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Objective:To analyze the characteristics of etiology and clinical indicators of hepatitis B virus (HBV) and non-HBV liver failure, and to evaluate their potential roles in reflecting disease outcomes.Methods:The clinical data of 369 patients with liver failure admitted to the intensive care unit (ICU) of the Fifth People's Hospital of Wuxi which was the designated hospital for treatment of liver failure from January 2018 to December 2020 were retrospectively analyzed. The classification and comparison of etiology of non-HBV and HBV liver failure patients were performed according to the Guidelines on the Diagnosis and Treatment of Liver Failure (2018 edition). The indicators of liver failure related etiologies, including gender, age, anticoagulant enzyme Ⅲ (ATⅢ), total bilirubin (TBil), length of ICU stay, hepatic encephalopathy, underlying disease (liver cirrhosis and liver cancer, etc.) and usage of artificial liver were analyzed. According to the 6-month follow-up results after discharge, the differences in the etiological indicators of died and survival patients and the outcome of patients with different types of liver failure were analyzed. Results:A total of 369 patients were enrolled, including 134 (36.3%) with liver failure not caused by HBV and 235 (63.7%) with liver failure caused by HBV. The male with HBV-related liver failure was 4.34 times higher than female (cases: 191 vs. 44), which was higher than non-HBV-related liver failure (1.03 times, cases: 68 vs. 66). The 6-month follow-up showed that the proportion of male with HBV-related liver failure who died and survived was significantly higher than that of female (78.76% vs. 21.24% in died patients, 92.86% vs. 7.14% in survival patients, both P < 0.01). The age of died patients in the non-HBV-related liver failure group was significantly higher than that of the survival patients (years: 58.53±0.15 vs. 54.38±3.01, P < 0.05), and the ATⅢ level was significantly lower than that of the survival patients [(32.20±6.43)% vs. (38.63±2.74)%, P < 0.05]. The length of ICU stay of the died HBV-related liver failure group was significantly shorter than that of the survival patients (days: 23.77±11.74 vs. 35.51±2.85, P < 0.01). The 6-month mortality after discharge of HBV-related liver failure combined with liver cancer was significantly higher than that of non-HBV-related liver failure (12.34% vs. 2.24%, P < 0.01), but there was no significant difference in 6-month mortality after discharge of patients receiving artificial liver and those with hepatic encephalopathy and cirrhosis between different types of liver failure groups. Conclusions:HBV is the main cause of liver failure. Patients with HBV-related liver failure were younger and had a longer hospitalization period, which was conducive to the recovery of the disease. HBV-related liver failure accompanied with liver cancer is the main factors of death. The ATⅢ has the potential value to reflect the disease outcome.
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Objective:To assess the predictors of outcomes for different subtypes of liver failure, and the effectiveness of artificial liver support systems in the treatment of liver failure.Methods:The clinical data of 112 patients with hepatitis B virus (HBV)- and non-HBV-related liver failure admitted to the intensive care unit (ICU) of the Fifth People's Hospital of Wuxi were collected from January to December 2020. The relevant etiologies of acute, subacute, acute-on-chronic, subacute-on-chronic, chronic subtype liver failure were analyzed. The efficacies of artificial liver support systems in the treatment of various subtypes of liver failure