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Objective:To investigate the efficacy of magnesium sulfate combined with labetalol on severe preeclampsia and the effects on serum levels of soluble intercellular adhesion molecule-1 (sICAM-1), vascular endothelial growth factor (VEGF) and pregnancy associated plasma protein-A (PAPP-A).Methods:Eighty-five patients with severe preeclampsia who received treatment in Jinhua Municipal Central Hospital between January 2019 and June 2020 were included in this study. They were randomly assigned to receive treatment either with magnesium sulfate (control group, n = 42) or magnesium sulfate combined with labetalol (observation group, n = 43). Before and after treatment, 24-hour dynamic blood pressure, 24-hour urinary protein excretion and umbilical artery hemodynamics were determined. In addition, serum levels of sICAM-1, VEGF and PAPP-A were detected. Results:After treatment, 24-hour mean arterial pressure, 24-hour urine protein excretion in the control and observation groups were significantly decreased compared with before treatment. After treatment, the 24-hour mean arterial pressure [(116.45 ± 9.63) mmHg vs. (120.74 ± 9.48) mmHg] and 24-hour urine protein excretion [(1.85 ± 0.52) g vs. (2.33 ± 0.75) g] were significantly lower than those in the control group ( t = 2.069, 3.436, both P < 0.05). The umbilical artery resistance index in the control group, and the peak systolic velocity/end-diastolic velocity ratio and the umbilical artery resistance index in the observation group were significantly decreased after treatment compared with before treatment (all P < 0.05). After treatment, the peak systolic velocity/end-diastolic velocity ratio in the observation group was significantly lower than that in the control group [(2.80 ± 0.50) vs. (3.01 ± 0.45), t = 2.034, P < 0.05]. After treatment, serum sICAM-1 and PAPP-A levels were significantly decreased, and serum VEGF level was significantly increased, in each group (all P < 0.05). After treatment, serum levels of sICAM-1 [(548.52 ± 102.74) mg/L vs. (647.52 ± 124.15) mg/L, t = 4.009, P < 0.05] and PAPP-A [(111.74 ± 28.52) U/L vs. (134.24 ± 35.96) U/L, t = 3.200, P < 0.05] in the observation group were significantly lower than those in the control group, and serum VEGF level in the observation group was significantly higher than that in the control group [(32.12 ± 7.45) ng/L vs. (28.17 ± 6.23) ng/L, t =2.659, P < 0.05]. There was no significant difference in the incidence of poor pregnancy outcome between the control and study groups ( P > 0.05). Conclusion:Magnesium sulfate combined with labetalol exhibits good therapeutic effects on severe preeclampsia. The treatment method can improve umbilical artery hemodynamics, and its mechanism may be related to its effect on vascular endothelial function.
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Objective@#To investigate the characteristics of hemolysis, resistance and homology of Staphylococcus cohnii urealyticum.@*Methods@#A retrospective study was carried out on thirteen clinical strains of Staphylococcus cohnii urealyticum. They were re-identified by MALDI-TOF MS. Their colony and hemolytic characteristics on blood agar plates were observed. The co-hemolysis between Staphylococcus cohnii urealyticum and Staphylococcus aureus was demonstrated. The hemolysin genes and drug resistance genes were detected by PCR. Pulsed field gel electrophoresis and mass spectrometry were used to analyze the homology of strains. The susceptibility of strains to antimicrobial agents was detected by agar dilution.@*Results@#The confirmed 13 strains of Staphylococcus cohnii urealyticum showed various levels of hemolysis and had enhanced synergistic hemolysis with Staphylococcus aureus. All strains were susceptible to vancomycin and tigecycline. There were 12 strains which carried mecA gene, 7 strains carried cfr gene, 7 strains carried ermC gene. The 13 strains were divided into 3 groups by MALDI-TOF MS, and 6 types by pulsed field gel electrophoresis.@*Conclusions@#Clinical strains of Staphylococcus cohnii urealyticum demonstrated various levels of hemolysis which could be enhanced by Staphylococcus aureus. Although they carried different drug resistance genes, they were all susceptible to vancomycin and tigecycline.
