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The clinical data of patients with chlamydia psitsiti pneumonia confirmed by metagenomic next-generation sequencing (mNGS) who were admitted to the Huizhou Municipal Central Hospital from January 2020 to November 2021 were retrospectively analyzed. Among 21 patients, the serum creatine kinase (CK) was elevated in 10 cases, and 5 cases was complicated with rhabdomyolysis (RM). The symptoms of patients with Chlamydia psittaci pneumonia-induced RM were severe, including high fever, dyspnoea, headache and myalgia; 2 case were complicated by acute kidney injury (AKI) and neurological symptoms. Laboratory testing showed a marked increase in CK, myoglobin (Mb), high sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and D-dimer levels in all 5 patients. The chest CT revealed large areas of pulmonary consolidation, ground-glass opacity in 1 case and a small amount of pleural effusion in 2 cases. One patient died from multiple organ failure, and the other 4 patients were discharged with considerable improvement. Patients with psittacosis pneumonia are prone to developing rhabdomyolysis, early detection and early treatment can effectively improve the prognosis of patients.
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Objective:To analyze the clinical features of patients with severe dengue (SD) in Guangdong Province, and to improve the understanding of the diagnosis and treatment of SD in China.Methods:The clinical data, laboratory examination and etiological test results of 257 SD cases from 29 dengue fever designated hospitals in Guangdong Province from January 1, 2013 to December 31, 2019 were respectively collected. The relevant indicators of the criteria for severe organ involvement were quantified. Logistic regression analysis was performed to analyze the risk factors for the development of multiple organ failure in SD patients.Results:Among the 257 SD patients, age was (64.1±20.1) years old, with 65.4%(168/257) of them ≥60 years old, 142 were male and 115 were female. One hundred and fifty-two (59.1%) patients had underlying conditions, including 115(44.7%) patients with hypertension. The clinical manifestations were mainly fever (98.4%(253/257)), fatigue (70.0%(180/257)), cough or expectoration (44.4%(114/257)), lethargy or irritability (39.3%(101/257)), vomiting (30.4%(78/257)), abdominal pain or tenderness (20.6%(53/257)), hepatomegaly (2.3%(6/257)), bleeding tendency (59.5%(153/257)), and pleural effusion or ascites (43.6%(112/257)). Platelet count levels were decreased in 90.9%(231/254) of the cases, and 97.1%(234/241) of patients had normal or decreased hematocrit. The most common of severe manifestations were severe organ involvement (61.1%(157/257)), followed by severe bleeding (37.0%(95/257)) and severe plasma leakage (30.0%(77/257)). Severe organ involvements were more common in the kidney (27.6%(71/257)) and heart (26.8%(69/257)). Multivariate logistic regression analysis showed that age (odds ratio ( OR)=1.051, 95% confidence interval ( CI) 1.004 to 1.100, P=0.035), hypertension ( OR=5.224, 95% CI 1.272 to 21.462, P=0.022), elevated aspartate aminotransferase (AST) level ( OR=1.002, 95% CI 1.001 to 1.003, P=0.001), blood urea nitrogen (BUN) ( OR=1.050, 95% CI 1.005 to 1.098, P=0.030), and international normalized ratio (INR) ( OR=4.604, 95% CI 1.601 to 13.238, P=0.005) were risk factors for the development of multiple organ failure in SD patients. The detection results of serum samples form 113 SD patients in acute phase showed that dengue virus (DENV)-1 accounted for 89.4%(101/113), DENV-2 accounted for 9.7%(11/113), and DENV-3 accounted for 0.9% (1/113). Conclusions:Elderly and those with co-existing conditions such as hypertension in SD patients in Guangdong Province are more common. Severe organ involvement such as kidney and heart is the main cause of SD. DENV-1 infection is predominant. Significant elevated levels of AST, BUN and INR may be related to a poor prognosis.
