Clinical Outcome and Risk Factors of Treatment Failure of Peritoneal Dialysis Associated Peritonitis Caused by Klebsiella Pneumoniae:A Multicenter Study / 中国医学科学院学报

Objective To investigate the treatment outcomes,prognosis,and risk factors of treatment failure of peritoneal dialysis associated peritonitis (PDAP) caused by Klebsiella pneumoniae,and thus provide clinical evidence for the prevention and treatment of this disease. Methods The clinical data of PDAP patients at four peritoneal dialysis centers from January 1,2014 to December 31,2019 were collected retrospectively.The treatment outcomes and prognosis were compared between the patients with PDAP caused by Klebsiella.pneumoniae and that caused by Escherichia coli.Kaplan-Meier method was employed to establish the survival curve of technical failure,and multivariate Logistic regression to analyze the risk factors of the treatment failure of PADP caused by Klebsiella pneumoniae. Results In the 4 peritoneal dialysis centers,1034 cases of PDAP occurred in 586 patients from 2014 to 2019,including 21 cases caused by Klebsiella pneumoniae and 98 cases caused by Escherichia coli.The incidence of Klebsiella pneumoniae caused PDAP was 0.0048 times per patient per year on average,ranging from 0.0024 to 0.0124 times per patient per year during 2014-2019.According to the Kaplan-Meier survival curve,the technical failure rate of Klebsiella pneumoniae caused PDAP was higher than that of Escherichia coli caused PDAP (P=0.022).The multivariate Logistic regression model showed that long-term dialysis was an independent risk factor for the treatment failure of Klebsiella pneumoniae caused PDAP (OR=1.082,95%CI=1.011-1.158,P=0.023).Klebsiella pneumoniae was highly sensitive to amikacin,meropenem,imipenem,piperacillin,and cefotetan,and it was highly resistant to ampicillin (81.82%),cefazolin (53.33%),tetracycline (50.00%),cefotaxime (43.75%),and chloramphenicol (42.86%). Conclusion The PDAP caused by Klebsiella pneumoniae had worse prognosis than that caused by Escherichia coli,and long-term dialysis was an independent risk factor for the treatment failure of Klebsiella pneumoniae caused PDAP.

Development and validation of a prediction model for treatment failure in peritoneal dialysis-associated peritonitis patients: a multicenter study / 南方医科大学学报

OBJECTIVE@#To develop and validate a risk prediction model of treatment failure in patients with peritoneal dialysis-associated peritonitis (PDAP).@*METHODS@#We retrospectively analyzed the data of patients undergoing peritoneal dialysis (PD) in 3 dialysis centers in Jilin Province who developed PDAP between January 1, 2013 and December 31, 2019. The data collected from the Second Hospital of Jilin University and Second Division of First Hospital of Jilin University) were used as the training dataset and those from Jilin Central Hospital as the validation dataset. We developed a nomogram for predicting treatment failure using a logistic regression model with backward elimination. The performance of the nomogram was assessed by analyzing the C-statistic and the calibration plots. We also plotted decision curves to evaluate the clinical efficacy of the nomogram.@*RESULTS@#A total of 977 episodes of PDAP were included in the analysis (625 episodes in the training dataset and 352 episodes in the validation dataset). During follow-up, 78 treatment failures occurred in the training dataset and 35 in the validation dataset. A multivariable logistic regression prediction model was established, and the predictors in the final nomogram model included serum albumin, peritoneal dialysate white cell count on day 5, PD duration, and type of causative organisms. The nomogram showed a good performance in predicting treatment failure, with a C-statistic of 0.827 (95% CI: 0.784-0.871) in the training dataset and of 0.825 (95% CI: 0.743-0.908) in the validation dataset. The nomogram also performed well in calibration in both the training and validation datasets.@*CONCLUSION@#The established nomogram has a good accuracy in estimating the risk of treatment failure in PDAP patients.

