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Objective:To study the risk factors and complications of hemodynamically significant patent ductus arteriosus(hsPDA)in preterm infants <32 weeks.Methods:From January 2021 to March 2022, a total of 150 premature infants with gestational age <32 weeks admitted to the Neonatal Intensive Care Unit of Liaocheng People′s Hospital were enrolled.Nine patients who did not meet the requirements were excluded and a total of 141 infants were finally analyzed retrospectively, including PDA group with 95 cases and non-PDA group with 46 cases.According to whether hsPDA existed or not, PDA group were dirided into hsPDA group with 42 cases and non-hsPDA group with 53 cases.Univariate and regression analyses were used to determine the risk factors and complication of hsPDA.Results:Univariate analysis showed that gestational age( t=-6.861, P<0.01), birth weight( t=-4.392, P<0.01), mode of delivery( χ2=9.018, P<0.01), caffeine( χ2=4.337, P<0.05) and suffocation( χ2=7.918, P<0.01)were associated with hsPDA.Logistic regression analysis showed that gestational age( OR=2.435, P<0.01, 95% CI: 1.669~3.552)was an independent risk factor for hsPDA in gestational age <32 weeks preterm infants.The incidences of necrotizing enterocolitis, intraventricular hemorrhage, bronchopulmonary dysplasia, and retinopathy of prematurity in the hsPDA group were higher than those in the non-hsPDA group( P<0.05). Conclusion:Gestational age is an independent risk factor for hsPDA with gestational age <32 weeks.Necrotizing enterocolitis, intraventricular hemorrhage, bronchopulmonary dysplasia, and retinopathy of prematurity are related complications of hsPDA.
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Objective:To explore the relationship between the standard deviation of red blood cell distribution width (RDW-SD), neutrophil/lymphocyte value (NLR), fibrinogen (FIB) and the prognosis of multiple myeloma (MM) patients and their predictive value.Methods:In this study, a retrospective study method was used to select 120 patients with MM who were initially diagnosed in the department of hematology of the Affiliated Hospital of Jining Medical College from January 2017 to October 2019. The follow-up time was 24 months, including 62 patients who survived (survival group) and 58 patients who died (death group). The RDW-SD, NLR and FIB values of the two groups were compared, and the value of the three indicators in predicting the follow-up outcome of MM patients was analyzed using the receiver operating characteristic (ROC) curve. Logistic regression model was used to analyze the related factors affecting the prognosis of MM patients.Results:Among 120 newly treated MM patients, the RDW-SD, NLR and FIB of the survival group were significantly lower than those of the death group (all P<0.05); The sensitivity, specificity and area under ROC curve (AUC) of RDW-SD+ NLR+ FIB in predicting adverse outcomes of MM patients were 88.96%, 84.50% and 0.919 respectively. Logistic multivariate regression analysis showed that ≥60 years old, International Staging System (ISS) Ⅲ, β2-microglobulin (β2-MG)≥3 500 ng/ml, increased RDW-SD, NLR, and FIB will increase the risk of poor prognosis in MM patients (all P<0.05). Conclusions:The RDW-SD, NLR and FIB have a close relationship with the poor prognosis of newly treated MM patients, and the combined application has certain value in predicting the prognosis of patients.
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Objective:To analyze the risk factors of bronchopulmonary dysplasia(BPD)in very preterm infants(VPI), and to provide scientific basis for the prevention and treatment of BPD in VPI.Methods:A prospective multicenter study was designed to collect the clinical data of VPI in department of neonatology of 28 hospitals in 7 regions from September 2019 to December 2020.According to the continuous oxygen dependence at 28 days after birth, VPI were divided into non BPD group and BPD group, and the risk factors of BPD in VPI were analyzed.Results:A total of 2 514 cases of VPI including 1 364 cases without BPD and 1 150 cases with BPD were enrolled.The incidence of BPD was 45.7%.The smaller the gestational age and weight, the higher the incidence of BPD( P<0.001). Compared with non BPD group, the average birth age, weight and cesarean section rate in BPD group were lower, and the incidence of male infants, small for gestational age and 5-minute apgar score≤7 were higher( P<0.01). In BPD group, the incidences of neonatal respiratory distress syndrome(NRDS), hemodynamically significant patent ductus arteriosus, retinopathy of prematurity, feeding intolerance, extrauterine growth restriction, grade Ⅲ~Ⅳ intracranial hemorrhage, anemia, early-onset and late-onset sepsis, nosocomial infection, parenteral nutrition-associated cholestasis were higher( P<0.05), the use of pulmonary surfactant(PS), postnatal hormone exposure, anemia and blood transfusion were also higher, and the time of invasive and non-invasive mechanical ventilation, oxygen use and total hospital stay were longer( P<0.001). The time of starting enteral nutrition, cumulative fasting days, days of reaching total enteral nutrition, days of continuous parenteral nutrition, days of reaching 110 kcal/(kg·d) total calorie, days of reaching 110 kcal/(kg·d) oral calorie were longer and the breastfeeding rate was lower in BPD group than those in non BPD group( P<0.001). The cumulative doses of amino acid and fat emulsion during the first week of hospitalization were higher in BPD group( P<0.001). Multivariate Logistic regression analysis showed that NRDS, invasive mechanical ventilation, age of reaching total enteral nutrition, anemia and blood transfusion were the independent risk factors for BPD in VPI, and older gestational age was the protective factor for BPD. Conclusion:Strengthening perinatal management, avoiding premature delivery and severe NRDS, shortening the time of invasive mechanical ventilation, paying attention to enteral nutrition management, reaching whole intestinal feeding as soon as possible, and strictly mastering the indications of blood transfusion are very important to reduce the incidence of BPD in VPI.