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Objective To compare the short-term surgical outcomes of robotic-assisted gastrectomy versus laparoscopic-assisted procedures for gastric cancer patients.Method From 2014 to 2018,108 robotic procedures and 263 laparoscopic surgery were done at the Department of Gastrointestinal Surgery Affiliated Hospital of Qingdao University.Results Compared with the laparoscopic group,the robotic group had longer operation time [(269 ± 32) min vs.(205 ± 30) min,t =18.314,P ＜0.05],less intraoperative blood loss [(94 ± 52) ml vs.(130 ± 32) ml,t =-8.212,P ＜ 0.05],lower conversion rate (2.9％ vs.8.7％,x2=4.184,P＜ 0.05),more lymph node dissection [(45±11) vs.(41±10),t=3.502,P＜ 0.05],earlier exhaust time [(59 ±8) hvs.(61 ±9) h,t=-2.396,P＜ 0.05],higher total hospitalization cost [(75 763 ±2 981) yuan vs.(52 746 ± 3 904) yuan,t =55.024,P ＜ 0.05].There were no significant differences in hospital stay [(6.6 ±0.9) d vs.(6.5 ± 1.1) d,t =0.618,P ＞0.05],the proximal margin [(5.7 ± 1.1) cm vs.(5.4 ± 1.2) cm,t =1.583,P ＞ 0.05] and distal tumor margin [(4.7 ± 2.1) cm vs.(4.9 ± 2.0) cm,t =0.848,P ＞ 0.05].There were no significant differences in the incidence of complications (13.9％ vs.15.2％,x2 =0.106,P ＞0.05)and grade by Clavien-Dindo operation complications (Z =-0.271,P ＞ 0.05) between the two groups.Conclusion Da Vinci robotic radical gastrectomy is safe,better than laparoscopic procedure in intraoperative manipulation.
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Objective@#To investigate the effects of stage Ⅰ opening and stage Ⅱ opening of prophylactic ileostomy on postoperative recovery in low rectal cancer.@*Methods@#The prospective study was conducted. The clinical data of 88 patients with low rectal cancer who underwent laparoscopic rectal resection and prophylactic terminal ileostomy in the Affiliated Hospital of Qingdao University from September 2016 to May 2017 were collected. According to random number table, patients undergoing laparoscopic rectal resection combined with prophylactic ileostomy with stage I opening were allocated into experimental group, and patients undergoing laparoscopic rectal resection combined with prophylactic ileostomy with stage Ⅱ opening were allocated into control group. Observation indicators: (1) comparison of postoperative clinical endpoints indices; (2) comparison of postoperative complications; (3) comparison of stress response indices. Follow-up was performed using outpatient examination and telephone interview to detect recovery of patients. The patients were followed up for the first time within 24 hours after discharge and kept in contact with the doctor at any time within 1 week after discharge. The patients were followed up at 2 weeks after discharge in outpatient department and then were followed up by telephone interview once a week within 1 month after operation. Patients returned to hospital if there was any discomfort after discharge, and were re-admitted if necessary. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the independent sample t test. Repeated measurement data were analyzed using repeated ANOVA. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact propability.