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Objective:To investigate the relationship between antibacterial treatment scheme and prognosis, and to analyze the mortality risk factors of bloodstream infection with carbapenem-resistant Klebsiella pneumoniae(CRKP).Methods:A retrospective case-control study was conducted. The CRKP isolated from clinical venous blood samples in the First Medical Center, Chinese PLA General Hospital between January 1, 2013 and December 31, 2018(not included from January 1, 2016 to December 31, 2017) was collected. According to relevant standards, a total of 50 patients with bloodstream infection with CRKP were included. The patients were divided into death (19 cases) or survival (31 cases) group according to their hospitalization outcomes, and clinical data and antibacterial treatment scheme after infection were collected. The clinical features of the two groups and the correlation between different antibacterial treatment regimens and prognosis were compared. Logistics regression model was used to analyze the risk factors for death in CRKP-infected patients.Results:The all-cause mortality rate of patients with CRKP bloodstream infection during hospitalization was 38%(19/50). The age ((66.89±18.13) vs. (55.06±14.39) years old, t=2.555, P=0.014), charlson's comorbidity index ((6.11±2.87) vs. (3.19±1.97), t=4.256, P<0.001) of the death group was higher than that of the survival group. The proportion of patients with chronic obstructive pulmonary disease (42.1%(8/19) vs. 3.2%(1/31), χ2=9.574, P=0.002), Charlson's comorbidity index ≥5 (68.4%(13/19) vs. 22.6%(7/31), χ2=10.314, P=0.001), septic shock (36.8%(7/19) vs. 6.5%(2/31), χ2=5.456, P=0.020), source of lung infection (36.8%(7/19) vs. 9.7%(3/31), χ2=3.868, P=0.049) was higher in death group than those in survival group. Kaplan-meier survival curve showed that the 30-day mortality of appropriate targeted treatment was lower than that of inappropriate targeted treatment ( χ2=8.138, P=0.004). Multivariate analysis showed that septic shock ( OR=56.363, 95% CI: 4.309-737.273, P=0.002) and charlson's comorbidity index ≥5 ( OR=18.605,95% CI: 1.813-190.896, P=0.014) were independent risk factors for mortality in patients with bloodstream CRKP infection. Conclusion:Appropriate targeted therapy can reduce 30-day mortality in patients with CRKP bloodstream infection. In order to reduce the risk of mortality, we should prevent the occurrence of septic shock and strengthen the diagnosis and treatment of patients with Chalson's comorbidity index ≥5.
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N-terminal pro-brain natriuretic peptide (NT-proBNP)is an endocrine hormone mainly derived from heart,partly from brain.During its process of secreting into blood,proBNP is decomposed into biological active BNP and biological inactive NT-proBNP.The plasma concentration of NT-proBNP is proportional to the ventricular volume and pressure,thus it is stable and has high value of quantitative analysis.NT-proBNP has strong effects on natriuresis,diuresis,dilation of blood vessels,and inhibition of renin angiotensin aldosterone system (RAAS)and sympathetic nervous system activity.The level of NT-proBNP in children's plasma is not affected by gestational age,sex,and birth weight,mode of delivery and nutrition of children.NT-proBNP is a specific indicator for diagnosing pediatric cardiovascular system disease,respiratory system disease,neonatal diseases,infectious diseases,kawasaki disease and other diseases,and should be used as a sensitive index to monitor the condition of diseases for its good predictive value.With the development of the research,NT-proBNP will play an increasingly important role in the diagnosis,risk stratification,monitoring treatment and prognostic evaluation of pediatric diseases.This article mainly reviews the biological characteristics,detective methods,normal range and diagnostic and predictive value of NT-proBNP in pediatric diseases.
