Objective:To investigate the changes and clinical significance of body mass index (BMI), blood lipid and fat soluble vitamin levels in patients with different types of severe preeclampsia.Methods:Sixty-eight pregnant women with severe preeclampsia who received antenatal examination in Lishui Maternal and Child Health Care Hospital, China from February 2017 to February 2019 were included in the study group. According to the onset time, the pregnant women were divided into an early onset group (≤ 34 weeks of gestation, n = 38) and a late onset group (> 34 weeks of gestation, n = 30). An additional 50 healthy pregnant women who concurrently received antenatal examination in the same hospital were included in the control group. Serum levels of triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), vitamin A (VA), vitamin E (VE) and vitamin D 3 (VD 3) were determined in all pregnant women. Logistic regression was used to analyze severe preeclampsia-related influential factors. Results:There were no significant differences in age, number of births and number of pregnancies among the three groups (all P > 0.05). BMI and serum levels of VA, VE, TC, TG, and LDL-C were (22.99 ± 4.39) kg/m 2, (0.48 ± 0.08) ng/mL, (11.91 ± 1.74) ng/mL, (4.93 ± 0.34) mmol/L, (1.57 ± 0.26) mmol/L, (2.68 ± 0.27) mmol/L, respectively, which were significantly higher than those in the control group [(20.68 ± 3.68) kg/m 2, (0.40 ± 0.07) ng/mL, (10.32 ± 2.56) ng/mL, (4.12 ± 0.67) mmol/L, (1.25 ± 0.32) mmol/L, (2.15 ± 0.32) mmol/L, t = 3.725, 6.698, 4.352, 8.731, 6.282, 10.512, all P < 0.05]. Serum levels of HDL-C and VD 3 in the study group were (1.51± 0.32) mmol/L and (16.16 ± 2.37) ng/mL, respectively, which were significantly lower than those in the control group [(1.88 ± 0.57) mmol/L, (17.86 ± 2.39) ng/mL, t = - 6.959, - 4.520, both P < 0.05]. BMI and serum levels of TC, TG, LDL-C, VA and VE in the early onset group were (23.13 ± 4.13) kg/m 2, (5.05 ± 0.34) mmol/L, (1.62 ± 0.27) mmol/L, (2.95 ± 0.32) mmol/L, (0.52 ± 0.06) ng/mL, (12.16 ± 1.80) ng/mL, respectively, which were significantly higher than those in the control group ( t = 6.507, 17.462, 11.217, 16.593, 9.075 and 4.142, all P < 0.05). Serum levels of HDL-C and VD 3 in the early onset group were (1.43 ± 0.28) mmol/L and (15.76 ± 2.42) ng/mL, respectively, which were significantly lower than those in the control group ( t = 14.635, 5.871, both P < 0.05). BMI and serum levels of TC, TG and VE in the late onset group were (22.70 ± 4.32) kg/m 2, (4.67±0.32) mmol/L, (1.49 ± 0.25) mmol/L and (11.45 ± 1.61) ng/mL, respectively, which were significantly higher than those in the control group ( t = 5.821, 12.857, 8.059, 3.482, all P < 0.05). Serum level of VD3 in the late onset group was (16.72 ± 2.31) ng/mL, which was significantly lower than that in the control group ( t = 4.319, P = 0.01). There were no significant differences in serum levels of LDL-C, HDL-C and VA between late onset group and control group (all P > 0.05). There were no significant differences in BMI, and serum levels of TC, TG, HDL-C, LDL-C, VA, VD 3 and VE between early onset and late onset groups (all P > 0.05). Logistic regression analysis results revealed that BMI and serum levels of TG, TC, HDL-C, LDL-C, VA, VD 3 and VE are independent influential actors of early onset severe preeclampsia ( P = 0.000, 0.008, 0.032, 0.043, 0.032, 0.002, 0.041, 0.009). BMI and serum levels of TG, TC, VD 3 and VE are independent influential actors of late onset severe preeclampsia ( P = 0.002, 0.016, 0.013, 0.031, 0.042). BMI, blood lipid and fat soluble vitamin in combination are of high value for the prediction of early onset severe preeclampsia (sensitivity 87.81% and specificity 76.67%), but they are not of high value for the prediction of late onset severe preeclampsia (sensitivity 52.51% and specificity 55.10%). Conclusion:BMI, serum lipid and fat soluble vitamin in combination are of high value in the prediction of early-onset severe preeclampsia.

