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Objective:On the basis of post evaluation,the hospital pharmacy posts are scientifically classified and stratified,and the performance evaluation standard of pharmacy posts is constructed.Methods:The hospital pharmacy posts are classified and stratified by factor comparison method and the post value coefficient is determined.Delphi method and analytic hierarchy process are used to construct the performance evaluation index system of pharmaceutical posts and determine the performance evaluation standards.Results:Pharmacy posts in hospitals are divided into 5 categories,including clinical pharmacists,research pharmacists,static pharmacists,dispensing pharmacists and purchasing pharmacists.The indexes and weights of pharmaceutical post performance evaluation are determined from 4 dimensions:service,process,quality and cost,and the evaluation standard of pharmaceutical post performance oriented to rational drug use is established.Conclusion:The construction of pharmaceutical performance evaluation system meets the requirements of the reform of public hospitals for the transformation and development of pharmaceutical services,which is conducive to enhancing the enthusiasm of pharmaceutical personnel and improving the efficiency and benefit of pharmaceutical services.
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Objective:To observe the size changes under ultrasound of 4C type thyroid micronodules classified by 2020 Chinese Thyroid Imaging Reporting and Data System (C-TIRADS)during follow-up.Methods:In this cross-sectional study, the data of thyroid ultrasonography in physical examination center in the Affiliated Zhongshan Hospital of Dalian University between December 2017 and December 2021 were retrospectively included, thyroid nodules were classified according to C-TIRADS, to observe the changes by ultrasound of maximum diameter and volume of 4C type thyroid micronodules during follow-up.Results:A total of 102 subjects receiving physical examinations with 103 thyroid micronodules were enrolled in this study. The maximum diameter and volume of thyroid micronodules at initial examination was 5.0 (4.0, 7.0) mm and 52.5 (25.2, 113.4) mm 3 respectively, and it was 6.0 (4.0,7.0) mm、65.6 (25.2,147.0) mm 3 at the last examination, respectively. Of the thyroid micronodules, 79 (76.7%) remained stable, 14 (13.6%) magnified and 10 (9.7%) shrunk during the follow-up. The cervical lymph nodes in all physical examiners were normal. There were significant changes in the maximum diameter and volume in the thyroid micronodules between the initial and last examination in subjects whose micronodules shrunk or magnified during the follow-up (all P<0.05). Conclusion:Size of most C-TIRADS 4C thyroid micronodules remains stable or even decreases during ultrasound follow-up observation, for such thyroid nodules, follow-up observation appears to be a safe and feasible way to postpone surgery.
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Scientific performance-based salary system is of great significance for hospitals to implement effective internal management, improve the enthusiasm of medical staff, and promote the high-quality development of public hospitals. Based on the requirements of the national salary system reform, a tertiary general hospital has been designing and implementing a performance-based salary system since 2016. The hospital has established a job evaluation index system to stratify various job sequences in the hospital, and determined the job value coefficients for different sequences and levels. It has also established a performance salary project system that covered job performance salary, specific performance salary, and innovative performance salary. In addition, the hospital has established a performance-based salary management system that covered salary standard formulation, performance salary accounting and distribution, and dynamic adjustment of the performance-based salary management system. The application of this performance-based compensation management system has achieved the matching of employee value, job hierarchy, and medical services. From 2016 to 2020, employees′ overall satisfaction with performance-based salary exceeded 85%. At the same time, the system could enhance the operational efficiency and quality of the hospital, drive technological development and scientific research innovation, playing a positive incentive role in the high-quality development of the hospital.
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Objective To investigate the clinical and pathological features of children with glycogen storage disease (GSD). Methods A retrospective analysis was performed for ten children with GSD who were admitted to the Third Hospital of Hebei Medical University and The Fifth Medical Center of Chinese PLA General Hospital from January 2002 to January 2022, based on medical history, liver biochemistry, and liver biopsy, and population characteristics, clinical manifestations, biochemical parameters, and liver histopathological characteristics were compared and analyzed. Results All ten children had developmental retardation and a short stature, with the manifestations of abnormal liver function, mild weakness, poor appetite, yellow urine, and yellow eyes, and four children had hepatosplenomegaly. Among the ten children, six had the clinical manifestations of hypoglycemia, and one had bilateral gastrocnemius hypertrophy and positive Gower sign. Two children had positive CMV IgG. Liver histopathological manifestations included diffuse enlargement of hepatocytes, light cytoplasm, and small nucleus in the middle like plant cells, with or without fibrous tissue proliferation. Conclusion Most patients with GSD have developmental retardation and abnormal aminotransferases, and liver pathological examination shows specific pathological features.
