 2011 to 2013, and gradually decreased year by year from 2014 (≤ 13 cases/year) . All the patients were infected with a single fungal strain, and a total of 122 strains were identified, including 46 (37.7%) strains of Microsporum ferrugineum, 44 (36.07%) strains of Microsporum canis, 10 (8.2%) strains of Trichophyton violaceum, 9 (7.38%) strains of Trichophyton schoenleini, 6 (4.91%) strains of Trichophyton tonsurans, 4 (3.28%) strains of Trichophyton mentagrophytes, 3 (2.46%) strains of Trichophyton verrucosum. Microsporum ferrugineum (anthropophilic species) mostly affected patients of Uygur nationality (34 cases, 73.91%) , and Microsporum canis (zoophilic species) mostly affected patients of Han nationality (26 cases, 59.09%) . Conclusion:In the Department of Dermatology, First Affiliated Hospital of Xinjiang Medical University from 2010 to 2018, tinea capitis commonly affected male children of Uygur nationality, and Microsporum ferrugineum and Microsporum canis were the dominant pathogenic species.

13.
Chinese Journal of Radiology ; (12): 1162-1166, 2020.
Article in Chinese | WPRIM | ID: wpr-868381

ABSTRACT

Objective:To investigate the differences in CT imaging features of head and neck mucoepidermoid carcinomas (MEC) from different origins and different histological grades.Methods:Clinical and CT imaging findings of 53 patients with pathologically proved MEC in the First Affiliated Hospital of Kunming Medical University admitted from January 2009 to May 2019 were retrospectively reviewed. On the basis of origins, all MECs were divided into 2 groups: large salivary gland group (23 cases) and small salivary gland group (30 cases). All MECs were further divided into 3 groups based on histological grades: highly differentiated (19 cases), moderately differentiated (28 cases) and poorly differentiated (6 cases). The CT imaging features of MEC from different origins and different histological grades (including location, number, size, morphology, boundary, density, calcification, cystic cavity, necrosis, bone changes, flat CT scan value, arterial phase CT enhancement value-added, venous phase CT enhancement value-added, enhancement method, adjacent structure invasion, cervical lymph node metastasis and distant metastasis) were analyzed and compared using t test, χ 2 test, Fisher exact probability or rank-sum test. Results:Comparisons of characteristics between different origins: only lesion size, morphology, bone changes, and plain CT values ( P<0.05) was significantly between different origin groups. There was no significant difference of residual image features ( P>0.05). Compared with MECs derived from large salivary glands, the small salivary gland group had larger MEC lesions, irregular shapes and was prone to have bone changes (including expansion and destruction). In addition, the plain scan CT value of MEC from the large salivary glands was slightly lower than that of the small salivary glands MEC (all P<0.05). Comparison of characteristics among different histological grade groups: only cystic cavity was statistically different (χ2=8.045, P=0.015). Compared with poorly differentiated MEC, highly differentiated MEC was more prone to have cysts (χ2=7.707, P=0.012). Conclusion:There are some differences in CT findings of head and neck MEC from different origins. The cystic cavity has reference value for evaluating histological grade.

