Clinical outcomes after treatment for NDM-producing Klebsiella pneumoniae infection after kidney transplantation / 中华器官移植杂志

Objective:To explore the clinical efficacy of ceftazidime/avibactam(CZA)plus aztreonam(ATM)for New Delhi metallo-β-lactamase(NDM)carbapenem-resistant Klebsiella pneumoniae(CRKP)infection after kidney transplantation.Methods:Clinical data are retrospectively reviewed for 11 RT recipients infected with NDM metallo-β-lactamase CRKP admitted into First Affiliated Hospital of Xi 'an Jiaotong University and Affiliated Renji Hospital of Shanghai Jiao Tong University from November 2018 to December 2019.Based upon treatment protocol, they are divided into two groups of ceftazidime/avibactam plus aztreonam(CZA-ATM, 5 cases)and other effective antibiotics(OAA, 6 cases).Age, gender, infection type, drug resistance gene, changes in body temperature and leucocyte count, treatment course and prognosis are summarized.Results:A total of 11 patients with NDM-producing CRKP infection after RT are recruited.There are seven males and four females with an age range of(19~66)(38.9±14.4)years.There are mixed pulmonary and urinary tract infections(3 cases), urinary tract infection(2 cases), pulmonary infection(1 case)and perirenal infection(5 cases).All isolates harbore NDM carbapenemase gene, 5 isolates carry Klebsiella pneumoniae carbapenemase(KPC)gene and 1 isolate contained both imipenemase metallo-β-lactamase(IMP)and verona integron-encoded metallo-β-lactamase(VIM)gene concurrently.Ceftazidime-avibactam plus aztreonam(CZA-ATM)is prescribed in five patients while the remainders receive OAA.No adverse reactions occurred in individuals on CZA-ATM and 2 cases on OAA have adverse reactions with a poor appetite and diarrhea.After 30-day infection, the curative cases of CZA-ATM and OAAs groups reach 4 and 5 respectively.No death occurred in neither groups at Day 30.And 90-day mortality is 0 and 1 respectively.Conclusions:For RT patients infected with NDM-producing CRKP, CZA-ATM combination therapy may be another effective treatment.

Relationship between cognitive function and brain event-related potentials in patients with lacunar cerebral infarction / 中国综合临床

Objective:To investigate the relationship between cognitive function and brain event-related potential in patients with lacunar cerebral infarction.Methods:A total of 464 patients with lacunar cerebral infarction admitted to the Department of Neurology, Kailuan General Hospital from 2014 to 2019 were prospectively selected as observation subjects (case group). According to mini-mental state examination (MMSE) score, the patients in the case group were divided into 352 cases of lacunar cerebral infarction with normal cognition and 112 cases of mild cognitive impairment. At the same time, 100 healthy volunteers were selected as the control group. All subjects were assessed by simple intelligent mental state, Zung self-rating anxiety scale, Zung self-rating depression scale and brain event-related potential P3a and P3b. The measurement data of normal distribution adopts one-way ANOVA, the measurement data of non normal distribution adopts Kruskal Wallis H test, and the counting data adopts χ2. Multivariate statistical analysis was performed by unconditional Logistics (stepwise method). Results:The proportions of smokers in control group, lacunar cerebral infarction cognitive normal group and lacunar cerebral infarction mild cognitive impairment group were 20.00% (20/100), 38.07% (134/352) and 46.42% (52/112), respectively. The proportions of drinkers were 18.00% (18/100), 33.24% (117/352), 33.93% (38/112), respectively. The proportions of hypertension were 38.00% (38/100), 58.24% (205/352), 59.82% (67/112), respectively. The proportions of hyperhomocysteinemia were 19.00% (19/100), 34.00% (120/352) and 68.75% (77/112), respectively, and the differences among the three groups were statistically significant ( χ2 values were 15.66, 7.91, 11.86 and 54.57, respectively; P<0.001, 0.019, 0.003, <0.001). The peak latency CZ leads of visual P3b wave group N2 were (271.48±40.65), (285.67±44.08) and (290.57±68.41) ms, respectively. PZ leads were (276.70±50.92), (287.86±43.28) and (312.16±62.75) ms. P3b peak latency FZ leads were (392.67±42.50), (405.82±52.43) and (410.34±64.27) ms. CZ leads were (395.04±42.44), (412.51±55.86) and (433.28±66.32) ms. PZ leads were (398.24±40.93), (411.17±49.48) and (435.78±67.69) ms. N2 amplitude CZ leads were (-3.99±2.81), (-3.60±3.00) and (-2.70±2.37) μV, PZ leads were (-3.18±2.69), (-2.91±2.62) and (-1.87±2.89) μV, respectively. Leads P3b amplitude of FZ were 5.27 (3.27, 7.40), 4.21 (2.31, 6.49) and 3.12 (1.61, 5.08) μV. CZ leads were 4.81 (2.78, 6.71), 4.15 (2.76, 6.16) and 3.51 (1.75, 5.15) μV. PZ leads were 5.17 (3.03, 6.97), 4.40 (2.89, 6.12) and 3.43 (1.52, 5.34) μV. There were statistically significant differences among the 3 groups ( F=3.29, 14.49, 3.95, 11.73, 14.06, 5.66 and 3.57, H=18.23, 10.33,18.25; P=0.027, <0.001, 0.025, <0.001, <0.001, 0.004, 0.042, <0.001, 0.006, <0.001). The peak latency FZ leads of visual P3a wave group N2 were 265.00 (256.00, 286.00), 277.00(260.00,300.00), 282.00(270.00,304.00) ms, respectively. CZ leads weres 274.00(255.00,305.00), 285.00(262.00,329.00), 293.50(270.00,346.00) ms. P3a peak latency FZ leads were (413.83±49.58), (429.83±55.38) and (449.04±54.79) ms, CZ leads were (441.53±61.78), (457.12±69.29) and (460.23±72.24) ms. PZ leads were (430.14±54.53), (462.31±69.2) and (470.02±74.92) ms. N2 amplitude FZ leads were (-6.34±3.13), (-5.72±2.96) and (-4.92±2.05) μV, respectively. Leads P3a amplitude of FZ were 4.00 (2.28, 5.55), 3.15 (2.14, 4.91) and 2.80 (2.19, 4.19) μV. CZ lead were 3.37 (1.98, 4.66), 2.73 (1.70, 3.97) and 2.41 (1.64, 3.45) μV. There were statistically significant differences among the three groups ( H=13.92, 8.65, 9.17, 10.02, F=8.18, 6.33, 10.73, 4.62, P =0.001,0.013,0.010,0.007, <0.001,0.002, <0.001,0.010). Logistic regression analysis showed that alcohol consumption, P3b peak latency and wave amplitude PZ lead, N1 wave amplitude of visual P3a group FZ lead were the influencing factors of MMSE ( OR=0.04, 1.01, 0.76, 1.51, 95% Cl were 0.00-0.30, 1.00-1.03, 0.59-0.97, 1.08-2.10, P=0.002,0.007,0.029,0.016). Conclusion:The peak latency and amplitude of endogenous psychological cognitive potentials N2, P3b and P3a of event-related potentials P3b and P3a in patients with lacunar cerebral infarction were prolonged and decreased. At the same time, with the occurrence of clinical cognitive impairment, the peak latency and amplitude of these cognitive potentials were further prolonged and decreased more significantly. Alcohol consumption, P3b peak latency and PZ lead of visual P3b wave group, and FZ lead of N1 wave of visual P3a wave group were the influencing factors of simple intelligent mental state.

