Association between mean platelet volume levels and inflammation in SLE patients presented with arthritis

Background

Systemic lupus erythematosus (SLE) may be characterized by periods of remissions and chronic or acute relapses. The complexity of clinical presentation of the SLE patients leads to incorrect evaluation of disease activity. Mean platelet volume (MPV) has been studied as a simple inflammatory marker in several diseases. There is no study in the literature about MPV levels in adult SLE patients with arthritis.

Objectives

We aimed to investigate the MPV levels in the SLE population with arthritis during and between activations.

Methods

The study consisted of 44 SLE patients with arthritis in activation period (Group 1), the same 44 SLE patients with arthritis in remission period (Group 2) and 44 healthy controls (Group 3). Erythrocyte sedimentation rate (ESR), creactive protein (CRP), white blood cell count, platelet count, and mean platelet volume (MPV) levels were retrospectively recorded from patient files.

Results

The mean ages of the SLE subjects were 42 ± 16 years, while the mean ages of controls was 41 ± 17 years. MPV was significantly lower in Group 1(7.66±0.89fL) than in Group 2 (8.61±1.06 fL) and Group 3(8.62±1.11fL) (p<0.0001). The differences between groups reached statistical significance.

Conclusions

We suggest that MPV levels decrease in patients with arthritis of SLE activation when compared to the same patients in remission and healthy controls.     

Polymorphism in miRNA-1 target site and circulating miRNA-1 phenotype are associated with the decreased risk and prognosis of coronary artery disease

MiRNA molecules have been identified to play key roles in a broad range of physiologic and pathologic processes. Polymorphisms in microRNA target sites (PolymiRTSs) can disturb or obstruct miRNA binding and consequentially influence regulation of the target genes. A two-step study design was used in this study. A case-control study was designed to assess the relationship between miRNA-1 target site rs9548934C→T polymorphism in target gene (Component of Oligomeric Golgi Complex 6, COG6) and risk of coronary artery disease (CAD) in 1013 patients and 610 normal controls. This genetic variant was also evaluated for the association with major adverse cardiovascular events (MACE) of CAD in a follow-up study, including 785 (785/1013) patients followed up for 42 months. The phenotypes of circulating miRNA-1 levels in 34 cases were slightly lower than that of 40 controls but not significantly different (P = 0.090). The CT and CT/TT genotypes were associated with a 34% and 26% decreased risk of CAD, and the TT and CT/TT genotypes were associated with a 76% and 49% decreased risk of MACE of CAD. Cox regression analysis showed that rs9548937 C/T variant was associated with a decreased risk of MACE, while age, diabetes mellitus, higher levels of CRP (≥ 3.80 mg/L) and three pathological changes in the coronary artery were associated with an increased risk of MACE. Our findings implicate miRNA-1 target site rs9548934C→T genotypes, circulating miRNA-1 phenotype and CRP levels may modulate the occurrence and MACE of CAD.     

Virtual surgery simulation in orbital wall reconstruction: Integration of surgical navigation and stereolithographic models

PurposeCorrection of post traumatic orbital and zygomatic deformity is a challenge for maxillofacial surgeons. Integration of different technologies, such as software planning, surgical navigation and stereolithographic models, opens new horizons in terms of the surgeons' ability to tailor reconstruction to individual patients. The purpose of this study was to analyze surgical results, in order to verify the suitability, effectiveness and reproducibility of this new protocol.MethodsEleven patients were included in the study. Inclusion criteria were: unilateral orbital pathology; associated diplopia and enophthalmos or exophthalmos, and zygomatic deformities. Syndromic patients were excluded. Pre-surgical planning was performed with iPlan 3.0 CMF software and we used Vector Vision II (BrainLab, Feldkirchen, Germany) for surgical navigation. We used 1:1 skull stereolithographic models for all the patients. Orbital reconstructions were performed with a titanium orbital mesh. The results refer to: correction of the deformities, exophthalmos, enophthalmos and diplopia; correspondence between reconstruction mesh positioning and preoperative planning mirroring; and the difference between the reconstructed orbital volume and the healthy orbital volume.ResultsCorrespondence between the post-operative reconstruction mesh position and the presurgical virtual planning has an average margin of error of less than 1.3 mm. In terms of en- and exophthalmos corrections, we have always had an adequate clinical outcome with a significant change in the projection of the eyeball. In all cases treated, there was a complete resolution of diplopia. The calculation of orbital volume highlighted that the volume of the reconstructed orbit, in most cases, was equal to the healthy orbital volume, with a positive or negative variation of less than 1 cm³.ConclusionThe proposed protocol incorporates all the latest technologies to plan the virtual reconstruction surgery in detail. The results obtained from our experience are very encouraging and lead us to pursue this path.     

Verification of blood volume for blood culture and detection rate in pediatrics

PurposeThis study was conducted to estimate the blood culture volume that should be collected from pediatric patients to improve diagnostic abilities.MethodsBlood cultures from neonates and children aged up to 18 years were collected and the volume was measured for over a 1-year period. During the intervention period, examiners were instructed to draw 3 mL of blood for culture, if possible. The pre-intervention period was from June 1 to August 31, 2016. The post-intervention period was from September 1, 2016, to May 30, 2017. The rate of positive detections was calculated and compared between pre and post-intervention periods.ResultsWe collected 1352 samples and measured 1327 bottles. During the pre-intervention period, 340 cases were collected with a median blood volume of 1.64 mL; 9 cases (2.7%) were true-positive. During the intervention period, 1012 cases were ordered with a median blood volume of 2.41 mL; 19 cases (1.9%) were true-positive. After intervention, blood volume was increased significantly (p < 0.01). However, there was no significant difference in the rate of positive detections during the study periods (p = 0.254).ConclusionsIn the pediatric clinical setting in a Japanese municipal hospital, the positive detection rate did not improve even when the collected blood volume was increased. One milliliter of blood volume may be adequate for the pediatric bottle in children.     