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Objective:To investigate the characteristics of hemolysis, resistance and homology of Staphylococcus cohnii urealyticum. Methods:A retrospective study was carried out on thirteen clinical strains of Staphylococcus cohnii urealyticum. They were re-identified by MALDI-TOF MS. Their colony and hemolytic characteristics on blood agar plates were observed. The co-hemolysis between Staphylococcus cohnii urealyticum and Staphylococcus aureus was demonstrated. The hemolysin genes and drug resistance genes were detected by PCR. Pulsed field gel electrophoresis and mass spectrometry were used to analyze the homology of strains. The susceptibility of strains to antimicrobial agents was detected by agar dilution. Results:The confirmed 13 strains of Staphylococcus cohnii urealyticum showed various levels of hemolysis and had enhanced synergistic hemolysis with Staphylococcus aureus. All strains were susceptible to vancomycin and tigecycline. There were 12 strains which carried mecA gene, 7 strains carried cfr gene, 7 strains carried ermC gene. The 13 strains were divided into 3 groups by MALDI-TOF MS, and 6 types by pulsed field gel electrophoresis. Conclusions:Clinical strains of Staphylococcus cohnii urealyticum demonstrated various levels of hemolysis which could be enhanced by Staphylococcus aureus. Although they carried different drug resistance genes, they were all susceptible to vancomycin and tigecycline.
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Objective To evaluate the ability of Matrix-assisted laser desorption ionization-time of flight mass spectrum (MALDI-TOF MS) on homology analysis of carbapenem-resistant Klebsiella pneumoniae(Carbapenemase-Resistant K. pneumoniae, CRKp). Methods During January 2017 to December 2017, a total of 57 strains isolatedfromChanghai Hospital, Shanghai and 36 strainsfrom Urumqi First Hospital, Xinjiang were included for retrospective study. Inclusion criteria:strains which resistant to one of the carbapenems and with more than 100 peaks in identification mass spectrum. A total of 39 isolates were selected and divided into three groups according to the PFGE typing results:(1) Highly homologous group (17 strains with blaOXA-48 gene); (2) Moderate homology group (16 strains with blaKPC gene); (3)The non-homology group (8 strains with other resistance mechanisms). Mass spectrometry results were analyzed using BioNumeric and the two classification methods in SARAMIS, respectively.The PFGE analysis results were regarded as standard when evaluate the reliability of the other three analytical methods. Results Forhighly homologous group, the analysisresults of KA-A type dientical mass by two classification methods in SARAMIS were accord with PFGE,and the identity mass value is>80％, the similarity is>85％. However, for non-homologous group, the identity mass value is<80％, the similarity is<85％ when compared with PFGE, which indicated that the method based on MALDI-TOF MS was not premium for this group of strains. For moderate homologous strains,the results of two SARAMIS methods for KC-A type havepoor consistency with PFGE, for the identity mass value is<70％, the similarity is<90％. Conclusions Based on MALDI-TOF MS using BioNumeric software and SARAMIS database software could be regarded as a screening method for phylogenetic analysis among CRKp strains with high homology. While, it should not be applied to evaluate homology of the strains with genetic diversity for lacking stability.
