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@#Objective To analyze the educational characteristics of physical therapy in universities of United States, and provide reference for the international development of rehabilitation therapy education in China.Methods Based on the data collected from the official websites of three universities in the United States and the databases at home and abroad, combined with the author's learning experience, the characteristics of physical therapy education in universities of United States in detail was analyzed.Results Characteristics of physical therapy education in universities of United States had strict accreditation system, course objectives oriented by practicing competence, comprehensive curriculum plan, educational concept of student-centered, high level of teaching informatization, diversified teaching and learning evaluation system, which conformed to the goal of rehabilitation competency of World Health Organization.Conclusion Physical therapy education in United States has remarkable characteristics and a well-developed system, which has certain reference value for China.
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Objective:To explore the resistance of common clinical isolates to chlorhexidine gluconate (CHG) and the clinical characteristics of patients with the infections.Methods:A total of 1 000 isolates from the First Affiliated Hospital of Wenzhou Medical University in 2018 (from January to May) were collected, which included 200 strains each of Escherichia coli ( E. coli), Acinetobacter baumanii ( A. baumanii), Pseudomonas aeruginosa ( P. aeruginosa), Staphylococcus aureus ( S. aureus), and Enterococcus spp.. Minimum inhibitory concentration (MIC) of CHG against 1 000 isolates were determined by the agar dilution method. The correlation between the resistance of isolates and clinical characteristics of infected patients was analyzed. Chi-square test or Fisher exact probability test were used for statistical analysis. Results:A total of 57 CHG resistant strains were detected in 1 000 clinical isolates. These CHG-resistant strains were mainly isolated from sputum and intensive care unit ward, accounting for 49.1%(28/57)and 38.6%(22/57), respectively. The resistance rates of P. aeruginosa, A. baumanii, Enterococcus spp., S. aureus, and E. coli to CHG were 16.0%(32/200), 7.0%(14/200), 3.0%(6/200), 1.5%(3/200) and 1.0%(2/200), respectively. The CHG-resistant rates of P. aeruginosa to ceftazidime, ciprofloxacin, levofloxacin and gentamicin were 53.1%(17/32), 78.1%(25/32), 65.6%(21/32) and 50.0%(16/32), respectively, which were all higher than those of CHG-sensitive P. aeruginosa (25.0%(8/32), 25.0%(8/32), 21.9%(7/32) and 15.6%(5/32), respectively), with statistical significance ( χ2=5.317, 18.080, 12.444 and 8.576, respectively, all P<0.05). The hospital mortality was 22.8%(13/57) in patients infected with CHG-resistant bacteria, which was higher than that in patients infected with CHG-sensitive bacteria ((7.0%(4/57); Fisher exact probability test, P=0.018)). CHG-resistant group had a higher history of CHG exposure and antimicrobial treatment (61.4%(35/57) and 70.2%(40/57), respectively), which were both higher than those with CHG-susceptible isolates (17.5%(10/57) and 47.4%(27/57), respectively), the differences were both statistically significant ( χ2=22.947 and 6.118, respectively, both P<0.05). In addition, the multi-drug resistance rate of CHG-resistant strains was 54.4%(31/57), which was higher than that of CHG-susceptible strains (35.1%(20/57)), the difference was statistically significant ( χ2=4.293, P=0.039). Conclusions:CHG resistant strains have higher antimicrobial resistance. Hospital mortality in patients infected with CHG-resistant bacteria is higher than patients infected with CHG-sensitive bacteria. The important risk factors are CHG exposure and antimicrobial therapy.
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Objective:To evaluate the correlation between the timed up and go(TUG)test and fall risks in elderly frail patients.Methods:From July to September 2019, elderly frail patients who were treated at the cardiovascular department of our hospital were enrolled.Basic clinical data and fall-related information of patients were collected.Patients were divided into the fall group and the non-fall group.Results on the body mass index(BMI), TUG, 4-meter maximum walking speed(4 m MWS)and Barthel index were compared between the two groups.The correlation between TUG and each indicator was examined.Multivariate Logistic regression analysis was used to analyze the correlation between the TUG and falls in elderly patients.Results:A total of 96 eligible patients were enrolled, including 35 in the fall group and 61 in the non-fall group.The average TUG time was longer in the fall group than in the non-fall group(16.45±6.44 s vs.10.17±2.91 s, t=-6.556, P<0.001). The correlation analysis results showed that the TUG was correlated with falls and 4 m MWS( r=0.582 and 0.875, both P<0.001). Multivariate Logistic regression analysis showed that the TUG( OR=1.201, 95% CI: 1.111-1.470, P=0.004)and 4 m MWS( OR=1.146, 95% CI: 1.063-1.244, P=0.015)were risk factors for falls. Conclusions:The TUG is correlated with fall risks in elderly frail patients and should be recommended as a routine test in clinical practice.