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Objective:To evaluate the safety and efficacy of daratumumab in the treatment of multiple myeloma (MM).Methods:The clinical data of 19 MM patients treated with daratumumab alone or in combination with chemotherapy regimens from June 2021 to December 2021 in the Affiliated Hospital of Jining Medical College were retrospectively analyzed, of which 2 patients received daratumumab alone, 6 cases received daratumumab combined with lenalidomide+dexamethasone (DRD) regimen, 1 case received daratumumab combined with liposomal doxorubicin+dexamethasone (DVD) regimen, 2 case received daratumumab combined with dexamethasone+cyclophosphamide+etoposide+cisplatin (DECP) regimen, 3 cases received daratumumab combined with isazomib+dexamethasone (ID) regimen, 2 cases received daratumumab combined with bortezomib+dexamethasone (BD) regimen, and 3 cases received daratumumab combined with dexamethasone (DD) regimen. The efficacy and incidence of adverse effects were analyzed.Results:Among the 19 patients, 8 had complete remission (CR), 1 had very good partial remission (VGPR), 5 had partial remission (PR), 1 had stable disease (SD), and 4 had progressive disease (PD). The overall response rate (ORR) was 73.7% (14/19). The median progression-free survival (PFS) time was 10.42 months (95% CI 8.04-12.79 months) and the median overall survival (OS) time was 52.06 months (95% CI 37.85-66.27 months). The main adverse reactions during treatment were grade 3 neutropenia in 3 cases, grade 3 lymphopenia in 3 cases, grade 2 anemia in 5 cases, grade 2 nausea and vomiting in 7 cases, and infusion-related adverse reactions in 7 cases. Conclusions:Daratumumab-based chemotherapy regimens for the treatment of MM patients can achieve great efficacy with good safety and tolerability.
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【Objective】 To provide reference for formulating relatively unified quality control strategies and meeting the requirements of homogenization construction of blood banks across Chongqing area by retrospectively analyzing sampling results of different blood components during the past two years in all levels of blood banks in Chongqing area. 【Methods】 The key quality data of blood components prepared by 6 blood banks in Chongqing were analyzed retrospectively. According to the issuing units to the clinical during the past two years, the research objects were selected as leukocyte-depleted suspended RBCs, cryoprecipitate, pathogen inactivated fresh frozen plasma(FFP) and apheresis platelets. The quality data of the above-mentioned blood components from January 2019 to June 2021 were collected and analyzed. 【Results】 For leukocyte-depleted suspended RBCs(1U)prepared by 5 blood banks, statistically significant differences in Hb, residual white blood cells and hemolysis rate at the end of storage, except for Hct, were noticed(P<0.05). For cryoprecipitate, the content of blood coagulation factor Ⅷ and fibrinogen were statistically different among 3 blood banks in 1U specification(P<0.05) and among 5 blood banks in 2U specification(P<0.05). For pathogen inactivated FFP, the content of blood coagulation factor Ⅷ, plasma proteins, and residual methylene blue were statistically different among 3 blood banks(P<0.05). For apheresis platelets, Plt, white/red blood cells contamination and pH at the end of storage were statistically different among 3 blood banks(P<0.05). 【Conclusion】 The quality data of blood components, prepared by different blood banks, meet the requirements of national standard, however, certain differences are existing among blood banks.Key points during the process of collection, preparation, storage and transportation need to be cleared and unified, so as to reduce the differences between each other, and determine the direction and basis for homogeneity construction in the next step.
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Objective:To investigate the efficacy and safety of ixazomib-based therapy for multiple myeloma.Methods:The data of 32 patients with multiple myeloma treated with isazomib-based regimen in the Affiliated Hospital of Jining Medical University from December 2020 to December 2021 were retrospectively analyzed. Among 32 patients, 17 cases were relapsed/refractory, and the remaining 15 cases had initial treatment. The treatment regimens included ID (isazomib + dexamethasone), IRD (isazomib + lenalidomide + dexamethasone) and ICD (isazomib + cyclophosphamide + dexamethasone). The short-term curative effect and adverse reactions of relapsed/refractory patients and patients at initial onset were analyzed.Results:The overall response rate (ORR) of relapsed/refractory patients was 52.9% (9/17), of which 6 cases achieved complete remission (CR), 2 cases achieved very good partial remission (VGPR) and 1 case achieved partial remission (PR). The ORR of refractory patients receiving bortezomib therapy was 40.0% (4/10). The ORR of patients at initial onset who could be evaluated the curative effect was 100.0% (14/14), including 9 cases of CR, 2 cases of VGPR and 3 cases of PR. After treatment, 2 patients (6.2%) had grade Ⅲ-Ⅳ adverse events (1 case of herpes zoster and 1 case of thrombocytopenia), and none of the patients had grade Ⅲ-Ⅳ peripheral neuropathy.Conclusion:Isazomib is effective and safe in the treatment of initially treated and relapsed/refractory multiple myeloma.
