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Objective:To investigate blood glucose variability, National Institutes of Health Stroke Scale (NIHSS) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score and prognosis in patients with acute and severe cerebrovascular disease, providing a reference for clinical treatment of this disease.Methods:The clinical data of 76 patients with acute and severe cerebrovascular disease who received treatment in Xixi Hospital of Hangzhou between January 2014 and December 2019 were retrospectively analyzed. These patients were divided into a survival group ( n = 51) and a death group ( n = 25) according to the prognosis 28 days after admission. Baseline data, baseline NIHSS score, APACHE II score, standard deviation of blood glucose, mean blood glucose, mean amplitude of glycemic excursions, and blood glucose variability rate were compared between the survival and death groups. The effects of these parameters on the prognosis of acute and severe cerebrovascular disease were analyzed. Results:There were no significant differences in gender, age, history of diabetes, type of disease, and length of hospital stay between the two groups ( χ2 = 1.674, t = 1.048, χ2 = 3.833, 0.263, t = 0.832, all P > 0.05). The proportion of patients with a history of hypertension in the death group was significantly higher than that in the survival group [15.69% (8/51) vs. 52.00% (13/25), χ2 = 11.063, P < 0.05]. There was no significant difference in mean blood glucose between the two groups ( t = 0.118, P > 0.05). The baseline NIHSS score, APACHE II score, standard deviation of blood glucose, mean amplitude of glycemic excursions and blood glucose variability rate in the death group were (24.41 ± 4.14) points, (25.00 ± 6.97) points, (2.72 ± 0.91) mmol/L, (6.27 ± 2.01) mmol/L, (34.83 ± 5.61) %,which were significantly higher than those in the survival group [(17.22 ± 3.63) points, (19.21 ± 5.36) points, (1.69 ± 0.70) mmol/L, (3.72 ± 1.68) mmol/L, (19.54 ± 3.22) %, t = 7.744, 3.999, 5.448, 5.823, 15.095, all P < 0.05]. The proportion of patients with blood glucose variability rate < 20% in the death group was significantly lower than that in the survival group [16.00% (4/25) vs. 74.51% (38/51), χ2= 23.230, P < 0.05]. The proportion of patients with blood glucose variability rate > 30% in the death group was significantly higher than that in the survival group [60.00% (15/25) vs. 13.73% (7/51), χ2 = 17.466, P < 0.05). Logistic regression analysis revealed that baseline NIHSS score, APACHE II score, standard deviation of blood glucose, mean amplitude of glycemic excursions, and blood glucose variability rate were the independent risk factors of death of cerebrovascular disease patients (all P < 0.05). Conclusion:In patients with acute and severe cerebrovascular disease, an obvious blood glucose fluctuation, high baseline NIHSS score, and high APACHE II score help to assess the prognosis of acute and severe cerebrovascular disease and determine the risk of death.
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Objective:To investigate the clinical value of liquid based cytology in the diagnosis of early non-small cell lung cancer (NSCLC).Methods:From October 2018 to October 2019, 120 patients with early NSCLC who were confirmed diagnossis by histopathology were selected from Xixi Hospital of Hangzhou and Tongde Hospital of Zhejiang Province.All patients underwent fiberbronchoscopy.All the specimens were performed liquid-based cell wax block and HE staining.Two or more experienced histopathological doctors read the histological samples and then gave pathological reports.The cytological samples were first screened by the primary cytological diagnosis doctors, and then read by the deputy director or chief physician.The cytological pathological reports were given in combination with the clinical practice.Results:HE staining in liquid-based cytology showed that squamous cell carcinoma had many different sizes and shapes, single scattered, polygonal and round, even distribution of chromatin, and no obvious nucleolus.HE staining of adenocarcinoma in liquid-based cytology often gathered solid mass, rich cytoplasm, regular cell size, round nucleus, fine chromatin, and obvious nucleolus.HE staining of small cell cancer in liquid-based cytology mostly scattered, the cytoplasm was rare as naked nucleus, the nucleus was deeply stained, some were angular or short shuttle shaped.The sensitivity and specificity of liquid based cytology in the diagnosis of NSCLC were higher than those of traditional smear (χ 2=4.874, 4.512, all P<0.05). The positive rates of squamous cell carcinoma (72.88%) and adenocarcinoma (85.29%) in liquid based cytology were significantly higher than those in traditional cytology (54.24% and 61.76%) (χ 2=4.427, 6.031, all P<0.05), but there was no statistically significant difference in positive rate of small cell cancer between the two groups (χ 2=1.333, P>0.05). The positive rate of stage Ⅰa in liquid based cytology (86.48%) was higher than that in traditional cytology (64.86%), there was statistically significant difference (χ 2=4.698, P<0.05), but there were no statistically significant differences in the positive rates of stage Ⅰb and stage Ⅱa between the two groups (all P>0.05). Conclusion:Liquid based cytology is of great value in the diagnosis of early NSCLC, which can increase the sensitivity and specificity of diagnosis.