Objective To discuss the clinical characteristics and treatment methods of lumbar disc herniation in adolescent and to in-crease the awareness of lumbar disc herniation among orthopedists.Methods Retrospectively reviewed the clinical data of 201 adolescent pa-tients(aged 20 years or less)with lumbar disc herniation who were admitted in General Hospital of Shenyang Military Area Command from January 2001 to December 2010.Analyzed the clinical characteristics and treatment methods,and compared the VAS score and ODI score be-fore operation,one week after operation and at the last follow up.Meanwhile,the complications were observed and compared.Results Among the 201 patients,187 patients(93.0%)presented with low back pain with or without radiating pain,20 patients(10.0%)presented with leg pain for the first symptom.There were only 97 patients(48.3%)were diagnosed with lumbar disc herniation for their first diagnosis in other hospital.Totally 70 patients(34.8%)had a history of trauma before the onset.The most common segments were L4 /L5 (101 cases,50.2%) and L5 /S1 (70 cases,34.8%).There were 140 patients treated by microendoscopy discectomy(MED),25 patients treated by percutaneous endoscopic lumbar discectomy(PELD),and 36 patients treated by open lumbar discectomy(OLD).All the patients were followed up for more than 12 months with averagely followed up for(22.9 ±11.7)months.There was significant improvement one week after operation and at the last follow up compared with the preoperative VAS score and ODI score,and the differences were statistically significant(P <0.05).The rate of postoperative complications was 3.6%,4.0%,8.3% in patients with MED,PELD and OLD respectively.Conclusion Diagnosis of LDH in adolescent is usually delayed.Increase the awareness of lumbar disc herniation could help orthopedists to get a exact medical history,per-form a directed physical examination,and order appropriate imaging studies.Minimally invasive surgery is an effective method to treat lumbar disc herniation in adolescent.

Objective To discuss and compare the clinical characteristics and difference of full-term and preterm neonatal purulent meningitis(NPM),for early diagnosis and reasonable treatment.Methods 72 newborns with NPM were collected.According to the gestational age,33 cases were divided into the full-term group(37-42 weeks) and 39 cases were divided into the preterm group (＜37 weeks).The clinical data,symptoms and signs,the related infection,the lab tests of blood and cerebrospinal fluid and pathogenic examination were analyzed and compared.Results The sex,the day age of hospital admission and onset between the two groups were no difference(P＞0.05).The rate of low-birth weight infant was 6.1％,which was significantly lower than preterm neonates(59.0 ％)(P＜0.05).The mainly clinical manifestations of full-term newborns with NPM were fever(75.8 ％),convulsions (45.5％),poor response(78.8％),and poor eating milk(45.5％).But the mainly clinical manifestations of preterm neonates with NPM were jaundice(30.8 ％),apnea(20.5 ％) and lower muscular tension(61.5 ％).There were 17 cases(51.5 ％) with NPM combined with septicemia in the full-term group,which was more than preterm neonates(20.5 ％)(P＜0.05).According to the results of the lab tests,18 full-term neonates (54.5 ％) with NPM with increased CRP levels were more than preterm neonates (28.2 ％) (P＜0.05).Besides,the preterm NPM neonates showed higher protein levels (2.35 ± 0.78) g/L and lower glucose(1.84 ±0.69) mmol/L in cerebrospinal fluid than these in the full-term group(P＜0.05).However,there was only 2 full-term NPM neonate with a positive cerebrospinal fluid culture,and 15 patients with a positive blood culture(8 full-term neonates and 7 preterm neonates).Conclusion Because of the atypical clinical characteristics and difference between the full-term neonates and the preterm neonates,the clinical symptoms and signs of neonates should be closely monitored.Therefore,it's suggested that the early diagnosis and reasonable treatment be a key plan for the low mortality and disability.

Objective To improve the quality of first aid,raise the working efficiency of nurses,make the management of endemic area crash truck more standard,scientific and simple and provide swift medical care to patients in emergency.Methods An endemic area crash truck is developed in accordance with the rule and regime of first aid item.Results Endemic area crash truck was given a national practical newtype patent and was carried out in hospitals.Conclusion Endemic area crash truck has a reasonable construction and can be locked by one time lock.It greatly shorten the time for handing over and counting by nurses,which elevates the efficiency of nurses and guarantee the management quality of first aid item.

