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Objective:High-throughput screening to obtain small molecular compounds against Gram-negative bacilli by targeting BamA outer membrane protein.Methods:The sybyl-X2.1 software was used to perform high-throughput virtual screening of small molecular compounds in Chemdiv compound library based on the molecular docking. The top 150 hits by high-throughput screening were re-screened through in vitro biological experiments. The top 4 small molecules with obvious antibacterial activity were selected for in-depth molecular docking analysis, and the small molecule 8308-0401 with the highest docking score was selected for further experiments. The antibacterial effect of 8308-0401 combined with rifampicin was tested by checkerboard assay. Finally, the affinity between 8308-0401 and BamA was tested by plasma surface resonance assay. Results:The docking score of the top 150 hits calculated by high-throughput virtual screening had a mean value of 5.63. In vitro biological experiments showed that small molecules 8308-0401, 8365-1335, C066-2507 and L582-0346 exhibited strong antibacterial activity. Among those molecules, 8308-0401 showed the highest molecular docking score, and synergistic antibacterial activity against both types of strains and clinical isolates when combined with rifampicin. 8308-0401 has a strong affinity to BamA with binding a constant of 182 μmol/L. Conclusion:The small molecule 8308-0401 exerts antibacterial activity against Gram negative bacilli by targeting the outer membrane protein BamA.
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Objective:To investigate the quality of life in patients with early-stage extra-nodal NK/T cell lymphoma of nasal type (ENKTL) arising from the upper aerodigestive tract, who had remained progression-free survival (PFS) for over 3 months after definitive intensity-modulated radiation therapy (IMRT), and to analyze the factors related to main adverse symptoms.Methods:276 patients who received IMRT from March, 2012 to June, 2021 were included. There were 201 males and 75 females with a median age of 41.5 years (range: 13-81 years) upon diagnosis. Consistent target delineation schemes and similar dose gradients were adopted for IMRT, with a median prescribed dose of 54.6 Gy/26F. Cross-sectional investigation was performed with a modified EORTC QLQ-H&N35 questionnaire, the incidence and severity of adverse symptoms, severity of disease and their influencing factors at each time-point during their survival were statistically analyzed.Results:The median age of patients at the investigation was 46.2 years, and the median PFS after IMRT was 47.2 months (range: 3.1-115.7 months). The most common adverse symptoms included nasal symptoms (incidence rate 63.8%), dry mouth (50%), tooth diseases (47.1%), smell and taste alteration, and sexual apathy, etc. Most symptoms were mild (the average standardized score was 5.50, the full score of 100 indicating the most severe), and could be relieved remarkably over survival time, but some symptoms, such as tooth diseases and sexual apathy, were more obvious and recurred for several years. Age and anti-PD-1 immune therapy influenced the symptom scores, and tooth diseases were closely correlated with dry mouth. Conclusion:The quality of life in patients with early-stage ENKTL after definitive IMRT is high, and the most significant symptoms include nasal symptoms, tooth diseases, and sexual apathy, etc. , which need to be mitigated with more studies.
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Objective:To analyze and compare the clinical characteristics and prognosis of imported patients infected with 2019 novel coronavirus (2019-nCoV) Omicron variants and Delta variants, so as to provide references for clinical diagnosis, treatment and epidemic prevention strategies.Methods:The patients with imported 2019-nCoV infection from August 1, 2021 to January 18, 2022 in Guangzhou Eighth People′s Hospital, Guangzhou Medical University were retrospectively analyzed. According to the whole genome sequencing of 2019-nCoV in nasal or throat swabs, they were divided into Omicron group and Delta group. The clinical characteristics, laboratory tests, antibody levels, viral nucleic acid (the cycle threshold (Ct) of N gene and open reading frame ( ORF) 1 ab), main treatment measures and clinical prognosis were analyzed in the two groups. Statistical analysis was performed using the rank sum test, chi-square test or Fisher′s exact test. Results:A total of 344 cases were enrolled, including 152 cases in the Delta group and 192 cases in the Omicron group, and there were 240 males (69.8%), with a median age of 33 years old. One hundred and two (29.7%) of those patients had underlying disease.Two hundred and seventy-one had completed full or booster vaccination. The overall full vaccination rate in Omicron group was 70.8%(136/192), which was higher than 51.3%(78/152) in Delta group. The proportion of mild patients in Omicron group was higher than that in Delta group (57.3%(110/192) vs 24.3%(37/152), respectively), and the proportions of common type and severe type were lower than those of the Delta group (33.9%(65/192) vs 55.3%(84/152) and 0(0/192) vs 10.5%(16/152)), the differences were all statistically significant ( χ2=37.64 and 15.84, respectively, Fisher′s exact test; all P<0.001). The duration and peak of fever in Omicron group were 1.5(1.0, 2.0) d and 38.1(37.8, 38.5) ℃, respectively, which were lower than those in Delta group (3.0(1.0, 4.8) d and 38.5(38.1, 39.0) ℃, respectively), and the differences were both statistically significant ( Z=-4.14 and -3.85, respectively, both P<0.001). The 2019-nCoV antibody IgG and the Ct values of virus nucleic acid N gene and ORF1 ab gene in the vaccinated Omicron group at admission were higher than those in the Delta group ( Z=-3.25, -2.18 and -2.82, respectively, all P<0.050). Compared with patients in Delta group, patients in Omicron group had lower proportion of receiving respiratory therapy support, shorter oxygen therapy time, shorter reversion time from admission to nucleic acid Ct value≥35 and shorter hospitalization time. The differences were all statistically significant ( χ2=47.86, Z=-5.41, -5.60 and -4.71, respectively, all P<0.001). There was no critical illness or 28-day death case in both groups. Conclusions:The severity of patients infected with Omicron variants is lighter than that of patients with Delta variants, and the viral nucleic acid has shorter conversion time, which is mainly related to the virulence of variant strain and vaccination.
