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Objective:To study the clinical application of ultrasound-guided puncture and catheter tip positioning in peripherally inserted central catheter (PICC) among very/extremely low birth weight infants (VLBWI/ELBWI).Method:From January 2019 to August 2020, VLBWI/ELBWI admitted to NICU of our hospital and received PICC were prospectively enrolled in the study. Based on the last digit of medical record number was odd or even, the infants were assigned into ultrasound group and X-ray group. In the ultrasound group, puncture and catheter tip positioning were performed at bedside guided by ultrasound, while in the X-ray group, these procedures were performed empirically. The differences of catheterization procedure duration, first-time success rate, the visibility of catheter tip, primary dislocation rate, secondary dislocation rate and complication rate were compared between the two groups using SPSS 25.0.Result:A total of 118 premature infants were enrolled, including 57 cases in ultrasound group (50 cases VLBWI and 7 cases ELBWI) and 61 cases in X-ray group (54 cases VLBWI and 7 cases ELBWI). The catheterization procedure duration [(23.2±7.1) min vs. (34.1±7.5) min], first-time success rate (93.0% vs. 65.6%), the visibility of catheter tip (96.5% vs. 83.6%), primary dislocation rate (7.0% vs. 24.6%) and complication rate (7.0% vs. 21.3%) in ultrasound group were all better than X-ray group ( P<0.05). For ELBWI, the above five indexes in the ultrasound group were better than the X-ray subgroup ( P<0.05). For VLBWI, only the catheterization procedure duration and first-time success rate were better in the ultrasound group than the X-ray group ( P<0.05). Conclusion:Ultrasound-guided PICC catheterization in VLBWI/ELBWI is convenient and accurate, which can improve success rate, reduce radiation exposure and repeated catheterization injury. Timely tracking and adjustment of the catheter under ultrasound can reduce complications after catheterization. This technique is worth popularizing among VLBWI/ELBWI.
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Patent foramen ovale (PFO) is a congenital heart disease that occurs in about 25% of healthy adults. In recent years, more and more studies have shown that PFO is closely associated with cryptogenic stroke (CS). Although it is currently believed that paradoxical embolism is one of the main mechanisms of the pathogenesis of CS, but the exact mechanism is still controversial. In addition, the treatment of CS in patients with PFO is also the focus of controversy. Recent clinical trials have shown that PFO occlusion is significantly better than drug therapy alone in preventing stroke recurrence, especially for patients with a large right-to-left shunt and atrial septal tumor. This article reviews the potential mechanisms and prevention strategies of CS in patients with PFO.
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Objective To analyze the rate and distribution of positive provocative tests in patients with inducible urticaria,and to investigate the role of provocative tests in the etiological diagnosis of chronic urticaria.Methods Among patients who visited the special clinic for urticaria in the Department of Dermatology of the Third Affiliated Hospital,Sun Yat-sen University from January 2016 to December 2017,127 patients with suspected inducible urticaria were selected,and underwent 6 provocative tests for inducible urticaria,including delayed pressure urticaria provocative test (DPUPT),symptomatic dermographism provocative test (SDPT),vibratory angioedema provocative test (VAEPT),cold urticaria provocative test (CUPT),heat urticaria provocative test (HUPT),and aquagenic urticaria provocative test (AUPT).Statistical analysis was carried out by chi-square test for comparison of positive rates between male and female patients.Results Among the 127 patients with suspected inducible urticaria,106(83.46％) showed one or more positive provocative tests.The positive rate of SDPT was the highest (79.53％,101/127),followed by HUPT (22.05％,28/127) and CUPT (9.45％,12/127).The positive rate of HUPT was significantly higher in female patients (30.14％,22/73) than in male patients (11.11％,6/54;X2 =4.301,P ＜ 0.05).The patients with positive DPUPT,VAEPT and AUPT all showed positive SDPT responses.Among the 12 patients with positive CUPT reactions,11 showed positive SDPT responses.Among the 28 patients with positive HUPT reactions,26 showed positive SDPT responses.Of the 48 patients with one or more positive non-SDPT provocative tests,the patients with 2 positive non-SDPT provocative tests accounted for 18.75％ (9/48).Conclusion Provocation tests for inducible urticaria are of great clinical significance for the etiological diagnosis of chronic urticaria.
