Objective:To explore the correlation between the intensity of net ultrafiltration in continuous renal replacement therapy (CRRT) and the survival prognosis in critically ill patients with acute kidney injury (AKI), and provide evidence-based references for establishing optimal net ultrafiltration target during CRRT.Methods:This was a retrospective observational study. Demographic and clinical data of critically ill AKI patients who received CRRT in the Intensive Care Unit of West China Hospital, Sichuan University from May 2021 to September 2023 were collected. Net ultrafiltration was defined as the hourly fluid clearance volume in the 72 hours prior of CRRT. This variable was converted into a categorical variable, including low net ultrafiltration <1.01 ml·kg -1·h -1, moderate net ultrafiltration 1.01-1.38 ml·kg -1·h -1 and high net ultrafiltration >1.38 ml·kg -1·h -1, and the differences of baseline characteristics and clinical treatment conditions among the three groups were compared. Kaplan-Meier survival curve and log-rank test were used to compare the survival conditions among the three groups in patients at 28 days and 60 days after CRRT. Logistic regression analysis method was used to analyze the related factors of mortality in patients 28 days and 60 days after CRRT. Results:This study included a total of 661 critically ill AKI patients who underwent CRRT for more than 72 hours. The age was 56.00 (43.00, 68.00) years, and 488 patients (73.83%) were males. The net ultrafiltration rate was 1.36 (0.94, 1.89) ml·kg -1·h -1. Among them, 188 patients (28.44%) were in the low net ultrafiltration group, 152 patients (23.00%) were in the medium net ultrafiltration group, and 321 patients (48.56%) were in the high net ultrafiltration group. There were statistically significant differences among the three groups in terms of gender distribution ( χ2=17.81, P<0.001), body mass index ( H=32.37, P<0.001), urine volume 24 hours before admission ( H=9.41, P=0.009), fluid overload ( H=6.02, P=0.049), platelets ( H=13.49, P=0.001), pro-B type natriuretic peptide ( H=14.18, P<0.001), serum creatinine ( H=9.66, P=0.008), lactate ( H=9.83, P=0.007), AKI stage distribution ( χ2=15.51, P=0.004), admission indication ( P<0.001), total CRRT duration ( H=8.45, P=0.015), ultrafiltration ( H=456.10, P<0.001), net ultrafiltration ( H=561.20, P<0.001), and vasoactive-inotropic score at 72 hours of CRRT treatment ( H=10.42, P=0.005). Kaplan-Meier survival analysis showed that there were statistically significant differences in the 28-day (Log-rank test, χ2=10.89, P=0.004) and 60-day (Log-rank test, χ2=8.55, P=0.014) survival rates among the three groups in patients after CRRT. Multivariate logistic regression analysis showed age ( OR=1.03, 95% CI 1.02-1.04, P<0.001), mean arterial pressure ( OR=0.98, 95% CI 0.97-1.00, P=0.011), bilirubin ( OR=3.02,95% CI 1.39-5.59, P=0.006), 72-hour vasoactive-inotropic score ( OR=1.01, 95% CI 1.00-1.02, P=0.004), low net ultrafiltration group (medium net ultrafiltration group as a reference, OR=1.66, 95% CI 1.02-2.72, P=0.042), and high net ultrafiltration group (medium net ultrafiltration group as a reference, OR=1.78, 95% CI 1.14-2.78, P=0.011) were independent correlated factors of 28-day mortality after CRRT. Age ( OR=1.02，95% CI 1.01-1.04， P<0.001), mean arterial pressure ( OR=0.98，95% CI 0.97-1.00， P=0.016), fluid overload ( OR=1.10, 95% CI 1.02-1.19, P=0.012), bilirubin ( OR=4.96，95% CI 1.00-17.80， P=0.013), 72-hour vasoactive-inotropic score ( OR=1.02，95% CI 1.01-1.03， P=0.003), and high net ultrafiltration group (medium net ultrafiltration group as a reference, OR=1.91，95% CI 1.22-3.00， P=0.005) were independent correlated factors of 60-day mortality after CRRT. Conclusions:During the first 72 hours of CRRT, net ultrafiltration > 1.38 ml·kg -1·h -1 and net ultrafiltration < 1.01 ml·kg -1·h -1 are associated with a higher mortality rate at 28 days or 60 days after CRRT. Net ultrafiltration of 1.01-1.38 ml·kg -1·h -1 may be a relatively safe range.