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Objective To investigate the application value of transjugular liver biopsy (TJLB) in the diagnosis and treatment of complicated and severe liver diseases. Methods A retrospective analysis was performed for the clinical data of 31 patients who underwent TJLB in The Fifth Medical Center of Chinese PLA General Hospital, including indication for puncture, success rate, and final diagnosis. Results Among the 31 patients, there were 15 male patients and 16 female patients. Percutaneous liver biopsy was unsuitable for 8 patients with liver failure and disturbances of blood coagulation, 13 with liver cirrhosis and ascites, and 10 with liver cirrhosis and thrombocytopenia (< 50×10 9 /L), which were the indications for TJLB. The success rate of TJLB puncture was 100%, with 2-4 passes for puncture. No serious adverse event was observed. Of all 31 patients, 26 (83.87%) had a definite diagnosis at discharge, among whom there were 5 patients with idiopathic portal hypertension, 9 patients with drug-induced liver failure or liver cirrhosis, 5 patients with autoimmune liver disease, and 7 patients with liver cirrhosis or liver failure due to other causes, and 5 patients had unknown etiology. In addition, 3 patients underwent biopsy to confirm the diagnosis and decision of whether liver transplantation should be performed. Conclusion TJLB plays an important role in the diagnosis and treatment of complicated and severe liver diseases and still has certain limitations, and therefore, suitable patients should be selected in clinical practice.
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Objective:To investigate the relationship between the down-regulation expression of sodium taurocholate cotransporting polypeptide (NTCP) in proliferating hepatocytes and the response to antiviral therapy of chronic hepatitis B (CHB) patients.Methods:Sixty-eight hepatitis B e antigen (HBeAg)-positive CHB patients admitted to the Fifth Medical Center of PLA General Hospital from January 2011 to March 2015 were included. Basic information and laboratory data were collected. Based on the baseline (before antiviral treatment) inflammatory activity (G), the patients were divided into ≤G2 group and >G2 group. Twelve liver puncture tissue samples were selected from each group for NTCP and Ki67 immunofluorescence staining.The proportion of Ki67-positive cells was calculated, and the staining of NTCP was scored. Five pairs of tissue specimens of patients who had hepatitis B virus (HBV) infection were diagnosed with focal nodular hyperplasia (FNH) and underwent nodular resection surgery from March 2014 to March 2017 were collected.Immunohistochemical staining was used to detect the expressions of Ki67, NTCP and hepatitis B surface antigen (HBsAg) in each tissue specimen, and the proportion of staining positive cells or the staining intensity was calculated. Statistical analysis was performed by Mann-Whitney U test, chi-square test or Spearman correlation analysis. Results:The proportion of Ki67-positive cells (6.75%(6.20%, 8.16%))in five liver FNH tissues with HBV infection was significantly higher than that in adjacent non-FNH tissues (0.75%(0.66%, 1.20%)), while the immunohistochemical scores of NTCP and HBsAg (3.00 (1.00, 3.00) and 2.00 (1.00, 2.00), respectively) were both significantly lower than those in adjacent non-FNH tissues (8.00 (8.00, 9.00) and 8.00 (6.00, 8.00), respectively), the differences were all statistically significant ( Z=-2.611, -2.424 and -2.635, respectively, P=0.009, 0.015 and 0.008, respectively). There were 37 patients in >G2 group, and 31 patients in ≤G2 group. After six months of antiviral treatment, CHB patients with persistent inflammation in >G2 group obtained a better virological response, with serum HBV DNA and HBeAg showing a greater decline ((0.71±0.14) lg IU/mL and (0.92±0.13) lg IU/mL, respectively) than those in ≤G2 group ((0.54±0.30) lg IU/mL and (0.49±0.65) lg IU/mL, respectively) ( Z=-3.048 and -2.666, respectively, P=0.002 and 0.008, respectively). The proportion of Ki67-positive cells in the specimens of >G2 group (4.34%(1.84%, 8.77%)) was significantly higher than that of ≤G2 group (0.34%(0, 0.80%)) ( Z=-3.640, P<0.01), and the immunohistochemical staining score of NTCP (1.00 (0, 3.25)) was significantly lower than that of ≤G2 group (6.00 (4.00, 8.00)) ( Z=-3.012, P=0.003). Spearman correlation analysis showed that the NTCP immunohistochemical score was negatively correlated with the proportion of Ki67-positive cells ( r=-0.512, P=0.01). Conclusions:CHB patients with persistent inflammationare often accompanied by more active hepatocyte proliferation and low membrane NTCP expression, which is not conducive to HBV reinfection. It may facilitate these patients to obtain better virological response.
