Guangzhou Military Command Research Articles

Sonoclot Signature Analysis: A New Point-of-Care Testing Method for Defining Heat Stroke-Induced Coagulopathy.

PurposeData regarding the incidence of a coagulable state following heat stroke as assessed by Sonoclot signature analysis are limited. Our purpose was to appraise coagulopathy using a dynamic test capable of analyzing the entire coagulation cascade and to characterize coagulation in patients with heat stroke prior to transfusion.Materials and MethodsThe data of 106 patients were collected prospectively from the Critical Care Center of the General Hospital of Guangzhou Military Command. Coagulable state was defined as normal. Both hyper- and hypo-coagulable states were defined as coagulation defects. Hypercoagulability was defined as an activated clotting time (ACT) ≦195s and a clot rate (CR) >23, and hypocoagulability was defined as an ACT ≧119s and a CR < 7. The Sonoclot signature t examination was performed at the time of admission. Conventional tests, such as the prothrombin time (PT) and activated partial thromboplastin time (aPTT), were compared with Sonoclot monitoring to identify coagulation defects.ResultsThe average age of the 106 patients was 23.2±2.5 years. There were 102 males (96.3%) and 4 females (3.7%). Thirty-four patients (32.1%) were hypercoagulable and 44 patients (41.5%) were hypocoagulable at the time of admission; 28 patients (26.4%) had no evidence of a coagulopathy. Patients with hypocoagulability, unlike patients with hypercoagulability, had a higher sequential Organ Failure Assessment score, indicating a more severe multiple organ dysfunction score. Mortality was 5.9% in patients with hypercoagulability compared with 3.5% in patients with normal coagulation, and 18.1% in patients with a hypocoagulable state (P < 0.05). ACT was a predictor of mortality, while the CR and platelet function did not show statistical significance.ConclusionThis study determined the clinical outcomes and prognostic value of coagulability in patients with heat stroke, as defined by Sonoclot signature analysis at the time of admission.

Therapeutic effect of laparoscopic Roux-en-Y gastric bypass in non-obese patients with type 2 diabetes

To evaluate the effectiveness of laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery for treatment of type 2 diabetes (T2D) in patients with a body mass index (BMI) &lt; 27.5 kg/m2. We retrospectively analyzed the data of patients who underwent LRYGB surgery from March, 2012 to June, 2018 in the General Hospital of Guangzhou Military Command and Jinshazhou Hospital of Guangzhou University of Chinese Medicine. The changes in the parameters of glucose metabolism and physical indicators of the patients in the first, second and third years after the surgery were analyzed in patients in low BMI group and high BMI group. All the 74 patients underwent LRYGB successfully without conversion to open surgery. One year after the surgery, fasting blood glucose (FBG), HbA1c, postprandial blood glucose, fasting insulin, HOMA-IR, fasting C-peptide, BMI, body weight and waistline were significantly improved compared with their preoperative values in low BMI group (P &lt; 0.05). At 2 years after the operation, FBG, HbA1c, postprandial blood glucose, HOMA-IR, BMI, body weight and waistline were significantly improved compared with the preoperative values in low BMI group (P &lt; 0.05). In the third year, FBG, HOMA-IR, fasting C-peptide, body weight and waistline were significantly improved compared with the preoperative values in low BMI group (P &lt; 0.05). There was no significant difference in the parameters of glucose metabolism and islet function between low BMI group and high BMI group at different stages. No serious complications occurred in these patients after the surgery. LRYGB is effective for treatment of T2D in Chinese patients with a BMI &lt; 27.5. After the surgery, the patient show reduced waistline without significant weight loss. The long-term results of the surgery still require further investigations with a larger samples and longer follow-up.

Effects of target value management for quality control indexes in chest pain center on efficiency and effectiveness of in-hospital treatment for STEMI patients

