OBJECTIVE: To observe the characteristics of changes in non-invasive hemodynamic parameters in neonates with septic shock so as to provide clinical reference for diagnosis and treatment. METHODS: A observational study was conducted. The neonates with sepsis complicated with septic shock or not admitted to neonatal intensive care unit (NICU) of the First Affiliated Hospital of Shantou University Medical College were enrolled as the study subjects, who were divided into preterm infant (< 37 weeks) and full-term infant (≥ 37 weeks) according to the gestational age. Healthy full-term infants and hemodynamically stable preterm infants transferring to NICU after birth were enrolled as controls. Electronic cardiometry (EC) was used to measure hemodynamic parameters, including heart rate (HR), mean arterial pressure (MAP), stroke volume (SV), stroke volume index (SVI), cardiac output (CO), cardiac index (CI), systemic vascular resistance (SVR) and systemic vascular resistance index (SVRI), before treatment in the septic shock group, at the time of diagnosis of sepsis in the sepsis without shock group, and before the discharge from the obstetric department or on the day of transferring to NICU in the control group. RESULTS: Finally, 113 neonates with complete data and parental consent for non-invasive hemodynamic monitoring were enrolled, including 32 cases in the septic shock group, 25 cases in the sepsis without shock group and 56 cases in the control group. In the septic shock group, there were 17 cases at the compensated stage and 15 cases at the decompensated stage. There were 21 full-term infants (20 cured or improved and 1 died) and 11 premature infants (7 cured or improved and 4 died), with the mortality of 15.62% (5/32). There were 18 full-term infants and 7 premature infants in the sepsis without shock group and all cured or improved without death. The control group included 28 full-term infants and 28 premature infants transferring to NICU after birth. Non-invasive hemodynamic parameter analysis showed that SV, SVI, CO and CI of full-term infants in the septic shock group were significantly lower than those in the sepsis without shock group and control group [SV (mL): 3.52±0.99 vs. 5.79±1.32, 5.22±1.02, SVI (mL/m²): 16.80 (15.05, 19.65) vs. 27.00 (22.00, 32.00), 27.00 (23.00, 29.75), CO (L/min): 0.52±0.17 vs. 0.80±0.14, 0.72±0.12, CI (mL×s^-1×m^-2): 40.00 (36.67, 49.18) vs. 62.51 (56.34, 70.85), 60.01 (53.34, 69.68), all P < 0.05], while SVR and SVRI were significantly higher than those in the sepsis without shock group and control group [SVR (kPa×s×L^-1): 773.46±291.96 vs. 524.17±84.76, 549.38±72.36, SVRI (kPa×s×L^-1×m^-2): 149.27±51.76 vs. 108.12±12.66, 107.81±11.87, all P < 0.05]. MAP, SV, SVI, CO and CI of preterm infants in the septic shock group were significantly lower than those in the control group [MAP (mmHg, 1 mmHg ≈ 0.133 kPa): 38.55±10.48 vs. 47.46±2.85, SV (mL): 2.45 (1.36, 3.58) vs. 3.96 (3.56, 4.49), SVI (mL/m²): 17.60 (14.20, 25.00) vs. 25.50 (24.00, 29.00), CO (L/min): 0.32 (0.24, 0.63) vs. 0.56 (0.49, 0.63), CI (mL×s^-1×m^-2): 40.01 (33.34, 53.34) vs. 61.68 (56.68, 63.35), all P < 0.05], while SVR and SVRI were similar to the control group [SVR (kPa×s×L^-1): 1 082.88±689.39 vs. 656.63±118.83, SVRI (kPa×s×L^-1×m^-2): 126.00±61.50 vs. 102.37±11.68, both P > 0.05]. Further analysis showed that SV, SVI and CI of neonates at the compensation stage in the septic shock group were significantly lower than those in the control group [SV (mL): 3.60±1.29 vs. 4.73±1.15, SVI (mL/m²): 19.20±8.33 vs. 26.34±3.91, CI (mL×s^-1×m^-2): 46.51±20.34 vs. 61.01±7.67, all P < 0.05], while MAP, SVR and SVRI were significantly higher than those in the control group [MAP (mmHg): 52.06±8.61 vs. 48.54±3.21, SVR (kPa×s×L^-1): 874.95±318.70 vs. 603.01±111.49, SVRI (kPa×s×L^-1×m^-2): 165.07±54.90 vs. 105.09±11.99, all P < 0.05]; MAP, SV, SVI, CO and CI of neonates at the decompensated stage in the septic shock group were significantly lower than those in the control group [MAP (mmHg): 35.13±6.08 vs. 48.54±3.21, SV (mL): 2.89±1.17 vs. 4.73±1.15, SVI (mL/m²): 18.50±4.99 vs. 26.34±3.91, CO (L/min): 0.41±0.19 vs. 0.65±0.15, CI (mL×s^-1×m^-2): 43.34±14.17 vs. 61.01±7.67, all P < 0.05], while SVR and SVRI were similar to the control group [SVR (kPa×s×L^-1): 885.49±628.04 vs. 603.01±111.49, SVRI (kPa×s×L^-1×m^-2): 114.29±43.54 vs. 105.09±11.99, both P > 0.05]. CONCLUSIONS Full-term infant with septic shock exhibit a low cardiac output, high vascular resistance hemodynamic pattern, while preterm infant with septic shock show low cardiac output and normal vascular resistance. At the compensated stage the hemodynamic change is low output and high resistance type, while at the decompensated stage it is low output and normal resistance type. Non-invasive hemodynamic monitoring can assist in the identification of neonatal septic shock and provide basis for clinical diagnosis and treatment.
Humans ; Shock, Septic/physiopathology* ; Infant, Newborn ; Hemodynamics ; Female ; Male ; Case-Control Studies ; Infant, Premature