Objective To investigate intradermal injection and subcutaneous injection of Gadodiamide MR lymphangiography (MRL) in evaluation on the central conducting lymphatics in rabbits.Methods T1 weighted three-dimendional fast low angle shot (fl3d) sequence was used before and after administration of Gadodiamide to undertake MRL.Gadodiamide was administed intrademally in the left and right footpad in 8 rabbits,and then undertake MRL in 1.5T MRI system (intradermal injection group).Three days later,Gadodiamide was administered subcutaneously in the left and right footpad in 8 rabbits,and MRL were underdone with the same sequence (subcutaneous injection group).The degree of contrast enhancement within the lumbar lymphatic trunk and thoracic duct were evaluated using a 3-point scoring system.Results Intradermal injection group showed the popliteal lymph nodes,sacral lymph node and inferior aortic lymph node enhanced obviously in all 8 rabbits,and the enhancement duration time was about 30 90 mini the lumbar lymphatic trunk and cisterna chyli were detected in 6 rabbits,and part of the thoracic duct were detected in 5 rabbits.Subcutaneous injection group showed the popliteal lymph nodes enhanced obviously in all 8 rabbits,but the lumbar lymphatic trunk and the thoracic duct were not detected.The score of contrast enhancement within the lymphatic system of intradermal injection group and subcutaneous injection group had statistical difference (t=100.00,P=0.0002).Conclusion MRL with intradermal injection Gadodiamide are better than subcutaneous injection in evaluation of the lumbar lymphatic trunk.

Objective To explore how medical staff in the oncology department understand management of cancer related fatigue (CRF), and explore what factors influencing the effective practice of CRF management. Methods Qualitative inquiry was adopted. Ten medical staffs in the oncology department were selected for in- depth interview. Generic analysis was applied to code, categorize and interpret the qualitative data. Results Participants believed that many factors influenced the CRF, which hadn′t been assessed as an independent symptom and lacked the systematic, effective and specific interventions. The medical staff, patients and their families neglecting the CRF management was the main barrier. Strengthening system construction and staff training was mentioned as major area which needed to be improved. Conclusions CRF management guideline should be formulated according to our national situations based on the clinical practices, besides, the training of correlated clinical knowledge and skills of medical staff should be strengthened and eventually promote the cancer patients′quality of life.

OBJECTIVE: To investigate the impact of coagulative parameters on different anticoagulation systems in molecular adsorbent recirculating system (MARS) in subjects with liver failure, and to evaluate the safety of different anticoagulation methods . METHODS: A prospective experimental observation was designed. According to anticoagulation Methods , 174 MARS treatment sessions for 146 patients with liver failure and prothrombin time activity percentage (PTA) ≤ 40% were randomly divided into 2 groups: 92 MARS treatment sessions in the heparin-free group and 82 in the low-dose heparin group. Time points of 0, 0.5, 1, 2, 3, 4, 5 and 6 h were selected to observe the coagulation changes of prothrombin time (PT), PTA, thrombin time (TT), activated partial thromboplastin time (APTT) and international normalized ratio (INR) dynamically. Adverse events such as line / filter coagulation, rupture and bleeding were also investigated and compared due to frequency and severity between the 2 groups. RESULTS: There was no difference in PT, PTA, INR between the 2 groups, but significant differences were observed in APTT and TT and fibrinogen (Fbg). APTT and TT levels in the low-dose heparin group was increased rapidly after the first given dose of anticoagulant heparin and reached the peak within 30 min.The levels at each time point was statistically different between the 2 groups (P<0.05). A significant difference in the Fbg level was obtained between the 2 groups. In the low-dose heparin group it was stabilized and increased slightly at the end of the treatment. While in the heparin-free group it was decreased gradually and reached a ravine at the end of the treatment. A curve was observed after 2.5 h treatment between the 2 groups (P=0.001). There were 2 cases of severe bleeding after MARS was finished in the heparin group, and 1 was terminated because of degree III clotting in the heparin-free group. CONCLUSION Fibrinogen should be adsorbed while the blood touches the MARS circuit path and anticoagulants can prevent it. Comprehensive analysis of blood platelet count (BPC), fibrin degradation products (FDP), D-dimer and clinical symptoms is critical and required to determine the coagulation status to select an anticoagulation system before MARS. The use of low dose heparin in MARS improves the disorder of hypercoagulable state during the high coaguation period, while heparin-free during low coagulation period can effectively prevent the occurrence of bleeding and improve the mechanism of blood coagulation by reducing heparin-like substance in the blood.
Adolescent ; Adsorption ; Adult ; Anticoagulants ; administration & dosage ; Disseminated Intravascular Coagulation ; prevention & control ; Female ; Heparin ; administration & dosage ; Humans ; Liver Failure ; therapy ; Liver, Artificial ; Male ; Middle Aged ; Prothrombin Time ; Sorption Detoxification ; methods ; Young Adult

