Optimal Glycated Hemoglobin Cutoff for Diagnosis of Diabetes and Prediabetes in Chinese Breast Cancer Women.

Purpose: Glycated hemoglobin (HbA1c) is widely used in diabetes management and now recommended for diagnosis and risk assessment. Our research focused on investigating the optimal cutoff points of HbA1c for diagnosis of diabetes and prediabetes in Chinese breast cancer women, aiming to enhance early detection and tailor treatment strategies. Patients and Methods: This study involved 309 breast cancer women without diabetes history in China. Patients were categorized into groups of newly diagnosed diabetes, prediabetes, and normal glucose tolerance using oral glucose tolerance test (OGTT) according to the 2010 ADA criteria. HbA1c data were collected from all patients. Receiver operating characteristic (ROC) curve analysis was used to assess the effectiveness of the HbA1c screening. Results: Among the 309 breast cancer women without diabetes history, 96 (31.0%) were identified with diabetes and 130 (42.1%) had prediabetes according to OGTT, and the incidence of normal glucose tolerance was only 26.9% (83). ROC curve analysis, using OGTT as a reference, revealed that the area under the curve of 0.903 (P<0.001, 95% CI, 0.867-0.938) for HbA1c alone, indicating high accuracy. The optimal HbA1c cutoff for identifying diabetes was determined to be 6.0%, with a sensitivity of 78.1% and specificity of 86.4%. For prediabetes, the ROC curve for HbA1c alone showed that the area under the ROC curve of 0.703 (P<0.001, 95% CI, 0.632-0.774), with an optimal cutoff of 5.5% (sensitivity of 76.9% and specificity of 51.8%). Conclusion: The prevalence of undiagnosed diabetes is very high in breast cancer women without diabetes history in China. The optimal cutoff points of HbA1c for identifying diabetes and prediabetes are 6.0% and 5.5% in Chinese breast cancer women, respectively.

[Epidemiology and Resistance Mechanisms of Group B Streptococci in Late-pregnant Maternal Birth Canal].

OBJECTIVE: To study the antibiotic-resistant rate of group B streptococci (GBS) in obstetric canal of late-pregnant women, evaluate the antibiotic-resistant status and finally to support the GBS prevention and curing by proper antibiotics. METHODS: 31 pregnant women between 35 to 37 gestational weeks were included, for whom the antibiotic sensitivity as well as the drug (erythromycin and clindamycin) resistance genes of GBS in obstetric canal was analyzed. RESULTS: 12 (38. 7%) strains of GBS were resistant to clindamycin, while 21 (67. 7%) to erythromycin, within which 12 strains were intrinsic phenotype - cMLS type-clindamycin resistance, other 9 were active efflux phenotype - MS type-clindamycin sensitive and all of which were confirmed by Double disk diffusion method. Eleven strains were mef (A) positive, and 12 strains were erm (B) positive, in which 3 with erm (C). CONCLUSIONS: In our research the GBS strains show a high erythromycin and clindamycin resistance rate. The resistance of our GBS strains are mainly caused by the ribosomal target changes induced by erm (B) and the increased efflux of clindamycin induced by mef (A).

[Clinical characteristics of children with meningitis caused by Streptococcus pneumoniae and antibiotic resistance of Streptococcus pneumoniae strains].

OBJECTIVE: To study the clinical characteristics of children with meningitis caused by Streptococcus pneumoniae (SP) and the drug sensitivity of SP strains. METHODS: A retrospective analysis was performed on the clinical data of 14 children with SP-infected meningitis between September 2008 and March 2014. RESULTS: Of the 14 cases, 8 cases (57%) aged under 2 years. 13 cases (93%) had fever, 9 cases (64%) had convulsions, and 7 cases (50%) were complicated by septicemia. Eleven cases (79%) had elevated white blood cell (WBC) counts and 10 cases (71%) had elevated serum C-reactive protein (CRP) levels. All 14 children had an elevated nucleated cell count and neutrophils were identified as the predominant cell type. CSF protein>1000 mg/dL was noted in 9 cases (64%). Ten cases (71%) were cured, 2 cases (14.2%) with sequelae and 2 cases (14.2%) died. The drug sensitivity analysis showed that SP had resistance rates of more than 60% to penicillin, erythromycin, clindamycin, tetracycline and sulfa, but it was sensitive to amoxicillin (93%), vancomycin (100%), chloramphenicol (100%) and levofloxacin (100%). CONCLUSIONS: The clinical characteristics of children with meningitis caused by SP are not different from those with meningitis caused by other bacteria. SP strains are resistant to common antibiotics used in clinical practice, so it is important to monitor the drug resistance of the strains.

[Species and drug resistance of pathogens in blood cultures from the pediatric hematology ward].

OBJECTIVE: To investigate the species and percentage changes of pathogens in blood cultures from the pediatric hematology ward, and to analyze the drug resistance of main pathogens and the risk factors for positive blood culture (sepsis). METHODS: A retrospective analysis was performed to analyze the species and drug sensitivity of the pathogens isolated from 2358 blood cultures from the pediatric hematology ward of the West China Second University Hospital between 2008 and 2011, as well as the related clinical data. RESULTS: A total of 110 strains of pathogens were isolated, with Escherichia coli (16 strains), Pseudomonas aeruginosa (12 strains) and Staphylococcus epidermidis (8 strains) being the most common ones. From 2008 to 2011, the percentage of Gram-positive bacteria decreased, while the percentage of Gram-negative bacteria increased. The detection rates of methicillin-resistant coagulase-negative Staphylococci and methicillin-resistant Staphylococcus aureus were 69% and 43% respectively, but both were sensitive to vancomycin. The detection rates of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and ESBL-producing Klebsiella pneumoniae were 69% and 62% respectively, but both were sensitive to imipenem and meropenem. Malignant tumor was a risk factor for positive blood culture (OR=3.564, P<0.05). CONCLUSIONS: A wide range of pathogens are responsible for bloodstream infection in the pediatric hematology ward and the percentages of bacteria are changing; these pathogens have a high drug resistance rate. Malignant tumor is a risk factor for positive blood culture in the pediatric hematology ward.

