Influential factors of hypoalbuminemia in patients with preeclampsia and observation of pregnancy outcomes / 中国基层医药

Objective:To analyze the influential factors of hypoalbuminemia in patients with preeclampsia and observe the pregnancy outcomes.Methods:The clinical data of 237 pregnant women with preeclampsia who received treatment in The Sixth Affiliated Hospital of Guangzhou Medical University (Qingyuan People's Hospital) from July 2018 to December 2020 were retrospectively collected and analyzed. These patients were divided into hypoproteinemia (observation group) and no hypoproteinemia (control group) groups according to whether they had hypoproteinemia. The general situation, clinical data, and adverse maternal and infant outcomes were statistically analyzed. Risk factors of hypoalbuminemia were analyzed using a logistic regression model. The predictive efficacy was evaluated using the receiver operating characteristic curve.Results:There were no significant differences in general data between the two groups (all P > 0.05). Multivariate analysis showed that D-dimer ( OR = 1.25, P = 0.004), 24-hour urinary protein ( OR = 1.29, P < 0.001), and total bile acid ( OR = 1.08, P = 0.010) were the independent risk factors for hypoproteinemia in preeclampsia. The predictive efficacy of these three indicators (area under the receiver operating characteristic curve = 0.855, P < 0.001) was greater than that of a single indicator. The incidences of adverse maternal and infant outcomes including placental abruption (9.4%, P = 0.019), liver and kidney dysfunction (34.4%, P < 0.001), pleural and ascitic fluid (28.1%, P = 0.001), fetal intrauterine growth restriction (50.0%, P = 0.001), fundus lesions (6.2%, P = 0.018), HELLP syndrome (9.4%, P = 0.019), mild neonatal asphyxia (15.6%, P = 0.022), severe asphyxia (6.2%, P = 0.049), metabolic acidosis (12.5%, P = 0.001), intrauterine infection (12.5%, P = 0.004), and neonatal hospitalization for more than 20 days (37.5%, P < 0.001) were greater in the observation group compared with the control group. There were no significant differences in postpartum hemorrhage, eclampsia, respiratory distress syndrome, fetal loss, and neonatal death between the two groups (all P > 0.05). Conclusion:D-dimer, 24-hour urinary protein, and total bile acid are independent risk factors for hypoproteinemia in preeclampsia. Patients with preeclampsia complicated by hypoproteinemia have a high risk of adverse maternal and infant outcomes.

Advances of chronic enteropathy associated with SLCO2A1 gene / 国际儿科学杂志

Chronic enteropathy associated with solute carrier organic anion transporter family member 2A1 gene(CEAS)is an autosomal recessive disease caused by SLCO2A1 gene mutation.Characterized by Persistent, intractable, nonspecific intestinal ulcers that lead to chronic loss of blood and protein.At present, pathogenesis of CEAS is still unclear.Endoscopic examination shows specific intestinal ulcers and intestinal stenosis, which mainly involves ileum.Due to its rare occurrence and similar clinical manifestations with Crohn′s disease and non-steroidal anti-inflammatory drug related bowel disease, it is easy to be confused clinically.No effective treatment has been established, and iron supplementation, blood transfusion and parenteral or enteral nutrition can be given symptomatic treatment.Surgical treatment is feasible in serious condition, however, all of them can only get a temporary effect.Usually, after the end of treatment, the disease relapses, and the life prognosis is not clear.

Correlation between traditional Chinese medicine and reduced risk of readmission in rheumatoid arthritis patients with hypoproteinemia:a retrospective cohort study / 中国中药杂志