Objective:To explore the correlation between the intensity of net ultrafiltration in continuous renal replacement therapy (CRRT) and the survival prognosis in critically ill patients with acute kidney injury (AKI), and provide evidence-based references for establishing optimal net ultrafiltration target during CRRT.Methods:This was a retrospective observational study. Demographic and clinical data of critically ill AKI patients who received CRRT in the Intensive Care Unit of West China Hospital, Sichuan University from May 2021 to September 2023 were collected. Net ultrafiltration was defined as the hourly fluid clearance volume in the 72 hours prior of CRRT. This variable was converted into a categorical variable, including low net ultrafiltration <1.01 ml·kg -1·h -1, moderate net ultrafiltration 1.01-1.38 ml·kg -1·h -1 and high net ultrafiltration >1.38 ml·kg -1·h -1, and the differences of baseline characteristics and clinical treatment conditions among the three groups were compared. Kaplan-Meier survival curve and log-rank test were used to compare the survival conditions among the three groups in patients at 28 days and 60 days after CRRT. Logistic regression analysis method was used to analyze the related factors of mortality in patients 28 days and 60 days after CRRT. Results:This study included a total of 661 critically ill AKI patients who underwent CRRT for more than 72 hours. The age was 56.00 (43.00, 68.00) years, and 488 patients (73.83%) were males. The net ultrafiltration rate was 1.36 (0.94, 1.89) ml·kg -1·h -1. Among them, 188 patients (28.44%) were in the low net ultrafiltration group, 152 patients (23.00%) were in the medium net ultrafiltration group, and 321 patients (48.56%) were in the high net ultrafiltration group. There were statistically significant differences among the three groups in terms of gender distribution ( χ2=17.81, P<0.001), body mass index ( H=32.37, P<0.001), urine volume 24 hours before admission ( H=9.41, P=0.009), fluid overload ( H=6.02, P=0.049), platelets ( H=13.49, P=0.001), pro-B type natriuretic peptide ( H=14.18, P<0.001), serum creatinine ( H=9.66, P=0.008), lactate ( H=9.83, P=0.007), AKI stage distribution ( χ2=15.51, P=0.004), admission indication ( P<0.001), total CRRT duration ( H=8.45, P=0.015), ultrafiltration ( H=456.10, P<0.001), net ultrafiltration ( H=561.20, P<0.001), and vasoactive-inotropic score at 72 hours of CRRT treatment ( H=10.42, P=0.005). Kaplan-Meier survival analysis showed that there were statistically significant differences in the 28-day (Log-rank test, χ2=10.89, P=0.004) and 60-day (Log-rank test, χ2=8.55, P=0.014) survival rates among the three groups in patients after CRRT. Multivariate logistic regression analysis showed age ( OR=1.03, 95% CI 1.02-1.04, P<0.001), mean arterial pressure ( OR=0.98, 95% CI 0.97-1.00, P=0.011), bilirubin ( OR=3.02,95% CI 1.39-5.59, P=0.006), 72-hour vasoactive-inotropic score ( OR=1.01, 95% CI 1.00-1.02, P=0.004), low net ultrafiltration group (medium net ultrafiltration group as a reference, OR=1.66, 95% CI 1.02-2.72, P=0.042), and high net ultrafiltration group (medium net ultrafiltration group as a reference, OR=1.78, 95% CI 1.14-2.78, P=0.011) were independent correlated factors of 28-day mortality after CRRT. Age ( OR=1.02，95% CI 1.01-1.04， P<0.001), mean arterial pressure ( OR=0.98，95% CI 0.97-1.00， P=0.016), fluid overload ( OR=1.10, 95% CI 1.02-1.19, P=0.012), bilirubin ( OR=4.96，95% CI 1.00-17.80， P=0.013), 72-hour vasoactive-inotropic score ( OR=1.02，95% CI 1.01-1.03， P=0.003), and high net ultrafiltration group (medium net ultrafiltration group as a reference, OR=1.91，95% CI 1.22-3.00， P=0.005) were independent correlated factors of 60-day mortality after CRRT. Conclusions:During the first 72 hours of CRRT, net ultrafiltration > 1.38 ml·kg -1·h -1 and net ultrafiltration < 1.01 ml·kg -1·h -1 are associated with a higher mortality rate at 28 days or 60 days after CRRT. Net ultrafiltration of 1.01-1.38 ml·kg -1·h -1 may be a relatively safe range.

