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Objective To analyze and compare the clinical manifestations and imaging features of children with secondary massive cerebral infarction after acute subdural hematoma(ASDH),and to evaluate its potential risk factors in order to provide evidence for the prevention,early diagnosis and early treatment of secondary massive cerebral infarction after ASDH.Methods The clinical data of children with ASDH aged 4～12 years were retrospectively studied.All the children received routine operation.The diagnosis of post-traumatic secondary massive cerebral infarction(MCI)was based on low-density areas on CT images and clinical signs.Clinical and radiographic findings related to patient outcomes were reviewed and statistically compared.Univariate and multifactor Cox regression analysis was used to evaluate the MCI after operation to obtain the factors affecting MCI.Results A total of 67 cases were included in the study,with 32 cases included in the MCI group and 35 cases included in the non-MCI group.There were significant differences between MCI and non-MCI groups in age(t=2.016,P= 0.048),body mass(t=2.389,P=0.020),multiple injuries(χ2=11.121,P=0.001),GCS(Z=-4.730,P＜0.001),hematoma volume(χ2=12.890,P=0.002),MLS(χ2=12.261,P=0.002)and perioperative shock(χ2= 14.417,P＜0.001).GCS(OR=0.322,P=0.002),perioperative shock(OR=10.992,P=0.007),multiple injury(OR= 6.547,P=0.046)and MLS score(OR= 46.974,P=0.025)were major risk factors for MCI in children with ASDH.Conclusion Perioperative shock,multiple injuries,low GCS and MLS greater than 10mm are risk factors for MCI.The incidence of MCI is significantly increased in children with multiple risk factors.
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Objective To explore the feasibility and effectiveness of the artificial intelligence(AI)diagnostic model for bone age imaging in the radiology information system-picture archiving and communication system(RIS-PACS)environment operation.Methods The optimized bone age AI model was integrated into the RIS-PACS platform.The bone age imaging data of 88 038 patients aged 0-18 years old were automatically evaluated.The reference bone age was determined by the consensus of two experienced radi-ologists based on GP map,with an error of±1.0 year old.The success rate,accuracy,system compatibility,stability,and influen-cing factors of results were further analyzed.Results The time for bone age AI evaluation of each case did not exceed 3 seconds,and the success rate of automatic evaluation reached 100%.AI model of bone age and RIS-PACS in hospital could be well integrated.Accord-ing to the readings evaluated by pediatric radiologists based on GP maps,the accuracy rate was 93.05%for girls and 89.53%for boys,with a mean absolute error(MAE)of(0.42±0.54)years old for girls and(0.45±0.60)years old for boys,respectively.The AI model could run efficiency in the RIS-PACS,which significantly reduced the burden of radiologists.The factors that affect the accuracy of the model were image position,exposures,multiple images in a single sequence and hand deformity,etc.Conclusion The bone age imaging AI diagnostic model can be seamlessly embedded into RIS-PACS in hospital,achieving one click bone age imaging diagnosis.
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BACKGROUND:The researchers noted that upon embedding clinical-grade catgut and polyglycolide-co-lactide threads in the normal human"Zusanli"(ST 36)acupoint,the local area displayed temporal and inflammatory stimulatory effects,resulting in thread differentiation.However,the underlying mechanism behind thread involvement remains to be studied. OBJECTIVE:To investigate the expression levels of calcitonin gene-related peptide,5-hydroxytryptamine,leukotriene B4,and bradykinin at point"Zusanli"(ST 36)in rats after embedding catgut and polyglycolide-co-lactide respectively at different time points. METHODS:110 male SD rats were divided into a blank group(10 rats),a catgut embedding group(50 rats),and a polyglycolide-co-lactide embedding group(50 rats)according to the random number table method.In the blank group,no thread was embedded.In catgut embedding group and the polyglycolide-co-lactide embedding group,the thread was embedded in the left side of the ST36 acupoint once.Tissue was collected from the left side of the ST36 acupoint area 8 hours,3,7,14,and 21 days after embedding.The expression levels of calcitonin gene-related peptide and 5-hydroxytryptamine were detected by immunohistochemistry,and the contents of leukotriene B4 and bradykinin were detected by ELISA. RESULTS AND CONCLUSION:(1)Compared with the blank group,the expression of calcitonin gene-related peptide,5-hydroxytryptamine,bradykinin,and leukotriene B4 was significantly increased in the 8 hours,3,7,14,and 21 days of the catgut embedding group(P<0.05);calcitonin gene-related peptide expression was significantly increased in 8 hours,3,7,and 14 days in the polyglycolide-co-lactide embedding group(P<0.05);the expression of bradykinin was significantly increased in 8 hours,3,and 7 days(P<0.05);the expression of leukotriene B4 was significantly increased at 8 hours,3,7,14,and 21 days(P<0.05).(2)Compared with the polyglycolide-co-lactide embedding group,the expression of calcitonin gene-related peptide was increased at 7,14,21 days after thread embedding(P<0.05),and the expression of 5-hydroxytryptamine was increased at 8 hours,3,7,14 and 21 days after thread embedding(P<0.05);contents of leukotriene B4 and bradykinin in tissues were increased at 8 hours,3,14 and 21 days after embedding(P<0.05)in the catgut embedding group.(3)The results show that calcitonin gene-related peptide,5-hydroxytryptamine,leukotriene B4,and bradykinin in the acupoint region alter after catgut embedding in the ST36 of rats,as well as the alteration of calcitonin gene-related peptide,leukotriene B4,and bradykinin is found in the acupoint region after polyglycolide-co-lactide embedding in rats,which may be one of the mechanisms involved in the local time sensitive stimulus effects caused by embedding threads at acupoints.Moreover,there is a discernible difference between the two thread types.
