摘要：目的：探讨晚期产后大出血的发生原因，提出防治措施。方法：对我院1992年1月至2000年1月收治的晚期产后大出血36例病例进行回顾性分析。结果：晚期产后出血的原因依次为胎盘残留、子宫复旧不全、切口裂开。结论：重视第三产程的处理，特别是对产时出血米索前列醇的应用，可有效预防大出血的发生。采用宫缩素及抗感染、清宫术等对症治疗可获得满意的治疗效果，对严重急性出血者可行子宫切除术。
Chronic kidney disease (CKD) has been highlighted as one of the most important public health problems due to sharply climbing incidence and prevalence. To efficiently attenuate the disease burden and improve the disease management, not only active and effective treatment should be administrated, but also comprehensive follow-up nursing management with innovative and evolving spirits should be implemented. Thus dynamic changes of diseases could be acquired in time and patients are under appropriate medical instruction as soon as possible. This editorial is based on quickly developing medical big data resources and advanced internet techniques, from both aspects of patients and health care providers, briefly talking about integrated management strategy of CKD and its future development in China.
Objective To assess reduction of adverse drug reaction incidence in patients with colorectal cancer receiving Jianpi herbs combined with chemotherapy. Methods The randomized controlled trials (RCTs) comparing Jianpi herbs combined with chemotherapy were searched through CBMdisc, CJFD, Wangfang Data and PubMed. The search was updated to September 2007. Software RevMan5, provided by Cochrane Library, was used to perform meta-analysis. Results Six RCTs were identified in this systematic review. All the methodology quality of the enrolled RCTs was gaded C. The pooled analysis showed that Jianpi herbs combined chemotherapy significantly reduced the incidences of grade I and grade II leucopenia [grade I with RR= 0.50 and 95%CI (0.31 to 0.80); grade II with RR= 0.37 and 95%CI (0.21 to 0.66)], grade II nausea and vomiting [RR= 0.51, 95%CI (0.31 to 0.84)] compared with routine chemotherapy. There was no statistical difference in reduction of neurotoxicity between the two groups. Conclusion The methodological quality of the RCTs using Jianpi herbs combined with chemotherapy on treating colorectal cancer should be improved. Based on this systematic review, Jianpi herbs combined with chemotherapy may reduce the incidence of mild to moderate adverse drug reaction, such as leucopenia and nausea and vomiting, in patients with colorectal cancer. Well-designed RCTs are needed in the future.
ObjectiveTo summarize functions and mechanisms of poly ADP-ribose polymerase (PARP) inhibitors and its application in germline BRCA mutated breast cancer.MethodThe literatures about the PARP inhibitors and their applications in the treatment of germline BRCA mutated breast cancer at home and abroad in recent years were collected to make a review.ResultsAs a DNA repair enzyme, the PARP played an important role in the DNA repair pathway. Based on this mechanism, the PARP inhibitors had been developed and widely used in the clinic. On the other hand, the previous studies had shown that the PARP inhibitors marked the synthetic lethal effect in the cancers with homologous recombination deficiency mechanism. By inhibiting the PARP activity in the tumor cells with BRCA mutation, all the DNA damage repair pathways were blocked, which could induce the cell apoptosis or increase the sensitivity of tumor cells to chemoradiotherapy, resulting in the cell death.ConclusionIn patients with germline BRCA mutated breast cancer, PARP inhibitors can selectively kill breast cancer cells and show a high potential for individualized treatment.
Objective To explore the prevention and control effect of carbapenem resistant Gram-negative bacillus (CRO) in geriatric ward based on transparent supervision model. Methods Patients admitted to the geriatric ward in the First People’s Hospital of Lianyungang between January 2018 and December 2022 were selected. A transparent regulatory model for CRO was established and implemented in 2019, including the establishment of a regulatory group, the development of cluster prevention and control measures, the implementation of transparent reminder, publicity, supervision and assessment and other management measures. We evaluated the effectiveness by comparing the detection rate and infection rate of CRO before and after the intervention. Results A total of 15015 patients were monitored, and a total of 418 strains of CRO were detected. The incidence rate of noso-comial infection was decreasing year by year（χ2=26.666, P<0.001), and the etiological submission rate of hospitalized patients before antimicrobial treatment had been increasing year by year（χ2=280.320, P<0.001). The detection rate of CRO infection had been decreasing year by year, but the difference was not statistically significant (P>0.05), and there was statistical significance in the detection rate of carbapenem-resistant Klebsiella pneumonia infection (P=0.030). The detection rate of CRO had been decreasing year by year (χ2=33.593, P<0.001), and there was statistical significance in the detection rate of carbapenem-resistant Klebsiella pneumonia (χ2=23.663, P<0.001) and carbapenem resistant Pseudomonas aeruginosa (χ2=14.527, P=0.006).Conclusions By establishing and promoting transparent supervision mode in the geriatric ward, the detection rate and infection rate of drug-resistant bacteria can be significantly reduced, and the prevention and control effect of CRO in the elderly patients in the ward can be effectively improved to ensure the safety of elderly patients.