Clinical Characteristics and Treatment Outcome of Pseudomonas Peritoneal Dialysis-associated Peritonitis / 中国医学科学院学报

Objective To explore the clinical characteristics and treatment of Pseudomonas peritoneal dialysis-associated peritonitis(PsP). Methods The data of patients receiving peritoneal dialysis in four tertiary hospitals in Jilin province from 2015 to 2019 were retrospectively analyzed.According to the etiological classification,the patients with peritoneal dialysis-associated peritonitis(PDAP)were classified into PsP group and non-PsP group.The incidence of PsP was calculated,and the clinical characteristics and treatment outcomes of the two groups were compared.Kaplan-Meier method was used to draw the survival curve,and Cox regression was performed to analyze the risk factors affecting the technical failure of PsP.The treatment options of Pseudomonas aeruginosa-caused PDAP and the drug sensitivity of PsP were summarized. Results A total of 1530 peritoneal dialysis patients with complete data were included in this study,among which 439 patients had 664 times of PDAP.The incidence of PsP was 0.007 episodes/patient-year.PsP group had higher proportion of refractory peritonitis(41.38% vs.19.69%,P=0.005),lower cure rate(55.17% vs.80.79%, P=0.001),and higher extubation rate(24.14% vs.7.09%,P=0.003)than non-PsP group.The technical survival rate of PsP group was lower than that of non-PsP group(P<0.001).Multivariate Cox regression analysis showed that Pseudomonas aeruginosa was an independent risk factor for technical failure in patients with PsP(HR=9.020,95%CI=1.141-71.279,P=0.037).Pseudomonas was highly sensitive to amikacin,meropenem,and piperacillin-tazobactam while highly resistant to compound sulfamethoxazole,cefazolin,and ampicillin. Conclusion The treatment outcome of PsP is worse than that of non-PsP,and Pseudomonas aeruginosa is an independent risk factor for technical failure of PsP.

Clinical features, prognosis, and related factors of severe viral encephalitis in children / 中国感染控制杂志

Objective To understand the clinical features and prognosis of children with severe viral encephalitis (SVE), evaluate the related factors affecting prognosis. Methods Clinical data of 102 children with SVE in pediatric neurological ward and pediatric intensive care unit in Hunan Children's Hospital between January 2014 and January 2016 were analyzed retrospectively. According to prognosis, children were divided into good prognosis group(n =24, children's Glasgow outcome scale[CGOS]: 4 — 5) and poor prognosis group(n = 78, CGOS: 1 - 3), clinical data of two groups of children were compared, risk factors affecting the prognosis of SVE children were analyzed. Results In good prognosis group, 15 cases were cured and 9 had mild sequelae; in poor prognosis group, 14 cases died, 25 had severe sequelae, and 39 had moderate sequelae. The duration of fever and length of hospital stay in good prognosis group were both shorter than poor prognosis group, difference was statistically significant (both P く0.05). Multivariate unconditioned logistic regression analysis showed that adverse factors for prognosis of SVE were as follows: convulsive status, respiratory failure, longer fever period(＞5 days), severely abnormal electroen-cephalogram(EEG), head magnetic resonance imaging (MRI) lesions involving more than two sites or lesions involving the infratentorial, and stress hyperglycemia, odds ratio(OR) were 13.468, 4.580, 2.378, 10.196, 3.012, and 6.316 respectively. Conclusion SVE is a serious threat to quality of children's life, convulsive status, respiratory failure, longer fever period, severely abnormal EEG, head MRI lesions involving more than two sites or lesions involving the infratentorial, and stress hyperglycemia are risk factors for prognosis of SVE in children.

