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Objective:To explore the clinical symptoms of effective blood volume deficiency caused by ultrafiltration in hemodialysis patients with chronic renal failure, and to analyze the changes of blood pressure during the formation of symptoms.Methods:From October 2016 to February 2019, 146 patients with maintenance hemodialysis were selected from the Yangquan coalmine group General Hospital for 39 658 hemodialysis.There were 3527 cases of clinical symptoms of definable hypovolemia.The characteristics of clinical symptoms in the early stage of dialysis (>0-≤60 min), medium (>60-≤180 min) and late (>180-≤240 min) were analyzed.To define the hypotension, hypertension and maintenance blood pressure in dialysis, and to count the incidence of various blood pressure when clinical symptoms appear.The mean arterial pressure (mean arterial pressure, MAP) measured at the onset of the disease was compared with (MAP) at the onset of dialysis, and the evolution of (MAP) was classified.The dialysis interval weight gain≥5% or<5%, was counted for the onset of the condition caused by dialysis ultrafiltration.To analyze the clinical symptoms of hemodialysis caused by ultrafiltration speed and excess.Results:The incidence of clinical symptoms was 8.9% (3527/39658). The clinical symptoms caused by the insufficiency of effective blood volume are manifested in each period of dialysis, and have the characteristics of disease.Blood pressure index can not accurately reflect the correlation of clinical symptoms.There were 493 cases of effective blood volume deficiency during dialysis >0-≤60 min.Among them, 341 cases of hypotension, accounting for 69.1% (341/493), 79 cases of hypertension, accounting for 16.1% (79/493), 73 cases of maintaining blood pressure, accounting for 14.8% (73/493). The incidence of clinical symptoms was increased when dialysis was >60-≤180 min, which was related to continuous or excessive ultrafiltration.There were 1306 cases in total, including 1003 cases of hypotension, accounting for 76.8% (1003/1306); 179 cases of hypertension, accounting for 13.7% (179/1306); 124 times of maintaining blood pressure, accounting for 9.5% (124/1306). Dialysis>180-≤240 min is the high incidence period of clinical symptoms, which is related to continuous ultrafiltration and exceeding the setting of dry body mass.There are 1728 cases in total, including 1408 cases of hypotension, accounting for 81.5% (1408/1728); hypertension is reduced, but there are still cases of stubborn hypertension.When the clinical symptoms of hypovolemia occurred, 1989 cases were hypotension, which was easy to attract clinical attention; 763 cases were hypotension, which was stable before the clinical symptoms appeared, and then the blood pressure dropped suddenly; 446 cases were significantly higher than before the clinical symptoms appeared, which made it difficult to judge the clinical symptoms; 329 cases maintained the blood before the dialysis pressure.Excessive water retention in the whole process of dialysis has clinical symptoms, the total number of times increased significantly.The incidence of common water retention was less than that of dialysis>180-≤240 min.The osmotic pressure of plasma colloid and crystal affects the refilling of plasma, the change of ultrafiltration mode and the change of dialysis temperature on blood pressure and blood volume.Conclusion:Because of the characteristics of the disease and the particularity of the treatment, the hemodialysis ultrafiltration process is prone to the related clinical symptoms caused by insufficient effective blood volume.However, the occurrence of clinical symptoms is not synchronous with the change of blood pressure.To improve the understanding of clinical symptoms of insufficient blood volume, to achieve early detection and early treatment is conducive to the safe treatment of follow-up hemodialysis and better completion of ultrafiltration target value.
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OBJECTIVE：To evaluate the quality of inflorescence of Coptis chinensis from different altitude with different growth years and drying processing methods ，and to provide reference for its utilization and quality control. METHODS ：The contents of total flavonoids and berberine hydrochloride in 24 batches of inflorescence of C. chinensis （S1-S24）from different altitude with different growth years and drying processing methods were determined by UV-Vis spectrophotometry and HPLC. Using the contents of total flavonoids and berberine hydrochloride as indexes ，and taking the short drying time as the best ，the weight ratios of total flavonoids content ，berberine hydrochloride content and standardized value of drying time were 30，40 and 30，respectively；comprehensive score was calculated ，then the quality of 24 batches of samples was evaluated. Using the contents of total flavonoids and berberine hydrochloride as variables ，systematic cluster analysis was performed for 24 batches of samples by using SPSS 19.0 statistical software. RESULTS ：For inflorescence of C. chinensis with altitude about 1 200 m and the growing years of 4 years and above ，the higher the comprehensive score （84-94 score）and the better the quality were. The comprehensive score of inflorescence of C. chinensis procesed by gradient drying method was generally higher than samples processed by other methods. Results of cluster analysis showed that S 1-S4，S9，S10，S13-S18 were clustered into one category ，and other 12 batches were clustered into one category ， which were basically consistent with the results of comprehensive scoring method. CONCLUSIONS：Different altitude ，different growth years and different drying processing methods have certain effects on the quality of inflorescence of C. chinensis ，among which the samples processed by gradient drying method with growth altitude of 1 200 m，growth years of 4 years and above are the best.
