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Objective:To explore the airway pathogen characteristics and examine the correlation between donor-derived pathogens and post-transplant outcomes in patients after lung transplantation (LT).Methods:Between January 1, 2015 and December 31, 2019, retrospective review was conducted for clinical and microbiological data of 88 LT recipients.Airway pathogen percentage of different microorganisms and evolution of drug-resistance were examined.Drug-resistant pathogen positive group (n=71) and negative group (n=17) were assigned according to whether or not drug-resistant pathogens were detected.Survival analysis was conducted by Log-rank with 3-year follow-ups.Between April 11, 2020 and September 5, 2020, prospective study was conducted in 14LT recipients.The potential pathogenic bacteria from donor lungs were detected by metagenomic next generation sequencing and the impact of those bacteria was examined on 1-year post-transplantation outcome in 2020.Microbial diversity and richness were shown with Shannon index.The outcome variables included heart rate, neutrophil count, lymphocyte count, immunoglobulin level and pulmonary spirometry.ANOVA and Pearson's correlation analysis were performed for elucidating the relationship between airway microbiota and post-LT outcomes.Results:From 2015 to 2019, 88 recipients were recruited and 992 strains of airway pathogens were isolated, including bacteria 796 strains and fungi 196 strains.Gram-negative bacteria (704 strains) accounted for 88.4% of all bacteria.The detection rates of Gram-positive bacteria, Klebsiella pneumonia (Kp), Acinetobacter baumannii (Ab), Stenotrophomonas maltophilia and Candida increased in 2019 than that in 2015 (8.2% vs. 5.3%, 13.6% vs. 13.2%, 33.2% vs. 17.5%, 6.5% vs. 5.3%, 26.6% vs. 20.2%). Drug resistance rate of Kp to imipenem was 68.18% in 2019 and drug resistance rate of Ab to imipenem 98.44%.The 3-year survival rate was 46.3% and 35.3% in drug-resistance positive and negative groups and the difference was insignificant ( P=0.410). Fourteen recipients were enrolled in 2020.Potential pathogenic bacteria could be detected in all donor samples.Five recipients carried the same bacteria and two died during 1-year follow-up.Nine recipients did not carry the donor-derived pathogens and two died during 1-year follow-up.The diversity of donor/recipient-derived airway microbiota (Shannon index) showed no correlation with the outcomes of 1-year follow-up by Pearson's correlation test. Conclusions:Gram-negative bacteria predominated in airway pathogens of recipients post-LT.The drug resistance rate to imipenem remained high.The donor/recipient-derived pathogen isolates showed no correlation with immediate outcomes post-LT.
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Objective:To investigate the effect of endometrial thickness(EMT) on the clinical outcome of blastocyst hormone replacement freeze-thawed embryo transfer (HRT-FET) on the first progesterone day, and to analyze the threshold and optimal thickness interval corresponding to ideal clinical pregnancy rate by statistical method.Methods:The endometrial preparation protocols of 2 825 blastocyst HRT-FET cycles from January 2013 to December 2016 in Henan Provincial People′s Hospital and the Second Hospital of Hebei Medical University were studied retrospectively. According to EMT on the first progesterone day, they were divided into 5 subgroups: group Q1(EMT: 3.5-7.9 mm), group Q2(EMT: 8.0-8.9 mm), group Q3(EMT: 9.0-9.5 mm), group Q4(EMT: 9.6-10.7 mm), group Q5(EMT: 10.8-21.0 mm). Univariate analysis, classification multivariate Logistic regression analysis, curve fitting and threshold effect analysis were used to investigate the effect of endometrial thickness on clinical outcome of blastocyst HRT-FET.Results:Group Q1 was set as the control group in classification multivariate Logistic regression analysis, after adjusting for confounding factors, the clinical pregnancy rate and live birth rate in other groups were higher than the control group. The clinical pregnancy rate and live birth rate in group Q3 and Q4 were significantly increased and the differences were statistically significant(all P<0.05). The cut-off value of the endometrial thickness was 9.6 mm. When endometrial thickness was less than 9.6 mm, with 1 mm increase of endometrial thickness, the clinical pregnancy rate increased by 23%( OR=1.23, 95% CI=1.11-1.36) and the live birth rate increased by 21%( OR=1.21, 95% CI=1.10-1.33). When the endometrial thickness was thicker than the threshold, the clinical pregnancy rate did not increase significantly( OR=0.92, 95% CI=0.84-1.02), and the live birth rate showed a downward trend( OR=0.88, 95% CI=0.81-0.96). Conclusions:In the blastocyst HRT-FET cycle, endometrial thickness showes a curvilinear relationship with clinical outcome. The optimal endometrial thickness range for ideal clinical outcome is 9.0-11.0 mm.
