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Bloodstream infection (BSI) is a systemic infectious disease. The incidence and mortality of BSI caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) remain high, which brought severe challenges into clinical anti-infection treatment and enormous economic burdens for the patients. This article reviews the current research progress on risk factors of BSI caused by CRKP, hoping to provide reference for the early diagnosis and treatment of this disease.
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Objective To investigate the effect of graded motor imagery ( GMI) therapy combined with rou-tine occupational therapy on the recovery of upper extremity function after stroke. Methods Thirty stroke survivors who met inclusion criteria were randomly assigned to a control group ( n=15) or a GMI group ( n=15) . The control group received routine medication, conventional physical therapy and routine occupational therapy ( one hour a day) , while the GMI group received 30 minutes of routine occupational therapy and 30 minutes of graded motor imagery therapy every day in addition to conventional medication and physical therapy. Before and after four weeks of treat-ment, the patients in both groups were evaluated using the Fugl-Meyer Assessment for the Upper Extremities ( FMA-UE) , the Box and Block Test ( BBT) and Brunnstrom arm and hand staging. Surface electromyography of the biceps brachii and triceps brachii was performed as the affected elbow flexed and stretched in maximum isometric contrac-tions, and the co-contraction ratios ( CRs) were calculated. Results After the treatment, the average FMA-UE score, Brunnstrom arm and hand stage, BBT and CR scores in both groups had improved significantly. The average improvement in the GMI group was significantly greater than in the control group. Conclusions Graded motor im-agery therapy can significantly promote motor recovery of the upper extremities of hemiplegic patients after a stroke.
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Objective To analyze the clinical profile of primary Sj(o)gren's syndrome (pSS) patientswith central nervous system (CNS) involvement.Methods Thirty-eight pSS-CNS patients at Nanjing Drum Tower Hospital between 2012 and 2016 were enrolled.These patients were divided into high activity group and moderate activity group,according to European League against Rheumatism Sj(o)gren's syndrome Disease Activity Index (ESSDAI).The imaging characteristics,clinical features,laboratory examinations and treatment of 38 cases were retrospectively analyzed.Quantitative differences were analyzed by the student's t-test and qualitative data were analyzed with chi-square or Fisher's exact test.Results The prevalence of central nervous system involvement in pSS patients was 2.93％(38/1 296),while 32％(12/38) as the initial symptom of pSS.Recurrence rate was 39％(15/38).Limb weakness,speech difficulty,sensory disorders,blurred visionwere the most frequent symptoms in pSS-CNS.Multiple lesions in Magnetic resonance imaging (MRI) examination and cerebrospinal fluid abnormality were seen in 94％ (15/16) pSS-CNS patients,among which intra-thecal IgG level increased in 50％ (8/16).In addition,the frequencies of lung involvement,immune associated thrombocytopenia,high-titer antinuclear antibody (ANA) were significantly higher in high activity group of pSS-CNS than those of moderate activity group.The value of above items was 4.7,5.0 and 5.3,respectively,and all the differences were significant (P＜0.05).After high-dose corticosteroids and immunosuppressive therapy,61％ (23/38) patient improved,37％(14/38) were unresponsive to treatment,and 3％(1/38) died because of acute massive cerebral infarction.For those unresponsive patients,mesenchymal stem cell transplantation or immune adsorption treatment might be effective.Conclusion The clinical manifestations of central nervous system are diverse,may be the initial presentations in some pSS patients,with low morbidity and high recurrence rate.Image and lumbar puncture are important for diagnosis.Pulmonary involvement,immune thrombocyto-penia,and high-titer ANA are frequently associated with the activity of pSS-CNS.Most patients have good response to the treatment regimens of high-dose corticosteroids and immunosuppressive therapy,mesenchymal stem cell transplantation or immuno-sorption therapy may be considered in those unresponsive cases.
