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Objective:To explore the application of list nursing management combined with different artificial liver treatment modes in patients with liver failure.Methods:Fifty-three patients with liver failure hospitalized in Bethune Hospital of Shanxi Province from July 2020 to July 2021 were selected as the control group, 63 patients with liver failure hospitalized in Bethune Hospital of Shanxi Province from July 2021 to July 2022 were selected as the intervention group. According to the different treatment modes of artificial liver for patients, plasma exchange (PE), double plasma molecular adsorption system (DPMAS) and PE + DPMAS treatment were set up in the two groups. The control group received routine nursing care, while the intervention group received checklist nursing care in addition. The changes of albumin (ALB) and prothrombin time (PT) indexes before and after the different treatment modes were compared, together with the occurrence of complications between the two groups after the intervention.Results:The baseline data between the two groups was balanced, the difference had no statistical significant ( P>0.05). After the therapy, the level of ALB of patients who had accepted DPMAS and PE + DPMAS in the intervention group were 25.3(24.0, 27.9) and 23.2(22.4, 26.3) g/L, which were lower than the 28.2(26.3, 29.7) and 29.4(27.2, 30.0) g/L in the control group, the differences were significant ( Z = 2.47, 3.55, both P<0.05). After the therapy, the level of PT of patients in the intervention group under all three treatment modes were 15.8(14.8, 16.8), 22.7(19.2, 26.2) and 6.0(14.6, 20.0) s, which were lower than the 17.4(15.9, 20.9), 26.3(21.4, 36.4) and 21.2(16.9, 23.4) s in the control group, the differences were significant ( Z = 2.10, 2.07, 2.21, all P<0.05). In the intervention group, there were 6 cases of hypotension, anaphylaxis, bleeding, coagulation and infection under the DPMAS treatment mode, which was significant lower than the 11 cases in the control group ( χ2 = 4.97, P<0.05). There were 4 cases in the intervention group with the PE + DPMAS treatment mode occurred complications in above, which were significant lower than the 11 cases in the control group ( χ2 = 6.87, P<0.01). Conclusions:Artificial liver treatment can improve patients′ liver function and coagulation, and list nursing management may help to improve the effect of artificial liver treatment. It can improve nurses′ awareness of risk prejudgement, reduce various risks in the treatment process, reduce the incidence of adverse reactions, and enhance health care and patient satisfaction.
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Objective:To analyze the characteristics, diagnosis and prognosis of acute fatty liver of pregnancy (AFLP), and to guide the management of AFLP patients.Methods:The clinical data of 34 AFLP patients admitted to Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January 2009 to December 2019 were retrospectively analyzed. The general situation, diagnostic characteristics, treatment and maternal and neonatal prognosis of the AFLP patients were collected and analyzed.Results:The incidence of AFLP in our hospital was 0.022% (34/152 383). The age of onset was (30.6±4.9) years old, and the gestational age was (35.3±2.4) weeks. Most of the first symptom was gastrointestinal symptoms of unknown cause in the third trimester of pregnancy (53%, 18/34), accompanied by different degrees of elevated liver enzymes. Cesarean section was performed in 97% (33/34) of patients for termination of pregnancy. Only one pregnant woman was diagnosed prenatal and delivered vaginally, and the prognosis of both mother and infant was good. Five cases were transferred to intensive care unit, including 2 cases of acute renal failure, 1 case of gastrointestinal bleeding and 2 cases of disseminated intravascular coagulation. There was no maternal death. Severe asphyxia occurred in 2 neonates.Conclusions:Attention should be paid to the digestive tract symptoms during the third trimester of pregnancy and the diversity of clinical manifestations of AFLP for early detection. Once AFLP is diagnosed, pregnancy should be terminated as soon as possible to improve maternal and infant outcomes.
