Objective To investigate the therapeutic effect of bundle treatments for critically ill patients with pulmonary tuberculosis and respiratory failure (RF).Methods A prospective study was conducted, including 56 patients with pulmonary tuberculosis and RF necessary for invasive mechanical ventilation admitted into Department of Critical Care Medicine of the Fourth People's Hospital of Nanning City from January 2013 to December 2014 as the observation group to be treated by bundle treatments. A series of treatments and cares were given to the critically ill patients, such as invasive mechanical ventilation, application of antibiotics by experience within the first hour, supportive treatment targeted to hemodynamics in early stage, correction of brain dysfunction, effective therapy for tuberculosis, establishment of enteral nutrition in early stage and prevention of ventilator-associated pneumonia (VAP), etc. All the above treatments were completed one by one in 6 hours to 12 hours. Meanwhile, 42 patients who hospitalized from January 2011 to December 2012 and treated with conventional targeted therapy were designed as the control group. The changes of vital signs, blood routine test, respiration, liver, kidney, etc organ functions, the improvement of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, expected mortality and sequential organ failure assessment (SOFA) score, the incidence of VAP, cure and improvement rate, mortality, duration of invasive mechanical ventilation, the length of stay in intensive care unit (ICU) were compared between the two groups after treatments.Results There were no statistically significant differences in the comparisons between the two groups before and after treatments in temperature, white blood cell count (WBC), blood glucose, total bilirubin (TBil), alanine transaminase (ALT), albumin (Alb) and cholesterol level (allP > 0.05), except the platelet (PLT) count in observation group was higher than that in control group before treatments. After treatments for 72 hours, in the two groups, the heart rate (HR), respiration rate (RR), APACHE Ⅱ score and expected mortality were lower than those before treatments, while the arterial partial pressure of oxygen (PaO2) and oxygenation index were higher than those before treatments. There were no statistically significant differences in pH value, PLT, arterial partial pressure of carbon dioxide (PaCO2) and SOFA score before and after treatments in the control group (allP > 0.05). In the observation group, after treatments, the pH value was increased compared with that before treatments, while PLT, PaCO2 and SOFA score were decreased compared with those before treatments (allP < 0.05). The degrees of improvement of PaCO2 and oxygenation index in the observation group were superior to those in the control group [PaCO2 (mmHg, 1 mmHg = 0.133 kPa): 43.32±9.10 vs. 56.10±9.39, oxygenation index (mmHg): 330.60±100.98 vs. 245.65±83.20, bothP < 0.05]. After bundle treatments, compared with control group, the incidence of VAP was decreased [16.07% (9/56) vs. 33.33% (14/42),P < 0.05], improvement and cure rate was increased [78.57% (44/56) vs. 59.52% (25/42),P < 0.05] and mortality was decreased significantly in observation group [10.71% (6/56) vs. 28.57% (12/42),P < 0.05]. The duration of invasive mechanical ventilation (days: 9.15±3.59 vs. 16.96±13.44) and the length of stay in ICU (days: 13.30±4.24 vs. 23.00±15.03) in the observation group were shorter than those in the control group, but no statistically significant differences were found (bothP > 0.05).Conclusion The bundle treatments can effectively reduce the incidence of VAP and elevate the improvement and cure rate in patients with pulmonary tuberculosis complicated with RF.

Purpose　To investigate relationship between androgen receptor and apoptotic index and to further understand the tumor biology of prostate cancer. Methods　Fifty-six patients with histologically proven prostate cancer and 20 cases with benign prostatic hyperplasia(BPH) were collected. Androgen receptor(AR) were stained by 2H12 monoclonal antibody using immunohistochemical method. The apoptotic index (AI) was determined by the terminal deoxynucleotidyl transterase-mediated dUTP biotin nick end labeling (TUNEL) technique on serial sections of formalin fixed, paraffin embedded tissues. Results　AR was not found significantly difference (P>0.05) between prostate cancer and BPH. The association of AR with AI according to Gleason score were not observed in prostate cancer. AI were significantly higher in prostate cancer compared to BPH (P<0.05).AI were also significantly higher in AR-positive prostate cancer than in AR-negative prostate cancer（P<0.05）. Conclusion　AR expression can induce prostate cancer cells to become apoptosis, and may be a useful predictor in functional classification and endocrine response of prostate cancer.

