Analysis of pregnancy outcomes, disease progression, and risk factors in patients with undifferentiated connective tissue disease / 北京大学学报(医学版)

OBJECTIVE@#To investigate the fetal and maternal outcomes, risk factors of disease progression and adverse pregnancy outcomes (APOs) in patients with undifferentiated connective tissue disease (UCTD).@*METHODS@#This retrospective study described the outcomes of 106 pregnancies in patients with UCTD. The patients were divided into APOs group (n=53) and non-APOs group (n=53). The APOs were defined as miscarriage, premature birth, pre-eclampsia, premature rupture of membranes (PROM), intrauterine growth restriction (IUGR), postpartum hemorrhage (PPH), and stillbirth, small for gestational age infant (SGA), low birth weight infant (LBW) and birth defects. The differences in clinical manifestations, laboratory data and pregnancy outcomes between the two groups were compared. Logistic regression analysis was performed to analyze the risk factors for APOs and the progression of UCTD to definitive CTD.@*RESULTS@#There were 99 (93.39%) live births, 4 (3.77%) stillbirths and 3 (2.83%) miscarriage, 20 (18.86%) preterm delivery, 6 (5.66%) SGA, 17 (16.03%) LBW, 11 (10.37%) pre-eclampsia, 7 (6.60%) cases IUGR, 19 (17.92%) cases PROM, 10 (9.43%) cases PPH. Compared with the patients without APOs, the patients with APOs had a higher positive rate of anti-SSA antibodies (73.58% vs. 54.71%, P=0.036), higher rate of leukopenia (15.09% vs. 3.77%, P=0.046), lower haemoglobin level [109.00 (99.50, 118.00) g/L vs. 124.00 (111.50, 132.00) g/L, P < 0.001].Multivariate Logistic regression analysis showed that leucopenia (OR=0.82, 95%CI: 0.688-0.994) was an independent risk factors for APOs in UCTD (P=0.042). Within a mean follow-up time of 5.00 (3.00, 7.00) years, the rate of disease progression to a definite CTD was 14.15%, including 8 (7.54%) Sjögren's syndrome, 4 (3.77%) systemic lupus erythematosus (SLE), 4 (3.77%) rheumatoid arthritis and 1 (0.94%) mixed connective tissue disease. Multivariate Cox proportional risk regression analysis showed that Raynaud phenomenon (HR=40.157, 95%CI: 3.172-508.326) was an independent risk factor for progression to SLE.@*CONCLUSION@#Leukopenia is an independent risk factor for the development of APOs in patients with UCTD. Raynaud's phenmon is a risk factor for the progression of SLE. Tight disease monitoring and regular follow-up are the key measures to prevent adverse pregnancy outcomes and predict disease progression in UCTD patients with pregnancy.

Trends in Antimicrobial Resistance against Enterobacteriaceae Strains Isolated from Blood: A 10-year Epidemiological Study in Mainland China (2004-2014) / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Antimicrobial resistance is a serious problem that compromises the empirical treatment of infections, resulting in a lack of effective antibiotics and high medical expenses. Here, we aimed to monitor the trends in antimicrobial resistance among Enterobacteriaceae isolated from blood samples in mainland China.</p><p><b>METHODS</b>A total of 2240 Enterobacteriaceae isolates from blood were collected from hospitalized patients at 19 tertiary hospitals between October 2004 and June 2014. The minimum inhibitory concentrations of all isolates were determined using the agar dilution method according to the Clinical and Laboratory Standards Institute 2016 guidelines.</p><p><b>RESULTS</b>The most commonly isolated bacteria were Escherichia coli, compromising 47.0% (1053/2240) of the total isolates, followed by Klebsiella spp. (26.3%), Salmonella spp. (10.4%), and Enterobacter spp. (9.2%). The detection rates of extended-spectrum β-lactamases (ESBLs) among E. coli were 68.9% (2004-2005), 73.2% (2007-2008), 67.9% (2009-2010), 72.6% (2011-2012), and 58.4% (2013-2014), whereas those in ESBL-producing Klebsiella pneumoniae were slightly decreased (75.9%, 50.0%, 41.4%, 40.2%, and 43.0%, respectively). Carbapenems were the most potent agents against the Enterobacteriaceae isolates, followed by moxalactam, tigecycline, and amikacin. However, there was a decrease in the susceptibility rates for carbapenems in all species, particularly K. pneumoniae(decreased by 10.6% for imipenem) and Enterobacter aerogenes (decreased by 21.1% for imipenem). Reviving antibiotics (tigecycline and polymyxins) showed good in vitro activity against Enterobacteriaceae.</p><p><b>CONCLUSIONS</b>The activity of antibiotics against Enterobacteriaceae isolated from blood was decreased overall. Large proportions of ESBL-producing isolates were identified among E. coli and Klebsiella spp. Carbapenem-resistant isolates have become a major challenge in the treatment of infections.</p>

Prognostic Value for the Risk Stratification of Circulating Monocyte Subsets Combining Left Ventricular Ejection Fraction in Patients With Acute ST-segment Elevation Myocardial Infarction / 中国循环杂志

