Aim:To explore the clinical characteristics of reversible respiratory chain deficiency in infants and young children.Methods:A retrospective analysis was conducted on the clinical data of a newborn with recurrent resp...Aim:To explore the clinical characteristics of reversible respiratory chain deficiency in infants and young children.Methods:A retrospective analysis was conducted on the clinical data of a newborn with recurrent respiratory distress and elevated lactate levels,and relevant literature was reviewed.The patient,male,22 days old,had difficulty breathing,no weight gain,and symptoms such as shortness of breath and cyanosis after birth,which lasted for 68 days.There was no history of birth asphyxia rescue;Treatment with antibiotics,respiratory support,diuresis,acid correction,multiple vitamins,and levocarnitine did not improve symptoms;Gradual worsening of breathing difficulties accompanied by feeding difficulties and slow weight gain;Multiple rechecks of blood gas analysis indicate an increase in lactate levels.The laboratory results showed that the child in this case had obvious clinical manifestations of MD.Genetic examination showed MT-TE gene mutation,and the mother was a carrier of MT-TE gene mutation.Conclusion:In the face of recurrent respiratory distress accompanied by elevated lactate levels in newborns,when clinical manifestations of unexplained lactate levels,feeding difficulties,poor aspiration,reduced spontaneous activity,and low muscle tone occur,the possibility of mitochondrial disease should be considered,and genetic testing should be actively improved to clarify the diagnosis.This type of disease is different from other types of mitochondrial diseases.After active and effective treatment,the prognosis is good.The key is early diagnosis,reasonable treatment,timely development of reasonable treatment plans,reduction of complications,and improvement of the final prognosis of the child.展开更多
AIM To investigate whether the short-term prognosis of hepatitis B virus(HBV)-related acute-on-chronic liver failure(ACLF) could be improved by using a modified model for end-stage liver disease(MELD) including serum ...AIM To investigate whether the short-term prognosis of hepatitis B virus(HBV)-related acute-on-chronic liver failure(ACLF) could be improved by using a modified model for end-stage liver disease(MELD) including serum lactate.METHODS This clinical study was conducted at the First Affiliated Hospital, Fujian Medicine University, China. From 2009 to 2015, 236 patients diagnosed with HBV-related ACLF at our center were recruited for this 3-month followup study. Demographic data and serum lactate levels were collected from the patients. The MELD scores with or without serum lactate levels from survival and nonsurvival groups were recorded and compared.RESULTS Two hundred and thirty-six patients with HBV-ACLF were divided into two groups: survival group(S) andnon-survival group(NS). Compared with the NS group, the patients in survival the S group had a significantly lower level of serum lactate(3.11 ± 1.98 vs 4.67 ± 2.43, t = 5.43, P < 0.001) and MELD score(23.33 ± 5.42 vs 30.37 ± 6.58, t = 9.01, P = 0.023). Furthermore, serum lactate level was positively correlated with MELD score(r = 0.315, P < 0.001). Therefore, a modified MELD including serum lactate was developed by logistic regression analysis(0.314 × lactate + 0.172 × MELD-5.923). In predicting 3-month mortality using the MELD-LAC model, the patients from the S group had significantly lower baseline scores(-0.930 ± 1.34) when compared with those from the NS group(0.771 ± 1.32, t = 9.735, P < 0.001). The area under the receiver operating characteristic curve(AUROC) was 0.859 calculated by using the MELD-LAC model, which was significantly higher than that calculated by using the lactate level(0.790) or MELD alone(0.818). When the cutoff value was set at-0.4741, the sensitivity, specificity, positive predictive value and negative predictive value for predicting short-term mortality were 91.5%, 80.10%, 94.34% and 74.62%, respectively. When the MELD-LAC scores at baseline level were set at-0.5561 and 0.6879, the corresponding mortality rates within three months were 75% and 90%, respectively.CONCLUSION The short-term prognosis of HBV-related ACLF was improved by using a modified MELD including serum lactate from the present 6-year clinical study.展开更多
Pediatric sepsis is the most common disease in pediatric critical illness,because the main reason for the disease is that children's immune level is not high or the immune system is not perfect,when children's...Pediatric sepsis is the most common disease in pediatric critical illness,because the main reason for the disease is that children's immune level is not high or the immune system is not perfect,when children's lung,abdominal cavity and blood system are infected,it will cause systemic inflammation and immune dysfunction.Early clinical symptoms are mainly irregular and intermittent fever.When the disease develops to severe sepsis,the children will suffer from acute heart failure,oliguria,respiratory alkalosis and even multiple organ failure.The incidence of death is high.It is reported