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Objective@#To establish and evaluate diagnostic efficacy and applicability of serum Golgi protein (GP) 73 based non-invasive diagnostic model with other conventional serological indicators for compensated stage hepatitis B cirrhosis.@*Methods@#666 cases with chronic hepatitis B (CHB) who had visited to the Fifth Medical Center of People’s Liberation Army General Hospital from January 2010 to December 2017 were selected as the study subjects, and were classified according to compensated stage cirrhosis into clinical and pathological diagnosis group based on whether or not the liver histological examination was performed. A diagnostic model of compensated stage hepatitis B cirrhosis in the clinical diagnosis group was established. The current clinically used diagnostic model of liver cirrhosis, aspartate aminotransferase/platelet ratio index (APRI), fibrosis index (FIB)-4 and liver stiffness measurement (LSM) were compared. Eventually, the diagnostic model was verified step by step by pathological diagnosis group.@*Results@#The area under the receiver operating characteristic curve (AUC) of GP73 and APRI, FIB-4, and LSM for cirrhosis patients in the clinical diagnosis group were 0.842, 0.857, 0.864, and 0.832, respectively. The diagnostic efficiency of the four indicators were of similar (P value > 0.05). A diagnostic model of compensated stage hepatitis B cirrhosis (GAPA) using logistic regression analysis was established: LogitP = 1/ [1 + exp (1.614-0.054 × GP73-0.045 × Age + 0.030 × PLT-0.015 × ALP)]. The AUC of the model was as high as 0.940 and the optimal cut-off value were 0.41. The corresponding diagnostic sensitivity and specificity were 0.92 and 0.82, respectively. The diagnostic efficiency was better than that of APRI, FIB-4, LSM and GP73 alone (P < 0.05). The AUC of GAPA was 0.877 in the pathological diagnosis group, which was similar to the diagnostic efficacy of LSM (0.891) and FIB-4 (0.847) (P > 0.1), but still superior to that of APRI (0.811) and GP73 alone (0.780) (P < 0.001).@*Conclusion@#GAPA, a diagnostic model for compensated stage hepatitis B cirrhosis established in this study, has a good diagnostic efficacy in both the clinical and pathological diagnosis group, and has certain auxiliary diagnostic value in the areas where resources are relatively scarce or where LSM has not been developed.
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Acute ischemic stroke (AIS), as the third leading cause of death worldwide, is characterized by its high incidence, mortality rate, high incurred disability rate, and frequent reoccurrence. The neuroprotective effects of Ginkgo biloba extract (GBE) against several cerebral diseases have been reported in previous studies, but the underlying mechanisms of action are still unclear. Using a novel in vitro rat cortical capillary endothelial cell-astrocyte-neuron network model, we investigated the neuroprotective effects of GBE and one of its important constituents, Ginkgolide B (GB), against oxygen-glucose deprivation/reoxygenation and glucose (OGD/R) injury. In this model, rat cortical capillary endothelial cells, astrocytes, and neurons were cocultured so that they could be synchronously observed in the same system. Pretreatment with GBE or GB increased the neuron cell viability, ameliorated cell injury, and inhibited the cell apoptotic rate through Bax and Bcl-2 expression regulation after OGD/R injury. Furthermore, GBE or GB pretreatment enhanced the transendothelial electrical resistance of capillary endothelial monolayers, reduced the endothelial permeability coefficients for sodium fluorescein (Na-F), and increased the expression levels of tight junction proteins, namely, ZO-1 and occludin, in endothelial cells. Results demonstrated the preventive effects of GBE on neuronal cell death and enhancement of the function of brain capillary endothelial monolayers after OGD/R injury in vitro; thus, GBE could be used as an effective neuroprotective agent for AIS/reperfusion, with GB as one of its significant constituents.