Objective:To explore the prognostic value for circulating monocyte subsets combining left ventricular ejection fraction (LVEF) in patients with acute ST-segment elevation myocardial infarction (STEMI).Methods:STEMI patients admitted within 24 h of onset received PCI in Pingjin hospital heart center were enrolled.Flow cytometry (FCM) was used to examine 3 subsets of monocyte in peripheral blood as classical CD14++CD16-monocyte,intermediate CD14++CD16+ monocyte and non-classical CD14+CD16++ monocyte.The patients were followedup in 3 years for major adverse cardiac events (MACE) occurrence.The relationship between monocyte subsets,LVEF and MACE occurrence was studied by COX model analysis and MACE prediction model was established by ROC combining multivariate Logistic regression analysis.Results:There were 50/221 patients suffered from MACE during 3-year follow-up period.Compared with Non-MACE patients,MACE patients had the elder age (63.82±11.88) years vs (58.84±11.40) years,P=0.009;more diabetes mellitus (28.0％ vs 18.7％),P＜0.001;higher blood levels of LDL-C (2.77 mmol/L) vs (2.41 mmol/L),P=0.003 and CD14++CD16+ monocyte (47.17 cells/μl) vs (21.47 cells/μl),P＜0.001;lower LVEF (52％ vs 46％),P＜0.001.Multivariate Cox analysis indicated that CD14++CD16+ (HR=2.211,95％ CI 1.211-3.635,P=0.016) and LVEF (HR=2.014,95％ CI 1.038-2.933,P=0.022) were the independent risk factors for MACE occurrence in STEMI patients.ROC combining multivariate Logistic regression analysis presented that MACE predictive value of CD14++CD16+ monocyte combining LVEF (AUC=0.744,95％ CI 0.664-0.823,P＜0.001) was higher than the single value of CD14++CD16+ monocyte (AUC=0.683,95％ CI 0.598-0.768,P＜0.001) and LVEF(AUC=0.640,95％ CI 0.552-0.7291,P=0.003) respectively.Conclusion:Circulating level of CD14++CD16+ monocyte combining LVEF may predict MACE occurrence within 3 years in STEMI patients;it had potential value in clinical practice.

Prognostic Value for the Risk Stratification of Circulating Monocyte Subsets Combining Left Ventricular Ejection Fraction in Patients With Acute ST-segment Elevation Myocardial Infarction / 中国循环杂志

Objective:To explore the prognostic value for circulating monocyte subsets combining left ventricular ejection fraction (LVEF) in patients with acute ST-segment elevation myocardial infarction (STEMI).Methods:STEMI patients admitted within 24 h of onset received PCI in Pingjin hospital heart center were enrolled.Flow cytometry (FCM) was used to examine 3 subsets of monocyte in peripheral blood as classical CD14++CD16-monocyte,intermediate CD14++CD16+ monocyte and non-classical CD14+CD16++ monocyte.The patients were followedup in 3 years for major adverse cardiac events (MACE) occurrence.The relationship between monocyte subsets,LVEF and MACE occurrence was studied by COX model analysis and MACE prediction model was established by ROC combining multivariate Logistic regression analysis.Results:There were 50/221 patients suffered from MACE during 3-year follow-up period.Compared with Non-MACE patients,MACE patients had the elder age (63.82±11.88) years vs (58.84±11.40) years,P=0.009;more diabetes mellitus (28.0％ vs 18.7％),P＜0.001;higher blood levels of LDL-C (2.77 mmol/L) vs (2.41 mmol/L),P=0.003 and CD14++CD16+ monocyte (47.17 cells/μl) vs (21.47 cells/μl),P＜0.001;lower LVEF (52％ vs 46％),P＜0.001.Multivariate Cox analysis indicated that CD14++CD16+ (HR=2.211,95％ CI 1.211-3.635,P=0.016) and LVEF (HR=2.014,95％ CI 1.038-2.933,P=0.022) were the independent risk factors for MACE occurrence in STEMI patients.ROC combining multivariate Logistic regression analysis presented that MACE predictive value of CD14++CD16+ monocyte combining LVEF (AUC=0.744,95％ CI 0.664-0.823,P＜0.001) was higher than the single value of CD14++CD16+ monocyte (AUC=0.683,95％ CI 0.598-0.768,P＜0.001) and LVEF(AUC=0.640,95％ CI 0.552-0.7291,P=0.003) respectively.Conclusion:Circulating level of CD14++CD16+ monocyte combining LVEF may predict MACE occurrence within 3 years in STEMI patients;it had potential value in clinical practice.

