Objective To investigate the value of employing pulse indicator continuous cardiac output (PiCCO) for cardiac function monitoring in patients with severe septic shock.Methods A prospective observation was conducted.Thirty-six septic shock patients in Department of Critical Care Medicine of Peking University Third Hospital admitted from August 2011 to December 2013 were enrolled.According to the degree of severity,the patients were divided into PiCCO monitor group and routine monitor group.The PiCCO monitor provided a continuous assessment of fluid resuscitation,vasopressors and inotropes infusion in the patients with severe septic shock.The following cardiac function parameters were assessed in severe septic shock patients on the 1st and 3rd day after intensive care unit (ICU)admission:cardiac index (CI),global ejection fraction (GEF),rate of left ventricular pressure increase (dp/dt max),echocardiography,and blood troponin T (TNT) and B-type natriuretic peptide (BNP).The central venous pressure (CVP),mean arterial pressure (MAP) and the time reaching their standard values,and the norepinephrine dosage and 3-day fluid balance in severe septic shock patients were compared between milrinone and non-milrinone usage groups.The severity degree and outcome were compared between PiCCO monitor group and routine monitor group.Results There were 15 patients in PiCCO monitor group and 21 in routine monitor group among 36 septic shock patients.① In 15 patients with PiCCO monitoring,the patients with decreased CI,GEF,and dp/dt max accounted for 40.0％,93.3％,and 33.3％ at 1 day after ICU admission,and accounted for 60.0％,93.3％,and 60.0％ at 3 days after ICU admission,and it showed that CI,GEF,and dp/dt max was not improved at 3 days after ICU admission.Echocardiography showed that 35.7％ patients had lower left ventricular ejection fraction (LVEF) at 1 day after ICU admission,71.4％ and 71.4％ of patients,respectively,had lower early diastolic mitral flow velocity/early diastolic myocardial velocity (E/Em) and early diastolic mitral flow velocity/end diastolic mitral flow velocity (E/A).Three days after ICU admission,80％ of patients with low LVEF value turned to normal,and diastolic dysfunction was ameliorated in 50％ patients.At 1 day after ICU admission,higher TNT was found in 92.9％ of patients,higher BNP in 100％ of patients,and 3 days after ICU admission,71.4％ and 78.6％ patients showed a decrease in TNT and BNP,respectively.② In PiCCO monitor group,there were no significant differences in initial CVP,MAP and their time reaching standard values,norepinephrine dosage between milrinone group (n =8) and non-milrinone group (n =7).However,3-day intake of liquid in milrinone group was significantly higher than that in non-milrinone group (mL:8 324±3 962 vs.4 372±2 081,t =-2.362,P =0.034).③ Compared with routine monitor group,there was a significant elevation in acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,sequential organ failure assessment (SOFA) score,duration of mechanical ventilation,length of ICU stay and 28-day hospital mortality in PiCCO monitor group [APACHE Ⅱ score:20.67 ± 6.15 vs.14.71 ±4.67,t =-3.304,P =0.002; SOFA score:9.53±3.00 vs.7.52± 1.97,t =-2.433,P =0.020; duration of mechanical ventilation (hours):132 (54-310) vs.63 (14-284),Z =-2.295,P =0.022; length of ICU stay (days):7 (4-15) vs.5 (1-14),Z =-2.360,P =0.018; 28-day hospital mortality:26.7％ vs.0,P =0.023].Conclusion With the use of the PiCCO hemodynamic monitoring in patients with severe septic shock,more comprehensive values of blood volume,systemic vascular resistance and cardiac function can be obtained for guiding fluid resuscitation and selection of vasopressor and inotropic drugs.