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Animales , Ratas , Apoptosis , Isquemia Encefálica , Quimioterapia , Supervivencia Celular , Células Cultivadas , Modelos Animales de Enfermedad , Células Endoteliales , Ginkgólidos , Farmacología , Glucosa , Lactonas , Farmacología , Neuronas , Fármacos Neuroprotectores , Farmacología , Oxígeno , Extractos Vegetales , Farmacología , Accidente Cerebrovascular , QuimioterapiaRESUMEN
Objective To evaluate the clinical curative effect of ulinastatin combined with CRRT in the treatment of multiple organ dysfunction syndrome(MODS).Methods Sixty eight patients with MODS who were admitted to ICU from July 2013 to July 2015 were randomly divided into three groups:control group,CRRT group,combined group;Patients' APACHE Ⅱ,SOFA scores level of inflammatory markers were recorded before treatment and after treatment of 72 hours and 7 days.The mortality of the three groups in ICU were compared.Results After 72 hours and a week of treatment,the level of IL-10,IL-6,TNF-α,WBC、PCT、CRP in CRRT group and combined group were significantly better than that of control group(P＜0.05),and combined group were significantly better than that of CRRT group.Compared with the control group,the oxygen index,lactic acid,ALT significantly im proved in CRRT group and combined group were better than control group,after 72 hours and a week of treatment(P＜0.05),and the cornbined group was the most obvious.After a week of treatment,the mortality rate of CRRT group and combined group was significantly better than the control group (P＜0.05),while there was no statistical differences between CRRT group and combined group(P＞0.05).Conclusion Ulinastatin combined with CRRT is an effective method for the treatment of MODS.
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Objective To analyze the isolation rates and antimicrobial resistance of Acinetobacter baumannii (AB) from intensive care unit (ICU)between 2010 and 2013,and provide evidence for clinical anti-infective therapy. Methods The isolation and antimicrobial resistance of AB from ICU between 2010 and 2013 were analyzed retro-spectively.Results A total of 1 413 pathogenic strains were isolated,556(39.35%)of which were AB,isolation rates in each year were 39.45%,41 .35%,29.44%,and 40.53% respectively.AB were mainly isolated from lower respiratory tract (75.72%).Antimicrobial susceptibility testing results showed that AB had low resistance rates to cefoperazone/sulbactam(5.85%)and amikacin (17.45%);detection rates of multidrug-resistant and extensively drug-resistant AB increased from 9.63% and 3.70% to 42.50% and 31 .88%,respectively (both P < 0.001 ). Conclusion AB is the common pathogen in ICU,antimicrobial resistance is serious,isolation of multidrug-resistant and extensively drug-resistant AB increased year by year;intensifying the monitoring of drug resistance is helpful for the treat-ment and prevention of AB infection.
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Objective To explore the possible mechanism of action of telomerase in hepatic precancerous lesions, and the regulatory effect of a Chinese medicine prescription HU Qi Shan ( HQS) and its principal drug mistletoe alkali on the telomerase activity in rat liver tissues.Methods Rat model of hepatic precancerous lesions was established by Solt-Farber two-step protocol.The model rats were randomly divided into 5 groups, including the model group, high-dose HQS [8 g/(kg· d)] group, low-dose HQS [4 g/(kg· d)] group, and mistletoe alkali[8 mg/(kg· d)] group.γ-Glutamy-transpeptidase (γ-GT) was analyzed by immunohistochemistry.AFP was detected by immunofluorescence technique.The telomerase activity was detected using a quantitative telomerase detection kit.The expression of NF-κB P65 was detected by immunohistochemistry.The cytoplasmic protein IκB-αwas detected by western blotting.Results After treated with HQS and mistletoe alkali, the areas ofγ-GT-positive foci and number of AFP-positive cells in the liver tissus were significantly decreased than those of the model group ( P<0.05 for both) , the telomerase activity was decreased, the number of NF-κB P65-positive cells was also decreased ( P <0.05 ) , whereas the intracytoplasmic expression of IκB-αproteins was significantly increased ( P <0.05 ) .Conclusions HQS and mistletoe alkali can suppress the telomerase activity.Its possible mechanism may be through inhibition of the over-expressed apoptosis-related genes such as NF-κB P65 and increase the expression of IκB-αdecreasing the telomerase activity.
