Progress in quality management and control of donor organ procurement in foreign countries / 器官移植

Since the 20th century, organ transplantation has become a breakthrough technology to effectively save the lives of patients with end-stage organ failure, which has significantly enhanced the quality of life of patients. Organ donation is an important source of organ transplantation. Improving the quality of donor organ procurement is the key to promote the translation of donor organs and improve the prognosis of organ transplantation recipients. The United States, Spain and other countries have put forward a series of policies and standards in the quality management and control of donor organ procurement and achieved positive results. In this article, related concepts of medical quality management and control, advanced strategies and models of international donor organ procurement quality management, and quality control measures of Organ Procurement Organization, donors and donor organs were reviewed, aiming to provide reference for establishing a quality management and control system of donor organs with "Chinese characteristics" and advancing high-speed and high-quality development of donor organ procurement.

Prognosis analysis of multi-indicator combined with sequential organ failure assessment in patients with sepsis / 中华危重病急救医学

OBJECTIVE@#To explore the prognostic value of early multiple detection indicators in combination with sequential organ failure assessment (SOFA) in sepsis patients.@*METHODS@#A retrospective analysis was conducted. Patients with sepsis admitted to the department of critical care medicine of Huanggang Central Hospital of Yangtze University from May 2020 to May 2022 were selected as the research subjects. Coagulation indicators, inflammatory factors, blood routine, liver and kidney function, and blood gas analysis were collected at admission. Organ dysfunction was assessed based on the SOFA score within 24 hours after admission. Patients were divided into a survival group and a death group according to the outcome of 28 days in ICU. Differences in the above indicators between the two groups were compared. Multifactorial Logistic regression analysis was used to analyze prognostic factors of 28-day mortality in sepsis patients. Receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive performance of various indicators, the SOFA score, and the combine model for the 28-day outcome in patients with sepsis.@*RESULTS@#A total of 101 patients with sepsis were enrolled, 56 patients survived and 45 patients died. Compared to the survival group, patients in the death group were older, the proportion of patients with septic shock was larger, the SOFA score, and the proportion of pulmonary infection were higher, the prothrombin time (PT) and activated partial thromboplastin time (APTT) were significantly prolonged, the prothrombin activity (PTA) was significantly shortened, and antithrombin (AT) was significantly decreased, the levels of hypersensitivity C-reactive protein (hs-CRP), blood urea nitrogen (BUN), total bilirubin (TBil), and lactic acid (Lac) were significantly increased, while the platelet count (PLT) was significantly decreased. Multifactorial Logistic regression analysis showed that pulmonary infection [odds ratio (OR) = 0.010, 95% confidence interval (95%CI) was 0.001-0.164, P = 0.001], AT (OR = 0.944, 95%CI was 0.910-0.978, P = 0.002), hs-CRP (OR = 1.008, 95%CI was 1.001-1.015, P = 0.017), Lac (OR = 1.619, 95%CI was 1.195-2.193, P = 0.002), and SOFA score (OR = 1.363, 95%CI was 1.076-1.727, P = 0.010) were independent prognostic factors for 28-day mortality in patients. A combined model was constructed using pulmonary infection, AT, hs-CRP, Lac, and SOFA score. ROC curve analysis showed that the area under the ROC curve (AUC) for the combine model in predicting sepsis prognosis was 0.936 (95%CI was 0.869-0.975, P < 0.001), which was higher in value compared to single indicators (AUC of AT, hs-CRP, Lac, and SOFA score were 0.775, 0.666, 0.802, 0.796, respectively, all P < 0.05).@*CONCLUSIONS@#The predictive ability of the SOFA score for sepsis patient outcomes is limited. The combine model combining infection site, AT, hs-CRP, and Lac shows better predictive ability.

Effect of intravitreal injection of Ranibizumab on choroid in patients with severe NPDR with macular edema / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To investigate the changes of choroidal thickness in patients with severe non-proliferative diabetic retinopathy (NPDR) after vitreous injection of ranibizumab,and to analyze the relationship between the thickness of choroid and the visual acuity of the patients.METHODS:Eighty patients with severe non-proliferative diabetic retinopathy were selected from January 1,2014 to January 1,2017.All patients were divided into observation group and control group according to the random number table,40 cases in each group.The control group was treated in a conventional manner,and the observation group was injected with ranibizumab in the vitreous.The thickness of the choroid in the macular area and the thickness of the retinal neuroepithelium in the macular area were compared between the two groups before and after treatment.The changes of the corrected visual acuity were analyzed at 1mo before and after treatment.The relationship between the thickness of the choroid and the thickness of the retinal neuroepithelium and the best corrected visual acuity were compared.The complications and adverse events were compared between the two groups after 6wk of treatment.RESULTS:The thickness of the choroid and the retinal neuroepithelium in the macular area before were 219.57± 51.24μm and 474.76 ± 95.56μm,respectively,in the observation group and the control group,217.56± 50.36μm and 473.27 ± 96.48μm,respectively.The thickness of the choroid and the thickness of the retinal neuroepithelium in the macular area after treatment were 180.15±42.06μm and 382.18±84.26,202.48±48.28μm and 407.88± 44.25μm,respectively.The difference between the two groups was statistically significant (P＜0.05).The best corrected visual acuity in the observation group and the control group were 0.47±0.19 and 0.53±0.25 respectively (P＜0.05).There was a positive correlation between the choroidal thickness and the best corrected visual acuity in the macular fovea (regression coefficient=1.12,S=0.48,OR=1.376,P＜ 0.05).There was a positive correlation between retinal neuroepithelial thickness and best corrected visual acuity in the macular area (regression coefficient =0.95,S=0.27,OR=1.020,P＜ 0.05).There were 2 eyes (5％) with subconjunctival hemorrhage,1 eyes (2.5％) of glaucoma,1 eyes (2.5％) of vitreous hemorrhage,0 of choroidal detachment,retinal detachment in 0 in observation group at 6wk after treatment.There were 4 eyes (10％) with subconjunctival hemorrhage,2 eyes (5％) of glaucoma,2 eyes of vitreous hemorrhage (5％),2 eyes of choroidal detachment (5％),retinal detachment in 2 eyes (5％) in the control group,and the difference between the two groups on the complications and adverse reactions was statistically significant (P＜0.05).CONCLUSION:The choroidal thickness of patients with macular edema in severe non-proliferative diabetic retinopathy is correlated with the best corrected visual acuity.Intravitreal injection of ranibizumab can effectively reduce the macular fovea choroidal thickness,reduce macular edema and improve vision,and less complications.

A Case of Primary Adrenal Diffuse Large B-cell Lymphoma Achieving Complete Remission with Rituximab-CHOP Chemotherapy

Primary adrenal lymphoma is a very rare extranodal lymphoma; its clinical features consist of a high incidence of bilateral adrenal involvement and diffuse large B-cell lymphoma. We report a patient with primary bilateral adrenal diffuse large B-cell lyphoma who achieved complete remission with R-CHOP (rituximab-cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy. A 52-yr-old man presented with fever and progressive fatigue for 3 months. Computed tomography (CT) scans of the abdomen and pelvis demonstrated large bilateral adrenal masses, and a needle biopsy of the left adrenal mass revealed diffuse large B-cell lymphoma. After 6 cycles of R-CHOP chemotherapy, CT scans showed no residual disease. To our knowledge, this is the second report to date of a patient with primary bilateral adrenal diffuse large B-cell lymphoma who achieved complete remission using R-CHOP chemotherapy.