Résumé
Objective:To investigate the collection efficiency of peripheral blood hematopoietic stem cells and explore its influencing factors.Method:The parameters of the collection process, blood routine indexes and the number of MNC and CD 34+ cells of the product were detected by Fresenius blood cell separator, Mindray blood cell analyzer and BD flow cytometer. A retrospective analysis was performed on 72 patients who underwent autologous peripheral blood hematopoietic stem cell transplantation in Southwest Hospital of Army Medical University from January 2013 to January 2021, including the correlation among gender, age, blood routine indexes, collection circulation volume and MNC and CD 34+ cell count in these cases, and influence of various factors on collection efficiency of peripheral blood stem cells. The correlation among gender, age, blood routine indexes, collection circulation volume and MNC and CD 34+ cell count in 72 cases of autologous transplantation patients, and influence of various factors on collection efficiency of peripheral blood stem cells were analyzed retrospectively. Results:There were no significant differences in collecting efficiency of peripheral blood stem cells among patients with different age, sex and disease type ( P>0.05). The collected MNC count of all patients was positively correlated with the collection cycle count ( r = 0.33, P<0.001) and WBC count after mobilization ( r = 0.41, P<0.001). The number of CD 34+ cells collected was positively correlated with MNC count after mobilization ( r = 0.38, P<0.001) and the amount of white membrane collected ( r = 0.48, P<0.001). Logistic multivariate regression analysis showed that MNC count after mobilization: P<0.001, 95% CI 0.07(0.05 - 0.09), collection cycle amount [ P<0.001, 95% CI 0.00(0.00 - 0.00)] and postharvest total amount [ P<0.001, 95% CI 0.07(0.05 - 0.10)] were the influencing factors of the collected MNC number. Meanwhile, these factorswere also the influencing factors of the collected CD 34+ number (MNC count after mobilization: P<0.001, 95% CI 0.09(0.04 - 0.14); collection cycle amount: P = 0.003, 95% CI 0.00(0.00 - 0.00); postharvest total amount: P = 0.005, 95% CI 0.08(0.03 - 0.14)). Conclusions:The collection efficiency of peripheral blood stem cells varies greatly among individuals. The more MNC counts after mobilization, the more peripheral blood stem cells could be collected. In order to obtain high collection efficiency, it is necessary to adjust the parameters of peripheral blood MNC before collection, and pay attention to the collection circulation quantity, postharvest total amount and white membrane volume.
Résumé
Objective To compare the clinical efficacy between single and double volume exchange transfusion for neonatal hyperbilirubinemia,and to verify whether single volume exchange transfusion had advantages in maintaining homeostasis and reducing blood transfusion related complications.Methods Clinical materials of 86 neonates with neonatal hyperbilirubinemia who received blood exchange transfusion,from December 2013 to December 2014,in the diagnosis and treatment center of our hospital were retrospectively analyzed.Cases were divided into the single volume group (35 cases,with a blood volume 80-110 mL/kg) and double volume group (51 cases,with a blood volume 150-180 mL/kg) based on blood volume per kilogram of body weight.Comparisons of the homeostasis changes between pre-transfusion and post-transfusion were performed for each group,and the incidence rate of major adverse events were compared between the two groups.Results (1)In the single volume group and double volume group,the average blood exchange transfusion volumes were (98.16 ± 10.75) mL/kg and (157.78 ± 7.37) mL/kg,the exchange rate of bilirubin were (41.68± 8.52) ％ and (50.22 ± 13.14) ％,and the average time for blood transfusion were (85.60 ±18.66) min and(1 1B.22± 24.81)min respectively,and there were statistically significant differences in the exchange rate of bilirubin and average time for blood transfusion between the two groups (P＜0.05).(2)Compared with pre-transfusion,WBC and platelet (PLT)count,levels of serum total bilirubin (TBIL),albumin,serum potassium,serum sodium,serum chlorine,serum calcium and HCO3-,and pH value were significantly decreased after blood exchange transfusion,while RBC count,PT,APTT and blood glucose were significantly increased in the two groups (P＜0.01).Moreover,the changes of blood glucose,PLT and TBIL in the double volume group were more significantly than those in the single volume group,there were statistically significant differences (P＜0.05).No statistically significant difference was found in the rate of major adverse events between the two groups (P＞0.05).Conclusion Compared with double blood exchange transfusion therapy,single volume exchange transfusion can significantly decrease plasmic bilirubin level with less change of homeostasis,less blood volume for transfusion and less human resources consumption,its value in clinical application is recognized.
