Objective To investigate the predictive effect of antithrombin Ⅲ(AT-Ⅲ)combined with procalcitonin(PCT)on sepsis-associated acute kidney injury(SA-AKI).Methods A total of 96 patients with sepsis who met the inclusion criteria were in-cluded,all patients were divided into the AKI group(n=42)and non-AKI group(n=54),and the data between the two groups were compared.We used the receiver operating characteristic(ROC)curves to evaluate the predictive effect of antithrombin Ⅲ level,procalCI tonin level,and combination on SA-AKI.Multivariate Logistic regression analysis was used to study the influencing factors of SA-AKI.Results The proportion of PCT,CRP,fibrinogen,SOFA score,APACHE Ⅱ score,vasoactive drug use,and blood purification applica-tion in the AKI group was higher than that in the non-AKI group(P＜0.05),as well as the AT-Ⅲ,and platelet count were lower than those in the non-AKI group(P＜0.05).The area under the ROC curve for predicting SA-AKI in patients with sepsis was 0.876(95％CI:0.793-0.935,P＜0.01),the sensitivity was 78.6％,and the specificity was 88.9％.Multivariate Logistic regression anal-ysis showed that AT-Ⅲ(OR=0.907,95％CI:0.860-0.956)and PCT(OR=1.037,95％CI:1.002-1.074)were independent influencing factors for SA-AKI.Conclusion AT-Ⅲ combined with PCT could be used to predict SA-AKI and has good predictive ef-ficacy.

Objective:To explore the application value of four-dimensional automatic left ventricular quantitation(4D Auto LVQ) technology, in evaluating the myocardial mechanics in patients with different risk stratifications of hypertrophic cardiomyopathy(HCM).Methods:A total of 88 HCM patients and 20 healthy volunteers were selected from February 2020 to February 2022 in the First Affiliated Hospital of Zhengzhou University. According to the HCM Risk-SCD score, HCM patients were divided into 3 groups: low-risk group( n=49), intermediate-risk group( n=21), and high-risk group( n=18). Conventional ultrasound parameters were collected, and 4D Auto LVQ technology was used to obtain the mechanical parameters of left ventricular myocardium, including global longitudinal strain(GLS) , global circumferential strain(GCS), global area strain(GAS), global radial strain(GRS), twist and torsion. The differences in these parameters among the four groups were compared. The predictive values of conventional ultrasound parameters and myocardial mechanical parameters in patients with intermediate- and high-risk HCM patients were analyzed by ROC curve. Results:①Left ventricular end-diastolic diameter, left ventricular end-diastolic volume, left ventricular end-systolic volume, and peak systolic velocity of mitral annulus in the low-, intermediate-, and high-risk groups were lower than those in the control group while left ventricular maximal wall thickness(LVMWT) and early diastolic peak velocity of mitral value orifice/early diastolic peak velocity of mitral annulus(E/e′) were higher, left atrial diameter(LAD) and left ventricular outflow tract gradients(LVOTG) in the intermediate- and high-risk groups were higher than the low-risk group(all P<0.05). ②Compared with the control group, the GLS of HCM patients was lower, and the GLS of the intermediate- and high-risk groups was lower than the low-risk group. GCS and GRS in the intermediate- and high-risk groups were lower than those in the low-risk group. GAS in the high-risk group was lower than the low-risk and the control group, but higher than the intermediate-risk group(all P<0.05). Compared with the control group, the twist and torsion in the intermediate- and high-risk groups were higher, but lower than the low-risk group, and the differences were statistically significant(all P<0.05). ③The ROC results showed that the area under the curve(AUC) of the model containing conventional ultrasound parameters(LVWMT, LAD, and LVOTG) for predicting intermediate- and high-risk HCM patients was 0.811, with a sensitivity of 0.769 and a specificity of 0.755. The AUC of the conventional ultrasound parameters combined with myocardial mechanical parameters was 0.904, as the sensitivity was 0.667 and the specificity was 0.980. Conclusions:4D Auto LVQ can evaluate the mechanical characteristics of LV myocardium in HCM patients with different risk stratifications. Myocardial mechanical parameters combined with conventional ultrasound parameters can improve the diagnostic performance of patients with intermediate- and high-risk HCM.

