ABSTRACT
Objective:To investigate the clinical relationship between carbapenem-resis-tant Klebsiella pneumoniae (CRKP) infection and the severity of acute pancreatitis. Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 109 patients with acute pancreatitis who were admitted to Sir Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine from January 2017 to January 2018 were collected. There were 66 males and 43 females, aged (48±17)years. Blood, body fluid or anal swab samples of patients were collected aseptically. Patients were treated with gallbladder puncture and drainage, nasobiliary drainage, surgical debridement, computed tomography (CT) guided interventional drainage or conservative treatment, respectively, after being comprehensively diagnosed. Observation indicators: (1) severity of acute pancreatitis and results of CRKP infection test; (2) diagnostic value of CRKP infection for severity of acute pancreatitis; (3) treatment of acute pancreatitis; (4) prognosis of patients. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Spearman correlation analysis were performed for correlation analyses. The receiver operating characteristic (ROC) curve was conducted to evaluate the diagnostic value. Results:(1) Severity of acute pancreatitis and results of CRKP infection test: of 109 patients, there were 37 cases with mild acute pancreatitis, 8 cases with moderate-severe acute pancreatitis, 64 cases with severe acute pancreatitis. There were 45 cases with mild disease and 64 cases with severe disease, 48 cases with CRKP infection and 61 cases without CRKP infection. There were 3 cases and 45 cases with CRKP infection in the 45 mild disease cases and 64 severe disease cases, respectively, showing a significant difference ( χ2=43.430, P<0.05). Result of Pearson correlation analysis showed that CRKP infection was positively correlated with the severity of acute pancreatitis ( r=0.631, P<0.05). The duration of hospital stay were (66±6)days and (24±3)days for the cases with CRKP infection and cases without CRKP infection, respectively, showing a significant difference ( t=47.661, P<0.05). (2) Diagnostic value of CRKP infection for severity of acute pancrea-titis: the area under the ROC curve, sensitivity, and specificity of CRKP infection for the diagnosis of SAP were 0.799 (95% confidence interval as 0.714?0.885, P<0.05), 0.688, and 0.911, respectively. (3) Treatment of acute pancreatitis: of 109 patients, 17 cases underwent nasobiliary drainage, 19 cases underwent gallbladder puncture and drainage, 42 cases underwent surgical debridement, 48 cases underwent CT guided interventional drainage and 43 cases underwent conservative treatment. One patient may undergo multiple treatments. Of 109 patients, 66 patients underwent one and more invasive treatments with 47 cases undergoing CRKP infection and 43 patients did not undergo invasive treatment with 1 case undergoing CRKP infection, respectively, showing a significant difference ( χ2=50.134, P<0.05). (4) Prognosis of patients: all 109 patients were followed up for 3?9 months, with a median follow-up time of 6 months. During the follow-up, there were 15 cases and 6 cases dead in the 48 cases with CRKP infection and the 61 cases without CRKP infection, respec-tively, showing a significant difference ( χ2=7.919, P<0.05). Conclusion:CRKP infec-tion is positively correlated with the severity of acute pancreatitis, and CRKP infection is associated with the duration of hospital stay and types of invasive treatments.
ABSTRACT
Objective To investigate the effects of a multidisciplinary round electronic checklist in ICU. Methods From October 2016 to September 2017,a total of 1 172 patients were provided with a multidisciplinary round electronic checklist. Another 886 patients with routine rounds between October 2015 to September 2016 were retrospectively analyzed. The duration of mechanical ventilation and ICU stay,the rate of nosocomial infection, the percentages of catheter days(central line catheter days,artificial airway days and urinary catheter days) and clinical staffs' satisfaction with the multidisciplinary collaboration were compared. Results The duration of mechanical ventilation and ICU stay in the intervention group were 1.42(0.68,3.63)days and 3.19(2.48,5.40)days respectively,in the control group were 2.16(1.40, 4.77) days and 4.14(3.46, 6.92) days respectively. The differences between two groups were statistically significant(t=2.084, 2.247, P <0.05). The application of a multidisciplinary round electronic checklist shortened the duration of mechanical ventilation and ICU stay. The percentages of catheter days and the rate of catheter-associated urinary tract infection were 0(0/6 269),60.34%(6 269/10 389)respectively,in the control group were 0.93‰(6/6 485),67.02%(6 485/9 676)respectively.The differences between two groups were statistically significant(χ2=96.187,Fisher's exact test=0.031,P<0.05).Besides,the level of multidisciplinary collaboration in ICU was greatly improved in the intervention group, 3.03 ± 0.11 vs. 4.13 ± 0.39 (t=24.587, P < 0.05). Conclusions A multidisciplinary round electronic checklist in ICU can improve the care quality and multidisciplinary collaboration.
ABSTRACT
Objective To investigate the expressions of FAT10 and p53 mutant in gastric cancer tissues and their relations. Methods Immunohistochemistry and RT-PCR were used to detect the expressions of FAT10 and p53 in gastric cancer tissues (n=62), para-cancerous tissues (2-5 cm apart from cancer, n=62), and normal gastric tissues (7>5 cm apart from cancer, n=62). The association of FAT10 with p53 and clinical outcomes were analyzed by Spearman and Pearson correlation. Results The immunohistochemistry examination showed that expressions of FAT10 [51.61%(32/62)] and p53 [45.16% (28/62)] were significantly higher in cancerous tissues than in para-cancerous tissues [12.90%(8/62) and 14.51% (9/62), χ2=21.26 and 20.69, P<0.01] and normal tissues [6.45% (4/62) and 9.68% (6/62), χ2=13.91 and 19.61, P<0.01]. Overexpressions of FAT10 protein and mRNA in cancerous tissues were closely related to lymph node metastasis and TNM staging (both P value<0.05). There was a positive correlation between FAT10 and p53 in protein and mRNA expressions (protein r=0. 865, P<0.05; mRNA r=0.761, P< 0.01). Those with positive expression of FAT10 had lower survival rate compared to those with negative expression (P<0.05). Conclusions The positive relation between over-expression of FAT10 and p53 implicates that both are involved in the gastric carcinogenesis, and FAT10 is a novel gastric cancer marker with prognostic significance.