This study aimed to explore the correlation between traditional Chinese medicine(TCM) and reduced risk of readmission in patients having rheumatoid arthritis with hypoproteinemia(RA-H). A retrospective cohort study was conducted on 2 437 rheumatoid arthritis patients in the information system database of the First Affiliated Hospital of Anhui University of Chinese Medicine from 2014 to 2021, and 476 of them were found to have hypoproteinemia. The patients were divided into TCM users and non-TCM users by propensity score matching. Exposure was defined as the use of oral Chinese patent medicine or herbal decoction for ≥1 month. Cox regression analysis was performed to explore the risk factors of clinical indicators of rheumatoid arthritis. Additionally, the use of TCM during hospitalization was analyzed, and analysis of association rules was conducted to investigate the correlation between TCM, improvement of indicators and readmission of patients. Kaplan-Meier survival curve was plotted to compare the readmission rate of TCM users and non-TCM users. It was found the readmission rate of RA-H patients was significantly higher than that of RA patients. By propensity score matching, 232 RA-H patients were divided into TCM group(116 cases) and non-TCM group(116 cases). Compared with the conditions in the non-TCM group, the readmission rate of the TCM group was lowered(P<0.01), and the readmission rate of middle-aged and elderly patients was higher than that of young patients(P<0.01). Old age was a risk factor for readmission of RA-H patients, while TCM, albumin(ALB) and total protein(TP) were the protective factors. During hospitalization, the TCMs used for RA-H patients were mainly divided into types of activating blood and resolving stasis, relaxing sinew and dredging collaterals, clearing heat and detoxifying, and invigorating spleen and resolving dampness. The improvement of rheumatoid factor(RF), immunoglobulin G(IgG), erythrocyte sedimentation rate(ESR), C-reactive protein(CRP) and ALB was closely related to TCM. On the basis of western medicine treatment, the application of TCM could reduce the readmission rate of RA-H patients, and longer use of TCM indicated lower readmission rate.

Síndrome Edematoso Generalizado por citomegalovirus

El síndrome edematoso generalizado o anasarca está presente secundario a un desequilibrio de la homeostasis hídrica, electrolítica y osmolar del organismo, En el adulto el estado de anasarca es más frecuente secundario a insuficiencia cardiaca, en pediatría, el edema que se generaliza está asociado con más frecuencia a bajo aporte proteico, baja síntesis de proteínas o debido a perdida de proteínas de origen gastrointestinal o renal. La disminución de la presión oncótica plasmática genera fuga de líquidos a compartimientos intersticiales de forma generalizada y produce edema. Existen múltiples patologías y mecanismos para la producción del edema generalizado; el conocimiento de la fisiopatología de su desarrollo permite un análisis clínico, de laboratorio y de gabinete que orientan al diagnostico. La infección por citomegalovirus es una causa poco frecuente de edema generalizado, reconocer esta entidad y llegar a un adecuado diagnóstico diferencial es el objetivo de esta revisión.

The generalized edematous syndrome or anasarca is present secondary to an imbalance in the body's water, electrolyte and osmolar homeostasis. In adults, the state of anasarca is more frequent secondary to heart failure; in pediatrics, generalized edema is associated with more frequency due to low protein intake, low protein synthesis or due to protein loss of gastrointestinal or renal origin. The decrease in plasma oncotic pressure generates generalized fluid leakage into interstitial compartments and produces edema. There are multiple pathologies and mechanisms for the production of generalized edema; knowledge of the pathophysiology of its development allows a clinical, laboratory and office analysis that guides the diagnosis. Cytomegalovirus infection is a rare cause of generalized edema; recognizing this entity and reaching an appropriate differential diagnosis is the objective of this review.

Clinical analysis of 105 cases of Kawasaki disease complicated by hypoproteinemia / 中国基层医药

Objective:To analyze the clinical characteristics of children with Kawasaki disease complicated by hypoproteinemia.Methods:The clinical data of 105 children patients with Kawasaki disease who received treatment in Ji'an Central People's Hospital, China between January 2015 and December 2019 were retrospectively analyzed. These patients were divided into normal-level albumin (ALB) group (≥ 35 g/L, n = 54) and low-level ALB group (< 35 g/L, n = 51). White blood cell count, hemoglobin, C-reactive protein, erythrocyte sedimentation rate, alanine aminotransferase, aspartate aminotransferase, total bile acid, and coronary artery B-ultrasound examination results were compared between the two groups. Results:The incidence of hypoproteinemia was similar among all age groups. There was significant difference in coronary artery dilatation rate between the two groups (χ 2 = 5.49, P < 0.05). There were no significant differences in the percentage of patients with hand and foot scleredema and urinary protein-positive rate between the two groups (χ 2 = 0.40, 0.39, both P > 0.05). White blood cell count, erythrocyte sedimentation rate, C-reactive protein level in the low-level ALB group were 15.2 × 10 9/L, (82.1 ± 26.1) mm/h, 94.7 mg/L, respectively, which were significantly higher than those in the normal-level ALB group [11.5 × 10 9/L, (54.5 ± 26.2) mm/h, 43.65 mg/L, Z = -2.94, t = 5.40, Z = -6.01, all P < 0.01]. There were no significant differences in alanine aminotransferase, aspartate aminotransferase, and total bile acid levels between the two groups (all P > 0.05). Conclusion:The incidence of Kawasaki disease complicated by hypoproteinemia is unrelated to age and it is related to inflammatory reaction. Hypoproteinemia is a risk factor of coronary artery dilatation. This study is of great science.