Objective:To investigate the safety and efficacy of balloon pulmonary angioplasty (BPA) for residual pulmonary hypertension (PH) of chronic thromboembolic pulmonary hypertension(CTEPH) after pulmonary endarterectomy (PEA).Methods:Patients diagnosed as PH after PEA in China-Japan Friendship Hospital from Oct 2016 to Jun 2022 were included. The indication for BPA was decided on the basis of a consensus of the multi-disciplinary team for all patients with CTEPH. Before treatment, the patient′s exercise tolerance and pulmonary artery flow parameters were evaluated. A comparative analysis of various parameters before BPA treatment and at the last BPA was conducted. 6-min walk distance (6MWD) was analyzed using the paired Wilcoxon test; N-terminal pro-brain natriuretic peptide (NT-proBNP), mixed venous oxygen saturation, mean pulmonary arterial pressure (mPAP), cardiac index (CI) and pulmonary vascular resistance (PVR) were compared using the paired-samples t-test. WHO functional class was compared using McNemar′s test. Results:Twenty patients with a total of 130 vessels underwent 46 sessions of BPA treatment. The postoperative 6-minute walk distance (6MWD) [447 (415, 485) m] showed a significant improvement compared to the preoperative baseline [389 (335, 470) m] ( Z=6.52, P<0.05), Postoperative mixed venous oxygen saturation (72.0%±1.9%) showed a significant improvement compared to the preoperative levels (64.0%±2.7%) ( t=2.14, P<0.05).Postoperatively, plasma NT-proBNP [(351.9±129.9) pg/ml], mPAP [(24.2±1.9) mmHg], and PVR [(3.0±1.4) WU] significantly decreased compared to preoperative levels [(982.5±426.2) pg/ml, (33±2.1) mmHg, (8.0±1.6) WU)] ( t=3.38, 1.22, 2.10, P<0.05 for all). Postoperatively, there was a significant improvement in WHO functional class (Ⅰ，Ⅱ，Ⅲ，Ⅳ: 14, 4, 2, 0 cases) compared to preoperative status (Ⅰ，Ⅱ，Ⅲ，Ⅳ: 0, 13, 5, 2 cases) ( χ2=20.17, P<0.05). Four cases of pulmonary artery dissection and one episode of hemoptysis occurred postoperatively, with no other complications reported. Conclusions:BPA can significantly improve exercise tolerance and hemodynamic parameters for residual PH after PEA. BPA is a relatively safe and effective treatment for residual PH after PEA.

