Humans ; Primary Myelofibrosis ; therapy

Objective To observe the clinical curative effect of enteral nutrition (EN) liquid rich in omega-3 polyunsaturated fatty acids (ω-3PUFA) for patients suffering from acute respiratory distress syndrome (ARDS) and treated with mechanical ventilation.Methods A prospective study was conducted, 40 patients with ARDS admitted and treated in the intensive care unit (ICU) and respiratory department in the Traditional Chinese Medicine Hospital of Huzhou from May 2007 to October 2016 were enrolled, and they were randomly divided into a study group and a control group, each group 20 cases. The same heat EN support of different prescriptions was given respectively in the two groups, nasal feeding with EN emulsion rich in ω-3PUFA (TPF-T) was applied in the study group, while in the control group, nasal feeding with EN suspension liquid of protein fiber type (TPF) was given, and the target energy established for the two groups was 104.0 - 125.5 kJ·kg-1·d-1. In the two groups, before and after treatment for 7 days, the changes of nutrition indexes [total protein (TP), albumin (ALB)], inflammatory index [C-reactive protein (CRP)], immune indexes (T cell subgroup CD4, CD8 and CD4/CD8), blood gas analysis indexes [arterial blood oxygen partial pressure (PaO2), oxygenation index (PaO2/FiO2)] and mechanical ventilation time, the length of stay in ICU and fatality rate were observed; the occurrences of false aspiration, feeding tube obstruction, high blood sugar, excessive water, diarrhea, constipation, etc. complications related to the process of the treatment were observed in the two groups. Results After treatment, the levels of TP, ALB, CD4, CD4/CD8, PaO2, PaO2/FiO2 in two groups were higher than those before treatment, the levels of CRP and CD8 were lower than those before treatment, and the improvement degrees of indexes in study group were superior to those in the control group [TP (g/L): 59.9±4.8 vs. 58.6±4.1, ALB (g/L): 31.9±3.4 vs. 31.1±4.4, CRP (mg/L): 25.8±18.5 vs. 38.1±24.9, CD4: 0.30±0.05 vs. 0.28±0.04, CD8: 0.21±0.03 vs. 0.19±0.04, CD4/CD8: 1.57±0.39 vs. 1.55±0.42, PaO2 (mmHg, 1 mmHg = 0.133 kPa): 152.7±15.8 vs. 140.6±22.2, PaO2/FiO2 (mmHg): 304.5±32.1 vs. 280.2±44.1]; the survival patient mechanical ventilation time (days: 7.1±2.2 vs. 9.2±3.5) and length of stay in ICU (days: 10.4±2.8 vs. 12.6±3.6) were significantly shorter in study group than those in control group (allP < 0.05), and fatality rate was 15.0%in both groups.Conclusion The EN liquid rich in ω-3PUFA is more beneficial to the recovery of respiratory function than EN of protein fiber type in patients with ARDS, and the former EN also can shorten the mechanical ventilation time and the length of stay in ICU.

Objective To investigate the expression of c-FLIPL in leukemia and explore its clinical significance. Methods The expression level of c-FLIPL mRNA in bone marrow mononuclear cells was determined by real-time polymerase chain reaction(PCR)in 103 leukemia patients with different types of leukemia,including 54 cases of acute lymphocytic leukemia(ALL)with 37 newly diagnosed,5 relapsed,and 12 complete remis-sion,38 cases of acute myeloid leukemia(AML)with 24 newly diagnosed,6 relapsed,and 8 complete remission,newly diagnosed 2 cases of acute undifferentiated leukemia(AUL),6 cases of chronic myelocytic leukemia(CML),and 3 cases of chronic myelomonocytic leukemia(CM-ML). The immunophenotype of patients were detected by flow cytometry. Results Expression level of c-FLIPL mRNA was higher in newly diag-nosed and relapsed leukemia patients. There was no significant difference between newly diagnosed and relapsed leukemia patients(P>0.05). Ex-pression level of c-FLIPL mRNA of AUL and CML was higher than that in other patients ,but there was no significant difference(P>0.05). Ex-pression level of c-FLIPL mRNA of all newly diagnosed and relapsed leukemia patients was significantly higher than that in control group and com-plete remission group(P<0.05). The expression level of c-FLIPL mRNA was correlated with risk stratification ,white blood cell(WBC),lactate dehydrogenase(LDH),hydroxybutyrate dehydrogenase(HBDH),CD45 and TEL-AML1,but was not associated with age,sex,fibrinogen and chromosome abnormality. Conclusion c-FLIPL mRNA is highly expressed in leukemia patients ,and is closely related with risk stratification , WBC,LDH,HBDH and prognosis.