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Traumatic cerebrospinal fluid leakage commonly presents in traumatic brain injury patients, and it may lead to complications such as meningitis, ventriculitis, brain abscess, subdural hematoma or tension pneumocephalus. When misdiagnosed or inappropriately treated, traumatic cerebrospinal fluid leakage may result in severe complications and may be life-threatening. Some traumatic cerebrospinal fluid leakage has concealed manifestations and is prone to misdiagnosis. Due to different sites and mechanisms of trauma and degree of cerebrospinal fluid leak, treatments for traumatic cerebrospinal fluid leakage varies greatly. Hence, the Craniocerebral Trauma Professional Group of Neurosurgery Branch of Chinese Medical Association and the Neurological Injury Professional Group of Trauma Branch of Chinese Medical Association organized relevant experts to formulate the " Chinese expert consensus on the diagnosis and treatment of traumatic cerebrospinal fluid leakage in adults ( version 2023)" based on existing clinical evidence and experience. The consensus consisted of 16 recommendations, covering the leakage diagnosis, localization, treatments, and intracranial infection prevention, so as to standardize the diagnosis and treatment of traumatic cerebrospinal fluid leakage and improve the overall prognosis of the patients.
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Methods:The clinical data and follow-up results of 56 patients with refractory hyperthyroidism who underwent laparoscopy or open surgery in Affiliated Nanhua Hospital of University of South China from January 2019 to August 2020 were retrospectively analyzed.Results:Among the 56 patients, there were 6 men and 50 women. Thirty-six (64.3%) patients underwent endoscopic surgery and twenty (35.7%) patients underwent open surgery. The operation time was (132.0 ± 32.0) minutes. Intraoperative blood loss was (32.4 ± 27.8) mL. Postoperative parathyroid hormone level was (27.8 ± 18.3) ng/L. Forty-nine (87.5%) patients showed benign pathology results after surgery. After surgery, 14 (25.0%) patients had hypothyroidism, including 7 (12.5%) patients with hyperthyroidism combined with thyroid cancer. There were no patients with permanent hypothyroidism or recurrent laryngeal nerve paralysis. All patients had a good prognosis and satisfactory surgical results.Conclusion:With the update of preoperative preparation methods for hyperthyroidism, the increasing maturity of thyroid surgery technology, and the use of new energy instruments and technologies, surgical treatment is undoubtedly a good treatment method for patients with refractory hyperthyroidism or a suspected malignant tumor.Objevtives:To investigate the indications and clinical efficacy of surgical treatment in patients with refractory hyperthyroidism.
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The condition of patients with severe traumatic brain injury (sTBI) complicated by corona virus 2019 disease (COVID-19) is complex. sTBI can significantly increase the probability of COVID-19 developing into severe or critical stage, while COVID-19 can also increase the surgical risk of sTBI and the severity of postoperative lung lesions. There are many contradictions in the treatment process, which brings difficulties to the clinical treatment of such patients. Up to now, there are few clinical studies and therapeutic norms relevant to sTBI complicated by COVID-19. In order to standardize the clinical treatment of such patients, Critical Care Medicine Branch of China International Exchange and Promotive Association for Medical and Healthcare and Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Chinese expert consensus on clinical treatment of adult patients with severe traumatic brain injury complicated by corona virus infection 2019 ( version 2023) based on the joint prevention and control mechanism scheme of the State Council and domestic and foreign literatures on sTBI and COVID-19 in the past 3 years of the international epidemic. Fifteen recommendations focused on emergency treatment, emergency surgery and comprehensive management were put forward to provide a guidance for the diagnosis and treatment of sTBI complicated by COVID-19.