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Objective To investigate the risk factors for hemorrhagic transformation (HT) and poor outcomes in patients with acute ischemic stroke after mechanical thrombectomy.Methods The patients with acute ischemic stroke received mechanical thrombectomy were enrolled retrospectively.The demography,vascular risk factors and other clinical data of the patents were collected.The modified Rankin scale (mRS) was used to evaluate the clinical outcomes at day 90.Good outcome was defined as mRS score 0-2.The patients were divided into either a HT group or a non-HT group according to their HT conditions.Multivariate logistic regression analysis was used to identify the independent risk factors for HT and poor outcomes.Results A total of 48 patients with acute ischemic stroke received mechanical thrombectomy were enrolled,including 25 males (52.1％).Their mean age was 64.77± 9.14 years.The mean National Institutes of Health Stroke Scale (NIHSS) score was 17.70 ± 3.77.Twenty-two patients (45.8％) occured HT,of which 9 were symptomatic HT;24 (50.0％) had good outcomes.The proportion of males in the HT group was significantly lower than that in the non-HT goup (30.4％vs.72.0％;x2 =8.293,P =0.004),while the proportions in patients with diabetes (65.2％ vs.36.0％;x2 =4.090,P =0.043) and atrial fibrillation (78.3％ vs.44.0％;x2 =5.880,P =0.015),as well as the baseline fasting blood glucose level (8.514 ± 4.400 mmol/L vs.6.354 ± 1.472 mmol/L;t =2.319,P =0.025) were significantly higher than those in the non-HT group.Multivariate logistic regression analysis showed that the atrial fibrillation (odds ratio [OR] 6.136,95％ confidence interval [CI] 1.617-23.291;P =0.042) was a risk factor for the occurrence of HT after mechanical thrombectomy.The proportion of diabetic patients (29.2％ vs.70.8％;x2 =8.333,P=0.04) and baseline NIHSS score (16.050±4.865 vs.19.210±4.423);t=2.310,P=0.026) of the good outcome group were significantly lower than those of the poor outcome group,while the proportions of patients in atrial fibrillation (75.0％ vs.45.8％;x2 =4.269,P =0.039),anterior circulation stroke (87.5％ vs.62.5％;x2 =4.000,P =0.046) middle cerebral artery (75.0％ vs.29.2％;x2 =10.113,P =0.006),vertebral basilar artery (37.5％ vs.12.5％;x2 =10.113,P =0.006) occlusion and parenchymal hematoma (33.3％ vs.4.1％;P=0.011) were significantly higher than the poor outcome group.Multivariate logistic regression analysis showed that diabetes (OR 5.898,95％ CI 1.699-20.479;P=0.005),baseline NIHSS score (OR 1.167,95％ CI 1.011-1.347;P =0.035),and parenchymal hematoma (OR 1.295,95％ CI 1.099-1.875;P=0.028) were the independent risk factors for poor outcomes.Conclusions Atrial fibrillation is an independent predictor of HT risk in patients with acute ischemic stroke after mechanical thrombectomy.Diabetes mellitus,higher baseline NIHSS score,and concurrent brain parenchymal hematoma are the independent predictors of poor outcomes.Therefore,the risk of HT and adverse outcomes should be fully assessed before mechanical thrombectomy in patients with acute ischemic stroke.
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To investigate the association between Helicobacter pylori ( Hp ) infection and type 2 diabetes.Total 4 129 health check up subjects aged (49.1 ±11.3) years (18-92 years), including 2 649 males and 1 480 females were enrolled in this cross-section study.Hp infection was confirmed by 13 C-urea breath test;type 2 diabetes mellitus was diagnosed according to WHO criteria (1999).Single factor analysis and multiple regression analysis were used to evaluate the association between Hp affection and the prevalence of type 2 diabetes.Hp infection rate in diabetic group was significantly higher than that in non-diabetic group (45.6%vs.39.0%, P<0.05).Hp infection rate in subjects with newly diagnosed diabetes was highest than those with previously diagnosed diabetes and non-diabetic subjects ( P<0.05).The glycosylated hemoglobin level in Hp infection group was higher than that in non infection group [ ( 5.88 ±0.64 )% vs.( 5.62 ± 0.88)%, P<0.05];the fasting plasma glucose and postprandial blood glucose levels in Hp infection group were also higher than those in non-infection group ( P<0.05 ).Logistic regression analysis showed that Hp infection was one of the independent risk factors of type 2 diabetes (OR=2.002, 95%CI:1.564-2.563, P<0.05).The study indicates that Hp infection is closely associated with type 2 diabetes mellitus.
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OBJECTIVE To investigate the time of aerosol inhalation using Budesonide Suspension and Mucosolvan drived by oxygen on prevention of pharyngeal and oral mucosa damage induced by radiotherapy in nasopharyngeal carcinoma (NPC). METHODS All 108 cases with NPC were divided into 4 groups, each group 27 cases. In 3 treatment groups,aerosol inhalation using Budesonide Suspension and Mucosolvan drived by oxygen were began at the initial , after 5 times, after 10 times radiotherapy respectively. In control group, aerosol inhalation was not used. The rates of third degree of pharyngeal and oral mucosa injury during different dose of radiotherapy were compared among the 4 groups. RESULTS At the dose below 30 Gy, there were no case of third degree of pharyngeal and oral mucosa injury occurred in 3 treatment groups, one case in control group. At the dose of 30 to 40 Gy, third degree injury occurred in all groups, there was no statistical difference among the 4 groups. At the dose over 40 Gy, the patients of third degree injury in group 1 and 2 were less than that in control group. There was no difference between group 3 and control group. CONCLUSION The right time of aerosol inhalation using Budesonide Suspension and Mucosolvan drived by oxygen for prevention of pharyngeal and oral mucosa complication induced by radiotherapy in NPC is at 5 to 10 times after radiotherapy.
