The predictive value of thrombus markers for venous thromboembolism in patients with malignant tumors after surgery / 肿瘤研究与临床

Objective:To explore the predictive value of thrombus markers for venous thromboembolism (VTE) in patients with malignant tumors after surgery.Methods:The clinical data of 150 patients with malignant tumors after surgery admitted to Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine in Hebei Province from July 2020 to February 2021 were retrospectively analyzed. All 150 patients followed-up for 4 weeks were treated as the observation group, including 30 cases with VTE (the thrombosis group) and 120 cases without VTE (the non-thrombosis group). Another 60 cases undergoing healthy physical examination during the same period were selected as the control group. The chemiluminescence immunoassay was used to detect thrombin-antithrombin complex (TAT), plasmin-α 2 plasmin inhibitor complex (PIC), thrombomodulin (TM), tissue-type plasminogen activator inhibitor-1 complex(tPAIC). The control group was tested once, and the observation group was tested on the 1 day before the operation and 1 day after the operation. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of thrombus markers for VTE in patients with malignant tumors after surgery. Results:The patients with lung cancer ( χ2 = 12.53, P = 0.014), ≥ 60 years old ( χ2 = 6.66, P = 0.036),body mass index>30 kg/m 2 ( χ2 = 40.53, P<0.001), tumor metastasis ( χ2 = 5.38, P = 0.031), Ⅲ-Ⅳ stage ( χ2 = 5.83, P = 0.023) had higher incidence of VTE after the operation, and the difference was statistically significant. The levels of TAT, PIC and TM in the observation group were higher than those in the control group (all P < 0.05).The levels of TAT and TM in the thrombosis group were higher than those in the non-thrombosis group before the operation, and the difference was statistically significant (all P < 0.05).The value of TM in predicting VTE was high [the best cut-off value was 10.70 TU/ml, area under the curve (AUC) was 0.786, the sensitivity was 73.30%, the specificity was 81.70%], the combination of TAT and TM could improve the predictive value (AUC was 0.796, the sensitivity was 80.00%, the specificity was 77.50%). The levels of TAT, PIC, TM and tPAIC in thrombosis group were all higher than those in the non-thrombosis group after the operation, and the difference was statistically significant (all P < 0.05). The value of TAT in predicting VTE was high (the best cut-off value was 16.50 ng/ml, AUC was 0.887, the sensitivity was 82.36%, the specificity was 71.65%), the combination of TAT, PIC, TM and tPAIC could improve the predictive value (AUC was 0.913, the sensitivity was 90.00%, the specificity was 88.60%). The level of PIC was positively correlated with TAT before and after the operation ( r = 0.66, P < 0.001; r = 0.64, P < 0.001). Conclusions:TM can be used as a sensitive indicator in the early prediction of VTE for the patients with malignant tumors and it aims at the prevention; TAT can be used as a specific indicator in predicting the development of VTE and it aims at the intervention in time. The combined detection of TAT, PIC, TM and tPAIC can improve the predictive value of VTE. At the same time, PIC can be used to evaluate the risk of bleeding.

Evaluating value of modified critical care ultrasonic examination scheme for the etiological diagnosis of various shock in ICU patients / 中华急诊医学杂志

Objective:The purpose of this study was to investigate the evaluating value of modified critical care ultrasonic examination(M-CCUE) scheme for the etiological diagnosis of shock in ICU patients.Methods:The prospective study collected relevant clinical data of various shock patients admitted to the Department of Intensive Care Medicine, Henan Provincial People's Hospital from May 2020 to July 2021, including hemodynamic、blood indicators、organ/tissue perfusion and prognostic evaluation indicators.All selected patients completed the initial M-CCUE assessment within 30 minutes, were scored according to the M-CCUE score system and related data results were analyzed.Results:Ninety-three patients were included in this study,Two of them were not completed the M-CCUE assessment due to emergency treatment immediately after entering our department, and five were excluded due to inconsistent ultrasound judgments by the two physicians. In the end, a total of 86 patients were enrolled in the group. In patients applied with M-CCUE scheme,time to preliminary diagnosis and final diagnosis were (13.02±3.15)min and (67.70±20.20)min respectively, the accuracy of diagnosis was 83.7%. Among them, distributed shock accounted for 60.4%, hypovolemic shock accounted for 25.6%, cardiogenic shock and obstructive shock accounted for 3.5%, and mixed shock accounted for 7%; MCS is (13.27±4.91), M-CCUE scheme had the high sensitivity and specificity for the diagnosis of distributed shock (sensitivity 91.2%, specificity 93.9%), hypovolemic shock (sensitivity 96.0%, specificity 96.7%), cardiogenic shock (sensitivity 85.7%, specificity 98.7%) and obstructive shock (sensitivity 60.0%, specificity 100%); MCS has a good positive correlation with APACHEⅡ score ( r=0.861, P<0.001), and has no correlation with ICU cost ( r=0.012, P=0.915). There is no significant difference in MCS between the 28d death group and the recovery group ( P=0.391). Conclusions:For shock patients admitted to ICU with unknown etiology, the initial diagnosis of the cause of the M-CCUE program takes less time, has a higher correct diagnosis rate, sensitivity and specificity, and its quantitative evaluation results can predict the patient's criticality.

