Objective To investigate the relation of Human Leukocyte Antigen-DRs to Pre-eclampsia/eclampsia （PE/E） by reviewing the observational studies on PE/E. Methods We searched the MEDLINE/PubMed, EMBASE, The Cochrane Library and CBMdisc to July 2005, by combining free text with MeSH words. We assessed the quality of included studies, extracted and analyzed data. Results The odds ratio of fetal-maternal HLA-DR4 antigen frequency in case group versus control group was 2. 60 （95% CI 1.87 to 3.60） with statistical significance. The antigen frequencies of＇other fetal-maternal HLA-DRs in case and control groups were not statistically significant. The antigen frequencies of the couple HLA DRs were not statistically significant between case and control groups. We found that neither the HLA-DR sharing between the couples nor between fetus and mothers in case and control groups were statistically significant. Conclusions The antigen frequencies of HLA-DRs between the couples may have no association with the development of PE/E. The fetal gene types may be related to the development of PE/E. The HLA-DR sharing in mothers and fetus and the couples may have no association with the development of PE/E.
Objective To investigate the effects of normal saline flushing and its frequency on extracorporeal circuit lifespan and solute removal in continuous renal replacement therapy (CRRT) without anticoagulation. Methods Patients undergoing continuous veno-venous hemodiafiltration (CVVHDF) without anticoagulation between June and September 2021 were prospectively collected. The patients were randomly divided into three groups by envelope method, namely 30 min-flushing group (flushing every 30 minutes for extracorporeal circulation), 2 h-flushing group (flushing every 2 hours for extracorporeal circulation), and non-flushing group (no flushing for extracorporeal circulation during treatment). All patients were treated with Prismaflex V8.0 CRRT machine and matched AN69ST-ST150 extracorporeal circuit, through either femoral or internal jugular venous double-lumen catheter. CVVHDF was adopted, the blood pump rate was 200 mL/min, and the rates of replacement fluid and dialysate were both 1 000 mL/h. The replacement fluid was pre-post dilution. Extracorporeal circuit lifespan, treatment time delayed by flushing, overall treatment time of CRRT, actual treatment time of CRRT, proportion of actual treatment time achieved, delayed daily treatment time, and small molecule solute removal efficiency before and after treatment were recorded. Results A total of 83 patients were included, including 24 in the 30 min-flushing group, 30 in the 2 h-flushing group, and 29 in the non-flushing group. There were significant differences in the indexes of extracorporeal circuit lifespan and various treatment time indicators among the three groups (P<0.05). Compared with the 2 h-flushing group and the non-flushing group, the 30 min-flushing group significantly shortened the extracorporeal circuit lifespan, delayed more treatment time by flushing, and delayed the longest daily treatment time (P<0.05). The proportion of actual treatment time in the non-flushing group was significantly higher than that in the 30 min-flushing group and the 2 h-flushing group (P<0.05), and in the 2 h-flushing group was also higher than that in the 30 min-flushing group (P<0.05). There was no significant difference in the blood urea nitrogen clearance rate among the three groups (P=0.570), but the serum creatinine clearance rate was significantly different among the three groups (P=0.020). Compared with the 30 min-flushing group, the 2 h-flushing group had a higher serum creatinine clearance rate, and there was statistical significance (P<0.05). Twenty-five patients had hypotension during treatment. The frequency of 30 min-flushing caused a higher risk of coagulation during cardiopulmonary bypass (hazard ratio=2.502, P=0.001). Conclusion For CVVHDF without anticoagulation, longer extracorporeal circuit lifespan and longer effective treatment time can be achieved without using normal saline flush.
During the medical rescue after Wenchuan earthquake, based on the design and implementation of the management process of blood purification equipment, we gave the top priority to those patients with post-disaster crush syndrome to ensure their hemodialytic treatment. Through strict management of blood purification technology, the outcomes of these patients have been fundamentally improved and the incidence of complications was substantially reduced. Safe and effective hemodialytic treatment have been administered to 77 patients with crush syndrome (813 case-times).
