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ObjectiveTo investigate the clinical features and outcomes of critically ill pregnant and parturient women with chronic hepatitis B virus （HBV） infection， and to provide clinical experience for the rescue of critically ill pregnant and parturient women and the prevention and treatment of the severe exacerbation of liver disease. MethodsA total of 41 pregnant and parturient women with chronic HBV infection who were admitted to Department of Critical Care Medicine， Nanjing Second Hospital， from March 2013 to March 2023 were enrolled in this study， and their clinical data were collected through the electronic medical record system of hospital to summarize the main causes of transfer to the intensive care unit （ICU）， the causes of death， and treatment. The independent-samples t test was used for comparison of normally distributed continuous data between two groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups. The chi-square test was used for comparison of categorical data between two groups. ResultsAmong the 41 patients， 13 （31.71%） did not receive regular antenatal examination and 8 （19.51%） with a high viral load （HBV DNA ≥2×105 IU/mL） did not receive antiviral therapy. Cesarean section was the main mode of delivery in 32 patients （78.05%）； 23 patients （56.10%） had premature delivery， and 5 patients died （12.20%）. The top three causes of transfer to the ICU were liver failure， postpartum hemorrhage， and hypertensive disorders of pregnancy. Liver failure mainly occurred in late pregnancy， with hepatic encephalopathy as the most common complication （28.57%） and intrahepatic cholestasis of pregnancy as the most common comorbidity （21.43%）； among the 14 patients with liver failure， 6 （42.86%） received regular antenatal examination， and 13 （92.86%） did not receive antiviral therapy before admission. The mean length of ICU stay was 3.31±1.65 days for the patients with postpartum hemorrhage， among whom the patients with severe liver disease had coagulation disorders before delivery， which were difficult to correct after 48 hours of treatment. ConclusionPregnant and parturient women with chronic HBV infection tend to have complex conditions and a relatively high mortality rate. For pregnant and parturient women with chronic HBV infection， assessment of liver status， regular antenatal examination， and timely antiviral therapy are of vital importance to reduce severe exacerbation and mortality rate.
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Objective:To evaluate the effect of 2019 novel coronavirus inactivated vaccine on the disease severity of patients with Delta variant of coronavirus disease 2019.Methods:A retrospective analysis was performed on 704 patients with coronavirus disease 2019 infected with Delta variant who were older than 18 years old and admitted in the coronavirus disease 2019 designated hospital of Yangzhou (Subei Hospital New Area Branch) from July 2021 to September 2021. They were divided into severe (severe, critical) group and non-severe (light, ordinary) group according to the clinical characteristics of patients. According to the vaccination status, they were divided into 0-dose group, 1-dose group and 2-dose group. We evaluated the effects of vaccination on the severity of the disease and the production of antibodies, and analyzed the influencing factors leading to the severe group of coronavirus disease 2019.Results:The proportion of severe group in the 2-dose vaccinated group was significantly lower than that in the 1-dose vaccinated group and 0-dose vaccinated group [3.02% (7/232) vs. 9.48% (22/232), 15.83% (38/240), P < 0.05]. The time from onset to admission (day: 1.97±1.66 vs. 2.66±2.70), age (years: 45.3±12.2 vs. 63.6±17.0), direct bilirubin [DBil (μmol/L): 3.70±1.83 vs. 5.30±5.13], lactate dehydrogenase [LDH (U/L): 240.69±74.29 vs. 256.30±85.18], creatinine [SCr (μmol/L): 63.38±19.86 vs. 70.23±25.43], interleukin-6 [IL-6 (ng/L): 7.32 (1.54, 17.40) vs. 18.38 (8.83, 33.43)], creatine kinase [CK (U/L): 66.00 (43.00, 99.75) vs. 78.00 (54.50, 144.00)] and D-dimer [mg/L: 0.30 (0.08, 0.49) vs. 0.41 (0.23, 0.69)] of patients in the 2-dose group were significantly lower than those in the 0-dose group (all P < 0.05), while