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OBJECTIVE@#To optimize the maintenance quality management of MRI equipment and ensure the quality and safety of its clinical use.@*METHODS@#The data of failure time and repair time of a MRI equipment in three years were collected by magnetic resonance repair report system, and then the reliability, availability and maintainability(RAM) were studied and analyzed.@*RESULTS@#The results of reliability analysis showed that the communication module was the key subsystem of the MRI equipment. The results of usability analysis showed that RF module was a key subsystem of MRI equipment. Maintainability results showed that the proportion of the MRI equipment not fully utilized due to maintenance-related problems was 2.58%. In order to improve the availability of MRI equipment, the maintenance time of MRI equipment should be shortened.@*CONCLUSIONS@#RAM-based analysis of MRI equipment can help hospital equipment managers to carry out the work of operation optimization, maintenance strategy formulation and safety management of MRI equipment.
Subject(s)
Equipment Safety , Equipment and Supplies, Hospital , Magnetic Resonance Imaging , Reproducibility of Results , Safety ManagementABSTRACT
Objective: To investigate the efficacy and safety of infliximab (IFX) therapy for children with Kawasaki disease. Methods: Sixty-eight children with Kawasaki disease who received IFX therapy in Children's Hospital of Fudan University from January 2014 to April 2021 were enrolled. The indications for IFX administration, changes in laboratory parameters before and after IFX administration, response rate, drug adverse events and complications and outcomes of coronary artery aneurysms (CAA) were retrospectively analyzed. Comparisons between groups were performed with unpaired Student t test or Mann-Whitney U test or chi-square test. Results: Among 68 children with Kawasaki disease, 52 (76%) were males and 16 (24%) were females. The age of onset was 2.1 (0.5, 3.8) years. IFX was administered to: (1) 35 children (51%) with persistent fever who did not respond to intravenous immunoglobulin (IVIG) or steroids, 28 of the 35 children (80%) developed CAA before IFX therapy; (2) 32 children (47%) with continuous progression of CAA; (3) 1 child with persistent arthritis. In all cases, IFX was administered as an additional treatment (the time from the onset of illness to IFX therapy was 21 (15, 30) days) which consisted of second line therapy in 20 (29%), third line therapy in 20 (29%), and fourth (or more) line therapy in 28 (41%). C-reactive protein (8 (4, 15) vs. 16 (8, 43) mg/L, Z=-3.38, P=0.001), serum amyloid protein A (17 (10, 42) vs. 88 (11, 327) mg/L, Z=-2.36, P=0.018) and the percentage of neutrophils (0.39±0.20 vs. 0.49±0.21, t=2.63, P=0.010) decreased significantly after IFX administration. Fourteen children (21%) did not respond to IFX and received additional therapies mainly including steroids and cyclophosphamide. There was no significant difference in gender, age at IFX administration, time from the onset of illness to IFX administration, the maximum coronary Z value before IFX administration, and the incidence of systemic aneurysms between IFX-sensitive group and IFX-resistant group (all P>0.05). Infections occurred in 11 cases (16%) after IFX administration, including respiratory tract, digestive tract, urinary tract, skin and oral infections. One case had Calmette-Guérin bacillus-related adverse reactions 2 months after IFX administration. All of these adverse events were cured successfully. One child died of CAA rupture, 6 children were lost to follow up, the remaining 61 children were followed up for 6 (4, 15) months. No CAA occurred in 7 children before and after IFX treatment, while CAA occurred in 54 children before IFX treatment. CAA regressed in 23 (43%) children at the last follow-up, and the diameter of coronary artery recovered to normal in 10 children. Conclusion: IFX is an effective and safe therapeutic choice for children with Kawasaki disease who are refractory to IVIG or steroids therapy or with continuous progression of CAA.
Subject(s)
Child , Female , Humans , Infant , Male , Coronary Aneurysm/etiology , Immunoglobulins, Intravenous/therapeutic use , Infliximab/adverse effects , Mucocutaneous Lymph Node Syndrome/drug therapy , Retrospective StudiesABSTRACT
Objective:To investigate the clinical value of virtual monoenergetic images (VMI) and electron density map (EDM) derived from the dual-layer spectral detector CT (DLCT) in the differential diagnosis of benign and malignant pulmonary ground glass nodules (GGN).Methods:From July 2019 to August 2020, a total of 65 patients with lung GGN (27 benign GGNs and 38 malignant GGNs) confirmed by pathology were retrospectively enrolled in Gulou Clinical Medical College of Nanjing Medical University. All the patients underwent DLCT plain scanning within two weeks before the surgery. The conventional 120 kVp polyenergetic image (PI), EDM and 40-80 keV VMI were reconstructed. The differences of CT and electron density (ED) values between benign and malignant lesions on different images were compared by Mann-Whitney U test. Independent t-test was used to compare the lesion size and χ 2 test was used to analyze the CT features (including lesion location, shape, edge, internal structure, adjacent structure, nodule type) between benign and malignant lesions. Receiver operating characteristic (ROC) curve was used to analyze the efficacy of different energy spectrum quantitative parameters in the differential diagnosis of benign and malignant GGN. The statistically significant CT signs and energy spectrum quantitative parameters were analyzed by logistic regression analysis to find out the independent risk factors of malignant GGN, and then ROC curve analysis was performed for each independent risk factor alone or in combination. Results:There were significant differences in lesion shape, spiculation, lobulation, location and size between benign and malignant groups ( P<0.05). The CT value of pulmonary GGN in PI, 40-80 keV VMI and the ED value in EDM were statistically different between benign and malignant lesions ( P<0.05). The area under ROC curve (AUC) were 0.680, 0.682, 0.683, 0.686, 0.694, 0.676 and 0.722, respectively, among which the ED value had the highest AUC. Binary logistic regression analysis was carried out with GGN shape, spiculation, lobulation, location, size, ED value and CT value in PI, 40-80 keV VMI as independent variables, and malignant GGN as dependent variables. The results showed that ED value (OR=1.045, 95%CI 1.001-1.090, P=0.044), lesion size (OR=1.582, 95%CI 1.159-2.158, P=0.004), spiculation sign (OR=11.352, 95%CI 2.379-54.172, P=0.002) were independent risk factors for malignant GGN. ROC curve analysis showed the AUC of ED value, lesion size, spiculation sign and combination of the three for differential diagnosis of benign and malignant GGN were 0.722, 0.772, 0.698 and 0.885. The AUC for the combined parameters was the largest, with sensitivity of 92.1% and specificity of 74.1%. Conclusion:The diagnostic efficacy of EDM is higher than that of other VMI in the differential diagnosis of pulmonary GGN by DLCT images; The efficacy is further improved when EDM is combined with lesion size and spiculation sign for comprehensive diagnosis.