Effects of hydroxyl acetylated curcumin induced sonodynamic therapy on viability, apoptosis and necrosis of THP-1 macrophages / 中国应用生理学杂志

<p><b>OBJECTIVE</b>We aim to investigate the sonodynamic effect induced by hydroxyl acetylated curcumin (HAC) on THP-1 macrophages.</p><p><b>METHODS</b>THP-1 derived macrophages (1 x 10(5) per milliliter) were cultured with HAC at a concentration of 5 µg/mL for 4 h and then exposed to pulse ultrasound treatment (0.5 W/cm2) for 5 min. Six hours later, cell viability analysis was performed with CCK-8 assay, apoptosis and necrosis analysis were detected with Annexin V/PI staining by flow cytometery.</p><p><b>RESULTS</b>The cell viability of THP-1 macrophage decreased significantly in the group treated with the combination of HAC and ultrasound (P < 0.01), and HAC-SDT induced both apoptosis and necrosis in THP-1 macrophages, the apoptotic rate was higher than the necrotic rate with appropriate conditions, the maximum apoptosis/necrosis ratio was detected in sonodynamic therapy (SDT) group (P < 0.01).</p><p><b>CONCLUSION</b>hAC-SDT was effective to induce THP-1 macrophages apoptosis.</p>

Cancer incidence and patient survival rates among the residents in the Pudong New Area of Shanghai between 2002 and 2006 / 癌症

With the growing threat of malignancy to health, it is necessary to analyze cancer incidence and patient survival rates among the residents in Pudong New Area of Shanghai to formulate better cancer prevention strategies. A total of 43,613 cancer patients diagnosed between 2002 and 2006 were recruited from the Pudong New Area Cancer Registry. The incidence, observed survival rate, and relative survival rate of patients grouped by sex, age, geographic area, and TNM stage were calculated using the Kaplan-Meier, life table, and Ederer II methods, respectively. Between 2002 and 2006, cancer incidence in Pudong New Area was 349.99 per 100,000 person-years, and the 10 most frequently diseased sites were the lung, stomach, colon and rectum, liver, breast, esophagus, pancreas, brain and central nervous system, thyroid, and bladder. For patients with cancers of the colon and rectum, breast, thyroid, brain and central nervous system, and bladder, the 5-year relative survival rate was greater than 40%, whereas patients with cancers of the liver and pancreas had a 5-year relative survival rate of less than 10%. The 1-year to 5-year survival rates for patients grouped by sex, age, geographic area, and TNM stage differed significantly (all P < 0.001). Our results indicate that cancer incidence and patient survival in Pudong New Area vary by tumor type, sex, age, geographic area, and TNM stage.

Effects of meteorological elements on admission rates of cerebral infarction patients with hypertensive nephropathy from nine hospitals in Changchun city, Jilin Province / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>It is well recognized that meteorological factors have important infuences on the onset and development of many kinds of diseases. The present study was undertaken to investigate the effects of the meteorological elements on admission rates of cerebral infarction patients with hypertensive nephropathy at Changchun city, Jilin Province, northeast China.</p><p><b>METHODS</b>A total of 763 medical records of inpatients from nine hospitals at Changchun city, during a period from April 6 to April 17 in 2010, were reviewed. These patients were admitted to hospitals due to the occurrence of cerebral infarction. The hypertensive nephropathy was evidenced with certain diagnosis of essential hypertension and hypertension-related kidney injuries. The cerebral infarction was diagnosed according to the World Health Organization (Stroke) standard. All the meteorological data were from practical monitoring records in Jilin Province Meteorological Observatory. The relationships between the epidemiological prevalence of cerebral infarction and meteorological variables were analyzed using the time series models of statistics.</p><p><b>RESULTS</b>Compared with admission rates before the violent change in meteorological status (April 6 to April 17, 2010), the number of admission patients suffering from cerebral infarction remarkably peaked on April 12. Such an increase was highly correlated with heavy precipitation, elevation of daily average relative humidity, and reduction of average daily air temperature. With the betterment of the meteorological conditions on April 17, the admission rates of cerebral infarction patients dropped to the same level as the dates before snowing (April 6 to April 11).</p><p><b>CONCLUSIONS</b>The meteorological changes are highly associated with the occurrence of cerebral infarction in patients with hypertensive renal injury in northeast China. This study also suggested that an intensive medical interference for those patients with hypertension-induced organ injuries is very necessary in preventing the occurrence of cerebral infarction with hypertensive nephropathy when there is a violent change in meteorological condition.</p>

