[An analysis of spectrum of allergen sensitization among patients with tree pollen allergy in Beijing].

Objective:To explore the feature of allergic sensitization of tree pollen and the relationship between tree pollen and airborne pollen in Beijing. Method:Two thousand five hundred and twenty-one patients with allergic diseases were enrolled between January to July in 2017 in an allergy department. All patients received SPT of 8 kinds of tree pollen. Result:①The overall tree pollen positive rate of SPT was 49.3% (1 244/2 521). Male had a higher positive rate than female (56.4% vs 45.0%, P<0.01) while child group had a higher positive rate than adult group (55.9% vs 48.6%, P<0.05). The poly sensitization was observed with a rate of 26.3%, take the percentage of 53.3% of the overall positive subjects. ②The highest sensitization rate was found in March (62.2%), followed by May (52.1%), the lowest was January (27.9%). There was a positive correlation between tree pollen sensitization rate and pollen count of each month (r=0.929, P<0.01). ③Cypress had the highest positive rate (34.6%), followed by poplar (21.3%), the lowest was sophora (13.3%). The sensitization rate was positively correlated with pollen count among different tree pollen (r=0.714, P<0.05). Conclusion:The main allergic pollen in Beijing was cypress. The tree pollen sensitization showed a seasonality with the peak in March. The sensitization status was tightly associated with the amount of airborne pollen.

Clinical and molecular characteristics of bloodstream infections caused by Candida albicans in children from 2003 to 2011.

We investigated the clinical and molecular characteristics of Candida albicans bloodstream infection (BSI) in children from a tertiary-level medical centre in Taiwan over a 9-year period from January 2003 to December 2011. We performed multilocus sequence typing (MLST) to investigate the genetic relatedness of these C. albicans BSI isolates. A total of 79 episodes of C. albicans BSI in 76 paediatric patients were identified, including 41 (51.9%) from the paediatric intensive care unit, 24 (30.4%) from the neonatal intensive care unit and 14 (17.7%) from general wards. More than half (59.5%) of these patients had underlying chronic co-morbidities, and the majority (94.9%) had a catheter or some other artificial device. All the isolates were susceptible to the antifungal agents tested. Only 32.9% (26/79) received effective antifungal agents within 24 h of onset of candidaemia. Twenty-five (31.6%) patients had persistent candidaemia (>3 days after the start of antifungal treatment) and candidaemia-attributable mortality rate was 22.8% (18/79). The 72 isolates available for MLST yielded 53 unique diploid sequence types (DSTs). Forty-five DSTs were singletons and eight DSTs were shared by 27 (37.5%) isolates. Seventy-one (98.6%) isolates were clustered within previously known clades. Based on the definition of two or more strains with shared DST occurring within a period of 90 days, 10.1% of the infections were categorized as nosocomial clusters, most commonly identified in the intensive care units. Although cluster-associated candidaemia was not associated with a higher mortality rate, none of the clusters were identified by the hospital infection control team.

Predictors of clinical and microbiological treatment failure in neonatal bloodstream infections.

This study aimed to identify independent predictors of clinical and microbiological treatment failure and develop a predictive model for neonates with bloodstream infection (BSI). This study included 1087 episodes of BSIs in 793 neonates in a tertiary-level neonatal intensive care unit of northern Taiwan between 2004 and 2012. Patient demographics, underlying chronic comorbidities, clinical features, antimicrobial treatment and microbiological characteristics were evaluated. The presence of underlying congenital anomalies (odds ratio [OR] 2.12, 95% confidence interval [CI] 1.09 to 4.10) and pulmonary hypertension (OR 3.63, 95% CI 1.70 to 7.74), infections caused by multidrug-resistant gram-negative bacteria (OR 2.89, 95% CI 1.23 to 6.79), group B Streptococcus (OR 3.15, 95% CI 1.33 to 7.46), and fungi (OR 4.13, 95% CI 2.02 to 8.46), a Neonatal Therapeutic Intervention Scoring System score of ≥ 23 (OR 6.96, 95% CI 2.55 to 28.58), inappropriate antibiotics (OR 2.13, 95% CI 1.41 to 3.23), and concomitant meningitis (OR 4.25, 95% CI 2.08 to 8.69) and ventilator-associated pneumonia (OR 2.73, 95% CI 1.22 to 6.13) were identified as independent risk factors for 28-day treatment failure in neonatal BSI. A risk score model was created by adding the points for each independent risk factor, and had a c-statistic of 0.83. Patients with risk scores of 0, 4, 8, 12 and 15 had estimated 28-day treatment failure rates of approximately 3.5%, 17.0%, 53.5%, 86.6% and 95.9%, respectively. This predictive model, calculated after documentation of a BSI, reflects a spectrum of BSI severity and was associated with subsequent treatment failure through illness severity score and case mix variables. This simple score could prove useful in clinical and research settings, and practical in estimating the prognosis.

