Volume 99 ·  Issue 25 ·  2019

In the case of physiological homeostasis, intestinal microbiota and intestinal tract coexist mutually, showing a symbiotic mode, which promotes the health of the organism. However, the intestinal microecology of critically ill patients is destroyed, the probiotic flora is reduced, and the harmful flora is increased. Intestinal microorganisms change their phenotype and virulence by sensing various bad signals produced by intestinal stress, and change from symbiotic mode to pathogenic mode, causing damage to the body. We should pay attention to and strengthen the awareness of this phenomenon, and protect the intestinal symbiotic microbiota as much as possible.

Acute kidney injury (AKI) is defined as a sharp decrease in renal function, manifested by a sudden decrease in glomerular filtration rate (GFR). This article discusses the bedside assessment of renal perfusion in patients with AKI in order to guide clinical practice.

Imaging markers of cerebral small vessel disease include recent small subcortical infarction, vascular lacunae, vascular white matter hyperintensity, perivascular space and cerebral microhemorrhage, etc. Its spatial distribution characteristics of radiology and disease burden have clinical guiding significance for etiological mechanism identification, prognosis evaluation and prevention and treatment decision-making.

With the development of critical nutrition in continuous practice and deepening understanding, nowadays, it no longer focuses on improving nutritional indicators and clinical prognosis through the evaluation of nutritional metabolism and nutritional supplement, nor is it any longer determined by a certain nutritional therapeutic element to the prognosis influence. Instead, it is more based on the purpose of in-depth understanding the metabolic characteristics and change mechanisms before and after the strike of serious diseases, more true, objective and accurate evaluation and judgment, realizing personalized nutritional treatment strategies, and finally changing the clinical outcome of critical illness.

The cultivation of clinical thinking of critical care physicians is inseparable from scientific, rigorous thinking and keen insight and judgment in complex environments. This article discusses how to cultivate the ability of critical care physicians to accurately obtain data in critical care treatment, the ability to accurately diagnose based on data, strengthen the core concept of critical care treatment of goal-oriented treatment, clarify that etiological treatment is an important part of the treatment of critical patients, and cultivate critical care physicians with good humanistic qualities.

In recent years, the treatment of local complications of acute pancreatitis has become increasingly mature, and the minimally invasive stepped drainage model has been widely accepted by people. This article will standardize the definition of local complications in different stages of acute pancreatitis combined with the current practice evidence, and make a specific elaboration on its intervention indications and timing.

Extracorporeal membrane oxygenation (ECMO), also known as extracorporeal life support (ECLS) technology, can quickly provide stable hemodynamic support for patients with acute respiratory and/or circulatory failure and successfully save the lives of some critically ill patients. However, the condition of ECMO treatment subjects is extremely critical, and the technology itself is highly invasive, highly consumable and highly professional. Therefore, how to make more critically ill patients benefit from ECMO assistance and make full use of ECMO technology should be the opportunity and challenge that every ECMO practitioner should face.

Multidrug-resistant bacteria (MDRO) infections pose an increasing threat to critically ill patients. Relevant WHO prevention and control guidelines point out that infection control measures such as hand hygiene, active screening, contact isolation, etc. can block the spread of MDRO, and antimicrobial drug management is an important tool to reduce the occurrence of MDRO. This paper analyzes the gap between the recommendations of the guidelines and the specific implementation of infection control measures in ICU, in order to promote the implementation of infection control measures in ICU and further reduce the incidence of MDRO-related infection in ICU.

Pulmonary edema is one of the common complications in hospitalized patients, which can prolong the hospital stay, increase the hospitalization cost and the mortality rate. Cardiogenic pulmonary edema is mainly caused by increased pulmonary capillary hydrostatic pressure, while non-cardiogenic pulmonary edema is mainly caused by increased pulmonary capillary permeability. This article will explore the treatment strategies of different types of pulmonary edema by explaining the mechanism of formation and clearance of pulmonary edema.

To explore the application of adaptive statistical iterative reconstruction Veo (ASIR-V) and 80 kV in renal computed tomography angiography(CTA).

Eighty patients with renal computed tomography angiography were prospectively collected from April 2018 to July 2018 in the Affiliated Hospital of Shaanxi University of Chinese Medicine and randomly divided into group A and group B. The patients in group A adopted tube voltage 120 kV and contrast agent concentration 600 mgI/kg and reconstructed with filtered back projection (FBP), while the patients in group B were scanned with tube voltage 80 kV and contrast agent concentration 350 mgI/kg and reconstructed with FBP and ASIR-V from 10% to 100% with 10% interval. The CT values and standard deviation (SD) of the right renal artery, left renal artery were measured respectively to calculate the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR).The image quality of renal CTA was subjectively scored by two experienced radiologists blindly using a 5-point criteria.The contrast agent,CT volume dose index(CTDI_vol) and dose length product(DLP) in both groups were recorded and the effective radiation dose(ED) was calculated.

