Objective To investigate maternal risk factors for fetal congenital heart diseases (CHD). Methods A case-control study was conducted on 16 645 pregnant women who underwent cardiovascular malformation screening for fetal cardiovascular system,whose pregnancy outcomes were recorded,and whose newborns were scanned by an echocardiography in Peking University People's Hospital,Haidian,Changping,Mentougou and Daxing Maternal and Child Health Hospital from Nov.2006 to Oct.2009.One hundred and twelve pregnant women whose babies were found to be CHD (40 severe CHD and 72 simple CHD) before or after delivery were taken as study group.Women in control group (n =304) were randomly selected from those pregnant women who had infants without CHD.Logistic regression analysis and x2 test were used to analyze the maternal risk factors for fetal CHD. Results (1) The average age of women whose infants had severe CHD was 28.3 years (21-40 years),and it was 29.9 years (22-39 years) for women whose infants had simple CHD.There were no significant differences between the control group (29.5 years,20-44 years) and the above two groups (t=1.511 and -0.826,P=0.138 and 0.410 respectively).(2) Single factor analysis:during first trimester,the rate of upper respiratory infection (18/39,46.2 ％) and exposure to certain chemicals (13/40,32.5％) of severe CHD group were higher than those of control group [(14.9％ (45/303) and 2.0％ (6/304)] (x2 =22.399 and 62.678,OR=4.895 and 23.753,95％CI:2.419-9.905 and 8.358-67.506,P =0.000 respectively).Compared with control group (0.0％,0/304),the rate of pregnant women with CHD family history in simple CHD group was significantly higher (4.2％,3/72)(Fisher exact test,P=0.007).(3) Logistic regression analysis:maternal upper respiratory infections (OR =5.120,95％CI:2.340-11.206,P =0.000) and exposure to certain chemicals (f)R=23.030,95％CI:7.506-70.665,P=0.000) during first trimester were risk factors for fetal severe CHD. Conclusions Upper respiratory infection and exposure to certain chemicals during first trimester might play important roles in the occurrence of fetal severe CHD.Maternal family history of CHD might associate with fetal simple CHD.

Objective To explore the prognostic value of peripheral blood absolute lymphocyte count (ALC) for patients with peripheral T-cell lymphoma,not otherwise specified (PTCL-NOS).Methods The clinical data of 69 patients with PTCL-NOS treated in Tianjin Union Medical Center from January 2008 to January 2016 were analyzed retrospectively.The relationship between different levels of ALC and clinical characteristics,therapeutic efficacy and prognosis was analyzed.Results Among 69 patients,23 cases (33.3％) had low ALC (＜1.0×109/L),and 46 cases (66.7％) had high ALC (≥ 1.0×109/L).Compared with the high ALC group,the low ALC group showed the higher International Prognostic Index (IPI) and PTCL-NOS Prognostic Index (PIT) scores,advanced clinical stage and higher lactate dehydrogenase level (all P ＜ 0.05).The total efficacy rate in the low ALC group was lower than that in the high ALC group [56.5％ (13/23) vs.67.4％ (31/46)],but the difference was not statistically significant (x2 =0.784,P =0.376).The 3-year survival rate in the low ALC group was significantly lower than that in the high ALC group,and the difference was statistically significant (40.5％ vs.68.6％,x2 =7.846,P =0.010).Univariate analysis showed that the US Eastern Cooperative Oncology Group performance status score ≥ 2,IPI score ≥2,Ann Arbor stage Ⅲ-Ⅳ and ALC＜1.0×109/L were the poor prognostic factors (all P ＜ 0.05),while Cox multivariate analysis showed that the Ann Arbor stage Ⅲ-Ⅳ and ALC＜1.0×109/L were the independent risk factors for prognosis of patients with PTCL-NOS (P =0.008,P =0.029).Conclusion The decrease of peripheral blood ALC in patients with PTCL-NOS at the initial diagnosis suggests a poor prognosis,and ALC can be used as a new indicator for prognosis evaluation of PTCL-NOS patients.

Objective To study the clinical features of neonates with enteroviral infection.Method We collected all neonates with enteroviral infection confirmed pathologically in the Department of Neonatology in the Children's Hospital of Fudan University from March 2009 to July 2016 retrospectively.The clinical data of the patients (clinical manifestation,first laboratory examinations,imaging findings,treatment procedures and outcomes) were retrieved to summarize the clinical features of neonatal enterovirus infection and to analyze the factors affecting the prognosis of neonatal enterovirus infection.Result A total of 81 neonates with enterovirus infection were included in the study.Among them,55 were full-term infants and 26 were premature infants,and the birth weight was (3 029±728)g.The median age of hospital admission was 5 (1,16) d,and multiple systemic manifestations were common in the course of the disease.Among them,19.8％(16/81)died.The factors for death are preterm birth,decreased hemoglobin,platelet count or serum albumin levels,abnormal coagulation,elevated blood lactate levels and acidosis.A scoring system was established based on high-risk factors.A score of ≥ 4 could reliably predict adverse outcomes,with a specificity of 92.3％ and a sensitivity of 93.8％.Conclusion Enteroviral infection in neonates can be highlt critical multiple system involvement.Neonates enterovirus infections with high risk factors(premature delivery,hemoglobin/ platelet/ albumin hypoplasia,coagulation dysfunction,lactic acid increase and acidosis) had higher mortality rate.There is a need to identify these neonates for intensive care and better treatment is warranted to improve the prognosis of these patients early.

