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Objective:To investigate the incidence and risk factors of human cytomegalovirus (HCMV) reactivation in immunocompetent severe pneumonia patients with mechanical ventilation and their effects on clinical outcomes.Methods:A prospective observational study was conducted. Forty-eight immunocompetent patients requiring invasive mechanical ventilation due to severe pneumonia in the department of critical care medicine of the First Affiliated Hospital of Guangzhou Medical University from June 30th, 2017 to July 1st, 2018 were enrolled. Meanwhile, all cases were followed up until 90 days after inclusion and were required to quantitatively detect HCMV DNA in serum at regular weekly intervals until 28 days after transferring to intensive care unit (ICU). Patients were divided into HCMV reactivation group (≥5×10 5 copies/L) and non-reactivation group (<5×10 5 copies/L) based on HCMV DNA at any time point within 28 days. Demographic data, basic indicators, respiratory indicators, disease severity scores, laboratory indicators, complication and clinical outcomes of the two groups were collected and analyzed. Multivariate Logistic regression analysis was performed to screen independent risk factors for HCMV reactivation. Results:All 48 subjects were tested positive for HCMV immunoglobulin G (IgG), so HCMV seropositive rate was 100%. HCMV reactivation occurred in 10 patients within 28 days after admission to ICU, and the reactivation incidence of HCMV was 20.83%. There was no significant difference in gender, age, body mass index (BMI), underling disease reasons for ICU transfer (except sepsis), basic vital signs, disease severity scores, or laboratory findings including infection, immune, blood routine, liver, kidney and circulatory indicators except neutrophils count (NEU), hypersensitivity C-reactive protein(hs-CRP), hemoglobin (Hb), blood urea nitrogen (BUN), N-terminal pro-brain natriuretic peptide (NT-proBNP) between the two groups. The height (cm: 160±6 vs. 166±8), body weight (kg: 49.4±11.2 vs. 57.6±10.5), Hb (g/L: 87±18 vs. 104±24) in HCMV reactivation group were significantly lower than non-reactivation group, as well as NEU [×10 9/L:12.7 (9.9, 22.5) vs. 8.9 (6.2, 13.8)], hs-CRP [mg/L: 115.5 (85.2, 136.6) vs. 39.9 (17.5, 130.2)], BUN [mmol/L:13.7 (8.9, 21.5) vs. 7.1 (4.9, 10.5)] and NT-proBNP [ng/L: 6 751 (2 222, 25 449) vs. 1 469 (419, 4 571)] within 24 hours of admission to ICU. The prevalence of sepsis [60.0% (6/10) vs. 15.8% (6/38)], blood transfusion [100.0% (10/10) vs. 60.5% (23/38)], hospitalization expense [ten thousand yuan: 35.7 (25.3, 67.1) vs. 15.2 (10.4, 22.0)], 90-day all-cause mortality [70.0% (7/10) vs. 21.1% (8/38)], length of ICU stay [days: 26 (16, 66) vs. 14 (9, 19)], the duration of mechanical ventilation [days: 26 (19, 66) vs. 13 (8, 18)] in HCMV reactivation group were significantly higher than non-reactivation group, and there were significant statistical differences between the two groups (all P < 0.05). Logistic regression analysis showed that sepsis was an independent risk factor for HCMV reactivation in immunocompetent mechanical ventilation severe pneumonia patients with mechanical ventilation [odds ratio ( OR) = 9.35, 95% confidence interval (95% CI) was 1.72-50.86, P = 0.010]. Conclusions:HCMV infection is very common in immunocompetent severe pneumonia patients on mechanical ventilation and incidence of HCMV reactivation is high. Moreover, HCMV reactivation could adversely affect clinical prognoses, and sepsis may be a risk factor for HCMV reactivation.
