Objective:To establish a nomogram model for preoperative prediction of infectious kidney stones.Methods:Total of 350 patients with kidney stones diagnosed in Wujin Hospital Affiliated to Jiangsu University (Wujin Clinical College of Xuzhou Medical University) from February 2020 to February 2023 were summarized, retrospectively, and were randomly divided into a modeling set (245 cases) and a validation set (105 cases) according to 7︰3. The modeling focused on 91 cases with infectious kidney stones and 154 cases with non-infectious kidney stones, and verified 39 cases of concentrated infectious kidney stones and 66 cases of non-infectious kidney stones. The clinical data of patients in infective kidney stone group and non-infective kidney stone group were compared in the modeling set. The minimum absolute convergence and selection operator regression (Lasso) model and multi-factor Logistic regression model were used to screen the risk factors of infective kidney stone. The nomographic model was established and verified by 1 000 self-repeated samples through R software.Results:Univariate comparison showed that female, recurrent kidney stones and staghorn stones in the infectious kidney stones group were more, the stone area was larger, while the Hounsfield unit (HU) of stones was significantly fewer; positive preoperative bladder urine culture (PBUC), urine white blood cell count (WBC) and bacterial count, urine protein positive, urine nitrite positive, positive urine leukocyte esterase (ULE), urine pH value, and urine turbidity positive were significantly higher, while urine specific gravity was significantly lower; blood uric acid was lower, while blood phosphorus and magnesium were higher (all P < 0.05). Lasso screened 8 most differential indicators, namely female, recurrent kidney stones, stone area ≥ 601 mm2, HU value < 1 000, positive PBUC, positive ULE, urine pH and urine turbidity positive. Logistic regression showed that female (OR = 1.568, 95%CI: 1.231-1.902, P < 0.001), recurrent kidney stones (OR = 3.023, 95%CI: 2.568-3.467, P < 0.001), stone area ≥ 601 mm2 (OR = 2.123, 95%CI: 1.756-2.569, P < 0.001), HU value < 1 000 (OR = 3.856, 95%CI: 3.456-4.325, P < 0.001), positive PBUC (OR = 1.895, 95%CI: 1.623-2.325, P < 0.001), positive ULE (OR = 1.754, 95%CI: 1.326-2.124, P < 0.001), urinary pH > 6.5 (OR = 1.323, 95%CI: 1.102-1.889, P < 0.001) and positive urine turbidity (OR = 1.602, 95%CI: 1.314-1.956, P < 0.001) were the risk factors to infectious kidney stones. R software was used to establishe a nomogram model, with a total score of 220 points. The receiver operating curve (ROC) showed that the area under the curve (AUC) of the nematic model was 0.856 (95%CI: 0.810-0.912, P < 0.001), the sensitivity and specificity were 79.8% and 83.2%, respectively, indicating that the diagnostic areas of the model were better. The calibration curve and decision curve also showed that the model had a good fit and clinical net benefit ratio.Conclusions:Female, recurrent kidney stones, stone area ≥ 601 mm2, HU value < 1 000, positive PBUC, positive ULE, urine pH and positive urine turbidity could assist in assessing the risk of infectious kidney stones. A nomogram model that has good application potential to guide clinical practice was established.
本视频重点介绍儿童支原体肺炎的定义、临床特征、影像学表现、实验室检查、诊断与鉴别诊断、常见肺内外并发症的早期识别和诊断、临床分型、重症和危重症早期预警指标、治疗原则以及住院指征等相关内容。一、定义1．肺炎支原体肺炎（MPP）：指肺炎支原体（Mycoplasma pneumoniae，MP）感染引起的肺部炎症，可累及支气管、细支气管、肺泡和肺间质。2．难治性肺炎支原体肺炎（refractory mycoplasma pneumoniae pneumonia，RMPP）：MPP患者使用大环内酯类抗菌药物正规治疗7 d及以上，仍持续发热、临床征象及肺部影像学所见加重、出现肺外并发症者。3．大环内酯类药物无反应性肺炎支原体肺炎（macrolide -unresponsive MPP，MUMPP）：MPP患者经过大环内酯类抗菌药物正规治疗72 h，仍持续发热，临床征象及肺部影像学无改善或呈进一步加重的MPP。4．重症肺炎支原体肺炎（severe MPP，SMPP）：MPP病情严重，符合重症判定标准。5．危重症肺炎支原体肺炎：指患者病情迅速进展、出现呼吸衰竭或危及生命的肺外并发症，需要进行生命支持治疗的少数SMPP。二、临床表现MPP多见于5岁及以上儿童，但5岁以下儿童也可发病。以发热和咳嗽为主要临床表现，可伴有头痛、流涕、咽痛、耳痛等。发热以中高热为主，持续高热者预示病情重。咳嗽较为剧烈，可类似百日咳样咳嗽。部分患儿有喘息表现，以婴幼儿多见。肺部早期体征可不明显，随病情进展可出现呼吸音降低和干、湿性啰音。重症肺炎支原体肺炎（SMPP）多发生于病程约为1周，伴有肺内和肺外并发症，可出现塑形性支气管炎（plastic bronchitis，PB）、中等-大量胸腔积液、大面积肺实变和坏死、肺栓塞（pulmonary embolism，PE）、气促或呼吸困难，发生肺栓塞的患儿还可出现胸痛和咯血。发生肺外并发症时可出现相应脏器损伤的临床表现：肺外并发症可发生于皮肤黏膜、神经系统、血液系统以及循环系统等，出现相应各系统受损的表现。少数MPP可发展为危重症，常以呼吸困难和呼吸衰竭为突出表现，急性呼吸窘迫综合征，如大气道发生塑形性支气管炎、弥漫性细支气管炎和严重肺栓塞等。个别病例以严重肺外并发症为主要表现。三、影像学表现影像学表现是临床判断病情严重程度和评估预后的主要依据之一，可见肺纹理增粗，支气管壁增厚，"树芽征"，小叶间隙增厚，网格影，肺泡炎症改变，多形态，大小不等和密度不均的病灶可混合存在；部分MPP可表现为局限或弥漫性细支气管炎特征。四、实验室检查实验室检查包括病原学和血清学检查、一般检查和MP耐药性检测。五、诊断符合以上临床和影像学表现，结合以下任何1项或2项，即可诊断为MPP：①单份血清MP抗体滴度≥ 1︰160（PA法）；病程中双份血清MP抗体滴度上升4倍及以上；②MP DNA或RNA阳性。六、鉴别诊断需要与病毒性肺炎鉴别：腺病毒肺炎、流感病毒肺炎和新型冠状病毒肺炎鉴别；与细菌性肺炎和肺结核鉴别。七、常见肺内外并发症的早期识别和诊断1．肺内并发症：塑形性支气管炎、肺栓塞、胸腔积液、坏死性肺炎、支气管哮喘急性发作和混合感染。2．肺外并发症：神经系统、循环系统、血液系统、皮肤黏膜损害和其他表现。八、临床分型临床分型分为轻型、重型和危重型。九、重症和危重症早期预警指标重症和危重症早期预警指标：治疗后72 h持续高热不退；存在感染中毒症状；病情和影像学进展迅速，多肺叶浸润；C-反应蛋白（C-reactionprotein，CRP）、乳酸脱氢酶（lactate dehydrogenase，LDH）、D-二聚体和丙氨酸氨基转移酶（alanine aminotransferase，ALT）水平显著升高，出现时间越早，病情越重；治疗后低氧血症和呼吸困难难以缓解或进展；存在基础疾病，包括哮喘和原发性免疫缺陷病等疾病；大环内酯类抗菌药物治疗延迟。九、治疗原则最佳治疗窗口期为发热后5~10 d以内，病程14 d以后仍持续发热，病情无好转者，常遗留后遗症。鉴于MPP临床表现的异质性，应根据分型制定个体化的治疗方案。轻症患儿除抗MP治疗外，不应常规使用全身性糖皮质激素治疗；重症患者应采取不同侧重的综合治疗（抗感染、糖皮质激素、支气管镜、抗凝等联合），既要关注混合感染，也要准确识别和治疗过强炎症反应及细胞因子风暴，若不及时控制，将可能导致混合感染和后遗症的发生率升高。十、支原体肺炎住院指征出现以下任意1条，需要考虑住院治疗：高热持续5 d；发热超过7 d；出现喘息或气促或呼吸困难；CRP > 40 mg/L；出现肺大叶实变；有肺外脏器症状如头疼、呕吐、精神不佳或皮疹或白细胞减少以及血小板减少等。
