Clinical characteristics and predictors of mortality in patients with candidemia in intensive care unit / 中华危重病急救医学

Objective To investigate the clinical characteristics and predictors of mortality in patients with candidemia in intensive care unit (ICU). Methods The patients with candidemia admitted to ICU of Peking University People's Hospital from January 2010 to December 2017 were enrolled. The general clinical data, indicators related to Candidia infection and prognosis were collected, and the clinical characteristics, infection characteristics and prognosis of patients with candidiasis were analyzed. Patients were divided into death group and survival group according to hospital survival status. The differences of each index were compared between two groups. The independent risk factors of mortality in patients with candidemia were analyzed by multivariate Logistic regression analysis. Results A total of 95 patients (55 males) with candidemia were included, with an average age of (69.3±16.5) years, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) was 24.7±3.6, sequential organ failure assessment (SOFA) was 6.6±2.7. Candida albicans accounted for the largest proportion of Candida infections (n = 56, 58.9%). Thirty-two (33.7%) patients received inadequate antifungal therapy and 38 (40.0%) patients received inadequate source control. Fifty-five (57.9%) patients were died in hospital. Compared with the survival group, patients in the death group was older (years: 72.5±14.6 vs. 64.9±18.0, P < 0.05), had higher APACHEⅡ and SOFA scores (26.6±2.2 vs. 22.1±3.6, 7.9±2.0 vs. 4.7±2.4, both P ﹤ 0.01), higher rate of glucocorticoid treatment (18.2% vs. 10.0%, P < 0.05), and higher proportion of Candida albicans and Candida glabrata (69.1% vs. 45.0%, 10.9% vs. 7.5%, both P < 0.05), the rate of multi-site Candida infection also significantly increased (47.3% vs. 17.5%, P < 0.05). Intra-abdominal infection was the primary infection site and more common in death group (49.1% vs. 35.0%, P < 0.05). The rates of sepsis (87.3% vs. 62.5%), inadequate antifungal therapy (49.1% vs. 10.0%), inadequate source control (60.0% vs. 12.5%) in death group were all higher than those in survival group (all P < 0.01). It was shown by multivariate Logistic regression analysis that APACHE Ⅱ[odds ratio (OR) = 1.605, P = 0.002, β = 0.473], SOFA (OR = 1.501, P = 0.029, β = 0.406), inadequate antifungal therapy (OR = 12.084, P = 0.006, β = 2.492) and inadequate source control (OR = 7.332, P = 0.024, β = 1.992) were independent risk factors for mortality in ICU patients with candidemia. Conclusions Candidemia patients were severe and had poor prognosis. APACHE Ⅱ, SOFA, inadequate antifungal therapy and inadequate source control were independent risk factors of mortality.

Defects existing in sepsis clinical research / 中国中西医结合急救杂志

Sepsis has relatively high morbidity and mortality in patients at intensive care unit (ICU). With the study of sepsis having continued to develop in recent years, the defects existing in this research have unceasingly exposed. Because the lack of design process of international standardized clinical randomized controlled trials (RCT) for septic patients, the situation of incomplete data record exists in these clinical studies, that may further affect the interpretation of the research results, therefore it is in urgent need to have an international standardized RCT design process for septic patients.

Reference value in normal adult echocardiography: a retrospective study / 中华全科医师杂志

