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Objective To explore the pathogen characteristics and related factors of nosocomial infection in adult ICU pa-tients after cardiac surgery, and provide a basis for the rational and standardized use of antibiotics and the control of nosocomial infection.Methods Patients in ICU after adult cardiac surgery from January 2015 to December 2017 were studied.Through the nosocomial infection monitoring and reporting system(HIS and LIS system), data of infected sites, specimens, pathogen and drug-sensitivity results were recorded, and the clinical data were collected and the related factors of nosocomial infection af-ter cardiac surgery were analyzed.Results 213 patients with nosocomial infections were diagnosed , and the nosocomial infec-tion rate was 3.59％.There were 261 cases of nosocomial infection, with a total infection cases rate of 4.39％.232 strains of pathogen were detected.Gram-negative bacteria173 strains(74.57％), klebsiella pneumoniae and acinetobacterbaumannii ac-count for 65(28.07％) and 37(15.95％)strains respectively.35 strains of gram-positive bacteria account for 15.08％, 12 strains of staphylococcus aureus account for 5.17％.24 strains of fungi account for 10.34％, 12 strains of candida albicans(5. 17％) were the most.The resistance rates of klebsiella pneumoniae to amoxicillin/kclavitrate, piperasil/tazobatan, tigacy-cline, tobramycin, and impenan were all<10％.Acinetobacter baumannii show high resistance rate to commonly used antibi-otics other than tigacycline(2.70％).The resistance rates of staphylococcus aureus and staphylococcus epidermis to vancomy-cin and linazolamide were 0.Logistic regression analysis showed that preoperative and postoperative stroke, secondary endotra-cheal intubation, postoperative low cardiac output, postoperative stroke, mechanical ventilation time >48 h, and postoperative ICU stay>72 h were related factors of postoperative nosocomial infection .Conclusion The main pathogen of nosocomial in-fection in ICU after adult cardiac surgery is gram-negative bacteria.Klebsiella pneumoniae, the most common bacteria, has a low resistance rate to antibiotics, while the secondary acinetobacter baumannii has a high resistance rate .According to the fac-tors related to nosocomial infection after cardiac surgery , prevention measures should be formulated .According to the results of pathogen and drug sensitivity, antimicrobial drugs should be selected reasonably so as to postoperative nosocomial infection and the occurrence of drug-resistant strains could be controlled effectively .
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Objective To explore the influence factors of the metabolic syndrome in the continuous ambu-latory peritoneal peptide(CAPD)patients. Methods A total of 104 CAPD in the PD center of the First and the Second Affiliated Hospital of Guangxi Medical University from June 2014 to June 2016 were enrolled in this study. Patients were divided into the metabolic syndrome(MS)and the non-metabolic syndrome(non-MS)group. The clinical data of patients with MS and non-MS was compared,and the influence factors of the MS in PD patients were analyzed. Results Twelve patients were diagnosed as metabolic syndrome. Significant differences in age, urine volume,serum phosphorus(P)and uric acid(UA)were observed between group MS and non-MS(P<0.05). Twenty people were overweight,with the prevalence rate of 19.2%. Compared with the normal and overweight group,age,high density lipoprotein(HDL),P and serum iron were statistically significant(P < 0.05). Thirty-one people were diagnosed as dyslipidemia,with the prevalence rate of 29.8%. Compared with the normal group, albumin,UA,BMI and D/P were statistically significant in the dyslipidemia group(P < 0.05). Ten patients were diagnosed as hyperglycemia,with the prevalence rate of 9.6 %. Significant differences in hemoglobin and the dia-stolic blood pressure(DBP)were found between the hyperglycemia group and the normal group(P < 0.05). Age and P were shown as independent risk factors for PD patients with MS(P<0.05,respectively).Conclusion The peritoneal dialysis patients were more likely to have metabolic syndrome than the normal population.Age and serum phosphorus are the factors influencing the occurrence of MS in peritoneal dialysis patients.
