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Objective:To explore the related factors influencing the length of hospital stay(LOS) of pregnant women with heart disease (PWHD) after cesarean section.Methods:A total of 306 patients with PWHD who underwent cesarean section from January 2012 to March 2019 were collected. Among them, 203 patients had not undergone heart surgery (uncorrected group) and 103 patients who had undergone heart surgery (corrected group) during the same period. Demographic, perioperative and postoperative data were recorded. Predictors associated with postoperative LOS were determined using univariate and multivariate linear regression analysis models.Results:(1) The median LOS after cesarean section in the uncorrected group was 6 days (5-8 days). The results of univariate linear regression analysis showed that 38 parameters had significant impact on LOS ( P<0.05). The results of multivariate linear regression analysis showed that 5 parameters were independent risk factors for prolonged LOS in the uncorrected group; among them, the median LOS in uncorrected group with hypertensive disorders of pregnancy was 3 days longer than that in patients with PWHD alone [7 days (5-8 days) vs 4 days (4-5 days), β=0.195, P=0.001]; the median LOS in uncorrected group with high serum creatinine was 3 days longer than normal patients [7 days (5-13 days) vs 4 days (4-5 days), β=0.145, P=0.015]; the LOS of patients who chose general anesthesia was 2 days longer than that of patients who chose spinal anesthesia [6 days (4-8 days) vs 4 days (4-5 days), β=0.154, P=0.007]; the LOS of patients with postoperative pulmonary infection was 4 days longer than that of patients without pulmonary infection [8 days (5-15 days) vs 4 days (4-5 days), β=0.269, P<0.01]; the LOS of patients who admitted to ICU after surgery was 2 days longer than that not admitted patients [6 days (5-8 days) vs 4 days (4-5 days), β=0.268, P<0.01]. (2) The median LOS after cesarean section in corrected group was 4 days (4-5 days). The results of univariate linear regression analysis showed that 8 parameters had significant impact on the LOS (all P<0.05). The results of multivariate linear regression analysis showed that 2 parameters, which were American Society of Anesthesiologists (ASA) grade ( β=0.198, P=0.028) and intraoperative blood loss ( β=0.285, P=0.003), were the independent risk factors for prolonged LOS in corrected group. Conclusion:Preoperative with hypertensive disorders of pregnancy, preoperative creatinine increase, intraoperative general anesthesia, postoperative pulmonary infection, and postoperative admission to ICU are independent predictors of prolonged LOS in uncorrected patients with PWHD; ASA classification and intraoperative bleeding are independent predictor of prolonged postoperative LOS in patients with corrected PWHD.
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Although pediatric thyroid nodules are rare,they have higher malignancy potential than those in adult.Prognosis is also different from adults;therefore,it is important to assess the diagnosis,differential diagnosis and treatment in children.The evaluation of thyroid nodules includes history collection,physical examination,laboratory test,ultrasound examination and fine needle aspiration biopsy (FNAB).Ultrasound and FNAB are of critical importance to assess the diagnosis.Ultrasound can not only accurately locate the lesion,but also provide the information including the size of the lesion,border,blood flow,and so forth.The cells of the lesion can be directly obtained by FNAB for analysis,which may further improve the accuracy of the diagnosis.The main concern in evaluation of thyroid nodules is the verification of whether a lesion is benign or malignant,as for benign nodules,only conservative treatment is needed,but for malignancies,more aggressive treatment is needed,such as lobectomy,total thyroidectomy,regional lymphadenectomy and so forth.Moreover,radioactive iodine therapy and complementary medicine should be recommended after thyroidectomy.
