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@#Abstract:Objective To investigate the clinical characteristics and early diagnostic methods of patients with Talaromyces marneffei infection, so as to reduce the mortality of patients. Methods The clinical characteristics and microbiological analysis data including fungal culture, smear examination and mass spectrometry were collected from 18 patients with Talaromyces marneffei infection in the Department of Respiratory Medicine, Department of Tuberculosis, and Department of Critical Respiratory Medicine in Fuzhou Pulmonary Hospital from January 2017 to December 2021, and descriptive analysis was conducted. Results All the 18 patients were confirmed to be infected with Talaromyces marneffei by conventional culture and matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) mass spectrometry (MS). The main infection sites of 18 patients with Talaromyces marneffei infection were lungs and lymph nodes, and the patients were accompanied by clinical manifestations such as cough, sputum and fever. The imaging features such as patchy shadows, mediastinal lymph node shadows and nodular shadows were common. Microbiological testing showed a statistically significant difference between smear and culture with a higher positive culture rate (χ2=13.74, P<0.05). The positive rate of blood culture in microbiological test was 60.0% (9/15), the positive rate of bronchial lavage fluid culture was 26.7% (4/15), the positive rate of sputum culture was 5.6% (1/18), one case each of pus, bone marrow, pleural fluid and cerebrospinal fluid was positive for culture and the other cases were negative, one case of sputum and one case of pus were positive for smear and the rest were negative. Colony characteristics showed that the colony morphology was mycelial phase at 25 ℃, producing red pigment, and the branching pattern of the penicillus was seen microscopically as monoverticillate or biverticillate; At 35 ℃, the yeast phase appeared at the initial stage, and then the mycelium phase changed after 5-6 days; the yeast phase was observed at 37 ℃, and yeast-like cells were seen under the microscope. All 18 patients with Talaromyces marneffei infection got better after using antifungal drugs. Compared with non-HIV patients with Talaromyces marneffei infection, leukopenia and anemia were common in HIV patients with Talaromyces marneffei infection, and the differences were statistically significant (P<0.05). Conclusions The infection of Talaromyces marneffei can be divided into localized type and disseminated type, which usually invade the lungs, skin, lymph nodes and other places. The main manifestations of patients are fever, cough, phlegm and other atypical symptoms. At present, the diagnosis of Talaromyces marneffei infection is mostly based on the fungal culture test, and the application of MALDI-TOF MS method can effectively shorten the diagnosis time of Talaromycosis marneffei. Clinical characteristics combined with microbiological analysis provide an objective basis for early diagnosis of patients with Talaromyces marneffei infection, and timely use of antifungal therapy can improve the prognosis of patients.
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OBJECTIVE@#To explore the risk factors of osteonecrosis of femoral head after internal fixation of femoral neck fracture in young patients, to describe the quality of life of patients with surviving femoral head, and to quantify the predictive factors.@*METHODS@#From January 2013 to December 2016, 172 patients (174 hips) with femoral neck fracture treated by closed reduction and cannulated screw internal fixation were selected for retrospective analysis. The general data of the patients were summarized, including age, gender, body mass index, trauma mechanism, trauma operation interval, trauma season and whether the internal fixation was removed. The imaging data included the Garden classification and Pauwel classification of fractures, femoral head retroversion angle, postoperative fracture reduction, screw distribution. Single factor analysis and multi-factor Logistic regression analysis were carried out to explore the risk factors of femoral head necrosis and internal fixation failure. The patients who survived the internal fixation were followed up. The quality of life of the patients was evaluated by the health survey of SF-36. The Harris score of hip joint function was used to evaluate the hip joint function. The predictors of the quality of life of the patients after the operation of femoral neck fracture were analyzed by multiple linear regression analysis.@*RESULTS@#Total 172 patients(174 hips) were included in the study, 29 patients(16.67%) had necrosis of the femoral head. In multivariate Logistic regression analysis, the significant differences were reduction quality (=0.126, =0.027) and posterior inclination angle (=4.380, =0.010). One hundred and thirty six patients (137 hips) who survived the femoral head were included in the quality of life survey. Harris score was 90.14±7.92, including excellent 96 hips (70.07%), good 28 hips (20.44%), medium 13 hips (9.49%) and poor 0 hip. In SF-36 score, physical health summary (PCS) was 46.12±9.12, mental health summary(MCS) was 50.21±3.97, there was no linear correlation between them (>0.05). In multiple linear regression analysis, the variables with significant difference in PCS were reduction quality and retroversion angle, and the variables with significant difference in MCS were fracture displacement and trauma mechanism.@*CONCLUSION@#Poor reduction quality and posterior inclination angle>15° are the risk factors of femoral head necrosis. The function of hip joint and MCS of patients with femoral neck fracture recovered well, but PCS could not recover to the average level of normal people. The reduction quality and retroversion angle could be used as the predictors of PCS, and the displacement and trauma mechanism of fracture could be used as the predictors of MCS.