Objective:To investigate the relationship of the acute radiation reactions of totalbody irradiation before hematopoietic stem cell transplantation with the different total and fractionated doses of irradiation.Methods:The clinical data of 48 patients who underwent 6 MV X-ray total body irradiation pretreatment from May 2015 to December 2019 in Shijiazhuang Ping'an Hospital before undergoing hematopoietic stem cell transplantation were retrospectively analyzed. The patients were divided into 8 Gy group (12 cases), 10 Gy group (31 cases) and 12 Gy group (5 cases) according to the total radiation dose, and divided into 4 Gy/f group (17 cases) and 5 Gy/f group (31 cases) according to the fractionated radiation dose. Acute radiation reactions in the oral mucosa, pharynx, salivary glands, upper gastrointestinal tract, lower gastrointestinal tract and lung of patients in each group after radiotherapy were summarized and compared.Results:Acute pharyngeal reaction in the total radiation dose of 8 Gy group showed that 11 cases (91.7%) were grade 0 and 1 case (8.3%) was grade 1; in the total radiation dose of 10 Gy group, 10 cases (32.3%) were grade 0, 13 cases (41.9%) were grade 1, 4 cases (12.9%) were grade 2, 3 cases (9.7%) were grade 3, and 1 case (3.2%) was grade 4; in the total radiation dose of 12 Gy group, 2 cases (40.0%) were grade 0, 1 case (20.0%) was grade 1, 1 case (20.0%) was grade 2, and 1 case (20.0%) was grade 3. The severity of acute pharyngeal radiation reaction in the total radiation dose of 8 Gy group was better than that in the 10 Gy and 12 Gy groups, and the difference was statistically significant ( χ2 = 11.338, P = 0.003); there was no significant difference in the incidence of acute radiation reactions in other parts (all P > 0.05). Acute pharyngeal radiation reaction in the fractionated radiation dose of 4 Gy/f group showed that 13 cases (76.5%) were grade 0, 2 case (11.8%) was grade 1, 1 case (5.9%) was grade 2, and 1 case (5.9%) was grade 3; in the 5 Gy/f group, 10 cases (32.3%) were grade 0, 13 cases (41.9%) were grade 1, 4 cases (12.9%) were grade 2, 3 cases (9.7%) were grade 3, and 1 case (3.2%) was grade 4. The severity of acute pharyngeal radiation reaction in the fractionated radiation dose 4 Gy/f group was better than that in the 5 Gy/f group, and the difference was statistically significant ( Z = -2.606, P = 0.009); there was no significant difference in the incidence of acute radiation reactions in other parts (all P > 0.05). Conclusion:The total dose of 8 Gy and fractionated dose of 4 Gy/f in the total body irradiation before hematopoietic stem cell transplantation can alleviate the acute pharyngeal radiation reaction.

Most patients with chronic subdural hematoma (CSDH) have a history of craniocerebral trauma. Avulsion of intracranial pontine vein is the main pathogenesis after craniocerebral injury. CSDH drilling and drainage is the most widely used surgical method, with low recurrence and mortality rate. However, the postoperative complication of subdural pyometra is extremely rare, which leads to high mortality and disability rate and thus representing a very challenging disease in trauma surgery. Old age, diabetes mellitus, drainage with foreign body, craniocerebral surgery, open wound, chronic systemic infectious diseases (sinusitis, otitis media, abdominal abscess, lung infection, urinary tract infection), tumor or immune deficiency diseases are all the high risk factors. This paper reviews the pathogenesis, pathogenic bacteria, clinical manifestations, auxiliary examination, treatment and prognosis of subdural empyema after CSDH drilling and drainage in recent years, and provides suggestions for clinical management.

Objective: To evaluate the outcomes of splenectomy in the treatment of relapsed/refractory autoimmune hemolytic anemia (AIHA). Methods: Retrospective analysis was performed in 30 cases with relapsed/refractory AIHA who were treated with splenectomy in our hospital. The pre- and post-operative blood routine indexes and responses were followed up. Results: Among the 30 relapsed/refractory AIHA patients, 20 were pure AIHA (including 13 patients with warm antibody AIHA, 2 with warm-cold double antibody AIHA and 5 with Coombs negative AIHA) and 10 were Evans syndrome. The short-term response was evaluated 10-14 days after operation, and the overall response rate (ORR) of short-term response was 90% [12 cases in complete response (CR), 6 cases in partial response (PR)] in 20 therapeutic evaluable cases. Among 13 patients with long-term follow-up data, except 3 patients with Evans syndrome died (2 cases were refractory to splenectomy, 1 case relapsed after surgery), the ORR of 10 patients with relapsed/refractory pure AIHA at 6 months and 12 months were 90% (9/10) and 70% (7/10), respectively, with a median follow-up of 14 (4-156) months. At the end of follow-up, 3 cases had maintained CR for more than 3 years. Conclusion The short-term response of splenectomy as a second-line treatment for relapsed/refractory AIHA is satisfactory, and long-term outcome of splenectomy is up to 70% at 1 year. Approximately one-third of patients could maintain sustained remission.

