目的:了解正常妊娠妇女血清中常用肝功能指标测定结果及变化。方法:分别在早孕（孕10～14周）、中孕（孕20～24周）、晚孕（孕30～34周）及产后（产后12周）四个时期序贯性测定120例正常妊娠妇女血清谷丙转氨酶（ALT）、谷草转氨酶（AST）、γ谷氨酰转移酶（GGT）、乳酸脱氢酶（LDH）、总胆红素（TBIL）、直接胆红素（DBIL）、总蛋白（TP）、白蛋白（ALB）、前白蛋白（PA）的水平并进行比较。结果:ALT、AST在早、中、晚孕及产后各期相对于正常对照均升高（P＜0.01）；TBIL和DBIL在早、中、晚孕均降低（P＜0.01）；TP、ALB随孕期增加逐渐下降,产后回升,到产后12周上升到正常水平（早、中、晚孕P＜0.01,产后P＞0.05）；GGT在孕期中逐渐升高,于晚孕期达最高峰（P＜0.01）,产后稍有下降；LDH在孕早中期无明显变化（P＞0.05）,孕晚期上升,到产后12周仍呈一上升趋势（P＜0.01）；PA在孕早期低于正常对照（P＜0.01）,后随孕期上升,到中孕期后上升到正常（P＞0.05）。结论:本次实验观察到在妊娠期肝功指标ALT、AST、GGT、LDH升高,可能因为孕妇肝脏负荷增加、基础代谢和能量消耗增多、甾体激素水平增高引起。胆红素代谢指标及营养性指标TBIL、DBIL、TP、ALB、PA降低,可能是妊娠期血浆稀释引起。临床诊断妊娠合并肝功能损害时应考虑上述变化。
ObjectiveTo summarize the research progress of early allograft dysfunction (EAD) predictors after liver transplantation. MethodThe literatures about the studies of predictive predictors of EAD after liver transplantation in recent years were reviewed. ResultsThe EAD was closely related to the prognosis and long-term survival of patients. In recent years, there were some reports of serum uric acid, neutrophil and lymphocyte ratio, von Willebrand factor to protein C ratio, serum brain natriuretic peptide, cytokine, hyaluronic acid, soluble CD163, serum lipid, lactic acid, coagulation factor Ⅴ, serum phosphorus etc. new serum biomarkers for early detection and recognition the occurrence and development of the EAD after liver transplantation. It was possible to intervene EAD early and effectively after liver transplantation. Conclusions Early recognition and prevention of EAD after liver transplantation is particularly important. Although some new predictive indicators have been proposed to predict occurrence of EAD after liver transplantation, relevant studies are lesser and there are still many problems to be solved. Further studies will be conducted to verify clinical application value of these new indicators.
ObjectiveTo establish a systematic, scientific, and sensitive index system to provide a scientific basis for quality evaluation and comprehensive quality management of day surgery nursing.MethodsThe databases of Wanfang, China National Knowledge Infrastructure, CQVIP, PubMed, and Web of Science were searched. The retrieval time was from the establishment of the databases to 15th July, 2019. Based on the “structure-process-outcome” management model, Delphi method was used to conduct two rounds of expert consultation for nursing experts related to day surgery in five tertiary hospitals. The results of the consultation were sorted out and the consensus of experts was obtained, so as to determine the quality-sensitive indicators of day surgery nursing.ResultsA total of 20 nursing experts participated in the questionnaire survey. The final evaluation indicators determined by expert correspondence included 1 structural indicator, 9 process indicators, and 4 outcome indicators.ConclusionsThe construction of quality evaluation standard of day surgery nursing not only embodies the connotation of nursing management of day surgery, but also puts forward clear requirements and quality standards for specialized nursing management. It has high reliability, scientificity, and strong operability, which can effectively improve the quality of nursing management and service level of day surgery.