Objective:To analyze the risk factors for severe acute pancreatitis (SAP) complicated with infection and the effects on immune level.Methods:A total of 150 SAP patients admitted to Deyang People′s Hospital from February 2018 to April 2019 were divided into the infected group ( n=90) and the uninfected group ( n=60) according to whether SAP was complicated with infection or not; the changes of pathogenic bacteria in the infection focus, infection risk factors, blood inflammatory cytokines levels and T-lymphocyte subgroups were analyzed. Results:A total of 105 pathogenic bacteria were detected in 90 SAP patients with infection, among which 74(70.5%) were gram-negative bacteria, mainly escherichia coli, klebsiella pneumoniae and pseudomonas aeruginosa. There were 27 strains (25.7%) of gram-positive bacteria, mainly staphylococcus aureus, and 4 strains (3.81%) of fungi. Biliary causes, total parenteral nutrition time≥1 week, APACHEⅡ score≥11, surgical intervention, and respiratory mechanical ventilation were all independent factors for SAP infection (all P<0.05). At 24 hours after onset, blood IL-4(59.1±6.2)ng/L, IL-6(134.1±12.2) ng/L, IL-10(146.4±13.2)ng/L, TNF-ɑ(76.3±5.2)ng/L in infected group were all significantly higher than those in the uninfected group (all P values <0.05); at 30 days after the onset, blood IL-4(33.6±5.8)ng/L, IL-6(49.2±6.8)ng/L of the infected group, IL-10(80.7±8.8)ng/L, TNF-ɑ(28.7±5.5)ng/L in infected group were significantly lower than those in the uninfected group (all P values <0.05). At 24 hours after onset, the proportion of CD 4+ T lymphocytes in the infected group was significantly higher than that in the uninfected group [(45.3±5.5)% vs (32.3±5.2)%], and the proportion of CD 8+ T lymphocytes was significantly lower than that in the uninfected group [(20.6±4.2)% vs (29.7±4.8)%]; at 30 days after onset, the proportion of CD 4+ T lymphocytes in the infected group was significantly lower than that in the uninfected group [(21.6±3.7)% vs (40.2±2.5)%], and the proportion of CD 8+ T lymphocytes was significantly higher in the uninfected group [(48.4±4.1)% vs (32.8±4.0)%]; and all the differences were statistically significant (all P <0.05). Conclusions:The strains of concurrent infection with SAP were mainly gram-negative bacteria. Biliary causes, total parenteral nutrition time, surgical intervention and respiratory mechanical ventilation were all risk factors for concurrent infection with SAP. SAP infection may cause excessive inflammatory response and lead to immune cell damage, which should be paid attention to in clinical treatment.

Objective To compare the clinical efficacy of anatomic locking compression plate augmented with anchor nail versus calvicular hook plate in the treatmeut of Neer type Ⅱb distal calvicular fractures.Methods The data of 65 patients were retrospectively analyzed who had undergone surgery in our hospital from January 2012 to January 2015 for Neer type Ⅱb distal calvicular fractures.They were 39 men and 26 women,aged from 18 to 58 years(average,42.6 years).Open reduction plus anatonical locking compression plating augmented with anchor nailing was performed in 33 patients (group A) and open reduction plus calvicular hook plating was conducted in 32 (group B).The internal fixation was removed oue year after surgery in all.Constant Scale was used to evaluate shoulder function at 1,3 and 6 months postoperatively.X-ray examination on the shoulder was also conducted to observe fracture healing.Complications and percentage of the patients who resumed their job 3 months postoperatively were documented.Results The 2 groups were comparable because they showed no significant differences in general clinical information preoperatively (P ＞ 0.05).All the 65 patients were followed up tor 12 to 18 months (average,15.2 months).The fracture clinical healing time in group A (23.9 ± 2.3 weeks) was significantly shorter than in group B (26.1 ± 3.0 weeks) (P ＜ 0.05).The mean Constant-Murley scores at 1,3,6 months and the last follow-up postoperatively in group A (91.2 ±3.6,95.2 ±2.4,96.1 ±5.1 and 97.3 ± 1.6) were significantly higher thau those in group B (89.2 ± 6.1,91.1 ± 1.1,91.2 ± 6.2 and 92.1 ± 3.1) (P ＜ 0.05).The rate of total complications in group A (6.1％,2/33) was significantly lower than in group B (25.0％,8/32) (P ＜ 0.05).At postoperative 3 months,31 patients (93.9％) in group A resumed their job while 23 (71.9％) ones did in group B,showing a significant difference (P ＜ 0.05).Conclusions For Neer lⅡb distal calvicular fractures,anatomical locking compression plate augmented with anchor nail is obviously superior to calvicular hook plate,because the former can avoid damage to the soft tissue surrounding the acromion,leading to satisfactory functional recovery of the affected shoulder.