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Objective:To investigate the clinical efficacy of autologous peripheral blood hematopoietic stem cell transplantation (HSCT) in treatment of lymphoma.Methods:The clinical data of 41 lymphoma patients undergoing autologous peripheral blood HSCT at the Affiliated Hospital of Jining Medical University between January 2014 to December 2020 were retrospectively analyzed. There were 6 cases of Hodgkin lymphoma and 35 cases of non-Hodgkin lymphoma. The mobilization regimens included chemotherapy drugs + granulocyte colony-stimulating factor (G-CSF) + thrombopoietin (TPO) or chemotherapy drugs + G-CSF. The pre-conditioning schemes before transplantation were listed as follows: BEAM (mustine + cytarabine + etoposide + melphalan) regimen + decitabine in 26 patients, BEAM regimen in 12 patients, BEAM regimen + chidamide in 3 patients. The progression-free survival (PFS), overall survival (OS), related complications, prognoses after transplantation were observed. The effects of clinical staging, B symptom,International Prognostic Score Index (IPI), extranodal involved sites, hemoglobin (Hb), lactic dehydrogenase (LDH), β 2-microglobulin (β 2-MG), transplantation regimen and the status before transplantation on PFS and OS after transplantation were evaluated. Results:Among 41 patients, 37 patients (90.24%) achieved complete remission (CR), 2 patients (4.88%) achieved partial remission (PR) and 2 patients loss assessment data (4.88%) before autologous peripheral blood HSCT. The median karyocyte count was 12.74×10 8 /kg [(3.91-22.68)×10 8/kg] in 24 patients with the complete data of stem cell collection, the median CD34 positive cell count was 6.74×10 6/kg [(0.91-50.47)×10 6/kg]. All 41 patients had hematologic reconstruction. The median time of platelet implantation was 11 d (7-32 d) and the median time of granulocyte implantation was 9 d (8-16 d). All patients achieved CR after transplantation and no one case had transplantation-related death. By the end of follow-up, 33 cases (80.49%) had no progression of disease, 8 cases (19.51%) died. The OS rates of 12-month, 24-month and 72-month were 93.4%, 85.3% and 60.9%, respectively after transplantation. The PFS rates of 12-month, 24-month and 72 month were 93.3%, 84.0% and 84.0%, respectively. Median PFS and OS had not been reached. There were no statistically significant differences in the PFS and OS of patients with different gender, clinical staging, B symptom, IPI score, extranodal involved sites, Hb, LDH, β 2-MG and the status before transplantation(all P > 0.05) . The PFS and OS of patients receiving BEAM regimen + decitabine were better than those of patients receiving BEAM regimen alone (all P < 0.05). Conclusions:Autologous peripheral blood HSCT is effective in treatment of lymphoma. Moreover, BEAM regimen + dicitabine preconditioning regimen can achieve longer survival time compared with BEAM regimen alone.
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Objective@#In order to provide guidance for the prevention and control of epidemic situations in schools, this paper explores the risk perception and prevention behaviors of college students after classes resume in the post-epidemic period of novel coronavirus pneumonia.@*Methods@#By using convenient sampling method, 835 college students who resumed classes were randomly selected from a university in Guizhou. Self-efficacy questionnaire, perceived social support questionnaire and self-designed questionnaire were adiministered.@*Results@#Totally 37.0% of college students believed that the risk of infection was high, 57.4% of college students believed the severity of infection was very high once get infected, meanwhile, 84.3% of them think that keeping away from crowded places was a better preventive behavior, 89.7% of college students often wear masks, 91.4% of college students wash their hands frequently. There was a significant positive correlation between general self-efficacy, perceived social support and preventive behavior (r=0.10-0.65, P<0.01). General self-efficacy and perceived social support play both a partial intermediary role and a chain intermediary role between risk perception and preventive behavior.@*Conclusion@#Risk perception of Novel Coronavirus was moderate among college students, who can take active measures to effectively prevent it. Risk perception could not only directly affect the prevention behavior of college students, but also indirectly affect the prevention behavior of college students through understanding social support and general self-efficacy.
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Objective:To investigate the significance of N-terminal pro-brain natriuretic peptide (NT-proBNP) in the early assessment of neonatal cardiac dysfunction in sepsis.Methods:The children diagnosed with neonatal sepsis and common infection neonates admitted to the department of pediatric neonatal intensive care unit (NICU) of Liaocheng People's Hospital from January 2016 to January 2019 were enrolled. Data of clinical sign, laboratory results, bedside echocardiography and survival data were collected, and the differences of clinical indexes were compared among sepsis patients with and without cardiac dysfunction and common infection. The risk factors of sepsis with cardiac dysfunction were analyzed by multivariate Logistic regression, and the early prediction value of NT-proBNP for neonatal septic cardiac dysfunction was evaluated by the receiver operating characteristic (ROC) curve.Results:There were 112 neonates with sepsis (49 with cardiac dysfunction and 63 without cardiac dysfunction) and 67 children with common infection included in the analysis. The onset time of neonates in septic cardiac dysfunction group was significantly earlier than that of septic non-cardiac dysfunction group and common infection group [hours: 52.9 (0, 180.3) vs. 53.9 (0, 183.6), 81.0 (45.6, 202.4), both P < 0.05]. Compared with the general infection group, albumin (ALB), white blood cell count (WBC), left ventricular ejection fraction (LVEF) in septic cardiac dysfunction group significantly decreased, NT-proBNP, hypersensitive C-reactive protein (hs-CRP)/ALB, pulmonary artery systolic pressure (PASP) significantly increased, while right ventricular (RV) and Tei index significantly increased [ALB (g/L): 24.1±3.8 vs. 27.8±3.6, WBC (×10 9/L): 12.7 (3.7, 18.9) vs. 15.4 (9.9, 23.2), LVEF: 0.626±0.123 vs. 0.700±0.021, NT-proBNP (ng/L): 20 230.6 (15 890.0, 35 000.0) vs. 7 324.5 (2 426.5, 13 890.0), hs-CRP/ALB: 0.33 (0.29, 0.81) vs. 0.06 (0.00, 0.21), PASP (mmHg, 1 mmHg = 0.133 kPa): 52.25±14.12 vs. 41.07±27.73, RV (mm): 10.74±2.42 vs. 8.55±1.41, Tei index: 0.52±0.03 vs. 0.30±0.04, all P < 0.05]. NT-proBNP and Tei index in septic cardiac dysfunction group were significantly higher than those in septic non-cardiac dysfunction group [NT-proBNP (ng/L): 20 230.6 (15 890.0, 35 000.0) vs. 13 057.6 (8 946.0, 35 000.0), Tei index: 0.52±0.03 vs. 0.39±0.02, both P < 0.05], and LVEF was significantly lower than that in septic non-cardiac dysfunction group (0.626±0.123 vs. 0.671±0.086, P < 0.05). Multivariate Logistic regression analysis showed that NT-proBNP, Tei index and hs-CRP/ALB were independent risk factors for cardiac dysfunction in sepsis neonates [odds ratio ( OR) and 95% confidence interval (95% CI) were 8.73 (1.54-5.67), 1.97 (1.26-2.87), 1.87 (1.03-3.40) respectively, all P < 0.05]. ROC curve analysis showed that NT-proBNP, Tei index and hs-CRP/ALB had good predictive value for the occurrence of cardiac dysfunction in septic neonates, the area under ROC curve (AUC) was 0.81 (95% CI was 0.84-0.91), 0.78 (95% CI was 0.65-0.79) and 0.77 (95% CI was 0.61-0.77), respectively. The sensitivity and specificity of NT-proBNP were 80.0% and 79.0% respectively with 12 291.5 ng/L as the cut-off value, the sensitivity and specificity of Tei index were 74.0% and 77.0% respectively with 0.45 as the cut-off value, and the sensitivity and specificity of hs-CRP/ALB were 76.0% and 76.3% respectively with 0.10 as the cut-off value. Conclusions:NT-proBNP can be used as a diagnostic marker of early cardiac dysfunction, and for rapid diagnosis of neonatal cardiac dysfunction in sepsis. The application may guide clinicians to use drugs better to improve cardiac function and treatment effect.
