目的 总结妊娠合并尿毒症患者血液透析的护理措施。 方法 回顾性分析2001年3月－2012年6月收治的15例妊娠合并尿毒症患者行血液透析的临床资料。患者年龄平均30.5岁；2例为早期妊娠，孕13周，其中1例伴有尿毒症急性发作，其余均为中晚期妊娠，孕24+周，均血清肌酐＞445 μmol/L（5 mg/dL），尿氮素＞20 mmol/L。15例患者入院后即刻行血液透析治疗，治疗过程中进行必要的心理干预，在透析前、中、后护理中，密切观察患者心理状况，孕妇各项生命体征及胎儿胎心胎动等，择期终止妊娠。 结果 9例经维持性血液透析治疗后，病情稳定，顺利产下胎儿；另外3例患者经血液透析治疗后病情稳定，其中1例产下一死婴，另2例行人工钳取术终止妊娠；还有3例患者由于经济条件限制而中途退出治疗。 结论 适时的干预和加强妊娠合并尿毒症患者血液透析的护理，可取得很好的治疗效果，有可能改变妊娠的结果。
目的:探讨肾上腺嗜铬细胞瘤的诊治方法。方法:回顾性分析我院1995年10月～2008年10月收治37例肾上腺嗜铬细胞瘤的临床资料,总结其主要临床表现、手术方法及围手术期血压的控制方法。结果:37例患者均行手术治疗,其中35例术后血压恢复正常,2例术后血压未降至正常水平。结论:肾上腺嗜铬细胞瘤的诊断主要依靠多种内分泌激素的测定及B超、CT的定位检查,确诊依赖于病理检查,手术切除是有效的治疗方法。术前的降压、扩容和术后的补液升压等围手术期的处理是手术治疗成功的关键。
Objective To establish a method for quality control of Astragalus Radix and Scutellariae Radix in Biqiaotong granules and provide basis for the establishment of quality standard. Methods The single-factor test method was used to investigate the factors of thin layer chromatography (TLC) conditions, including different extract method and solvents, developing system, comogemc agents, temperature, humidity, drawing amounts and thin layer boards, and to screen the best TLC conditions of Astragalus Radix and Scutellariae Radix . Results The TLC conditions of Astragalus Radix were used trichloromethane-methanel-water (13:7:2) as developing solvent, separated on silica gel G, heatd under 105℃ until the spots bacame clear. The TLC conditions of Scutellariae Radix were used methylbenzene-ethy acetate- formic acid-methanel (9:3:2:2) as developing solvent, separated on silica gel G, observed after 30 minutes under daylight until the spots were clear. Conclusions The spot features are clear, and with good separating degree, strong specificity, and good repeatability without the inference of negative control. The TLC method is simple, sensitive and accurate, which can be adopted for the quality control of Biqiaotong granules.
ObjectiveTo investigate the effect of timing of removal of drainage tube on complications after radical thyroidectomy by da Vinci robot.MethodsThree hundred and fifteen patients with thyroid cancer treated by da Vinci robot from July 2014 to December 2018 in our department were reviewed. The patients were divided into two groups according to the amount of drainage fluid at extubation: observation group (99 cases) and control group (216 cases). The extubation indication: in the observation group, the drainage volume was less than 20 mL for 24 hours in two days; in the control group, according to most clinical concepts, the drainage volume was less than 10 mL for 24 hours in two days. The infection rate of wound and tunnel, the incidence of hematoma, wound healing, the time of drainage tube removal and the time of hospitalization were observed.ResultsThere were no significant difference in infection rate, hematoma incidence and wound healing rate between the observation group and the control group (P>0.05). The postoperative extubation time and hospitalization time in the observation group was significantly shorter than that in the control group (P<0.05).ConclusionsAfter the radical operation of thyroid cancer by Leonardo da Vinci robot, taking the amount of wound drainage fluid less than 20 mL/24 hours for 2 days as the time of extubation does not increase the incidence of complications, but it can significantly shorten the time of extubation and hospitalization of patients, which can be widely used in clinical practice.
ObjectiveTo review the research progress of adrenergic β-antagonists on wounds and diabetic chronic cutaneous ulcers healing in recent years, and to investigate its application prospect in diabetic foot ulcer (DFU).MethodsThe latest literature about the role of adrenergic β-antagonists in wounds and diabetic chronic cutaneous ulcers healing was extensively reviewed, and the mechanisms of adrenergic β-antagonists for wounds and its potential benefit for DFU were analyzed thoroughly.ResultsThe adrenergic β-antagonists can accelerate the wound healing. The possible mechanisms include accelerating re-epithelialization, promoting angiogenesis, improving neuropathy, and regulating inflammation and growth factors, etc. At present clinical research data showed that the adrenergic β-antagonists may be an adjuvant treatment for diabetic chronic cutaneous ulcers.ConclusionAdrenergic β-antagonists maybe promote the healing of wounds and diabetic chronic cutaneous ulcers. However, more long-term follow-up and high-quality randomized control studies are needed to further verify their efficacy and safety for DFU.