Correlation between post-transplant non-HLA antibodies and humoral rejection after kidney transplantation / 中华器官移植杂志

Objective:To explore the correlation between post-transplant non-HLA antibodies and humoral rejection(HR)after kidney transplantation(KT).Methods:A retrospective study was conducted for KT recipients with non-HLA antibody level detected from September 2019 to January 2021.The recipients with biopsy confirmed HR and donor-specific HLA antibodies negative or feeble positive at the time of HR were designated as HR group while recipients with stable renal allograft function from 2 weeks post-KT to the time of detecting non-HLA antibody as stable group.The levels of HLA antibody, MHC classⅠchain-related gene A(MICA)antibody and 32 non-HLA antibodies were tested by Luminex single antigen bead and the levels of angiotensin Ⅱ type 1 receptor(AT1R)antibody quantified by enzyme-linked immunosorbent assay (ELISA). Inter-group differences in positive rate of non-HLA antibodies and number of positive non-HLA antibodies were analyzed.Results:Twenty-four recipients had positive non-HLA antibodies while the remainders had no positive non-HLA antibodies.Three HR recipients were positive for actin antibody, collagen Ⅲ antibody, glutathione S-transferase theta-1 antibody or IFN-γ antibody respectively.However, all four non-HLA antibodies of stable recipients were negative.There was significant inter-group difference( P=0.017). Four HR recipients were positive for collagenⅡantibody while only 1 stable recipient was positive for collagenⅡantibody.The positive rate of collagenⅡ antibody was significantly higher in HR recipients than that in stable recipients( P=0.023). HR recipients had an average of 2.36 positive non-HLA antibodies while stable recipients had an average of 0.90.There was significant inter-group difference ( P=0.008). Conclusions:A high level of non-HLA antibodies may elevate the risk of HR after KT.

Relationship between homology and genomics of Klebsiella pneumoniae in patients with neurocritical infection / 中国综合临床

Objective:To analyze the relationship between homology of Kleber pathogen pneumoniae (KP) in patients with neurocritical infections and the Genomics.Method:Five non-multidrug resistant pathogen KP were identified in 2015 to 2018, including the same cloning strain of P90 and P91, the same popular cloning system of P66,P90 and P91, and there is no homology between P20,P39 and other strains, which makes a second generation full genome sequencing. A variety of bioinformatics software were used for genomic analysis to understand the basic genomic information, chromosomal and plasmid distribution, single nucleotide polymorphism (SNP) differences and gene family clustering characteristics, meanwhile with the National Center for Biotechnology Information (NCBI) website registered 18 KP strains (2013--2016) to analyze the evolutionary affinity between strains.Results:The total genome sizes of P20, P39, P66, P90 and P91 were 5 469 543 bp, 5 480 332 bp, 5 768 352 bp, 5 745 666 bp, 5 722 999 bp. The GC contents were 57.07% (1 559 929+1 561 432)/5 469 543, 57.27% (1 566 970+1 571 424)/5 480 322, 56.96% (1 640 438+1 645 432)/5 768 352, 56.88% (1 634 285+1 634 038)/5 745 666, and 56.95% (1 627 360+1 631 781)/5 722 999, respectively. Compared with P20 reference strains, the total number of SNP in P39, P66, P90 and P91 were 32 682, 34 226, 34 292, 34 375, and the total mutation rates of gene coding region sequences were87.18% (28 491/32 682), 86.71% (29 679/34 226), 85.26% (29 238/34 292), 86.22% (29 638/34 375), respectively. Nonsynonymous mutations accounted for some advantages, and the rates were 44.57% (14 566/32 682), 44.01% (15 063/34 226), 48.01% (16 465/34 292), 48.75% (16 758/34 375), and synonymous mutations were 42.61% (13 925/32 682), 42.70% (14 616/34 226), 37.25% (12 773/34 292), 37.47% (12 880/34 375), respectively. P90 and P91 have 6 specific gene families, and P66 has 4 specific gene families. The same popular clone lines P66, P90 and P99 are on the same evolutionary branch of the phylogenetic tree. The same clone P90 and P99 are on the same subbranch. P20 and P39 without homology are on different evolutionary branches respectively. P20, P39, P66, P90 and P91 on the evolutionary branches of phylogenetic tree are closely related to the evolutionary grade of strain KP52-145 from France and strain ED23 from Taiwan, China submitted on NCBI website.Conclusion:Klebsiella pneumoniae in patients with neurocritical infection has the same clone, and the number of unique gene families among strains is the same. There are small differences in the number of unique gene families and the total number of SNPs among the same epidemic clone lines, and they are characteristic of the same evolutionary branch of the phylogenetic tree. The number of unique gene families and the total number of SNPs of non homologous strains are quite different, and they are in different evolutionary branches of the phylogenetic tree.