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Objective:To investigate the value of N-terminal pro-brain natriuretic peptide (NT-proBNP) combined with bedside echocardiography in diagnosis and treatment of neonatal sepsis with cardiac dysfunction.Methods:A total of 56 children diagnosed with neonatal sepsis in the Neonatal Intensive Care Unit, Liaocheng People′s Hospital from July 2016 to July 2017 were enrolled and divided into 2 groups, namely, the cardiac dysfunction group (26 cases) and the non-cardiac dysfunction group (30 cases). Children with general infection (45 cases) hospita-lized at the same period were taken as the control group.The clinical characteristics, related laboratory indexes and prognosis were compared among 3 groups.The related factors of neonatal sepsis with cardiac dysfunction were analyzed by the multivariate Logistic regression approach, and the value of related indexes in the early prediction neonatal sepsis with cardiac dysfunction was analyzed by using the receiver operating characteristic curve (ROC). Results:The onset age of sepsis patients with cardiac dysfunction [63.0 h (30.5 h, 185.6 h)] was significantly earlier than that of the patients without cardiac dysfunction [65.0 h (34.5 h, 170.6 h)] and the control group [80.0 h (45.5 h, 202.3 h)] ( P<0.05). The main primary site of the disease was the lung, which was not statistically significant among the 3 groups ( P>0.05). The NT-proBNP level and the high sensitivity-C-reactive protein (hs-CRP)/albumin (ALB) ratio in the cardiac dysfunction group [20 230.6 ng/L (15 890.0 ng/L, 35 000.0 ng/L); 0.33(0.29, 0.81)] were significantly higher than those in the control group [7 324.5 ng/L (2 426.5ng/L, 13 890.0 ng/L); 0.06(0, 0.21)] (all P<0.05). The right ventricular diameter and the Tei index of the cardiac dysfunction group [(8.74±2.42) mm; 0.52±0.03] were significantly higher than those in the control group [(8.55±1.41)mm; 0.30±0.04], while the EF of the cardiac dysfunction group [(62.61±2.56)%] was significantly lower than that in the control group [(70.03±0.35)%] (all P<0.05). The ROC curve analysis showed that NT-proBNP and the Tei index could effectively predict sepsis with cardiac dysfunction.Specifically, NT-proBNP had a cutoff value of 12 291.5 ng/L, with sensitivity of 80%, specificity of 79%, and the area under ROC curve (AUC) of 0.81.The Tei index had a cutoff value of 0.45, with sensitivity of 74%, specificity of 77%, and the AUC of 0.78. Conclusions:NT-proBNP can be used as a marker of early cardiac dysfunction.Its combination with the Tei index of bedside echocardiography can quickly diagnose cardiac dysfunction of children with sepsis, better guide clinicians in drug use, improve cardiac function of patients and enhance the treatment effect.
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Understanding of the nephrotoxicity induced by drug candidates is vital to drug discovery and development. Herein, an metabolomics method based on air flow-assisted desorption electrospray ionization mass spectrometry imaging (AFADESI-MSI) was established for direct analysis of metabolites in renal tissue sections. This method was subsequently applied to investigate spatially resolved metabolic profile changes in rat kidney after the administration of aristolochic acid I, a known nephrotoxic drug, aimed to discover metabolites associated with nephrotoxicity. As a result, 38 metabolites related to the arginine-creatinine metabolic pathway, the urea cycle, the serine synthesis pathway, metabolism of lipids, choline, histamine, lysine, and adenosine triphosphate were significantly changed in the group treated with aristolochic acid I. These metabolites exhibited a unique distribution in rat kidney and a good spatial match with histopathological renal lesions. This study provides new insights into the mechanisms underlying aristolochic acids nephrotoxicity and demonstrates that AFADESI-MSI-based metabolomics is a promising technique for investigation of the molecular mechanism of drug toxicity.
