ObjectiveTo study and analyze the clinical characteristics, treatment and prognosis of chronic kidney disease (CKD) patients with tuberculosis.MethodsThe cases of CKD with tuberculosis treated in respiratory department, nephrology department and infection department of the Affiliated Hospital of Southwest Medical University during January 2014 to December 2018 and followed up for at least half a year were collected as the study subjects. The clinical characteristics of CKD patients with tuberculosis and to observe the treatment, prognosis and adverse reactions were analyzed.ResultsA total of 74 patients were enrolled in the analysis, including 51 males (68.91%) and 23 females (31.08%), and with a mean age of (52.1±15.5) years. The use rate of immunosuppress drug in CKD G1\G2\G3 stage was very high (100%, 100%, 70%, respectively), and patients in G5 stage had the highest TB infection by 49 cases. There were 58 cases of pulmonary tuberculosis, which was the main form of tuberculosis. Extrapulmonary tuberculosis was very common too, and there were 40 cases including 29 cases of lymph node tuberculosis. Among 53 cases of acid fast bacilli smear, 8 cases were positive; lung biopsy positive in 1; lymph node biopsy was positive in 5 cases; 53 cases were initially treated and 21 cases were retreated. The main symptoms of 74 patients were emaciation (33 cases), fever (30 cases), and fatigue (25 cases); the common symptoms of 58 patients with pulmonary tuberculosis were cough and expectoration (41 cases). Pulmonary tuberculosis mainly infected the upper field of lung (39 cases). The most common imaging features was patchy shadow in 17 cases, followed by single or multiple nodules in 15 cases. The number of cases with lymph node enlargement in drainage area, pleural effusion, and pleural thickening were 36, 34 and 24, respectively. The sensitivity of tuberculosis interferon-gamma release assays (TB-IGRA), tuberculosis polymerase chain reaction (TB-PCR) and Mycobacterium tuberculosis protein chip was 79.6%, 18.8% and 61.7%, respectively. After tuberculosis treatments, 51 cases were successful, 14 cases failed, 5 cases died, and 4 cases could not be evaluated. Sixteen cases had serious and typical adverse reactions, including 12 cases of drug-induced liver injury, and 11 cases of treatment failure due to these serious adverse reactions.ConclusionsThe incidence rate of tuberculosis is high in CKD patients and the clinical manifestations are atypical. Pulmonary tuberculosis is the main form of tuberculosis, extrapulmonary tuberculosis is very common and mainly lymph node tuberculosis. The sensitivity of TB-IGRA, TB-PCR and Mycobacterium tuberculosis protein chip detection are lower than that of common patients. The success rate of tuberculosis treatment in CKD patients is low, the adverse reaction rate is high, and the adverse reactions are the main causes of treatment failure.
Objective To explore the postoperative satisfaction of patients with lumbar disc herniation after enhanced recovery after surgery and its related factors. Methods A total of 102 patients with lumbar disc herniation were selected and analyzed by convenient sampling method from September 2016 to June 2017. The patients’ general information, functional status [using the Oswestry Disability Index (ODI) to investigate the preoperative, postoperative and post-discharge ODI] and patients’ satisfaction (1 month after the discharge) were collected. Results A total of 102 patients, including 62 males and 40 females, aged from 14 to 82 years with an average of (43.8±14.4) years were included in the study.The mean length of hospital stay was (6.61±2.49) days. The total score of patients’ satisfaction was 62.43±6.37, and the satisfaction degree was at the middle and high level. Postoperative and post-discharge ODIs were associated with patients’ satisfaction (rs=0.328, 0.452; P<0.05). Conclusions The postoperative satisfaction of patients with lumbar disc herniation after enhanced recovery after surgery should be further improved. The medical staff should pay attention to the recovery of postoperative function in order to improve the patients’ satisfaction.
Objective To evaluate the safety and necessity of shortening the time of preoperative fasting and fluid limitation in lumber disc herniation patients undergoing minimally invasive surgery. Methods A total of 141 eligible patients were assigned into the control group (n=70) and the intervention group (n=71) between April and September 2015. The control group received traditional fasting method while the intervention group received new preoperative fasting method. The time of fasting food and fluid limitation, the incidences of hunger, thirsty, aspiration, postoperative nausea and vomiting, postoperative abdominal distension, and length of stay and the subjective feeling in hospital were compared between the two groups. Results The average time of preoperative fasting and fluid limitation were (13.09±2.30) and (7.84±2.10) hours in the control group and (6.88±0.96) and (4.68±1.08) hours in the intervention group. The incidence of thirsty in the intervention group was shorter than that in the control group, and the subjective feeling in hospital of the intervention group was better than that in the control group (P<0.05). There were no significant differences in the incidence of postoperative nausea and vomiting, the incidence of postoperative abdominal distension, and length of hospital stay between the two groups (P>0.05). Conclusions Shortening the time of preoperative fasting and fluid limitation can improve the subjective feeling in hospital of lumber disc herniation patients undergoing minimally invasive surgery, not increasing the incidences of complications. It can be applied gradually.
ObjectiveTo analyze responsiveness of Chinese version of Neck Outcome Score (NOOS-C) and provide a reliable measure to assess intervention effect for patients with neck pain.MethodsCross-cultural adaptation of NOOS was performed according to the Beaton’s guidelines for cross-cultural adaptation of self-report measures. Eighty patients with neck pain were recruited between September 2016 and May 2017. Those patients were assessed using NOOS-C and Chinese version of Neck Disability Index (NDI) before and after intervention. And 71 patients completed those questionnaires. The statistic differences of the score of each subscale and the total scale before and after intervention were evaluated by paired-samples t test. Internal responsiveness was determined by effect size (ES) and standardized response mean (SRM) based on the calculated difference before and after intervention. External responsiveness was analyzed by Spearman correlation coefficient.ResultsThe differences in symptom subscale, sleep disturbance subscale, participating in everyday life subscale, every day activity and pain subscale, and the scale between before and after intervention were significant (P<0.05) except for mobility subscale (P>0.05). The difference of NDI-C before and after intervention was –12.11%±17.45%, ES was 0.77, and SRM was 0.69. The difference of NOOS-C before and after intervention was 13.74±17.22, ES was 0.83, and SRM was 0.80. Spearman correlation analysis revealed that the relativity about NOOS-C and NDI-C before and after intervention were both negative (r=–0.914, P=0.000; r=–0.872, P=0.000).ConclusionNOOS-C’s responsiveness is good.
ObjectiveTo summarize the protective effect of peroxisome proliferator-activated receptor-beta (PPAR-β) in sepsis-induced liver injury and the mechanism, and to provide new ideas for the prevention and treatment of sepsis-induced liver injury.MethodRelevant literatures about protective effect of PPAR-β in sepsis-induced liver injury were collected and reviewed.ResultsPPAR-β played an important role in cell survival, anti-inflammatory, and anti-oxidation. It acted on a variety of pathophysiological processes, could reduce the activation of inflammatory factors, reduce the production of oxygen free radicals, and inhibit the expression of apoptotic proteins, as well as played an important role in anti-inflammatory, anti-oxidative, and anti-apoptotic.ConclusionPPAR-β can inhibit the activation of NF-κB, reduce the release of inflammatory factors, reduce apoptosis, and reduce liver injury by antioxidation, thereby reducing the mortality of sepsis-induced liver injury.