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Objective To investigate the significance of serum HbA1c and N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with acute coronary syndromes. Methods 120 patients with acute coronary syndromes were enrolled in Jinhua Wenrong hospital from June 2015 to December 2016. Among them, 68 patients with diabetes mellitus (group A) and 52 patients without diabetes (group B) were selected. 80 healthy cases in this hospital were selected as the control group. (HbA1c) and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured and compared. Results The level of serum HbA1c in group A was (9.52±1.57)%, which was significantly higher than that in group B (5.92±0.36)%, control group (5.82±0.41)%, t=(16.19, 20.29), P=(0.00, 0.00); And group B compared with the control group, t=1.43, P=0.15. The level of NT-proBNP in group A was (442.78±79.14) μg/mL, which was significantly higher than that in group B (221.45±33.89) μg/mL, control group (87.14±14.82) μg/mL, t=(18.87, 39.41), P= (0.00, 0.00); and group B was significantly higher than those in the control group, t=31.19, P=0.00. Cardiac function in patients with acute coronary syndromes was positively correlated with serum HbA1c and NT-proBNP (r=0.624, 0.582). Conclusion The levels of HbA1c and NT-proBNP in patients with acute coronary syndromes were significantly higher than those in patients with acute coronary syndromes. The levels of HbA1c and NT-proBNP in patients with acute coronary syndromes were helpful to evaluate their cardiac function.
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Objective To investigate the significance of serum HbA1c and N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with acute coronary syndromes. Methods 120 patients with acute coronary syndromes were enrolled in Jinhua Wenrong hospital from June 2015 to December 2016. Among them, 68 patients with diabetes mellitus (group A) and 52 patients without diabetes (group B) were selected. 80 healthy cases in this hospital were selected as the control group. (HbA1c) and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured and compared. Results The level of serum HbA1c in group A was (9.52±1.57)%, which was significantly higher than that in group B (5.92±0.36)%, control group (5.82±0.41)%, t=(16.19, 20.29), P=(0.00, 0.00); And group B compared with the control group, t=1.43, P=0.15. The level of NT-proBNP in group A was (442.78±79.14) μg/mL, which was significantly higher than that in group B (221.45±33.89) μg/mL, control group (87.14±14.82) μg/mL, t=(18.87, 39.41), P= (0.00, 0.00); and group B was significantly higher than those in the control group, t=31.19, P=0.00. Cardiac function in patients with acute coronary syndromes was positively correlated with serum HbA1c and NT-proBNP (r=0.624, 0.582). Conclusion The levels of HbA1c and NT-proBNP in patients with acute coronary syndromes were significantly higher than those in patients with acute coronary syndromes. The levels of HbA1c and NT-proBNP in patients with acute coronary syndromes were helpful to evaluate their cardiac function.
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OBJECTIVE@#To observe the antitumor effect and mechanism of recombinant human endostatin (Endostar) injection in tumor combined with intraperitoneal injection of cisplatin on subcutaneous transplanted Lewis lung cancer in rats.@*METHODS@#A total of 30 C57 rats were selected, and the monoplast suspension of Lewis lung cancer was injected into the left axilla to prepare the subcutaneous transplanted tumor models in the axilla of right upper limb. The models were randomly divided into Groups A, B, and C. Medication was conducted when the tumor grew to 400 mm(3). Group A was the control group without any interventional treatment. Group B was injected with Endostar 5 mg kg(-1) d(-1) for 10 d. Group C was given the injection of Endostar 5 mg kg(-1) d(-1) combined with intraperitoneal injection of cisplatin 5 mg kg(-1) d(-1) for 10 d. All the rats in three groups were executed the day after the 10 d medication and the tumor was taken off for measurement of volume and mass changes and calculation of antitumor rate, after which the vascular endothelial growth factor (VEGF) concentration in rats' plasma was determined by ELISA. The tumor tissues were cut for the preparation of conventional biopsies. After hematoxylin-eosin staining, the pathologic histology was examined to observe the structures of tumor tissues, VEGF score and microvessel density (MVD) in each group.@*RESULTS@#The volume and mass of tumor in Groups B and C were significantly lower than Group A (P < 0.05) while the tumor volume and mass in Group C were significantly lower than Group B (P < 0.05). The antitumor rate in Group C was significantly higher than Group B (P < 0.05), but the tumor VEGF score, MVD and plasma VEGF level in Group C were significantly lower than Groups A and B (P < 0.05). In Group B, the tumor VEGF score, MVD and plasma VEGF level were significantly lower than Group A (P < 0.05). The microscopic image of Group C showed that its number of active tumor cells and the blood capillary around tumor was significantly smaller than that of Groups A and B, and meanwhile atrophy and liquefactive necrosis were seen in local tumor.@*CONCLUSIONS@#Endostar injection combined with intraperitoneal injection of cisplatin is effective in reducing tumor VEGF score and MVD of transplanted tumor tissues in rats with Lewis lung cancer to obstruct the nutrient supply of tumor cells and kill tumor cells, so that the inhibition of tumor cell proliferation and metastasis can be achieved with a remarkable effect.