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Objective:To investigate the knowledge, attitudes, and practices (KAP) of pulse oximetry among pediatric healthcare providers in China and analyze the factor influencing the KAP.Methods:A self-developed questionnaire was used for an online research on the KAP of 11 849 pediatric healthcare providers from 31 provinces, autonomous regions, and municipalities of China from March 11 to 14, 2022.The factors influencing the KAP of pulse oximetry among pediatric healthcare providers were examined by Logistic regression. Results:The scores of KAP, of pulse oximetry were 5.57±0.96, 11.24±1.25 and 11.19±4.54, respectively.The corresponding scoring rates were 69.61%, 74.95%, and 55.99%, respectively. Logistic regression results showed that the gender and working years of pediatric healthcare providers, the region they were located, and whether their medical institution was equipped with pulse oximeters were the main factors affecting the knowledge score (all P<0.05). Main factors influencing the attitude score of pediatric healthcare providers included their knowledge score, gender, educational background, working years, region, medical institution level, and whether the medical institution was equipped with pulse oximeters (all P<0.05). For the practice score, the main influencing factors were the knowledge score, gender, age, and whether the medi-cal institution was equipped with pulse oximeters (all P<0.05). Conclusions:Chinese pediatric healthcare providers need to further improve their knowledge about and attitudes towards pulse oximetry.Pulse oximeters are evidently under-used.It is urgent to formulate policies or guidelines, strengthen education and training, improve knowledge and attitudes, equip more institutions with pulse oximeters, and popularize their application in medical institutions.
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Objective:To explore the expression and clinical significance of immunosuppressive receptor T cell immunoglobulin and immunoreceptor tyrosine-based inhibitory motif domain (TIGIT) on the peripheral blood mononuclear cells (PBMC) in silicosis patients with Mycobacterium tuberculosis infection. Methods:August 2018, a total of 78 patients with silicosis (all were quarry workers in Sanmen County, Zhejiang Province) were enrolled and divided into silicosis combined with active pulmonary tuberculosis group (APTB group), silicosis combined with latent tuberculosis infection group (LTBI group), and simple silicosis with non-tuberculosis infection group (non-TB group). Flow cytometry was used to analyze the expressions of TIGIT, programmed death-1 (PD-1) and transcription factor T-bet on PBMC from patients. Mann-Whitney U test and Pearson correlations analysis were used for statistical analysis. Results:Among the 78 patients, eight were in the APTB group, 24 in the LTBI group, and 46 in the non-TB group. The expressions of PD-1 and TIGIT on CD8 + T cells in the APTB group (29.45%(16.78%) and 65.40%(12.12%), respectively) were significantly higher than those in the LTBI group (17.40%(11.17%) and 48.30%(28.75%), respectively; U=23.500 and 43.500, respectively, P=0.000 8 and 0.020 5, respectively) and non-TB group (15.95%(12.46%) and 45.30%(19.75%), respectively; U=64.000 and 69.000, respectively, P=0.002 3 and 0.003 8, respectively), and the differences were all statistically significant. The expression of TIGIT was positively correlated with PD-1 on CD8 + T cells in silicosis patients ( r=0.434 3, P<0.01). The proportion of PD-1 + TIGIT + CD8 + T cells in the APTB group (19.90%(22.67%)) was significantly higher than those in the non-TB group (11.55%(11.29%), U=76.500, P=0.007 1) and LTBI group (11.55%(10.53%), U=41.000, P=0.015 4), while the proportion of PD-1 -TIGIT -CD8 + T cells in the APTB group (30.60%(12.90%)) was significantly lower than non-TB group (48.90%(18.98%), U=58.000, P=0.001 3) and LTBI group (47.20%(24.59%), U=41.000, P=0.015 4). The differences were all statistically significant. The expression of T-bet on the peripheral blood CD8 + T cells in the APTB group (29.45%(16.78%)) was higher than that in the non-TB group (15.95%(12.46%)) and the LTBI group (17.40%(11.17%)), and the differences were both statistically significant ( U=46.500 and 46.000, respectively, P=0.000 3 and 0.028 3, respectively). The expression of T-bet on CD8 + T cells was positively correlated with TIGIT on CD8 + T cells ( r=0.456 7, P<0.01). The expression of T-bet on PD-1 + TIGIT + CD8 + T cells in the APTB group (65.40%(12.12%)) was higher than those in the LTBI group (48.30%(28.75%), U=23.500, P=0.000 8) and non-TB group (45.30%(19.75%), U=65.000, P=0.002 6), and the differences were both statistically significant. Conclusion:The immunosuppressive receptor PD-1 and TIGIT are highly expressed on CD8 + T cells in silicosis patients with active pulmonary tuberculosis, which indicates CD8 + T cells exhaustion in these population, while the highly co-expression of T-bet suggests the exhausted subsets may have reversed potentiality.