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The mammalian epididymis not only plays a fundamental role in the maturation of spermatozoa, but also provides protection against various stressors. The foremost among these is the threat posed by oxidative stress, which arises from an imbalance in reactive oxygen species and can elicit damage to cellular lipids, proteins, and nucleic acids. In mice, the risk of oxidative damage to spermatozoa is mitigated through the expression and secretion of glutathione peroxidase 5 (GPX5) as a major luminal scavenger in the proximal caput epididymidal segment. Accordingly, the loss of GPX5-mediated protection leads to impaired DNA integrity in the spermatozoa of aged Gpx5-/-mice. To explore the underlying mechanism, we have conducted transcriptomic analysis of caput epididymidal epithelial cells from aged (13 months old) Gpx5-/-mice. This analysis revealed the dysregulation of several thousand epididymal mRNA transcripts, including the downregulation of a subgroup of piRNA pathway genes, in aged Gpx5-/-mice. In agreement with these findings, we also observed the loss of piRNAs, which potentially bind to the P-element-induced wimpy testis (PIWI)-like proteins PIWIL1 and PIWIL2. The absence of these piRNAs was correlated with the elevated mRNA levels of their putative gene targets in the caput epididymidis of Gpx5-/-mice. Importantly, the oxidative stress response genes tend to have more targeting piRNAs, and many of them were among the top increased genes upon the loss of GPX5. Taken together, our findings suggest the existence of a previously uncharacterized somatic piRNA pathway in the mammalian epididymis and its possible involvement in the aging and oxidative stress-mediated responses.
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Objective: To investigate the inhibitory effect on Burkholderia pseudomallei (B. pseudomallei) strain HNBP001 of a bacillomycin D-like cyclic lipopeptide compound named bacillomycin DC isolated from Bacillus amyloliquefaciens HAB-2. Methods: The antibacterial effect of bacillomycin DC on B. pseudomallei was determined using the disk diffusion method. The minimum inhibitory concentrations were evaluated by microdilution assay. In addition, transmission electron microscopy was performed and quantitative real-time polymerase chain reaction assay was carried out to determine the expression of MexB, OprD2, and qnrS genes. Results: Bacillomycin DC produced an inhibition zone against B. pseudomallei with minimum inhibitory concentration values of 12.5 μg/mL 24 h after treatment and 50 μg/mL at 48 and 72 h. Transmission electron microscopy showed that bacillomycin DC resulted in roughening cell surface and cell membrane damage. Quantitative real-time polymerase chain reaction analysis showed low expression of MexB, OprD2 and qnrS genes. Conclusions: Bacillomycin DC inhibits the growth of B. pseudomallei and can be a new candidate for antimicrobial agents of B. pseudomallei. Rajaofera Mamy 1 Key Laboratory of Tropical Translational Medicine of Ministry of Education and School of Tropical Medicine and Laboratory Medicine, Hainan Medical University, Haikou, Hainan Kang Xun 2 Key Laboratory of Tropical Translational Medicine of Ministry of Education and School of Tropical Medicine and Laboratory Medicine, Hainan Medical University, Haikou, Hainan Jin Peng-Fei 3 Key Laboratory of Green Prevention and Control of Tropical Plant Diseases and Pests (Hainan University), Ministry of Education, Haikou 570228, Hainan Chen Xin 4 Key Laboratory of Tropical Translational Medicine of Ministry of Education and School of Tropical Medicine and Laboratory Medicine, Hainan Medical University, Haikou, Hainan Li Chen-Chu 5 Key Laboratory of Tropical Translational Medicine of Ministry of Education and School of Tropical Medicine and Laboratory Medicine, Hainan Medical University, Haikou, Hainan Yin Li 6 Key Laboratory of Tropical Translational Medicine of Ministry of Education and School of Tropical Medicine and Laboratory Medicine, Hainan Medical University, Haikou, Hainan Liu Lin 7 Key Laboratory of Tropical Translational Medicine of Ministry of Education and School of Tropical Medicine and Laboratory Medicine, Hainan Medical University, Haikou, Hainan Sun Qing-Hui 8 Key Laboratory of Tropical Translational Medicine of Ministry of Education and School of Tropical Medicine and Laboratory Medicine, Hainan Medical University, Haikou, Hainan Zhang Nan 9 Key Laboratory of Tropical Translational Medicine of Ministry of Education and School of Tropical Medicine and Laboratory Medicine, Hainan Medical University, Haikou, Hainan Chen Chui-Zhe 10 Key Laboratory of Tropical Translational Medicine of Ministry of Education and School of Tropical Medicine and Laboratory Medicine, Hainan Medical University, Haikou, Hainan He Na 11 Key Laboratory of Tropical Translational Medicine of Ministry of Education and School of Tropical Medicine and Laboratory Medicine, Hainan Medical University, Haikou, Hainan Xia Qian-Feng 12 Key Laboratory of Tropical Translational