The pandemic of the Coronavirus Disease 2019 (COVID-19) is ongoing exacerbated worldwide. The clinical consequence of this disease was characterized with pneumonia and hypoxemia, even systemic injuries, especially in severe cases. Patients with underlying chronic cardiovascular diseases, or complicated with new onsetting cardiovascular problems, were correlated with a high mortality. However, the mechanisms of myocardial and vascular damage complicated with SARS-CoV-2 viral infection have not been clarified yet. They might be correlated with direct viral invasion, severe hypoxemia, and systemic cytokine storm. Hence, the therapeutic strategy for SARS-CoV2 viral infections related to myocardial and vascular damage, and the protocol for critical ill patients with emergent cardiovascular problems need comprehensive research urgently.
Objective To evaluate the levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in coronavirus disease 2019 (COVID-19) patients. Methods PubMed, MedRxiv and bioRxiv, WangFang Data, CNKI, VIP, and Chinese Medical Journal Network databases were searched to collect researches for COVID-19 up to April 10, 2020. RevMan 5.3 software was used for meta-analysis. Two evaluators independently screened the literature, extracted the data, and evaluated the risk of bias of relevant studies. Results There were 18 studies included. Among the 2 405 patients, 1 898 of them suffered from not severe COVID-19 (non-severe group), and the rest 507 patients from severe COVID-19 (severe group). The severe group had significantly higher proportion of transaminase abnormality/liver injury when compared with the non-severe group (OR=0.35, 95%CI: 0.27~0.46, Z=7.78, P < 0.000 01; RR=0.53, 95%CI: 0.46~0.61, Z=8.60, P < 0.000 01). Obvious differences were seen in the transferase levels between the 2 groups (ALT: MD=-0.63 U/L, 95%CI: -1.26~-0.01, Z=2.00, P=0.05; AST: MD=-0.81 U/L, 95%CI: -1.45~-0.16, Z=2.46, P=0.01). Conclusion COVID-19 maybe accompanied with liver injury. There are a larger proportion of patients with transaminase abnormality/liver injury in the severe COVID-19 patients, especially in the abnormality.
Objective To investigate the epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19) in non-endemic areas. Methods From January 2020, the Nanjing Public Health Medical Center began to treat confirmed patients. Retrospective analysis was carried out in 57 patients with identified novel coronavirus-infected pneumonia and having been discharged for the epidemiological characteristics, clinical signs and symptoms, laboratory test results, and CT images. Results The 57 patients were at an age ranging from 5 to 97 years (median 37 years), and 29 males (50.9%) and 28 females (49.1%). Among them, 35 cases had clear contact with the epidemic area Wuhan, and 16 were clustered cases. The average incubation period was 7.4 d for the disease. In them, 54 cases occurred locally, 23 patients had fever as the first symptom, and 13 patients had normal temperature. Other main first symptoms included dry cough (14 cases, 24.6%) and body aches and fatigue (5 cases, 8.8%). The patients with decreased peripheral white blood cell count accounted for 26.3%, those with reduced lymphatic or eosinophils count for 47.4%, those with increased average platelet volume for 24.7%, elevated serum ALT or AST levels for 15.8%, raised CKMB for 5.3%, and those with decreased blood potassium for 40.4%. All patients had lung illness and were positive to nucleic acid test, and 66.7% of them got both lung involved. Of the 57 patients, 26.3% were mild and 73.7% were ordinary. Their average length of hospital stay was 10.1 d, and they had an average course of 15.6 d. All of them were treated with interferon αb1 combined with acetylcysteine, 47 cases were combined with kriging, and 18 cases with abidol. All the 57 cases were improved and discharged. Conclusion All these cases in Najing are almost imported from the epidemic area. The clinical classification is mainly ordinary type. Low fever, dry cough, sore throat and systemic soreness, decreased lymphocytes, ground glass shadow in CT images, and positive to nucleic acids are the main clinical features of the disease.