Objective To investigate the efficacy of liver transplantation for the treatment of polycystic liver disease.Methods The clinical data of 8 patients with polycystic liver disease who received liver transplantation at the Third Affiliated Hospital from September 2003 to July 2009 were retrospectively analyzed.All patients underwent modified piggyback liver transplantation with vena cava plasty,and 1 of the patients received simultaneons liver-kidney transplantation.Data including acute rejections,complications,graft functions and survival time of patients were recorded.Results Operation was successfully performed on all patients.The mean operation time,anhepatic phase and operative blood loss were (7.5 +2.8)hours (range,4-11 hours),(42 + 14)minutes (range,25-70 minutes) and (2250 ± 1850)ml (range,2000-6500 ml),respectively.One patient received liver retransplantation at 45 days after primary liver transplantation because of hepatic artery stenosis.Two patients died during perioperative period.One patient died of pulmonary infection and multiple organ disfunction syndrome (MODS) at 39 days after operation,and the other one died of MODS at 59 days after operation.The median follow-up time was 60 months (range,37-93 months).Six patients survived for more than 3 years,4 patients survived for more than 5 years and 2 patients survived for more than 7 years.No acute rejection of gratis was observed at the end of the follow up.Conclusion Liver transplantation is safe and effective for the treatment of polycystic liver disease.

Objective To evaluate the efficacy and indications of salvage liver transplantation for patients with recurrent hepatecellular carcinoma(HCC)after liver resection.MethodsThe clinical data of 35 HCC patients who received salvage liver transplantation after liver resection at the Third Affiliated Hospital of Sun Yatsen University from October 2003 to March 2006 were retrospectively analyzed.All patients were divided into the salvage liver transplantation(SLT)group(n = 19)and extended SLT group(n = 16).Perioperative condition,postoperative complications and prognosis of the 2 groups were compared.The survival rate was analyzed and compared by the Kaplan-Meier method and Log-rank test,respectively.Results The anhepatic phase,ischaemic time,operation time,intraoperative blood loss,packed red blood cell transfusion,fresh frozen plasms transfusion,mobidity and retransplantation rate were(32 ± 9)minutes,(8.0 ± 2.1)hours,(7.6 ± 1.5)hours,2300 ml,8 U,23 U,6/19 and 2/19 in the SLT group,and(34 ± 7)minutes,(7.4 ± 2.3)hours,(7.4 ± 2.0)hours,2750 ml,12 U,20 U,4/16,1/16 in the extended SLT group,respectively,with no significant difference between the 2 groups(t=0.726,-0.804,-0.366,Z=-0.348,-0.549,-0.149,x2 =0.184,0.203,P＞0.05).The perioperative mortality,tumor recurrence rate were 0 and 2/19 in the SLT group,and 4/16 and 9/16 in the extended SLT group,with significant differences between the 2 groups(x2 = 5.363,8.426,P ＜ 0.05).The 1-,3-,5-year cumulative survival rates were 100%,84% and 84% in the SLT group,and 75%,33% and 33% in the extended SLT group.The 1-,3-,5-year tumor-free survival rates were 100%,89% and 89% in the SLT group,and 48%,29% and 19% in the extended SLT group.There were significant differences in the cumulative and tumor-free survival rates between the2 groups(x2 =11.58,19.31,P＜0.05).Conclusions The efficacy of SLT is satisfactory in the treatment of recurrent HCC.The optimal indication for SLT is Milan criteria.

Objective To explore the theory of curriculum contents for gerontological nurse practitioner training which is suitable for the situation of our country. Method Delphi technique was used in this research to build content indicators of gerontological nurse practitioner training curricu-lum, and calculate the variation coefficient. Results The theory training curriculum includes founda-tions of gerontological nursing, geriatric syndrome, facilitating physiological balance and general gero-tological care modules and 41 core indexs. Every coefficient of variation is less than 20 percent [(4.35±0.71), (4.63±0.57), (4.55±0.57), (4.67±0.55)]. The mean values of the importance (4.54± 0.622) and general characteristics are more than four. Conclusion The content setting of the geron-tological nurse practitioner training theory course not only highlights the training characteristics of the geriatric care, but also has comprehensive and systematic content, reflects humanistic care spirit and pays attention to developing nurses’clinical practice ability. Therefore, it is worthy of reference and promotion.

Objective To improve the effect of clinical diagnosis and treatment of acetabular fracture with a femoral nerve injury by analyzing the causes of femoral nerve injury following acetabular fractures.Methods From January 1996 to November 2004,146 cases of acetabular fractures were treated operatively.Six cases of them were complicated with femoral nerve injury.The causes of femoral nerve injury were analyzed on the basis of clinical manifestations,CT scan and 3-dimensional reconstruc- tion.All the cases were classified according to Letournel and Judet classification.Three cases had hema- toma compression (2 cases with double column fractures and 1 with transverse-posterior wall fractures);2 cases had femoral nerve injury caused by fracture fragments (1 case with anterior wall fracture following anterior hip dislocation,the another with old fracture of anterior column combined with fracture of superior ramus of pubis);and one case had anterior column fracture combined with fracture of wing of ilium,and the femoral nerve was injured by traction in operation.Clearance of hematoma,nerve tract decompression and epineuria solution were performed in 5 cases,and 1 case was treated conservatively.Results The average follow-up period was 1.8 years(ranging from 1 to 3 years).The muscle power of quadriceps fem- oris recovered from 1-2 grade before operation to 4-5 grade after operation in 5 cases.The function of ex- tensor knee and gait was normal.The function of sensory completely recovered in 4 cases.One case was followed up for 2 years,which showed the patient still suffered from hypoesthesia in the lower 2/3 of the thigh and the medial of the leg.One ease of traction injury was followed up for 1.2 years,showing the muscle power recovered to normal,but still presented with sensory disability.Conclusion Acetabular fractures associated with femoral nerve injury are rare.For complex acetabular fractures and severe trau- ma,attention should be given to the possibility of femoral nerve injury.Fragment stabbing and compres- sion of hematoma around iliopsoas muscle are the common causes of femoral nerve injury following ace- tabular fractures.Iatrogenic injury should not be ignored.

