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Objective To evaluate the performance of polymerase chain reaction (PCR)‐based rapid detection of methicillin‐resistant S .aureus (MRSA) from the respiratory specimens of ICU patients in comparison with conventional sputum culture . Methods We collected 3 respiratory specimens from each patient simultaneously for bacterial culture ,fungal culture and PCR‐based detection of MRSA .The performance of the established PCR method was compared with the results of sputum culture in terms of sensitivity ,specificity ,positive predictive value (PPV) and negative predictive value (NPV) .Results The sensitivity , specificity ,PPV and NPV of PCR assay were 88 .9% ,73 .6% ,36 .4% ,and 97 .5% ,respectively ,which were lower than the reported results of PCR assay with nasal swabs .Conclusions The utility of PCR assay for active screening of MRSA from respiratory specimens still needs further supportive data .However ,PCR assay is somewhat informative in excluding MRSA infection or colonization because of its high NPV .
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Objective To study the changes of serum procalcitonin (PCT) in the patients with simple brain trauma and its relationships with injury of severity, complications and outcome of injury.Methods A total of 120 patients with simple brain trauma were evaluated in a prospective observational study.The serum levels of procalcitonin and C-reactive protein were measured 1,2,3,5,7 and 10 days after the admission.During the following ten days after admission,the clinical data of patients with simple brain trauma were recorded,and also the patients with 28-day survival were followed up.Another 30 healthy subjects were enrolled in normal group for comparison. Results In different periods after trauma,the PCT levels in brain injury patients with different degree of injury severity were significantly different ( P ＜ 0.05 ).During the first two days after admission,there were no significant differences in serum PCT levels between non-infection group and infection group,but significant differences were found between two groups on the 3rd,5th,7th and 10th days ( P ＜ 0.05 ).Kaplan-Meier survival analysis showed the 28 days survival between the group with high PCT level and the group with lower PCT level was statistically significant ( P ＜0.05 ). Conclusions Poor outcomes and complications such as infection were often occurred in simple brain trauma patients with initially high PCT.The frequent determination of serum PCT levels is a useful approach to the judgment of injury severity and proguosis in patients with simple brain trauma.
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Objective To explore the clinical implications of the initial levels of serum uric acid (SUA) after admission in the critically ill patients with infection,and to investigate the relationship between SUA and prognosis of infection.Methods From January 2003 to April 2010,471 patients with infection were admitted to the ICU of Huashan Hospital,Fudan University,Shanghai.Data,including serum uric acid (SUA),serum creatinine,blood urea nitrogen (BUN) and other relevant laborartory results within 24hours after admission,were retrospectively analyzed.The distribution of uric acid was described.The t test was used to evaluate the relation between SUA and preexisting disorders.Patients with different level of SUA were classfied for further analysis.x2 test was used to examine the difference in the prognosis of infection.Results The mean initial level of SUA within 24 hours after admission was 0.232 ± 0.131 mmol/L and the median 0.199 mmol/L. Remarkable difference in initial levels of SUA were observed in patients with preexisting hypertension (t=-3.084,P=0.002),diabetes mellitus (t=-2.487,P=0.013),cerebral infarction (t=-3.061,P=0.002),renal insufficiency (t=-4.547,P＜0.01),central nervous system infection (t =5.096,P ＜ 0.01 ) and trauma (t =2.875,P =0.004).Serum uric acid was linearly correlated with serum creatinine and blood urea nitrogen (F =159.470 and 165.059,respectively; P ＜0.01).No statistical correlation was found between initial levels of SUA and prognosis of infection (x2=60.892,P=0.100).Conclusions There is no direct correlation between the initial levels of SUA afteradmission and the prognosis of infection in the critically ill patients.
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Objective To investigate the efficacy and safety of fluid resuscitation with 75 g/L NaCl solution in traumatic hypovolemic shock using Meta-analysis. Methods Based on the inclusion criteria,the randomized controlled trials (RCTs) were identified by retrieving the databases including PUBMED,EMBASE,OVID,Cochrane library and EBSCO.The quality of studies was also evaluated.Indices including systolic blood pressure,hemoglobin,serum Na level and mortality were extracted from the enrolled RTCs and were comparatively analyzed between the 75 g/L NaCl group and the isotonic saline group for evaluating the safety and efficacy of 75 g/L NaCI solution.The extracted data were analyzed by using the Review Manager 5.0.25. Results Six RCTs were eligible for Meta-analysis.The 75 g/L NaCl group displayed remarkable increase in systolic blood pressure and decrease in hemoglobin level,compared with the isotonic saline group ( MD =6.23,95％ CI 2.78-9.69,P ＜ 0.01 ; MD =-6.11,95％CI -8.25-3.96,P ＜ 0.01,respectively).Short-term hyperosmolar state in 75 g/L NaCl group was increased significantly but was considered acceptable ( MD =7.97,95％ CI 7.55-8.38,P ＜ 0.01 ).No significant difference in mortality was found between 75 g/L NaCl group and isotonic saline group ( RR =0.96,95％ CI 0.84-1.10,P ＞ 0.05). Conclusion Fluid resuscitation with 75 g/L NaCl solution is safe and effective for traumatic hypovolemic shock.
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The effect of diet with various fatty acid composition on insulin resistance in male OLETF ratswas observed. The results showed that it was beneficial to insulin sensitivity in rats fed with ? 3 polyunsaturated fatty acid rich food.