Analysis of changes in percentage of phenotype CD4 + CD45RA + and CD4+ CD45RO + in peripheral blood and effect of immunomodulation in aged male patients with chronic cardiac insufficiency / 中国应用生理学杂志

<p><b>OBJECTIVE</b>Autoimmunity participates in chronic heart failure (CCI), it is CD4+ T lymphocytes that mainly induces myocardial infiltration and the progression of the disease. The purpose of this research is to assess changes of CD4+, CD8+ T lymphocyte subset, and phenotype of primary T cell (CD4+ CD45RA+) and memory T cells (CD4+ CD45RO+) in peripheral blood in aged male patients with CCI. And to investigate the immunomodulatory effects on subsets of CD4+, CD8+ and phenotype of CD4+ CD45RA+ and CD4+ CD45RO+ and the possible therapeutic mechanism.</p><p><b>METHODS</b>The participant were 155 aged men among whom 94 cases were diagnosed as CCI and heart function of the rest 41 cases were normal. All patients underwent echocardiography examination and were collected peripheral blood before and after treatment. Serum N terminal pro-brain natriuretic peptide (NT-proBNP) levels were detected by heterogeneous immunoassay. Serum C reactive protein (CRP) were measured by immunoturbidimetry assay. T lymphocytes in peripheral blood were separated and determined distribution of CD4+, CD8+, CD4+ CD45RA+, CD4+ CD45RO+ using flow cytometry. Participants were divided into 3 groups: the CCI intervention group, who received regular therapy and thymopentin (20 mg intramuscular injection, once every other day for 3 month; n = 60) , the CCI control group, who received regular therapy (n = 54) and 41 healthy individual older than 57 years of age, who served as normal controls.</p><p><b>RESULTS</b>Compared with the control group, left ventricular ejection fraction (LVEF) and CD4+ CD45RO+ levels decreased, left ventricular end diastolic diameter (LVEDD), NT-proBNP, CRP, CD4+, CD4+ CD45RA+, CD4+/CD8+, CD4+ CD45RA+/CD4+ CD45RO+ levels were obviously higher in CCI group. Distribution of CD8+ was not significantly changed. The level of NT-proBNP, CRP, CD4+/CD8+, CD4+ CD45RA+/CD4+ CD45 RO+ was negatively correlated with LVEF. LVEF could be much improved via decreasing distribution of CD4+/CD8+, CD4+ CD45RA+/CD4+ CD45RO in CCI intervention group than in CCI control group.</p><p><b>CONCLUSION</b>The changes of CD4+/CD8+ and CD4+ CD45RA+/CD4+ CD45RO+ suggest that CD4+ T lymphocyte subset and its phenotype play an important role in the process of CCI. The regulation of CD4+ T lymphocyte and its phenotype may be one of the strategy in the treatment of CCI.</p>

Relationship between hvperuricemia and chronic kidney disease in Pudong New Area of Shanghai / 中华流行病学杂志

Objective To investigate the relationships between hyperuricaenia,serum uric acid (SUA) level and the chronic kidney disease (CKD) in adult residents of Pudong New Area,Shanghai.Methods 3326 residents aged 20-80 years were randomly selected from Pudong New Area,Shanghai through multistage sampling and interviewed between April and July of 2008.Fasting blood sample and morning ovid urine sample were collected for each participant for testing of SUA,serum creatinine,urinary albumin and creatinine.Both urine albumin to creatinine ratio (ACR)and glomerular filtration rate (GFR) were calculated to estimate the renal function.Results The overall prevalence of CKD was 16.0％ (age standardized 13.2％ ).The mean values of estimated GFR in participants with CKD and without CKD were (89.19 ± 27.25) and ( 105.88 ± 98.37) ml· min-1 ·(1.73 m2) -1,respectively.The prevalence rates of CKD in serum uric acid quartiles:first quartile,less than 4.2 mg/dl; second quartile,4.2-5.0 mg/dl; third quartile,5.0-6.0 mg/dl; and fourth quartile,6.0 mg/dl or more were 13.9％,15.0％,15.8％and 19.4％ (P＜0.05) respectively,increasing along with the increase of SUA among both sexes.Compared to the serum uric acid first quartile,the multivariate-adjusted odds for CKD of the second,third and fourth quartiles were 1.19 [95％ confidence interval (CI):0.90-1.58],1.27 (95％ CI:1.02-1.70),1.28 (95％ CI:1.10-1.68),respectively. Conclusion Hyperuricaemia was independently associated with the increased prevalence of CKD among population living in the Pudong New Area,Shanghai.