Objective: To verify the accuracy of oxygen concentration (FiO₂) of modified oxygen treatment with Venturi and humidity system. Methods: Patients just after ventilator weaning and before the removal of tracheal intubation/tracheotomy tube, who admitted to the intensive care unit (ICU) of Henan Provincial People's Hospital from May 1st to December 15th in 2017, were enrolled. All patients were given a modified oxygen treatment with Venturi and humidity system, and the oxygen flow rate (Flow) of the Venturi device and the oretical value of FiO₂ were adjusted according to the patient's condition. Patients were divided into five groups based on doctor's orders: Flow 3 L/min FiO₂ 0.24, Flow 3 L/min FiO₂ 0.26, Flow 6 L/min FiO₂ 0.28, Flow 6 L/min FiO₂ 0.30, Flow 9 L/min FiO₂ 0.35. The value of FiO₂ at the inhalation end of patients of each group was measured by TSI airflow analyzer, and the consistency between the measured value of FiO₂ at the inhalation end and the FiO₂ marked value of Venturi was compared and analyzed. Results: When the FiO₂ theoretical value of Venturi were adjusted to 0.24, 0.26, 0.28, 0.30, and 0.35, the measured values of FiO₂ at the inhalation end of patients were 0.38±0.05, 0.38±0.05, 0.40±0.04, 0.41±0.04, and 0.77±0.11, respectively, which were all significantly higher than the theoretical value of FiO₂ (all P < 0.01). The difference between the measured value of FiO₂ at the inhalation side and the FiO₂ value of the Venturi annotated and the difference rate were both "V"-shaped, both of which decreased with the increase in theoretical value of FiO₂ to a Flow of 9 L/min and a theoretical value of FiO₂ 0.35, the accuracy was the worst, with the FiO₂ difference of 0.42±0.11, and the FiO₂ difference rate of (121.6±36.5)%. Conclusion There is a difference between the measured value and the theoretical value of FiO₂ at the inhalation end of the modified Venturi oxygen therapy humidification system, which needs to be paid attention to during clinical oxygen therapy.

OBJECTIVE: To verify the accuracy of oxygen concentration (FiO₂) of modified oxygen treatment with Venturi and humidity system. METHODS: Patients just after ventilator weaning and before the removal of tracheal intubation/tracheotomy tube, who admitted to the intensive care unit (ICU) of Henan Provincial People's Hospital from May 1st to December 15th in 2017, were enrolled. All patients were given a modified oxygen treatment with Venturi and humidity system, and the oxygen flow rate (Flow) of the Venturi device and the oretical value of FiO₂ were adjusted according to the patient's condition. Patients were divided into five groups based on doctor's orders: Flow 3 L/min FiO₂ 0.24, Flow 3 L/min FiO₂ 0.26, Flow 6 L/min FiO₂ 0.28, Flow 6 L/min FiO₂ 0.30, Flow 9 L/min FiO₂ 0.35. The value of FiO₂ at the inhalation end of patients of each group was measured by TSI airflow analyzer, and the consistency between the measured value of FiO₂ at the inhalation end and the FiO₂ marked value of Venturi was compared and analyzed. RESULTS: When the FiO₂ theoretical value of Venturi were adjusted to 0.24, 0.26, 0.28, 0.30, and 0.35, the measured values of FiO₂ at the inhalation end of patients were 0.38±0.05, 0.38±0.05, 0.40±0.04, 0.41±0.04, and 0.77±0.11, respectively, which were all significantly higher than the theoretical value of FiO₂ (all P < 0.01). The difference between the measured value of FiO₂ at the inhalation side and the FiO₂ value of the Venturi annotated and the difference rate were both "V"-shaped, both of which decreased with the increase in theoretical value of FiO₂ to a Flow of 9 L/min and a theoretical value of FiO₂ 0.35, the accuracy was the worst, with the FiO₂ difference of 0.42±0.11, and the FiO₂ difference rate of (121.6±36.5)%. CONCLUSIONS There is a difference between the measured value and the theoretical value of FiO₂ at the inhalation end of the modified Venturi oxygen therapy humidification system, which needs to be paid attention to during clinical oxygen therapy.
Humans ; Humidity ; Oxygen/analysis* ; Oxygen Inhalation Therapy ; Respiration, Artificial ; Ventilator Weaning

