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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? 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 study the clinical features,diagnosis,treatment and prognosis of neonatal fulminant myocarditis.Method From January 2016 to August 2016,clinical data of neonates with fulminant myocarditis admitted to the neonatal intense care unit (NICU) were retrospectively collected and analyzed.Result A total of 11 neonates were enrolled,including 6 males and 5 females,and 5 preterms and 6 full term infants.The average gestation age was (37.7 ± 1.6) weeks and their weight on hospital admission was (3 382 ± 675) g.Among the infants,9 got ill in summer and 2 in spring and winter.The onset of illness was within 3 ～ 5 d after birth in 8 cases and 2 ～ 3 weeks in the other 3 cases.The main clinical presentations included fever,anorexia,shortness of breath and lethargy.Various degrees of cardiac dysfunction appeared in all 11 cases,including cardiogenic shock in 10 cases,severe arrhythmias with multiple organ dysfunction in 7 cases,and viral meningitis in 7 cases.10 infants had significantly elevated brain natriuretic peptide (BNP) and troponin Ⅰ,and those with troponin Ⅰ above 20 μg/L had poor prognosis.A comprehensive treatment of limiting liquid volume,high-dose adrenocortical steroids,and IVIG were carried out.Meanwhile,therapy to prevent shock,improve cardiac function,reverse arrhythmia,and mechanical ventilation were used in children with dyspnea.7 cases were cured and 6 patients were followedup for 6 to 12 months.Among the 6 followed-up patients,within 1 ～3 months after discharge,4 cases had normal echocardiogram,and persistently abnormal echocardiogram were found in the other 2 cases and eventually confirmed as dilated cardiomyopathy.4 patients were dead.Conclusion The clinical manifestations of neonatal fulminant myocarditis are unspecific.It's difficult to recognize the early symptoms,missed and delayed diagnosis are common,resulting in high mortality rate.Timely diagnosis and effective treatment can improve the survival rate.
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Objective To investigate the effects of different treatments on elderly patients with breast cancer, and to analyze the factors that affect the treatment effect.MethodsA retrospective analysis was used to analysis the clinical data of elderly patients with breast cancer treated in our hospital from March 2012 to October 2013 were selected as the study object and according to the treatment methods, which were divided into three groups (A, B, C, which a group by breast modified radical surgery combined with intravenous chemotherapy and endocrine therapy, group B with breast modified radical mastectomy+endocrine therapy, group C with breast mass resection and endocrine therapy.The differences of survival rate of 1 groups after three years, 2 years and 3 years were observed, and the difference of survival rate of patients with different clinical pathological characteristics after 3 years was compared.The factors influencing the survival rate of patients after operation were analyzed.ResultsThere was no significant difference in survival rate between the three groups after 1 years, 2 years and 3 years;High differentiation, lymph node metastasis, depth of invasion, T1+T2, TNM stage I+II, immune group of non Yin in the elderly patients with breast cancer of the 3 year survival rate was higher, while patients of different age and diameter of the tumor patients and 3 years survival rate had no significant difference;Will the elderly breast cancer patients age, differentiation degree, tumor size, lymph node metastasis, depth of invasion, clinical stage, immune group of three yin as independent variables, will survival in patients with multi factors logistic regression analysis was used.Statistical analysis available, lymph node metastasis, infiltration depth and the three Yin of the immune group were the risk factors affecting the treatment effect of patients, their OR values were 4.412, 5.138 and 4.085.ConclusionDifferent treatment methods have no significant effect on the survival rate of elderly patients with breast cancer, and lymph node metastasis, depth of invasion and the three Yin of the immune group are the factors that affect the treatment effect.
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Objective To observe the diagnostic value of high-sensitivity C-reactive protein/albumin ratio (hs-CRP/ALB) in early-onset infection in premature and its clinical significance. Methods Clinical data of premature patients with high risk factors of intrauterine infection admitted to neonatal intensive care unit (NICU) of Liaocheng People's Hospital in Shandong Province from July 2013 to July 2015 were analyzed retrospectively. They were divided into infection and non-infection groups, as well as survival and death groups according to the outcome of the premature babies. The pre-albumin (PA), ALB, white blood cell count (WBC), platelet count (PLT), and hs-CRP at the moment of NICU admission (0 hour) and 24, 48 and 72 hours after NICU admission were compared. The receiver operating characteristic (ROC) curve was plotted for evaluation of the predictive value of serum hs-CRP/ALB ratio for the babies during hospitalization. Results A total of 214 cases of premature infants were enrolled, with 102 cases in infection group, and 112 in non-infection group. In infection neonates, 97 of them survived, and 5 died. ① The level of hs-CRP after NICU admission was increased in infection and non-infection groups, and it was significantly higher at 48 hours in infection group than that of the non-infection group [mg/L: 22.0 (7.6, 40.4) vs. 18.3 (12.9, 23.4),Z = 5.257, P = 0.038]. Then hs-CRP was decreased in non-infection, but it was persistently increased in infection group, and it was significantly higher at 72 hours in infection group than that of the non-infection group [mg/L: 25.5 (9.8, 43.5) vs. 12.2 (1.9, 22.1), Z = 5.879, P = 0.042]. The levels of ALB and WBC in infection group was significantly lower than those of the non-infection group [ALB (g/L): 27.9±2.7 vs. 29.1±2.9, t = 5.178, P = 0.026; WBC (×109/L): 13.7±7.1 vs. 16.1±7.9, t = 4.368, P = 0.037], and at 48 hours hs-CRP/ALB in infection group was significantly higher than that of non-infection group [0.16 (0.08, 0.57) vs. 0.07 (0.00, 0.23), Z = 3.436, P = 0.042]. There was no significant difference in PA and PLT between infection and non-infection groups. ② In premature patients with infection, ALB in non-survival group was decreased (g/L: 20.4±6.9 vs. 29.6±7.5, t = 7.859, P = 0.003), and 48-hour hs-CRP and hs-CRP/ALB ratio was significantly increased when compared with that of survival group [hs-CRP (mg/L): 25.8 (15.6, 54.8) vs. 18.2 (12.9, 36.2), Z = 4.067, P = 0.043; hs-CRP/ALB: 0.31 (0.28, 0.76) vs. 0.06 (0.00, 0.21), Z = 6.102, P = 0.011].③ It was shown by ROC curve analysis that the area under ROC curve (AUC) of 48-hour hs-CRP/ALB ratio for evaluating infection was 0.765, when the cut-off of 48-hour hs-CRP/ALB ratio was 0.08, the sensitivity was 84.2%, and the specificity was 76.3%. Conclusions The values of hs-CRP and ALB can be used as effective indexes in early diagnosis of intrauterine bacterial infection, and increase in 48-hour hs-CRP/ALB can improve the sensitivity of the diagnosis. Hs-CRP/ALB can be combined to guide rational use of antibiotics.
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BACKGROUND: Resin-modified glass ionomer (RMGI) cements have higher bond strength, especially can release fluoride. But there are fewer reports of the clinical application for the prevention of decalcification.OBJECTIVE: To test the benefit from using RMGI cement instead of a conventional composite resin in bracket bonding for patients with malocclusion, and observe bracket-failure rates and decalcification on enamel surfaces at pretreatment and at debonding.DESIGN: Observational and comparative trial.SETTING: The Second Hospital Affiliated to Hebei Medical University.PARTICIPANTS: Forty successive patients (358 teeth) with malocclusion admitted to the Department of Orthodontics in the Second Hospital Affiliated to Hebei Medical University, were selected for the study from July to August in 2002. All the patients (21 females and 19 males, mean age 16 years) had normal and complete anterior teeth, good oral hygiene. There were no obvious differences in bilateral teeth. Informed consents were obtained from all the subjects. The experiment was also approved by the ethical committee of the hospital. Experimental materials were RMGI adhesive (Fuji, GC, Japan, Lot 0005111) and composite resin cement (enamel adhesive of Beijing and Tianjin, Tianjin product, Lot 020402). Brackets produced from Hangzhou 3B and 37% phosphoric acid were used.METHODS: ①Bonding brackets: Subjects selected according to random procedure were divided into two groups, each with 20. GroupⅠ: The left buccal surfaces bonded with light-cure RMGI were etching for 30 seconds with 37% phosphoric acid, rinsed with water; the right buccal surfaces bonded with composite resin cement were etching for 60 seconds with 37% phosphoric acid, rinsed with water and dried; Group Ⅱ: After etching for 30 seconds with 37% phosphoric acid, the right buccal surfaces were rinsed with water and bonded brackets with light-cure RMGI. The left buccal surfaces were bonded brackets with composite resin cement after etching for 60 seconds with 37% phosphoric acid, rinsing with water and drying; Attachment of 0.036-cm NiTi wires with ligature to the brackets was conducted 10 minutes after light-curing. The information about differences in bilateral bonding materials was not told to patients. To ensure an equal bonding materials containing fluoride and minimize the error, all the patients were instructed to use toothpaste containing fluoride, a fluoride mouthwash was not prescribed. The treatment period was 9-26 months (mean 18 months).②Patients were rechecked at intervals of 4 weeks postoperatively. Each bonded tooth was checked for loose or missing brackets, and failures were recorded. A color transparency of anterior teeth area was taken using a standardized photographic technique. The enamel surface conditions were classified at a magnification of ×10. The condition of enamel surface recorded was made according to the scoring system by Geiger before treatment and at debonding.MAIN OUTCOME MEASURES: ①The number and site of bonding failures.②Enamel surface conditions at before treatment and debonding.RESULTS: Forty patients were all involved in the result analysis. Eliminating 4 teeth occurring bond failure and 4 teeth of opposite side at anterior teeth, a total of 232 teeth were evaluated.①The number and sit of bonding failures: There was no significant difference between the failure rates of RMGI adhesive and composite resin cement (P > 0.05). Significantly more premolar brackets failed than incisor brackets.②Decalcification of enamel surface: At debonding after treatment, the incidence rates of white spots in the surfaces bonded with the RMGI were significantly lower than that in the composite resin (25.9%, 38.8%, P < 0.05).CONCLUSION:The use of RMGI for brackets bonding results in a significant reduction in the incidence of white spot at debonding. Reducing etching time may obtain a similar survival rate with the routine etching time.