Changes of dietary pattern among adults in Liaoning province, 1989 to 2006 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To study the changes of dietary pattern among adult residents in different areas of Liaoning province from 1989 to 2006.</p><p><b>METHODS</b>Healthy adults (6213 subjects) at age of 18 - 65 years from 480 households in three cities (Shenyang, Yingkou, Wafangdian) and three counties (Qingyuan, Huanren, Chaoyang) were selected with stratified multiple cluster random sampling. The information on nutrient intake of the subjects were collected from datasets of Chinese Health and Nutrition Survey conducted in 1989, 1991, 1993, 2000, 2004, and 2006. Different food intake, the nutrients intake percentages for recommended nutrition intake (RNI) and appropriate intake (AI), and the percentages of total energy and protein from grain, animal product, bean and its product were calculated to assess the residents' dietary pattern and nutrition status. The changes of dietary pattern among adult residents were analyzed.</p><p><b>RESULTS</b>Among the residents, there were a 38.1% of decreased intake for grain (from 601.9 to 372.5 g/d), 20.5% for potato (from 75.6 to 60.1 g/d), 25.1% for beans (from 38.7 to 29.0 g/d), and a 77.2% of increased intake for fish and shrimp (from 25.0 to 44.3 g/d), 36.9% for livestock and poultry (from 65.6 to 89.8 g/d), 47.7% for fruit (from 70.7 to 104.4 g/d), and intake of milk product (from 5.8 to 21.3 g/d), egg (from 17.3 to 35.7 g/d), vegetable (from 296.1 to 316.3 g/d) were also increased from 1989 to 2006. During the period, the intake percentages of energy and protein from grain decreased from 67.5% (8.7 MJ/12.8 MJ per day) to 51.5% (5.0 MJ/9.6 MJ per day) and from 72.0% (66.2 g/91.9 g per day) to 59.7% (45.3 g/75.9 g per day), and on the contrary those from animal products increased from 8.9% (1.1 MJ/12.8 MJ per day) to 14.8 (1.4 MJ/9.6 MJ per day) and from 15.9% (14.6 g/91.9 g per day) to 27.9% (21.2 g/75.9 g per day), respectively. In 2006, the intake of vitamin A (508.9 µg/d) was 67.6% of it's RNI, intake of vitamin B(2) (0.9 mg/d) was 64.6% and the intake of calcium (453.7 mg/d) was 52.5% of it's AI among the residents.</p><p><b>CONCLUSION</b>The intake of plant food decreased and that of animal food increased from 1989 to 2006 and the dietary intakes of calcium, vitamin A, vitamin B(2) need to be increased among adult population of Liaoning province.</p>

Coronary artery bypass grafting in patients over 70 years old / 中华外科杂志

<p><b>OBJECTIVE</b>To retrospectively analyze the experiences, indications, technique, and results of coronary artery bypass grafting (CABG) in patients over 70 years old.</p><p><b>METHODS</b>Ninety-one patients received coronary artery bypass grafting from March 2004 to March 2008. Ages ranged from 70 to 83 years old, 22 patients over 75 years old. Conventional CABG (CCABG) in 72 patients, off-pump CABG (OPCAB) in 19 patients. Clinical data has no significant differences in two groups. The rate of using left internal mammary artery was 96.7%. The number of grafts in CCABG and OPCAB group were 2 to 5 (3.5 +/- 0.8) and 1 to 4 (2.9 +/- 0.7) respectively.</p><p><b>RESULTS</b>In-hospital death in 2 cases, both were from chronic obstructive pulmonary disease and pulmonary infection. Cerebral infarction in 1 case and pulmonary infection in 2 cases in CCABG group, but no significant difference between two groups, and no difference in intubation, ICU stay, respiratory failure, renal function failure. But number of grafts in CCABG was significantly more than that in OPCAB (P < 0.01). Postoperative follow-up was 3 to 36 months, 1 case with recurrent angina in OPCAB.</p><p><b>CONCLUSIONS</b>According to the characteristic of coronary artery disease in elderly, fully revascularization and improving myocardial blood supply, patients over 70 years old with CABG can obtain the same efficacy as younger patients. There were not significant difference between CCABG and OPCAB.</p>

Analysis on the SARS-CoV genome of PUMC01 isolate / 中国医学科学院学报

<p><b>OBJECTIVE</b>To perform variation and phylogenetics analysis on the SARS-CoV genome sequence (PUMC01) isolated in the Peking Union Medical College Hospital.</p><p><b>METHODS</b>The cDNA library of SARS-CoV (PUMC01 isolate) was constructed by means of random-priming strategy. Random selected plasmid was sequenced and the genome sequence of SARS-CoV-PUMC01 was assembled by conventional methods (The Genebank Accession No. of SARS-CoV-PUMC01 is AY350750). The variation and phylogenetics analysis were performed by comparing the PUMC01 sequence with other SARS-CoV isolates.</p><p><b>RESULTS</b>Ten variation sites were found by comparing PUMC01 isolate with Tor2 and Urbani isolates. In phylogenetic analysis of 18 SARS-CoV isolates, two classes were observed and there is different differential time between these two classes and the different isolates in each class.</p><p><b>CONCLUSIONS</b>The evidence of phylogenetic analysis of different SARS-CoV isolates from different region is instructive for understanding the clinical relations between the different isolates and the transmission chain of SARS-CoV.</p>