Objective To explore the effects of target value management for quality control indexes in chest pain center on the efficiency and effectiveness of in-hospital treatment for STEMI patients. Methods The database of Chest Pain Center in General Hospital of Guangzhou Military Command was retrospectively analyzed. STEMI patients who visited our hospital from March 2011 to March 2018 were selected as the research subjects. During the review period, the target values of quality control indexes were adjusted 4 times. Before and after the 4 adjustment, the efficiency indexes of in-hospital treatment STEMI patients were compared, including the first medical contact to the first electrocardiogram (FMC2ECG) time, catheter lab activation time and Door-to-Balloon (D2B) time. Length of hospital stay, in-hospital mortality and hospitalization cost were compared as well. Results A total of 332 STEMI patients were included in the study. As the quality control target values became stricter, the median and the average value of FMC2ECG time, catheter lab activation time and D2B time showed a downward trend. Among these data, the D2B time decreased from 95 (74, 134.5) min to 50 (44.5, 71) min, and its differences were of the most significance. However, there is no significant difference in the hospitalization cost, length of hospital stay and in-hospital mortality of STEMI patients. Conclusions The target value management of quality control indexes can improve the in-hospital treatment efficiency for STEMI patients, but the improvements of treatment efficiency and effectiveness cannot be immediately revealed. It takes a certain amount of time and needs enough cases to reach a significant difference. Key words: Chest pain center; Quality control; Target value management; Efficiency of in-hospital treatment; D2B time; FMC2ECG time; Catheter lab activation time

The ERP of slow cortial potential resting-state networks from ECoG in intraoperative mapping of motor related cortices

Objective To explore the sensitivity and specificity of electrocorticography (ECoG) in intraoperative mapping of motor cortices with the event-related potential (ERP) of slow cortical potential resting-state networks. Methods Thirteen patients with brain lesions near eloquent areas who were admitted to Department of Neurosurgery, Guangzhou General Hospital of Guangzhou Military Command from December 2014 to June 2016 were treated under awake craniotomy. The motor-related cortices were detected by intraoperative direct electrical stimulation. The ECoG were collected from patients in resting state. The ERP of slow cortical potential resting-state networks was analyzed. The sensitivity and specificity of ECoG in mapping of motor cortices were evaluated. Results Motor areas were identified by DES in all patients. The ERP of slow cortical potential resting-state networks was significant and regarded as the specific rhythm of motor cortex. When the threshold of ERP of the specific rhythm was chosen as 1.6, this method showed the optimal sensitivity (90.6%) and modest specificity (59.2%) compared with the other threshold. Conclusion Data analysis of the ERP of slow cortical potential resting-state networks from ECoG can be used to map motor areas intraoperatively, which is expected as a new adjunct to DES for intraoperative mapping. Key words: Brain diseases; Electrocorticography; Slow cortial potential; Mapping of motor cortices

Predictive value of glycosylated serum protein combined with glycemic variability on secondary persistent inflammatory immunosuppressed catabolic syndrome prediction in elderly septic patients

To investigate the predictive value of glycosylated serum protein (GSP) combined with glycemic variability (GV) in persistent inflammation immunosuppressive catabolic syndrome (PICS) in elderly septic patients. A retrospective study was conducted. The septic patients aged ≥ 60 years old with 28 days hospitalized duration admitted to geriatric intensive care unit (ICU) of Guangzhou General Hospital of Guangzhou Military Command from January 2014 to December 2017 were enrolled. The patients were divided into two groups according to whether PICS occurred within 14 days after ICU admission according to the PICS diagnostic criteria. General patients' data including gender, age, underlying disease, site of infection, the length of ICU stay were collected, acute physiology and chronic health evaluation II (APACHE II), GSP at 1 day after hospitalization and lymphocyte count (LYM), C-reactive protein (CRP), albumin (ALB), prealbumin (PA) levels at 1 day and 14 days were recorded. The levels of blood glucose on the 1st day and 14th day were observed, the GV was calculated. Data were cross-validated using the random forest method. Receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of glycemic parameters for PICS. A total of 315 elderly septic patients were included. Patients with malignant tumors, severe autoimmune diseases, and immunosuppressive therapy or dead within 28 days of hospitalization were excluded. A total of 132 patients were enrolled in the analysis, including 45 in the PICS group and 87 in the non-PICS group. The length of ICU stay in the PICS group was significantly longer than that in the non-PICS group [days: 35.0 (22.0, 49.5) vs. 8.0 (5.0, 23.0), P < 0.01]. No significant difference in the baseline data of gender, age, underlying disease, infection site or APACHE II score between the two groups was found. (1) Parameters for PICS diagnosis: with the prolongation of ICU stay, LYM and PA in the non-PICS group were increased and those in the PICS group were decreased, and CRP and ALB levels were decreased in both groups. LYM, ALB and PA levels in the PICS group were significantly lower than those in the non-PICS group at 14 days after ICU admission [LYM (×109/L): 0.6 (0.5, 0.7) vs. 1.1 (0.9, 1.6), ALB (g/L): 25.4±2.7 vs. 29.9±4.3, PA (g/L): 0.08 (0.05, 0.14) vs. 0.11 (0.10, 0.21), all P < 0.01], and CRP level was significantly higher than that in the non-PICS group (mg/L: 87.5±56.3 vs. 49.2±49.1, P < 0.01). (2) Glycemic parameters: the GSP level of the PICS group at 1 day after ICU admission was significantly lower than that of the non-PICS group (mmol/L: 2.3±0.6 vs. 2.7±0.6, P < 0.01), but there was no statistically significant difference in the level of blood glucose or GV at 1 day and 14 days after ICU admission as compared with the non-PICS group [blood glucose (mmol/L): 10.0±3.3 vs. 9.4±3.3 at 1 day, 10.8±3.6 vs. 10.4±3.5 at 14 days; GV: (24.2±1.4)% vs. (23.7±1.2)% at 1 day, (24.8±7.8)% vs. (24.7±7.7)% at 14 days, all P > 0.05]. (3) ROC curve analysis: 1-day GSP as well as 1-day and 14-day GV had certain predictive value for PICS secondary to sepsis in the elderly. The predictive value of 1-day GSP combined with 14-day GV was the highest, its area under ROC curve (AUC) was 0.637, with a sensitivity of 95.8% and a specificity of 25.0%, while the positive likelihood ratio was 1.278, the negative likelihood ratio was 0.167, the positive predictive value was 71.9%, and the negative predictive value was 75.0%. GSP combined with GV could effectively predict secondary PICS in elderly septic patients.

