Prevalence,risk factors and outcomes associated with pulmonary hemorrhage in newborns

Objectivesto determine the prevalence of pulmonary hemorrhage in newborns and evaluate the associated risk factors and outcomes.Methodsthis was a retrospective case-control study involving 67 newborns who met the criteria for pulmonary hemorrhage. A control was selected for each case: the next-born child of the same gender, similar weight (± 200 g) and gestational age (± 1 week), with no previous pulmonary hemorrhage and no malformation diagnosis. Factors previous to pulmonary hemorrhage onset, as well as aspects associated to the condition, were assessed.Resultsthe prevalence was 6.7 for 1,000 live births, and the rates observed were: 8% among newborns < 1,500 g, and 11% among newborns < 1,000 g. Intubation in the delivery room (OR = 7.16), SNAPPE II (OR = 2.97), surfactant use (OR = 3.7), and blood components used previously to pulmonary hemorrhage onset (OR = 5.91) were associated with pulmonary hemorrhage. In the multivariate logistic regression model, only intubation in delivery room and previous use of blood components maintained the association. Children with pulmonary hemorrhage had higher mortality (OR = 7.24). Among the survivors, the length of stay (p ≤ 0.01) and mechanical ventilation time were longer (OR = 25.6), and oxygen use at 36 weeks of corrected age was higher (OR = 7.67).Conclusionspulmonary hemorrhage is more prevalent in premature newborns, and is associated with intubation in the delivery room and previous use of blood components, leading to high mortality and worse clinical evolution.     

The receptor‐like kinases GSO1 and GSO2 together regulate root growth in arabidopsis through control of cell division and cell fate specification

COVER PHOTOGRAPH: Confocal image of a median optical section through a heart stage Arabidopsis embryo expressing the epidermalmarker pATML1:: HTA6‐GFP and counterstained with propidium iodide. From The receptor‐like kinases GSO1 and GSO2 together regulate root growth in Arabidopsis through control of cell division and cell fate specification; Racolta et al, Developmental Dynamics 243:257–278.     

白大衣高血压患者血压变异性对靶器官损害的影响

目的探讨血压变异性对白大衣高血压患者靶器官损害的影响。方法门诊患者119例,根据24 h动态血压和诊室血压分为正常血压组(NT)和白大衣高血压组(WCH)。其中白大衣高血压组根据24 h收缩压变异程度分为:白大衣高血压血压变异性低组(WCH-L),白大衣高血压血压变异性高组(WCH-H)。心脏和颈动脉超声检查:计算二尖瓣环心肌舒张早期峰值运动速度(Em)与舒张晚期峰值运动速度(Am)比值(Em/Am),评价左心室舒张功能及颈动脉损害的发生率。结果 (1)NT组左心室舒张功能减退发生率(21.87%,7例/32例)、颈动脉损害的检出率(18.75%,6例/32例)与WCH-L组(31.11%,14例/45例;22.22%,10例/45例)相近,组间差异无统计学意义(P=0.370、0.711);(2)WCH-H组左心室舒张功能减退发生率(52.38%,22例/42例)、颈动脉损害的检出率(42.85%,18例/42例)明显高于NT组(P=0.008、0.028)和WCH-L组(P=0.044、0.040),差异均有统计学意义。结论血压变异性较大的白大衣高血压患者具有较高的靶器官损害发生率。     

Relationship between the incidence of non-hepatic hyperammonemia and the prognosis of patients in the intensive care unit

BACKGROUNDAmmonia is a normal constituent of body fluids and is found mainly through the formation of urea in the liver. Blood levels of ammonia must remain low as even slightly elevated concentrations (hyperammonemia) are toxic to the central nervous system.AIMTo examine the relationship between the incidence of non-hepatic hype-rammonemia (NHH) and the prognosis of patients who were admitted to the intensive care unit (ICU).METHODSThis is a prospective, observational and single-center study. A total of 364 patients who were admitted to the ICU from November 2019 to February 2020 were initially enrolled. Changes in the levels of blood ammonia at the time of ICU admission and after ICU admission were continuously monitored. In addition, factors influencing the prognosis of NHH patients were analyzed.RESULTSA total of 204 patients who met the inclusion criteria were enrolled in this study, including 155 NHH patients and 44 severe-NHH patients. The incidence of NHH and severe-NHH was 75.98% and 21.57%, respectively. Patients with severe-NHH exhibited longer length of ICU stay and higher Acute Physiologic Assessment and Chronic Health Evaluation and Sequential Organ Failure Assessment scores compared to those with mild-NHH and non-NHH. Glasgow Coma Scale scores of patients with severe-NHH were than those of non-NHH patients. In addition, the mean and initial levels of ammonia in the blood might be helpful in predicting the prognosis of NHH.CONCLUSIONHigh blood ammonia level is frequent among NHH patients admitted to the ICU, which is related to the clinical characteristics of patients. Furthermore, the level of blood ammonia may be helpful for prognosis prediction.     