were also compared. The correlation of various indicators was analyzed by Spearman correlation analysis, the risk factors affecting the prognosis of patients with liver failure were analyzed by multivariate Logistic regression equation, and receiver operator characteristic curve (ROC curve) of subjects was plotted to evaluate the predictive value of each risk factor for the prognosis of patients with liver failure.Results:Among the 112 liver failure patients, 63 were caused by hepatitis B and 49 were caused by non-hepatitis B. The liver failure caused by hepatitis B was 6 times higher than for men than for women, which was higher than that of non-HBV liver failure group (1.33 times). Antithrombin Ⅲ (AT Ⅲ) and total bilirubin (TBil) levels of subacute liver failure were higher than those of pre-liver failure in the HBV liver failure group [AT Ⅲ: (59.33±14.57)% vs. (35.66±20.72)%, TBil (μmol/L): 399.21±112.94 vs. 206.08±126.96, both P < 0.05]. The levels of AT Ⅲ in patients with pre-liver failure and chronic liver failure in the non-HBV liver failure group were significantly higher than those with acute liver failure [(58.33±15.28%), (44.00±19.10)% vs. (31.33±7.57)%, both P < 0.05], patients with acute liver failure had significantly lower level of TBil than pre-liver failure (μmol/L: 107.83±49.73 vs. 286.20±128.92, P < 0.05), the TBil levels in patients with subacute and acute-on-chronic liver failure were also significantly higher than that in pre-liver failure group (μmol/L: 417.27±118.60, 373.00±187.00 vs. 286.20±128.92, both P < 0.05). Patients with subacute liver failure, subacute-on-chronic liver failure and chronic liver failure in the non-HBV failure group were significantly longer than those in acute liver failure (days: 36.00±8.31, 27.52±11.71, 27.72±22.71 vs. 11.00±1.41, all P < 0.05). There was no statistically significant difference in the case fatality rate of using the artificial liver support system between the HBV failure group and the non-HBV failure group (55.6% vs. 50.0%, P < 0.05), the levels of AT Ⅲ in the two groups of surviving patients were significantly higher than that of the dead [HBV liver failure group: (36.20±6.26)% vs. (27.33±8.87)%, non-HBV liver failure group: (41.06±4.16)% vs. (28.71±12.35)%, both P < 0.01]. Correlation analysis showed that there was a clear positive correlation between AT Ⅲ and TBil in the dead patients of HBV liver failure group and the survival and death patients of non-HBV liver failure group ( r values were 0.069, 0.341, 0.064, and P values were 0.723, 1.196 and 0.761, respectively); there was a significant inverse correlation between AT Ⅲ and TBil in the HBV liver failure group ( r = -0.105, P = 0.745). Multivariate Logistic regression analysis showed that AT Ⅲ was an independent risk factor affecting the prognosis of patients with non-HBV liver failure [odd ratio ( OR) = 1.023, 95% confidence interval (95% CI) was -0.001 to 0.001, P = 0.007]. TBil was an independent risk factor affecting prognosis of patients with HBV liver failure ( OR = 1.005, 95% CI was -0.002 to -7.543, P = 0.033). The analysis of ROC curve showed that AT Ⅲ had a predictive value for the prognosis of patients with non-HBV liver failure, the area under the ROC curve (AUC) = 0.747, the 95% CI was 0.592-0.902, P = 0.009. When the optimal truncation value was 39.5%, its sensitivity and specificity were 83.33% and 56.25%, respectively. Conclusions:Artificial liver support system treatment of liver failure was difficult to effectively reduce the mortality of patients with end-stage liver failure. In addition to AT Ⅲ, TBil also could be used as an indicator to assess liver compensatency and predict prognosis in liver failure patients.