Recurrent late-onset sepsis in the neonatal intensive care unit: incidence, clinical characteristics and risk factors.

We aimed to characterize the incidence, clinical features, risk factors and outcomes of recurrent late-onset sepsis (LOS) in the neonatal intensive care unit (NICU). All neonates with LOS from the NICU of a tertiary-level teaching hospital in northern Taiwan between 2004 and 2011 were enrolled for analyses. A case-control study was performed to determine risk factors for recurrence. Of 713 neonates with LOS, 150 (21.0%) experienced recurrence and 48 (6.7%) had >1 recurrences; c. two-thirds of recurrent LOS occurred in infants with birth weight (BW)≦1500 g or gestational age (GA)≦30 weeks. The recurrent LOS episodes were significantly more severe and had a higher sepsis-attributable mortality rate than the first episodes. The overall in-hospital mortality rate was 30.7% for neonates with recurrent LOS and 7.8% for those with single LOS (odds ratio (OR), 5.22; 95% CI, 3.28-8.30). When both BW and GA were controlled, neonates with recurrent LOS had a significantly prolonged hospitalization compared with the controls (median 109 vs. 84 days, p<0.001). After multivariate logistic regression, longer duration of total parenteral nutrition (TPN; OR, 1.30; 95% CI, 1.10-1.52 for every 10-day increment), presence of congenital anomalies (OR, 2.64; 95% CI, 1.10-6.35) and neurological co-morbidities (OR, 4.14; 95% CI, 1.14-15.10) were identified as the independent risk factors for LOS recurrence. We concluded that c. one-fifth of neonates with LOS had recurrence, which significantly resulted in prolonged hospitalization and increased mortality. Longer TPN administration, presence of congenital anomalies and neurological co-morbidities are independently associated with recurrent LOS.

Hypernatremia and grade III/IV intraventricular hemorrhage among extremely low birth weight infants.

OBJECTIVE: To identify the risk factors contributing to intraventricular hemorrhage (IVH) in extremely low birth weight infants during early postnatal life, after appropriate matching for gestational age (GA) and birth body weight (BBW). STUDY DESIGN: A case-control retrospective study was designed to evaluate preterm infants with a GA ≤ 26 weeks and a BBW ≤ 1000 g admitted to our hospital during a 7.5-year period. From a cohort of 347 preterm infants, 36 infants (10.7%) had severe IVH (grades III and/or IV). We selected a control group of 36 preterm infants without IVH who were closely matched for GA (± 1 week) and body weight (± 100 g). Univariate and multivariate logistic regression analyses were performed to identify risk factors for severe IVH. RESULT: The GA and BBW of the IVH and control groups were 24.6 ± 1 weeks and 764.4 ± 118.5 g, and 24.8 ± 0.9 weeks and 771.5 ± 125.9 g, respectively. Vaginal delivery, male sex, resuscitation in the delivery room, high sodium serum levels (meq l(-1)) (162.6 vs 148.8), fluctuation of serum sodium (meq l(-1)) (17.3 vs 6.2), pH, PaCO(2), hemoglobin and platelet counts were associated with an increased risk of severe IVH. Multivariate logistic regression indicated that sodium fluctuations >13 meq l(-1), vaginal delivery, male sex and hemoglobin fluctuations are strongly associated with the development of severe IVH. CONCLUSION: Hypernatremia and fluctuations of sodium seem to be related to early severe IVH among preterm infants; however, further studies are required to clarify the causal relationship.

Carcinoid tumour of the kidney in a Chinese woman presenting with loin pain.

Renal carcinoid tumours are uncommon. The aetiology is not yet fully understood and there is still no useful diagnostic tool for detecting them. We report our experience managing a Chinese woman with a primary renal carcinoid tumour.

Laparoscopic nephrectomy: an early experience at Queen Mary Hospital.