Mechanism of mouse bone marrow mesenchymal stem cells for alleviating kidney ischemic-reperfusion injury via glucose metabolism / 中华器官移植杂志

Objective:To explore the protective effects of exosomes derived from bone marrow mesenchymal stem cells(BMSC)on ischemia-reperfusion injury(IRI)in mice.Methods:A total of 30 C57BL/6 mice were randomly grouped into 6 groups of control, Norm-BMSC-exo, Hypo-BMSC-exo, IRI, Norm-BMSC-exo+ IRI and Hypo-BMSC-exo+ IRI.The model for IRI(25 min)was constructed.The serum levels of creatinine(Cr)and blood urea nitrogen(BUN)and histomorphology were examined at 24 h post-reperfusion.The levels of tumor necrosis factor-alpha (TNF-α), interleukin-1β(IL-1β)monocyte chemoattractant protein-1(MCP-1)and interleukin-10 (IL-10)were measured.The survival rate was observed for 7 days post-IRI.We also detected macrophage polarization glycolysis and oxidative phosphorylation(OXPHOS).Results:Compared with IRI group, Norm-BMSC-exo+ IRI group showed low levels of creatinine(Cr)and blood urea nitrogen(BUN)and mild pathological injury.The protective effects were enhanced in Hypo-BMSC-exo+ IRI group.BMSC-exo pretreatment could significantly improve the survival rate of mice post-IRI.Reverse transcription-polymerase chain reaction(RT-PCR)revealed that BMSC-exo significantly lowered the levels of TNF-α, IL-1β, MCP-1 and elevated the level of IL-10.BMSC exosomes polarized macrophage toward an M2 phenotype.And Hypo-exo could reprogramme macrophages to undergo a metabolic switch toward OXPHOS and away from glycolysis.Conclusions:Hypo-BMSC-exo could improve kidney injury via inducing M2 polarization in macrophages through promoting OXPHOS and suppressing glycolysis.

Influence factors of depression in patients with lacunar cerebral infarction with mild cognitive impairment / 中国综合临床

Objective:To observe the related factors of depression in patients with lacunar cerebral infarction with mild cognitive impairment.Methods:From 2016 to 2019, 114 patients with mild cognitive impairment of lacunar cerebral infarction in Kailuan General Hospital were selected as the research objects.MRI brain scan was completed within 72 hours after admission, and Zung′s self rating Depression Scale (SDS) was used to evaluate emotion within 1 week.According to the results of SDS, 69 patients with mild cognitive impairment and no depression of lacunar infarction were selected as the control group, and 45 patients with mild cognitive impairment and mild depression of lacunar infarction were selected as the case group.The general clinical data, the proportion of patients with lacunar infarction in different brain regions and cognitive function of the two groups were observed.Logistic regression method was used to analyze the risk factors of depression in patients with mild cognitive impairment of lacunar infarction, and the characteristics of clinical somatization symptoms were observed.Results:(1)There were 53 males (76.81%, 53/69) and 16 females (23.19%, 16/69) in the control group, 29 males (64.44%, 29/45) and 16 females (35.55%, 16/45) in the case group, and the difference between the two groups was statistically significant ( P=0.049). Hyperhomocysteinemia in the control group and the case group was 31.88% (22/69) and 53.33%(24/45), respectively, with statistically significant differences between the two groups ( P=0.003). (2) The incidence rates of lacunar infarction in basal ganglia and oval center was 80% (36/45) and 71.11% (32/45) in case group respectively, and 59.42% (41/69) and 18.84% (13/69) in control group respectively.The difference between two groups was statistically significant ( P values were 0.001 and <0.001), and there was no significant difference in infarct size in other regions ( P>0.05). (3) The rate of impaired attention and computing power in the case group was 88.89%(40/45), which was higher than that in the control group 78.26%(54/69), and the difference was statistically significant ( P=0.036). (4) Multivariate Logistic regression analysis showed that hyperhomocysteemia ( OR=2.659, 95% CI 1.041-6.793, P<0.05) and central oval infarction ( OR=10.332, 95% CI 4.069-26.235, P<0.01) were independent risk factors for mild cognitive dysfunction and depression in lacunar cerebral infarction.(5) The proportion of insomnia and tears with somatization symptoms in the case group was 35.56%(16/45) and 37.77%(17/45), respectively, which were higher than that in the control group 8.70%(6/69) and 2.90%(2/69), respectively, with statistically significant differences (all P<0.001). Conclusion:Hyperhomocysteinemia and hemioval central cerebral infarction are independent risk factors for depression in patients with lacunar cerebral infarction with mild cognitive dysfunction, accompanied by somatization symptoms of insomnia and tearing.

