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Objective:To investigate the predictive value of neutrophil/lymphocyte ratio (NLR) on the discharge outcome in elderly patients with acute ischemic stroke (AIS) receiving intravenous thrombolysis (IVT).Methods:Elderly patients with AIS received IVT in the Department of Neurology, the Second Affiliated Hospital of Soochow University from August 2018 to August 2020 were retrospectively included. The modified Rankin Scale was used to evaluate discharge outcome, and the score >2 was defined as poor outcome. Symptomatic intracranial hemorrhage (sICH) was defined as any intracranial hemorrhage found on imaging examination accompanied by neurological deterioration, where the National Institutes of Health Stroke Scale (NIHSS) score increased by ≥4 from baseline or bleeding led to death. Multivariate logistic regression analysis was used to determine independent risk factors for sICH and poor discharge outcome. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of NLR for sICH and poor discharge outcome. Results:A total of 228 elderly patients with AIS receiving IVT were enrolled, including 118 males (51.8%), aged 73.64±8.16 years, with a baseline NIHSS score of 6.23±6.54. Ninety patients (39.5%) had poor outcome at discharge, and 16 (7.0%) developed sICH. Univariate analysis showed that the NLR in the poor outcome group was significantly higher than that in the good outcome group ( P<0.01). Multivariate logistic regression analysis showed that a higher NLR was an independent risk factor for poor discharge outcome (odds ratio [ OR] 1.245, 95% confidence interval [ CI] 1.044-1.484; P< 0.05) and sICH ( OR 1.124, 95% CI 1.010-1.251; P<0.05). ROC curve analysis showed that the area under the curve of NLR for predicting poor discharge outcome was 0.693 (95% CI 0.620-0.765; P<0.01). The optimal cutoff value was 4.345. Its corresponding sensitivity and specificity were 47.8% and 87.7%, respectively. The area under the curve of NLR for predicting sICH was 0.651 (95% CI 0.498-0.804; P<0.05). The optimal cutoff value was 3.515. Its corresponding sensitivity and specificity were 68.8% and 61.8%, respectively. Conclusions:A higher NLR is independently associated with sICH and poor discharge outcome in elderly patients with AIS receiving IVT, and have certain predictive value for sICH and poor discharge outcome.
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Objective To explore the application disturbance coefficient (DC) value of noninvasive brain edema monitoring in patients after traumatic brain injury.Methods A total of 54 cerebral injury patients were performed by non-invasive brain edema monitoring from June to November 2016.The essential information,DC,intracranial pressure (ICP),and 6-month-later glasgow outcome score (GOS) were collected.Results DC was negatively correlated with ICP (r=-0.779 5,P＜0.01),and it was positively correlated with glasgow coma scale (GCS) and GOS (r=0.667 5,P＜0.01;r=0.630 6,P＜0.01).The mean of DC with good prognosis patients was 106.99±4.09,and that of the poor prognosis patients was85.26±4.45,the difference was statistically significant (P＜0.05).Conclusion DC has a good clinical application value.
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Objective To explore the effects of different flushing and sealing procedures on blood pressure fluc-tuation in patients receiving norepinephrine(NE) via micro-pump. Methods A total of 40 cases of critically ill pa-tients receiving intravenous infusion of NE via micro-pump,were randomly divided into two groups(20 cases in each group) from March to September,2016. For the experimental group,the liquid medicine in central venous catheter was sucked out,followed by flushing or sealing the tube according to conventional operation method. For the control group,conventional operation method was used to flush or seal the tube. The effects of two methods on arterial blood pressure were compared. Results Overall 423 flushing and sealing events were recorded among 40 cases in this study (209 in the experimental group and 214 in the control group). The fluctuation of blood pressure was small in the experimental group,while patients in the control group had significant fluctuation of blood pressure(P<0.05). Conclusion The new method that sucking liquid medicine out of the central venous catheter before flush-ing or sealing the tube followed by flushing or sealing using conventional operation method can reduce the risk of sudden increase in blood pressure for patients receiving small dose infusion with micro-pump.
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Objective:To explore the effect of continuous quality improvement theory on patients' satisfaction and nurses'perception of working environment.Methods:Quality nursing service satisfaction survey was conducted in 450 patients,at the same time,100 nurses were investigated for the situation of working environment.Patients' satisfaction and the status of nurses' perception of their own work environment were compared before and after the implementation of continuous quality improvement theory.Results:After the implementation of continuous quality improvement theory,both patients' satisfaction and nurses' perception of working environment were significantly improved (P ＜ 0.05).Gonclusions:Continuous quality improvement theory can improve the satisfaction of patients with high quality nursing service,and enhance the nurses' perception of their working environment.
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Through the analysis of current situation of the tension relationship between doctor and patient,this paper expounded that the harmonious management organization theory took the cooperation order as the core of the development of the group organization,and emphasized the running-in process of the internal staffs in the collective group.And it pointed out that the internal cooperation between doctor and patient had the certain cooperation order,and also had obstacles that might cause conflict in cooperation from the perspective of the harmonious management organization theory.This paper analyzed and understood the process of doctor-patient coordination at the group level of harmonious management organization theory,explored and analyzed the obstacles that might cause the conflict during the cooperation process and the reasons in the view of innovation,explored and concluded relevant measures to ease the tension of the doctor-patient relationship,and finally achieved the outcome of maximization of common interests and optimization of treatment effect.