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Polyphosphate kinase plays an important role in the catalytic synthesis of ATP in vitro. In order to find a polyphosphate kinase that can efficiently synthesize ATP using short-chain polyphosphate (polyP) as substrate, the polyphosphate kinase 2 (PPK2) from Sphingobacterium siyangensis was cloned and expressed in Escherichia coli BL21(DE3). As an enzyme for ATP regeneration, PPK2 was used in combination with l-amino acid ligase (YwfE) to produce l-alanyl-l-glutamine (Ala-Gln). The length of ppk2 of S. siyangensis is 810 bp, encoding 270 amino acids. The SDS-PAGE showed that PPK2 was expressed correctly and its molecular weight was 29.7 kDa as expected. The reaction conditions of PPK2 were optimized. PPK2 could maintain good activity in the range of 22-42 ℃ and pH 7-10. The highest enzyme activity was observed at 37 ℃, pH 7, 30 mmol/L magnesium ion (Mg2+), 5 mmol/L ADP and 10 mmol/L sodium hexametaphosphate, and the yield of ATP reached 60% of the theoretical value in 0.5 hours at this condition. When used in combination with YwfE to produce Ala-Gln, the PPK2 showed a good applicability as an ATP regeneration system, and the effect was similar to that of direct addition of ATP. The PPK2 from S. siyangensis shows good performance in a wide range of temperature and pH, synthesizes ATP with cheap and readily available short chain polyP as substrate. The PPK2 thus provides a new enzyme source for ATP dependent catalytic reaction system.
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Sphingobacterium/metabolism , Phosphotransferases (Phosphate Group Acceptor)/metabolism , Amino Acids , Adenosine Triphosphate , Regeneration , Polyphosphates/metabolismABSTRACT
Objective:To investigate the safety and efficacy of nimotuzumab combined with IMRT radiotherapy in the treatment of elderly patients with locally advanced cervical cancer (LACC).Methods:A retrospective analysis was conducted for 34 elderly LACC patients treated with nimotuzumab combined with IMRT radiotherapy or concurrent chemoradiotherapy in the Zhangzhou Affiliated Hospital of Fujian Medical University from June 2020 to December 2021. The efficacy and side effects were evaluated one and two years after treatment.Results:Median follow-up time was 13.3 months (6.1-24.3 months). A total of 24 cases of complete response (CR) and eight cases of partial response (PR) were achieved after treatment, with an objective response rate (ORR) of 94.1% (32/34). The tumor diameters were (49.56 ± 19.22) mm before treatment and (19.61 ± 14.59) mm after treatment, with a tumor regression rate (TRR) of 59.22%.The 1- and 2- year progression-free survival (PFS) rates were 84.9% and 84.9%, overall survival (OS) rates 91.8% and 87.2%, respectively, disease-free survival (DFS) rates 91.8% and 87.2%, respectively, and the cancer-specific survival (CSS) rates 95.7% and 90.9%, respectively. The main adverse events included radiation enteritis, leukopenia, hypoproteinemia and anemia.Conclusions:Nimotuzumab combined with IMRT radiotherapy or concurrent chemoradiotherapy is safe and effective in the treatment of LACC.