14.
Chinese Critical Care Medicine ; (12): 943-946, 2020.
Article in Chinese | WPRIM | ID: wpr-866938

ABSTRACT

Objective:To analyze the clinical characteristics of septic shock caused by upper and lower gastrointestinal perforation.Methods:Clinical data of patients with septic shock due to gastrointestinal perforation admitted to the department of critical care medicine of the Affiliated Hospital of Guizhou Medical University from January 2018 to December 2019 were analyzed retrospectively. The general information; procalcitonin (PCT), acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) and sequential organ failure assessment (SOFA) scores during the first 24 hours in intensive care unit (ICU); results of ascites culture during the first 72 hours in ICU; the maximum dosage and total time of norepinephrine (NE) in ICU; mechanical ventilation time, the length of ICU stay, occurrence of acute kidney injury (AKI), continuous renal replacement therapy (CRRT) and 28-day mortality were collected. The patients were divided into upper gastrointestinal tract group (stomach and duodenum) and lower gastrointestinal tract group (jejunum, ileum, appendix, colon and rectum), with a boundary of Treitz. The clinical features between the two groups were compared.Results:There were 33 patients in the upper gastrointestinal tract group and 30 patients in the lower gastrointestinal tract group. There was no significant difference in gender and age between the two groups. The main pathogens in the ascites cultures in the upper gastrointestinal tract group were Candida albicans (45.5%), Enterococcus faecalis (18.2%) and Escherichia coli (18.2%). Escherichia coli (46.2%) and Enterococcus faecalis (30.8%) were the main pathogens in the lower gastrointestinal tract group. There were significant differences in PCT, the length of ICU stay, mechanical ventilation time, the maximum dosage and total time of NE between the upper gastrointestinal tract group and lower gastrointestinal tract group [PCT (μg/L): 17.69 (3.83, 26.62) vs. 32.82 (4.21, 100.00), the length of ICU stay (hours): 149.0 (102.5, 302.0) vs. 115.5 (30.8, 214.5), mechanical ventilation time (hours): 106.0 (41.5, 183.0) vs. 57.5 (25.0, 122.3), the maximum dosage of NE (μg·kg -1·min -1): 1.2 (0.5, 2.0) vs. 0.7 (0.5, 1.2), the total time of NE (hours): 72.0 (21.0, 145.0) vs. 26.5 (18.0, 80.5), all P < 0.05], while there was no statistically differences in APACHEⅡ or SOFA scores [APACHEⅡ: 30.0 (24.5, 35.0) vs. 28.0 (25.0, 33.5), SOFA: 10.67±4.14 vs. 9.50±3.33, both P > 0.05]. Compared with the lower gastrointestinal tract group, patients in the upper gastrointestinal tract group were more likely to have AKI (78.8% vs. 53.3%, P < 0.05) and require CRRT (39.4% vs. 16.7%, P < 0.05), but there was no significant difference in the 28-day mortality (39.4% vs. 43.3%, P > 0.05). Conclusions:The clinical characteristics of septic shock caused by upper and lower gastrointestinal perforation are not the same. Patients with septic shock caused by upper gastrointestinal perforation are more likely to suffer from fungal infection, with more severe shock, more likely to have AKI and require CRRT, and significantly longer mechanical ventilation and the length of ICU stay. While patients with septic shock caused by lower gastrointestinal perforation showed higher PCT.

15.
Chinese Critical Care Medicine ; (12): 871-872, 2020.
Article in Chinese | WPRIM | ID: wpr-866907

ABSTRACT

Carbon dioxide (CO 2) ejection syndrome is common after artificial pneumoperitoneum, and it often attracts the attention of anesthesiologists because of its rapid changes in vital signs. CO 2 ejection syndrome is not uncommon in critically ill patients, and may occur after mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). There are few relevant reports about CO 2 ejection syndrome, and a considerable number of clinicians have little understanding of the pathological changes. A case of AECOPD patient with CO 2 ejection syndrome after endotracheal intubation was admitted to the intensive care unit (ICU) of the Affiliated Hospital of Guizhou Medical University. After treatment, such as fluid expansion, vasoactive drugs and ventilator assistance, the patient's condition improved and was transferred out of the ICU. It is expected to provide some references by summarizing the diagnosis and treatment of this case and reviewing relevant literature reports.

16.
Chinese Critical Care Medicine ; (12): 367-370, 2020.
Article in Chinese | WPRIM | ID: wpr-866833

ABSTRACT

Objective:To discuss the feasibility of offering specialized courses of critical care medicine in undergraduate clinical medicine education, so as to alleviate the shortage of critical care medicine staffs and lay a foundation for improving the success rate for the treatment of critical cases.Methods:The undergraduates majoring in clinical medicine from 2008 to 2011 in Guizhou Medical University (the former Guiyang Medical College) were enrolled. After they had been enrolled in the undergraduate education for 3 years and were ready for Grade four, which meant basic medicine teaching had been completed and clinical medicine teaching was about to start, they were introduced and preached to each discipline, including critical care medicine. The undergraduates were free to choose professional direction of clinical training in Grade four. Students majoring in clinical medicine from 2012 to 2014 were free to choose their major direction when they entered the school.Results:From September 2011 to July 2019, the university had cultivated 246 undergraduates majoring in clinical critical care medicine from 2008 to 2014, and the critical care medicine professional team of affiliated hospital had undertaken 540 teaching hours. By July 2019, all students had graduated on time, with an employment rate of 100%. Forty students took postgraduate programs in our school and other schools, accounting for 16.3%.Conclusions:Professional education of critical care medicine in the undergraduate course of clinical medicine can mobilize students' interest in learning and subjective initiative, which is conducive to career selection. During the clinical training, the students can identify and timely cure critical care cases in the early stage, and partly alleviate the current shortage of critical care medical staffs.