Tríada de Herbst: una presentación inusual de una patología común. Reporte de caso / Herbst Triad: A rare clinical manifestation of a common pathology

Resumen La tríada de Herbst es una manifestación inusual de la enfermedad por reflujo gastroesofágico y de otras patologías esofágicas. Se caracteriza por la presencia de anemia, acropaquias (hipocratismo digital) y enteropatía perdedora de proteínas. Al ser una condición anecdótica, la información disponible deriva de los reportes de caso. La fisiopatología aún no es clara. Se reporta el caso de una escolar, en quien se revierten los síntomas una vez se realiza el manejo quirúrgico.

Abstract The Herbst triad is a rare manifestation of gastroesophageal reflux disease and other esophageal pathologies. It is characterized by the presence of anemia, digital clubbing, and protein-losing enteropathy. Since evidence on this condition is anecdotal, the available information is mostly derived from case reports and its physiopathology remains unclear. The following is the case of a schoolchild, whose symptoms were reversed once she underwent surgery.

Retrospective analysis of 182 cases of pemphigus complicated by infections / 中华皮肤科杂志

Objective@#To analyze the prevalence of and risk factors for infections in patients with pemphigus, and to evaluate their effect on prognosis.@*Methods@#Clinical data were collected from 182 inpatients with pemphigus in Department of Dermatology, Xijing Hospital, Fourth Military Medical University from May 2011 to May 2017, and retrospectively analyzed. Associations of infection rates with age, disease severity, comorbidities, maximum dose of glucocorticoids, hospitalization duration and costs were analyzed. Statistical analysis was carried out with SPSS 22.0 software by using Logistic regression analysis for analyzing risk factors for concurrent infections in pemphigus patients who were hospitalized for the first time.@*Results@#Among the 182 patients, 82 (45.05%) experienced infections. Additionally, 107 pathogenic strains were cultured from secretions from skin lesions of 77 patients, including 60 strains of Staphylococcus aureus (56.07%) , and 58 Staphylococcus aureus strains were resistant to penicillin (96.67%) . Among the 182 patients, infections were observed in 11 of 14 patients with hypoproteinemia, 69 (41.07%) of 168 patients without hypoproteinemia, 4 (4.81%) of 27 patients with mild pemphigus, 34 (37.7%) of 90 patients with moderate pemphigus and 44 (67.69%) of 65 patients with severe pemphigus. Logistic regression analysis showed that the prevalence rate of infections was significantly higher in the patients with hypoproteinemia than in those without hypoproteinemia (OR = 5.559, 95% CI 1.053-29.347, P = 0.043) . Compared with the patients with mild pemphigus, the prevalence rate of infections significantly increased in the patients with moderate (OR = 4.676, 95% CI 1.276-17.123, P < 0.05) or severe pemphigus (OR = 16.529, 95% CI 4.183-65.314, P < 0.001) . The prevalence of infections in patients with pemphigus was unaffected by gender, types of pemphigus, or the presence of hypertension or diabetes (all P > 0.05) . Among the 145 patients who were followed up, 33 were completely cured, 67 were cured clinically, 23 received improvement, 10 experienced relapse or exacerbation, and 12 died. Of the 12 dead patients, 3 died of pneumonia, 2 died of exacerbated pemphigus and skin infections, and 1 died of sepsis.@*Conclusions@#High disease severity and hypoproteinemia are risk factors for infections in patients with pemphigus. Bacterial infection is a common complication in patients with pemphigus, and severe infections are one of the causes of death in patients with pemphigus.

Retrospective analysis of 182 cases of pemphigus complicated by infections / 中华皮肤科杂志

