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Objective:To investigate the safety and effectiveness of extracorporeal membrane oxygenation (ECMO) in emergency treatment of critically ill pregnant women.Methods:Clinical data of 8 pregnant women with severe cardiopulmonary dysfunction during the perinatal period treated by ECMO in the department of intensive care unit (ICU) of Nanjing Drum Tower Hospital, the Affiliated Hospital to Nanjing University Medical School from September 2017 to November 2020 were retrospectively analyzed. Results:For the 8 pregnant women, the mean age was (32.5±6.3) years old. Body weight was (73.5±8.1) kg. Gestational age was (31.0±4.4) weeks. Acute physiology and chronic health evaluationⅡ (APACHEⅡ) score was 13.0±6.6, and sequential organ failure assessment (SOFA) score was 8.3±3.8. Among them, 5 pregnant women suffered from severe pneumonia and were treated with veno-venous ECMO (VV-ECMO). Another 3 pregnant women with heart failure underwent veno-arterial ECMO (VA-ECMO). The initial ECMO flow rate was set to 2.0-3.0 L/min. Then the highest flow rate was (3.1±0.6) L/min, and the average ECMO running time was (174±36) hours. The length of ICU stay was (16.0±5.4) days. Six pregnant women (5 with severe pneumonia and 1 with peripartum cardiomyopathy) successfully evacuated from ECMO and survived. Two pregnant women with pulmonary hypertension showed poor prognosis. In total, seven babies survived. Two of them were delivered after ECMO evacution, and one underwent emergency cesarean section with ECMO support. In another case, the fetus could not be delivered due to under-gestational weeks. During this period, there were no serious bleeding complications. One pregnant woman developed heparin-induced thrombocytopenia and thrombosis (HITT), then she received another anticoagulant treatment. One pregnant woman got sequential anticoagulation therapy for 3 months on account of thrombosis in the puncture vessel.Conclusions:ECMO has played an active role in the rescue of critically ill pregnant women. For those with reversible severe cardiopulmonary dysfunction, it is necessary to evaluate the application of ECMO as early as possible to improve the survival rate of mothers and infants.
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Objective To analyze the clinical characteristics of bloodstream infection in patients with immune function inhibition. Methods A retrospective analysis was conducted. 234 patients with bloodstream infection admitted to intensive care unit (ICU) of the Affiliated Drum Tower Hospital of Nanjing University Medical School from August 1st in 2015 to December 31st in 2017 were enrolled. According to the immune function on the day of bloodstream infection, they were divided into normal immune function group [human leukocyte antigen DR (HLA-DR) > 30%, n = 144] and immunosuppression group (HLA-DR ≤30%, n = 90). The gender, age, primary disease, complication, acute physiology and chronic health evaluationⅡ (APACHEⅡ) with 24 hours after ICU admission, sequential organ failure assessment (SOFA) score, etiology, infection parameters on the day of bloodstream infection [peak temperature, white blood count (WBC), neutrophils ratio, procalcitonin (PCT), and C-reactive protein (CRP)] and prognosis parameters (bacterial clearance time, the length of ICU and hospital stay, 28-day mortality) between the two groups were analyzed. Results 234 patients were enrolled in the final analysis, including 132 males and 102 females, with an average age of (60.5±18.4) years old. Severe pneumonia and abdominal infection were the main causes of primary diseases. There was no significant difference in gender composition, age, APACHEⅡ, SOFA score, other complications and primary morbidity between the two groups except that the proportion of malignant tumors in the immunosuppressive group was higher than that in the normal immune function group [43.3% (39/90) vs. 41.7% (60/144), P < 0.05]. Compared with the normal immune function group, the Gram-positive cocci infection rate in the immunosuppressive group was significantly lowered [40.0% (36/90) vs. 56.2% (81/144)], Gram-negative bacilli infection rate [50.0% (45/90) vs. 39.6% (57/144)] and fungus infection rate [10.0% (9/90) vs. 4.2% (6/144)] were significantly increased (both P < 0.05). The levels of WBC, neutrophils ratio, and PCT on the day of bloodstream infection in the immunosuppressive group were significantly lower than those of normal immune function group [WBC (×109/L): 10.2±2.1 vs. 13.5±3.6, neutrophils ratio: 0.87±0.17 vs. 0.96±0.22, PCT (μg/L): 1.3±1.1 vs. 4.7±2.1, all P < 0.05], but no significant difference in the peak temperature (℃: 38.5±1.7 vs. 38.9±1.3) or CRP (mg/L: 134.0±42.6 vs. 164.0±55.8) was found as compared with normal immune function group (both P > 0.05). Compared with the normal immune function group, the bacterial clearance time in the immunosuppressive group was significantly prolonged (days: 16.0±10.1 vs. 12.3±4.7), 28-day mortality was significantly increased [61.1% (55/90) vs. 44.4% (64/144)] with statistical significances (both P < 0.05), but no significance was found in the length of ICU stay (days: 21.0±17.1 vs. 18.7±10.4) or the length of hospital stay (days: 36.0±28.1 vs. 33.8±16.8, both P > 0.05). Conclusion Gram-negative bacilli was the main pathogen of bloodstream infection in immunosuppressive patients, and the fungal infection rate was high, inflammation reaction was not obvious, bacterial clearance time was long, and prognosis was poor.