ObjectiveTo investigate the current situation of intensive care unit (ICU) inpatients in Infectious Disease Hospital of Nanning to provide a reference for the prevention and control of infectious diseases and construction and development of ICU in such a hospital.Methods The clinical data of inpatients from January 2011 to December 2015 in the Infectious Disease Hospital Affiliated to Guangxi Medical University (that is the Fourth People's Hospital of Nanning City) were retrospectively analyzed, and the distributions of patients with various diseases, ages, of the characteristics of children severe infectious diseases in ICU, the numbers of patients with infectious diseases in general ward and ICU, the average time and daily cost of hospitalization and mortality were conducted.Results During 2011 to 2015, 855 cases in ICU were treated, including 709 cases of infectious diseases, 146 cases of non-infectious disease. The top 5 infectious diseases were ranked as follows: tuberculosis, human acquired immune deficiency syndrome (AIDS), hand-foot-mouth disease (HFMD), viral hepatitis, tetanus, accounting for 96.47% of the total infectious disease inpatients in ICU; there were 25 cases of other legal infectious diseases, accounting for 3.53%, including dengue fever, measles, malaria, chicken pox, mumps, rabies, typhoid fever, paratyphoid fever, scrub typhus, bacillary dysentery, leptospirosis, human infections with highly pathogenic H7N9 avian influenza, epidemic hemorrhagic fever, A H1N1 influenza, and besides, critically ill patients carrying virus (viral hepatitis B and AIDS) in 7 pregnant women, 22 surgical patients, and 117 patients with internal medicine diseases were also admitted and treated. The top 4 infectious diseases causing deaths in ICU were tuberculosis, AIDS, viral hepatitis and HFMD: The infectious diseases with top 6 high mortalities in ICU were as follows: rabies, viral hepatitis, AIDS, tuberculosis and tetanus. The age range was wide in this study, from 73 days to 97 years, among which there were 167 cases of pediatric infectious diseases from pediatric department, accounting for 23.55% of ICU inpatients, being mainly severe HFMD, tuberculosis and severe varicella. From 2011 to 2015, the number of hospitalized patients showed a rising trend, and the average length of stay of patients in general wards presented a downward tendency, but the average time of hospitalization of inpatients with infectious disease in ICU, mortality and daily cost of hospitalization revealed a gradually increasing trend year by year.Conclusions It is of far-reaching significance to master the spectrum of dangerous severe infectious diseases to deal with the infectious disease epidemic situation and outburst with public health events.

Objective This study is about to detect the KCNJ5 gene variations in aldosterone-producing adenoma (APA) with primary hyperaldosteronism (PA),and to investigate the association of the KCNJ5 gene missense mutations with APA and PA.Methods A total of 46 APA tumors and their clinical characteristics were collected from Hypertension Center of the People's Hospital of Xinjiang Uygur Autonomous Region,and all the tumors were confirmed by pathology.All the samples of the coding region segments of KCNJ5 were detected by PCR and direct DNA sequencing to compare the different missense mutations in the tumor cells and peripheral blood cells and to analyze the association between the genotype and phenotype.Results Three missense mutations were found in 46 patients with APA:c.451G ＞ C/A (p.G151R) (5/46),c.503T ＞ G (p.L168R) (4/46),c.830T ＞ A (p.S209T) (12/46).S209T,as an unreported somatic mutation was observed.There were no missense mutations detected in the peripheral blood.Sex,age,systolic blood pressure,diastolic blood pressure,duration of hypertension,plasma potassium,urine potassium,aldosterone,plasma renin activity,aldosterone,and plasma renin activity ratio,as well as the rate of positive family history were compared between the mutants and wild-types.Systolic blood pressure and plasma potassium level among G151 R,L168R,and S209T had statistical differences.Systolic blood pressure in G151R was significantly higher than the other two groups,while the plasma potassium level was significantly lower than the other groups.Conclusions Three missense mutations were found in 46 patients with APA.The subjects with mutations had more serious condition than those without mutations after comparing their clinical phenotype.Besides,other different subtypes may exist in PA.

