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Background: The increasing in antibiotic resistance of Helicobacter pylori (Hp) has become the main cause leading to the decreasing of the eradication rate for Hp treatment. Aims: To investigate the risk factors of drug resistance of Hp. Methods: Data on 396 patients with Hp infection from Dec. 2016 to Mar. 2021 at Army Medical University were retrospectively analyzed. Drug susceptibility test was used to evaluate the resistance of 6 antibacterial drugs (metronidazole, clarithromycin, levofloxacin, amoxicillin, tetracycline and furazolidone). Unconditional Logistic regression was used to investigate the risk factors affecting Hp antibiotic resistance. Results: In 396 patients with Hp infection, the resistance rates of metronidazole, clarithromycin, levofloxacin, amoxicillin, tetracycline and furazolidone were 96.5%, 45.5%, 41.9%, 0.3%, 0.3% and 0, respectively. Multivariate analysis showed that previous regimen containing clarithromycin was a risk factor for clarithromycin resistance (P 40 years old was a risk factor for levofloxacin resistance (P< 0.001). Conclusions: The resistance rates of metronidazole, clarithromycin and levofloxacin are relatively high, and regimens containing these antibiotics should be avoided without the support from drug susceptibility results, especially in patients who have accepted clarithromycin‑containing regimen or more than 40 years old. Amoxicillin, tetracycline and furazolidone should be recommended preferentially for Hp treatment empirically.
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Background: The benefits and risks of eradicating Helicobacter pylori (Hp) should be balanced in aged people. Aims: To investigate the efficacy, safety and antibiotic resistance status of Hp eradication treatment in the elderly. Methods: Four cohorts of subjects who received Hp eradication treatment in randomized controlled trials conducted in Chongqing Daping Hospital were reviewed; the demographic and clinical data were extracted and recorded. Propensity score matching was performed to select comparable elderly group (≥60 years old) and non-elderly group (0.05). Furthermore, there were no significant differences in the Hp eradication rates in terms of gender, cigarette smoking, alcohol consumption, comorbidities (hypertension, diabetes, surgical history, and inflammation), compliance, etc. in the elderly group (all P> 0.05). But in retreated elderly subjects, the resistance rate of clarithromycin was higher than that in naïve elderly subjects (P<0.05). Smoking and poor compliance were identified as independent risk factors for Hp eradication by multivariate Logistic regression analysis. Conclusions: Hp eradication in the elderly demonstrates comparable efficacy and safety with non-elderly subjects. Clarithromycin-containing regimens are not recommended for empirical retreatment in aged people.
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Objective:To analyze current situation of hospice care in Jinshan District of Shanghai and provide recommendations for development of hospice care. Methods:This cross-sectional study included 8 hospice care institutions， their health staff and 316 patients during May-August， 2019. Results were analyzed by quantitative and qualitative methods. Results:There had 80 approved beds in Jinshan District， but only 53 beds were used for 189 inpatients in 2017. Hospice care institutions received financial supports from district government at the construction stage， but relied on their own for daily operation costs. The motivation of health staff to work in hospice care was not strong. Among the hospice care workers， 18% had no certification for hospice care， and only 5% of them had senior professional titles. Continued education for health workers in hospice care was weak and the workers were under heavy stress. Conclusion:The potential needs for hospice care were unmet while hospice care was under-utilization in Jinshan District. The development of hospice care was unbalanced， and the health workers lacked motivation. The resources of hospice care need to be strengthened.
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Background: Helicobacter pylori (Hp) infection is related to the occurrence of many upper digestive tract diseases, and the eradication rate has been decreasing year by year. Aims: To investigate the risk factors affecting initial eradication rate of Hp infection. Methods: Clinical data of 428 patients with Hp infection were retrospectively analyzed. Four regimens (14-day esomeprazole 20 mg + amoxicillin 750 mg, qid; 10-day esomeprazole 20 mg + amoxicillin 750 mg, qid; 14-day esomeprazole 20 mg + amoxicillin 1 000 mg, tid; 14-day esomeprazole 20 mg + bismuth 220 mg + amoxicillin 1 000 mg + clarithromycin 500 mg, bid) were given, and effect of antibiotic resistance on Hp eradication was analyzed, the relevant risk factors affecting the eradication rate of Hp were investigated. Results: The eradication rate of ITT analysis was 86.4%, PP analysis was 87.6%. The eradication rates of 4 regimens for ITT analysis were 90.8%, 79.8%, 82.7%, 91.9%, respectively, and were 90.8%, 81.2%, 85.1%, 92.7% for PP analysis, respectively. The antibiotic resistance rate was 30.3%, 97.4% and 36.8% for clarithromycin, metronidazole and levofloxacin, respectively. The recurrence rate of 116 patients was 4.3% after one year of eradication. Smoking, poor compliance, CYP2C19 gene polymorphism were risk factors for eradication rate of Hp (P<0.05). Conclusions: Smoking, poor compliance and ultra-rapid metabolizers, extensive metabolizers of CYP2C19 gene polymorphism can reduce Hp eradication rate. In clinical practice, patient education should be strengthened to urge patients to quit smoking. The quality of follow-up should be improved and proton pump inhibitor that has less impact on CYP2C19 gene polymorphism should be used, thereby increase the Hp eradication rate.
