Effect of early continuous renal replacement therapy on in-hospital mortality of patients with sepsis / 中华急诊医学杂志

Objective:To investigate the effect of early continuous renal replacement therapy (CRRT) within 24 h on in-hospital mortality in patients with sepsis.Methods:This study retrospectively analyzed the patients diagnosed as sepsis in the Emergency Intensive Care Unit of the First Affiliated Hospital of Wenzhou Medical University from January 2013 to December 2017. According to the prognosis, the patients were divided into the survival group and death group. The clinical baseline data of the two groups were compared, and multivariate logistic regression analysis was performed to screen out the risk factors of death in patients with sepsis and evaluate the effect of CRRT on mortality. According to whether CRRT was performed within 24 h after admission, the patients were divided into the CRRT group and non-CRRT group to compare fluid balance.Results:Among the 612 patients, 416 (67.9%) patients were male, the median age was 66 years; 362 patients survived and 250 patients died, with a mortality rate of 40.8%. Multivariate logistic regression analysis showed that the independent risk factors for death in patients with sepsis were: sex, simplified acute physiology score Ⅱ, sequential organ failure assessment, lactate, procalcitonin, and complicated with chronic obstructive pulmonary disease. Multivariate logistic regression analysis showed that patients received CRRT within 24 h had a higher risk of mortality ( OR=1.981 95% CI: 1.120-3.504, P=0.019). There was a statistically significant difference in fluid balance between the CRRT group and the non-CRRT group on the first day ( P<0.05), and there was no significant difference in total fluid balance in the first 3 days ( P>0.05). Conclusions:Early CRRT within 24 h cannot reduce the in-hospital mortality of patients with sepsis. The failure of CRRT which did not timely correct the volume overload state of patients with sepsis after fluid resuscitation may affect the outcome.

Predictive value of early platelet count dynamic changes for prognosis of sepsis patients / 中华急诊医学杂志

Objective:To explore the value of early dynamic changes of platelet count (PLT) in evaluating the prognosis of sepsis patients.Methods:A retrospective study was conducted to select sepsis patients admitted to the Emergency Intensive Care Unit (EICU) of the First Affiliated Hospital of Wenzhou Medical University from January 2013 to December 2017. The sepsis patients were divided into the survival group and death group according to the 28-day prognosis after EICU admission. The basic and clinical data of the two groups of patients were compared, and the risk factors for the 28-day prognosis of sepsis patients were screened, and the value of platelet change (ΔPLT) in the prognosis of sepsis was evaluated.Results:A total of 549 sepsis patients were included, 184 died within 28 days, and 365 survived, with a 28-day mortality rate of 33.5%. Compared with the survival group, the death group had a higher proportion of males, were older, and had more chronic diseases and tumors such as chronic obstructive pulmonary disease (COPD); simplified acute physiology score Ⅱ (SAPS-Ⅱ), sequential organ failure score (SOFA), procalcitonin, C-reactive protein, blood urea nitrogen, fibrinogen, and mean arterial pressure were lower, the PLT was lower on d1-5, the value of ΔPLT d2-5 were decreased more significantly, and the platelet to lymphocyte ratio (PLR) value was higher, and the difference was statistically significant ( P<0.05). However, there was no significant difference in mean platelet volume and platelet distribution width between the two groups (all P>0.05). Multivariate logistic regression analysis showed that COPD ( OR=4.167, 95% CI: 1.769-9.815, P<0.001), malignant tumor ( OR=1.815, 95% CI: 1.034-3.817, P=0.038), SAPS-Ⅱ score ( OR=1.071, 95% CI: 1.046-1.096, P<0.001), SOFA score ( OR=1.060, 95% CI: 1.001-1.021, P=0.041), and PLR value ( OR=1.001, 95% CI: 1.001-1.002, P<0.001) were independent risk factors affecting the 28-day prognosis of sepsis patients. PLT d1 ( OR=0.996, 95% CI: 0.995-0.998, P<0.001) was a protective factor for better prognosis in sepsis patients. The ROC curve analysis showed that the SAPS-Ⅱ score and SOFA score could predict the 28-day ICU prognosis of sepsis patients, and the SAPS-Ⅱ score had the largest area under the ROC curve (AUC=0.726). The AUC (0.678) of ΔPLT d4 was greater than those of the other days. When the optimal critical value was -26.5×10 9/L, the sensitivity was 57.8% and the specificity was 71.7%. Conclusions:The early dynamic changes of PLT are closely related to the prognosis of sepsis patients, which is worthy of clinical reference and promotion.