@*Results@#Eighty-eight patients were screened for eligibility, including 61 males and 27 females, aged from 44 to 74 years, with an average age of 61 years. There were 45 patients in the experimental group and 40 in the control group, respectively. (1) Comparison of postoperative clinical endpoints indices: the operation time, time to first semiliquid diet, postoperative fever time, quality of life score, duration of hospital stay, and total hospitalization expenses were (122±9)minutes, (5.1±1.6)days, (54±8)hours, 18.6±1.5, (6.7±1.2)days, (53 269±2 888)yuan in the experimental group, and (128±10)minutes, (6.4±2.4)days, (65±7)hours, 17.1±1.3, (8.1±1.4)days, (59 419±1 921)yuan in the control group, respectively. There was no significant difference in operation time or time to first semiliquid diet between the two groups (t=1.716, 1.329, P>0.05). There were significant differences in the postoperative fever time, quality of life score, duration of hospital stay, and total hospitalization expenses between the two groups (t=8.688, 5.850, 3.897, 11.707, P<0.05). (2) Comparison of postoperative complications: the incidence of ileostomy-related complications was 22.2%(10/45) in the experimental group, including 5 cases of ileostomy edema, 2 of fluid and electrolyte imbalance, 2 of fecal dermatitis, 1 of ileostomy infection; the incidence of ileostomy-related complications was 34.9%(15/43) in the control group, including 4 cases of ileostomy edema, 3 of fluid and electrolyte imbalance, 4 of fecal dermatitis, 2 of ileostomy infection, 1 of ileostomy membrane separation, and 1 of ileostomy stenosis; there was no significant difference in the incidence of ileostomy-related complications between the two groups (χ2=1.733, P>0.05). The incidence of system complications was 17.8%(8/45) in the experimental group, including 2 case of acute urinary retention, 2 of incisional infection, 1 of abdominal infection, 1 of pulmonary infection, 1 of urinary infection, 1 of deep venous thrombosis of the lower extremities; the incidence of system complications was 20.9%(9/43) in the control group, including 1 case of acute urinary retention, 1 of incisional infection, 1 of intestinal obstruction, 1 of pulmonary infection, 1 of urinary infection, 1 of deep venous thrombosis of the lower extremities, 1 of anastomotic fistula; there was no significant difference in the incidence of system complications between the two groups (χ2=0.140, P>0.05). There was no death in the two groups. Patients with postoperative anastomotic leakage in the experimental group were recovered and discharged after re-surgical exploration and continuous abdominal irrigation, and the remaining patients were discharged after active conservative treatment. (3) Comparison of stress response indices: from preoperation to postoperative 5 days, the C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) were changed from (2.2±0.7)ng/L to (43.9±12.0)ng/L, from (12.2±1.9)fmmol/L to (11.3±1.4)fmmol/L, from (95±17)ng/L to (107±14)ng/L in the experimental group, and from (2.2±0.8)ng/L to (58.8±10.7)ng/L, from (11.6±1.6)fmmol/L to (12.7±1.3)fmmol/L, from (94±16)ng/L to (117±13)ng/L in the control group, respectively, showing significant differences in the changing trends of CRP, TNF-α, IL-6 between the two groups (F=260.042, 55.428, 120.337, P<0.05). However, the changing trend within groups had interactive effects with time, showing no significant difference (F=3.514, 2.366, 1.864, P>0.05).@*Conclusion@#Compared with stage Ⅱ opening, stage Ⅰ opening of prophylactic ileostomy in laparoscopic rectal resection for low rectal cancer is safe and effective, which can reduce postoperative stress response and promote patients′ rehabilitation.
