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ObjectiveTo investigate the clinical application value of a predictive model for the efficacy of third-generation cephalosporin in the treatment of community-acquired spontaneous bacterial peritonitis （CASBP）. MethodsThis prospective study was conducted among 50 patients with liver cirrhosis and CASBP who were admitted to The Ninth Hospital of Nanchang from January 2021 to June 2022， and the patients were randomly divided into optimized treatment group and traditional treatment group， with 25 patients in each group. The patients in the optimized treatment group received ceftazidime or imipenem for initial treatment based on the above predictive model， and those in the traditional treatment group received ceftazidime for initial treatment， with the subsequent use of antibiotics adjusted based on the efficacy of initial treatment. The two groups were compared in terms of the response rate of initial treatment， cure rate on day 5， and 30-day mortality rate. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups， and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. ResultsAll patients completed the study. The optimized treatment group had a significantly higher response rate of initial treatment than the traditional treatment group （88.0% vs 60.0%， χ2=5.094， P=0.024）， while there was no significant difference in the cure rate on day 5 between the two groups （80.0% vs 56.6%， χ2=3.309， P=0.069）. As for the patients who received ceftazidime for initial treatment， the optimized treatment group had a significantly higher response rate of initial treatment than the traditional treatment group （88.9% vs 60.0%， χ2=4.341， P=0.037）， while there was no significant difference in the cure rate on day 5 between the two groups （83.3% vs 56.0%， χ2=2.425， P=0.119）. There was no significant difference in 30-day mortality rate between the two groups （8.0% vs 20.0%， χ2=0.664， P=0.415）. For all patients， there was a significant association between response of initial treatment and cure on day 5 （odds ratio ［OR］=9.643， 95% confidence interval ［CI］： 2.292 — 40.564） and between cure on day 5 and 30-day mortality （OR=0.138， 95%CI： 0.023 — 0.813）. ConclusionThis predictive model for efficacy helps clinicians to identify the patients who can benefit from third-generation cephalosporin treatment and improve the efficacy of third-generation cephalosporin in the initial empirical treatment of CASBP.
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Objective To observe the effect of 15°-head up tilt position on quality of respiratory system during anesthesia recovery period in obese patients.Methods Eighty obese patients in ASA physical status Ⅰ or Ⅱ,aged 18-60 years,with BMI≥28 kg/m2,scheduled for elective otological surgery with microscopy,were randomly divided into 2 equal groups (n =40 each):the 15°-head up tilt position group (group H) and the supine position group (group C).With traditional induction,an esthesia was maintained by TCI of propofol 2-4 μg/ml and remifentanil 5-6ug/ml,not supplying muscle relaxant during operation.After operation,group H was in 15°-head up tilt position,while group C in supine position.The time spans from recovery of spontaneous breathing to meeting the extubation standard (X) and to meeting the standard for discharging form PACU (Y) were recorded.After extubation,we also recorded the time for SpO2decreased from 100％ to 92％ with fresh air (Z) and for SpO2 increased from 92％ to 100％ with pure oxygen (W).PaO2,PaCO2 and pH were monitored before oxygen inhalation,after 3 min of oxygen inhalation,at the end of surgery,before extubation and before discharging from PACU.Results Compared with group C [(19±6) min,(57±10) min,(51 ±9) s],the time of X (14±7) min,Y (45±7) min and W (39±11) s,was significantly shorter and the time of W was obviously longer in group H(P＜0.05).Compared with group C [(169.1± 29.4) mm Hg,(70.8±4.1) mm Hg],the PaO2was increased obviously before extubation and discharging from PACU in group H [(193.4±30.5) mm Hg,(82.2±3.4) mm Hg](P＜0.05).There was no significantly difference in PaO2 at other time points.There was no significantly difference in PaCO2and pH at all points.Conclusion 15°-head up tilt position during anesthesia recovery period in obese patients can effectively improve the quality of respiratory system.
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To investigate the effect of pancreatic elastase on diabetic nephropathy,104 cases of type Ⅱ diabetic patients were selected as control group and group treated with elastase separately for a course of 6 months.The results showed that pancreatic elastase reduced microproteinuria significantly,especially mi- croalbuminuria and microtransfer rrinuria which reflect the glomerular filtration rate.It was concluded that elastase could improve early diabetic nephropathy and might have some protective effect as well.At the same time,elastase had some good effect on lipid and lipoprotein metabolism.
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The relationship between blood pressure and various risk factors were investigated in 54 cases of non-insulin-dependent diabetes mellitus (NIDDM) with stepwise regression analysis. After evaluating the influence of age, course, body mass index (BMI), fasting and postprandial blood glucose, serum IRI, C-peptide, HbA1c, plasma lipids (Ch, TG, HDL-C. LDL-C). ApoA1, ApoB2, 24h urine Alb/Cr, NAG/Cr. TRF Cr and RBP/Cr levels on blood pressure, the following results were found: 1) NIDDM patients had a two-fold increased risk of hypertension than normal population. 2) Among the 21 risk factors analysed, 6 variables were strongly correlated with blood pressure, i. e. , age, postprandial blood glucose, serum IRI, blood total cholesterol, 24h urine Alb/Cr and TRF/Cr level. 3) Postprandial hyperglycemia was the most important variable positively correlated with hypertension, followed by 24h urine Alb/Cr and plasma total cholesterol.
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Objective To investigate the relationship between serum nitric oxide (NO) and bone metabolism in streptozotocin induced early diabetic (STZ DM) rats. Methods Twenty SD rats were divided into 2 groups, 12 STZ DM rats and 8 controls. Fasting blood glucose, HbA 1c , serum insulin, bone mineral density (BMD) (whole body, lumbar and femoral bone), bone metabolic parameters 〔such as serum calcium, vitamin D 3, parathyroid hormone (PTH), calcitonin, osteocalcin, and urinary pyridinoline/creatinine〕, as well as serum NO were measured. Results Compared with the controls, serum NO in STZ DM group significantly elevated 〔(51.3?11.9 vs 38.1?12.0)?mol/L, P