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Objective To investigate the expression of lysyl oxidase like protein?2(LOXL?2)in the sera of patients with active systemic scleroder?ma(SSc)and mixed connective tissue disease(MCTD). Methods An enzyme?linked immunosorbent assay was adopted to measure LOXL?2 in the serum of 20 patients with active SSc,20 patients with active MCTD,and 20 healthy controls. The measurements among different groups was com?pared,and correlations between LOXL?2 levels and clinical manifestations of SSc and MCTD were examined. Results The levels of LOXL?2 ex?pression in MCTD and SSc groups were significantly higher than those in control group(P<0.05 for all groups). LOXL?2 expression is also related to the presence of skin lesions in SSc(r=0.982 P=0.001). Conclusion High serum level of LOXL?2 in these patients with active SSc and active MCTD suggests that LOXL?2 may be involved in the process of fibrosis and the resulting vasculitis in multiple organs.
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<p><b>OBJECTIVE</b>To systematically evaluate the values of 4 serum markers in the diagnosis of rheumatoid arthritis (RA).</p><p><b>METHODS</b>Serum samples were obtained from 278 RA patients and 510 control subjects and the levels of rheumatoid factor (RF), anticyclic citrullinated peptide antibody (CCP), antikeratin antibody (AKA), and glucose-6-phosphate isomerase (GPI) were detected using immune turbidimetry, ELISA, indirect immunofluorescence, and ELISA, respectively. The values of these 4 serum markers and their combinations in RA diagnosis were systemically assessed.</p><p><b>RESULTS</b>In RA diagnosis using one serum marker, two markers, and three or four markers, RF, RF+CCP, RF+CCP+GPI, respectively, had the highest sensitivity; CCP, CCP+AKA, and RF+CCP+AKA+GPI, respectively, had the highest specificity; CCP, CCP+GPI, and RF+CCP+AKA+GPI, respectively, had the highest positive predictive value; GPI, RF+CCP, and RF+CCP+GPI, respectively, had the highest negative predictive value; CCP, CCP+GPI, and RF+CCP+AKA+GPI, respectively, had the highest positive likely ratio; GPI, RF+CCP, and RF+CCP+GPI, respectively, had the lowest negative likely ratio.</p><p><b>CONCLUSION</b>CCP, RF+CCP, and RF+CCP+GPI are the most ideal for RA diagnosis using one, two, and three or more markers, respectively. CCP is the essential marker for RA diagnosis, and a combined detection of the serum makers can significantly improve the diagnostic accuracy.</p>
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Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Arthritis, Rheumatoid , Blood , Diagnosis , Autoantibodies , Blood , Biomarkers , Blood , Case-Control Studies , Citrulline , Allergy and Immunology , Glucose-6-Phosphate Isomerase , Blood , Keratins , Allergy and Immunology , Rheumatoid Factor , BloodABSTRACT
Objective To improve the differential diagnosis between autoimmune pancreatitis (AIP) and pancreatic cancer (PC) by a contrast analysis of imageological features.Methods Thirty-six patients who had postoperative pathological with Asian AIP standards and 95 patients who had postoperative pathological consistent with PC.The imageological results of these AIP and PC patients were analyzed.Results AIP was significantly less than PC in the enhanced CT of a mass or enlargement of the pancreatic head,enlargement of the lymph nodes around the pancreas,dilation and interrupt in pancreatic and bile duct,peripheral vascular and organ involvement (11/27 vs.28/40,2/27 vs.17/40,13/27 vs.32/40,1/27 vs.10/40,8/27 vs.26/40,2/27 vs.15/40,0/27 vs.15/40,0/27 vs.10/40,P ＜ 0.05).AIP was significantly more than PC in the enhanced CT of a diffusely enlarged pancreas,calcification or pancreatic calculus,capsule-like rim or the vague peripancreatic fat interval (4/27 vs.0/40,7/27 vs.0/40,10/27 vs.6/40,P ＜ 0.05).AIP was significantly less than PC in the three-dimensional ultrasonography of dilation diameter of pancreatic duct and dilation of common bile duct [(0.421 ± 0.270) cm vs.(0.594 ± 0.270) cm,1/18 vs.16/26,P＜ 0.05].AIP was significantly less than PC in the magnetic resonance cholangiopancreatography of dilation of common bile duct and interrupt in pancreatic duct (7/13 vs.16/18,1/13 vs.10/18,P ＜ 0.05).Conclusion AIP as a unique type of chronic pancreatitis can be distinguished from PC on distinctive imageological features