强化血糖控制对改善冠脉支架植入患者临床预后的作用

目的:分析强化血糖控制对行冠脉支架植入(PCI)患者的作用。方法:2017年1月至8月我科120例PCI患者被随机均分为常规治疗组(根据血糖水平适当调节胰岛素泵入量)和强化血糖控制组(每餐前增加2~4U/h胰岛素泵入量,持续至餐后2h,其余同常规治疗组)。观察比较两组术后血糖达标时间、胰岛素用量、并发症以及再狭窄情况。结果:与常规治疗组比较,强化血糖控制组术后血糖达标时间[(3.58±0.27)d比(2.31±0.15)d]、胰岛素用量[(101.54±13.65)U比(96.41±12.82)U]、并发症总发生率(15.00%比3.33%)和再狭窄率(15.52%比3.57%)均显著降低,P<0.05或<0.01。结论:为冠脉支架植入患者行强化血糖控制,可促使血糖更快达标,减少胰岛素用量,降低术后并发症和再狭窄风险,应用前景广阔。     

Synchronous and metachronous neoplasms in gastric cancer patients: A 23-year study

AIM: To determine the prevalence and characteristics of additional primary malignancies in gastric cancer (GC) patients.METHODS: GC patients (862 total; 570 men, 292 women; mean age 59.8 ± 12.8 years) diagnosed at the Department of Gastroenterology at Pomeranian Medical University over a period of 23 years were included in this retrospective analysis of a prospectively maintained database. Mean follow-up time was 31.3 ± 38.6 mo (range 1-241 mo). The following clinicopathological features of patients with synchronous tumors were compared to those with metachronous tumors: age, sex, symptom duration, family history of cancer, tumor site, stage (early vs advanced), histology, and blood group. GC patients with and without a second tumor were compared in terms of the same clinicopathological features.RESULTS: Of 862 GC patients, 58 (6.7%) developed a total of 62 multiple primary tumors, of which 39 (63%) were metachronous and 23 (37%) synchronous. Four (6.9%) of the 58 multiple GC patients developed two or more neoplasms. The predominant tumor type of the secondary neoplasms was colorectal (n = 17), followed by lung (n = 9), breast (n = 8), and prostate (n = 7). Age was the only clinicopathological feature that differed between GC patients with synchronous vs metachronous malignancies; GC patients with synchronous neoplasms were older than those with metachronous neoplasms (68.0 ± 10.3 years vs 59.9 ± 11.1 years, respectively, P = 0.008). Comparisons between patients with and without a second primary cancer revealed that the only statistically significant differences were in age and blood group. The mean age of the patients with multiple GC was higher than that of those without a second primary tumor (63.4 ± 11.4 years vs 59.5 ± 13.0 years, respectively, P = 0.026). GC patients with a second primary tumor were more commonly blood group O than those without (56.2% vs 31.6%, respectively, P = 0.002).CONCLUSION: GC patients may develop other primary cancers; appropriate preoperative and postoperative diagnostic modalities are thus required, particularly if patients are older and blood group O.     