Objective: To investigate the effect of space glucose control (SGC) on the quality of blood glucose management in ICU patients with stress hyperglycemia. Methods: A prospective, cross-controlled, quasi-trial was conducted to observe patients with ICU-induced stress hyperglycemia between January 2018 and January 2019. Patients with conventional blood glucose management served as the control group, and SGC blood glucose management was used as the intervention group. The enrolled patients were interchanged between the two groups every 24 h, and the end point was 96 h. The differences in blood glucose management quality indicators between the two groups were compared, including the average blood glucose level, the highest and lowest blood glucose level, the average blood glucose monitoring interval, and the accumulated insulin dosage. SPSS 23.0 was used to analyze the data. The paired t test was used for the normal distributed data. Otherwise, two nonparametric correlation sample tests was used. A P<0.05 was considered statistically significant. Results: A total of 41 patients enrolled in this study during the study period. The average blood glucose value in the intervention group was significantly lower than that in the control group [(8.60 ±1.42)mmol/L vs (10.02 ±1.49)mmol/L, P< 0.01]. The frequency of hyperglycemia was lower than that of the control group (16.59 ±8.56 vs 18.73 ±7.91, P=0.023). The frequency of blood glucose value in the target blood glucose range was significantly higher than that of the control group (53.07±19.11 vs 29.44±19.60, P< 0.01). However, the frequency of hypoglycemia, the frequency of blood glucose monitoring and the accumulated insulin dosage in the intervention group were higher than those in the control group [1 (0, 5) vs 0 (0, 2), P< 0 01; 1 36 ±0 23 vs 1 89 ±0 28, P< 0.01; and (139.61 ±77.06)U vs (107.49 ±64.41)U, P<0.01]. Conclusions SGC can optimize the control of blood glucose in the target blood glucose range, but it can easily lead to mild hypoglycemia, and to a certain extent increases the workload of medical staff.

BACKGROUND: Pain and cartilage destruction caused by osteoarthritis (OA) is a major challenge in clinical treatment.Traditional intra-articular injection of hyaluronic acid (HA) can relieve the disease, but limited by the difficulty of longterm maintenance of efficacy. METHODS: In this study, an injectable and self-healing hydrogel was synthesized by in situ crosslinking of N-carboxyethyl chitosan (N-chitosan), adipic acid dihydrazide (ADH), and hyaluronic acid–aldehyde (HA-ALD). RESULTS: This supramolecular hydrogel sustains good biocompatibility for chondrocytes. Intra-articular injection of this novel hydrogel can significantly alleviate the local inflammation microenvironment in knee joints, through inhibiting the inflammatory cytokines (such as TNF-a, IL-1b, IL-6 and IL-17) in the synovial fluid and cartilage at 2- and even 12-weeks post-injection. Histological and behavioral test indicated that hydrogel injection protected cartilage destruction and relieved pain in OA rats, in comparison to HA injection. CONCLUSION This kind of novel hydrogel, which is superior to the traditional HA injection, reveals a great potential for the treatment of OA.

BACKGROUND: Pain and cartilage destruction caused by osteoarthritis (OA) is a major challenge in clinical treatment.Traditional intra-articular injection of hyaluronic acid (HA) can relieve the disease, but limited by the difficulty of longterm maintenance of efficacy. METHODS: In this study, an injectable and self-healing hydrogel was synthesized by in situ crosslinking of N-carboxyethyl chitosan (N-chitosan), adipic acid dihydrazide (ADH), and hyaluronic acid–aldehyde (HA-ALD). RESULTS: This supramolecular hydrogel sustains good biocompatibility for chondrocytes. Intra-articular injection of this novel hydrogel can significantly alleviate the local inflammation microenvironment in knee joints, through inhibiting the inflammatory cytokines (such as TNF-a, IL-1b, IL-6 and IL-17) in the synovial fluid and cartilage at 2- and even 12-weeks post-injection. Histological and behavioral test indicated that hydrogel injection protected cartilage destruction and relieved pain in OA rats, in comparison to HA injection. CONCLUSION This kind of novel hydrogel, which is superior to the traditional HA injection, reveals a great potential for the treatment of OA.