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Objective:To investigate the prognosis and influencing factors in critically ill surgical patients of different feeding intolerance trajectories.Methods:The retrospective cohort study was conducted. The clinical data of 354 critically ill surgical patients who were admitted to 69 medical centers in the Chinese Critical Care Nutrition Trials Group -NEED database from March 2018 to July 2019 were selected. There were 247 males and 107 females, aged 58(46,68)years. According to the trajectory model of feeding intolerance change, 354 patients were divided into 3 categories as feeding intolerance, decreased feeding intolerance, continuous feeding intolerance, including 164, 49, 141 cases respectively. Observation indicators: (1) general situations of patients of different feeding intolerance trajectories; (2) treatment of patients of different feeding intolerance trajectories; (3) survival of patients of different feeding intolerance trajectories; (4) analysis of pro-gnostic factors in critically ill surgical patients. Measurement data of normal distribution were expressed as Mean± SD, and one-way analysis of variance was used for comparison between groups. Measurement data of skewed distribution were expressed as M( Q1, Q3), and Kruskal-Wallis rank sum test was used for comparison between groups. Count data were expressed as absolute numbers or percentages, and chi-square test was used for comparison between groups. Ordinal data were compared using the Kruskal-Wallis rank sum test. Bonferroni correction was used for pairwise comparison. Group-based trajectory model was constructed according to Traj plug-in in Stata17.0 statistical software, and the optimal trajectory model was evaluated by Bayesian information criterion and average posterior probability parameter. The Kaplan-Meier method was used to draw the survival curve and calculate the survival rate, and Log-Rank test was used for survival analyses. Univariate and multivariate analyses were conducted using the COX proportional hazard regression model. Results:(1) General situations of patients of different feeding intolerance trajectories. Of 354 critically ill surgical patients, 257 cases underwent enteral nutrition and 97 cases underwent enteral plus parenteral nutrition. The acute physiological and chronic health score (APACHEII) was 17(13,21), and the sequential organ failure score (SOFA) was 6(5,8). The modified Critical Illness Nutritional risk score (mNUTRIC) was 4 (2,5), the number of complications was 2(1,3). There were 293, 55 and 6 patients with grade Ⅰ, grade Ⅱ and grade Ⅲ acute gastrointestinal injury (AGI), and there were 224, 17 and 61 patients who were treated with mechanical ventilation, continuous renal replacement therapy and vasoactive drugs, respectively. The incidence of feeding intolerance in 354 patients increased first and then decreased, reaching a peak of 25.42%(90/354) on the third day and 53.67%(190/354) within 7 days. Of 354 critically ill surgical patients, cases with no feeding intolerance, decreased feeding intolerance, continuous feeding intolerance had the APACHE Ⅱ as 16(12,20), 17(14,25), 18(13,22), mNUTRIC as 3(2,5), 4(3,6), 4(3,5), the number of complications as 2(1,2), 2(2,3), 2(2,3). There were 152, 27, 114 cases with grade Ⅰ AGI, 12, 22, 27 cases with grade Ⅱ-Ⅲ AGI, 95, 39, 90 cases with mechanical ventilation. There were significant differences in the above indicators among the three groups ( H=6.14, 13.11, 28.05, χ2=37.96, 7.65, P< 0.05). Further analysis showed that compared with patients with no feeding intolerance, patients with decreased feeding intolerance and continuous feeding intolerance had the higher number of complications and grade of AGI ( Z=60.32, 54.69, χ2=39.72, 9.52, P<0.05), patients with decreased feeding intolerance had the higher mNUTRIC scores and ratio of mechanical ventilation ( Z=53.41, χ2=7.59, P<0.05). (2) Treatment of patients of different feeding intolerance trajectories. Cases with prokinetic drugs use and post-pyloric feeding were 36, 13 of patients with no feeding intolerance, 25 and 10 of patients with decreased feeding intolerance, 46 and 19 of patients with continuous feeding intolerance, respectively, showing significant differences in the above indicators among the three groups ( χ2=15.76, 6.20, P<0.05). Further analysis showed that compared with patients with no feeding intolerance, patients with decreased feeding intolerance had higher ratio of prokinetic drugs use and ratio of post-pyloric feeding ( χ2=15.60, 6.10, P<0.05). (3) Survival of patients of different feeding intolerance trajectories. The 28-day overall survival rates of patients with no feeding intolerance, decreased feeding intolerance, and continued feeding intolerance were 96.96%, 95.92%, and 87.94%, respectively, showing a significant difference ( χ2=10.39, P<0.05). Further analysis showed a significant difference between patents with no feeding intolerance and patients with continuous feeding intolerance ( χ2=9.19, P<0.05). (4) Analysis of prognostic factors in critically ill surgical patients. Multivariate analysis showed that continuous feeding intolerance was an independent risk factor for 28-day death in critically ill surgical patients ( hazard ratio=3.92, 95% confidence interval as 1.43-10.79, P<0.05). Conclusion:For surgical critically ill patients, patients with continuous feeding intolerance have a higher 28-day mortality than patients with no feeding intolerance, and the continuous feeding intolerance is an independent risk factor for 28-day death in critically ill surgical patients.