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We describe the prenatal diagnosis and postnatal follow-up of a fetus with a pericallosal lipoma diagnosed by MRI. The pregnant woman was admitted to Zhongnan Hospital of Wuhan University in February 2019. MRI examinations with multiple sequences and imaging methods were performed prenatally at 31 +6 and 38 +3 weeks of gestation, and at two days and three months postnatally. The MRI images showed that the corpus callosum was normal and the lesion was located around the corpus callosum, with high signal intensity on T1 weighted imaging, medium-to-high signal intensity on T2 weighted imaging, and low signal intensity on fat suppression sequence. No abnormal blood vessels were found on susceptibility-weighted imaging and time-of-flight magnetic resonance angiography sequences. Based on the prenatal and postnatal MRI findings, the tumor was clinically diagnosed as a pericallosal lipoma.
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<p><b>OBJECTIVE</b>To identify the risk factors for death in children with septic shock.</p><p><b>METHODS</b>Clinical data of 53 children with septic shock admitted to the Yuying Children's Hospital between January 2006 and July 2008 were retrospectively studied. Risk factors for death were assessed using univariate analysis and logistic regression analysis.</p><p><b>RESULTS</b>Nineteen cases died out of 53 children with septic shock. Univariate analysis and logistic regression analysis showed that arterial blood pH value<7.0 (OR=89.66), hypotension (OR=84.00), the pediatric critical illness score<70 (OR=60.00), the number of organ dysfunction>or=3 (OR=38.98), incompletion of volume resuscitation within 6 hrs after shock (OR=26.41), and no administration of effective antibiotics within 1 hr after shock (OR=11.43) and of vasoactive drugs (OR=75.68) were risk factors for death in children with septic shock.</p><p><b>CONCLUSIONS</b>A low arterial blood pH value (<7.0), hypotension, a pediatric critical illness score (<70) and the number of organ dysfunction>or=3 are related to a high mortality in children with septic shock. If the volume resuscitation can be completed within 6 hrs after shock, effective antibiotics can be administered within 1 hr after shock, and vasoactive drugs can be used properly, the outcome of children with septic shock may be improved.</p>
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Child , Child, Preschool , Female , Humans , Infant , Male , Hydrogen-Ion Concentration , Logistic Models , Risk Factors , Shock, Septic , Metabolism , MortalityABSTRACT
<p><b>OBJECTIVE</b>To recognize the clinical features of the enterovirus 71 (EV71) infection with pulmonary edema or pulmonary hemorrhage as a fulminant and often fatal illness.</p><p><b>METHODS</b>We retrospectively reviewed the medical records of the three cases with EV71 infection for clinical manifestation, laboratory data, medications, outcome etc.</p><p><b>RESULTS</b>All the cases were infants and they all died. These infants had no skin or mucosal lesions, however, they had sudden onset of cyanosis and tachypnea 1 to 2 days after the onset of the febrile disease with vomiting. All these 3 cases were misdiagnosed and were treated for shock on admission. Pulmonary hemorrhage was not considered in any of the cases on admission. All the cases received tracheal intubation when foamy secretions were discharged from mouth and nose of the patients and notable cyanosis was noted. After intubation, all had pink foamy fluid flew out from the endotracheal tube. The patients had hyperglycemia and limb weakness, two had tachycardia, and hypertension was found in one case. Chest X-ray showed bilateral or unilateral widespread air space opacity, but the cardiac size and shape were normal. All the patients had leucocytosis. EV71 infection was confirmed by detection of specific sequences of the virus in throat swab and tracheal secretions samples and in one case in cerebrospinal fluid sample.</p><p><b>CONCLUSION</b>Pulmonary edema or pulmonary hemorrhage occurred in the 3 cases with EV71-infected infants. The initial presentation was often nonspecific with fever and vomiting, and sudden appearances of cyanosis, tachypnea, tachycardia, hypertension or hypotension, limb weakness may suggest pulmonary edema or hemorrhage. Excessive fluid resuscitation may deteriorate the illness, on the contrary, fluid restriction and inotropic agents, and early intubation with positive pressure mechanical ventilation may be the proper treatment.</p>
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Female , Humans , Infant , Male , Enterovirus A, Human , Enterovirus Infections , Pathology , Hemorrhage , Virology , Pulmonary Edema , Virology , Retrospective StudiesABSTRACT
Multi-stage membranes processes, including ultrafiltration and nanofiltration are used in concentration of Biyankang extracts at room temperature, and the concentrations of main active ingredient in retentions after membrane processes were determined by HPLC. The results showed that the removal rate of water is about 45%, and the cost is only one fourth of the vacuum heating method. The retention rates of buddleoside and ephedrine hydrochloride are above 80% and 90% respectively, which meet the efficient concentration and energy-saving needs. The concentration method of Biyankang with multi-stage membranes processes provides some instructive theories and experimental foundations.