Characteristics of somatosensory changes in patients with acute middle cerebral artery infarction and its relationship with neurological impairment / 中国综合临床

Objective:To observe the changes of somatosensory evoked potential (SEP) in the upper limbs of patients with acute middle cerebral artery (MCA) cerebral infarction, and to explore its relationship with neurological impairment.Methods:From January 2015 to December 2016, 62 patients with 38 cases of male and 24 women of cerebral infarction who were treated in the department of neurology, Kailuan General Hospital were selected for a retrospectively prospective cohort study, including 38 males and 24 females.aged (66.7 ± 10.9) years old and ranging from 33.0 to 85.0 years old.According to the side of cerebral infarction, 37 cases were divided into left MCA group and 25 cases into right MCA group.During the 48 hours of admission, the electromyography evoked potential meter was used to detect the upper limb SEP, and the peak latency, amplitude and electrical activity waveform of the cerebral cortex potentials N20, P25 and N35 were recorded.Results:The results of SEP in the contralateral limbs of the left and right MCA cerebral infarction group were as follows: 1 case (2.70%) and 5 cases (20.00%) of normal median nerve; 36 cases (97.30%) and 20 cases (80.00%) of abnormality.The ratio of median nerve abnormalities in the group was statistically significant (χ 2=12.577, P<0.001). The ulnar nerve was normal in 3 cases (8.11%), 4 cases (16.00%); 34 cases (91.89%) and 21 cases (84.00%) were abnormal.There was no statistically significant difference between the two groups (χ 2=2.320, P=0.128). The peak latency and/or amplitude of each peak decreased in 34 groups (60.71%) and 33 cases (60.00%) of the ulnar nerve; the waveform of electrical activity disappeared, 22 cases (39.29%) of median nerve and 22 cases of ulnar nerve (40.00%). The peak latency and/or amplitude decreased, the electrical activity waveform disappeared, and the median nerve and ulnar nerve were compared, and the difference was not statistically significant (χ 2=0.021, P=0.885). The National Institue of Health Storke Scale(NIHSS) scores of left and right MCA cerebral infarction group were 34 (91.89%) and 19 (76.00%) respectively.Among them, the disappearance of electrical activity waveform were 18 cases (52.94%) and 4 cases (21.05%)of median nerve; 18 cases (52.94%) and 4 cases (21.05%) of ulnar nerve.The SEP electrical activity waveform disappeared in patients with moderate or higher neurological impairment, and the median nerve and ulnar nerve were statistically significant (χ 2=20.613, 20.613, all P<0.001). Conclusion:The median nerve and ulnar nerve SEP of the contralateral upper limb, which is dominated by the acute middle cerebral artery cerebral infarction, were abnormally changed.The main manifestations were that the latency of each peak of N20, P25 and N35 was prolonged and/or the amplitude was significantly decreased, and the waveform of SEP electrical activity disappeared.In addition, the disappearance of SEP wave activities only occurred in moderate and above neurological damage

Detection of donor kidney carrier carbapenem-resistant Klebsiella pneumoniae using combined GeneXpert and culture of kidney perfusion fluid / 中华器官移植杂志

Objective:To explorer the optimal method of detecting donor kidney carrier carbapenem-resistant Klebsiella pneumoniae (CRKP).Methods:Clinical data were retrospectively analyzed for 1120 donation-after-circulatory-death (DCD) kidneys and bacterial detection of kidney perfusion fluid was performed from January 2015 to January 2019. A total of 1120 kidney perfusion fluid samples were collected with sterile tubes and submitted for culturing. And 451 specimens were delivered in sterile tubes and blood culture bottles simultaneously And 729 specimens assayed for carbapenemase genes with GeneXpert.Results:Among 1120 kidneys, CRKP was confirmed in 21 grafts with an infection rate of 1.87 %. The detection of carbapenemase genes with Genexpert showed that KPC was positive for 9/16 CRKP positive grafts. Sensitivity, specificity, false-positive rate, false-negative rate and ROC-AUC were calculated at 56.3 %, 100 %, 0, 43.7 % and 0.781 respectively. And 11 specimens delivered with sterile tube were culture positive for CRKP. Sensitivity, specificity, false-positive rate, false-negative rate and ROC-AUC were calculated at 52.3 %, 100 %, 0, 47.6 % and 0.762 respectively. Among 451 perfusion fluid samples collected with anaerobic blood culture bottle, 15 samples had a positive culture for CRKP. Sensitivity, specificity, false-positive rate, false-negative rate and ROC-AUC were calculated at 100 %, 100 %, 0, 0 and 1 respectively. In terms to anaerobic blood culture bottle, sensitivity, specificity, false-positive rate, false-negative rate and ROC-AUC were calculated at 60 %, 100 %, 0 , 40 % and 0.80 respectively.Conclusions:Genexpert assay is suitable for rapid and convenient detection of carbapenemase genes using kidney perfusion fluid. Culturing perfusion fluid samples collected with anaerobic blood culture bottle is clinically valuable diagnostic tool of CRKP. A combination of both methods is worthy of clinical promotion and application diagnosis of donor kidney derived CRKP in terms of greater accuracy and timeliness.