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Objective To summarize the clinical features of neonatal lupus erythematosus (NLE) and to have a better clinical understanding. Methods We retrospectively analyzed the clinical data of 13 patients with NLE who were hospitalized in Fujian Provincial Maternity and Children's Hospital from September 2010 to September 2017. The pathogenesis, clinical manifestations, laboratory examinition, management and long term outcomes of these babies were summarized, and the relevant literatures were also reviewed. Descriptive statistical analysis was performed. ResuLts The 13 NLE cases included eight boys and five girls. Among them, skin lesions, cardiac impairment, hematological problems, hepatobiliary system damage, central nervous system involvement and renal function damage occurred in eight, seven (six cases were atrioventricular block), seven, three, one and one case, respectively. Antinuclear antibodies and anti-Sjogren's syndrome antigen A antibodies were positive in all neonates, anti-Sjogren's syndrome antigen B antibodies were positive in 11, and anti-double-stranded DNA antibodies were positive in two cases. Among the 13 mothers, three were diagnosed with Sjogren's syndrome and two had systemic lupus erythematosus(SLE) before pregnancy, two were diagnosed with Sjogren's syndrome and one developed SLE during pregnancy. Eight babies with skin lesions were asked to avoid light and the skin rash all gradually receded within 1-6 months after birth. Five cases with thrombocytopenia were treated with intravenous immunoglobulin and one anemic baby received erythrocyte transfusion. Within 2 to 3 months, the impaired blood system in these babies were back to normal. For the three babies with abnormal liver functions, hepatic protectants and jaundice relieving agents were given, and 2 to 6 months later they recovered. The 13 patients were followed up for five months to seven years, among which, seven improved with normal growth and development; five still had grade Ⅲ atrioventricular block; one installed an atrial pacemaker at 11 months. Three mothers who were asymptomatic during pregnancy were found to have autoimmune diseases after their babies were diagnosed with NLE, including one case of Sjogren's syndrome and two of SLE. ConcLusions NLE is mainly characterized by skin lesions and congenital heart block, while liver, blood system, central nervous system and other organs may also be involved. For high-risk mothers and babies, timely autoantibody screening and relevant examinations are suggested for early diagnosis and interventions. In addition, long term follow-up is required for affected cases.
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Objective To construct the eukaryotic expression vector of human telomerase RNA component ( hTR) and study its biological function tentatively .Methods hTR Gene was obtained by PCR from cDNA template , which was reverse transcribed from 293T mRNA and cloned into pCDNA3.0 vector.The recombinant plasmid and empty vector were trans-fected into 293T cells, and hTR expression was identified by qRT-PCR.HepG2 cells that stably transfected with pCDNA3.0-hTR were constructed and identified by qRT-PCR.These cells were used to assess the interaction of hTR with human telomerase revese transcriptase ( hTERT ) and dyskerin .Telomerase activity was also detected in HepG 2 cells transfected with pCDNA3.0-hTR.Results pCDNA3.0-hTR eukaryotic expression vector was successfully constructed by double digestion identification .The inserted fragment was confirmed by sequencing .The expression of hTR in human 293T cells and HepG2 pCDNA3.0-hTR stable cell line was identified.In addition, qRT-PCR and Western blotting results showed that hTR could interact with hTERT and dyskerin , while hTR overexpression could not regulate the telomerase activity in HepG2 cells.Conclusion The eukaryotic expression vector of pCDNA 3.0-hTR is successfully constructed and expressed.This study will contribute to the further study of cancer therapy targeting hTR .