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Objective: To observe the antitumor effect and mechanism of recombinant human endostatin (Endostar) injection in tumor combined with intraperitoneal injection of cisplatin on subcutaneous transplanted Lewis lung cancer in rats. Methods: A total of 30 C57 rats were selected, and the monoplast suspension of Lewis lung cancer was injected into the left axilla to prepare the subcutaneous transplanted tumor models in the axilla of right upper limb. The models were randomly divided into Groups A, B, and C. Medication was conducted when the tumor grew to 400 mm3. Group A was the control group without any interventional treatment. Group B was injected with Endostar 5 mg kg-1 d-1 for 10 d. Group C was given the injection of Endostar 5 mg kg-1 d-1 combined with intraperitoneal injection of cisplatin 5 mg kg-1 d-1 for 10 d. All the rats in three groups were executed the day after the 10 d medication and the tumor was taken off for measurement of volume and mass changes and calculation of antitumor rate, after which the vascular endothelial growth factor (VEGF) concentration in rats' plasma was determined by ELISA. The tumor tissues were cut for the preparation of conventional biopsies. After hematoxylin-eosin staining, the pathologic histology was examined to observe the structures of tumor tissues, VEGF score and microvessel density (MVD) in each group. Results: The volume and mass of tumor in Groups B and C were significantly lower than Group A (P < 0.05) while the tumor volume and mass in Group C were significantly lower than Group B (P < 0.05). The antitumor rate in Group C was significantly higher than Group B (P < 0.05), but the tumor VEGF score, MVD and plasma VEGF level in Group C were significantly lower than Groups A and B (P < 0.05). In Group B, the tumor VEGF score, MVD and plasma VEGF level were significantly lower than Group A (P < 0.05). The microscopic image of Group C showed that its number of active tumor cells and the blood capillary around tumor was significantly smaller than that of Groups A and B, and meanwhile atrophy and liquefactive necrosis were seen in local tumor. Conclusions: Endostar injection combined with intraperitoneal injection of cisplatin is effective in reducing tumor VEGF score and MVD of transplanted tumor tissues in rats with Lewis lung cancer to obstruct the nutrient supply of tumor cells and kill tumor cells, so that the inhibition of tumor cell proliferation and metastasis can be achieved with a remarkable effect.
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The outcome of surgery alone for advanced gastric cancer is unsatisfactory. Local recurrence rate and distant metastasis rate are still high in postoperative patients. In recent years, people have paid more attention to neo- adjuvant chemotherapy, because it can reduce tumor loading, degrade the staging, increase the surgery excision rate and improve the long-term survival. Preoperative regional arterial infusion chemotherapy can directly act on the tumor endothelial cells with higher local drug concentration, but with fewer systemic side effects. So it may offer an effective treatment for advanced gastric cancer. The indications, complications, therapeutic evaluation, timing of surgery, chemotherapy regimens and pathomorphological changes and so on of the preoperative regional arterial infusion chemotherapy are summarized in this review.
