[Clinical analysis of prenatal diagnosis and intervention for primary pleural effusion of 13 cases].

Objective: To optimize the clinical managements of primary fetal hydrothorax (PFHT) fetus by comparing the perinatal survival rate of different prenatal treatments. Methods: Totally 13 fetuses diagnosed with PFHT from July 2009 to December 2015 in the First Affiliated Hospital of Jinan University were collected and received prenatal expectant treatment, thoracocentesis (TC), and thoraco-amniotic shunting (TAS), respectively. The perinatal survival rate was compared among the three treatments. Results: Among 13 fetuses of PFHT, pleural effusion was absorbed or remained stable in 2(2/13) cases, and progressed in 11(11/13) cases. Six cases received expectant treatment (2 cases had termination of pregnancy due to progressing effusion, 2 cases had term delivery, and 2 cases had intrauterine death); the perinatal survival rate was 2/6. Six cases received TC (2 cases had term delivery, 2 cases had preterm delivery, and 2 cases had termination of pregnancy due to progressing effusion), the perinatal survival rate was 4/6. One case received TC+TAS (term delivery), the perinatal survival rate was 1/1. The overall perinatal survival rate of prenatal intrauterine intervention was 5/7. Conclusions: The clinical process of PFHT is changeable, and the pleural effusion will progress with gestational age. Intrauterine interventions could improve the perinatal survival rate.

[Patients of Escherichia coli bloodstream infection: analysis of antibiotic resistance and predictors of mortality].

Objective: To analyze the drug resistance of Escherichia coli (E.coli) from bloodstream infection (BSI) and the predictors of mortality in E. coli bloodstream infection (BSI). Methods: The clinical data of 139 E. coli BSI cases diagnosed from January 2012 to December 2015 in The Second Affiliated Hospital of Zhejiang University School of Medicine, Lanxi Branch (Lanxi People's Hospital), Zhejiang Province, were retrospectively analyzed. The antimicrobial susceptibility testing was performed using Vitek 2 system. Extended-spectrum beta-lactamases (ESBLs) were detected by disk diffusion confirmatory testing. The factors associated with ESBLs-producing strains were identified by univariate analysis. Multivariate analysis was used to identify independent predictors of infection mortality by applying Logistic regression. Results: 42.4% of E. coli isolates were ESBLs-producing. The resistant rate of imipenem was 0.7%. The percent of ESBLs in hospital-acquired infection was higher than that in community-acquired infection but without statistical significance (48.7% versus 40.0%, P=0.350). Univariate analysis suggested that the percent of ESBLs-producing strains in BSI happened on ≥15 d after admission and in BSI of biliary tract infection source was 76.9% and 68.0%, which were much higher than those in BSI happened on <15 d after admission and in BSI of non-biliary tract infection source (34.6% and 36.8%, P=0.013 and 0.004). The overall mortality of E. coli BSI was 13.7%. Multivariate Logistic regression analysis indicated that Sequential Organ Failure Assessment (SOFA ) score (OR=1.393, P<0.001), ceftazidime non-susceptibility (OR=4.444, P=0.018) and liver cirrhosis (OR=13.513, P=0.001) were independent risk factors of mortality. Conclusions: The frequency of ESBLs-producing E. coli was high in primary hospital of Zhejiang Province. SOFA score, ceftazidime non-susceptibility and cirrhosis were predictors of poor outcome in E. coli BSI.

Hypertonic saline activates CD4+ and CD8+ T-lymphocytes in the small intestine to alleviate intestinal ischemia-reperfusion injury.

OBJECTIVE: Intestinal ischemia-reperfusion injury (I/R) is a common syndrome encountered in clinic following intestinal surgery, strangulated hernia, and shock. Hypertonic saline has been shown to prevent inflammatory tissue damages caused by I/R and regulate immunologic disorders in peripheral blood. However, the immunoregulatory effects of hypertonic saline on the small intestine response to intestinal I/R have not been reported. MATERIALS AND METHODS: To investigate this, we created the intestinal I/R model by clamping the superior mesenteric artery in Sprague-Dawley rats. After 1 hour of ischemia, the vascular clamp was removed, and either normal saline (0.9% NaCl, NS group) or hypertonic saline (7.5% NaCl, HS group) was administered through the tail vein (6 ml/kg). The CD4(+) and CD(8+), primarily T-lymphocytes subpopulation yielded from the intestinal tissues, were determined by immunohistochemistry. RESULTS: A pro-inflammatory cytokine, tumor necrosis factor (TNF)-α, and nuclear factor kappa B (NF-κB), a critical transcription factor for the TNF-α gene, were measured in the intestinal and lung tissues with ELISA. HS induced an increase in CD4(+) and CD8(+) T cells in the jejunum and ileum compared with the NS group. The levels of TNF-α and NF-κB in the intestinal and lung tissues were significantly decreased in the HS group compared with those of the NS group. CONCLUSIONS: HS treatment may ameliorate the tissue damage induced by intestinal I/R. This protective effect is possibly due to its ability to activate the CD4(+) and CD8(+) T-lymphocytes cells in the intestinal tissues and inhibit the intestinal I/R-induced expression of pro-inflammatory cytokines.

Detection of placenta elasticity modulus by quantitative real-time shear wave imaging.

OBJECTIVE: To explore the clinical values in detecting the placental elastic modulus using real-time quantitative shear wave elasticity imaging. METHODS: A total of 30 women in the late pregnancy stage without complications and having normal, single pregnancies, as well as normal fetal growth, amniotic fluid index, and anterior placenta were selected. A real-time elasticity imaging shear wave ultrasonic diagnostic apparatus was used to randomly select regions of interest at the central and edge of the placenta. The elastography imaging mode was launched to measure the elasticity of the elastic modulus of these placental parts. A total of 15 measured values were obtained at the placental center and edge for each pregnancy case. Umbilical artery and uterine artery pulsatility index (PI) values for 18 cases were also randomly measured. RESULTS: The average value of 30 placental edges of the elastic modulus (n = 15) was (7.60 +/- 1.71) kPa. The average value of the 30 placental central elastic modulus (n = 15 ) was (7.84 +/- 1.68) kPa. No significant difference was observed between placenta central and edge elastic modulus. The PI mean value of umbilical artery in 18 cases was 0.94, whereas the average PI values of the uterine artery was 0.83. No linear correlation was found among the elastic modulus, the placental uterine artery PI values, and the umbilical artery PI values (p > 0.05). CONCLUSION: No difference between the placental center of normal pregnancies and the edge of the elastic modulus was detected. The elastic modulus of the placenta could be obtained in the best position. The placenta varied greatly between elastic modulus. No correlation was found between the placental elastic modulus, the uterine artery, and umbilical artery PI values. Real-time shear wave elasticity imaging technology can provide morphological evidence of placental function, which may emerge as a new clinical assessment approach.