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Objective:To investigate the changes and correlation of intestinal and pulmonary microecological structures in patients with ventilator-associated pneumonia (VAP).Methods:A prospective observational study was conducted. Thirty-one patients with VAP admitted to the department of critical care medicine of General Hospital of Ningxia Medical University from May 1st 2019 to May 1st 2020 were enrolled. Feces and alveolar lavage fluid samples from patients with the same day, feces and alveolar lavage specimen flora composition and the structure of biological information analysis by 16S rRNA sequencing technologies, the comprehensive sequencing results, and clinical data of patients were analyzed.Results:① The diversity (abundance and diversity) of flora in the alveolar lavage fluid of VAP patients was higher than that of fecal flora. Among them, Ace index, Chao index and Shannon index describing the abundance of flora showed statistically significant differences [Ace index: 305.89 (214.39, 458.66) vs. 204.51 (165.15, 247.61), Chao index: 259.83 (194.20, 459.31) vs. 187.67 (153.28, 234.01), Shannon index: 3.01 (2.39, 3.54) vs. 2.55 (1.86, 2.95), all P < 0.05], but there was no significant difference in Simpson index describing diversity [0.14 (0.08, 0.27) vs. 0.19 (0.10, 0.33), P > 0.05]. ② In the sequencing results of feces and alveolar lavage fluid of VAP patients, there were some intestinal related bacteria groups with high abundance, such as Escherichia-Shigella, Faecalibacterium, Bacteroides, and Lachnospira, etc. ③ In 31 VAP patients, suspicious pathogenic bacteria was found in 20 cases (6 cases of Streptococcus viridans, 5 cases of Escherichia coli, 3 cases of Klebsiella pneumoniae, 3 cases of Acinetobacter baumannii, 2 cases of Staphylococcus aureus, 1 case of Pseudomonas aeruginosa), and the same suspected pathogens also existed in the 17 patients' alveolar lavage and waste sequencing. ④ Fourteen VAP patients combined with sepsis, 14 patients without sepsis were selected for sample size matching. The results showed that, Jaccard similarity index to describe lung-correlation of intestinal flora in VAP with sepsis group was significantly elevated, and the difference was statistically significant (0.24±0.08 vs. 0.19±0.06, P < 0.01). Conclusions:There is a certain correlation between pulmonary and intestinal flora in VAP patients. In addition to the exclusion of pulmonary infection caused by environmental and upper respiratory micro-inhalation, the lower digestive tract may also be source of infection.
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BACKGROUND: Maxillary skeletal expander is a non-surgical expansion technique of the maxilla. It is different from the traditional maxillary rapid expander, micro-implant assisted rapid palatal expansion, and surgically assisted rapid palatal expansion. It provides new ideas and methods for the correction of maxillary transverse deficiency, and especially for adult patients with the growth finished, provides an efficient and minimally invasive bone expansion. OBJECTIVE: To review the application and advantage of the maxillary skeletal expander in the treatment of maxillary transverse deficiency, providing scientific reference for the clinical therapeutic schedule in such patients. METHODS: A computer search for Cochrane Library, PubMed, Embase, Web of Science, CNKI, WanFang Database, and CBM databases was performed for Chinese and English literature related to the maxillary expansion device published before May 31st, 2019. RESULTS AND CONCLUSION: The maxillary skeletal expander is an effective method for correcting the maxillary transverse deficiency, and the expansion of the arch is not limited by age. This device also has a good outcome in bone expansion for adults. The maxillary skeletal expander expands the entire mid-face structure, causing the mid-sacral suture to be parallel, followed by ruptured palatine suture, increased width between the zygomatic bones, as well as the entire nasal cavity involving the upper nasal bone area is widened. This device also causes less adverse reactions, for example, the teeth are inclined buccally and the height of the alveolar bone is reduced.