Objective To observe normal range based on normal adult echocardiography with data mining retrospectively.Methods Analyzed the echocardiography data of 15 553 patients who came to Peking university People's Hospital from Nov 2012 to Nov 2014 without obvious abnormalities of cardiac structure and function.The reference range of 15 parameters were calculated and analyzed in correlation with gender,age and other factors for each group.Results The reference ranges of basic measurement parameters in two-dimensional echocardiography:main pulmonary artery diameter(MPA) (2.14 ± 0.22)cm,diameter of ascending aorta (asc Aorta) (2.87 ± 0.35) cm;The reference ranges of basic measurement parameters in M-mode echocardiography:aortic root diameter (Ao root diam) (2.82 ± 0.35) cm,left atrial dimension (LA dimension) (3.14 ± 0.37) cm,interventricular septal end-diastole thickness (Ⅳsd) (0.86 ±0.12)cm,left ventricular internal diameter at end-diastole (LVIDd)(4.67 ± 0.41)cm,left ventricular internal diameter at end-systole (LVIDs) (2.83 ± 0.34) cm,left ventricular posterior wall end-diastolic thickness(LVPWd) (0.85 ± 0.12) cm,end diastolic volume (EDV) (101.21 ± 19.83) ml,end-systole volume (ESV) (31.09 ± 9.07) ml,ejection fraction (EF) (69.55 ± 5.70) ％;The reference ranges of basic measurement parameters in pulsed doppler echocardiography:mitral A wave velocity (MVA) (73.14 ±16.42) cm/s,mitral E wave velocity(MVE) (84.18 ± 16.17) cm/s,E/A (1.21 ± 0.35),aortic peak velocity (Ao V2 max) (124.95 ± 19.87) cm/s.The measured parameters of males were higher than those of females and value of measured was increased with age for example measured parameters in LVIDd (r =0.225,P =0.00),IVSd(r =0.216,P =0.00),LA dimension (r =0.231,P =0.00) and E/A(r =0.212,P =0.00),with age were positive correlated.The range of 15 parameters in this study and the ASE 2015 guide are similar but have slightly different,such as this research shows that men's left ventricular end-diastolic diameter (4.77 ±0.41) cm,the ASE recommend (5.02 ±0.41) cm which is smaller than the result of this study.And this study for women (4.60 ± 0.40) cm is higher than the ASE recommended (4.50 + 0.36)cm.Conclusions Based on preliminary analysis of large data from normal adult echocardiography,the rang of measured values could be used as a normal reference value of echocardiographyfor routine practice in China.

[Preliminary study of semi-quantitative and quantitative dynamic contrast-enhanced MRI in evaluating the response to concurrent chemoradiotherapy in patients with non-small cell lung cancer].

OBJECTIVE: To investigate the capability of semi-quantitative and quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to predict the response to concurrent chemoradiotherapy( CCRT) in patients with non-small cell lung cancer (NSCLC). METHODS: A total of 24 patients with stage III or IIIB NSCLC, who underwent 3.0T DCE-MRI before CCRT, were enrolled in this study. Semi-quantitative and quantitative parameters were calculated by Funtool and Omnikinetics software. The relationship between these obtained parameters and tumor response was evaluated by Spearmen' s correlation analysis. The patients were classified into two groups according to the tumor regression rate after treatment, as response group (group A) and non-response group ( group B). Mann-Whitney U test was used to compare the parameters of responders and non-responders. The value of the parameters on predicting response was calculated by receiver operating characteristic curve (ROC). RESULTS: The tumor regression rate after treatment was negatively correlated with time to peak (TTP) and the extravascular-extracellular volume fraction (Ve), and was positively correlated with signal enhancement ratio (SERmax) and volume transfer constant (Ktrans) (P < 0.05 for all). Statistical significant differences were found between group A and group B both in semi-quantitative and quantitative parameters (P < 0.05). Group A had a lower TTP value [(34.66 ± 16.37) s vs. (44.09 ± 17.41) s] and Ve value [(0.19 ± 0.03) vs. (0.25 ± 0.05)] than group B, whereas group A had a higher SERmax [(166.50 ± 44.95)% vs. (113.57 ± 46.62)%] and Ktrans [(0.41 ± 0.17) min(-1) vs. (0.28 ± 0.12) min(-1)] than group B (P < 0.05 for all). The ROC analysis indicated that when setting the threshold of Ve on ≤ 0.21 for predicting response, the specificity, sensitivity and accuracy were 85.7%, 80.0% and 83.3%, respectively, with an area under curve of 0.875 (P < 0.001). CONCLUSIONS: Both the semi-quantitative and quantitative DCE-MRI parameters are helpful for predicting the response after CCRT of NSCLC. Quantitative parameters seem to be more meaningful than semi-quantitative parameters.

Investigation on Clinical Curative Effect of Xiaoshitie Plaster(Rhizoma Atractylodis Macrocephalae, Fructus Aurantii Immaturus,etc / 中成药

A new plaster of Chinese materia medica,Xiaoshitie Plaster,is used to treat externally the internal disease through the navel application therapy method(giving medicine by trans- dermal absorption).It possesses the functions of invigoration the spleen and regulating the stomach-energy,promoting digestion and relieving dyspepsia,and is used for anorectic symp- tom in children.The investigation on clinical curative effect on 173 cases indicated that the total effective rate is up to 89.3%.It especially suited to anorectic symptom in children with asthenia of the spleen and stomach-energy.The effective rate is 93.94% and no toxicity and side-effect were observed.