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Objective To explore the relationship and clinical significance among glycosylated hemoglobin (HbA1c),fasting blood glucose (FPG),insulin (Ins),C peptide (CP)and urinary mirco-albumin (urine m-Alb)inpatients with type 2 diabetes melli-tus (T2DM).Methods A total of inpatients with type 2 diabetes were choose in this study and divided into mild diabetic group (HbA1c ≤ 9%)with 45 cases,severe diabetic group (HbA1c > 9%)with 44 cases.Twenty healthy persons were selected into control group.The levels of HbA1c,FPG,Ins,CP and m-Alb in urine of each group were detected and compared,the relationships of them were analyzed.Results There were significant differences on the levels of HbA1c,FPG,Ins,CP and m-Alb in urine of each group,and the former three indicators from low to high followed by the control group,the mild diabetic group,the severe diabetic group.There was no significant difference on the level of Ins between the control group and the severe diabetic group(P >0.05), but the level of Ins in the mild diabetic group was significant higher than that of the control group and the severe diabetes group (P <0.05).The CP level in the mild diabetic group was significant higher than that in the control group (P <0.05),and has a posi-tive correlation with the level HbA1c (r=0.427,P <0.05 ).The CP level in the severe diabetic group was significant lower than that in the control group,(P <0.05)and was negatively correlated with the level HbA1c (r=-0.415,P <0.05).Conclusion The joint detection of HbA1c,FPG,Ins,CP and urine m-Alb has positive significance to control type 2 diabetes,protect islet function and prevent diabetic nephropathy,CP is better than Ins on the assessment of the secretory function of islet,and CP might be in-volved in the occurrence and development of diabetic nephropathy.
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Objective To investigate clinical value of arginine stimulation test to estimate the first-phase insulin release of pancreatic isletβ-cell and evaluation indicators of insulin release.Methods Choose inpatients with diabetes in the department of endocrinology,divide into type 1 diabetes mellitus group (T1DM group)12 cases,type 2 diabetes mellitus group a (T2DMa group,duration of no more than 1 year)57 cases and type 2 diabetes mellitus group b (T2DMb group,more than 1 year),82 cases.Theserum levels of blood glucose (PG),insulin (INS)and C-peptide (CP)were determined at fasting 0 mi-nutes and 2,4,6 minutes after arginine stimulation,and process the results statistically.Results After arginine stimulation, three groups of PG and the T1DM group of INS and CP had no obvious change and there were no statistical significance (F=0.150~0.696,P>0.05).In T2DMa group and T2DMb group,the peak level of INS and CP appeared at 2nd minute,and those in T2DMa group were higher than those in T2DMb group and these were statistical significance (F=12.145~40.518,P0.05).In T2DMa and T2DMb groups,those had positive correlation (r=0.768, 0.722,P<0.01).Conclusion Arginine stimulation test can be sensitively estimated the first-phase insulin release of pancre-atic isletβ-cell and that has certain clinical application value.△INS and △CP can be used to evaluating insulin release.
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The application of simulated therapy in surgical clinical teaching can stimulate the students' learning enthusiasm and improve their unified qualities in all-rounded way,improve the teacher's teaching level to acquire satisfactory results.
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Objective To analyze the effect of total parenteral nutrition (TPN) and enteral nutrition (EN) in patients with acute pancreatitis. Methods Randomized controlled trials of TPN and EN in patients with acute pancreatitis were searched in Medline and China Biological Medicine Disk from Jan 1966 to June 2004. Eight studies were enrolled into the analysis. The detail about the trial design, characters of the subjects, results of the studies were reviewed by two independent authors and analysed by using Revman 4.2 software. Results Compared with TPN, EN was associated with a significantly lower incidence of secondary infections (RR 0.45, 95% CI 0.29-0.68, P=0.0002) and other complications(RR 0.67, 95% CI 0.47-0.96, P=0.03), fewer surgical interventions (RR 0.47, 95%CI 0.24-0.94, P=0.03) and shorter hospitalization. However, there was no significant difference in mortality (RR 0.61, 95%CI 0.32-1.18, P=0.14) between patients with TPN and EN. Conclusion EN could be the preferred nutrition feeding method in patients with acute pancreatitis.
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AIM The purpose is to construct D-hydantoinase genetic engineering strain for the purpose of the industrial production of D-p-hydroxyphenylglycine. METHODS D-hydantoinase gene was created from Pseudomonas putida 9801 by PCR technique and inserted into pMD18-T vector. The recombinant plasmid was transformed into several Escherichia coli strains. The positive transformants with D-hydantoinase activity were obtained by the two step screening, digoxigenin DNA labeling in situ hybridization and D-hydantoinase activity assay. RESULTS The D-hydantoinase activity of the genetic engineering strain E.coli BL21/pMD-dht was 1700 U*L-1 and increased as high as 8 times compared with those of wild-type strain Pseudomonas putida 9801. The subunit molecular weight of recombinant D-hydantoinase was about 53 kDa measured by SDS-PAGE. The amount of the recombinant D-hydantoinase was about 20 percent of total bacterial soluble proteins. CONCLUSION The genetic engineering strain E.coli BL21/pMD-dht possesses the initial industrial production prospects.