Medicine of Ministry of Education and School of Tropical Medicine and Laboratory Medicine, Hainan Medical University, Haikou, Hainan Miao Wei-Guo 13 Key Laboratory of Green Prevention and Control of Tropical Plant Diseases and Pests (Hainan University), Ministry of Education, Haikou 570228, Hainan Kung CT, Lee CH, Li CJ, Lu HI, Ko SF, Liu JW. Development of ceftazidime resistance in Burkholderia pseudomallei in a patient experiencing melioidosis with mediastinal lymphadenitis. Ann Acad Med Singapore 2010; 39(12): 945-947. Mohamad NI, Harun A, Hasan H, Deris Z. In-vitro activity of doxycycline and β-lactam combinations against different strains of Burkholderia pseudomallei. Indian J Microbiol 2018; 58(2): 244-247. Limmathurotsakul D, Wongratanacheewin S, Teerawattanasook N, Wongsuvan G, Chaisuksant S, Chetchotisakd P, et al. Increasing incidence of human melioidosis in Northeast Thailand. Am J Trop Med Hyg 2010; 82(6): 1113-1117. Bond TEH, Sorenson AE, Schaeffer PM. Functional characterization of Burkholderia pseudomallei, biotin protein ligase: A toolkit for anti-melioidosis drug development. Microbiol Res 2017; 199: 40-48. Alatoom A, Elsayed H, Lawlor K, AbdelWareth L, El-Lababidi R, Cardona L, et al. Comparison of antimicrobial activity between ceftolozane-tazobactam and ceftazidime-avibactam against multidrug-resistant isolates of Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Int J Infect Dis 2017; 62: 39-43. Limmathurotsakul D, Golding N, Dance DA, Messina JP, Pigott BM, Moyes CL, et al. Predicted global distribution of Burkholderia pseudomallei and burden of melioidosis. Nat Microbiol 2016; 1(1): 15008. Dutta S, Haq S, Hasan MR, Haq JA. Antimicrobial susceptibility pattern of clinical isolates of Burkholderia pseudomallei in Bangladesh. BMC Research Notes 2017; 10(1): 299. Platt R. Adverse effects of third-generation cephalosporins. J Antimicrob Chemother 1982; 10(Suppl C): 135-140. Ahmad N, Hashim R, Mohd Noor A. The in vitro antibiotic susceptibility of malaysian isolates of Burkholderia pseudomallei. Int J Microbiol 2013; 2013: 121845. Sarovich DS, Price EP, Von Schulze AT, Cook JM, Mayo M, Watson LM, et al. Characterization of ceftazidime resistance mechanisms in clinical isolates of Burkholderia pseudomallei from Australia. PLoS One 2012; 7(2): e30789. Jenney AWJ, Lum G, Fisher DA, Currie BJ. Antibiotic susceptibility of Burkholderia pseudomallei from tropical northern Australia and implications for therapy of melioidosis. Int J Antimicrob Agents 2001; 17(2): 109-113. Thibault FM, Hernandez E, Vidal DR, Girardet M, Cavallo JD. Antibiotic susceptibility of 65 isolates of Burkholderia pseudomallei and Burkholderia mallei to 35 antimicrobial agents. J Antimicrob Chemother 2004; 54(6): 1134-1138. Wuthiekanun V, Amornchai P, Saiprom N, Chantratita N, Chierakul W, Koh GC, et al. Survey of antimicrobial resistance in clinical Burkholderia pseudomallei isolates over two decades in Northeast Thailand. Antimicrob Agents Chemother 2011; 55(11): 5388-5391. Behera B, Babu TP, Kamalesh A, Reddy G. Ceftazidime resistance in Burkholderia pseudomallei: First report from India. Asian Pac J Trop Med 2012; 5(4): 329-330. Blower RJ, Barksdale SM, van Hoek ML. Snake cathelicidin NA-CATH and smaller helical antimicrobial peptides are effective against Burkholderia thailandensis. PLoS Negl Trop Dis 2015; 9(7): e0003862. Dean SN, Bishop BM, Van HML. Susceptibility of Pseudomonas aeruginosa biofilm to alpha-helical peptides: D-enantiomer of LL-37. Front Microbiol 2011; 2: 128. Kampshoff F, Willcox MDP, Dutta D. A pilot study of the synergy between two antimicrobial peptides and two common antibiotics. Antibiotics (Basel) 2019; 8(2): E60. Dawson RM, Liu CQ. Properties and applications of antimicrobial peptides in biodefense against biological warfare threat agents. Crit Rev Microbiol 2008; 34(2): 89-107. Jin P, Wang H, Liu W, Fan Y, Miao W. A new cyclic lipopeptide isolated from Bacillus amyloliquefaciens HAB-2 and safety evaluation. Pestic Biochem Physiol 2018; 147: 40-45. Boottanun P, Potisap C, Hurdle JG, Sermswan RW. Secondary metabolites from Bacillus amyloliquefaciens isolated from soil can kill Burkholderia pseudomallei. Amb Express 2017; 7(1):16. Kang X, Fu Z, Rajaofera MJN, Li C, Zhang N, Liu L, et al. Whole-genome sequence of Burkholderia pseudomallei strain HNBP001, isolated from a melioidosis patient in Hainan, China. Microbiol Resour Announc 2019; 8(36): e00471-19. Liu L, Sun QH, Pei H, Chen CZ, Xiu H, Zhang N, et al. Multilocus sequence typing of Burkholderia pseudomallei collected in Hainan, China. Chin J Zoono 2019; 35(06): 514-517+524. Gay K, Robicsek A, Strahilevitz J, Park CH, Jacoby G, Barrett TJ, et al. Plasmid-mediated quinolone resistance in non-Typhi serotypes of Salmonella enterica. Clini Infect Dis 2006; 43(3): 297-304. Fu QY, Chen CY, Wu J, Wu Q, Qin X, Qian SY, et al. Establishment and evaluation of real-time PCR for rapid and quantitative detection of Burkholderia pseudomallei. J Third Mil Med Univ 2015; 17: 1734-1738. Serra C, Bouharkat B, Tir Touil-Meddah A, Guénin S, Mullié