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Objective@#To study the application of multiple row spiral CT (MSCT) in the diagnosis of inferior vena cava lesions in Budd Chiari syndrome (BCS) and its clinical value.@*Methods@#Eighty patients with BCS admitted to the Central Hospital of Shan County from May 2017 to May 2018 were divided into two groups by digital grouping method, with 40 cases in each group.The control group was diagnosed by ultrasound, and the study group was diagnosed by multi-slice CT.The pathological changes, tissue contrast of inferior vena cava and hepatic vein and the diagnostic sensitivity, specificity, positive predictive value and negative predictive value of inferior vena cava obstruction were compared between the two groups.@*Results@#The pathological diagnosis rate in the study group was significantly higher than that in the control group(χ2=4.562, 4.695, 4.125, 5.124, all P<0.05). The contrast of inferior vena cava and hepatic vein tissues in the study group was significantly higher than that in the control group (t=12.897, 13.214, all P<0.05). The sensitivity, specificity, positive predictive value and negative predictive value of the diagnosis of inferior vena cava occlusion in the study group were higher than those in the control group (the control group: 91.2%, 98.6%, 97.3%, 80.3%, the study group: 100.0%, 99.5%, 98.2%, 100.0%, χ2=11.897, 10.214, 11.235, 13.564, all P<0.05).@*Conclusion@#The application of MSCT in the diagnosis of BCS-inferior vena cava lesions, can display the lesions comprehensively and intuitive guidance in the treatment of inferior vena cava lesions, has high diagnostic value, it is worthy of popularization and application in clinic.
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Objective@#To explore the safety and efficacy of intravenous nutrition strategy for preterm infants with birth weight < 1 500 g combined with literatures.@*Methods@#The clinical data of 93 preterm infants with very low or extremely low birth weight (< 1 500 g) who were admitted to the neonatal intensive care unit (NICU) of Liaocheng People's Hospital of Shandong Province from October 2012 to December 2018 were retrospectively analyzed. On the basis of active treatment of primary disease and early enteral nutrition, all preterm infants received "all-in-one" intravenous nutrition strategy. The intravenous nutrient solution containing 6% pediatric compound amino acids, 20% fat emulsion, glucose, vitamins, NaCl, KCl, microelements and minerals was transfused uniformly in 20-24 hours. The changes in growth and biochemical indexes of preterm infants before and after intravenous nutrition intervention were observed. The occurrence of intravenous nutritional complications such as parenteral nutrition associated cholestasis (PNAC) and prognosis were recorded. The receiver operating characteristic (ROC) curve was plotted to assess the predictive power of each indicator for extra uterine growth retardation (EUGR).@*Results@#Ninety-three preterm infants were enrolled in the final analysis. The gestational age was (28.75±1.93) weeks and the birth weight was (1 113.28±190.48) g. All the children except 4 non-surviving preterm infants were discharged from hospital. The average hospitalization time was (51.64±15.98) days. In 89 surviving preterm infants, the maximum weight loss percentage was (4.42±3.12)%, and the time to regain birth weight was (6.36±2.60) days. In these surviving preterm infants, the daily average growth rate of weight gain was (19.53±4.64) g/kg, and the weekly average growth of body length and head circumference gain was (1.06±0.34) cm and (0.69±0.22) cm, respectively. The mean duration of intravenous nutrition was (21.56±8.54) days in 89 surviving preterm infants. The body weight, body length and head circumference of these surviving preterm infants were increased significantly at discharge compared with their admission to NICU [body weight (g): 2 191.63±186.00 vs. 1 118.71±188.78, body length (cm): 45.21±1.50 vs. 37.34±2.56, head circumference (cm): 31.04±1.27 vs. 25.96±1.80]. The level of albumin (Alb) was significantly increased (g/L: 27.52±3.77 vs. 25.70±3.88), however the blood urea nitrogen (BUN) level was significantly reduced (mmol/L: 1.65±1.39 vs. 5.11±3.20) with statistical differences (all P < 0.05). In the 89 surviving preterm infants, 79 preterm infants (88.8%) suffered from premature anemia and 48 (53.9%) achieved transfusion criteria. Forty-two preterm infants (47.2%) had glucose metabolism disorder and 38 (42.7%) had electrolyte disturbances. PNAC occurred in 9 preterm infants (10.1%). Thirty-eight preterm infants (42.7%) had EUGR in weight. ROC curve analysis showed that the combination of gestational age, birth weight and time to restore birth weight had a good predictive value for EUGR in very low or extremely low birth weight preterm infants, and the area under the ROC curve (AUC) was 0.902, the sensitivity was 86.4%, and the specificity was 86.8%.@*Conclusions@#The intravenous nutrition strategy for preterm infants with birth weight < 1 500 g is effective and safe. However, intravenous nutrition can cause some complications, such as glucose metabolism disorder, electrolyte disturbances and PNAC, etc. So the process of intravenous nutrition should be closely monitored. To start EN as early as possible and shorten the duration of intravenous nutrition is an important measure for the prevention of PNAC. The combination of gestational age, birth weight and the time to regain birth weight has a good predictive value for EUGR, and intervention can be strengthened early in hospital to avoid EUGR.
