This paper summarises the nursing experiences with a lung cancer patient who suffered Grade 4 mixed hepatotoxicity characterised with cholestasis.Summarised key care measures include close observation of liver biochemical indexes,timely and safe administration of immunosuppressants,implementation of skincare procedure,prevention of opportunistic infections,individualised exercises,nutrition care,sleep care and psychological care.The patient was discharged with oral immune inhibitors after 29 days of hospitalisation when the hepatotoxicity had been improved and down to Grade 1.In the second month of follow-up,the patient had a well-recovered liver function.

OBJECTIVE: To evaluate the long-term prognosis of patients with ST-segment elevation myocardial infarction (STEMI) treated with different reperfusion strategies in Chinese county-level hospitals. METHODS: A total of 2,514 patients with STEMI from 32 hospitals participated in the China Acute Myocardial Infarction registry between January 2013 and September 2014. The success of fibrinolysis was assessed according to indirect measures of vascular recanalization. The primary outcome was 2-year mortality. RESULTS: Reperfusion therapy was used in 1,080 patients (42.9%): fibrinolysis ( n= 664, 61.5%) and primary percutaneous coronary intervention (PCI) ( n= 416, 38.5%). The most common reason for missing reperfusion therapy was a prehospital delay > 12 h (43%). Fibrinolysis [14.5%, hazard ratio ( HR): 0.59, 95% confidence interval ( CI) 0.44-0.80] and primary PCI (6.8%, HR= 0.32, 95% CI: 0.22-0.48) were associated with lower 2-year mortality than those with no reperfusion (28.5%). Among fibrinolysis-treated patients, 510 (76.8%) achieved successful clinical reperfusion; only 17.0% of those with failed fibrinolysis underwent rescue PCI. There was no difference in 2-year mortality between successful fibrinolysis and primary PCI (8.8% vs. 6.8%, HR = 1.53, 95% CI: 0.85-2.73). Failed fibrinolysis predicted a similar mortality (33.1%) to no reperfusion (33.1% vs. 28.5%, HR= 1.30, 95% CI: 0.93-1.81). CONCLUSION In Chinese county-level hospitals, only approximately 2/5 of patients with STEMI underwent reperfusion therapy, largely due to prehospital delay. Approximately 30% of patients with failed fibrinolysis and no reperfusion therapy did not survive at 2 years. Quality improvement initiativesare warranted, especially in public health education and fast referral for mechanical revascularization in cases of failed fibrinolysis.
Humans ; ST Elevation Myocardial Infarction/therapy* ; Percutaneous Coronary Intervention ; East Asian People ; Treatment Outcome ; Myocardial Reperfusion ; Myocardial Infarction ; Registries ; Hospitals

Humans ; Mutation ; NAV1.5 Voltage-Gated Sodium Channel/genetics*

OBJECTIVE: To evaluate whether the efficacy of Getong Tongluo Capsule (, GTC, consisted of total flavone of Radix Puerariae) on improving patients' quality of life and lowering blood pressure are superior to the extract of Ginkgo biloba (EGB) for patients with convalescent-phase ischemic stroke and primary hypertension. METHODS: This randomized, positive-drug- and placebo-controlled, double-blind trial was conducted from September 2015 to October 2017. Totally 477 eligible patients from 18 hospitals in China were randomly assigned in a 2:1:1 ratio to the following interventions, twice a day for 12 weeks: (1) GTC 250 mg plus EGB-matching placebo 40 mg (237 cases, GTC group), (2) EGB 40 mg plus GTC-matching placebo 250 mg (120 cases, EGB group) or (3) GTC-matching placebo 250 mg plus EGB-matching placebo 40 mg (120 cases, placebo group). Moreover, all patients were orally administered aspirin enteric-coated tablets 100 mg, once a day for 12 weeks. The primary outcome was the Barthel Index (BI). The secondary outcomes included the control rate of blood pressure and National Institutes of Health Stroke Scale (NIHSS) scores. The incidence and severity of adverse events (AEs) were calculated and assessed. RESULTS: The BI relative independence rates, the clinical recovery rates of NIHSS, and the total effective rates of NIHSS in the GTC and EGB groups were significantly higher than the placebo group at 12 weeks after treatment (P<0.05), and no statistical significance was found between the GTC and EGB groups (P>0.05). The control rate of blood pressure in the GTC group was significantly higher than the EGB and placebo groups at 12, 18 and 24 weeks after treatment (P<0.01). There were no statistically significant differences in the incidences of AEs, adverse drug reactions, or serious AEs among the 3 groups (P>0.05). CONCLUSION GTC exhibited significant efficacy in improving patients' quality of life as well as neurological function and controlling hypertension. (Registration No. ChiCTR1800016667).