Erratum: Epidermal growth factor receptor gene mutations in non-small-cell lung cancer cells are associated with increased radiosensitivity in vitro [Erratum

[This corrects the article on p. 3551 in vol. 10.].

Effects of health education video based on Knowledge, Attitude and Practice model in patients with initial stroke

Objective To explore the effects of health education video based on Knowledge, Attitude and Practice (KAP) model in patients with initial stroke. Methods A total of 146 patients with initial stroke hospitalized in General Hospital of Guangzhou Military Command of PLA from January to August 2016 were selected and randomly divided into control group (n=74) and observation group (n=72) according to the hospitalized ward. The control group received routine health education. In the observation group, health education videos based on KAP mode were circulated daily in the ward on the basis of the control group. Before the intervention, at the time of discharge, and one month after discharge, the scores of the disease related knowledge and the Champion Health Belief Model Scale (CHBMS) were compared between the two groups. One month after discharge, the scores of the Morisky Medication Adherence Scale (MMAS-8) were compared between the two groups. Results At the time of discharge, the scores of disease related knowledge and CHBMS were (6.49±1.34) and (111.58±17.95) respectively, which were both higher than those of the control group, with statistical significance (t=4.448, 6.695; P<0.01) . One month after discharge, the score of MMAS-8 was (6.05±1.43) , which was higher than that of the control group (4.50±1.06) , with statistical significance (t=7.454, P<0.01) . Conclusions Health education video based on KAP model can improve the knowledge, health belief and medication compliance of patients with initial stroke. The video strengthens the knowledge of patients with initial stroke, which is conducive to the formation of the correct attitude and behavior of patients, suitable for further promotion in the future. Key words: Stroke; Health education; Knowledge, attitude and practice model; Video

Automatic benign and malignant classification of pulmonary nodules in thoracic computed tomography based on RF algorithm

Classification of benign and malignant pulmonary nodules can provide useful indicators for estimating the risk of lung cancer. In this study, an improved random forest (RF) algorithm is proposed for classification of benign and malignant pulmonary nodules in thoracic computed tomography images. First, an improved random walk algorithm is proposed to automatically segment pulmonary nodules. Then, intensity, geometric and texture features based on the grey-level co-occurrence matrix, rotation invariant uniform local binary pattern and Gabor filter methods are combined to generate an effective and discriminative feature vector. Mutual information is employed to reduce the dimensionality. Finally, an improved RF classifier is trained to classify benign and malignant nodules. An appropriate feature subset is selected by the bootstrap method and an effective combination method is introduced to predict a class label. The proposed classification method on the lung images dataset consortium dataset achieves a sensitivity of 0.92 and the area under the receiver-operating-characteristic curve of 0.95. An additional evaluation is performed on another dataset coming from General Hospital of Guangzhou Military Command. A mean sensitivity and a mean specificity of the proposed method are 0.85 and 0.82, respectively. Experimental results demonstrate that the proposed method achieves the satisfactory classification performance.