Objective:To investigate the risk factors of the occurrence of bloodstream infection, and to analyze the difference of clinical characteristics between multi-bacterial bloodstream infection and single negative bacteria, to provide evidence for the prevention and treatment of bloodstream infection in cardiac surgery.Methods:Medical records of patients with bloodstream infection in Department of Cardiac surgery, Beijing Anzhen Hospital, Capital Medical University from January 2018 to October 2021 were selected to summarize the detection and distribution of pathogens. Non-infection patients were selected with 1︰1 according to the age and gender of patients in infection group during the same period. The clinical data of the bloodstream infection group (including the multi-bacterial infection and single infection of Gram-negative bacteria and Gram-positive bacteria) and the non-infection group were analyzed, respectively. The measurement data were analyzed by t test or non-parametric test, and the counting data was analyzed by χ2 test. The indicators that may affect bloodstream infection were analyzed by multivariate Logistic regression, the risk factors of bloodstream infection and mixed bloodstream infection were analyzed.Results:During the same period, a total of 55 908 cardiac surgery patients were admitted, and 181 cases with bloodstream infection, with an infection rate of 0.3% (181/55 908). The results showed that CPB time (Z = 5.031, P = 0.001) and operation time (Z = 3.830, P = 0.001), usage of ECMO (χ2 = 11.569, P = 0.001), IABP (χ2 = 30.685, P = 0.001) and CRRT (χ2 = 24.761, P = 0.001), exposure to carbapenems (χ2 = 11.661, P = 0.001), quinolones (χ2 = 4.096, P = 0.043), vancomycin (χ2 = 4.096, P = 0.043) and combined antibiotics (χ2 = 13.286, P = 0.001) before infection were statistically different between infection group and non-infection group. Multivariate Logistic regression analysis showed that CPB time (OR = 5.031, 95%CI: 1.843-6.798, P < 0.001) and operation time (OR = 1.228, 95%CI: 1.056-1.427, P = 0.008), usage of ECMO (OR = 4.180, 95%CI: 1.863-9.377, P = 0.001), IABP (OR = 4.017, 95%CI: 1.572-10.267, P = 0.004), CRRT (OR = 8.586, 95%CI: 2.494-29.560, P = 0.001), exposure to carbapenems (OR = 15.742, 95%CI: 5.699-43.478, P < 0.001), quinolones (OR = 2.272, 95%CI: 1.057-4.886, P = 0.030) and vancomycin (OR = 4.297, 95%CI: 1.199-15.400, P = 0.025) and combined use of antibiotics (OR = 4.520, 95%CI: 2.154-9.484, P = 0.001) before infection were all risk factors of postoperative bloodstream infection, with statistically significant differences. The total hospital duration of patients in infection group was significantly longer than that of non-infection group, with significant difference (Z = 8.033, P = 0.001). There were 52 deaths (28.7%) in infection group and 17 deaths (9.3%) in non-infecteion group, the mortality rate of the two groups was significantly different (χ2 = 21.935, P = 0.001). Among bloodstream infection group, 37 patients (20.4%) were infected with single Gram-negative bacilli, 28 patients (15.5%) were infected with single Gram-positive cocci, 116 patients (64.1%) were infected with Gram-negative bacilli and Gram-positive cocci. Total of 234 Gram-negative bacillus strains were detected, Acinetobacter baumannii (64 strains, 27.3%) and Klebsiella pneumoniae (56 strains, 23.9%) were the most common pathogens. Total of 145 strains of Gram-positive cocci were detected, among which Staphylococcus epidermidis (69 strains, 47.6%) was the most common. The results showed that CPB time (t =-4.010, P = 0.001) and operation time (t =-8.532, P = 0.001), exposure to 3 kinds of invasive endovascular devices (χ2 = 11.723, P = 0.001) and more than 3 kinds of invasive endovascular devices (χ2 = 4.618, P = 0.032), exposure to carbapenems (χ2 = 11.661, P = 0.001), vancomycin (χ2 = 4.096, P = 0.043), linezolid (χ2 = 15.174, P = 0.001), polycolistin (χ2 = 6.353, P = 0.012) and combined antibiotics (χ2 = 13.286, P = 0.001) before infection were significantly different between multi-bacterial bloodstream infection and single negative bacteria group. Multivariate Logistic regression analysis showed that CPB time (OR = 4.851, 95%CI: 1.190-1.313, P = 0.015) and operation time (OR = 14.764, 95%CI: 1.363-17.264, P = 0.014), exposure to 3 (OR = 1.257, 95%CI: 1.046-1.510, P = 0.015) or more than 3 (OR = 1.006, 95%CI: 1.001-1.012, P = 0.032) invasive endovascular devices, usage of carbapenems (OR = 4.765, 95%CI: 1.770-12.828, P = 0.002), vancomycin (OR = 7.750, 95%CI: 1.277-4.203, P = 0.026), linezolid (OR = 3.925, 95%CI: 1.665-9.254, P = 0.002), polycolistin (OR = 1.987, 95%CI: 1.985-3.451, P = 0.020) and combined use of antibiotics (OR = 1.466, 95%CI: 1.012-1.976, P = 0.012) before infection were the risk factors of postoperative multi-bacterial bloodstream infection, and the differences were statistically significant. The length of hospital duration was significantly prolonged after multi-bacterial bloodstream infection, with significant difference (Z =-1.576, P = 0.001).Conclusions:Bloodstream infection and mixed bloodstream infection of patients with cardiac surgery are mostly associated with invasive intravascular device implantation and antibiotic exposure, and can lead to prolonged hospitalization and increased mortality, which seriously affect the prognosis of patients. Therefore, it is necessary to pay attention to the surgical operation and the rational use of antibiotics to reduce the occurrence of blood flow infection in cardiac surgery.
