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Objective To analyze the content of clinical practice guidelines and provide references for developing Chinese clinical practice guideline of dysphagia with stroke. Methods Content analysis was used to analyze the contents of clinical practice guideline related to dysphagia with stroke which were searched from Internet. Results Ten guidelines were included which were consisted of 2 Chinese guidelines and 8 English guidelines. These guidelines' themes were stroke involving dysphagia, and only two of them were targeted on dysphagia. And one of them was targeted on dyshagia with stroke. Only one guideline hadn't been revised yet, and the rest had been updated. Twenty items were identified from 10 guidelines as been concerning to dysphagia with stroke. Conclusions Current clinical practice guideline about dysphagia with stroke can be used to guide clinical practice. However, some recommendations of guidelines are not clear and not updated in time which can't provide specific references for dysphagia. A clinical practice guideline which is suitable for dysphagia with stroke in China should be developed based on best evidece and Chinese actual conditions.
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Objective To investigate the value of bone marrow imprint in the diagnosis of plasma cell myeloma and the remission rate after chemotherapy.Methods Bone marrow aspiration,bone marrow imprint,and bone marrow biopsy of plasma cell myeloma with 128 patients were collected.The bone marrow biopsy was used as the standard.Bone marrow imprint was compared to bone marrow aspiration in bone marrow nucleated cells quantity,infiltration degree,and diagnostic coincidence rate.Sensitivity,specificity,positive predictive value,and Youden index were evaluated.Results The results of bone marrow imprint showed that the number of nucleated cells was better than that of bone marrow aspiration (P ＜ 0.05),and was similar to that of bone marrow biopsy (P ＞ 0.05).Bone marrow biopsy combined with CD38 (+) showed the degree of infiltration of bone marrow as the standard,and the bone marrow imprint was better than that of bone marrow aspiration (P ＜ 0.05),and was similar to that of bone marrow biopsy (P ＞0.05).To evaluate the compliance rate of bone marrow infiltration in bone marrow imprint:In phase Ⅰ,the compliance rate of bone marrow aspiration was 95.83％ (23/24) and bone marrow imprint of 91.67％ (22/24),the difference was not statistically significant (P ＞ 0.05);In phase Ⅱ,bone marrow imprint coincidence rate was 92.86％ (65/70),which was significantly higher than that of bone marrow aspiration in 65.71％ (46/70) (P ＜0.05);In phase Ⅲ,bone marrow imprint coincidence rate was 79.41％ (27/34),which was significantly higher than that of bone marrow aspiration in 44.12％ (15/34) (P ＜ 0.05).The other parameters,such as sensitivity,specificity,positive predictive value,and Youden index were better than those of bone marrow aspiration.Conclusions Bone marrow imprint has characteristics that both bone marrow aspiration and bone marrow biopsy have.It has obvious advantages in diagnosis of plasma cell myeloma and monitoring the remission after chemotherapy.
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Objective To investigate the value of bone marrow imprint in the diagnosis of plasma cell myeloma and the remission rate after chemotherapy.Methods Bone marrow aspiration,bone marrow imprint,and bone marrow biopsy of plasma cell myeloma with 128 patients were collected.The bone marrow biopsy was used as the standard.Bone marrow imprint was compared to bone marrow aspiration in bone marrow nucleated cells quantity,infiltration degree,and diagnostic coincidence rate.Sensitivity,specificity,positive predictive value,and Youden index were evaluated.Results The results of bone marrow imprint showed that the number of nucleated cells was better than that of bone marrow aspiration (P ＜ 0.05),and was similar to that of bone marrow biopsy (P ＞ 0.05).Bone marrow biopsy combined with CD38 (+) showed the degree of infiltration of bone marrow as the standard,and the bone marrow imprint was better than that of bone marrow aspiration (P ＜ 0.05),and was similar to that of bone marrow biopsy (P ＞0.05).To evaluate the compliance rate of bone marrow infiltration in bone marrow imprint:In phase Ⅰ,the compliance rate of bone marrow aspiration was 95.83％ (23/24) and bone marrow imprint of 91.67％ (22/24),the difference was not statistically significant (P ＞ 0.05);In phase Ⅱ,bone marrow imprint coincidence rate was 92.86％ (65/70),which was significantly higher than that of bone marrow aspiration in 65.71％ (46/70) (P ＜0.05);In phase Ⅲ,bone marrow imprint coincidence rate was 79.41％ (27/34),which was significantly higher than that of bone marrow aspiration in 44.12％ (15/34) (P ＜ 0.05).The other parameters,such as sensitivity,specificity,positive predictive value,and Youden index were better than those of bone marrow aspiration.Conclusions Bone marrow imprint has characteristics that both bone marrow aspiration and bone marrow biopsy have.It has obvious advantages in diagnosis of plasma cell myeloma and monitoring the remission after chemotherapy.