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Objective:To evaluate the effect of Xuebijing injection on the improvement of pneumonia severity index (PSI) and prognosis in patients with severe coronavirus disease 2019 (COVID-19).Methods:A multicenter prospective cohort study was designed. Adult patients with COVID-19 admitted to the intensive care unit (ICU) of 28 designated COVID-19 hospitals in 15 provinces and cities of China from January to March 2020 were enrolled. All patients were treated according to the standard treatment plan of COVID-19 issued by the National Health Commission of the People's Republic of China. They were divided into Xuebijing group and standard treatment group according to whether they received Xuebijing injection or not. In the standard treatment group, routine medical care measures such as antiviral, respiratory support, circulatory support and symptomatic treatment were taken. In the Xuebijing group, on the basis of standard treatment, Xuebijing was used within 12 hours of admission to the ICU, 100 mL each time, twice daily. The minimum duration of Xuebijing administration was 1 day. The improvement rate of PSI risk rating on the 8th day and clinical outcome on the 28th day were recorded.Results:A total of 276 COVID-19 patients were screened continuously, and the data of 144 severe patients who met PSI risk rating Ⅲ-Ⅴ were analyzed. Seventy-two cases were involved each in standard treatment group and Xuebijing group. The average age of the standard treatment group and Xuebijing group were (65.7±7.9) years old and (63.5±10.9) years old, and male accounted for 75.0% (54/72) and 70.8% (51/72), respectively. There were no significant differences in general conditions, comorbidities, PSI risk rating and score, sequential organ failure assessment (SOFA) score, oxygenation index (PaO 2/FiO 2), respiratory support mode and other baseline indicators between the two groups. Compared with the standard treatment group, the improvement rate of PSI risk rating in Xuebijing group on the 8th day after admission was significantly improved [56.9% (41/72) vs. 20.8% (15/72), between-group difference and 95% confidence interval (95% CI) was 36.1% (21.3% to 50.9%), P < 0.01], PSI score, SOFA score and PaO 2/FiO 2 were significantly improved [PSI score: 83.7±34.8 vs. 108.2±25.6, between-group difference (95% CI) was -24.5 (-34.9 to -14.1); SOFA score: 2.0 (1.0, 4.0) vs. 7.0 (4.0, 10.0), between-group difference (95% CI) was -3.5 (-5.0 to -2.0); PaO 2/FiO 2 (mmHg, 1 mmHg = 0.133 kPa): 289.4±111.6 vs. 188.5±98.1, between-group difference (95% CI) was 100.9 (65.3 to 136.5); all P < 0.01]. The 28-day discharge rate of Xuebijing group was 44.5% higher than that of standard treatment group [66.7% (48/72) vs. 22.2% (16/72), P < 0.01], and the 28-day survival rate was 9.8% [91.7% (66/72) vs. 81.9% (59/72), P < 0.01]. There was no significant difference in the combination of antiviral drugs, antibiotics, anticoagulants and vasopressor drugs between the two groups. There was no significant difference in the incidence of adverse events between the Xuebijing group and standard treatment group [41.7% (30/72) vs. 43.1% (31/72), P > 0.05], and no serious adverse events and adverse reactions of Xuebijing were reported. Conclusion:Standard treatment combined with Xuebijing injection can significantly improve the PSI risk score and clinical prognosis of patients with severe COVID-19 without increasing drug safety risk.
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Objective:To summarize the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) infected with Delta variant, so as to provide further references for clinical diagnosis and treatment.Methods:A real-world study was conducted to analyze the characteristics of 166 COVID-19 patients infected with Delta variant at Guangzhou Eighth People’s Hospital, Guangzhou Medical University.Results:The study enrolled 5 asymptomatic cases, 123 non-severe cases (mild and moderate type), and 38 severe cases (severe and critical type). Among these patients, 69 (41.6%) were male and 97 (58.4%) were female, with a mean age of 47.0±23.5 years. Thirty-nine cases (23.5%) had received 1 or 2 doses of inactivated vaccine. The incidence of severe COVID-19 cases was 7.7% in 2-doses vaccinated patients, which was lower than that of 11.5% in 1-dose and 26.8% in unvaccinated patients. The proportion of severe cases in 2 dose-vaccinated patients was 7.7%, which was lower than that of 11.5% in 1-dose vaccinated patients and 26.8% in unvaccinated patients, but the difference was not significant ( P>0.05). The most common clinical symptom was fever (134 cases, 83.2%), and 39.1% of cases presented with high-grade fever (≥39 °C); other symptoms were cough, sputum, fatigue, and xerostomia. The proportion of fever in severe cases was significantly higher than that of non-severe cases (97.4% vs. 76.4%, P<0.01). Similarly, the proportion of severe cases with high peak temperature (≥39 ℃) () was also higher than that of non-severe cases (65.8% vs. 30.9%, P<0.01). The median minimal Cycle threshold (Ct) values of viral nucleic acid N gene and ORFlab gene were 20.3 and 21.5, respectively, and the minimum Ct values were 11.9 and 13.5, respectively. Within 48 h of admission, 9.0% of cases presented with decreased white blood cell counts, and 52.4% with decreased lymphocyte counts. The proportions of increased C-reactive protein, serum amyloid A, interleukin 6, and interleukin 10 were 32.5%, 57.4%, 65.3%, and 35.7%, respectively. The proportions of elevated C-reactive protein, serum amyloid A and interleukin-6 in severe cases were significantly higher than those in non-severe cases ( P<0.01). Logistic regression analysis showed that older age and higher peak temperature were associated with a higher likelihood of severe cases ( OR>3, 95% CI: 2-7, P<0.01). In terms of treatment, traditional Chinese medicine (TCM) was used in 97.6% of non-severe cases and 100% in severe cases. Other treatments included respiratory and nutritional support, immunotherapy (such as neutralizing antibodies and plasma of recovered patients). The median times from admission to progression to severe cases, of fever clearance, and of nucleic acid conversion were 5 days, 6 days and 19 days, respectively. No deaths were reported within 28 days. Conclusions:The symptoms of Delta variant infection in Guangzhou are characterized by a high proportion of fever, high peak temperature, long duration of fever, high viral load, a long time to nucleic acid conversion, and a high incidence of severe cases. The severe cases exhibit a higher percentage of elderly patients, a longer duration of fever and have a higher fever rate and a higher hyperthermia rate than non-severe cases. Age and hyperthermia are independent risk factors for progression to severe disease. The combination of TCM and Western medicine can control the progression of the disease effectively.
