ABSTRACT
Objective To explore the clinical characteristics, risk factors of mortality and antimicrobial therapy of carbapenemresistant Klebsiella pneumoniae (CRKP) bloodstream infections. Methods A 5-year retrospective study was conducted for 60 patients with CRKP bloodstream infection, who were treated in Chinese People's Liberation Army (PLA) General Hospital during the period from June 2011 to August 2016. The patients were assigned to death (n=24) or survival (n=36) group according to 28-day survival after bloodstream infection to identify the predictors of mortality. The patients treated with combination antimicrobial therapy (n=32) were compared with those received monotherapy (n=14). Results A total of 60 nonduplicate CRKP blood isolates were identified. The 28-day mortality was 40.0％ (24/60). High APACHE Ⅱ score (OR=1.15, 95％ CI 1.0-1.3, P=0.048) was identified as an independent risk factor for 28-day mortality in patients with CRKP bloodstream infection. The 46 patients receiving antimicrobial therapy showed 28-day mortality of 34.8％. Univariate analysis indicated that the 28-day mortality rate was similar between the patients receiving combination antimicrobial therapy and those receiving monotherapy. Conclusions Bloodstream infection due to CRKP is associated with high mortality. APACHE II score is an independent predictor for mortality in patients with CRKP bloodstream infection.
ABSTRACT
<p><b>OBJECTIVE</b>We used functional magnetic resonance imaging (fMRI) to explore the effects of noxious coldness and non-noxious warmth on the magnitude of cerebral cortex activation during intraoral stimulation with water.</p><p><b>METHODS</b>Six male and female subjects were subjected to whole-brain fMRI during the phasic delivery of non-noxious hot (23 °C) and no- xious cold (4 °C) water intraoral stimulation. A block-design blood oxygenation level-dependent fMRI scan covering the entire brain was also carried out.</p><p><b>RESULTS</b>The activated cortical areas were as follows: left pre-/post-central gyrus, insula/operculum, anterior cingulate cortex (ACC), orbital frontal cortex (OFC), midbrain red nucleus, and thalamus. The activated cortical areas under cold condition were as follows: left occipital lobe, premotor cortex/Brodmann area (BA) 6, right motor language area BA44, lingual gyrus, parietal lobule (BA7, 40), and primary somatosensory cortex S I. Comparisons of the regional cerebral blood flow response magnitude were made among stereotactically concordant brain regions that showed significant responses under the two conditions of this study. Compared with non-noxious warmth, more regions were activated in noxious coldness, and the magnitude of activation in areas produced after non-noxious warm stimulation significantly increased. However, ACC only significantly increased the magnitude of activation under noxious coldness stimulation.</p><p><b>CONCLUSION</b>Results suggested that a similar network of regions was activated common to the perception of pain and no-pain produced by either non-noxious warmth or noxious coldness stimulation. Non-noxious warmth also activated more brain regions and significantly increased the response magnitude of cerebral-cortex activation compared with noxious coldness. Noxious coldness stimulation further significantly increased the magnitude of activation in ACC areas compared with noxious warmth.</p>