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Objective To investigate the effects of stage Ⅰ opening and stage Ⅱ opening of prophylactic ileostomy on postoperative recovery in low rectal cancer.Methods The prospective study was conducted.The clinical data of 88 patients with low rectal cancer who underwent laparoscopic rectal resection and prophylactic terminal ileostomy in the Affiliated Hospital of Qingdao University from September 2016 to May 2017 were collected.According to random number table,patients undergoing laparoscopic rectal resection combined with prophylactic ileostomy with stage Ⅱ opening were allocated into experimental group,and patients undergoing laparoscopic rectal resection combined with prophylactic ileostomy with stage Ⅱ opening were allocated into control group.Observation indicators:(1) comparison of postoperative clinical endpoints indices;(2) comparison of postoperative complications;(3) comparison of stress response indices.Follow-up was performed using outpatient examination and telephone interview to detect recovery of patients.The patients were followed up for the first time within 24 hours after discharge and kept in contact with the doctor at any time within 1 week after discharge.The patients were followed up at 2 weeks after discharge in outpatient department and then were followed up by telephone interview once a week within 1 month after operation.Patients returned to hospital if there was any discomfort after discharge,and were re-admitted if necessary.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed using the independent sample t test.Repeated measurement data were analyzed using repeated ANOVA.Count data were described as absolute numbers or percentages,and comparison between groups was analyzed using the chi-square test or Fisher exact propability.Results Eighty-eight patients were screened for eligibility,including 61 males and 27 females,aged from 44 to 74 years,with an average age of 61 years.There were 45 patients in the experimental group and 40 in the control group,respectively.(1) Comparison of postoperative clinical endpoints indices:the operation time,time to first semiliquid diet,postoperative fever time,quality of life score,duration of hospital stay,and total hospitalization expenses were (122± 9) minutes,(5.1 ± 1.6) days,(54 ± 8) hours,18.6 ± 1.5,(6.7 ± 1.2) days,(53 269 ± 2 888)yuan in the experimental group,and (128 ± 10) minutes,(6.4 ± 2.4) days,(65 ± 7) hours,17.1 ± 1.3,(8.1± 1.4)days,(59 419± 1 921)yuan in the control group,respectively.There was no significant difference in operation time or time to first semiliquid diet between the two groups (t=1.716,1.329,P＞0.05).There were significant differences in the postoperative fever time,quality of life score,duration of hospital stay,and total hospitalization expenses between the two groups (t =8.688,5.850,3.897,11.707,P＜0.05).(2) Comparison of postoperative complications:the incidence of ileostomy-related complications was 22.2％ (10/45) in the experimental group,including 5 cases of ileostomy edema,2 of fluid and electrolyte imbalance,2 of fecal dermatitis,1 of ileostomy infection;the incidence of ileostomy-related complications was 34.9％ (15/43) in the control group,including 4 cases of ileostomy edema,3 of fluid and electrolyte imbalance,4 of fecal dermatitis,2 of ileostomy infection,1 of ileostomy membrane separation,and 1 of ileostomy stenosis;there was no significant difference in the incidence of ileostomy-related complications between the two groups (x2 =1.733,P＞0.05).The incidence of system complications was 17.8％ (8/45) in the experimental group,including 2 case of acute urinary retention,2 of incisional infection,1 of abdominal infection,1 of pulmonary infection,1 of urinary infection,1 of deep venous thrombosis of the lower extremities;the incidence of system complications was 20.9％ (9/43) in the control group,including 1 case of acute urinary retention,1 of incisional infection,1 of intestinal obstruction,1 of pulmonary infection,1 of urinary infection,1 of deep venous thrombosis of the lower extremities,1 of anastomotic fistula;there was no significant difference in the incidence of system complications between the two groups (x2 =0.140,P＞0.05).There was no death in the two groups.Patients with postoperative anastomotic leakage in the experimental group were recovered and discharged after re-surgical exploration and continuous abdominal irrigation,and the remaining patients were discharged after active conservative treatment.(3) Comparison of stress response indices:from preoperation to postoperative 5 days,the C-reactive protein (CRP),tumor necrosis factorα (TNF-α),interleukin-6 (IL-6) were changed from (2.2±0.7)ng/L to (43.9±12.0) ng/L,from (12.2±1.9) fmmol/L to (11.3 ± 1.4) fmmoL/L,from (95 ± 17) ng/L to (107 ± 14) ng/L in the experimental group,and from (2.2±0.8) ng/L to (58.8±10.7) ng/L,from (11.6±1.6) fmmol/L to (12.7±1.3) fmmol/L,from (94± 16) ng/L to (117± 13)ng/L in the control group,respectively,showing significant differences in the changing trends of CRP,TNF-α,IL-6 between the two groups (F=260.042,55.428,120.337,P＜0.05).However,the changing trend within groups had interactive effects with time,showing no significant difference (F =3.514,2.366,1.864,P＞0.05).Conclusion Compared with stage Ⅱ opening,stage Ⅰ opening of prophylactic ileostomy in laparoscopic rectal resection for low rectal cancer is safe and effective,which can reduce postoperative stress response and promote patients' rehabilitation.
