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Objective@#To explore the prevalence of elevated blood pressure and overweight/obesity and their comorbidities among Tibetan middle school students in Lhasa, and to analyze their association with lifestyle and other factors, so as to provide a basis for the intervention measures targeting elevated blood pressure, overweight and obesity among middle school students in high altitude area.@*Methods@#Using a stratified cluster random sampling method in September 2021, a total of 1 488 Tibetan junior and high students from Lhasa City were investigated with blood pressure measurement, physical examination and questionnaire survey. The influencing factors of elevated blood pressure, overweight and obesity and their comorbidities association were analyzed by multivariate Logistic regression.@*Results@#The prevalence of elevated blood pressure, overweight/obesity and their comorbidities were 17.8%, 17.4% , 5.0% respectively. Multivariate Logistic regression analysis showed that age( OR =0.81), residence, body mass inex(BMI) and gender were the influencing factors of elevated blood pressure; and the risks of elevated blood pressure in female students were higher than male students ( OR =1.89), suburban students were higher than urban students ( OR =8.06), overweight and obesity groups were higher than normal groups ( OR =2.55, 2.87) ( P <0.05). Adjusting for confounding factors such as gender, residence and school, and BMI (only for elevated blood pressure), daily screen time ≥2 h was positively correlated with elevated blood pressure, overweight/obesity and its comorbidities ( OR =1.56, 1.59 , 2.51) ( P <0.05).@*Conclusions@#The prevalence of elevated blood pressure, overweight/obesity are relatively high in Lhasa. Longer screen time is a common factor affecting with elevated blood pressure, overweight/obesity and comorbidities among Tibetan students. Measures should be taken intervene in the lifestyle of Tibetan students, in order to reduce elevated blood pressure and overweight/obesity.
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Background@#and Purpose Non-high-density lipoprotein cholesterol (non-HDL-C), which represents the total cholesterol content of all pro-atherogenic lipoproteins, has recently been included as a new target for lipid-lowering therapy in high-risk atherosclerotic patients in multiple guidelines. Herein, we aimed to explore the relationship between non-HDL-C level and the efficacy and safety of ticagrelor-aspirin versus clopidogrel-aspirin in preventing stroke recurrence. @*Methods@#This study comprised a post hoc analysis of the CHANCE-2 (Ticagrelor or Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events II) trial, from which 5,901 patients with complete data on non-HDL-C were included and categorized by median non-HDL-C levels, using a cutoff of 3.5 mmol/L. The primary efficacy and safety outcomes were recurrent stroke and severe or moderate bleeding within 90 days. @*Results@#Ticagrelor-aspirin significantly reduced the risk of recurrent stroke in patients with low non-HDL-C (71 [4.8%] vs. 119 [7.7%]; adjusted hazard ratio [HR] 0.54; 95% confidence interval [CI], 0.40–0.74), but not in those with high non-HDL-C (107 [7.3%] vs. 108 [7.6%]; adjusted HR, 0.88; 95% CI, 0.67–1.16), compared with clopidogrel-aspirin (P for interaction=0.010). When analyzed as a continuous variable, the benefit of ticagrelor-aspirin for recurrent stroke decreased as non-HDL-C levels increased. No significant differences in the treatment assignments across the non-HDL-C groups were observed in terms of the rate of severe or moderate bleeding (5 [0.3%] vs. 8 [0.5%] in the low non-HDL-C group; 4 [0.3%] vs. 2 [0.1%] in the high non-HDL-C group; P for interaction=0.425). @*Conclusion@#CHANCE-2 participants with low non-HDL-C levels received more clinical benefit from ticagrelor-aspirin versus clopidogrel-aspirin compared to those with high non-HDL-C, following minor ischemic stroke or transient ischemic attack.