platelet [PLT (×10 9/L): 176.69±60.25 vs. 149.25±59.07], white blood cell count [WBC (×10 9/L): 5.43±1.77 vs. 5.03±1.88] and lymphocyte [LYM (×10 9/L): 1.34±0.88 vs. 1.17±0.50] were significantly higher than those in the 0-dose group (all P < 0.05). The titer of immunoglobulin G (IgG) in the 2-dose group was significantly higher than those in the 1-dose group and 0-dose group on the 10th day after admission [U/L: 130.94 (92.23, 326.31), 113.18 (17.62, 136.20), 117.85 (33.52, 156.73), both P < 0.05], and higher than 0-dose group on the 16th day [U/L: 156.12 (120.32, 167.76) vs. 126.52 (61.34, 149.57), P < 0.05]. The proportion of complete 2-dose vaccination [10.45% (7/67) vs. 35.32% (225/637)], LYM (×10 9/L: 1.09±0.32 vs. 1.25±0.56) and PLT (×10 9/L: 138.55±68.03 vs. 166.93±59.70) in the severe group were significantly lower than those in the non-severe group ( P < 0.05), while the time from onset to admission (day: 3.01±2.99 vs. 2.25±2.09), the length of hospital stay (day: 28±18 vs. 16±6), male proportion [77.61% (52/67) vs. 34.54% (220/637)], age (years: 69.13±12.63 vs. 52.28±16.53), DBil [μmol/L: 4.20 (3.18, 6.65) vs. 3.60 (2.80, 4.90], LDH (U/L: 310.61±98.33 vs. 238.19±72.14), SCr (μmol/L: 85.67±38.25 vs. 65.98±18.57), C-reactive protein [CRP (μmol/L): 28.12 (11.32, 42.23) vs. 8.49 (2.61, 17.58)], IL-6 [ng/L: 38.38 (24.67, 81.50) vs. 11.40 (4.60, 22.07)], CK [U/L: 140.00 (66.00, 274.00) vs. 72.80 (53.00, 11.00)] and the D-dimer [mg/L: 0.46 (0.29, 0.67) vs. 0.35 (0.19, 0.57)] in the severe group were significantly higher than those in the non-severe group (all P < 0.05). Multivariate regression analysis showed that the odds ratio ( OR) of severe group was 0.430 ( P = 0.010) in the 1-dose group and the 2-dose group compared with the 0-dose group. However, the risk of severe group was 0.381-fold in the 2-dose group compared with the 0-dose group [ OR = 0.381, 95% confidence interval (95% CI) was 0.121-1.199] which was not statistically significant, when the age was included in the regression analysis ( P > 0.05). PLT ( OR = 0.992, 95% CI was 0.986-0.998) were protective factors, but older than 60 years old ( OR = 3.681, 95% CI was 1.637-8.278), CK ( OR = 1.001, 95% CI was 1.000-1.001), IL-6 ( OR = 1.006, 95% CI was 1.002-1.010), SCr ( OR = 1.020, 95% CI was 1.007-1.033) were risk factors for severe group (all P < 0.05). Conclusions:Compared with the 0-dose vaccinated patients, the coronavirus disease 2019 patients infected with delta variant and fully vaccinated with 2-dose 2019 novel coronavirus inactivated vaccine had lower level of IL-6, SCr, CK and D-dimer, and higher PLT, LYM and IgG titer, who were not easy to develop into the severe condition.
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Tetanus consists of neonatal tetanus and non-neonatal tetanus. Non-neonatal tetanus remains a serious public health problem, although neonatal tetanus has been eliminated in China since 2012. Non-neonatal tetanus is a potential fatal disease. In the absence of medical intervention, the mortality rate of severe cases is almost 100%. Even with vigorous treatment, the mortality rate remains 30%-50% globally. These specifications aim to regulate non-neonatal tetanus diagnosis and treatment in China, in order to improve medical quality and safety. These specifications introduce the etiology, epidemiology, pathogenesis, clinical manifestations and laboratory tests, diagnosis, differential diagnosis, grading and treatment of non-neonatal tetanus.
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Tetanus consists of neonatal tetanus and non-neonatal tetanus.Non-neonatal tetanus remains a serious public health problem,although neonatal tetanus has been eliminated in China since 2012.Non-neonatal tetanus is a potential fatal disease.In the absence of medical intervention,the mortality rate of severe cases is almost 100％.Even with vigorous treatment,the mortality rate remains 30％-50％ globally.These specifications aim to regulate non-neonatal tetanus diagnosis and treatment in China,in order to improve medical quality and safety.These specifications introduce the etiology,epidemiology,pathogenesis,clinical manifestations and laboratory tests,diagnosis,differential diagnosis,grading and treatment of non-neonatal tetanus.