Objective To investigate the indications, complication and survival of combined liver-kidney transplantation (CLKTs) after liver/kidney transplantation. Methods From Oct. 2003 to Dec. 2008, the clinical data of 3 patients who underwent CLKTs after liver/kidney transplantation were retrospectively followed up and literature was reviewed at our institution. The perioperative mortality, post-operative complications, survival were analyzed. Results The perioperative mortality of patients with CLKTs was 1/3. The postoperative complications: one patient with massive abdominal bleeding died of pulmonary infection, acute renal failure of graft, multiple organ failure on the 29th day after operation; 3 patients with pulmonary infection; no acute rejection of the graft. Two of 3 patients survived 56 months, 228 months from primary transplantation, respectively, while survived 40 months, 48 months from CLKTs, respectively. Conclusion CLKTs is only radical treatment method for patients with end-stage liver disease and end-stage kidney disease. CLKTs after liver/kidney transplantation were feasible.

Objective To analyze the clinical characteristics, risk factors, prevention, and treatments of de novo malignant tumors after orthotopic liver transplantation (OLT). Methods The clinical data of 4 patients with de novo malignant tumors out of the 726 patients undergoing OLT from October 2003 to December 2008 were analyzed. Results The morbidity of de novo malignant tumors after OLT was 0.6 % (4/726), and all of them were men. The 4 de novo malignant tumors were respectively diagnosed as acute myeloid leukaemia, gastric carcinoma, lung cancer, undifferentiated embryonal sarcoma of the liver. The age of patients during OLT was 42-57 years (mean 52 years). The age of patients' onset was 45-60 years (mean 53 years). The length was 6-38 months from liver transplantation to diagnosis of de novo malignant tumors (mean 31 months). All of the 4 patients died of tumor progression and multiple organ failure. The survival time was 12-48 months after OLT (mean 39.5 months), and that was 6-10 months after diagnosis of de novo malignant tumors (mean 8.5 months). Conclusion The incidence of de novo malignant tumors after OLT in China is lower than in abroad. The delayed diagnosis time is a main cause of death for patients with de novo malignant tumors after OLT. To think highly of precancerous lesions and high risk of factors, early diagnosis, and early treatment are the keys to improve the survival time.

BACKGROUND AND PURPOSE: The requirement for neurology liaison is increasing in accordance with the growing health care demands associated with aging populations. The aim of this study was to characterize the nature of neurological inpatient liaisons (NILs) to help plan for the appropriate use of neurology resources. METHODS: This was a retrospective cross-sectional study of NILs in a secondary referral hospital over a 12-month period. RESULTS: There were 853 neurological consultations with a liaison rate of 3% per admission case. Chest medicine, gastroenterology, and infectious disease were the three most frequent specialties requesting liaison, and altered consciousness, seizure, and stroke were the three most frequent disorders for which a NIL was requested. Infection was the most common cause of altered consciousness. Epilepsy, infection, and previous stroke were common causes of seizure disorders. Acute stroke accounted for 44% of all stroke disorders. Electroencephalography was the most recommended study, and was also the most frequently performed. Ninety-five percent of emergency consultations were completed within 2 hours, and 85% of regular consultations were completed within 24 hours. The consult-to-visit times for emergency and regular consultations were 44+/-47 minutes (mean+/-standard deviation) and 730+/-768 minutes, respectively, and were shorter for regular consultations at intensive care units (p=0.0151) and for seizure and stroke disorders (p=0.0032). CONCLUSIONS: Altered consciousness, seizure, and stroke were the most common reasons for NILs. Half of the patients had acute neurological diseases warranting immediate diagnosis and treatment by the consulting neurologists. Balancing increasing neurologist workloads and appropriate health-care resources remains a challenge.
Aging ; Communicable Diseases ; Consciousness ; Cross-Sectional Studies* ; Delivery of Health Care ; Diagnosis ; Electroencephalography ; Emergencies ; Epilepsy ; Gastroenterology ; Humans ; Inpatients* ; Intensive Care Units ; Nervous System Diseases* ; Neurology ; Referral and Consultation ; Retrospective Studies* ; Secondary Care Centers* ; Seizures ; Stroke ; Taiwan* ; Thorax