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Objective The purpose of this study was to explore a suitable method to model no-reflow phenomenon following ischemic stroke and to evaluate perfusion decrease from multiple perspectives.Methods Laser scatter contrast imaging and two-photon live imaging were used to compare transient middle cerebral artery occlusion in C57BL/6 and BALB/c mice and perfusion alterations in BALB/c mice with 1 or 1.5 h of ischemia.Several imaging techniques including laser scatter contrast imaging,low and higher magnification images of perfused brain slices and two-photon microscopy to monitor erythrocyte flow rate and flux were used to assess in vivo dynamics as well as whole brain sections and microvasculature for decreased cerebral perfusion after transient middle cerebral artery occlusion.Infarct size and behavioral deficits were assessed with microtubule-associated protein 2 staining and behavioral scoring.Results In C57BL/6 mice,most capillaries in the middle cerebral artery region remained flowing during ischemia,whereas most capillaries were blocked in BALB/c mice.In addition,cortical perfusion at 24 h of recanalization was significantly reduced to 76.1%of baseline following 1.5 h of ischemia in BALB/c mice(P=0.046 compared with the sham group),whereas for it was reduced to 79.9%following 1h of ischemia which was not significantly different from the sham group(P=0.299).Transient middle cerebral artery occlusion in BALB/c mice for 1.5 h resulted in a reduction in whole-brain perfusion to 75.1%(P＜0.001 compared with the sham group),and erythrocyte flow rate assessed by two-photon live-imaging of erythrocyte flow on the cortical surface of the middle cerebral artery basin was reduced to 50.3%of baseline levels at 24 h of recanalization(P=0.010 compared with the sham group),and erythrocyte flux decreased to 38.9%of baseline levels(P= 0.010 compared with the sham group);high-magnification imaging of sections assessed an approximately 76%reduction in the length of capillaries with perfusion(P=0.0001 compared with the sham group),and a reduction in the fraction of the total volume occupied by perfused capillaries by an approximately 76%reduction(P＜0.001 compared with the sham-operated group).Microtubule-associated protein 2 staining suggested that transient middle cerebral artery occlusion for 1.5 h in BALB/c mice resulted in infarcts that accounted for approximately 36%of the total cerebral area and behavioral scores elevated to 9,suggesting behavioral deficits.Conclusion Transient ischemia in BALB/c mice for 1.5 h resulted in a significant decrease in cerebral perfusion as well as capillary no-reflow and thus can model the no-reflow phenomenon following ischemic stroke.The combination of laser scatter contrast imaging,low magnification and higher magnification images of perfused brain slices,and two-photon microscopy live imaging allows for a multifaceted assessment of perfusion changes.
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Purpose To investigate the value of ultrasound radiomics nomogram in predicting lymph node metastasis(LNM)of papillary thyroid carcinoma(PTC).Materials and Methods A retrospective analysis was conducted on 400 cases of PTC in the First Hospital of Shanxi Medical University from March 2021 to January 2022 confirmed by surgery and pathology,all of which underwent preoperative ultrasound examination,and were randomly divided into training cohort(n=280)and testing cohort(n=120)in a ratio of 7∶3.The relationship between ultrasound clinical features and LNM was evaluated via univariate analysis and a clinical model was established via multivariable Logistic regression.A total of 3 348 features were extracted from preoperative ultrasound images.Pearson correlation coefficient was used to screen the features,and Logistic regression was used to establish the radiomics model.Clinical risk factors and rad scores were combined to construct the nomogram,and the receiver operating characteristic curves and decision curve analysis were applied to evaluate the predictive efficacy and clinical benefit of each model for LNM of PTC.Results Age,primary lesion size,C-TIRADS and ultrasound-reported LNM were the independent risk factors for LNM(t/χ2=2.938,55.923,30.081,34.639,all P<0.05).The area under the curve of ultrasound radiomics nomogram to predict LNM of PTC in the training cohort and the testing cohort was 0.860 and 0.847,respectively;the combined model in 43%-85%had the highest clinical benefit.Conclusion Ultrasound radiomics nomogram has a certain value in predicting LNM of PTC.
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Recently, the gut microbiota-based live biotherapeutics (LBPs) development, the interaction between gut microbial species and the host, and the mining of new antimicrobial peptides, enzymes and metabolic pathway have received increasing attention. Culturing gut microbial species is therefore of great importance. This review systemically compared the construction advances of gut microbial culture banks and also analyzed the differences of methods used by research groups to give insight into the construction and enrichment of gut microbial resources. Presently, the gut microbial culture banks have included more than 1 000 bacterial species, belonging to 12 phyla, 22 classes, 39 orders, 96 families, and 358 genera. Among these, Firmicutes, Proteobacteria, Bacteroidota, and Actinomycetota exhibited the greatest diversities at the species level. The sequencing data showed that there are more than 2 000 species inhibited in the human gut. Therefore, the cultured gut microbial species are far from saturation. In terms of the construction method, the stool samples were pre-treated with ethanol or directly spread and cultured in the non-selective nutritional rich medium (represented by Gifu anaerobic medium) to obtain single colony. Then single colony was further purified. Generally, a simplified isolation and culture method is sufficient to obtain the most common and important intestinal bacterial species, such as Bifidobacteria-Lactobacillus, Akkermansia muciniphila, Faecalibacterium prausnitzii, Prevotella and S24-7 family strains. Finally, microbial resources with great diversities at the strain level are required for further functional research and product development. Samples covering hosts with distinct physiological status, diets or regions are necessary.