Objective To summarize the clinical features and prognosis of extensively drug-resistant Acinetobacter baumannii (XDRAB) bacteremia. Methods This retrospective study included patients with Acinetobacter baumannii bacteremia diagnosed and treated in RICU of this hospital during January 1, 2012 and December 31, 2015. Demographic features, clinical data, clinical outcome within 3 days and 14 days after sample collection for blood culture were collected. Results Eight patients were included, with the mean age of (62.4±18.0) years, and including 3 males and 5 females. All patients had underlying diseases, 6 patients were immune suppressed, 7 patients had been exposed to β-lactam/enzyme inhibition or carbapenems for at least 7 days within 2 weeks before blood sample collection, and 6 patients received mechanical ventilation. Lung is the main pathogen source (6 cases). Within 48 hours after blood collection, the mean acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score was 28.3±7.5, the level of serum C-reactive protein (18.2 to 231.0 mg/L) and procalcitonin (0.1 to 25.0 ng/ml) had individual differences. The 3-day mortality rate was 4/8, the death group had APACHEⅡ >25. The 14-day mortality rate was 6/8, all the patients with procalcitionin>0.5 ng/ml died. Conclusions The 14-Day mortality is associated with the severity and increased procalcitionin in XDRAB patients. Preemptive therapy is recommend for patients with multiple risk factors, receiving mechanical ventilation, and with elevated procalcitonin and high APACHEⅡ score ( >25).
ObjectiveBy detecting the expression of the long non-coding RNA metastasis associated lung adenocarcinoma transcript 1 (MALAT1) in myocardial tissue under different hypoxia patterns, to explore the possible mechanism of obstructive sleep apnea (OSA)-induced cardiovascular diseases.MethodsSD rats were randomly and equally divided into 4 groups namely a normal (N) group, a continuous hypoxia (CH) group, an intermittent hypoxia (IH) group and an intermittent hypoxia with hypercapnia (IHH) group, and were treated for 1, 2, and 3 weeks. The expression of MALAT1 and associated immune factors of the myocardial tissue were examined by qRT-PCR.ResultsAn elevation without significance was observed in those three hypoxia groups in contrast with N group after 1 week’s treatment. However, in 2 and 3 weeks’ groups, the mRNA expression of MALAT1 was significantly higher in IHH group than the other three groups (all P<0.01), while there was no significant difference among IH, CH or N groups despite an increasing tendency in IH and CH groups against N group were observed. Additionally, the expressions of hypoxia inducible factor-1α (P<0.05), Toll-like receptor 4 (P<0.01) and interleukin-6 (P<0.05) mRNA were also increased significantly in IHH group compared with IH, CH and IHH groups in 3 weeks’ treatment respectively, which were coordinated with the change of MALAT1 mRNA.ConclusionsThe expression of MALAT1 in myocardial tissue is elevated by intermittent hypoxia with hypercapnia, and the tendency is similar with hypoxia-induced inflammation factors. These findings indicate that MALAT1 is probably a regulatory factor of OSA induced myocardial immune injury.
ObjectiveTo perform a meta-analysis on the positive rate of hepatitis C virus (HCV) antibody among pregnant females in China from 2008 to 2018, so as to provide scientific references for the prevention and treatment of HCV infection among pregnant females.MethodsDatabases including PubMed, Web of Science, SinoMed, CNKI, VIP, and WanFang Data were electronically searched to collect observational studies on the positive rate of HCV antibody among pregnant females in China from January, 2008 to December, 2018. Two reviewers independently screened literature, extracted data and evaluated risk of bias of included studies. Meta-analysis was then performed using Stata 15.0 software.ResultsA total of 108 studies involving 657 765 individuals were included. Results of meta-analysis showed that the overall positive rate of HCV antibody among pregnant females in Chinese was 0.235% (95%CI 0.189% to 0.286%). Subgroup analysis showed that the positive rate of HCV antibody among pregnant females in western China to be the highest 0.291% (95%CI 0.221% to 0.378%), the northeast China to be 0.240% (95%CI 0.099% to 0.442%), the central China to be 0.235% (95%CI 0.016% to 0.319%), and the east China to be the lowest 0.193 % (95%CI 0.119% to 0.281%). The HCV antibody positive rate of pregnant females from hospital was 0.291% (95%CI 0.221% to 0.372%) and was higher than that from AIDS surveillance site which was 0.164% (95%CI 0.122% to 0.207%).ConclusionsThe prevalence of HCV antibody among pregnant females maintains at a low level in China.