Day surgery is a new medical service model, which has developed rapidly in China because of its advantages of safety, efficiency and resource conservation. However, along with the rapid development in quantity, it also presents contradictions such as the mismatch with the previous surgical quality and safety management model, the urgent need for the unification of the new system of quality and safety evaluation indicators at the national level, and the imbalance in the construction of information technology of medical institutions in China, leading to the new problem of uneven quality control of day surgery. This article constructs a “five-in-one” new system for the quality and safety management of day surgery from the perspective of high-quality development, aiming to provide a theoretical basis for the formulation of relevant policies in China and to promote the safe, efficient, and orderly development of day surgeries.
Electroencephalogram (EEG) is the primary tool in investigation of the brain science. It is necessary to carry out a deepgoing study into the characteristics and information hidden in EEGs to meet the needs of the clinical research. In this paper, we present a wavelet-nonlinear dynamic methodology for analysis of nonlinear characteristic of EEGs and delta, theta, alpha, and beta sub-bands. We therefore studied the effectiveness of correlation dimension (CD), largest Lyapunov exponen, and approximate entropy (ApEn) in differentiation between the interictal EEG and ictal EEG based on statistical significance of the differences. The results showed that the nonlinear dynamic characteristic of EEG and EEG subbands could be used as effective identification statistics in detecting seizures.
Progressive ischemic stroke is one of the major diseases damaging the health of Chinese people. Its pathogenesis is complex and there are many influencing factors, but the treatment methods are limited. In recent years, the rapid development of neuroimaging and the results of various clinical trials have been reported in succession, which have made new progress in the clinical diagnosis and treatment of progressive ischemic stroke. This paper summarizes the progress of progressive ischemic stroke, introduces its pathogenesis (including increased intracranial pressure and reduced perfusion pressure, thrombosis progression, hemorrhagic transformation, cerebral edema, and inflammatory response), influencing factors, predictive indicators (including image indicators, biochemical indicators, and molecular biology indicators) and treatment (including admission to “stroke unit”, intravascular treatment, platelet aggregation inhibition treatment, anticoagulation treatment, and general treatment), to provide references for preventing the occurrence and development of progressive ischemic stroke, assessing the condition, guiding treatment and improving the prognosis.
Objective To analyze the substitution mechanism of surrogate endpoints for traditional Chinese medicine (TCM) clinical efficacy evaluation of chronic heart failure (CHF). Methods To obtain data from the occurrence of surrogate endpoints and cardiogenic death of patients with CHF in 7 hospitals. The causal relationship between surrogate endpoints and cardiogenic mortality was inferred by the Bayesian network model, and the interaction among surrogate endpoints was analyzed by non-conditional logistic regression model. Results A total of 2 961 patients with CHF were included. The results of Bayesian network causal inference showed that cardiogenic mortality had a causal relationship with the surrogate endpoints including NYHA classification (P=0.46), amino-terminal pro-B-type natriuretic peptide (NT-proBNP) (P=0.24), left ventricular ejaculation fraction (LVEF) (P=0.19), and hemoglobin (HB) (P=0.11); non-conditional logistic regression analysis showed that NYHA classification had interaction with NT-proBNP, LVEF, and HB prior to and after adjusting confounders. Conclusions The substitution capability of surrogate endpoints for TCM clinical efficacy evaluation of CHF for cardiogenic mortality are NYHA classification, NT-proBNP, LVEF, and HB in turn, and there is a multiplicative interaction between the main surrogate endpoint NYHA classification and the secondary surrogate endpoints including NT-proBNP, LVEF, and HB, suggesting that when the two surrogate endpoints with interaction exist at the same time, it can enhance the substitution capability of surrogate endpoints for cardiogenic mortality.
