Role of thromboelastography in assessing the risk of spontaneous bleeding in patients with liver cirrhosis / 临床肝胆病杂志

ObjectiveTo investigate the association between thromboelastography (TEG) parameters and bleeding in patients with liver cirrhosis and whether TEG can be used to predict the risk of spontaneous bleeding in patients with liver cirrhosis, and to provide a basis for its preventive treatment. MethodsA retrospective analysis was performed for the clinical data of 174 patients with liver cirrhosis who attended Huadu People’s Hospital from May 2018 to April 2020 and did not receive invasive procedure, and according to the condition of bleeding, they were divided into non-bleeding group(n=64), gastrointestinal bleeding group(n=61), and mucocutaneous/oronasal bleeding group(n=49). The medical record system and laboratory information system were used to collect related information and laboratory test results for statistical analysis. The t-test was used for comparison of normally distributed continuous data between two groups; an analysis of variance was used for comparison between multiple groups, and the least significant difference t-test was used for further comparison between two groups. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups, and the Kruskal-Wallis H test was used for comparison between multiple groups. MedCalc software was used for receiver operating characteristic (ROC) curve analysis, and the area under the ROC curve (AUC) was calculated for commonly used coagulation markers and TEG parameters in predicting the risk of bleeding in patients with liver cirrhosis. Cut-off value, sensitivity, specificity, positive predictive value, and negative predictive value were determined, and the Z test was used for comparison of indices in predicting mucocutaneous/oronasal bleeding. ResultsOf all 174 patients, 110 (63.2%) experienced spontaneous bleeding, among whom 61 (55.5%) had gastrointestinal bleeding and 49 (44.5%) had mucocutaneous/oronasal bleeding. There were significant differences in maximum amplitude (MA) and K between the bleeding group and the non-bleeding group (t=2.241 and -2.605, both P＜0.05). There were significant differences between the mucocutaneous/oronasal bleeding group and the non-bleeding/gastrointestinal bleeding groups in platelet count (PLT) and the TEG parameters of clot formation time, a-angle, MA, and coagulation index (CI) (F=3.947, H=12.867, F=4.007, F=8.498, F=5.420, all P＜0.05). Among the TEG parameters, reaction time and Lys30 were generally within the normal range, while there was a prolonged kinetics (K) time and reductions in a-angle, MA, and CI. PLT ≤40×109/L, MA ≤357 mm, K time ＞4.2 minutes, a-angle ≤51.6, and CI ≤-5.9 could be used to predict spontaneous mucocutaneous/oronasal bleeding in patients with liver cirrhosis (all AUC ＞0.7), with positive predictive values of 82.4, 88.9, 81.0, 72.7, and 73.7, respectively, and negative predictive values of 68.3, 72.5, 73.0, 69.4, and 66.7, respectively. ConclusionPLT and the TEG parameters of K time, a-angle, MA, and CI can predict spontaneous bleeding caused by abnormal coagulation in liver cirrhosis, while conventional coagulation parameters prothrombin time and activated partial thromboplastin time cannot predict such bleeding, which provides a basis for the treatment of coagulation disorder and transfusion of blood components for patients with liver cirrhosis.

The Dynamic change and clinical significance of C-reactive protein and platelet in patients with acute brain injury / 国际检验医学杂志

Objective To investigate C‐reactive protein in patients with acute brain injury (CRP) ,platelet (PLT) dynamic chan‐ges and clinical significance .Methods A hospital in 2014-2015 120 cases of acute brain injury ,depending on whether surgery di‐vided into :64 cases of surgical group ,56 cases of non‐surgical group .According to Glasgow Outcome Scale (Glasgow Outcome Score ,GOS) divided into 61 cases of poor prognosis group (GOS 1 -3 scores) ,59 patients with good prognosis (GOS 4 -5 scores) .Another choice the same period 50 cases of healthy control group .After the patients were injured 1 d ,3 d ,7 d dynamic tes‐ting CRP ,PLT levels .Results The surgical group and the non‐surgical group patients after injury 1 d serum CRP levels were sig‐nificantly increased ,decreased gradually after all ,the two groups showed a downward trend ,but the surgery group were decreased slowly ,always maintain a high level ,still significantly at 14 d the control group (P<0 .05) .Patients with non‐surgical group de‐creased significantly ,significantly higher than the decline in the extent of the surgery group (P<0 .05) .Surgical and non‐surgical group patients after injury when PLT 1 d showed no increased after 3d began to rise ,increased significantly when 7 d ,PLT levels were elevated degree of surgical group was significantly higher than the non‐surgical group (P<0 .05) .Good prognosis group and a poor prognosis group ,serum CRP on admission were increased ,and reached a peak after 1 d ,after declining in both groups ,with good prognosis group decreased significantly ,while the poor prognosis group ,no significant decline in CRP levels ,continued high levels of state for a long time When postoperative 7d still significantly higher than the normal level (P<0 .05) .At each time point the poor prognosis group ,serum CRP levels were significantly higher than the good prognosis group (P< 0 .05) .When the good prognosis group and a poor prognosis group was mean change 1d PLT little water ,began to increase after the 3 d were poor progno‐sis group of patients was significantly higher than 7 d PLT good prognosis group (P<0 .05) .Conclusion Patients with acute brain injury CRP ,PLT dynamic changes are certain rules ,is to determine the acute phase of the disease of brain injury and prognosis of change .

