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Objective To investigate the expression of programmed death ligand 1(PD-L1) in primary tumor cells(TCs) and tumor-infiltrating immune cells(TICs) in patients with liver metastases from colorectal cancer(CRC) and determine its predictive value for recurrence after microwave ablation(MWA) of liver metastases. Methods The paraffin-embedded specimens of 28 patients with CRC liver metastasis were collected retrospectively. The expression of PD-L1 in the primary lesions was detected by immunohistochemistry, and the relationship between PD-L1 and clinical features was analyzed. Recurrence-free survival(RFS) was analyzed by Kaplan-Meier method and Log rank test. Cox proportional hazards regression model was used to analyze the factors influencing recurrence. Results The positive rates of PD-L1 in TCs and TICs in primary CRC were 14.3%(4/28) and 46.4%(13/28), respectively. PD-L1 expression in primary TICs of CRC patients with liver metastases was significantly correlated with the largest hepatic tumor diameter (P < 0.05). PD-L1 expression in primary TICs of CRC patients with liver metastasis was correlated with poor RFS after MWA (P < 0.05). PD-L1 expression in primary TICs and the largest hepatic tumor diameter > 3 cm in CRC patients with liver metastases were the risk factors for recurrence after MWA (P < 0.05). Conclusion PD-L1 expression in primary TICs of CRC patients with liver metastasis may increase the risk of recurrence after MWA for liver metastasis.
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Objective:To investigate the etiological characteristics and drug resistance patterns of multidrug-resistant organism (MDRO) infection in patients after cardiac surgery, so as to help clinicians rationally prescribe antimicrobials recommended by guidelines, increase the success rate of empirical antibacterial therapy and improve the prognosis of inpatients.Methods:Clinical data of 409 patients diagnosed with nosocomial infection (NI) after cardiac surgery from January 2018 to October 2021 were retrospectively collected. According to the results of culture, these cases were divided into two groups: MDR bacterial infection group (MDR, n=176) and non-MDR bacterial infection group (non-MDR, n=233). The etiological characteristics of MDRO infection and the patterns of drug resistance to commonly used clinical antibiotics were analyzed. Meanwhile, the etiological distribution, drug resistance and clinical outcome corresponding to different surgical types and clinical infection types were statistically analyzed. Results:A total of 306 strains of MDR bacteria were detected. Among the 176 patients, 97 (55.1%) were infected with more than one kind of MDRO and the mix infections were mainly caused by Klebsiella pneumoniae, Acinetobacter baumannii and/or Pseudomonas aeruginosa. Carbapenem-resistant (CR) bacteria accounted for 69.6% (213/306). Regardless of surgical type and clinical infection type, Acinetobacter baumannii (114/306, 37.3%) was the most common pathogenic bacteria, followed by Klebsiella pneumoniae (72/306, 23.5%) and Pseudomonas aeruginosa (55/306, 18.0%). Most of the clinical specimens were sputum specimens (528/601, 87.9%) and most of the isolated strains were carbapenem resistant, MDR and extensively drug-resistant (XDR). The positive rates of MDR bacteria were 53.7% and 53.1% in patients undergoing coronary artery bypass grafting (CABG) and aortic surgery, respectively, while the positive rates of pandrug-resistant bacteria were relatively low. In vitro drug sensitivity test results showed that MDR bacteria were highly resistant to levofloxacin (64.4%) and cefepime (61.4%), and then to ciprofloxacin (54.6%), ceftazidime (53.9%) and cotrimoxazole (52.4%). However, the resistance rates to polycolistin (5.5%) and amikacin (7.2%) were low. Compared with non-MDR bacteria, MDR bacteria were less susceptible to ceftazidime (χ 2=156.663, P<0.001), ceftriaxone (χ 2=27.844, P<0.001), cefepime (χ 2=210.181, P<0.001), imipenem (χ 2=173.242, P<0.001), levofloxacin (χ 2=201.521, P<0.001), ciprofloxacin (χ 2=180.187, P<0.001), amikacin (χ 2=16.661, P<0.001), gentamicin (χ 2=46.047, P<0.001), tobramycin (χ 2=106.546, P<0.001), piperacillin (χ 2=7.325, P=0.007), ampicillin/sulbactam (χ 2=5.415, P=0.020), piperacillin/tazobactam (χ 2=139.506, P<0.001), cefoperazone/sulbactam (χ 2=102.832, P<0.001), cotrimoxazole (χ 2=121.217, P<0.001), aztreonam (χ 2=6.977, P=0.008) and minocycline (χ 2=53.107, P<0.001). Although there was no significant difference in the detection rates of pathogenic