Epileptiform discharges and sleep structure in children with nocturnal epilepsy / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the epileptiform discharges and sleep structure in children with nocturnal epilepsy.</p><p><b>METHODS</b>A total of 54 children with nocturnal epilepsy (NE group) between December 2009 and June 2011 were enrolled in this study using a cluster sampling method. Their epileptiform discharges and sleep structure were monitored using nocturnal 12 h-video-echoencephalography (EEG) and polysomnography. Meanwhile, 40 age- and gender-matched normal children were enrolled as the control group.</p><p><b>RESULTS</b>All the 54 children in the NE group suffered from epileptiform discharges and a varied number of clinical seizures, especially at S1 and S2 states. Compared with the control group, S1 and S2 states had significantly higher proportions in the NE group, and S3 and S4 states and REM state had significantly lower proportions (P<0.01).</p><p><b>CONCLUSIONS</b>Epileptiform discharges and clinical seizures are more common in children with nocturnal epilepsy, especially during the non-rapid eye movement sleep. Meanwhile, remarkably disordered sleep structure also exists.</p>

Incidence and survival condition of primary liver cancer among residents in Pudong district of Shanghai, from 2002 to 2011 / 中华流行病学杂志

Objective To analyze the incidence and survival rates of primary liver cancer (PLC) among residents in Pudong district of Shanghai.Methods Permanent residents of Pudong district,Shanghai were recruited in the study between 2002 and 2011,among whom 7981 PLC cases were diagnosed and 7233 death cases were certified.Both morbidity and mortality of PLC were calculated and standardized (ASR) by the world population of 1966,in order to analyze the survival condition of PLC patients on gender or address,to explore the prognosis of surgical excision treatment.Results Among the incident cases of PLC between 2002 and 2011,5754 cases were males,with an average age of 60.27; while 2227 cases were females,with an average age of 68.26.The crude incidence rate for both sexes was 30.73 per 100 000 person-year,and was 44.30 per 100 000 person-year for males,higher than that in females,17.16 per 100 000 person-year.The difference showed statistical significance (u=3.46,P＜0.01).The ASR for incidence rates were 25.72 per 100 000 person-year in males and 8.22 per 100 000 person-year in females,respectively,with difference statistically significant (u=3.00,P＜0.01).There were 7233 PLC death cases in total,including 5151 males and 2082 females,with the crude mortality rate as 27.85 per 100 000 person-year.Rate for males was 39.65 per 100 000 person-year,significantly different from 16.04 per 100 000 person-year in females,statistically (u=3.16,P＜0.01).The ASRs for mortality were 22.77 per 100 000 person-year in males and 7.39 per 100 000 person-year in females,with statistically significant difference (u=2.80,P＜0.01).Both incidence and mortality rates increased apparently for males aged over 35 and females aged over 45.The 1-to 5-year survival rates of PLC were 19.88％,14.91％,12.19％,10.29％ and 8.56％,respectively.There were statistically significant differences among urban,town and rural areas in the over-all survival rates(x2=8.711,P=0.013) ;The differences in 1-to 5-year survival rates between surgical and non-surgical groups showed statistically significant differences (u=10.8,6.93,4.75,3.3 and 2.61,respectively,P＜0.01).Conclusion The incidence and mortality rates in males were significantly higher than in females and the over-all survival in rural area was significantly lower than in other areas of Pudong district,suggesting that surgical treatment could improve the prognosis of PLC.

