Value of stress hyperglycemia ratio in predicting the prognosis of patients with acute heart failure / 中华急诊医学杂志

Objective:To explore the value of stress hyperglycemia ratio (SHR) in predicting the prognosis of patients with acute heart failure (AHF).Methods:AHF patients admitted to the Emergency Department of Shanghai Jiao Tong University Affiliated Sixth People's Hospital from December 2016 to January 2019 were retrospectively included. Clinical data were recorded and SHR was calculated. According to the survival of the patients within 1 year, they were divided into the death group ( n=89) and the survival group ( n=218). Logistic regression analysis was used to analyze the risk factors of mortality. Kaplan-Meier analysis was used to evaluate the correlation between SHR and the prognosis of AHF patients. Results:A total of 307 patients aged 83 ( range 74-87) years old who met the inclusion criteria were included in this study, including 153 males and 104 females. The age, SHR and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) in the death group were higher than those in the survival group [84 (78, 88) vs 82 (72, 86), 1.11 (0.91, 1.51) vs 1.02 (0.86, 1.27), 5 351 (2 098, 14 039)μg/L vs 4 243 (2 294, 7 565)μg/L ]. The left ventricular ejection fraction (LVEF) in the death group was significantly lower than that of the survival group [53 (45, 57) % vs 58 (44, 64) %, P< 0.05]. Logistic regression analysis showed that SHR was an independent risk factor for death in AHF patients ( OR=2.397, 95% CI: 1.285-4.471, P< 0.05). Median SHR was used to draw the survival curve. Patients with high SHR had a lower cumulative survival rate, and the difference was statistically significant ( P<0.05). Conclusion:SHR can identify critically ill patients and is an independent risk factor for death in AHF patients.

Assisting Scalable Diagnosis Automatically via CT Images in the Combat against COVID-19

Introductory paragraphThe pandemic of coronavirus Disease 2019 (COVID-19) caused enormous loss of life globally. 1-3 Case identification is critical. The reference method is using real-time reverse transcription PCR (rRT-PCR) assays, with limitations that may curb its prompt large-scale application. COVID-19 manifests with chest computed tomography (CT) abnormalities, some even before the onset of symptoms. We tested the hypothesis that application of deep learning (DL) to the 3D CT images could help identify COVID-19 infections. Using the data from 920 COVID-19 and 1,073 non-COVID-19 pneumonia patients, we developed a modified DenseNet-264 model, COVIDNet, to classify CT images to either class. When tested on an independent set of 233 COVID-19 and 289 non-COVID-19 patients. COVIDNet achieved an accuracy rate of 94.3% and an area under the curve (AUC) of 0.98. Application of DL to CT images may improve both the efficiency and capacity of case detection and long-term surveillance.

Study on the diagnosis and transfusion treatment of thrombelastography for trauma-induced coagulopathy / 中华急诊医学杂志

Objective To assess the diagnosis of thrombelastography (TEG) for trauma-induced coagulopathy (TIC) and explore whether TEG could guide transfusion for TIC patients.Methods We retrospectively analyzed all trauma patients who underwent the TEG and conventional coagulation tests (CCTs) admission in the emergency intensive care unit from February to December 2018.The definition of TIC is prothrombin time (PT) 18 s,international normalized ratio (INR) 1.5,activated partial thromboplastin time (APTT) 60 s or platelet count (PLT) 100 x 109/L.The diagnostic value of TEG for TIC was evaluated by receiver operating characteristic curve,area under the curve (AUC),sensitivity,specificity,positive predictive value (PPV) and negative predictive value (NPV),and the transfusion guidance of TEG for TIC patients was assessed by multivariate regression analyses.Results A total of 242 patients were included,including 62 patients in the TIC group and 180 patients in the non-TIC group.The differences in TEG between the two groups were statistically significant.The AUCs of TIC assessed by maximum amplitude (MA) and coagulation index (CI) were the largest,0.779 and 0.786 respectively,and the sensitivity were greater than 80％ and NPV were greater than 90％.The sensitivity,PPV and NPV of reaction time (R) were minimal.After confounders were controlled,all TEG values were correlated with blood volumes within the first 24 h and massive transfusion,of which R had the highest odds ratio and regression coefficient.Conclusions MA and CI have the highest diagnostic value,while R has little diagnostic value but a relatively large blood therapeutic significance of TIC.MA ＜ 52.9 mm or CI ＜-1.0 can be used as a threshold for identifying TIC.The diagnosis of TIC and the guidance transfusion for TIC patients by TEG is beneficial.