Objective To analyze the prevalence of and risk factors for infections in patients with pemphigus,and to evaluate their effect on prognosis.Methods Clinical data were collected from 182 inpatients with pemphigus in Department of Dermatology,Xijing Hospital,Fourth Military Medical University from May 2011 to May 2017,and retrospectively analyzed.Associations of infection rates with age,disease severity,comorbidities,maximum dose of glucocorticoids,hospitalization duration and costs were analyzed.Statistical analysis was carried out with SPSS 22.0 software by using Logistic regression analysis for analyzing risk factors for concurrent infections in pemphigus patients who were hospitalized for the first time.Results Among the 182 patients,82 (45.05％) experienced infections.Additionally,107 pathogenic strains were cultured from secretions from skin lesions of 77 patients,including 60 strains of Staphylococcus aureus (56.07％),and 58 Staphylococcus aureus strains were resistant to penicillin (96.67％).Among the 182 patients,infections were observed in 11 of 14 patients with hypoproteinemia,69 (41.07％) of 168 patients without hypoproteinemia,4 (4.81％) of 27 patients with mild pemphigus,34 (37.7％) of 90 patients with moderate pemphigus and 44 (67.69％)of 65 patients with severe pemphigus.Logistic regression analysis showed that the prevalence rate of infections was significantly higher in the patients with hypoproteinemia than in those without hypoproteinemia (OR =5.559,95％ CI 1.053-29.347,P =0.043).Compared with the patients with mild pemphigus,the prevalence rate of infections significantly increased in the patients with moderate (OR =4.676,95％ CI 1.276-17.123,P ＜ 0.05) or severe pemphigus (OR =16.529,95％ CI 4.183-65.314,P ＜ 0.001).The prevalence of infections in patients with pemphigus was unaffected by gender,types of pemphigus,or the presence of hypertension or diabetes (all P ＞ 0.05).Among the 145 patients who were followed up,33 were completely cured,67 were cured clinically,23 received improvement,10 experienced relapse or exacerbation,and 12 died.Of the 12 dead patients,3 died of pneumonia,2 died of exacerbated pemphigus and skin infections,and 1 died of sepsis.Conclusions High disease severity and hypoproteinemia are risk factors for infections in patients with pemphigus.Bacterial infection is a common complication in patients with pemphigus,and severe infections are one of the causes of death in patients with pemphigus.

A Comparative Study of Plasma Protein and Hemoglobin in 18-21 Years Age Group Students of MGM Medical College, Jamshedpur, Jharkhand

Background: Anaemia is a global public health problem. InIndia, Jharkhand state is one of the state where under nutritionis highly prevalent. Most of the health problems like lowimmunity, Anaemia, hypoprotienemia arise due to low proteinintake. During erythropoiesis, Haemoglobin synthesis requiresprotein, Vitamin B12, Folic acid, Vitamin C as well as mineralslike Fe, Cu etc. Adequate nutrition is of prime importance andthis is reflected in plasma also.Objectives: To assess the level of Hb and plasma proteinamong study subjects with a co-relation of Hb with plasmaprotein.Materials and Methods: Present study was undertaken atMGM Medical College, Jamshedpur. 177 participants wereselected for the study and the data were obtained on differentvariables. Blood samples were also taken from the participants.Results: Most of the study subjects were anaemic. Anaemiawas more common among female subjects in comparison withmales. The present study found a positive co-relation betweenHb and Plasma protein.Conclusion: There is a strong co-relation observed betweenplasma protein, daily protein intake, and BMI withhaemoglobin.

Linfangiectasia intestinal primaria: primer reporte de caso en Perú / Primary intestinal lymphangiectasia: first case report in Peru

La linfangiectasia intestinal primaria es una entidad clínica poco común de etiología desconocida. La edad típica de presentación de esta enfermedad es durante los 3 primeros años de vida, pero también se han reportado casos en adultos. Posee sintomatología variable, pero la manifestación clínica principal es el edema, puede presentarse también diarrea y pérdida de peso. La pérdida de fluido linfático en el tracto gastointestinal conlleva también a hipoproteinemia y linfopenia. El diagnóstico se establece en base a la clínica, a los estudios de laboratorio, al estudio endoscópico y se confirma con la evaluación histológica de la biopsia realizada. El manejo se da mediante una dieta rica en proteínas, baja en grasas y triglicéridos de cadena media. A continuación, se presenta el caso de un paciente varón de 1 año de edad que presenta edema generalizado, con predominio de miembros inferiores, y diarrea. Los exámenes de laboratorio muestran la presencia de hipoproteinemia marcada. Posteriormente, se realiza una endoscopía digestiva alta y una biopsia duodenal. El estudio histológico confirma el diagnóstico de linfangiectasia intestinal primaria. El paciente recibe el tratamiento establecido para esta enfermedad y, finalmente es dado de alta.