Proteomic Analysis of Exosomes Released from Heatstressed Hepatocytes Reveals Promotion of Programmed Cell Death Pathways

Background: Liver injury is a common feature of heat stroke (HS). Exosomes, which are recognized as a novel cell-cell communication pathway that harbour functional cargo, may be involved in the pathogenesis underlying HS. However, little is known about the role of hepatocyte-derived exosomes in HS liver injury and their protein expression patterns under HS. Methods: In this study, isobaric tags for relative and absolute quantitation (iTRAQ) technology with liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis were applied to explore changes in the proteomic profiles of HS-hepatocyte exosomes. Findings: In total, 53 and 21 proteins were identified as up- and downregulated in the HS-exosomes. Based on bioinformatics analysis using gene ontology (GO) and the Kyoto encyclopedia of genes and genomes (KEGG) pathway database, we found that regulation of programmed cell death was the most significantly altered pathway. Next, a candidate protein (TRAIL, TNF-related apoptosis-inducing ligand) that played a central role in the target pathway was chosen for validation. Western blotting clearly demonstrated enrichment of TRAIL in the HS-exosomes. We also confirmed that serum exosomal TRAIL could be used as a clinical marker for disease severity assessment and prognostic prediction of HS liver injury. Interpretation: Taken together, this study presented the first comprehensive analysis of the HS-hepatocyte exosomal proteome, confirming the induction of HS liver injury by exosomes and revealing novel potential pathways and proteins awaiting further investigation for clinical application. Funding Statement: This work was supported by the National Natural Science Foundation of China (grant No. 81471839, No. 81671896 and No. 81873583). Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: All animal experiments were conducted in compliance with the criteria outlined in the Guide for the Care and Use of Laboratory Animals (National Institutes of Health publication 86-23, 1985 revision) and were approved by the Animal Care and Use Committee of the General Hospital of Guangzhou Military Command.

Three methods for controlling presacral massive bleeding during pelvic operations

To evaluate three different methods for controlling presacral massive bleeding during pelvic operations. Clinical data of 11 patients with presacral massive bleeding during pelvic operation at The Sixth Affiliated Hospital of Sun Yat-sen University and 157 Branch Hospital of Guangzhou General Hospital of Guangzhou Military Command from January 2001 to January 2016 were analyzed retrospectively. Hemostasis methods for presacral massive bleeding during operation included gauze packing (whole pressure), drawing pin (local pressure) and absorbable gauze (absorbable gauze was adhered to bleeding position with medical glue after local pressure). Efficacy of these 3 methods for controlling bleeding was evaluated and compared. Ten patients were male and 1 was female with average age of 65.2 (40 to 79) years old. Eight cases were rectal cancer, 2 were presacral malignancies and 1 was rectal benign lesion. Bleeding volume during operation was 300 to 2 500 (median 800) ml. From 2001 to 2012, 4 cases received gauze packing, of whom, 3 cases were scheduled Dixon resection before operation and then had to be referred to Hartman resection; 3 cases died of systemic failure due to postoperative chronic errhysis and infection, and 1 underwent re-operation. At the same time from 2001 to 2012, 5 cases received drawing pin, of whom, bleeding of 3 cases was successfully controlled and Dixon resection was completed. In other 2 cases with hemostasis failure, 1 case underwent re-operation following the use of gauze packing, and another 1 case received absorbable gauze hemostasis. All the 5 patients were healing. From 2013 to 2016, 2 cases completed scheduled anterior resection of rectum after successful hemostasis with absorbable gauze and were healing and discharged. Gauze packing hemostasis is a basic method for controlling presacral massive bleeding. Drawing pin and absorbable gauze hemostasis are more precise and may avoid the change of surgical procedure. But drawing pin has the possibility of hemostasis failure. Absorbable gauze hemostasis with medical adhesive is effective, simple and fast.

Clinical value of preventative surgical resection in the treatment of extra-hepatic portal vein aneurysm