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Tetanus consists of neonatal tetanus and non-neonatal tetanus. Although neonatal tetanus in China has been eliminated since 2012, non-neonatal tetanus remains a serious public health problem. Non-neonatal tetanus is a potential fatal disease, and the mortality rate of severe cases is almost 100% in the absence of medical intervention. Even with vigorous treatment, the mortality rate is still 30~50% globally. In order to standardize the diagnosis and treatment of non-neonatal tetanus in China, this specification is hereby formulated. This standard includes etiology, epidemiology, pathogenesis, clinical manifestations, laboratory tests, diagnosis, differential diagnosis, classification, grading and treatment of non-neonatal tetanus.
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Adaptive physiological changes during pregnancy lead to increased fragility of the liver, impaired buffer capacity, and rapid disease progression, and such changes may weaken the signals or clinical manifestations of liver diseases, which increases the difficulties in early diagnosis and treatment. However, severe liver disease is a dynamic process, and timely identification of early signs of liver disease during pregnancy and establishment of early diagnosis and disease severity scoring system based on big data are the basis for determining the diagnosis and treatment of liver disease during pregnancy and deciding the timing and mode of delivery, as well as the key to improving the cure and reducing the mortality rate of liver disease during pregnancy.
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Objective:To investigate the effects of two different routes of nutrition support on the treatment of severe pneumonia in elderly patients.Methods:From January 2015 to January 2016,84 elderly patients with severe pneumonia in our hospital were randomly divided into two groups,42 patients in each group.The enteral nutrition (EN) group was treated with nasogastric feeding and another group was defined as combined treatment group.After 4 weeks of treatment,the nutritional status of two groups of patients was compared.The incidence of complications during treatment were documented.Results:After treatment,the hemoglobin was (111.34 ± 20.33) g/L,and the albumin was (23.33 ± 5.09) g/L in the EN group.The hemoglobin was (132.13 ±24.39) g/L,and the albumin was (35.43 ±9.12)g/L.There was significant difference between the two groups (P ＜ 0.05).The cure rates of the two groups were 92.86％ and 95.24％,respectively,and there was no significant difference (P ＞ 0.05).Conclusion:For elderly patients with severe pneumonia,the combination of enteral and parenteral nutrition is more likely to improve the nutritional index,and has a lower incidence of adverse events.
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<p><b>OBJECTIVE</b>To study the correlation between clinically detected serum galectin-3 levels and prognosis of liver failure.</p><p><b>METHODS</b>Fifty-five patients diagnosed with liver failure were administered a combined modality therapy and followed up until death or for 6 months. Fifty-five patients with liver failure were administered a combined modality therapy and followed up until death or for 6 months. In addition, 30 patients with chronic hepatitis B (CHB) and 30 healthy volunteers were matched for use as controls. Serum galectin-3 levels were detected at baseline and last follow-up visit and compared between groups by statistical analysis.</p><p><b>RESULTS</b>At baseline, the CHB group had a significantly higher level of serum galectin-3 than the healthy control group (F=2.701, P less than 0.01). However, the galectin-3 level 5 of the liver failure group was significantly higher than that of both the CHB group (F=8.121, P less than 0.01) and the healthy control group (F=11.231, P less than 0.01). When patients within the liver failure group were divided by survival and death occurring during the 6-month follow-up period, the patients who died (n=28) were found to have a significantly higher level of serum galectin-3 than the surviving patients (n=27) (P less than 0.01). The area under the curve of ROC curve is 0.766, and cut off value is 0.246 5 ng/ml.</p><p><b>CONCLUSION</b>The level of serum galectin-3 is positively correlated with risk of death in patients with liver failure. Up-regulation of galectin-3 may act as a protective factor in patients with severe liver injury.</p>
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Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos de Casos e Controles , Galectina 3 , Sangue , Hepatite B Crônica , Sangue , Falência Hepática , Sangue , Diagnóstico , PrognósticoRESUMO
Objective To investigate the safety and therapeutic effects ot a novel multi-layer flat-plate bioartificial liver (BAL) for patients with liver failure.Methods Thirty-eight patients with liver failure from Dec.2010 to Dec.2011 were treated with a novel BAL based on multi-layer flatplate bioreactor and the co-cultured cells of the porcine hepatocytes and mesenchymal stem cells.A total of 48 treatments was performed,4 h each time.The clinical signs and symptoms,liver function,ammonia,coagulation function and complete blood count were evaluated before,during and after the treatment.DNA in the collected PBMCs was extracted for PCR with PERV specific primers and the porcine specific primer Sus scrofa cytochrome B.The RT activity was detected as well.Levels of xenoantibodies (IgG,IgM) were determined by using ELISA kit. Titers of complement were quantified by CH50 kit.Results All treatment procedures were completed successfully without any adverse reaction. All samples presented negative PERV DNA and RT activity. The levels of antibodies were similar before and after treatment.Treatment was associated with a temporary decline in levels of complement,and then the levels were recovered quickly.The clinical symptoms such as acratia,anorexia and abdominal distension were improved.The stage of hepatic encephalopathy in 16 patients was decreased. The liver function and ammonia was reduced disproportionately. Seven patients in all were bridged to liver transplantation,2 patients died and 2 patients gave up the treatment,and the others were turned better.After the outcome judgment according to the standard developed by the Artificial Liver Group,and Chinese Association of Infectious and Parasitic Diseases,there were 9 patients with clinical healing,25 patients with improvement and 4 patients with no effect,and the cure-improvement rate was 89.5％.Conclusion The novel multi-layer flat-plate BAL could be used as a safe and effective therapy for patients with liver failure.