Primary intestinal lymphangiectasia is a rare clinical condition of unknown etiology. The common age of presentation is during the first 3 years of life, but cases in adults have also been reported. It has a variable symptomatology, but the main clinical manifestation is edema, also diarrhea and weight loss can occur. The loss of lymph fluid into the gastrointestinal tract also leads to hypoproteinemia and lymphopenia. Diagnosis is based on clinical manifestations, laboratory and endoscopic findings, and is confirmed on histopathological examination of biopsy. The main treatment is a protein rich, low in fat and medium chain triglyceride diet. We present the case of a 1-year-old male patient who presents with generalized edema, predominantly in lower limbs, and diarrhea. Laboratory findings show the presence of marked hypoproteinemia. Then an endoscopy and a duodenal biopsy are performed, and the histopathological study confirms the diagnosis of primary intestinal lymphangiectasia. The patient is treated and after a satisfactory evolution, is discharged.

Application of Vitamin D level in nutritional status evaluation of patients with chronic kidney disease and its significance / 吉林大学学报(医学版)

Objective: To study the Vitamin D levels and deficiency rates in the patients with chronic kidney disease (CKD) in different stages, and to clarify the value of serum Vitamin D levels in the evaluation on nutritional status of the patients with CKD. Methods: The patients diagnosed as CKD in the Department of Nephrology and volunteered to participate in the survey were selected as the subjects. According to the different renal function stages, the patients were divided into early stage (CKD1-2 stage) group (n=115), middle and late stage (CKD3-5 stage) group (n=131) and dialysis group (n=38); the serum 25 (OH) D levels and Vitamin D deficiency rates of the patients in various groups were compared. According to K/DOQI guidelines, the patients were divided into Vitamin D deficiency group (n=196), Vitamin D insufficiency group (n=76), and Vitamin D sufficiency group (n=12); the red blood cell (RBC) count, hemoglobin (Hb), hematocrit (Hct), mean red blood cell volume (MCV), mean red blood cell hemoglobin (MCH), mean red blood cell hemoglobin concentration (MCHC), serum albumin (Alb), prealbumin (PA), total protein (TP), creatinine (Cr), blood urea nitrogen (BUN), 25 hydroxy Vitamin D [25 (OH) D] and urea protein (Up) of the patients in various groups were compared. The serum 25 (OH) D-related factors were analyzed by Spearman correlation analysis method; the influencing factors of serum 25 (OH) D level were analyzed by multiple linear regression analysis. Results: The Vitamin D deficiency rates of the patients in early stage group, middle and late stage group, and dialysis group were 77. 4%, 66. 4%, and 52. 6%, respectively; the serum 25 (OH) D level of the patients in early stage group was significantly lower than those of the patients in middle and late group and dialysis group (P<0. 05); the Vitamin D deficiency rate of the patients in early stage group was significantly higher than that of the patients in dialysis group (P<0. 05). The count of RBC, the level of Hb, and Hct of the patients in Vitamin D deficiency group were significantly lower than those of the patients in Vitamin D insufficiency group (P<0. 05). The Cr levels of the patients in Vitamin D deficiency group and Vitamin D insufficiency group were significantly lower than that in Vitamin D sufficiency group (P<0. 05). The levels of Alb and TP of the patients in Vitamin D deficiency group were significantly lower than those in other two groups (P<0. 05); the level of Up in Vitamin D deficiency group was significantly higher than that in Vitamin D deficiency group (P<0. 05). The Spearman correlation analysis results showed that the serum 25 (OH) D level was positively correlated with the RBC count, Hb level, Hct, MCV, Cr, PA, Alb, and TP levels (r=0. 199, P=0. 01; r=0.232, P<0.01; r=0. 232, P<0. 01; r=0. 131, P=0. 028; r= 0.147, P=0. 013; r=0. 277, P<0.01; r=0.696, P<0.01; r=0.677, P<0. 01); and it was negatively correlated with Up (r= -0. 603, P<0. 01). When 25 (OH) D was selected as the dependent variable, the RBC count, Hb, Hct, MCV, PA, Alb, TP, Cr, and Up as the independent variables, multiple linear regression analysis was performed; as Hb was positively correlated with Hct and the RBC count (r=0. 974, P<0. 01; r = 0.943, P<0. 01) and Alb was positively correlated with TP (r=0. 874, P<0. 01), Hb, MCV, PA, Alb, Cr, and Up were selected as the independent variables in order to avoid collinearity. The multiple linear regression analysis results showed that Alb and Up were the independent factors of 25 (OH) D level. Conclusion: Vitamin D deficiency is a serious problem in the patients with CKD in Dalian area, especially in the patients with early stage CKD. The too low serum 25 (OH) D levels are associated with anemia, hypoproteinemia, and urinary protein loss in the patients with CKD.

