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γδ TCR T lymphoblastic leukemia in a youngster presenting along with notable hyperleukocytosis.
Sepsis is a life-threatening systemic inflammatory response syndrome (SIRS) caused by the host's maladjustment response to infection, which eventually leads to septic shock and multiple organ failure. Pancreatic injury was found to be an important pathological change in sepsis. Autophagy is a crucial way to maintain the normal metabolism of cell substances and energy, which plays an important role in many diseases. Recent studies have found that autophagy plays a dual role in pancreatic injury in sepsis. Moderate autophagy can protect the pancreas and reduce the injury, while excessive autophagy can cause apoptosis-related autophagic cell death and aggravate the pancreatic injury. In sepsis, activated nuclear factor-κB (NF-κB) has a promoting effect on autophagy, and lysosome associated membrane protein (LAMP) degradation can result in impaired autophagy flux and aggravate pancreatic injury. The exploration of the mechanism of autophagy in pancreatic injury of sepsis will help to restore the normal autophagy function, so as to find a new target for the treatment of pancreatic injury of sepsis.When the skin barrier is damaged, surgical dressings are often used to cover wounds, sustain skin barrier, protect the injured area, prevent bacterial infection, and promote wound healing. However, at present, traditional dressings will be come stiffing as it absorbs the exudates of wound and sometimes cause secondary injury to the wound during the application process, which aggravate the pain of patients without analgesic effect. For this reason, the medical staff from Northern Jiangsu People's Hospital designed a new antibacterial analgesic dressing that can reduce the pain and increase the antibacterial ability. The dressings provide a sterile, moist environment to facilitate wound healing. Meanwhile, this dressing has the advantages of low cost, safeness and effectiveness, which can reduce the frequency of dressing changes, the possibility of wound infection, the pain and the medical expenses, which is worthy of clinical promotion.Objective To select the animal model more consistent with the pathophysiology of abdominal compartment syndrome (ACS) through the comparative study of the methods of multiple water sacs superimposed compression and gas perfusion. Methods Ten experimental pigs were randomly divided into two groups (n = 5) the "constant volume model" (constant volume model group) and the "constant pressure model" (constant pressure model group) of intra-abdominal hypertension. The models were prepared by the method of water sac superposition and pressurization, and artificial pneumoperitoneum respectively. The abdominal pressures of both groups were 25 mmHg (1 mmHg = 0.133 kPa) and observed for 4 hours. The pressure was measured once an hour for 4 hours and the pressure-time curves of the two groups were drawn respectively. The experimental animals were sacrificed 4 hours after modeling. The heart and lung were harvested, and the histopathological changes were observed by hematoxylin-eosin (HE) staining. Results Two groups of ey, focal hyaline degeneration, disappearance of local striae, hyaline degeneration of myocardial fiber, dilation and congestion of intermyocardial artery were observed. Slight hyperplasia of alveolar epithelium in some areas, heart failure cells, dilation and congestion of bronchi and trachea artery, a large number of red blood cells and uniform light staining substances in lumen were found. Conclusions After the model was made by the method of multiple water sacs, the pressure of the abdominal cavity continued to increase with the development of the disease, which was in line with the clinical pathological changes of ACS, and was more suitable for making the animal model of the intra-abdominal hypertension.Objective To explore the diagnostic accuracy of bedside ultrasound measurement of limb skeletal muscle thickness for intensive care unit-acquired weakness (ICU-AW) in patients receiving mechanical ventilation. Methods A prospective observational study was conducted. Patients receiving mechanical ventilation admitted to the emergency ICU of Cangzhou Central Hospital from June 2018 to March 2020 were enrolled. The demographic data were collected. Medical Research Council (MRC) score was used to assess muscle strength and to determine the presence of ICU-AW once the patients were awake. The thicknesses of biceps brachii (BB), flexor carpi radialis (FCR), rectus femoris (RF) and tibialis anterior (TA) were measured by bedside ultrasound. The difference of each index was compared between the patients in ICU-AW group and in non-ICU-AW group. Receiver operator characteristic (ROC) curves were plotted to examine the values of the thicknesses of these four muscles in diagnosing ICU-AW. Results Forty-one patients receiR, RF and TA measured by bedside ultrasound in patients with mechanical ventilation had diagnostic values for ICU-AW, while the thickness of BB could not diagnose ICU-AW.Objective To screen the clinical parameters in predicting continuous renal replacement therapy (CRRT)-related hypotension in the patients with renal failure. Methods A retrospective analysis was conducted. Patients with renal failure received CRRT admitted to Qingdao Municipal Hospital from July 1st, 2012 to June 30th 2019 were enrolled. Clinical data was recorded for the patients, including gender, age, weight, parameters before CRRT [systolic pressure (SBP), diastolic pressure (DBP), mean arterial pressure (MAP), central venous pressure (CVP), heart rate, blood routine examination, blood biochemistry, B-type natriuretic peptide (BNP), cardiothoracic ratio, left ventricular ejection fraction (LVEF)], CRRT duration, blood flow velocity, replacement fluid volume, net ultrafiltration volume, ultrafiltration rate and 30-day prognosis. The patients who had CRRT-related hypotension or whose net ultrafiltration was zero were enrolled as intolerance ultrafiltration group. Others were enrolled in normal ultrafiltratiROC curve (AUC) and 95% confidence interval (95%CI) age was 0.734 (0.626-0.842), BNP was 0.868 (0.776-0.960), CVP was 0.846 (0.757-0.935), CRRT duration was 0.746 (0.595-0.897), net ultrafiltration volume was 0.926 (0.845-1.000), and ultrafiltration rate was 0.794 (0.620-0.969), respectively]. Furthermore, according to the cut-off point of ultrafiltration rate, the patients were divided into ≥ 99.50 mL/h group and less then 99.50 mL/h group. There were statistical differences in BNP, CVP and net ultrafiltration volume between the two groups. ROC curve analysis showed that BNP and CVP had good prediction value for hypotension when ultrafiltration rate exceeds ≥ 99.50 mL/h. see more The AUC (95%CI) of BNP and CVP were 0.716 (0.604-0.828) and 0.749 (0.651-0.847), the sensitivity was 70.0%, 78.8%, and the specificity was 35.5%, 45.2%, respectively. Conclusions The values of age, BNP and CVP are more useful than other parameters in predicting CRRT-related hypotension before the start.
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