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Objective To investigate the characteristics of gut microbiota dysbosis in patients with severe pneumonia using 16SrDNA sequencing. Methods A prospective observational research was conducted. The stool samples retained by natural defecation or enema within 2 days after hospital were collected from 16 patients with severe pneumonia admitted to department of intensive care unit (ICU) of General Hospital of Ningxia Medical University from June to December in 2018 and 10 persons for physical exam were enrolled as the healthy control group. The 16SrDNA sequencing technology was used to detect fecal flora and analyze biological information. Results ① 1015475 effective sequences were obtained from the stool samples from the severe pneumonia group and the healthy control group. Using 16SrDNA method, it was found that the average effective length of the sample sequence was 458.35 bp and the average sequence number of the total samples was 39056.73. ② Analysis of α diversity of gut microbiota showed that, compared with the healthy control group, the Ace index, Chao index and the Shannon index of gut microbiota diversity in the severe pneumonia group were significantly decreased [Ace index: 167.23 (143.14, 211.26) vs. 227.71 (214.53, 247.05), Chao index: 152.38 (138.09, 182.54) vs. 228.25 (215.49, 248.95), Shannon index:2.37 (1.68, 2.89) vs. 3.39 (3.03, 3.63), all P < 0.01], and the Simpson index was significantly increased [0.21 (0.11, 0.33) vs. 0.07 (0.06, 0.12), P < 0.01], which indicated the gut microbiota diversity of the severe pneumonia group was decreased. ③ Analysis of β diversity of gut microbiota, principal coordinate analysis (PCoA) showed that gut microbiota structural with the healthy control group was similar, while that in the severe pneumonia group was different. Adonis analysis showed that the structural of the gut microflora revealing significant differences between the severe pneumonia group and the healthy control group (R2 = 0.061, P = 0.05). ④ Analysis of phylum difference gut microflora showed that, compared with the healthy control group, the proportion of Firmicutes in severe pneumonia group was decreased [27.36 (18.12, 39.28)％ vs. 52.25 (38.36, 63.82)％, P = 0.02], the proportions of Actinobacterias, Synergistetes and Fusobacterias were increased [2.30 (0.30, 4.80)％ vs. 0.02 (0.00, 0.06)％, 0.36 (< 0.01, 0.57)％ vs. < 0.01 (< 0.01, < 0.01)％, 0.01 (< 0.01, 0.08)％ vs. < 0.01 (< 0.01, < 0.01)％, all P < 0.05]. ⑤ Analysis of genus difference gut microflora showed that, the proportions of Bifidobacterium, Ruminococcus, Pseudobutyrivibrio, Coprococcus, Lachnospira and Prevotella in the severe pneumonia group were significantly lower than those in healthy control group [0.18 (0.01, 0.25)％ vs. 3.40 (0.46, 5.78)％, 0.01 (< 0.01, 0.29)％ vs. 2.26 (0.84, 4.86)％, 0.01 (< 0.01, 0.02)％ vs. 2.73 (1.87, 5.74)％, 0.02 (< 0.01, 0.07)％vs. 0.80 (0.50, 2.32)％, < 0.01 (< 0.01, < 0.01)％ vs. 0.88 (0.33, 2.08)％, 0.02 (< 0.01, 0.31)％ vs. 7.74 (0.07, 36.27)％, all P < 0.05]; the proportions of Escherichia and Enterococcus in the severe pneumonia group were higher than those in healthy control group, but there was no difference between the two groups [2.00 (0.57, 10.23)％ vs. 1.16 (0.23, 2.68)％, 0.02 (< 0.01, 0.42)％ vs. < 0.01 (< 0.01, 0.04)％, both P > 0.05]; the proportions of Fusobacterium and Staphylococcus in severe pneumonia group were significantly higher than those in healthy control group [0.01 (< 0.01, 0.08)％ vs. < 0.01 (< 0.01, < 0.01)％, 0.01 (< 0.01, 0.02)％ vs. < 0.01 (< 0.01, < 0.01)％, both P < 0.05]. Conclusion Gut microbiota dysbiosis in patients with severe pneumonia shows that the abundance and diversity decrease, structure of intestinal flora changes, and beneficial symbiotic bacteria decrease and pathogenic bacteria increase, which may be associated with the occurrence and development of severe pneumonia.