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Objective To examine the value of bronchoscopy in the diagnosis of sputum-negative pulmonary tuberculosis in a general hospital.Methods A retrospective study was conducted for the 459 patients treated in a general hospital from June 2010 to May 2015.All the patients had symptoms and radiographic changes suggestive of pulmonary tuberculosis but smearnegative.All patients were subjected to bronchoscopy,including brushing,bronchoalveolar lavage (BAL) and transbronchial biopsy (TBB).The bronchoscopic specimens were submitted for direct smear and acid-fast stain,Mycobacterium tuberculosis culture or histopathological assay,respectively.Results The diagnosis was confirmed by bronchoscopy in 378 (82.4％) of the 459 patients.Of the 378 patients whose diagnosis was confirmed,pulmonary tuberculosis was identified in 238 patients (63.0％).Other diagnoses included bronchogenic carcinoma,non-specific inflammation,organizing pneumonia,pulmonary fungal infection,interstitial pneumonia,sarcoidosis,nontuberculous mycobacterial infection.Of the patients with confirmed diagnosis by bronchoscopy,the sensitivity for diagnosis was 57.95％ by direct smear and acid-fast stain of brushing or BALF,79.78％ by culture of BALF,and 56.93％ by histopathological assay of TBB specimens.The integrated method by combining smear and stain,culture and histopathological assay of TBB specimens could improve the sensitivity,specificity,positive predictive value,and negative predictive value to 91.01％,97.46％,97.98％ and 88.89％.Conclusions For the patients whose clinical manifestations and imaging changes are suggestive of pulmonary tuberculosis but smear-negative,bronchoscopy is a valuable method for the diagnosis,which should be adopted as a routine test in clinical practice.
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Objective To explore the serum expression of DKK1 protein, a Wnt signaling pathway inhibitor in patients with non-small cell lung cancer (NSCLC) and its relationship with osseous metastasis. Methods Serum DKK1 protein levels were assayed by enzyme-linked immunosorbent assay (ELISA) in NSCLC patients, including 33 NSCLC patients with osseous metastasis and 41 NSCLC patients without respectively, and 32 healthy volunteers were served as the control group. Furthermore, the differential expression of the serum DKK1 protein level between the patients and the volunteers was compared by using the variance analysis and the independent sample t test. The correlation between DKK1 expression and bone metastasis was detected by Pearson correlation analysis. Results Serum DKK1 protein level of NSCLC patients was (79.6±8.3) ng/ml, which was significantly higher than that in healthy volunteers [(21.5±6.4) ng/ml, t=13.17, P=0.001]. The serum DKK1 level in osseous metastasis group was (110.3±11.4) ng/ml, which was significantly higher than that in non-skeletal metastasis group [(60.7±10.5) ng/ml, t=14.128, P=0.003]. The positive association was observed between the DKK1 level in the peripheral blood and osseous metastasis in NSCLC patients (r=0.855, P<0.001). Conclusion The serum expression level of DKK1 protein in NSCLC patients is closely related to the osseous metastasis, which may be a predicting biomarker for the osseous metastasis.
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Objective To assess the clinical significance of SAA, IP-10 and PCT in the diagnosis of AECOPD. Methods Sixty AECOPD patients, 52 with sCOPD, and 28 healthy subjects were assigned to three groups. Clinical data and serum specimen were obtained from another 19 AECOPD patients at stable stage as AECOPD-sCOPD group. Serum levels of SAA, IP10 and PCT were quantitatively measured by ELISA. Levels of multiple serum markers were statistically compared among different groups. Results The concentration of SAA significantly differed between the AECOPD and sCOPD groups (P 0.05). Conclusions As compared with the sCOPD group, levels of serum SAA and IP-10 in the AECOPD group were significantly elevated, which is helpful in the diagnosis of AECOPD with a sensitivity and specificity of 100% and 54.9%for SAA, and 96.1%and 75.0%for IP-10. However, PCT level failed to identify AECOPD from sCOPD.