本视频重点介绍戊型肝炎的流行病学、肝外表现及其治疗及预防。过去认为戊型肝炎仅在部分发展中国家流行，但近20年，戊型肝炎在发达国家流行的证据越来越多。欧洲国家戊型肝炎发病呈上升态势：欧洲报告的戊型肝炎病例由2005年的514例增加到2015年的5 617例，总数增加了10倍。2012年至2021年以来我国戊型肝炎病例数已连续9年超过甲型肝炎病例数，居急性病毒性肝炎首位，且漏报率可能较高，需引起重视。戊型肝炎病毒（hepatitis E virus，HEV）有多个基因型，为重要人畜共患病毒，HEV基因型在人和动物中分布：HEV1和HEV2只感染人，HEV3和HEV4为人畜共患病原体；猪是主要动物宿主，近年来从野猪分离到的HEV株被归为HEV5和HEV6；骆驼HEV则被归分为HEV7和HEV8。HEV广泛存在于常见食物中，HEV是全球流行的食源性病原，家猪，野猪，绵羊，山羊，鹿和兔子等家畜和野生动物都是传染来源。即食产品、加工肉制品、牛/羊奶类和贝类等食物的HEV RNA阳性率很高。我国职业相关人群的HEV感染风险较高，我国的荟萃分析显示，职业人群（养猪者、屠宰场、养猪散户和兽医）的HEV IgG血清阳性风险比一般人群高2.63倍，主要型别为HEV4型。与一般人群相比，兔子屠宰场工人患HEV的风险增加了6.9倍，且血清阳性率随着工作年限的增加而增加。对我国24个城市的HEV血清阳性率的职业调查研究发现，农民（含养殖者）、中年和老年群体和男性HEV感染风险更高。急性戊型肝炎患者肝外表现常见，最常见为胆囊炎、低钾血症与贫血等。急性戊型肝炎合并肝外表现住院时间更长，但临床预后与无肝外表现患者无显著性差异。迄今为止，尚未批准任何特定药物用于治疗戊型肝炎，临床治疗受限。关于急性戊型肝炎的治疗：急性戊型肝炎一般为自限性，大多可完全恢复，急性期应隔离，宜清淡易于消化，适当补充维生素，辅以药物对症及恢复肝功能治疗，一般不采用抗病毒治疗。有研究显示，在如急性肝功能衰蝎严重病例中，使用利巴韦林治疗可获益。有病例报道显示，暴发性戊型肝炎患者应用皮质类固醇可减缓进展为肝功能衰竭的速度。慢性戊型肝炎的治疗：减少免疫抑制剂的用量是第一线治疗方案。停用或减少免疫抑制剂，使1/3慢性戊型肝炎患者体内HEV自动清除；但大多数患者难以停用免疫抑制剂，导致该方法受限；聚乙二醇化干扰素和利巴韦林均可选用，但因耐受性问题，更推荐使用利巴韦林；利巴韦林推荐疗程为3个月（平均剂量为8.1 mg/kg），主要不良反应为贫血。接种疫苗是预防戊型肝炎最为经济有效的手段，2012年10月，我国在全球率先批准上市戊肝疫苗为预防戊型肝炎提供了有效的方法。戊肝疫苗国际化成果：自2012年上市以来，在世界卫生组织、无国界医生组织、盖茨基金会等国际组织的积极协助下，国际化进程加快。2017年5月，由挪威政府公益基金资助的首个海外临床试验（预防孕妇戊肝）在孟加拉国正式启动，目前已完成约7万人次的4次随访工作；首个获美国FDA批准进行临床试验的疫苗已于2019年4月启动，并获美国国立卫生研究院全额资助；2018年世界卫生组织公布首个《关于重组戊肝疫苗质量、安全性及有效性的审评技术建议》，2019年已纳入《世界卫生组织技术报告丛书》。一项临床研究，为4名受试者按照标准接种3剂戊肝疫苗，并进行血清学检测分析，结果表明戊肝疫苗可诱导显著的免疫反应。有研究表明，戊肝疫苗诱导的抗体可提供跨基因型保护。2020年发表在《自然通讯》上发表的一项新的研究，证实在完成3针接种后，疫苗诱导的抗体可识别1型、2型、3型、4型HEV衣壳蛋白，对全球范围流行的HEV主要基因型均具有良好的预防效果。国内外权威机构推荐戊肝疫苗用于戊型肝炎的预防，对于特殊人群，戊肝疫苗对孕妇和胎儿具有一定的安全性，关于戊肝疫苗Ⅲ期临床试验的回顾分析显示，37例女性在接种戊肝疫苗期间意外怀孕，未发现在怀孕过程中有异常现象发生，其所产婴儿也均健康；65岁以上老年人群按计划接种3针后1个月，血清阳转率为96.7%（176/182）；对畜牧养殖者、疫区旅行者、餐饮业人员、集体生活者等高危人群，以及感染HEV后可能病情较重的慢性肝病患者、育龄期女性以及老年人等可按0-1-6个月程序接种3针30 μg/0.5 ml重组戊型肝炎疫苗。另外，要注意切断传播途径，搞好环境卫生，加强水源和粪便管理，改善供水条件加强宿主动物及相关肉类产品管理养成良好的个人卫生习惯；并做好传染源管理，加强戊型肝炎患者的隔离和接触者的医学观察做好疫情报告。
Objetctive:To improve the understanding of antiviral treatment for human immunodefeciency virus (HIV) complicated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) co-infection.Method:The diagnosis and treatment process of 2 patients with HIV/SARS-CoV-2 co-infection admitted to Shantou Central Hospital on February 2023 were analyzed and relevant literature were reviewed.Results:Two HIV infected patients presented with respiratory symptoms were admitted to our hospital. Both patients had oral candidiasis and chest CT imaging showed multiple ground-glass opacities in lungs. After admission, they were detected positive for SARS-CoV-2 nucleic acid. They received antiviral and anti-infection treatments such as Nirmatrelvir Tablets/Ritonavir Tablets. SARS-CoV-2 nucleic acid turned negative in two patients on the 4th days and 3rd day after using Nirmatrelvir Tablets/Ritonavir Tablets. Their respiratory symptoms improved and they were discharged. One month after discharge, the patients did not have a fever but still had coughing, although both improved compared to before. They also experienced fatigue symptoms during the follow-up visits.Conclusions:HIV/SARS-CoV-2 co-infected patients still mainly presents lower respiratory tract infections as the primary clinical manifestation. CD4+ T lymphocyte levels may not affect the outcomes of HIV/SARS-CoV-2 co-infection. However, antiviral treatments for SARS-CoV-2 can improve the prognosis of HIV/SARS-CoV-2 co-infection, which should be paid more attention.