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Objective To evaluate the difference and correlation of 24 h energy expenditure in patients with sepsis by indirect calorimetry (IC) and HB coefficient equation. Methods A prospective comparative study including 60 patients with sepsis who was suitable for nutritional support and respiratory indirect calorimetry in the intensive care unit (ICU) from January to October 2015 was conducted. Resting energy expenditure (REE) was measured simultaneously by respiratory indirect calorimetry and HB coefficient (Harris-Benedict formula×stress coefficient) in 60 patients with sepsis at 0 day, 3 day, 7 day, and 14 day after nutritional support, and the differences in dynamic REE were compared between the two methods. The consistency of REE by indirect calorimetry (IC) and HB coefficient equation was evaluated by Bland-Altman. The correlation of IC and HB methods was determined by Pearson analysis. The linear regression equation was determined by linear regression analysis. Results Within 2 weeks after nutritional support, 188 times of measures by IC method and HB method respectively were finished in all patients with sepsis. The dynamic REE in respiratory indirect calorimetry group was significantly higher than that in HB coefficient method group (P<0. 05). The average bias of REE between the IC method and the HB method was (1930. 9±597. 7) kJ/24 h. For the consistency boundaries was over large and beyond the scope of clinical acceptance, there was a bias between the two methods and they could not directly substituted. There was a linear correlation of REE between the IC method and the HB coefficient (r =0. 757, P =0. 000). The equation associated with the HB coefficient method is fitted using a oneway regression: Y=1. 17X+ 834. 11 (kJ/24 h), and X was the 24 h energy expenditure measured by the HB coefficient method. Conclusion The energy metabolism of patients with sepsis is not obvious in the first 2 weeks. The HB coefficient method significantly underestimates the 24 h energy expenditure of patients with sepsis. The prediction equation can be used to correct the HB coefficient method and improve the HB coefficient method to predict the energy expenditure of patients with sepsis.
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Objective@#To investigate the characteristics of gut microbiota dysbosis in patients with severe pneumonia using 16SrDNA sequencing.@*Methods@#A prospective observational research was conducted. The stool samples retained by natural defecation or enema within 2 days after hospital were collected from 16 patients with severe pneumonia admitted to department of intensive care unit (ICU) of General Hospital of Ningxia Medical University from June to December in 2018 and 10 persons for physical exam were enrolled as the healthy control group. The 16SrDNA sequencing technology was used to detect fecal flora and analyze biological information.@*Results@#① 1 015 475 effective sequences were obtained from the stool samples from the severe pneumonia group and the healthy control group. Using 16SrDNA method, it was found that the average effective length of the sample sequence was 458.35 bp and the average sequence number of the total samples was 39 056.73. ② Analysis of α diversity of gut microbiota showed that, compared with the healthy control group, the Ace index, Chao index and the Shannon index of gut microbiota diversity in the severe pneumonia group were significantly decreased [Ace index: 167.23 (143.14, 211.26) vs. 227.71 (214.53, 247.05), Chao index: 152.38 (138.09, 182.54) vs. 228.25 (215.49, 248.95), Shannon index: 2.37 (1.68, 2.89) vs. 3.39 (3.03, 3.63), all P < 0.01], and the Simpson index was significantly increased [0.21 (0.11, 0.33) vs. 0.07 (0.06, 0.12), P < 0.01], which indicated the gut microbiota diversity of the severe pneumonia group was decreased. ③ Analysis of β diversity of gut microbiota, principal coordinate analysis (PCoA) showed that gut microbiota structural with the healthy control group was similar, while that in the severe pneumonia group was different. Adonis analysis showed that the structural of the gut microflora revealing significant differences between the severe pneumonia group and the healthy control group (R2 = 0.061, P = 0.05). ④ Analysis of phylum difference gut microflora showed that, compared with the healthy control group, the proportion of Firmicutes in severe pneumonia group was decreased [27.36 (18.12, 39.28)% vs. 52.25 (38.36, 63.82)%, P = 0.02], the proportions of Actinobacterias, Synergistetes and Fusobacterias were increased [2.30 (0.30, 4.80)% vs. 0.02 (0.00, 0.06)%, 0.36 (< 0.01, 0.57)% vs. < 0.01 (< 0.01, < 0.01)%, 0.01 (< 0.01, 0.08)% vs. < 0.01 (< 0.01, < 0.01)%, all P < 0.05]. ⑤ Analysis of genus difference gut microflora showed that, the proportions of Bifidobacterium, Ruminococcus, Pseudobutyrivibrio, Coprococcus, Lachnospira and Prevotella in the severe pneumonia group were significantly lower than those in healthy control group [0.18 (0.01, 0.25)% vs. 3.40 (0.46, 5.78)%, 0.01 (< 0.01, 0.29)% vs. 2.26 (0.84, 4.86)%, 0.01 (< 0.01, 0.02)% vs. 2.73 (1.87, 5.74)%, 0.02 (< 0.01, 0.07)% vs. 0.80 (0.50, 2.32)%, < 0.01 (< 0.01, < 0.01)% vs. 0.88 (0.33, 2.08)%, 0.02 (< 0.01, 0.31)% vs. 7.74 (0.07, 36.27)%, all P < 0.05]; the proportions of Escherichia and Enterococcus in the severe pneumonia group were higher than those in healthy control group, but there was no difference between the two groups [2.00 (0.57, 10.23)% vs. 1.16 (0.23, 2.68)%, 0.02 (< 0.01, 0.42)% vs. < 0.01 (< 0.01, 0.04)%, both P > 0.05]; the proportions of Fusobacterium and Staphylococcus in severe pneumonia group were significantly higher than those in healthy control group [0.01 (< 0.01, 0.08)% vs. < 0.01 (< 0.01, < 0.01)%, 0.01 (< 0.01, 0.02)% vs. < 0.01 (< 0.01, < 0.01)%, both P < 0.05].@*Conclusion@#Gut microbiota dysbiosis in patients with severe pneumonia shows that the abundance and diversity decrease, structure of intestinal flora changes, and beneficial symbiotic bacteria decrease and pathogenic bacteria increase, which may be associated with the occurrence and development of severe pneumonia.