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Objective To investigate the clinical characteristics of diffuse alveolar hemorrhage. Methods 12 patients with diffuse alveolar hemorrhage hospitalized in Guangzhou NO.1 Hospital were included in the research, whose clinical characteristics were analyzed. Results 7 cases of the 12 diffuse alveolar hemorrhage cases were male and 5 cases were female. 8 cases were caused by ANCA associated vasculitis , 1 cases by connective tissue disease, 1 cases by poisoning, and 2 cases of unknown etiology (medication could be considered). The clinical manifestations were fever (91.67%), hemoptysis (100%), anemia (100%), and dyspnea (3.33%). Conclusion Diffuse alveolar hemorrhage is a life-threatening clinical syndrome. It can be caused by many causes. It should be considered if there is the presence of hemoptysis, dyspnea, anemia, etc. Timely examination and early intervention can effectively improve the prognosis of the disease.
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Objective To evaluate the level changes of serum WASP-family verprolin homologous protein-1 (WAVE1) and vascular endothelial growth factor-C (VEGF-C) and their clinical significance in patients with advanced non-small lung cancer (NSCLC) before and after chemotherapy.Methods Serum WAVE1 and VEGF-C were measured in 43 patients with advanced NSCLC by ELISA,and the results were compared with 43 healthy volunteers.Results The levels of serum WAVE1 and VEGF-C before chemotherapy in patients group were (0.573±0.082) ng/ml and (947.3±125.4) pg/ml respectively,while in healthy volunteers group,they were (0.256±0.064) ng/ml and (425.5±110.1) pg/ml respectively,which suggested that before chemotherapy the levels of serum WAVE1 and VEGF-C in NSCLC group were significantly higher than those of in the control (P ＜ 0.05).The serum levels of WAVE1 and VEGF-C in advanced NSCLC patients were closely related to lymph node metastasis status and distant metastasis status (P ＜ 0.05),but not to the gender,age,tumor length,histology type,differentiation grade and C-TNM stage (P ＞ 0.05).The serum WAVE1 and VEGF-C levels of the effective treatment group was (0.290±0.037) ng/ml and (596.1±127.5) pg/ml after chemotherapy respectively,which decreased obviously compared with the group before chemotherapy which levels were (0.517±0.051) ng/ml and (964.6±100.3) pg/ml (both P ＜ 0.05).But the serum WAVE1 and VEGF-C levels of the ineffective treatment group were (0.547±0.065) ng/ml and (957.0±111.2) pg/ml after treatment,which had no difference compared with the group before chemotherapy which levels were (0.517±0.051) ng/ml and (964.6±100.3) pg/ml (both P ＞ 0.05).Furthermore,statistically significant relationship was found between the serum WAVE1 and the VEGF-C levels (r =0.331,r =0.540,both P ＜ 0.05).Conclusion Serum WAVE1 and VEGF-C may be used as indicators for prediction of the efficacy of chemotherapy in patients with advanced NSCLC.