Objective To explore the value of comprehensive biochemical and serological test in Salmonella clinical test .Methods A total of 95 cases of suspected salmonella infection with enteric fever were selected as subjects in this study from April 2013 to A‐pril 2014 ,and 48 cases randomly divided in research group ,47 cases in control group .Regular inspection was conducted in the con‐trol group ,comprehensive biochemical and serological test were conducted in the control group .Compared the results in the two groups .Results The salmonella detection rate in the research group was 93 .75% ,which was significant higher than 68 .09% in the control group (P< 0 .05) .Conclusion Combined detection of comprehensive biochemical and serology test could detect Salmonella effectively ,it is worthy of application and popularization in clinic .

Objective To explore a variety of levels of serum marker test applications in the diagnosis of fatty liver .Methods Data were randomly selected from April 2013 to April 2014 for treatment of patients with fatty liver hospital 45 cases ,set the study group ,choose the same period in healthy volunteers to undergo a medical examination in our hospital 45 cases ,it was set to control group ,two groups of subjects were taking a variety of levels of serum markers tested .Comparison and analysis of two groups of subjects to detect a variety of levels of serum markers and positive case detection rate .Results The study group subjects ALT , AST ,TG ,TC index the average level of detection was higher than the control group ,statistically significant differences (P<0 .01);study group subjects ALT ,AST ,TG ,TC index the positive rates were 77 .78% ,93 .33% ,55 .56% ,46 .67% more than 8 .89% in the control group ,4 .44% ,15 .56% ,11 .11% higher ,statistically significant differences (P<0 .05);United biochemical indicator de‐tection of biochemical indicators of detection rate of fatty liver was obviously higher than that of single detection rate ,the difference was statistically significant (P<0 .05) .Conclusion Multiple levels of serum markers of fatty liver diagnostic test in higher detec‐tion rate .

With the development of the medicine industry and the expansion of global commu-nication and cooperation , more and more Chinese higher vocational college students who major in pharmaceutical management and administration are aware of the demands and are trying to master English for Specific Purpose (ESP) for their better future development. The necessity, course orienta-tion, curriculum design and teaching method for opening ESP course in pharmaceutical management and administration major of higher vocational college were studied in this paper.

OBJECTIVETo isolate and purify gallic acid and brevifolincarboxylic acid simultaneously by high-speed counter-current chromatography (HSCCC) from a crude extract of Polygonum capitatum.

METHODThe biphasic solvent system composed of ethyl acetate-n-butanol-0.44% acetic acid (3:1:5) was used at a flow rate of 2.0 mL x min(-1), while the aqueous phase was selected as the mobile phase and the apparatus was rotated at 860 r x min(-1). The effluent was detected at 272 nm.

RESULT51.5 mg of gallic acid and 5.9 mg of brevifolincarboxylic acid were separated from 1.07 g of the crude extract with the purities of 99.7% and 97.5%, respectively, while brevifolincarboxylic acid was obtained firstly from the genus Polygonum. The structures of the compounds were identified by ultraviolet spectrometry (UV), infra-red spectrometry (IR), liquid chromatography/mass spectrometry (LC/MS), time-of-flight mass spectrometry( TOF-MS), 1H-nuclear magnetic resonance (NMR) and 13C-NMR.

CONCLUSIONThis method is feasible and rapid for isolation and purification of gallice acid and brevifolincarboxylil acid.

Carboxylic Acids ; analysis ; isolation & purification ; Countercurrent Distribution ; methods ; Gallic Acid ; analysis ; isolation & purification ; Plant Extracts ; analysis ; isolation & purification ; Polygonum ; chemistry