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Objective@#To evaluate the difference and correlation of 24 h energy expenditure in patients with sepsis by indirect calorimetry (IC) and HB coefficient equation.@*Methods@#A prospective comparative study including 60 patients with sepsis who was suitable for nutritional support and respiratory indirect calorimetry in the intensive care unit (ICU) from January to October 2015 was conducted. Resting energy expenditure (REE) was measured simultaneously by respiratory indirect calorimetry and HB coefficient (Harris-Benedict formula×stress coefficient) in 60 patients with sepsis at 0 day, 3 day, 7 day, and 14 day after nutritional support, and the differences in dynamic REE were compared between the two methods. The consistency of REE by indirect calorimetry (IC) and HB coefficient equation was evaluated by Bland-Altman. The correlation of IC and HB methods was determined by Pearson analysis. The linear regression equation was determined by linear regression analysis.@*Results@#Within 2 weeks after nutritional support, 188 times of measures by IC method and HB method respectively were finished in all patients with sepsis. The dynamic REE in respiratory indirect calorimetry group was significantly higher than that in HB coefficient method group (P<0.05). The average bias of REE between the IC method and the HB method was (1 930.9±597.7)kJ/24 h. For the consistency boundaries was over large and beyond the scope of clinical acceptance, there was a bias between the two methods and they could not directly substituted. There was a linear correlation of REE between the IC method and the HB coefficient (r=0.757, P=0.000). The equation associated with the HB coefficient method is fitted using a one-way regression: Y=1.17X+ 834.11 (kJ/24 h), and X was the 24 h energy expenditure measured by the HB coefficient method.@*Conclusion@#The energy metabolism of patients with sepsis is not obvious in the first 2 weeks. The HB coefficient method significantly underestimates the 24 h energy expenditure of patients with sepsis. The prediction equation can be used to correct the HB coefficient method and improve the HB coefficient method to predict the energy expenditure of patients with sepsis.
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The purpose of this study was to analyze the clinical characteristics of a patient with pycnodysostosis caused by cathepsin K ( CTSK ) gene mutation and his family members in order to improve the understanding of this rare diseases. A pediatric patient with pycnodysostosis was referred to us when he was eight years old. He presented with elevated bone mineral density, short stature, dentition abnormality and multiple fractures of right tibia. Next generation sequencing ( NGS) and Sanger sequencing confirmed that the proband carried carrying compound heterozygous mutations of cathepsin K(CTSK) gene, including a missense mutation c.440C>T in exon 5 (p.Ala147Val) and a deletion mutation c. 778delA in exon 6 ( p. Ser260AlafsX15) which was inherited from his father. His mother and sister did not carry the above variations. Clinically, it is necessary to differentiate pycnodysostosis from osteopetrosis and other osteosclerotic diseases.
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Objective@#To evaluate the early and long-term outcomes cardiac surgery of patients with Ebstein anomaly.@*Methods@#The clinic data of 237 patients with Ebstein anomaly received surgical procedures from March 2004 to December 2017 at Department of Cardiac Surgery, First Hospital of Tsinghua University was analyzed retrospectively. There were 105 male and 132 female patients with age of (19.4±16.7) years (ranging from 3 months to 64 years). The surgical procedures include anatomical repair in 188 patients, one and a half ventricle repair in 37 patients, tricuspid valve repair in 4 patients, tricuspid valve replacement in 10 patients, and Fontan procedure in 3 patients (total cavopulmonary connection in 2 patients; Glenn procedure in 1 patient).@*Results@#The early mortality was 2.1% (n=5). One case of atrioventricular (0.4%) newly occurred. There were 228 patients available to follow-up. The range of follow-up duration was 3 to 168 months. Late survival was 99.1% (2 cases of late death) at 10 years. Three patients received reoperation (1.3%), including tricuspid valve repair of 1 patient and one and a half ventricle repair of 2 patients). Indication of tricuspid valve regurgitation improved from 3.6±0.3 to 1.5±0.4. Survival rate at 5 and 10 years was 98.6% and 98.2%, respectively.@*Conclusions@#The principle of the techniques is to reconstruct the tricuspid valve and right ventricle anatomically. For most cases, the anatomical repair was demonstrated with low mortality, less complications and excellent durability at long-term follow-up. If the tricuspid valve is severely hypoplastic, one and a half ventricle repair and valve replacement may be alternatie.