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Objective@#To explored the bio-compatibility and cartilage regeneration of the rabbits genipin cross-linked decellularized scaffold, to provide experimental and theoretical support for the clinical application of genipin cross-linked decellularized scaffold.@*Methods@#Detergent-enzyme method was used to prepare decellularized tracheal scaffolds. Cellular content of native trachea and decellularized trachea were compared by 4′, 6-diamidino-2-phenylindole(DAPI) staining. Masson trichrome staining was used to compare the histological structure of the progenitor tube, decellularized trachea, and genipin cross-linked decellularized trachea. Nine adult New Zealand white rabbits were randomly divided into autologous tracheal transplantation group (negative control group), allogeneic tracheal transplantation group (positive control group), and genipin cross-linked decellularized tracheal transplantation group (experimental group). Autologous bone marrow mesenchymal stem cells were implanted on the surface of trachea in each group. The blood cells and type II collagen were detected to compare the inflammatory response and chondrocyte regeneration after tracheal orthotopic transplantation in the three groups.@*Results@#After DAPI staining and light microscope observation (×200), the cell content of the acellular 7-cycle trachea [(143.0 ± 71.1) cells/field] was significantly lower than that of the native trachea [(853.5 ± 149.6) cells/field], and the difference was statistically significant (P<0.001). Masson′s trichrome staining showed that the tissue structure of genipin cross-linked decellularized trachea was more complete. Blood cell analysis and type II collagen test results showed that genipin cross-linked decellularized trachea transplanted with bone marrow mesenchymal stem cells after transplantation in situ has little rejection and can be converted into chondrocytes by the action of related growth factors in vivo.@*Conclusions@#Genipin cross-linked decellularized tracheal scaffold combined with stem cell transplantation can successfully construct a tracheal in situ replacement model. This study provides a strong support for the research of tissue engineering trachea.
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Objective To explored the bio-compatibility and cartilage regeneration of the rabbits genipin cross-linked decellularized scaffold, to provide experimental and theoretical support for the clinical application of genipin cross-linked decellularized scaffold. Methods Detergent-enzyme method was used to prepare decellularized tracheal scaffolds. Cellular content of native trachea and decellularized trachea were compared by 4', 6-diamidino-2-phenylindole(DAPI) staining. Masson trichrome staining was used to compare the histological structure of the progenitor tube, decellularized trachea, and genipin cross-linked decellularized trachea. Nine adult New Zealand white rabbits were randomly divided into autologous tracheal transplantation group (negative control group), allogeneic tracheal transplantation group (positive control group), and genipin cross-linked decellularized tracheal transplantation group (experimental group). Autologous bone marrow mesenchymal stem cells were implanted on the surface of trachea in each group. The blood cells and type II collagen were detected to compare the inflammatory response and chondrocyte regeneration after tracheal orthotopic transplantation in the three groups. Results After DAPI staining and light microscope observation (×200), the cell content of the acellular 7-cycle trachea [(143.0 ± 71.1) cells/field] was significantly lower than that of the native trachea [(853.5 ± 149.6) cells/ field], and the difference was statistically significant (P<0.001). Masson's trichrome staining showed that the tissue structure of genipin cross -linked decellularized trachea was more complete. Blood cell analysis and type II collagen test results showed that genipin cross-linked decellularized trachea transplanted with bone marrow mesenchymal stem cells after transplantation in situ has little rejection and can be converted into chondrocytes by the action of related growth factors in vivo. Conclusions Genipin cross-linked decellularized tracheal scaffold combined with stem cell transplantation can successfully construct a tracheal in situ replacement model. This study provides a strong support for the research of tissue engineering trachea.