Objective To analyze the data of percutaneous coronary stent implantation related groups in certain hospi-tal of Beijing,so as to provide data support for promoting CHS-DRG payment reform and provide guidance and reference for its refined management.Methods The case data of local medical insurance patients in Beijing who received percutaneous coronary stent implantation from January 2020 to December 2021 in certain hospital were statistically analyzed,collect the medical insurance settlement information of the selected patients,and analyze the factors that affect their entry into FM19 group settlement.Results There are differences in the factors affecting FM19 inclusion in different reform stages,overtransfer personnel is a new independent factor that interferes with the group settlement in the actual operation stage.Some special operation codes may interfere with cases entering FM19 group due to pri-ority effect among disease groups.Conclusion The grouping settlement conditions of CHS-DRG are more complex,patients with different expense types need to be specifically analyzed according to the current grouping scheme and reimbursement policy.At present,there are relatively few disease groups settled by package for urban residents,and they continue to be affected by the rule of grouping priority.However,it is necessary to fully implement and strengthen the cost control of disease groups for urban employees,and rationally optimize the diagnosis and treat-ment plan to finely control medical costs.

Objective:To analyze the epidemiological characteristics of pneumoconiosis in Hunan Province.Methods:In November 2018, we collected the type of work, pneumoconiosis type, pneumoconiosis stage, length of service, age of onset and complications of pneumoconiosis cases diagnosed by Hunan occupational disease prevention and control hospital from January 2017 to October 2018. A total of 3 325 cases of pneumoconiosis were collected, including 651 cases (19.58%) of occupational pneumoconiosis and 2674 cases (80.42%) of clinically diagnosed pneumoconiosis. The measurement data were expressed by ± s. The comparison between groups was performed by independent sample t test and one-way ANOVA. Results:The age of 651 patients with occupational pneumoconiosis was 35.59-85.15 years old, the average age of onset was (54.27±8.29) years, and the average exposure to dust was (14.74±8.60) years. 2 674 cases of clinically diagnosed pneumoconiosis were 26.85~87.02 years old. The average age of onset was (55.26±7.38) years, and the average exposure time was (18.83±9.35) years. Compared with silicosis patients, coal workers' pneumoconiosis patients had longer exposure time, the difference was statistically significant ( P<0.05) , and the difference was statistically significant ( F=3.678, P<0.05) . There were no complications in 651 cases of occupational pneumoconiosis. Among 2 674 cases of clinically diagnosed pneumoconiosis, 710 cases (26.55%) had complications. Conclusion:Further attention should be paid to the clinical diagnosis of pneumoconiosis in Hunan Province.

Objective:To analyze the epidemiological characteristics of pneumoconiosis in Hunan Province.Methods:In November 2018, we collected the type of work, pneumoconiosis type, pneumoconiosis stage, length of service, age of onset and complications of pneumoconiosis cases diagnosed by Hunan occupational disease prevention and control hospital from January 2017 to October 2018. A total of 3 325 cases of pneumoconiosis were collected, including 651 cases (19.58%) of occupational pneumoconiosis and 2674 cases (80.42%) of clinically diagnosed pneumoconiosis. The measurement data were expressed by ± s. The comparison between groups was performed by independent sample t test and one-way ANOVA. Results:The age of 651 patients with occupational pneumoconiosis was 35.59-85.15 years old, the average age of onset was (54.27±8.29) years, and the average exposure to dust was (14.74±8.60) years. 2 674 cases of clinically diagnosed pneumoconiosis were 26.85~87.02 years old. The average age of onset was (55.26±7.38) years, and the average exposure time was (18.83±9.35) years. Compared with silicosis patients, coal workers' pneumoconiosis patients had longer exposure time, the difference was statistically significant ( P<0.05) , and the difference was statistically significant ( F=3.678, P<0.05) . There were no complications in 651 cases of occupational pneumoconiosis. Among 2 674 cases of clinically diagnosed pneumoconiosis, 710 cases (26.55%) had complications. Conclusion:Further attention should be paid to the clinical diagnosis of pneumoconiosis in Hunan Province.