Objective To explore the characteristics of resting myocardial perfusion of type 2 diabetes mellitus(T2DM) by real-time myocardial contrast echocardiography(RT-MCE). Methods Thirteen patients with T2DM and 12 in control were enrolled in the study. RT-MCE was performed using a continuous infusion of SonoVue with vena mediana in elbow. Images of left ventricle filled with contrast were acquired from apical 4-, 2-chamber and long axis views with real-time myocardial contrast mode of GE Vivid 7 Dimension system. All above images were captured in continuous 3 cardiac cycles before "flash" ,and then 15 cardiac cycles after "flash". All clips were stored for off-line analysis. Results In quiescent condition, there were significant decrease on indices of A,k and A × k in patients compared with control group (A:6.46 ±1.60 vs 6.81 ± 1.53, P ＜0.05;k:1.04 ± 0.39 vs 1.28 ± 0.31*, P ＜0.01;A× k:6.55 ± 2.72 vs 8.78 ±3.16, P ＜ 0.01, respectively). Conclusions RT-MCE could evaluate the early change of myocardial perfusion in T2DM patients and offers important reference for clinical diagnosis and treatment.

Objective:To explore the effect of quality control circle ( QQC) on the error control in PIVAS. Methods:QQC group was established in the department of PIVAS to reduce the errors in intravenous admixture practice. The status was analyzed using the total errors per week as the index, and the improvement target value was calculated by the eighty-twenty rule. The concrete causes for the errors were found out by the method of“brain storm”, and the main causes were confirmed using a fishbone diagram and the eighty-twenty rule, and then some countermeasures were summarized and carried out. The application effect of QQC was judged by the intan-gible and tangible outcomes before and after the activity, and some suggestions for the further improvement were provided. Results:Af-ter the implementation of QQC activity, the number of errors was reduced from 47 per week to 22 per week with the rate of target a-chievement of 104. 1% and the progress rate of 53. 2%. Moreover, QQC showed positive influence on the sense of being masters, co-operation ability, team spirit and sense of responsibility and confidence in the whole staff, and the ability of analyzing, summarizing and solving problems was also enhanced. Conclusion: QQC can significantly reduce the errors in the practice of intravenous admix-ture. The management method is valuable to explore and analyze the deep problems encountered in PIVAS in order to make rational and efficient measures. It is also helpful to improving the service conception of pharmacists and nurses, and enhancing the roles of pharma-cists in quality management and control to ensure medication safety.

Objective To summarize the effect of venous anastomisis from left atrium-common venous anastomisis ( supracardiac anasto-mosis) at the top of left atrium,and to find the best method to treat total anomalous pulmonary venous connection ( TAPVC) . Methods 52 cases,of which 35 male and 17 female with the age of 1 month to 41 years old and the weight of 3. 1~77 kg,hospitalized in West China hos-pital from January 2000 to April 2008,were treated by supracardiac anastomosis. Results One was dead and the other 51 cases were fully recovered and left hospital. After the operation,no anastomotic stenosis or arrhythmia was observed except the dead one. During follow-up peri-od which lasted from 3 months to 12 years,the heart function of 45 cases were normal. Conclusion supracardiac anastomosis can reduce the risk of anastomotic stenosis and arrhythmia,it is a promising method to treat supracardiac type TAPVC .

Objective: To establish a hypertension risk assessment model among the middle-aged and elderly populations based on residents' electronic healthcare records of the basic public health service program, so as to provide insights into prevention of hypertension. Methods: Demographic features and physical examinations were collected among residents at ages of 40 years and older from residents' electronic healthcare records of the basic public health service program in a county of Zhejiang Province from 2019 to 2020. The risk factors of hypertension were identified using a multivariable logistic regression model, and the odds ratio (OR) for each risk factor was transformed into approximate relative risk (RR), which was included in the formula for calculation of the disease risk proposed by Harvard School of Public Health to create a hypertension risk assessment model. The predictive value of the model was evaluated using a receiver operator characteristic (ROC) curve. Results: Totally 7 275 subjects were enrolled, with a mean age of (66.15±7.91) years, and the participants included 3 189 males and 4 086 females, with a male-to-female ratio of 0.78∶1. There were 190 cases with new-onset hypertension (2.61%). Multivariable logistic regression analysis revealed that overweight, obesity, central obesity, borderline high triacylglycerol (TG), elevated TG, abnormal fasting plasma glucose (FPG), prehypertension and family history of hypertension were included in the hypertension risk assessment model, with approximate RR values of 1.66, 1.96, 1.54, 1.17, 1.64, 1.45, 1.69 and 1.11. The area under the ROC curve (AUC) of the model was 0.678 (95%CI: 0.641-0.715, P<0.001), and the optimal positive cut-off was 0.899. The model predicted 139 subjects with RR>0.899 for hypertension, with a sensitivity of 73.16% and specificity of 55.79%. Conclusions The hypertension risk assessment model created in this study is feasible to predict the RR for developing hypertension among the middle-aged and elderly populations, which has a predictive value in healthcare management.