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Drugs, Chinese Herbal , Chemistry , Economics , Filtration , Economics , Methods , Membranes, Artificial , Ultrafiltration , MethodsABSTRACT
Objective To explore the changes of plasma somatostatin(SST) in children with septic shock.Methods The level of plasma SST in children with septic shock (test group,n=21) on an empty stomach at shock stage,blood pressure and heart rate recovery stage,recovery stage(at that time clinical symptoms and signs disappeared,infection indicators such as blood routine and CRP returned to normal,about 6-12 days after admission) were detected by competive radioimmunassay,the level of SST in healthy children(healthy control group,n=25) on an empty stomach on morning was detected,too.The levels of plasma SST between septic shock concbined with paralytic ileus group and without paralytic ileus group were compared.Results 1.Level of plasma SST of test group at shock stage[(44.60?16.83) ng/L]was significantly lower than that of control group[(123.15?6.57) ng/L](t=-12.16 P0.05).The level of plasma SST of children with paralytic ileus [(28.10?7.0) ng/L] was significantly lower than that of children without paralytic ileus [(56.98?9.44) ng/L](t=-7.70 P
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<p><b>OBJECTIVE</b>To investigate the change in endothelium-dependent vasodilation and arterial elasticity and the association between them in patients with coronary artery disease (CAD).</p><p><b>METHODS</b>Thirty patients with CAD and thirty control subjects were recruited for this study. Flow-mediated dilation (FMD) in the brachial artery was evaluated by ultrasound Doppler flow method. They also underwent a non-invasive assessment of C(1) large artery and C(2) small artery indices by using pulse wave analysis.</p><p><b>RESULTS</b>FMD was significantly reduced in CAD group compared with that in control group [(5.17 +/- 2.13)% vs (11.1 +/- 4.36)%, P < 0.05], C(1) large artery elasticity index was similar between the two groups [(11.59 +/- 4.56) ml/mm Hg x 10 vs (12.11 +/- 3.82) ml/mm Hg x 10, P > 0.05]. However, C(2) small artery elasticity index was significantly reduced in CAD group compared with that in control group [(4.20 +/- 1.80) ml/mm Hg x 100 vs (6.26 +/- 2.36) ml/mm Hg x 100, P < 0.05]. There was a positive association between reduced C(2) small artery elasticity index and impaired FMD (r = 0.53, P < 0.05).</p><p><b>CONCLUSIONS</b>There were impaired endothelium-dependent vasodilation and reduced C(2) small artery elasticity index in the patients with CAD, which were closely correlated with each other. The present study suggested that the measurement of C(2) small artery elasticity might be used as a novel index for the determination of endothelial function.</p>
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Aged , Female , Humans , Male , Middle Aged , Arteries , Case-Control Studies , Coronary Artery Disease , Elasticity , Endothelium, Vascular , Vasodilation , PhysiologyABSTRACT
Objective To explore the relations among blood lipid,blood rheology and microcirculation of bulbar conjunctiva of model rats of diabetesⅡwith heart blood stasis syndrome.Methods The rats were fed with high fat and caloric feed.Intraperitoneal injection of streptozotocin(STZ)in small dosage was applied to make the model of diabetesⅡ.Then the model of heart blood stasis syndrome was made through introperitoneal injecting dexamethasone and adrenalin.Eight hours after empty stomach,the rats were anaesthetized to measure the microcireulation of bulbar conjunctiva and test the blood lipid and carotid blood rheology.Results The indices of blood lipid,blood rheology and bulbar eonjunetiva microcirculation of model rats were all changed to abnormal,tallying with the changes of cardiovascular complications of diabetes.