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Objective:To explore more clinical characteristics and outcomes of children with severe pneumonia induced by adenovirus type 7(Adv-7).Methods:Seventy children with severe pneumonia induced by Adv-7 admitted to the pediatric intensive care unit of Guangzhou Women and Children′s Medical Center from January 2016 to October 2019 were enrolled.The clinical features, treatments and outcomes of these children were recorded.Results:(1)There were 43 males(61.4%)and 27 females(38.6%). Thirty(42.9%)patients were 0-12 months old, 28(40.0%)patients were 13-36 months old, and 12(17.1%)patients were over 36 months old.(2)The average onset time of severe pneumonia induced by Adv-7 was(11.87±7.10)days before being admitted to PICU.The average sequential organ failure assessment score was 6.80±3.13.The average Murray lung injury score was 2.49±1.15.The average P/F value was(150.57±86.25)mmHg(1 mmHg=0.133 kPa). Sixty-four cases(91.4%)were involved in two or more area of lung on X-rays.All cases were diagnosed with sepsis.(3)Laboratory examination: white blood cell count was(7.6±5.5) ×10 9/L, platelet count was(238.8±164.2)×10 9/L, and C-reactive protein was(39.4±37.2)mg/L.(4)Treatments: intravenous gamma globulin was used in 65 cases(92.9%). Intravenous glucocorticoid was used in 45 cases(64.3%). Fiberoptic bronchoscopy was performed in 43 cases(61.4%). Blood purification treatment was performed in 21 cases(30%). Sixty-three patients(90.0%)were treated with non-invasive or invasive ventilator, high frequency ventilator-assisted ventilation was used in 20 cases(28.6%). Surfactant was used in six cases(8.6%). Extracorporeal membrane oxygenation was used in 19 cases(27.1%). (5)The average treatment time for ventilation was(13.10±11.58)days.The average time for temperature recover was(4.69±4.01)days in PICU.The average PICU stay time was(15.76±12.20)days.The average length of stay was(27.04±13.10)days.There were 16 patients died and the mortality was 22.9%. Conclusion:The children with severe pneumonia induced by Adv-7 were critical and had significant lung injuries.Suffering from active clinical treatment such as extracorporeal membrane oxygenation, some of these patients still had poor prognosis.
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Objective@#To analyze the change trend of HIV genetic subtypes and compare the first CD4+T cell counts of newly diagnosed HIV infected patients in Liuzhou from 1998 to 2012, and provide a reference for AIDS prevention and control.@*Methods@#Newly diagnosed HIV-infected patients from 1998 to 2012 in Liuzhou were selected through national HIV/ADIS comprehensive response information management system. Their plasma samples were used for RNA gene extraction, amplification, sequencing and genotyping. Coharan-Armitage trend test was used to analyze the ratio trend of genetic subtypes and phylogenetic clusters of HIV and Wilcoxon Rank Sum Test was used to compare the first CD4+T cell counts (CD4) of the different subtype HIV infected patients.@*Results@#A total of 1 877 newly diagnosed HIV infected patients were included in the study. From 1998 to 2012, the proportions of CRF01_AE and CRF01_AE (Cluster 1) increased from 78.4% (76/97) to 91.5% (1 441/1 574), from 63.9% (62/97) to 74.0% (1 164/1 574), and the proportion of CRF07_BC decreased from 17.5% (17/97) to 4.6% (72/1 574), respectively (Z=4.632, P<0.001; Z=2.455, P=0.014; Z=-5.943, P<0.001). The median and interquartile range of the first CD4 of the patients infected with subtype CRF01_AE (Cluster 1), CRF01_AE (Cluster 2), CRF07_BC and CRF08_BC were 230 (83-375), 215 (48-351), 365 (254-503) and 334 (206-479) cell/μl, respectively. The first CD4 levels of the patients infected with subtype CRF01_AE (Cluster 1) or CRF01_AE (Cluster 2) were significantly lower than those of CRF07_BC (Z=-4.795, P<0.001; Z=-4.238, P<0.001).@*Conclusion@#The genetic subtypes of HIV were mainly CRF01_AE in newly diagnosed HIV-infected patients and this subtype proportion was in increase and the first CD4 levels of the patients were low in Liuzhou during 1998 to 2012.