The ED ((2.11±0.19)mSv) and contrast agent ((21.9±3.0)g) in group B were 65.1% (P<0.05) and 42.2% (P<0.05) lower than those in group A ((6.04±1.89)mSv and (38.0±3.8)g).With the increase of ASIR-V percentage in group B, CT values showed no significant difference, SD values gradually decreased, SNR values and CNR values gradually increased.The CT values with different reconstruction algorithm showed no statistically significant difference (all P>0.05) between group A and group B. The SD values with 40%ASIR-V to 100%ASIR-V reconstruction in group B were significantly lower than those of group A (all P<0.05).The SNR values with 50% ASIR-V to 100% ASIR-V reconstruction and CNR values with 70%ASIR-V to 100%ASIR-V were significantly higher than those of group A(all P<0.5).Two radiologists had excellent consistency in subjective scores of image quality for renal CTA(all kappa>0.75,P<0.05). The subjective scores with 60% ASIR-V to 90% ASIR-V in group B were significantly higher than those in group A (P<0.05), of which 70%ASIR-V reconstruction achieved the highest subjective score for renal CTA.

ASIR-V and 80 kV can significantly reduce radiation dose (about 65.1%) and contrast agent (about 42.2%) in renal CTA, ASIR-V reconstruction can significantly improve the image quality of renal CTA, of which 70% ASIR-V reconstruction achieved the best image quality in 80 kV renal CTA.

To investigate the prognostic values of IDH, TERT and 1p/19q in patients with anaplastic oligodendroglioma.

In the study, 66 patients with pathological diagnosis of anaplastic oligodendroglioma were enrolled (The First Affiliated Hospital of Zhengzhou University 2011 to 2016 years). Kaplan-Meier method was used to calculate the survival rates. Log-rank was used to calculate the differences in group. Chi-square testwas used tocalculate the differences in common factor group. Cox regression model was used to conduct multivariate analysis.

The median survival time of IDH-wt and IDH-mt subgroups were 16.10 and 42.00 months with statistical significance (P=0.001). The median survival time of 1p/19q codeleted and 1p/19q noncodeleted subgroups were 42.00 and 22.40 months with statistical significance (P=0.012). IDH-mt and 1p/19q codeleted predicted better survivals compared with IDH-wt and 1p/19q noncodeleted (P=0.001). And IDH-mt and 1p/19q noncodeleted predicted better survivals compared with IDH-wt and 1p/19q noncodeleted (P=0.041), too. Multivariate survival analysis demonstrated that Molecular groups was an independent factor to evaluate the prognosis of anaplastic oligodendroglioma (P=0.008).

IDH-mtand (or) 1p/19q codeletedpredicted better survivals in patients with anaplastic oligodendroglioma. IDH and 1p/19q deleted might be a biomarker for predicting prognosis of patients with anaplastic oligodendroglioma.

To investigate the cinical value of FAM19A4promoter methylation in cervicalexfoliated cells for triage of cervical cancer.

A total of 162 high-risk HPV-infected patients who were pathologically confirmed as different cervical lesions from August 2017 to December 2017 were collected in Guangdong Women and Children Hospital. Taqman probe-based quantitative PCR (qPCR) was used to detect the methylation of FAM19A4 promoterin different grades of cervical lesions, and the value of FAM19A4 methylation in predicting cervical HSIL and the above lesions was calculated by diagnostic test.

(1)The positive rates of FAM19A4 methylation in cervical exfoliated cells increased with the severity of cervical lesions, which were 7.69% (4/52) , 34.62% (9/26) , 55.56% (20/36) , 95.83% (46/48) in normal cervix/cervicitis, cervical LSIL, HSIL, and cervical cancer, respectively(P<0.05).(2)There was no significant difference in the detection rates of FAM19A4 methylation between different age groups, pathological types, clinical stage, tumor size and lymph node metastasis status (P>0.05). (3) The specificity and positive predictive value of FAM19A4 methylation in detecting cervical HSIL alone and ≥HSIL lesions were the optimal, with the AUC of 0.69 and 0.84, respectively. When combined with HPV16/18 genotyping, the sensitivity was significantly improved.

The detection of FAM19A4 promoter methylation in cervical exfoliated cells has a high clinical value of discriminating ≥HSIL lesions; and the cotest of methylated FAM19A4 and HPV16/18 genotyping can identify ≥HSIL lesions more sensitively.

