ABSTRACT
OBJECTIVE@#To explore the effect of thrombocytopenia on the prognosis of patients with septic shock and its mechanism in leading to death.@*METHODS@#A retrospective case-control study was conducted. Patients with septic shock admitted to emergency intensive care unit (EICU) and intensive care unit (ICU) in Peking University People's Hospital from April 1, 2015 to January 31, 2023 were enrolled. Patients were divided into the thrombocytopenia group and the non-thrombocytopenia group, according to whether the minimum platelet count was less than 100×109/L within 24 hours after admission to ICU. The outcome index was the mortality during ICU stay. The baseline data, hospitalization information and laboratory test results of the two groups were compared, and the risk factors of in-hospital death were analyzed by Logistic regression, and the mediation effect was performed by Bootstrap method.@*RESULTS@#A total of 301 patients with septic shock were enrolled, of which 172 (57.1%) had thrombocytopenia and 129 (42.9%) did not. There were significant differences between the two groups in age, mortality, disseminated intravascular coagulation (DIC), continuous renal replacement therapy, and level of creatinine, urea nitrogen, total bilirubin, white blood cell count, lymphocyte count, prothrombin time (PT) and activated partial thromboplastin time (APTT). Univariate Logistic regression analysis showed thrombocytopenia [odds ratio (OR) = 4.478], continuous renal replacement therapy (OR = 4.601), DIC (OR = 6.248), serum creatinine (OR = 1.005), urea nitrogen (OR = 1.126), total bilirubin (OR = 1.006) and PT (OR = 1.126) were risk factors of death during hospitalization in patients with septic shock (all P < 0.05). Multivariate Logistic regression analysis showed that thrombocytopenia [OR = 3.338, 95% confidence interval (95%CI) was 1.910-5.834, P = 0.000], continuous renal replacement therapy (OR = 3.175, 95%CI was 1.576-6.395, P = 0.001) and PT (OR = 1.077, 95%CI was 1.011-1.147, P = 0.021) were independent risk factors for in-hospital mortality in patients with septic shock. Mediation analysis showed that 51% of the deaths due to thrombocytopenia in patients with septic shock were due to coagulopathy.@*CONCLUSIONS@#Thrombocytopenia is a powerful predictor of death in septic shock patients, and half of all thrombocytopenia-related deaths may be due to abnormal coagulation function.
Subject(s)
Humans , Shock, Septic , Retrospective Studies , Case-Control Studies , Hospital Mortality , Prognosis , Thrombocytopenia , Intensive Care Units , Bilirubin , Nitrogen , Urea , SepsisABSTRACT
Objective:To understand the mental health of residents and specialists during the COVID-19 outbreak and provide references for improving their mental health.Methods:An online questionnaire survey was conducted, using the Generalized Anxiety Disorder Scale and the Patient Health Questionnaire Depression Rating Scale, to evaluate the mental health of 302 residents and specialists in a top general hospital. SPSS 23.0 was used to perform t-test on the relevant data. Results:Among them, 32.5% (98/302) and 49.7% (150/302) of those physicians showed varying degrees of anxiety disorder and depression, of which 6.3% (19/302) and 18.6% (56/302) were moderate or higher anxiety and depression. After they were grouped according to work fatigue scores (boundary as 60 points), risk degree of infection with the COVID-19, frequency of duty, and sleep time (boundary as 7 h), there were statistically differences in the physician self-evaluation rates of anxiety and depression between the two groups ( P<0.05). After controlling the above variables, Logistic regression results showed that the physicians with high risk of infection with the COVID-19 were more likely to show anxiety ( OR=2.142, 95%CI=1.170-3.922) and depression ( OR=2.038, 95%CI=1.185-3.505) than those with low-risk. Conclusion:In the context of the COVID-19 outbreak, residents and specialists, especially those with high risk of infection with the COVID-19, show severe mental health problems such as anxiety disorders and depression, which requires special attention and support.