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Objective@#To evaluate the in vitro antibiotic effects of colistin combined with meropenem, levofloxacin or fosfomycin against colistin-heteroresistant Acinetobacter baumannii (A.baumannii).@*Methods@#A total of 576 A. baumannii clinical isolates were collected from the First Affiliated Hospital of Wenzhou Medical University from 2014 to 2015. Minimal inhibitory concentrations (MICs) of colistin against A. baumannii were detected by broth dilution method. Colistin-heteroresistant A. baumannii isolates were screened using population analysis profiles (PAPs). MICs of colistin combined with meropenem, levofloxacin or fosfomycin, and the four drugs used alone against colistin-heteroresistant A. baumannii were detected by checkerboard method and broth dilution method. Fractional inhibitory concentration index (FICI) was calculated to evaluate antibiotic effects.@*Results@#None of the 576 A. baumannii isolates was resistant to colistin as indicated by the broth dilution method. Nine colistin-heteroresistant A. baumannii isolates were identified using PAPs. Compared with the MICs of colistin used alone, the MICs of colistin used in combination with meropenem, levofloxacin or fosfomycin against colistin-heteroresistant isolates were all decreased. Colistin-meropenem combination showed synergistic (55.6%), additive (33.3%) and indifferent effects (11.1%), but no antagonistic effect. Colistin-levofloxacin combination showed synergistic (55.6%), additive (22.2%) and indifferent effects (22.2%), but no antagonistic effect. Colistin-fosfomycin combination showed synergistic (77.8%) and additive (22.2%) effects, but no indifferent or antagonistic effect.@*Conclusion@#In vitro use of colistin in combination with meropenem, levofloxacin or fosfomycin has synergistic and additive antibacterial effects against colistin-heteroresistant A. baumannii. Combinations of colistin-meropenem and colistin-levofloxacin have fewer indifferent effects and no antagonistic effect.
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ObjectiveTo observe the lung injury of rats caused by PM2.5 induced imbalance of TH17/Treg immune system and the intervention effect of two different TCM treatments.Methods Wistar male rats were randomly divided into normal group, model group, TCM-treated group1 and TCM-treated group 2. PM2.5-induced lung injury model was established by airway instillation. Model group was given normal saline for gavage. TCM- treated group 1 and 2 were given Yupingfeng Powder and Guomin Decoction combined with Zhisou Powder for gavage. The pathological changes of bronchial and lung tissues, the contents of IL-8, IL-10, IL-17, NE, and MUC5AC in serum and BALF were compared, and the expressions of Foxp3 and IL-17 in lung tissue of each group were analyzed.Results Compared with normal group, the contents of IL-8, IL-17, NE and MUC5AC in serum and BALF of model group increased significantly, while IL-10 decreased significantly (P<0.05,P<0.01); the expression of IL-17 increased significantly and the expression of Foxp3 decreased significantly in lung tissue (P<0.01). Compared with model group, the contents of IL-8, IL-17, and NE decreased in TCM-treated group 1 and 2, while the content of BALF IL-10 increased significantly (P<0.05). The content of IL-10 in serum increased significantly in TCM-treated group 2 (P<0.05); the protein expression of IL-17 of lung issue decreased significantly, and the protein expression of Foxp3 increased significantly (P<0.01). The pathological changes were improved significantly.Conclusion PM2.5 can induce lung injury caused by the imbalance of TH17/Treg. Both two treatments can significantly improve the lung injury induced by PM2.5 and the imbalance of TH17/Tregs immune system.
