Repeated stellate ganglion blockade for the treatment of ventricular tachycardia storm in patients with nonischemic cardiomyopathy: a new therapeutic option for patients with malignant arrhythmias / 中华心血管病杂志

Objectives: This study sought to describe our institutional experience of repeated percutaneous stellate ganglion blockade (R-SGB) as a treatment option for drug-refractory electrical storm in patients with nonischemic cardiomyopathy (NICM). Methods: This prospective observational study included 8 consecutive NICM patients who had drug-refractory electrical storm and underwent R-SGB between June 1, 2021 and January 31, 2022. Lidocaine (5 ml, 1%) was injected in the vicinity of the left stellate ganglion under the guidance of ultrasound, once per day for 7 days. Data including clinical characteristics, immediate and long-term outcomes, and procedure related complications were collected. Results: The mean age was (51.5±13.6) years. All patients were male. 5 patients were diagnosed as dilated cardiomyopathy, 2 patients as arrhythmogenic right ventricular cardiomyopathy and 1 patient as hypertrophic cardiomyopathy. The left ventricular ejection fraction was 37.8%±6.6%. After the treatment of R-SGB, 6 (75%) patients were free of electrical storm. 24 hours Holter monitoring showed significant reduction in ventricular tachycardia (VT) episodes from 43.0 (13.3, 276.3) to 1.0 (0.3, 34.0) on the first day following R-SGB (P<0.05) and 0.5 (0.0, 19.3) after whole R-SGB process (P<0.05). There were no procedure-related major complications. The mean follow-up was (4.8±1.1) months, and the median time of recurrent VT was 2 months. Conclusion: Minimally invasive R-SGB is a safe and effective method to treat electrical storm in patients with NICM.

Epidemiological analysis on the norovirus detection based on diarrhea syndromic surveillance in Pudong , Shanghai ,2012—2016 / 中华传染病杂志

Objective To understand the epidemiological characteristics of norovirus detection based on the diarrhea syndromic surveillance in Pudong ,Shanghai .Methods Diarrhea syndromic surveillance program was conducted in outpatient and emergency departments of 12 sentinel hospitals during 2012 -2016 .The clinical and epidemiological data of diarrheal patients were collected .The fecal specimens were also sampled . The detections for norovirus by polymerase chain reaction and gene sequencing were performed .Chi-square test or Fisher exact probability test was used to compare the detection rate .Binary logistic regression was used to explore the impact factors of norovirus infection among diarrheal patients . Results The detective rate of norovirus among diarrheal patients was 21 .59％ ,peaking from October to next March .Among all the age groups ,the detection rate was highest among patients with 25 - 64 years old .The patients with more severe diarrhea symptoms (> 5 times a day) were more likely to be infected with norovirus than those with diarrhea 3 - 5 times a day (χ2 = 21 .167 ,P< 0 .01) .Vomiting was also an indicator of norovirus infection .Patients presented with vomiting had a higher norovirus detection rate (χ2 = 198 .543 , P < 0 .01) . Norovirus G Ⅱ was the predominant genotype .Conclusions The recent epidemic of norovirus infection in diarrheal patients in Pudong new district has an apparent seasonality peaked from October to next March .Adult ,patients with vomiting and more severe diarrhea symptoms are at risk of norovirus infection .The long-term surveillance is critical for the norovirus infection control .

Healthcare-associated Pneumonia: Clinical Features and Retrospective Analysis Over 10 Years / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Healthcare-associated pneumonia (HCAP) is associated with drug-resistant pathogens and high mortality, and there is no clear evidence that this is due to inappropriate antibiotic therapy. This study was to elucidate the clinical features, pathogens, therapy, and outcomes of HCAP, and to clarify the risk factors for drug-resistant pathogens and prognosis.</p><p><b>METHODS</b>Retrospective observational study among hospitalized patients with HCAP over 10 years. The primary outcome was 30-day all-cause hospital mortality after admission. Demographics (age, gender, clinical features, and comorbidities), dates of admission, discharge and/or death, hospitalization costs, microbiological results, chest imaging studies, and CURB-65 were analyzed. Antibiotics, admission to Intensive Care Unit (ICU), mechanical ventilation, and pneumonia prognosis were recorded. Patients were dichotomized based on CURB-65 (low- vs. high-risk).</p><p><b>RESULTS</b>Among 612 patients (mean age of 70.7 years), 88.4% had at least one comorbidity. Commonly detected pathogens were Acinetobacter baumannii, Pseudomonas aeruginosa, and coagulase-negative staphylococci. Initial monotherapy with β-lactam antibiotics was the most common initial therapy (50%). Mean age, length of stay, hospitalization expenses, ICU admission, mechanical ventilation use, malignancies, and detection rate for P. aeruginosa, and Staphylococcus aureus were higher in the high-risk group compared with the low-risk group. CURB-65 ≥3, malignancies, and mechanical ventilation were associated with an increased mortality. Logistic regression analysis showed that cerebrovascular diseases and being bedridden were independent risk factors for HCAP.</p><p><b>CONCLUSION</b>Initial treatment of HCAP with broad-spectrum antibiotics could be an appropriate approach. CURB-65 ≥3, malignancies, and mechanical ventilation may result in an increased mortality.</p>