Objective: Several COVID-19 patients have overlapping comorbidities. The independent role of each component contributing to the risk of COVID-19 is unknown, and how some non-cardiometabolic comorbidities affect the risk of COVID-19 remains unclear. Methods: A retrospective follow-up design was adopted. A total of 1,160 laboratory-confirmed patients were enrolled from nine provinces in China. Data on comorbidities were obtained from the patients' medical records. Multivariable logistic regression models were used to estimate the odds ratio ( Results: Overall, 158 (13.6%) patients were diagnosed with severe illness and 32 (2.7%) had unfavorable outcomes. Hypertension (2.87, 1.30-6.32), type 2 diabetes (T2DM) (3.57, 2.32-5.49), cardiovascular disease (CVD) (3.78, 1.81-7.89), fatty liver disease (7.53, 1.96-28.96), hyperlipidemia (2.15, 1.26-3.67), other lung diseases (6.00, 3.01-11.96), and electrolyte imbalance (10.40, 3.00-26.10) were independently linked to increased odds of being severely ill. T2DM (6.07, 2.89-12.75), CVD (8.47, 6.03-11.89), and electrolyte imbalance (19.44, 11.47-32.96) were also strong predictors of unfavorable outcomes. Women with comorbidities were more likely to have severe disease on admission (5.46, 3.25-9.19), while men with comorbidities were more likely to have unfavorable treatment outcomes (6.58, 1.46-29.64) within two weeks. Conclusion Besides hypertension, diabetes, and CVD, fatty liver disease, hyperlipidemia, other lung diseases, and electrolyte imbalance were independent risk factors for COVID-19 severity and poor treatment outcome. Women with comorbidities were more likely to have severe disease, while men with comorbidities were more likely to have unfavorable treatment outcomes.
Adult ; Aged ; COVID-19/virology* ; China/epidemiology* ; Comorbidity ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Severity of Illness Index ; Treatment Outcome

Objective Cataract surgery is also considered as a type of refractive surgery , but there is few research on the change of preoperative and postoperative ocular biometry measurements .The aim of the study was to compare the A-scan ultrasound biom-etry measurements before and after phacoemulsification with intraocular lens implantation , followed by the analysis on its clinical signifi-cance . Methods Dynamic observation was conducted in 188 eyes of 155 cataract patients who received cataract operation from January 2011 to January 2013 in the department of ophthalmology in Nanjing Gernal Hospital .Measurements were made before surgery and 14 days after surgery by Ultrascan Digital 2000 contact ultraound A-scan (Alcon), including anterior chamber depth (ACD), vitreous cham-ber depth ( V) and axial length ( AL) .Simultaneously , a prospective comparison of measurements was made by A-scan ultrasound in sit-ting and decubitus position .Measurements were also conducted in preoperative and postoperative visual acuity and intraocular pressure of the patients. Results visual acuity and intraocular pressure: The difference between preoperative and postoperative visual acuity [(0.17 ±0.19) vs (0.61 ±0.27)] and intraocular pressure [(15.09 ±8.50) mmHg vs (12.99 ±4.44) mmHg] was of statistical sig-nificance ( P<0.05) .ACD:The difference between peroperative and postoperative ACDs measured by A-scan ultrasound was of statisti-cal significance (P<0.05).No significant difference existed between ACDs in sitting and decubitus positions before and after the opera -tion (P>0.05).V:The difference between peroperative and postoperative Vs was of significant difference (P<0.05).No significant difference existed between Vs in sitting and decubitus position before the operation [(16.568 ±2.406) mm vs (16.524 ±5.544) mm,with intraocular lens implantation can get better operation result. In addition, different measuring positions have no influence on A-scan ultrasound measurements except the postoperative vitreous cavity depth .