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Objective@#To understand the characteristics of HIV/AIDS epidemic in Guangxi Zhuang Autonomous Region (Guangxi) with a purpose to accurately provide scientific basis for prevention and control measures, 2010-2017.@*Methods@#Data were retrieved from case reporting cards of Guangxi during 2010 to 2017 through National HIV/AIDS Comprehensive Response Information Management System. Data was analyzed using epidemiological methods such number of cases, proportion and rate. χ2 test was used for statistical analysis.@*Results@#The HIV positive rate was 12.53 per ten thousand (85 182/67 959 000) in Guangxi during 2010 to 2017. The number of newly diagnosed HIV/AIDS cases and the number of death yearly respectively increased by 22.34%(2 602/11 648) and 32.83% (952/2 900) in 2011 compared with 2010, and both showed a six-year continuous downward trend (the number of newly diagnosed cases respectively 12 229 cases, 10 877 cases, 9 460 cases, 9 190 cases, 8 848 cases, 8 680 cases, and the number of death respectively 3 888 cases, 3 316 cases, 2 914 cases, 2 717 cases, 2 595 cases, 2 600 cases) from 2012 to 2017. But proportion of late discovery remained above 50.00% (50.53%-57.06%) for eight-years continuously. The ratio of male and female was 2.47 ∶ 1 (60 639/24 543). The ratio of males and females aged 50 and over was 2.71∶1 (28 654/10 557). Proportion of the cases in 25-49 years old group and 50 years old group accounting for 47.40%(40 377/85 182) and 46.03% (39 211/85 182) respectively. The occupation was farmers accounting for 68.40% (58 262/85 182), housekeeping, housework and unemployment accounting for 11.21% (9 546/85 182), student accounting for 0.86% (729/85 182). Heterosexual transmission accounted for 90.60% (77 171/85 182, homosexual transmission accounted for 3.13% (2 669/85 182), injection drug use transmission accounted for 4.60%(3 924/85 182) and mother-to-child transmission accounted for 0.73% (619/85 182).@*Conclusions@#The number of newly diagnosed cases and the number of death yearly showed a continuous downtrend for six-years from 2012 to 2017. However, proportion of late discovery remained above 50.00% for eight-years. The major route of infection was heterosexual transmission. With the change of HIV/AIDS newly epidemic mode in Guangxi, there are many new challenges for HIV/AIDS prevention and control work. Strategy of targeted intervention modes should be innovated for a new breakthrough.
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Objective@#To investigate the characteristics and clinical value of visual evoked potentials(VEP) in children with optic neuritis.@*Methods@#The VEP of 33 children with optic neuritis were tested by NICOLET evoked potential instrument.The results were compared with those of cranial and/or orbital MRI and fundus examination, and the consistency with visual performance was analyzed.The correlation between visual sensitivity and VEP results was analyzed.@*Results@#Among 33 children with optic neuritis, the abnormal rate of VEP in 52 abnormal eyes was 88.5%; the abnormal rate of cranial and/or orbital MRI was 38.5%; the abnormal rate of fundus examination was 62.2%; the abnormal rate of VEP examination was significantly higher than that of cranial and/or orbital MRI and fundus examination (P<0.05); the consistency rate between VEP examination and visual acuity was 84.8%.The consistency rate between pattern reversal visual evoked potential (P-VEP) and visual acuity was 86.8%, and that between flash visual evoked potential (F-VEP) and visual acuity was 82.1%.With the increase of visual impairment, the percentage of P100 wave loss increased gradually.There was no correlation between visual acuity and the prolongation of P100 wave latency.@*Conclusion@#There are significant differences between VEP and fundus examination and MRI, the sensitivity of VEP is superior to both.P-VEP is more consistent with visual acuity than F-VEP.VEP has certain value in evaluating the degree of visual impairment in children with optic neuritis.It can not be used to evaluate the level of optic sensitivity when the latency of P100 wave is prolonging.