that the incidence rate of sepsis in children can reach 0.3%,and the mortality rate is 50%.High incidence rate,high mortality rate and high treatment cost are the biggest problems in the pediatric field.In the past,the clinical hope of clearing away heat and toxin,promoting blood circulation and removing stasis,strengthening inflammation and other methods in traditional Chinese medicine,but the treatment effect is not ideal.With the improvement of modem medical understanding of sepsis,continuous blood purification therapy is introduced into the treatment of children with severe sepsis.In order to further explore the effect of continuous blood purification in the treatment of children with severe sepsis,the author summarizes the clinical practice experience and relevant literature,hoping to provide reference for relevant medical staff。展开更多
Purpose： Exsanguination is the most common leading cause of death in trauma patients. The massive transfusion （MT） protocol may influence therapeutic strategies and help provide blood components in timely manner. T...Purpose： Exsanguination is the most common leading cause of death in trauma patients. The massive transfusion （MT） protocol may influence therapeutic strategies and help provide blood components in timely manner. The assessment of blood consumption （ABC） score is a popular MT protocol but has low predictability. The lactate level is a good parameter to reflect poor tissue perfusion or shock states that can guide the management. This study aimed to modify the ABC scoring system by adding the lactate level for better prediction of MTo Methods： The data were retrospectively collected from 165 trauma patients following the trauma acti- vated criteria at Songklanagarind Hospital from January 2014 to December 2014. The ABC scoring system was applied in all patients. The patients who had an ABC score 〉2 as the cut point for MT were defined as the ABC group. All patients who had a score 〉2 with a lactate level 〉4 mmol/dL were defined as the ABC plus lactate level （ABC ＋ L） group. The prediction for the requirement of massive blood transfusion was compared between the ABC and ABC ＋ L groups. The ability of ABC and ABC ＋ L groups to predict MT was estimated by the area under the receiver operating characteristic curve （AUROC）. Results： Among 165 patients, 15 patients （9%） required massive blood transfusion. There were no sig- nificant differences in age, gender, mechanism of injury or initial vital signs bet^teen the MT group and the non-MT group. The group that required MT had a higher Injury Severity Score and mortality. The sensitivity and specificity of the ABC scoring system in our institution were low （81%, 34%, AUC 0.573）. The sensitivity and specificity were significantly better in the ABC ＋ L group （92%, 42%, AUC = 0.745）. Conclusion： The ABC scoring system plus lactate increased the sensitivity and specificity compared with the ABC scoring system alone.展开更多
Objective The present study investigated the sodium/iodide symporter mRNA expression in mouse lactating mammary gland cells under different iodine levels and the effects of thyroid-stimulating hormone(TSH),estradiol(E...Objective The present study investigated the sodium/iodide symporter mRNA expression in mouse lactating mammary gland cells under different iodine levels and the effects of thyroid-stimulating hormone(TSH),estradiol(E2)and prolactin(PRL)on NIS mRNA expression in mouse lactating mammary gland cells.展开更多
文摘Aim:To explore the clinical characteristics of reversible respiratory chain deficiency in infants and young children.Methods:A retrospective analysis was conducted on the clinical data of a newborn with recurrent respiratory distress and elevated lactate levels,and relevant literature was reviewed.The patient,male,22 days old,had difficulty breathing,no weight gain,and symptoms such as shortness of breath and cyanosis after birth,which lasted for 68 days.There was no history of birth asphyxia rescue;Treatment with antibiotics,respiratory support,diuresis,acid correction,multiple vitamins,and levocarnitine did not improve symptoms;Gradual worsening of breathing difficulties accompanied by feeding difficulties and slow weight gain;Multiple rechecks of blood gas analysis indicate an increase in lactate levels.The laboratory results showed that the child in this case had obvious clinical manifestations of MD.Genetic examination showed MT-TE gene mutation,and the mother was a carrier of MT-TE gene mutation.Conclusion:In the face of recurrent respiratory distress accompanied by elevated lactate levels in newborns,when clinical manifestations of unexplained lactate levels,feeding difficulties,poor aspiration,reduced spontaneous activity,and low muscle tone occur,the possibility of mitochondrial disease should be considered,and genetic testing should be actively improved to clarify the diagnosis.This type of disease is different from other types of mitochondrial diseases.After active and effective treatment,the prognosis is good.The key is early diagnosis,reasonable treatment,timely development of reasonable treatment plans,reduction of complications,and improvement of the final prognosis of the child.