Objective:To investigate the incidence and main risk factors of plastic bronchitis (PB) caused by refractory Mycoplasma pneumoniae pneumonia (RMPP) in children, and to construct a quantitative risk nomograph model for guiding early clinical high-risk stratification.Methods:The clinical data of 350 children diagnosed as RMPP admitted to Jianhu Clinical Medical College, Yangzhou University from February 2020 to February 2023 were analyzed, retrospectively, and were divided into modeling set (280 cases) and validation set (70 cases) by 4︰1, randomly. The model set was divided into PB group (120 cases) and no PB group (160 cases) according to bronchofiberscopy and histopathological findings. The clinical manifestations, blood biochemistry and chest CT signs of patients in different groups were compared, the most different indicators were screened by LASSO regression, the main risk factors were screened by multivariate Logistic regression, and the prediction model was drawn by histogram. The area under the curve (AUC) of plastic bronchitis was predicted by receiver operating curve (ROC) calculation model. The goodness of fit of the model was evaluated by Hosmer-Lemeshow test. The consistency and benefit of the model were evaluated by calibration curve and decision curve.Results:The modeling set diagnosed 120 cases of PB (42.9%, 120/280) and the verification set diagnosed 25 cases of PB (35.7%, 25/70). The positive rates of PB and other general clinical data were comparable between the two groups (all P > 0.05). Single-factor comparison showed that peak body temperature (t = 3.659, P = 0.001), fever duration (t = 5.021, P < 0.001), hypoxemia (χ2 = 4.060, P = 0.044), glucocorticoid (χ2 = 7.154, P = 0.007), intravenous gamma globulin (χ2 = 16.169, P < 0.001), atelectasis (χ2 = 13.810, P < 0.001), pleural effusion (χ2 = 11.118, P < 0.001), neutrophil percentage (N%) (Z =1.659, P < 0.001), C-reactive protein (CRP) (Z =15.659, P < 0.001), procalcitonin (PCT) (Z = 9.654, P < 0.001), interleukin 6 (IL-6) (Z = 23.324, P < 0.001), alanine aminotransferase (ALT) (Z = 3.425, P < 0.001), lactate dehydrogenase (LDH) (Z = 123.325, P < 0.001) and D-dimer (Z = 5.246, P < 0.001) were significantly higher than those without PB, while platelet count (PLT) was significantly decreased (Z = 1.995, P < 0.001). Total of 6 non-collinear indexes were selected by LASSO regression, namely peak body temperature, atelectasis, pleural effusion, N%, IL-6 and LDH. Multivariate Logistic regression showed that peak body temperature (OR = 2.756, 95%CI: 2.03-3.567, P < 0.001), atelectasis (OR = 3.526, 95%CI: 2.869-4.123, P < 0.001), pleural effusion (OR = 2.032, 95%CI: 1.456-2.758, P < 0.001), N% (OR = 1.856, 95%CI: 1.235-2.632, P < 0.001), IL-6 (OR = 1.525, 95%CI: 1.124-2.201, P < 0.001), and LDH (OR = 1.302, 95%CI: 1.052-1.968, P < 0.001) were all the risk factors to PB caused by RMPP. The nomogram model was established by R software, with a total score of 500 points. The AUC of the model for predicting PB in model set and validation set were 0.902 (95%CI: 0.856-0.945, P < 0.001) and 0.866 (95%CI: 0.823-0.914, P < 0.001), respectively. Both the calibration curve and the decision curve showed that the model had good degree of coincidence and clinical net benefit ratio.Conclusions:Children with RMPP have a high incidence of PB, peak body temperature, atelectasis, pleural effusion, N%, IL-6 and LDH are all main risk factors; a nomograph model was developed that has good potential for guiding clinical evaluation of high-risk PB and is worth promoting.
Objective:To investigate the characteristics of distribution and drug resistance of bacterial infection in neonates from 2020 to 2022 in Xi’an Children’s Hospital.Methods:The specimens were collected from hospitalized neonates from January 2020 to December 2022 in Xi’an Children’s Hospital, and the distribution, composition and drug resistance of the specimens were analyzed, which were compared with the national children surveillance data by Pearson Chi-square test.Results:Total of 496 strains of bacteria were isolated from 9 346 specimens; including 251 (50.60%) strains of Gram-negative bacteria and 231 (46.57%) strains of Gram-positive bacteria; 14 (2.83%) strains of fungi. The top-five bacteria were Escherichia coli (Eco) (90 strains, 18.15%), Coagulase negative Staphylococci (CNS) (71 strains, 14.31%), Klebsiella peneumoniae (Kpn) (69 strains, 13.91%), Staphylococcus aureus (Sau) (57 strains, 11.49%) and Enterococcus faecium (Efa) (41 strains, 8.27%). Total of 184 strains of multi-drug resistant bacteria were detected from 496 pathogenic bacteria (37.09%); 105 (57.07%) strains of Gram-negative bacteria and 79 (42.93%) strains of Gram-positive bacteria were detected among multiple drug resistant bacteria. The detection rates of Kpn, CNS, Sau, Eco, AB and Pa were 58 strains (84.06%), 56 strains (78.87%), 23 strains (40.35%), 36 strains (40.00%), 4 strains (36.36%) and 7 strains (33.33%). The strains were highly resistant to many kinds of antibiotics, some drug resistance rates were significantly different from the national surveillance levels. The resistance rate of CNS (97.2%) to penicillin were significantly higher than those of Sau (94.7%). The resistance rate of Sau and CNS against clindamycin were 68.4% and 59.2%, which were significantly higher than those of the national surveillance levels (36.7% and 42.3%) (χ2 = 24.431, P < 0.001; χ2 = 8.119, P = 0.004). The resistance rates of Eco to cephalosporins were different as the follows: 75.5% to cefazolin, 67.8% to cefuroxime, 65.5% to cefatriaxone, which were significantly higher than those of the national surveillance levels (58.8%, 47.5% and 46.6%) (χ2 = 10.329, P = 0.001; χ2 = 14.674, P < 0.001; χ2 = 12.841, P < 0.001). The resistance rates of Kpn to cephalosporins were as the follows: 76.81% to cefatriaxone, 68.1% to Cefazolin, 62.8% to ceftazidime, 62.3% to cefuroxime, which were significantly higher than those of the national surveillance levels (44.1%, 53.2%, 30.6% and 49.0%), with significant differences (χ2 = 29.240, P < 0.001; χ2 = 6.056, P = 0.014, χ2 = 34.583, P < 0.001; χ2 = 4.789, P = 0.029). The resistance rates to meropenem and imipenem were 39.1% and 40.6%, respectively, significantly higher than 14.8% and 11.7% of the national monitoring data, with significant differences (χ2 = 30.816, P < 0.001; χ2 = 52.243, P < 0.001).Conclusions:The majority of hospitalized neonatal pathogens from 2020 to 2022 in our hospital were CNS, Eco and Kpn. The drug resistance rates of Sau and CNS to clindamycin; Eco to cefazolin, cefuroxime, and ceftriaxone, and Kpn to cephalosporins and carbapenems were significantly higher than the national surveillance data. Antibiotics should be used rationally according to the distribution of main pathogenic bacteria locally and the results of drug sensitivity.