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Objective To understand the prevalence of Salmonella and the characteristics of drug resistance genes in General Hospital of People's Liberation Army, and to provide evidence for the prevention and treatment of Salmonella infection. Methods A retrospective study was conducted to collect 78 clinical isolates of Salmonella from 2015 to 2017. The age of the patients was 49 ± 21 years old. The infected patients were mainly young and middle-aged. The clinical samples mainly came from feces and venous blood, accounting for 44.87％(35/78) and 33.33％(26/78), respectively. After serotype identification, drug sensitivity test and whole genome sequencing, multilocus sequence typing and drug resistance genotyping were performed. Cluster of Cefotaxime or Ciprofloxacin resistant Salmonella was analyzed. Results Salmonella group D (53.85％) and Salmonella group C (21.79％) were dominant Salmonella serotype. ST11 was mainly ST type. Drug sensitivity test showed that the multidrug resistance rate of Salmonella was 64.11％ (50/78). The sensitivity to all antimicrobial agents' rate was 25.64 (20/78). The resistance rate of Salmonella to nalidixic acid was 65.38％(51/78). The most common drug resistance gene of Salmonella was extended-spectrum β-lactam drug resistance gene, accounting for 78.21％ (61/78). Conclusions The ST-type and carrying resistance genes of Salmonella in this hospital were diverse. Most pathogens were multi-drug resistant to antimicrobial agents. Molecular typing and drug resistance gene analysis of Salmonella and construction of resistant strains to determine the inheritance of Salmonella relationships have a certain clinical significance.
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Objective@#To discuss the application of matrix assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF MS) in the identification of Aspergillus and evaluate its performance.@*Methods@#the clinical isolates of Aspergillus collected from May 2017 to March 2018 in PLA General Hospital were identified by VITEK MS V3.0 and the results were analyzed. The ITS sequencing resultswere used as the gold standard.@*Results@#It identified 9 Aspergillus species (including 12 Aspergillus species in total) through the V3.0 database, accounting for 86.24% of the total clinical isolates. The identification rate by VITEK MS was 91.49% with 16.51% was not identified. The coincidence rate of genus was 93.62%, of which only two Aspergillus versicolor were identified to the level of the genus. According to the confidence level analysis, 88.30% of the strains obtained more than 99% of the identification rate. 13.83% of the strains did not have the identification results for the first time, with the error rate of 3.19%. After secondary extractions, the percentage of unidentified strain was reduced to 6.38%, and the identification error rate was reduced to 2.13%. Combined with traditional identification and VITEK MS identification, the correct rate of strains identification was 98.94% on genus level, and was 93.62% on species level. The influence of other fungi on Aspergillus identification was 0%.@*Conclusion@#As a powerful supplement to the traditional identification method, MALDI-TOF MS showed a lot of convenience when applied in the identification of Aspergillus, which improves the identification accuracy and the identification ability for fungi in laboratory.(Chin J Lab Med, 2018, 41: 577-582)
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<p><b>OBJECTIVE</b>To investigate the relationship between polymorphisms of the growth arrest specific 6 (GAS6) gene and severe preeclampsia in a South West Han Chinese population.</p><p><b>METHODS</b>Blood samples from 167 patients with severe preeclampsia and 312 normal pregnant women as controls from Han Chinese in Chengdu area were analyzed by polymerase chain reaction-restriction fragment length polymorphisms.</p><p><b>RESULTS</b>C and T allele frequencies for +1332C/T site were 85.63% and 14.37% in the patient group, respectively, and 78.04% and 21.96% in control group, respectively. The TT genotype and variant T allelic frequencies of the +1332C/T polymorphism were significantly lower in patients with severe preeclampsia than in the control group (both P<0.05), and the odds ratio for the risk of severe preeclampsia was 0.602 (95%CI: 0.401-0.904) in carriers for the variant T allele (χ=6.045, P=0.014). G and A allele frequencies for 834+7G/A site were 72.75% and 27.25% in case group, respectively, and 74.36% and 25.64% in control group, respectively. The genotype and allele frequencies of the 834+7G/A polymorphism in patients with severe preeclampsia and controls showed no significant differences (both P>0.05). In addition, there was no significant association between the polymorphisms and blood pressure levels in the patient or control groups.</p><p><b>CONCLUSION</b>The variant GAS6+1332 T allele is associated with a decreased risk for severe preeclampsia in a South West Han Chinese population. On the other hand, the 834+7G/A polymorphism has no effect on the severe preeclampsia.</p>