In order to understand the situation of schistosomiasis in Fujian Province, the surveillance and field survey data of 16 counties (cities or districts) were statistically analyzed from 2003 to 2008 according to the national and provincial surveillance protocols. The snail areas were 69 400 m~2 in 2003, and 506 700 m~2 in 2004, then decreased to 57 700 m~2 in 2008 after the snail control in 2005 and 2006. Serological examinations were conducted in 18 000 people, among which 5 412 people were the mobile population from schistosome-endemic areas, and 110 persons were positive, among which 8 persons had eggs and miracidia in their stools, among 7 885 appendix samples, Schistosoma japonicum eggs were found in 8 samples of the patients who came from the o-riginal endemic areas. By the stool examination, 2 709 head of farm cattle in the region with snails were not found infected with Schistosoma japonicum. It is suggested that the areas of residual snails are large and widespread, and the imported patients are found frequently, so the danger of schistosomisis transmission still remains.

OBJECTIVE: To investigate the clinical features, laboratory results, chest CT imaging manifestations and treatments of severe and critical influenza A (H1N1), and to analyze the relationship with the prognosis. METHODS: The clinical data of 54 adult patients with severe and critical H1N1 admitted to the Fourth People's Hospital of Nanning from November 2018 to February 2019 were analyzed retrospectively. Throat swab specimens of the patients were determined for nucleic acid detection of influenza A (H1N1) virus, and all of the patients were confirmed. The gender, age, course of disease, underlying diseases, symptoms, body temperature, hospital stays, chest CT findings and laboratory results were collected, and the treatments and prognosis were recorded. RESULTS: Of 54 patients, 38 patients were enrolled in severe group, and 16 in critical group. Fever, cough, sputum, shortness of breath and so on could be found in the two groups. The CD4⁺T lymphocytes were less than normal reference value (410-1 590/μL) in both groups. The chest CT findings manifestations of severe group were scattered patchy shadows and ground glass appearance, all of them were cured and discharged after antiviral, antibiotics, and oxygen treatment. In critical group, the time in hospital was longer, the disease progresses varied faster, the shortness of breath was more apparent, and a large patch of fuzzy and real change shadows on both lungs could be found from CT findings. Compared with the severe group, creatine kinase (CK), lactic dehydrogenase (LDH), C-reactive protein (CRP) and procalcitonin (PCT) levels in the critical group were increased more significantly [CK (U/L): 704.50 (908.50) vs. 146.00 (220.75), LDH (U/L): 614.50 (492.25) vs. 217.00 (142.75), CRP (mg/L): 85.65 (56.13) vs. 18.80 (50.63), PCT (μg/L): 1.30 (5.00) vs. 0.10 (0.16), all P < 0.01], white blood cells count (WBC) and neutrophil ratio were also increased more significantly [WBC (×10⁹/L): 12.37±7.63 vs. 8.29±3.32, neutrophil ratio: 0.81±0.11 vs. 0.75±0.11] without statistical differences (both P > 0.05). Nine patients in critical group were cured with cure rate of 56.25%. Seven patients died with mortality of 43.75%, including 2 patients with acquired immunodeficiency syndrome (AIDS) and uremia respectively, who had multiple organ failure (MOF) on admission and waive the mechanical ventilation treatment; 3 patients complicated with acute renal failure but abandon hemodialysis; 1 patient with nasopharyngeal carcinoma radiotherapy after operation; and 1 patient with chronic renal failure uremia period combined multiple drug-resistant bacteria infection, and died from MOF finally. CONCLUSIONS The patients with severe and critical influenza A (H1N1) show fever, cough, dyspnea, and organ dysfunction in varying degrees. Severe patients were mainly pulmonary lesions, while critical patients show MOF such as heart, lung and kidney, and the lesions progressed rapidly. The major cause of death for critical influenza A (H1N1) may be chronic underlying diseases and MOF.
Adult ; Antiviral Agents ; Critical Illness ; Humans ; Influenza A Virus, H1N1 Subtype ; Influenza, Human ; Retrospective Studies