Objective:To investigate the regulation of RNAⅢ transcription by Staphylococcus aureus (SA) surface-anchored protein SasX and its effect on bacterial aggregation and biofilm (BF) formation, which will reveal the effect of SasX on the pathogenicity of SA ST239 clones via RNAⅢ.Methods:SA ST239 HS770 isolated from clinical specimens of hospitalized children of Children’s Hospital of Nanjing Medical University from April to June in 2022 was used to establish mutant strains △SasX and complementary strains △SasX (pRB473-SasX) by gene knockout and complementation technology, and further treated with RNAⅢ inhibitory peptide (RIP). The effect of SasX gene on RNAⅢ transcription level was detected by quantitative real-timePCR (qRT-PCR), and the growth rate of the strains was observed by proliferation curve. The aggregation ability was analyzed by microscopic examination and the BF formation was observed by semi-quantitative BF formation experiments.Results:The RNAⅢ of △SasX was significantly lower than that of wild strain (t = 4.273, P = 0.037). The BF formation ability of the △SasX was significantly weaker than that of the wild strain (t = 4.619, P = 0.032). The BF-forming ability of the △SasX (pRB473-SasX) + RIP strain was significantly lower than that of the △SasX (pRB473-SasX) (t = 7.874, P = 0.011). The mRNA levels of icaA (t = 5.324, P = 0.027), sarA (t = 6.250, P = 0.016) and fnbA (t = 4.833, P = 0.031) in the △SasX were significantly lower than those in the wild strain. The levels of icaA (t = 4.386, P = 0.034) and sarA (t = 5.531, P = 0.023) mRNA in the △SasX (pRB473-SasX) + RIP strain were significantly lower than those in the △SasX (pRB473-SasX). Under the microscope, it can be seen that the wild strains had large aggregates and clusters, and the △SasX were mostly scattered alone or aggregated in a small area. The aggregation ability of the △SasX was obviously weaker than that of the wild strain, the aggregation ability of the △SasX (pRB473-SasX) + RIP strain was weaker than that of the △SasX (pRB473-SasX).Conclusions:SA SasX promotes the aggregation and enhances the ability of BF formation of SA by regulating the transcriptional expression of RNAⅢ, and thus participates in its pathogenic processes.
Objective:To investigate the risk factors of rotavirus enteritis complicated with convulsions and construct related prediction models, and to provide theoretical basis for the treatment of patients with enteritis and the prevention of convulsions.Methods:Total of 80 children with rotavirus enteritis admitted to Second People’s Hospital of Hefei from January 2019 to February 2021 were selected, retrospectively. They were divided into convulsion group (18 cases) and non-convulsion group (62 cases) according to whether the children had convulsions during hospitalization. Single factor and multiple factor Logistic regression analysis were conducted to analyze the risk factors of rotavirus enteritis complicated with convulsion, and related prediction models were constructed.Results:The children in convulsion group had a history of previous seizures (66.67% vs. 30.65%), fever (72.22% vs. 38.71%), creatine kinase isoenzyme (CK-MB) [(71.59 ± 19.34) IU/L vs. (32.71 ± 9.26) IU/L], blood sodium [(65.10 ± 14.05) mmol/L vs. (138.60 ± 30.16) mmol/L], blood calcium [(1.20 ± 0.26) mmol/L vs. (2.46 ± 0.50) mmol/L], blood glucose [(2.05 ± 0.42) mmol/L vs. (4.90 ± 1.03) mmol/L], standard bicarbonate (SB) [(11.40 ± 3.21) mmol/L vs. (20.50 ± 4.80) mmol/L], actual bicarbonate (AB) [(10.80 ± 2.40) mmol/L vs. (18.80 ± 4.04) mmol/L], carbon dioxide binding capacity (CO2CP) [(9.11 ± 2.05) mmol/L vs. (17.15 ± 3.20) mmol/L], blood pH [(8.25 ± 1.10) vs. (7.08 ± 0.70)], the difference were all significantly different (χ2 = 7.626, P = 0.006; χ2 = 6.224, P = 0.013; t = 11.880, P < 0.001; t = 9.995, P < 0.001; t = 10.260, P < 0.001; t = 11.420, P < 0.001; t = 7.550, P < 0.001; t = 7.980, P < 0.001; t = 10.050, P < 0.001; t = 5.433, P < 0.001). Multivariate Logistic regression analysis showed that fever (OR = 1.600, 95%CI: 1.220-2.705, P < 0.001), serum sodium (OR = 7.920, 95%CI: 4.10-11.100, P < 0.001), serum calcium (OR = 6.566, 95%CI: 3.706-10.970, P < 0.001), blood sugar (OR = 10.549, 95%CI: 7.710-16.570, P < 0.001), CK-MB (OR = 0.540, 95%CI: 0.790-0.920, P < 0.001), and CO2CP (OR = 6.024, 95%CI: 2.303-10.949, P < 0.001) were all independent influencing factors for rotavirus enteritis complicated by convulsions, the differences were statistically significant. The Hosmer-Leme-show Test was applied to evaluate the calibration of this prediction model, and the result showed there was no significant difference between the fitted equation and the true equation (χ2 = 6.039, P = 0.570) with good fitting degree; the area under the receiver operating characteristic (ROC) curve was 0.817 (95%CI: 0.767-0.868), the sensitivity and specificity were 91.80% and 80.00%, respectively.Conclusions:Fever, blood sodium, blood calcium, blood glucose, CK-MB and CO2CP are all independent influencing factors of convulsion in rotavirus enteritis. The prediction model based on these factors has good fitting degree and high predictive value.
Monocyte chemotactic protein-1 (MCP-1) is a chemokine in vivo, which is mainly produced by lymphocytes, monocyte macrophages and other cells in human body. It induces immune cells to participate in inflammatory response by acting on its related receptors. MCP-1 has a variety of biological functions. Early domestic and foreign studies have found that MCP-1 is associated with a variety of common clinical diseases, such as pneumonia, encephalitis, urinary tract infection, systemic lupus erythematosus, various cancers, etc. Recent studies have shown that MCP-1 is involved in the occurrence and development of a variety of infectious diseases. It has played important roles to the diagnosis, evaluation and prognosis of clinical diseases. This paper will briefly introduce the research progress of MCP-1 and multi-system infectious diseases. In particular, MCP-1 and infectious diseases in children will be described in detail, and the association between MCP-1 and common infectious diseases in children will be expounded. It provides new help and insight for the application of MCP-1 in the diagnosis and treatment of infectious diseases.