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Humans , Gastrointestinal Microbiome , Microbiota , Bacteriaالملخص
Objective:To investigate the curative effects of Beck's cognitive therapy (BCT) combined with transcranial magnetic stimulation (TMS) on post-stroke sleep disorders in patients.Methods:A total of 120 patients with post-stroke sleep disorders who were diagnosed and treated in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine between January and December 2020 were included in this study. They were randomly assigned to undergo TMS (TMS group), BCT (BCT group), or TMS plus BCT (combined group) ( n = 40/group). Before and after treatment, sleep quality and mental state scores were evaluated in each group. Results:After treatment, the Pittsburgh Sleep Quality Index (PSQI) score in the combined group [(5.68 ± 0.33) points] was significantly lower than that in the TMS group [(9.11 ± 0.83) points] and BCT group [(11.37 ± 1.06) points, F = 512.63, P < 0.001]. Sleep efficiency in the combined group [(56.73 ± 2.62)%] was significantly higher than that in the TMS group [(39.55 ± 3.02)%] and BCT group [(35.23 ± 1.41)%, F = 863.59, P < 0.001]. The Self-Rating Anxiety Scale (SAS) scores and Self-Rating Depression Scale (SDS) scores were significantly lower in the combined group compared with the TMS and BCT groups ( F = 412.52, 310.60, both P < 0.001). Conclusion:BCT combined with TMS can effectively improve sleep quality and reduce negative emotions in patients with post-stroke sleep disorders.
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【Objective】 To retrospectively analyze the safety and product quality of NGL XCF 3000 blood cell separator for collecting platelet-rich plasma (PRP) in 256 cases, so as to provide reference for safe collection and product quality control of PRP. 【Methods】 The data of 256 patients receiving PRP treatment in our hospital from June 2021 to June 2022 were statistically analyzed, and the differences in the collection time, circulating blood volume and the occurrence of adverse reactions to blood donation were analyzed when NGL XCF 3000 was used to collect autologous PRP among patients of different genders, ages and platelet counts. The differences in platelet content, red blood cell(RBC) contamination and white blood cell(WBC) residues in PRP products were analized. 【Results】 1) There were no significant differences in collection time, circulating blood volume and collection volume among patients of different genders, ages and platelet counts (P<0.05). 2) The contents of WBC, RBC and platelet were not significantly different between male and female patients after collection (P<0.05); 3) The WBC contents increased with the increase of age, and the WBC residue in the elder group[ 56 to78 years old, (0.64±0.41) ×109/L] was significantly higher than that in the younger group[group 1,18 to 40 years old, (0.50±0.35)×109/L], with significant difference was Statistically significant (P<0.05). 4) The residues of WBCs and RBCs in in low platelet group [group 1, (100-150)×109/L] were higher than those in other platelet count groups, and the difference was Statistically significant (P<0.05), and the platelet count in this product was significantly lower than that in other platelet count groups (P<0.05). Conclusion The NGL XCF 3000 blood cell separator is safe and stable for PRP collection in patients with different genders, ages and platelet counts of (100-450)×109/L, and the PRP products collected can meet clinical therapeutic needs.
