Status of fungal sepsis among preterm infants in 25 neonatal intensive care units of tertiary hospitals in China / 中华儿科杂志

Objective: To analyze the prevalence and the risk factors of fungal sepsis in 25 neonatal intensive care units (NICU) among preterm infants in China, and to provide a basis for preventive strategies of fungal sepsis. Methods: This was a second-analysis of the data from the "reduction of infection in neonatal intensive care units using the evidence-based practice for improving quality" study. The current status of fungal sepsis of the 24 731 preterm infants with the gestational age of <34+0 weeks, who were admitted to 25 participating NICU within 7 days of birth between May 2015 and April 2018 were retrospectively analyzed. These preterm infants were divided into the fungal sepsis group and the without fungal sepsis group according to whether they developed fungal sepsis to analyze the incidences and the microbiology of fungal sepsis. Chi-square test was used to compare the incidences of fungal sepsis in preterm infants with different gestational ages and birth weights and in different NICU. Multivariate Logistic regression analysis was used to study the outcomes of preterm infants with fungal sepsis, which were further compared with those of preterm infants without fungal sepsis. The 144 preterm infants in the fungal sepsis group were matched with 288 preterm infants in the non-fungal sepsis group by propensity score-matched method. Univariate and multivariate Logistic regression analysis were used to analyze the risk factors of fungal sepsis. Results: In all, 166 (0.7%) of the 24 731 preterm infants developed fungal sepsis, with the gestational age of (29.7±2.0) weeks and the birth weight of (1 300±293) g. The incidence of fungal sepsis increased with decreasing gestational age and birth weight (both P<0.001). The preterm infants with gestational age of <32 weeks accounted for 87.3% (145/166). The incidence of fungal sepsis was 1.0% (117/11 438) in very preterm infants and 2.0% (28/1 401) in extremely preterm infants, and was 1.3% (103/8 060) in very low birth weight infants and 1.7% (21/1 211) in extremely low birth weight infants, respectively. There was no fungal sepsis in 3 NICU, and the incidences in the other 22 NICU ranged from 0.7% (10/1 397) to 2.9% (21/724), with significant statistical difference (P<0.001). The pathogens were mainly Candida (150/166, 90.4%), including 59 cases of Candida albicans and 91 cases of non-Candida albicans, of which Candida parapsilosis was the most common (41 cases). Fungal sepsis was independently associated with increased risk of moderate to severe bronchopulmonary dysplasia (BPD) (adjusted OR 1.52, 95%CI 1.04-2.22, P=0.030) and severe retinopathy of prematurity (ROP) (adjusted OR 2.55, 95%CI 1.12-5.80, P=0.025). Previous broad spectrum antibiotics exposure (adjusted OR=2.50, 95%CI 1.50-4.17, P<0.001), prolonged use of central line (adjusted OR=1.05, 95%CI 1.03-1.08, P<0.001) and previous total parenteral nutrition (TPN) duration (adjusted OR=1.04, 95%CI 1.02-1.06, P<0.001) were all independently associated with increasing risk of fungal sepsis. Conclusions: Candida albicans and Candida parapsilosis are the main pathogens of fungal sepsis among preterm infants in Chinese NICU. Preterm infants with fungal sepsis are at increased risk of moderate to severe BPD and severe ROP. Previous broad spectrum antibiotics exposure, prolonged use of central line and prolonged duration of TPN will increase the risk of fungal sepsis. Ongoing initiatives are needed to reduce fungal sepsis based on these risk factors.

Investigation and anaIysis of bacteriaI spectrum and drug sensitivity test in conjunctivaI sac of cataract patients of Kazak / 国际眼科杂志(Guoji Yanke Zazhi)

· ATM:To analyze bacterial spectrum and drug sensitivity in conjunctival sac of cataract patients of Kazak. · METHODS:A total of 538 cases of conjunctival sac secretion in cataract patients of Kazak were collected.The samples were cultured and their sensibilities to antibiotics were tested. · RESULTS: The bacterial culture was positive in 214 cases.The positive rate was 39.8%. The variety of pathogenic bacteria were mainly made up of gram positive cocci ( 88.3%), and most of them were Staphylococcus epidermidis ( 66.4%), followed by Micrococcus(9.8%).Sex had no effect on conjunctival bacteria rate in the cataract patients of Kazak, while age, place of residence had an effect on camier rate. The camier rate of conjunctival bacteria was significantly higher in people over 60 years old than that in people with age between 40 to 59 years old.And the people from city had a significant lower bacteria positive rate than those from countryside and pastoral. Most of grams were sensitive to Vancomycin, Teicoplanin, Rifampicin, Duly cloth mildew mutual and Amikacin, the tolerance was less than 20%, and they usually had higher tolerance to Penicillin, Erythromycin, Tetracycline and Chloramphenicol (>70%) . ·CONCLUSlON:Gram positivecocci is the most common bacteria in conjunctival sac in cataract patients of Kazak. Staphylococcus epidermidis was most common, followed by Micrococcus.The germ-carrying rate of conjunctival SAC in Kazakh population is associated with the patient’s age and area of residence.The clinical use of antibacterial drugs should be strictly grasp the indications, to reduce the incidence of bacterial resistance.