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Objective To investigate the mortality risk factors of nosocomial infection patients in intensive care unit (ICU), and to guide clinicians to take effective control measures. Methods A retrospectively cohort study was conducted. The relevant information of patients with nosocomial infection treated in ICU of Hengshui Harrison International Peace Hospital Affiliated to Hebei Medical University from June 2009 to December 2015 was analyzed. The patients who admitted to ICU again, with length of ICU stay less than 48 hours, without first etiology of screening within 48 hours of ICU admission, or without complete pathogenic information were excluded. The gender, age, diagnosis, length of ICU stay, invasive operation, nutritional status, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, sequential organ failure assessment (SOFA) score, distribution and drug resistance of the pathogens, and procalcitonin (PCT) levels at 7 days after nosocomial infection were recorded. The risk factors leading to death in patients with nosocomial infection were analyzed by logistic regression, and the receiver operating characteristic curve (ROC) was drawn to evaluate the predictive value of all risk factors on the outcome of patients with nosocomial infection. Results In 864 enrolled patients with male of 54.75% and mean age of (63.50±15.80) years, 732 (84.72%) patients survived and 132 (15.28%) died. Compared with survivors, the non-survivors had higher age (years: 65.47±15.32 vs. 58.15±13.27), incidence of urgent trachea intubation (32.58% vs. 22.81%), deep venous catheterization (83.33% vs. 63.25%), and multiple drug-resistant infection (65.91% vs. 33.20%), longer length of ICU stay (days: 13.56±4.29 vs. 10.29±4.32) and duration of coma (days: 7.36±2.46 vs. 5.48±2.14), lower albumin (g/L: 23.64±8.47 vs. 26.36±12.84), higher APACHEⅡ score (19.28±5.16 vs. 17.56±5.62), SOFA score (8.55±1.34 vs. 6.43±2.65), and PCT (μg/L: 3.06±1.36 vs. 2.53±0.87, all P 0.05). The low respiratory tract was the most common site of infection followed by urinary tract and bloodstream in both groups. It was shown by logistic regression analysis that prolonged ICU stay [odds ratio (OR) = 2.039, 95% confidence interval (95%CI) = 1.231-3.473, P = 0.002], APACHEⅡ score (OR = 1.683, 95%CI= 1.002-9.376, P = 0.000), SOFA score (OR = 2.060, 95%CI = 1.208 -14.309, P = 0.041), PCT (OR = 2.090, 95%CI = 1.706-13.098, P = 0.004), and multi-drug resistant pathogens infection (OR = 5.245, 95%CI = 2.213-35.098, P = 0.027) were independent risk factors for ICU mortality in patients with nosocomial infection. The area under ROC curve (AUC) of length of ICU stay, APACHEⅡ score, SOFA score, and PCT level for predicting death of nosocomial infection patients was 0.854, 0.738, 0.786, and 0.849, respectively, the best cut-off value was 16.50 days, 22.45, 6.37 and 3.38 μg/L, respectively, the sensitivity was 83.6%, 90.0%, 81.1%, and 89.6%, and the specificity was 70.3%, 75.6%, 71.3%, and 85.4%, respectively. Conclusions Prol onged ICU stay, nosocomial infection with secondary sepsis and multiple organ dysfunction syndrome were the leading causes of death for nosocomial infection patients in ICU. Prolonged ICU stay, APACHE Ⅱ score, SOFA score, and PCT level could effectively predict death risks for nosocomial infection patients.