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Objective To evaluate the efficacy of Gant-Miwa and anal encircling procedure with Xiaozhiling injection for complete rectal prolapse.Methods Clinical data of 16 patients with complete rectal prolapse undergoing Gant-Miwa and anal encircling procedure with Xiaozhiling injection between Feb.2011 and Nov.2014 were retrospectively analyzed.Results All patients were operated successufully and theirs prolapse symptons disappeared.Urinary retention was found in 3 cases,2 cases were observed a replase who were infected in the area of the anal operation,1 cases was found delayed healing of perianal incision,and 2 cases were happened constipation duing to the rectal stenosis.Complications wasn't happened such as bleeding,perianal abscess,anal fistula,and so on.Thirteen cases were followed-up of average 2.2 years and 2 cases were observed postoperative recurrance.Conclusions Gant-Miwa and anal encircling procedure with Xiaozhiling injection for the treatment of complete rectal prolapse is a procedure with minimally trauma,fewer complications and low recurrence rate,which is worth promoting after innovation and improvement.
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Objective To construct PES1 shRNA stable expression cell lines in tongue squamous cell carcinoma ( TSCC) cells and to study the effect of knockdown of PES 1 on the growth of TSCC cells .Methods Recombinant lentivirus carrying PES1 shRNA was packaged and obtained in 293T cells.TSCC cells (Tca8113, SCC6 and SCC15) were infected with the lentivirus and selected for stable cells .PES1 expression was identified by Western blot .The effect of inhibition of PES1 on the growth and cell cycle of TSCC cells was detected by growth curve and flow cytometry .Results TSCC cells stably expressing PES1 shRNA were constructed.Knockdown of PES1 inhibited cell proliferation and induced cell cycle ar-rest at G0/G1 phase.Knockdown of PES1 inhibited expression of cyclin D1 in TSCC cells.Conclusion Inhibition of PES1 results in reduced cell proliferation , cell cycle arrest at G 0/G1 phase and reduction of cyclin D 1 expression in TSCC cells . PES1 may be a target for TSCC gene therapy .
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<p><b>OBJECTIVE</b>To assess the differences in the health promotion demand of practitioners between urban and rural private enterprises by a comparative analysis, and to probe into the more scientific and targeted health promotion measures.</p><p><b>METHODS</b>Stratified cluster random sampling and self-designed questionnaire were adopted to survey 852 practitioners in urban and rural private enterprises of a Chinese city.</p><p><b>RESULTS</b>There were significant differences in practitioners between the two sorts of enterprises in terms of age, length of service, educational level, and forms of employment (P < 0.05 or P < 0.01). The basic knowledge and skills of practitioners in rural private enterprises were worse than those in urban private enterprises(P < 0.05 or P < 0.01). Practitioners in rural private enterprises were significantly less inclined to gain basic health promotion knowledge through enterprise training and network(P < 0.01). The demand of practitioners for health examination and hazard notification was significantly lower in rural private enterprises than in urban private enterprises (P < 0.05).</p><p><b>CONCLUSION</b>Focused and targeted health promotion should be carried out based on different demand characteristics of practitioners in rural and urban private enterprises.</p>
Sujet(s)
Humains , Chine , Collecte de données , Emploi , Promotion de la santé , Secteur privé , Population rurale , Enquêtes et questionnaires , Population urbaineRÉSUMÉ
Infectious disease hospitals are obliged to cope with public health emergencies such as outbreak of infectious diseases.Such hospitals are required to make early detection,early containment,proper management,reasonable preplans,timely training,targeted drills,reasonable deployment of hospital resources,appropriate protection for hospital staff.General hospitals should also cope with prevention and control of infectious diseases to some extent,and work with infectious disease hospitals hand in hand to better cope with such outbreaks.
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OBJECTIVE:To summarize the experience of pharmaceutical care provided by pharmacists of Chinese medicine for AIDS sufferers in our hospital.METHODS:The practical experience of pharmacists of Chinese medicine in providing pharmaceutical care for AIDS sufferers in our hospital was analyzed to achieve rational knowledge from perceptual knowledge.RESULT:To carry out pharmaceutical care for AIDS patients by applying expertise achieved satisfactory effect.CONCLUS-ION:Pharmacists of Chinese medicine should strive to establish a new open pharmaceutical care model,attach great importance to the communication with patients,integrating psychotherapy and humanistic care into the pharmaceutical care all along so as to assure patient's compliance.
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OBJECTIVE:To explore the method and approach for traditional Chinese pharmacists to play an active role in case of emergent epidemic situation. METHODS:Taking the opportunity of H1N1 flu treatment,the traditional Chinese pharmacists carried out pharmaceutical services such as drug counseling,establishing medication history for typical cases,offering guidance and advice on medication,retrospectively analyzing prescription and consulting records. RESULTS & CONCLUSION:In the differential treatment,pharmacists of traditional Chinese medicine should take full account of patients' individual differences,actively participate in the design of individualized dose scheme and offer medication guidance so as to enhance patients' medication compliance meanwhile enhancing the status of pharmacists of traditional Chinese medicine.