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Objective:To investigate the clinical effect of Shenqi Dihuang Decoction and Xiaochengqi Decoction enema combined with hemodialysis in the treatment of qi deficiency, blood stasis and dampness and turbidity in chronic kidney disease (CKD) stage 5.Methods:Randomized controlled trial. A total of 102 elderly CKD stage 5 patients with Qi and Yin deficiency and turbid poison inherent type were selected from May 2021 to January 2022 of the Beijing Longfu Hospital. The patients were divided into two groups by random number table method. Control group (51 cases) received hemodialysis treatment for 4 weeks, and the observation group (51 cases) received Shenqi Dihuang Decoction and Xiaochengqi Decoction enema combined with hemodialysis treatment for 4 weeks. The levels of BUN, SCr and β2-microglobulin (β2-MG), and K +, Ca 2+, P 3- content, hemoglobin were detected by automatic blood cell analyzer, and serum CRP and IL-6 levels were detected by latex enhanced immune scattering turbidimetry. The adverse reactions during the treatment and evaluate the clinical efficacy were observed and recorded. Results:During the treatment, 2 patients in the observation group withdrew from the study due to severe diarrhea, and other patients completed the study. There were significant differences in total response rate between observation group and control group [91.84%(45/49) vs. 74.51%(38/51); χ2=5.32, P=0.002]. After treatment, scores of lumbar and knee acerbity, tiredness and fatigue, edema, dizziness and tinnitus, fear of cold and warm, yellow face, dry stool and total score in observation group were significantly lower than those in the control group ( t=8.38, 13.44, 15.14, 13.09, 7.12, 7.73, 11.16, 11.45, P<0.01); the scores of SF-12-PCS and SF-12-MCS were significantly higher than those in the control group ( t=3.24, 4.22, P<0.01). After treatment, levels of serum BUN [(15.02±2.35)mmoL/L vs. (18.02±3.65)mmoL/L, t=4.87], SCr[(155.26±23.65) μmol/L vs. (184.49±35.49) μmol/L, t=4.83], β2-MG[(7.12±1.27)mg/L vs. (9.56±2.14)mg/L, t=6.90] and P 3-[(1.51±0.10) mmol/L vs. (2.02±0.19) mmol/L, t=16.70], K +[(3.65±0.54) mmol/L vs. (4.21±0.63)mmol/L, t=4.76] in observation group were significantly lower than those in the control group ( P<0.01); Ca 2+[(1.86±0.36)mmol/L vs. (2.35±0.42)mmol/L, t=6.25] was significantly higher than that of the control group ( P<0.01). No adverse reactions occurred during the treatment in the two groups ( P>0.05). Conclusion:Shenqi Dihuang Decoction and Xiaochengqi Decoction enema and hemodialysis can improve renal function, correct electrolyte disorder, reduce the level of inflammatory factors, improve the quality of life, and improve the therapeutic effect of the patients with CKD stage 5 and Qi and Yin deficiency and turbid poison inherent pattern.
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Objective To analyze the prevalence of common chronic diseases and comorbidities in the elderly ≥65 years old in Xinzhou District, Wuhan. Methods A questionnaire survey, physical examination and a retrospective analysis of 12 common chronic diseases comorbidities were conducted in 2016 and 2018 in the resident elderly ≥65 years old. Results In 2016, the medical examination rate of the elderly aged ≥65 years old, the prevalence rate of ≥1 chronic disease, and the comorbidity rate of ≥2 chronic diseases in Xinzhou District were 57.37%, 82.53%, and 48.13%, respectively; in 2018, the medical examination rate, The prevalence of ≥1chronic diseases and the prevalence of ≥2 comorbidities were 47.57%, 83.13%, and 50.02%, respectively. The comparison of the three rates in two years was statistically significant (P＜0.006).The comorbidity of chronic diseases in the elderly accounted for more than 58.32%. The physical examination rate of the elderly is higher in women than in men, and higher in rural areas than in urban areas. The prevalence of chronic diseases is higher in women than in men, and the prevalence of chronic diseases is gradually increasing as the elderly ages. The prevalence of chronic diseases in people with normal BMI is lower than those with abnormal BMI, and the prevalence tend increased gradually with the increase of BMI in abnormal people. Hypertension (70.75%), hyperlipidemia (24.97%), diabetes (16.61%), osteoarthropathy (12.65%), hyperuricemia (9.35%), stroke (8.32%), eyes and appendages (5.88%)ranked the same in 2016 and 2018. Except for hyperuricemia, the prevalence of the other six diseases decreased in 2018 compared with 2016. Conclusion The prevalence of chronic diseases in the elderly ≥65 years old in Xinzhou District is relatively high, showing a slow upward trend. About 50.00% of the elderly suffer from comorbidities. The situation of chronic disease prevention and control is still severe. It is recommended to develop comprehensive prevention and control interventions among this population.