Analysis of drug resistance and drug resistance genes of imipenem-resistant Pseudomonas aeruginosa strains isolated from burn wards / 中华烧伤杂志

<p><b>OBJECTIVE</b>To analyze the drug resistance and drug resistance genes of imipenem-resistant Pseudomonas aeruginosa (IRPA) strains isolated from burn wards.</p><p><b>METHODS</b>From June 2011 to June 2012, 30 strains of IRPA were isolated from wound excretion, sputum, and venous catheter attachment from burn patients hospitalized in Guangzhou Hospital of Integrated Traditional Chinese and Western Medicine. Drug resistance of the IRPA to 12 antibiotics commonly used in clinic, including ceftazidime, amikacin, ciprofloxacin, etc., was tested with K-B paper agar disk diffusion method. Metallo-β-lactamase (MBL)-producing IRPA was detected by synergism test with imipenem-2-mercaptoethanol. Plasmid of IRPA was extracted, and it was inserted into competent cells, producing transformation strains (TSs). Drug resistance of TSs to imipenem and the MBL-producing TSs were detected. The genes blaIMP, blaVIM, blaOXA-1, blaOXA-2 and blaOXA-10 of IRPA and the TSs were detected by polymerase chain reaction. The drug resistance of IRPA producing MBL or OXA enzyme was summed up.</p><p><b>RESULTS</b>The sensitive rates of the 30 strains of IRPA to the 12 antibiotics were equal to or above 60.0%. Six strains of MBL-producing IRPA were screened. Twenty-four TSs were resistant to imipenem, and 6 strains among them were MBL-producing positive. Among the 30 strains of IRPA, 6 strains and their corresponding TSs carried blaVIM; 20 strains and their corresponding TSs carried blaOXA-10; no strain was detected to carry blaIMP, blaOXA-1 or blaOXA-2. Two strains and their corresponding TSs were detected carrying both blaVIM and blaOXA-10. No significant difference of drug resistance was observed between strains producing only MBL or OXA enzyme, with the same high resistance to β-lactam antibiotics and some degree of sensitivity to aminoglycoside antibiotics. Strains producing enzymes MBL and OXA were all resistant to the 12 antibiotics.</p><p><b>CONCLUSIONS</b>IRPA strains isolated from burn wards of Guangzhou Hospital of Integrated Traditional Chinese and Western Medicine are multidrug-resistant, and they mainly produce type B and D carbapenemases.</p>

Rep-PCR and plasmid profile analysis for typing Klebsiella pneumoniae strains / 中华检验医学杂志

Objective To establish the rep-PCR DNA fingerprinting technique for typing K. pneumoniae strains and apply it in the epidemiological investigation.Methods The 39 strains of K. pneumoniae were typed by plasmid profile analysis, then their chromosomal DNA were extracted and purified by NaI-lyses-glass-powder absorption method for rep-PCR. Results Different strains of K.pneumoniae showed different rep-PCR fingerprint patterns. Phylogenetic analysis showed that they could be classified into six types, mainly type 1, type 2, and type 3. Otherwise, plasmid profile analysis suggested that there were four types; mainly type 1 which contained only one plasmid.Conclusions (1) Rep-PCR DNA fingerprinting technique developed in this study is enough for epidemiological studies with its high typeability, strong discrimination, simplicity and rapidness. (2) There were three predominant K. pneumoniae transmitted between patients in Taihe Hospital during the last two years, and there might be serious cross-infection among different types.