To explore the factors influencing incision healing time in postoperative patients with spinal canal tumors.

The clinical data of 116 patients with spinal canal tumors (60 males and 56 females, with an average age of 44±16 years) in neurosurgery department of Henan People′s Hospital from December 2017 to February 2019 were retrospectively analyzed. The influencing factors of incision healing time were analyzed by Logistic regression.

Univariate analysis showed that limb muscle strength (P=0.011), the location of tumors (P=0.031), indwelling catheters (P=0.029), spinal neural function (P=0.000), Types of spinal canal tumors (P=0.006) , Diabetes (P=0.043) ,BMI (P=0.001) , Length of surgical incision (P=0.006) ,Cerebrospinal fluid leakage (P=0.001) , the operation duration (P=0.002) presented statistical significance; Logistic regression analysis showed that there were significant differences in Types of spinal canal tumors (P=0.038) , Length of surgical incision (P=0.000) , Cerebrospinal fluid leakage (P=0.004) , spinal neural function (P=0.002) and the operation duration (P=0.046).

Extremity muscle strength, the location of tumors, indwelling catheters, the operation duration, spinal neural function, Types of spinal canal tumors, Diabetes, BMI, Length of surgical incision, Cerebrospinal fluid leakage were influencing factors of incision healing time in postoperative patients with spinal canal tumors; Among which Types of spinal canal tumors, Length of surgical incision, Cerebrospinal fluid leakage, Spinal neural function and The operation duration were independent influencing factors.

To investigate the effect of birth ball on the outcome of COOK balloon induction.

A total of 580 patients were hospitalized in the obstetrics department of Jiaxing Maternal and Child Health Hospital from May 1, 2017 to December 31, 2017. According to the patient′s wishes, 290 cases of cervical ripening with birth ball combined with COOK balloon were taken as experimental group, and 290 cases of cervical ripening group with COOK balloon were set as control group. Bishop score improvement, labor time, cesarean section rate, delivery forceps rate, postpartum hemorrhage, and neonatal scores were compared between the two groups of patients.

(1)There was no significant difference in the ag, Body Mass Index (BMI), education background, registered residence and gravidity between the two groups (P>0.05). (2)There was no significant difference in Bishop score improvement between the two groups (P>0.05). (3)The labor time in the experimental group (8.4 h±1.5 h)was significantly shorter than that in the control group (10.6 h±2.7 h). The differences were statistically significant (P<0.05). The cesarean section rate (11.03% vs 15.17%), forceps delivery rate (5.52% vs 8.28%), and postpartum hemorrhage (308 ml±9 ml vs 367 ml±16 ml) were significantly lower in the experimental group than in the control group. The differences were statistically significant (P<0.05).

The application of the birth ball in the induction of the COOK balloon can shorten the labor time, reduce the cesarean section rate and the forceps delivery rate, and reduce the postpartum hemorrhage, which has certain clinical application value.

Investigate the causes of poor prognosis of mechanical thrombectomy in the time window of acute ischemic stroke (AIS) with anterior circulation.

A retrospective analysis was made on the data of 78 patients with anterior circulation AIS who underwent mechanical thrombectomy in the time window from January 2017 to December 2017 in the Department of Vascular Neurosurgery of Liaocheng Brain Hospital. The modified Rankin scale (mRS) was used to evaluate the prognosis of the patients 3 months after operation. According to the prognosis,the patients were divided into the group with good prognosis (42 cases, mRS<2 points) and the group with poor prognosis (36 cases, mRS<3 points). Univariate and multivariate Logistic regression analysis was used to analyze the related factors of poor prognosis.

(1) Univariate analysis showed that the prognosis of patients with good combination and primary stenosis of diabetes mellitus and atherosclerosis was lower than that of patients with poor prognosis (P<0.05). The collateral circulation compensation rate and vascular recanalization rate of patients with good prognosis were higher than those of patients with poor prognosis (P<0.05). Learning significance (P<0.05). (2) Multivariate analysis showed that diabetes mellitus (P=0.035), collateral circulation compensation (P=0.011) and primary atherosclerotic stenosis (P=0.042) were independent risk factors for poor prognosis.

Perfect preoperative evaluation and strict screening of patients, good collateral circulation compensation,individualized treatment for patients with primary atherosclerotic stenosis,and strict control of postoperative hyperglycemia can improve the clinical prognosis of endovascular therapy.

To investigate serum status of folate, vitamin B₁₂, homocysteine (Hcy) and hydroxyvitamin D (25OHD) and their trends in different gender and age groups.