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BACKGROUND:YOUMET cervical dilating rod is made of absorbent polymer materials and has non-toxic side effects, which can avoid cross-infection in one-time use. OBJECTIVE:To observe the clinical effects of YOUMET cervical dilating rod used for cervical orifice dilation before intrauterine device insertion and removal as wel as before artificial abortion operations. METHODS:Totaly 275 female subjects schedule for cervical dilation during intrauterine device insertion and removal operations, and suction abortion for pregnancy within 10 weeks were randomly divided into two groups: 137 were included in observation group in which YOUMET cervical dilating rods were applied and 138 were included in control group in which Gongshuning glue sticks were used. Their cervical softening and dilatation situation, analgesic effect, and combined reactions during operation were observed. RESULTS AND CONCLUSION:Between the two groups, no statistical significance in general biological characteristics was found; Dilating effects in intrauterine device removing operations during child-bearing period and menopause were better in the observation group than the control group (P < 0.05). Rates of pain during insertion were higher in the observation group than the control group (P < 0.05). Rates of pain during indweling period for both groups were comparatively low, which showed no statistical significance. There was no record related to the application of cervical orifice dilating products in postoperative folow-up visit. Both products were safe with no cervical injury, slow heart rate and drop in blood pressure. YOUMET cervical dilating rod has trustworthy and safe dilating effects, which can remarkably aleviate pain.
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Objective To analyse the efficacy of lamivudine(LAM) combined adefovir dipivoxil(ADV) and entecavir(ETV) in the treatment of naive patients with chronic hepatitis B (CHB) .Methods Cochrane Library ,MEDLINE ,Web of Science ,CNKI (China National Knowledge Infrastructure ) ,WANFANG database and VIP database were searched and the references of eligible studies were screened .All relevant literatures published before March 6th ,2012 were reviewed .Comparison of the efficacy of lami-vudine combined adefovir dipivoxil and entecavir in the treatment of naive patients with chronic hepatitis B was included and Rev Man 5 .1 software was used for Meta analysis .Results Four eligible studies (587 patients in all) were included for the analysis .In the entecavir monotherapy group ,the serum ALT normalization rate was a little higher at the 12 weeks and 24 weeks of the treat-ment compared to the combination group[OR=0 .52 ,95% CI(0 .28 ,0 .97) ,Z=2 .04 ,P=0 .04] ,[OR=0 .45 ,95% CI(0 .22 ,0 .95) , Z=2 .11 ,P=0 .04] ,respectively .But after 36 weeks there was no significance between the two groups .For HBV DNA undetect-able rate ,there were no significant differences between the two groups at the 12 weeks ,24 weeks ,36 weeks ,48 weeks ,18 months , 24 months and 30 months of the treatment (P=0 .22 ,P=0 .30 ,P=0 .86 ,P=0 .31 ,P=0 .93 ,P=0 .84 and P=0 .83 respectively) . At the 48 weeks ,HBeAg negative rate has no significant difference between the two groups [OR=0 .93 ,95% CI(0 .29 ,2 .95) ,Z=0 .13 ,P=0 .90] .Conclusion Both LAM+ADV combination therapy and ETV monotherapy are effective in the treatment of naive patients with CHB ,but further studies are still needed to obtain long term results and safety by high quality ,large scale randomized controlled trials .
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Objective To investigate the expression and the clinical significance of Lewis y antigen and Mucin 1 (MUC1),as well as to evaluate the correlation between them in epithelial ovarian tumor.Methods The expression of Lewis y antigen and MUC1 in 60 cases of epithelial ovarian malignant tumors,30 cases of borderline ovarian tumors,30 cases of benign ovarian tumors and 20 cases of normal ovarian tissues were detected by immunohistochemical staining.The relationship between Lewis y antigen and MUC1,and their relationship with biology characteristic of ovarian carcinoma were analyzed.An immunofluorescence double labeling methods was performed to detect the correlation between Lewis y antigen and MUC1.Results In malignant epithelial ovarian tumors,the positive rates of Lewis y antigen was 88.33％,which was significantly higher than the positive rates in borderline(60.00％,x2 =9.6405,P ＜0.01) and benign ovarian tumors(33.33％,x2 =28.8095,P ＜0.01) and normal ovarian samples (0,x2 =52.3457,P ＜ 0.01).The positive rates of Lewis y antigen had nothing to do with the clinical pathological parameters of ovarian tumor,but the expression intensity of Lewis yantigen was increased with the development of the malignant degree(P ＜ 0.05).The positive rates of MUC1 in malignant epithelial ovarian tumors was also significantly higher than that in borderline,benign ovarian tumors and normal ovarian samples (86.67％ vs 53.33％,30.00％,25.00％,x2 =12.0321,29.4064,27.8464 ; P ＜0.01).And the expression intensity of MUC1 also increased with the development of clinical stage(P ＜0.01),but had nothing to do with the lymph node metastasis and histological grade(P ＞ 0.05).In ovarian cancer,both Lewis y antigen and MUC1 were highly expressed,and their expression levels were positively correlated (r =0.707,P ＜0.01),and Lewis y antigen colocalized with MUC1.Conclusion Both Lewis y antigen and MUC1 are associated with the occurrence and development of ovarian cancer.Lewis y antigen and MUC1 might be a sigh of biological behavior in ovarian cancers,and this study provides theoretical evidence of ovarian cancer biological treatment.