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Objective To explore the risk factom of hepatitis B virus infection and alcoholic liver disease in patients with decompensated cirrhosis complicated with liver failure.Methods One hundred and fifty-eight cases hepatitis B virus infection and alcoholic liver disease in patients with decompensated cirrhosis were selected.According to whether complicated with liver failure,the patients were divided into observation group with 62 cases (complicated with liver failure group) and control group with 96 cases (without liver failure group).The clinical data and results of 2 groups were analyzed to screen the risk factors of liver failure.Results Compared with control group,observation group in alanine aminotransferase,aspartate aminotransferase,cholinesterase,total bilirubin,and prothrombin time,activated partial thrombin time live enzymes,thrombin time,fibrinogen,serum creatinine,the differences were not statistically significant (P ＞ 0.05);in albumin ((28.02±7.36) g/L vs.(23.26±6.54) g/L,t =4.421,P =0.002),serum urea nitrogen ((8.84±4.71) mmol/L vs.(9.33±5.24) mmol/L,t =3.656,P=0.007),upper gastrointestinal bleeding(x2 =7.534,P=0.006),ascites (x2 =8.615,P =0.003),infection (x2 =10.321,P =0.001),hepatic encephalopathy (x2 =6.561,P =0.010),hepatorenal syndrome(x2 =4.952,P=0.026),the difference were statistically significant.(2)The results of logistic regression analysis showed that upper gastrointestinal bleeding (OR =1.020,95％ CI:1.003-1.036),hepatorenal syndrome(OR=2.872,95％CI:0.385-21.423) were risk factor of hepatitis B virus infection and alcoholic liver disease in patients with decompensated cirrhosis complicated with liver failure.Conclusion Upper gastrointestinal bleeding,hepatorenal syndrome are independent risk factors of hepatitis B virus infection and alcoholic liver disease in patients with decompensated cirrhosis complicated with liver failure.
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Objective To explore the influence factors of cirrhosis complicated with upper gastrointestinal bleeding,and to guide the clinical treatment of patients with cirrhosis and prevent upper gastrointestinal bleeding.Methods One hundred and seventy-five cases patients with cirrhosis and upper gastrointestinal bleeding were treated in the Infectious Disease Hospital of Tangshan and the Affiliated Hospital of North China University of Science and Technology from July 2013 to July 2015 as the case group.One hundred and eighty-two patients with cirrhosis and no upper gastrointestinal bleeding at the same period in hospital as the control group.A face to face questionnaire was used to fill in the questionnaire.Results Multifactor conditional Logistic regression analysis showed that onset season (OR =4.185,95％ CI:1.874-8.354),non steroidal drugs (OR =6.215,95％ CI:2.681-15.532),drinking (OR =5.481,95％ CI:3.205-11.225),portal vein highpressure gastropathy(OR =7.658,95％ CI:3.227-14.714),diameter of portal vein (OR =8.901,95％ CI:1.218-9.026),liver function classification (OR =13.124,95 ％ CI:2.107-15.228) and esophageal varices (OR =11.021,95％ CI:2.181-13.487) were related with patients with liver cirrhosis complicated with upper digestive tract hemorrhage.Conclusion The onset season,nonsteroidal anti-inflammatory drugs,drinking,portal hypertensive gastropathy,portal vein diameter,liver function classification and esophageal varices are the risk fators of liver cirrhosis complicated with upper digestive tract hemorrhage factors.
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The purpose of this study was to compare the pharmacokinetic profiles of tetramethylpyrazine phosphate (TMPP) in plasma and extracellular fluid of the cerebral cortex of rats via three delivery routes: intranasal (i.n.), intragastric (i.g.) and intravenous (i.v.) administration. After i.n., i.g. and i.v. administration of a single-dose at 10 mg/kg, cerebral cortex dialysates and plasma samples drawn from the carotid artery were collected at timed intervals. The concentration of TMPP in the samples was analyzed by HPLC. The area under the concentration-time curve (AUC) and the ratio of the AUCbrain to the AUCplasma (drug targeting efficiency, DTE) was calculated to evaluate the brain targeting efficiency of the drug via these different routes of administration. After i.n. administration, TMPP was rapidly absorbed to reach its peak plasma concentration within 5 min and showed a delayed uptake into cerebral cortex (t max=15 min). The ratio of the AUCbrain dialysates value between i.n. route and i.v. injection was 0.68, which was greater than that obtained after i.g. administration (0.43). The systemic bioavailability obtained with i.n. administration was greater than that obtained by the i.g. route (86.33% vs. 50.39%), whereas the DTE of the nasal route was 78.89%, close to that of oral administration (85.69%). These results indicate that TMPP is rapidly absorbed from the nasal mucosa into the systemic circulation, and then crosses the blood-brain barrier (BBB) to reach the cerebral cortex. Intranasal administration of TMPP could be a promising alternative to intravenous and oral approaches.