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Objective@#To explore the clinical symptoms of effective blood volume deficiency caused by ultrafiltration in hemodialysis patients with chronic renal failure, and to analyze the changes of blood pressure during the formation of symptoms.@*Methods@#From October 2016 to February 2019, 146 patients with maintenance hemodialysis were selected from the Yangquan coalmine group General Hospital for 39 658 hemodialysis.There were 3527 cases of clinical symptoms of definable hypovolemia.The characteristics of clinical symptoms in the early stage of dialysis (>0-≤60 min), medium (>60-≤180 min) and late (>180-≤240 min) were analyzed.To define the hypotension, hypertension and maintenance blood pressure in dialysis, and to count the incidence of various blood pressure when clinical symptoms appear.The mean arterial pressure (mean arterial pressure, MAP) measured at the onset of the disease was compared with (MAP) at the onset of dialysis, and the evolution of (MAP) was classified.The dialysis interval weight gain≥5% or<5%, was counted for the onset of the condition caused by dialysis ultrafiltration.To analyze the clinical symptoms of hemodialysis caused by ultrafiltration speed and excess.@*Results@#The incidence of clinical symptoms was 8.9% (3527/39658). The clinical symptoms caused by the insufficiency of effective blood volume are manifested in each period of dialysis, and have the characteristics of disease.Blood pressure index can not accurately reflect the correlation of clinical symptoms.There were 493 cases of effective blood volume deficiency during dialysis >0-≤60 min.Among them, 341 cases of hypotension, accounting for 69.1% (341/493), 79 cases of hypertension, accounting for 16.1% (79/493), 73 cases of maintaining blood pressure, accounting for 14.8% (73/493). The incidence of clinical symptoms was increased when dialysis was >60-≤180 min, which was related to continuous or excessive ultrafiltration.There were 1306 cases in total, including 1003 cases of hypotension, accounting for 76.8% (1003/1306); 179 cases of hypertension, accounting for 13.7% (179/1306); 124 times of maintaining blood pressure, accounting for 9.5% (124/1306). Dialysis>180-≤240 min is the high incidence period of clinical symptoms, which is related to continuous ultrafiltration and exceeding the setting of dry body mass.There are 1728 cases in total, including 1408 cases of hypotension, accounting for 81.5% (1408/1728); hypertension is reduced, but there are still cases of stubborn hypertension.When the clinical symptoms of hypovolemia occurred, 1989 cases were hypotension, which was easy to attract clinical attention; 763 cases were hypotension, which was stable before the clinical symptoms appeared, and then the blood pressure dropped suddenly; 446 cases were significantly higher than before the clinical symptoms appeared, which made it difficult to judge the clinical symptoms; 329 cases maintained the blood before the dialysis pressure.Excessive water retention in the whole process of dialysis has clinical symptoms, the total number of times increased significantly.The incidence of common water retention was less than that of dialysis>180-≤240 min.The osmotic pressure of plasma colloid and crystal affects the refilling of plasma, the change of ultrafiltration mode and the change of dialysis temperature on blood pressure and blood volume.@*Conclusion@#Because of the characteristics of the disease and the particularity of the treatment, the hemodialysis ultrafiltration process is prone to the related clinical symptoms caused by insufficient effective blood volume.However, the occurrence of clinical symptoms is not synchronous with the change of blood pressure.To improve the understanding of clinical symptoms of insufficient blood volume, to achieve early detection and early treatment is conducive to the safe treatment of follow-up hemodialysis and better completion of ultrafiltration target value.