Objective:To investigate the risk factors of liver damage in patients with hepatitis B virus (HBV) infection complicated with pulmonary tuberculosis, and to construct a nomogram prediction model.Methods:Total of 192 patients with HBV infection combined with tuberculosis were selected from Songjiang District Central Hospital of Shanghai from January 2018 to December 2021 were collected. According to whether had liver injury or not, patients were grouped into control group (104 cases) and liver injury group (88 cases). Logistic regression analysis was used to screen the risk factors of liver damage in patients with hepatitis B virus infection complicated with pulmonary tuberculosis; The nomogram model for predicting liver damage in patients with HBV infection and pulmonary tuberculosis was constructed by R software, and the receiver operator characteristic curves (ROC) curve and calibration curve were used to verify the nomogram model.Results:The comparison between patients of the two group in terms of education level (χ2 = 5.224, P = 0.022), albumin (χ2 = 15.147, P < 0.001), preventive antiviral therapy (χ2 = 10.831, P = 0.001), use of hepatoprotective drugs (χ2 = 6.159, P = 0.013), treatment type (χ2 = 13.135, P < 0.001) and history of liver disease (χ2 = 5.493, P = 0.019) were all significantly different. Logistic regression analysis showed that albumin < 35 g/L (OR = 4.062, 95%CI: 1.993-8.280, P < 0.001), no preventive antiviral therapy (OR = 2.586, 95%CI: 1.295-5.165, P = 0.007), no hepatoprotective drugs (OR = 2.327, 95%CI: 1.190-4.551, P = 0.014), treatment type of "retreatment" (OR = 2.701, 95%CI: 1.299-5.615, P = 0.008) and history of liver disease (OR = 3.024, 95%CI: 1.149-7.955, P = 0.025) were all independent risk factors for liver injury in patients with HBV infection complicated with pulmonary tuberculosis. The area under the ROC curve of nomogram model predicts HBV infection with tuberculosis was 0.766 (95%CI: 0.701-0.832). The slope of the constructed nomogram prediction model calibration curve is close to 1, and the H-L goodness-of-fit test showed good fitting degree (χ2 = 6.272, P = 0.617).Conclusions:The nomogram prediction model constructed based on five risk factors including albumin < 35 g/L, no preventive antiviral treatment, no use of hepatoprotective drugs, treatment type of "retreatment", and history of liver disease can effectively predict liver damage in patients with HBV infection complicated with pulmonary tuberculosis.
Objective:To investigate the risk factors for the development of pulmonary infections after thoracoscopic surgery for pulmonary nodules.Methods:Total of 1 526 patients admitted to the Department of Thoracic Surgery of the First Affiliated Hospital of Guangzhou Medical University with confirmed diagnosis of thoracoscopic surgery for pulmonary nodules treatment from June 2020 to June 2021 were collected. According to whether pulmonary infection occurred after surgery, the patients were divided into pulmonary infection group and control group. The clinical baseline data and surgical data of patients in both groups were collected. The clinical and surgical influencing factors of patients with lung nodules after thoracoscopy were analyzed by single factor analysis, and the risk factors of pulmonary infection after thoracoscopy were analyzed by Logistic regression.Results:Among the 1 526 patients, 700 patients (45.87%) occurred pulmonary infection (pulmonary infection group), while 826 patients (54.13%) did not develop pulmonary infection (control group). The proportion of male patients (61.86%), smoking history (66.43%), nodule size > 2 cm (66.57%), diabetes history (57.29%), resection area (56.43%), smoking index [ (538.01 ± 18.26) annual expenditure] and intraoperative blood loss [(121.53 ± 12.16) ml] of patients in pulmonary infection group were all significantly higher than those in control group (all P < 0.05). The operative time [(202.15 ± 77.83) min] in the pulmonary infection group were significantly longer than that of control group (all P < 0.05). Logistic regression analysis results showed that male (OR = 5.226, 95%CI: 2.600-10.501, P < 0.001), history of smoking (OR = 2.484, 95%CI: 1.137-5.427, P = 0.022), smoking index (OR = 3.304, 95%CI: 1.614-6.767, P = 0.001), history of diabetes (OR = 3.569, 95%CI: 1.684-7.564, P < 0.001), nodule size > 2 cm (OR = 6.157, 95%CI: 2.855-13.276, P < 0.001), intraoperative blood loss (OR = 7.572, 95%CI: 3.166-18.112, P < 0.001), operative time (OR = 10.180, 95%CI: 4.251-24.374, P < 0.001) and pulmonary segmental resection (OR = 9.485, 95%CI: 1.398-64.363, P = 0.021) were all risk factors for pulmonary infection in patients with thoracoscopic surgery for pulmonary nodules.Conclusions:The factors of pulmonary infection in patients with pulmonary nodules after thoracoscopic surgery include male, smoking, nodule size, intraoperative blood loss, diabetes, operation time and pulmonary segmental resection, which should be prevented and controlled clinically to reduce the risk of infection in patients.
Objective:To investigate the influence of cold agglutination caused by severe acute respiratory syndrome coronavirus 2 ( SARS-CoV-2) infection on routine blood parameters and the effect of 30 min correction at 37 ℃, and to improve the accuracy of routine blood test results.Methods:From December 26th, 2022 to January 17th, 2023, a total of 2 875 blood routine samples of patients infected with SARS-CoV-2 were collected from the First People’s Hospital of Tianmen, which were classified as the coronavirus disease 2019 (COVID-19) group. Total of 50 influenza patients with SARS-CoV-2 nucleic acid negative were selected as the control group, while 28 072 inpatients with SARS-CoV-2 nucleic acid negative were selected as the non-COVID-19 group from August to November 2022, and the COVID-19 group was further divided into the cold agglutination group (54 cases) and the non-cold agglutination group (2 821 cases). The COVID-19 group was divided into four groups: light, medium, severe and critical groups. According to the mean corpuscularhemoglobin concentration (MCHC) results, the cold agglutination group was divided into the strong cold agglutination group (> 380 g/L) (32 cases) and the weak cold agglutination group (≤ 380 g/L) (22 cases). The cold agglutination specimens were warmed at 37 ℃, and the changes of blood routine parameters in each group before and after the correction were compared.Results:The cold agglutination rate of the COVID-19 infected group was 1.88% (54/2 875) compared with that of the non-COVID-19 group [0.071% (20/28 072)], the difference was statistically significant (χ2 = 356.97, P < 0.001). There were no significant differences in white blood cell (WBC), red blood cell (RBC), hemoglobin (HGB), hematocrit (HCT) and platelet (PLT) between COVID-19 infected patients and non-COVID-19 infected patients (Z = -1.680, t = 1.376, t = 1.069, t = 1.127, Z =-0.532; P = 0.093, 0.185, 0.299, 0.274, 0.601); The differences of mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and MCHC were statistically significant (t =-3.194, Z = -3.622, -2.435; P = 0.005, < 0.001, 0.015). The incidence of cold agglutination in mild, medium, severe and critical COVID-19 patients was 0.18% (4/2 242), 3.96% (18/455), 17.88% (27/151) and 18.52% (5/27), respectively, with significant difference (Z = 260.40, P < 0.001). Comparison between moderate and mild, severe and light, critical and light, and severe and medium showed statistically significant differences (χ2 = 97.97, 18.87, 20.66, 93.85; all P < 0.001). There were no significant difference between severe and medium type, severe and critical type (χ2 = 3.068, P = 0.08; χ2 = 1.06, P = 0.937). The cold agglutination group samples were all corrected after incubation at 37℃ for 30 min, and there were significant differences between WBC, RBC, HCT, MCV, MCH and MCHC before and after correction (Z =-4.953, t = 10.137, t = 8.614, t =-6.307, t =-4.918, Z =-6.334; all P < 0.001), PLT (Z =-1.317, P = 0.188), HGB (t = 0.212, P = 0.833) had no significant difference. There were also significant differences between WBC and PLT before and after incubation in strong condensing group (MCHC > 380 g/L) (Z =-4.283, -3.489; both P < 0.001), but there was no significant difference in PLT before and after mild condensation group (Z =-1.923, P = 0.054).Conclusions:Patients with COVID-19 are prone to cold agglutination, and the condensation increased with the severity of the disease. Besides affecting erythrocyte parameters, cold agglutination may also lead to lower level of WBC and PLT. Therefore, timely correction of COVID-19 cold agglutination can improve the accuracy of blood routine test results.
