الملخص
Objective:To analyze the epidemiological and clinical characteristics of brucellosis patients in Altay City of Xinjiang Uygur Autonomous Region, and to provide basis for prevention and treatment of brucellosis.Methods:Using retrospective analysis, the clinical data of 141 patients with brucellosis admitted to Beitun Hospital in Altay City from 2016 to 2018 were collected, and their epidemiological characteristics, clinical manifestations, laboratory examinations, treatment and outcome were analyzed.Results:In 141 cases of brucellosis patients, there were 100 males and 41 females, with a sex ratio of 2.4∶1.0; the age was (44.8 ± 15.7) years old, ranging from 3-86 years old. The age of onset was mainly 41-60 years old, accounting for 48.9% (69 cases); the occupation distribution was mainly farmers and herdsmen, accounting for 42.6% (60 cases); the onset time was mainly from April to September, accounting for 71.6% (101 cases); and 54.6% (77 cases) had a definite contact history. The patients in acute stage, chronic stage and subacute stage accounted for 71.6% (101 cases), 27.7% (39 cases) and 0.7% (1 case), respectively. The clinical manifestations were mainly fatigue, fever, and hyperhidrosis, which were 101 (71.6%), 97 (68.8%), and 68 cases (48.2%), respectively; those with joint pain, lymphadenopathy, splenomegaly, hepatomegaly, testicular swelling and pain were 98 (69.5%), 54 (38.3%), 35 (24.8%), 22 (15.6%), and 11 cases (7.8%), respectively. Serum rose-bengal plate agglutination test of 141 patients with brucellosis were all positive, 116 cases (82.3%) were positive by standard tube aglutination test, and 49 cases(34.8%) were positive by blood culture. There were 16 (11.3%), 22 (15.6%), and 24 cases (17.0%) with leukocyte, hemoglobin, and platelet reduction, respectively; and 58 cases(41.1%) with accelerated erythrocyte sedimentation rate. The aspartate aminotransferase and alanine aminotransferase were elevated in 61 (43.3%) and 68 cases (48.2%), 63 cases (44.7%) were elevated in myocardial enzymes, and 98 cases (69.5%) were elevated in C-reactive protein. After treatment, 141 cases of brucellosis had no symptoms of fever, fatigue and hyperhidrosis; among 98 patients with joint pain, 76 cases had pain disappeared and 22 cases had obvious pain relief. After 3 and 6 months of follow-up, the patients in both acute and subacute stages had recovered and no recurrence had been seen; there were still 8 cases in the chronic stage with mild joint pain.Conclusion:Most of the brucellosis patients in Altay City, Xinjiang Uygur Autonomous Region are middle-aged men, with fever and fatigue as the main clinical manifestations, and always accompanied by joint pain; more patients have liver and heart damage; the curative effect and prognosis of patients in acute stage are better after treatment.
الملخص
Objective To investigate the multimodal imaging characteristics of central serous chorioretinopathy (CSC) converted to polypoidal choroidal vasculopathy (PCV) and pachychoroidal neovascularization(PNV).Methods A retrospective case series study was adopted.The clinical data of 91 eyes from 79 patients with CSC who received treatment from June 2009 to September 2017 in Shenzhen Eye Hospital were analyzed.Color fundus photography,fundus fluorescein angiography (FFA),spectral domain optical coherence tomography (SD-OCT) and indocyanine angiography (ICGA) were performed in the patients.The eyes with recurrence or maintained serous retinal pigment epithelium (RPE) after treatment were examined once more.Results In 91 eyes,11 eyes of 9 patients converted to PNV.Late stage of FFA showed multifocal hyperfluorecnece in macular area.ICGA showed plaque hyperflurorescence overlying dilated choroidal vessel.OCT revealed irregular flap shallow RPE detachment with retinal neurosensory detachment.OCTA revealed mass-like enlarged choroidal vessel between RPE and Bruch membrane.Nine eyes of 7 patients with CSC converted to PCV,and late stage of FFA showed serous-hemorrhage pigment epithelium detachment(PED) and multifocal enlargement hyperfluorecnece.ICGA showed branch vessels network (BVN) with small polyps.OCT revealed PED like thumb with double-layer sign and retinal neurosensory detachment.OCTA en-face revealed BVN with small polyps at choroidal capillaries layer.The baselines BCVA of PCV and PNV (LogMAR) was 0.282±0.220 and 0.413±0.190,respectively with a significant difference between them (t =0.037,P ＜ 0.05).Subfoveal choroidal thickness (SFCT) of CSC,PCV and PNV patients was (373.61 ±65.11),(296.22 ±30.24) and (328.63 ±76.18) μm,with siginificant differences among them (F =3.48,both at P＜0.05).SFCT of PNV patients was thicker than that of PCV patients,with a significant difference between the two groups (t =2.91,P＜0.05).Conclusions Chronic or recurrence CSC is probably to develop to PNV,and the PNV with serous or hemorrhage PED is probably to switch to PCV.Multimodal imaging examination is helpful to the diagnosis of PNV and PCV.