C. MexXY multidrug efflux system is more frequently overexpressed in ciprofloxacin resistant french clinical isolates compared to hospital environment ones. Front Microbiol 2019; 10: 366. Cai S, Chen Y, Song D, Kong J, Wu Y, Lu H. Study on the resistance mechanism via outer membrane protein OprD2 and metal ß-lactamase expression in the cell wall of Pseudomonas aeruginosa. Exp Ther Med 2016; 12(5): 2869-2872. Kamjumphol W, Chareonsudjai P, Chareonsudjai S. Antibacterial activity of chitosan against Burkholderia pseudomallei. Microbiologyopen 2018; 7(1). Doi: 10.1002/mbo3.534 Livak KJ, Schmittgen TD. Analysis of relative gene expression data using real-time quantitative PCR and the 2(T)(-AAC) method. Methods 2001; 25(4): 402-408. Baindara P, Mandal SM, Chawla N, Singh PK, Pinnaka AK, Korpole S. Characterization of two antimicrobial peptides produced by a halotolerant Bacillus subtilis strain SK.DU.4 isolated from a rhizosphere soil sample. AMB Express 2013; 3(1): 2. Chalhoub H, Sáenz Y, Nichols WW, Tulkens PM, Van Bambeke F. Loss of activity of ceftazidime-avibactam due to Mex-AB-OprM efflux and overproduction of AmpC cephalosporinase in Pseudomonas aeruginosa, isolated from patients suffering from cystic fibrosis. Int J Antimicrob Agents 2018; 52(5): 697-701. Verchère A, Picard M, Broutin I. Functional investigation of the MexA-MexB-OprM efflux pump of Pseudomonas aeruginosa. Biophysic J 2013; 104(2): 286a. Van Duin D, Lok JJ, Earley M, Cober E, Richter SS, Perez F. Colistin versus ceftazidime-avibactam in the treatment of infections due to carbapenem-resistant Enterobacteriaceae. Clin Infect Dis 2018; 66(2): 163-171. Schweizer HP. Mechanisms of antibiotic resistance in Burkholderia pseudomallei: Implications for treatment of melioidosis. Future Microbiol 2012; 7(12): 1389-1399. Quinn JP, Darzins A, Miyashiro D, Ripp S, Miller RV. Imipenem resistance in Pseudomonas aeruginosa PAO: Mapping of the OprD2 gene. Antimicrob Agents Chemother 1991; 35(4): 753-755. Dong F, Xu XW, Song WQ, Lü P, Yang YH, Shen XZ. Analysis of resistant genes of beta-lactam antibiotics from Pseudomonas aeruginosa in pediatric patients. Zhonghua Yi Xue Za Zhi 2008; 88(42): 3012-3015. Shen J, Pan Y, Fang Y. Role of the outer membrane protein OprD2 in carbapenem-resistance mechanisms of Pseudomonas aeruginosa. PLoS One 2015; 10(10): e0139995. Georges B, Conil JM, Dubouix A, Archambaud M, Bonnet E, Saivin S, et al. Risk of emergence of Pseudomonas aeruginosa resistance to ß-lactam antibiotics in intensive care units. Crit Care Med 2006; 34(6): 1636-1641. Literak I, Dolejska M, Janoszowska D, Hrusakova J, Meissner W, Rzyska H, et al. Antibiotic-resistant Escherichia coli bacteria, including strains with genes encoding the extended-spectrum beta-lactamase and QnrS, in waterbirds on the Baltic Sea Coast of Poland. Appl Environ Microb 2010; 76(24): 8126-8134. Wang J, Zhang X, Sun G, Wang Q, Lu L, Feng X, et al. Utility of multiple-locus variant-repeat analysis method for the outbreak of the Pseudomonas aeruginosa isolates. Clin Lab 2014; 60(7): 1217-1223. El-Badawy MF, Alrobaian MM, Shohayeb MM, Abdelwahab SF. Investigation of six plasmid-mediated quinolone resistance genes among clinical isolates of pseudomonas: A genotypic study in Saudi Arabia. Infect Drug Resist 2019; 12: 915-923. Martín-Gutiérrez G, Rodríguez-Martínez JM, Pascual Á, Rodríguez-Beltrán J, Blázquez J. Plasmidic qnr genes confer clinical resistance to ciprofloxacin under urinary tract physiological conditions. Antimicrob Agents Chemother 2017; 61(4): e02615-e02616. Paiva MC, Reis MP, Costa PS, Dias MF, Bleicher L, Scholte LLS, et al. Identification of new bacteria harboring qnrS and aac(6')-Ib/cr and mutations possibly involved in fluoroquinolone resistance in raw sewage and activated sludge samples from a full-scale WWTP. Water Res 2017; 110: 27-37.
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Objective: To investigate the inhibitory effect on Burkholderia pseudomallei (B. pseudomallei) strain HNBP001 of a bacillomycin D-like cyclic lipopeptide compound named bacillomycin DC isolated from Bacillus amyloliquefaciens HAB-2. Methods: The antibacterial effect of bacillomycin DC on B. pseudomallei was determined using the disk diffusion method. The minimum inhibitory concentrations were evaluated by microdilution assay. In addition, transmission electron microscopy was performed and quantitative real-time polymerase chain reaction assay was carried out to determine the expression of MexB, OprD2, and qnrS genes. Results: Bacillomycin DC produced an inhibition zone against B. pseudomallei with minimum inhibitory concentration values of 12.5 μg/mL 24 h after treatment and 50 μg/mL at 48 and 72 h. Transmission electron microscopy showed that bacillomycin DC resulted in roughening cell surface and cell membrane damage. Quantitative real-time polymerase chain reaction analysis showed low expression of MexB, OprD2 and qnrS genes. Conclusions: Bacillomycin DC inhibits the growth of B. pseudomallei and can be a new candidate for antimicrobial agents of B. pseudomallei.