Objective: To explore the clinical features of 143 patients suffering from coronavirus disease 2019 (COVID-19) in the Northeast area of Chongqing
2019 coronavirus disease (COVID-19) is an infectious disease caused by SARS-COV-2 virus, and lacks specifically effective treatment till now. Its clinical manifestations and the concerning studies at home and abroad have shown that viral sepsis caused by SARS-COV-2 virus has typical characteristics of pathophysiology of sepsis, that is, early cytokine storm and subsequent immunosuppression stage. At present, although great attention has been paid to the treatment and clinical research on cytokine storm, the later stage of immunosuppression is neglected. Patients' lower immunity, secondary infection and multiple organ failure are quite common, and all these lead to rapid deterioration and even death. Therefore, it is of great significance to pay attention to the investigation and treatment of sepsis immunosuppression stage caused by COVID-19, and to study the drugs with bidirectional immune regulation such as artesunate so as order to reduce the mortality of patients with severe or critical COVID-19. What's more, we strongly recommend that chloroquine phosphate should be used with great caution for severe and critical patients.
Objective To analyze the factors contributing to heat stroke in troops from different regions on the first day after arrival in Chongqing.Methods Using a self-designed questionnaire,we investigated the daily activities,training,and the occurrence of heat stroke in 2 troops from 2 different regions before and during the transportation and after their arrival at Chongqing.The individuals having heat stroke on the first day of arrival served as the heat stroke group,and those without heat stroke served as the control group for comparison of the data to identify the factors contributing to heat stroke in the 2 troops.Results Twelve(33.3%)individuals in troop A and 16(48.6%)in troop B had heat stroke on the first day after arrival in Chongqing.In troop A,the volume of daily water intake,sleep time and sleep quality differed significantly between the individuals with heat stroke and those without during the transportation(P＜0.05);In troop B,the weekly training time and the volume of water intake on the first day of arrival differed significantly between the heat stroke and non-heat stroke groups(P＜0.05).Logistic multivariate regression showed that an increased mean daily water intake and improved daily sleep quality during transportation in troop A and a longer weekly training time in troop B were the protective factors against heat stroke.Conclusion The differences in the geographical environment in terms of climate and altitude between the 2 troops resulted in significant differences in the factors affecting the occurrence of heat stroke on the first day after their arrival,suggesting the importance of addressing the geographical differences between the stationing site and the mission site in designing measures for controlling environmentally sensitive diseases for the trans-regional mobile troops.
Objective To investigate the current situation of heatstroke among the officers and soldiers in Southern Theatre Command from 2017 to 2018, and to analyze the possible influencing factors. Methods A total of 1 699 officers and soldiers were subjected by random cluster sampling from 23 units of 5 military categories, including Army, Navy, Air Force, Joint Logistics Support Force and Rocket Army. The current situation and influencing factors of heatstroke in them were analyzed by means of questionnaire and case study. Results In the past year, 138 officers and soldiers (8.1%) had heatstroke, and the incidence of heatstroke in each military service ranked from high to low as Navy (11.2%), Army (10.1%), Joint Logistics Support Force (7.3%), Rocket Army (5.1%) and Air Force (4.2%), with significant differences among among different military services (P < 0.05, P < 0.01). According to the different military specialties, the top 3 specialties experiencing heatstroke were armored units (22.4%), surface warships (15.8%) and artillery (10.7%), and significant difference was seen among different military specialties (P < 0.01). The most common onset time of heatstroke was during June and August, and the most prone training subject was 5 km off-road. The results of the comparison study showed that the ratios of female, married and drinkers were significantly higher in those with heatstroke than those without (P < 0.05). Obvious differences were also seen in sleep quality, dietary status, average daily physical work time, frequency of fatigue training, training when avoiding the heat and the knowledge related to heatstroke between the 2 groups (P < 0.05, P < 0.01). Conclusion The incidence of heatstroke in the officers and soldiers of Southern Theatre Command is relatively high from 2017 to 2018. Sleep quality, dietary status, average daily physical work time, frequency of fatigue training, training when avoiding the heat and knowledge related to heatstroke may be factors influencing the occurrence of heatstroke in them.