Clinicopathological features and prognostic analysis of initially diagnosed stage Ⅳ breast cancer bone metastasis / 中国肿瘤临床

Objective: To examine the relationship of clinicopathological features and treatment strategies with the prognosis of patients with initially diagnosed stageⅣbreast cancer bone metastasis (IDBCBM). Methods: Clinical data from 74 patients with IDBCBM who were treated at Tianjin Medical University Cancer Institute and Hospital between March 2007 and November 2016 were analyzed retrospectively. A univariate analysis of prognosis was conducted using a Log-rank test, and the subsequent multivariate analysis was conducted using a Cox regression model. Results: The median age of the patients was 53.3 years. The median total survival duration (overall survival, OS) was 34.3 months, and the 3-and 5-year survival rates were 37.8% and 12.2%, respectively. Patients for whom the first distant metastasis was bone metastasis only had a better prognosis, with a median survival duration of 41.7 months and overall 3-and 5-year survival rates of 54.5% and 20.4%, respectively. In the univariate analysis, molecular subtype, hormonal receptor status, HER-2 expression levels, nodal status, Ki-67 index, number of bone metastases (NBM), initial mode of metastasis, mode of therapy, and locoregional treatment showed an association with prognosis. Further, multivariate analysis demonstrated that Ki-67 index, NBM, mode of therapy, and initial mode of metastasis were independent factors affecting OS (P<0.05). Conclusions: A high Ki-67 index, single mode therapy, the presence of multiple bone metastases, and accompanying visceral metastasis were associated with a poor prognosis. However, it remains unclear whether locoregional treatment, including surgery and radiotherapy treatment of the primary tumor, is beneficial.

Effect of estrogen on proliferation of astrocytes in hippocampus of mice following middle cerebral artery occlusion / 中华老年心脑血管病杂志

Objective To study the effect of estrogen on proliferation of astrocytes in hippocampus of mice following middle cerebral artery occlusion(MCAO).Methods One hundred and eight Kunming mice were randomly divided into estrogen group(n=54)and saline group(n=54).The animals in two groups underwent right MCAO with tissue samples taken at 3,6,12,24,48and 72h after MCAO.The ischemic site was detected and the ischemic size was measured with TTC staining,the damage of neurons in hippocampus was assayed with HE staining,the expression of GFAP in hippocampal astrocytes was detected with immunohistochemical staining.Results The cerebral infarction size was significantly smaller in estrogen group than in saline group at different time points after MCAO(P＜0.05,P＜0.01)especially at 12hafter MCAO(31.50％±3.36％vs 54.50％±5.68％,P=0.019).The damage of hippocampal neurons aggregated with the prolonged ischemia time in two groups and was milder in estrogen group than in saline group at the same time points.The expression level of GFAP positive cells in bilateral hippocampal areas was higher when the ischemia time was prolonged and was significantly higher in ischemic hippocampus of estrogen group than in that of control group except at 6hin CA3ischemic area(P＜0.05).Conclusion Estrogen can protect mice against focal cerebral ischemia,stimulate the genesis of astrocyte synapses,alleviate neuronal damage after ischemia,and can thus reduce the size of cerebral infarction.

Hemodynamic changes of cerebral arteries in patients with chronic unilateral internal carotid artery occlusion / 中国综合临床

Objective To analyze the hemodynamic changes of cerebral arteries in patients with chronic extracranial internal carotid artery occlusion (EICAO).Methods Ninety-six patients with chronic unilateral EICAO who were admitted to Kailuan General Hospital from September 2012 to December 2015 were selected as the case group (EICAO group),and 30 volunteers were selected as the control group.Color transcranial Doppler ultrasonography was used to detect the anterior communicating artery (ACOA) of the grade Ⅰ collateral circulation,the posterior communicating artery (PCOA),the ocular artery of the grade Ⅱ collateral circulation,and the pial collateral branch.Circulation rate and cerebral hemodynamic parameters:(Mean blood flow velocity (Vm) and pulsatility index).Results In the left and right EICAO groups,the opening rates of collateral circulation at grade Ⅰ were 86.96％ (40/46),96.00％ (48/50) and 78.26％ (36/46) and 88.00％ (44/50) respectively.There were significant differences in the opening rates of collateral circulation at grade Ⅰ between the two groups (x2 =4.114,P =0.043).There was no significant difference in the opening rates of collateral circulation at grade Ⅱ between the two groups (x2 =3.544,P =0.060).The left and right sides of EICAO group were compared with the same side of control group.The Vm of the common carotid artery (left side of the EICAO group (24.08 ± 9.25) cm/s),left side of the control group (32.52±3.28) cm/s,P＜0.01);right side of the EICAO group (22.20±5.51) cm/s),right side of the control group(31.58±3.35) cm/s,P＜0.01)) and the end-carotid artery end stage (TICA) The pulsation index (left side of left EICAO group (0.78 ±0.17),left side of control group (0.92±0.08),P ＜0.01);right side of right EICAO group (0.75 ± 0.19),right side of control group (0.91 ± 0.10),P ＜0.01),Vm of middle cerebral artery (MCA) (left side of left EICAO group(40.29 ±20.61) cm/s,left side of control group(55.72 ±5.60) cm/s,right side of EICAO;The right side of group (37.10±19.70) cm/s),the right side of control group (53.70±6.28) cm/s,P＜0.01),the pulsation index of MCA (left side of left EICAO group(0.74±0.19),left side of control group(0.87±0.10),P＜0.01;right side of right EICAO group (0.69±0.23),right side of control group:(0.90 ± 0.08),P ＜ 0.01).There were significant differences.NIHSS score of neurological impairment:normal 17.39％ (8/46),mild 39.13％ (18/46),moderate 30.44％ (14/46),moderate severe 13.04％ (6/46) in left EICAO group,and normal 18.00％ (9/50),mild 54.00％ (27/50),moderate 24.00％ (12/50),moderate severe 4.00％ (2/50) in right EICAO group.There was no significant difference between the two groups (P =0.178).Conclusion The ipsilateral common carotid artery and its distal middle cerebral artery in patients with chronic unilateral internal carotid artery occlusionshow hypoperfusion of hemodynamics,accompanied by neurological impairment.