Objective To evaluate the safety and efficacy of simplified regional citrate anticoagulation in sustained low efficiency dialysis (SLED). Methods We prospectively analyzed the patients with acute kidney injury or end stage renal disease in Department of Nephrology, West China Hospital of Sichuan University from March 2017 to May 2018. All the patients received SLED treatment by Fresenius 4008s ARrTplus through either femoral or internal jugular venous catheter, with each session of SLED treatment lasting for 8 to 10 hours. We pumped in 4% tri-sodium citrate solution through the arterial line at 300 mL/h and citrate infusion was stopped 15 minutes before ending of treatment. The blood flow was 150 mL/min while the calcium-containing dialysate (Ca 1.25 mmol/L) was delivered at 200 mL/min. We recorded peripheral, post filter ionized calcium level, and systemic citrate concentration at 0, 2 and 6 hours, respectively. Results Sixty-two patients underwent 185 sessions of SLED. Three sessions of two patients were discontinued for filter clotting, while the rest 182 SLED sessions (98.4%) were all successfully completed. The systemic citrate concentrations at 2 and 6 hours after beginning were of no statistical difference [(0.82±0.31) vs. (0.86±0.31) mmol/L, P=0.21]. The 0-, 2-, 6-hour peripheral blood ionized calcium levels were (1.12±0.21), (1.09±0.12), and (1.11±0.09) mmol/L, respectively, with no significant difference (P>0.05), and post filter ionized calcium at 2 and 6 hours after beginning were recorded as (0.35±0.06) and (0.31±0.04) mmol/L. The trans-membrane pressure at 2 and 6 hours after beginning were (106.2±13.8) and (105.3±22.4) mm Hg (1 mm Hg=0.133 kPa), with no significant difference (P=0.42). At 6 hours after beginning, prothrombin time and activated partial thrombin time were identified to be similar to those before SLED. During SLED treatments, in 4 sessions (2.2%), patients suffered mild metabolic alkalosis, but all of them recovered 4 hours later by themselves. No bleeding complication, thrombocytopenia, cardiac arrhythmia, hypernatremia, metabolic alkalosis or hypotension was observed. Conclusion SLED under simplified citrate anticoagulation is safe and effective by using calcium containing dialysate, which achieves satisfying regional anticoagulation effect without interfering systemic clotting function, and provides a new option of anticoagulation for SLED.
ObjectiveTo explore the application effect of information-based circuit teaching mode for training refresher nurses in continuous renal replacement therapy (CRRT).MethodsCRRT refresher nurses studied in West China Hospital of Sichuan University from January 2016 to December 2019 were selected. The CRRT refresher nurses who were selected as the control group (studied from January 2016 to December 2017) accepted the conventional teaching method. The CRRT refresher nurses who were selected as the test group (studied from January 2018 to December 2019) accept the information-based combined with circuit teaching mode for teaching and training. After 6 months of training, the theoretical performance, operation performance, teaching satisfaction and the incidence of adverse events were compared between the two groups.ResultsA total of 112 CRRT refresher nurses were enrolled. Among them, there were 52 nurses in the control group and 60 in the test group. The scores of theory achievement (t=−2.421, P=0.017), operation achievement (t=−2.305, P=0.023) and teaching satisfaction [including teaching effect (t=−4.067, P<0.001), operation skill (t=−5.013, P<0.001), teaching mode (t=−5.589, P<0.001) and teaching content (t=−2.586, P<0.001)] of refresher nurses in the test group were higher than those in the control group. There was no significant difference between the control group (4 cases) and the test group (1 case) in the occurrence of adverse nursing events (adjusted χ2=1.169, P=0.280).ConclusionThe information-based circuit teaching mode has achieved good results in the teaching of CRRT refresher nurses, which is conducive to improving the post competency of CRRT refresher nurses.
With the development of medical information technology, smart teaching has been widely applied in various fields of medical education. The application of smart teaching technologies such as virtual simulation, intelligent evaluation, and smart teaching platform in blood purification specialized nursing teaching have gradually increased. This article provides an overview of the application of smart teaching mode in blood purification specialized nursing teaching both domestically and internationally, and introduces the integration of online and offline smart teaching mode, in order to provide a theoretical basis for improving the quality of blood purification specialized nursing teaching.
