ABSTRACT
Abstract Objective: Studies focusing on bone and joint infections (BJIs) in young infants are rare. Some cases of BJI are accompanied by sepsis. This study aimed to identify the clinical and bacteriological features of sepsis in neonates and young infants with BJIs. Methods: Neonates and infants younger than 3 months diagnosed with BJI in the present institution from 2014 to 2021 were retrospectively reviewed. Patient characteristics, clinical data, and outcomes were documented and compared between those with and without sepsis. Results: Twenty-five patients with a mean age of 34.8 days were included. Nine BJI cases had concomitant sepsis (group A), and 16 had BJI without sepsis (group B). Within group A, staphylococcus aureus was the major pathogenic germ (5 cases, of which 4 were of the methicillin-resistant staphylococcus aureus (MRSA) type). There was no statistical difference in male-to-female ratio, age, history of hospitalization, anemia, birth asphyxia, peripheral leukocyte counts, C-reactive protein on admission, and sequelae between groups. Univariate analyses indicated a significant difference in the incidence of septic arthritis (SA) combined with osteomyelitis (OM) (88.9% vs 37.5%), congenital deformities (44.4% vs 0%), and mean duration of symptoms (2.83 days vs 9.21 days) in comparisons between groups A and B. Conclusion: Staphylococcus aureus is the main pathogenic bacteria in BJI cases complicated with sepsis in neonates and young infants. Among infants younger than 3 months diagnosed with BJI, those with concurrent SA and OM, MRSA infection, or congenital deformities are more likely to develop sepsis.
ABSTRACT
Objective To study the clinical value of hysteroscopy with narrow-band imaging (NBI) in diagnosis of different endometrial lesions. Methods 148 patients suffered from abnormal uterine bleeding with hysteroscopy examination and observed under hysteroscopy with ordinary white light and the NBI model respectively. Suspicious lesions targeted biopsy and gave pathological examination. With pathological diagnosis as a golden standard, it evaluated the value of hysteroscopy with NBI in different type of endometrial lesions. Results Low-risk type of endometrial lesions gave priority to type II microvascular and high-risk type of endometrial lesions gave priority to type III ~ IV microvascular. Sensitivity of low-risk endometrial lesions under white light and NBI modes was 65.52% and 86.21% respectively (χ2 = 6.78, P = 0.009), the difference was statistically significant in the two modes. The diagnosis of endometrial lesions low-risk type with NBI mode had medium consistency compared with the pathological diagnosis (Kappa value was 0.617). Under white light and the NBI modes, the accuracy rate of diagnosis in high-risk endometrial lesions was 81.08% and 89.86% respectively (χ2 = 4.60, P = 0.032), sensitivity was 57.14%and 92.86% respectively (χ2 = 14.29, P = 0.000), negative predictive value was 84.21% and 96.91% (χ2 = 9.43, P = 0.002), the difference was statistically significant in the two modes. The specificity was 90.57% and 88.68%respectively (χ2 = 0.20, P = 0.652), positive predictive value was 70.59% and 76.47% (χ2 = 0.37, P = 0.544). There was no significantly difference between the two modes. The diagnosis of endometrial lesions in high-risk pattern with NBI mode had good consistency with pathological diagnosis (Kappa value was 0.766). Conclusion NBI can observe mucosal surface and deep microvascular morphology clearly. It could reduce the missed diagnosis of low-risk type of endometrial lesions and improve the accuracy in diagnosis of high-risk type of endometrial lesions with NBI mode. NBI is a novel and valuable technique in the diagnosis of different endometrial lesions.