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The mammalian epididymis not only plays a fundamental role in the maturation of spermatozoa, but also provides protection against various stressors. The foremost among these is the threat posed by oxidative stress, which arises from an imbalance in reactive oxygen species and can elicit damage to cellular lipids, proteins, and nucleic acids. In mice, the risk of oxidative damage to spermatozoa is mitigated through the expression and secretion of glutathione peroxidase 5 (GPX5) as a major luminal scavenger in the proximal caput epididymidal segment. Accordingly, the loss of GPX5-mediated protection leads to impaired DNA integrity in the spermatozoa of aged Gpx5
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Autoimmune encephalitis (AE) is a recurring disease that refers to central nervous system inflammatory diseases caused by the body’s immune system’s abnormal immune response to neuronal antigenic components. The clinical features are characterized by acute or subacute episodes of mental behavior abnormalities, epilepsy and cognitive impairment. The positive anti-neuronal antibody in cerebrospinal fluid is the main basis for the diagnosis of AE. AE can be divided into anti-N-methyl-D-aspartate receptor encephalitis, anti-leucine-rich glioma-inactivated protein-1 encephalitis, anti-gamma-aminobutyric acid type B receptor encephalitis, anti-α-amino 3-hydroxy-5-methyl-4-isoxadic acid receptor encephalitis and the like. Recurrence cases have been reported in almost all types of AE, with the most reported of anti-N-methyl-D-aspartate receptor encephalitis recurrence. Recurrence is easy to occur when hormones or immunosuppressive drugs are discontinued; second-line immunotherapy can reduce the recurrence rate are the common features of all types of AE recurrence. The rate, interval, and clinical symptoms of recurrence of various types AE are different. This article summarizes the clinical features of AE recurrence and hopes to enrich clinicians’ understanding of AE recurrence.
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Objective@#To investigate the application of coronary angiography (CAG) in children with Kawasaki disease complicated with coronary artery lesion (CAL).@*Methods@#A total of 139 patients (115 boys and 24 girls, age (48±42) months) with Kawasaki disease complicated with CAL underwent CAG between June 2006 and June 2018 in Children′s Hospital of Fudan University. CAL in all children were at grade Ⅲ and above assessed by echocardiography and underwent CAG under general anesthesia with parental consent. A retrospective analysis was performed to identify the safety and complication of CAG, degree of satisfaction of image, distribution of CAL, and the treatment and follow-up management according to the result of CAG.@*Results@#All the 139 patients underwent CAG, and 17 patients received CAG twice. In these cases, there was a total of 309 CAL with an average of 2.22 CAL per patient. After CAG, children were re-graded as grade Ⅲ in 33 cases, grade Ⅳ in 56 cases, grade Ⅴa in 33 cases and grade Ⅴb in 17 cases according to the clinical severity. Ten patients (7.2%) had only aortic root angiography and 129 (92.8%) patients had selective left or right CAG. Among these, 27 cases (19.4%) showed thrombosis in coronary aneurysm, 23 cases (16.5%) showed coronary artery stenosis, 4 cases (2.9%) showed recanalization after occlusion in right coronary artery. All the patients obtained satisfied images, and no complication was found. Eight of the grade Ⅴb patients underwent coronary artery bypass grafting (CABG). One patient died during the surgery due to severe heart failure, and the other seven patients received CABG successfully and recovered well during a long-term follow up (18 to 108 months).@*Conclusions@#CAG is safe for children with Kawasaki disease with CAL, and the images of CAG are satisfied. Patients who were graded according to CAG and received the corresponding surgical treatment could get satisfied effect in the medium and long-term follow-up.
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Objective To monitor the dynamic changes of radiation-induced parotid damage using T2 ? mapping.Methods Thirty-four patients with nasopharyngeal carcinoma (NPC)were enrolled.All patients underwent T1 WI,T2 WI and T2 ? mapping for bilateral parotid glands at pre-RT (2 weeks before radiotherapy),mid-RT (5 weeks after the beginning of radiotherapy)and post-RT (4 weeks after the completion of radiotherapy).Parotid MR parameters,mean radiation dose and xerostomia degrees of the patients at different time points were recorded.Furthermore,nine healthy volunteers were enrolled,who undergone T2 ? mapping twice with an interval of 4 weeks in order to analyze the reproducibility of T2 ? value.Results From pre-RT to mid-RT and post-RT,parotid volume decreased [atrophy rates,(25.34±11.33)％ and (25.74±9.93)％,respectively]and T2 ? values decreased [change rates,(-5.63±8.86)％ and (-4.81±10.67)％, respectively]significantly (all P < 0.01 ).Parotid normalized T1 signal intensity decreased significantly from pre-RT to post-RT [change rate,(-7.43±10.61)％,P =0.007],and the change rate was correlated inversely with mean radiation dose significantly (r =-0.646, P <0.001).Parotid volume and T2 ? value changed correspondingly with xerostomia degrees of the patients during radiotherapy.Parotid MR parameters showed excellent reproducibility (intraclass correlation coefficient,0.843 -0.993).Conclusion The dynamic changes of radiation-induced parotid damage in patients with NPC can be noninvasively evaluated by routine MRI and T2 ? mapping.
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Objective To monitor the dynamic changes of radiation-induced parotid damage using T2 ? mapping.Methods Thirty-four patients with nasopharyngeal carcinoma (NPC)were enrolled.All patients underwent T1 WI,T2 WI and T2 ? mapping for bilateral parotid glands at pre-RT (2 weeks before radiotherapy),mid-RT (5 weeks after the beginning of radiotherapy)and post-RT (4 weeks after the completion of radiotherapy).Parotid MR parameters,mean radiation dose and xerostomia degrees of the patients at different time points were recorded.Furthermore,nine healthy volunteers were enrolled,who undergone T2 ? mapping twice with an interval of 4 weeks in order to analyze the reproducibility of T2 ? value.Results From pre-RT to mid-RT and post-RT,parotid volume decreased [atrophy rates,(25.34±11.33)％ and (25.74±9.93)％,respectively]and T2 ? values decreased [change rates,(-5.63±8.86)％ and (-4.81±10.67)％, respectively]significantly (all P < 0.01 ).Parotid normalized T1 signal intensity decreased significantly from pre-RT to post-RT [change rate,(-7.43±10.61)％,P =0.007],and the change rate was correlated inversely with mean radiation dose significantly (r =-0.646, P <0.001).Parotid volume and T2 ? value changed correspondingly with xerostomia degrees of the patients during radiotherapy.Parotid MR parameters showed excellent reproducibility (intraclass correlation coefficient,0.843 -0.993).Conclusion The dynamic changes of radiation-induced parotid damage in patients with NPC can be noninvasively evaluated by routine MRI and T2 ? mapping.