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Objective To observe the expression of triggering receptor-1 on myeloid cells (TREM-1) of mice with acute lung injury (ALI) in oder to find out its regularity and significance in inflammatory response of or-ganisms. Method Thirty BALB/C mice were randomly(random number) divided into normal control group (n =6) and ALl group (n = 24). The models of ALI were made with intraperitonal injection of lipopolysaccharide (LPS) in dose of 10 mg/kg. Specimens from peripheral blood and lung tissue were collected 6 h, 12 h, 24 h and 48 h after LPS injected. The fluorescent real-time quantitative reverse transcriptiun-polymerase chain (RT-PCR) was used to detect TREM-1 mRNA, and ELISA was employed for detection of TREM-1 protein and TNF-α protein, and HE staining was made doe the pathological Smith lung score under light microscope. Analysis of variance was used for comparison of TREM-1 mRNA, TNF-α and Smith lung injury score between two groups. Spearman corre-lation analysis was made to find out the relationship among these three variables. Results The expressions of TREM-1 mRNA in lung tissue of ALI mice 6 h, 12 h, 24 h, and 48 hours after injection of LPS were 6.61±0.08,34.71±0.83, 61.85±14.05 and 56.46±8.89, respectively which were higher than that in control group (1.00±0.00, P = 0.017, 0.009, 0.002 and 0.003, respectively). The expressions of TREM-1 mRNA in blood were 14.01±3.24, 47.07±0.98, 8.18±0.43 and 8.06±0.05, respectively which were higher than that in normal control group (1.00±0.00, P = 0.010, 0.004, 0.011 and 0.011, respectively). The expression of TREM-1 rnRNA in tissue began to increase 6 hours after modeling and reached its peak 24 hours later, and expres-sion of TREM-1 mRNA in blood reached its peak after 12 hours. The levels of TREM-1 protein in lung tissue of ALl mice 6 h,12 h,24 h and 48 hours after LPS injected were 997.8±114.62, 1579.70±45.92, 1123.9±108.2 and 429.8±89.96 pg/mL, respectively which were higher than that of mice in control group (279.22±4.62 pg/mL, P = 0.024, 0.007, 0.011 and 0.04, respectively). The level of TREM- 1 protein reached the peak 12 hours after LPS injected, but it had no significant correlation with the expression of TREM-1 mRNA (P =0.14). The levels of TNF-α protein in lung tissue of ALI mice 6 h, 12 h, 24 h and 48 hours after LPS injection were 313.16±39.50, 491.91±96.65, 388.48±29.84 and 282.5±52.76 pg/mL, respectively which were sig-nificantly higher than that of mice in control group (256.6±28.31 pg,/mL, P = 0.037, 0.019, 0.032 and 0.043, respectively). The TNF-α concentration was positively correlated with TREM-1 levels in lung tissue and with Smith pathological score (r = 0.795, P = 0.001: r = 0.499, P = 0.034), but not with the expression of TREM-1 mRNA (P = 0.176). Conclusions The expression of TREM-1 mRNA in lung tissue of mice with ALI is elevated, and the expression of TREM-1 mRNA is related to the level of TNF-α and the severity of the ALI in in-flammatory responses in lung. The expressions of TREM- 1 gene are not consistent with the levels of TREM- 1 pro-tein, suggesting another new functional proteins involved in immune regulation.