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Objective@#To investigate the relationship between neutrophil-to-lymphocyte ratio (NLR) and myocardial injury induced by acute carbon monoxide poisoning.@*Methods@#A retrospective analysis was performed on 214 patients with acute carbon monoxide poisoning who were admitted to Emergency Depart-ment of Harrison International Peace Hospital, Hebei Medical University, from 2015 to 2017. According to the diagnostic criteria for toxic heart disease and the level of cardiac troponin I (cTnI), a biomarker of cardiac injury, these patients were divided into myocardial injury group (n = 84) and non-myocardial injury group (n=130). The general information of age and sex, as well as routine blood test results and cardiac injury biomarkers on admission, were collected. NLR was calculated and compared between the two groups. The relationship between NLR and cTnI was analyzed. Logistic regression analysis was used to identify the influenc-ing factors for myocardial injury induced by acute carbon monoxide poisoning. The receiver operating charac-teristic curve was used to evaluate the predictive value of NLR on admission for myocardial injury induced by acute carbon monoxide poisoning.@*Results@#There were significant differences between two groups in male patients, the history of smoking, white blood cell count (WBC), NLR, creatine kinase-MB, and lactate dehydro-genase(P<0.01). In the myocardial injury group, NLR was positively correlated with cTnI (r=0.295, P<0.01). The multivariate logistic regression analysis showed that NLR (odds ratio OR=1.079, 95% confidence inter-val CI: 1.017~1.144, P<0.01), WBC (OR=1.216, 95% CI: 1.098~1.346, P<0.01), and male sex (OR = 2.693, 95% CI: 1.045~6.939, P= 0.05) were independent risk factors for myocardial injury induced by acute carbon monoxide poisoning. In predicting myocardial injury induced by acute carbon monoxide poisoning, NLR on admission had a sensitivity of 85.7% and a specificity of 45.4% at the optimal cut-off value of 4.83.@*Conclusion@#Increased NLR on admission has a certain predictive value for myocardial injury induced by acute carbon monoxide poisoning.
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Objective@#To observe the effect of ulinastatin on myocardial injury in patients with acute severe carbon monoxide poisoning (ASCOP) .@*Methods@#By using the prospective study method, 123 cases of ASCOP patients admitted to our hospital, were randomly divided into two groups. There were no significantly different between the two groups in the abnormal rates of ECG, brain natriuretic peptide (BNP) , troponin I (cTNI) , creatine phosphokinase (CK-MB) and creatine phosphokinase (CK) . The control group according to the patients need to be treated with hyperbaric oxygen and routine medical treatment; the observation group was treated with ulinastatin 100 thousand u intravenous injection based on routine treatment measures on Q8 h, the two groups were 7 d for the 1 course of treatment. Compared two groups of patients after 3 days, 7 days of electrocardiogram, brain natriuretic peptide (BNP) , troponin I (cTNI) , creatine kinase isoenzyme (CK-MB) , creatine kinase (CK) , the case fatality rate within 14 days, and the abnormality rate of BNP, cTNI, CK-MB and Ck.@*Results@#the observation group for 3 days, 7 days, 14 days were abnormal, brain natriuretic peptide (BNP) , cardiac troponin I (cTNI) , creatine kinase isoenzyme (CK-MB) , creatine kinase (CK) the average results were significantly lower than those in the control group (P<0.05) ; The 14 d BNP in the observation group was significantly lower than the control group (P<0. 05) ; the case fatality rateof observation group was lower than the control group within 14 days (1.2% vs 3.3%) .@*Conclusion@#Ulinastatin can significantly improve the ASCOP to reduce the damage to the heart, reduce the case fatality rateand improve the prognosis.
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BACKGROUND:Rabbit bone marrow mesenchymal stem cels as a kind of adult stem cels with strong proliferation and multilineage differentiation potential exhibit a tremendous application potential in tissue engineering and biological therapy. OBJECTIVE:To in vitro culture, proliferate and identify rabbit bone marrow mesenchymal stem cels and to observe cel biological characteristics. MEHTODS:Bone marrow of rabbits was extracted under sterile conditions to separate bone marrow mesenchymal stem cels using the whole bone marrow adherence method and Percol density gradient centrifugation method. Afterwards, the cels were purified and proliferated using differential adherence method. Morphology and growth pattern of cels were observed under microscope, and expression of cel surface antigen markers was detected by flow cytometry. RESULTS AND CONCLUSION:Rabbit bone marrow mesenchymal stem cels presented with short adherent time and fast growth. After passage and purification, impurities cel counts were decreased. Primary cels presented with triangular, fusiform and spindly shapes. Passage 5 cels with single shape showed the typical polar swirling growth, and could not express CD34 and CD45, but expressed CD29 and CD44. These findings indicate that the cels cultured using the whole bone marrow adherence method and Percol density gradient centrifugation method possess stem cel characteristics in morphology, surface markers and multilineage differentiation, which have been identified as bone marrow mesenchymal stem cels by flow cytometry.