Clinical value of point of care ultrasound on cardiac output and volume responsiveness in patients with septic shock / 中华危重病急救医学

Objective:To assess the value of point of care ultrasound on cardiac output (CO) and volume responsiveness in patients with septic shock.Methods:A prospective investigation study was conducted. Twenty-four mechanical ventilation patients with septic shock who needed pulse-indicated continuous cardiac output (PiCCO) monitoring in the department of critical care medicine of Zhengzhou University People's Hospital, Henan Provincial People's Hospital from November 25, 2020 to April 30, 2021 were selected as the subjects, the patient's basic information and laboratory test results were recorded. PiCCO was used as standard to monitor CO and stroke volume variability (SVV) at 0, 2, 6, 12, 24 and 48 hours. At the same time, point of care transthoracic echocardiography (TTE) was used to measure velocity time integral (VTI) and inferior vena cava diameter (dIVC), the CO, VTI variation rate (△VTI) and dIVC variation rate (△dIVC) were calculated. Then, using the value monitored by PiCCO as the standard, the consistency and correlation analysis were carried out between point of care ultrasound with PiCCO.Results:Twenty-two out of 24 patients obtained satisfactory ultrasound Doppler images, the heart rate (HR), mean arterial pressure (MAP) and body temperature of the enrolled patients were consistent with the pathophysiological characteristics of septic shock. With the extension of treatment time, HR and CO both gradually decreased, and MAP gradually increased, reaching a peak or trough at 48 hours after admission. The difference were statistically significant compared with the time of admission [HR (bpm): 90.36±15.35 vs. 116.82±19.82, MAP (mmHg, 1 mmHg = 0.133 kPa): 87.82±11.06 vs. 58.82±9.85, CO (L/min): 4.80±0.56 vs. 6.78±1.31, all P < 0.05]. The CO obtained by PiCCO and point of care ultrasound had good agreement [5.36 (4.78, 6.33) L/min and 5.21 (4.88, 6.35) L/min, respectively], the average difference value at each time point was (-0.02±0.69) L/min, the 95% agreement limit range was -1.35-1.34, and there was a high degree of correlation ( rs = 0.800, P < 0.001); The SVV by PiCCO and the △dIVC by point of care ultrasound were in good agreement [18.00% (14.00%, 24.00%) and 21.00% (14.00%, 25.75%), respectively], the average difference value at the time point was (-3.16±6.89)%, the 95% agreement limit range was -16.89-10.54, and there was a moderate correlation ( rs = 0.702, P < 0.001); The SVV by PiCCO and the △VTI by point of care ultrasound were in good agreement [18.00% (14.00%, 24.00%) and 16.00% (11.25%, 20.75%), respectively], the average difference value at each time point was (13.03±14.75)%, and the 95% agreement limit range was 1.72-27.78, and there was a high correlation ( rs = 0.918, P < 0.001). Conclusion:Point of care ultrasound can accurately assess CO and volume responsiveness of patients with septic shock, and the △VTI is better than the △dIVC in assessing volume responsiveness.

Effects of dexmedetomidine on content of glutamate and expression of NR1 in hippocampus of mice with endotoxemia and the role of cholinergic anti-inflammatory pathway / 中华麻醉学杂志

Objective:To evaluate the effects of dexmedetomidine on the content of glutamate and expression of NR1 in hippocampus of mice with endotoxemia and the role of cholinergic anti-inflammatory pathway.Methods:Eighty clean-grade male C57BL/6 mice, aged 8 weeks, weighing 24-28 g, were divided into 4 groups ( n=20 each) using a random number table method: control group (group C), endotoxemia group (group LPS), dexmedetomidine group (group DEX) and alpha-bungarotoxin (α-BGT) group.Lipopolysaccharide 20 mg/kg was intraperitoneally injected to establish the model of endotoxemia in LPS, DEX and α-BGT groups. Dexmedetomidine 40 μg/kg was intraperitoneally at 15 min before establishing the model in DEX and α-BGT groups.In group α-BGT, alpha-7 nicotinic acetylcholine receptors specific agonist α-BGT 1 μg/kg was intraperitoneally injected at 15 min before injecting dexmedetomidine.Ten mice taken in each group were selected to collect the blood samples from the eyeball and then sacrificed, and hippocampi were isolated.Enzyme-linked immunosorbent assay was used to measure the concentration of serum S100β protein and NSE, and high-performance liquid chromatography was used to determine the content of glutamate in hippocampus.Ten mice in each group were sacrificed at 6 h after establishing the model to detect the expression of NR1 in hippocampus by immumofluorescence method. Results:Compared with group C, the concentrations of serum S100β protein and NSE concentrations and hippocampal glutamate content were significantly increased, and NR1 expression was up-regulated in LPS, DEX and α-BGT groups ( P<0.01). Compared with group LPS, the concentrations of serum S100β protein and NSE concentrations and hippocampal glutamate content were significantly decreased, and NR1 expression was down-regulated in DEX and α-BGT groups ( P<0.01). Compared with group DEX, the concentrations of serum S100β protein and NSE concentrations and hippocampal glutamate content were significantly increased, and NR1 expression was up-regulated in group α-BGT ( P<0.01). Conclusion:The mechanism by which dexmedetomidine alleviates cerebral injury is associated with activating cholinergic anti-inflammatory pathway, decreasing glutamate content and down-regulating NR1 expression in mice with endotoxemia.

