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Objective:To analyze the epidemiological and clinical characteristics of patients with tsutsugamushi disease in Guangdong Province from 2016 to 2021, and to provide a reference for clinical diagnosis, treatment, scientific prevention and control of tsutsugamushi disease.Methods:A retrospective analysis was conducted to collect the information of patients with tsutsugamushi disease admitted to Guangzhou Eighth Hospital Affiliated to Guangzhou Medical University from 2016 to 2021, including the basic information, epidemiological characteristics, clinical manifestations, auxiliary examinations, complications, misdiagnosis at first diagnosis and treatment outcomes.Results:Among 155 patients with tsutsugamushi disease, there were 75 males (48.39%) and 80 females (51.61%), with an e age of (54.41 ± 13.78) years old, and 30 cases (19.35%) had other underlying diseases. The peak time of onset was from June to September. There were 97 local patients (62.58%) in Guangzhou, and 58 cases (37.42%) in other prefecture-level cities; 76.77% (119/155) had a history of field activities before the onset of the disease. 36.13% (56/155) were farmers. The most common clinical manifestations were fever (100.00%, 155/155), chills and/or shivering (77.42%, 120/155), headache and/or dizziness (74.19%, 115/155), fatigue (65.81%, 102/155), eschar or ulcer (92.90%, 144/155), and lymphadenopathy (49.68%, 77/155). The laboratory test results mainly showed a decrease in eosinophils (81.94%, 127/155), a decrease in hematocrit (78.71%, 122/155), a decrease in hemoglobin (52.26%, 81/155), a decrease in platelet count (50.97%, 79/155), a decrease in albumin (92.26%, 143/155), an increase in lactate dehydrogenase (90.32%, 140/155), an increase in adenosine deaminase (88.39%, 137/155), and an increase in alanine aminotransferase (85.16%, 132/155), elevated aspartate aminotransferase (85.16%, 132/155), and elevated procalcitonin (52.90%, 82/155); 30 cases (19.35%) were positive for the Weil-Felix Test. There were 95 cases (61.29%) with abnormal chest imaging results, and 34 cases (21.94%) with abnormal abdominal ultrasound or CT results. Common complications were toxic hepatitis, pulmonary infection, organ failure, and acute kidney injury, etc. The misdiagnosis rate of the initial diagnosis of this disease was 75.48% (117/155). Doxycycline and symptomatic and supportive therapy were given, 154 patients (99.35%) were cured or improved and discharged from hospital.Conclusions:Tsutsugamushi disease is prevalent in summer and autumn in Guangdong Province. Before the onset, most of the patients have a history of field activities. Farmers are susceptible people. Its clinical manifestations are diverse, and can affect multiple systems and organs. There are many complications, and doxycycline can be used for anti-infection treatment, with a high cure rate.
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Objective:To explore the clinical characteristics of imported malaria from Africa, and the correlation between blood lipids and disease severity.Methods:The clinical data of 172 imported malaria patients from Africa were collected from January 1, 2018 to January 31, 2021 in Guangzhou Eighth People′s Hospital, Guangzhou Medical University. The general conditions, clinical symptoms, laboratory tests, treatment and prognosis of the patients were analyzed retrospectively. The independent samples t-test, Mann-Whitney U test and binary multivariate logistic regression analysis were used for statistical analysis when appropriate. Results:A total of 172 patients were divided into 39 severe cases and 133 non-severe cases in this study. The main infection species was Plasmodium falciparum, with a total of 153 cases (89.0%), and the severe cases were all falciparum malarias. Compared with the non-severe group, the white blood cell count and triacylglycerol level were increased in the severe group.The differences were both statistically significant ( Z=2.397 and 4.368, respectively; both P<0.05). The hemoglobin, hematocrit, platelet count, high-density lipoprotein cholesterol, apolipoprotein A (ApoA)Ⅰ and ApoAⅠ/apolipoprotein B (ApoB) were significantly decreased in the severe group. The differences were all statistically significant ( Z=-4.473, -4.464, -4.750, -4.826, -5.488 and -4.419, respectively; all P<0.01). The total cholesterol and low-density lipoprotein cholesterol were also reduced in the severe group. The differences were both statistically significant ( t=3.817 and 5.285, respectively; both P<0.01). The area under receiver operator characteristic curve of high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triacylglycerol, ApoAⅠ, and ApoAⅠ/ApoB were 0.754, 0.727, 0.730, 0.789 and 0.733, respectively (all P<0.01). When the Youden index was at its maximum, the best cut-off value of ApoAⅠ was 0.535 g/L with sensitivity of the prediction for severe malaria of 79.5% and the specificity of 68.4%. ApoAⅠ had independent predictive value for severe malaria (odds ratio ( OR)=0.013, 95% confidence interval ( CI) 0.002 to 0.086, P<0.01), and stratified according to the best cut-off value, the risk of severe malaria when ApoA Ⅰ<0.535 g/L was 8.396 times of ApoA Ⅰ≥0.535 g/L ( OR=8.396, 95% CI 3.557 to 19.820, P<0.01). The case fatality rate of severe malaria was 2.6%(1/39). Conclusions:The imported malaria patients from Africa are mainly infected with Plasmodium falciparum and the case fatality rate of severe malaria is high. The high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triacylglycerol, ApoAⅠ, ApoAⅠ/ApoB of blood lipids show higher predictive value for severe malaria, among which, ApoAⅠ has independent predictive value for severe malaria. Changes in blood lipids will help to identify severe malaria as early as possible, improve the cure rate, and reduce the risk of death.