Objective: To analyze the status of personnel in occupational disease prevention and treatment institutions in Hunan Province, China, from 1996 to 2015, to predict staff composition using grey model (GM) (1, 1) , and to provide a scientific basis and reference for optimizing human resource planning of occupational disease prevention and treatment in other provinces and regions and promoting the service capacity of the institutions. Methods: The data of the staff in occupational disease prevention and treatment institutions in Hunan Province, China, from 1996 to 2015 were obtained from the established basic information management system. The descriptive analysis method was used to analyze the dynamic changes in number and composition of the staff and the GM (1, 1) was used to predict the staff composition. Results: The numbers of the staff members in 1996 and 2015 in occupational disease prevention and treatment institutions in Hunan Province, China were 1591 and 1429, respectively. In the twenty years, the main education level of the staff transformed from "technical secondary school education and non-academic qualifications" to "bachelor degree or above and college degree"; the main major of the staff transformed from "other majors" to "public health and clinical medicine"; the proportion of the staff members without professional titles changed from >1/3 to 5%; and the proportions of the staff members with senior, intermediate, and junior professional titles were steadily rising. GM prediction showed that the proportions of highly educated staff members in 2018 and 2020 would be up to 41.00% and 45.61%, respectively; and the proportions of the staff members with a major in public health in 2018 and 2020 would be up to 44.15% and 46.60%, respectively. Conclusion The staff in occupational disease prevention and treatment institutions in Hunan Province, China, in the twenty years have slight changes in staff size and great improvement in staff quality, which is beneficial to sustainable development of the occupational disease prevention and treatment undertakings. The education level and major will be further optimized in the next five years.

Objective: To investigate the clinicopathological features and prognostic parameters of the inflammatory pseudotumor-like follicular dendritic cell sarcoma (IPT-like FDCS) of liver and spleen. Methods: Ninteen cases of inflammatory pseudotumor (IPT) and 5 cases of IPT-like FDCS of the liver and spleen were collected at the First Affiliated Hospital, Army Medical University from 2006 to 2016. HE sections, immunohistochemical staining, and Epstein-Barr virus encoded nuclear RNA (EBER) in situ hybridization were reviewed along with a summary of the literature. Results: Among the previously diagnosed 19 cases of IPT of the liver and spleen, 2 cases were misdiagnosed (the ratio of 2/19). Among 7 new cases including 3 males and 4 females, 3 cases involved the liver and 4 cases involved the spleen. The age range was 37-64 years (mean 53 years). The maximum tumor diameter ranged from 3.0 to 11.0 cm (mean 6.5 cm). Surgical resections were performed in all patients with follow-up time ranging from 3 to 84 months.All patients were disease-free.7 new cases were all positive for EBER, and showed the expression of at least one of the FDC markers, including CD21, CD23, and CD35. The rest of 17 cases of IPT were all negative for EBER and essentially negative for FDC markers, but were all positive for SMA. Conclusions IPT-like FDCS of the liver and spleen is a rare low-grade malignant tumor morphologically mimicking inflammatory pseudotumor, and is easy to be misdiagnosis due to under-recognition. EBER in situ hybridization and FDC markers are indispensable for confirming the diagnosis.

Objective To probe the association between possible single nucleotide polymorphism (SNP) in the FGB promoter region and idiopathic deep venous thrombosis.Methods A prospective analysis was performed in both IDVT group and control group (120 cases each) followed by a duplex examination using gene sequencing technique and restriction fragment length polymorphism (RFLP) in the promoter region of fibrinogen gene β.Possible SNPs in this region were detected arranged before HardyWeinberg equilibrium test and Linkage disequilibrium (LD) analyses.Ultimately,we compared the genotype frequencies between the two groups and undertook a multiple Logistic regression.Results Six kinds of SNPs were determined in the promoter region of β-fibrinogen gene:-148C/T,-249C/T,-455G/A,-854G/A,-993C/T and-1420G/A.A stronger linkage disequilibrium was confirmed between-993C/T and -455G/A (r2 =0.699) ;-993C/T and-148C/T (r2 =0.509) ;-455G/A and-148C/T (r2 =0.556).Statistical differences of genotype frequencies between two groups were observed in-148C/T,-249C/T,-455G/A and-1420G/A polymorphisms (all P ＜ 0.05).Conclusions The risk of IDVT was 4.579 times higher with every 1 g/L increase of fibrinogen concentration.Allele-148T,-455G and-1420A are IDVT risk factors.-993C/T may indirectly affect IDVT through linkage disequilibrium with-455G/A and-148C/T.