OBJECTIVE: To report our early experience of laparoscopic nephrectomy. DESIGN: Prospective data collection. SETTING: Queen Mary Hospital, Hong Kong. PATIENTS: Transperitoneal laparoscopic nephrectomies were performed on 40 patients between July 1997 and December 2002. MAIN OUTCOME MEASURES: Demographic and perioperative data including operating time, blood loss, postoperative pain score, analgesic requirement, complications, time to resume oral intake, ambulatory state, and length of hospital stay. RESULTS: Laparoscopic nephrectomy was performed for 21 solid renal masses, five transitional cell carcinomas, and 14 non-functioning kidneys. Seven (17.5%) patients had previous abdominal surgery. The mean body mass index of the patients was 23.9 kg/m(2) and the mean operating time was 229 minutes. The mean estimated blood loss was 370 mL, and two patients required conversion to open surgery because of intra-operative bleeding. Other complications include diaphragmatic injury, port-site bleeding, chyle leakage, bleeding peptic ulcer, and myocardial ischaemia. The postoperative mean analgesic requirement was 26 mg of morphine sulphate equivalent. The mean time for patients to resume oral diet and full ambulation was 1.3 and 2.8 days, respectively, and the mean length of hospital stay was 6.7 days. The mean diameter of the solid renal tumour was 4.1 cm and the surgical margins of all resected specimen for malignant tumours were negative. CONCLUSION: Laparoscopic nephrectomy is a safe and efficacious approach for resection of benign non-functioning kidneys and malignant renal tumours.

Clinical and radiographic spectrum of septic pulmonary embolism.

AIMS: To review the clinical presentation, radiographic findings, and outcome of therapy in children with septic pulmonary embolism. METHODS: Retrospective analysis of patients in a tertiary paediatric facility in northern Taiwan. RESULTS: Ten children were identified with septic pulmonary emboli in a four year retrospective chart review between 1998 and 2001. Seven were immunocompetent, two were premature infants, one had beta thalassemia major. Seven had community acquired staphylococcal infections and bacteraemia, of which six were methicillin resistant Staphylococus aureus (MRSA) isolates. Five had soft tissue infections, two bone infections, one suppurative otitis media, one catheter related infection, and one unknown foci of infection. Multiple and bilateral nodular pulmonary parenchymal lesions were common on plain chest radiographs, but chest computed tomography scans showed the additional findings of a "vessel sign" and central cavitations, confirming the existence of septic pulmonary embolism. CONCLUSIONS: Community acquired MRSA infections occurred in seven patients with septic pulmonary embolism but without predisposing high risk factors. Critically ill children with skin, soft tissue, or bone infections, when associated with septic pulmonary embolism in an area with a high rate of MRSA, should be empirically treated with glycopeptides (such as vancomycin or teicoplanin) before susceptibility results are known, in order to minimise morbidity and avoid mortality.

Prospective study on ultrasonography plus plain radiography in predicting residual obstruction after extracorporeal shock wave lithotripsy for ureteral stones.

OBJECTIVES: To compare ultrasonography (US) and plain radiography with intravenous urography (IVU) in predicting ureteral obstruction after in situ extracorporeal shock wave lithotripsy (ESWL) for ureteral stones. METHODS: From April 1998 to September 2000, 100 consecutive patients with solitary ureteral stones were treated by primary in situ ESWL. ESWL failures were salvaged by ureteroscopic lithotripsy. Ninety-three patients completed the follow-up assessment. US and IVU were performed when plain radiography showed no residual stone. The occurrence of hydronephrosis on US was compared with IVU, the reference standard for ureteral obstruction. RESULTS: Of the 93 patients, 72 were men and 21 women (mean age 52 years; mean stone size 11.2 mm). ESWL successfully treated 70 ureteral stones (75%), and the 23 failures were treated by ureteroscopic lithotripsy. Sixty-nine patients without hydronephrosis on US had no ureteral obstruction on IVU. Of the 24 patients who had hydronephrosis on US, 8 had ureteral obstruction on IVU. Of the 85 patients who had no ureteral obstruction on IVU, 69 patients showed no evidence of hydronephrosis on US. However, all patients with ureteral obstruction on IVU demonstrated hydronephrosis on US. The sensitivity, specificity, and positive and negative predictive value concerning sonographic hydronephrosis in the prediction of ureteral obstruction was 100%, 81%, 33%, and 100%, respectively. US alone could not define the cause of ureteral obstruction. CONCLUSIONS: Plain abdominal radiography plus US is highly sensitive for screening ureteral obstruction after primary in situ ESWL for ureteral calculi. It can save up to 74% of patients from the potential risk of IVU. The detection of the cause of obstruction by IVU is only necessary when sonographic evidence of hydronephrosis is present.

Outpatient ureteroscopy: predictive factors for postoperative events.

