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Objective To investigate the clinical characteristics and risk factors of secondary infection in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV).Methods One hundred and eighteen patients newly diagnosed with AAV at the institute of nephrology,Tongji hospital affiliated to Huazhong university of science and technology,from 2012 to 2017,were analyzed retrospectively.Induction therapy included single corticosteroids,combination of corticosteroids with cyclophosphamide and combination of corticosteroids with other immunosuppressive agents.End point was defined as moderate to severe infection which was diagnosed by the clinical and radiological manifestation as well as microbiological evidences.The infection-related survival curve was drawn to reflect the time when the infection occurred.The clinical baseline variables in patients with and without infection were compared.Multivariate Logistic regression model was used to determine the independent predictors of infection.Receiver-operating characteristic curve (ROC) was plotted for evaluating the predictive value of lymphocyte on moderate to severe infection.Results During followup of median 3 months (1-30 months),88 infection episodes were found in 63 (53.4％) patients,of which 54 times (61.4％) occurred within 6 months after treatment,46 times (52.3％) happened within 3 months after treatment.The most common organ of infection was lung (62.5％),and the most common pathogen was bacteria (51.1％).Multivariate Logistic regression model showed that lung involvement (OR=4.44,95％ CI 1.59-12.41),moderate reduction of lymphocyte in follow-up (OR=5.69,95％ CI 2.05-15.85) and severe lymphocyte reduction (OR=36.28,95％CI 3.45-381.17) were independent risk factors of secondary infection in AAV patients (all P ＜ 0.05).ROC curve showed that the area under the curve of lymphocyte as a predictor of severe infection was 0.767 (95％ CI 0.64-0.89,P ＜ 0.05).Based on lymphocyte less than 0.49× 109/L which was the cut-off value for predicting severe infection,the sensitivity and the specificity were 83.9％ and 71.9％,respectively.Conclusions Lung involvement and moderate-severe lymphopenia during follow-up are independent risk factors of secondary infection in AAV patients.Hence,physician should pay more attention to those patients,and adjust treatment in time to avoid the occurrence of infection.
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Objective To identify the significance of serum phospholipase A2 receptor antibody (PLA2R-Ab) in idiopathic membranous nephropathy (IMN) patients.Methods A total of 108 patients diagnosed as IMN by medical history,physical examination,laboratory examination and renal biopsy in Tongji Hospital affiliated to Tongji Medical College,Huazhong University of Science and Technology between Dec 1,2014 and Aug 31,2017 were enrolled,and all related data were recorded.According to the results of serum PLA2R-Ab test,patients were divided to positive group and negative group,and the data were compared with the independent sample t test and the chi-square test.Kaplan-Meier survival analysis was performed to compare remission rates between groups,and the Logrank method was used to evaluate the significance of differences.Univariate and multivariate Cox regression analysis were used to verify predicting factors for achieving remission.Results Overall,67.6％(73/108) patients had detectable serum PLA2R-Ab.Compared with patients in negative group,patients in positive group exhibited higher proportion of male patients (P=0.002),lower level of serum albumin (P ＜ 0.001),higher level of cholesterol (P ＜ 0.001),lower level of immunoglobulin G (P ＜0.001),higher level of proteinuria (P=0.003),a lower of chance of remission (P=0.049),longer time needed to achieve partial remission (P=0.001) and complete remission (P=0.002).The 1-and 2-year cumulative renal partial remission rates were 72.4％,86.1％,and the cumulative renal complete remission rates were 43.8％,54.0％,respectively.Patients in negative group had higher partial remission (x2=9.84,P=0.002) and complete remission (x2=15.50,P＜0.001) than those in positive group.Multivariate Cox regression model indicated that serum positive PLA2R-Ab was a significant independent risk factor.Conclusions IMN patients with serum PLA2R-Ab show more severe condition and lower remission rates than those without serum PLA2R-Ab.Serum positive PLA2R-Ab is an independent remission-related predictor for IMN patients.
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ObjectiveTo explore the treatment desicions of Contusion and laceration of the brain at temporal lobe and frontal lobe with small hematoma and base pond changes. MethodsAccording to three grades of consciousnee,areas of brain contusion or quantity of hematoma,and changes of base pond,it divided 274 patients into different types,then analyzed treatments and retrospect to them. Results33 cases of Type Ⅰ:33 cases had operated immediatelly and 3 cases had died;44 cases of Type Ⅱ:17 cases had delayed operations and 1 case had died;27 cases without operations.Type Ⅲ: 15 cases without operations. ConclusionThese "three-3" method of grade could be regarded as the quantification index of treatment desicions before deterioration.