Objective To assess the effect of probiotic intervention on intestinal flora and immune status in patients with secondary infections to HBV-related acute-on-chronic liver failure(HBV-ACLF).Methods A total of 101 patients with HBV-ACLF treated in our hospital between January,2017 and June,2018 were enrolled in this study,including 56 without secondary infections(HBV-ACLF group)and 45 with secondary infections to HBV-ACLF(secondary infection group),with 67 healthy participants as controls.All the patients with HBV-ACLF were treated with bifidobacterium quadruple live bacteria tablets in addition to the routine treatments for 1 month.From all the participants,fecal specimens were collected before and after the treatment to analyze the changes in Lactobacillus,Bifidobacterium,Escherichia coli,Enterococcus,yeast,Staphylococcus,Bacteroides and Streptococcus mutans;peripheral blood samples were also obtained for testing the serum levels of immunoglobulin A(IgA),IgG and IgM using ELISA;the changes in T lymphocyte subsets CD3+,CD4+ and CD8+ were detected using immunofluorescence flow cytometry,and the levels of C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and interleukin-8(IL-8)were determined using ELISA.Results Compared with the control group,the patients with HBV-ACLF in both groups before the treatment showed significantly reduced abundance of intestinal Lactobacilli and Bifidobacteria and increased abundance of Escherichia coli,Enterococcus,yeast,Staphylococcus,Bacteroides,and Streptococcus pneumoniae(P＜0.05),with significantly lowered levels of IgA,IgG,IgM,NK,CD4+ and CD4+/CD8+(P＜0.05)and elevated levels of CRP,TNF-α,IL-6 and IL-8(P＜0.05);These changes were even more obvious in patients with secondary infections than in those without infections(P＜0.05).After the treatment,the intestinal Lactobacilli,Bifidobacteria and blood levels of IgA,IgG,IgM,NK,CD4+ and CD4+/CD8+ increased significantly(P＜0.05),and intestinal Escherichia coli,Enterococcus,yeast,Staphylococcus,Bacteroides,Streptococcus pneumoniae and the levels of CRP,TNF-α,IL-6 and IL-8 were all decreased in both HBV-ACLF group and the secondary infection group(P＜0.05).No significant differences in CD3+ or CD8+ cells were found among the 3 groups either before or after the treatment(P＞0.05).Conclusion The patients with secondary infections to HBV-ACLF have abnormal changes in intestinal flora and immune status,which can be improved by probiotic intervention.
Objective To investigate the association of the interaction between brain-derived neurotrophic factor (BDNF) gene and neurotrophic tyrosine kinase receptor type 2 (NTRK2) gene with suicide attempt in adolescents. Methods One single nucleotide polymorphism (SNP) of BDNF gene (rs1491851) and 3 SNPs of NTRK2 (rs1147198, rs11140800, rs1565445) were tested by IMLDRtm multiplex SNP typing in 70 suicide attempters (15~24 years old) and 111 healthy young individuals (control). Analysis on gene-gene interaction was conducted by generalized multifactor dimensionality reduction (GMDR). Results No significant differences were found in genotype frequencies and allele frequencies between the attempters and controls at 4 SNPs (BDNF rs1491851, and NTRK2 rs1147198, rs1140800, rs1565445)(P>0.05). GMDR analysis indicated the interactions between BDNF gene and NTRK2 gene included a two-locus combination (rs1491851, rs1147198), a three-locus combination (rs1491851, rs1147198, rs11140800) and four-locus combination (rs1491851, rs1147198, rs11140800, rs1565445). The four-locus combination was identified as the best model (Bal. Acc. CV test: 0.632 5, CVC consistency: 10/10, permutation test: P=0.032~0.033). Conclusion There are interactions between BDNF gene and NTRK2 gene, which may be associated with suicide attempt in adolescents.
目的 以脉冲场凝胶电泳(pulsed field gel electrophoresis,PFGE)为金标准,评价基质辅助激光解吸电离飞行时间质谱(matrix-assisted laser desorption/ionization time-of-flight mass spectrometry,MALDI-TOF MS)在多重耐药铜绿假单胞菌(multi-drug resistant Pseudomonas aeruginosa,MDR-PA)同源性分析中应用的可行性.方法 收集陆军军医大学第三附属医院2017年1-12月重症监护病房住院患者分离的20株MDR-PA非重复菌株,利用VITEK MS SARAMIS软件对MDR-PA蛋白图谱进行聚类分析,同时对其进行PFGE同源性分析,并将两种方法所得的分型结果进行对比分析.结果 MALDI-TOF MS同源性分析结果与PFGE同源性分析结果比较显示,20株MDR-PA通过MALDI-TOF MS聚类分析将其分为三大簇(Ⅰ型13株,Ⅱ型6株,Ⅲ型l株),而依据PFGE分型结果则将其分为6种亚型(A型2株,B型3株,C型4株,D型3株,E型7株,F型1株),其中有C型和E型中具有相同基因型菌株间,其MALDI-TOF MS亲缘性关系也较近,而其余4种亚型菌株间亲缘性比较,发现PFGE分型结果与MALDI-TOF MS聚类分析结果不完全相符.结论 与PFGE同源性分析相比,MALDI-TOF MS同源性分析结果一致性不稳定,具有一定局限性,尚不能取代PFGE同源性分析.