Diagnosis and treatment in 9 cases of donor-derivedcarbapenem-resistant Klebsiella pneumoniae Infection after kidney transplantation / 中华器官移植杂志

Objective To explore the rapid diagnosis and clinic treatment of donor-derived carbapenem-resistant Klebsiella pneumoniae (CRKP) infection in renal transplant recipients .Methods Retrospective analysis was performed for clinical data and the diagnosis and treatment of 9 renal transplant recipients with donor-derived CRKP infection from March 2017 to May 2019 .Results Among 526 renal transplant recipients ,nine were diagnosed with donor-derived CRKP infection by bacterial culture or KPC enzyme gene test .The infection rate was 1 .71％ .One recipient receiving carbapenem and tigecycline died while the remainders survived after a treatment of ceftazidime-avibactam and carbapenem . One recipient underwent graft resection . Among 8 recipients on ceftazidime-avibactam ,5 cases received a standard dose of 3 .75 g/d while another 3 cases had a high dose of 7 .5 g/d .One patient in standard-dose group underwent graft resection due to an arteriorrhexis of artery anastomosis .After graft resection ,the patient received a high dose of ceftazidime-avibactam and survived to date .The grafts of three patients in high-dose treatment group survived .Conclusions KPC enzyme gene detection plus injecting lavage fluid into blood culture bottle for bacterial culture is rapid and accurate for diagnosing donor-derived CRKP infection . A combination of ceftazidime-avibactam plus carbapenem is effective for donor-derived CRKP infection .A high dose of ceftazidime-avibactam may improve the efficacy without obvious side effects .

Radiological features of follicular dendritic cell tumor of spleen / 中华放射学杂志

Objective To summarize the radiological features of follicular dendritic cell tumor of spleen (FDCS).Methods The clinical, radiological and pathological data of 8 patients from November 2011 to November 2017 in 5 hospitals with FDCS confirmed by pathology were retrospectively analyzed. All patients underwent CT examinations including plan and enhanced CT. Three patients underwent additional MRI and two patients underwent PET‐CT examinations simultaneously. The imaging features such as location, number, shape, boundary, size, internal structure, density (or signal, 18F‐fluorodeoxyglucose uptake), enhancement model and the relationship with surrounding structures were observed and compared with pathological results. Results Of the 8 patients with FDCS, 7 were located in the spleen and 1 was located in the spleen of the ectopic spleen of the pancreas. Seven patients with splenic FDCS underwent splenectomy and 1 patient with pancreatic ectopic spleen FDCS underwent resection of the pancreas. Multiple lesions were detected in 1 case, while single in the others. Tumor was round or oval. The tumors were well‐circumscribed and presented as expansive growth. On unenhanced CT, the tumors showed a slightly lower density, and hemorrhage and necrosis could be detected in 6 lesions. Calcification was seen in 1 case, significant necrosis, and cystic change was presented in the pancreatic ectopic spleen FDCS. The solid part presented isointensity or slightly hypointensity on T1WI, and hyperointensity on T2WI. Cystic necrosis areas were hypointensitive on T1WI, and hyperointensitive on T2WI. Spoke‐like areas with hypointensity on T1WI and hyperointensity on T2WI were detected in the center of the solid part with the distribution among the substantial degenerative and necrotic regions. PET‐CT showed that the 18F‐fluorodeoxyglucose was uptaked obviously. The enhancement CT showed that at the arterial phase, the tumors were markedly enhanced and continuously enhanced at portal vein phase and balance phase. Multiple liver metastases were detected in 1 case with huge FDCS. One patient was followed up for 6 years, and gastric lymphoma was detected. The others were followed up for 6 to 53 months, there remained no transfer or recurrence.Conclusions The features of FDCS of spleen mainly manifest as solid or cystic mass with clear solitary sphenoma accompanied by scarring, calcification and hemorrhage. The enhancement mode is persistent enhancement. MRI and PET‐CT help to further reflect the tumor pathological basis and biological characteristics.

Clinical observation of continuous and intermittent application of lamivudine or entecavir resistance mutations in patients with chronic hepatitis B / 中华肝脏病杂志

Objective@#To observe continuous and intermittent application of lamivudine or entecavir resistance mutations in patients with chronic hepatitis B.@*Methods@#Data of patients with active stage of chronic hepatitis B over the past 6 years were collected and analyzed retrospectively. The incidence of drug resistance mutation and related factors between patients taking LAM or ETV continuously and intermittently were compared with those taking LAM or ETV. Data comparison was performed using χ2 test.@*Results@#Patients with HBV DNA≥105 copies / ml at the time of initial treatment had higher resistance mutation rates than those with HBV DNA < 105 copies / ml at either continuous or intermittent treatment, and patients with intermittent treatment had higher resistance mutation rates than those with continuous treatment. Simultaneously, the incidence of drug resistance mutation in LAM and ETV in the first, second and third years were significantly higher in intermittent treatment than that of continuous treatment (P < 0.05). There was a positive correlation between the frequency of drug withdrawal and the rate of drug resistance mutation. There were no individual difference and drug difference between LAM and ETV.@*Conclusion@#In the treatment of chronic hepatitis B with oral nucleoside analogues, drug resistance may occur in either continuous or intermittent treatment. When comparing continuous with intermittent treatment, it suggests that intermittent is more likely to cause viral resistance mutation.