17.
Chinese Critical Care Medicine ; (12): 230-234, 2020.
Article in Chinese | WPRIM | ID: wpr-866788

ABSTRACT

Objective:To know the critical care resources of the different class-hospitals in Guizhou Province, China, and to provide the direction and evidence for quality improvement and discipline construction of critical care medicine in Guizhou Province.Methods:The resource status of the departments of intensive care unit (ICU) in Guizhou Province was obtained through form filling and/or field investigation. The forms were filled and submitted from May 2017 to February 2018, and the field investigation (some of the hospitals) was carried out in March 2018. The data of hospitals in Guizhou Province in 2018, was obtained from the official website of Health Committee of Guizhou Province, which was released online on November 28th, 2019. The obtained data were summarized and analyzed according to different aspects such asthe status of ICU construction, main equipment configuration and technology implementation.Results:There were 39 third-class hospitals and 77 second-class hospitals included in this study, which accounted for 76.5% (39/51) of third-class public hospitals and 50.0% (77/154) of second-class public hospitals respectively. Among them, there were 86.8% (33/38) of third-class general hospitals and 50.4% (69/137) of second-class general hospitals respectively. In terms of ICU construction, compared with the ICUs of second-class hospitals, the ICUs of third-class hospitals were established earlier [years: 2011 (2008, 2012) vs. 2013 (2011, 2015), P < 0.01], had more ICU beds, doctors and nurses [15 (11, 20) vs. 8 (6, 10), 9 (8, 11) vs. 6 (5, 7), 25 (20, 41) vs. 15 (12, 19), respectively, all P < 0.01]. However, there were no significant differences regarding the doctor-bed ratio and the nurse-bed ratio in ICUs between second-class hospitals and third-class hospitals. In terms of main equipment configuration, compared with the ICUs of second-class hospitals, the ICUs of third-class hospitals had more ventilators, higher ratio of ventilators to beds, more infusion pumps, higher ratio of infusion pumps to beds, more monitor, gastrointestinal nutrition pumps and single rooms, and higher proportion of ICUs equipped with negative pressure rooms [ventilators: 14 (10, 18) vs. 6 (4, 8), ratio of ventilators to beds: 1.0 (0.7, 1.1) vs. 0.8 (0.6, 1.0), infusion pumps: 10 (6, 20) vs. 5 (3, 8), ratio of infusion pumps to beds: 0.8 (0.0, 1.0) vs. 0.0 (0.0, 0.4), monitor: 18 (13, 24) vs. 9 (6, 12), gastrointestinal nutrition pumps: 2 (1, 5) vs. 1 (0, 3), single rooms: 2 (1, 3) vs. 1 (0, 3), proportion of ICUs equipped with negative pressure rooms: 53.8% (21/39) vs. 31.5% (23/73), respectively, all P < 0.05]. Furthermore, there were higher proportions of ICUs equipped with portable ventilator, pulse indicator continuous cardiac output monitoring (PiCCO), intra-aortic balloon pump (IABP), extra-corporeal membrane oxygenation (ECMO), B ultrasound machine, bronchoscope, pressure of end-tidal carbondioxide (P ETCO 2) monitoring, bispectral index (BIS) monitoring, bedside gastroscopy, the apparatus used for the prevention of deep vein thrombosis of lower extremity in third-class hospitals than in second-class hospitals [portable ventilator: 86.7% (26/30) vs. 59.6% (28/47), 43.3% (13/30) vs. 1.5% (1/66), 14.3% (4/28) vs. 0% (0/65), 10.7% (3/28) vs. 0% (0/65), 62.5% (20/32) vs. 37.3% (25/67), 97.1% (33/34) vs. 63.6% (42/66), 60.6% (20/33) vs. 28.4% (19/67), 17.2% (5/29) vs. 0% (0/65), 27.6% (8/29) vs. 1.5% (1/65), 77.4% (24/31) vs. 52.3% (34/65), respectively, all P < 0.05]. In terms of skills development, there were more ICUs carried out intracranial pressure monitoring, abdominal pressure monitoring, ultrasound diagnosis, bronchoscope examination and treatment and blood purification in third-class hospitals than in second-class hospitals [31.6% (12/38) vs. 14.7% (11/75), 75.7% (28/37) vs. 38.6% (27/70), 61.5% (24/39) vs. 24.3% (18/74), 89.7% (35/39) vs. 45.9% (34/74), 92.3% (36/39) vs. 48.6% (36/74), respectively, all P < 0.05]. Conclusions:The data were mainly derived from public general hospitals in Guizhou Province. Compared with the ICUs of second-class hospitals, the ICUs of third-class hospitals were founded earlier and larger, had better hardware configuration and could carry out more skills. However, the human resource situations were similar between second-class hospitals and third-class hospitals. Both second-class hospitals and third-class hospitals have a need to improve the allocation of manpower and equipment and expand various skills in ICUs, while it is more urgent for second-class hospitals.