Study on the diagnosis and transfusion treatment of thrombelastography for trauma-induced coagulopathy / 中华急诊医学杂志

Objective@#To assess the diagnosis of thrombelastography (TEG) for trauma-induced coagulopathy (TIC) and explore whether TEG could guide transfusion for TIC patients.@*Methods@#We retrospectively analyzed all trauma patients who underwent the TEG and conventional coagulation tests (CCTs) admission in the emergency intensive care unit from February to December 2018. The definition of TIC is prothrombin time (PT) 18 s, international normalized ratio (INR) 1.5, activated partial thromboplastin time (APTT) 60 s or platelet count (PLT) 100×109/L. The diagnostic value of TEG for TIC was evaluated by receiver operating characteristic curve, area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), and the transfusion guidance of TEG for TIC patients was assessed by multivariate regression analyses.@*Results@#A total of 242 patients were included, including 62 patients in the TIC group and 180 patients in the non-TIC group. The differences in TEG between the two groups were statistically significant. The AUCs of TIC assessed by maximum amplitude (MA) and coagulation index (CI) were the largest, 0.779 and 0.786 respectively, and the sensitivity were greater than 80% and NPV were greater than 90%. The sensitivity, PPV and NPV of reaction time (R) were minimal. After confounders were controlled, all TEG values were correlated with blood volumes within the first 24 h and massive transfusion, of which R had the highest odds ratio and regression coefficient.@*Conclusions@#MA and CI have the highest diagnostic value, while R has little diagnostic value but a relatively large blood therapeutic significance of TIC. MA < 52.9 mm or CI < -1.0 can be used as a threshold for identifying TIC. The diagnosis of TIC and the guidance transfusion for TIC patients by TEG is beneficial.

Serum calcium and other test results in 17 patients with primary familial brain calcification / 中国医师杂志

Objective@#To investigate the correlation between Ca, Al, As, Co, Mg, P, Fe, parathyroid hormone (PTH), Ct levels and primary familial brain calcification (PFBC).@*Methods@#We recruited 17 PFBC families from July, 2015 to October, 2016. Groups were divided according to clinical symptoms, the serum concentrations of Ca, P, Fe, Al, As, Co, PTH and Ct were compared among different family groups.@*Results@#There was no significant difference in serum levels of Ca, P, Fe, Al, As, Co, PTH and Ct among the healthy and patient groups or the symptomatic and asymptomatic groups, symptomatic and asymptomatic groups in movement disorder families and in psychiatric families (P>0.05).@*Conclusions@#Among the 17 PFBC families, neither serum concentrations of Ca, Al, As, Co, Mg, P, and Fe nor the levels of PTH and Ct were associated with PFBC.

Serum calcium and other test results in 17 patients with primary familial brain calcification / 中国医师杂志

Objective To investigate the correlation between Ca,Al,As,Co,Mg,P,Fe,parathyroid hormone (PTH),Ct levels and primary familial brain calcification (PFBC).Methods We recruited 17 PFBC families from July,2015 to October,2016.Groups were divided according to clinical symptoms,the serum concentrations of Ca,P,Fe,Al,As,Co,PTH and Ct were compared among different family groups.Results There was no significant difference in serum levels of Ca,P,Fe,Al,As,Co,PTH and Ct among the healthy and patient groups or the symptomatic and asymptomatic groups,symptomatic and asymptomatic groups in movement disorder families and in psychiatric families (P ＞ 0.05).Conclusions Among the 17 PFBC families,neither serum concentrations of Ca,Al,As,Co,Mg,P,and Fe nor the levels of PTH and Ct were associated with PFBC.