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Objective To observe the effect of rhTRAIL on survivin gene expression of human lung adeno-carcinoma A549 xenografted tumor in nude mice,and investigate the possible inhibitory mechanism of rhTRAIL on the implanted-tumor growth.Methods The solid tumor model was formed in nude mice with human lung adeno-carcinoma cell line.A549.24 mice were randomly divided into the four groups,rhTRAIL single treated group (1 μg/mL),rhTRAIL combined with cisplatin (DDP) treated group,cisplatin treated (1.5mg/kg) and 0.9％ sodium chloride injection(NS) control group.The rhTRAIL and DDP were injected once every other day by intraperitoneal injection to mice in the treated groups,lasting eight times,the same volume of saline solution was injected to the control group.After these,mice were killed and dissected completely.The expression level of survivin mRNA and protein in the tumor tissues was detected by real-time polymerase chain reaction (RT-PCR) and immunohistochemistry,respectively.And the expression of survivin gene in serum of each group was tested by ELISA.Results The expression levels of survivin mRNA in implanted-tumor tissues in rhTRAIL,rhTRAIL combined with DDP,DDP and NS group were (48.7 ± 2.5) ％,(53.1 ± 4.6) ％,(99.1 ± 5.3) ％ and (95.6 ± 3.7) ％,respectively.While the protein expressions of survivin gene in those groups were (0.319 ± 0.025),(0.483 ± 0.058),(0.635 ± 0.041) and (0.619 ± 0.017),respectively.Moreover,the serum levels of survivin were (71.9 ± 7.05),(80.26 ± 10.80),(112.75 ± 15.41) and (105.03 ± 20.37),respectively.The data showed that the expression levels of rhTRAIL and rhTRAIL combined with DDP group were lower than that of DDP-treated group or the NS control group (P ＜ 0.0 5).Compared with the rhTRAIL combined with DDP group,the survivin gene expression level of rhTRAIL-single treated group decreased a little lower,but the difference was not significant (P ＞ 0.05).Conversely,the survivin gene level was increased to some degree compared with the NS control group,and uniformly there was no significant difference (P ＞ 0.05).Conclusion rhTRAIL can downregulate the expression level of survivin gene of human lung adeno-carcinoma A549 xenografted tumor in nude mice.It may be one of the possible inhibitory mechanisms of rhTRAIL on the implanted-tumor growth that rhTRAIL can downregulate survivin gene expression and promote tumor cell apoptosis.
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Objective To study the therapeutic effect and safety of pleurodesis with medical thoracoscopy by powdery talc on treatment of malignant pleural effusion.Methods Retrospective analysis were done in 74 cases of malignant pleural effusion accepted simple powdery talc pleurodesis under medical thoracoscopy.Results The doses of powdery talc were from 1g to 5g,average 2.18g in the course of the treatment.After operation,45 (60.8％) cases which were complete remission(CR) were full pleural adhesion and complete lung recruitment,14cases (18.9％),which were partial remission(PR),were less pleural adhesion and most lung recruitment,and 10cases(13.6％) were stable diseases(SD),while 5cases(6.7％),which were progressive diseases(PD),were without pleural reaction.The total effective rate,including CR,PR and SD,was 93.3 ％ (69/74).The complications of simple powdery talcage under medical thoracoscopy were included in:95.9％ (71/74) with chest pain,64.8％ (48/74) with fever,28.4％ (21/74) with shortness of breath,12.2 ％ (9/74) with mediastinal and subcutaneous emphysema,5.4％ (4/74) with nausea and vomiting,4.1％ (3/74) with abdominal distension,while the complications of acute pulmonary edema,massive hemorrhage,pulmonary embolism and wound infection were not observed.Conclusion Treatment of malignant pleural effusion by simple powdery talcage under medical thoracoscopy has definite clinic therapeutic effect,which is safe,cost-effective,less trauma and worthy of clinical application.
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Objective To investigate the distribution of blaOXA-51-like genes and the clonal relation-ship among Acinetobacter baumannii strains isolated from three teaching hospitals in Guangzhou , China. Methods Fifty-two Acinetobacter baumannii isolates were genotyped by multilocus sequence typing (MLST).eBURST algorithm was performed to define clonal complexes (CCs).blaOXA-51-like genes were am-plified by using polymerase chain reaction ( PCR) and sequenced .Results MLST grouped the A.bauman-nii isolates into 5 existing sequence types (STs) and 7 new STs.STn4 carried allele G1 with a T→C muta-tion at the 3rd nucleotide site (nt3) on the gpi111 locus.STn5 carried allele A1, possessing A→C muta-tions at nt156 and nt159 on the gltA1 locus.ST195 and ST208 accounted for 69.2%of all isolates.Clonal relationship analysis showed that ST 195 and ST208 belonged to CC92.Fifty-one A.baumannii isolates car-ried OXA-66 and the rest one carried OXA-199.Conclusion A.baumannii strains that belonged to CC92 and carried OXA-66 were the predominant genotype circulating in Guangzhou , China.