Visual Eye movement-vestibular ocular balance assessment in the diagnosis of central and peripheral vertigo / 中国综合临床

Objective To explore the role of visual oculomotor-vestibular eye balance function in the diagnosis of central and peripheral vertigo. Methods From January 2015 to June 2016,one hundred and sixty-two patients with central vertigo who were treated at Kailuan General Hospital were enrolled in the study, including 124 males and 38 females, aged ( 64. 09 ± 10. 98 ) years old; there were 166 cases of peripheral vertigo,75 males and 91 females,aged (52. 13±12. 20) years old. Spontaneous nystagmus test,gaze test,position test, saccade test, smooth visual tracking test, visual single-speed test, visual sinus test, swivel chair rotation- emergency stop test using infrared video nystagmus and static balance posture instrument,open-closed eye hard plate erect test, open-closed eye sponge soft bottom erect test balance function electrophysiological test were conducted. Results The detection rate of pathological spontaneous nystagmus and pathological gaze nystagmus was higher in the central vertigo group than that in the peripheral vertigo group (χ2=5. 674,16. 458,P<0. 05) . The occurrence rate of positional nystagmus was higher in peripheral vertigo group than that in central vertigo group (χ2=48. 896,P<0. 001). The abnormal rate of scanning test,stable visual tracking test,visual movement single speed and sinusoidal test,and static balance posture test were higher in the central vertigo group than those in the peripheral vertigo group (χ2 =137. 169, 166. 972, 150. 877, 150. 877, 27. 273, P<0. 001 ) , while the abnormal rate of rotating chair sudden stop test was higher in the central vertigo group than that in the peripheral vertigo group (χ2=51. 000,P<0. 001) . The abnormal results were mainly scanned underflush and slow scan in central vertigo group (χ2=103. 846,4. 296,P<0. 05),stable visual tracking curve (χ2=147. 389,4. 296,P<0. 05) in type III-IV,and the gain of nystagmus decreased unilaterally and bilaterally (χ2=47. 531,44. 477, 52. 529,53. 255,P<0. 001) . Anomalies of proprioception in reverse and vertical nystagmus and static balance posture were induced by rotating chair sudden stop test (χ2=11. 847, 23. 778, P<0. 001 ) , while peripheral vertigo group showed unilateral decrease of nystagmus gain induced by rotating chair sudden stop test. (χ2=79. 771, P < 0. 001 ) . Conclusion The patients with peripheral vertigo have obvious body position spontaneous vestibular response and vestibular oculomotor system dysfunction, while the patients with central vertigo mainly have visual and oculomotor system dysfunction,and may be accompanied by vestibular oculomotor system and vestibular spinal reflex dysfunction.

Compensatory effects of grade Ⅰ compensatory circulation on hemodynamics in the distal occlusion of internal carotid artery / 中国综合临床

Objective To analyze the hemodynamic changes of cerebral arterial collateral circulation and distal perfusion of cerebral arteries after external carotid artery occlusion (EICAO).Methods Ninety-six patients with EICAO were selected as the case group,of which 46 cases of left EICAO (group A),50 cases of right EICAO (group B) and 30 normal volunteers were selected as the control group.Color Doppler ultrasonography (TCD) was used to detect peak systolic velocity (Vs) in the middle cerebral artery (MCA),end diastolic velocity (Vd),mean blood flow velocity (Vm),pulsatility index (PI),hemodynamic parameters of arteries,and opening rate of grade Ⅰ anterior communicating artery (ACOA) and posterior communicating artery (PCOA).Results There were significant differences in Vs,Vm,Vd,and PI among group A,B and C (F =56.046,31.027,39.283,18.614,49.658,24.992,15.035,22.069,P＜ 0.001).The Vs,Vd,Vm,and PI of the left MCA in the group A were significantly lower than those of the left side in the control group (P＜0.01);the Vs,Vd,Vm,and PI of the right MCA in the group B were significantly lower than those of the right side in the control group (P＜0.01).In group A and B,the open rate of simple ACOA in the stage Ⅰ collateral circulation was 26.09％ and 30.00％.The open rate of PCOA alone was 23.91％ and 36.00％,respectively,and the concurrent opening rate of ACOA and PCOA was 36.96％ and 30.00％,respectively,There was no significant difference in the open rate of grade Ⅰ collateral circulation among the three types of blood vessels (x2 =0.223,2.881,0.808,P=0.637,0.090,0.369).The incidence of cerebral infarction at the MCA donor site in the group A was 60.87％ on the left side and 8.70％ on the right side.The data of the left side was significantly higher than that of the right side (x2 =57.165,P＜0.001).The incidence of cerebral infarction at the MCA in the group B was 14.00％ on the left side and 60.00％ on the right side,and the data of the fight side was significantly higher than that of the left side (x2 =43.436,P＜ 0.001).Conclusion Although there is a higher grade Ⅰ collateral circulation opening rate in patients with EICAO,the MCA blood supply area of the distal internal carotid artery is still in a state of low blood flow perfusion,and the incidence of cerebral infarction is also high,so opening the grade Ⅰ collateral circulation does not completely reduce the risk of cerebral infarction in these patients,and these patients are still at high risk of cerebral infarction.