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Objective To explore the value of virtual touch tissue quantification(VTQ) on the early diagnosis of gouty nephropathy.Methods 180 healthy controls and 109 gout patients including 57 cases with normal renal function,and 52 cases with gouty nephropathy were measured by VTQ in this study.The shear wave velocity (SWV) of renal cortex,renal medulla and renal sinus were measured using virtual touch tissue quantification(VTQ).The recorded SWV value was compared.Results In all groups,the SWV of renal cortex was the highest with significant difference (P ＜0.01).The SWV of renal cortex in gouty nephropathy group was higher than those in control group (t =0.342,P =0.026).The SWV of renal medulla and sinus in gout with normal renal function group and gouty nephropathy group were higher than those in control group,respectively (gout with normal renal function group:t =-0.311,-0.628; P =0.012,0.000;gouty nephropathy group:t =-0.369,-0.701 ; P =0.000,0.000).The SWV of renal cortex,medulla and sinus had no significant difference between gout patients with normal renal function and gouty nephropathy patients(t =0.117,-0.059,-0.073; P =0.232,0.575,0.523).Conclusions The VTQ technology could quantitatively evaluate tissue elasticity of the gout patients and provide evidence for the early diagnosis of gouty nephropathy.
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Objective To evaluate the relationship between the change of Heart-fatty acid-binding protein and myocardial injury/infarction in postoperative of off-pump coronary artery bypass grafting (OPCAB).Methods 59 patients (male 37 and female 22,from 46 to 83 years old) who were the first time to undergoing OPCAB were included in this study.Serial venous blood samples were taken at after induction of anesthesia,the OPCAB finished (after the last anastomosis),entered ICU,2,4 and 8 hours after the patient entered ICU,and at 1 and 2 day postoperative to test H-FABP.The cTnI and CK-MB were tested at 4 and 8 hours,after entering ICU,and at 1 and 2 days postoperative.Patients were divided into 3 groups by the changes of ECG and the level of cTnl at 8 hours after they entered ICU:normal group (group I,cTnI ＜0.1 ng/ml),myocardial injury group(group Ⅱ,cTnI 0.l-1.0 ng/ml) and.myocardial infarction group(group Ⅲ,cTnI ＞ 1.0 ng/ml).Results The level of H-FABP released was significantly higher in the myocardial infarction group than normal group and myocardial injury group (P ＜ 0.01).There is good correlation between the H-FABP and cTnI or CK-MB.But the peak level of H-FABP is earlier (finished OPCAB) (P ＜ 0.05),and it peaked early at 2h after entered ICU (P ＜ 0.01),it began to decrease at 4 hours after entered ICU and returned to baseline at 1 day postoperative,while the cTnI and CK-MB peaked at postoperative day 1 and 8h after entered ICU respectively,and maintained in higher level at postoperative 2 days.Conclusion There is good correlation between the H-FABP and perioperative myocardial infarction in OPCAB,and it has superiority compared with cTnI,which is as gold standard for perioperative myocardial infarction,on a certain degree.It can benefit from early detection of H-FABP for myocardial infarction in perioperative of OPCAB.
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Objective To evaluate the early diagnostic value of Heart-type fatty acid-binding protein(H-FABP) for myocardial infarction in patients post off-pump coronary artery bypass (OPCAB).Methods Between March 2009 and July 2009,59 patients had been undergone OPCAB for the first time.They were divided into 3 groups (normal group,myocardial injury group and myocardial infarction group) by myocardial-bound creatiue kinase (CK-MB) 、cardiac troponio Ⅰ (cTnI) 、electrocardiogram (ECG) and echocardiogram.Serial blood samples were taken during perioperation to quantify blood levels of H-FABP,CK-MB,cTnI.Results The average H-FABP value for the patients in the myocardial infarction group is higher than the others ( P ＜ 0.01 ).H-FABP reached the peak valve at 2 hours and decreased at 4 hours after the patients arrived at ICU.H-FABP got back to the baseline one day postoperation.Receiver operating characteristic curves( ROC curve) demonstrated that H-FABP had greater diagnostic ability of myocardial infarction postoperation with area under the curve at the time of arriving at ICU ( 0.900,95％ CI 0.818 -0.981 )and 2 hours later (0.832,95％ CI 0.718 -0.946).At the time of arriving at ICU,sensitivity of H-FABP for diagnosis was 90.9％ and specificity was 77.1％.At the point of 2 hours later,sensitivity was 72.7％ and specificity was 75.0％.Conclusion The H-FABP seems to be an excellent early biomarker of cardiac necrosis after OPCAB.