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Objective:To investigate the effect of sodium hyaluronate on chronic periodontitis and its influence on serum hyper sensitive C-reactive protein(hs-CRP), interleukin 8(IL-8) and tumor necrosis factor-α(TNF-α).Methods:Using the random number table method, 98 patients with chronic periodontitis from March 2017 to March 2019 in Hangzhou Xixi Hospital were randomly divided into observation group (49 cases) and control group (49 cases). The control group was treated with tinidazole tablets, and the observation group was treated with sodium hyaluronate on the basis of the control group. The course of treatment was 4 weeks. The total effective rate was compared and the gingival index(GI), sulcus bleeding index (SBI), plaque index (PLI), and the levels of serum hs-CRP, IL-8, TNF-α before and 4 weeks after treatment were compared between the two groups.Results:The total effective rate of the observation group was higher than that of the control group:93.88%(46/49) vs. 71.43%(35/49), the difference was statistically significant ( χ2=8.612, P<0.05). After treatment of 4 weeks, the scores of GI, SBI and PLI in the observation group were lower than those in the control group: (1.10 ± 0.23 vs. 1.63 ± 0.36, 0.38 ± 0.10 vs.0.71 ± 0.15, 0.83 ± 0.29 vs. 1.36 ± 0.21), the differences were statistically significant ( P<0.05). After treatment of 4 weeks, the levels of hs-CRP, IL-8 and TNF-α in the observation group were lower than those in the control group: (4.53 ± 1.29) mg/L vs. (7.65 ± 1.82) mg/L, (6.17 ± 1.08) ng/L vs. (9.98 ± 1.56) ng/L, (2.27 ± 0.26) μg/L vs. (3.98 ± 0.32) μg/L, the differences were statistically significant ( P<0.05). No obvious adverse reactions occurred in the two groups. Conclusions:Sodium hyaluronate has a significant clinical effect on chronic periodontitis. It can reduce the levels of hs-CRP, IL-8, TNF-α and alleviate the inflammatory reaction.
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Objective@#To investigate the expression of integrin β3 in the endometrial implantation window of patients with cesarean scar and infertility, and its correlation with endometrial receptivity.@*Methods@#A total of 40 patients with previous cesarean scar defect (PCSD) secondary infertility treated in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from April 2018 to December 2019 were enrolled as the observation group.The natural cycle of 40 normal women who were examined in our hospital at the same time were selected as the control group.The two groups were enrolled in the endometrium of the glandular epithelial cells for MMP-9, TIMP-1 and LIF immunohistochemical staining, and statistical analysis was performed.The serum E2 and P levels of the implantation group were compared.The E2/P ratio was measured and compared, and the expression level of integrin β3 endometrial planting window was compared.@*Results@#The MMP-9, TIMP-1 and LIF in the observation group [(175.31±56.36), (201.46±51.34), (209.23±45.23)] were significantly lower than those in the control group [(252.35±78.43), (257.23±74.13), (298.34±72.35)] (t=5.334, 5.766, 6.023, all P<0.05), but the E2, P and E2/P in the observation group [(515.31±56.36)pmol/L, (53.71±8.34)pmol/L, (13.23±5.23)] were higher than those in the control group[(352.35±78.43)pmol/L, (33.13±4.13)pmol/L, (8.17±2.91)] (t=7.334, 4.251, 3.241, all P<0.05). The level of beta 3 in the observation group (0.163±0.013) was significantly lower than that in the control group (0.253±0.031) (t=4.342, P<0.05). The thickness of endometrium in the observation group [(9.12±2.03)mm] was significantly thinner than that in the control group [(12.24±2.45)mm] (t=3.226, P<0.05).@*Conclusion@#The expression of integrin β3 in the endometrial implantation window of patients with cesarean section scar infertility has a certain influence on endometrial receptivity.
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BACKGROUND: The formation of long-term memory includes acquisition, consolidation and reconsolidation. Reconsolidation is very important for the new memory transforming into stable memory. Stress is an important environmental factor in the process of learning and memory. Corticosterone is very important for stress response. At present, research about the impact of corticosterone on reconsolidation of novel object recognition memory is less. Thus, it is very important to test the impact of corticosterone on reconsolidation of novel object recognition memory in rats. OBJECTIVE: To analyze the effects of corticosterone on the reconsolidation of novel object recognition memory in rats. METHODS: (1) The rats were intraperitoneal y injected with corticosterone (0.1, 1 and 3 mg/kg) immediately after reactivation. The discrimination index was used to assess memory performance and calculated as the difference in time exploring the novel and familiar objects. (2) The rats were intraperitoneal y injected with corticosterone (3 mg/kg) 6 hours after reactivation. The discrimination index was used to assess memory performance and calculated as the difference in time exploring the novel and familiar objects. (3) The rats were intraperitoneal y injected with corticosterone 3 mg/kg without reactivation. The discrimination index was used to assess memory performance and calculated as the difference in time exploring the novel and familiar objects. RESULTS AND CONCLUSION: Immediate injection of corticosterone 3 mg/kg after reactivation significantly decreased the discrimination index. At 6 hours after reactivation or without reactivation, corticosterone administration did not impact the discrimination index. These results confirmed that corticosterone administration immediately after reactivation impairs the reconsolidation of novel object recognition memory. The damage effect depends on the reactivation experience and the specific time window after reactivation.