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Venous thromboembolism (VTE) is a common perioperative complication in patients with thoracic malignant tumor. Once it occurs, it will not only affect the prognosis of patients, but also occupy a lot of medical resources, which is gradually causing our widespread attention. However, the understanding of VTE in thoracic surgery in our country is relatively late, and the recognition and attention are not enough, and there is still a lack of guidance support for perioperative VTE. Based on the current understanding and preventive measures of VTE in thoracic surgery in China, The China National Research Collaborative Group released the first edition of Chinese experts consensus on the perioperative VTE prophylaxis in 2018. This article will interpret the high-risk patients with perioperative VTE in patients with thoracic malignant tumors, in order to provide a better understanding of Chinese experts consensus for readers.
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s] Objective To detect the feasibility and efficiency of bone age(BA) artificial intelligence(AI) estimation based on deep learning features from traditional regions of interest(ROI) in hand digital radiographs(DR). Methods BA dataset of left hand DR with 11 858 subjects aged from 0 to 18 years in Children′s Hospital of Shanghai were split to training(80.0%) and validation (20.0%) set in this study. An improved regression convolutional neural networks and extreme gradient boosting decision tree method were utilized for the BA analysis based on traditional ROIs in the images. Another set of BA data with 1 229 subjects also in the hospital was adopted for test. Mean average precision(mAP) and mean absolute error(MAE) were used to assess model accuracy of detection and BA prediction, respectively. Results The mAP of ROIs detection of the model was 0.91,and MAE of all male and female subjects was 0.461 and 0.431 years respectively in validation and test sets. The difference less than 1 year in test accounted for 90.07% between BA assessment of the model and of the peadiatric radiologists, with an accuracy rate of 96.67%.The difference over 1 year was 9.03% (with underestimation of 6.43% and overestimation of 2.60%), in which corresponding age data was of being less in training set or sesamoid nearby adductor pollicis or fusion of epiphysis appeared in test set. Conclusion An AI model based on deep learning of traditional ROIs′features in hand DR images is initially achieved to automatically predict BA rapidly and effectively, yet it still needs further optimization.
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Objective@#To detect the feasibility and efficiency of bone age(BA) artificial intelligence(AI) estimation based on deep learning features from traditional regions of interest(ROI) in hand digital radiographs(DR).@*Methods@#BA dataset of left hand DR with 11 858 subjects aged from 0 to 18 years in Children′s Hospital of Shanghai were split to training(80.0%) and validation (20.0%) set in this study. An improved regression convolutional neural networks and extreme gradient boosting decision tree method were utilized for the BA analysis based on traditional ROIs in the images. Another set of BA data with 1 229 subjects also in the hospital was adopted for test. Mean average precision(mAP) and mean absolute error(MAE) were used to assess model accuracy of detection and BA prediction, respectively.@*Results@#The mAP of ROIs detection of the model was 0.91,and MAE of all male and female subjects was 0.461 and 0.431 years respectively in validation and test sets. The difference less than 1 year in test accounted for 90.07% between BA assessment of the model and of the peadiatric radiologists, with an accuracy rate of 96.67%.The difference over 1 year was 9.03% (with underestimation of 6.43% and overestimation of 2.60%), in which corresponding age data was of being less in training set or sesamoid nearby adductor pollicis or fusion of epiphysis appeared in test set.@*Conclusion@#An AI model based on deep learning of traditional ROIs′ features in hand DR images is initially achieved to automatically predict BA rapidly and effectively, yet it still needs further optimization.