Correlation and prognosis analysis of hypoalbuminemia in patients with heart failure with preserved ejection fraction / 中国医师进修杂志

Objective@#To investigate the correlation between hypoalbuminemia and heart failure with preserved ejection fraction (HFpEF) and to analyze the prognosis of patients with HFpEF and hypoalbuminemia.@*Methods@#Three hundred and fourteen patients with HFpEF who were hospitalized in Department of Cardiology, Shengjing Hospital of China Medical University from January 2012 to December 2013 were analyzed retrospectively. These patients were divided into two groups according to the serum albumin, hypoalbuminemia (< 35g/L) group and normal albumin group (≥ 35g/L). The prognostic correlation between hypoalbuminemia and HFpEF was analyzed by COX regression analysis.@*Results@#Patients with hypoalbuminemia had a higher mortality: 20.2%(20/99) vs. 9.8%(21/215). There was no significant difference in the average hospitalization time、hospital mortality and readmissions for heart failure between two groups. Univariate COX regression analysis showed that the relative risk ratio of readmissions between normal albumin group and hypoalbuminemia group was 0.554(0.374-0.820), and the relative risk ratio of cardiogenic death was 0.283(0.148-0.538), P < 0.05.@*Conclusions@#HFpEF patients with hypoalbuminemia have relative poor heart function; hypoalbuminemia may be a risk factor of cardiac death for patients with HFpEF.

Correlation and prognosis analysis of hypoalbuminemia in patients with heart failure with preserved ejection fraction / 中国医师进修杂志

Objective To investigate the correlation between hypoalbuminemia and heart failure with preserved ejection fraction (HFpEF) and to analyze the prognosis of patients with HFpEF and hypoalbuminemia. Methods Three hundred and fourteen patients with HFpEF who were hospitalized in Department of Cardiology, Shengjing Hospital of China Medical University from January 2012 to December 2013 were analyzed retrospectively. These patients were divided into two groups according to the serum albumin, hypoalbuminemia ( < 35g/L) group and normal albumin group ( ≥ 35g/L). The prognostic correlation between hypoalbuminemia and HFpEF was analyzed by COX regression analysis. Results Patients with hypoalbuminemia had a higher mortality: 20.2%(20/99) vs. 9.8%(21/215). There was no significant difference in the average hospitalization time、hospital mortality and readmissions for heart failure between two groups. Univariate COX regression analysis showed that the relative risk ratio of readmissions between normal albumin group and hypoalbuminemia group was 0.554(0.374-0.820), and the relative risk ratio of cardiogenic death was 0.283(0.148-0.538), P < 0.05. Conclusions HFpEF patients with hypoalbuminemia have relative poor heart function; hypoalbuminemia may be a risk factor of cardiac death for patients with HFpEF.

Analysis of the characteristics of cellular immune function and its prognostic risk factors in patients with community-acquired pneumonia / 中华危重病急救医学

Objective To analyze the characteristics of cellular immune function and its prognostic risk factors in patients with community-acquired pneumonia (CAP). Methods The clinical data of patients diagnosed as CAP admitted to department of respiratory and critical care medicine of the Second Affiliated Hospital of Anhui Medical University from June 2018 to February 2019 were retrospectively analyzed. The patients were divided into survival group and death group according to the mortality at discharge and 28-day survival after hospital discharge; in addition, they were divided into bacterial group, fungi group and mixed infection group according to pathogen results at discharge. The differences of general clinical characteristics, arterial blood gas analysis indexes, plasma albumin, cellular immune function, inflammatory cytokines, the length of hospital stay among groups were analyzed. The correlation between the prognosis-related indicators in patients were analyzed by Pearson test or Spearman test, and Logistic regression model was used to analyze the risk factors of patients in non-survival group. Results 106 patients were finally enrolled, 69 of whom were survived, and 37 dead. Among 56 patients with pathogen results, 27 were diagnosed as bacterial infection, 11 as fungal infection, and 18 with mixed infection. Compared with the survival group, plasma albumin level, total T cell count, CD4+ T cell count, CD8+ T cell count were decreased in the death group, temperature, pH, acute physiology and chronic health evaluationⅡ(APACHEⅡ), procalcitonin (PCT), interleukin-6 (IL-6), C-reactive protein (CRP) were increased, and the length of hospital stay was significantly shortened. While there was no significant difference in gender, age, mean arterial pressure, arterial oxygen pressure, CD4+/CD8+, regulation T cell/effect T cell (TREG/TEF) between the two groups. Correlation analysis showed that plasma albumin, the length of hospital stay, APACHEⅡ score, CD4+ T cell count, CD8+ T cell count, CD4+/CD8+, PCT, IL-6, CRP were correlated with death (r value was -0.480, -0.209, 0.203, -0.279, -0.270, 0.271, 0.247, 0.410, 0.329, all P <0.05). Logistic regression analysis showed that plasma albumin, CD4+ T cell count, CD8+ T cell count, CD4+/CD8+decreased; APACHEⅡ score, PCT, IL-6, and CRP increased; the length of hospital stay were correlated with death, and all were independent risk factors for death in CAP patients (all P < 0.05). Correlation analysis showed that the APACHEⅡ score was negatively related to plasma albumin (r = -0.375, P < 0.05), positively related to CRP and IL-6 (r value was 0.363 and 0.333 respectively, both P < 0.05); negative correlation between plasma albumin and IL-6 (r = -0.372, P < 0.05), PCT and CD4+ T cell count (r = -0.354, P < 0.05), CRP and the length of hospital stay (r = -0.356, P < 0.05). There were no significant correlations between the others. There was no significant difference in cellular immune function or inflammatory factor expression between different pathogenic infections. Conclusions Cellular immune dysfunction, hypoproteinemia, APACHEⅡ score and elevated inflammatory index are all influential factors for the death of CAP patients. Apart from conventional anti-infective treatment, the symptoms of hypoproteinemia and cellular immune function can predict the severity and prognosis of CAP patients.