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BACKGROUND:As bone marrow mesenchymal stem cel s can be differentiated into osteoblasts under certain induction conditions, autologous bone marrow mesenchymal stem cel s can be implanted into the bone nonunion site of bone fracture. This new technology garners increasing attention of orthopedic clinicians. OBJECTIVE:To summarize the clinical efficacy of transplantation of bone marrow mesenchymal stem cel s in the treatment of bone nonunion of limb fractures. METHODS:A computer-based search of Foreign Medical Journal Ful-Text Service and CNKI databases was performed for articles related to bone marrow mesenchymal stem cel s for treatment of bone nonunion of limb fractures published from 1998 to 2014 using the keywords of“bone marrow stem cel s (BMSCs), stem cel transplantation (SCT), nonunions, tissue engineering”in English and Chinese, respectively. Literatures with repetitive content and lack of originality were excluded. A total of 36 literatures were obtained for further analysis. RESULTS AND CONCLUSION:Bone marrow mesenchymal stem cel s are transplanted into the end of bone nonunion, and then can be induced to differentiate into osteoblasts to repair bone nonunion and bone defects, laying a theoretical basis for clinical application. Bone marrow mesenchymal stem cel s can repair bone defects, which provides an effective method and material to promote fracture healing. Transplantation of bone marrow mesenchymal stem cel s is safe and effective for treatment of bone nonunion of limb fracture.
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Objective To compare the clinical effects between the two-level ladder ultrafiltration and sequential dialysis for hemodialysis patients with excessive water retention.Methods According to our hospital standard,23 patients with water retention during treatment with dialysis from January 2010 to September 2011 were selected.And they conducted a total of 198 dialysis.Both the two-level of high-level segment and sequential ultrafiltration step dialysis were set for 1 hour.Ultrafiltration accounted for one-third of the total,and the remaining two-thirds of the amount of ultrafiltration was completed in the remaining time.The blood pressure,ultrafiltration volume completed,plasma osmotic pressure,detection of vascular access pressure,and other observed indicators during dialysis were compared.Results The occurrence of hypotension and muscle spasms in two-level ladder ultrafiltration was slightly more than that in sequential dialysis,ultrafiltration volume completed actually in two-level ladder ultrafiltration was a little less than sequential dialysis.However,the difference was not statistically significant ( P ＞ 0.05 ).It took more time during sequential dialysis simple ultrafiltration,occasionally dialysis fluid stopped flowing and dialyzer and the trail tube lack of incubation,and some patients could not adapt to it.Amount of heparin( [7.48 ± 1.73 ] mg/h vs[6.25 ± 1.36] mg/h,t =5.374,P ＜ 0.01 ),venous pressure ( [ 128.62 ± 10.53 ] mm Hg vs [ 96.35 ± 11.84 ] mm Hg,t =20.166,P ＜ 0.01 ),trausmembrane pressure( [ 236.84 ± 23.65 ] mm Hg vs [ 175.94 ± 24.72] mm Hg,t =17.516,P ＜ 0.01 ) were significantly higher than those in the high level of ultrafiltration period.Mean arterial pressure ( MAP ) ( [ 100.48 ± 5.78 ] mm Hg vs [ 102.54 ± 5.39 ] mm Hg,t =2.571,P ＜ 0.05 ) and plasma osmotic pressure ( [ 311.42 ± 7.36] mOsm/( kg · H2O ) vs [ 3 1 7.31 ± 6.89 ] mOsm/( kg · H2O ),t =5.774,P ＜ 0.01 ) in high level period were significantly lower than those in the singal ultrafiltration period,and the MAP difference was higher than that in the singal ultrafiltration period ( [ 11.46 ± 6.53 ] mm Hg vs [ 9.42 ± 5.46 ] mm Hg,t =2.385,P ＜ 0.05 ).There is less symptomatic hypotension and other adverse reactions.Conclusion Two dialysis ultrafiltration method can both be used for patients with excessive water retention,they can reduce the ultrafiltraion complications and achieve ultrafiltration targets.Two-level ladder ultrafiltration with dialysis and ultra.filtration unity is more likely to be adopted by the clinic.
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OBJECTIVE To evaluate the commonly encountered pathogens and drng resistance of bacteria causing secondary infection in patients with malignant tumors and provide reference for clinical antimicrobial usage.METHODS Statistical analysis was made retrospectively in the classification and antimicrobial susceptibility testing in 1 204 strains of pathogens isolated from clinical samples of hospitalized patients with malignant tumors from Jan 2003 to Oct 2005.RESULTS Among 1 204 strains,Gram-positive strains accounted for 31.1%;Gram-negative ones accounted for 52.8%;and fungi accounted for 16.1%.The principal strains were Candida albicans,Escherichia coli,Staphylococcus aureus,Klebsiella pneumoniae,and Pseudomonas aeruginosa.The most frequent infection sites were in respiratory tract,urinary tract and skin-soft tissue.Multiple drug resistant rate of Gram-positive and Gram-negative strains had a tendency of elevation.CONCLUSIONS To reduce the coming of drug resistant strains,etiologic examination should be done in treatment of infectious diseases and antimicrobial therapy should be decided according to the results of susceptibility.