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Objective To analyze the therapeutic effect of emergency surgery in the treatment of severe valvular heart disease and its influence on heart function.Methods 87 cases with severe valvular heart disease were selected,and they were given emergency surgical treatment.Before and after treatment,the cardiac function index[end -diastolic volume (EDV),end-systolic volume (ESV),left ventricular end systolic volume index (LVESVI),left ventricular end-diastolic volume index (LVEDVI),left ventricular ejection fraction (LVEF)],postoperative complications and survival rate were compared.Results After treatment,the EDV [(125.78 ± 31.67) mL],ESV [(71.30 ± 16.58) mL] and LVESVI [(50.39 ± 13.30) mL/m2],LVEDVI [(88.74 ± 13.51) mL/m2],LVEF [(51.48 ± 12.73) ％] were better than those before treatment [(116.48 ± 28.94) mL,(63.26 ± 15.47) mL,(33.27 ± 8.54) mL/m2,(64.47 ± 12.69)mL/m2,(47.53 ± 11.20)％],the differences were statistically significant (t =2.022,2.022,3.307,12.213,2.173,all P ＜ 0.05).The incidence rate of complications was 24.14％ (21/87),included arrhythmia in 4 cases,low cardiac output syndrome in 8 cases,acute renal failure in 9 cases.Postoperative 1 year,2 years,the survival rates were 91.95％ (80/87),85.06％ (74/87),respectively.Conclusion Emergency surgical treatment for severe valvular heart disease can effectively improve cardiac function index,improve the survival rate.
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BACKGROUND:Acel ular tracheal matrix is similar to the native trachea with structure and biological performance preserved after decel ularization, and it is an important aim in tissue engineering to find an effective method of decel ularization. OBJECTIVE:To select the optimal decel ularization method through comparing chemical extraction method with detergent-enzymatic method for preparing rabbit tissue engineering trachea matrix. METHODS:Thirty tracheas from New Zealand white rabbits were randomly divide into three groups. Twenty of rabbit tracheas were subjected to decel ularization using 2%TritonX-100 combined with deoxyribonuclease I and ribonuclease (chemical extraction method group), and sodium deoxycholate combined with deoxyribonuclease I (detergent-enzymatic group), respectively. The other ten were given no intervention as controls. Samples were col ected and observed by hematoxylin-eosin staining, Masson-trichrome staining, safranin O staining, DAPI staining and scanning electronic microscope. RESULTS AND CONCLUSION:Hematoxylin-eosin staining demonstrated that compared with the control group, almost al cel ular components of the mucosal epithelium were removed in the detergent-enzymatic and chemical extraction groups, and there were few remnant chondrocytes. Masson-trichrome staining indicated that compared with the control group, components of the mucosal layer chondrocytes in the chemical extraction and detergent-enzymatic groups were completely removed, with only part of remained chondrocytes in the cartilage zone. Glycosaminoglycan was slightly decreased both in the chemical extraction and detergent-enzymatic groups shown by Safranin O staining, but more reduction was found in the chemical extraction group. DAPI staining reveled that only a smal amount of cartilage cel s remained in the dense layer of cartilage and lacuna both in this two methods. Scanning electronic microscope showed that using the detergent-enzymatic method there were the hierarchical structures of native trachea, but slight disruption using the chemical extraction method. In conclusion, decel ularized rabbit trachea matrix obtained by detergent-enzymatic method is better, with little disruption to the matrix.