Nodular muscular sarcoidosis: MRI manifestation and pathological features / 中华内分泌外科杂志

Objective To analyze the MR imaging performances and pathological characteristics of nodular muscular sarcoidosis,and to improve the diagnostic accuracy.Methods Six cases with pathologically confirmed nodular muscular sarcoidosis were included,the MRI imaging findings and pathologic appearance were analyzed,and the literature was reviewed.Results Six patients underwent plain and enhanced MRI examination with 3 cases of unilateral gastrocnemius muscle single lesion,1 case of unilateral anterior medial thigh muscle lesions,and 2 cases of bilateral gastrocnemius muscle lesions.MRI plain scan showed a strip-shaped or fusiform with slightly short TI-long T2 signal along the muscle fibers,and the occupancy effect was not obvious."Dark star" sign showed in lesion center with axial T2WI and enhanced T1WI,and "three stripes" sign could be seen along the long axis view image lesions.The lesion obviously enhanced after enhancement,with mild enhancement center.Similar small nodular satellite lesions were seen around 5 large lesions,and 4 cases showed similar small nodule enhancement in distant muscle groups.Pathological manifestations:granulomatous inflammation of muscle fibers,intermuscular epithelial cells,and multinucleated tissue cells with or without lymphocytic infiltration;no cheese-like necrosis in the nodules,visible fusion of nodules.Conclusion On MRI,it is characterized by strips or fusiform lesions along the muscle fibers,visible "three-layer stripe sign" and "black star sign",and the characteristics of the enhanced muscle nodules in the surrounding muscle groups,which contributes to the diagnosis and differential diagnosis of muscular sarcoidosis.

Diagnostic value of MSCT in cystic lung cancer with ground glass opacity / 实用放射学杂志

Objective To study the diagnostic value of MSCT in cystic lung cancer with ground glass opacity(GGO),and improve understanding of the disease as well as diagnostic accuracy.Methods 2 1 cases of pathologically confirmed cystic lung cancer with GGO were analyzed retrospectively,all patients were examined by MSCT.CT features of the GGO and the cysts,including bronchovascular convergence sign,speculation sign,pleural indentation sign,lobulation,thickness and uniformity of the cyst wall,septa and the location of the lesion were analyzed.Results The image findings of the 21 cases of the cystic lung cancer with GGO included:bronchovasular convergence sign in 6 cases(28.6%),speculation sign in 10 cases(47.7%),pleural indentation sign in 12 cases(57.1%),lobulation in 8 cases(38.1%),10 cases(47.7%)showed pure GGO.The cyst wall was(1.7±0.9)mm in thickness and the cyst was (13.2±7.0)mm in diameter.Cyst wall was uniform in 9 cases(42.9%),septa was seen in 14 cases(66.7%),cysts of 16 cases(76.1%)were located in the upper lobes of the lung,1 case(4.7%)had distinctly mediastinal lymph node metastasis.Air-fluid lever,mural nodule or intrapulmonary metastasis were not present in any of the cases.Conclusion The majority of the cystic lung cancer with GGO are adenocarcinoma.In addition of the interference of its prominent cystic features on MSCT,the cystic lung cancer have characteristics of lung cancer with GGO.By analyzing its CT features,diagnostic accuracy can be improved before operation.

The retrospective analysis in forensic of 135 killing familiar cases / 中国法医学杂志

Objective Summarize the information of 135 killing familiar cases and study the characteristics of these cases, in order to analysis the key points of the case investigation. Methods Collected the data of the 135 killing familiar homicides cases which have solved and happened in a province middle of China from 2011 to 2013. The paper analyzed the data accordding the basic information, the forensic professional, the forensic scene and so on. Results Most killing familiar cases occured between husband and wife or parents and children. The cases frequently occur in rural areas. Most of the cases occur between the adults. The killing familiar cases commonly occur in Decemember, January, Feburary, the cases commonly occur in evening(from 6 pm to 6 am). The motivate of the cases is unobvious, the murder suffer from the mental patient is commonly. In these cases, mostly tools of crime is the blunt tools and the sharp tools. Mechanical asphyxia and mechanical iniury were the most commonly causes of death in these cases. Conclusion The social characteristics of suspect, injury tool, cause of death, time of the incident in the killing familiar case showed similar general characteristics, but how collect evidence in the case is the difficulty of the case investigation.