This was a cross-sectional study. The enrolled subjects were those received medical examination in Beijing Hospital from September to November 2018 and were identified as appeared healthy persons. 1220 subjects were recruited and were divided into groups of young and middle age group (30-49 years, 50-59 years) and the elderly group (60-69 years, 70-79 years and ≥80 years). We measured folate, vitamin B₁₂, and 25OHD using electrochemiluminescence by chemiluminescence immunoassay. Hcy was measured by autobiochemical analyzer.

Total folate levels in male and female subjects were 7.16 (4.74-10.75) and 9.17 (6.49-13.55) μg/L respectively. Total vitamin B ₁₂ levels in the male and female were 505.60 (386.80-700.90) and 582.60 (430.70-846.98) ng/L respectively. Hcy levels were 14.68 (12.25-18.58) and 11.29 (9.65-13.58) μmol/L. 25OHD levels were 21.60 (16.40-28.70) and 16.80 (12.30-24.15) μg/L respectively. Total folate and vitamin B ₁₂ levels in female were higher than that in male subjects (Z=-7.796, -4.772, P<0.001). However, total Hcy and 25OHD levels in male were higher than that in female subjects (Z=-15.230, -8.447, P<0.001). Comparing with the substances in the above age groups, folate level in the elderly was lower than that in the younger age and middle age groups.However, vitamin B₁₂, 25OHD and Hcy levels were higher in the elderly groups. Furthermore, the levels of folate, vitamin B₁₂ and 25OHD were getting higher in the group of ≥80 years female compared with the rest of the age groups, but it turned lower in the male group of ≥80 years.

There are some differences in the serum values of folate, vitamin B₁₂, Hcy and 25OHD among various age groups as well as between males and females. These should be considered in the development of national reference ranges.

To discuss the clinical features, diagnosis, therapy and prognosis of anti-GABA _B receptor encephalitis.

Clinical data of patients with anti-gaba B receptor encephalitis admitted to the department of neurology of the second hospital of hebei medical university from April 2016 to February 2018 were collected and retrospectively analyzed.

Eight patients with anti-GABA _B receptor encephalitis were included. All the eight cases presented with epileptic seizures. The initial symptoms were clinical seizures in six cases, memory deficit in one case, mental and behavior disorder in one case. Cerebrospinal fluid (CSF) test indicated high intracranial pressure in four patients, increased protein in two patients and lymphocytosis in four patients. Long-term electroencephalogram (EEG) showed abnormal in all patients. Brain MRI showed limbic system lesions in four patients. The anti-GABA _B receptor antibody was positive in both serum and CSF in all patients. Four patients had small cell lung cancer. All the eight patients received immunotherapy and symptoms were improved. After 6-24 months' follow-up, 1 patient recovered completely, and in the remaining 7 patients, mild symptoms were left behind.

The anti-GABA _B receptor encephalitis is characterized by refractory epilepsy. Epilepsy is the most common initial symptom. About 50% patients are accompanied by tumors. Anti-GABA _B receptor antibodies testing and tumor screening should be actively carried out.

Two cases of Listeria infection in the central nervous system confirmed by second-generation sequencing of cerebrospinal fluid were reported, which revealed the important role of second-generation sequencing technology in the diagnosis of Listeria meningitis and improved clinicians' understanding of Listeria infection in the central nervous system.

The prevalence of BPH in benign prostatic hyperplasia exceeds 50% in men over 50 years old and 90% in men over 80 years old. Severe symptoms can cause acute urinary retention, repeated urinary tract infection and renal function damage, and lose the opportunity of surgical treatment. This patient was a 77-year-old male, mainly due to frequent urination and urgency for more than 5 years, which was aggravated and retained with a catheter for 1 month. Urology considered ureteral obstruction and renal function impairment caused by benign prostatic hyperplasia (BPH). There was no indication for surgical treatment. Left nephrostomy was recommended, but the patient strongly refused. Transcatheter superselective prostatic artery embolization was performed.

Digital subtraction angiography has been widely used in the diagnosis and treatment of cerebrovascular diseases. iohexol is one of the most commonly used nonionic contrast agents. Its main adverse reactions include contrast agent nephropathy, allergic reaction, vagal reflex, arrhythmia, etc. It is generally believed that the occurrence of adverse neurological reactions caused by contrast agents is rare. This article reports a case of contrast encephalopathy complicated by cerebral angiography.

Recyclable filters have been widely used in clinical practice. Most recyclable filters can be removed by conventional methods (snare method), but a few need special methods to remove them. For the failure of conventional removal methods, appropriate special removal methods should be selected according to the reasons for the failure of removal, and the surgeon should know the characteristics, indications, advantages and disadvantages of various removal methods.