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To establish the experts consensus on the management of delirium in critically ill patients.A special committee was set up by 15 experts from the Chinese Critical Hypothermia-Sedation Therapy Study Group.Each statement was assessed based on the GRADE (Grading of Recommendations Assessment,Development,and Evaluation) principle.Then the Delphi method was adopted by 36 experts to reassess all the statements.(1) Delirium is not only a mental change,but also a clinical syndrome with multiple pathophysiological changes.(2) Delirium is a form of disturbance of consciousness and a manifestation of abnormal brain function.(3) Pain is a common cause of delirium in critically ill patients.Analgesia can reduce the occurrence and development of delirium.(4) Anxiety or depression are important factors for delirium in critically ill patients.(5) The correlation between sedative and analgesic drugs and delirium is uncertain.(6) Pay attention to the relationship between delirium and withdrawal reactions.(7) Pay attention to the relationship between delirium and drug dependence/ withdrawal reactions.(8) Sleep disruption can induce delirium.(9) We should be vigilant against potential risk factors for persistent or recurrent delirium.(10) Critically illness related delirium can affect the diagnosis and treatment of primary diseases,and can also be alleviated with the improvement of primary diseases.(11) Acute change of consciousness and attention deficit are necessary for delirium diagnosis.(12) The combined assessment of confusion assessment method for the intensive care unit and intensive care delirium screening checklist can improve the sensitivity of delirium,especially subclinical delirium.(13) Early identification and intervention of subclinical delirium can reduce its risk of clinical delirium.(14) Daily assessment is helpful for early detection of delirium.(15) Hopoactive delirium and mixed delirium are common and should be emphasized.(16) Delirium may be accompanied by changes in electroencephalogram.Bedside electroencephalogram monitoring should be used in the ICU if conditions warrant.(17) Pay attention to differential diagnosis of delirium and dementia/depression.(18) Pay attention to the role of rapid delirium screening method in delirium management.(19) Assessment of the severity of delirium is an essential part of the diagnosis of delirium.(20) The key to the management of delirium is etiological treatment.(21) Improving environmental factors and making patient comfort can help reduce delirium.(22) Early exercise can reduce the incidence of delirium and shorten the duration of delirium.(23) Communication with patients should be emphasized and strengthened.Family members participation can help reduce the incidence of delirium and promote the recovery of delirium.(24) Pay attention to the role of sleep management in the prevention and treatment of delirium.(25) Dexmedetomidine can shorten the duration of hyperactive delirium or prevent delirium.(26) When using antipsychotics to treat delirium,we should be alert to its effect on the heart rhythm.(27) Delirium management should pay attention to brain functional exercise.(28) Compared with non-critically illness related delirium,the relief of critically illness related delirium will not accomplished at one stroke.(29) Multiple management strategies such as ABCDEF,eCASH and ESCAPE are helpful to prevent and treat delirium and improve the prognosis of critically ill patients.(30) Shortening the duration of delirium can reduce the occurrence of long-term cognitive impairment.(31) Multidisciplinary cooperation and continuous quality improvement can improve delirium management.Consensus can promote delirium management in critically ill patients,optimize analgesia and sedation therapy,and even affect prognosis.
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Objective To explore the relationship between serum sialic acid(SA),high-sensitivity C-reactive protein(hs-CRP) and prehypertension and their clinical significance.Methods According to the blood pressure range,160 residents who received physical examination were divided into three groups:normal group (40 cases),prehypertension group (60 cases) and hypertension group (60 cases).The blood pressure,height and weight were measured in all subjects,and the serum levels of SA,hs-CRP,serum total cholesterol (TC),low density lipoprotein (LDL),high density lipoprotein(HDL),triacylglycerol(TG) and fasting plasma glucose(FBG) were detected on the same day.Multiple linear regression was used to investigate the relationship between serum SA and hs-CRP levels and systolic blood pressure(SBP) and diastolic blood pressure(DBP).Results The levels of DBP,SBP,body mass index(BMI),SA,hs-CRP,TC,LDL,HDL and FBG among the three groups were statistically significant (F =1 102.039,2 690.642,9.163,116.511,103.634,5.431,4.267,67.352,4.236,all P ＜ 0.05).The levels of BMI,SA and hs-CRP increased gradually with the increase of blood pressure,while the level of HDL decreased (P ＜ 0.05).The levels of TC and LDL in the hypertension group were higher than those in the normal blood pressure group,but there were no statistically significant differences in TC and LDL levels between the pre hypertension group and normal blood pressure group (all P ＞ 0.05).Multiple linear regression showed that the levels of BMI,SA,hs-CRP and FBG were positively correlated with SBP(r =3.66,2.61,3.24,2.39,all P ＜ 0.05),and the levels of BMI,SA,hs-CRP and LDL were positively correlated with DBP (r =2.20,2.34,3.48,2.28,P all ＜ 0.05).Conclusion The levels of serum SA and hs-CRP are positively correlated with blood pressure,which can be used as assessment criteria for prehypertension.