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OBJECTIVE To investigate the epidemiology of bacterial infections isolated from liver disease patients with septic shock and analyze the antimicrobial susceptibility of major pathogens to provide reference for clinical therapy. METHODS A retrospective survey was conducted in 83 liver disease patients with septic shock of our hospital from Jan 2005 to Aug 2006. Identification and susceptibility of pathogens were assayed by MicroScan Auto-4 System. RESULTS The infection was frequently identified in intra-abdominal cavity (73.5%),blood stream (24.1%) or respiratory tract (13.3%). The top 3 pathogens were Escherichia coli (36.6%),Klebsiella pneumoniae (15.9%) and Staphylococcus aureus (6.1%). Gram-negative bacilli were usually resistant to multiple antimicrobial agents,but less resistant to imipenem,levofloxacin or piperacillin-tazobactam. Extended-spectrum ?-lactamases (ESBLs) positive rates of E. coli and K. pneumoniae were 53.3% and 7.7%. Asprergillus and Candida glabrata were the predominant pathogens from fungal infections,and they were mostly resistant to fluconazole. CONCLUSIONS Pathogens of liver disease patients with septic shock are mostly multi-drug resistant. The microbiological surveillance is important for guiding clinical therapy.
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Objective To investigate the therapeutic effect and its mechanisms on the treatment of subclinical hepatic encephalopathy(SHE)caused by hepatocirrhosis(compensatery phase)due to hepatitis B by Bifido(Haisi pharmacy).Methods 50 cases were randomized into therapeutic group and control group wtih twenty-five patients each.Patients in therapeutic group were given Bifido two capsule pills t.i.d in addifion to conventional therapy,while patients in controgroup were given the conventional therapy namely soft food with low salt,protective drugs for liver and supporting therapy.The therapeutic course in two groups was 8 weeks.We observed the changes of clinical symptoms,signs,arterial blood ammonia level,hepatic functions,number connection test(NCT) and other indexes prior to treatment and 4,8 weeks after treatment.Results It showed that Bifido capsules could not only improve the clinical symptoms,signs,Child-Turcotte-Pugh function grade,but also could decrease arterial blood ammonia,LPS level and time of number connection fest and the occurrence of HE(P
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Objective To observe the gastric intramucosal pH( pHi) and gastric intramucosal carbon dioxide tension (PgCO2) in patients, using an automated recirculating air tonometer during weaning from mechanical ventilation ,and to study the value of intramucosal PCO2 and pH measurements to predict weaning outcome from mechanical ventilation.Methods The study population included thirty -two adult critically patients who were mechanically ventilated because of acult respiratory failure and were considered ready to be weaned. Thirty-two patients were randomly assigned to synchronized intermittent mandatory ventilation combined with positive end-expiratory pressure and pressure support ventilation (SIMV+PEEP+PSV) group and continuous positive airway pressure with pressure support ventilation (CPAP+PSV)group,sixteen patients in each group . Respiratory and hemodynamic variables were measured during the weaning process. Simulaneously, the gastric intramucosal PCO2 and pH were measured. At the same time, an arterial blood sample was drawn for blood gas analysis.Results Eighteen patients were successfully weaned from mechanical ventilation and fourteen failed. The gastric intramucosal pH was initially 7.35?0.13 and decreased to 7.238?0.18 during the weaning process in patients who failed (P
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OBJECTIVE To investigate the epidemiology of bacterial infections in patients with severe liver disease in intensive care unit(ICU) and analyze the antimicrobial susceptibility of major pathogens to provide reference for clinical therapy.METHODS A retrospective survey was conducted in 206 patients with severe liver disease in ICU of our hospital from Oct 2005 to Dec 2006.Identification and susceptibility of pathogens were assayed by MicroScan Auto-4 System.RESULTS Infection was identified in 70.87% of the 206 patients with severe liver disease.Most infections were caused by single pathogen.The infection was frequently identified in respiratory tract,blood stream or intra-abdominal cavity.The top 5 pathogens were Escherichia coli(12.8%),Klebsiella pneumoniae(9.9%),Staphylococcus haemolyticus(8.5%),Pseudomonas aeruginosa(7.8%) and Stenotrophomonas maltophilia(6.4%).Gram-negative bacilli were usually resistant to multiple antimicrobial agents,but less resistant to piperacillin-tazobactam or imipenem.Most of S.haemolyticus isolates were meticillin-resistant(MRSH)(25%),which were susceptible to penicillin,ampicillin and vancomycin.CONCLUSIONS Pathogens of patients with severe liver disease in ICU are mostly multi-drug resistant.The microbiological surveillance is important for guiding clinical therapy.