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To explore the safety and efficacy of intravenous nutrition strategy for preterm infants with birth weight < 1 500 g combined with literatures. Methods The clinical data of 93 preterm infants with very low or extremely low birth weight (< 1 500 g) who were admitted to the neonatal intensive care unit (NICU) of Liaocheng People's Hospital of Shandong Province from October 2012 to December 2018 were retrospectively analyzed. On the basis of active treatment of primary disease and early enteral nutrition, all preterm infants received "all-in-one" intravenous nutrition strategy. The intravenous nutrient solution containing 6% pediatric compound amino acids, 20% fat emulsion, glucose, vitamins, NaCl, KCl, microelements and minerals was transfused uniformly in 20-24 hours. The changes in growth and biochemical indexes of preterm infants before and after intravenous nutrition intervention were observed. The occurrence of intravenous nutritional complications such as parenteral nutrition associated cholestasis (PNAC) and prognosis were recorded. The receiver operating characteristic (ROC) curve was plotted to assess the predictive power of each indicator for extra uterine growth retardation (EUGR). Results Ninety-three preterm infants were enrolled in the final analysis. The gestational age was (28.75±1.93) weeks and the birth weight was (1 113.28±190.48) g. All the children except 4 non-surviving preterm infants were discharged from hospital. The average hospitalization time was (51.64±15.98) days. In 89 surviving preterm infants, the maximum weight loss percentage was (4.42±3.12)%, and the time to regain birth weight was (6.36±2.60) days. In these surviving preterm infants, the daily average growth rate of weight gain was (19.53±4.64) g/kg, and the weekly average growth of body length and head circumference gain was (1.06±0.34) cm and (0.69±0.22) cm, respectively. The mean duration of intravenous nutrition was (21.56±8.54) days in 89 surviving preterm infants. The body weight, body length and head circumference of these surviving preterm infants were increased significantly at discharge compared with their admission to NICU [body weight (g): 2 191.63±186.00 vs. 1 118.71±188.78, body length (cm): 45.21±1.50 vs. 37.34±2.56, head circumference (cm): 31.04±1.27 vs. 25.96±1.80]. The level of albumin (Alb) was significantly increased (g/L: 27.52±3.77 vs. 25.70±3.88), however the blood urea nitrogen (BUN) level was significantly reduced (mmol/L: 1.65±1.39 vs. 5.11±3.20) with statistical differences (all P < 0.05). In the 89 surviving preterm infants, 79 preterm infants (88.8%) suffered from premature anemia and 48 (53.9%) achieved transfusion criteria. Forty-two preterm infants (47.2%) had glucose metabolism disorder and 38 (42.7%) had electrolyte disturbances. PNAC occurred in 9 preterm infants (10.1%). Thirty-eight preterm infants (42.7%) had EUGR in weight. ROC curve analysis showed that the combination of gestational age, birth weight and time to restore birth weight had a good predictive value for EUGR in very low or extremely low birth weight preterm infants, and the area under the ROC curve (AUC) was 0.902, the sensitivity was 86.4%, and the specificity was 86.8%. Conclusions The intravenous nutrition strategy for preterm infants with birth weight < 1 500 g is effective and safe. However, intravenous nutrition can cause some complications, such as glucose metabolism disorder, electrolyte disturbances and PNAC, etc. So the process of intravenous nutrition should be closely monitored. To start EN as early as possible and shorten the duration of intravenous nutrition is an important measure for the prevention of PNAC. The combination of gestational age, birth weight and the time to regain birth weight has a good predictive value for EUGR, and intervention can be strengthened early in hospital to avoid EUGR.
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Objective To study the application of multiple row spiral CT (MSCT) in the diagnosis of inferior vena cava lesions in Budd Chiari syndrome (BCS) and its clinical value.Methods Eighty patients with BCS admitted to the Central Hospital of Shan County from May 2017 to May 2018 were divided into two groups by digital grouping method,with 40 cases in each group.The control group was diagnosed by ultrasound , and the study group was diagnosed by multi-slice CT.The pathological changes ,tissue contrast of inferior vena cava and hepatic vein and the diagnostic sensitivity,specificity,positive predictive value and negative predictive value of inferior vena cava obstruction were compared between the two groups.Results The pathological diagnosis rate in the study group was significantly higher than that in the control group (χ2 ＝4.562,4.695,4.125,5.124,all P＜0.05).The contrast of inferior vena cava and hepatic vein tissues in the study group was significantly higher than that in the control group ( t＝12.897, 13.214, all P ＜0.05 ).The sensitivity, specificity, positive predictive value and negative predictive value of the diagnosis of inferior vena cava occlusion in the study group were higher than those in the control group (the control group:91.2%,98.6%,97.3%,80.3%,the study group:100.0%,99.5%,98.2%,100.0%,χ2 ＝11.897,10.214, 11.235,13.564,all P＜0.05).Conclusion The application of MSCT in the diagnosis of BCS -inferior vena cava lesions,can display the lesions comprehensively and intuitive guidance in the treatment of inferior vena cava lesions , has high diagnostic value ,it is worthy of popularization and application in clinic.
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Objective? To? explore? the? clinical? significance? of? early? oral? intervention? measures? in? the?prognosis?of?premature?infants.? Methods? 151?preterm?infants?admitted?to?neonatal?intensive?care?unit?(NICU)?of?Liaocheng?People's?Hospital?from?January?2015?to?January?2017?were?enrolled.?Premature?infants?were?divided?into?intervention?group?and?control?group?according?to?random?number?table?method?and?with?the?consent?of?legal?guardian.?Both?groups?received?routine?treatment?of?preterm?infants?after?stable?vital?signs.?The?intervention?group?received?the?oral?massage?method?adopted?by?none-nutritive?sucking,?stimulating?swallowing?function?and?SandraFucile?on?the?basis?of?routine?treatment,?once?a?day?for?14?consecutive?days.?Both?groups?were?followed?up?for?6?months.?The?oral?feeding?ability?of?premature?infants?was?evaluated?by?the?proficiency?(PRO),?rate?of?transfer?(RT),?feeding?process?and??non-nutritive?suction?(NNS).?At?40?weeks?of?postmenstrual?age?(PMA),?neonatal?behavioral?neurological?(NBNA)?was?used?to?assess?neonatal?brain?development;?Infanib?was?used?for?early?motor?development?evaluation?at?3?months?and??6?months?after?birth.? Results? Finally,?151?premature?infants?were?enrolled,?including?78?in?the?intervention?group?and?73?in?the?control?group.?The?time?to?complete?oral?feeding?of?the?intervention?group?was?significantly?shorter?than?that?of?the?control?group?(days:?18.1±3.7?vs.?23.4±5.8,?P?