ObjeCtive To explore the drug resistance and epidemiological characteristics of isolated Acinetobacter baumannii (A.baumannii).Methods A total of 69 stains of A.baumannii were isolated from the different clinical specimens of nosocomial infectious patients hospitalized in the respiratory department of the First Affiliated Hospital of Army Medical University from January 2015 to December 2015.The clinical data of these patients were obtained from the electronic medical record system of the hospital.The antimicrobial susceptibility was evaluated by agar disk dilution.The carbapenemase resistance genes were amplified by PCR,and the gene types were analyzed by the pulsed-field gel electrophoresis (PFGE).Results Mechanical ventilation,prior antibiotics and long hospital stay were the risk factors for A.baumannii infection (P ＜ 0.001).Except for minocycline,our isolated strains showed high drug resistance rates to the other antibiotics.All the isolates carried OXA-51 gene,and 51 isolates had OXA-23 gene.VIM gene presented in 13 isolates,and IMP gene only existed in 2 isolates.The PFGE results showed that the 69 isolates had 9 different genotypes and 19 subtypes,and D and E genotypes were the most popular.Conclusion Our isolated A.baumannii stains have quite higher resistance rate,and are characterized by horizontal spread of resistance genes and small-scale epidemic outbreak.
Objective To systematically evaluate the effects of internet-delivered acceptance and commitment therapy( IACT) on depression, anxiety and well-being. Methods Pub Med, EMbase,CENTRAL,Psyco INFO,CSTJ,CNKI and Wan Fang databases were searched for randomized controlled trials( RCTs) evaluating the effects of IACT on depression,anxiety or well-being,with depression and anxiety as the primary outcome indicators and well-being as the secondary outcome indicator. The outcomes were calculated using the standard mean difference( SMD) with 95% confidence intervals( 95% CI). Results Fourteen RCTs involving a total of 1 497 patients were included in the analysis. The results of meta-analysis showed that IACT could significantly improve depression [SMD =-0. 33,95% CI(-0. 55,-0. 12),P =0. 003],anxiety [SMD =-0. 23,95% CI(-0. 42,-0. 04),P = 0. 02],and well-being [SMD = 0. 21,95% CI( 0. 05,0. 36),P = 0. 01]. Subgroup analyses suggested that IACT had significant effects in improving depression,anxiety and well-being in healthy populations( P < 0. 01); self-administered IACT with assistance by therapists could significantly improve depression and promote well-being( P < 0. 05).Conclusion IACT can effectively improve depression,anxiety and well-being.
