A case of Kounis syndrome characterized by cardiac arrest / 中国综合临床

Kounis syndrome is an acute coronary syndrome associated with mast cell and platelet activation in the case of allergy or allergic injury. This case of Kounis syndrome type Ⅱ patients with myocardial infarction and cardiac arrest is rare. The patient came to the clinic because of wasp sting. During the treatment, he had cardiac arrest. After cardiopulmonary resuscitation, anti allergy, antithrombotic and coronary revascularization, his condition improved. After discharge, he was followed up regularly. After 1 month and 1 year follow-up, the patient had no chest pain, chest tightness, discomfort and allergic reaction.

Study on the growth curve of uncorrected visual acuity of children and adolescents with relative safe refractive range / 中国学校卫生

Objective@#To analyze the distribution of uncorrected visual acuity in children and adolescents aged 3-18 years with relative safe refractive range, and to develop the growth curve and reference range of uncorrected visual acuity in children and adolescents of different ages, so as to provide reference for formulating the referral threshold for myopia screening practice.@*Methods@#Using cluster sampling method, 9 146 children and adolescents aged 3-18 years old in Shanghai were selected for uncorrected visual acuity, cycloplegic refraction, slit lamp and other ophthalmic examinations, and the percentiles and growth curve of uncorrected visual acuity of children and adolescents in the relative safe refractive range were fitted by LMS method. Besides, the area under the ROC curve and the sensitivity and specificity of different cut-off values were analyzed.@*Results@#The uncorrected visual acuity was skewed, with a median of 4.8. There were 4 675 individuals with safe refraction, the median of uncorrected visual acuity in which was 4.9. The LMS curve showed that the uncorrected visual acuity increased with age in the lower age group, and gradually stabilized to the best level at the age of 6-10. P 50 was 4.8 in 3-4 years old, 4.9 in 5-8 years old, 5.0 in 9 years old and above. The area under ROC curve of uncorrected visual acuity predicting refractive abnormality increased with age, with the lowest value of 0.55(95%CI=0.50-0.61) at 3 years old and the highest value of 0.95 (95%CI=0.94-0.96) at 12-18 years old. The Youden index was the highest for P25 at 3-6 years old, and the highest for P 10 at 7 years old and above. With the increase of the cut off value, the sensitivity increased and the specificity decreased.@*Conclusion@#The uncorrected visual acuity increases gradually with age, and reaches the best level after 6-10 years old. The screening effect of uncorrected visual acuity predicting refractive abnormality increased with age. It is suggested that the referral threshold of children and adolescents with abnormal uncorrected visual acuity should be set according to their ages, and P 25-P 75 can be selected according to the screening purposes.

Effect of early enteral nutrition on mechanically ventilated patients / 中华临床营养杂志

Objective To observe the effectiveness of early enteral nutrition (EEN) in managing ICU mechanically ventilated patients.Methods Totally 47 patients who had been ventilated for more than one week were randomly divided into EEN group and control group.The EEN group was supplied with enteral nutrition (EN) 12-24 hours after ICU admission,whereas the control group received EN 72 hours-5 days later.The function of intestinal mucosal barrier was evaluated by the reabsorb concentration of disaccharides lactulose/mannitol (L/M).In addition,the body mass index (BMI),body temperature,urine L/M ratio,serum albumin,pre-albumin,and ventilation days were recorded or calculated.Results On the seventh day,the L/M ratio was (0.036 ±0.004) in the EEN group,which was significantly lower than that (0.108 ±0.020) in the control group (t =2.746,P ＜0.01) ; the average body temperature was significantly lower in the EEN group than in the control group [(38.25 ± 1.20) ℃ vs (38.92 ± 1.40) ℃ ; t =2.683,P ＜ 0.05)] ; the incidences of adverse reactions such as constipation and diarrhea were significantly lower in the EEN group [16.7％ (4/23) vs 27.3％ (6/22),P＜0.05].The weaning rate within 2 weeks also favoured the EEN group [90％ (18/20) vs 80％ (16/20),P ＜ 0.05].Compared with the control group,the nutritional status of serum albumin and pre-albumin also showed a favourbale trends in the EEN group.Conclusions EEN can improve intestinal mucosal barrier and increase the weaning possibility in patients with mechanical ventilation.

Surveillance of pathogens from patients with hospital infection and analysis of drug resistance in intensive care unit / 中国综合临床

Objective To review the prevalence of nosocomial infection and the change of drug resistance in a comprehensive intensive care unit (ICU) and to provide theoretical basis for clinical prevention and treatment.Methods The strains of bacteria and fungi were isolated from ICU and their drug resistance was retrospectively analyzed from Jan.1st,2010 to Dec.31th,2011.Results The main pathogen of nosocomial infection were Gram-negative bacteria ( 73.3％ ),Gram-positive bacteria ( 17.9％ ) and fungi ( 8.7％ ).In bacterial infection,Gram-negative and G-positive bacteria accounted for 80.3％ and 19.7％ respectively.In Gram-negative bacteria,pseudomonas aeruginosa was the major type (21.7％).In Gram-positive bacteria,staphylococcus aureus (31.4％) was most prominent.Drug resistance of bacteria was severe,while that of fungi was mild.Conclusion Bacteria has severe drug resistance and exhibits multi-drug resistance for commonly used antibiotics.The principle of antibiotics application should be mastered and antibiotics should be chosen according to drug-sensitivity tests.

A continuous low-dose cyclophosphamide and prednisone regimen for multiple myeloma with severe complications / 白血病·淋巴瘤

Objective To assess the efficacy and tolerability of continuous low-dose cyclophosphamide and prednisone regimen(CP)as salvage therapy for multiple myeloma patients with severe complications.Methods The CP regimen consisted of oral cyclophosphamide at 50 mg and oral prednisone at 15 mg daily.The patients were withdrawn if the response was invalid or not improved after 6 months,and follow-up was carried on if CR maintained for 6 weeks.A total of 23 consecutive patients received the CP regimen,with 18 patients having severe complications,and 5 patients unwilling to accept conventional chemotherapy because of severe infection.All patients had received one to four regimens before.Results Among 23 patients with CP regimen,the overall response rate(CR+VGPR+PR)was 61%,with 1 CR,4 VGPR,9 PR,3 MR and 6 PD.The quality of life and physical conditions were improved significandy.Conclusion Our data showed that CP was an effective,well-tolerated,and convenient regimen as salvage therapy for MM with severe complications.