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Objective:To investigate the efficacy of different surgical treatments for hypertensive cerebral hemorrhage in older adult patients and their effects on traumatic stress and cerebral edema.Methods:A total of 100 older adult patients with hypertensive cerebral hemorrhage who received treatment in Zhejiang Xin'an International Hospital from January 2018 to June 2020 were included in this study. They underwent either craniotomy (craniotomy group, n = 50) or hard channel minimally invasive puncture drainage (minimally invasive puncture group, n = 50) according to the willingness of patients and their close relatives. Perioperative indexes, Barthel index after treatment, nerve injury indexes before and after treatment, prognosis related indexes, trauma stress indexes and brain edema were compared between the two groups. Results:Operative time, intraoperative blood loss and postoperative hospital stay in the craniotomy group were (147.21 ± 31.35) minutes, (289.74 ± 22.75) mL and (42.74 ± 6.82 ) days, respectively, which were significantly longer or greater than (41.88 ± 7.19) minutes, (4.62 ± 0.88) mL and (16.27 ± 4.02) days in the minimally invasive puncture group ( t = 38.73, 62.17, 23.17, all P < 0.001). Barthel index at 1 and 3 months after treatment in the minimally invasive puncture group was (63.11± 9.64) and (93.51 ± 11.38), respectively, which was significantly greater than (44.78 ± 8.85) and (81.29 ± 10.37) in the craniotomy group ( t = 3.17, 6.21, both P < 0.05). Before treatment, there were no significant differences in nerve injury index, prognosis index, trauma stress index and brain edema between the two groups (all P > 0.05). At different time points after treatment, each indicator in the minimally invasive puncture group was significantly superior to that in the craniotomy group (all P < 0.05). Conclusion:Hard channel minimally invasive puncture drainage exhibits advantages over traditional craniotomy in the treatment of hypertensive cerebral hemorrhage in older adult patients. Hard channel minimally invasive puncture drainage can more greatly reduce injury to brain tissue, better control nerve injury and brain edema, and more remarkably improve patient's quality of life than traditional craniotomy.
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Objective:To explore the method of early prediction of the risk of limb infection in patients bitten by trimersurus mucrosquamatus snake. Methods:Totally 108 inpatients with limbs bitten by trimersurus mucrosquamatus snake in Chongqing Emergency Medical Center from January 2019 to October 2020 were respectively collected. They were divided into the infection group (23 cases) and non infection group (85 cases) according to whether they had secondary infection in the course of the disease. The clinical characteristics and serum indexes before admission were compared between the two groups to screen out the risk factors of infection. By combining all the above methods, the risk factor score was screened out; and the prediction model was constructed according to the snake bite severity score (SSS) and appearance score. The differences of the three prediction models between the two groups of patients were compared, and the predictive value of the three prediction models for the risk of limb infection in patients bitten by trimersurus mucrosquamatus snake was evaluated through the receiver operating characteristic (ROC) curve. Results:There were significant differences in clinical characteristics and serum indexes before admission, injury time, hand and foot finger injury, edema score, tension blister, subcutaneous hemorrhage and admission platelet count between the two groups ( P<0.05). The scores of the three predictive models differed between the two groups ( P<0.05). The ROC curve was used to evaluate the predictive value of the three models for the risk of infection in the course of the disease. The predictive AUC value of the risk factors score was 0.830 (95% CI: 0.635-0.850), the cutoff value was 2.5, the sensitivity was 0.870 and the specificity was 0.671, which was the best in the three prediction models. Conclusions:The prediction model based on the risk factors can effectively predict the infection risk of snake bite patients. It indicates that the infection risk is high when the score of risk factors ≥3 points, which can be used as the basis for guiding clinical treatment plan and is worthy of promotion.