目的观察淋巴瘤及淋巴结结核的 18 F-FDG PET/CT表现,评价其诊断价值,以期提高诊断准确率。方法回顾性分析2015年9月至2017年9月在本院行 18 F-FDG PET/CT检查的51例经病理证实的淋巴瘤和淋巴结结核患者的 18 F-FDG PET/CT表现,分别从病灶的分布、形态、大小、FDG摄取情况进行观察与分析。结果淋巴瘤（41例）及淋巴结结核（10例）伴病灶融合（16例、0例）、纵隔淋巴结钙化（1例、5例）、环形摄取（1例、0例）及合并肺结核（0例、1例）;其 18 F-FDG PET/CT诊断正确率分别为100%、50%。淋巴瘤及淋巴结结核的PET/CT表现有全身淋巴结肿大（18例、1例）、局部淋巴结肿大（23例、9例）;伴脾脏受累或脾脏FDG摄取增高（14例、2例）、骨质受累或全身骨骼FDG摄取增高（6例、1例）及二者均受累（4例、0例）。淋巴瘤淋巴结直径（30. 42±14. 03） mm、SUVmax值13. 40±7. 56;淋巴结结核淋巴结直径（18. 59±6. 56） mm、SUVmax值7. 66±3. 32;两者淋巴结直径和SUVmax值差异均有统计学意义（P ＜0. 05）。当界限SUV值（Cutoff值）为2. 5时,诊断淋巴瘤的敏感性、特异性为100%、0%～10%,根据ROC曲线,确定SUV=9. 725时为最佳界限值,其敏感性、特异性为65. 9%、80%。结论淋巴瘤及淋巴结结核的临床及 18 F-FDG PET/CT表现类似, 18 F-FDG PET/CT对淋巴瘤的诊断价值较高,但对淋巴结结核的诊断效能较低;提高SUVmax界限值并结合淋巴结大小,可在一定程度上对两者鉴别诊断提供一定的帮助。
目的 调查高原官兵的膳食结构和身体状况,为指导部队合理膳食,提高高原官兵的膳食营养水平提供依据.方法 选取驻海拔3 680 m高原地区陆军某部一个伙食单位就餐人员(青年男性官兵)190名,采取称量法进行连续4d的膳食调查;同时利用体质量身体脂肪测量器及皮脂测量仪进行体格检查;抽取官兵空腹全血,进行血样生化检查,测定贫血3项、全血矿物质8项以及血清维生素A、血清维生素D、血清维生素E等生化指标.并以GJB 826A-2010《军人食物定量》、GJB 823 B-2016《军人营养素供给量》、GJB 1636A-2016《军队营养调查与评价方法》和血样检测结果参考值为依据进行评价.结果 膳食调查结果显示该部官兵肉类、禽蛋及食用菌等食物摄入充足,但鱼虾、蔬菜、水果、大豆和牛奶等食物摄入量不足,部分食物摄入低于标准的50％;蛋白质、铁、维生素E等多数营养素供给达标,但钙、锌、碘、维生素A、维生素B1、维生素B2摄入量不足;能量摄入量达标,其中3大营养素蛋白质、脂肪、碳水化合物供能所占比例分别为12.0％、45.0％、43.0％,脂肪供能比偏高,蛋白质和碳水化合物供能比未达到标准;体质指数在18.5 ～23.9范围内的官兵有91名,占比为75.8％,表明大多数官兵营养状况正常,但也存在慢性营养不良的情况.血样检测结果显示,官兵多种营养素在标准范围内,但维生素D和钙普遍缺乏,铁元素部分人员超标.结论 部分人员存在营养不良的情况,维生素D和钙缺乏明显,还需调整膳食结构和进行营养宣教来改善高原部队膳食营养现状.
Objective To investigate the differences in drug resistance and virulence factor of Escherichia coli (E.coli) strains isolated from the patients with recurrent and acute simple urinary tract infection.Methods The clinical samples of the hospitalized patients in our hospital from 2014 to 2015 were collected.Then the minimal inhibitory concentration of the strains was tested by the agar double dilution.The adhesion of the E.coli strains was tested with flat colony counting.The motility of E.coli was analyzed by the diameter of the zone on the semisolid medium.Type 1 fimbriation was determined by a rabbit erythrocyte hemagglutination for the hemolysis of E.coli.The virulence of E.coli to the 5637 cells was tested by lactate dehydrogenase test.Results There were 26 strains of E.coli isolated from clinical samples, including 15 from the patients of recurrent and 11 from acute simple urinary tract infection.For the toxicity of the strains, theadhesion ability was 4.95 × 107 ± 1.21 × 106 CFU/mL for the recurrent isolates and 2.57 × 107 ± 1.63 ×106 CFU/mL in the acute isolates (P ＜ 0.001).The recurrent isolates had stronger hemagglutination (7.3 ±0.58 vs 6.03 ± 0.73, P ＜ 0.001), and stronger toxicity to 5637 cells [(76.66 ± 3.65) ％ vs (64.14 ±8.85) ％, P =0.019] than the acute isolates.Whereas, there were no significant differences in the resistance and motility of the 2 kinds of isolates (P ＞ 0.05).Conclusion The E.coli strains isolated from recurrent urinary tract infections have higher virulent than those from acute simple urinary tract infections.