Analysis of the assessment of clinical students' doctor-patient communication skills and recom-mendations for improvement / 中华医学教育探索杂志

Objective To investigate the mastery of clinical students' doctor-patient communi-cation skills and to assess the teaching effectiveness about the doctor-patient communication, and then propose some improvement ideas. Methods We conducted a study in students of clinical medicine of Nanjing Medical University in Grade 2009, using Objective Structured Clinical Examination (OSCE) after internship, which included graduation assessment of doctor-patient communication skills. Then we analyzed the doctor-patient communication skills and related scores of students trained in different clinical medical programs. Results The average score of doctor-patient communication skills of 549 students was (82.72±4.23), of which, the average score of 329 five-year students of clinical medicine was (81.88±4.23) and the average score of seven-year students was (83.96±3.91) in. The average score of seven-year students of clinical medicine was significantly higher than five-year students (P=0.000). Moreover, there was a significant positive correlation between the total score of OSCE and the score of doctor-patient communication skills in both five-year and seven-year students of clinical medicine (five year program students' score correlation coefficient was 0.520, P=0.000;seven year pro-gram students' score correlation coefficient 0.416, P=0.000). Conclusion The teaching effectiveness of doctor-patient communication has proved to be quite effective, and it is definitely of great significance in improving clinical students' doctor-patient communication skills. The score of the assessment of the doctor-patient communication reflects not only the training effectiveness of the communication skills, but also the comprehensive capacity.

pharmacodynamic simulation to evaluate tigecycline in treatment of nosocomial pneumonia caused by multidrug-resistant Acinetobacter baumannii

The shortage of effective antibiotics against multidrug-resistant Acinetobacter baumannii [MDR-Ab] has posed great threat to the public health. But the advent of tigecycline gives us new hope. The goal of our research was to assess the clinical efficacy of tigecycline at different doses by using a pharmacokinetic/pharmacodynamic [PK/PD] model which can incorporate pharmacokinetic data of tigecycline from patients with pneumonia and MICs of MDR-Ab from a tertiary hospital. A 10000-patient Monte-Carlo Simulation based on the PK/PD model was conducted to calculate the probability of target attainment [PTA] and the cumulative fraction of response [CFR] of tigecycline. 97% isolates displayed susceptibility and 3% were tigecycline-intermediate strains and the values of MIC ranged from 0.125 to 4microg/ml. A CFR of 61.62% was predicted for tigecycline at current dosage [50 mg q12h]. When the dosage was increased, the predicted CFRs for 75 mg q12h, 100 mg q12h, 125 mg q12h, 150 mg q12h were 81.00%, 89.86%, and 94.57%, 96.77%, respectively. Despite presented higher susceptibility, the CFR obtained was not optimal at current dosage. A higher CFR indicating a better clinical efficacy can be gained by the increased dosage.

Concentration of polybrominated diphenyl ethers in umbilical cord serum and the influence on newborns birth outcomes in Shanghai / 中华预防医学杂志

<p><b>OBJECTIVE</b>To explore the concentration of polybrominated diphenyl ethers (PBDEs) in umbilical cord serum and analyze the influence of exposure to PBDEs during fetal stage on newborn birth outcomes in Shanghai.</p><p><b>METHODS</b>Fifty delivery women in a Shanghai hospital were surveyed by questionnaire, and the umbilical cord serum were collected from September 2006 to April 2007. All the delivery women were singleton pregnancies, excluding high blood pressure, diabetes, HIV infection and adverse medical history. Seven congeners (BDE-28, BDE-47, BDE-99, BDE-100, BDE-153, BDE-154 and BDE-183) were measured by gas chromatography-negative chemical ionization-mass spectrometry and the influencing factors were analyzed.</p><p><b>RESULTS</b>Newborns' length, weight, chest circumference, head circumference and body mass index (BMI) were (50.15 ± 0.75) cm, (3.49 ± 0.42) kg, (34.76 ± 1.51) cm, (35.03 ± 1.40) cm, (13.76 ± 1.36) kg/m(2), respectively. The median of Σ(7PBDEs) concentration in umbilical cord serum was 14.06 (1.03 - 379.73) ng/g lipid weight (lw). The detection rate of BDE-28, BDE-47, BDE-99, BDE-100, BDE-153, BDE-154 and BDE-183 were 22% (11/50), 22% (11/50), 98% (49/50), 72% (36/50), 76% (38/50), 90% (45/50) and 14% (7/50), respectively. The median (range) of PBDEs (BDE-28, BDE-47, BDE-99, BDE-100, BDE-153, BDE-154, BDE-183) congeners were < LOD (< LOD-137.20 ng/g lw), < LOD (< LOD-33.17 ng/g lw), 7.54 ng/g lw (< LOD-94.01 ng/g lw), 1.57 ng/g lw (< LOD-46.95 ng/g lw), 0.63 ng/g lw (< LOD-79.08 ng/g lw), 0.63 ng/g lw (< LOD-22.30 ng/g lw) and < LOD (< LOD-21.63 ng/g lw), respectively. The newborns' BMI showed a negative correlation with BDE-99 (r = -0.347, P < 0.05) and BDE-154 (r = -0.292, P < 0.05). BDE-99 in low-length group (≤ 50 cm, 10.59 ng/g lw) was significantly higher (t = 2.32, P = 0.03) than that in high-length group (> 50 cm, 3.60 ng/g lw).</p><p><b>CONCLUSION</b>PBDEs were commonly detected in newborns' umbilical cord serum in this study. Our findings indicated that exposure to PBDEs adversely affected the development of the newborns.</p>