This article is based on the work practice of Deyang People’s Hospital in carrying out financial digital transformation under the background of artificial intelligence technology. It clarifies the concepts of financial digitization and artificial intelligence technology, summarizes the practical path of hospital financial digital transformation, and analyzes the specific applications and implementation effects of intelligent filling of expense reimbursement forms, intelligent review of documents, and intelligent management of medical insurance funds. These experiences have positive significance for optimizing financial business processes, improving data quality and utilization efficiency, and enhancing employee satisfaction. They can provide a reference for the digital transformation of financial management in public hospitals and the reconstruction of the value positioning of hospital financial management.
Objective To investigate the risk factors for hypotension in liver failure patients during double plasma molecular adsorption system (DPMAS) treatment, providing a theoretical basis for targeted clinical prevention and intervention. Methods Liver failure patients undergoing DPMAS at West China Hospital of Sichuan University between March 2021 and March 2023 were retrospectively enrolled. General data and clinical indicators were compared between the hypotension group and non-hypotension group. Multivariate logistic regression analysis was used to identify risk factors for hypotension. Results Of the 403 included patients, 60 (14.89%) developed hypotension, while 343 (85.11%) did not. Univariate analyses showed statistically significant differences between groups in age, sex, body mass index (BMI), albumin, serum sodium, pre-treatment systolic blood pressure, pre-treatment diastolic blood pressure, pre-treatment mean arterial pressure, and intraoperative vasoactive drug use (P<0.05). Multivariate logistic regression revealed that low BMI [odds ratio (OR)=0.712, 95% confidence interval (CI) (0.587, 0.863)], low serum sodium [OR=0.715, 95%CI (0.646, 0.792)], and intraoperative vasoactive drug use [OR=11.382, 95%CI (4.438, 29.194)] were independent risk factors for hypotension (P<0.05). Receiver operating characteristic curve analysis combining these three factors yielded an area under the curve of 0.922 [95%CI (0.886, 0.957)] for predicting hypotension incidence. Conclusions Low serum sodium, intraoperative vasoactive drug use, and low BMI are significant risk factors for hypotension during DPMAS therapy. Clinical emphasis should be placed on anticipating and mitigating hypotension to ensure uninterrupted treatment, reduce economic burdens, and improve patient prognosis.
In this article, the first time use of continuous veno-venous hemofiltration(CVVH) combined with toxic absorption for the treatment of a crush syndrome patient injured in earthquake is described. Correct therapeutic regimen, close observation and prescription condition are crucial for the success of management. The evidence for the application of this method is also discussed in detail.
Objective To investigate the safety and efficacy of two different anticoagulation regimens of fondaparinux and low molecular weight heparin (LMWH) in continuous renal replacement therapy (CRRT). Methods The clinical data of patients undergoing CRRT in West China Hospital of Sichuan University between October 2021 and April 2022 were retrospectively analyzed. The patients were divided into fondaparinux sodium group and LMWH group according to anticoagulation with fondaparinux or LMWH during CRRT. The general condition, life expectancy of cardiopulmonary bypass, coagulation events, bleeding events, hemoglobin, and coagulation function-related indicators were compared between the two groups. Results A total of 78 patients were finally included, including 38 in the LMWH group and 40 in the fondaparinux group. The age of the patients in the LMWH group was older than that in the fondaparinux group [76.0 (57.0, 85.0) vs. 63.0 (52.3, 76.0) years, P=0.016]. There was no significant difference in other clinical baseline conditions (including gender, vascular access site, and treatment indications) between the two groups (P≥0.05). The cardiopulmonary bypass life of patients in the fondaparinux group was better than that in the LMWH group [67.1 (35.0, 72.0) vs. 42.0 (20.0, 55.3) h, P=0.003]. The survival rate of cardiopulmonary bypass in the fondaparinux group at 24, 48, and 72 h were higher than that in the LMWH group (87.5% vs. 65.8%, P=0.023; 67.5% vs. 36.8%, P=0.007; 42.5% vs. 13.2%, P=0.004). The incidence of blood filter coagulation events in the fondaparinux group was lower than that in the LMWH group (50.0% vs. 84.2%, P=0.001). There was no significant difference in the incidence of coagulation events and mild bleeding events between the two groups (P>0.05). There was no significant difference in hemoglobin and coagulation function-related indicators between the two groups before and after CRRT (P>0.05). Conclusion The continuity of maintenance therapy with fondaparinux is better than that of LMWH, and the safety of both in the course of CRRT treatment is comparable.