Subject(s)
Adult , Female , Humans , Pregnancy , Young Adult , Alleles , Asian People , Genetics , China , Gene Frequency , Genetic Predisposition to Disease , Ethnology , Genetics , Genotype , Intercellular Signaling Peptides and Proteins , Genetics , Polymerase Chain Reaction , Polymorphism, Single Nucleotide , Pre-Eclampsia , Ethnology , Genetics , Pathology , Risk Factors , Severity of Illness IndexABSTRACT
Objective To discuss the influence of preoperative family purge care for the quality of life of patients with long type of congenital Hirschsprung′s disease (HD) who had enterocolitis history in neonatal period. Preoperative family purge care, which can shorten the HD postoperative treatment, improve the quality of life. Methods A total of 40 cases of patients with long type of congenital HD who had enterocolitis history in neonatal period received 1-stage radical preoperative by family phone call. Nineteen cases from January 2010 to February 2013 were as normal group and 21 cases from March 2013 to April 2016 were as improved group. Routine family purge nursing care 3-6 months were used in both the groups, while the combined nursing care of expanding anus were used in the improved group in addition. Evaluated the effects of postoperative observation indicates: the first defecation time, length of hospital stay, time needed for expanding anus, patency rate of defecation and not patency rate in 9-12 days, need enema intervention to assist defecate rate after postoperative 1 year, the recurrence of enterocolitis at 1-3 years after operation. Results The first defecation time, length of hospital stay, time needed for expanding anus were (39.15±8.23) h, (7.89±0.82)d, (5.17±0.98) min in normal group, (23.79± 7.54) h, (7.10± 0.29) d, (3.15±0.73) min in improved group, and there were significant differences between two groups (t=6.13, 5.46, 15.54, all P0.05). Conclusions Patient with long type of congenital HD who had enterocolitis history in neonatal period neonatal period,received family enema and expanding anus in 3- 6 months before 1-stage radical preoperative can shorten the postoperative HD treatment, improve the quality of life.
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Objective To shorten the turn around time of positive blood culture results by optimizing the blood culture positive specimen processing flow.Methods In January 26,2015,the microbiology department started the blood culture positive specimen processing flow optimization project,and applied the Lean Six Sigma method in the microbiological process management.The TAT data of 124 positive blood cultures containing Enterobacteriaceae were collected before and after the start of the project in about two months.We analyzed the turnaround time median,mean and standard deviation and reference Z value,process performance index,millions of error opportunities.We decompose the turnaround time into six time periods to find the key points of the process improvement and the influencing factors,and then put forward the reform measures to optimize the blood culture inspection process.MiniTab17.0 statistical software was used to process capability analysis and double sample t test.Results After the implementation of the project,the average turnaround time of the blood culture was shortened from 77.10 h to 64.03 h,improved by 13.06 h(16.94％).Process performance greatly improved in Ppk value increased from 0.49 to 0.88,the benchmark Z value increased from 1.48 to 2.63.After the improvement,except the positive alarm time of blood culture,the mean of the other decomposition time was significantly shorter than before.Conclusions The application of Six Sigma in process management can greatly improve the work efficiency and process performance.This project can save a lot of manpower,material and financial resources,reduce the waiting,shorten turnaround time,that achieve the desired results.
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Objective To analyze the correlations between pediatric intersive cave unit (PICU) nurses′job satisfaction and their perception of job characteristics. Method One hundred and thirty-six PICU nurses from a women and children′s hospital of Guangzhou participated in the study and the job diagnostic survey (JDS) and Minnesota satisfaction questionnaire short-form (MSQ20) were used to investigate the relationship between the job characteristics and job satisfaction. Results The average score on general satisfaction was (3.57 ± 0.41). The dimensions like skill variety, task integrity, feedback from job and feedback from others, had a significant positive impact on general satisfaction (all P<0.05). Conclusion Nurses generally have a relatively middle level of job satisfaction and measures should be taken to improve their job satisfaction as well as the quality of nursing.