Clinical analysis on death cases of visceral leishmaniasis / 中国感染控制杂志

Objective To understand the clinical characteristics and changes in laboratory indicators of patients died of visceral leishmaniasis (VL).Methods Clinical data of 4 patients died of VL in Beijing Friendship Hospital from January 2013 to June 2018 were analyzed, differences in laboratory indicators were compared.Results Disease course of 4 cases of VL ranged from3 to 12 months, all patients had multiple organ damage, including 3 cases with hepatomegaly and splenomegaly, 2 cases with central nervous system damage.IgG antibodies of leishmania were positive in 4 patients, Leishman-Donovan body was found in bone marrow smears.Routine peripheral blood test results in 4 patients decreased significantly, albumin decreased significantly and globulin increased;level of serum sodium ion in 4 patients was lower than 135 mmol/L.Conclusion Long disease course, multiple organ damage, involvement of central nervous system, significant reducing in peripheral blood routine test results, hypoproteinemia, and hyponatremia in patients with VL all indicate poor prognosis and high mortality.

Common features of atopic dermatitis with hypoproteinemia / 소아과

PURPOSE: The purpose of this study was to identify the causes, symptoms, and complications of hypoproteinemia to prevent hypoproteinemia and provide appropriate treatment to children with atopic dermatitis. METHODS: Children diagnosed with atopic dermatitis with hypoproteinemia and/or hypoalbuminemia were retrospectively reviewed. The patients’ medical records, including family history, weight, symptoms, treatment, complications, and laboratory test results for allergies and skin cultures, were examined. RESULTS: Twenty-six patients (24 boys) were enrolled. Seven cases had growth retardation; 7, keratoconjunctivitis; 6, aural discharges; 5, eczema herpeticum; 4, gastrointestinal tract symptoms; and 2, developmental delays. In 21 cases, topical steroids were not used. According to the blood test results, the median values of each parameter were elevated: total IgE, 1,864 U/mL; egg white-specific IgE, 76.5 kU(A)/L; milk IgE, 20.5 kU(A)/L; peanut IgE, 30 kU(A)/L; eosinophil count, 5,810/μL; eosinophil cationic protein, 93.45 μg/L; and platelet count, 666.5×10³/μL. Serum albumin and total protein levels decreased to 2.7 g/dL and 4.25 g/dL, respectively. Regarding electrolyte abnormality, 10 patients had hyponatremia, and 12, hyperkalemia. Systemic antibiotics were used to treat all cases, and an antiviral agent was used in 12 patients. Electrolyte correction was performed in 8 patients. CONCLUSION: Hypoproteinemia accompanying atopic dermatitis is common in infants younger than 1 year and may occur because of topical steroid treatment continuously being declined or because of eczema herpeticum. It may be accompanied by growth retardation, keratoconjunctivitis, aural discharge, and eczema herpeticum and can be managed through skin care and topical steroid application without intravenous albumin infusion.