苏子降气汤辅助治疗慢性阻塞性肺疾病急性加重69例临床观察

目的 观察苏子降气汤辅助治疗慢性阻塞性肺疾病急性加重（acute exacerbation chronic obstructive pulmonary disease,AECOPD）患者的临床疗效。方法 将138例AECOPD患者随机分为试验组和对照组,每组69例。对照组给予西医常规治疗,试验组在西医常规治疗基础上给予苏子降气汤治疗。观察两组治疗前后中医证候评分、肺功能［1秒用力呼气容积（forced expiratory volume in one second,FEV1）,用力肺活量（forced vital capacity,FVC）及FEV1/FVC］、血气分析指标［动脉血氧饱和度（arterial oxygen saturation,SaO2）、动脉血氧分压（arterial PO2,PaO2）、动脉血二氧化碳分压（arterial PCO2,PaCO2）］、血清炎症因子［降钙素原（procalcitonin,PCT）、白细胞介素-38（interleukin,IL-38）及超敏C反应蛋白（hypersensitive C-reactive protein,hs-CRP）］和D-二聚体（D-Dimer,D-D）水平。结果 治疗后两组患者喘息、咳嗽、哮鸣、纳呆、咳痰及胸膈满闷评分均较治疗前显著降低（P＜0.05）;FEV1、FVC及FEV1/FVC均较治疗前显著增加（P＜0.05）;SaO2、PaO2均显著升高（P＜0.05）,PaCO2显著降低（P＜0.05）;PCT、IL-38、hs-CRP、D-D水平均较治疗前显著降低（P＜0.05）。试验组咳嗽、纳呆、咳痰及胸膈满闷评分降低程度均显著大于对照组（P＜0.05）;FEV1、FVC及FEV1/FVC升高程度显著大于对照组（P＜0.05）;PaO2升高程度和PaCO2降低程度显著大于对照组（P＜0.05）;IL-38、hs-CRP水平降低程度均显著大于对照组（P＜0.05）。试验组疗效优于对照组（P＜0.05）。结论 苏子降气汤治疗AECOPD可有效抑制PCT、IL-38、hs-CRP等炎症相关因子生成,降低D-D水平,改善患者肺功能、血气分析指标及中医证候评分。     

生活方式干预对妊娠糖尿病病人的血糖控制和妊娠结局的影响探讨

目的研究分析生活方式干预对妊娠糖尿病患者的血糖控制和妊娠结局的影响。方法选取该院2013年5月—2014年5月所收治的妊娠糖尿病患者130例作为研究对象,按随机表法将其分成两组,即观察组与对照组,对照组患者采取常规护理措施,在此基础之上,对观察组患者实施生活方式干预措施,并对两组患者的血糖控制及其妊娠结局进行对比与观察。结果干预前,观察组与对照组在FPG、2hPG以及HbAlc等的比较上无明显差异;干预后,观察组患者FPG、2hPG以及HbAlc等指标明显低于对照组,差异显著,具有统计学意义（P〈0.05）。结论在常规护理的基础之上,对妊娠期糖尿病患者实施生活方式干预,能够有效降低患者的血糖水平,降低并发症的发生率,值得在临床上大力推广与使用。     

阻塞性睡眠呼吸暂停低通气综合征患者治疗前后血压变化临床分析

目的：分析阻塞性睡眠呼吸暂停低通气综合征（ OSAHS）患者治疗前后血压变化情况。方法选取206例主诉打鼾患者,根据睡眠呼吸监测的结果,分为OSAHS组（ A组）139例和非OSAHS组（ B组）67例,观察OSAHS患者治疗前后24 h动态血压变化情况。结果 A组高血压的发生率均明显高于B组（ P＜0.05）,其血压多呈非勺型。 OSAHS患者经过有效的经鼻持续气道正压通气（ NCPAP）、手术等治疗后,血压有下降的趋势。结论 OSAHS患者经有效治疗后血压等趋向于正常,可预防、减少心血管事件的发生。     

H型高血压患者的血压变异性研究

目的观察H型高血压患者血压变异性的特点。方法连续选择2011年2月~2013年2月于军事科学院门诊部就诊的80例原发性高血压患者,分别进行血浆同型半胱氨酸(Hcy)水平测定和动态血压监测,根据Hcy水平分为H型高血压组(n=44)和非H型高血压组(n=36),分析比较两组间的血压变异性。结果与非H型高血压患者相比,H型高血压组患者24h平均收缩压标准差(24hSSD)[(15.83±4.02)mmHg vs.(13.25±3.89)mmHg]、白昼收缩压标准差(dSSD)[(16.82±4.98)mmHg vs.(12.75±3.86)mmHg]、白昼舒张压标准差(dDSD)[(10.29±2.23)mmHg vs.(8.62±1.82)mmHg]和夜间收缩压标准差(nSSD)[(12.88±4.54)mmHg vs.(10.12±3.36)mmHg]明显增高,差异具有统计学意义(P均0.05)显著。结论与非H型高血压患者相比,H型高血压患者血压变异性增高。