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Objective:To analyze the clinical characteristics and pathogen distributions of the patients with bone and joint infection.Methods:The clinical data and etiological results of 225 patients with bone and joint infection from January 2008 to October 2020 in Huashan Hospital, Fudan University were retrospectively analyzed.Statistical analysis was conducted by chi-square test.Results:Of the 225 cases with bone and joint infection, 75.6%(170/225) were extremities and other osteomyelitis, 16.0%(36/225) were suppurative arthritis, 8.4%(19/225) were spinal osteomyelitis. Non-implants related infection accounted for 80.4%(181/225) of the cases, while 19.6%(44/225) of the cases were implants related infection. The main clinical manifestations were localized pain (48.4%(109/225)), dyskinesia (47.6%(107/225)), localized swelling (28.9%(65/225)), fever (28.0%(63/225)), and increased purulent exudation (24.9%(56/225)). The proportions of localized pain (55.8%(101/181)) and fever (31.5%(57/181)) of non-implants infection were higher than those of implants infection (18.2%(8/44) and 13.6%(6/44), respectively), while the proportion of increased purulent exudation in implants infection (50.0%(22/44)) was higher than that in non-implants infection (18.8%(34/181)). There were all significant differences between the two groups ( χ2=15.49, 5.60 and 18.45, respectively, all P<0.050). Of the 225 cases, 63 cases(28.0%) had complications with other site infection, especially soft tissue infection and bloodstream infection. A total of 106 strains of pathogens were isolated from 225 specimens, 58.5%(62/106) of them were Gram positive bacterium.Among them, 34.0%(36/106) were Staphylococcus aureus, with the rate of methicillin resistant Staphylococcus aureus (MRSA) isolation accounting for 11.3%(12/106). Laboratory tests showed that 40.4%(91/225) of the patients had elevated erythrocyte sedimentation rate (ESR), 32.9%(74/225) patients had elevated C-reactive protein (CRP). Proportions of patients with elevated ESR (43.6%(79/181)) and CRP (37.6%(68/181)) in non-implants infection were significantly higher than those in implants infection (27.3%(12/44) and 13.6%(6/44), respectively). There were significant differences between the two groups ( χ2=3.94 and 9.19, respectively, P=0.047 and 0.002, respectively). Conclusions:The main clinical manifestations of bone and joint infection are localized pain, dyskinesia, localized swelling, fever and increased purulent exudation. Patients with bone and joint infection are easy to be complicated with soft tissue infection and bloodstream infection, and often accompanied by increased ESR and CRP levels. Gram positive bacterium are the main pathogens.
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@#Objective To evaluate the prognostic value of preoperative inflammatory indexes in patients with local-advanced esophageal squamous cell carcinoma. Methods We retrospectively analyzed the clinical and prognostic data of 150 local-advanced esophageal squamous cell carcinoma patients who were treated by esophagectomy in Guangyuan Central Hospital from July 2014 to July 2015. There were 128 males and 22 females with average age of 62.23±8.48 years. The optimal cutoff value was determined by receiver operation characteristics (ROC) curve analysis. Patients were grouped according to the optimal cutoff values (NLR=3.49, PLR=152.28, MLR=0.36). Log-rank test, and multivariate Cox logistic regression modelling were used to assess the simultaneous influences of prognostic factors for survival outcomes after esophagectomy. Results The patients with higher ratio (NLR>3.49, PLR>152.28, MLR>0.36) had significantly shorter median progression free survival (PFS) and lower postoperative recurrent rate than those of the patients with lower ratio. The stratified analyses found that thelymph node staging and postoperative recurrent rate were positively correlated with the higher ratio. However, the tumor differentiation was negatively correlated with it. In univariate analyses, patients with preoperative NLR>3.49, PLR>152.28 and MLR>0.36 had a poorer prognosis. Furthermore, in multivariate analyses we found MLR>0.36 was also significantly associated with a decreased postoperative recurrent rate (HR=12.945, 95%CI 2.31 to 72.548, P=0.00). Conclusions The preoperative NLR, PLR and MLR are useful prognostic markers in patients with stage ⅢA-ⅣA esophageal squamous cell carcinoma who conducted esophagectomy.
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Objective To investigate the effect of vancomycin on neonatal sepsis and its clinical effect . Methods The clinical data of 67 children with methicillin resistant Staphylococcus aureus (MRSA) infection and septicemia treated in the hospital from January 2010 to January 2017 were reviewed .The children were treated with ceftazidime+piperacillin/sulbactam when they did not diagnosed with MRSA infection .The chil-dren were treated with vancomycin when they diagnosed with MRSA infection .The immunological and inflam-matory indexes of children before and after vancomycin treatment were compared ,and the clinical effects and adverse reactions were evaluated .Results After vancomycin treatment ,the serum IgG and NK cell activities in 67 children were significantly higher than those before vancomycin treatment (P<0 .05) ,the level of IgM in children was lower than that before treatment ( P< 0 .05) .After treatment ,the serum levels of IL-6 ,IL-8 , IL-2 ,sIL-2R ,CRP ,TNF-α,PCT ,WBC in 67 children were significantly lower than those before treatment (P<0 .05) .The total effective rate of vancomycin treatment was 89 .55％ ,which was higher than that without vancomycin treatment (58 .21％ ,P< 0 .05);the occurrence of adverse reactions before and after treatment with vancomycin were 19 .40％ and 23 .88％ ,and the difference was not statistically significant (P>0 .05);the children of two groups did not appear serious adverse reactions during treatment ,they were treated by symp-tomatic treatment or respite medication ,and continue treated after symptom relief .Conclusion Vancomycin in the treatment of neonatal septicemia caused by M RSA infection can significantly improve the immune level of children ,reduce the degree of systemic inflammatory response ,and the treatment effect is better .
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Objective To investigate the effect of povidone iodine irrigation combined with levofloxacin eye drops on the inflammatory indexes, NO and antioxidant indices in serum and tear fluid of patients with diabetic cataract.Methods 50 cases of pati ents with diabetic cataract and admitted into the hospital during January 2013 to January 2015 were selected as the research objects all of whom received cataract surgery.According to the randomized double blind method, the patients were divided into two groups with 20 cases in each group.The control group received levofloxacin eye drops intervention before surgery while the observation group were treated withpovidone iodine irrigation, based on the control group.The inflammatory indexes (IL-2, sIL-2R, IL-6), NO, antioxidant indexes (TAC, SOD, CAT) and condition of postoperative infection were compared between the two groups before and after irrigation.ResuIts In the observation group, the sIL-2R, IL-6 and NO levels in serum and tear fluid after irrigation were significantly lower than those in the control group while IL-2, TAC, SOD and CAT were significantly higher than those in the control group.The differences were statistically significant (P<0.05).The postoperative infection rate of the observation group was 0.0% which was significantly lower than 16.0% of the control group.The difference was statistically significant ( P<0.05 ) .ConcIusion Povidone iodine irrigation combined with levofloxacin eye drops can significantly reduce the inflammatory reactions in patients with diabetic cataract and improve their antioxidant level.