[Common pathogens and clinical characteristics of neonatal pneumonia].

OBJECTIVE: To study common pathogens and their antibiotic susceptibility as well as clinical characteristics of neonatal pneumonia. METHODS: A retrospective study on neonatal pneumonia was performed. The study investigated antibiotic susceptibility of four common pathogens (339 strains) that caused neonatal pneumonia. Clinical characteristics of the newborns with pneumonia were analyzed. Of the 339 strains, 185 were isolated from bronchial secretions, 72 from blood samples, and 82 with positive results of both samples. RESULTS: Four hundred and seventy-four neonates with pneumonia presented positive results of bacterial culture. the most common pathogens Staphylococcus aureus (21.9%), Escherichia coli (19.2%), Klebsiella pneumoniae (19.0%) and Enterobacter cloacae (11.4%). The birth weight of newborns infected with Staphylococcus aureus was generally normal, and the time of hospital admission was later (after 24 hours of life). In contrast, the newborns with gram-negative bacterial infection, especially Klebsiella pneumoniae infection, had lower birth weights and early time of hospital admission (within 24 hours of life). Nearly more than 50% gram-negative bacteria were resistant to second, third and forth generation cephaloporins. CONCLUSIONS: Gram-negative bacteria are predominant pathogens of neonatal pneumonia. Neonatal pneumonia caused by gram-negative bacteria is common in newborns with low birth weight and its onset time is relatively earlier. Gram-negative bacteria that cause neonatal pneumonia are highly resistant to cephaloporins.

[Clinical characteristics and pathogens of invasive fungal infections in children].

OBJECTIVE: To study the clinical characteristics and pathogens of invasive fungal infection in children. METHODS: The clinical data of 104 children who suffered from invasive fungal infections between 2008 and 2012 was retrospectively reviewed. RESULTS: Of the 104 cases, 20 occurred in neonates, 48 in infants and 36 in preschool and school-aged children (old-aged children). Prematurity (70%), hyaline membrane disease (45%) and pneumonia (30%) were commonly comorbid in the neonate group. In addition, the percentage of cases receiving total parenteral nutrition was higher in the neonate group than in the other two age groups (P<0.01). Mechanical ventilation was more frequent in neonate and infant groups than in the old-aged children (P<0.01). Hematological malignancy was the most common underlying disease, and the percentage of children who had neutropenia and accepted chemotherapy was higher in the old-aged children than in the other two age groups (P<0.05). Lung infection was the most common (61.5%), followed by sepsis (14.4%) and intestinal tract infection (12.5%), while nervous system infections were found only in old-aged children. A total of 105 strains of fungi were isolated from the 104 patients, including Candida (n=90, 85.7%), Cryptococcus (n=6) and others (n=9). The most commonly isolated species was Candida albicans (n=52, 49.5%). Non-Candida albicans Candida accounted for 36.2% (n=38). The rate of susceptibility of Candida species to 5-fluorocytosine and amphotericin B was higher than fluconazole. CONCLUSIONS: Invasive fungal infections can occur in children at various ages. There are differences in the risk factors for invasive fungal infections between age groups. Candida species are the main pathogens of childhood invasive fungal infections, and both Candida albicans and non-Candida albicans Candida are common. Fluorocytosine and amphotericin B are sensitive antifungal agents for infections caused by Candida species.

[Metabolic syndrome is an independent risk factor for cardiovascular disease events in patients with ischemic stroke].

OBJECTIVE: To explore the association between metabolic syndrome (MS) and risk of cardiovascular disease events (CVD) in patients with ischemic stroke. METHOD: A total of 1087 patients with ischemic stroke were enrolled from 5 community-based medical centres and underwent baseline evaluation on risk factors of stroke during the period of Jan. 2003 to Dec. 2006. After baseline survey, all patients were followed up until Dec 31, 2008 and new CVD events were recorded. MS was defined using CDS criteria. Proportional hazard models were used to assess the HRs and 95% CI of CVD events associated with MS and other components. RESULTS: The prevalence of MS was 40.4% at baseline. During an average follow-up of 3.5 years, 178 patients developed new CVD events. After adjusted for age, gender, smoking, drinking, marriage status, education level, hospitalization, recurrence of stroke, stroke duration, depression, cognition impairment and ADL, MS remains the independent predictor for the risk of CVD events. Compared with patients with non-MS, the risk of CVD events increased by 44% (HR: 1.44, 95%CI: 1.06 - 1.95). The risk of CVD also increased with the number of MS components. Compared with patients with 1 or less than 1 components of MS, the risk of CVD events increased by 30% (HR: 1.30, 95% CI: 0.83 - 2.04) in those with 2 components and by 69% (HR: 1.69, 95%CI: 1.11 - 2.56) in those with 3 or more components of MS. Hypertension and hyperglycemia and impaired fasting glucose also served as independent risk factors for CVD event (all P < 0.001). CONCLUSIONS: MS was independently associated with increased risk of CVD events in patients with ischemic stroke. There was a dose-response relationship between the numbers of MS components and the risk of CVD event.