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Objective To determine the clinical significance of measuring the levels of 25-(OH) vitamin D3 [(25-(OH) D3)],immune globulins and serum alkaline phosphatase(AKP) in children with recurrent community-acquired pneumonia(CAP).Methods Serum samples were collected in children with recurrent CAP (recur-rent CAP group,n =38),first CAP (first CAP group,n =123),and age matched normal children (heath control group,n =39).The 25-(OH) D3 level,IgG,IgM,IgA and AKP levels were measured.Results The serum 25-(OH)D3 concentration of the recurrent CAP group was (47.87 ± 2.28)nmol/L,that of the first CAP group was (84.43 ± 4.12) nmol/L,and that of the heath control group was (91.2 ± 7.85) nmol/L,the differences among the three groups were statistically significant (t =3.716,8.881,all P ＜0.05).The differences of the serum IgA concen tration among the three groups had statistically significant differences (t =4.596,5.319,9.230,all P ＜ 0.05).But the serum IgG concentration among the three groups had no statistically significant differences(t =1.115,1.887,1.090,all P ＞ 0.05).The serum IgM concentration among the three groups had no statistically significant differences (t =0.804,0.942,0.918,all P ＞ 0.05).The serum AKP concentration among the three groups had no statistically signifi cant differences(t =0.277,0.661,0.866,all P ＞ 0.05).The serum 25-(OH) D3 levels in 161 cases of CAP patients were not correlated to any of the levels of IgM,IgG,IgA,or AKP.Conclusion The levels of 25-(OH) D3 and IgA are significantly lower in children with recurrent CAP,indicating that vitamin D deficiency may play a role in the pathogenesis of recurrent CAP.Prophylactic use of vitamin D supplementation may improve the immune function and reduce the development of recurrent CAP in children.
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Objective To investigate vitamin D ( VD) level and its influencing factors in 4-15-year-old children in southwest of Zhejiang province, so as to guide intervention strategy for improving VD level. Methods A total of 2 620 4 -15-year-old healthy children who visited Lishui People's Hospital for regular physical check-up between January and December 2014 were divided into 4 age groups, namely 4 -6 years (kindergarten), 7 -9 years (lower grades in primary school), 10 -12 years (higher grades in primary school), and 13-15 years (junior middle school).We randomly selected 200 children from each age group using a random number table.A survey using self-developed questionnaire was conducted to obtain information regarding diet, exposure to sunlight, and VD supplement.Serum 25-( OH) D level was measured with electro-chemiluminescence.VD nutritional status and composition, diet, sunlight exposure, VD supplement were com-pared among the groups.Results In southwest Zhejiang, the mean VD level in primary and middle school students was ( 24.76 ±8.39 ) μg/L, clinical deficiency rate was 31.5%, subclinical deficiency rate was 45.0%, and only 23.5% reached the appropriate level, which was even lower ( 14.5%) in junior middle school students.The VD deficiency rate elevated significantly along with the growth of age (P=0.036).The level of VD was positively correlated with sunlight exposure and VD supplementation, and showed significant in-ter-group differences ( all P7 years should be given more attention to in the intervention of increasing sunlight exposure. Students with difficulties in getting adequate sunlight exposure need VD supplements.
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Objective To investigate the relationship and clinical significance between the concentration of 25-hydroxy vitamin D3 [25-(OH)D3 ]in the serum and community-acquired pneumonia(CAP)in infants.Methods The study recruited 98 infants.There were 68 cases of mild pneumonia and 30 cases of severe pneumonia.The con-centration of 25-(OH)D3 in serum,IgA and alkaline phosphatase(AKP)were measured.33 infants who accepted physical examination in the outpatient department were selected as control group at the same time.Results The serum 25-(OH)D3 concentration of severe pneumonia was (21.09 ±7.32)ng/mL,mild pneumonia was (25.77 ± 8.06)ng/mL and the control group was (37.13 ±6.94)ng/mL.The differences among the three groups had statisti-cally significant differences(t =9.18,3.72,5.34,all P 0.05).The prevalence of Vitamin D deficiency was 40.0%,which was higher than mild pneumonia patients(20.6%)and the healthy children(9.1%)(χ2 =8.43,17.55,all P <0.05).Conclusion The serum 25-(OH)D3 concentration and IgA of CAP patients were lower than healthy children,especially in severe pneumonia cases.The prevalence of Vita-min D deficiency was significantly higher than healthy children.There were no relevance between the serum concentra-tion of 25-(OH)D3 ,IgA and AKP.25-(OH)D3 plays an important role in the development of CAP.The low level of serum 25-(OH)D3 concentration may be one of the risk factors and has correlation to the severity of pneumonia.
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64 ?g/mL, turbinafine 0.125 ?g/mL, ketoconazole 4.0 ?g/mL, and miconazole 8.0 ?g/mL. Conclusion Based on the morphology of colony on SDA and the characteristic structures under the microscope, this is a case of subcutaneous infection caused by Arthrinium phaeospermum.
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Objective To study the clinical features, laboratory findings and therapy of patients with bullous pemphigoid. Methods Clinical data of 89 cases of bullous pemphigoid were retrospectively analyzed. Results The male female ratio was 1.07∶1. The mean age of first onset was 58 years old. Patients presented erythema multiforme and dermatitis herpetiformis like lesions besides typical bullae and erythema. Oral mucosal lesions occurred in 33.7% of patients, and oral bullae and erosions were the inital symptoms in 6.7% of patients. Nikolsky′s sign was present in 18% of patients. Direct and indirect immunoflorescence were positive in 95% and 74.4% of patients, respectively. The patients were mainly treated with corticosteroids or the combination of corticosteroids with immunosuppressive agents. The mean dose of coricosteroid needed to control lesions was 65.5 mg (equivalent of prednisone), except patients treated with pulse therapy of corticosteroids. Conclusions Histopathological and immunofluorescent findings are the most important evidence for the diagnosis of bullous pemphigoid. The maximum doses needed to control lesions vary greatly in different individuals.