Objective To investigate the correlation between obstructive sleep apnea hypopnea syndrome (OSAHS) and biochemical indexes in children. Methods Seventy-eight children with OSAHS in our hospital from January 2015 to February 2017 were recruited as an observation group, and 100 normal children who underwent physical examination were selected as a control group in the same period. The mean values and positive rates of biochemical markers were compared between two groups including alanine aminotransferase (ALT), blood urea nitrogen (BUN), total cholesterol (TC), triglyceride (TG), creatine kinase isoenzyme (CK-MB), cardiac troponin I (cTnI), fasting blood glucose (FPG) level. Results The mean values of biochemical indexes showed significant differences between the observation group and the control group except BUN and FPG [ALT, (52.1±26.2) U/L vs. (41.3±18.5) U/L; TC, (4.9±0.9) mmol/L vs. (4.3±0.8) mmol/L; TG, (1.4±0.7) mmol/L vs. (1.0±0.4) mmol/L; CK-MB, (24.3±9.5) U/L vs. (11.2±8.2) U/L; cTnI, (1.4±0.7) μg/L vs. (1.0±0.6) μg/L] (all P<0.05). The positive rates also showed significant differences between the observation group and the control group except BUN and FPG [ALT (48.7%vs. 14.0%), TC (24.4% vs. 8.0%), TG (23.1% vs. 8.0%), CK-MB (41.0% vs. 11.0%), cTnI (34.6% vs. 7.0%) (all P<0.05). Conclusions The cardiac function and liver function are significantly impaired in children with OSAHS, showing the disorder of lipid metabolism to some extent. These abnormal indexes may be the occurrence and development of OSAHS. More attention should be paid to the detection of biochemical indexes in children with OSAHS.
ObjectiveTo analyze the risk factors for seizures in patients with autoimmune encephalitis (AE) and to assess their predictive value for seizures. MethodsSeventy-four patients with AE from the First Affiliated Hospital of Xinjiang Medical University from January 2016 to March 2023 were collected and divided into seizure group (56 cases) and non-seizure group (18 cases), comparing the general clinical information, laboratory tests and imaging examinations and other related data of the two groups. The risk factors for seizures in AE patients were analyzed by multifactorial logistic regression, and their predictive value was assessed by receiver operating characteristic (ROC) curves. ResultsThe seizure group had a higher proportion of acute onset conditions in the underlying demographics compared with the non-seizure group (P<0.05). Laboratory data showed statistically significant differences in neutrophil count, calcitoninogen, lactate dehydrogenase, C-reactive protein, homocysteine, and interleukin-6 compared between the two groups (all P<0.05). Multi-factor logistic regression analysis of the above differential indicators showed that increased C-reactive protein [Odds ratio (OR)=4.621, 95% CI (1.123, 19.011), P=0.034], high homocysteine [OR=12.309, 95CI (2.217, 68.340), P=0.004] and onset of disease [OR=4.918, 95% CI (1.254, 19.228), P=0.022] were risk factors for seizures in AE patients, and the area under the ROC curve for the combination of the three indicators to predict seizures in AE patients was 0.856 [95% CI (0.746, 0.966)], with a sensitivity of 73.2% and a specificity of 83.3%. ConclusionHigh C-reactive protein, high homocysteine and acute onset are independent risk factors for seizures in patients with AE, and the combination of the three indices can better predict seizure status in patients.
目的：了解正常妊娠妇女常用血常规指标的变化，建立其参考值范围。方法:分别在早孕（孕10～14周）、中孕（孕20～24周）、晚孕（孕30～34周）及产后（产后12周）四个时期序贯性测定120例正常妊娠妇女血常规指标:红细胞（RBC）、血红蛋白（HB）、红细胞压积（HCT）、血小板（PLT）、白细胞（WBC），并建立参考值范围。同期选取53例健康体检非孕者为对照。结果：RBC、HCT早、中、晚孕相对于正常对照均降低（Plt;0.01）。HB在孕期降低，中、晚孕降低较明显，相对于正常对照差异有统计学意义（Plt;0.01）。PLT早、中孕降低不明显（Pgt;0.05），到晚孕期相对于正常对照降低差异有统计学意义（Plt;0.05）。WBC在妊娠四期相对于正常对照均升高（Plt;0.01）。结论：血常规各项指标随孕期发展均产生不同程度的变化，从该序惯性研究中得出了正常妊娠妇女的5个血常规指标水平的参考值范围，该参考值范围可以用于评估正常妊娠妇女的孕期健康水平。