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PURPOSE: We report sharp rise of incidence of mumps meningitis at our institute and describe the clinical manifestations, laboratory findings, and complications. METHODS: This is a retrospective study involving 34 patients with mumps meningitis at Eulji University Hospital from July 2012 to June 2014. They were diagnosed by definite parotid gland swelling and leukocytosis in cerebrospinal fluid (CSF) study. RESULTS: Nineteen (55.9%) of the 34 patients with mumps meningitis were confirmed as positive by the mumps virus-specific immunoglobulin M (IgM) antibody in serum or CSF and the remaining 15 patients (44.1%) were classified as probable cases. We identified 31 boys and 3 girls clearly showing male predominance. The median age of the patients was 15.8 years and all patients were in the middle school and high school age group. Sixteen patients (47.1%) had unilateral mumps and 29 patients (85.3%) were diagnosed with meningitis after parotid swelling. Six patients (17.6%) were accompanied by testicular involvement and one (2.9%) showed hearing loss. The positivity of mumps virus specific IgM was 17 of 34 (50.0%) in serum and 4 of 34 (11.8%) in CSF. The total duration of illness including hospitalization was 5 to 21 days, median being 11 days. There was no serious neurologic deficit but 5 of 34 (14.7%) complained dizziness after discharge. It caused delay in back-to-work. CONCLUSION: It is worthy to notice that recent outbreak of mumps among adolescents are more complicated. We need to be more aggressive about prevention of mumps outbreak which bring on substantial socioeconomic loss.
Subject(s)
Adolescent , Female , Humans , Male , Cerebrospinal Fluid , Dizziness , Hearing Loss , Hospitalization , Immunoglobulin M , Incidence , Leukocytosis , Meningitis , Mumps virus , Mumps , Neurologic Manifestations , Parotid Gland , Retrospective Studies , Return to WorkABSTRACT
<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of evaluation,treatment and follow-up of Kawasaki coronary artery disease based on the clinical severity classification.</p><p><b>METHOD</b>This study evaluated 52 patients admitted to the Children's Hospital of Fudan University between July 2005 and December 2013 who were diagnosed with Kawasaki Disease with coronary artery disease.Inclusion criteria were a disease course of more than two months, initial echocardiography showing severity of grade IV and above, and confirmation of disease severity by angiography. Of those studies, 44 were male and eight were female, aged 6 to 142 (average 41) months. Treatment was planned according to protocols in "Suggestions for Management of Kawasaki Coronary Artery Disease" with follow-up. Those patients with grade IV and above confirmed by angiogram were given oral low-dose asprin and warfarin, and those with grade Vb were given coronary artery bypass grafting (CABG) after comprehensive evaluation. Analysis was carried out for diagnosis, treatment, complications, and results of follow-up.</p><p><b>RESULT</b>(1) Satisfied images were shown by the angiography of all 52 cases. Forty five patients (86%) had giant aneurysm or multiple aneurysms, with thrombosis found in 10 of 45 patients (22%). Coronary artery lesions occurred in 138 coronary branches, and more common in left anterior descending branch (47 branches, with incidence 34%) and right coronary artery (48 branches, with incidence 35%). There were no complications during or after angiography. (2) After angiography, 49 patients remained at grade IV or above, and three improved to grade III. Ultimately, clinical severities of coronary artery disease included three patients at grade III, 31 patients at grade IV, nine patients at grade Va, and nine patients at grade Vb. (3) Thirty-eight patients were properly using aspirin and warfarin, and two patients with severely elevated international normalized ratio (INR) levels presented with knee joint and gastric hemorrhage, both of which were treated successfully.Patients with INR levels between 1.5 and 2.5 did not show signs of hemorrhage. (4) In follow-up visits between 6 months and 8 years, one patient had representation of thrombosis on angiography, but did not lead to coronary stenosis; four patients were improved from grade IV to either grade III or II. The remaining showed no new thrombotic formation or stenosis. (5) Of the nine grade Vb patients, five underwent coronary artery bypass grafting. The youngest of these patients, a 22 months old girl, died intraoperatively. The remaining four recovered postoperatively and were followed up for 8 to 90 months. One patient had a preoperative left ventricular ejection fraction (LVEF) of only 32.8%, with LVEF remaining abnormal post-CABG, between 35% and 44%. The remaining three patients had normal heart size, cardiac function, and electrocardiogram.Of the other four grade Vb patients, two were contraindicated for surgery due to severe heart failure and loss of myocardial activity. Two other cases are being followed up closely due to their young age of 9 months.</p><p><b>CONCLUSION</b>Coronary angiography is safe and efficacious in children, and even in infants.It is the current gold standard tool for grading Kawasaki coronary artery disease. Proper anticoagulation therapy can markedly decrease the incidence of coronary artery occlusion in patients with Kawasaki coronary artery disease. Safe ranges of corrected INR should be between 1.5 and 2.5 after taking warfarin. CABG is an effective treatment for severe coronary artery disease with myocardial ischemia.</p>
Subject(s)
Child , Child, Preschool , Female , Humans , Infant , Male , Aspirin , Therapeutic Uses , Coronary Angiography , Coronary Artery Bypass , Coronary Artery Disease , Therapeutics , Disease Management , Echocardiography , Electrocardiography , Mucocutaneous Lymph Node Syndrome , Therapeutics , Treatment Outcome , Ventricular Function, Left , Warfarin , Therapeutic UsesABSTRACT
PURPOSE: The aim of this study was to investigate the causative organisms, clinical manifestations, and prognosis of pediatric patients with bacterial meningitis in Daejeon and Chungcheong area, occurred from 2006 to 2010. METHODS: We retrospectively reviewed medical records of patients aged between 1 month and 15 years, diagnosed with bacterial meningitis at 8 university or general hospitals in Daejeon and Chungcheong area. The bacterial meningitis was defined by isolation of organism from cerebrospinal fluid(CSF). The data was collected from January 2006 to December 2010, and analyzed including patient's demographics, causative organisms, clinical presentation, laboratory findings and complications. RESULTS: During the 5-year study period, 24 patients were diagnosed with CSF culture-proven bacterial meningitis. The most common causative organism was Streptococcus pneumoniae (S. pneumoniae, 37.5%), and the others were group B streptococcus (GBS, 20.8%), Escherichia coli (E. coli, 16.7%), Neisseria meningitidis (N. meningitidis, 8.3%), Haemophilus influenzae (H. influenzae, 4.2%), respectively. They initially complained of fever (95.8%), vomiting (83.3%), anorexia (45.8%), seizure (29.2%), headache (20.8%). The leukocyte counts exceeding 1,000/mm3 in CSF was observed in 14 patients (58.3%). In 15 patients (62.5%), the glucose concentration in CSF was less than 50 mg/dL, 18 patients showed that the protein concentration in CSF was more than 100 mg/dL. Long-term neurologic sequelae were observed in 4 patients (16.7%) and described as hearing disturbance (2 patients), hemiparesis (1 patient) and endocrine dysfunction (1 patient). Ten patients (41.7%) showed abnormal neuroradiologic findings and the most common abnormalities was subdural effusion (25.0%). CONCLUSION: Compared to the previous study performed between 2001 and 2005, S. pneumonia continued to be the leading cause of the pediatric bacterial meningitis in Daejeon and Chungcheong area. The frequency of pneumococcal meningitis was not decreased, despite of the introduction of conjugated pneumococcal vaccination. On the other hand, H. influenzae meningitis was notably decreased.