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<p><b>OBJECTIVE</b>To investigate the correlation of serum osteoprotegerin (OPG) with the progression of nonalcoholic fatty liver disease (NAFLD) and the noninvasive prediction and diagnosis of nonalcoholic steatohepatitis (NASH).</p><p><b>METHODS</b>A total of 136 patients with NAFLD were enrolled, and their tissue samples for liver biopsy and serum samples obtained at 1 week after liver biopsy were collected; 83 healthy subjects without the symptoms of fatty liver disease proved by ultrasound examination were enrolled as controls. The physiological indicators including height, body weight, and waist circumference were measured, and body mass index was calculated. The biochemical parameters including alanine aminotransferase (ALT), aspartate aminotransferase (AST), AST/ALT, alkaline phosphatase, gamma-glutamyl transferase, total cholesterol, triglyceride (TG), high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol were measured. Double-antibody sandwich enzyme-linked immunosorbent assay was used to determine the serum level of OPG. The rank sum test, chi-square test, t-test, one-way analysis of variance, Spearman correlation analysis, least significant difference test, and receiver operating characteristic (ROC) curve were applied for statistical analysis of various data.</p><p><b>RESULTS</b>Serum OPG level was correlated with AST and TG (P < 0.05), and was highly correlated with hepatocyte fatty degeneration, ballooning degeneration, intralobular inflammation, portal inflammation, and fibrosis degree (P < 0.01). With the increasing NAFLD activity score (NAS), serum OPG level decreased, and there was a highly negative correlation between them (r = -0.928, P < 0.01). Serum OPG level was significantly lower in NASH patients than non-NASH patients. The area under the ROC curve of serum OPG level was 0.963, and according to the Youden index, its optimal sensitivity and specificity were 96.1% and 97.4%, respectively, at an optimal cut-off value of 242.96 ng/L, which suggested a high diagnostic power.</p><p><b>CONCLUSION</b>In NASH patients, serum OPG level decreases significantly. Serum OPG level can be used as an independent predictive factor to evaluate NASH and its severity, as well as a noninvasive diagnostic index for NASH.</p>
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Humanos , Alanina Transaminasa , Sangre , Fosfatasa Alcalina , Sangre , Aspartato Aminotransferasas , Sangre , Biopsia , Índice de Masa Corporal , Estudios de Casos y Controles , Colesterol , Sangre , Progresión de la Enfermedad , Ensayo de Inmunoadsorción Enzimática , Fibrosis , Inflamación , Patología , Hígado , Patología , Enfermedad del Hígado Graso no Alcohólico , Sangre , Diagnóstico , Osteoprotegerina , Sangre , Curva ROC , Triglicéridos , Sangre , gamma-Glutamiltransferasa , SangreRESUMEN
Objective To compare the therapeutic effects of bone marrow stem treatment by different bone marrow mobilization,distinct separation methods or cell suspension density, and to explore the optimal treatment plan of autologous bone marrow stem cell transplantation for decompensated cirrhosis.Methods Twenty three patients with decompensated cirrhosis were studied.100 ~200 mL bone marrow from each patient was harvested in aseptic condition, after isolation and purification by density gradient centrifugation,the stem cells were obtained and transplanted into the liver via hepatic artery.The serum glutamic acid alanine aminotransferase (ALT), albumin (ALB), prothrombin time (PT) and total bilirubin (TBIL) were checked before and l, 2, 3 months after therapy respectively,changes in these indicators of each group were compared by different bone marrow mobilization, distinct separation methods, or cell suspension density.Results After transplantation, levels of albumin increased significantly 1, 2, 3 months after treatment compared with baseline(P<0.05).Patients in bone marrow mobilization group obtained higher stem cell density (P<0.05), which had no significant difference in improving liver function ( ALT, TBIL, ALB, PT) compared with non-bone marrow mobilization group.Patients using the kit significantly improved their albumin (3 months after treatment, P<0.05), which had no significant difference in improving liver function (ALT, TBIL, ALB, PT) compared with using ordinary lymphocyte isolation method group.There was no significant difference in improving liver function ( ALT, TBIL, ALB, PT) between lower magnitude stem cell density group(≤1 ×1010/L) and higher magnitude stem cell density group(1 ×1010/L).Conclusion The treatment for decompensated cirrhosis by transplantation of autologous bone nlarrow stem cells is safe and effective, which can significantly increase the level of albumin in patients with decompensated cirrhosis.Preoperative bone marrow mobilization can increase the rate of stem cells obtained, and the method using the kit improves the leves of protein respectively.They are helpful to improve the efficacy.