Clinical investigate and epidemiological of rotavirus enteritis in children / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>Study on the infection rate,influence factors and clinical characteristic of rotavirus diarrhea in children.</p><p><b>METHODS</b>634 hospitalized diarrhea children was collected from 2006 June to 2010 October. The gold immunochromatographic double-antibody sandwiched assay was used to detect the antigen of Rotavirus directly. The age of onset, incidence, clinical features and multiple organ damage and other aspects were summarized and analyzed.</p><p><b>RESULTS</b>308 cases was detected positively in the 634 specimens, the positive rate was 48.6%. In 6 to 12 months old children 197 cases was detected positively, accounted for 66.3%. Rotavirus was detected all the year round and the positive rate was higher in the first quarter and the forth quarter and was 63.8% and 62. 6% respectively. 68.6% accompanied with myocardial damage, 41.2% with lower respiratory tract infection, 13.3% with liver damage, 14.9% with renal damage, 9.4% with convulsions in 4.9%, accompanied by the damage of blood system.</p><p><b>CONCLUSION</b>Rotavirus is the leading cause of pediatric diarrhea the main pathogens, 6-12 months infants with the highest infection rate, the first, the fourth quarter is higher. Rotavirus infection can cause multiple organ dysfunction.</p>

Cloning, Sequence Analysis and Proeukaryotic Expression of Peroxisomal Membrane Protein Allergen Gene from Chaetomium globosum / 中国生物工程杂志

The full length cDNA encoding peroxisomal membrane protein from Chaetomium globosum was cloned using RACE technology and the sequence in cDNA library of C. globosum in GenBank ( Accn: BP099709). The 747bp full length cDNA encoding peroxisomal membrane protein allergen (pero) gene was assembled with 412bp 3'and 508bp 5'RACE products. The open reading frame was 501 bp encoding 166 amino acids. The molecular weight of the protein was 17. 5kDa and its theoretical isoelectric point was 5.75. The pero gene was amplified using specific primers of cDNA 5'and 3'untranslated region, sequence analysis indicated that the gene have 3 exons and 2 introns. ClustalX analysis revealed that amino acids sequence of pero gene from C. globosum and Neurospora crassa shared 83% high similarity. To construct pET28a-pero expressive plasmid, pero gene was inserted into pET28a expressive vector. Escherichia coli BL21 transformed by pET28a-pero plasmid was induced with IPTG. The protein expression was analyzed with SDS-PAGE. A 21kDa pero fusion protein representing the pero gene was expressed in recombinant E. coli BL21. The sequences of cDNA,DNA and deduced amino acid of the pero gene from C. globosum were submitted to GenBank (Accn: AY555771, AY584753,AAS66898).

Analysis of EGFR mutations in 176 cases of non-small cell lung cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the incidence and profile of mutations in epidermal growth factor receptor (EGFR) in Chinese patients with non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>A total of 176 cases of NSCLC tissue was enrolled in this study, among which 123 normal lung samples were also included. The tissue DNA was extracted and the EGFR gene in exon 19 to 21 was subjected for PCR amplification and direct sequencing.</p><p><b>RESULTS</b>The EGFR gene in exon 19-21 was of wild type in all normal lung tissues detected. Mutations were found in 57 cases of 176 lung cancer samples, with an incidence of 32. 4%. Mutations were mainly detected in the exon 19 (37/57 cases, 64. 9% ) and exon 21 (18/57 cases, 31. 6% ) , while that in the exon 20 was rare (2/57 cases, 3. 5% ). There were 7 types of EGFR mutation in the exon 19, resulting in the deletion of codon 746 to 753. A missense mutation was detected in exon 20, dealing with codon 789 to 793. The mutation in exon 21 belonged to the single missense substitution in codon 858. The EGFR mutations were more frequent in female patients than male ones, in adenocarcinoma and adenosquamous cell carcinoma versus cancer of other histologies.</p><p><b>CONCLUSION</b>EGFR mutation is a tumor-specific somatic abnormality. Some one third of Chinese NSCLC tumors harbor EGFR mutations, especially in exons 19 and 21. These mutations are more frequently detected in female, adenocarcinoma and adenosquamous cell carcinoma.</p>