Subject(s)
Humans , Anorexia , Demography , Escherichia coli , Fever , Glucose , Haemophilus influenzae , Hand , Headache , Hearing , Hospitals, General , Influenza, Human , Leukocyte Count , Medical Records , Meningitis , Meningitis, Bacterial , Meningitis, Pneumococcal , Neisseria meningitidis , Paresis , Pneumonia , Prognosis , Retrospective Studies , Seizures , Streptococcus , Streptococcus pneumoniae , Subdural Effusion , Vaccination , VomitingABSTRACT
<p><b>OBJECTIVE</b>To evaluate the clinical characteristics and short-term outcomes of neonatal asymmetric crying facies (ACF), in order to improve recognition of the disease.</p><p><b>METHODS</b>The clinical data of 11 infants with ACF between January 2010 and February 2012 were retrospectively studied. Physical and neurological development were followed up at correct gestational age 44 weeks and 3 months.</p><p><b>RESULTS</b>Of the 11 infants with ACF, 4 had ipsilateral ear malformation, 2 had congenital heart disease and 1 had syndactyly and polydactyly. Of the 11 infants, 8 were male and 3 were female. Eight infants presented with lesions on the left side and 3 presented with lesions on the right. The fathers were aged over 35 in 8 cases and the mothers were over 30 in 7 cases. Eight mothers had a history of at least 3 pregnancies and 2 infants were born to mothers with diabetes mellitus. Physical index was below P10 in 1 case and 2 cases showed a low NBNA score and mild abnormal GMs (poor repertoire PR) during the writhing period at correct gestational age 44 weeks. Physical index was between P10-P90 and GM assessment during the fidgety period showed normal movements in all infants at correct gestational age 3 months, but they still had ACF.</p><p><b>CONCLUSIONS</b>ACF is associated with a high rate of other congenital malformations. The short-term outcomes of ACF infants are satisfactory, but long-term follow-up and interdisciplinary cooperation are necessary to improve prognosis.</p>
Subject(s)
Female , Humans , Infant, Newborn , Male , Crying , Facial Paralysis , Follow-Up Studies , Retrospective StudiesABSTRACT
Objective To establish the reference ranges for fetal cardiac axis in the mid-second trimester and to evaluate the use of fetal cardiac axis in prenatal diagnosis.Methods 6744 unselected singleton pregnancies were enrolled from September 2008 to October 2010.Routine screening scan of second trimester and fetal echocardiography were performed at 18- 23+6 weeks gestation.Fetal cardiac axis was measured on the four-chamber view of the heart.Results The 6744 fetuses had a mean cardiac axis of (37.03 ± 6.10)°,ranging from 9.80° to 102.41°. Using above or below 95％ range of population (26.63° -49.40°) as a cut-off,there were significant difference of cardiac axis between normal group [(36.96 ± 5.91)°,P ＜0.01] and the group with heart defects [(43.12 ± 15.67)°,P ＜0.01],the group with intrathoricic anomalies or abdominal wall defect [(51.74 ± 15.97)°].ConclusionsThe reference ranges of fetal cardiac axis for local population in mid-second trimester may helpful for detecting congenital defects.Presence of an abnormal cardiac axis in the fetuses is associated with a substantial risk of congenital heart disease and/or other extra cardiac defects.