bacteria between patients undergoing different types of surgery or having different types of infection, the mortality rate of NI after cardiac surgery, especially MDR bacterial infection, was as high as 30.0%. Moreover, the mortality rate was closely related to the types of clinical infection. The all-cause mortality of common pulmonary infection and bloodstream infection (BSI) was 10.0% to 20.0%, and once the patient′s condition was not under control and progressed to severe infection or even septic shock, the all-cause mortality would double. Conclusions:MDR bacterial infections would bring great challenges to patients after cardiac surgery, especially gram-negative bacteria (GNB) such as Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa. More than half of the patients would have mixed infections caused by carbapenem resistant, XDR or even pandrug-resistant bacteria, resulting in limited choice of anti-infective drugs and poor prognosis in hospitalized patients.
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China still has more than 30,000 patients of advanced schistosomiasis while new cases being reported consistently. D-dimer is a fibrin degradation product. As ascites being the dominating symptom in advanced schistosomiasis, the present study aimed to explore a prediction model of ascites with D-dimer and other clinical easy-achievable indicators. A case-control study nested in a prospective cohort was conducted in schistosomiasis-endemic area of southern China. A total of 291 patients of advanced schistosomiasis were first investigated in 2013 and further followed in 2014. Information on clinical history, physical examination, and abdominal ultrasonography, including the symptom of ascites was repeatedly collected. Result showed 44 patients having ascites. Most of the patients' ascites were confined in the kidney area with median area of 20 mm². The level of plasma D-dimer and pertinent liver function indicators were measured at the initial investigation in 2013. Compared with those without ascites, cases with ascites had significantly higher levels of D-dimer (0.71±2.44 μg/L vs 0.48±2.12 μg/L, P=0.005), as well ALB (44.5 vs 46.2, g/L) and Type IV collagen (50.04 vs 44.50 μg/L). Receiver operating characteristic curve analyses indicated a moderate predictive value of D-dimer by its own area under curve (AUC) of 0.64 (95% CI: 0.54–0.73) and the cutoff value as 0.81 μg/L. Dichotomized by the cutoff level, D-dimer along with other categorical variables generated a prediction model with AUC of 0.76 (95% CI: 0.68–0.89). Risks of patients with specific characteristics in the prediction model were summarized. Our study suggests that the plasma D-dimer level is a reliable predictor for incident ascites in advanced schistosomiasis japonica patients.
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Humanos , Área Sob a Curva , Ascite , Estudos de Casos e Controles , China , Estudos de Coortes , Colágeno Tipo IV , Fibrina , Rim , Fígado , Exame Físico , Plasma , Estudos Prospectivos , Curva ROC , Schistosoma japonicum , Esquistossomose Japônica , Esquistossomose , UltrassonografiaRESUMO
Objective To evaluate whether an intervention with a health promotion program can reduce prevalence of the health risk factors of non-communicable chronic diseases (NCD) and improve the knowledge awareness of NCD prevention of employees from a security corporation in Beijing selected by the study team. Methods A cross-sectional study was conducted by selecting 157 employees of a security corporation in Beijing, and a quasi-experiment method and a self-developed Questionnaire of Intervention for Health Risk Factors were used. Based on the results of the distribution of risk factors for NCD and the focus-group discussion, one year health promotion program intervention was performed. According to the comparison of prevalence of risk factors between baselines and after intervention of the studied employees, the intervention effectiveness was evaluated. Results After the health intervention, rate of reported unhealthy diet reduced from 75.0%to 56.8%, which showed statistically significant (?2=8.53, P0.05). The median value of health knowledge awareness of the studied employees was significantly improved from 10.20 to 11.33(S=-2 545, P<0.05) and awareness of recommended daily intake of dietary salt increased significantly from 46.20%to 67.09%after intervention (χ2=17.85, P<0.05). Conclusion The non-communicable chronic diseases intervention program can reduce the health risk factors and improve health knowledge awareness of the studied population.