Objective To investigate the effect of mycophenolate mofetil combined with small dose of glucocorticoids on the serum ions and β2-GPI/ox-LDL of patients with IgA nephropathy.Methods A total of 68 patients with IgA nephropathy were randomly divided into two groups, 34 cases in each group.Control group was treated with small dose of glucocorticoid, while the study group was treated with mycophenolate mofetil on the basis of control group.Serum markers and adverse reactions were recorded during the treatment.Results After treatment, levels of serum phosphorus and β2-GPI/ox-LDL decreased significantly in both groups, levels of serum calcium increased significantly, Scr, BUN, CysC and 24 h urine protein decreased significantly, levels of serum TGF-β1, IL-4 decreased significantly, IFN-γ increased significantly, levels of serum VEGF, ET-1 and MMP-9 decreased significantly (P<0.05).Compared with the control group, levels of serum phosphorus and β2-GPI/ox-LDL in the study group were significantly lower, levels of blood calcium were significantly higher, levels of Scr, BUN, CysC and 24 h urine protein were significantly lower, levels of serum TGF-β1, IL-4 were significantly lower, IFN-γ were significantly higher, and levels of serum VEGF, ET-1 and MMP-9 were significantly lower (P<0.05).Conclusion Mycophenolate mofetil combined with small dose of glucocorticoids is effective in the treatment of patients with IgA nephropathy, and it can reduce the levels of serum ions and β2-GPI/ox-LDL.

Objective To investigate the effect of mycophenolate mofetil combined with small dose of glucocorticoids on the serum ions and β2-GPI/ox-LDL of patients with IgA nephropathy.Methods A total of 68 patients with IgA nephropathy were randomly divided into two groups, 34 cases in each group.Control group was treated with small dose of glucocorticoid, while the study group was treated with mycophenolate mofetil on the basis of control group.Serum markers and adverse reactions were recorded during the treatment.Results After treatment, levels of serum phosphorus and β2-GPI/ox-LDL decreased significantly in both groups, levels of serum calcium increased significantly, Scr, BUN, CysC and 24 h urine protein decreased significantly, levels of serum TGF-β1, IL-4 decreased significantly, IFN-γ increased significantly, levels of serum VEGF, ET-1 and MMP-9 decreased significantly (P<0.05).Compared with the control group, levels of serum phosphorus and β2-GPI/ox-LDL in the study group were significantly lower, levels of blood calcium were significantly higher, levels of Scr, BUN, CysC and 24 h urine protein were significantly lower, levels of serum TGF-β1, IL-4 were significantly lower, IFN-γ were significantly higher, and levels of serum VEGF, ET-1 and MMP-9 were significantly lower (P<0.05).Conclusion Mycophenolate mofetil combined with small dose of glucocorticoids is effective in the treatment of patients with IgA nephropathy, and it can reduce the levels of serum ions and β2-GPI/ox-LDL.

Objective To investigate the association between donor complement factor component 7 (C7) rs6876739 gene polymorphisms and risk of early bacterial infection following orthotopic liver transplantation (OLT).Methods A total of 113 patients who had undergone OLT in Shanghai General Hospital between July 2007 and January 2011 were included.A single nucleotide polymorphism (SNP),donor C7 rs6876739 was genotyped and analyzed together with clinical data.Results We demortstrated that donor C7 rs6876739 CC genotype had higher risk of early bacterial infection than TT genotype following OLT (55.6％ vs.26.5％,P =0.021).The multivariate logistic regression analysis revealed that gender (P =0.018),biliary complications (P =0.018),ICU stay after LT (P＜0.001) and donor C7 rs6876739 genotype (P =0.001) were identified as independent factors of early bacterial infection.Conclusion Donor C7 rs6876739 genotype polymorphism is associated with early bacterial infection following OLT and may be a new marker of risk for the development of potentially serious bacterial infection after liver transplantation.