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Objective To evaluate the efficacy and safety of different antimicrobial regimens in patients with bloodstream infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP).Methods The clinical date of patients with CRKP bloodstream infections were retrospectively analyzed at the First Affiliated Hospital of Zhejiang University Medical College between January 2017 and January 2018.All subjects were separated into three groups based on antibiotics regimens over 72 hours,including meropenem 2.0 g every 8 hours,tigecycline 200 mg as initial dose and 100 mg every 12 hours,and polymyxin B 1.25 mg/kg every 12 hours as salvage treatment of tigecycline.Results A total of 86 patients were finally recruited,including 14,52 and 20 patients in groups of meropenem,tigecycline and polymyxin B salvage,respectively.All of the strains were resistant to meropenem and susceptible to tigecycline and polymyxin B initially,while 2 of them became resistant to tigecycline during treatment.The 28-day mortality was significantly higher in meropenem group (13/14) than that in tigecycline group and polymyxin B salvage group (61.5％,32/52) and (12/20),respectively (P＜0.01),while as no significant difference was seen in the last two groups (x2=0.014,P＞0.05).The incidences of hepatic impairment [3.8％(2/52) vs.1/20] and renal dysfunction (0 vs.1/20) between tigecycline group and polymyxin B salvage group were both comparable (P＞0.05).Conclusion The meropenem-based therapy is not recommended for CRKP-related bloodstream infections.Tigecycline-based therapy is still disappointing despite salvage use of polymyxin B after 72 hours.Hepatic and nephretic toxicities caused by additional polymyxin B are acceptable.
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Objective:To investigate the factors and mechanisms in forming uric acid stones in patients with type 2 diabetes (T2DM).Methods:106 patients with diabetes were divided into observation group and control group according to the combination of urinary calculi,53 cases in each group,The differences of clinical data and biochemical indexes between the two groups were compared,The relationship between type 2 diabetes mellitus and urinary stones was analyzed by multi factor regression analysis.Results:There were no significant difference in observation group and control group in age,sex,SBP,DBP,TC,FBG,2hPBG and HbA1C (P＞0.05),and there were of statistical difference significance in BMI,urinary pH,HOMA-IR,SUA,TUA in the two gruops (P ＜0.05) and the Logistic regression analysis showed blood uric acid,the urinary pH,HOMA-IR,SUA were independent risk factors in urolithiasis in T2DM (P ＜ 0.05).Conclusion:High uric acid hematic disease,high uric acid excretion,insulin resistance,overweight or obesity,high blood triglycerides in patients with type 2 diabetes is risk factors for urinary stone formation,in which blood uric acid,urinary pH,HOMA-IR is the independent risk factor for type 2 diabetic patients with urinary calculi.
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Objective To investigate the relationship between subclinical hypothyroidism and diabetic nephropathy in type 2 diabetic patients (T2DM).Methods We retrospectively analyzed the clinical data of 218 patients with T2DM treated at the Department of Endocrinology,Shanghai Tongren Hospital from January 2015 to December 2016.Based on the level of thyroid stimulating hormone (TSH),patients were divided into a hypothyroidism group (TSH＞4.20 mU/L) and a control group (TSH 0.35-4.20 mU/L),and the relationship between subclinical hypothyroidism and diabetic nephropathy was evaluated.Results There were 46 cases in the subclinical hypothyroidism group and 172 cases in the control group.The incidences of diabetic nephropathy were significantly different between the two groups (P ＜0.05).Furthermore,the incidence of diabetic nephropathy was significantly higher in patients with high levels of TSH (≥10.0 mU/L) than in those with low levels of TSH (＜10.0 mU/L) (P＜0.05).Conclusions Diabetic patients with subclinical hypothyroidism are prone to diabetic nephropathy,so it is necessary to screen thyroid function.
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This study was aimed to introduce the key link in the process of granulating of small-dose methyl can-tharis amine tablets. Combined with practical experiences in daily jobs, related literatures in recent years from the fineness of raw materials, choice of main materials mixing, selection of adhesive, drying methods and grain quality were analyzed. The results showed that in order to ensure the content uniformity of small-dose tablets and conform to requirements of the Chinese Pharmacopoeia, the fineness of raw materials should be appropriate; the main supple-mentary material must be evenly mixed with enough time; the choice of adhesive should be scientific and reasonable;the drying method should be practical; and the grain quality should meet the technological requirements.