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Objective:To explore the clinical features and risk factors of severe mycoplasma pneumoniae pneumonia(SMPP) in children, and to provide guidance for early identification of SMPP.Methods:The clinical data of 263 children with mycoplasma pneumoniae pneumonia admitted to the Respiratory Department at Anhui Children′s Hospital from January 2019 to December 2021 were analyzed retrospectively.According to the severity of the disease, the patients were divided into severe group( n=88) and mild group( n=175). The general conditions, clinical manifestations, laboratory examination, imaging features and bronchoscopic findings between two groups were compared and statistically analyzed. Results:There was no significant difference in sex and onset season between two groups( P>0.05). The age of severe group was older than that of mild group( P<0.05). According to the age group, the incidence of SMPP in the infant group(14.10%) was lower than that in the preschool group (45.00%) and the school age group (37.65%) ( P<0.05), but there was no significant difference between preschool group and school age group ( P>0.05). The degree of fever and the proportion of extrapulmonary complications in severe group were higher than those in mild group, and the duration of fever, length of hospital stay and use of macrolides in severe group were longer than those in mild group ( P<0.05). There were significant differences in white blood cell count/lymphocyte count, C-reactive protein (CRP), prealbumin, glutamic pyruvic transaminase, lactate dehydrogenase (LDH), immunoglobulin G, immunoglobulin A, procalcitonin, erythrocyte sedimentation rate (ESR) and D-dimer between two groups(all P<0.05). There was significant difference in the copies of mycoplasma pneumoniae DNA in bronchoalveolar lavage fluid between two groups ( P<0.05). The proportion of large shadow, pleural thickening, atelectasis, pleural effusion, bronchoalveolar lavage and airway mucus thrombus blockage in severe group were higher than those in mild group ( P<0.05). Multivariate Logistic regression analysis showed that hot course ( OR=1.294, 95% CI: 1.127-1.485), CRP level( OR=1.027, 95% CI: 1.003-1.052), LDH level( OR=1.006, 95% CI: 1.002~1.011), D-dimer level( OR=1.406, 95% CI: 1.065~1.875), ESR( OR=1.042, 95% CI: 1.008-1.077), large shadow( OR=21.811, 95% CI: 6.205~76.664) and pleural effusion( OR=5.495, 95% CI: 1.604-18.826) were independent risk factors for SMPP.ROC curve analysis showed that thermal path, CRP level, LDH level, D-dimer level and ESR had high predictive value in the diagnosis of SMPP, and the best thresholds were 8.50 d, 25.625 mg/L, 412.50 IU/L, 0.98 mg/L and 36.5 mm/h, respectively. Conclusion:Children with SMPP had high degree of fever, long duration of fever, length of hospital stay, long use of macrolides, significantly increased inflammatory indexes, and severe changes in pulmonary imaging and bronchoscopy.Hot course, CRP level, LDH level, D-dimer level, ESR, large shadow and pleural effusion are risk factors for SMPP.It is helpful for early identification of SMPP when the hot course is >8.50 d, CRP>25.625 mg/L, LDH > 412.50 IU/L, D-dimer > 0.98 mg/L, ESR > 36.5 mm/h.
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Objective:To investigate the feasibility and safety of endovascular mechanical thrombectomy (EMT) combined with continuous intrasinus thrombolysis for the treatment of severe hemorrhagic cerebral venous sinus thrombosis (CVST).Methods:The clinical and imaging data of 5 consecutive patients with severe hemorrhagic CVST who received EMT combined with continuous intrasinus urokinase thrombolysis in Beijing Tiantan Hospital from March 2019 to February 2020 were retrospectively analyzed.Results:The average age of 5 patients was 39 years (range, 19-65 years). Two were males and 3 were females. Risk factors associated with CVST were identified in 3 patients. Four had more than two venous sinuses involved, with a total of 10 blood vessels affected by CVST. The affected venous sinus thrombus burden was high, the lesion volume was large, and the clinical manifestations were severe. The average duration of heparin anticoagulation therapy before EMT was 2.3 d (range, 0.5-7 d), and the average duration of intrasinus thrombolysis was 64 h (range, 30-95 h). After treatment, 1 vessel was completely recanalized and 7 vessels were partially recanalized. Four patients who achieved recanalization had good long-term clinical outcomes (modified Rankin Scale score: 0-2 at 3 months, 0-1 at 1 year). One patient failed to achieve recanalization and underwent decompressive craniectomy due to intracranial hypertension, had residual hemiparesis at 1-year follow-up. No procedure-related complications occurred.Conclusion:EMT combined with continuous intrasinus thrombolysis is a potential treatment option for patients with severe hemorrhagic CVST.