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Humanos , Quimioterapia Adyuvante , Infusiones Intraarteriales , Cuidados Preoperatorios , Neoplasias Gástricas , Quimioterapia , Cirugía GeneralRESUMEN
Objective To explore how Vibrio vulnificus (Vv) invades dendritic cells (DC) and induces acute necrosis of DC via toll-like receptor (TLR) 2 and 4 pathways.Methods Vv 1.1758 strain and DC 2.4 mixed culture model was established,observed the infection rates of DC with optical microscope,the location of Vv and structural changes of DC by transmission electron microscope.The expression levels of TLR2 and TLR4 mRNA were determined by real-time quantitative reverse transcription polymerase chain reaction (RT-qPCR) and tumor necrosis factor-α (TNFα) protein titers were measured by enzyme-linked immunosorbent assay (ELISA).DNA ladder qualitative test was used to detect cell apoptosis,while flow cytometry was used to quantify cell apoptosis and necrosis rates.Statistical analysis was done by chi-square test and one-way ANOVE.Results The infection rates of DC after 0.5,1,2,4 and 6 h of mixed culture were (7.8±0.8) ％,(13.9± 1.1) ％,(34.6±4.9) ％,(77.8± 10.2)％ and (95.8 ± 13.1)％,respectively.Vv was generally located in the internal cell membrane of DC 2.4.After 2 h co-culture,nuclear chromatins of DC became active and intranuclear apoptosis bodies appeared.After 4 h,cytoplasmic vacuoles appeared,chromatin gathered,and cell membranes were seriously damaged.After 6 h,mitochondria was highly swelled and distorted,and cell apoptosis and necrosis occurred.TLR2 and TLR4 mRNA levels reached peak values after co-culture for 0.5 h; TNF-α level began to increase at 1 h (P＜0.05) and reached peak values at 2 h.DNA Ladder electrophoresis presented scouring necrosis after 2 h culture and apoptotic bands appeared between 720 bp and 900 bp after 4 to 5 h culture.Early apoptosis rates of DC after 2,4 and 6 h culture were (3.1±3.8)％,(7.8±4.7)％ and (12.7±8.2)％,and necrosis rates of DC were (16.7±12.5)％,(41.6±25.9)％ and (75.5±33.6)％,higher than that of control group (all P＜0.05).Conclusions Vv infects DC and induce DNA degradation through up-regulated expression of TLR2 and TLR4 and increasing of TNF-α inflammatory mediators.During cell degradation,apoptosis and necrosis coexist,while necrosis is predominant.
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Objective To evaluate the value of ultrasound elastography score and strain ratio index in the differential diagnosis of thyroid solid nodules. Methods Eighty-six thyroid solid nodules of 69 patients were divided into 2 groups based on their pathologic results: benign nodules group and malignant nodules group.Compared with pathological results, each thyroid solid nodules' elastographic scores and strain ratio index were respectively analyzed. The sensitivity, specificity and accuracy of elasticity score and strain ratio index were calctlated.The receiver operator characteristic (ROC) curves were drawn according to the results, to choose the best cut-off value.Results There were 67 nodules in benign nodules group and 19 nodules in malignant nodules group. The diameter of benign nodules was (2.05 ± 0.21)cm, malignant nodules was (1.62 ± 0.12)cm. There were no significant differences in the elasticity score and strain ratio index between benign and malignant nodules(t= - 1.736, P ＞ 0.05). Malignant lesions had a higher score and strain ratio index(median 3, 3.97, respectively) than benign ones(median 2, 1.66,respectively, Z = - 5.290, - 5.450, all P ＜ 0.05). If the cut-off value of the elastographic scores was equal or more than 3, the sensitivity, specificity and accuracy were 84.2%(16/19) ,86.6%(58/67) and 86.0%(74/86), respectively,with an area under ROC curve of 0.854. If the cut-off value of the strain ratio index was equal or more than 2.50,the sensitivity, specificity and accuracy were 89.4%(17/19),86.6%(58/67) and 87.2%(75/86), respectively, with an area under ROC curve of 0.911. Conclusion Elasticity score and strain ratio index are helpful in differentiating benign and malignant lesions of thyroid with high clinical value.