Objective To investigate the clinical value of preventative surgical resection in the treatment of extra-hepatic portal vein aneurysm. Methods The method of retrospective descriptive study was conducted. The clinical data of 1 patient with extra-hepatic portal vein aneurysm who was admitted to the Guangzhou General Hospital of Guangzhou Military Command of PLA in May 2014 were collected. The patient suffered from dull pain in his epigastrium, with no obvious causative factors. The patient recieved abdominal B-ultrasound, CT scans abdominal and superior mesenteric artery, angiographies after admission in May 2014, and was diagnosed as with extra-hepatic portal vein aneurysm. The preventative surgical resection was selected according to the patient′s individual health status. Extra-hepatic portal vein aneurysm resection was conducted under the guidance of intraoperative ultrasonography after abdominal exploration. A double-cavity drainage tube was placed in the venturis hole when portal vein aneurysm was dissected and removed. Then the abdomen was closed. The patient received regular perioperative management. The operation time, volume of intraoperative blood loss, time for diet recovery, time of drainage tube removal, postoperative complications, results of laboratory tests, results of imaging findings, healing of incision, time of postoperative discharge from hospital, results of pathologic examination and follow-up were observed. Follow-up using outpatient examination or telephone interview was performed to detect the inspect status of portal vein and inspect recurrence of portal vein aneurysm by abdominal B-ultrasound and CT examinations till December 2014. Results The patient underwent successful extra-hepatic portal vein aneurysm resection. The operation time was 85 minutes and the volume of intraoperative blood loss was around 150 mL. The patient gradually returned to normal diet and self-care ability at postoperative day 3, and the abdominal drainage tube was removed at postoperative day 3. No postoperative complications including hemorrhage, portal vein thrombosis and dysfunction of liver were detected after operation. There were normal levels of blood routine and blood biochemical test. Postoperative B-ultrasound examination showed smooth blood flow in portal vein and the abdominal blood vessel CT angiography presented clear image of the portal vein, with smooth blood flow and normal lumen. The surgical incision recovered very well and the patient was discharged from hospital at postoperative day 9. Results of postopeartive pathologic examination showed that there were cystic-like tissues with simple squamous epithelium cells on the interior, the wall of which consisted of smooth muscle was in accordance of the structure of vein. The patient didn′t receive any other special treatment or take medicines postoperatively. The patient had good physical health and can take care of himself during six-month follow-up, without narrow portal vein, recurrence of portal vein aneurysm and other complications. Conclusion Preventative surgical resection is safe and feasible for extra-hepatic portal vein aneurysm, with a good efficacy. Key words: Portal vein aneurysm, extra-hepatic; Surgical procedures, operative; Preventability; Portal vein aneurysm resection

Effects of modified three-step procedure for anatrophic nephrolithotomy in the treatment of complex staghorn renal calculi

Objective: To investigate the effects of modified three-step procedure for anatrophic nephrolithotomy in the treatment of complex staghorn renal calculi. Methods: A total of 22 patients with complex staghorn renal calculi between June 2013 and June 2016 at Department of Urology in Guangzhou General Hospital of Guangzhou Military Command were retrospective analyzed. There were 13 males and 9 females, ranging from 35 to 62 years old with mean age of 47 years. There were 17 patients with dull pain, and 5 patients who were found through physical examinations. Kidney calculi located in left kidney in 15 patients, right kidney in 7 patients. All patients were treated with modified three-step procedure for anatrophic nephrolithotomy. The operation time, blood loss, time of intraoperative renal ischemia, and postoperative complications were recorded. Serum creatinine (Scr), blood urea nitrogen(BUN), β(2)-microglobulin(β(2)-MG), diseased side glomerular filtration rate(GFR) , and renal cortical thickness of the diseased kidney in preoperative and postoperative were compared. The clinical data were compared by paired sample t test between pre-operation and post-operation. Results: The calculi were completely removed in 22 patients, the mean operation time was 84 minutes (50 to 126 minutes), the mean time of intraoperative renal ischemia was 31 minutes (20 to 56 minutes), the mean blood loss was 246 ml (150 to 360 ml). There were no secondary bleeding or urinary fistula happened, the perinephric drainage tub was removed in 3 to 7 days postoperative, the mean hospitalization time was 7 days.Compared with the preoperative, the Scr ((172.7±21.3)μmol/L vs. (146.4±22.8)μmol/L, t=7.197, P=0.000), BUN ((9.2±1.8)mmol/L vs. (8.0±0.5)mmol/L, t=3.798, P=0.001) and β(2)-MG ((203.0±32.0)μg/L vs. (175.6±23.8)μg/L, t=5.009, P=0.000) in postoperative decreased, the diseased side GFR increased ((28.6±4.0) ml/min(31.8±3.3) ml/min, t=-3.521, P=0.002). There were no significant difference of diseased renal cortical thickness between preoperative and postoperative(t=-1.323, P=0.200). There were 12 patients with postoperative pain, 2 patients with vomiting, 3 patients with fever, and 2 patients with wound infection. The follow-up time was 6 months, no residual stones in 22 patients. Conclusion: The modified three-step procedure for anatrophic nephrolithotomy has high stone free rates with less effects on renal function and fewer complications, the method could be widely applied.