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Objective To establish the expression profiles of differentially expressed miRNA and mRNA in oral squamous cell carcinoma(OSCC)and to investigate the roles of miRNA and mRNA associated with the occurrence and development of OSCC. Methods The expression profiles of miRNA and mRNA were constructed using a new generation of high-throughput sequencing techniques. The miRNA and mRNA associated with the occurrence and development of OSCC were predicted by Gene Ontology enrichment analysis and KEGG pathway analysis. Results We successfully constructed the differentially expressed miRNA and mRNA profiles of Chinese hamster buccal pouch squamous cell carcinoma. 11 known and 3 novel significantly differentially expressed miRNAs and 194 differentially expressed mRNAs were found. A miRNA can regulate multiple mRNAs, and multiple miRNAs can control one mRNA. Conclusions Differential expression of miRNA play a an important role in the carcinogenesis and development of OSCC through regulating mRNA and forming a complex regulatory network. It provides theoretical data for the occurrence,pathogenesis,clinical treatment and prognosis of OSCC.
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Objective To study the changes of maternal serum lipid,free fatty acid levels and the neonatal arterial blood gas,lactic acid and myocardial enzyme levels in the patients with early-onset pre-eclampsia(EOPE) combine with gestational diabetes mellitus(GDM).Methods One hundred and fifty cases EOPE patients were divided into EOPE+GDM group(observation group,n=67) and normal glucose tolerance EOPE group(control group,n=83) according to international association of diabetic pregnancy study group standard.The maternal BMI,serum lipid(TC,TG,LDL-C,very low density lipoprotein cholesterol(VLDL-C)),free fatty acid(FFA),HbA1c levels and the blood routine and biochemical tests were compared between two groups.The neonatal peripheral arterial blood-gas,lactate(LAC) and myocardial enzymes(creatine kinase(CK),lactate dehydrogenase(LDH),creatine kinase isoenzyme(CK-MB)) levels within 1 h after birth were measured and compared between two groups.Pearson correlation analysis was used to explore the impact of maternal glucose/lipid metabolic index,the birth condition on the neonatal LAC and CK-MB levels in EOPE patients.Results (1)In observation group,the patients had significantly higher BMI((32.66±4.23) kg/m2 vs.(29.98±5.44) kg/m2,t=4.904),TC((7.28±1.34) mmol/L vs.(6.65±0.76) mmol/L,t=5.760),TG((4.10±1.26) mmol/L vs.(3.51±0.71) mmol/L,t=4.199),LDL-C((4.85±1.24) mmol/L vs.(3.77±0.82) mmol/L,t=5.292),VLDL-C((1.91±0.37) mmol/L vs.(1.26±0.48) mmol/L,t=4.498),HbA1c((5.95±0.41)% vs.(5.20±0.37)%,t=8.821) levels than control group(P<0.05),and the patients had significantly elevating levels of LAC((5.76±3.32) mmol/L vs.(3.89±1.53) mmol/L,t=5.348) and CK((419.03±198.29) U/L vs.(323.22±154.38) U/L,t=6.632),CK-MB((218.97±86.74) U/L vs.(142.18±60.12) U/L,t=5.562),LDH((723.22±180.16) U/L vs.(584.57±139.81) U/L,t=4.987)(P<0.05).(2)Stepwise multiple regression showed that in patients with early-onset preeclampsia,maternal HbA1c(β=70.821,t=5.461),FFA levels(β=88.590,t=4.990),the gestational age (β=-8.776,t=-4.901) and the neonatal LAC levels(β=5.948,t=4.047) were the independent factors of newborn's CK-MB level.Conclusion In patients with early-onset preeclampsia combine with GDM,the disorders in glucose and lipid metabolism are more severe.And the metabolic disturbance will further interfere with the perinatal material metabolism,resulting in the elevating levels of lactic acid and the potential myocardial injury in neonates.
