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Objective:To explore the value and risk of electronic bronchoscope applied in perioperative management of children with congential tracheoesophageal fistula.Methods:Sixty-five children with congential tracheoesophageal fistula performed electronic bronchoscope examination from September 2014 to November 2020 were enrolled in this study.The results of examination and complications were analyzed.Results:Sixty-three children with congenital tracheoesophageal fistula were diagnosed by electronic bronchoscopy.The diagnosis rate was 96.92%.Fifty-four children with congenital tracheoesophageal fistula were diagnosed by esophagography.The diagnosis rate was 91.53%.Sixty-one children with congenital tracheoesophageal fistula were diagnosed by multislice spiral computed tomography.The diagnosis rate was 93.85%.Airway anatomic abnormity was found in 27 children, including three cases of nasopharyngeal soft tissue collapse, 14 cases of laryngomalacia, five cases of tracheal stenosis, nine cases of tracheobronchomalacia, and nine cases of tracheobronchial and abnormal opening of the bronchus.The incidence was 41.54%.Three children with difficult ventilator weaning were related to tracheobronchial stenosis or tracheobronchomalacia.They were gradually weaning from ventilator after a long period of mechanical ventilation and treatment.Two children with transient decrease in oxygen saturation were noticed as complication.Conclusion:Electronic bronchoscopy is a safe and effective method for the diagnosis of congenital tracheoesophageal fistula and recurrence after operation.It is of great value to the airway management after operation by early detection of respiratory anatomic abnormity.
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Objective:To explore the value of radiographic assessment of lung edema (RALE) score in evaluating the severity and prognosis of patients with acute respiratory distress syndrome (ARDS).Methods:A retrospective study was conducted. Patients with ARDS admitted to the department of intensive care unit (ICU) of Affiliated Nantong Third Hospital of Nantong University from January 2016 to November 2020 were enrolled. Clinical data of those patients were collected, and two senior radiologists who did not know the outcome of the patients independently scored each chest radiograph, the mean value of which was taken as the RALE score. The patients were divided into death group and survival group according to the 28-day prognosis. The differences of the basic data, PaO 2/FiO 2, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score and RALE score between groups were analyzed. ARDS patients were classified according to the Berlin standard and RALE scores were compared between groups. Then, the correlations between RALE score and PaO 2/FiO 2, SOFA score, APACHEⅡ score were analyzed. The prognostic capacity of RALE score for 28-day prognosis of ARDS patients were analyzed by Kaplan-Meier survival curve. Results:Of the 98 ARDS patients, 62 were included in the final analysis, 39 patients survived and 23 patients died. The 28-day mortality was 37.1%. Compared with the survival group, patients in the death group were older (years old: 72.83±12.21 vs. 64.44±14.68), had lower PaO 2/FiO 2 [mmHg (1 mmHg = 0.133 kPa): 122.66±48.32 vs. 150.26±50.40], and higher SOFA score and greater difference of RALE score between the third day and the first day after admission (D3-D1 RALE score) (SOFA score: 11.26±3.91 vs. 9.04±3.72, D3-D1 RALE score: 1.35±6.42 vs. -2.74±7.35), with statistically significant differences (all P < 0.05). However, there were no significant differences in gender, cause of ARDS, APACHEⅡ score, and RALE scores on the first and the third day of admission (D1 RALE, D3 RALE) between the two groups. Among the 62 patients, there were 11 mild cases (17.7%), 36 moderate cases (58.1%), and 15 severe cases (24.2%). The D1 RALE score of patients with mild and moderate ARDS were lower than those of patients with severe ARDS (19.09±3.65, 22.58±6.79 vs. 27.07±5.23, both P < 0.05). Correlation analysis showed that D1 RALE score was negatively correlated with PaO 2/FiO 2 ( r = -0.385, P = 0.002), and positively correlated with SOFA score and APACHEⅡ score ( r1 = 0.433, r2 = 0.442, both P < 0.001). Kaplan-Meier survival curve analysis showed that the 28-day survival rate of ARDS patients in D3-D1 RALE score ≥ -1 group was significantly higher than that in D3-D1 RALE score < -1 group (73.08% vs. 55.56%; log-rank test: χ 2 = 3.979, P = 0.046). Conclusions:The RALE score is a simple and reliable non-invasive evaluation index, which can be used to evaluate the severity of ARDS patients. The difference of RALE score in early stage is helpful to identify ARDS patients with poor prognosis.
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To develop a new recombinant hepatitis E vaccine, we used Hansenula polymorpha expression system to express recombinant hepatitis E virus-like particles (HEV VLPs), to construct a recombinant engineered strain HP/HEV2.3. The fermentation conditions and purification process were studied next. The first working seed lots were fermented in liquid culture, and the fermentation products were collected, then crushed, clarified, purified by ultrafiltration, silica gel adsorbed and desorbed, concentrated by ultrafiltration, purified by liquid chromatography and sterilized by filtration. The purity reached 99% with a yield of 33%. Electron microscopy analysis revealed that both the purified recombinant HEV VLPs from HP/HEV2.3 and natural hepatitis E virus particles appear identical of being 32 nm. The resulting DNA sequence obtained from VLPs is identical to the published HEV sequence. The SDS-PAGE analysis has revealed that the protein molecular weight of the HEV VLPs is 56 kDa, and the expression product HEV VLPs were accumulated up to 26% of total cellular protein. The expression level is 1.0 g/L. Western blotting, enzyme-linked immunosorbent assay (ELISA) results of the protein and ED₅₀ of the vaccine showed that the HEV VLPs have good antigenicity and immunogenicity. In summary, the recombinant HEV VLPs from Hansenula polymorpha can be used in the manufacture of a new genetically engineered vaccine against hepatitis E.
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Objective To evaluate the predictive value of modified early warning score (MEWS) and SMART-COP score on mechanical ventilation in patients with severe influenza A H1N1. Methods Fifty cases diagnosed with severe influenza A H1N1 were retrospectively analyzed. The MEWS and SMART-COP score were calculated. The area under the receiver operating characteristic (ROC) curve (AUC) was evaluated using ROC curve. MEWS, SMART-COP score and AUC were analyzed by Z test. Results The AUCs of MEWS and SMART-COP score for predicting mechanical ventilation were 0. 923 and 0. 889, respectively, which were not significantly different (Z=0. 548, P =0. 584).Conclusion Both of MEWS and SMART-COP score are predictive factors of mechanical ventilation in the patients with severe influenza A H1N1.
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Objective To investigate whether efflux mechanism is involved in azole resistant Candida albicans strains isolated in China. Methods We compared rhodamine 6G uptake and glucose induced efflux between azole sensitive and azole resistant strains to elucidate resistance to azole due to efflux pump, then measured mRNA level of efflux gene cdr1 and cdr2 by reverse transcriptase polymerase chain reaction (RT PCR). Results Rhodamine 6G moved from extra into the intracellular compartment in both azole resistant and azole sensitive strains quickly when in glucose free incubation condition. However, efflux of rhodanmine 6G was enhanced significantly in azole resistant strains and decreased in azole sensitive strains while adding glucose in the media. The mRNA level of efflux gene cdr1 and cdr2 was higher in clinical azole resistant strains and fluconazole induced resistant strains than strains reverted from resistance to sensitivity. However, all such strains had higher efflux gene expression than azole sensitive strains. Conclusions Efflux mechanism is associated with the resistance to azole in Candida albicans strains isolated in China. Fluconazole can induce efflux pumps expression leading to resistance to azole but the resistance to azoles can be reversed after withdrawing fluconazole.