<?0.05).?Compared?with?the?control?group,?at?the?time?of?complete?oral?feeding,?the?PMA?of?the?intervention?group?was?significantly?decreased?(weeks:?33.4±0.9?vs.?35.9±1.9,?P <?0.05),?the?feeding?efficiency?was?significantly?increased?(mL/min:?10.6±5.1?vs.?8.1±4.7,?P?<?0.05),?and?PRO?was?significantly?increased?[(95±8)%?vs.?(72±28)%,?P <?0.05],?and?the?body?weight?was?significantly?decreased?(g:?1?836.0±193.0?vs.?2?000.8±204.5,?P?<?0.05).?The?NNS?scores?of?the?intervention?group?and?the?control?group?were?increased?gradually?with?time?(F?values?were?86.21?and?75.23,?respectively,?both?P?<?0.01),?and?the?NNS?scores?of?the?intervention?group?at??10?days?and?14?days?were?significantly?higher?than?those?of?the?control?group?(52.89±6.26?vs.?46.74±6.24,?73.90±7.01? vs.?63.53±6.80,?both?P?<?0.01).?The?NBNA?scores?of?the?two?groups?were?lower,?but?there?was?no?significant?difference?between?the?intervention?group?and?the?control?group?(32.7±3.6?vs.?32.0±4.1,?P?>?0.05).?Infanib?evaluation?at?3?months?of?age?showed?that?the?proportion?of?normal?children?in?the?intervention?group?was?significantly?higher?than?that?in?the?control?group?[67.95%?(53/78)?vs.?49.31%?(36/73),?P?<?0.05],?and?at?6?months?of?age,?the?proportion?of?normal?children?in?the?intervention?group?was?significantly?higher?than?that?in?the?control?group?[84.62%?(66/78)?vs.?58.90%?(43/73),??P <?0.01].? Conclusion? Early?oral?exercise?intervention?can?shorten?the?transition?time?from?tube?feeding?to?full?oral?feeding?in?NICU?premature?infants?and?improve?the?performance?of?infants?during?feeding.
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Objective@#To investigate the effect of hypertensive disorder complicating pregnancy (HDCP) on the mortality and early complications of premature infants.@*Methods@#The general clinical data of preterm infants with gestational age 24-36+ 6 weeks were collected from the cooperative units in the task group from January 1, 2013 to December 31, 2014.According to the severity of HDCP, the infants were divided into 4 groups: HDCP group, preeclampsia group, eclampsia group and non HDCP group, the mortality and major complications of preterm infants were compared, and the influencing factors were analyzed.@*Results@#The mortality rate of preterm in the HDCP group was significantly higher than that of non HDCP group, and there was statistical significance (χ2=9.970, P=0.019). Eclampsia had a highest fatality rate (4.8%) in the early stage, compared with non HDCP group (2.2%), and the difference was statistically significant.Comparison of HDCP group (1.8%) and eclampsia group (3.2%) suggested that there was no statistically significant difference.The incidence of respiratory distress syndrome (RDS) in preterm in HDCP group was significantly higher than that of non HDCP group, and there was statistical significance (χ2=13.241, P=0.004). Eclampsia group showed the highest incidence (35.4%), compared with non HDCP group (16.2%), the difference was statistically significant, but compared with HDCP group (19.9%), preeclampsia group (17.1%), there was no significant diffe-rence.The incidence of bronchopulmonary dysplasia (BPD) in preterm in HDCP group was significantly higher than that of non HDCP group (χ2=9.592, P=0.022), the highest incidence showed up in eclampsia group (9.7%), compared with non HDCP group (2.0%) and HDCP group (1.7%), the difference was statistically significant.But there was no statistically significant difference, compared with preeclampsia group.As the degree of HDCP aggravated, the incidence of BPD gradually rose.There was no significant impact on necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH) and sepsis of HDCP (χ2=7.054, 7.214, 0.358, 3.852; P=0.070, 0.065, 0.949, 0.278). Considering the overall outcome of the child, that was, whether the child died or survived, he had at least one complication, and HDCP had an effect on it (χ2=15.697, P=0.001), so the incidence increased while the degree of HDCP rose gradually.After adjusting gestational age, birth weight, sex, way of delivery, placental abruption and front placenta, prenatal hormonal, gestational diabetes, neonatal asphyxia and other factors, the results displayed that HDCP was the factor leading to the death of premature baby (OR=2.159, 95%CI: 1.093-4.266), and comparison between preeclampsia and eclampsia showed no statistical difference (P=0.714, 0.389); HDCP had no significant influence on RDS, BDP, ICH, NEC, ROP and sepsis.@*Conclusions@#HDCP leads to increased risk of premature death, but also leads to the increased incidence of RDS and BPD, but it had no obvious effect on NEC, ROP, IVH, sepsis and other complications.
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Objective To evaluate the cardioprotection induced by combination of dexmedetomidine and limb ischemic preconditioning in the patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB).Methods Eighty American Society of Anesthesiologists physical starus Ⅱ or Ⅲ patients of both sexes,aged 52-64 yr,weighing 51-78 kg,with New York Heart Association Ⅱ or Ⅲ,scheduled for elective CABG with CPB,were divided into 4 groups (n =20 each) using a random number table method:control group (group C),limb ischemic preconditioning group (group L),dexmedetomidine group (group D) and dexmedetomidine plus limb ischemic preconditioning group (group DL).Limb ischemic preconditioning was induced by 3 cycles of 5-min unilateral lower limb ischemia followed by 5-min reperfusion starting from 30 min before aortic clamping in L and DL groups.Dexmedetomidine was injected via the central vein in a loading dose of 1 μg/kg after induction of anesthesia,followed by an infusion of 0.4 μg · kg-1 · h-1 until the end of operation in D and DL groups.Venous blood samples were obtained immediately before aortic clamping,at the end of CPB and at the end of operation for determination of plasma concentrations of cardiac troponin Ⅰ (cTnI) by enzyme-linked immunosorbent assay.Myocardial tissues were obtained from the right auricle immediately before aortic clamping and at the end of CPB for determination of the expression of Bcl-2 and Bax (by immunohistochemistry) and apoptosis index (AI) (using TUNEL).The restoration of spontaneous heart beat was recorded.Bcl-2/Bax ratio was calculated.Results Compared with group C,the plasma cTnI concentrations were significantly decreased,the Bcl-2 expression was up-regulated,the Bcl-2/Bax ratio was increased,Bax expression was down-regulated,and AI was decreased in the other three groups (P＜0.05).Compared with L and D groups,the plasma cT-nI concentrations were significantly decreased,the Bcl-2 expression was up-regulated,the Bcl-2/Bax ratio was increased,Bax expression was down-regulated,and AI was decreased in group DL (P＜0.05).The rate of restoration of spontaneous heart beat was significantly increased in group DL as compared with the other three groups (P＜0.05).Conclusion Combination of dexmedetomidine and limb ischemic preconditioning can mitigate myocardial injury,it provides better efficacy than either alone,and the mechanism is related to inhibiting cell apoptosis in the patients undergoing CABG with CPB.