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Objective:To evaluate the clinical effect of high-intensity focused ultrasound(HIFU)and drug con-servative treatment on the treatment of type Ⅰ and type Ⅱ cesarean scar pregnancy(CSP).Methods:A retrospec-tive analysis was performed on 191 patients diagnosed with type Ⅰ and type Ⅱ CSP by ultrasonography and trea-ted in Mianyang Central Hospital from January 2018 to December 2021,and they were divided into drug group(n=67)and HIFU group(n=124)according to different treatment methods before curettage surgery.After receiv-ing conservative drug treatment or HIFU treatment,preformnegative pressure suction curettage under ultrasound monitoring to evaluate the effectiveness and safety of the two pretreatment methods.Results:There were no sig-nificant differences in age,number of cesarean sections,gestational age,the maximum diameter of the gestational sac,number of incision pregnancies,the β-hCG level before pretreatment,the heart tube pulse in the gestational sac,size of fetal bud,and fertility requirements between the medication group and HIFU group(P＞0.05).The proportion of type Ⅱ incision in HIFU group was higher than that in drug group(P＜Q.05).There were no signifi-cant differences between the two groups in intraoperative bleeding,treatment outcome effective rate after pretreat-ment,postoperative vaginal bleeding duration,postoperative uterine cavity residual,rate of reoperation and rate of repregnancy(P＞0.05).There were statistical differences between the two groups in the operation time of curet-tage surgery,whether the operation method was changed after pre-treatment,total hospital stay,β-hCG recovery time and hospitalization cost(P＜0.05).Following up to November 2022,there were 12 cases re-pregnancies in the drug group and 16 cases re-pregnancies in the HIFU group.Conclusions:For type Ⅰ and type Ⅱ CSP,HIFU pretreatment before negative pressure suction curettage under ultrasound monitoring is a safe and effective treat-ment,which improves the treatment effect and reduces the hospitalization time of patients.It may be an effective clinical therapy for type Ⅰ and type Ⅱ CSP treatment.
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Objective:To explore the related risk factors of secondary thoracotomy to stop bleeding after rheumatic heart disease valve replacement.Methods:A retrospective analysis of 373 patients in the Department of Cardiac Surgery of the First Hospital of Shanxi Medical University who underwent rheumatic heart disease valve replacement surgery from December 2013 to October 2020. According to whether or not to perform secondary thoracotomy to stop bleeding after operation, they were divided into two thoracotomy case group and control group. Collect the relevant clinical data of the patients, and analyze the risk factors that affect the second postoperative thoracotomy to stop bleeding through univariate and multivariate Logistic regression.Results:Among the 373 patients, 62 cases (16.62%) were in the secondary thoracotomy group and 311 cases (83.38%) were in the control group. Univariate analysis showed that the patient' s age, gender, prehospital cardiac function classification, pulmonary artery pressure, hemoglobin value (Hb), prothrombin time (PT), operation time, combined hypertension, intraoperative blood transfusion and postoperative two The occurrence of secondary thoracotomy to stop bleeding was related, and the difference was statistically significant ( P<0.05). The results of unconditional logistic regression analysis showed that prehospital cardiac function classification, Hb, PT, and hypertension are the risk factors leading to secondary thoracotomy to stop bleeding after rheumatic heart disease valve replacement. Conclusion:Effective control of risk factors can reduce the incidence of secondary thoracotomy after rheumatic heart disease valve replacement, and reduce the risk caused by secondary operations.
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【Objective】 To explore the clinical application of a universal platelet product for emergency, which was prepared by suspending O-type apheresis platelet concentrate in AB-type fresh frozen plasma, so as to improve the platelet support ability in emergency and special treatment. 【Methods】 A retrospective analysis of 21 hematological patients, which was divided into 3 groups of platelet transfusion schemes: universal type, AB type and the same type, was performed to analyze the differences in PLT, dose, 24 h PPR, 24 h CCI, follow-up platelet transfusion units and interval, and adverse reactions to transfusion. 【Results】 1)There was no significant difference in PLT, MPV, PDW, K, MA and pH between the initial O-type apheresis platelets and the finished universal platelets (P>0.05). The titers of both anti-A and anti-B in the universal platelets were less than 2. 2) Twenty-one patients were transfused with universal platelet for 27 occasions[1~5 occasions per person; 1 (0.4, 1.0) dose per time]. No adverse reactions to transfusion occurred. 3)There was no significant difference in the effective rate of 24 h CCI and 24 h PPR between the three groups after transfusion(P>0.05). The time interval of the first subsequent platelet transfusion between the compatible group and the universal group was longer than that in the AB-type transfusion group, with significant difference(P0.05) among three groups. 【Conclusion】 In emergency, the application of this universal platelet product can make hematological patients get timely and effective treatment. Its accessibility and effectiveness can be elevated and the infusion interval can be prolonged by improving the preparation method and storage conditions. This product is not only expected to improve the platelet support capacity for patients with emergency and also those undergoing hematopoietic stem cell transplantation during the blood type conversion period, but also may be a practical method to alleviate the contradiction between platelet supply and demand.