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Objective To study the relationship between serum neutrophil gelatinase-associated lipocalin (NGAL),kerbs von lungren 6 antigen (KL-6) and bronchopulmonary dysplasia (BPD) in preterm infants.Method From Jan.2015 to Dec.2015,preterm infants admitted to NICU of Guangzhou Women and Childrem's Medical Center with gestational age less than 32 weeks and birth weight less than 1 500 g were enrolled.The serum levels of procalcitonin (PCT),NGAL and KL-6 protein were detected at 24 h,7 d and 14 d after birth.At the 28 d after birth,according to the presence of BPD or not,the infants were assigned into BPD group and non-BPD group.The differences of the serum levels of PCT,NGAL and KL-6 between the two groups were compared.Result A total of 55 cases were included in the study (BPD group 20 cases,non-BPD group 35 cases).No significant differences existed in gender,birth weight and gestational age between the two groups (P ＞ 0.05).The incidence of respiratory distress syndrome were siginificantly higher in the BPD group (P ＜ 0.05) and the duration of mechanical ventilation and oxygen therapy were siginifantly longer in the BPD group (P ＜ 0.05).No significant difference between the two groups in the level of PCT at 24 h after birth (P ＞ 0.05).The levels of serum PCT at 7 d and 14 d after birth in BPD group were significantly higher than non-BPD group [7 d:(1.5 ± 1.7) ng/ml vs.(0.4 ± 0.2)ng/ml,14 d:(0.8 ± 0.7) ng/ml vs.(0.2 ± 0.1) ng/ml] (P ＜ 0.001).The levels of serum NGAL at 24 h,7 d and 14 d were significantly higher than non-BPD group [24 h:(1.6 ± 0.3) pg/ml vs.(0.8 ±0.2) pg/ml,7 d:(2.3 ±0.5) pg/ml vs.(0.7 ±0.2) pg/ml,14 d:(2.5 ±0.3) pg/ml vs.(0.8 ±0.2)pg/ml] (P ＜0.001).The levels of serum NGAL at 7 d and 14 d after birth in BPD group were significantly higher than 24 h in BPD group (P ＜ 0.05).No significant difference between KL-6 at 24 h after birth in BPD group and non-BPD group (P ＞0.05).The levels of serum KL-6 at 7 d and 14 d after birth in BPD group were significantly higher than non-BPD group [7 d:(1.2 ± 0.2) ng/ml vs.(0.8 ± 0.1) ng/ml,14 d:(1.3 ±0.2) ng/ml vs.(0.8 ±0.9) ng/ml] (P ＜0.001).The level of serum KL-6 at 7 d and 14 d after birth in BPD group were significantly higher than 24 h in BPD group (P ＜ 0.05).Conclusion Respiratory distress syndrome and prolonged mechanical ventilation were risk factors of BPD.The rising of serum NGAL and KL-6 early after birth might be involved in the development of BPD,which had predictive value of BPD.
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Objective To understand the impact of HIV and Mycobacterium tuberculosis (MTB) co-infectious (HIV/MTB) on related mortality in Guangxi Zhuang Autonomous Region,provide evidence for the development of a better HIV/MTB co-infection control and prevention program.Methods A multiple cross-systems check (MCSC) approach was used to confirm the HIV/MTB co-infection individuals on data related to treatment,follow-up,epidemiological comprehensive and Tuberculosis (TB) special report system.Social demography characteristics,incidence of TB among HIV positive individuals,HIV incidence among MTB infection persons etc.,were described.We compared the mortalities and related risks between HIV/MTB co-infection and mono HIV positive individuals as well as between the HIV/MTB co-infection and mono MTB infection persons,using both the Chi Square test and the Cox's proportional hazard regression model (Cox).Results Reported data showed that the incidence of MTB co-infection in the HIV cohort was 17.72％ (2 533/14 293),while HIV incidence in the TB patients was 5.57％ (2 351/42 205),respectively.The mortality of HIV/MTB co-infection in the HIV/AIDS cohort was 15.16％ (384/2 533) within one-year of observation and was significantly higher than the mortality (13.63 ％,1 603/11 760) of mono HIV positive individuals (P＜0.000 1).The percentage of the HIV/AIDS death cases was 19.33％ (384/1 987) who registered and died in the 2011 calendar year were caused by MTB co-infection.Among all the HIV/MTBco-infection patients who had been identified from the HIV cohort,60.05％ (1 521/2 533) had initiated ART,15.48％ (392/2 533) had been cured for TB and 27.48％ (696/2 533) had been under complete TB regimen.Among the confirmed HIV/MTB cases from the TB cohort,the cure rate of TB was 19.70％ (463/2 351) and the percentage of completed TB regimen was 37.26％ (876/2 351).The percentage of the individuals whose CD4+ T lymphocyte cells count appeared less than 200 cell/μl was 64.13％ (785/1 224),upon the HIV diagnoses were made.Compared with individuals who were under mono HIV infection,the mortality risk on HIV/MTB co-infection was 1.17 times higher during the five-year observation period,then the patients with only mono MTB infection and the mortality risk in patients with HIV/MTB co-infection was 25.68 times higher under the 12-month observation period.Conclusions Both the incidence and mortality of HIV/MTB appeared high in Guangxi,with mortality and the risk of mortality in the HIV/MTB co-infection group significantly higher than that in both the HIV mono infection and the MTB mono infections groups.Both the rate of antiretroviral treatment coverage and the cure rate of TB treatment should be increased in no time as well as the capability of early TB case-finding among people living with HIV.