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The objective of the study was to estimate the prevalence of hypertension and associated factors among older rural adults in Liaoning Province, China. The study was conducted in 2004-2006, using a multistage, stratified clustering sampling scheme to select a representative sample. A total of 10,065 adults aged 60 years or older were examined. A survey of blood pressure and associated factors was carried out. All data analyses were conducted using SPSS 11.5 statistical software package. Overall, the prevalence rates of hypertension are 57, 64.4 and 64.9% for the age groups 60-69, 70-79 and >/= 80 years, respectively. The prevalence of hypertension was positively correlated with age, female gender, Mongolian ethnicity, overweight and obesity, smoking and drinking, whereas income level was a protective factor for hypertension. The rates of awareness, treatment and control among older rural adults were very low [overall 35.2, 28.7 and 1.0%, respectively] Hypertension was highly prevalent among older rural adults in Liaoning Province, and it was associated with many factors. The percentages of hypertensives who were aware, treated, and controlled were very low. These data underscore the urgent need to strengthen the public health education and blood pressure monitoring system to better manager hypertension among older adults in rural China
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Humans , Female , Male , Middle Aged , Aged , Rural Population , Prevalence , Smoking , Obesity , Sex Distribution , Cross-Sectional Studies , Alcohol Drinking , Age DistributionABSTRACT
Objective To review the diagnosis and treatment of children with systemic lupus erythematosus. Methods 13 children of systemic lupus erythematosus with acute immune thrombocytopenic purpura as the first symptom were analyzed retrospectively, who were admitted from Jan 2004 to Jun 2009 in our hospital. Results Thirteen cases were diagnosed as acute immune thrombocytopenie purpura according to clinical manifestations and bone marrow examination results. Hormones and intravenous gamma globulin treatment were ineffective. The immune parameters and other clinical manifestations were monitored. According to the characteristics of blood system change and the response to hormone, other immunosuppressive agents such as cyclosporine A ,mycophenolate mofetil and cyclophosphamide were adminitrated. Thirteen children were diagnosed finally as systemic lupus erythematosus at 2 to 24 months from onset. Other immunosuppressive treatment was effective. Conclusion For children with thrombocytopenia, especially adolescent girls, we should pay attention to dynamic monitoring of anti-nuclear antibodies and other immunological parameters,for fear of the possibility of systemic lupus erythematosus.
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AIM: To evaluate the safety and tolerance of ibandronate in Chinese healthy volunteers. METHODS: The trial protocol was designed according to the Good Clinical Practice(GCP). After physical examination and laboratory tests were performed, 36 healthy volunteers were divided randomly into 6 dose groups, including 1 mg , 2 mg , 3 mg , 4 mg , 5 mg and 6 mg , with 6 subjects in each group(3 male and 3 female). Clinical symptoms, vital signs, routine blood tests, routine urine tests, hepatic function, renal function, blood electrolytes, electrocardiogram, and electroencephalogram were observed or examined before and after a single intravenous infusion of ibandronate. RESULTS: After single intravenous infusion doses of 1- 6 mg , the vital signs, clinical symptoms and laboratory tests were all in the normal range, but there were some slight ADRs concerned with the drug, such as hypophosphataemia, increased body temperature, perspiring,pain of bone or muscle and hypocalcaemia. But the ADRs were found vanishing in one or two weeks. CONCLUSION: Single intravenous infusion (up to 6 mg ) of domestic ibandronate in 36 chinese healthy volunteers is safe and tolerable.