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Objective@#To analyze the clinical characteristics of community-acquired pneumonia (CAP) in children under five years of age and analyze the safety and efficiency of nasal continuous positive airway pressure (NCPAP) ventilation for CAP in this population.@*Method@#This was a prospective multicenter study. Children who were admitted to these six centers with CAP and met the NCPAP ventilation indications, aged from 29 d to 5 years, were continuously included during November 2013 to October 2015. The baseline data were collected and NCPAP ventilation were then followed up by operation standards, and the vital signs and arterial blood gas change at special time points were observed and recorded. Any side effect associated with NCPAP were recorded. For categorical variables, comparisons were performed using Fisher test. Rank-sum test and t test were performed respectively for abnormal and normal distribution continuous variables. The variables pre-NCPAP and post-NCPAP were analyzed by repeated measures ANOVA analysis.@*Result@#Totally 145 children were included, and 13 children were excluded due to incomplete data. One hundred and two children(77.3%)were ≤12 months; 91 children (68.9%) were from rural area. NCPAP ventilation was effective in 123 children, with a response rate of 93.2%, were all discharged with a better condition; it was ineffective in 9 children(6.8%), and they were all intubated and went on mechanical ventilation, 5 were discharged with a better condition, and 4 died after gaving up treatment. The gender, age, body weight, residence, main symptoms, main signs, imaging diagnosis, medications, partial pressure of oxygen(PaO2), breath and heart rate before NCPAP treatment of two groups had no significant differences(allP>0.05). The rates of combining underlying diseases, trouble with feeding and cyanosis, and the partial pressure of carbon dioxide(PaCO2 ) before NCPAP ventilation were higher in NCPAP ineffective group ((59±11 )vs.( 49±11) mmHg, 1 mmHg=0.133 kPa, t=-2.597, P=0.028); while the PaO2/fraction of inspiration O2 (FiO2 ) before NCPAP was lower((150±37) vs. (207±63) mmHg, t=2.697, P=0.008). The breathing, heart rate and PaCO2 of NCPAP effective group decreased significantly, while the PaO2 and PaO2/FiO2 increased significantly after 2, 8, 24 h of NCPAP ventilation(all P=0.000). PaCO2 in children with hypercapnia before NCPAP ventilation in NCPAP effective group decreased significantly ((48±9), (47±12), (45±11)vs.(58±7)mmHg, all P=0.000). All children tolerated well to NCPAP ventilation, and there were no severe side effects or complications associated with NCPAP ventilation.@*Conclusion@#NCPAP ventilation is safe and effectively improved the oxygenation and hypercapnia in infants with CAP. But it may not work well in children with underlying diseases, manifest as difficulty in feeding/cyanosis and extremely high PaCO2 or low PaO2/FiO2, and they may need early intubation.
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Objective To explore the influence on intraoperative hemorrhage and relative complications of temporary balloon occlusion of the abdominal aorta in cesarean section for the pernicious placenta previa and placenta accreta.Methods One hundred and thirty-four cases of pernicious placenta previa and placenta accrete from January 2011 to January 2016 were analyzed retrospectively.Before the cesareans,temporary balloon occlusion in abdominal aorta was carried out in 69 patients (observation group).The other 65 patients didnt get the balloon occlusion in abdominal aorta (control group).The situation during and after the operation and relative complications were compared.Results The operation duration [(65.2 ± 6.3)min vs (93.2 ±8.8)min],postpartum hemorrhage [(923.2 ± 188.6)ml vs (2 791.8 ±336.2)ml],intraoperative blood transfusion [(423.7 ±59.3)ml vs (1 581.6 ±68.3)ml],the prothrombin time during the operation [(9.3 ± 1.1) s vs (12.4 ± 1.5) s],the hysterectomy rate [0 vs 7.7％ (5/65)],hospitalization time [(5.2 ±0.9)d vs (6.8 ± 1.1)d],and the rate of transferring to intensive care unit [1.4％ (1/69) vs 12.3％ (8/65)] in the observation group were lower than control group,with a statistical significant difference (P ＜ 0.05).There was no significant difference between two groups in Apgar score and birth weight of the neonate (P ＞ 0.05).Conclusions Temporary balloon occlusion of the abdominal aorta in cesarean section is a safe and effective technique,which can reduce the relative complications,such as the volume of bleeding and the risk of hysterectomy.