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Objective To investigate the effect of baseline CD4+T cell count (CD4) on drop-out of antiretroviral therapy (ART) in HIV infected persons.Methods Retrospective cohort was conducted in this study.HIV infected persons aged≥ 18 years and receiving free ART for the first time in Guangxi Zhuang Autonomous Region (Guangxi) from 2008 to 2015 were selected from the antiretroviral treatment database of National Comprehensive HIV/AIDS Information System,with follow-up conducted till May 30,2016.Cause-specific Cox proportional hazard models were used to evaluate effect of different CD4 on the drop-out of ART in the HIV infected persons.Results A total of 58 502 eligible study participants were included in this retrospective cohort study.The average drop-out ratio was 4.8/100 person-years.After controlling the following baseline covariates:age,sex,marital status,route of HIV infection,WHO clinical stage before ART,initial/current ART regiment,ART regiment adjustment,and year of initiating ART for potential confounding,the adjusted HR of drop-out for HIV infected persons with 200-cells/μl,351-cells/μl and ≥500 cells/μl were 1.110 (95％CI:1.053-1.171,P＜0.001),1.391 (95％CI:1.278-1.514,P＜0.001) and 1.695 (95％CI:1.497-1.918,P＜ 0.001),respectively,in risk for drop-out compared with those with baseline CD4 ＜200 cells/μ 1.Among the HIV infected persons,56.0％ (1 601/2 861) of drug withdrawal was due to poor compliance with medication.Conclusions With the increase of baseline CD4 when initiating ART,the risk for the drop-out in HIV infected persons increased significantly.To further reduce the drop-out of ART,it is important to take CD4 into account in initiating ART and to strengthen the health education on treatment compliancy and training for healthcare providers.
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Objective To understand the impact of HIV and Mycobacterium tuberculosis (MTB) co-infectious (HIV/MTB) on related mortality in Guangxi Zhuang Autonomous Region,provide evidence for the development of a better HIV/MTB co-infection control and prevention program.Methods A multiple cross-systems check (MCSC) approach was used to confirm the HIV/MTB co-infection individuals on data related to treatment,follow-up,epidemiological comprehensive and Tuberculosis (TB) special report system.Social demography characteristics,incidence of TB among HIV positive individuals,HIV incidence among MTB infection persons etc.,were described.We compared the mortalities and related risks between HIV/MTB co-infection and mono HIV positive individuals as well as between the HIV/MTB co-infection and mono MTB infection persons,using both the Chi Square test and the Cox's proportional hazard regression model (Cox).Results Reported data showed that the incidence of MTB co-infection in the HIV cohort was 17.72％ (2 533/14 293),while HIV incidence in the TB patients was 5.57％ (2 351/42 205),respectively.The mortality of HIV/MTB co-infection in the HIV/AIDS cohort was 15.16％ (384/2 533) within one-year of observation and was significantly higher than the mortality (13.63 ％,1 603/11 760) of mono HIV positive individuals (P＜0.000 1).The percentage of the HIV/AIDS death cases was 19.33％ (384/1 987) who registered and died in the 2011 calendar year were caused by MTB co-infection.Among all the HIV/MTBco-infection patients who had been identified from the HIV cohort,60.05％ (1 521/2 533) had initiated ART,15.48％ (392/2 533) had been cured for TB and 27.48％ (696/2 533) had been under complete TB regimen.Among the confirmed HIV/MTB cases from the TB cohort,the cure rate of TB was 19.70％ (463/2 351) and the percentage of completed TB regimen was 37.26％ (876/2 351).The percentage of the individuals whose CD4+ T lymphocyte cells count appeared less than 200 cell/μl was 64.13％ (785/1 224),upon the HIV diagnoses were made.Compared with individuals who were under mono HIV infection,the mortality risk on HIV/MTB co-infection was 1.17 times higher during the five-year observation period,then the patients with only mono MTB infection and the mortality risk in patients with HIV/MTB co-infection was 25.68 times higher under the 12-month observation period.Conclusions Both the incidence and mortality of HIV/MTB appeared high in Guangxi,with mortality and the risk of mortality in the HIV/MTB co-infection group significantly higher than that in both the HIV mono infection and the MTB mono infections groups.Both the rate of antiretroviral treatment coverage and the cure rate of TB treatment should be increased in no time as well as the capability of early TB case-finding among people living with HIV.