Objective: To investigate the ultrastructural pathogenesis of retina injury by observing the ultrastructural changes under the transmission electron microscope(TEM) after ocular blast injury in rabbits.Methods: Ocular blast injury models were set up in 20 rabbits by the bow wave produced with a bioshock tube.The rabbits were sacrificed at scheduled times after injury,their retinas obtained and their ultrastructural changes observed by TEM.Results: The axonal ultrastructural changes of the retina induced by blast were summarized as follows.The microfilaments and microtubules were swollen and distorted in the early stage,followed by reactive swelling of the ganglion cells.The swollen mitochondria and endoplasmic reticula focally accumulated and the cytoskeleton was destroyed.Finally the intraaxonal cellular structure disappeared and the axon disconnected.Conclusion: Ocular blast injury may cause retinal ultrastructural changes.The pathological changes of ganglion cells in the optic nerve may be associated with the direct effect of the blast and/or ischemia and are possibly important factors in the pathogenesis of vision disturbance.

Obiective: To observe the changes in corneal tissue after seawater soaking following explosive injury in rabbits and the effects of seawater soaking on the healing of cornea after explosive injury. Methods:Make 20 similar explosive injury models of rabbit's eyeball using 10 adult grey rabbits. For each rabbit, the right eye was in experiment and the left one was for comparison. After the injury, the experimental eyes were soaked in seawater for 30 minutes and the comparable eyes were soaked in 0.9% sodium chloride injection for the same time. All eyes were underwent slit lamp examinations, fluorescein dyeing, and ultrasonic cornea thickness metering on the corneas before the injury and 1,2,3,4,5,7,9,10,15 and 20 days after the injury respectively. At the same time, 2 rabbits were killed and the eyes were examined pathologically. The cornea thickness numbers were compared using self- comparison t test and grouping t test. Results: After seawater soaking following explosive injury, slit lamp microscope examination found that the corneas were edema and turbidity, the experimental eyes were stricter than the control eyes. The corneas of the experimental eye were vascularized 10 days after the injury. Fluorescein dyeing showed that more apparent pigmentations were found on the experimental eyes than that on the control ones.Comparative examination under the optical microscope showed that the corneal tissues of the experiment eyes changed distinctly, their inflammations were patency and healing was delayed and the vascularization degree became high after the injury. Cornea thickness of the experimental eyes became apparently thicker than that of the control eyes. The difference was statistically significant. Conclusion:Scars and vascularization of various degrees will appear in corneal stroma after the explosive injuries. Seawater soaking will have bad effects on the healing of the cornea injured in explosions.

Objective: To observe the clinical results of eyeball double perforation caused by metal foreign body treated by virectomy. Methods: By clinical examination combined with orbital CT, 12 eyes in 12 cases were diagnosed as eyeball double perforation caused by metal foreign body, all these eyes underwent vitrectomy, endocoagulation, and C_3F_8 vitreous cavity tamponade. Postoperative follow-up ranged from 6 months to 5 years. Results: Nine eyes’ retina remained attached. 3 eyes with retina detachment and PVR were reoperated with vitrectomy and silicon oil tamponade, and the retina reattached. Conclusion: Orbital CT is an accurate and sensitive method in diagnosing eyeball double perforation caused by metal foreign body, vitrectomy is an efficacious surgical method in the treatment of eyeball double perforation.

Objective:To observe the clinic effectiveness of cryoretinopexy under light fiber illumination during vitreoretinal surgery. Methods: Twenty-two patients with complex retinal detachment underwent vitrectomy,fluid-air exchange,cryoretinopexy under light fiber illumination.Postoperative vitreous cavity tamponade was accomplished with silicone oil in 14 cases,perfluoropropane gas in 8 cases,8 cases combined with sclera encircling. Results: Postoperative follow-up ranged 3 months to 1 year,retinal tear or hole closed and retina reattached in 20 cases.The success rate of operation was 90.9%. Conclusion: Cryoretinopexy under light fiber illumination during vitreoretinal surgery positioning is easy and accurate and the effect is definite.