Objective To explore the characteristics of parenting styles of female patients with anorexia nervosa (AN) and bulimia nervosa (BN), to and provide a reference for the clinical treatment of eating disorders. Methods Patients with AN and BN between November 2019 and May 2020 in the Centre for Mental Health, West China Hospital, Sichuan University were retrospectively included. Female teachers and students from Sichuan University were used as normal controls. The general conditions of the subjects in the three groups were collected, and the parenting styles and behaviors of the subjects in the three groups were evaluated using Egna Minnen av Barndoms Uppfostran (Parenting Style Evaluation Scale). Results Finally, 30 subjects were included in the AN group, 44 subjects were included in the BN group, and 33 subjects were included in the healthy control group. There was no significant difference in the course of disease between the AN group and the BN group (P>0.05). There were no significant differences in age, place of residence, education level, parental divorce, parental education level and parental occupation among the three groups (P>0.05). The body mass index of the AN group was lower than that of the BN group and the healthy control group (P<0.05). The parenting style evaluation scale scores showed that in terms of father scores, there was no significant difference in the excessive interference dimension scores among the three groups (P>0.05). The score of preference dimension in AN group (14.60±4.45 vs. 10.18±5.98 vs. 10.36±5.90) was higher than that in BN group and healthy control group, the score of emotional warmth and understanding dimension in BN group (50.55±11.81 vs. 55.33±9.12 vs. 57.03±6.13) was lower than that in the AN group and the healthy control group, and the scores of rejection and denial dimension (7.91±3.65 vs. 10.10±3.85 vs. 10.16±3.83) and overprotection dimension (11.76±2.82 vs. 14.10±3.16 vs. 13.25±2.97) in healthy control group were lower than those of AN group and BN group (P<0.05). In terms of mother scores, the scores of preference dimension (14.40±4.64 vs. 10.59±5.92 vs. 10.94±5.34) in AN group was higher than that in the BN group and the healthy control group, and the scores of emotional warmth and understanding dimension (58.06±7.05 vs. 51.40±11.79 vs. 52.91±11.57) in healthy control group was higher than that in AN group and BN group (P<0.05). Conclusion Compared with healthy controls, the parenting styles of female patients with eating disorders show more negative emotions such as rejection and denial. The parenting styles of female BN patients show more negative emotions than female AN patients. These all suggest that the parenting style, attitude and behavior may be the influencing factors of female AN and BN.
Objective To evaluate the value of Epworth sleepiness scale ( ESS) in evaluating the severity of obstructive sleep apnea hypopnea syndrome ( OSAHS) . Methods A total of 340 cases with suspected OSAHS were enrolled. The ESS scores and polysomnography ( PSG) monitoring data were analyzed. According to the PSG monitoring results the patients were classified into non-OSAHS, mild, moderate and severe OSAHS groups. The average ESS scores and the ratio of patients whose ESS score was ≥9 were compared among the four groups. The diagnostic value of ESS score was evaluated by ROC curve. The correlation of ESS scores with age, apnea hypopnea index ( AHI) , the lowest SpO2( LSpO2 ) and microarousal index was analyzed. Results The ESS scores had an ascending tendency as the severity of OSAHS was increased but only in the severe OSAHS cases the difference was significant statistically compared with the other three groups ( P lt; 0. 05) . The mean ESS scores in the four groups were 9. 96 ± 4. 81,10. 21 ±5. 48, 11. 48 ±5. 28 and 13. 52 ±5. 84, respectively. There was no statistical significance while comparing the ratio of patients whose ESS scores were ≥9 among the four groups. The analysis of ROC curve showed the area under the ROC curve ( AUC) was lesser( 0. 601) and a best cutoff could not be obtained. When ESS score ≥9 was made as the cutoff in screening OSAHS patients the sensitivity was 70. 0% and the misdiagnosis rate was 63. 21% . The ESS scores had positive correlation with the apnea hypopnea index ( AHI)( r =0. 240, P lt; 0. 01) and negative correlation with LSpO2 ( r = - 0. 198, P lt;0. 01) . The ESSscores had no correlation with age or the microarousal index ( P gt; 0. 05) . Conclusions The ESS score has some significance in screening severe OSAHS patients but can not exactly reflect the severity of OSAHS patients among Chinese population, suggesting ESS score has limited value in the evaluation of OSAHS severity. The ESS score ≥9 as a cutoff is not a reliable parameter to estimate the severity of OSAHS. A more effective scoring system need to be established for better screening of OSAHS patients.