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Objective To evaluate the application value of early lung ultrasound score(LUS)in the eval-uation of severity and prognosis of severe pneumonia and investigate its correlations with oxygenation index(OI), alveolar-arterial oxygen difference(A-aDO2),lymphocyte count(LYM),positive end-expiratory pressure(PEEP), acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score,and clinical pulmonary infection score (CPIS). Methods Thirty severe pneumonia patients admitted to intensive care unit(ICU)of Guangzhou Eighth People's Hospital from May 2015 to July 2017 were enrolled,including 14 cases with low PEEP and 16 cases with high PEEP. Among them,17 patients were diagnosed with non-viral pneumonia and 13 ones with viral pneumonia;15 of them survived,and 15 died. The clinical data and cores of all patients were recorded by one observer,including baseline date,OI,A-aDO2,LYM,PEEP,and APACHEⅡ and CPIS score. The other observer was specifically responsible for pulmonary ultrasonography and LUS. The correlation between LUS and OI,A-aDO2,LYM,PEEP, as well as APACHEⅡand CPIS scores was analyzed by bivariate correlation analysis. Receiver operator character-istic curves(ROC)were plotted,and the prediction value,sensitivity and specificity of high PEEP and mortality by LUS were calculated respectively. Results LUS had a negative correlation with OI(r =-0.755,P = 0.000) and LYM(r =-0.518,P = 0.03),and a good positive correlation with A-aDO2(r = 0.642,P = 0.000),PEEP (r = 0.583,P = 0.001),APACHEⅡ(r = 0.461,P = 0.010)and CPIS(r = 0.595,P = 0.001)was respectively found. LUS in the survival group was significantly lower than the death group(15.00 ± 5.90 vs. 22.27 ± 4.68,P<0.01),low PEEP group was obviously lower than high PEEP group(14.23 ± 5.40 vs. 22.00 ± 4.98,P < 0.01), and there was no significant difference between non-viral pneumonia group and viral pneumonia group(18.59 ± 6.49 vs. 18.69 ± 6.56,P > 0.05). The area under ROC cure(AUC)was calculated:the predictive value for high PEEP by LUS was 19,with the sensitivity of 77% and specificity of 92%,and the patients with LUS > 17 had a high mortality,with the sensitivity for predicting death of 87% and specificity of 67%. Conclusion Bedside lung ultrasound can easily evaluate the changes in pulmonary ventilation area ,and early LUS has important clinical application value in assessing the severity and prognosis of severe pneumonia patients.
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Objective To investigate the expression of hypoxia-inducible factor-1α (HIF-1α),insulin-like growth factor (IGF-1) and epidermal growth factor receptor (EGFR) in non-small cell lung cancer (NSCLC) and their clinical significance.Methods The expression of HIF-1α,EGFR and IGF-1 in NSCLC tissues and adjacent non-tumor tissues were detected by western blot,and the correlation with clinicopathological features and prognosis were analyzed.Results The expression of HIF-1α,IGF-1 and EGFR in NSCLC tissues were significantly higher than that in non-tumorous tissues.There were no significant difference in the expression of HIF-1 α and IGF-1 in squamous cell carcinoma and adenocarcinoma(P ＞ 0.05).The expression of EGFR in squamous cell carcinoma was significantly higher than that in adenocarcinoma(P ＜ 0.05).The expression of HIF-1α,IGF-1 and EGFR in low differentiated carcinoma were significantly higher than those in medium and high differentiated carcinoma tissues,and the expression of HIF-1α,IGF-1 and EGFR in stage Ⅰ and Ⅱ tumor tissues were significantly lower than those in stage Ⅲ and Ⅳ tumor tissues(P ＜0.05).The expression of HIF-1 α,IGF-1 and EGFR with lymph node metastasis were significantly higher than that without lymph node metastasis in tumor tissues.There was a significant positive correlation between the expression of HIF-1 α and EGFR (r2 =0.301,P ＜ 0.05),and the expression of HIF-1 α was positively correlated with the expression of IGF-1 (r2 =0.611,P ＜ 0.05).The expression of HIF-1α,EGFR and IGF-1 had no significant correlation with the prognosis (P ＞ 0.05).Conclusion HIF-1,EGFR and IGF-1 were significantly increased in NSCLC tissues,and HIF-1 was positively correlated with EGFR and EGF-1,and the expression of HIF-1α,IGF-1 and EGFR are closely related to the degree of differentiation,TNM staging and lymph node metastasis,and EGFR is closely related to pathological type.They play an important role in the development and progression of NSCLC.
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Objective To quantify the validity and reliability of the Hong Kong version of the functional test for the Hemiplegic Upper Extremity (FTHUE-HK).Methods Forty-two stroke patients were studied.Patients were assessed twice within one week using the FTHUE-HK,the upper extremity component of Fugl-Meyer movement assessment (FMA) and the modified Barthel index (MBI).The test-retest reliability and inter-rater reliability of the FTHUE-HK were thus quantified.The FTHUE-HK's validity was evaluated according to the correlation between the FTHUE-HK,FMA and MBI results.Results Significant correlations between the three assessments were demonstrated(P≤0.01).The intra-and inter-class correlation coefficients were 0.983 and 0.985 respectively.Conclusion The FTHUE-HK is a simple and useful assessment of the upper extremity function of stroke patients with good validity and reliability.