ObjectiveTo establish a prediction model for ipsilateral cervical lateral lymph node metastasis (LLNM) in stages T1–T2 unilateral papillary thyroid carcinoma (PTC) and to verify its efficacy. MethodsA retrospective case-control study was conducted to analyze the clinical information of 280 patients with unilateral PTC at stages T1–T2 who underwent ipsilateral cervical lateral lymph node dissection and were diagnosed postoperatively via pathological examination in the Department of Thyroid Surgery (General Surgery) at the First Hospital of Shanxi Medical University from February 2019 to February 2024. The patients were randomly allocated into a training set and a test set in a 7∶3 ratio. The general, clinical, laboratory, and imaging data were collected for all patients. The univariate and multivariate logistic regression analyses were used to compare the differences in data of the patients between with and without LLNM in the training set. Then the risk factors affecting on the LLNM were used to construct a nomogram prediction model. The receiver operating characteristic (ROC) curve was generated for both the training and test sets, and the area under the ROC curve (AUC) was calculated to evaluate model discrimination. The calibration curve was used to assess model calibration, and decision curve analysis (DCA) was conducted to evaluate the clinical utility of the nomogram prediction model. ResultsA total of 280 patients were included, including 196 in the training set and 84 in the testing set. There were no statistically significant differences in the clinical and pathological data between the training set and the testing set (P>0.05). There were 147 cases of LLNM in the training set and 63 cases of LLNM in the testing set. The results of multivariate logistic regression analysis showed that the patients with T1–T2 stage unilateral PTC who were male in gender, had cancer lesions located in the upper pole, had central lymph node metastasis, had larger cancer lesions, and higher serum thyroid stimulating hormone level had a higher probability of developing ipsilateral cervical LLNM (P<0.05). The AUC (95%CI) of the nomogram prediction model constructed based on these risk factors in the training and testing sets were 0.822 (0.747, 0.897) and 0.838 (0.743, 0.933), respectively. The calibration curves of the training and testing sets roughly overlapped with the reference curve. The DCA results indicated that the net benefit for patients was positive when the threshold probabilities were within the ranges of 15% to 92% for the training set and 10% to 100% for the test set. ConclusionsThe results of this study suggest that gender, maximum cancer lesion diameter, cancer lesion location, central lymph node metastasis, and serum thyroid stimulating hormone are risk factors affecting the occurrence of ipsilateral cervical LLNM in T1–T2 stages unilateral PTC. The nomogram prediction model developed based on these risk factors demonstrates good discrimination, accuracy, and clinical applicability for its prediction.
ObjectiveTo systematically review the diagnostic value of miRNAs for Alzheimer’s disease (AD).MethodsPubMed, Web of Science, EMbase, The Cochrane Library, CNKI, WanFang Data, VIP, and CBM databases were electronically searched to collect diagnostic tests of miRNAs for AD from inception to October 31, 2020. Two researchers independently screened literature, extracted data, and assessed the risk of bias of the included studies. RevMan 5.3 and Stata 14.0 software were used for meta-analysis. ResultsA total of 22 studies involving 4 006 subjects were included. The meta-analysis results showed that the pooled sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio, and the areas under the working characteristic curve of miRNA in AD diagnosis were 0.83 (95%CI 0.79 to 0.87), 0.80 (95%CI 0.76 to 0.83), 4.07 (95%CI 3.37 to 4.92), 0.21 (95%CI 0.17 to 0.27), 19.20 (95%CI 12.96 to 28.48) and 0.88 (95%CI 0.85 to 0.90), respectively. ConclusionThe current evidence shows that miRNAs have a high diagnostic value for AD. However, because of the limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusion.
Objective To evaluate the effect of PNS on Idiopathic facial palsy. Methods A total of 86 cases of acute idiopathic facial paralysis were randomly divided into the treatment group (PNS group, 44 cases), and the control group (42 cases). The basis of the two groups included hormone therapy, B vitamins, anti-viral treatment, as well as acupuncture and physical therapy, both in the incidence of 7 days to give the treatment. House-Brackmann facial nerve function classification and evaluation were used to determine clinical efficacy; ENoG line was tested before and after treatment. Results Before H-B classification of facial nerve function, EnoG side of the latency and amplitude in the two groups were comparable. At 28 days after treatment, H-B scores for the treatment group and the control group were (2.33 ± 1.21) and (3.08 ± 1.35), respectively, and the two groups had significant differences (Plt;0.05); ENoG incubation period (2.46 ± 0.34) and amplitude (189 ± 67) of the treatment group were more than those of the control group; the incubation period (3.37 ± 0.49) and amplitude (131 ± 52) improved, and there were significant differences between the two groups (Plt;0.05). Comparison of efficacy of the two groups showed the total effective rate: 95.45% in the treatment group, 80.95% in the control group, and the efficacy of the treatment group was better than that of the control group (Plt;0.05). Conclusion Sanqi tongshu, B vitamins, anti-virus, such as the acupuncture and physical therapy for the treatment of acute idiopathic facial paralysis have significant effect.