A case of vocal cord contact granuloma after vocal cord polyp surgery / 临床耳鼻咽喉头颈外科杂志

The vocal cord polyp is easy to relapse after surgery, but if the patient has recurrence in a short term, it is necessary to consider it as postoperative vocal cord contact granuloma. If the patients with contact granuloma after surgical treatment had severe impact on the pronunciation, it is necessary to be operated and confirmed by pathology and given the treatment of acid suppression, in order to avoid postoperative recurrence.

Risk factor analysis of cognitive impairment of elderly patients after cerebral infarction / 中国综合临床

Objective To explore the risk factors of cognitive impairment of elderly patients with cerebral infarction in order to provide the theoretical basis for the clinical intervention. Methods A total of 237 cases with senile cerebral infarction were selected as ours subjects who were hospitalized from Mar. 2010 to Jun. 2013 in Kailuan General Hospital Affiliated to Hebei United University. The general condition and medical history were recorded. The auxiliary examination was performed. Cerebral infarction was diagnosed based on the onset to diagnosis standard and MoCA scores of within 2 weeks. The patients with less than 26 MoCA score were diagnosed as cognitive dysfunction and otherwise were thought as normal. Single factor analysis methods and non conditional Logistic regression were applied to analyze the analysis. Results There was no significant difference in terms of incidence between patients with different gender. Patients with age more than 75 years old and lower education levels had the high incidence rate than those with younger age and high education levels( χ2=16. 661,5. 453;P﹤0. 05). The cognitive dysfunction incidence of patients with white collar was lower than those with blue collar(χ2 = 5. 458,P ﹤ 0. 05 ). And the cognitive dysfunction incidence of patients with hypertention,diabetes,heart disease and leukoaraiosis were higher than those without the above diseases(χ2 =28. 423,5. 621,7. 768,6. 070;P﹤0. 05). The incidence of patients smoking more was significantly higher than that of smoking less or no(χ2 =5. 045,P ﹤0. 05 ). Multiple factors and non conditional Logistic regression analysis showed that,67 Senile cerebral infarction patients occurred cognitive impairment within 2 weeks. The independent risk factors for its occurrence included age greater than 75 years( P=0. 000 ),diabetes mellitus( P=0. 043),hypertension(P=0. 000)and leukoaraiosis(P=0. 041). Conclusion There are many risk factors related to cognitive impairment after cerebral infarction occurred in the elderly. The intervention should take in many aspects and the risk factors should early found.

The correlations of chronic rhinonasal diseases and chronic obstructive pulmonary disease / 临床耳鼻咽喉头颈外科杂志

Chronic rhinonasal diseases and chronic obstructive pulmonary disease (COPD) cause impairment to the quality of life, increase the hospitalization and mortality. But we know little about the relationship between chronic rhinonasal disease (such as rhinitis, sinusitis, nasal polyps and so on) and COPD. This review aimed to reveal the correlation of rhinonasal disease and COPD, as in epidemiology, mechanism, clinical presents, treatment and so on.

Prospective study of serum uric acid and risk of brain infarction / 中华神经科杂志

Objective To prospectively investigate the association between serum uric acid concentration and the risk of brain infarction in Chinese adults.Methods In this prospective cohort study,a total of 95 738 participants (aged 18-98 years old) were included and were categorized into sex-specific quintiles according to serum uric acid concentration which were collected during 2006-2007 by health examinations.The study was followed up for an average of 4 years.We used Cox regression models to calculate hazard ratios (HR) and their 95％ confidence intervals (CI).Results (1) Higher concentrations of serum uric acid were associated with older age,obesity,higher blood pressure,higher serum concentrations of total cholesterol,triglycerides,and high sensitivity C-reactive protein,smoking,alcohol drinking,history of hypertension,hyperlipidemia and atrial fibrillation,and antihypertensive medication use.(2) The incidence of brain infarction for sex-specific quintiles were 0.84％ (33/3913),0.35％ (14/3985),0.44％(17/3888),0.54％ (21/3909),0.91％ (35/3860) in women (x2 =15.676,P =0.003) and 1.18％(180/15 238),1.26％ (191/15 170),1.11％ (170/15 323),1.45％ (221/15 216),1.82％ (277/15 236)in men (x2 =36.641,P =0.000).(3) After adjusting for potential confounders,including age,body mass index,blood pressure,fasting plasma glucose,total cholesterol,triglyceride,smoking,alcohol,and medical history of major chronic conditions and antihypertensive medication use,the HR (95％ CI) of brain infarction across serum uric acid quintiles were 2.06 (1.14-3.72),0.91 (0.45-1.84),1.00 (ref),1.11 (0.58-2.09),1.31(0.73-2.34) in women and 1.07 (0.86-1.34),1.02 (0.47-2.25),1.00 (ref),1.23(1.00-1.52),1.24(1.01-1.52) in men.Conclusions In this prospective cohort study,we find a U-shaped relationship between serum uric acid concentrations and brain infarction,a higher risk of developing brain infarction in association with low or high serum uric acid concentrations.Women with lowest or highest serum uric acid concentrations and men with higher serum uric acid concentrations are more likely to develop brain infarction.This probably because women have lower serum uric acid concentrations relative to men.Confirmation of our findings in larger cohorts with longer follow-up duration is warranted.