The association of blood IL-1β to injury and its complications in patients with multiple trauma / 中华急诊医学杂志

Objective To investigate the relationship between the dynamic changes of interleukin-1β (IL-1β) levels and severity and complications of patients with multiple trauma at the early stage.Methods Among 97 patients with multiple trauma in Emergency Department of Shanghai Jiao Tong University Affiliated Sixth People's Hospital between August 2015 and May 2016,12 patients were excluded as follows,(1) with burns or chemical injuries;(2) pregnancy or menopausal women;(3) had bacterial infection a week ago;(4) with chronic diseases.The other 85 patients with multiple traumas were classified into three categories according to the injury severity score (ISS).That is,the slight group (22 cases,9≤ ISS ＜ 15),moderate group (35 cases,15 ≤ ISS ＜ 25) and severe group (28 cases,ISS ≥ 25).Their venous blood samples were collected at 6,12,24,48 and 72 hours after trauma respectively,and the serum IL-1 β levels were measured using a specific immunoluminometric assays.The basal conditions including age,the hospitalization days and so on among these three groups were compared via ANOVA.The mean IL-1 β levels at above time intervals among three groups were compared.Finally,the relationship between the peak concentration of IL-1β and injury severity and complications was analyzed by multiple Logistic regression.Results (1) As the increasing severity of trauma,the patients with longer days of hospitalization and higher rate of multiple organ dysfunction syndrome (MODS) (P ＜ 0.05).(2) The levels of IL-1 β in the moderate and severe groups were remarkably higher than those in the slight group (P ＜ 0.02).(3) The IL-1β levels in each group peaked at 6 hours after trauma and began to decline.(4) Multivariate logistic analysis showed that peak concentration of IL-1 β was still an independent predictor for injury severity (moderate group:odds ratio,1.21;95％ confidence interval:1.05-1.39,P =0.007;severe group:odds ratio,1.20;95％ confidence interval:1.03-1.40,P =0.019) and sepsis (odds ratio,1.28;95％ confidence interval:1.10-1.50,P =0.001),but had no significant association with MODS and trauma mortality even after controlling other risk factors.Conclusions The serum IL-1β at 6 hours after injury could be used as an early effective indicator to evaluate the injury severity and infectionrelated complications in patients with multiple trauma.

Study on Determination Method for Dissolution of Pentoxyverine Citrate and Guaifenesin Tablets / 中国药房

OBJECTIVE:To establish a method for the dissolution determination of Pentoxyverine citrate and guaifenesin tab-lets,and to compare the difference of preparations from different manufactures. METHODS:The paddle method was used to deter-mine the dissolution,using water as medium with medium volume of 1000 mL and rotation speed of 75 r/min,sampling at 45 min. HPLC method was used to determine the accumulative dissolution of pentoxyverine citrate and guaifenesin:CAPCELL PAK C18 MGⅡ S-5 column;mobile phase of acetonitrile-triethylamine phosphoric buffer solution(pH 2.6±0.05)(33:67,V/V),flow rate of 1.0 mL/min,detection wavelength of 215 nm(pentoxyverine citrate)and 275 nm(guaifenesin),column temperature of 35 ℃,sample size of 20 μL. RESULTS:The linear range of pentoxyverine citrate and guaifenesin were 5.0916-50.9155 μg/mL(r=0.9999)and 29.9995-299.9952 μg/mL(r=0.9999),respectively. RSDs of precision,stability and reproducibility tests were all lower than 2.0%. Average recoveries were 97.90%-100.68%(RSD=0.95%,n=9)and 97.09%-101.85%(RSD=1.32%,n=9). Average accu-mulative dissolution of pentoxyverine citrate in 6 manufactures of samples were 12%,98%,66%,97%,91%,32%(n=3);those of guaifenesin were 8%,95%,68%,90%,93%,18%(n=3),respectively. CONCLUSIONS:The method is simple,ac-curate,sensitive,specific and suitable for the dissolution determination of Pentoxyverine citrate and guaifenesin tablets. The dissolu-tion of samples between different manufactures and the same manufactures different batches are quite different.