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Objective The aim of our study was to examine the clinical value of neuroendoscopic surgery in hypertensive cerebellar hemorrhage.Methods The clinical data from 38 patients with cerebellar hemorrhage were retrospectively analyzed.Thirty-eight patients included 18 cases with neuroendoscopic hematoma evacuation (neuroendoscopic group) and 20 cases with craniotomy hematoma evacuation (craniotomy group).The perioperative parameters and clinical outcome were statistically analyzed.Results Compared with craniotomy group,the mean operative time was shorter [(82.9±17.0)min vs.(177.9±28.8)min,t=12.545,P=0.000],the loss of mean blood volume was smaller [(45.1±15.6)mL vs.(197.9±29.5)mL,t=20.237,P=0.000]ml,ventricle drainage time [(3.5±1.5)d vs.(5.3±1.4)d,t=3.751,P=0.001],ICU stay time [(2.9±1.0)d vs.(4.7±1.5)d,t=4.146,P=0.000] and hospital stay time [(7.4±1.5)d vs.(9.9±2.8)d,t=3.348,P=0.002] were shorter (P＜0.05).Two weeks after surgery,1 cases died in neuroendoscopic group and 2 cases died in craniotomy group (P=1.000,P＞0.05).Three months after surgery,GOSE was greater than 4 in 14 cases in neuroendoscopic group and in 13 cases in craniotomy group and the difference was not significant (2=0.752,P=0.386,P＞0.05).Conclusion Although there are no differences in mortality and clinical outcomes between neuroendoscopic hematoma evacuation and occipital craniotomy hematoma evacuation for hypertensive cerebellar hemorrhage patients,neuroendoscopic hematoma evacuation can significantly reduce the mean operative time,the loss of mean blood volume,ventricle drainage time,ICU stay time and hospital stay time.Thus,neuroendoscopic hematoma evacuation in hypertensive cerebellar hemorrhage is safe and effective,which has a great value of application in the future.
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Objective The aim of our study was to examine the clinical value of neuroendoscopic surgery in hypertensive cerebellar hemorrhage.Methods The clinical data from 38 patients with cerebellar hemorrhage were retrospectively analyzed.Thirty-eight patients included 18 cases with neuroendoscopic hematoma evacuation (neuroendoscopic group) and 20 cases with craniotomy hematoma evacuation (craniotomy group).The perioperative parameters and clinical outcome were statistically analyzed.Results Compared with craniotomy group,the mean operative time was shorter [(82.9±17.0)min vs.(177.9±28.8)min,t=12.545,P=0.000],the loss of mean blood volume was smaller [(45.1±15.6)mL vs.(197.9±29.5)mL,t=20.237,P=0.000]ml,ventricle drainage time [(3.5±1.5)d vs.(5.3±1.4)d,t=3.751,P=0.001],ICU stay time [(2.9±1.0)d vs.(4.7±1.5)d,t=4.146,P=0.000] and hospital stay time [(7.4±1.5)d vs.(9.9±2.8)d,t=3.348,P=0.002] were shorter (P＜0.05).Two weeks after surgery,1 cases died in neuroendoscopic group and 2 cases died in craniotomy group (P=1.000,P＞0.05).Three months after surgery,GOSE was greater than 4 in 14 cases in neuroendoscopic group and in 13 cases in craniotomy group and the difference was not significant (2=0.752,P=0.386,P＞0.05).Conclusion Although there are no differences in mortality and clinical outcomes between neuroendoscopic hematoma evacuation and occipital craniotomy hematoma evacuation for hypertensive cerebellar hemorrhage patients,neuroendoscopic hematoma evacuation can significantly reduce the mean operative time,the loss of mean blood volume,ventricle drainage time,ICU stay time and hospital stay time.Thus,neuroendoscopic hematoma evacuation in hypertensive cerebellar hemorrhage is safe and effective,which has a great value of application in the future.
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Objective To investigate the efficacy and cardiovascular disease of Danhong injection in the treatment after cardiac interventional therapy.Methods A total of 64 cases with cardiac intervention from September 2013 to July 2015 in our hospital were selected and divided into control group and experiment group with 32 cases in each group.Patients in the control group were given aspirin 100mg orally,and patients in the experiment group revieved Danhong injection 20mL intravenous drip qd,one times a day for 14 days.Two groups of patients underwent cardiac intervention.After the operaiton,the control group was given aspirin enteric-coated tablets 100mg orally,clopidogrel 75mg orally,and patients in the experiment group revieved Danhong injection 20mL intravenous drip qd,seven days for a course and the patients treated for three courses.The clinical efficacy,C-reactive protein(CRP),cardiac troponin T(TnT),P-selectin(Ps),PSGL-1,cardiovascular events(cardiovascular events),and adverse events were compared.Results After treatment,the clinical efficacy in experiment group was 93.75％,which significant higher than that in control group 71.88％,the difference was statistically significant(P<0.05).The rate of cardiovascular events in experiment group was 21.88％,which significant lower than that in control group 40.63％,the difference was statistically significant(P<0.05).The serum C-reactive protein,troponin T,Ps and PSGL-1 were significantly decreased in the two groups,and the experimental group was significantly smaller than the control group,the difference was statistically significant(P<0.05).The incidence of adverse reactions was 15.63％in the control group and 9.38％in the experimental group,the difference was not statistically significant.Conclusion Danhong injection treatment of elderly patients with cardiac intervention after the clinical effect is significant,high security,the incidence of cardiovascular events is low.