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Objective To investigate the choice and efficacy of surgury in treatment of hypertensive intracerebral hemorrhage. Methods The clinical data of 278 cases of hypertensive cerebral hemorrhage were retrospectively analyzed. These cases respectively used CT Stereotactic puncture and drainage, minimally invasive craniotomy and Craniotomy hematoma surgical treatment. According to the GCS cores and hematoma volume,they were divided into 3 groups so as to comparatively analyze the efficacy of different surgical methods. Results Hypertensive cerebral hemorrhage CT stereotactic puncture good prognosis group was 74 cases(59.6% ) ,minimally invasive craniotomy group of good prognosis ,48 cases(56.4% ) ,there was no significant difference between the two groups(P＞ 0.05). Craniotomy mortality is 15 cases (21.7% ). Conclusion Three surgical treatment of hypertensive cerebral hemorrhage had their own characteristics:CT stereotactic puncture and drainage characteristics with less trauma,faster recovery,timely and effectively discharge brain compression. It was a simple and effective treatment for hypertensive intracerebral hemorrhage. In many cases, CT sterotactic puncture and drainage could replace invasive hematoma evacuation.
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Objective To explore the the rapeutic efficacies of different surgical methods for hypertensive intracerebral hemorrhage so as to find out their indications. Methods Admittedin to 218 eases of hypertensive intracerebral hemorrhage since, which treated by tereotaetie aspiration or eraniotomy through small bone window or eraniotomy through bone flap was divided into three subgroups according to GCS scores and hematoma volume indications and trerapeutic outcomes of these three surgical methods were analyzed comparatively. Results Satisfactory prognosis was found in 64(60.4%) patients of brain hematoma puncture drainage. Satisfactory prognosis was found in 35(54.7%) patients of small windowing skull. No significant was occurred between the two groups (P＞0.05). The mortality rate decreased obviously in the bone-flap eraniotomy group with greathematoma volume (29.2%). Conclusions Puncture drainagc has small wound and instauration quickly. And valid for time to relief encephalothlipsis. In most circumstances, puncture drainage can replace the small hole craniotomy. Bone flap craniotomy can lower a great deal of apoplexy death rate.
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Objective To investigate the effect of severe eraniocerebral injury patients with hypernatremia.Methods Review and analysis of 356 cases of severe craniocerebral injury and 185 cases of hypernatremia. Analysis on the relationship between hypernatremia and prognosis. Results The 185 eases of severe craniocerebral injury with hypernatremia, the incidence is 52 %. Including 136 death cases, the mortality rate was 73.5 %. Hypernatremia appeared after admission since 1～18 days,the average days for this were 4.1 days. 69 cases appeare hypernatremia in 24 hours,60 cases in 48 hours,16 cases in 72 hours,145 cases of hypematremia appeared after admission within 3 days,about 78%. Blood sodium level was 148～196mmol/L, average was 172mmol/L, duration time was 1～25 days, average was 5.4 days. Conclusion It seems that almost hypernatremia appeared, when severe crartiocerebral was injuried in 3 days. The mortality is very high.
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Objective To disscuss the effect of traeheotomy on pneumonia in patients with severe cranial trauma. Methods The clinical information of 102 patients suffering severe cranial trauma after traeheotomy were analyzed retrospectively. Results The infection rate is lower than those of tracheotomy after 24 hours(P < 0.01 ) ; Infection control rate of server cranial trauma after tracheotomy in 24 hours was obviously higher than those of tra- cheotomy after 24 hours(P < 0.05) ; but contrary in control time ( P < 0.01 ). Conclusion Tracheotomy should be applied as soon as possible,it is important to prevent and cure pulmonary infection for patients who are suffering se- vere cranial trauma.
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Objective To study the causes for dysphoria and discuss the medication methods of controlling the dysphoria in craniocerebral injury patients. Methods First, craniocerebral injury patients were grouped to analyze the causes for their dyshoria. Then, the patients were injected with Tramadol (1 mg/kg), Droperidol (0.05 mg/kg) and Midazolam (0.1 mg/kg). Successively, analgestic pump containing combined Tramadol that included Tramadol (15 mg/kg), Droperidol (0.15 mg/kg), Midazolam (0.4 mg/kg) and 100 ml 10 g/L Procaine was used for 50 hours, (1.5-2.5) ml/h, continuously. The medication time ranged from 40 hours to 160 hours. Results Of 71 patients with dysphoria, 43 patients with grades Ⅰ and Ⅱ dysphoria were under complete control, 19 with grade Ⅲ dysphoria (eight were injected with more load) under basic control, one with grade Ⅳ dysphoria under control and eight degraded to grade Ⅱ dysphoria but needed additional load. Of all, 63 patients were successfully controlled (89%) and eight (11%) got better, with effectiveness rate of 100%. Blood pressure, heart rate and breath remained clam, which was good for oxygen transferring to brain and reducing of encephalic pressure. Conclusions The causes for dysphoria in craniocerebral injury patients include stimulation of pain and acute psychopathic impediment. Continuous injection of Tramadol via analgesic pump is an ideal medication methhod for analgesia and sedation, for it can not only hold blood and medicament in invariableness, but also make the patients quiet, without bad reaction or affecting process of regaining consciousness.