This paper introduces a data warehouse model for outpatient payments, which is designed according to the requirements of the hospital financial management while dimensional modeling technique is combined with the analysis on the requirements. This data warehouse model can not only improve the accuracy of financial management requirements, but also greatly increase the efficiency and quality of the hospital management.
Ambulatory Care ; economics ; Databases, Factual ; Efficiency, Organizational ; Financial Management, Hospital

Adult ; Aged ; Airway Management ; Cyanides ; poisoning ; Female ; Humans ; Male ; Middle Aged ; Poisoning ; nursing ; Young Adult

Objective To compare and explore impact of subclinical hypothyroidism on metabolic risk factors of type 2 diabetes mellitus.Methods A total of 204 inpatients with type 2 diabetes mellitus.The patients were divide into two groups according to whether complicated with subclinical hypothyroidism:combination of simple type 2 diabetes mellitus (150 cases) and type 2 diabetes mellitus with SCH group(54 cases),two groups of age,gender,duration were no statistical difference.and collecting the clinical data of two groups of patients by Professional people,detection of blood lipids,glycated hemoglobin (HbA1c),uric acid (UA),Oral glucose tolerance test (OGTT),insulin and C peptide releasing test were taken in all groups.The improvement of insulin,C peptide index [HOMR-islet(CP)] and whole body insulin sensitivity index (ISIcomp) were used to estimate insuhn sensitivity,and improvement of insulin,C peptide secretion index [HOMR-isle (CP)] was used to evaluate the function of pancreatic islet β cell.T test was used for statistic alanalysis.Risk factors of type 2 diabetes mellitus with microvascular Complication by using Logistic regression analysis.Results (1) Compared with type 2 diabetes mellitus group,blood pressure,body mass index (BMI),triglycerides(TC),Low density lipoprotein cholesterol (LDL-C),UA,fasting C peptide(C-P0),postprandial 120 min C peptide(C-Pm),HOMA-IR(CP) were increased (P ＜ 0.05),while fasting blood glucose(FPG),bloods glucose in postprandial 120 min (G120),HbA1c,ISI-comp were decreased (P ＜ 0.05).(2) The incidence of diabetic nephropathy was higher in diabetic patents with subclinical hypothyroidism than those without subchnical hypothyroidism,the difference was statistically significant (P ＜ 0.05).(3) Logistic analysis showed that duration,SBP,TSH were the major risk factors of type 2 diabetes mellitus with nephropathy (P ＜ 0.05).Conclusions Type 2 diabetes mellitus patients with subclinical hypothyroidism compared to pure insulin resistance is more obvious,the degree of lipid metabolism disorders more severe.Elevated TSH can predict the occurrence of diabetic nephropathy in type 2 diabetes mellitus.

Adult ; Diabetes Mellitus ; etiology ; Humans ; Male ; Nose Diseases ; etiology ; surgery ; Pancreatitis ; complications ; Reconstructive Surgical Procedures ; Ulcer

Objective:This study investigated the prognostic significance of age at diagnosis, stage, tumor subtype, pelvic lymph node metastasis (PLNM), lymph-vascular space involvement (LVSI), presence or absence of deep cervical stromal invasion (DCSI) in stage ⅠB-ⅡA cervical cancer patients. It also investigated the inter-relationship among these factors. Methods: 152 patients treated with radical hysterectomy plus pelvic lymphadenectomy were followed up for a median of 49 months and were evaluated retrospectively. Results: The 5-year overall survival rate was 84.8%. The distribution of age at diagnosis is of bimodal shape, peaking at 42 and 68 years, respectively. Tumor subtype, PLNM, DCSI, and LVSI were found to be significant prognostic factors individually. After multivariate analysis, only tumor subtype and PLNM were found to be independent, significant prognostic factors for survival. The prognostic importance of LVSI appeared to be eclipsed by the presence of PLNM. DCSI was statistically related with FIGO stage, LVSI and PLNM. Conclusion: Tumor subtype and PLNM are the two most important independent prognostic factors for stages ⅠB-ⅡA cervical cancer. Some prognostic factors are inter-related and may reflect different facets of tumor progression.

AIM: To evaluate the physiologic change of retinal thickness during pregnancy.
METHODS:Forty cases ( 80 eyes ) were included two groups:40 eyes ( 20 cases ) in healthy pregnant women group (including in the second and last trimester), and 40 eyes (20 cases) in healthy nonpregnant women group ( control group ) . The macular volume, average thickness, central subfield thickness and retinal thickness of other parafoveal areas were measured by optical coherence tomography scan.
RESULTS: The macular volume was 10. 06±0. 41mm3 and 9. 87±0. 30mm3 in healthy pregnant women group and control group respectively. The average thickness was 279. 43±10. 86μm and 274. 25±8. 07μm in healthy pregnant women group and control group respectively. The central subfield thickness was 235. 15±15. 05μm and 233. 00±15. 81μm in healthy pregnant women group and control group espectively. Statistically significant difference was found in macular volume and average thickness (P<0. 05). The retinal thickness of 8 parafoveal areas in healthy pregnant women group increased comparing with control group, but statistical significance was only found in superior-outer area and inferior-outer area(P<0. 05). OCT images of all cases were normal.
CONCLUSION:The macular retinal thickness increases during pregnancy in the second and last trimester. The physiologic change of retinal thickness should be considered when evaluating pathologic retinal disease of pregnant women.