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Humans , Femoral Neck Fractures , Femur Head , Fracture Fixation, Internal , Osteonecrosis , Quality of Life , Retrospective StudiesABSTRACT
To systematically evaluate the clinical efficacy and safety of modified Qingjin Huatan Decoction in the treatment of community-acquired pneumonia in the elderly, and provide evidence-based reference for the clinical application of this prescription. Randomized controlled trials of Qingjin Huatan Decoction in the treatment of community-acquired pneumonia in the elderly were collected by searching PubMed, EMbase, Cochrane Library, CNKI, China Biomedical Literature database, VIP database and WanFang database. Outcome indicators included clinical effective rate, inflammation index, symptom improvement time, chest radiograph improvement time, hospitalization time and adverse reactions. RevMan 5.3 and Stata/IC 15.1 software were used for Meta-analysis; TSA 0.9.5.10 Beta software was used for trial sequential analysis, and GRADE profiler 3.6 was used for grade evidence quality evaluation. Thirteen studies were included finally, including 1 058 patients, 536 patients in the experimental group and 522 patients in the control group.Meta-analysis showed that, the clinical effective rate of the experimental group was significantly higher than that of the control group(RR=1.16, 95%CI[1.10, 1.21], P<0.000 01); fever time(MD=-1.32, 95%CI[-1.93,-0.71], P<0.000 1), cough time(MD=-1.95, 95%CI[-2.69,-1.21), P<0.000 01), time to rale disappearance(MD=-1.55, 95%CI[-2.37,-0.73], P=0.000 2), time to chest radiograph improvement(MD=-1.72, 95%CI[-2.98,-0.46], P=0.007), and hospitalization time(MD=-3.16, 95%CI[-4.58,-1.74], P<0.000 01) in the experimental group were significantly shorter than those in the control group. The improvement in CRP(WMD=-3.44,95%CI[-4.50,-2.38],P<0.001), WBC(WMD=-2.04,95%CI[-3.31,-0.78],P<0.01), IL-6(WMD=-4.27,95%CI[-4.62,-3.92],P<0.001), and TNF-α(WMD=-0.47,95%CI[-0.55,-0.39], P<0.001) of the experimental group was significantly better than that of the control group. There was no significant difference in PCT improvement between the two groups(WMD=-0.63, 95%CI[-1.65, 0.40], P=0.23). No serious adverse reactions occurred in both groups. Sequential analysis of the trial showed that in the studies with cumulative inclusion of clinical effective rate, the data passed the traditional threshold and TSA threshold, further confirming its clinical efficacy. GRADE evaluation showed that the evidence level was low to extremely low. Western medicine treatment combined with Qingjin Huatan Decoction may improve clinical efficiency in the treatment of community-acquired pneumonia in the elderly, improve clinical symptoms faster, reduce CRP, WBC and other inflammatory indicators, and shorten hospital stay. The level of evidence obtained in this study is low, which needs to be further verified by high-quality multi-center, randomized controlled trials.