Résumé
Objective To compose a scientific, systematic and operative nursing quality evaluation system for neonatal blood exchange transfusion, and to provide a reference for quality control of clinical nursing practice. Methods Semi-structured interviews were conducted, the related literature was reviewed, and a preliminary Delphi enquiry questionnaire with the frame of structure quality, process quality and outcome quality was ultimately formed. Through Delphi enquiry questionnaires and analytic hierarchy processing method, all the indictors and the weights were affirmed. Results Totally 19 experts participated in the inquiry, the authority coefficients in the 2 rounds were 0.91 and 0.93 respectively, theχ2 test of Kendall′s W coefficients was significance with P<0.01. The nursing quality evaluation system for neonatal blood exchange transfusion was finalized with 3 level-1 indicators, 9 level-2 indicators and 39 level-3 indicators. Conclusions The nursing quality evaluation system developed through this study can provide practical reference to clinical nursing practice.
Résumé
Objective To investigate the different immune status of TCM classification and the levels of T and B cells and the re-lationship between the NK cells .Methods Three different immune state of patients with chronic HBV were divided into asthenia syndrome(AS) group and sthenia syndrome(SS) group ,and then we detected the peripheral blood lymphocyte subsets and NK cells ,and compared the above each index analysis .Results In three different immune status ,all patients with AS and SS groups CD4+ T cell percentages are lower than normal control group (P control group> the AS group (P<0 .05) .Three different immune status ,the ratio of CD4+ /CD8+ SS group were significantly lower than the AS group or control group ,in a state of immune clearance the SS and the AS group B lymphocyte percentage were higher than the control group ,the percentage of NK cells was lower than the control group (P<0 .05) .Conclusion Chronic HBV infection have immune dysfunction ;HBV infected different immune status of TCM classification have relationship with T and B cell subsets and NK cells ,and the immune function test has certain clinical application value for the judgment of TCM syndrome type .
Résumé
Objective To investigate the application of OSCE evaluation system on the medical skills examination of clinical medical students and the significance of this system on the training of their medical skills.Methods 20 teachers examed 150 students by the OSCE evaluation system with 4 test stations,by comparing the score of the students of different test stations by one-way ANOVA and evaluating the system by questionnaire survey with Likert 5 on the degree of satisfaction and Likert 3 on effects and intrinsic influencing factors of the system.Results The score of the first and forth test stations was lower than that in the other stations(P＜0.05).8/5.48％ students and 1/5％ teachers were not satisfied with the system.The OSCE evaluation system could exam the psychological diathesis,ability of communication,cooperation,and clinical thinking,practical skill of the students and its effects are moderate (the score was more than 2.0).Evaluation on the intrinsic influencing factors:Students considered the questions were more difficulty in the 2nd,3rd,1st,4th test stations order.4/20％ teachers considered the questions of the second test station was easy.8/40％ teachers considered the duration of the second test station was too long.More than 70％ students and teachers considered the other indexes were rational.Conclusion The OSCE evaluation system can play an effective role in directing the teaching and learning.It can also help to culture the comprehensive capacity of the students.We should gradually improve the design of the system by considering the intrinsic influencing factors.
Résumé
Objective To explore the percentage changes of peripheral T , B cell subsets and NK cells in chronic HBV infectors under different immune states and hepatitis B cirrhosis . Methods Seventy-five chronic HBV infectors, including 20 cases with immune clearance, 20 cases with immunodeficiency (inactive) and 35 cases with cirrhosis, and 20 healthy control were enrolled. The percentages of peripheral T and B lymphocyte subsets and NK cells were detected by Flow Cytometry. The differences of the groups were analyzed. Results Comparing with the control group, CD4+T cells were decreased in the other four groups (P<0.05). The sequence of CD4+T cells, from high to low, was the control group, the immunodeficiency group, the immune clearance group, the compensated cirrhosis group and the de-compensated cirrhosis group. CD4+/CD8+T cell and NK cell were lower , but CD8+T cell and B cell were higher in immune clearance group than that of the control group (P < 0.05). Patients in immunodeficiency group had lower ratio of CD4+/CD8+T cell and higher CD8+T cell than those in the control group (P < 0.05). In all the groups, patients with de-compensated cirrhosis showed highest ratio of CD4+ to CD8+ T cells and B cells, but lowest CD3+T, CD8+ T and NK cells (P < 0.05). Conclusions Results suggests immune dysfunction exists in patients with chronic HBV infection. It has potential clinical value in understanding patients′ immune states and progression of disease by detecting peripheral blood lymphocyte subsets and NK cells.