Influences of glutamine on liver function, C-reactive protein, lymphocyte count in the patients after hepatectomy with nutritional risk

Objective To evaluate the impact of glutamine nutritional support on liver function, immune function in postoperative patients after hepatectomy. Methods The clinical data of patients who have been subjected to the hepatectomy in general surgery of hospital of Guangzhou Military Command from January 2011 to December 2015 were continuously collected. The enrolled patients included those with NRS≥3, graded by NRS2002 scoring criteria. The liver function (AST, ALT, ALB, PAB, and CHE), C-reactive protein (CRP) and lymphocyte count (LY) were measured on the preoperative day and postoperative day 5, 7. The hospital stay and incidence of infectious complications were observed. Results 143 cases of patients in total were included in this study, and 84 cases were given glutamine treatment and 59 cases were not. The levels of ALT, ALB and PAB at postoperative day 7 were (54.5±38.0) U/L, (38.2±4.3) g/L and (175.7±17.6) mg/L respectively, which were significantly higher than (71.1±55.9) U/L, (34.6±5.2) g/L and (156.4±21.9) mg/L in the control group (t=-2.116, 4.503, 5.827, P=0.036, 0.019, 0.001). There was no significant difference in the levels of AST and CHE between the experimental group and the control group at postoperative day 7. The levels of CRP at postoperative day 7 were (32.4±15.4) mg/L, Which were significantly higher than (59.5±21.4) mg/L in the control group (t=-6.180, P=0.012). There was no significant difference in the levels of LY between the experimental group and the control group at postoperative day 7. There were 3 cases of infectious complication in the experimental group, and 7 cases in the control group, respectively (P=0.056). The hospital stay was (11.44±4.48) and (13.60±6.10) days in the experimental group and control group (t=-2.439, P=0.016). Conclusion Gln nutritional support can significantly improve liver function and immune function, reduce the incidence of infectious complication, and shorten the hospital stay for patients after hepatectomy. Key words: Glutamine; Hepatectomy; Nutritional risk; Liver function; Immune function

Application of quality control circle in improving awareness rate of health knowledge among COPD patients

Objective To explore the application effect of quality control circle in improving awareness rate of health knowledge among COPD patients. Methods 160 COPD patients treated in Department of Respiratory Medicine, Guangzhou Hospital of Guangzhou Military Command of PLA from March to December 2015 were selected, with the 80 admitted from March to May in 2015 as the control group, and the other 80 admitted from September to December in 2015 as the intervention group. Before the intervention, patients in the two groups were surveyed by a self-designed questionnaire on status quo of the COPD patients' health knowledge. Patients in the control group were instructed in a conventional way, while those in the intervention group were instructed by quality control circle activities. For patients in the intervention group, goal of this activity was set according to tesults of the survey, causal factors were analyzed and implementation countermeasures were made. Before leaving the hospital, patients in both groups were surveyed by the questionnaire again about their awareness on COPD health knowledge, basing on which, intervention effect was compared. Results After the intervention, awareness rate of COPD health knowledge among patients in the intervention group was 100%. Before the intervention, difference in awareness on COPD health knowledge between patients in the two groups was not statistically significant (P>0.05) . After the intervention, the awareness rate in the intervention group was higher than that in the control group (P<0.05) . Conclusions Hospitalized COPD patients' awareness rate on health knowledge is low, which can be effectively improved by implementing quality control circle. Key words: Pulmonary disease, chronic obstructive; Quality control circle; Awareness rate

Predictive value of SOFA score combined AGI grading system in elderly patients with sepsis: a retrospective analysis with 91 patients