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Article in Chinese | WPRIM | ID: wpr-864337

ABSTRACT

Objective:To investigate the pathology characteristics, so as to provide treatment experience of primary cardiac tumors for pediatric patients.Methods:A retrospective study was conducted for 135 patients with primary cardiac tumor between January 2004 and December 2017 in Shanghai Children′s Medical Center.The median age was 0.54 years (range, 0-14.36 years). Single tumor was discovered in 61 cases and multiple rumors were found in 74 cases.Forty-five patients presented obvious clinical symptoms, 4 patients with mild symptoms and 86 patients without symptoms.Forty-one patients underwent surgical treatment, including complete resection of the tumor in 24 cases, partial resection in 16 cases and heart transplantation in 1 case.Concomitant valvuloplasty was required in 13 patients.Ninety-four patients did not receive surgical treatment.Results:A total of 40 patients underwent surgical treatment in Shanghai Children′s Medical Center.Three patients died of low cardiac output (in-hospital mortality: 7.5%), and 2 patients recovered from postoperative low cardiac output.The hemodynamic status was stable in the remaining 35 cases.One patient who received heart transplantation in another hospital survived and had good cardiac function during 24 months follow-ups.There were no significant differences in the survival rate between partial resection and complete resection of benign tumors.One late death was observed in patients with malignant tumors for 2 years after operation.Surveillance was kept in 94 non-surgical patients, among whom 1 case died for the abandon of surgery and 1 case died when waiting for heart transplantation.Other 2 patients were waiting for heart transplantation and other 90 patients had no hemodynamic disorder.Conclusion:Most of primary cardiac tumors are benign and long time follow-up should be able to get on for pediatric patients.When patients develop hemodynamical obstruction, arrhythmia or malignant tumor, surgical treatment is necessary.The principle of surgical therapy in these patients is to restore normal hemodynamic status, instead of completely removing tumor.Heart transplantation is potentially the only way for patients whose tumor cannot be resected.

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Chinese Journal of Hematology ; (12): 112-116, 2020.
Article in Chinese | WPRIM | ID: wpr-799577

ABSTRACT

Objective@#To compare the difference of the clinical and laboratory characteristics between γδ T-cell large granular lymphocyte leukemia (γδT-LGLL) and αβ T-cell large granular lymphocyte leukemia (αβT-LGLL) .@*Methods@#The clinical and laboratory characteristics of 17 patients with γδT-LGLL and 91 patients with αβT-LGLL in the department of therapeutic center of anemia of enrolled in our hospital from January 2009 to January 2019 were retrospectively analyzed.@*Results@#The median age of the 17 patients with γδT-LGLL was 54 years (range, 25-73 years) , the most common presenting symptom was anemia. In comparison with αβT-LGLL patients, splenomegaly was common (41% and 44%, respectively) , whereas hepatomegaly (12% and 5%, respectively) and lymphadenopathy (6% and 8%, respectively) were rare. The positive rates of antinuclear antibody (59% and 45%, respectively) were high, whereas the positive rates of rheumatoid factor (6% and 10%, respectively) were rare for both groups. There were no differences on peripheral blood counts between the two groups. However, γδT-LGLL patients were found to be predominantly expressed a CD4−/CD8− phenotype. Steroid therapy with prednisone was used alone as first-line therapy for 1 patient. Cyclosporin A (CsA) was used alone as first-line therapy for 3 patients. CsA in combination with steroids were administered in 13 patients. After 4 months treatment, 2 patients acquired complete response, 4 patients acquired partial response, the overall response was 35%.@*Conclusion@#γδT-LGLL is a rare mature T-lymphocyte proliferative disease. Clinical and laboratory characteristics were quite similar for γδT-LGLL in compare with αβT-LGLL. γδT-LGLL predominantly expressed a CD4−/CD8− phenotype. The data presented here indicate the CsA is an effective option for the first-line treatment of γδT-LGLL.