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Objective To discuss clinical significance on early diagnosis of brain injury in premature infants with multiple sequence joint inspection of magnetic resonance imaging (MRI).Methods The brain MRI findings of 160 premature infants treated by Neonatal Intensive Care Unit were analyzed retrospectively.Results In 160 premature infants,brain injury occurred in 76 cases,the incidence of brain injury was 47.5％.Ischemic lesions were seen more in brain injury in premature infants,cerebral white matter injury was the most common,especially periventricular leukomalacia.Ischemic brain injury performed patchy or large sheet increased signal intensity on T1-weighted images(T1 WI),decreased signal intensity on T2-weighted images (T2WI) and obviously increased signal intensity on diffusion weighted imaging (DWI) in half egg circle center and around the lateral ventricle.Periventricular leukomalacia performed patchy decreased signal intensity on T1WI,increased signal intensity on T2WI and decreased signal intensity on DWI.Periventricular-intraventricular hemorrhage was seen more in hemorrhagic lesions.Hemorrhage stove was performed different signal because of different bleeding time.MRI performance in acute phase was iso-signal or slightly decreased signal intensity on T1WI,increased signal intensity on T2WI,increased signal intensity on T1WI,slightly decreased signal intensity on T2WI in early subacute,increased signal intensity on T1 WI and T2WI in late subacute and obviously decreased signal intensity on magnetic sensitive weighted imaging.The detection rate of ischemic lesions by DWI was higher than the conventional MRI,and DWI could show cerebral white matter damage of premature infants much earlier than the conventional MRI.The detection rate of hemorrhage stove by susceptibility weighted imagingc (SWI) was higher than the conventional MRI (x2 =23.78,P ＜ 0.05),and SWI could show hemorrhagic lesions much earlier than conventional MRI (x2 =27.02,P ＜ 0.05).Conclusions MRI,especially combined multiple sequence checking,could provide accurate imaging evidence for the early diagnosis of brain injury in premature infants.
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Objective To study magnetic resonance imaging(MRI) features of dysembryoplastic neuroepithelial tumor(DNT) and to improve accurate diagnosis of DNT.Methods The MRI appearance and clinical features of 10 patients with DNT confirmed by surgery and pathology were analyzed retrospectively.Results In 10 cases,9 tumors located in supratentorial hemisphere cortex,3 tumors located in the temporal lobe,5 in the frontal lobe,1 in the parietal lobe,and 2 of them encroached the adjacent white matter.In 9 tumors located in supratentorial hemisphere cortex,8 cases had decreased signal intensity on T1-weighted MR images,1 case iso-decreased mixed signal intensity on T1-weighted MR images,and 9 cases increased signal intensity on T2-weighted images,9 cases slightly increased signal intensity on fluid attenuated inversion recovery weighted images.The manifestation of tumors was cystic or cystic partially oriented and was seen separate section intratumoral in some cases.Three cases appeared as hyperintense ring sign and internal septation,2 cases appeared as a triangle in shape,3 cases appeared as gyms-like shape,and 1 case as round shape,similar to cyst.Nine tumors had no significant mass effect and peritumoral edema.Enhanced MR imaging showed only 1 case with slight and heterogeneous enhancement,the rest 6 cases showed non enhancement.One case located in cerebellar hemisphere,and appeared cystic-solid mass,the solid part had decreased signal intensity on T1-weighted MR images,and increased signal intensity on T2-weighted images,the cystic part had decreased signal intensity on T1-weighted MR images,and increased signal intensity on T2-weighted images.On enhanced MR imaging,the wall-node obviously contrast enhancement,cyst wall slightly contrast enhancement,cystic part non enhancement.The tumor had peritumoral edema and mass effect.Ten cases had no hemorrhage and calcification.Conclusion The MRI appearance of DNT is characteristic and is helpful for the preoperative diagnosis of DNT.