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Influenza virus is one of the common pathogens causing acute respiratory infectious diseases, and is easy to cause acute respiratory distress syndrome (ARDS) after infecting human body, which is an important cause of death of influenza patients. Influenza-induced ARDS results from a combination of overwhelming inflammation and immune response, causing tissue damage and apoptosis. Furthermore, virus-mediated oxidative stress is another important mechanism. Viral infection can produce excessive reactive oxygen species, which damage the epithelial-endothelial barrier with pulmonary edema. In this content, numerous studies have highlighted the importance of antioxidants as a new therapy aimed at blocking both viral replication and virus-induced inflammation. Therefore, this paper summarizes the epidemiology and mechanisms of influenza-induced ARDS, the role of oxidative stress in the occurrence and development of influenza-related ARDS and the role of antioxidants in anti influenza virus infection, in order to provide reference for effective treatment of influenza patients, reducing mortality, developing new anti influenza drugs and preventing and controlling influenza epidemic.
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Objective:To investigate the incidence and risk factors of human cytomegalovirus (HCMV) reactivation in immunocompetent severe pneumonia patients with mechanical ventilation and their effects on clinical outcomes.Methods:A prospective observational study was conducted. Forty-eight immunocompetent patients requiring invasive mechanical ventilation due to severe pneumonia in the department of critical care medicine of the First Affiliated Hospital of Guangzhou Medical University from June 30th, 2017 to July 1st, 2018 were enrolled. Meanwhile, all cases were followed up until 90 days after inclusion and were required to quantitatively detect HCMV DNA in serum at regular weekly intervals until 28 days after transferring to intensive care unit (ICU). Patients were divided into HCMV reactivation group (≥5×10 5 copies/L) and non-reactivation group (<5×10 5 copies/L) based on HCMV DNA at any time point within 28 days. Demographic data, basic indicators, respiratory indicators, disease severity scores, laboratory indicators, complication and clinical outcomes of the two groups were collected and analyzed. Multivariate Logistic regression analysis was performed to screen independent risk factors for HCMV reactivation. Results:All 48 subjects were tested positive for HCMV immunoglobulin G (IgG), so HCMV seropositive rate was 100%. HCMV reactivation occurred in 10 patients within 28 days after admission to ICU, and the reactivation incidence of HCMV was 20.83%. There was no significant difference in gender, age, body mass index (BMI), underling disease reasons for ICU transfer (except sepsis), basic vital signs, disease severity scores, or laboratory findings including infection, immune, blood routine, liver, kidney and circulatory indicators except neutrophils count (NEU), hypersensitivity C-reactive protein(hs-CRP), hemoglobin (Hb), blood urea nitrogen (BUN), N-terminal pro-brain natriuretic peptide (NT-proBNP) between the two groups. The height (cm: 160±6 vs. 166±8), body weight (kg: 49.4±11.2 vs. 57.6±10.5), Hb (g/L: 87±18 vs. 104±24) in HCMV reactivation group were significantly lower than non-reactivation group, as well as NEU [×10 9/L:12.7 (9.9, 22.5) vs. 8.9 (6.2, 13.8)], hs-CRP [mg/L: 115.5 (85.2, 136.6) vs. 39.9 (17.5, 130.2)], BUN [mmol/L:13.7 (8.9, 21.5) vs. 7.1 (4.9, 10.5)] and NT-proBNP [ng/L: 6 751 (2 222, 25 449) vs. 1 469 (419, 4 571)] within 24 hours of admission to ICU. The prevalence of sepsis [60.0% (6/10) vs. 15.8% (6/38)], blood transfusion [100.0% (10/10) vs. 60.5% (23/38)], hospitalization expense [ten thousand yuan: 35.7 (25.3, 67.1) vs. 15.2 (10.4, 22.0)], 90-day all-cause mortality [70.0% (7/10) vs. 21.1% (8/38)], length of ICU stay [days: 26 (16, 66) vs. 14 (9, 19)], the duration of mechanical ventilation [days: 26 (19, 66) vs. 13 (8, 18)] in HCMV reactivation group were significantly higher than non-reactivation group, and there were significant statistical differences between the two groups (all P < 0.05). Logistic regression analysis showed that sepsis was an independent risk factor for HCMV reactivation in immunocompetent mechanical ventilation severe pneumonia patients with mechanical ventilation [odds ratio ( OR) = 9.35, 95% confidence interval (95% CI) was 1.72-50.86, P = 0.010]. Conclusions:HCMV infection is very common in immunocompetent severe pneumonia patients on mechanical ventilation and incidence of HCMV reactivation is high. Moreover, HCMV reactivation could adversely affect clinical prognoses, and sepsis may be a risk factor for HCMV reactivation.