Objective To summarize the latest research progress on the relationship between cN0 multifocal papillary thyroid microcarcinoma (PTMC) and central lymph node metastasis (CLNM) at home and abroad, so as to provide a reference for surgeons to balance the benefits and risks of surgery and select the best treatment plan. Method The latest studies on the relationship between CLNM and tumor characteristics of cN0 multifocal PTMC (including number of tumor foci, total tumor diameter, primary tumor diameter, total tumor surface area, etc.) were reviewed. Results Current domestic and international guidelines differ on whether cN0 PTMC should be used to prevent central lymph node dissection (pCLND). Proponents believe that pCLND could reduce the recurrence rate of disease and facilitate postoperative risk stratification and management under the premise of technical support. Opponents argue that it was not clear whether pCLND actually improves the prognosis of PTMC patients, but postoperative complications do correlate with pCLND. In order to guide the application of pCLND in the surgical treatment of cN0 PTMC, a large number of studies had reported the risk factors of CLNM in PTMC in recent years, among which multifocal was considered to be a very important risk factor for CLNM. In order to further understand the internal relationship between multifocal PTMC and CLNM, scholars at home and abroad quantified the feature of multifocal PTMC into various parameters, and studied the relationship between them and CLNM in multiple dimensions. It was found that total tumor diameter >1 cm, increased tumor number, total tumor surface area >3.14 cm2, diameter ratio <0.56, tumor volume >90 mm3 and bilateral multifocal PTMC might be the risk factors for increased CLNM risk in patients with cN0 multifocal PTMC. Conclusion These screened parameters are initially considered to be effective tools for predicting the risk of CLNM in multifocal PTMC. Multiple risk parameters coexist, especially in patients with multifocal PTMC characterized by bilateral intralar multifocal PTMC, who are expected to benefit more from pCLND. However, a large number of clinical studies are still needed to provide reliable evidence-based evidence for clinical diagnosis and treatment. In the future, by combining these valuable parameters, a scoring system can be constructed to predict the disease status of multifocal PTMC more accurately and identify patients with necessary pCLND, which will be of great significance for the appropriate treatment of PTMC.
Objective To explore the effect of “net bottom” management in the control of device-associated infections (DAIs) in elderly patients by setting infection monitoring doctors and nurses in the emergency intensive care unit (EICU). Methods Elderly patients who aged≥60 years old admitted to the EICU of the First People’s Hospital of Lianyungang between April 2018 and March 2021 were selected as the research subjects. A “net bottom” management mode was established and implemented for the purpose of infection prevention and control, taking medical and other departments as the coordination and management subjects, and infection monitoring doctors and nurses as the core. The effectiveness of the management intervention was evaluated by comparing the incidences of DAIs in elderly patients, the compliance rates of medical staff in hand hygiene, and the consumption of hand sanitizer per bed day in EICU among the primary stage (from April 2018 to March 2019), intermediate stage (from April 2019 to March 2020), and later stage (from April 2020 to March 2021). Results During the primary stage, intermediate stage, and later stage, there were 540, 497, and 507 elderly inpatients in EICU monitored, respectively, and the incidences of nosocomial infections were 7.22% (39/540), 5.84% (29/497), and 4.14% (21/507), respectively, showing a decreasing trend (χ2trend=4.557, P=0.033). The incidences of ventilator-associated pneumonia, central line-associated bloodstream infections, and catheter-associated urinary tract infections decreased from 4.82‰, 2.53‰, and 0.95‰, respectively in the primary stage, to 0.51‰, 1.01‰, and 0.53‰, respectively in the later stage, among which the difference in the incidence of ventilator-associated pneumonia was statistically significant (P<0.05). The hand hygiene compliance rate of EICU medical staff increased from 70.39% to 86.67% (P<0.05), and the consumption of hand sanitizer per bed day increased from 33.70 mL to 67.27 mL. The quarterly hand hygiene compliance rate was positively correlated with the quarterly consumption of hand sanitizer per bed day (rs=0.846, P=0.001), and negatively correlated with the quarterly incidence of nosocomial infections (rs=–0.769, P=0.003). Conclusion The “net bottom” management by setting up infection monitoring doctors and nurses in the EICU and multi-department collaboration can reduce the incidence of DAIs in elderly patients in EICU, which plays a positive role in promoting the hospital infection management and improving the quality of hospital infection management.