Levels of polybrominated diphenyl ethers in human breast milk from a hospital in Shanghai / 中华预防医学杂志

<p><b>OBJECTIVE</b>To measure the concentration of polybrominated diphenyl ethers (PBDEs) in human breast milk from a hospital in Shanghai and analyze the influencing factors.</p><p><b>METHODS</b>Forty-eight puerperal from a hospital in Shanghai were selected to answer a questionnaire, and their breast milk samples were collected from September 2006 to April 2007. All the puerperal were singleton pregnancies, excluding high blood pressure, diabetes, HIV infection and adverse medical history. Seven congeners (BDE-28, BDE-47, BDE-100, BDE-99, BDE-154, BDE-153 and BDE-183) were measured by gas chromatography-negative chemical ionization-mass spectrometry and the influencing factors were analyzed.</p><p><b>RESULTS</b>The median of total PBDEs concentration in breast milk was 8.81 ng/g lipid weight (lw), and the range was 1.92 - 41.55 ng/g lw. The detection rates of seven congeners (BDE-28, BDE-47, BDE-100, BDE-99, BDE-154, BDE-153, BDE-183) were 98% (47/48), 96% (46/48), 86% (41/48), 90% (43/48), 83% (40/48), 98% (47/48), 90% (43/48), and the median of them was 0.88, 0.99, 0.97, 1.39, 1.14, 2.17, 1.41 ng/g lw, respectively. LogΣ(7PBDEs) in breast milk from mothers with different education levels were divided into junior high school or lower (0.89 ± 0.24), senior high school (1.02 ± 0.17), junior college or higher (1.08 ± 0.28). LogΣ(7PBDEs) in breast milk from mothers with different income levels were divided as < 1000 yuan (0.89 ± 0.12), 1000 - 3000 yuan (1.01 ± 0.24), > 3000 yuan (1.13 ± 0.21). Correlation analysis showed that both the mothers' education level (r = 0.322, P < 0.05) and income level (r = 0.388, P < 0.05) have a positive correlation to PBDEs levels in breast milk.</p><p><b>CONCLUSION</b>It is very common to detect PBDEs in human breast milk, however, the education and income levels of the mothers may be the influencing factors.</p>

Levels of hexabromocyclododecane in human breast milk and the daily intake of newborns in a Shanghai hospital / 中华预防医学杂志

<p><b>OBJECTIVE</b>To explore the level of hexabromocyclododecane (HBCD) in human breast milk of delivery women in a Shanghai hospital, and estimate the daily intake of newborns from breast milk.</p><p><b>METHODS</b>Forty-eight delivery women in a Shanghai suburb hospital (Class A, Grade 3) were surveyed by questionnaires, and their breast milk samples were collected from September 2006 to April 2007. All the delivery women were singleton pregnancies, excluding high blood pressure, diabetes, HIV infection and adverse medical history. Three diastereoisomers (α-HBCD, β-HBCD, γ-HBCD) were measured by the liquid chromatography-electrospray ion source-tandem mass spectrometry, and then estimated the daily intake of the newborns from the breast milk.</p><p><b>RESULTS</b>The total HBCD concentration of breast milk, which was detected in 79% (38/48) of samples, ranged from 0.11 ng/g lipid weight (lw) to 37.75 ng/g lw, with the median at 1.42 ng/g lw. The most abundant diastereoisomer was α-HBCD which detected in 77% (37/48) of samples, with a median of 1.24 ng/g lw; followed by γ-HBCD and β-HBCD, detected in 13% (6/48) and 17% (8/48) of samples respectively, whose median were both under the limit of detection (LOD). The daily intake of the newborns from the breast milk ranged from 0.71 ng/kg to 243.46 ng/kg.</p><p><b>CONCLUSION</b>The concentrations of HBCD in breast milk of delivery women in a Shanghai hospital have been in a high level, and the influence on newborns' health need to be further studied.</p>