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Objective To study the species and amount of bacteria in sputum of patients with ventilator associated pneumonia (VAP) by using 16S rDNA sequencing analysis,and to explore the new method for etiologic diagnosis of VAP.Methods Bronchoalveolar lavage sputum samples were collected from 31 patients with VAP.Bacterial DNA of the samples were extracted and identified by polymerase chain reaction (PCR).At the same time,sputum specimens were processed for routine bacterial culture.The high flux sequencing experiment was conducted on PCR positive samples with 16S rDNA macro genome sequencing technology,and sequencing results were analyzed using bioinformatics,then the results between the sequencing and bacteria culture were compared.Results ① 550 bp of specific DNA sequences were amplified in sputum specimens from 27 cases of the 31 patients with VAP,and they were used for sequencing analysis.103 856 sequences were obtained from those sputum specimens using 16S rDNA sequencing,yielding approximately 39 Mb of raw data.Tag sequencing was able to inform genus level in all 27 samples.② Alpha-diversity analysis showed that sputum samples of patients with VAP had significantly higher variability and richness in bacterial species (Shannon index values 1.20,Simpson index values 0.48).Rarefaction curve analysis showed that there were more species that were not detected by sequencing from some VAP sputum samples.③ Analysis of 27 sputum samples with VAP by using 16S rDNA sequences yielded four phyla:namely Acitinobacteria,Bacteroidetes,Firmicutes,Proteobacteda.With genus as a classification,it was found that the dominant species included Streptococcus 88.9％ (24/27),Limnohabitans 77.8％ (21/27),Acinetobacter 70.4％ (19/27),Sphingomonas 63.0％ (17/27),Prevotella 63.0％ (17/27),Klebsiella 55.6％ (15/27),Pseudomonas 55.6％ (15/27),Aquabacterium 55.6％ (15/27),and Corynebacterium 55.6％ (15/27).④ Pyrophosphate sequencing discovered that Prevotella,Limnohabitans,Aquabacterium,Sphingomonas might not be detected by routine bacteria culture.Among seven species which were identified by both methods,pyrophosphate sequencing yielded higher positive rate than that of ordinary bacteria culture [Streptococcus:88.9％ (24/27) vs.18.5％ (5/27),KlebsieHa:55.6％ (15/27) vs.18.5％ (5/2 7),Acinetobacter:70.4％ (19/27) vs.37.0％ (10/27),Corynebacterium:55.6％ (15/27) vs.7.4％ (2/27),P＜0.05 or P＜0.01].Sequencing positive rate was found to increase positive rate for culture of Pseudomonas [55.6％ (15/27) vs.25.9％ (7/27),P=0.050].No significant differences were observed between sequencing and ordinary bacteria culture for detection Staphylococcus [7.4％ (2/27) vs.11.1％ (3/27)] and Neisseria bacteria genera [18.5％ (5/27) vs.3.7％(1/27),both P＞0.05].Conclusions 16S rDNA sequencing analysis confirmed that pathogenic bacteria in sputum of VAP were complicated with multiple drug resistant strains.Compared with routine bacterial culture,pyrophosphate sequencing had higher positive rate in detecting pathogens.16S rDNA gene sequencing technology may become a new method for etiological diagnosis of VAP.
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Objective To observe the mode of RET proto-oncogene mutation in a pedigree with multiple endocrine neoplasia type 2A (MEN2A).Methods Six members from a MEN2A family,including the proband,were enrolled.Genomic DNAs of these members were extracted from peripheral blood lymphocytes for polymerase chain reaction(PCR),PCR products of 21 exons of the RET proto-oncogene were purified and a direct gene sequence analysis was performed.DNA sequencing was performed on the related exon of the other family members after verifying the mutation site.Results The female proband sufferd from pheochromocytoma and medullary thyroid carcinoma since the age of 45,two missense mutations of TGC(Cys) to TCC(Ser) at codon 634 and CTG(Leu) to TTT(Phe) at codon 633 in exon 11 of the RET proto-oncogene were detected in the proband,while the other members remain unchanged.Conclusions Analysis of the RET proto-oncogene identifies a united mutation of TGC (Cys) to TCC (Ser) at codon 634 and CTG(Leu) to TTT(Phe) at codon 633 in the proband.The former is a proven mutation related to MEN2A,while the latter has never been reported before.
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Objeetive To evaluate the diagnostic value of axially loaded MR imaging with supine position in patients with degenerative disorders of lumbar spine.Methods Thirty asymptomatic volunteers and 89 patients were examined in psoas-relaxed position(PRP)and axially compressed supine position(ACE)of the lumbar spine.Sixty-one patients with low back pain,19 with sciatica and 9 with neurogenic claudication were included in the symptomatic study group.The disc levels from L3 to S1 were examined.Results In 30 asymptomatie volunteers,a significant decrease in dural sac cross-sectional area(DSCA)was found at 14 disc levels(15.6%)in 10 individuals(33.3%)during ACE(>15 mm2).In 89 patients.a significant decrease in DSCA was found at 55 disc levels(20.6%)in 38 patients(42.7%)during ACE(>15 mm2),and the mean decrease was 28 mm2.During ACE,32 disc levels with an increasing severity of disc herniation were noted in 26 patients.16 disc levels with neural foramen stenosis were found in 12 patients,11 disc levels with ligamentum flavum thickening were observed in 10 patients,3 cases facet dislocation and 3 cases lumbar spondylolisthesis were also seen.In 22 of the 89 patients(24.7%).additional valuable information(AVI)was found during ACE,including 7 patients(7/9)with neurogenic claudication,8 patients(8/19)with sciatica,and 11.5%(7/61)of the patients with low back pain.Conclusion As compared with conventional imaging methods,axially loaded imaging provides AVI,and more occult lesions can be found during ACE.ACE MRI is a valuable tool in diagnosing degenerative disorders of lumbar spine.