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Objective:To describe the long-term outcomes of intensive care unit (ICU) survivors of mechanical ventilation, and investigate the views of survivors on ICU rehabilitation clinics.Methods:A single-center cross-sectional descriptive study was designed. ICU survivors of mechanical ventilation admitted to the First Affiliated Hospital of Guangzhou Medical University from January to December 2016 were enrolled. Data were collected from August 2017 to March 2018. The general information questionnaire, Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and ICU rehabilitation clinics questionnaire were used to evaluate ICU survivors social-demographic factors, social and economic outcomes, clinical data, quality of life and the views on ICU rehabilitation clinics.Results:A total of 248 ICU survivors of mechanical ventilation were included in the study, 130 (52.4%) of them were followed up successfully. The mean time from ICU discharge to follow-up day was (19.64±3.20) months. The average age of the survivors was (60.09±15.42) years old, and 55.4% of them were over 60 years old. Among 130 ICU survivors, severe pneumonia was the dominant ICU admission diagnosis (23.1%), followed by surgical operations (cardiac surgery 16.9%, other surgical operations 20.8%), lung transplantation (13.1%), and acute exacerbation of chronic obstructive pulmonary disease (AECOPD, 12.3%), etc. The first APACHEⅡ score after ICU admission was 16.88±7.37, the mechanical ventilation time was (12.52±12.34) days, and the length of ICU stay was (16.71±15.11) days. In terms of social and economic outcomes, the proportion of having full-time or part-time jobs decreased from 32.3% (42/130) before ICU admission to 25.4% (33/130) by the date of follow-up, while the unemployed rate increased from 6.9% (9/130) to 18.5% (24/130). Only 45.1% (23/51) of the ICU survivors returned to the post before ICU admission. 36.2% (47/130) of the ICU survivors reported that they needed care from others, and 86.9% (113/130) reported that their treatment experiences in ICU had an impact on their lives. In terms of quality of life, physiological function dimension, which was 34.62±33.15, scored the lowest and suffered the most. The physical pain dimension and mental health dimension suffered the least, and the scores were 90.19±16.98 and 75.28±15.15, respectively. Furthermore, physical component summary (PCS) score was 61.12±17.09, and mental component summary (MCS) score was 65.97±21.85. In terms of the views of ICU rehabilitation clinics, 68.5% (89/130) of the subjects believed that the establishment of ICU rehabilitation clinics was very helpful or helpful.Conclusions:The long-term outcomes of ICU survivors of mechanical ventilation are not optimistic. Their quality of life is lower than that of general people. It is necessary to set up ICU rehabilitation clinics.
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To study the risk factors and the clinical characteristics of non-tuberculous mycobacterial (NTM) pulmonary diseases in patients with mechanical ventilation. Methods Retrospective survey was carried out in the patients with mechanical ventilation who combined with NTM pulmonary disease admitted to intensive care unit (ICU) of the First Affiliated Hospital of Guangzhou Medical University from May 2016 to May 2019. The general information, basic diseases, symptoms, signs, biochemical examinations, acid-fast stain test, mycobacterium culture and strain identification results, and chest CT data were collected to summarize the clinical characteristics of patients with mechanical ventilation combined with NTM pulmonary disease. Results There were 12 patients with mechanical ventilation combined with NTM pulmonary disease, 6 males and 6 females, 37-82 years old, with an average age of 65 years. In these 12 cases, patients with cancer (lung cancer were 4 cases, mediastinal tumor was 1 case) and after lung transplantation (use of anti-rejection drugs at the same time) were 5 and 2 respectively. Patients with at least 3 underlying diseases [included hypertension, diabetes, coronary heart disease, chronic obstructive pulmonary disease (COPD), bronchiectasis, chronic renal insufficiency] were 5. Clinical symptoms of the 12 cases were non-specific. The CT findings were not characteristic, including nodules, patchy infiltrations and fibrous streak. Pleural effusion was common among these subjects but nodular bronchiectatic patterns were absence. Routine laboratory indicators of bacterial infection were non-specific. But the number of lymphocytes of all cases decreased. Mycobacteria cultures were positive with the rapid growth of mycobacteria in these 12 cases. Mycobacterium avium (4 cases), Mycobacterium chelonae (4 cases), Mycobacterium chelonae-abscessus complex (2 cases) and Mycobacterium intracellulare (2 cases) were isolated. Anti-NTM therapy was given to the patients when the acid-fast staining test of their airway secretion was positive and the TB-DNA test was negative, including oral levofloxacin and clarithromycin. Finally, all patients were successfully weaned and discharged from ICU. Conclusions The clinical symptoms of NTM patients with pulmonary disease are non-specific, and the imaging features of chest CT are varied. Patients with mechanical ventilation in ICU, who have the risk of immune dysfunction or underlying structural lung diseases, and who have difficult controlled lung infection, accompanied by pleural effusion and with decreased lymphocytes, should be aware that pneumonia may be caused by non-tuberculous mycobacteria.