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Objective To look for suitable short-term weight loss and long-term maintenance method for army cadres. Method A total of 142 patients with simple overweight and obesity were randomly selected as the research subjects, and were followed up for 2 years, 130 of them were valid for analysis, 97 were male, and 33 female, age 27-59 years, average(47.41±7.55)years. SPSS 16.0 was used for analysis. Repeated measurements analysis of variance was used for data analysis, K-related samples nonparametric test was used for enumeration data. Result The army cadres population weight intervention management model was divided into three stages. They were respectively intensified weight loss stage for 6 months, the consolidation of weight loss for 6 months, and self-management stage maintained for 12 months, totally 24 months. Variance analysis results showed that after two years of focused intervention and health management, the body mass index(BMI)fell from(27.42 ± 2.81)kg/m2 to(24.69 ± 2.63)kg/m2 (F=2 649.945, P<0.05), waist circumference decreased from(91.09±8.24)cm to(85.26±7.76)cm(F=1 207.248, P<0.05). Nonparametric test results showed that after two years intervention management the behavior patterns concerning physical exercise became better. Exercisers increased from 33.8%to 73.3%(H=68.448, P<0.05); proportion of smoking decreased from 38.5% to 20.0%(H=33.692, P<0.05); drinking alcohol decreased from 50.8%to 20.8%(H=59.128, P<0.05);high salt diet decreased from 39.2%to 23.1%(H=31.722, P<0.05);high-fat diet decreased from 46.2%to 27.7%(H=41.571, P<0.05). Conclusion The practice showed that the short-term intensified weight loss, long-term maintenance, exercise and psychological intervention, changed the cadres population from passive to active on the weight control and self-management with remarkable effects, therefore such intervention is worthy of promoting.
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Objective To investigate the effects of early tracheotomy on the prognosis of patients with severe brain lesions .Methods The clinical data of 68 patients with severe brain lesions were retrospectively analyzed . According to the time of tracheotomy ,we assigned 68 patients to receive either early tracheotomy or late tracheotomy . 34 patients who were given tracheotomy within 72 hours in Intensive Care Unit were selected as the early tracheotomy group (ET group).34 patients who were given tracheotomy after 14 days in Intensive Care Unit were selected as the late tracheotomy group(LT group).The time of mechanical ventilation,length of hospital stay,and the incidence of ventilator associated pneumonia ( VAP ) , sedative drug use time , antibiotic use time , in-hospital mortality were compared between the two groups.Results In ET group,the hospitalization time,mechanical ventilation time, incidence of VAP,sedative drug use time,antibiotic use time were (4.2 ±2.4)d,(3.5 ±0.6)d,(14.5 ±3.2)%, (1.5 ±0.5)d,(3.3 ±0.3)d,those in LT group were (12.5 ±4.8)d,(8.5 ±5.6)d,(28.6 ±8.6)%,(6.3 ±1.2)d, (13.2 ±1.1) d respectively,the differences between the two groups were statistically significant ( t =3.14,2.96, 3.28,3.46,2.57,all P<0.05).The hospitalization mortality rates of ET group ,LT group were (23.8 ±4.38)%, (24.5 ±4.16)%,respectively no significant difference between the two groups ( t=1.49,P<0.05).Conclusion The use of early tracheotomy can reduce the hospitalization time ,shorten the time of mechanical ventilation ,reduce the incidence of ventilator associated pneumonia ,and reduce the time of using sedative drugs and antibiotics ,but the mor-tality has no significant effect in the severe craniocerebral injury patients .
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Objective To explore the effect of the transcutaneous tracheostomy tube in patients with pneumothorax and its clinical value. Methods A prospective randomized controlled trial was conducted. Thirty-two patients with pneumothorax admitted to Department of Critical Care Medicine of Harrison International Peace Hospital of Hebei Medical University from June 2010 to June 2014 were enrolled. The patients were divided into control group and observation group,with 16 cases in each group. Beside the treatment for primary disease,the patients in control group received thoracic close drainage with traditional silica gel tube as performed by thoracic surgeons,and those in observation group received thoracic close drainage with transcutaneous tracheostomy tube by intensive care doctors. The curative effect and complications of the two groups were observed. Results Compared with control group,the time from diagnosis to operation(minutes:8.00±1.36 vs. 23.06±3.83,t=14.790,P=0.000)and the operation time were significantly shortened(days:5.37±1.02 vs. 7.31±1.70,t=7.286,P=0.000),the frequency of drainage tube replacement(times:0.18±0.40 vs. 3.87±1.14,t=12.128,P=0.000)and the times of repeated chest radiography(times:1.12±0.34 vs. 2.93±0.77,t=8.589,P=0.000)in observation group were significantly reduced,the length of hospital day was significantly shortened(days:8.30±1.37 vs. 24.56±5.62,t=17.289, P=0.000),the rates of dislocation of drainage tube(0 vs. 3 cases),obstruction of the tube(0 vs. 5 cases),and subcutaneous emphysema(3 vs. 16 cases)were reduced obviously,but there was no difference in incidence of incision infection(1 vs. 3 cases)and infection of thoracic cavity(0 vs. 2 cases). Conclusions The usage of transcutaneous tracheostomy tube in patients with pneumothorax is safe and simple. Doctors in ICU can independently do this procedure,and its effect is positive.