OBJECTIVES: To identify risk factors that can predict the postoperative events of outpatient ureteroscopy. METHODS: The data of 329 consecutive patients who underwent outpatient ureteroscopy from January 1996 to July 2000 were analyzed. Patient selection for outpatient surgery was based solely on their general medical status and social factors. Eighty-three percent of the procedures were therapeutic ureteroscopy. The reported postoperative events included sleep disturbances, postoperative pain score, emesis, unplanned admission, and other complications. These were compared with the various patient and operative factors. Multivariate analysis was performed to identify the predictive factors for different postoperative events. RESULTS: The overall success rate of ureteroscopic access to the pathologic site was 99.7%. Most of the therapeutic ureteroscopy performed was ureteroscopic lithotripsy (93%), with a stone-free rate of 91%. Ninety-seven percent of the operations were completed within 90 minutes, and 98% of patients were fit for discharge within 5 hours. Female patients reported more symptoms on the way home (25.8% versus 16%, P = 0.047) and more postoperative emesis (14.4% versus 2.1%, P <0.001). The postoperative pain score on day 1 was higher if the operation had lasted more than 60 minutes (2.4 versus 1.5, P = 0.002). Patients who received postoperative stenting had a higher postoperative pain score on day 3 (1.1 versus 0.4, P <0.001) and a higher complication rate compared with those who required no postoperative stenting (16.8% versus 4%, P <0.001). No predictive factors for unplanned admission were identified. CONCLUSIONS: Ureteroscopy can be successfully performed in an outpatient setting. Although the early postoperative pain was associated with nature of the operation (which could not be changed), the subsequent postoperative pain and complications were associated with ureteral stenting, which could be reduced by selective stenting. Unplanned admissions could not be predicted.

Treatment and outcome of congenital diaphragmatic hernia.

BACKGROUND AND PURPOSE: Congenital diaphragmatic hernia (CDH) is a challenging condition and is associated with a high mortality rate; optimal therapy remains unclear. This retrospective study describes the clinical characteristics of treatment and outcome in 48 infants with CDH. METHODS: Twenty-eight male (58%) and 20 female (42%) infants with CDH were treated from 1987 through 1998. The goals of the ventilator strategy were permissive hypercapnea (PaCO2 < or = 55 mm Hg) and avoidance of hyperventilation. Infants were initially ventilated with an intermittent mandatory rate of 40 to 60 per minute, peak inspiratory pressure of 20 to 25 cm H2O, and positive end-expiratory pressure of 5 cm H2O. High-frequency positive pressure ventilation was used if hypoxemia or severe hypercapnea (PaCO2 > 60 mm Hg) occurred. Most infants underwent repair after 3 days of age and only four infants underwent early repair within 24 hours of birth. A prophylactic chest tube was placed in the ipsilateral hemithorax postoperatively in all patients treated before 1996. The severity of respiratory distress was estimated by alveolar-arterial oxygen difference, oxygenation index, and alveolar-arterial ratio. RESULTS: Forty-six patients presented with Bochdalek CDH, and two with Morgangni CDH. Antenatal diagnosis was made in 10 cases. Respiratory distress was the major manifestation and usually occurred immediately after birth. Six cases were diagnosed several months after birth and presented mainly with gastrointestinal symptoms. Eleven patients died before surgery and 37 patients underwent surgical repair. Two infants died postoperatively because of congestive heart failure and tension pneumothorax, respectively. The overall mortality rate was 27%. The major causes of mortality were severe respiratory failure, persistent pulmonary hypertension, pneumothorax, and associated anomalies. CONCLUSION: Nearly 75% of patients in this series survived. This suggests that noninvasive respiratory care combined with delayed surgery may be an acceptable strategy for the treatment of CDH, and can be used in most medical institutions without equipment for extracorporeal membrane oxygenation therapy.

Successful treatment of Sjögren's syndrome with cyclophosphamide pulse therapy: report of one case.

The treatment of Sjögren's syndrome (SS) is very controversial, though several therapeutic regimens have been proposed. Cyclophosphamide pulse therapy has been widely used in many disease entities. However, reports concerning its clinical application in SS were very rare. We report a 17-year-old girl presenting with lupus nephritis and SS, which was refractory to corticosteroid therapy but successfully treated with cyclophosphamide pulse therapy. The improvement of clinical features was confirmed by Schirmer's test and minor salivary gland biopsy.

Composite Paraganglioma-Ganglioneuroma of the Urinary Bladder: A Clinicopathologic, Immunohistochemical, and UItrastructural Study of a Case and Review of the Literature.

Urinary bladder paragangliomas are rare. An 81-yr-old woman was admitted because of whole-stream painless hematuria. Investigations revealed a pedunculated bladder tumor Pathological examination showed a biphasic tumor, composite paraganglioma-ganglio neuroma. The two separate components were documented by both immunohistochemical and ultrastructural studies. A review of the English literature on urinary bladder paragangliomas showed that the present case is the first case with this unique feature documented in detail, and the patient is the oldest one being reported.