Objective To investigate clinical characteristics of elderly patients with sepsis combined with congestive heart failure and risk factors for short-term mortality.Methods Clinical data of elderly patients with sepsis combined with congestive heart failure who were admitted in our hospital from January 2013 to January 2018 were selected and retrospectively analyzed.They were divided into the survival group(n=134)and the death group(n=83)according to survival status during hospitalization.The clinical characteristics and risk factors for mortality were analyzed and compared.Results A total of 217 elderly patients were enrolled,with 113 males and a mean age of(72.3 ± 7.5)years.The death rate of sepsis was 38.3％ (83/217 cases),and 29 cases died of sepsis and 54 cases died of other diseases.Pneumonia accounted for 78.8％ (171/217 patients) in all patients of two groups,and skin and soft tissue infection for 12.9 ％ (28/217 cases).There were significant differences between two groups in age,body mass index,smoking,diabetes,chronic obstructive pulmonary disease,mean arterial pressure,arterial oxygen partial pressure(PaO2),C-reactive protein,white blood cell counts,neutrophil and lymphocyte counts,glomerular filtration rate,serum sodium level,albumin level,lactate level,and left ventricular ejection fraction(P ＜0.05).Furthermore,the rates of invasive mechanical ventilation and continuous renal replacement therapy were higher in the death group than in the survival group(x2=13.209 and 7.402,P＜0.001 and 0.007).Multivariate Cox regression analysis showed that advanced age,chronic obstructive pulmonary disease,low albumin level and low glomerular filtration rate were risk factors for mortality(P＜0.05).Conclusions Elderly patients with sepsis combined with congestive heart failure often have severe pneumonia and violent skin and soft tissue infection,with worse heart and renal function.Advanced age,chronic obstructive pulmonary disease,low albumin level and low glomerular filtration rate are risk factors for mortality.

Objective:To investigate the influencing factors of ultrasonic missed diagnosis of kidney neoplasm.Methods:The clinical data of 2 033 patients pathologically diagnosed with kidney neoplasm after operation and with complete medical record in Shanxi Province Cancer Hospital from January 2013 to October 2021 were retrospectively analyzed. Preoperative ultrasound diagnosis, clinical data, CT/magnetic resonance imaging (MRI) were analyzed, and ultrasound missed diagnosis rate was calculated. Chi-square test and multivariate logistic regression were used to analyze the influencing factors of ultrasonic missed diagnosis of kidney neoplasm mainly based on the anatomic characteristics of neoplasm.Results:The ultrasonic missed diagnosis rate of kidney neoplasm was 1.87% (38/2 033), among which the ultrasonic missed diagnosis rate of renal parenchymal neoplasm was 1.33% (25/1 874) and the ultrasonic missed diagnosis rate of renal pelvis neoplasm was 8.18% (13/159). The results of multivariate logistic regression analysis showed that the patients' body mass index (BMI) ≥ 24 kg/m 2 ( OR = 2.805, 95% CI 1.030-7.641), the small lesion ( OR = 0.425, 95% CI 0.293-0.617), the lesion located on the left kidney ( OR = 0.307, 95% CI 0.113-0.834), the lesion located on the body ( OR = 0.344, 95% CI 0.124-0.956 compared to lesions in the upper pole of the kidney; OR = 0.239, 95% CI 0.069-0.834 compared to lesions in the lower pole of the kidney) and the lesion located on the dorsal side ( OR = 0.409, 95% CI 0.172-0.970) were independent influencing factors for ultrasound missed diagnosis of renal parenchymal neoplasms (all P < 0.05). Patients with BMI ≥ 24 kg/m 2 ( OR = 10.464, 95% CI 1.042-105.087), concurrent ureteral or (and) bladder urothelial carcinoma ( OR = 32.937, 95% CI 4.017-270.063), and small lesion size ( OR = 0.216, 95% CI 0.081-0.577) were independent influencing factors for ultrasound missed diagnosis of renal pelvis neoplasms (all P < 0.05). Conclusions:Obesity, small focus, focus on the left kidney, focus on the body, and focus on the back may be the main reasons for ultrasonic missed diagnosis of renal parenchymal neoplasms. Obesity, concurrent ureteral or/and bladder urothelial carcinoma and small lesions may be the main reasons for ultrasonic missed diagnosis of renal pelvis neoplasms.

OBJECTIVETo investigate the property of genipin-crosslinked silk fibroin(SF)/chitosan(CS) microspheres for slow releasing of bovine serum albumin (BSA).

METHODSBSA-loaded genipin-crosslinked SF/CS microspheres were prepared by emulsion cross-linking technique. The micropheres were observed for surface morphology and size distribution under scanning electron microscope (SEM), and X-ray diffractometry (XRD) and fourier transform infrared spectroscopy (FTIR) were used to analyze their structural characteristics. BCA method was used for determining the drug entrapment, loading rate and cumulative drug release in 21 days.

RESULTThe microspheres were spherical and showed a smooth surface with an average diameter of 7.84∓0.97 µm. The drug entrapment efficiency of the microspheres was (50.16∓4.32)% with a drug loading ratio of (1.25∓0.11)% and a cumulative release of the total drug of (75.2∓2.53)% in 21 days.

CONCLUSIONGenipin-crosslinked SF/CS microspheres have a high drug entrapment efficiency and possess good capacity of sustained drug release.

Chitosan ; chemistry ; Delayed-Action Preparations ; Emulsions ; Fibroins ; chemistry ; Iridoids ; chemistry ; Microscopy, Electron, Scanning ; Microspheres ; Particle Size ; Spectroscopy, Fourier Transform Infrared ; X-Ray Diffraction ; X-Rays

Objective To study the effect of evidence-based nursing in patients with cerebral apoplexy in ICU by blind bedside spiral nasointestinal tube application.Methods To choose between September 2016 and September 2017 in our hospital ICU were 140 cases of patients with cerebral apoplexy as analysis object,randomly divided into two groups,two groups all use bedside blind spiral nose long intestinal tube technology,the control group using conventional nursing method for nursing,observation group using evidence-based nursing intervention,compared two groups of a success rate of catheter,accident to take off the tube (unscheduled decannulation rate),reflux hiccups,vomiting incidence of aspiration and patient satisfaction.Results The success rate of catheterization in the observation group was higher than that in the control group,and the incidence of accidental catheterization was lower than that in the control group.The incidence of reflux hiccup and vomiting aspiration was significantly lower than that in the control group,and the patient satisfaction was higher than that in the control group (all P＜0.05).Conclusion For patients with cerebral apoplexy in the ICU bed of blind plug spiral nasal bowel technology combined evidence-based nursing intervention,clinical effect is remarkable,improve the success rate of catheter,reduces the surprise success rate of tube,unscheduled tube drawing number,reduces the incidence of reflux hiccups,vomiting aspiration,improve patient satisfaction and quality of life.