Résumé
BACKGROUND: In the researches of Ginkgo Biloba Extract(GBE) in the treatment of cerebra ischemia, because of the application of generally anaesthesia medication that may induce the alteration of cerebral temperature, the accuracy of the results may be affected.OBJECTIVE: To investigate the impact of domestic GBE on antioxidase and lipid peroxide of cerebral ischemic reperfusion tissue as well as the water content of ischemic brain tissue under normothermia.DESIGN: A randomised controlled trial.SETTING and MATERIALS: Study was conducted in the Tongji Medical University of Huazhong Science and Technology University. A total of 24 Wistar rats with a mass from 250 g to 300 g were randomly allocated into sham-operation group ( n = 8 ), cerebral ischemia control group ( n = 8) and cerebral ischemia GBE treatment group( n = 8) . The animal model of normothermia rat with left middle cerebral artery ischemia for 2 hours and reperfusion for 2 hours was prepared with the reference of Nagasawa method in the animals of control group and treatment group for contrast study.INTERVENTIONS: The cerebral temperature of the rats was reflected by the temperature of the temporal muscle. The temperature-measuring probe was embedded into the deep part of the left temporal muscle closed to osseous ectoblast. The temperature was continuously monitored by semiconductor oxide temperature sensor. The temperature of the head was heated with 60 W filament lamp and adjusted by automatic double-controlling craniocerebral cooling instrument to maintain the cerebral temperature at normothermia level of 36.5 ℃ - 37 ℃. The normothermia cerebral ischemic reperfusion injury rat model was established according to the design. GBE injection was injected respectively into abdominal cavity in the rats of cerebral ischemia GBE treatment group at the following time point: 12 hours, 8 hours and 4 hours before operation, immediately after cerebral ischemia and immediately after reperfusion, with 3 mL each time and 5 times in total. Same times and dose of normal saline was injected into the abdominal cavity in the rats of both control group and sham-operation groups.MAIN OUTCOME MEASURES: Superoxide dismutase (SOD), glutathione peroxidase(GSH-Px), reduced glutathione(GSH), malondialdehyde(MDA)and water contents in the cerebral ischemic tissue.RESULTS: The levels of SOD, GSH-Px and GSH in cerebral ischemia control group were(73.35 ± 12. 86) NU/mg, (167.37 ±54.34) μkat/g and (196. 84 ± 22.75) μg/g respectively, which significantly lower than that (96. 02± 16. 83) NU/mg, (338.57±84.02) μkat/g and(337.51± 34. 89) μg/g of sham-operation group( P ＜ 0. 01 or P ＜ 0.05) . The SOD, GSH-Px and GSH levels of cerebral isehemia GBE treatment group were (87.24± 15.03) NU/mg, (316. 56 ±93.52) μkat/g and(263.16±28.54) μg/g, which significantly higher than that of cerebral ischemia control group(P ＜ 0.01 or P ＜ 0.05) .The MDA level of cerebra ischemia control group was (308.34 ± 26.81 ) nmol/g, which significantly higher than that(101.46 ± 10.97) nmol/g of sham-operation group( P ＜ 0.01 ) .The MDA level of cerebral ischemia GBE treatment group was(125.86± 13.90) nmol/g, which was significantly lower than that of sham-operation group ( P ＜ 0.01 ) . The water content of cerebral ischemia control group was(80. 45 ± 0.44)%, which was significantly higher than that (78.20 ± 0. 25 ) % of sham-operation group ( P ＜ 0.01 ) . The water content of cerebral ischemia GBE treatment group was(79.63 ± 0.46) %, which was significantly lower than that of cerebral ischemia control group( P ＜ 0.05).CONCLUSION: Domestic GBE can inhibit the excessive production of free radicals and the lipid peroxidation during cerebral ischemia and reduce cerebral oedema and the destruction of blood-brain barrier to protect cerebral ischemic tissues under cerebral normothermia.