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Previous studies have shown that hepatitis E virus （HEV） infection in pregnancy can cause liver failure and adverse pregnancy outcomes such as miscarriage， stillbirth， and vertical transmission， especially in countries where HEV genotypes 1 and 2 are prevalent. In recent years， HEV infection in China is sporadic and is mainly caused by HEV genotype 4， and although studies have shown that most pregnant women with HEV infection in China have no signfinicant clinical symptoms， there is still a high incidence rate of adverse pregnancy outcomes. This article reviews the recent studies on HEV infection in pregnancy， including the advances in pathogenesis， epidemiology， prognosis， mechanism of severe exacerbation， treatment， and prognosis， and puts forward recommendations for the screening and evaluation of HEV infection in pregnancy.
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Objective@#To investigate the clinical experience of patients with novel coronavirus (2019-ncov) infection after kidney transplantation.@*Method@#Clinical data of two patients with 2019-nCoV infection after renal transplantationin Jan 2020 Renmin Hospital of Wuhan Universiyt were retrospectively analyzed.Case 1 was a 48-year-old male with CMV pneumonia secondary to 2019-nCoV infection at 4 months after transplantation. CT imaging showed multiple patchy ground-glass images of both lungs. Case 2 was a 59-year-old male, who was screened positive for 2019-nCoV nucleic acid due to fever at 9 days after renal transplantation and showed no clinical manifestations of pneumonia. After diagnosis, case 1 was transferred to a designated hospital for isolation. Treatment regimens: cefoperazone sulbactam sodium + linezolid to resist infection, gamma globulin to enhance immunity function, methylprednisolone to control inflammatory response, antiviral regimens including arbidol tablets + lopina-velitonavir tablets. Case 2 was treated with isolated treatment in a single room. The treatment plan included anti-infection (cefoperazone sulbactam sodium), enhancing immunity function (gamma globulin), antivirus therapy with arbidol and other symptomatic treatment.@*Result@#Follow up with 3 weeks, case 1 recovered with renal dysfunction, nucleic acid test with nasopharyngeal swabs turned negative, and pulmonary imaging improved. Case 2 showed no obvious clinical symptoms, and the nucleic acid test of nasopharyngeal swabs turned negative for 3 times.@*Conclusion@#Renal transplant recipients should receive fine protection to avoid exposure to high-risk environments. Diagnosis should be defined with combination of clinical manifestations, nucleic acid test and pulmonary imaging. At present, there are no antiviral drugs and symptomatic treatment is the main choice.
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Objective:To summarize the clinical experiences of managing patients with novel coronavirus(2019-nCoV) infection after kidney transplantation.Methods:Clinical data were retrospectively analyzed for two patients with 2019-nCoV infection after renal transplantation in January 2020. Case 1 was a 48-year-old male with CMV pneumonia secondary to 2019-nCoV infection at 4 months post-transplantation. CT imaging showed multiple patchy ground-glass opacities of both lungs. Case 2 was a 59-year-old male who screened positive for 2019-nCoV nucleic acid due to fever at 9 days post-transplantation and he showed no clinical manifestations of pneumonia. After a definite diagnosis, case 1 was transferred to a designated hospital for isolation. Treatment regimens: cefoperazone sulbactam sodium plus linezolid for anti-infection, gamma globulin for enhancing immunity, methylprednisolone for controlling inflammatory responses and antiviral regimens of arbidol tablets plus lopina-velitonavir tablets. Case 2 was isolated in a single room. The treatment plan included cefoperazone sulbactam sodium for anti-infection, gamma globulin for enhancing immunity, arbidol for antiviral therapy and other symptomatic measures.Results:During a follow-up period of 3 weeks, case 1 recovered with renal dysfunction, nucleic acid test of nasopharyngeal swab turned negative and pulmonary imaging improved. Case 2 showed no obvious clinical symptoms and nucleic acid test of nasopharyngeal swab turned negative thrice.Conclusions:Renal transplant recipients should take precautions to avoid exposure to high-risk environments. A definite diagnosis should be made on the basis of clinical manifestations and results of nucleic acid test and pulmonary imaging. Currently there is no effective antiviral agent and symptomatic treatment is a major option.