Objective To investigate the occlusion effect of a novel nanoscaled procyanidins containing-strontium-substituted-hydroxyapatite varnish (SrHAP-PA) on the dentin tubules in vitro.Methods The model of dentin hypersensitivity was established in cow central incisors,then the sealing effect of SrHAP-PA varnish was examined on dentinal tubules under simulated human oral environment.Fluorine coating was used for the positive control group,and blank group served as negative control.Morphological alterations were observed by scanning electron microscopy (SEM).Energy dispersive X-ray microanalysis (EDX) were used to analyze the changes of element quality on dentin surface.Fourier transform infrared spectroscopy (FTIR) was carried out and confocal laser scanning microscopy was used to observe the dentin tubules.Results The dentin-hypersensitivity model was successfully constructed.The SrHAP-PA varnish was observed to effectively occlude the dentinal tubules by SEM.EDX showed that the SrHAP-PA composite film promoted remineralization and FTIR displayed that the SrHAP-PA varnish can quickly enter into the dentinal tubules,and save for a long time in the simulation of the oral environment.Conclusion The SrHAP-PA complex as the active ingredient of the coating material can effectively seal the dentinal tubules.
Objective To investigate the genotypic characteristics and prevalence of multidrug resistant Mycobacterium tuberculosis in Chongqing.Methods This retrospective study was conducted among 753 patients with a clinical diagnosis of multidrug-resistant tuberculosis,who received treatments in the Public Health Medical Center and the 12th People's Hospital of Chongqing from July,2013 to March,2015.Mycobacterial strains were isolated from the sputum or other body fluid samples from the patients and cultured using the liquid culture method.The isolates of Mycobacterium tuberculosis were tested with PCR and genotyped using multiple-locus variable-number tandem repeat analysis (MLVA).Bionumerics Version 3.0 and Phyloviz software was used to analyze the polymorphisms and clustering of the genetic loci.Results A total of 538 multidrug-resistant mycobacterial strains were isolated and identified,including 503 (95.8％) strains of Mycobacterium tuberculosis and 35 (4.2％) strains of other species.Of the 503 strains of Mycobacterium tuberculosis,470 (93.4％,470/503) were of the Beijing family genotype and 33 (6.6％,33/503) were of other genotypes.A total of 348 genotypes were identified among the 503 mycobacterial strains;267 strains had a single genotype while the remaining 236 strains were classified into 81 clusters with a clustering rate of 30.8％.The strains of Beijing family genotype had 76 clusters with a clustering rate of 30.8％ and a clustering ratio of 35.9％.Five clusters were identified among the strains with non-Beijing family genotypes with a clustering rate of 30.3％ and a clustering ratio of 33.3％.Vulnerability analysis showed that the infection with Mycobacterium tuberculosis of Beijing family genotype was significantly correlated with the patients' age (Chi square =784.00,P ＜ 0.05) but not with their gender (Chi square =2.68,P ＞ 0.05).Conclusion The multidrug-resistant Mycobacterium tuberculosis strains isolated from Chongqing have polymorphic genotypes,among which the Beijing family genotype is predominant.The vulnerability to infections by multidrug-resistant Mycobacterium tuberculosis of Beijing family genotype is related with age but not with gender.