The incidence of hashimoto's thyroiditis in medical examination population in Huanghua City, Hebei Province / 中华地方病学杂志

Objective To understand the detection rate of hashimoto's thyroiditis (HT) and the occurrence of abnormal thyroid function in medical examination population in Huanghua City,Hebei Province.Methods Using the retrospective analysis method,the thyroid examination data of residents of Huanghua City who were examined in the Cangzhou Hospital of Traditional Chinese and Western Medicine in Hebei Province from 2014 to 2016 were collected,the detection rate of HT and the occurrence of abnormal thyroid function were analyzed.Results A total of 4 413 people were examined,aged (45.76 ± 10.13) years old;including 2 099 males and 2 314 females.The HT detection rate of the medical examination population in Huanghua City was 6.55％ (289/4 413),and there was a trend of increasing year by year (x2trend =7.126,P ＜ 0.05).The difference in HT detection rates between different genders (male:2.86％,famale:9.90％) was statistically significant (x2 =89.077,P ＜ 0.05);there was a statistically significant difference in the HT detection rates among women of different age groups (x2 =18.541,P ＜ 0.05),and there was no significant difference in the detection rates of HT among men of different age groups (x2 =8.424,P ＞ 0.05).The incidence of abnormal thyroid function in HT patients was 25.61％ (74/289),of which the highest detection rate was 34.74％ (33/95) in the 40-＜ 50 years old group;the detection rates of HT with hyperthyroidism,hypothyroidism and subclinical hypothyroidism were 3.11％ (9/289),6.57％ (19/289) and 15.92％ (46/289),respectively.The detection rate of HT with subclinical hypothyroidism was higher.Conclusions The HT detection rate of the population in Huanghua City has increased year by year,and some HT patients are associated with abnormal thyroid function,and their detection rate of HT with subclinical hypothyroidism is the highest.Early diagnosis of HT should be strengthened,and appropriate prevention and treatment measures should be taken in time to reduce the occurrence of HT with abnormal thyroid function.

Analysis on drug resistance of Staphylococcus aureus between 2006 and 2011 / 国际检验医学杂志

Objective To study the drug resistance of Staphylococcus aureus in 2006 -2011 ,and to provide the evidence for treatment infection .Methods The isolated bacteria were identified and antibiotic sensitivity were tested by automated system in 503 Staphylococcus aureus collected from 2006 to 2011 .Methicillin resistant Staphylococcus aureus(MRSA) was screened by oxacillin disk diffusion .Results 503 strains mainly derived from secretion and sputum .The incidence of MRSA was 44 .9% during 6 years . Detection rate of MRSA was decreased year by year .The difference was statistically significant between 2009 ,2010 ,2011 and 2006 , 2007 ,2008(P<0 .05) .No resistance to quinupristin/dalfopristin ,linezoiid ,vancomycin and nitrofurantoin was found .The resistance of Staphylococcus aureus was below 30% to levofloxacin ,imipenem ,compound sulfamethoxazole and rifampicin ,above 80% to ce-fazolin and penicillin .Although the resistant to cefazolin ,levofloxacin ,imipenem was risen ,the resistant rate of rest antibiotics was downed year after year .Conclusion Monitoring of drug resistance should be strengthened .The antimicrobial therapy should be de-fined on the basis of drug-sensitive test in order to control the incidence of infection and to delay the growth of clinical resistant strains of Staphylococcus aureus .

Role of teaching resource database in blood disease testing technology teaching reform / 中华医学教育探索杂志

This paper introduced the necessity, background, principle, content, function of construction of teaching resource database of blood disease testing technology and its role played in teach-ing reform. Construction of teaching resource database made up for the insufficiency of blood disease test-ing technology in teaching time and resource, explored more scientific learning mode and teaching meth-ods and strengthened the cooperation between part-time teachers and professional teachers of blood dis-ease testing technology courses.