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Objective To investigate the effect of intrathecal dexmedetomidine pretreatment on my-ocardial ischemia-reperfusion (I∕R) injury in rats. Methods Forty-five adult Sprague-Dawley rats of both sexes, weighing 200-250 g, in which intrathecal catheters were successfully placed without complications, were divided into 3 groups (n= 15 each) using a random number table: sham operation group (group S), group I∕R and intrathecal dexmedetomidine pretreatment group ( group DEX). Myocardial I∕R injury was produced by occlusion of the left anterior descending branch of the coronary artery for 30 min followed by 120 min reperfusion. Dexmedetomidine 1 μg∕kg (diluted to 10 μl in normal saline) was intrathecally injec-ted at 30 min before ischemia in group DEX. The equal volume of normal saline was given in group I∕R. Blood samples were collected from the cardiac apex at the end of reperfusion for measurement of plasma nor-epinephrine (NE) and cardiac troponin I ( cTnI) concentrations. Then all the rats were sacrificed, and myocardial tissues were obtained for determination of myocardical infarct size, and the spinal cord was isola-ted to detect the expression of c-fos in the spinal dorsal horn by Western blot. Results Compared with group S, the myocardical infarct size, plasma NE and cTnI concentrations were significnatly increased, and the expression of c-fos in the spinal dorsal horn was up-regulated in I∕R and DEX groups (P<0. 05). Compared with group I∕R, the myocardical infarct size, plasma NE and cTnI concentrations were signific-natly decreased, and the expression of c-fos in the spinal dorsal horn was down-regulated in group DEX (P<0. 05). Conclusion Intrathecal dexmedetomidine pretreatment can reduce myocardial I∕R injury in rats, and the mechanims may be related to decreasing plasma NE levels and inhibiting c-fos expression in the spinal dorsal horn.
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Objective To investigate the recovery mechanism of brain function in patients with mo-tor aphasia after cerebral infarction by resting-state functional magnetic resonance imaging (fMRI) functional connectivity. Methods 10 patients with aphasia after cerebral infarction (aphasia group),and 10 patients without aphasia (control group)in the same period were enrolled.Both patients underwent resting-state fMRI examination.Patients with aphasia received a second fMRI examination 1 month later.The SPM8 software and DPARSF software were used to process the data.The back of the left middle frontal gyrus ( LFMG) was se-lected as the seed point for functional connectivity analysis.REST was used for pairing and two-sample t-tests. Results Compared with the control group,the brain regions with increased LMFG-ROI functional connectiv-ity were right insula(MNI:x,y,z:45,12,0,t＝7.98),right inferior frontal gyrus (triangular,ankle,island cap) (MNI:x,y,z:42,6,27,t＝6.75),right upper temporal gyrus and right middle temporal gyrus( MNI:x, y,z:48,－45,6,t＝10.57),right superior border gyrus(MNI:x,y,z:15,－66,60,t＝5.59) and right angle gy-rus(MNI:x,y,z:54,－50,12,t＝9.55) in the aphasia group (before rehabilitation),and the brain regions with reduced functional connectivity were left posterior cingulate gyrus( MNI:x,y,z:6,－75,9,t＝－10.05), and left anterior wedge lobe(MNI:x,y,z:－6,－69,33,t＝－9.07).Compared with the control group,the brain regions with enhanced LMFG-ROI functional connectivity in the aphasia group (after rehabilitation 1 month) included head of left caudate nucleus,left middle frontal gyrus and inferior frontal gyrus,left globus pallidus, left central anterior gyrus,central posterior gyrus,left insula; the brain regions with reduced functional con-nectivity were right hippocampus,left cerebellum,right lingual gyrus,posterior left cingulate gyrus,right oc-cipital lobe and right anterior wedge lobe.Compared with aphasia group before rehabilitation,the brain regions with increased LMFG-ROI functional connectivity after rehabilitation 1 month were the left frontal frontal gy-rus(MNI:x,y,z:－51,15,24),t＝15.87),left frontal parietal island cover(MNI:x,y,z:－24,－66,42,t＝5.20),left central anterior gyrus and central posterior gyrus(MNI:x,y,z:－15,－16,55,t＝6.53); and the reduced brain regions were the right superior temporal gyrus and middle temporal gyrus(MNI:x,y,z:57,－18,30,t＝－15.21),right insula (MNI:x,y,z:－24,－66,42,t＝－5.20)and right superior border gyrus (MNI:x,y,z:15,－66,60,t＝－7.69). Conclusion The functional reorganization of the brain regions around the left hemisphere's injury lingual area may be the main mechanism of brain functional plasticity in patients with aphasia after cerebral infarction,and the right hemisphere is also involved in this process.In both the a-cute and chronic phases of motor aphasia,activation of the posterior left cingulate gyrus is reduced.