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Artificial Intelligence are emerging as poweful tools for many field including medicine.It has be applied to radiation therapy in different degree,such as automatic OAR or tumor volume segmentation,automatic radiotherapy planning,prediction of toxicity and prognostic,etc.In this article,the research progress on Artificial Intelligence in the radiotherapy for malignant tumor was reviewed.
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Objective@#To investigate the cause of massive hemoptysis in critical patients, and to evaluate the effect of bronchial artery embolization (BAE) on critical patients with massive hemoptysis.@*Methods@#A retrospective controlled analysis was conducted. The clinical data of 35 patients with life-threatening massive hemoptysis admitted to intensive care unit (ICU) of the First Hospital Affiliated to Guangzhou Medical University from January 2009 to December 2017 were analyzed. The patients were divided into BAE and non-BAE group according to whether receiving BAE or not. BAE patients were subdivided into subgroups: hemoptysis after ventilation and hemoptysis before ventilation subgroups, as well as survival and non-survival subgroups. The etiology of all massive hemoptysis was analyzed. The gender, age, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, amount of hemoptysis, whether presence of pleural thickening in chest CT, the length of ICU stay, total length of hospital stay, the duration of mechanical ventilation (MV), clinical effective and prognostic indicators of patients were recorded. The correlation between variables was analyzed by Spearman correlation analysis.@*Results@#All 35 patients were enrolled in the finally analysis. The main cause of critical patients with massive hemoptysis was fungal infection [37.1% (13/35)], followed by pneumonia and abnormal coagulation [17.1% (6/35)], bronchiectasis [11.4% (4/35)], tumor [8.6% (3/35)], etc. In all 35 patients, 27 were treated with BAE and 8 were treated without BAE. There was no difference in gender, age, the length of ICU stay, total length of hospital stay, the duration of MV, amount of hemoptysis, APACHEⅡ score, whether use antiplatelet agents or anticoagulants, or whether presence of pleural thickening in chest CT between the two groups. The rate of hemoptysis remission in BAE group was significantly higher than that of non-BAE group [92.6% (25/27) vs. 25.0% (2/8), P < 0.01], but there was no statistically significant difference in hospital survival as compared with that of non-BAE group [48.1% (13/27) vs. 25.0% (2/8), P > 0.05]. Subgroup analysis showed that 64.3% (9/14) of patients with hemoptysis after ventilation was caused by pulmonary fungal infection, which was significantly higher than those with hemoptysis before ventilation [15.4% (2/13), P = 0.018]. Compared with hemoptysis after ventilation group, the length of ICU stay and the duration of MV in hemoptysis before ventilation group were significantly shortened [the length of ICU stay (days): 12.0 (14.0) vs. 30.0 (81.8), the duration of MV (days): 10.0 (16.0) vs. 25.0 (68.3)], the patients using antiplatelet drugs or anticoagulant drugs was decreased significantly (case: 1 vs. 9, all P < 0.05). However, there was no statistically significant difference in gender, age, total length of hospital stay, amount of hemoptysis, APACHEⅡ score, whether presence of pleural thickening in chest CT, the rate of hemoptysis remission, the incidence of secondary BAE or hospital survival rate between the two groups. Compared with the survival subgroup (n = 13), more patients in the non-survival subgroup (n = 14) were treated with antiplatelet or anticoagulants (P < 0.05); and Spearman correlation analysis showed that the survival of the patients with BAE was negatively correlated with the use of antiplatelet or anticoagulants (r = -0.432, P = 0.024). There was no significant difference in the gender, age, the length of ICU day, total length of hospitalization, duration of MV, estimated hemoptysis, APACHE Ⅱ score, or the proportion of pleural thickening between the two groups.@*Conclusions@#The study indicated that the etiology of massive hemoptysis in critical patients was complicated. Fungal infection was the main cause in patients with hemoptysis after ventilation. BAE was effective in the control of massive hemoptysis in ICU, but it was not ideal for patients with abnormal coagulation function or abnormal platelet count or platelet dysfunction from antiplatelet or anticoagulant drugs, the overall survival rate was still low.