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Objective To evaluate the significance of color Doppler ultrasound examination of renal blood flow combined with the detection of bone morphogenetic protein-7(BMP-7)in early diagnosis of type 2 diabetic nephropathy.Methods Blood BMP-7 level was tested in 90 patients with type 2 diabetic nephropathy and 30 controls,and parameters of renal blood flow were measured by color Doppler ultrasound examination.Blood BMP-7 level as well as resistant index(RI)of segmental renal artery(SRA)and interlobar renal artery(IRA),were compared between these two groups.Results Compared with controls,blood BMP-7 level gradually decreased with the aggravation of diabetic kidney damage(P＜0.01).The peak systolic velocity(Vmax)and the end diastolic velocity(Vmin)of SRA and TRA were slowed gradually,while RI increased(P＜0.01).Blood BMP-7 level was negatively correlated with IRA's and SRA's RI of IRA and SRA(r =-0.603,P＜0.01;r =-0.652,P＜0.01).Conclusions Color Doppler ultrasound examination of renal blood flow combined with detection of BMP-7 might play an important role in early diagnosis of type 2 diabetic nephropathy.
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BACKGROUND: Bone marrow mesenchymal stem cells (BMSCs) can be induced to differentiate into neuron-like cells in new environment after transplantation, and then to replace damaged cells for reconstructing neural circuit. OBJECTIVE: To establish the co-culture system between rat BMSCs and neural cells in vitro, and to study the influence of neural cells on the differentiation of BMSCs into neuron-like cells in the co-culture system. METHODS: The neural cells obtained from Wistar rat fetal brain tissue and BMSCs gained from rat thighbone were co-cultured in Transwell culture plate. The morphological changes of BMSCs were observed and the special markers of neural cells in BMSCs were examined by immunofluorescence on the fifth day of the co-culture. The results were compared with control group which where BMSCs were alone cultured. RESULTS AND CONCLUSION: BMSCs in the neural cells co-culture system extended, were radial, connected each other. Neuron specific enolase immunoreactions showed positive results, showing neuron-like cells. The positive ratio of neuron specific enolase-positive cells was (33.0±10.5)%. However, BMSCs in the control group did not express neuron morphological character. Immunofluorescence exhibited that cells were negative for neuron specific enolase. These indicate that microenvironment provided by neurons improves the differentiation of BMSCs into neuron-like cells.
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Objective To determine the molecular characteristics of predominant Salmonella typhi and Salmonella paratyphi A strains prevalent in Hangzhou area from 2002 to 2008.Methods Pulse field gel electrophoresis (PFGE),multi-locus variable-number tandem repeat analysis (MLVA) and multi-locus sequence typing (MLST) were applied for typing as well as analysis of the molecular characteristics of 31 S.typhi isolates and 404 S.paratyphi A isolates from Hangzhou area during 2002 to 2008.Results The 404 S.paratyphi A isolates could be divided into six PFGE types (P1-P6).99.0％ of the S.paratyphi A isolates (400/404) belonged to the same one clone family (P1 and P2 types),in which P1 strains occupied 93.3％ (373/400) of the isolates.The 31 S.typhi isolates displayed a high diversity,which could be classified into 14 PFGE types,28 MLVA types with 90.3％ resolving power and 3 MLST types.The S.typhi strains prevalent in Hangzhou area were similar to those in Southeast Asia but different from those in Europe.The variable number tandem repeat (VNTR) sites with high polymorphism,TR1,TR2 and Sal02,could be used to the markers for diagnosis of S.typhi isolates in the area.The MLST types of 31 S.typhi isolates included all the three types currently found in the world but the ST2 type of S.typhi strains was predominant (23/31,74.2％).Conclusion The paratyphoid A prevalence in Hangzhou area in the recent years is caused by infection of the same clone family of S.paratyphi A whereas the S.typhi strains prevalent in the area display a high diversity.
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No abstract available.