ABSTRACT
Objective To investigate the clinicopathological characteristics and independent risk factors of hepatocellular carcinoma (HCC) differentiation. Methods A total of 108 HCC patients who underwent operation and treatment were reviewed and classified into low differentiation group (n= 29, 26.85%), medium differentiation group (n=53, 49.07%) and high differentiation group (n=26, 24.07%) according to pathological diagnosis. The clinicopathological characteristics and the expression levels of Ki67 and P53 in each group were compared and analyzed. Logistic regression model was used to analyze the risk factors for low differentiation of HCC. Results The proportion of cirrhosis, the positive rate of P53 and Ki67 expression level in different degrees of HCC differentiation were statistically significant (P0.05). Multivariate logistic analysis showed that cirrhosis (OR=3.408), high expression of Ki67 (OR=11.113) and positive P53 (OR=9.711) were the main risk factors for poorly differentiated HCC. Conclusion There are differences in clinical characteristics and expressions of Ki67 and P53 in HCC patients with different degrees of differentiation. Logistic regression analysis can identify clinicopathological risk factors affecting the degree of differentiation of HCC, which can provide criterion support for accurate diagnosis and prognostic treatment.
ABSTRACT
Objective To investigate the clinical characteristics and predictors of mortality in patients with candidemia in intensive care unit (ICU). Methods The patients with candidemia admitted to ICU of Peking University People's Hospital from January 2010 to December 2017 were enrolled. The general clinical data, indicators related to Candidia infection and prognosis were collected, and the clinical characteristics, infection characteristics and prognosis of patients with candidiasis were analyzed. Patients were divided into death group and survival group according to hospital survival status. The differences of each index were compared between two groups. The independent risk factors of mortality in patients with candidemia were analyzed by multivariate Logistic regression analysis. Results A total of 95 patients (55 males) with candidemia were included, with an average age of (69.3±16.5) years, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) was 24.7±3.6, sequential organ failure assessment (SOFA) was 6.6±2.7. Candida albicans accounted for the largest proportion of Candida infections (n = 56, 58.9%). Thirty-two (33.7%) patients received inadequate antifungal therapy and 38 (40.0%) patients received inadequate source control. Fifty-five (57.9%) patients were died in hospital. Compared with the survival group, patients in the death group was older (years: 72.5±14.6 vs. 64.9±18.0, P < 0.05), had higher APACHEⅡ and SOFA scores (26.6±2.2 vs. 22.1±3.6, 7.9±2.0 vs. 4.7±2.4, both P ﹤ 0.01), higher rate of glucocorticoid treatment (18.2% vs. 10.0%, P < 0.05), and higher proportion of Candida albicans and Candida glabrata (69.1% vs. 45.0%, 10.9% vs. 7.5%, both P < 0.05), the rate of multi-site Candida infection also significantly increased (47.3% vs. 17.5%, P < 0.05). Intra-abdominal infection was the primary infection site and more common in death group (49.1% vs. 35.0%, P < 0.05). The rates of sepsis (87.3% vs. 62.5%), inadequate antifungal therapy (49.1% vs. 10.0%), inadequate source control (60.0% vs. 12.5%) in death group were all higher than those in survival group (all P < 0.01). It was shown by multivariate Logistic regression analysis that APACHE Ⅱ[odds ratio (OR) = 1.605, P = 0.002, β = 0.473], SOFA (OR = 1.501, P = 0.029, β = 0.406), inadequate antifungal therapy (OR = 12.084, P = 0.006, β = 2.492) and inadequate source control (OR = 7.332, P = 0.024, β = 1.992) were independent risk factors for mortality in ICU patients with candidemia. Conclusions Candidemia patients were severe and had poor prognosis. APACHE Ⅱ, SOFA, inadequate antifungal therapy and inadequate source control were independent risk factors of mortality.