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Objective:This paper aims to investigate the awareness and demand for medical liability insurance of doctors, and to provide policy recommendations for the further development of medical liability insurance in China. Method:A stratified random sampling survey is conducted on doctors from a Top3 general hospital in Guangzhou, and the relevant departments and individual doctors were interviewed. Results:The higher the risk in a department, the higher their awareness of medical liability insurance becomes;the longer the length of service for a doctor, the more understanding of medical liability insurance the doctor has. Medical liability insurance is generally supported by doc-tors with a strong willingness of demand, but they opinions on bearing and sharing the insurance premium are quite different. Discussion:Doctors still lack sufficient knowledge of medical liability insurance due to the lack of effective publicity. The structural mode of medical liability insurance is still relatively vague, and the government leadership and market operation ability have a serious shortage. Suggestion:This paper suggest to improve the relevant laws and regulations of medical liability insurance, to strengthen government supervision and publicity, to build a reasonable development model of medical liability insurance in line with the national circumstances, and to strengthen an effec-tive combination of government leadership and market operation.
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Objective To investigate the effect of the complementary matching character teaching model in clinical infectious department nursing teaching and improve the effect of nursing teaching. Methods 164 student nurses in our hospital from June 2010 to May 2011 were selected and they were randomly divided into the experimental group(37 nurses) and the control group(127 nurses). Besides, the experimental group was divided into introverts (60 nurses) and extroverts (70 nurses) according to the 16 personality factor test scale. The traditional nursing teaching mode was adopted in the control group while in the experimental group complementary matching character teaching model was applied, including four groups: outgoing teachers for introverted students, outgoing teachers for outgoing students, introverted teachers for outgoing students and introverted teachers for introverted students. After two months of training, all the nurses were requested to take a closed book examination and the data of the examination scores and the students' evaluation were analyzed as the teaching effect evaluation by using SPSS 19.0 and the counting data by χ2 inspection, the measurement data by single factor analysis of variance and the test level of α=0.05(bilateral). Results The final evalua-tion results of control group and the group of introverted teacher for introverted students are significantly lower than those of other groups ( P<0 . 05 ) . Conclusion The complementary matching character teaching method has more advantages than the traditional one, but the matching of introverted teacher and introverted students should be avoided. The interaction of teachers and students should be given full play to improve the quality of practice nurse teaching.
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Objective To know about the students'wills on the reform in the practical teachings.Methods Sample survey and the relevant analysis were made by the grades of students.Results The main factors to influence students'attitude in learning were as the following order:personal interests,the way of teachings,the importance of the content in teachings,the students asking for more cases,information and topic contents as well as the additional practical teachings such as outdoor visits,situational simulation and community survey,with the low evaluation on social practice and internship.Conclusion Reform in practical teachings should be implemented to meet the various needs to develop pragmatic capacity for the students in different grades.
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Due to the limit of large number of students,the traditional teaching mode of lecture in morality and politics theory simply emphasizes teaching lectures in theory and basic knowledge,while ignores the connection between theory and practice.This paper holds that only by creating a novel teaching mode which integrates lecture teaching and multiple chains of practice teaching,together with the mechanism guarantee,can an effective teaching be realized.