Objective:To investigate the clinical characteristics of Chlamydia psittaci infection.Methods:The diagnosis and treatment of a patient admitted to Anhua County People’s Hospital in April 2022 with severe community-acquired pneumonia caused by Chlamydia psittaci and pancreatic injury were analyzed, while the relevant literatures were reviewed.Results:This patient had a clear history of contact with poultry, and the main symptoms were cough, sputum, fever and fatigue at the onset of the disease; one week later after admission, the condition gradually worsened and multiple organ dysfunction occurred. In Intensive Care Unit, the patient was confirmed to be infected with Chlamydia psittaci by metagenomic next-generation sequencing of the bronchial alveolar lavage fluid. After 21 days of intravenous infusion of moxifloxacin (0.4 g/time once a day) and 35 days of oral administration of doxycycline (0.1 g/time twice a day), the condition improved. Although pancreatic enzymes increased (the peak value: Serum amylase 710 U, lipase 548.6 IU/L) during the period, the overall prognosis was good. Follow-up for 2 months and lung CT re-examination showed that the lesions were basically absorbed, and the organ functions of this case basically returned to normal.Conclusions:Chlamydia psittaci infection progresses rapidly, and definite diagnosis is extremely important to control the disease. After effective drug treatment, the overall prognosis is good, but it is necessary to closely monitor pancreas and other organ functions, and manage well at pharmacovigilance during the treatment.
Objective:To analyze the characteristics and surgical treatment effect of tuberculous empyema with pleural calcification.Methods:The clinical data of 149 patients with chronic tuberculous empyema who received surgical treatment in Wuhan Pulmonary Hospital from January 2018 to June 2021 were analyzed, retrospectively. According to the iconography characteristics, the pleural calcified tuberculous empyema were included in calcification group (46 cases), and those without pleural calcification were included in control group (103 cases). The baseline data of the two groups were analyzed with propensity score matching. The cases with similar propensity values were matched according to 1︰1. Finally, 32 cases of each group were matched and joined into the study. The perioperative data, postoperative recovery data and etiology of surgical specimens of both groups were compared and analyzed, respectively.Results:No perioperative deaths occured in both group. The operation time of the calcification group and control group [(272.81 ± 60.82) min vs. (254.44 ± 72.87) min: t = 1.07, P = 0.29] and blood loss during operation [400.00 (262.50, 600.00) ml vs. 325.00 (200.00, 500.00) ml: U = 444.00, P = 0.358] were without significant differences. Compared with control group, the postoperative drainage time [14 (9, 38) d vs. 8 (7, 12) d: U = 744.50, P = 0.002] and postoperative hospital stay [14.50 (10.25, 26.75) d vs. 11.00 (9.00, 15.75) d: U = 337.50, P = 0.019)] were significantly longer, the complications were more [62.50% (20/32) vs. 31.25% (10/32): χ2 = 6.27, P = 0.010], and postoperative pulmonary reexpansion duration was significantly longer [5 (3, 6) d vs. 3 (2, 5) d: U = 704.50, P = 0.003] in calcification group. And there was no difference in the unhealed cases [3.12% (1/32) vs. 9.38% (3/32): P = 0.61] between calcification group and control group. Compared with control group, there were fewer cured cases [31.25% (10/32) vs. 65.62% (21/32): χ2 = 7.57, P = 0.006] and more improved cases [65.63% (21/32) vs. 25.00% (8/32): χ2 = 10.66, P = 0.001] in calcification group. There were no significant differences between calcification group and control group in the comparison of Gene X-pert MTB/RIF [65.62% (21/32) vs. 84.38% (27/32): χ2 = 3.00, P = 0.080], SAT-TB [6.25% (2/32) vs. 15.62% (5/32): χ2 = 0.64, P = 0.420] and tuberculosis culture [3.12% (1/32) vs. 3.12% (1/32): P = 1.00].Conclusions:Pleural calcification tuberculous empyema is not a completely stable disease. In certain conditions, it can cause clinical symptoms, even the recurrence of tuberculosis. The difficulty and risk of surgical treatment with pleural calcification are more than those without pleural calcification, and the postoperative recovery and prognosis are also worse.
Objective:To investigate the clinical characteristics, treatment and prognosis of patients with human immunodeficiency virus (HIV) infection and Burkkit lymphoma.Methods:The clinical data of HIV-positive patients with Burkkit lymphoma from December 2010 to June 2021 in Beijing Ditan hospital, Capital Medical University were collected. The disease features, treatment regimens and prognosis were analyzed. And the prognostic factors were evaluated by multivariable Cox proportional hazards model.Results:Total of 179 HIV-positive patients with Burkkit lymphoma were enrolled consecutively. The frequency of Burkkit lymphoma was 31.8% (57/179), of whom 46 cases were diagnosed by histology and 11 cases were diagnosed by cytology. Three patients were primary central nervous Burkkit lymphoma, the others were diagnosed as non-primary central nervous Burkkit lymphoma, of whom 41 patients were diagnosed with Ann Arbor stage Ⅲ/Ⅳ. Median age was 43 years (21-60 years old). There were 27 cases (47.4%) with baseline median absolute CD4+ T < 200 cells/μl. Five patients could not be treated due to liver and kidney failure or severe infection, and 4 patients were lost to follow-up. And the rest 45 patients with non-primary central nervous Burkkit lymphoma received systemic chemotherapy with or without rituximab. The 45 patients received CODOX-M (cyclophosphamide, vincristine, doxorubixin, dexamethasone-MTX)/IVAC ± R (ifosfamide, cytarabine, etoposide ± rituximab) or EPOCH-R (etoposide, prednison, vincristine, cyclophosphamide, doxorubixin-rituximab) treatment. The complete response rate was 37.8% (17/45). The median overall survival was 16.0 months (95%CI: 12.4-19.6). The primary extral nodal organ disease was defined as an adverse prognostic factor (HR = 10.18, 95%CI: 2.48-41.73, P = 0.001).Conlusions:Most patients with HIV infection combined with Burkkit lymphoma are in the advanced stage of the disease when diagnosed, which partially lose the opportunity of treatment, and the prognosis is poor. More effective and low-toxicity treatment options need to be explored.