ABSTRACT
Objective To compare the value of ELISA and indirect immunofluorescence (IIF)method in diagnosis for autoim-mune diseases.Methods A total of 33 patients in systemic lupus erythematosus(SLE)group,59 patients in other autoimmune dis-eases group,43 patients in non-autoimmune disease group,20 people accepted physical examination in control group.The antinuclear antibody (ANA)in each group were detected by two methods and analyzed.Results The high titer ANA detected by ELISA and IIF in SLE group and other autoimmune diseases group were (2.621±1.700),(2.248±1.781);(2.71 5±0.730),(2.544±0.59). The titer ANA detected by ELISA in non-autoimmune disease group was (1.034±1.050),which was lower than(2.253 ±0.691) detected by IIF.Conclusion ELSA might improve the detection effects of ANA antibody.
ABSTRACT
OBJECTIVE To analyze the pathogen distribution and resistance pattern of the positive clinical sputum specimens in our hospital.METHODS The bacteria and fungi were identified by API system.The susceptibility of antimicrobial and antifungal agents was tested by KB and Rosco disk diffusion method and the data were analyzed by WHONET 5.4 software.RESULTS In 2008,in our hospital,the majority of the positive specimens were distributed among cerebral surgery department,intensive care unit(ICU),respiratory and pediatric departments.The pathogens of the eight highest isolating rate were Pseudomonas aeruginosa(20%),Candida albicans(18%),Acinetobacter baumannii(10.7%),Staphylococcus aureus(6.5%),Klebsiella pneumoniae(6%),Enterobacter cloacae(4%),Haemophilus influenzae(3.8%),and Stenotropho maltophilia(3.5%).In view of the resistance,no Staphylococcus species were resistant to vancomycin,but they were resistant to many other antimicrobial agents.Gram-negative Enterobactericaeae were sensitive to carbapenems,cefoperazone/sulbactam and piperacillin/tazobactam.Among nonfermenters,P.aeruginosa and S.maltophilia were resistant to the most antimicrobial agents while Acinetobacter were comparatively sensitive to carbapenems and cefoperazone/sulbactam.CONCLUSIONS The pathogens in lower respiratory tract infections have a high resistance rate to many antimicrobial agents.In view of the seriousness of this problem,we should emphasis on it and select antimicrobial agents rationally.
ABSTRACT
OBJECTIVE To study the molecular cytogenetic alterations of transitional cell carcinoma of the urinary bladder with exfoliated cells by fluorescence in situ hybridization(FISH) analysis of chromosome-specific probes.METHODS FISH was performed using 3,7,9 and 17 of chromosome-specific probes to examine chromosome aberration of exfoliated cells in 50 urine samples from patients with transitional cell urinary bladder carcinoma.RESULTS The frequency of numerical aberration of chromosomes 3,7,9 and 17 was 28%,32%,56% and 38% in urinary exfoliated cells,respectively.Loss of chromosome 9 was the most common finding,but it was not correlated with pathological grade of cancer and stage of the disease.Abnormality of chromosomes 3,7 and 17 was associated with the clinical stage.CONCLUSIONS A number of chromosome aberrations are detected in transitional cell carcinoma of the urinary bladder by FISH technique which provides a basis for further understanding of its molecular pathogenesis.It is a rapid,accurate and very sensitive method and can be used in clinical diagnosis.
ABSTRACT
OBJECTIVE To characterize bacteriophage isolated from sewage with indicator of Klebsiella pneumoniae subsp pneumoniae.METHODS Bacteriophage was isolated from sewage by double-layer agar plate method,identified lytic or lysogenic capacity by induced methods of ultraviolet ray and mitomycin C,performed one-step growth experiments,decided the optimal multiplicity of infection,and its structure was observed with electron microscope.RESULTS The study found a strain of bacteriophage against the K.pneumoniae subsp pneumoniae.The phage had a head of 180 nm in diameter and a tail of 210 nm in length.The plaque was transparent and 4-7 mm in diameter.the optimal multiplicity of infection was 4,latent period was 35 min and burst period was 40 min,the average burst size was about 94 PFU/cell.CONCLUSIONS The isolated bacteriophage belongs to Stylovinidae,and it is a lytic bacteriophage with narrow host spectrum.Moreover,it is only sensitive to a part of K.pneumoniae subsp pneumoniae and a few of Escherichia coli strains.