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Article in Chinese | WPRIM | ID: wpr-799472

ABSTRACT

Objective@#To analyze the alterations and clinical significance of serum calcium binding protein S100A8/A9 and soluble receptor for advanced glycation end products (sRAGE) levels in patients with chronic obstructive pulmonary disease(COPD).@*Methods@#Enzyme-linked immonosorbent assay was established to detect serum levels of S100A8/A9 and sRAGE in 203 patients with COPD[male166, female 37, aged 52-92 years, average years(69.72±9.079)] and in 41 smoking elderly non-COPD patients[male 35,female 6, aged 55-89 years, average years(68.66±8.74)], and 167 non-smoking healthy subjects as the control group[male 132, female 35, aged 57-92 years, average years(69.13±7.21)] from April 2018 to January 2019. The relationship between the S100A8/A9, sRAGE and clinical biomarkers [the percentage of fored expiratory volume in one second(FEV1) in the predicted value, FEV1/fored vital capacity(FVC), neutrophile granulocyte(NEU)%, pack-year] were investigated. The diagnostic value of S100A8/A9, sRAGE and their combined detection for COPD was analyzed using the subject operating characteristic curve.@*Results@#The serum S100A8/A9 level [(2.70±1.11)μg/ml] in COPD patients was significantly higher than that in the smoking control group [(1.65±0.63) μg/ml] and the non-smoking control group[(0.99±0.48)μg/ml], t=5.807, P<0.000 1; t=18.45, P<0.000 1. The serum S100A8/A9 levels in patients with COPD[GOLD Ⅰ(2.08±1.08) μg/ml, GOLDⅡ (2.58±1.06) μg/ml, GOLD Ⅲ (2.69±1.12) μg/ml, GOLDⅣ (2.95±1.10)μg/ml] were significantly higher than the non-smoking control group(0.99±0.48)μg/ml, t=6.616, P<0.000 1; t=14.56, P<0.000 1; t=17.10, P<0.000 1; t=18.09, P<0.000 1.The serum sRAGE level [(0.29±0.25)ng/ml] in COPD patients was significantly higher than that in the smoking control group[(0.60±0.24)ng/ml] and the non-smoking control group[(0.85±0.35)ng/ml], t=7.367, P<0.000 1; t=18.14, P<0.000 1. The serum sRAGE levels in patients with COPD[GOLD Ⅰ(0.46±0.40),GOLDⅡ (0.28±0.25),GOLD Ⅲ (0.29±0.25),GOLD Ⅳ (0.25±0.19)ng/ml] were significantly lower compared with non-smoking control group[(0.85±0.35)ng/ml], t=3.459, P=0.000 5; t=10.23, P<0.000 1; t=13.95, P<0.000 1; t=11.70, P<0.000 1. Serum S100A8/A9 levels were positively correlated with smoking amount and NEU% (r=0.458 5, P<0.000 1; r=0.228 3, P=0.001 1), negatively correlated with FEV1/FVC, the percentage of FEV1 in the predicted value, and sRAGE(r=-0.190 6, P=0.006 4; r=-0.186 3, P=0.007 8; r=-0.201 7, P=0.003 9). sRAGE levels were negatively correlated with NEU% (r=-0.155 9, P=0.026 4). In the ROC curve, the area under the curve of S100A8/A9, sRAGE and combined detection were 0.922[95%CI(0.897-0.947)], 0.926[95%CI(0.899-0.952)]and 0.966 [95%CI(0.950-0.983)], respectively.@*Conclusion@#S100A8/A9 and sRAGE are closely correlated with the degree of airflow constrains and the levels of serum inflammatory mediators, which are expected to be as potential biomarkers of COPD.

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