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Objective To study the diagnostic and distinguishing diagnostic value in primary hepatic carcinoma (PHC)and metastatic hepatic carcinoma (MHC)by the serum sialic acid (SA)detection.Methods During January 2012 to June 2014, 100 cases of patients with PHC,91 cases of patients with MHC,155 cases of benign liver disease patients,and 139 healthy people in Wuyi Traditional Chinese Medicine Hospital were included into the study.The concentration of serum SA and AFP were detected by chemical enzymatic method and chemiluminescence method,SPSS1 9.0 was used to analysis the results.Re-sults The concentration of serum SA in PHC patients (701.08±189.33 mg/L)were significantly higher than benign liver disease patients (588.38±98.51 mg/L)and healthy people (572.37±89.13 mg/L),there was statistical significance (P=0.000),the significantly statistical differences were also in MHC (790.20±162.29 mg/L)and PHC patients (P=0.027). Serum SA in the diagnosis of MHC sensitivity,specificity and AUC were 84.6%,85.2% and 0.895,compared with serum AFP (sensitivity 22.2%,specificity 29.6% and AUC 0.301)had statistically significance (P=0.000).Conclusion The se-rum SA has important clinical significance in the diagnosis and distinguishing diagnosis of PHC and MHC.
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Objective To explore job satisfaction of nurses in the pediatric department and the influential factors.Methods Four hundred and fifty four nurses from children’s hospital in Guangzhou involved the study.The Minnesota Satisfaction Questionnaire Short-Form(MSQ20)was used to measure their satisfaction.Results The score on job satisfaction was 70.41±9.28,with the inner satisfaction(3.62±0.45),the extrinsic satisfaction(3.30±0.60)and general satisfaction(3.52±0.46).Salary was one of the important factors affecting job satisfaction.Conclusions The job satisfaction of the nurses of pediatric departments or hospitals can be improved by raising their salary level and benefits and improving their educational level.
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ObjectiveTo evaluate the application value of the quantitative procalcitonin (PCT) test in bloodstream infection.Methods Of 1066 patients with blood culture and PCT detection were collected in our hospital,retrospectively,1010 were effective cases.The relationship between blood culture results and serum PCT levels was investigated.PCT levels in gram-negative bacterial infection,gram-positive bacterial infection and candidiasis were compared.The prognosis of 33 blood culture positive patients with repeated PCT detection results were analyzed.Mann-Whitney U test was used to compare the PCT value among the three groups,and Fisher' s test was used to compare the death rate among the three groups.ResultsIn the patients with negative blood culture results,the median of PCT was 0.37 (0.11 - 1.67) μg/L.But in the patients with positive blood culture results,the median of PCT were 2.24(0.57 -11.59) μg/L The positive rate of PCT in gram-negative bacteria infection,gram-positive bacterial infection and candidiasis were 86.6％,72.0％ and 75.7％,respectively.In the 33 patients subjected to repeated PCT detections,the mortality of the patients with decreasing PCT was lower than the others.The patients whose PCT levels were greater than 5 μg/L had poor prognosis.ConclusionsQuantitative PCT is proved to be an effective method for rapid diagnosis of bloodstream infection.The changing trends of PCT test results has certain reference value for the patients' prognosis.
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0.05).Our results showed that,for recommended oral doses of ciprofloxacin and moxifloxacin,44.2% of E.coli isolates from the intestine of the health population,and 29.5%,18.7% and 10.7% of isolates from the three sterile sites of the patients,would be selected as resistant mutants.When ciprofloxacin and moxifloxacin were taken by injection route,the ratio of the selection of resistant mutants would be 9.3% for E.coli isolates from the intestine of the health population and 8.2%,6.2% and 8.9% for the three sterile sites of the patients,respectively.The maximum attainable concentration of levofloxacin in serum showed little distinction between the oral and the other routes.CONCLUSIONS The values of MIC and MPC of three fluoroquinolones in E.coli isolates from different populations and sites show no association.The values of MPC couldn't be predicted by the MIC.The values of MPC and MPC90 of three drugs show no significant discrepancy for tested isolates,these E.coli strains are isolated from the intestine of heath persons,and from the blood,ascites,bile of patients.