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<p><b>OBJECTIVE</b>To study the efficacy of pedicled greater omentum transposed to mediastinum in prevention against postoperative in-hospital intrathoracic complications after esophagectomy.</p><p><b>METHODS</b>Clinical data of 148 consecutive patients with esophageal cancer undergoing Ivor-Lewis surgery in our department from January 2010 to May 2014 were retrospectively reviewed. Among them, 84 patients with omental transposition(transposition group) and 64 patients without omental transposition(non-transposition group) were compared.</p><p><b>RESULTS</b>Postoperative hospital stay was shorter in patients with omental transposition compared to those without omental transposition(P<0.05). Intrathoracic infection rate was significantly lower in transposition group(33/84, 39.3%) than that in non-transposition group(36/64, 56.2%), and as was the combined sepsis rate[19/33, 57.6% vs. 31/36, 86.1%, P<0.05]. No significant differences were found in the morbidity of anastomotic leakage, wound infection, cardiac complication and mortality during hospitalization. The median postoperative hospital stay was significantly shorter in transposition group than that in non-transposition group(13.0 vs. 16.5 days, P<0.05).</p><p><b>CONCLUSION</b>Omental transposition to mediastinum can reduce the development and severity of intrathoracic infection and shorten hospital stay in patients undergoing esophagectomy.</p>
Subject(s)
Humans , Anastomotic Leak , Esophageal Neoplasms , General Surgery , Esophagectomy , Methods , Mediastinum , General Surgery , Omentum , Transplantation , Postoperative Complications , Retrospective StudiesABSTRACT
Objective To investigate the curative effect of Teprenone combined with esomeprazole for reflux esophagitis. Methods 96 cases of reflux esophagitis comfirmed by endoscope were obtained and divied into observation group and control group randomly. Both groups were offered with esomeprazole and motilium. Teprenone was added to the observation group and sucralfate was added to the control group. Clinical effective rate,healing rate,adverse reactions and one-year follow up were observed closely after the course of 8 weeks. Results The relief time of clinical symptom and total effective rate in the observation group were(9.3 ±3.5)d and 95.8% respectively,which were significantly higher than those in the control group(P ＜0.05). Endoscopic effective rate was 93.8% in observation group and 81.2% in control group respectively and statistically significant difference was observed (P ＜0. 05). Recurrence rate after one year in the observation group was 8. 3% ,which was significantly lower than in the control group (P ＜ 0.05). One case of headache and nausea occurred in both groups but no severe adverse reaction was observed. Conclusion Teprenone combined with esomeprazole were more effective and more likely to approach the complete cure for reflux esophagitis.
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Objective To investigate the recent decade (1999 to 2009) incidence of committed suicide and attempted suicide of the Jinuo nationality in Jinuo Mountain and study the clinical characteristics of it. Methods 10 610 subjects at 44 Jinuo villagers committees were investigated by the method of door-to-door inquiry under the help of clues and collected the data of larithmics and medical history. Results 32 committed suicide patients were found in total, and the average incidence rate per year in the recent decade was 30. 16/100 000. 5 attempted suicide patients were found and the average incidence rate per year in the recent decade was 4.71/100 000. Conclusion The Jinuo committed suicide incidence rate is higher than nationwide level. The attempted suicide incidence rate is lower than nationwide level.
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Objective To analyze the incidence and pathological characteristic of gastric cancer in young patients and to explore the possibility of screening and preventing hereditary gastric cancer. Methods 68 young patients with gastric cancer under 35 years of age were retrospectively analyzed about their sex, endoscopes datum, clinic representation,pathology and expression of c-erbB-2 protein. Results The hemoglobin was lower in the female group (94. 5 ±21.7) g/L than male group(126. 2 ± 12. 8) g/L(t =4. 502 ,P ＜0.05) ;The malignant pathology was significant difference(P ＜0.05) in young female group than the male' s;The expression of c-erbB-2 protein has no significant difference(P ＞ 0.05). Conclusions Gastric cancer in young patients was diagnosed later, misdignosed more,and move highly malignant. The prognosis is poor. Those phenomena was obviously in female.
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Objective To investigate the relationship between the expression of c-erbB-2 and rim23, and their clinical significance in gastric cancer. Methods The expression of c-erbB-2 and nm23 were detected by using immunohistochemical (SP) method in 85 surgi-cally removed specimens from patients with gastric cancer. Results The expression rate of c-erbB-2 and nm23 were 74.1% (63/85),52.9% (45/85). c-erbB-2 was positively correlated with the location, size and depth of invasion of gastric cancer, but not related with the histological types and lymph node metastasis. The expression rate of nm23 in patients without lymph node metastasis (85.7%) and in stage Ⅰ+Ⅱ (72.7%) was higher than that in patients with lymph node metastasis (42.2%) and in stage Ⅲ + Ⅳ (46.0%). The depth of inva-sion and clinical stage between the patients with c-erbB-2 over-expression and nm23 low-expression were positively related(P<0.01 or P<0.01). Conclusion c-erbB-2 promoted growth and invasion of gastric cancer, and nm23 restrained metastasis of gastric cancer. Both c-erbB-2 and nm23 could be served as predictors for biological behavior of gastric cancer.