Subject(s)
Aged , Humans , China , Community-Acquired Infections , Cough , Drugs, Chinese Herbal , PneumoniaABSTRACT
BACKGROUND: The perioperative hemorrhage of knee surgeries is a difficulty in clinic, and the efficacy of tranexamic acid to reduce postoperative bleeding has attracted more attention, but choosing which administrations remains controversial. OBJECTIVE: To investigate the efficacy of tranexamic acid by intravenous injection or articular injection for reducing the perioperative hemorrhage of total knee arthroplasty. METHODS: Sixty patients undergoing unilateral total knee replacement were enrolled, and were then randomized into three groups (n=20 per group): no tranexamic acid administration (group A); intravenous dropping of 15 mg/kg tranexamic acid before tourniquet application plus 10 mg/kg tranexamic acid at 3 hours postoperatively (group B); articular injection of 50 mL saline diluted with 1 g tranexamic acid through a drainage tube (group C). Two-hour closure of drainage tube was performed in all patients. The postoperative dominant and hidden blood loss, blood transfusion rate, pulmonary embolism as well as lower extremity deep venous thrombosis were recorded. RESULTS AND CONCLUSION: (1) The dominant and hidden blood loss in the groups B and C were significantly less than those in the group A (P < 0.05); the dominant blood loss showed no significant difference between groups B and C (P > 0.05); the group B exhibited a significantly less hidden blood loss compared with group C (P < 0.05). (2) The blood transfusion rate in the groups B and C was significantly lower than that in the group A (P < 0.05). (3) No pulmonary embolism or lower extremity deep venous embolism occurred during 3-month follow-up. (4) That is to say, tranexamic acid can obviously reduce perioperative blood loss and blood transfusion rate without pulmonary embolism or lower extremity deep venous thrombosis, and intravenous administration exerts better clinical effectiveness.
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Objective:To evaluate the stress distribution and displacement pattern in the restoration of Stern-ERA attachment mandible removable partial denture (RPD) with different designs through three-dimensional (3D) finite element (FE) analysis.Methods:3D-FE models were established based on human CT data and manufacturer's catalog.Vertical and 45° lingual oblique forces of 100 N were applied on the artificial teeth of the RPD.Three ERA attachment partial dentures with different bracing arms were designed,namely the basic design,rest bracing arm design and cross-arch bracing arm design.The von Mises stresses and displacements of abutment teeth and mucosa under denture base were analysed.The displacement of denture bases was examined.Results:Under the vertical and oblique loading,the maximum yon Mises stress was found at the distal shoulder on the distal abutment.The maximun displacement was observed at the buccal and distal occlusal surfaces of the distal abutment.The maximum displacement on the abutment was found to be the highest in rest bracing arm design group (14.91 μm and 63.09 μm),followed by the basic design group (9.38 μm and 50.56 μm) and the cross-arch bracing arm design group exhibited the smallest displacement (8.85 μm and 47.31 μm).Conclusion:The basic design Stern_ERA attachment for unilateral mandible distal extension defect appears to be more reasonable compared with rest arm and crossing-arch arm design from biomechanical point of view.
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Objective: To study the effect of Lactobacillus sp. A-2 metabolites on viability of CAL-27 cells and apoptosis in CAL-27 cells. Methods: Lactobacillus sp. A-2 metabolites 1 and 2 (LM1 and LM2) were obtained by culturing Lactobacillus sp. A-2 in reconstituted whey medium and whey-inulin medium; the cultured CAL-27 cells were treated with different concentrations of LM1 and LM2 (0, 3, 6, 12, 24, 48 mg/mL) and assayed by methyl thiazolyltetrazolium (MTT) method; morphological changes of apoptotic cell were observed under fluorescence microscopy by acridine orange (Ao) fluorescent staining; flow cytometry method (FCM) and agarose gel electrophoresis were used to detect the apoptosis of CAL-27 cells treated LM1 and LM2. Results: The different concentrations of LM1 and LM2 could restrain the growth of CAL-27 cells, and in a dose-dependent manner; the apoptosis of CAL-27 cells was obviously induced and was time-dependent. Conclusions: Viability of CAL-27 cells was inhibited by Lactobacillus sp. A-2 metabolites; Lactobacillus sp. A-2 metabolites could induce CAL-27 cells apoptosis; study on the bioactive compounds in the Lactobacillus sp. A-2 metabolites and their molecular mechanism is in progress. .