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Objective To discuss the position nursing for neonates with type three congenital esophageal atresia after operation. Methods We selected 10 patients with type three congenital esophageal atresia from September 2004 to May 2007.The respirator, trachea catheter was removed after operation and the SpO2 was lower than 95% through head mask.Then the SpO2 was compared in different positions of patients,that is face forward,face lateral, face forward with hypsokinesis,face lateral with hypsokinesis. Results All the ten patients survived the operation.The Sp02 in the four positions under oxygen inhalation were (90.30±0.95)%, (89.90±0.74)%, (96.80±1.48)%, (95.90±0.88)%.The former two results were statistically different from the latter two results (P ＜ 0.01). Conclusions The position of face forward with hypsokinesis and face lateral with hypsokinesis facilitated the transition to natural respiration for patients with type three congenital esophageal atresia after remove of respirator and trachea catheter.This could prevent the incidence of complications and the probability of reuse of respirator.
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OBJECTIVE To investigate the susceptibility of Enterococcus faecalis and E.faecium isolated from system and urinary tract infected patients and provide data for anti-infection therapy.METHODS The susceptibility(MIC) of 249 Enterococcus strains was tested by agar dilution method.RESULTS All 249 strains of Enterococcus(117 strains of E.faecalis and 132 strains of E.faecium) were isolated from urinary tract or systemic infection patients.The isolated rate of E.faecalis(68.4%) was higher than that of E.faecium(50.0%) in urinary tract isolates.Meanwhile,the isolated rate of E.faecium(50.0%) was obviously higher than that of E.faecalis(31.6%) in systemic infection isolates.The drug susceptibility rate of E.faecalis was higher than that of E.faecium to gatifloxacin,ciprofloxacin,penicillin,ampicillin and high-level gentamicin but lower for minocycline.All Enterococcus were susceptible to vancomycin,teicoplanin and linezolid.They were almost 100.0% resistant to erythromycin.The susceptibility rate of E.faecalis(39.5%)was higher than E.f aecium(15.3%) to high-level gentamicin.The susceptibility rate of E.faecalis isolated from blood was higher than the strains isolated from urinary tract to all antibiotics.E.faecium isolated form blood was almost 100% resistant to gatifloxacin,ciprofloxacin,penicillin,ampicillin and erythromycin.CONCLUSIONS The drug susceptibility of E.faecalis and E.faecium which cause systemic and urinary tract infection is different.The available therapy project should be selected based on the resistance character.At present,vancomycin,teicoplanin and linezolid are the best choice for treatment against the infection caused by Enterococcus.
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<p><b>OBJECTIVE</b>To study the status of oral pharyngeal carriage and characteristics of Haemophilus influenzae (Hi) in healthy preschool children in Fuzhou.</p><p><b>METHODS</b>Six hundred and three healthy children in two representative kindergartens in Fuzhou were studied as research subjects, and the rates of oral pharyngeal carriage of Hi were studied in four seasons. All Hi strains were serotyped and biotyped.</p><p><b>RESULTS</b>The oral pharyngeal carriage of Hi in day care nursery healthy children were 36.7% in winter, 18.0% in autumn, 12.4% in summer and 10.9% in spring respectively. Serotype Hib was preponderant in autumn (6.9%). In winter, the carriage rates of NTHi and Hib were 17.1%, 5.4% respectively. The carriage rates of other serotypes were low. Biotype VII and VIII were preponderant in autumn, spring and summer but biotype VII and VIII were decreasing evidently in winter.</p><p><b>CONCLUSION</b>There was evident seasonal difference in the rates of oral pharyngeal carriage and type of Hi in healthy preschool children. The carriage rate of Hi strains was high in autumn and winter. Results suggested that while the inoculation of Hib-binding bacterial vaccine was expanded the study on new bacterial vaccine of Hi still needs to be augmented.</p>