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Objective To investigate the extended-spectrum beta-lactamases ( ESBLs) producing clinical isolates of gram negative bacilli and their antibiotic resistance in Shantou and to provide suggestions on empirical treatment against the bacteria.Methods A total of 1 445 strains of gram negative bacilli (895 strains of Escherichia coli and 550 strains of Klebsiella pneumonia) were collected and examined for the production of ESBLs and antibacterial susceptibility test by Vitek-2.Results There were 69.4% of escherichia coli and 33.6% of klebsiella pneumonia producing ESBLs.The resistance rate of the ESBLs-producing strains to penicillins,cephalosporins and monocyclic beta-lactam antibiotics were very high.The ESBLs-producing strains were multidrug resistant and the resistance rates were higher than that of the non-ESBLs-producing strains.Both ESBLs-producing and non-ESBLs-producing strains were susceptible to Imipenem.Conclusion The incidence of ESBLs-producing strains was high in gram negative bacilli in Shantou.The resistance rates of the ESBLs-producing strains were higher than that of the non-ESBLs-producing strains and they expressed multiple drug resistance phenotypes.Imipenem was the best drug in the treatment of infections caused by ESBLs-producing strains.
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Objective To explore the possible role of CD28 +/CD152 +:B7 eostimulators in immune pathophysiology of severe pneumonia.Methods 22 severe pneumonia peripheral blood sample were used to analyze the expression of CD3+ T cell CD28+,CD152+,CD14++ on mononuelear cell CD86+,and HLA - DR + by FACS expression.The relationship between CD28+,CTLA4,CD86+ and the HLA-DR +,and the relationship between APACHE Ⅱ Grading,CD28+,CD152+,CD86+ and HLA-DR + were analyzed.Results Compared with the control group,the expression of CD3 + T cell,CD86+ and HLA - DR + were remarkably reduced while the expression of CD28+ and CD152+ were markedly increased in patients with severe pneumonia who were hospitalized in 24 h(P＜0.05).However,T cells with positive CD8+ CD3+ and CD4+ CD3+ had no significant change between two groups(P＞0.05).For patients with severe pneumonia who survived,the APACHE Ⅱ scores were significantly reduced while the expression of CD28+,CD152+,CD86+,HLA-DR + and CD3+ + cells were significantly increased after 10 days from admission(P＜0.05).By contrast,T cells with positive CD8+ CD3+ and CD4+CD3+ had no significant change between two groups(P＞0.05).There were no relation between costimulators CD28+ and HLA - DR + (r=-0.12,P=0.54)and APACHE Ⅱ scores(r=-0.30,P=0.19) in control group.CD86+ and HLA - DR + showed positive correlation(r=0.65,P=0.00).CD86+ and APACHE Ⅱ scores had no correlation(r=-0.38,P=0.09).Conclusion The costimulators expressed abnormally in circumference blood of patients with severe pneumonia,CD86+ decreased,but CD28+,CD152+ increased.T cell of circumference blood was at the condition of "anergy".The increase of CD28+,CD86+,CD86+ and HLA - DR + during convalescence stages in patient with severe pneumonia showed that spocific immunity was advantageous for restoration in these patients.The relationship among CD86+,CTLA4 and HLA - DR + indicated that CD28+/CD152+:B7 play an role in the occurrence and development of severe pneumonia.