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Objective To investigate the effect of baseline CD4+T cell count (CD4) on drop-out of antiretroviral therapy (ART) in HIV infected persons.Methods Retrospective cohort was conducted in this study.HIV infected persons aged≥ 18 years and receiving free ART for the first time in Guangxi Zhuang Autonomous Region (Guangxi) from 2008 to 2015 were selected from the antiretroviral treatment database of National Comprehensive HIV/AIDS Information System,with follow-up conducted till May 30,2016.Cause-specific Cox proportional hazard models were used to evaluate effect of different CD4 on the drop-out of ART in the HIV infected persons.Results A total of 58 502 eligible study participants were included in this retrospective cohort study.The average drop-out ratio was 4.8/100 person-years.After controlling the following baseline covariates:age,sex,marital status,route of HIV infection,WHO clinical stage before ART,initial/current ART regiment,ART regiment adjustment,and year of initiating ART for potential confounding,the adjusted HR of drop-out for HIV infected persons with 200-cells/μl,351-cells/μl and ≥500 cells/μl were 1.110 (95％CI:1.053-1.171,P＜0.001),1.391 (95％CI:1.278-1.514,P＜0.001) and 1.695 (95％CI:1.497-1.918,P＜ 0.001),respectively,in risk for drop-out compared with those with baseline CD4 ＜200 cells/μ 1.Among the HIV infected persons,56.0％ (1 601/2 861) of drug withdrawal was due to poor compliance with medication.Conclusions With the increase of baseline CD4 when initiating ART,the risk for the drop-out in HIV infected persons increased significantly.To further reduce the drop-out of ART,it is important to take CD4 into account in initiating ART and to strengthen the health education on treatment compliancy and training for healthcare providers.
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Objective To investigate the effects of epinephrine in sepsis-associated lung injury in rats. Methods Thirty SD rats were randomly divided into three groups(n =10 per group):control group received intravenous 0. 9% saline 2. 4 ml/( kg·h ); LPS group received intravenous LPS ( 6 mg/kg ); epi-nephrine treatment group received an infusion of epinephrine 0. 6μg/( kg·min) after LPS intravenous injec-tion . Blood samples were taken at 2 h and 6 h after LPS injection and the levels of serum tumor necrosis factor ( TNF)-α,interleukin( IL)-6 and IL-10 were detected. The rats were sacrificed at 6 h. The lung tissues and bronchoalveolar lavage fluid( BALF) were collected. Pathological changes of the lung tissues were observed under light microscope. Water content of lung,expression of TNF-α,IL-6 and IL-10 in BALF and in serum were detected. Results (1) The water content of lung in LPS group significantly increased compared with that in control group(85. 24% ± 5. 87% vs. 70. 19% ± 5. 87%) and epinephrine group(78. 00% ± 6. 41%) (P<0. 05). (2)Pathological examination showed that LPS could cause pulmonary capillary hyperemia,ede-ma,inflammatory cells infiltration. Atelectasis and alveolar edema were found in small number of lung tissue. Compared with LPS group, epinephrine ameliorated the lung pathological injury. ( 3 ) Compared with LPS group,serum levels of TNF-α and IL-6 significantly decreased ( P <0. 05 ) , whereas IL-10 increased ( P <0. 05) in epinephrine group. (4)Compared with LPS group,BALF levels of TNF-α[(78 ± 9)ng/L vs. (102 ±16)ng/L]andIL-6[(268±42)ng/Lvs.(347±50)ng/L]significantlydepressed(P<0.05),whereas BALFlevelsofIL-10[(210±23)ng/Lvs.(146±34) ng/L]elevated(P <0.05) inepinephrinegroup. Conclusion Epinephrine could reduce the acute lung injury caused by LPS. Its protective effect may be re-lated to decreasing the levels of TNF-α and IL-6,elevating IL-10 level.