OBJECTIVE: To determine whether the composite acoustic therapy is effective to treat tinnitus in patients with sudden deafness and to explore the mechanisms. METHOD: Ninety-six cases (96 ears) were divided into experimental group and control group, and all the patients underwent drug treatment. The patients in experimental group were given personalized composite acoustic therapy in the first 30 days, music therapy in next 31-90 days, however, the patients in control group were not given sound therapy. Additionally, pure tone audiogram, tinnitus pitch and loudness as well as questionnaires (including THI, VAS, and SAS) were conducted for each patient before treatment, at day 30 and day 90 posttreatment. RESULT: Eighty-nine patients (n = 47 for experimental group and n = 42 for control group) completed the trial. The results of day 30 posttreatment showed there were no significant differences in VAS and hearing recovery rate between these two groups, but THI and SAS showed significant differences. The results of day 90 posttreatment showed significant differences in VAS (P < 0.05), THI (P < 0.01) and SAS (P < 0.01), and no significant difference of hearing recovery rate was detected. The most significant changes of VAS appeared in the first 30 days of treatment. The hearing and tinnitus recovery in experimental group were better for the first 30 days of treatment than for the next 31-90 days, and similar results were obtaind in control group. (P < 0.01). CONCLUSION Composite acoustic treatment combined with drug therapy can improve the tinnitus and anxiety symptoms of patients with sudden deafness, and the effect on hearing recovery still need to be confirmed in further studies.
Acoustics ; Anxiety ; Hearing Loss, Sudden ; complications ; therapy ; Hearing Tests ; Humans ; Surveys and Questionnaires ; Tinnitus ; complications ; therapy ; Treatment Outcome

OBJECTIVE: To explore the risk factors of the newborns who failed initial hearing screening by analysing the distortion production otoacoustic emission (DPOAE) results of 1021 newborns with potential risk factors of hearing loss. METHOD: All newborns, who were born in obstetrical department and admitted in the neonatal department of the Nanfang Hospital during June 2009 to January 2012 and underwent initial hearing screening, were included in this study. Their clinical data and DPOAE results were analyzed retrospectively in order to identify the risk factors for failure of initial hearing screening in infants; cases who failed the DPOAE test were followed up by telephone interviews. RESULT: (1) One hundred and thirty-seven cases (13.42%) of the 1021 newborns did not pass the hearing screening. 51 cases (5.00%) did not pass the test in both ears. Meanwhile, left ear in 47 cases (4.60%) and right ear in another 39 cases (3.82%) failed the test respectively. (2) Univariate analysis showed that 14 factors had significant influence on the hearing screening results, such as birth weight, small for gestational age, multiple pregnancy, gestational age, delivery mode, oligohydramnion, oxytocin, blood sugar level of newborn, Apgar scores at 1 min, exposed prenatally to glucocorticoid, maxillofacial deformity, hypoxic-ischemic encephalopathy, neonatal respiratory distress syndrome and neonatal asphyxia (P < 0.01). (3) Multivariate Logistic regression analysis suggested that birthweight less than 1500 g, multiple pregnancy, Apgar scores of 0-4 at 1 min, exposed prenatally to glucocorticoid and maxillofacial deformity were risk factors for failure of initial hearing screening (OR were 3.132, 1.808, 2.615, 1.827 and 12.174 respectively; 95% CI were 1.466-6.691, 1.120-2.917, 1.317-5.336, 1.130-2.953 and 1.986-74.632 respectively). (4) Results of telephone interviews revealed that Apgar scores of 0-4 at 1 min would be a risk factor of language development. CONCLUSION Birthweight less than 1500 g, multiple pregnancy, Apgar scores of 0-4 at 1 min, exposed prenatally to glucocorticoid and maxillofacial deformity are risk factors of failure of initial hearing screening among newborns with potential hearing loss. Monitoring of the hearing condition of the infants at risk should be strengthened.
Deafness ; diagnosis ; Female ; Hearing Disorders ; diagnosis ; Hearing Tests ; Humans ; Infant, Newborn ; Neonatal Screening ; Otoacoustic Emissions, Spontaneous ; Pregnancy ; Risk Factors