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Objective To observe whether high-level insulin increases serum uric acid level and rosiglitazone improves hyperuricemia, and to explore the mechanism. Methods OLETF rats with spontaneous type 2 diabetes complicated with metabolic syndrome and normal control LETO rats were randomly divided into three groups (n=20 each). The animals were fed with standard chow diet in control group, high-purine diet and adenine administered intragastrically in experimental group, and rosiglitazone in interventional group. Body weight, serum levels of uric acid, insulin, triglyceride ( TG ) , and total cholesterol ( TC ) were measured after 3 weeks. Urate transporter 1 ( URAT1 ) and uric acid transporter (UAT) mRNA expressions in renal cortex were examined. HK-2 cells were incubated with various concentrations of insulin for 24 hours. UAT mRNA expression in HK-2 cells was examined. Results ( 1 ) In control group, the insulin level of OLETF rats was significantly higher than that of LETO rats ( P<0. 05 ), and there was no significant difference in serum uric acid level between OLETF and LETO rats. (2)In experimental groups, the insulin level in OLETF rats was significantly higher than that in LETO rats [(61.83±12.13 vs 36.73±12.73 )μIU/ml ,P<0. 05], and the incidence of hyperuricemia (76.92% vs 36.13%,P<0.01 ) and serum uric acid level[( 327.75 ±45.73 vs 264.40±36.32 ) μmol/L, P<0. 01]in OLETF rats were significantly higher than those in LETO rats. (3) Insulin[(41.3± 10.2 vs 61.8±12. 1 )μIU/ml,P<0. 05]and uric acid[( 198.0±45.4 vs 236.9±29.30 ) μmol/L, P<0. 05]levels in OLETF rats in interventional group were significantly lower than those of OLETF rats in experimental group, meanwhile the amount of urinary uric acid excretion was significantly increased[(5 644±371 vs 4 692±278 ) μ mol/L, P<0. 05]. (4) There was no significant difference in insulin level and the expressions of URAT1 and UAT mRNA in renal cortex between OLETF rats in control group and experimental group. URAT1 mRNA expression of OLETF rats in interventional group was significantly decreased, while UAT mRNA expression was significantly increased. (5)With the increase of insulinconcentration in culture medium, the expression of UAT mRNA expression in HK-2 cells was gradually decreased. Conclusions Rosiglitazone may alleviate hyperinsulinemia-induced hyperuricemia via regulating UAT and URAT1 mRNA expression.
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Objective:To investigate the role of serum inflammatory cytokines in the development of acute coronary syndrome (ACS). Methods: All of enrolled patients were diagnosed by clinical and coronary angiographic features and divided into four groups, the acute myocardial infarction (AMI) group, unstable angina pectoris (UAP) group, stable angina pectoris (SAP) group and control group. The values of high-sersitivity C-reactive protein(hs-CRP), matrix metallopeptidase 9(MMP-9) and tumor necrosis factor-a (TNF-a) in serum were measured by cytokine detection equipment system (B10-RAD Biological Technology Co.Ltd, USA) and analysed in four groups with statistics. Results: Compared with SAP and the control groups, the levels of TNF-a and MMP-9 were increased significantly in AMI group(P 0.05). It was found that there was positive relation between hs-CRP, MMP-9 and TNF-a by Pearson correlation analysis. Conclusion:There was obvious relation between coronary heart disease and inflammation. The cytokines characterized by the increases of hs-CRP, TNF-a and MMP-9 were involved in the formation and progression of atherosclerosis and served as markers of unstable plagues.
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Objective To investigate the protective effect of ulinastatin on myocardium against ischemia-reperfusion injury in open heart surgery with cardiopulmonary bypass (CPB) .Methods Twenty ASA Ⅰ - Ⅱ patients undergoing atrioseptopexy or surgical repair of VSD under CPB were randomly divided into two groups: in ulinastatin group (U n = 10) patients received ulinastatin 12000 unit?kg-1, half of the dose was given iv, 10 min before aorta cannulation and another half was added into the priming fluid; in control group (C n = 10) the patients received same volume of saline instead of ulinastatin. Premedication consisted of intramuscular pethidine 1 mg?kg-1 and scopolamine 0.01 mg?kg-1 .Anesthesia was induced with midazolam 0.1 mg?kg-1, fentanyl 10 ?g?kg-1 and pancuronium 0.1 mg**kg-1 and maintained with fentanyl, enflurane or isoflurane, diazepam and pancuronium. Arterial blood samples were taken before CPB (T1), at release of the aortic cross-clamp (T2), 30 min after aortic release (T3), 4h and 24h after discontinuation of CPB (T4, T5 ) for determination of plasma levels of cardiac troponin I (cTnI), creatine phosphokinase (CK) and creative phosphokinase isoenzyme (CK-MB) .Results The demographic data were comparable between the two groups. The CPB time, aortic cross-clamping time and duration of operation were also comparable. The plasma cTnI level and CK, CK-MB activity were all within normal range before CPB in both groups. In group C the plasma level of cTnI started increasing at T2, peaked at T4 and started decreasing at T5. In group U the plasma level of cTnI at T3 and T4 was significantly higher than the baseline (P