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<p><b>OBJECTIVE</b>To evaluate the fetal cardiac function in gestational diabetes mellitus (GDM) pregnancies under different maternal glycemic controls.</p><p><b>METHODS</b>Forty four GDM mothers received 78 fetal echocardiographic evaluations at three gestational periods (<28, 28-34 and >34 weeks) and were divided into poorly-(DM1) and well-(DM2) controlled groups according to their glycemic control at examination. Seventy uncomplicated mothers were selected as controls. Parameters of fetal cardiac anatomy and function were measured and analyzed.</p><p><b>RESULTS</b>GDM fetuses' cardiac ventricular walls were thicker than controls', and the differences between DM1 and DM2 were not significant except for end-diastolic left ventricular walls. In both GDM groups, the aortic flow velocities increased earlier than pulmonary artery and DM1 fetuses changed earlier than DM2 ones. GDM fetuses' left atrial shortening fraction was smaller than the controls' in the period of ⩾34 weeks and negatively correlated with thicknesses of left ventricular walls and interventricular septum in DM1 fetuses (r=-0.438 and -0.506). The right ventricular diastolic function in DM1 and DM2 fetuses decreased after the period of 28-34 weeks and in the period of >34 weeks respectively. Tei index of both left and right ventricles increased in DM1 group after the period of <28 weeks and in DM2 group only in the period of ⩾34 weeks, with no significant differences between DM1 and DM2 groups in this period.</p><p><b>CONCLUSION</b>Fetuses of GDM mothers showed cardiac function impairments. Good maternal glycemic control may delay the impairments, but cannot reduce the degree. Some cardiac changes in GDM fetuses were similar to those in pregestational diabetic pregnancies except for several parameters and their changing time.</p>
Subject(s)
Female , Humans , Pregnancy , Case-Control Studies , Diabetes, Gestational , Diagnostic Imaging , Pathology , Diastole , Echocardiography , Fetal Heart , Diagnostic Imaging , Pathology , Systole , Ventricular FunctionABSTRACT
<p><b>OBJECTIVE</b>To assess the relationship between diurnal temperature range (DTR) and sudden infant death (SID) between 2001 and 2004 in Shanghai, China.</p><p><b>METHODS</b>We conducted a time-stratified case-crossover analysis to estimate the percent increase of SID associated with changes in DTR after adjustment for daily weather conditions (temperature and relative humidity) and outdoor air pollution.</p><p><b>RESULTS</b>DTR was significantly associated with daily SID. An increase of 1 °C in the current-day (L0) and in the 2-day moving average (L01) DTR corresponds to a 1.56% (95% CI: 0.97%, 2.15%) and a 1.89% (95% CI: 1.17%, 2.60%) increase in SID, respectively.</p><p><b>CONCLUSION</b>An increased DTR was associated with an increased risk of SID in Shanghai. More studies are needed to understand the effect of DTR on infant deaths.</p>
Subject(s)
Humans , Infant , Infant, Newborn , Air Pollutants , China , Epidemiology , Death Certificates , Humidity , Nitrogen Dioxide , Ozone , Particulate Matter , Risk Factors , Sudden Infant Death , Epidemiology , Sulfur Dioxide , TemperatureABSTRACT
Objective To follow up the changes of postnatal cardiac sizes and function in infants of mothers with gestational diabetes mellitus (GDM). Methods Eighteen GDM mothers with euglycemia (GDM group) and 24 gestational age-matched normal pregnant women (control group),having prenatal examination and delivered in Women's Hospital of Fudan University from January to August in 2007, received fetal echocardiographic examination in late pregnancy. Infants of these GDM mothers and 24 age-matched healthy infants of normal pregnancy (control group) received sonographic follow up. Cardiac sizes and function were evaluated and compared. Results At birth, there were six (33.3%) infants of large for gestational age (LGA) and 12(66.7%) appropriate for gestational age(AGA) in GDM group, while in the control group, there were two LGA (8. 3%) and 22(91.7%)AGA infants (x2 =3. 840, P= 0. 05). Both the interventricular septum and left ventricular walls in GDM fetuses were thicker than in control fetuses (P ＜ 0.05). No increase in the thickness of ventricular walls was observed till infantile period. However, the end-systolic thickness of left ventricular walls in LGA infants was still larger than in control infants [(4.55 ± 0.37) mm vs (4. 13±0.39)mm, P＜0. 05], and end-diastolic left ventricular long-diameters were also larger [(37. 3±2.3) mm vs (34.6±2.6) mm] (P＜0. 05). In GDM fetuses, the peak velocities of aorta and pulmonary artery and left cardiac output were higher than in the controls (P＜ 0. 01 ), and right/left cardiac outputs ratios were lower (1.198±0.206 vs 1. 430±0. 321, t= -2.668,P=0. 011). Till infantile period, only right/left cardiac outputs ratios in AGA infants of GDM group were larger than in controls (P＜0. 05). GDM fetuses' left atrial shortening fraction and tricuspid E/A ratios were smaller (P＜0. 05). In infantile period, only left atrial shortening fraction in GDM infants was still smaller than in controls (0. 356 ± 0. 040 vs 0. 386 ± 0. 041, t = - 2. 332, P = 0. 025). Left and right ventricular Tei index in GDM fetuses were 0. 482±0. 129 and 0. 414±0. 094, both larger than those of control fetuses (0. 309 ± 0. 074 and 0. 283 ± 0. 072) (t = 5. 075 and 5. 129, P = 0. 000 ). Till infantile period they both became significantly lower and no differences were found among LGA, AGA and control infants. Conclusions The cardiac sizes and function at 2-3 months of age, in infants of GDM mothers with good glucose control, became better than that in uterus.
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<p><b>OBJECTIVE</b>To study the feasibility of umbilical cord brain natriuretic peptide (BNP) level measurement for the evaluation of perinatal cardiac function in fetuses from pregnant women with abnormal blood glucose levels and the influence of abnormal blood glucose on fetal cardiac function.</p><p><b>METHODS</b>Twenty-four mothers with gestational diabetes mellitus (n=18) or gestational impaired glucose tolerance (n=6) (diabetic group) were classified into two subgroups according to blood glucose level before delivery: good (n=17) and poor (n=7) glucose control. They underwent fetal echocardiography in their late pregnant periods and fetal cardiac sizes and function were measured. Twenty-five normal pregnant mothers served as the control group. Umbilical cord blood BNP concentrations were measured at delivery.</p><p><b>RESULTS</b>The umbilical cord blood BNP concentrations in the diabetic group were significantly higher than in the control group(114.0+/-39.0 pg/mL vs 80.6+/-13.7 pg/mL; p<0.01). The poor glucose control subgroup demonstrated higher umbilical cord blood BNP concentrations than the good glucose control subgroup (142.1+/-44.1 pg/mL vs 102.4+/-31.2 pg/mL; p<0.01). No difference was found between the gestational diabetes mellitus and the impaired glucose tolerance groups. The BNP concentration was positively correlated to the thicknesses of fetal left ventricular walls and the peak velocities of mitral A wave (r=0.715, 0.491 respectively, p<0.05), and negatively correlated to the mitral E/A ratio (r=-0.507, p<0.05).</p><p><b>CONCLUSIONS</b>The fetuses of pregnant women with abnormal blood glucose levels have an increased BNP level in umbilical cord blood. Umbilical cord BNP level is related to maternal blood glucose control and the changes in fetal cardiac function. It may reflex the latent impairments of fetal cardiac function. A good glucose control may decrease the impact of abnormal maternal blood glucose on fetal hearts.</p>