Kaposi varicelliform eruption with severe complications:a case report / 临床儿科杂志

Objective To investigate the clinical features and prognosis of Kaposi varicelliform eruption with severe complications. Methods The clinical data of one child with Kaposi varicelliform eruption with severe complications was retrospectively analyzed. The related literatures were reviewed. Results A 5-month-old boy presented with recurrent rash on the head and face for 3 months and aggravated for 3 days. The skin lesions showed a characteristic of typical dome-shaped blisters with hemorrhagic crusting. At admission, the boy suffered with severe hypoproteinemia, hypocalcemia, and electrolyte disorder. The hypocalcemia was aggravated gradually. On the fifth day of admission, the boy had fever, convulsions, and tachycardia. Blood culture showed methicillin-resistant Staphylococcus aureus (MASA) infection. The diagnosis of sepsis was confirmed. At that very day, the boy started to have coagulopathy, so Fusidic and Vancomycin for anti-infection, Acyclovir for antivirus, intravenous infusion immunoglobulin, albumin, cryoprecipitate, plasma and calcium gluconate were administered, supplied with albumin and blood coagulation factor. The boy's condition gradually became stable and discharged on the 19th day after admission. Conclusions When Kaposi varicelliform eruption is complicated with hypoproteinemia and hypocalcemia, the critical illness is indicated. Clinicians should be alerted to the existence of sepsis, coagulation disorders, even septic shock and disseminated intravascular coagulation.

Baseline HBV Load Increases the Risk of Anti-tuberculous Drug-induced Hepatitis Flares in Patients with Tuberculosis / 华中科技大学学报（医学）（英德文版）

Hepatitis associated anti-tuberculous treatment (HATT) has been a main obstacle in managing patients co-infected with Mycobacterium tuberculosis and hepatitis B virus (HBV).Therefore,we evaluated the factors related to the severity of adverse effects during HATT,especially those associated with liver failure.A retrospective study was carried out at Tongji Hospital from 2007 to 2012.Increases in serum transaminase levels of＞3,5,and 10 times the upper limit of normal (ULN) were used to define liver damage as mild,moderate,and severe,respectively.Patients with elevated total bilirubin (TBil) levels that were more than 10 times the ULN (＞171 μrnol/L) with or without decreased (＜40％) prothrombin activity (PTA) were diagnosed with liver failure.A cohort of 87 patients was analyzed.The incidence of liver damage and liver failure was 59.8％ (n=52) and 25.3％ (n=22),respectively.The following variables were correlated with the severity of hepatotoxicity:albumin (ALB) levels,PTA,platelet counts (PLT),and the use of antiretroviral therapies (P＜0.05).Hypo-proteinemia and antiretroviral therapy were significantly associated with liver failure,and high viral loads were a significant risk factor with an odds ratio (OR) of 2.066.Judicious follow-up of clinical conditions,liver function tests,and coagulation function,especially in patients with high HBV loads and hypoalbuminemia is recommended.It may be advisable to reconsider the use of antiviral drugs failure during the course of anti-tuberculous treatment of HBV infection patients to avoid the occurrence of furious liver failure.

Chylopericardium after Cardiac Surgery

Chylopericardium after intra-thoracic surgery is rare. Its incidence is reported to be between 0.22% and 0.5%[1, 2] following paediatric cardiac surgery, but is not quantified following cardiac surgery in the adult population. A delay in diagnosis can lead to serious consequences with tamponade and death[3]. Chronic lymph leak can also lead to immunosuppresion, hypoproteinemia and malnutrition[3]. The majority of published literatures on this condition after cardiac surgery are in children. There are few reports of chylopericardium in adults following coronary artery bypass grafting and valvular surgery[4–6], and these advocate treatment with either total parental nutrition or surgical intervention. We report on the case of chylopericardium after a trial. Septal defect surgical closure in an adult patient treated successfully by oral dietary manipulation.

The evaluation of human albumin in patients with hypoproteinemia / 中国基层医药

Objective To analysis the rational use of human albumin in patients with hypoproteinemia in our hospital.Methods The drug evaluation criteria of human albumin were developed and the patients of different gen-dem,ages,departments,clinical diagnoses,human albumin species,administration,doses,course of treatment and pur-poses in our hospital were investigated.Results The using rate of human albumin in patients with hypoproteinemia was 53.1% in our hospital,20% human albumin accounted for the most(89cases),and the consumption of human albumin used in department of respiration was the most in our hospital (70cases).Diagnosis of 14 cases were not anastomosis with indications and 8 cases hadprolonged use and no indicative use and inappropriate medication. Conclusion The irrational use of human albumin are existed in our hospita1.We should develop the drug using standard of human albumin and strictly grasp the indications of drug use to avoid overuse of human albumin.