To explore the predictive value of sequential organ failure assessment (SOFA) score combined the acute gastrointestinal injury (AGI) grading system in critical elderly patients with sepsis. A retrospective analysis was conducted. Elderly patients with sepsis aged > 60 years admitted to medical intensive care unit (MICU) of General Hospital of Guangzhou Military Command from March 2014 to December 2015 and experiencing critical care over 48 hours were enrolled. Age, gender, acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score and AGI score at admission (SOFAinitial, AGIinitial), the highest SOFA score and AGI score within the first week (SOFAmax, AGImax), serum procalcitonin (PCT), C-reactive protein (CRP), albumin (ALB), platelet (PLT), hemoglobin (Hb) and lactate (Lac) levels, length of ICU stay, usage of mechanical ventilation and renal replacement therapy were recorded. The primary end point was 28-day mortality. To extract factors affecting 28-day mortality, the risk factor of death of the senile sepsis patients were analyzed by binary logistic regression analysis (stepwise method). Fitness of the model was assessed by the Hosmer-Lemeshow test and calibration plot (P > 0.05). Receiver operating characteristic (ROC) analysis was performed for APACHE II score, SOFAinitial score, SOFAmax score, AGIinitial score, AGImax score and SOFAmax and combined AGImax score. Ninety-one patients were enrolled, the incidence of AGI in elderly patients with sepsis was 100%; 34 patients died 28 days after the admission, and the 28-day mortality rate was 37.4%. Non-survivors presented a higher APACHE II score, SOFAinitial score, SOFAmax score, AGIinitial score, AGImax score and longer usage of mechanical ventilation and renal replacement therapy. SOFAmax score [odds ratio (OR) = 1.576] and AGImax score (OR = 5.695) were associated with 28-day mortality in binary logistic regression analysis (both P < 0.01). The area under the curve (AUC) and 95% confidence interval (95%CI) of SOFAmax score combined AGImax score was significantly higher than that of SOFAinitial score, SOFAmax score, AGIinitial score, AGImax score and APACHE II score [0.806 (0.710-0.881) vs. 0.723 (0.619-0.812), 0.786 (0.688-0.865), 0.641 (0.533-0.739), 0.633 (0.526-0.881), 0.638 (0.531-0.736), all P < 0.05]. The Youden index (55.37) and positive predict value (5.51) of SOFAmax score combined AGImax score were the largest. When its cut-off value reached 14, the sensitivity and specificity was 67.65% and 87.72%, respectively. According to score of APACHE II, SOFAinitial, SOFAmax or AGImax, the higher of each score, the higher mortality rate could be. The combination of SOFAmax score and AGImaxscore enable accurate prediction in elderly patients with sepsis.

Analysis of prognostic influencing factors of glioblastoma multiforme

Objective To investigate the prognostic influencing factors in patients with glioblastoma multiforme (GBM) after surgery and adjuvant radiochemotherapy. Methods From December 2004 to December 2014, the clinical data of 61 patients with GBM operated and treated with postoperative adjuvant radiochemotherapy at the Department of Neurosurgery, Guangzhou General Hospital of Guangzhou Military Command were analyzed retrospectively. The influence of 16 factors on the survival time of the patients were evaluated, including gender, age, lesion site, number of lesions, tumor volume, disease duration, preoperative Karnofsky Performance Scale (KPS) score, operation duration, operative bleeding volume, tumor residual volume, extent of resection, postoperative complications, secondary tumor resection, radiotherapy, chemotherapy, and concurrent radiochemotherapy. Multivariate Cox regression analysis was conducted for the indices of the differences with statistical significance of Kaplan-Meier single factor analysis. Results The survival time of 61 patients was 1 to 63 months, and the median survival time was 14.0 months, 1-year, 2-year, and 5-year survival rates were 75.4%, 34.4% and 1.6%, respectively. The univariate analysis of Kaplan-Meier method showed that preoperative KPS score, operation time, residual tumor, total resection, radiotherapy, chemotherapy and concurrent radiochemotherapy were the factors of impacting on the survival time of patients. Multivariate Cox regression analysis showed that preoperative KPS score (OR, 0.302, 95% CI 0.153-0.597, P=0.001), residual tumor volume (OR, 0.225, 95% CI 0.114~0.441, P=0.000) and concurrent radiochemotherapy (OR, 0.275, 95% CI 0.128-0.591, P=0.001) were the independent factors for impacting the prognosis of patients with GBM. Conclusions Surgery is still the most important means for the treatment of GBM. The preoperative KPS score is ≥70, the postoperative residual tumor volume is ≤3 cm3, and postoperative concurrent radiochemotherapy may prolong the survival time of patients. Key words: Glioblastoma, multiforme; Risk factors; Prognosis

Clinical research of X-ray plain film assessment of recurrence after interventional treatment of intracranial aneurysms