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ObjectiveTo investigate the effects of epinephrine in intestinal injury caused by lipopolysaccharide (LPS) in rats.MethodsFifty SD rats were randomly divided into five groups ( n =10 pet group ):saline control group received intravenous infusion of 0.9％ saline 2.4 ml/( kg· h) ;LPS group received intravenous injection of LPS 6 mg/kg;small-dose,medium-dose,and large-dose epinephrine treatment group received an intravenous infusion of epinephrine 0.12 μg/(kg· min),0.3 μg/( kg· min),and 0.6 μg/( kg· min)after LPS 6 mg/kg intravenous injection,respectively.Intestinal injury was evaluated by intestinal pathological examination.Blood samples were taken at 0,2 and 6 h after LPS infection,and the levels of serum TNF-α,IL-1β and IL-10 were detected by enzyme-linked immunoadsorbent assay.The pathological changes of intestine were observed at 24 h.ResultsPathological examination showed that LPS caused severe congestion,edema,neutrophil infiltration,hemorrhage and cell necrosis in intestine.Compared with LPS group,large-dose epinephrine ameliorated the damage of intestine.In LPS group,serum levels of TNF-α[ ( 1164 ± 145) ng/L],IL-1β[ (521 ±68) ng/L],IL-10 [ (303 ±20) ng/L] all increased compared with control group (P＜0.05)at 2 h.Compared with LPS group,serum levels of TNF-α[ (576 ± 105) ng/L] were significantly depressed (P＜0.05),whereas IL-10 was elevated at 2 h[ (424 ±29) ng/L] and6 h[ (245 ± 14) ng/L] (P＜0.05)in large-dose epinephrine treatment group.Serum IL- 1β levels were unaffected by large-dose epinephrine treatment.Small-dose and medium-dose epinephrine could not reduce the pathological injury of intestine induced by lipopolysaccharide.Compared with LPS group,levels of serum TNF-α,IL-1β and IL-10 were also unaffected by small-dose and medium-dose epinephrine treatment ( all P＞0.05 ) at any time points.ConclusionEpinephrine reduced the intestine injury caused by LPS by down-regulating pro-inflammatory cytokines production and up-regulate anti-inflammatory cytokines production.
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<p><b>BACKGROUND</b>To detect DNA adduct in lung cancer tissues and analyze the factors influencing formation of DNA adduct.</p><p><b>METHODS</b>DNA was extracted from the tumor tissues derived from 34 patients with lung cancer. DNA adducts were analyzed using 32P-postlabeling method with P 1 nuclear modification.</p><p><b>RESULTS</b>DNA adduct level was significantly higher in smoking patients than that in non smoking patients(P < 0.05). DNA adduct level was related to the histological classification, degree of cell differentiation and lymph node metastasis, but not to age and sex.</p><p><b>CONCLUSIONS</b>DNA adduct level might be used as a potential marker to estimate malignant degree for lung cancer.</p>
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Objective To explore the health effects of organic extracts from ambient air particulates with various diameters on the DNA damage of human peripheral blood lymphoctys. Methods Using a 5-stage air sampler, the ambient air particulats samples were collected in a residential area of Taiyuan city and were extracted with dichloromethane, acetone and methanol. The damage of DNA in human peripheral blood lymphocytes induced by organic extracts from ambient air particulates with various diameters at doses of 25, 50, 100 ,200 ?g/ml were detected by sigle cell gelelectrophoresis assay. Results The toxic efficiency of organic extraction of ambient air particulates increased with the decreases of the diameters of particulates. The tail lengthes of the comets induced by organic extracts from ambient air particulcctes with various diameters