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【Objective】 To analyze the safety of apheresis granulocyte(AG) collection from blood donors mobilized by G-CSF and apheresis granulocyte transfusion efficacy in patients. 【Methods】 The blood routine results, collection process and follow-up of blood donors mobilized by G-CSF before and after AG collection were collected to analyze the safety of AG collection, and the blood routine results, clinical symptom improvement and treatment outcome of patients before and after AG transfusion were collected to analyze the transfusion efficacy. 【Results】 A total of 27 blood donors donated 29 U AG, with collection time at (229±20)min, circulating blood volume at (9 890±1 107)mL, and the dosage of anticoagulant at (1 002±97)mL.Two blood donors had adverse reactions to blood donation, and the AG collection was carried out after treatment.After G-CSF mobilization, WBC increased significantly from (5.61±1.06) ×109/L to (22.85±5.23) ×109/L, while RBC, Hb, Hct and Plt showed no significant change.The blood routine returned to the level before G-CSF mobilization 1-2 days after blood donation.No physical discomfort occurred during the one week after blood donation.Four patients with granulocyte deficiency complicated with multidrug-resistant bacterial infection, who failed to respond to antibiotic treatment, were transfused with 29 U AG, with no adverse reactions and no obvious change in blood routine, but the infection symptoms were improved significantly judged from clinical manifestation, bacterial culture results, temperature monitoring and CT examination, suggesting that the AG infusion was effective.Among the 4 patients, 1 was cured and discharged, 1 gave up treatment, 1 died of sepsis, and 1 died of multiple organ failure. 【Conclusion】 It is safe to collect AG from blood donors mobilized by G-CSF through blood cell separator, and the AG products basically meet the national quality requirements and the treatment needs.Sustained high-dose AG transfusion has a significant effect on infection control in patients with agranulocytosis combined with refractory multidrug-resistant bacterial or fungal infection.
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ObjectiveTo investigate the association between obesity phenotype and the occurrence of hypertension in middle-aged and elderly adults in China. MethodsData were obtained from the China Health and Retirement Longitudinal Study （CHARLS） in 2011 and 2015. Participants who completed two visits with ≥45 years old age at baseline were enrolled. Obesity phenotype was defined as the following four groups according to weight and metabolic status：metabolically healthy non-overweight/obesity （MHNO）， metabolically healthy overweight/obesity （MHO）， metabolically abnormal non-overweight/obesity （MANO）， and metabolically abnormal overweight/obesity （MAO）. Cox proportional risk regression model was used to analyze the relationship between obesity phenotype and the incidence of hypertension. ResultsA total of3 781 subjects with 1 775（46.95%） males and mean age of （57.76±8.57） years were included in this study. When the metabolically normal non-overweight/obese group （MHNO） was regarded as the reference group， the risk of developing hypertension was significantly increased （P<0.01） in MHO， MANO， and MAO with HRs of 1.35（1.11‒1.63）， 1.51（1.15‒1.97）， and 2.00（1.68‒2.38） respectively.ConclusionBoth MHO phenotype and MAO/MANO are significantly associated with the occurrence of hypertension in middle-aged and elderly adults.
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Objective:To evaluate the clinical feasibility, safety, and advantages of small lateral cervical incision for parathyroid exploration and resection.Methods:A total of 31 consecutive patients who underwent parathyroidectomy with a small lateral cervical incision, in the Department of Endocrinology and Breast Surgery of the First Affiliated Hospital of Chongqing Medical University from Apr. to Nov. 2021, including 11 males and 20 females, aged (49.32±13.79) years, ranging from 28 to 86 years, were selected to make retrospective statistical analysis of the surgical time, hospital stay, intraoperative blood loss, postoperative drainage and postoperative complications of the patients. All patients were injected with carbon nanoparticles suspension injection guided by color ultrasound to locate the enlarged parathyroid gland before surgery. EXCEL 2019 software was used for statistical analysis.Results:Thirty-one patients underwent parathyroidectomy through a small lateral cervical incision. Primary hyperparathyroidism was performed in 19 cases (including 2 cases with bilateral small lateral cervical incision, 2 cases with unilateral excision of thyroid mass combined with parathyroidectomy, 1 case with resection of huge parathyroid adenoma, and 1 case with local anesthesia) . Twelve patients with secondary hyperparathyroidism underwent total parathyroidectomy through bilateral small lateral cervical incision and forearm autogenous parathyroid transplantation (including bilateral thyroid mass resection combined with bilateral total parathyroidectomy and forearm autogenous parathyroid transplantation in 2 cases, local anesthesia and cervical plexus nerve block in 2 cases, and ectopic parathyroid gland in thyroid in 1 case) . Among them, the average operative time of patients with primary hyperparathyroidism was (54.74±27.71 & 74.14±31.73) min, the average intraoperative blood loss was (8.11±5.05 & 14.43±10.94) ml, the average postoperative drainage was (14.37±24.64 & 26.36±32.87) ml, the average postoperative parathyroid hormone was (11.59±16.46 & 26.65±56.38) pg/ml, the average hospital stay was (10.00±5.09 & 10.96±4.55) d, and the postoperative complication rate was (3.2% & 0%) .Conclusions:Parathyroid gland exploration and resection through small lateral cervical incision is a safe and effective surgical method and can also complete thyroid exploration and parathyroidectomy at the same time. Appropriate anesthesia should be selected after a full assessment of the patient’s basic condition.