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Objective:To evaluate the medical services of tertiary hospitals in Shanxi province from the perspective of patients and provide references for improving the quality of medical services.Methods:From April to December 2018, 1 358 patients at 8 tertiary hospitals in Shanxi province were selected for the survey of medical service quality evaluation scale based on patient experience, while the status quo of patient experience in tertiary hospitals in Shanxi province was evaluated, and the multivariate mixed linear model was constructed based on the three-level model of hospital-department-patient to analyze the relevant factors of patient experience. If the quantitative data conform to the normal distribution, it was expressed as ± s. Otherwise, it was expressed as M(QR). Results:The patient experience score was 626±126, which was in the middle level. Whether the hospital was directly affiliated to the teaching hospital, and patient factors(marriage, occupation, education, medical insurance, number of hospital stays, etc.)were the main factors that affect the patient experience score( P<0.05). Conclusions:Through the investigation, the influence characteristics of patients′ medical experience were discussed to improve the medical service and the overall service level.
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Objective@#To evaluate the medical services of tertiary hospitals in Shanxi province from the perspective of patients and provide references for improving the quality of medical services.@*Methods@#From April to December 2018, 1 358 patients at 8 tertiary hospitals in Shanxi province were selected for the survey of medical service quality evaluation scale based on patient experience, while the status quo of patient experience in tertiary hospitals in Shanxi province was evaluated, and the multivariate mixed linear model was constructed based on the three-level model of hospital-department-patient to analyze the relevant factors of patient experience. If the quantitative data conform to the normal distribution, it was expressed as ±s. Otherwise, it was expressed as M(QR).@*Results@#The patient experience score was 626±126, which was in the middle level. Whether the hospital was directly affiliated to the teaching hospital, and patient factors(marriage, occupation, education, medical insurance, number of hospital stays, etc.)were the main factors that affect the patient experience score(P<0.05).@*Conclusions@#Through the investigation, the influence characteristics of patients′ medical experience were discussed to improve the medical service and the overall service level.
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BACKGROUND:Immunosuppressants fight against acute rejections by influencing humoral and celular immune to suppress the immune function, and then improve patient/renal graft survival. OBJECTIVE:To evaluate the effectiveness and safety of alemtuzumab, daclizumab and antithymocyte globulin in inducing immunosuppression in kidney transplantation. METHODS:The randomized controled trials of alemtuzumab or daclizumabversusATG in kidney tranplantation published from 1966 to 2011 were enroled by searching PubMed and EMBASE using Cochrane systematic review. We colected data and major outcomes. And a meta-analysis was conducted on homogeneous studies. RESULTS AND CONCLUSION: A total of 9 randomized controled trials (777 patients) about kidney transplantation were included. The meta-analysis results showed that the safety items including patient/renal graft survival and acute rejection at a folow-up of 24 months had no statistical differences among the three drugs (al P > 0.05). But there was a significant difference between the infection rates of alemtuzumab and antithymocyte globulin at 36 months of folow-up (P < 0.05). The results indicate that alemtuzumab, daclizumab and antithymocyte globulin are equaly effective in inducing immunosuppression at a folow-up of 24 months in kidney transplantation. However, compared to antithymocyte globulin, alemtuzumab has a lower rate of infection at a folow-up of 36 months.