The paper introduces the Change Data Capture based on change-track-table implementation in hospital information system. It improves efficiency of the change data capture and distribution in the data flat.
Automatic Data Processing ; methods ; Hospital Information Systems

OBJECTIVETo analyze the epidemiological characteristics of occupational diseases in Guangzhou City, China in 2001 - 2010, and to provide a scientific basis for the prevention and control of occupational diseases.

METHODSStatistical analysis was performed on the reported data on the occupational diseases in Guangzhou from 2001 to 2010.

RESULTSA total of 380 cases of occupational diseases (37 types,8 classes) were diagnosed and reported in 2001 - 2010. The three most frequent diseases were occupational poisonings (48.9%), pneumoconiosis (20.0%), and occupational ear, nose, and throat (ENT) diseases (18.7%). In the cases of occupational poisonings, 25.3% suffered from acute occupational poisonings, especially the poisoning by dichloroethane (19.1%), and 74.7% suffered from chronic occupational poisonings, mainly caused by lead (38.8%), benzene (37.4%), and n-hexane (18.0%). The cases of silicosis accounted for 77.6% of all cases of pneumoconiosis. The cases of noise-induced deafness accounted for 97.2% of all cases of occupational ENT diseases. Patients with occupational diseases were reported in 13 districts of Guangzhou, mostly in Panyu (18.9%), Tianhe (13.2%), Baiyun (12.9%), and Liwan (11.1%). All the cases occurred in 19 industries, mainly including light industry (27.1%) and machinery industry (23.7%). Of all cases, 29.5% were in the public sector, 40.3% in the private sector, and 30.3% in the foreign-funded enterprises and those funded by businessmen from Hong Kong, Macao, and Taiwan. The ratio of male to female cases was 15:4. The mean age of onset was 42.2 ± 10.9 years. The average speed of development of occupational diseases was 134.0%, and the average growth rate was 34.0%.

CONCLUSIONThe incidence of occupational diseases tends to increase year by year, with younger age of onset and shorter history of exposure in patients. The occupational poisonings caused by lead, benzene, n-hexane, and dichloroethane, silicosis, and noise-induced deafness seem to be the main occupational hazards in Guangzhou, China. Occupational diseases occur in all districts of Guangzhou and in various industries. The private sector and small enterprises should be the focuses of occupational health supervision.

Adolescent ; Adult ; Aged ; China ; epidemiology ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Occupational Diseases ; epidemiology ; Young Adult

Objective To evaluate the stability of U6 and let-7a as internal reference genes of miRNAs in RTqPCR by using femoral head samples of cartilage tissue from inbred DA rats.Methods Total RNA was extracted from femoral head cartilage tissues of female DA rats at three different time points,i.e.at birth (D0),ablactation (D21) and maturation (D42).The expressions of different miRNAs (miR-1,-25,-26a,-140,-146a,-150,-181a,-195,-223 and-337) were detected by RT-qPCR using U6 or let-7a as the internal reference.The two sets of miR expression were compared with the results from Solexa sequencing in our pioneer work to evaluate the stability of the two internal references.Results The relative values of U6 (P =0.045) and let-7a (P =0.021 5) revealed significant difference in the D42 sample.Both in U6 and let-7a systems,miR-26a,-140,-223,and-337 showed a similar tendency in expression and quantification but miR-1 and-146a did not have significant differences.miR-25,-150,-181a and-195 differed significantly (P＜0.05).Comparison of absolute quantification results between the two generations' sequencing showed that let-7a is more stable than U6.Conclusion Let-7a is more suitable to be used as the internal reference gene in RT-qPCR for miRNAs in cartilage tissue.