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<p><b>OBJECTIVE</b>To evaluate the clinical effect of Liqi Kuanxiong Huoxue method LKH, traditional Chinese medicine, TCM therapeutic method for regulating qi, relieving chest stuffiness and promoting blood circulation) in treating patients with cardiac syndrome X (CSX).</p><p><b>METHODS</b>The prospective, non-randomized controlled study was conducted on 51 selected patients with CSX, who were non-randomly assigned to 2 groups, the treated group treated with LKH in addition to the conventional treatment (32 patients), and the control group treated with conventional treatment (19 patients) like nitrate, diltiazem hydrochloride, etc. The treatment course was 14 days. The changes of such symptoms as angina pectoris, TCM syndrome and indexes of treadmill exercise test before and after treatment were observed.</p><p><b>RESULTS</b>After treatment, such symptoms as chest pain and stuffy feeling and palpitation in the treated group were improved more than those in the control group (P<0.05); the total effective rate on angina pectoris and TCM syndrome in the treated group was better than that in the control group (P<0.05). The treadmill exercise test showed that the maximal metabolic equivalent (Max MET), the time of angina onset and ST segment depression by 0.1 mV were obviously improved after treatment in both groups, but the improvement in the treated group was better than that in the control group respectively (P<0.05).</p><p><b>CONCLUSION</b>The LKH method could reduce the frequency of angina attacks and improve the clinical condition of patients with CSX.</p>
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Femenino , Humanos , Masculino , Persona de Mediana Edad , Circulación Sanguínea , Combinación de Medicamentos , Medicamentos Herbarios Chinos , Usos Terapéuticos , Prueba de Esfuerzo , Angina Microvascular , Diagnóstico , Terapéutica , Qi , Tórax , Resultado del TratamientoRESUMEN
<p><b>OBJECTIVE</b>To explore the objective special features and role of various indexes of treadmill exercise test (TET) in patients of coronary heart disease (CHD) caused angina pectoris with Qi-Yin deficiency syndrome (QYD) with or without accompanied phlegm and blood stasis syndrome (PBS), to provide references for preventing and treating CHD in clinical practice.</p><p><b>METHODS</b>One hundred and one patients, whose diagnosis measured to the diagnostic standard and the inclusion criteria of angina pectoris and CHD, were classified according to their TCM syndrome type to two groups, the QYD without PBS group (49 cases) and the QYD with PBS group (52 cases). TET was conducted on all the patients. The relative parameters were measured and compared.</p><p><b>RESULTS</b>As compared with the QYD without PBS group, in the QYD with PBS group, (1) the TET positive rate was higher; (2) total exercise time was lesser; (3) the maximal metabolic equivalent (Max MET) was lower; (4) the average depression of ST segment at the exercise endpoint of test (mV) was higher; (5) the time of ST segment depressed for 0.1mV (min) was longer; (6) the metabolic equivalent during ST-segment depressed by 0.1mV was shorter; and (7) the change of QRS wave time-limit before and immediately after TET was more evident. Moreover, in the testing time more patients revealed angina episode after exercise, and less patients had their heart rate reached the requirement in the QYD with PBS group than those in the QYD without PBS group. Comparison between the two groups in all the above-mentioned indices showed significant difference respectively (P < 0.01 or P < 0.05).</p><p><b>CONCLUSION</b>Patients with CHD caused angina pectoris of QYD with PBS are worse in the tolerance for exercise and severer in pathological change of coronary artery than those in those without PBS, they belong to the severe phase of TCM syndrome.</p>