目的 探讨重症患者导管相关性尿路感染(catheter-associated urinary tract infections,CAUTI)的影响因素及差异性.方法 采用自行设计的经过信度和效度检验的留置尿管评估观察表,前瞻性监测某院13个病区留置尿管的重症住院患者654例,包括本科室置管和带管入院2组患者CAUTI 的影响因素并分析其差异性.结果 本科室置管的重症患者417例,发生CAUTI 56例,CAUTI影响因素的多因素分析结果显示:女性,OR=5.937,95％ CI(1.474 ～ 23.909);ICU置管,OR=60.499,95％ CI (1.455～2515.992);置管前未预先连接尿管与集尿袋,OR =5.585,95％CI(1.278～24.411);置管时手触摸尿管前端,OR =9.802,95％CI(2.413 ～39.816);尿管留置时间≥7 d,OR=47.652,95％ CI(9.733～233.297);尿管留置时间≥14 d,OR=334.843,95％CI(56.700～1977.434);乳胶尿管,OR=0.158,95％CI(0.037 ～0.671).带管入院237例,发生CAUTI 38例,Logistic回归分析结果显示:尿管留置时间≥7 d,OR=7.277,95％ CI(2.004～26.420);尿管留置时间≥14 d,OR=57.492,95％ CI(16.549～199.728);置管后未更换引流袋,OR=3.429,95％CI(1.245～9.443);乳胶尿管,OR=0.323,95％ CI (0.123 ～0.846).2组重症患者CAUTI影响因素差异性分析结果显示:心血管疾病、慢性呼吸道疾病、三腔尿管、更换引流袋及普通引流袋对本科室置管组重症患者CAUTI的影响稍大于带管入院组,而尿管留置时间及乳胶尿管对本科室置管组重症患者CAUTI的影响稍小于带管入院组,2组差异有统计学意义(P＜0.05).结论 女性、ICU置管、置管前未预先连接尿管与集尿袋、置管时手触摸尿管前端及尿管留置时间是本科室置管重症患者CAUTI的危险因素,乳胶尿管则是保护因素;尿管留置时间和置管后未更换引流袋是带管入院重症患者CAUTI的危险因素,乳胶尿管也是保护因素.针对相关因素进行预防性干预和规范护理,对降低CAUTI发生率具有重要意义.
目的探讨艾滋病患者合并阴茎癌的临床诊断与治疗。方法收集作者2012年3月至2015年2月援助博茨瓦纳期间所诊治的艾滋病合并阴茎癌患者共24例,对其临床表现、诊断、手术治疗方案、术后疗效等影响因素进行分析总结。结果 24例患者平均年龄38.6岁。临床表现为局部肿块（11/24,45.8%）、溃疡（9/24,37.5%）及丘疹（4/24,16.7%）。发病时22例患者正接受HAART治疗,18例（75.0%）患者CD4水平较低（低于350/μL）,存在明显的免疫抑制状态。病理类型为鳞状细胞癌22例,鳞癌合并卡波西肉瘤2例。22例患者进行手术治疗,2例T4期患者未手术治疗。2例阴茎鳞癌合并卡波西肉瘤,于发病后4个月和6个月得到确诊,并行阴茎全切加尿道会阴部造口术,术后恢复良好,未见肿瘤转移。结论卡波西肉瘤是艾滋病患者常见的皮肤病损,阴茎卡波西肉瘤容易掩盖阴茎鳞状细胞癌的症状,从而耽误阴茎癌诊断与治疗,需要引起足够的注意。
Objective To determine the anti-proliferative effect of evodiamine( Evo) on colon cancer cells and investigate the possible underlying mechanism. Methods Lo Vo cells were treated with 0,0. 5,1,2and 4 μmol / L Evo,and then the anti-proliferation effect of Evo was assessed by crystal violet staining. Flow cytometry was used to determine the apoptosis of Lo Vo cells after the treatment of 0,0. 5,1 and 2 μmol / L Evo.Western blotting was adopted to detect the expression of proliferating cell nuclear antigen( PCNA) and Caspase-3 in the cells treated with 0,0. 5 and 1 μmol / L Evo. Hypoxia inducible factor 1-alpha( HIF-α)-responsive firefly luciferase reporter was employed to measure the transcription activity of HIF-1α in 0,0. 5,1 and 2 μmol / L Evo treated cells,and Western blotting was used to detect the expression of HIF-1α,Akt1 /2,and p-Akt1 /2in the Lo Vo cells. Results Evo obviously inhibited the proliferation of Lo Vo cells,down-regulated the expression of PCNA and promoted the cell apoptosis. Luciferase reporter system indicated that Evo decreased the transcriptional activity of HIF-1α in a dose-dependent manner( Evo 0. 5 μmol / L,P < 0. 05; 1 or 2 μmol / L,P < 0. 01). Western blotting showed that the expression levels of HIF-1 α and p-Akt1 /2 were reduced after Evo treatment. Conclusion Evo inhibits the proliferation and promotes the apoptosis in Lo Vo cells,which may be due to its down-regulating HIF-1α and inhibiting the transconduction of PI3 K / Akt signaling pathway.