Subject(s)
Humans , Apoptosis/physiology , Carcinoma, Squamous Cell/pathology , Lactobacillus/metabolism , Tongue Neoplasms/pathology , Analysis of Variance , Cell Survival , Cells, Cultured , Electrophoresis, Agar Gel , Flow Cytometry , Lactobacillus/growth & development , Microscopy, Fluorescence , Tetrazolium Salts , Thiazoles , Time FactorsABSTRACT
<p><b>OBJECTIVE</b>To evaluate the influence of shape of four different short implants on the stress characteristics of jaw bone around implants in the posterior maxilla.</p><p><b>METHODS</b>Finite element models of the jaw bone and crown were established based on computed tomography (CT) data and implant geometries were obtained from manufacturers' catalogues. The whole models included jaw bone, four different short implants (A: torpedo-shape implant with fin threads; B: taper implant with triangle threads; C: cylindrical implant with fine threads; D:cylindrical implant with sparse threads), implant abutments, abutment screws and crowns. Three-dimensional hexahedral and wedge-shaped brick elements were used to mesh the finite element models. Assumptions made in the analyses were: linear elastic material properties for bone, type IV jaw bone, and 50% osseointegration between bone and implant. Inclined load of 200 and 1 000 N at 45° to the axis of the implant were applied to the cusps of ceramic crown respectively. The von Mises stresses in cortical bone and cancellous bone around the implants were calculated. Measure lines were designed along the crest in cortical bone and nearly 0.2 mm distance away from thread tips in cancellous bone for stress comparation and discussion.</p><p><b>RESULTS</b>All short implants showed the same stress distribution characteristics in the cortical bone. Different stress distribution characteristics in cancellous bone were found in different implant system. From the measure line the maximum stress were located at the level of the neck of implant A, C and D. Under inclined load of 200 N, the maximum stress were 6.60, 6.50 and 7.79 MPa for implant A, C, and D respectively. For implant B the maximum stress was located at the periapical area (5.84 MPa)instead of the level of neck of implant (5.72 MPa). The stress along A and C was more evenly distributed compared with implant B and C. Under inclined load of 200 N, the maximum stress around implant A and C in the periapical area were 5.02, 4.96 MPa; for implant B and D they were 5.84, 7.52 MPa respectively. Under inclined load of 1 000 N, the maximum stress around implant A and C in the periapical area were 25.96, 24.06 MPa; for implant B and D they were 29.52, 38.53 MPa respectively.</p><p><b>CONCLUSIONS</b>Torpedo-shape implant with fin threads and cylindrical implant with fine threads are recommended to be choosed in type IV jaw bone with limited height.</p>
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Humans , Crowns , Dental Implants , Dental Porcelain , Dental Prosthesis Design , Finite Element Analysis , Maxilla , Osseointegration , Stress, MechanicalABSTRACT
<p><b>OBJECTIVE</b>To evaluate the expression of CD4+, CD8+ T cells and cell apoptosis in oral lichen planus (OLP) and investigate the role and the relationship of immunological reaction and cell apoptosis in the pathogenesis of OLP2.</p><p><b>METHODS</b>Immunohistochemical technique was used to study the expression of CD4+, CD8+ T cells in 27 OLP cases. TUNEL was used for detecting the cell apoptotic index (AI) in 17 OLP2 cases.</p><p><b>RESULTS</b>The expression of CD4+, CD8+ T cells were obviously elevated in lamina propria of OLP group compared with control group (P<0.05). There was a strong significance when compared the ration of CD4/CD8 in both group. AI was remarkably increased in epithelia cells and significantly decreased in lymphocytes in lamina propria in OLP cases compared with its expression in the control group respectively.</p><p><b>CONCLUSION</b>The increased amount of CD4+, CD8+ T cells in lamina propria of OLP and the change ration of CD4/CD8 suggest that immune response is involved in the pathogenesis of OLP. The abnormal cell apoptosis plays an important role in the pathogenesis of OLP.</p>
Subject(s)
Humans , Apoptosis , Epithelial Cells , Lichen Planus, OralABSTRACT