护理组长目标管理考核模式对综合医院临床护理质量、护理不良事件及护士综合能力的影响

[目的]探讨护理组长目标管理考核模式对综合医院临床护理质量、护理不良事件及护士综合能力的影响。[方法]选取2018年6月-2019年6月某院各科室20名护理组长为研究对象,按照随机数字表法将其分为观察组和对照组各10人。对照组给予常规护理管理模式,观察组给予护理组长目标管理考核模式,观察并比较两组干预前后的临床护理质量、护理不良事件发生率及护士综合能力。[结果]观察组临床护理质量评分显著高于对照组(P<0.05),观察组护理不良事件发生率显著低于对照组(P<0.05),观察组综合能力评分显著高于对照组(P<0.05)。[结论]护理组长目标管理考核模式能够显著提升护士临床护理质量和综合能力,有利于提升其自我控制能力和责任意识,达到有效降低不良事件发生率,对医院护理质量管理有着重要意义。     

急性呼吸窘迫综合征患者早期应用气道压力释放通气的疗效

目的探讨早期应用气道压力释放通气（APRV）对急性呼吸窘迫综合征（ARDS）患者的临床疗效。 方法将2017年9月至2019年6月收住在兰州大学第一医院ICU的71例ARDS患者分为APRV组（36例）和小潮气量（LTV）组（35例）。APRV组患者起初给予容量辅助控制通气模式,测量气道平台压后转为APRV模式;LTV组患者接受LTV通气,目标潮气量设置为6~8 mL/kg,依据ARDSnet协议调节呼气末正压（PEEP）水平、潮气量和呼吸频率。记录两组患者的一般资料,比较其机械通气第1天和第7天呼吸机参数、呼吸力学指标、血气功能指标、循环功能指标及预后情况;绘制Kaplan-Meier生存曲线,比较两组患者28 d生存情况。 结果机械通气第7天,APRV组和LTV组患者吸入氧浓度（FiO₂）[（47 ± 5）% vs.（66 ± 5）%,t = 3.746,P < 0.001]、呼吸频率[（24 ± 4）次/min vs.（18 ± 4）次/min,t = 3.453,P < 0.001]、PEEP[（5.6 ± 2.3）cmH₂O vs.（10.8 ± 4.4）cmH₂O,t = 3.011,P < 0.001]、气道峰压[23.9（18.5,29.6）cmH₂O vs. 25.1（11.3,31.8）cmH₂O,H = 2.736,P = 0.014]、气道平台压[22.2（18.7,24.3）cmH₂O vs. 19.6（17.2,22.4）cmH₂O,H = 2.154,P = 0.023]、平均气道压[23.8（22.1,24.3）cmH₂O vs. 15.4（13.9,19.4）cmH₂O,H = 2.814,P = 0.018]、肺顺应性[52.7（37.4,62.3）mL/cmH₂O vs. 41.8（31.5,57.6）mL/cmH₂O,H = 2.008,P = 0.034]、动脉血氧分压（PaO₂）[（89 ± 7）mmHg vs.（72 ± 7）mmHg,t = 2.324,P < 0.001]、PaO₂/FiO₂ [（201 ± 15）mmHg vs.（140 ± 12）mmHg,t = 2.743,P < 0.001]、动脉血氧饱和度（SaO₂）[（95.4 ± 2.1）% vs.（92.3 ± 1.8）%,t = 2.658,P < 0.001]、心率[（99 ± 9）次/min vs.（108 ± 9）次/min,t = 2.733,P = 0.014]及平均动脉压[（84 ± 11）mmHg vs.（74 ± 13）mmHg,t = 3.012,P = 0.011]比较,差异均有统计学意义。APRV组ARDS患者机械通气时间[（9.6 ± 2.2）d vs.（11.9 ± 2.9）d,t = 3.687,P < 0.001]、住ICU时间[（11.3 ± 3.1）d vs.（13.2 ± 2.7）d,t = 2.722,P = 0.008]、住院时间[（13.9 ± 2.5）d vs.（16.2 ± 2.4）d,t = 3.924,P = 0.004]均较LTV组显著缩短,拔管成功率[80.6%（29/36）vs. 54.3%（19/35）,χ² = 5.592,P = 0.018]显著升高,肺复张[5.6%（2/36）vs. 48.6%（17/35）,χ² = 16.753,P < 0.001]、俯卧位通气[11.1%（4/36）vs. 34.3%（12/35）,χ² = 5.460,P = 0.019]、气胸发生率[8.3%（3/36）vs. 28.6%（10/35）,χ² = 4.860,P = 0.028]及28 d住院病死率[13.9%（5/36）vs. 34.3%（12/35）,χ² = 4.054,P = 0.044]均显著降低。Kaplan-Meier生存曲线结果显示,APRV组ARDS患者生存情况显著优于LTV组（χ² = 4.118,P = 0.015）。 结论与LTV组比较,早期应用APRV可显著改善ARDS患者的氧合功能和呼吸系统顺应性,提高拔管成功率,降低气胸发生率,并减少机械通气时间和住院时间。