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<p><b>OBJECTIVE</b>To investigate the changes of caries susceptibility factors during the transition from caries-free to caries in three-year-old children.</p><p><b>METHODS</b>The study included 144 caries-free children aged 34-38 months. All participants underwent clinical examination and full-mouth supragingival plaque collection.Survey of children's oral health behaviors involving feeding habits and oral health care was also taken from children's parents of all participants. The children were reexamined 6 and 12 months later. According to the potential changes of caries status in twelve months follow up, all the participants were divided into three groups: caries-free group (caries free children in twelve months follow up), caries at 6-month group (children who were found with caries or cavities fillings at six months review) and caries at 12-month group (children who were caries free at six months but found with caries or cavities fillings at twelve months). Streptococcus mutans (Sm)and Streptococcus sobrinus (Ss) loads were compared among the three groups by real time fluorescence quantitative polymerase chain reaction (FQ-PCR).</p><p><b>RESULTS</b>One hundred and thirty children completed twelve months review, the dropout rate was 9.7% (14/144). At the end of twelve months follow up, the number of children in caries-free group, caries at 6-month group and caries at 12-month group was 58, 44 and 28 respectively. The changes of oral behavioral habits in caries-free group, caries at 6-month group and caries at 12-month group during twelve months follow up were not significantly different (P > 0.05). At baseline, the frequency of sweets consumption and eating sweets before sleeping in caries-free group was significantly lower than that in caries at 6-month group and caries at 12-month group (P < 0.001). At baseline, the quantity of Sm and Ss in caries at 6-month group[copy number of Sm: (6.33 ± 2.21)×10(3), copy number of Ss: (1.99 ± 0.45)×10(3)] was significantly higher than that in the caries-free group[copy number of Sm: (5.81 ± 2.43)×10(3), copy number of Ss: (1.34 ± 0.53)×10(3)] (P < 0.05). There was no significant difference in the quantity of Sm and Ss in the caries-free group and caries at 12-month group(P > 0.05). At six months, the quantity of Sm and Ss in caries at 12-month group was significantly higher than that in the caries-free group although both groups of children were caries-free at six months (P < 0.05).</p><p><b>CONCLUSIONS</b>The quantity of Sm and Ss increased six months before the caries onset in three-year-old children.High frequency sweets consumption and eating sweets before sleeping were important susceptibility factors for caries onset in the future.</p>
Assuntos
Pré-Escolar , Humanos , Cárie Dentária , Suscetibilidade à Cárie Dentária , Placa Dentária , Seguimentos , Boca , Saúde Bucal , Reação em Cadeia da Polimerase em Tempo Real , Streptococcus mutans , Streptococcus sobrinusRESUMO
ObjectiveUsing dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to evaluate the hemodynamic perfusion characteristics of bone marrow infiltration in patients with acute leukemia (AL). MethodsForty-seven patients with AL received coronal pelvic T1WI DCE-MRI with fast low angle shot (FLASH) sequence. Among them, 25 were initial onset untreated (IOU) patients, 22 were treated AL patients, including 14 with complete remission (CR) and 8 with non-remission ( NR). The hemodynamic perfusion parameters including maximum percentage of enhancement ( Emax ) and slope were determined based on enhancement-time curves ( ETCs ) of iliac and lumbar vertebra. The proportion of marrow myeloblasts was recorded.For all patients, quantitative perfusion parameters of bone marrow infiltration in ilium were compared with those in lumbar. The values of Emax and ES were compared among IOU,CR and NR patients.Correlations between perfusion parameters and histopathological results were assessed. ResultsIn all the 47 patients, the Emax values of bilateral iliac bone marrow ( 15.70 ± 7.06)were slightly higher than that of lumbar bone marrow ( 11. 28 ± 5.52 ), and the difference was statistically significant (P ＜0. 01 ).There was no significant difference in the slop value between bilateral iliac bone marrow (0. 82 ± 0. 12 ) and lumbar bone marrow (0. 80 ± 0. 09 ) ( P ＞ 0. 05 ). In the 25 untreated patients,the Emax and slop values were 17. 15 ± 5.75 and 0. 98 ± 0. 13, respectively; in the 14 CR patients, they were 8. 76 ±3.93 and 0. 26 ± 0. 04, respectively, and in the 8 NR patients, they were 21.62 ± 6. 50 and 1. 38 ± 0. 02, respectively. There was significant difference in the Emax and slop values among the three groups (P＜0. 05).Compared with IOU and NR patients, both the Emax and slop values decreased significantly in iliac bone marrow of AL patients with CR (P ＜ 0. 05 ). There was no significant difference between IOU and NR patients ( P ＞ 0. 05 ). A significant positive correlation was found between Emax value of iliac bone marrow and the proportion of marrow myeloblasts ( r ＝0. 501 ,P ＜0. 05 ). There was a negative correlation between slop value of iliac bone marrow and the proportion of marrow myeloblasts ( r ＝0. 235 ,P ＞0.05).ConclusionsDCE-MRI can beused for evaluating the hemedynamic characteristics of microcirculation of bone marrow infiltration in patients with AL, which can provide useful information in evaluating prognosis and monitoring therapeutic effect.