<p><b>OBJECTIVE</b>To examine the expression of TGF-beta1, Smad7 and cell apoptosis in oral lichen planus (OLP) and to evaluate the possible pathogenesis of oral lichen planus.</p><p><b>METHODS</b>Immunohistochemical technique was used to study the expression of TGF-beta1 and Smad7 in the epithelia cells of 17 OLP cases and 7 normal oral mucosa (NOM). TUNEL was used for detecting the cell apoptosis in 17 OLP cases and 7 NOM.</p><p><b>RESULTS</b>TGF-beta1 was moderately positive in the epithelia cells of OLP. All the epithelia cells in OLP showed strong cytoplasmic staining. The expression of TGF-beta1 and Smad7 were significantly increased in OLP compared with that in NOM (P < 0.05). Cell apoptotic index (AI) was remarkably increased in epithelia cells in OLP cases, and the cell apoptosis was localized in basal and suprabasal epithelial layers. There was a positive correlation between TGF-beta1 expression and cell apoptosis in the epithelia of OLP (r = 0.69, P <0.05).</p><p><b>CONCLUSIONS</b>High expression of TGF-beta1 and Smad7 in the epithelia of OLP suggests that TGF-beta1-Smad7 signal pathway was disturbed in oral lichen planus. The imbalance of TGF-beta1-Smad7 pathway may contribute to the mechanisms of cell apoptosis of epithelial cells in OLP.</p>
Subject(s)
Female , Humans , Male , Apoptosis , Case-Control Studies , Epithelium , Metabolism , Pathology , Lichen Planus, Oral , Metabolism , Mouth Mucosa , Metabolism , Pathology , Smad7 Protein , Metabolism , Transforming Growth Factor beta1 , MetabolismABSTRACT
Objective: To understand the relationship between chloroquine resistance and the virulence of Plasmodium berghei. Met hods: Dynamic changes of histopathologic features of livers, spleens, brains, hearts, lungs and kidneys of mice infected with the chloroquine-sensitive (N) and the chloroquine-resistant (RC) strains of P. berghei were compared. Results: In mice infected with the N strain, deposition of heavy hemoz oin in livers and spleens, congestive edema in lungs, and congestion and embolis m in the brain capillaries were observed. The histopathologic features revealed ac ute inflammatory reaction. In mice infected with the RC strain, histopathologic variations of livers and spleens were associated with changes of parasitemia. In terstitial pneumonia was displayed in lungs. There were chronic histopathologic changes of the organs in the mice infected with RC strain. Conclusion: The mice infected by the N strain with potent virulence die due to adher ence of the erythrocytes to microvascular endothelia and embolism of the microva scula, especially in their brain. Immune responses of the mice infected by the R C strain with poor virulence may be a delayed-type hypersensitive inflammation a ssociated with CD4+Th1 at an early stage of the infection, but may become anti body-dependent immune response assisted with CD4+Th2, which play a key role in elimination of the malaria parasites at later stage of the infection.
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Objective: To understand the relationship between chloroquine resistance and the virulence of Plasmodium berghei. Met hods: Dynamic changes of histopathologic features of livers, spleens, brains, hearts, lungs and kidneys of mice infected with the chloroquine-sensitive (N) and the chloroquine-resistant (RC) strains of P. berghei were compared. Results: In mice infected with the N strain, deposition of heavy hemoz oin in livers and spleens, congestive edema in lungs, and congestion and embolis m in the brain capillaries were observed. The histopathologic features revealed ac ute inflammatory reaction. In mice infected with the RC strain, histopathologic variations of livers and spleens were associated with changes of parasitemia. In terstitial pneumonia was displayed in lungs. There were chronic histopathologic changes of the organs in the mice infected with RC strain. Conclusion: The mice infected by the N strain with potent virulence die due to adher ence of the erythrocytes to microvascular endothelia and embolism of the microva scula, especially in their brain. Immune responses of the mice infected by the R C strain with poor virulence may be a delayed-type hypersensitive inflammation a ssociated with CD4+Th1 at an early stage of the infection, but may become anti body-dependent immune response assisted with CD4+Th2, which play a key role in elimination of the malaria parasites at later stage of the infection.