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Objective:To explore the feasibility of emergency video call system in remote guidance of non-medical volunteers to implement single person cardiopulmonary resuscitation (CPR).Methods:A scenario of sudden cardiac arrest with a bystander in a public place was created at Clinical Skill Training Center. 60 non-medical volunteers were randomly (ramdom number) divided into video group ( n = 40) and audio group ( n = 20). Volunteers in video group were remote instructed with the smart phone application software (APP) of Emergency Video Call System to implement CPR; the audio group receives remote voice guidance for CPR with a smart phone. The pressing depth, pressing frequency, volume of ventilation and the time of the first compression were compared between the two groups. The video group was divided into 5 subgroups to compare the cardiopulmonary resuscitation effect of 5 different models of smart phones. Ten CPR cycles were observed in each group. Results:the accuracy rate of pressing position in the video group was significantly higher than that in the audio group (91.5% vs 71.35%, P < 0.05); the proportion of pressing depth in the range of 5-6 cm was significantly higher than that in the audio group (62.79% vs. 44.73%, P < 0.05); the average pressing frequency was 100-120 times / min (70% vs. 52%, P < 0.05); the ventilation volume was 500-600 mL / time (18.25% vs. 10.75%, P < 0.05); The proportion of ventilation volume greater than 500ml / min was higher than that of audio group (64.88% vs. 43%, P < 0.05). The first pressing time was longer in the video group than in the audio group (131 s vs. 106 s, P < 0.05). There was no significant difference in the first ventilation time between the two groups (148 s vs. 144 s, P > 0.05). The total pressing pause time in video group was less than that in audio group (122.4 s vs. 164.2 s, P < 0.05). There was no significant difference in the above indicators among the five different models of smart phones in the video group ( P > 0.05). Conclusions:compared with audio remote guidance, video emergency system has obvious advantages in the accuracy of pressing position, pressing depth, pressing frequency, ventilation volume and pressing pause time, but the first pressing time is slightly longer than that of audio group. The popularization and application of the video system is supposed to improve the CPR quality and recovery success rate of non-medical personnel, and facilitated to encourage the first witness to implement CPR.
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OBJECTIVE@#To explore the genetic basis for a fetus with renal abnormalities through whole exome sequencing and imaging examination.@*METHODS@#Clinical data and result of medical imaging of the fetus was collected. Amniotic fluid sample was collected for the extraction of fetal DNA. Whole exome sequencing was carried out. Candidate variants were verified by Sanger sequencing.@*RESULTS@#Prenatal ultrasonography showed that the fetus had bilateral enlargement of the kidneys with hyperechogenicity and diffuse renal cysts. Whole exome sequencing revealed that the fetus carried compound heterozygous variants of the PKHD1 gene, namely c.5137G>T and c.2335_2336delCA, which were derived from its mother and father, respectively.@*CONCLUSION@#The fetus was diagnosed with autosomal recessive polycystic kidney disease through combined prenatal ultrasonography and whole exome sequencing. The compound heterozygous variants of the PKHD1 gene probably underlay the pathogenesis in the fetus. The results have enabled prenatal diagnosis and genetic counseling for its parents.
Subject(s)
Female , Humans , Pregnancy , Genetic Testing , Polycystic Kidney, Autosomal Recessive/genetics , Prenatal Diagnosis , Receptors, Cell Surface/genetics , Exome SequencingABSTRACT
RT-PCR and immunohistochemistry were used to measure the mRNA and protein expression of insulin receptor substrate 2 (IRS-2) in the muscle of smoking rats. The mRNA and protein expressions of IRS-2 in the smoking subgroups fed with normal diet or high-fat diet were significantly lower than those in corrsponding control groups (0.27±0.02 vs 0.41±0.25, 0.40±0.04 vs 0.51±0.02 for mRNA; 2.91±0.42 vs 4.90±0.29, 2.43±0.36 vs 3.80±0.30 for protein, all P<0.01). There were no differences in mRNA and protein expressions of IRS-2 between the smoking group of diabetic rats and the matched control rats (P>0.05). The variation of gene expression of IRS-2 may be involved in the mechanism of insulin resistance caused by smoking.