Efficacy of salvage chemotherapy with ICE regimen in 52 patients with recurrent and refractory diffuse large B-cell lymphoma and its prognostic factors / 肿瘤

Objective: To investigate the efficacy and safety of salvage chemotherapy with ICE regimen (ifosfamide, etoposide and carboplatin) in patients with recurrent and refractory diffuse large B-cell lymphoma (DLBCL) and the related prognostic factors. Methods: The efficacy and side effects of salvage chemotherapy with ICE regimen in 52 patients with recurrent and refractory DLBCL were evaluated. The survival analysis was performed. The univariate and multivariate analyses were used to examine the related prodnostic factors. Results: The objective response rate (ORR) was 61.5% (32/52). The gender, age at diagnosis, extranodal involvement (≤1 vs>1), tumor cell origin [germinal-center B-cell-like (GCB) vs non-GCB] and B symptom were not associated with response to salvage chemotherapy with ICE regimen (all P>0.05). The patients with Ki-67≥75% had better response than those with Ki-670.05). The result of multivariate analysis showed that extranodal involvement and tumor cell origin were independent prognostic factors of PFS (both P0.05). The major side effect induced by ICE regimen was myelosuppression (80.8%), including grade 3/4 myelosuppression accounted for 55.8%. Conclusion: In patients with recurrent and refractory DLBCL, ICE can serve as an effective salvage chemotherapy regimen. The extranodal involvement and tumor cell origin were independent prognostic factors.

Implications of the CD4+ and CD25+ positive regulatory T cells and its associated regulatory factors in immunopathology of patients with middle to late stage of nasopharyngeal carcinoma / 中国医师杂志

Objective To investigate the implications of ratio of the CD4+ and CD25+ positive regulatory T cells (CD4+CD25+Tregs) in peripheral blood mononuclear cells (PBMC) and its associated regulatory factors such as forkhead transcription factor 3 (Foxp3) mRNA transcriptional activity in PBMC,serum levels of transforming growth factor beta-1 (TGF-β1),and interleukin 10 (IL-10) in the immunopathology of patients with middle to late staged nasopharyngeal carcinoma (NPC) based on a clinical trial.Methods In this study,18 NPC cases at middle to late stage as observing group and 10 healthy persons as control group were included to detect their ratio of the CD4+CD25+Tregs in the PBMC with flow cytometry (FCM) technique,transcriptional activity of Foxp3 with RT-PCR procedure,and serum levels of TGF-β1 and IL-10 with enzyme-linked immunosorbent assay (ELISA) method.A comparative analysis was used to explore their implications in the immunopathological correlation of NPC cases with their lesion.Results The ratio of the CD4+CD25+Tregs to total CD4+T cells in PBMC was significantly increased [(4.23 ±0.53)％ vs (2.65 ±0.31)％,t =8.60,P ＜0.01],accompanied with significantly elevated levels of Foxp3 transcription in PBMC (3.699 ± 0.309 vs 1.109 ± 0.146,t' =31.08,P ＜ 0.05],and serum contents of TGF-β1 [(645.56 ± 39.61) pg/ml vs (488.82 ± 36.91) pg/ml,t =10.27,P ＜ 0.01] and IL-10 [(1.27 ± 0.21) pg/ml vs (0.68 ± 0.08) pg/ml,t' =10.61,P ＜ 0.05] in these patients,when compared with that of healthy controls.Conclusions It may be true that CD4 + CD25 + Tregs,transcriptional regulatory factor Foxp3,and cytokines TGF-β1 as well as IL-10 altogether were composed of a regulating system in a positive feedback way to promote the developing process of immunotolerance phenomena in the tumor microenvironment and the initiation of immunoescape among patients with middle to late staged nasopharyngeal carcinoma.

Prevalence of Female Urogenital System Infections in Shijiazhuang / 中华医院感染学杂志

0.5).The positive rate of mixing infection due to Mycoplasma+Gardnerella,Candida+Gardnerella,T.vaginitis accompanied with Gardnerella and Mycoplasma,Candida accompanied with Gardnerella and Mycoplasma was 46.7%,23.4%,16.9% and 12.9%,respectively.CONCLUSIONS Urogenital infection is prevalent among 21-60 yeas old females.Mycoplasma,Gardnerella and Candida are the major pathogens.The cross infection is serious in gynecologic infections.