Objective:To investigate the effect of measles vaccination on the clinical characteristics of measles in children.Methods:Clinical data of 726 children with measles admitted to the Department of Pediatrics, BeijingDitan Hospital, Capital Medical University from March 2009 to July 2019 were analyzed, retrospectively, including onset time, gender, age, measles vaccination, clinical manifestations, complications, auxiliary examinations and prognosis. All children were grouped according to whether or not vaccinated against measles: the unvaccinated group (622 cases) and vaccinated group (104 cases), Chi-square test or continuously corrected Chi-square and rank sum (Mann-Whitney U) test were used to compare the clinical characteristics of measles between the two groups.Results:Total of 726 children with measles were collected, including 486 boys (66.9%) and 240 girls (33.1%), the median age was [8.6 (6.6, 11.9)] months, among whom, children younger than one year old accounted for 73.1%. Total of 622 children (85.7%) were not vaccinated against measles, with 251 (40.4%) children aged 0-8 months, and 104 children (14.3%) were vaccinated, without < 8 months. The incidence peak was in spring (March to May) in both groups. For the cases in the vaccinated group, the incidence of typical rash (67.0% vs.50.0%: χ2 = 11.316, P = 0.001), measles mucosal plaque (Koplik plaque) (61.7% vs. 38.5%: χ2 = 19.868, P < 0.001), eyelid edema (22.5% vs. 11.5%: χ2 = 6.477, P = 0.011), conjunctival congestion (45.0% vs. 24.0%: χ2 = 16.095, P < 0.001), eye secretions (50.0% vs. 30.8%: χ2 = 13.221, P < 0.001), watery eyes (12.1% vs. 3.8%: χ2 = 6.196, P = 0.013), diarrhea (29.3% vs. 18.3%: χ2 = 5.376, P = 0.020), cough (77.2% vs. 63.5%: χ2 = 8.980, P = 0.003) and respiratory complications laryngitis (44.7% vs. 26.9%: χ2 = 11.541, P = 0.001) and pneumonia (80.4% vs. 59.6%: χ2 = 21.982, P < 0.001) in the unvaccinated group were significantly higher; while the incidence of liver damage (12.1% vs. 34.6%: χ2 = 35.006, P < 0.001) was significantly lower.Conclusions:Measles vaccination has an effect on the clinical characteristics of children with measles. Children who are not vaccinated against measles have typical clinical manifestations and more respiratory complications. The clinical manifestations of children vaccinated against measles are atypical. Children who are not vaccinated against measles are the main cases infected with measles. Attention should be paid to measles vaccination and supplementary immunization for infants and young children.
Objective:To develop a new nano-drug delivery system, to improve bioavailability and reduce adverse effect of antiretroviral drugs for human immunodeficiency virus (HIV).Methods:Nano-drug delivery system produced by awater-oil-water emulsion and solvent evaporation technique was prepared by mixing anti-viral drug: efavirenz (EFV), tenofovir (TDF) and lamivudine (LAM) (weight ratio of 2︰1︰1) with poly (lactic-co-glycolic acid) (PLGA) and PLGA-chitosan (PLGA-CS). The drug-loaded nanoparticles were characterized for their particle size, poly-dispersity index and ζ-potential. The drug loading, encapsulation efficiency and drug release of PLGA and PLGA-CS nanoparticles were analyzed by high-performance liquid chromatography (HPLC). In vitro, cell viability was performed to evaluate biocompatibility and cytotoxicity.Results:Both PLGA-CS and PLGA nanoparticles exhibit good uniformity in particle size. Due to be coated with CS, the particle size of PLGA-CS nanoparticle was increased from (198.2 ± 2.3) nm to (219.8 ± 6.5) nm; the ζ-potential was increased from (-25.0 ± 1.6) mV to (23.5 ± 1.9) mV; drug encapsulation efficiency was increased from 49%-52% to 68%-77%. After a 2-month storage at 4 ℃ or 25 ℃, the drug retention of PLGA-CS nanoparticles remained above 90%. These results confirmed the excellent stability of PLGA-CS nanoparticles. The initial burst release of the antiretroviral drug from PLGA-CS nanoparticles exhibited a significant reduction, with the drug release remaining below 20% within 24 hours. The results in vitro studies pointed to the prolonged antiviral activity of AR-PLGA-CS. The stability of PLGA-CS was better than PLGA. Regardless of the concentration of PLGA-CS nanoparticles, the MTT assay showed that the cell viability was higher than 90%. This result indicated that PLGA-CS nanoparticles have low toxicity and excellent biocompatibility.Conclusions:PLGA-CS nanoparticles exhibited high drug encapsulation efficiency, excellent stability, and the capacity of sustained drug release and enhanced therapeutic efficacy. This provides a new way for the clinical administration of antiretroviral drugs to patients with HIV infection.
Objective:To improve the clinical understanding of the characteristics, diagnosis and treatment methods and prognosis of empyema caused by Candida krusei infection.Methods:The clinical data of a patient with empyema caused by Candida krusei infection admitted to the Second Affiliated Hospital of Nanjing Medical University in July 2022 was analyzed, retrospectively. Relevant literatures at home and abroad were searched to explore the pathogenesis, clinical characteristics, diagnosis and treatment of the disease.Results:This patient had a history of long-term drug abuse and bronchial asthma, and had severe hypoproteinemia at the initial stage of admission. After the diagnosis of Candida krusei empyema was confirmed, micafungin and voriconazole were given successively during chest drainage, and he was discharged after the empyema was completely absorbed. Total of 6 case reports (including 8 cases) of empyema caused by Candida krusei infection were retrieved, there were 4 patients with esophageal perforation, 2 patients with esophageal-tracheal fistula formation, and 1 patient after heart transplantation, 1 patient after occlusion of the ductus arteriosus; this patient had a bronchial-pleural fistula during the course of the disease; the initial clinical manifestations of this case and the 8 patients reported in the literature were cough, expectoration, and dyspnea, while the etiological diagnosis of empyema was all routine culture; according to the literatures, 4 cases among the 8 patients died, 1 patient was treated with amphotericin B, 2 patients with voriconazole, and 1 patient with echinocandin combined with voriconazole, and 1 case among the 4 survived patients was treated with echinocandin alone, 3 patients were treated with echinocandin combined with voriconazole.Conclusions:This case of empyema caused by Candida krusei infection is the first reported case in China. Patients with this disease are more common inesophageal-tracheal fistula formation and surgical trauma, the clinical manifestations are not characteristic, treatment with echinocandoxin or combined with triazole voriconazole may improve the survival.
Objective:To establish a dimensionality reduction and clustering method of flow cytometric data for measuring T cell subpopulations in peripheral blood and ascites of patients with spontaneous bacterial peritonitis (SBP), and to explore the differences in the expression of markers of T lymphocytes in the peripheral blood and ascites.Methods:Total of 4 patients with SBP were recruited in Beijing Ditan Hospital, Capital Medical University from December 2021 to January 2022. The monoclonal antibodies targeting cell surface antigen were used to establish the multi-color flow cytometry analysis panel. The peripheral blood mononuclear cell (PBMC) sample from one healthy donor was applied to adjust optimal detection voltage and fluorescence compensation. This panel was applied to detect peripheral blood and ascites samples from 4 patients with SBP. Uniform manifold approximation and projection (UMAP) and FlowSOM were used to analyze the results from multicolor flow cytometric data.Results:Using UMAP combined with FlowSOM, CD4+ T cells and CD8+ T cells were both divided into 12 clusters, respectively. Through the visual UMAP map positioning and statistical analysis, compared with the peripheral blood, the proportion of CD69+PD-1+CD4+ TEM cells (t = 3.427, P = 0.0416) and CD25-TIGIT-CD4+TEM cells (t = 3.203, P = 0.0492) in ascites of patients with SBP were increased, with significant differences.Conclusions:The dimensionality reduction and clustering method of flow cytometric data can be used to detect the groups and functions of T lymphocyte in peripheral blood and ascites samples of patients with SBP, which has the advantages of rapidity, accuracy, multi-dimensionality and strong visualization.