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Objective To explore the value of minimal residual disease with acute myeloid leukemia in prognostic evaluation and its correlation with cell morphology and genetics.Methods A total of 105 patients with acute myeloid leukemia (AML) (non M3) was used as the research subjects to evaluate the correlation between the level of minimal residual disease (MRD) and the degree of cellular morphological remission,and cytogenetics.According to the different levels of MRD,78 patients of cell morphology complete remission (CR) were grouped to evaluate the one-year recurrence rate after the first chemotherapy treatment.Results The correlation was evaluated between MRD level and morphological remission in 105 patients with AML after initial chemotherapy.In the degree of cellular morphological remission cell evaluation showed 78 (74.29％) cases of CR,27 (25.71％) cases of partial remission (PR) or non remission (NR).Among 78 cases of CR,MRD negative rate was 66.67％ (52/78),MRD was 33.33％ (26/78);and 27 cases of NR or PR,MRD was 100％ (27/27).The correlation between MRD level and cytogenetic evaluation,cytogenetic prognosis group and prognosis of middle group and poor prognosis group,and the negative rate of MRD were 66.67％,45.90％,and 35.29％,without significant difference (P ＞ 0.05).Seventy eight patients with CR were divided into two groups according to the level of MRD to evaluate the recurrence rate of the 1 year,the recurrence rate of the positive group was significantly higher than that of the negative group (P ＜ 0.05).Conclusions With the development of hematology,the meaning of CR deeply,using flow cytometry method to detect the MRD,MRD positive cells relapse earlier than the traditional morphology,it has important clinical significance for guiding treatment and early prediction of recurrence of CR AML.
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Objective To investigate the phenotypes and genotypes of extended -spectrum β-lacta-mases (ESBLs) and AmpC β-lactamases produced by cefoxitin-resistant Shigella strains isolated from Zhe-jiang province and the virulence of those strains .Methods Kirby-Bauer antibiotic testing was performed to screen cefoxitin-resistant strains from 356 Shigella isolates.The serotypes of the cefoxitin-resistant strains were detected .The phenotypes of ESBLs and AmpC β-lactamases from cefoxitin-resistant strains were detec-ted by ESBLs confirmatory test and AmpC-three-dimensional test ,respectively .The genotypes of ESBLs and AmpC β-lactamases were analyzed by PCR and sequence analysis .The virulence genes ( virA, ial, iapH, set1A, set1B and sen) in the cefoxitin-resistant strains were screened by PCR .Results Eight cefoxitin-re-sistant strains were identified from 356 Shigella isolates.Among them,six strains were identified as Shigella flexneri (S.fleaneri) strain (four F2a,one F2b and one F2c),and the rest were identified as Shigella sonnie (S.sonnei) strain.Among all eight cefoxitin-resistant strains,five strains showed positive results for ESBLs confirmatory test and two strains showed positive results for AmpC-three-dimensional test .Seven out of the eight strains harbor ESBLs genes (CTX-M-14,15,57 and/or OXA-30),two of which were positive for AmpC genes (DHA-1 and CMY-2).Five out of the eight cefoxitin-resistant strains carried all of the six tested viru-lence genes,while the other three strains possessed four virulence genes except for set1A and set1B.The two strains producing both ESBLs and AmpC β-lactamases were susceptible only to imipenem .Conclusion ESBLs positive isolates are prevalent strains of cefoxitin-resistant Shigella with potential high virulence .Some of them also produce AmpC β-lactamases ,and the DHA-1 type of AmpCβ-lactamase is identified for the first time in China .
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Objective To investigate the distribution and antibiotic resistance of pathogens isolated from inpatients with urinary tract infections.Methods A retrospective analysis was carried out on 1033 strains of pathogens isolated from urine culture in patients with urinary tract infections in Zhejiang Xiaoshan Hospital during January 2009 and December 2011.Urine specimens were cultured with Uricult,and K-B method was used for drug susceptibility test,WHONET 5.6 software was used to analyse drug susceptibility test.Results Among 1033 strains of pathogens,681 (65.9％) were gram-negative bacteria,197 (19.1％) were gram-positive bacteria,and 155 (15.0％) were fungi.The three most prevalent bacteria were Escherichia coli (402 strains,38.9％),Klebsiella pneumoniae (74 strains,7.2％) and Candida albicans (64 strains,6.2％).60.7％ (244/402) of Escherichia coli and 45.9％ (34/74) of Klebsiella pneumoniae were extended-spectrum β-lactamases (ESBLs) positive.Escherichia coli and Klebsiella pneumoniae were susceptible to imipenem,meropenem,cefoperazone/sulbactam,piperacillin/tazobactam and amikacin.Enterococcus and staphylococcus were susceptible to vancomycin,linezolid and furadantin.Candida was sensitive to flucytosine,voriconazole and amphotericin B.Conclusion Gram-negative bacteria mainly E.coli is the predominant pathogen to urinary tract infections in this group of patients.Regular analysis and monitoring of pathogen species and drug resistance is important for rational use of antibiotics.