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Trauma registration is an important tool to record the process and timeline in the treatment of trauma patients. The operation of trauma database is of great significance for reducing the mortality of patients, promoting the construction of trauma treatment system, and providing reference for policy-making. Trauma registration system has been established in the United States, United Kingdom, Germany and other developed countries for many years. However, the domestic system is still at an initial stage, and there are problems like data deficiencies, data incoherence, no item of complications, no treatment data after discharge and limits of human and financial resources. Therefore, there is room for improvements in terms of personnel fixation, financial support and continuous data monitoring should be further improved. In this study, the authors summarize the traum registration system from aspects of basic situation both at home and abroad, data analysis, clinical value, operation mechanism and challenges so as to provide important data for clinical researches.
الملخص
Objective:To translate the Healthcare Education Micro Learning Environment Measure (HEMLEM), and test the reliability and validity of the Chinese version of HEMLEM.Methods:HEMLEM was translated into Chinese version, convenient sampling and electronic questionaire survey methods were applied, and the reliability and validity of the scale was tested by electronic questionnaire survey among 141 nursing interns in China-Japan Friendship Hospital from November to December, 2021.Results:The Cronbach α coefficient of internal consistency of the total scale was 0.971, and the Cronbach α coefficient of the two sub-scales was 0.953 and 0.951, respectively, and the retest reliability was 0.901, the correlation coefficient with the Chinese version of Clinical Learning Environment Assessment Scale was 0.799. Two common factor was extracted from exploratory factor analysis, with a cumulative contribution of 83.478%.Conclusions:The Chinese version of HEMLEM has the same structure as the original scale, and has high reliability and validity, which can be used to evaluate the teaching environment of clinical departments.
الملخص
Objective:To evaluate the effect of neuromuscular electrical stimulation (NMES) on muscle strength and duration of mechanical ventilation through cumulative Meta-analysis and sequential trial analysis (TSA).Methods:Randomized controlled trial (RCT) of NMES intervention in intensive care unit (ICU) patients with mechanical ventilation were searched from PubMed database of US National Library of Medicine, EMbase database of Netherlands Medical Abstract, Web of Science, SinoMed database of China, CNKI, Wanfang data, VIP and other Chinese and English databases from database construction to July 15, 2021. The control group received ICU routine nursing or rehabilitation exercise; the experimental group received NMES (low frequency electric current through electrode stimulation to make muscle groups twitch or contract) based on routine care in ICU. Relevant data were screened, evaluated and extracted by two researchers independently. After extracting data, STATA 15.0 and TSA software were used to analyze the data and evaluate the research results. Results:A total of 9 studies were enrolled, including 619 subjects. Among the 9 articles included, 2 were grade A and 7 were grade B, indicating good overall quality. Cumulative Meta-analysis showed that compared with ICU routine care, NMES improved muscle strength of patients undergoing mechanical ventilation [standardized mean difference ( SMD) = 0.64, 95% confidence interval (95% CI) was 0.07 to 1.21] and shortened the duration of mechanical ventilation ( SMD = -1.84, 95% CI was -2.58 to -1.10). TSA analysis of the two outcomes showed that the sample size of muscle strength outcome index ( n = 518) and mechanical ventilation outcome index ( n = 419) did not meet the expected information (RIS; n values of 618 and 685); the cumulative Z-value line of the muscle strength outcome index crossed the traditional boundary line and TSA boundary line, indicating that more tests were not needed to verify this result. In the outcome index of mechanical ventilation duration, it was found that the cumulative Z-value line only crossed the traditional boundary line, but did not cross the TSA boundary line, indicating that further studies in this area should be carried out in the future to demonstrate this result. Conclusion:NMES can improve ICU patients' muscle strength and reduce the duration of mechanical ventilation.