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Objective To evaluate the efficacy, safety and risk factors of endoscopic treatment for patients with early gastric cancer. Methods A retrospective study was conducted in a single center and data was collected from 186 early gastric cancers in 168 pathologically confirmed patients who received endoscopic treatment in Peking Union Medical College Hospital from January 2006 to December 2015. The cases were divided into different groups according to indications of endoscopic treatment. The curative resection rate and complication rate were analyzed. Post-resection outcomes were evaluated by long-term surveillance. Results The curative resection rate was 86. 9%( 73/84) in the group with absolute indications, 61. 7%(50/81)in the group with expanded indications, and 33. 3%(7/21) in the group beyond indications (P＜0. 01). Multivariate analysis revealed that the significant independent predictors for curative resection included lower third location of stomach, no ulceration,≤2 cm at diameter, no adhesion, and well-differentiation in histopathology. In the expanded indications group, discordance of differentiation type and deeper invasion mainly resulted in non-curative resection in en bloc lesions. The rate of bleeding and perforation was 4. 8%( 9/186) and 3. 8%( 7/186), respectively. The perforation rate was significantly lower in the lesions located in the lower third of stomach, without adhesion or performed by en bloc resection. During a median follow-up period of 22. 3 months, 154 patients were followed successfully. The incidence of synchronous and metachronous gastric cancers in curative resected lesions was 7. 5%( 8/106) and 0. 9%(1/106), respectively. Conclusion Endoscopic resection is an optimal treatment with high curative resection rate for early gastric cancer patients with absolute indications. Patients with expanded indications should take precise preoperative evaluation to avoid higher risk of non-curative resection endoscopically. Close follow-up is necessary for synchronous and metachronous gastric cancers after endoscopic resection.
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Objective To study the accuracy of lactic dehydrogenase (LDH) in the diagnosis of pneumocystis pneumonia (PCP). Methods The data of this systemic review was retrieved from the PubMed, China Biology Medicine disc, Wanfang, Weipu and China National Knowledge Infrastructure (CNKI) databases from establishment till to October 31st, 2017. Case-control studies about the diagnosis of PCP were enrolled. Enrolled studies were required that patients in case group ware PCP and patients in control group were lung diseases other than PCP. The QUADAS tool was used to evaluate the quality of studies. The RevMan 5.3 software was used to draw a forest plot. The StataMP 14 software was used to make subgroup analyses by drawing receiver operator characteristic (SROC) curves for the whole group, the acquired immune deficiency syndrome (AIDS) group, and the not all-AIDS group, and calculating their diagnostic odds ratio (DOR) and 95% confidential interval (95%CI). Results Thirteen studies, all in English, were included. There were 825 patients in the case group, in which 650 patients were AIDS. There were 1 341 patients in control group, in which 888 patients were AIDS and most of them were Pulmonary Kaposi Sarcoma, bacterial pneumonia, pulmonary tuberculosis etc. Although there were different positive values of LDH in different studies, from 200 U/L to 598 U/L, sensitivities were good, especially in AIDS patients all values were above 80% (80%-100%). The specificities had big fluctuations, from 6% to 85%, which made them poor. The DOR (95%CI) of LDH in PCP diagnosis of all patients, AIDS patients and not-all AIDS patients were 6.73 (3.19-14.21), 9.17 (3.79-22.18) and 5.07 (1.30-19.80) respectively. Conclusions The sensitivity of LDH in the diagnosis of PCP is high, especially in AIDS group. In practice if LDH is negative, there should be more evidences to support the treatment of PCP.
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There exists unbalanced development of medical technology and uneven quality of medi-cal staff in our current medical status,so it is urgent to reform the training mode of talents. Through the analysis of the shortcomings of traditional talents training and based on the thought of training applied talents, we explore the best training model of application-oriented professionals of otolaryngology head and neck surgery which is suitable for our country's national conditions by reforming clinical teaching methods, theo-retical teaching curriculum revision and clinical skills training, in order to strengthen the quality of person-nel training.