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Objective:To explore the related risk factors of stress hyperglycemia in patients with acute cerebral infarction and the effect of stress hyperglycemia on short-term cognitive function and prognosis of acute cerebral infarction.Methods:A prospective study was used to select non-diabetic acute cerebral infarction patients who were hospitalized in Department of Neurology, North China University of Science and Technology Affiliated Hospital from June 2016 to November 2019 for observation.According to the increase in blood sugar, the study subjects were divided into stress hyperglycemia group (107 cases) and normal blood sugar group (202 cases), record two groups of general information.After single-factor and multi-factor analysis, independent risk factors for stress hyperglycemia were screened.The degree of neurologic impairment and cognitive function were evaluated on admission and 30 days after onset of the disease in the two groups.The incidence of complications within 30 days after onset of the disease was recorded, and the outcome evaluation of 30 days after onset was completed.The incidence of adverse prognosis was compared between the two groups.Results:The incidence of stress hyperglycemia was 34.6%.By univariate analysis, the proportion of hypertension history, smoking history and multifocal infarction in stress hyperglycemia group was higher than that in normal blood glucose group (all P<0.05), and age, body mass index (BMI), national institute of health stroke scale(NIHSS) score, admission systolic blood pressure, total cholesterol, low density lipoprotein cholesterol and hypersensitive C-reactive protein (hs-CRP) in the blood glucose group were higher than those in the normal blood glucose group (all P<0.05). Multivariate logistic regression analysis showed that age, admission systolic blood pressure, BMI, NIHSS score and multifocal infarction were independent risk factors of stress hyperglycemia in patients with non-diabetic acute cerebral infarction (all P<0.05); the incidence of cognitive impairment in stress hyperglycemia group was higher than that in normal blood glucose group (21.8% vs.12.7%; χ 2=4.155, P=0.042), and the 30-day MOCA score was lower than that of the normal blood glucose group.According to multivariate Logistic regression analysis, stress hyperglycemia was independently associated with cognitive impairment in the 30 days after acute cerebral infarction( OR=1.788, 95% CI: 1.127-2.836, P=0.014). The results showed that the incidence of poor prognosis in stress hyperglycemia group was significantly higher than that in normal blood glucose group ( P<0.05); multivariate logistic regression analysis showed that stress hyperglycemia was independent of other factors related to disease outcome, and closely related to poor prognosis ( OR=1.824, 95% CI1.410-2.664, P=0.003). In addition, disease progression ( OR=2.208, 95% CI1.542-3.104, P<0.001) and severity of admission ( OR=2.340, 95% CI1.670-3.279, P<0.001) were also independent risk factors for poor prognosis. Conclusion:The occurrence of stress hyperglycemia after acute cerebral infarction in non-diabetic patients is the result of multiple factors.It is an independent influencing factor of poor prognosis, and can be used as one of the important reference indicators to predict the disease condition.
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Objective To study the risk factors and outcome of symptomatic BAAS.Methods Eighty symptomatic BAAS patients served as a BAAS group and 80 symptomatic anterior circulation stroke (ACS) patients served as a ACS group in this study.The risk factors for symptomatic BAAS were compared.The symptomatic BAAS patients were further divided into mild-moderate stenosis group (n =43) and severe stenosis group (n=37),progressive stenosis group (n =34) and non-gressive group (n=46),survival group (n=42) and death group (n=38) respectively.The relationship between risk factors and outcome of symptomatic BAAS was analyzed.Results The rate of male patients and the incidence of hypertention were significantly higher in BAAS group than in ACS group (75.0％ vs 57.5％,80.0％ vs 66.3％,P＜0.01).The history of ischemic stroke and smoking was related with the severity of BAAS (P＜0.05).Premonitory symptoms were re lated with the progression of BAAS (P＜0.01).Pulmonary infection and tracheal intubation or tracheotomy were related with the outcome of BAAS (P＜0.01).Conclusion Male gender,hypertension,and history of ischemic stroke and smoking are the independent risk factors for symptomatic BAAS which is less likely to progress in patients with premonitory symptoms.Pulmonary infection and tracheal intubation or tracheotomy are the independent risk factors.