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<p><b>BACKGROUND</b>Community acquired pneumonia (CAP) is one of the most common infectious disease in emergency department. In 2005 the concept of healthcare associated pneumonia (HCAP) was proposed by the ATS/IDSA guidelines. The clinical features and microbiology of HCAP are different from CAP, however, the initial antimicrobial treatment is still controversial. We aimed to compare the clinical efficacy between HCAP patients treated initially with HCAP guideline-concordant antimicrobial agents and those with CAP guideline-concordant antimicrobial agents.</p><p><b>METHODS</b>We conducted a retrospective observational study on HCAP patients who were admitted to emergency department between December 2011 and December 2012. Patients were divided into 2 groups according to their different initial antimicrobial treatment. We compared clinical features, distribution of pathogen, severity, days and spending on intravenous antimicrobial, length and charge of hospitalization and clinical outcomes, and meanwhile analyzed the clinical efficacy as well.</p><p><b>RESULTS</b>Of the 125 HCAP patients, 55 patients received CAP guideline-concordant antimicrobial agents and 70 received HCAP agents. The major pathogens were Klebsiella pneumoniae, methicillin-resistant staphylococcus aureus (MRSA), Pseudomonas aeruginosa and Escherichia coli. The 2 groups were similar at baseline, including old age, comorbidities, Pneumonia Severity Index scores, APACHE scores, and length of intravenous antimicrobial use and hospitalization duration, and in-hospital mortality. Overall efficacy rate occurred in 70.0% of HCAP agent patients and 50.9% of CAP agent patients (P = 0.029). Antimicrobial charge and total hospital charge for HCAP agent patients were significantly higher than that for CAP agent patients.</p><p><b>CONCLUSIONS</b>Initial treatment of HCAP patients in emergency department with HCAP guideline-concordant antimicrobial could increase clinical efficacy rate, as well as antimicrobial charge and total hospital charge, but was not associated with shortening the length of stay, or lowering in-hospital mortality.</p>
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Aged , Aged, 80 and over , Female , Humans , Male , Anti-Bacterial Agents , Pharmacology , Emergency Service, Hospital , Escherichia coli , Virulence , Klebsiella pneumoniae , Virulence , Methicillin-Resistant Staphylococcus aureus , Virulence , Pneumonia , Drug Therapy , Microbiology , Pseudomonas aeruginosa , Retrospective StudiesABSTRACT
ObjectiveTo investigate the efficiency of autologous transplantation of peripheral blood stem cells for treatment of patients with diabetic lower limb ischemia.MethodsEighteen patients of type 2 diabetes with diabetic lower limb ischemia (30 legs) were treated by autologous transplantation of peripheral blood stem cells.ResultsThe limb pain, cool feeling and numbness feeling improved significantly after PBSC transplantation,the improvement rate were 96.7％, 100.0％ and 95.8％ respectively.Intermittent claudication was also relieved significantly, total remission rate was 76.9％.The ABI and TcPO2 of patients increased significantly at 3 months after transplantation.After the transplantation ABI raised from 0.60 ± 0.11 to 0.71 ±0.12(t =-6.882, P ＜ 0.01) .93.3％ of patients' TcPO2 raised in different degrees.The foot infections were well controlled.Ulcer or toes gangrene got better or healed.No obvious complications or adverse reaction were observed after the transplantation.ConclusionAutologous transplantation of peripheral blood stem cells shows to be a simple, safe and effective method in treating patients with diabetic lower limb ischemia.
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Objective:To investigate the efffects of protease inhibitor on lipopolysaccharide-induced acute lung injury in rats and its possible mechanisms. Methods: Thirty-two male Wister rats, weighting 250-270 g, were divided into four groups randomly. C, normal controls (n=8); A: acute lung injury group (n=8), receiving intravenous endotoxin (lipopolysaccharide O55:B5, LPS 5 mg/kg); V, low-dose group (n=8), U, high-dose intervention group (n=8,receiving Ulinastatin 50 000 U/kg and (100 000) U/kg respectively and LPS 5 mg/kg). The specimens were collected 2 hours later, We observed the following changes: blood gas analysis, the lung wet/dry weight ratio, the pulmonary vascular permeability, histological manifestations, lung tissue myeloperoxidase activity, plasma endothelin-1, lung tissue malonaldehyde and conjugated-diene. Results: Compared with Group C, the lungs of the rats in Group A had significant hyperemia and spotted hemorrhage. The inflammatory granulocyte infiltrating, diffused alveolar septum thickening and spotted hemorrhage were observed in pathological examinations. The lung wet/dry weight ratio and Evans Blue content (per gram) increased significantly in group A[(5.41?(0.06),)(27.64?(2.48) ?g)] compared with group C[(4.95?0.08),(12.99?2.83) ?g], in the intervention groups((U:5.0?)0.05,19.47?2.09;V:4.98?0.06,21.44?3.12)however the difference was not significant between the intervention groups; The plasma endothelin-1 and lung tissue myeloperoxi- △Corresponding author’s e-mail, chenxuyan@medmail.com.cn dase activity increased significantly in group A[(948.23?103.45) u/g,(152.90?8.41) u/g] compared with group C[(729.38?88.64) u/g],[(54.62?15.49) u/g] but intervention groups[U:(633.27?93.27) u/g,(119.40?11.32) u/g;V:(671.87?105.45) u/g,(129.55?9.57) u/g] decreased significantly compared with group A, no significant difference between intervention groups; lung tissue Lipid- peroxide(malonaldehyde,MDA and conjugated-diene,C-diene)increased significantly in group A[MDA:(73.95?4.62) nmol/g;C-diene:(10.96?0.81)nmol/g] compared with group C[MDA:((39.65?)6.21) nmol/g;C-diene:(3.34?0.51) nmol/g],intervention groups [U:MDA:((51.26)?5.56) nmol/g,C-diene:(7.59?0.84) nmol/g;V:MDA:(59.87?4.62) nmol/g,C-diene:((8.79?)0.45) nmol/g] decreased significantly compared with group A. MDA decreased significantly in group U compared with group V. Conclusion: The protease inhibitor, Ulinastatin, may decrease inflammatory reaction and further decrease lung damage induced by LPS in rats, all indicating protection of protease inhibitor against acute lung injury.
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Objective To observe the changes of plasma ghrelin in patients with severe sepsis and to explore the correlation of the plasma ghrelin and cytokines with sepsis.Methods Choose the healthy volunteer(n=10)as control group,and measure the plasma ghrelin(by ELISA),TNF-?,IL-1?,PCT(procalcitonin)and CRP at the 1st day,3rd day and 10th day in sepsis group(n=26).Results The plasma ghrelin level in sepsis group increased significantly compared with control group(P