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With the discovery of the significant medicinal value of alginate oligosaccharides and bioethanol produced by microalgae, alginate lyase has been the focus of research in all fields. Five alginate lyase genes in cluster from Vibrio alginolyticus were cloned and expressed in Escherichia coli. SDS-PAGE and enzyme activity showed that four of the five genes have the activity to degrade alginate. Optimization of the induction conditions, protein purification and enzyme properties of rAlgV3 with the highest enzyme activity were studied. The results showed that the enzyme activity of recombinant enzyme rAlgV3 increased from 2.34×10⁴ U/L to 1.68×10⁵ U/L, which was 7.3 times higher than before. The optimal reaction temperature was 40 °C, and the enzyme was relatively stable between 4 °C and 20 °C. The enzyme had a higher activity between pH 6.5 and 9.0, with the optimum pH 8.0. It showed a wide range of pH that the alginate lyase can exist stably between pH 4.5 and 9.5. Appropriate concentrations of NaCl and Fe²⁺, Fe³⁺ ions promoted enzyme activity. SDS and Cu²⁺ ions inhibited the enzyme activity. The enzyme degraded Poly-M fragments and Poly-G fragments, with a wide range of substrate properties. The degraded product of sodium alginate of rAlgV3 analyzed by ESI-MS mainly was oligosaccharides with a polymerization degree of 2 to 3, which means that rAlgV3 was an endo-type alginate lyase. This enzyme has the potential in the development of third-generation bioethanol and the production of alginate oligosaccharides.
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Objective To evaluate the clinical value of endoscopic technique in the diagnosis of early esophageal carcinoma and precancerous lesions .Methods 52 patients with early esophageal cancer and precancerous lesions in the digestive tract of Dongguan People's Hospital from January 2016 to December 2017 were selected as the research subjects and randomly divided into observation group and control group according to the digital table , with 26 patients in each group .The patients in the control group were examined and diagnosed by white light endoscopy , and the patients in the observation group were diagnosed by the endoscopic technique of digestive tract .The diagnostic value of the two techniques in patients with early esophageal cancer and precancerous lesions was compared and analyzed.Results The diagnostic rate, operation time, hospitalization time, cost and incidence rate of adverse reactions in the observation group were 84.61％,(46.43 ±4.58)min,(5.71 ±1.96)d,(1.46 ±0.39)ten thousand CNY,11.54％,which were significantly better than those in the control group [(61.53％,(89.33 ±13.44) min, (12.87 ±2.14) d,(2.93 ±0.72) ten thousand CNY,38.46％] (χ2 =15.234,t =22.652,9.025,5.142,χ2 =10.354 ,all P<0.05 ) .Conclusion Endoscopic mucosal resection can cause minimal injury to the patients .The recovery time is fast and the probability of complications is small .This treatment method is more effective in the treatment of early digestive tract tumors instead of surgery .
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Objective To understand the community transitional care in the process of development of the difficulties and problems. Methods The qualitative research method was used to conduct semi-structured interviews with community nurses and community care managers(11 cases) who met the standards and analyzed the interview data with Colaizzi 7 footwork. Results The factors that affected the effective care of the community were:there was no clear continuation of nursing service fees, lack of internal and external incentive mechanism; home service risk, no security; community human resources, job responsibilities were not clear; the mechanism was not perfect, the lack of medical cooperation with large hospitals;community nurses professional ability uneven;patients did not trust the community health service agencies, community nurses were not taken seriously. Conclusions There are many obstacles in the community to carry out continuous care, the establishment of hospital-community-family linkage type of continuous care to the government and the Ministry of Health within the practical issues for the development of effective and effective care service system and policy.
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Kluyveromyces marxianus, as unconventional yeast, attracts more and more attention in the biofuel fermentation. Although this sort of yeasts can ferment pentose sugars, the fermentation capacity differs largely. Xylose and arabinose fermentation by three K. marxianus strains (K. m 9009, K. m 1911 and K. m 1727) were compared at different temperatures. The results showed that the fermentation performance of the three strains had significant difference under different fermentation temperatures. Especially, the sugar consumption rate and alcohol yield of K. m 9009 and K. m 1727 at 40 ℃ were better than 30 ℃. This results fully reflect the fermentation advantages of K. marxianus yeast under high-temperature. On this basis, five genes (XR, XDH, XK, AR and LAD) coding key metabolic enzymes in three different yeasts were amplified by PCR, and the sequence were compared by Clustalx 2.1. The results showed that the amino acid sequences coding key enzymes have similarity of over 98% with the reference sequences reported in the literature. Furthermore, the difference of amino acid was not at the key site of its enzyme, so the differences between three stains were not caused by the gene level, but by transcribed or translation regulation level. By real-time PCR experiment, we determined the gene expression levels of four key enzymes (XR, XDH, XK and ADH) in the xylose metabolism pathway of K. m 1727 and K. m 1911 at different fermentation time points. The results showed that, for thermotolerant yeast K. m 1727, the low expression level of XDH and XK genes was the main factors leading to accumulation of xylitol. In addition, according to the pathway of Zygosaccharomyces bailii, which have been reported in NCBI and KEGG, the xylose and arabinose metabolic pathways of K. marxianus were identified, which laid foundation for further improving the pentose fermentation ability by metabolic engineering.