Objective To comprehensively evaluate the clinical efficacy of hemoperfusion (HP) combined with continuous veno-venous hemofiltration (CVVH) on acute paraquat poisoning (APP).Methods Literatures of Chinese and English randomized controlled trials (RCTs), case control and cohort study on HP combined with CVVH in the treatment of APP from the PubMed, Embase, Wanfang, and CNKI up to November 2017 were enrolled (the subjects were > 16 years old). The obtained literatures were strictly screened and evaluated in quality, and data such as mortality, the life time of dead patients, inefficiency rate, incidence of multiple organ dysfunction syndrome (MODS) and acute respiratory distress syndrome (ARDS) were extracted. Meta-analysis was performed by RevMan 5.3. Results Twenty-one studies were included with 2222 subjects, among whom 976 subjects were in HP combined with CVVH group (experimental group) and 1246 subjects in HP group (control group). Compared with control group, the mortality in experimental group were significantly decreased [43.77％ (362/827) vs. 55.26％ (604/1093), odds ratio (OR) =0.68, 95％ confidential interval (95％CI) = 0.56-0.82,P = 0.0001], the life time of death patients was significantly prolonged [mean difference (MD) = 4.63, 95％CI = 2.60-6.66,P < 0.00001], incidence of MODS [25.93％ (70/270) vs. 55.36％ (155/280),OR = 0.26, 95％CI = 0.14-0.49,P< 0.0001], and incidence of ARDS [30.37％ (82/270) vs. 51.07％(143/280),OR = 0.42, 95％CI = 0.30-0.61,P < 0.00001], and inefficiency rate [8.72％ (13/149) vs. 34.64％ (53/153),OR=0.17, 95％CI = 0.09-0.34, P < 0.00001] were significantly reduced. Funnel chart showed that except the publication bias of mortality rate, there were less publication bias about other indicators among studies.Conclusion HP combined with CVVH can significantly reduce the mortality of patients with APP compared with HP alone on the whole, prolong the life time and reduce the occurrence of MODS and ARDS, thus improving the treatment efficiency.

Objective To investigate the effect of extracorporeal membrane oxygenation (ECMO) on critical patients with non-pulmonary primary disease in the emergency department. Methods The literature of English and Chinese clinical studies on the ECMO treating critical patients with non-pulmonary primary disease published before August 2017 were electronically searched on PubMed, Embase and other databases. The obtained articles were selected, their qualities were strictly evaluated, and the in-hospital survival rate, 3-month, 6-month and 1-year survival rate, as well as the average intensive care unit (ICU) and length of hospital stay were extracted. This meta-analysis were performed using RevMan software (Version 5.0, Cochrane collaboration). Results A total of 11 articles (n=3043) were enrolled including 616 cases of ECMO treatment group and 2427 cases of control group. Fitting results showed that compared with the traditional treatment, application of ECMO can improve the in-hospital survival rate[52.1％(321/616) vs. 32.1％ (780/2427); OR=2.02; 95％CI:1.11-3.67, P=0.02] and the survival rate more than 90 days[42.1％ (61/145) vs. 17.1％ (38/222); OR=3.98; 95％CI:2.30-6.89, P<0.01];and prolong the average length of hospital stay (MD=-5.35, 95％CI:-8.10--2.60, P<0.01) and ICU time(MD=-8.99, 95％CI:-8.20--1.80, P<0.01). Conclusions Meta-analysis of existing studies showed that application of ECMO can improve the short-term and long-term prognosis of critical patients with non-pulmonary primary disease. However, due to the small number of studies and the large heterogeneity of the study population, it is necessary to carry out more, large samples and high quality randomized controlled clinical trials.

Objective:To evaluate and summarize the best evidence of energy and protein intake targets and calculation in adult critically ill patients, and to provide evidence-based basis for critical nutrition management.Methods:Evidence related to energy and protein intake targets and calculation of adult critically ill patients, including guideline, expert consensus, systematic review and evidence summary, were systematically searched in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Cochrane Library, UpToDate, BMJ Best Practice, Joanna Briggs Institute (JBI), Web of Science, SinoMed, Medive, China National Knowledge Infrastructure, Wanfang database, VIP database, Guidelines International Network (GIN), National Institute for Health and Care Excellence (NICE), National Guideline Clearinghouse (NGC), Registered Nurses Association of Ontario (RNAO), and Society of Critical Care Medicine (SCCM) from January 2012 to June 2022. Two researchers independently evaluated the quality of the included literatures using the JBI Evidence-based Health Care Center evaluation tool and the Appraisal of Clinical Practice Guidelines for Research and Evaluation Ⅱ (AGREE Ⅱ), extracted and summarized the best evidence for the nutritional intake goal and calculation of adult critically ill patients, and described the evidence.Results:A total of 18 literatures were included, including 5 clinical guidelines, 8 expert consensus, 3 systematic reviews and 2 evidence summaries. After literature quality evaluation, 18 articles were all enrolled. The evidence was summarized from the four aspects, including energy target calculation method, dose body weight, energy and protein intake target, and calculation method, 24 pieces of the best evidence were finally formed.Conclusions:The best evidence of energy and protein intake targets and calculation for critically ill patients was summarized based on evidence-based. Clinical medical staff can choose indirect calorimetry to calculate energy goals when equipment is available. Patient's height, body weight should be recorded accurately, dose body weight can be determined by body mass index (BMI). Meanwhile, blood urea nitrogen (BUN) loss, fat-free body weight, simple formulas and other methods should be used to continuously evaluate and adjust protein intake targets, to achieve the purpose of optimizing intensive nutrition support.

Algorithms ; Humans ; Radiotherapy, Intensity-Modulated ; methods