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Objective To investigate the inhibition mechanism of tetramethylpyrazine combined with cisplatin on angiogenesis in Lewis lung cancer mice and to observe the mechanism of Arresten on angiogenesis in lung cancer. Methods The model of Lewis lung adenocarcinoma mouse xenograft was established in this work, and 40 mice were randomly divided into 4 groups: 0.9% sodium chloride solution group(NS group), tetramethylpyrazine group(TMP group), cisplatin group(DDP group), tetramethylpyrazine plus cisplatin group(TMP + DDP group), 10 mice in each group.Mice in NS group were given 0.2 mL of 0.9% sodium chloride solution, mice in DDP group were given 0.2 mL of 2 mg.kg-1 of cisplatin, mice in TMP group were given 0.2 mL of 100 mg.kg-1 of tetramethylpyrazine, mice in TMP+DDP group were given 2 mg.kg-1 of cisplatin and 100 mg.kg-1 of tetramethylpyrazine, each 0.1 mL .Tumor size was measured every day to calculate the tumor volume.The mice were sacrificed to stripp the subcutaneous tumor after continuous medication. The expressions of Arresten, integrin α1β1 and VEGF were determinated by immunhistochemistry and Western blotting. Results The tumor growth of NS group was the fastest and TMP+DDP group was the slowest. Compared with NS group, the expression of Arresten in the other three groups was increased( P<0.01) , and the TMP+DDP group exhibited the highest expression;at the same time, integrin α1β1 , VEGF in the other three groups was decreased(P<0.01), and the TMP+DDP group exhibited the lowest expression.The expression of integrinα1β1 and VEGF was negatively related to Arresten, and the expression of integrin α1β1 was positively correlated with VEGF. Conclusion TMP can inhibited the growth of Lewis lung carcinoma and angiogenesis. Moreover, in combination with cisplatin, TMP can also improved the effect of chemotherapy and then the survival state of mice. The mechanism of action, which TMP suppress tumor angiogenesis may be through improving Arresten and inhibiting integrin α1β1 and VEGF. And the action mechanism of Arresten may be implemented by inhibiting the expression of VEGF by incorporation with integrinα1β1 or by itself to inhibit the expression of VEGF.
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Objective To investigate the effect of tetramethylpyrazine (TMP) combined with cisplatin(DDP) on the expression of Mac2-binding protein(Mac2-BP) and vascular endothelial growth factor (VEGF) in mice with lung cancer. Methods C57 BL/6 mice were subcutaneously inoculated with Lewis lung adenocarcinoma cells , and Lewis lung adenocarcinoma mouse xenograft model was established .Forty mice were randomly divided into four groups:normal saline group(NS group,0.9%NaCl,0.2 ml), TMP group (TMP 100 mg/kg,0.2 ml), DDP group (DDP 2 mg/kg,0.2 ml), TMP plus DDP group (doses as above,0.2 ml totally) with 10 mice in each group.After 2 drug intervention,following 14 days of inoculation , the tumor diameter was measured every two days to calculate the tumor volume .The mice were sacrificed after 14 days of continuous medication , and the subcutaneous tumors were weighed after stripping to calculate the inhibitory rate.The expressions of Mac2-BP and VEGF was detected by Western blot and immunhistochemistry .Results Compared with NS group, the tumor growth rate of TMP group , DDP group and TMP+DDP group was slowed down , and the tumor growth rate in the TMP+DDP group was decreased most significantly .The inhibitory rate of TMP group , DDP group and TMP+DDP group was 25.57%, 45.24% and 66.5%,respectively.Kim, s formula was used to evaluate the synergy of the combined treatment .The q values for TMP +DDP group was 0.85
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Objective To investigate health status of medical staff and its impacting factors so as to provide useful health guidance. Methods Health examination data from 2 hospitals in Zhejiang province were collected. The medical staff group was classified into 5 subgroups according to the departments; the control group was composed of other mental labors. The health examinations included clinical, laboratory and special testing. SPSS 11.0 software was used for data analysis. Results Compared with the control group, the morbidity rate of the medical staff group was higher, especially in those aged < 50 (χ2 = 6. 651,8. 883, and 7. 446; all P < 0.05 ). All medical staff subgroups showed significant difference in morbidity rate ( χ2 = 39. 099 ,P < 0.05 ). Hyperlipidemia,cervical erosion,and breast hyperplasia were the most common diseases found in medical staff; while the control group developed more breast hyperplasia, hyperlipidemia, and retinal arteriosclerosis. Conclusions Health status of medical staff could not be optimal. Effective health education would be needed to improve life style and relieve stress.
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Objective To discuss causes, characteristics and clinical treartment measures for negative fluid balance and systemic edema in patients with traumatic hemorrhagic shock. Methods A retrospective chart study was done on 205 cases with systemic edema posterior to traumatic hemorrhagic shock admitted to ICU between May 1994 and August 2002. Results All cases showed systemic edema at various degrees. The survived 173 cases demonstrated spontaneous diuresis and negative fluid balance at different time in the first week but the died 32 ones not. The negative fluid balance and the spontaneous diuresis were not more severe than that in the control group under conditions of age (≥60 years old), injury severity score (ISS ≥16), acute physiological and chronic health evaluation (APACHE) Ⅱ≥12 and Cr≥2.0 g/L ( P