ABSTRACT
OBJECTIVE To investigate the change in antimicrobial resistance to Pseudomonas aeruginosa in our hospital from Jan 2005 to Dec 2006 and direct the using of drugs reasonably. METHODS P. aeruginosa was identified by API and VITEK2 system, and its antimicrobial resistance was determined by Kirby-Bauer method and VITEK2 system. The antimicrobial resistance rates were analyzed by WHONET5.4 software. RESULTS The resistant rates of P. aeruginosa to SAM, CTX, and CRO were higher than 70%. The resistant rate to CIP was the lowest (about 30% or so). CONCLUSIONS P. aeruginosa is still a major pathogenic bacterium in our hospital. It is very important to select antibiotics correctly according to the results of susceptibility tests.
ABSTRACT
To study factors related to visual field damage in Possner- Schlossman Syndrome(PSS) .Methods 145 cases of PSS and 166 cases of promary open angle glaucoma(POAG)were followed up with tonometer and perimeter. Results①Prevalence of visual field damageamong PSS and POAG cases were 35.43% and 93.42% respectively;72.11% of the visual field damage in the PSS group was of early stage,while 78.92% of that in the POAG group was of middle or late stage.②Compared with PSS cases with no visual field damage,the damaged cases were older;their course of the disease was longer;the average IOP between crises was higher;more cases were involved binocularly;more cases demonstrated abnormal diurnal and nocturnal IOP varianle or no crossover phenomenon. ③Systematic examination was given to 26 PSS cases with visual field damage and among them, 11 cases were confirmed to be complicated with POAG. Conclusion①Although the incidence of visual field damage done by PSS is much smaller and the symptoms slighter than those done by POAG,the prognosis of PSS is by no means optimistic. ②Coses at more advanced age, with longer course, with higher IOP between crises, with binocular involvement or without IOP crossover phenomenon are at a higher risk of visual field damage. ③Serious damage can be done by PSS itself.
ABSTRACT
Objective To evaluate the treatment of interapleural talc on the patients with malignant pleural effusion.Method There were 44 patients with malignant pleural effusion in the study.Every cases was inserted a chest drain to release the effusion with the rate of 200 ml per 2 hours.When there was no evidence of fluid in the pleural space as assessed by plain chest roentgenography,the talc slurry containing 4 g talc、40 ml of saline solution (0.9%) and 5 ml of 2% lidocaine was injected via the intercostal drain into the pleural space.An additional 20 ml of saline solution was used to flush the drain.Then,the drain was clamped,and the patient was asked to change position to allow adequate distribution of talc.After 2 hours,the drain was opened again.When the drainage decreased to less than 150 ml per 24 hours,the chest drain was removed.Result complete success was observed in 36 cases (81.8%),partial success in 6 cases (13.7%),and ineffective success in 2 cases (4.5%).There were 21 (47.7%) and 24 (54.4%) cases experienced pleuritic pain and fever after talc pleurodesis respectively,1 cases suffered from respiratory insufficiency which controled by using glucocorticoid later.Conclusion The talc pleurodesis is an effective treatment for the patients with malignant pleural effusion.It is safe and easily performed,and should be used extensively in clinic.
ABSTRACT
Objective:To understand the psychological characteristics of nephrotic syndrome.Methods:The personality characteristics,intelligence and social adaptive behavior(SAB) of 67 moderate to severe nephrotic syndrome aged 7～14 years were measured by means of EPQ,CBCL,CRT and SAB scales.Results:The EPQ-N score of nephritic syndrome group was higher than that of control group( P 0.05).The nephritic group got a significantly lower social/self direction factor score than the control group.Conclusion:The results showed that nephritic syndrome possessed personality characteristics of neuroticism and obvious behavior problems;and their social adaptive behavior,particularly social/self-direction factor,was significantly lower than that of normal children.