Complications of tracheoesophageal puncture for Blom-Singer voice restoration after total laryngectomy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate causes and treatment of complications of tracheoesophageal puncture for Blom-Singer voice restoration after total laryngectomy.</p><p><b>METHODS</b>From 1986 to 2004, one hundred and fifty one cases with Blom-Singer technique after total laryngectomy for voice restoration were retrospectively analyzed.</p><p><b>RESULTS</b>All cases were followed up from 6 months to 15 years. Among 151 cases, 138 cases got successful phonation and the total success rate of voice restoration was 91.4%. Of the 151 cases, 15 cases occurred complications. The rate of complications was 9.9%. The common complications included fistula granulations, infection, and leakage. Twelve cases got successful treatment accordingly, and the other 3 cases failed in phonation.</p><p><b>CONCLUSIONS</b>The procedure of tracheoesophageal puncture for voice restoration is relatively simple and has low complications. this method had high phonation success and good phonation quality, which is one of the best way to make laryngectomee to speak.</p>

Forty-three tracheal stricture with Ni-Ti shape memory alloy stent / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the application of Ni-Ti shape memory alloy stent for treating tracheal stricture, including its indications and complications.</p><p><b>METHODS</b>Forty-three patients clinical data were analyzed, among them, 15 suffered from tumor; 7 trauma; 4 granulation; 1 Wegener's granuloma, 2 rhinoscleroma, 1 without clear diagnosis; 7 were relapsing polychondritis; 1 were respiratory amyloidosis; 4 were tracheobronchial tuberculosis, 5 were tracheobronchomalacia. The stricture degree: Level I: 15 patients, Level II:24 patients, Level III:4 patients. The location of stricture in 5 patients extended to the subglottis area. All patients had tracheal stricture and accepted the treatment with Ni-Ti shape memory alloy stent.</p><p><b>RESULTS</b>Forty-two patients breathed freely after the operation, 1 patient died after surgery. The tracheostoma in 18 patients was closed 34 days after operation. Among the remaining 8 patients with tracheostoma:3 patients left hospital with tracheal cannula; 1 patient died,2 patients were found stent shifted and no evident breath improving; 2 patients were found granulation and had secondary operation with laser.</p><p><b>CONCLUSION</b>Ni-Ti shape memory alloy stent can expand the tracheal stricture quickly and thus improve the breath effectively, which is minimally invasive and simple. It can be used as a method in the treatment of tracheal stricture.</p>

Surgical management of metastatic disease in the conjunctive area between neck and thorax / 中国医学科学院学报

<p><b>OBJECTIVE</b>To study the surgical management of metastatic disease in the conjunctive area between the neck and thorax and its efficacy.</p><p><b>METHODS</b>Fourteen cases with metastatic node disease in the area between neck and thorax were collected and analysed. Eleven tumors were from the thyroid cancer, and the other three were from the hypopharyngeal cancer, esophagual cancer and malignant pheochromocytoma, respectively. The clavicle was displaced or resected, and the upper half of the manubrium might also be resected when necessary. The recurrent laryngeal nerve and phrenic nerve were exposed and protected. The metastatic disease was completely removed with the internal jugular and/or the brachiocephalic vein resected or spared, depending on the disease condition.</p><p><b>RESULTS</b>In 10 cases with metastases from the thyroid, no local recurrence was found within the follow-up period from 2 to 5 years. In contrast, no patient with metastatic disease from hypopharyngeal or esophageal cancer survived more than 11 months. No serious complications were found in this group.</p><p><b>CONCLUSIONS</b>The surgical treatment of node metastases in the conjunctive area between neck and thorax from the well-developed thyroid cancer has promising effect and is comparatively safe.</p>

Analysis of clinical manifestations of pharyngeal and laryngeal amyloidosis / 中国医学科学院学报

<p><b>OBJECTIVE</b>To study the clinical manifestations of pharyngeal and laryngeal amyloidosis.</p><p><b>METHODS</b>Retrospective analysis of the clinical data of the inpatients with systemic and local amyloidosis.</p><p><b>RESULTS</b>Of the 25 cases, sex ratio was 21:4, and average age was 48 years. Seventeen cases were systemic, of which 7 patients died in 2 years since diagnoses were made. One case was local bronchial amyloidosis. Seven cases were local primary pharyngeal and laryngeal amyloidosis and no affirmative death report was recorded since diagnoses were made.</p><p><b>CONCLUSIONS</b>Amyloidosis occurs more likely in male and middle- and old-aged patients. Pharyngeal and laryngeal local primary amyloidosis have relatively better prognosis than that of systemic amyloidosis. Follow-up is important because local recurrence may be happened.</p>

Culture and identification of dendritic cells from the peripheral blood of patients with laryngeal squamous cell carcinoma in vitro / 中国医学科学院学报

<p><b>OBJECTIVE</b>To culture dendritic cells (DC) from peripheral blood of patients with laryngeal carcinoma for therapeutic aid.</p><p><b>METHODS</b>Adherent peripheral blood mononuclear cells from peripheral blood were cultured with 15 ng/ml rhGM-CSF and 7 ng/ml rhIL-4 for one or two weeks. The purity of DC was detected by immunocytochemistry method. The mixed leukocyte reactions stimulated by DC loaded with laryngeal carcinoma antigen were tested by measuring 3H-TdR uptake.</p><p><b>RESULTS</b>A considerable number of suspended cells with spicular or dendritic appearance were observed after 1 week of culture, and their mitochondria were rich in cytoplasm. The positivity of DC was about 30%-60%. DC loaded with laryngeal antigen could induce proliferation of syngeneic T lymphocytes.</p><p><b>CONCLUSION</b>A large number of DC with high purity can be cultured from peripheral blood of patients with laryngeal carcinoma in vitro. It may be used in further experimental studies for clinical applications.</p>