文摘AIM To investigate whether the short-term prognosis of hepatitis B virus(HBV)-related acute-on-chronic liver failure(ACLF) could be improved by using a modified model for end-stage liver disease(MELD) including serum lactate.METHODS This clinical study was conducted at the First Affiliated Hospital, Fujian Medicine University, China. From 2009 to 2015, 236 patients diagnosed with HBV-related ACLF at our center were recruited for this 3-month followup study. Demographic data and serum lactate levels were collected from the patients. The MELD scores with or without serum lactate levels from survival and nonsurvival groups were recorded and compared.RESULTS Two hundred and thirty-six patients with HBV-ACLF were divided into two groups: survival group(S) andnon-survival group(NS). Compared with the NS group, the patients in survival the S group had a significantly lower level of serum lactate(3.11 ± 1.98 vs 4.67 ± 2.43, t = 5.43, P < 0.001) and MELD score(23.33 ± 5.42 vs 30.37 ± 6.58, t = 9.01, P = 0.023). Furthermore, serum lactate level was positively correlated with MELD score(r = 0.315, P < 0.001). Therefore, a modified MELD including serum lactate was developed by logistic regression analysis(0.314 × lactate + 0.172 × MELD-5.923). In predicting 3-month mortality using the MELD-LAC model, the patients from the S group had significantly lower baseline scores(-0.930 ± 1.34) when compared with those from the NS group(0.771 ± 1.32, t = 9.735, P < 0.001). The area under the receiver operating characteristic curve(AUROC) was 0.859 calculated by using the MELD-LAC model, which was significantly higher than that calculated by using the lactate level(0.790) or MELD alone(0.818). When the cutoff value was set at-0.4741, the sensitivity, specificity, positive predictive value and negative predictive value for predicting short-term mortality were 91.5%, 80.10%, 94.34% and 74.62%, respectively. When the MELD-LAC scores at baseline level were set at-0.5561 and 0.6879, the corresponding mortality rates within three months were 75% and 90%, respectively.CONCLUSION The short-term prognosis of HBV-related ACLF was improved by using a modified MELD including serum lactate from the present 6-year clinical study.
文摘Pediatric sepsis is the most common disease in pediatric critical illness,because the main reason for the disease is that children's immune level is not high or the immune system is not perfect,when children's lung,abdominal cavity and blood system are infected,it will cause systemic inflammation and immune dysfunction.Early clinical symptoms are mainly irregular and intermittent fever.When the disease develops to severe sepsis,the children will suffer from acute heart failure,oliguria,respiratory alkalosis and even multiple organ failure.The incidence of death is high.It is reported that the incidence rate of sepsis in children can reach 0.3%,and the mortality rate is 50%.High incidence rate,high mortality rate and high treatment cost are the biggest problems in the pediatric field.In the past,the clinical hope of clearing away heat and toxin,promoting blood circulation and removing stasis,strengthening inflammation and other methods in traditional Chinese medicine,but the treatment effect is not ideal.With the improvement of modem medical understanding of sepsis,continuous blood purification therapy is introduced into the treatment of children with severe sepsis.In order to further explore the effect of continuous blood purification in the treatment of children with severe sepsis,the author summarizes the clinical practice experience and relevant literature,hoping to provide reference for relevant medical staff。
文摘Purpose： Exsanguination is the most common leading cause of death in trauma patients. The massive transfusion （MT） protocol may influence therapeutic strategies and help provide blood components in timely manner. The assessment of blood consumption （ABC） score is a popular MT protocol but has low predictability. The lactate level is a good parameter to reflect poor tissue perfusion or shock states that can guide the management. This study aimed to modify the ABC scoring system by adding the lactate level for better prediction of MTo Methods： The data were retrospectively collected from 165 trauma patients following the trauma acti- vated criteria at Songklanagarind Hospital from January 2014 to December 2014. The ABC scoring system was applied in all patients. The patients who had an ABC score 〉2 as the cut point for MT were defined as the ABC group. All patients who had a score 〉2 with a lactate level 〉4 mmol/dL were defined as the ABC plus lactate level （ABC ＋ L） group. The prediction for the requirement of massive blood transfusion was compared between the ABC and ABC ＋ L groups. The ability of ABC and ABC ＋ L groups to predict MT was estimated by the area under the receiver operating characteristic curve （AUROC）. Results： Among 165 patients, 15 patients （9%） required massive blood transfusion. There were no sig- nificant differences in age, gender, mechanism of injury or initial vital signs bet^teen the MT group and the non-MT group. The group that required MT had a higher Injury Severity Score and mortality. The sensitivity and specificity of the ABC scoring system in our institution were low （81%, 34%, AUC 0.573）. The sensitivity and specificity were significantly better in the ABC ＋ L group （92%, 42%, AUC = 0.745）. Conclusion： The ABC scoring system plus lactate increased the sensitivity and specificity compared with the ABC scoring system alone.
文摘Objective The present study investigated the sodium/iodide symporter mRNA expression in mouse lactating mammary gland cells under different iodine levels and the effects of thyroid-stimulating hormone(TSH),estradiol(E2)and prolactin(PRL)on NIS mRNA expression in mouse lactating mammary gland cells.