الملخص
Objective To investigate the clinical effect of nicorandil for treatment of patients with acute respiratory distress syndrome (ARDS).Methods A prospective randomized controlled trial was conducted. A total of 40 cases of patients with ARDS admitted to Department of Critical Care Medicine of Guizhou Provincial People's Hospital from October 2012 to October 2014 were enrolled, and they were randomly divided into two groups, 20 cases in each group. The two groups were treated with routine western medicine after admission. On this basis, the observation group was given nicorandil 10 mg, while the control group was given warm boiled water 10 mL, through gastric tubes 3 times a day, the therapeutic course being consecutive 5 days in both groups. The length of stay in intensive care unit (ICU), duration of mechanical ventilation after treatment, oxygenation index (OI), alveolo-arterial oxygen partial pressure difference (PA-aO2), positive end-expiratory pressure (PEEP), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, Glasgow coma score (GCS) before and after treatment, the predicted death rate (PDR) and 28-day mortality were compared between the two groups. The predicitive factors for 28-day mortality were screened by binary logistic analysis.Results The length of stay in ICU and duration of mechanical ventilation of control group were longer than those of observation group, but the difference was not statistically significant [ICU length of stay (day): 14.55±12.71 vs. 9.15±6.00, duration of mechanical ventilation (day): 13.25±12.27 vs. 7.75±5.32, bothP > 0.05]. After treatment, the GCS was higher than that before treatment in control group and observation group (11.95±3.98 vs. 10.75±4.89, 12.95±3.67 vs. 12.20±4.56), while APACHE Ⅱ score, PDR and PEEP were all lower than those before treatment [APACHE Ⅱ: 21.05±8.58 vs. 24.90±5.63, 18.70±11.21 vs. 26.65±7.67; PDR: (47.71±29.49)% vs. (61.00±23.29)%, (36.79±18.49)% vs. (56.12±18.16)%; PEEP (cmH2O, 1 cmH2O = 0.098 kPa): 4.40±3.14 vs. 5.75±2.59, 3.80±2.55 vs. 7.55±3.32], but there were no statistically significant differences between the two groups before and after treatment (allP > 0.05). After treatment, the OI was significantly higher and the PA-aO2 was significantly lower than those before treatment in the two groups, and the degrees of improvement of the observation group were more remarkable than those of the control group [OI (mmHg, 1 mmHg = 0.133 kPa): 224.72±85.12 vs. 141.37±45.82, PA-aO2 (mmHg): 132.60±46.64 vs. 204.30±121.2, bothP 0.05). Binary logistic regression analyses showed that the PA-aO2 [odds ratio (OR) = 0.958,P = 0.013, 95% confidence interval (95%CI) = 0.927 - 0.991], APACHE Ⅱ score (OR = 0.882,P = 0.010, 95CI = 0.803 - 0.970), GCS (OR = 1.399, P = 0.004, 95%CI = 1.111 - 1.761) and PDR (OR = 0.907,P = 0.002, 95%CI = 0.853 - 0.965) after treatment were the independent predictors of 28-day mortality.Conclusion Nicorandil can significantly improve oxygenation, but cannot reduce 28-day mortality in patients with ARDS.