Objective To investigate the clinical application value of using conventional X-ray fluoroscopy follow-up after interventional treatment of intracranial aneurysms. Methods From August 2013 to June 2015, all patients with intracranial aneurysm treated with interventional therapy and followed up with digital subtraction angiography (DSA) at the Department of Neurosurgery, Wuhan General Hospital of Guangzhou Military Command were analyzed retrospectively. The patients were asked to have both immediately after procedure and reexamination operation position angiograms (all patients took conventional0°/CRAN 30°andLAO 90°/0°angiograms). A total of 86 patients with 102 aneurysms met the demands. The shadowgraphs of the microcoils were collected: the immediately after procedureoperating position, reexaminationoperation position,0°/CRAN 30°, andLAO 90°/0°shadowgraphs. The coil shape documented with the corresponding projection angle were compared in the immediately after procedure and follow-up shadowgraphs and determined whether the coil shape changed or not. Whether the aneurysms recurrence or not were identified according to the DSA result of the same case. Kappa test was used to analyze the consistency. Results In 102 aneurysms using microcoil embolization, 90 coils did not have any change. DSA examination revealed no relapse. Under X-ray fluoroscopy, the coil shape did not have any change in 3 cases, but DSA revealed aneurysm recurrence. Under X-ray fluoroscopy, the coil shape changed in 9 cases, and DSA did not reveal recurrence. Using Kappa test, both methods were highly consistent (K=0.76, P<0.05). Conclusions Observing microcoil shape with X-ray fluoroscopy can well predict whether aneurysms recurrence or not. It has better clinical application value in the follow-up after intracranial aneurysm intervention. Key words: Radiography; Intracranial aneurysm; Embolism; Follow-up studies

A new method for early detection of myocardial ischemia: cardiodynamicsgram (CDG)

Early detection of myocardial ischemia via electrocardiographic methods is important and challenging. In the study, based on the standard 12-lead electrocardiography (ECG), a new method called cardiodynamicsgram (CDG) is proposed for early detection of myocardial ischemia. Using a recently proposed deterministic learning algorithm, the cardiodynamics information is extracted from the ST-T segments of standard 12-lead ECG. The CDG is generated by plotting the three-dimensional cardiodynamics information. By analyzing CDG morphology, it is found that significant correlations exist between CDG and ischemia. By evaluating ischemia patients and healthy controls from the Physikalisch-Technische Bundesanstalt (PTB) database and the General Hospital of Guangzhou Military Command, the CDG method achieves a mean sensitivity of 90.3% and a mean specificity of 87.8%, which are higher than those of both the standard 12-lead ECG and the exercise ECG. As it is noninvasive, convenient, and inexpensive, it is hopeful that CDG may become a cost-effective screening method for early detection of ischemic heart diseases.

Molecular characterization and antimicrobial susceptibility of tcdA-negative Clostridium difficile isolates from Guangzhou, China

This study aimed to investigate the molecular characteristics and antimicrobial susceptibility of Clostridium difficile clinical isolates in Guangzhou, China. One hundred twenty isolates were collected from Guangzhou General Hospital at the Guangzhou Military Command in China from March 2014 to April 2015, and 9 isolates were identified as tcdA-negative/tcdB-positive (A−B+) strains. Results showed that all of the strains were confirmed to be ST37 and 0 single nucleotide variants (SNVs) were found in the PaLoc region, and >60 SNVs were identified throughout the whole genome sequence. The results show the diversity of the antibiotic and gene mutations present in these strains. All of the A−B+ isolates were highly resistant to clindamycin and erythromycin; showed an average sensitivity to fluoroquinolones; and maintained a high susceptibility to metronidazole, vancomycin, and tigecycline.

Efficacy of Q-switch 1064 nm laser combined with microneedle technology for treatment of melasma

Objective To investigate the clinical efficacy of Q-switch 1064 nm wavelength laser combining with microneedle technology for the treatment of melasma. Methods 70 melasma patients were selected in the Out- patient Department of Wuhan General Hospital of Guangzhou Military Command from July 2012 to Sept. 2013. The patients were randomly divided into 3 groups: the combining therapy group (patients in this group received Q-switch 1064 nm wavelength laser combining with microneedles technology, the treatment interval was 2 or 3 weeks, and the whole course was 2-6 months); the microneedle group and the Q-switch 1064 nm wavelength laser group. The effect and the adverse reaction were observed and recorded during the treatment, and the reduced area of the pigment patch was also measured to judge the total efficacy after the course. Results The total effective rate was 78.6% (22/28) in the combining therapy group and 40.0% (8/20) in the microneedle group, 45.5% (10/22) in the Q-switch 1064 nm wavelength laser group. There were statistically significant differences between the combining therapy group and the other groups (P1<0.05, P2<0.05), without obvious adverse reaction. Conclusions It is significantly better to use American Medlite C6 Q-switch 1064 nm wavelength laser combining with microneedles technology than that of the single use of Q-switch 1064 nm wavelength laser or microneedles in the treatment for the patients with melasma. The method is also simple to handle and suitable for clinical application. Key words: Melasma; Q-switch laser; Microneedle