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Objective To study the clinical curative effect of syndrome differentiation-based treatment with traditional Chinese medicine on patient with Chronic Kidney Disease (CKD3-4). Method According to prospective multicenter randomized controlled study which was applied to the patients with CKD3-4 , the total of 339 patients were divided into two groups. To one group as standard including 167 patients ,the other including 172 patients. Chinese Traditional Patent Medicine single or combined-prescription oral treatment according to syndrome differentiation-based treatment was employed. To the other group as reference , Chinese Traditional Patent Medicine oral treatment according to experienced rule was applied. The clinical curative effect results were obtained after a 24 weeks-treatment. Result The Scr ,eGFR and UTP with CKD3 in standard group illustrate statistics significance (P 0.05). The clinical curative effect result of patient in standard group was better than that of reference group. About the clinical curative effect of CKD4, no statistics significance difference (P > 0.05) could be found between groups or between patients in one group. The TCM score of patient with CKD3-4 in standard group have improved (P 0.05). Conclusion Syndrome differentiation-based treatment with traditional Chinese medicine illustrated a better result in protection of renal function, reduction in urinary protein and decline in TCM score than the treatment according to experienced rule.
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Objective To understand the affecting factors of health and health promotion needs of one company staff so as to provide evidence for effective health intervention.Methods A convenience sampling method was used to enroll subjects in this cross-sectional study.All the participants were required to fill in a questionnaire to learn their demographics,health related factors and health promotion needs in the 2 work days of June 2012 had been studied.Chi-square test and unconditional logistic regression were used for data analysis.Results More males showed higher risk of disease than females (x2 =5.394,P < 0.05).In conditional logistic regression,age was the main factor affecting health (odds ratio (OR) =3.127,95% (confidence interval) CI 1.020-9.591,P < 0.05) when gender,marital status,educational level and occupation were adjusted.Dietary nutritional knowledge (69.6%) and physical check-up (64.6%) were urgent needs among those surveyed.Conclusion Staff with varied demographic characteristics have different health related factors and physical check-up may provide a tool to meet their urgent needs of health promotion.
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Objective To evaluate the diagnostic value of H-FABP for early detection of acute myocardial infarction(AMI). Methods Serum H-FABP of 126 healthy individuals and 53 AMI patients were measured by self developed ELISA. MYO, cTnI and CK-MB, traditional biochemistry diagnostic markers were estimated at the same time. The dynamic movement of these myocardial indicators for AMI patients, and their diagnostic sensitivity and specificity in the earlier period of AMI onset was analyzed. Results The plasma concentration of H-FABP began to increase at (1.84?0.64) h after AMI onset, earlier than CK-MB and cTnI. The time-concentration dynamic curves of H-FABP was similar to that of MYO and moved to left in comparison with both CK-MB and cTnI. The sensitivity and specificity of H-FABP at 2 h after AMI were 76.47% and 80.41%, and 89.16% and 91.26% at 4 h, respectively;. Conclusions H-FABP is more sensitive and specific in the early diagnosis of AMI within 2 hours and at 4 hours after symptom onset. It is hoped that H-FABP become an important myocardial marker for both early diagnosis and elimination diagnosis of AMI.
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Growth kinetics and diosgenin production by Dioscorea zingiberensis cells under suspension culture were studied. Effect of different culture media and hormones on the yield of diosgenin and growth of callus were compared. The results may provide a scientific basis for the selection of optimum condition for continuous cell culture of D. zingiberensis.