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Objective To analyze the clinical data of brucellosis, provide the references for brucellosis therapy. Methods The patients definitely diagnosed brucellosis at the First Affiliated Hospital of Xinjiang Medical University from 2005 to 2015 were assessed, data of clinical features, laboratory examination, complications, treatment and prognosis were analyzed. Results Of all 590 cases,the mean age was(44.24 ± 15.83)years old,the range was 3-75 years old,357(60.51%) cases had a history of raising and closely contacted with cattle and sheep, acute phase in 316(53.56%)cases,and chronic phase in 127(21.53%).The most common symptoms were fatigue in 537 (91.02%) cases, sweating in 520 (88.14%), fever in 513 (86.95%) and arthralgia in 478 (81.02%). Serum test tube agglutination test was positive in 583 (98.81%), blood culture was positive in 159 (33.97%,159/468).After patients receive antimicrobial treatment, body temperature decreased in 2 - 14 d. The overall recurrence rate was 5.98%(28/468),those patients with osteoarticular involvement even reached 23.22%(137/590).Doxycycline combined with rifampicin was the most common used antibiotics regimen, triple antibacterial drug program was recommended for patients with comorbidities. Conclusions The clinical manifestations of brucellosis is diversity, fatigue, sweaty, fever and arthralgia are the most common symptoms, and osteoarticular is the most frequently involved. Serum agglutination test is an important method in diagnosis of the disease, and combination of antibacterial drugs therapy is recommended.
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Objective To summarize the characteristics of liver injury due to brucellosis to provide reference for clinical diagnosis and treatment of brucellosis.Methods A total of 359 patients with brucellosis at the First affiliated Hospital of Xinjiang Medical University during 2010-2016 were enrolled, among them 113 (31.5%) developed liver injury.Alanine aminotransferase (ALT), aspartate transaminase (AST), γ-glutamyl transferase (γ-GT), serum albumin (Alb), alkaline phosphatase (ALP) and total bilirubin (TBil) were obtained before and after treatment.Ultrasound of upper abdomen was performed to observe the morphological changes of liver and spleen at admission.The routine blood test, erythrocyte sedimentation rate, C-reactive protein and other laboratory examinations were also performed.The data of patients before and after therapy were analyzed by t test.Results A total of 113 patients were included in this study.Eighty-eight (77.9%) were male.The mean age was (43.2±15.8) years old, among whom 81(71.7%) cases were between 31 and 60 years old.Seventy-one cases (62.8%) was in acute phase, and 42(37.2%) in chronic phase.The Han, Uighurs and Kazak nationalities accounted for 41.6%(47 patients),31.0%(35 patients) and 18.6%(21 cases), respectively.At admission, ALT level was (98.54±59.32) U/L before treatment, and decreased to (38.18±17.13) U/L after treatment, with statistically significant difference (t=6.627, P<0.05).AST levels before and after treatment were (93.17±59.19) U/L and (30.67±12.56) U/L, respectively, with significant difference (t=8.042, P<0.05).γ-GT levels before and after treatment were (162.27±48.19) U/L and (69.53±32.17) U/L, respectively, with statistically significant difference (t=8.271, P<0.05).Alb was (32.31±5.29) g/L before therapy, and increased to (38.00±4.27) g/L after therapy, with statistically significant difference (t=4.429, P<0.05).Conclusions Liver injury is common in patients with brucellosis.Elevation of transaminase is usually mild to moderate, accompanied by reduced ALB.For brucellosis patients with liver injury, antimicrobial treatment combined with liver protecting drugs could improve liver function effectively, and even within the normal range.
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OBJECTIVE:To explore the safety,superiority and reliability of the application of dexmedetomidine-assisted con-trolled anti-hypertension combined with high capacity hemodilution in spinal surgeries. METHODS:40 patients with spinal surger-ies under general anesthesia were randomly divided into dexmedetomidine group (group D) and normal saline (group S) with 20 cases in each group. Both groups were given controlled anti-hypertension combined with high capacity hemodilution to carry out blood conservation and intraoperative wakeup experiment. Group D was given 1 μg/kg dexmedetomidine within 10 min by micro pump 10 min before anesthesia induction;maintained with 0.4-0.8 μg/(kg·h)during controlled anti-hypertension;injected with dex-medetomidine 0.2 μg/(kg·h) during wakeup experiment and anesthesia maintenance period until tracheal catheter was extracted. Group S was given normal saline instead,and the usage was same as group D. Heart rate (HR),mean arterial pressure (MAP) and central venous pressure(CVP)of patients were observed and recorded before pump injection of dexmedetomidine(T0),1 min after tracheal intubation(T1),10 min after anesthesia induction(T2),30 min after anesthesia induction(T3),wakeup(T4),at the end of controlled anti-hypertension(T5),at the end of operation(T6),during tracheal extubation(T7). Meanwhile,the wakeup ex-periment time,blood loss when wakeup,total amount of nitroglycerin,mean density of inhaled isoflurane,total amount of nitro-glycerin,total blood loss,and post-operative wakeup time of both groups were recorded. The case number of post-operative de-layed wakeup chill and dysphoria were calculated in both groups. RESULTS:Compared with at T0,HR of both groups at T1 and T7 were faster,and MAP and CVP increased,and that of group S was more significant than that of group D(P<0.05). HR and MAP of both groups at T3 were significantly lower than T0(P<0.05). Compared to group D at T4,MAP and CVP of group S at T4 were increased and HR were faster (P<0.05);the wakeup experiment time and post-operative wakeup time of group D were shorter than those of group S (P<0.05);the blood loss when awaken and total blood loss were less than group S (P<0.05);the total amount of nitroglycerin,mean density of inhaled isoflurane and total amount of remifentanil were all lower than those of group S (P<0.05);the incidence of post-operative delayed wakeup,chill and dysphoria in group D were significantly lower than those of group S (P<0.05). CONCLUSIONS:The application of dexmedetomidine-assisted controlled anti-hypertension combined with high capacity hemodilution in spinal surgeries can bring more stable and effective controlled anti-hypertension. It can also reduce the amount of nitroglycerin,remifentanil,propofol and isoflurane significantly. It is a reliable and safe drug to be applied in assist-ed controlled anti-hypertension combined with high capacity hemodilution in spinal surgeries.